ILF 13 IIIo. Mr. HALLETT. Borough of Ilford Health Report FOR THE YEAR 1936 A. H. G. BURTON M.D., B.S., M.R.C.P., D.P.M., D.P.H., Barriscer-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, 1936. Ilford Borough Council NOVEMBER, 1935—NOVEMBER, 1936 Alderman James Henry Shipman, J.P., C.C., Mayor. Alderman Albert Philip Griggs, J.P., E.C.C., Deputy Mayor. Aldermen: Billlington, Henry, J.P. Clark, Charles William, L.R.A.M. Dane, Frederick Hopper, M.B.E. J.P., C.A. (E.C.C.). Griggs, Albert Philip, J.P., E.C.C., Deputy Mayor. Gunary, George, J.P. Pitt, Bertram Sidney John, J.P. Shipman, James Henry, J.P., C.C., Mayor. Smith, Frank Douglas, J.P., C.A. (E.C.C.). Young, Alexander, Major, T.D. Councillors : Ames, James Henry. Bisson, Walter William Preston, E.C.C. Braithwaite, Thomas. Clark, Harry. Colvin, Gilbert, F.C.I.S. Cooper Albert Edward. Daniels, Russell Stearn. Dixon, Robert James, F.C.I.S. Eke, William Benjamin. Elborne, John, M.A. Fallaize, Mrs. Lilian. 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. Holness, Richard Thomas (from July, 1936). Hurlin, Herbert. Jay, Charles Frederick. Jones, Ioan Llewellyn. Meade, William Edward. Parfitt, William Arnold. Spiller, Leslie Thomas. Smith, Harold (resigned June, 1936). Tubb, John. Tyler, George Frederick, F.C.I.I. Wetton, George John, E.C.C. Woods, Sidney Charles Victor PUBLIC HEALTH COMMITTEE NOVEMBER, 1935—NOVEMBER, 1936 Alderman F. D. Smith, J. P., C.A. (E.C.C.), Chairman. Councillor G. F. Tyler, F.C.I.I., Vice-Chairman. Alderman C. W. Clark, L.R.A.M. Alderman A. P. Griggs, J.P., E.C.C., Deputy Mayor. Alderman J. H. Shipman, J.P., C.C., Mayor. Councillor J. H. Ames. Councillor T. Braithwaite. Councillor H. Clark. Councillor G. Colvin, F.C.I.S. Councillor R. S. Daniels. Councillor W. B. Eke. Councillor Mrs. L. Fallaize. 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 R. T. Holness (from July, 1936). Councillor H. Hurlin. Councillor W. E. Meade. Councillor W. A. Parfitt. Councillor H. Smith (resigned June, 1936). Councillor L. T. Spiller. Councillor S. C. V. Woods. * Ex-officio Members. MATERNITY AND CHILD WELFARI STATUTORY COMMITTEE NOVEMBER, 1935—NOVEMBER, 1936 Councillor Mrs. B. A. L. Alderman A. P. Griggs, J.P., E.C Alderman H. Billington, J.P. Alderman C. W. Clark, L.R.A.M. Alderman B. S. J. Pitt, J.P. ♦Alderman J. H. Shipman, J.P., C.C., Mayor. Alderman F. D. Smith, J. P., C.A., (E.C.C.). Councillor J. H- Ames. Councillor R. J. Dixon, F.C.I.S. Councillor W. B. Eke. A. Harding, Chairman. C.t Deputy Mayor, Vice-Chairman. Councillor Mrs. L. Fallaize. Councillor A. W. Green, J.P., E.C.C. Councillor A. D. B. Harding. Councillor R. T. Holness (from July, 1936). Councillor W. A. Parfitt. Councillor H. Smith (resigned June, 1936). 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, 1935—NOVEMBER, 1936 Councillor C. A. Farman, Chairman. * Mr. W. R. Spencer, Vice-Chairman. Alderman H. Billington, J.P. Alderman F. H. Dane, M.B.E., J.P., C.A. (E.C.C.). †Alderman A. P. Griggs, J.P., E.C.C., Deputy Mayor. Alderman B. S. J. Pitt, J.P. †Alderman J. H. Shipman, J.P. C.C., Mayor. Alderman Major A. Young, T.D. Councillor T. Braithwaite. Councillor G. Colvin, F.C.I.S. Councillor A. E. Cooper. Councillor R. S. Daniels. Councillor R. T. Dixon, F.C.I.S. 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. Councillor G. F. Tyler, F.C.I.I. *Miss E. Blomfield. *Mr. A. Catto. *Mr. S. P. Lonergan. *Mr. C. J. Ridout. *Mr. W. Sanford. *Mr. J. J. Taylor, J.P. * Co-opted Members. + Ex-officio Members. OFFICERS OF THE PUBLIC HEALTH SERVICES, January, 1937 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), M.M.S.A. 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). Assistant Medical Officer of Health 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. Pinguey. G. W. Newman, Assoc. Royal San. Inst. T. B. Tompkins, Assoc. Royal San. Inst. Chief Clerk: F. J. Hocking. Officers of the Public Health Services Health Visitors and School Nurses: Miss A. Batten. Miss O. Bell. Miss E. Blackwall. Miss M. E. Cartwright. Miss H. E. Clynes. Miss A. L. Drink water. District Midwife : Miss C. Blockley. Miss K. French. Miss K. B. Mathieson. Miss R. Noble. Miss E. G. Parry. Miss E. Prior. Miss M. D. Seager. Ante-Natal Clinic Nurse : Miss F. E. Mathison. Part Time:— Consulting Obstetrician (Maternity Home and Puerperal Fever Regulations): Everard H. G. Williams, M.D., M.R.C.P., M.C.O.G. Deputy Consulting Obstetrician: R. L. Dodds, F.R.C.S., M.C.O.G. Consultant Anœsthetist: Frankis T. Evans, M.B., B.S., D.A. Surgeon in charge of Orthopœdic 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: VV. P. H. Sheldon, M.D., F.R.C.P. Veterinary Surgeon: Ralph Bennett, F.R.C.V.S. Masseuses : Miss G. U. Comyn, C.S.M.M.G., M.E. Miss B. E. Townley, C.S.M.M.G., M.E. TABLE OF CONTENTS SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. page Preface 15 Statistical Summary 19 Physical Features of District 20 Rainfall 20 Population 21 Births 21 Deaths 21 Inquests 23 Death-rates from Tuberculosis and Cancer 23 Public Assistance Relief 24 Marriages 24 Vital Statistics—Table I 25 „ „ Table Ia 26 Causes of Death—Registrar-General's Short List 27 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Public Health Officers of the Authority 12 Nursing in the Home 28 Laboratory Facilities 29 Table of number of specimens examined (Bacteriological Laboratory) 30 Legislation in Force 31 Essex County Council Act, 1933:— Part IV.—Establishments for Massage and Special Treatment 31 Part VI.—Hairdressers' and Barbers' Premises 31 Part XI.—Manufacture and Sale of Ice Cream 32 Camping Grounds and Moveable Dwellings 31 Shops Acts, 1912-34 32 Hospital Provision 32 Ambulance Facilities 35 Clinic and Treatment Centres 35 Tuberculosis Dispensary 37 Maternity and Nursing Homes 37 Other Institutions 38 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. Water Supply 39 Drainage and Sewerage 40 Rivers and Streams 40 Closet Accommodation 41 Public Cleansing, Collection of House Refuse 41 Sanitary Inspection of the Area:— (a) Summary of Inspections 43 (b) Notices served 43 (c) Complaints of Nuisances 44 10 PAGE Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1933 44 Smoke Abatement 44 Swimming Baths and Pools 45 Premises and Occupations which can be controlled by Bye-laws or Regulations 45 Slaughter of Animals Act, 1933 45 Eradication of Bed Bugs 46 Bye-laws relating to Houses, Lodgings, Tents, etc. 45 Other sanitary conditions requiring notice 46 Rag Flock Acts, 1911 and 1928 46 Schools 47 SECTION D.—HOUSING. Overcrowding 48 Unhealthy Areas 48 Housing Statistics 48 Housing Act, 1935, Overcrowding Survey 50 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply 55 Dairies, Wholesale and Retail Purveyors, etc. 55 Licences—Graded Milk 56 Milk, and Ice-Cream Sampling 57 Tubercular Milk 57 Inspection of Dairy Herds 58 Legal Proceedings 58 Registration 58 Meat and Other Foods:— Meat Marking Scheme 58 Slaughterhouses 58 Shell Fish 59 Articles of Food Surrendered 59 Unsound Food 59 Sale of Food and Drugs Acts (Adulteration, etc.) 59 Food Poisoning 60 Bakehouses. 60 Contagious Diseases (Animals) Acts 60 Rats and Mice Destruction Act 61 Petroleum (Consolidation) Act 61 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Disease Generally 62 Notifications in Institutions 62 Treated in Institutions 63 Table II.—Summary of Cases of Infectious Diseases Notified 64 Deaths from Infectious Diseases 66 Incidence of Chief Infectious Diseases 66 Smallpox 66 Vaccination 66 11 PAGE Scarlet Fever 66 Diphtheria 67 Table of Nos. Schick Tested and Immunised 68 Enteric Fever 69 Cerebro-spinal Fever 69 Ophthalmia Neonatorum 69 Acute Influenzal and Acute Primary Pneumonia 70 Encephalitis Lethargica 70 Acute Anterior Poliomyelitis 71 Puerperal Fever 71 Puerperal Pyrexia 71 Zymotic Diseases 72 Incidence of Infectious Disease in Age Groups and Total Deaths 73 Tuberculosis—New Cases and Deaths 74 Tuberculosis, Treatment of 75 Tuberculosis Care Association 76 Tuberculosis Regulations, 1925 76 Public Health Act, 1925, Section 62 76 Infectious Disease (Prevention) Act, 1890 76 Venereal Diseases 77 Notification of Non-notifiable Acute Infectious Diseases 78 Disinfection 78 SECTION G.— FACTORIES AND WORKSHOPS. Factories 79 Workshops 80 Table I—Inspection of Factories, Workshops, Workplaces 81 „ II—Defects Found 82 „ III—Homework 83 „ IV—Other Matters 84 ISOLATION HOSPITAL. Patients Admitted 87 Deaths in Hospital 88 Scarlet Fever 89 Enteric Fever 90 Pneumonia 90 Puerperal Fever 91 Puerperal Pyrexia 91 Diphtheria 91 Pemphigus Neonatorum 92 Observation Cases 92 Tuberculosis 92 Training of Nurses 93 Schick and Dick Testing of Staff 93 Hospital Extensions 93 MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907 and 1915 99 Stillbirths 99 Registration Act, 1836 and 1926 100 Infant Mortality 101 12 PAGE Neonatal Mortality 105 Table IV 108 Illegitimate Births and Deaths 109 Maternal Mortality 109 Infant Life Protection 111 Children and Young Persons Act, 1932 111 Work of Health Visitors 112 Supervision of Midwives 113 Compensation to Midwives 114 Supply of Milk to Expectant and Nursing Mothers and fot Infants 116 Infant Welfare Centres 116 Ante-Natal Clinics 121 Post-Natal Clinic 122 Dental Clinic 122 Ophthalmic Clinic 123 Orthopaedic Clinic 124 Artificial Sunlight 125 Aural Clinic 125 Rheumatism Clinic 126 Ophthalmia Neonatorum 127 Treatment of Minor Ailments 127 Convalescent Home Treatment 128 Midwives Acts, 1936 129 Maternity Home 133 Maternity cases—Queen Mary's Hospital and Old church Hospital 141 District Midwife 145 SCHOOL MEDICAL SERVICE. General Survey 149 Staff 153 School Premises 153 Medical Inspection 154 Findings of Medical Inspection 155 Infectious Disease 156 Diphtheria Prevention 157 " Following-up 158 Medical Treatment:— Minor Ailments 159 Ophthalmic Department 160 Orthopaedic Department 162 Artificial Sunlight 164 Aural Department 165 Rheumatism Department 167 Dental Department 167 Treatment of Uncleanliness 171 Other Ailments 172 Open Air Education 172 Physical Training 174 Provision of Meals 175 Provision of Milk 176 Supply of Free Cod Liver Oil, Emulsion, etc 176 13 page Co-operation of:— Parents, Teachers, School Attendance Officers and Voluntary Bodies 176 Physically and Mentally Defective Children 177 Nursery, Secondary and Continuation Schools 182 Employment of School Children and Young Persons 182 Medical Examination of Teachers, etc. 183 Statistical Tables:— I.—Number of Children Inspected 183 IC.—Number of Children found to Require Treatment 184 IIA.*—Return of Defects 185 IIB.—Classification of Nutrition of Children Inspected 186 III.—Numerical Return of Exceptional Children 186 IIIA.—Number of Children notified to the Local Mental Deficiency Authority 190 IV.—Group I—Minor Ailments 191 Group II—Visual Defects 192 Group III—Nose and Throat Defects 192 Group IV—Orthopaedic and Postural Defects 193 Group V—Dental Defects 193 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 15 PREFACE. Public Health Offices, Ilford. June, 1937. His Worship the Mayor, Aldermen and Councillors, of the Borough of Ilford. Mr. Mayor, Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health and the Board of Education. Reference to Table la on page 26 of the Report will show that Ilford still compares favourably with other districts for its health record, the death rate being 8.2 as compared with 12.1 for England and Wales, 12.5 for London, 12.3 for County Boroughs and large towns and 11.5 for the smaller towns with populations of 50,000 or under. The death rate of children under 1 year of age was 43.4, compared with figures of 59, 66, 63 and 55 of the same areas. The death rates from infectious diseases also compares favourably. The birth rate has increased from 13.9 to 14.4, whereas the maternal mortality rate has been reduced to a figure this year of 1.75, compared with the maternal mortality rate for England and Wales of 3.81. This is the lowest maternal mortality rate in Ilford since 1924, when it reached the very low figure of 0.69. It is hoped that the operation of the new Midwives Act will further reduce these rates. The year was signalised by a considerable incidence of infection with the organism known as Staphylococcus Aureus. Apart from the cases which occurred in puerperal women in the Maternity Home and on the district, the deaths took place at the Isolation Hospital of two patients, one a girl of 11 years and one a man of 26 years, who on admission were found to be suffering from blood poisoning due to this particular organism, while a third patient, admitted suffering from puerperal fever, who had been 16 confined by a private midwife, was also found to be suffering from blood poisoning due to the same organism. The latter patient recovered. The Overcrowding Survey carried out under the Housing Act 1935 has been completed and full particulars of the result are contained in the body of this Report. Some cases of para-typhoid fever occurred in this and other Essex districts, and it is possible that this may portend another outbreak of this disease such as occurred in 1928, when a considerable outbreak occurred in the whole of the London area, the cause of which was not traced. It will be observed in the report of the School Medical Service section that 320 children attended the Aural Clinic, 691 the Orthopaedic Clinic, 248 the Rheumatism Clinic and 1,583 the Ophthalmic Clinic, showing how much these special services are appreciated in the district. I wish again to thank the Members of the Council for their support, and I. have the honour to be, Your obedient Servant, A. H. G. BURTON, Medical Officer of Health. GENERAL 19 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land 8,402 8,435 Inland Water 26 Tidal Water 7 Population (Census, 1931) 131,061 „ (Census, 1921) 85,194 Registrar-General's Estimate of resident Population, June 30th, 1936 157,300 „ 30th, 1935 151,390 Number of inhabited houses (end of 1936) according to Rate Books 42,000 (approx.) Rateable Value—October 1st, 1936 (Houses and Land) £1378,288 Sum represented by a penny rate, October 1st, 1936 £5,490 (approx.) Education Rate— 1935-36. 1936-37. Elementary 2s. 4.36d. in the £. 2s. 5.76d. in the £. Higher (County) 0s. 6.75d in the £. 0s. ,83d. in the £. ,, (Ilford Council) 0s. .05d in the £. 0s. .05d. in the £. Combined Rate (all services) 12. 4d. in the £. 12s. 6d. 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. Total M. F. 1936 1935 Live Births Legitimate 2,158 1,158 1,0001 Birth Illegitimate 55 24 31 Rate 14.4 13.9 20 Still Births 65 33 32 Rate per 1,000 total births 28.5 34.0 Deaths 1,291 638 653 [Death Rate 8.4 8.2 Percentage of total deaths occurring in public stitutions 32.7 35.8 Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. 1936. 1935. 1936. 1935. Puerperal sepsis 1 3 .44 1.41 Other puerperal causes 3 4 1.31 1.88 Total 4 7 1.75 3.29 Death-rate of Infants under one year of age:— 1936. 1935. All infants per 1,000 live births 43.4 42.8 Legitimate infants per 1,000 legitimate live births 43.1 43.5 Illegitimate infants per 1,000 illegitimate live births 54.6 20.8 Deaths from Cancer 190 224 Deaths from Measles (all ages) 9 — „ Whooping Cough (all ages) 3 6 „ Diarrhoea (under 2 years of age) 10 14 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 22.71 inches. 21 The greatest fall in 24 hours was registered on 6th May, being .99 inches. The number of days on which rain fell was 168. 3. Population. Census, 1911 78,188 Census, 1921 85,194 (including institutions) Census, 1931 131,061 Registrar-General's Estimate on 30th June, 1935 151,390 Registrar-General's Estimate on 30th June, 1936 157,300 The number of patients and resident staff on the 30th June, 1936, at the following public institutions, was: — Claybury Mental Hospital 2,596 West Ham Mental Hospital 1,414 Total 4,010 The net population for 1936 of 153,290 is obtained by deducting the population in institutions (4,010) from the RegistrarGeneral's Estimate, 157,300 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 2,213. Legitimate 1,158 Males 1000 Females Illegitimate 24 „ 31 „ i.e., 2.48 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was: 2.34 in 1935; 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. The birth-rate, calculated on the net estimate of the population of 153,290 is 14.4 per 1,000, as compared with 13.9 in 1935; 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. 5. Deaths.—The total number of deaths of Ilford residents was 1,291. 22 This is obtained by taking the total deaths registered in the district (1,128) subtracting the deaths of non-residents occurring in the district (303), and adding the deaths of Ilford residents registered as having died in other districts (466). The total number of deaths registered in the district during the year was 1,128 Number of deaths of non-residents registered in the district (principally in large institutions) 303 The latter 303 deaths occurred as follows:— Claybury (L.C.C.) Mental Hospital 107 West Ham Borough Mental Hospital 53 King George Hospital 106 Ilford Isolation Hospital 6 Other Non-Residents 31 303 Included in the deaths of residents belonging to the district are 6 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 466. This figure includes deaths at the following institutions:— Oldchurch Hospital, Romford 181 Essex County Mental Hospital, Brentwood 11 The London Hospital 24 Queen Mary's Hospital, West Ham 1 Hospital for Sick Children, Great Ormond Street 6 St. Bartholomew's Hospital 11 Charing Cross Hospital 7 Middlesex Hospital 2 Guy's Hospital 2 East Ham Memorial Hospital 6 St. Thomas' Hospital University College Hospital Brompton Hospital St. Luke's Hospital Severalls Mental Hospital, Colchester 5 Carried Forward 260 23 Brought forward 260 London Fever Hospital 9 Westminster Hospital 2 Royal Eastern Counties Institution, Colchester 3 Epping Institution 5 National Hospital, Queen's Square 1 Queen Charlotte's Hospital 1 In other Hospitals, Institutions and Residences outside the Ilford District 185 466 The death-rate, calculated on the net estimate of the population of 153,290 is 8.4 per 1,000; as compared with 8.2 in 1935 ; 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. Inquests.—During the year, 62 inquests were held in the district, 30 on Ilford residents, and 32 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. 1 2 — 2 6 15 18 18 Causes of inquest-deaths. Accidents 42 Suicides 10 Asphyxia due to drowning ; open verdict Pulmonary asbestosis, cancer of lung 1 Asphyxiation due to suffocation whilst in an epileptic lit whilst in bed 1 Asphyxia from drowning ; fall into an ornamental pond in garden at home 1 Syncope ; coronary atheroma precipitated by shock following dive into water of swimming bath 1 Asphyxia following an epileptic fit (minor epilepsy), pressure of a pillow on face while in bed 1 Thrombo phlebitis ; pulmonary embolism consequent on operation for removal of fibroids of uterus 1 Heart failure; toxic myocardial softening; sub-diaphramatic abscess, following perforation of a duodenal ulcer Asphyxia due to drowning in bath filled with water; murder 1 Septicaemia following cellulitis of left arm which arose from a boil just above elbow joint 1 Death-Rates from Tuberculosis and Cancer, 1936. The following Table shows the death-rates for 1936 for 24 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 .469 .583 Other Tuberculosis .065 .109 Cancer 1.239 1.625 6. Public Assistance Relief.—The total amount expended in Ilford during the year was £16,282 18s. 1d. The average weekly number of cases in receipt of relief was 875, including dependants. The number of admissions to Oldchurch Hospital from Ilford during the year was 319, made up as follows :— Men 135 Women 177 Children 7 The number of destitute persons admitted to the Institution during 1936 was 16, made up as follows :— Men 7 Women 7 Children 2 7. Marriages.—1169 marriages have taken place during 1936. The following details explain the allocation :— Marriages taking place in the Ilford District 863 Marriages of Ilford Residents at Register Office, Romford— Both Parties belonging to Ilford 194 The Male only belonging to Ilford.47 The Female only belonging to Ilford65 8. Tables of Vital Statistics.—Table 1 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 1936, arranged according to the age groups at which deaths occurred. 25 TABLE I.—Vital Statistics of Whole District During 1936 and Previous Years Year. Gross Population estimated to Middle of each Year. Net Population estimated to Middle of each Year (a). Births. Total Deaths Registered in the District. Transferable Deaths. Net Deaths Belonging to the District. Uncorrected Number. Net (6). of Non-Residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate (c). Number. Rate (d). Number. Rate per 1,000 Net Births. Number. Rate (e). 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 1930 125,000 121,256 1,710 1,845 15.2 882 7.0 224 322 61 33.0 980 8.1 1931 132,150 128,266 1,821 1,979 15.4 1,048 7.9 270 416 110 55.6 1,194 9.3 1932 137,480 133,620 1,787 1,987 14.9 1,095 7.9 318 385 79 398 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 1936 157,300 153,290 1,830 2,213 14.4 1,128 7. 2 303 466 96 43. 4 1,291 8.4 (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. 26 TABLE 1a Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1936 (Provisional figures). The rates for England and Wales have been calculated on a population estimated to the middle of 1936, but those for London and the Towns have been calculated on populations estimated to the middle of 1935. 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 14.8 0.61 12.1 0.01 — 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59 122 County Boroughs and Great Towns, including London 14.9 0.67 12.3 0.01 — 0.09 0.01 0.06 0.08 0.14 0.45 8.2 63 143 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 15.0 0.64 11.5 0.00 — 0.04 0.01 0.04 0.05 0.15 0.39 3.4 55 London 13.6 0.53 12.5 0.01 — 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66 ILFORD (Estimated) Gross Population 157,300 mid. 1936 14.0 0. 41 8.2 0. 00 — 0.06 00. 0 0.02 0. 03 0. 13 0.28 4.5 43. 4 27 The following is the Registrar General's Short Li'st of Deaths c.d Causes :— TABLE II Causes of, and Ages at, Death during the Year 1936 Causes of Death. Net Deaths at the subjoined ages of " Residents," whether occurring within or without the District. All Ages. j 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 1,291 96 14 15 29 32 69 79 111 216 294 336 1 Typhoid and paratyphoid fevers 1 — — — — — 1 — — — — — 2 Measles 9 1 3 ] 3 — — — 1 — — — 3 Scarlet fever — — — — — — — — — — — — 4 Whooping Cough 3 2 — 1 — — — — — — — — 5 Diphtheria 5 — — 2 3 — — — — — — — 6 Influenza 21 — — 1 2 — 1 2 1 3 6 5 7 Encephalitis lethargica — — — — — — — — — — — — 8 Cerebro-spinal fever 1 — 1 — — — — — — — — — 9 Tuberculosis of respiratory system 72 — — 1 — 9 29 12 9 7 5 — 10 Other tuberculous diseases 10 — 2 2 1 2 — — 1 1 1 — l1 Syphilis 2 — — — — — — 1 1 — — — 12 General paralysis of the insane, tabes dorsalis 4 — — — — — — 2 1 1 — — 13 Cancer, malignant disease 190 1 — — — 1 5 16 24 54 58 31 14 Diabetes 22 — — — — 1 — — 1 5 3 12 15 Cerebral haemorrhage, etc 63 — — — — — 1 4 2 14 22 20 16 Heart disease 338 — — — 1 5 3 12 26 53 106 132 17 Aneurysm 1 — — — — — — — — — 1 — 18 Other circulatory diseases 58 — — — — — — 4 3 14 17 20 19 Bronchitis 40 1 2 — 3 — — 2 2 4 10 16 20 Pneumonia (all forms) 58 12 1 2 5 5 2 3 5 9 10 4 21 Other respiratory diseases 17 1 — 1 — — 1 1 1 3 4 5 22 Peptic ulcer 12 — — — — — — 1 2 2 5 2 — 23 Diarrhoea, etc. 17 8 2 — — — 1 — 2 2 — 2 24 Appendicitis 4 — — — — — 1 — 2 — 1 — 26 Cirrhosis of liver 4 — — — — — — — 1 1 2 — 26 Other diseases of liver, etc 6 — — — — — 1 — 1 — 2 2 27 Other digestive diseases 23 3 — 1 1 — 1 2 2 6 4 3 28 Acute and chronic nephritis 26 — — — — — 3 3 9 4 4 3 29 Puerperal sepsis 1 — — — — 1 — — — — — — 30 Other puerperal causes 3 — — — — 1 2 — — — — — 31 Congenital debility, premature birth, malformations, etc 66 65 — — — — 1 — — — — — 32 Senility 51 — — — — — — — — — 7 44 33 Suicide 10 — — — — — 2 1 — 4 3 — 34 Other violence 44 — 1 — 2 5 5 7 1 6 6 11 35 Other defined diseases 107 2 2 3 8 1 8 5 13 20 20 25 36 Causes ill-defined or unknown 1 — — — — — — — — — — 1 Special Causes (included in No. 35 above) :— Smallpox — — — — — — — — — — — — Poliomyelitis — — — — — — — — — — — — Polioencephalitis — — — — — — — — — — — — 28 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. 10,195 visits were paid by the nurses in 1936 compared with 10,367 in 1935. The following is a summary of the work carried out during the year 1936 :— Number of New Cases 820 Number of Visits—Medical 7,631 Surgical 1,580 Operations 12 Massage 972 Number of applications made for Nurses' services 820 Number of patients under the charge of a Doctor at 31st December 50 Number of patients not under the charge of a Doctor — Number of necessitous cases referred to Committee 12 Number of cases on the books at the end of the year 50 The cases were distributed in wards as under :— Cranbrook 80 Park 76 Seven Kings 167 North Hainault 109 Loxford 100 Clementswood 48 South Hainault 51 Goodmayes 96 Barkingside 93 29 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 llford Public Health Offices. The accompanying table shows that 1,038 specimens have been examined at the Laboratory during the year. 30 Bacteriological Laboratory, 1936. Nature of Specimen Disease Suspected. Sent by Local Medical Practitioners Sent by Medical Officer of Health. Sent by School Medical Officer. Sent by Isolation Hospital. Totals. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Pos. Neg. Swabs—Throat Diphtheria 48 573 1 8 1 96 35 106 85 783 Nose, Ear, Eye, etc. if 9 19 — 7 1 49 5 14 15 89 Throat Contacts „ 3 52 — — — — — — 3 52 Nose „ „ — 1 — — — — — — — 1 Hairs Ringworm — — — — — 6 — — — 6 Urine Various Abnormalities — — — — — 4 — — — 4 Totals 103 935 Grand Total 1,038 1 Direct Smear examined (negative). 12 Diphtheritic Specimens were sent to laboratories in London for a test for virulence—6 were virulent, 3 avirulent, 3 no K.L.B in culture. 31 (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 :— (a) Bone boilers. (b) Fellmongers. (c) Leather dressers. (d) Soap boilers. (e) Tanners. (/) Tallow melters. (g) Fat melters or fat extractors. (h) Glue makers. (i) Tripe boilers. (/) Size makers. (k) Gut scrapers. (l) Fish fryers. (m) 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) 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 1936, 21 Applications for renewal of Licences and 5 Applications for Licences were received. The Council renewed the licences in respect of the 21 establishments, and granted licences in respect of 6 establishments (one application being deferred from 1935, pending satisfactory information and structural alterations to premises). All such licences expire on 31st March, 1937. Change of address was sanctioned in respect of 3 licensed establishments. The Town Clerk communicated with 2 licensees in reference to the keeping of records, and with another as to the designation of a special treatment displayed on the shop front, and for which no licence was granted (b) (Part VI—Hairdressers' and Barbers' Premises.) The Sanitary Inspectors have been appointed "as the Officers duly authorised by the Local Authority for the purposes of Part VI of the Act", and during 1936 made 430 visits of inspection to these premises. (c) Camping Grounds and Moveable Dwellings. ( 32 (d) (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 61 applications for registration in respect of 58 premises were considered or re-considered during the year. Registration was granted in 60 cases (concerning 57 premises) follows :— as Purveyors retailing multiple firms' productions 48 Purveyors manufacturing and retailing their own productions (made apart from domestic premises) 9 Purveyors manufacturing and retailing their own productions (made on domestic premises) 3 In 1 case, registration was refused as the premises were not suitable for the manufacture of ice cream. The manufacturer, however, refused to discontinue, and on the 24th June, at Stratford Police Court, legal proceedings were taken by the Council for manufacturing ice cream without registration. The manufacturer was fined 40/-. 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. 33 (c) Children.— Vide Annual Report, 1932. (d) Fever.—Vide Annual Report, 1931. (e) Smallpox.—Vide Annual Report, 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 following is a statistical return in respect of King George Hospital for the year 1936 :— Number of Beds. Total number of Beds at 31st December, 1936. 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. Number of adult in-patients admitted 555 644 89 71 249 196 357 332 *Number of children admitted 504 47 435 226 Number of operations performed †l,742 Number of new casualties attended 3,884 710 2,862 1,716 Number of attendances 26,782 Number of new patients, Massage Dept. 741 72 89 204 Number of attendances Number of X-Ray examinations 3,162 614 2,603 1,143 Number seen in Consultative OutPatient Department 2,563 208 1,582 1,960 Number of attendances †8,426 Number of new patients, X-Ray Therapy Department 36 8 18 Number of treatments †3,972 * The allocation as between male and female is not ascertained, †The allocation as between Ilford and other Districts is not ascertained. The 24,175 new Out-patients from all districts made 87,880 attendances. I he complete allocations were as rollows :— In-patients (Adults and Children). New Out-patients. ] Ilford 1,703 Ilford 10,386 Barking 207 Barking 1,604 Dagenham 880 Dagenham 7,144 (excluding the Becontree Centre) Other Districts 915 Other Districts 5.041 Th average cost per patient per week in the Hospital tor the year 1936 was £0s. 6d. for General Ward and £4 10s. l1d. for Private Ward patients. Male. Female. Children. Number resident on 30th June, 1936 :—Patients 98 82 14 Staff 8 136 — 35 The Council has arrangements with certain hospitals as mentioned on pages 32, 122, 127, 141, 163, 172 of this Report. There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,240 patients (males 597, females 643), and Claybury Mental Hospital, with 2,387 patients (males 1,005, females 1,382) in residence on the 30th June, 1936. (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 cases. (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. Monday, 2.0 p.m. Holy Trinity Church Hall, Mossford Green. Monday, 2.0 p.m. Newbury Hall, Perrymans Farm Road, Newbury Park. Tuesday, 2.0 p.m. Public Health Offices, Valentines Mansion. Tuesday, 2.0 p.m. Congregational Church Hall, Grosvenor Road, Ilford. Wednesday, 2.0 pm.. Congregational Church Hall, Woodford Avenue (entrance in Ethelbert Gardens) Wednesday, 2.0 p.m. Mayesbrook Clinic, Goodmayes Lane, Goodmayes. Wednesday, 2.0 p.m. 36 Chadwell Christian Mission Hall, Essex Road, Chadwell Heath. Thursday, 9.30 a.m. Cecil Hall, Granville Road, Ilford Thursday, 9.30 a.m. and 2.0 p.m. Mayesbrook Clinic, Goodmayes Lane Thursday, 2.0 p.m. Emmanuel Church, Ilford Lane, Ilford Friday, 9.30 a.m. and 2.0 p.m. St. John's Church Hall (entrance in Devonshire Road), Seven Kings. Friday, 2.0 p.m. Fairlop Temporary School, Fencepiece Road Saturday, 9.30 a.m. Ante-Natal 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); (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 ; 37 (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). 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, 1936, there were 3 private registered nursing homes in the district, 2 for maternity and medical or minor surgical cases, and 1 for medical and surgical cases. On December 31st, 1936, 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. In October, information was received of the occurrence of two births at a private house in the district, not registered as a Nursing Home. The occupier of the house was interviewed, who stated that the first confinement was that of her daughter. In the other case the occupier stated she had been engaged as a Nurse to attend the patient at her home address at 38 Dagenham. By reason of the fact that she was already nursing her daughter she could not leave the house, and upon the advice of the patient's doctor, she received the other patient. A doctor was present at each delivery. The circumstances were reported to the Town Clerk, who communicated with the occupier of the house, who replied expressing her ignorance of the Nursing Homes Registration Act, and promised that the offence should not recur. The doctor in the second case was also communicated with, and stated that he agreed to the transfer of the patient to the house, the question as to whether the premises were registered being overlooked. The doctor stated the patient received good attention whilst at the house. The premises and effects were found to be generally in a very clean and orderly condition when visited by the Sanitary Inspector. In accordance with Circular 1574, issued by the Ministry of Health on 30th September, 1936, the local medical practitioners were communicated with, supplying them with a list of the registered Nursing Homes in the district, and requesting that particulars of any unregistered premises known to them should be brought to the notice of the Medical Officer of Health. (ii) Other Institutions. The Chelmsford Diocesan Girls' Aid Association have a Rescue and Prevention Home at 80, Ingleby Road, for girls and young unmarried women, with accommodation for 5 cases. In addition, there is the Girls' Village Homes, one of the late Dr. Barnardo's Institutions, which had 1,501 children and 201 Staff in residence on 30th June, 1936. 39 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. 1. (i) Water Supply.—Vide Annual Report, 1925. 3 samples of the piped water supply (2 from one Company and 1 from another, supplying the district) were sent for examination, and each sample gave a satisfactory bacteriological and chemical analysis. The Public Health Committee, at its meeting in January, considered the question of complaints received towards the end of 1935 as to "fresh-water shrimps" found in the drinking water supply, from occupiers in the Cranbrook Ward. As a result, the Town Clerk referred the subject of complaint to the Metropolitan Water Board. A reply was then received to the effect that the Board's Director of Water Examinations had the matter under investigation. From August to December several complaints (one involving six other premises) were received from householders in this Ward. Each complaint received during 1936 was referred to the Water Board, whose Chief Engineer and Director of Water Examinations dealt personally with the difficulty. Remedial measures were taken by the Board, i.e., main flushing, diversion of the source of supply, etc., and it is hoped that the steps taken by the Board will result in the ultimate elimination of the trouble. A sample of the drinking water (included above) taken by the Department at the end of the year for both chemical and bacteriological examination proved satisfactory. 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 1936. During the year 5,277 yards of main were laid in the Borough, the diameter of the mains being 9in., 6in., 4in. and 3in. 40 During the year 1935 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 is proceeding satisfactorily. 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. 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 supplybefore 1940. (ii) Drainage and Sewerage.—The Borough Engineer has kindly supplied me with the following report. (a) Survey of Main Trunk Sewers. The survey of the existing main trunk sewers in the Borough has now been completed. Schemes are in course of preparation for the re-construction of the Cranbrook Road System and the Horns Road system. A scheme is also in course of preparation for the re-construction of the Roden Street Pumping Station together with the incoming mains, rising and discharging mains. (b) Ilford and Barking Joint Sewerage Scheme. The Ilford and Barking Joint Sewerage Scheme completed in 1935 has been in operation for over a year and is working satisfactorily. The average dry weather flow amounts to 5½ million gallons per day. 2. Rivers and Streams.—Vide Annual Report, 1925. (a) Seven Kings Stream. (1) Pollution by sewage taking place outside the Borough boundary. This has now been remedied, the overflow from cesspools not now discharging into the stream. (2) Observation has been maintained of this stream, and apart from slight 41 oily deposits from garages in the vicinity and trade effluent from a firm whose premises adjoin the stream, no nuisances were detected. These garages were visited and requests made for more satisfactory attention to be given to the question of car-washings, and the Engineer is dealing with the firm in question. (b) Sutjace Water Stream, Cranbrook. A number of complaints were received during the year with regard to the Hooding of this stream at Cantley Gardens, Cantley Drive, Yoxley Drive, Horns Road, etc. The sewer in Horns Road will be dealt with when the scheme for re-constructing the main sewers materialises. (c) Mayesbrook. Certain cleansing works were carried out by the occupiers of premises in Reynolds Avenue, adjacent to this stream. Further action by the Borough Surveyor with regard to service of notice on owners to complete the cleansing of this stream will be taken early in the new year. (d) River Roding. Observation has been maintained and no further cleansing of the river bed has been carried out by the River Roding C atchment Board. The exceptional rainfall at the end of the year and early part of 1937 has improved the condition of the River and its banks. 3. (i) Closet Accommodation.—In addition to the water carriage system of sewage, there are in the rural area 23 cesspools, 19 pail closets and 10 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 1936 :— Cesspools.—One in London Playing Fields, Forest Road, one in New North Road, and one in Goodmayes Lane. Pail Closets.—One in Woodford Bridge Road, one in Mossford Lane, and one in Roding 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. 423 defective and unsuitable receptacles have been replaced during the year. 42 The following table gives information as to the collection of house refuse during 1936 :— STATISTICS AS TO REFUSE COLLECTION, 1936 Horse. Electric. Vulcan. S.D. Freighters. Karriers. Total. Nos. 6, 7 & 8. No. 9. No. 11. Nos. 12 to 20 2, 3 & 5. Nos. 4 and 9. Number of collection days 19 260 307 177 244 307 57 1,371 Aggregate number of days vehicles employed 114 315 626 177 244 3,313 100 4,889 Total number of loads collected 373 894 2,282 596 1,003 10,990 311 16,449 Average number of vehicles employed per day 6.0 1.2 2.0 1.0 1.0 10.8 1.8 23.8 Average number of loads collected per day 19.6 3.4 7.4 3.4 4.1 35.8 5.5 79.2 Average number of loads collected per vehicle per day 3.3 2.8 3.6 3.4 4.1 3.3 * 3.1 3.4 Tons Cwts Qrs. Tons C wts. Qrs. Tons Cwts Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs. Tons Cwts. Qrs Total weight of refuse collected 413 16 0 2,500 3 3 6,440 19 0 1,261 3 1 2,025 7 1 28,372 19 2 944 10 3 41,958 19 2 Average weight per load 1 2 0.7 2 15 3.7 2 16 1.8 2 2 1.3 2 0 1.5 2 11 2.5 3 0 3 2 11 0.1 s d. s. d. s. d. s. d. s. d. s. d. s. d. s d. Estimated average cost of collection per ton 9 9.6 7 9.7 7 0 8 6.8 7 3.2 8 4.4 7 4.1 6.4 Collection has been improved by the purchase of 2 Karriers and 1 Vulcan during 1936. The Council now has one electric, three Vulcans and thirteen Freighters and two Karriers engaged upon Refuse Collection. 43 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 30,372 tons. Arrangements are still in force whereby a special daily collection of refuse is made from Claybury Mental Hospital. Collection and Disposal of Wastepaper. Weight Collected. Income. Cost. Profit. T. c. q. £ s. d. £ s. d.. £ s. d. l,048 ! 16 0 1,679 7 8 508 5 6 1,171 2 2 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 of the Area.—The following is a summary of the work of the Sanitary Inspectors during the year :- Houses and premises inspected 14,068 Houses and premises reinspected (works in progress) 11,831 Visits during disinfection 2,085 Houses in which nuisances were detected 1,426 Houses in which nuisances were abated 1,196 Premises disinfected 878 Premises from which articles only disinfected 268 Articles disinfected 4,560 Premises disinfested for verminous conditions 18 Shops Act—inspections (food shops 50; other shops 78) 128 do. reinspections ( do. 1583; do. 438) 2,021 Notices served :— Statutory :— Served. Complied with. Public Health Act, 1875 19* 3 Public Health Act, 1925 (Verminous Premises) 4 3 Housing Act, 1930 253 151 Pave Yard (Ilford Improvement Act). 4 4 Provide Dustbin (Ilford Improvement Act) 320 276 Provide Water Supply to Dwelling House 6 6 Cleanse Water Storage Cistern (Byelaws) 17 16 Cover Water Storage Cistern (Byelaws) 1 1 Informal 776 581 Total 1,400 1,041 * 13 of these were served on 31. 12. 36 44 In addition to the above, 214 notices (68 statutory and 146 informal) served during 1935 were also complied with. Complaints.—During- the year, 731 complaints of nuisances have been received and investigated. The following is a summary :— Accumulation of manure and refuse 69 Animals improperly kept 11 Bad smells 38 Dampness of premises 30 Defective drains, w.c.'s and fittings 87 Defective roofs, gutters, downpipes, etc. 35 Defective water fittings 26 Dirty and verminous houses 51 Dirty condition of rearway 13 Flooding of premises 11 Overcrowding 17 Smoke nuisances 58 Miscellaneous 285 Total 731 (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. No application was received under Section 2 (4) of the Act. (v) Smoke Abatement. Since the erection of a new soot extraction plant at a factory in the eastern part of the Borough there has been a great improvement. Three complaints were received in December, but the sooty deposit was not traced to the premises in question. Observation has been maintained throughout the year and no serious nuisance has been detected. Apart from the above, observation has been maintained of several factories in the same vicinity, and also in the western part of the Borough. As a result, three letters of warning have been served on the owners to abate smoke nuisances. 45 (vi) Swimming Baths and Pools. (a) There are two Public Baths in Ilford, owned by the Council, one an indoor bath with two swimming pools, vapour baths, etc.; the other, an open-air swimming pool, is opened for approximately seven months yearly. Samples of water for examination are taken from the indoor and open-air swimming baths monthly during May, June, July, August and September, and during November, January and March in respect of the indoor bath. The samples taken during 1936 were all satisfactory. In the case of the open-air swimming pool one sample was found to contain free chlorine slightly in excess of the required limit, and in another sample the free chlorine content was rather low. (b) There are no privately owned swimming baths or pools in the borough. (vii) Special Classes of Premises and Occupations subject to Control by the Local Authority.—(a) Fish-frying licences (5 of which were transfers) have been granted in respect of 7 premises during 1936. The Council has decided that all new licences and transfers shall be granted for a period of one year, and be renewable annually. 3 licences, affecting 3 premises, were renewed during 1936. (b) Slaughter of Animals Act, 1933.—Three licences to act as slaughtermen were granted during the year. (c) Byelaws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc.—It has not been considered necessary to 46 seek any revision of existing byelaws. A full list of the byelaws in operation is given on page 31 of this report. (viii) Eradication of Bed Bugs. (la) Council Houses :— Found to be infested 13 Disinfested 13 (lb) Other Houses :— Found to be infested 37 Disinfested 40* * Includes 3 found in 1935 and complied with in 1936. (2) Methods employed :— Stripping of walls ; removal of woodwork, viz., picture rails, skirting, mouldings, etc.; spraying by "Rodesco" Insecticide, and repeated where necessary; removal of bedding for disinfection by steam; stopping of injured wall surfaces later. (3) Where necessary the above methods have been employed for ensuring that the belongings of tenants are free from vermin before removal to Ilford Council houses, and in 2 cases the furniture was treated with Cyanide gas before delivery at the Council houses. (4) The work of disinfestation has been carried out by the Local Authority in the case of Ilford Council houses, generally by the owners and occupiers in the case of private property, and by the L.C.C. for their own houses. (ix) Other Sanitary Conditions Requiring Notice. (a) On 4 occasions it has been found necessary to remove encampments of gipsies from waste land within the Borough. No action has been found necessary in respect of underground sleeping rooms (Housing Act, 1925, Sect. 18 (1) ). (x) Under Section 25 of the Burial Act, 1857, no exhumation licences were issued by H.M. Home Office. (xi) 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, 47 but 4 premises are using rag flock and are periodically inspected. 4. Schools.—The sanitary conditions of the 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. 48 SECTION D.—HOUSING. (i) During the year 193G, the number of houses built by private enterprise was 2,302. At the end of the year 1,194 houses were in course of erection. (ii) Overcrowding.—Informal Notices were served in respect of 3 premises, 2 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) 1,426 (b) Number of inspections made for the purpose 3,179 (2) (a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 347 (b) Number of inspections made for the purpose 1,735 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 19 (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 775 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 682 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 253 49 (2) Number of dwelling-houses which were rendered fit after service of formal Notices:— (а) By owners 186* (b) By local authority in default of owners — b. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 18 (2) Number of dwelling-houses in which defects were remedied after service of formal Notices:— (a) By owners 3 (b) By local authority in default of owners — c. Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 5+ d. Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — 4. Housing Act, 1935.—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 123 (ii) Number of families dwelling therein130 (iii) Number of persons dwelling therein 884½ (b) Number of new cases of overcrowding reported during the year 295 (c) (i) Number of cases of overcrowding relieved during the year 172 (ii) Number of persons concerned in such cases 1,046½ (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil * Includes compliances during 1936 of Notices served in 1935. + In addition 9 dwelling-houses were demolished in anticipation of formal procedure under Section 19, and 5 insanitary houses have been closed. 50 (v) Housing Act, 1935: Overcrowding Survey.—In accordance with the instructions of the Ministry of Health, an overcrowding survey under the above-mentioned Act was made. HOUSING ACT, 1935. Overcrowding Survey. The whole of the houses in the Borough, with the exception of those belonging to Public Institutions and Dr. Barnardo's Homes, were surveyed. The work commenced on November 28th, 1935, and Forms “A” were delivered by hand to each occupier, and part occupier where let separately. Fourteen days was allowed before collection. Delivery of the forms and collection was made by enumerators. Forms “A” were reviewed by the application of the factor-table, page 22 memo “B” and where review proved necessary, measurements of rooms were obtained from the Rating and Valuation Department. Forms “B” were made out and the Sanitary Inspectors visited these houses to check the allocation of rooms. Final review of forms “B” was then made, determining the incidence of overcrowding. The whole of the forms were then tabled and abstracted in accordance with memo “B” and form “C” prepared. Each of the 9 Wards in the Borough was separately enumerated, also the housing estates of the Ilford Borough Council and the London County Council. Where difficulty of collection of the forms was experienced special letters from the Town Clerk were sent. It was necessary to arrange evening visits in some cases; the result was that all the forms with one exception were collected. In the one case referred to, it appeared there was temporary residence only. Unemployed men were engaged as enumerators, also on the tabling and abstracting under supervision. From the commencement of the enumeration in November, 1935, and until April, 1936, an average of 19 men were employed for 10 weeks, reduced to an average of 8 men for 8 weeks. From November, 1936, to date, 8 men have been employed on the preparation of the certificates as to the “permitted number," which it is the Council's duty to provide, on request. Up to the 31st December, 1936, 3,900 certificates as to the “permitted number” have been granted in respect of 6,987 houses; with a grand total to date, 23/4/37, of 10,121 certificates in respect of 13,722 houses. A report was submitted to the Ministry of Health in April, 1936. The number of cases of overcrowding disclosed in the Borough was 290, as shown in the following report:— 51 The enumeration showed that in Ilford there were 43,541 separately occupied dwellings, viz., 39,661 separate houses and 3,880 sub-let premises. The number of cases of overcrowding in the Borough was 290 and the percentage of overcrowding was 0.666 for the Borough (including the estates owned by the L.C.C. and the Borough Council). The percentage of overcrowding in the Borough without the above estates was 0.447. The percentage of overcrowding of the Ilford Council Housing Estates was 3.732 and that of the L.C.C. Estates was 3.223. Further facts are set out in detail in the following tables:— Ward. Separately occupied dwellings enumerated Sub-let. Vacant. Separately occupied dwellings overcrowded Loxford 5,031 690 102 49 Clementswood 5,180 611 173 49 Goodmayes 5,083 184 120 78 South Hainault 4,004 363 175 14 Seven Kings 4,729 491 117 26 Park 4,352 574 125 10 Cranbrook 4,553 484 172 3 Barkingside 5,619 199 305* 31 North Hainault 4,990 284 227* 30 43,541 3,880 1,516 290 * A number of new houses not included. The overcrowding incidence occurred in the following types of separately occupied dwellings:— Ward. 1 2 Rooms 5 6 Total 3 4 Loxford 6 16 12 6 9 49 Clementswood 2 23 13 4 7 49 Goodmayes 11 53 12 2 78 South Hainault 1 1 3 6 3 14 Seven Kings 4 5 7 3 7 26 Park 1 1 5 1 2 10 Cranbrook 2 1 3 Barkingside 3 25 2 1 31 North Hainault 1 6 3 13 3 4 30 14 54 55 108 49 10 290 52 Ilford Borough Council Housing Estates. Incidence of overcrowding:— Ward. Separately occupied dwellings. Separately occupied dwellings. No. Sublet. Overcrowded Per Cent. Rooms. Total. 4 5 South Hainault 112 4 Nil Nil — — — Seven Kings 61 1 2 3.278 — 2 2 Barkingside 354 2 22 6.214 22 — 22 North Hainault 250 Nil 5 2.0 5 — 5 777 7 29 3.732 27 2 29 London County Council Housing Estate. Incidence of overcrowding:— Ward. Houses. Roomed Houses. Total No. Sub let Overcrowded Per Cent. 2 3 4 5 6 South Hainault 123 Nil 4 3.252 1 3 4 Goodmayes 2,390 10 77 3.221 11 53 11 2 77 2,513 10 81 3.223 11 54 11 5 81 Percentage of overcrowded houses or parts:— Ward Houses or parts. Overcrowded. Percentage. Loxford 5,031 49 .974 Clementswood 5,180 49 .945 Goodmayes 5,083 78 1.534* South Hainault 4,004 14 .349*† Seven Kings 4,729 26 .549† Park 4,352 10 .229 Cranbrook 4,553 3 .065 Barkingside 5,619 31 .551† North Hainault 4,990 30 .601† Borough 43,541 290 .666 (* Includes L.C.C. Estates.) († Includes Ilford Borough Council Estates.) 53 Houses in which possible overcrowding will occur within two years and will call for review:— Ward No. of Houses. Loxford 12 Clementswood 6 Goodmayes 20 South Hainault 2 Seven Kings 2 Park 2 Cranbrook Nil Barkingside Nil North Hainault 5 Total 49 Ilford Borough Council Estates.—Houses in which possible overcrowding will occur within two years and will call for review London County Council Estates.—Houses in which possible overcrowding will occur within two years and will call for review 1 18 London County Council Estates.—Population shown by returns. Under 1 year. Over 1 and under 10 years. Over 10 years. Total. Males. Females. Males. Females 125 1,206 1,100 4,916 4,824 12,171 There are 158 L.C.C. houses where there would appear to be excess accommodation. The population occupying these 43,541 premises is 150,707, and including public Institutions equals 156,589, and is shown in Wards in the following table:— Wards. Under l yr. Over 1 and under 10 years Over 10 years. Total. Males. Females Males Females Loxford 201 995 952 7,182 8,017 17,347 Clementswood 187 1,108 1,089 7,304 8,179 17,867 Goodmayes 194 1,597 1,393 8,110 8,548 19,842 South Hainault 134 835 752 5,804 6,579 14,104 Seven Kings 176 982 973 6,493 7,432 16,056 Park 129 713 728 5,939 7,104 14,613 Cranbrook 134 676 651 5,943 7,861 15,265 Barkingside 234 1,369 1,195 7,509 8,339 18,646 North Hainault 245 1,271 1,192 6,851 7,408 16,967 Total 1,634 9,546 8,925 61,135 69,467 150,707 54 King George Hospital (Resident Staff) 140 West Ham Mental Hospital (Resident Staff and Patients) 1,335 Claybury Mental Hospital (Resident Staff and patients) 2,585 Maternity Home (Resident Staff) 37 Isolation Hospital (Resident Staff) 51 Dr. Barnardo's Homes (Resident Staff and children) 1,704 Police Stations 30 Total 156,589 The Report was considered by the Public Health Committee in July, 1936, when the number of cases had been reduced to 198. Of these 69 were in the L.C.C. Housing Estates and 25 in the Ilford Council Housing Estates. The balance of 104 cases was referred to the Works, Housing and Town Planning (Housing Estates) Sub-Committee on 7th October, 1936, and the 104 cases were revisited by the Sanitary Inspectors, when it was found that this number had been reduced to 65. In addition a number of cases will require to be reviewed within 1937 and 1938. A report to this effect was placed before the Public Health Committee in October, 1936. The Public Health Committee again considered the matter on 10th March, 1937, when the number of cases was found to be 43 (exclusive of L.C.C. and Ilford Corporation houses), which were again referred to the Works, Housing and Town Planning (Housing Estates) Sub-Committee. 55 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) The following is a summary of Persons and Premises registered as at 31st December, 1936:— Premises registered as dairies and milkshops 42 Cowkeepers registered 5 Persons registered as retail purveyors of milk 47 Persons registered as retail purveyors of milk in sealed cartons or containers 82 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 15 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 21 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 1 357 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 119 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. Of the 203 premises from which milk is retailed in Ilford, 17 are branches of one firm, 5 another, and 2 another, 3 retail from dairy shops or stores, 2 from general shops and 5 from restaurants, 12 are retailers in a small way with rounds and also provision for storage of milk; while 60 sell sterilised bottled milk only, 15 sell sterilised milk and also milk in sealed containers, and 82 retail milk in sealed containers only. In 2 premises, pasteurising plant has been installed. Only 1 of these has, however, been licensed. 56 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) Orders 1923 and 1936 during 1936, for the sale of:— "Certified" Milk 6 "Grade A" Milk 6 "Grade A (Tuberculin Tested)" Milk 19 "Pasteurised" Milk 26 "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, 9; and "Pasteurised" milk, 10. 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. The Milk (Special Designations) Order, 1936. The new Order, which operated from the 1st June, 1936, prescribed the following special designations for milk, viz.:— 1. "Tuberculin Tested" Milk. If raw, this milk must, until the 31st December, 1936, be so produced that a sample taken at any time before delivery to the consumer, shall not contain more than 200,000 bacteria per millilitre; after that date it must satisfy a prescribed methylene blue reduction test for cleanliness. At all dates it must contain no coliform bacillus in one-hundredth of a millilitre. Tuberculin Tested Milk is milk obtained from cows that are tuberculintested at an interval of not less than two and not more than six months after the last preceding test of such animal. 2. “Tuberculin Tested” (Certified) Milk. This is milk which is bottled on the farm, and complies with the above conditions. 3. “Tuberculin Tested” (Pasteurised) Milk. This is milk produced from tuberculin-tested herds, and must not contain more than 30,000 bacteria per millilitre. It must be pasteurised according to the conditions given under (5) Pasteurised Milk. 4. "Accredited" Milk. This is milk obtained from cows that are submitted to a veterinary examination once in every three months, and it must satisfy the same bacteriological tests as raw tuberculin-tested milk. 57 5. "Pasteurised" Milk. This is milk which has been retained at a temperature of 145 deg. F. and not more than 150 deg. F. for at least thirty minutes, and then immediately cooled to a temperature of not more than 55 deg. F. It must not have been so heated more than once, and shall not be otherwise treated by heat. The milk at any time before delivery to the consumer must not contain more than 100,000 bacteria per millilitre. Under the terms of the 1936 Order licences in force which had been granted before the 1st June, 1936, under the Order of 1923, continued in operation until the 31st December, 1936, licences to sell milk as "Certified" or "Grade A (Tuberculin Tested)" being deemed to be licences to use the designation "Tuberculin Tested," and a licence to sell milk as "Grade A" being deemed to be a licence to use the designation "Accredited." 4 licences to use the designation " Pasteurised " were issued during 1936 under the new Order. (iii) Sampling.— (a) "Certified" Milk.—9 samples were taken for bacteriological examination for the Ministry of Health. All were satisfactory. (b) "Grade A (Tuberculin Tested)" Milk.—14 samples were taken, 1 of which did not comply with the standard as regards B. Coli Content in the case of 1 retailer. (c) "Grade A" Milk.—3 samples were taken, all of which were satisfactory. (d) "Grade A Pasteurised" Milk.—3 samples were taken, all of which were satisfactory. (e) "Pasteurised" Milk.—41 samples were taken, 1 of which did not comply with the standard as regards Bacterial Count. (f) Ungraded Milk.—55 samples were taken. In 6 cases, affecting 5 firms, the retailers were communicated with owing to a high Bacterial or B. Coli Content. (g) Ice Cream.—54 samples were taken. In 10 cases, affecting 9 firms, the retailers were communicated with owing to a high Bacterial or B. Coli Content. Samples taken of graded milk, after 1st June, 1936:— (h) "Tuberculin Tested" Milk.—8 samples were taken, all of which were satisfactory. (i) "Tuberculin Tested (Pasteurised) Milk."—5 samples were taken, all of which were satisfactory. (j) "Tuberculin Tested (Certified) Milk."—2 samples were taken for the Ministry of Health, both of which were satisfactory. (iv) Tubercular Milk.—43 samples of milk were submitted to a biological test for tuberculosis; 3 samples were found to be positive. The following is a brief resume of the cases:— (a) Ungraded Milk.—Sample taken from Ilford retailer on 30th January. Supplies obtained from retailer's farm, in Ilford, having 31 cows. 2 cows were found to be tuberculous and were slaughtered. 58 (b) Ungraded Milk.—Sample taken from Ilford retailer on 21st May. Supplies obtained from a farm in Essex, having 53 cows. 1 cow was found to be tuberculous and was slaughtered. (c) Ungraded Milk.—Further sample taken from the same Ilford retailer as in (a) on 10th September. Herd of 29 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 in the case of (b) but a positive result in the case of (a) as shown in (c) above, and a further sample will be taken in 1937. (v) Milk and Dairies Order, 1926: Inspection of Dairy Herds.— Mr. J. F. Mason, M.R.C.V.S., Assistant Veterinary Officer, Essex County Council, has been appointed by the E.C.C. as County District Veterinary Officer for the purposes of this Order. His district includes that of the Borough of Ilford. As a result of inspections during the year by the Veterinary Officer, one notification was received of a suspected case of tuberculosis at the farm of a Public Institution. One cow was slaughtered and post-mortem examination revealed the presence of tuberculosis. (vi) Legal Proceedings.—None were taken during the year. (vii) Registration.—No application for registration was refused during 1936. Meat and Other Foods.—All the local tradesmen are now complying with the Public Health (Meat) Regulations, 1924. With regard to the inspection of meat (other than local retail shops), there was only 1 licensed slaughterhouse in the district, and nothing but sheep were killed there. The premises are not now used for this purpose, and no application for a renewal of the licence has been received. From 1st January to 9th June 30 inspection visits were made, and since the latter date no slaughtering has taken place. The Meat Marking Scheme under Part III of the Public Health (Meat) Regulations, 1924, is under the jurisdiction of the Essex County Council. 59 Shell-fish (Molluscan). There are no shell-fish beds or layings In the district. Articles of Food Surrendered. During the year the following articles of food were surrendered and condemned as being unfit for the food of man:— (i) 472 tins of fruit (mixed), salmon, sardines, crab, cream, peas and condensed milk; 2 jars of preserved ginger, 61bs. dried pears; 8 pairs of kippers; 7¾ stone of skate; 121bs. dog-fish; 31bs. 6ozs. smoked ham; 20 61b. tins corned beef; 71bs. "Golden Fillets" (fish); and one barrel of herrings and sprats. (ii) Unsound Food. A tuberculous and fluky liver which was exposed for sale was seized by a Sanitary Inspector from a butcher's shop in the Borough in April, 1936. The matter was taken up with the Medical Officer of Health of a neighbouring Borough where the slaughtering took place. 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 8 Samples of Butter taken 74 Other Samples 297 Total 379 One prosecution was undertaken during the year, relating to 60 pork sausages, containing preservative without being so labelled, and costs amounting to 10s. were imposed in this case. Food Poisoning. No cases were reported to the Department during the year. Bakehouses.—There are 42 bakehouses in the district, including 27 factory bakehouses. 231 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 30 instances, and the requests were complied with. Contagious Diseases (Animals) Acts, 1894-1925. (i) Regulation of Movement of Swine Fever Order, 1922.—6 Licences have been received from various Local Authorities affecting 194 animals sent into the district for stock and other purposes. Isolation for the necessary period was enforced. (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, 1936, 2,256 (1st dippings 1,128, 2nd dippings 1,128) sheep have been dipped as required at a farm in the Borough. (iii) Swine Fever Order, 1908.—Notices were received of 3 suspected cases of Swine Fever at 3 farms in the Borough. Form "A" Notices were served creating the premises infected places. They were later cleared by the Ministry of Agriculture and Fisheries from being infected places. (iv) Parasitic Mange Orders of 1911 and 1918.—No cases were notified during the year. (v) The following Orders were made by the Ministry of Agriculture and Fisheries:— 1. Fowl Pest Order of 1936. 2. Poultry Markets and Receptacles (Disinfection) Order of 1936. 3. Poultry and Hatching Eggs (Importation) Order of 1936. They were issued by the Ministry on the 9th December, 1936, and in accordance with their instructions were advertised in the public press. 61 Rats and Mice Destruction Act, 1919.—89 complaints have been received of the existence of rats affecting 209 premises. In 47 of these cases poison gas has been used, and in the remaining cases other steps have been taken. National Rat Week (November, 1936).—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:— (i) Four sets of three special slides were provided, and these were put on the screens at four Cinemas in the Borough at each performance during the week. In addition a special illustrated poster was exhibited in the vestibule at four of the Cinemas in the Borough. (ii) At three 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 2 posters on the outside boards and at the other Cinemas 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, Town Hall, and other buildings owned by the Borough Council. (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, or suspected, this was treated by gassing. (vi) Five thousand 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, as last year, somewhat disappointing, only three complaints being received apparently as a direct result. Petroleum (Consolidation) Act, 1928.—The Senior Sanitary Inspector made 429 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 20 petroleum appliances or fittings. The number of Licences issued was 130, and the fees paid to the Council for such Licences was £90 15s. 4 Licences were issued for the storage of calcium-carbide, the fees payable being £1. 62 SECTION F.—PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. 1.—Infectious Diseases Generally.—During 1936, 950 cases were notified, as compared with 964 in 1935. 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. Dysentry (including amoebic and bacillary dysentery). Malaria. Acute Poliomyelitis. Acute Polio-Encephalitis. Acute Encephalitis Lethargica. Anthrax. Acute Rheumatism (up to 16 years). 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, mercurical, carbon bisulphide, aniline and chronic benzene poisoning, anthrax, toxic jaundice, epitheliomatous or chrome ulceration, contracted in any factory or workshop. Table II shows the number of cases of infectious diseases notified during 1936, arranged according to age and distribution in wards. Of these 113 were notified from institutions as follows: Claybury Mental Hospital:— Pneumonia 1 Enteric Fever 1 Erysipelas Tuberculosis—Pulmonary 9 1 Diphtheria 1 13 63 Dr. Barnardo's Girls, Village Homes:— Scarlet Fever 17 Diphtheria 12 Erysipelas 1 Pneumonia 1 Tuberculosis—Pulmonary 2 Non Pulmonary 1 34 Ilford Council Maternity Home:— Pemphigus Neonatorum 3* Puerperal Fever 1 Puerperal Pyrexia 27 Ophthalmia Neonatorum 2 Pneumonia 1 Scarlet Fever 1 35 West Ham Mental Hospital:— Pneumonia 1 Tuberculosis—Pulmonary 16 Erysipelas 1 18 King George Hospital:— Diphtheria 1 Scarlet Fever 5 Pneumonia 3 Tuberculosis—Pulmonary 1 Non-Pulmonary 1 Erysipelas 1 Cerebro-spinal Fever 1 13 * 2 admitted to Isolation Hospital, 1 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 81.6 Diphtheria and Membranous Croup 96.3 Enteric Fever 94.1 Puerperal Fever 80.0 Puerperal Pyrexia 88.8 Pneumonia 49.2 64 TABLE II.—Cases of Infectious Diseases Notified during the Year 1936 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 Barkinsgide North Hainault Loxford Clementswood South Hainault Goodmayes Smallpox — — — — — — — — — — — — — — — — — — Scarlet Fever 349 1 61 239 27 20 1 — 19 13 64 35 58 19 28 38 75 285 (a) Diphtheria, including Membranous Croup 137 — 28 68 20 20 1 — 14 13 6 16 30 11 11 9 27 132 (b) Enteric Fever (Typhoid and para-Typhoid) 17 — 1 3 5 5 3 — 1 5 — 3 — 1 5 2 — 16 (c) Pneumonia 130 7 20 20 14 30 28 11 7 13 11 11 33 4 14 21 16 64 (d) Puerperal 5 — — — 3 2 — — 1 — — — 1 1 — 1 1 4 (e) Puerperal Pyrexia 36 — — — 10 26 — — 2 — 2 1 28 — 1 1 1 32(f) Cerebro-Spinal Fever 1 — 1 — — — — — — — — — 1 — — — — 1 (g) Acute Poliomyelitis 7 — 3 3 1 — — — 1 1 — — 1 — 2 1 1 7 (h) Acute Polio-Encephalitis — — — — — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — — — — Dysentry 1 — 1 — — — — — — — — — — — — 1 — 1 (i) Ophthalmia Neonatorum 9 9 — — — — — — 1 — 2 1 1 — — 4 — 7 (j) Erysipelas 45 1 1 1 4 16 18 4 1 2 2 15 8 3 7 4 3 31 (k) Pemphigus Neonatorum 7 7 — — — — — — 1 — — 2 3 — — — — 2 (l) Tuberculosis—Pulmonary 143 — — 4 35 70 28 6 10 18 12 15 13 20 12 27 16 — Other Forms 33 — 4 15 6 6 2 — 2 — 4 4 7 2 1 5 8 — Anthrax — — — — — — — — — — — — — — — — — — Malaria—Believed to be contracted in this — — — — — — — — — — — — — — — — — — Believed to be contracted abroad 1 — — — — — — — — — — — — — — — — — Acute Rheumatism 29 — 1 28 — — — — — 1 4 — 2 2 2 6 12 11 Totals 950 25 121 381 125 196 81 21 61 66 107 103 186 63 83 120 161 593 • See note on following page. 65 * Note to Table II. (a ) Includes 17 cases notified from and treated at Girls' Village Homes. „ 5 cases „ King George Hospital, 4 of which were transferred to Ilford Isolation Hospital and 1 to Romford Isolation Hospital. „ 1 case „ Ilford Council Maternity Home and transferred to Ilford Isolation Hospital. „ 2 cases „ London Hospital (1) and Central London Throat, Nose and Ear Hospital (1) and transferred to L.C.C. Hospital. (b) „ 12 cases „ and treated at Girls' Village Homes. „ 1 case „ Claybury Mental Hospital and transferred to Ilford Isolation Hospital. „ 1 „ „ King George Hospital and transferred to Ilford Isolation Hospital. „ 1 „ „ London Hospital and tranfserred to L.C.C. Hospital. (c) „ 1 case „ and treated at Claybury Mental Hospital. (d) „ 1 „ „ „ Girls' Village Homes. „ 1 „ „ ,, Claybury Mental Hospital. „ 1 „ „ „ West Ham Mental Hospital. „ 1 „ „ „ Ilford Council Maternity Home. „ 3 cases ,, King George Hospital, 2 being treated at that Institution and 1 transferred to Ilford Isolation Hospital. (e) „ 1 case „ Ilford Council Maternity Home and transferred to Ilford Isolation Hospital. „ 1 „ „ and treated at Queen Charlotte's Isolation Hospital, Hammersmith. (f) „ 27 cases ,, from Ilford Council Maternity Home, 11 being transferred to Ilford Isolation Hospital. „ 1 case „ and treated at Mothers Hospital, Clapton. 1 „ „ „ Queen Charlotte's Isolation Hospital, Hammersmith. (g) „ 1 „ „ ,, King George Hospital. (h) „ 1 „ „ „ Oldchurch Hospital. (i) „ 1 „ „ Gt. Ormond St. Hospital and transferred to Ilford Isolation Hospital. (j) „ 2 cases „ Ilford Council Maternity Home and treated at Royal London Ophthalmic Hospital, City Road. (k) „ 9 „ „ and treated at Claybury Mental Hospital. „ 1 case „ „ West Ham Mental Hospital. „ 1 „ „ ,, Girls' Village Homes. 1 „ „ King George Hospital and transferred to Ilford Isolation Hospital. (l) ,, 2 cases ,, Ilford Council Maternity Home and transferred to the Ilford Isolation Hospital. 66 The total number of deaths of Ilford residents from the following infectious diseases during 1936 was 192, as against 157 in 1935. 1936. 1936. Scarlet Fever 1 1 Enteric Fever — 1 Encephalitis Lethargica 2 — Diphtheria 8 5 Measles — 9 Whooping Cough 6 3 Influenza 16 21 Tuberculosis—Pulmonary 60 72 Other forms 10 10 Pneumonia 35 58 Diarrhoea (under 2 years) 14 10 Cerebro-spinal Fever 2 1 Puerperal Fever 3 1 Total 157 192 The following table shows a comparison of the incidence of the following infectious diseases for the past five years:— 1936. 1935. 1934. 1933. 1932. Scarlet Fever 349 357 461 406 257 Diphtheria 137 189 343 150 85 Enteric Fever 17 16 6 19 21 Pneumonia 130 69 159 152 126 (a) Smallpox.—Notifications of 6 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 following gives particulars as to Vaccination during 1936:— Certificates of Successful Vaccination 1,029 Postponed 107 Conscientious Objections 842 Unsuccessful Vaccination 5 Left the District 132 (b) Scarlet Fever.—349 cases were notified in 1936, as compared with 357 in 1935; 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. One death occurred at the Ilford Isolation Hospital four days after admission. The patient had developed the disease in King George Hospital following an operation for Empyema. 67 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. 1932 257 206 7 3.4 44 — — 1933 406 321 9 2.1 58 — — 1934 461 326 19 5.8 94 — — 1935 357 266 8 3.0 60 — — 1936 349 265 10 3.7 65 1 1.5 (c) Diphtheria.—137 cases were notified in 1936 as compared with 189 in 1935; 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. One death occurred at Brook L.C.C. Hospital of an Ilford resident, having been transferred from the London Hospital. Four deaths occurred at the Ilford Isolation Hospital. The following table shows the number of children Schick Tested and immunised at the Diphtheria Clinics held at the Public Health Offices and the Mayesbrook School Clinic. 68 Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1936, to 31st December, 1936. 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 36 2 38 30 30 68 Negative 24 3 27 22 3 25 52 Numbers inoculated (full course) 484* 282 766 358* 103 461 1,227 Positive after full course of inoculations, and re-inoculated 18 4 22 5 2 7 29 Negative after full course of inoculations 321 178 499 176 56 232 731 Awaiting re-test 136 93 229 170 44 214 443 Not re-tested after inoculation (on account of leaving District, etc.) 9 7 16 6 1 7 23 Positive after re-test, but not inoculated for same reason — — — 1 — 1 1 Final Schick Test in 1936 (1935 Cases):— Positive after full course of inoculations, and re-inoculated 5 3 8 1 1 2 10 Negative 116 95 211 34 19 53 264 * Schick + 1936= 36; Schick+ 1935= 2; Not Tested= 446. * Schick+1936=30;Not Tested=328. During 1936 a total number of 1,553 children attended at the Diphtheria Prevention Clinics (1,012 at the Public Health Offices and 541 at Mayesbrook), making a total number of attendances of 7,066 (4,559 and 2,507), with an average per session of 97 and 47 respectively. 69 In 1936, under the arrangements mentioned in the 1935 Report, 20 private doctors were supplied with prophylactic for the immunisation of 61 children (27 under 5 years and 34 over 5 years of age). The following is a brief summary:— 1935 Cases: Final Schick Test in 1936 (all negative) 30 No final Schick Test, left district etc. 5 1936 Cases: Numbers inoculated (full course) by medical practitioners 51 Final Schick Test (all negative) 36 No final Schick Test, left district, etc. 4 Forms not yet returned 10 To be Schick Tested in 1937 11 (d) Enteric Fever.—17 cases were notified in 1936 as compared with 15 in 1935; 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. 1 of the cases occurred at Claybury Mental Hospital. Fifteen cases were admitted to the Ilford Isolation Hospital. Three cases were not confirmed bacteriologically. Of the remaining 12 cases, in 2 the infecting organism was B. Typhosus and in 10 the Bacillus Para-typhosus B. The source of infection was not traced in any of the cases. The above patients recovered. One death from Typhoid fever, however, occurred in the Port of London Hospital, Gravesend, of a man in the Merchant Service, whose residence was in Ilford. One case was nursed at home; bacteriologically this case was not confirmed. (e) Cerebro-Spinal Fever.—One notification of this disease was received during the year. Meningococci were found in the cerebro-spinal fluid. The child, aged 2 years, died in the King George Hospital. 70 (/) Ophthalmia Neonatorum.—9 cases were notified during 1936, as compared with 11 in 1935; 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. Of the 9 cases notified, 2 cases were admitted to St. Margaret's Hospital, 2 were treated at home by private medical practitioners; 4 attended the Out-Patient Department of the Royal London Ophthalmic Hospital; and 1 attended the Out-Patient Department of King George Hospital. Cases. Vision Unimpaired. Vision Impaired Total Blindess Deaths Notified. Treated. At Home. In Hospital. 9 2 7 9 — — — (g) Acute Influenzal and Acute Primary Pneumonia.—130 cases were notified (of which 7 were in institutions) in 1936, compared with 69 in 1935; 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. The following is a statement of the number of cases of acute influenzal pneumonia and acute primary pneumonia notified during 1936, together with the number of deaths of notified cases, compared with the year 1935:— Acute Inf. Pneumonia. Acute Primary Pneumonia. Total. Cases. Deaths. Cases. Deaths. Cases. Deaths. 1936 54 14 76 18 130 32 1935 28 6 41 14 69 20 71 (h) Encephalitis Lethargica.—One case was notified, but the notification was subsequently withdrawn. (i) Acute Poliomyelitis.—7 cases were notified during 1936—5 males (ages 1¼, 3, 8, 11 and 13 years), and 2 females (1½ and 16 years). All the patients were removed to hospitals as follows:— llford Isolation Hospital, 3; Oldchurch Hospital, 2; Westminster Hospital, 1; Middlesex Hospital, 1. (j) Puerperal Fever.—5 cases were notified during the year; 3 were treated at the Isolation Hospital, 1 at Queen Charlotte's Isolation Hospital, and 1 was nursed at home. All were residents of llford, and all recovered. (k) Puerperal Pyrexia.—36 cases were notified, 13 being treated at the Isolation Hospital; 1 at Queen Charlotte's Isolation Hospital, Hammersmith; 16 at the Maternity Home; 1 at the London Hospital; 1 at the Mothers' Hospital, Clapton (where the patient had been confined); and 4 at home. All the patients recovered. The 36 patients were suffering from the following conditions: Cause of Pyrexia. Number of Cases. Ante-natal sepsis 2 B. coli septicaemia 1 Bilateral thrombosis 1 Difficult labour 1 Incomplete abortion 1 Labial herpes 1 Mastitis 7 Miscarriage 2 Parametritis 2 Phlegmasia alba dolens 1 Pleurisy 2 Pyelitis 9 Pyelonephritis 1 Re-action due to serum injection 2 Tubercle bacilli in sputum 1 Uterine clots 1 Uterine infection 1 72 2. Zymotic Diseases.—The deaths registered were as follows:— Smallpox - Measles 9 Scarlet Fever 1 Diphtheria and Croup 5 Enteric Fever 1 Diarrhoea 10 73 Table showing Incidence of Infectious Disease, 1936, in age groups; and total Deaths 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 Smallpox — — — — — — — — — — — — — — — Scarlet Fever 349 1 6 15 21 19 182 57 15 27 5 1 — 268 1 Diphtheria 137 — 5 5 11 7 48 20 9 24 7 1 — 120 5 Enteric Fever (including Paratyphoid) 17 — — — — 1 1 2 4 1 2 3 3 15 1 Pneumonia 130 7 6 3 7 4 17 3 3 25 16 28 11 61 58 Puerperal Fever 5 — — — — — — — — 5 — — — 4 1 Puerperal Pyrexia 36 — — — — — — — — 32 4 — — 32 — Cerebro-spinal Fever 1 — 1 — — — — — — — — — — 1 1 Acute Poliomyelitis 7 — 2 — 1 — 1 2 1 — — — — 7 — Acute Polio-Encephalitis — — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — Continued Fever — — — — — — — — — — — — — — — Dysentry 1 — — — 1 — — — — — — — — 1 — Ophthalmia Neonatorum 9 9 — — — — — — — — — — — 7 — Erysipelas 45 1 — — — 1 1 — 1 7 12 18 4 20 4 Anthrax — — — — — — — — — — — — — — — Malaria believed to be contracted in this country — — — — — — — — — — — — — — — „ —believed to be contracted abroad 1 — — — — — — — — 1 — — — — — Pemphigus Neonatorum 7 7 — — — — — — — — — — — 2 — Acute Rheumatism 29 — — — — 1 10 18 — — — — — 11 — * Excludes cases occurring at Barnardo's Homes, Claybury Mental Hospital, and West Ham Mental Hospital. 74 3. Tuberculosis.— During the year 1936, there were 143 new notifications of Pulmonary Tuberculosis and 33 of other forms of Tuberculosis. 22 cases of Pulmonary and 12 cases of NonPulmonary Tuberculosis were transferred to Ilford. Notification and Deaths from Tuberculosis of Ilford Residents during 1936 Age Periods. New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year — — — — — — — — 1-5 years — — 2 2 1 — 1 3 5-10 — — 9 1 — — — 1 10-15 — 4 1 4 — — — — 15-20 3 6 3 — 1 1 1 — 20-25 11 15 1 2 4 3 1 — 25-35 19 16 3 3 15 14 — — 35-45 19 16 — — 8 4 — — 45-55 15 5 1 — 7 2 — 1 55-65 4 4 1 — 4 3 — 1 Over 65. 2 4 — — 4 1 1 — Totals 73 70 21 12 44 28 4 6 Of the above new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis. Nonrespiratory Tuberculosis. The Girls' Village Homes, Barkingside 2 1 King George Hospital 1 1 Claybury Mental Hospital 1 — West Ham Mental Hospital 16 — Of the 82 deaths which occurred of Ilford residents, notification had previously been made of 69 of the cases; 2 were notified after death; 11 were not notified (13.5 per cent, of the deaths, or a ratio of 1 in 7). Communications were sent to enquire why notification had not been carried out, in 5 cases the diagnosis was only 75 made after a P.M.; in one case the patient died a few hours after admission to hospital; two were cases of tuberculous meningitis the diagnosis only being confirmed after death; one case had been transferred from another district where it had been thought to have been notified. The remaining three cases allocated to Ilford by the Registrar General, I have been unable to trace in my returns. During the year 1936 the following deaths occurred from Tuberculosis:— Pulmonary. Non-Pulmonary. Ilford Residents 72 10 Non-Residents:— Claybury Mental Hospital 2 West Ham Mental Hospital 4 - King George Hospital 4 2 On the 1st January, 1936, there were 771 cases on the register of the department. On the 31st December, 1936, with 176 new cases notified and 34 transfers, and allowing for deaths, removals from district and cases removed from the register as "cured," there were 772 cases on the register. The new cases of Tuberculosis are visited by the Tuberculosis Nurse of the Essex County Council. 782 of the cases of longer standing were visited by the Sanitary Inspectors during the year, and the following reports were obtained:— Pulmonary Cases. Other Cases. Stated to be cured, recovered or better 238 114 Improved or fairly well 163 38 Not so well .. 51 8 In Sanatorium 72 21 No information as to present condition 9 1 Removed from district, etc. 57 10 Totals 590 192 The treatment of Tuberculosis is under the control of the 76 Essex County Council. The Tuberculosis Dispensary in Ilford is attended on four occasions a week by the Tuberculosis Officer. On the 31st December, 1936, there were 553 patients on the register of the dispensary. The arrangements made with the Essex County Council for the dental treatment of tuberculous patients from Ilford, Romford, Leyton and Walthamstow were continued. Two afternoon sessions per month were set aside for the treatment of these cases. 69 patients were treated, 16 being supplied with dentures. The Council's Dentist also made 2 visits to the tuberculous patients at the Ilford Sanatorium. 39 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 Ilford sent to Institutions under the County Tuberculosis Scheme during 1936 was as follows:— Pulmonary. Non-Pulmonary. Total. Males. Females. Males. Females. Adults 67 40 8 4 119 Children - 2 5 1 8 Tuberculosis Care Association.—This Association has assisted 102 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 Disease (Prevention) Act, 1890.—In connection with deaths from infectious diseases, 13 certificates in respect 77 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 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 1-5 5-15 15-25 25-35 35-45 45-55 55-65 65-75 75-85 85 up Syphilis — — — — — 1 1 — — — — — 2 Locomotor Ataxy — — — — — — — — — — — — — General Paralysis of Insane — — — — — 2 — 1 — — — 16 19 Aortic Aneurysm — — — — — — — — — — — 1 1 The deaths in Institutions of Ilford non-residents occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 10.3 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 of Ophthalmia Neonatorum notified since notification of this disease was first enforced in 1914: 1914, 8 cases; 1915, 6 cases; 1916, 6 cases; 1917, 5 cases; 1918, 9 cases; 1919, 9 cases; 1920, 10 cases; 1921, 7 cases; 1922, 9 cases; 1923, 9 cases; 1924, 4 cases; 1925, 3 cases; 1926, 3 cases; 1927, 2 cases; 1928, 4 cases; 1929, 6 cases; 1930, 5 cases; 1931, 11 cases; 1932, 11 cases; 1933, 14 cases; 1934, 16 cases; 1935, 11 cases; 1936, 9 cases. It is to be remembered that 78 many cases of ophthalmia neonatorum are not due to gonorrhoeal infection. The diagnosis and treatment of Venereal Disease is carried out as stated in 1932 Report. 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. 19 verminous premises were disinfested 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. 79 SECTION G.— FACTORIES AND WORKSHOPS. Factories. There are 321 factories on the register, made up as follows:— Advertising Novelty Maker 1 Nautical Instrument Maker 1 Bakehouses 27 Optician 1 Bedstead Maker 1 Oxygen Maker 1 Blind Maker 1 Paint Manufacturer 1 Boot Makers and Repairers 52 Paper Mills 2 Brick Maker 1 Photographic Works 2 Brush Maker 1 Plating and Enamelling 1 Builders, Joinery and Carpentry Works 15 Poultry Appliance Maker 1 Printer's Engineer 1 Cabinet Makers 3 Printing Works 15 Cable Works 1 Provender Preparers 2 Carbon Works 1 Rubber Workers 2 Carriage Works and Wheelwrights 2 Saw Mills and Timber Merchants 9 Cellulose Sprayers 3 Seed Sorting 1 Chemical Works 3 Shirt Makers 4 Confectionery Makers 3 Sign Makers 2 Corset Maker 1 Spectacle Case Makers 1 Cycle Repairers 2 Sports Goods and Electrical Fittings Maker 1 Dentist's Mechanic 1 Dyers and Cleaners 6 Stone Masons 2 Ebonite Goods 1 Tarpaulin Repairer 1 Electric Battery Charging 2 Tailor 1 Electric Lamp Maker 1 Tile Fender Maker 1 Electric Equipment Repairers 4 Tool Engineers 3 Electricity Supply Works 3 Toy Maker 1 Engineers 13 Umbrella Repairers 2 Fire Cement Maker 1 Undertaker 1 Gas Mantle Manufacturer 1 Upholsterers 2 Hardware Manufacturer 1 Vulcanising Works 1 Iron Cutting Works 1 Watch and Clock Makers and Repairers 3 Laundries 8 Leather Workers 5 Water-proof Works 1 Mattress Makers 2 Water Softener Maker 1 Meat Cutting 13 Wearing Apparel Makers 21 Metal Workers 4 Wheelwrights and Farriers 4 Metal Polish Maker 1 Wireless Apparatus Makers 3 Milk Pasteurisers 2 Wood Cutters 6 Mineral Water Manufacturer 1 Total 321 Motor Engineers 30 80 Workshops. There are 419 workshops on the register, made up as follows:— Artificial Flower Makers 2 Mineral Water Manufacturer 1 Bakehouses 15 Motor and Cycle Engineers and Repairers 39 Beet Boiler 1 Bookbinder 1 Optician 1 Boot Repairers 15 Packing Case Repairer 1 Boot Makers and Shoe Sewers 3 Photographers 3 Box Worker 1 Piano Repairer 1 Brush Workers 2 Picture Framers 4 Builders and Carpenters 34 Plumbers 6 Cabinet Maker 1 Poster Writers 3 Carpet Planning 1 Poultry Dealer 1 Cartage Contractor 1 Printers and Stationers 3 Cellulose Sprayer 1 Rag and Bone Merchants 2 Clergy Robe Maker 1 Scale Maker 1 Coffee Grinder 1 Scrap Metal Merchant 1 Confectioners 1 Shirt Makers 2 Dressmakers 54 Sign Makers and Writers 3 Dyers and Cleaners 13 Soft Furnishings Workers 4 Electrical and Mechanical Engineers 4 Sports Outfit Repairers 2 Tailors 29 Electric Battery Charging 7 Tie Maker 1 Embroidery and Lace Workers 9 Tile Fender Maker 1 Flag Maker 1 Timber Merchants 4 Floor Polish Makers 2 Tinsmith 1 Florists 4 Toilet Requisites 1 Food Packing 1 Toy Makers and Repairer 1 French Polisher 1 Typewriter Repairer 1 Furriers 3 Umbrella Repairers 2 Glass Cutters and Glaziers 5 Undertakers 6 Glove Maker 1 Upholsterers, etc. 13 Hand Laundry 1 Watch and Jewellery Repairers 13 Hairdressers 2 Wearing Apparel and Underclothiers 45 Hat Maker 1 Leather Workers 4 Wheelwrights and Farriers 6 Monumental Mason 1 Wig Maker 1 Mica Cutter 2 Wire Worker 1 Milliners 15 Wireless Apparatus Makers 3 Total 419 81 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections Made by Sanitary Inspectors. Premises. Number of Inspections Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 212 — — Workshops (including Workshop Laundries) 575 3 — Workplaces (other than Outworkers' premises Included in Part 3 of this report) — — — Total 787 3 — 82 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) (6) Nuisances under the Public Health Acts*:— Want of cleanliness 1 1 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 1 1 — — Sanitary accommoda tion insufficient — — — — unsuitable or defective 3 3 — — not separate for sexes — — — — Offences under the Factory and Workshops Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) — — — — Other offences — — — — (Excluding offences rerelating to outwork which are included in Part 3 of this report) — — — — Total 5 5 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshops Act, 1901, as remediable under the Public Health Acts. 83 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) (6) (6) (7) Wearing Apparel:— Making, etc. 20 17 51 1 — 1 Cleaning and Washing — — — — — — Household Linen — — — — — — Lace, Lace Curtains and Nets — — — — — — Total 20 17 51 1 — 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. 84 4.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshops Act (s. 133, 1901) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshops Act (s. 5, 1901) "Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Other — Underground Bakehouses (s. 101):— In use at the end of the year - ISOLATION HOSPITAL 87 ISOLATION HOSPITAL. 662 patients were admitted during 1936, as compared with 558 in 1935, 706 in 1934, 569 in 1933, 422 in 1932, and 421 in 1931. 86.8 per cent, of the cases of diphtheria and 75.9 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. 1936 86.8 75.9 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 The following table shows the total admissions for the past ten years:— Year. Scarlet Fever. Diphtheria. Tuberculosis. Other Diseases. Total. 1936 265 119 58 220 662 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 88 The 662 patients admitted during 1936 were as follows:— Scarlet Fever 265 Diphtheria 119 Enteric Fever 16 Puerperal Pyrexia 13 Puerperal Fever 3 Pemphigus Neonatorum 2 Tuberculous Diseases 58 Acute Anterior Poliomyelitis 3 Pneumonia 53 Measles 32 Whooping Cough 12 Dysentery 1 Erysipelas 17 Scabies 5 Acute Rheumatism 11 Under observation 52 Number of deaths in Hospital:— Diphtheria 4 Scarlet Fever 1 Pneumonia 4 Cancer of lung and Pneumonia 1 Whooping Cough and Pneumonia 2 Measles and Pneumonia 3 Erysipelas 3 Pulmonary Tuberculosis 7 Convulsions 1 Staphylococcal Pyaemia 1 Staphylococcal Septicaemia and Dermatitis 1 Streptococcal Septicaemia 1 Number of patients in Hospital on 1st January, 1936 and 1937 respectively:— 1st Jan., 1936. 1st Jan., 1937. Scarlet Fever 43 27 Diphtheria 28 11 Tuberculous Diseases 20 20 Puerperal Pyrexia — 1 Enteric Fever — 1 Erysipelas 1 2 Measles 2 — Whooping Cough — 3 Pneumonia 2 10 Acute Rheumatism 4 4 Under observation 3 1 89 The average length of stay in Hospital was for— Scarlet Fever 37.4 days. Diphtheria 57.3 „ Tuberculous Diseases 80.6 „ Average stay in Hospital of all cases 41.5 „ The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day, 90.4. Scarlet Fever.— The 265 cases admitted during 1936 were distributed among the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. — 49 182 20 10 3 1 One death occurred from scarlet fever four days after admission. The patient had developed the disease in King George Hospital following an operation for Empyema. 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. 1932. 1933. 1934. 1935. 1936. Ilford Nil. Nil. .3 .37 .39 The following complications occurred in the patients discharged during the year:— Complications present on admission:— Percentage. Adenitis 1 .37 Onychia 4 1.49 Bilateral otorrhoea 1 .37 Bronchitis 1 .37 Vaginitis 1 .37 Albuminuria 1 .37 90 Complications developing after admission:— Adenitis 13 4.86 Onychia 5 1.87 Bilateral Otorrhoea 2 .74 Otorrhoea 10 3.74 Rhinitis 2 .74 Vaginitis 4 1.49 Albuminuria 2 .74 Acute arthritis 1 .37 Mastoiditis and operation 1 .37 Three cases suffered from Chickenpox and 4 from Measles as well as Scarlet Fever. In 14 cases the diagnosis of Scarlet Fever could not be definitely confirmed. Enteric Fever.—16 cases were admitted. Two gave a positive Widal Test for B. Typhosus and 11 gave positive Widal Tests for B. Para-typhoid B. Three gave negative results—one of these proved to be a case of gastro-enteritis, 1 a case of cancer of the colon. Of the 16 persons admitted one was from Epping Institution by arrangement, the cost of maintenance being charged to the Essex Public Assistance Committee. All the patients recovered satisfactorily. Pneumonia.—53 patients were admitted, of whom 5 died (aged 11 months, 4, 41, 60 and 63 years). The following complications occurred:— Pleuritic effusion 1 Nephritis 1 Empyema thoracis 2 Of the 5 deaths, one occurred within 24 hours of admission, one within 2 days, and 3 within 3 days. The patients were admitted during the following months:— Jan. 9, Feb. 7, Mar. 6, April 8, May 3, June 3, July 1, Oct. 1, Nov. 2, Dec. 13. and were in the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 45. 8 12 9 5 6 7 6 91 Puerperal Fever.—3 cases of Puerperal Fever were admitted. All made a good recovery. One case was subsequently admitted to the London Hospital for further treatment for abscess of the leg. Puerperal Pyrexia.—13 cases were admitted. They were due to:—Mastitis (5 cases), Parametritis (2 cases), Pyelitis (2 cases), Phlegmasia alba dolens (1 case), Pyelonephritis (1 case), Incomplete abortion (1 case), Tubercle bacilli in sputum (1 case). All made a good recovery. Diphtheria.—The 119 cases admitted were distributed among the following age groups:— Under 1 yr. 1—5. 5—15. 15—25. 25—35. 35—45. Over 46. — 27 56 17 12 7 — 31 of the above cases did not show, on admission, clinical evidence of diphtheria. Of these 31 cases, 1 proved to be a case of Vincents Angina and avirulent K.L.B. carrier, 1 was a case of Tonsillitis, 1 of septic faucitis, 1 of erysipelas complicated by neck abscess, 1 of streptococcal tonsillitis, 1 of laryngitis, 1 of pneumonia, 1 of double otorrhoea, and 1 of otorrhoea and albuminuria. 4 deaths due to Diphtheria occurred in the Hospital. The ages of the patients were 4 years, 7 years, 7 years, and 7 years. The following complications occurred in the patients discharged during the year:— 7 cases developed Palatal Paresis (2 complicated by streptococcal tonsillitis). Other complications:— Tonsillitis 9 Subcutaneous emphysema, palatal and pharyngeal paralysis 1 Phlebitis and thrombosis of femoral vein 1 Pharyngeal Paralysis 1 Otorrhoea 1 Two cases suffered from Scarlet Fever and one from Measles as well as Diphtheria. 92 Intravenous Therapy.—Fifteen cases were treated with intravenous injections of anti-toxic serum, glucose and insulin. 12 recovered, 2 developed palatal paresis; 1 developed palatal paresis and tonsillitis; 1 developed thrombosis of the femoral vein; 1 developed subcutaneous emphysema, palatal and pharyngeal paralysis; two were cases of haemorrhagic diphtheria (fatal) and one developed cardiac failure (fatal). 1 case suffered from laryngeal diphthera, 6 from nasal diphtheria, and 4 from laryngeal and faucial diphtheria. The operation of tonsillectomy was performed in one case for a persistent carrier condition. 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. 1932. 1933. 1934. 1935. 1936. Ilford 1.28 4.8 8.8 5.7 4.5 Pemphigus Neonatorum.—2 cases were admitted and made a satisfactory recovery. Observation Cases.—Of the B2 cases admitted for observation, four died. They were:— (1) a baby, aged 4 days, who died from convulsions (the child had been admitted with its mother, who was suffering from otitis media following a mastoid operation six months previously). (2) a girl, aged 11 years, admitted as a doubtful case of rheumatism; the case proved to be suffering from septicaemia due to an infection of the blood stream of staphylococcus aureus; death occurred within 48 hours. (3) a man, aged 26 years, admitted as a doubtful case of meningitis; the case proved to be suffering from acute staphylococcal pyaemia; death occurred within 36 hours. (4) a woman, aged 35 years; the case proved to be one of streptococcal septicaemia; death occurred within 24 hours. Tuberculosis.—58 cases of Pulmonary Tuberculosis were admitted, as compared with 49 in 1935. 93 Training of Probationer Nurses.—During 1936, 5 nurses passed Part I of the examination of the General Nursing Council, and 15 obtained the Certificate by completing Part II (11 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 1936, and also the number inoculated:— Numbers Schick Tested:— Staff. Positive 17 Negative 29 Numbers inoculated (full course) 18 Numbers re-tested:— Negative after full course of inoculations 13 Positive after full course of inoculations, and reinoculated — Numbers Dick Tested :— Positive 13 Negative 35 Numbers inoculated (full course) 11 Numbers re-tested:— Negative after full course of inoculations 5 Positive after full course of inoculations, and reinoculated - Two members of the Nursing Staff contracted Scarlet Fever during the year. Isolation Hospital Extensions.— New Mortuary and Garages. The two buildings were erected and completed in 1936 at a total cost of £4,579, excluding the cost of constructing the roads around these blocks and the boundary walls. The Mortuary building comprises the following:—Mortuary, Viewing Room, Visitors' Room, Post Mortem Room and Shell Room. The building is of one storey built of red brick with flat roof. The interior walls are carried out in white glazed tiles with the 94 exception of the Visitors' Room, Shell Room and Corridor adjoining, and the whole of the floors are covered in Red Quarry Tiles. The Mortuary is fitted with a rack with accommodation for six trays. The Post Mortem Room is equipped with white glazed fireclay table, Surgeon's basin, sink and draining board. Two lavatories are provided. The Viewing Room has been so constructed that one body only can be seen at one time. The Garages have accommodation for eight vehicles. At the rear of the building is a repair workshop, store and a covered washdown large enough to take two cars. Lavatories are adjacent. This building is heated from the central boiler house. It is constructed in rustic fletton bricks and has a slated pitched roof over the garages with flat roof over the back portion. The following page shows the plan of the new Garages and Mortuary. 95 BOROUGH.OF. ILFORD ISOLATION. HOSPITAL MORTUARY.&. GARAGE MATERNITY AND CHILD WELFARE 99 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 1936 was 1,896 (1,012 males and 884 females). Of these, 20 (10 males and 10 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 369 notifications of birth (207 males and 162 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, 31 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 23.05 By Certified Midwives 66.14 By Parents and others 10.81 In addition, 50 stillbirths (27 males and 23 females) were notified. In one case (a female) the ordinary place of residence of the parents was outside the district. 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. 100 The causes of the 50 stillbirths which took place in Ilford were as follows:— Anencephalic foetus 2 Ante-partum haemorrhage 2 Asphyxia pallida 1 Atelectasis 1 Breech presentation 7 Congenital abnormality of foetus 1 Craniotomy 1 Difficult labour 4 Failed forceps and internal version 1 Hydrocephalic foetus 3 Induction of labour for disproportion 1 Maternal toxaemia 5 Placenta prævia 2 Precipitate labour 3 Premature separation of placenta 1 Prematurity 4 Pressure on cord 3 Unknown 8 The causes of the 14 stillbirths which took place outside the district, although the parents reside in Ilford, were as follows:— 7 at Oldchurch Hospital, Romford— Anencephalic foetus 1 Congenital abnormality of foetus 1 Hydramnios 1 Hydrocephalic foetus 1 Maternal toxaemia 2 Prematurity 1 3 at Maycroft Nursing Home, Woodford— Anencephalic foetus 1 Unknown 2 1 at Bethnal Green Hospital, E.— Prematurity 1 1 at Charing Cross Hospital, W.C.— Maternal toxaemia 1 1 at Kelvingrove Nursing Home— Placenta praevia 1 1 at Queen Mary's Hospital, Stratford— Maternal toxaemia 1 Where necessary, visits are paid by the Health Visitors to obtain particulars as to the cause of stillbirths. In this connection 24 visits were paid during 1936. Registration Act, 1836. By the Registration Act, 1836, all live births are registered with the Registrar of Births within six weeks. 101 The birth-rate is calculated on the live births registered, and during last year 2,213 (1,182 males and 1,031 females) births were registered, giving a birth-rate of 14.4 per 1,000 persons, calculated an the net population, mid-year 1936, as compared with 2,050 births and a birth-rate of 13.9 per 1,000 persons in 1935. 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 1936, 65 stillbirths (33 males and 32 females) were registered. Of these, 3 males were illegitimate. The figures of 2,213 live births and 65 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 96, the total number born being 2,213. The infant mortality or rate of death per 1,000 live births was, therefore, 43.4. 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 1936 96 43.4 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 44.0 102 The infant mortality rate for 1936 was 59 for England and Wales, 66 for London, and 63 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 1936 43.4 59 66 63 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 The deaths from pneumonia totalled 16, as compared with 8 for 1935. There were 29 deaths of premature infants as compared with 33 in 1935. The following table shows the infant mortality in each ward of the district:— 103 Ward. Sex. No. of Births. No. of Infant Deaths. Infant Mortality Rate per 1,000 live Births. Infant Mortality Rate per 1,000 live Births both sexes together. 1936 1935 1934 Barkingside M. 126 4 31.7 36.6 47.6 – F. 120 5 41.7 North Hainault M. 137 8 58.4 59.0 60.1 25.1 F. 134 8 59.7 Cranbrook M. 69 2 29.0 27.7 35.1 70.6 F. 39 1 25.6 Park M. 72 3 41.7 52,2 83.9 60.7 F. 62 4 64.5 Seven Kings M. 98 3 30.6 38.2 27.1 65.9 F. 85 4 47.1 South Hainault M. 93 9 96.2 57.8 47.9 49.4 F. 99 2 20.2 Loxford M. 116 8 69.0 70.8 49.7 37.4 F. 96 7 72.9 Clementswood M. 133 11 82.7 73.9 63.4 58.8 F. 97 6 61.8 Goodmayes M. 126 8 63.5 43.3 48.3 47.2 F 128 3 23.4 The above table only accounts for 1,830 of the total live births registered and belonging to the district. The remaining 383 are included by the Registrar-General as belonging to Ilford, but have not been allocated by him to the various wards. 30 live births were registered in this district belonging to other areas. These have not been included in the foregoing figures. 1 birth was re-registered, and this is also not included in the above figures. An analysis of the figures in the foregoing table will show that the infant mortality rate has fallen in each ward except Seven Kings, South Hainault, Loxford and Clementswood. 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 9 deaths. 4 died under 1 week. 1 died at 1 month from prematurity. *1 died at 4 months from gastro-enteritis. 1 died at 6 months from congenital abnormality of heart (patent foramen ovale and congenital mitral stenosis). 1 died at 6 months from cardiac failure and acute bronchopneumonia. 1 died at 11 months from generalised septicaemia and erysipelas. 104 In the North Hainault Ward there were 16 deaths. 10 died under 1 week. 1 died at 1 month from broncho-pneumonia and acute bronchitis. *1 died at 1 month from broncho-pneumonia. *1 died at 3 months from cardiac failure and broncho-pneumonia. *1 died at 5 months from broncho-pneumonia. 1 died at 7 months from gastro-enteritis. *1 died at 11 months from colitis and congenital disease of the heart. In the Cranbrook Ward there were 3 deaths. 1 died under 1 week. *1 died at 2 months from marasmus and malnutrition. *1 died at 3 months from marasmus. In the Park Ward there were 7 deaths. 4 died under 1 week. 1 died at 1 month from cardiac failure following inanition and oedema and congestion of the left lung. *1 died at 6 months from abscess of lung and broncho-pneumonia. *1 died at 10 months from gastro-enteritis and broncho-pneumonia with measles. In the Seven Kings Ward there were 7 deaths. 2 died under 1 week. 1 died at 2 weeks from congenital morbus cordis. 1 died at 1 month from septicaemia, meningocoele and spina bifida. 1 died at 1 month from tetany, broncho-pneumonia and whooping cough. 1 died at 8 months from gastro enteritis. *1 died at 11 months from lobar pneumonia. In the South Hainault Ward there were 11 deaths. 7 died under 1 week. 1 died at 1 week from broncho-pneumonia and atelectasis. 1 died at 2 weeks from infantile asthenia and premature birth. 1 died at 2 weeks from marasmus. 1 died at 4 months from acute intussusception and operation. In the Loxford Ward there were 15 deaths. 6 died under 1 week. 1 died at 1 week from convulsions and pyloric obstruction. 1 died at 1 week from marasmus and premature birth. 1 died at 2 weeks from debility and imperforate anus. 1 died at 3 weeks from heart failure and broncho-pneumonia. 1 died at 3 weeks from meningocoele. 1 died at 1 month from portal pyaemia and umbilical sepsis. 1 died at 1 month from broncho-pneumonia. 1 died at 4 months from broncho-pneumonia, bronchitis, cardiac and respiratory failure. *1 died at 4 months from shock following intussusception. 1 died at 2 weeks from infantile asthenia and premature birth 105 In the Clementswood Ward there were 17 deaths. 9 died under 1 week. 1 died at 1 week from prematurity. 1 died at 1 month from broncho-pneumonia. « *1 died at 3 months from congenital heart disease. 1 died at 3 months from gastro-enteritis. *1 died at 3 months from asphyxia from bronchitis. *1 died at 4 months from syncope, tonsillitis, bronchitis and mastoid disease. 1 died at 4 months from gastro-enteritis. 1 died at 11 months from angio-sarcoma in neck. In the Goodmayes Ward there were 11 deaths. 6 died under 1 week. 1 died at 1 month from gastro-enteritis. 1 died at 2 months from cardiac failure and congenital abnormality of heart. *1 died at 2 months from gastro-enteritis. 1 died at 5 months from cardiac failure and lobar pneumonia. *1 died at 9 months from broncho-pneumonia, pertussis and varicella. * These children had attended an Infant Welfare Centre. It will be seen that of the 96 infants who died under one year of age, only 16 had attended infant welfare centres, and in some cases only one attendance was made. 59, 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 9.2 per 1,000, as compared with 169.1 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 16 had attended an infant welfare centre, or, in other words, that 57 per cent. of the deaths of children between one month and one year of age occurred in children who had never attended an infant welfare centre. Neonatal Mortality. The death-rate of infants under four weeks of age is known as the Neonatal Mortality. 106 There were 59 deaths of infants under four weeks of age during 1936, and the rate for the year was 26.7 per 1,000 live births. The deaths of infants under one month increased from 51 during 1935 to 59 during 1936. The following were the causes:— 1935 1936 Bronchitis 1 – Convulsions – 1 Pneumonia – 3 Injury at Birth 1 7 Atelectasis 2 6 Congenital Malformations 9 9 Premature birth 31 28 Atrophy, debility and marasmus – 3 Other causes 7 2 51 59 The rate increased from 24.8 for 1935 to 26.7 for 1936. In the group one month to one year the deaths occurred from the following causes:— 1935 1936 Diphtheria and croup 1 – Erysipelas 1 1 Meningitis (not tuberculous) 1 – Bronchitis 2 2 Pneumonia (all forms) 8 13 Whooping Cough – 1 Enteritis 14 7 Congenital malformations 5 5 Premature birth 2 1 Atrophy, debility and marasmus 3 4 Other causes – 3 37 37 The largest number of deaths occurred in the first 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:— 107  llford. England and Wales. 1936 26.7 – 1935 24.8 30 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 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. 108 Table IV.—Infant Mortality. 1936. Net deaths from stated causes at various ages under one year of age. Cause of Death. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks & under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total Deaths under 1 year  Smallpox .. .. .. .. .. .. .. .. .. .. Chickenpox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 1 .. .. .. 1 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. 1 1 Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. .. Meningitis (not tubercuous) .. .. .. .. .. .. .. .. .. .. Convulsions .. l .. .. 1 .. .. .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. 2 .. .. 2 Pneumonia (all forms) l l .. l 3 4 4 2 3 16 Diarrhœa .. .. .. .. .. .. .. .. .. .. Enteritis .. .. .. .. .. 2 3 2 .. 7 Gastritis .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. Rickets .. .. .. .. .. .. .. .. .. .. Suffocation (overlying) .. .. .. .. .. .. .. .. .. .. Injury at birth 7 .. .. .. 7 .. .. .. .. 7 Atelectasis 6 .. .. .. 6 .. .. .. .. 6 Congenital Malformations 7 .. l l 9 2 1 1 1 14 Premature birth 26 2 .. .. 28 1 .. .. .. 29 Atrophy, Debility and Marasmus .. .. 3 .. 3 3 1 .. .. 7 Other Causes 2 .. .. .. 2 .. 2 .. 1 5 Totals 49 4 4 2 59 13 13 5 6 96 109 Illegitimate Births and Deaths. 55 of the live births registered (24 males and 31 females) were illegitimate, that is 2.5 per cent. of the births registered. Three illegitimate children died under one year of age. The deaths of the 3 illegitimate children occurred as follows:— 1 died at 1 month at the mother's own home from bronchopneumonia; 1 died at 2 months at King George Hospital, Ilford, from marasmus and malnutrition; 1 died at 1 month at Oldchurch Hospital, Romford, from prematurity. The infant mortality rate of illegitimate children was 54.6 per 1,000, compared with the infant mortality rate of 43.1 for legitimate children. The following table shows the death-rate of illegitimate and legitimate infants for the past ten years :— Year. Illegitimate Infants. Legitimate Infants. Live Births. Deaths. Rate per 1,000 Illegitimate Live Births. Live Births. Deaths. Rate per 1,000 Legitimate Live Births. 1936 55 3 55 2,158 93 43 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 Maternal Mortality. The total number of deaths due to childbirth during the year was 4, which gives a maternal mortality rate (i.e., number of deaths per 1,000 live births) of 1.8 (or 1.75 including stillbirths). The causes of the deaths were as follows:— 110 Puerperal Fever:— Confined at and died at own home ; Cardiac failure, pulmonary embolism, sapraemia, child born 18 days previously 1 Other Causes:— Confined at and died in Council Maternity Home, Ilford; General peritonitis; Caesarian section 1 Confined at and died in Oldchurch Hospital, Romford; post partum haemorrhage ; adherent retained placenta 1 Confined at and died in Oldchurch Hospital, Romford, acute myocardial failure in pregnancy with severe disproportion; caesarian section 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:— 111 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. 1936 1 3 2,213 1.8 3.81* 1935 3 4 2,050 3.4 3.94 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 *Revised Table. †Provisional Figure. 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, 1,007 visits being- paid during the year 1936. 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. Six 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 32 foster-mothers each had one child in 112 their care, and 4 foster-mothers each had 2 children in their care. 19 new foster-mothers were registered during the year. The Sanitary Inspectors have visited all the houses which have been reported during the year as accommodating fosterchildren, or where transfers have taken place. In ten houses 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 register on 1st January, 1936 35 Number of foster-children who were notified during 1936 36 Number of foster-children returned to their mothers during 1936 7 Number of foster-children taken off the register for various other reasons during 1936 24 Number of foster-children qn the register on 31st December, 1936 40 Fostbr-Mothbrs. Number of foster-mothers with children on the register on 1st January, 1936 32 Number of persons who became foster-mothers during 1936 19 Number of foster-mothers whose names were taken off the register during 1936 15 Number of foster-mothers with children on the register on the 31st December, 1936 36 Houses Visited by Sanitary Inspectors. Number of houses visited by the Sanitary Inspectors for the purpose of the Act during the year 1936 22 Number of visits made by the Sanitary Inspectors for the purpose of the Act during the year 1936 49 Work of Health Visitors. All live infants notified in the district, or transferred (601 during 1936) 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 an average of two visits are paid annually. In addition, many infants attending the welfare centres are seen more frequently by the Health Visitors. 113 24,008 attendances of children from 1 to 5 years were made at the Welfare Centres in 1936. 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 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 1936 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 2,627 Subsequent visits to children under 1 year of age 7,412 Subsequent visits to children over 1 year of age and under 5 14,523 Visits to expectant mothers 212 Home visits for other reasons 1,650 Total visits paid 26,424 Supervision of Midwives. There are 10 certified midwives resident and practising in the district (apart from those at the Maternity Home and private nursing homes), and 15 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 midwives during 1936:— Medical Help 543 Death of Mother or Child 29 Laying out the Dead 11 Stillbirths 30 Liability to be a source of infection 32 Artificial Feeding 85 730* * Of these, 533 were received from the Ilford Maternity Home. 114 Death of Mother or Child. Twenty-six of the notices received related to infants and three to mothers. The causes of death are embodied in Table IV, Infant Mortality, on page 108, and Maternal Mortality on page 109. Laying out the Dead. Eleven notifications of having laid out a dead body were received. The causes of death were as follows:— Acute influenzal pneumonia; placenta praevia (2 notifications received) 1 Acute yellow atrophy 1 Atelectasis of lungs; Caesarian section 1 General peritonitis; Caesarian section (2 notifications received) 1 Patent foramen ovale; congenital malformation of heart 1 Prematurity 2 Stillborn infants 2 Stillbirths. Thirty notifications were received. The causes of the stillbirths are included in the particulars set out on page 100. Liability to be a Source of Infection. Thirty-two notices were received from midwives after attendance on 29 cases suffering from the following conditions:— Discharging Ear 1 Discharging Eyes 1 Erysipelas 1 Influenzal Pneumonia 1 Mastitis 5 Otitis Media 1 Pemphigus Neonatorum 2 Puerperal Fever 3 Puerperal Pyrexia 11 Scarlet Fever 1 ? Scarlet Fever 1 Stillborn Child 1 29* * 16 of these were received from the Ilford Maternity Home. Compensation. In October, 1936, The Minister of Health sanctioned under Section 1 of the Maternity and Child Welfare Act, 1918, the arrangements made by the Council for the payment of compensation to a midwife whose patient has been recommended by her to an Ante-Natal Clinic and has subsequently been admitted to a Hospital or Home for confinement. The Council have adopted the following conditions suggested by the Minister in connection with the payment of such compensation:— (1) That in each case the patient will be required to confirm the statement that she had engaged the midwife to attend her confinement and had been referred by the midwife to the Clinic. 115 (2) That the Medical Officer of the Clinic will certify that he or she advised the patient to be confined in a Hospital or a Home. (3) That no payment will be made to the midwife where the patient herself has applied to be confined in a Hospital or Home. The Minister has also sanctioned the payment of compensation in cases where a midwife refers a patient to her private medical practitioner, and on his advice the patient is subsequently admitted to a Hospital or Home for confinement. In these cases the Council have adopted the suggestion of the Minister to obtain a certificate from the doctor that he advised the removal of the patient to a Hospital or Home; no payment to be made to the midwife in a case in which the patient had herself applied for admission to the Institution. Claims were received from midwives in respect of two cases who attended the Ante-Natal Clinic at the request of the midwives and on the advice of the doctor were subsequently admitted to the Council's Maternity Home. In both instances 10,/6d. was paid. Payment of Midwife's Fee in Necessitous Cases. The Council paid the whole of the private midwife's fee in 2 instances. A total of £3 0s. 0d. was paid. Artificial Feeding. Eighty-five notifications were received from midwives that it was proposed to substitute artificial feeding for breast feeding. The reasons given were as follows:— Depressed nipples 2 General condition of mother 13 History of previous breast abscess 4 Insufficient breast milk 11 Insufficient lactation; engorged breasts 1 Inverted and cracked nipples 5 Lactation insufficiently established and persistent sore nipples 6 Lactation not established 1 Lactation unsatisfactory 2 Mastitis 5 Mother employed and unable to feed baby 1 No breast milk 4 Persistent sore nipples 12 Persistent vomiting of breast milk 1 Poor quality of milk 1 Premature infant and general condition of mother 1 Premature infant and insufficient lactation 2 Premature infant and lactation not established 1 Pulmonary tuberculosis 1 Refusal of mother to feed baby 1 Retracted nipples 5 Transfer of mother to Hospital 5 Seventy-six of these were received from the Ilford Maternity Home. Inflammation of, or Discharge from, the Eyes of an Infant. Medical aid was sought in 24 instances where the infant was found to 116 have inflamed or discharging eyes. One of the cases was subsequently notified as suffering from Opthalmia 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 (he 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. 128 outfits were supplied in 1936—125 at full cost and 3 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. Supply of Milk to Expectant and Nursing Mothers and for Infants. Under the Regulations of the Ministry of Health, during 1936, 280 families were supplied with cows' milk free, and 110 with dried milk. A total of 23,269 quarts of cows' milk and 2,010 lbs. of dried milk were given free under the Regulations to 76 nursing mothers, 27 expectant mothers and 438 infants. In 1935, 330 families were supplied free with cows' milk, 117 with dried milk and 4 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. 86 ladies were engaged in the work at the end of December, 1936. 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 117 whole or part of their contributions as necessity arose. During 1936, £9 0s. 0d. was saved by 16 mothers. During the year the following attendances were recorded:— Figures for 1935. 1936. Total number of attendances of infants 54,011 53,883 First attendances 2,127 2,239 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 2,994 3,334 First Attendances— Jan. Feb. Mar. Apl. may June July Aug. Sept. Oct. Nov. Dec. 186 178 155 176 188 222 221 189 219 194 159 152 Subsequent Attendances— 4861 4020 4020 4060 4057 4273 4148 3276 5752 4758 4488 3931 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. 1936 53,883 2,239 3,334 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 1,768 699 sessions were held during- the year, the average attendance at each session being 77 mothers with their infants. The following are the figures for each Centre:— 118  Sessions. Average Attendance Downshall 50 100 Seven Kings 49 75 Barkingside 49 141 Goodmayes 49 53 Valentines 49 58 Newbury Park 49 76 Grosvenor Road 49 95 Woodford Avenue 49 101 Park and Cranbrook (morning) 49 76 Park and Cranbrook (afternoon) 49 64 Becontree 49 73 Chadwell 49 51 Ilford Lane (morning) 49 53 Ilford Lane (afternoon) 49 64 Fairlop 12 67 The session of the Downshall Infant Welfare Centre was altered from Monday afternoon to Friday afternoon of each week commencing on the 21st February, and the Goodmayes Centre was transferred from Tuesday morning to Wednesday afternoon of each week as from the 11th March. In order to relieve the congestion of mothers and infants at the Barkingside Infant Welfare Centre a new Centre was held weekly at the Fairlop Temporary School in Fencepiece Road, Barkingside, commencing on Saturday morning, the 10th October. Newbury Park Centre. This Welfare Centre was transferred to the Newbury Hall, situated in Perrymans Farm Road, Newbury Park, adjacent to Newbury Park School, as and from Tuesday, 24th November, 1936. Originally the building was a Methodist Chapel, and has now been adapted for use as a Clinic, with 2 Consulting Rooms, Waiting Hall, Kitchen, Perambulator Shelter and Lavatory accommodation. The Perambulator Shelter situated at the rear of the buildings is reached by means of an open passageway on the north-east side 119 of the premises. From this shelter access can be gained through a short corridor to the Consulting Rooms and Waiting Hall. The Waiting Hall has been provided with a small platform for use in connection with Lectures. Adjoining this Hall is a small Kitchen having facilities for provision of light refreshments, which are transferred from the Kitchen to the Hall through a small Serving Hatch. The Electrical installation has been designed to cover the provision of lighting, heating, cooking and hot water units and the whole of the work was carried out under the supervision of the Borough Electrical Engineer. The conversion of the existing premises and the building of the new Consulting Room was carried out by the Council's Workshops, under the direction of the Borough Engineer. The purchase price of the Hall was £550 and the cost of adaptations of the building (including £199 7s. 2d. for electrical lighting and heating work) was £799 5s. 0d. On the following page will be found a plan of the building. 120 121 Ante-Natal Clinics. The Ante-Natal Clinics were continued during 1936 at the Maternity Home, on Thursday, Friday and Saturday mornings and Tuesday afternoons. Additional Clinics were commenced on Monday, Wednesday, Thursday and Friday afternoons, 10th, 12th, 13th and 14th February respectively. A weekly session is held at Mayesbrook Clinic on Tuesday mornings. The session was altered from Wednesday afternoon to Tuesday morning as from 10th March. The following attendances were recorded at the respective Clinics:— Maternity Home. Mayesbrook Clinic. First attendances 783 184 Subsequent attendances 6,846 1,176 Number of expectant mothers on the rolls on 31st December, 1936 225 77 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. 1936 967 8,989 302 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 All patients entering the Maternity Home and those who are to be attended by the District Midwife, are medically examined at the Ante-Natal Clinic. 122 During the year, 90 cases other than those booked for admission to the Maternity Home and attendance by the District Midwife, were examined at the Clinic. There were 378 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. 33 examinations were made in 1936. The fee is charged to the patient, in accordance with the scale adopted by the Council. Post-Natal Clinic. The Post-Natal Clinic was continued during 1936 at the Maternity Home. The session was altered from Tuesday morning to Monday morning of each week on Monday, 9th March. The following attendances were recorded:— First attendances 105 Subsequent attendances 185 Number on roll on 31st December, 1936 91 Dental Clinic. The Council dentist has continued the dental treatment of expectant and nursing mothers and of children under 5 years of age, 84 half-days being allocated for this purpose in 1936. 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 1936 345 Number of attendances of patients 1090 123 Number of administrations of "general" anaesthetics 347 Number of administrations of " local " anaesthetics 79 Number of fillings and other operations 133 Number of mothers having dentures supplied 62 (including 12 free of charge and 3 at part cost). (b) Treatment of Children under five years of age. Number of patients treated 198 Number of attendances of patients 274 Number of administrations of "general" anaesthetics 207 Number of fillings and other operations 91 The following are the figures for the past five years:— 1932. 1933. 1934. 1935. 1936. Number of mothers treated 155 247 151 220 345 Number of children treated 156 255 220 239 198 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 1936:— (a) Number of children for whom spectacles were prescribed and provided 46 (b) Number of children examined by Oculist for whom spectacles were not prescribed 24 (c) Number of children examined by Oculist wearing spectacles already and the lenses in use did not require changing ... 3 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. Eleven mothers were so treated by the Council Oculist during 1936. 124 Orthopaedic Department. (i) Valentines Clinic—33 sessions were held during 1936, 267 children under five years of age being examined, making 552 attendances. (ii) Mayesbrook Clinic.—12 sessions were held during 1936, 63 children under five years of age being examined, making 132 attendances. The 330 children were found to be suffering from the following defects :— Valentines. Mayesbrook. Rickets 5 — Genu-varum 2 - Genu-valgum 111 31 Outward curvature of tibia 45 4 Congenital calc. valgus 1 1 Deformity of toes 7 — Pes-valgus 19 6 Flat feet 9 1 Other defects 68 20 Totals 267 63 Six children were admitted to the Royal National Orthopaedic Hospital, Country Branch, Stanmore, during the year, suffering from (1) Congenital equino-varus (2 cases), (2) webbed fingers, (3) severe pes planus, (4) amputation of 5th toes, Rt. and Lt., and (5) scoliosis. Five of the children were discharged during the year, and one was still in the Hospital on 31st December. At the Valentines Clinic, 134 children under five years of age were treated by the Masseuse during the year, and 336 attendances were made by these children. She also treated 35 children who made 71 attendances at the Mayesbrook Clinic. 125 Artificial Sunlight Clinic. 50 sessions were held at the Valentines Clinic and 51 at Mayesbrook Clinic. 78 children in all were treated, making 1,021 attendances. The conditions treated were as follows :— Rickets 47 Anaemia, debility or malnutrition 20 Hypotonia 2 Bow-legs 3 Genu-valgum 4 Rt. Spastic Hemiplegia 1 Bronchiectasis 1 Total 78 24 cases were still attending at the end of the year ; of the remainder, three had left the district and in seven cases the parents had discontinued treatment. All the others were discharged from further treatment, having improved. Aural Clinic. The Aural Surgeon attended at 53 afternoon sessions during 1936, and 89 attendances were made by 23 children of pre-school age, 19 being new cases, who were found to be suffering from the following conditions :— 126 Nature of Disease. Still under treatment. Recommended Hospital treatment. Discharged as cured. Discharged as no treatment required. Totals. 1. Acute suppurative otitis media - — 6 - 6 2. Chronic suppurative otitis media due to (i) Tympanic Sepsis - - 2 - 2 (ii) Tympanic sepsis and previous mastoid operation - - 1 - 1 3. Mastoid disease (previous operation) 1 — — - 1 4. Partial deafness due to nerve deafness 1 1 - - 2 5. Rhinitis 1 2 3 6. Rhinitis and septic antra - — — 1 1 7. History of otorrhoea and scarring of membrana tympani - - - 1 1 8. External otitis - — 1 - 1 9. Enlarged or unhealthy tonsils and adenoids -- 4 - - 4 10. Mouth breathing - 1 — - 1 Totals .. 2 7 12 2 23 Two nursing mothers were also seen by the Aural Surgeon. One, a case of Otosclerosis, made seven attendances and was discharged as the condition had much improved. The second, a case of old mastoid disease, attended on one occasion, but no treatment was required. Rheumatism Clinic. A total of 28 sessions were held during the year. Six children, 4 being new cases, made 10 attendances. The following is a summary of the cases treated :— Discharged (no active rheumatic condition) 2 Anaemia, subnormal nutrition or debility 1 Congenital heart disease 1 History of rheumatism for observation 2 Total 6 127 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 £4 7s. 5d. per week per person. Two 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. 207 belts and 12 trusses have been supplied to infants suffering from hernia during the year 1936. 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 37 children under five years of age were treated under the above arrangements, of these 3 were provided free of charge and one at a reduced rate on necessitous grounds. 128 Under the agreement with the King George Hospital eight children were operated on at that hospital for the removal of enlarged tonsils and adenoids. Two of these cases were treated free of charge. Convalescent Home Treatment. By arrangement with the Invalid Children's Aid Association one child under five years of age was sent to a Convalescent Home for a period of weeks. The Council contributed the sum of £1 19s. 6d. towards the child's maintenance. Children Under School Age (Circular 1550 of the Ministry of Health). This circular asked Councils to review their arrangements for supervising the health of young children up to 5 years of age and to inform the Minister of Health of the result of their consideration of this circular. The main points of the Circular were as follows :— (1) the establishment of " toddlers " clinics at the Infant Welfare Centres. (2) the availability of the facilities of the school clinics for young children. (3) provision of day nurseries for the care of young children in areas where a considerable number of mothers go out to work. (4) regular visiting of these children by Health Visitors. The Minister was informed on the 13th October, 1936, as follows :— 129 (1) that the Council proposed to establish two " toddlers " clinics for the medical examination once per annum of children between the ages of 2 and 5 years ; (2) that the following facilities are already provided by this Council for children under 5 years of age, viz. :— (a) Orthopaedic Clinic (including Artificial Sunlight) (b) Aural Clinic (c) Rheumatism Clinic (d) Ophthalmic Clinic (e) Dental Clinic (3) that the Council are of the opinion that the number of mothers in Ilford who are regularly employed away from home does not warrant the establishment of a day nursery; (4) That the average number of visits by Health Visitors to children between the ages of 1 and 5 is 2 per annum. The Minister in a letter dated the 14th January, 1937, informed the Town Clerk that the proposals of the Council under this circular were considered satisfactory. Midwives Act, 1936. (1) The following are the proposals of the Ilford Council under the above Act, which were approved by the Council in December, 1936, and forwarded to the Minister of Health (vide Section 1 (2) ). Midwives Act, 1936. (1) Representations of local organisations.—The Town Clerk reported that, as instructed and after consultation with the Medical Officer of Health, communications had been addressed to local organisations in accordance with the provisions of the Act, and that a copy of the replies received had been circulated to the members of this Sub-Committee ; also submitted circular letter dated the 10th October last, received from the Central Midwives Board, with reference to teaching facilities for pupil-midwives. The Medical Officer of Health submitted a report* giving details of the local requirements for the proper administration of the Act, and we have given 130 instructions for a copy of such report to be circulated to each member of the Maternity and Child Welfare Committee. Arising out of such report— Recommended : That the following proposals be submitted to the Ministry of Health under section 1 of the Midwives Act, 1936 :— (a) Ten midwives to be appointed under the Scheme ; (b) The allocation of such midwives to be as set out hereunder, viz., Barkingside and North Hainault Wards 3 Park and Cranbrook Wards 1 Loxford and Clementswood Wards 3 South Hainault and Seven Kings Wards 2 Goodmayes Ward 1 (2) The salaries and allowances to be paid to such midwives shall be as follows, viz., Annual salary of midwives who are State Registered Nurses .£200 by £10 annually to £250. Annual salary of midwives who are not State Registered Nurses £180 by £5 annually to £220; all midwives to be paid in addition the following allowances :— Uniform £10 per annum. Cycle As Council's Scale. Equipment £3 on appointment, plus £3 per annum for renewals. Telephone Payment of rental and all official calls. (3) The holidays allowed to be 16 days yearly (18 after 5 years); 1 day and 1$ days alternate weeks. (4) A grant to be made to the Salvation Army Mothers' Hospital commensurate with the number of cases attended by them. (5) A Superintendent of Midwives to be appointed at a commencing salary of £300 by £10 to £350 per annum, plus allowances (except cycle) mentioned in (2), and car allowance in accordance with the Council's scale. (6) The fees for the attendance of midwives to be as follows :— (a) As midwives—£2 6 3d. (primipara) £1 14 3d. (multipara) (b) As maternity nurses—£1 15 Od. (primipara) £1 5 Od. (multipara) (the fee in each case to include a maternity outfit) ; the fee of any doctor called in by the midwife under the Act to be assessed according to the existing scale. 131 (7) All midwives shall reside in suitable rooms or flats provided by the Maternity and Child Welfare Committee on a rental basis. We report that the estimated cost of carrying out these proposals for the first year (excluding telephone, but including Council's superannuation contributions and grant to the Salvation Army midwives) will be £2,500, less such fees as are received for attendance on cases. * The following is the report referred to above :— MATERNITY AND CHILD WELFARE (MIDWIVES ACT, 1936) SUBCOMMITTEE, 7th December, 1936. Minimum attendance 14 days (CMB new rule). Number of cases annually in populous districts—100 (70 as midwife, 30 as maternity nurse)—Ministry of Health suggestion. (See reference of Midwives* Institute who state 80 cases as average.) Based on the number of births in Ilford in 1935 attended as under :— (1) Doctor without Midwife 365 (2) Doctor with Midwife 211 (3) Midwife without Doctor 413 989 To meet the Ministry's recommendations, therefore, at least 10 midwives would be required. Their allocation might be as follows :— Barkingside and North Hainault Wards 3 ... (246 births in 1935 under above categories) Park and Cranbrook Wards ... ... 1 ... (117 do. ) Loxford and Clementswood Wards ... 3 ... (242 do. ) South Hainault and Seven Kings Wards 2 ... (220 do. ) Goodmayes Ward ... ... ... ... 1 ... (164 do. ) The Salvation Army Mothers' Hospital informed the Town Clerk that they are definitely prepared to make arrangements for their midwives at Dagenham to attend any confinements either as midwives or maternity nurses within the area bordered by Goodmayes Lane, Green Lane, Bennetts Castle Lane and Longbridge Road, and including these four roads, but that they will be unable to attend any confinements outside this area. These mMwives during the past year attended only 24 cases in Ilford, whereas in 1935 in the area now suggested there were 126 births under the three categories, and it is very doubtful if all patients within such area would be prepared to book one of the Salvation Army's Midwives ; and for this reason one midwife employed by the Council must probably be allocated to the Goodmayes Ward, and assuming that the Salvation Army Midwives will attend at 60 confinements annually that they be made a grant of £120 per year (approximately half of salary and allowance of a Council Midwife). 132 The cost of the above would be as follows :— Salary scale £200 by £10 to £250. (If the scale of Health Visitors' salaries is applied, the Sub-Committee should decide whether the scale should apply to midwives who are not State Registered Nurses). Uniform Allowance £10 per annum. Cycle Allowance £4 10s. per annum. Equipment ,, £3 on appointment + £3 per annum for renewals. Telephone ,, Payments of rentals and all official calls. Holidays 16 days yearly (18 after 5 years), 3-day weekly. A charge for the first year (excluding telephone, but including Council's superannuation contributions and grant to the Salvation Army Midwives) of £2,425, less fees for attendance on cases. At present there are 10 practising Midwives resident in Ilford in the following Wards (excluding Maternity Home Midwives and Midwives at Private Nursing Homes) :— N. Hainault 2 Park 3 Cranbrook .. 1 Loxford 1 S. Hainault 2 Goodmayes 1 A number of midwives resident in Barking (3), Dagenham (7), and East Ham (2) also attend confinements in Ilford. All such midwives must be individually notified of the Council's intention to engage midwives, in addition to a press advertisement. Fees for Attendance of Midwives. (1) As Midwives £2 6 3 (primipara). £1 14 3 (multipara). (2) i4s Maternity Nurses ... £1 15 0 (primipara). £15 0 (multipara). (Fee in each case to include a maternity outfit) The fee of any doctor called in by the midwife under the Midwives Act will be assessed according to the existing scale. Accommodation. It will be necessary for the Committee to rent suitable rooms or flats for the midwives to reside in. (2) Compensation to midwife ceasing practice : One midwife, aged 65 years, voluntarily surrendered her certificate under Section 5 (1) and the/ Council, after enquiries, agreed to pay her compensation in a lump sum to the amount of £121 5s. 6d. Her certificate has been sent to the Central Midwives Board for cancellation. 133 MATERNITY HOME. 48 patients were admitted direct to the Surgical Block ; 22 of these patients were confined therein, 11 were admitted for treatment and subsequently re-admitted to the Ward Blocks for confinement; the other 15 cases were not confined. In addition, 57 other patients were transferred to the Surgical Block from the Ward Blocks after confinement for various reasons. The patients were admitted to the Home from the following wards :— Barkingside 96 North Hainault 104 Cranbrook 32 Park 56 Seven Kings 73 South Hainault 53 Loxford 81 Clementswood 83 Goodmayes 69 82 cases could not be admitted during the year owing to lack of accommodation. At the end of the year 281 cases were booked for future admission to the Home. The average number of patients in the Home per day during During 1936, 647 women were admitted into the Home, as compared with :— 1935 450 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 139 134 1936 was 29.93, and the average length of stay of patients 17.00 days. Of the 647 cases admitted during 1936, 585 were confined in the Ward Blocks of the Home and 22 in the Surgical Block. 40 cases were not confined in the Home for the following reasons :— Transferred to hospital 9 Admitted and subsequently confined at home 5 Admitted for ante-natal treatment and had not been re-admitted for the confinement at the end of year 11 Curettage 3 Dilation and curettage 3 Miscarriages 2 Abortion 1 Pregnancy terminated; hyperemesis 1 Born before arrival at the Home 5 V In 40 of the 607 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 607 confinements there were :— (a) 363 cases of first confinement. (b) 244 cases having their second or subsequent confinement. (c) 40 cases living in 2 rooms or less (27 being first confinements). (d) 145 cases living in 3 rooms (91 being first confinements). Of the 607 cases, 46 women had engaged their own doctor. 21 of these cases were, however, delivered by a midwife, the doctor not being present at the birth. 582 were attended by one of the midwives at the Home. 135 It was necessary to call in a doctor in 308 of the latter cases for the following reasons :— (a) Ante-natal 37 Ante-partum haemorrhage 5 Appendicitis 2 Dilatation and curettage 2 General condition 1 Hyperemesis 2 Rupture of membranes 5 Surgical induction 20 (b) During labour 65 Breech delivery 4 Caesarian section 25 Episiotomy 2 Foetal distress 3 General condition 1 Maternal distress 3 Prolonged labour 22 Retained placenta 3 Uterine inertia 2 (c) After labour 162 Abdominal pain 1 Eclampsia 1 Inverted nipples 1 Mastitis 7 Mental condition 3 Obstetric shock 2 Pain in chest 1 Pain in legs 1 Perineal or vaginal laceration 120 Phlebitis 4 Pneumonia 1 Post-partum haemorrhage 8 Pyrexia 10 Rash 2 (d) For infant 44 Asphyxia 3 Conjunctivitis 11 Convulsions 2 Cyanosis 3 Cystic swelling of lower jaw 1 Feebleness at birth 4 General condition 7 Haemorrhage 1 Persistent vomiting 2 Prematurity 3 Rash 1 Septic spots 6 Forty-one cases were delivered by means of forceps, 8 following surgical induction ; 4 of the infants were stillborn ; and 1 died aged 2 days. In addition, labour was surgically induced in 17 cases; 1 of the infants was stillborn. 136 AThere were 8 deaths of infants in the Ward Blocks of the Home, from the following causes :— Atelectasis ; maternal toxaemia 1 Atelectasis of lungs ; caesarian section 1 Debility ; imperforate anus 1 Haemorrhagic disease of the new born 1 Prematurity (28 weeks) 2 Prematurity (32 weeks) ; twin 1 Prematurity and debility ; maternal toxaemia 1 No deaths occurred amongst infants born in the Surgical Block. The neo-natal death-rate of babies born in the Ward Blocks of the Maternity Home was 1.9 per cent. compared with 2.9 per cent. in the district in general. The death-rate of babies who died before 14 days, born in the Ward Blocks of the Maternity Home, was 1.4 per cent. in 1936 and 1.8 per cent. in 1935. The infant mortality rate of children born in the Ward Blocks of the Maternity Home was 24.2 per 1,000 births, as compared with 50.6 born in their own homes. The figure of 50.6 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. The following table compares the infant mortality rate in the Maternity Home and in the district generally for the past ten years :— Maternity Home. Ward Blocks. District generally. 1930 24.2 60.6 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 52.0 137 The causes of the 20 stillbirths in the Home during 1936 were as follows :— Anencephalic foetus 1 Ante-partum haemorrhage 2 Breech presentation 3 Congenital abnormality of foetus 1 Difficult labour 1 Failed forceps and internal version 1 Induction of labour for disproportion 1 Maternal toxaemia 1 Placenta praevia 2 Prematurit 3 Pressure on cord 1 Unknown 3 6 of these stillbirths occurred in the Surgical Block. The average stillbirth rate for the Ward Blocks of the Maternity Home for the past five years was 3.00 per cent., compared with 3.14 per cent. for births elsewhere in the Ilford district. The rate for 1936 for the Surgical Block was 27.3 per cent. One case was notified as suffering from puerperal fever, and 27 cases as puerperal pyrexia, twelve being removed to the Isolation Hospital. The causes of the pyrexia were due to pyelitis (9 cases), mastitis (6), serum re-action (2), pleurisy with effusion (1), pleurisy (1), T.B. in sputum (1), bilateral thrombosis (1), phlegmasia alba dolens (1), parametritis (1), labial herpes (1), difficult labour (1), miscarriage (1), and incomplete abortion (1). Two cases of ophthalmia neonatorum were notified from the Home. Both cases were due to conjunctivitis. The Consulting Obstetrician or his Deputy made fortnightly visits to the Home until the 10th March, and as from that date visits were made each week. Dr. F. T. Evans was appointed as Consultant Anaesthetist in December, 1936. 138 During the year 48 ordinary visits were made, and 381 patients referred from the Ante-Natal and Post-Natal Clinics were examined. During 1936 80 other cases were visited as follows : To perform Caesarian section operations 35 To perform other operations 27 For consultations 18 The reasons for the 35 Caesarian section operations were as follows :— Ante-partum haemorrhage 1 Disproportionate measurements 10 Extended breech 1 Fibroids 1 Narrow outlet 18 Occipito-posterior position 1 Placenta praevia 1 Toxaemia 2 The twenty-seven other operations were as follows :— Appendectomy 2 Laparotomy 1 Curettage 3 Dilatation and curettage 3 Cauterisation of cervix 3 Cervical diathermy 4 Surgical diathermy 1 Excision of polypi 1 Termination of pregnancy for hyperemesis 1 Carneous mole—evacuation of uterus 1 Secondary repair of perineum 1 Acute retroverted uterus 1 Ante-flexion of uterus 1 External version 1 Internal version for central placenta praevia 1 Manual removal of placenta 1 Manual interference for placenta praevia. 1 The consultations were for the following reasons :— 139 Mastitis 5 Pyrexia 2 Pyelitis 1 Probable caesarian section 1 Post partum haemorrhage 1 High blood pressure and epigastric pain 1 Ante-partum haemorrhage and toxaemia 1 Toxaemia 1 Placenta praevia 1 Threatened labour 1 Head still high following surgical induction 1 Haemorrhage following surgical induction 1 Forceps delivery 1 Three patients died at the Maternity Home from (1) Acute yellow atrophy ; (2) General peritonitis; Caesarian section (emergency case, difficult labour); and (3) Acute influenzal pneumonia; placenta praevia. The latter two cases were confined in the Surgical Block. The maternal mortality rate for the Ward Blocks of the Home for the ten years from 1927—1936 is .84, as compared with the maternal mortality rate in the district generally of 3.3, the rate in each case being calculated on the total live births. Fees.—Until July, 1936, the circumstances of those unable to pay a fee of two guineas per week were inquired into by the Health Visitors, and a fee was decided on by the Medical Officer of Health, special cases being referred to the Maternity and Child Welfare Committee. As from that date, the Council adopted a scale of charges for maintenance and treatment of patients in the Home. The following tables show in extenso the fees which were paid by women admitted to the Home :— (a) Old Rate. Fees Paid per Week. No. of Patients Admitted. Fees Paid per Week. No. of Patients Admitte. Free 3 63/— 3 51- 2 65/— 4 7/6 1 67/6 6 10/- 8 70/— 11 15/- 7 72/6 7 17/6 1 75/- 2 20/— 27 77/6 3 21/- 4 80/- 9 25/— 28 82/6 1 27/6 1 84/- 1 30/- 77 85/- 1 32/6 3 90/- 1 35/- 43 92/6 1 36/— 1 95/- 1 40/- 17 100/- 2 42/- 105 105/- 3 42/6 2 45/- 35 47/6 11 F Fees for whole period 50/- 25 10/- 1 52/6 32 20/- 1 55/— 15 44/- 1 57/6 8 45/— 1 60/— 31 80/- 1 Of the above patients :— (a) 242 paid an additional fee of 15s. to the Council for the services of one of the midwives of the Home. (b) 236 paid a fee of <£1 1s. for the services of the Assistant Medical Officer of Health. (b) New Rate (According to Scale). Fees Paid, per Day. No. of Patients Admitted. Fees Paid per Day. No. of Patients Admitted. 3/- 1 7/6 13 4/- 7 8/- 11 4/6 2 9/- 9 5/- 4 10/- 2 5/6 8 11/- 2 6/- 9 12/- 3 6/6 10 18/- 4 7/- 14 140 141 (a) Twelve paid a fee of £5 5s. for the services of the Consulting Obstetrician. In 56 instances part of the fee was paid by the patient, the remainder being paid by the Council. In 12 instances, the Council paid the whole of the fee. (b) One paid a fee of 7/6d. per week and 3 10/- per week for the maintenance of the baby in the Home apart from its mother. Pupil Midwives.—The work of training Pupil Midwives has continued in a satisfactory manner; eight who were engaged during the year were successful in passing the examination of the Central Midwives Board. Maternity Cases. (a) Queen Mary's Hospital. There has been an arrangement since July, 1923, with the Queen Mary's Hospital, Stratford, for the treatment of maternity cases requiring operative or other treatment which cannot be carried out in the Ilford Maternity Home, and cases which require admission to a maternity home and cannot be dealt with at our own institution, the agreed charge being 7s. per day. This is, of course, subject to accommodation being available. One case was treated during 1936. (b) Oldchurch Hospital. Where no accommodation is available at the Maternity Home an arrangement has been made with the Essex County Council for the admission of those maternity cases to Oldchurch Hospital, on my authorisation, at a charge to the Council of lis. 6d. per day, such cases to be charged in accordance with the scale for the admission of cases to the Council's Maternity Home. Three cases were admitted under this arrangement during 1936. Closure of Home. Owing to a number of cases of mastitis and pemphigus 142 which occurred in mothers and babies at the Maternity Home, and after their discharge, the Home was closed to further admissions from March 17th until April 1st. The whole circumstances were reported to the Ministry of Health, who sent one of their Medical Officers to investigate the matter. The following is the letter received from the Minister of Health, as a result of the enquiry, dated June 23rd, together with my report to the Committee, dated June 29th :— 44 I am directed by the Minister of Health to state that he has had under consideration the report made by Dr. Dorothy Taylor, one of the Medical Officers of the department, after her visit to the Ilford Maternity Home to investigate the recent outbreaks of mastitis in women and of pemphigus and dermatitis in infants at the Home, and to examine the system of administration at the Home. 14 The Minister is advised that the administration of the Home under normal conditions is well performed and that the routine technique and methods are satisfactory. The extension of the accommodation at the beginning of the year, and the consequent changes in administration and additions—to a large extent temporary—to the staff, may have involved some passing disorganisation of services and provided possibilities for an extension of infection which might not have arisen under normal conditions, but the Minister is advised that careful enquiry has not traced responsibility for the outbreaks to any failure of technique or lack of care. 44 The course of the outbreaks suggests, however, that by way of special precaution it would be desirable in the event of any similar outbreak in the future for nasal and throat swabs of the nursing staff to be examined, and that the nurses should wear masks while attending to the mothers' breasts and while giving the infants to the mothers to be fed. 44 The Minister desires me to express his appreciation of the careful efforts which were made by the medical staff, with the assistance of the nursing staff, to investigate the causes of the outbreaks, and of the ready help they afforded his Medical Officer in her investigations." To the Chairman and Members of the Maternity and Child Welfare Committee. Ladies and Gentlemen, It would appear that there is a good deal of misconception with regard to the cases of abscesses of the breast that have occurred at the Ilford Maternity Home, and that there is some idea that these are due to negligence and that they do not occur in other maternity institutions, or elsewhere. It is therefore necessary to state that such cases occurred in Ilford women apart from those that were confined in the Maternity Home, some of these 143 being in another Hospital, while a doctor's wife developed the trouble. Elsewhere outbreaks have occurred at Hospitals in London, Birmingham and as far north as Lanarkshire. The most complete account of such cases has been carried out on those which occurred at the City of London Maternity Hospital, a long-established voluntary hospital of high repute. In April 1935 an account of those cases was given owing to an increased incidence amounting almost to an epidemic. A hundred consecutive cases were described. The maximum number of cases fell during the last two and the first two months of the year, suggesting that an epidemic .factor was at work. The authors of the report stated that they did not find any factor such as ward distribution, nursing personnel, or variations in local treatment by different surgeons, to be significant, in fact, no adequate cause of the cases could be discovered. They stated that the frequency of infection of the breast is probably under-estimated, and that one of the chief reasons for this is that patients pass to surgical care other than that responsible for delivery of the patient. In Ilford the latter did not hold good, as many of the cases were admitted to the Isolation Hospital, and thus enabled a much more complete investigation to be made, although it will be seen that the problem was a most intricate one, intensified by the fact that some of the abscesses did not develop until a month or more after the confinement. The cause of the infection in each case was found to be an organism known as the Staphylococcus Aureus. It has been generally held that a breast abscess is caused by the nipples being sore or cracked and coming in contact with some infected article. It was therefore first necessary to bacteriologically examine such articles at the Maternity Home to be satisfied that the sterilisation of such things as breast binders (which precaution is not taken at all institutions) was effective. All investigations of this kind yielded, however, no positive result. This confirms the results of the City of London Maternity Hospital, where it was considered that the importance of cracked nipples tended to be exaggerated. A complete bacteriological examination, however, of the patients at the Isolation Hospital yielded the important fact that they were carrying the particular organism in their nose or throa^. This discovery caused me, as an additional precaution, to give instructions that the nursing staff at the Maternity Home must wear masks whenever they were in the wards, and not simply when attending to patients. It will be remembered that the Ilford Maternity Home was one of the first to take the precaution of the wearing of masks, and the Ilford Council to supply such masks to independent District Midwives. The next question was to consider how the infection was conveyed from the nose or throat to the breast, and I therefore had throat swabs taken of a number of babies whose mothers showed no evidence of trouble in the breasts. These showed that 40% of the babies who were thus examined were carrying the infecting organism in their throat and an examination of the nose and throat of their mothers showed that they also were carrying the organism. The probable sequence of events is therefore that the mother, carrying the organism in her nose and throat, infected her baby's throat, probably by kissing, and that the baby in turn infected the mother's breast when suckling. 144 As the organism is frequently to be found in the nose or throat, the next question which arose was as to whether the women found carrying the organism entered the Home with the organism already in their nose and throat. In order to clear this point, swabs were taken of a number of women in the later stages of pregnancy. It was found that one-third were carrying the organism in their nose and throat, showing that the infection did not take place primarily in the Maternity Home. It is possible that, as suggested by the Ministry of Health, some cross-infection might occur by patients being moved into other wards with other patients during the alterations at the Home. The fact, however that cases occurred before the moving of the patients took place, and after the additional precaution with masks, shows that this factor was not an important one. The problem remains as to how to prevent the occurrence of these cases. One solution which might be suggested would be to refuse admission to the Home of all cases that showed infection of the nose or throat with the particular organism. This would not only mean a great hardship to many women, but might be valueless, as one negative swab would be of no value and some women might be infected after their admission to the Home from visitors. I consider the better course would be to immunise the women before admission to the Home. A new product has recently been prepared to which I propose to give a trial, although unfortunately no test of immunity such as the Dick and Schick tests for scarlet fever and diphtheria has been yet devised. The question has been raised as to why an isolation block is not provided at the Maternity Home. I should decline to take the responsibility for any such course, as in my opinion it would be a focus of infection for the whole institution. The surgical block is intended for emergency and observation cases only. The dermatitis which affected the babies is due to the same organism as that which affected the mothers, and explicable by the above results. In my opinion, therefore, mastitis must be considered in some cases to act similarly to an infectious disease, the primary infection taking place in the nose and throat, the disease, like other infectious diseases, taking on epidemic proportions when (1) the carrier-rate in the population is high compared with the number of susceptibles, (2) the local or general immunity of the patients is lowered (in some cases the organism was found in the breast milk although no mastitis followed), and (3) the virulence of the organism is increased. It is satisfactory to note that the Ministry of Health, after a very full investigation and with information of all the complaints made, states that careful enquiry has not traced responsibility for the outbreaks to any failure of technique or lack of care. This confirms the high record which the Maternity Home holds. It was first opened in July 1918 and since that date, for the 17 complete years of working, the average death rate of mothers in the Home is 1.03 per 1,000, compared with 3.72 per 1,000 in Ilford excluding the Maternity Home ; and the infant mortality rate of babies born in the Home is 21.5 per 1,000, compared with 52,66 per 1,000 of those in Ilford excluding the Maternity Home. 145 District Midwife. During 1936 the District Midwife attended 158 cases. They were in the following wards:—Barkingside, 17; North Hainault, 22; Cranbrook, 7; Park, 16; Seven Kings, 29; South Hainault, 9; Loxford, 23; Clementswood, 27; Goodmayes, 8. Nine cases were delivered by doctors and 147 by the district midwifery staff, and in two cases the babies were born before the Midwife's arrival. One case was also transferred to Oldchurch Hospital suffering from Puerperal mania. Of the infants born there were 3 stillbirths from the following causes:— A doctor was called in, however, in 35 of the 147 cases delivered by the district midwifery staff for the following reasons :— (a) Ante-natal 3 Albuminuria 1 Ante-partum haemorrhage 1 Thrombosis of vein in leg 1 (b) During labour 7 f Breech delivery 1 Foetal distress 1 Hydrocephalus 1 Maternal distress Prolonged labour 1 Uterine inertia 1 (c) After labour 16 Anaemia 1 Bronchitis 1 Perineal tear 10 Phlebitis 2 Shock 2 (d) For infant 9 Conjunctivitis 3 Feebleness at birth 3 General condition 1 Haemorrhage 1 _ Mastitis 1 146 Hydrocephalic foetus 1 Prematurity 1 Unknown 1 Five infants died from the following causes :— Asphyxia from bronchitis, aged 3 months. Convulsions and cerebral haemorrhage, aged 4 days. Congenital cardiac malformation, aged 3 hours. Melaena neonatorum, aged 4 days. Pulmonary atelectasis, aged 9 hours. Thirteen cases who applied for the services of the District Midwife had to be refused owing to her services being already booked. SCHOOL MEDICAL SERVICE 149 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE There were 18,910 children on the school rolls on December 31st, 1936, compared with 18,920 on the same date in 1935. The number of children in average attendance at school for the period April 1st, 1935, to March 31st, 1936, was 16,415 (or 16,508 including the Open Air School). 7,534 children were examined at routine medical inspections, compared with 7,483 in 1935. 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, 1935 to 31st March, 1936) Blind :— Totally 0.4 0.3 Partially 1.0 0.9 Deaf :— Totally 0.9 0.6 Partially 0.3 0.3 Mentally Defective (educable) 8.6 4.8 Epileptics (Severe) 0.6 0.5 Physically Defective :— (a) Delicate 15.5 9.1 (b) Crippled 10.0 3.5 150 The following table shows a comparison of the incidence of physical defects found at routine school medical inspection in Ilford in 1935 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. 1935. Incidence of Defects per 1,000 under Observation. 1935. board of education. ilford. board of education. ilford. Skin Diseases 9.5 7.75 2.1 5.87 Defects of Vision * 81.7 * 73.1 * 40.4 * 21.2 Squint 7.8 3.6 4.6 1.47 Other Eye Diseases 7.3 5.07 2.3 6.3 Defects of Hearing 2.8 1.87 2.2 2.0 Otitis Media 4.1 1.9 1.2 1.07 Chronic Tonsillitis 19.9 3.6 48.3 39.03 Adenoids 2.7 0.1 3.4 2.4 Chronic Tonsillitis and Adenoids 19.9 4.0 12.6 8.0 Other Defects Nose & Throat 6.5 6.5 7.0 5.07 Defects of Speech 1.1 0.67 2.7 4.9 Organic Heart Disease 1.6 2.5 3.4 3.2 Pulmonary T.B.— (a) Definite 0.1 0.1 0.1 — (b) Suspected 0.4 — 0.6 — Non-Pulmonary Tuberculosis 0.6 — 0.8 5.34 Epilepsy 0.2 — 0.4 0.26 Chorea 0.5 0.26 0.5 1.33 Other Nervous Conditions . . 1.2 1.9 2.0 10.0 Deformities— Rickets 1.4 0.26 2.8 5.34 Spinal 2.5 2.0 2.1 0.1 Other Forms 8.0 39.2 7.6 10.0 • In calculating this figure, the entrants have been left out of account. 151 Table B shows the same figures for Ilford for 1936, those for the country generally not yet being available. TABLE B. Defect. ILFORD. Incidence of defects per 1,000 requiring treatment. 1936. Incidence of defects per 1,000 under observation. 1936. Skin Diseases 6.6 11.4 Defects of Vision 51.5* 29.9* Squint 5.3 3.1 Other Eye Diseases 6.7 3.8 Defects of Hearing 1.3 1.8 Otitis Media 3.3 0.8 Chronic Tonsillitis 2.5 62.8 Adenoids 0.07 2.4 Chronic Tonsillitis and Adenoids 2.9 5.8 Other Nose and Throat 4.4 6.4 Defects of Speech 0.4 6.5 Organic Heart Disease 1.2 3.6 Pulmonary T.B.— (a) Definite. . — — (b) Suspected — 0.13 Non-Pulmonary T.B. 0.3 1.2 Epilepsy 0.13 0.93 Chorea 0.13 0.53 Other Nervous Conditions 0.8 8.1 Deformities— Rickets 0.3 0.3 Spinal 0.8 0.3 Other Forms 24.9 19.4 * In calculating this figure, the entrants have been left out of account. 152 Table showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years) in England and Wales during 1934 and 1935 compared with those in Ilford for 1934 and 1935. The Table also cives 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. 1934 1935 1934 1935 1934 1935 1934 1935 1. Measles 0.8 0.3 0.97 - 3.6 1.4 5.9 — 2. Scarlet Fever 0.2 0.1 0.16 0.1 3.0 1.9 5.9 — 3. Whooping Cough 0.4 0.3 — 0.5 0.8 0.7 — 3.7 4. Diphtheria 0.8 0.7 1.35 0.6 18.7 1.9 32.4 14.8 5. Influenza 1.2 1.6 0.97 1.6 1.1 1.4 — — 6. Tuberculosis 6.5 6.1 6.4 5.8 11.5 11.7 5.9 14.8 7. Rheumatic Fever 0.3 0.2 0.4 0.1 3.8 3.7 — — 8. Bronchitis, Pneumonia and other respiratory diseases 10.5 12.2 10.9 6.1 9.2 8.8 5.9 7.4 9. Meningitis and Nervous system 8.2 8.3 0.97 11.2 8.0 7.7 5.9 3.8 10. Heart Disease 22.9 29.5 23.1 26.6 6.7 7.1 2.9 — 10. Acute and Chronic Nephritis 3.3 3.0 2.28 2.9 2.5 1.9 — 7.4 12. Violence 4.8 4.6 4.8 4.5 10.7 12.8 11.7 25.9 13. Other causes 40.1 33.1 47.7 40.1 20.4 39.0 23.5 22.2 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 * Excludes Meningococcal infections. England and Wales.—The deaths of children of School Age during 1935 represent 2.2 per cent, of the Total Deaths registered (all ages), and during 1934, 2.6 per cent. Ilford.—The deaths of children of School Age during 1935 represent 2.2 per cent, of the Total Deaths registered (all ages), and during 1934 represent 2.7 per cent. 153 1. Staff—Nursing.—Miss M. F. Pittar and Miss W. E. Phebey, Health Visitors and School Nurses, resigned their appointments as from the 30th April and 31st August respectively. Miss K. French and Miss E. G. Parry were appointed to the vacancies, and •commenced duties on the 15th June and 27th August respectively. 2. Co-ordination.—Vide Annual Report, 1920. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. 3. School Premises.—There are 24 schools, with 57 departments, including the open air school. The schools have accommodation for approximately 18,948 scholars, and 18,910 were actually on the rolls on December 31st, 1936. The following are the additions which have taken place in the accommodation at the elementary schools during the year :— Date of School. Opening. Accommodation. Dane Central, Boys 20-4-36 300 Girls 20-4-36 300 The proposed new schools or extensions are as follows:— School. Accommodation. •Eastern Avenue (Aldborough) Middle 480 „ „ „ Lower 480 •Redbridge Middle 300 ,, Lower 300 Clayhall Middle 300 „ Lower 300 Barkingside Roman Catholic (Junior) 230 Barkingside Chadwell Heath Sites being acquired. * 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 408 visits have been made during the year. 154 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 slates : The Authority must provide for the medical inspection of all children in Public Elementary Schools as soon as possible in the twelve months following— (a) their first admission to Public Elementary Schools, and (b) their attaining the age of eight years, and (c) their attaining the age of twelve years. During 1936 the number of visits by the Medical Officers to 57 different departments of 24 schools for the purposes of routine medical inspection was 401. The number of children examined during the year, falling within the above age groups, totalled 7,534 (3,730 boys and 3,804 girls), an increase of 51 over the figures for 1935. 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 1936, 287 such children (150 boys and 137 girls) were examined. 4,457 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 12,278 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. 1936 7,534 287 4,457 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 1,811 155 Routine medical inspection at the Mossford School, Dr. Barnardo's Girls' Village Home, was again carried out by my Department during the year, 270 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. (a) Uncleanliness.—At routine medical inspection 137 children out of a total of 7,534 (or 1.8 per cent.) were found to have nits or vermin in their hair, while 4 (or .53 per cent.) were found to be flea-bitten. (b) Tonsils and Adenoids.—46 children (or .61 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 suspected pulmonary tuberculosis was referred to the Tuberculosis Officer. (d) Skin Disease.—2 cases of Scabies, 6 cases of Impetigo, and 127 cases of other diseases were discovered. (e) External Eye Disease.—40 cases of Blepharitis, i.e., inflamed eyelids, and 5 cases of Conjunctivitis were discovered. (/) Vision.—290 children (or 3.8 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. 44 of these cases saw 6/6 , while the remaining 246 had vision of 6/9 or less, and 303 cases were referred for re-examination at a later date. 79 per cent. of the cases referred for treatment received treatment from the School Oculist. Further particulars of these cases will be found on page 160. 156 (g) Ear Disease and Hearing.—10 children (or .13 per cent, of those examined) were found to be suffering from defective hearing. In addition, 7 out of 31 children found to be suffering from a discharge from the ear, due to an old otitis media, were also deaf. (h) Dental Defects.—295 (or 3.9 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 193, Table IV (Group V). (i) Deformities.—8 children were found to be suffering from slight spinal curvature, and 334 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 1927:— Scarlet Fever. Diphtheria. Measles. Chicken Pox. Whooping Small Pox. Mumps. Cough. 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 — 1936 217 60 1,098 428 187 474 — Disinfection of all the cloakrooms at the public elementary schools was carried out during the Summer vacation. 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 1936. 157 Diphtheria Prevention Clinics.—The following are the particulars showing work carried out at Valentines (47 sessions) and Mayesbrook (53 sessions) Clinics in connection with children of school age during 1936 :— Valentines. Mayesbrook. Primary Schick tested 60 52 Positive 36 30 Negative 24 22 Inoculated (full course) 484 358 Schick + 1935 2 — Schick + 1936 36 30 Not tested 446 328 Negative after full course of inoculation 321 176 Positive after full course of inoculation and re-inoculated 18 5 Awaiting re-test 136 170 Not re-tested after inoculation on account of leaving district, etc. 9 6 Result of final Schick test in 1936 of cases inoculated in 1935: Valentines. Mayesbrook. Positive and re-inoculated 5 1 Negative 116 34 1,044 individual children were treated (629 at Valentines and 415 at Mayesbrook), making 4,890 attendances (2,970 and 1,920 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. Since the first introduction of immunisation against Diphtheria in Ilford in 1929, 3,493 children of school age, and 2,129 children under school age have been immunised. During 1936, 5 Teachers attended for the final Schick Test, with a negative result. These Teachers were immunised in 1935. Measles.—1,098 cases were notified from the schools, compared with 445 in 1935 and 1,053 in 1934. 4 deaths occurred from Measles of children of school age. 158 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 in the 1,098 cases, the following complications occurred :— Tonsillitis 3 Enlarged Cervical Glands 4 Styes 2 Pneumonia 29 Otorrhoea 8 Bronchitis 19 Whooping Cough 7 Blepharitis 4 Chicken-pox 4 Rheumatism 1 Scarlet Fever 1 The two school children suffering from ringworm of scalp received treatment from a private practitioner. 7. Following Up.—This has been carried out in the manner described in my previous reports. During 1936, 4,381 home visits by the Nurses were paid for the purpose, and 4,457 re-examinations of children were carried out by the doctors at school ; 403 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, 3,210 home visits were paid by the Health Visitors in connection with cases of minor infectious disease. Ringworm :— No. of cases at beginning of 1936. No. of cases reported during 1936. Total. Remedied during 1936. No. of cases under observation at end of 1936. Ringworm :— Scalp — 2 2 1 1 Body 1 15 16 15 1 1 17 18 16 2 159 and on Monday, Wednesday and Saturday mornings at the Mayesbrook School Clinic. (a) Minor Ailments.—The attendances during 1936 were as follows:— Valentines. Mayesbrook. Number of individual children seen at the Clinics 1,908 1,443 Number of attendances of children 6,162 4,714 Number of exclusion certificates granted 2,843 1,781 Number of certificates of fitness to attend school granted 1,055 721 The following table shows the conditions dealt with at both the School Clinics during the year:— Malnutrition 4 Uncleanliness:— Head 197 Skin :— Ringworm:— Head — Body 15 Scabies 34 Impetigo 176 Other Diseases (Non-Tuberculous) 455 Eye :— Blepharitis 30 Conjunctivitis 65 Keratitis 2 Defective Vision (excluding Squint) 252 Squint 12 Other conditions 170 Ear :— Defective Hearing 39 Otitis Media 86 Other Ear Diseases 71 Nose and Throat Chronic Tonsillitis only 46 Adenoids only 11 Chronic Tonsillitis and Adenoids 112 Other Conditions 380 Enlarged Cervical Glands (Non-Tuberculous) 13 Defective Speech 4 Teeth—Dental Diseases 66 160 Heart and Circulation:— Anaemia 28 Debility 17 Infectious Diseases :— Scarlet Fever 1 Diphtheria 1 Whooping Cough 33 Mumps 23 Chicken Pox 19 Measles and German Measles 14 Influenza 45 Colds 188 Lungs:— Bronchitis 252 Other Non-Tubercular Diseases — Tuberculosis :— Pulmonary :— Suspected 4 Nervous System :— Chorea 5 Other conditions 118 Deformities :— Spinal Curvature 6 Other forms 100 Minor Injuries 145 Rheumatism 80 Other Defects and Diseases 371 Total number of ailments 3,690 (b) Ophthalmic Department.—During the year 1936, the School Oculist held 244 sessions for the refraction of children suffering from defective vision (158 at Valentines and 86 at Mayesbrook). Full details of the work are given in Table IV, Group II, on page 192. 4,322 attendances (2,741 at Valentines Clinic, 1,581 at Mayesbrook Clinic) were made by 1,583 school children (1,029 at 161 Valentines Clinic, 554 at Mayesbrook Clinic), as compared with 1,202 school children in 1935. 65 of the cases were referred for refraction in 1935. Of the 1,583 cases, 456 were referred from medical inspection, 349 were referred from the School Clinic, 685 were " under observation," cases examined, 92 were re-examined at parents' requests, and 1 case referred by the Director of Education. The 1,583 children were not all suffering- from grave defects of vision. The following table shows the vision in the worst eye, as tested by Snellen's Type :— 6/6 6/9 6/12' 6/18 6/24 6/36 6/60 6/0 551 250 254 205 105 127 69 22 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 1,583 children examined, 1,037 were found to require spectacles, 525 being children who had previously had spectacles and 512 (new cases) by reason of the following defects :— Myopia 37 Myopic Astigmatism 53 Hypermetropia 98 Hypermetropic Astigmatism 179 Mixed Astigmatism 45 Anisometropia 27 Hypermetropia with Squint 73 Total 512 Of the remaining 546 children, (i) 62 were suffering from the following other diseases, and spectacles were not prescribed:— 162 Amblyopia 2 Corneal Ulcers, Nebulae, Conjunctivitis, Blepharitis, etc. 24 Keratitis 2 Chalazion, Hordeolum 7 Optic Atrophy 1 Strabismus 14 Choroiditis 1 Congenital Cataract 2 Detachment of Retina 1 Diphtheritic Paralysis 1 Epiphora 2 Infantile Glaucoma 1 Injury (Burn) 2 Nystagmus 1 Ptosis 1 Total 62 (ii) 130 children were found not to require spectacles, having no refractive error requiring correction. (iii) 297 children were wearing spectacles already and the lenses in use did not require changing. (iv) 57 children were also seen but treatment was not completed owing to the following causes:— Moved out of District 5 Parents objected to treatment or received treatment elsewhere 11 Atropine given for examination early 1937 41 57 Under the Education Committee's scheme 748 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, 517 cases the lenses of spectacles were changed after re-examination or repairs of frames were carried out. 59 pairs of spectacles were provided free of charge and 2 pairs at a reduced rate on necessitous grounds. (c) Orthopaedic Department.— (i) Valentines Clinic.—33 sessions were held during 1936, 465 163 individual children of school age being examined making 789 attendances. (ii) Mayesbrook Clinic.—12 sessions were held during 1936, 226 individual children of school age being examined, making 385 attendances. The 691 children were found to be suffering from the following defects :— Valentines. Mayesbrook. Paralyses :— Infantile paralysis 19 6 Spastic monoplegia 1 — Spastic paraplegia 3 — Spastic hemiplegia 4 — Spastic diplegia 1 — Spinal curvature:— Scoliosis 26 12 Kyphosis 15 12 Slight Kypho-Lordosis 41 15 Congenital equino-varus (club-foot) 5 2 Torticollis (wry-neck) 6 3 Genu valgum (knock-knee) 120 50 Flat feet 31 16 Round shoulders 6 3 Pigeon chest 11 17 Pes valgus 39 24 Old osteomyelitis 1 — Deformity of toe 17 9 Congenital dislocation of hips 3 1 Flat chest 10 4 Depressed sternum 9 1 Hallux valgus 3 2 Other defects 94 49 465 226 13 children of school age were admitted to the country branch of the Royal National Orthopaedic Hospital, at Stanmore, in 1936, suffering from:— (1) Webbed fingers. (2) Exostosis on dorsum of left foot. (3) Multiple septic arthritis. (4) Hammer toe. (5) Genu valgum. (6) Postural kypho-lordosis. (7) Spastic paralysis of left leg. (8) Scoliosis. (9) Congenital dislocation of both hips. (10) Pes cavus (2 cases). (11) Anterior Poliomyelitis (2 cases). 164 10 children were discharged during the year, 4 of whom were admitted during 1935, and 7 were still in the institution on the 31st December, 1936. 8 surgical instruments were supplied to school children during the year. 36 cases were discharged from the Orthopaedic Clinic as cured and 146 cases were discharged but recommended to be kept under observation at school. 16 cases left the district and 47 cases left school or were transferred to private or secondary schools. Of the 146 cases discharged for observation at school, 43 were examined during the year, 19 were found to be permanently cured, in 24 cases the condition was considerably improved and the children are being kept under observation. At Valentines Clinic, 256 individual children of school age were treated by the Masseuse during the year and 2,793 attendances were made by these children. She also treated 140 children, who made 992 attendances at the Mayesbrook Clinic. ' (d) Artificial Sunlight Clinic.—50 sessions were held at Valentines Clinic and 51 at Mayesbrook Clinic. 56 children in all were treated, making 820 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 25 Pulmonary Fibrosis 1 Bronchitis 3 Bronchiectasis 1 Asthma 1 Adenitis 9 Recurrent Boils 3 Other conditions 13 165 23 cases were still attending at the end of the year. Of the remainder, 2 had left the district, 5 left school, and in 3 cases the parent had discontinued treatment. All the others, having improved, were discharged from further treatment. A 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. A Masseuse attends the Mayesbrook Clinic on Tuesday morning and afternoon for orthopaedic treatment and on Wednesday morning for artificial sunlight treatment. A total number of 407 sessions were held by the Masseuse for treatment during 1936 (258 at Valentines Clinic and 149 at Mayesbrook Clinic). (e) Aural Clinic.—This Clinic is held at Valentines Mansion, the Surgeon attending on one afternoon weekly. 53 sessions were held during 1936 and 1,127 attendances were made by 320 children of school age, of whom 224 were 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 Discharged as cured. Discharged as improved. Discharged as no treatment required Discharged as left school. Totals (i) Acute Suppurative Otitis Media 2 - 18 - - - 20 (ii) „ Catarrhal — — 2 — — — 2 (iii) Chronic Suppurative Otitis Media due to :— 1. Tympanic Sepsis 8 1 12 1 — — 22 2. „ „ and Granulations 4 2 3 — — — 9 3. „ „ and previous 10 toid Operation 5 — 2 1 1 1 (iv) Tympanic Sepsis and Rhinitis. . 2 — 2 — — — 4 (v) Mastoid Disease (previous operation). . — — 1 — 3 — 4 (vi) Partial Deafness due to :— 1. Nerve Deafness 1 — — — — — 1 2. Tonsils and Adenoids — 10 — — — — 10 3. Retraction of Membrana Tympani 3 3 4 1 — — 11 4. Scarring — 1 - 1 1 — 3 5. Catarrhal Rhinitis — — 3 — — — 3 6. Wax 1 1 2 — — — 4 7. No apparent disease — — — — 2 — 2 (vii) Other diseases or defects 23 95 43 17 35 2 215 Totals 49 113 92 21 42 3 320 167 (/) Rheumatism Clinic.—The Physician attended 28 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 248 children (105 of these being new cases), made 569 attendances. Of these, 118 were discharged, showing no active rheumatic condition. The remainder were as follows :— History of Rheumatism for observation 38 History of Chorea for observation 7 Rheumatic Carditis 43 Other Forms of Carditis 3 Congenital Heart Disease 6 Rheumatism 14 Chorea 2 Habit Spasm 2 Heart Murmur—Functional 2 Rheumatoid Arthritis 1 Anaemia, Subnormal Nutrition or Debility 12 Number of cases referred to Convalescent Home 13 „ „ „ Heart Home 5 „ „ „ Hospital (In-patients) 1 „ „ „ „ (Tonsils and Adenoids operation) 5 (g) Dental Department.—During the year the Dentists paid 95 visits to the schools for the purpose of inspecting the teeth of children. Until June, 1935, it had been the practice to examine all children from 5 to 11 years of age. Since then Dental Inspection Charts have been divided into two categories:— (i) Children who have reached the age of 8 years and whose parents have not accepted dental treatment. (ii) All other children. New entrants and children in the second category are inspected, together with any in the first category where inspection is requested by the parents. 168 Of 17,738 children inspected by the Dentists (including special cases), 11,547 (or 65 per cent.) were found to require treatment, compared with 7,541 (or 59 per cent.) in 1935; 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. 46.6 per cent. of the cases requiring treatment obtained it at the School Dental Clinic. In 1935, 63.2 per cent.; 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 done. 67 regulation plates were supplied during 1936. 981 visits were made by children to the Dental Clinic for regulation purposes. I he amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the School Dentists :— Age groups (in years). No. inspected. No. referred for treatment. Percentage. 5 2,314 1,651 71.3 6 2,726 1,812 66.4 7 2,968 2,115 71.2 8 2,538 1,798 70.8 9 2,697 1,700 63.0 10 2,247 1,318 58.6 11—12 1,918 1,153 60.6 The following table shows the percentage of acceptances of treatment by the School Dentists in the various departments of the schools during 1936:— 169 School. Department. Number inspected. No. referred for treatment. No. of acceptances of treatment. Percentage of acceptances. Beal Modern Boys 126 63 17 26.98 „ Girls 117 59 25 42.37 Becontree Lower 797 581 267 45.95 „ M. Boys 679 574 254 44.25 „ M. Girls 601 376 225 59.84 „ U. Boys 198 87 28 32.18 „ U. Girls 174 95 18 18.94 Chadwell Middle 325 231 76 32.90 „ Lower 218 143 73 51.05 Christchurch Girls 274 180 85 47.22 „ Boys 265 168 60 35.71 „ Junior 516 369 152 41.19 Cleveland Girls 742 530 191 36.04 „ Boys 738 559 198 35.42 „ Junior 424 303 98 32.34 Dane Central Boys 29 22 13 59.09 „ Girls 38 23 13 56 52 Downshall U. Girls 259 145 70 48,28 „ U. Boys 202 102 30 29.41 „ M. Girls 544 373 176 47.18 „ M. Boys 509 382 187 48.95 „ Junior 712 510 183 35.88 Fairlop U. Boys 48 36 20 55.56 „ U. Girls 38 27 21 77.78 „ Middle 282 168 76 45.24 „ Lower 759 562 179 31.85 Gearies U. Girls 54 24 21 87.50 „ U. Boys 48 22 17 77.27 „ Middle 774 476 314 65.97 „ Junior 975 661 361 54.61 Goodmayes M. Girls 207 141 62 43.97 „ M. Boys 213 134 47 35.07 „ Lower 271 160 63 39.38 Gordon Mixed 365 239 93 38.91 Highlands Girls 304 161 77 47.83 „ Boys 245 195 87 44.61 „ Junior 471 314 162 51.59 Loxford Central Boys 79 68 30 44.12 Mayfield „ Boys 38 25 10 40.00 „ Girls 48 33 25 75.76 The Mount Cent. Girls 78 49 17 34.69 Newbury Park .. Upper 33 24 11 45.83 „ Middle 157 101 33 32.67 „ Lower 416 267 101 37.83 SS. Peter & Paul Upper 216 148 61 41.89 „ Lower 123 70 33 47.14 St. Vincent Mixed 297 164 105 64.03 South Park U. Girls 138 84 30 35.71 „ U. Boys 151 96 36 37.50 „ Middle 606 383 201 52.48 „ Lower 521 348 176 50.57 Uphall Jun. Mixed 169 117 34 29.06 Valentines Mixed 398 205 108 52.68 Woodlands Mixed 298 230 75 32.61 170 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 72 68 24 35.29 Chadwell „ 38 36 20 55.55 Christchurch „ 90 83 49 59.04 Cleveland „ 40 39 16 41.03 Downshall „ 56 55 28 50.91 Fairlop „ 130 130 71 54.62 Gearies „ 83 81 41 50.61 Goodmayes „ 60 60 29 48.33 Gordon „ 21 21 8 38.09 Highlands „ 69 67 40 59.07 Newbury Park . . „ 32 32 17 53.13 SS. Peter & Paul „ 23 22 12 54.54 St. Vincents „ 11 11 4 36.36 South Park „ 67 67 40 59.70 Uphall „ 28 26 16 61.52 Valentines „ 30 29 17 58.62 Woodlands „ 67 67 40 59.07 Totals 917 894 472 52.79 In addition, the Dentist has carried out four complete inspections of the children's teeth at the Open Air School, 383 children being examined, and 114 referred for treatment, 3 received treatment privately, and the remainder have received attention by the School Dentists. The Dentist also made 4 visits for inspection at Mosford School, 525 children being examined, 219 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 193. 171 (h) Treatment of Uncleanliness.—It was found necessary to serve statutory notices under the Education Act, 1921, Section 87, on the parents of 52 children. In 20 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. In March, 1936, the Education Committee decided that reports of second offences be referred to the School Attendance Sub-committee with power to take suitable action. Seven cases were reported in May, of which five were given a final warning, the remaining two were prosecuted on the 15th July, when a maximum fine of 10/- was imposed by the Justices in each case. One of the latter was again reported in September to the Committee, and on the 11th December was again prosecuted and fined 10/-. The School Nurses paid 174 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. 50,536 *1,102 2.3 *69 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 years were as follows :— 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 1936 2.3 172 (i) Other Ailments.—During the past year 119 children have been operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford. 14 children were treated free and 2 at a reduced rate on necessitous grounds. Under the agreement with the King George Hospital, 42 children were operated on at that Hospital for the removal of enlarged tonsils and adenoids, 9 children being treated free on necessitous grounds. In addition to the treatment of tonsils and adenoids, 103 letters were given to Ilford school children, for whom hospital treatment was required, to attend Queen Mary's Hospital. 9. Open-Air School.-—During 1936, 34 children were admitted, 36 ceased attendance, and on the 31st December, 1936, 111 children were on the school roll. Those admitted were recommended for examination from the following sources :— School Medical Officer 27 Director of Education 1 Tuberculosis Officer 2 Orthopaedic Surgeon 2 Others 2 The above 34 children were admitted for the following reasons :— School Medical Officer :— Malnutrition, Anaemia and Debility 13 Recurrent Bronchitis 2 Malnutrition and Bronchial Asthma. 1 Bronchitis and Cervical Adenitis 2 Post Pneumonia, Catarrh and Old Empyema 1 Recurrent Bronchitis, Anaemia and Debility 1 Spastic Diplegia 1 Pulmonary Catarrh 1 Pulmonary Fibrosis 1 Fracture of skull, Old Paralysis of right arm and leg, and unstable gait 1 173 Old Dislocation of both hips and Subnormal Nutrition 1 Infantile Paralysis 1 Recurrent Catarrh and Nervous Debility 1 Director of Education:— Subnormal Nutrition and Debility 1 Tuberculosis Officer:— T.B. Knee (quiescent) 1 T.B. Cervical Adenitis 1 Orthopaedic Surgeon:— Infantile Paralysis 2 Others :— Bronchitis and Asthma 1 Bronchitis and Nasal Catarrh 1 The 36 children not now on the school roll ceased attendance for the following' reasons :— Resumed attendance at ordinary School 18 Left the district 6 Left School—Over age 7 Removed from roll owing to illness 3 Admission to South Essex Technical College 1 Removed from School at parents' request 1 109 of the children discharged since the opening of the school were re-examined at their ordinary schools during 1936, and 102 were found to have maintained their improvement in health, but in 7 cases the children suffered a relapse; 3 of these were re-admitted to the Open Air School, 3 were placed on the waiting list for readmission to the Open Air School but have not yet been admitted, and the remaining 1 is due for further re-examination at an early date. Of the children admitted to the Open Air School since its commencement in 1929, 28 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, 3 in 1935, and 5 in 1936), and 27 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, 9 in 1935, and 6 in 1936). 174 The School Dentist has carried out at the Open Air School four complete inspections of the children's teeth. The following table shows briefly the dental work carried out:— Number of children examined by the School Dentist 383 Number of children referred for treatment 114 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 35 Administration of Cod-liver Oil Emulsion 32 Administration of Malt and Oil, Parrish's Food, etc. 5 To see Oculist 9 Treatment for Otorrhœa, Blepharitis, etc. 10 To see Orthopaedic Surgeon re Remedial Exercises, etc. 11 To see Dentist 16 To attend Rheumatism Clinic 2 To attend Aural Clinic 10 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. (a) During the winter months classes in physical training for 175 men teachers were held at the Beal Modern School under the direction of the Supervising Instructor on one evening per week. (b) An official visit of inspection was made by Major Syson, one of the Board of Education's Inspectors for Physical Training, on 19th February. (c) During the year evening demonstrations in the more modern methods of physical training have been given in several schools in the presence of parents. (d) During the year increased facilities have been made available by the provision of further playing fields and additional apparatus. (e) Further success has been achieved during the year in connection with swimming instruction, the number of certificates awarded being as follows:— Boys. Girls. Preliminary 574 579 Intermediate 261 351 Proficiency 79 78 Advanced 9 9 Totals 923 1,017 The annual gala, organised by the Ilford Schools Swimming Association, was held on the evenings of 8th and 9th October, the function again proving extremely popular and highly successful. The Ilford team in the Inter-District Events had another successful season ; South Park Girls School established a new record by winning the Girls' Championship Award of the Essex County Swimming Association for the fourth year in succession, and the Dane Central Boys' School won the Boys' Championship Award of the same Association. (f) The Cricket, Football and Netball Associations all experienced a very successful year. Several successes were recorded by the Athletics team competing in the Essex County Meeting at the West Ham Stadium in June. (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. 11. Provision of Meals.—The Education (Provision of Meals) Acts, 1906-1914, have not been put into operation in Ilford. 176 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 186.) l1b.—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, 1936, 9,328 children were receiving milk in school. Of this number 234 received it free of charge. During the year 231 children were recommended, on medical grounds, to have milk in school, free if the parents were not in a position to pay for it, and 133 previously recommended were reported to the Director of Education for continuance. 11c.—Supply of Free Cod-Liver Oil Emulsion, Cod-Liver Oil and Malt, etc.—During 1936, 174 necessitous cases were dealt with. 12. School Baths.—Vide Annual Report, 1920. 13. Co-operation of Parents.—During 1936, 7,039 parents, or 93 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. 177 The following is a brief resume of the work done by the Society in Ilford during the past year:— Total number of cases investigated, 32, made up as follows :— (1) Of Neglect 22 (4 reported from the Public Health Department, for neglecting medical advice, and 18 reported from other sources for general neglect.) (2) Ill-treatment cases 4 (3) Other cases 6 64 children (37 boys and 27 girls) were involved, 43 being of school age. In addition to this work, 171 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— 33 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 rceords 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 1936, 16 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:— 178 Deaf or Deaf and Dumb Children.—Recommended special school for Partially Deaf Children 1 Blind Children.—Recommended special school for Blind Children 1 Crippled Children.—Recommended school for Physically Defective Children 2 Delicate Children.—Recommended Residential Open-Air School 9 Epileptic Children.—Recommended Residential Institution for Epileptic Children 3 16 1st. Totally and Partially Blind Children.—There are 5 children so blind that they can only be appropriately taught in a school or class for totally blind children; four are in a certified residential school for the blind. One is attending an Elementary School pending a vacancy in a special Residential School. There are 15 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. 7 of these children are in certified residential schools for the blind or partially blind, 6 cases are awaiting admission to certified residential schools for the blind and partially blind (5 are attending ordinary elementary schools, and 1 at the Girls Village Homes), 1 is attending a private school, and 1 not attending any school being over 14 years of age. 2nd. Totally and Partially Deaf and Dumb Children.—There are 11 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, and are in residential special schools for the deaf. There are 6 children who can appropriately be taught in a school or class for the partially deaf. 1 is in a Convalescent Home, 2 are in a Certified School and 3 are awaiting admission to a special school, and at present attending public elementary schools ; 2 of these are at the Girls Village Homes. 179 3rd. Epileptic Children.—There are 9 children suffering from severe epilepsy, 3 are in certified residential schools for epileptics, 1 attending an ordinary elementary school, 3 at other institutions, and 2 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, being over 14 years of age.) There are 7 children suffering from epilepsy whose disease is of such a kind as not to unfit them for attendance at an ordinary elementary school, 4 are not attending any school, being over 14 years of age. 4th. Tuberculous Children.—There are 5 children notified as suffering from pulmonary tuberculosis; all are active cases, 2 being in a sanatorium, 2 at no school or institution, both being over 14 years of age, and one in a General Hospital. 37 children are on the Tuberculosis Register suffering from non-pulmonary tuberculosis. 21 are at present attending Public Elementary schools; 9 attending the Open-Air School; 6 are not attending any school (1 being over 14 years). 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 151 children who are so delicate as to necessitate open-air school treatment. 94 are in the Ilford Open-Air School and 7 in a special school. 6th. Crippled Children.—There were at the end of the year 58 crippled children (other than those with active tuberculous disease) who are suffering from a degree of crippling sufficiently severe to interfere with the children's normal mode of life ; 7 of these were not attending school (3 being over 14 years of age), 32 were attending public elementary schools, 10 were attending the 180 Benton Open-Air School in Ilford, 7 were attending certified residential cripple schools, 2 at private schools. In addition, there were also 4 children included under the heading " Children suffering from Multiple Defects " ; 3 were mentally defective (feeble-minded) as well as cripples, and 1 was crippled and also suffering from abdominal tuberculosis. 2 of the 4 latter children were attending ordinary elementary schools, 1 not attending any school, and 1 attending a technical school. 7th. Children suffering from severe heart disease. There are 15 children with severe heart disease; 2 are not attending school (1 being over 14); 1 at a certified hospital school; 2 are at the Ilford Open-Air School, and 10 at public elementary schools. In addition, 2 children are included under the heading " Children suffering from Multiple Defects," also mentally defective and are not attending an elementary school, one being over 14 years of age. (b) Mentally Defective Children:— During 1936, 19 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 1936 and recommended for admission to a special school (day or residential) 19 Imbecile Children.—Total number certified in 1936 and recommended for notification to Essex County Council 4 Dull and Backward Children.—Total number certified in 1936 and recommended attendance at special class for dull and backward children for one year, and then to be reexamined 19 The following table shows the mental age (by the Binet Simon tests) and the intelligence quotient of the feeble-minded children examined during 1936. The border-line of mental deficiency is where the intelligence quotient is about 75. 181 Actual age in years. Mental age in years. ligence Quotient. 5.1 2.8 55.0 5.4 3.0 55.0 6.5 2.6 40.0 6.9 4.8 69.0 7.0 — – 7.5 3.6 48.0 8.3 3.6 43.4 8.3 6.4 77.0 9.5 6.1 64.2 9.8 7.0 71.4 10.8 7.8 72.0 11.2 7.8 69.6 12.8 9.4 73.4 13.1 9.4 71.7 13.25 9.6 72.4 14.0 10.5 75.0 14.2 8.0 56.0 14.2 9.2 64.8 14.4 10.0 69.4 (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 13 cases under the age of 16 years known to the department. 6 are in a residential institution and 7 are at home. (2) Imbecilcs.—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. 3 are in a residential institution and 17 are at home. (3) Feeble-minded Children.—Feeble-minded children are those whose mental defectiveness does not amount to imbecility, yet is so pronounced that they are incapable of receiving proper benefit from instruction in an ordinary school. The Authority responsible for the proper instruction of these children is the Ilford 182 Education Authority. There were (at the end of 1936) 80 such cases under the age of 16 years known to me, of whom 34 are attending public elementary schools in the district (3 being in Dr. Barnardo's Girls' Village Homes, Barkingside); 8 attend private schools; 16 are in residential schools, and 22 are not at school (16 being over 14 years of age). All feeble minded 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 1936, it was found that 161 children were employed out of school hours. 155 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 154 „ unfit—certificate not granted 1 The Byelaws made under the Children and Young Persons Act, 1933, came into force on 1st February, 1935. Employment of Children in Entertainments Rules 1933. Seven certificates have been granted during the year by the School Medical Officer. Application for a Licence was made on behalf of a school girl to take part daily in a stage entertainment at approximately the hours of 3, 6, 9 and also some time before 11 o'clock p.m. In this case I was not prepared to certify that she could be employed, in the manner proposed, without prejudice to her health or physical development. 183 The parent appealed to the Board of Education under Section 22 of the Children and Young Persons Act, 1933. The Board issued the Licence for a period of 3 months, the girl to leave the theatre not later than 10.30 p.m. On the expiration of this Licence the parent made application to the Local Authority for a renewal. I was not prepared to grant the certificate for three performances daily. The parent then appealed again to the Board of Education, who, however, refused to grant the Licence. The parent then amended the application to two shows each day. I then examined the girl and issued a certificate permitting her to appear on the stage for the two shows only each day at 5 and 9 p.m. for a period of 3 months. This girl has since attained the age of 14 years. 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 56 Teachers absent through illness 38 Total 94 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 2,762 Second Age Group 2,973 Third Age Group 1,799 Total 7,534 Number of other Routine Inspections Nil 184 B.—Other Inspections. Number of Special Inspections 4,020 Number of Re-Inspections 15,333 Total 19,353 C.—Children found to Require Treatment. Number of individual children found at Routine Medical Inspection to require treatment (excluding Nutrition, Uncleanliness and Dental Diseases):— Group. (1) For defective vision (excluding squint). (2) For all other conditions recorded in Table IIa. (3) Total. (4) Entrants 44 209 215 Second Age Group 135 161 297 Third Age Group 111 132 229 Total (Prescribed Groups) 290 502 741 Other Routine Inspections — — — Grand Total 290 502 741 Note.—No individual child is counted more than once in any column of above Table. 185 Table II. A.—Return of Defects found by Medical Inspection in the Year ended 31st December, 1936. K 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 requiring Treatment. (1) (2) (3) (4) (5) Skin Ringworm : (1) Scalp — — — — (2) Body I — 15 — (3) Scabies 2 — 34 — (4) Impetigo 6 — 176 — (5) Other Diseases (Non-Tuberculous) 41 86 455 1 Total (Heads 1 to 5) 50 86 680 1 Eye (6) Blepharitis 34 6 30 — (7) Conjunctivitis 5 — 65 — (8) Keratitis 1 – 2 – (9) Corneal Opacities – – – — (10) Other Conditions (excluding Defective Vision and Squint 10 22 172 1 Total (Heads 6 to 10) 50 28 269 1 (11) Defective Vision 290 303 252 3 .(12) Squint 40 23 12 – Ear (13) Defective Hearing 10 13 39 — (14) Otitis Media 25 6 86 – (15) Other Ear Diseases 6 19 71 1 Nose and Throat (16) Chronic Tonsillitis only 19 473 46 1 (17) Adenoids only 5 18 11 1 (18) Chronic Tonsillitis and Adenoids 22 44 112 – (19) Other Conditions 33 48 380 5 (20) Enlarged Cervical Glands (Non-Tuberculous 3 102 13 2 (21) Defective Speech 3 49 4 2 Heart and Circulation Heart Disease : (22) Organic 9 27 – — (23) Functional 2 63 – – (24) Anaemia 4 63 28 1 Lungs * (25) Bronchitis 30 178 252 5 (26) Other Non - Tuberculous Diseases 2 8 – 2 Tuberculosis Pulmonary : (27) Definite (28) Suspected — 1 4 — Non-Pulmonary (29) Glands — 4 2 — (30) Bones and Joints — — 2 — (31) Skin — — — — _ (32) Other Forms 2 5 — — Total (Heads 29 to 32) 2 9 4 — Nervous System (33) Epilepsy 1 7 — — (34) Chorea 1 4 5 — (35) Other Conditions 6 61 118 6 Deformities (36) Rickets 2 2 — — (37) Spinal Curvature 6 2 6 — (38) Other Forms 188 146 100 8 (39) Other defects and diseases (excluding Uncleanliness and Dental Diseases) 99 335 1,198 29 Total 908 2,118 3,690 68 186 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 2,762 167 6.04 2,282 82.6 300 10.86 13 0.5 Second Age Group 2,973 312 10.5 2,354 79.2 298 10.0 9 0.3 Third Age Group 1,799 361 20.1 1,293 71.9 143 7.9 2 0.1 Other Routine Inspections – – – – – – – – – Total 7.534 840 11.2 5,929 78.7 741 9.8 24 0.3 Table III. Return of Exceptional Children in the Area on 31st December, 1936. 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 – 1 3 „ „ „ Epileptic 2 1 — 2* 5 „ „ „ Deaf Mute 1 — — — 1 ,, ,, „ Severe Heart — — — 2* 2 Abdominal Tuberculosis & Cripple — — 1 — 1 * One over 14 years of age. 187 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* 1 — — 6 * One over 14 years of age. 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. 7* — 6*† 1* 1* 15 * One over 14 years of age. † One at Girls Village Home. Deaf Children. At Certified Schools for the Deaf. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 11* — — — 11 * Two over 14 years of age. 188 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. 2 — 3* 1 — 6 * 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. 16* 34†‡ 8§ 22|| 80 * Nine over 14 years of age. ‡ Three at Girls' Village Home. † Five over 14 years of age. || Sixteen over 14 years of age. § One at Girls' Village Home. Epileptic Children. (Children suffering from Severe Epilepsy.) At Certified Special Schools. At Public Elementary Schools. At other Institutions. At no School or Institution. Total. 3 1 3 2* 9 * One over 14 years of age. 189 Physically Defective Children. A.—T uberculous 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.) 2* — 1 2† 5 (ii) Children suffering from non-Pulmonary Tuberculosis (This includes all sites other than those shown in (i) above.) 9 21† 1 6* 37 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 101 46 1 3 151 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 32‡ 2 7§|| 58 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 3 10 – 2* 15 * One over 14 years of age. † Two over 14 years of age. § Three over 14 years of age. ‡ Six at Girls' Village Home. || One at Girls' Village Home. 190 Table IIIa. (Form 307 M.) Statement of the Number of Children Notified During the Year Ended 31st December, 1936, by the Local Education Authority to the Local Mental Deficiency Authority. Total Number of Children Notified 8 Analysis of the Above Total. Diagnosis. Boys. Girls. (1) i. Children incapable of receiving benefit or further benefit from instruction in a Special School : (a) Idiots 2 – (b) Imbeciles 2 — (c) Others — — ii. Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives – – (b) Others — 1 (2) Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 2 1 (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 2 191 Table IV.—Return of Defects Treated during the Year ended 31st December, 1936 TREATMENT TABLE Group I.—Minor Ailments (excluding Uncleanliness, for which see Group VI). Disease or Defect. (1) Number of Defects treated or under treatment during the year Under the Authority's Scheme. (2) Otherwise. (3) Total. (4) Skin - Ringworm—Scalp (i) X-Ray Treatment — — — (ii) Other — 2 2 Ringworm—Body 15 — 15 Scabies 32 1 33 Impetigo 176 6 182 Other skin diseases 412 53 465 Minor Eye Defects 274 26 300 (External and other, but excluding cases falling in Group II.) 226 Minor Ear Defects 189 37 Miscellaneous 1,499 319 1,818 (e.g., minor injuries, bruises, sores, chilblains, etc.) Total 2,597 444 3,041 192 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.) 1,521 01 1,612 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 62 7 69 Total 1,583 98 1,681 No. of Children for whom spectacles were :— (a) Prescribed 1,037 81 1,118 (b) Obtained 1,002 105 1,107 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. (4) Total Number treated. (6) Under the Authority's Scheme, in Clinic or Hospital. (1) By Private Practitioner or Hospital, apart from the Authority's Scheme. (2) Total (3) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) (i) (ii) (iii) (iv) 29 345 1 5 155 12 49 3 62 29 50 8 217 41 (i) Tonsils only. (ii) Adenoids only. (iii) Tonsils and adenoids. (iv) Other defects of the nose and throat. 193 Table IV.-—Continued. Group IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme. (1) Otherwise. (2) Total number treated. Residential treatment with education. (i) Residential treatment without education. (ii) Nonresidential treatment at an orthopaedic clinic. (iii) Residential treatment with education. (i) Residential treatment without education. (it) Nonresidential treatment at an orthopaedic clinic. (iii) No. of children treated. 16 — 691 – 1 24 701 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. . 2,314 2,726 2,968 2,538 2,697 2,247 1,918 — — — 17,408 (b) Specials 330 (c) Total (Routine and Specials) 17,738 (2) Number found to require treatment 11,547 (3) Number actually treated 5,380 (4) Attendances made bv children for treatment 13.075 (5) Half-days devoted to Inspection 229 Treatment 1,148 Total 1,377 (6) Fillings Permanent Teeth 5,439 Temporary Teeth 4.875 Total 10,314 (7) Extractions Permanent Teeth 951 Temporary Teeth 8,617 Total 9,568 (8) (a) Administration of general anaesthetics for extractions 2,516 (b) Administrations of local anaesthetics for extractions 1,841 Total 4,357 (9) Other operations Permanent Teeth 3,244 Temporary Teeth 861 Total 4,105 194 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 50,536 (iii) Number of individual children found unclean 1,012* (iv) Number of children cleansed under the arrangements made by the Local Education Authority 20 (v) Number of cases in which legal proceedings were taken:— (а) Under the Education Act, 1921 2 (b) Under School Attendance Bye-laws Nil * In addition 137 children were found unclean at medical inspection and 197 in the School Clinic 196 197 Table V.—Table showing number of Children Med???ly Inspected at various Schools during 1936. 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. Beal Modern — — — — — — — – — 1 9 12 65 69 1 5 2 1 1 – 2 1 80 89 Becontree 123 107 32 29 22 22 112 110 17 12 19 17 10 11 99 89 8 12 2 1 – – 444 410 Chadwell 30 52 13 13 8 10 30 53 11 4 5 7 6 9 34 21 6 6 – – – – 143 175 Christchurch 51 56 12 11 6 9 52 57 9 11 10 4 2 1 16 12 1 1 – — — – 159 162 Cleveland 43 34 14 6 8 14 92 103 17 13 13 14 5 2 – – – – – – – – 192 186 Dane Central — — — — — — — – — — — — 6 5 32 61 1 8 – — – – 39 74 Downshall 116 91 23 29 12 16 116 120 21 23 13 15 13 13 86 74 10 12 1 1 — 411 394 Fairlop 111 87 19 11 19 11 80 81 8 10 14 5 16 11 67 64 15 7 5 7 — 354 294 Gearies 109 82 21 25 4 17 94 82 19 19 15 11 7 7 38 41 3 5 — 1 — – 310 290 Goodmayes 41 47 10 10 5 10 47 52 10 13 9 6 4 2 — — – – – – – – 126 140 Gordon 41 35 8 11 2 5 9 16 — — — — — — — — — — — — — – 60 67 Highlands 46 32 15 10 4 6 57 61 14 4 7 12 2 3 20 18 2 4 – — — – 167 150 Loxford Central — — — — — — — – — — — — 5 — 129 — 14 — 2 — — 150 – Mayfield Central — — — — — — — – — — 2 1 6 4 81 77 10 6 2 1 — – 101 89 Mossford 20 14 4 18 3 12 6 48 1 12 — 22 — 18 — 67 — 19 — 6 — – 34 236 Mount Central — — — — — — — – — — — — — 19 — 128 — 14 — 3 — – – 164 Newbury Park 37 31 2 3 9 2 55 37 9 6 4 1 1 — 44 48 3 6 1 — — — 158 134 Open Air 2 2 2 6 8 14 14 11 11 9 12 10 14 7 6 6 4 3 1 1 — 1 74 70 S.S. Peter and Paul 20 25 5 4 7 6 25 19 8 3 4 4 1 2 33 21 3 3 — — — – 106 87 South Park 103 69 24 34 12 10 86 74 17 9 8 9 3 8 50 63 3 6 1 — — — 307 282 St. Vincent's 8 10 4 4 4 4 17 11 2 5 3 5 – 2 12 10 3 2 — 2 — – 53 55 Uphall 42 26 10 6 6 5 12 9 — — — — – — — — — — — — — — 70 46 Valentines 45 49 10 16 5 6 44 51 2 4 1 2 107 128 Woodlands 52 48 7 11 10 7 16 16 – – – – – – – – – – – – – – 85 82 Total 1040 897 235 257 147 186 964 1011 176 158 148 157 166 193 748 805 88 115 16 23 2 2 3730 3804 Specials. Beal Modern – – – – – – – – – – – – 1 – – 1 – 1 – – – – 1 2 Becontree — — 1 1 – 3 – 2 3 — 2 — — 5 — — — — – — — — 6 11 Chadwell 3 — – 1 1 3 – – 1 – – – – – 1 – – 1 – – – – 6 5 Christchurch – – – – – – – – – – 1 – – – 1 – – – – – – – 22 — Cleveland — — 1 – – – 1 – — 2 — 1 1 — — — — — – – – — 3 3 Dane Central – – – – – – – – – – – 1 – 2 – – – 2 – 1 – – – 6 Downshall – – – 1 – – 2 – – – – – 1 – – – – – – 1 – – 5 2 Fairlop — 2 – 1 – — – 2 1 — 1 — — 1 — — — — – — — — 2 6 Gearies 1 1 1 – 1 – 1 1 1 – – 1 – – – – – – – – – – 5 3 Goodmayes – – – – – – – – – – – – 1 – – – – – – – – – 1 1 Gordon — — 4 1 2 – – – – – – – – – – – – – – – – – 6 1 Highlands – – 2 – 1 – – 1 – 1 – – – – – – – – – – – – 3 2 Loxford Central – – – – – – – – – – – – 1 – – – – – – – – – 1 — Mayfield Central – – – – – – – – – – – – 1 – – – – – – – – – 1 — Mossford – – – – – – – – – – – – – – – – – – – – – – – – Mount Central – – – – – – – – – – – – – 1 – – – 3 – – – – – 4 Newbury Park — — — – – – – – — — 1 — — — — — 1 1 – – — — 2 1 Open Air 1 — 5 2 13 12 17 13 9 13 21 8 20 14 5 7 3 4 – 2 — 1 94 76 S.S. Peter and Paul — — – 1 – – – – — — — — — — 1 — — — – — — — 1 1 South Park – – – – – – – 2 1 1 1 7 – – – – – – – – – – 3 10 St. Vincent's – – – – – 1 – – 1 – 1 – – – – – – – – – – – 2 1 Uphall – – 1 – – – – – – – – – – – – – – – – – – – 1 — Valentines – – – – 1 – – – – – – – – – – – – – – – – – 1 — Woodlands 3 — 1 1 — — — 1 — — — — — — — — — — – – – 4 2 Total 8 3 16 9 19 19 21 22 19 17 28 19 26 23 8 8 5 12 — 4 — 1 150 137 198 199 Table VI. A.—Table Showing ??? Average Heights ???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. 12—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). Beal Modern – – – – – – – – – – – – – – – 9 142 37.6 65 144 35.9 1 153 46.7 2 162 48.9 Becontree 123 109 18.9 32 113 20.5 22 120 22.8 112 123 24.4 17 132 28.5 19 128 27.8 10 136 32.4 99 141 36.4 8 151 43.7 Chadwell 30 113 19.9 13 113 19.9 8 119 21.4 30 127 25.8 11 131 28.5 5 137 30.9 6 140 33.0 34 144 36.5 6 152 45.1 Christchurch 51 109 19.5 12 116 22.3 6 123 24.5 52 127 26.4 9 130 281 10 136 31.3 2 144 36.0 16 145 38.2 1 141 31.4 Cleveland 43 111 19.2 14 115 20.7 8 122 22.7 92 127 26.7 17 131 28.0 13 133 29.5 5 138 32.0 — — — — — — Dane Central — – — — — — — – – – – – – – – – – – 6 136 31.8 32 145 36.5 1 147 36.2 Downshall 116 111 19.2 23 115 20.7 12 120 22.6 116 127 26.3 21 131 28.9 13 136 33.1 13 140 34.4 86 145 380 10 146 37.8 Fairlop 111 110 19.1 19 116 21.4 19 122 23.8 80 127 25.4 8 130 27.3 14 134 30.8 16 143 34.7 67 145 36.4 15 150 39.2 Gearies 109 110 19.2 21 115 20.4 4 118 21.4 94 126 25.6 19 135 31.9 15 130 32.5 7 135 31.3 38 146 36.9 3 148 42.5 Goodmayes 41 112 19.7 10 116 21.1 5 125 24.0 47 128 26.4 10 136 31.3 9 139 32.3 4 144 31.8 — — — – — — Gordon 41 112 19.6 8 116 20.1 2 118 22.5 9 132 28.1 – – – – – – – — — — — — – — — Highlands 46 112 20.3 15 117 21.5 4 124 26.1 57 127 26.4 14 131 28.6 7 135 30.4 2 132 29.1 20 143 37.4 2 142 35.4 Loxford Central — – — — — — — – – – – – – – – – – – 5 141 33.5 129 144 35.1 14 152 41.9 Mayfield Central — — — — — – – – – – – – – – – 2 138 31.0 6 144 36.1 81 148 36.6 10 149 40.9 Mossford 20 107 18.7 4 113 20.5 3 11.9 22.9 6 124 23.6 1 130 28.0 – – – – – – – – – – – — Mount Central – – – – – – – – – – – – – – – – – – – – – – — — — – — Newbury Park 37 110 19.5 2 115 20.9 2 123 21.6 55 129 26.7 9 133 28.4 4 134 29.3 1 142 34.6 44 146 38.4 3 151 37.3 Open Air 2 113 20.2 2 113 19.1 8 120 22.0 14 129 26.8 11 131 28.8 12 136 30.3 14 138 30.1 6 145 37.1 4 160 45.1 S.S. Peter & Paul. . 20 114 20.6 5 117 23.4 7 123 23.9 25 129 26.4 8 131 27.6 4 139 32.5 1 129 25.0 33 145 36.5 3 145 39.3 South Park 103 113 19.8 24 116 20.9 12 124 240 86 128 26.3 17 132 28.4 8 134 29.7 3 144 35.8 50 145 36.5 3 148 40.5 St. Vincent's 8 111 20.2 4 111 17.8 4 121 24.7 17 122 23.3 2 130 28.1 3 130 26.1 – – — 12 144 35.0 3 148 38.7 Uphall 42 109 18.6 10 114 21.0 6 117 21.4 12 124 24.2 – – – – – – — — — — — — — — – Valentines 45 111 19.5 10 116 21.3 5 116 22.1 44 128 27.5 2 125 28.0 1 126 26.0 – – – – – – – – – Woodlands 52 110 191 7 118 221 10 120 22.5 16 127 25.5 – – – – – – — — — — — — — — — Average Heights and Weights of Ilford Children 1040 111 19.4 235 115 20.9 147 121 230 964 127 260 176 132 28.9 148 136 30.7 166 141 34.3 748 145 36.6 88 150 40.8 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.) j Height (In Cms.) Weight (In Klgms.) Height (In Cms.) Weight (In Klgms.) 103 16.6 108 191 114 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 ??? 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. 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). Beal Modern – – – – – – – – – – – – 1 138 33.6 12 141 33.7 69 145 34.0 5 154 45.6 1 157 53.8 Becontree 107 109 18.4 29 113 20.2 22 119 22.2 110 124 24.7 12 130 27.0 17 134 30.5 11 139 32.7 89 142 34.9 12 151 41.9 Chadwell 52 112 18.3 13 111 18.7 10 121 23.2 53 126 25.2 4 131 29.6 7 137 31.1 9 144 38.6 21 149 39.2 6 155 45.9 Christchurch Cleveland 56 34 108 110 18.4 19.0 11 6 114 114 19.6 19.4 9 14 119 123 22.5 23.2 57 103 126 125 22.8 24.6 11 13 129 131 27.0 27.6 4 14 134 137 29.0 31.2 1 2 140 129 32.4 27.3 12 – 145 – 37.2 – 1 – 147 – 33.0 – Dane Central — — — — — — — — — — — — – – – – – — 5 144 331 61 148 39.9 8 153 48.7 Downshall 91 109 18.4 29 113 19.6 16 119 22.2 120 125 24.6 33 130 26.8 15 136 30.4 13 141 31.2 74 148 38.7 12 151 40.4 Fairlop 87 109 18.5 11 114 20.0 11 124 23.4 81 124 24.6 10 133 28.2 5 136 28.6 11 142 35.1 64 147 36.6 7 153 42.8 Gearies 82 109 18.9 25 116 20.9 17 121 23.2 82 126 24.7 19 130 27.5 11 137 32.4 7 142 35.6 41 147 361 5 155 46.8 Goodmayes 47 109 18.3 10 113 20.0 10 120 22.5 52 126 25.6 13 131 28.6 6 136 32.2 2 145 41.2 — — — — — — Gordon 35 110 18.2 11 116 20.5 5 121 21.7 16 128 26.3 – – – – – — — — — — — — — — — Highlands 32 110 19.0 10 113 19.0 6 123 23.9 61 127 25.3 4 132 29.6 12 137 31.5 3 143 37.3 18 155 40.2 4 154 Loxford Central – – – – – – – – – – – – – – – – – – – – – – – – – – – Mayfield Central — — — — — — — — — — — — – – – 1 150 380 4 141 31.7 77 145 38.0 6 155 44.0 Mossford 14 107 18.3 18 112 20.7 12 119 23.9 48 123 24.4 12 132 27.5 22 132 30.2 18 139 34.3 67 147 37.7 19 150 43.4 Mount Central — — — — — — — — — — — — – – — — — – 19 141 33.3 128 148 38.6 14 153 41.7 Newbury Park 31 110 19.3 3 116 21.3 2 125 21.8 37 127 26.0 6 128 25.6 1 134 28.0 — — — 48 142 38.1 6 156 40.0 Open Air 2 96 13.6 6 115 19.9 14 121 22.8 11 121 22.0 9 133 26.1 10 133 28.2 7 145 35.9 6 139 34.1 3 149 35.7 S.S. Peter & Paul 25 111 19.2 4 116 210 6 118 20.2 19 128 25.8 3 132 30.4 4 134 29.1 2 143 36.7 21 151 40.6 3 155 42.4 South Park 69 112 19.4 34 111 19.9 10 121 23.0 74 127 25.4 9 131 26.0 9 137 31.5 8 144 37.6 63 149 38.1 6 152 42.0 S. Vincents 10 108 17.7 4 114 20.0 4 119 21.7 11 123 22.5 5 131 26.9 5 137 291 2 142 32.0 10 149 37.2 2 156 40.2 Uphall 26 109 18.4 6 116 20.1 5 120 21.4 9 125 23.6 – – — — — — — — — — — — — — Valentines 49 110 18.8 16 114 20.5 6 121 23.2 51 127 27.0 4 129 29.2 2 133 27.5 — — — — — — — — — Woodlands 48 109 18.3 11 113 20.1 7 120 21.5 16 125 24.1 — — — — — — — — — — — — — – Average Heights and Weights of Ilford Children 897 109 18.6 257 113 20.1 186 121 22.6 1011 125 24. 158 131 27.4 157 136 30.5 193 142 34.1 805 147 38.1 115 153 42.9 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.) 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.) 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 Table V11.—Summary of Cases of 1nfectious Diseases among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1936. SCHOOLS. Number on Roll. D1SEASES AND CONTACTS. Scarlet Fever. Diphtheria. Measles & German Measles. Chickenpox. Whooping Cough. Mumps. Smallpox. Ringworm. Pneumonia Totals. 1936 Totals. 1935 Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Contacts. Cases. Cases. Cases. Contacts. Cases. Contacts. Beal Modern 631 3 10 1 1 — — 1 — — — 1 — — — — — 6 M 6 12 Becontree 1786 35 46 10 14 76 14 13 2 18 3 43 — — — — — 195 79 137 91 Chadwell 815 15 12 — 1 89 7 60 11 13 2 4 — — — — 2 183 33 91 88 33 Christchurch 735 5 4 4 8 28 4 9 4 16 1 5 — — — — 1 68 21 27 Cleveland 1273 6 4 3 3 26 10 19 3 6 4 10 — — — — — 70 24 191 47 †Dane 563 — 1 1 2 — — — 0 — — — — — — — — 1 5 — — Downshall 2040 48 49 2 0 116 14 75 13 74 11 11 — — — — 1 327 89 241 80 Fanlop 1556 11 12 1 3 104 10 28 23 64 9 2 — — — — — 210 57 181 66 Gearies 1689 17 9 3 9 10 1 38 5 29 1 4 — — — 2 1 104 25 146 16 Goodmayes 693 10 8 3 1 79 15 25 4 29 3 4 — — — — — 150 31 43 15 Gordon 238 1 1 — 1 26 0 15 9 23 4 11 — — — — — 76 17 99 16 Highlands 686 9 5 8 5 121 8 31 7 107 9 3 — — — — — 279 27 304 29 Loxford Central 518 1 1 2 — — 0 — — — — — — — — — — 3 3 8 12 Mayfield Central 643 7 12 — 7 1 1 5 3 — — 3 — — — — — 16 23 12 10 Newbury Park 754 4 4 2 o 29 3 40 8 4 — — — — — — 3 82 20 100 32 Open Air 115 2 2 1 — 1 1 1 — 1 — 2 — — — — — 8 3 — 3 SS. Peter and Paul's 543 1 7 1 — 11 0 3 1 2 1 — — — — — 3 21 11 78 33 8 St. Vincent's 351 2 2 3 3 1 — 7 1 3 — — — — — — — 16 6 9 South Park 1301 10 13 ] 3 131 10 30 14 23 2 54 — — — — 3 252 42 54 25 The Mount Central 464 1 3 — — 1 1 1 — — — 1 — — — — — 4 4 26 10 Uphall 223 — 3 1 — 37 3 4 1 21 5 — — — — — — 63 12 74 10 Valentines 406 4 1 1 1 120 15 7 2 3 — 27 — — — — — 162 19 110 16 Woodlands 295 1 3 — — 91 9 16 0 38 5 9 — — — — — 148 19 45 14 *Mossford (G.V.H.) 592 8 — 5 — — — — — — — — — — — — — 13 9 33 8 * County High — 5 3 3 — — — — — — — — — — — — 1 6 9 #Private — 11 4 4 4 — — — — — — — — — — — — 15 8 593 13 12 Totals 18910 217 219 60 76 1098 132 428 115 474 53 187 — — — 2 15 2481 2102 626 Poliomyelitis : 1 case at Becontree School. 1 case at Chadwell School. 1 case at SS. Peter and Paul's School Para-tyfoid fever : 1 case at Christchurch School. 1 case at Gearies School. 1 case at South Park School. *Notification of minor infectious diseases in these schools are not received. †Ooened on 27th April. 202 SCARLET FEVER Table V111.—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, 1936. SCHOOLS. No. on Roll. Jan. Feb. Mar. April. May. June. July. August. Sept. Oct. Nov. Dec. Total 1936. Totals, 1935. 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. Beal Modern 631 — 1 1 1 — 2 — 1 — 1 — — — — 1 1 — 2 — 1 — — 1 — 3 10 1 8 Becontree 1786 6 6 2 — 2 7 1 — 2 4 1 2 1 9 3 2 3 2 4 2 8 10 2 2 35 46 29 37 Chadwell 815 3 3 3 4 3 — — 2 3 1 i — — — — — 1 — — — 1 — — — 15 12 8 13 Christchurch 735 — — — — 1 — 1 — — — i — — 1 1 — — — — — — — 1 1 5 4 6 2 Cleveland 1273 — — — — — — 1 — 1 — — 1 — — — 1 — — 1 — 3 2 — — 6 4 6 9 *Dane 563 — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 — — Downshall 2040 4 2 5 6 6 9 2 1 2 2 3 5 3 1 2 6 10 11 5 2 2 1 4 3 48 49 21 30 Fairlop 1556 1 4 1 — 1 — — 1 — 0 1 2 1 — — — 2 2 3 1 1 — — — 11 12 20 23 Gearies 1689 1 — 1 — 2 1 2 2 — — 2 — 1 — — 2 1 1 — 3 2 3 — 17 9 12 7 Goodmayes 693 1 1 — — t> 4 — 1 — — 2 — — — 1 — — — — — 1 2 — — 10 8 10 5 Gordon 238 — — — — — — — — — 1 1 — — — — — — — — — — — — — 1 1 2 0 Highlands 686 1 — 2 — 1 — — — — — 1 1 3 2 2 — — 1 — — — — — — 9 5 9 10 Loxford Central 518 — 1 — — — — — — — — — — — — — — — — — — — — 1 1 2 1 Mayfield Central 643 4 — — — — — — — — — — — 1 — — — — — — 2 2 — 2 7 12 6 7 Newburv Park 754 1 — — — — — — — 1 2 — — — — — — — — — — — 1 1 4 4 6 6 Open Air 115 — — — — 1 — — — — 1 — — — — — — — — 1 — — — — 2 2 1 3 SS. Peter and Pauls 543 — — — — — — 1 2 — 1 — — — 2 — — — — — 2 — — — — 1 7 5 . 4 S. Vincent's 351 — — — — — — — — — — — — — — — 2 — — 2 — — — — — 2 2 — — South Park 1301 2 1 — 3 3 2 — 2 — 2 2 2 — — — 1 — — 1 — — — — — 10 13 20 13 The Mount Central 464 — — — — — — — — — — — 2 — — — — — — — — 1 1 — — 1 3 2 5 Uphall 223 — — — 1 — — — — — — — — — — — — — — — — — 1 — — — 3 3 — Valentines 406 — — — — — — — — — — 2 — — — — — — — 1 1 — — 1 — 4 1 3 1 Woodlands 295 — — — — — — — — — — 1 1 v 2 — — — — — — — — — — 1 3 2 2 Mossford (G.V.H.) 592 2 — — — 1 — 1 — 3 — 1 — — — — — — — — — — — — — 8 — 22 — County High — — 1 1 — 2 — 1 — — — — 1 — — — 1 — — 1 — — — — — 5 3 5 3 Private — — — — 2 1 1 1 — — — 1 — 1 — 2 — 3 — — 1 — — — — 11 4 8 4 Totals 18910 26 20 20 19 28 31 11 12 12 18 21 19 12 22 12 16 21 20 19 11 22 21 13 10 217 219 209 195 *Opened on 27th April. 203 D1PHTHER1A. Table 1X.—Summary of Cases of Diphtheria among School Children, and of Contacts of such Cases excluded from School Attendance, during the Year ended the 31st December, 1936 SCHOOLS. No. on Roll. Jan. Feb. March. Apri May. June. July. August. Sept. Oct. Nov. Dec. Totals, ] 936. Totals, 1935. 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. Beal Modern 631 1 1 1 1 2 2 Becontree 1786 2 1 — i — i 1 i i 2 1 3 4 3 1 2 10 14 6 19 Chadwell . 815 1 8 16 13 Christchurch 735 1 i 2 1 1 2 i 3 4 3 8 Cleveland 1273 1 2 3 3 17 13 *Dane 563 1 2 Downshall 2040 2 2 9 16 Fairlop 1556 — 1 i 2 1 3 3 3 9 Gearies 1689 2 2 i o i 1 2 1 9 5 Goodmayes 693 1 i 1 i 3 1 1 6 Gordon 238 1 1 2 Highlands 686 — 1 3 i 1 i 1 i i 1 1 1 8 5 8 11 Loxford Central 518 5 Mayfield Central 643 3 7 3 2 Newbury Park 754 — — 1 1 1 — — — 1 1 2 5 6 Open Air 115 1 SS. Peter and Paul's 543 1 — — — — — — — — — — — — — — — — — — — — 1 3 1 3 S. Vincent's 351 — — — — — — — — — — — — — — — — — 1 1 2 3 1 5 South Park 1301 1 3 2 7 The Mount Central 464 — — — — — — — — — — — — — — — — — — — — — — — — 1 3 Uphal 223 — — — — — — — — — — — — — — — — — — — — — — — — 1 5 4 Valentines 406 1 1 2 3 Woodlands 295 2 5 Mossford (G.V.H.) 592 1 County High 3 m 3 6 Private 4 5 8 Totals 18910 4 10 7 7 6 5 6 8 4 3 3 5 4 1 3 3 9 4 8 13 4 14 2 3 60 76 106 161 •Opened on 27th Aprii. 204 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, 1936. SCHOOLS No. on Roll Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Totals, 1936. > Totals, 1935. 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. Beal Modern 631 — Becontree 1786 18 2 53 9 5 1 76 14 2 3 Chad well 815 4 1 21 — 55 5 8 1 1 89 7 5 1 Christchurch 735 2 1 Cleveland 1273 1 1 •Dane 563 Downshall 2040 19 6 oo Fairlop 1556 4 1 Gearies 1689 — Goodmaves 693 9 Gordon 238 1 — — 14 — 10 1 1 26 Highlands 686 2 — 30 3 87 3 1 1 121 8 6 3 Loxford Central . . 518 Mayfield Central 643 1 1 — — Newburv Park 754 — — 5 2 17 1 1 29 3 33 7 Open Air 115 1 1 1 1 — — 543 1 — — — 1 2 1 1 1 — 4 — — ' — — — — 11 2 4 — S. Vincent's 351 South Park 1301 — — — — 44 4 70 5 17 1 131 10 1 — The Mount Central 464 1 1 1 — Uphall 223 3 1 27 — 6 2 37 3 1 1 Valentines 406 24 3 93 11 3 1 120 15 3 — Woodlands 295 3 1 50 9 28 4 4 — 6 2 91 9 19 3 JMossford (G.V.H.) 592 Totals 8910 14 17 363 36 375 48 153 12 51 8 46 8 10 — — — 1 i 1 1 3 1 i — 1098 132 445 77 •Opened on 27th April. tNotifications of Measles and German Measles in this School are not received. 205 CH1CKENPOX. Table X1.—Summary of Cases of Chickenpox among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended 31st December, 1936. SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Totals, 1936. Totals, 1935. 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. w O ■ o V) c o U Beal Modern 631 1 i 2 2 Becontree 1786 7 — 1 1 — — — — 1 — — — — 3 1 1 — 13 2 23 19 Chadwell 815 21 3 32 6 3 2 1 i 1 1 60 11 11 3 Christchurch 735 2 2 2 — 1 — 2 — — — — — 1 2 — 1 — 9 4 28 7 Cleveland 1273 — — 1 — 1 — 1 2 3 — 5 1 8 19 3 19 3 •Dane 563 — — — — — — — — — — — — — — — 2 — — 2 — Downshall 2040 35 5 5 2 3 — — — 1 — 1 1 1 1 — 2 — 3 1 14 2 9 2 75 13 57 18 Fairlop 1556 3 5 8 8 4 1 — — — • 1 — — — — 1 6 2 2 7 — 3 — 28 23 26 12 Gearies 1689 26 4 2 1 3 — — — — — 1 — — 2 — — — — — 4 — — — 38 5 15 0 Goodmayes 693 3 1 6 — 7 2 — — 3 1 4 1 1 25 4 5 2 Gordon 238 — — — — 3 1 5 3 6 4 — 1 1 15 9 12 4 Highlands 686 — — — — — 2 4 — 2 — 12 4 2 3 — 4 3 1 — 1 — — — 31 7 12 3 Loxford Central . . 518 2 2 Mayfield Central . . 643 1 1 1 — 1 1 2 1 5 3 3 1 Newbury Park 754 19 1 13 5 5 2 1 1 1 — 40 8 21 5 Open Air 115 1 1 1 SS. Peter and Paul's 543 1 1 1 1 3 1 57 26 S. Vincent's 351 — — — — 2 1 — — 2 — 3 — — — — — — — — — — — — 7 1 3 2 South Park 1301 2 2 2 — 3 — 3 1 8 3 3 2 — — — — 1 — 3 4 4 — 1 2 30 14 4 2 The Mount Central 464 1 1 — 2 2 Uphall 223 — — — — — — — — — — 1 — 3 1 — — — — — — — — — — 4 1 1 Valentines 406 2 — 1 — 3 2 — — — — — — — — — — — — — — 1 — — — 7 2 38 4 Woodlands 295 — — 2 — — — — — — — — — 11 2 2 — 1 16 2 12 3 JMossford (G.V.H.) 592 Totals 18910 122 24 77 23 40 14 16 6 28 10 32 4 31 7 9 — ii 13 13 7 34 3 15 4 428 115^^4 122 •Opened on 27th April. J No tifications of Chickenpox in this School are not received. 206 WHOOP1NG COUGH. TABLE X11.—Summary of Cases of Whooping Cough among School Children, School Attendance during the Year ended 31st and of Contacts December, 1936. of such Cases Excluded from SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept. O :t. Nov. Dec. Totals, ^ 1936. ^Totals, 1935. 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. 1 Conts. Beal Modern 631 i — Becontree . . 1786 — — — — 2 5 5 — 5 2 1 1 18 3 69 13 Chadwell 815 1 1 i 10 2 13 3 Christchurch 735 1 — 2 — 3 2 — 1 1 — 3 — 1 — — 16 1 27 5 1273 1 1 — — — 1 2 — — — — 1 1 1 — 6 4 37 5 ♦Dane 563 Downshall 2040 1 2 1 4 — 1 1 3 1 1 19 1 34 4 10 2 74 11 50 6 Fairlop 1556 22 5 9 2 1 1 5 — 9 1 9 — 8 — — — — — — — — 1 — 64 9 12 6 Gearies 1689 — — — — 4 1 9 — 11 1 — — — 1 — — — 2 — 1 — 29 1 7 1 Goodmayes 693 — — 2 — 1 1 — 2 16 1 2 1 5 — 1 29 3 23 2 Gordon 238 — — — — — — — — 1 — 7 — 6 1 8 2 — — 1 1 — — 23 4 16 2 Highlands 686 1 1 15 — 69 1 21 — 1 1 107 2 12 2 Loxford Central . . 518 1 — Mayfield Central 643 Newbury Park 754 o 31 8 Open Air 115 — — — — — — 1 — — — — — — — — — — 1 — 3 — SS. Peter and Paul's 543 1 1 2 1 6 — S. Vincent's 351 4 1 South Park 1301 3 — 6 1 5 1 — — — <> — 2 — — — 5 — 23 2 22 3 The Mount Central 464 1 — Uphall 223 1 — 4 — — 2 — 5 2 9 3 5 24 4 Valentines 406 o 58 9 Woodlands 295 — — — — — 2 5 10 1 19 4 2 38 5 6 1 JMossford (G.V.H.) 592 Totals 18910 24 7 ia 3 7 3 24 — 44 4 65 8 42 7 23 4 32 3 97 3 62 5 35 6 474 53 447 71 ♦Opened on 27th April J Notifications of Whooping Cough in this School are not received. 207 MUMPS. TABLE X111.—Summary of Cases of Mumps among School Children, during the Year ended 31st December, 1936 SCHOOLS. No. on Roll. Jan. Feb. March. April. May. June. July. August. Sept. Oct. Nov. Dec. Totals, 1936. Totals, 1935. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. Cases. Conts. to ■ w V 2 c o 0 co <u U t/j c o U Beal Modern 631 Becontree 1786 i 1 2 1 7 12 7 3 4 4 1 43 8 Chadwell 815 Christchurch 735 — — 1 1 1 _ ' 1 — 1 5 13 Cleveland 1273 — 3 — — 2 2 2 1 10 71 •Dane 563 Downshall 2040 i 1 2 — — —: 4 1 — 2 11 9 Fairlop 1556 i — — — — — — — — 1 2 26 Gearies 1689 Goodmayes 693 Gordon 238 — — — 1 2 — 1 6 — 1 11 5 Highlands 686 — — — — — — — — — — — — — — — — — — — — — — — — Loxford Central . . 518 — — — — — — — — — — — — — — — — — — — — — — — — — — 3 Mavfield Central 643 1 — — — — — — — — — — — — — — — — — — — — — — — — — Newbury Park 754 — — — — — — — — — — — — — — — — — — — — — — — — — — 9 Open Air 115 — — — — — — — — — — — — — — — — — — — — — — — — — — SS. Peter and Paul's 543 — — — — — — — — — — — — — — — — — — — — — — — — — — 5 S. Vincent's 351 — — — — — — — — — — — — — — — — — — — — — — — — — — 1 South Park 1301 — — 15 21 11 — 4 2 1 54 5 The Mount Central 464 1 18 Uphall 223 40 Valentines 406 19 Woodlands 295 1 2 4 JMossford (G.V.H.) 592 Totals 18910 26 — 9 — 28 — 26 — 23 — 27 — 21 — 7 — 13 5 — 1 — 1 — 187 %0 — •Opened on 27th April. J Notifications of Mumps in this School are not received. 208 The Ilford Recorder Ltd., High Road, Ilford