ILF 17 Borough of llford Health Report For the year 1942 A. H. G. BURTON M.D,. B.S., M.R.C.P., D.P M.. D.P.H., Barrister-at-Law. Medical Officer of Health, etc. Ilford Borough Council NOVEMBER, 1941—NOVEMBER, 1942 Alderman Thomas Braithwaite, J.P., E.C.C., Mayor. Alderman Claude Augustus Farman, J.P., E.C.C., Deputy Mayor. Aldermen: Billington, Henry. Braithwaite, Thomas, J.P., E .C.C., Mayor. Clark, Charles William, L.R.A.M. Dane, Frederick Hopper, M.B .E., J.P., C.A., (E.C.C.). Farman, Claude Augustus, J.P., E.C.C., Deputy Mayor. Griggs, Albert Philip, J.P., E.C.C. Pitt, Bertram Sidney John, J.P. (Resigned June, 1942). Smith, Frank Douglas, J.P., C.A. (E.C.C.). Wetton, George John, E.C.C. Young, Alexander, Major, T.D., J.P. Councillors: Barker,John. Bramston, John, E.C.C. Bryan, William Allen Vernon. Chester, Herbert. Collischon, Sidney Walter. Colvin, Gilbert, F.C.I.S. Cooper, Albert Edward. Cropper, Cyril Clifford. Daniels, Russell Stearn Eke, William Benjamin. Elborne, John, M.A. Eves, Charles. (From August, 1942). Fallaize, Mrs. Lilian, J.P. Green, Arthur William, J.P., C.A. (E.C.C.). Gregory, William Sidney. Harding, Alfred Daniel Bartlett. Harding, Mrs. Beatrice Alice Louise Anne. Hess, Philip Jack. (Resigned January, 1942). Hinton, Charles Stanley. Holness, Richard Thomas. Ingham, Edgar Frank. Parfitt, William Arnold. Spencer, William Robert. (From November, 1942). Spiller, Leslie Thomas. (Ceased October, 1942). Taylor, Sidney William. Tyler, George Frederick, F.C.I.I. Westhrop, George William Henry. Woods, Sidney Charles Victor. Wootton, Mrs. Florence Emily, O.B.E. (From February, 1942). WAR EMERGENCY (EXECUTIVE) COMMITTEE NOVEMBER, 1941—NOVEMBER, 1942 Alderman T. Braithwaite, J.P., E.C.C., Mayor. Alderman C. A. Farman, J.P., E.C.C., Deputy Mayor. Alderman F. H. Dane,M.B.E., J.P., C.A. (E.C.C.) Alderman G. J. Wetton, E.C.C. Councillor G. F. Tyler, F.C.I.I. EDUCATION COMMITTEE NOVEMBER, 1941 - NOVEMBER, 1942 Councillor A. W. Green, J.P., C.A. (E.C.C.), Chairman. Councillor R. S. Daniels, Vice-Chairman. Alderman H. Billinoton Alderman T. Braithwaite, J.P., E.C.C., Mayor. Alderman F. H . Dane, M.B.E., J.P., C.A. (E.C.C.), Alderman C. A. Farman, J.P., Councillor Mrs. B. A. L. A. Harding Councillor C. S. Hinton. (From July, 1942). Councillor E. F. Ingham. Councillor W. A. Parfitt. Councillor S. W. Taylor. E.C.C., Deputy Mayor. Alderman B.S.J. Pitt, J. P. (Resigned June, 1942.) Councillor J. Barker Councillor J. Bramston, E.C.C. Councillor W. A. V. Bryan. Councillor G. Colvin, F.C.I.S. Councillor C. C. Cropper. Councillor W. B. Eke. Councillor Mrs. L. Fallaize, J.P. Councillor G. F. Tyler, F.C.I.I. Councillor G. W. H. Westhrop. Councillor S. C. V. Woods. *Mr. P. V. Faning. *Mr. S. P. Lonergan. *Miss H. S. Rich. *Mr. C.J. Ridout. *Mr. W. R. Spencer. (To November, 1942). *Mr. J. J. Taylor, J.P. *Mr. F. R. Masters. *Co-opted Members. OFFICERS OF THE PUBLIC HEALTH SERVICES 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: J. H. Weir, M.D., B.S., B.Hy., D.P.H. (Durham). Assistant Medical Officers of Health: D. M. B. Gross, M.D., Ch.B. (Leeds), M.M.S.A., D.P.H. (Lond.) F. E. O'Connor, B.A., M.B., B.Ch., B.A.O., D.P.H. (T.C. Dub.) L.M. (Rot.) I. Gordon, M.D., Ch.B., D.P.H. (Edin.) M.R.C.P. (Lond.) (In H.M. Forces). A. Collins, M.B., B.Ch., B.A.O. (Cork). Assistant Medical Officer of Health and Resident Medical Officer (Isolation Hospital): S. R. Jamieson, M.D., Ch.B., D.P.H. (Glas.). Resident Medical Officer (Maternity Home): K. R. Barker, M.R.C.S., L.R.C.P. Senior Dental Surgeon: M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Assistant Dental Surgeons: A. G. Clark, L.D.S., R.C.S. (Eng.) (In H.M. Forces). Mrs. G. M. Shalders, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital: Miss I. Millar. Matron of Maternity Home: Miss M. E. Roberts. Senior Sanitary Inspector: T. V. Haigh, Mem. Roy. San. Inst. Deputy Senior Sanitary Inspector: S. R. Daly, D.P.A. (Lond.), Mem. Roy. San. Inst. Sanitary Inspectors: S. G. Rackham. P. W. English. A. C. R. Neale. G. W. Newman. R. E. Smalley. T. F. Johnson. Chief Administrative Clerk: F. J. Hocking. Superintendent of Council's Midwives: Miss C. Blockley. Officers of the Public Health Services—continued Health Visitors and School Nurses: Miss A. Batten. Miss O. Bell. Miss M. G. Bennett. Miss B. C. Blackley. Miss A. L. Drinkwater. Miss M. Graham. Miss F. S. Leader. Miss I. L. Mobbs. Mrs. M. D. Smith. Miss D. M. Whitmarsh. Ante-Natal Clinic Nurse: Mrs. D. W. Quick. Part Time:— Consulting Obstetrician (Maternity Home and Puerperal Pyrexia Regulations): R. L. Dodds, M.Ch., F.R.C.S., F.R.C.O.G. (in H.M. Forces). Consulting Anaesthetist: Frankis T. Evans, M.B., B.S., D.A. Surgeon in charge of Orthopaedic Clinic: J. A. McLauchlan, M.D., F.R.C.S. Oculist: H. D. Smart, M.D., B.S. Surgeon in charge of Aural Clinic: C. Keogh, F.R.C.S. Physician in charge of Rheumatism Clinic: K. Playfair, M.A., M.B., M.R.C.P. Temporary Medical Officer for A.R.P. Casualty Service R. M. Noordin, M.R.C.S., L.R.C.P. Veterinary Surgeon: Ralph Bennett, F.R.C.V.S. Public Analysts: Bernard Dyer, D.Sc., F.I.C. Georoe Taylor, F.I.C. J. Hubert Hamence, M.Sc., Ph.D. Masseuse: Mrs. C. I. V. Curry, C.S.M.M.G. (M.). PREFACE. Public Health Offices, Ilford. October, 1943. Mr. Mayor, Ladies and Gentlemen, I herewith submit the Annual Report required by the Ministry of Health and Board of Education. It is limited in scope to mainly statistical figures. There are, however, two records to which I would call the Council's attention. (1) No death occurred from diphtheria. This is the first year since any Annual Report was published in Ilford (in 1900) that such has been the case. A study of the figures will show that only 7 children attending Ilford schools were notified as suffering from diphtheria. In 1929, 305 cases of diphtheria were notified, 210 of which were among children of school age. Immunisation against diphtheria cannot be considered to be the only factor at work to produce such a remarkable result, since it is necessary for two-thirds of the children of school age, and at least one-third of the children under school age to be immunised to eliminate the possibilities of an epidemic, but it is difficult to believe that its effect has not been very considerable. As I pointed out in my Report for 1930, although there are other epidemiological factors which must be taken into account, the effect of immunisation, by providing a mass of insusceptible children, is a considerable agent in producing the results achieved. I made that remark in connection with the outbreaks of diphtheria which were occurring in the Becontree and Goodmayes area of the town, and I showed in that Report that by a considerable amount of immunisation the number of cases in the Becontree and Goodmayes schools had been reduced by nine-tenths for the months when diphtheria was most prevalent, while the number of cases of diphtheria in the other schools had not been appreciably diminished; also that the number of cases of diphtheria in the Goodmayes Ward was less than one-seventh of what it was in the corresponding period of October, 1929, to February, 1930, although the number of cases of diphtheria in Ilford was much the same. I first recommended immunisation to the Council in a report which I presented in December. 1927. Application to the Ministry of Health was made for approval; the Ministry of Health replied that as under the existing law this is held to be outside the normal functions of a sanitary authority, the Minister would be prepared to give his formal sanction under Section 133 of the Public Health Act, 1875; further, that no part of the expenditure incurred in connection with the scheme would be eligible for grant under the Maternity and Child Welfare regulations. The Ministry of Health has travelled far since those days, and has been of considerable service to local authorities by its broadcasts and other propaganda. The work of the Diphtheria Clinics for 1942 is summarised on page 24. (2) The infant mortality rate is the lowest on record, reaching the low figure of 30.6, and compares with the rate of 49 for England and Wales, and 60 for the L.C.C. area. The birth rate has risen from 13.3 to 17.2, and is a factor in the reduction of the infant mortality rate. As regards other infectious diseases, it will be seen that such diseases as scarlet fever, measles and chicken pox, over which we have little or no means of control, have been very prevalent. The incidence of scarlet fever has been such that it has only been with great difficulty that I have been able to allow the Essex County Council the use of the extra beds for advanced pulmonary tuberculosis cases. If it were not for the modern treatment of scarlet fever, by which such cases can be discharged in half the previous period, serious difficulties would have occurred. The Isolation Hospital has admitted more cases than ever before in its history, the variety of admissions being seen from the table on page 30. 6 The Maternity Home has, owing to the difficulties in obtaining staff which I have referred to in previous reports, been unable to admit many mothers who have desired admission there. I am hoping that with it becoming a Part I Training School, some of these staff difficulties may be removed, but I cannot say that I am impressed with the value of the Rushcliffe Committee Report, accompanied as it has been by the recognition of the partly trained "Assistant Nurse" as a member of the nursing profession. The medical treatment of school children at the various Clinics has been carried out under the most adverse conditions, upon which I have reported to the Education Committee, and for which I hope they will be able to obtain a remedy before long. The efficacy of immunisation is shown at the Camp Schools, where no case of scarlet fever or diphtheria occurred during the year. No doubt the large amount of food which was surrendered as unsound will be noticed. It is the largest amount which I have ever had to deal with, and is of course due to the difficulties of sea transport. A good deal has been said about the stubborn good health of the British people in war time. It is well, however, to bear in mind that we have not been afflicted by an outbreak of influenza. If we are fortunate enough to escape such an outbreak, no doubt the vital statistics of the nation will remain good. Those, however, who remember the disastrous outbreak which occurred in the last phases of the last war, and the following year, will realise that it is too early to boast of our good health. Unfortunately no satisfactory means has been found to immunise against influenza, and if it breaks out in a pandemic form, little can be done to prevent its spread. The work of the staff has been carried out with loyalty and efficiency. I have again to thank the members of the Council for their continued support, and I have the honour to be Your obedient Servant, A. H. G. BURTON, Medical Officer of Health. 7 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land 8,402 Inland Water 26 Tidal Water 7 8,435 Number of inhabited houses (end of 1942) according to Rate Books 44,500 (approx.) Rateable Value—October 1st, 1942 (Houses and Land) £1,560,092 Sum represented by a penny rate, October 1st, 1942 £6,000 Education Rate— 1941-42 1942-43 Elementary 2s.4.39d. 2s.4.50d. in the £ in the £ Higher (County) 0s.ll.41d. 0s. 10.83d. in the £ in the £ ,, (Ilford Council) 0s.0.07d. 0s. 0.07d. in the £ in the £ Combined Rate (all services) 13s. l1d. 13s. 8d. in the £ in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— (a) Number of unemployed males at end of 1941 287 ,, ,, ,, ,, 1942 158 (b) Number of unemployed females at end of 1941 305 ,, ,, ,, ,, 1942 168 Total M. F. 1942 1941 Live Births Legitimate 2,330 1,236 1,094 Birth Rate per 1,000 of the estimated resident population 17.2 13.3 Illegitimate 85 36 49 Still Births 78 46 32 Rate per 1,000 total (live and still) births 31.3 35.6 Deaths 1,486 763 723 Death Rate per 1,000 of the estimated resident population 10.6 11.9 Percentage of total deaths occurring in public institutions. 39.5 61.7 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List):— Deaths, Rate per 1,000 total (live and still) births 1942 1941 1942 1941 No. 29, Puerperal sepsis 2 1 0.80 0.59 No. 30, Other puerperal causes 6 6 2.41 3.53 Total 8 7 3.21 4.12 8 Death-rate of Infants under one year of age:— 1942 1941 All infants per 1,000 live births 30.6 40.9 Legitimate infants per 1,000 legitimate live births 30.4 38.5 Illegitimate infants per 1,000 illegitimate live births 35.3 105.3 Deaths from Cancer (all ages) 292 271 ,, Measles (all ages) 1 4 ,, Whooping Cough (all ages) .. 2 9 ,, Diarrhoea (under 2 years of age) 3 5 1. Rainfall. Total rainfall registered in the district during the year was 21.91 inches, the greatest fall in 24 hours was registered on 5th November, being .98 inches. Rain fell on 145 days. 2. Population. The number of patients and resident staff on the 30th June, 1942, at the following public institutions, was:— Claybury Mental Hospital and Emergency Hospital 2,614 West Ham Mental Hospital and Emergency Hospital 1,453 Australasian Hospital (Girls' Village Homes) 73 Total 4,140 3. Births.—The number of births registered during the year was 2,415. Males Females Legitimate 1,236 1,094 Illegitimate 36 49 i.e., 3.05 per cent. of the births registered were illegitimate. The birth-rate, calculated on the net estimate of the population is 17.2 per 1,000. 4. Deaths.—The total number of deaths of Ilford residents was 1,486. This is obtained by taking the total deaths registered in the district (1,326), subtracting the deaths of non-residents occuring in the district (386), and adding the deaths of Ilford residents registered as having died in other districts (546). The death-rate, calculated on the net estimate of the population is 10.6 per 1,000. Inquests.—During the year, 57 inquests were held in the district, 45 on Ilford residents, and 12 on non-residents. The ages at death were as follows :— Under 1 year 1-2 years 2-5 years 5-15 years 15-25 years 25-45 years 45-65 years 65 years and upwards 2 — 3 2 3 19 14 14 Death-Rates from Tuberculosis and Cancer, 1942. The following Table shows the death-rates for 1942 for Ilford, compared with the provisional death-rates for England and Wales for the same period, per 1,000 population; the figures having been supplied by the RegistrarGeneral:— Ilford England and Wales Respiratory Tuberculosis .542 .542 Other Tuberculosis .121 .115 Cancer 2.081 1.834 9 5.—Public Assistance Relief.—The total amount expended in Ilford during the year was £20,439 8s. 3d. The average weekly number of cases in receipt of relief was 612, including dependants. The number of admissions to Oldchurch Hospital from Ilford during the year was 746, made up as follows:— Men 204 Women 495 Children 47 In addition there were 261 admissions of patients from Ilford to other County Institutions, owing to no accommodation being available at Oldchurch Hospital; their allocation was as follows:— Men 113 Women 148 Children — The number of destitute persons admitted to the Institution during 1942 was 9, made up as follows:— Men 2 Women 3 Children 4 6. Marriages.—1,699 marriages took place in the Ilford district during 1942, both parties or one of the contracting parties being Ilford residents. 7. Tables of Vital Statistics.—Table I gives a comparative statement of the birth-rate and death-rate for the past five years. Table 1a 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 1942, arranged according to the age groups at which deaths occurred. 10 TABLE I.—Vital Statistics of Whole District During 1942 and Previous Years. Year Births Total Deaths Registered in the District Transferable Deaths Net Deaths Belonging to the District Uncorrected Number Net of Non-Residents registered in the District of Residents not registered in the District Under 1 Year of Age At all Ages Number Rate Number Rate Number Rate per 1,000 Net Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 1938 1,847 2,289 14.0 1,134 6.8 278 498 84 36.7 1,354 8.3 1939 1,669 2,307 13.9 1,288 7.9 386 548 75 33.9 1,450 9.2 1940 1,558 2,024 13.9 1,538 10.3 481 484 63 32.8 1,541 10.6 1941 1,164 1,816 13.3 1,874 13.3 754 507 67 40.9 1,627 11.9 1942 1,679 2,415 17.2 1,326 9.2 386 546 74 30.6 1,486 10.6 11 TABLE 1a showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1942 (Provisional figures). Rate per 1,000 Total Population Annual Death-rate per 1,000 Population Rate per 1,000 Live Births All Causes Typhoid and Paratyphoid Fevers Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Diarrhoea and Enteritis (under 2 Yrs.) Total Deaths under 1 Year Live Births Stillbirths England and Wales 15.8 0.54 11 .6 0. 0 — 0.01 0.00 0.02 0.05 0.09 5.2 49 126 County Boroughs and Great Towns, including London 17.3 0.66 13.3 0.00 — 0.02 0.00 0.03 0.06 0.09 7.5 59 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 18.4 0.62 12.1 0.00 — 0.01 0.00 0.02 0.04 0.10 4.8 46 London Administrative Co. 14.0 0.48 13.9 0.00 — 0.01 0.00 0.04 0.02 0.07 8.6 60 ILFORD 16.7 0.54 10.3 0 00 — 0.00 0.00 0.01 0.00 0.08 1.2 30.6 12 Registrar-General's Short List of Deaths and Causes:— TABLE II Causes of, and Ages at. Death during the Year 1942 Causes of Death Net Deaths at the subjoined ages of "Residents," whether occurring within or without the District All Ages Under 1 year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 years and upwards ALL CAUSES 1486 74 8 9 13 31 55 100 156 284 391 365 1 Typhoid and paratyphoid fevers — — — — — — — — — — — — 2 Cerebro-spinal fever 3 1 — — — 2 — — — — — — 3 Scarlet fever — — — — — — — — — — — — 4 Whooping cough 2 1 — 1 — — — — — — — — 5 Diphtheria — — — — — — — — — — — — 6 Tuberculosis of respiratory system 76 — — — 1 12 12 14 13 18 5 1 7 Other forms of tuberculosis 17 1 2 1 2 5 2 2 — 1 1 — 8 Syphilitic disease 14 1 — — — — — — 4 3 5 1 9 Influenza 12 1 — — 1 — — — 2 2 5 1 10 Measles 1 — 1 — — — — — — — — — 11 Acute Poliomyelitis and polioencephalitis — — — — — — — — — — — — 12 Acute infectious encephalitis 1 — — — — — — 1 — — — — 13 Cancer of buccal cavity and oesophagus (males only) 13 — — — — — — — 2 3 1 7 Cancer of uterus (females only) 18 — — — — — — 1 6 5 5 1 14 Cancer of stomach and duodenum 46 — — — — — 2 3 9 13 13 6 15 Cancer of breast 30 — — — — — 1 6 7 4 10 2 16 Cancer of all other sites 185 — — 1 1 — 3 11 21 51 62 35 17 Diabetes 14 — — — — — 2 1 3 4 4 — 18 Intra-cranial vascular lesions 135 — — — — — — 2 8 27 50 48 19 Heart disease 299 — — — — 1 5 11 27 53 90 112 20 Other diseases of the circulalatory system 67 — — — — — — 2 5 10 23 27 21 Bronchitis 74 2 — — — 1 1 1 2 19 26 22 22 Pneumonia 23 Other respiratory diseases 54 25 8 3 2 — 2 1 2 1 2 8 2 10 4 13 8 5 8 24 Ulceration of the stomach or duodenum 29 — — — — — 2 3 6 9 7 2 25 Diarrhoea (under 2 years of age) 3 3 — — — — — — — — — — 26 Appendicitis 7 — — — — 1 1 1 1 2 1 — 27 Other digestive diseases 43 1 — 2 — — 4 2 5 10 8 11 28 Nephritis 34 — — — — — 2 3 4 8 10 7 29 Puerperal and post-abortive sepsis 2 — — — — — — 2 — — — — 30 Other maternal causes 6 — — — — 1 2 3 — — — — 31 Premature birth 26 26 — — — — — — — — — — 32 Congenital malformations, birth injury, infantile disease 32 23 — 1 1 — 1 3 2 1 — — 33 Suicide 13 — — — — — 3 2 4 2 — 2 34 Road traffic accidents 17 — — — 2 1 2 2 5 — 4 1 35 Other violent causes 30 1 — — — 1 — 5 3 10 2 8 36 All other causes 158 5 2 1 5 3 8 16 7 15 38 58 Special Causes (included in No. 36 above):— Smallpox — — — — — — — — — — — — 13 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Nursing in the Home.—There is a voluntary District Nursing Committee, 11,622 visits being paid by the nurses in 1942, compared with 10,927 in 1941. Laboratory Facilities.—During the year 568 specimens were examined in the Bacteriological Laboratory. In addition 10 diphtheritic specimens were sent to other Laboratories for a test for virulence. Essex County Council Act, 1933. Establishments for Massage and Special Treatment. Inspections of licensed establishments are carried out quarterly. During 1942, 14 applications for renewal of licences and 1 application for a licence were received. The Council renewed the licences in respect of the 14 establishments and granted a new licence in respect of 1 establishment. All the licences expire on 31st March, 1943. Change of address was sanctioned in respect of one licenced establishment. Hairdressers' and Barbers' Premises. During 1942, 118 visits of inspection were made to these premises. Manufacture of Ice Cream. 2 applications for registration in respect of 2 premises were considered during the year. The applications were in respect of purveyors retailing multiple firms' productions, and registration was granted in both cases. Ilford Corporation Act, 1937. (а) Section 77 of this Act provides for the registration of hawkers of meat, fish, fruit and vegetables, and their storage premises. Registration was granted to 4 persons (concerning 2 premises). (b) Section 80 of the Act requires the registration of premises used for the preparation or manufacture of sausages, or potted, pressed, pickled or preserved meat, fish or other food intended for sale. Applications for registration were received in respect of 4 premises. These applications (with one exception) were in respect of premises used for fish frying. In 4 cases registration was granted. 10 fishfrying registrations were granted for the duration of the War, the applications having been received in 1941. By the operation of the Public Health Act, 1936, fish frying ceased to be an "offensive trade" but registration under this Section of the Ilford Act is necessary. Shops Acts, 1912-1934 (Sections 10 and 13).—During the year 1942, 6 inspections and 2,799 reinspections were made. 6 preliminary notices were served, 2 of which were complied with. In addition 3 notices served prior to 1st January, 1942, were also complied with. Maternity and Nursing Homes. On the 1st January and on December 31st, 1942, there were 2 private registered nursing homes in the district, 1 for medical and senile cases, and 1 for maternity cases. All Nursing Homes in the district are visited by the Deputy Medical Officer of Health and the Senior Sanitary Inspector (or his deputy) quarterly and at other times when necessary. A case of Puerperal Scarlet Fever occurred at a private nursing home in the district on the 28th April. The patient was removed to the Ilford Isolation Hospital and made a satisfactory recovery. As a result of bacteriological investigations a member of the Nursing Staff at the Nursing Home 14 was found to have haemolytic streptococcal organisms in her throat. The nurse was admitted to the Isolation Hospital, where her tonsils were removed, the "carrier" condition cleared up and the nurse was able to resume duties at the Nursing Home. SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. 1, (i) Water Supply.—Mr. B. W. Bryan, the Engineer to the South Essex Waterworks, Coy., states that the Company has not obtained a supplementary supply of water from the Metropolitan Water Board during 1942. Mr. Bryan also stated that about 3,000 chemical, bacteriological and biological analyses were made of the various water supplies during the year 1942, and all were reported on as pure and wholesome and suitable for the purposes of a public supply. (ii) Drainage and Sewerage.—The Borough Engineer regrets that owing to the pressure of work and the shortage of staff he is unable to supply the usual information regarding (a) Drainage and Sewerage and (b) Closet Accommodation, but has kindly supplied me with the following statement as regards Refuse and Salvage Collection:— Collection and Disposal of Refuse:— Tons Cwts. The total amount of refuse collected 20,552 3 ,, ,, ,, disposed of by barge 18,520 4 ,, ,, ,, ,, at Destructor 2,031 19 Trade refuse disposed of at Refuse Destructor 100 12 Salvage and Kitchen Waste:— Tons Value £ Wastepaper 1,770 10,428 Metals 3,498 3,783 Textiles 117 2,614 Bottles 455 1,734 Cullet 302 391 Bones 75 271 Kitchen Waste 2,358 3,522 Rubber 45 108 Miscellaneous 35 104 8,655 £22,955 (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 24,053 Houses and premises reinspected (works in progress) 7,783 Visits during disinfection 861 Houses in which nuisances were detected 1,568 Houses in which nuisances were abated 1,393* Premises disinfected 839 Premises from which articles only disinfected 187 Articles disinfected 4,452 Premises disinfested for verminous conditions 2 * Includes 194 nuisances detected before 1st January, 1942. 15 Notices served:— Served Complied with Statutory:— Public Health Act, 1936 27 38 Housing Act, 1936 — — Housing Act, 1936 (Overcrowding) 1 1 Factories Act, 1937 — — Provide Dustbin (Ilford Improvement Act) 302 310 Provide Water Supply to Dwelling House 5 6 Cleanse Water Storage Cistern (Byelaws) 2 2 Cover Water Storage Cistern (Byelaws) 2 2 Informal 1,204 1,014 1,543 1,373 In addition to the above, 189 notices (87 statutory and 102 informal) served previous to 1st January, 1942, were also complied with. Complaints.—During the year, 1,492 complaints of nuisances have been received and investigated. The following is a summary:— Accumulation of manure and refuse 40 Animals improperly kept 24 Bad smells 54 Dampness of premises 69 Defective drains, w.c's and fittings 338 Defective roofs, gutters, downpipes, etc. 87 Defective water fittings 75 Dirty and verminous houses 34 Dirty condition of rearway 5 Flooding of premises 21 Overcrowding 22 Smoke nuisances 14 Miscellaneous 709 Total 1,492 (iv) Swimming Baths and Pools.—Samples of water for examination were taken from the open-air swimming bath from May to September (5); and from January to November (10) in respect of the two indoor baths. All the samples were satisfactory. (v) Eradication or Bed Bugs:— Houses Found to be infested Disinfested 21 19 (vi) Slaughter of Animals Act, 1933.—No licence to act as slaughterman was granted during the year. Section 25 of the Burial Act, 1857.—Supervision was carried out on one occasion in connection with the removal and reinternment of human remains at Barkingside Cemetery, an exhumation licence having been issued by H.M. Home Office. 16 SECTION D.—HOUSING. (i) Overcrowding .—Informal notices were served in respect of 16 premises, all of which were complied with. (ii) Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. (iv) HOUSING STATISTICS. 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) 2,015 (b) Number of inspections made for the purpose 6,110 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (b) Number of inspections made for the purpose — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,209 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 1.014* 3. Action under Statutory Powers during the year:— a. No proceedings were taken under Sections 9, 10 and 16 of the Housing Act, 1936. b. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 35 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 44* (b) By local authority in default of owners — c & d. No proceedings were taken under Section 11, 12 and 13 of the Housing Act, 1936. 4. Housing Act, 1936, Part IV—Overcrowding:— (а) (i) Number of dwellings overcrowded at the end of the year 16 (ii) Number of families dwelling therein 18 (iii) Number of persons dwelling therein 119 (b) Number of new cases of overcrowding reported during the year 14 (c) (i) Number of cases of overcrowding relieved during the year 13 (ii) Number of persons concerned in such cases 98 (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 — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report — *Includes compliances during 1942 of Notices served prior to 1st January, 1942. 17 HOUSING ACT, 1936. During the year 1942, the work of receiving applications, calling for calculations for the "permitted number," was continued with a view to the issue of housing certificates. One temporary clerk was employed. Altogether applications were received in respect of 15,621 houses. At the end of the year the total certificates issued to date numbered 17,791 in respect of 24,212 houses. Where no application for a certificate was received for the permitted number arising from the 1935 survey, lists were forwarded to the Town Clerk, who communicated in 1,343 cases with the persons responsible, pointing out the requirements of the Act. Of this number, 1,336 were received up to 31st December, 1942, and the balance of 7 is receiving attention. As new premises were constructed and placed upon the rating lists, these lists were obtained and survey forms sent with a view to the issue of "permitted number" certificates, and in all, new premises (not enumerated under the 1935 survey) have been dealt with to the extent of 8,175. 18 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) Persons and Premises registered as at 31st December, 1942:— Premises registered as dairies and milkshops 38 Cowkeepers registered 3 Persons registered as retail purveyors of milk 44 Persons registered as retail purveyors of milk in sealed cartons or containers 77 Persons registered as retail purveyors of milk (sterilised) in sealed bottles 41 Persons registered as retail purveyors of milk in sealed cartons or containers; and also sterilised in sealed bottles 19 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 19 Persons registered as wholesale purveyors of milk 7 Persons registered as wholesale purveyors of milk (sterilised) in sealed bottles 3 Person registered as a wholesale purveyor of milk in sealed cartons or containers 1 324 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 34 inspections (included in above) were made of 3 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. 2 of the 3 registered cow-keepers are wholesale and retail purveyors of milk; 1 is a retail purveyor only. Of the 181 premises from which milk is retailed in Ilford, 16 are branches of one firm, 5 of another, and 2 another, 3 retail from dairy shops or stores, 1 from a general shop and 6 from restaurants, 11 are retailers in a small way with rounds; while 41 sell sterilised bottled milk only, 19 sell sterilised milk and also milk in sealed containers, and 77 retail milk in sealed containers only. In 3 premises, pasteurising plant has been installed. Only 2 of these have, however, been licensed. 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, 1936 and 1938 during 1942 for the sale of:— "Tuberculin Tested" Milk 15 "Pasteurised" Milk 23 The above include supplementary licences which were issued for "Tuberculin Tested" milk, 7; and "Pasteurised" milk, 8. 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. In addition to the above, the Essex County Council granted 1 producer's licence in respect of "Tuberculin Tested" milk produced on a farm in the Borough during the year 1942. 19 (iii) Sampling.—The routine practice of sampling was given in the 1938 Report, the following gives the results for 1942:— Grade of milk or ice cream Total Satisfactory Unsatisfactory Remarks Tuberculin Tested milk 15 10 5 4 were unsatisfactory to the methylene blue reductase test, and one showed a high B. Coli content. The County Medical Officer was communicated with in three cases, and the local retailer in one case. In one case the supply was obtained from a neighbouring Borough, and the local Medical Officer communicated with. Tuberculin Tested (Pasteurised) milk 2 2 — — Tuberculin Tested (Certified) milk 17 17 — — Pasteurised milk 32 32 — — Ungraded milk 113 94 19 The retailers were communicated with owing to the high B. Coli content or high bacterial count of the unsatisfactory samples. In 4 cases the supplies were obtained from neighbouring Boroughs and the local Medical Officers were communicated with in these cases. It was also necessary to communicate with the County Medical Officer in 7 cases. Ice cream 17 17 — — (iv) Tubercular Milk.—29 samples of milk were submitted to a biological test for tuberculosis, 1 of which was found to be positive. The following is a brief r6sum6 of the case:— Sample of ungraded milk taken on 19th March from retailer who obtained his supplies from 11 farms in the County of Essex. The matter was reported to the County Medical Officer, who thereupon arranged for samples to be obtained from the producers and submitted to biological examination. The County Medical Officer subsequently reported that all samples gave a negative result. (v) Milk and Dairies Orders, 1926 and 1938: Inspection of Dairy Herds.—One inspection was made by the Veterinary Officers of the Ministry of Agriculture and Fisheries of a non-designated herd of 167 animals and a clear certificate issued. The Ministry's Divisional Inspector states there was no case of suspected tuberculosis in the Borough during 1942. (vi) Legal Proceedings.—None were taken during the year. (vii) Registration.—No application for registration was refused during 1942. 20 Articles of Food Surrendered. During the year the following articles of food were surrendered and condemned as being unfit for the food of man:— 416 tins luncheon meat; 46 tins sardines; 45 tins ham; 1,957 tins milk; 259 tins pilchards; 70 tins herrings; 136 tins meat roll; 13 tins corned beef; 78 tins sausage meat; 1,476 tins vegetables; 3 tins brawn; 11 tins of spaghetti; 15 tins tongue; 153 tins stewed steak; 112 tins salmon, lobster and crayfish, etc.; 416 tins fruit; 14 tins prepared meals; 371 tins soup; 3 tins biscuits; 127 tins tomatoes; 16 tins rabbit; 6 tins sausages; 1 tin curried mutton; 3 tins fish roll; 1 tin biscuits and cheese; 2 tins fishcakes; 1 tin macaroni; 3 tins mackerel; 290 tins vegetable stew; 16 tins corned beef hash; 1 tin rice; 1 tin caviette; 8 tins custard powder (each containing 28 lbs.); 1 tin syrup; 7 tins sandwich spread; 1 tin beef; 1 tin peanut butter; 3 tins jam; 8 jars paste; 16 jars jam and marmalade, etc.; 12 bottles sauce; 30 bottles pickle; 51 bottles salad cream and mayonnaise; 89 jars herrings; 4 bottles lemonade powder; 2 bottles coffee; 1 jar mustard; 11 jars caviette; 1 jar olives; 70 lbs. dates; 168 lbs. yeast; 6 lbs. tongue; 48 lbs. ham; 16¾ lbs. luncheon meat; 143½ lbs. bacon; 9½ lbs. luncheon sausage; 67½ lbs. cake; 38 lbs. butter; 224 lbs. sugar; 3½ lbs. margarine; 255 lbs. cheese; 95 lbs. ground rice; 233 lbs. flour; 49 lbs. sausage meat; 15½ lbs. sausages; 240 lbs. fish; 1 lb. lard; 2¾ lbs. meat; 2 Swiss rolls; 12 boxes fish; 1 case rabbits (containing 68 lbs.); 15 pkts. pudding and cake mixtures; 48 pkts. margarine; 83 pkts. soup; 2 pkts. dried eggs; 1 turkey; 8 pkts. cocoa. Since 21st August food surrendered and condemned has been collected by the Ministry of Food Salvage Department, under the Ministry's instruction, except for the following which was sent to the Dust Destructor for immediate destruction:— Wet fish (12 boxes and 240 lbs.), 68 lbs. rabbits, 64½ lbs. sausages, and 1 turkey. (i) Food and Drugs Act, 1938.—During 1942, 279 samples (270 formal and 9 informal) of Food and Drugs were obtained, 6 of the formal samples were not genuine. Prosecutions were undertaken in three cases as follows:— (а) Orange Squash.—Orange juice did not exceed 2 per cent. Retailer fined 40s. and £5 5s. costs. (b) Onion Extract.—Water 99.94 per cent. Extractive matter .06 per cent. Fined £20 and 20 guineas costs. (c) Mixed Herbs.—Sand 12.5 per cent at least 9.5 per cent above that ordinarily found in dried mixed herbs. Dismissed on "Warranty." Fresh case against Manufacturers, case dismissed on payment of £5 5s. costs. Of the remaining 3 cases, the following was the result:— Letter of warning sent by Town Clerk 1 (Parsley, sweet herb). Proceedings authorised, but unable to be taken as the responsible person had joined H.M. Forces 1 (Onion Extract). Further sample taken and found satisfactory 1 (Milk) (ii) Food and Drugs Act, 1938, S. 34.—One certificate of registration was granted in respect of premises used for the carrying on of the business of a Wholesale Dealer in Margarine. Food Poisoning. By virtue of Section 82 of the Ilford Corporation Act, 1937, food poisoning became compulsorily notifiable in Ilford as from 1st October, 1937. 2 cases were notified under the Act and 3 cases of suspected food poisoning were reported to me, but not notified. All were investigated but none found to be cases of genuine food poisoning. 21 Bakehouses.—There are 36 bakehouses in the district, 26 of which use motive power. 167 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 work in 16 instances, and the requests were complied with in 15 cases. Diseases of Animals Acts, 1894-1927. (i) Regulation of Movement of Swine Fever Order, 1922.—Licences were issued for entry into the Borough of 105 pigs and for removal from the Borough of 41 pigs. In addition, under the Diseases of Animals Acts, 1894-1927, licences were issued for entry into the Borough of 1 cow and 1 calf, and for removal from the Borough of 25 sheep. (ii) Sheep Scab Orders and Amendment Orders, 1928, 1930, 1934 and 1934 (No. 2).—There has been no occasion for this Borough to be made into a "double-dipping" area under these Orders during the year 1942. The only sheep in the borough, at a large farm, have been double-dipped unofficially by the owner in his own interests. (iii) Swine Fever Orders, 1908, 1911, 1912, 1916 and 1917: Swine Fever (Regulation of Movement) Order, 1922: and Amendment Orders 1922 (No. 1), 1936 and 1936 (No. 3).—Owing to the suspicious deaths of pigs on the 26th May at a Public Institution in the Borough, and on the 5th December at a Pig Club in the district, it was necessary to serve Form "A" Notices under the Swine Fever Orders, defining the premises as infected places. These notices were subsequently withdrawn by the Ministry of Agriculture and Fisheries. Rats and Mice Destruction Act, 1919.—174 complaints have been received of the existence of rats affecting 374 premises. In 66 of these cases poison gas has been used, and in the remaining cases other steps have been taken. Petroleum (Consolidation) Act, 1928.—The Sanitary Inspectors made 814 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 11 petroleum appliances or fittings. The number of Licences issued was 98, and the fees paid to the Council for such Licences was £76 15s. 2 Licences were issued for the storage of calcium-carbide, the fees payable being 15s. Examination of Officers, Teachers and Servants. The following medical examinations were carried out during 1942:— Officers Teachers Servants New Appointments 349 15 16 Under Sickness Regulations 19 4 60 Totals 368 19 76 22 SECTION F.—PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. TABLE III—Cases of Infectious Diseases Notified during the Year 1942 NOTIFIABLE DISEASE At all Ages Number of Cases Notified At Ages—years Total Cases Notified in each Ward Total Cases Admitted to Hospital Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Seven Kings Barkingside North Hainault Loxford Clementswood South Hainault Goodmayes Smallpox — — — — — — — — — — — — — — — — — — Scarlet Fever 425 1 68 320 13 22 1 — 12 11 24 68 51 36 57 87 79 335 Diphtheria, including Membranous Croup 39 — 11 15 8 3 2 — 1 1 7 14 2 4 3 4 3 37 Enteric Fever (Typhoid and Para-Typhoid) 3 — — — 1 2 — — — — — 1 — 1 — — 1 2 Pneumonia 192 11 30 33 12 41 44 21 17 12 15 40 27 11 18 17 35 126 Puerperal Pyrexia 37 — — — 7 30 — — 4 2 1 5 20 — — 1 4 34 Cerebro-Spinal Fever 18 6 4 2 3 2 1 — — — 3 3 5 2 — 2 3 18 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — Acute Polio-Encephalitis — — — — — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — — — — Dysentery 3 — 1 1 — — 1 — — — 1 1 1 — — — — 2 Ophthalmia Neonatorum 9 9 — — — — — — 1 1 1 2 1 1 1 1 — — Erysipelas 69 — 1 4 7 22 24 11 12 6 2 10 9 8 5 6 11 21 Pemphigus Neonatorum 4 4 — — — — — — — 1 1 2 — — — — — 1 Tuberculosis Pulmonary 225 — 2 7 60 104 47 5 19 23 19 39 24 24 25 26 26 — Other Forms 37 1 5 12 9 6 4 — 3 3 3 4 7 3 2 5 7 — Anthrax — — — — — — — — — — — — — — — — — — Malaria—Believed to be contracted in this country — — — — — — — — — — — — — — — — — — Believed to be contracted abroad 1 — — — — — 1 — — 1 — — — — — — — — Acute Rheumatism 14 — 1 12 1 — — — — 1 4 2 2 — — 3 2 6 Measles 1614 46 529 1016 16 7 — — 113 23 171 341 164 199 117 231 255 19 Whooping Cough 417 26 175 204 1 11 — — 79 24 26 87 79 23 22 41 36 22 Food Poisoning 2 — — — 1 1 — — — — — — — 2 — — — — Totals 3109 104 827 1626 139 251 125 37 261 109 278 619 392 314 250 424 462 623 23 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 78.8 Diphtheria and Membranous Croup 94.8 Enteric Fever 66.6 Puerperal Pyrexia 91.9 Pneumonia 68.2 The total number of deaths of Ilford residents from the following infectious diseases during 1942 was 170 as against 199 in 1941. 1941 1942 Scarlet Fever — — Enteric Fever — — Diphtheria 3 — Measles 4 1 Whooping Cough 9 2 Influenza 24 12 Tuberculosis—Pulmonary 70 76 Other forms 17 17 Pneumonia 64 54 Diarrhoea (under 2 years) 5 3 Cerebro-spinal Fever 2 3 Puerperal Sepsis 1 2 Total 199 170 (a) Smallpox.—Notification of 12 persons who had been in contact with cases of Smallpox on board ship were received. These were visited by the Sanitary Inspectors for the usual period. No case of Smallpox occurred. The following gives particulars as to Vaccination during 1942:— Certificates of Successful Vaccination 1,229 Postponed 35 Conscientious Objections 552 Unsuccessful Vaccination 33 Left the District 117 (b) Scarlet Fever.—425 cases were notified in 1942. 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 Ilford Isolation Hospital "Return" Hospital Cases Per Cent. Home Cases Cases arising in same house Per Cent. 1938 303 262 6 2.3 40 — — 1939 370 283 4 1.4 53 — — 1940 136 108 1 .9 25 1 .04 1941 182 141 3 2.1 41 — — 1942 425 336 13 3.9 89 1 1.12 (c) Diphtheria.—39 cases were notified in 1942. There were no deaths from Diphtheria during the year. Diphtheria Immunisation.—As soon as births are notified, the parents are circularised with regard to diphtheria immunisation facilities and this has been carried out as a routine measure since 1929, when immunisation against diphtheria commenced in this Borough. Consent to treatment forms are available at all clinics, welfare centres and school medical inspections. An intensified campaign was conducted during the year, particularly during the Autumn and Winter months. Notices were inserted in the local Press, and leader comment was also made. Repeated broadcasts were made by the Chief Medical Officer to the Ministry of Health subsequent to a broadcast by the Minister of Health. As a result of this, together with the efforts of the Assistant Medical Officers at school medical inspection 24 and at the welfare centres, and with visits by the Health Visitors, a very considerable increase (in fact, toe heaviest since the work started in 1929) is shown, as will be seen from the following table. A Film Display was held on February 12th at Cleveland School under the auspices of the Ilford Local Committee of the Ministry of Information. The films exhibited included "the Defeat of Diphtheria" and "Breath of Danger." Tabulae Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1942, to 31st December, 1942. Newbury Hall Clinic 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 324 — 324 182 - 182 506 Negative 71 — 71 39 — 39 110 Numbers inoculated (full course) 1.041* 1,432 2,473 721* 765 1,486 3,959 Positive after full course of inoculations, and re-inoculated 9 11 20 5 6 11 31 Negative after full course of inoculations 548 526 1,074 333 237 570 1,644 Awaiting re-test 420 842 1,262 334 458 792 2,054 Not re-tested after inoculation (on account of leaving District, etc.) 64 53 117 49 64 113 230 Positive after re-test, but not inoculated for same reason - - - - - - - Final Schick Test in 1942 (1941 Cases):— Positive after full course of inoculations, and re-inoculated 5 7 12 2 4 6 18 Negative 131 284 415 69 124 193 608 * Schick+1942=324; Schick+1941=9; Not Tested=708 * Schick+1942=182; Not Tested=539 During 1942 a total number of 4,695 children attended at the Diphtheria Prevention Clinics (2,971 at the Newbury Hall and 1,724 at Mayes brook), making a total number of attendances of 21,695 (11,511 and 10,184), with an average per session of 131 and 132 respectively. 25 In 1942, under the arrangements mentioned in the 1935 Report, 31 private doctors were supplied with prophylactic for the immunisation of 256 children (220 under 5 years and 36 over 5 years of age). The following is a brief summary:— 1941 Cases: Final Schick Test in 1942:— Negative 73 Positive and re-inoculated 2 Positive and not re-inoculated (left district) 1 No final Schick Test, left district, etc. 17 1942 Cases: Numbers inoculated (full course) by medical practitioners.. 256 Final Schick Test—Negative 155 Positive and re-inoculated 3 No final Schick Test, left district, etc. 14 Forms not yet returned 19 To be Schick Tested in 1943 65 (d) Ophthalmia Neonatorum.—9 cases were notified during 1942. Of the 9 cases notified, 7 were treated at home by private medical practitioners, 2 were treated as out-patients at the Royal London Ophthalmic Hospital. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 9 7 2 9 — — — (e) Enteric Fever.—3 cases of enteric fever were notified. One case was admitted to the Essex County Council Hospital, Wanstead, being confirmed bacteriologically; 1 was admitted to the Ilford Isolation Hospital but confirmation of the disease could not be obtained by bacteriological examination; the other case was treated at home, this also was not confirmed by bacteriological examination. (f) Scabies Order, 1941 (dated 28th October, 1941).—591 cases of Scabies (195 adults and 396 children) were reported. 10 Ilford residents were admitted to the Isolation Hospital during the year. 26 Table showing Incidence of Infectious Disease, 1942, in age groups; and total Deaths. Disease Total cases notified Under 1 year 1—2 2—3 3—4 4—5 5—10 10—15 15—20 1 20—35 35—45 45—65 Over 65 *Cases admitted to Hospital Total Deaths Smallpox - - - - - - - - - - - - - - - Scarlet Fever 425 1 5 15 23 25 258 62 9 16 10 1 - 335 - Diphtheria 39 - 3 1 4 3 12 3 6 4 1 2 - 37 - Enteric Fever (including Paratyphoid) 3 - - - - — — — — 2 1 — - 2 - Pneumonia 192 11 6 5 10 9 26 7 6 23 24 44 21 118 54 Puerperal Pyrexia 37 - — — — — — — — 29 8 — — 34 2 Cerebro-spinal Fever 18 6 1 2 — 1 2 — 2 1 2 1 — 18 3 Acute Poliomyelitis — — — — — — — — — — — — — — — Acute Polio-Encephalitis - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - Dysentery 3 — — — 1 — — 1 — — — 1 - 2 - Ophthalmia Neonatorum 9 9 — — — — — — — — — — — — - Erysipelas 69 — — — 1 — — 4 4 8 17 24 11 19 1 Anthrax - - - - - - - - - - - - - - - Malaria believed to be contracted in this country - - - - - - - - - - - - - - - Malaria believed to be contracted abroad 1 - - - - - - - - - - 1 - - - Pemphigus Neonatorum 4 4 — — — - - - - - - - - 1 1 Acute Rheumatism 14 — 1 — — — 7 5 1 — — — — 6 — Food Poisoning 2 — — — — — — — 1 1 - - - - - Measles 1614 46 108 137 155 129 985 31 11 12 — — — 18 1 Whooping Cough 417 26 40 43 43 49 191 13 - 12 - - - 14 2 * Excludes cases occurring at Barnardo's Homes, Claybury Mental Hospital and West Ham Mental Hospital. 27 3. Tuberculosis. During the year 1942 there were 225 new notifications of Pulmonary Tuberculosis and 37 of other forms of Tuberculosis. 29 cases of Pulmonary and 6 cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notifications and Deaths from Tuberculosis of Ilford residents during 1942: Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - - 1 - - - 1 - 1-5 years — 2 1 4 — — — 3 5-15 3 4 7 5 — 1 1 1 15-25 26 34 3 6 6 6 3 25-35 33 31 2 2 6 6 1 1 35-45 29 11 2 - 10 4 — 2 45-55 26 6 1 2 10 3 — — 55—65 12 3 1 — 11 7 1 — Over 65 4 1 — — 6 — 1 — Totals 133 92 18 19 49 27 7 10 Of the above new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 9 6 Claybury Mental Hospital 4 — Claybury Emergency Hospital 3 — West Ham Mental Hospital 5 — Ilford Isolation Hospital 1 1 Australasian Hospital (Girls' Village Homes) 4 1 Of the 93 deaths which occurred of Ilford residents, notification had previously been made of 76 of the cases; of the other 17, 8 were notified after death; 8 were not notified (8.6 per cent. of the deaths, or a ratio of 1 in 11); one death included by the Registrar-General it has not been possible to trace. Of the 8 cases not notified (previously referred to) in 7 instances the presence of tuberculosis was discovered following P.M., and in the remaining instance notification was overlooked. During the year 1942 the following deaths occurred from Tuberculosis:— Pulmonary Non-Pulmonary Ilford Residents 76 17 N on-Residents— Claybury Mental Hospital 19 — West Ham Mental Hospital 4 — Ilford Isolation Hospital 40 1 28  Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1942 658 184 842 Number of cases entered on register during the year 254 43 297 Number of cases removed from the register during the year:— Pul. NonPul. • Recovered 7 7 Deaths 81 15 Left District 50 11 Lost sight of 7 5 Diagnosis not established 6 4 151 42 193 Number of cases remaining on register on 31st December, 1942 761 185 946 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurse of the Essex County Council. 856 of the cases of longer standing were visited by the Sanitary Inspectors during the year, a visit being made to each patient every six months. The following reports were obtained:— Pulmonary Cases Other Cases Stated to be recovered or better 5 8 Improved or fairly well 456 116 Not so well 69 12 In Sanatorium 90 19 No information as to present condition 22 9 Removed from district, etc. 42 8 Totals 684 172 The treatment of Tuberculosis is under the control of the Essex County Council. On the 31st December, 1942, there were 830 patients on the register of the dispensary. The arrangements made with the Essex County Council for the dental treatment of tuberculosis patients from Ilford, Romford, Leyton, Walthamstow, Barking and Dagenham were continued. Two afternoon sessions per month were set aside for the treatment of these cases. 193 patients were treated, 22 being supplied with dentures. The Council's Dentist also made 16 visits to the tuberculosis patients at the Ilford Sanatorium. 40 Patients were inspected, all of whom received treatment. The number of patients from Ilford sent to Institutions under the Essex County Tuberculosis Scheme during 1942 was as follows:— Pulmonary Non-Pulmonary Total Males Females Males Females Adults 66 59 7 2 134 Children 5 2 4 2 13 Tuberculosis Care Association.—This Association has assisted 55 cases with extra nourishment, clothing, and in other ways. 29 SECTION G.—FACTORIES. The Factory and Workshop Act, 1901, was superseded by the Factories Act, 1937, which came into operation on 1st July, 1938. There are 327 factories with mechanical power on the register. There are 286 factories without mechanical power on the register. There are 320 outworkers on the register. 1 .—INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) Factories with Mechanical Power 489 9 - Factories without Mechanical Power 204 1 - Other premises (not including Outworkers' premises) — — — Total 693 10 — 2.—DEFECTS FOUND IN FACTORIES. Particulars. Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) 3 3 - - Overcrowding (S.2) 1 1 — — Unreasonable Temperature (S.3) - - - - Inadequate Ventilation (S .4) 1 — — — Ineffective Drainage of Floors (S.6) - - - - Sanitary Conveniences (S.7):— Insufficient 11 7 - - Unsuitable or Defective 28 25 - - Not Separate for Sexes — — - — Other Offences 19 14 - — Total 63 50 — — 30 ISOLATION HOSPITAL. 1,091 patients were admitted during 1942. 94.8 per cent. of the eases of diphtheria and 78.8 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 1,091 patients admitted during 1942 suffered from the following complaints:— Puerperal Scarlet Fever 1 Scarlet Fever 464 (141) Scarlet Fever and Chicken Pox 5 (5) Scarlet Fever and Mumps 1 Scarlet Fever, Whooping Cough and Chicken Pox 1 Scarlet Fever and Scabies 4(1) Diphtheria 42(18) Diphtheria and Scabies 1 Cerebro-spinal Fever 16(6) Cerebro-spinal Fever and Pneumonia 1 Tuberculous Diseases—Pulmonary 132 „ „ Non-Pulmonary 5(1) Pneumonia 85(9) Pneumonia and Whooping Cough 1 Pneumonia and Measles 1(1) Whooping Cough 16(4) Whooping Cough and Measles 1(1) Measles and German Measles 30(15) Measles and Chicken Pox 1 Measles, Scabies and Impetigo 1 Mumps 6(2) Chicken Pox 3 Erysipelas 24(7) Pemphigus Neonatorum 1 Puerperal Pyrexia 24(10) Scabies 10 Impetigo and Dermatitis 5 Acute Rheumatism 6 Influenza 5 Bronchitis 8 Enteritis 3(1) Sonne Dysentery 1(1) Observation and Other Cases 186(63) Number of deaths in hospital:— Pulmonary Tuberculosis 46 Tuberculous Meningitis 3(1) Pneumonia 13(1) Cerebro-spinal Fever 2 Pemphigus Neonatorum 1 Staphylococcal Septicaemia 1(1) Streptococcal Toxaemia 1(1) Septic Abortion 1 Whooping Cough 4(2) Meningeal Cyst 1(1) Congenital Heart Disease 1 Infective Endocarditis 1 Retro-pharyngeal Abscess 1 Acute Exfoliative Dermatitis 1 Cardiac Failure due to Toxaemia due to Broncho Pneumonia 1 Ruptured Aneurysm of Circle of Willis 1 (1) The figures in brackets represent cases admitted from Barking. 31 Number of patients in Hospital on 1st January, 1942 and 1943, respectively:— 1st Jan., 1st Jan., 1942 1943 Scarlet Fever 22 50 Diphtheria 8 15 Tuberculous Diseases 71 64 Puerperal Pyrexia 2 2 Erysipelas — 1 Cerebro-spinal Fever 1 — Enteric Fever 1 — Pneumonia 4 8 Acute Rheumatism 1 — Mumps — 1 Whooping Cough 5 — Scabies 1 3 Observation and other cases 2 6 The average length of stay in Hospital was for:— Scarlet Fever 23.9 days Diphtheria 52.7 „ Tuberculous Diseases 86.9 „ Average stay in Hospital of all cases 27.7 „ The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day 141.9. Scarlet Fever.—The diagnosis of scarlet fever could not be confirmed in 16 patients admitted. There have been no deaths from scarlet fever during the past five years. Diphtheria.—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. 1938 1939 1940 1941 1942 Ilford 5.3 1.3 2.4 7.1 Nil Tuberculosis.—132 cases of Pulmonary Tuberculosis were admitted, as compared with 127 in 1941. The arrangement entered into with the Essex County Council whereby the 26 beds in Block 1 and the 6 beds in Block 2 were allocated to the use of Tuberculosis patients continued during the year. These beds, together with the 20 beds in Block 10, were paid for at the rate of 55s. per bed per week as and when occupied from 1st January to 31st March, and from 1st April to 31st December at the rate of 63s. per bed per week. The 20 beds in Block 6 continued to be occupied during the year by Tuberculosis patients by agreement with the Essex County Council; 12 beds being paid for at the rate of 45s., and the remaining 8 beds at 52s. 6d. per week, whether occupied or not. Training of Nurses.—During 1942 8 nurses passed Parts I and II and 1 passed Part I of the Preliminary examination of the General Nursing Council, and 10 obtained the Certificate by passing the final examination (6 probationers, 4 staff nurses). 32 The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick tested during 1942, and also the number inoculated:— Numbers Schick Tested:— Nurses Domestics Positive 17 10 Negative 32 22 Numbers inoculated (full course) 17 10 Numbers re-tested:— Negative after full course of inoculations 9 5 Positive after full course of inoculations, and re-inoculated 5 3 Numbers Dick Tested:— Positive 16 15 Negative 33 17 Numbers inoculated (full course) 16 15 Numbers re-tested:— Negative after full course of inoculations 4 8 Positive after full course of inoculations, and re-inoculated 10 4 No member of the Nursing Staff contracted Scarlet Fever during the year, but one nurse contracted Diphtheria. The Hospital is recognised by the Conjoint Board for Part 2 of the D.P.H. Regulations of the Board. Admission of Cases from Barking.—The arrangement entered into with Barking Corporation for the reception of cases of infectious disease occurring in that area, as far as accommodation permitted, continued during the year. During 1942 the number of cases admitted was 286. Payment was at the agreed rate of 10/- per day, plus a charge of 2/- per mile for use of ambulance; from 1st October the charge was increased to 12s. 6d. per day. Reciprocal Arrangements—Waltham Joint Hospital Board.—The arrangements made in 1938 continued during the year, although it was not necessary to use them. The charge for maintenance was increased from 10s. to 12s. 6d. per day, as from 1st October. 33 MATERNITY AND CHILD WELFARE Births.—By the Public Health Act, 1936, 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 this Act during 1942 was 1,680 (898 males and 782 females). Of these, 33 (18 males and 15 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 755 notifications of birth (377 males and 378 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, 18 cases in which there was default in complying with the requirements of the Act relating to the Notification of Births 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 8.75 By Certified Midwives 88.33 By Parents and Others 2.92 In addition, 53 stillbirths (32 males and 21 females) were notified. The notifications of 19 stillbirths (11 males and 8 females) which took place outside the district, although the ordinary residence of the parents is in Ilford, were transferred to this district. Infant Mortality.—The number of infants dying within the first year of life was 74, the total number born being 2,415. The latter figure is supplied by the Registrar-General for calculating infant and maternal mortality rates. The infant mortality, or rate of deaths per 1,000 live births, was, therefore, 30.6. Neonatal Mortality.—The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 49 deaths of infants under four weeks of age during 1942 and the rate for the year was 20.3 per 1,000 live births. The deaths of infants under one month increased from 36 during 1941 to 49 during 1942. The following table gives the deaths of infants under one year of age, classified according to age. Infant Mortality. Cause of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and 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 Whooping Cough - - - - - 1 - - - 1 Miliary Tuberculosis - - - - - - 1 - - 1 Meningitis (not tuberculous) - - - - - 1 1 - - 2 Bronchitis — — — — — 1 2 — — 3 Pneumonia (all forms) 1 2 1 — 4 2 2 1 1 10 Enteritis - - - - - - 2 2 — 4 Convulsions 2 - - - 2 - - - - 2 Syphilis - - - - - - 1 - - 1 Suffocation - - - - - - - 1 — 1 Injury at birth 4 — — — 4 — — — — 4 Atelectasis 7 — — — 7 — — — — 7 Congenital Malformations 4 2 — — 6 1 — — — 7 Premature birth 21 — — — 21 — — — — 21 Marasmus - - - - - 2 - - - 2 Other causes 2 1 2 — 5 2 — 1 — 8 Totals 41 5 3 — 49 10 9 5 1 74 34 Foster-Children. Number of foster-children on register on 1st January, 1942 23 Number of foster-children who were notified during 1942 29 Number of foster-children returned to their mothers during 1942 6 Number of foster-children taken off register for various other reasons during 1942 10 Number of foster-children on the register on 31st December, 1942 36 Foster-Mothers . Number of foster-mothers with children on the register on the 1st January, 1942 21 Number of persons who became foster-mothers during 1942 25 Number of foster-mothers whose names were taken off the register during 1942 16 Number of foster-mothers with children on the register on the 31st December, 1942 30 Number of houses visited by the Sanitary Inspectors for the purpose of the Act during 1942 27 Number of visits made by the Sanitary Inspectors for the purpose of the Act during 1942 36 Work of Health Visitors.—The Ilford area is divided into 13 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 home visits made by the Health Visitors during 1942 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 2,677 Subsequent visits to children under 1 year of age 6,470 Subsequent visits to children over 1 year of age and under 5 14,999 Visits to expectant mothers 185 Home visits for other reasons 1,797 Total visits paid 26,128 Issue of Clothing Coupons to Expectant Mothers.—The issue of 50 additional clothing coupons to each expectant mother to enable her to buy materials for garments for her baby has been made through the Public Health Offices since the inception of the Scheme by the Board of Trade on the 7th August, 1941. The coupons were increased to 60 as from 1st June, 1942. During 1942 additional coupons were issued to 2,620 expectant mothers. Supply of Milk to Expectant and Nursing Mothers and Infants.— A total of 2,105 lbs. of dried milk were given free under the Regulations of the Ministry of Health during 1942 to 166 infants. These figures include the supplementary issue of 600 20 oz. packets of National Dried Milk to 75 infants who were receiving the Dried Milk under the National Milk Scheme. Since July, 1940, the supply of liquid milk by the Council has been suspended as this is now provided under the National Milk Scheme. Infant Welfare Centres.—81 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1942. During the year the following attendances were recorded:- Total number of attendances of infants 43,023 First attendances 2,621 Total number of children on roll, December 3lst, after omission of all those who had not attended for six months 3,575 14,564 attendances of children from 1 to 5 years were made at the Infant Welfare Centres during the year. 35 Special Clinics.—Attendances of children under 5 years of age and expectant and nursing mothers at the various Clinics during 1942 are set out in the following table:— Clinic. Number of Sessions. Attendances. Individual Expectant and Nursing Mothers. Attendances. Individual Children. Total Attendances. A. B. C. D. A. B. C. D. A. B. C. D. A. B. C. D. (i) Ophthalmic 102 51 — — 17 3 — — 39 14 — — 106 45 — — (ii) Orthopaedic 19* 11 — — — — — — 145 66 — — 241 123 — — (iii) Artificial Sunlight 48 52 — — — — — — 36 38 — — 455 701 — — (iv) Remedial Exercises 104 — 52 — — — — — 18 — 8 — 122 — 99 — (v) Aural 36 — — — 3 — — — 96 — — — 174 — — — (vi) Rheumatism 16 — — — — — — — 10 — — — 13 — — — (vii) Dental — 5 — 154 — 24 — 509 — 7 — 180 — 40 — 1514 A=Newbury Hall. B=Mayesbrook. C=All Saints Hall. D=Valentines Dental Clinic. * Includes one session at Cecil Hall. Note.—(i) Three children under 5 years of age were admitted to the Country branch of the Royal National Orthopaedic Hospital at Stanmore. All were discharged during the year. (ii) 33 children were prescribed and provided with glasses. (iii) 4 children were referred for X-Ray and Electro-Cardiogram. 36 War-time Day Nurseries.—The Governors of Dr. Barnardo's Homes have kindly granted the use of Sunshine House, in the grounds of the Girls' Village Homes, Barkingside, at a nominal rent of 10s. per week, for use as a war-time Day Nursery for mothers in employment. The Nursery accommodates 45 children under 5 years of age and was opened on the 17th August, 1942. The Nursery is open each week-day and the average daily attendance during the period ended 31st December. 1942, was 27 children. The Nursery was in quarantine for a period of 7 days as two children were notified as suffering from Scarlet Fever. Treatment op Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 43 belts and 3 trusses have been supplied to infants suffering from hernia during 1942. A certain number of infants were brought to the Clinics at Newbury Hall and All Saints' Church Hall to receive treatment for minor ailments. 49 children under 5 years of age were operated upon at Queen Mary's Hospital, Stratford, and at King George Hospital, Ilford, for removal of tonsils and adenoids. 7 were treated free of charge as cases of necessity. By arrangement with the Invalid Children's Aid Association 1 child under 5 years of age was sent to a Convalescent Home for a period of 10 weeks. The Council contributed £2 5s. Od. towards the cost of the maintenance of the child. Midwives.—There are 12 State certified midwives (including the Superintendent and 9 Council midwives) resident and practising in the district. In addition there were at the end of the year, 19 State certified midwives at the Council's Maternity Home and 2 at a private nursing home in Ilford. Their supervision has been carried out as in previous years. The Council paid the balance of a private midwife's fee in one case, amounting to £1 5s. Od. Four midwives were suspended from practice for varying periods following attendance on four cases rendering them liable to be a source of infection as follows:—(i) Puerperal Pyrexia due to retained chorion; (ii) Puerperal Pyrexia due to mastitis; (iii) Scarlet Fever and (iv) Non-notifiable Pyrexia following retained membranes. Three of the midwives were in the employ of the Council and the other midwife was a domiciliary midwife in the employ of the Salvation Army. Medical aid was sought in 33 instances where the infant was found to have inflamed or discharging eyes. Three of the cases were subsequently notified as suffering from Ophthalmia Neonatorum. In all cases the condition of the eyes cleared satisfactorily. The Council has adopted the suggestion of the Minister of Health that they should refrain from exercising their power of recovery of the fee of the Medical Practitioner under Section 14 (4) of the Midwives Act, 1918, in this class of case. Council District Midwifery Service.—During the year 931 cases were attended by the nine Council District Midwives. In 552 cases the midwives were engaged to attend as midwives and in 379 as maternity nurses. The cases resided in the following wards : Barkingside 184; North Hainault 140; Cranbrook48; Park 81; Seven Kings 84; South Hainault 115; Loxford 101; Clementswood 107; Goodmayes71. 4,262 ante-natal visits were made during the year. 44 medical practitioners are now participating in the Council's scheme for the ante-natal examination of patients who have engaged a Council Midwife to attend them. Fifty-five patients were referred by the private Doctors to the Council's Consulting Obstetrician at the Ante-Natal Clinic for a further opinion. 13 of these women and 21 other patients who had engaged a Council Midwife (24 as a midwife and 10 as a maternity nurse) were, for various reasons, 37 admitted to the Council's Maternity Home or other Hospitals for confinement. 24 were admitted to the Maternity Home, and 10 to Oldchurch Hospital, Romford. In addition three patients were admitted to the Maternity Home following confinement for various reasons. One patient who had engaged the Council's midwife was admitted to the Council's Maternity Home for ante-natal treatment and subsequently confined at her own home. A Doctor was called in at the time of the confinement or subsequently to 192 of the 552 cases in which a midwife had been engaged. Five cases were notified as suffering from Puerperal Pyrexia, 4 of these cases and 4 other patients were removed to the Isolation Hospital. 4 of the cases had engaged their own Doctor to attend them. One mother transferred to the Council's Maternity Home on account of ante-partum haemorrhage died 14 hours later (2½ hours after delivery) from Shock from inter- and post-partum haemorrhage due to retained placenta. Nine babies were notified as suffering from Ophthalmia Neonatorum. The condition of the eyes cleared satisfactorily. In five instances the midwife was engaged as a maternity nurse. Of the infants born, there were 19 stillbirths. In seven instances the midwife was engaged as a maternity nurse only. Twenty-five infants died. In eleven instances the midwife was engaged as a maternity nurse only. Salvation Army Midwifery Service.—117 eases were attended by the Salvation Army midwives during the year; 98 as a midwife and 19 as a maternity nurse. Ante-Natal Clinics. Maternity Mayesbrook Home Clinic First attendances 682 151 Subsequent attendances 4,953 963 Number of expectant mothers on the rolls on 31st December, 1942 292 54 All patients booked for admission to the Maternity Home are mcdically examined at the Ante-Natal Clinics. During the year, 410 cases other than those booked for admission to the Maternity Home were examined at the Clinics. There were 2,259 attendances by such cases. The Consulting Obstetrician made weekly visits to the Ante-Natal Clinic during 1942 During the year 53 ordinary visits were made, 270 patients referred from the Ante-Natal and Post-Natal Clinics, and 70 patients referred by private Doctors, were examined. A total of 671 examinations were made. X-Ray Examination of Ante-Natal Patients. 21 examinations were made at King George Hospital in 1942. Post-Natal Clinic. The following attendances were recorded:— First attendances 271 Subsequent attendances 340 Number on roll on 31st December, 1942 34 Maternal Mortality.—The total number of deaths due to childbirth during the year was 8, which gives a maternal mortality rate i.e., number of deaths per 1,000 live births of 3.31 (or 3.21 including stillbirths). The causes of death were as follows:—Puerperal Sepsis.—(1) Died in Council's Isolation Hospital: cardiac failure from Toxaemia due to Septicaemia; septic abortion; self induced. (2) Died in Oldchurch County Hospital, Romford; Toxaemia from infected abortion; conviction of manslaughter. Other Puerperal Causes.—(1) Died in Council's Maternity Home; Concealed accidental haemorrhage due to placental separation at childbirth. (2) Confined at and died in Council's Maternity Home; Acute eclampsia. 38 (3) Confined at and died in Council's Maternity Home; Shock from interand postpartum haemorrhage due to retained placenta. (Emergency admission to the Home). (4) Confined at and died in Oldchurch County Hospital; Cerebral Thrombosis; pre-eelamptic Toxaemia; bi-lateral detached retinae; induction of premature labour; Stillbirth. (5) Confined at and died in Oldchurch County Hospital, Romford; Cardiac failure from Toxaemia of pregnancy; Stillbirth. (6) Confined at and died in Oldchurch County Hospital, Romford; Acute left ventricular failure; myocardial degeneration; anaemia hydramnios; hydramnios labour. MATERNITY HOME. During 1942, 396 women were admitted into the Home (66 direct to the Emergency Block and 330 to the Ward Blocks). 679 cases could not be admitted during the year and other arrangements were made for their confinement. At the end of the year 253 eases had booked for future admission to the home. The average number of patients in the home per day during 1942 was 17.1 and the average length of stay of patients was 16.7 days. Emergency Block.—108 cases were treated, 66 being admitted direct to this block and 42 being transferred from the Ward Blocks. 45 of these 66 cases had not been booked for admission to the Maternity Home. 6 of the 66 patients were admitted direct to the Emergency Block for ante-natal treatment and were subsequently transferred to or re-admitted to the Ward Blocks for confinement. The average number of patients in the Emergency Block per day during 1942 was 4.2 (including cases transferred from the Ward Blocks) and the average length of stay of patients admitted direct to this Block was 19.6 days. 55 patients were confined in the Emergency Block (43 admitted direct to this Block and 12 transferred from the Ward Blocks). The six cases mentioned above have been included in the figures for those confined in the Ward Blocks. 39 of the 55 cases were first confinements and 16 were second or subsequent confinements. 14 cases (or 25.5. per cent.) were delivered by means of forceps, 4 following surgical induction; 2 of the infants were stillborn. In addition labour was surgically induced in 8 cases. 3 of the infants were stillborn; 1 infant died aged 14 hours. There were five deaths of infants born in the Emergency Block and twelve stillbirths. Three cases were notified as suffering from Puerperal Pyrexia. Two of these cases and one other patient were removed to the Isolation Hospital. The Consulting Obstetrician or his Deputy was called in to 19 cases as follows:— To perform Caesarean section operations 3 To perform other operations 13 For consultation 3 The reasons for the Caesarian section operations were as follows:— Ante-partum haemorrhage; central placenta praevia 1 Obstructed labour 2 The thirteen other operations were as follows:— Breech Presentations; version 2 Dilatation and curettage 2 Drew Smythe induction of labour 2 Forceps delivery 5 Rupture of membranes on account of (1) intra-partum eclampsia, and (2) ante-partum haemorrhage and central placenta praevia 2 39 One mother admitted in a collapsed and almost moribund condition as an emergency on account of antepartum haemorrhage died 14 hours later (2½ hours after delivery) from Shock from inter and post-partum haemorrhage due to retained placenta. The other 17 cases admitted direct to this block were not confined therein for the following reasons:— Abortion or miscarriage 10 Abortion before arrival at Home 1 Admitted for ante-natal treatment and subsequently evacuated, confined at own home or admitted to Oldchurch Hospital 3 Born before arrival at Home 3 Ward Blocks.—330 cases were admitted to the Ward Blocks. In addition six patients admitted to the Emergency Block for ante-natal treatment were subsequently transferred to or re-admitted to the Ward Blocks for confinement. Twelve patients admitted to the Ward Blocks were transferred to the Emergency Block for confinement. 20 of the 330 cases had not been booked for admission to the Home. Seven cases were not confined in the Home for the following reasons:— Abortions 2 Admitted for ante-natal treatment and subsequently evacuated or confined at Oldchurch Hospital 3 Mother died before delivery 1 Admitted for ante-natal treatment, not yet re-admitted for confinement 1 The average number of patients in the Ward Blocks per day during 1942 was 12.9 and the average length of stay of patients was 16.1 days. In 21 of the 317 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 317 confinements there were:— (a) 193 cases of first confinement. (b) 124 cases having their second or subsequent confinement. (c) 21 cases living in 2 rooms or less (19 being first confinements). (d) 58 cases living in 3 rooms (41 being first confinements). Of the 317 cases, 2 women had engaged their own doctors who were present at the births. Thirty-one cases (or 9.8 per cent.) were delivered by means of forceps, 6 following surgical inductions; 1 of the infants was stillborn and 4 died aged 20 minutes, 6 days, 5 months and 8 months. In addition, labour was surgically induced in 34 cases; 2 of the infants were stillborn and 1 died aged 12 days. The neo-natal death-rate of babies born in the Ward Blocks for the five years 1938 to 1942, was 1.9 per cent. compared with 2.12 per cent. in the district in general. The death-rate of babies who died before 14 days, born in the Ward Blocks for the five years 1938-1942 was 1.7 per cent. The infant mortality rate of children born in the Ward Blocks of the Maternity Home for the five years 1938-1942 was 28.1 per 1,000 births, as compared with 35.4 born in their own homes. The figure of 35.4 has been arrived at after deduction of all deaths of infants born in the Maternity Home, and is calculated on the total births in the district, excluding those in the Maternity Home. There were 7 stillbirths in the Ward Blocks. Sixteen cases were notified as suffering from Puerperal Pyrexia. Six of these cases and eight other patients were removed to the Isolation Hospital. 40 Special visits were made by the Consulting Obstetrician or his Deputy to 10 cases in the Ward Blocks as follows:— To perform Caesarean section operations 4 To perform other operations 3 For consultations 3 One mother, confined in a Ward Block, died from Acute Eclampsia, and another woman admitted with a history of membranes having ruptured, died 6 hours later, un-delivered, from Concealed accidental haemorrhage due to placental separation at childbirth. The maternal mortality rate for the Ward Blocks of the Home for the ten years from 1933 to 1042 is 1.72 per 1,000 births, as compared with the maternal mortality rate in the district generally of 3.44, the rate in each case being calculated on the total live births. Other Maternity Hospitals.—260 cases were admitted to Oldchurch County Hospital during 1942. The fee payable to the Essex County Council is at the rate of 14/- per day. By arrangement, all Ilford cases found to be normal at the first antenatal examination at the Oldchurch Hospital Clinic are referred to the Ilford Ante-Natal Clinics for further examinations until the 36th week of pregnancy. The cases are then referred to the Oldchurch Hospital Clinic again and if still normal are referred again to the Ilford Clinics for examination until the date due for confinement. If any abnormality develops whilst under supervision at the Ilford Clinics the cases are referred to the Oldchurch Hospital Clinic. 196 cases were examined at the Council's Ante-Natal Clinics during 1942, making a total of 881 attendances. These figures are included in the table of attendances at the ante-natal clinics. 41 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE The Board of Education, Form 6 M, desires that the Reports for 1942 might be as brief as possible, and the following is the information which the Board particularly ask for. (a) Nutrition. The summary of heights and weights over 10 years which is printed at the end of this Report in Table VI A. and B. shows no appreciable change. I have added the heights and weights of the children at the Camp Schools for the past 3 years for comparative purposes. (Table VI C.) (b) Incidence of Pediculosis and Scabies. (i) Pediculosis.—This shows a further increase, 63 children being found to be infected with living vermin as against 36 in 1941 and 10 in 1940. (ii) Scabies.—This also shows a further increase, 374 cases (48 from routine medical inspection) being seen at the Minor Ailment Clinics, as compared with 109 in 1941 and 25 in 1940. In addition to the 374, 13 cases were treated privately. There was no particular incidence in any one School. Changes in Staff.—(a) Medical.—Dr. M. B. Marchant commenced duties as Assistant School Medical Officer on the 16th February. (6) Health Visitors and School Nurses.—Miss K. Mathieson terminated her appointment on the 28th February, and Miss F. S. Leader commenced on the 14th December. School Premises.—There are 25 schools, with 42 departments, 14,665 children were actually on the rolls on 12th December, 1942, as compared with 12,299 in December, 1941. The number of children in average attendance at school for the year ended 18th December, 1942 =11,447. On the 12th December, 1942, 1,766 children were in reception areas evacuated under the Government Evacuation Scheme and there were approximately 2,250 private evacuees. The Sanitary Inspectors have paid the usual monthly visits to the elementary schools (1) to enquire as to the milk supplies, (2) to inspect the sanitary arrangements. 363 visits have been made during the year. Medical Inspection.—In accordance with the Board's Circular, 1523, dated the 21st August, 1940, a rapid survey of all the children in the schools was carried out during each term to September, 13,525 examinations were made, 199 were recommended for special treatment and 171 for supplementary nourishment; since the issue of the Board's circular, 1604, dated 28th August, 1942, the School Nurses have carried out "Rapid Surveys" at the Bchools. 6,512 examinations were made, 62 were recommended special treatment and 94 for supplementary nourishment. In addition, a full routine medical examination is made of all the following children seen at each survey:— 42 (a) Newly admitted to Public Elementary Schools, (b) who had attained the age of eight years, (c) who had attained the age of twelve years. Since September, 1942, the Routine Medical Examination of the Intermediate (8 year olds) Group, has been discontinued. During 1942, 5,720 parents, or 87 per cent., attended the full routine medical inspections. Infectious Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1937:— Scarlet Fever. Diphtheria. Measles and German Measles Chicken Pox. Mumps. Whooping Cough. Small Pox. 1937 178 44 58 667 834 373 - 1938 187 62 2,026 539 318 169 - 1939 217 56 42 177 162 419 — 1940 53 30 341 73 6 55 — 1941 107 14 1,401 214 21 495 - 1942 300 7 980 404 373 176 — Disinfection of all the cloakrooms at the public elementary schools was carried out during the Summer and Winter vacations. No schools were closed during the year on account of infectious disease. Table VII shows the incidence of infectious disease in the Ilford schools during 1942. 1,788 home visits were paid by the Health Visitors to cases of minor infectious disease. Diphtheria Prevention Clinics.—The following shows the work carried out at Newbury Hall (104 sessions) and Mayesbrook (61 sessions) Clinics for children of school age during 1942:— Newbury Hall. Mayesbrook. Primary Schick tested 395 221 Positive 324 182 Negative 71 39 Inoculated (full course) 1041 721 Schick+1941 9 — Schick+1942 324 182 Not tested 708 539 Negative after full course of inoculation 548 333 Positive after full course of inoculation and reinoculated 9 5 Awaiting re-test 420 334 Not re-tested after inoculation on account of leaving district, etc. 64 49 Result of final Schick test in 1942 of cases inoculated in 1941: Newbury Hall. Mayesbrook. Positive and re-inoculated 5 2 Negative 131 69 2,079 individual children were treated (1,248 at Newbury Hall and 831 at Mayesbrook) making 11,511 attendances (6,801 and 4,710 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, 8,316 children of school age, and 7,613 children under school age have been immunised. 43 Ringworm:— No. of cases at beginning of 1942. No. of cases reported during 1942. Total. Remedied during 1942. No. of cases under observation at end of 1942. Ringworm:— Scalp — 10 10 6 4 Body — 13 13 12 1 — 23 23 18 5 Following Up.—During 1942, 2,456 home visits by the School Nurses were paid for the purpose, and 1,252 re-examinations of children (some on several occasions) were carried out by the doctors at school; 5 visits to schools were made for this purpose alone, and other children were seen at the visits for routine medical inspection. Medical Treatment. (a) Minor Ailments Clinics.—The attendances during 1942 were as follows:— Newbury Hall Mayesbrook Number of individual children seen 1,563 1,211 Number of attendances of children 3,092 2,563 Number of exclusion certificates granted 983 1,029 Number of certificates of fitness to attend school granted 707 528 The following table shows the conditions dealt with at both the Clinics during the year:— Subnormal Nutrition 164 Uncleanliness:— Head 196 Body — Skin:— Ringworm:— Head 10 Body 13 Scabies 374 Impetigo 148 Other Diseases (Non-Tuberculous) 327 Eye:— Blepharitis 19 Conjunctivitis 11 Defective Vision (excluding Squint) 196 Squint 8 Other conditions 50 Ear:— Defective Hearing 11 Otitis Media 29 Other Ear Diseases 36 Nose and Throat:— Chronic Tonsillitis only 12 Adenoids only 1 Chronic Tonsillitis and Adenoids 137 Other conditions 105 Enlarged Cervical Glands (Non-Tuberculous) 22 Defective Speech 1 Teeth—Dental Diseases 282 44 Heart and Circulation:— Functional 3 Organic 1 Anaemia 6 Infectious Diseases:— Scarlet Fever 1 Whooping Cough 6 Chicken Pox 4 Mumps 6 Colds 80 Lungs:— Asthma 9 Bronchitis 27 Other Non-Tubercular Diseases 7 Norvous System:— Epilepsy 2 Nervous Debility 3 Habit Spasm 2 Chorea 5 Other conditions 4 Deformities:— Genu Valgum 3 Round Shoulders 7 Rickets 2 Flat Feet 28 Lordosis 1 Scoliosis 3 Other forms 24 Minor Injuries 41 Rheumatism 30 Other Defects and Diseases 168 Total number of ailments 2,625 Special Clinics.—Attendances at the various Clinics during 1942, are set out in the following table:— Number of Sessions. Attendances Individual Children. Total Attendances. Clinic. A. B. C. A. B. C. A. B. C. (i) Ophthalmic 102 51 - 616 357 - 1235 704 - (ii) Orthopaedic 20 11 — 312 161 — 490 255 — (iii) Artificial Sunlight 48 52 - 44 28 668 406 - (iv) Remedial Exercises 104 - 52 166 - 83 1839 - 1064 (v) Aural 36 — — 382 — — 677 — — (vi) Rheumatism 16 — - 158 — — 322 — — A=Newbury Hall. B=Mayesbrook. C=All Saints Hall. Note.—(i) 546 children were prescribed and provided with glasses, of which 5 were supplied free. (ii) 12 children of school age were admitted to the Country branch of the Royal National Orthopaedic Hospital at Stanmore and 11 discharged. 58 children were supplied with appliances. (vi) 29 cases referred for X-ray and Electro-Cardiogram and 28 for Blood Sedimentation Rate. 45 School Dentists.—Of 15,172 inspections by the Dentist (including special cases), 9,223 (or 61 per cent.), were found to require treatment, compared with 8,289 (or 65 per cent.) in 1941, 5,583 (or 56 per cent.) in 1940, 10,491 (or 58 per cent.) in 1939, 14,597 (or 64 per cent.) in 1938. In addition to the ordinary dental work of fillings and extractions, a considerable amount of "regulation" work has been done. 78 regulation plates, and 3 dentures were supplied. 1,112 visits were made by children to the Dental Clinic for regulation purposes. The amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the school Dentists:— Age groups (in years) No. of inspection of children No referred for treatment. Percentage. 5 1,430 906 63.3 6 1,718 1,114 64.7 7 1,652 1,108 66.7 8 1,591 1,025 61.3 9 1,655 1,077 64.7 10 .. 1,764 1,066 60.4 11 .. 1,530 954 62.3 12 .. 1,443 886 61.4 13 .. 1,449 908 62.7 14-15 277 179 64.6 Full details of the dental work are shown in Table IV. Treatment for Uncleanliness.—26 statutory notices were served under the Education Act, 1921, Section 87. The School Nurses paid 131 visits to the schools (an average of 5 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 of Children Number Infected. Per cent. 34,101 *888 2.6 *63 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 percentage for the past 5 years were as follows:— 1938 1.5 1939 1.5 1940 1.8 1941 2.8 1942 2.6 These figures do not include the Gilbraltarians housed at the Girls' Village Homes, Barkingside, 475 were inspected in 1942, of whom 95 were found unclean. Other Ailments.—During 1942, 67 children were operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford, 66 as in-patients. 11 children were treated free on necessitous grounds. Under the agreement with the King George Hospital, 75 children were operated on at that Hospital, all as in-patients, for the removal of enlarged tonsils and adenoids, 5 children being treated free on necessitous grounds. In addition to the treatment of tonsils and adenoids, 17 letters were given to Ilford school children, for whom hospital treatment was required, to attend Queen Mary's Hospital. The Open-Air School, which was closed at the outbreak of war, was re-opened on the 7th December, 1942. On the 31st December, 108 children were on the School roll. 46 Provision of Meals and Milk for School Children in War-Time.—The provision of meals in the schools commenced on 7th October, 1940, The total number of mid-day meals served during 1942 was 777,283, approximately 3,475 daily, 70 being free and 3,405 at full or part payment. There are ten kitchens in the Borough, established at the following schools:— Becontree, Benton, Dane, Fairlop, Gearies, Goodmayes, The Mount, Newbury Park, South Park and Uphall. 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. In October, 1942, 10,478 children were receiving milk in school. Of this number 195 received it free of charge. 6,035 were receiving an additional third pint. During the year 317 children were recommended, on medical grounds, to have milk in school, free if parents were not in a position to pay for it, and 78 previously recommended were reported to the Director of Education for continuance. 141 necessitous cases were dealt with during the year for the supply of free Cod Liver Oil, Emulsion, Oil and Malt and Virol. Work done by the N .S. P .C .C.—Total number of cases investigated, 50 (no cases were reported from the Public Health Department for neglecting medical advice; 38 were reported from other sources for general neglect) made up as follows:— (1) Of Neglect 38 (2) Ill-treatment cases 1 (3) Other cases 11 102 children (52 boys and 50 girls) were involved, 51 being of school age In addition to this work, 144 supervision visits were paid to different cases, some of which were made to those reported during the previous year. An annual grant of £2 2s. is made by the Ilford Education Committee to this Society. The Invalid Children's Aid Association.—8 children were sent to residential schools and paid for by the Education Committee in 1942. In addition 16 children were sent to Convalescent Homes or Residential Schools and paid for through voluntary funds. Also 3 children were placed in various Homes, their parents voluntarily paying the full costs. An annual grant of £50 is made by the Ilford Education Committee to this Association. Physically Defective Children.—During 1942, 4 cases were referred for medical examination and report by the School Medical Officer, and the following is a detailed summary of the children dealt with under this heading: Deaf Children.—Recommended special school for Partially Deaf Children 1 Epileptic.—Special school for Epileptics 3 4 Mentally Defective Children:— During 1942, 46 children were medically examined and reported upon under the Mental Deficiency (Notification of Children) Regulations, 1928, classified as follows:— 47 Feeble-minded Children.—Total number certified in 1942 and recommended for admission to a special school (day or residential) 28 Imbecile Children.—Total number certified in 1942 and recommended for notification to Essex County Council 6 Idiots.—Total number certified in 1942, and recommended for notification to Essex County Council 2 Dull and Backward Children.—Total number certified in 1942 and recommended attendance at special class for dull and backward children for one year, and then to be re-examined 10 Idiots, Imbeciles, Feeble-Minded, Dull and Backward Children. Summary of cases at end of 1942:— Idiots. Imbeciles. FeebleMinded. Dull and Backward At Residential Institution 3 8 17 — At Elementary School — — 44 28 At no School or Institution 2 35 9* — Total 5 43 70 28 * 5 of these are over 14 years of age. All feeble minded children and dull and backward children are reexamined once a year and the feeble-minded children are visited at home by the School Nurses at least once a quarter. Employment of School Children and Young Persons.—From special inquiries made at the various schools during 1942, it was found that 7 children were employed out of school hours. 7 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 7 Employment of Children in Entertainments Rules, 1933.—One certificate has been granted during the year by the School Medical Officer. Examination of Officers, etc.—In accordance with the Education Committee's regulations, the undermentioned teachers and other officers were medically examined and reported upon during the year by the School Medical Officer:— Newly-appointed Teachers 31 Teachers—Sickness Regulations 12 Newly-appointed Woman School Enquiry Officer 1 Newly-appointed Supervisor British Restaurants 1 45 School Camps.—The three Ilford School Camps are still in being, and the general procedure outlined in my report for 1940 still continues. Incidence of Infection at the Camp Schools during 1942. Kenny lands. Finnamore Wood Elmbridge. German Measles — — 1 Chicken Pox — — 3 Mumps 20 22 — Pneumonia 1 — — Scabies — 6 6 Ringworm — — 2 Jaundice 1 — 4 Impetigo 10 1 — Glandular Fever — 81 - 48 Medical Officers from the department attended the three School Camps in April and May and again in November-December to Schick and Dick test certain children who had previously been inoculated against Scarlet Fever and Diphtheria, and also to inoculate new admissions, for whom consent forms had already been obtained. The following is a brief summary of the work carried out:— Immunisation. Elmbridge Finnamore Wood. Kenny lands. April Nov. April Nov. April Nov. Scarlet Fever— No. of Dick Tests 45 76 91 95 95 132 Inoculations 64 51 38 79 41 44 Re-inoculations - 9 - 39 - 33 Diphtheria— No. of Schick Tests 24 38 26 37 28 20 Inoculations 30 27 1 25 5 16 Re-inoculations — 2 — 8 — 5 Totals 366 439 419 Table Showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years) in Ilford for 1940 and 1941. The Table also gives a Comparative Percentage of Deaths Registered at all Ages, from 5—15 Years. Disease. Ilford, Percentage of total deaths (all ages). Ilford, Percentage of total deaths at ages 5—15 1940 1941 1940 1941 I. Measles - 0.2 - 3.3 2. Scarlet Fever — — — - 3. Whooping Cough — 0.5 — — 4. Diphtheria 0.3 0.2 9.5 3.3 5. Influenza 1.4 1.5 — — 6. Tuberculosis 4.6 5.4 14.2 6.7 7. Rheumatic Fever 0.1 0.2 4.8 8. Bronchitis, Pneumonia and other respiratory diseases 12.7 10.3 4.8 3.3 9. *Meningitis and Nervous system 11.7 9.2 19.0 6.7 10. Heart Diseases 22.8 24.3 4.8 — 11. Acute and Chronic Nephritis 2.4 2.8 4.8 3.3 12. Violence 11.4 12.6 33.3 60.0 13. Other causes 32.6 32.8 4.8 13.4 100.0 100.0 100.0 100.0 * Excludes Meningococcal infections. Ilford.—The deaths of children of School Age during 1941 represent 1.8 per cent. of the Total Deaths registered (all ages), and during 1940 represent 1.3 per cent. 49 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups:— Entrants 2,279 Second Age Group 2,424 Third Age Group 1,338 Total 6,491 (2) Number of Other Routine Inspections Nil. Grand Total 6,491 b.—other inspections. Number of Special Inspections and Re-Inspections 10,601 Number of Children seen at "Rapid Surveys'' at Schools 20,037 Table II. 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 2,729 197 7.2 2,235 81.9 296 10.9 1 .03 Second Age-Group 2,424 199 8.3 1,974 81.5 248 10.1 3 0.1 Third Age-Group 1,338 209 15.6 980 73.3 148 11.0 1 .07 Total 6,491 605 9.3 5,189 79.9 692 10.6 5 0.1 Group I.—Treatment of Minor Ailments. (Excluding Uncleanliness), for which see Table V. Total Number of Defects treated or under treatment during the year under the Authority's Scheme 2,429 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease No. of Defects dealt with Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Errors of Refraction (including squint) 1024 16 1040 (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) Other Defect or Disease of the Eyes (excluding those recorded in Group I) 26 3 29 Total 1050 19 1069 No. of Children for whom spectacles were:— (a) Prescribed 546 15 561 (b) Obtained 546 15 561 50 Group III.—Treatment of Defects of Nose and Throat. Number of Delects Received Operative Treatment. Received other forms of Treatment. Total Number treated. 142 — 142 Table IV.—Dental Inspection and Treatment. (I) Number of Children inspected by the Dentists:— (a) Routine Age Groups— Age 5 6 7 8 9 10 11 12 13 14 Total. Number 1430 1718 1652 1591 1655 1764 1530 1443 1449 277 14,509 (6) Specials 663 (c) Total (Routine and Specials) 15,172 (2) Number found to require treatment 9,223 (3) Number actually treated 4,726 (4) Attendances made by children for treatment 7,226 (5) Half-days devoted to Inspection 104 Treatment 736. Total 840 (6) Fillings Permanent Teeth 3,395 Temporary Teeth 2,558 Total 5,953 (7) Extractions . Permanent Teeth 960 Temporary Teeth 6,681 Total 7,641 (8) Administrations of general anaesthetics for extractions 1,860 (9) Other operations Permanent Teeth 2,155 Temporary Teeth 515 Total 2,670 Table V.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 5 (ii) Total number of examinations of children in the Schools by School Nurses 34,101 (iii) Number of individual children found unclean 888* (iv) Number of children cleansed under the arrangements made by the Local Education Authority Nil (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-laws Nil * In addition 166 children were found unclean at medical inspection and 196 in the School Clinic. 51 The examinations, as under, of the "Gibraltarians" at the Barkingside Reception Centre are not included in the above:— Number of examinations made = 475 ,, found unclean = 95 ,, of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 = 20 Table VI. Blind and Deaf Children. (1) At a Public Elementary School (2) At an Institution other than a Special School (3) At no School or Institution (4) Total not receiving suitable Education Blind Children — — — — Deaf Children 2 — — 2 Mentally Defective Children. Total number of children notified during 1942, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928 .. .. 2 Table VII. School Medical and Dental Staff. Name of Officer Proportion of whole time devoted to— School Medical Service Public Health S.M.O.—Dr. A. H. G. Burton 1/11 Various according Deputy S.M.O.—Dr. J. H. Weir 9/11 to demands of services. Assistant S.M.O's.:— Dr. D. M. B. Gross 3/14 11/14 M. & C.W. Dr. C. M. Gray 3/11 8/11 Dr. A. Simpson ¼ ¾ Dr. M. B. Marchant ½ ½ Senior Dentist—Mr. M. J. K. Soutter 8/11 1/11 T.B. 2/11 M. & C.W. Dentists—Mrs. G. Shalders Whole – School Nursing Staff. (excluding specialist Nurses, such as Orthopaedic Nurses). Number of Officers Aggregate of time given to S.M.S. work in terms of whole-time officers School Nurses 13 One half Dental Attendants 2 19/22nds 52 53 Table VI. A.—Table Showing the Average Heights and Weights of the BOYS Examined. Age Groups. Age Groups School 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) Becontree 53 109.8 19.6 24 115.2 21.4 22 119.0 24.2 31 125.2 25.8 11 128.1 27.0 17 138.1 31.9 31 140.1 33.8 59 145.7 36.9 22 151.8 42.4 Benton (Open Air) 2 106.0 17.9 10 114.2 19.9 15 119.6 22.2 9 124.0 23.3 4 129.2 24.1 6 135.1 29.0 7 139.3 30.9 3 144.0 32.9 2 153.0 36.0 Chadwell 39 105.8 19.2 14 109.9 21.8 12 116.7 24.9 64 126.7 26.3 17 132.7 30.4 14 138.1 33.2 8 143.6 34.4 — — — — — — Christchurch 7 112.6 20.1 10 117.9 22.0 6 127.3 23.7 13 128.3 25.5 6 131.0 26.9 5 142.0 37.2 6 143.0 35.0 1 145.0 30.8 — — — Cleveland 54 110.9 19.6 27 116.3 21.3 18 120.7 24.0 20 126.8 26.2 16 132.1 30.1 16 139.4 32.8 5 140.0 33.7 2 144.0 33.5 — — — Dane Central — — — — — — — — — — — — — — — — — — 14 139.3 34.9 72 147.1 39.6 32 150.5 42.8 Downshall 94 113.3 20.2 39 116.9 21.6 17 121 .6 23.5 44 120.4 26.3 14 126.3 29.5 22 130.9 31.1 20 141.2 33.6 57 148.9 39.1 19 152.8 40.8 Fairlop 70 110.7 19.8 35 116.8 21.8 20 119.8 22.6 24 126.6 25.5 7 132.2 28.8 11 142.1 33.2 23 142.1 35.0 90 145.2 36.9 23 156.0 42.6 Gearies 33 112.3 20.4 28 116.4 21.9 11 123.0 24.6 50 129.0 27.9 20 130.6 28.7 10 135.4 31.7 14 142.4 39.2 29 148.4 39.6 5 149.7 38.7 Goodmaves 18 111.0 20.3 8 115.0 21.5 15 123.4 24.7 16 126.5 27.8 7 134.7 30.9 8 132.6 29.6 3 137.3 32.8 1 145.0 39.6 — — — Highlands 25 111.2 19.6 24 114.7 20.8 18 120.6 23.6 36 127.9 26.9 5 131.7 30.9 10 137.4 32.5 2 142.0 35.6 — — — — — — Loxford Central — — — — — — — — — — — — — — — 1 146.0 32.0 25 144.6 35.5 103 145.8 37.6 26 149.9 39.9 Mayfield Central — — — — — — — — — — — — — — — 1 136.0 30.8 7 143.1 33.7 52 144.0 36.7 14 151.0 41.1 Mossford 49 111.9 20.3 22 117.0 22.2 7 123.0 25.6 43 127.4 26.3 14 131.3 27.8 9 135.4 30.7 6 139.0 32.9 — — — — — — Newbury Park 27 108.7 19.7 15 116.1 21.8 6 121.3 22.4 18 127.3 27.3 9 133.4 29.6 6 134.2 30.0 4 147.5 34.5 2 150.5 41.9 — — — Parkhill 77 111.0 19.4 40 115 7 22.6 13 120.4 23.5 66 126.5 25.8 15 133.3 29.1 21 137.4 32.5 8 137.4 31.6 1 151.0 40.0 — — — St. Augustines 3 113.7 20.7 — — — 2 125.0 22.4 6 124.8 25.2 3 129.0 28.9 2 135.0 28.1 2 147.5 38.2 5 147.8 39.5 2 154.5 42.8 S .S. Peter & Paul 4 109.0 20.1 6 115.3 23.1 5 119.6 23.0 5 128.4 28.5 6 132.8 29.2 1 137.0 26.8 3 141.7 34.5 9 147.6 38.2 3 156.0 38.8 South Park 59 113.1 20.1 47 116.0 21.3 28 121.5 23.1 59 127.8 26.5 29 134.5 30.4 23 138.7 32.7 8 140.2 32.4 — — — — — — St. Vincent 14 112.1 20.0 17 117.4 22.2 10 120.4 23.6 14 122.4 25.4 10 133.6 29.8 5 136.0 31.6 8 140.4 34.1 23 151 3 41 5 The Mount Central — — — — — — — — — — — — — — — — — — — — — — — — — — — The Redbridge 23 112.6 20.3 15 119.3 22.4 7 126 4 24 4 5 131.4 27.4 5 134.6 29.36 6 133.5 29.8 1 153.0 39.0 — — — — — The Wm. Torbitt Uphall 21 30 111.4 109.8 19.3 19.2 11 11 116.3 114.4 21.4 21 2 5 4 124.6 120.7 26.5 20.0 32 20 128.7 126.6 26.4 25 9 8 9 131.4 129.7 28.9 27.5 9 10 142.1 135.0 32.5 32.2 5 2 146.2 147.0 36.0 37.3 2 — 139.0 — 33.1 — — — — — — Woodlands 33 111.2 19.4 17 115.3 21.4 18 123.1 23.8 25 128.9 26.6 5 132.2 28.8 4 137.5 32.2 2 142.5 35.5 2 140.5 39.1 — — — Ilford Boys—Averages for 10 years. 1942 735 111 .1 19.8 420 114.9 20.9 259 121.3 23.7 600 126.8 26.4 220 131.4 29.2 217 136.9 32.0 214 141.7 34.6 513 146.1 37.8 162 151.3 41.5 1941 377 111 19.6 257 116 21.2 158 122 23.5 519 127 25.9 265 128 28.7 227 137 31.7 201 143 35.9 427 145 37.2 119 151 41.1 1940 626 111 19.5 296 119 21.6 210 122 23.5 632 127 26.1 239 132 28.7 208 136 31.2 296 142 35.1 601 146 37.7 215 151 42.1 1939 634 110 19.4 128 116 21.4 87 120 23.3 739 127 26.3 80 131 28.2 80 134 30.2 72 141 35.0 520 145 37.8 69 151 41.1 1938 982 110 19.5 224 116 21.2 132 120 22.6 1106 127 26.7 160 131 28.2 104 136 31.1 188 141 34.5 770 145 37.3 85 150 40.2 1937 1007 109 19.3 251 110 20.1 152 121 23.6 947 126 25.9 149 131 28.3 153 137 31.3 135 141 33.1 681 146 37.2 118 151 42.3 1936 1040 111 19.4 235 115 20.9 147 121 23.0 964 127 26.0 176 132 28.9 148 136 30.7 166 141 34.3 748 145 36.6 88 150 40.8 1935 897 111 19.2 207 115 20.8 154 121 23.1 1020 126 25.3 154 132 28.5 121 135 30.3 182 141 33.6 773 145 47.5 109 149 39.7 1934 828 110 19.1 218 115 20.9 135 121 23.5 909 126 26.2 167 130 27.8 132 135 30.7 165 141 33.4 832 145 36.7 109 150 40.0 1933 819 109 18.8 207 114 20.9 144 120 22.2 915 125 25.2 141 131 28.6 99 135 29.7 158 140 32.8 846 144 35.9 81 150 40.3 54 Table VI B.—Table Showing the Average Heights and Weights of the GIRLS Examined. 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 School 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) Becontree 40 108.5 18.5 35 113.9 20.0 21 116.6 21.0 41 122.9 24.1 19 130.3 27.9 11 135.9 30.1 11 145.4 36.6 54 146.1 37.7 32 151.7 43.6 Benton (Open Air) 3 110.3 18.3 11 114.3 18.9 3 123.3 18.6 9 123.8 23.3 9 129.8 24.1 4 137.5 27.4 4 139.2 31.5 3 147.6 34.5 3 139.3 36.9 Chadwell 32 110.2 19.1 29 116.3 20.7 5 122.8 25.4 58 126.3 25.5 18 130.0 26.5 30 136.4 31.2 3 144.0 34.9 — — — — — — Christchurch 16 111.4 19.9 17 114.6 21.5 2 128.5 27.5 12 127.6 25.9 2 125.0 24.0 8 135.6 30.1 1 141.0 33.0 — — — — — — Cleveland 35 110.4 18.9 25 114.9 21.0 18 121.7 23.6 27 125.5 25.2 19 132.2 29.9 8 139.0 30.8 6 139.3 30.9 1 141 30.1 — — — Dane Central — — — — — — — — — — — — — — — — — — 17 142.0 34.9 76 144.6 38.1 26 152.6 43.1 Downshall 84 111.2 19.3 45 117.6 21.7 22 121.5 23.3 42 120.2 25.5 13 123.0 28.3 27 132.6 31.2 20 143.5 34.5 50 152.6 40.2 21 156.0 43.9 Fairlop 71 109.0 18.9 38 114.6 20.3 13 121.5 22.9 43 127.2 25.2 8 131.1 25.8 9 134.0 28.5 18 144.0 35.8 44 146.1 36.9 9 153.8 43.3 Gearies 32 109.9 19.1 21 117.1 21.9 18 121.2 22.8 41 128.1 26.2 17 132.4 28.6 14 137.0 31.5 10 142.9 35.3 37 148.8 38.8 9 158.5 49.1 Goodmayes 11 109.2 19.0 14 115.3 20.5 12 120.6 23.2 11 126.9 25.8 7 127.4 27.1 6 135.6 29.8 4 141.5 34.5 — — — — — — Highlands 14 110.5 20.2 14 118.0 22.5 9 123.4 24.8 35 128.4 25.3 15 134.0 29.5 10 140.0 35.0 — — — — — — — — — Loxford Central — — — — — — — — — — — — — — — — — — 15 140.6 35.1 108 148.0 38.9 36 153.5 Mayfield Central — — — — — — — — — — — — — — — — — — 4 145.5 35.8 52 146.0 37.8 20 151.2 42.2 Mossford 46 110.9 19.3 18 114.7 20.2 13 121.5 23.0 28 127.4 25.4 5 131.6 27.6 11 137.9 30.0 2 146.5 33.8 — — — — — — Newbury Park 19 109.0 19.0 15 114.7 20.3 5 118.8 22.4 26 124.8 24.7 6 136.2 30.5 5 138.0 30.3 4 136.0 29.5 — — — — — — Parkhill 54 110.3 19.1 39 115.2 21.1 20 124.9 24.7 56 126.4 25.3 18 131.8 29.0 12 136.6 30.6 8 140.0 33.7 — — — — — — St. Augustines 1 110.0 19.0 4 108.7 18.5 — — — 9 125.2 24.4 2 134.0 28.2 2 133.0 27.8 1 132.0 26.2 4 150.7 44.0 1 157.0 51.0 SS. Peter & Paul 6 110.0 20.9 5 111.2 19.4 3 125.7 24.6 11 126.5 25.7 4 129.7 27.1 5 140.2 33.6 2 140.0 32.0 4 146.0 36.9 1 148.0 35.2 South Park 45 110.7 18.7 31 116.3 21.1 19 123.3 22.8 43 126.5 25.2 20 132.6 28.1 14 132.1 35.6 5 140.8 33.1 — — — — — — St. Vincent's 16 109.5 19.7 12 114.2 21 .4 9 120.2 22.8 14 124.5 24.6 10 130.8 26.7 10 134.9 30.2 6 147.9 35.6 18 148.6 40.2 13 156.4 45.8 The Mount Central — — — — — — — — — The Red bridge 19 111.0 19.3 12 115.8 20.7 17 125.7 24.9 6 127.1 27.4 2 134.5 30.7 6 139.7 30.9 5 141.6 33.9 — — — — — — The Wm. Torbitt 19 109.9 19.0 15 115.7 20.1 8 122.5 24.3 21 125.0 24.9 10 134.2 29.4 7 137.0 30.2 1 156.0 41.0 — — — — — — Uphall 25 106.4 19.0 23 114.8 20.0 10 120.8 23.0 21 124.3 24.4 15 130.6 25.8 9 133.9 28.9 2 141.0 34.9 — — — — — — Woodlands 29 109.2 18.6 25 116.8 21.3 13 119.0 21.9 34 127.1 24.8 19 132.8 28.8 5 134.2 30.3 1 140.0 38.7 — — — — — — Ilford Girls—Averages for 10 years:— 1942 617 110.1 19.1 448 115.4 20.7 240 122.1 23.2 588 126.4 24.4 228 131.1 27.9 213 136.3 30.8 150 142.6 34.5 451 147.8 38.5 171 154.4 43.8 1941 330 110 19.2 268 115 20.6 161 121 23.0 523 127 26.0 255 132 28.1 208 137 31.5 139 142 33.9 423 148 38.5 163 153 43.1 1940 548 110 18.9 286 116 20.7 185 121 23.5 579 127 26.6 216 133 28.3 192 137 30.9 232 143 35.6 540 148 39.8 172 153 44.7 1939 588 110 18.7 121 114 20.7 100 120 23.2 634 126 25.1 87 131 28.3 67 134 30.1 85 142 34.8 567 147 37.7 106 151 42.7 1938 993 110 18.9 221 114 20.5 139 120 22.9 1083 126 25.2 145 130 27.3 127 135 30.2 193 143 35.6 709 147 38.2 122 151 42.5 1937 937 109 18.9 224 114 21.0 144 119 22.3 1022 126 24.1 164 131 27.5 144 136 31.3 205 141 33.9 841 147 38.0 169 152 42.9 1936 897 109 18.6 257 113 20.1 186 121 22.6 1011 125 24.0 158 131 27.4 157 136 30.5 193 142 34.1 805 147 38.1 115 153 42.9 1935 868 110 18.6 232 115 20.3 131 120 22.2 1059 125 25.0 149 130 27.5 168 135 30.1 193 139 32.8 884 146 37.8 140 152 43.6 1934 837 109 18.5 221 114 20.3 150 119 22.6 925 125 24.9 184 129 27.1 155 135 30.4 219 141 34.7 764 146 38.6 154 150 42.2 1933 799 109 18.6 236 114 19.9 152 119 22.1 932 125 24.5 165 129 26.9 129 134 30.0 180 140 32.8 790 147 37.1 117 150 41.3 55 56 Table VI C. Heights and Weights—(Three-year Period = 1940, 1941 and 1942). Comparison of Camp with other Ilford Schools. Camp School. 11—12 12—13 13—14 No. Ex'd. Ht. C'm. Wt. Kilo. No. Ex'd. Ht. C'm. Wt. Kilo. No. Ex'd. Ht. C'm. Wt. Kilo. Kennylands (Beal Boya) 146 142 34.5 154 147 37.7 136 152 41.9 Boys at other Ilford Schools 711 142 35.2 1541 146 37.6 496 151 41.6 Elmbridge (Loxford Boys) 106 140 33.3 157 145 36.7 144 150 39.7 Finnamore Wood (Beal Girls) 188 142 34.9 146 146 40.4 114 153 44.9 Girls at other Ilford Schools 521 143 34.8 1414 148 39.0 506 153 43.8 57 Table VII.—Summary of Cases of Infectious Diseases among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1942. SCHOOLS DISEASES AND CONTACTS No. on Roll Scarlet Fever Diphtheria Measles & German Measles Chickenpox Whooping Cough Mumps Totals, 1942 Totals, 1941 Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Contacts Becontree 1448 19 26 2 3 90 15 9 3 7 4 5 132 51 112 86 Benton (Open Air) 115 — 1 — — 1 — — — — — — 1 1 — — Chadwell 652 47 14 — 1 83 12 86 6 11 1 56 283 34 152 22 Christchurch 533 3 5 — — 4 — 7 4 2 2 6 22 11 72 18 Cleveland 667 16 13 2 1 29 9 13 6 2 1 5 67 30 119 29 Dane 500 2 2 — — — — 8 2 2 — 4 16 4 1 11 Downshall 1203 17 15 1 2 122 19 72 18 3 — 27 242 54 184 42 Fairlop 1318 30 15 — — 14 5 3 — 3 1 8 58 21 223 55 Gearies 1176 13 9 — 1 86 12 50 7 18 2 53 220 31 135 27 Goodmayes 421 21 7 — — 59 7 13 4 9 — 9 111 18 82 13 Highlands 398 3 1 — — 71 11 40 5 42 6 35 191 23 66 8 Loxford Central 375 5 12 — 1 3 2 1 — — — 9 15 8 10 Mayfield Central 761 8 20 1 — — — 1 2 — — 1 11 22 10 7 Mossford 444 7 4 — — 8 2 5 1 1 1 52 73 8 142 23 Newbury Park 366 10 3 — — 3 2 8 1 5 3 60 86 9 156 34 Parkhill 722 23 6 — — 99 12 26 3 1 2 1 150 23 147 43 St. Augustine's 191 3 7 — — — 2 2 — 9 — 1 15 9 32 10 SS. Peter and Paul's 387 6 9 — — 4 5 2 — — 1 — 12 15 17 3 St. Vincent's 356 2 3 — — 9 3 — — 1 — — 12 6 9 3 South Park 815 39 16 1 — 16 4 4 — 9 — 5 74 20 120 11 The Mount Central 364 — — — — — — — — — — — — — — — The Redbridge 399 5 6 — — 57 8 6 1 29 1 15 112 16 151 26 The William Torbitt 371 2 1 — — 44 2 1 — 4 1 — 51 4 103 14 Uphall 269 2 — — — 31 3 16 1 4 — 5 58 4 12 2 Woodlands 414 14 10 — — 104 24 8 1 — 1 19 145 36 67 18 *County High — — 1 — — — — 4 1 — — 3 7 2 29 8 *Private — 3 17 — — 43 5 19 2 14 2 3 82 26 103 21 Totals 14665 300 223 7 9 980 164 404 68 176 29 373 2240 493 2252 544 *Notification of minor infectious diseases in these schools are not received.