LIBRARY ???F 18 Borough of llford Health Report FOR THE YEAR 1943 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, 1942—NOVEMBER, 1943 Alderman George John Wetton, J.P., E.C.C., Mayor. Alderman Thomas Braithwaite, J.P., E.C.C., Deputy Mayor. Aldermen: Billington, Henry. Braithwaite, Thomas, J.P,, E.C.C., Deputy Mayor. Clark, Charles William, L.R.A.M. (Resigned January, 1943). Dane, Frederick Hopper, M.B .E., J .P., C.A., (E.C.C.). Daniels, Russell Stearn. (From January, 1943). Farmas, Claude Augustus, E.C.C. Griggs, Albert Philip, J.P., E.C.C. Smith, Frank Douglas, J.P., C.A. (E.C.C.). Wetton, George John, J.P., E.C.C. Mayor. 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, F.I.A.S., F.V.T. 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, Mrs. Beatrice Alice Louise Anne. Hinton, Charles Stanley. Holmes, Percy. (From February, 1943). Holsess, Richard Thomas. Ingham. Eooar Frank. Parfitt, William Arnold. (Resigned July, 1943). Slater, Frank. (From August, 1943). Spencer, Walter Robert. Taylor, Joseph John, J.P. (From January, 1943). 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. WAR EMERGENCY (EXECUTIVE) COMMITTEE NOVEMBER, 1942-NOVEMBER, 1943 Alderman G. J. Wetton, J.P., E.C.C., Mayor. Alderman T. Braithwaite, J.P., E.C.C., Deputy Mayor. Alderman F. H. Dane, M.B.E., J.P., C.A. (E.C.C.) Alderman R. S. Daniels. Alderman C. A. Farman, E.C.C. Councillor G. Colvin, F.C.I.S. Councillor G. F. Tyler, F.C.I.I. EDUCATION COMMITTEE NOVEMBER, 1942 — NOVEMBER, 1943 Councillor A. W. Green, J.P., C.A. (E.C.C.), Chairman. Alderman R. S. Daniels, Vice-Chairman. Alderman H. Billington Alderman T. Braithwaite, J.P., E.C.C., Deputy Mayor. Alderman F. H. Dane, M.B.E.,J.P., C.A. (E.C.C.), Alderman C. A. Farman, E.C.C. Alderman G. J. Wetton, J.P., E.C.C., Mayor. 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, F.I.A.S., F.V.I. Councillor W. B. Eke. Councillor Mrs. L. Fallaize, J.P. Councillor Mrs. B. A. L. A. Hardino Councillor E. F. Ingham. Councillor W. R. Spencer. Councillor S. W. Taylor. 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. J. J. Taylor, J.P. (To January, 1943). *Mr. F. R. Masters. *Mr. E. R. Lower, B.A. *Mr. A. Beech. *Mr. C. R. H. Webber. (From February, 1943). * 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.). (In H.M. Forces). Dr. L. Lichtenstein, M.D. (Vienna). 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). MrB. G. M. Shalders, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital: Matron of Maternity Home: Miss K. Bellaers. 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. G. W. Newman. P. W. English. R. E. Smalley. A. C. R. Neale. T.F.Johnson, Chief Administrative Clerk: F. J. Hooking, Superintendent of Council's Midwives: Miss C. Blockley. Officers of the Public Health Services—continued Public Analysts-. Bernard Dyeb, D.Sc., F.I.C. George Taylob, F.I.C. J. Hubert Hamence, M.Sc., Ph.D. Masseuse: Miss E. R. Coleman, C.S.M.M.G. (M), Certificate of Medical Electricity, Hospital for Nervous Diseases, London. Veterinary Surgeon: Ralph Bennett, F.R.C.V.S. 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. Mrs. G. H. Hughman. Miss M. Irons. Miss N. M. Le Maitre. Miss I. L. Mobbs. Miss E. du Randt. Mrs. M. D. Smith. Miss D. M. Whitmarsh. Ante-Natal Clinic Nurse: Mrs. D. W. Qcick. Past 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). Miss K. M. Robinson, M.D., F.R.C.S., M.R.C.O.G. Consulting Anaesthetist: Frankis T. Evans, M B., B.S., D.A. Surgeon in charge of Orthopaedic Clinic: J. A. MoLauchlan, M.D., F.R.C.S. Oculist: H. D. Smabt, M.D., B.S. Surgeon in charge of Aural Clinic: W. Ibbotson, F.R.C.S. Physician in charge of Rheumatism Clinic: K. Playfaib, 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. PREFACE. Public Health Offices, Ilford. October, 1944. Me. Mayor, Ladies and Gentlemen, I herewith submit the Annual Report for the year 1943 as required by the Ministry of Health and Board of Education. This is the 24th Annual Report which I have submitted to you, and in October, 1944, 1 shall have been for a quarter of a century Medical Officer of Health to the Town of Ilford. The Health Services have been built up to their present state of efficiency by the correlation of the various activities mentioned year by year in the Annual Report. It will be highly unfortunate for the health of the district if the School Medical Service is to be carried out by one Authority, the Maternity Service by another Authority, the Isolation Hospital by another Authority, and the remainder of the Public Health Services by still another Authority. Such proposals which are at present being envisaged will lead neither to efficiency nor to economy. It is unfortunate that Ilford was not made a County Borough many years ago, and it is also unfortunate that in the new health proposals the Health Services which are primarily concerned with the prevention and detection and treatment of disease in its earliest forms should be mixed up with the treatment of sickness and the sickness benefits which are at present administered by the Insurance Committee. During war-time it is necessary to limit the observations which I might have to make on the advance in the Public Health Services which have taken place during the past 25 years. I would refer the Council again to the Table on page 11 of the Report, which shows the infantile death rate to be 35, very much lower than any of the other comparative figures. It will be noted on page 30 of the Report that 3 deaths from Diphtheria occurred, none of the fatal cases having been previously immunised against Diphtheria, which adds weight again to the insistence with which parents have been advised as to the necessity of this protection. An outbreak of Influenza commenced in November, and together with it many severe cases of Influenzal Pneumonia. By evacuating some of the beds which had been loaned to the Essex County Council for cases of Pulmonary Tuberculosis patients with Pneumonia were able to be admitted to the Isolation Hospital, and it will be noted that on the 1st January, 1944, there were 27 cases in the Hospital. In spite of war-time difficulties and the fact that 2 of the Clinics have not been able to be used for their proper purpose, the large attendances at the Special Clinics will be seen from the figures given in the Maternity and Child Welfare and the School Medical Sections of the Report. Unfortunately, the King George Hospital has found it is unable to establish a Child Guidance Clinic for the examination and psychological treatment of delinquent and difficult children, and I must express my indebtedness to Queen Mary's Hospital, Stratford, for their assistance in allowing such children to attend the Psychiatric Department conducted by Dr. Ffoulkes Edwards. With the war the number of such children has increased, and as I have pointed out on various occasions, it is highly desirable that such a Clinic should be readily available for children only, also that a number of mentally defective children who are educable should not be left as at present without the special means of education which they require. In my Annual Report for the year 1924, I pointed out the difficulties which arose from the position (1) that there are two definitions of feeble-minded persons—for those over the age of 16 years and those under. In those under 16 the question of educability is the sole factor to be considered; (2) that even for persons under the age of 16 years the definitions 6 in the two Acts differ. In the Mental Deficiency Act the lack of educability has to be a permanent one; (3) yet the certificate has to be given under the Mental Deficiency Act, 1913, and not under the Education Act, 1921; (4) the certificate, although given under the Mental Deficiency Act, 1913, is not allowed to be in force after the age of 16. In 1941 the Board of Education appreciated these difficulties and prescribed a separate form for certification of children mentally defective within the meaning of the Education Act. Miss I. Millar, the Matron of the Isolation Hospital, retired in August, 1943, after giving the Council the benefit of an additional year beyond her pensionable period. The invaluable work which Miss Millar did at the Isolation Hospital is well known to the members of the Council as well as to many hundreds of the Ilford ratepayers. The war-time Nurseries have been carrying out their work efficiently, but it will be seen from the Report that the anticipated incidence of so-called minor infectious disease has not been absent. The School Camps also have not been free from the risks of epidemics. It will be seen from the Report how these have been dealt with, and I must express my appreciation to Professor Wilson of the great assistance which he has rendered in the bacteriological examinations required. The Clerical Staff of the Department has been depleted by 12 of its members who have gone into His Majesty's Service, 3 of whom have lost their lives. The resulting increase of work which has fallen upon those remaining has been carried out as is shown by this Report with the utmost industry 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 1943) according to Rate Books 44,500 (appro.) Rateable Value—October 1st, 1943 (Houses and Land) £1,563,687 Sum represented by a penny rate, October 1st, 1943 £6,000 Education Rate— 1942-43 1943-44 Elementary 2s.4.50d. 2s.7.52d. in the £ in the £ Higher (County) 0s.10.83d. 0s. 10.52d. in the £ in the £ ,, (Ilford Council) 0s.0.07d. 0s. 0.06d. in the £ in the £ Combined Rate (all services) 13s. 8d. 14s. Od. 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 January, 1943 152 ,, ,, ,, ,, ,, 1944 60 (6) Number of unemployed females at end of ,, 1943 171 ,, ,, ,, ,, ,, 1944 15 Total M. F. 1943 1942 Live Births Legitimate 2,532 1,283 1,249 Birth Rate per 1,000 of the estimated resident population 18.2 17.2 Illegitimate 89 47 42 Still Births 73 37 36 Rate per 1,000 total (live and still) births 27.1 31.3 Deaths 1,630 841 789 Death Rate per 1,000 of the estimated resident population 11.4 10.6 Percentage of total deaths occurring in public institutions. 36.7 39.5 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 1943 1942 1943 1942 No. 29, Puerperal sepsis 2 2 0.74 0.80 No. 30, Other puerperal causes 6 6 2.23 2.41 Total 8 8 2.97 3.21 8 Death-rate of Infants under one year of age:— 1943 1942 All infants per 1,000 live births 35.1 30.6 Legitimate infants per 1,000 legitimate live births 35.1 30.4 Illegitimate infants per 1,000 illegitimate live births 33.7 35.3 Deaths from Cancer (all ages) 283 292 ,, Measles (all ages) 1 1 ,, Whooping Cough (all ages) 4 2 ,, Diarrhoea (under 2 years of age) 12 3 1. Rainfall. Total rainfall registered in the district during the year was 20.23 inches, the greatest fall in 24 hours was registered on 18th December, being .81 inches. Rain fell on 137 days. 2. Population. The number of patients and resident staff on the 30th June, 1943, at the following public institutions, was:— Claybury Mental Hospital and Emergency Hospital 2,648 West Ham Mental Hospital and Emergency Hospital 1,476 Australasian Hospital (Girls' Village Homes) 115 Total 4,239 3. Births .—The number of births registered during the year was 2,621. Males Females Legitimate 1,283 1,249 Illegitimate 47 42 i.e., 3.39 per cent. of the births registered were illegitimate. The birth-rate, calculated on the net estimate of the population is 18.2 per 1,000. 4. Deaths.—The total number of deaths of Ilford residents was 1,630. This is obtained by taking the total deaths registered in the district (1,416), subtracting the deaths of non-residents occuring in the district (376), and adding the deaths of Ilford residents registered as having died in other districts (590). The death-rate, calculated on the net estimate of the population is 11.4 per 1,000. Inquests.—During the year, 47 inquests were held in the district, 35 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 1 1 — 5 2 12 12 14 Death-Rates from Tuberculosis and Cancer, 1943. The following Table shows the death-rates for 1943 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 .467 .785 Other Tuberculosis .077 .129 Cancer ,. 1.974 2.140 9 5.—Public Assistance Relief.—The total amount expended in Ilford during the year was £22,106 12s. 6d. The average weekly number of cases in receipt of relief was 593, including dependants. The number of admissions to Oldchurch Hospital from Ilford during the year was 1,164, made up as follows:— Men 402 Women 568 Children 194 In addition there were 271 admissions of patients from Ilford to other County Institutions, owing to no accommodation being available at Oldchurch Hospital; their allocation was as follows:— Men 93 Women 166 Children 12 The number of destitute persons admitted to the Institution during 1943 was 16, made up as follows:— Men 3 Women 3 Children ' 10 6. Marriages.—1,241 marriages took place in the Ilford distriot during 1943, 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 Ia gives a comparison of the vital statistics of Ilford with England and Wales, London and other towns. Table II gives a classified statement of the causes of death in 1943, arranged according to the age groups at which deaths occurred. 10 TABLE I.—Vital Statistics of Whole District During 1943 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 1 12 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 1943 1,795 2,621 18.2 1,416 9.6 376 590 92 35.1 1,630 11.4 11 TABLE 1A Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1943 (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 16.5 0.51 12.1 0.00 — 0.02 0.00 0.03 0.03 0.37 5.3 49 126 County Boroughs and Great Towns, including London 18.6 0.63 14.2 0.00 — 0.02 0.00 0.03 0.04 0.36 7.9 58 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census, 1931) 19.4 0.61 12.7 0.00 — 0.02 0.00 0.03 0.04 0.37 4.4 46 London Administrative Co. 15.8 0.45 15.0 0.00 — 0.02 0.00 0.03 0.02 0.27 10.4 58 ILFORD 17.7 0.49 11.0 0 .00 — 0.00 0.00 0.03 0.03 0.26 4.6 35.1 12 Registrar-General's Short List of Deaths and Causes:— TABLE II Causes of, and Ages at, Death during the Year 1943 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 1630 92 15 9 19 33 57 90 189 261 399 466 1 Typhoid and paratyphoid fevers – — — — — — — — — — — — 2 Cerebro-spinal fever 4 — 3 — — — — 1 — — — — 3 Scarlet fever 1 — — — — — — 1 — — — — 4 Whooping cough 4 — 2 2 — — — — — — — — 5 Diphtheria 4 — — 1 2 1 — — — — — — 6 Tuberculosis of respiratory system 67 — 1 — — 8 17 7 18 12 4 — 7 Other forms of tuberculosis 11 1 1 2 — 1 2 1 2 — — 1 8 Syphilitic disease 14 — — — — — — 1 2 2 5 4 9 Influenza 39 1 — — — — — 2 5 2 8 21 10 Measles 1 1 — — — — — — — — — — 11 Acute Poliomyelitis and polioencephalitis 1 — — — 1 — — — — — — — 12 Acute infectious encephalitis 1 — — — — — — 1 — — — — 13 Cancer of buccal cavity and oesophagus (males only) 9 — — — — — — — — 4 2 3 Cancer of uterus (females only) 11 — — — — — — 2 6 1 1 1 14 Cancer of stomach and duodenum 61 — — — — — — — 8 19 27 7 15 Cancer of breast 37 — — — — — — 3 11 8 9 6 16 Cancer of all other sites 165 — — — — — 2 13 24 45 51 30 17 Diabetes 13 — — — — — — 1 1 2 4 5 18 Intra-cranial vascular lesions 163 — — — — — 1 3 11 30 54 64 19 Heart disease 353 — — — — 3 5 12 33 55 99 146 20 Other diseases of the circulalatory system 71 — — — — — — — 3 10 24 34 21 Bronchitis 92 1 — — — 1 3 1 7 17 24 38 22 Pneumonia 70 15 — — 1 1 1 5 11 13 14 9 23 Other respiratory diseases 18 — 1 — 1 — 1 1 5 2 3 4 24 Ulceration of the stomach or duodenum 26 — — — — — 2 2 4 8 7 3 25 Diarrhoea (under 2 years of age) 12 12 — — — — — — — — — — 26 Appendicitis 5 — — 1 — 1 — — 2 1 — — 27 Other digestive diseases 37 1 — — 3 2 — 2 4 6 11 8 28 Nephritis 35 — — 2 — 1 1 5 5 5 11 5 29 Puerperal and post-abortive sepsis 2 — — — — — 1 1 — — — — 30 Other maternal causes 6 — — — — — 4 2 — — — — 31 Premature birth 14 14 — — — — — — — — — — 32 Congenital malformations, birth injury, infantile disease 50 42 2 — — 2 1 2 1 — — — 33 Suicide 18 — — — — 1 1 3 4 4 5 — 34 Road traffic accidents 15 — — — 3 1 1 2 2 2 — 4 35 Other violent causes 55 2 2 — 8 6 5 11 7 3 5 6 36 All other causes 145 2 3 1 — 4 9 5 13 10 31 67 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, 12,373 visits being paid by the nurses in 1943, compared with 11,622 in 1942. Laboratory Facilities.—During the year 762 specimens were examined in the Bacteriological Laboratory at the Isolation Hospital. In addition 15 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 1943, 14 applications for renewal of licences were received ; The Council renewed the licences in respect of the 14 establishments. All the licences expire on 31st March, 1944. Hairdressers' and Barbers' Premises. During 1943, 111 visits of inspection were made to these premises. 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 4 premises). (б) 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. No applications for registration were received. Shops Acts, 1912-1934 (Sections 10 and 13).—During the year 1943, 1,885 reinspections were made. 2 preliminary notices were served, 1 of which was complied with. Maternity and Nursing Homes. On the 1st January and on December 31st, 1943, 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. 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 1943. Mr. Bryan also stated that more than 3,000 chemical, bacteriological and biological analyses were made of the various water supplies during the year 1943, and all were reported on as pure and wholesome and suitable for the purposes of a public supply. Six samples of the two public water supplies were also taken officially by this Department, and all were reported upon as satisfactory. 14 (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 20,181 16 ,, ,, ,, disposed of by barge 19,410 12 ,, ,, ,, ,, at Destructor 560 9 Trade refuse disposed of at Refuse Destructor 210 15 Salvage and Kitchen Waste:— Tons Value Wastepaper 1,345 £ 8,819 Metals 1,353 1,808 Textiles 123 2,502 Bottles 431 1,648 Cullet 489 676 Bones 76 362 Kitchen Waste 2,285 3,428 Rubber 42 105 Miscellaneous 23 132 6,167 £19,480 (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 27,315 Houses and premises reinspected (works in progress) 6,868 Visits during disinfection 1,049 Houses in which nuisances were detected 1,854 Houses in which nuisances were abated 1,207* Premises disinfected 1,075 Premises from which articles only disinfected 154 Articles disinfected 5,879 Premises disinfested for verminous conditions 8 * Includes 250 nuisances detected before 1st January, 1943. Notices served:— Statutory:— Served Complied with Public Health Act, 1936 36 17 Housing Act, 1936 — — Housing Act, 1936 (Overcrowding) 4 2 Factories Act, 1937 — — Provide Dustbin (Ilford Improvement Act) 461 396 Provide Water Supply to Dwelling House 3 2 Cleanse Water Storage Cistern (Byelaws) 1 Cover Water Storage Cistern (Byelaws) — — Informal 1,325 1,099 1,830 1,516 In addition to the above, 250 notices (96 statutory and 154 informal) served previous to 1st January, 1943, were also complied with. Complaints.—During the year, 1,970 complaints of nuisances have been received and investigated. 15 The following is a summary:— Accumulation of manure and refuse 22 Animals improperly kept 18 Bad smells 79 Dampness of premises 99 Defective drains, w.c's and fittings 314 Defective roofs, gutters, downpipes, etc. 198 Defective water fittings 42 Dirty and verminous houses 52 Dirty condition of rearway 13 Flooding of premises 14 Overcrowding 16 Smoke nuisances 11 Miscellaneous 1,092 Total 1,970 (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 (14) in respect of the two indoor baths. All the samples were satisfactory, but in two samples (one each from the 1st and 2nd Class indoor Baths) the chlorine content was below the minimum. (v) Eradication of Bed Bugs:— Houses Found to be infested 27 Disinfested 25 (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 reinterment of human remains at St. Mary's Cemetery, an exhumation licence having been issued by H.M. Home Office. SECTION D.—HOUSING. (i) Overcrowding.—Informal notices were served in respect of 7 premises, 6 of which were complied with. (ii) Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. (iii) 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) 1,096 (6) Number of inspections made for the purpose 4,884 (2) (a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 — (6) 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 1,363 16 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 .. .. .. .. 1.121* 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 Acta:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 48 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 25* (6) By local authority in default of owners — c 4 d. No proceedings were taken under Section 11, 12 and 13 of the Housing Act, 1936. 4. Housing Act, 1936, Part IV—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 16 (ii) Number of families dwelling therein 17 (iii) Number of persons dwelling therein 116½ (6) Number of new cases of overcrowding reported during the year 5 (c) (i) Number of cases of overcrowding relieved during the year 5 (ii) Number of persons concerned in such cases 26 (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 — HOUSING ACT, 1936. During the year 1943, 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 15,867 houses. At the end of the year the total certificates issued to date numbered 18,020 in respect of 24,504 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, 1,337 were received up to 31st December, 1943, and the balance of 6 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 8,186. 17 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) Persons and Premises registered as at 31st December, 1943:— 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 78 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 1 231 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 25 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 182 premises from which milk is retailed in Ilford, 16 are branohes of one firm, 5 of another, and 2 another, 7 retail from dairy shops or stores, 7 from a general shop and 8 from restaurants, 11 are retailers in a small way with rounds; while 40 sell sterilised bottled milk only, 14 sell sterilised milk and also milk in sealed containers, and 72 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 1943 for the sale of:— "Tuberculin Tested" Milk 9 "Pasteurised" Milk . 15 The above include supplementary licences which were issued for "Tuberculin Tested" milk, 2; and "Pasteurised" milk, 3. 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 "Accredited'' milk produced on a farm in the Borough during the year 1943. 18 (iii) Sampling.—The routine practice of sampling was given in the 1938 Report, the following gives the results for 1943:— Grade of milk or ice cream Total Satisfactory Unsatisfactory Remarks , Tuberculin Tested milk 9 8 1 This sample showed a high B. Coli content. The County Medical Officer was communicated with, and also the local retailer. Tuberculin Tested (Pasteurised) milk 11 11 — — Tuberculin Tested (Certified) milk.. 17 15 2 Of the 2 samples, one was unsatisfactory to the methylene blue reductase test and also had a high B. Coli content, the other had a high B. Coli content. In both cases the County Medical Officer was communicated with, and also the local retailers. Pasteurised milk 27 26 1 A letter was sent to the retailer as to the high bacterial count. Ungraded milk 93 69 24 The retailers were communicated with owing to the high B. Coli content or high bacterial count of the unsatisfactory samples, and two letters of warning were sent by the Town Clerk. In 2 cases the supplies were obtained from neighbouring Boroughs and the local Medical Officers were communicated with in these cases. Ice cream — — — — (iv) Tubercular Milk.—36 samples of milk were submitted to a biological test for tuberculosis, none of which were found positive. (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. The Ministry's Divisional Inspector states there was no case of suspected tuberculosis in the Borough during 1943. (vi) Legal Proceedings.—None were taken during the year. (vii) Registration.—No application for registration was refused during 1943. Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Meat—12 cwts. 36 lbs.; 989 tins. Fish—1,003 tins. Vegetables, including beans, peas, etc., 1,291 tins, 258 lbs. Soup—-315 tins. Eggs—75 lbs. dried, 58 pkts. dried, 216 shell eggs. Milk—1,243 tins. 19 Cream—28 lbs. Fish paste—30 jars. Lard—83 lbs. Margarine and Butter—300 lbs. Pudding mixtures—114 pkts., 14 lbs. Cheese— 7 cwts., 85 lbs. Processed cheese in cartons—444. Fruit—1,430 tins, 1 box prunes, 94 lbs. mixed fruit. Sugar—18½ lbs. Jams and Syrups— 559 lbs., 2 jars, 43 tins. Jellies—139 pkts. Pickles—62 jars. Cereals (various)—13 cwts. 39£ lbs., 9 pkts., 18 tins. Flour—33 bags, 1,051 lbs. Dough—20 qtrns. Yeast—10½ lbs. Crumpets—8,730 and 3 lots mixture. Cakes (assorted)—2,663, 6 slabs, 135 lbs. mixture. Custard powder— 26 pkts. Mincemeat—216 lbs. Sweets—359 lbs., 11 boxes and bottles, 2,964 chocolate bars, etc. Tea—4½ lbs. Coffee—4½ lbs. Cocoa—29 lbs. Potatoes—28 cwts. Miscellaneous canned foods—1 ton 2 cwts. 2 qtrs., etc. In accordance with instructions issued by the Ministry of Food a considerable proportion of the above goods were collected by the Ministry of Food Salvage Department. The following were sent to the Refuse Destructor for immediate destruction:— 215 lbs. rabbits, 32 rabbits; 1 pig's head and collar and 11} lbs. pork; 1 crate, 5 stone catfish; 1 crate megrims; 1 crate dogfish; 5 crans herrings; 13 lbs. cod fillets; 11 stone whiting; 5 stone fillets; 21 stone headless cod; 9 stone smoked haddock; 6 stone pilchards; 2 boxes fresh haddock; 5½ stone mackerel and herring (mixed); 5 stone lemon soles; 5 stone codling; 5 stone gurnet; 150 crabs; 81 fish cakes. (i) Food and Drugs Act, 1938.—During 1943, 240 samples (227 formal and 13 informal) of Food and Drugs were obtained, 3 of the formal samples were not genuine. Prosecution was undertaken in one case, as follows:— (a) Milk.—The presence of added water to the extent of 12 per cent. was established. Retailer fined £5 and £1 11s. 6d. costs. Of the remaining two cases, the following action was taken:— (b) Egg Substitute Powder.—A letter of warning was sent by the Town Clerk. The balance of this vendor's stock was taken over by the Ministry of Food, for reconditioning. (c) Mixed Spice.—This sample contained traces of lead, excessive, but not harmful in small proportions. The Analyst could not support prosecution of the firm, but a letter of warning was sent by the Town Clerk. 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. 4 cases were notified under the Act and 1 case of suspected food poisoning was reported to me, but not notified. All were investigated but none found to be cases of genuine food poisoning. Bakehouses.—There are 33 bakehouses in the district, 27 of which use motive power. 191 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 9 instances, and the requests were complied with in 4 cases. Diseases of Animals Acts, 1894-1927. (i) Regulation op Movement of Swine Fever Order, 1922.—Licences were issued for entry into the Borough of 175 pigs. (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 1943. The only sheep in the borough, at a large farm of a public Institution, have been double-dipped unofficially by the owners. 20 (iii) Swine Fever Orders, 1908, 1911, 1912, 1916 and 1917: Swine Fever (Regulation or Movement) Order, 1922: and Amendment Orders 1922 (No. 1), 1936 and 1936 (No. 3).—Owing to the suspicious deaths of pigs on the 24th March at a Public Institution in the Borough, and on the 5th and 14th June at Pig Clubs 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.—328 complaints have been received of the existence of rats affecting 361 premises. In 81 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 466 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 6 petroleum appliances or fittings. The number of Licences issued was 95, and the fees paid to the Council for such Licences was £75 10s. 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 1943:— Officers Teachers Servants New Appointments 102 13 6 Under Sickness Regulations 13 33 31 Totals 115 46 37 TABLE III—Cases of Infectious Diseases Notified during the Year 1943 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 Clement8wood South Hainault Goodmayes Smallpox .. Scarlet Fever 579 3 126 407 24 18 1 — 19 34 50 121 95 43 81 69 67 429 Diphtheria, including Membranous Croup 59 1 8 32 8 10 — — 6 12 4 6 4 6 11 5 5 59 Enteric Fever (Typhoid and Para-Typhoid) — — — — — — — — — — — — — — — — — — Pneumonia 297 30 23 33 18 67 85 41 28 26 23 52 32 24 23 36 53 213 Puerperal Pyrexia 47 — — — 11 36 — — 3 1 — 5 32 1 — — 5 41 Cerebro-Spinal Fever 9 — 2 3 1 3 — — — — — 2 4 — — 1 2 9 Acute Poliomyelitis 1 — 1 — — — — — — — — 1 — — — — — 1 Acute Polio-Encephalitis 1 — — 1 — — — — — — — — — — — — 1 1 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — Dysentery 20 1 — — 3 8 7 1 1 — — 16 1 — 1 — 1 17 Ophthalmia Neonatorum 8 8 — — — — — — — 1 — 1 1 — 2 2 1 2 Erysipelas 76 — — 2 10 20 34 10 1 6 7 18 13 7 10 2 12 26 Pemphigus Neonatorum 1 1 — — — — — — — 1 — 1 Tuberculosis Pulmonary 234 1 3 3 61 114 47 5 21 19 28 43 30 19 13 26 35 — Other Forms 37 1 5 8 11 6 4 2 3 1 6 3 4 7 8 5 — Anthrax — — — — — — — — — — — — — — — — — — Malaria—Relieved to be contracted in this country — — — — — — — — — — — — — — — — — — Believed to be contracted abroad — — — — — — — — — — — — — — — — — — Acute Rheumatism 28 — — 27 1 — — — 1 1 1 8 4 4 5 2 2 16 Measles 2424 70 870 1401 65 18 — — 69 183 208 563 402 140 307 272 280 40 Whooping Cough 566 40 252 268 2 4 — — 15 16 55 140 56 73 77 69 66 16 Food Poisoning 4 — — — 3 1 — — — — — — 4 — — — — 3 Totals 4391 156 1290 2185 218 305 178 59 164 302 377 982 682 321 537 492 534 874 21 SECTION F.—PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. 22 Of the cases notified, the following table shows the percentage created in institutions, including those who were treated in the institutions from which they were notified:— Scarlet Fever 74.1 Diphtheria and Membranous Croup 100.0 Puerperal Pyrexia 87.2 Pneumonia 71.7 The total number of deaths of Ilford residents from the following infectious diseases during 1943 was 215 as against 170 in 1942. 1942 1943 Scarlet Fever — 1 Enteric Fever — — Diphtheria — 4 Measles 1 1 Whooping Cough 2 4 Influenza 12 39 Tuberculosis—Pulmonary 76 67 Other forms 17 11 Pneumonia 54 70 Diarrhoea (under 2 years) 3 12 Cerebro-spinal Fever 3 4 Puerperal Sepsis 2 2 Total 170 215 (a) Smallpox.—No case of Smallpox occurred. The following gives particulars as to Vaccination during 1943:— Certificates of Successful Vaccination 1,473 Postponed 51 Conscientious Objections 678 Unsuccessful Vaccination 32 Left the District 172 (6) Scarlet Fever.—579 cases were notified in 1943. One death occurred at the Ilford Isolation Hospital. 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. 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 1943 579 427 11 2.6 152 2 1.31 (c) Diphtheria.—59 cases were notified in 1943. There were 4 deaths from Diphtheria during the year, 3 at the Ilford Isolation Hospital and 1 at the Grove (L.C.C.) Hospital, Wandsworth. 23 Diphtheria Immunisation.— Tabulae Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1943, to 31st December, 1943. 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 189 — 189 111 — 111 300 Negative 60 — 60 60 — 60 120 Numbers inoculated (full course) 580* 1,597 2,177 439* 839 1,278 3,455 Positive after full course of inoculations, and re-inoculated 7 23 30 8 14 22 52 Negative after full course of inoculations 408 1,094 1,502 320 618 938 2,440 Awaiting re-test 126 432 558 82 164 246 804 Not re-tested after inoculation (on account of leaving District, etc.) 39 48 87 29 43 72 159 Positive after re-test, but not inoculated for same reason — — — — — — — Final Schick Test in 1943 (1942 Cases):— Positive after full course of inoculations, and re-inoculated 9 14 23 6 9 15 38 Negative 359 612 971 271 385 656 1,627 * Schick+1943 = 189; Schick+1942 = 9; Not Tested = 39I * Schick+1943 = 111 Not Tested = 328 During 1943 a total number of 5,240 children attended at the Diphtheria Prevention Clinics (3,231 at Newbury Hall and 2,009 at Mayesbrook), making a total number of attendances of 23,057 (14,463 and 8,594), with an average per session of 136 and 126 respectively. 24 In 1943, under the arrangements mentioned in the 1935 Report, 29 private doctors were supplied with prophylactic for the immunisation of 136 children (108 under 5 years and 28 over 5 years of age). The following is a brief summary:— 1942 Cases: Final Schick Test in 1943:— Negative 58 Positive and re-inoculated 1 Positive and not re-inoculated (left district) 1 No final Schick Test, left district, etc. 5 1943 Cases: Numbers inoculated (full course) by medical practitioners 122 Final Schick Test—Negative 73 Positive and re-inoculated 2 No final Schick Test, left district, etc. 5 Forms not yet returned 14 To be Schick Tested in 1944 28 (d) Ophthalmia Neonatorum.—8 cases were notified during 1943. Of the 8 cases notified, 6 were treated at home by private medical practitioners, 2 were admitted to White Oak (L.C.C.) Hospital, Swanley. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 8 6 2 8 — - - (e) Enteric Fever.—No cases of this disease were notified during the year. (/) Scabies Order, 1941 (dated 28th October, 1941).—403 cases of Scabies 144 adults and 259 children) were reported. 16 Ilford residents were admitted to the Isolation Hospital during the year. Table showing Incidence of Infectious Disease, 1943, 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 i 20—35 35—45 45—65 Over 65 * Cases admitted to Hospital Total Deaths Smallpox Scarlet Fever 579 3 9 19 43 55 320 87 14 24 4 1 427 1 Diphtheria 59 1 — 3 1 4 22 10 6 10 2 - - 59 4 Enteric Fever (including typhoid) - - - - - - - - - - - - - - - Pneumonia 297 30 14 5 2 2 24 9 10 32 43 85 41 197 70 Puerperal Pyrexia 47 — — — — — — 1 1 39 7 — — 41 9 2 Cerebro-spinal Fever .. 9 — 1 — - — 2 - 2 2 - - - Acute Poliomyelitis 1 — — 1 - - - - - - - - - 1 - Acute Polio-Encephalitis 1 - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - 1 - - - 1 1 - Dysentery 20 1 7 3 7 - Ophthalmia Neonatorum Erysipelas .. .. 8 76 8 1 1 4 9 17 34 10 24 1 Anthrax - - - - - - - - - - - - - - - Malaria believed to be contracted - - - - - - - - - - - - - - - in this country - - - - - - - - - - - - - - - Malaria believed to be contracted - - - - - - - - - - - - - - - abroad Pemphigus Neonatorum 1 1 - - - - 14 13 1 - - - - 16 - Acute Rheumatism 28 — — — - Food Poisoning 4 — — — — — — — 1 2 1 — — — 1 Measles 2424 70 150 208 218 294 1267 134 49 34 — — — 35 Whooping Cough 566 40 61 67 57 67 258 10 1 5 - - - 15 4 * Excludes cases occurring at Barnardo's Homes, Clay bury Mental Hospital and West Ham Mental Hospital. 25 26 3. Tuberculosis. During the year 1943 there were 234 new notifications of Pulmonary Tuberculosis and 37 of other forms of Tuberculosis. 21 cases of Pulmonary and 6 cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notifications and Deaths from Tuberculosis of Ilford residents during 1943: Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year 1 - 1 - - - 1 - 1-5 years 2 1 1 4 1 — 1 2 5-15 3 5 3 - - - - 15-25 25 36 5 6 4 4 1 25-35 37 42 2 1 8 9 - 35-45 19 16 3 6 1 1 - 45-55 26 7 2 1 15 3 1 1 55-65 11 3 1 8 4 - Over 65 3 2 1 1 1 3 1 — Totals 127 107 18 19 43 24 8 3 Of the above new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 6 2 Claybury Mental Hospital 2 — Claybury Emergency Hospital 6 1 West Ham Mental Hospital 12 2 Ilford Isolation Hospital 1 — Australasian Hospital (Girls' Village Homes) 7 Of the 78 deaths which occurred of Ilford residents, notification had previously been made of 68 of the cases; of the other 10, 3 were notified after death; 7 were not notified (8.9 per cent. of the deaths or a ratio of 1 in 11). Of the 7 cases not notified (previously referred to), in 4 instances the presence of tuberculosis was discovered following P.M.; in one instance the patient was a service man having no civilian address since discharge from the Army; and in the remaining two instances notification was overlooked. During the year 1943 the following deaths occurred from Tuberculosis:— Pulmonary Non-Pulmonary Ilford Residents 67 11 Non-Residents—- Claybury Mental Hospital 26 1 West Ham Mental Hospital 4 Ilford Isolation Hospital 44 — 27 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurse of the Essex County Council. 993 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 211 73 Improved or fairly well 318 77 Not so well 46 10 In Sanatorium 94 18 No information as to present condition 59 13 Removed from district, etc. 57 17 Totals 785 208 The treatment of Tuberculosis is under the control of the Essex County Council. On the 31st December, 1943, there were 950 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. 101 patients were treated, 13 being supplied with dentures. The Council's Dentist also treated 20 tuberculosis patients from the Ilford Sanatorium. The number of patients from Ilford sent to Institutions under the Essex County Tuberculosis Scheme during 1943 was as follows:— Pulmonary Non-Pulmonary Total Males Females Males Females Adults 49 52 1 102 Children 2 1 1 1 5 Tuberculosis Care Association.—This Association has assisted 76 cases with extra nourishment, clothing, and in other ways.  Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1943 761 185 946 Number of cases entered on register during the year 255 43 298 Number of cases removed from the register during the year:— Pul. NonPul. Recovered 18 7 Deaths 77 7 Left District 44 6 Lost sight of 7 1 Diagnosis not established 2 2 148 23 171 Number of cases remaining on register on 31st December, 1943 868 205 1 073 28 Health Education.—-On 6th January, 1943, a Public Meeting was held under the auspices of the Central Council for Health Education at the Town Hall, Ilford. The chair was taken by His Worship the Mayor and the speaker was Mrs. Davidson of the Central Council for Health Education. Two films, "A Doctor Talks" and "Love on Leave" were shown. Insulin.-—On 4th January, 1943, a Circular (No. 2734) was issued by the Ministry of Health under the Public Health Act, 1936, authorising Local Authorities to assist the poorer inhabitants of the district, until the termination of the war, with supplies of Insulin. Three persons were assisted during 1943 with the Insulin required at half cost. 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 225 factories with mechanical power on the register. There are 205 factories without mechanical power on the register. There are 408 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 (i) (2) (3) (4) Factories with Mechanical Power 354 13 - Factories without Mechanical Power 181 7 - Other premises (not including Outworkers' premises) — — - Total 535 20 2.—DEFECTS FOUND IN FACTORIES. Particulars. Number of Defects No. ol defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) 6 2 - - Overcrowding (S.2) — — - — Unreasonable Temperature (S.3) - - - - Inadequate Ventilation (S .4) 1 1 - — Ineffective Drainage of Floors (S.6) 10 4 - - Sanitary Conveniences (S.7):— Insufficient .. 5 3 - — Unsuitable or Defective 12 8 - - Not Separate for Sexes — — - —- Other Offences 13 3 - — Total 47 21 - - 29 ISOLATION HOSPITAL. 1,246 patients were admitted during 1943. 98.3 per cent, of the cases of diphtheria and 73.7 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 1,246 patients admitted during 1943 suffered from the following complaints:— Puerperal Scarlet Fever 1 Scarlet Fever 604 (194) Scarlet Fever and Measles 1 (1) Scarlet Fever and Chicken Pox 1^(4) Scarlet Fever and Whooping Cough 1(1) Scarlet Fever and Mumps 1(1) Scarlet Fever and Pneumonia 1 Scarlet Fever and Erysipelas 1 Scarlet Fever and Diphtheria 1 (1) Diphtheria 42(9) Diphtheria and Streptococcal Faucitis 1 Mumps 3 Pneumonia 108(8) Pneumonia and Measles 1 Pneumonia and Whooping Cough Pneumonia and Scabies 1 Measles and German Measles 37 (9) Measles and Meningo Encephalitis 1 Whooping Cough 9 Chicken Pox 2 Erysipelas 21 (2) Pemphigus Neonatorum 1 Puerperal Pyrexia 20(3) Cerebro-Spinal Fever 4(2) Acute Aseptic Meningitis 4 Pneumococcal Meningitis 1 Influenza 8 Tuberculous Diseases—Pulmonary 145 ,, ,, Other Forms 4(1) Polio-Encephalitis 1 Acute Rheumatism and Rheumatic Fever 8(1) Bronchitis 12(1) Tonsillitis 14(7) Impetigo and Pyodermia 6 Scabies -. 15 Observation and Other Cases 154 (13) Number of deathB in hospital:— Scarlet Fever (Toxic) 1 Diphtheria 3 Tuberculous Diseases—Pulmonary 53 ,, ,, Other Forms 4(1) Pneumonia 14(1) Pneumonia and Whooping Cough 2 Pneumonia and Mitral Disease 1 Pneumococcal Meningitis 1 Influenza Chronic Bronchitis and Myocarditis 1 Polio-Encephalitis 1 Erysipelas 1 Cerebro-Spinal Fever 1 General Peritonitis 1 Cerebral Tumour 1 Marasmus 1 Convulsions, Gastro Enteritis and Marasmus 1 Acute Infective Hepatitis 1 Multiple Congenital Aneurysm 1 The figures in brackets represent cases admitted from Barking. 30 The average length of stay in Hospital was for:— Scarlet Fever 21.9 days Diphtheria 45.1 Tuberculous Diseases 91.0 ,, Average stay in Hospital of all cases 29.0 ,, The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day 137.5. Scarlet Fever.—The diagnosis of scarlet fever could not be confirmed in 17 patients admitted. One death occurred during the year—a female patient, aged 32 years, five days after admission. 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. 1939 1940 1941 1942 1943 Ilford 1.3 2.4 7.1 Nil 9.1 Three deaths occurred—two male and one female patients, ages 5, 9 and 19 years; one within 7 days of admission, one immediately after admission and the other within 5 days of admission. All were of the toxic type and in view of their occurrence, I sent a circular letter to all doctors in the district informing them of the facts. None of these 3 fatal cases had been previously immunised against Diphtheria. Tuberculosis.—145 cases of Pulmonary Tuberculosis were admitted, as compared with 132 in 1942. Number of patients in Hospital on 1st January, 1943 and 1944. respectively:— 1st Jan., 1943 1st Jan., 1944 Scarlet Fever 50 39 Diphtheria 15 25 Tuberculous Diseases 64 47 Puerperal Pyrexia 2 1 Erysipelas 1 — Pneumonia 8 27 Acute Rheumatism — 5 Mumps 1 — Whooping Cough — 3 Scabies 3 1 Observation and other cases 6 5 The arrangements entered into with the Essex County Council, whereby beds were allocated to the use of Tuberculosis patients, were as follows during 1943:— Block. No. of Beds. Period occupied. Charges per bed per week. 1 26 1 Jan.-31 Dec. 11 Jan.-31 March, at £3 3s., as and when occupied. 2 6 1 Jan.-31 Dec. 1 1 Apri)-31 Dec., at £3 12s. 6d., whether or not occupied. 6 20 1 Jan.-31 Dec. 1 Jan.-31 March, 12 beds, at £2 5s. 1 Jan.-31 March, 8 beds, at £2 12s. 6d. 1 1 April-31 Dec., 20 beds, at £3 12s. 6d. 1 whether or not occupied. 10 20 1 Jan.-25 Nov 1 Jan.-31 March, at £3 3s., as and when occupied. 1 April-25 Nov., at £3 12s. 6d., whether or not occupied. On the 25th November it became necessary to evacuate the 20 beds in Block 10 in order to provide accommodation for persons suffering from influenzal pneumonia. 31 Training of Nurses.—During 1943 3 nurses passed Parts X and II and 2 passed Part I of the Preliminary examination of the General Nursing Council, and 18 obtained the Certificate by passing the final examination (2 probationers, 16 staff nurses). The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick tested during 1943, and also the number inoculated:— Numbers Schick Tested:— Nurses Domestics Positive 23 8 Negative 18 10 Numbers inoculated (full course) 17 8 Numbers re-tested:— Negative after full course of inoculations .. Positive after full course of inoculations, and re-inoculated 2 3 Numbers Dick Tested:— Positive 18 8 Negative 22 10 Numbers inoculated (full course) .. 15 7 Numbers re-tested:— Negative after full course of inoculations .. — — Positive after full course of inoculations, and re-inoculated 4 No member of the Nursing Staff contracted Scarlet Fever or Diphtheria during the year. 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 1943 the number of cases admitted was 258. Payment was at the agreed rate of 12s. 6d. per day, plus a charge of 2s. per mile for use of ambulance. Reciprocal Arrangements—Waltham Joint Hospital Board.—The arrangements made in 1938 continued during the year, although it was not necessary to use them. The agreed charge for maintenance is 12s. 6d. per day. 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 1943 was 1,824 (916 males and 908 females). Of these, 52 (26 males and 26 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition. 851 notifications of birth (435 males and 416 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, 16 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 7.51 By Certified Midwives 89.25 By Parents and Others 3.24 In addition. 41 stillbirths (23 males and 18 females) were notified. The notifications of 26 stillbirths (12 males and 14 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 92, the total number born being 2,621. 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, 35.1. Neonatal Mortality.—The death-rate of infants under four weeks of age is known as the'Neonatal Mortality. There were 54 deaths of infants under four weeks of age during 1943 and the rate for the year was 20.6 per 1,000 live births. The deaths of infants under one month increased from 49 during 1942 to 54 during 1943. The following table gives the deaths of infants under one year of ago, 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 weeka 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 Tuberculous Meningitis 1 i Bronchitis — — 1 — i — — — — i Pneumonia (all forms) 3 2 1 1 7 5 6 3 3 24 Enteritis — — — — — 4 4 — 2 10 Convulsions — — 1 1 — — — 1 Suffocation (overlying) 1 1 Injury at birth 2 — — — 2 — — — — 2 Atelectasis 5 — — — 5 — — — — 5 Congenital Malformations 6 4 — 3 13 3 1 — — 17 Premature birth 17 — — — 17 — — — — 17 Atrophy, Debility and Marasmus 1 1 o 1 3 Other causes 5 — 1 — 6 2 1 1 — 10 Totals 39 6 3 6 54 14 13 5 6 92 34 Foster-Children. Number of foster-children on register on 1st January, 1943 36 Number of foster-children who were notified during 1943 19 Number of foster-children returned to their mothers during 1943 10 Number of foster-children taken off register for various other reasons during 1943 21 Number of foster-children on the register on 31st December, 1943 24 Foster-Mothers . Number of foster-mothers with children on the register on the 1st January, 1943 30 Number of persons who became foster-mothers during 1943 15 Number of foster-mothers whose names were taken off the register during 1943 25 Number of foster-mothers with children on the register on the 31st December, 1943 20 Number of houses visited by the Sanitary Inspectors for the purpose of the Act during 1943 15 Number of visits made by the Sanitary Inspectors for the purpose of the Act during 1943 34 Adoption of Children (Regulation) Act, 1939.—This Act came into operation on the 1st June, 1943. Section 7 of the Act in which Welfare Authorities are concerned, provides inter alia:— (a) That any person (other than a registered adoption society or a local authority, and not being the parent or guardian or a near relative of the child or the person in whose care or possession he is to be placed), who participates in making arrangements for the adoption of a child under the age of nine years, must give notice, in writing, of the arrangements to the Welfare Authority for the area in which the adopter resides, not less than seven days before possession is taken of the child by the adopter. This does not apply when an adoption order is made. (b) That an adopter must notify a Welfare Authority if he changes his address or if the child dies. In the latter event he must also notify a coroner. No notices were received during the year. 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 1943 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 2.786 Subsequent visits to children under 1 year of age 7,656 Subsequent visits to children over 1 year of age and under 5 18.567 Visits to expectant mothers 352 Home visits for other reasons 2,773 Total visits paid 32,134 Issue of Clothing Coupons to Expectant Mothers.—The issue of additional clothing coupons to each expectant mother to enable her to buy materials for garments for her baby was made through the Public Health Offices from the inception of the Scheme by the Board of Trade on the 7th August, 1941 until the 24th July, 1943, when the distribution was taken over by the Ministry of Food through the Local Food Office. During 1943 additional coupons were issued to 1,601 expectant mothers from the Public Health Offices. Supply of Milk to Expectant and Nursing Mothers and Infants.— A total of 1,002J lbs. of dried milk were given free under the Regulations of the Ministry of Health during 1943 to 65 infants. These figures include the supplementary issue of 90 20 oz. packets of National Dried Milk to 17 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. 85 Special Clinics.—Attendances of children under 5 years of age and expectant and nursing mothers at the various Clinics during 1943 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 HI 62 — — 23 3 — — 55 21 — 122 57 (ii) Orthopaedic 31 14 — — — 1 — — 231 89 — — 379 156 — — (iii) Artificial Sunlight 41 42 — — — — — — 26 36 — — 449 506 — — (iv) Remedial Exercises 91 — 46 — — — — — 22 — 4 — ' 190 — 26 — (v) Aural .. .. 48 — — — 1 — — — 156 — — — 236 — — — (vi) Rheumatism "77 .. 77" 25 — ■ — — 6 — — — 24 — — — 49 — — — (vii) Dental — 11 — 145 — 50 — 535 — 15 — 179 — Ill — 1577 A=Newbury Hall. B = Mayesbrook. C=A11 Saints Hall. D = Valentines Dental Clinic. Note.—(i) One child under 5 years of age was admitted to the Country branch of the Royal National Orthopaedic Hospital at Stanmore. (ii) 51 children were prescribed and provided with glasses. (iii) 5 children and 1 expectant mother were referred for X-Ray and Electro-Cardiogram. 36 War-time Day Nitrseries.—The following War-time Day Nurseries for children under 5 years of age. whose mothers are in employment, have been opened:— Situation. Date of Opening Accommodation (Children) Average Dai durin Including Saturday y Attendance g 1943 Excluding Saturday No. of Days in Quarantine Reasons for Quarantine Sunshine House, Girls' Village Homes, Barkingside 17.8.1942 45 27 29 258 8 cases of Chicken Pox. 1 case of Diphtheria. 20 cases of Measles. 3 cases of Mumps. 3 cases of Scarlet Fever. 14 cases of Whooping Cough. 359-381, Green Lane, Seven Kings 5.5.1943 50 32 35 62 1 case of Chicken Pox. 2 cases of German Measles. 1 case of Mumps. 3 cases of Scarlet Fever. 226-236, Ley Street, Ilford 16.8.1943 50 1 30 32 79 11 cases of Chicken Pox. 1 case of Mump3. 4 cases of Scarlet Fever. 2 cases of Whooping Cough. 37 Infant Welfare Centres.—80 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1943. During the year the following attendances were recorded:— Total number of attendances of infants 45,821 First attendances 2,225 Total number of children on roll, December 31st, after omission of all those who had not attended for six mcDthb 3,380 14,022 attendances of children from 1 to 5 years were made at the Infant Welfare Cert.res during the year. Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 20 belts and 5 trusses have been supplied to infants suffering from hernia during 1943. A certain number of infants were brought to the Clinics at Newbury Hall and All Saints' Church Hall to receive treatment for minor ailments. 50 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. 12 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 St. Vincent's Orthopaedic Hospital, Pinner, for a period of 13 weeks. The Council contributed £8 2s. 6d. towards the cost of the maintenance of the child. Midwives.—There are 14 State certified midwives (including the Superintendent and 11 Council midwives) resident and practising in the district. In addition there were at the end of the year, 20 State certified midwives at the Council's Maternity Home and 3 at a private nursing home in Ilford. Their supervision has been carried out as in previous years. 7 Midwives (5 on 2 occasions) were suspended from practice for varying periods following attendance on 10 cases rendering them liable to be a source of infection, as follows:— Notified cases of Puerperal Pyrexia due to Haemolvtic Streptococcal infection (3); Sub-involution and foot drop; Sub-involution; Gervical tear and sub-involution; Mammary abscess (2) and non-notified cases of Pyrexia due to Thrombo Phlebitis of both legs and Thrombo Phlebitis of left leg. 0 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 16 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 821 cases were attended by the eleven Council District Midwives. In 447 cases the midwives were engaged to attend as midwives and in 374 as maternity nurses. The cases resided in the following wards : Barkingside 173 ; North Hainault 127; Cranbrook 49; Park 48; Seven Kings 92 ; South Hainault 106 ; Loxford 105; Clementswood 80; Goodmayes41. 4,247 ante-natal visits were made during the year. 49 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. 23 of these women and 23 other patients who had engaged a Council Midwife (24 as a midwife and 22 as a maternity nurse) were, for various reasons, 38 admitted to the Council's Maternity Home or other Hospitals for confinement. 33 were admitted to the Maternity Home, 8 to Oldchurch Hospital, Romford, 2 to King George Hospital, Ilford, 2 to Queen Mary's Hospital, Stratford, and 1 to Queen Charlottes Hospital. In addition three patients were admitted to the Maternity Home following confinement for various reasons. Five patients who had engaged a Council midwife were admitted to the Council's Maternity Home for antenatal treatment and subsequently confined at their own homes, evacuated or admitted to Oldchurch Hospital. A Doctor was called in at the time of the confinement or subsequently to 156 of the 447 cases in which a midwife had been engaged. Ten cases were notified as suffering from Puerperal Pyrexia, 5 of these cases and 2 other patients were removed to the Isolation Hospital. 4 of the cases had engaged their own Doctor to attend them. One mother who had engaged her own Doctor to attend her died 8J hours after delivery from cardiac failure and post partum haemorrhage. Four babies were notified as suffering from Ophthalmia Neonatorum. The condition of the eyes cleared satisfactorily. In one instance the midwife was engaged as a maternity nurse. Of the infants born, there were 15 stillbirths. In three instances the midwife was engaged as a maternity nurse only. Twenty-four infants died. In ten instances the midwife was engaged as a maternity nurse only. Home Helps.—At the end of 1943 there were 13 Home Helps available for full time employment at the homes of expectant and nursing mothers and where there were children under 5 years of age. During the year 200 cases were attended. Salvation Army Midwifery Service.—132 cases were attended by the Salvation Army midwives during the year; 123 as a midwife and 9 as a maternity nurse. Ante-Natal Clinics. Maternity Mayesbrook Home Clinic First attendances .. .. .. 988 209 Subsequent attendances .. .. 7,302 1,176 Number of expectant mothers on the rolls on 31st December, 1943 .. 382 91 All patients booked for admission to the Maternity Home are medically examined at the Ante-Natal Clinics. During the year, 596 cases other than those booked for admission to the Maternity Home were examined at the Clinics. There were 3,118 attendances by such cases. The Consulting Obstetrician made weekly visits to the Ante-Natal Clinic during 1943 During the year 52 ordinary visits were made, 397 patients referred from the Ante-Natal and Post-Natal Clinics, and 55 patients referred by private Doctors, were examined. A total of 956 examinations were made. X-Ray Examination of Ante-Natal Patients. 66 examinations were made at King George Hospital in 1943. Pcst-Natal Clinic. The following attendances were recorded:— First attendances .. .. .. .. .. 446 Subsequent attendances .. .. .. .. 439 Number on roll on 31st December, 1943 .. 44 Nutrition.—In March, 1943, the Ministry of Health conducted surveys of expectant and nursing mothers at the Clinics at the Maternity Home. The results of the inspection are as follows:— "58 women only presented themselves for examination—38 ante-natal; 20 post-natal. Of the former it was the 1st pregnancy in 29; 2nd in 7; 1 woman previously had a miscarriage and a stillborn child; 1 woman had had 2 previous children. 39 It is noteworthy that 11 of the 29 women in their first pregnancy were over 30 years of age, the oldest being 39. Of the total of 38 all were in an excellent state of nutrition except (1) a 34 year old woman who earlier on had had "vomiting" and phlebitis and latterly dyspepsia; she showed no signs of hypovitaminosis, (2) the woman aged 29 who had had the miscarriage and stillbirth. There was one case aged 22 who exhibited probably a mild degree of riboflavin deficiency—she showed an early angular stomatitis, a tongue with hvpertrophied papillae, a fine scurfy dermatitis of forehead, conjunctival and pericorneal injection with fine "streamer" invasion of the cornea. Otherwise there is little to record. 4 others showed red enlarged fungi form papillae at tip and edges of tongue, in the distribution more diffuse. Minor caries noted in a few, for the most part treated. Only 1 case of gingivitis and that of hypertrophic type. Beyond those mentioned, 10 showed a mild pericorneal injection and 2 a minor degree of "streamer" formation. In the post-natal group (total 20), 15—1st pregnancy; 5—2nd pregnancy. Five were not in such good condition as the remainder, and 4 exhibited pallor, but it was generally stated that they had never been fat and always pale. The only case of interest was a very fat woman of 30 exhibiting scurvy dermatitis of face, enlarged lingual papillae, pericorneal injection and "streamers." All 20 women showed some pericorneal injection—fairly well marked in 8, less marked in 8; 2 other cases showed some "streamers." 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 3.05 (or 2.97 including stillbirths). The causes of death were as follows:—Puerperal Sepsis.—(1) Died at Stepney, E .1; general peritonitis due to an instrumental abortion; conviction of manslaughter. (2) Confined at and died in Oldchurch Hospital, Romford; puerperal septic infection, post partum haemorrhage. Other Puerperal Causes.—(1) Died at Leyton, E.; Shock from instrumental abortion; conviction of murder, but reduced to manslaughter and using instrument to procure miscarriage. (2) Confined at and died at Woodside Nursing Home, Woodford; Obstetric shock, prolapsed uterus. (3) Confined at and died in London Hospital, E.l; Pulmonary embolism due to thrombosis of the uterine veins following Caesarian section for toxaemia of pregnancy. (4) Confined at and died in own home; Cardiac failure; post-partum haermorrhage. (5) Confined at and died in Victoria Hospital. Romford; Eclampsia, albuminuria of pregnancy. (6) Confined at and died in Queen Mary's Hospital, Stratford, E.15; Toxaemia of pregnancy. MATERNITY HOME. During 1943, 601 women were admitted into the Home (70 direct to the Emergency Block and 531 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 401 eases had booked for future admission to the Home. The average number of patients in the Home per dav during 1943 was 26.9 and the average length of stay of patients was 16.3 days. Emergency Block.—111 cases were treated, 70 being admitted direct to this Block and 41 being transferred from the Ward Blocks. 37 of these 70 cases had not been booked for admission to the Maternity Home. 6 of the 70 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 1943 was 4.5 (including cases transferred from the Ward Blocks) and the average length of stay of patients admitted direct to this Block was 15.9 days. 40 49 patients were confined in the Emergency Block (39 admitted direct to thia Block and 10 transferred from the Ward Blocks). The six cases mentioned above have been included in the figures for those confined in the Ward Blocks. 31 of the 49 cases were first confinements and 18 were second or subsequent confinements. Eight cases (or 16.3 per cent.) were delivered by means of forceps, 1 following surgical induction; 1 of the infants was stillborn. In addition labour was surgically induced in 7 cases. One of the infants was stillborn. There were four deaths of infants born in the Emergency Block and four stillbirths. Nine cases were notified as suffering from Puerperal Pyrexia. Three of these cases and five other patients were removed to the Isolation Hospital. The Consulting Obstetrician or his Deputy was called in to 16 cases as follows:— To perform Caesarean section operations .. .. 2 To perform other operations .. .. .. .. 13 For consultation .. .. .. .. .. 1 The reasons for the Caesarian section operations were as follows:— Ante-partum haemorrhage; extended breech; failed version; placenta praevia .. .. .. 1 Ovarian cyst ., .. .. .. .. .. 1 The thirteen other operations were as follows:— Dilatation and curettage .. .. .. .. 3 Drew Smythe induction of labour . .. .. 2 Excision of Bartholin cyst .. .. .. .. 1 Excision of polypi arising from posterior vaginal wall and containing varicose veins .. .. 1 Forceps delivery .. .. ... .. .. 5 Removal of adherent placenta .. .. .. 1 The other 25 cases admitted direct to this Block were not confined therein for the following reasons:— Abortion or miscarriage .. .. .. .. 13 Abortion before arrival at Home .. .. .. 2 Admitted for ante-natal treatment and subsequently evacuated or confined at own home .. .. 4 Born before arrival at Home (including one stillbirth). 6 Ward Blocks.—531 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. Ten patients admitted to the Ward Blocks were transferred to the Emergency Block for confinement. 43 of the 531 cases had not been booked for admission to the Home. Nine cases were not confined in the Home for the following reasons:— Abortion .. .. .. .. .. .. .. 1 Admitted for ante-natal treatment and subsequently evacuated, confined at own home, Queen Mary's Hospital or at Oldchurch Hospital .. .. 7 Admitted for ante-natal treatment, and left district 1 The average number of patients in the Ward Blocks per day during 1943 was 22.4 and the average length of stay of patients was 16.4 days. In 39 of the 518 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 518 confinements there were:— (a) 312 cases of first confinement. (b) 206 cases having their second or subsequent confinement. (e) 24 cases living in 2 rooms or less (20 being first confinements). (d) 90 cases living in 3 rooms (62 being first confinements). 41 Forty-five cases (or 8.7 per cent.) were delivered by means of forceps, 11 following surgical induction; 1 of the infants was stillborn and 2 died aged 40 minutes, and 15 minutes. In addition, labour was surgically induced in 55 other cases; 1 of the infants was stillborn. The nco-natal death-rate of babies born in the Ward Blocks for the five years 1939 to 1943, was 1.82 per cent, compared with 2.18 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 1939-1943 was 1.62 per cent. The infant mortality rate of children born in the Ward Blocks of the Maternity Home for the five years 1939-1943 was 26.6 per 1,000 births, as compared with 35.0 born in their own homes. The figure of 35.0 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 14 stillbirths in the Ward Blocks. Twenty-one cases were notified as suffering from Puerperal Pyrexia. Six of these cases and five other patients were removed to the Isolation Hospital. One baby notified^as suffering from Pemphigus Neonatorum was removed to the Isolation Hospital. Eight other babies were also sent to the Isolation Hospital for the following reasons; (1) Abscess of face, (2), (3) Finger sucking, (4) Impetigo, (5) Septic fingers, (6) Staphylococcal conjunctivitis, (7), (8) Staphylococcal infection of eye. Special visits were made by the Consulting Obstetrician or his Deputy to 34 oases in the Ward Blocks as follows:— To perform Caesarean section operations 6 To perform other operations 16 For consultations 12 There were no deaths of mothers admitted to the Emergency Block or Ward Blocks of the Home during the year. The maternal mortality rate for the Ward Blocks of the Home for the ten years from 1934 to 1943 is 1. 49 per 1,000 births, as compared with the maternal mortality rate in the district generally of 3.36, the rate in each case being calculated on the total live births. Training of Pcpil Midwives.—As mentioned in my Report for 1943 the Home has been approved by the Central Midwives Board as a Part 1 Training School for not less than ten pupil midwives in training at one time. 11 pupil midwives commenced their training at the end of September, 1943. Gas and Air Analgesia.—A Hospital Model Walton Minnitt Gas Air Machine has been provided for the purpose of producing analgesia during labour. Gas and air was administered to 116 patients during the year. The Home has been approved by the Central Midwives Board for the purpose of providing instruction in the essentials of obstetric analgesia and in the use of a recognised apparatus such as that provided at the Home. OTHER MATERNITY HOSPITALS. (a) Oldchurch County Hospital.—295 cases were admitted to Oldchurch County Hospital during 1943. 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 Clinio 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. 42 307 cases were examined at the Council's Ante-Natal Clinics during 1943, making a total of 1.891 attendances. These figures are included in the table of attendances at the ante-natal clinics. In October, 1943, the Essex County Council advised the Ilford Council that owing to the pressure on the maternity beds at Oldchurch County Hospital it would not be possible to admit maternity cases from Ilford to the Hospital after that month other than those cases already booked. Following representations to the Ministry of Health and the Essex County Council the latter decided to accept 15 maternity patients from Ilford for the three months of April, May and June, 1944. (6) Queen Mary's Hospital, Stratford.—In June, 1943, the Chairman of Queen Mary's Hospital advised me that the maternity wing at the Hospital would be re-opening on the 1st July, 1943. and that a limited number of patients from Ilford could be admitted at a charge of 10/- per day. Seven cases were admitted for confinement to the end of 1943. 43 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE The Board of Education, Form 6 M, desires that the Reports for 1943 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. 1 have added the heights and weights of the children at the Camp Schools for the past 4 years for comparative purposes. (Table VIC.) In March, 1943, the Ministry of Health conducted surveys of the nutrition at Ilford of factory workers, school children, expectant mothers and nursing mothers. The results of the inspection of the school children are of interest. 1. In a school of boys and girls of the 11-14 age group, the children examined consisted of 52 boys and 43 girls, a total of 95. 9 boys classified as of only fair nutrition; 1 as poor. 5 girls of fair nutrition. 3 boys and 1 girl showed facial pallor. Folliculosis in 9 boys and 7 girls. 1 cheilosis, I angular stomatitis—both boys. The tongue showing red enlarged fungiform papillae against a greyish background as described later was seen in 20 boys and 22 girls. Minor caries present in 30 children—15 in each sex. Gingivitis in 9 children. 7 showed some conjunctival injection. S girls and boys exhibited pericorneal injection. 2 of the former ' 'streamers''. In only one case was there any association of signs—a girl aged 13 of good nutrition showed pallor, folliculosis, hvpertrophied tongue papillae, minor caries, gingivitis, conjunctival and pericorneal injection. One girl exhibiting * 'streamers'1 had associated folliculosis, minor caries, and was a well nourished 12 year old. 2. In a school of senior girls aged 11-14 (total scholars 230 with a 25 per cent, non-attendance), 100 girls were examined. School dinners are provided. 19 were considered as below the nutritional standard, of the remainder these were in the 11-12 age group, i.e., they were still in the ' 'skinny" age period. 5 were pale and belonged to the same group. 15 showed scurfy patches or seborrhoea. In 15, folliculosis present. No cheilosis or angular stomatitis. The tongue above mentioned and referred to below was noted in 31. 1 girl exhibited a "furrowed" tongue. 16 cases of minor caries noted; 1 case in which more marked caries was present . 2 cases of gingivitis and 1 of gum hypertrophy. 17 cases of pericorneal injection and 11 in which condition minimal. 44 3 girls had "streamers"; 3 conjunctival injection. Very few exhibited anything worthy of note in the way of association of signs. 1 girl aged 13, well-nourished, showed hvpertrophied tongue papillae, well-marked caries, gingivitis and pericorneal injection. County High School for Boys.—140 boys were examined. 89 nutrition good; 37 fair; 14 poor. Those marked fair and poor were all younger boys, mostly aged 11-13, who had not grown out of the "skinny youngster" stage. As is commonly seen among boys of this age-group 11-16 there were marked variations in height . In some cases deficient growth was associated with past illness— "a patch on the lung", hay fever; in others the parents were said to be of small stature. Pallor was noted in 19; of these nutrition was marked before normal in 14. 32 showed folliculosis, these cases were for the most part in the 11-13 age group. 4 had more generalised hyperkeratosis and 2 were classed as congenital. 7 showed the knee-elbow distribution hyperkeratosis. In 61 boys a condition of the tongue was remarked which consisted of a mild degree of furring of the dorsum with reddened tip and edges which were the seat of numerous enlarged red papillae; in many these same hypertrophic papillae were scattered over the whole dorsum. Microscopically the whole of the filiform papillae were enlarged and oedematous in appearance, while the fungiform were enlarged appearance with enlarged capillary plexus within. The exact significance of this condition is not known. There was no definite association with either folliculosis or with minor caries though in many cases the conditions coincided. In three boys a rough furrowed tongue was said to have "always been present" , in one of them it was associated with an icthyosis-like condition of the skin. Stripping of the lower lip giving rise to a brilliant vermilion colour, u form of cheilosis was noted. No case of angular stomatitis was seen. 30 boys presented minor caries; 7 gingivitis—1 very marked. 2 had pyorrhoea and one a deposit of tartar. 17 exhibited pericorneal injection, and a further 19 the same thing in minor degree. 3 showed "streamer" vascularisation of the cornea. (1) a tall boy of 12, well developed and without other signs, (2) aged 12, of fair nutrition with minor caries, enlarged tongue papillae and ' 'stripped'' lip, (3) aged 12, well nourished with folliculosis, and the same tongue condition and scurfy patches on face. County High School for Girls.—140 girls were examined in the 11-16 age group. 40 were between 15 and under 17; the 100 were over 11 and under 15 years. These figures merely give a rough idea of the age distribution and is not a physiological grouping. We would have liked to make a division between the pre-and postpuberty groups, but this was not possible. From conversation with the staff we gained the impression that the onset of puberty in the majority was during the year 12$-131. but, of course, it was very variable. Of the 140 examined 112 were classed as of good nutrition, most of them being well developed and plump. 25 were called "fair", but thi9 down-grading was only in comparison with the majority and was partly accounted for by younger age. 3 were placed in the category of "poor"; [(1) had chronic bronchitis aged 14, (2) also aged 14 had a mild kind of congenital icthvosis, (3) aged 16, unexplained.] Pallor was noted in 11; seborrhoea in 10. 59 exhibited Folliculosis of arm or leg; 13 knee-elbow. Hyperkeratosis, in one or two cases very marked; 5 showed more generalised hyperkeratosis. No case of cheilosis or angular stomatitis discovered. 45 The tongue in 83 girls presented the same appearance as that noted in the Bovs School and described above. Of these in 26 the tip and/or margin of the tongue was affected; in a few the condition was very marked. In 43 minor caries noted, for the most part treated; in 2 more marked caries present. In only 4 was gingivitis seen, and in none pyorrhoea. 1 girl had blepharitis, 14 some conjunctival injection. 31 exhibited pericorneal injection of moderate degree, 20 in rather more marked degree. In none was there corneal vascularisation but showed a minor degree of "streamers" formation. 1 girl of 12 showed defective dental enamel. 2 showed furrowed "beefy" tongues which were stated to have always been present. 1 was a pituitary type; 1 suggested hypothyroidic type. 1 exhibited a tag of iris tissue attached at one end to the middle of the substance of the iris, the other end floating freely in the aqueous. (b) Incidence of Pediculosis and Scabies. (i) Pediculosis.— This shows a decrease, 25 children being found to be injected with living hair vermin as against 63 in 1942, 36 in 1941 and 10 in 1940. (ii) Scabies.—This also shows a decrease, 217 cases (44 from routine medical inspection) being seen at the Minor Ailment Clinics, as compared with 374 in 1942 and 109 in 1941 and 25 in 1940. In addition to the 217. 4 cases were treated privately. There wa3 no particular incidence in any one. School. (c) School Camps. Sonne Dysentery at Finnamore Wood Camp.—In December the Camp Matron reported that she had admitted 17 cases of diarrhoea and sickness to the Hospital Block. Professor Wilson of the F.mergencv Public Health Laboratory Service, Oxford, took a rectal swab of one of these cases, which proved to be Sonne Dysentery. It was decided that the girls should remain at the Camp and not return home to Ilford. Professor Wilson took rectal swabs of 195 girls and reported that the infection had practically saturated the Camp; a considerable number of the contacts must almost certainly have suffered from the disease in a mild clinical or sub-clinical form. Of the 195, 54 were negative and these girls were allowed to return to Ilford. A second batch of swabs were taken of the remaining 141; 31 were found positive. The third batch of swabs were taken from these 31, and 15 proved positive; of the fourth batch taken from these 15, 4 proved positive. All the girls returned home to Ilford with the exception of these 4 positive cases. The Sanitary Inspector called at the homes of the girls in Ilford and further swabs were taken which proved negative. The kitchen and teaching staff were swabbed, with negative results. The Education Committee decided that all the girls should be examined before re-opening the Camp. All the girls had returned to the School Camp by 12th March, 1944. Glandular Fever at Finnamore Wood Camp.—An outbreak of an epidemic infectious disease occurred at this Camp in October to December 1942, SI cases occurring among 195 girls. After prolonged pathological examinations, the epidemic proved to be one of glandular fever. 46 Changes in Staff.— (a) Medical.—Dr. C'. M. Gray terminated duties as Assistant School Medical Officer on the 6th May, Dr. F. E. O'Connor commenced on the 3rd March, and Dr. A. Collins on the 24th May. (b) Health Visitors und School Nurses.—Miss H. Dolan terminated her appointment on the Sth May, and Miss F. S. Leader on the 10th November. Miss M. G. Bennett commenced on the 7th June. Miss B. C. Blackley on the 21st June, and Miss I. Alderson on the 17th December. School Premises.—There are 26 schools, with 43 department*, 14,944 children were actually on the rolls on 17th December, 1943, as compared with 14,665 in December, 1942. The number of children in average attendance at school for the year ended 17th December, 1943 = 12.248. On the 17th December, 1943, 2,225 children were in reception areas evacuated undpr the Government Evacuation Scheme (including Mossford School Groups and three Camp Schools) and there were approximately 1,250 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. 310 visits have been made during the year. Medical Inspection.—Tn accordance with the Board's Circular, 1604, dated 28th August, 1942, the School Nurses have carried out "Rapid Surveys" at the schools. 14.340 examinations were made, 26 were recommended special treatment and 50 for supplementary nourishment. The following children had a full routine medical examination, in addition to those recommended for examination at the Rapid Surrey:— (а) Newly admitted to Public Elementary Schools, (б) who had attained the age of twelve years. During 1943, 4,372 parents, or 83 per cent., attended the full routine medical inspections. Infectious Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1938:— Scarlet Fever. Diphtheria . Measles and German Measles Chicken Pox. Mumps Whooping Cough. 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 1943 386 30 1402 399 369 221 Disinfection of all the cloakrooms at the public elementary schools w as 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 1943. 843 home visits were paid by the Health Visitors to cases of minor infectious disease. In addition the Sanitary Inspectors paid 1,327 visits to measles cases, and 221 visits to whooping cough cases. 47 Result of final Schick test in 1943 of cases inoculated in 1942: Newbury Hall. Mayesbrook. Positive and re-inoculated 9 6 Negative 359 271 1,769 individual children were treated (999 at Newbury Hall and 770 at Mayesbrook) making 8,557 attendances (4,901 and 3,056 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. Following Up.—During 1943, 3,036 home visits by the School Nurses were paid for the purpose, and 4,181 re-examinations of children (some on several occasions) were carried out by the doctors at school; 93 visits to schools were made for this purpose alone, and other children were seen at the visits for routine medical inspection. Medical Treatment. Diphtheria Prevention Clinics.—The following shows the work carried out at Newbury Hall (106 sessions) and Mayesbrook (68sessions) Clinics for children of school age during 1943:— Newbury Hall. Mayes brook. Primary Schick tested Positive 189 249 111 171 Negative 60 60 Inoculated (full course) 580 439 Schick -|- 1942 9 — Schick + 1943 189 111 Not tested 391 328 Negative after full course of inoculation 408 320 Positive after full course of inoculation and reinoculated 7 8 Awaiting re-test 126 82 Not re-tested after inoculation on account of leaving district, etc. 39 29 Since the first introduction of immunisation against Diphtheria in Ilford in 1929, 9,335 children of school age, and 10,049 children under school age have been immunised. Ringworm:— No. of No. of No. of cases at cases Remedied cases under beginning reported Total, during observation of 1943. during 1943. at end of 1943. 1943. Ringworm:— Scalp 4 7 11 11 — Body 1 12 13 12 1 5 19 24 23 1 (a) Minor Ailments Clinics.—The attendances during 1943 were as follows:— ] Newbury Hall Mayesbrook Number of individual children seen 1,489 1,385 Number of attendances of children 2,631 2,959 Number of exclusion certificates granted 846 1.015 Number of certificates of fitness to attend school granted 639 695 48 The following table shows the conditions dealt with at both the Clinics during the year:— Subnormal Nutrition 192 Uneleanliness:— Head 247 Skin:— Ringworm:— Head . 7 Body ■ ■ 12 Scabies •• 217 Impetigo •. 140 Other Diseases (Non-Tuberculous) 404 Eye:— Blepharitis ■■ 24 Conjunctivitis 31 Keratitis Defective Vision (excluding Squint) 230 Squint 6 Other conditions 55 Ear:— Defective Hearing 19 OtitiB Media . - 37 Other Ear Diseases 54 Nose and Throat:— Chronic Tonsillitis only 37 Adenoids only . • • • 2 Chronic Tonsillitis and Adenoids 65 Other conditions 172 Enlarged Cervical Glands (Non-Tuberculous) 9 Defective Speech 3 Teeth—Dental Diseases 218 Heart and Circulation:— Functional 2 Organic 1 Anaemia -• •• 35 Infectious Diseases:— Measles ■ • • • ■ • • • 1 Whooping Cough 6 Chicken Pox 3 Mumps 4 Colds 120 Influenza . • 9 Lungs:— Asthma •. • • • • 9 Bronchitis 53 Other Non-Tubercular Diseases 3 Tuberculosis:— Pulmonary—Definite 1 ,, Suspected (Referred to T.B. officer.) 3 Nervous System:— Epilepsy Nervous Debility 1 Habit Spasm 2 Chorea • • • • 4 Other conditions 12 49 Deformities:— Genu Valgum 9 Round Shoulders 5 Rickets I Flat Feet 31 Lordosis 1 Scoliosis 2 Valgus Ankles 24 Other forms 41 Minor Injuries 32 Rheumatism 26 Other Defects and Diseases 167 Total number of ailments 2,791 Special Clinics.—Attendances at the various Clinics during 1943, are set out in the following table:— Clinic. Number of Sessions. Attendances Individual Children. Total Attendances. A. B. C. A. B. C. A. B. C. (i) Ophthalmic 111 62 - 669 413 - 1283 815 - (ii) Orthopaedic 31 14 - 454 227 - 772 374 - (iii) Artificial Sun light 41 42 - 34 20 - 639 498 - (if) Remedial Exercises 91 - 46 122 - 66 1426 - 870 (f) Aural 48 — — 703 — — 1049 - - (vi) Rheumatism 26 - — 250 - — 475 — — A = Newbury Hall. B = Mayesbrook. C = A11 Saints Hall. Note.—(i) 626 children were prescribed and provided with glasses, of which 4 were supplied free. (it) 9 children of school age were admitted to the Country branch of the Royal National Orthopaedic Hospital at Stanmore and 8 discharged. 41 children were supplied with appliances. (vi) 54 cases referred for X-ray and Electro-Cardiogram and 47 for Blood Sedimentation Rate. School Dentists.—Of 13,448 inspections by the Dentist (including special cases), 7,763 (or 61 per cent.), were found to require treatment, compared with 9,223 (or 61 per cent.) in 1942, 8,289 (or 65 per cent.) in 1941, 5,583 (or 56 per cent.) in 1940, 10,491 (or 58 per cent.) in 1939. In addition to the ordinary dental work of fillings and extractions, 80 regulation plates, and 4 dentures were supplied. 984 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:— 50 Age groups (in years) No. of inspections of children No referred for treatment. Percentage 5 1,354 759 56.0 6 1,512 928 61.3 7 1,703 1,053 61.8 8 1,538 988 64.2 9 1,474 946 64.1 10 1,631 990 60.7 11 1,243 661 53.1 12 1,053 621 58.9 13 1,007 663 65.8 14-15 277 154 55.5 Full details of the dental work are shown in Table IV. Treatment for Uncleanliness.—29 statutory notices were served under the Education Act, 1921, Section 87. The School Nurses paid 143 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. 35,679 Number Infected. *881 Per cent. 2.5 *31 of this number were found to be infected with living vermin; the remainder with nits only. A child with any nits in the hair at all is included in these figures. The percentages for the past 5 years were as follows:— 1939 1.5 1940 1.8 1941 2.8 1942 2.6 1943 2.5 These figures do not include the Gibraltarians housed at the Girls' Village Homes, Barkingside, 438 were inspected in 1943, of whom 79 were found unclean. Other Ailments.—During 1943, 59 children were operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford, as in-patients. 11 children were treated free on necessitous grounds. Under the agreement with the King George Hospital, 122 children were operated on at that Hospital, all as in-patients, for the removal of enlarged tonsils and adenoids, 19 children being treated free on necessitous grounds. In addition to the treatment of tonsils and adenoids, 18 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 September, 1942. Since this date 155 children were admitted, 40 ceased attendance, and 115 were on the school roll on the 31st December. 1943. Those admitted were recommended for examination from the following sources:— School Medical Officer 64 Head Teachers 70 Orthopaedic Surgeon 5 Others 16 51 School Medical Officer:— Malnutrition and Pulmonary Fibrosis 5 Malnutrition and Debility 2 Malnutrition and Bronchial Catarrh 1 Subnormal Nutrition and Debility 3 Subnormal Nutrition 7 Malnutrition 3 Subnormal Nutrition, Debility and Anaemia 1 Subnormal Nutrition, Bronchitis and Asthma 1 Asthma and Malnutrition 1 Asthma and Pulmonary Catarrh 1 Asthma and Bronchitis 5 Asthma and Subnormal Nutrition 2 Bronchial Catarrh 3 Bronchial Catarrh and Debility 1 Bronchial Catarrh and Subnormal Nutrition 4 Bronchitis 2 Pulmonary Catarrh 2 Pulmonary Catarrh and Nerves 1 Pulmonary Catarrh and Sub. Nurition 1 Pulmonary Fibrosis and Debility 2 Pulmonary Catarrh, Malnutrition and General Debility 1 Nasal Catarrh and General Debility 1 Anaemia and Debility 1 Debility 3 Malnutrition and History of Broncho-Pneumonia 1 Chest Deformity, Asthma and Pulmonary Fibrosis 1 Lymphangioma of Face, Neuro-Fibrosis and Pulmonary Fibrosis 1 Congenital Heart Disease and Scoliosis 1. Cervical Adenitis 1 Artificial Leg 1 Old Infantile Paralysis 1 Scoliosis 1 Neck Glands 1 Stunted Growth 1 Head Teachers:— Malnutrition, Bronchitis and Asthma 1 Malnutrition and Pulmonary Catarrh 1 Malnutrition and Pulmonary Fibrosis 3 Malnutrition and Debility 8 Malnutrition 3 Malnutrition and Anaemia 1 Subnormal Nutrition 4 Subnormal Nutrition and Bad Posture 1 Subnormal Nutrition and Hist. of T.B. 1 Subnormal Nutrition and Double Talipes 1 Subnormal Nutrition, Bronchitis and Debility 1 Subnormal Nutrition and Bronchial Catarrh 2 Subnormal Nutrition and Debility 4 Subnormal Nutrition, Pulmonary Fibrosis and General Debility 4 Subnormal Nutrition and Difficulty in Walking I Debility 7 Debility and Rheumatism 1 Debility and Abdominal Pains 1 Anaemia and Debility 1 Anaemia 1 Bronchitis and Debility 2 Bronchitis 2 Bronchial Catarrh 2 Asthma and Bronchitis 2 52 Bronchitis and Rheumatism Asthma and Ichthyosis 1 Asthma 2 Pulmonary Fibrosis and Debility 1 Pulmonary Fibrosis and Spinal Curvature 1 History of Pulmonary Catarrh 1 T.B. Glands of Neck 5 Old Myocarditis 1 Fits (not Epileptic) 1 Mitral Stenosis 1 Orthopaedic Surgeon:— Achondroplasia and Rickets 1 Subnormal Nutrition and Small Stature 1 Polio-Encephalitis 1 Talipes Equino-Varus 1 Subnormal Nutrition and Dorsal Scoliosis 1 Others:— Malnutrition and Poor Physique 1 Malnutrition 1 Chronic Asthma 1 Pulmonary Catarrh 2 Debility 1 Debility and Subnormal Nutrition 2 Bronchitis and Asthma 3 Bronchitis 1 Subnormal Nutrition and Old T.B. Knee 1 T.B. Arthritis of Knee 1 General Debility 1 Pulmonary Fibrosis 1 The 40 children not now on the roll ceased attendance for the following reasons:— Resumed attendance at ordinary school 18 Left school—over age 4 Removed from school at parents request 5 Evacuated 2 Admission to Camp School 4 Admission to Convalescent Home 1 Admission to Hospital 2 Admission to Heritage Craft School 1 Incapable of receiving further benefit (mentally defective) 3 The Dental Surgeon has carried out two complete inspections of the children's teeth at the Open Air School. The following table shows the dental work carried out:— No. of children examined by the School Dentist 177 No. of children referred for treatment 74 No. of children treated by Dental Surgeon 73 As a result of the Medical Officer's periodic examinations, a number of the children have been recommended certain treatment as follows:— Administration of Milk in School 148 Administration of Cod-Liver Oil Emulsion 151 Administration of Malt and Oil, Parish's Food, etc. 11 To see:— Ophthalmic Surgeon 6 Orthopaedic Surgeon re Remedial Exercises, etc. 4 Dental Surgeon 15 Aural Surgeon 4 Rheumatism Clinic Specialist 1 Tuberculosis' Officer 3 53 Recommendations have also been made to the Head Teacher as to the amount of exercises individual children should undergo, and also as to the taking of shower-baths and natural sunshine. 4 children received artificial sunlight treatment during the year. 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 1943 was 1,046,971, approximately 4,219 daily, 45 being free and 4,174 at full or part payment. There are eleven kitchens in the Borough, established at the following schools Becontree, Benton, Dane, Fairlop, Gearies, Goodmayes, Loxford, The Mount, Newbury Park, South Park and Uphall. Additional kitchens are being provided for at the following schools:— Mayfield, Redbridge and Wm. Torbitt. 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, 1943, 11,096 children were receiving milk in school, Of this number 170 received it free of charge. 7,091 were receiving an additional third pint. During the year 516 children were recommended, on medical grounds, to have milk in school, free if parents were not in a position to pay for it, and 125 previously recommended were reported to the Director of Education for continuance. 87 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 (two cases were reported from the Public Health Department for neglecting medical advice; 31 were reported from other sources for general neglect), made up as follows:— (1) Of Neglect 33 (2) Ill-treatment cases 4 (3) Other cases 13 136 children (54 boys and 82 girls) were involved, 104 being of school age. In addition to this work, 221 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.—23 children were sent to residential schools and paid for by the Education Committee in 1943. In addition 13 children were sent to Convalescent Homes or Residential Schools and paid for through voluntary funds. Also 16 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 1943, 3 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 Totally Deaf Children 1 Epileptic.—Special school for Epileptics 1 Cripple—Special school for Cripples 1 3 54 Mentally Defective Children:— During 1943, 45 children were medically examined and reported upon under the Mental Deficiency (Notification of Children) Regulations, 1928, classified as follows:— Feeble-minded Children.—Total number certified in 1943 and recommended for admission to a special school (day or residential) 23 Imbecile Children.—Total number certified in 1943 and recommended for notification to Essex County Council 7 Dull and Backward Children.—Total number certified in 1943 and recommended attendance at special class for dull and backward children for one year, and then to be re-examined 15 Idiots, Imbeciles, Feeble-Minded, Dull and Backward Children. Summary of cases at end of 1943:— Idiots. Imbeciles. FeebleMinded. Dull and Backward At Residential Institution 2 6 22 — At Elementary School — 42 24 At no School or Institution 4 34 *17 — Total 6 40 81 24 * 11 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 1943, it was found that 23 children were employed out of school hours. 24 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 23 ,, unfit 1 Employment of Children in Entertainments Rules, 1933.—Five certificates have 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 13 Teachers—Sickness Regulations 33 Newly-appointed Camp Matron 1 „ „ Supervisor British Restaurants 1 „ „ Clerks—Education Department 4 52 School Camps.—The three Ilford School Camps are still in being, and the general procedure outlined in my report for 1940 still continues. 55 Infection at the Camp Schools in 1943 (in addition to Epidemics on Page 5). Kenny lands. Finnamore Wood Elmbridge. Measles 2 3 - Chicken Pox 2 9 - Mumps 1 - 26 Influenza 60 2 2 Scabies 3 2 12 Shingles 2 - - Jaundice 49 4 6 Impetigo 5 1 2 Professor G. S. Wilson of the Emergency Public Health Laboratory Service, School of Pathology at Oxford, undertook the Schick and Dick testing of 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. In previous years our own medical staff did this work, but owing to travel restrictions this was not possible. The following is a brief summary of the work carried out:— Immunisation. Elmbridge Finnamore Wood. Kenny lands. Scarlet Fever— No. of DickTests 2 10 16 Inoculations .. 84 46 45 Re-inoculations — 5 8 Diphtheria— No. of Schick Tests 33 26 25 Inoculations .. 36 12 10 Re-inoculations 2 — 1 Totals 157 99 105 Table Showing the Principal Causes of Death among Children or School Age (i.e., from 5—15 years) in Ilford for 1941 and 1942. 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 1941 1942 1941 1942 1. Measles 0.2 0.1 3.3 - 2. Scarlet Fever - - - - 3. Whooping Cough 0.5 0.1 - - 4. Diphtheria 0.2 - 3.3 - 5. Influenza 1.5 0.8 - 7.7 6. Tuberculosis 5.4 6.3 6.7 23.0 7. Rheumatic Fever 0.2 - - - 8. Bronchitis, Pneumonia and other respiratory diseases 10.3 10.3 3.3 - 9. *Meningitis and Nervous system 9.2 0.8 6.7 7.7 10. Heart Diseases 24.3 20.1 - - 11. Acute and Chronic Nephritis 2.8 2.3 3.3 - 12. Violence 12.6 4.0 60.0 15.5 13. Other causes 32.8 55.2 13.4 46.1 100.0 100.0 100.0 100.0 * Excludes Meningococcal infections. Ilford.—The deaths of children of School Age during 1942 represent .9 per cent, of the Total Deaths registered (all ages), and during 1941 represent 1.8 per cent. 56 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups:— Entrants 2,514 Second Age Group 1,161 Third Age Group 1,551 Total 5,226 (2) Number of Other Routine Inspections Nil. Grand Total 5,226 B.—Other Inspections. Number of Special Inspections and Re-Inspections1 13,663 Number of Children seen at "Rapid Surveys" at Schools 14,340 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. 0/ /o No. % No. 0/ /o Entrants 2,514 117 4.6 2,037 81.0 358 14.3 2 0.08 Second Age-Group 1,161 89 7.6 896 77.2 175 15.1 1 0.08 Third Age-Group 1,551 117 7.5 1,238 79.8 194 12.6 2 0.12 Total 5,226 323 6.2 4,171 79.8 727 13.9 5 0.09 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 . 2,544 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease (1) No. of Defects dealt with Under the Authority's Scheme (2) Otherwise (3) Total (4) Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) 1082 12 1094 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 20 1 21 Total 1102 13 1115 No. of Children for whom spectacles were:— (a) Prescribed 626 12 638 (b) Obtained 626 12 638 57 Group III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment. Received other forms of Treatment. Total Number treated. 181 — 181 Table IV.—Dental Inspection and Treatment. (1) Number of Children inspected by the Dentists:— (a) Routine Age Groups— Age 5 6 7 8 9 10 11 12 13 14 Total. Number 1354 1512 1703 1538 1474 1631 1243 1053 1007 277 12,792 (b) Specials 656 (c) Total (Routine and Specials) 13,448 (2) Number found to require treatment 7,763 (3) Number actually treated 4,080 (4) Attendances made by children for treatment 6,708 (5) Half-days devoted to . Inspection 101 Total 837 Treatment 736 (6) Fillings Permanent Teeth 2,590 Total 5,336 Temporary Teeth 2,746 (7) Extractions Permanent Teeth 844 Total 7,866 Temporary Teeth 7,022 (8) Administrations of general anaesthetics for extractions 1,800 (9) Other operations Permanent Teeth 1,695 Total 2,403 Temporary Teeth 708 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 35,679 (iii) Number of individual children found unclean 881* (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 (6) Under School Attendance Bye-laws Nil * In addition 152 children were found unclean at medical inspection and 247 in the School Clinic. 58 The examinations, as under, of the "Gibraltarians" at the Barkingside Reception Centre are not included in the above:— Number of examinations made = 438 ,, found unclean = 79 ,, of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 = Nil 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 .. — — — — Mentally Defective Children. Total number of children notified during 1943, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928 .. .. 21 59 Table VII. School Medical and Dental Staff. Name of Officer Proportion of whole School Medical Service time devoted to— Public Health S.M.O.—Dr. A. H. G. Burton .. Deputy S.M.O.—Dr. J. H . Weir Various according to demands of services Assistant S.M.O's.:— Dr. D. M. B. Gross 3/14 11/14 M. & C.W. Dr. A. Collins 3/11 8/11 Dr. F. E. O' Connor 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 60 61 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 56 109.6 20.0 48 114.4 21.1 26 118.8 22.1 22 123.1 24.8 7 129.3 28.4 20 134.1 31.9 13 141.0 34.3 87 146.2 36.8 30 151.2 42.6 Benton (Open Air+) 2 109.0 18.2 10 114.9 19.9 13 119.9 22.4 22 125.1 24.0 12 128.6 26.9 7 134.6 28.2 6 143 .5 32.8 8 144.0 36.1 2 153.0 40.2 Chadwell 40 112.1 19.9 16 118.8 22.0 12 122.7 23.6 5 127.0 26.2 6 135.8 30.3 6 138.7 32.9 4 140.2 36.2 - - - - - - Christchurch 56 109.7 19.6 27 117.2 22.2 10 125.9 25.3 10 125.9 27.3 10 136.8 32.8 3 139.6 30.8 2 140.5 35.1 - - - - - - Cleveland 38 109.4 21.7 18 114.4 20.6 9 119.3 22.9 9 128.1 29.6 11 132.9 29.1 12 134.8 31.0 8 140.9 31.9 - - - 1 162.0 47.8 Dane Central - - — — — — — — — — — — - - - - - - 8 142.6 35.7 32 147.6 37.2 15 151.4 39.5 Downshall 34 108.7 19.2 10 116.2 22.1 13 118.3 24.5 12 121.3 26.8 5 130.8 28.9 11 136.0 34.1 14 139.5 33.9 64 148.2 37.3 13 149.9 39.6 Fairlop 52 110.0 19.4 8 113.1 20.3 1 122.0 22.0 11 125.9 25.2 8 130.0 27.3 6 133.0 28.5 16 144.1 36.2 92 144.5 36.4 9 153.6 45.9 Gearies 43 112.8 20.5 25 115.7 21.3 11 120.1 23.1 12 128.4 26.3 7 134.7 30.3 9 136.6 31.3 13 139 .8 34.1 47 145.2 37.1 16 151.4 44.1 Goodmayes 33 111.1 19.6 16 117.2 21.7 8 119.1 22.8 3 130.3 31.4 7 129.7 26.5 4 134.2 34.4 1 145.0 33.3 - - - - - - Gordon 12 111.7 21.1 11 112.8 20.9 5 122.8 24.6 — — — - - - - - - - - - - - - - - - Highlands 42 111.9 20.2 19 117.3 21.7 6 121.7 22.9 8 127.7 25.6 3 126.0 27.2 7 138.4 32.7 6 142.3 33.3 - - - - - - Loxford Central - - - - - - - - - - - - - - - - - - 5 140.4 34.9 71 145.7 38.1 29 151.5 42.9 Mayfield Central - - - - - - - - - - - - - - - - - 9 145.8 38.2 79 145.7 37.1 42. 150.4 41.0 Mossford 32 111 .4 19.7 13 117.9 21.4 5 121.6 23.1 5 126.6 25.9 4 132.7 28.8 5 140.0 33.0 3 136.6 29.0 — — — — — — Newbury Park 20 110.6 19.3 9 117.9 22.1 4 128.2 28.1 6 128.8 26.7 3 130.3 29.3 6 141.5 31.9 2 154.5 47.2 — — — — — — Parkhill 49 112.9 20.5 18 115.2 20.5 10 124.2 21.8 11 128.0 26.2 6 133.8 26.3 3 137.7 31.2 8 144 4 34.2 — — — — — — St. Augustines 9 109.0 18.7 4 117.0 20.0 4 121.2 23.3 3 128.7 27.8 1 127.0 26.0 3 136.0 31.5 1 130.0 31.0 7 151.8 41.6 1 153 0 37.4 S .S. Peter & Paul 13 111.1 19.5 10 114.8 20.3 1 122.0 24.9 8 128.9 26.0 6 130.0 27.2 1 131.0 30.2 1? 143 9 36.4 23 147 .4 37.7 11 149.4 42.4 South Park 43 113.2 20.6 26 118.0 22.4 20 124.1 24.8 14 128.5 26.5 8 129.9 27.8 7 139.0 33.5 11 144.8 36.1 — — — — — — St. Vincent's 21 108.8 19.6 5 113.4 21.0 3 122.0 24.2 4 121.2 24.2 4 127.5 26.8 3 134.0 31.3 3 139 3 31 9 24 145.4 24.4 9 145.5 38.9 The Mount Central — — — — — — — — — — — — — — — — — — — — — — — — — — — The Redbridge 32 112.7 20.3 7 117.3 21.6 10 124.9 25.1 2 134.0 27.1 4 137.0 31.0 2 136.0 29.7 2 140 5 32 0 11 149 4 42 4 The Wm. Torbitt 37 112.6 19.9 15 117.1 22.6 10 120.7 23.5 7 126.8 25.9 13 134.3 32.0 7 143.6 34.5 4 138.2 32.1 — — — — — — Uphall 14 110.5 18.9 7 116.1 21.1 3 114.0 19.2 2 125.5 29.1 1 135.0 30.3 2 142.0 36 4 1 147 0 37 8 Woodlands 45 110.7 19.6 25 117.8 22.6 8 120.4 23.7 8 127.5 28.1 4 133.2 28.9 1 141.0 35.6 1 144.0 37.8 — — — Gibraltarians 17 107.1 19.9 11 112.5 21.0 17 116.7 22.9 8 121.0 23.9 7 128.4 28.3 6 130.9 29.8 12 139.1 32.8 14 143.3 0.2 6 144.9 39.1 Ilford Boys—Averages for 10 years. 1943 723 110.9 19.6 348 116.1 22 .1 192 121.4 23.6 184 126.2 26 6 130 131 .9 28.1 125 136.8 32.0 IS? 143.0 34.8 546 145.2 36 4 171 151 0 42 0 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 7? 141 35.0 520 145 37 8 69 151 41 1 1938 982 110 19.5 224 115 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 19.1 218 116 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 62 63 Table VI B.—Table Showing the Average Heights and Weights of the GIRLS 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) umber 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 53 108.1 18.4 58 112.9 20.1 27 118.0 22.0 31 122.4 24.3 12 124.7 26.1 17 132.9 29.7 12 140.3 34.5 83 147.4 38.6 33 155.8 42.6 Benton (Open Air) 2 104.5 19.4 5 117.4 20.7 12 117.5 21.2 11 125.8 24.7 14 128.5 25.4 10 133.3 29.5 8 143.0 32.8 9 147.7 33.3 8 146.0 33.2 Chadwell 39 110.0 18.6 18 116.0 21.1 8 123.6 23.3 4 123.7 24.0 5 133.4 31.7 1 136.0 29.8 8 140.3 35.6 — — — — — — Christchurch 59 110.5 19.8 34 117.4 21.1 9 118.4 22.2 9 124.9 25.8 5 131.6 27.6 6 136.0 36.7 2 142.5 32.5 — - —- — — — Cleveland 32 109.0 18.4 17 116.8 21.7 13 124.7 24.2 5 128.6 26.5 10 133.3 29.3 4 136.0 31.9 4 146.5 33.6 — — — — — — Dane Central - - - - - - - - - - - - - - - - - - 4 142.2 37.8 57 148.2 38.1 23 151.7 41.1 Downshall 26 109.3 19.1 14 116.1 20.8 9 117.0 22.1 13 119.7 24.3 10 122.2 26.4 7 128.8 29.3 9 137.0 38.5 80 149.9 37.4 6 159.2 44.3 Fairlop 47 109.6 18.8 9 113.3 20.2 6 121 .5 21.8 11 127.5 26.3 7 131.9 29.7 7 134.7 29.7 1 143.0 33.0 109 147.8 38.6 11 153.0 43.5 Gearies 31 110.3 19.4 23 114.9 20.3 8 117.0 21.4 13 128.1 26.7 9 132.6 29.0 14 137.2 30.9 7 146.5 37.9 67 147.6 39.2 17 151.2 42.2 Goodmayes 28 110.4 19.6 19 116.4 21.6 11 122.6 24.7 6 125.8 28.4 3 123.7 24.7 — — — — —■ — I 134.0 28.6 — — — Gordon 15 109.6 19.8 4 118.7 23.2 5 119.6 21.6 — — — — — — — — — — — — — — — — — Highlands 40 110.1 19.1 22 113.2 20.7 11 120.6 22.3 13 129.1 28.6 6 132.5 29.9 4 140.7 33.6 3 145.3 34.6 — — — — — — Loxford Central - - - - - - - - - - - - - - - - - - - - - - - - - - - Mayfield Central - - - - - - - - - - - - - - - - - - 6 142.0 37.1 101 149.3 39.9 23 153.8 43.3 Mossford 30 109.8 19.3 9 116.0 21.2 2 117.0 21.4 1 119.0 22.4 2 128.5 25.7 3 141.3 33.6 5 141.4 31.7 - - - - - - Newbury Park 20 111.5 20.0 15 115.5 21.7 7 120.3 23.0 4 123.0 25.2 3 129.3 25.5 2 136.5 28.8 5 144.4 35.3 - - - - - - Parkhill 42 111.4 19.4 26 115.0 20.4 9 119.1 21.5 15 126.9 25.8 10 134.4 27.9 13 139.7 31.8 2 137.5 30.8 - - - - - - St. AugustineS 5 106.8 17.6 3 115.3 19.3 2 128.5 24.5 2 120.0 21.8 2 136.5 28.2 - - - 1 146.0 35.6 4 148.2 37.5 1 152.0 38.8 SS. Peter & Paul 23 108.9 18.6 5 114.8 20.4 3 120.0 23.9 1 134.0 28.5 1 125.0 25.2 5 136.0 34.2 9 137.1 31.1 11 146.2 36.8 1 146.0 45.2 South Park 38 110.7 19.6 38 116.9 20.9 13 120.9 22.9 8 125.8 25.2 4 132.2 25.8 5 137.0 31.9 6 143.5 35.5 - - - - - - St. Vincent's 17 106.8 19.0 10 116.5 20.8 3 116.7 19.5 1 120.0 22.4 3 125.0 24.1 - - - 7 135.5 29.1 17 143.6 36.7 1 152.0 43.1 The Mount CentraL - - - - - - - - - - - - - - - - - - 3 135.3 32.4 58 148.9 38.7 19 154.6 43.9 The Redbridge 17 112.7 20.4 10 114.7 20.5 2 118.5 20.4 6 129.3 26.6 9 133.0 29.7 6 136.1 28.9 1 141.0 31.0 - - - - - - The Wm. Torbitt 33 109.0 18.3 16 114.3 20.6 5 118.4 23.1 8 123.7 23.2 7 134.0 29.4 5 138.0 33.1 1 145.0 33.8 - - - - - - Uphall 19 112.5 20.1 10 110.1 18.9 2 120.5 22.3 2 131.5 28.7 3 125.3 24.1 1 140.0 29.2 3 141.0 35.2 - - - - - - Woodlands 20 109.2 18.9 10 114.3 20.6 8 121.0 22.9 8 123.9 24.9 - - - 1 134.0 29.3 - - — — — — — — — Gibraltarians 12 102.7 17.3 10 114.0 20.9 8 118.3 22.8 9 122.4 26.6 9 127.4 27.6 9 133.4 29.5 7 137.3 33.2 6 148.3 37.8 6 150.3 44.4 Ilford Girls—Averages for 10 years:— 1943 636 109.9 19.2 375 114.7 20.8 175 120 0 22.5 172 125.2 25.5 125 130.1 27.6 111 135.9 30.8 107 143.1 34.7 597 148.0 1 38.4 143 153.3 42.2 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 30.8 155 142.6 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 28.3 191 137 30.9 231 143 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 64 Table VI C. Heights and Weights—(Four-year Period = 1940, 1941, 1942 and 1943). Comparison of Camp with other Ilford Schools. Camp School. 11—12 12—13 13—14 No. Ex'd. Ht. Wt. No. Ex'd. Ht. Wt. No. Ex'd. Ht. Wt. Kennylands (Beal Boys) 189 ft. in. 4 8¼ Cms. 143 st. lb. 5 6½ Kilo. 34.7 206 ft. in. 4 10 Cms. 147 st. lb. 6 0½ Kilo. 38.5 180 ft. in. 5 0 Cms. 152 st.lb. 6 8½ Kilo. 42.1 Boys at other Ilford Schools 863 ft. in. 4 8 Cms. 142 st. lb. 5 7½ Kilo. 35.1 2087 ft. in. 4 9 Cms. 145 st. lb. 5 12 Kilo. 37.2 667 ft. in. 4 114 Cms. 151 st. lb. 6 8 Kilo. 41.7 Elmbridge (Loxford Boys) 168 ft. in. 4 7½ Cms. 141 st. lb. 5 4¼ Kilo. 33.7 202 ft. in. 4 9 Cms. 145 st. lb. 5 10½ Kilo. 36.5 174 ft. in. 4 11 Cms. 150 st. lb. 6 2 Kilo. 39.7 Finnamore Wood (Beal Girls) 238 ft. in. 4 8 Cms. 142 st. lb. 5 7½ Kilo. 35.1 178 ft. in. 4 10 Cms. 147 st. lb. 6 5 Kilo. 40.3 164 ft. in. 5 0½ Cms. 154 st. lb. 7 3 Kilo. 45.8 Girls at other Ilford Schools 628 ft. in. 4 8½ Cms. 143 st. lb. 5 6½ Kilo. 34.8 2011 ft. in. 4 10¼ Cms. 148 st. lb. 6 2 Kilo. 39.0 649 ft. in. 5 0¼ Cms. 153 st.lb. 6 12 Kilo. 43.5 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, 1943. SCHOOLS DISEASES AND CONTACTS No. on Roll Scarlet Fever Diphtheria Measles & German Measles Chickenpox Whooping Cough Mumps Totals, 1943 Totals, 1942 Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Cases Contacts Cases Contacts Becontree 1461 20 19 - - 46 3 21 12 2 5 104 24 132 51 Benton (Open Air) 115 2 1 - - 6 - 9 - - 1 18 1 1 1 Chadwell 644 20 8 - 1 134 1 47 11 - 46 258 10 283 34 Christchurch 549 18 9 7 3 84 4 2 7 - 8 126 16 22 11 Cleveland 715 7 9 - 3 54 6 2 - - 7 70 18 67 30 Dane 533 - 7 2 1 9 - 2 - - 4 17 8 16 4 Downshall 1188 28 17 2 4 92 4 18 27 - 46 213 25 242 54 Fairlop 1325 9 5 1 4 119 6 31 - - 8 168 15 58 21 Gearies 1215 26 18 - 1 111 3 36 18 - 33 224 22 220 31 Goodmayes 428 4 4 1 — 37 1 4 4 - 25 75 5 111 18 Gordon 165 4 4 4 — — — — - - - 8 4 - - Highlands 439 8 4 1 2 2 2 4 4 — 36 55 8 191 23 Loxford Central 360 5 7 - 1 7 — — 3 - 3 18 8 9 15 Mayfield Central 719 7 10 1 3 9 - 1 - - 6 24 13 11 22 Mossford 438 25 18 - - 88 5 25 20 - 20 178 23 73 8 Newbury Park 333 16 12 - - 69 2 17 2 - 6 110 14 86 9 Parkhill 473 37 18 3 - 50 2 6 22 2 5 123 22 150 23 St. Augustine's 198 6 3 - - 27 1 5 - - 1 39 4 15 9 SS. Peter and Paul's 439 12 12 5 10 61 1 14 7 1 6 105 24 12 15 St. Vincent's 336 2 1 - - - 1 - 1 - - 3 2 12 6 South Park 831 40 20 1 - 158 2 6 28 6 1 234 28 74 20 The Mount Central 344 3 2 1 - 6 - 1 1 - - 12 2 - - The Redbridge 418 3 5 - - 57 2 2 4 — 65 131 7 112 16 The William Torbitt 416 14 9 1 1 9 - 74 10 1 6 114 11 51 4 Uphall 307 6 8 - - 6 - 15 13 - 1 41 8 58 4 Woodlands 282 15 9 - - 32 1 50 10 - 14 121 10 145 36 County High — 11 13 - 1 9 - 7 1 - 14 42 14 7 2 Private — 38 5 — 1 120 3 — 16 — 2 176 9 82 26 Totals 14941 386 257 30 36 1402 50 399 221 12 369 2807 355 2240 493 Notification of minor infectious diseases in these schools are not received. 65 66 SECONDARY SCHOOLS. Medical Inspection and Treatment of Secondary School Pupils. Medical inspection, Dental inspection and treatment of pupils at the Boys' and Girls' County High Schools and the "specially placed" pupils at the Ursuline school commenced on the 1st January, 1943. Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups:— Entrants 489 Leavers 357 Total 846 (2) Number of Other Routine Inspections Nil. Grand Total 846 B.—Other Inspections. Number of Special Inspections and Re-Inspections 232 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 489 80 16.4 336 68.7 73 14.9 — — Leavers 357 74 20.8 274 76.7 9 2.5 — — Total 846 154 18.2 610 72.1 82 9.7 — — Group I.—Treatment of Minor Ailments. (Excluding Uncleanliness), Total Number of Defects treated or under treatment during the year under the Authority's Scheme 64 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. (1) No. of Defects dealt with Under the Authority's Scheme (2) Otherwise (3) Total (4) Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) 128 7 135 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 3 1 4 Total 131 8 139 No. of Children for whom spectacles were:— (a) Prescribed 99 7 106 (b) Obtained 99 7 106 67 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. 5 — 5 Table IV.—Dental Inspection and Treatment. (1) Number of Children inspected by the Dentists:— (a) Routine Age Groups— Age 11 12 13 14 15 16 17 18 Total. Number 172 245 228 192 211 65 50 7 1170 (6) Specials — (c) Total (Routine and Specials) 1,170 (2) Number found to require treatment 678 (3) Number actually treated 385 (4) Attendances made by children for treatment 649 (5) Half-days devoted to .. Inspection 6 (6) Fillings Permanent Teeth 952 Total 952 Temporary Teeth - (7) Extractions Permanent Teeth 353 Total 432 Temporary Teeth 79 (8) Administrations of general anaesthetics for extractions 54 (9) Other operations Permanent Teeth 231 Total 242 Temporary Teeth 11 Attendances made by children for Regulation purposes 104 Regulation Plates supplied 5 Dentures supplied 3 The amount of dental disease present in children at various ages is show by the following table, relating to schoolchildren inspected by the School Dental Surgeons:— Age Groups (in years). No. of Inspections of Children. No. referred for Treatment. Percentage. 11 172 103 59.8 12 245 143 58.1 13 228 132 57.8 14 192 114 59.3 15 211 121 57.3 16 65 40 61.5 17 50 21 42.0 18 7 4 57.1 Totals 1,170 678 57.9 Of the 678 children referred for treatment, only 393 or 58% acceptance were received. 63 Attendances at Specialists' Clinics. Clinic. Individual Children. Total Attendances. Aural 21 (a) 34 Rheumatism 13 20 Orthopaedic 39 (b) 67 Artificial Sunlight 1 36 Remedial Exercises 6 87 (a) Five cases received operative treatment for removal of Tonsils and Adenoids. (b) Three Surgical appliances were supplied, and one case admitted to the Country Branch of the R.N.O. Hospital at Stanmore. Service & Quality CRUSHA & SON LTD. TOTTENHAM, ENFIELD & WOOD GREEN