ILF 19 Borough of Ilford Health Report FOR THE YEAR 1944 A. H. G. BURTON M.O.. B.S., M.R.C.P., D.PM., D.P.H., Barrlster-at-Law Medical Officer of Health, etc. Ilford Borough Council NOVEMBER, 1943-NOVEMBER, 1944 Alderman Russell Stearn Daniels, J.P., Mayor. Alderman George John Wetton, J.P., E.C.C., Deputy Mayor. AIdermen: Billington, Henry. Griggs, Albert Philip, J.P., E.C.C. Braithwaite, Thomas, J.P., E.C.C. Smith, Frank Douglas, J.P., C.A. Dane, Frederick Hopper, M.B.E., (E.C.C.). J.P., C.A., (E.C.C.). Wetton, George John, J.P., E.C.C. Daniels, Russell Stearn, J.P. Deputy Mayor. Mayor. Young, Alexander, Major, Farman, Claude Augustus, E.C.C. T.D., J.P. Councillors: Barker, John. Gregory, William Sydney. Bramston, John, E.C.C. Harding, Mrs. Beatrice Alice (Died April, 1944). Louise Anne. Bryan, William Allen Vernon. Hinton, Charles Stanley. Chester, Herbert. Holmes, Percy. Collischon, Sidney Walter. Holness, Richard Thomas. Colvin, Gilbert, F.C.I.S. Ingham. Edgar Frank. Cooper, Albert Edward. Slater, Frank. Cropper, Cyril Clifford, Spencer, Walter Robert. F.I.A.S., F.V.I. Taylor, Joseph John, J.P. Eke, William Benjamin. Taylor, Sidney William. Elborne, John, M.A. (Resigned January, 1944). Tyler, George Frederick, F.C.I.I. Eyes, Charles. Webber, Cecil Reginald Henry. (From June, 1944). Fallaize, Mrs. Lilian, J.P. Westhrop, George William Henry. Faning, Percy Victor. (From February, 1944). Woods, Sidney Charles Victor. Green, Arthur William, J.P., Wootton, Mrs. Florence Emily, C.A. (E.C.C.). O.B.E. WAR EMERGENCY (EXECUTIVE) COMMITTEE NOVEMBER. 1943-NOVEMBER, 1944 Alderman Russell Stearn Daniels, J.P., Mayor. Alderman G. J. Wetton, J.P., E.C.C., Deputy Mayor. Alderman T. Braithwaite, J.P., E.C.C. Alderman F. H. Dane, M.B.E., J.P., C.A. (E.C.C.) 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, 1943 - NOVEMBER, 1944 Councillor A. W. Green, J.P., C.A. (E.C.C.), Chairman. Alderman R. S. Daniels, J.P., Mayor, Vice-Chairman. Alderman H. Billinoton Alderman T. Braithwaite, J.P., E.C.C. 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., Deputy Mayor. Alderman Major A. Young, T.D., J.P. Councillor J. Barker Councillor J. Bramston, E.C.C. (Died April, 1944). 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. Harding Councillor E. F. Ingham. (From May, 1944). 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. (To February, 1944). *Mr. S. P. Lonerqan. *Miss H. S. Rich. *Mr. F. R. Masters. *Mr. E. R. Lower, B.A. *Mr. A. Beech. *Mr. C. R. H. Webber. (To June, 1944). *Mr. A. J. B. Haynes. (From April, 1944). *Mr. A. W. Davison. (From July, 1944). *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). *M. B. Marchant, M.B., Ch.B. (Edin.) D.P.H. (Ed. and Glas.) (To 31.1.45). 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). *L. Lichtenstein, M.D. (Vienna). (25.5.44 to 5.4.45). 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). *E. V. Haigh, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital: Matron of Maternity Home Miss K. Bellaers. Miss M. E. Roberts. Senior Sanitary Inspectors: T. V. Haigh, M.R.S.I. (To 5.8.44). S. R. Daly, D.P.A.(Lond.), M.R.S.I. (Deputy until 5.8.44.) Sanitary Inspectors: S. G. Rackham. P. W. English. A. C. R. Neale. G. W. Newman. B. E. Smalley. T. F. Johnson. Chief Administrative Clerk: F. J. Hocking. Superintendent of Council's Midwives: Miss C. Blockley. *Temporary. Officers of the Public Health Services—continued Health Visitors and School Nurses: Miss A. Batten. Miss 0. Bell. Miss M. G. Benwett. Miss A. L. Drinkwater. Miss M. Graham. Miss M. E. Harper. Mrs. G. H. Huohman. 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. Quick. Matrons of War-time Day Nurseries. Sunshine House. *Miss I. E. Sandall. Green Lane *Mrs. C. Weatherall. Ley Street *Miss A. R. Jones. Becontree Avenue *Mrs. E. Drower. *Temporary. Part Time:— Consulting Obstetrician (Maternity Home and Puerperal Pyrexia Regulations): R. L. Dodds, M.Ch., F.R.C.S., F.R.C.O.G. A. Davis, M.D., F.R.C.S. (Deputy). Consulting Anaesthetist: Frankis T. Evans, M.B., B.S., D.A. Surgeon in charge of Orthopaedic Clinic: J. A. McLauchlan, M.D., F.R.C.S. Oculist: H. D. Smart, M.D., B.S. Surgeon in charge of Aural Clinic: W. Ibbotson, F.R.C.S. Physician in charge of Rheumatism Clinic: K. Playfaip., M.A., M.B., M.R.C.P. Temporary Medical Officer for A.R.P. Casualty Service R. M. Noordin, M.R.C.S., L.R.C.P. Veterinary Surgeon: Ralph Bennett, F.R.C.V.S. Public Analysts: Bernard Dyep., 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. PREFACE. Public Health Offices, Ilford. September, 1945. Madam Mayor, Ladies and Gentlemen, I submit herewith the Annual Report for the year 1944, as required by the Ministry of Health and the Ministry of Education. This is the 25th and last Annual Report which I shall submit to you, as I am retiring on 30th September for reasons of ill-health, having completed 26 years' service as Medical Officer of Health to the Town of Ilford. The comparative vital statistics for the year 1944 of Ilford and other districts will be found in Table 1a on Page 11. A brief retrospect of the progress of the local health services during this time shows considerable advancements and improvements in "the life of our Town." During my term of office, the population has increased from 79.524 to 149,330, and correspondingly the work of all sections of the Public Health Department has increased. In particular, the environmental hygiene section has vastly extended the scope of work, much of which has been necessitated by such legislation as the Public Health Act, 1936, the Housing Act, 1936, Ilford Corporation Act, 1937, Food and Drugs Act, 1938, and the innumerable statutory rules and orders, regulations and Ministry circulars which have been issued from time to time. In these developments I had for many years the capable and conscientious assistance of Mr. T. V. Haigh, Senior Sanitary Inspector from 1929 until his well-earned retirement in October 1944, when he left with the good wishes of all his colleagues and associates. The School Medical Service from small beginnings has grown to a large comprehensive and efficient organisation, operating six Specialist Clinics, in addition to the usual school medical facilities At present work is proceeding to restore the premises of the Valentines and Mayesbrook School Clinics, which were converted into First Aid Posts during hostilities. As I advised the Education Committee in 1943, it will be necessary for the continuing development of the School Medical Service to provide at least three new School Clinics in the future in the localities which I then indicated. The Open Air School, opened in January, 1929, and now unfortunately partly out of service owing to enemy action, has proved of benefit to hundreds of Ilford's delicate children. The Service now caters for the pupils of the County High Schools in the Town, in addition to the elementary school children, and facilities are now available for upwards of 17,000 children as compared with 10,781 in 1919. Considerable improvements have been effected in the physical condition and well-being of the school children, and in this the provision of school milk and meals has played a material part during the war years. A noticeable feature has been the improvement in cleanliness. Whereas in 1919, 10.7 per cent of children inspected were found to be infected with vermin or nits, during 1944 only 2.4 per cent were thus affected. Under the Education Act, 1944, the Essex County Council assumed responsibility for the School Medical Service as from April 1st, 1945. Pending the coming into operation of a scheme of Divisional Administration or Ilford, an Interim Local Education Committee has been continuing the local administration as previously and the School Medical Service has similarly continued its operation. Arrangements for the future of the local School Medical Service are still sub judice, and it remains to be seen how 6 they will be affected by the implementation of the provisions of the Education Act, and how arrangements made will be correlated with the foreshadowed National Health Service. The Maternity and Child Welfare Service has similarly expanded. The Maternity Home, represented by nine beds in two houses in Cranbrook Road in 1919, is now housed in a modern and well equipped institution of 51 beds on the main arterial road. This was built in 1925 and extended in 1935. It includes two ward blocks, operating theatre, labour wards, an emergency cubicle block of 6 beds, and accommodation for Ante- and Post-Natal Clinics. The Central Midwives Board has recognised it as a training school for Part 1 of the training syllabus leading to the State Midwives Certificate. Ante-Natal Clinics are held also in Mayesbrook School Clinic. Since 1937, a domiciliary midwifery service has been provided, and 12 Municipal Midwives, working under the supervision of Miss Blockloy, the very capable Superintendent Midwife, have been appointed. By agreement with the British Medical Association, a Practitioners' Ante-Natal Scheme has been in operation for the past 8 years. The strain on the Maternity Home is seen by the figures given in the body of the Report. It is hard to visualise what would have happened to many Ilford mothers if the Maternity Home had not been extended when it was. The impending retirement of Miss M. E. Roberts, Matron of the present and former Maternity Homes for the past 25 years, on medical grounds, will be regretted by all. Her self-less devotion and conscientious and capable services to midwifery in the Town have earned the well-deserved appreciation of the Council and the sincere gratitude of countless mothers. The Infant Welfare Centres have multiplied from 5 in 1919 to 13 in 1944. Attendances have increased from 5,643 to 35,700 in the same period (the latter figure is considerably below normal owing to enemy action). Owing to wartime conditions it has been necessary to merge some of the Centres, but so far as circumstances have permitted, the service has been maintained. The war has seen the institution of four nurseries, each accommodating approximately 50 children below school age. The Isolation Hospital, which 20 years ago consisted of 84 beds, contained in 6 ward blocks, and a small administrative Block, now has 190 beds, of which 76 are of the modern cubicle isolation type. Additions to the administrative block and the erection of 3 cruciform cubicle blocks, centralised kitchen, Medical Officer's residence, garages, laundry and mortuary block between the years 1935 and 1939, has made this one of the most upto-date institutions of its kind in the country. The Hospital has continued to carry out efficient service for infectious cases, both for Ilford and Barking. I would refer you particularly to the report on the outbreak of Influenza given on Page 27. The campaign of active immunisation against Diphtheria introduced locally in 1929, has been vigourously prosecuted, and the existing low incidence and mortality of Diphtheria is a direct result. The war brought to the Department greatly increased duties and responsibilities. These included the organisation and operation of the Casualty Services of the Civil Defence organisation, a summary of which is given on Pages 35 and 36. I would refer in this connection to the indefatigable and able assistance which was rendered by Dr. Noordin which has been not only appreciated by myself but also by the Council and all those who have come in contact with him. The members of the Casualty Services generally deserve the grateful thanks of the Town; for many of them their duties have been tiresome and irksome and yet they have been always everready when the occasion arose. There have also been medical duties in connection with the evacuation of school children and expectant mothers, issue of special concessionary certificates to expectant mothers, war-time day nurseries, food decontamination services, and the inauguration of the National Milk Scheme, for which I acted as Milk Officer for a considerable time. 7 I do not wish to labour statistics, but I would point out that the infantile mortality rate, usually regarded as the most significant criterion of the health of a community, was 61 in 1919 and 36.8 in 1944. The general death rate in 1919 was 9.9, whereas in 1944 it was 11.4, but the latter figure includes civilian deaths due to war operations, and if these be excluded the death rate would be reduced. It has, however, to be remembered that Ilford is an ageing population and when the area is completely built up the general death rate may be expected to rise. It is, however, interesting to compare these figures with those for England and Wales and the Administrative County of London for 1944, which give an infantile mortality rate of 46 and 61, and a death rate of 11.6 and 15.7 respectively. During the year the work of the Department has been continued with industry and efficiency despite staff shortages, and the interference due to enemy activity, which so seriously affected the Town. I would express to the staff my sincere thanks for their loyalty, assistance and co-operation during our association, which in some cases covers the whole period of my occupation of the office. I must also make reference to my colleagues in other Departments of the Council, whose helpful co-operation and assistance have been greatly appreciated. To them, and to the voluntary helpers who have assisted in the work of the various clinics I express my deep gratitude. I feel proud that the health services have been able to be kept together in these unhappy war years, and this would have been impossible if I had not had such an able and willing deputy as Dr. Weir whose services to the A.R.P. organisation as well as to other branches of the Public Health Department are well known and valued by the Council as they have been by myself. I must also gratefully acknowledge the valuable support of Councillor G. F. Tyler whom I have been fortunate enough to have as Chairman of the Public Health Committee throughout the war years. His interest and knowledge of Public Health matters are well known to members of the Council and the Town. In taking my leave I would thank the members of the Council for their support during my tenure of office. Especially would I tender my grateful appreciation to the Chairmen and Vice-Chairmen of those Committees with which the work of this Department has been principally concerned. Quite simply, may I express my valediction to the Council and the citizens of the Town in wishing them "Good Health." I have the honour to be, Your obedient Servant, A. H. G. BURTON, Medical Officer of Health. 8 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land 8,402 8,435 Inland Water 26 Tidal Water 7 Population (Census 1921) 85,194 ,, (Census 1931) 131,061 Registrar-General's Estimate of resident Population:— June 30th, 1940 148,910 1941 141,100 1942 144,460 1943 147,600 1944 149,330 Number of inhabited houses (end of 1944) according to Rate Books 44,150 approx.) Rateable Value—October 1st, 1944 (Houses and Land) £1,571,139 Sum represented by a penny rate, October 1st, 1944 £6,095 (approx.) Education Rate— 1943-44 1944-45 Elementary 2s.7.52d. in the £ 2s. 7.54d. in the £ Higher (County) 0s 10.52d. in the £ 0s. 11,79d. in the £ ,, (Ilford Council) 0s.0.06d. in the £ 0s. 0.06d. in the £ Combined Rate (all services) 14s. Od. in the £ 14s. 8d. in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— (a) Number of unemployed males at end of January, 1944 60 ,, ,, ,, ,, December, 1944 34 (6) Number of unemployed females atend of January, 1944 15 ,, ,, ,, ,, December, 1944 13 Total M. F. 1944 1943 Live Births Legitimate 2,655 1,337 1,318 Birth Rate per 1,000 of the estimated resident population 19.1 18.2 Illegitimate 116 54 62 Still Births 57 34 23 Rate per 1,000 total (live and still) births 20.1 27.1 Deaths 1,657 848 809 Death Rate per 1,000 of the estimated resident population 11.4 11.4 Percentage of total deaths occurring in public institutions. 37.2 36.7 9 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 1944 1943 1944 1943 No. 29, Puerperal sepsis 2 2 0.71 0.74 No. 30, Other puerperal causes 5 6 1.76 2.23 Total 7 8 2.47 2.97 Death-rate of Infants under one year of age:— 1944 1943 All infants per 1,000 live births 36.8 35.1 Legitimate infants per 1,000 legitimate live births 35.7 35.1 Illegitimate infants per 1,000 illegitimate live births 60.3 33.7 Deaths from Cancer (all ages) 268 283 ,, Measles (all ages) — 1 ,, Whooping Cough (all ages) .. 2 4 ,, Diarrhoea (under 2 years of age) 7 12 1. Rainfall. Total rainfall registered in the district during the year was 22.47 inches, the greatest fall in 24 hours was registered on 7th September, being .75 inches. 2. Population. The number of patients and resident staff on tho 30th June, 1944, at the following public institutions, was:— Claybury Mental Hospital and Emergency Hospital 2,776 West Ham Mental Hospital and Emergency Hospital 1,384 Australasian Hospital (Girls' Village Homes) 91 Total 4,251 3. Births .—The number of births registered during the year was 2,771. Males Females Legitimate 1,337 1,318 Illegitimate 54 62 i.e., 4.2 per cent. of the births registered were illegitimate. The birth-rate, calculated on the net estimate of the population is 19.1 per 1,000. 4. Deaths.—The total number of deaths of Ilford residents was 1,657. This is obtained by taking the total deaths registered in the district (1,517), subtracting the deaths of non-residents occurring in the district (404), and adding the deaths of Ilford residents registered as having died in other districts (544). 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, 29 on Ilford residents, and 18 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 3 1 — 5 5 7 17 9 10 Death-Rates from Tuberculosis and Cancer, 1944. The following Table shows the death-rates for 1944 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 .503 .524 Other Tuberculosis .069 .103 Cancer 1.847 1.897 5.—Public Assistance Relief.—The total amount expended in Ilford during the year was £23,792 2s. 3d. The average weekly number of cases in receipt of relief was 551, including dependants. The number of admissions to Oldchurch Hospital from Ilford during the year was 1,044, made up as follows:— Men 320 Women 537 Children 187 In addition there were 411 admissions of patients from Ilford to other County Institutions, owing to no accommodation being available at Oldchurch Hospital; their allocation was as follows:— Men 124 Women 167 Children 20 The number of destitute persons admitted to the Institution during 1944 was 5, all children. 6. Marriages.—1,314 marriages took place in the Ilford district during 1944, 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 1944, arranged according to the age groups at which deaths occurred. 11 TABLE I.—Vital Statistics of Whole District During 1944 and Previous Years. Year Gross Population, estimated to middle of each Year. Net Population estimated to middle of each Year. Uncorrected Number Births Total Deaths Registered in the District Transferable Deaths Net Deaths Belonging to the District Net (b) of Non-Residents registered in the District of Residents not registered in the District Under 1 Year of Age At all Ages Number Rate (c) Number Rate (d) Number Rate per 1,000 Net Births Number Rate (e) 1 2 2 a 3 4 5 6 7 8 9 10 11 12 13 1940 148,910 144,654 1,558 2,024 13.9 1,538 10.3 481 484 63 32.8 1,541 10.6 1941 141,000 136,835 1,164 1,816 13.3 1,874 13.3 754 507 67 40.9 1,627 11.9 1942 144,460 140,320 1,679 2,415 17.2 1,326 9.2 386 546 74 30.6 1,486 10.6 1943 147,600 143,361 1,795 2,621 18.2 1,416 9.6 376 590 92 35.1 1,630 11.4 1944 149,330 145,079 1 ,949 2,771 19.1 1,517 11.1 404 544 102 36 8 1,657 11.4 (а) The net estimated population is found by deducting the population of Claybury and West Ham Mental and E.M.S. Hospitals from the gross estimated population. The population of Dr. Bamardo's Girls' Village Homes is included in the net estimated population of the dis trict. (b) The net number of births is obtained by taking the uncorrected number of births supplied by the local Registrar and adding to or subtracting from it such a number as is supplied for this purpose by the Registrar-General. (c) and (e) Calculated on the estimated net population. (d) Calculated on the estimated gross population. 12 TABLE 1A Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1944 (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 17.6 0.50 11.6 0.00 0.00 0.01 0.00 0.03 0.02 0.12 4.8 46 126 County Boroughs and Great Towns, including London 20.3 0.64 13.7 0.00 — 0.01 0.00 0.03 0.03 0.10 7.3 52 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 20.9 0.61 12.4 0.00 — 0.01 0.00 0.02 0.03 0.11 4.4 44 London Administrative Co. 15.0 0.42 15.7 0.00 — 0.00 0.00 0.04 0.01 0.08 10.1 61 ILFORD (Estimated Gross Population, mid 1944 = 149,330 18.5 0.38 11.1 — — — — 0.01 0.03 0.07 2.5 36.8 A dash (—) signifies that there were no deaths. 13 Registrar-General's Short List of Deaths and Causes:— TABLE II Causes of, and Ages at, Death during the Year 1944 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 1657 102 13 11 26 48 64 98 202 00 408 43" 1 Typhoid and paratyphoid — — — — — — — — — — — — 2 Cerebrospinal fever 1 — — — — — — — — 1 — — 3 Scarlet fever — — — — — — — — — — — — 4 Whooping cough 2 2 — — — — — — — — — — 5 Diphtheria 4 — — 1 3 — — — — — — — 6 Tuberculosis of respiratory system 73 2 — — — 11 12 15 21 4 4 4 7 Other forms of tuberculosis .. 10 3 1 2 1 1 — — — 1 — 1 8 Syphilitic disease 14 — — — — — 3 1 3 5 2 9 Influenza 10 1 — — 1 — — — 1 1 2 4 10 Measles — — — — — — — — — — — — 11 Acute Poliomyelitis and polioencephalitis 1 — — — 1 — — — — — — — 12 Acute infectious encephalitis 2 — — — — — — 1 1 — — — 13 Cancer of buccal cavity and oesophagus (males only) 21 — — — — — — 1 4 1 10 5 Cancer of uterus (females only) 8 — — — — — — — 5 — 3 — 14 Cancer of stomach and duodenum 46 — — — — — — 3 6 13 13 11 15 Cancer of breast 31 — — — — 1 — 4 10 9 4 3 16 Cancer of all other sites 162 — 1 1 — 2 2 8 28 32 52 36 17 Diabetes 12 — — — 1 — 1 — — 2 6 2 18 Intra-cranial vascular lesions 163 — — — — — — 1 13 31 55 63 19 Heart disease 404 — — — — 4 7 12 28 64 136 153 20 Other diseases of the cireulalatory system 47 — — — — 1 1 2 3 7 12 21 21 Bronchitis 77 1 — 1 — — 3 1 8 12 22 29 22 Pneumonia 59 14 3 3 — 1 1 2 6 4 11 14 23 Other respiratory diseases 23 — 2 — — 3 2 2 4 4 4 2 24 Ulceration of the stomach or duodenum 25 — — — — — — 3 5 6 8 3 25 Diarrhoea (under 2 years of age) 7 7 — — — — — — — — — — 26 Appendicitis 6 — — — 1 2 — 1 — — 2 — 27 Other digestive diseases 31 1 — — 4 1 1 0 3 5 7 7 28 Nephritis 32 — — — — 1 1 5 7 5 7 6 29 Puerperal and post-abortive 2 — — — — 2 — — — — — — 30 Other maternal causes 5 — — — — — 4 1 — — —r — 31 Premature birth 29 29 — — — — — — — — — — 32 Congenital malformations,birth injury, infantile disease 36 33 — — 1 1 — — 1 — — — 33 Suicide 14 — — — 1 — 2 — 5 4 2 — 34 Road traffic accidents 10 — — — 1 3 2 — 1 1 1 1 35 Other violent causes 141 5 4 2 8 10 18 22 30 18 9 15 36 All other causes 149 4 2 1 3 4 7 9 11 20 33 55 Special Causes (included in No. 36 above):— Small pox — — — — — — — — — — — — 14 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Nursing in the Home.—There is a voluntary District Nursing Committee, 11,016 visits being paid by the nurses in 1944, compared with 12,973 in 1943. Laboratory Facilities.—During the year 694 specimens were examined in the Bacteriological Laboratory at the Isolation Hospital. In addition 34 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 1944, 13 applications for renewal of licences were received. The Council renewed the licences in respect of the 13 establishments. Two new applications were received, which were granted. All the licences expire on 31st March, 1945. Hairdressers' and Barbers' Premises. During 1944, 73 visits of inspection were made to these premises. Ilford Corporation Act, 1937. (a) Section 77 of this Act provides for the registration of hawkers of meat, fish, fruit and veeetables, and their storage premises. Registration was granted to 1 person (concerning 1 premise) and registration of premises was granted to 1 hawker of an adjoining borough. (b) Section 80 of the Act requires the registration of premises used for the preparation or manufacture of sausages, or potted, pressed, pickled or preserved meat, fish or other food intended for sale. 1 application for registration was received. Shops Acts, 1912-1934 (Sections 10 and 13).—During the year 1944, 2,472 reinspections were made. One preliminary notice was served, which was complied with. Maternity and Nursing Homes. On the 1st January and on December 31st, 1944, 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 Co., states that the Company has not obtained a supplementary supply of water from the Metropolitan Water Board during 1944. Extension of mains during the year were 69 yards. Mr. Bryan also stated that more than 3,000 chemical, bacteriological and biological analyses were made of the various water supplies during the year 1944, and all were reported on as pure and wholesome and suitable for the purposes of a public supply. The Director of Water Examination to the Metropolitan Water Board states that 4,941 samples were analysed with satisfactory results. Nine samples of the two public water supplies were also taken officially by this Department, and all were reported upon as satisfactory. 15 (ii) Drainage and Sewerage.—The Borough Engineer regrets that owing to 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 20,868 6 ,, ,, ,, disposed of by barge 20,092 11 9 9 9 9 9 9 9 9 at Destructor 775 15 Salvage and Kitchen Waste:— Tons Value Wastepaper 1,058 £ 7,056 Metals 1,051 1,680 Textiles 122 2,793 Bottles 444 1,685 Cullet 524 697 Bones 68 319 Kitchen Waste 2,224 3,339 Rubber 39 121 Miscellaneous 23 133 5,553 £17,823 (iii) Sanitary Inspection of the Area.—The following is a summary of the work of the Sanitary Inspectors during the year:— Houses and premises inspected 24,516 Houses and premises reinspected (works in progress) 6,743 Visits during disinfection .. 738 Houses in which nuisances were detected 1,405 Houses in which nuisances were abated 1,169* Premises disinfected 502 Premises from which articles only disinfected 110 Articles disinfected 2,383 Premises disinfested for verminous conditions 4 * Includes 411 nuisances detected before 1st January, 1944. Notices served:— Served Complied with Statutory:— Public Health Act, 1936.. 39 38 Housing Act, 1936 — — Housing Act, 1936 (Overcrowding) 2 2 Factories Act, 1937 — — Provide Dustbin (Ilford Improvement Act) 515 422 Provide Water Supply to Dwelling House 2 2 Cleanse Water Storage Cistern (Byelaws) 6 4 Cover Water Storage Cistern (Byelaws) Informal 821 712 1,415 1,180 In addition to the above, 411 notices (4 statutory and 407 informal) served previous to 1st January, 1944, were also complied with. Complaints.—During the year, 1,610 complaints of nuisances have been received and investigated. 16 The following is a summary:— Accumulation of manure and refuse 32 Animals improperly kept .. 8 Bad smells 42 Dampness of premises 58 Defective drains, w.c's and fittings 217 Defective roofs, gutters, downpipes, etc. 94 Defective water fittings 70 Dirty and verminous houses 62 Dirty condition of rearway 13 Flooding of premises 6 Overcrowding 20 Smoke nuisances 49 Miscellaneous 939 Total 1,610 I iv) Swimming Baths and Pools.—Samples of water for examination were taken from the open-air swimming bath from May to September (4); and from January to November (15) in respect of the two indoor baths. All the Bamples 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:— „ I Found to be infested .. .. .. .. .. 17 Houbcs | Diainfested 25* •Includes 12 nuisances detected before 1st January, 1944. (vi) Slaughter of Animals Act, 1933.—No licence to act aB slaughterman was granted during the year. SECTION D.—HOUSING. (i) Overcrowding.—Informal notices were served in respect of 8 premises, 5 of which were complied with. 7 informal notices served during 1943 were also complied with during the year. (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) .. .. .. .. .. .. 958 (6) Number of inspections made for the purpose .. 6,005 (2) (a) Number of dwelling-houses (included under head (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 .. .. .. .. ,, 839 17 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 714* 3. Action under Statutory Powers during the year:— a. No proceedings were taken under Sections 9, 10 and 16 of the Housing Act, 1936. b. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 39 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 38 (b) By local authority in default of owners — c & d. No proceedings were taken under Section 11, 12 and 13 of the Housing Act, 1936. 4. Housing Act, 1936, Part IV—Overcrowding:— (а) (i) Number of dwellings overcrowded at the end of the year 3 (ii) Number of families dwelling therein 4 (iii) Number of persons dwelling therein 14½ (b) Number of new cases of overcrowding reported during the year 8 (c) (i) Number of cases of overcrowding relieved during the year 5 (ii) Number of persons concerned in such cases .. 27 (d) Particulars of any case9 in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report .. — *Includes compliances during 1944 of Notices served prior to 1st January, 1944. HOUSING ACT, 1936. During the year 1944, 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 15,910 houses. At the end of the year the total certificates issued to date numbered 18,090 in respect of 24,579 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, 1,338 were received up to 31st December, 1944, and the balance of 5 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 8,201. 18 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) Persons and Premises registered as at 31st December, 1944:— Premises registered as dairies and milkshops 38 Cowkeepers registered 3 Persons registered as retail purveyors of milk 45 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 bottles19 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 1 258 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 103 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 183 premises from which milk is retailed in Ilford, 16 are branches 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 73 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 1944 for the sale of:— "Tuberculin Tested" Milk 8 "Pasteurised" Milk 14 The above include supplementary licences which were issued for "Tuberculin Tested" milk, 3; and "Pasteurised" milk, 4. 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 1944. This licence was, however, revoked by the Essex County Council on the 28th September, 1944. 19 (iii) Sampling.—The routine practice of sampling was given in the 1938 Report, the following gives the results for 1944:— Grade of milk or ice cream Total Satisfactory Unsatisfactory Remarks Tuberculin Tested (Pasteurised) milk 19 18 1 This sample had a high bacterial count, and the retailer was communicated with by letter. Tuberculin Tested (Certified) milk 16 5 11 In all these samples, the analyses showed a high B. Coli Content. In 2 cases the County Medical Officer was communicated with, in 1 case a letter of warning was sent from the Town Clerk, and in the remaining cases the retailers were communicated with. Pasteurised milk 86 81 5 In all these samples, the analyses showed a high B Coli Content. In 2 of these cases the supplies were obtained from a neighbouring Borough, and the local Medical Officer was communicated with. In the remaining cases the retailers were communicated with, and re-sampling was ordered at later dates. Ungraded milk 45 23 22 In all these samples, the analyses showed a high B. Coli Content. In 1 case a letter of warning was sent to the Solicitors acting for the firm in question, in 1 case the supplier was communicated with, and in the remaining cases re-sampling was ordered at later dates. Ice cream — — — — (iv) Tubercular Milk.—30 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 or Dairy Herds.—Two inspections were 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 1944. One sample was taken from a cow in one of the herds and examined microscopically, with negative results. (vi) Legal Proceedings.—None were taken during the year. (vii) Registration.—No application for registration was refused during 1944. Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Meat—1,802 tins. Fish—1,300 tins. Vegetables 717 tins; 847 lbs. Soup—129 tins; 171 pkts. Eggs (dried)—64 pkts. Eggs (shell)—658. 20 Milk—1,371 tins. Cream—6 tins. Fish Paste—118 jars. Lard—2 cwt. 39 lbs. Margarine and Butter—4 cwt. 52 lbs. Pudding Mixture—493 pkts. Cheese—18 cwt. 28 lbs. Fruit—100 tins. Sugar—4 cwts. 89 lbs. Jams and Syrups—866 jars. Pickles—115 jars. Cereal (various)—582 pkts. Flour—32 cwt. 63 lbs. Cakes (assorted)—171. Cake Mixture— 142 pkts. Custard Powder—2 cwt. 76 lbs. Sweets—2 cwt. 62 lbs. Tea— 10J cwt. Coffee—27 tins. Cocoa—251 tins. Potatoes—6 lbs. Biscuits —3 cwts. 69 lbs. Salt—4 cwt. 51 lbs. Poultry—1 cwt. 98 lbs. (i) Food and Drugs Act, 1938.—During 1944, 200 samples (196 formal and 4 informal) of Food and Drugs were obtained, 4 of the formal samples were not genuine. Prosecution was undertaken in one case, as follows:— (a) Milk.—Deficient in milk fat to the extent of at least 45 per cent, of the normal quantity proper to natural milk. Retailer fined, as a first offence, £2 2s. Advocate's Fee, Analyst's Fee £3 3s., and Court Costs 7s. Of the remaining three cases, the following action was taken:— (b) Baking Powder.—Deficient in available carbon dioxide to the extent of approximately 20 per cent. As a result of detailed analysis this showed that the Baking Powder may have deteriorated to some extent, and a prosecution was therefore not advised. (c) Egg Substitute Powder.—Deficient in available carbon dioxide to the extent of 25 per cent, of the quantity proper to egg substitute powder. A letter of warning was sent to the Retailer by the Town Clerk. (d) Seidlitz Powder.—Two white packets deficient in Tartaric Acid to the extent of 20.8 and 15.6 per cent. respectively of the quantity prescribed in the B.P. A letter of warning was sent by the Town Clerk to the Retailer, and also the firm responsible for dispensing the product. As a result of complaint that Cider was being sold as Sherry, a sample was taken and submitted to analysis. Whilst the Analyst reported the sample as satisfactory in respect of alcoholic strength and freedom from methylated spirit, further enquiries were instituted by a neighbouring Metropolitan Borough. Under the provisions of Section 83 of the Food and Drugs Act, 1938, the licensee laid information against the Producers, who were fined £20 with 10 guineas costs, for selling Sherry deficient in Alcohol 22.5 per cent., and by flavour and presence of Malic Acid 50 per cent., indicating apple juice. 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. No cases were "notified" under the Act, but 8 cases of suspected food poisoning were reported to me. All were investigated but none were found to be cases of genuine food poisoning. Bakehouses.—There are 37 bakehouses in the district, 29 of which use motive power. 182 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 10 instances, and the requests were complied with. Diseases of Animals Acts, 1894-1927. (i) Regulation of Movement of Swine Fever Order, 1922.—Licences were issued for entry into the Borough of 96 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 21 "double-dipping" area under these Orders during the year 1944. The only sheep in the borough, at a large farm and a public Institution, have been double-dipped unofficially by the owners. Rats and Mice Destruction Act, 1919.—256 complaints have been received of the existence of rats affecting 273 premises. In 49 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 435 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested one petroleum appliance or fitting. The number of Licences issued was 102, and the fees paid to the Council for such Licences was £78 Is. 8d. 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 1944:— Officers Teachers Servants New Appointments 113 2 1 Under Sickness Regulations 16 6 48 Totals 129 8 49 22 SECTION F.—PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. TABLE III—Cases of Infectious Diseases Notified during the Year 1944 NOTIFIABLE DISEASE At all Ages Number of Cases Notified At Ages—years Total Cases Notified in each Ward Total Cases Admitted to Hospital Under 1 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Cranbrook Park Seven Kings Barkingside North Hainault Loxford Clementswood South Hainault Goodmayes Smallpox — — — — — — — — — — — — — — — — — — Scarlet Fever 278 3 46 200 15 12 2 — 22 19 16 82 37 29 22 31 20 193 Diphtheria, including Membranous Croup 56 — 10 23 16 7 — — 4 7 5 12 7 7 5 7 2 56 Enteric Fever (Typhoid and Para-Typhoid) 3 — — — 1 2 — — — — 1 2 — — — — — 3 Pneumonia 287 21 37 43 18 53 75 40 21 18 19 63 36 25 24 47 34 189 Puerperal Pyrexia 31 — — — 9 22 — — — 1 — 4 24 1 — — 1 24 Cerebor-Spinal Fever 5 2 1 1 — — 1 — — — 1 — 2 — 2 — — 4 Acute POliomyelitis — — — — — — — — — — — — — — — — — Acute Polio-Encephalitis — — — — — — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — — — — — — Dysentery 59 1 6 4 3 14 17 14 4 — — 39 1 1 1 13 54 Ophthalmia Neonatorum 4 4 — — — — — — — — — — 1 1 — — 2 2 Erysipelas 73 — 1 1 5 20 32 14 10 8 1 15 14 3 6 6 10 28 Pemphigus Neonatorum 4 4 — — — — — — — — — 1 2 — — 1 — 3 Tuberculosis Pulmonary 205 2 2 7 71 81 38 4 20 16 23 23 22 21 19 30 31 — Other Forms 29 1 2 8 9 5 1 3 1 3 1 5 3 3 4 3 6 — Anthrax — — — — — — — — — — — — — — — — — — Malaria—-Believed to be contracted in this country — — — — — — — — — — — — — — — — — — Believed to be contracted abroad 3 — — — — 3 — — 1 — — — — — — 2 — 2 Acute Rheumatism 15 — 2 10 3 — — — 2 — — 4 6 — — 1 2 7 Measles 425 19 93 256 44 12 1 — 12 26 19 84 45 55 51 84 49 25 Whooping Cough 957 71 444 421 6 7 — — 64 49 32 219 210 95 89 110 89 32 Food Poisoning — — — — — — — — — — — — — — — — — — Totals 2434 128 644 982 200 238 167 75 161 147 118 553 410 240 223 323 259 622 23 Of the eases notified, the following table shows the percentage treated in institutions, including those who were treated in the institutions from which they were notified :— Scarlet Fever 69.4 Diphtheria and Membranous Croup 100.0 Puerperal Pyrexia 77.4 Pneumonia 65.8 The total number of deaths of Ilford residents from the following infectious diseases during 1944 was 168 as against 215 in 1943. 1943 1944 Scarlet Fever 1 — Enteric Fever — — Diphtheria.. 4 4 Measles 1 — Whooping Cough 4 2 Influenza 39 10 Tuberculosis—Pulmonary 67 73 Other forms 11 10 Pneumonia 70 59 Diarrhoea (under 2 years) 12 7 Cerebro-spinal Fever 4 1 Puerperal Sepsis 2 2 Total 215 168 (а) Smallpox.—No case of Smallpox occurred. Notification of 45 persons who had been in contact with cases of Smallpox were received. These were visited by the Sanitary Inspectors for the usual period. The following gives particulars as to Vaccination during 1944:— Certificates of Successful Vaccination 1,788 Postponed 55 Conscientious Objections 603 Unsuccessful Vaccination 15 Left the District 323 (b) Scarlet Fever.—278 cases were notified in 1944. There were no deaths from this disease. 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. 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 1944 278 193 3 1.5 85 1 1.2 (c) Diphtheria.—56 cases were notified in 1944. There were 4 deaths from Diphtheria during the year, 2 at the Ilford Isolation Hospital, 1 at the City Hospital, Bucknall, Stoke-on-Trent, and 1 at the patients' home (this case was not notified the cause of death being discovered at postmortem conducted by H. M. Coroner). 24 Diphtheria Immunisation.— Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1944, to 31st December, 1944. 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 37 — 37 25 — 25 62 Negative 24 — 24 16 — 16 40 Numbers inoculated (full course) 147* 808 955 112* 465 577 1,532 Positive after full course of inoculations, and re-inoculated 3 10 13 4 11 15 28 Negative after full course of inoculations 124 652 676 87 274 361 1,037 Awaiting re-test 14 221 235 14 151 165 400 Not re-tested after inoculation (on account of leaving District, etc.) 6 25 31 7 29 36 67 Positive after re-test, but not inoculated for same reason - - - - - - - Final Schick Test in 1944 (1943 Cases):— Positive after full course of inoculations, and re-inoculated 2 7 9 3 6 9 18 Negative 86 295 381 56 85 141 522 * Schick+1944 = 37; Schick+1943 = 2; Not Tested = 108 * Schick-(-1944=25; Not Tested = 87 During 1944 a total number of 2,112 children attended at the Diphtheria Prevention Clinics (1,369 at Newbury Hall and 743, at Mayesbrook), making a total number of attendances of 9.479 (5,810 and 3,669) with an average per session of 94 and 71 respectively. 25 In 1944, under the arrangements mentioned in the 1935 Report, 18 private doctors were supplied with prophylactic for the immunisation of 81 children (69 under 5 years and 12 over 5 years of age). The following is a brief summary:— 1943 Cases: Final Schick Test in 1944:— Negative 35 Positive and re-inoculated — Positive and not re-inoculated (left district) 1 No final Schick Test, left district, etc. 6 1944 Cases: Numbers inoculated (full course) by medical practitioners 65 Final Schick Test—Negative 40 Positive and re-inoculated 1 No final Schick Test, left district, etc. 3 Forms not yet returned 9 To be Schick Tested in 1945 12 (d) Ophthalmia Neonatorum.—4 cases were notified during 1944. Of the 4 cases notified, 2 were treated at home by private medical practitioners, 1 was admitted to White Oak (L.C.C.) Hospital, Swanley, and 1 to the Ilford Isolation Hospital. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 4 2 2 4 — — - (e) Enteric Fever.—Three cases of this disease were notified during the year. Two of these cases were notified from Claybury Mental Hospital. Both patients had been in the Institution for long periods; the infecting organism was the B. Typhosus and Bacillus para-typhosus "B" respectively. The other case occurred in the district in a female of 24 years. The patient was admitted to the Isolation Hospital and made a good recovery after seven weeks in the Hospital. The infection was due to Bacillus paratyphosus "B". (/) Scabies Order, 1941 (dated 28th October, 1941).—187 cases of Scabies (81 adults and 106 children) were reported. 5 Ilford residents were admitted to the Isolation Hospital during the year. 20 Table showing Incidence of Infectious Disease, 1944, 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 20—35 35—45 45—65 Over 65 *Cases admitted to Hospital Total Deaths Smallpox - - - - - - - — — — — - - - — Scarlet Fever 278 3 6 8 16 16 145 55 11 10 6 2 - 193 — Diphtheria 56 — 4 1 3 2 12 11 8 13 2 — - 56 4 Enteric Fever (including Paratyphoid) 3 - - - - - - - - 2 1 — - 1 — Pneumonia 287 21 11 7 11 8 32 11 11 35 25 75 40 166 59 Puerperal Pyrexia 31 — - — — — — — 1 29 1 — — 24 2 Cerebro-spinal Fever 5 2 - 1 - - 1 - - 1 1 - - 4 1 Acute Poliomyelitis - - - - - - - - - - - - - - 1 Acute Polio-Encephalitis - - - - - - - - - - - - - - - Encephalitis Lethargica — — - - — — — — — — — — — — — Dysentery 59 1 - 2 2 2 3 1 3 7 7 17 14 16 1 Ophthalmia Neonatorum 4 4 - — — — — - - - — — — 2 — Erysipelas 73 — - 1 — — — 1 3 9 13 32 14 24 1 Anthrax - - - - - - - - - - - - - - - Malaria believed to be contracted in this country - - - - - - - - - - - - - - - Malaria believed to be contracted abroad 3 - - - - - - - - 2 1 - — — — Pemphigus Neonatorum 4 4 - - - - - - - - - - - 3 — Acute Rheumatism 15 — - — 1 1 2 8 3 — — — — 7 — Food Poisoning — — - — — — — — — — — — — — — Measles 425 19 25 21 24 23 200 56 26 24 6 1 — 17 — Whooping Cough 957 71 107 107 111 119 407 22 2 9 2 — - 31 2 * Excludes cases occurring at Barnardo's Homes, Claybury Mental Hospital and West Ham Mental Hospital. 27 Influenza.—Ministry of Health Circular No. 2879 called on Local Authorities to asoertain what assistance could be given to the local general practitioners by the military medical authorities, and also assistance to patients in regard to nursing, domestic duties, shopping, etc. On 14th December, 1943, I wrote to the local W.V.S. Centre, to the British Red Cross Society and the St. John Ambulance Brigade, asking for the names of volunteers who were prepared to give assistance, and wrote to all the doctors in the district asking them to let me know as soon as possible:— (1) Whether any additional medical assistance was required to deal with patients, either (a) at their surgery, or (6) at the homes of the patients. (2) Any cases which required nursing attention other than cases of Influenzal pneumonia, which should be removed to the Isolation Hospital or such other hospitals. (3) Those cases which required a certain amount of nursing attention, but were not cases of pneumonia, and which could be dealt with by people who were not trained nurses. (4) Those who required meals to be supplied to their homes from British Restaurants and school canteens, stating whether there was a person who could collect the meals, or whether assistance in this respect was necessary. (5) Homes which required assistance in the way of collecting shopping, etc., whioh could be done by local youth services. The appreciation of the doctors of the action taken is shown by the replies I received from them, some of which I quote:— “I note with gratefulness of the arrangements you have made for nursing attention, supply of meals, and other assistance. I shall inform my patients of the facilities available and shall inform you as soon as possible, should they require such assistance". “ At present I do not require any of the services, but should the occasion arise wherein any of the services mentioned may be required, I will be only too pleased to let you know". “With regard to nursing, the patients can usually find someone to look after them, but if any instances of complete inability to obtain help occur, I shall do as you say and ask for the help of the various organisations which you control". “ Nursing attention, meals and assistance for shopping will betaken advantage of wherever such needs will arise. Thank you for your communication". Telephone requests were received from 8 doctors in respect of 13 cases where a certain amount of nursing attention or domestic help were required, and in each case this was arranged for either through the British Red Cross or the W.V.S. The epidemic of Influenza commenced at the end of November, 1943, and continued until the end of January, 1944. The incidence of the disease and its fatality rate is shown by the table following, which shows the number of notifications of pneumonia with the percentage death rates according to where the cases were nursed. In order to cope with the situation in Ilford I had to ask the Essex -County Council to remove 20 cases of tuberculosis from the beds in the Isolation Hospital which had been loaned to the Essex County Council for hat purpose. 28 Week ending No. of Notifications of Pneumonia. Admissions to Hospitals. Cases Nursed at Home Ilford Isolation Hospital Oldehurch Hospital, Romford. Essex County Hospital, Wanstead. King George Hospital, Ilford. Other Hospitals. 1943/44 December 4th 16 5 2 1 1 1 6 11th 13 8 — - - - 5 18th 28 13 2 1 - - 12 25th 18 11 1 - 1 - 5 January 1st 17 12 1 — - - 4 ,, 8th 21 7 1 2 2 1 8 ,, 15th 9 5 1 — — 1 2 ,, 22nd 11 4 2 — 1 - 4 ,, 29th 11 4 — — — - 7 Totals 144 69 10 4 5 3 53 Of the 144 persons notified as suffering from Pneumonia, 91 were admitted to hospitals, or 63.2 per cent. (47.9 per cent. of them being admitted to the Ilford Isolation Hospital). Of this number 13 persons died or 14.3 per cent. The remaining 53 persons were nursed at home, and of this number 18 died or 33.9 per cent. The above figures show the importance of having adequate Hospital accommodation to deal with an influenza epidemic. In addition to the cases notified as Pneumonia, 18 deaths certified as having died from influenza occurred in patients nursed at home. In 1918, when an epidemic of Influenza occurred, there were no fewer than 249 deaths of Ilford residents from influenza and 55 from pneumonia. 3. Tuberculosis. During the year 1944 there were 205 new notifications of Pulmonary Tuberculosis and 29 of other forms of Tuberculosis. 17 cases of Pulmonary and 4 cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notifications and Deaths trom luberculosis ot lltord residents during 1944: Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 Year - 2 1 - - 2 2 1 1-5 years 2 — — 2 — — 1 2 5-15 3 4 2 6 — — 1 — 15-25 23 4S 3 6 4 7 1 — 25-35 25 17 2 1 6 6 — — 35-45 22 17 2 — 9 6 — — 45-55 19 3 — — 17 4 — — 55-65 14 2 1 — 4 — 1 — Over 65 3 1 2 1 7 1 — 1 Totals 111 94 13 16 47 26 6 4 29 Of the above new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 2 2 Claybury Emergency Hospital 5 — West Ham Mental Hospital 10 1 Ilford Isolation Hospital 1 — Australasian Hospital (Girls' Village Homes) 1 Of the 83 deaths which occurred of Ilford residents, notification had previously been made of 72 of the cases. Of the other 11, 2 were notified after death; 8 were not notified (9.6 per cent. of the deaths or a ratio of 1 in 10). Of the 8 not notified (previously referred to) in 5 instances the presence of tuberculosis was discovered following P.M. ; in one instance the presence of tuberculosis was found at an operation; in 2 instances the notification was overlooked. One other death included by the RegistrarGeneral I have not been able to trace. During the year 1944 the following deaths occurred from Tuberculosis:— Pulmonary Non-Pulmonary Ilford Resident' 73 10 Non - Residents— Claybury Mental Hospital 17 - West Ham Mental Hospital 7 2 Ilford Isolation Hospital 40 — King George Hospital 1 2 Pulmonary NonPulmon ary Total Number of cases on register, 1st January, 1944 868 205 1073 Number of cases entered on register during the year 222 33 255 Number of cases removed from the register during the year:— Non Pul. Pul Recovered 16 1 Deaths 77 12 Left District 73 10 Lost sight of 6 1 Diagnosis not established 10 1 182 25 207 Number of cases remaining on register on 31st December, 1944 907 214 1121 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurse of the Essex County Council. 979 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 184 70 Improved or fairly well 344 80 Not so well 49 8 In Sanatorium 73 20 No information as to present condition 41 17 Removed from district, etc. 62 31 Totals 753 226 30 The treatment of Tuberculosis is under the control of the Essex County Council. On the 31st December, 1944, there were 970 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. 113 patients were treated, 16 being supplied with dentures. The Council's Dentist also treated 27 tuberculosis patients from the Ilford Sanatorium. The number of patients from Ilford sent to Institutions under the Essex County Tuberculosis Scheme during 1944 was as follows:— Pulmonary Non-Pulmonary Total Males Females Males Females Adults 40 56 2 1 99 Children 3 1 — 1 5 Tuberculosis Cart Association.—This Association has assisted 84 cases with extra nourishment, clothing, and in other ways. 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. Thirteen persons were assisted during 1944 with the Insulin required. Ten persons were assisted at part cost. one at cost price, and two free of charge. 31 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 269 factories with mechanical power on the register. There are 212 factories without mechanical power on the register. There are 246 outworkers on the register. 1 —INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by Sanitary Inspectors . Premises (1) Number of Inspections (2) Written Notices (3) Occupiers prosecuted (4) Factories with Mechanical Power 288 2 - Factories without Mechanical Power 141 4 Other premises (not including Outworkers' premises) — — — Total 429 6 — 2.—DEFECTS FOUND IN FACTORIES. Particulars. Number of Defects No. ot defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) - - - - Overcrowding (S.2) — — — — Unreasonable Temperature (S.3) - - - - Inadequate Ventilation (S .4) — — - — Ineffective Drainage of Floors (S .6) - - - - Sanitary Conveniences (S .7):— Insufficient 1 1 - — Unsuitable or Defective 4 4 - — Not Separate for Sexes — — - — Other Offences 7 7 - — Total 12 12 - — 32 ISOLATION HOSPITAL. 965 patients were admitted during 1944. 100 per cent, of the notified cases of diphtheria and 69.4 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 981 patients admitted during 1944 suffered from the following complaints:— Ilford Barking Admissions Deaths Admissions Deaths Scarlet Fever 179 - 88 1 Scarlet Fever and Chicken Pox 1 - 1 - Diphtheria 34 2 6 - Pneumonia 82 17 6 1 Pneumonia and Chicken Pox 1 - - - Pneumonia and Whooping Cough 3 — - - Chicken Pox 7 — - - Chicken Pox and Whooping Cough 1 — - - Whooping Cough 25 2 6 - Whooping Cough and Measles 1 — - - Measles and German Measles 25 - - - Erysipelas 23 1 5 - Sonne Dysentery 13 - 9 - Para-typhoid Fever 1 — - - Puerperal Pyrexia 9 — - - Bronchitis 4 - - - Influenza 2 - - - Pemphigus Neonatorum 3 1 1 - Cerebro-spinal Fever 1 - - - Acute Aseptic Meningitis 1 — - - Influenzal Meningitis 1 1 - - Tuberculous Diseases—Pulmonary 162 43 - - Tuberculous Diseases—Other forms 1 1 - - Acute Rheumatism 7 - - - Tonsillitis 36 - 17 - Laryngitis — — 1 - Scabies 5 — 2 - Dermatitis 2 - - - Impetigo 2 — — - Impetigo and Scabies 1 — — - Enteritis 1 — - - Gastritis - — - - Pleurisy 1 — 1 - Tetanus — — 1 1 Acute Infective Hepatitis 3 — 1 - Acute Anterior Poliomyelitis 1 1 — - Acute Encephalitis I 1 — - Chronic Myocarditis 1 1 — - Staphylococcal Septicaemia 1 1 — - Carcinoma of Bronchus 1 1 - - Broncho-pneumonia, secondary to inhalation of foreign body, cardiac failure 1 1 - - Haemolytic Streptococcal Empyema 1 1 - - Cardiac failure, pyelonephritis, operated Bpinal tumour, premature labour 1 1 - - Observation and other cases 162 — 11 - Post Mortems were held by H.M. Coroner in connection with 11 of the above 79 deaths. 33 Number of patients in Hospital on 1st January, 1944 and 1945 respectively:— 1st Jan., 1944 1st Jan., 1945 Scarlet Fever 39 11 Diphtheria 25 6 Tuberculous Diseases 47 66 Puerperal Pyrexia 1 3 Erysipelas - 1 Pneumonia 27 7 Acute Rheumatism 5 — Measles — 3 Whooping Cough 3 1 Scabies 1 — Dysentery — 2 Observation and other cases 5 10 The average length of stay in Hospital was for:— Scarlet Fever 23.7 days Diphtheria 63.7 ,, Tuberculous Diseases 79.0 ,, Average stay in Hospital of all cases 29.7 „ The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day 107.8. Scarlet Fever.—The diagnosis of scarlet fever could not be confirmed in 14 patients admitted. One death from Septic scarlet fever occurred during the year—a male child, age 12 months, six days after admission. (This was a Barking case). 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. 1940 1941 1942 1943 1944 Ilford .. 2.4 7.1 Nil 9.1 5.8 Two deaths occurred—both female patients from extensive diphtheritic paralysis ending in cardiac failure, aged 5 years; one 43 days after admission, and the other 23 days after admission. Neither of these patients had been previously immunised against Diphtheria. Tuberculosis.—162 cases of Pulmonary Tuberculosis were admitted, as compared with 145 in 1943. During the year arrangements entered into with the Essex County Council were in force for the treatment of Tuberculosis patients, as follows:— Blocks. Beds, Patients. Period Charges. occupied. 1, 2 & 6 52 Males Whole year £3 12s. 6d. per week whether occupied or not. 10 20 Females 30th Oct. ditto. to 31st Dec. Training of Nurses.—During 1944 7 nurses passed Parts I and II and 1 passed Part I of the Preliminary examination of the General Nursing Council, and 17 obtained the Certificate by passing the final examination (6 student nurses, 11 staff nurses). 34 The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick tested during 1944, and also the number inoculated:— Numbers Schick Tested:— Nurses Domestics Positive 19 - Negative 22 4 Numbers inoculated (full course) 19 — Numbers re-tested:— Negative after full course of inoculations 19 — Positive after full course of inoculations, and re-inoculated - - Numbers Dick Tested:— Positive 18 2 Negative 23 2 Numbers inoculated (full course) 18 2 Numbers re-tested:— Negative after full course of inoculations 24 — Positive after full course of inoculations, and re-inoculated 6 — 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 1944 the number of cases admitted was 156. 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. 35 CIVIL DEFENCE CASUALTY SERVICES. In 1937, arrangements were made for the preparation of a scheme for the formation of an Air Raid Precautions Casualty Service. During 1938, training and preparations proceeded and at the time of the Munich crisis in September of that year, arrangements were made at short notice for the equipping and staffing of three First Aid Posts, with provision for a fourth to be held in reserve. Subsequent to this a more permanent scheme was proceeded with, and just prior to the outbreak of hostilities the Service was mobilised on a war-time basis. First Aid Posts and Decontamination Stations were established in Redbridge, Fairlop and Cleveland Road Schools, and at the King George Hospital, the Australasian Hospital, Isolation Hospital, Mayesbrook School Clinic, and Valentines Mansion. In each case the necessary structural alterations were carried out by the Borough Engineer's Department. To these fixed First Aid Posts were ultimately added one Heavy Mobile Unit and two Light Mobile Units, and there were established three Invalid Rest Centres, and four Gas Cleansing Stations. Arrangements were also made for medical and nursing services to be available at the various Rest Centres in the Borough and at public shelters. In staffing these Units, considerable assistance was rendered by members of the St. John Ambulance Brigade and the British Red Cross Society and other volunteers. In this, and in the training of personnel, ready assistance was given by Mr. F. T. Dean, Divisional Superintendent of the St. John Ambulance Brigade, who acted as Liaison Officer between the Local Authority and the two voluntary organisations. First Aid training was undertaken by the Assistant Medical Officer of Health for A.R.P. Casualty Services, local medical practitioners, and instructors from the St. John Ambulance Brigade, and ultimately there was organised a system of basic training carried out by the Borough Civil Defence Training Officer, who assumed responsibility for instruction in the general principles of Air Raid Precautions, Anti-Gas Measures and Incendiary Bomb Control. Members of the staff of the Department were engaged on various duties connected with First Aid Posts, Rest Centres, Control and Report Centres, Food Decontamination, courses of instruction, air raid incidents, inspection of First Aid Posts and Depots, and general administration of the Service. In the training and in the actual treatment of casualties at incidents and First Aid Posts, much valuable assistance was rendered by medical staff of the Department and local medical practitioners, 9 of whom were initially appointed as First Aid Post Medical Officers. The organisation worked in conjunction with four Casualty Receiving Hospitals—the King George Hospital, Australasian Hospital, Goodmayes Emergency Hospital and Claybury Emergency Hospital, operating under the Emergency Hospital Service under the aegis of the Ministry of Health. Close collaboration was maintained with the Borough Engineer's Department, who had charge of the Ambulance Service, and the First Aid Party and Rescue Party Services, which were ultimately merged to form the Rescue Service. These were accommodated in three multiservice Depots at the Beal School, Clarks Road and Clayhall. The statistical picture is indicated by the following figures:— The Casualty Services Personnel (8 First Aid Posts, 1 Heavy Mobile Unit and 2 Light Mobile Units) totalled 1846, made up as follows:— Full-time 192 Part-time 1,556 “Directed'' personnel from the Ministry of Labour 98 For Security reasons it is impossible to give the number of casualties treated at First Aid Posts or the number of civilian war deaths due to enemy action. 36 Summary of Lectures and Demonstrations given or arranged by the Staff of the Public Health Department. 1. Anti-Gas. 35 courses (280 lectures and demonstrations), involving 1,437 Casualty Services Personnel. 6 lectures to staff of Isolation Hospital and Maternity Home. (This training was later taken over by the C. D. Training Officer). 2. Basic Training (Anti-Gas, Incendiary Bomb Control, etc.). Classes held in conjunction with Wardens, etc. :—524 Casualty Services Personnel attending. 3. First Aid. (а) Casualty Services Personnel.—37 courses (272 lectures and demonstrations), involving 1,263 personnel. (A number of the volunteers were already trained in First Aid, and members of the S.J.A.B. or B.R.C.S.). (b) Depot Personnel (Ambulance Drivers, Attendants, Stretcher Bearers, Rescue and Demolition Parties).—22 full courses (132 lectures and demonstrations) to 1,250 personnel. (c) Wardens Service.—30 full courses, 24 short courses (276 lectures) to 3,080 Wardens. (d) Dr. Noordin, the temporary part-time Assistant Medical Officer of Health for Casualty Services, gave 72 courses (432 lectures) on First Aid to the Depot personnel. These were to meet the revised training syllabus. (e) 10 courses (60 lectures) for the Auxiliary Nursing Services, of whom 79 attended. (/) Classes in First Aid were arranged at three schools for teachers, and at one school for Home Nursing. 4. 11 courses (62 lectures) in both Anti-Gas and First Aid were arranged for the general public, at which a total of 1,300 attended. Note.—During 1941, part of 1943 and 1944, the training was much affected through enemy action. There were originally 8 First Aid Posts, one Mobile Unit and two Light Mobile Units. One Post, King George Hospital, was taken over by the Hospital for the Essex County Council on 16th June, 1941, another, Valentines, was closed in June, 1944; two others, Mayesbrook and Fairlop, on 28th March, 1945, and one, Dr. Barnardo's, on 2nd June, 1945. The whole Service was officially disbanded on 1st July, 1945. 37 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 1944 was 1,950 (976 males and 974 females). Of these, 116 (62 males and 54 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 858 notifications of birth (441 males and 417 females) which took place outside the district, although the ordinary residence of l.he parents is in Ilford, were transferred to this district. During the year, 18 cases in which there was default in complying with the requirements of the Act relating to the Notification of Births were referred to the Town Clerk. The percentage of live births occurring in Ilford. notified by the various responsible persons, was as follows:— By Medical Practitioners 5.95 By Certified Midwives 91.59 By Parents and Others 2.46 In addition. 41 stillbirths (26 males and 15 females) were notified. The notifications of 16 stillbirths (9 males and 7 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 102, the total number born being 2,771. 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, 36.8. Neonatal Mortality.—The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 64 deaths of infants under four weeks of age during 1944 and the rate for the year was 23.1 per 1,000 live births. The deaths of infants under one month increased from 54 during 1943 to 64 during 1944. The following table gives the deaths of infants under one year of age, classified according to age. Infant Mortality. Cause of Death Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total Deaths under 1 year Whooping Cough - - - - - - 1 - 1 2 Tuberculous Meningitis - - - - - - - - 1 1 Abdominal Tuberculosis - - - - - - - 1 — 1 Other Tuberculous Diseases - - - - - - - 1 1 2 Meningitis (not tuberculous) - - - - - 1 - - - 1 Convulsions 1 — — — 1 — — — — 1 Bronchitis - - - - - 1 - - - 1 Pneumonia (all forms) 2 2 1 — 5 9 4 — 2 20 Enteritis - - - - - 2 2 — 2 6 Suffocation (overlying) - - - - - - 1 - - 1 Atelectasis 4 2 — — 6 — — — — 6 Congenital Malformations 9 — — — 9 — 1 2 — 12 Premature Birth 25 4 — — 29 — — — — 29 Atrophy, Debility and Marasmus 3 - - - 3 1 - - - 4 Other causes 6 1 3 1 11 1 3 — — 15 Totals 50 9 4 1 64 15 12 4 7 102 38 Foster-Children. Number of foster-children on register on 1st January. 1944 .. 24 Number of foster-children who were notified during 1944 . 8 Number of foster-children returned to their mothers during 1944 . 4 Number of foster-children taken off register for various other reasons during 1944 7 Number of foster-children on the register on 31st December, 1944 21 Foster-Mothers. Number of foster-mothers with children on the register on the 1st January, 1944 20 Number of persons who became foster-mothers during 1944 6 Number of foster-mothers whose names were taken off the register during 1944 8 Number of foster-mothers with children on the register on the 31st December, 1944 18 Number of houses visited by the Sanitary Inspectors for the purpose of the Act during 1944 7 Number of visits made bv the Sanitary Inspectors for the purpose of the Act during 1944 15 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:— (а) 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. Three notices were received during the year. One person who was participating in the arrangements for the adoption of a child, failed to give notice. The circumstances were reported by the Town Clerk to the Maternity and Child Welfare Committee, and in consequence a letter of warning was sent by the Town Clerk. (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. 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 1944 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 2,742 Subsequent visits to children under 1 year of age 8,572 Subsequent visits to children over 1 year of age and under 5 16,295 Visits to expectant mothers 620 Home visits for other reasons 4,866 Total visits paid 33,095 Supply of Milk to Expectant and Nursing Mothers and Infants.— A total of 529½ lbs. of dried milk were given free under the Regulations of the Ministry of Health during 1944 to 76 infants. These figures include the supplementary issue of 14 20 oz. packets of National Dried Milk to two 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. 39 Special Clinics.—Attendances of children under 5 years of age and expectant and nursing mothers at the various Clinics during 15)44 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 99 49 18 2 88 39 173 83 (ii) Orthopaedic 41 18 - — — — — — 292 100 — — 478 166 — — (iii) Artificial Sunlight 45 49 — — — — — — 16 23 — — 334 232 — — (iv) Remedial Exercises 90 — 50 — — — — — 25 — 3 — 194 — 6 — (v) Aural 37 — — — 1 — — — 107 — — — 134 — — — (vi) Rheumatism 25 — — — — — — — 25 — — — 44 — — — (vii) Dental — — — 146 — — — 481 — - — 143 — — — 1372 A = Newbury Hall. B = Mayes brook. C= All Saints Hall. D = Valentines Dental Clinic. Note.—(i) Two children under 5 years of age were admitted to the Country branch of the Royal National Orthopaedic Hospital at Stanmore. (ii) 59 children were prescribed and provided with glasses. (iii) 7 children and 3 expectant mothers were referred for X-Ray and Electro-Cardiogram. 40 War-time Day Nurseries.—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 Daily Attendance during 1944 Including Excluding Saturday Saturday No. of Days in Quarantine Reasons for Quarantine Sunshine House, Girls' Village Homes, Barkingside 17.8.1942 45 24 28 73 5 cases German Measles 1 case Whooping Cough. 359-381, Green Lane, Seven Kings 5.5.1943 50 19 24 215 25 cases Chicken Box 23 cases German Measles 1 case Mumps 7 cases Whooping Cough. 226-236, Ley Street, Tlford 16.8.1943 50 28 31 112 24 cases of German Measles 8 cases Whooping Cough Becontree Avenue, corner of Winding Way, Dagenham 17.1.1944 50 25 29 120 3 cases of Chicken Pox 17 cases German Measles 12 cases Whooping Cough. Attendances were considerably reduced during the latter half of the year owing to evacuation. Sunshine House Day Nursery was damaged due to enemy action on the 30th June, and closed from that date until 30th July. The four Day Nurseries are affiliated to the National Society of Children's Nurseries to enable the Students to take the examination of that Society for the Nursery Nurses Diploma. Two Students from the Sunshine House Nursery sat for the examination in November, one of whom obtained the Diploma, 41 Infant Welfare Centres.—84 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1944. During the year the following attendances were recorded:— Total number of attendances of infants 35,700 First attendances 2,048 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 2,970 11,332 attendances of children from 1 to 5 years were made at the Infant Welfare centres during the year. Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 21 belts and 6 trusses have been supplied to infants suffering from hernia during 1944. A certain number of infants were brought to the Clinics at Newbury Hall and All Saints' Church Hall to receive treatment for minor ailments. 18 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. Four were treated free of charge as cases of necessity. 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, 21 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. Three Midwives were suspended from practice for varying periods following attendance on 2 cases rendering them liable to be a source of infection, as follows:— Notified cases of Pyrexia due to Pyelitis (1), and sub-involution (1). Medical aid was sought in 7 instances where the infant was found to have inflamed or discharging eyes. Two 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 836 cases were attended by the eleven Council District Midwives. In 500 cases the midwives were engaged to attend as midwives and in 336 as maternity nurses. The cases resided in the following wards : Barkingside 185; North Hainault 135; Cranbrook 41 ; Park 80; Seven Kings 89; South Hainault 109; Loxford 70; Clementswood 76; Goodmayes 51. 4,317 ante-natal visits were made during the year. 52 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. 37 patients were referred by Private Doctors to the Council's Consultant Obstetrician at the Ante-Natal Clinic for a further opinion. 20 of these women and 35 other patients who had engaged a Council Midwife (29 as a Midwife and 26 as a Maternity Nurse) were for various reasons admitted to the Council's Maternity Home or other Institutions for confinement. 46 were admitted to the Maternity Home, 2 to the Ilford Isolation Hospital, 2 to the London Hospital, 1 to Oldchurch County Hospital, Romford, 1 to Queen Mary's Hospital, Stratford, 1 to King George Hospital, Ilford, and 2 to Private Nursing Homes. 42 In addition 5 patients were admitted to the Maternity Home following confinement for various reasons. A Doctor was called in at the time of the confinement or subsequently to 121 of tho 500 cases in which a midwife had been engaged. Three cases were notified as suffering from Puerperal Pyrexia, 2 of these cases and 1 other patient was removed to the Isolation Hospital. Two of the cases had engaged their own Doctor to attend them. One baby was notified as suffering from Ophthalmia Neonatorum. The condition of the eyes cleared satisfactorily. The midwife was engaged as a midwife. Of the infants born, there were 9 stillbirths. In 2 instances the midwife was engaged as a maternity nurse only. Twenty infants died. In 6 instances the midwife was engaged as a maternity nurse only. Two patients who had engaged the District Midwives (1 as a Maternity Nurse) died in the Maternity Home following their confinement. (1) Admitted owing to Obstructed Labour and failed forceps delivery. Delivered of a stillborn infant the following morning by forceps and died 2 days later from Obstetric shock due to forceps delivery for obstructed labour (full term child in rigor mortis). (2) Admitted owing to Vaginal placenta praevia, delivered the following day and died 1½ hours later due to Cardiac failure due to Ante-partum Haemorrhage due to placenta praevia. Home Helps.—At the end of 1944 there were 6 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 189 cases were attended. Salvation Army Midwifery Service.—121 cases were attended by the Salvation Army midwives during the year; 115 as a midwife and 6 as a maternity nurse. Ante-Natal Clinics. Maternity Mayesbrook Home Clinic First attendances 809 212 Subsequent attendances 6,792 1,482 Number of expectant mothers on the rolls on 31st December, 1944 309 88 All patients booked for admission to the Maternity Home are medically examined at the Ante-Natal Clinics. During the year, 383 cases other than those booked for admission to the Maternity Home were examined at the Clinics. There were 1,834 attendances by such cases. The Consulting Obstetrician made weekly visits to the Ante-Natal Clinic during 1944. During the year 52 ordinary visits were made, 410 patients referred from the Ante-Natal and Post-Natal Clinics, and 58 patients referred by private Doctors, were examined. A total of 1,150 examinations were made. X-Ray Examination of Ante-Natal Patients. 87 examinations were made at King George Hospital in 1944. Post-Natal Clinic. The following attendances were recorded:— First attendances 523 Subsequent attendances 395 Number on roll on 31st December, 1944 60 43 Supply of Sheets for Expectant Mothers.—In accordance with Circular 154/44 of the Ministry of Health of the 3rd November, 1944, women holding RB2 expectant mother's ration books are eligible to purchase Utility Sheets on priority dockets if the Midwife or Maternity nurse booked for the case certifies that the woman is genuinely in need of additional sheets. Up to the end of the year 21 dockets were issued by me to 9 expectant mothers. Maternal Mortality.—The total number of deaths due to childbirth during the year was 7, which gives a maternal mortality rate i.e., number of deaths per 1,000 live births of 2.52 (or 2.47 including stillbirths). The causes of death were as follows:—Puerperal Sepsis—(1) died at Oldchurch County Hospital, Romford; Septicaemia from infected criminal abortion; Manslaughter; conviction on charge of using an instrument to procure abortion. (2) Died at Luton and Dunstable Hospital, Luton; Acute obstruction; Plastic peritonitis; Ruptured ectopic gestation. Other Puerperal causes—(1) Died at own home; Air embolus due to introduction of fluid and air into uterine cavity; Self induced abortion. (2) Confined and died at Maycroft Nursing Home, Woodford; Massive collapse of lungs; Parturition. (3) Confined at and died at Oldchurch County Hospital, Romford; Obstetric shock following Caesarean section operation for obstructed labour; Toxaemia of pregnancy. (4) Confined at and died at Ilford Council Maternity Home; Obstetric shock due to forceps delivery for obstructed labour (full term child in rigor mortis). (5) Confined at and died at Ilford Council Maternity Home; Cardiac failure due to ante-partum haemorrhage due to placenta praevia. MATERNITY HOME. During 1944, 784 women were admitted into the Home (98 direct to the Emergency Block and 686 to the Ward Blocks). 441 cases could not be admitted during the year and other arrangements were made for their confinement. At the end of the year 368 cases had booked for future admission to the Home. The average number of patients in the Home per day during 1944 was 32.54 and the average length of stay of patients was 15.12 days. Emergency Block.—129 cases were treated, 98 being admitted direct to this Block and 31 being transferred from the Ward Blocks. 66 of these 98 cases had not been booked for admission to the Maternity Home. Ten of the 98 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 1944 was 3.79 (including cases transferred from the Ward Blocks) and the average length of stay of patients admitted direct to this Block was 13.16 days. 62 patients were confined in the Emergency Block (52 admitted direct to this Block and 10 transferred from the Ward Blocks). The 10 cases mentioned above have been included in the figures for those confined in the Ward Blocks. 36 of the 62 cases were first confinements and 26 were second or subsequent confinements. 11 cases (or 17.7. per cent.) were delivered by means of forceps; 4 of the infants were stillborn. In addition labour was surgically induced in 2 cases. 1 of the infants were stillborn and 1 died aged 1 week. There were 9 deaths of infants born in the Emergency Block and 10 stillbirths. Seven cases were notified as suffering from Puerperal Pyrexia. Three of these cases and 15 other patients were removed to the Isolation Hospital. 44 One baby had Pemphigus when born and was also removed to the Isolation Hospital. The Consulting Obstetrician or his Deputy was called in to 32 cases as follows:— To perform Caesarean section operations 4 To perform other operations 22 For consultation 6 The reasons for the Caesarean Section operations were:— Chronic Colitis (patient was also sterilised) 1 Obstructed Labour 3 The other 22 operations were as follows:— Artificial rupture of membranes 1 Bi-Polar version; ante-partum haemorrhage; placenta praevia 1 Dilatation and curettage. 11 Drew Smythe induction of labour 1 Failed forceps delivery; removal of adherent placenta 1 Forceps delivery due to obstructed labour (1) and foetal distress (2) 3 Hysterotomy and sterilisation 1 Removal of adherent placenta 2 Removal of cervical polypi 1 There were 3 deaths of patients admitted in an emergency to this block. (1) Admitted owing to Obstructed Labour and failed forceps delivery. Delivered of a stillborn infant the following morning by forceps and died 2 days later from Obstetric shock due to forceps delivery for obstructed labour (full term child in rigor mortis). (2) Admitted owing to Vaginal placenta praevia, delivered the following day and died 1½ hours later due to Cardiac failure due to Ante-partum haemorrhage due to placenta praevia. (3) Admitted owing to Pneumonia, confined 3 days later and died 2 days later from Cardiac failure due to parturition associated with ulcerated endocarditis. These 3 cases were reported to the Coroner and the cause of death was certified by him in each case after a Post Mortem examination. One patient also admitted in an emergency to this Block, confined therein the same day, and transferred to the Ilford Isolation Hospital the following day, died 3 days later from Cardiac failure, Pyelonephritis, operated spinal tumour and premature parturition. The other 3 ' cases admitted direct to this Block were not coufiued therei n for the following reasons:— Abortion or miscarriage 19 Not pregnant 2 Pregnancy terminated 1 Admitted for ante-natal treatment and subsequently evacuated or confined at Queen Mary's Hospital 5 Born before arrival at Home 10 Ward Blocks.— 68 cases were admitted to the Ward Blocks. In addition 10 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. 60 of the 686 cases had not been booked for admission to the Home. 20 cases were not confined in the Home for the following reasons:— Abortion or miscarriage 7 Admitted for ante-natal treatment and subsequently evacuated or confined at Queen Mary's Hospital 10 Born before arrival at Home 2 Pregnancy terminated 1 45 The average number of patients in the Ward Blocks per day during 1944 was 28.75 and the average length of stay of patients was 15.40 days. In 53 of the 665 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 665 confinements there were:— (а) 356 cases of first confinement. (b) 309 cases having their second or subsequent confinement. (c) fO oases living in 2 rooms or less (38 being first confinements). (d) 92 cases living in 3 rooms (50 being first confinements). 57 cases (or 8.6 per cent.) were delivered by means of forceps, 12 following surgical induction; 1 of the infants was stillborn. In addition, labour was surgically induced in 64 other cases; 3 of the infants were stillborn. The neo-natal death-rate of babies born in the Ward Blocks for the five years 1940 to 1944, was 2.09 per cent. compared with 2.0 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 1940-1944 was 1.91 per cent. The infant mortality rate of children born in the Ward Blocks of the Maternity Home for the five years 1940-1944 was 29.8 per 1,000 births, as compared with 34.5 born in their own homes. The figure of 34.5 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 15 stillbirths in the Ward Blocks. 15 cases were notified as suffering from Puerperal Pyrexia. 9 of these cases and 10 other patients were removed to the Isolation Hospital. Two babies had Pemphigus when born and were removed to the Ilford Isolation Hospital. Seven other babies were also sent to the Ilford Isolation Hospital for the following reasons:— (1) Blocked lachrymal duct and Pyodermia; (2) Follicular Dermatitis; (3) ? Fracture of right Parietal bone; (4) Haemorrhagia Neonatorum; (5) Pustules on face; (6) Septic Forceps mark; (7) Staphylococcal Conjunctivitis. Special visits were made by the Consulting Obstetrician or his Deputy to 31 oases in the Ward Blocks as follows:— To perform Caesarean section operations 13 To perform other operations 13 For consultations 5 The maternal mortality rate for the Ward Blocks of the Home for the ten years from 1935 to 1944 is 1.22 per 1,000 births, as compared with the maternal mortality rate in the district generally of 3.19, the rate in each case being calculated on the total live births. Training op Pupil Midwives.—As mentioned in my Report for 1944 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. 22 Pupil Midwives commenced their training during 1944. 8 of these and 7 of the 11 who commenced in 1943 passed Part 1 Examination in 1944. Gas and Air Analgesia.—Two Hospital Model Walton Minnitt Gas Air Machines have been provided for the purpose of producing analgesia during labour. Gas and air was administered to 281 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. Three of the staff qualified and obtained the Certificate during 1944. 4(5 OTHER MATERNITY HOSPITALS. (а) Oldchurch County Hospital.— 71 cases were admitted to Oldchurch County Hospital during 1944. The fee payable to the Essex County Council is at the rate of 14/- per day. By arrangement, all Ilford cases found to be normal at the first antenatal examination at the Oldchurch Hospital Clinic are referred to the Ilford Ante-Natal Clinics for further examinations until the 36th week of pregnancy. The cases are then referred to the Oldchurch Hospital Clinic again and if still normal are referred again to the Ilford Clinics for examination until the date due for confinement. If any abnormality develops whilst under supervision at the Ilford Clinics the cases are referred to the Oldchurch Hospital Clinic. 48 cases were examined at the Council's Ante-Natal Clinics during 1944, making a total of 143 attendances. These figures are included in the table of attendances at the ante-natal clinics. As mentioned in my Report for 1943, the Essex County Council ceased taking maternity cases from Ilford at the end of June, 1944. (b) Queen Mary's Hospital, Stratford.—By arrangement 13 cases were admitted to Queen Mary's Hospital for confinement during 1944. The fee payable to the Hospital authorities is at the rate of 10s. per day. (c) East End Maternity Hospital, Stepney.—In May, 1944, the Secretary of this Hospital informed me that a limited number of maternity cases from Ilford could be accepted for admission to their Wards at their Hospital at Stepney, or their Hospital evacuated to Newport Pagnell, Buckinghamshire, at a charge of 13s. per day. Two cases were admitted for confinement to the Hospital at Newport Pagnell during 1944. (d) Emergency Maternity Homes.—322 mothers who registered for evacuation under the Government Evacuation Scheme for admission to the Emergency Maternity Homes in the country for their confinement attended the Council's Ante-Natal Clinics. There were 1,667 attendances by such cases. These figures are included in the table of attendances at the AnteNatal Clinics. 47 GENERAL SURVEY OF THE SCHOOL MEDICAL SERVICE The Board of Education, Form 6 M, desires that the Reports for 1944 might be as brief as possible, and the following is the information ivhich the Board particularly ask for. (a) Nutrition. The summary of heights and weights over 10 years which is printed at the end of this Report in Table VI A. and B. shows no appreciable change. I have added the heights and weights of the children at the Camp Schools for the past 5 years for comparative purposes. (Table VI C) . (b) Incidence of Pediculosis and Scabies. (i) Pediculosis.—This shows a slight increase on last year, 36 children being found to be infected with living hair vermin as against 25 in 1943, 63 in 1942, 36 in 1941 and 10 in 1940. (ii) Scabies.—This shows a decrease, 128 cases (26 from routine medical inspection) being seen at the Minor Ailment Clinics, as compared with 217 in 1943, 374 in 1942, 109 in 1941 and 25 in 1940. In addition to the 128, 2 cases were treated privately. There was no particular incidence in any one School. (c) Secondary Schools. Medical and Dental Inspection and Treatment continued during the year. For particulars, see Tables on pages 22, 23 and 24. (d) Evacuation of Unaccompanied School Children. On Saturday, 8th July, the Director informed me that the Government had decided to evacuate children again and I was able to obtain the assistance of eight local practitioners who examined 914 children on Monday, 10th July. During the period 2nd July to 7th September, 2,394 school children were examined, in addition 1,001 children under 5 years of age, and 886 mothers, were examined prior to evacuation. Changes in Staff.—(a) Medical.—Mr. C. Keogh, F.R.C.S., Ear, Nose and Throat Surgeon, resigned on the 12th May, and Mr. W. Ibbotson, F.R.C.S., commenced on the 14th August. Mrs. G. M. Shalders terminated duties as Temporary Assistant Dental Surgeon on the 2nd September, and Mr. E. V. Haigh commenced on the 1st September as Part-time Dental Surgeon and as Full-time Surgeon on 1st February, 1945. (6) Health Visitors and School Nurses.—Miss I. Alderson terminated her appointment on the 19th August. Miss M. Irons commenced on the 3rd January, Miss N. M. Le Maitre on the 15th May, Miss E. du Randt on the 1st June, and Mrs. C. H. Hughman on the 18th September. School Premises.—There are 26 schools, with 47 departments, 12,155 children were actually on the rolls on 19th December, 1944, as compared with 14,944 in December, 1943. The number of children in average attendance at school for the year ended 19th December, 1944=9,692. On the 19th December, 1944, 4,225 children were in reception areas evacuated under the Government Evacuation Scheme (including Mossford School Groups and three Camp Schools) and there were approximately 2,000 private evacuees. 48 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. 425 visits have been made during the year. Medical Inspection.—In accordance with the Board's Circular, 1604, dated 28th August, 1942, the School Nurses have carried out "Rapid Surveys" at the schools. 13,464 examinations were made, 38 were recommended special treatment and 75 for supplementary nourishment. The following children had a full routine medical examination, in addition to those recommended for examination at the Rapid Survey— (а) Newly admitted to Public Elementary Schools, (b) who had attained the age of twelve years. During 1944, 3,091 parents, or 83 per cent., attended the full routine medical inspections. INFECTiors Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1939:— Scarlet Fever. Diphtheria Measles and Ger. man Measles Chicken Pox. Mumpis Whooping Cough. 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 1,402 399 369 221 1944 183 25 968* 252 29 412 *Of this number 275 were notihed as measles. Disinfection of all the cloakrooms at the public elementary schools was carried out during the Summer and Winter vacations. No schools were closed during the year on account of infectious disease. Table VII shows the incidence of infectious disease in the Ilford schools during 1944. 767 home visits were paid by the Health Visitors to cases of minor infectious disease. In addition the Sanitary Inspectors paid 275 visits to measles cases, and 412 visits to whooping cough cases. Diphtheria Prevention Clinics.—The following shows the work carried out at Newbury Hall (62 sessions) and Mayesbrook (52 sessions) Clinics for children of school age during 1944:— Newbury Hall. Mayesbrook. Primary Schick tested 61 41 Positive 37 25 Negative 24 16 Inoculated (full course) 147 112 Schick + 1943 2 - Schick + 1944 37 - Not tested 108 87 Negative after full course of inoculation 124 87 Positive after full course of inoculation and re- inoculated 3 4 Awaiting re-test 14 14 Not re-tested after inoculation on account of leaving district, etc. 6 7 49 Result of final Schick test in 1944 of cases inoculated in 1943: Newbury Hall. Mayesbrook Positive and re-inoculated 2 3 Negative 86 56 446 individual children were treated (259 at Newbury Hall and 187 at Mayesbrook) making 2,328 attendances (1,307 and 1,021 respectively). Since June, 1932, children under 8 years of age have not been Schick tested prior to immunisation, unless there was some particular reason to suppose that the child might give a combined reaction to the Schick test. Since the first introduction of immunisation against Diphtheria in Ilford in 1929, 9,594 children of school age, and 11,322 children under school age have been immunised. Ringworm:— No. of cases at beginning of 1944. No. of cases reported during 1944. Total. Remedied during 1944. No. of cases under observation at end of 1944. Ringworm:— Scalp — — — — — Body 1 3 4 4 — 1 3 4 4 — Following Up.—During 1944, 4,514 home visits by the School Nurses were paid for the purpose, and 3,237 re-examinations of children (some on several occasions) were carried out by the doctors at school; 62 visits to schools were made for this purpose alone, and other children were seen at the visits for routine medical inspection. Medical Treatment. (a) Minor Ailments Clinics.—The attendances during 1944 were as follows:— Newbury Hall Mayesbrook Number of individual children seen 1,142 1,237 Number of attendances of children 1,717 2,154 Number of exclusion certificates granted 484 681 Number of certificates of fitness to attend school granted 440 502 The following table shows the conditions dealt with at both the Clinics during the year:- Subnormal Nutrition 287 Uncleanliness:— Head 334 Skin:— Ringworm:— Head - Body 3 Scabies 128 Impetigo 130 Other Diseases (Non-Tuberculous) 336 Eye:- Blepharitis 28 Conjunctivitis 40 Keratitis 1 Defective Vision (excluding Squint) 215 Squint 12 Other conditions 60 50 Ear:— Defective Hearing 20 Otitis Media 25 Other Ear Diseases 67 Nose and Throat:— Chronic Tonsillitis only 36 Adenoids only 5 Chronio Tonsillitis and Adenoids 41 Nasal Catarrh 41 Other conditions 92 Enlarged Cervical Glands (Non-Tuberculous) 20 Cervical Adenitis 10 Defective Speech 3 Teeth—Dental Diseases 311 Heart and Circulation:— Functional 6 Organic 1 Anaemia 20 Infectious Diseases:— Measles 2 Whooping Cough 1 Chicken Pox 3 Mumps 1 Colds 81 Influenza 10 Lungs:— Asthma 17 Bronchitis 32 Bronchial Catarrh 24 Other Non-Tubercular Diseases 2 Tuberculosis:— Pulmonary—Definite — ,, Suspected (Referred to TB officer) — Nervous System:— Epilepsy 1 Nervous Debility 6 Habit Spasm 7 Chorea 12 Other Conditions 9 Deformities:— Genu Valgum 18 Round Shoulders 2 Rickets 1 Flat Feet 21 Lordosis 1 Scoliosis 4 Valgus Ankles 42 Other forms 18 Minor Injuries 33 Rheumatism 24 Other Defects and Diseases 146 Total number of ailments 2,790 51 Special Clinics.—Attendances at the various Clinics during 1944, 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 99 49 - 539 322 - 999 604 - (ii) Orthopaedic 41 18 — 484 249 — 841 437 — (iii) Artificial Sun light 45 49 - 22 21 - 345 273 (iv) Remedial Exercises 90 - 50 75 - 59 875 - 619 (v) Aural 37 — — 583 — — 694 - - (vi) Rheumatism 25 - — 231 - — 401 - - A=Newbury Hall. B = Mayesbrook. C = All Saints Hall. Note.—(i) 586 children were prescribed and provided with glasses, of which 11 were supplied free. (ii) 6 children of school age were admitted to the Country branch of the Royal National Orthopaedic Hospital at Stanmore and 5 discharged. 26 children were supplied with appliances. (iii) 49 cases referred for X-ray and Electro-Cardiogram and 36 for Blood Sedimentation Rate. School Dentists.—Of 11,048 inspections by the DentiBt (including special cases), 5,914 (or 53 per cent.), were found to require treatment, compared with 7,763 (or 61 per cent.) in 1943, 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, 51 regulation plates, and 2 dentures were supplied. 633 visits were made by children to the Dental Clinic for regulation purposes. The amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the school Dentists:— Age groups (in years) No. of inspections of children No. referred for treatment. Percentage. 5 1,181 609 50.6 6 1,382 854 61.7 7 1,221 745 61.0 8 1,352 818 60.5 9 1,586 868 54.7 10 1,315 723 55.0 11 810 439 54.2 12 688 352 51.2 13 757 430 56.8 14-15 154 81 52.6 Full details of the dental work are shown in Table IV. 52 Treatment for Uncleanliness.—2 statutory notices were served under the Education Act, 1921, Section 87. The Sohool Nurses paid 138 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 Number Per of Children. Infected. cent. 29,700 *730 2.4 *36 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 inoluded in these figures. The percentages for the past 5 years were as follows:— 1940 1.8 1941 2.8 1942 2.6 1943 2.5 1944 2.4 Other Ailments.—During 1944, 28 children were operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford, as in-patients. 9 children were treated free on necessitous grounds. Under the agreement with the King George Hospital, 78 children were operated on at that Hospital, all as in-patients, for the removal of enlarged tonsils and adenoids, 18 children being treated free on necessitous grounds. In addition to the treatment of tonsils and adenoids, 20 letters were given to Ilford school children, for whom hospital treatment wai required, to attend Queen Mary's Hospital. Open Air School.—There were 115 children on the Open Air School roll on the 31st December, 1943. During the year 20 children were admitted, 56 ceased attendance, and 79 were on the school roll on the 31st December, 1944. The school was severely damaged by a flying bomb on 15th August, and the children in attendance were dispersed to ordinary elementary schools whilst repairs were carried out. It was re-opened with accommodation for 85 children on the 2nd January, 1945. Those admitted were recommended for examination from the following sources:— School Medical Officer 14 Head Teachers 2 Others 4 School Medical Officer :— Subnormal Nutrition and Debility 1 Asthma 3 Asthma and Bronchitis 1 Asthma, Subnormal Nutrition and Bronchitis 1 Bronchial Catarrh and Asthma 1 Chronic Bronchitis and Bronchial Asthma 1 Debility and Anaemia 1 Debility and T.B. Lumbar Spine 1 Nervous Debility 1 Diabetes Mellitis . 1 Scoliosis 1 Rheumatic Heart 1 53 Head Teachers:— Subnormal Nutrition 1 Debility 1 Others:— Asthma 1 Suspected T.B. Knee 1 T.B. Knee 1 Advanced Mitral Stenosis 1 The 56 children not now on the roll ceased attendance for the following reasons:— Resumed attendance at ordinary school 29 Left school—over age 4 Removed from school at parents' request 11 Evacuated 3 Incapable of receiving further benefit (mentally defective) 1 House demolished—unable to trace child 1 Admission to Convalescent Homes 3 Admission to Boarding Schools 2 Left district 1 Admission to Private School 1 The Dental Surgeon has carried out one complete inspection 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 36 No. of children referred for treatment 19 No. of children treated by Dental Surgeon 19 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 13 Administration of Cod-Liver Oil Emulsion 13 Administration of Malt and Oil, Parrish Food, etc. — Convalescent Home treatment 2 To see:— Ophthalmic Surgeon 5 Orthopaedic Surgeon re Remedial Exercises, etc. 4 Dental Surgeon 1 Aural Surgeon 1 Tuberculosis Officer 1 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. Five 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 1944 was 932,303 approximately 2,843 daily, 304 being free and 2,539 at full or part payment. There are thirteen kitchens in the Borough, established at the following schools:— Becontree, Benton, Dane, Fairlop, Gearies, Goodmayes, Loxford, The Mount, Mayfield, Newbury Park, Redbridge, South Park and Uphall. Additional kitchen is being provided for at the Wm. Torbitt Sohool. 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. 54 In October, 1944, 6,896 children were receiving milk in school. Of this number 411 received it free of charge. 4,611 were receiving an additional third pint. During the year 280 children were recommended, on medical grounds, to have milk in school, free if parents were not in a position to pay for it, and 24 previously recommended were reported to the Director of Education for continuance. 75 necessitous cases were dealt with during the year for the supply of free Cod Liver Oil, Emulsion, Oil and Malt and Virol. Statistics for a day in February, of Public Elementary School Children receiving School Meals and Milk under the Milk in Schools Scheme, as presented by the President of the Board of Education to Parliament:— Percentage of those present who received— Ilford. Barking. Levton. Walthamstow. Essex. London. 1. Milk in School— 1942 92.2 82.3 87.7 - 81.5 80.1 1943 87.6 72.6 84.1 75.1 82.3 77.3 1944 87.8 68.6 82.0 77.8 75.7 75.9 2. Dinners in School— 1942 23.3 34.1 4.5 - 13.9 24.9 1943 31.0 37.6 32.2 36.8 24.2 26.5 1944 34.1 41.8 38.8 39.4 39.5 33.4 Work doneby the N.S.P.C.C.—Total number of cases investigated, 34 (one case was reported from the Public Health Department for neglecting medical advice; 24 were reported from other sources for general neglect), made up as follows:— (1) Of Neglect 25 (2) Ill-treatment cases 1 (3) Other cases 8 83 children (40 boys and 43 girls) were involved, 42 being of school age. In addition to this work, 173 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.—20 children were sent to residential schools and paid for by the Education Committee in 1944. In addition 21 children were sent to Convalescent Homes or Residential Schools and paid for through voluntary funds. Also 9 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 1944, 6 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 4 Cripple—Special school for Cripples 1 6 55 Blind, Deaf, Epileptic, Delicate abd Cripple Children. Summary of cases at end of 1944:— Blind Deaf Partially Deaf Epileptic Delicate Cripples Major Minor At Special Residential School 4 7 2 2 4 5 8 (1) (1) (2) (1) At Special Day School — 4 4 — — 79 2 (2) At Elementary School — — 1 — 5 30 18 (4) Not attending any School - - - - - - 5 (5) Total 4 11 7 2 9 114 33 Figures in brackets indicate number over 14 years of age. Mentally Defective Children:— During 1944, 36 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 1944 and recommended for admission to a special school (day or residential) 24 Imbecile Children.—Total number certified in 1944 and recommended for notification to Essex County Council 7 Dull and Backward Children.—Total number certified in 1944 and recommended attendance at special class for dull and backward children for one year, and then to be re-examined 5 Idiots, Imbeciles, Feeble-Minded, Dull and Backward Children. Summary of cases at end of 1944:— Idiots. Imbeciles. FeebleMinded. Dull and Backward At Residential Institution 5 16 (3) 9 - At Special Day School — — 8(1) — At Elementary School — — 46(2) 17 At no School or Institution 3 33 (7) 20(13) — Total 8 49 83 17 Figures in brackets indicate number 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 1944, it was found that 8 children were employed out of school hours. 8 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 8 Employment of Children in Entertainments Rules, 1933.—One certificate has been granted during the year by the School Medical Officer. 56 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 2 Teachers—Sickness Regulations 6 Newly-appointed Asst. Supervisor British Restaurants 1 „ „ Clerks—Education Department 2 Intending Nurses 6 17 School Camps.—The three Ilford School Camps are still in being, and the general procedure outlined in my report for 1940 still continues. Infection at the Camp Schools in 1944. Kennylands. Finnamore Wood Elmbridge. German Measles 16 29 4 Chicken Pox - 2 - Mumps - 10 - Influenza 19 - Scabies 3 2 5 Shingles 1 — - Jaundice 1 - - Impetigo 1 1 18 Professor G. S. Wilson of the Emergency Public Health Laboratory Service, School of Pathology at Oxford, who previously 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, was unable to continue during the year. Dr. L. Foulds, of Christ's Hospital, Horsham, was, however, able to continue the inoculations at the Elmbridge Camp. These were completed early in the year and the figures were included in my report for 1943. Table Showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years) in Ilford for 1942 and 1943. 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 1942 1943 1942 1943 1. Measles 0.1 0.1 - - 2. Scarlet Fever — 0.1 - - 3. Whooping Cough 0.1 0.2 - — 4. Diphtheria — 0.2 - 10.5 5. Influenza 0.8 2.4 7.7 — 6. Tuberculosis 6.3 4.8 23.0 - 7. Rheumatic Fever - - - - 8. Bronchitis, Pneumonia and other respiratory diseases 10.3 11.0 - 10.5 9. *Meningitis and Nervous system 0.8 9.5 7.7 — 10. Heart Diseases 20.1 26.0 — - 11. Acute and Chronic Nephritis 2.3 2.1 — — 12. Violence 4.0 5.4 15.5 57.9 13. Other causes 55.2 38.0 46.1 21.1 100.0 100.0 100.0 100.0 * Excludes Meningococcal infections. Ilford.—The deaths of children of School Age during 1943 represent 1.2 percent, of the Total Deaths registered (all ages), and during 1942 represent .9 per cent. 57 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups:— Entrants0 1,965 Second Age Group 539 Third Age Group 1,192 Total 3,696 (2) Number of Other Routine Inspections Nil. Grand Total 3,696 B.—Other Inspections. Number of Special Inspections and Re-Inspections 10,161 Number of Children seen at "Rapid Surveys" at Schools 13,464 Table II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups No. of Children Inspected A. (Excellent) B. (Normal) C. (Slightly Subnormal) D. (Bad) No. % No. % No. % No. % Entrants 1,965 45 2.3 1,680 85.5 240 12.2 — — Second Age-Group 539 32 6.9 429 79.6 78 14.5 — — Third Age-Group 1,192 92 7.7 979 82.1 121 10.2 — — Total 3,698 169 4.5 3,088 83.6 439 11.9 — — 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' 8 Scheme 2,456 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease No. of Defects dealt with Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) 861 16 877 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 26 4 30 Total 887 20 907 No. of Children for whom spectacles were:— (a) Prescribed 586 16 602 (b) Obtained 686 16 602 All spectacles prescribed were obtained during the year, or in January, 1945. 58 Group III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment. Received other forms of Treatment. Total Number treated. 106 5 111 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 1181 1382 1221 1352 1586 1315 810 688 757 154 10,446 (6) Specials 602 (e) Total (Routine and Specials) 11,048 (2) Number found to require treatment 5,914 (3) Number actually treated 3,048 (4) Attendances made by children for treatment 4,897 (5) Half-days devoted to Inspection 92 Total . 670 Treatment 578 (6) Fillings Permanent Teeth 1.878 Total 3,949 Temporary Teeth 2,071 (7) Extractions Permanent Teeth 653 Total 5,449 Temporary Teeth 4,796 (8) Administrations of general anaesthetics for extractions 1,331 (9) Other operations Permanent Teeth 1,282 Total 1,856 Temporary Teeth 574 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 29,700 (iii) Number of individual children found unclean 730* (iv) Number of children cleansed under the arrangements made by the Local Education Authority Nil (v) Number of cases in which legal proceedings were taken:- (a) Under the Education Act, 1921 Nil (b) Under School Attendance Bye-laws Nil * In addition 63 children were found unclean at medical inspection and 334 in the School Clinic. 59 Table VI. Blind and Deaf Children. (1) (2) (3) (4) At a Public Elementary School At an Institution other than a Special School At no School or Institution Total not receiving suitable Education Blind Children — — — — Deaf Children — — — — Mentally Defective Children. Total number of children notified during 1944, by the Local Education Authority to the Local Mental Deficiency Authority, under the Mental Deficiency (Notification of Children) Regulations, 1928 13 Table VII. School Medical and Dental Staff. Name of Officer Proportion of whole time devoted to— School Medical Service Public Health S.M.O.—Dr. A. H. G. Burton 1/11 Various according to demands of services Deputy S.M.O.—Dr. J. H. Weir Assistant S.M.O's.:— ¼ Dr. D. M. B. Gross ½ 2/3 Dr. A. Collins ½ ½ Dr. F. E. O'Connor 1/3 2/3 Dr. M. B. Marchant 5/8 3/8 Senior Dentist—Mr. M. J. K. Soutter 8/11 1/11 T.B. 2/11 M. & C.W. Dentists—Mr. E. V. Haigh 9/11 2/11 M. & C.W. School Nursing Staff. (excluding specialist Nurses, such as Orthopaedic Nurses). Number of Officers Aggregate of time given to S.M.S. work in terms of whole-time officers School Nurses 13 One half Dental Attendants 2 17/22nds 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 Centimetre) Average Weight (in Kilogramme) 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 62 108.4 19.0 13 112.8 20.7 3 116.7 21.1 5 127.0 25.6 4 126.7 25.7 5 135.6 30.7 12 140.0 33.4 59 145.0 36.9 5 154.4 45.6 Benton (Open Air 1 112.0 21 .8 6 114.3 20.2 14 120.0 22.5 14 126.8 26.1 16 132.8 29.2 5 136.6 31.7 4 139.2 32.5 8 146.5 38.4 2 139.5 30.4 Chadwell 29 113.2 20.5 8 116.3 21.4 2 129.5 28.1 1 124.0 25.2 — — — 3 136.6 32.4 4 145.7 35.6 — - - - - - Christchurch 37 109.2 19.8 4 115.5 22.6 — — — 4 129.2 25.8 5 133.6 31.3 7 140.4 36.3 116.0 20.6 143.0 35.5 - - - Cleveland 15 107.7 19.8 4 109.7 19.2 1 113.0 19.0 3 126.0 27.5 1 136.0 46.9 4 138.7 32.5 7 140.6 37.3 — - - - - - Dane Central — — — — — — — — — — — — — — — — — — 6 140.3 33.3 65 148.2 39.6 8 152.0 38.8 Downshall 55 111.3 19.8 11 115.1 20.8 5 121 .4 23.1 4 123.2 24.5 3 135.7 28.4 1 136.0 30.0 11 135.8 31.3 38 147 .3 37.2 3 155.6 43.8 Fairlop 54 110.8 20.3 6 115.3 21.2 1 120.0 23.8 2 127.0 26.0 1 138.0 33.0 4 142.7 34.7 7 143.9 33.3 47 144.9 37.4 5 149.2 37.8 Gearies 79 111.6 20.0 13 117.0 22.7 6 119.0 23.6 4 126.2 26.9 2 136.5 32.4 4 137.2 29.3 12 142.3 34.5 62 146.6 38.6 11 152.0 43.3 Goodmayes 39 109.7 19.8 7 116.3 21.3 1 117.0 20.4 7 129.3 26.8 6 131.6 29.4 1 138.0 31.6 2 136.0 29.3 — - - - - - Gordon 18 110.0 19.9 4 114.2 21.6 1 126.0 24.2 - - - - - - - - - - - - - - - - - - Highlands 12 110.5 19.9 5 118.6 24.3 5 125.6 26.7 3 132.0 27.3 1 134.0 29.9 2 140.5 33.9 1 144.0 31.8 — — - - - - Loxford Central — — — — — — — — — — — — — — — — — — 7 142.8 35.1 128 145.6 38.1 15 149.0 41.8 Mayfield Central - - - - - - - - - - - - - - - - - - 6 138.2 33.3 94 147.1 38.8 11 153.0 43.8 Mossford 21 112.4 20.7 4 110.7 20.7 1 126.0 27.5 1 135.0 30.0 2 135.0 36.1 2 142.5 37.4 5 146.4 36.7 — - - - - Newbury Park 23 111.4 20.5 6 118.5 23.6 2 126.5 28.8 2 119.5 22.1 2 132.5 29.3 — — — 5 146.6 38.1 2 145.0 43.1 - - - Parkhill 81 112.5 20.0 19 116.7 21.7 4 125.0 23.5 1 127.0 27.7 1 132.0 29.2 4 138.5 31.6 5 141.6 33.1 — — - - - - St. Augustine's . 14 112.6 20.2 4 113.0 20.9 6 120.3 21.2 2 123.0 26.7 2 133.0 29.5 2 134.5 30.6 — — — 11 144.0 35.7 1 144.0 38.5 S .S. Peter & Paul 29 112.7 21.1 8 116.0 21.7 3 124.0 26.1 3 123.7 24.4 4 124.5 24.3 3 142.7 35.9 19 141.7 35.9 29 39.2 10 142.4 36.6 South Park 81 112.4 20.3 19 117.2 21.2 11 120.4 22.5 1 133.0 26.4 3 137.0 28.8 5 137.0 30.7 9 143.2 35.8 - - - - - St. Vincent's 10 110.1 19.8 3 114.7 22.9 2 117.0 20.7 1 125.0 27.5 2 127.0 28.1 - - - - - - 4 143.0 32.8 2 152.0 42.9 The Mount Central - - - - - - - - - - - - - - - - - - - - - - - - - - - The Redbridge 40 110.9 19.7 4 114.5 25.6 3 124.3 25.4 7 125.6 27.8 3 129.0 30.7 3 143.0 35.3 1 139.0 31.2 - - - - - - The Wm. Torbitt 30 110.0 20.1 7 115.6 21.8 4 122.5 23.5 3 129.3 28.4 1 134.0 27.5 1 140.0 32.8 3 142.3 36.0 - - - - - - Uphall 21 111.1 19.8 4 113.5 20.0 2 119.5 21.5 0 121.0 22.4 — — — 3 140.3 29.9 1 139 0 37.2 - - - - - - Woodlands 32 111.7 19.4 9 116.3 21.1 6 122.3 24.4 6 126.5 26.8 2 131.5 29.0 - - - - - - - - - - - - Ilford Boys—Averages for 10 years.- 1944 783 112.5 19.9 168 115.6 21.7 83 121.5 22.4 76 126.6 26.3 61 132.1 29.5 59 138.8 32.6 128 141.2 34.4 548 146.4 37.3 73 150.0 41.0 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 32.0 152 143.0 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 72 141 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 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 Centimetre#) Average Weight (in Kilogrammes) | Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) 1 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 ol Children Examined Average Height (in Centimetre*) 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 55 108.7 19.0 11 116.4 21.4 1 123.0 23.8 5 125.4 25.7 4 131.2 26.8 2 136.5 28.9 13 141.0 35.4 69 145.7 37.4 5 156.4 42.5 Benton (Open Air) 1 110.0 20.2 2 113.5 19.2 6 122.5 23.5 7 127.6 26.0 13 131.6 28.0 13 134.0 29.1 5 143.8 32.9 6 148.5 37.3 6 156.5 40.3 Chadwell 41 111.3 19.5 8 114.1 20.1 4 118.2 21.8 5 127.2 25.8 — — — 3 141.0 31.2 1 147.0 38.0 - - - - - - Christchurch 29 110.4 20.1 8 117.1 22.4 1 122.0 21.3 3 127.7 26.6 4 127.0 25.6 2 138.0 30.3 5 147.4 38.3 - - - - - - Cleveland 12 107.6 17.9 3 110.3 21.8 1 122.0 23.6 — — — 2 130.5 24.8 3 138.3 30.9 3 143.3 33.2 — - - - - - Dane Central — — — — — — — — — — — — — — — — — — 5 142.4 35.8 67 151.0 39.9 8 152.0 41.1 Downshall 58 109.4 18.5 11 116.3 20.4 8 123.6 23.7 2 126.0 25.5 3 133.0 29.0 3 143.7 37.7 1 145.0 35.7 46 151.0 40.3 9, 157.0 47.7 Fairlop 46 109.5 19.5 6 113.0 21.0 3 121 .7 24.6 1 130.0 30.6 2 139.0 35.4 3 143.0 31.5 4 145.5 35.2 43 148.0 39.3 5 153.6 42.5 Gearies 68 111.5 19.9 7 116.0 21.7 3 116.6 22.7 1 120.0 20.1 2 128.5 23.5 — — - 6 146.0 34.5 75 148.3 39.4 10 150.3 44.0 Goodmayes 20 110.6 19.3 6 116.3 22.2 3 123.3 28.9 — — — 4 132.2 26.1 2 141.5 30.9 4 137.0 30.6 — - - - - - Gordon 15 108.0 19.1 1 117.0 20.4 — — — — — — — — — — — — — — - - - - - - - Highlands 13 109.5 18.4 8 116.4 21.6 2 122.0 23.4 3 126.7 27.2 5 137.0 31.7 1 128.0 27.6 1 146.0 37.0 - - - - - - Loxford Central - - - - - - - - - - - - - - - - - - - - - - - - - - - Mayfield Central - - - - - - - - - - - - - - - - - - 1 146.0 33.2 70 150.0 41.6 4 149.5 40.1 Mossford 29 111.5 19.2 6 116.5 21.5 1 121.0 33.5 — — — — — — — — — 1 139.0 32.2 - - - - - - Newbury Park 15 110.6 19.9 8 115.5 22.8 1 115.0 21.4 — — — 1 137.0 39.2 1 139.0 30.5 2 145.0 31.9 - - - - - - Parkhill 65 114.5 20.0 25 117.4 21.5 3 121.0 22.7 1 123.0 22.4 2 132.5 31.4 2 138.0 29.8 2 141.0 33.7 - - - - - - St. Augustine's 14 109.1 18.9 8 113.8 19.7 1 123.0 25.0 — — — 4 133.8 31.8 2 142.5 36.3 — - - 2 153.5 44.5 1 168.0 46.5 SS. Peter & Paul 32 109.5 20.5 5 115.6 22.4 1 127.0 26.5 6 124.0 25.4 — — — 5 139.4 32.7 9 142.2 38.5 22 148.0 38.2 6 151.0 41.5 South Park 72 110.6 19.5 20 114.6 21.2 3 125.6 24.5 1 137.0 34.6 — — — 4 139.7 34.8 2 141.5 33.9 - - - - - - St. Vincent's 8 109.2 19.4 2 117.5 26.2 — — — — — — — — — — — - - - - 13 145.7 36.8 2 156.5 44.5 The Mount Central - - - - - - - - - - - - - - - - - - 3 150.0 42.4 89 147.6 38.1 11 152.3 45.5 The Redbridge 32 110.1 20.1 2 113.5 19.8 2 118.0 20.1 2 131.5 27.0 1 138.0 33.7 1 135.0 30.8 1 142.0 40.2 - - - - - - The Wm. Torbitt 28 110.0 19.6 9 115.3 20.7 2 118.5 20.2 1 124.0 22.4 — — — 1 145.0 33.0 - - - - - - - - - Uphall 26 111.4 19.9 2 117.0 21.0 2 120.5 22.6 3 125.3 24.3 2 137.5 24.7 1 135.0 29.5 - - - - - - - - - Woodlands 31 109.9 19.4 9 114.5 21.3 7 122.4 23.6 4 130.8 26.4 2 132 0 29.4 - - - - - - - - - - - — Ilford Girls—Averages for 10 years:- 1944 710 110.3 19.7 167 115.6 21.3 55 121.6 23.7 45 126.7 26.1 51 132.7 29.2 49 138.1 31.4 69 143.3 35.8 492 148.6 39.2 59 152.5 42.9 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 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 30.8 150 142.6 34.5 451 147.8 38.5 171 154.4 43.8 1941 330 110 19.2 268 115 20.6 161 121 23.0 523 127 26.0 255 132 28.1 208 137 31.5 139 142 33.9 423 148 38.5 163 153 43.1 1940 548 110 18.9 286 116 20.7 185 121 23.5 579 127 26.6 216 133 28.3 192 137 30.9 232 143 35.6 540 148 39.8 172 153 44.7 1939 588 110 18.7 121 114 20.7 100 120 23.2 634 126 25.1 87 131 28.3 67 134 30.1 85 142 34.8 567 147 37.7 106 151 42.7 1938 993 110 18.9 221 114 20.5 139 120 22.9 1083 126 25.2 145 130 27.3 127 135 30.2 193 143 35.6 709 147 38.2 122 151 42.5 1937 937 109 18.9 224 114 21.0 144 119 22.3 1022 126 24.1 164 131 27.5 144 136 31.3 205 141 33.9 841 147 38.0 169 152 42.9 1936 897 109 18.6 257 113 20.1 186 121 22.6 1011 125 24.0 158 131 27.4 157 136 30.5 193 142 34.1 805 147 38.1 115 153 42.9 1935 868 110 18.6 232 115 20.3 131 120 22.2 1059 125 25.0 149 130 27.5 168 135 30.1 193 139 32.8 884 146 37.8 140 152 43.6 64 Table VI C. Heights and Weights—(Five-year Period = 1940, 1941, 1942, 1943 and 1944). 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) 234 ft. in. at. lb. 249 ft. in. St. lb. 233 ft. in. St. lb. 4 5 61 4 10 6 0¼ 5 0 6 8¾ Cms. Kilo. Cms. Kilo. Cms. Kilo. 143 34.8 147 38.2 152 42.3 Boys at other Ilford Schools 991 ft. in. St. lb. 2635 ft. in. st. lb. 740 ft. in. St. lb. 4 8 5 7 4 9½ 5 12 4 11½ 6 8 Cms. Kilo. Cms. Kilo. Cms. Kilo. 142 34.9 146 37.2 151 41.6 Elmbridge (Loxford Boys) 213 ft. in. St. lb. 253 ft. in. St. lb. ft. in. St. lb. 4 7½ 5 40½ 4 9 5 10½ 207 4 11 6 3 Cms. Kilo. Cms. Kilo. Cms. Kilo. 141 33.7 145 36.6 150 39.5 Finnamore Wood (Beal Girls) 300 ft. in. St . lb. ft. in. Bt. lb. ft. in. St. lb. 4 8 5 7¼ 223 4 10 6 5 216 5 0½ 7 3½ Cms. Kilo. Cms. Kilo. Cms. Kilo. 142 35.3 147 40.3 154 46.0 Girls at other Ilford Schools 697 ft. in. St. lb. 2503 ft. in. St. lb. 708 ft. in. St. lb. 4 8¼ 5 7 4 10¼ 6 2 5 0¼ 6 12 Cms. Kilo. Cms. Kilo. Cms. Kilo. 143 34.9 148 39.0 153 43.4 65 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, 1944. SCHOOLS DISEASES AND CONTACTS No. on Roll Scarlet Fever Diphtheria Measles & German Measles Chickenpox Whooping Cough Mumps Totals, 1944 Totals, 1943 Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Cases Contacts Cases Contacts Becontree 1394 7 8 - - 43 3 21 16 3 - 87 14 104 24 Benton (Open Air) — 1 - — — — — — 2 — 1 4 — 18 1 Chadwell 509 9 7 1 1 108 — 6 10 1 1 135 9 258 10 Christchurch 480 14 4 1 3 35 — 6 3 — 2 61 7 126 16 Cleveland 547 3 3 1 - 9 1 2 18 1 — 33 5 70 18 Dane 380 6 4 1 1 11 - - 2 - 1 21 5 17 8 Downshall 1021 7 8 2 3 81 - 19 9 2 9 127 13 213 25 Fairlop 1020 12 6 — — 42 1 10 55 6 1 120 13 168 15 Gearies 929 16 8 3 — 104 — 8 43 1 12 186 9 224 22 Goodmayes 441 3 - - - 12 - 7 19 1 - 41 1 75 5 Gordon 102 6 2 1 - 35 - 37 21 2 - 100 4 8 4 Highlands 452 13 4 1 1 37 — 1 30 3 — 82 8 55 8 Loxford Central 270 2 2 1 2 3 - - - - - 6 4 18 8 Mayfield Central 603 3 3 - - 10 - 2 1 - - 16 3 24 13 Mossford 324 1 - - 1 7 2 18 10 1 - 36 4 178 23 Newbury Park 267 2 - - - 49 1 20 24 1 — 95 2 110 14 Parkhill 604 18 9 - - 17 1 7 14 - - 56 10 123 22 St. Augustine's 131 - 2 2 2 1 - - 9 1 - 12 5 39 4 SS. Peter and Paul's 317 1 6 - - 17 - 12 6 1 - 36 7 105 24 St. Vincent's 269 - - - - 2 - - - - - 2 - 3 2 South Park 811 5 2 - - 58 2 12 10 - - 85 4 234 28 The Mount Central 237 1 1 1 - 2 - - - - 1 5 1 12 2 The Redbridge 299 16 5 3 2 84 - 56 32 1 - 191 8 131 7 The William Torbitt 381 5 5 - - 79 - - 11 - 1 96 5 114 11 Uphall 221 3 1 - - 20 - 2 13 2 - 38 3 41 8 Woodlands 146 11 8 3 1 21 1 1 25 2 - 61 12 121 10 *County High - 4 5 4 3 72 - 4 2 - - 86 8 42 14 Private — 14 6 - - 9 — 1 27 1 — 51 7 176 9 Totals 12155 183 109 25 20 968 12 252 412 30 20 1869 171 2807 355 *Notification of minor infectious diseases in these schools are not received. Benton Open Air School closed on 15th August owing to damage by enemy action. 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 have continued during the year. Number of pupils on school rolls =1,036 Number of pupils found to require treatment at Routine Medical Inspections = 118 Table I.—Return of Medical Inspections. A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups:— Entrants 207 Leavers 117 Total 324 (2) Number of Other Routine Inspections Nil. Grand Total 324 B.—Other Inspections. Number of Special Inspections and Re-Inspections 398 Table II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups No. of Children Inspected A. (Excellent) B. (Normal) C (Slightly Subnormal) D. (Bad) No. % No. % No. % No. % Entrants 207 7 3.3 175 84.6 25 12.1 — — Leavers 117 17 14.6 99 84.6 1 0.8 — — Total 324 24 7.4 274 84.6 26 8.0 — — Group I.—Treatment of Minor Ailments. (Excluding Uncleanliness), Total Number of Defects treated or under treatment durinc the year under the Authority's Scheme 41 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease. No. of Defects dealt with Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Errors of Refraction (including squint) (Operations for squint should be recorded separately in the body of the School Medical Officer's Report.) 123 2 125 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 3 — 3 Total 126 2 128 No. of Children for whom spectacles were:— (a) Prescribed 90 2 92 (b) Obtained 90 2 92 67 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received Operative Treatment. Received other forms of Treatment. Total Number treated. 1 — 1 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 83 140 172 165 111 50 25 8 754 (6) Specials — (c) Total (Routine and Specials) 754 (2) Number found to require treatment 407 (3) Number actually treated 165 (4) Attendances made by children for treatment 285 (5) Half-days devoted to .. Inspection 5 (6) Fillings Permanent Teeth 385 Total 385 Temporary Teeth — (7) Extractions Permanent Teeth 101 Total 127 Temporary Teeth 26 (8) Administrations of general anaesthetics for extractions 17 (9) Other operations Permanent Teeth 116 Total 130 Temporary Teeth 14 Attendances made by children for Regulation purposes 59 Regulation Plates supplied 3 The amount of dental disease present in children at various ages is shown 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 83 49 59.0 12 140 66 47.1 13 172 84 48.8 14 165 100 60.6 15 111 59 53.1 16 50 29 58.0 17 25 16 64.0 18 8 4 50.0 Totals 754 407 53.9 Of the 407 children referred for treatment, only 164 or 40% acceptances were received. 68 Attendances at Specialists' Clinics. Clinic. Individual Children. Total Attendances. Ophthalmic 123 185 Aural 17 (a) 24 Rheumatism 9(b) 14 Orthopaedic 30 (c) 54 Remedial Exercises 4 28 (a) One case received operative treatment for removal of Tonsils and Adenoids. (b) Four cases referred for X-Ray and Electro-Cardiogram and two for Blood Sedimentation Rate. (c) One case admitted to the Country Branch of the R.N.O. Hospital at Stanmore. Service & Quality CRUSHA & SON LTD. TOTTENHAM,ENFIELD & WOOD GREEN