Journal Rebind Co. Ltd. Unit 4, Pier Wharf Grays, Essex ILF 20 AC4411(1) ILFORD Borough of Ilford HEALTH REPORT FOR THE YEAR 1945 J. H. WEIR M.D., B.S., B.HY., D.P.H. Medical Officer of Health, etc. 67962 Ilford Borough Council 1st NOVEMBER, 1944—3lSt OCTOBER, 1945 Councillor Mrs. B. A. L. A. Harding, J.P., Mayor. Alderman Russell Stearn Daniels, J.P., Deputy Mayor. AIdermenT Billinqton, Henry. Braithwaite, Thomas, J.P., E.C.G. Dane, Frederick Hopper, M.B.E., J.P., C.A., (E.C.C.). Daniels, Russell Stearn, J.P. Deputy Mayor. Farman, Claude Augustus, E.C.C. Griggs, Albert Philip, J.P., E.C.C. Smith, Frank Douglas, J.P., C.A. (E.C.C.). Wetton, George John, C.A. (E.C.C.). Young, Alexander, Major, T.D., J.P. Councillors: Barker,John. Bryan, William Allen Vernon. Chester, Herbert. Collischon, Sidney Walter. Colvin, Gilbert, F.C.I.S. Cooper, Albert Edward. Cropper, Cyril Clifford, F.I.A.S., F.V.I. Eke, William Benjamin. Eves, Charles. Fallaize, Mrs. Lilian, J.P. Faning, Percy Victor. Green, Arthur William, J.P., C.A. (E.C.C.). Gregory, William Sydney. Harding, Mrs. Beatrice Alice Louise Anne, Mayor. Hinton, Charles Stanley. Holmes, Percy. Holness, Richard Thomas. Ingham. Edgar Frank. Slater, Frank. Spencer, Walter Robert. Taylor, Joseph John, J.P. Taylor, Sidney William. Tyler, George Frederick, F.C.I.I. Webber, Cecil Reginald Henry. Westhrop, George William Henry. Woods, Sidney Charles Victor. Wootton, Mrs. Florence Emily, O.B.E. PUBLIC HEALTH COMMITTEE 1st NOVEMBER, 1944—31st OCTOBER, 1945 Councillor G. F. Tyler, F.C.I.I., Chairman. Alderman F. D. Smith, J.P., C.A. (E.C.C.), Vice-Chairman. Alderman H. Billington. Alderman T. Braithwaite, J. P. (E.C.C.) Alderman R. S. Daniels, J.P., Deputy Mayor. Alderman A. P. Griggs, J.P. (E.C.C.) Councillor J. Barker. Councillor W. A. V. Bryan. Councillor H. Chester. Councillor W. B. Eke. Councillor Mrs. L. Fallaize, J.P. Councillor Mrs. B. A. L. A. Harding, J.P., Mayor. Councillor W. S. Gregory. Councillor R. T. Holness. Councillor J. J. Taylor, J. P. Councillor S. C. V. Woods. Councillor Mrs. F. E. Wootton, O.B.E. MATERNITY AND CHILD WELFARE COMMITTEE 1st NOVEMBER, 1944—31st OCTOBER, 1945 Councillor Mrs. B. A. L. A. Harding, J.P., Mayor, Chairman. Councillor W. B. Eke, Vice-Chairman. Alderman H. Billington. Alderman T. Braithwaite, J. P. (E.C.C.) Alderman R. S. Daniels, J.P., Deputy Mayor. Alderman A. P. Griggs, J.P. (E.C.C.) Alderman F. D. Smith, J.P., C.A. (E.C.C.) Councillor W. A. V. Bryan. Councillor Mrs. L. Fallaize, J.P. Councillor E. F. Ingham. Councillor J. J. Taylor, J. P. Councillor S. W. Taylor. Councillor G. W. H. Westhrop. Councillor Mrs. F. E. Wootton O.B.E. *Mrs. M. Armitage. *Mrs. H. Ashby. *Mrs. B. Butcher. *Mrs. W. Butler. *Mrs. S. Charles. *Mrs. B. E. Paddon. *Mrs. N. E. Thomas. * Co-opted Members. WAR EMERGENCY (EXECUTIVE) COMMITTEE 1st NOVEMBER, 1944—31st OCTOBER, 1945 Councillor Mrs. B. A. L. A. Harding, J.P., Mayor. Alderman Russell Stearn Daniels, J.P., 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. Alderman G. J. Wetton, J.P., C.A. (E.C.C.) Councillor G. Colvin, F.C.I.S. Councillor G. F. Tyler, F.C.I.1. EDUCATION COMMITTEE 1st NOVEMBER, 1944 — 3lst OCTOBER, 1945 Alderman R. S. Daniels, J.P., Deputy Mayor, Chairman. Councillor A. W. Green, J.P., C.A. (E.C.C.), Vice-Chairman. Alderman H. Billington 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., C.A. (E.C.C.) Alderman Major A. Young, T.D.,J.P. Councillor J. Barker 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, Mayor. Councillor E. F. Ingham. Councillor W. R. Spencer. Councillor S. W. Taylor. Councillor G. F. Tyler, F.C.I.I. Councillor G. W. H. Westhrop. Councillor S. C. V. Woods. •Mr. S. P. Lonergan. *Mi3s H. S. Rich. *xMr. F. R. Masters. *Mr. E. R. Lower, B.A. *Mr. A. Beech. *Mr. A. J. B. Haynes. *Mr. A. W. Davison. * 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 to 30.9.45. Consultant from 1.10.45. 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. Acting Medical Officer of Health (from 1.10.45): Deputy Medical Officer of Health (to 30.9.45): 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., M.R.C.P (Lond.) D.P.H. (Edin.) (In H.M. Forces). A. Collins, M.B., B.Ch., B.A.O. (Cork). Assistant Medical Officer of Health and Resident Medical Offictr (Isolation Hospital): S. R. Jamieson, M.D., Ch.B., D.P.H. (Glas.,. (In H.M Forces). 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. Halgh, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital-. Matron of Maternity Home : Miss K. Bellaers. Miss F. G. 0. Moorcroft. Senior Sanitary Inspector: S. R. Daly, D.P.A.(Lond.), M.R.S.I. Deputy Senior Sanitary Inspector: P. W. English. Sanitary Inspectors: S. G. Rackham. A. C. R. Neale. G. W. Newman. R. E. Smalley. T. F. Johnson. E. Stirk. Chief Administrative Clerk-. F. J. Hocking. Superintendent of Council’s Midwives: Miss C. Blockley. Officers of the Public Health Services—continued Superintendent Health Visitor: Mrs. M. D. Smith. Health Visitors and School Nurses-. Miss A. Batten. Mrs. G. H. Huqhman. Miss 0. Bell. Miss M. Irons. Miss M. G. Bennett. Miss N. M. Le Maitre. Miss A. L. Drinkwater. Miss I. L. Mobbs. Miss M. Graham. Miss E. du Randt. 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. V. J. Norman. Ley Street *Miss A. R. Jones. Becontree Avenue *Mrs. E. Drower. *Temporary. Part Time:— Consulting Obstetrician (Maternity Home and Puerperal Pyrexti 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. MoLauohlan, M.D., F.R.C.S. Oculist: F. J. Darbyshire, B.Sc., M.B., B.S., D.P.H. (Eng.), D.O.M.S. Surgeon in charge of Aural Clinic: W. Ibbotson, F.R.C.S. Physician in charge of Rheumatism Clinic: K. Playfair, M.A., M.B., M.R.C.P. Veterinary Surgeon: Ralph Bennett, F.R.C.V.S. Public Analysts: Bbbhabd Dyer, D.Se., F.I.C. George Taylor, 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, 1946. To the Mayor, Aldermen and Councillors of the Borough of Ilford. Ms. Mayor, Ladies and Gentlemen, I submit herewith the Annual Report on the Health Services for the year 1945. On 1st October of that year I assumed, the office of Acting Medical Officer of Health on the much regretted retirement of Dr. A. H. G. Burton, who, on medical advice, resigned his position as Medical Officer of Health and vacated office on 30th September. In this, my first annual report, I would pay unstinted tribute to Dr. Burton's work in building up the Public Health services of the town during the past quarter of a century. His achievements were briefly outlined in the Annual Report for 1944, and further to that typically modest summary I would additionally make mention of his great leadership, superb clinical acumen, and especially his great humanity exemplified in conscientious and untiring solicitude for all who came under his professional care. Since his retirement and appointment as Consultant to the Council he has given great assistance in connection with various Infant Welfare Centres, holiday relief, and the Open Air School. I welcome this opportunity of expressing my great indebtedness to him for this and. for his helpful counsel and advice, which, drawn from profound knowledge and long experience, have been of the utmost value. The comparative Vital Statistics of Ilford and other districts for the year 1945 will be found in Table 1a on page 13.. These show that the health of the Town has been maintained and compare favourably with the National figures and those for the Administrative County of London. It will be noted that the uncorrected Death Rate of 10.0 is lower than that for 1944, despite the inclusion of 105 deaths due to enemy action. The Infantile Mortality Rate remains gratifvingly low; a decimal point lower than last year. The Birth Rate shows a decrease, being 16.8, as compared with 19.1 for 1944, but this is doubtless accounted for by the large exodus of Service men from the country after "D" Hay, on 6th June, 1944. Present indications are that the birth rate for the current year will probably exceed that for 1944. So far as Infectious Diseases are concerned, there have been no serious major epidemics affecting the inhabitants of the district, although the incidence of measles was five times that of 1944. This was attributable to the periodic cycle of incidence which characterises this complaint. Whooping cough cases were approximately half those of the previous year. The number of cases of diphtheria remained low thanks to the immunisation scheme, and only one small outbreak (recorded in the School Medical Section of the Report) occurred. An outbreak of acute anterior poliomyelitis which occurred is described in the Infectious Diseases Section. The year saw the disbandment of the Civil Defence Casualty Service which, after almost six years of sterling service, officially ceased its existence on 1st July. A full account and appreciation of its activities was given in the last Annual Report, but for security reasons it was not permissible to publish figures regarding local casualties. It may now 7 be revealed that during the war years 618 H.E. Bombs, 33 Paramines, 35 Flying Bombs and 35 Rockets fell in the Borough, in connection with which there were 530 civilian deaths and 1,453 patients treated at First Aid Posts. The Education Act, 1944 became operative on 1st April, 1945, and Ilford now holds the status of an "Excepted District" under Essex County Council, which is the Local Education Authority. The School Medical Service, while operating locally as hitherto; is under the administrative aegis of the County Council. The cessation of hostilities and the return of many children from reception areas has resulted in increased clinic attendances, especially of those requiring attention for dental, visual and tonsil defects. This increase, together with the continued shortage of hospital accommodation, staff and supply difficulties, has in many instances caused unavoidable delay in securing treatment. As pointed out on former occasions, there is a pressing local need for the establishment of a Child Guidance Clinic. Increased provision of day and residential school accommodation for educationally sub-normal pupils and institutional facilities for ineducable children is similarly required. Since the cessation of hostilities efforts have been made to remove some of the curtailments necessarily imposed on the Maternity and Child Welfare Services during the War. Additional Ante-Natal Post-Natal and Infant Welfare Olinic sessions have been arranged, although at times shortage of accommodation, Medical Officers and Health Visitors has restricted expansion. In this connection I gratefully acknowledge the very considerable assistance rendered by several of the local medical practitioners who have kindly undertaken sessional duties at Infant Welfare Centres. The shortage of Health Visitors is causing increasing concern as, owing to the national shortage, it is difficult to fill vacancies, let alone increase the establishment, which contemplated action has the approval of the Ministry of Health. This shortage of personnel is similarly causing anxiety in connection with the Midwifery Services. The Maternity Home staff is depleted to the extent of seven Midwives as compared with the pre-war figures. Great strain has been thrown on the Maternity Home and Domiciliary Midwives as a result of the steady and rapidly progressive increase in the number of births since the latter months of 1945. Their devoted service merits the highest praise. At the time of writing the Maternity Home is, of necessity, having to accept monthly 25 per cent, more cases than normal and the Domiciliary Midwives are attending 52 per cent more home confinements. The demand for institutional accommodation for Maternity Cases has been exceedingly heavy. The Maternity Home accommodation has been severely taxed, and as a temporary measure it has been necessary to reduce the lying-in period to 10—12 days whenever possible. Negotiations are now in progress to establish a Post-Natal Hostel to relieve pressure on the existing provision of Maternity Beds. Owing to the closure of many of the Emergency Maternity Homes in Reception Areas, it has been impossible to evacuate the desired number of expectant mothers for whom institutional confinement has been rendered necessary owing to lack of facilities for home confinement. It must be appreciated that enemy action resulted in the total loss of 1,257 houses in the Borough, the very serious damage to 9,410, and varying degrees of less serious damage to 29,974 more. This, coupled with no significant diminution in population and a now rising birth rate, has produced the present difficulties of making arrangements for confinements. Despite continual efforts it has not been possible to meet the considerable demand for the services of Home or Domestic Helps. The Future of the Health Services of the Borough will be largely dependent on the provisions of the National Health Service Act—which 8 will become operative in 1948—and the result of the Council's present application for County Borough Powers. Under the Act. apart from functions connected with environmental hygiene, the only direct control of Health Services which may be permitted to Municipal Boroughs is that concerned with the care of children under 5 years of age. This may be delegated by the major authority, i.e., the County Council. On the other hand. County Boroughs will have direct representation on the Executive Councils controlling the General Practitioner services. They will also have a voice in the selection of the Regional Hospital Boards which will administer all non-teaching Hospital and Consultant services (including locally the Isolation Hospital and the Maternity Homes) and in the appointment of the Board of Governors of the teaching Hospitals of their particular Region. They will be additionally responsible for the administration of their Local Government and Domiciliary Services, including maternity and child welfare, midwifery, health visiting, home nursing, local mental health services, vaccination, immunisation, ambulance services, care and after-care of the sick, domestic help, and health centres. Whatever the outcome of the Council's application and whatever administrative machinery ultimately becomes operative, there will still be need for the pursuance of a vigorous policy to maintain and further the improvement of the local publie health. In particular, when building conditions permit, there is urgent necessity for an early extension of the present Maternity Home and for the establishment of an adequate number of multi-service clinics to serve the various needs of the Town. Owing to existing difficulties of accommodation and staffing there is insufficient provision of institutional accommodation for the local chronic sick, especially aged invalids. It is hoped that when conditions permit adequate provision will be made for this type of case. I would place on record my appreciation of the work performed and the loyal support which has been accorded to me by members of all sections of the Public Health Department during my tenure of office in an acting capacity and since my permanent appointment as Medical Officer of Health. In welcoming back those who have so far returned from service with H.M. Forces. I record with profound sorrow the loss of five who gave their lives in the service of their country. I would also mention the kind co-operation and assistance received from the officers and members of other Departments of the Corporation. To them, and to the voluntary helpers who have assisted in the work of the various clinics, I express my sincere gratitude. To the members of the Council generally, and particularly to the Chairmen, Vice-Chairmen, and members of the various Committees with which the work of the Department is especially concerned, may I offer my grateful thanks for their co-operation and support throughout the year. I have the honour to be, Your obedient Servant, J. H. WEIR, Medical Officer of Health. 9 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, 1944 149,330 1945 151,520 Number of inhabited houses (end of 1945) according to Rate Books 44,000 (approx.) Rateable Value—October 1st, 1945 (Houses and Land £1,668,568 Sum represented by a penny rate, October 1st, 1945 £6.000 (approx.) Education Rate— 1945-46 Elementary 2s.7.54d in the £ 4s. 9.06d. in the £ Higher (Country) 0s.11.79d in the £ „ (Ilford Council) 0s.0.06d in the £ Combined Rate (all services) 14s..8d in the £ 16s. 0d. in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— (a) Number of unemployed males at end of December, 1944 34 ,, ,, ,, ,, December, 1945 166 (6) Number of unemployed females at end of December, 1944 13 ,, ,, ,, ,, December, 1945 28 Total M. F. 1945 1944 Live Births Legitimate 2,343 1,202 1,141 Birth Rate per 1,000 of the estimated resident population 16.8 19.1 Illegitimate 136 79 57 Still Births 55 29 26 Rate per 1,000 total (live and still) births 21.7 20.1 Deaths 1,664 810 854 Death Rate per 1,000 of the estimated resident population 11.3 11.4 Percentage of total deaths occuring in public institutions 34.8 37.2 10 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. 1945 1944 1945 1944 No. 29, Puerperal sepsis 0 2 0.0 0.71 No. 30, Other maternal causes 3 5 1.18 1.76 Total 3 7 1.18 2.47 Death-rate of Infants under one year of age:— 1945 1944 All infants per 1,000 live births 32.7 36.8 Legitimate infants per 1,000 legitimate live births 31.2 35.7 Illegitimate infants per 1,000 illegitimate live births 58.8 60.3 Deaths from Cancer (all ages) 255 268 ,, Measles (all ages) 2 - ,, Whooping Cough (all ages) - 2 ,, Diarrhoea (under 2 years of age) 8 7 1. Rainfall. Total rainfall registered in the district during the year was 19.44 inches, the greatest fall in 24 hours was registered on 14th July, being 1.87 inches. The fall of longest duration was on the 25th Maroh—10.1 hours. July was the wettest month. 2. Population. The number of patients and resident staff on the 30th June, 1945, at the following public institutions, was:— Claybury Mental Hospital and Emergency Hospital 2,488 West Ham Mental Hospital and Emergency Hospital 1,181 Australasian Hospital (Girls' Village Homes) 92 Total 3,761 3 . Births.—-The number of births registered during the year was 2,479. Males Females Legitimate 1,202 1,141 Illegitimate 79 57 i.e., 5.5 per cent, of the births registered were illegitimate. The birth-rate, calculated on the net estimate of the population is 16.8 per 1,000. 4. Deaths.—The total number of deaths of Ilford residents was 1,664. This is obtained by taking the total deaths registered in the district (1,516), subtracting the deaths of non-residents occurring in the district (403), and adding the deaths of Ilford residents registered as having died in other districts (551). The number of deaths of non-residents registered in the district (principally in large institutions) was as follows:— Claybury (L.C. C.) Mental and Emergency Hospitals 185 West Ham Borough Mental and Emergency Hospitals 83 King George Hospital 40 Ilford Isolation Hospital and Sanatorium 62 Other Non-residents 33 Total 403 11 The number of deaths of Ilford residents registered as having died in other districts during the year was as follows, and includes deaths at the following Institutions:— Oldchurch County Hospital, Romford 71 Essex County Mental Hospital, Brentwood 15 Essex County Hospital, Wanstead 38 Queen Mary's Hospital, West Ham 11 Hospital for Sick Children, Great Ormond Street 4 London Hospital 43 St. Bartholomew's Hospital 15 Charing Cross Hospital 1 Westminster Hospital 1 Royal Eastern Counties Institution, Colchester 1 St. Margaret's Hospital, Epping 5 Severalls Mental Hospital, Colchester 14 East Ham Memorial Hospital 7 Poplar Hospital 2 Whipps Cross Hospital 5 St. Luke's Hospital 1 St. Mary's Hospital, Paddington 1 Chase Farm Hospital, Enfield 9 In other Hospitals, Institutions and residences outside the Ilford district 307 Total 551 The death rate, calculated on the net estimate of the population of 147,759, is 11.3 per 1,000. Inquests.— During the year, 41 inquests were held in the district, 29 on Ilford residents, and 12 on non-residents. The ages at death were as follows:— Under 1 year 1-2 Years 2-5 years 5-15 years 15-25 years 25-45 years 45-65 years 65 years and upwards — - — 4 7 5 16 9 Death-Rates from Tuberculosis and Cancee, 1946. The following Table shows the death-rates tor 1945 lor lltord, 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 .462 .519 Other Tuberculosis .088 .100 Cancer 1.725 1.945 5.—-Public Assistance Relief.— The total amount expended in Ilford during the year was £23,874 16s. 3d. The average weekly number of cases in receipt of relief was 553, including dependants. The number of admissions to County Institutions from Ilford during the year was 1,227, made up as follows:— Men 431 Women 613 Children 183 The number of destitute persons admitted to the Public Assistance Institution during 1945 was 11; men 3, women 2, children 6. 6. Marriages.-—1,837 marriages took place in the Ilford district during 1945, 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 I a 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 1945, arranged according to the age groups at which deaths occurred. 12 TABLE I.— Vital Statistics of Whole District During 1945 and Previous Years. Year Gross Population, estimated to middle of each Year. Net Population estimated to middle of each Year. Births Total Deaths Registered in the District Transferable Deaths Net Deaths Belonging to the District Uncorrected Number Net (6) | of Non - Residents registered in the District of Residents not registered in the District Under 1 Year of Age At all Ages Number Rate (c) Number Rate (d) Number Rate per 1,000 Net Births Number Rate (e) 1 2 2 a 3 4 5 6 7 8 9 10 11 12 13 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 1945 151 ,520 147,759 1 ,888 2,479 16.8 1,516 10.0 403 551 81 32 7 1 ,664 11.3 (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. Ba rnardo'a Girls' Village Homes is included in the net estimated population of the district. (b) The net number of births is obtained by taking the uncorrected number of births supplied by the local Registrar and adding to or subtracting from it such a number as is supplied for this purpose by the Registrar-General. (c) and (e) Calculated on the estimated net population. (d) Calculated on the estimated grows population. TABLE 1A Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1945 (Provisional figures). Rate per 1,000 Total Population Annual Death-rate per 1,000 Population Rate per 1,000 Live Births All Causes Typhoid and Paratyphoid Fevers Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Diarrhoea and Enteritis (under 2 Yrs.) Total Deaths under 1 Year Live Births Stillbirths England and Wales 16.1 0.46 11.4 0.00 — 0.02 0.00 0.02 0.02 0.08 5.6 46 126 County Boroughs and Great Towns, including London 19.1 0.58 13.5 0.00 — 0.02 0.00 0.02 0.02 0.07 7.8 54 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 19.2 0.53 12.3 0.00 - 0.02 0.00 0.01 0.02 0.07 4.5 43 London Administrative Co. 15.7 0.40 13.8 0.00 — 0.01 0.00 0.02 0.01 0.07 7.6 53 ILFORD (Estimated Gross Population, mid 1945 = 151,520 16.4 0.36 11.0 - - 0.01 - - 0.01 0.05 3.2 32.7 A dash (—) signifies that there were no deaths. 14 Registrar-General's Short List of Deaths and Causes:— TABLE II Causes of, and Ages at, Death during the Year 1945 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 1664 81 11 9 28 44 49 89 178 273 409 493 1 Typhoid and paratyphoid fevers - - - - - - - - - - - - 2 Cerebro-spinal fever 2 1 - - 1 - - - - - - - 3 Scarlet fever - - - - - - - - - - - - 4 Whooping cough - - - - - - - - - - - - 5 Diphtheria 2 - - - - - - - - - - - 6 Tuberculosis of respiratory system 68 - - - 1 8 13 14 13 11 7 1 7 Other forms of tuberculosis 13 — 4 3 1 2 1 1 — — — 1 8 Syphilitic disease 8 - - - - - - - 4 1 3 — 9 Influenza 7 1 - - - - - - 1 — 3 2 10 Measles 2 — 1 - 1 - - - - - - - 11 Acute Poliomyelitis and polioencephalitis 1 - - - - - - - - - - - 12 Acute infectious encephalitis 1 - - - - - - - - - 1 — 13 Cancer of buccal cavity and oesophagus (males only) 9 - - - - - - - 2 2 2 3 Cancer of uterus (females only) 10 - - - - - - 1 3 1 2 3 14 Cancer of stomach and duodenum 43 - - - - - - 3 4 13 15 8 lfi Cancer of breast 23 - - - - - 2 2 4 8 5 2 16 Cancer of all other sites 170 - - - - - - 7 25 54 45 39 17 Diabetes 17 - - - - 1 1 1 1 1 5 7 18 Intra-cranial vascular lesions 156 - - - - - - 4 9 26 47 70 19 Heart disease 428 - - - - 2 7 12 28 63 147 169 20 Other diseases of the circulalatory system 45 - - - - - - 2 2 10 14 17 21 Bronchitis 94 2 2 - - — — 1 7 16 27 39 22 Pneumonia 61 16 2 - - 1 2 2 5 6 5 22 23 Other respiratory diseases 19 — — - 1 — 1 2 1 1 5 8 24 Ulceration of the stomach or duodenum 20 - - - 1 - 2 1 7 5 3 1 25 Diarrhoea (under 2 years of age) 8 7 1 - - — — — — — — — 26 Appendicitis 4 — — - I — 1 — — — 1 1 27 Other digestive diseases 44 4 — - - 2 — 3 6 4 10 15 28 Nephritis 26 — — - - I — 2 2 5 y 29 Puerperal and post-abortive sepsis - — — - - — — — — — — — 30 Other maternal causes 3 - - - - - l 2 — - - - 31 Premature birth 12 12 - - - - - - - - - - 32 Congenital malformations,birth injury, infantile disease 40 32 - - 1 1 — 3 1 — 2 — 33 Suicide 15 — — - - — — 1 4 0 5 - 34 Road traffic accidents 20 — 1 - 4 2 2 3 2 3 2 - 35 Other violent causes 120 1 — 5 11 16 4 16 28 18 13 8 36 All other causes 173 5 — 1 2 8 12 6 19 20 31 69 Special Causes (included in No. 3G above):— Smallpox - - - - - - - - - - - - 15 SECTION B. GENERAL PROVISION OP HEALTH SERVICES FOR THE AREA. I. (i) Public Health Officers of the Authority.— Vide list at the beginning of this report. (ii) Nursing in the Home.— There is a voluntary District Nursing Committee, 12,260 visits being paid by the Nurses in 1945, compared with II,016 in 1944. The following is a summary of the work carried out during the year 1945:— Number of New Cases and applications for Nurses' Services 824 Number of Visits—Medical 9,287 Surgical 2,322 Operations 4 Massage 647 Number of necessitous cases referred to the Committee. 10 Number of cases on books at end of year 124 The cases were distributed in wards as under:— Cranbrook 107 Park 123 Seven Kings 107 North Hainault 53 Loxford 85 Clementswood 52 South Hainault 53 Goodmayes 136 Barkingside 108 (iii) Laboratory Facilities.—During the year 837 swabs were examined for the presence of diphtheria organisms in the Bacteriological Laboratory at the Isolation Hospital; 79 gave positive results and 758 negative results. In addition 26 diphtheritic specimens were sent to other Laboratories for a test for virulence. (iv) Legislation in Force.—Byelaws exist for:— (1) Prevention of Nuisances. (2) Cleansing of footways and pavements, and cleansing of earth closets, privies, ashpits and cesspools. (3) Dealing with common lodging houses and houses let in lodgings. (4) Houses let in lodgings or occupied by members of more than one family. (Sec. 84, Ilford Act, 1937.) (5) Slaughterhouses and humane slaughtering of animals. (6) Pleasure Fairs. (Sec. 128, Ilford Act, 1937.) (7) Tipping of Dust, Spoil and Refuse. (Sec. 85, Ilford Act, 1937.) (8) For securing the cleanliness and freedom from pollution of tanks, cisterns and other receptacles used for storing water used or likely to be used by man for drinking or domestic purposes, or for manufacturing drink for the use of man. (9) Nuisances in connection with the removal of offensive or noxious matter. (10) Byelaws with respect to Private Schools. (Sec. 68, Ilford Act, 1937.) (11) Byelaws made under the Essex County Council Act, 1933. (Parts IV, VI and IX). Part IV—Establishments for Massage and Special Treatment. Inspections of licensed establishments are carried out quarterly. 16 During 1945 fifteen applications for renewal of licences were received. The Council renewed the licences in respect of the 15 establishments. Three new applications were received, which were granted. All the licences expire on 31st March, 1946. Part VI.—Hairdressers' and Barbers' Premises. During 1945, 107 visits of inspection were made by the Sanitary Inspectors to these premises. Part IX.—Camping Grounds and Moveable Dwellings. Part XI.—Manufacture of Ice Cream. Section 158 of this Act, which requires the registration of manufacturers and vendors of ice cream and the premises used by them, came into operation in the Borough on the 1st February, 1934, and 23 applications for registration in respect of 23 premises were considered during the year. The registrations were granted as follows:— Purveyors retailing multiple firms' productions 17 Purveyors manufacturing and retailing their own productions (made apart from domestic premises) 6 Purveyors manufacturing and retailing their own productions (made on domestic premises) Nil (12) Ilford Corporation Act, 1937. (a) Section 77 of this Act provides for the registration of hawkers of meat, fish, fruit and vegetables, and their storage premises. Registration was granted to two persons (concerning two premises), but refused in a third case on account of the unsuitability of the proposed storage premises. (b) Section 80 of the Act requires registration of premises used for the preparation or manufacture of sausages, or potted, pressed, pickled or preserved meat, fish or other food intended for sale. No applications for registration were received during 1945. (13) Shops Acts, 1912-1934 (Sections 10 and 13). Since this Act came into operation the Sanitary Inspectors have made inspections in accordance with Sections 10 and 13 (3). During the year, 2,189 re-inspections were made. Five preliminary notices were served, and compliance obtained. There are three local Acts in operation—(1) The Ilford Improvement Act, 1898, which has important sanitary provisions; (2) The Ilford Urban District Council Act, 1904, the Section which deals with the control of tuberculosis is repealed, the powers of the Corporation now being contained in the Food and Drugs Act, 1938; and (3) The Ilford Corporation Act, 1937. The Ilford Corporation Act, 1937, repealed Section 62 of the Ilford Improvement Act, 1898, dealing with the holding of a wake over a body of any person who died while suffering from a notifiable disease. This offence is now dealt with in Section 165 of the Public Health Act, 1936. (v) Hospitals, Etc. Isolation Hospital.—190 beds are provided. Of this number 20 are permanently maintained by the Essex County Council for the treatment of advanced cases of pulmonary tuberculosis. During the year 52 of the remaining beds were allocated to the Essex County Council for the reception of 32 male and 20 female patients for the treatment of cases of tuberculosis, on the understanding that if the beds were required for infectious cases the tuberculosis patients would be discharged home or transferred to other Sanatoriums. The arrangement was not interrupted during 1945. Maternity Home.-—51 beds for the reception of maternity cases are maintained at the Ilford Council Maternitv Home. King George Hospital.—This is a voluntary Hospital. The following is a return in respect of bed accommodation:— 17 Total number of Beds at 31st December, 1945. Private Patients. Other Patients. Children. Medical. Surgical. Male. Female. Male. Female. 207 21 27 10 54 63 32 Maternity and Nursing Homes.— On the 1st January and on 31st December, 1945, 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. One letter was sent calling the attention of the keeper of a home to a sanitary defect. Mental Hospitals.—There are two large Mental Hospitals in the district' the West Ham Mental Hospital, with 1,114 patients (males 463, females 651)' and Claybury Mental Hospital, with 2,131 patients (males 880, females l,25l) in residence on 30th June, 1945. Other Institutions.—Girls' Village Homes, one of the late Dr. Barnardo's Institutions; this Institution was evacuated during the war period. (vi) Ambulance Facilities.—The Council maintains a fully adequate ambulance service as follows :— (a) Infectious Diseases.—Two Austin motor ambulances are provided for the conveyance of cases to the Isolation Hospital. These are housed in the garages at the Isolation Hospital. Reciprocal arrangements are in force with the Barking Council and Romford Joint Hospital Board if breakdown occurs. (b) Non -Infectious and Accident Cases.—Four vehicles are available during the hours of daylight in the mid-week period and three at the weekend. Two ambulances are available for service in the middle hours of the night. The service is available for street accidents, emergency illnesses, hospital evacuation cases and for private removals for residents and nonresidents. A scheme is in operation whereby support can be given to other Authorities should occasion demand this being a reciprocal agreement between the Borough of Ilford and the neighbouring Authorities of Dagenham, Barking and East Ham and the Essex County Council. Accident cases are removed free of charge, but normal removal and cases requiring conveyance to Hospitals, etc., are paid for in accordance with the scale laid down by the Council. The Authority has always attached importance to the provision of an adequate and efficient Ambulance Service and this is available day and night. The Town Ambulance Service now operates from Clark's Road Depot, High Road, Ilford. (vii) Clinics and Treatment Centres: Maternity and Child Welfare.—Infant Welfare Centres are held at the following premises:— Holy Trinity Church Hall, Mossford Green, Barkingside (for residents of Barkingside and Fairlop areas) Monday, 2 p.m. Chadwell Christian Mission Hall, Essex Road, Chadwell Heath (for residents of Chadwell Heath area) Monday, 2 p. m. Mayesbrook Clinic, Goodmayes Lane, Goodmayes (for residents of Becontree and Goodmayes areas) Tuesday, 2 p.m. 13 St. John's Church Hall, Devonshire Road, Seven Kings (for residents of Downshall area)Tuesday, 2 p. m. Congregational Church Hall, Woodford Avenue, Ilford (for residents of Woodford Avenue and Valentines areas) Wednesday, 2 p.m. Cecil Hall, Granville Road, Ilford (for residents of the north side of Cranbrook Road) Wednesday, 2 p. m. Cecil Hall, Granville Road, Ilford (for residents of the south side of Cranbrook Road) Thursday, 2 p. m. St. John's Church Hall, Devonshire Road, Seven Kings (for residents of Seven Kings area) Wednesday, 2 p.m. Newbury Hall, Perryman's Farm Road, Newbury Park (for residents of the Newbury Park area) Thursday, 2 p. m. Vine Memorial Church Hall, Grosvenor Road, Ilford (for residents of Grosvenor Road area) Thursday, 2 p.m. Mayesbrook Clinic (for residents of area) Thursday, 2 p.m. Vine Memorial Church Hall, Grosvenor Road, Ilford (for residents of Ilford Lane area) .. Friday, 2 p.m. Ante-Natal Clinics.—An Ante-Natal Clinic is held at the Maternity Home, Eastern Avenue, Ilford, on Wednesday, Thursday and Saturday mornings, and on Tuesday, Wednesday, Thursday and Friday afternoons, and at the Mayesbrook Clinic, Goodmayes Lane, on Monday afternoons and Thursday mornings. Post-Natal Clinics.—These Clinics are held at the Maternity Home on each Monday afternoon, and at the Mayesbrook Clinic, Goodmayes Lane, once monthly on a Friday morning. School and other Clinics.—Clinics are held at the following premises:— (i) Public Health Offices, Valentines Mansion for— Diphtheria Prevention. Aural, Ophthalmic treatment. (ii) Newbury Hall, Perrymans Farm Road for— Minor Ailments. Orthopaedic treatment. Rheumatism. Artificial Sunlight treatment. Infant Welfare. (iii) Mayesbrook Clinic, Goodmayes Lane, for— Minor Ailments. Dental (Children and Expectant Mothers). Ophthalmic treatment. Sunlight treatment. Ante-Natal and Post-Natal. Diphtheria Prevention. Orthopaedic treatment. Infant Welfare. (iv) Valentines School, Beehive Lane, for— Dental (Children and Expectant Mothers and Tuberculosis Patients). Tuberculosis Dispensary.—A dispensary is provided by the Essex County Council at 130-132, Cranbrook Road, Ilford. The following sessions are held each week:— For Adults—Tuesday, 10 to 12 noon; Wednesday evening, for workers only, by appointment; Friday, 2 to 5 p.m. For Children—Wednesday, 10 to 12 noon. A Pneumothorax Refill Clinic is held on Monday morning at 10.30 a.m., and on Thursday afternoon at 2.30 p.m. 19 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. (i) Water Supply.—The district is served by the Metropolitan Water Board and the South Essex Waterworks Co., both maintaining a constant supply. The onus on these Undertakings to provide a pure water supply was laid down by Section 35 of the Waterworks Clause Act, 1847, "to provide and keep in the pipes to be laid down by them a supply of pure and wholesome water" ; they have also a specific obligation; Section 17 of the South Essex Waterworks Act, 1901, imposes a duty on the Company "to provide a supply of pure and wholesome water," while Section 7 of the Metropolitan Water Board (Charges) Act, 1907, lays an obligation on the Board that "subject to the provisions of this Act the Board shall cause service mains or pipes (not being communication pipes) to be laid down and a supply of pure and wholesome water for domestic purposes to be brought to every part within the limits of supply." The Waterworks Clauses Act of 1847 was repealed in 1945 by the passing of the Water Act which placed upon the Minister of Health the duty of promoting the conservation and proper use of water resources and the provision of water supplies in England and Wales and of securing the effective execution by water undertakers, under his control and direction, of a National policy relating to water. From the Barking boundary the South Essex Waterworks Co. supply (with certain exceptions referred to hereunder) that portion of the district lying East of the River Roding, South of the L.N.E.Rly., East of Cranbrook Road and High Street, Barkingside, South of Forest Road to and including Fairlop Station, East of the railway to a point approximately 500 ft. South of Hainault Station, then South of a line drawn from this point to the South end of Dryden Close, West of a continuing line to Forest Road and South from this point to the Dagenham boundary. In addition the Company are about to supply the Council's temporary housing estate fronting Forest Road and abutting the Dagenham boundary, by arrangement with the Board. Nos. 130-144, Cranbrook Road (even numbers inclusive), though on the West side of Cranbrook Road are also supplied by this Company. The portion of the district to the West and North of the area is served by the Metropolitan Water Board, together with a number of isolated premises which include Valentines Mansion, Emerson Road, Nos. 65, 67, 69, 71a, and 36, High Road, 6, 8, 18 and 20, Station Approach, Ilford, and six shops known as Old Post Office Buildings, High Street, Barkingside. The Metropolitan Water Board has one deep well within the district at Eastern Avenue to augment its river supply. The South Essex Waterworks Co. obtain their water from the River Stour and from seven deep wells situated in their area of supply, three of which are within the district at Mill Road, Grove Road and Roding Lane. The water supplied by the South Essex Waterworks Co. is derived from two sources, namely:— (1) The River Stour after purification at the Langham Filtration Works. (2) The Seven Kings, Ilford and Roding Pumping Station, each of which obtain their supply from deep wells in the chalk which has a superficial covering of London Clay, Woolwich and Reading Beds, and Thanet Sand, thereby preventing any possibility of surface contamination. In regard to the River Stour supply, which constitutes about 65 per cent, of the water distributed in Ilford by this Company, the river water is subjected to preliminary storage and equalisation in a Sedimentation Reservoir from which it passes through Continuous Flow Settlement Tanks provided with facilities for the addition of chemical precipitants, should such be necessary. 20 Subsequently the water from these Tanks is submitted to Rapid Gravity Filtration followed by Slow Sand Filtration. Finally the water is uniformly sterilised by means of Chlorine and Ammonia (Chloramine). Such method of purification is in accordance with the highest standard of practice and the finally purified water, consistently proves to be of the highest degree of purity and therefore at all times pure and wholesome. In addition, samples of water are frequently examined both chemically and bacteriologically throughout the process of purification thereby ensuring its efficient operation. In regard to the Seven Kings, Ilford and Roding Pumping Stations, the water from these wells is under constant chemical and bacteriological observation and the water has consistently proved to be of the highest degree of organic and bacterial purity and therefore at all times pure and wholesome. Three samples of piped water supply (South Essex Waterworks Co.) were taken for chemical and bacteriological examination and each sample gave a satisfactory analysis. All new and repaired mains are chlorinated before being used. Mr. B. W. Bryan, the Engineer to the South Essex Waterworks Co. has very kindly supplied me with the following information regarding the water supplied by his Company:— 'The Stour Supply Scheme, for which Parliamentary sanction was obtained in 1935, came into supply early in 1941. It includes a large reservoir some 4 miles long and 1 mile wide in the widest place, situated at Abberton, about 4 miles south of Colchester, and by means of this reservoir, the maximum capacity of which is about 5,700 million gallons, it is possible to store large quantities of water from the River Stour otherwise running to waste in the winter, the raw river water being pumped through a main of about 11 miles in length from the intake on the River at Stratford St. Mary to the Abberton Reservoir. "After storage it receives treatment in the same manner as that mentioned in respect of the Langham Filtration Works. "The filtered and treated water is then pumped to Danbury Reservoir and gravitates therefrom to a service reservoir at Herongate near Brentwood and from thence to the Company's district. "For some years past we have had a laboratory at our Langham Works, our chief chemist and bacteriologist, Mr. G. U. Houghton, M.Sc., F.I.C., together with an assistant, last year made a total of about 3,300 chemical, bacteriological and biological examinations and all water going into supply was reported as wholesome. Samples of water as pumped to supply from the Langham and Layer-de-la-Haye Stations receive bacteriological examination daily, except Sundays. "Samples from the wells situated in our statutory area are analysed weekly and all are likewise reported on as above; in addition we have more recently taken several samples a week from houses in the various parts of our supply area for bacteriological examination and they are invariably perfectly satisfactory." Lieut. -Col. E. F. W. Mackenzie, Director of Water Examination to the Metropolitan Water Board has kindly supplied me with the information that 967 samples of filtered water derived from the River Lea supplied to the Ilford area during 1945 were submitted to chemical and bacteriological examination and found to be pure and wholesome. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. The water is not plumbo-solvent. The length of mains laid in Ilford during 1945 by the South Essex Waterworks Co. were 349 yards of 6-inch, and 891 yards of 4-inch, and by the Metropolitan Water Board 1,172 yards of 4-inch. There are now no public wells in existence. There are a few private wells for commercial and domestic purposes, the latter serve the needs of those properties (six in number) not conveniently sitated for connecting to the main supply. 21 (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 21,730 11 „ „ „ disposed of by barge 20,680 7 „ „ „ „ at Destructor 820 1 at Shoots 230 3 Salvage and Kitchen Waste:— Tons Value £ Wastepaper 867 5,878 Metals 1,086 1,675 Textiles 96 2,053 Bottles 462 1,874 Cullet 340 434 Bones 43 211 Kitchen Waste 2,563 3,894 Rubber 7 16 Miscellaneous 26 120 5,490 £16,155 (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 22,657 Houses and premises reinspected (works in progress) 7,063 Visits during disinfection 534 Houses in which nuisances were detected 1,865 Houses in which nuisances were abated 2,115* Premises disinfected 623 Premises from which articles only disinfected 135 Articles disinfected 3,079 Promises disinfested for verminous conditions 1 * Includes 405 nuisances detected before 1st January, 1945. Notices served:— Served Complied with Statutory:— Public Health Act, 1936 72 52 Housing Act, 1936 6 — Housing Act, 1936 (Overcrowding) 12 4 Factories Act, 1937 2 2 Provide Dustbin (Ilford Improvement Act) 388 349 Provide Water Supply to Dwelling House — — Cleanse Water Storage Cistern (Byelaws) 6 6 Cover Water Storage Cistern (Byelaws) 6 6 Informal 1,493 1,374 1,985 1,793 In addition to the above, 427 notices (108 statutory and 319 informal) served previous to 1st January, 1945, were also complied with. 22 Complaints.—During the year, 2,539 complaints of nuisancer have been received and investigated. The following is a summary:— Accumulation of manure and refuse 58 Animals improperly kept — Bad smells 58 Dampness of premises 73 Defective drains, w.c's and fittings 577 Defective roofs, gutters, downpipes, etc. 119 Defective water fittings 138 Dirty and verminous houses 70 Dirty condition of rearway 4 Flooding of premises 22 Overcrowding 22 Smoke nuisances 15 Miscellaneous 1,383 Total 2,539 (iv) Swimming Baths and Pools.—Samples of water for examination were taken from the open-air swimming bath from May to September (5); all the samples were satisfactory, but in 3 samples the chlorine content was below the minimum. Samples were also taken from the two indoor baths during January, March, May, June, July, August, September and November (13); all the samples were satisfactory, but in 5 samples (2 from the 1st and 3 from the 2nd class) the chlorine contentwas below the minimum. (v) Eradication of Bed Bugs:— Houses (Found to be infested 19 (Disinfested 19* *Includes 4 nuisances detected before 1st January, 1945. (vi) Slaughter of Animals Act, 1933.—No licence to act as slaughterman was granted during the year. (vii) Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1933.—The Senior Sanitary Inspector is authorised by the Council to make visits and certify under the provisions of the Acts. Certificates were issued in respect of 3 premises during 1945. (viii) Rag Flock Acts, 1911 and 1928.—The Medical Officer of Health and the Sanitary Inspectors are the appointed Officers for the purposes of enforcing the provisions of these Acts. There are no premises on which rag flock is manufactured, but one firm is using rag flock and is periodically inspected. (ix) Smoke Abatement.—Complaints were received of alleged smoke nuisances from a factory at Chadwell Heath and a dairy depot in the centre of the town. Observation was maintained, but no further nuisance was detected, in either case. SECTION D.—HOUSING. (i) Overcrowding.—Informal notices were served in respect of 12 premises, 10 of which were complied with. Seven statutory notices were also served, 2 of which were complied with. Two informal notices and 1 statutory notice served during 1944, were also complied with during the year. (ii) Unhealthy Areas.—No representations or complainte" have been made regarding unhealthy areas during the year. 23 (iii) HOUSING STATISTICS. 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,790 (b) Number of inspections made for the purpose 7,167 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 2 (b) Number of inspections made for the purpose 2 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,459 2. Remedy of defects during the year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,069* 3. Action under Statutory Powers during the year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 6 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners — (b) By local authority in default of owners — B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 72 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 64* (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:— (a) (i) Number of dwellings overcrowded at the end of the year 9 (ii) Number of families dwelling therein 13 (iii) Number of persons dwelling therein 43½ (b) Number of new cases of overcrowding reported during the year 21 (c) (i) Number of cases of overcrowding relieved during the year 15 (ii) Number of persons concerned in such cases 75 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report — *Includes compliances during 1945 of Notices served prior to 1st January, 1945. 24 HOUSING ACT, 1936. During the year 1945, 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 15,916 houses. At the end of the year the total certificates issued to date numbered 18,099 in respect of 24,592 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, 1,339 were received up to 31st December, 1945, and the balance of 4 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 8,207. SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) Persons and Premises registered as at 31st December, 1945:— Premises registered as dairies and milkshops 35 Cowkeepers registered 2 Persons registered as retail purveyors of milk 185 Persons registered as retail purveyors of milk in the Ilford district, whose premises are outside the Borough 20 Persons registered as wholesale purveyors of milk 13 298 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 70 inspections (included in above) were made of 2 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 Orders, 1926 and 1938. One of the 2 registered cow-keepers is a wholesale and retail purveyor of milk; the other is a retail purveyor only. Of the 185 premises from which milk is retailed in Ilford, 16 are branches of 1 firm, and 5 another, 3 retail from dairy shops or stores, 11 from provision stores, 1 from a general shop and 6 from restaurants, 6 are retailers in a small way with rounds, while 37 sell sterilised bottled milk only, 18 sell sterilised milk and also milk in sealed containers, and 82 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. 25 (ii) Licences were granted under the Milk (Special Designations) Regulations, 1936 to 1943, during 1945 for the sale of:— "Tuberculin Tested" Milk 8 "Pasteurised" Milk 16 The above include supplementary licences which were issued for "Tuberculin Tested" milk, 3; and "Pasteurised" milk, 5. These are licences granted to firms who already have a primary licence from another Authority, the milk being bottled outside the town, but sold in Ilford. The Essex County Council granted no producer's licence in respect of graded milk produced on farms in the Borough during the year 1945. (iii) Sampling.—The following is the routine practice adopted:— Designated Milks.—These are sampled bi-monthly and after unsatisfactory reports. Ungraded Milks.—Samples of these milks are taken from all registered purveyors quarterly and repeated after unsatisfactory results. Biological Tests.—Samples of all milks, designated or otherwise, are submitted for biological test for T.B. in Spring. Repeat samples if positive after clearance by County Medical Officer. Milk Supplies to Elementary Schools.—These are sampled monthly and after unsatisfactory results. Ice Cream.—Samples are taken monthly from April to September and at regular intervals during the winter months from all local manufacturers, tricycle salesmen and local retailers. Samples are repeated after unsatisfactory results. The Heat-Treated Milk (Prescribed Tests) Order, 1944, prescribes two tests, a phosphatase test for adequate heat-treatment and a methylene blue test for keeping quality. The Order defines temperatures at which samples must be kept both before reaching the laboratory and before the test and stipulates the hours during which the test must be conducted. 26 The following results were obtained:— Grade of Milk or Ice Cream Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested (Pasteurised) Milk 6 5 1 Supplies were obtained from a neighbouring County Borough. Retailer, supplier and Medical Officer of Health concerned were communicated with. Tuberculin Tested (Certified) Milk 6 5 1 The analysis of this sample showed a high B. Coli content. The County Medical Officer was communicated with. Pasteurised Milk 24 22 2 The analyses of the unsatisfactory samples showed a high B. Coli Content. In one case supplies were obtained from a neighbouring Borough and the Local Medical Officer was informed. In the other case the retailer was communicated with and re-sampling ordered at a later date. Heat-Treated Milk 22 15 7 All these unsatisfactory samples failed to satisfy the Methylene Blue Reduction Test. Investigations were made as to bottling arrangements and re-sampling was ordered at a later date. Ungraded Milk 32 27 5 In all these samples, the analyses showed a high B. Coli Content. In one case the Medical Officer of Health of a neighbouring County Borough and firm concerned were advised. Investigations and re-sampling were ordered in the remaining cases. Ice Cream 27 19 8 Two samples from a vendor were considered by the Analyst to be grossly impure. The Medical Officer of Health, East Ham, in whose area the ice cream was manufactured was notified—see (viii) below. The Town Clerk sent a letter of warning to one retailer calling attention to the dirty condition of the ice cream servers and wafer maker. In the remaining instances the vendors were advised and re-sampling ordered at a later date. 27 (iv) Biological Tests.—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 of Dairy Herds.—No 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 1945. (vi) Legal Proceedings.—None were taken during the year. (vii) Registration.—As a result of the continued unsatisfactory condition of premises occupied by a person registered as a Retail Purveyor of Milk, the Council cancelled the registration in pursuance of Sec. 22 of the Food and Drugs Act, 1938. An appeal against the cancellation was allowed at Stratford Magistrates' Court. Costs were not awarded against the Corporation. It was subsequently necessary for the Town Clerk to send a letter of warning to this Purveyor in respect of the storage of milk in unregistered premises. (viii) Ice Cream Registration.—An ice cream vendor, registered under Sec. 158 of the Essex County Council Act, 1933, manufacturing ice cream in East Ham, was summoned before the Council to show cause why the Council, having regard to the results of bacteriological examination of samples of ice cream sold by him within the Borough, should not remove his name from the Register. The vendor and his representative appeared before the Council who resolved to remove his name from the Register of Vendors. (ix) Articles op Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Ale—1 bottle. Bacon—152 lbs. 7 ozs. Baking Powder—145 packets. Biscuits—166½ lbs.; 52 packets; 840 biscuits. Bread— 607½ lbs.; 91 rolls. Cakes—2,336; 409½ lbs. Cake Mixture—749 packets; 56½ lbs. Cereal—15 cwt. 69½ lbs.; 597 packets; 6 tins. Cheese—1 cwt. 50 lbs. 8 ozs. Cocoa—99 lbs. ; 5 tins. Coffee—18 bottles; 14 lbs. Cream—1 tin. Custard—269 packets; 25 lbs.; 15 drums. Cooked food—32 ozs. Eggs (Shell)—788. Eggs (Dried)— 95 packets; 20 lbs. ; 14 ozs. Eggs (Substitute)—76 lbs. ; 150 packets; 266 tubs. Fish—114 stone, 3 lbs. 2 ozs. ; 1,041 tins; 70 jars. Fish (Cakes)—2,197. Fish (Shell)—1 bushel. Flour—129 cwt. 19£ lbs.; 1,165 packets. Fruit—43 cwt. 7½ lbs.; 4 tins. Flavouring, Gravy Powders, etc. —14 lbs. ; 367 packets; 130 bottles. Herbs—152 packets; 28¼ lbs. ; 9 drums. Jam, Marmalade, Preserves, etc.—12 cwt. 75 lbs. Jellies—12. Gelatine—82 lbs. Margarine, Butter, Lard, etc.— 102 pats; 4 cwt. 41 lbs. 6 ozs. Meat—5 cwt. 10 lbs. 10 ozs. ; 519 tins; 1,541 cases; 15 boxes. Sausages—99 lbs. Rabbits—63 lbs. Poultry —42. Milk (Fresh)—6 galls. 2 qts. 1 pt. Milk (Tinned)—1,243 tins; 18 lbs. 6 ozs. Mustard—68 tins; 29½ lbs.; 8 jars. Minerals—434 bottles. Pudding Mixtures—577 packets; 144½ lbs. Pickles, Sauces, etc.—162 jars; 167 bottles. Salt—15 cwt. 66½ lbs.; 140 packets; 40 tins. Salt (Health)—29 packets ; 5 tins. Soda (Bicarb.)—249½ lbs. Soup—307 tins; 1 tub; 783 packets. Sugar—8 cwt. 55¾ lbs. Confectionery—6 cwt. 25 lbs. 5 ozs.; 1,818 bars; 2 boxes; 1 bottle; 2 tins. Tea—249½ lbs. Vegetables—2 cwt. 103 lbs. ; 79 bags; 841 tins; 4 trays; 48¾ boxes; 158 vegetables. Vegetable (Extract)—5 tins; 18 bottles. Vinegar—86 bottles; 13 pints. Wine—5 bottles. Food and Drugs Act.—During 1945, 263 samples (258 formal and 5 informal) of Food and Drugs were obtained. Four formal and one informal samples were not genuine. The following action was taken:— (i) (a) Egg Substitute Powder.—Deficient in available carbon dioxide to the extent of 58 per cent. of the quantity proper to egg substitute 28 powder. Detailed analysis showed that the preparation had deteriorated. (b) Throat Tablets.—Deficiency of iodine approximately two-thirds of prescription on the label. The Analyst stated that iodised foodstuffs rapidly lose iodine in storage. (c) Baking Powder.—Deficient in available carbon dioxide to the extent of approximately 31 per cent. and percentage of residual carbon dioxides twice the maximum amount allowed. Detailed analysis showed that the preparation had deteriorated. (d) Beef Suet.—Deficient in fat to the extent of approximately 9 per cent. of the minimum quantity laid down. In respect of cases (a), (b), (c) and (d), a letter of warning was sent to the retailer by the Town Clerk. (e) Vinegar.—A non-brewed vinegar of full acid strength, containing considerable quantity of matters in suspension. Letters of warning sent by the Town Clerk to the retailer and to the wholesaler. (ii) Legal proceedings were taken against the proprietor of one bakehouse, where foodstuff, stated to be custard, was exposed for the purpose of cooling in the yard, within close proximity to bins of ashes and a full manure pit. The defendant was fined £40 and £5 5s. Od. costs. 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. (Also notifiable under Sec. 17, Food and Drugs Act, 1938.) No cases were "notified" under the Act, but in two instances cases of suspected food poisoning were reported to me. One of these occurred at a Depot then used by Rescue Squads (all A. R. P. personnel), and the other at a School Communal Kitchen, where meals were prepared for schools in the vicinity. Detailed investigation was carried out in each case, and samples of sauces, semolina, plain flour, sweetened chocolate, green vegetables, together with faecal matter, were submitted for bacteriological examination. In no case were the symptoms found to be attributable to genuine food poisoning. Bakehouses.—There are 37 bakehouses in the district, 29 of which use motive power. 211 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 12 instances, and the requests were complied with. Diseases of Animals Acts, 1894-1927. (i) Foot and Mouth Disease Order, 1928.—Notification was received, on 1st January, of an outbreak of the disease at Paddington. An Order made by the Minister of Agriculture and Fisheries, defining the "restricted area," included Ilford. The Order was withdrawn, so far as this Borough was concerned, on 17th January. (ii) Swine Fever Order, 1938.—On 11th May a report was received from the Veterinary Officer of the Ministry of Agriculture and Fisheries of suspected Swine Fever in pigs at a works' pig club. A Notice (Form "A") under the Order was served on the occupier. On 12th May a movement licence was issued permitting the removal of 9 pigs to the Ministry of Food Abattoir, Romford. On the 15th May, Notice confirming the disease was received from the Ministry and, on 31st May, Notice withdrawing Form "A''. Carcases of pigs affected with the disease were buried in accordance with the requirements of the Order, and scraping, cleansing and disinfection of the pig styes was carried out. 29 On 24th December, a notification of suspected Swine Fever was received, and subsequently confirmed by the Ministry. Six pigs died, the remaining 9 pigs from this sty were removed for slaughter on 28th December. (iii) Regulation of Movement of Swine Order, 1922-1926.— 11 Licences were issued for the removal of 33 pigs from the Borough, and 3 Licences were countersigned for the entry into the Borough of 22 pigs. (iv) Parasitic Mange Order, 1938.—One case of suspected Parasitic Mange was reported, but it was not confirmed by the Ministry of Agriculture and Fisheries. (v) Rabies Order, 1938.—One dog was admitted into the Borough under authority of the Ministry of Agriculture and Fisheries. The regulations respecting isolation were complied with. (vi) Sheep Scab Orders and Amendment Orders, 1928, 1930, 1934 and 1934 (No. 2).—There has been no occasion for this Borough to be made into a "double-dipping" area under these Orders during the year 1945. 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.—196 complaints have been received of the existence of rats affecting 205 premises. In 13 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 406 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 2 petroleum appliances or fittings. The number of Licences issued was 104, and the fees paid to the Council for such Licences was £76 15s. Od. Two 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 1945:— Officers Teachers Servants New Appointments 183 1 1 Under Sickness Regulations 15 — 18 Totals 193 1 19 30 SECTION F.—PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. TABLE III—Cases of Infectious Diseases Notified during the Year 1945 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 225 1 48 152 11 12 - 1 6 14 27 28 39 15 13 40 43 168 Diphtheria, including Membranous Croup 63 - 8 39 7 5 3 1 — 3 5 2 2 3 37 3 8 63 Enteric Fever (Typhoid and Para-Typhoid) 1 - — — — — 1 — — — — 1 — — — — — 1 Pneumonia 247 35 37 30 12 38 62 33 21 25 19 57 24 22 16 38 25 147 Puerperal Pyrexia 34 — — — 15 19 — — — — — 1 27 1 1 4 — 33 Cerebro-spinal Fever 1 - - - - - 1 - - - - - - - - - 1 1 Acute Poliomyelitis 13 — 2 7 3 1 — — — 3 — 6 1 — — 1 2 12 Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - - Encephalitis Lethargica — — — — — — — — — — — — — — — — — — Dysentery 63 — 11 7 7 17 14 7 1 — — 16 4 2 1 32 7 38 Ophthalmia Neonatorum 3 3 — — — — — — — — — 1 — — — 1 1 1 Erysipelas 51 — — — 5 17 24 5 2 5 5 12 10 2 2 3 10 17 Pemphigus Neonatorum — — — — — — — — — — — — — — — — — — Tuberculosis Pulmonary 203 1 3 13 64 85 29 8 21 13 12 28 19 23 21 28 38 — Other Forms 36 2 7 8 4 10 5 — 3 — 4 5 5 6 3 8 2 — Anthrax — — — — — — — — — — — - - — — - — — Malaria—Believed to be contracted in this country - - - - - - - - - - - - - - - - - - Believed to be contracted abroad 4 — — — 1 3 — — — 1 — 1 — 1 — 1 — 2 Acute Rheumatism 7 — — 7 — — — — 1 — 1 3 1 — — — 1 3 Measles 2154 80 875 1156 31 7 5 — 142 117 206 452 339 190 195 214 299 47 Whooping Cough 536 48 249 229 4 4 2 — 25 34 20 166 89 16 55 87 44 6 Food Poisoning - - - - - - - - - - - - - - - - - - Totals 3641 170 1240 1648 164 218 146 55 222 215 299 779 560 281 344 460 481 539 31 Of the cases notified, the following table shows the percentage treated in institutions, including those who were treated in the institutions from which they were notified:— Scarlet Fever 74.6 Diphtheria and Membranous Croup 100.0 Puerperal Pyrexia 97.0 Pneumonia 59.5 The total number of deaths of Ilford residents from the following infectious diseases during 1945 was 163 as against 168 in 1944. 1944 1945 Scarlet Fever — — Enteric Fever — — Diphtheria 4 2 Measles — 2 Whooping Cough 2 — Influenza 10 7 Tuberculosis— Pulmonary 73 68 Other forms 10 13 Pneumonia 59 61 Diarrhoea (under 2 years) 7 8 Cerebro-spinal Fever 1 2 Puerperal Sepsis 2 — Total 168 163 (а) Smallpox.—No case of Smallpox occurred. Notification of 32 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 1945:— Certificates of Successful Vaccination 1,382 Postponed 48 Conscientious Objections 617 Unsuccessful Vaccination 14 Left the District 318 (b) Scarlet Fever.—225 cases were notified in 1945. 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. 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 1945 225 166 7 4.2 57 1 1.7 (c) Diphtheria.—63 cases were notified in 1945. There were 2 deaths from Diphtheria during the year, both at the Ilford Isolation Hospital. In neither case had the patient been immunised against Diphtheria. One was admitted in a moribund condition and the other on the fifth day after onset of the disease. 32 Diphtheria Immunisation.— Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1945, to 31st December, 1945. Valentines 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 33 — 33 19 6 25 58 Negative 19 — 19 35 — 35 54 Numbers inoculated (full course) 92* 1,137 1,229 104* 701 805 2,034 Positive after full course of inoculations, and re-inoculated 4 16 20 7 14 21 41 Negative after full course of inoculations 72 862 934 69 438 507 1,441 Awaiting re-test 9 228 237 23 210 233 470 Not re-tested after inoculation (on account of leaving District, etc.) 7 31 38 5 39 44 82 Positive after re-test, but not inoculated for same reason - - - - - - - Final Schick Test in 1945 (1944 Cases):— Positive after full course of inoculations, and re-inoculated 1 3 4 2 4 6 10 Negative 9 204 213 8 143 151 364 * Schick+1945 = 19; Schick+1944 = 1; Not Tested = 72 * Schick+1945 = 12; Not Tested = 92 During 1945 a total number of 2,462 children attended at the Diphtheria Prevention Clinics (1,465 at Valentines Clinic and 997, at Mayesbrook), making a total number of attendances of 11,017 (6,642 and 4,375), with an average per session of 89 and 85 respectively. 33 In 1945, under the arrangements mentioned in the 1935 Report, 17 private doctors were supplied with prophylactic for the immunisation of 134 children (129 under 5 years and 5 over 5 years of age). The following is a brief summary:— 1944 Cases: Final Schick Test in 1945:— Negative 16 Positive and re-inoculated 2 Positive and not re-inoculated (left district) 1 No final Schick Test, left district, etc. 2 1945 Cases: Numbers inoculated (full course) by medical practitioners 119 Final Schick Test—Negative 78 Positive and re-inoculated 3 No final Schick Test, left district, etc. 7 Forms not yet returned 12 To be Schick Tested in 1946 19 (d) Ophthalmia Neonatorum.—3 cases were notified during 1945. Of these 2 were treated at home by private medical practitioners, and 1 at Goodmayes Emergency Hospital, where the infant had been transferred from the Out-Patient Department, Moorfields Hospital. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 3 2 1 3 - - - (e) Enteric Fever.—One case of this disease was notified during the year. This occurred at Claybury Mental Hospital. (f) Typhus Fever.—Notice of the arrival of 24 persons in this country from areas infected with Typhus Fever were received. These persons were visited by the Sanitary Inspectors; 86 visits were made. (g) Scabies Order, 1941 (dated 28th October, 1941).—186cases of Scabies (43 adults and 143 children) were reported. Seven Ilford residents were admitted to the Isolation Hospital during the year. 34 (h) Acute Anterior Poliomyelitis.—13 cases of this disease were notified during the year; 11 of them were admitted to the Borough Isolation Hospital. On the 19th August a boy belonging to a local Scout Troop who had been in Camp at Forest Row, Sussex, was admitted to the Isolation Hospital. The boy was in a very critical condition on admission and died four days later. Five other boys from the same Troop were admitted within the following 19 days. A sister of one of the boys also contracted the disease and was admitted to the Isolation Hospital on the 27th August. In all 130 local boys attended the Camp which terminated on the 10th August. Immediately on establishment of the diagnosis, advice was sent to the Ministry of Health, the Principal Regional Medical Officer, the County Medical Officers of Health of Essex and East Sussex, the Medical Officer of Health, Uckfield U.D.C. (the district in which the Camp was situate), the London Regional Scout Headquarters and the Director of Education, and all local medical practitioners and hospitals were circularised informing them of the presence of the disease. Camp and case contacts were kept under close surveillance by the Sanitary Inspectors and all contacts were given appropriate advice regarding precautions and maintenance of the necessary quarantine periods. A local Church Hall to which items of camp equipment had been returned was visited and spray disinfection carried out. The Boy Scouts' Association supplied a list of 62 various troops representing 1,161 boys who were at the Camp at the same time as the Ilford boys. A letter was sent to 49 Medical Officers of Health of other districts informing them of the occurrence with the names of any boys residing in their district and asking them to advise any developments. The Both Respirator (Iron Lung) was used for one of the cases admitted to the Isolation Hospital. The outbreak was investigated by a Medical Officer of the Ministry of Health, who visited the Hospital in this connection. Four other cases of Acute Anterior Poliomyelitis were admitted to the Isolation Hospital during the year, one a postman of 41 years of age. The cases were of varying degrees of severity and were all seen by the orthopaedic consultant and arrangements were made for physiotherapy. Apart from the fatal case all made satisfactory progress, treatment where necessary being continued after discharge at the Council's Orthopaedic and Massage Clinics. In 3 cases recovery was complete; in 6 cases one muscle group only had slight residual paralysis and in 2 cases more extensive paralysis necessitated transfer to a special orthopaedic unit at Orsett Lodge Hospital. Of the remaining 2 cases (both 2 years of age), 1 was admitted to the London Hospital and the other attended the Out-Patients' Department Hospital for Sick Children, Great Ormond Street. The first had some muscular weakness of the right leg in the early stages of the disease; the patient, however, made a good recovery following prolonged hospital treatment. The other child received electrical treatment at the Hospital for Sick Children and made a good recovery without disability. 35 Table showing Incidence of Infectious Disease, 1945, in aqe 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 225 1 7 12 13 16 109 43 6 12 5 - 1 168 - Diphtheria 63 - 1 1 3 3 35 4 — 11 1 3 1 63 2 Enteric Fever (including Paratyphoid) 1 - - - - - - - - - - 1 - - - Pneumonia 247 35 6 7 13 11 23 7 8 19 23 62 33 133 61 Puerperal Pyrexia 34 — — — — — — — 1 25 8 — — 33 — Cerebro-spinal Fever 1 - - - - - - - - - - 1 - 1 2 Acute Poliomyelitis 13 — - 2 - — — 7 3 — 1 — — 12 1 Acute Polio-Encephalitis - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - Dysentery 63 - 2 4 1 4 3 4 3 11 10 14 7 9 - Ophthalmia Neonatorum 3 3 - - - - - - - - - - - 1 - Erysipelas 51 - - - - - - - 3 7 12 24 5 17 2 Anthrax - — — - - — — — — — — - - - - Malaria believed to be contracted in this country - - - - - - - - - - - - - - - Malaria believed to be contracted abroad 4 - - - - - - - - 4 - - - 2 - Pemphigus Neonatorum - - - - - - - - - - - - - - - Acute Rheumatism 7 — — — — — 4 3 — — - - - 3 - Food Poisoning — — — — — — — — — — — — — — — Measles 2154 80 217 246 195 217 1089 67 22 13 3 5 - 47 2 Whooping Cough 536 48 64 78 57 50 226 3 1 3 4 2 — 6 - * Excludes cases occurring at Barnado's Homes, Claybury Mental Hospital and West Ham Mental Hospital. 36 Influenza.'—On 15th November, 1945, the Ministry of Health issued a circular letter No. 196/45 stating the Minister had had under consideration the action which should be taken to assist householders if infectious disease assumed serious epidemic proportions during the winter, and that the Minister had primarily in mind the possibility of an influenza epidemic not requiring hospitalization on a large scale, and that he thought that local plans made in advance of a possible emergency would be a valuable additional insurance which local authorities would wish to do their best to prepare in conjunction with the Government Departments concerned. The main types of assistance mentioned were in respect of (a) Doctors and Nurses; (6) help in the home; and (c) provision of meals. (a) Through the County Medical Officer, arrangements were made with the military authorities for assisting general practitioners, by application to the Honorary Secretary of the Local Medical War Committee. Assistance with regard to pharmacists was arranged through the County of Essex Pharmaceutical Committee, by application to the local representative. (b) In regard to help in the home, communications were sent to the following local voluntary organisations:—W.V.S., Boy Scouts' Association (East and West Ilford), Mr. F. T. Dean (St. John Ambulance and British Red Cross Liaison Officer), and former Civil Defence First Aid Post personnel. Through the good offices of the representatives of these organisations, arrangements were made for the rendering of substantial assistance should the need arise. (c) With regard to the provision of meals, a scheme was envisaged by the Borough Treasurer to supply meals from the British Restaurants on a "cash and carry" basis. The transport for the meals service to households would be by this Council's own vehicles, supplemented, if necessary, by private cars, petrol for which could be supplied from this authority's pumps. Fortunately the anticipated epidemic did not materialize and it was not necessary to bring the scheme into operation. Nevertheless, during December 1945, January and February 1946, a number of cases of Influenza, mostly attributable to infection by Influenza virus "B," did occur. In the main the attacks were mild and the outbreak did not assume epidemic proportions. In this connection it may be well to view the future with caution. In January 1943, an outbreak of virus "B" Influenza was succeeded by a lull and later by a steadily increasing number of cases of the more severe virus "A" type Influenza, which reached epidemic proportions in the early winter. This previous experience may have been coincidental, but it is worthy of note at the present time. The incidence of influenza and its fatality rate is shown by the following table, which shows the number of notifications of pneumonia with the percentage death rates according to where the cases were nursed, covering a period of 17 weeks from December, 1945, to March, 1946:— 37 Week ending No. of Notifications of Pneumonia. Admissions to Hospitals. Cases Nursed at Home Ilford Isolation Hospital Oldchurch Hospital, Romford. Essex County Hospital, Wanstead. King George Hospital, Ilford. Other Hospitals. 1945-46 8th December 7 4 — - 1 - 2 15th „ 8 2 1 - - - 5 22nd „ 10 6 - - - - 4 29th „ 13 5 1 - - - 7 5th January 8 2 - - 1 - 5 12th „ 12 4 2 - 1 1 4 19th „ 5 2 1 - 1 - 1 26th „ 10 7 - - 1 - 2 2nd February 14 5 1 - 2 - 6 9th „ 18 8 2 2 — - 6 16th „ 11 5 1 1 1 - 3 23rd „ 9 1 - 1 1 2 4 2nd March 5 2 — 1 - — 2 9th „ 7 — — 1 1 — 5 16th „ 8 5 — - 2 - 1 23rd „ 10 7 1 1 - - 1 30th „ 4 4 - - - - - Totals 159 69 10 7 12 3 58 Of the 159 persona notified as suffering from Pneumonia, 101 were admitted to hospitals, or 63.6 per cent. (43.4 per cent. of them being admitted to the Ilford Isolation Hospital). Of this number 14 persons died or 13.9 per cent. The remaining 58 persons were nursed at home and of this number 9 died or 15.5 per cent. In addition to the cases notified as Pneumonia 10 deaths certified as having died from Influenza occurred in patients nursed at home. 3. Tuberculosis. During the year 1945 there were 203 new notifications of Pulmonary Tuberculosis and 36 of other forms of Tuberculosis. 33 cases of Pulmonary and 2 cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notifications and Deaths from Tuberculosis of Ilford residents during 1945: Age Periods New Cases Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - 1 1 1 - - - - 1-5 years 1 2 5 2 — - 2 5 5-15 7 6 4 4 1 - - 1 15-25 27 37 1 3 1 7 2 - 25-35 21 24 2 3 5 8 - 1 35-45 30 10 4 1 12 2 - 1 45-55 18 5 1 3 12 1 - - 55-65 6 - 1 - 11 - - - Over 65 7 1 — — 7 1 — 1 Totals 117 86 19 17 49 19 4 9 38 Of the foregoing new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 4 1 Claybury Mental Hospital 1 — Claybury Emergency Hospital 3 — West Ham Mental Hospital 6 1 West Ham Emergency Hospital 2 — Of the 81 deaths which occurred of Ilford residents, notification had previously been made of 71 of the cases. Of the other 10, 1 was notified after death; 9 were not notified (11.1 per cent. of the deaths or a ratio of 1 in 9). Of the 9 not notified (previously referred to), in 8 instances the presence of Tuberculosis was discovered following P.M.; in 1 instance the notification was overlooked. During the year 1945 the following deaths occurred from Tuberculosis:— Pulmonary Non-Pulmonary Ilford Residents 68 13 Non - Residents— Claybury Mental Hospital 15 2 West Ham Mental Hospital 2 — Ilford Isolation Hospital 60 1 Non- Pulmonary Pulmonary Total Number of cases on register, 1st January, 1945 907 214 1121 Number of cases entered on register during the year 236 38 274 Number of cases removed from the register during the year:— Non- Pul. Pul. Recovered 19 7 Deaths 83 6 Left District 69 6 Lost sight of 7 5 Diagnosis not established 8 3 186 27 213 Number of cases remaining on register on 31st December, 1945 957 225 1182 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurse of the Essex County Council. 1,114 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 Other Cases Cases Stated to be recovered or better 214 66 Improved or fairly well 442 74 Not so well 30 5 In Sanatorium 77 8 No information as to present condition 41 9 Removed from district, etc. 134 14 Totals 938 176 39 The treatment of Tuberculosis is under the control of the Essex County Council. On the 31st December, 1945, there were 1,028 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. 134 patients were treated, 18 being supplied with dentures. The Council's Dentist also treated 25 tuberculosis patients from the Ilford Sanatorium. The number of patients from Ilford sent to Institutions under the Essex County Tuberculosis Scheme during 1945 was as follows:— Pulmonary Non-Pulmonary Total Males Females Males Females Adults 44 35 8 1 88 Children 2 2 1 - 5 Tuberculosis Care Association.—This Association has assisted 147 oases with extra nourishment, clothing, and in other ways. Public Health Act, 1936 (Section 163).—Six certificates in respect of the death of patients were issued, stating that bodies should not be removed from hospital except for the purpose of being buried forthwith. 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. Sixteen persons were assisted during 1945 with the Insulin required. Eleven persons were assisted at part cost, two at cost price, and three free of charge. 4. Venereal Diseases.—In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease:— Ilford Residents—Ages Non-Residents in Institutions Total 0—1 1—5 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 up Syphilis - - - - - - - 1 - - - 1 2 Locomotor Ataxy - - - - - - - - - - - - - General Paralysis of the Insane — — — — — — — 3 — — — 6 9 Aortic Aneurysm - - - - - - - - - - - - - 40 The deaths in Institutions of Ilford non-residents occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 2.6 per cent. of the registered causes of death in these Institutions fell under the above headings. Many other patients died from incidental causes; the reason, however, for their admission to the Mental Hospital was some venereal infection. The following figures show the number of cases of Ophthalmia Neonatorum notified during the past five years:—1941, 8; 1942, 9; 1943, 8; 1944, 4; 1945, 3. It is to be remembered that many cases of ophthalmia neonatorum are not due to gonorrheal infection. By the Public Health (Venereal Diseases) Regulations, 1916, diagnosis and treatment of Venereal Disease is under the control of the Essex County Council. Arrangements have been made with the various London Hospitals for the treatment of patients, and with the London Hospital for the free examination of bacteriological specimens submitted by doctors in the district. The following are the V.D. Treatment Centres situate nearest to Ilford:— Romford.—The Annexe, Oldchurch County Hospital, Waterloo Road, Romford:— Sessions Monday, 4 to 6.30 p.m. Tuesday, 4.30 to 7.30 p.m. Thursday, 12.30 to 3.30 p.m. Whitechapel.—Whitechapel Clinic (London County Council), Turner Street, Mile End, E. 1:— Sessions Monday to Friday, 10 a.m. to 7 p.m. Saturday, 10 a.m. to 3 p.m. West Ham.—Queen Mary's Hospital for the East End, West Ham Lane, Stratford, E.15:— Sessions Males Monday, 3 to 5 p. m. Thursday, 6 to 8 p.m. Saturday, 4.30 to 6.30 p.m. Females Monday, 6 to 8 p.m. Thursday, 3 to 5 p.m. Saturday, 2.30 to 4.30 p. m. 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 370 factories with mechanical power on the register. There are 300 factories without mechanical power on the register. There are 375 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 572 25 - Factories without Mechanical Power 156 4 - Other premises (not including Outworkers' premises) - - - Total 728 29 - 41 2.—DEFECTS FOUND IN FACTORIES. Particulars. Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) 5 5 - — Overcrowding (S.2) — — — — Unreasonable Temperature (S.3) - - - - Inadequate Ventilation (S .4) 2 2 — — Ineffective Drainage of Floors (S .6) - - - - Sanitary Conveniences (S.7):— Insufficient 5 5 - — Unsuitable or Defective 8 8 - — Not Separate for Sexes — — - — Other Offences 14 14 - — Total 34 34 — — ISOLATION HOSPITAL. 964 patients were admitted during 1945. 100 per cent. of the notified cases of diphtheria and 74.4 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 964 patients admitted during the year suffered from the following complaints:— Ilford Barking Admissions Deaths Admissions Deaths Scarlet Fever 161 — 47 1 Scarlet Fever and Chicken Pox — — 1 — Diphtheria 44 2 13 1 Diphtheria and Measles 1 — — — Pneumonia 88 12 3 — Chicken Pox 2 — 2 — Whooping Cough 5 — — 2 Measles and German Measles 52 — 33 — Measles and Pneumonia 1 — — — Erysipelas 16 1 5 — Dysentery 8 — — — Puerperal Pyrexia 15 — — — Bronchitis 4 — 1 — Influenza 3 — — — Influenzal Meningitis 1 1 — — Pneumococcal Meningitis 1 — — — Acute Aseptic Meningitis 1 — — — Streptococcal Meningitis 1 1 — — Tuberculous Diseases—Pulmonary 186 71 — — Tuberculous Diseases—Other forms 4 4 — — Acute Rheumatism 3 - — - Tonsillitis 16 — 3 — Acute Follicular and Streptococcal Tonsillitis 15 - 6 - 42  Ilford Barking Admissions Deaths Admissions Deaths Acute Streptococcal Laryngitis — — 1 1 Mumps 1 — — — Scabies 7 — — — Gastro-enteritis 4 3 1 — Cerebro-spinal Fever 1 — — — Pleurisy 2 — — — Catarrhal Jaundice — — 1 — Acute Anterior Poliomyelitis 10 — — — Acute Poliomyelo Encephalitis 1 1 — — Convulsions 1 1 — — Pyaemia due to carbuncle of face — — 1 1 Mastitis and Mammary Abscess 2 — — — Post-Scarlatinal Nephritis 3 — — — Asthma 1 — — — Bronchitis and Asthma 1 — — — Abortions 16 — — — Meningitis 3 — — — Observation and other cases 155 — 10 — Post-Mortems were held by H.M. Coroner in connection with 17 of the above 103 deaths. Number of patients in Hospital on 1st January, 1945 and 1946. respectively:— 1st Jan., 1945 1st Jan., 1946 Scarlet Fever 11 20 Diphtheria 6 15 Tuberculous Diseases 66 65 Puerperal Pyrexia 3 1 Erysipelas 1 — Pneumonia 7 12 Acute Rheumatism — 1 Measles 3 — Whooping Cough 1 — Chicken Pox — 1 Dysentery 2 — Acute Anterior Poliomyelitis — 1 Observation and other cases 10 8 The average length of stay in Hospital was for:— Scarlet Fever 23.5 days Diphtheria 50.5 „ Tuberculous Diseases 87.6 „ Average stay in Hospital of all cases 31.5 „ The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day 115.8. Scarlet Fever.—The diagnosis of scarlet fever could not be confirmed in 16 patients admitted. One death from scarlet fever occurred during the year—a female child, age 2 years, twenty-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. 1941 1942 1943 1944 1945 Ilford 7.1 Nil 9.1 5.8 4.6 43 Two deaths occurred—both female patients, aged 5 and 7 years, from extensive diphtheritic paralysis ending in cardiac failure; one within 20 minutes of admission and the other seven days after admission. Neither of these children had been immunised against diphtheria. Tuberculosis.—180 cases of Pulmonary Tuberculosis were admitted, as compared with 162 in 1944. 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 ditto ditto. Training of Nurses.—"During 1945, 8 nurses passed Parts I and II, 1 passed Part I and 4 passed Part II of the Preliminary Examination of the General Nursing Council, and 19 obtained the Certificate by passing the Final Examination (6 student nurses, 13 staff nurses). The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick tested during 1945, and also the number inoculated:— Numbers Schick Tested:— Nurses Domestics Positive 17 1 Negative 23 13 Numbers inoculated (full course) 40 14 Numbers re-tested:— Negative after full course of inoculations 3 — Positive after full course of inoculations, and re-inoculated 1 1 Numbers Dick Tested:— Positive 14 5 Negative 25 9 Numbers inoculated (full course) 39 14 Numbers re-tested:— Negative after full course of inoculations 7 — Positive after full course of inoculations, and re-inoculated 3 1 No member of the Nursing Staff contracted Diphtheria; but one contracted Scarlet Fever. Since April, 1945, arrangements have been operative whereby all nursing and domestic staff are examined for evidence of tuberculous infection. All entrants are subjected to clinical and radiological examination and tuberculin testing. Where necessary they are kept under supervision and re-examined at stated intervals. In 1945 examinations were conducted as follows:— Primary examination on Re-examinations. engagement. Nursing Staff 70 43 Domestic Staff 24 17 44 These investigations have been carried out by Dr. Currid, Tuberculosis Officer, Essex County Council, to whom I am greatly indebted for so willingly undertaking the considerable amount of work entailed and for his most helpful advice and co-operation. 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 n that area, as far as accommodation permitted, continued during the year. During 1945 the number of cases admitted was 128. 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. 45 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 1945 was 1,910 (1,002 males and 908 females). Of these, 114 (57 males and 57 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 659 notifications of birth (334 males and 325 females) which took place outside the district, although the ordinary residence of the parents is in Ilford, were transferred to this district. During the year, 13 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 4.71 By Certified Midwives 94.08 By Parents and Others 1.21 In addition, 32 stillbirths (15 males and 17 females) were notified. The notifications of 19 stillbirths (10 males and 9 females) which took place outside the district, although the ordinary residence of the parents is in Ilford, were transferred to this district. Care of Premature Infants.—Of the 1,910 live births occurring in Ilford during 1945, 104 weighed 5½lbs. or less at birth; 38 of these babies were born at home and 66 in Hospital (including 12 in a Private Nursing Home). The number of those born at home:— (i) who were nursed entirely at home =32 (ii) who died during the first 24 hours =3 (iii) who survived at the end of one month =26 The number of those born in Hospital:— (i) who died during the first 24 hours =5 (ii) who survived at the end of one month =58 Owing to wartime conditions it has not been possible to implement any of the following recommendations made by the Ministry of Health in their Circular No. 20/44, dated 22nd March, 1944:— (а) Provision of suitable equipment in the home. (б) Supply of expressed breast milk where this is necessary. *(c) Services of a Paediatrician. (d) Giving of particular attention to babies by Midwives or Health Visitors, preferably with special training and experience with premature infants. (e) Services of Home Help specifically for this type of case. (/) Admission of selected cases to Institutions where special care is appropriate to such cases. (g) Special form of transport for the conveyance of infants to Hospital. * The Council will shortly appoint a part-time Paediatrician. Infant Mortality.—The number of infants dying within the first year of life was 81, the total number born being 2,479. 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, 32.7. Neonatal Mortality.—The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 49 deaths of infants under four weeks of age during 1945 and the rate for the year was 19.8 per 1,000 live births. The deaths of infants under one month decreased from 64 during 1944 to 49 during 1945. The following table gives the deaths of infants under one year of age, classified according to age. 46 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 Meningitis (not tuberculous) - - - - - - 1 1 1 3 Convulsions 1 1 - — 2 — — — — 2 Bronchitis — — — — — 1 — — — 1 Pneumonia (all forms) 1 — 2 2 5 1 5 1 2 14 Enteritis — 1 — — 1 2 3 3 — 9 Injury at Birth 1 — — — 1 — — — — 1 Atelectasis 6 — 1 — 7 — — — — 7 Congenital Malformations 4 2 2 - 8 4 2 — 1 15 Premature Birth 14 — — — 14 — — — — 14 Atrophy, Debility and Marasmus 2 - - - 2 - - - - 2 Other causes 4 2 2 1 9 2 1 1 — 13 Totals 33 6 7 3 49 10 12 6 4 81 The comparative figures for the past 10 years are as follows:— Year. No. of Deaths under 1 year. Rate per 1,000 Registered Live Births.  1945 81 32.7 1944 102 36.8 1943 92 35.1 1942 74 30.6 1941 67 40.9 1940 63 32.8 1939 75 33.9 1938 84 36.7 1937 95 42.0 1936 96 43.4 The following table shows the comparison for Ilford, England and Wales, London and Towns having a population exceeding 50,000 for the past 10 years:— Year. ILford. England and Wales. London. Towns with population over 50,000. 1945 32.7 46 53 54 1944 36.8 46 61 52 1943 35.1 49 58 58 1942 30.6 49 60 59 1941 40.9 59 68 71 1940 32.8 55 50 61 1939 33.9 50 48 53 1938 36.7 53 57 57 1937 42.0 58 60 62 1936 43.4 59 66 63 47 Illegitimate Births and Deaths.—136 of the live births registered (79 males and 57 females) were illegitimate, that is 5.5 per cent. of the births registered. Eight illegitimate children died under one year of age from the following causes:— Acute bronchitis. Acute primary pneumonia. Asphyxia due to premature inhalation of birth fluids and vernix caseosa. Broncho-pneumonia. Difficult delivery by forceps. Extreme prematurity (26 weeks gestation). Gastro-enteritis; broncho-pneumonia. Heart failure; atelectasis. The infant mortality rate of illegitimate children was 58.8 per 1,000, compared with the infant mortality rate of 31.2 for legitimate children. The following table shows the death-rate of illegitimate and legitimate infants for the past five years:— Year. Illegitimate Infants. Legitimate Infants. Live Births. Deaths. Rate per 1,000 Illegitimate Live Births. Live Births. Deaths. Rate per 1,000 Legitimate Live Births. 1945 136 8 58.8 2,343 73 31.2 1944 116 7 60.3 2,655 95 35.7 1943 89 3 33.7 2,532 89 35.2 1942 85 3 35.3 2,330 71 30.4 1941 60 6 100.0 1,756 61 34.7 The Council has not appointed a Social Worker for the purposes of Circular 2866 of the Ministry of Health with regard to the care of illegitimate children. There is, however, co-operation with a Voluntary Moral WelfareWorker in the district and all bases are followed up by the Health Visitors. By arrangement with the Essex County Council, 2 girls were admitted with their babies during the year to the Ardmore Hostel, Buckhurst Hill, for a period of 14 weeks 3 days and 4 weeks 6 days respectively, at a cost to this Council of £3 5s. Od. per week each. The girls contributed £1 and 10s. per week respectively towards the cost of their maintenance in the Hostel. One baby was subsequently adopted and the other infant remained in the care of its mother who returned to her parents' home. A number of unmarried mothers from Ilford are also accepted at the Romford, Hornchurch and Upminster Moral Welfare Committee's Hostel at 51, Junction Road, Romford. Foster-children. Number of foster-children on register on 1st January, 1945 21 Number of foster-children who were notified during 1945 11 Number of foster-children returned to their mothers during 1945 4 Number of foster-children taken off register for various other reasons during 1945 4 Number of foster-children on the register on 31st December, 1945 24 48 Foster-Mothers. Number of foster-mothers with children on the register on the 1 at January, 1945 18 Number of persons who became foster-mothers during 1945 9 Number of foster-mothers whose names were taken off the register during 1945 6 Number of foster-mothers with children on the register on the 31st December, 1945 21 Number of houses visited by the Sanitary Inspectors for the purpose of the Act during 1945 9 Number of visits made by the Sanitary Inspectors for the purpose of the Act during 1945 12 Adoption of Children (Regulation) Act, 1939.—This Act came into operation on the 1st June, 1943. Section 7 of the Act in which Welfare Authorities are concerned, provides inter alia:— (a) That any person (other than a registered adoption society or a local authority, and not being the parent or guardian or a near relative of the child or the person in whose care or possession he is to be placed), who participates in making arrangements for the adoption of a child under the age of nine years, must give notice, in writing, of the arrangements to the Welfare Authority for the area in which the adopter resides, not less than seven days before possession is taken of the child by the adopter. This does not apply when an adoption order is made. During 1945 notices were received from 14 persons in respect of 26 children. Adoption Orders were made by the Courts in respect of 13 of these children during the year; two children, aged 2 weeks and 4 weeks, died from acute primary pneumonia and acute bronchitis respectively. The other 11 children were still under supervision at the end of the year. (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. One proposed adopter was summoned for failing to give notice in writing of the death of the infant to the Welfare Authority, but the summons was dismissed, being regarded as a technical offence only. 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 1945 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infanta 2,844 Subsequent visits to children under 1 year of age 8,102 Subsequent visits to children over 1 year of age and under 5 16,929 Visits to expectant mothers 530 Home visits for other reasons 3,097 Total visits paid 31,502 Supply of Milk to Expectant and Nursing Mothers and Infants.— A total of 39 lbs. of dried milk were given free under the Regulations of the Ministry of Health during 1945 to 2 infanta. Since July, 1940, the supply of liquid milk by the Council haa been suspended as this is now provided under the National Milk Scheme. 49 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 1945 Including Excluding Saturday Saturday No. of Days in Quarantine Reasons for Quarantine Sunshine House, Girls' Village Homes, Barkingside 17.8.1942 45 25 26 233 5 cases of Chicken Pox. 1 case of Measles. 1 case of Mumps. 1 case of Scarlet Fever. 13 cases of Sonne Dysentery. 25 cases of Whooping Cough. 359-381, Green Lane, Seven Kings 5.5.1943 50 31 32 173 26 cases of Measles 1 case German Measles 1 case Mumps 10 cases Whooping Cough. 226-236, Ley Street, Ilford 16.8.1943 50 35 37 42 3 cases of Measles. 1 case of Scarlet Fever. Becontree Avenue, corner of Winding Way, Dagenham 17.1.1944 50 28 31 151 27 cases of Measles. 6 cases Whooping Cough. Attendances were considerably reduced during the first half of the year owing to evacuation. 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. Four Students from the Ley Street Nursery and three from the Green Lane Nursery sat for the examination and obtained the Diploma during 1945. 50 Infant Welfare Centres.—79 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1945. During the year the following attendances were recorded:— Total number of attendances of infants 37,710 First attendances 2,362 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 3,246 13,254 attendances of children from 1 to 5 years were made at the Infant Welfare Centres during the year. The following is a comparison of the attendances at the Infant Welfare Centres for the past five years:— Total No. of attendances of infants. First attendances. Total No. of children on roll on 31st December. 1945 37,710 2,362 3,246 1944 35,700 2,048 2,970 1943 45,821 2,225 3,380 1942 43,023 2,621 3,575 1941 28,545 1,871 2,715 393 sessions were held during the year, the average attendance being 96 mothers with their infants. The following are the figures for each Centre:— Sessions. Average attendance. Barkingside and Fairlop 48 122 Chadwell and Seven Kings (part) 48 76 Becontree and Goodmaves 48 104 Woodford Avenue and Valentines 48 140 Downshall and Seven Kings (part) 47 95 Cecil Hall 60 74 Newbury Hall 47 54 Grosvenor Road and Ilford Lane 47 108 Dental Clinics.—162 half-days were taken up for the treatment of expectant and nursing mothers and children under 5 years of age during 1945: 113 at Valentine's Clinic, and 49 at Mayesbrook Clinic. The following is a summary of the work carried out for the Maternity and Child Welfare Committee during the vear:— (a) Treatment of Mothers: Valentines Clinic. Mayesbrook Clinic. No. of patients treated during 1945 398 68 No. of attendances of patients 949 292 No. of administrations of "general" anaesthetics 134 69 No. of administrations of "local" anaesthetics 64 71 No. of fillings and other operations 1,447 243 No. of mothers having dentures supplied (including 4 free of charge and 55 at part cost) 86 17 (6) Treatment of Children under 5 years of age: No. of patients treated 130 46 No. of attendances of patients 162 68 No. of administrations of "general" anaesthetics 58 48 No. of administrations of "local" anaesthetics - 2 No. of fillings and other operations 246 35 51 The following are the figures for the past 5 years:— 1941. 1942. 1943. 1944. 1945. No. of Mothers treated: (i) Valentines Clinic 356 509 535 481 398 (ii) Mayesbrook Clinic — 24 50 — 68 No. of Children treated: (i) Valentines Clinic 232 180 179 143 130 (ii) Mayesbrook Clinic — 7 15 — 46 Ophthalmic Clinic.—25 expectant and nursing mothers and 102 children under 5 years of age were treated by the Council Oculist during 1945 : 67 pairs of spectacles were supplied, 15 to mothers and 52 to children. Orthopaedic Clinic. (i) Newbury Hall Clinic.—48 sessions were held during 1945, 295 children under 5 years of age being examined, making 648 attendances. (ii) Mayesbrook Clinic.—20 sessions were held during 1945, 1 expectant or nursing mother and 140 children under 5 years of age being examined, making 290 attendances. At the Newbury Hall Remedial Exercises Clinic 88 sessions were held and 28 children under 5 years of age were treated by the Masseuse during the year, 284 attendances being made by these children. Treatment was also given to 8 children who made 58 attendances at the 46 sessions held at All Saints' Church Hall Clinic. One child was admitted to the Royal National Orthopaedic Hospital, Country Branch, Stanmore, during the year, suffering from Right Congenital Displacement of Hip. Artificial Sunlight Clinic.—46 sessions were held at Newbury Hall Clinic and 46 at Mayesbrook Clinic. 67 children in all were treated, making 1,135 attendances. 56 cases were still attending the Clinics at the end of the year; of the remainder 3 had left the district, and in 5 cases the parents had discontinued treatment. All the others were discharged from further treatment, having improved. Aural Clinic.—The Aural Surgeon attended at 48 sessions during 1945 and 128 attendances were made by 1 expectant mother and 79 children of pre-school age. Of 53 recommendations made, 42 children were operated upon for removal of tonsils and adenoids, 31 at Queen Mary's Hospital and 11 at King George Hospital. 9 were treated free of charge as cases of necessity and 6 at part cost. Rheumatism Clinic.—19 sessions were held at the Newbury Hall Clinic during the year at which 22 children under 5 years of age, 2 expectant and 1 nursing mother made 49 attendances. 15 children and 1 mother had an electrocardiogram. Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 31 belts and 3 trusses have been supplied to infants suffering from hernia during 1945. A certain number of infants were brought to the Clinics at Newbury Hall and All Saints' Church Hall to receive treatment for minor ailments. Midwives.—There are 15 State certified midwives (including the Superintendent and 12 Council midwives) resident and practising in the district. In addition there were at the end of the year, 20 State certified midwives at the Council's Maternity Home and 5 at a private nursing home in Ilford. Their supervision has been carried out as in previous years. Suspension from Practice.—Five midwives were suspended from practice for varying periods during the year following attendance on 5 cases rendering them liable to be a source of infection. One of the midwives was in the employ of the Salvation Army and the other four midwives were employed by the Council. 52 The reasons for suspension from practice were as follows:— (1) Attended notified case of Puerperal Pyrexia stated to be due to Pelvic Thrombo-phlebitis and left Femoral Thrombosis. (2) Attended notified case of Puerperal Pyrexia stated to be due to Pyelonephritis. (3) Attended notified case of Puerperal Pyrexia stated to be due to Parametritis. Swab from the throat of the midwife showed the presence of Haemolytic Streptococci. (4) Attended notified case of Puerperal Pyrexia stated to be due to Phlegmasia Alba Dolens and Pulmonary Embolism. (5) Attended patient whose child was notified during the puerperium as suffering from Scarlet Fever and removed to the Council's Isolation Hospital. Medical aid was sought in 11 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 rase. Council District Midwifery Service.—During the year 699 cases were attended by the twelve Council District Midwives. In 411 cases the midwives were engaged to attend as midwives and in 288 as maternity nurses. The cases resided in the following wards: Barkingside 132; North Hainault 118; Cranbrook40; Park 42; Seven Kings 86; South Hainault 77; Loxford 83; Clementswood 70; Goodmayes 51. 3,841 ante-natal visits were made during the year. 50 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. 31 patients were referred by Private Doctors to the Council's Consultant Obstetrician at the Ante-Natal Clinic for a further opinion. 12 of these women and 19 other patients who had engaged a Council Midwife (15 as a Midwife and 16 as a Maternity Nurse) were for various reasons admitted to the Council's Maternity Home or other Institutions for confinement. 27 were admitted to the Maternity Home, 2 to the Ilford Isolation Hospital, 1 to the London Hospital and 1 to Oldchurch County Hospital, Romford. In addition 2 patients were admitted to the Maternity Home for antenatal treatment and subsequently confined at home. A Doctor was called in at the time of the confinement or subsequently to 102 of the 411 cases in which a midwife had been engaged. Five cases were notified as suffering from Puerperal Pyrexia, 3 of these cases were removed to the Isolation Hospital and one to King George Hospital. Two of the cases had engaged their own Doctor to attend them. Two babies were notified as suffering from Ophthalmia Neonatorum. The condition of the eyes cleared satisfactorily. The midwife was engaged as a midwife in both cases. Of the infants born there were 5 stillbirths from the following causes:— Breech presentation 1 Domestic worries 1 Cause unknown 3 53 There were 14 deaths of infants during the first year of life from the following causes:— Broncho-pneumonia, aged 2 weeks 1 Broncho-pneumonia, aged 7 months 1 Broncho-pneumonia, Inhaled vomitus, Intestinal obstruction due to congenital defect of gut, aged 12 days 1 Cachexia, Congenital malformation, Congenital hand, congenital heart and congenital absence of vertebra, aged 4 months 1 Cardiac failure due to toxaemia due to acute intestinal obstruction due to intussusception, aged 3 months 1 Cardiac failure due to Broncho-pneumonia due to acute Gastro Enteritis, aged 10 months 1 Cardiac failure due to Streptococcal Peritonitis, aged 3 months 1 Convulsions, aged 6 days 1 Gastro Enteritis, aged 6 weeks 1 Heart failure, Congenital heart disease, aged 6 weeks 1 Heart failure, Dehydration, Gastro Enteritis, aged 8 months 1 Inanition, Extreme prematurity (29 weeks preg.), aged 4 days 1 Myocardial failure, Asphyxia, aged 30 minutes 1 Premature birth, aged 5 days 1 In 6 of these cases the Midwife was engaged as a Maternity Nurse only. Salvation Army Midwifery Service.—126 cases were attended by the Salvation Army midwives during the year; 119 as a midwife and 7 as a maternity nurse. Home Helps.—At the end of 1945 there were 5 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 143 cases were attended. Ante-Natal Clinics. Maternity Mayesbrook Home Clinic First attendances 927 213 Subsequent attendances 6,995 1,581 Number of expectant mothers on the rolls on 31st December, 1945 361 99 All patients booked for admission to the Maternity Home are medically examined at the Ante-Natal Clinics. During the year, 349 cases other than those booked for admission to the Maternity Home were examined at the Clinics. There were 1,527 attendances by such cases. The Consulting Obstetrician made weekly visits to the Ante-Natal Clinic during 1945. During the year 52 ordinary visits were made, 442 patients referred from the Ante-Natal and Post-Natal Clinics, and 127 patients referred by private Doctors, were examined. This last figure represents an increase of 119 per cent. over the number examined during the previous year. A total of 1,007 examinations were made. X-Ray Examination of Ante-Natal Patients. 93 examinations were made at King George Hospital in 1945. 54 Post-Natal Clinic. The following attendances were recorded:— First attendances 592 Subsequent attendances 301 Number on roll on 31st December, 1945 112 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. During 1945, 1,500 dockets were issued by me to 529 expectant mothers. Maternal Mortality.—The total number of deaths due to childbirth during the year was 3, which gives a maternal mortality rate i.e., number of deaths per 1,000 live births of 1.21 (or 1.18 including stillbirths). The causes of death were as follows :— (1) Died at Oldchurch County Hospital, Romford; Shock and haemorrhage due to ruptured tubal pregnancy. (2) Confined at and died at Ilford Council Maternity Home; Obstetric shock (natural) due to post-partum haemorrhage. (3) Confined at and died at Ilford Council Maternity Home; Obstetric shock (natural) due to acute inversion of the uterus. MATERNITY HOME. During 1945. 824 patients were admitted into the Home 105 direct to the Emergency Block and 719 to the Ward Blocks). 252 cases could not be admitted during the year and other arrangements were made for their confinement. At the end of the year 407 cases had booked for future admission to the Home. The average number of patients in the Home per dav during 1945 was 34.57 and the average length of stay of patients was 15.42 days. Emergency Block.—147 cases were treated, 105 being admitted direct to this Block and 42 being transferred from the Ward Blocks. The 105 cases were admitted for the following reasons:— Abortion 12 Placenta praevia 1 Albuminuria 1 Post-maturity 1 Ante-partum Haemorrhage. 12 Post-partum Haemorrhage (confined before admission) 1 Breech presentation 1 Cold and Sore Throat 5 Premature labour 5 Dental Abscess 1 Pyelitis (including 1 confined before admission) 7 Extended breech 1 General condition 1 Pyrexia 6 History of Erythroblastosis in previous pregnancy 1 Retained placenta (confined before admission) 1 Incomplete abortion 4 Retroverted uterus 1 Inevitable abortion 4 Ruptured membranes 1 Infective jaundice 1 Threatened abortion 16 Influenza 1 Toxaemia 3 No arrangements made (including 3 confined before admission) 4 Toxic rash 1 Twin pregnancy 1 Uterine inertia 1 Obstructed labour 2 Vaginal discharge 1 Oedema and Boil of Labia 2 Haemolytic Streptococci infection, previous pregnancy 1 Otorrhoea 3 Pelvic obstruction 1 55 62 of these 105 cases had not been booked for admission to the Maternity Home. Ten of the 105 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 1945 was 4.45 (including cases transferred from the Ward Blocks) and the average length of stay of patients admitted direct to this Block was 14.34 days. 60 patients were confined in the Emergency Block (54 admitted direct to this Block and 6 transferred from the Ward Blocks). The 10 cases mentioned above have been included in the figures for those confined in the Ward Blocks. 31 of the 60 cases were first confinements and 29 were second or subsequent confinements. Seven cases (or 11.6 per cent.) were delivered by means of forceps, 1 following surgical induction; 2 of the infants were stillborn and 2 died aged 1 hour and 5 hours. In addition labour was surgically induced in 9 cases; 1 of the infants was stillborn. There were 8 deaths of infants born in the Emergency Block, as follows:— Cardiac failure due to atelectasis, aged 2 hours. Cardiac failure due to atelectasis due to cerebral haemorrhage due to tentorial tear due to forceps delivery, aged 5 hours. Congenital heart, marasmus, prematurity, aged 29 days. Extreme prematurity (26 weeks gestation), aged 3 days. Prematurity (29 weeks' gestation), aged 3 hours. Prematurity, multiple malformations, aged 7 hours. White asphyxia, breech presentation, twin pregnancy, aged 1 hour. Septicaemia, aged 2 weeks. (Died at Children's Hospital, Great Ormond Street, W.C.) The causes of the 9 stillbirths in this Block were as follows:— Accidental haemorrhage-trauma caused by moving furniture. Ante-partum haemorrhage. Ante-partum haemorrhage, placenta praevia. Breech delivery (primipara), second twin. Difficult breech delivery in primipara. History of influenza and pyrexia of mother. Toxaemia of pregnancy. Toxaemia of pregnancy and prematurity. Unknown. Ten cases were notified as suffering from Puerperal Pyrexia, 5 being removed to the Isolation Hospital. The causes of the pyrexia were due to local uterine infection (1), Pyelitis (5), reaction due to blood transfusion given owing to anaemia and haemorrhage (1), retained membranes (2) and Staphylococcal infection of wound following caesarian section (1). In addition 12 other patients were removed to the Isolation Hospital for the following reasons:—Abortion (1), chronic otorrhoea (1), furunculosis of mother and follicular dermatitis of infant (1), mammary congestion and delayed involution (1), no arrangements made for confinement (2), observation (2), pyrexia (1), secondary post-partum haemorrhage (1), streptococcal carrier (1), sub-involution drug rash (1). The Consulting Obstetrician or his Deputy was called in to 18 cases as follows:— To perform Caesarian section operations 3 To perform other operations 12 For consultation 3 The reasons for the Caesarian section operations were:— Extended breech 1 General condition (patient was also sterilized) 1 Transverse lie 1 56 The other 12 operations were as follows:— Dilatation and curettage 6 Drew Smythe induction of labour 1 Excision of vaginal tumour 1 External version 1 Forceps delivery 1 Hysterotomy and sterilization 2 The other 41 cases admitted direct to this Block were not confined therein for the following reasons:— Abortion or miscarriage 28 Not pregnant 2 Pregnancy terminated 2 Admitted for ante-natal treatment and subsequently evacuated for confinement 3 Born before arrival at Home 6 Ward Blocks.—719 cases were admitted to the Ward Blocks. In addition 10 patients admitted to the Emergency Block for ante-nata treatment were subsequentlv transferred to or re-admitted to the Ward Blocks for confinement. Six patients admitted to the Ward Blocks were transferred to the Emergency Block for confinement. 60 of the 719 cases had not been booked for admission to the Home. 11 cases were not confined in the Home for the following reasons:— Abortion or miscarriage 4 Admitted for ante-natal treatment and subsequently evacuated, confined at own Home or transferred to Isolation Hospital for confinement 7 The average number of patients in the Ward Blocks per day during 1945 was 30.12 and the average length of stay of patients was 15.57 days. In 34 of the 712 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 712 confinements there were:— (a) 370 cases of first confinement. (b) 342 cases having their second or subsequent confinement. (c) 62 cases living in 2 rooms or less (38 being first confinements). (d) 124 cases living in 3 rooms (75 being first confinements). 65 cases (or 9.1 per cent.) were delivered by means of forceps, 14 following surgical induction; 1 of the infants was stillborn, and 3 infantsdied aged 5 minutes, 1 hour and 4 months. In addition, labour was surgically induced in 115 other cases; 1 of the infants was stillborn. There were 18 deaths of infants born in the Ward Blocks as follows:— * Acute cerebro-spinal fever, aged 3 months. *Acute intestinal obstruction due to ileo-intussusception, aged 9 months. Atelectasis, aged 5 minutes. *Broncho-pneumonia, aged 5 months. *Broncho-pneumonia, aged 6 months. Broncho-pneumonia, congenital heart, aged 14 days. *Cardiac failure due to broncho-pneumonia, aged 3 months. Cardiac failure due to broncho-pneumonia due to atelectasis, aged 4 days. Congenital abnormalities, mongol (foetal ascites), aged 1 hour. Congenital malformation of heart, aged 14 days. Debility due to prematurity, mongol, aged 56 hours. *Meningitis, influenza and chicken pox, aged 10 months. *Operation for intussusception, aged 4 months. Prematurity (35 weeks gestation), aged 4 hours. 57 Prematurity, ante-partum haemorrhage, placenta praevia, aged 1 hour. Prematurity (35 weeks gestation), convulsions, aged 1 day. *Septicaemia, pyelonephritis, aged 12 days. *Septic meningitis, congenital hydrocephalus, aged 4 months. * Died after discharge from Maternity Home. The neo-natal death-rate of babies born in the Ward Blocks for the five years 1941 to 1945, was 2.04 per cent. compared with 1.91 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 1941-19 15 was 1.88 per cent. The infant mortality rate of children born in the Ward Blocks of the Maternity Home for the five years 1941-1945 was 30.7 per 1,000 births, as compared with 33.9 born in their own homes. The figure of 33.9 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. The causes of the 10 stillbirths in the Ward Blocks were as follows:— Anencephalic with spina bifida. Breech presentation with cord prolapsed on admission. Eclampsia. Erythroblastosis. Immature and premature twin. Intra-uterine death of foetus. Macerated foetus. Obstructed labour, prolapsed cord. Shock following a fall. Unknown. 18 cases were notified as suffering from puerperal pyrexia, 8 being removed to the Isolation Hospital. The causes of the pyrexia were due to anaemia (1), jaundice (1), mammary abscess (1), mastitis (2), offensive lochia (1), perineal tear (1), pyelitis (7), reaction following blood transfusion (1), retention of urine (1), septic perineal lacerations (1), transient and asymptomatic pyrexia (1). In addition 30 other patients were removed to the Isolation Hospital for the following reasons:—Abortion (1), chronic left otorrhoea (1), leueorrhoea and bartholinitis (1), localized puerperal phlebitis (1), mammary abscess (2), mastitis (2), phlebitis (1), phlegmasia alba dolens (1), pyelitis (2), scabies (1), septic finger (1), staphylococcal conjunctivitis of infant (5), staphylococcal dermatitis (1), stitch abscess following Caesarian section (1), streptococcal carrier (7), stye on eye (1), infected breast follicle (1). Special visits were made by the Consulting Obstetrician or his Deputy to 28 cases in the WTard Blocks as follows:— To perform Caesarian section operations 17 To perform other operations 6 For consultations 5 The reasons for the 17 Caesarian section operations were as follows:— Contracted pelvis 7 Extended breech 5 Malpresentation 1 Obstructed labour 2 Placenta praevia 1 Transverse lie 1 The 6 other operations were as follows:— Dilatation and curettage 1 Forceps delivery—foetal distress 1 Forceps delivery—lateral placenta praevia 1 Forceps delivery—uterine inertia 1 Internal podalic version 1 Manual removal of adherent placenta 1 There were two deaths of mothers admitted to the Ward Blocks:— (1) Died 13½ hours after delivery due to Obstetric shock due to post-partum haemorrhage. (2) Died 2½ hours after delivery due to Obstetric shock due to acute inversion of uterus. 58 Both cases were reported to the Coroner and the causes of death were certified by him after a post-mortem examination. The maternal mortality rate for the Ward Blocks of the Home for the ten years from 1936 to 1945 is 1.55 per 1,000 births, as compared with the maternal mortality rate in the district generally of 2.83, the rate in each case being calculated on the total live births. Training of Pupil Midwives.—As mentioned in the 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. 35 Pupil Midwives commenced their training during 1945. 8 of these and 9 of the 22 who commenced in 1944 passed Part 1 Examination in 1945. 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 337 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. Five of the staff qualified and obtained the Certificate during 1945. OTHER MATERNITY HOSPITALS. (a) Oldchurch County Hospital.—As mentioned in the Report for 1944, the Essex County Council ceased to book any Maternity cases from Ilford at the end of June, 1944. Nine cases were, however, admitted to that Hospital from Ilford during 1945 as an emergency measure. (b) Queen Mary's Hospital, Stratford.—By arrangement 9 cases were admitted to Queen Mary's Hospital for confinement during 1945. 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 stated 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. Seven cases were admitted for confinement to the Hospital at Newport Pagnell during 1945. (d) Emergency Maternity Homes.—As from 31st August, 1945, the Government decided that the cost of the maintenance of expectant mothers in Ante-Natal Hostels or Billets and Emergency Maternity Homes could no longer be justified as a charge on the Evacuation Account, and that Welfare Authorities who were responsible for sending patients away would be required to pay a flat rate of 14s. per day during the whole of the time the mother was away. This charge is to cover the cost of accommodation in the Ante-Natal Hostel or Billet, cost of maintenance in the Maternity Home, and travelling. The Ministry of Health stated that it would be for the sending authority to recover fees from the mother on their normal basis of recovery. In view of the fact that patients are away for an average period of 5 weeks, and in order to obviate, as far as possible, any hardship on the patients, the Council decided that the scale of charges for admission to their Maternity Home should be amended in the case of patients evacuated only by halving such charges; in effect this means that a patient evacuated contributes approximately 1½ times the charge for maintenance in the Council's Maternity Home for a period of 2 weeks. 196 patients were evacuated to the Emergency Maternity Homes during 1945; 78 from the period 31st August to 31st December, for whom the Council were responsible for the financial arrangements. The latter 78 cases were away for an average of 37 days each. All the patients attended the Council's Ante-Natal Clinics and there were 1,055 attendances by such cases. These figures are included in the Table of Attendances at the Ante-Natal Clinics. 59 SCHOOL MEDICAL SERVICE (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. (b) Incidence of Pediculosis and Scabies. (i) Pediculosis.—This shows an increase on last year, 65 children being found to be infected with living hair vermin as against 36 in 1944. 25 in 1943, 63 in 1942, 36 in 1941, and 10 in 1940. (ii) Scabies.—This shows a decrease, 104 cases (21 from routine medical inspection) being seen at the Minor Ailment Clinics, as compared with 128 in 1944, 217 in 1943, 374 in 1942, 109 in 1941, and 25 in 1940. In addition to the 128, 5 cases were treated privately. There was no particular incidence in any one School. Changes in Staff. (a) Medical.—Dr. A. H. G. Burton, Medical Officer of Health, resigned on medical grounds, on 30th September. Dr. M. Marchant, Assistant School Medical Officer, resigned 31st January. Dr. H. D. Smart, Ophthalmic Surgeon, resigned on 21st March. Dr. F. J. Darbyshire commenced duties as Ophthalmic Surgeon on 27th March. (b) Health Visitor and School Nurse.—Miss B. C. Blackley resigned on 21st March. (c) Dental Clerk Attendant.—Miss D. Pearl resigned on 10th November and Miss M. Moir commenced on the 3rd December, in a temporary capacity. School Premises.—There are 28 schools, with 48 departments, 15,609 children were actually on the rolls on 21st December, 1945, as compared with 12,155 in December, 1944. The number of children in average attendance at school for the year ended 21st December, 1945 = 13,293. 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. 378 visits hp,ve been made during the year. Medical Inspection.—In accordance with the Handicapped Pupils and Medical Services Regulations, 1945 (para. 49), this is carried out as follows:— (а) Every pupil who is admitted for the first time to a maintained school, shall be inspected as soon as possible after the date of his admission. (б) Every pupil attending a maintained primary school shall be inspected during the last year of his attendance at such a school. (c) Every pupil attending a maintained secondary school shall be inspected during the last year of his attendance at such a school. During 1945, 2,815 parents, or 77 per cent., attended the full routine medical inspections. 60 Infectious Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1940:— Scarlet Fever. Diphtheria Measlee and German Measles Chicken Pox. Mumps. Whooping Cough. 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 1945 133 39 1,070 183 85 222 * Of this number 1,066 were notified 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 1945. 95 home visits were paid by the Health Visitors to cases of minor infectious disease. In addition the Sanitary Inspectors paid 1,066 visits to measles cases, and 222 visits to whooping cough cases. Diphtheria Prevention Clinics.—The following shows the work carried out at Valentines Mansion (75 sessions) and Mayesbrook (52 sessions) Clinics for children of school age during 1945:— Valentines. Mayesbrook. Primary Schick tested 52 54 Positive 33 19 Negative 19 35 Inoculated (full course) 92 104 Schick + 1944 1 — Schick + 1945 19 12 Not tested 72 92 Negative after full course of inoculation 72 69 Positive after full course of inoculation and reinoculated 4 7 Awaiting re-test 9 23 Not re-tested after inoculation on account of leaving district, etc. 7 5 Result of final Schick test in 1945 of cases inoculated in 1944: Valentines. Mayesbrook. Positive and re-inoculated 1 2 Negative 9 8 270 individual children were treated (121 at Newbury Hall and 149 at Mayesbrook) making 1,717 attendances (749 and 968 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, 11,310 children of school age, and 19,570 children under school aga have been immunised. 61 Disinfection of school premises and articles likely to convey infection was carried out. Ringworm:- No. of cases at beginning of 1945. No. of cases reported during 1945. Total. Remedied during 1945. No. of cases under observation at end of 1945. Ringworm:— Scalp — 3 3 3 — Body — 5 5 5 — - 8 8 8 - Following Up.—During 1945, 3,838 home visits by the School Nurseswere paid for the purpose, and 2,192 re-examinations of children (some on several occasions) were carried out by the doctors at school; 36 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 1945 were as follows:— Newbury Hall Mayesbrook Number of individual children seen 1,387 1,870 Number of attendances of children 1,768 2,298 Number of exclusion certificates granted 351 671 Number of certificates of fitness to attend school granted 292 499 The following table shows the conditions dealt with at both the Clinicsduring the year:— Subnormal Nutrition 430 Debility 47 Uncleanliness:— Head 267 Body 1 Skin:— Ringworm:— Head 3 Body 5 Scabies 104 Impetigo 155 Other Diseases (Non-Tuberculous) 336 Eye:— Blepharitis 16 Conjunctivitis 26 Keratitis 1 Defective Vision (excluding Squint) 234 Squint 8 Other conditions 110 Ear:— Defective Hearing 40 Otitis Media 38 Other Ear Diseases 31 Diphtheria.—Eighteen cases of diphtheria and/or diphtheria carriers occurred in children between 8-9 years of age all attending South Park School. They were admitted to the Borough Isolation Hospital. School contacts were immediately followed up, and some 622 swabs were examined. 62 Nose and Throat:— Chronic Tonsillitis only 109 Adenoids only 62 Chronic Tonsillitis and Adenoids 51 Nasal Catarrh 34 Sore Throat 48 Nasal Obstruction 21 Nasal Discharge 12 Other conditions 31 Enlarged Cervical Glands (Non-Tuberculous) 27 Cervical Adenitis 7 Defective Speech 9 Teeth—Dental Diseases 444 Heart and Circulation:— Functional 3 Organic Anaemia 40 Infectious Diseases:— Measles — Whooping Cough — Chicken Pox Mumps * 4 Colds and Coughs 203 Influenza 7 Lungs:— Asthma 16 Bronchitis 42 Bronchial Catarrh 6 Other Non-Tubercular Diseases — Tuberculosis:— Pulmonary—Definite — ,, Suspected (Referred to T.B. officer.) 4 Nervous System:— Epilepsy 4 Nervous Debility 6 Habit Spasm 10 Chorea 4 Other Conditions 8 Deformities:— Genu Valgum 15 Round Shoulders 5 Pigeon Chest 8 Flat Feet 35 Pes Valgus 12 Intoeing 4 Valgus Ankles 19 Other forms 13 Minor Injuries 84 Rheumatism 72 Other Defects and Diseases 202 Total number of ailments 3,534 63 Special Clinics.—Attendances at the various Clinics during 1945, are set out in the following table:— Number of Sessions. Attendances Individual Children. Total Attendances. Clinic. A. B. C. A. B. C. A. B. C. (i) Ophthalmic 96 51 - 586 330 - 1123 630 — (ii) Orthopaedic 48 20 — 615 270 — 1176 379 — (Hi) Artificial Sun light 46 46 - 23 18 - 405 291 - (if) Remedial Exercises 83 - 46 97 - 46 1153 - 661 (v) Aural 48 — — 656 — — 1091 — — (vi) Rheumatism 19 — — 188 — — 312 — — A = Newbury Hall. B = Mayesbrook. C = All Saints Hall. Note.—(i) 595 children were prescribed and provided with glasses. (ii) 7 children of school age were admitted to the Country branch of the Roval National Orthopaedic Hospital at Stanmore and 6 discharged. 19 children were supplied with appliances. (vi) 41 cases referred for X-ray and Electro-Cardiogram and 17 for Blood Sedimentation Rate. School Dentists.—Of 8,069 inspections by the Dentist (including special cases) 5,159 (or 64 per cent.) were found to require treatment, compared with 5,914 (or 53 per cent.) in 1944, 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. In addition to the ordinary dental work of fillings and extractions, 75 regulation plates, and 7 dentures were supplied. 853 visits were made by children to the Dental Clinic for regulation purposes. The amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the school Dentists:— Age groups {in years) No. of inspection of children No. referred for treatment. Percentage. 5 403 201 50.0 6 703 391 55.6 7 655 392 60.0 8 801 491 61.4 9 943 590 62.6 10 1,063 611 57.5 11 956 626 65.4 12 895 631 70.5 13 941 680 72.3 14 349 260 74.5 15 212 164 77.4 16 85 72 84.7 17 47 38 80.8 18 16 12 75.0 Full details of the dental work are shown in Table IV. 64 Treatment for Uncleanliness.—The School Nurses paid 142 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. rent. 34,782 *1169 3.3 *65 of this number were found to be infected with living vermin; the remainder with nits only. A child with any nits in the hair at all is included in these figures. The percentages for tho past 5 years were as follows:— 1941 2.8 1942 2.6 1943 2.5 1944 2.4 1945 3.3 Other Ailments.—During 1945, 208 children were operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford, as in-patients. Under the agreement with the King George Hospital, 94 children were operated on at that Hospital, all as in-patients, for the removal of enlarged tonsils and adenoids. Plantar Warts at the Mount School.—Arising out of a large number of recommendations to the School Clinic from the Mount School for plantar warts, I arranged for a School Nurse to inspect the feet of the 338 children on the roll. As a result 14 children were found to be suffering from this condition and arrangements were made for their treatment at the Dermatological Department of Queen Mary's Hospital, Stratford. Open Air School.—These premises were damaged by enemy action in August, 1944, and repairs effected to date have only rendered it possible to accommodate 85 children instead of the 115 children normally on roll. Efforts were made to have the necessary repairs carried out under a priority certificate but this was not possible. The Ilford Education Committee agreed to my recommendation for the conversion of the Air Raid Shelters at the School for use for Medical Inspection purposes, and the Borough Engineer's plans and estimate of £270. These were forwarded to the Essex County Council for their approval to this work being carried out. During the year 105 children were admitted, 25 ceased attendance, and 80 were on the school roll on the 21st December, 1945. Those admitted were recommended for examination from the following sources:— T. B. Officer 2 Medical Officer of Health 63 Head Teachers 21 Others 19 Medical Officer of Health:— Subnormal Nutrition and Pulmonary Catarrh 1 Subnormal Nutrition 6 Subnormal Nutrition and Small Stature 1 Subnormal Nutrition, Nerves and Debility 1 Subnormal Nutrition and Rheumatic Heart 1 Subnormal Nutrition and Bronchial Catarrh 2 Subnormal Nutrition and Debility 1 Subnormal Nutrition, Bronchitis and Asthma 2 Malnutrition 2 65 Medical Officer of Health—continued. Malnutrition and History of Broncho-Pneumonia 1 Malnutrition and Debility 7 Malnutrition, Pulmonary Catarrh and General Debility 2 Debility, Subnormal Nutrition and Myalgia of Allergic Nature 1 Debility 3 General Debility and Underweight 2 Debility and Chronic Bronchitis 2 Pulmonary Fibrosis and General Debility 1 Bronchitis 2 Bronchial Catarrh 2 Asthma and Bronchitis 7 Bronchial Catarrh and Malnutrition 1 Chronic Pulmonary Catarrh 2 Asthma 1 Pulmonary Catarrh and Nerves 1 T.B. Peritonitis 1 Old A. P. M 1 T.B. Glands of Neck 2 Congenital Morbus Cordis 1 Mitral Stenosis 1 Neurosis 1 Artificial Leg 1 Cardiac Disease and Debility 1 Achondroplasia and Rickets 1 Spastic Hemiplegia 1 Head Teachers:— Malnutrition 1 Malnutrition and Anaemia 1 Malnutrition and Debility 1 Malnutrition, General Debility and Pulmonary Fibrosis 3 Debility 2 Debility and Rheumatism 1 Sub-Nutrition and Bronchial Catarrh 1 Asthma and Bronchitis 2 Bronchitis 1 Anaemia 1 Old Myocarditis 1 Little's Disease 1 T.B. Adenitis of Neck 2 Mitral Stenosis 1 Neurosis and Nutritional Myalgia 1 Old Chorea 1 T. B. Officer:— T.B. Left Knee 1 T.B. Spinal Caries 1 Others:— Pulmonary Fibrosis 1 Debility 1 General Debility and Anaemia 2 Asthma and Bronchitis 3 Malnutrition and Poor Physique Old Bronchitis 1 Mitral Stenosis 1 Suspected T.B. Knee 1 Pulmonary Catarrh 2 Malnutrition and Cerv. Glands 1 Debility 1 Bronchiectasis 1 Catarrhal Bronchitis 1 Enteritis and Nervous Debility 1 66 The 25 children not now on the roll ceased attendance for the following reasons:— Resumed attendance at ordinary school 10 Removed from school at parent's request 5 Left school—over age 5 Admission to Convalescent Home 1 Left District 3 Going to Boarding School 1 The Dental Surgeon 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 75 No. of children referred for treatment 45 No. of children treated by Dental Surgeon 45 As a result of the Medical Officer's periodic examinations, a number of children were recommended the following:— Virol 4 Cod-Liver Oil Emulsion 67 Cod-Liver Oil and Malt 21 Parrish's Food 11 Convalescent Home Treatment 2 Residential Open Air School treatment 2 Treatment at Asthma Clinic, St. Mary's Hospital 1 To see:— Ophthalmic Surgeon 7 Orthopaedic Clinic re Remedial Exercises, etc. 1 Dental Surgeon 5 Aural Clinic 6 Rheumatic Clinic 1 Recommendations were made to the Head Teacher as to the amount of exercises individual children should undergo, and also as to the taking of milk, shower-baths and natural sunshine. Four children received artificial sunlight treatment during the year. Provision of Meals and Milk for School Children.—The provision of meals in the schools commenced on 7th October, 1940. The total number of mid-day meals served during 1945 was 1,828,200 approximately. There are thirteen kitchens in the Borough, established at the following schools:— Becontree, Benton, Dane, Fairlop, Gearies, Goodmayes, Loxford, Mayfield, Newbury Park, Redbridee, South Park, Uphall, and Wm. Torbitt. The Provision of Milk and Meals Regulations, 1945, issued by the Board of Education, dated the 22nd March, 1945, provides for the supply of milk to children in school at the price of ½d. for one-third of a pint. As from 6th August, 1946, milk in school will be supplied free of charge in accordance with the Provision of Free Milk Regulations, 1946. In October 1945, 11,381 children were receiving milk in school. Of this number 987 received it free of charge. 8,859 were receiving an additional one-third pint. Work done by the N.S.P.C.C.—The following 36 cases were investigated:— (1) Neglect 30 (2) Ill-treatment cases 2 (3) Other cases 4 (2 cases were reported from the Public Health Department for neglecting medical advice; 28 were reported from other sources for general neglect). 67 100 children (43 boys and 57 girls) were involved, 57 being of school age. In addition to this work, 261 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 Committee for Education to this Society. The Invalid Children's Aid Association.—27 children were sent to residential schools and paid for by the Education Committee in 1945. In addition 11 children were sent to Convalescent Homes or Residential Schools and paid for through voluntary funds. Also 2 children were placed in various Homes, their parents voluntarily paying the full costs. An annual grant of £50 is made by the Ilford Committee for Education to this Association. Physically Defective Children.—During 1945, 6 cases were referred for medical examination and report. The following is a detailed summary of the children dealt with under this heading:— Deaf Children.—Recommended special school for Totally Deaf Children 3 Epileptic.—Special school for Epileptics 1 Cripple—Special school for Cripples 3 Blind.—Special School for the Blind 1 8 Summary of Handicapped Pupils at end of 1945:— Blind Partially Sighted Deaf Partially Deaf Epileptic Diabetic Delicate Crippling Defect Speech Defect Major Minor At Special Residential School 3 1 5 2 1 1 — 4 4 ~~ At Special Day School — — 5 3 — — — 76 4 - At Elementary School — — — 2 — 6 (2) — 31 11 54 Not attending any School - - 1 (1) - - - - - 3 (3) — Total 3 1 11 7 1 7 - 111 22 54 Figures in brackets indicate number over 14 years of age. Children Examined for Disability of Mind.—During 1945. 30 children were medically examined and reported upon under the Education Act, 1944, classified as follows:— Maladjusted 2 Educationally subnormal 19 Unfit for Education within the school system 9 Total number examined 30 68 Summary of Children with Disability of Mind at end of 1945:— Maladjusted Educationally Subnormal Uneducable At Residential Institution 2 6 (1) 13 (2) At Special Day School — 16(1) 16(1) At Elementary School 1 61 (6) 2 At no School or Institution — 15 (12) 22 (9) Total 3 98 53 Figures in brackets indicate number over 14 years of age. All educationally subnormal children are re-examined once a year and, where necessary, 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 1945, it was found that 11 children were employed out of school hours. 11 children were submitted for medical examination in accordance with the Byelaws made under Part 11 of the Children and Young Persons Act, 1933, with the following result:— Medically fit 11 Employment of Children in Entertainments Provisional Amending Rules, 1945.—Three certificates were granted during the year. Examination of Officers, etc.—The undermentioned teachers and other officers were medically examined and reported upon during the year:— Newly-appointed Teachers 2 Teachers—Sickness Regulations 4 Newly-appointed Staff 6 Staff—Sickness Regulations 1 13 School Camps.—The three Ilford School Camps remained in being during 1945 and the general procedure outlined in the report for 1940 continued. Infection at the Camp Schools in 1945. Kennylands. Finnamore Wood Elmbridge. Scarlet Fever 1* 2† Diphtheria — 1* - German Measles 2 .—; — Chicken Pox 23 20 Mumps — 4 — Influenza 58 — — Scabies — 3 Shingles — — 1 Jaundice — — 1 * Admitted Booker Isolation Hospital, High Wycombe, † Admitted Farnham Isolation Hospital. Immunisation (Diphtheria and Scarlet Fever).—Owing to the depletion of medical staff of the Department, and the inability of Professor Wilson, of the Emergency Public Health Laboratory Service at Oxford, for a similar reason, to undertake the work again, the immunisation at Kennylands and Finnamore Wood School Camps could not be carried out. 69 It was found possible, however, to carry out the immunisation of the pupils at Elmbridge School Camp in April and May, through the kindly co-operation of Dr. L. Foulds, of the Emergency Public Health Laboratory Service at Horsham. 125 children received treatment. Table Showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years) in Ilford for 1943 and 1944. 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 1943 1944 1943 1944 1. Measles 0.1 - - - 2. Scarlet Fever 0.1 — - — 3. Whooping Cough 0.2 0.1 - — 4. Diphtheria 0.2 0.2 10.5 11.5 5. Influenxa 2.4 0.6 — 3.8 6. Tuberculosis 4.8 6.0 3.8 7. Rheumatic Fever - - - - 8. Bronchitis, Pneumonia and other respiratory diseases 11.0 9.6 10.5 - 9. *Meningitis and Nervous system 9.5 10.3 — 3.8 10. Heart Diseases 26.0 24.3 — - 11. Acute and Chronic Nephritis 2.1 1.9 — — 12. Violence 5.4 10.0 57.9 38.5 13. Other causes 38.0 27.0 21.1 38.5 100.0 100.0 100.0 100.0 * Excludes Meningococcal infections. Deaths of School Children. Ilford.—The deaths of children of School Age during 1944 represont 1.6 percent, of the Total Deaths registered (all ages), and during 1943 represent 1.2 per cent. Table I.—Return of Medical Inspections. (These returns include Primary, Secondary and Grammar Schools.) A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups:— Entrants 1,686 Second Age Group 720 Third Age Group 1,211 Total 3,617 (2) Number of Other Routine Inspections Nil. Grand Total 3,617 B.—Other Inspections. Number of Special Inspections and Re-Inspections 6,539 70 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 1,686 30 1.8 1,452 86.1 204 12.1 — — Second Age-Group 720 21 3.0 684 81.3 113 15.5 2 0.2 Third Age-Group 1,211 94 7.8 991 81.8 126 10.4 — — Total 3,617 145 4.0 3.027 83.9 443 12.1 2 0.2 Group I.—Treatment of Minor Ailments. (Excluding Uncleanliness), for which see Table V. Total Number of Defects treated or under treatment during the year under the Authority's Scheme 3,289 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease (1) No. of Defects dealt with Under the Authority's Scheme (2) Otherwise (3) Total (4) Errors of Refraction (including squint) 916 14 930 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 24 2 26 Total 940 16 956 No. of Children for whom spectacles were:— (a) Prescribed 595 16 611 (J) Obtained 595 16 611 All spectacles prescribed were obtained during the year, or in January, 1946. Group III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment. Received other forms of Treatment. Total Number treated. 302 90 392 Table IV.—Dental Inspection and Treatment. (1) Number of Children inspected by the Dentists:— 71 (a) Routine Age Groups— Age 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Total. Number 393 623 580 701 793 913 806 745 791 339 208 85 47 16 7,040 (6) Specials 1,029 (e) Total (Routine and Specials) 8,069 (2) Number found to require treatment 5,159 (3) Number actually treated 3,838 (4) Attendances made by children for treatment 6,336 (5) Half-days devoted to {Inspection 55} {Treatment 760} Total 815 (6) Fillings {Permanent Teeth 2,905} {Temporary Teeth 2,414}Total 5,319 (7) Extractions {Permanent Teeth 876 {Temporary Teeth 3,443} Total 4,319 (8) Administrations of general anaesthetics for extractions 1,461 (0) Other operations {Permanent Teeth 1,787} {Temporary Teeth 483} Total 2,270 Table.—Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 5 (ii) Total number of examinations of children in the Schools by School Nurses 34,782 (iii) Number of individual children found unclean 1,169* (iv) Number of children cleansed under the arrangements made by the Local Education Authority Nil * In addition 71 children were found unclean at medical inspection and 268 in the School Clinic. Table VI. Blind and Deaf Children. (1) At a Public Elementary School (2) At an Institution other than a Special School (3) At no School or Institution (4) Total not receiving suitable Education Blind Children — — 1 1 Deaf Children — — 2 2 72 Mentally Defective Children. Total number of children notified during 1945 by the Local Education Authority to the Local Mental Deficiency Authority 20 Table VII. School Medical and Dental Staff. Name of Officer Proportion of whole School Medical Service time devoted to— Public Health S.M.O.—Dr. A. H. G. Burton (Resigned 30.9.45) 1/11 Various according to demands of services Deputy S.M.O.—Dr. J. H. Weir To 30.9.45 From 1.10.45 ¼ 1/11 Assistant S .M.O's.:— 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 (Resigned 31.1.45) Senior Dentist—Mr. M. J. K. Soutter 8/11 {1/11 T.B. {2/11 M. & C.W. Dentist—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 75 76 Table VI B.—Table Showing the Average Heights and Weights of the GIRLS Examined. (Primary and Secondary Schools.) 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 14—15 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in kilogrammes) Number of Children Examine^ 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 Centime tree) 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 J((in Kilogrammes) Number of Children Examined Average Height (in Centime toes) Average Weight (in Kilogrammes) Becontree 33 111.0 20.1 12 112.7 20.0 5 124.0 24.8 — — - 1 122.0 25.0 1 132.0 27.2 3 137.3 30.3 82 147.7 37.8 6 153.8 45.2 - - - Benton (Open Air) 2 111.5 20.0 4 110.3 19.1 5 119.0 21.1 10 122.2 22.2 13 127.6 26.9 9 134.1 28.7 12 141.0 30.6 12 148.7 37.0 8 148.1 42.1 - - - Chadwell 26 111.1 19.2 9 121.0 23.3 7 123.3 23.4 3 125.0 28.9 — — - 1 143.0 43.8 3 147.3 35.7 - - - - - - - - - Christchurch 13 110.4 19.2 7 119.1 22.6 - - - 1 128.0 26.7 - - - 1 146.0 26.7 2 149.0 40.9 - - - - - - - - - Cleveland 31 110.6 19.3 23 114.9 20.8 7 119.1 21.9 - - - - - - 2 140.0 27.5 2 141.0 37.0 — — — — — — - - - Dane Central - - - - - - - - - - - - - - - - - - 15 144.1 33.9 76 149.3 38.9 15 155.2 44.6 4 159.5 47.5 Downshall 20 111.6 20.4 6 114.0 21.6 2 125.0 24.6 1 139.0 40.3 - - - - - - 1 151.0 47.2 46 151.0 40.7 5 158.6 45.2 1 163.0 62.0 Fairlop 62 110.5 19.2 16 117.8 21.8 8 121.6 23.3 - - - 1 140.0 31.8 - - - 7 149.0 41.1 57 147.1 38.5 5 148.8 42.7 - - - Gearies 20 113.4 20.4 9 115.2 20.0 1 116.0 21.4 2 124.0 25.8 - - - 1 142.0 34.8 12 141.1 34.6 51 148.7 39.0 10 152.3 45.2 3 159.7 55.3 Goodmayes 13 110.4 19.2 7 119.6 24.2 2 119.5 23.4 1 118.0 22.0 1 140.0 32.2 4 138.0 30.7 2 136.5 29.2 - - - - - - - - - Gordon 23 110.5 19.3 16 115.3 20.7 1 116.0 20.6 - - - - - - - - — — - — — — — — — - - - - Highlands 33 111.8 20.0 22 116.2 21.2 6 122.0 23.3 6 130.3 29.7 — — — 3 135.3 30.8 - - - - - - - - - - - - Loxford Central - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Mayfield Central — — — — — — — — — — — — — — — — — — 4 142.0 37.9 89 150.5 41.4 8 152.1 44.0 2 162.0 57.7 Mossford 15 109.5 19.2 13 115.5 20.9 2 127.5 26.5 4 133.0 30.3 2 136.0 32.2 3 140.6 32.2 2 148.5 34.6 — — — — — — - - - Newbury Park 6 113.5 19.6 3 117.7 23.5 — - — — - — — — — — — — 4 142.7 34.4 - — — — - - - - - Parkhill 30 112.1 20.2 8 115.9 20.3 2 121.0 23.3 1 134.0 35.7 1 122.0 22.7 2 144.5 34.0 3 146.6 40.6 - - - - - - - - - St. Augustine's 1 112.0 17.6 1 121.0 22.6 - — — — — — — — — — — — — — — 3 153.3 40.1 — — — — — — SS. Peter & Paul 8 108.1 19.6 — — — 1 121.0 21.9 2 130.0 27.3 1 137.0 31.0 3 137.3 31.3 9 144.4 35.9 9 147.1 39.3 3 156.7 44.5 — — — South Park 46 111.4 19.6 32 116.8 21.9 8 109.0 23.3 6 130.8 26.6 — — — 1 141.0 28.4 2 138.5 31.8 — — — — — — - - - St. Vincent's 12 110.0 19.6 4 114.0 20.9 4 121.0 24.8 1 131.0 27.0 3 131.0 27.7 1 141.0 34.0 2 145.0 35.7 17 148.2 38.1 3 153.3 44.5 - - - The John Bramston 20 107.5 18.1 7 114.0 20.6 2 123.0 23.7 4 124.8 27.7 2 132.5 27.8 — — — — — — — — — — — — — — — The Mount Central - - - — - - -— — — — — — — —. — — — — 2 139.5 31.5 57 149.4 39.8 3 151.7 46.2 - - - The Redbridge 30 111.0 19.9 16 118.3 21.5 8 124.1 24.4 3 127.3 26.7 3 133.3 30.0 2 137.0 33.0 - - - - - - - - - - - - The Wm. Torbitt 28 110.7 18.9 13 113.8 20.4 5 115.8 21.1 2 123.0 22.3 - - - 1 126.0 26.5 — - - - — — — - - - - - Uphall 1 112.0 17.6 1 122.0 25.3 - - -- - - - - - - - - - - - - - - - - - - - - Woodlands 15 112.0 19.6 20 113.5 20.1 1 121.0 22.4 — — — — — — — — — — — — — — — — — — — — — Ilford Girls—Averages for 10 years:— 1945 488 110 19.6 249 116 21.2 77 121.2 23.3 47 127.3 26.8 28 130.4 28.1 35 137.3 30.7 87 143.3 34.9 499 149.1 39.4 66 153.0 44.3 10 160.4 53.3 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 49? 148.6 39.2 59 152.5 42.9 - - - 1943 636 109.9 19.2 375 114.7 20.8 175 120 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 I69 152 42.9 — — — 1936 897 109 18.6 257 113 20.1 186 121 22.6 1011 125 24.0 158l 131 27.4 157 136 30.5 193 142 34.1 805 147 38.1 115 153 42.9 — — — 77 78 Table VI C. Table showing the Average Heights and Weights of Grammar School BOYS. Age Groups Age Groups School 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years 17—-18 Years 18—19 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight 1 (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 of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) County High School for Boys 33 141.0 34.0 95 143.0 36.3 8 150.0 39.9 2 156.0 44.1 — — — 83 167.0 58.4 24 171.0 63.6 28 174.0 64.8 2 167.6 66.3 Table VI D. Table showing the Average Heights and Weights of Grammar School GIRLS. Age Groups Age Groups School 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years 17—18 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined ~ Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) County High School for Girls 27 143.0 33.6 60 145.0 34.8 12 144.0 34.9 3 156.0 44.2 - - - - - - - - - - - - Ursuline 9 140.0 35.8 25 142.0 34.0 5 150.0 44.4 - - - - - 1 163.8 54.0 - - - - - - 79 Table VII.- Summary of Cases of Infectious Diseases Among School Children, and of Contacts of such Cases , Excluded DISEASES AND CONTACTS SCHOOLS No. on Roll Scarlet Fever Diphtheria Measles & German Measles Chickenpox Whooping Cough Mumps Totals, 1945 Totals, 1944 Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Cases Contacts Cases Contacts Becontree 1349 21 29 1 5 109 2 1 12 - - 144 36 87 14 Benton (Open Air) 84 2 1 - - 21 - 1 8 1 - 32 2 4 - Chadwell 630 8 3 1 - 21 1 6 21 — 2 59 4 135 9 Christchurch 575 1 3 2 2 37 - 11 13 1 — 64 6 61 7 Cleveland 812 6 3 1 6 36 — 4 2 — — 49 9 33 5 Dane 559 2 4 — — 1 — — — — 2 5 4 21 5 Downshall 1243 12 8 1 4 59 1 13 2 — 13 100 13 127 13 Fairlop 1331 10 6 1 3 78 — 2 11 1 22 124 10 120 13 Gearies 1199 2 3 - 1 101 — 48 20 3 12 183 7 186 9 Goodmayes 507 1 1 - - 37 1 64 13 3 - 115 5 41 1 Gordon 171 - - 3 3 32 — 2 11 — 1 49 3 100 4 Highlands 520 1 — — — 80 11 — 20 — 2 103 11 82 8 Loxford Central 315 — 1 1 1 5 — 1 — — — 7 2 6 4 Mayfield Central 754 1 4 1 8 6 — 1 — — 1 10 12 16 3 Mossford (Fairlop) 255 1 4 — — 7 — 6 12 — — 26 4 36 4 Mossford (Barnardos) 71 — — — — — — — — — — — — — — Newbury Park 295 5 4 — — 38 1 1 2 — 1 47 5 95 2 Parkhill 878 5 2 — — 115 1 5 33 1 1 159 4 56 10 St. Augustine's .. 209 — — — — 14 1 — 5 — — 19 1 12 5 SS. Peter and Paul's 506 13 5 3 5 47 2 — 6 — 7 76 12 36 7 St. Vincent's 329 — 1 — — 6 — 1 — — — 7 1 2 — South Park 959 12 3 22 8 30 2 2 13 1 10 89 14 85 4 The John Bramston 273 4 8 — — — — — 1 — — 5 8 — — The Mount Central 338 — — — 1 1 —- 1 — — — 2 1 5 1 The Redbridge 442 1 1 — — 44 1 6 3 1 1 55 3 191 8 The William Torbitt 461 10 7 — — 11 1 2 8 — 3 34 8 96 5 Uphall 323 2 1 — — 26 — — — — 1 29 1 38 3 Woodlands 221 2 1 2 1 42 — — — — 2 48 2 61 12 *County High — 3 5 — - 41 — 5 3 — 4 56 5 86 8 *Private — 8 1 — — 25 — — 3 — — 36 1 51 7 Totals 15609 133 109 39 48 1070 25 183 222 12 85 1732 194 1869 171 * Notification of minor infectious diseases in these schools are not received.