AC 4411(1) iLFORD ILF 21 Borough of ilford Health Report FOR THE YEAR 1946 J. H. WEIR m.d., b.s., b.hy., d.p.h. Medical Officer of Health, etc. Ilford Borough Council 1st NOVEMBER, 1945—31st OCTOBER, 1946 Alderman W. B. Eke, J.P., Mayor. Councillor Mrs. B. A. L. A. Harding, J.P., Deputy Mayor. Aldermen: Bryan, William Allen Vernon. Holness, Richard Thomas. Daniels, Russell Stearn. Eke, William Benjamin, J.P., Mayor. Fallaize, Mrs. Lilian, J.P., E.C.C. Griggs, Albert Philip, J.P., C.A. (E.C.C.). Wetton, George John, C.A. (E.C.C.) Wootton, Mrs. Florence Emily, O.B.E. Young, Major Alexander, T.D., J.P. (E.C.C.). Councillors: Andrews, Fred. Barker, John. Barnes, Mrs. Winifred Amy. Bennett, Mrs. Florence Edith. Bishop, Mrs. Agnes Ethel. Brown, Harold John. Brown, William Thomas. Caunt, George Louis. Clements, John Anthony, F.R.S.A., F.S.S., F.R.Econ.S. Colvin, Gilbert, F.C.I.S. Cowan, Harold Douglas, F.C.P.A., F.C.C.S. Cropper, Cyril Clifford, F.I.A.S., F.V.I. East, John. Eke, Reginald George. Harding, Mrs. Beatrice Alice Louise Anne, J.P., Deputy Mayor. Hooker, Harold Leonard Benjamin. Howell, Thomas David. Littlejohn, Mrs. Ruth Constance, M.A. O'Connor, Mrs. Ethel. Payne, Robert Wilfred. Slater, Frank. Spalding, Mrs. Amine. Taylor, Sidney William. Todd, Norman. Tyler, Bertie Charles Newcombe. Watts, Frederick. Woods, Sidney Charles Victor. PUBLIC HEALTH COMMITTEE 1st NOVEMBER, 1945—31st OCTOBER 1946 Alderman Mrs. F. E. Wootton, O.B.E., Chairman. Councillor Mrs. R. C. Littlejohn, M.A., Vice-Chairman. Alderman W. B. Eke, J.P., Mayor. Alderman Mrs. L. Fallaize, J.P. Councillor J. Babkeb. Councillor Mrs. W. A. Barnes. Councillor Mrs. A. E. Bishop. Councillor G. Colvin, F.C.I.S. Councillor J. East. Councillor R. G. Eke. Alderman A. P. Griggs, J.P., C.A. (E.C.C.). Alderman R. T. Holness. Councillor Mrs. B. A. L. A. Harding, J.P., Deputy Mayor. Councillor Mrs. E. O'Connor. Councillor R. W. Payne. Councillor Mrs. A. Spalding. Councillor N. Todd. Councillor B. C. N. Tyler. Councillor S. C. V. Woods. MATERNITY AND CHILD WELFARE COMMITTEE 1st NOVEMBER, 1945—31st OCTOBER, 1946 Councillor Mrs. A. Spalding (Chairman). Councillor Mrs. B. A. L. A. Harding, J.P., Deputy Mayor, (Vice-Chairman). Alderman W. B. Eke, J.P., Mayor. Alderman Mrs. L. Fallaize, J. P. Councillor Mrs. W. A. Barnes. Councillor Mrs. F. E. Bennett. Councillor Mrs. A. E. Bishop. Councillor J. East. Councillor H. L. B. Hooker. Councillor Mrs. R. C. Littlejohn, M.A. *Mrs. M. Armitage *Mrs. H. Ashby. *Mrs. A. R. Brown. *Mrs. B. Butcher. * Co-opted Members. Alderman A. P. Griggs, J.P., C.A. (E.C.C.). Alderman Mrs. F. E. Wootton, O.B.E. Councillor Mrs. E. O'Connor. Councillor R. W. Payne. Councillor B. C. N. Tyler. Councillor N. Todd. *Mrs. W. Butler *Mrs. S. Charles. *Mrs. B. E. Paddon. ILFORD COMMITTEE FOR EDUCATION 6th FEBRUARY—8th NOVEMBER, 1946 Councillor Mrs. R. C. Littlejohn, M.A., Chairman. Councillor Mrs. F. E. Bennett, Vice-Chairman. Alderman W. A. V. Bryan. Alderman R. S. Daniels. Alderman W. B. Eke, J.P., Mayor. Councillor J. Barker." Councillor Mrs. W. A. Barnes. Councillor H. J. Brown. Councillor G. L. Caunt. Councillor J. A. Clements, F.R.S.A., F.S.S., F.R.Econ.S. Councillor G. Colvin, F.C.I.S. Councillor J. East. *Mr. J. K. K. Harrison *Mr. S. P. Lonergan. *Mr. L. R. Maddieson *Mr. D. O'Brien. Alderman Mrs. L. Fallaize, J.P. Alderman Mrs. F. E. Wootton, O.B. E. Councillor Mrs. B. A. L. A. Harding J.P., Deputy Mayor. Councillor H. L. B. Hooker. Councillor T. D. Howell. Councillor Mrs. E. O'Connor. Councillor Mrs. A. Spalding. Councillor N. Todd. Councillor F. Watts. *Mr. C. J. Ridout. *Mrs. N. Spiller. *Rev. W. C. Johnson. * Co-opted Members. OFFICERS OF THE PUBLIC HEALTH SERVICES Medical Officer of Health, Borough School Medical Officer, Medical Superintendent of the Isolation Hospital and Maternity Home, Medical Officer to the Maternity and Child Welfare Statutory Committee. J. H. Weir, M.D., B.S., B.Hy., D.P.H. (Durham). Deputy Medical Officer of Health: I. Gordon, M.D., Ch.B., M.R.C.P.(Lond.), D.P.H.(Edin.). Consultant Medical Officer of Health: 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. 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.) A. Collins, M.B., B.Ch., B.A.O. (Cork). L. Rich, M.B., Ch.B., M.R.C.O.G., D.P.H.(Man.) (from 1.10.46). C. M. Small, M.B., B.S., D.P.H.(Lond.) (from 3.3.47). Assistant Medical Officer of Health and Resident Medical Officer (Isolation Hospital): S. R. Jamieson, M.D., Ch.B., D.P.H. (Glas). Resident Medical Officer (Maternity Home): K. R. Barker, M.R.C.S., L.R.C.P. Senior Dental Surgeon: Sr. J. K. Soutter, L.D.S., R.C.S. (Eng.). Assistant Dental Surgeons: A. G. Clark, L.D.S., R.C.S. (Eng.) E. V. Haigh, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital: Matron of Maternity Home: Miss K. Bellaers. Miss F. G. o. Moorcroft. Senior Sanitary Inspector: S. R. Daly, D.P.A.(Lond.), F.A.L.P.A., M.R.S.I. Deputy Senior Sanitary Inspector: P. W. English. Sanitary Inspectors: S. G. Rackham. R. E. Smalley. A. C. R. Neale. T.F.Johnson. G. W. Newman. E. Stirk. Chief Administrative Clerk: F. J. Hocking. Superintendent of Council's Midwives: Miss C. Blookley. Officers of the Public Health Services—continued Superintendent Health Visitor: Mrs. M. D. Smith. Health Visitors and School Nurses: Miss A. Batten. Miss A. L. Drinkwater. Miss 0. Bell. Miss I. L. Mobbs. Miss M. G. Bennett. Miss M. H. Thurtle. Ante-Natal Clinic Nurse: Mrs. D. W. Quick. Matrons of War-time Day Nurseries. Sunshine House . Green Lane Ley Street Becontree Avenue *Miss I. E. Sandall. *Miss E. Hearn. *Miss A. R. Jones. *Mrs. E. Drower. *Temporary. Part Time:— Consulting Obstetrician (Maternity Home and Puerperal Pyrexia Regulations): R. L. Dodds, M.Ch., F.R.C.S., F.R.C.O.G. A. Davis, M.D., F.R.C.S. (Deputy). Consulting Anaesthetist: Frankis T. Evans, M.B., B.S., D.A. Surgeon in charge of Orthopaedic Clinic: J. A. McLauchlan, M.D., F.R.C.S. Oculist: F. J. Darbyshire, B.So., 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. Physician in charge of Paediatric Clinic: I. M. Andebson, M.D., M.R.C.P. Veterinary Surgeon: Ralph Bennett, F.R.C.V.S. Public Analysts: Bernard Dyer, D.Sc., F.I.C. George Taylor, F.I.C. J. hubert Hamence, M.Sc., Ph.D. Masseuse: Mrs. M. E. King, M.C.S.P. PREFACE Public Health Offices, Ilfobd. September, 1947. To the Mayor, Aldermen and Councillors of the Borough of Ilford. Me. Mayor, Ladies and Gentlemen, I submit herewith the Annual Report on the Health Services for the year 1946. The health of the town's inhabitants has remained uniformly good, as evidenced by the vital statistics given on pages 11 and 12. A reference to table 1a on page 15 will show that the local figures compare most favourably with those for England and Wales, and the Administrative County of London. It will be noted that the uncorrected death rate of 8.9 is 1.1 below the figure for 1945, and the corrected death rate of 9.7 is 1.6 below the 1945 figure. The Infantile Mortality rate continued its decline, falling to 29.6. the lowest ever recorded in Ilford, and substantially below that given for England and Wales (43) or the Administrative County of London (41). The Birth rate, as predicted in the last report, showed a rapid rise, reaching the figure of 20.2, the highest since 1911. The actual number of births registered totalled 3,443 as compared with 2,479 for 1945. It is satisfactory to note that the number of illegitimate births registered was only 3.1% of the total. This is the lowest figure since 1940, and contrasts with 5.5% for 1945. The graphic representation appearing at the end of this review illustrates the trend of health affairs in the Borough throughout the past 47 years. In the envrionmental hygiene section the work of the Department was considerably increased. Apart from the routine supervision of matters of general hygiene and sanitation, particular attention has been paid to the purity of food supplies, especially milk and ice cream. During the year the responsibility for executing war damage repairs passed from the Council. In consequence applications for certificates of housing defects to support claims for war damage repairs or for building licences have greatly multiplied with resultant increase in the work of the Sanitary Inspectors. A large number of house inspections have been necessitated by complaints received of insanitary or overcrowded housing conditions upon the substantiation of which complainants wish to base claims for the provision of alternative accommodation. The Inspectors have also had to deal with numerous requests for the removal of aged and infirm or chronic invalids from insanitary premises. Unfortunately institutional accommodation for these persons is totally insufficient. So far as Infectious Diseases are concerned, there have been no serious epidemics affecting the citizens of the Borough. The commonest ailment was measles, there being, however, 1,135 cases as against 2,154 in 1945. Whooping cough, the next common infection, similarly showed a reduction from 536 to 341 cases. Despite large numbers of smallpox contacts returning from abroad, only one case of this disease occurred in the Borough. Fortunately, no secondary cases developed. It will be noted that the sanitary inspectors paid 2,099 visits to houses in connection with the surveillance of contacts. One local resident developed typhoid fever on return from holiday at Aberystwyth, where the disease was epidemic. No secondary cases occurred. The number of cases of diphtheria notified fell to 25, the lowest for this century. It is gratifying to report that no death occurred among the Ilford patients admitted to the Isolation Hospital. During the year a diphtheria reinoculation scheme was instituted. This provides for the reinforoement of immunity in children previously immunised. With the removal of restrictions on the civilian purchase of penicillin in June, 1946, increasing use has been made of this antibiotic in the treatment of patients in the Isolation Hospital and Maternity Home, with most encouraging results. Cases previously regarded as inevitably fatal, e.g. pneumococcal meningitis, have been saved by its use. The arrangements for the regular hire of oxygen tents commenced during the year has similarly proved most satisfactory. It will be noted, in the section dealing with the Isolation Hospital, that a considerable number of obstetrical cases—ante-natal, confinement, or post-natal—were admitted. This policy, which incidentally lightened the burden on the depleted and overworked staff at the Maternity Home, was adopted in all cases where any suspicion of infection existed. It was designed to obviate any risk of an epidemic in the Maternity Unit, which inevitably would have resulted in ward closure and refusal of cases, for whom it would have been practically impossible to find alternative accommodation. A particularly fatal type of neonatal enteritis which affected many maternity units in various parts of the country fortunately did not occur in Ilford. The satisfactory results of hospital treatment of primary and influenza pneumonia are indicated in the table on page 38. Many of these patients were of advanced age and there is little doubt that recovery would not have been possible with home nursing facilities. A disturbing feature mentioned in the 1945 Report, and continuedly manifest, has been the lack of provision of adequate institutional accommodation for the chronic sick, aged and infirm in the district. Several of such cases have been admitted to the Isolation Hospital by reason of an intercurrent attack of pneumonia, bronchitis or cardiac decompensation under the diagnosis of pneumonia and after prolonged treatment it has been difficult to arrange their discharge owing to lack of suitable housing, home care or institutions to which they could be transferred. In a recent case it was necessary to retain such a patient for three months before suitable domestic arrangements could be made for his future welfare. This position naturally causes serious difficulties at times when the Isolation Hospital beds are in frequent demand and prejudices other acutely ill patients for whom admission is desired. It will be recalled that particulars of the activities of the Civil Defence Casualty Services were given in the last two Annual Reports. Additional information as to the extent to which the Borough suffered from enemy activities is given in the Report of the Essex County Council A.R.P. Committee published at the beginning of the present year. From this it is seen that in Metropolitan Essex the total Air Raid casualties sustained by Ilford residents and the gross damage to local property exceeded that of any other Borough in this area. The actual figures are:— Casualties: fatal 530; serious 854; slight 1,786; total 3,170. Houses: demolished 1,313; badly damaged 9,410; minor damage 29,974; total nett 40,697; total gross 95,000; the last figure represents the number of incidents to all properties, many being damaged more than once. The Maternity and Child Welfare Services, in the face of continued difficulties of shortage of staff, accommodation and housing, have nobly coped with 2,222 births, the largest annual number ever dealt with by the local organisation. The Maternity Home admissions, numbering 1,020, 8 sent an increase of 23.7% over 1945. It will be noted that 176 of these were emergency cases, most of which required operative or other specialised treatment. The Domiciliary Midwifery Service has similarly been heavily taxed, dealing with 1,202 cases as compared with 699 in 1945. It has been increasingly difficult to obtain midwives for institutional or domiciliary midwifery, and in the latter regard the position has been aggravated by the great difficulty in obtaining suitable housing accommodation for district midwives. It would appear that, in the future flats or houses within their area of practice should be provided to attract applicants, and indeed recruits to the service generally. Again I would pay tribute to the work of all those engaged in the local midwifery service who have so willingly responded to the greatly increased demands for their services. The arrangements for the transfer of patients to Emergency Maternity Homes in the Provinces continued during the year. At times, however, the desired number of patients could not be accepted and for these special "last minute" arrangements had to be made. Towards the end of the year the London Emergency Bed Service kindly proferred welcome assistance for eases of this type. Many patients have, through this agency, been accommodated in various London Maternity Units. In May, 1946, the Minister of Health approved the Council's proposal to establish a Post-Natal Home at Wilnett Lodge, Chadwell Heath. On about the seventh day of confinement, mothers are transferred to this institution, thereby freeing beds at the Maternity Home. The official opening ceremony will be performed by His Worship the Mayor in the near future. During the year representations were made to the Ministry of Health regarding the difficulties of securing adequate local institutional accommodation for maternity cases. Arising thereout it was ascertained that the Minister would be prepared to consider proposals for the erection of an additional ward block of a "utility" type of construction. Plans for this and the necessary associated alterations have been prepared. Subject to their approval by the Minister and the obtaining of the necessary licenoes, materials and labour, it is hoped that the scheme will proceed. Corresponding with the increased work of the Maternity Home, attendances at both ante-natal clinics were greatly augmented. Post-Natal Clinic facilities were extended and appointments offered to all patients confined in the Maternity Home and to other mothers on request. The work of the Infant Welfare Centres has expanded by the re-opening or establishment of six additional weekly sessions. Altogether 46,620 attendances were made as compared with 37,710 in 1945. The number of children on the Welfare Centre rolls increased from 3,246 in 1945 to 4,049 in 1946. Home visiting by Health Visitors has had to be curtailed owing to shortage of staff. It has been increasingly difficult to fill vacancies, and so far it has not been possible to reach the increased establishment agreed by the Council. This experience, however, is general, as there is an acute shortage of Health Visitors throughout the country. As in the case of Domiciliary Midwives, consideration to the provision of living accommodation will have to be given when the time is opportune. With the appointment of a whole-time Organiser the scheme for the supply of Home and Domestic Helps has steadily progressed, and is fulfilling a long-felt and urgent need. To the Specialist Clinics has been added a Paediatric Clinic in charge of a consultant paediatrician to whom may be referred children in whose cases a specialist opinion is required. An additional clinic to which cases of cardiac disease in pregnancy can be referred has recently been established under the direction of the Council's Rheumatism and Cardiac Consultant. 9 After negotiations with the H.S.A. and the H.S.F., the Council, as from 1st April, 1946, agreed to accept vouchers from eligible contributors to these organisations in full discharge of all payment liabilities in respect of confinements in Maternity Homes or domiciliary confinement, including ante-natal treatment, medical aid, X-ray examination or Specialist's fees. The School Medical Service is now catering for a school population of 18,070 children, an increase of 2,461 on the previous year. Routine medical inspections were increased by 84.1% and re-inspections and special examinations increased by 65.9%. During the year the pre-war practice of reviewing and revising the lists of mentally and physically handicapped children was resumed. With the co-operation of Head Teachers all old cases were confirmed, and new cases notified and examined. Attendances at the various specialist clinics were again increased. The position regarding the operative treatment of tonsils and adenoids remains unsatisfactory. Owing to lack of adequate hospital facilities, the waiting lists are large and undue delay in securing treatment results. So far as is possible, priority of treatment is secured for children urgently in need of operation. Every possible endeavour has been made to ameliorate the position, without avail. The situation is not peculiar to Ilford, as enquiry reveals a similar situation obtaining throughout the County. It also appears that most of the hospitals in London have similarly overburdened waiting lists. Reference is made in the report to the projected provision of facilities for orthoptic treatment and surgical treatment of cardiac defects. The newly-established speech therapy clinic is proving of considerable value. As indicated in the 1945 report, there is an urgent local need for increased provision of day and residential school accommodation for educationally subnormal pupils and institutional facilities for ineducable children. During the year under review special classes attached to a selected primary school were arranged. These already have proved to be of inestimable value, but unfortunately all the available places are filled and a waiting list exists. Whenever accommodation can be made available it is highly desirable that further provision should be made, as, with the increased ascertainment programme now operative, many more educationally subnormal children are being certified. In point of fact, during the year examinations of children suffering from disability of mind were more than quadrupled. Proposals for the establishment of a Child Guidance Clinic have been made to the local Education Authority. During the year extensive repairs to the Central Administrative Offices were necessitated by deterioration in the timbering which threatened the safety of the fabric. Alterations and improvements were effected by the provision of a cleansing station, an interviewing room and additional cloakroom and lavatory accommodation for the staff. It was also found possible to rearrange and improve the accommodation of the M. and C. W. and stenography staff. The Future position of the Borough's Health Services is largely dependent on the awaited proposals of the Local Health Authority, the Essex County Council, and the N.E. Metropolitan Regional Hospital Board. The latter has recently been constituted and will administer all hospital and specialist services in an area including the Counties of Essex (except area in Cambridge region), Herts (Hertford B., U.D.'s of Bishop's Stortford, Cheshunt, Hoddesdon, Sawbridgeworth, Ware; R.D.'s of Braughing, Hertford and Ware); Middlesex (Edmonton B., Tottenham B., Enfield U.D.); London (Bethnal Green, City, Finsbury, Hackney, Poplar, Shoreditch, Stepney, Stoke Newington); County Boroughs of East Ham, Southendon-Sea and West Ham. The County Council are required to submit to the Minister their proposals under Part III of the National Health Service Act which deals with M. and C. W. Services, domiciliary midwifery, health visiting, home nursing, 10 local mental health services, vaccination, immunisation, ambulance services, care and after-care of the sick, domestic help and health centres before certain dates, the latest being 31st December, 1947, so that the scheme may become operative by July 5th, 1948. It is stipulated that copies must be served upon local authorities and other interested bodies who are given a period of two months in which to make any observations they desire. In a recently published circular of the Ministry of Health, it is suggested that all Counties should be subdivided into areas of health administration, whose day to day administration would be delegated to Sub-Committees of the County Council. These it is suggested would be responsible for the decentralised administration not only of the child care services, but of other Part III services also. The circular states: "there is, moreover, a limited number of non-county boroughs and large urban districts which, besides being excepted districts under the Education Act, have an unusually high proportion of the total population of the County or possess exceptionally welldeveloped public health (including school health) services. Such a borough or urban district would ordinarily become an area of health administration separate from surrounding districts." It therefore seems possible that Ilford may become an area of Divisional Administration for the purposes of this section of the Act. One topic of medical and social interest which has been engaging considerable attention during the past few years is the science of gerontology or knowledge of the problems of old age, with its logical corollary—the care of the aged or geriatrics. Recently some authorities, Essex County Council included, have given attention to this question and have made some provision for care of the aged, either in institutions, special communities, hostels, flats or small houses. Authority for this social improvement is, however, limited to County Councils and County Boroughs, and it is hoped that some provision in this direction may ultimately be made available to the aged residents of the Borough. 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 the year. In particular, I desire to acknowledge the continued assistance and invaluable advice so willingly given by Dr. A. H. G. Burton, the Council's Consultant, to whom I am greatly indebted for his friendly co-operation. Especially in connection with the Welfare Centres and the Open Air School has he rendered most signal services to the community. 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 specially 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. 11 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, 1945 151,520 „ 1946 173,900 Number of inhabited houses (end of 1946) according to Rate Books 44.210 (approx.) Rateable Value—October 1st, 1946 (Houses and Land) £1,574,777 Sum represented by a penny rate, October 1st, 1946 £6,350 (approx.) 1945-46 1946-47 Education Rate— (E.C.C.) 4s.9.06d. in the £ 5s. 3.88d. in the £ Combined Rate (all services) 16s. 0d. in the £ 16s. 0d. in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males. Females. As at January 14th, 1946 250 82 As at January 13th, 1947 726 87 Total M. F. 1946 1945 Live Births Legitimate 3,336 1,780 1,656 Birth Bate per 1,000 of the estimated resident population 20 2 16 8 Illegitimate 107 45 62 Still Births 94 49 45 Rate per 1,000 total (live and still) births 26.5 21 7 Deaths 1.653 845 808 Death Rate per 1,000 of the estimated resident population 9 7 11.3 Percentage of total deaths ooourring in public institutions. 31.6 34.8 12 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. 1946 1945 1946 1945 No. 29, Puerperal sepsis 0 0 0.0 0.0 No. 30, Other maternal causes 8 3 2.26 1.18 Total 8 3 2.26 1.18 Death-rate of Infants under one year of age:— 1946 1945 All infants per 1,000 live births 29.6 32.7 Legitimate infants per 1,000 legitimate live births 29.1 31.2 Illegitimate infants per 1,000 illegitimate live births 46.7 58.8 Deaths from Cancer (all ages) 318 255 ,, Measles (all ages) — 2 ,, Whooping Cough (all ages) 1 — ,, Diarrhoea (under 2 years of age) 5 8 1. Rainfall. Total rainfall registered in the district during the year was 26.87 inches, the greatest fall in 24 hours was registered on 26th August, being 2.16 inches. The fall of longest duration was on the 14th November—22 hours. August was the wettest month. 2. Population . The number of patients and resident staff on the 30th June, 1946. at the following public institutions, was:— Claybury Mental Hospital 2,291 West Ham Mental Hospital 1,278 Australasian Hospital (Girls' Village Homes) 37 Total 3,606 3. Births.—The number of births registered during the year was 3,443. Males Females Legitimate 1,780 1,556 Illegitimate 45 62 i.e., 3.1 per cent. of the births registered were illegitimate. *The percentage of illegitimate births registered in the previous 10 years was: 5.5; 4.2; 3.4; 3.5; 3.3; 2.5; 2.2; 2.4; 2.7; 2.5. The birth-rate, calculated on the net estimate of the population is 20.2 per 1,000. 4. Deaths.—The total number of deaths of Ilford residents was 1,653. This is obtained by taking the total deaths registered in the district (1,546), subtracting the deaths of non-residents occurring in the district (321), and adding the deaths of Ilford residents registered as having died in other districts (428). The number of deaths of non-residents registered in the district (principally in large institutions) was as follows:— Claybury (L.C.C.) Mental Hospital 93 West Ham Mental Hospital 103 King George Hospital 67 Ilford Isolation Hospital and Sanatorium 37 Other Non-residents 21 Total 321 13 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 67 Essex County Mental Hospital, Brentwood 15 Essex County Hospital, Wanstead 16 Queen Mary's Hospital, West Ham 3 Hospital for Sick Children, Great Ormond Street 5 London Hospital 45 St. Bartholomew's Hospital 12 Charing Cross Hospital 2 Westminster Hospital 1 Royal Eastern Counties Institution, Colchester 1 St. Margaret's Hospital, Epping 3 Severalls Mental Hospital, Colchester 23 East Ham Memorial Hospital 3 Poplar Hospital 4 Whipps Cross Hospital 6 St. Luke's Hospital 2 Chase Farm Hospital, Enfield 1 In other Hospitals, Institutions and residences outside the Ilford district 219 Total 428 The death rate, calculated on the net estimate of the population of 170,331, is 9.7 per 1,000. Inquests.—During the year, 64 inquests were held, 45 on Ilford residents, and 19 on non-residents. The ages at death were as Following:- Under 1 year 1-2 years 2-5 years 5-15 years 15-25 years 25-45 years 45-65 years 65 years and upwards 2 — 1 2 6 20 11 22 Death-Rates from Tuberculosis and Cancer, 1946. The following Table shows the death-rates for 1946 for Ilford, compared with the provisional death-rates for England and Wales for the same period, per 1,000 population; the figures having been supplied by the Registrar- General:— Ilford England and Wales Respiratory Tuberculosis .334 .464 Other Tuberculosis .050 .083 Cancer 1.867 1.843 5.—Public Assistance Relief.—The total amount expended in Ilford during the year was £27,980 3s. 0d. The average weekly number of cases in receipt of relief was 603, including dependants. The number of admissions to County Institutions from Ilford during the year was 1,274, made up as follows:— Men 458 Women 646 Children 170 The number of destitute persons admitted to the Public Assistance Institutions during 1946 was 7; women 2, children 5. 6. Marriages.—1,739 marriages took place in the Ilford district during 1946, both parties or one of the contracting parties being Ilford residents. 7. Tables of Vital Statistics.—Table 1 gives a comparative statement of the birth-rate and death-rate for the past five years. Table 1a gives a comparison of the vital statistics of Ilford with England and Wales, London and other towns. Table II gives a classified statement of the causes of death in 1946. arranged according to the age groups at which deaths ocourred. 14 TABLE I.—Vital Statistics of Whole District During 1946 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 (b) of Non-Residents registered in the District of Residents not registered in the District Under 1 Year of Age At all Ages Number Rate (c) Number Rate (d) Number Rate per 1,000 Net Births Number Rate (e) 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 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 1,049 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 1946 173,900 170,331 2,690 3,443 20.2 1,546 8.9 321 428 102 29.6 1,653 9.7 (а) The net estimated population is found by deducting the population of Claybury and West Ham Mental Hospitals from the gross estimated population. The population of Dr. Barnardo's Girls Village Homes is included in the net estimated population of the district. (b) The net number of births is obtained by taking the uncorrected number of births supplied by the local Registrar and adding to or subtracting from it such a number as is supplied for this purpose by the Registrar-General. (c) and (e) Calculated on the estimated net population. (d) Calculated on the estimated grow population. 15 Table 1a Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1946 (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 19.1 0.53 11.5 0.00 0.00 0.00 0.00 0.02 0.01 0.15 4.4 43 126 County Boroughs and Great Towns, including London 22.2 0.67 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.13 6.1 46 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 21.3 0.59 11.7 0.00 0.00 0.00 0.00 0.02 0.01 0.14 2.8 37 London Administrative Co. 21.5 0.54 12.7 0.00 — 0.01 0.00 0.02 0.01 0.12 4.2 41 ILFORD (Estimated Gross Population, mid 1946 = 173,900) 19.8 0.54 9.5 - - - - 0.00 0.00 0.11 1.4 29 A dash (—) signifies that there were no deaths. 16 Registrar-General's Short List of Deaths and Causes:— TABLE II Causes of, and Ages at, Death during the Year 1946 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 1653 102 3 10 10 42 38 87 160 257 399 545 1 Typhoid and paratyphoid fevers - - - - - - - - - - - - 2 Cerebro-spinal fever 3 — — 1 — 1 — - - 1 - - 3 Scarlet fever - - - - - - - - - - - - 4 Whooping cough 1 - - - - - - - - - - - 5 Diphtheria 1 - - - - 1 - - - - - - 6 Tuberculosis of respiratory system 57 1 — — — 11 9 6 15 9 5 1 7 Other forms of tuberculosis 9 1 1 2 — 2 - - - - - - 8 Syphilitic disease 14 1 - - - - - 2 1 6 2 2 9 Influenza 20 - - - - - - 1 - 2 3 14 10 Measles - - - - - - - - - - - - 11 Acute Poliomyelitis and polioencephalitis - - - - - - - - - - - - 12 Acute infectious encephalitis 1 - - - - - - - 1 - - - 13 Cancer of buccal cavity and oesophagus (males only) 16 - - - - - - 1 2 3 4 6 Canoer of uterus (females only) 13 - - - - - - 1 2 1 5 4 14 Cancer of stomach and duodenum 53 - - - - - - 2 4 12 18 17 15 Cancer of breast 33 - - - - - - 5 13 6 5 4 16 Cancer of all other sites 203 — — — 1 1 8 16 26 50 63 43 17 Diabetes 14 — — — 1 — 2 1 1 4 5 - 18 Intra-cranial vascular lesions 183 1 - - - - - 3 14 24 61 80 19 Heart disease 402 — — — — 1 2 14 21 64 117 183 20 Other diseases of the circulalatory system 57 — — — — 2 — 1 6 12 17 19 21 Bronchitis 81 2 — 1 1 - - 6 5 8 21 37 22 Pneumonia 74 17 1 — 1 3 1 3 8 13 11 16 23 Other respiratory diseases 33 — — — — 1 1 l 6 8 7 9 24 Ulceration of the stomach or duodenum 17 - - - - - - 2 4 3 2 6 25 Diarrhoea (under 2 years of age) 5 4 1 — — — — — - - - - 26 Appendicitis 4 — — — 1 - - - 2 - - 1 27 Other digestive diseases 30 1 — 1 - 1 - 1 5 4 7 10 28 Nephritis 36 — — — — 5 2 - 4 4 11 10 29 Puerperal and post-abortive sepsis - - - - - - - - - - - - 30 Other maternal causes 8 - — — — 2 2 4 — — — - 31 Premature birth 30 30 - - - - - - - - - - 32 Congenital malformations ,birth injury, infantile disease 44 37 - 1 1 2 — 2 — 1 - - 33 Suicide 20 — — — — 1 6 6 6 2 4 1 34 Road traffic accidents 15 — — — — 1 3 1 2 5 2 6 35 Other violent causes 22 2 — — — 2 4 2 1 1 4 6 36 All other causes 154 5 — 3 4 5 6 9 8 14 25 75 Special Causes (included in No. 36 above):— Smallpox - - - - - - - - - - - - 17 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. (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, 9,417 visits being paid by the Nurses in 1946, compared with 12,260 in 1945. The following is a summary of the work carried out during the year 1946:— Number of New Cases and applications for Nurses' Services 373 Number of Visits—Medical 8,187 Surgical 1,019 Operations 2 Massage 209 Number of necessitous cases referred to the Committee 19 Number of cases on books at end of year 118 The cases were distributed in wards as under:— Cranbrook 42 Park 52 Seven Kings 49 North Hainault 36 Loxford. 51 Clementswood 28 South Hainault 32 Goodmayes 29 Barkingside 54 (iii) Laboratory Facilities.—During the year 566 swabs were examined for the presence of diphtheria organisms in the Bacteriological Laboratory at the Isolation Hospital; 17 gave positive results and 549 negative results. In addition 13 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 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. 18 During 1946 sixteen applications for renewal of licences were received. The Council renewed the licences in respect of these establishments. Six new applications were received, which were granted. All the licences expire on 31st March, 1947. Part VI.—Hairdressers' and Barbers' Premises. During 1946, 122 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 22 applications for registration in respect of 1 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) 3 Purveyors manufacturing and retailing their own productions (made on domestic premises) Nil Registration was refused in two cases; on account of lack of suitable accommodation in one, and lack of provision of utensils and equipment in the other case. (11) Ilford Corporation Act, 1937. (a) Section 72 provides for the compulsory removal of persons to hospital who are unable to devote to themselves or to receive from others with whom they are residing proper care and attention and for preventing injury to the health of other persons. One order was obtained during the year regarding an aged man. (b) 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 29 persons (concerning 16 premises), but refused in five cases on account of the unsuitability of the proposed storage premises. (c) 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, Three applications for registration were received during 1946, all of which were granted. (12) 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, 2,871 re-inspections were made. Nine preliminary notices were served, 7 of which were complied with; 2 Statutory Notices were also served, both of which were complied with. 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. (13) Nurses Act, 1943 (Part 2). Nurses' Agencies. The Essex County Council, on application by the Ilford Council, delegated to them, in pursuance of Section 11 (1) the powers conferred upon the County Council by Part II of the Act, subject to certain conditions. 19 During 1946 a licence was granted to one Nurses' Agency in Ilford; later a new licence was issued when the Agency transferred to new premises. Such licence expires on the 31st December, 1947. The Council refused to grant a licence in one case, as the provisions of Section 7 of the Act were not complied with. Agencies are inspected before the issue of a licence, and thereafter at intervals of not more than once a quarter. The Medical Officer of Health and his deputy are authorised under Part 2, Section 9 (2) to enter and inspect any such licensed premises in the Borough. (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. Fifty-two of the remaining beds are allocated to the Essex County Council for the reception of 32 male and 20 female tuberculous patients on the understanding that if the beds are required for infectious cases the tuberculous patients will be discharged home or transferred to other Sanatoria. The arrangement was not interrupted during 1946. Maternity Home.—51 beds for the reception of maternity cases are maintained at the Ilford Council Maternity Home. King George Hospital.—This is a voluntary Hospital. The following is a return in respect of bed accommodation:— Total number of Beds at 31st December, 1946. Private Patients. Other Patients. Children. Medical. Surgical. Male. Female. Male. Female. 207 21 27 27 54 46 32 Maternity and Nursing Homes.—On the 1st January there were 2 private registered Nursing Homes in the district, 1 for medical and senile cases, and 1 for maternity cases. On 31st December there were 3 private registered Nursing Homes, 2 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. Two letters were sent calling the attention of the keepers of homes to sanitary defects. Mental Hospitals.—There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,182 patients (males 543, females 639), and Claybury Mental Hospital, with 2,142 patients (males 885, females 1,257) in residence on 30th June, 1946. Other Institutions.—Girls' Village Homes, one of the late Dr. Barnardo's Institutions; with 24 children in the Hospital on 30th June, 1946. (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.—Five vehicles are engaged. Four crews are held available, shifts being so arranged that four ambulances are held in readiness during the daytime hours and two between 10 p. m. and 8 a.m. During 1946 the Ambulance Service dealt with 6,308 calls, representing 54,000 miles (approx). 20 The service is available for street accidents, emergency illnesses, hospital evacuation cases and for private removals of 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 area) 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 area) Tuesday, 2 p.m. 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 area) 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 Goodmayes area) Thursday, 2 p.m. Vine Memorial Church Hall, Grosvenor Road, Ilford (for residents of Ilford Lane area) Friday, 2 p. m. Valentines Mansion, Emerson Road, Ilford (for residents of Valentines area) Friday, 2 p.m. Fairlop School, Fencepiece Road, Barkingside (for residents of Hainault area) Saturday, 9.30 a.m. Ante-Natal Clinics.—An Ante-Natal Clinic is held at the Maternity Home, Eastern Avenue, Ilford, on Wednesday, Thursday, Friday and Saturday mornings, and on Tuesday, Wednesday, Thursday and Friday afternoons and at the Mayesbrook Clinic, Goodmayes Lane, on Monday and Thursday mornings. Post-Natal Clinics.—These Clinics are held at the Maternity Home on each Monday afternoon, and at the Mayesbrook Clinio, Goodmayes Lane, once monthly on a Saturday morning. School and other Clinics.—Clinics are held at the following premises:— (i) Public Health Offices, Valentines Mansion for— Diphtheria Prevention. 21 Aural. Ophthalmic treatment. Paediatric. Infant Welfare. (ii) Newbury Hall, Perry mans Farm Road for— Minor Ailments. Orthopaedic and Remedial Exercises treatment. Rheumatism. Artificial Sunlight treatment. Infant Welfare. Cardiac Clinic. (iii) Mayesbrook Clinic, Goodmayes Lane, for— Minor Ailments. Dental (Children and Expectant Mothers). Ophthalmic treatment. Artificial Sunlight Treatment. Ante-Natal and Post-Natal. Diphtheria Prevention. Orthopaedic and Remedial Exercises treatment. Infant Welfare. (iv) Valentines School, Beehive Lane, for— Dental (Children and Expectant Mothers and Tuberculosis Patients). Speech therapy. 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. 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 subject of the water supply of the Borough was dealt with at length in my report for 1945. The part of Ilford within the area of the Metropolitan Water Board is supplied with water derived from the River Lea, which after passing through storage reservoirs is filtered and chlorinated at Lea Bridge and Ferry Lane, and pumped from those works. An additional amount of water is supplied from Wanstead Well. Samples of the water in all stages of purification are analysed daily at the laboratories of the Board. Lieutenant-Colonel E. F. W. Mackenzie, Director of Water Examination of the Board has kindly supplied me with the information that 1,411 samples of filtered water were submitted to chemical and bacteriological examination and found to be pure and wholesome. All new and repaired mains are ohlorinated 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 by the Metropolitan Water Board in Ilford during 1946 was 3 yards of 3-inch and 2,477 yards of 4-inch. The water to the other part of the area is supplied by The South Essex Waterworks Co. The supply is obtained from the River Stour and from deep wells at Mill Road, Grove Road and Roding Lane. 22 Mr. Hugh G. Ramsay, Engineer to the South Essex Waterworks Co., has kindly supplied me with the information that over 3,000 chemical, bacteriological and biological examinations were made at the Langham laboratory, and all were reported as wholesome. The length of mains laid by the South Essex Waterworks Co. in Ilford during 1946 was 34 yards of 3-inch, 1,705 yards of 4-inch, and 147 yards of 6-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 situated for connecting to the main supply. Ten samples of piped water supply (7 South Essex Waterworks Co. and 3 Metropolitan Water Board) were taken for chemical and bacteriological examination, and all gave satisfactory analyses. (ii) Drainage and Sewerage.—The Borough Engineer has kindly supplied me with the following statement:— Collection and Disposal of Refuse:— Tons. Cwts. The total amount of refuse collected 28,906 10 ,, ,, disposed of by barge 28,189 9 „ „ „ „ at Destructor 717 1 Collection of Salvage:- Weight Collected 6,160 tons Gross Income £19,188 Net Income £11,155 ILFORD AND BARKING JOINT SEWERAGE SCHEME. Personnel Re-organisation.—A complete re-organisation of the operating and maintenance staff has been carried out. As a result maintenance matters now receive more adequate attention and the men are engaged on duties where their skilled craftsmanship is more suitably employed. Painting Shafts and Tunnel.—The two shafts and tunnel carrying the four 21 inch pumping mains underneath the adjacent River Roding between the Joint Pumping Station and the L.C.C. culverts have been thoroughly wire brushed and painted (3 coats). The tunnel is 300 ft. long and 7 ft. 6 ins. in diameter. Two shafts each 70 ft. in depth were constructed in 1933 at a cost of £31,500. Provision of New 16/18-inch Centrifugal Type Sewage Pump.—In view of the small reserve of pumping plant capacity available, it has been decided to extend the pumping plant by another pumping unit complete capable of pumping 500,000 gallons per hour. At present seven large volume pumping units are installed at the Joint Pumping Station comprising five centrifugal type and two reciprocating type pumps. All units are at present duplicated except the 500,000 gallons per hour unit. When the new pumping unit becomes available, all the eight large volume pumping units will then be in duplicate and should, it is estimated, provide sufficient pumping capacity to cope with all requirements. New 660 B.H.P. Diesel Engine.—A new 660 B.H.P. Diesel Engine was recently installed to replace the 400 B.H.P. Diesel Engine which was damaged beyond repair following a crankshaft failure. Allowing for overload conditions, the overall power station electric generating capacity has been increased by nearly 40 per cent. Having regard to the existing Electric power supply difficulties such increase in generating capacity is a most valuable factor. 23 The foresight displayed by the Joint Committee in providing this alternative source of electricity supply and the manner in which this plant is employed to effect safeguard and economy for the vital and essential disposal of sewage and drainage reflects the greatest credit. (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 17,717 Houses and premises reinspected (works in progress) 14,216 Visits during disinfection 1,083 Houses in which nuisances were detected 2,811 Houses in which nuisances were abated 2,013* Premises disinfected 546 Premises from which articles only disinfected 125 Articles disinfected 2,774 Premises disinfested for verminous conditions 9 *Included 141 nuisances detected before 1st January, 1946. Notices served:— Served Complied with Statutory:— Public Health Act, 1936 179 111 Housing Act, 1936 76 49 Housing Act, 1936 (Overcrowding) 4 2 Factories Act, 1937 1 1 Shops Act, 1934 2 2 Provide Dustbin (Ilford Improvement Act) 50 39 Provide Water Supply to Dwelling House - - Food and Drugs Act, 1938 4 2 Cleanse Water Storage Cistern (Byelaws) 3 3 Cover Water Storage Cistern (Byelaws) 3 3 Informal 2,711 1,803 3,033 2,015 In addition to the above, 164 notices (51 statutory and 113 informal) served previous to 1st January, 1946, were also complied with. Complaints.—During the year, 2,486 complaints of nuisances have been received and investigated. The following is a summary:— Accumulation of manure and refuse 86 Animals improperly kept 4 Bad smells 67 Dampness of premises 148 Defective drains, w.c's and fittings 455 Defective roofs, gutters, downpipes, etc. 350 Defective water fittings 198 Dirty and verminous houses 72 Dirty condition of rearway 6 Flooding of premises. 18 Overcrowding 96 Smoke nuisances 36 Miscellaneous 950 Total 2,486 (iv) Swimming Baths and Pools.—Samples of water for examination were taken from the open-air swimming bath from May to September (4); all the samples were satisfactory, but in 1 sample the chlorine content was below, and in 2 samples above, the prescribed standard. Samples were also taken from the two indoor baths during January, March, April, May, June, 24 July, September and November (13); all except one of the samples were satisfactory, but in 1 sample (from the 2nd class) the chlorine content was below the prescribed standard, and in 3 samples (1 from the 1st and 2 from the 2nd class) the chlorine content was above the prescribed standard. Following the unsatisfactory sample (from the 2nd class) the bath water was immediately replenished. (v) Eradication of Bed Bugs:— Found to be infested 19 Houses Disinfested 19* *Includes 3 nuisances detected before 1st January, 1946. (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 5 premises during 1946. (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 laundry at Newbury Park. Statutory Notices under the Public Health Act were served in both cases and the nuisances were abated. SECTION D.—HOUSING. (i) Overcrowding.—Informal notices were served in respect of 9 premises, 4 of which were complied with. Four statutory notioes were also served, 2 of which were complied with. (ii) Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. (iii) HOUSING STATISTICS. 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,679 (b) Number of inspections made for the purpose 10,726 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 256 (b) Number of inspections made for the purpose 1,864 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,531 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 1,730* 25 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 76 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 55* (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 177 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 119* (b) By local authority in default of owners — 0 & d. No proceedings were taken under Section 11, 12 and 13 of the Housing Act, 1936. 4. Housing Act, 1936, Part IV—Overcrowding:— (а) (i) Number of dwellings overcrowded at the end of the year 84 (ii) Number of families dwelling therein 95 (iii) Number of persons dwelling therein 369½ (b) Number of new cases of overcrowding reported during the year 80 (c) (i) Number of cases of overcrowding relieved during the year 5 (ii) Number of persons concerned in such cases 23½ (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 1946 of Notices served prior to 1st January, 1946. HOUSING ACT, 1936. During the year 1946, the work of receiving applications, calling for calculations for the "permitted number," was continued with a view to the issue of housing certificates. Altogether applications were received in respect of 16,054 houses. At the end of the year the total certificates issued to date numbered 18,125 in respect of 24,625 houses. 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 8,536. SE.CTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) Persons and Premises registered as at 31st December, 1946:— Premises registered as dairies and milkshops 34 Cowkeepers registered 2 Persons registered as retail purveyors of milk 161 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 14 23 253 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 98 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 161 premises from which milk iB retailed in Ilford, 16 are branches of 1 firm, and 5 another, 3 retail from dairy shops or stores, 11 from provision stores, and 7 from restaurants; 7 are retailers in a small way with rounds, while 34 sell sterilised bottled milk only, 12 sell sterilised milk and also milk in sealed containers, and 66 retail milk in sealed containers only. In 3 premises, pasteurising plant has been installed. Only 2 of these have, however, been licensed. In addition, 1 firm, having premises outside the district, is registered as a wholesale purveyor of milk in sealed containers. (ii) Licences were granted under the Milk (Special Designations) Regulations, 1936 to 1943, during 1946 for the sale of:— "Tuberculin Tested" Milk 16 "Pasteurised" Milk 24 The above include supplementary licences which were issued for "Tuberculin Tested" milk, 7; and "Pasteurised" milk, 8. These are licences granted to firms who already have a primary licence from another Authority, the milk being bottled outside the town, but sold in Ilford. The Essex County Council granted one producer's licence in respect of graded milk produced on a farm in the Borough during the year 1946. (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 looal 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 andstipulates the hours during which the test must be conducted. 27 The following results were obtained:— Grade of Milk or Ice Cream Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested (Pasteurised) Milk 16 16 — Tuberculin Tested (Certified) Milk 15 11 4 The analyses of these samples showed a high B. Coli. content. The County Medical Officer was communicated with in each case. Pasteurised Milk 58 53 5 These samples failed to satisfy the Methylene Blue Reduction test. In two cases supplies were obtained from a neighbouring Borough and the local Medical Officer of Health was infdrmed. In the other cases the retailers were communicated with and re-sampling ordered at a later date. Further samples proved satisfactory. Heat-Treated Milk 18 16 2 One sample failed to satisfy the Methylene Blue Reduction tgst, and the other failed to pass the Phosphatase test. The retailer was communicated with and further samples proved satisfactory. Ungraded Milk .. 66 58 8 Three samples failed to satisfy the Methylene Blue Reduction test, and the others had high Bacterial or B. Coli contents. In two cases supplies were received from districts outside the Borough, and the local Medical Officers of Health were communicated with. Resampling was ordered in all cases. Ice Cream 64 60 4 In one case supplies were received from outside the Borough, and the local Medical Officer of Health was communicated with. In all the other cases the premises were visited by the Sanitary Inspectors, and the processes and storage arrangements over hauled. Further available samples proved satisfactory. 28 (iv) Biological Tests.—42 samples of milk were submitted to a biological test for tuberculosis, none of which was found positive. (v) Milk and Dairies Orders, 1926 and 1938: Inspection or Dairy Herds.—One inspection was made by the Veterinary Officers of the Ministry of Agriculture and Fisheries. The Ministry's Divisional Inspector states there was no case of suspected tuberculosis in the Borough during 1946. (vi) Legal Proceedings.—As a result of the discovery of the body of a mouse contained in a bottle of milk delivered to one of the schools in the Borough, legal proceedings were taken against the dairy firm concerned, and at Stratford Magistrates' Court the firm was fined £20, \?ith 5 guineas costs, for selling milk unfit for human consumption. A month later another bottle of milk delivered by the same firm to another school in the Borough was found to contain an earwig. Legal proceedings, on the same grounds as in the previous case, were again instituted, and at the Stratford Court a fine of £30, with 5 guineas costs, was imposed. (vii) Registration.—No application for registration was refused during 1946. (viii) Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Bacon—31 lbs. 9 ozs. Biscuits—152 lbs. ; 23 packets; 26 tins. Bread—15 cwt. 8 ozs. Butter—5 lbs. 2 ozs. Cake Mixture—20 packets. Cereals—1 cwt. 56½ lbs.; 22 bags; 100 packets; 24 tins. Cheese—99J lbs. Cocoa—1 tin. Confectionery—-8 cwt, 102 lbs., 2 ozs. 14 packets, 830 lollies, 13 sticks, and 107 bars. Eggs (shell)—97. Eggs (dried)—2 packets, 1 tin. Fish—1 ton, 13 cwt., 3 stones; 19 boxes. Fish (tinned)—1,061 tins. Fish (shell)—1 bag; 26 lobsters. Fish (cakes)—2,160. Flour—5½ cwt. Fruit (tinned)—437 tins. Fruit (dried)—9 cwt., 56½ lbs. Fruit juices—6 bottles. Flavouring, Gravy Powders, etc.—237 packets, 22 bottles, 54½ dozen cubes. Herbs—87 packets. Jam, Marmalade, Preserves, etc.—210 jars. Jellies—148. Margarine—16 lbs. 4 ozs. Meat—4 cwts. 15J lbs. Meat (tinned)—768 tins. Meat (pies)—64. Medical foods—4 tins. Milk (tinned)—3,438 tins. Milk (dried)—21 packets. Mustard—1 tin. Paste (meat, fish, etc.)—114 jars. Puddings (tinned)—28. Pudding Mixtures—92 packets. Pickles, Sauces, etc.—38 jars. Rabbit—48 lbs. Salt—3 packets. Soup (tinned)—70 tins. Soup (powder)—4 packets. Sausages—16½ lbs.; 10 tins. Sausage Rusk—279 lbs. Suet—7 packets; 14 lbs. Sugar—2 cwt. Vegetables—122 lbs. Vegetables (tinned)— 944 tins. Food and Drugs Act.—During 1946, 190 samples (189 formal and 1 informal) of Food and Drugs were obtained. One formal sample was not genuine. The following action was taken:— (а) Egg Substitute Powder.—Deficient in available carbon dioxide to the extent of approximately 13 per cent, of the quantity proper to egg substitute powder. Detailed analysis showed that the preparation had deteriorated. In respect of this case a letter of warning was sent to the retailer by the Town Clerk. (b) Semolina.—Though genuine, found to be very lumpy and out of condition. A letter of warning was sent by the Town Clerk to the retailer, who was advised to remove the old stock from sale. 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.) Five cases were "notified" under the Act, and in one instance a case of suspected food poisoning was reported to me. 29 Notified Cases:— (а) 22.7.47. A mother and daughter were taken ill with symptoms suggestive of food poisoning. The examination of blood and faeces did not establish the presence of organisms of the Salmonella group. (b) Removed to Isolation Hospital 10th August, 1947. A faecal specimen was taken and an organism of the Salmonella Group was identified. After hospital treatment further faecal swabs were taken and no pathogenic organisms were isolated. (c) Removed to Isolation Hospital 26.7.46. Examination of blood and faeces showed the presence of a Salmonella organism. (d) Removed to Isolation Hospital 21.8.46. No pathogenic organisms were isolated and blood for agglutination against the Salmonella Group gave a negative result. Non-notified Case:— A teacher at one of the schools was reported as being absent from duty, owing to alleged food poisoning. Investigation did not substantiate the diagnosis. In all the above-mentioned cases detailed investigation was carried oul as to the food consumed, and samples were submitted for bacteriologicat examination. In no case was it possible to incriminate any particular article of food, nor was any public danger manifest. No secondary cases occurred and all patients made a good recovery. Bakehouses.—There are 34 bakehouses in the district, 26 of which use motive power. 172 inspections of bakehouses were carried out during the year. It was necessary to call upon the occupiers of bakehouses to carry out oleansing and other work in 6 instances, and the requests were complied with. Diseases of Animals Acts, 1894-1927. (i) Foot and Mouth Disease Order, 1946.—Notification was received, on 2nd July, of an outbreak of the disease at King's Cross. An Order made by the Minister of Agriculture and Fisheries, defining the "infected area," included Ilford. The Order was withdrawn, so far as this Borough was concerned, on 14th July. Movement of 11 pigs and 119 cows was permitted by licences issued in accordance with the Regulation of Movement Order, 1938. (ii) Swine Fever Order, 1938.—On 16th July, Notice was received from the Veterinary Officer of the Ministry of Agriculture and Fisheries of suspected Swine Fever at a Mental Hospital piggery. Form A was served. 219 Pigs (including 92 suckers) were dealt with as follows:—11 died (9 suckers) and were destroyed. The remaining 208 were killed at the slaughterhouse at the Institution upon the advice of the Veterinary Officer. Forty of these (12 suckers) were condemned and destroyed as being unsound and unfit for human consumption, and the remaining 168 carcases (71 suckers) were passed as sound except for one head and neck affected by tuberculous glands. These carcases were used or disposed of by the Hospital authorities. Swine fever was confirmed by the Ministry on 18th July, and complete disinfection and cleansing of the piggeries was carried out. The Form A notice was withdrawn by the Ministry as and from 6th August, 1946. (iii) Regulation of Movement of Swine Order, 1922-1926.— One Licence was countersigned for the entry into the Borough of 12 pigs. (iv) Poultry Exhibition Pens and Fittinos (Disinfection) Order, 1946.—A draft of this Order was received from the Ministry of Agriculture and Fisheries. It prescribes the manner of cleansing and disinfection of pens and fittings in connection with the exhibition of poultry and for egglaying trials. 30 (v) 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 1946. 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.—144 complaints have been received of the existence of rats affecting 155 premises. In 17 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 355 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 5 petroleum appliances or fittings. The number of Licences issued was 115, and the fees paid to the Council for such Licences was £84 10s. Od. Three Licences were issued for the storage of calcium-carbide, the fees payable being £1. Examination of Officers, Teachers and Servants. The following medical examinations were carried out during 1946:— Officers Teachers Servants New Appointments 246 4 51 Under SicknesB Regulations 12 — 65 Total 258 4 116 31 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The following diseases are notifiable to the Medical Officer of Health:— 1. Under Sections 144 and 343, Public Health Act, 1936. Smallpox. Typhoid Fever. Cholera. Entcric Fever or Relapsing Fever. Diphtheria. Anthrax (made notifiable by the Local Membranous Group. Authority as from 1.4.22). Erysipelas. Pemphigus Neonatorum (made notiScarlatina or Scarlet Fever. fiable by Local Authority as from Typhus Fever. 29.6.29). 2. Under Regulations of the Ministry of Health. Plague L.G.B. Order, 19.9.1900. Puerperal Pyrexia The Puerperal Pyrexia Regulations, 1939. Cerebro-spinal Fever Acute Poliomyelitis P. H. (Cerebro-spinal Fever and Acute Poliomyelitis) Regulations, 1912. Ophthalmia Neonatorum P. H. (Ophthalmia Neonatorum) Regulations, 1926. Acute Primary and Acute Influenzal Pneumonia Dysentery Malaria P. H. (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1927. Acute Polio-encephalitis Encephalitis Lethargica P.H. (Acute Encephalitis Lethargica and Acute Polio-encephalitis) Regulations, 1918. Tuberculosis .. .. .. P.H. (Tuberculosis) Regulations, 1930. Acute Rheumatism (up to 16 Ilford (Acute Rheumatism) Regulations, years). 1944. Measles and Whooping Cough The Measles and Whooping Cough Regulations, 1940. 3. By Local Act. Food Poisoning.. .. .. Ilford Corporation Act, 1937, and Food and Drugs Act, 1938. In addition to the above diseases notifiable to the Medical Officer of Health, certain industrial diseases are notifiable to the Chief Inspector of Factories, Home Office, under Section 66 of the Factories Act, 1937. These .are cases of Lead, Phosphorus, Arsenical or Mercurial Poisoning or Anthrax contracted in any factory. The Secretary of State can add other diseases to those mentioned by Regulation. S6 TABLE III—Cases of Infectious Diseases Notified dubino the Tear 1946 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 1 - - - - 1 - - - - - - - - - - 1 1 Scarlet Fever 242 1 45 159 31 5 - 1 33 11 39 45 33 18 18 26 19 181 Diphtheria, including Membranous Croup 25 - 2 11 5 4 3 — 1 6 1 2 4 I 5 3 2 25 Enteric Fever (Typhoid and Para-Typhoid) .. 3 - — 1 1 1 — — — — — 1 1 — — — 1 3 Pneumonia 274 21 31 30 14 54 70 54 16 33 35 51 21 25 30 31 32 176 Puerperal Pyrexia 53 — — — 23 36 — — 1 1 2 45 1 1 2 6 58 Cerebro-Spinal Fever 4 - 1 1 2 - - - - - - 1 2 1 - - - 4 Acute Poliomyelitis - - - - - - - - - - - - - - - - 1 2 Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - Dysentery 22 — 6 3 1 7 4 1 — 1 1 4 4 2 — 4 6 16 Ophthalmia Neonatorum 5 5 - - - - - - 1 - - - 3 1 - - - 4 Erysipelas 59 - - 4 1 16 21 17 1 10 3 15 10 9 3 - 8 23 Pemphigus Neonatorum 7 7 - - - - - - 1 - 1 3 - - - 2 Tuberculosis Pulmonary 230 1 4 11 66 114 28 6 15 10 21 36 24 29 30 37 28 - Other Forms 33 2 3 7 6 9 5 1 4 3 4 5 6 2 2 5 2 — Anthrax - - - - - - - - - - - - - - - - - - Malaria—Believed to be contracted in this country — - - - - - - - - - - - - - - - - - Believed to be contracted abroad .. 13 — - - 2 11 - - 2 1 - 4 1 - - - 5 6 Acute Rheumatism 19 - - 19 - - - - 1 - 2 3 2 1 1 4 5 13 Measles 1135 25 495 590 13 3 1 2 33 42 114 223 186 41 90 254 149 58 Whooping Cough 341 34 193 107 3 4 — — 25 20 41 67 25 43 29 39 52 10 Food Poisoning 5 — — 1 — 2 1 1 — — 1 — — — — 3 1 3 Totals 2479 96 780 952 168 207 133 83 133 140 262 460 370 177 209 408 320 584 33 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 74.8 Diphtheria and Membranous Croup 100.0 Puerperal Pyrexia 98.3 Pneumonia 64.3 The total number of deaths of Ilford residents from the following infeotious diseases during 1945 and 1946 were as follows:— 1945 1946 Scarlet Fever — — Enteric Fever — — Diphtheria 2 1 Measles 2 — Whooping Cough — 1 Influonza 7 20 Tuberculosis- Pulmonary 68 57 Other forms 13 9 Pneumonia 61 74 Diarrhoea (under 2 years) 8 5 Cerebro-spinal Fever 2 3 Puerperal Sepsis — — Total 163 170 The year 1946, on the whole, showed a lighter incidence to that of 1945. The number of cases of measles notified was 1,135 as compared with 2,154 the previous year. (а) Smallpox.—One modified case of smallpox occurred during the year. The patient—a naval petty officer, aged 26 years—had arrived home on 9th April from the Far East, having disembarked from a troopship at Liverpool the previous day. The patient was removed to Colchester Isolation Hospital on the day of notification, 14th April, and was discharged on 29th April. Four other members of the patient's family, and three other persons who had been in direct contact were vaccinated and were kept under strict observation. No secondary case occurred. Appropriate administrative action was taken and intimation sent to all local medical practitioners and adjoining local authorities. The year 1946 witnessed the homecoming of a large number of service personnel from the Far East, where smallpox is a prevalent disease. In consequence, notification of 225 persons who had been in contact with smallpox were received. These were visited by the Sanitary Inspectors for the usual period, 2,099 visits being paid to these persons. The following gives particulars as to Vaccination during 1946:— Certificates of Successful Vaccination 2,110 Postponed 48 Conscientious Objections 723 Unsuccessful Vaccination 35 Left the District 328 (b) Scarlet Fever.—242 cases were notified in 1946. There were no deaths from this disease. 34 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. 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 1946 242 180 7 3.8 01 4 6.5 (c) Diphtheria.—25 cases were notified in 1946. One death occurred at Hill End Hospital, St. Albans, a female patient, aged 18 years, the day following admission. 35 Diphtheria Immunisation .— Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1946, to 31st December, 1946. 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 96 6 102 9 1 10 112 Negative 67 3 70 31 — 31 101 Numbers inoculated (full course) 166* 1246 1,412 140* 644 784 2,196 Positive after full course of inoculations, and re-inoculated 5 14 19 - 4 11 15 34 Negative after full course of inoculations 159 1011 1170 122 569 691 1,861 Reinoculations (one only) 350 25 375 114 7 121 496 Awaiting re-test 2 206 208 12 57 69 277 Not re-tested after inoculation (on account of leaving District, etc.) - 15 15 2 7 9 24 Positive after re-test, but not inoculated for same reason - - - - - - - Final Schick Test in 1946 (1945 Cases):— Positive after full course of inoculations, and re - inoculated - 4 4 - 2 2 6 Negative 9 189 198 14 161 175 373 *Schick+1946 = 96; Schick+1945 = 2; Not Tested = 6 *Schick+1946 = 9; Not Tested=131 During 1946 a total number of 3,206 children attended at the Diphtheria Prevention Clinics (2,078 at Valentines Clinic and 1,128 at Mayes brook) .making a total number of attendances of 14.971 (9,635 and 5,336), with an average per session of 94 and 105 respectively DIPHTHERIA IMMUNISATION PUBLICITY CAMPAIGN. Publicity was intensified during 1946 by:— (а) Advertisements in the "Ilford Recorder" and "Ilford Guardian" for four issues commencing 2nd May. (b) Film. The showing of a trailer film (1½ minutes) at the three local Cinemas, one week at each, commencing on May 13th. (c) Posters. Double crown posters for display at the Council's Infant Welfare Centres, School Clinics and on refuse vans. (d) Distribution of a leaflet with extracts from recent broadcasts on Diphtheria by Sir Wilson Jameson, the Chief Medical Officer, Ministry of Health. (e) Continuation and intensification of the routine efforts by medical and nursing staff to ensure that all infants are immunised on reaching one year of age. (f) The inauguration of a campaign for a systematic re-inoculation of children at 4-5 year intervals. 36 In 1946, under the arrangements mentioned in the 1935 Report, 16 private doctors were supplied with prophylactic for the immunisation of 86 children (73 under 5 years and 13 over 5 years of age). The following is a brief summary:— 1945 Cases: Final Schick Test in 1946:— Negative 25 Positive and re-inoculated 1 No final Schick Test, left district, etc. 5 1946 Cases: Numbers inoculated (full course) by medical practitioners 74 Final Schick Test—Negative 52 Positive and re-inoculated 1 No final Schick Test, left district, etc. 4 Forms not yet returned 12 To be Schick Tested in 1947 5 (d) Ophthalmia Neonatorum.—5 cases were notified during 1946. Of these 1 was treated at home by a private medical practitioner, and 4 at the Isolation Hospital. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 5 1 4 5 — — — (e) Enteric Fever. —Three cases of this disease were notified during the year; they were two females aged 26 and 11 years and one male 15 years. One was a case of Typhoid fever and the others, cases of Paratyphoid fever "B." All were admitted to the Isolation Hospital and made good recoveries. It will be remembered there was an outbreak of Typhoid fever in Aberystwyth in the summer of 1946 due to infected Ice-cream. The patent who suffered from Typhoid fever had been on holiday at Aberystwyth and was taken ill after her return home to Ilford. (f) Typhus Fever.—Notice of the arrival of 15 persons in this country from areas infected with Typhus Fever were received. These persons were visited by the Sanitary Inspectors; 51 visits were made. (g) Scabies Order, 1941 (dated 28th October, 1941).—197 cases of Scabies (76 adults and 121 children) were reported. Six Ilford residents were admitted to the Isolation Hospital during the year. (h) Acute Anterior Poliomyelitis.—Two cases of this disease were notified during 1946. Both were boys of six years of age and were admitted to the Isolation Hospital. Despite prolonged hospital treatment both suffered some residual paralysis of the legs, and treatment was continued after discharge from hospital at the Council's Orthopaedic and Massage Clinics. 37 Table showing Incidence op Infectious Disease, 1946, in age groups; and total Deaths. Disease Total cases notified Under 1 year 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 Over 65 Cases admitted to Hospital Total Deaths Smallpox 1 - - - - - - - - 1 - - - 1 - Scarlet Fever 242 1 2 13 14 16 122 37 26 8 2 - 1 181 — Diphtheria 25 - 1 — — 1 10 1 2 6 1 3 - — 1 Enteric Fever (including Paratyphoid) 3 - - - - - - 1 1 1 - - - 3 - Pneumonia 274 21 9 10 6 6 26 5 5 35 28 70 54 168 74 Puerperal Pyrexia 59 — — — — — — — 4 59 8 — — 58 — Cerebro-spinal Fever 4 — 1 — — — — 1 1 1 — — — 4 3 Acute Poliomyelitis 2 - - - - - 2 - - - - - - 2 — Acute Polio-Encephalitis - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - Dysentery 22 — 2 2 2 — 3 — 1 6 1 4 1 13 — Ophthalmia Neonatorum 5 5 — — — — — — — — — — — 4 — Erysipelas 59 - - - - - 2 2 1 8 8 21 17 23 1 Anthrax - — - — — — — — — — — — - — Malaria believed to be contracted - - - - - - - - - - - - - - - Malaria believed to be contracted abroad 13 - - - - - - - - 11 2 - - 5 - Pemphigus Neonatorum 7 7 - - - - - - - - - - 2 — Acute Rheumatism 19 — - — — — 14 5 — — — — — 13 2 Food Poisoning 5 - - — — — — 1 — — 2 1 1 3 — Measles 1135 25 115 110 127 134 558 38 7 7 2 1 2 16 — Whooping Cough 341 34 52 62 43 36 104 3 2 4 I — — 9 1 *Excludes cases occurring at Barnardo's Homes, Claybury Mental Hospital and West Ham Mental Hospital. 88 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 period of 1945-46, having primarily in mind the possibility of an influenza epidemic. Fortunately there was no epidemic but a scheme was prepared, particulars being given in my report for 1945. Nevertheless, during January and February, 1946, a number of cases of Influenza, mostly attributable to infection by Influenza "B" did occur. In the main the attacks were mild and the outbreak did not assume epidemic proportions. The incidence of influenzal and primary pneumonia and the fatality rates throughout the year is shown by the following table. Month 1946 Acute Primary Pneumonia. Acute Influenzal Pneumonia. Hospital Admissions. Nursed at Home. Hospital Admissions. Nursed at Home. Isolation Hospital. Other Hospitals. Isolation Hospital. Other Hospitals. Cases Deaths Cases Deaths Cases Deaths Oases Deaths Oases Deaths Cases Deaths January 6 2 8 - 5 — 12 - 5 - 11 4 February 7 - 8 4 9 2 9 1 9 3 6 1 March 8 — 5 1 4 1 8 1 1 — 4 - April 5 2 3 - 5 - 2 1 2 - 2 1 May 3 - 4 — 4 - 3 — - - 2 - June 5 - 4 - 1 - 6 2 1 1 2 1 - July 2 1 2 - 3 - 2 1 - - - - August - - 2 — 2 1 - - — - 1 - September - - 1 - 1 - 3 1 - - - October 1 1 3 2 2 — 1 — - — 5 - November 3 - 7 1 8 3 3 - 3 - 5 - December 3 - 9 1 10 1 9 1 2 2 2 - Totals 43 6 56 9 54 8 58 8 23 6 40 16 It will be seen from the above figures that of 153 persons notified as suffering from acute primary pneumonia there were 23 deaths, equal to 15 per cent.; and in the case of acute influenzal pneumonia 121 notifications with 20 deaths, equal to 16.5 per cent. Of the 274 persons notified 101 were admitted to the Isolation Hospital, equal to 36.8 per cent. Of this number 14 persons died, equal to 13.8 per cent. 3. Tuberculosis. During the year 1946 there were 230 new notifications of Pulmonary Tuberculosis and 33 of other forms of Tuberculosis. 17 cases of Pulmonary and 1 case of Non-Pulmonary Tuberculosis were transferred to Ilford. 39 Notifications and Deaths from Tuberculosis of Ilford residents during 1946: Age Periods New Cases Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - 1 1 1 1 1 1-5 years 1 3 1 2 — — 1 2 5-15 4 7 5 2 — — — — 15-25 25 41 3 3 3 8 — 2 25-35 37 28 2 1 5 4 — — 35-45 34 15 3 3 6 — — — 45-55 12 3 2 1 11 4 2 1 55-65 9 4 2 — 8 1 — — Over 65 .. 5 1 1 — 5 1 — — Totals 127 103 20 13 38 19 3 6 Of the foregoing new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 1 1 Claybury Mental Hospital 2 — West Ham Mental Hospital 7 1 Australasian Hospital 2 — Isolation Hospital and Sanatorium 2 1 Of the 66 deaths which occurred of Ilford residents, notification had previously been made of 57 of the cases. Of the other nine, three were notified after death; five were not notified (9.0 per cent, of the deaths or a ratio of 1 in 11). Of the five not notified in two instances the notification was overlooked; and in three instances the presence of tuberculosis was discovered at Post-Mortem. One other death included by the RegistrarGeneral was untraceable. During the year 1946 the following deaths occurred from Tuberculosis:— Pulmonary Non-Pulmonary Ilford Residents 57 9 Non-Residents— Claybury Mental Hospital 10 — West Ham Mental Hospital 4 1 Ilford Isolation Hospital.. 33 1 Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1946 957 225 1182 Number of cases entered on register during the year 247 34 281 41 Number of cases removed from the register during the year:— Pul. NonPul. Pul. Non- Pul. Total Recovered 22 8 Deaths 66 8 Left District 84 11 Lost sight of 13 2 Diagnosis not established 7 - - 192 29 221 Number of cases remaining on register on 31st December, 1946 1012 230 1242 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurse of the Essex County Council. 1024 of the cases of longer standing were visited by the Sanitary Inspectors during the year, a visit being made to each patient every six months. The following reports were obtained:— Pulmonary Cases Other Cases Stated to be recovered or better .. .. 318 110 Improved or fairly well 296 67 Not so well 66 13 In Sanatorium 100 6 No information as to present condition 9 2 Removed from district, etc. 31 6 Totals 820 204 The treatment of Tuberculosis is under the control of the Essex County Council. On the 31st December, 1946, there were 1,094 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. 157 patients were treated, 34 being supplied with dentures. The Council's Dentist treated 36 tuberculosis patients from the Ilford Sanatorium, four visits being paid to the sanatorium. The number of patients from Ilford sent to Institutions under the Essex County Tuberculosis Scheme during 1946 was as follows:— • Pulmonary Non-Pulmonary Total Males Females Males Females Adults 28 34 11 4 77 Children 4 2 1 1 8 Tuberculosis Care Association.—This Association has assisted 93 cases with extra nourishment, clothing, and in other ways. Public Health Act, 1936 (Section 163).—Two 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. 41 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. Twenty-one persons were assisted during 1946 with the Insulin required. Thirteen persons were assisted at part cost, four at cost price, and four free cf 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 - - - - - - - - - - - - — Locomotor Ataxy — — — — — — 1 I — — — 2 General Paralysis of the Insane — — — — — 2 — 2 — — — 3 7 Aortic Aneurysm - - — — — — — 2 — 1 — 1 4 The deaths in Institutions of Ilford non-residents occurred chiefly at Claybury Mental Hospital and West Ham Mental Hospital; 1.5 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 eases of Ophthalmia Neonatorum notified during the past five years :—1942, 9; 1943, 8; 1944, 4; 1945, 3; 1946, 5. It is to be remembered that many cases of ophthalmia neonatorum are not due to gonorrheal infection. By the Public Health (Venereal Diseases) Regulations, f916, 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, 12.15 to 3.15 p.m. 42 Whitechapel.—Whitechapel Clinic (London County Counoil), Turner Street, Mile End, E. 1:— Sessions .. Monday to Saturday. Males, Females and Children—Mornings, afternoons and evenings. West Ham.—Queen Mary's Hospital for the East End, West Ham Lane, Stratford, E.15:— Sessions .. Males .. Monday, 3.0 to 5.0 p.m. Thursday, 11.0 to 1.0 p.m. f 6.0 to 8.0 p. m. Females .. Monday, 6.0 to 8.0 p.m. Thursday 11.0 to 1.0 p.m. 3.0 to 5.0 p. m. Saturday.. 2.30 to 4.30 p.m. In conjunction with the Essex County Council, 422 posters and 1,000 pamphlets issued by the Ministry of Health were distributed to factories, cinemas and public houses in the Borough. Arrangements were made with the co-operation of the Borough Engineer and Surveyor for the posters to be exhibited in all public conveniences under his control. PUBLICITY AND PROPAGANDA. In connection with the exhibition of the interest film "Young and Healthy" to a child audience at a local cinema, the Chairman of the Public Health Committee and myself made a short introductory talk stressing the importance of personal hygiene. The Ministry of Information films, entitled "Blood Transfusion," "Scabies" and "Scabies Mite," were shown in the Lecture Room at the Isolation Hospital on 18th January, 1946, to the Nursing Staff, Sanitary Inspectors and Health Visitors. Fifty copies of the magazine "Better Health" are distributed monthly to the reading rooms of Public Libraries, at Infant Welfare Centres, and in the waiting rooms of the School and Dental Clinics. Public lectures to Ratepayers' Associations, Evening Institutes, Rotary Clubs and Church organisations, etc., on health topics were given during the year. The Chairman of the Public Health Committee also made reference at a number of Council meetings to health subjects. Poster displays regarding Diphtheria immunisation and health topics were also given prominence. 43 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 346 factories with mechanical power on the register. There are 306 factories without mechanical power on the register. There are 94 outworkers on the register. 1.—INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections madi by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) Factories with Mechanical Power 553 22 - Factories without Mechanical Power 194 4 - Other premises (not including Outworkers' premises) — — — Total 747 26 — 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) 7 6 - - Overcrowding (S.2) — — - — Unreasonable Temperature (S.3) 2 2 - - Inadequate Ventilation (S.4) — — - — Ineffective Drainage of Floors (S.6) Sanitary Conveniences (S.7):— Insufficient 6 4 - — Unsuitable or Defective 6 4 - — Not Separate for Sexes 3 2 - — Other Offences 5 5 - — Total 29 23 - - 44 ISOLATION HOSPITAL. 965 patients were admitted during 1946. 100 per cent, of the notified cases of diphtheria and 74.8 per cent, of scarlet fever occurring in the district (excluding those cases treated at the Institutions at which they were notified, or were transferred to other Isolation Hospitals) were admitted to the hospital. The 965 patients admitted during the year suffered from the following complaints:— Ilford Barking Admissions Deaths Admissions Deaths Surgical Scarlet Fever 2 — 1 — Scarlet Fever 157 — 67 — Diphtheria 11 — 4 1 Pneumonia 90 11 7 — Chicken Pox 4 — 2 — Whooping Cough 8 — 1 — Whooping Cough and Pneumonia — — 1 — Whooping Cough and Bronchitis — — 1 — Measles and German Measles 19 — 8 — Measles and Pneumonia 5 — — — Measles and Bronchitis 1 — 1 — Erysipelas 19 1 4 — Dysentery 6 — — — Puerperal Pyrexia 20 — 3 — Puerperal Varicella 1 — — — Acute Purulent Bronchitis 2 2 — — Bronchitis 11 — 1 — Bronchitis and Asthma 2 — — — Influenza 4 — — — Pneumococcal Meningitis 1 1 — — Tuberculous Diseases—Pulmonary 121 39 — — Tuberculous Diseases—Other forms 2 2 1 1 Acute Rheumatism 7 2 — — Tonsillitis 9 — 3 — Acute Follicular and Streptococcal Tonsillitis 11 - 16 - Mumps 2 — 1 — Scabies 6 — — — Enteritis 2 — — — Cerebro-Spinal Fever 1 — — — Infective Hepatitis 4 — — — Acute Anterior Poliomyelitis 2 — — — Abortions 21 — 2 — Acute Aseptic Meningitis 1 — t — — Laryngitis and Bronchitis 4 — — — Staphylococcal Dermatitis 3 — — — Staphylococcal Conjunctivitis 4 — — — Malaria 2 — — — Typhoid—Para-typhoid Fever 3 — — — Food Poisoning 3 — — — Cancer 3 1 — — Ophthalmia Neonatorum 4 — — — Cerebral Astrocytoma, broncho pneumonia - - 1 1 Coronary Thrombosis 1 1 — — Acute Ulcerative Colitis 1 1 — — Subarachnoid haemorrhage due to ruptured aneurism of right middle cerebral artery 1 1 - - Others 225 — 34 — Post-Mortems were held by H.M. Coroner in connection with 16 ot the above 65 deaths. 45 Number of patients in Hospital on 1st January, 1946 and 1947. respectively:— 1st Jan., 1946 1st Jan., 1947 Scarlet Fever 20 14 Diphtheria 15 2 Tuberculous Diseases 65 72 Puerperal Pyrexia 1 3 Para-typhoid fever — 1 Pneumonia 12 9 Acute Rheumatism 1 — Chicken Pox 1 — Dysentery — 1 Acute Anterior Poliomyelitis 1 1 Observation and other cases 8 10 The average length of stay in Hospital was for:— Scarlet Fever 24.4 days Diphtheria 63.3 „ Tuberculous Diseases 103.9 ,, Average stay in Hospital of all eases 25.6 ,, The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day 119.4. Scarlet Fever.—The diagnosis of scarlet fever could not be confirmed in 30 patients admitted. No deaths occurred from this disease. 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. 1942 1943 1944 1945 1946 Ilford Nil 9.1 5.8 4.5 Nil One death occurred—a female patient, aged 10 years, admitted from the Borough of Barking. The child was in a moribund state on admission, and died within a few minutes; she had not been immunised. PUERPERAL PYREXIA AND OBSTETRICAL COMPLICATIONS. The years 1945 and 1946 were notable for an increased number of admissions of obstetrical cases to the Isolation Hospital, owing to pressure of accommodation for maternity cases, and as a precautionary measure againstrisk of infection. The two years are compared:— 1945 1946 Confinements 3 5 Abortions 16 23 Mothers and infants 52 72 Tuberculosis.—121 cases of Pulmonary Tuberculosis were admitted, as compared with 186 in 1945. 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 occupied. Charges. 1, 2 & 6 52 Males Whole year £3 12s. 6d. per week whether occupied or not. 10 20 Females ditto ditto. 46 Training of Nurses.—During 1946, 5 nurses passed Parts I and II, 5 passed Part I and 3 passed Part II of the Preliminary Examination of the General Nursing Council, and 14 obtained the Certificate by passing the Final Examination (9 student nurses, 6 staff nurses). The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick tested during 1946, and also the number inoculated:— Numbers Schick Tested:— Nurses Domestics Positive 9 3 Negative 24 13 Numbers inoculated (full course) 7 3 Numbers re-tested:— Negative after full course of inoculations 5 1 Positive after full course of inoculations, and re-inoculated - - Numbers Dick Tested:— Positive 7 2 Negative 26 14 Numbers inoculated (full course) 7 2 Numbers re-tested:— Negative after full course of inoculations 6 1 Positive after full course of inoculations, and re-inoculated - - No member of the Nursing Staff contracted Diphtheria or 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 1946 examinations were conducted as follows:— Primary examination on engagement. Re-examinations. Nursing Staff 44 87 Domestic Staff 29 39 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 in that area, as far as accommodation permitted, continued during the year. During 1946 the number of cases admitted was 159. Payment was at the agreed rate of 12s. 6d. per day, plus a charge of 2s. per mile for use of ambn lance. 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. Oxygen Tents.—During 1946 oxygen tents were used on 34 occasions with very satisfactory results. The charge for the use of a tent is 17s. 6d. per day. 47 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 1946 was 2,661 (1,425 males and 1,236 females). Of these, 207 (101 males and 106 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 899 notifications of birth (464 males and 435 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, 26 cases in which there was default in complying with the requirements of the Public Health Aot 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 3.27 By Certified Midwives 94.40 By Parents and Others 2.33 In addition, 78 stillbirths (43 males and 35 females) were notified. The notifications of 18 stillbirths (8 males and 10 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 2,661 live births occurring in Ilford during 1946, 149 weighed 5½ lbs. or less at birth; 66 of these babies were born at home and 83 in Hospital (including 8 in a Private Nursing Home). The number of those born at home:— (i) who were nursed entirely at home 66 (ii) who died during the first 24 hours 5 (iii) who survived at the end of one month 52 The number of those born in Hospital:— (i) who died during the first 24 hours 17 (ii) who survived at the end of one month 59 Owing to existing 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. (b) Supply of expressed breast milk where this is necessary. . (c) Giving of particular attention to babies by Midwives or Health Visitors, preferably with special training and experience with premature infants. (d) Services of Home Help specifically for this type of case. (e) Admission of selected cases to Institutions where special care is appropriate to such cases. (f) Special form of transport for the conveyance of infants to Hospital. Dr. I. M. Anderson has been appointed as Consultant Paediatrician to the Council's Maternity Home, and he also attends a fortnightly Clinic at these offices. Details of the cases seen at the Clinic are given on page 55. Infant Mortality.—The number of infants dying within the first year of life was 102, the total number born being 3,443. 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 29.6, the lowest figure ever recorded in Ilford. Neonatal Mortality.—The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 74 deaths of infants under four weeks of age during 1946 and the rate for the year was 21.5 per 1.000 live births. The deaths of infants under one month increased from 49 during 1945 to 74 during 1946. The following table gives the deaths of infants under one year of ago, classified according to age. 48 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 Acute bacterial enteritis — 1 — — 1 — — — — 1 Acute bronchitis — — - - - - - - 1 1 Acute pneumococcal peritonitis - 1 - - 1 — — — — 1 Acute pyelonephritis - - - - - 1 — — — 1 Acute capillary bronchitis - - - - - 1 — — Acute suppurative bronchitis - - - 1 1 — — — — 1 Asphyxia - - - - - - - 1 — 1 Atelectasis 6 — — — 6 — — — — 6 Bilateral pyelonephritis - - - - - - - - - 1 Cerebral haemorrhage — 1 — — 1 — — - - 1 Congenital malformations 6 — — — 6 2 — — — 8 Erythroblastosis foetalis — — — — — — 1 - — 1 Gastro enteritis — — — 3 3 — — 1 - 4 Haemolytic Jaundice 1 — — — 1 — — — — 1 Icterus gravis neonatorum 2 2 — — 4 — — — — 4 Infected spina bifida — 1 — — 1 — — — — 1 Marasmus, debility and atrophy - - - - - - 1 l — 2 Mongolism 2 — — — 2 — — — — 2 Other tuberculous diseases - - - - - - - l — 1 Pneumonia (all forms) 2 1 1 1 5 6 1 3 1 16 Prematurity 38 — 1 1 40 — — — — 40 Protracted labour, disproportion ,. 1 — — _ 1 — — - — 1 Rhesus incompatability - - - - - - - 1 - 1 Septicaemia — 1 — — 1 — — - - 1 Sub-cranial hydrocephalus - - - - - - - 1 — 1 Subcutaneous gluteal abscess - - - - - 1 — — — 1 Suffocation - - - - - — — 1 — 1 Tubercular meningitis - - - - - - - - 1 1 Totals 58 8 2 6 74 12 3 10 3 102 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. 1946 102 29.6 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 49 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. 1946 29.6 43 41 46 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 63 57 57 1937 42.0 58 60 62 Illegitimate Births and Deaths.—107 of the live births registered (45 males and 62 females) were illegitimate, that is 3.1 per cent, of the births registered. Five illegitimate children died under one year of age from the following causes:— Atelectasis; prematurity 36 weeks, due to eclampsia. Broncho pneumonia. Cardiac failure due to pneumonia. Extreme prematurity, approximately 30 weeks gestation. Marasmus; Congenital heart disease. The infant mortality rate of illegitimate children was 46.7 per 1,000, compared with the infant mortality rate of 29.1 for legitimate children. The following table shows the birth and death rate9 of legitimate and illegitimate infants for the past ten years:— Year. Legitimate Infants. Illegitimate Infants Live Births. Percentage of Registered Births. Deaths. Rate per 1,000 Legitimate Live Births. Live Births. Percentage of Registered Births. Deaths. Rate per 1,000 Illegitimate Live Births. 1946 3,336 96.9 97 29.1 107 3.1 5 46.7 1945 2.343 94.5 73 31.2 136 5.5 8 58.8 1944 2,655 95.8 95 35.7 116 4.2 7 60.3 1943 2,532 96.6 89 35.2 89 3.4 3 33.7 1942 2,330 96.5 71 30.4 85 3.5 3 35.3 1941 1,756 96.7 61 34.7 60 3.3 6 100.0 1940 1,974 97.5 60 30.4 50 2.5 3 60.0 1939 2,255 97.8 72 31.9 52 2:2 3 57.7 1938 2,233 97.6 83 37.2 56 2.4 1 17.8 1937 2,202 97.3 91 41.3 61 2.7 4 65.6 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. 50 There is, however, co-operation with a Voluntary Moral Welfare Worker in the distriot and all cases are followed up by the Health Visitors. If necessary arrangements are made with the Essex County Council for the admission of girls with their babies to the Ardmore Hostel, Buckhurst Hill. No cases were admitted from Ilford during 1946. A number of unmarried mothers from Ilford are also aocepted at the Eomford, Hornchurch and Upminster Moral Welfare Committee's Hostel at 51, Junction Road, Romford. Foster-Childbbn . Number of foster-children on register on 1st January, 1946 24 Number of foster-children who were notified during 1946 8 Number of foster-children returned to their mothers during 1946 5 Number of foster-children taken off register for various other reasons during 1946 6 Number of foster-children on the register on 31st December, 1946 21 Fo8Tek-Mothers . Number of foster-mothers with children on the register on the 1st January, 1946 21 Number of persons who became foster-mothers during 1946 8 Number of foster-mothers whose names were taken off the register during 1946 11 Number of foster-mothers with children on the register on the 31st December, 1946 18 Number of houses visited by the Sanitary Inspectors for the purpose of the Act during 1946 11 Number of visits made by the Sanitary Inspectors for the purpose of the Act during 1946 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:— (а) That any person (other than a registered adoption society or a local authority, and not being the parent or guardian or a near relative of the child or the person in whose care or possession he is to be placed), who participates in making arrangements for the adoption of a child under the age of nine years, must give notice, in writing, of the arrangements to the Welfare Authority for the area in which the adopter resides, not less than seven days before possession is taken of the child by the adopter. This does not apply when an adoption order is made. During 1946 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; the other 13 children were still under supervision at the end of the year. (б) That an adopter must notify a Welfare Authority if he changes his address or if the child dies. In the latter event he must also notify a coroner. No notices were received during 1946. Work of Health Visitors.—The Ilford area is at present 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, but at the end of the year there were only 12 Health Visitors. 51 The following is a summary of the home visits made by the Health Visitors during 1946 as far as the Maternity and Child Welfare work is concerned:— First visits to newly-born infants 3.741 Subsequent visits to children under 1 year of age 5,819 Subsequent visits to children over 1 year of age and under 5 9,276 Visits to expectant mothers 466 Home visits for other reasons 2,004 Total visits paid 21,306 Supply of Milk to Expectant and Nursing Mothers and Infants.— A total of 55 lbs. of dried milk were given free under the Regulations of the Ministry of Health during 1946 to 2 infants. Since July, 1940, the supply of liquid milk by the Council has been suspended as this is now provided under the National Milk Scheme. Day Nurseries. (a) On the 31st December, 1945, notification was received from the London County Council, the owners of the site of the Becontree Avenue Day Nursery, that it was necessary for the Council to resume possession of the land in order that the work of re-building of the housing accommodation, formerly occupying the site could be proceeded with, and subsequently requesting that the site should be cleared by the 1st July, 1946. Following discussions with the London County Council, the Council have fortunately been able to retain the Nursery on the site until such time as a proposed Nursery on land in Stevens Road is built. The Ministry of Health have sanctioned the proposal of the Council to erect a Nursery in Stevens Road to accommodate 50 children, and the work will be proceeded with as soon as the plans have been approved by the Ministry. (b) Future Provision of Nursery Accommodation for Children under Five.— Arising from a circular issued by the Ministry of Health and the Ministry of Education, and from a letter received from the Clerk of the Essex County Council, on the future planning, development and operation of Day Nurseries the Ilford Council agreed that, as a short-term policy, the four Day Nurseries in the Borough be continued as heretofore, pending the formulation of the Educational Development Plan, subject to the continued availability of premises. The Ministry of Health subsequently approved the arrangements made. (c) In the circular mentioned the Ministry stated that the arrangement under which the Authorities' net expenditure on war-time nurseries was re-imbursed from the Exchequer would continue until the 31st March, 1946, and that as from that date a special grant payable in respect of their net approved expenditure which was approximately 50%, would instead be payable. {d) The Council were further empowered to vary as from the 1st April, 1946, the existing charge of 1s. per day for the maintenance of children in the nurseries. It was decided, however, not to make any variation in such charge, but to review the matter in twelve months' time. (e) Owing to the exceptionally lengthy waiting lists of children for admission to the Day Nurseries the Council decided to admit the children on a priority basis, dependent upon the domestic circumstances of the parent or parents of the children. (/) The Nursery Nurses Examination Board has now replaced the National Society of Children's Nurseries as the examination authority for Students trained at the Day Nurseries. As all the four Day Nurseries were affiliated 52 to" the National Sooiety of Children's Nurseries, they are recognised for training purposes by the newly-established Board. The training covers a period of two years, during which time Students are required to attend one of the local technical colleges on two days per week during their normal working hours; the practical training is undertaken in tha Nurseries. During the year three Students from the Sunshine House Nursery, one from the Green Lane Nursery, and one from the Ley Street Nursery sat for the examination, four of whom obtained either the diploma of the N.S.C.N. or the certificate of the National Nursery Nurses Examination Board. The following is a table showing the attendances, eto. at the four Day Nurseries during 1946:— 53 Situation Date of Opening Accommodation (Children) Average Daily Attendance during 1946 No. of Days in Quarantine Reasons for Quarantine No. on WaitingList at 31st Dec. 1946. Including Saturday Exoluding Saturday Sunshine House, Girls' Village Homes, Barkingside 17.8,42 45 29 33 82 1 case of Mumps. 53 10 cases of Chicken Pox. 1 case of German Measles. 359-381, Green Lane, Seven Kings 5.5.43 50 30 33 83 8 cases of Measles. 55 2 cases of Mumps. 1 case of Chicken Pox. 226-236, Ley Street, Ilford 16.8.43 50 34 36 94 4 cases of Measles. 79 1 case of Scarlet Fever. 2 cases of Chicken Pox. 1 case of Whooping Cough. Becontree Avenue, corner of Winding Way, Dagenham 17.1.44 50 29 32 52 1 case of Measles. 24 1 case of Scarlet Fever. 1 case of Whooping Cough. 54 Infant Welfare Centres.—77 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1946. Daring the year the following attendances were recorded:— Total number of attendances of infants 46,620 First attendances 2,886 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 4,049 14.016 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 ohildren on roll on 31st December. 1946 46,620 2,886 4,049 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 In consequence of the rise in the Birth Rate, the attendances at the Infant Welfare Centres increased during 1946 by 23.6% compared with the attendances for 1945. To cope with the increased attendances additional Centres were opened on the following dates:— Seven Kings on the 3rd April (previously combined with the Downshall and Chadwell Centres). Cecil Hall on the 9th May (additional session). Ilford Lane on the 12th July (previously combined with the Grosvenor Road Centre). Goodmayes on the 12th September (previously combined with the Becontree Centre). Valentines on the 15th November (previously combined with the Woodford Avenue Centre). Fairlop on the 7th December (previously combined with the Barkingside Centre). 497 sessions were held during the year; the average attendance at each session being 93 mothers with their infants. The following are the figures for each Centre:— Sessions. Average attendance. Chadwell 48 86 Barkingside 48 141 Downshall 48 80 Becontree 48 93 Woodford Avenue 48 137 Seven Kings 35 71 Cecil Hall (Wednesday) 48 83 Cecil Hall (Thursday) 31 78 Newbury Hall 48 64 Grosvenor Road 48 113 Goodmayes 15 67 Ilford Lane 23 80 Valentines 6 52 Fairlop 3 37 55 Paediatrio Clinic. Dr. Anderson, the Council's Consultant Paediatrician, commenced his first fortnightly Clinic on 29th October, 1946, and 6 sessions were held from then until the end of the year. 29 children were referred from the Infant Welfare Centres and Maternity Home for the following reasons:— Condition requiring Attention. Still attending. Ref. to Hospital Clinic or Specialist Discharged, cured. Discharged. No treatment required Discharged. Improved. Discharged; other reasons. Total. Anaemia, anorexia 1 - - - - - 1 Backward in talking. Behaviour problem 1 - - - - - 1 Birth injury to brain — 1 - - - - 1 Bronchitis 2 - - - - - Chest deformity. Rickets 1 - - - - - 1 Multiple adenitis 1 - - - - - 1 Testicular enlargement 1 - - - - - 1 Exophthalmos, large abdomen, genu valgum 1 - - - - - 1 Nutritional difficulties 1 1 - 2 1 — 5 General debility, malnutrition - - - - 1 - 1 Generalised rash. Erythromelalgia - 1 - - - - 1 Lipoma of left thigh 1 - - - - - 1 Maldevelopment of genitalia 1 - - - - - 1 Nocturnal enuresis — 1 - — — — 1 Athrepsia 1 - - - - - 1 Paranasal tumour. Lachrymal obstruction - 1 - - - - 1 Projectile vomiting 2 - - - - - 2 Seborrhoea of scalp — — - — 1 — 1 Sub-nutrition and debility — 1 - — — — 1 Deformity of leg 1 - - - - - 1 Tumour on buttock 1 - - - - - 1 Talipes, left foot, ventral hernia, squint. ? M. D. - - - - - 1 1 Xanthomatic rash on face — — - — 1 — 1 Totals 16 6 — 2 4 1 29 Dental Clinics.—209 half-days were taken up for the treatment of expectant and nursing mothers and children under 5 years of age during 1946: 110 at Valentine's Clinic, and 99 at Mayesbrook Clinic. The following is a summary of the work carried out for the Maternity and Child Welfare Committee during the year:— (a) Treatment of Mothers: Valentines Clinic. Mayesbrook Clinic. No. of patients treated during 1946 378 179 No. of attendances of patients 889 719 No. of administrations of "general" anaesthetics 162 161 No. of administrations of "local" anaesthetios 71 49 No. of fillings and other operations 1,269 1,439 No. of mothers having dentures supplied (inoluding 17 at part cost) 75 49 56 (b) Treatment of Children under 5 years of age: No. of patients treated 130 88 No. of attendances of patients 149 164 No. of administrations of "general" anaesthetics 57 76 No. of administrations of "local" anaesthetics - - No. of fillings and other operations 211 265 The following are the figures for the past 5 years:— 1942. 1943. 1944. 1945. 1946. No. of Mothers treated: (i) Valentines Clinic 509 635 481 398 378 (ii) Mayesbrook Clinic . 24 50 — 68 179 No. of Children treated: (i) Valentines Clinic 180 179 143 130 130 (ii) Mayesbrook Clinic . 7 15 — 46 88 Ophthalmic Clinic.—23 expectant and nursing mothers and 179 children under 5 years of age were treated by the Council Oculist during 1946: 54 pairs of spectacles were supplied, 5 to mothers and 49 to children. Orthopaedic Clinic. (i) Newbury Ball Clinic.—52 sessions were held during 1946, 356 children under 5 years of age being examined, making 820 attendances. (ii) Mayesbrook Clinic.—-25 sessions were held during 1946, 183 ohildren under 5 years of age being examined, making 417 attendances. The 539 children were found to be suffering from the following defeots:— Diagnosis. New Cases. Old Cases. A B A B Paralyses:— Hemiplegia 1 — 1 — Paraplegia — — 1 — Foot drop 2 — — — Scoliosis — — 2 — Kyphosis — 1 — — Slack poBture 1 — 1 — Deformity of hips 2 — 1 — Genu valgum 65 37 72 47 O.C.T. 27 16 33 21 Genu varum. 3 4 2 1 Pes valgo planus 15 9 29 13 Valgus ankles 21 5 24 10 Talipes calo. valgus 2 — — 2 Cong, talipes E. V. .. 1 — 1 1 Pes calc. valgus 2 — — — Intoeing 2 — 8 4 Deformity of toes 4 2 8 2 Rickets — — 1 — Torticollis 3 — 2 — N.A.D 5 2 2 1 Other conditions 5 2 7 3 Totals 161 78 195 105 A—Newbury Hall. B—Mayesbrook. 57 No children were admitted to the Country Branch of the Royal National Orthopaedic Hospital at Stanmore under the scheme in force between the hospital and this authority. At the Newbury Hall Clinic, 21 children under five years of age were treated by the Masseuse during the year, and 214 attendances were made by these children. Treatment was also given to 10 children who made 60 attendances at the Mayesbrook Clinic. Aural Clinio.—The Aural Surgeon attended at 65 sessions during 1946 and 167 attendances were made by 1 expectant mother and 120 children of pre-school age. 34 children were operated upon for removal of tonsils and adenoids : 24 at Queen Mary's Hospital and 10 at King George Hospital. Rheumatism Clinic.—30 sessions were held during the year at Newbury Hall, at which 26 children under 5 years of age, 13 being new cases, made 69 attendances. The following is a summary of the cases treated:— Condition. New. Old. Total. History of Chorea - 1 1 Congenital Heart Disease 2 9 11 No active Rheumatic disease 2 — 2 Heart murmur functional 2 1 3 Pains due to Orthopaedic conditions 6 1 7 Other conditions 1 1 2 Totals 13 13 26 Number of cases referred to Ear, Nose and Throat Surgeon 1 ,, ,, ,, Orthopaedic Surgeon 5 ,, ,, ,, for X-ray and Electrocardiogram 6 ,, ,, ,, Blood Sedimentation Rate 4 Artificial Sunlight Clinic. 41 sessions were held at the Newbury Hall Clinic and 46 at Mayesbrook Clinic. 102 children in all were treated, making 1,628 attendances. The conditions treated were as follows:— Conditions. New Cases. Old Cases. A B A B Anaemia, Debility and Malnutrition 9 5 13 6 Bronchitis - 1 1 - Genu varum 6 10 13 6 Adenitis 3 — 1 1 T.B. glands 1 - 1 1 Asthma 2 - - 1 Genu valgum 2 2 1 — Old Rickets 7 3 1 1 Other conditions — 2 1 1 Totals 30 23 32 17 A—Newbury Hall. B—Mayesbrook. 50 cases were Btill attending at the end of the year; of the remainder 2 had removed from the district, 17 were discharged, not having shown any improvement, and 33 were discharged having made a satisfactory recovery. 58 Treatment oe Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 130 belts and one truss have been supplied to infants suffering from hernia during 1946. A certain number of infants were brought to the Clinics at Newbury Hall and Mayesbrook Clinic to receive treatment for minor ailments. Midwives.—There are 19 State certified midwives (including the Superintendent and 13 Council midwives) resident and practising in the district. In addition there were at the end of the year, 13 State certified midwives at the Council's Maternity Home and 4 at a private nursing home in Ilford. Their supervision has been carried out as in previous years. Suspension from Practice.—Two Midwives were suspended from practice for varying periods during the year following attendance on 2 cases rendering them liable to be a source of infection. Both Midwives were employed by the Council. The reasons for suspension from practice were as follows:— (1) Attended notified case of Puerperal Pyrexia stated to be due to sepsis and widespread erythema. The vaginal swab showed a pure growth of haemolytic streptococci. A swab from the throat of the Midwife also showed the presence of haemolytic streptococci. (2) Attended notified case of Puerperal Pyrexia stated to be due to post partum haemorrhage, osteomyelitis of pubis with abscess formation. Swab from the throat of the Midwife showed the presence of haemolytic streptococci. In addition two Midwives from the Salvation Army were suspended from duty for a short period as one of their Pupil Midwives developed Tonsillitis, a swab from her throat showing the presence of haemolytic streptococci. Medical aid was sought in 12 instances where the infant was found to have inflamed or discharging eyes. One of the cases was subsequently notified as suffering from Ophthalmia Neonatorum. In all cases the condition of the eyes cleared satisfactorily. The Council has adopted the suggestion of the Minister of Health that they should refrain from exercising their power of recovery of the fee of the Medical Practitioner under Section 14 (4) of the Midwives Act, 1918, in this class of case. Council District Midwifery Service.—During the year 1,202 cases were attended. In 718 cases the midwives were engaged to attend as midwives and in 484 as maternity nurses. The cases resided in the following wards: Barkingside 207; North Hainault 181; Cranbrook 65; Park 103; Seven Kings 121; South Hainault 148; Loxford 179; Clementswood 152; Goodmayes 46. 3,855 ante-natal visits were made during the year. In October, 1946, the Council decided to purchase a car for the use of the Deputy Superintendent of Midwives. This was delivered in April, 1947. At the end of the year there were 12 District Midwives employed by the Council in addition to the Superintendent and Deputy Superintendent. 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. 55 patients were referred by Private Doctors to the Counoil's Consultant Obstetrician at the Ante-Natal Clinic for a further opinion. 28 of these women and 57 other patients who had engaged a Council Midwife (40 as a Midwife and 45 as a Maternity Nurse) were for various reasons admitted to the Council's Maternity Home or other Institutions for confinement. 75 were admitted to the Maternity Home, 1 to the Ilford Isolation Hospital, 1 to the City of London Hospital, 2 to Oldchurch County Hospital, Romford, 3 to Queen Mary's Hospital, Stratford, 1 to King George Hospital, Ilford, 1 to Queen Charlotte's Hospital and 1 to a Private Nursing Home. In addition 1 patient was admitted to the Maternity Home for antenatal treatment and subsequently confined at home. 59 A Doctor was called in at the time of the confinement or subsequently to 229 of the 718 cases in which a midwife had been engaged. 7 cases were notified as suffering from Puerperal Pyrexia, 5 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. In one case the midwife was engaged as a maternity nurse only. One infant was notified as suffering from Pemphigus Neonatorum. The midwife was engaged as a midwife. Of the infants born there were 20 BtillbirthB from the following causes:— Anencephalio 4 Breech presentation, prematurity 1 Cord around neck 1 Fall when 32 weeks pregnant 1 Gross enlargement of the liver 1 Hydrocephalus, spina bifida, meningocele 1 Malformation of head 1 Partial placenta praevia 1 Prematurity 2 Prematurity—both parents deaf and dumb 1 Prematurity, spina bifida, hydrocephalus 1 Prolonged labour 1 Unknown 4 In 8 of these cases the midwife was engaged as a maternity nurse. There were 32 deaths of infants during the first year of life from the following causes:— Acute bronchitis; teething, aged 9 months. Acute suppurative broncho-pneumonia, aged 5 weeks. Acute suppurative broncho-pneumonia, aged 6 weeks. Bilateral pyonephrosis; collapse of right lower lobe, aged 1 month. Broncho-pneumonia, aged 2 months. Bronch-pneumonia, aged 2 months. Broncho-pneumonia, aged 10 months. Cardiac failure; premature birth (one of twins), aged 3 hours. Cardiac failure; prematurity, aged 6 hours. Cardiac failure, premature twin birth, aged 1 day. Complete congenital stenosis of oesophagus, aged 2 days. Congenital heart disease; congenital absence of left femur, aged 16 hours. Congenital morbus cordis; Mongolism, aged 5 days. Erythroblastosis foetalis, aged 3 months. Gastro-enteritis, aged 3 weeks. Haemolytic jaundice, aged 30 minutes. Heart failure; patent interventricular septum; oongenital heart defect; complete scrotal hernia, aged 2 months. Icterus gravis neonatorum, aged 8 days. Inanition and diarrhoea; acute pyelonephritis, aged 2 months. Inanition; prematurity, aged 5 hours. Insufficient inherent vitality; prematurity, aged 1 day. Marasmus, congenital heart disease, aged 7 months. Myocardial degeneration, extreme prematurity, aged 2 days. Pneumonia; marasmus; spastic diplegia, aged 5 months. Prematurity, aged 11 hours. Prematurity (8th month twin) aged 1 day., Prematurity (8th month twin), aged 1 day. Prematurity; inanition (7th month twin), aged 1 day. Prematurity, aged 2 days. Protracted labour; disproportion, aged 2 days. Respiratory failure; prematurity, aged 1 day. Subarachnoid haemorrhage; icterus gravis neonatorum, aged 11 days. 60 In 16 of these cases the Midwife was engaged as a Maternity Nurse only. Four patients who had engaged Midwives to attend them (three as Midwives and one as Maternity Nurse) died during the year:— (1) Died two hours after delivery from obstetric shock due to post partum haemorrhage from retained placenta. The cause of death was certified by the Coroner, following a post mortem examination and inquest, as due to natural causes. (2) Admitted to Oldchurch County Hospital. Romford, owing to eclampsia, confined 4 days later and died 19 hours after delivery, due to cerebral haemorrhage, due to toxaemia of pregnancy. Death was certified by the Coroner after a post mortem examination. (3) Confined at own home, admitted to the Council's Maternity Home four hours after delivery and died three hours 35 minutes later, due to Bhock. due to post partum haemorrhage, due to retained placenta. (4) Confined at own home and admitted to Council's Maternity Home 2 hours after delivery and died 5 hours 10 minutes later, due to obstetrio shock due to retained placenta. Salvation Army Midwifery Service.—137 cases were attended by the Salvation Army midwives during the year; 109 as a midwife and 28 as a maternity nurse. Home and Domestic Helps.—Arising from Circular 110/46 of the Ministry of Health dated 6th June, 1946, the Council decided in July to appoint a full time Home and Domestic Help Organiser. Approval was given by the Ministry of Health to the appointment on a temporary basis for a period of 3 months, when the Ministry wished to review the position in the light of the progress made in the organisation of the scheme. The Ministry subsequently decided that the matter should be kept under review by the Council, so that the appointment could be terminated at the end of a period of 12 months if the number of Home and Domestic Helps who had been employed or were likely to be employed did not appear to justify its continuance. The Organiser appointed commenced duties on 28th October, 1946, but terminated her employment on 30th November, 1946. Her successor commenced on 9th December, 1946, and the following is a summary of the cases dealt with since the inception of the scheme until 31st December, 1946:— (а) Number of applications received for assistance 82 (b) Number for whom Home or Domestic Helps were provided 24 (c) Number of cases which on investigation did not require assistance 31 (d) Number of cases where Home Help is required in future months 21 (e) Enquiries incomplete 6 At the end of the year, 15 Home and Domestic Helps were employed. In a circular dated 14th December, 1944, the Ministry of Health mentioned that provision could be made for help in the home where there were persons sick or infirm, whether through old age or otherwise, and that the type of cases to which, in the Ministry's view, attention should be given were as follows:— (а) Where the housewife falls sick or must have an operation. (b) Where the wife is suddenly called away to see her husband in hospital and arrangements have to be made to look after the children. (c) With elderly people who are infirm, or one of whom suddenly falls ill. (d) Where several members are ill at the same time, e.g., during an influenza epidemic. 61 With regard to Home Helps, these can be provided for any expectant or nursing mother with children under the age of 5, or for help in the home at the time of confinement, but generally this is applicable to the latter type of case. This is quite apart from the scheme for the service of Domestic Helps as mentioned above. Payment is made to the Home and Domestic Helps at the rate of Is. 9fd. per hour; travelling expenses are also paid by the Council, and the fees are recovered from the person responsible in accordance with the financial oircumstances of the applicants. Ante-Natal Clinics. [ ] Maternity Home Mayesbrook Clinio First attendances 1,102 299 Subsequent attendances 8,247 2,229 Number of expectant mothers on the rolls on 31st December, 1946 .. 324 140 All patients booked for admission to the Maternity Home are medically examined at the Ante-Natal Clinics. During the year, 507 cases other than those booked for admission to the Maternity Home were examined at the Clinics. There were 2,917 attendances by such cases. The Consulting Obstetrician made weekly visits to the Ante-Natal Clinic during 1946. During the year 52 ordinary visits were made, 508 patients referred from the Ante-Natal and Post-Natal Clinics, and 77 patients referred by private Doctors, were examined. A total of 1,308 examinations were made. X-Ray Examination of Ante-Natal Patients. 129 examinations were made at King George Hospital in 1946. Post-Natal Clinics. It is the practice to make appointments for all patients confined in the Council's Maternity Home, and other patients on request, to attend the Post-Natal Clinics for the first time approximately 6 weeks after the confinement. Two Clinics are now held, one at the Maternity Home each week and the other at the Mayesbrook Clinic once each month. The latter Clinic commenced on 28th March, 1946. The following attendances were recorded:— Sessions. First attendances. Subsequent attendances. Average attendance each session. Maternity Home 51 683 348 20 Mayesbrook Clinic 10 112 42 15 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 Materqity nurse booked for the case certifies that the woman is genuinely in need of additional sheets. During 1946, 3,541 dockets were issued to 1,242 expectant mothers. Maternal Mortality.—The total number of deaths due to childbirth during the year was 8, which gives a maternal mortality rate i.e., number of deaths per 1,000 live births of 2.32 (or 2.26 including stillbirths). 62 The causes of death were as follows:— (1) Confined and died at a private Nursing Home, Wanstead. Severe toxaemia and anaemia of pregnancy; Concealed haemorrhage and death (7½ months) of foetus; Caesarean Section and hysterectomy on 10th January; Baby dead previous to operation. (2) Confined and died at own home; Obstetric shock due to post partum haemorrhage from retained placenta. (3) Confined and died at Oldchurch County Hospital. Romford. Toxaemia of pregnancy; Full-term live birth; No previous pregnancy; Eclampsia. (4) Confined and died at Thorpe Combe Maternity Hospital. Walthamstow; Uraemia due to suppression of urine following post partum haemorrhage; Stillbirth. (5) Confined and died at Ilford Council Maternity Home; Cardiac failure due to paralytic ileus due to infected Caesarean Section for obstructed labour. (6) Confined in own home and admitted to Ilford Council Maternity Home two hours after delivery. Died five hours 10 minutes later, due to Obstetric shock due to retained placenta. (7) Confined at own home and admitted to Ilford Council Maternity Home four hours after delivery. Died 3½ hours later due to shock (natural) due to post Partum haemorrhage due to retained placenta. (8) Confined and died at Ilford Council Maternity Home; Eclampsia. MATERNITY HOME. During 1946 1,020 patients were admitted into the Home compared with 824 in 1945, 784 in 1944, 601 in 1943, 396 in 1942, and 369 in 1941. Of the 1,020 patients admitted during 1946, 143 were admitted direct to the Emergency Block and 877 to the Ward Blocks. The patients were admitted to the Home from the following Wards:— Barkingside 228 North Hainault 107 Cranbrook 60 Park 80 Seven Kings 94 South Hainault 126 Loxford 104 Clementswood 102 Goodmayes 119 838 cases could not be admitted during the year, and other arrangements were made for their confinement. At the end of the year 418 cases had booked for future admission to the Home. The average number of patients in the Home per day during 1946 was 37.75 and the average length of stay of patients was 13.55 days. In March the Council decided that in order to relieve pressure on the accommodation at the Maternity Home and to enable more cases to be admitted, patients should be discharged on the 12th or even the 10th day if, in the opinion of the Resident Medical Officer, this was possible. In consequence, 601 patients were discharged from the Home during the year, before the 14th day of the puerperium. Official endorsement of this policy was given in Circular 82/46, dated 17th April, 1946, received from the Ministry of Health, which stated that in 63 view of the shortage of Midwives and the consequential pressure on institutional maternity accommodation, the Central Midwives Board had decided that so far as Midwives working wholly within institutions were concerned, they would not take disciplinary action against a Midwife in accordance with their rules, solely on account of the period of attendance given in a case where a Midwife had attended a patient during the time occupied by the labour and a period of not less than 10 days thereafter. The Ministry hoped that the Authorities of all maternity institutions would take advantage of the Board's action in order that the maximum possible use might be made of every available staffed maternity bed. In view of the large amount of work being undertaken by the nursing staff and the difficulty in obtaining additional staff, the Council decided in Ootober, 1946, to increase the salaries of the nursing staff at the MaternityHome by 20% over the soales contained in the recommendations of the Midwives' Salaries Committee, as from 1st Ootober, 1946, the matter to be reviewed in 12 months' time. Emergency Block.—170 cases were treated, 143 being admitted direot to this Block and 27 being transferred from the Ward Blocks. Two of the latter cases were confined in the Ward Blocks, discharged, and subsequently admitted to the Emergenoy Block owing to Secondary Post-partum Haemorrhage. The 143 cases were admitted for the following reasons:— Abortion or miscarriage 6 Monilia infection of vagina 2 Absence of foetal movements 1 Multiple fibroids (for hysterectomy) 1 Acne 1 Albuminuria 3 No arrangements made (confined before admission) 1 Albuminuria & hyperpiesia 1 Ante Partum Haemorrhage 15 Obstructed labour 2 Ante Partum Haemorrhage and Pre-eclampsia 1 Oedema of leg 1 Otorrhoea 1 Ante Partum Haemorrhage, Placenta Praevia 1 Placenta Praevia 8 Post-maturity 2 Breech presentation 3 Post Partum haemorrhage (including 2 confined before admission) 3 Colitis 1 Collapse in street 1 Constipation 1 Premature labour and partum haemorrhage 2 Corysa and faucitis 1 Diarrhoea and vomiting 1 Premature labour (including 2 confined before admission) 9 Pelvic disproportion 2 Early rupture of membranes 1 Eclampsia 2 Premature twins 2 Elderly primipara and uterine inertia 1 Pyelitis 4 Pyrexia and high blood pressure 3 Failed forceps delivery at own home 1 Pubic folliculitis 1 Fundal pain 1 Retained placenta after abortion 1 Furunculosis and aural discharge 1 Retained placenta (all confined before admission) 7 Hand presentation 1 Haemolytic streptococcal infection of throat 1 Scabies 2 Severe anaemia 2 History of Colostomy 1 Skin infection 1 History of Mastoiditis 1 Staphylococcal infection of cervix, vagina or urethra 3 Hydramnios 2 Impacted breech 2 Stye 1 Incomplete abortion 5 Threatened abortion 8 Inertia 2 Threatened phlebitis and excessive oedema of legs l Inevitable Abortion 1 Influenza and postmaturity 2 Toxaemia 4 Intra uterine death of foetus 1 Transverse Lie 1 Investigation and treatment of jaundice 1 Urinary infection 1 Vaginal discharge 2 Malpresentation 1 64 97 of these 143 oases had not been booked for admission to the Maternity Home. Fourteen of the 143 patients were admitted direct to the Emergency Block for ante-natal treatment and were subsequently transferred to or readmitted to the Ward Blocks for confinement. The average number of patients in the Emergency Block per day during 1946 was 4.72 (including cases transferred from the Ward Blocks) and the average length of stay of patients admitted direct to this Block was 13.76 day. 103 patients were confined in the Emergency Block (93 admitted direot to this Block and 10 transferred from the Ward Blocks). The 14 cases mentioned above have been included in the figures for those cofined in the Ward Blocks. 50 of the 103 cases were first confinements and 53 were second or subsequent confinements. Thirteen oases (or 12.6 per oent.) were delivered by meanB of forceps, 2 following surgical induction; 3 of the infants were stillborn. In addition labour was surgically induced in 10 cases; 1 of the infants was stillborn and 1 died aged 2 days. There were 15 deaths of infants born in the Emergency Block, as follows:— Atelectasis; prematurity (32 weeks), aged 12 hours. Broncho pneumonia, aged 2 months (died in Isolation Hospital). Extreme prematurity; atelectasis, aged 13½ hours. Extreme prematurity; twin pregnancy, aged 1 hour. Extreme prematurity; twin pregnancy, aged 5½ hours. Extreme prematurity, aged 14 hours. Non-viable foetus (26 weeks), aged 9 hours. Prematurity (26 weeks), aged 20 hours. Prematurity (26 weeks), aged 40 hours. Prematurity (30 weeks), aged 9½ hours. Prematurity (30 weeks); atelectasis, aged 1 day. Prematurity (30 weeks), aged 2 days. Prematurity (30 weeks), aged 5 days. Prematurity (32 weeks); imperforate anus, aged 2 days. Prematurity (33 weeks), aged 9 hours. The mothers of 10 of these infants had not been booked for admission to the Home but were admitted as emergency cases for various reasons. The causes of the 23 stillbirths in this Block were as follows:— Ante-partum haemorrhage 6 Breech delivery 2 Difficult extended breech delivery 1 Instrumental delivery 1 Intra-uterine death, macerated foetus 1 Obstructed labour 1 Placenta praevia 2 Premature labour and intra-partum haemorrhage 1 Prematurity and obstructed labour 1 Probably due to Influenza 1 Strangulation by cord 1 Toxaemia, ante-partum haemorrhage 1 Unknown 4 The Mothers of 18 of these infants were admitted as emergency cases. Eleven cases were notified as suffering from Puerperal Pyrexia, three being removed to the Isolation Hospital. The causes of the Pyrexia were due to infected wound following Caesarian Section (1), Influenzal Pneumonia (1), local uterine infection (1), Pyelitis (3), Pyelitis and deep popliteal thrombosis (1), reaction following retained placenta (1), reaction following 65 blood transfusion due to ante-partum haemorrhage and placenta praevia (1), retained products (1), thrombophlebitis and cellulitis associated with varicose veins (X). One infant notified as suffering from Pemphigus Neonatorum, which transpired to be a case of pustular dermatitis of the neck, was removed to the Isolation Hospital. In addition 28 other patients were removed to the Isolation Hospital for the following reasons:—Abscess of buttock (1), Anaerobic streptococcal oarrier (1), Bartholin's cyst (1), Chronic otitis media (1), Chronic otorrhoea (2), Colitis (1), Colostomy (1), Eczema (1), Haemorrhoids during puerperium (1), Infected perineal laceration (1), Observation (1), Phlebitis (2) Phlegmasia alba dolens (1), Post-partum foot drop (1), Sapraemia (2), Scabies (2), Septic abortion (2), Septic abrasion of scalp of infant with paranasal tumour (1), Secondary anaemia (1), Staphylococcal abscess of thigh of infant (1), Staphylococcal carrier (1), Streptococcal carrier (1), Threatened abortion (1). The Consulting Obstetrician, his Deputy or other consultants were oalled in to 28 cases as follows:— To perform Caesarian section operations 4 To perform other operations 15 For consultation 9 The reasons for the Caesarian seotion operations were:— Contracted pelvis 1 Obstructed labour 1 Ovarian tumour 1 Unsuccessful induction of labour 1 The other 15 operations were as follows:— Dilatation and curettage 6 Forceps delivery 2 Hysterotomy and sterilisation 2 Internal version 1 Removal of retained placenta 4 The reasons consultations were necessary were as follows:— Ante-partum Haemorrhage 2 Chronic otorrhoea (seen by Aurist) 1 Eclampsia 2 Excessive moulding of baby's head (seen by Paediatrician) 1 Facial paralysis (seen by Physioian) 1 Imperforate anus (seen by Paediatrician) 1 Infective jaundice (seen by Physician) 1 There were five deaths of mothers admitted to the Emergency Block:— (1) Died 5 days after delivery from cardiao failure due to paralytic ileus due to infected Caesarian section for obstructed labour. (2) Confined at own home and admitted to Emergency Block two hours after delivery and died 5 hours 10 minutes later due to obstetric shock due to retained placenta. (3) Confined at own home and admitted to Emergency Block 4 hours after delivery and died 3 hours 35 minutes later due to shock due to post-partum haemorrhage, due to retained placenta. (4) Died 13 hours 15 minutes after delivery due to eclampsia. (5) Died 5 hours 20 minutes after delivery due to obstetric shock due to post-partum haemorrhage. All the patients were admitted as emergency cases. 66 The cases were reported to H. M. Coroner and the cause of death in each case was certified by him after a post-mortem examination. The other 36 cases admitted direct to this Block were not confined therein for the following reasons:— Abortion or miscarriage 16 Pregnancy terminated 1 Admitted for ante-natal treatment and subsequently evacuated for confinement or confined at own home 7 Born before arrival at Home 12 Ward Blocks.—877 cases were admitted to the Ward Blocks. In addition 14 patients admitted to the Emergency Block for ante-natal treatment were subsequently transferred to or re-admitted to the Ward Blocks for confinement. Ten patients admitted to the Ward Blocks were transferred to the Emergency Block for confinement. 79 of the 877 cases had not been booked for admission to the Home. 14 cases were not confined in the Home for the following reasons:— Abortion or miscarriage 3 Admitted for ante-natal treatment and subsequently evacuated, confined at own Home or transferred to Isolation Hospital for confinement 10 Born before arrival at Home 1 The average number of patients in the Ward Blocks per day during 1946 was 33.03 and the average length of stay of patients was 13.51 days. In 51 of the 867 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 867 confinements there were:— (a) 422 cases of first confinement. (b) 445 cases having their second or subsequent confinement. (c) 153 cases living in 2 rooms or less (103 being first confinements). (d) 229 cases living in 3 rooms (134 being first confinements). 67 oases (or 7.7 per cent.) were delivered by means of foroeps, 16 following surgical induction; 3 of the infants were stillborn, and 2 infants died aged 10 hours and 2 days. In addition, labour was surgically induced in 98 other cases; 6 of the infants were stillborn, and 3 infants died aged 10 hours, 1 day, and 3 days There were 20 deaths of infants bora in the Ward Blocks aa follows:— Asphyxia, prematurity (35 weeks), aged 40 minutes. Atelectasis, aged 1 hour. Atelectasis, aged 10 hours. Atelectasis, aged 1 day. Atelectasis, prematurity, aged 5 minutes. Atelectasis, prematurity (35 weeks), aged 10 hours. Atelectasis, prematurity (34 weeks), aged 2 days. Atelectasis, spina bifida, hydrocephalus, aged 1 hour. *Broncho-pneumonia, aged 7 months. Broncho-pneumonia, atelectasis, aged 2 days. Bronoho-pneumonia due to icterus gravis neonatorium, aged 3 days. Extreme prematurity, aged 1 day. *Gastro-enteritis, aged 1 month. Imperforate anus, atelectasis, aged 6 days. (Died in King George Hospital.) *Infantile convulsions, broncho-pneumonia, aged 6 months. Multiple abnormalities, spina bifida, talipes, aged 20 minutes. Non-viable foetus, aged 11 hours. 67 Non-viable foetus, aged 24 hours. Non-viable foetus, multiple pregnancy, aged 1 minute. Spina bifida; hydrocephalus, aged 5 days. *Died after discharge from the Maternity Home. The mothers of three of these infants had not been booked for admission to the Home, but were admitted as emergency cases for various reasons. The neo-natal death-rate of babies born in the Ward Blocks for the five years 1942 to 1946, was 2.01 per cent. compared with 1.85 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 1942-1946 was 1.91 per cent. The infant mortality rate of children born in the Ward Blocks of the Maternity Home for the five years 1942-1946 was 27.3 per 1,000 births, as compared with 31.4 born in their own homes. The figure of 31.4 has been arrived at after deduction of all deaths of infants born in the Maternity Home, and is calculated on the total births in the district, excluding those in the Maternity Home. The causes of the 27 stillbirths in the Ward Blocks were as follows:— Anencephalio spina bifida 1 Anencephalus 1 Cord around neek 2 Difficult breeoh delivery 1 Extended breech; premature inspiration 1 Hydrocephalus 1 Hydrops foetalis 1 Lower abdomen and genitals maldeveloped 1 Macerated foetus—cause unknown 2 Placenta eroded; retroplacental clots 1 Premature labour: intra partum haemorrhage 1 Prematurity; ante partum haemorrhage 1 Prolapsed cord, breech presentation 1 Prolapse of cord 1 Toxaemia 1 Toxaemia; prematurity 2 Unknown 7 W. R. positive 1 The mothers of five of these infants were admitted as emergency cases. Thirty-five patients were notified as suffering from puerperal pyrexia, thirteen being removed to the Isolation Hospital. The causes of the pyrexia were abdominal wound infection (1), constipation (1), dermatitis and pericarditis (1), engorged breasts and herpes labialis (1), engorgement of breasts (3), furunculosis and sinusitis (1), local infection of operation scar (1), mammary abecess (1), mastitis (1), nephritis (1), postoperative reaction (Caesarian Section) (1), constipation (1), puerperal varicella (1), pulmonary embolism (2), pyelitis (3), reaction following manual removal of retained placenta (1), retained products (1), retention of urine (1), sapraemia (2), sapraemia and mastitis (1), sapraemia and tonsillitis (1), staphylococcal urinary infection and subinvolution (1), subinvolution (1), superficial infection of Caesarean Section incision and pulmonary infarction (1), threatened mastitis (1), toxaemia, albuminuria and general debility (1), transient pyrexia of unknown origin (2), upper respiratory tract infection (1). In addition, four infants, three of whom were removed to the Isolation Hospital, were notified as suffering from Ophthalmia Neonatorum. All of the cases were due to a staphylococcal conjunctivitis and the condition of the eyes satisfactorily cleared. One infant was removed to the Isolation Hospital notified as suffering from Pemphigus Neonatorum. The condition was due to a staphylococcal dermatitis of the fingers. In addition thirty-one other patients were removed to the Isolation Hospital for the following reasbns:—acute coryza (1), acute ulcerative colitis (1), B. Coli bacilluria (1), blister on finger of infant (1), bronchitis 68 and haemolytic streptococcal carrier (1), chronic otorrhoea and facial paralysis (1), femoral phlebitis (1), folliculitis of infant (1), haemolytic streptococcal carrier (2), infective hepatitis (1), laryngitis of infant and bronchitis (1), leucorrhoea (2), non-specific conjunctivitis of infant (1), perineal abscess (1), phlebitis and haemolytio streptococcal carrier (1), pustular dermatitis of infant (1), pyelitis and epilepsy (1), sapraemia and offensive lochia (1), sebaceous cyst of ear (1), septic abrasion of scalp of infant (1), septic spot3 on infant (1), staphylococcal conjunctivitis of infant (2), staphylococcal dermatitis of infant (4), staphylococcal urinary infection (1), stye (1). Special visits were made by the Consulting Obstetrician, his Deputy or other Consultants to 38 cases in the Ward Blocks as follows:— To perform Caesarean Section operations 23 To perform other operations 6 For consultations 9 The reasons for the 23 Caesarean Section operations were as follows:— Breech presentation 3 Contracted pelvis 9 Elderly primipara, small pelvis 2 Extended breech 4 Flattened pelvis 1 Foetal abnormality 1 Overlap at symphysis 2 Transverse lie 1 The other operations were as follows:— Dilatation and curettage 3 Forceps delivery 3 The reasons consultations were necessary were as follows:— Breech presentation 1 Cardiac condition (seen by Physician) 1 Cerebral irritation of infant (seen by Paediatrician) 1 Corneal abrasion (seen by Ophthalmic Surgeon) 1 Pulmonary embolism (seen by Physician) 1 Pyloric stenosis (seen by Paediatrician) 1 Right facial paralysis and general condition of infant (seen by Paediatrician) 1 Toxaemia; premature infant (seen by Paediatrician) 1 Umbilical stump of infant (seen by Paediatrician) 1 There were 3 deaths of mothers admitted to the Ward Blocks:— (1) Died 4½ hours after delivery, due to cardiac failure due to coarctation of the aorta and patent ductus arteriosis associated with pregnancy. (2) Transferred to Council's Isolation Hospital 15 days after delivery and died 28 days later, due to acute ulcerative colitis. (3) Died 2½ hours after delivery from coronary thrombosis associated with Caesarean Section. These cases were reported to H.M. 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 tho ten years from 1937 to 1946 is 1.47 per 1,000 births, as compared with the maternal mortality rate in the district generally of 2.74, the rate in each case being calculated on the total live births. Wireless Equipment. In May, 1946, the Council decided to provide wireless equipment complete with headphones for each of the patient beds at the Home at a cost of £306 3s. 6d., including cost of wiring and installation. The work was completed in July, 1947. 69 Fees. (a) In January, 1946, the Council decided to accept vouchers from eligible members of the Hospital Saving Association and Hospital Saturday Fund to cover the cost of the maintenance of patients in the Council's Maternity Home, Emergency and other Maternity Homes, admitted on or after 1st April, 1946, and in respect of the services of the Domiciliary Midwives for confinements attended on or after 1st April, 1946. The payments made by the H.S. A. and H.S.F. for the services provided are as follows:— Council's Maternity Home. H.S.A.=£3 3s. 0d. per case, irrespective of the length of stay in the Home and in full discharge of debt, including fee for services of Obstetric Specialist and X-ray examination. H.S.F. =£4 2s. 6d. per case, irrespective of the length of stay in the Home and in full discharge of debt, including fee for services of Obstetrio Specialist and X-ray examination. East End Maternity Hospital and other Hospitals. H.S.A.=£3 3s. 0d. per case, irrespective of the length of stay in Hospital and in full discharge of debt. H.S.F.=£4 2s. 6d. per case, irrespective of the length of stay in Hospital and in full discharge of debt. Evacuation to Emergency Maternity Homes. H.S.A.=£3 3s. 0d. per case, irrespective of the length of stay in the Home and in full discharge of debt. To include cost of maintenance in Ante-Natal Hostel. H.S.F.=£3 3s. 0d. per case, irrespective of the length of stay in the Home and in full discharge of debt. To include cost of maintenance in Ante-Natal Hostel. Domiciliary Midwifery Service. H.S.A. and H.S.F.=£1 0s. 0d. per case for attendance of Midwife and including Ante-Natal examinations by private Doctor and any fee for the Doctor called in by the Midwife under the Midwives Act, 1918. All patients, irrespective as to whether or not they are members of H.S. A. or H.S.F. to pay the current cost of the sterile maternity outfit provided by the Council. The H.S. A. subsequently agreed to pay to the Council a fee of £1 12s. 6d. for the services of the Domiciliary Midwives for cases attended from 1st July, 1946. (b) The Council also decided in June, 1946, to revise the chargesf or the maintenance of patients in the Maternity Home and Ante-Natal Hostels and Emergency Maternity Homes as follows:— A reduction of 2s. per day in the daily charge on all assessments, provided that the daily charge is not reduced below 2s. After the 14th day, when the fees are charged at half the daily rate, the reduction to be 1s. per day. When applied to patients admitted to the Emergency Maternity Homes the fees to be one-half, as at present. Further, an allowance is to be made of 10s. for the first and second living child (not the expected child) and 5s. for the third and each subsequent child up to the age of 16 years. The revision applied to all patients confined on or after 1st July, 1946, and does not affect the arrangement with regard to members of H.S.A. or H.S.F., as mentioned above. Training or 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. 38 Pupil Midwives commenced their training during 1946. 11 of these and 13 of the 35 who commenced in 1945 passed Part 1 Examination in 1946. 70 Gas and Air Analgesia. Two Hospital model Walton Minnitt gas and air machines have been provided at the Council's Maternity Home for the purpose of producing analgesia during labour. Gas and air was administered to 521 patients during the year. In November, 1945, the Central Midwives Board introduced changes affecting the training of Midwives and Pupil Midwives in the administration of gas and air analgesia, to become operative as from 1st July, 1946. The object of the amendment is to ensure that Pupil Midwives should undergo the course of training for the certificate in the administration of gas and air analgesia during either their Part 1 or Part 2 training before enrolment as a Midwife, and the Board expressed the wish that in the majority of cases the Pupil Midwife would pass the test at her Part 1 training school. The Maternity Home is 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. Nineteen of the staff, including 16 Pupil Midwives, qualified and obtained the certificate during 1946. Other Maternity Hospitals. Arrangements were made for the admission of maternity cases to the following Hospitals during 1946, for which the Council were responsible for the cost of maintenance:— No. of Cases. Fees payable. (a) Oldchurch County Hospital, Romford .. Although the Essex County Council ceased to book any maternity cases from Ilford at the end of June, 1944, the cases mentioned were admitted there as an emergency measure. 10 14s. per day. (b) Queen Mary's Hospital, Stratford 9 10s. per day. (c) Maldon Hospital, Maldon 1 11s. 8d. ,, (d) St. Margaret's Hospital, Epping 2 11s. 8d. ,, (e) Plaistow Maternity Hospital, Howards Road, Plaistow 2 15s. ,, (f) East End Maternity Hospital, Commercial Road, E. 1 40 16s. ,, Emergency Maternity Homes. The arrangements for the admission of patients to ante-natal hostels or billets and emergency maternity homes, as outlined in my report for 1945, continued during the year. The Minister of Health, however, raised the charge for maintenance from 14s. per day to 15s. per day for cases leaving London after 1st April, 1946. 580 patients registered for evacuation to these Homes for their confinements expected during the year but only 252 went away, the other 328 either cancelling the arrangements as they subsequently decided to have their confinement elsewhere, or could not be accepted owing to insufficient accommodation in the Emergency Maternity Homes. 407 of these patients attended the Council's Ante-Natal Clinics, making a total of 2,506 attendances during the year. These figures are included in the table of attendances at the Ante-Natal Clinics. Intimation was periodically received during the year from the London County Council, the authority responsible for making the arrangements for the admission of patients to these Homes, that the registrations had reached the limit for which accommodation could be provided by the Ministry of Health, which meant that mothers who had delayed applying could not be accepted. 91 cases which had registered were referred back during the last weeks of pregnancy owing to lack of sufficient accommodation in the Homes, and 71 arrangements had to be made for the mothers to be accommodated elsewhere. The position became so acute towards the end of the year, and in view of the heavy strain on the accommodation at the Council's Maternity Home and the impossibility of obtaining alternative hospital accommodation, recourse was had to the Voluntary Hospitals' Emergency Bed Service in December, who kindly agreed to arrange for the admission of patients to the London Hospitals if there were vacant beds when a patient went into labour. Through this arrangement 3 patients were admitted to the following Hospitals during December:— Salvation Army Mothers' Hospital, Clapton 2 Poplar Hospital 1 Wilnett Lodge. The Ministry of Health were advised of the grave difficulties existing in Ilford in regard to maternity accommodation, attributable to the very heavy damage resulting from enemy action and the consequent lack of housing accommodation to enable mothers to have their confinements at home, coupled with the very considerable rise in the birth rate. As a result of these representations, approval was given to a proposal for the adaptation of Wilnett Lodge, in High Road, Chadwell Heath, as a Post-Natal Home to accommodate 9 mothers and infants. With the opening of the Home selected cases will be transferred there from the Council's Maternity Home on about the 7th day of the puerperium, thus relieving the heavy strain on the accommodation at the Council's Maternity Home. SCHOOL MEDICAL SERVICE 73 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 IX A . and B. shows no appreciable change. (b) Incidence of Pediculosis and Scabies. % (i) Pediculosis.—This shows a decrease on last year, 46 children being found to be infected with living hair vermin as against 65 in 1945, 36 in 1944, 25 in 1943, 63 in 1942, and 36 in 1941. (ii) Scabies.—This shows a decrease, 76 cases (30 from routine medical inspection) being seen at the Minor Ailment Clinics, as compared with 104 in 1945, 128 in 1944, 217 in 1943, 374 in 1942, and 109 in 1941. In addition to the 76, 3 cases were treated privately. There was no particular incidence in any one School. CHANGES IN STAFF. (а) Medical.—Dr. I. Gordon appointed Deputy Borough School Medical Officer on 1st November, 1946. Dr. L. Rich appointed Assistant School Medical Officer; commenced duties 1st October, 1946. Miss R. Coleman, the masseuse, resigned, and Mrs. M. E. King commenced on 16th December. (b) Health Visitors and School Nurses:— Miss M. Graham resigned 28th February. Miss M. Harper on 23rd February. Miss D. M. Whitmarsh on 10th August. Miss F. M. Stockham on 5th October. Miss M. M. Goldsmith commenced duties on 9th October. Mrs. M. M. Taylor on 16th September. Miss E. Blackwall on 23rd December. (c) Clerical:— Miss R. Mead resigned on 5th January. Mrs. J. Fern on 14th February. Miss E. M. Eqerton on 25th May. Mrs. E. I. Cooper on 5th October. Miss G. Morgan, Dental Clerk Attendant, commenced duty on 26th September. School Premises.—There are 29 schools, with 54 departments, 18,070 children were actually on the rolls on 20th December, 1946, as compared with 15,609 in December, 1945. The figure 18,070 includes Barking Abbey (226) and Ursuline County Placed pupils (196). The number of children in average attendance at school for the year ended 20th December, 1946 = 15,926. The Sanitary Inspectors have paid the usual monthly visits to the elementary schools (1) to enquire as to the milk supplies, (2) to inspect the sanitary arrangements. 425 visits have been made during the year. Medical Inspection.—In accordance with the Handicapped Pupils and Medical Services Regulations, 1945 (para. 49), this is carried out as follows:— (a) 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. (b) 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 1946, 5,131 parents, or 77 per oent., attended the full routine medioal inspections. 74 Infectious Disease.—The following table shows the incidence of infeotious diseases in the Ilford schools since 1940:— Soarlet Fever. Diphtheria. Measles 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 1946 156 13 *576 259 312 95 *Of this number 569 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 VIII shows the incidence of infectious disease in the Ilford schools during 1940. 299 home visits were paid by the Health Visitors to cases of minor infectious disease. In addition the Sanitary Inspectors paid 576 visits to measles cases, and 95 visits to whooping cough cases. Diphtheria Prevention Clinics.—The following shows the work carried out at Valentines Mansion (103 sessions) and Mayesbrook (51 sessions) Clinics for children of school age during 1946:— Valentines. Mayesbrook. Primary Sohick tested 163 40 Positive 96 9 Negative 67 31 Inoculated (full course) 166 140 Schick +1945 2 — Schick+1946 96 9 Not tested 68 131 Negative after full course of inoculation 159 122 Positive after full course of inoculation and reinoculated 5 4 Awaiting re-test 2 12 Not re-tested after inoculation on account of leaving district, etc. — 2 Reinoculations (one only) 350 114 Result of final Schick test in 1946 of cases inoculated in 1945: Valentines. Mayesbrook. Positive and re-inooulated .. .. — — Negative .. .. .. .. .. 9 14 891 individual children were treated (592 at Newbury Hall and 299 at Mayesbrook) making 3,270 attendances (1,866 and 1,404 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, 11,616 children of school age, and 21,460 children under school age bave been immunised. 78 During 1946 a scheme for systematic reinoculation was introduced. By giving single doses of immunising, material at the ages of approximately 5 and 10 years the immunity conferred by inoculation in infancy is perpetuated. Ringworm:— No. of cases at beginning of 1946. No. of cases reported during 1946. Total. Remedied during 1946. No. of cases under observation at end of 1946. Ringworm:— Scalp — 8 8 8 — Body — 9 9 9 — — 17 17 17 — The 8 cases of ringworm of the scalp received X-Ray treatment at the Queen Elizabeth Hospital for Children (Glamis Road Branch), London, E. 1, under the existing arrangements. Following Up.—During 1946, 2,495 home visits by the School Nurses were paid for the purpose, and 4,240 re-examinations of children (some on several occasions) were carried out by the doctors at school; 79 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 atter follows:— (dances during 1946 were as Newbury Hall Mayesbrook Number of individual children seen 1,717 1,857 Number of attendances of children 2,611 3,092 Number of exclusion certificates granted 439 893 Number of certificates of fitness to attend school granted 295 448 The following table shows the conditions dealt with at both the Clinics during the year:— Subnormal Nutrition 681 Debility 63 Uncleanliness:— Head 419 Body 1 Skin:— Ringworm:— Head 8 Body 9 Scabies 76 Impetigo 162 Other Diseases (Non-Tuberculous) 317 Eye:— Blepharitis 23 Conjunctivitis 18 Keratitis 1 Defective Vision (excluding Squint) 214 Squint 24 Other conditions 106 Ear:— Defective Hearing 59 Otitis Media 35 Other Ear Diseases 66 76 Nose and Throat:— Chronic Tonsillitis only 96 Adenoids only 23 Chronic Tonsillitis and Adenoids 77 Nasal Catarrh 40 Sore Throat 42 Nasal Obstruction 15 Nasal Discharge 8 Other conditions 70 Enlarged Cervical Glands (Non-Tuberoulous) 14 Defective Speech 6 Teeth—Dental Diseases 654 Heart and Circulation:— Functional 5 Organic 3 Anaemia 82 Infectious Diseases:— Dysentery 2 Measles — Whooping Cough 2 Chicken Pox 4 Mumps 6 Colds and Coughs 196 Influenza 4 Lungs:— Asthma 22 Bronchitis 42 Other Non-Tuberoular Diseases 1 Tuberculosis:— Pulmonary—Definite — ,, Suspected (Referred to T.B. officer.) 9 Nervous System:— Epilepsy Nervous Debility 10 Habit Spasm 1 Chorea 3 Other Conditions 33 Deformities:— Genu Valgum 12 Round Shoulders 6 Pigeon Cheat 3 Flat Feet Pes Valgus 12 Intoeing 3 Valgus Ankles 24 Other forms 27 Minor Injuries 74 Rheumatism Other Defects and Diseases 237 Total number of ailments 4,245 77 SPECIAL CLINICS Ophthalmic Clinic. During the year 1946, the School Oculist held 196 sessions for the refraction of children suffering from defective vision (117 at Valentines and 79 at Mayesbrook). Full details of the work are given in Table II, Group II, on page 90. 2,206 attendances (1,363 at Valentines Clinic, 843 at Mayesbrook Clinic) were made by 1,416 schoolchildren (873 at Valentines Clinic, 543 at Mayesbrook Clinic), as compared with 916 schoolchildren in 1945. Of the 1,416 cases, 408 were referred from medical inspections, 257 were referred from the School Clinic, 643 were "under observation" cases re-examined, 83 were re-examined at parents' requests, and 25 were referred from other sources. The 1,416 children were not all suffering from grave defects of vision. The following table shows the vision in the worst eye, as tested by Snellen's Type:— 6/6 6/9 6/12 6/18 6/24 6/36 4/60 less than 6/60 380 275 210 197 134 110 101 9 The children who saw 6/6 (praotically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., whioh rendered further examination necessary. Of the 1,416 children examined, 734 were found to require spectacles, 438 being children who had previously had spectacles and 296 (new cases) by reason of the following defects:— Myopia 49 Myopic Astigmatism 46 Hypermetropia 36 Hypermetropic Astigmatism 62 Mixed Astigmatism 30 Hypermetropia with Squint 28 Squint 45 Total 296 Of the remaining 682 children, (i) 24 were suffering from the following other diseases, and spectacles were not prescribed:— Blepharitis 15 Chalazion 4 Congenital Cataract 1 Congenital Coloboma 2 Corneal Nebulae 1 Retinal Detachment 1 Total 24 (ii) 241 children were found not to require spectacles, having no refractive error requiring correction. (iii) 360 children were wearing spectacles already and the lenses in use did not require changing. (iv) 57 children were also seen but treatment was not completed owing to the following causes:— Moved out of District 3 Parents objected to treatment or received treatment elsewhere 5 Atropine given for examination early 1947 10 Waiting Appointment 39 Total 57 78 Under the Education Committee's scheme 728 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 151 cases the lenses of spectacles were replaced or repairs of frames were carried out. Arrangements for orthoptic treatment are required. It is hoped that in the near future it may be possible to make the necessary facilities available for children in this area. Orthopaedic Clinic. (i) Newbury Hall Clinic.—52 sessions were held during 1946, 287 children of school age were examined for the first time during the year and 493 children were seen, who had previously attended the clinic. These 780 children made 1,533 attendances. (ii) Mayesbroolc Clinic.—25 sessions were held during 1946, 136 children of school age were examined for the first time during the year and 204 children were seen, who had previously attended the clinic. These 340 children made 658 attendances. The 1,120 children were found to be suffering from the following defects:— Diagnosis. New Cases. Old Cases. A B A B Paralyses:— A.P.M 1 3 10 9 Hemiplegia 1 — 2 2 Paraplegia — — 2 — Monoplegia — — 1 — Spastic foot 1 — — — Scoliosis 2 3 13 2 Kyphosis — — 10 3 Slack posture 16 6 24 5 Deformity of hips — 2 5 1 Depressed sternum — — 2 1 Genu valgum 87 41 147 58 O.C.T. 9 4 16 4 Genu varum. 10 4 2 — Pes valgo, planus 46 17 68 34 Valgus ankles 83 41 119 52 Talipes calcaneo valgus — — 4 2 Congenital talipes E.V. — — 9 6 Pes calcaneo valgus 1 — — — Intoeing — — 7 3 Pes cavus 4 — 3 — Hallus valgus 10 2 2 4 Deformity of toes 11 6 27 5 Rickets — — 2 2 Torticollis — — 6 — N.A.D. 1 2 — — Other conditions 4 5 12 11 Totals 287 136 493 204 A—Newbury Hall. B—Mayesbrook. 5 ohildren of school age were admitted to the country branch of the Royal National Orthopaedic Hospital, at Stanmore, in 1946, Buffering from:—(1) Deformity of toes (4 cases); (2) Tendo-achilles tight (1 case). 79 These 5 children were discharged during the year. In addition one child was discharged from St. Vincent's Orthopaedic Hospital, Pinner, following treatment for spastic condition and another similar case was admitted during the year. During the year 25 pairs of valgus insoles, 15 pairs of surgical boots, 1 spinal support, 2 artificial limbs and 3 walking calipers with special boots, were supplied to school children. 268 cases were discharged from the Orthopaedic Clinic, 10 as cured, 177 discontinued attendance as parents considered condition improving under home exercises; 58 left school or the district, and in 23 cases treatment was refused. A Masseuse attends the Newbury Hall Clinic for orthopaedic treatment on Thursday morning and Friday afternoon, and the Mayesbrook Clinic on Monday afternoon. A total number of 134 sessions were held by the Masseuse for treatment during 1946 (90 at Newbury Hall Clinic and 44 at Mayesbrook Clinic). At Newbury Hall Clinic 113 individual children of school age were treated by the Masseuse during the year and 1,745 attendances were made by these children. Treatment was also given to 61 children, who made 865 attendances at the Mayesbrook Clinic. Artificial Sunlight Clinic.—A Masseuse attends the Newbury Hall Clinic on Monday morning and the Mayesbrook Clinic on Tuesday morning for artificial sunlight treatment. 41 sessions were held at Newbury Hall Clinic and 46 at Mayesbrook Clinic. At the Newbury Hall Clinio 31 children of school age were treated, making 301 attendances for treatment. At the Mayesbrook Clinio 29 children of school age were treated, making 481 attendances for treatment. During the year the lamp used at each Clinic was replaced by a new Centrosol Unit. The conditions treated were as follows:— Defects Treated. New Cases. Old Cases. A B A B Anaemia, Debility and Malnutrition 4 7 10 9 Pulmonary Fibrosis — 1 — — Bronchitis 1 2 — 1 Bowlegs 1 — — 1 Alopecia 2 2 — — Adenitis 2 1 1 — Asthma 3 — 2 Knock Knees 2 — Old Rickets — — 1 1 Other Conditions 2 3 — 1 17 16 14 13 A = Newbury Hall Clinic. B = MayesbrookClinic. Of the 29 cases treated at the Mayesbrook Clinic, 12 were Open Air school children. At Newbury Hall Clinio, 14 children of school age were discharged from the Artificial Sunlight Clinic, 7 were cured. 4 were showing considerable improvement, 2 had not made any progress under treatment, and 1 removed from the area. 80 17 children were still receiving treatment at the end of the year. At Mayesbrook Clinic, 10 children of school age were discharged from the Artificial Sunlight Clinic, 3 were cured, 2 were showing considerable improvement, 4 had not made any progress under treatment and 1 had removed from the area. 19 children were still receiving treatment at the end of the year. Aural Clinic. The Aural Clinic is held at Valentines Mansion, the Surgeon attending on two afternoons weekly. 65 sessions were held during 1946 and 1,112 attendances were made by 750 children of school age, of whom 568 were new cases. The following table shows the work of the Clinic:— 81 AURAL CLINIC Nature of Disease. Still under treatment. Recommended Hospital treatment. Discharged as cured. Discharged as no treatment required. Discharged as left district. Discharged as left school. Discharged. Children whose parents refused to continue attendance or who did not keep appointments. Totals. New. Old. New. Old. New. Old. New. Old. New. Old. New. Old. New. Old. New. Old. (i) Acute Suppurative Otitis Media 1 — 4 1 1 — — — — — — — — — — — (ii) Acute Catarrhal Otitis Media - — — — — — — — — — — — — — — — (iii) Chronic Suppurative Otitis Media due to:— 1. Tympanic Sepsis 2 5 8 3 1 8 — — 1 — 1 1 5 3 18 20 2. ,, and Granulations — 1 — 1 — — — — — — — 2 1 — 1 4 3. Other Causes — — 1 — — 1 — — — — — — — — 1 1 (iv) Mastoid Disease (previous operation) — 1 — 3 — 1 — — — — — 1 — — — — 1. Nerve Deafness 2 — 5 — — — — — — — — — — — 7 — 2. Tonsils and Adenoids — 3 19 1 2 2 — — 1 — — — 1 — 23 6 3. Retraction of Membrana Tympani 4 1 1 — — — — — — — — — — — 5 1 4. Scarring ,, ,, - — — 1 1 — — — — — — — — — 1 1 5. Other causes 6 4 — 1 2 2 — — — — — — 1 2 9 9 (vi) Opinion on Tonsils 7 2 342 18 39 35 — 1 4 — — — — — — — (Vii) Rhinitis 5 3 12 8 2 5 — — 1 — — — 1 1 21 17 (viii) Other diseases or defects 10 13 36 12 4 23 — — 1 — 3 1 7 5 61 54 Totals 37 33 431 40 53 77 — 1 8 - 4 5 35 17 568 182 82 Rheumatism Clinic. The Physician attended 30 morning sessions during the year, and 246 children (129 of these being new cases) made 461 attendances. The 246 children were found to be suffering from the following conditions:— Defects Found. New Cases. Old Cases. Totals. History of Rheumatism (observation) 10 9 19 ,, Chorea 6 6 12 Rheumatic Carditis 3 9 12 Other forms of Carditis 1 3 4 Tachycardia of Nervous origin 1 1 2 Congenital Heart Disease 12 27 39 Rheumatism 3 2 5 Chorea 1 1 Habit Spasm 6 5 10 Anaemia, Subnormal-nutrition and Debility 2 4 6 No active Rheumatic disease 15 2 17 Heart Murmur functional 31 27 58 Acidosis, metabolic disturbance of Alimentary origin 6 8 14 Pains due to Orthopaedic condition 15 10 25 Other conditions 18 4 22 Totals 129 117 246 Number of cases referred to Convalescent Home 3 ,, ,, ,, Heart Home 1 ,, ,, ,, General Hospital (In-patients) 1 ,, ,, ,, Isolation Hospital 2 ,, ,, ,, Ear, Nose and Throat Surgeon 19 ,, ,, ,, Orthopaedic Surgeon 12 ,, ,, ,, for X-ray and Electro-Cardiogram 69 ,, ,, ,, Blood Sedimentation Rate 37 The possibility of making arrangements for the operative treatment of selected cases of heart disease has been discussed with the physician in charge of the Clinic. Representations in this regard have been made to the County School Medical Officer. Speech Clinic.—Miss P. Lough, the Speech Therapist commenced, treatment at the temporary Clinic at 118, Cranbrook Road on Monday, September 16th. The Clinic was transferred to permanent premises at the Valentines School, Beehive Lane, on Monday, September 30th. By the end of the year, 78 individual children of school age had received speech therapy at this Clinic, making a total of 542 attendances. The defects treated were as follows:— Stammering 16 Dyslalia 38 Cleft palate 2 Mouth breathing 20 Neurological 1 Deafness (congenital) 1 Continuity of after treatment is secured with the co-operation of teachers who have been supplied with an explanatory memorandum on the subject prepared by the Speech Therapist. 83 School Dentists.—Of 7,348 inspections by the Dentist (including special cases) 5,079 (or 69 per cent.) were found to require treatment, compared with 5,159 (or 64 per cent.) in 1945, 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, 149 regulation plates, 5 crowns, and 7 dentures were supplied. 1,274 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 s No. referred for treatment Percentage. 5 863 503 58.2 6 920 627 68.1 7 1182 835 70.6 8 831 636 76.5 9 894 657 73.4 10 884 654 73.9 11 581 389 66.9 12 592 328 55.4 13 336 263 78.2 14 192 118 61.4 15 73 69 94.5 Full details of the dental work are shown in Table IV. Open-air School.—During 1946, 50 children were admitted, 46 ceased attendance, and on the 31st December, 1946, 84 children were on the school roll, 1 vacancy remaining unfilled. Those admitted were recommended for examination from the following sources:— School Medical Officer 31 Rheumatism specialist 5 Others 14 The above 50 children were admitted for the following reasons:— School Medical Officer:— Malnutrition 1 Debility 3 Debility and Subnormal Nutrition 2 Debility and Asthma 1 Subnormal Nutrition and Cardiac abnormality 1 Subnormal Nutrition, Anaemia & Nasal Catarrh 1 Subnormal Nutrition and Pulmonary Catarrh 1 Subnormal Nutrition 2 Bronchial Catarrh and Subnormal Nutrition 1 Bronchitis and Asthma 9 Bronchitis 1 Asthma 4 Nervousness 1 Dislocation of Hip Joint and Nervous Debility 1 Asthma and Pulmonary Catarrh 1 Amputated leg 1 Rheumatism Specialist:— Mitral Stenosis 1 Congenital Heart Disease 1 Debility 2 Subnormal Nutrition and Anaemia 1 84 Others:— Malnutrition and debility 1 Malnutrition and Neuropathic tendencies 1 Debility and Bronchitis 2 Asthma and Bronchial Catarrh 2 Asthma 1 Arthritis and debility 1 Asthma and Emphysema 1 Spina Bifida Occulta and Paresis of lower limbs 1 Achondroplasia 1 Osteomyelitis 1 Nervousness 1 Deficient lung expansion 1 The 46 children not now on the school roll ceased attendance for the following reasons:— Transferred to County High School and Ursuline Sohool 2 Resumed attendance at ordinary school 33 Left the district 3. Left school—over age 1 Admission to convalescent home or residential O.A.S. 5 Temperamentally unsuitable for Open Air School 1 Certified as Educationally Subnormal l The Dental Surgeon has carried out one complete inspection of the children's teeth at the Open Air School. The following table shows briefly the dental work carried out:— Number of children examined by the School Dentist 88 Number of children referred for treatment 49 Number of children treated by Dental Surgeon 49 As a result of the Medical Officer's periodic examinations, a number of the children have been recommended certain treatment as follows:— Administration of Milk in school 23 Administration of Cod-liver Oil Emulsion 17 Administration of Malt and Oil, Parrish's Food, etc. 91 Referred to Ophthalmic Surgeon 6 ,, Orthopaedic Surgeon re Remedial Exercises, etc. 9 ,, Dental Surgeon 15 ,, Aural Surgeon 5 ,, Rheumatism Clinic Specialist 1 ,, Speech Clinic 2 ,, Psychologist 1 ,, Artificial Sunlight Clinic 4 ,, T.B. Officer 8 Recommended Asthma exercises 10 A course of Asthma Injections has been given to 31 children during the year. Recommendations have also been made to the Head Teacher as to the amount of exercises individual children should undergo, and also as to the taking of shower baths and natural sunshine. 12 children received Artificial Sunlight treatment during the year. Treatment for Uncleanliness.—The School Nurses paid 175 visits to the schools (an average of 6 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. eent. 42,234 *1136 2.6 *48 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. 85 The percentages for the past 5 years were as follows:— 1942 2.6 1943 2.5 1944 2.4 1945 3.3 1946 2.6 Other Ailments.—During 1946, 120 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, 104 children were operated on at that Hospital, all as in-patients, for the removal of enlarged tonsils and adenoids. 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 1946 was 1,788,670 approximately. There are sixteen kitchens in the Borough, established at the following schools:— Barking Abbey, Becontree, Benton, County High Boys, County High Girls, Dane, Fairlop. Gearies, Goodmayes, Loxford, Mayfield, Newbury Park, Redbridge, 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 has been supplied free of charge in accordance with the Provision of Free Milk Regulations, 1946. In October, 1946, 16,838 children were receiving milk in school. 380 were receiving an additional one-third pint. Work done by the N.S. P.C.C.—The following 40 cases were investigated :— (1) Neglect ' 21 (2) Ill-treatment cases 4 (3) Other cases 15 (1 caBe was reported from the Public Health Department for neglecting medical advice; 20 were reported from other sources for general neglect). 66 children (32 boys and 34 girls) were involved, 39 being of school age. In addition to this work, 161 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 o this Society. The Invalid Children's Aid Association.—37 children were sent to residential schools and paid for by the Education Committee in 1946. In addition 4 children were sent to Convalescent Homes or Residential Schools and paid for through voluntary funds. An annual grant of £50 is made by the Ilford Committee for Education to this Association. Hospital Investigation and Treatment.—In connection with children referred to hospitals from the various clinics for specialist advice or treatment it is here appropriate to record sincere appreciation of the willing assistance and courteous co-operation of the medical and surgical staff concerned. Among others, grateful thanks are in particular expressed to Drs. Playfair, Doyne-Bell, Deville, Neustatter and Messrs. Small and Hervey, of Queen Mary's Hospital. Stratford, and to Mr. Hogg, of King George Hospital, Ilford. Most valuable help in connection with the investigation of pulmonary ailments has been rendered by Dr. Currid of the E.C C. Tuberculosis Dispensary. 86 Physically Defective Children.—During 1946, 11 new cases were recommended for special educational treatment. The following is a detailed summary of the children dealt with under this heading:— Deaf Children.—Recommended special school for Totally Deaf Children 1 Epileptic.—Special school for Epileptics 3 Cripple—Special school for Cripples 3 Partially Sighted—Special School for the Partially Sighted 1 Debility—Residential Open Air School 3 11 * (between 2 and 5 years of age.) Return of Handicapped Pupils in the Area on 31st December, 1946 (Aged 2-16 Years,) In Special Schools. In Maintained Primary and Secondary Schools. In Independent Schools. Not at School. Total. Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls A. Blind Pupils 1 2 — — — — — — 1 2 B. Partially Blind Pupils — — — 1 — — — —- — 1 c. Deaf Pupils 2 6 — — — — 3 2 5 8 D. Partially Deaf Pupils 3 2 1 — — — — 1 4 3 E. Delicate Pupils 44 37 29 17 — — — 1 73 55 F. Diabetic pupils — — — — — — — — — — G. Educationally Subnormal Pupils 48 15 71 34 — 1 14 3 133 53 H. Epileptic Pupils 1 — 2 — — 1 3 2 6 3 I. Maladjusted Pupils 1 1 3 3 — — — — 4 4 J. Physically Handicapped Pupils 10 11 2 3 — — 5 1 17 15 K. Pupils Suffering from Speech Defect — — 53 14 — — 4 — 57 14 L. Pupils Suffering from Multiple Disabilities 2 2 — 2 — — 1 1 3 5 Children Examined fob Disability op Mind.—During 1946, 136 children were medically examined and reported upon under the Eduoation Act, 1944, classified as follows :— Maladjusted 8 Educationally subnormal 115 Unfit for Education within the school system ‡15 Total number examined 136 ‡3 cases between 2 and 5 years of age 87 Summary of Children with Disability of Mind at end of 1946:— Maladjusted Educationally Subnormal Ineducable At Residential Institution 2(1) 7(1) 8(1)* At Special Day School — 57(3) 19 At Ordinary School 8 102 — At no School or Institution — 19 (14) 42(10)‡ Total 10 185 69 Figures in brackets indicate number over 14 years of age. * Includes 2 cases between 2 and 5 years of age. ‡ Includes 6 cases between 2 and 5 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 1946, it was found that 19 children were employed out of school hours. 18 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 18 Employment of Children in Entertainments Provisional Amending Rules, 1945.—No 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 3 Newly-appointed Staff 26 Staff—Sickness Regulations 7 36 Camp Schools. The Finnamore Wood Camp School, near Marlow, was closed for Ilford children in December, 1945. The Elmbridge Camp School at Cranleigh, Surrey, and Kennylands Camp School at Kidmore End, near Reading, were taken over by the Essex Education Committee on the 1st April, 1945. These two schools are administered by the Ilford Committee for Education for the Essex County Council, and accept children not only from Ilford but from other parts of the county, at Kennylands for short periods of stay. Drugs, medicines and medical appliances are still supplied through these offices and the matrons submit a weekly return showing the variety of cases dealt with in the School Clinic and cases admitted to the Isolation Dormitory, Camp Hospital or other hospital. At Kennylands on the 26th April, 1946, there was an outbreak of Gastroenteritis—70 cases including the matron; the last case occurring on the 2nd May. Seven days' quarantine was imposed and children were allowed to return home on the 13th May. 24 children, however returned to Ilford before that date, against medical advice. These were kept under observation by the Sanitary Inspectors and examined by the School Medical Officer before being allowed to return to school. It has been necessary, as in former years, to draw attention to the inadequacy of the isolation facilities at the Camp Schools. 88 It was possible in 1946 to continue with the inoculation against diphtheria and scarlet fever of the children at the Elmbridge Camp School, Dr. A. H. Gerrard, of Dorking, undertaking the service on a sessional basis; the numbers immunised were Scarlet Fever Inoculations = 48}= 97 Dick Re-tests = 49} Diphtheria Inoculations = 28}=78 Schick tests =50} Handicapped Children. Section 33 of the Education Act, 1944, and the regulations made thereunder have placed on the Local Education Authorities new responsibilities for the provision of suitable education for children suffering from disability of mind or body. A record of all such children is revised annually from returns submitted by all Head Teachers, and any new cases attending local maintained schools are reported to me with a view to medical examination and ascertainment of their suitability or otherwise of attendance at an ordinary school. The several categories of pupils requiring special educational treatment are defined as follows:— (а) Blind Pupils, that is to say, pupils who have no sight or whose sight is or is likely to become so defective that they require education by methods not involving the use of sight. (b) Partially Sighted Pupils, that is to say, pupils who by reason of defective vision cannot follow the ordinary curriculum without detriment to their sight or to their educational development, but can be educated by special methods involving the use of sight. (c) Deaf Pupils, that is to say pupils who have no hearing or whose hearing is so defective that they require education by methods used for deaf pupils without naturally acquired speech or language. (d) Partially Deaf Pupils, that is to say, pupils whose hearing is so defec tive that they require for their education special arrangements or facilities but not all the educational methods used for deaf pupils. (e) Delicate Pupils, that is to say, pupils who by reason of impaired physical condition cannot, without risk to their health, be educated under the normal regime of an ordinary school. (f) Diabetic Pupils, that is to say, pupils suffering from diabetes, who cannot obtain the treatment they need while living at home and require residential care. (g) Educationally Sub-Normal Pupils, that is to say, pupils who, by reason of limited ability or other conditions resulting in educational retardation, require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. In connection with the last, a special class for such pupils was opened at the Newbury Park school on June 17th, 1946. 29 children, who had previously been medically examined and found to fall within this category, were admitted to this class on that date. Since then a further 18 children have been admitted. At the end of the year, 42 were in attendance and 39 were awaiting admission. (h) Epileptic Pupils, that is to say, pupils who by reason of epilepsy cannot be educated in an ordinary school without detriment to the interests of themselves or other pupils and require education in a Special School. 89 (i) Maladjusted Pupils, that is to say, pupils who show evidence of emotional instability or psychological disturbance and require special educational treatment in order to effect their personal, social, or educational readjustment. (j) Physically Handicapped Pupils, that is to say, pupils, not being pupils suffering solely from a defect of sight or hearing, who by reason of disease or crippling defect cannot be satisfactorily educated in an ordinary school or cannot be educated in such a school without detriment to their health or educational development. (k) Pupils suffering from Speech Defect, that is to say, pupils who on account of stammering, aphasia, or defect of voice or articulation not due to deafness, require special educational treatment. The number of children coming within these categories and their disposition as on the 31st December, 1946, are tabulated on page 86. Ineducable Pupils.—During the year 15 children were specially examined and found to be ineducable. These cases were reported to the Borough Education Officer with a view to particulars being forwarded to the Local Authority for the purposes of the Mental Deficiency Acts, 1913-28, under Section 57 of the Education Act, 1944. Particulars of ineducable children in this area and their disposition at the end of the year can be found on page 87. Table Showing the Principal Causes of Death among Children of School Age (i.e., from 5—15 years) in Ilford for 1944 and 1945. The Table also give3 a Comparative Percentage of Deaths Registered at all Ages, and from 5—15 Years. Disease. Ilford, Percentage of total deaths (all ages). Ilford, Percentage of total deaths at ages 5—15 1944 1945 1944 1945 1. Measles — 0.2 — 3.6 2. Scarlet Fever — — — — 3. Whooping Cough 0.1 — — — 4. Diphtheria 0.2 0.2 11.5 7.1 5. Influenza 0.6 0.4 3.8 — 6. Tuberculosis 6.0 4.9 3.8 7.1 7. Rheumatic Fever — 0.06 — — 8. Bronchitis, Pneumonia and other respiratory diseases 9 6 10.4 — 3.6 9. *Meningitis and Nervous system 10.3 14 6 3.8 17.8 10. Heart Diseases 24.3 25.7 — — 11. Acute and Chronic Nephritis 1.9 1.5 — — 12. Violence 10.0 9.4 38.5 53.6 13. Other causes 37.0 32.64 38.6 7.2 100.0 100.0 100.0 100.0 * Excludes Meningococcal infections. Deaths of School Children. Ilford.—The deaths of children of School Age during 1945 represent 1.6 percent, of the Total Deaths registered (all ages), and during 1944 represent 1.6 per cent. 90 Table I.—Return or Medical Inspections. (These returns include Primary, Secondary and Grammar Schools.) A.—Routine Medical Inspections. (1) Number of Inspections in the prescribed Groups:— Entrants 2,599 Second Age Group 2,227 Third Age Group 1,834 Total 6,660 (2) Number of Other Routine Inspections Nil. Grand Total 6,660 B.—Other Inspections. Number of Special Inspections and Re-Inspections 10,848 Table II. Classification of the Nutrition of Children Inspected during the Year in the Routine Age Groups. Age Groups No. of Children Inspected A. (Excellent) B. (Normal) C. (Slightly Subnormal) D. (Bad) No. % No. % No. % No. % Entrants 2,599 139 5.3 2,261 87.0 199 7.7 — — Second Age-Group 2,227 196 8.8 1,876 84.3 154 6.9 2 — Third Age-Group 1,834 113 6.2 1,560 85.1 161 8.7 — — Total 6,660 448 6.7 5,696 85.6 514 7.7 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 3,825 Group II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease No. of Defects dealt with Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Errors of Refraction (including squint) 1,392 20 1,412 Other Defect or Disease of the Eyes (excluding those recorded in Group I) 24 2 26 Total 1,416 22 1,438 No. of Children for whom spectacles were:— (a) Prescribed 734 20 750 (6) Obtained 728 20 748 All spectacles prescribed were obtained during the year, or in January, 1947. 91 Oroup III.—Treatment of Defects of Nose and Throat. Number of Defects Received Operative Treatment. Received other forms of Treatment. Total Number treated. 224 133 357 Table IV.—Dental Inspection and Treatment. (1) Number of Children inspected by the Dentists:— (a) Routine Age Groups— Age 5 6 7 8 9 10 11 12 13 14 15 16 Total. Inspected at Schools 586 702 983 649 716 711 393 451 260 151 30 - 5,632 Specials 277 218 199 182 178 173 188 141 76 41 43 - 1,716 (b) Specials 1,716 (c) Total (Routine and Specials) 7,348 (2) Number found to require treatment 5,079 (3) Number actually treated 3,598 (4) Attendances made by children for treatment 7,804 (5) Half-days devoted to Inspection 45 Total 852 Treatment 807 (6) Fillings Permanent Teeth 2,550 Total 5,281 Temporary Teeth 2,731 (?) Extractions Permanent Teeth 1,167 Total 6,733 Temporary Teeth 5,566 (8) Administrations of general anaesthetics for extractions 2,008 (9) Other operations Permanent Teeth 2,830 Total 3,810 Temporary Teeth 980 Table V.—Uncleanliness and Verminous Conditions. (') Average number of visits per school made during the year by the School Nurses 6 (ii) Total number of examinations of children in the Schools by School Nurses 42,234 (ii) Number of individual children found unclean 1,136* (iv) Number of children cleansed under the arrangements made by the Local Education Authority Nil * In addition 83 children were found unclean at medical inspection and 420 in the School Clinic. 92 Table VI. Blind and Deaf Children. (1) At a Public Elementary School (2) At an Institution other than a Special School (3) At no School or Institution (4) Total not receiving suitable Education Blind Children — — — — Deaf Children — — 4* 4* * Includes one child between 2 and 5 years of age. Table VII. School Medical and Dental Staff. Name of Officer Proportion of whole time devoted to— School Medical Service. Public Health S.M.O.—Dr. J. H. Weir, M.D., B.S., B.Hy., D.P.H. 0.25 Varies according to demands of services Deputy S.M.O.—Dr. I. Gordon, M. D., Ch.B., M.R.C.P., D.P.H. 0.36 ,, Assistant S.M.O.'S.:— Dr. D. M. B. Gross, M.D., Ch.B., M.M.S.A., D.P.H. 0.45 ,, Dr. A.Collins, M.B., B.Ch.,B.A.O. 0.54 ,, Dr. F. E. O'Connor, B.A., M.B., B.Ch.,B.A.O.,D.P.H.,L.M. 0.45 ,, Dr. L. Rich, M.B., Ch.B., M.R.C.O.G., D.P.H. 0.36 ,, Assistant S.M.O. (Vacant post) 0.63 ,, Senior Dentist—Mr. M. J. K. Soutter 8/11 l/li T.B. 2/11 M. & C.W. Dentists—Mr. E. V. Haigh 9/11 2/11 M. & C.W. Mr. A. G. Clark whole School Nursing Staff. (excluding specialist Nurses, such as Orthopaedic Nurses). Number of Officers Aggregate of time given to S.M.S. work in terms of whole-time officers School Nurses 12 One half Dental Attendants 3 17/22nds 93 Table VIII. Summary of Cases of Infectious Diseases among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1946. SCHOOLS No. on Roll DISEASES AND CONTACTS Scarlet Fever Diphtheria Measles & German Measles Chickenpox Whooping Cough Mumps Ringworm. Pneumonia. Totals, 1946. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Cases Contacts Beal Modern 623 1 5 — — 2 — 1 — — — 2 — — — 6 5 Becontree 1266 10 12 2 2 5 — 3 — 7 11 5 1 2 35 25 Benton (Open Air) 85 1 — 1 — 2 — — — — — 1 — — — 5 — Chadwell 632 6 2 — — 80 2 20 — 7 4 77 — — — 190 8 Christchurch 641 3 4 1 1 5 — 19 — 11 2 10 — 1 2 52 7 Cleveland 854 3 18 1 — 4 1 2 - 1 3 1 — 2 1 15 22 County High 1305 6 8 — — 4 — 4 — 2 — 4 — — — 20 8 Dane 541 5 7 — — — — 5 — — — 3 — — — 13 7 Downshall 1191 32 21 — 2 53 3 11 — 20 1 13 — 2 3 134 27 Fairlop 1338 13 12 2 4 101 — 32 — 2 — 5 — — 1 156 16 Gearies 1153 2 1 — — 1 — 15 — 9 — 10 — — 4 41 1 Goodmayes 520 3 2 — — 42 2 1 — 1 1 3 — — 2 52 5 Gordon 164 2 — 1 — — — — — — — 5 — — — 8 — Highlands 585 21 12 — — 5 — 13 — 4 3 5 — — 3 51 15 Loxford 279 2 1 — — 1 — — — — — — — — — 3 1 Mayfield 659 2 3 — 1 5 — 3 — — — 3 — — 1 14 4 Mossford (Fairlop) 286 5 6 — — 25 — 12 — — — 27 — — — 69 6 Mossford (G.V.H.) 126 — — — — 22 — — —— — — — — — — — — Newbury Park 282 1 1 — — — — — — — — — — — — 1 1 Parkhill 958 9 7 — — 20 1 18 — 5 1 22 — — 2 76 9 St. Augustine's 179 2 2 — — — — — — — 1 1 — — — 3 3 SS. Peter and Paul's 580 3 3 — — 30 — 2 — — 3 5 — — 1 41 6 St. Vincent's 308 — — — — 1 — — — — — — — — — 1 — South Park 1021 4 1 4 2 58 1 1 — 8 — 2 — 2 2 81 4 The John Bramston 282 1 1 — — 1 — 8 — — — 2 — — — 12 1 The Mount 279 1 1 — — — -— — — — — 4 — — — 5 1 The Redbridge 467 5 1 — — 5 — 78 — 3 — 70 — — 2 163 1 The William Torbitt 471 2 3 — — 55 — 6 — — — 15 — — — 78 3 Uphall 354 — 6 1 — — — 1 — 7 — 6 — — — 15 6 Ursuline — — 1 2 — — — — — — — — — 3 1 Woodlands 219 7 5 — — 2 — 2 — 8 2 9 — — — 28 7 Private — 4 1 — — 45 2 2 — — — 1 '— — 1 53 3 Totals 17,648 156 146 13 13 576 12 259 — 95 32 312 — 8 27 1446 203 Acute Anterior Poliomyelitis: 1 case at Christehurch, 1 case at Goodmaves. Erysipelas: 1 case at Fairlop, 1 case at St. Augustine's. Dvsentery: 1 case at Becontree. and 1 case at Cleveland. Para-Typhoid Fever: 1 case at Wm. Torbitt. Cerebro-Spinal Fever: 1 case at Cleveland. * Notification of minor infectious diseases in these schools are not received. 94 95 Table IX A.—Table Showing the Average Heights and Weights of the BOYS Examined. Age Groups. Age Groups School 5—6 Years 6—7 Years 7—8 Years 8—9 Years 9—10 Years 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years. Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight fin Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) _ Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of.Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children ; Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Beal Modern - - - - - - - - - - - - - - - - - - 7 144 43.2 1 132 35.2 1 176 70.2 — — — — — — Becontree 39 110 19.8 14 115 21.4 4 119 22.5 4 126 25.5 4 128 25.4 38 138 31.7 32 139 33.3 1 148 38.0 29 152 42.0 7 158 47.0 — — — Benton (Open Air) 7 112 20.6 2 120 22.1 3 118 21.2 15 127 24.9 15 127 27.4 14 135 29.8 4 138 30.8 6 148 39.8 1 157 35.0 1 156 52.2 — - — Chadwell 59 113 20.2 17 115 20.9 6 126 24.7 6 136 25.9 3 136 27.9 23 138 32.1 24 143 33.6 - - - - - - - - - - - - Christchureh 47 112 20.5 29 117 22.1 13 126 25.5 4 132 27.9 3 132 25.1 22 142 33.2 30 144 33.6 — — — — — — — — — — - - Cleveland 26 115 20.1 18 115 21.7 4 124 25.0 1 126 24.7 5 136 30.5 63 137 32.0 49 140 33.9 — — — — — — — — — — — - Dane Central - - - - -_ - - - - - - - - - - - - - 4 142 31.9 4 152 41.2 13 161 49.3 32 162 50.3 9 166 51.7 Downshall 77 109 19.7 32 114 21.1 10 123 23.6 9 128 24.3 6 133 29.3 19 138 30.3 39 143 33.6 3 144 34.2 23 156 44.9 14 158 45.7 1 149 40.0 Fairlop 44 113 20.2 17 114 24.0 5 123 25.8 2 125 27.0 3 137 31.0 19 141 34.0 46 143 34.7 3 144 34.6 35 152 45.3 12 155 42.0 — - — Gearies 68 112 20.3 13 118 23.1 13 125 24.9 6 129 27.0 2 134 28.9 22 139 30.5 37 143 33.7 2 148 41.9 22 156 43.8 14 162 51.2 — - — Goodmayes 1 107 18.4 23 117 22.9 12 122 25.3 3 127 24.9 7 130 27.3 23 138 30.7 21 140 33.1 - - — — — — — — —- — - - Gordon 25 113 20.7 18 114 21.1 4 130 31.1 - - - - - - - - — — — — — — — — — — — — — — - - Highlands 45 111 20.6 27 114 21.2 13 122 25.4 9 128 27.7 7 136 30.6 21 144 33.4 25 142 33.4 1 137 29.1 — — — — — — — - — Loxford - - - - - -- - - - - - - - - - - - 4 143 36.6 53 146 37.9 50 153 43.1 19 153 44.6 — — — Mayfield - - - -- - - - - - - - - - - - - - - 6 144 35.3 51 146 35.6 35 156 43.0 30 156 45.2 — — — Mossford 6 109 19.7 - - - 4 122 22.6 - - - - - - 12 139 30.9 4 142 31.0 1 154 41.3 — — — — — — — — — Newbury Park 10 109 19.3 9 116 21.2 5 125 23.6 1 128 29.1 2 125 26.0 11 138 32.8 16 142 33.8 — — — — — — — — — - — — Newbury Pk. Spec. — — — — — — 3 126 26.4 5 123 24.3 3 130 25.9 4 137 31.4 6 142 35.1 3 144 33.8 5 156 45.1 - - - - - - Parkhill 49 113 20.1 59 117 21.5 34 122 23.7 7 125 25.5 3 135 32.1 58 139 32.8 14 139 32.3 — — — — — — — — — — - - St. Augustine's 12 113 20.5 9 119 20.6 - - - 1 121 22.8 3 132 28.3 7 142 31.6 2 142 36.1 2 148 38.7 2 148 36.4 1 159 50.7 — — — SS. Peter & Paul 28 109 19.7 22 117 22.9 9 121 25.4 2 128 27.0 5 125 25.6 22 138 32.5 7 142 34.8 9 151 41.2 20 153 40.5 9 159 47.4 — — — South Park 64 110 20.5 31 119 23.4 5 128 28.8 7 131 28.7 8 134 29.2 29 141 32.6 40 144 34.2 — — — — — — — — — — — — St. Vincent's 2 115 21.5 1 113 19.4 1 110 18.8 - - - 1 124 23.2 6 138 32.8 9 140 33.2 — — — 5 154 43.1 4 157 47.3 — — — The John Bramston 11 110 19.6 1 105 17.5 1 103 18.0 1 117 21.6 1 120 24.0 20 132 28.6 6 135 31.5 - - - - - - - - - - - - The Redbridge 35 113 20.9 6 117 23.6 7 125 24.7 6 132 28.4 2 137 29.9 17 139 32.3 17 141 34.0 - - - - - - - - - - - - The Wm. Torbitt 33 113 20.3 15 117 21.6 4 123 26.1 2 129 26.0 10 136 33.5 29 137 31.4 13 141 33.6 - - - - -- - - - - - - Uphall 41 110 18.9 13 115 20.4 5 120 21.5 7 127 24.7 1 134 30.0 8 139 34.6 6 141 33.9 - - - - - - - - - -- - - Woodlands 42 112 20.1 11 118 22.7 5 118 22.7 3 127 26.3 - - - - - - - - - - - - - - - - - - - - - Ilford Boys—Averages for 10 years:— 1946 771 112 20.2 387 117 21.9 170 124 24.5 101 128 26.0 94 132 28.6 487 139 31.9 468 142 36.1 140 146 37.2 241 155 41.9 146 158 46.9 40 166 54.0 1945 542 112 20.2 238 117 21.7 92 122 24.0 58 127 26.5 31 131 28.5 74 138 31.8 122 143 35.5 410 146 37.2 41 148 39.3 6 155 42.5 — — — 1944 783 112 19.9 168 116 21.7 83 122 22.4 76 127 26.3 61 132 29.5 59 139 32.6 128 141 34.4 548 146 37.3 73 150 41.0 - - - - - - 1943 723 111 19.6 348 116 22.1 192 121 23.6 184 126 26.6 130 132 28.1 125 137 32.0 152 143 34.8 546 145 36.4 171 151 42.0 - - - -- - - 1942 735 111 19.8 420 116 20.9 259 121 23.7 600 127 26.4 220 131 29.2 217 137 32.0 214 142 34.6 513 146 37.8 162 151 41.5 - - - - - - 1941 377 111 19.6 257 115 21.2 158 122 23.5 519 127 25.9 265 128 28.7 227 137 31.7 201 143 35.9 427 145 37.2 119 151 41.1 - - - - - - 1940 626 111 19.5 296 116 21.4 210 122 23.5 632 127 25.1 239 132 28.7 208 137 31.2 296 142 35.1 601 146 37.7 215 151 42.1 - - - - - - 1939 634 111 19.4 128 119 21.4 87 120 23.3 739 127 26.3 80 131 28.2 80 134 30.2 72 141 35.0 520 145 37.8 69 151 41.1 - - - - - - 1938 382 110 19.5 224 115 21.2 132 120 22 6 1106 127 26.7 160 131 28 2 104 136 31.1 188 141 34.5 770 145 37.3 85 150 40.2 - - -- - - - 1937 1007 109 19.3 251 110 20.1 152 121 23.6 947 126 25.9 149 131 28.3 153 137 31.3 135 141 33.1 681 146 37.2 118 151 42.3 - - - - - - 96 97 Table IX B.—Table Showing the Average Heights and Weights of the GIRLS Examined. School. Age Groups Age Groups 5—6 Years 6—7 Years 7—8 Years 8 —9 Years 9—10 Years 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years. Number o.f Children Examined Average Height (in Oentimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Cemtimetres) 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 <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) Avera,ge Weight (in Kilogrammes) Number of Children Examined Average Height (in Oentimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) No. of Clhildren Examined. Average Height (in Centimetres). Average Weight, (in Kilogrammes). No. of Children Examined. Average Height (in Centimetres). Average Weight (in Kilogrammes). Beal Modern — — - — — — — — — — — — — — — —— — — — — — 32.8 — — — —— — — — — — — — — — — — Becontree 43 108 18.5 21 113 19.5 6 118 22.3 2 132 28.8 1 130 25.4 42 137 31 1 49 140 32.8 6 149 44.9 3 156 44.7 3 159 50.7 19 162 56.9 18 160 56.9 Benton (Open Air) 3 104 16.1 6 108 19.0 4 120 20 0 14 120 21.8 7 133 27.3 11 132 28.7 6 136 27.8 — — — 27 155 44.1 16 158 48.0 — — — — — — Chadwell Christchurch 60 59 111 111 19.3 19.7 29 28 115 118 20.8 22.1 12 5 122 121 23.3 22.2 5 12 130 128 26.2 26.5 2 3 129 132 21.7 27.4 27 12 139 140 32.1 31 143 27.8 34.9 7 143 31.0 4 153 43.1 2 152 39.1 — — — — — — Cleveland 35 109 18.9 12 113 20.4 8 119 22.3 3 130 26.9 6 134 32.7 47 140 32.6 30 143 32.9 — — —— — — — — — — — — — — — — Dane Central — — — — —— — — — — — — — —— — — — — — — 145 31.3 2 136 34.3 41 157 45.8 29 160 48.8 4 160 47.9 — — — Downshall 79 110 18.7 31 115 20.5 13 121 22.9 13 129 24.9 9 133 27.9 21 138 30.7 36 144 35.5 4 150 41.0 25 154 45.4 11 157 43.8 — — — — — — Fairlop 49 114 20.4 17 114 20 2 9 117 21 4 2 125 23.2 2 137 32.6 25 137 .1.2 31 142 34.9 — — — 30 155 46.8 6 150 48.0 — — — — — — Gearies 43 112 19.9 15 116 22.2 10 121 24.9 3 123 23.2 2 132 25.9 31 139 32.0 32 143 34.1 1 142 41.0 23 151 48.1 14 156 50.0 — — — — — — Goodmayes 4 113 19.5 25 115 21.1 6 123 23.8 9 126 25.1 5 134 29.5 22 138 30.6 19 142 35.3 — — — — — — — — — — — — — — — Gordon 19 109 18.8 11 112 19.8 3 115 20.4 —— — — — — — — — — — — — — —— — — — — — — — — — — — —— — Highlands 28 112 20.5 14 118 22.2 7 118 22.5 9 128 26.3 5 129 26.1 13 140 32.0 34 146 37.4 — — — —— — — — — — — — — — — — Mayfield — — — — — — — — — — — —— — — —— — — — 4 150 41.7 4 153 41.5 29 155 45.8 22 159 49.4 — — — — — — Mossford 2 117 19.1 2 112 19.5 1 122 25.0 1 144 33.0 — — — 9 139 30.0 7 142 34.6 — — — — — — — — — — — — —. — — Newbury Park 6 108 19.8 7 115 20.1 5 122 23.1 2 130 29.2 1 141 35.5 15 141 32.1 10 143 36.7 — — — — — —— — — — — — — — — — Newbury Pk.Spec'l — — — — 1 113 21 0 4 128 27.2 1 125 23.3 2 141 32.0 — 143 36.7 — — — — — — — — — — — — — — — Parkhill 44 108 18.3 62 116 20.9 30 123 23.5 9 128 25.7 2 135 31.5 39 137 29.0 19 140 34.3 — —— — — —— — 1 150 32.0 — — — — — — St. Augustine's 11 112 18.9 10 114 20.3 2 121 24.9 1 125 22.9 1 136 27.9 6 140 31.4 5 138 31.1 1 150 39.6 — — —- — — — — — — — — — S.S.Peter & Paul 31 109 19.3 20 117 22 4 9 120 25.1 5 128 25.1 1 124 22.8 12 137 32.0 10 143 35.5 5 150 39.6 10 157 46.3 3 160 48.6 — — — — — — South Park 53 111 19.0 20 118 21.5 12 123 23.7 6 130 25.9 11 136 30.2 18 141 31.8 33 145 34.4 — — — — — — — — — — — — — —— — St. Vincent's 2 118 21.5 1 115 23.2 2 120 24.6 — — — 1 141 31.0 7 137 29.0 12 145 36.8 — — — 1 156 42.0 5 152 42.8 — — — —— — — The John Bramston 9 109 19.9 3 113 23.3 — — — 1 121 24.6 — — — 16 139 31.2 6 137 33.8 — — — — — — — — — — — — — — — The Mount — — — — — — — — — — — — — — — — — — 4 141 33.8 46 150 40.5 72 156 15.4 9 155 51.2 — — — — — — The Redbridge 29 112 19.5 9 117 22. 6 125 26.3 5 122 23.6 7 132 27.6 20 141 32.3 13 147 36.6 — — — — — — — — — — — — — — — The Wm. Torbitt 27 111 19.9 16 118 22.0 4 122 23.6 3 126 25.3 3 133 27.2 29 140 339 10 140 34.3 — — —— — — — — — — — — — — — — Uphall 38 111 19.8 25 119 22.2 6 120 21.3 7 126 25.3 1 133 33.2 21 136 29.2 7 141 33.2 — — — — — — — — — — — — — — — Woodlands 33 112 19.5 12 117 21.6 6 124 24.3 — — — — — — — — — — — — — — — — — — — — — —— — — — — —— —Ilford Girls—Averages for 10 years:— 1946 708 111 19.3 396 116 21.2 167 121 23.2 116 127 25.2 71 152 28.6 445 138 31.5 445 142 34.4 76 148 39.8 265 156 45.8 121 157 48.5 25 1362 56.1 18 160 56.9 1945 488 110 19.6 249 116 21.2 77 121 23.3 47 127 26.8 28 130 28.1 35 137 30.7 87 143 34.9 499 149 39.4 66 153 44.3 10 160 53.3 — — — — — — 1944 710 110 19.7 167 116 21.3 55 122 23.7 45 127 26.1 51 133 29.2 49 138 31.4 87 143 35.8 492 149 39.2 59 153 42.9 — — — — — — — — — 1943 636 110 19.2 375 115 20.8 175 120 22.5 172 125 25.5 125 130 27.6 111 136 30.8 107 143 34.7 597 148 38.4 143 153 42.2 — — — — — — — — — 1942 617 110 19.1 448 115 20.7 240 122 23.2 588 126 24.4 228 131 27.9 213 136 30.8 150 143 34.5 597 148 38.4 143 153 42.2 — — — — — — — — — 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 34.5 451 148 38.5 171 154 43.8 — — — — — — — — — 1940 548 110 18.9 286 116 20.7 185 121 23.5 579 127 26.6 216 133 28.3 192 137 30.9 232 143 35.6 540 148 39.8 172 153 44.7 — — — — — — — — — 1939 588 110 18.7 121 114 20.7 100 120 23.2 634 126 25.1 87 131 28.3 67 134 30.1 85 142 34.8 567 147 37.7 106 151 42.7 — — — — — — — — — 1938 993 110 18 9 221 114 20.5 139 120 22.9 1083 126 25.2 145 130 27.3 127 135 30.2 193 143 35.6 709 147 38.2 122 151 42.5 — — — — — — — — — 1937 937 109 18.9 224 114 21.0 144 119 22.3 1022 126 24.1 164 131 27.5 144 136 31.3 205 141 33.9 841 147 38.0 169 152 42.9 — — — — — — — — — . I 98 99 Table IX C. Table showing the Average Heights and Weights of Grammar School BOYS. School Age Groups Age Groups 10—11 Years 11—12 Years 12—13 Years 13-14years 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 j 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 Oentimetres) 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 Oentimetres) Average Weight (in Kilogrammes) County High School for Boys — — - 14 146 37.7 11 155 44.0 20 158 48.4 9 154 45.1 163 168 56.3 74 172 59.1 18 172 60.9 8 175 62.8 Table IX D. Table showing the Average Heights and Weights of Grammar School GIRLS. School Age Groups Age Groups 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 Oentimetres) 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 Oentimetres) 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 — — — 27 148 . 36.3 12 152 42.2 17 156 45.3 36 161 49.7 149 162 51.3 37 162 55.8 35 162 55.0 3 164 52.3 Ursuline — — — 30 145 35.7 20 147 37.6 4 163 44.0 2 158 48.1 50 159 54.0 8 160 54.4 1 156 44.9 — — —