Library AC4411(1)IL FORD Borough of Ilford Health Report FOR THE YEAR 1947 J. H. WEIR M.D., B.S., B.Hy., D.P.H. Medical Officer of Health, etc. Ilford Borough Council 1st NOVEMBER, 1946—31st OCTOBER, 1947 Alderman W. A. V. Bryan, J.P., Mayor. Alderman w. b. Eke, J.P., Deputy Mayor. Aldermen: Bryan, William Allen Vernon, Holness, Richard Thomas. J.P. (Mayor). Dan,els, Russeil Stearn. Wetton, George John, C.A. (E.C.C.). Eke, William Benjamin, J.P. (Deputy Mayor). Wootton, Mrs. Florence Emily. Fallaize, Mrs. Lilian, J.P., E.C.C. O.B.E. Griggs, Albert Philip, J.P., C.A. Young, Major Alexander, T.D., (E.C.C.). J.P. (E.C.C.). Councillors: Barker, John. eke, Reginald George. Barnes, Mrs. Winifred Amy. Faning, Percy Victor (E.C.C.). Bennett, Mrs. Florence Edith. Gibson, Cyril Irving. Billings, John. Littlejohn, Mrs. Ruth Constance, M.A. Bishop, Mrs. Agnes Ethel. O'Connor, Mrs. Ethel. Brown, H.tRoiD John. Payne, Robert Wilfred. Brown, William Thomas. Pointer, Frederick George. caunt, George Louis. Slater, Frank. Clements, John Anthony, F.R.S.A., F.S.S., F.R.Econ.S, Spalding, Mrs. Amine. Colvin, Gilbert, F.C.I.S. Taylor, Sidney William. Cooper, Aibert Edward, M.B.F. I odd, Norman. Tyler, Bertif. Charles Newcombe. Cowan, Harold Douglas, I-.C .P.A., F.C.C.S. Watts, Frederick. Fast, John. Woods, Sidney Charles Victor. PUBLIC HEALTH COMMITTEE 1st NOVEMBER, 1946—31st OCTOBER, 1947 Alderman Mrs. F. E. Wootton, O.B.E., Chairman. Councillor Mrs. R. C. Littlejohn, M.A., Vice-Chairman. Alderman W. A. V. Bryan, J.P. Alderman A. P. Griggs, J.P., C.A. (Mayor). (E.C.C.). Alderman W. B. Eke, J.P. (Deputy Alderman R. T. Holness. Mayor). Councillor J. Barker. Councillor Mrs. E. O'Connor. Councillor J. Billings. Councillor Mrs. A. Spalding. Councillor Mrs. A. E. Bisiiop. Councillor B. C. N. Tyler. Councillor C. I. Gibson. Councillor S. C. Y. Woods. MATERNITY AND CHILD WELFARE COMMITTEE 1st NOVEMBER, 1946—31st OCTOBER, 1947 Councillor Mrs. A. Spalding, Chairman. Councillor Mrs. W. A. Barnes, Vice-Chairman. Alderman W. A. V. Bryan, J.P. Alderman A. P. Griggs, J.P., C.A. (Mayor). (E.C.C.). Alderman W. B. Eke, J.P. (Deputy Alderman Mrs. F. E. Woottox, Mayor). O.B.E. Alderman Mrs. L. Fallaize, J.P. Councillor C. I. Gibson. Councillor Mrs. F. E. Bennett. Councillor Mrs. R. C. Littlejohn. Councillor J. Billings. M.A. Councillor Mrs. A. E. Bishop. Councillor Mrs. E. O'Connor. Councillor J. East. Councillor R. W. Payne. *Mrs. M. Armitage. Councillor B. C. N. Tyler. *Mrs. H. Ashby. *Mrs. Meggs. *Mrs. B. Butcher. *Mrs. B. E. Paddon. *Mrs. W. Butler. *Mrs. E. Weekes. *Co-opted Members. ILFORD COMMITTEE FOR EDUCATION 7th NOVEMBER, 1946—8th NOVEMBER, 1947 Councillor Mrs. R. C. Littlejohn, M.A., Chairman. Councillor Mrs. F. K. Bennett, Vice-Chairman. Alderman W. A. V. Bryan, J.P. Alderman Mrs. I.. Fallaize, J.P. (Mayor). Alderman Mrs. F. F. Wootton, Alderman R. S. Daniels. O.B.E. Alderman W. B. Fke, J.P. (Deputy Alderman A. M. Young, T.D., Mayor). J.P. (E.C.C.). Councillor J. Barker. Councillor Mrs. E. O'Connor. Councillor Mrs. W. A. Barnes. Councillor N. Todd. Councillor H. J. Brown. Councillor B. C. X. Tyler. Councillor G. L. Caunt. Councillor F. Watts. Councillor J. A. Clements, Councillor S. C. V. Woods. F.R.S.A., F.S.S., F.R.Econ.S. ,Mr D O,Brien Councillor G. Coivin, F.C.I.S. .Miss H. S. Rich. Councillor A. E. Cooper, M.B.E. „Mr. W. R. Spencer. Councillor J. East. *Mrs. n. Spiller. County Alderman A. W. Green, JP. *Rev. W. C. Johnson. *Mr. S. P. Lonergan. *.Mr. E. R. Lower, B.A. *Mr. I.. R. Maddieson. *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 (To 30/9/47) : 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 : I). 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.). C. M. Small, M.B., B.S., D.P.H.(Lond.). (To 13/12 47.) I. D. M. Nelson, M.B., B.Ch., B.A.O., C.P.H., D.P.H. (Belfast). (From 5/1 48.) Assistant Medical Officer of Health and Resident Medical Officer (Isolation Hospital) : S. R. Jamieson, M.D., Ch.B., D.P.H.(Glas.). (To 2/7/47.) G. L. Brown, M.D., Ch.B., D.P.H. (Glasgow). (From 1/7 47.) Resident Medical Officer (Maternity Home) : K. R. Barker, M.R.C.S., L.R.C.P. Senior Dental Surgeon : M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Assistant Dental Surgeons : A. G. Clark, L.D.S., R.C.S. (Eng.). E. V. Haigh, L.D.S., R.C.S. (Eng.). Matron of Isolation Hospital : Matron of Maternity Howe : Miss K. Bellaers. Miss F. G. O. Moorcroft. Senior Sanitary Inspector: S. R. Daly, B.Sc., D.P.A.(Lond.), F.A.L.P.A., M.R.San.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. J. Cook. J. H. Butler. F. Nau. Chief Administrative Assistant : F. J. Hocking. Superintendent of Council's Midwives : Miss C. Blockley. Officers of the Public Health Services—continued Superintendent Health Visitor: Mrs. M. D. Smith. Health Visitors and School Nurses : Miss A. Batten. Miss A. L. Drinkyvater. Miss O. Bell. Miss I. L. Mobbs. Miss M. G. Bennett. Mrs. I. Quirk. Mrs. V. M. Whiting. Ante-Natal Clinic Nurse : Mrs. D. W. Quick. Matrons of War-time Day Nurseries: Sunshine House Miss I. E. Sandal.i. Green Lane Mrs. E. Drower. Ley Street Miss A. R. Jones. Becontree Avenue Mrs. N. Nicholas. 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. Derbyshire, B.Sc., M.B., B.S., D.P.H. (Eng.), D.O.M.S. Surgeon in charge of Aural Clinic: W. Ibbotson, F.R.C.S. Physician in charge of Rheumatism Clinic: K. Playfair, M.A., M.B., M.R.C.P. Physician in charge of Paediatric Clinic : I. M. Anderson, M.D., M.R.C.P. Veterinary Surgeon: Ralph Bennett, F.R.C.V.S. Public Analysts: 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, Ilford. To the Mayor, Aldermen and Councillors September, 1948. of the Borough of Ilford. Mr. Mayor, Ladies and Gentlemen, I submit herewith the Annual Report on the Health Services for the year 1947. The health of the town's inhabitants has remained uniformly good, as evidenced by the vital statistics given on pages 10 and 11. Reference to Table la on page 14 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.G is slightly below the figure for 1946, and the corrected death rate of 9.8 is 0.1 above the 1946 figure. The infantile mortality rate continued its decline, falling to 24.3, the lowest ever recorded in Ilford, and substantially below that given for England and Wales (41) or the Administrative County of London (37). The birth rate showed a slight fall to 19.1 as compared with last year's figure of 20.2. The actual number of births registered totalled 3,368 as compared with 3,443 for 1946. It is satisfactory to note that the number of illegitimate births registered was only 3.3 per cent, of the total. In September, as part of a Civic Week Exhibition, a comprehensive display was arranged to illustrate the activities of the Department. Diagrams, charts, and exhibits of apparatus appliances and equipment used in the various sections were arranged in a narrative sequence. During the year under review, the environmental hygiene section of the Department continued its work, which was considerably increased by housing and infectious disease enquiries. In addition to the routine supervision of matters of general sanitation, particular attention was paid to the purity of food supplies, especially milk and ice cream. Many applications were received for certificates of housing defects to support claims for war damage repairs, or for building licences. A large number of house inspections were instituted by complaints received of insanitary or overcrowded housing conditions, upon the substantiation of which complainants wished to base claims for the provision of alternative accommodation. The Sanitary inspectors have also had to deal with numerous requests for the removal of aged and infirm or chronic invalids from insanitary premises, or where adequate care could not be provided at home. Unfortunately, institutional accommodation for these persons continues to be totally insufficient. At the time of writing a campaign against food and drink infections is in progress. A long term educational policy has been adopted and this is being directed to school children, the public generally, and executives of all grades in the food handling trades. Propaganda by means of posters, leaflets, press articles, lectures, demonstrations and films, is being used and the goodwill, co-operation and assistance of all concerned is earnestly sought. In connection with this campaign, the Sanitary Inspectors are conducting an intensive survey of all food preparing, catering and retail premises. 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 2,232 cases, as against 1,135 in 1946. Whooping cough, the next common infection, showed an increase from 341 to 935 cases. During the year an extensive outbreak of acute anterior polio-myelitis affected the country. In all, 7,800 cases were notified, as against 1,581 notifications 7 in 1938, the year of highest recorded incidence prior to 1947. Locally, 29 verified cases occurred, with 1 fatality. Of the remainder, 20 had recovered completely on discharge from hospital, 7 had slight paralysis, and 1 had some permanent paralysis. No case of smallpox occurred in the year, during which the Sanitary Inspectors paid 331 visits to houses in connection with the surveillance of contacts. The number of cases of diphtheria notified fell to 22, the lowest for this century. Only one fatal case occurred among Ilford patients admitted to the Isolation Hospital. The progress of the diphtheria immunisation scheme has continued satisfactorily, and the re-inoculation scheme introduced last year has been well accepted, many parents availing themselves of the facilities offered. It will be noted in the section dealing with the Isolation Hospital that a considerable number of obstetrical cases—ante-natal, confinement or postnatal—were admitted. This is a continuation of the policy mentioned in my last annual report and is designed to obviate any risk of an epidemic in the Maternity Unit and to lighten the burden on the depleted and overworked staff at the Maternity Home. The Maternity and Child Welfare Services have dealt with 2,215 births, as compared with 2,222 in 1946. The Maternity Home admissions, numbering 1,056, represent an increase of 3.5 percent. as compared with 1946. It will be noted that 114 of these were emergency cases, most of which required operative or other specialised treatment. The domiciliary midwifery serVice dealt with 1,159 cases, as compared with 1,202 in 1946. The difficulty of obtaining midwives for institution or domiciliary midwifery continues. So far as district midwives are concerned, one of the main factors has been the impossibility of obtaining suitable housing accommodation. It is imperative that flats or houses within their areas of practice should be provided to attract applicants and recruits to the service generally. All the domiciliary midwives have now completed a course of instruction in gas and air analgesia during childbirth, the necessary apparatus has been obtained and it is intended to make this facility available to patients whenever desired and possible. The arrangements for the transfer of patients to emergency maternity homes in the provinces continued during the year. Through the medium of the London Emergency Bed Service many patients were accommodated in various London maternity units, and others were admitted to these units by previous agreement and direct booking. In September 1947, the Post-Natal Hostel at Wilnett Lodge, Chadwell Heath, was opened, and this has proved to be of considerable value in freeing beds at the Maternity Home for the reception of an increased number of patients. The Ministry of Health have given approval in principle to the erection of an additional ward block and administrative accommodation at the Maternity Home. Negotiations are now proceeding between the Ministry of Health and Regional Hospital Board with a view to the building operations being put in hand. Corresponding with the work of the Maternity Home, attendances at Loth Ante-Natal Clinics and at the Post-Natal Clinic have continued at a busy level. The work of the infant welfare centres has continued to increase. Altogether 49,690 attendances were made as compared with 46,620 in 1946. The number of children on the welfare centre rolls increased from 4,049 in 1946, to 4,146 in 1947. Home visiting by Health Visitors has had to be further curtailed owing to shortage of staff. It has been exceedingly difficult to fill vacancies and impossible to reach the full establishment. A temporary easement of the position has been sought by the appointment of five Clinic Nurses, but their functions are limited, as they cannot undertake all duties normally 8 performed by qualified Health Visitors. As in the case of domiciliary midwives, consideration to the provision of living accommodation for Health \ isitors will have to be given at the earliest possible moment. 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 urgent need. I he School Medical Service is now catering for a school population of 19,002 an increase of 932 on the previous year. The number of routine medical inspections, re-inspections and special examinations conducted are indicated in the School Medical Section of the Report. 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 ol treatment is secured for children urgently in need of operation. Every possible endeavour has been made to ameliorate the position, which 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 similar over-burdened waiting lists. During the year, arrangements were made for the provision of orthoptic clinic facilities. By courtesy of the Medical Officer of Health of Walthamstow, and with the sanction of the County Council, arrangements have been made for school children requiring this treatment to attend the orthoptic clinic at Walthamstow. The urgent local need for increased provision of day and residential school accommodation for educationally subnormal pupils and institutional facilities for ineducable children still exists. The Special Classes attached to Newbury Park School are fulfilling a most important function and producing very satisfactory results. The Local Education Authority have approved the establishment of a Child Guidance Clinic to be accommodated in Loxford Hall by permission of the Borough Council. It is hoped that this will come into operation in the near future. The future position of the various health services is bound up with the operation of the National Health Service Act, 1946. Under its provisions Ilford becomes an area of Divisional Administration for certain of the services administered by the County Council under Part III of the Act. For this purpose the County Council have constituted an Area sub-Committee, which will assume responsibility for the day to day administration of the Maternity and Child Welfare Services, domiciliary midwifery, health visiting, home nursing, vaccination, immunisation, care and after-care of the sick, and domestic help. For the administration of these services it has been proposed that I shall be appointed Area Medical Officer. The immediate result of this alteration in control is that at' the executive level the services formerly existing continue unaltered but the actual work is increased, partly by reason of added facilities—vaccination and home nursing—and partly by the considerably increased records, correspondence and complications of administrative procedure. At the administrative level, locally and inter-departmentally, the work will be much more involved and of necessity, more complicated and protracted. At the representative level, local representation will be considerably lessened. So far as the hospitals are concerned, the Isolation Hospital, the Maternity Home and Wilnett Lodge pass from the control of the Council to that of the North East Metropolitan Regional Hospital Board, as from 5th July 1948. For a period, at present limited to nine months, the Borough Council have agreed to continue certain services (supplies, maintenance of premises and plant, accounting, certain legal work and estate management) on an agency basis. It has been further agreed that in the meantime I shall continue as Medical Superintendent of the Institutions, having the assistance of certain "non 9 transferred" medical, administrative and clerical officers, in addition to the full-time stall of the Hospitals who are automatically transferred to the service of the Regional Hospital Board. Here again work at the executive level continues unchanged except for some administrative additions. Administrative procedures are more involved and representation of the Borough Council is greatly reduced. A Hospital Management Committee of 20 members controls the hospitals of Group 12 (Ilford and Barking) which comprises the King George Hospital, Ilford ; Ilford Isolation Hospital; Ilford Council Maternity Home and Wilnett Lodge; Barking Upney Isolation Hospital; Upney Maternity Home; Ilford Tuberculosis Dispensary and Dagenham Sanatorium, a total of 713 beds. So far as the general future of Public Health Services is concerned, there is no need for despondency or pessimism. Although Local Authorities such as Ilford have lost direct control of Part III and Hospital Services, much remains to be done in the field of Public Health. In addition to their operation of health services under the the aegis of the Major Authorities there still remain to them many problems of environmental hygiene. Much can be done in the direction of improving the social and economic background of the family. In this, health education in its many and varied aspects, can play a significant part and there is ample scope for endeavour in this field of activity. There are many problems of epidemiology as yet unsolved, and there is ample scope for work in this direction. Among the many problems still confronting the public health authorities may be mentioned industrial and office hygiene, eugenics, rehabilitation and after-care, and gerontology. The problems of the causation of congenital defects and mental deficiency, the question of physical education and rehabilitation, and education in the prevention of contamination of food and drink, in marriage hygiene, sex problems and in mothercraft, should alone provide ample scope for the energies of all those concerned. 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. 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 workers who have assisted in the work of the various Clinics, I express my sincere gratitude. I am happy to record that the Ilford Federation of Voluntary Workers have been given two places on the Area Sub-Committee. It is pleasing that their valuable work, so efficiently carried out over the past 35 years, has been thus recognised, and it is hoped that they will be willing to continue their assistance at the Welfare Centres and that the operation of the National Health Service Act will in no way interfere with, or diminish their efforts. 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. 10 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. {Land 8,402} Area (in Acres) {Inland Water 26 } 8,435 {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 1947 179,820 Number of inhabited houses (end of 1947) according to Rate Books 44,976 (approx.) Rateable Value—October 1st, 1947 (Houses and Land) £1,604,337 Sum represented by a penny rate, October 1st, 1947 £6,530 (approx.) 1946-47 1947-48 Education Rate— (E.C.C.) 5s. 3-88d. 5s. 11.66d. in the £ in the £ Combined Rate (all services) 16s. Od. 17s. 6d. in the £ in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males Females. As at January 13th, 1947 678 98 As at January 12th, 1948 570 101 Total M. F. 1947 1946 Live Births Legitimate Illegitimate 3,258 110 1,684 60 1,574 50 Birth Rate per 1,000 of the estimated resident population 191 20. Still Births 85 41 44 Rate per 1,000 total (live) and still) births 24. 26. Deaths 1,739 897 842 Death Rate per 1,000 of the estimated resident population 9.8 9. Percentage of total deaths occurring in public institutions. 27. 31.6 11 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. 1947 1946 1947 1946 No. 29, Puerperal sepsis 0 0 0.0 0.0 No. 30, Other maternal causes 2 8 2.26 0.58 Total 2 8 2.26 0.58 Death-rate of Infants under one year of age: — 1947 1946 All infants per 1,000 live births 24.3 29.6 Legitimate infants per 1,000 legitimate live births 23.9 29.1 Illegitimate infants per 1,000 illegitimate live births 36.4 46.7 Deaths from Cancer (all ages) 318 318 ,, Measles (all ages) 1 — ,, Whooping Cough (all ages) 2 1 ,, Diarrhoea (under 2 years of age) 6 5 1. Rainfail. Total rainfall registered in the district during the year was 18.77 inches, the greatest fall in 24 hours was registered on 27th June, being 1.3 inches. The fall of longest duration was on the 29th March—12.7 hours. March was the wettest month. 2. Population. The number of patients and resident staff on the 30th June, 1947, at the following public institutions, was:— Claybury Mental Hospital 2,360 West Ham Mental Hospital 1,311 Australasian Hospital (Girls' Village Homes) 47 Total 3,718 3. Births. The number of births registered during the year was 3,368. Males Females Legitimate 1,684 1,574 Illegitimate 60 50 i.e. 3.3 percent. of the births registered were illegitimate. *The percentage of illegitimate births registered in the previous 10 years was : 3.1; 5.5; 4.2; 3.4; 3.5; 3.3; 2.5; 2.2; 2.4; 2.7. The birth-rate, calculated on the net estimate of the population is 19.1 per 1,000. 4. Deaths. The total number of deaths of Ilford residents was 1,739. This is obtained by taking the total deaths registered in the district (1,547), subtracting the deaths of non-residents occurring in the district (285), and adding the deaths of Ilford residents registered as having died in other districts (477). The number of deaths of non-residents registered in the district (principally in large institutions) was as follows:— Claybury (L.C.C.) Mental Hospital 68 West Ham Mental Hospital 04 King George Hospital 80 Ilford Isolation Hospital and Sanatorium 45 Other Non-residents 28 Total 285 12 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 70 Essex County Mental Hospital, Brentwood 11 Essex County Hospital, Wanstead 31 Queen Mary's Hospital, West Ham 5 Hospital for Sick Children, Great Ormond Street 9 London Hospital 43 St. Bartholomew's Hospital 12 Charing Cross Hospital 7 Westminster Hospital 1 Royal Eastern Counties Institution, Colchester 1 Guy's Hospital 2 Severalls Mental Hospital, Colchester 11 East Ham Memorial Hospital 8 University College Hospital 2 Whipps Cross Hospital 5 St. Luke's Hospital 4 London Chest Hospital 6 In other Hospitals, Institutions and residences outside the Ilford district 249 Total 477 The death rate, calculated on the net estimate of the population of 176,149, is 9.8 per 1,000. Inquests.—During the year, 69 inquests were held, 49 on Ilford residents, and 20 on non-residents. The ages at death were as follows :— Under 1-2 2-5 5-15 15-25 25-45 45-65 65 years and 1 year years years years years years years upwards 2 — 1 2 5 11 19 29 Death-Rates from Tuberculosis and Cancer, 1947. The following Table shows the death-rates for 1947 for Ilford, compared with the provisional death-rates for England and Wales for the same period, per 1,000 population ; the figures having been supplied by the RegistrarGeneral:— Ilford England and Wales Respiratory Tuberculosis .312 .470 Other Tuberculosis .057 .079 Cancer 1.805 1.853 5.—Public Assistance Relief.—The total amount expended in Ilford during the year was .£30,952 lis. 7d. The average weekly number of cases in receipt of relief was 646, including dependants. The number of admissions to County Institutions from Ilford during the year was 1,494, made up as follows:— Men 591 Women 718 Children 185 The number of destitute persons admitted to the Public Assistance Institutions during 1947 was ; men 1, women 4, children 1. 6. Marriages.—1,952 marriages took place in the Ilford district during 1947, both parties or one of the contracting parties being Ilford residents. 7. Tables of Vital Statistics.—Table I gives a comparative statement of the birth-rate and death-rate for the past five years. Table IA gives a comparison of the vital statistics of Ilford with England and Wales, London and other towns. Table II gives a classified statement of the causes of death in 1947, arranged according to the age groups at which deaths occurred. 13 TABLE I.—Vital Statistics of Whole District During 1947 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 1943 147,600 143,361 1,795 2,621 18.2 1,416 9.6 376 590 92 35.1 1,630 11.4 1944 149,330 145,079 1,949 2,771 19.1 1,517 11.1 404 544 102 36.8 1,657 11.4 1945 151,520 147,759 1,888 2,479 16.8 1,516 10.0 403 551 81 32.7 1,664 11.3 1946 173,900 170,331 2,690 3,443 20.2 1,546 8.9 321 428 102 29.6 1,653 9.7 1947 179,820 176,149 2,764 3,368 19.1 1,547 8.6 285 477 82 24.3 1,739 9.8 (a) 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 gross population. 14 TABLE 1A Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1947 (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 20.5 0.50 12.0 0.00 0.00 0.01 0.00 0.02 0.01 0.09 5.8 41 126 County Boroughs and Great Towns, including London 23.3 0.62 13.0 0.00 0.00 0.02 0.00 0.03 0.01 0.09 8.0 47 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 22.2 0.54 11.9 0.00 0.00 0.02 0.00 0.02 0.01 0.08 3.7 36 London Administrative Co. 22.7 0.49 12.8 0.00 — 0.01 0.00 0.02 0.01 0.08 4.8 37 ILFORD (Estimated Gross Population, mid 1947=179,820) 18.7 0.47 9.6 - — 0.00 - 0.01 0.00 0.11 1.8 24 A clash (—) signifies that there were no deaths. 15 Registrar-General's Short List of Deaths and Causes:— TABLE II Causes of, and Ages at, Death during the Year 1947 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 1,739 82 5 7 10 24 37 92 185 272 426 599 1 Tvphoid and paratyphoid fevers - - - - - - - - - - - - 2 Cerebro-Spinal fever 1 - - 1 - - - - - - - - 3 Scarlet fever - - - - - - - - - - - - 4 Whooping cough 2 2 - - - - - - - - - - 5 Diphtheria 1 - - - 1 - - - - - - - 6 Tuberculosis of respiratory system 65 - - 1 1 5 8 22 12 8 8 - 7 Other forms of tuberculosis 10 — 1 1 — 2 1 1 3 1 — — 8 Syphilitic disease 10 - - - - - - - - 3 2 2 9 Influenza 20 - - - - - 1 - 3 3 4 9 10 Measles 1 - - - 1 - - - - - - - 11 Acute Poliomyelitis and polio-encephalitis 1 - - - - - 1 - - - - - 12 Acute infectious encephalitis — - - - - - - - - - - - 13 Cancer of buccal cavity and oesophagus (males only) 10 - - - - - - - - 1 2 7 Cancer of uterus (females only) 15 — — — — — — 2 2 7 3 i 14 Cancer of stomach and duodenum 51 - - - - - 2 4 6 14 13 12 l5 Cancer of breast 42 - - - - - 1 - 10 9 7 10 16 Cancer of all other sites 200 1 - - - 1 5 12 31 51 55 44 17 Diabetes 14 - - - — 1 - 1 — 9 7 3 18 Intra-cranial vascular lesions 176 - - - - - - 5 11 29 56 75 19 Heart disease 480 — — — — 3 4 15 35 58 141 224 21) Other diseases of the circulatory system 57 - - - - - 1 2 6 10 8 30 21 Bronchitis . 106 1 1 — — — - 1 10 10 33 50 22 Pneumonia 68 16 - 1 - - 1 1 2 12 13 22 23 Other respiratory diseases 24 - 1 - - - - 3 2 4 6 8 24 Ulceration of the stomach or duodenum 16 - - - - - - 1 5 5 4 1 25 Diarrhoea (under 2 years of age) 6 5 1 - - - - - - - - - 26 Appendicitis - - - - 1 - - - 1 1 2 - 27 Other digestive diseases 41 1 1 — - 2 3 3 7 17 7 28 Nephritis 51 — — — — 1 — 2 7 7 13 21 29 Puerperal and post-abortive sepsis - - - - - - - - - - - - 30 Other matetrnal causes - - - - - - 1 1 - - - - 31 Premature birth 11 11 - - - - - - - - - - 32 Congenital malformations, birth injury, infantile disease 39 84 - - - 2 1 1 - 1 - - Suicide - - - - - - 3 3 6 2 3 1 34 Road Traffic accidents 22 1 - 1 2 4 - - 4 3 5 2 35 36 Other violent causes All other causes 33 141 2 8 — 2 2 2 1 2 3 4 1 6 3 20 5 19 3 21 13 57 Special Causes (included in No. 36 above):— Smallpox - - - - - - - - - - - - 16 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, 10,792 visits being paid by the Nurses in 1947, compared with 9,417 in 1946. The following is a summary of the work carried out during the year 1947:— Number of New Cases and applications for Nurses' Services 408 Number of Visits—Medical 9,142 Surgical 1,636 Operations 1 Massage 13 Number of necessitous cases referred to the Committee 26 Number of cases on books at end of year 89 The cases were distributed in wards as under:— Cranbrook 66 Park 58 Seven Kings 39 North Hainault 34 Loxford 59 Clementswood 30 South Hainault 23 Goodmayes 27 Barkingside 72 • (iii) Laboratory Facilities.—During the year 680 swabs were examined for the presence of diphtheria organisms in the Bacteriological Laboratory at the Isolation Hospital; 33 gave positive results and 647 negative results. In addition 6 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. 17 During 1947 eighteen applications for renewal of licences were received. The Council renewed the licences in respect of these establishments. Three new applications were received, which were granted. All the licences expire on 31st March, 1948. Part VI.—Hairdressers.' and Barbers' Premises. During 1947, 74 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 34 applications for registration in respect of 26 premises were considered during the year. The registrations were granted as follows:— Purveyors retailing multiple firms' productions27 Purveyors manufacturing and retailing their own productions (made apart from domestic premises)Nil Purveyors manufacturing and retailing their own productions (made on domestic premises)Nil Registration was refused in 7 cases, on account of lack of suitable accommodation and/or provision of utensils and equipment. Legal proceedings were taken against an ice cream vendor for failing to keep the utensils clean and not displaying his name on the van from which sale was being made. A fine of £5, and £1 costs was imposed. Ice Cream (Heat Treatment, etc.) Regulations 1947 and 1948. These Regulations came into operation on 1st May 1947, and broadly require that, except in the case of a completely cold mix, the ingredients of ice cream shall be heat treated after mixing and the mixture then cooled until the freezing process is begun. After freezing the ice cream must not be sold unless it has been kept at a temperature of not more than 28° F. In the case of a cold mix (a product capable of being manufactured into ice cream with the addition of water only) the requirements of heat treatment and cooling do not apply, but the product when reconstituted for manufacture must be converted into ice cream within one hour of reconstitution and then kept before sale at the same temperature as for heat treated mix. The Regulations also lay down that ice cream must be protected from all forms of contamination and all utensils used in the processes of manufacture and sale must be thoroughly cleansed after use and be kept clean at all times. Owing to the difficulty of obtaining suitable cooling apparatus, a saving clause in respect thereto is in operation until 1st Mav 1949. (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 36 persons (concerning 26 premises), but refused in 12 cases on account of the unsuitability of the proposed storage premises. 18 (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 1947, 2 of which were granted, the third being refused on account of the unsuitability of the premises. (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, 1,937 inspections were made. 22 Preliminary Notices were served, 17 of which were complied with. 2 Preliminary Notices served in 1946 were also complied with. 3 Certificates of Exemption from the provisions of Sub-Sections 2 and 4 of Section 10 were granted in 1947. 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 conferrec upon the County Council by Part II of the Act, subject to certain conditions. During 1947 a licence was granted to one Nurses' Agency in Ilford; such licence expires on the 31st December 1948. 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 arc permanently maintained by the Essex County Council for the treatment of advanced cases of pulmonary tuberculosis. Fifty-two of the remaining beds were allocated to the Essex County Council for the reception of tuberculosis patients up to the 9th August. From that date it was necessary to reduce the number of beds available for this purpose to 32 owing to the shortage of nursing and domestic staff and in order to provide additional accommodation for cases of infectious disease, more particularly in view of the outbreak of acute anterior polio-myelitis. The continued shortage of nursing and domestic staff rendered it impossible to revert to the previous arrangement for the reception of the 52 tuberculosis patients. 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, 1947. Private Patients. Other Patients. Children. Medical. Surgical. Male. Female. Male. Female. 207 19 26 18 57 55 32 19 Maternity and Nursing Homes.—On the 1st January there were 3 private registered Nursing Homes in the district, 2 for medical and senile cases, and 1 for maternity cases. On 31st December there were 3 private registered Nursing Homes, 1 for medical and senile cases and 2 for maternity cases. All Nursing Homes in the district are visited by the Deputy Medical Officer of Health and the Senior Sanitary Inspector (or his deputy) quarterly and at other times when necessary. One letter sent calling the attention of the keeper of the home to sanitary defects. One application for registration as a maternity nursing home was refused under section 187 of the Public Health Act, 1936, during the year. Mental Hospitals.—There are two large Mental Hospitals in the district, the West Ham Mental Hospital, with 1,230 patients (males 549, females 681), and Claybury Mental Hospital, with 2,184 patients (males 919, females 1,265) in residence on 30th June 1947. Other Institutions.—Girls' Village Homes, one of the late Dr. Barnardo's Institutions; with 25 children in the Hospital on 30th June 1947. (vi) Ambulance Facilities.—The Council maintains a fully adequate ambulance service as follows :— (a) Infectious Diseases.—Two 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 provided. 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 1947 the Ambulance Service dealt with 7,805 calls, representing 68,000 miles (approx.). The service is available for street accidents, emergency illnesses, hospital evacuation cases and for private removals of residents and non-residents. 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. 20 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 Cranbrok Road) Thursday, 2 p.m. Seven Kings Methodist Church Hall, Seven Kings Road (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 Clincs.—These Clinics are held at the Maternity Home on each Monday afternoon, and at the Mayesbrook Clinic, 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. Aural. Ophthalmic treatment. Paediatric. Infant Welfare. (ii) Newbury Hall, Perrymans Farm Road, for— Minor Ailments. Orthopaedic and Remedial Exercises treatment. Rheumatism. Artificial Sunlight treatment. Infant Welfare. Cardiac Clinic. (iii) Mayesbrook Cllnlc, 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. Tuberculcsls 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. 21 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 2,652 samples of filtered water were submitted to chemical and bacteriological examination and found to be pure and wholesome. All new and repaired mains are chlorinated before being restored to use and samples of water from them are tested bacteriologically. The water is not plumbo-solvent. The length of mains laid by the Metropolitan Water Board in Ilford during 1947 was 1,274 yards of 4-inch. On the 15th March 1947, Hooding caused disorganisation at the Lea Bridge Pumping Station thereby contaminating the water supplies to the East London district which included approximately one-third of the Ilford area. Steps were immediately taken to warn consumers to boil water before use, by means of B.B.C. broadcasts, notices displayed on the screens of local cinemas and on the public libraries and town hall notice boards, visits by the Sanitary Inspectors and loud speaker vans provided by the Metropolitan Water Board, Police and the Ilford Electricity Department. The Sanitary Inspectors also visited all premises wherein food was prepared, cooked or treated in any manner, giving instructions for procedure to prevent contamination of foodstuffs and utensils. 13,000 reminder leaflets drawing attention to the need for boiling the water, were circulated throughout the affected district with the assistance of the W.Y.S., Boy Scouts and Girl Guides Associations. The Provision of Meals services for the schools were discontinued owing to the administrative difficulties arising from the sterilising of water and the chlorine content of available supplies. In most of the affected areas intermittent mains supplies were maintained and supplemented by a water cart service. On the 28th March, notification was received from the Water Board that conditions had so improved at the Lea Bridge Works that normal pumping would be resumed, and that the need for boiling water from their mains had ceased. Publicity was given to a recommendation that in premises which had remained empty throughout the period all cisterns should be sterilised and flushed out immediately afterwards. For this purpose a supply of chloros was made available at the Public Health Department. Three samples of water were taken daily from various premises in the district and all proved satisfactory. 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. Mr. Hugh G. Ramsay, Engineer to the South Essex Waterworks Co., has kindly supplied me with the information that over 3,200 chemical, bacteriological and biological examinations were made at the Langham laboratory, and all were reported as wholesome. 22 The length of mains laid by the South Essex Waterworks Co. in Ilford during 1947 was 134 yards of 3-inch, 1,499 yards of 4-inch, and 384 yards of 6-inch. On 4th June 1947, complaints were received that the supply in the Chadwell Heath district was inadequate. Investigation revealed that the pressure was insufficient to provide water to the upper storeys of certain schools. One school in particular having an insufficient water supply for use in the sanitary accommodation. Representations were immediately made to the Water Company, who stated that the complaints were justified and were caused by increased consumption and it was pointed out that the work of laying a new main to augment the supply was completed at about the time of reduction in supply. No further reduction in water pressure has since been notified. There are now no public wells in existence. There are a few private wells for commercial purposes. 38 samples of piped water supply (1 South Essex Waterworks Co. and 37 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 The total amount of refuse collected 34,916 ,, ,, disposed of by barge 31,802 ,, ,, ,, at Destructor 3,114 Collection of Salvage:— Weight collected 4,835 tons 16cwts. Value £16,976 Survey of Main Trunk Sewers.—During the year 1947 the Drainage Department has been chiefly engaged upon the preparation of Schemes in connection with the improvement and reconstruction of both the Foul and Surface Water Systems of the Borough. Both Schemes are major projects requiring extensive research and preparation before reports can be presented to the appropriate Committees of the Council. The preliminary investigations are now fairly well advanced and brief outlines of the Schemes are presented below. Foul Water—Main Drainage Scheme.—The drainage of foul water in the Borough is accomplished by means of subsidiary sewers feeding into main sewers which converge to a point at the junction of Upney Lane and Longbridge Road. From this point trunk sewers run to a pumping station in the Borough of Barking, where it is pumped, in conjunction with the sewage from Barking, with the L.C.C. northern outfall sewer. The land to the west of the Borough is low-lying and so the sewage emanating from this area is collected at a pumping station in Roden Street and pumped to a higher level, after which it flows by gravity to join the sewage from other parts of the Borough. Owing to the lapse of time since they were constructed, coupled with the rapid building development which took place in the inter-war years, most ol the main sewers are now too small for requirements and their condition has also deteriorated, nor is the pumping station at Roden Street now always able to meet the demands made upon it. The general result is that flooding occurs in various places from time to time and the storage tanks at the Roden Street Pumping Sation become full and overflow. 23 A comprehensive draft scheme is now being prepared to deal with the situation which has arisen, taking into account the Greater London Plan as it affects Ilford. A larger Pumping Station will have to be provided at Roden Street and altogether something like 16 miles of new sewers will have to be laid, in many cases under roads which carry a heavy volume of daily traffic. The sizes of the sewers vary from 12-inch diameter to 57-inch diameter, and the depths at which they will be laid vary from as little as 4 feet to as much as 24 feet below the surface of the ground. It will be appreciated that such a scheme is bound to be expensive to construct and the present preliminary estimated cost is in the region of £800,000. Surface Water—Main Drainage Scheme. Present System.—The major part of Ilford drains into three main watercourses, the Cranbrook, Seven Kings Water and the Mayes Brook. The remaining areas drain directly into the River Roding. The present system of watercourses originally drained open country, from which only a small proportion of the rainfall (about 10 per cent.) discharged into the streams. Subsequent building development has increased this "runoff" up to eight times its original volume. Furthermore, Ilford was first developed in the south, which is also the lower lying part of the Borough, and new development has all taken place in the north and higher part of the area, with the result that the early sewers are now quite inadequate to deal with the additional flow. For many years there has been recurrent flooding at several points in the Borough and year by year these instances are becoming more numerous and more frequent. Proposals.—A comprehensive scheme has been prepared providing for the improvement of the main watercourses in the Borough and for the construction of adequate main sewers discharging into these watercourses. It is intended to pipe or box culvert the main watercourses along their existing line other than in Parks, where the open waterways form an ornamental feature. This closed form of construction will prevent further nuisance due to the present too prevalent practice of using the open watercourses as dumps for rubbish and garden refuse, etc. Incidental works include the provision of storm water storage and balancing units by means of works to be carried out on the lakes in Valentines Park and South Park. The preliminary estimated cost of the whole scheme at current prices is £1,200,000. This does not make any allowance for contributions which may be claimable from neighbouring authorities, the Ministry of Civil Aviation and other riparian owners who may be developing land adjacent to open watercourses. (iii) Sanitary Inspection of the Area.—The following is a summary of the work of th? Sanitary Inspectors during the year:— Houses and premises inspected 14,041 Houses and premises reinspected (works in progress) 24,206 Visits during disinfection 1,257 Houses in which nuisances were detected 3,443 Houses in which nuisances were abated 3,168* Premises disinfected 522 Premises from which articles only disinfected 81 Articles disinfected 2,875 Premises disinfested for verminous conditions 30 *Includes 882 nuisances detected before 1st January 1947. 24 Notices served:— Statutory:— Served Complied with Public Health Act, 1936 125 82 Housing Act, 1936 198 126 Housing Act, 1936 (Overcrowding) — — Factories Act, 1937 7 2 Shops Act, 1934 — — Provide Dustbin (Ilford Urban District Council Act) 33 16 Provide Water Supply to Dwelling House — — Food and Drugs Act, 1938 — — Rats and Mice (Destruction) Act, 1919 1 — Cleanse Water Storage Cistern (Byelaws) 2 2 Cover Water Storage Cistern (Byelaws) Informal 3 3,339 2 2,220 3,708 2,450 In addition to the above, 943 notices (167 statutory and 776 informal) served previous to 1st January 1947 were also complied with. Complaints.—During the year, 3,972 complaints of nuisances have been received and investigated. The following is a summary:— Accumulation of manure and refuse 107 Animals improperly kept 15 Bad smells 113 Dampness of premises 249 Defective drains, w.c's and fittings 655 Defective roofs, gutters, downpipes, etc. 499 Defective water fittings 197 Dirty and verminous houses 91 Dirty condition of rearway 2 Flooding of premises 34 Overcrowding 326 Smoke nuisances 37 Miscellaneous 1,647 Total 3,972 (iv) Swimming Baths and Pools.—Samples of water for examination were taken from the open-air swimming bath from May to July (4); one sample was unsatisfactory owing to the presence of B. Coli and the Analyst recommended an increase of free chlorine content. The other samples were satisfactory, but in one sample the chlorine content was above, and in one sample below, the prescribed standard. Samples were also taken from the two indoor baths during January, March, May, June, July and November (10); all of the samples were satisfactory, but in 4 samples (2 from the 1st and 2 from the 2nd class) the chlorine content was below the prescribed standard, and in 1 sample (from the 2nd class) the chlorine content was above the prescribed standard. (v) Eradication of Bed Bugs :— { Found to be infested 31 Houses{Disinfested 30 (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. 25 Certificates were issued in respect of 3 premises during 1947. (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 etc. Abatement.—Complaints were received of alleged smoke nuisances from 2 factories at Chadwell Heath, 1 at Seven Kings, and 1 in Barking. One informal notice was served. As a result of plant alterations and installations made by the companies concerned, the nuisances were abated. In the case of the Barking factory, a Notice was served by the Barking Corporation on the firm concerned and no further complaints were received SECTION D.—HOUSING. (i) Overcrowding.—One informal notice was served and was 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) 4,354 (b) Number of inspections made for the purpose 15,206 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 182 (b) Number of inspections made for the purpose 3,715 (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 3,442 2. Remedy of defects during the year without service of formal Notices :— Number of defective dwelling-houses rendered fit in consesequence of informal action by the Local Authority or their officers 3,167* 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 198 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 234* (b) By local authority in default of owners 8* b. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 158 26 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 146* (b) By local authority in default of owners 1* c. & d. No proceedings were taken under Sections 11, 12 and 13 of the Housing Act, 1936. 4. Housing Act, 1936, Part IV—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 243 (ii) Number of families dwelling therein 270 (iii) Number of persons dwelling therein 893½ (b) Number or new cases of overcrowding reported during the year 252 (c) (i) Number of cases of overcrowding relieved during the year 93 (ii) Number of persons concerned in such cases 449 (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 tions upon which the Medical Officer of Health may consider it desirable to report — * Includes compliances during 1947 of Notices served prior to 1st January 1947. HOUSING ACT, 1936. During the year 1947, 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 16,212 houses. At the end of the year the total certificates issued to date numbered 18,151 in respect of 24,773 houses. As new premises were constructed and placed upon the rating lists, those 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 8,684. SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) Persons and Premises registered as at 31st December, 1947:— Premises registered as dairies and milkshops 33 Cowkeepers registered 2 Persons registered as retail purveyors of milk 164 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 14 296 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 95 inspections (included in above) were made of 2 cowsheds on farms registered under the provisions of the Milk and Dairies Regulations, 1926 to 1943. One of the 2 registered cowkeepers is a wholesale and retail purveyor of milk ; the other is a retail purveyor only. Of the 164 premises from which milk is retailed in Ilford, 16 are branches of 1 firm, and 5 another, 3 retail from dairy shops or stores, 11 from provision 27 stores, and 7 from restaurants; 7 are retailers in a small way with rounds, while 34 sell sterilised bottled milk only, 13 sell sterilised milk and also milk in sealed containers, and 68 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 1946, during 1947 for the sale of:— "Tuberculin Tested" Milk 16 "Pasteurised" Milk 23 The above include supplementary licences which were issued for "Tuberculin Tested" milk, 7; and "Pasteurised" milk, 8. These are licences granted to firms who already have a primary licence from another Authority, the milk being bottled outside the town, but sold in Ilford. The Essex County Council granted one producer's licence in respect of graded milk produced on a farm in the Borough during the year 1947. (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 repealed after unsatisfactory results. Biological Tests.—Samples of all milks, designated or otherwise, are submitted for biological test for T.B. in Spring. Repeat samples if positive after clearance by County Medical Officer. Milk Supplies to Elementary Schools.—These are sampled monthly and after unsatisfactory results. Ice Cream.—Samples are taken monthly from April to September and at regular intervals during the winter months from all local manufacturers, tricycle salesmen and local retailers. Samples are repeated after unsatisfactory results. I he Heat-Treated Milk (Prescribed Tests) Order, 1944, prescribes two tests, a phosphatase test for adequate heat-treatment and a methylene blue test for keeping quality. The Order defines temperatures at which samples must be kept both before reaching the laboratory and before the test and stipulates the hours during which the test must be conducted. 28 The following results were obtained : Grade of Milk or Ice Cream Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested (Pasteurised) Milk 16 15 1 The sample failed to satisfy the Methylene Blue Reduction test. The supply was obtained from outside the Borough and both the supplier and the local M.O.H. were communicated with on the matter. Tuberculin Tested (Certified) Milk 12 10 2 The analyses of these samples showed a high B. Coli. content. The County Medical Officer was communicated with in each case. Pasteurised Milk 57 51 6 Five samples failed to satisfy the Methylene Blue Reduction test and one sample failed to satisfy the Phosphatase Test. In all cases supplies were obtained from outside the Borough and the local Medical Officers of Health were informed. The retailers were communicated with and re-sampling ordered at a later date. Further samples proved satisfactory. Heat-Treated Milk 53 47 5 Two samples failed to satisfy the Methylene Blue Reduction test, two failed to pass the Phosphatase test, and the remaining sample failed both tests. The retailers were communicated with and further samples proved satisfactory. Ungraded Milk 75 32 43 36 of these samples were of milk as received from farms in Essex. All had high bacterial and/or B. Coli contents, and 16 also failed to satisfy the Methylene Blue Reduction Test. Representations were made to the C.M.O. on the matter. Of the other 7 samples, one failed to satisfy the Methylene Blue Reduction test, and the others had high Bacterial or B. Coli contents. The retailers were communicated with and resampling was ordered. Ice Cream 35 30 5 In three cases supplies were received from outside the Borough, and the local Medical Officer of Health was communicated with. In the other cases the retailers were communicated with and further available samples proved satisfactory. 29 (iv) Biological Tests.—35 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 of Dairy Herds.—Two inspections were made by the Veterinary Officers of the Ministry of Agriculture and Fisheries. The Ministry's Divisional Inspector states that one cow was removed from a farm under the Tuberculosis Order on clinical evidence. (vi) Legal Proceedings.—28 complaints of the presence of foreign bodies in milk were received and investigated during 1947. Legal proceedings were taken in 11 cases, involving 4 firms. One was fined a total of £140 and £9 9s. costs in respect of 7 cases, another was fined a total of £25 and £3 3s. costs in respect of 2 cases, the third was fined £20 and £3 3s. costs in respect of 1 case, and the fourth was fined £10 in respect of 1 case. An appeal against the Magistrates' decision in this latter case was dismissed, with costs against the appellants, at the Chelmsford Quarter Sessions. (vii) Registration.—No application for registration was refused during 1947. (viii) Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man :— Bacon and Ham—67½ lbs.; Biscuits—300 lbs., 5 tins; Butter—½ lb.; Cereals—30 cwts. 93 lbs., 209 packets, 21 tins; Cheese—147 lbs., 3 packets, 50 cartons; Cocoa—55 tins; Confectionery—162 lbs., 436 cartons; Eggs (shell)—836, 1 case; Eggs (dried)—7 lbs., 17 tins, 4 packets; Fish—44 cwts. 1 lb., 5 boxes; Fish (tinned)—942 tins; Fish (shell)—3 cwts. 45½ lbs. 28 jars; Fish (cakes)—6,581; Fruit (fresh)—1 cwt. 60 lbs.; Fruit (tinned and bottled)—370 tins, 10 bottles; Fruit (dried)—171 lbs.; Flavouring—32 bottles; Herbs—31 packets; Jam, Preserves, etc.—542 tins, 83 jars; Jellies —9 packets; Margarine—8 lbs.; Meat (fresh)—9 cwt. 105g lbs.; Meat (tinned)—1,812 tins, 24 lbs.; Meat (pies)—112; Medical foods—1 tin, 44 jars; Milk (tinned)—4,678 tins; Milk (dried)—162 lbs., 25 tins, 5 packets; Paste (meat, fish, etc.)—406 tins, 8 jars; Puddings (tinned)—15 tins; Pudding mixtures—225 packets; Poultry—72 lbs.; Poultry (tinned)— 2 tins; Pickles, Sauces, etc.—218 jars, 140 tins, 11 bottles; Raising and Baking Powder—10 tins; Rabbits—230½ lbs., 63; Soup—183 tins; Suet— ½ lb.; Sugar—16 cwts. 74 lbs.; Tea—78½ lbs.; Vegetables (fresh)—2 boxes; Vegetables (dried)—10 cwt. 21¾ lbs.; Vegetables (tinned and bottled)— 1,148 tins, 1 bottle. Food and Drugs Act.—During 1947, 245 samples (235 formal and 10 informal) of Food and Drugs were obtained. 2 formal samples and 6 informal samples were not satisfactory as follows:— (a) Self-raising Flour.—2 samples (1 formal and 1 informal) were found to have an objectionable acid taste. Detailed analysis of both samples indicated that the acidity was due, in each instance, to the presence of an excess of the acid consituent of the aerating or self-raising ingredients, probably the result of uneven mixing of these ingredients. A letter of warning was sent to the firm involved. (b) Almond flavoured Cake Flour (formal).—This preparation was found on analysis to be a satisfactory cake mixture, but was very poor in respect of its almond flavouring. No action was taken. (c) Malt Vinegar (informal).—This sample was deficient in strength, containing only 3.42 per cent. of acetic acid. The Analyst considered this deficiency to be caused by the growth of acetic bacteria which had produced gelatinous masses in the vinegar. This condition may result through air having access to the vinegar and may be avoided by efficient sterilisation of the vinegar. A letter of warning was sent by the Town Clerk to the manufacturer in this case. 30 (d), (e), (f) and (g) Milk (informal).—These samples were submitted for investigation of the foreign matters contained therein. These were identified as farmyard dirt; meat fibre; vegetable and animal fibres and portions of a small insect; and a piece of leather strap. No action was taken in two of the cases on account of unsatisfactory evidence, but in the other cases legal proceedings were taken and fines of £20 with £3 3s. costs, and £5 with £1 1s. costs, respectively, were imposed. 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.) Eight cases were "notified" under the Act, and in eight instances cases of suspected food poisoning were reported to me. Notified Cases. (a) May. Mother and son were taken ill following the consumption of a meat product. Bacteriological examination of a sample of the product revealed the presence of infection with staphylococcus aureus. (b) May. A visiting doctor at King George Hospital taken ill following meal at home; one other member of family also affected. Patient recovered after one day's indisposition. (c) June. Child of 5 years. Faecal swabs confirmed the presence of Salmonella typhi-murium organisms. (d) June. Child of two years. Faecal swabs confirmed the presence of Salmonella typhi-murium organisms; child admitted to Isolation Hospital. (e) July. Female, aged 36 years. Illness commenced following tion of fried duck egg; faecal swab revealed presence of Salmonella typhi-murium organisms. (f) July. Children of 3 years and 10 weeks respectively. Faecal swabs confirmed presence of Salmonella typhi-murium organisms. Non Notified Cases. In one of the eight instances investigated, an organism of the Salmonella group was isolated, two persons being infected. All the persons concerned eventually made good recoveries. Bakehouses.—There are 35 bakehouses in the district, 28 of which use motive power. 100 inspections of bakehouses were carried out during the year. It was necessary to call upon the occupiers of bakehouses to carry out cleansing and other work in 4 instances, and the requests were complied with. Diseases of Animals Acts, 1894-1937. (i) Foot and Mouth Disease (Infected Areas Restrictions) Order, 1938.—An outbreak occurred at Romford, Essex, on 24th February, and the Minister of Agriculture and Fisheries, by Special Order No. 33, declared the "infected area", which included Ilford. The "infected area" was contracted by Special Orders Nos. 44 and 47 and excluded the Borough of Ilford as and from 27.3.47. A second outbreak occurred at Hoddesdon, Hertfordshire, on 24th March, and the Minister by Special Order No. 50, declared the "infected area", which included Ilford. The "infected area" was modified by Special Order No. 53, and excluded the Borough of Ilford as from 2.4.47. The necessary public notices were issued restricting the movement of animals, within the "infected areas", except by licence. Licences were issued permitting the entry into the Borough of 6 cows (2 with calves) and 1,360 sheep; and were countersigned to permit the exit from the Borough of 6 cows and 4 pigs. 31 (ii) Swine Fever Order, 1938.—No cases of Swine Fever occurred in the Borough during 1947. (iii) Regulation of Movement of Swine Order, 1922-1926.—One Licence was countersigned for the entry into the Borough of 22 pigs. (iv) Fowl Pest Orders, 1936 and 1947.—17 cases of Fowl Pest were notified during 1947. The Veterinary Officer of the Ministry of Agriculture and Fisheries took all necessary steps to deal with all infected poultry and premises. (v) Sheep Scab Orders and Amendment Orders, 1928, 1930, 1934, 1934 (No. 2) and 1948.—There has been no occasion for this Borough to be made into a "double-dipping" area under these Orders during the year 1947. 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.—232 complaints have been received of the existence of rats affecting 231 premises. In 33 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 504 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 14 petroleum appliances or fittings. The number of Licences issued was 116, and the fees paid to the Council for such Licences was £85 10s. Two Licences were issued for the storage of calcium-carbide, the fees payable being 10s. Examination of Officers, Teachers and Servants. The following medical examinations were carried out during 1947:— Officers Teachers Servants New Appointments 240 4 26 Under Sickness Regulations 14 — 61 Totals 254 4 87 32 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. Enteric Fever or Relapsing Fever. Diphtheria. Anthrax (made notifiable by the Local Authority as from 1.4.22). Membranous Croup. Erysipelas. Pemphigus Neonatorum (made notifiable by Local Authority as from 29.6.29). Scarlatina or Scarlet Fever. Typhus Fever. 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 P.H. (Pneumonia, Malaria, Dysentery, etc.) Regulations, 1927. Dysentery Malaria Acute Polio-encephalitis P.H. (Acute Encephalitis Lethargica and Acute Polio-encephalitis) Regulations, 1918. Encephalitis Lethargica Tuberculosis P.H. (Tuberculosis) Regulations, 1930. Acute Rheumatism (up to 16 years). Ilford (Acute Rheumatism) Regulations, 1947. 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. 33 TABLE III- Cases OF Infectious Diseases Notified during the Year 1947. 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 Loxford Clementswood Mayfield Goodmayes Fairlop Clayhall Barkingside N. Hainault Seven Kings S. Hainault Smallpox - - - - - - - - - - - - - - - - - - - - - Scarlet Fever 201 — 40 136 18 5 1 1 17 6 7 24 5 19 1 6 28 44 23 21 145 Diphtheria, including Membranous Croup 22 — 3 10 5 4 — — — - 1 3 2 8 — 1 2 1 2 2 22 Enteric Fever (Typhoid and Para-Typhoid 3 — - — — 1 2 — — — — — — — — 1 2 — - — 1 Pneumonia 346 38 42 40 18 63 80 65 22 39 45 34 4 36 5 7 53 44 27 30 197 Puerperal Pyrexia 45 — — — 14 31 — — 1 2 — 1 — 1 — — 2 32 1 5 44 Cerebro-Spinal Fever 7 1 4 — — — 1 1 — — — 2 — 1 — — — 4 - - 7 Acute Poliomyelitis 29 1 5 14 - 3 — - 5 2 1 3 — 5 — — 2 5 — 6 27 Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - Dysentery 8 — — 3 — 3 2 — 1 — — — — 3 — — 2 1 — 1 6 Ophthalmia Neonatorum 11 11 — — — — — — — — 1 3 2 1 — — 2 1 1 - 8 Erysipelas 42 — — 1 2 10 21 8 4 5 2 2 1 5 — 1 7 6 2 7 16 Pemphigus Neonatorum 1 1 - - - - - - - - - - - - - - - - - - - Tuberculosis Pulmonary 231 — 2 6 74 102 44 3 16 14 23 18 4 33 3 3 26 27 17 47 - Other Forms 29 — 4 5 4 10 6 — 1 2 2 5 — 2 — — 4 3 5 5 - Anthrax — — — - - - - - - - - - - - - - - - - - - Malaria—Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - Believed contracted abroad 1 - - - 1 - - - - - - — - - - - 1 - - - 1 Acute Rheumatism 26 — 2 23 1 — — — 2 — 2 2 — 4 — — 3 5 1 7 11 Measles 2,232 65 996 1,116 38 16 1 - 216 212 288 220 - 208 — 2 517 290 155 124 29 Whooping Cough 935 85 470 358 4 14 4 — 44 63 70 105 1 82 2 8 168 200 90 102 32 Food Poisoning 8 1 3 1 — 3 - - - - - — - 4 — — 1 1 — 2 6 Totals 4,177 203 1,571 1,713 185 265 162 78 329 345 442 423 19 412 11 29 820 664 324 359 552 The figures for Mayfield, Fairlop and Clayhall wards are for the months of November and December only. 34 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 69.0 Diphtheria and Membranous Croup 100.0 Puerperal Pyrexia 97.7 Pneumonia 56.9 1 he total number of deaths of Ilford residents from the following infectious diseases during 1946 and 1947 were as follows:— 1946 1947 Scarlet Fever - - Enteric Fever — - Diphtheria 1 1 Measles — 1 Whooping Cough 1 2 Influenza 20 20 Tuberculosis—Pulmonary 57 65 Other forms 9 10 Pneumonia 74 68 Diarrhoea (under 2 years) 5 6 Cerebro-spinal Fever 3 1 Puerperal Sepsis — — Total 170 174 The year 1947, on the whole, showed a higher incidence than that of 1946. The number of cases of measles notified was 2,232 as compared with 1,135 the previous year. (a) Smallpox.—No cases were notified during 1947. Notifications regarding 42 persons who had been in contact with cases of Smallpox in this country and on the Continent were received. These were visited by the Sanitary Inspectors, 331 visits being paid. The following gives particulars as to Vaccination during 1947: Certificates of Successful Vaccination 2,502 Postponed 65 Conscientious Objections 825 Unsuccessful Vaccination 46 Left the District 381 (6) Scarlet Fever.-201 cases were notified in 1947. There were no deaths from this disease. The following "return" cases have occurred during the past five years, a "return" case being one which arises within 28 days of the release 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. 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 I 1.7 1946 242 180 7 3.8 61 4 6.5 1947 201 144 4 2.8 57 - - (c) Diphtheria.—22 cases were notified in 1947. One death occurred at the Ilford Isolation Hospital, an unimmunised male child, aged 5 years, seven days after admission. Of the 22 notifications received, only 12 were actually cases of diphtheria, one being a case of diphtheroid conjunctivitis. 35 Diphtheria Immunisation Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January. 1947, to 31st December, 1947. 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 44 - 44 3 — 3 47 Negative 15 — 15 28 — 28 43 Numbers inoculated (full course) 61* 1,383 1,444 42* 680 722 2,166 Positive after full course of inoculations, and re-inoculated - - - - - - - Negative after full course of inoculations 57 1,149 1,206 42 674 716 1,922 Re-inoculations (one only) 622 36 658 336 81 417 1,075 Awaiting re-test — 172 172 9 49 58 230 Not re-tested after inoculation (on account of leaving District, etc.) - 12 12 3 7 10 22 Positive after re-test, but not inoculated for same reason - - - - - - - Final Schick Test in 1947 (1946 Cases):— Positive after full course of inoculations, and re-inoculated 5 3 8 2 - 2 10 Negative 3 158 161 2 134 136 297 * Schick + 1947 = 57; Schick + 1946= 1 Not Tested = 70. * Schick +1947= 10; Not Tested = 86. During 1947, a total number of 2,979 children attended at the Diphtheria Prevention Clinics (1,918 at Valentines Clinic and 1,061 at Mayesbrook), making a total number of attendances of 13,571 (8,914 and 4,657), with an average per session of 87 and 89 respectively. DIPHTHERIA IMMUNISATION PUBLICITY CAMPAIGN. Publicity was intensified during 1947 by:— (a) Film. The showing of a trailer film (1 minute) at four local Cinemas, one week at each, during May. (b) Posters. Double crown posters for display at the Council's Infant Welfare Centres and School Clinics. (c) 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. (d) The inauguration of a campaign for a systematic re-inoculation of children at 4-5 year intervals. (e) Civic Exhibition. At this exhibition, held in the autumn of 1947, posters and illustrations were displayed advocating immunisation. 36 In 1947, under the arrangements mentioned in the 1935 Report, 13 private doctors were supplied with prophylactic for the immunisation of 61 children (58 under 5 years and 3 over 5 years of age). The following is a brief summary:— 1946 Cases: Final Schick Test in 1947:— Negative 7 Positive and re-inoculated — No final Schick Test, left district, etc. 2 1947 Cases: Numbers inoculated (full course) by medical practitioners 54 Final Schick Test—Negative 38 Positive and re-inoculated - No final Schick Test, left district, etc. 6 Forms not yet returned 10 To be Schick Tested in 1948 — (d) Ophthalmia Neonatorum.—11 cases were notified during 1947. Of these 2 were treated at home by private medical practitioners; 5 at the Isolation Hospital; 1 at the Ilford Maternity Home; 2 at the Mothers' Hospital, Clapton, and I at the Royal London Ophthalmic Hospital. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 11 2 9 11 — — — (e) Enteric Fever.—Three cases of this disease were notified during the year; they were two females and one male. Two were cases of Typhoid fever and one of Paratyphoid fever "B". The two cases of Typhoid fever occurred at Claybury Hospital. The case of Paratyphoid fever was admitted to the Isolation Hospital; the patient made a satisfactory recovery. (/) Scabies Order.—1941 (dated 28th October 1941).—55 cases of Scabies were reported. Two Ilford residents were admitted to the Isolation Hospital during the year. The order was rescinded at the end of 1947. (g) Acute Anterior Poliomyelitis.—29 cases of this disease were notified during 1947. The ages and sex of the cases were distributed as follows:— Males—5 months, 1, 2, 3, 4, 4, 5, 5, 6, 7, 9, 9, 10, 11, 13, 15, 16, 17, 17, 19, 26, 31 and 36 years. Females—5, 5, 7, 8, 9 and 17 years. It will be remembered this disease reached unprecedented heights during 1947, and no fewer than 9,262 cases were notified throughout the country. In 1938, the year of highest recorded incidence prior to 1947, there were 1,581 notifications. During the national prevalence of the disease, the first case to occur in Ilford was a mild one, and was admitted to the Isolation Hospital on 25th July. In view of the possibility of further cases precautionary measures were taken. The local doctors were circulated with details of the facilities which were available for diagnosis and treatment of cases. 37 Fortunately, the schools were already closed for the holidays but it was advised that Sunday Schools, gatherings, meetings and camps of the various youth organisations, Boy Scouts, Boys' Brigade, Army Cadets, A.T.C. and the equivalent girls' organisations and youth clubs, should be cancelled. The public swimming baths, and the children's paddling pools in the public parks, were also closed to the public. The managements of the local cinemas were communicated with as to the advisability of discontinuing the children's cinema clubs and this was put into effect. In view of the risk of infection, the local hospitals were advised to consider the postponement of operations on the nose and throat until the epidemic period had passed. To prevent the disruption of the health services, it was decided to continue the work of the Day Nurseries, Welfare Centres, School Clinics and Treatment Clinics, but the strictest vigilance on the part of the medical and nursing staffs was maintained to ensure that any child showing any suspicious symptoms should be immediately excluded. At the same time, every endeavour was made to keep the numbers using the treatment or waiting rooms to a minimum. In the main, the cases which occurred in Ilford were of a mild type, with one exception, where death occurred three days after admission to the Isolation Hospital, despite treatment in the "Iron Lung". In only 7 instances was there any residual paralysis on discharge from hospital. In 5 cases treatment was continued after discharge from hospital at the Council's Orthopaedic and Massage Clinics. One patient was transferred to a Special Orthopaedic Unit for further treatment. Mention should be made of the fact that the Both mechanical respirator ("Iron Lung") and the Bragg Paul pulsator proved of considerable value in the treatment of severe cases. Of the 29 cases notified during the year, 25 cases were admitted to the Ilford Isolation Hospital; two to the London Hospital; one was notified from tho Hospital for Sick Children, Great Ormond Street, and subsequently received electrical treatment at King George Hospital; one was notified and treated by a private doctor after reference to the Hospital for Sick Children. By arrangement with the Central Office for Information, the Ministry of Health film "Early Diagnosis of Acute Anterior Poliomyelitis" supported by the film "Penicillin" were shown in the Lambourne Room on 9th September to approximately 160 general practitioners of the Stratford Division of the British Medical Association. The Chairman of the Public Health Committee welcomed the doctors who expressed their appreciation of the arrangements made. Discussion followed the showing of the films. 38 Table showing Incidence of Infectious Disease, 1947, in age groups; and total Deaths. Disease Total cases notified Under 1 year 1—2 2—3 3—4 4—5 5—10 10—15 15—20 20—35 35—45 45—65 Over 65 * Cases admitted to Hospital Total Deaths Smallpox - - - - - - - - - - - - - - - Scarlet Fever 201 — 6 13 9 12 86 50 15 5 3 1 1 144 - Diphtheria 22 — 1 — 1 1 5 5 3 5 1 - — 22 1 Enteric Fever (including Paratvphoid) 3 - - - - - - - - - 1 2 - - - Pneumonia 346 38 9 16 11 6 31 9 13 33 35 80 65 190 68 Puerperal Pyrexia 45 - - - - - - - 1 36 8 — — 44 — Cerebro-spinal Fever 7 1 1 2 — 1 - - - - - 1 1 7 1 Acute Poliomyelitis 29 1 1 1 1 2 11 3 6 2 1 — — 27 1 Acute Polio-Encephalitis - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - Dysentery 8 - - - - - 3 — — 2 1 2 — 5 — Ophthalmia Neonatorum 11 11 - - - - - - - - - - - 8 — Erysipelas 42 - - - - 1 — 2 3 7 21 8 16 1 Anthrax - - - - - - - - - - - - - - - Malaria believed to be contracted in this country - - - - - - - - - - - - - - - Malaria believed to be contracted abroad 1 - - - - - - - - 1 - - - 1 - Pemphigus Neonatorum 1 1 - - - - - - - - - - - - - Acute Rheumatism 26 — — 1 — 1 12 11 1 — — — — 11 — Food Poisoning 8 1 — — 1 2 1 — — — 3 — — 5 — Measles 2,232 65 209 240 276 271 1,073 43 25 23 6 1 — 28 1 Whooping Cough 935 85 107 115 140 108 347 11 2 8 8 4 - - 2 * Excludes cases occurring at Barnardo's Homes, Claybury Mental Hospital and West Ham Mental Hospital. 39 Influenza and Pneumonia.—These diseases showed a greater incidence in 1947 as compared with 1946. It will be recalled that the winter of 1947 was a severe one, and during the first three months of the year no fewer than 189 notifications of influenzal and primary pneumonia were received out of a total of 346 for the whole year. The incidence of influenzal and primary pneumonia and the fatality rates throughout the year is shown by the following table. Month 1947. 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 Cases Deaths Cases Deaths Cases Deaths January 10 - 15 I 21 2 12 2 2 1 13 - February 7 - 13 6 12 1 12 3 5 1 11 2 March 7 1 6 - 20 3 10 1 2 1 11 3 April 5 — 7 — 2 1 3 — 2 — 1 — May 4 — 4 1 6 2 - — 1 — 1 — June 3 1 2 1 5 1 1 - — — 1 — July 1 1 1 - 3 - 9 — 1 1 1 - August 4 - 1 - 2 - 1 — — — — — September 2 - — — 1 - 1 - — — 3 — October 6 - 3 - 4 - 5 - - - 2 - November 10 - 4 - 7 2 3 - 1 - 2 1 December 7 — 7 1 10 3 4 — 3 — 7 — Totals 66 3 63 10 93 15 54 6 17 4 53 6 It will be seen from the above figures that of 222 persons notified as suffering From acute primary pneumonia there were 28 deaths, equal to 12.6 per cent.; and in the case of acute influenzal pneumonia 124 notifications with 16 deaths, equal to 12.9 per cent. Of the 346 persons notified 120 were admitted to the Isolation Hospital, equal to 34.7 per cent. Of this number 9 persons died, equal to 7.5 per cent. 3. Tuberculosis..—During the year 1947 there were 231 new notifications of Pulmonary Tuberculosis and 29 of other forms of Tuberculosis. 20 cases of Pulmonary and 2 cases of Non-Pulmonay Tuberculosis were transferred to Ilford. 40 Notifications and Deaths from Tuberculosis of Ilford residents during 1947:— Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under I year - - - - - - - - 1-5 years 1 1 2 2 — 1 1 1 5-15 2 4 3 2 1 — — — 15-25 38 36 9 2 1 4 — 2 25-35 37 27 2 3 2 6 — 1 35-45 25 13 2 3 14 8 1 - 45-55 20 4 1 — 10 2 2 l 55-65 13 7 4 1 6 2 1 — Over 65 2 1 - — 6 2 — - Totals 138 93 16 13 40 25 5 5 Of the foregoing new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 2 2 Claybury Mental Hospital 5 — West Ham Mental Hospital 14 1 Barnardo's Homes 1 — Isolation Hospital and Sanatorium 7 — Of the 75 deaths which occurred of Ilford residents, notification had previously been made of 66 of the cases. Of the other nine, two were notified after death; seven were not notified (9.3 per cent. of the deaths or a ratio of 1 in 11). Of these seven in two instances the notification was overlooked; in four instances the presence of tuberculosis was discovered at Post-Mortem; and one other death included by the Registrar-General was untraceable. During the year 1947 the following deaths occurred from Tuberculosis:— Pulmonary Non-Pulmonary Ilford Residents 65 10 Non - Residents— Claybury Mental Hospital 11 — West Ham Mental Hospital 9 — Ilford Isolation Hospital 44 — King George Hospital 4 1 Non- Pulmonary Pulmonary Total Number of cases on register, 1st January, 1947 1,012 230 1,242 Number of cases entered on register during the year 252 30 282 41 Number of cases removed from the register during the year:— Pul. Non- Pul. Pul. Non- Pul. Total. Recovered 28 21 Deaths 64 9 Left District 63 11 Lost sight of 29 — Diagnosis not established 8 1 192 42 234 Number of cases remaining on register on 31st December 1947 1,072 218 1,290 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurse of the Esssex County Council. 955 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 450 125 Improved or fairly well 144 28 Not so well 72 11 In Sanatorium 64 9 No information as to present condition 13 — Removed from district, etc. 35 4 Totals 778 177 The treatment of Tuberculosis is under the control of the Essex County Council. On the 31st December 1947, there were 1,128 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. 118 patients were treated, 20 being supplied with dentures. The Council's Dentist treated 29 tuberculosis patients from the Ilford Sanatorium, five visits being paid to the Sanatorium. The number of patients from Ilford sent to Institutions under the Essex County Tuberculosis Scheme during 1947 was as follows:— Pulmonary Non-Pulmonary Total Males Females Males Females Adults 81 69 6 4 160 Children 2 4 2 2 10 Tuberculosis Care Association.—This Association has assisted 96 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. 42 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 with supplies of Insulin. Twenty-seven persons were assisted during 1947 with the Insulin required. Nineteen persons were assisted at part cost, three at cost price, and five free of charge. 4. Venereal Diseases.- In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease:— Ilford Residents—Ages Non- Residents in Institutions Total 0-1 1—5 5—15 15—25 25—35 35 —45 45—55 55—65 65—75 75—85 85 up Syphilis - - - - - 1 1 — - - — 2 Locomotor Ataxy - - - - - - 1 - - 1 - - 2 General Paralysis of the Insane - - - - - - - 1 1 - - 2 4 Aortic Aneurysm - - - - - - - 1 - - - - 1 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 cases of Ophthalmia Neonatorum notified during the past five years:—1943, 8; 1944, 4; 1945, 3; 1946, 5; 1947, 11. It is to be remembered that many cases of ophthalmia neonatorum are not due to gonorrheal infection. By the Public Health (Venereal Diseases) Regulations, 1916, diagnosis and treatment of Venereal Disease is under the control of the Essex County Council. Arrangements have been made with the various London Hospitals for the treatment of patients, and with the London Hospital for the free examination of bacteriological specimens submitted by doctors in the district. The following are the V.D. Treatment Centres situate nearest to Ilford : Romford.—The Annexe, Oldchurch County Hospital, Waterloo Road, Romford:— Sessions Monday, 4 to 6.30 p.m. Tuesday, 4.30 to 7.0 p.m. Thursday, 12.15 to 3.15 p.m. 43 Whitechapel.—Whitechapel Clinic (London County Council), Turner Street, Mile End, E.l:— Sessions Monday to Friday. Males, Females and Children—mornings, afternoons and evenings. Saturday—mornings and afternoons only. 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. 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. PUBLICITY AND PROPAGANDA. Copies of the magazine "Better Health" are distributed monthly to the reading rooms of Public Libraries, the Infant Welfare Centres, and the waiting rooms of the School and Dental Clinics. Public lectures to Ratepayers' Associations, Evening Institutes, Rotary Clubs and Church organisaions, 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. CIVIC EXHIBITION. In the autumn of 1947 an exhibition was held for seven days at the Town Hall, Ilford, dealing with all aspects of the work of a Local Authority. The activities of all branches of the Health Service were displayed by means of diagrams, charts, photographs, models and actual equipment. 44 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 390 factories with mechanical power on the register. There are 314 factories without mechanical power on the register. There are 139 outworkers on the register. 1.—INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) Factories with Mechanical Power 579 30 - Factories without Mechanical Power 222 10 - Other premises (not including Outworkers' premises) 20 — — Total 821 40 - 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. 1) 4 4 - - Overcrowding (S.2) — - - - Unreasonable Temperature (S.3) 1 - - - Inadequate Ventilation (S.4) 1 1 - - Ineffective Drainage of Floors (S.6) - - - - Sanitary Conveniences (S.7):— Insufficient 16 7 - - Unsuitable or Defective 7 6 - - Not Separate for Sexes 1 1 - - Other Offences 13 5 - - Total 43 24 - - 45 ISOLATION HOSPITAL. 915 patients were admitted during 1947. 100 per cent. of the notified cases of diphtheria and 69.0 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 915 patients admitted during the year suffered from the following complaints:— Ilford Barking Admissions Deaths Admissions Deaths Scarlet Fever 134 — 63 — Surgical Scarlet Fever 4 — 1 — Diphtheria 12 1 5 — Acute Anterior Poliomyelitis 24 1 2 1 Pneumonia 102 7 1 — Chicken Pox 4 1 — — Whooping Cough 2 — 2 — Whooping Cough and Pneumonia 10 2 — — Measles and German Measles 17 — 1 — Measles and Pneumonia 14 1 — — Measles and Bronchitis 1 — — — Erysipelas 12 1 4 — Dermatitis of Face 4 — — — Puerperal Pyrexia 22 — 3 — Abortions 23 — — — Ophthalmia Neonatorum 4 — — — Staphylococcal Conjunctivitis 4 — — — Staphylococcal Dermatitis (Neonatorum) 5 — — — Rheumatic Chorea 2 — — — Ulcerative Colitis 1 — 1 — Bronchitis 10 — — — Laryngitis and Bronchitis 1 — — — Pharyngitis 5 — — — Tonsillitis 8 — 1 — Acute Follicular and Streptococcal Tonsillitis 15 - 116 - Haemolytic Streptococcal Tonsillitis 6 — 2 — Influenza 7 — 1 — Cerebro-Spinal Fever 1 — — — Meningococcal Meningitis 3 — 1 — Pneumococcal Meningitis 3 3 1 — Tuberculous Diseases—Pulmonary 100 44 — — —Others 2 — — — Acute Rheumatism 5 — 1 — Mumps 1 — — — Scabies 2 — — — Enteritis 13 1 1 — Food Poisoning 1 — — — Dysentery 3 — — — Infective Hepatitis 1 — — — Carcinoma of Kidney 1 1 — — Encephalocele and Meningocele 1 1 — — Miliary Tuberculosis associated with tuberculosis, broncho-pneumonia & pertussis - - 1 1 Cerebral Haemorrhage (Pontine) due to hypertension 1 1 — — Bronchial Pneumonia and Mediastritis due to retropharyngeal abscess 1 1 — — Inanition, spina bifida and hydrocephalus 1 1 — — Ruptured aneurism of left common iliac artery 1 1 — — 46  Ilford Barking Admissions Deaths Admissions Deaths Laryngeal obstruction due to acute membranous laryngitis of staphylococcal origin 1 1 - - Hypostatic pneumonia, cerebral haemorrhage 1 1 - - Others 198 — 13 — Post-mortems were held by H.M. Coroner in connection with 16 of the above 72 deaths. Number of patients in Hospital on 1st January, 1947 and 1948 respectively:— 1st Jan., 1947 1st Jan., 1948 Scarlet Fever 14 18 Diphtheria 2 6 Tuberculous Diseases 72 50 Puerperal Pyrexia 3 2 Para-typhoid fever 1 — Pneumonia 9 12 Pneumonia and Whooping Cough — 1 Acute Rheumatism — 2 Erysipelas — 2 Dysentery 1 — Acute Anterior Poliomyelitis 1 1 Observation and other cases 10 17 The average length of stay in Hospital was for:— Scarlet Fever 25.5 days Diphtheria 58.4 „ Tuberculous Diseases 80.0 „ Average stay in Hospital of all cases 25.9 „ The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day 110.6. Scarlet Fever.—The diagnosis of scarlet fever could not be confirmed in 13 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 live years, the rate being calculated each year only on those admissions which proved to be clinically diphtheria. 1943 1944 1945 1946 1947 llford 9.1 5.8 4.5 Nil 8.3 One death occurred—a male patient, aged 5 years, seven days after admission, from cardiac failure and naso-faucial diphtheria. He had not been immunised. PUERPERAL PYREXIA AND OBSTETRICAL COMPLICATIONS. The years 1945, 1946 and 1947 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 against risk of infection. The three years are compared:— 1945 1946 1947 Confinements 3 5 8 Abortions 16 23 23 Mothers and infants 52 72 84 47 Tuberculosis.—100 cases of Pulmonary Tuberculosis were admitted, as compared with 121 in 1946. 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 and 2 32 Males Whole year £"3 12s. 6d. per week, Jan. 1st-April 5th. £4 10s. 0d. per week, April 6th—Dec. 31st, whether occupied or not. 6 20 Males Jan. 1st-Aug. 9th. ditto. Females Aug. 18th-Dec. 31st ditto. 10 20 Females Jan. 1st-Aug. 17th ditto. Training of Nurses.—During 1947, 3 nurses passed Part 11 of the Preliminary Examination of the General Nursing Council, and 16 obtained the Certificate by passing the Final Examination (7 student nurses, 9 staff nurses). The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick tested during 1947, and also the number inoculated:— Numbers Schick Tested:— Nurses Domestics Positive 3 1 Negative 22 16 Numbers inoculated (full course) 3 1 Numbers re-tested:— Negative after full course of inoculations — — Positive alter full course of inoculations, and re-inoculated - - Numbers Dick Tested:— Positive 3 2 Negative 22 16 Numbers inoculated (full course) 3 2 Numbers re-tested:— Negative after full course of inoculations — — 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 tuberculosis 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 1947 examinations were conducted as follows:— Primary examination on engagement Re-examinations Nursing Staff 37 88 Domestic Staff 50 90 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. 1 he Hospital is recognised by the Conjoint Board for Part 2 of the D.P.H. Regulations of the Board. 48 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 1947 the number of cases admitted was 121. Payment was at the agreed rate of 12s. 6d. per day, up to 31st May and £1 per day from 1st June plus a charge of 2s. per mile for use of ambulance. Reciprocal Arrangements—Waltham Joint Hospital Board.—The arrangements made in 1938 continued during the year, although it was not necessary to use them. The agreed charge for maintenance was 12s. 6d. per day from 1st January to 31st May and £1 per day from 1st June. Oxygen Tents.—During 1947 oxygen tents were used on 26 occasions with very satisfactory results. The charge for the use of a tent is 15s. per day. 49 MATERNITY AND CHILD WELFARE Births.—In accordance with the provisions of 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 1947 was 2,704 (1,400 males and 1,364 females). Of these, 243 (118 males and 125 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 882 notifications of birth (483 males and 399 females) which took place outside the district, although the ordinary residence of the parents i:; in Ilford, were transferred to this district. During the year, 30 cases in which there was default in complying with the requirements of the Public Health Act relating to the Notification of Births were referred to the Town Clerk. The percentage of live births occurring in Ilford, notified by the various responsible persons, was as follows:— By Medical Practitioners 2.57 By Certified Midwives 94.61 By Parents and Others 2.82 In addition, 71 stillbirths (34 males and 37 females) were notified The notifications of 12 stillbirths (6 males and 6 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 2,764 live births occurring in Ilford during 1947, 163 weighed 5½ lbs. or less at birth; 55 0; these babies were born at home and 108 in Hospital (including 16 in Private Nursing Homes). The number of those born at home:— (i) who were nursed entirely at home 54 (ii) who died during the first 24 hours 2 (iii) who survived at the end of one month 50 The number of those born in Hospital:— (i) who died during the first 24 hours 10 (ii) who survived at the end of one month 94 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:— (a) 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 is the 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 56. Infant Mortality.—The number of infants dying within the first year of life was 82, the total number born being 3,368. 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 24.3, 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 51 deaths of infants under four weeks of age during 1947 and the rate for the year was 15.1 per 1,000 live births. The deaths of infants under one month decreased from 74 during 1946 to 51 during 1947. The following table gives the deaths of infants under one year of age, classified according to age. 50 Infant Mortality—1947. Cause of Death Under 1 week I—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 1—3 months 3— 6 months 6—9 months 9 months to 1 year Total Acute Capillary Bronchitis - - - - - 1 - - - l Acute Gastritis - - - - - - - 1 — 1 Acute Pneumococcal Meningitis - - - - - - 1 - - 1 Adverse reaction to Atropine as premedication for repair of hare lip - - - - - - 1 - - 1 Asphyxia - - - - - 1 - - - l Atelectasis 15 — 1 — 16 — - — — 16 Bronchitis - - - - - - 1 - - 1 Broncho-pneumonia, tuberculosis - - - - - - 1 - - 1 Cerebral Haemorrhage 1 — — — 1 — - — — 1 Congenital Heart Disease 1 — — — 1 — - 1 — 2 Congenital Hypertrophic Pyloric Stenosis - - - - - 1 - - - 1 Congenital malformations — — 1 — - — - — — 1 Debility—prematurity 5 — — 1 6 — - — — 6 Encephalitis — — 1 — 1 — - — — 1 Erythroblastosis foetalis 3 — — — 3 — - — — 3 Gastro Enteritis — — — 1 1 — 2 1 — 4 Haemorrhagic disease of the newborn 1 - - - 1 - - - - 1 Heart failure — — — 1 1 — - — — 1 Intra-cranial haemorrhage 1 — — — 1 — - — — 1 Marasmus — 1 — - 1 — - — — 1 Meningitis — — 1 — 1 — - — — 1 Myocardial failure 1 — — — 1 — - — — 1 Neonatal Pyaemia 1 - — — 1 — - — — 1 Obstructed labour 1 — — — 1 — - — — l Osteogenesis Imperfecta — — — 1 1 — - — — 1 Pertussis - - - - - 1 - - - 1 Pneumonia, all forms 1 — 2 — 3 7 4 1 1 16 Prematurity 7 — — — 7 — — — — 7 Retroperitoneal Sarcoma - - - - - - 1 - - 1 Respiratory failure - - - - - - - 1 — 1 Rupture of Meningocele 1 — — — 1 — — — — 1 Shock following motor accident - - - - - - 1 - - 1 Staphylococcal Furunculosis - - - - - - - - - 1 Suffocation — — — - — 1 1 — - 2 39 1 7 4 51 12 13 5 1 82 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 1947 82 24.3 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 The mean average Infant Mortality rate for the past 10 years is therefore 33.3 per 1,000 live births. 51 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. 1947 24.3 41 47 36 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 1949 33.9 50 48 53 1938 36.7 53 57 57 Illegitimate Births and Deaths.—110 of the live births registered (60 males and 50 females) were illegitimate, that is 3.3 per cent, of the births registered. Four illegitimate children died under one year of age from the following causes:- Atelectasis Pulmonum, aged 8 hours. Broncho-Pneumonia, aged 21 days. Broncho-Pneumonia, Pertussis, aged 7 weeks. Prematurity, aged 10 hours. The infant mortality rate of illegitimate children was 36.8 per 1,000, compared with the infant mortality rate of 23.9 for legitimate children. The following table shows the birth and death rates of legitimate and illegitimate infants for the past ten years:- Legitimate Infants. Illegitimate Infants. Year. 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. 1947 3,258 96.7 78 23.9 110 3.3 4 36.4 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 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 I he 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. 52 There is, however, co-operation with a Voluntary Moral Welfare Worker in the district 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. A number of unmarried mothers from llford are also accepted at the Romford, Hornchurch and Upminster Moral Welfare Committee's Hostel at 51, Junction Road, Romford, and at 71, Caernarvon Road, Stratford. Foster-Children. Number of foster-children on register on 1st January 1947 21 Number of foster-children who were notified during 1947 12 Number of foster-children returned to their mothers during 1947 2 Number of foster-children taken off register for various other reasons during 1947 4 Number of foster-children on the register on 31st December 1947 27 Foster-Mothers. Number of foster-mothers with children on the register on the 1st January 1947 18 Number of persons who became foster-mothers during 1947 11 Number of foster-mothers whose names were taken off the register during 1947 6 Number of foster-mothers with children on the register on the 31st December 1947 23 Number of houses visited by the Sanitary Inspectors for the purpose of the Act during 1947 14 Number of visits made by the Sanitary Inspectors for the purpose of the Act during 1947 43 Number of visits made by Child Life Protection Visitors 219 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 arc concerned, provides inter alia :— (a) That any person (other than a registered adoption society or a local authority, and not being the parent or guardian or a near relative of the child or the person in whose care or possession he is to be placed), who participates in making arrangements for the adoption of a child under the age of nine years, must give notice, in writing, of the arrangements to the Welfare Authority for the area in which the adopter resides, not less than seven days before possession is taken of the child by the adopter. This does not apply when an adoption order is made. During 1947 notices were received from 10 persons in respect of 16 children. Adoption Orders were made by the Courts in respec.t of 15 of these children during the year; the other child was still under supervision at the end of the year. (b) That an adopter must notify a Welfare Authority if he changes his address or if the child dies. In the latter event he must also notify a coroner. No notices were received during 1947. Health Visitors and School Nurses.—Consequent upon the increase in the volume of work, the Ministry of Health decided, following a visit of one of their inspectors, that the number of Health Visitors and School Nurses should be increased to 18 in addition to the Superintendent Health Visitor. This was agreed by the Council. Unfortunately, owing to the extreme difficulty in obtaining staff, it has been quite impossible even to approach this number in spite of repeated advertisements and applications to various organisations. The Ministry, however, have stated that they would raise no objection to employment of assistants to relieve the Health Visitors by undertaking certain duties at the Infant Welfare Centres, Immunisation Clinics and in connection with school inspection work which does not require the special qualifications of certificated Health Visitors. 53 Further, it is mentioned that these assistants should not be given any title which could be confused with that of Health Visitor, and it is suggested that they might be styled as Clinic Nurses. In no circumstances should they be required to undertake home visiting or act in an advisory capacity to the mothers. The Ministry of Health have since decided that there would be no objection to Clinic Nurses visiting the homes of children under 5 years of age to see how they are progressing, to invite attendance at the Infant Welfare Centres for advice from the Health Visitor or Doctor, but not in any way to give advice, At the end of the year there were only 6 qualified Health Visitors and School Nurses in addition to the Superintendent Health Visitor, and 5 Clinic Nurses. The following is a summary of the home visits made by the Health Visitors and Clinic Nurses during 1977 as far as the Maternity and Child Welfare work is concerned:- First visits to newly-born infants 4,024 Subsequent visits to children under 1 year of age 3,855 Subsequent visits to children over 1 year of age and under 5 5,374 Visits to expectant mothers 365 Home visits for other reasons 3,094 Total visits paid 16,712 Day Nurseries. (a) Becontree Avenue Day Nursery.—The London County Council agreed during the year to allow the building to remain on its present site in Winding Way until such time as the new Day Nursery to be erected on the site in Stevens Road was ready, subject to this Council demolishing approximately 12 ft. of one wing of the present Nursery and breaking up a portion of the concrete playground; fencing off a portion of the site on the land required for rebuilding houses in Winding Way and raising no objection to the County Council stacking bricks on a portion of the site forthwith. In consequence, since the demolition of part of one of the wings of the Nursery, it has been necessary to restrict the accommodation to 40 children instead of 50 as hitherto. Up to the present it has not been possible to proceed with the work on the new Nursery in Stevens Road. (b) Green Lane Day Nursery.—As the present Nursery comprises the sites of five private dwelling houses which were demolished as a result of enemy action, steps have been taken to obtain an alternative site. The Ministry of Health have now confirmed the compulsory purchase order made by the Council for the acquisition of a site for a new Day Nursery in Goodmayes Lane to replace the one in Green Lane. (c) The Council decided during the year to continue to charge 1/- per day for the care of children in the Nurseries. (d) I he training of Students at the Nurseries for the certificate of the Nursery Nurses' Examination Board continued. One Student from the Green Lane Day Nursery entered for the examination and obtained the certificate during the year. The following is a table showing the attendances, etc., at the four Day Nurseries during 1947:- 54 Situation Date of Opening Accommodation (Children) Average Daily Attendance during 1947 Including Excluding Saturday Saturday No. of Days in Quarantine Reasons for Quarantine No. on Waiting List at 31st Dec., 1947 Sunshine House, Girls' Village Homes, Barkingside 17.8.42 45 22 26 76 18 cases of Measles. 11 cases of Whooping Cough. 86 359-381, Green Lane, Seven Kings 5.5.43 50 26 29 148 1 case of German Measles. 19 cases of Measles. 8 cases of Whooping Cough. 1 case of Scarlet Fever. 81 2-26-236, Lev Street Ilford 16.8.43 50 31 35 145 33 cases of Measles. 1 case of Chicken Pox. 3 cases of Whooping Cough. 129 Becontree Avenue, corner of Winding Way, Dagenham 17.1.44 40 21 25 82 17 cases of Measles. 5 cases of Chicken Pox. 9 cases of Whooping Cough. 3 cases of Mumps. 1 case of German Measles. 39 55 Infant Welfare Centres.—95 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December 1947. During the year the following attendances were recorded:- Total number of attendances of infants 49,690 First attendances 3,133 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 4,146 12,798 attendances of children from 1 to 5 years were made at the Infant Welfare Centres during the year. The following is a comparison of the attendances at the Infant Welfare Centres for the past five years:- Total No. of attendances of infants. First attendances. Total No. of children on roll on 31st December. 1947 49,690 3,133 4,146 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 The attendances at the Infant Welfare Centres increased during 1947 by 6.6 per cent. compared with the attendances for 1946. The Seven Kings Infant Welfare Centre was transferred from St. John's Church Hall, Devonshire Road, to the Seven Kings Methodist Church, Seven Kings Road, commencing on the 22nd October 1947. 686 sessions were held during the year; the average attendance at each session being 72 mothers with their infants. The following are the figures for each Centre:- Sessions Average Attendance Chadwell 49 80 Barkingside 49 89 Downshall 49 72 Becontree 49 57 Woodford Avenue 49 91 Seven Kings 49 74 Cecil Hall (Wednesday) 49 65 Cecil Hall (Thursday) 49 67 Newbury Hall 49 56 Grosvenor Road 49 78 Goodmayes 49 83 llford Lane 49 79 Valentines 49 63 F'airlop 49 58 56 Paediatric Clinic.-Dr. Anderson, the Council's Consultant Paediatrician, continued to attend the Clinic at Valentines Mansion each fortnight during the year. Twenty-six sessions were held and 105 new cases were referred from the Infant Welfare Centres and Maternity- Home for the following reasons; a total of 270 attendances were made. Conditions Requiring Attention. Still attending. Ref. to Hospital Clinic or Specialist. Discharged cured. Discharged. No treatment. Discharged. Improved. Discharged, other reasons. Total. Adenitis - - - 1 - - 1 Adiposity 1 - - - - - 1 Anaemia 3 - 2 - 2 - 7 Bronchitis 1 - - - 1 - 2 Cardiac 1 - - - 2 1 4 Colic - - - - - 2 2 Cretinism 1 - - - - - 1 Defective Vision - - - 1 - - 1 Deformity of Chest 1 - - - - - 1 Deformity of Face 1 - - - - - 1 Deformity of Limb 1 - - - - - 1 Dysuria - 1 - - - - 1 Eczema - 3 - - 1 - 4 Epilepsy, major or minor 1 1 - - - 1 3 Facial Paralysis 1 - - - 1 - 2 Failure to gain weight 1 1 4 - 6 1 13 Haematemesis - - - - 1 - 1 Haemophilia - - 1 - - - 1 Hernia - 1 1 - - - 2 Hydrocele 1 - 1 - - - 2 Hydrocephalus 2 - - - - - 2 Laryngeal Stridor - 2 - - - 1 3 Melaena - - - - 1 -- 1 Miscellaneous 4 4 1 2 1 - 12 Mongolism - - - 1 - 1 2 Nocturnal Enuresis 1 - 1 - - - 2 Nystagmus - - - - 1 - 1 Otitis Media 1 - - - - - 1 Paraplegia 1 - - - - - 1 Prolapse of Rectum - - - 1 - - 1 Pyrexia of Unknown Origin 1 - - - - - 1 Rash 1 3 1 1 - 1 7 Recurrent Styes - - 1 - - - 1 Retarded Development 7 - - - - 1 8 Rickets - 1 1 1 - - 3 Spina-Bifida - - 1 - - - 1 Sterno-Mastoid tumour - 1 - - - - 1 Unequal Pupils - - - - - 1 1 Vomiting 1 - - - 1 1 3 Wide fontanelles 1 - - - - - 1 Wry neck - - 1 - - - 1 Total 34 18 16 8 18 11 105 Dental Clinics.-231 half-days were taken up for the treatment of expectant and nursing mothers and children under 5 years of age during 194/ : 105 at Valentines Clinic and 126 at Mayesbrook Clinic. 57 The following is a summary of the work carried out for the Maternityand Child Welfare Committee during the year:- Valentines Clinic Mayesbrook Clinic (a) Treatment of Mothers: No. of patients treated during 1947 333 239 No. of attendances of patients 862 1,026 No. of administrations of " genera"l anaesthetics 100 196 No. of administrations of "local" anaesthetics 55 6 No. of fillings and other operations 1,509 1,027 No. of mothers having dentures supplied (including 2 at part cost) 74 85 (b) Treatment of Children under 5 years of age No. of patients treated 153 83 No. of attendances of patients 170 129 No. of administrations of " general " anaesthetics 69 72 No. of fillings and other operations 211 69 The following are the figures for the past 5 years:- No. of Mothers treated : 1943 1944 1945 1946 1947 (i) Valentines Clinic 535 481 398 378 333 (ii) Mayesbrook Clinic 50 - 68 179 239 No. of Children treated : (i) Valentines Clinic 179 143 130 130 153 (ii) Mayesbrook Clinic 15 - 46 88 83 Ophtiiaimic Clinic.-15 expectant and nursing mothers and 148 children under 5 years of age were treated by the Council Oculist during 1947 : 61 pairs of spectacles were supplied, 13 to mothers and 48 to children. Orthopaedic Clinic. (i) Newbury Hall Clinic.-46 sessions were held during 1947, 301 children under 5 years of age being examined, making 765 attendances. (ii) Mayesbrook Clinic.-30 sessions were held during 1947, 174 children under 5 years of age being examined, making 415 attendances. The 475 children were found to bo suffering from the following defects:- Diagnosis. New Cases. Old Cases. A B A B Paralyses:- A.P.M 2 1 - - Hemiplegia 1 - 1 - Foot drop - 1 1 - Scoliosis 2 - - - Kyphosis - - - 1 Slack posture 1 - - 1 Deformity of hips 1 2 - - Genu valgum 66 39 64 38 O.C.T 13 6 34 29 Genu varum. 2 - 5 5 Pes valgo planus 14 8 16 11 Valgus ankles 10 4 23 10 Talipes calc. valgus 3 1 - 2 Cong, talipes E.V. 1 2 - - Pes calc. valgus - - 2 - Intoeing - - 6 1 Deformity of toes 3 3 10 4 Torticollis . - 1 - N.A.D. 5 - 3 2 Spasticfoot 1 - 1 - Metatarsus Varus - - 1 2 Other conditions 2 1 6 - Totals 127 68 174 106 A-Newbury Hall. B-Mayesbrook. 58 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, 20 children under five years of age were treated by the Masseuse during the year, and 172 attendances were made by these children. Treatment was also given to 11 children who made 45 attendances at the Mayesbrook Clinic. AurM Clinic.—The Aural Surgeon attended at 90 sessions during 1947 and 167 attendances were made by 1 expectant mother and 117 children of pre-school age. 19 children were operated upon for removal of tonsils and adenoids: 10 at Queen Mary's Hospital and 9 at King George Hospital. Rheumatism Clinic.—33 sessions were held during the year at Newbury Hall, at which 19 children under 5 years of age, 9 being new cases, made 43 attendances. The following is a summary of the cases treated:- Condition. New. Old. Total. Congenital Heart Disease 4 6 10 No active Rheumatic disease 1 1 2 Heart murmur functional 3 2 5 Pains due to Orthopaedic conditions 1 1 Totals 9 10 19 Number of cases referred to Ear, Nose and Throat Surgeon 1 Orthopaedic Surgeon 2 ,, ,, for X-ray and Electrocardiograph 10 Artificial Sunlight Clinic. 47 sessions were held at the Newbury Hall Clinic and 49 at Mayesbrook Clinic. 69 children in all were treated, making 1,088 attendances. The conditions treated were as follows: Conditions. Cases. A B Anaemia, Debility and Malnutrition 16 5 Bronchitis 4 2 Genu varum 2 7 Asthma 1 2 Genu valgum 2 2 Old Rickets 16 4 Alopecia 2 - Other conditions 1 3 Totals 44 25 A—Newbury Hall. B.—Mayesbrook. 38 cases were still attending at the end of the year ; of the remainder 1 had removed from the district, 7 were discharged, having shown improvement, 5 were discharged having made a satisfactory recovery, 17 were discharged due to absence and 1 was discharged having made no progress. 59 Convalescent Treatment.-By arrangement with the Invalid Children's Aid Association four children were admitted to Convalescent Homes during the vear, the Council contributing towards the cost of maintenance. The Council also made a grant of £25 to the funds of the Association. Treatment ok Minor Ailments.-Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 41 belts were supplied to infants suffering from hernia during 1947. A certain number of infants were brought to the Clinics at Newbury Hall and Mayesbrook Clinic to receive treatment for minor ailments. Cardiac Clinic.-In April 1947, the Council decided to hold a Cardiac Clinic each month at Newbury Hall, Perrymans Farm Road, at which expectant and nursing mothers could attend on reference from the ante-natal or post-natal clinics, thus obviating them the journey to Queen Mary's Hospital, Stratford. Dr. K. Playfair agreed to attend as the cardiologist. The first clinic was held on the 7th June and up till the end of 1947 five sessions were held. 26 expectant and nursing mothers were referred from either the ante-natal or post-natal clinics, who made a total of 36 attendances. The following is a summary of the cases examined:- Condition. PostNatal AnteNatal Antecedent history of acute rheumatism - 3 Aortic valvular incompetence - 1 Cardiac Decompensation - 1 Cardiac symptoms and epilepsy - 1 Congenital valvular lesion - 1 Mitral stenosis - 6 Mitral stenosis with decompensation - 1 Pulmonary systolic murmur-hypertension - 1 Rheumatic heart-syncopal attacks - 1 Systolic mitral murmur 1 7 Tachycardia 1 Thyrotoxicosis - 1 Total 1 25 9 of these patients were, however, referred to Queen Mary's Hospital for X-Ray and electrocardiograph. The Council agreed to pay a charge of £1 1s. per film for X-Ray examination, with 10s. 6d. for each subsequent film if required and 10s. 6d. for each electrocardiograph. Midwives.-There were 22 State certified midwives (including the Superintendent, Deputy Superintendent and 13 Council midwives and 2 part-time midwives) resident and practising in the district. In addition there were at the end of the year 14 State certified midwives at the Council's Maternity Home, 2 at Wilnett Lodge post-natal home and 5 at private nursing homes in Ilford. Their supervision has been carried out as in previous years. Suspension from Practice.-Eight midwives were suspended from practice for varying periods during the year following attendance on 7 cases rendering 60 them liable to be a source of infection. Five of the midwives were employed by the Council and the other three by the Salvation Army. The reasons for suspension from practice were as follows:- (1) and (2) Attended two babies suffering from diarrhoea. No pathogenic organisms were found in faecal swabs from the infants but the swab from the throat of the midwife showed the presence of haemolytic streptococci. (3) Attended notified case of scarlet fever, removed to the Ilford Isolation Hospital. Swabs from the throat and nose of the midwife did not show any haemolytic streptococci. (4) Attended notified case of puerperal pyrexia stated to be due to sapraemia after post -part uni haemorrhage and manual removal of the placenta. No haemolytic streptococci isolated from throat or nose swabs of midwife. (5) Attended notified case of puerperal pyrexia stated to be due to mastitis. No haemolytic streptococci isolated from throat or nose swabs of two midwives. (6) Attended notified case of puerperal pyrexia stated to be due to sapraemia. No haemolytic streptococci isolated from throat or nose swabs of two midwives. (7) Attended a case of pyrexia due to sub-involution; admitted to the Ilford Isolation Hospital. No haemolytic streptococci isolated from throat or nose swabs of midwife. Medical aid was sought in 18 instances where the infant was found to have inflamed or discharging eyes. Three of the cases were subsequently notified as suffering from Ophthalmia Neonatorum. In all cases the condition of the eyes cleared satisfactorily. The Council has adopted the suggestion of the Minister of Health that they should refrain from exercising their power of recovery of the fee of the Medical Practitioner under Section 14 (4) of the Midwives Act, 1918, in this class of case. Council District Midwifery Service.—During the year 1,159 cases were attended. In 735 cases the midwives were engaged to attend as midwives and in 424 as maternity nurses. The patients resided in the following wards:- Barkingside 214; North Hainault 128; Cranbrook 76; Park 112, Seven Kings 116; South Hainault 123; Loxford 158; Clementswood 137; Goodmayes 48; Fairlop 18; Clayhall 16; Mayfield 13. 3,820 ante-natal visits were made during the year. At the end of the year there were 13 District Midwives employed wholetime by the Council and 2 part-time midwives, in addition to the Superintendent and Deputy Superintendent. 54 medical practitioners are now participating in the Council's scheme tor the ante-natal examination of patients who have engaged a Council midwife to attend them. 81 patients were referred by private doctors to the Council's Consultant Obstetrician at the Ante-natal Clinic for a further opinion. 22 of these women and 48 other patients who had engaged a Council midwife (40 as a midwife and 30 as a maternity nurse) were for various reasons admitted to the Council's Maternity Home or other Institutions for confinement. 60 were admitted to the Maternity Home, 6 to the Essex County Hospital, Wanstead, 1 to the Ilford Isolation Hospital, 1 to the Salvation Army Mothers Hospital, Clapton, 1 to a private Nursing Home and 1 to Oldchurch County Hospital, Romford. In addition, 2 patients were admitted to the Maternity Home for antenatal treatment and subsequently confined at home. 61 A Doctor was called in to 241 of the 735 cases in which a midwife had been engaged for the following reasons:- (a) Ante-Natal. Abdominal pain for several days 2 Ante-partum haemorrhage 13 Mal-presentation 9 Persistent vomiting 3 Premature labour 3 Premature rupture of membranes 6 Rigid perineum 2 Swollen feet 1 Tenderness and swelling of leg 3 Varicose veins 1 Vomiting with pain 1 Total 44 (b) During Labour. Born before arrival of midwife 1 Breech delivery 1 Delayed second stage 17 Extended breech 2 Foetal distress 3 Intra-eclamptic fit 1 Patients general condition 7 Prolapsed cord 1 Prolonged labour 5 Retained placenta 3 Total 41 (c) After Labour. Adherent placenta 1 Eclampsia 1 Mastitis 1 Obstetric shock 1 Perineal tear 93 Persistent headache 1 Post-partum haemorrhage 8 Pyrexia 1 Red lochia and cracked nipples 1 Strained muscle in neck 1 Nasal Tumour 1 Total 110 (d) For Infant. Blocked tear duct 1 Cyanosis 1 Dangerous feebleness 2 Diarrhœa 2 Distressed breathing 2 General condition 12 Inflammation of ear 1 Inflammation and discharging eye 1 Imperforate anus 1 Jaundice 1 Loss of weight and skin rash Naevus on head 1 Premature infant 4 Skin condition of scalp Spina Bifida 1 Sticky eye 12 Swollen right elbow Very drowsy—weak cry 1 Total 46 62 Four patients were notified as suffering from Puerperal Pyrexia, three of them being removed to the Council's Isolation Hospital. One of the patients had engaged her own doctor to attend her. The causes of the pyrexia were due to:- Mastitis 1 Retained products and sapraemia 1 Sapraemia 2 Five 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. Two of these babies were admitted to the Council's Isolation Hospital. Of the infants born there were 26 stillbirths ascribed to the following causes:- Anencephalic 2 Asphyxia 2 Breech presentation 3 Cord around neck 1 Cord twisted with large blood clot 1 Difficult breech delivery with after coming head ; arms extended 2 Psychological disturbance during pregnancy 1 Fall of mother during pregnancy 3 Placenta infarcts 1 Post-maturity 1 Precipitate labour 1 Prolonged labour 1 Unknown 7 In 11 of the cases the midwife was engaged as a maternity nurse only. There were 18 deaths of infants during the first year of life from the following causes:- Acute capillary bronchitis, aged 11 weeks. Acute gastro-enteritis, aged 5 months. Atelectasis, aged 1 day. Broncho-pneumonia, aged 5 months. Broncho-pneumonia, aged 6 months. Broncho-pneumonia, atelectasis, aged 2 days. Broncho-pneumonia, gastro-enteritis, congenital hypertrophic pyloric stenosis, aged 7 weeks. Broncho-pneumonia, pertussis, aged 7 weeks. Broncho-pneumonia, premature twin, aged 6 weeks. Cardiac failure, Fallot's tetralogy, aged 8 months. Congenital heart disease, aged 1 day. Convulsions, broncho-pneumonia, aged 5 months. Marasmus, mental deficiency, aged 3 weeks. Myocardial failure, asphyxia neonatorum, prolapsed cord, breech birth, aged 30 minutes. Pneumonia, aged 10 weeks. Prematurity, aged 10 hours. Prematurity, aged 2 days. Prematurity, asphyxia livida, aged 17 hours. In 8 of these cases the midwife was engaged as a maternity nurse only. Notices were received from the District Midwives stating that artificial feeding had been substituted in respect of 30 infants attended by them during 1947 for the following reasons :— Deformed nipples 1 Domestic reasons 1 General condition of mother 3 History of tuberculosis 1 Inability of infant to take breast 1 63 Lactation poor or insufficient 17 Mastitis 1 Mother refused to breast feed infant 3 Mother's request 1 Puerperal pyrexia—doctor's advice 1 One patient who had engaged a District Midwife to attend her as a midwife, died during the year. The patient, a primipara, delivered at her own home was transferred to the Council's Maternity Home 16 hours after her confinement and died 13g hours later due to oedema of the lungs, post partum eclampsia and toxaemia of pregnancy. Salvation Army Midwifery Service.—190 cases were attended by the Salvation Army Midwives during the year, 161 as a midwife and 29 as a maternity nurse. A Doctor was called in to 60 of the 161 cases in which a midwife had been engaged for the following reasons :— Ante-Natal. Ante Partum Haemorrhage 1 Hypertension and Albuminuria 3 Severe pain in left iliac fossa 1 Total 5 During Labour. Breech Delivery 1 Delayed second stage ,.. 1 Extended breech 1 Incomplete Abortion 1 Maternal distress 2 Miscarriage—complete 1 Prolapsed cord 1 Prolonged first stage 1 Total 9 After Labour. Mastitis 1 Laceration of Perineum 28 Post Partum haemorrhage 3 Prolapse—for insertion of pessary 1 Puerperal insanity 1 Pyrexia 2 Total 36 Infant. Atelectasis 1 Blue Asphyxia 1 Cyanosis 1 Septic finger 1 Sticky eye 4 Stillbirth 1 Vomiting and loss of weight 1 Total 10 One patient was notified as suffering from puerperal pyrexia, stated to be due to chronic otitis media, and was removed to the Council's Isolation Hospital. Of the infants born there were two stillbirths from the following causes :— Congenital abnormality 1 Delayed labour 1 64 There were two deaths ol infants during the first year of life from the following causes:- Atelectasis associated with patent inter-ventricular septum, aged 2 days. (iastro-enteritis, aged 3 months. A notification was received that it was proposed to substitute artificial feeding in respect of one infant owing to puerperal pyrexia of the mother. In March 1947, the Council decided to extend the facilities for the acceptance of vouchers from eligible members of the U.S.A. and H.S.F. to cover the cost of the services of cases attended by the Salvation Army midwives, including ante-natal examinations by the private Doctor and any fee for a Doctor called in by the midwives under the Midwives Act, 1918. The arrangement, as mentioned below, which became operative in respect of all cases confined on or after 1st July 1947, also covered the payment of a grant to the Salvation Army for each case attended to meet the increased costs of their services. Charges made to patients:- Midwife (primipara) £2 10 0 per case (multipara) £2 0 0 ,, ,, Maternity Nurse (primipara and multipara) £2 0 0,, Patients who are covered by H.S.A. or H.S.F. vouchers—no charge. Where a case is covered by U.S.A. or H.S.F. voucher the Salvation Army collect the voucher as soon as possible after the case is booked and forward the same to the Borough Treasurer. The Council pay to the Salvation Army in respect of all cases the following sums:- (1) Cases not covered by H.S.A. or H.S.F. vouchers, whether attended as midwife, primipara or multipara, or as maternity nurse (primipara and multipara) £1 (2) Cases for which the H.S.A. or H.S.F. accept responsibility. (a) Midwife (primipara) £3 10 0 per case (b) ,, (multipara) £'3 0 0,, ,, (c) Maternity Nurse (primipara and multipara) ;£3 0 0 ,, ,, In these cases the Council recover the value of the voucher from the U.S.A. or H.S.F. Ilotne and Domestic Helps.—The service inaugurated in October 1946, as mentioned in my Report for 1946, continued during the year. The scheme steadily progressed throughout 1947 and at the end of the year 45 Home and Domestic Helps, either full-time or part-time, were employed. The following is a summary of the cases dealt with during 1947:- (a) Number of applications received for assistance 480 (b) Number for whom Home or Domestic Helps were vided (including 10 who were having the service at the commencement of the year) 341 (c) Number of cases which on investigation were either not eligible for assistance or did not require the service 110 (d) Number of cases where Home Help is required in future months 26 (e) Enquiries incomplete 3 During the year, the Council decided to pay a retaining fee of 5/- per week to those Home or Domestic Helps who are available for full-time emplovment, and also to grant a maximum of 12 working days' leave per annum with pay, or one day after one month's service, to all the Home and Domestic Helps, such leave to be proportionate to the average number of hours employed weekly during the 3 months immediately prior to such leave. 65 Ante-Natal Clinics.—The following is a summary of the attendances at the Ante-Natal Clinics during the year:- Maternity Mayesbrook Home Clinic First attendances 1,057 259 Subsequent attendances 9,578 2,481 Total 10,635 2,740 Number of sessions 413 106 Average attendance at each session 26 26 Number of expectant mothers on the rolls on 31st December 1947 436 97 All patients booked for admission to the Maternity Home are medically examined at the Ante-Natal Clinics, the first appointment normally being made at the 16th week of pregnancy. During the year 497 cases other than those booked for admission to the Maternity Home were examined at the Clinics. There were 2,198 attendances by such cases. The Consulting Obstetrician or his Deputy visited the Ante-Natal Clinic each week during 1947. During the year 53 visits were made, 200 patients referred from the Ante-Natal and Post-Natal Clinics and 222 patients referred by private doctors were examined. A total of 1,122 examinations were made. X-Ray Examination of Ante-Natal Patients.—114 patients were referred from the Ante-Natal Clinic to King George Hospital for X-Ray examination during the year. Post-Natal Clinics.—All patients confined in the Council's Maternity Home, and other patients on request are invited to attend the Post-Natal Clinics for the first time approximately six weeks after confinement. Two Clinics are held, one at the Maternity Home each week and the other at Mayesbrook Clinic once monthly. The following attendances were recorded :— The following attendances were recorded :- Maternity Home Mayesbrook Clinic First attendances 796 176 Subsequent attendances 292 55 Total 1,088 231 Number of sessions 54 12 Average attendances each session 20 19 Supply of Sheets for Expectant Mothers.—In accordance with circular 154 44 of the Ministry of Health of the 3rd November 1944, amended by circular 25/1947 of February 1947, women holding R.B.2 expectant mother's ration books are eligible to purchase sheets on coupon equivalent certificates if the midwife or maternity nurse booked for the case certifies that her patient is genuinely in need of additional sheets at the time of the confinement. During 1947 2,533 certificates were issued to 877 expectant mothers. Maternal Mortality.—The total number of deaths of Ilford mothers credited by the Registrar-General as due to childbirth during the year was 2, which gives the maternal mortality rate, i.e. number of deaths per 1,000 live births, of 0.59 (or 0.58 including stillbirths) the lowest figures recorded in Ilford. The causes of death were as follows:- (1) Confined and died at Ilford Council Maternity Home ; pulmonary embolus due to phlebothrombosis of the right femoral vein following upon operation for lower segment Caesarean Section for central placenta praevia. (2) Confined in own home and admitted to Ilford Council Maternity Home 16 hours after delivery. Died 13½ hours later due to oedema of lungs, post partum eclampsia and toxaemia of pregnancy. 66 MATERNITY HOME. During 1947, 1,056 patients were admitted into the Home, compared with 1,020 in 1946, 824 in 1945, 784 in 1944, 601 in 1943, 396 in 1942 and 369 in 1941. Of the 1,056 patients admitted during 1947, 108 were admitted direct to the Emergency Block and 948 to the Ward Blocks. The patients were admitted to the Home from the following Wards:- Barkingside 174 Loxford 107 Clayhall 8 Mayfield 5 Clementswood 103 North Hainault ... 124 Cranbrook 87 Park 81 Fairlop 12 Seven Kings 108 (ioodmayes 116 South Hainault ... 131 The number of Electoral Wards in the Borough was increased by 3 from 1st November 1947, therefore admissions from the Clayhall, Mayfield and Fairlop Wards prior to this date are included in the figures for the other Wards. 975 cases could not be admitted during the year and other arrangements were made for their confinement. At the end of the year 564 cases had booked for future admission to the Home. The average number of mothers in the Maternity Home per day during 1947 was 37.07. Wilnett Lodge Post-Natal Home with accommodation for 9 mothers and babies was opened on 22nd September and 85 patients were transferred there from the Maternity Home from that date until the end of the year. The average length of stay of mothers in the Maternity Home was 13.50 days, which included an average stay of 6.07 days in respect of those patients transferred to Wilnett Lodge. The policy of discharging patients, where possible, before the 14th day of the puerperium was continued during the year, thus enabling more cases to be admitted. 824 of the lx056 patients admitted were discharged from either the Maternity Home or Wilnett Lodge before the 14th day. In September 1947 the Council decided to continue to pay to the nursing staff at the Maternity Home and Wilnett Lodge 20 per cent. above the scales contained in the recommendations of the Mid wives' and Nurses' Salaries Committees as an encouragement to retain the existing staff at the Homes and in an endeavour to obtain additional staff to cope with the great increase in the number of cases being admitted. It is interesting to note that during the year 57 of the patients admitted (or 5.2 per cent.) were primiparas aged 35 years or over, compared with only 16 (or 2.5 per cent.) in 1938 the last complete year prior to the war. EMERGENCY BLOCK. 125 cases were treated, 108 being admitted direct to this Block and 17 being transferred to the Ward Blocks. One of the latter cases was confined in the Ward Block, discharged, and subsequently admitted to the Emergency Block owing to retained placenta. The 108 cases were admitted for the following reasons:- Abdominal Pain 1 Delayed labour Active Tuberculosis 1 Disproportionate measurements Acute Hydramnios 1 (for Caesarean Section and Albuminuria ... 1 sterilization) 1 Ante-partum haemorrhage 11 Doubtful pregnancy... 1 Asthma and bronchitis 1 Eclampsia 2 Breech presentation (for Caes- Failed forceps delivery at own arean Section) 2 home 2 Cardiac condition 1 Head high 1. Contact of ? infectious case 1 Herpes Zoster 1 Coryza and pyrexia 1 High blood pressure 1 67 High blood pressure, dead foetus 1 History of broncho-pneumonia 1 History of gonorrhoea 1 History of haemolytic streptococcal infection 1 Hydramnios, no movements felt 1 Hydronephrosis 1 No arrangements made 3 Notified case of tuberculosis, inevitable abortion 1 Obstetric shock with retained placenta (confined before admission) 1 Obstructed breech 1 Obstructed labour 1 Occipito-posterior presentation 1 Otorrhoea 2 Placenta Praevia 7 Post-part um eclampsia (confined before admission 2 Post-partum haemorrhage (confined before admission) 2 Premature breech presentation 1 Premature labour 2 Premature twins and pyrexia 1 Presentation and history 1 Prolapsed cord 1 Prolonged labour 3 Pyelitis 1 Pyrexia (confined before admission) 1 Raised blood pressure 1 Raised blood pressure, preeclamptic, oedema of feet 1 Recent influenza 1 Rectocele and cystocele 1 Retained placenta (confined before admission 8 Retained placenta and postpartum haemorrhage (confined before admission) 1 Synovitis and pyrexia 1 Threatened abortion... 5 Toxaemia 8 Urinary infection 1 Uterine inertia—retained placenta (confined before admission) 1 Version under general anaesthetic 1 Vaginal discharge (one confined before admission) 4 Whooping cough contact 1 80 of these 108 cases had not been booked for admission to the Maternity Home. Seven of the 108 patients were admitted direct to the Emergency Block for ante-natal treatment and were subsequently transferred to or re-admitted to the Ward Blocks for confinement. The average number of mothers in the Emergency Block per day during 1947 was 4.73 (including cases transferred from the Ward Blocks) and the average length of stay of patients admitted direct to this Block was 14.56 days. 68 patients were confined in the Emergency Block (64 admitted direct to this Block and 4 transferred from the Ward Blocks). The seven cases mentioned above have been included in the figures for those confined in the Ward Blocks. 31 of the 68 cases were first confinements and 37 were second or subsequent confinements. 15 cases (or 22.1 per cent.) were delivered by means of forceps, one following surgical induction ; two of the infants were stillborn and one died aged 10 minutes. In addition labour was surgically induced in eight cases ; one of the infants was stillborn and one died aged 34 hours. 27 of the 63 live infants born in this Block were weaned prior to their discharge from the Home for the following reasons:- Baby's condition following forceps delivery 1 Extreme prematurity; lactation not established 3 Inverted nipples 1 General condition of mother following Caesarean Section 1 History of breast abscess 1 History of tuberculosis 3 Lactation poor or insufficient 7 Maternal death 1 Mother's general condition 4 Mother's condition—chronic nephritis 1 —pre eclampsia 2 Mother's request 2 15 infants (including two sets of twins) born to patients in the Emergency Block were retained in the Home for varying periods, an average of 18.8 days each, following discharge of their mothers, either due to prematurity or feeding difficulties. 10 of these infants weighed 5½ lbs. or less at birth. 68 There were eight deaths of infants born in the Emergency Block as follows:- Atelectasis, extreme prematurity, aged 2 hours 55 minutes. Atelectasis, premature breech, aged 10 minutes. Broncho-pneumonia associated with atelectasis, aged 4 days. Broncho-pneumonia, associated with erythroblastosis foetalis, aged 3 weeks. Broncho-pneumonia, pylorospasm, aged 2 months (died in King George Hospital). Debility, prematurity (36 weeks), aged 34 hours. Extreme prematurity (29 weeks), aged 9 hours. Extreme prematurity (30-32 weeks), aged 29½ hours. The mothers of six 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 eight stillbirths in this Block were as follows:- Abdominal ascites, extensively maceratedh1 Ante-partum haemorrhage 1 Eclampsia of mother 1 Maternal toxaemia 1 Misapplication of forceps—repeated attempts to deliver at home 1 Prolapse of cord 2 Unknown 1 The mothers of six of these infants were admitted as emergency cases. 14 cases, four of whom were confined prior to admission to the Home, were notified as suffering from Puerperal Pyrexia. Four of these patients worn-moved to the Isolation Hospital. The causes of the Pyrexia were due to ante-partum haemorrhage—parametric abscess (1), B. Coli pyelitis (1), bronchitis—twin abortion (1), history of pulmonary tuberculosis (1), infection of site occupied by large clot removed by operation (laparotomy) (1), mastitis of right breast (1), reaction following shock and blood transfusion (1), reaction following shock caused by retained placenta (1), retained products—sapraemia (1), sapraemia, haemolytic streptococcal infection (1), toxaemia—post-parium eclampsia (1), transient pyrexia of unknown origin (2), urinary infection (1). In addition, eight other patients were removed to the Isolation Hospital for the following reasons :—Faucitis (1), Influenza, threatened eclampsia (1), Osieomy<-ltitis of femur and septic arthritis of knee (1), Parturition (1), Pulmonary tuberculosis (1), Right otorrhoea (1), Streptococcal carrier (1), Ulceration of legs (1). The Consulting Obstetrician, his Deputy, or other Consultants, were called in to 24 cases as follows: To perform Caesarean Section operations 7 To perform other operations 9 For consultation 8 The reasons for the Caesarean Section operations were:- Ante-partum haemorrhage and general condition 1 Breech presentation and toxaemia 1 Breech presentation 1 Disproportionate measurements 1 Head high and underlying placenta 1 High head 1 Placenta praevia 1 The other nine operations were as follows:- Dilatation and curettage 3 Forceps delivery 1 Hysterotomy 1 Laparotomy; extra uterine pregnancy 1 Removal of retained placenta 3 The reasons consultations were necessary were as follows:- Acute hydramnios 1 Broncho-pneumonia (seen by Paediatrician) 1 69 Eclampsia 1 Haemorrhage Neonatorum (seen by Paediatrician) 1 Intestinal abnormality (seen by Paediatrician) 1 Placenta praevia 1 Possibility of Caesarean Section 1 Retained placenta 1 One mother admitted to the Emergency Block 16 hours after delivery at her own home died 13½ hours later due to oedema of lungs, post partum eclampsia and toxaemia of pregnancy. The patient had not been booked for admission to the Maternity Home. The other 37 cases admitted direct to this Block were not confined therein for the following reasons:- Abortion or miscarriage (including 3 sets of twins) 11 Admitted for ante-natal treatment and subsequently evacuated for confinement or confined at own home 7 Born before arrival at Home 17 Pregnancy terminated 1 Secondary post partum haemorrhage 1 Ward Blocks.—948 patients were admitted to the Ward Blocks. In addition, seven patients admitted to the Emergency Block for ante-natal treatment were subsequently transferred to or re-admitted to the Ward Blocks lor confinement. Four patients admitted to the Ward Blocks were transferred to the Emergency Block for confinement. 758 of the 948 patients had been booked for admission to the Home. Of the other 190 cases 34 were admitted as emergency cases at the request of the private medical practitioner owing to medical or obstetric reasons and it was found possible to admit 156 patients for whom provisional arrangements had been made for admission to the Emergency Maternity Homes. 19 patients 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 8 Born before arrival at Home 7 Pregnancy terminated 1 The average number of mothers in the Ward Blocks per day during 1947 was 32.34 and the average length of stay of mothers was 13.37 days including an average stay of 6.07 days in respect of 85 patients transferred to Wilnett Lodge Post-Natal Home. In 47 of the 932 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 932 confinements there were:- (a) 395 cases of first confinement. (b) 537 cases having their second or subsequent confinement. (c) 245 cases living in two rooms or less (135 being first confinements). (d) 180 cases living in three rooms (83 being first confinements). 72 cases (or 8.3 per cent.) were delivered by means of forceps, 23 following surgical induction; four of the infants were stillborn and three infants died aged 34 hours, 4 days and 20 days. In addition, labour was surgically induced in 105 other cases; six of the infants were stillborn and one died aged 11 hours. 164 of the 930 live infants born in this Block were weaned prior to their discharge from the Home for the following reasons:- Infantile sepsis—lactation poor 1 Baby for adoption 1 Blocked lacrimal duct—difficult infant 1 Breasts inactive 3 70 Cracked, flat, depressed, inverted or sore nipples 28 Domestic reasons 2 History of artificial pneumothorax 1 History of breast abscess 3 History of mastitis 3 History of tuberculosis 7 Inability to feed owing to operation on breasts 1 Infant's general condition 1 Infant's feeding difficulties 2 Infant's digestive disorder 1 Lactation failed, poor or insufficient 68 Maternal death 3 Meningocele 1 Mitral stenosis of mother 2 Mother's general condition 8 Mother's condition—cardiac complication 2 Mother's condition—post-partum eclampsia 2 Mother's condition—post-operative condition 1 Mother's condition—toxaemia 1 Mother's request 9 No co-operation from mother 2 Poor maternal condition following Caesarian section 1 Pyrexia following Caesarian section 1 Prematurity 4 Thickening of breast 2 Spina bifida 2 58 infants (including four sets of twins) born to patients in the Ward Blocks were retained in the Home for varying periods, an average of 15.6 days each, following discharge of their mothers, either due to prematurity or feeding difficulties. 28 of these infants weighed lbs. or less at birth. There were 18 deaths of infants under one year of age born in the Ward Blocks as follows:- Atelectasis, aged 12 hours. Atelectasis, aged 34 hours. Atelectasis, cerebral haemorrhage, Mongolism, aged 20 days. Atelectasis due to cerebral haemorrhage due to tentorial tear, associated with prematurity, aged 5 hours. Atelectasis, extreme prematurity, maternal intra-partum haemorrhage, aged 11 hours. *Bronchitis, Mongolism, aged 5 months. * Broncho-pneumonia, aged 3 months. *Broncho-pneumonia, aged 7 months. Broncho-pneumonia due to atelectasis associated with prematurity, aged 4 days. * Broncho-pneumonia, osteogenesis imperfecta, aged 1 month. Congenital defects, myelocele, spina bifida, hydrocephalus, aged 3 weeks. Erythroblastosis foetalis, aged 16 hours. Extreme prematurity (30 weeks) aged 11 hours. Inanition, spina bifida, hydrocephalus, aged 25 days. (Died in Isolation Hospital.) Prematurity, aged 20 hours. Pulmonary oedema, Hedges foetalis, erythroblastosis foetalis, aged 2 days. (Died in Great Ormond Street Hospital.) * Retro-peritoneal sarcoma, aged 5 months. Rupture of meningocele, imperfect development, aged 8 days. (Died in Isolation Hospital.) *Died after discharge from 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. 71 The neo-natal death-rate of babies born in the Ward Blocks for the five years 1943—1947 was 1.78 per cent. compared with 1.75 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 1943—1947 was 1.61 per cent. The infant mortality rate of children born in the Ward Blocks of the Maternity Home for the five years 1943—1947 was 24.1 per 1,000 live births as compared with 30.5 born in their own homes. The figure of 30.5 has been arrived at after deduction of all deaths of infants born in the Maternity Home, and is calculated on the total live births belonging to the district, excluding those in the Maternity Home. The causes of the 23 stillbirths in the Ward Blocks were as follows:Ante-partum haemorrhage 4 Breech presentation 2 Cord tightly round neck 1 Difficult breech delivery 1 Exomphalus and bilateral talipes 1 Instrumental delivery 1 Malformations 1 No apparent cause. Foetal movements not felt for some days prior to admission 2 Probably due to maternal toxaemia 1 Prolapsed cord due to shoulder presentation 1 Toxaemia 3 Unknown 5 The mothers of 11 of these infants were admitted as emergency cases. Twenty patients were notified as suffering from Puerperal Pyrexia, twelve being removed to the Isolation Hospital. The causes of the Pyrexia were due to B. Coli pyelitis (2), B. Coli pyelitis and unhealed perineal laceration (1), collapsed lung ; post-operative (1), engorgement of breasts (2), faecal incontinence ; third degree perineal tear following forceps delivery (1), infected perineal laceration (1), mastitis (1), pyelitis, thrombo-phlebitis and pulmonary embolism (1), retained membranes and shock following manual removal of placenta (1), retained products and sapraemia (1), sapraemia (2), subinvolution and sapraemia (1), thrombo-phlebitis of femoral vein and pulmonary embolism (1), transient pyrexia associated with coryza and augmented by worry over illness of infant (1), transient pyrexia due to congestion of breasts (1), transient pyrexia of unknown origin (2). In addition, four infants, all 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. Thirty-seven other patients were removed to the Isolation Hospital for the following reasons, including three patients from Wilnett Lodge : acute rhinitis icterus of infant (1), Bartholin's abscess (1), coryza and conjunctivitis of infant (1), coryza and infected umbilicus of infant (1), encephalocele and meningocele of infant (1), folliculitis (1), haemolytic streptococcal carrier (8), haemolytic streptococcal carrier, sinusitis and rhinitis (1), herpes zoster (1), inanition, spina bifida and hydrocephalus of infant (1), lactational mastitis (2), mastitis and phlebitis of leg (1), pemphigoid skin lesion of infant (1), perineal sepsis (1), puerperal erythema (1), pyelitis (1), pyelitis of pregnancy (1), secondary post partum haemorrhage (1), septic dermatitis and coryza (1), staphylococcal abscess of neck of infant (2), staphylococcal conjunctivitis of infant (1), staphylococcal dermatitis of infant (5), subinvolution and endometritis (1), transient pyrexia probably reactionary following delivery (1). Special visits were made by the Consulting Obstetrician, his Deputy or other Consultants to 49 cases in the Ward Blocks as follows :— To perform Caesarean Section operations 20 To perform other operations 4 For consultations 25 The reasons for the 20 Caesarean Section operations were as follows :— Abnormal outlet 1 Breech presentation 2 72 Breech presentation and haemophilia 1 Central placenta praevia 2 Contracted pelvis 3 Extended breech 2 Head high 2 Head in mid-pelvis, and foetal distress 1 History of Colporrhaphy 1 Oblique lie 2 Pelvic deformity 1 Post maturity and head not engaged 1 Transverse lie (elderly primipara) 1 The other operations were as follows:- Perineal repair 1 Manual removal of placenta 1 Forceps delivery 1 Re-suturing abdominal wound 1 The reasons consultations were necessary were as follows:- Ante-partum haemorrhage 3 Breech presentation 3 Collapse of lung (seen by Physician) 1 Collapsed condition of mother 1 Condition of baby's eyes (seen by Ophthalmic Surgeon) 2 Congenital heart (seen by Paediatrician) 1 Examination of heart prior to blood transfusion (seen by Physician) 1 General condition of infant (seen by Paediatrician) 1 Infantile enteritis (seen by Paediatrician) 1 Hepatic derangement 1 ? Mongol condition of infant (seen by Paediatrician) 1 Post-operative condition 1 Post partum eclampsia 1 Post partum haemorrhage and obstetric shock 1 Premature infant, chest complication (seen by Paediatrician) 1 Pulmonary congestion 1 Pyloric stenosis (seen by Paediatrician) 1 Spina bifida (seen by Paediatrician) 3 There were three deaths of mothers admitted to the Ward Blocks :— (1) Died 21 hours after delivery due to cardiac failure due to toxaemia of pregnancy following Caesarean Section. (2) Died six days after delivery due to pulmonary embolus due to phlebothrombosis of the right femoral vein following upon operation for lower segment Caesarean Section for central placenta praevia. (3) Died 5£ hours after delivery duo to post partum haemorrhage due to retained placenta (marginal placenta praevia). 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 the ten years 1938—1947 is 1.57 per 1,000 births, as compared with the maternal mortality rate in the district generally of 2.16, the rate in each case being calculated on the total live births. Training of Pupil Midwives.—As mentioned in the Report for 1944, the Home is approved by the Central Midwives Board as a Part I Training School for not less than ten pupil midwives in training at one time. 41 pupil midwives commenced their training during 1947. 19 of these and 19 of the 38 who commenced in 1946 passed Part I examination in 1947. Gas and Air Analgesia.—Three 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. Analgesia was administered to 560 patients during the year. 73 The Maternity Home is approved by the Central Midvvives 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. 19 of the staff including 18 pupil midvvives qualified for the certificate during 1947. With the approval of the Central Midvvives Board arrangements were completed in the latter part of the year for the District Midvvives who had not obtained the certificate to receive instruction in the administration of gas and air analgesia, so that when qualified, patients having their confinement at home could have the advantage of the service. In this connection four portable Minnitt Gas-Air machines have been purchased, which are kept at the Ambulance Depot in Clarks Road, llford, and will be transported to the homes of the patients by ambulance on request of the midwife engaged for the confinement. Other Maternity Hospitals.—Arrangements were made for the admission of maternity cases to the following hospitals during 1947, for which the Council were responsible for the cost of maintenance :— No. of Fees payable Cases. per day. s. d. (a) Oldchurch County Hospital, Romford 3 15 8 Although the Essex County Council ceased to book any maternity cases from llford at the end of June, 1944, the cases mentioned were admitted there as an emergency measure. {b) East End Maternity Hospital, Commercial Road, E.l ..." 70 16 0 (c) Essex County Hospital, Wanstead 17 15 4 (d) Pembury Hospital, nr. Tunbridge Wells ... 1 16 6 (e) Queen Mary's Hospital, Stratford ... 3 10 0 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, again raised the charge for maintenance from 15/- per day to 17 - per day for cases leaving London after 1st April 1947. 771 patients provisionally registered for- evacuation to these Homes for their confinement expected during the year, but only 242 went away. Of the other 529 patients, 46 subsequently engaged the Council's District Midwives for confinement at home, 14 had a miscarriage, 10 booked for admission to private Nursing Homes, 221 were admitted to other Homes or Hospitals and 238 cancelled the arrangements. 367 of these patients attended the Council's Ante-Natal Clinic making a total of 1,960 attendances during the year. These figures are included in the table of attendances at the Ante-Natal Clinics. 1 he arrangement for the admission of patients to various London Hospitals through the Voluntary Hospital's Emergency Bed Service as mentioned in my Report for 1946 continued during the year and the following table shows the number of cases admitted:- City of London Maternity Hospital 4 East End Maternity Hospital 1 Elizabeth Garrett Anderson Hospital 1 General Lying-in Hospital, York Road, S.E. 1 German Hospital, Dalston 5 Plaistow Maternity Hospital 1 Princess Beatrice Hospital, Earls Court 1 Queen Mary's Hospital, Stratford 4 Queen Mary's Maternity Home, Hampstead 4 Salvation Army Mother's Hospital, Clapton 12 Westminster Hospital 1 Total 35 SCHOOL MEDICAL SERVICE 75 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 slight increase on last year, 49 children being found to be infected with living hair vermin as against 46 in 1946, 65 in 1945, 36 in 1944, and 25 in 1943. (ii) Scabies.—This shows a decrease, 43 cases (5 being seen at the Minor Ailment Clinics) as compared with 76 in 1946, 104 in 1945, 128 in 1944, 217 in 1943. In addition to the 43, 2 cases were treated privately. There was no particular incidence in any one School. School Premises.—There are 32 schools, with 60 departments, 19,002 children were actually on the rolls on 19th December 1947, as compared with 18,070 in December 1946. The figure 19,002 includes Barking Abbey (226) and Ursuline County Placed pupils (196). The number of children in average attendance at school for the year ended 19th December 1947 = 16,205. 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. 451 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 1947, 4,028 parents, or 82 per cent., attended the full routine medical inspections. Infectious Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1943:- Scarlet Fever. Diphtheria. Measles and Gerlan Measles Chicken Pox. Mumps. Whooping Cough. 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 1847 120 7 *1,056 122 27 332 *Of this number 1,042 were notified as measles. Disinfection of all the cloakrooms at the maintained primary and secondary 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 llford schools during 1947. 137 home visits were paid by the Health Visitors to cases of minor infectious disease. In addition the Sanitary Inspectors paid 1,042 visits to measles cases, and 332 visits to whooping cough cases. 76 Diphtheria Prevention Clinics.—The following shows the work carried out at Valentines Mansion (102 sessions) and Mayesbrook (52 sessions) Clinics for children of school age during 1947:- Valentines Mayesbrook Primary Schick tested 59 31 Positive 44 3 Negative 15 28 Inoculated (full course) 128 96 Schick+ 1946 1 - Schick+ 1947 57 10 Not tested 70 86 Negative after full course of inoculation 57 42 Positive after full course of inoculation and re-inoculated - - Awaiting re-test - 9 Not re-tested after inoculation on account of leaving district, etc. - 3 Re-inoculations (one only) 622 336 Result of final Schick test in 1947 of cases inoculated in 1946. Valentines Mayesbrook Positive and re-inoculated 5 2 Negative 3 2 1,151 individual children were treated (742 at Valentines Mansions and 409 at Mayesbrook) making 3,630 attendances (2,100 and 1,530 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, 12,767 children of school age, ahd 23,640 children under school age have been immunised. During 1946 a scheme for systematic re-inoculation 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 No. of No. of cases at cases Remedied cases under beginning reported Total. during observation of 1947. during 1947. at end of 1947. 1947. Ringworm:- Scalp - 4 4 4 Body -6 6 6 10 10 10 The 4 cases of ringworm of the scalp received X-Ray treatment at the Queen Elizabeth Hospital for Children (Glamis Road Branch), London, E.l, under the existing arrangements. Following Up.—During 1947, 2,067 home visits by the School Nurses were paid for the purpose, and 2,440 re-examinations of children (some on several occasions) were carried out by the doctors at school ; 55 visits to schools were made for this purpose alone, and other children were seen at the visits for routine medical inspection. Medical Treatment. (a) Minor Ailments Clinics.—The attendances during 1947 were as follows :— Newbury Hall Mayesbrook Number of individual children seen 1,486 1,482 Number of attendances of children 3,097 2,873 Number of exclusion certificates granted 375 491 Number of certificates of fitness to attend school granted 348 347 77 The following table shows the conditions dealt with at both the Clinics during the year :— Subnormal Nutrition 1,308 Debility 20 Uncleanliness:— Head 332 Body 1 Skin:— Ringworm:— Head 4 Body 6 Scabies 43 Impetigo 131 Other Skin Diseases (Non-Tuberculous) 175 Eye:— Blepharitis 27 Conjunctivitis 47 Keratitis 1 Defective Vision (excluding Squint) 118 Squint 31 Other conditions 65 Ear:— Defective Hearing 26 Otitis Media 27 Other Ear Diseases 79 Nose and Throat:— Chronic Tonsillitis only 99 Adenoids only 5 Chronic Tonsillitis and Adenoids 67 Nasal Catarrh 60 Sore Throat 17 Nasal Obstruction 23 Other conditions 17 Enlarged Cervical (Hands (Non-Tuberculous) 26 Defective Speech 25 Teeth—Dental Diseases 445 Heart and Circulation:— Functional 6 Organic 2 Anaemia 103 Infectious Diseases:— German Measles 2 Measles 3 Whooping Cough 7 Chicken Pox 9 Mumps 2 Colds and Coughs 216 Influenza 7 Lungs :— Asthma 26 Bronchitis 69 Other Non-Tubercular Diseases 9 Tuberculosis:— Pulmonary—Definite — —Suspected (Referred to T.B. Officer) 9 Nervous System:— Nervous Debility 22 Habit Spasm 2 Chorea 3 Other Conditions 44 Deformities:— Genu Valgum 10 Posture 17 Pigeon Chest 2 Flat Feet 13 Pes Valgus 2 Intoeing 3 Valgus Ankles 13 Other forms 17 Minor Injuries 110 Rheumatism 25 Other Defects and Diseases 273 Total number of ailments 4,251 SPECIAL CLINICS. Ophthalmic Clinic. During the year 1947, the School Oculist held 182 sessions for the refraction of children suffering from defective vision (98 at Valentines and 84 at Mayesbrook). Full details of the work are given in Table III, Group II, on page 93. 2,792 attendances (1,631 at Valentines Clinic, 1,161 at Mayesbrook Clinic) were made by 1,309 schoolchildren (792 at Valentines Clinic, 517 at Mayesbrook Clinic), as compared with 1,416 schoolchildren in 1946. The 1,309 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 6/34 6/36 6/60 less than 6/60 361 234 157 185 119 162 75 16 I he children who saw 6/6 (practically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. The 1,309 children were found to be suffering from the following defects:— Diagnosis New Cases Old Cases A B A B Myopia 51 35 120 64 Myopic Astigmatism 5 6 36 15 Hypermetropia 47 25 162 72 Hypermetropic Astigmatism 22 23 66 48 Anisometropia 1 - 8 7 Hypermetropia with Squint 7 - 35 6 Squint 32 22 105 122 Blepharitis 6 3 10 8 Chalazion — 1 2 2 Congenital Cataract — — - 2 Congenital Coloboma — — 1 2 Corneal nebulae — — 2 1 Conjunctivitis 1 — 1 3 Nystagmus - — 1 3 Other conditions 11 10 9 7 N.A.D. 18 10 33 20 Totals 201 135 591 382 A—Valentines. B—Mayesbrook. 78 79 Under the Education Committee's scheme 666 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 187 cases the lenses of spectacles were replaced or repairs of frames were carried out. Orthoptic Clinic.—Arrangements have been made with the Walthamstow Education Committee, through the Essex County Council, for Ilford cases to be seen on two afternoons each week by Mrs. K. S. Box, Orthoptist at the Orthoptic Clinic held in Walthamstow Town Hall. The first session was held on Monday 17th November. 11 sessions were held by the end of the year. 86 children made their first attendance, of whom 31 were recommended for treatment, 22 are to be kept under observation, and 33 were found to be unsuitable for treatment. Orthopaedic Clinic. (i) Newbury Hall Clinic.—46 sessions were held during 1947, 191 children of school age were examined for the first time during the year and 558 children were seen, who had previously attended the clinic. These 749 children made 1,611 attendances. (ii) Mayesbrook Clinic.—30 sessions were held during 1947, 129 children of school age were examined for the first time during the year and 249 children were seen, who had previously attended the clinic. These 378 children made 827 attendances. The 1,127 children were found to be suffering from the following defects:— Diagnosis. New Cases. Old Cases. A B A B Paralyses:— A.P.M. 2 1 8 8 Hemiplegia 2 — 4 3 Paraplegia — — 1 — Monoplegia — — 1 — Spastic foot — — 1 — Scoliosis 4 — 13 2 Kyphosis 3 — 8 2 Slack posture 16 13 24 11 Deformity of hips — 1 4 1 Depressed sternum — 1 3 1 Genu valgum 47 30 188 78 O.C.T. 5 4 21 5 Genu varum. 1 - 7 5 Pes valgo, planus 54 27 85 41 Valgus ankles 38 38 112 61 Talipes calcaneo valgus — — 2 3 Congenital talipes E.V. 2 — 6 4 Pes calcaneo valgus — — — — Intoeing — — 7 2 Pes cavus 1 2 4 1 Hallus valgus 5 3 8 2 Deformity of toes 3 5 27 13 Rickets — — 2 — Torticollis — — 5 — N.A.D. 4 2 — — Other conditions 4 2 17 6 Totals 191 129 558 249 A—Newbury Hall. B—Mayesbrook. 2 children of school age were admitted to the country branch of the Royal National Orthopaedic Hospital, at Stanmore, in 1947, suffering from :—(1) Angioma right tibia (1 case), and (2) Exostosis right radius (1 case). 80 These 2 children were discharged during the year. During the year 46 pairs of valgus insoles, 10 pairs of surgical boots or shoes, 3 walking calipers with special boots, and 14 pairs Genu Valgum splints were supplied to school children. 659 cases were discharged from the Orthopaedic Clinic, 12 as cured, 169 discontinued attendance and were kept under observation at school, 416 were showing improvement and were kept under observation at school, and 62 cases left school or left the district. A Masseuse attends the Newbury Hall Clinic for orthopaedic treatment on Thursday morning and Friday afternoon, and the Mayesbrook Clinic on Monday and Thursday afternoons. A total number of 176 sessions were held by the Masseuse for treatment during 1947 (97 at Newbury Hall Clinic and 79 at Mayesbrook Clinic). At Newbury Hall Clinic 148 individual children of school age were treated by the Masseuse during the year and 2,162 attendances were made by these children. Treatment was also given to 75 children, who made 876 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. 47 sessions were held at Newbury Hall Clinic and 49 at Mayesbrook Clinic. At the Newbury Hall Clinic 34 children of school age were treated, making 736 attendances for treatment. At the Mayesbrook Clinic 40 children of school age were treated, making 830 attendances for treatment. The lamp used at each Clinic is a Centrosol Unit. The conditions treated were as follows:— Defects Treated. Cases. A B Anaemia, Debility and Malnutrition 15 14 Pulmonary Fibrosis - 1 Bronchitis 4 12 Bowlegs — 1 Alopecia 3 1 Adenitis — 1 Asthma 1 4 Knock Knees 2 1 Old Rickets — 1 Chilblains 3 - Other Conditions 6 4 34 40 A—Newbury Hall Clinic. B—Mayesbrook Clinic. Of the 40 cases treated at the Mayesbrook Clinic, 12 were Open Air school children. At Newbury Hall Clinic, 15 children of school age were discharged from the Artificial Sunlight Clinic, 4 were cured, 7 were showing considerable improvement, and 4 were discharged due to absence. 81 19 children were still receiving treatment at the end of the year. At Mayesbrook Clinic, 11 children of school age were discharged from the Artificial Sunlight Clinic, 4 were showing considerable improvement, 3 had removed from the area, and 4 were discharged due to absence. 29 children were still receiving treatment at the end of the year. Aural Clinic. The Aural Clinic is held at Valentines Mansion, the Surgeon attending two sessions weekly. 90 sessions were held during 1947 and 1,172 attendances were made by 687 children of school age, of whom 528 were new cases. The following table shows the work of the Clinic:— 82 AURAL CLINIC Nature of Disease. Still under treatment. Recommended Hospital treatment. Discharged as cured. Discharged as improved. 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 New Old (i) Acute Suppurative Otitis Media - - - - - 1 - - - - - - - - 1 - 8 1 (ii) Acute Catarrhal Otitis Media 13 - - - - 1 - - - - - - - - - - 3 1 (iii) Chronic Suppurative Otitis Media due to:— 1. Tympanic Sepsis 8 3 1 2 - 1 — — — - 1 1 - 1 1 — 11 8 2. „ and Granulations - - 3 - - - - - - - - - - - - 2 3 2 3. Other Causes 4 — — — - — - — — - — — — — — — 4 — (iv) Mastoid Disease (previous operation) — 1 - - - 1 - - - - - - - - - 1 — 3 (v) Partial Deafness due to:— 1. Nerve Deafness - 2 - - - 1 - - - - - - - - - - - 3 2 Tonsils and Adenoids 1 2 14 1 1 - - - 1 - - - - - 1 1 18 4 3. Retraction of Membrana Tympani - 1 — 1 — 1 — - — - — — — 1 — 1 3 4. Scarring of Membrana Tympani 1 - - - - - - - - - - - - - - 1 1 1 5. Other causes 6 6 — 1 1 3 - - - - - - - - - 4 7 14 (vi) Opinion on Tonsils 5 1 300 27 22 23 1 1 2 - 9 - - 1 21 6 360 59 (vii) Rhinitis 14 3 — 2 — 4 — - — — - — — — 5 3 19 12 (viii) Other diseases or defects 50 17 16 5 9 11 - 1 - - - 1 1 1 8 14 93 48 Totals 108 36 334 37 33 47 1 2 3 — 10 2 1 3 38 32 528 159 83 Rheumatism Clinic. The Physician attended 33 morning sessions during the year, and 290 children (153 of these being new cases) made 506 attendances. The 290 children were found to be suffering from the following conditions:— Defects Found. New Cases. Old Cases. Totals. History of Rhuematism (observation) 11 7 18 „ Chorea 1 7 8 Rheumatic Carditis 6 9 15 Other forms of Carditis — 5 5 Tachycardia of Nervous origin 2 2 4 Congenital Heart Disease 12 40 52 Rheumatism 2 3 5 Chorea 2 2 4 Habit Spasm — 5 5 Anaemia, Subnormal-nutrition and Debility — 1 1 No active Rheumatic disease 12 11 23 Heart Murmur functional 37 15 52 Acidosis, metabolic disturbance of Alimentary origin 10 13 23 Pains due to Orthopaedic condition 21 11 32 Allergic Type 6 — 6 Fibrositis 1 2 3 Arrhythmia 2 — 2 Exocardial Bruit 3 — 3 Other Conditions 25 4 29 Totals 153 137 290 Number of cases referred to Convalescent Home 1 „ ,, ,, Heart Home 2 „ „ „ General Hospital (In-patients) 1 „ „ „ Isolation Hospital 1 „ ,, ,, Ear, Nose and Throat Surgeon 10 ,, ,, ,, Orthopaedic Surgeon 17 ,, ,, ,, for X-ray and Electro-Cardiogram 63 ,, „ „ Blood Sedimentation Rate 43 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 attends the Clinic at the Valentines School daily. By the end of the year, 138 individual children of school age had received speech therapy at this Clinic, making a total of 1,429 attendances. The defects treated were as follows:— Dysphonia 1 Stammering 36 Dyslalia 55 Cleft Palate 3 Post Operative (Tonsillectomy) 39 Neurological 2 Lip Reading 2 90 children of school age were discharged from the Clinic during the year. In 39 cases the speech was normal, and in 14 cases the speech was much improved. Of the remaining 37 cases, 31 ceased to attend for treatment, 4 left school or left the district and in 2 cases the treatment proved ineffective. 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. 84 School Dentists.—Of 11,653 inspections by the Dentists (including special cases) 7,440 (or 64 per cent.) were found to require treatment, compared with 5,079 (or 69 per cent.) in 1946, 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. In addition to the ordinary dental work of fillings and extractions, 208 regulation plates, 18 crowns, and 2 dentures wore supplied. 2,518 visits were made by children to the Dental Clinic for regulation purposes. The amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the school Dentists:— Age groups (in years) No. of inspections No. referred of children for treatment Percentage 5 1,045 659 63.0 6 1,186 856 72.1 7 1,082 740 68.3 8 1,618 1,052 65.0 9 1,472 990 67.2 10 1,442 933 64.7 11 865 550 63.5 12 999 515 51.5 13 937 557 59.4 14 643 397 61.7 15 253 153 60.5 16 66 20 30.3 17 38 18 47.3 18 6 — — 19 1 — — Full details of the dental work are shown in Table IV. Open-air School.—During 1947 32 children were admitted, 33 ceased attendance, and on the 31st December 1947, 83 children were on the school roll, 2 vacancies remaining unfilled. Those admitted were recommended for examination from the following sources:— School Medical Officer 14 Rheumatism specialist 6 Others 12 The above 32 children were admitted for the following reasons:— School Medical Officer:— Subnormal Nutrition 1 Malnutrition and Debility 1 Chronic Bronchitis, Undernutrition, and Nasal Obstruction 1 Asthma 4 Bronchial Asthma 1 Bronchitis, Asthma and Eczema 1 Cardiac Debility 1 Spastic Diplegia 1 Congenital Morbic Cordis 1 Contracted Tendo-Achilles 1 Chronic Catarrh 1 Head Teachers:— Cardiac Debility and Poor Nutrition 1 Asthma and Bronchial Catarrh 1 Undernutrition 1 Bronchitis and Asthma 1 Undernutrition, Slack Posture and Debility 1 Delicate, Migraine and Malnutrition 1 85 Others:— Asthma 2 T.B. Right Hip 1 T.B. Spine 1 Spastic Diplegia 1 Old T.B. Lungs 1 Recent Primary T.B. Infection 1 Debility 3 Post Pneumonia 1 Epilepsy 1 The 33 children not now on the school roll ceased attendance for the following reasons:— Transferred to Commercial School 1 Resumed attendance at ordinary school 21 Left the district 5 Left school—over age 11 Parents Request 1 Admission to convalescent home 1 Temperamentally unsuitable for Open Air School 2 Unfit for school 1 The Dental Surgeon has carried out one complete inspection of the children's teeth at the Open Air School. The following table shows briefly the dental work carried out:— Number of children examined by the School Dentist 95 Number of children referred for treatment 54 Number of children treated by Dental Surgeon 50 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 36 Administration of Cod-liver Oil Emulsion 27 Administration of Malt and Oil, Parrish's Food, etc. 10 Referred to Ophthalmic Surgeon 4 ,, Orthopaedic Surgeon re Remedial Exercises, etc. 2 „ Dental Surgeon 13 ,, Aural Surgeon 6 ,, Rheumatism Clinic Specialist 7 ,, Artificial Sunlight Clinic 1 T.B. Officer 1 Recommended Asthma exercises 2 Recommended Convalescent Home treatment 5 A course of Asthma Injections has been given to 25 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. One child received Artificial Sunlight treatment during the year. Treatment for Uncleanliness.—The School Nurses paid 180 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. cent. 43,792 *780 1.7 *40 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. 86 The percentages for the past 5 years were as follows:— 1943 2.5 1944 2.4 1945 3.3 1946 2.6 1947 1.7 Other Ailments.—During 1947, 137 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, 109 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 1947 was 2,120,526 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. 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 1947, 16,797 children were receiving milk in school. Work done by the N.S.P.C.C.—The following 40 cases were investigated :— (1) Neglect 29 (2) Ill-treatment cases 4 (3) Other cases 7 (1 case was reported from the Public Health Department for neglecting medical advice ; 28 were reported from other sources for general neglect). 100 children (58 boys and 42 girls) were involved, 61 being of school age. In addition to this work, 245 supervision visits were paid to different cases, some of which were made to those reported during the previous year. The Invalid Children's Aid Association.—40 children were sent to residential schools and paid for by the Education Committee in 1947. In addition 58 children were sent to Convalescent Homes and in 2 cases fees were paid for through voluntary funds. 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, DoyneBell, 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. 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. 87 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 suitablity or otherwise of attendance at an ordinary school. The several categories of pupils requiring special educational treatment are defined as follows:— (a) 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 defective 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 connecton with (g) 124 children were medically examined during 1947 and found to fall within this category. 12 children were found to have sufficiently improved to permit of their transfer from the special class at Newbury Park to ordinary schools. 10 were admitted and 75 were awaiting admission to the special class. At the end of the year 40 children were on the roll. (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. (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 1947, are tabulated hereunder:— 88 Return of Handicapped Pupils in the Area on 31st December 1947 (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 2 3 — — — — 2 4 C. Deaf Pupils 4 8 — - - - 1 — 5 8 D. Partially Deaf Pupils 3 2 - - - - - - 3 2 E. Delicate Pupils 40 34 23 15 — — — - 63 49 F. Diabetic Pupils - - - - - - - - - - G. Educationally Subnormal Pupils 62 26 93 43 - 1 9 3 164 73 H. Epileptic Pupils 1 - 1 1 — - 2 2 4 3 I. Maladjusted Pupils 2 1 6 9 — - — — 8 10 J. Physically Handicapped Pupils 10 9 1 2 — — 2 — 13 11 K. Pupils Suffering from Speech Defect — - 43 17 — — — — 43 17 L. Pupils Suffering from Multiple Disabilities 3 5 1 1 - — 4 2 8 8 Physically Handicapped Children.—During 1947, 40 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 Partially Sighted.—Special School for the Partially Sighted 4 Delicate or Physically Handicapped.—Open Air School 35 40 Children Examined for Disability of Mind.—During 1947 the following numbers of children were medically examined and reported upon under the Education Act, 1944:— Initial Re- Examination examination (a) Maladjusted 9 — (b) Educationally Subnormal 75 101 (c) Unfit for Education within the school system 6 — Total number examined 90 101 Children coming within heading (b) are re-examined once a year and, where necessary, are visited at home by the School Nurses at least once a quarter. Children coming within heading (c) are reported to the Local Authority for the purposes of the Mental Deficiency Acts 1913-28, in accordance with Section 57 of the Education Act, 1944. No further examination is made by this Authority. 89 Summary of Children Unfit for Education within the School System at the end of 1947:— At Residential Institution 8(2) At Special Day School 19(5) At Ordinary School 1 At Private School 1(1) At no School or Institution 31(6) Total 60(14) Figures in brackets indicate number over 14 years of age. Employment of School Children and Young Persons.—From special inquiries made at the various schools during 1947 it was found that 124 children were employed out of school hours. 45 children were submitted for medical examination in accordance with the Byelaws made under Part II of the Children and Young Persons Act, 1933, with the following result:— Medically fit 45 Employment of Children in Entertainments Provisional Amending Rules, 1945.—4 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 16 Staff Sickness Regulations 2 21 Camp Schools. 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. It has been necessary, as in former years, to draw attention to the inadequacy of the isolation facilities at the Camp schools. It was possible in 1947 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 = 51}51 Dick Re-tests = - Diphtheria Inoculations = 40 Schick tests = 17 57 90 Table Showing the Principal Causes of Death among Children of School Age (i.e. from 5—15 years) in Ilford for 1945 and 1946. The Table also gives a Comparative Percentage of Deaths Registered at all Ages, and from 5—15 Years. Disease. Percentage of total deaths (all ages). Percentage of total deaths at ages 5—15 1945 1946 1945 1946 1. Measles 0.2 - 3.6 - 2. Scarlet Fever - — — — 3. Whooping Cough - 0.1 — — 4. Diphtheria 0.2 0.1 7.1 — 5. Influenza 0.4 1.2 — — 6. Tuberculosis 4.9 4.0 7.1 — 7. Rheumatic Fever 0.06 — — — 8. Bronchitis, Pneumonia and other respiratory diseases 10.4 11.4 3.6 16.7 9. *Meningitis and Nervous system 14.6 15.0 17.8 16.7 10. Heart Diseases 25.7 24.2 — — 11. Acute and Chronic Nephritis 1.5 2.1 — — 12. Violence 9.4 3.4 5.36 8.3 13. Other causes 32.64 38.5 7.2 58.3 100.0 100.0 100.0 100.0 *Excludes Meningococcal infections. Deaths of School Children. Ilford.—The deaths of children of School Age during 1946 represent 0.7 per cent, of the Total Deaths registered (all ages), and during 1945 represent 1.6 per cent. Ministry of Education. MEDICAL INSPECTION RETURNS. Year Ended 31st December 1947. TABLE I. Medical Inspection of pupils attending maintained Primary and Secondary Schools. a.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,256 Second Age Group 1,721 Third Age Group 895 Total 4,872 Number of other Periodic Inspections - Grand Total 4,872 B.—Other Inspections. Number of Special Inspections 3,361 Number of Re-Inspections 6,735 Total 10,096 C.—Pupils Found to Require Treatment. Number of Individual Pupils found at Periodic Medical Inspection to Require Treatment. (Excluding Dental Diseases and Infestation with Vermin.) (No individual pupil is recorded more than once in any column of this 91 Table, and therefore the total on column (4) will not necessarily be the same as the sum of columns (2) and (3).) Group. For defective vision (excluding squint). For any of the other conditions recorded in Table IIa. Total individual pupils. (1) (2) (3) (4) Entrants 42 549 516 Second Age Group 88 301 343 Third Age Group 119 421 467 Total (Prescribed Groups) 249 1,271 1,326 Other Periodic Inspections - — — Grand Total 249 1,271 1,326 TABLE II. A.—Return ok Defects found by Medical Inspection. (All defects noted as requiring treatment are included in this return.) Defect Code No. Defect or Disease Periodic Inspections. Special Inspections Number of Defects. Number of Defects. Requiring Treatment Requiring to be kept under observation, but not requiring treatment. Requiring Treatment Requiring to be kept under observation, but not requiring treatment. (1) (2) (3) (4) (5) 4. Skin 83 14 - - 5. Eyes- a. Vision 271 167 2 — b. Squint 38 8 — — c. Other 7 10 1 — 6. Ears— a. Hearing 18 4 — — b. Otitis Media 6 1 1 - c. Other 17 22 1 - 7. Nose or Throat 204 345 2 — 8. Speech 21 34 1 — 9. Cervical Glands 8 74 — — 10. Heart and Circulation 53 157 - - 11. Lungs 38 101 1 — 12. Developmental— a. Hernia 12 20 — — b. Other 14 15 1 — 13. Orthopaedic— a. Posture 278 45 — — b. Flat foot 203 34 — — 14. c. Other 319 127 — — Nervous System— a. Epilepsy 3 2 — — b. Other 10 42 — — 15. Psychological— a. Development 6 10 — — b. Stability .- 13 — — 16. Other 86 36 5 - 92 B.—Classification of the General Condition of Pupils Inspected in the Age Groups. Age Groups Number of Pupils Inspected A.—(Good). B.—(Fair). C.—(Poor). No. % of Col. 2. No. % of Col. 2. No. % of Col. 2. (1) (2) (3) (4) (5) (6) (7) (8) Entrants 2,256 869 38.5 1,342 59.4 45 2.1 Second Age Groups 1,721 556 32.4 1,097 63.7 68 3.9 Third Age Groups 895 337 37.6 533 59.6 25 2.8 Other Periodic Inspections - Total 4,872 1,762 36.2 2,972 61.0 138 2.8 TREATMENT TABLES. TABLE III. Notes.—These Tables deal with all defects during the year, however they were brought to the Authority's notice, i.e. whether by periodic inspection, special inspection, or otherwise, during the year in question or previously. Group I.—Minor Ailments (Excluding Uncleanliness, for which see Table v). (a) Skin. Number of defects treated, or under treatment during the year Ringworm—Scalp:— (i) X-Ray treatment 4 (ii) Other treatment — Ringworm—Body 6 Scabies 44 Impetigo 131 Other skin diseases 222 Eye Disease (External and other, but excluding errors of refractions, squint and cases admitted to Hospital.) 140 Ear Defects (Treatment for serious diseases of the ear, (e.g. operative treatment in Hospital) are not recorded here, but in the body of this Report.) 109 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 436 Total 1,092 (b) Total number of attendances at the Authority's Minor Ailments Clinics 5,970 93 Group 11.—Defective Vision and Squint. (Excluding Eye Disease treated as Minor Ailments—Group 1.) Number of defects dealt with Errors of Refraction (including Squint) 1,142 Other defects or disease of the eyes 167 Total 1,309 Number of Pupils for whom spectacles were:— (a) Prescribed 666 (b) Obtained 665 Group 111.—Treatment of Defects of Nose and Throat. Received Operative Treatment:— Total number treated (a) For Adenoids and Chronic Tonsillitis 312 (b) For other nose and throat conditions 29 Received other forms of treatment 161 Total 502 Group IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in Hospitals or Hospital Schools 2 (b) Number treated otherwise, e.g. in Clinics or out-patients department 1,127 Group V.—Child Guidance Treatment and Speech Therapy. Number of pupils treated:— (a) Under Child Guidance arrangements 12 (b) Under Speech Therapy arrangement 138 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils inspected by the Dental Officers:— (a) Routine Age Groups:— Age 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Total. Inspected at Schools 808 946 841 1,432 1,317 1,279 750 903 854 574 200 66 38 6 1 10,015 Specials 237 240 241 186 155 163 115 96 83 69 53 - - — - 1,638 (b) Specials 1,638 (c) Total (Routine and Specials) 11,653 (2) Number found to require treatment 7,440 (3) Number actually treated 5,744 (4) Attendances made by children for treatment 11,581 (5) Half-days devoted to Inspection 74 Total 1,213 Treatment 1,139 (8) Fillings Permanent Teeth 4,040 Total 7,766 Permanent Teeth 3,726 (7) Extractions Permanent Teeth 1,726 Total 9,362 Permanent Teeth 7,636 (8) Administrations of general anaesthetics for extractions 2,973 (9) Other operations Permanent Teeth 4,8401 Total 6,302 Temporary Teeth 1,462 94 TABLE V. Infestation with Vermin. (i) Total number of examinations in the Schools by the School Nurses 43,792 (ii) Total number of individual pupils found to be infested... 780 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) - (vii) Number of individual pupils in respect of which cleansing orders were issued (Section 54 (3), Education Act, 1944) - These figures relate to individual pupils and not to instances of infestation. TABLE VI. School Medical and Dental Staff. Names of Medical Officers. Proportion of whole time (expressed as a percentage) devoted to— School Health Service. Public Health S.M.O.— J. H. Weir, M.D., B.S., B.Hy., D.P.H. 0.25 Varies according to demands of services. A.S.M.Os.— I. Gordon, M.D., Ch.B., M.R.C.P., D.P.H. (Deputy, S.M.O.) 0.36 „ D. M. B. Gross, M.D., Ch.B., M.M.S.A., D.P.H. 0.45 „ F. E. O'Connor, B.A., M.B., B.Ch., B.A.O., D.P.H., L.M. 0.45 „ A. Collins, M.B., B.Ch., B.A.O. 0.45 „ L. Rich, M.B., Ch.B., M.R.C.O.G., D.P.H. 0.36 „ C. M. Small, M.B., B.S., D.P.H. from 3/3/47 to 13/12/47. 0.63 „ Names of Dental Officers. Senior Dental Officer- Mr. M. J. K. Soutter, L.D.S., R.C.S. 8/11 1/11 = T.B. 2/11=M. &C.W. Assistant Dental Officers— Mr. A. G. Clark, L.D.S., R.C.S. Whole — Mr. E. V. Haigh, L.D.S., R.C.S. 9/11 2/11 = M. & C.W. Nurses. Number of Officers. Aggregate of time given to School Health Service work in terms of whole-time Officers. School Nurses 13 one half. District Nurses — — Nursing Assistants — — Dental Attendants 3 17/22nds. 95 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, 1947. SCHOOLS No. on Roll DISEASES AND CONTACTS Scarlet Fever Diphtheria Measles & German Measles Whooping Cough Chickenpox Poliomyelitis Mumps Pneumonia Totals, 1947 Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Cases Cases Contacts Beal Modern 644 1 4 1 - 1 - - - 1 - - - - 4 4 Becontree 1,304 4 7 - - 37 - 2 — 14 1 2 — 1 59 9 Benton (Open Air) 85 — — - - 1 - 2 — 1 - — — 1 5 — Chadwell 638 6 2 - - 7 - 12 — 18 - — — 1 44 2 Christchurch 700 6 4 - - 87 1 22 - - - - - - 121 5 Cleveland 876 5 3 - - 61 1 17 - — 1 - — 3 87 4 County High 1,305 3 6 - — 2 - — — 1 - 1 — 1 7 7 Dane 602 6 3 - - 4 - — — — - — — 1 11 3 Downshall 1,147 11 10 - - 46 - 16 1 6 - 1 — - 80 12 Fairlop 1,471 11 4 1 - 62 - 32 — 14 1 1 — 3 124 5 Gearies 1,201 5 4 - - 121 - 32 1 7 2 — 16 2 185 5 Goodmayes 577 9 5 1 1 36 - 16 1 2 1 — — 2 68 7 Gordon 189 2 1 - - 53 - 9 — 5 — — — — 69 1 Highlands 652 7 3 - - 84 - 15 — 2 2 — — 1 111 3 Loxford 308 2 — 2 - 3 - 2 — — — — — - 9 — Mayfield 719 — 1 — 1 3 - — — — — — — — 3 2 Mossford (Fairlop) 301 1 1 1 1 18 - - - - - - - - 20 2 Mossford (G.V.H.) 110 — — — - 2 - 7 — 1 — — — - 10 — Newbury Park 273 — 2 — - 32 - 13 — — — — 1 — 46 2 Parkhill 1,012 5 4 — 1 100 - 18 1 3 — — — — 126 6 St. Augustine's 196 1 — — - 21 - — — — 1 — — — 23 SS. Peter and Paul's 625 3 1 — 1 3 - 10 1 3 1 — *1 3 24 3 St. Vincent's 320 — - — 1 7 - 1 - 2 — - 1 1 12 1 South Park 1,025 5 8 1 - 47 - 16 2 4 1 - - 1 75 10 The John Bramston 284 11 6 — - 3 - 38 — 1 — - 2 - 55 6 The Mount 305 — 2 — - 2 - - — - — - - - 2 2 The Redbridge 473 2 — — - 42 - 10 — 2 1 — 5 1 63 — The William Torbitt 618 4 1 — - 33 - 21 — 33 — — 1 - 92 1 Uphall 364 — — — - 35 - 3 — 2 — 1 — 2 42 1 Ursuline — 3 1 — - 13 - — — — — — - 1 17 1 Woodlands 255 4 1 — - 58 - 4 — - - - - 2 68 1 *Private — 3 3 — - 30 - 14 — — 2 — — — 49 3 Totals 18,580 120 87 7 6 1,056 2 332 7 122 14 6 27 33 1,711 108 Dysentery: 3 cases at Becontree. *Notification of minor infectious diseases in these schools are not received. 96 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 (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 i 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 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Becontree 44 109 19.2 13 112 21.1 5 114 21.7 6 125 25.6 - - - 36 138 32.2 39 140 33 5 145 34.9 8 154 45.1 9 153 41.8 — — — Benton (Open Air) 5 105 17.5 5 114 19.7 10 118 21 3 122 23.3 14 130 26.5 12 134 30 8 146 33.6 5 141 31.6 4 147 34.8 •> 148 37 — — - Chadwell 19 112 20.6 8 116 21.1 1 132 33 4 131 33.6 5 128 25.4 13 139 33.4 25 142 34 — — — — - — — — — — — - Christchurch 61 111 19.5 9 115 21.5 7 123 23.9 2 133 28.2 2 130 28 15 141 32.5 22 142 33.6 — — — — — - — — — — — - Cleveland 47 111 19.5 10 115 21.9 2 120 24.2 1 107 19.7 7 132 29.4 40 136 33.3 7 134 31.4 - - - - - - - - - - - - Dane Central — — — — — — — — — — — — — — — — — — 3 145 36.2 3 147 36.3 5 160 44.7 26 158 46.6 — — — Downshall 47 111 20 17 115 20.4 2 121 24 2 134 30.1 4 139 33.8 26 136 33.3 20 137 31.6 6 150 36.1 24 160 43.1 8 161 47.5 — — — Fairlop 86 109 19.3 14 116 21.2 5 124 25.2 6 127 27 3 132 30.5 38 139 33 31 143 34.1 5 141 36.3 50 158 47 7 160 46.4 1 166 68 Gearies 56 112 20.1 10 114 21.8 4 123 24.6 8 130 28.3 2 137 30.8 22 141 33.9 36 142 34.6 — — - 3 157 47.4 18 158 48.4 — — — Goodmayes 66 111 19.9 16 114 21.2 7 121 25 5 131 26.3 3 129 26.3 14 139 32 18 138 32.3 1 143 35 — - — — — — — — . — Gordon 35 109 19 1 115 20.6 1 128 26.4 - - - - - - - - - - - - - - - - - - - - - - - - Highlands 55 110 19.4 10 116 22.4 9 120 22.5 2 131 28 5 134 31.1 27 136 33 9 137 34 - — - - - - - - - - - - Loxford — — — — — — — — — — — - — - - - - — - - - — - - 5 154 41.9 9 156 44.9 — — - Mayfield — — — — — — — — — — — — — — — — — — 1 139 31.2 6 145 39.5 8 153 44.2 6 159 47.7 1 149 45.3 Mossford 19 109 18.5 6 115 20.4 5 123 24.2 •> 121 24 1 132 28.3 5 139 33.8 9 138 31.7 — — — — - — — — — — — — Mossford G.V.H. 18 109 20 15 110 21.1 11 124 23.1 6 121 23.9 1 129 23.9 — - — - - — — - - — - - — — — — — - Newbury Park 2 108 20 3 116 20.7 — — - — — — — — — 9 144 38.1 11 144 35.3 - - - - - - - - - - - - Parkhill 83 112 19.6 14 118 21.1 3 126 24 4 130 27.4 5 127 26.5 10 141 32.7 32 143 34.3 1 146 36.3 - - — — — — — — — St. Augustine's 3 113 21.5 1 113 18.7 3 116 20.6 1 121 22.7 — — — 3 136 30.4 10 143 34 — — — - - — — — — — — — SS. Peter & Paul 30 111 20.7 12 117 24.3 6 119 23.1 1 130 26.9 2 139 31.9 11 140 33.5 14 141 35 8 144 35.3 25 153 44 0 156 49.3 — — — South Park 64 112 19.5 11 115 21.4 4 122 23.6 3 123 23.1 3 137 31 27 143 33.7 53 142 34.6 1 145 33.4 - - — — — — — — — St. Vincent's 7 111 19.7 3 115 22.2 — - — — - - — - - 10 136 32.3 6 138 35.9 — - - 7 151 42.3 4 153 43.5 — — — The John Bramston 11 108 17.4 10 114 21 3 115 20.8 3 126 24.4 3 127 25.1 3 126 27.4 7 141 36.1 2 145 35 — — — — — — — — — The Redbridge 29 112 19.6 4 117 21.6 - — — - 129 27 1 140 36.2 16 140 33.5 3 141 34.2 — — — — — — — — — — — The Wm. Torbitt 50 109 20 7 119 22.4 — — — — - - 3 127 27.3 22 138 34 6 140 34.2 - - - - - - - - - - - - Uphall 4 110 21.2 1 115 22.2 — - — 1 121 26 — - — 10 138 33.6 1 144 34.4 - - - - - - - - - - - - Woodlands 30 110 19.4 9 115 20.3 3 125 27.1 — — — — - — — — — — — — — — — — - — — — — - — Ilford Boys—Averages for 10 years:— 1947 871 110 19.6 209 115 21. 91 121 23.4 62 127 26.5 64 131 28.4 369 139 33.1 381 141 33 8 43 145 35.7 139 156 44.7 98 157 46 2 157 56.6 1946 771 112 20.2 387 117 21.9 170 124 24.5 101 128 260 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 19.8 420 115 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 19.6 257 116 21.2 158 122 23.5 519 127 25.9 265 128 28.7 227 137 31.7 201 143 35.9 427 145 37.2 119 151 41.1 — — — — — - 1940 626 111 19.5 296 119 21.6 210 122 23.5 632 127 26.1 239 132 28.7 208 136 31.2 296 142 35.1 601 146 37.7 215 151 42.1 — — — — — — 1939 634 110 19.4 128 116 21.4 87 120 23.3 739 127 26.3 80 131 28.2 80 134 30.2 72 141 35.0 520 145 37.8 69 151 41.1 — - — — — — 1938 982 110 19.5 224 115 21.2 132 120 22.6 1 106 127 26.7 160 131 28.2 104 136 31.1 188 141 34.5 770 145 37.3 85 150 40.2 — - — — — — 97 98 99 Table IX B.—Table Showing the Average Heights and Weights of the GIRLS Examined. Age Groups Age Groups School 5—6 Years 6—7 Years 7—8 Years 8—9 Years 9—10 Years 10—11 Years 11—12 Y ears 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—-17 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetrers) 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 - - - - - - — - — — — - — — - - - - - - - - - - - - - - - - — - - - - — Becontree 50 111 18.5 14 112 20.1 1 117 20.2 4 12.5 23.6 2 130 25.5 27 138 31 19 141 35 2 137 34.6 3 155 53.2 18 154 47.3 - - - - - - Benton (Open Air) 5 108 16.8 3 107 16.9 6 109 20.5 13 120 20.3 9 124 21.7 8 133 25.8 6 137 30.1 4 134 29.4 5 149 37.2 1 158 49.9 1 154 38.7 - - - Chadwell 21 113 19.5 6 115 20.4 2 121 22.4 3 126 25.8 6 132 28.2 14 133 32.3 18 144 35.6 - - - - - - - - - - - - - - - Christchurch 78 111 19 9 116 20.7 3 126 23 2 128 27.9 2 130 29 22 140 33.7 22 142 34 - - - - - - - - - - - - - - - Cleveland 41 109 19 5 117 21.6 1 121 22.7 5 132 29.3 6 129 27.2 38 138 31.7 20 141 32 - - - - - - - - - - - - - - - Dane Central — — — — — — — — — — - - - - - - - - 4 141 36.2 1 146 40.6 4 156 45.9 12 156 48.8 - - - - - - Downshall S3 109 18.5 8 115 20.3 1 123 22.9 5 128 28 1 137 44.8 33 137 31 21 142 34.6 2 153 38.1 15 162 46.6 9 162 50.3 - - - - - - Fairlop 51 112 19.8 21 113 20.8 5 122 24.4 2 128 28.3 3 136 32.4 42 139 32.9 21 144 35.5 2 148 46.1 46 153 45.3 9 155 47 - - - - - — Gearies 40 111 19.6 10 114 19.8 6 119 22.2 3 122 23.3 5 136 29.5 24 140 39.4 24 141 35.4 - - - - - - - - - - - - — — — Goodmayes 62 111 19.4 26 114 21.1 9 121 23.2 3 128 24.3 4 128 26.5 20 140 32.4 8 -142 33.4 - - - - - - - - - - - - - - - Gordon 20 110 19.9 4 111 16.5 1 119 19.2 - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 50 108 18.7 14 118 22.4 2 128 25.3 9 129 27.4 3 133 30.3 13 143 35.9 11 140 35.1 - - - - - - - - - - - - - - - Mayfield - - - - — — — -— — — — — — — —. - - - 2 142 35 5 148 39.1 6 155 46.6 14 157 46.6 - - - - - - Mossford 18 108 18.7 5 114 20.1 2 116 21.1 1 143 31.4 6 122 23 12 139 30.6 8 142 33./ - - - - - - - - - - - - - - - Mossford G.V.H. 7 106 19.4 18 112 21.2 16 116 24.5 11 122 27.2 3 118 25.4 17 131 29.6 2 143 36.3 - - - - - - - - - - - - - - - Newbury Park 7 109 19 1 127 30.1 — — — 1 125 23.8 — — 4 135 30.6 9 142 33.7 — — — — - - - - - - - - - - - Parkhill 65 112 19 10 118 21.1 6 123 22.8 4 128 28.9 1 132 28.8 14 141 32.3 20 142 32.9 - - - - - - - - - - - - - - - St. Augustine's 5 111 19.2 1 119 20 1 116 23.8 — — — 2 129 27.4 10 143 34.6 10 143 34.6 - - - - - - - - - - - - - - - S.S. Peter & Paul 20 112 19.7 13 114 21.1 3 121 25.7 1 132 23.6 2 127 28.7 6 130 31.3 14 143 34.1 5 151 33.6 14 156 47.8 1 163 59.4 - - - - - - South Park 57 112 21.1 16 115 20.1 9 121 23 4 130 29.3 6 134 29.5 26 140 32.6 39 144 34.5 - - - - - - - - - - - - - - — St. Vincent's 8 108 18.2 1 108 18.3 — — — — - - - - - 11 139 33.3 5 136 28.9 - - - 6 155 43.3 4 163 52.9 - - - - - — The John Bramston 12 109 18.5 11 115 21 4 120 25.4 5 123 27.2 4 133 30 3 139 34.1 10 138 33.4 - - - - - - - - - - - - - - - The Mount - - — — - — — - — — — — — - - - - - - - - 1 134 29 8 156 44.1 9 155 43.7 - - - - - - The Redbridge 26 109 19 8 116 21.7 1 112 21.3 1 124 25.4 — — 16 138 31.5 8 143 33.2 - - - - - - - - - - - - - - - The William Torbitt 42 110 19 7 114 20.9 4 120 21.2 3 125 25.7 - - - 24 139 33 4 140 32.6 - - - - - - - - - - - - - - - Uphall - - - 1 120 24.3 1 138 28.8 — — — — — 10 139 33.9 11 138 33.8 - - - - - - - - - - - - - - - Woodlands 39 110 18.8 12 117 24.2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ilford Girls-Averages for 10 years:- 1947 777 111 19.0 224 115 20.7 84 119 23.2 80 126 25.9 65 129 27.4 384 138 32.2 316 141 34.1 29 145 35.9 116 155 45.6 92 157 4.4 1 38.7 - - - - 1946 708 111 19.3 396 116 21.2 167 121 23.2 116 127 25.2 71 132 28.6 445 138 31.5 445 142 34.4 76 148 39.8 265 156 45.8 121 157 48.5 25 162 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 69 143 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 34.5 451 148 38.5 171 154 43.8 - - - - - - - - - 1941 330 110 19.2 268 115 20.6 161 121 23.0 523 127 26.0 255 132 28.1 208 137 31.5 139 142 33.9 423 148 38.5 163 153 43.1 - - - - - - - - - 1940 548 110 18.9 286 116 20.7 185 121 23.5 579 127 26.6 216 133 28.3 192 137 30.9 232 143 35.6 540 148 39.8 172 153 44.7 - - - - - - - - - 1939 588 110 18.7 121 114 20.7 100 120 23.2 634 126 25.1 87 131 28.3 67 134 30.1 85 142 34.8 567 147 37.7 106 151 42.7 - - - - - - - - - 1938 993 110 18.9 221 114 20.5 139 120 22.9 1083 126 25.2 145 130 27.3 127 135 30.2 093 143 35.6 709 147 38.2 122 151 42.9 - - - - - - - - - 100 101 Table IX C. Table showing the Average Heights and Weights of Grammar School BOYS. Age Groups Age Groups School 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years 17—18 Years 18—19 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) County High School for Boys 20 145 37.1 4 146 35.5 2 157 57.8 8 169 56.4 117 167 55.9 13 169 57.4 9 173 63.8 — — — Table IX D. Table showing the Average Heights and Weights of Grammar School GIRLS. Age Groups Age Groups School 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years 17—18 Years 18—19 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (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 15 147 38.2 4 146 49.5 6 146 49.5 5 160 48.4 64 162 49.7 17 160 54.6 15 160 55.3 2 165 54.1 Ursuline 30 146 37.5 12 146 39.7 5 152 44.1 3 163 61.5 20 161 54.5 4 160 54.8 — — — — — —