ILF 23 LIBRARY AC 4411(1) ILFORD Borough of llford Health Report FOR THE YEAR 1948 J. H. WEIR M.D., B.S., B.Hy., D.P.H. Medical Officer of Health, etc, Waterlow & Sons Ltd., London Wall, London. \ ILFORD BOROUGH COUNCIL November, 1947—May, 1949 Alderman G. Colvin, J.P., F.C.I.S., Mayor. Alderman W. A. V. Bryan, J.P., Deputy Mayor. Aldermen: Bryan, William Allen Vernon, J.P., Deputy Mayor. Colvin, Gilbert, J.P., F.C.I.S., Mayor. Cooper, Albert Edward, M.B E. Daniels, Russell Stearn. Eke, William Benjamin. Fallaize, Mrs. Lilian, J.P. (E.C.C.). Griggs, Albert Philip, J.P., C.A. (E.C.C.). Holness, Richard Thomas. Wetton, George John, C.A. (E.C.C.). Woods, Sidney Charles Victor. Wootton, Mrs. Florence Emily, O.B.E. Young, Major Alexander, T.D., J.P. (E.C.C.). Councillors: Barker, John. Bartlett, Albert Edward. Bennett, Mrs. Florence Edith. Billings, John. Brown, William Thomas. Clements, John Anthony, F.R.S.A. F.S.S., F.R.Econ.S. Cowan, Harold Douglas, F.C.P.A. F.C.C.S. East, John. Eke, Reginald George. Faning, Percy Victor (E.C.C.). Gibson, Cyril Irving. Gleed, Sydney George. Gooch, Lionel Archer Scott. Headley, Cecil Aubrey. Hewitt, Reginald. Hughes, Thomas Bernard. Johnson, Stanley. Lawrence, Samuel George. Lee, Leonard Gordon Victor. Littlejohn, Mrs. Ruth Constance, M.A. Manders, Ralph James David. Masters, Frank Robert. Milburn, Mrs. Elizabeth Florence. O'Connor, Mrs. Ethel. Payne, Robert Wilfred. Pearson, Frederick Thomas. Pohl, Mrs. Winifred Elizabeth. Pointer, Frederick Georce. Pryce, Harold. Slater, Frank. Taylor, Sidney William. Terry, Miss Anne Sylvia. Todd, Norman. Tyler, Bertie Charles Newcombe. Watts, Mrs. Mabel Lucy. Wickens, Maurice Morley. PUBLIC HEALTH COMMITTEE November, 1947—May, 1949 Councillor C. I. Gibson, Chairman. Councillor Mrs. W. E. Pohl, Vice-Chairman. Alderman W. A. V. Bryan, J.P. (Deputy Alderman Mrs. L. Fallaize, J.P. Mayor). (E.C.C.). Alderman G. Colvin, J.P., F.C.I.S. Alderman A. P. Griggs, J.P., C.A. (Mayor). (E.C.C.). Alderman W. B. Eke. Alderman Mrs. F. E. Wootton, O.B.E. Alderman S. C. V. Woods. Councillor J. Barker. Councillor R. G. Eke. Councillor H. Pryce. Councillor L. G. V. Lee. Councillor Mrs. M. L. Watts. Councillor Mrs. R. C. Littlejohn, Councillor M. M. Wickens. M.A. MATERNITY AND CHILD WELFARE COMMITTEE November, 1947—July, 1948 Councillor Mrs. M. L. Watts, Chairman. Councillor Miss A. S. Terry, Vice-Chairman. Alderman W. A. V. Bryan, J.P. (Deputy Alderman W. B. Eke. Mayor). Alderman A. P. Griggs, J.P., C.A. Alderman G. Colvin, J.P., F.C.I.S. (E.C.C.). (Mayor). Alderman G. J. Wetton, C.A. (E.C.C.). Alderman Mrs. F. E. Wootton, O.B.E. Councillor R. G. Eke. Councillor Mrs. R. C. Littlejohn, Councillor C. I. Gibson. M.A. Councillor L. A. S. Gooch. Councillor Mrs. E. F. Milburn. Councillor T. B. Hughes. Councillor Mrs. E. O’Connor. Councillor Mrs. W. E. Pohl. Co-opted Members: Mrs. M. Armitage, Mrs. B. Butcher, Mrs. W. Butler, Mrs. Meggs, Mrs. B. E. Paddon, Mrs. E. Weeks, Mrs. Witney. ILFORD HEALTH AREA SUB-COMMITTEE OF THE HEALTH COMMITTEE OF THE ESSEX COUNTY COUNCIL July, 1948—May, 1949 Ilford Borough Council Representatives: Aldermen Bryan (Deputy Mayor), Eke, Griggs, Woods and Mrs. Wootton; Councillors Barker, East, Eke, Faning, Gibson, Hughes, Mrs. Littlejohn, Mrs. Pohl, Miss Terry and Mrs. Watts (Chairman). Essex County Council Representatives: Aldermen Green and Wade ; Councillors Denton, Mrs. Fallaize (Vice-Chairman), Green, Morris and Sherrell. The Executive Council for Essex Representative: Dr. H. N. Rose. Local Medical Committee Representative: Dr. J. A. Moody. Hospital Management Committee Representative: Mr. B. F. J. Nichols. Voluntary Organisations' Representatives: Mesdames B. Butcher, A. C. Hatcher, L. Megcs and A. M. Pearce. ILFORD COMMITTEE FOR EDUCATION November, 1947—May, 1949 Alderman G. Colvin, J.P., F.C.I.S. (Mayor), Chairman. Alderman A. Young, T.D., J.P. (E.C.C.), Vice-Chairman. Alderman A. E. Cooper, M.B.E. Alderman S. C. V. Woods. Alderman W. B. Eke. Alderman Mrs. F. E. Wootton, O.B.E. Alderman Mrs. L. Fallaize, J.P. (E.C.C.). Councillor J. Barker. Councillor F. T. Pearson Councillor Mrs. F. E. Bennett. Councillor Mrs. W. E. Pohl. Councillor J. East. Councillor S. W. Taylor. Councillor P. V. Faning (E.C.C.). Councillor Miss A. S. Terry. Councillor Mrs. R. C. Littlejohn, Councillor N. Todd. M.A. Councillor B. C. N. Tyler. Councillor R. J. D. Manders. Councillor Mrs. M. L. Watts. Councillor Mrs. E. F. Milburn. Co-opted Members: Rev. W. C. Johnson. Mr. H. Kenward, M.A. Mr. S. P. Lonergan. Mr. E. R. Lower, B.A. Mr. L. R. Maddieson. Mr. W. E. Parker. Miss H. S. Rich. OFFICERS OF THE PUBLIC HEALTH SERVICES Medical Officer of Health, Borough School Medical Officer, Medical Superintendent of the Isolation Hospital and Maternity Hospital, Medical Officer to the Maternity and Child Welfare Statutory Committee (to 4/7/48), Acting Area Medical Officer, Ilford Health Area Sub-Committee (from 5/7/48): 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.). Assistant Medical Officers of Health: D. M. B. Gross, M.D., Ch.B.(Leeds), 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.). (To 31/7/48.) I. D. M. Nelson, M.B., B.Ch., B.A.O., C.P.H., D.P.H. (Belfast). F. Groarke, M.B., B.Ch. (N.U.I.), C.P.H., D.C.H., D.P.H. (From 27/7/48.) Assistant Medical Officer of Health and Resident Medical Officer (Isolation Hospital): G. L. Brown, M.D., Ch.B., D.P.H. (Glasgow). Junior Resident Medical Officer (Isolation Hospital): I. M. Librach, M.B., B.Ch., B.A.O., D.P.H., D.C.H. Resident Medical Officer (Maternity Hospital): K. R. Barker, M.R.C.S., L.R.C.P. Senior Dental Officer: M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Assistant Dental Officers: 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 Hospital: Miss K. Bellaers. Miss F. G. O. Moorcroft. Chief Sanitary Inspector: S. R. Daly, B.Sc., D.P.A.(Lond.), F.A.L.P.A., M.R.San.I. Deputy Chief 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 I. L. Mobbs. Miss O. Bell. (To 1/7/48.) Mrs. I. Quirk. Miss M. G. Bennett. Mrs. V. M. Whiting. Miss A. L. Drinkwater. Mrs. B. A. Wheeler. Ante-Natal Clinic Nurse: Mrs. D. W. Quick. (Till 11/9/48.) Matrons of Day Nurseries: Sunshine House Miss I. E. Sandali. Green Lane Mrs. E. Drower. Ley Street Miss A. R. Jones. Becontree Avenue Mrs. N. Nicholas. Domestic Help Organizer: Mrs. L. A. Horwood. Part Time:— Consulting Obstetrician (Maternity Hospital and Puerperal Pyrexia Regulations): R. L. Dodds, M.Ch., F.R.C.S., F.R.C.O.G. A. Davis, M.D., F.R.C.S. (Deputy). Consulting Anaesthetist: Frankis T. Evans, M.B., B.S., D.A. Surgeon in charge of Orthopaedic Clinic: J. A. McLauchlan, M.D., F.R.C.S. Oculist: F. J. Darbyshire, B.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 and Cardiac Clinics: 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. (To 4/6/48.) C. B. M. Warren, B.A., M.R.C.P. (From 16/6/48.) 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. September, 1949. To the Mayor, Aldermen and Councillors of the Borough of Ilford. Mr. Mayor, Ladies and Gentlemen, I submit herewith the Annual Report on the Health Services for the year 1948. Although the operation of the National Health Service Act, 1946, removed some of the Health Services from the control of the Borough Council on 5th July, 1948, it has been considered convenient on this occasion to give an account of these services throughout the year. During 1948 Ilford became 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 constituted an Area Sub-Committee, which assumed 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 I have been appointed Acting Area Medical Officer. The Council's former responsibilities in regard to Infant Life Protection were also terminated by the provisions of the Children Act, 1948, which, coming into operation on 5th July, transferred these functions to Essex County Council who have appointed a Children's Officer for this purpose. 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 IA on page 15 will show that the local figures compare most favourably with those for England and Wales and the Administrative County of London. It will be noted that the uncorrected death rate of 7.3 is 1.3 below the figure for 1947, and the corrected death rate of 8'4 is the lowest recorded since 1935. For the first time since 1900 (before which local figures are not available) no maternal death occurred in connection with childbirth. The infantile mortality rate continued its decline, falling to 21.7, the lowest ever recorded in Ilford, and substantially below that given for England and Wales (34) or the Administrative County of London (31). There were only 37 deaths of infants under the age of four weeks giving a neonatal mortality rate of 12.9 per 1,000 live births. This is the lowest locally recorded since 1905 before which it does not appear in annual reports. The stillbirth rate shows a reduction to 22.3 as compared with the 1947 figures of 24 6. The birth rate showed a fall to 15.8 as compared with last year's figure of 19.1. The former figure is the lowest since 1941. The actual number of births registered totalled 2,848 as compared with 3,368 for 1947. It is satisfactory to note that the number of illegitimate births registered was only 3.2 per cent. of the total. 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. During the year a campaign against food and drink infections was launched. A long term educational policy was adopted, directed to school children, the public generally, and executives of all grades in the food 7 handling trades. Propaganda by means of posters, leaflets, press articles, lectures, demonstrations and films, was used and the goodwill, co-operation and assistance of all concerned earnestly sought. In connection with this campaign, the Sanitary Inspectors conducted an intensive survey of all food preparing, catering and retail premises. A food hygiene exhibition was held, a detailed account of which appears on page 41. 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 2,937 cases, as against 2,232 in 1947. Whooping cough, the next common infection, showed an increase from 935 to 1,061 cases. The incidence of poliomyelitis (4cases) was much lower than in 1947 (29 cases). Attention is directed to a remarkable case recovery detailed on page 35. No case of smallpox occurred in the year, during which the Sanitary Inspectors paid 64 visits to houses in connection with the surveillance of contacts. It will be noted that during the year infant vaccination ceased to be compulsory. Responsibility for providing facilities for vaccination generally became a function of the Local Health Authorities under the National Health Service Act, 1946. The number of cases of diphtheria notified fell to 16, the lowest for this century. No 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 in 1947 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 post-natal—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 Hospital. The Maternal and Child Health Services dealt with 1,888 births, as compared with 2,215 in 1947. The Maternity Hospital admissions, numbering 1,144, represent an increase of 8"3 per cent. as compared with 1947. It will be noted that 125 of these were emergency cases, most of which required operative or other specialised treatment. It is here appropriate to pay tribute to the work of the late Mr. R. L. Dodds, whose untimely death in January, 1949, was deeply regretted by all connected with the Maternity Hospital. Since December, 1940, he had been Consulting Obstetrician to the Borough Council's Maternity Services, having previously held the appointment of Deputy Consulting Obstetrician since December, 1934. The domiciliary midwifery service dealt with 744 cases, as compared with 1,159 in 1947. The difficulty of obtaining midwives for institutional or domiciliary midwifery continues. All the domiciliary midwives are qualified to administer gas and air analgesia during childbirth, and this facility is available to patients whenever desired and possible. Four sets of apparatus are kept at the Ambulance Station from whence they are delivered on the request of a midwife. 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. The Post-Natal Hostel 8 at Wilnett Lodge, Chadwell Heath, continued to be of considerable value in freeing beds at the Maternity Hospital for the reception of an increased number of patients. Corresponding with the work of the Maternity Hospital, attendances at both Ante-Natal Clinics and at the Post-Natal Clinic have continued at a busy level. The work of the infant welfare centres showed a slight decrease. Altogether 49,444 attendances were made as compared with 49,690 in 1947. The number of children on the welfare centre rolls decreased from 4,146 in 1947 to 3,712 in 1948. This was mainly attributable to the fact that mothers now tend to take advantage of the new facilities under the National Health Service Act, 1946, whereby the services of their family doctor are now available free of charge. Home visiting by Health Visitors remained somewhat curtailed owing to shortage of staff. It has been exceedingly difficult to fill vacancies and impossible to reach the full establishment. Some easement of the position was afforded by the appointment of 5 Clinic Nurses, but their functions are limited, as they cannot undertake all duties normally performed by qualified Health Visitors. The scheme for the supply of Domestic Helps has steadily progressed and is fulfilling a long felt urgent need. At the end of the year 108 part time Domestic Helps were employed as compared with 45 twelve months previously. Domestic Help was provided in 651 cases as against 341 cases during 1947. During the year the Nurseries and Child Minders Regulation Act, 1948, became operative. This welcome measure, details of which are given on page 56, gave supervisory powers to the Local Health Authority in regard to private nurseries and to persons who undertake for reward the care of children under 5 years of age. The School Medical Scrvice is now catering for a school population of 20,267, an increase of 1,265 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 of 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. 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. With the permission of the Borough Council, the Local Education Authority approved the establishment of a Child Guidance Clinic accommodated in Loxford Hall. This came into operation on January 1st, 1949. It was fortunately possible to secure the services of Dr. A. H. G. Burton as the Clinic Psychiatrist. The rapid expansion of the Borough necessitates the provision of additional clinic facilities. Although sites for Health Centres have previously been agreed with the County Council, building operations are still held in abeyance. The County Council have, however, obtained the necessary sanction to the erection of a Combined Treatment Centre on the Grange Hill Estate. This will serve the needs of Estate families living in the three contiguous Health Areas—Forest, Dagenham and Ilford. While the maintenance of the premises, non-professional staffing and general 9 istration will be the concern of the Ilford Area Health Sub-Committee, each Area will be responsible for the professional staffing of clinics held for the benefit of its own inhabitants. It is hoped that building operations will shortly commence and pending the completion of the Centre, there is a project to establish a temporary Centre in two houses on the L.C.C. Estate. So far as the Hospitals are concerned, the Isolation Hospital, the Maternity Hospital and Wilnett Lodge passed from the control of the Council to that of the North East Metropolitan Regional Hospital Board on 5th July, 1948. For a period of nine months, the Borough Council agreed to continue certain services (supplies, maintenance of premises and plant, accounting, certain legal work and estate management) on an agency basis. The Hospitals are now under the local control of the Hospital Management Committee Group 12 (Ilford and Barking) which comprises the King George Hospital, Ilford; Ilford Isolation Hospital; Ilford Maternity Hospital and Wilnett Lodge; Barking Upney Isolation Hospital; Upney Maternity Hospital; Ilford Tuberculosis Dispensary and Dagenham Sanatorium, a total of 713 beds. The future of the local Health Services will be largely governed by the effects of the National Health Service Act, 1946. Preventive medicine cannot be dramatic in its results. Its policy, though important and far reaching, is essentially long-term and unspectacular. Its effects are frequently not evident for many years—often for generations. The benefits which we are now reaping and which are evidenced in this report are the fruits of the labours of our forbears. Time alone will show whether the Public Health Services, as modified by recent legislation, will maintain or improve the achievements of the past. 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. It is most pleasing to note that they are continuing their voluntary duties at the Infant Welfare Centres with unabated enthusiasm and undiminished effort despite the legislative and administrative changes which have taken place. 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. Area (in Acres) Land 8,402 8,435 Inland Water 26 Tidal Water 7 Population (Census 1921) 85,194 „ (Census 1931) 131,061 Registrar-General's Estimate of resident Population:— June 30th, 1945 151,520 1946 173,900 1947 179,820 1948 183,400 Number of inhabited houses (end of 1948) according to Rate Books 45,991 (approx.) Rateable Value—April 1st, 1948 (Houses and Land) £1,580,011 Sum represented by a penny rate, April 1st, 1948 £6,370 (approx.) Education Rate— 1947-48 1948-19 (E.C.C.) 5s. ll.66d. 6s. 6'85d. in the £ in the £ Combined Rate (all services) 17s. 6d. 19s. . 4d. in the £ in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males. Females. As at December, 1947 556 68 As at December, 1948 714 152 Live Births Total M. F. 1948 1947 Legitimate 2,757 1,436 1,321 Birth Rate per 1,000 of the estimated resident population Rate per 1,000 15.8 19.1 Illegitimate 91 43 48 Still Births 65 35 30 total (live and still) births 22.3 24.6 Deaths 1,518 765 753 Death Rate per 1,000 of the estimated resident population 8.4 98 Percentage of total deaths occurring in public institutions 26.7 27.5 11 Death-rate of Infants under one year of age:— 1948 1947 All infants per 1,000 live births 21.7 24.3 Legitimate infants per 1,000 legitimate live births 21.0 23.9 Illegitimate infants per 1,000 illegitimate live births 43.9 36.4 Deaths from Cancer (all ages) 297 318 „ „ Measles (all ages) - 1 „ „ Whooping Cough (all ages) - 2 „ „ Diarrhoea (under 2 years of age) 1 6 1. Rainfall. Total rainfall registered in the district during the year was 23'67 inches; the greatest fall in 24 hours was registered on 14th June, 2.56 inches (thunder storm). June was the wettest month. 2. Population. The number of patients and resident staff on the 30th June, 1948, at the following public institutions, was:— Claybury Hospital 2,442 Goodmayes Hospital 1,321 Australasian Hospital (Dr. Barnardo's Homes) . 49 Total 3,812 3. Births. The number of births registered during the year was 2,848. Males Females Legitimate 1,436 1,321 Illegitimate 43 48 i.e., 3.2 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was: 3.3; 3.1; 5.5; 4.2; 3.4; 3.5; 3.3; 2.5; 2.2; 2.4. The birth-rate, calculated on the net estimate of the population is 15.8 per 1,000. 4. Deaths. The total number of deaths of Ilford residents was 1,518. This is obtained by taking the total deaths registered in the district (1,351), subtracting the deaths of non-residents occurring in the district (260), and adding the deaths of Ilford residents registered as having died in other districts (427). The number of deaths of non-residents registered in the district (principally in large instituitions) was as follows:— Claybury Hospital 96 Goodmayes Hospital 42 King George Hospital 70 Ilford Isolation Hospital and Sanatorium 21 Other Non-residents 31 Total 260 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. 1948 1947 1948 1947 No. 29, Puerperal sepsis 0 0 0.0 0.0 No. 30, Other maternal causes 0 2 0.0 0.58 Total 0 2 0.0 0.58 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 Hospital, Romford 74 Brentwood Mental Hospital 9 Wanstead Hospital 18 Queen Mary's Hospital, West Ham 9 Hospital for Sick Children, Great Ormond Street 2 London Hospital 43 St. Bartholomew's Hospital 5 Charing Cross Hospital 4 Westminster Hospital 3 Guy's Hospital 2 Severalls Mental Hospital, Colchester 8 East Ham Memorial Hospital 10 University College Hospital 3 Whipps Cross Hospital 15 St. Luke's Hospital 4 London Chest Hospital 2 In other Hospitals, Institutions and residences outside the Ilford district 216 Total 427 The death rate, calculated on the net estimate of the population of 179,637, is 8.4 per 1,000. Inquests.—During the year, 58 inquests were held, 41 on Ilford residents, and 17 on non-residents. The ages at death were as follows — Under 1 year 1-2 years 2-5 5-15 years years 15-25 years 25-45 years 45-65 years 65 years and upwards 2 - 3 2 14 16 21 Death-Rates from Tuberculosis and Cancer, 1948. The following Table shows the death-rates for 1948 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 .345 .440 Other Tuberculosis .038 .067 Cancer 1.653 1.858 5. Public Assistance Relief.—The total amount expended in Ilford from 1st January to 4th July was £17,657 2s. 8d. The average weekly number of cases assisted was 712, including dependants. The number of admissions to County Institutions from Ilford during the year was 457, made up as follows:— Men 154 Women 235 Children 68 The number of destitute persons admitted to the Social Welfare establishments during 1948 was 9; men 1, women 4, children 4. 13 During the period 5th July to 31st December the number of persons admitted to Institutions under Part III of the National Assistance Act, 1948, was as follows:— Men Women Children Permanent 4 10 Temporary 5 8 9 From 5th July, 1948, the National Assistance Act, 1948, superseded the arrangements previously in existence whereby relief was granted to those in need, and those requiring Institutional care. 6. Marriages.—1,736 marriages took place in the Ilford district during 1948, 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 1948, arranged according to the age groups at which deaths occurred. 14 TABLE I.—Vital Statistics of Whole District During 1948 and Previous Years. Year Gross Population, estimated to middle of each Year. Net Population estimated to middle of each Year. Births Total Deaths Registered in the District Transferable Deaths Net Deaths Belonging to the District Uncorrected Number Net (6) of Non-Residents registered in the District of Residents not registered in the District Under 1 year of Age At all Ages Number Rate (c) Number Rate (d) Number Rate per 1,000 Net Births Number Rate (e) 1 2 2a 3 4 5 6 7 8 9 10 11 12 13 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 1948 183,400 179,637 2,239 2,848 15.8 1,351 7.3 260 427 62 21.7 1,518 8.4 (a) The net estimated population is found by deducting the population of Claybury and Goodmayes 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. 15 TABLE 1A Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1948 (Provisionalfigures). 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 Tuberculosis (all forms) Pneumonia Whooping Cough Diphtheria Influenza Acute Poliomyelitis and Polioencephalitis Diarrhoea and Enteritis (under 2 Yrs.) Total Deaths under 1 Year Live Births Stillbirths England and Wales . 17.9 0.42 10.8 0.00 - 0.51 0.41 0.02 0.00 0.03 0.01 3.3 34 126 County Boroughs and Great Towns, including London 20.0 0.52 11.6 0.00 - 0.59 0.38 0.02 0.00 0.03 0.01 4.5 39 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 19.2 0.43 10.7 0.00 - 0.46 0.36 0.02 0.00 0.04 0.01 2.1 32 London Administrative Co. 20.1 0.39 11.6 0.00 - 0.63 0.54 0.01 0.01 0.02 0.00 2.4 31 ILFORD (Estimated Gross Population, mid 1948 = 183,400) 15.5 0.35 8.2 - - 0.37 0.27 - - 0.04 0.00 0.3 21 A dash (—) signifies that there were no deaths. 16 Registrar-General's Short List of Deaths and Causes: — TABLE II. Causes of, and Ages at, Death during the Year 1948. 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 1,518 62 2 5 15 23 30 70 129 265 378 539 1 Typhoid and paratyphoid fevers - - - - - - - - - - - 2 Cerebro-Spinal fever 3 2 - 1 - - - - - - - - 3 Scarlet fever - - - - - - - - - - - 4 Whooping cough - - - - - - - - - - - - 5 Diphtheria - - - - - - - - - - - - 6 Tuberculosis of respiratory svstem 62 - 1 - 1 9 11 6 13 12 7 2 7 Other forms of tuberculosis 7 - - 1 2 2 - - 1 1 - - 8 Syphilitic disease 6 - - - - - - - 2 2 1 4 9 Influenza 8 - - - - - - 2 - - - 10 Measles - - - - - - - - - - 11 Acute Poliomyelitis and polioencephalitis 1 - - - - - -- - - - - 12 Acute infectious encephalitis - - - - - - - - - - - - 13 Cancer of buccal cavity and oesophagus (males only) 9 - - - - - - - 2 - 6 1 Cancer of uterus (females only) 14 - - - - - - 1 2 4 4 3 14 Cancer of stomach and duodenum 49 - - - - - - - 6 14 16 13 15 Cancer of breast 34 - - - - - 1 2 8 12 6 5 16 Cancer of all other sites 191 - - - 2 1 4 10 20 51 56 47 17 Diabetes 9 - - - - - - 1 1 3 4 18 Intra-cranial vascular lesions 179 - - - - - - 1 11 28 60 79 19 Heart disease 422 - - - 1 - 2 10 20 63 121 205 20 Other diseases of the circulatory system 74 - - - - 1 - 1 6 13 20 33 35 21 Bronchitis 83 1 - 1 - - 1 4 7 15 - - 22 Pneumonia 50 11 - - - 1 1 1 4 6 9 23 Other respiratory diseases 22 - - - - 1 1 2 4 6 24 Ulceration of the stomach or duodenum 15 - - - - - 1 2 2 3 4 3 25 Diarrhoea (under 2 years of age) 1 1 - - - - - - - - 1 26 Appendicitis 3 - - 1 - - 1 — 5 10 27 Other digestive diseases 29 - - 1 2 - - 3 1 6 - 6 28 Nephritis 21 - - - -- 1 - 2 1 5 - - 29 Puerperal and post-abortive sepsis - - - - - - - - - - - 30 Other maternal causes - - - - - - - - - - - 31 Premature birth 16 16 - - - - - - - - - - 32 Congenital malformations, birth injury, infantile disease 32 26 1 - - - 1 1 3 - - - 33 Suicide 25 - - - - 1 2 7 6 5 4 1 34 Road Traffic accidents 13 - - - 1 3 1 1 2 1 - 11 35 Other violent causes 25 4 - - 1 1 1 2 1 1 - 51 36 All other causes 115 1 - - 5 3 2 13 6 18 - Special Causes (included in No. 36 above):— Smallpox - - - - - - -- - - - - - 17 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. (i) Public Health Officers of the Authority.—Vide list at the beginning of this report. (ii) Nursing in the Home.—There was a voluntary District Nursing Committee, 5,484 visits being paid by the Nurses between 1st January and 4th July, 1948. The following is a summary of the work carried out:— Number of New Cases and applications for Nurses' Services 234 Number of Visits—Medical 4,563 Surgical 921 Number of necessitous cases referred to the Committee 4 Number of cases on books at 4th July 93 The Essex County Council empowered by the National Health Service Act, 1946, now covers the services previously administered by the above Voluntary Committee. This Authority commenced its administration on the 5th July. The following is a summary of work carried out from that date until 31st December, 1948:— Number of Cases attended 571 Number of Visits paid 10,448 The number of Nurses employed on the 31st December, 1948, as (a) whole-time 7, (6) part-time 2. (iii) Laboratory Facilities.—During the year 666 swabs were examined for the presence of diphtheria organisms in the Bacteriological Laboratory at the Isolation Hospital; 36 gave positive results and 630 negative results. (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) Depositing of Rubbish, etc. (Sec. 249, Local Government Act, 1933.) 18 (11) Byelaws made under the Essex County Council Act, 1933. (Parts IV, VI and IX.) Part IV—Establishments for Massage and Special Treatment. Inspections of licensed establishments are carried out quarterly. During 1948 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, 1949. Part VI.—Hairdressers' and Barbers' Premises. During 1948, 125 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 74 applications for registration in respect of 70 premises were considered during the year. The registrations were granted as follows:— Purveyors retailing multiple firms' productions 63 Purveyors manufacturing and retailing their own productions (made apart from domestic premises) 11 Purveyors manufacturing and retailing their own productions (made on domestic premises) Nil In 1948, the Council delegated to the Public Health Committee, its powers and duties under Section 158 of the Essex County Council Act, 1933, and Section 77 and 80 of the Ilford Corporation Act, 1937, with regard to the granting, refusal or revocation of registrations, including the duty of interviewing applicants who are required to show cause why applications for registration should not be refused or existing registration should not be revoked. (12) 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. From 5th July, 1948, this Section was replaced by Section 47 of the National Assistance Act, 1948. (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 32 persons (concerning 10 premises), but refused in 6 cases on account of the unsuitability of the proposed storage premises. Legal proceedings were taken against 7 persons for selling goods without being registered and for failing to have their names and addresses legibly inscribed on their barrows contrary to the provisions of Sections 77 and 78 of the Ilford Corporation Act. In each case the defendants were convicted and fines totalling £16 10s. and £1 1s. costs were imposed. (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, Two applications for registration were received during 1948, both of which were granted. (13) Shops Acts, 1912-1934 (Sections 10 and 13). Since this Act came into operation the Sanitary Inspectors have made inspections in accordance with Sections 10 and 13 (3). 19 During the year, 3,274 inspections were made, 14 Preliminary Notices were served, 13 of which were complied with and 2 Statutory Notices were served, both of which were complied with. 7 Preliminary Notices served in 1947 were also complied with. No Certificates of Exemption from the provisions of sub-Sections 2 and 4 of Section 10 were granted in 1948. 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. (14) Nurses Act, 1943 (Part 2). Nurses' Agencies. The Essex County Council, on application by the Ilford Council, delegated to them, in pursuance of Section 11 (1) the powers conferred upon the County Council by Part II of the Act, subject to certain conditions. During 1948 a licence was granted to one Nurses' Agency in Ilford; such licence expires on the 31st December, 1949. Agencies are inspected before the issue of a licence, and thereafter at intervals of not more than once a quarter. A letter of warning was sent to the Agency in reference to two irregularities which had occurred in the conducting of the Agency. 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.—189 beds are provided. Of this number 19 are permanently maintained for the treatment of advanced cases of pulmonary tuberculosis. Thirty-two of the remaining beds were allocated for the reception of tuberculosis patients during the year. Maternity Hospital.—51 beds for the reception of maternity cases are maintained at the Ilford Maternity Hospital. King George Hospital.—The following is a return in respect of bed accommodation:— Total number of Beds at 31st December, 1948. Private Patients. Other Patients. Children. Medical. Surgical. Male. Female. Male. Female. 207 21 26 18 55 55 32 The above three hospitals are now included in the Ilford and Barking Group. (Group 12 N.E. Metropolitan Regional Hospital Board). Maternity and Nursing Homes.—On the 1st January there were 3 private registered Nursing Homes in the district, 1 for medical and senile cases, and 2 for maternity cases. On 31st December there were 3 private registered Nursing Homes, 1 for medical and senile cases, 1 for medical and surgical cases and 1 for maternity cases. 20 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. Four letters were sent calling the attention of the keepers of the homes to sanitary defects. Mental Hospitals.—There are two large Mental Hospitals in the district, the Goodmayes Hospital, with 1,224 patients (males 550, females 674), and Claybury Hospital, with 2,244 patients (males 968, females 1,276) in residence on 30th June, 1948. Since 5th July, 1948, these Hospitals are in Groups 21 and 20 respectively of the North East Metropolitan Regional Hospital Board. Other Institutions.—Girls' Village Homes, one of the late Dr. Barnardo's Institutions; with 29 children in the Hospital on 30th June, 1948. (vi) Ambulance Facilities.—The Council maintained an adequate ambulance service. This was under the control of the Council from 1st January to 4th July when it was taken over by the Essex County Council under Section 27 of the National Health Service Act, 1946. (a) Infectious Diseases.—Two motor ambulances were provided for the conveyance of cases to the Isolation Hospital; one new ambulance came into service during the year. These were housed in the garages at the Isolation Hospital. (b) Non-Infectious and Accident Cases.—Five vehicles were provided. Four crews were held available, shifts being so arranged that four ambulances were held in readiness during the daytime hours and two between 10 p.m. and 8 a.m. There was a steady increase in the number of calls on the service. Between 1st January and 4th July the ambulance service dealt with 2,292 calls representing a travelling distance of 19,208 miles. The service was available for street accidents, emergency illness, hospital evacuation cases and for private removals of residents and non-residents. A scheme existed whereby support was given to other Authorities when occasion demanded, this being a reciprocal agreement between Ilford and the neighbouring areas of Dagenham, Barking and East Ham. The service is now entirely free of charge, and operates from Clarks Road Depot, High Road, Ilford. (vii) Clinics and Treatment Centres: Maternity and Child Welfare.—Infant Welfare Centres are held at the following premises:— Holy Trinity Church Hall, Mossford Green, Barkingside (for residents of Barkingside area) Monday, 2 p.m. Chadwell Christian Mission Hall, Essex Road, Chadwell Heath (for residents of Chadwell Heath area) Monday, 2 p.m. Mayesbrook Clinic, Goodmayes Lane, Goodmayes (for residents of Becontree area) Tuesday, 2 p.m. St. John's Church Hall, Devonshire Road, Seven Kings (for residents of Downshall area) Tuesday, 2 p.m. Congregational Church Hall, Woodford Avenue, Ilford (for residents of Woodford Avenue area) Wednesday, 2 p.m. Cecil Hall, Granville Road, Ilford (for residents of the north side of Cranbrook Road) Wednesday, 2 p.m. Cecil Hall, Granville Road, Ilford (for residents of the south side of Cranbrook Road) Thursday, 2 p.m. 21 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 Hospital, Eastern Avenue, Ilford, on Tuesday (Obstetric Specialists' Clinic), Wednesday, Thursday, Friday and Saturday mornings, and on Tuesday, Wednesday, Thursday and Friday afternoons and at the Mayesbrook Clinic, Goodmayes Lane, on Monday and Thursday mornings. Post-Natal Clinics.—These Clinics are held at the Maternity Hospital 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 Clinic, Goodmayes Lane, for— Minor Ailments. Dental (Children and Expectant Mothers). Ophthalmic treatment. Artificial Sunlight treatment. Ante-Natal and Post-Natal. Diphtheria Prevention. Orthopaedic and Remedial Exercises treatment. Infant Welfare. (iv) Valentines School, Beehive Lane, for— Dental (Children and Expectant Mothers). Speech Therapy. Tuberculosis Dispensary.—A dispensary is provided by the North East Metropolitan Regional Hospital Board 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. 22 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 2,576 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 1948 was 1,425 yards of 4-inch. The water to the other part of the area is supplied by the South Essex Waterworks Co. The supply is obtained from the River Stour and from deep wells at Mill Road, Grove Road and Roding Lane. Mr. Hugh G. Ramsay, Engineer to the South Essex Waterworks Co., has kindly supplied me with the information that over 3,300 chemical, bacteriological and biological examinations were made at the Langham laboratory, and all were reported as wholesome. The samples taken were from wells and houses in various parts of the area. The length of mains laid by the South Essex Waterworks Co. in Ilford during 1948 was 24 yards of 4-inch, and 487 yards of 6-inch. There are now no public wells in existence. There are a few private wells for commercial purposes. 4 samples of piped water supply (2 South Essex Waterworks Co. and 2 Metropolitan Water Board) were taken for chemical and bacteriological examination, and all gave satisfactory analyses. (ii) Drainage and Sewerage. Survey of Main Trunk Sewers.—The Borough Engineer has*kindly supplied me with the following statement:— (a) Foul Water—Main Drainage Scheme.—Reference was made in my report last year to a comprehensive report then being prepared by the Borough Engineer on proposals to reconstruct the main trunk sewers in the Borough so as to enable them to deal with the increased flow resulting from building development both past and to be anticipated. This report has now been presented to the Council and has received approval. Details are now being prepared of the first section of the scheme and negotiations are about to commence with the Port of London Authority regarding storm water overflows into the River Roding which forms an important part of the scheme. On completion of these negotiations, this portion of the scheme will then be submitted to the Ministry of Health for approval for loan sanction, a stage which it is hoped to reach within the current year. (b) Surface Water—Main Drainage Scheme.—A comprehensive scheme to improve the main watercourses and main sewers discharging into the watercourses was referred to in my last report and that portion of the scheme which dealt with the Hainault Area of the Borough is now before the Ministry of Health for the purpose of obtaining loan sanction. 23 Certain legal difficulties have arisen regarding the right of the Corporation to expend money on the culverting of the main watercourses and some delay in progressing with that portion of the scheme will result. (iii) Collection and Disposal of Refuse.—The Borough Engineer has kindly supplied me with the following information:— Tons The total amount of refuse collected 40,908 „ „ disposed of by barge 34,859 „ „ „ at Destructor 6,049 Collection of Salvage:— Weight collected 2,685 tons. Value £10,440 (iv) Sanitary Inspection of the Area.—The following is a summary of the work of the Sanitary Inspectors during the year:— Houses and premises inspected 16,839 Houses and premises reinspected (works in progress) 27,631 Visits during disinfection 1,096 Houses in which nuisances were detected 3,032 Houses in which nuisances were abated 3,823* Premises disinfected 589 Premises from which articles only disinfected 83 Articles disinfected 2,642 Premises disinfested for verminous conditions 22 *Includes 1,559 nuisances detected before 1st January, 1948. Notices served:— Complied Statutory:— Served with Public Health Act, 1936 224 144 Housing Act, 1936 78 30 Factories Act, 1937 6 3 Shops Act, 1934 2 2 Provide Dustbin (Ilford Urban District Council Act) 57 47 Food and Drugs Act, 1938 6 5 Cleanse Water Storage Cistern (Byelaws) 2 — Cover Water Storage Cistern (Byelaws 5 1 Informal 3,048 2,306 3,428 2,538 In addition to the above, 1,663 notices (163 statutory and 1,500 informal) served previous to 1st January, 1948, were also complied with. Complaints.—During the year, 3,237 complaints of nuisances have been received and investigated. The following is a summary:— Accumulation of manure and refuse 84 Animals improperly kept 24 Bad smells 58 Dampness of premises 190 Defective drains, w.c.'s and fittings 412 Defective roofs, gutters, downpipes, etc. 372 Defective water fittings 103 Dirty and verminous houses 90 Dirty condition of rearway 5 Flooding of premises 8 Overcrowding 356 Smoke nuisances 26 Miscellaneous 1,509 Total 3,237 24 (v) Swimming Baths and Pools.—Samples of water for examination were taken from the open-air swimming bath from April to October (7). The samples were satisfactory, but in one sample the chlorine content was above, and in three samples below, the prescribed standard. Samples were also taken from the two indoor baths during January, March, April, May, June, July, August, September and October (16); all of the samples were satisfactory, but in 1 sample (from the 2nd class) the chlorine content was below the prescribed standard, and in 4 samples (1 from the 1st and 3 from the 2nd class) the chlorine content was above the prescribed standard. (vi) Eradication of Bed Bugs :— Found to be infested 27 House Disinfested 26 (vii) Slaughter of Animals Act, 1933.—No licence to act as slaughterman was granted during the year. (viii) Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920 and 1933.—The Chief Sanitary Inspector is authorised by the Council to make visits and certify under the provisions of the Acts. No Certificates were issued in respect of premises during 1948. (ix) 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. (x) Smoke, etc., Abatement.—Complaints were received of alleged smoke nuisances from 2 factories in the Ilford Lane area, 1 at Newbury Park, and a canteen at Redbridge. Regarding the factories at Ilford Lane, the complaint concerning one could not be substantiated, but in the other instance a Statutory Notice was served for the abatement of the nuisance. At the Newbury Park factory, in spite of plant alterations by the company, the nuisance has recurred and action is being taken for its abatement. In the case of the canteen at Redbridge the nuisance was abated as a result of informal action. (xi) Under Section 25 of the Burial Act, 1857, two exhumation licences were issued by H.M. Home Office in 1948, and in accordance with the recommendations of the Ministry of Health an officer of the Public Health Department was present to ensure that the conditions of the licences, with regard to due care, attention to decency, liming, etc., were satisfactorily carried out. (xii) During 1948, a person was detected exchanging day-old chicks in return for rags received from a child under the age of 14 years. Legal proceedings were taken against the rag dealer in respect of the contravention of Section 154 of the Public Health Act, 1936. The case was dismissed under the Probation of Offenders Act on payment of £1 Is. costs. SECTION D.—HOUSING. (i) Overcrowding.—No notices were served during 1948. (ii) Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. 25 (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) 3,354 (b) Number of inspections made for the purpose 16,809 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 100 (b) Number of inspections made for the purpose 2,384 (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 3,030 2. Remedy of defects during the year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,704* 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 78 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 110* (b) By local authority in default of owners 7* B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 286 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 263* (b) By local authority in default of owners —* 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 394 (ii) Number of families dwelling therein 452 (iii) Number of persons dwelling therein 1,522 (6) Number of new cases of overcrowding reported during the year 199 26 (c) (i) Number of cases of overcrowding relieved during the year 48 (ii) Number of persons concerned in such cases 180½ (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report — *Includes compliances during 1948 of Notices served prior to 1st January, 1948. HOUSING ACT, 1936. During the year 1948 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 have been received in respect of 16,234 houses. At the end of the year the total certificates issued to date numbered 18,165 in respect of 24,795 houses. As new premises were constructed and placed upon the rating lists, these lists were obtained and survey forms sent with a view to the issue of "permitted number" certificates, and in all, new premises (not enumerated under the 1935 survey) have been dealt with to the extent of 9,131. SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) Persons and Premises registered as at 31st December, 1948:— 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 14 272 inspections of dairies, milkshops, cowsheds and other premises where milk is sold were carried out during the year. 86 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 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. 27 (ii) Licences were granted under the Milk (Special Designations) Regulations, 1936 to 1946, during 1948 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 1948. (iii) Sampling.—The following is the routine practice adopted:— Designated Milks.—These are sampled bi-monthly and after unsatisfactory reports. Ungraded Milks.—Samples of these milks are taken from all registered purveyors quarterly and repeated after unsatisfactory results. Biological Tests.—Samples of all milks, designated or otherwise, are submitted for biological test for T.B. in Spring. Repeat samples if positive after clearance by County Medical Officer. Milk Supplies to Elementary Schools.—These are sampled monthly and after unsatisfactory results. Ice Cream.—Samples are taken monthly from April to September and at regular intervals during the winter months from all local manufacturers, tricycle salesmen and local retailers. Samples are repeated after unsatisfactory results. The Heat-Treated Milk (Prescribed Tests) Order, 1944, prescribes two tests, a phosphatase test for adequate heat-treatment and a methylene blue test for keeping quality. The Order defines temperatures at which samples must be kept both before reaching the laboratory and before the test and stipulates the hours during which the test must be conducted. 28 The following results were obtained: Grade of Milk or Ice Cream Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested 2 2 - - Tuberculin Tested (Pasteurised) Milk 14 14 - - Tuberculin Tested (Certified) Milk. 12 10 2 Both samples failed to satisfy the Methylene Blue Reduction test and one failed to satisfy the Coliform Test. The County Medical Officer was communicated with in each case. Pasteurised Milk 68 65 3 All samples failed to satisfy the Phosphatase test. The retailers were communicated with and resampling ordered at a later date. Further samples proved satisfactory. Heat-Treated Milk 25 24 1 The sample failed to satisfy the Phosphatase test. The retailer was communicated with and further samples proved satisfactory. Ungraded Milk 62 59 3 One of these samples was of milk as received from farms in Essex and had high bacterial and B. Coli content. Representations were made to the C.M.O. on the matter. Of the other 2 samples one failed to satisfy the Methylene Blue Reduction test, and both had high Bacterial or B. Coli contents. The retailers were communicated with and resampling was ordered. Further samples proved satisfactory. Ice Cream 92 78 14 In three cases supplies were received from outside the Borough, and the local Medical Officers of Health were communicated with. In the other cases the retailers were communicated with and the Sanitary Inspectors visited the premises to check the arrangements for storage, etc. Further available samples proved satisfactory. (iv) Biological Tests.—30 samples of milk were submitted to a biological test for tuberculosis, none of which was found positive. 29 (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 no cows were found to be suffering from tuberculosis. (vi) Legal Proceedings.—16 complaints of the presence of foreign bodies in milk were received and investigated during 1948. Legal proceedings were taken in 6 cases, involving 2 firms. One was fined a total of £105 in respect of 5 cases, and the other was fined £20 and £2 2s. costs in respect of one case. (vii) Registration.—No application for registration was refused during 1948. Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Baking Powder—184 lbs.; Biscuits—17 lbs.; Butter, Margarine and Cooking Fat—4 lbs. 10 ozs.; Cereals—9 cwt. 84½ lbs., 141 packets and 39 tins; Cheese—184¼ lbs.; Confectionery—88¾ lbs. and 136 packets; Chocolate—155½ lbs. and 1,301 bars; Cake—89 lbs.; Cake and Pie Fillings—159 lbs.; Cocoa—35 lbs.; Coffee—17½ lbs. and 3 bottles; Chocolate Spread—2 packets; Cordials—2 bottles; Eggs (shell)—1,270; Eggs (dried)-—27 packets; Fish (wet)—37 cwt. 52½ lbs.; Fish (tinned)— 1,131 tins; Fish (cakes)—17; Fish (paste)—402 jars; Fish (shell)—66 lbs., 1 case, and 11 gallons; Fruit (tinned)—713 tins; Fruit (bottled)—10 bottles; Fruit (dried)—220½ lbs. and 99 boxes; Flavourings—1 bottle and 12 tins; Foods (medicinal)—8 jars, 30 tins and 36 lbs.; Gelatine— 10 lbs.; Gravy Mixtures—2 bottles and 5 packets; Jam, Preserves, Jellies, etc.—510 tins, 10 jars and 6 packets; Meat (dehydrated)—342 lbs.; Meat (fresh)—1 ton, 15 cwts. 83½ lbs.; Meat (tinned)—1,931 tins; Meat (paste)—19 jars; Meat (pies)—90; M.O.F. Emergency Rations—372 tins; Milk (dried)—3 tins; Milk (tinned)—1,999 tins; Puddings—7 tins; Pudding (black)—113½ lbs.; Poultry—22½ lbs.; Pickles—1,992 jars and 235 tins; Pudding Mixture—77 packets and 87 lbs.; Rabbits—18; Soups (tinned)—117 tins; Soups (powdered)—21 lbs.; Suet—29 lbs.; Sugar—550¼ lbs.; Salt—9 packets; Salad Dressing—2 jars and 1 bottle; Spices—65¼ lbs.; Tea—37¼ lbs.; Vegetables (tinned)—1,370 tins; Vegetables (dried)—26 lbs.; Vinegar—1 bottle; Yeast (dried)—65 lbs. Foreign Bodies in Food. 12 complaints were received during 1948 of the presence of foreign bodies in foodstuffs. All were investigated and letters of warning served in 4 cases. Food and Drugs Act.—During 1948, 344 samples (340 formal and 4 informal) of Food and Drugs were obtained; 4 formal samples and 2 informal samples were not satisfactory as follows:— (a) Milk (formal).—The sample was found to be deficient in milk fat to the extent of 7 per cent. of the normal quantity proper to natural milk. A letter of warning was sent to the retailer concerned. (b) Milk Powder (informal).—The sample did not reconstitute into a satisfactory milk in that it rapidly settled out on standing and curdled on heating, and had a strong acid taste. Analysis showed that the acidity, in terms of lactic acid, amounted to 4.35 per cent. The stock of milk powder, at a canteen of the Schools Meals Service, was condemned. (c) Gin (formal).—The sample was found to have a strength of only 39.5 degrees Under Proof which corresponded to a dilution with 6½ per cent. of water. 30 Legal proceedings were taken against the publican, but the case was dismissed under the Probation of Offenders Act, on payment of £10 10s. costs. (d) Pure White Oil for Sponge Mixture (formal).—The sample consisted of a light paraffin oil having no real food value, but not unfit for human consumption. The analyst considered that the use of mineral oil for cooking purposes was to be deprecated. Representations were made to the Ministers of Food and Health on the matter and an Order, the Mineral Oil in Food Order, 1949, has now been made prohibiting the use of mineral oils in food. The sale of the oil was immediately discontinued by the retailer. (e) Iodised Table Salt (formal).—The sample contained 335 micrograms per ounce of iodine, whereas it was stated to contain 540 micrograms of iodine per ounce. The analyst considered that the loss of iodine probably occurred in storage, and that the matter was one for discussion with the manufacturers. This procedure was adopted. (f) Bread (informal).—The sample was submitted for investigation of the extraneous matter contained therein. Examination showed that the matter was mouse excretion but no evidence of the presence of any living B. Coli organisms was found on bacteriological examination. A letter of warning was sent to the firm concerned. 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. It is also notifiable under Section 17, Food and Drugs Act, 1938. Thirty-eight notifications were received. No. of outbreaks No. of cases No. of deaths. Organisms or other Agents responsible with No. of outbreaks of each. Foods involved with No. of outbreaks of each. 7 38 Nil Salmonella Enteritidis dublin 1 Tinned beans 1; fish 2; Duck eggs 2; sausages 1; sausage meat 1. Salmonella Typhimurium 4 Presumedenterotoxin 2 In 16 notified cases the diagnosis was not substantiated by bacteriological investigation. Eight other instances of suspected food poisoning were investigated, but no definite evidence as to the cause was found. All the persons affected recovered. Bakehouses.—There are 38 bakehouses in the district, 31 of which use motive power. 255 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 7 instances, and the requests were complied with in all but 2 cases. Meat and Other Foods.—During 1948, 3,323 inspections were made of foodshops and food preparing premises, 6 Formal and 63 Informal Notices were served under the Food and Drugs Act, 1938, and 7 Formal and 64 Informal Notices were complied with, including 2 Formal and 18 Informal Notices served in 1947. 31 Diseases of Animals Acts, 1894-1937. (i) Foot and Mouth Disease.—No outbreaks, affecting the Borough, occurred during 1948. (ii) Swine Fever Order, 1938.—No cases of Swine Fever occurred in the Borough during 1948. (iii) Live Poultry (Regulations of Sales, Exhibitions and Movements) (No. 3) Order, 1948.—This Order deals with the requirements necessary to prevent the spread of Fowl Pest by controlling the movement and sale of poultry. No cases of Fowl Pest were notified during 1948. (iv) Sheep Scab (Amendment) Order, 1948.—This Order substitutes single dipping in place of double dipping provided an approved "Singledipping" type sheep dip as defined in the Order is used. Rats and Mice Destruction Act, 1919.—155 complaints have been received of the existence of rats affecting 162 premises. In 30 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 750 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 11 petroleum appliances or fittings. The number of Licences issued was 121, and the fees paid to the Council for such Licences was £92 5s. One Licence was issued for the storage of calcium-carbide, the fee payable being 5s. Legal proceedings were instituted against a Company in connection with the unlicensed storage of petroleum. A fine of £5, plus £2 2s. costs, was imposed. Examination of Officers, Teachers and Servants. The following medical examinations were carried out during 1948:— Officers Teachers Servants New Appointments 223 2 32 Under Sickness Regulations 5 — 35 Totals 228 2 67 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 Membranous Croup. Authority as from 1/4/22). Erysipelas. Pemphigus Neonatorum (made notiScarlatina or Scarlet Fever. fiable by Local Authority as from Typhus Fever. 29/6/29). 2. Under Regulations of the Ministry of Health. Plague L.G.B. Order, 19/9/1900. Puerperal Pyrexia The Puerperal Pyrexia Regulations, 1939. Cerebro-spinal Fever P.H. (Cerebro-spinal Fever and Acute Acute Poliomyelitis Poliomyelitis) Regulations, 1912. Ophthalmia Neonatorum P.H. (Ophthalmia Neonatorum) Regulations, 1926. Acute Primary and Acute Influenzal Pneumonia P.H. (Pneumonia, Malaria, Dysentery, Dysentery etc.) Regulations, 1927. Malaria P.H. (Acute Encephalitis Lethargica and Actue Polio-encephalitis Acute Polio-encephalitis Regulations, Encephalitis Lethargica 1918. Tuberculosis P.H. (Tuberculosis) Regulations, 1930. Acute Rheumatism (up to 16 Ilford (Acute Rheumatism) Regulations, years) 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. u> ux TABLE III.—Cases of Infectious Diseases Notified during the Year 1948. 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 304 2 87 199 10 6 - - 20 16 18 17 27 23 34 44 22 19 31 33 185 Diphtheria, including Membranous Croup 16 - 3 8 3 2 - - 1 - 1 6 2 - 2 - 2 - 2 - 16 Enteric Fever (Typhoid and Para-Typhoid) 2 - - 1 - 1 - - - - - 1 - - - 1 - - - - 2 Pneumonia 198 17 25 24 5 39 44 44 5 24 9 12 17 24 10 18 22 20 13 24 100 Puerperal Pyrexia 43 — — — 12 31 - - - - - 1 1 - - - - 38 1 2 43 Cerebro-Spinal Fever 7 4 3 — - - - - 1 1 1 - 1 - - - 1 2 - - 7 Acute Poliomyelitis 4 — 1 1 1 1 - - - - 1 - 1 1 - - 1 - - - 4 Acute Polio-Encephalitis - - - - - - - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - Dysentery 5 - 2 - 1 - - 2 - 1 - - 1 - - - 1 - 2 - 2 Ophthalmia Neonatorum 4 4 - - - - - - - 1 1 1 - - - - - 1 - - 3 Erysipelas 48 1 - - 2 11 25 9 2 5 4 3 2 4 2 6 9 5 4 2 14 Pemphigus Neonatorum 3 3 - - - - - - - 1 - - - - - 1 - 1 - - 1 Tuberculosis Pulmonary 255 - 3 19 67 101 54 11 23 20 29 15 23 28 17 19 16 22 14 29 - Other Forms 24 - 3 3 8 5 3 2 - 2 1 3 1 3 2 3 1 4 2 2 - Anthrax - - - - - - - - - - - - - - - - - - - - - Malaria—Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - Believed contracted abroad - - - - - - - - - - - - - - - - - - - - - Acute Rheumatism 16 - 1 15 - - - - - 1 1 - - 4 1 2 1 2 2 2 10 Measles 2,937 96 1,413 1,406 9 11 2 - 118 213 198 214 261 232 392 313 171 166 321 338 39 Whooping Cough 1,061 95 548 405 3 7 3 - 66 29 58 86 78 69 106 176 105 76 105 107 18 Food Poisoning 38 — 8 5 3 14 6 2 7 4 — — 2 7 - - 6 1 8 3 14 Totals 4,965 222 2,097 2,086 124 229 137 70 243 318 322 359 417 395 566 583 358 357 505 542 468 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 60.8 Diphtheria and Membranous Croup 100.0 Puerperal Pyrexia 100.0 Pneumonia 55.5 The total number of deaths of Ilford residents from the following infectious diseases during 1947 and 1948 were as follows:— 1947 1948 Scarlet Fever — — Enteric Fever — — Diphtheria 1 — Measles 1 — Whooping Cough 2 — Influenza 20 8 Tuberculosis—Pulmonary 65 62 Other forms 10 7 Pneumonia 68 50 Diarrhoea (under 2 years) 6 1 Cerebro-spinal Fever 1 3 Puerperal Sepsis — — Total 174 131 The year 1948, on the whole, showed a higher incidence of infectious disease than 1947. The number of cases of measles notified was 2,937 as compared with 2,232 the previous year. (a) Smallpox.—No cases were notified during 1948. Notifications regarding 8 persons who had been in contact with cases of Smallpox on the Continent were received. These were visited by the Sanitary Inspectors, 64 visits being paid. The following gives particulars as to Vaccination during 1948: — Certificates of Successful Vaccination 690 Postponed 18 Conscientious Objections 297 Unsuccessful Vaccination 20 Left the District 119 The above figures are for the period 1st January to 4th July only. Under the National Health Service Act, 1946, compulsory vaccination was abolished, and from 5th July, 1948, this service became the responsibility of the Essex County Council vide Section 2 of the National Health Service Act, 1948. (b) Scarlet Fever.—304 cases were notified in 1948. 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. 1944 278 193 3 1.5 85 1 1.2 1945 225 166 7 4.2 57 1 1.7 1946 242 180 7 3.8 61 4 6.5 1947 201 144 4 2.8 57 — — 1948 304 183 3 1.6 119 1 .8 35 (c) Diphtheria.—16 cases were notified in 1948. Fifteen cases were admitted to the Ilford Isolation Hospital and one to the Eastern Hospital, Homerton, E. Fourteen were true cases of Diphtheria, one was a "carrier" case, and one a case of tonsillitis. There were no deaths from this disease. (d) Ophthalmia Neonatorum.—4 cases were notified during 1948. Of these 1 was treated at home by a private medical practitioner; 2 at the Isolation Hospital; and 1 at White Oak Hospital, Swanley. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 4 1 3 4 — — — (e) Enteric Fever.—Two cases of this disease were notified during the year a female child of 8 years and an adult male of 28 years. The child proved to be a case of Paratyphoid fever "B". The adult male was a case of Typhoid fever. The patient, a cafe proprietor, had contracted the infection abroad. Both patients were admitted to the Isolation Hospital and made satisfactory recoveries. (/) Acute Anterior Poliomyelitis.—Four cases of this disease were notified during 1948. Three male patients aged 2, 13 and 33 years, and one female patient aged 20 years. All were admitted to the Isolation Hospital. The three male patients were all severe cases, being in hospital for 82, 105 and 124 days respectively. In the instance of the patient aged 13, transfer to a Special Orthopaedic Unit for further treatment of extensive paralysis of arms and legs was arranged. The patient aged 33 years had slight residual paralysis affecting the leg and abdominal muscles, for which treatment was continued at the physiotherapy clinic. The child aged 2 years developed grave respiratory paralysis upon which extensive pneumonia supervened. It was initially necessary to treat him in a "Both" mechanical respirator and later the chest condition demanded the simultaneous use of an oxygen tent. The necessary mechanical improvisation was made by Messrs. Oxygenaire, Ltd., and a complete recovery, apart from slight weakness of the right arm, ensued. Continuation treatment for this was arranged at the physiotherapy clinic. The female patient was a mild case and was only in hospital for 21 days, recovering completely with no residual paralysis. The "Both" mechanical respirator (better known as the "Iron Lung") again proved its value in treatment of two cases. By courtesy of the Borough Council and through arrangements made with the Central Office for Information, the Ministry of Health film "Poliomyelitis—Diagnosis and Management" was shown in the Lambourne Room, Town Hall, Ilford, on 20th July to the general practitioners of the Stratford Division of the British Medical Association. The Chairman of the Public Health Committee was present. 36 Table showing Incidence of Infectious Disease, 1948 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 304 2 9 13 29 36 173 26 6 8 2 - - 185 - Diphtheria 16 - — 1 1 1 5 3 3 — 2 - - 16 - Enteric Fever (including Para-typhoid) 2 - - - - - 1 - - 1 - - - 2 - Pneumonia 198 17 6 8 6 5 21 3 2 17 25 44 44 108 50 Puerperal Pyrexia 43 — — — — — — — — 36 7 — — 43 — Cerebro-spinal Fever 7 4 2 1 - - - - - - - - - 7 3 Acute Poliomyelitis 4 — 1 — — — — 1 — 1 1 — — 4 1 Acute Polio-Encephalitis - - - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - - - Dysentery 5 - - 1 1 - - - - 1 - - 2 2 - Ophthalmia Neonatorum 4 4 - - - - - - - - - - - 3 — Erysipelas 48 1 — — — — - — 1 6 6 25 9 14 — Anthrax — — — — — — - - - - - — — — — Malaria believed to be contracted in this country - - - - - - - - - - - - - - - Malaria believed to be contracted abroad - - - - - - - - - - - - - - - Pemphigus Neonatorum 3 3 - - - - - - - - - - - 1 — Acute Rheumatism 16 — — — — 1 6 8 1 — — — — 10 — Food Poisoning 38 — 2 2 1 3 4 1 - 6 10 6 3 14 — Measles 2,937 96 316 336 363 398 1,362 44 4 14 2 2 - 39 — Whooping Cough 1,061 95 110 146 148 144 400 5 2 5 3 3 — 18 - * Excludes cases occurring at Barnardo's Homes, Claybury Hospital and Goodmayes Hospital. 37 Influenza and Pneumonia.—These diseases showed a lower incidence in 1948 as compared with 1947. The winter of 1948 was comparatively mild. The incidence of influenzal and primary pneumonia and the fatality rates throughout the year is shown by the following table. Month, 1948 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 1 - 9 - 9 2 2 — 2 — 3 — February 2 — 7 — 12 — 2 — — — 7 2 March 5 — 5 1 6 2 1 —- 1 — 6 — April 1 — 1 — 8 — 5 2 1 — 2 — May 10 1 2 — 4 — 3 — — — 2 — June 2 — 1 — 2 — 1 — — — 1 — July 2 — 1 - - - - - - - - - August 1 — — — 1 1 — — — — 1 — September 3 — — — 2 — — — — — — — October — — 2 — 1 1 1 — — — 1 — November 8 - 4 1 6 1 1 — — — 2 — December 9 1 9 1 7 1 3 — 2 — 5 — Totals 44 2 41 3 58 8 19 2 6 — 30 2 It will be seen from the above figures that of 143 persons notified as suffering from acute primary pneumonia there were 13 deaths, equal to 9 0 per cent.; and in the case of acute influenzal pneumonia 55 notifications with 4 deaths, equal to 7.2 per cent. Of the 198 persons notified 63 were admitted to the Isolation Hospital, equal to 31.8 per cent. Of this number 4 persons died, equal to 6.3 per cent. Tuberculosis.—During the year 1948 there were 255 new notifications of Pulmonary Tuberculosis and 24 of other forms of Tuberculosis. 11 cases of Pulmonary and 2 cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notifications and Deaths from Tuberculosis of Ilford residents during 1948:— Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - - - - - - - - 1-5 years 1 2 2 1 1 — 1 — 5-15 9 10 2 1 — 1 — 2 15-25 37 30 4 4 3 6 2 — 25-35 26 35 3 — 7 4 — — 35-45 25 15 1 1 3 3 — — 45-55 29 8 - 3 10 3 — 1 55-65 13 4 — — 11 1 — 1 Over 65 10 1 — 2 9 — — — Totals 150 105 12 12 44 18 3 4 38 Of the foregoing new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 8 3 Claybury Hospital 1 1 Goodmayes Hospital 10 — Ilford Isolation Hospital and Sanatorium 1 1 Of the 69 deaths which occurred of Ilford residents, notification had previously been made of 63 of the cases. Of the other six, one was notified after death, in one instance notification was overlooked (1.4 per cent.), and in 4 instances the presence of tuberculosis was discovered at Post Mortem examination. During the year 1948 the following deaths occurred from Tuberculosis:— Pulmonary Non-Pulmonary Ilford Residents 62 7 Non-Residents— Claybury Hospital 15 — Goodmayes Hospital 5 — Ilford Isolation Hospital 16 1 King George Hospital 1 1 Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1948 1,072 218 1,290 Number of cases entered on register during the year 266 26 292 Number of cases removed from the register during the year:- Pul. NonPul. Pul. NonPul. Total. Recovered 34 20 Deaths 79 4 Left District 55 11 Lost sight of 6 — Diagnosis not established 5 - 179 35 214 Number of cases remaining on register on 31st December, 1948 1,159 209 1,368 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurses. 1,094 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. Condition Improved. (a) Good 63 30 (b) Moderate health 40 6 Condition Stationary. (a) Good 389 85 (b) Moderate health 137 16 (c) Poor health 26 1 Condition Deteriorated 19 2 In Sanatorium 95 3 No information as to present condition 35 6 Removed from district, etc. 125 16 929 165 39 The treatment of Tuberculosis is now under the control of the Regional Hospital Board. On the 31st December, 1948, there were 1,204 patients on the register of the dispensary. The arrangements 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. 119 patients were treated, 22 being supplied with dentures. The Dentist treated 15 tuberculosis patients from the Ilford Sanatorium, six visits being paid to the Sanatorium. The number of patients from Ilford sent to Institutions under the Tuberculosis Scheme during 1948 was as follows:— Pulmonary Non-Pulmonary Total Males Females Males Females Adults 74 67 7 4 152 Children 2 3 — 2 7 Tuberculosis Care Association.—This Association has assisted 124 cases with extra nourishment, clothing, and in other ways. Public Health Act, 1936 (Section 163).—No certificates in respect of the death of patients were issued, stating that bodies should not be removed from hospital except for the purpose of being buried forthwith. Insulin.—On 4th January, 1943, a Circular (No. 2734) was issued by the Ministry of Health under the Public Health Act, 1936, authorising Local Authorities to assist the poorer inhabitants of the district with supplies of Insulin. Twenty-six. persons were assisted during 1948 with the Insulin required. Sixteen persons were assisted at part cost, five at cost price, and five free of charge. Insulin is now provided under the terms of the National Health Service Act, 1946. 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 - - - 1 3 Locomotor Ataxy - - - - - - - - - - - - - General Paralysis of the Insane - - - - - - 1 — - - - 1 2 Aortic Aneurysm — — — — — — — — 1 — — — 1 40 The deaths in Institutions of Ilford non-residents occurred chiefly at Claybury and Goodmayes Hospitals; 1.4 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 these Mental Hospitals was some venereal infection. The following figures show the number of cases of Ophthalmia Neonatorum notified during the past five years:—1944, 4; 1945, 3; 1946, 5; 1947, 11; 1948, 4. 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 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. Whitechapel.—Whitechapel Clinic, Turner Street, Mile End, London, E. 1:— Sessions Monday to Friday, 10 a.m. to 7 p.m. Saturday, 10 a.m. to 3 p.m. West Ham.—Queen Mary's Hospital, West Ham Lane, Stratford, London, E.15:— Sessions (Males) Monday, 3 to 5 p.m. Thursday, 11 a.m. to 1 p.m., and 6 to 8 p.m. Saturday, 2.30 to 4.30 p.m. (Females) Monday, 6 to 8 p.m. Thursday, 11 a.m. to 1 p.m., and 3 to 5 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 and Church organisations, etc., on health topics were given during the year. The Chairman of the Public Health Committee also made reference at a number of Council meetings to health subjects. Poster displays regarding Diphtheria immunisation and health topics were also given prominence. 41 FOOD AND DRINK HYGIENE CAMPAIGN AND EXHIBITION In view of the importance and seriousness of infection spread through the medium of contaminated foods and its alarming demands on manpower, research was carried out to ascertain the most comprehensive way in which the importance of clean handling of food could be brought to the attention of the inhabitants of the Borough. A report was received on the Food and Drink Infections Conference and Exhibition held by the Central Council for Health Education in October, 1947, giving details of material available for this form of health education. A detailed report on the main causes of Food and Drink Infections, the major diseases spread by such contaminated food and the precautions that should be taken to minimise such infection was prepared and presented, together with specimen posters and material that could be used in a local campaign, to a Committee formed to pursue the matter evolving a programme of lectures for all the food-handling trades and generally to further education in food hygiene. A visit was paid to the Health of the People Exhibition held in London, and arrangements were made to borrow display material from the Food and Drink Infections Section for a local exhibition. Posters and pamphlets were obtained from the C.C.H.E., including the Food-handlers leaflet, for circulation to all the Food-handling trades in the Borough and for display in the various canteens and restaurants and Public buildings. A Press Conference was held in April and the scheme outlined to representatives of the local newspapers who kindly gave Press Publicity to the project. Invitations were sent to representatives of the Food-handling trades to a meeting when the campaign was discussed and co-operation and suggestions requested. Circulation of the Food-handlers leaflets and posters presented by the British Tourist and Holidays Board to all Food-handling shops was made with the assistance of the Sanitary Inspectors. A coloured pamphlet was produced on food contamination, describing some of the causes and their effects with suggestions for their prevention illustrated by 12 two-coloured drawings. 40,000 of these were circulated by the Corporation's Refuse Department to all householders in the Borough. Local General Practitioners were circularised individually, acquainting them with details of the campaign and requesting their co-operation. A supply of leaflets was sent to each for distribution to patients requiring advice on food infection. Talks were given to the various trade organisations, including the Butchers, London Retail Meat Traders Association Inc., and representatives of the Ice Cream trade. Lectures were given to Supervisors and Cooks of the Provision of Meals and Civic Catering Services. Subsequent to the lectures and discussions with the various foodhandling trades in the Borough, I was requested and consented to write an article on Food and Drink Infections which subsequently appeared in the Essex County Federation of Master Bakers' 1948 Year Book. An Exhibition of Food and Drink Infections precautions was held for one week in October at the Dane Secondary School with the co-operation of the Borough Education Officer. Invitations were sent to a number of industrial firms in the Borough. 42 A programme was produced and circulated, giving details of the opening ceremony, exhibits and acknowledgments for assistance and loan of material. The material included a narrative sequence of photographs showing the investigation of an outbreak of Food Poisoning, enlargements of the descriptive wording and the coloured drawings from the leaflet circulated to householders, culture plates from dirty hands, sputum, soiled tea cloths and many other sources of infectious transmission, the correct and incorrect use of a food storage cupboard, a display stand demonstrating a technique for the sterilizing of babies bottles and charts and diagrams covering most aspects of Food and Drink infections. The Exhibition was opened by His Worship the Mayor, and the visitors attending included members of the Public Health Committee, representatives of the Ministry of Health, Ministry of Food, C.C.H.E., E.C.C., and various Boroughs, Chief Officers and other members of the Staff of Departments of the Ilford Borough Council. The Exhibition was favourably reviewed in the Local and National Press and in the Medical Journals. Requests were received for the Food Contamination leaflet, pamphlets, loan of charts and other material, and advice on exhibition organisation from Medical Officers in Singapore, Australia, South Africa and many "home" Authorities. These requests were complied with and many letters of appreciation were received. National Assistance Act, 1948.—Section 50 requires a Local Authority to arrange for the burial or cremation of a person who has died or been found dead, and where it appears to the Local Authority no suitable arrangements are being made for the disposal of the body. Provision is made in the Act for recovery from the estate of the deceased person or any person who for the purposes of this Act was liable to maintain the deceased immediately before his death of the whole or part of the expenses incurred. On the 1st March, 1949, the Ministry of Health issued a circular (No. 13/49), dealing more particularly with persons dying in hospital. The circular asks Hospital Committees and Boards to exercise their power to arrange burial where— (a) deceased patients' relatives cannot be traced; (b) those whose relatives are traceable but were not, immediately before the patient's death, liable for his maintenance under Section 42 (1) of the National Assistance Act and are not willing to arrange for the burial; and (c) those whose relatives are unable to obtain a death grant under the National Insurance Act, 1946, and cannot otherwise afford to arrange for burial. Where a "liable" relative fails to carry out his responsibility, Hospital Committees and Boards are advised to refer the matter to the Local Authority upon whom the duty rests under Section 50 of the Act, in view of the powers of recovery from the liable relative. Similarly, in the area of a County Council, the duty of burial or cremation rests with the County Council where the deceased person had been provided with accommodation under Part III of the Act. The burials of three deceased persons were dealt with up to the end of the year. They were :— (1) A widow, 89 years, who died in King George Hospital, lived in lodgings in one room. (2) A widow, 80 years, lived in one room. (3) A child, 3 months, who died at the Ilford Isolation Hospital (resident of Barking). 43 Health Investigation: "Survey of Sickness." A "Survey of Sickness" was made by the Government Social Survey Organisation at the request of the Ministry of Health in Ilford during September, 1948. Forty-seven enquiries were made among residents of the town. The object of the Survey, carried out at regular monthly intervals, and based on samples of the population seeks to obtain information about the amount of ill-health occurring in the country under present conditions. This includes particularly ill-health not included in the ordinary statistics report to the Medical Officers of Health and the Registrar General, which apply only to deaths and to the more serious diseases. It is, for example, essential to have information about the type and extent of minor illness, such as coughs and colds and rheumatism, which frequently do not come to a doctor's notice. No information is available on these subjects and the only way of obtaining it is by direct enquiry from samples of the population. It is generally agreed that it is essential that the medical profession should have this information. Members of the general public who are included in each sample are chosen by statistical methods so as to be representative of the whole population. Only a limited number are selected from each district. No names are included in the reports. All the information collected is analysed by medical statisticians and represented in numerical tables. The tables separate out results for particular groups of the population in order to find out whether there is any special incidence of illness in any particular section, and in order to do this efficiently, questions are asked about the sex, age, housing and occupations of the people interviewed. For this purpose a similar question is also asked about the economic group of informants. Officers carrying out the Survey have instructions to ask questions only where there is willingness to answer, and each officer has a credential card issued by the Government Social Survey on behalf of the Ministry of Health. Only one person in every 200 has shown unwillingness to cooperate. 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 449 factories with mechanical power on the register. There are 346 factories without mechanical power on the register. There are 186 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 1,121 20 - Factories without Mechanical Power 261 4 - Other premises (not including Outworkers' premises) 22 — — Total 1,404 24 — 44 2.—DEFECTS FOUND IN FACTORIES. Particulars Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.l) 3 3 - - Overcrowding (S.2) — — — — Unreasonable Temperature (S.3) - - - - Inadequate Ventilation (S.4) 7 4 - — Ineffective Drainage of Floors (S.6) - - - - Sanitary Conveniences (S.7):- Insufficient 7 7 - — Unsuitable or Defective 10 8 - - Not Separate for Sexes 1 1 - — Other Offences 2 2 - — Total 30 25 — — 45 ILFORD ISOLATION HOSPITAL From the 5th July, 1948, the Hospital was included in Group 12 (Ilford and Barking Hospital Management Committee) of the North East Metropolitan Regional Hospital Board. 934 patients were admitted during 1948. 93.7 per cent. of the notified cases of diphtheria and 60.2 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 934 patients admitted during the year suffered from the following complaints:— 46  Ilford Barking Admissions Deaths Admissions Deaths Scarlet Fever 164 — 46 — Surgical Scarlet Fever 7 — 1 — Diphtheria 13 — 4 — Diphtheria carrier 1 — 1 — Acute Anterior Poliomyelitis 4 — — — Typhoid and Para-Typhoid fever 2 — 1 — Pneumonia 52 2 7 — Chicken pox 5 — — — Chicken pox and Bronchitis — — 1 — Whooping cough 3 — — — Whooping cough and Pneumonia 7 — 1 — Whooping cough and Bronchitis 1 — — — Whooping cough and Laryngitis 1 — — — Measles and German Measles 19 — 7 — Measles and Pneumonia 16 — 7 1 Measles and Bronchitis 6 — 4 — Erysipelas 8 — 7 — Puerperal Pyrexia 15 — 2 — Abortions 7 — — — Ophthalmia Neonatorum 2 — — — Pemphigus Neonatorum 1 — — — Acute Rheumatism 6 — 1 — Rheumatic Chorea 2 — — — Bronchitis 12 — — — Bronchitis and Pleurisy 1 — — — Rhinitis and Bronchitis — — 1 — Laryngitis 2 — — — Ulcerative Pharyngitis — — 1 — Tonsillitis 6 — 3 — Acute Follicular and Streptococcal Tonsillitis 17 - 13 - Haemolytic Streptococcal Tonsillitis 20 - 8 - Meningococcal Meningitis 4 — — — Pneumococcal Meningitis 1 1 — — Tuberculous Diseases— Pulmonary 72 21 — — Others 2 — 1 1 Infective Hepatitis 1 — — — Mumps 3 — — — Enteritis—all forms 26 — 9 1 Food Poisoning 13 — — — Dysentery—Amoebic and Sonné 2 — — — Scabies 1 — — — Neo-natal dermatitis 4 — — — Pyaemia following acute staphylococcal arthritis of hip 1 1 - - Septic broncho pneumonia and lung abscess (staphylococcus aureus infection) 1 1 - - Staphylococcal septicaemia, acute bacterial endocarditis superimposed on chronic rheumatic endocarditis 1 1 - - Broncho pneumonia following atelectasis 1 1 — — Atelectasis and broncho pneumonia 1 1 — — Leukaemia, cerebral haemorrhage 1 1 — — Prematurity 1 1 — — Others 259 — 23 — Post-mortems were held by H.M. Coroner in connection with 10 of the above 34 deaths. 47 Number of patients in Hospital on 1st January, 1948 and 1949 respectively:— 1st January 1948 1st January 1949 Scarlet Fever 18 16 Diphtheria 6 — Tuberculous Diseases 50 50 Puerperal Pyrexia 2 1 Typhoid and Para-Typhoid Fever — 2 Pneumonia 12 10 Pneumonia and Whooping Cough 1 2 Whooping Cough — 1 Acute Rheumatism 2 — Erysipelas 2 — Acute Anterior Poliomyelitis 1 — Measles — 7 Measles and Pneumonia — 4 Gastro-enteritis — 3 Observation and other cases 17 18 The average length of stay in Hospital was for: — Scarlet fever 27.8 days. Diphtheria 64.6 „ Tuberculous Diseases 97.6 „ Average stay in Hospital of all cases 24.9 „ The above averages are based on cases that completed their stay in Hospital during the year. Average number of patients in Hospital per day 104.1. Scarlet Fever.—The diagnosis of scarlet fever could not be confirmed in 14 patients admitted. No deaths occurred from this disease. Diphtheria.—The following table shows the percentage death-rate of cases of diphtheria admitted to the Ilford Isolation Hospital during the past five years, the rate being calculated each year only on those admissions which proved to be clinically diphtheria. 1944 |1945 1946 1947 1948 Ilford 5.8 4.5 Nil 8.3 Nil No deaths occurred during the year. Puerperal Pyrexia and Obstetrical Complications.—The years 1945, 1946, 1947 and 1948 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 four years are compared:— 1945 1946 1947 1948 Confinements 3 5 8 11 Abortions 16 23 23 7 Mothers and Infants 52 72 84 77 Tuberculosis.—72 cases of Pulmonary Tuberculosis were admitted, as compared with 100 in 1947. Fifty-two beds were allocated for the reception of cases of Pulmonary Tuberculosis throughout the year. 48 Training of Nurses.—During 1948, 1 student nurse passed Part II, and 2 student nurses passed Part I, of the Preliminary Examination of the General Nursing Council, and 7 obtained the Certificate by passing the Final Examination (3 student nurses, 4 staff nurses). The following table shows the number of the Staff at the Isolation Hospital who were Schick and Dick tested during 1948, and also the number inoculated:— Nurses Domestics Numbers Schick tested— Positive 7 1 Negative 51 12 Numbers inoculated (full course) 4 1 Numbers retested— Negative after full course of inoculations 4 1 Positive „ „ „ „ „ and re-inoculated - - Numbers Dick tested— Positive 4 1 Negative 54 12 Numbers inoculated (full course) 4 1 Numbers retested— Negative after full course of inoculations 4 1 Positive „ „ „ „ „ 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 1948 examinations were conducted as follows:— Primary examination on engagement Re-examinations Nursing Staff 38 70 Domestic Staff 34 107 These investigations have been carried out by Dr. Currid, Tuberculosis Officer, to whom I am greatly indebted for so willingly undertaking the considerable amount of work entailed and for his most helpful advice and co-operation. The Hospital is recognised by the Conjoint Board for Part 2 of the D.P.H. Regulations of the Board. Admission of Cases from Barking.—The financial arrangement entered into with Barking Corporation for the reception of cases of infectious disease occurring in that area, as far as accommodation permitted, terminated on July 4th. Since then the admission of cases from Barking and contiguous areas has continued as part of the hospital services under the National Health Service Act, 1946, locally administered by the Group 12 Management Committee of the North East Metropolitan Regional Hospital Board. During 1948 the number of Barking cases admitted was 149. 49 PART III.—SERVICES. National Health Service Act, 1946. 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 1948 was 2,246 (1,181 males and 1,065 females). Of these, 177 (99 males and 78 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 782 notifications of birth (395 males and 387 females) which took place outside the district, although the ordinary residence of the parents is in Ilford, were transferred to this district. During the year, 8 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 .71 By Certified Midwives 96.93 By Parents and Others 2.36 In addition, 59 stillbirths (31 males and 28 females) were notified. The notifications of 11 stillbirths (7 males and 4 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 2,246 live births occurring in Ilford during 1948, 103 weighed 5½ lbs, or less at birth; 37 of these babies were born at home and 66 in Hospital (including 9 in Private Nursing Homes). The number of those born at home— (i) who were nursed entirely at home 36 (ii) who died during the first 24 hours 7 (iii) who survived at the end of one month 27 The number of those born in Hospital— (i) who died during the first 24 hours 6 (ii) who survived at the end of one month 59 Owing to existing conditions it has not been possible to implement any of the following recommendations made by the Ministry of Health in their Circular No. 20/44, dated 22nd March, 1944:— (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 Domestic Help specifically for this type of case. (e) Admission of selected cases to Institutions where special care is appropriate to such cases. (/) Special form of transport for the conveyance of infants to Hospital. 50 Dr. I. M. Anderson, the Consultant Paediatrician to the Maternity Hospital, also attended a fortnightly Clinic at these offices until 4th June, 1948. He was succeeded by Dr. C. B. M. Warren as from 16th June, 1948. Infant Mortality.—The number of infants dying within the first year of life was 62, the total number born being 2,848. 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 21'7, 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 37 deaths of infants under four weeks of age during 1948 and the rate for the year was 12 9 per 1,000 live births. The figures for the past 44 years were as follows:— Year Number Rate Year Number Rate 1948 37 12.9 1926 32 21.2 1947 51 15.1 1925 37 24.9 1946 74 21.5 1924 28 19.5 1945 49 19.8 1923 34 21.2 1944 64 23.1 1922 40 27.1 1943 54 20.6 1921 38 25.5 1942 49 20.3 1920 45 27.0 1941 36 22.0 1919 36 30.8 1940 43 22.3 1918 32 30.4 1939 57 25.8 1917 29 24.7 1938 50 21.8 1916 43 28.8 1937 52 23.0 1915 54 35.1 1936 59 26.7 1914 43 28.7 1935 51 24.8 1913 37 24.6 1934 37 18.8 1912 45 30.2 1933 48 25.9 1911 34 21.4 1932 41 20.6 1910 54 32.2 1931 64 32.3 1909 56 34.0 1930 31 16.8 1908 55 33.2 1929 48 27.4 1907 54 31.5 1928 41 23.6 1906 57 33.5 1927 32 19.3 1905 56 35.6 51 The following table gives the deaths of infants under one year of age, classified according to age:— Infant Deaths—1948. Cause of Death Under 1 week 1—2 weeks 2—3 weeks 3—4 weeks Total under 4 weeks 1—3 months 3—6 months 6—9 months 9—12 months Total Acute Capillary Bronchitis - - - - - - - 1 — 1 Acute Suppurative Bronchitis - - - - - - - - - 1 Anencephalic—Premature 30 weeks gestation 1 - - - 1 - - - - 1 Asphyxia - - - - - - 2 - 1 3 Atelectasis 11 - - - 11 - - - - 11 Cerebral Haemorrhage 3 - - - 3 - - - - 3 Cerebral Thrombosis, congenital heart disease - - - - - 1 — - - 1 Cleft Palate—congenital heart disease 1 - - - 1 - - - - 1 Congenital Heart Disease 1 - - - 1 - - - - 1 Empyema—pneumonia - - 1 - 1 - - - - 1 Erythroblastosis foetalis—icterus gravis Neonatorum 1 - - - 1 - - - - 1 Heart failure 2 - - - 2 2 1 2 - 7 Immaturity—premature birth 1 - - - 1 - - - - 1 Internal Hydrocephalus—post Meningococcal Meningitis - - - - - - - 1 1 2 Intraventricular haemorrhage of brain following fall from Mother's lap - - - - - - 1 - - 1 Marasmus - - - - - 1 — — - 1 Microcephaly - - - - - 1 — — - 1 Pneumonia, all forms - 2 - - 2 1 2 2 1 8 Prematurity 12 1 - - 13 - — — - 13 Septic Broncho-Pneumonia—lung abscess - - - - - 1 - - - 1 Toxaemia, associated with Stomatitis and Oesophagitis following upon Broncho-Pneumonia - - - - - - - - 1 1 Toxaemia-Jaundice—Obstruction of bile duct - - - - - 1 - - - 1 33 3 1 - 37 9 6 6 4 62 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 1948 62 21.7 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 52 The mean average Infant Mortality rate for the past 10 years is therefore 31.8 per 1,000 live births. 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 1948 21.7 34 39 32 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 1939 33.9 50 48 53 Illegitimate Births and Deaths.—91 of the live births registered (43 males and 48 females) were illegitimate, that is 3'2 per cent, of the births registered. Four illegitimate children died under one year of age from the following causes:— Anencephalic, Prematurity (30 weeks gestation), aged 10 minutes. Broncho-Pneumonia, Prematurity, aged 2 weeks. Prematurity (26 weeks gestation), aged 8 hours. Prematurity, aged 1 week. The infant mortality rate of illegitimate children was 43.9 per 1,000, compared with the infant mortality rate of 21 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 1948 2,757 96.8 58 21.0 91 3.2 4 43.9 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 7 60.3 1943 2,532 96.6 89 35.2 89 3.4 3 33.7 1942 2,330 96.5 71 30.4 85 3.5 3 35.3 1941 1,756 96.7 61 34.7 60 3.3 6 100.0 1940 1,974 97.5 60 30.4 50 2.5 3 60.0 1939 2,255 97.8 72 31.9 52 2.2 3 57.7 The Council has not appointed a Social Worker for the purposes of Circular 2866 of the Ministry of Health with regard to the care of illegitimate children. 53 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 for the admission of girls with their babies to the Essex County Council, Ardmore Hostel, Buckhurst Hill. A number of unmarried mothers from Ilford are also accepted at the Romford, Hornchurch and Upminster Moral Welfare Committee's Hostel at 51, Junction Road, Romford, and at 71, Caernarvon Road, Stratford. Children Act, 1948.—Under the provisions of the Children Act, 1948, the Children's Officer of the Essex County Council assumed responsibility for child life protection from the 5th July, 1948. On the 4th July, 1948, the records showed:— (a) Foster-children. Number of foster-children on register on 1st January, 1948 27 Number of foster-children who were notified up to 4th July, 1948 5 Number of foster-children returned to their mothers up to 4th July, 1948 2 Number of foster-children taken off register for various other reasons 9 Number of foster-children on the register on 4th July, 1948 21 (b) Foster-mothers. Number of foster-mothers with children on the register on the 1st January, 1948 23 Number of persons who became foster-mothers up to 4th July, 1948 3 Number of foster-mothers whose names were taken off the register up to 4th July, 1948 7 Number of foster-mothers with children on the register on the 4th July, 1948 19 Number of houses visited by the Sanitary Inspectors for the purpose of the Act up to 4th July, 1948 6 Number of visits made by the Sanitary Inspectors for the purpose of the Act up to 4th July, 1948 7 Number of visits made by Child Life Protection Visitors 156 Adoption of Children (Regulation) Act, 1939.—This Act came into operation on the 1st June, 1943. Section 7 of the Act in which Welfare Authorities are concerned, provides inter alia:— (a) That any person (other than a registered adoption society or a local authority, and not being the parent or guardian or a near relative of the child or the person in whose care or possession he is to be placed), who participates in making arrangements for the adoption of a child under the age of nine years, must give notice, in writing, of the arrangements to the Welfare Authority for the area in which the adopter resides, not less than seven days before possession is taken of the child by the adopter. This does not apply when an adoption order is made. The provisions of this Act, also, became the responsibility of the Children's Officer of the Essex County Council from the 5th July, 1948, under the Children Act. Up to 4th July, 1948, notices were received from 4 persons in respect of 7 children. Adoption Orders were made by the Courts in respect of 3 of these children during this period; the other children are still under supervision. (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 up to 4th July, 1948. 54 Health Visitors and School Nurses.—The establishment of 18 in addition to the Superintendent Health Visitor was agreed by the Ilford Council on the recommendation of the Ministry of Health. 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, 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. It was suggested that these nurses be known as Clinic Nurses. 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 7 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 1948 as far as the Maternity and Child Welfare work is concerned. First visits to newly-born infants 3,148 Subsequent visits to children under 1 year of age 2,969 Subsequent visits to children over 1 year of age and under 5 7,595 Visits to expectant mothers 272 Home visits for other reasons 1,765 Total visits paid 15,749 Day Nurseries. (a) Becontree Avenue Day Nursery.—It was not possible during the year to proceed with the erection of the new Nursery in Stevens Road and the Nursery, therefore, continued to occupy the premises in Becontree Avenue, at the corner of Winding Way, with the reduced accommodation for 40 children. The Ministry of Health approved the acceptance of a tender of £6,443 for the erection of the new nursery, with an additional expenditure of £750, the cost of standard hutment components supplied direct by the Ministry of Works. Work commenced on the erection of the new Nursery in April, 1949. (b) Green Lane Day Nursery.—A tender of £5,980 was accepted in May, 1949, for the erection of the new Nursery on the site in Goodmayes Lane. (c) The charge of Is. per day for the care of children in the Nurseries was continued during the year. (d) The training of Students at the Nurseries for the certificate of the National Nursery Examination Board continued. Seven Students (three from the Becontree Avenue Nursery, three from the Ley Street Nursery and one from the Green Lane Day Nursery) entered for the examination during the year, six of whom obtained the certificate. In addition, one Nursery Assistant from the Sunshine House Day Nursery entered for this examination and gained the certificate. 55 (e) The following is a table showing the attendances, etc., at the four Day Nurseries during 1948:— Situation Date of Opening Accommodation (Children) Average Daily during Including Saturday Attendance 1948 Excluding Saturday No. of Days in Quarantine Reasons for Quarantine No. on Waiting List at 31st. Dec. 1948 Sunshine House, Girls' Village Homes, Barkingside 17.8.42 45 27 31 176 18 Cases of W. Cough 112 18 „ „ Mumps 3 „ „ Measles 359-381, Green Lane, Seven Kings 5.5.43 50 31 35 128 14 Cases of W. Cough 84 4 „ „ Mumps 8 „ „ Meales 5 „ „ S. Fever 226-236, Ley Street, Ilford 16.8.43 50 30 35 107 5 Cases of W. Cough 144 5 „ „ Mumps 2 „ „ Measles 2 „ „ S. Fever Becontree Avenue, corner Winding Way, Dagenham 17.1.44 40 21 24 105 16 Cases of W. Cough 24 19 „ „ Measles 1 „ „ C. Pox 56 Nurseries and Child-minders Regulation Act, 1948.—This Act which came into operation in August, 1948, requires, inter alia, that every local health authority shall keep registers— (a) of premises in their area, other than premises wholly or mainly used as private dwellings, where children are received to be looked after for the day or a substantial part thereof or for any longer period not exceeding six days; (b) of persons in their area who for reward receive into their homes children under the age of five to be looked after as aforesaid. No premises or persons were registered during the year, but at the 31st December three applications from persons coming within the purview of paragraph (b) were under consideration, the appropriate certificates of registration being issued in 1949. Infant Welfare Centres.—94 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1948. During the year the following attendances were recorded:— Total number of attendances of infants 49,444 First attendances 2,641 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 3,712 14,613 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 1948 49,444 2,641 3,712 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 The attendances at the Infant Welfare Centres decreased during 1948 by 0.5 per cent. compared with the attendances for 1947. 672 sessions were held during the year; the average attendance at each session being 73 mothers with their infants. The following are the figures for each Centre:— Sessions Average Attendance Chadwell 48 87 Barkingside 48 83 Downshall 48 85 Becontree 48 53 Woodford Avenue 48 95 Seven Kings 48 72 Cecil Hall (Wednesday) 48 68 Cecil Hall (Thursday) 48 61 Newbury Hall 48 51 Grosvenor Road 48 81 Goodmayes 48 78 Ilford Lane 48 93 Valentines 48 64 Fairlop 48 54 Paediatric Clinic.—Dr. Anderson, to 4th June, 1948, and Dr. Warren, from 16th June, 1948, the Consultant Paediatrician, continued to attend the Clinic at Valentines Mansion each fortnight during the year. 24 sessions were held and 87 new cases were referred from the Infant Welfare Centres and Maternity Hospital for the following reasons; a total of 204 attendances were made. 57 Diagnosis. Discharged, Improving. Discharged, Other reasons. Discharged, no treatment. Discharged cured. Referred to Dr. Hospital or clinic. Still attending. Total. Aerophagy - - — — 1 — 1 Behaviour problem - 2 3 — — 3 8 Bronchitis - — — — 1 — 1 Buccal Cyst - — — — - 1 1 Congenital atresia of urinary meatus - - - - 1 — 1 Congenital deformity of chest 1 - - — - - 1 Congenital heart disease - 2 — — — — 2 Congenital hydrocele - — — — — 1 1 Congenital spastic diplegia - — — — — 1 1 Constipation - — — — 1 2 3 Cretinism - — — — 1 — 1 Debility - — — — — 2 2 Delayed development - — 1 — — 1 2 Diarrhoea associated with throat infection - - 1 - - - 1 Eczema - 1 — 1 1 — 3 Enuresis - — — — 1 — 1 Faecal incontinence - — — — 1 — 1 Feeding problem 1 2 1 1 1 — 6 Fibroid tumour of scalp - — — — 1 — 1 Gastro-Enteritis - - - - - 1 1 Haematuria - — — 1 — — 1 Hypersensitivity to Schick test - - - - 1 - 1 Hypospadias - - - - - 1 1 Ichthyosis - — — — 1 — 1 Infected tonsils - 1 — — — — 1 Jaundice - 1 — — — — 1 Lordosis - - - - - 1 1 Lymphadenopathy - 1 1 — — — 2 Masturbation - — 1 — — — 1 Mentally retarded 1 2 — — — — 3 Miscellaneous 1 — — — — 1 2 Mongol - - - - - 1 1 Naevus of scalp - — — — 1 — 1 Normal child—nil abnormal discovered - - 3 - - - 3 Obesity 1 - - - - - 1 Papilloma - — — — 1 — 1 Paronychia 1 1 — 2 1 — 5 Petit Mal 1 1 — — — — 2 Post Pyloric Stenosis 2 — — 1 — — 3 Post-virus Meningitis — — — — 1 — 1 Prematurity 1 - - - - - 1 Right Inguinal Hernia — — — — 1 — 1 Rumination - - - - - 1 1 Sternomastoid tumour - - - - - 1 1 Teething — — 2 — — — 2 Tongue-tie - - - - - 1 1 Toxticollis 1 1 — — — — 2 Umbilical granuloma — 1 — — — — 1 Upper respiratory infection — 1 — — 1 — 2 Vulvites — — — 1 — — 1 Vulvo vaginitis 1 — — — 1 — 2 Total 12 17 13 7 19 19 8 58 Dental Clinics.—253 half-days were taken up for the treatment of expectant and nursing mothers and children under 5 years of age during 1948: 152 at Valentines Clinic and 101 at Mayesbrook Clinic. The following is a summary of the work carried out:— (a) Treatment of Mothers: Valentines Clinic. Mayesbrook Clinic. No. of patients treated during 1948 672 245 No. of attendances of patients ... 1,185 432 No. of administrations of "general" anaesthetics 165 153 No. of administrations of "local" anaesthetics 92 101 No. of fillings and other operations 2,146 1,026 No. of mothers having dentures supplied 60 97 (b) Treatment of Children under 5 years of age: No. of patients treated 217 80 No. of attendances of patients 229 84 No. of administrations of "general" anaesthetics 112 60 No. of fillings and other operations 413 79 The following are the figures for the past 5 years:— No. of Mothers treated: 1944 1945 1946 1947 1948 (i) Valentines Clinic 481 398 378 333 672 (ii) Mayesbrook Clinic — 68 179 239 245 No. of Children treated: (i) Valentines Clinic 143 130 130 153 217 (ii) Mayesbrook Clinic — 46 88 83 80 Ophthalmic Clinic.—9 expectant and nursing mothers and 110 children under 5 years of age were treated by the Council Oculist during 1948: 51 pairs of spectacles were supplied, 6 to mothers and 45 to children. Since 5th July, 1948 expectant and nursing mothers were referred for treatment under National Health Service Act and discontinued treatment at the Ophthalmic Clinic. Orthopaedic Clinic. (i) Newbury Hall Clinic.—48 sessions were held during 1948, 318 children under 5 years of age being examined, making 828 attendances. (ii) Mayesbrook Clinic.—27 sessions were held during 1948, 168 children under 5 years of age being examined, making 442 attendances. 59 The 486 children were found to be suffering from the following defects:— Diagnosis New Cases Old Cases A B A B Paralysis:— A.P.M 2 1 2 1 Hemiplegia — — — — Foot drop - — — — Scholiosis 1 — — — Kyphosis — — 1 — Slack posture — — 1 — Deformity of hips 1 1 1 — Genu valgum 50 40 60 35 O.C.T 25 10 31 26 Genu varum 6 3 5 3 Pes valgo planus 31 8 20 10 Valgus ankles 20 12 10 5 Talipes calc. valgus 1 3 2 2 Cong, talipes E.V. 1 — 1 — Pes calc. valgus — — 1 — Intoeing — — 3 1 Deformity of toes 12 1 7 3 Torticollis 5 1 — — N.A.D 4 1 4 — Spastic Diplegia 1 — — — Pes Cavus - — 1 — Orthopaedic defect connected with birth injury - - 3 - Traumatic condition 1 — - - Hallux Valgus 1 1 — - Other conditions 3 — — - Totals 165 82 153 86 A—Newbury Hall. B—Mayesbrook. 68 pair of Valgus Insoles and 38 G.V. night splints were supplied during 1948. One child was admitted to the Country Branch of the Royal National Orthopaedic Hospital at Stanmore, and three other children were admitted to other hospitals, 1 to King George Hospital and 2 to Harold Wood Hospital. At the Newbury Hall Clinic, 39 children under five years of age were treated by the Masseuse during the year, and 425 attendances were made by these children. Treatment was also given to 15 children who made 191 attendances at the Mayesbrook Clinic. Aural Clinic.—The Aural Surgeon attended at 91 sessions during 1948 and 186 attendances were made by 1 nursing mother, 2 expectant mothers and 103 children of pre-school age. 27 children were operated upon for removal of tonsils and adenoids. 21 at Queen Mary's Hospital and 6 at King George Hospital. 60 Rheumatism Clinic.—29 sessions were held during the year at Newbury Hall, at which 14 children under 5 years of age, 4 being new cases, made 19 attendances. The following is a summary of the cases treated:— Condition New Old. Total Congenital Heart Disease - 3 3 No active Rheumatic disease 1 1 2 Functional heart murmur 2 4 6 Pains due to Orthopaedic conditions 1 2 3 Totals 4 10 14 Number of cases referred to Ear, Nose and Throat Surgeon 1 „ „ „ „ „ General Hospital 2 „ „ ,, „ for X-ray and Electrocardiograph 6 Artificial Sunlight Clinic.—41 sessions were held at the Newbury Hall Clinic and 43 at Mayesbrook Clinic, 74 children in all were treated, making 1,285 attendances. The conditions treated were as follows:— Conditions Cases A B Anaemia, Debility and Malnutrition 13 10 Bronchitis 7 1 Genu valgum 3 2 Pigeon Chest - 1 Old Rickets 10 1 Genu varum 1 5 Other conditions 6 14 Totals 40 34 A—Newbury Hall. B—Mayesbrook. 53 cases were still attending at the end of the year; of the remainder 1 had removed from the district, 2 were discharged, having shown improvement, 9 were discharged having made a satisfactory recovery, 5 were discharged due to absence and 4 were discharged having made no progress. Speech Clinic.—10 children of pre-school age attended, making 114 attendances. The following is a summary of the cases:— Classification of Defects: Stammering 5 Dyslalia 3 Dysphasia 2 6 children discharged: 5 speech normal and 1 treatment deferred for 1 year. 61 Diphtheria Immunisation.— Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1948, to 31st December, 1948. 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 15 — 15 14 — 14 29 Negative 38 — 38 20 — 20 58 Numbers inoculated (full course) 92* 1,430 1,522 58* 737 795 2,317 Positive after full course of inoculations, and re-inoculated - 5 5 - - - 5 Negative after full course of inoculations 79 1,355 1,434 51 702 753 2,187 Re-inoculations (one only) 1,009 35 1,044 506 50 556 1,600 Awaiting re-test 16 276 292 8 136 144 436 Not re-tested after inoculation (on account of leaving District, etc.) - 7 7 2 4 6 13 Positive after re-test, but not inoculated for same reason 3 - 3 5 2 7 10 Final Schick Test in 1948 (1947 Cases):— Positive after full course of inoculations, and re-inoculated - 1 1 4 - 4 5 Negative 4 375 379 5 227 232 611 * Schick + 1948 = 35; Not Tested=41. * Schick + 1948 = 14; Not Tested=22. During 1948, a total number of 3,915 children attended at the Diphtheria Prevention Clinics (2,572 at Valentines Clinic and 1,343 at Mayesbrook), making a total number of attendances of 15,689 (10,290 and 5,399) with an average per session of 100 and 103 respectively. 62 During 1948 45 private doctors were supplied with prophylactic for the immunisation of 432 children (325 under 5 years and 107 over 5 years of age). The following is a brief summary:— 1947 Cases: Final Schick Test in 1948:— Negative 37 Positive and re-inoculated 1 No final Schick Test, left district, etc. 33 1948 Cases: Numbers inoculated (full course) by medical practitioners 439 Final Schick Test—Negative 102 Positive and re-inoculated 3 No final Schick Test, left district, etc. 62 To be Schick Tested in 1949 74 Vaccination.—This service became the responsibility of the Essex County Council (the Local Health Authority) as from 5th July, 1948, by Section 26 of the National Health Service Act, 1946. From that date to the end of 1948 record cards were received from general practitioners as follows:— Ages 1 to 14— No. of children primarily vaccinated 385 No. of children revaccinated 16 Ages 15 and over— No. of adults primarily vaccinated 30 No. of adults revaccinated 91 Convalescent Treatment.—By arrangement with the Invalid Children's Aid Association eight children were admitted to Convalescent Homes up to the 4th July, the Ilford Council contributing towards the cost of maintenance. The Ilford Council also made a grant of £25 to the funds of the Association. As from the 5th July, convalescence in the case of children under the age of five years became the responsibility of the Essex County Council under Section 22 of the National Health Service Act, 1946, but the Invalid Children's Aid Association continued to assist in the arrangements. Convalescent facilities at the Essex Convalescent Home, Clacton-on-Sea, were also made available by the County Council under Section 28 of the Act to other persons requiring a change of "air and surroundings to aid recovery and rehabilitation." From that date until the end of the year one child was sent away under Section 22 and 6 adults under Section 28. Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 19 belts were supplied to infants suffering from hernia during 1948. A certain number of infants were brought to the Clinics at Newbury Hall and Mayesbrook Clinic to receive treatment for minor ailments. Cardiac Clinic.—During 1948 eleven sessions were held. 42 expectant and nursing mothers were referred from either the ante-natal or post-natal clinics, who made a total of 73 attendances. 63 The following is a summary of the cases examined by Dr. K. Playfair:— Condition. PostNatal. AnteNatal. Chronic Nephritis 1 — Congenital Cardiac lesion 1 — Extrasystoles — 1 Functional Cardiac Disorders 2 11 Heart block and Cardiac failure — 1 History of Rheumatic Fever — 1 Idiopathic Oedema 1 1 Valvular Disease of the Heart 3 19 Total 8 34 23 of these patients were, however, referred to Queen Mary's Hospital for X-Ray and electrocardiograph. The Ilford Council continued 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, up to 4th July, 1948. Midwives.—There were 21 State certified midwives (including the Superintendent, Deputy Superintendent and 10 domiciliary 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 Ilford Maternity Hospital, 2 at Wilnett Lodge post-natal home and 3 at private nursing homes in Ilford. Their supervision has been carried out as in previous years. Suspension from Practice.—No midwives were suspended from practice during the year. Medical aid was sought in 11 instances where the infant was found to have inflamed or discharging eyes. In all cases the condition of the eyes cleared satisfactorily. In accordance with the suggestion of the Minister of Health the power of recovery of the fee of the Medical Practitioner under Section 14 (4) of the Midwives Act, 1918, in this class of case was not exercised. Domiciliary Midwifery Service.—During the year 744 cases were attended. In 544 cases the midwives were engaged to attend as midwives and in 200 as maternity nurses. The patients resided in the following wards:— Barkingside 57; North Hainault 59; Cranbrook 43; Park 58; Seven Kings 96; South Hainault 82; Loxford 81; Clementswood 68; Goodmayes 19; Fairlop 71; Clayhall 47; Mayfield 63. 4,406 ante-natal visits were made during the year. At the end of the year there were 10 Domiciliary Midwives employed wholetime and 2 part-time midwives, in addition to the Superintendent and Deputy Superintendent. 54 medical practitioners participated up to 4th July in the Council's scheme for the ante-natal examination of patients who had engaged a Council midwife to attend them. 70 patients were referred by private doctors to the Consultant Obstetrician at the Ante-Natal Clinic for a further opinion. 16 of these women and 50 other patients who had engaged a domiciliary midwife (42 as a midwife and 8 as a maternity nurse) were for various reasons admitted to the Ilford Maternity Hospital or other Institutions for confinement. 39 were admitted to the Maternity Hospital, 3 to the Wanstead Hospital, 64 4 to the Ilford Isolation Hospital, 2 to Oldchurch Hospital, Romford, 1 to East End Maternity Home, E.1, and 1 to North Herts, and South Beds. Maternity Unit, Hitchin. In addition, 4 patients were admitted to the Maternity Hospital for ante-natal treatment and subsequently confined at home. A Doctor was called in to 195 of the 544 cases in which a midwife had been engaged. Two patients were notified as suffering from Puerperal Pyrexia, both being removed to the Ilford Isolation Hospital. One baby was notified as suffering from Ophthalmia Neonatorum. The condition of the eyes cleared satisfactorily. Of the infants born there were 15 stillbirths ascribed to the following causes:— Abnormality of umbilical cord 1 Breech presentation (3 weeks premature) 1 Dystocia—disproportion 1 Dystocia—shoulder impaction 1 Intrauterine death 1 Obstetric shock 1 Placental maldevelopment 1 Probably maternal overstrain: domestic causes 2 Unknown 6 In 3 of the cases the midwife was engaged as a maternity nurse only. There were 16 deaths of infants during the first year of life from the following causes:— Atelectasis, aged 30 minutes. Atelectasis, associated with supra renal haemorrhage, aged 1 hour. Broncho-pneumonia, following upon atelectasis, aged 1 week. Cardiac failure; Broncho-pneumonia; Gastro enteritis, aged 6 months. Cardiac failure; Immaturity (weight 4 lbs.) (Mother suffering with Pulmonary tuberculosis), aged 6 hours. Cardiac failure; Pneumonia, aged 5 months. Cardiac failure; Prematurity, aged 1 day. Cerebral haemorrhage following prolonged delivery, aged 5 weeks. Congenital heart disease (wide patency of auricular septal defect and ductus arteriosus), aged 2 days. Immaturity; Premature birth, aged 1 hour. Lobar pneumonia, aged 9 months. Marasmus, aged 2 months. Premature birth (26 weeks pregnancy), aged 6 hours. Premature birth (26 weeks pregnancy), aged 8 hours. Prematurity, aged 1 day. Prematurity; Atelectasis of the lungs, aged 1 hour. In 5 of these cases the midwife was engaged as a maternity nurse only. Notices were received from the Domiciliary Midwives stating that artificial feeding had been substituted in respect of 22 infants attended by them during 1948. Salvation Army Midwifery Service.—126 cases were attended by the Salvation Army Midwives during the year, 109 as a midwife and 17 as a maternity nurse. A Doctor was called in to 48 of the 109 cases in which a midwife had been engaged. 65 There were two deaths of infants during the first year of life from the following causes:— Broncho-pneumonia, Prematurity, aged 2 weeks. Cardiac failure, Broncho-pneumonia, aged 7 months. Notifications were received that it was proposed to substitute artificial feeding in respect of three infants. Gas and Air Analgesia.—In September, 1948, arrangements were made for the administration of gas and air analgesia by domiciliary midwives. From that time to the end of the year analgesia was administered in 69 cases, of which 37 were attended by the Domiciliary Midwives (36 when acting as midwives and 1 when acting as maternity nurse) and 32 were attended by the Salvation Army midwives (30 when acting as midwives and 2 when acting as maternity nurses). All the domiciliary midwives employed at the end of the year were qualified to administer gas and air analgesia and the two Salvation Army midwives were also so qualified. In addition, two of the private midwives practising in the area were qualified in this respect. Four sets of apparatus for the purpose of the administration of gas and air analgesia are stored at the Ambulance Depot and the apparatus is transported to the house of the patient on the request of the midwife. The Salvation Army midwives also have one machine, which is kept at their Branch Home and taken or sent to the home of the patient when required. The service is freely available to all having home confinements, provided there are no medical contra-indications, and each expectant mother on booking the midwife is supplied with a leaflet explaining the nature and the availability of the service. Domestic Helps.—By Section 29 of the National Health Service Act, 1946, the Domestic Help Service became the responsibility of the Local Health Authority (Essex County Council) from 5th July, 1948, who delegated the functions in llford to the Health Area Sub-Committee. At 31st December, 108 part-time Domestic Helps were on the register. A full-time Organiser controls the service under the general direction of the Area Medical Officer. The following is a summary of the cases dealt with in 1948:— (а) Number of applications received for assistance 890 (b) Number for whom Home or Domestic Helps were provided (including 39 who were having the service at the commencement of the year) 651 (c) Number of cases which on investigation were either not eligible for assistance or did not require the service 126 (d) Number of cases where Domestic Help is required in future months 69 (e) Enquiries incomplete Nil. Ante-Natal Clinics.-—The following is a summary of the attendances at the Ante-Natal Clinics during the year:— Maternity Hospital Mayesbrook Clinic First attendances 1,157 297 Subsequent attendances 9,701 2,304 Total 10,858 2,601 Number of sessions 413 104 Average attendance at each session 26 25 66 All patients booked for admission to the Maternity Hospital are medically examined at the Ante-Natal Clinics, the first appointment normally being made at the 16th week of pregnancy. During the year 447 cases other than those booked for admission to the Maternity Hospital were examined at the Clinics. There were 1,700 attendances by such cases. The Consulting Obstetrician or his Deputy visited the Ante-Natal Clinic each week during 1948. During the year 52 visits were made, 372 patients referred from the Ante-Natal and Post-Natal Clinics, and 114 patients referred by private doctors were examined. A total of 952 examinations were made. X-Ray Examination of Ante-Natal Patients.—122 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 Ilford Maternity Hospital, 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 Hospital each week and the other at Mayesbrook Clinic once monthly. The following attendances were recorded:— Maternity Hospital Mayesbrook Clinic First attendances 818 164 Subsequent attendances 251 43 Total 1,069 207 Number of sessions 52 12 Average attendances each session 20 17 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 were eligible to purchase sheets on coupon equivalent certificates if the midwife or maternity nurse booked for the case certified that her patient was genuinely in need of additional sheets at the time of the confinement. During 1948 1,881 certificates were issued to 640 expectant mothers. Maternal Mortality.—During 1948 no deaths of Ilford mothers were recorded by the Registrar-General as due to or in consequence of childbirth. 67 MATERNITY HOSPITAL From the 5th July, 1948, the Hospital was included in Group 12 (Ilford and Barking Hospital Management Committee), North-East Metropolitan Regional Hospital Board. During 1948, 1,144 patients were admitted into the Hospital, compared with 1,056 in 1947, 1,020 in 1946, 824 in 1945, 784 in 1944, 601 in 1943, 396 in 1942 and 369 in 1941. Of the 1,144 patients admitted during 1948, 110 were admitted direct to the Emergency Block and 1,034 to the Ward Blocks. 296 cases could not be admitted during the year and other arrangements were made for their confinement. At the end of the year 578 cases had booked for future admission to the Hospital. The average number of mothers in the Maternity Hospital per day during 1948 was 34.93. Wilnett Lodge Post-Natal Home received 320 patients from the Maternity Hospital during 1948. The Home, opened on 22nd September, 1947, has accommodation for 9 mothers and babies. The average length of stay of mothers in the Maternity Hospital was 12.96 days, which included an average stay of 6.44 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. 926 of the 1,144 patients admitted were discharged from either the Maternity Hospital or Wilnett Lodge before the 14th day. It is interesting to note that during the year 48 of the patients admitted (or 4'2 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. 127 cases were treated, 110 being admitted direct to this Block and 17 being transferred from the Ward Blocks. 64 of these 110 cases had not been booked for admission to the Maternity Hospital. 10 of the 110 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 1948 was 4.47 (including cases transferred from the Ward Blocks) and the average length of stay of patients admitted direct to this Block was 12.7 days. 69 patients were confined in the Emergency Block (64 admitted direct to this Block and 5 transferred from the Ward Blocks). The 10 cases mentioned above have been included in the figures for those confined in the Ward Blocks. 35 of the 69 cases were first confinements and 34 were second or subsequent confinements. 17 cases (or 24 6 per cent.) were delivered by means of forceps, 6 following surgical induction. In addition labour was surgically induced in 11 cases. 68 24 of the 61 live infants born in this Block were weaned prior to their discharge from the Hospital. 13 infants born to patients in the Emergency Block were retained in the Hospital for varying periods, an average of 21.6 days each, following discharge of their mothers, either due to prematurity or feeding difficulties. 7 of these infants weighed 5½ lbs. or less at birth. There were 4 deaths of infants born in the Emergency Block. None of the mothers of these infants had been booked for admission to the Hospital, but they were all admitted as emergency cases for various reasons. The mothers of 5 of the 8 stillborn infants were admitted as emergency cases. 8 cases, 2 of whom were confined prior to admission to the Hospital, were notified as suffering from Puerperal Pyrexia. 3 of these patients were removed to the Ilford Isolation Hospital. In addition, 7 other patients were removed to the Isolation Hospital for various reasons. The Consulting Obstetrician, his Deputy, or other Consultants, were called in to 21 cases as follows:— To perform Caesarean Section operations 4 To perform other operations 7 For consultation 10 The other 26 cases admitted direct to this Block were not confined therein for the following reasons:— Abortion or miscarriage (including 3 sets of twins) 6 Admitted for ante-natal treatment and subsequently evacuated for confinement or confined at own home 5 Born before arrival at Hospital 15 Ward Blocks.—1,034 patients were admitted to the Ward Blocks. In addition, 10 patients admitted to the Emergency Block for ante-natal treatment were subsequently transferred to or re-admitted to the Ward Blocks for confinement. 5 patients admitted to the Ward Blocks were transferred to the Emergency Block for confinement. 958 of the 1,034 patients had been booked for admission to the Hospital. Of the other 76 cases 14 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 62 patients for whom provisional arrangements had been made for admission to the Emergency Maternity Homes. 19 patients were not confined in the Hospital for the following reasons:— Abortion or miscarriage 7 Admitted for ante-natal treatment and subsequently evacuated, confined at own home or transferred to Ilford Isolation Hospital for confinement 9 Born before arrival at Hospital 3 The average number of mothers in the Ward Blocks per day during 1948 was 34.93, and the average length of stay of mothers was 14.35 days including an average stay of 6.44 days in respect of 320 patients transferred to Wilnett Lodge Post-Natal Home. 69 In 29 of the 1,030 confinements the patient had been previously admitted for varying periods of observation, being subsequently re-admitted for the confinement. Of the 1,030 confinements there were:— (a) 481 cases of first confinement. (b) 649 cases having their second or subsequent confinement. 89 cases (or 8.6 per cent.) were delivered by means of forceps, 32 following surgical induction; 6 of the infants were stillborn and 2 infants died aged 5 minutes and 12 hours. In addition, labour was surgically induced in 122 other cases; 5 of the infants were stillborn and 2 died aged 5 minutes and 15 hours. 182 of the 1,016 live infants born in this Block were weaned prior to their discharge from the Hospital. 32 infants (including 1 set of twins) born to patients in the Ward Blocks were retained in the Hospital for varying periods, an average of 24.7 days each, following discharge of their mothers, either due to prematurity or feeding difficulties. 14 of these infants weighed 5½ lbs. or less at birth. There were 14 deaths of infants under one year of age born in the Ward Blocks. The mothers of five of these infants had not been booked for admission to the Hospital, but were admitted as emergency cases for various reasons. The mothers of 5 of the 29 stillborn infants were admitted as emergency cases. 30 patients were notified as suffering from Puerperal Pyrexia, 15 being removed to the Ilford Isolation Hospital. In addition, 1 infant, who was removed to the Isolation Hospital, was notified as suffering from Ophthalmia Neonatorum, the condition of the eyes clearing satisfactorily, and 1 infant, who was also removed to the Isolation Hospital, was notified as suffering from Pemphigus Neonatorum. 59 other patients were removed to the Isolation Hospital for various reasons, including 8 patients from Wilnett Lodge. Special visits were made by the Consulting Obstetrician, his Deputy, or other Consultants to 26 cases in the Ward Blocks as follows: — To perform Caesarean Section operations 11 For consultations 15 There were no deaths of mothers admitted to the Ward Blocks. Training of Pupil Midwives.—As mentioned in the Report for 1944, the Hospital 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. 37 pupil midwives commenced their training during 1948. 15 of these and 17 of the 41 who commenced in 1947 passed Part I examination in 1948. Gas and Air Analgesia.—Analgesia was administered to 642 patients during the year. 70 Other Maternity Hospitals.—Arrangements were made for the admission of maternity cases to the following hospitals up to 4th July, 1948, for which the Council were responsible for the cost of maintenance:— No. of Cases. Fees payable per day (till 4/7/48). s. d. (a) Oldchurch Hospital, Romford 3 26 8 Although the Essex County Council ceased to book any maternity cases from Ilford at the end of June, 1944, the cases mentioned were admitted there as an emergency measure. (b) East End Maternity Hospital, Commercial Road, E.l 62 16 0 (c) Essex County Hospital, Wanstead 24 30 0 (d) St. Margarets Hospital, Epping 1 11 8 (e) Queen Mary's Hospital, Stratford 3 10 0 Emergency Maternity Hospitals.—The arrangements for the admission of patients to ante-natal hostels or billets and emergency maternity hospitals, as outlined in my Report for 1945 continued during the year. The Minister of Health, however, again raised the charge for maintenance from 15s. per day to 17s. per day for cases leaving London after 1st April, 1947. 810 patients provisionally registered for evacuation to these Hospitals for their confinement expected during the year, but only 87 went away. Of the other 723 patients, 37 subsequently engaged the Domiciliary Midwives for confinement at home, 26 had a miscarriage, 22 booked for admission to private Nursing Homes, 525 were admitted to other Homes or Hospitals and 113 cancelled the arrangements. 287 of these patients attended the Council's Ante-Natal Clinic making a total of 1,315 attendances during the year. These figures are included in the table of attendances at the Ante-Natal Clinics. The 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. SCHOOL HEALTH SERVICE 73 SCHOOL HEALTH 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, 56 children being found to be infected with living hair vermin as against 49 in 1947, 46 in 1946, 65 in 1945 and 36 in 1944. (ii) Scabies.—This shows a decrease, 19 cases as compared with 43 in 1947, 76 in 1946, 104 in 1945, 128 in 1944. School Premises.—There are 32 schools, with 61 departments, 20,267 children were actually on the rolls on 21st December, 1948, as compared with 19,002 in December 1947. The figure 20,267 includes Barking Abbey (429) and Ursuline County Placed pupils (198). The number of children in average attendance at school for the year ended 21st December 1948 = 17,483. 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. 449 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. (e) Every pupil attending a maintained secondary school shall be inspected during the last year of his attendance at such a school. During 1948, 4,194 parents, or 79 per cent., attended the full routine medical inspections. Infectious Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1944:— Scarlet Fever. Diphtheria. Measles and German Measles Chicken Pox. Mumps. Whooping Cough. 1944 183 25 968 252 29 412 1945 133 39 1,070 183 85 222 1946 156 13 576 259 312 95 1947 120 7 1,056 122 27 332 1948 179 7 *1,330 116 87 376 *Of this number 1,315 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 Ilford schools during 1948. 218 home visits were paid by the School Nurses to cases of minor infectious disease. In addition the Sanitary Inspectors paid 1,315 visits to measles cases, and 376 visits to whooping cough cases. 74 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 1948:— Valentines Mayesbrook Primary Schick tested 53 34 Positive 15 14 Negative 38 20 Inoculated (full course) 92 58 Schick+ 1947 — — Schick+1948 35 14 Not tested 41 22 Negative after full course of inoculation 79 51 Positive after full course of inoculation and re-inoculated — — Awaiting re-test 16 8 Not re-tested after inoculation on account of leaving district, etc. — 2 Re-inoculations (one only) 1,009 506 Result of final Schick test in 1948 of cases inoculated in 1947. Valentines Mayesbrook Positive and re-inoculated — 4 Negative 4 5 1,752 individual children were treated (1,154 at Valentines Mansions and 598 at Mayesbrook) making 5,250 attendances (3,460 and 1,790 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, 14,633 children of school age, and 26,030 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 cases at beginningof 1948. No. of cases reported during 1948.Total. No. of Remedied cases under during observation 1948. at end of 1948. Ringworm:— Scalp — 1 1 1 — Body — 1 1 1 — — 2 2 2 - The 1 case 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 1948, 2,134 home visits by the School Nurses were paid for the purpose, and 3,270 re-examinations of children (some on several occasions) were carried out by the doctors at school ; 61 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 1948, were as follows:— Newbury Hall. Mayesbrook. Number of individual children seen 1,675 1,569 Number of attendances of children 3,095 3,187 Number of exclusion certificates granted 405 501 Number of certificates of fitness to attend school granted 408 497 75 The following table shows the conditions dealt with at both the Clinics during the year:— Subnormal Nutrition 639 Debility 34 Uncleanliness:- Head 209 Body 1 Skin:— Ringworm:— Head 1 Body 1 Scabies 19 Impetigo 73 Dermatitis 14 Urticaria 27 Furunculosis 54 Eczema 32 Other Skin Diseases (Non-Tuberculous) 303 Eye:— Blepharitis 42 Conjunctivitis 40 Keratitis 1 Defective Vision (excluding Squint) 213 Squint 27 Other conditions 63 Ear:— Defective Hearing 45 Otitis Media 29 Other Ear Diseases 201 Nose and Throat:— Chronic Tonsillitis only 45 Adenoids only 15 Chronic Tonsillitis and Adenoids 87 Nasal Catarrh 73 Sore Throat 6 Nasal Obstruction 45 Other conditions 89 Enlarged Cervical Glands (Non-Tuberculous) 43 Defective Speech 21 Teeth—Dental Diseases 407 Heart and Circulation:— Functional 10 Organic 2 Anaemia 51 Infectious Diseases:— German Measles 6 Measles 4 Whooping Cough 12 Chicken Pox 6 Mumps 8 Colds and Coughs 210 Influenza 2 Lungs:— Asthma 34 Bronchitis 72 Pulmonary Catarrh 32 Other Non-Tubercular Diseases 10 Tuberculosis:— Pulmonary—Definite — —Suspected (Referred to T.B. Officer) 21 76 Nervous System:— Nervous Debility 59 Habit Spasm 9 Chorea 4 Petit Mai 6 Enuresis 35 Other Conditions 12 Deformities:— Genu Valgum 9 Posture 26 Pigeon Chest 2 Flat Feet 56 Pes Valgus 2 Intoeing 6 Valgus Ankles 46 Other forms 16 Minor Injuries 109 Rheumatism 69 Other Defects and Diseases 201 Total number of ailments 4,046 SPECIAL CLINICS. Ophthalmic Clinic. During the year 1948, the School Oculist held 188 sessions for the refraction of children suffering from defective vision (100 at Valentines and 88 at Mayesbrook). Full details of the work are given in Table III, Group II, on page 90. 3,023 attendances (1,663 at Valentines Clinic, 1,360 at Mayesbrook Clinic) were made by 1,464 schoolchildren (811 at Valentines Clinic, 653 at Mayesbrook Clinic), as compared with 1,309 schoolchildren in 1947. The 1.464 children were not all suffering from crave defects of vision. The following table shows the vision in the worst eye, as tested by Snellen's Type:— 6/6 6/9 6/12 6/18 6/24 6/36 6/60 less than 6/60 362 267 221 208 137 169 87 13 The children who saw 6/6 (practically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. The 1,464 children were found to be suffering from the following defects:- Diagnosis. New Cases. Old Cases. A B A B Myopia 73 50 120 93 Myopic Astigmatism 4 6 35 15 Hypermetropia 70 27 145 105 Hypermetropic Astigmatism 17 28 65 36 Anisometropia 10 5 3 8 Hypermetropia with Squint 20 4 Squint 46 42 113 140 Blepharitis 7 4 6 4 Chalazion 2 1 — — Congenital Cataract — — — 2 Congenital Coloboma 1 — 1 2 Corneal nebulae - 1 — 2 Conjunctivitis — 2 1 2 Nystagmus 2 1 4 3 Other conditions 2 5 1 9 N.A.D. 23 20 40 36 Totals 257 192 554 461 A—Valentines. B—Mayesbrook. 77 Under the Education Committee's scheme 922 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 241 cases the lenses of spectacles were replaced or repairs of frames were carried out. Orthoptic Clinic.— Arrangements with the Walthamstow Education Committee for Ilford children to be seen by the Orthoptist at the Walthamstow Clinic have now ceased. Dr. Powell, the School Medical Officer, Walthamstow, reported that he was unable to accept any new cases after 12th October, but that the treatment of children already referred would continue. Particulars of children seen during the year are as follows :— Number of cases investigated 137 „ „ treated 98 of this number— 33 were discharged cured. 10 are still under treatment. 23 are being kept under observation. 8 awaiting operation. 15 failed to attend. 9 transferred to other Clinics. Number of cases of Amblyopia included in the above total cured = 31 Total number of attendances for the year = 416. Orthopaedic Clinic. (i) Newbury Hall Clinic.—48 sessions were held during 1948, 210 children of school age were examined for the first time during the year and 374 children were seen, who had previously attended the clinic. These 584 children made 1,318 attendances. (ii) Mayesbrook Clinic.—27 sessions were held during 1948, 109 children of school age were examined for the first time during the year and 180 children were seen, who had previously attended the clinic. These 289 children made 696 attendances. The 1,083 children were found to be suffering from the following defects:— Diagnosis. New Cases. Old Cases. A B A B Paralyses :— A.P.M - 1 11 5 Hemiplegia - 1 6 1 Paraplegia - - 1 - Monoplegia - - 1 - Spastic deplegia - - 1 - Scoliosis 2 1 9 1 Kyphosis - - 3 1 Slack posture 22 7 20 2 Deformity of hips 1 - 2 - Depressed sternum 1 - - 1 Deformity of chest 1 - 2 - Genu valgum 59 30 100 65 78 Diagnosis. New Cases. Old Cases. A B A B O.C.T. 6 - 25 15 Genu varum 4 7 - 6 Pes valgo, planus 42 30 65 30 Valgus ankles 46 20 76 30 Talipes calcaneo valgus - 2 4 2 Congenital talipes E.V. 2 - 2 2 Congenital defect - 1 8 3 Intoeing - - 4 1 Pas cavus 2 1 2 2 Hallux valgus 3 1 10 4 Deformity of toes 10 1 9 3 Traumatic condition 3 1 - - Rickets - - - 1 Torticollis 2 1 2 - N.A.D. 3 3 - - Other conditions 1 1 8 4 Ortho : defect connected birth injury - - 3 1 Totals 210 109 374 180 A—Newbury Hall. B—Mayesbrook. 8 children of school age were admitted to Hospitals. Particulars as follows :—- No. of Cases. Hospital. Defect. 1 Royal National Orthopaedic Country Branch, Stanmore. Genu Valgum. 4 Harold Wood Tight Tendo achilles. Exostosis— Rt. femur. Torticollis = 2 cases. 3 Black Notley Talipes Cavo varus. Arthritis. Old Erbo palsy. During the year 124 pairs of valgus insoles, 14 pairs of surgical boots or shoes, 9 pairs Genu Valgum splints, 1 spinal jacket, 1 toe spring for drop foot, 4 metatarsal bars and 5 repairs to artificial limbs, were supplied to school children. 286 cases were discharged from the Orthopaedic Clinic, 5 as cured, 120 discontinued attendance and were kept under observation at school, 137 were showing improvement and were kept under observation at school, and 24 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 174 sessions were held by the Masseuse for treatment during 1948 (88 at Newbury Hall Clinic and 86 at Mayesbrook Clinic). 79 At Newbury Hall Clinic 117 individual children of school age were treated by the Masseuse during the year and 1,586 attendances were made by these children. Treatment was also given to 64 children, who made 1,074 attendances at the Mayesbrook Clinic. Artificial Sunlight Clinic.—A Masseuse attends the Newbury Hall Clinic on Monday morning and the Mayesbrook Clinic on Tuesday morning for artificial sunlight treatment, 41 sessions were held at Newbury Hall Clinic and 43 at Mayesbrook Clinic. At the Newbury Hall Clinic 53 children of school age were treated, making 845 attendances for treatment. At the Mayesbrook Clinic 43 children of school age were treated, making, 801 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 13 Pulmonary Fibrosis 2 - Bronchitis 10 8 Bowlegs 1 2 Alopecia 2 - Adenitis 2 1 Asthma 1 2 Knock Knees 1 - Old Rickets 4 1 Chilblains 3 - Flat feet 1 1 Psoriasis 2 - Posture 1 2 Other Conditions 8 13 53 43 A—Newbury Hall Clinic. B—Maybrook Clinic. Of the 43 cases treated at the Mayesbrook Clinic, 4 were Open Air school children. At Newbury Hall Clinic, 16 children of school age were discharged from the Artificial Sunlight Clinic, 7 were cured, 3 were showing considerable improvement, and 6 were discharged due to absence. 31 children were still receiving treatment at the end of the year. At Mayesbrook Clinic, 20 children of school age were discharged from the Artificial Sunlight Clinic, 7 were showing considerable improvement, 11 were cured, and 2 were discharged due to absence. 17 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. 91 sessions were held during 1948 and 1,436 attendances were made by 776 children of school age, of whom 530 were new cases. The following table shows the work of the Clinic :— 80 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 treated elsewhere. 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 1 - - - - - - - - - - - - 1 2 (ii) Acute Catarrhal Otitis Media 3 - 5 - - 2 - - - - - - - - - 1 8 3 (iii) Chronic Suppurative Otitis Media due to :— 1. Tympanic Sepsis - 10 3 - - 3 - - - - - - - - 2 1 5 14 2. „ and Granulations 1 3 - 1 - - - - - - - - - - - - 1 4 3. Other Causes - 2 1 - - 1 1 - - - - - - - 1 - 3 3 (iv) Mastoid Disease (previous operation) ... - - 2 - - - - - - - - - - - - 1 2 1 (v) Partial Deafness due to :— 1. Nerve Deafness 2 - - - - - - - - - - - - - - - 2 - 2. Tonsils and Adenoids 4 3 17 - - 2 - - - 1 - - - - - - 21 6 3. Retraction of Membrana Tympani 4 2 3 - 1 1 - - 1 - - 2 - - 2 1 11 6 4. Scarring of Membrana Tympani 1 - 1 - - - - - - - - - - - 1 - 3 - 5. Other causes 2 4 13 - 1 4 - - 1 - - - - - 2 3 19 11 (vi) Opinion on Tonsils 4 6 318 35 10 16 - - 6 1 2 3 1 - 14 12 355 73 (vii) Rhinitis - 6 3 - - 5 1 1 - - - - - - - 4 4 16 (viii) Other diseases or defects 18 33 54 12 5 42 - - 2 - 3 4 - 2 12 14 94 107 Totals 39 70 421 49 17 76 2 1 10 2 5 9 1 2 34 37 530 246 81 Rheumatism Clinic. The Physician attended 29 morning sessions during the year, and 223 children (73 of these being new cases) made 441 attendances. The 223 children were found to be suffering from the following conditions :— Defects Found. New Cases. Old Cases. Totals. History of Rheumatism (observation) 11 15 26 „ Chorea 1 1 2 Rheumatic Carditis ... - 8 8 Other forms of Carditis - 2 2 Tachycardia of Nervous origin 1 - 1 Congenital Heart Disease 4 40 44 Rheumatism 1 2 3 Chorea 1 2 3 Habit Spasm - 2 2 Anaemia, Subnormal-nutrition and Debility 1 3 4 No active Rheumatic disease 5 7 12 Heart Murmur functional 13 25 38 Acidosis, metabolic disturbance of Alimentary origin 1 10 11 Pains due to Orthopaedic condition 15 15 30 Allergic Type 1 2 3 Arrhythmia 2 1 3 Other Conditions 16 15 31 Totals 73 150 223 Number of cases referred to Convalescent Home 3 ,, „ ,, General Hospital (In-patients) 2 „ „ „ Isolation Hospital 1 ,, ,, ,, Ear, Nose and Throat Surgeon 19 ,, „ „ Orthopaedic Surgeon 23 „ „ ,, for X-ray and Electro-Cardiogram 83 Blood Sedimentation Rate 20 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 attended the Clinic at the Valentines School daily. By the end of the year, 111 individual children of school age had received speech therapy at this Clinic, making a total of 1,452 attendances. The defects treated were as follows :— Dysphonia 1 Stammering 35 Dyslalia 41 Cleft Palate 3 Post Operative (Tonsillectomy) 28 Neurological 2 Lip Reading 1 69 children of school age were discharged from the Clinic during the year. In 56 cases the speech was normal. Of the remaining 13 cases, 6 ceased to attend for treatment, 6 left school or left the district and in 1 case 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. 82 Miss Lough resigned her full-time appointment as Speech Therapist with effect from 31st December, 1948, but has continued to be engaged on a part-time sessional basis for 5 half-days weekly. School Dentists.— Of 11,467 inspections by the Dentists (including special cases) 7,887 (or 68-7 per cent.) were found to require treatment, compared with 7,440 (or 64 per cent.) in 1947, 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. In addition to the ordinary dental work of fillings and extractions, 240 regulation plates, 10 crowns, and 7 dentures were supplied. 3,038 visits were made by children to the Dental Clinic for regulation purposes. The amount of dental disease present in children at various ages is shown by the following table relating to school children inspected by the school Dentists :— Age groups (in years) No. of inspections of children No referred for treatment Percentage 5 1,486 1,036 69 6 1,461 1,056 72 7 1,173 891 76 8 1,109 775 70 9 1,146 819 71 10 1,073 746 69 11 918 601 65 12 884 568 64 13 903 562 62 14 918 588 64 15 350 227 64 16 33 12 36 17 11 4 36 18 2 2 100 Total 11,467 7,887 68 Full details of the dental work are shown in Table IV. Open-air School.— During 1948 41 children were admitted, 41 ceased attendance, and on the 31st December, 1948, 83 children were on the school roll, 2 vacancies remaining unfilled. Those admitted were recommended for examination from the following sources :— School Medical Officer 31 Tuberculosis Officer 4 Head Teachers 2 Others 4 The above 41 children were admitted for the following reasons :— School Medical Officer :— Anaemia and dyspepsia 1 Asthma 3 Bronchial Asthma 7 Bronchitis and Anaemia 1 Bronchitis and Pulmonary Catarrh 1 Debility and Asthma 3 Recurrent pneumonia and Asthma 1 Debility and Sub-normal nutrition 3 Debility and Catarrh 1 Debility and Nephritis 1 Malnutrition and Pulmonary Catarrh 1 Malnutrition 3 Heart—mitral cystolic murmur 1 Recurrent rheumatic carditis 1 Partially sighted and hemiparesis 1 Spastic paraplegia 1 Chronic osteomyelitis 1 83 Tuberculosis Officer :— Old T.B. lungs 1 T.B. Spine and ankle 1 T.B. left hip 1 Nerves 1 Head Teachers :— Bronchitis 1 Debility 1 Others :— Bronchitis, Asthma and Pulmonary Catarrh 1 Bronchicetasis 1 Perthes Disease 1 Rheumatic Carditis 1 The 41 children not now on the school roll ceased attendance for the following reasons :— Transferred to Fyfield Open Air School 1 Resumed attendance at ordinary school 34 Left school—over age 1 Admission to convalescent home 2 Admission to Black Notley Sanatorium 3 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 61 Number of children referred for treatment 23 Number of children treated by Dental Surgeon 23 In addition, 39 children, on the recommendation of the Medical Officer at the Open Air School, received priority treatment at the Dental Clinic. 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 29 Administration of Cod-liver Oil Emulsion 29 Administration of Malt and Oil, Parrish's Food, etc. 11 Referred to Ophthalmic Surgeon 5 Orthopaedic Surgeon re Remedial Exercises, etc. 3 „ Dental Surgeon 4 „ Aural Surgeon 4 Rheumatism Clinic Specialist 1 „ Artificial Sunlight Clinic 2 „ T.B. Officer 6 Recommended Asthma exercises 12 Recommended Convalescent Home treatment 1 A course of Asthma Injections has been given to 32 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. 14 children received Artificial Sunlight treatment during the year. Treatment for Uncleanliness.— The School Nurses paid 185 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 results:— Number of Examinations of Children. Number Infected. Per cent. 49,020 *670 1.3 *56 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. 84 The percentages for the past 5 years were as follows :— 1944 2.4 1945 3.3 1946 2.6 1947 1.7 1948 1.3 Other Ailments.— During 1948, 199 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 1948 was 2,472,426 approximately. There are 19 kitchens in the Borough, established at the following schools :— Barking Abbey, Beal, Becontree, Benton, County High Boys, County High Girls, Dane, Fairlop, Gearies, Goodmayes, Gordon, Loxford, Mayfield, Newbury Park, Redbridge, South Park, The Glade, 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, 1948, 17,748 children were receiving milk in school. Work done by the N.S.P.C.C.—The following 40 cases were investigated :— (1) Neglect 28 (2) Ill-treatment cases 3 (3) Other cases 4 (1 case was reported from the Public Health Department for neglecting medical advice ; 27 were reported from other sources for general neglect). 93 children (46 boys and 47 girls) were involved, 58 being of school age. In addition to this work, 231 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.— 49 children were sent to residential schools and paid for by the Education Committee in 1948. In addition 55 children were sent to Convalescent Homes and in 1 case 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 the staffs of the King George Hospital, Ilford, and of Queen Mary's Hospital, Stratford. Most valuable help in connection with the investigation of pulmonary ailments has been rendered by Dr. Currid of the 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. 85 A record of all such children is revised annually from returns submitted by all Head Teachers, and any new cases attending local maintained schools are reported to me with a view to medical examination and ascertainment of their suitability or otherwise of attendance at an ordinary school. The several categories of pupils requiring special educational treatment are defined as follows :— (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. (/) Diabetic Pupils, that is to say, pupils suffering from diabetes, who cannot obtain the treatment they need while living at home and require residential care. (g) Educationally Sub-Normal Pupils, that is to say, pupils who, by reason of limited ability or other conditions resulting in educational retardation, require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. In connection with (g) 198 children were medically examined during 1948 and found to fall within this category, 5 children were found to have sufficiently improved to permit of their transfer from the special class at Newbury Park to ordinary schools. 31 were admitted and 138 were awaiting admission to the special class. At the end of the year 61 children were on the roll, an additional class having been formed on 1st March, 1948. (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, 1948, are tabulated hereunder :— 86 Return of Handicapped Pupils in the Area on 31st December, 1948 (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 2 3 1 - - - - - 3 3 C. Deaf Pupils 6 7 - - - - 1 - 7 7 D. Partially Deaf Pupils 2 2 - 1 - - - - 2 3 E. Delicate Pupils 34 38 25 11 - - 1 - 60 49 F. Diabetic Pupils - - - - - - - - - - G. Educationally Subnormal Pupils 53 30 161 71 - - 18 11 232 112 H. Epileptic Pupils - 1 3 3 - - 1 1 4 5 I. Maladjusted Pupils 8 - 9 11 - - - - 17 11 J. Physically Handicapped Pupils 17 11 6 5 - - 4 - 27 16 K. Pupils Suffering from Speech Defect - - 56 33 - - 6 6 62 39 L. Pupils Suffering from Multiple Disabilities 5 6 4 4 - - 3 4 12 14 Physically Handicapped Children.— During 1948, 67 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 2 Delicate or Physically Handicapped. Open Air School 56 Residential Special School 8 67 Children Examined for Disability of Mind.— During 1948 the following numbers of children were medically examined and reported upon under the Education Act. 1944 :—• Initial Examination Reexamination (a) Maladjusted 25 1 (b) Educationally Subnormal 106 73 (c) Unfit for Education within the school system 5 3 Total number examined 136 77 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. 87 Summary of Children Unfit for Education within the School System at the end of 1948 :— At Residential Institution 8 At Special Day School 1(1) At Occupation Centre 21(3) At Ordinary School 1 At no School or Institution 21(1) Total 52(5) Figures in brackets indicate number over 15 years of age. Employment of School Children and Young Persons.— From special inquiries made at the various schools during 1948 it was found that 101 children were employed out of school hours. 16 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 16 Employment of Children in Entertainments Provisional Amending Rules, 1945.—6 Certificates were granted during the year. Examination of Officers, etc.—The undermentioned teachers and other officers were medically examined and reported upon during the year :— Newly-appointed Teachers 2 Newly-appointed Staff 32 Staff Sickness Regulations 1 Total 35 Camp Schools. The Elmbridge Camp School at Cranleigh, Surrey, and Kennylands Camp School at Kidmore End, near Reading, were taken over entirely by the Essex Education Committee on the 1st April, 1948. Admissions and re-admissions of Ilford School Children to these two Camp Schools and the Hydon Heath Camp, are medically examined by the Assistant Medical Officers prior to entry. Table Showing the Principal Causes of Death among Children of School Age (i.e. from 5—15 Years) in Ilford for 1946 and 1947. 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. 1947 1946 1947 1946 1. Measles .06 - 10.0 - 2. Scarlet Fever - - - - 3. Whooping Cough .12 0.1 - - 4. Diphtheria .06 0.1 10.0 - 5. Influenza 1.20 1.2 - - 6. Tuberculosis 4.31 4.0 10.0 - 7. Rheumatic Fever - - - - 8. Bronchitis, Pneumonia and other respiratory diseases 11.39 11.4 16.7 9. *Meningitis and Nervous system 12.19 15.0 - 16.7 10. Heart Diseases 30.88 24.2 - - 11. Acute and Chronic Nephritis 2.93 2.1 - - 12. Violence 4.19 3.4 40.0 8.3 13. Other causes 32.67 38.5 30.0 58.3 100.0 100.0 100.0 100.0 *Excludes Meningococcal infections. 88 Deaths of School Children. Ilford.— The deaths of children of School Age during 1947 represent 0-6 per cent. of the Total Deaths registered (all ages), and during 1946 represent 0-7 per cent. Ministry of Education. MEDICAL INSPECTION RETURNS. Year Ended 31st December, 1948. TABLE I. Medical Inspection of pupils attending maintained Primary and Secondary Schools. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 2,015 Second Age Group 1,027 Third Age Group 2,250 Total 5,292 Number of other Periodic Inspections - Grand Total 5,292 B.—Other Inspections. Number of Special Inspections 3,770 Number of Re-inspections 7,423 Total 11,193 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 Table, and therefore the total on column (4) will not necessarily be the same as the sum of columns (2) and (3).) Group. (1) For defective vision (excluding squint). (2) For any of the other conditions recorded in Table IIa. (3) Total individual pupils. (4) Entrants 57 499 618 Second Age Group 86 274 325 Third Age Group 220 587 734 Total (Prescribed Groups) 363 1,360 1,677 Other Periodic Inspections - - - Grand Total 363 1,360 1,677 89 TABLE II. A.— Return of 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 151 72 3 - 5 Eyes—a. Vision 368 436 13 2 b. Squint 44 14 - - c. Other 25 33 1 1 6 Ears—a. Hearing 80 52 2 1 b. Otitis Media 33 6 1 - c. Other 34 36 2 - 7 Nose or Throat 314 863 7 10 8 Speech 24 56 - 1 9 Cervical Glands 12 342 - - 10 Heart and Circulation 37 175 3 2 11 Lungs 76 280 4 4 12 Developmental— a. Hernia 7 6 - - b. Other 4 5 - - 13 Orthopaedic— a. Posture 309 81 8 1 b. Flat foot 269 51 9 - c. Other 441 217 10 - 14 Nervous System— a. Epilepsy 4 2 - - b. Other 10 55 - 1 15 Psychological— a. Development 2 31 - - b. Stability 12 153 2 - 16 Other 156 303 10 8 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 2,015 584 28.98 1,363 67.64 68 3.38 Second Age Groups 1,027 264 25.7 705 68.65 58 5.65 Third Age Groups 2,250 858 38.13 1,315 58.45 77 3.42 Other Periodic Inspections - - - - - - - Total 5,292 1,706 32.24 3,383 63.93 203 3.83 90 TREATMENT TABLES. TABLE III. Notes.— These Tables deal with all defects treated, or under treatment, 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). Number of defects treated, or under treatment during the year (a) Skin. Ringworm—Scalp :— (i) X- Ray treatment 1 (ii) Other treatment - Ringworm—Body 1 Scabies 19 Impetigo 73 Other skin diseases 450 Eye Disease (External and other, but excluding errors of refractions, squint and cases admitted to Hospital.) 151 Ear Defects 287 (Treatment for serious diseases of the ear, (e.g. operative treatment in Hospital) are not recorded here, but in the body of this Report.) Miscellaneous 527 (e.g. minor injuries, bruises, sores, chilblains, etc.) Total 1,509 (b) Total number of attendances at the Authority's Minor Ailments Clinics 6,282 Group II.— Defective Vision and Squint. (Excluding Eye Disease treated as Minor Ailments—Group 1.) Number of defects dealt with Errors of Refraction (including Squint) 1,391 Other defects or disease of the eyes 140 Total 1,531 Number of Pupils for whom spectacles were :— (a) Prescribed 922 (b) Obtained 762 91 Group III.— Treatment of Defects of Nose and Throat. Total number treated. Received Operative Treatment :— (a) For Adenoids and Chronic Tonsillitis 446 (b) For other nose and throat conditions 42 Received other forms of treatment 156 Total 644 Group IV.— Orthopaedic and Postural Defects. (a) Number treated as in-patients in Hospitals or Hospital Schools 8 (b) Number treated otherwise, e.g. in Clinics or out-patients department 1,075 Group V.— Child Guidance Treatment and Speech Therapy. Number of pupils treated :— (a) Under Child Guidance arrangements 23 (b) Under Speech Therapy arrangement 111 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 Total. Inspected at Schools 1,156 1,150 898 883 924 879 759 777 803 823 270 33 11 2 9,368 Specials 330 311 275 226 222 194 159 107 100 95 80 - - - 2,099 (b) Specials 2,099 (c) Total (Routine and Specials) 11,467 (2) Number found to require treatment 7,887 (3) Number actually treated 5,360 (4) Attendances made by children for treatment 12,793 (5) Half-days devoted to Inspection 71 Total 1,186 Treatment 1,115 (6) Fillings Permanent Teeth 4,755 Total 7,372 Temporary Teeth 2,617 (7) Extractions Permanent Teeth 1,184 Total 8,534 Temporary Teeth 7,350 (8) Administrations of general anaesthetics for extractions 2,915 (9) Other operations Permanent Teeth 8,229 Total 10,348 Temporary Teeth 2,119 TABLE V. Infestation with Vermin. (i) Total number of examinations in the Schools by the School Nurses 49.020 (ii) Total number of individual pupils found to be infested 670 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) - (iv) 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. 92 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. 0.63 „ 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. (Resigned 31.7.48) 0.36 „ I. D. M. Nelson, M.B., B.Ch., B.A.O., C.P.H., D.P.H. (Commenced 5.1.48) 0.45 „ F. L. Groarke, M.B., B.Ch., C.P.H., D.C.H., D.P.H. (Commenced 27.7.48) 0.36 „ 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/ll = 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/ll=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 93 Table VIII.— Summary of Cases of Infectious Diseases among School Children, and of Contacts of such Cases excluded from School Attendance during the Year ended the 31st December, 1948 SCHOOLS No. on Roll DISEASES AND CONTACTS Scarlet Fever Diphtheria Measles and German Measles Whooping Cough Chickenpox Poliomyelitis Mumps Pneumonia Rheumatism. Totals. Cases Contacts Cases Contacts Cases Contacts Cases Contacts Cases Cases Contacts Cases Contacts Cases Cases Contacts Beal Modern 666 2 1 - - 2 - - - 1 - - - - - 5 1 Becontree 1,356 6 14 - - 28 1 13 3 2 - 1 - 2 - 51 19 Benton (Open Air) 85 - - - - 4 1 - - - - - - - 3 7 1 Chadwell 675 7 6 - - 101 4 25 3 9 - - 31 - - 173 13 Christchurch 703 9 5 - - 92 - 1 - 7 - - 11 2 1 123 5 Cleveland 865 7 6 3 - 64 1 1 1 - - - 1 - 1 77 8 County High 1,256 2 6 - 1 5 - - 4 1 - - - - 10 11 Dane 699 4 1 - - - - - - - - - - - - 4 1 Downshall 1,217 20 12 2 - 111 5 28 1 7 - - 4 - 2 174 18 Fairlop 1,608 14 15 - - 61 5 17 1 3 - - 2 2 - 99 21 Gearies 1,267 10 8 - 1 44 - 21 5 6 - - 25 - 1 107 14 Goodmayes 599 10 4 - - 63 1 3 - 2 - - - 1 1 80 5 Gordon 220 4 - - - 27 - 20 - 32 - - - 1 - 84 - Highlands 700 - 5 - 2 40 - 16 - 1 - - - - - 57 7 Loxford 335 1 - - 1 1 - 1 - 1 - - - - - 4 1 Mayfield 871 1 4 - 1 1 - - - - - - - - 1 3 5 Mossford (Fairlop) 298 3 - 1 - 15 - 14 - - - - - - - 33 - Mossford (G.V.H.) 84 - - - - 6 - 4 - - - - - - - 10 - Newbury Park 248 1 2 - - 22 2 1 4 - - - - 1 1 26 8 Parkhill 717 9 6 - - 72 1 38 - 2 - - 2 1 - 124 7 St. Augustine's 220 2 1 - - 30 1 3 - - - - 1 - - 36 2 SS. Peter and Paul's 637 6 7 - - 34 1 12 - 15 - - - 1 - 68 8 St. Vincent's 343 - - - - 9 - - - - - - - - - 9 - South Park 1,001 15 5 - 1 110 3 31 5 1 - 1 - 3 - 160 15 The Glade 392 8 - - - 69 - 6 - 2 - - - 1 - 86 - The John Bramston 332 3 2 - - 114 2 7 - - - - - - - 124 4 The Mount 317 - 2 - - - - - - 1 - - 5 - - 6 2 The Redbridge 493 13 5 - - 7 1 18 1 2 - - - 2 - 42 7 The William Torbitt 786 10 4 - - 89 3 49 - 1 - - 1 1 - 151 7 Uphall 367 5 4 - - 22 - 1 - - - - - - - 28 4 Ursuline 198 3 1 - - 19 2 4 - - - - - 1 - 27 3 Woodlands 283 1 3 1 - 11 2 23 1 19 - - 4 1 - 60 6 Private - 3 5 - - 57 - 19 2 1 1 - - - - 81 7 Totals 19,838 179 134 7 7 1,330 36 376 31 116 1 2 87 20 13 2,129 210 Paratyphoid fever: one case at Downshall. 94,95 Table IX A.— Table Showing the Average Heights and Weights of the BOYS Examined. Age Groups. Age Groups. School 5—6 Years 6—7 Years 7—8 Years 8—9 Years 9—10 Years 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Beal Modern - - - - - - - - - - - - - - - - - - 1 145 31.8 1 146 34.7 - - - 1 165 45.0 39 168 55.4 Becontree 20 112 20.1 15 115 21.4 7 118 23.6 2 124 27.7 2 131 31.3 31 137 32.6 45 141 34.0 2 142 36.2 4 149 41.1 34 154 44.5 - - - Benton (Open Air) 5 106 19.0 14 115 21.0 13 118 21.9 15 123 24.2 7 128 25.3 10 134 28.2 16 138 30.2 8 137 30.9 6 149 36.8 3 152 39.9 - - - Chad well 69 112 20.3 5 117 23.0 1 125 25.0 1 132 28.0 1 136 30.4 17 142 35.2 38 141 33.9 - - - - - - - - - - - - Christchurch 27 114 21.4 8 114 21.9 3 128 25.7 2 139 32.4 1 136 29.1 21 140 32.3 23 144 35.6 - - - - - - - - - - - - Cleveland 32 111 19.9 5 113 18.9 2 125 24.5 1 131 27.0 - - - 69 139 31.0 47 141 33.6 - - - - - - - - - - - - Dane Central - - - - - - - - - - - - - - - - - - 1 146 33.8 - - - 1 163 49.4 39 163 50.4 1 169 50.0 Downshall 31 114 21.0 16 117 22.3 4 122 23.2 2 125 24.2 2 131 26.6 30 140 33.8 33 142 34.4 4 150 40.7 1 174 58.2 3 154 45.7 - - - Fairlop 37 114 20.6 8 118 21.3 2 119 23.3 2 130 27.6 1 137 29.8 40 139 35.5 35 142 35.1 10 143 36.4 5 151 42.4 11 162 50.0 1 175 65.5 Gearies 33 112 20.6 10 113 18.6 5 125 24.7 - - - 2 131 28.3 23 142 35.1 36 143 34.8 1 142 31.5 2 154 42.9 37 163 52.1 1 166 56.9 Goodmayes 70 112 21.3 8 116 26.4 4 123 22.9 4 129 28.4 - - - 23 137 31.0 28 142 33.9 - - - - - - - - - - - - Gordon 39 112 20.5 5 113 21.0 - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 26 113 19.2 8 117 20.4 1 120 20.3 4 133 27.3 6 134 29.9 32 143 34.5 19 141 34.0 - - - - - - - - - - - - Loxford - - - - - - - - - - - - - - - - - - 1 136 29.0 2 145 40.5 2 156 43.2 86 159 48.5 3 163 50.4 Mayfield - - - - - - - - - - - - - - - - - - - - - 5 150 41.0 17 153 46.4 75 159 48.8 2 171 61.7 Mossford 24 112 19.6 8 116 22.5 - - - - - - 3 130 27.6 10 140 34.0 13 143 36.2 - - - - - - - - - - - - Mossford G.V.H. 2 114 20.9 4 112 21.8 - - - 2 119 22.0 - - - - - - - - - - - - - - - - - - - - - Newbury Park 15 111 20.9 18 116 21.3 2 123 24.4 - - - 1 138 30.1 8 140 32.6 15 141 34.7 - - - - - - - - - - - - Parkhill 64 111 190 6 116 20.4 8 126 231 1 134 30.0 8 134 27.8 16 137 30.3 55 142 33.0 - - - - - - - - - - - - St. Augustine's 13 113 20.7 9 115 20.9 2 131 27.0 4 125 23.2 1 134 27.2 12 137 32.1 12 141 33.5 - - - - - - - - - - - - SS. Peter & Paul 32 113 20.4 9 118 23.2 1 121 20.4 - - - 1 127 28.7 15 139 32.5 13 140 30.9 5 146 40.8 2 148 37.8 6 162 49.1 1 163 46.9 South Park 38 113 19.8 8 116 20.7 - - - 1 136 29.8 4 135 30.8 16 140 32.9 94 143 34.8 - - - - - - - - - - - - St. Vincent's 11 111 20.8 3 117 22.4 1 122 24.6 1 129 27.7 - - - 11 135 31.8 3 138 34.5 1 146 39.9 - - - 3 152 50.3 - - - The Glade 16 116 22.1 7 118 19.9 2 119 22.7 2 133 30.7 1 150 34.8 2 133 26.8 2 133 30.2 - - - - - - - - - - - - The John Bramston 24 113 19.2 18 117 21.2 2 123 26.0 1 129 25.2 - - - 4 136 30.2 15 141 33.9 - - - - - - - - - - - - The Redbridge 40 112 19.4 4 117 21.6 3 122 22.4 3 129 331 1 140 36.0 13 142 37.1 21 143 34.2 - - - - - - - - - - - - The Wm. Torbitt 39 112 19.7 5 119 22.6 3 124 25.8 4 129 26.9 3 131 28.9 18 140 33.3 22 144 36.0 - - - - - - - - - - - - Uphall 31 111 20.3 11 116 23. 0 2 128 22.4 - - - - - - 9 137 32.0 14 141 34.1 - - - - - - - - - - - - Woodlands 26 111 19.3 2 114 20.0 - - - - - - - - - - - - - - - - - - - - - - - - - - - Ilford Boys—Averages for 10 years :— 1948 764 112 20.2 214 116 21.5 68 122 23.5 52 127 26.6 45 133 28.7 430 137 32.4 602 142 34.2 39 144 37.0 40 153 43.6 298 159 48.6 48 168 55.3 1947 871 110 19.6 209 115 21.3 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 26.0 94 132 28.6 487 139 31.9 468 142 36.1 140 146 37.2 241 155 41.9 146 158 46.9 40 166 54.0 1945 542 112 20.2 238 117 21.7 92 122 24.0 58 127 26.5 31 131 28.5 74 138 31.8 122 143 35.5 410 146 37.2 41 148 39.3 6 155 42.5 - - - 1944 783 112 19.9 168 116 21.7 83 122 22.4 76 127 26.3 61 132 29.5 59 139 32.6 128 141 34.4 548 146 37.3 73 150 41.0 - - - - - - 1943 723 111 19.6 348 116 22.1 192 121 23.6 184 126 26.6 130 132 28.1 125 137 32.0 152 143 34.8 546 145 36.4 171 151 42.0 - - - - - - 1942 735 111 19.8 420 115 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 - - - - - - 96,97 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 Years 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 Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Beal Modern - - - - - - - - - - - - - - - - - - 1 147 39.1 6 150 42.8 6 155 48.9 4 161 51.6 19 162 52.0 1 158 59.2 Becontree 25 111 19.6 7 113 20.8 8 117 21.5 5 124 23.8 9 130 29.3 43 137 33.0 47 139 33.4 3 140 37.1 2 151 48.1 46 157 47.8 - - - - - - Benton (Open Air) 3 110 12.5 8 115 18.8 10 117 21.4 7 123 23.1 10 126 23.6 9 130 27.3 8 138 28.6 8 144 34.7 4 155 42.7 7 155 42.1 - - - - - - Chad well 42 113 19.6 3 118 23.0 1 117 20.2 5 132 27.8 2 129 24.9 13 140 30.4 33 144 36.2 - - - - - - - - - - - - - - - Christchurch 21 113 19.7 11 116 21.3 1 127 25.2 3 125 25.8 2 128 28.3 21 138 32.3 36 145 36.6 - - - - - - - - - - - - - - - Cleveland 20 110 18.9 2 106 16.3 - - - 2 129 25.9 2 132 26.8 29 138 31.6 41 142 36.2 1 140 34.5 - - - - - - - - - - - - Dane Central - - - - - - - - - - - - - - - - - - - - - 5 156 47.2 1 136 25.0 54 158 48.3 2 157 44.0 - - - Downshall 28 106 19.3 14 116 20.7 6 126 25.2 2 120 26.0 1 136 30.0 37 139 33.3 42 144 35.5 2 170 33.0 1 159 36.5 1 160 49.4 - - - - - - Fairlop 37 113 19.1 7 118 21.3 4 121 27.1 1 131 27.5 2 129 25.1 39 136 29.2 30 141 32.4 5 151 44.0 8 157 51.8 6 158 48.7 - - - - - - Gearies 37 112 19.7 17 114 20.6 4 121 23.4 3 125 26.1 3 135 30.1 18 143 33.7 34 143 34.6 2 153 44.2 4 156 46.4 43 157 48.0 3 154 53.7 - - - Goodmayes 49 109 19.1 13 115 20.4 3 127 25.5 1 129 28.2 2 129 27.9 15 140 34.4 24 142 36.2 - - - - - - - - - - - - - - - Gordon 30 110 18.8 6 113 20.4 3 120 22.8 - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 35 114 19.5 6 117 21.5 6 120 23.4 2 123 22.4 - - - 24 140 33.7 17 141 34.0 - - - - - - - - - - - - - - - Mayfield - - - - - - - - - - - - - - - - - - 3 148 39.7 2 143 35.1 4 148 41.6 69 158 51.3 3 158 49.2 1 162 61.6 Mossford 17 1ll 19.4 2 110 - - - - - - - - - - 10 140 35.0 7 144 37.2 - - - - - - - - - - - - - - - Mossford G.V.H. 4 111 19.8 2 108 19.7 3 115 22.8 5 126 28.6 3 135 31.3 4 123 32.6 1 140 41.6 - - - - - - - - - - - - - - - Newbury Park 16 112 19.6 10 117 21.3 1 124 23.7 2 125 26.3 - - - 10 141 331 22 141 32.5 - - - - - - - - - - - - - - - Parkhill 74 111 19.4 9 116 22.3 4 120 22.3 2 131 30.2 4 133 30.1 20 140 31.3 60 144 36.3 - - - - - - - - - - - - - - - St. Augustine's 11 117 19.9 8 115 20.2 4 120 22.2 2 123 27.1 1 139 27.6 4 136 29.4 9 144 34.8 - - - - - - - - - - - - - - - S.S. Peter & Paul 29 110 19.9 8 115 20.5 2 124 23.7 - - - 1 127 27.5 19 137 31.2 14 138 32.5 1 158 31.3 2 152 40.3 3 156 53.2 - - - - - - South Park 65 113 19.6 4 117 20.0 5 124 25.0 3 129 25.2 5 131 29.3 18 143 34.1 70 144 35.0 - - - - - - - - - - - - - - - St. Vincent's 7 108 18.5 7 113 19.9 - - - 1 125 24.5 - - - 9 142 33.9 5 141 34.2 1 147 36.6 - - - 3 159 46.7 - - - - - - The Glade 17 113 18.3 13 116 19.0 5 120 21.8 1 131 23.1 2 134 32.4 2 131 28.4 - - - - - - - - - - - - - - - - - - The John Bramston 23 108 18.0 11 114 20.0 6 120 24.5 2 122 23.3 1 126 23.4 9 142 33.2 14 143 36.1 - - - - - - - - - - - - - - - The Mount - - - - - - - - - - - - - - - - - - - - - 2 149 44.0 3 155 46.7 67 158 49.5 - - - - - - The Redbridge 32 111 19.5 6 116 20.2 - - - 2 131 28.4 1 120 35.2 15 141 34.5 23 144 36.1 - - - - - - - - - - - - - - - The William Torbitt 23 111 19.6 1 110 18.9 2 131 24.0 3 128 25.7 - - - 13 139 32.9 16 141 34.1 - - - - - - - - - - - - - - - Uphall 30 109 19.0 6 113 20.0 2 120 23.1 1 125 25.5 2 129 26.0 10 136 33.4 12 140 31.9 - - - - - - - - - - - - - - - Woodlands 24 113 19.4 7 115 20.7 2 122 21.3 1 164 26.8 - - - - - - - - - - - - - - - - - - - - - - - - Ilford Girls—Averages for 10 years :— 1948 699 111 19.4 188 115 20.5 82 120 23.1 56 127 25.8 53 130 27.8 391 138 32.4 569 142 35.0 38 149 39.9 35 154 45.9 303 157 49.1 27 160 51.3 2 160 60.4 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 47.4 1 154 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 - - - - - - - - - 98,99 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 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 12 145 35.5 4 154 41.3 1 166 55.9 11 167 58.0 103 169 58.2 7 170 62.2 3 170 67.8 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 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 15 150 41.3 12 147 42.2 4 166 56.2 6 161 51.6 53 160 55.5 12 161 55.5 4 165 54.2