AC 4411(1) ILFORD ILF 24 Borough of llford Health Report FOR THE YEAR 1949 J. H. WEIR M.D., B.S., B.Hy., D.P.H. Medical Officer of Health, etc. . GORDON \ M.D., Ch.B., M.R.C.P., D.P.H. 1 Acting Medical Officer of Health 1950/ Wattrlow & Sons Ltd., London and Dunstable. I. GORDON M.D., Ch.B., M.R.C.P., D.P.H. Acting Medical Officer of Health 1950 ILFORD BOROUGH COUNCIL Municipal Year 1949/50 Alderman S. C. V. Woods, J.P., Mayor. Alderman G. Colvin, J.P., F.C.I.S., Deputy Mayor. Aldermen : Barker, John. Bryan, William Allen Vernon. Colvin, Gilbert, J.P., F.C.I.S., Deputy Mayor. Cooper, Albert Edward, M.B E. Daniels, Russell Stearn. Eke, William Benjamin. Fallaize, Mrs. Lilian, J.P. Griggs, Albert Philip, J.P. Holness, Richard Thomas. Woods, Sidney Charles Victor, J.P., Mayor. Wootton, Mrs. Florence Emily, O.B.E. Young, Major Alexander, T.D., J.P. (E.C.C.). Councillors : Bartlett, Edward Albert. Bennett, Mrs. Florence Edith. Billings, John. Bone, George Robert. Caunt, George Louis. Cowan, Harold Douglas, F.C.P.A., F.C.C.S. Drew, Leslie Victor. East, John. Faning, Percy Victor (E.C.C.). Gibson, Cyril Irving. Gleed, Sydney George. Gooch, Lionel Archer Scott. Groom, Victor William. Headley, Cecil Aubrey. Hewitt, Reginald. Hughes, Thomas Bernard. Johnson, Stanley A. (E.C.C.). Lawrence, Samuel George. Lee, Leonard Gordon Victor. Littlejohn, Mrs. Ruth Constance, M.A. Masters, Frank Robert. Milburn, Mrs. Elizabeth Florence (E.C.C.). Pearson, Frederick Thomas. Pohl, Mrs. Winifred Elizabeth. Pointer, Frederick George. Root, Harold Goldstone. Sherrell, Albert R. (E.C.C.). Slater, Frank. Smith, Mrs. Lily Maude, S.R.N. Tamplin, Lewis Henry. Taylor, Sidney William. Terry, Miss Anne Sylvia. Tullett, Mrs. Ethel Ross. Tyler, Bertie Charles Newcombe. Watts, Mrs. Mabel Lucy. Wickens, Maurice Morley. PUBLIC HEALTH COMMITTEE Municipal Year 1949/50 Councillor C. I. Gibson, Chairman. Councillor Mrs. M. L. Watts, Vice-Chairman. Alderman J. Barker. Alderman G. Colvin, J.P., F.C.I.s. (Deputy Mayor). Alderman W. B. Eke. Councillor J. East. Councillor L. G. V. Lee. Councillor Mrs. R. C. Littlejohn, M.A. Councillor F. R. Masters. Alderman A. P. Griggs, J.P. Alderman Mrs. F. E. Wootton, O.B.E. Alderman S. C. V. Woods, J.P. (Mayor). Councillor Mrs. W. E. Pohl. Councillor A. R. Sherrell (E.C.C.). Councillor Mrs. L. M. Smith, S.R.N. Councillor Mrs. E. R. Tullett. ILFORD HEALTH AREA SUB-COMMITTEE OF THE HEALTH COMMITTEE OF THE ESSEX COUNTY COUNCIL Municipal Year 1949/50 Ilford Borough Council Representatives: Aldermen Barker, Eke, Mrs. Fallaize, Woods (Mayor) and Mrs Wootton; Councillors Gibson, Groom, Huches, Mrs. Littlejohn, Mrs. Milburn, mrs. Fohl, Mrs. Smith, Miss Terry (Vicechairman), Mrs. Tullett and Mrs. Watts (Chairman). Essex County Council Representatives: Alderman Green; Councillors Mrs. Ball, Berry, Glenny, Herridce and Porter, and Mrs. Warr. 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 A. Armitage, B. Butcher, Miss N. L. Odell and Mrs. A. M. Pearce. ILFORD COMMITTEE FOR EDUCATION Municipal Year 1949/50 Alderman G. Colvin (Deputy Mayor), J.P., F.C.I.S., Chairman Mr. R. J. D. Manders, Vice-Chairman. Alderman S. C. V. Woods, J.P. (Mayor). Alderman Major A. Young, T.D., J.P. (E.C.C.). Councillor Mrs. E. F. Milburn (E.C.C.). Councillor F. T. Pearson Councillor Mrs. W. E. Pohl. Councillor Mrs. L. M. Smith'S.R.N. Councillor S. W. Taylor. Councillor Miss A. S. Terry. Councillor B. C. N. Tyler. Councillor Mrs. M. L. Watts. Alderman J. Barker. Alderman W. A. V. Bryan. Alderman A. E. Cooper, M.B.E. Councillor Mrs. F. E. Bennett. Councillor J. East. Councillor P. V. Faning (E.C.C.). Councillor L. A. S. Gooch. Councillor T. B. Hughes. Councillor Mrs. R. C. Littlejohn, M.A. Councillor F. R. Masters. Co-opted Members : Rev. W. C. Johnson. Mr. H. S. Kenward, M.A. Mr. S. P. Lonergan. Mr. E. R. Lower, B.A. Mr. L. R. Maddieson. Mr. R. J. D. Manders. Miss H. S. Rich. County Nominated Members: County Alderman A. W. Green, M.B.E., J.P. Mr. W. R. Spencer. OFFICERS OF THE PUBLIC HEALTH SERVICES Medical Officer of Health, Borough School Medical Officer, Acting Area Medical Officer, Ilford Health Area Sub-Committee. J. H. Weir, M.D., B.S., B.Hy., D.P.H. (Durham). Deputy Medical Officer of Health: I. Gordon, M.D., Ch.B., M.R.C.P.(Lond.), D.P.H.(Edin.). Assistant Medical Officer of Health: I. D. M. Nelson, M.B., B.Ch., B.A.O., C.P.H., D.P.H. (Belfast). Chief Sanitary Inspector: S. R. Daly, B.Sc., LL.B., D.P.A.(Lond.), F.A.L.P.A. Deputy Chief Sanitary Inspector: P. W. English. Sanitary Inspectors: S. G. Rackham. T. F. Johnson. A. C. R. Neale. J. Cook. G. W. Newman. F. Nau. R. E. Smalley. D. F. Scott. Chief Administrative Assistant: F. J. Hocking. Essex County Council. Assistant County Medical Officers: D. M. B. Gross, M.D., Ch.B.(Leeds), M.M.S.A., D.P.H.(Lond.). F. E. O'Connor, B.A., M.B., B.Ch., B.A.O., D.P.H. (T.C. Dub.), L.M.(Rot.). A. Collins, M.B., B.Ch., B.A.O. (Cork). F. Groarke, M.B., B.Ch. (N.U.I.), C.P.H., D.C.H., D.P.H. Senior Dental Officer: E. V. Haigh, L.D.S., R.C.S. (Eng.). Assistant Dental Officers (Part-time): A. G. Clark, L.D.S., R.C.S. (Eng.). M. J. K. Soutter, L.D.S., R.C.S. (Eng.). Educational Psychologist: K. Pickett, B.Litt. (Oxon.), D.i p.Psych. Superintendent of Midivives: Miss C. Blockley. Superintendent Health Visitor: Mrs. M. D. Smith. Health Visitors and School Nurses: Miss A. L. Drinkwater. Miss M. Illing. Miss A. Batten. (To 30/11/49.) Mrs. V. M. Whiting. Miss I. L. Mobbs. Miss G. E. Lewis. Miss M. G. Bennett. Mrs. B. A. Wheeler. Mrs. I. Quirk. Miss V. L. Gardner. Officers of the Public Health Services—continued. Tuberculosis Visitors. Mrs. T. E. Bowman. Mrs. A. T. Jones. Mrs. P. B. Lascelles. Matrons of Day Nurseries : Sunshine House Miss I. E. Sandall. Green Lane Mrs. E. Drower. Ley Street Miss A. R. Jones. Stevens Road Miss M. Vose. Domestic Help Organizer : Mrs. L. A. Horwood. Part Time:— Regional Hospital Board. Consulting Obstetrician (Puerperal Pyrexia Regulations): B. G. Spiers, F.R.C.S., M.R.C.O.G. Surgeon in charge of Orthopaedic Clinic: J. A. McLauchlan, M.D., F.R.C.S. Oculist: J. J. Kennedy, M.R.C.S., L.R.C.P., 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 : C. B. M. Warren, B.A., M.R.C.P. Psychiatrist in charge of Child Guidance Clinic : A. H. G. Burton, M.D., M.R.C.P., D.P.M., D.P.H. Essex County Council. Physiotherapist : Mrs. M. E. King, M.C.S.P. Speech Therapist : Miss P. M. Lough, L.C.S.T. Ilford Borough Council. Public Analysts : George Taylor, F.I.C. J. Hubert Hamence, M.Sc., Ph.D. PREFACE Public Health Offices, Ilford. September, 1950. 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 1949. In February, 1950, Dr. Weir resigned his appointment of Medical Officer of Health to take up a similar position with the Royal Borough of Kensington and the Metropolitan Borough of Chelsea. His departure was a matter of great regret to his many friends and colleagues in Ilford, where he served with ability and distinction for fifteen years—as Resident Medical Officer at the Isolation Hospital, as Deputy Medical Officer of Health, and finally as Medical Officer of Health. This report covers the last year of his stewardship; that continuity and completeness is preserved in the following pages is largely due to the efforts of members of all sections of the Public Health Department. During 1949 the new system of administration of the personal health services under Part III of the National Health Service Act, by means of a sub-Committee of the County Health Committee, was further developed. Stresses were made apparent, but nevertheless I believe the services supplied to the public of Ilford were of a high order. Vital statistics continue to show that the health of the inhabitants of Ilford remains well above the average for England and Wales. The most important index, the infant mortality rate, continues to fall and reached the record low level of 20.1 deaths per 1,000 live births, as compared with 32 for England and Wales, and 29 for the Administrative County of London. Another significant index of hygiene is the number of deaths per 1,000 live births from diarrhoea and enteritis in children under 2. For Ilford it is 0 4, for England and Wales 3, and for the Administrative County of London 1.7. Neonatal Mortality, deaths of infants under the age of 4 weeks, again fell to a new low record of 12'5 per 1,000 live births. The death rate is, however, showing an opposite tendency and has risen from 8.4 per 1,000 to 9.5. These extra 210 deaths over the previous year can be accounted for entirely by the higher mortality from cancer, heart disease and the effects of arterio-sclerosis. A similar tendency prevails throughout the country and is the result of an ageing population with a decline in births. The birth rate continues to fall from the high level reached immediately after the war and was 14.5 per 1,000, as compared with 15.8 the previous year. Should this fall continue and the maternity beds controlled by the Regional Hospital Board continue to be utilised as fully as they are to-day, it is to be anticipated that there will be some difficulty in providing sufficient work for the domiciliary midwives. Such a tendency is already becoming apparent. It is to be noted, however, that there were 2,403 marriages last year, as compared with 1,736 in 1948. The environmental hygiene section continues to be fully occupied. Certain diseases, such as smallpox and typhoid, are controlled and others, such as cholera, banished, but lest we relax, other problems arise that prove less amenable to our efforts. I refer especially to poliomyelitis, of which 33 cases were notified and 4 died, and food poisoning, of which 82 notifications were received, both these incidences being the highest so far in Ilford. The 7 importance of these diseases, however, must not obscure the fact that the 4 deaths from both combined is to be compared with 53 during the year from tuberculosis. It is gratifying to note that this latter total is 16 less than the previous year. A pleasing record is the fact that no cases of diphtheria were confirmed during the year. This is to be attributed entirely to the immunisation campaign, and it would be a great pity if the campaign were to slacken because of press publicity with respect to poliomyelitis manifesting itself in those recently immunised. It is extremely doubtful if there is any association between the agent used in Ilford for immunisation (T.A.F.) and poliomyelitis, the majority of the cases so far reported being associated with whooping cough immunisation and other diphtheria antigens. I have investigated the immunisation history of all Ilford cases of poliomyelitis in the epidemic years of 1947 and 1949 and in no case could the disease have been brought about by immunisation in our clinics or by private doctors working under schemes of which we have records. During the year the number of immunisations at our clinics declined from 3,917 to 2,811, but when to these figures are added the number of immunisations carried out by general practitioners of which we have records, the totals are 4,349 for 1948, and 4,359 for 1949, a difference of no significance. No cases of smallpox occurred during the year, but the sanitary inspectors paid 489 domiciliary visits in connection with the surveillance of 43 contacts of smallpox aboard ship. Since the introduction of the National Health Service Act on 5th July, 1948, vaccination has no longer been compulsory, and is carried out by general practitioners. Throughout the country there has been a marked fall in the incidence of vaccination; in Ilford we were notified of 831, 726 of which were among infants under 1 year of age; as a percentage of the year's births this is 27.5 per cent., which compares with 16 4 per cent. for the aggregate of 79 County Boroughs. I have investigated the incidence of vaccination amongst children attending the Infant Welfare Centres in Ilford, with interesting results. They are as follows:— Per cent. Per cent. Per cent. Cecil Hall (West) 54 Valentines 53 Woodford Avenue 42 Newbury Park 38 Goodmayes 34 Seven Kings 32 Cecil Hall (East) 31 Ilford Lane 30 Chadwell Heath 30 Fairlop 29 Elmbridge 27 Barkingside 27 Becontree 26 Grosvenor Road 26 Downshall 22 It is apparent that children living in the three districts which contain the higher income groups are protected to a greater extent than those living elsewhere in spite of the fact that vaccination is free. Measles, whilst still remaining the commonest notifiable disease, with 1,663 cases, showed a marked decline over the previous year, and whooping cough the next highest at 566, was about half the previous year. These diseases only contributed one death each. Probably the incidence for 1950 will be much higher. The routine supervision of the purity of food supplies still continues at a high level, probably the most difficult problem being the ensuring of a hygienic standard of ice cream. During the year 140 samples were taken and 27 proved unsatisfactory, requiring re-inspections and further sampling. Milk is now dealt with under revised Regulations, the general effect of which is to transfer to the Ministry of Agriculture and Fisheries the responsibility for the supervision of the production side of the industry and the Local Authority the retailing side. On the whole the quality of the milk has been of a high standard. During the coming year thought will have to be given to measures to increase the standard of food-handling, a subject of criticism by visitors to England. Lectures and film shows to all sections of the public would seem to be amongst the foremost lines of attack. 8 The School Health Service now deals with a school population of 21,123, and can be expected to increase still further. It is with regret that I have to report a further decline in the efficiency of the dental services; we in Ilford had the services of one full-time dentist and two part-time in lieu of at least seven considered necessary. The condition of the children's teeth is steadily deteriorating and the assistant school medical officers have an exacting task in attempting to deal with the many requests for urgent treatment. The number of attendances at the school clinics requesting urgent appointments rose 50 per cent. over the previous year. This breakdown of the priority dental services is a national problem. Largely due to the enthusiasm of Alderman A. E. Cooper, M.P., who also raised the question in the House, a conference was held with the local dentists to endeavour to work out some scheme whereby more dentists would work for the school dental service on a part-time basis. Unfortunately the response has been very poor, even to the suggestion of a sessional fee double that permitted by the County Council. There has been a steady fall in the number of children attending the minor ailments clinics. This is no doubt partly due to the fact that many children now attend their private doctors as a result of the National Health Service Act, and also to a rather spectacular drop in recent years of cases of impetigo—131 (1947), 73 (1948), 43 (1949); scabies 43 (1947), 19 (1948), 5 (1949); and pediculosis 332 (1947), 209 (1948), 175 (1949). Probably penicillin and DDT emulsions have as much to do with this as increased hygiene. Attendances at the various specialist clinics showed a small increase. It is hoped in the near future to add to the facilities of the Ophthalmic Clinic by the provision of an Orthoptic Clinic, to deal with the many cases of squint that hitherto have had to proceed elsewhere or do without this necessary treatment. The clinic will be held at the Mayesbrook Combined Treatment Centre, but the provision of an Orthoptist and equipment is the subject of negotiation between the County and the Regional Hospital Board. There is no improvement, as compared with the 1948 report, in the provision of facilities for the operative treatment of tonsils and adenoids, in fact the situation is probably worse. There is likewise still a considerable lack of day and residential accommodation for mentally and physically handicapped pupils. The Child Guidance Clinic was opened in January, 1949, at Loxford Hall, under the part-time supervision of Dr. Burton as Psychiatrist. This clinic has fulfilled a long-felt need in the borough, and has also been utilised by the Juvenile Courts, who referred 19 cases during the year. Unfortunately, there has been considerable change of staff and it is difficult to obtain sufficient personnel, as child psychiatrists and psychiatric social workers are almost unobtainable. An interesting experiment at the Open Air School, the provision of i. small class for spastic children, has proved a great success, and has been the subject of favourable comment both by visitors from the Ministry of Education and the County. In the past, many of these unfortunate children have, because of their physical defect, been considered mentally defective and either received no education at all or the wrong sort of education. Furthermore, many of them need a special attendant for their simplest needs. The class of 9 requires a specially trained teacher and an attendant, and is quite insufficient for the needs of the borough. The results, however, are most satisfying. The children concerned remain under the care of their own specialists for any specific treatment required. Part III Services as the successor to the old Maternity and Child Welfare Service is now known, is probably the department which is most likely to undergo considerable expansion when the public become fully aware of the services it supplies. I refer in particular to the domestic helps, the recuperative holiday scheme for individuals under section 28, and the provision of sick room appliances. 9 There were 13 domiciliary midwives, in addition to the Superintendent and Deputy, employed, who attended at 726 confinements, as compared with 1,234 in hospitals and private maternity homes in the area. All are qualified in gas and air analgesia, and the four sets of apparatus in use are required at about half the deliveries. As the number of confinements in hospital tends to increase rather than diminish, the attendances at the ante-natal and post-natal clinics, which in Ilford cater solely for hospital cases, has increased, and in fact extra clinics have been opened this year at Elmbridge Road and Mayesbrook. Every prospective mother now has her blood tested for the "Rhesus-factor" grouping in addition to the other tests, an essential link in the saving of child life. Cases confined at home have ante-natal and post-natal care from their private doctors and midwives. Attendances at the Infant Welfare Centres have shown a further decline from 49,444 to 43,668, again probably due to the decline in the birth rate and the increased facility with which mothers may attend their own doctors under the National Health Service Act scheme. In order to meet the need of the new estate at Grange Hill, an Infant Welfare Centre has now been opened in Elmbridge Road on Tuesday afternoons. In this connection I am pleased to state that work has now commenced on the Combined Treatment Centre in Manford Way, which is to take the place of the temporary Elmbridge Road Clinic. The domestic help service showed considerable expansion during the year, the number employed rising to 150 as compared with 108 the previous year, and the number of individuals supplied rising from 651 to 808. The extent to which this service can expand is limited only by finance and the number of domestic helps available. The Nurseries and Child Minders Regulation Act, 1948, was implemented and at the end of the year 5 Child-minders were registered and inspected regularly. The services of the 4 Day Nurseries continue to be greatly in demand by the public as evinced by the waiting lists which varied from 42 to 186 for the 45 to 50 places available in each nursery. A strict scheme of priority is in force, and each case has to be considered by a special sub-committee of the Health Area Sub-Committee. This year the Nursery in Winding Way was closed and the children transferred to a new building in Stevens Road. It is hoped that an early start will be made on a new nursery in Goodmayes Lane to replace the present one in Green Lane. Sick room appliances, such as invalid chairs, mattresses and the like, were supplied to 5 individuals during the year. Recuperative holidays were provided for 7 children and nursing and expectant mothers, and for 37 other adults, on receipt of a certificate from their doctors that they needed it, and were not requiring medical and nursing attention. (Where such attention is required, convalescence must be supplied by the Regional Hospital Board.) A fee is payable in respect of both these services. With regard to the Maternity Hospital, Wilnett Lodge, and the Isolation Hospital, the period of nine months, during which the Borough Council carried on administration on an agency basis, ended in 1949, and the hospitals are now entirely under the control of Hospital Management Committee Group 12. An effective liaison, however, is still maintained with the Isolation Hospital, as is essential for the effective control of infectious disease. After a further period of a year of functioning of the National Health Service Act, 1946, it has become possible to consider its working. It has benefited the community in many ways, but in spite of its manifest advantages, in at least three aspects of its relationship with local Authorities, there has been considerable heart-searching. I refer, firstly, to the relationship of the larger Municipal Boroughs to the County Councils, who have been given much of the responsibilities formerly enjoyed by the boroughs, and many think unnecessarily so. Secondly, the division of the Maternity 10 Services, formerly controlled by one authority, into three parts, supervised by the Regional Hospital Board, the Executive Council, and the Local Health Authority, has given rise to much adverse comment. Finally, the discrepancy of remuneration given to salaried officers in the Civil Service, Army, and Local Authorities, especially dentists, as compared with that available to doctors and dentists working under Parts II and IV of the Act, has caused considerable bitterness, and has already resulted in cessation of recruitment to these services. I wish to express my thanks for the continued efficiency and loyalty of the staff of all the sections of the Public Health Department. I would also mention the kind co-operation and assistance received from the officers and members of other Departments of the Corporation. Ilford is probably unique in the extent of the help given by the Ilford Federation of Voluntary Workers, and to them I wish to give thanks for the enthusiastic way in which they have co-operated in the past year. Finally, may I express my gratitude to the members of the Council, and especially the Chairmen, Vice-Chairmen and members of the various Committees most concerned with the Public Health Department for their support and the confidence they have reposed in me. I have the honour to be, Your obedient Servant, I. GORDON, Acting Medical Officer of Health. 11 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land 8,402 Inland Water 26 8,435 Tidal Water 7 Population (Census 1921) 85,194 „ (Census 1931) 131,061 Number of inhabitated houses (end of 1949) according to Rate Books (approx.) 46,949 Rateable Value—April 1st, 1949 (Houses and Land) £1,613,209 Sum represented by a penny rate, April 1st, 1949 (approx.) £6,450 Education Rate— 1948-49 1949-50 (E.C.C.) 6s. 6.85d. 6s. 10.47d. in the £ in the £ Combined Rate (all services) 19s. 4d. 19s. 2d. in the £ in the £ The following figures as to unemployment were supplied by the Ministry of Labour:— Males. Females. As at January, 1949 606 148 As at January, 1950 463 163 Total M. F. 1949 1948 Live Births Legitimate 2,567 1,313 1,254 Birth Rate per 1,000 of the estimated net resident population 14.5 15.8 Illegitimate 63 30 33 Still Births 61 32 29 Rate per 1,000 total (live and still) births 22.6 22.3 Deaths 1,728 847 881 Death Rate per 1,000 of the estimated net resident population 9.5 8.4 Percentage of total deaths occurring in public institutions 33.7 26.7 Registrar-General's Estimate of resident Population: — June 30th, 1946 173,900 1947 179,820 1948 183,400 1949 185,000 12 Deaths from puerperal causes (Headings 29 and 30 of the Registrar-General's Short List): — Deaths. Rate per 1,000 total (live and still) births. 1949 1948 1949 1948 No. 29, Puerperal sepsis 1 0 0.37 0.0 No. 30, Other maternal causes 1 0 0.37 0.0 Total 2 0 0.74 0.0 Death-rate of Infants under one year of age: — 1949 1948 All infants per 1,000 live births 20.1 21.7 Legitimate infants per 1,000 legitimate live births 19.9 21.0 Illegitimate infants per 1,000 illegitimate live births 31.7 43.9 Deaths from Cancer (all ages) 319 29.7 „ „ Measles (all ages) 1 — „ „ Whooping Cough (all ages) 1 — „ „ Diarrhoea (under 2 years of age) 1 1 The number of patients and resident staff on the 30th June, 1949, at the following public institutions, was: — Claybury Hospital 2,532 Goodmayes Hospital 1,360 Australasian Hospital (Dr. Barnardo's Homes) 97 Total 3,989 4. Deaths. The total number of deaths of Ilford residents was 1,728. This is obtained by taking the total deaths registered in the district (1,646), subtracting the deaths of non-residents occurring in the district (402), and adding the deaths of Ilford residents registered as having died in other districts (484). The number of deaths of non-residents registered in the district (principally in large institutions) was as follows: — Claybury Hospital 168 Goodmayes Hospital 66 King George Hospital 99 Ilford Isolation Hospital and Sanatorium 34 Other Non-residents .k. 35 Total 402 1. Rainfall. Total rainfall registered in the district during the year was 19 58 inches; The greatest fall in 24 hours was registered on 16th July, 148 inches (thunder storm). October was the wettest month. 2. Population. 3. Births. The number of births registered during the year was 2,630. Males Females Legitimate 1,313 1,254 Illegitimate 30 33 i.e., 2 4 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was: 3.2; 3.3; 3.1; 5.5; 4.2; 3.4; 3.5; 3.3; 2.5; 2.2. The birth-rate, calculated on the net estimate of the population is 14.5 per 1,000. 13 The number of deaths of Ilford residents registered as having died in other districts during the year was as follows, and includes deaths at the following Institutions: — Old church Hospital, Romford 69 Brentwood Mental Hospital 14 Wanstead Hospital 13 Queen Mary's Hospital, West Ham 12 Hospital for Sick Children, Great Ormond Street 1 London Hospital 45 St. Bartholomew's Hospital 9 Charing Cross Hospital 1 Westminster Hospital 4 Guy's Hospital 1 Severalls Mental Hospital, Colchester 6 East Ham Memorial Hospital 5 University College Hospital 2 Whipps Cross Hospital 14 St. Luke's Hospital 2 London Chest Hospital 2 In other Hospitals, Institutions and residences outside the Ilford district 284 Total 484 The death rate, calculated on the net estimate of the population of 181,108, is 9.5 per 1,000. Inquests.—During the year, 47 inquests were held, 30 on Ilford residents, and 17 on non-residents. The ages at death were as follows: — Under 1 year 1-2 years 2-5 years 5-15 years 15-25 years 25-45 years 45-65 years 65 years and upwards 1 _ 2 2 1 12 15 14 Death-Rates from Tuberculosis and Cancer, 1949. The following Table shows the death-rates for 1949 for Ilford, compared with the provisional death-rates for England and Wales for the same period, per 1,000 population; the figures having been supplied by the Registrar- General :— Ilford England and Wales Respiratory Tuberculosis .265 .403 Other Tuberculosis .027 .054 Cancer 1.761 1.871 5. Marriages.—2,403 marriages took place in the Ilford district during 1949, both parties or one of the contracting parties being Ilford residents. 7. Tarles 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 1949, arranged according to the age groups at which deaths occurred. TABLE I.—Vital Statistics of Whole District During 1949 and Previous Years. Year Gross Population, estimated to middle of each Year. Net Population estimated to middle of each Year. Births Total Deaths Registered in the District Transferable Deaths Net Deaths Belonging to the District Uncorrected Number Net (6) of Non-Residents registered in the District of Residents not registered in the District Under 1 year of Age At all Ages Number Rate (c) Number Rate (d) Number Rate per 1,000 Net Births Number Rate (e) 1 2 2 a 3 4 5 6 7 8 9 10 11 12 13 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 1949 185,000 181,108 2,027 2,630 14.5 1,646 8.9 402 484 53 20.1 1,728 9.5 (a) The net estimated population is found by deducting the population of Clay bury 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. 14 TABLE IA Table showing comparison between the Birth.rate, Death.rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1949 (Provisional figures). Rate per 1,000 Total Population Annual Death.rate per 1,000 Population Rate per 1,000 Live Births All Causes Typhoid and Paratyphoid Fevers Smallpox 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 (a) 16.7 (a) 0.39 (a) 11.7 0.00 0.00 0.45 0.51 0.01 0.00 0.15 0.01 3.0 32 126 County Boroughs and Great Towns, including London 18.7 0.47 12.5 0.00 0.00 0.52 0.56 0.02 0.00 0.15 0.02 3.8 37 148 Smaller Towns (Estimated Resident Populations 25,000 to 50,000 at Census 1931) 18.0 0.40 11.6 0.00 - 0.42 0.49 0.01 0.00 0.14 0.02 2.4 30 London Administrative County 18.5 0.37 12.2 0.00 — 0.52 0.59 0.01 0.00 0.11 0.01 1.7 29 ILFORD (Estimated Gross Population, mid 1949 = 185,000) 14.2 0.33 9.3 - - 0.29 0.33 0.01 - 0.09 0.02 0.4 20 (a) Rates per 1000 total population; otherwise rates are based on civilian population. A dash (—) signifies that there were no deaths. 15 16 Registrar-General's Short List of Deaths and Causes:— TABLE II. Causes of, and Ages at, Death during the Year 1949. 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 1,728 53 5 7 8 15 36 69 144 290 445 656 1 Typhoid and paratyphoid fevers - - - - - - - - - - - - 2 Cerebro-Spinal fever 1 - - - - - 1 - - - - - 3 Scarlet fever - - - - - - - - - - - - 4 Whooping cough 1 1 - - - - - - - - - - 5 Diphtheria - - - - - - - - - - - - 6 Tuberculosis of respiratory system 48 - - - 1 2 14 11 7 7 4 2 7 Other forms of tuberculosis 5 - - - 1 1 2 - - - - - 8 Syphilitic disease 2 - - - - - - - 1 - 1 - 9 Influenza 18 - - - 1 - - 1 2 1 4 9 10 Measles 1 - 1 - - - - - - - - - 11 Acute Poliomyelitis and encephalitis 4 - - - 1 1 1 1 - - - - 12 Acute infectious encephalitis - - - - - - - - - - - - 13 Cancer of buccal cavity and oesophagus (males only) 6 - - - - - - 1 - 2 3 - Cancer of uterus (females only) 14 - - - - - - 1 2 5 4 2 14 Cancer of stomach and denum 43 - - - - - 1 2 6 7 11 16 15 Cancer of breast 36 - - - - - 1 2 6 12 6 9 16 Cancer of all other sites 220 - - 2 - 2 2 10 32 50 62 60 17 Diabetes 13 - - - - - - - 1 1 6 5 18 Intra-cranial vascular lesions 220 - - - - - - - 19 34 66 101 19 Heart disease 552 - - - - 3 - 9 29 90 165 256 20 Other diseases of the tory system 79 - - - - - - 2 2 12 25 38 21 Bronchitis 95 1 - - - - 2 4 7 11 25 45 22 Pneumonia 62 10 1 3 - - 1 3 1 9 11 23 23 Other respiratory diseases 24 1 1 - - - - 2 - 8 8 4 24 Ulceration of the stomach or duodenum 17 - - - - - - 2 5 7 1 2 25 Diarrhoea (under 2 years of age) 1 1 - - - - - - - - - - 26 Appendicitis 4 - - 1 1 1 - - - - - 1 27 Other digestive diseases 28 - - - - - 1 - 2 4 7 14 28 Nephritis 39 - - - 1 — 1 5 3 8 8 13 29 Puerperal and post-abortive sepsis 1 - - - - - - 1 - - - - 30 Other maternal causes 1 - - - - - - - - - - - 31 Premature birth 9 9 - - - - - - - - - - 32 Congenital malformations, birth injury, infantile disease 30 24 - - - 1 2 1 3 2 - 1 33 Suicide 16 - - - - - 3 3 3 2 1 34 Road Traffic accidents 9 - - - 1 - 1 2 1 1 1 3 35 Other violent causes 17 2 1 1 — 1 2 2 - - 22 .11 36 All other causes 112 4 1 - 1 3 2 3 - - - - 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) Home Nursing.—This service is administered by the Essex County Council. A report of the work performed during 1949 will be found in Part III Services section. (iii) Laboratory Facilities.—During the year 449 swabs were examined for the presence of diphtheria organisms in the Bacteriological Laboratory at the Isolation Hospital; 2 gave positive results and 447 negative results. Swabs for the presence of diphtheria organisms are now forwarded to Oldchurch Hospital, Romford, for examination. (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, llford Act, 1937.) (5) Slaughterhouses and humane slaughtering of animals. (6) Pleasure Fairs. (Sec. 128, llford Act, 1937.) (7) Tipping of Dust, Spoil and Refuse. (Sec. 85, llford 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.) (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 1949 twenty applications for renewal of licences were received. The Council renewed the licences in respect of these establishments. Two new applications were received, which were granted. The licences expire on 31st March of each year. Part VI.—Hairdressers' and Barbers' Premises. During 1949, 93 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. 105 applications for registration in respect of 97 premises were 18 considered during the year. The registrations were granted as follows: — Purveyors retailing multiple firms' productions 98 Purveyors manufacturing and retailing their own productions (made apart from domestic premises) 3 Purveyors manufacturing and retailing their own productions (made on domestic premises) Nil Registration was refused in 4 cases on account of unsatisfactory storage provision. 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. Legal proceedings were taken against a person selling ice cream without registration. A fine of 10s. was imposed. (12) Ilford Corporation Act, 1937. 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 40 persons (concerning 18 premises), but refused in 4 cases on account of the unsuitability of the proposed storage premises. The registration of 2 hawkers, who were found to be using an unapproved and unsatisfactory store, was revoked. Legal proceedings were taken against a person for selling goods without being registered and for failing to have his name and address legibly inscribed on the barrow contrary to the provisions of Sections 77 and 78 of the Ilford Corporation Act. The defendant was fined a total of £9 and £2 2s. costs. Section 80 of the Act requires registration of premises used for the preparation or manufacture of sausages, or potted, pressed, pickled or preserved meat, fish or other food intended for sale. Three applications for registration were received during 1949, all 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). During the year, 4,619 inspections were made, 23 Preliminary Notices were served, 15 of which were complied with. 1 Preliminary Notice served in 1948 was also complied with. 7 Certificates of Exemption from the provisions of sub-Section 2 of Section 10 were granted in 1949. 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. 19 (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 1949 a licence was granted to one Nurses' Agency in Ilford; such licence expires on the 31st December, 1950. Agencies are inspected before the issue of a licence, and thereafter at intervals of not more than once a quarter. The Medical Officer of Health and his deputy are authorised under Part 2, Section 9 (2) to enter and inspect any such licensed premises in the Borough. (15) National Assistance Act, 1948.—(a) Section 47 provides for the removal of persons to hospital who are unable to devote to themselves proper care and attention. Two persons were dealt with under this Act during the year. They were two aged women of 80 years. One was blind, the other of weakened mental powers. The rooms occupied were insanitary and the occupants unable to maintain them in a state of cleanliness. An order for the compulsory removal of the persons was obtained from a Justice of the Peace and removal became effective two days later. (b) 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 burial of five deceased persons were dealt with up to the end of the year. They were: — (1) A male, 69 years, who died in King George Hospital, lived in lodgings. (2) A male, 59 years, lived in lodgings. (3) A female, 62 years, lived in one furnished room. (4) A male, 85 years, lived in one room. (5) A female, 73 years, lived in one room. 20 (16) Hospitals, Etc. Isolation Hospital.—189 beds are provided. Maternity Hospital.—51 beds for the reception of maternity cases are maintained at the Ilford Maternity Hospital. Wilnett Lodge Post-Natal Home has accommodation for 9 patients. King George Hospital.—The following is a return in respect of bed accommodation: — Total number of Beds at 31st December, 1949. Private Patients. Other Patients. Children. Medical. Surgical. Male. Female. Male. Female. 215 21 26 18 55 59 36 The above three hospitals are 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, 1 for medical and surgical cases and 1 for maternity cases. These Nursing Homes were still functioning on 31st December, 1949. All Nursing Homes in the district are visited by the Deputy Medical Officer of Health and the Senior Sanitary Inspector (or his deputy) quarterly and at other times when necessary. One letter was sent calling the attention of the keeper of the home to sanitary defects. Mental Hospitals.—There are two large Mental Hospitals in the district, the Goodmayes Hospital, with 1,275 patients (males 574, females 701), and Claybury Hospital, with 2,336 patients (males 1,020, females 1,316) in residence on 30th June, 1949. These Hospitals are included 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 51 children in the Hospital on 30th June, 1949. (17) Ambulance Facilities. The Ambulance Service maintained and controlled by the Essex County Council has an Ambulance Station situated at Clarks Road, High Road, Ilford, which serves this area. The station is manned continuously; the telephone numbers are Ilford 1818 and 1634. (1) The general procedure for obtaining an ambulance in emergency, is as follows: — Where there is a dialling system in operation in the Ilford Area, dial "999" or use the "emergency" buttons where provided. Where there is no dialling system, lift receiver and ask for an ambulance, or alternatively arrangements can be made to get in touch with the Ambulance Station. (2) In the case of "special" non-emergency requests for ambulance transport, application must be made to the County Medical Officer, County Hall, Chelmsford. Requests are only accepted from the staff of a hospital, doctors, midwives, home nurses or other competent persons (e.g., health visitors or an authorised officer on the M ental Health Service). 21 In these cases it is necessary to indicate whether— (a) a trained nurse is required, or (b) a sitting case car is required, or (c) if the case is one of infectious disease, the nature of the disease as pronounced by the medical attendant. If any difficulty should arise in obtaining an ambulance a call may be made direct to the County Medical Officer, County Hall, Chelmsford; telephone numbers: 4388 and 2543. (18) 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. Elmbridge Clinic, Elmbridge Road (for residents of Hainault 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. 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 morning, Tuesday afternoon (Obstetric Specialist), Wednesday morning and afternoon, Thursday morning and afternoon, Friday morning, Friday afternoon (Obstetric Specialist), Saturday morning; at Mayesbrook Clinic, Goodmayes Lane, on Monday and Thursday mornings, and alternate Saturday mornings; at Elmbridge Clinic, Elmbridge Road, on Wednesday mornings. Post-Natal Clinics.-—These Clinics are held at the Maternity Hospital on each Monday afternoon; at the Mayesbrook Clinic, Goodmayes Lane, on alternate Saturday mornings; and at the Elmbridge Clinic, Elmbridge Road, on first Wednesday mornings each month. 22 School and other Clinics.—Clinics are held at the following premises:— (i) Public Health Offices, Valentines Mansion for— Diphtheria Immunization. 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 Immunization. Orthopaedic and Remedial Exercises treatment. Infant Welfare. (iv) Valentines School, Beehive Lane, for— Dental (Children). Speech Therapy. (v) Loxford Hall, Loxford Lane, for— Child Guidance Clinic. (vi) Chest Clinic.—A clinic for the diagnosis of tuberculosis 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—Monday, 2 to 4 p.m.; Tuesday, 10 to 12 noon; Wednesday evening, for workers only, by appointment; Friday, 10 to 12 noon and 2 to 5 p.m. For Children—Wednesday, 10 to 12 noon. A Pneumothorax Kehll Clinic is held on Monday morning and on Thursday afternoon. (19) National Assistance Act, 1948.—The County Welfare Officer has kindly supplied me with the following information regarding Ilford residents: — Persons admitted to residential and/or temporary accommodation provided by or on behalf of Essex County Council: — Aged and other classes—Adults 61 Children 24 Blind persons 8 93 Blind persons: — Registered as blind 201 Partially sighted 14 Defective sighted 60 275 of whom 261 were under the supervision of Home Teachers and 14 were participating in the Home Workers Scheme operating through the agency of the National Institute for the Blind. Five other blind persons were placed in employment (open industry). 23 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 the 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 2,277 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 1949 was 667 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 3,800 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 1949 was 151 yards of 4-inch, and 111 yards of 6-inch. There are now no public wells in existence. There are a few private wells for domestic and commercial purposes. 2 samples of piped water supply (1 South Essex Waterworks Co. and 1 Metropolitan Water Board) were taken for chemical and bacteriological examination, and both gave satisfactory analyses. (ii) Drainage and Sewerage.—The Borough Engineer has kindly supplied me with the following statement: — In connection with the proposals for the improvement of the main Surface Water drainage system of the Borough, it has been necessary to promote a Bill in Parliament with the object of obtaining powers to deal with that portion of the scheme which relates to the improvement of natural watercourses; these natural watercourses being privately owned and, therefore, outside the control of the Council except for matters connected with public health and any danger thereto. Inasmuch as the watercourses referred to are widely distributed over the Borough, a considerable amount of work was entailed in the preparation of the plans, sections and estimate and in the preparation of the Book of Reference which accompanied the Bill. Following the holding of the Town's Meeting at which the Bill received approval, it was duly deposited in Parliament. Flooding of Streams. Despite a somewhat dry year there were again instances of flooding in many and widely distributed parts of the Borough and affecting each of the main watercourses. Pollution of Streams. With one exception, there were no serious instances of pollution of watercourses during the year 1949. Minor pollution occurred to the 24 Seven Kings Water affecting the South Park Lake and in the factory area around Grove Road occasional pollution of the Mayesbrook occurred. The more serious instance mentioned above affected the River Roding. The Port of London Authority, who deal with the question of pollution of the River Roding, informed the Corporation that there was a discharge of a strongly acid nature from one of the Corporation's sewers discharging into the River Roding at the southern end of the Borough. On investigation, the sewer in question proved to be the disused effluent pipe from the Council's former sewerage works. This pipe runs through an industrial area before discharging into the River Roding. The complaint was enquired into and dealt with to the satisfaction of the Port of London Authority. (iii) Collection and Disposal of Refuse.—The Borough Engineer also kindly supplied the following infromation:- Tons. The total amount of refuse collected 44,942 „ „ disposed of by barge 38,331 „ „ „ at Destructor 6,611 Collection of Salvage: — Tons. Income. Wastepaper 980 £7,663 Kitchen Waste 1,764 4,046 Other Salvage 177 785 2,921 £12,494 (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 19,344 Houses and premises reinspected (works in progress) 23,896 Visits during disinfection 968 Houses in which nuisances were detected ... 1,828 Houses in which nuisances were abated 2,118* Premises disinfected 710 Premises from which articles only disinfected 99 Articles disinfected 2,622 Premises disinfested for verminous conditions 34 'Includes 784 nuisances detected before 1st January, 1949. Notices served: — Complied with Statutory: — Served Public Health Act, 1936 235 166 Housing Act, 1936 60 25 Factories Act, 1937 — — Shops Act, 1934 — — Provide Dustbin (IIford Urban District Council Act, 1904) 19 14 Food and Drugs Act, 1938 7 5 Cleanse Water Storage Cistern (Byelaws) 4 3 Cover Water Storage Cistern (Byelaws) 5 4 Informal 1,852 1,373 2,182 1,590 In addition to the above, 897 notices (137 statutory and 760 informal) served previous to 1st January, 1949, were also complied with. 25 Complaints.—During the year, 2,496 complaints of nuisances were received and investigated. The following is a summary: — Accumulation of manure and refuse 77 Animals improperly kept 15 Bad smells 57 Dampness of premises 95 Defective drains, w.c.'s and fittings 326 Defective roofs, gutters, downpipes, etc. 162 Defective water fittings 60 Dirty and verminous houses 47 Dirty condition of rearway 6 Flooding of premises 12 Overcrowding 274 Smoke nuisances 27 Miscellaneous 1,338 Total 2,496 (v) Swimming Baths and Pools.—Samples of water for examination were taken from the open-air swimming bath from May to October (7). The samples were satisfactory, but in one sample chlorine was absent, and in three samples the chlorine content was below the prescribed standard. Samples were also taken from the two indoor baths during January, March, May, June, July, August, September, October, November and December (16); all of the samples were satisfactory, but in 2 samples (1 from the 1st and 1 from the 2nd class) the chlorine content was below the prescribed standard. (vi) Eradication of Bed Bugs : — Houses/Found to be infested 25 \Disinfested 27* "Includes 2 houses found to be infested in 1948. (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 1949. (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 nuisance from 9 factories in the Barkingside, Newbury Park, Grove Road, Ilford Lane and Green Lane areas. In all cases the firms concerned made efforts to remedy the unsatisfactory conditions by installing new plant or by making repairs and adjustments to existing plant. Two informal notices were served, both of which were complied with. Regular observations were maintained and no further complaints were received. 26 SECTION D.—HOUSING. (i) Overcrowding.—Three notices were served during 1949, all of which were complied with. (ii) Unhealthy Areas.—No representations or complaints have been made regarding unhealthy areas during the year. (iii) HOUSING STATISTICS. 1. Inspection of dwelling-houses during the year: — (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,965 (b) Number of inspections made for the purpose 12,690 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 56 (b) Number of inspections made for the purpose 1,564 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,828 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 2,039* 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 60 (2) Number of dwelling-houses which were rendered fit after service of formal notices: — (a) By owners 63* (b) By local authority in default of owners 3* b. Proceedings under Public Health Acts: — (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 263 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 276* (b) By local authority in default of owners 3* 27 c. Proceedings under Sections 11 and 13 of the Housing Act, 1936: — (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 D. No proceedings were taken under Section 12 of the Housing Act, 1936. 4. Housing Act, 1936, Part IV—Overcrowding: — (a) (i) Number of dwellings overcrowded at the end of the year 485 (ii) Number of families dwelling therein 565 (iii) Number of persons dwelling therein 1,885 (b) Number of new cases of overcrowding reported during the year 171 (c) (i) Number of cases of overcrowding relieved during the year 80 (ii) Number of persons concerned in such cases 306 (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 1949 of Notices served prior to 1st January, 1949. HOUSING ACT, 1936. During the year 1949 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 16,239 houses. At the end of the year the total certificates issued to date numbered 18,177 in respect of 24,800 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 9,563. 28 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. (i) The following new legislation came into operation on the 1st October, 1949, viz.: — 1. The Food and Drugs (Milk and Dairies) Act, 1944. 2. Milk (Special Designations) Act, 1949. 3. Regulations made under the two foregoing Acts and the Food and Drugs Act, 1938, as follows: — (a) Milk and Dairies Regulations, 1949. (b) Milk (Special Designation) (Raw Milk) Regulations, 1949. (c) Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949. The general effect of the two Acts was to transfer to the Ministry of Agriculture and Fisheries the responsibility for the registration of dairy farms and dairymen, and to empower the Minister of Food to prescribe specified areas in which an obligation is imposed on the retailing of milk or associated sales (e.g., catering sales), to use special designations. (а) Milk and Dairies Regulations, 1949.—-The Ministry of Agriculture and Fisheries is now responsible for the registration of dairy farms and of persons carrying on or proposing to carry on the trade of dairy farmer. The duties of executing and enforcing the Regulations are divided between the Ministry and the Local Authorities, so that in the Borough the Ministry is responsible for enforcing the Regulations so far as they relate to dairy farms or to the registration of persons carrying on or proposing to carry on the trade of dairy farmer, whilst the Council is responsible for executing and enforcing (1) the Regulations so far as they apply outside dairy farms, (2) the provisions relating to diseases communicable to man, and (3) the sanitary provisions of the Regulations. The Council is required to keep a register of all persons carrying on the trade of milk distributor, and of all dairy premises (other than dairy farms) in their district, and to remove from such register the name of any person who ceases so to trade and the address of any premises which cease to be so used. Persons and premises registered as at 31st December, 1949: — Persons registered as distributors of milk 68 Premises registered as dairy premises (other than dairy farms) 15 215 inspections of dairy premises were carried out during the year. (b) Milk (Special Designation) (Raw Milk) Regulations, 1949.—These Regulations re-enact, with amendments, the Milk (Special Designations) Regulations, 1936 to 1948, so far as they relate to raw milk. They provide that licences to produce raw milk to use any special designation shall be granted by the Minister of Agriculture and Fisheries, while in " specified areas " the Local Authorities will continue to grant licences to dealers to use special designations in respect of such milk. The conditions, subject to which the designations may be used, are laid down in the Regulations. The designations authorised by the Regulations are, as at present, " Accredited " and "Tuberculin Tested." The use of the former designation will, however, no longer be permitted after 1st October, 1954. 29 The following licences were granted, during 1949: — Under 1936/48 Under 1949 Regulations. Regulations. Accredited Nil Nil do. (Supplementary) Nil Nil Tuberculin Tested 11 1 do. (Supplementary) 8 3 (c) Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949.—These Regulations re-enact, with amendments, the Milk (Special Designations) Regulations, 1936 to 1948, so far as they relate to pasteurized milk and provide for a new special designation " sterilized milk." Licences in respect of pasteurizing and sterilizing establishments in specified areas are issued by Food and Drugs Authorities but Local Authorities continue to be responsible for all other licences. The conditions, subject to which the designations may be used are laid down in the Regulations. The following licences were granted during 1949: — Under 1936/48 Under 1949 Regulations. Regulations. Pasteurized (Dealer's) 14 2 do. do. (Supplementary) 8 4 do. (Pasteurizer's) 2 Nil Sterilized (Dealer's) Nil 33 do. do. (Supplementary) Nil 9 The Council delegated to the Public Health Committee all its powers and duties under the Food and Drugs (Milk and Dairies) Act, 1944, the Milk (Special Designations) Act, 1949, the Milk and Dairies Regulations, 1949, the Milk (Special Designation) (Raw Milk) Regulations, 1949, and the Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949. The Essex County Council granted one producer's licence in respect of graded milk produced on a farm in the Borough during the year 1949. The Essex County Agricultural Executive Committee also granted one producer's licence in respect of graded milk. (iii) Sampling.—The following is the routine practice adopted: — Designated Alilks.—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 the Divisional Inspector of the Ministry of Agriculture and Fisheries. 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. 30 The following results were obtained: Grade of Milk or Ice Cream Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested 2 2 — — Tuberculin Tested 14 14 — — (Pasteurized) Milk Tuberculin Tested (Certified) Milk. 15 12 3 One sample failed to satisfy the Methylene Blue Reduction test and all failed to satisfy the Coliform Test. The County Medical Officer was communicated with in all cases. Further samples proved satisfactory. Pasteurized Milk 71 69 2 Both samples failed to satisfy the Methylene Blue Reduction test. The retailers were communicated with and resampling ordered at a later date. Further samples proved satisfactory. Sterilized 21 21 — — Heat-Treated Milk 18 17 1 The sample failed to satisfy the Methylene Blue Reduction test. The retailer was communicated with and further samples proved satisfactory. Ungraded Milk 16 13 3 One of these samples was of milk as received from farms in Essex and had high Bacterial content. Of the other 2 samples one failed to satisfy the Methylene Blue Reduction test, and the other had high Bacterial content. The retailers were communicated with and resampling was ordered. Further sa mples proved satisfactory. Ice Cream 140 113 27 In four 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. 31 (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.—25 complaints of the presence of foreign bodies in milk were received and investigated during 1949. Legal proceedings were taken in 11 cases, involving 2 firms. One was fined a total of £70 and £7 7s. costs in respect of 9 cases, and the other was fined £20 in respect of 2 cases. (vii) Registration.—No application for registration was refused during 1949. Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man: — Biscuits—½ lb.; Butter, Margarine and Fats—21½ £ lbs.; Cake—96 lbs.; Cake Mixtures—25 packets; Cereals—104 lbs., 87 packets, 51 tins; Cheese—136½ lbs., 63 boxes; Chocolate Spread—6 packets; Coffee—5 bottles; Cokernut, desiccated—390 lbs.; Confectionery—32 lbs.; Cordials —7 bottles; Drinks, powdered—7 packets; Eggs (shell)—464; Egg (dried) —12 packets; Fish (wet)—768 stone, 3 boxes; Fish (tinned)—524 tins; Fish (paste)—1,690 jars; Fish (cakes)—123 cakes, 16 tins; Fish (shell)— 75 lbs., 4 bags; Foods, medicinal—39 tins, 3 bottles, 15 lbs.; Fruit (tinned)—413 tins; Fruit (bottled)—2 bottles; Fruit (dried)—71½ lbs., 25 packets; Gravy Mixtures, etc.—36 packets, 4 jars; Groundnuts— 80 lbs.; Jams, Preserves, etc.—229 jars and tins; Meat (fresh)—10 cwt. 106 lbs.; Meat (tinned)—601 tins; Meat (paste)—16 jars; Meat (pies)— 9 pies; Milk (malted)—4 tins; Milk (tinned)—1,756 tins; Pastry and Pudding Mixture—112 packets; Puddings (Black)—59 lbs.; Puddings (tinned)—143 tins; Pickles—197 jars; Poultry—-4 cwt. 68 lbs., 53 chickens; Rabbits—1 cwt. 106 lbs., 2 cases, 1 tin; Sandwich Spread— 629 jars; Sauces and Salad Dressings—81 jars; Savoury Cutlets—27; Suet—42 lbs., 4 packets; Spices—1 packet; Soup (tinned)—279 tins; Tomato Paste—2,827 tins; Vegetables (tinned)—958 tins; Vegetables (dried)—1 box; Vegetables (fresh)—90 crates and boxes; Vegetables (bottled)—180 bottles; Vegetable Sausages—25½ lbs.; Vinegar—1 bottle. Foreign Bodies in Food. 10 complaints were received during 1949 of the presence of foreign bodies in foodstuffs. All were investigated and legal proceedings were taken in one case and a fine of £5 was imposed on the food manufacturer. Letters of warning were served in 4 cases. Food and Drugs Act.—During 1949, 256 samples (249 formal and 7 informal) of Food and Drugs were obtained; 5 formal samples and 4 informal samples were not satisfactory as follows: — (a) and (b) Milk (formal).—These samples were found to contain 10 per cent, and 6 per cent, of added water respectively. Legal proceedings were taken against the farmer concerned and a fine of £10 was imposed in each case. (c) Beef Sausages (formal).—These were found to contain 160 parts per million of Sulphur Dioxide, but no notice as to the presence of preservatives was displayed by the vendor. A letter of warning was sent to the firm concerned. (d) Pastry Mix (formal).—This sample included 14.4 per cent, of fat, which on analysis was found to be in a rancid condition and to contain 45 per cent, of free fatty acids. Having regard to the rancid condition of the fat the analyst considered the preparation to be unfit for human consumption. A letter of warning was sent to the firm concerned. 32 (e) Cut Mixed Peel (formal).—This sample was preserved with sulphur dioxide to the extent of 250 parts per million which quantity exceeded the maximum limit of 100 parts per million allowed by the Public Health (Preservatives, etc., in Food) Regulations for this type of article. A letter of warning was sent to the firm concerned. (f),(g)< W and (i) Tomato Extract (informal).—These samples contained 5.5; 7.8; 4.2 and 5.6 grains of tin per lb. respectively, and 13, 30, 35 and 30 parts per million of copper respectively. They were submitted by a firm of multiple grocers on account of suspected metallic contamination. In view of the fact that the generally accepted maximum safe limit for tin contamination of foodstuffs is 2 grains of tin per pound, the samples were found to be unfit for human consumption and the whole stock was surrendered by the firm. Two samples described respectively as "Edible Animal Oil" (formal) and "Cooking Oil" (informal) were purchased from an establishment where horse flesh is sold for human consumption. The analyst considered that no exception could be taken to the samples under the Food and Drugs Act, although the results were consistent with the oils having been derived from the horse. This was admitted by the vendor and a strong letter of warning was served in view of the fact that there was a contravention of the Labelling of Food Order, 1946. The sale of the oil was discontinued. 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. Eighty-two notifications were received. Two were not verified and a further five were not notified. No. of outbreaks No. of cases No. of deaths. Organisms or other Agents responsible with No. of outbreaks of each. Suspected foods involved with No. of outbreaks of each. 5 58 Nil Salmonella Typhi- Fish mould 1 murium 1 Pressed beef 1 Staphylococcus aureus 1 Shellfish 1 Fruit 2 Not determined 3 Twenty-four other notifications—all single cases—were received, but in only five instances was the responsible agent identified, viz. Salmonella Typhi-murium 3, Salmonella Newport 1, and Salmonella Bovis Morbificans 1. Six other instances of suspected food poisoning were investigated. In one only was Salmonella Newport isolated from a sample of dried egg; about 80 persons were affected, but all recovered. Bakehouses.—There are 35 bakehouses in the district, 29 of which use motive power. 239 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 6 instances, and the requests were complied with in all but 1 case. Meat and Other Foods.—During 1949, 4,660 inspections were made of foodshops and food preparing premises, 7 Formal and 57 Informal Notices were served under the Food and Drugs Act, 1938, and 5 Formal and 63 Informal Notices were complied with, including 17 Informal Notices served in 1948. 33 A strong letter of warning was served on the proprietor of a Continental Butchery, selling horse flesh for human consumption, on account of the uncleanliness of the containers in which the meat was delivered to customers, and the generally unsatisfactory conditions at the premises. The conditions were remedied. Diseases of Animals Acts, 1894-1937. (i) Foot and Mouth Disease (Infected Areas Restrictions) Order, 1938.—The Minister of Agriculture and Fisheries declared an area having a radius of 15 miles from Foots Cray, Sidcup (including Ilford), to be an " infected area." Control of movement of animals into the area was thereby instituted and 7 licences were issued for the movement of 18 sheep, 119 cows, 6 cows in calf, 8 heifers in calf and 1 calf into the Borough, and licences issued by other authorities were countersigned for the movement of 16 pigs, 1 cow and 3 calves, out of the Borough. The " infected area " was contracted by the Minister on 19th September, 1949, to exclude Ilford. (ii) Regulation of Movement of Swine Order, 1922, and (Amendment) Order, 1936.—A licence was issued for the transfer of 2 boars and 2 gilts from Cambridge to Ilford. Isolation of the animals was effectively carried out. (iii) Importation of Dogs and Cats Order, 1928.—The Minister of Agriculture and Fisheries granted a licence for the movement into Ilford of a tigress, 9 adult lions and one cub. Conditions of the licence were complied with. (iv) Live Poultry (Regulation of Sales, Exhibitions and Movements) Order, and (Amendment) Orders, 1949. The Movement of Poultry Carcases from Orkney Islands (Regulation) Order, 1949, and The Movement of Live Poultry from Orkney Islands (Prohibition) Order, 1949.—These Orders deal with the requirements necessary to prevent the spread of Fowl Pest by controlling the movement and sale of live poultry and poultry carcases. No cases of Fowl Pest were notified during 1949. Rats and Mice Destruction Act, 1919.—170 complaints have been received of the existence of rats affecting 179 premises. In 27 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 821 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and tested 8 petroleum appliances or fittings. The number of Licences issued was 131, and the fees paid to the Council for such Licences was £96. One Licence was issued for the storage of calcium-carbide, the fee payable being 5s. Examination of Officers, Teachers and Servants. The following medical examinations were carried out during 1949: — Officers Teachers Servants New Appointments 156 1 53 Under Sickness Regulations 9 - 38 Totals 165 1 91 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 the period October, 1949, to March, 1950. 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. A survey of this kind has been in progress for more than two years. C 34 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 noti- Scarlatina 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. Ophthalmia Neonatorum P.H. (Ophthalmia Neonatorum) Regulations, 1926. Acute Primary and Acute" Influenzal Pneumonia P.H. (Pneumonia, Malaria, Dysentery, Dysentery etc.) Regulations, 1927. Malaria 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. Acute Poliomyelitis P.H. (Acute Poliomyelitis, Acute EnAcute Encephalitis cephalitis and Meningococcal Infection) Meningococcal Infection Regulations, 1949. The Public Health (Acute Poliomyelitis, Acute Encephalitis, and Meningococcal Infection) Regulations, 1949. (These regulations came into operation on 1st January, 19S0. They were designed to replace, with slight modifications, the Public Health (Cerebro-spina! Fever and Acute Poliomyelitis) Regulations, 1912, and the Public Health (Acute Encephalitis Lethargica and Acute Polio-Encephalitis) Regulations, 1918. They introduced nomenclature consistent with the international standard classification of diseases which was brought into general use on 1st January, 1950, slightly extend the scope of clinical conditions notifiable under the head of acute encephalitis, and distinguish between paralytic and non-paralytic forms of acute poliomyelitis.) 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. 35 TABLE III.—Cases of Infectious Diseases Notified during the Year 1949. NOTIFIABLE DISEASE Number of Cases Notified At Ages—years Total Cases Notified in each Ward Total Cases Admitted to Hospital. At all Ages 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 402 1 100 276 13 9 2 1 28 14 35 50 23 27 64 71 24 21 15 30 216 Diphtheria, including Membranous Croup 1 - - - - - 1 - - - - - 1 - - - - - - - 1 Enteric Fever (Typhoid and Para-Typhoid) 1 - - 1 - - - - 1 - - - - - - - - - - - 1 Pneumonia 241 6 13 27 7 58 71 59 22 28 18 13 11 30 8 17 23 21 32 18 112 Puerperal Pyrexia 35 — — — 5 30 — — — — 1 — 1 1 — 1 — 27 — 4 33 Cerebro-Spinal Fever 1 — - — — 1 — — 1 — — — — — — — — — — — 1 Acute Poliomyelitis 31 1 9 11 5 5 — — — 2 1 2 2 5 2 1 4 2 5 5 30 Acute Polio-Encephalitis 2 — — 2 — — — — — — — — — — 1 — — 1 — — 2 Encephalitis Lethargica - - - - - - - - - - - - - - - - - - - - - Dysentery 1 — — — — — 1 — — — — — — — — — — — 1 — 1 Ophthalmia Neonatorum 1 1 — — — — — — — — — — — 1 — — — — — — 1 Erysipelas 49 — — 1 4 14 19 11 7 3 3 6 1 5 2 7 3 4 3 5 17 Pemphigus Neonatorum — — — — — — — — — — — — — — — — — — — — — Tuberculosis Pulmonary 159 — 4 5 54 67 27 2 16 18 16 8 9 13 16 18 10 13 6 16 — Other Forms 25 1 1 5 6 10 1 1 — 3 — 2 2 — 5 — 1 5 2 5 — Anthrax - - - - - - - - - - - - - - - - - - - - - Malaria—Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - Believed contracted abroad 1 - - - 1 - - - - - - - - - - - - - 1 1 Acute Rheumatism 13 — — 13 — — — — — 3 2 1 — 1 2 — 2 1 — 1 13 Measles 1,663 66 905 672 14 6 — — 149 64 177 139 54 58 140 204 186 193 128 171 35 Whooping Cough 566 42 299 219 — 5 1 — 39 43 43 32 31 23 76 70 44 73 46 46 16 Food Poisoning 82 — 4 5 10 20 31 12 6 4 2 2 5 9 4 8 9 5 20 8 13 Totals 3,274 118 1,335 1,237 119 225 154 86 269 182 298 255 140 173 320 397 306 366 259 309 493 36 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 53.7 Diphtheria and Membranous Croup lOO.O Puerperal Pyrexia 94.3 Pneumonia 46.4 Acute Poliomyelitis 97.0 The total number of deaths of Ilford residents from the following infectious diseases during 1948 and 1949 were as follows: — 1948 1949 Scarlet Fever — — Enteric Fever — — Diphtheria — — Acute Poliomyelitis 1 4 Measles — 1 Whooping Cough — 1 Influenza 8 18 Tuberculosis—Pulmonary 62 48 Other forms 7 5 Pneumonia 50 70 Diarrhoea (under 2 years) 1 1 Cerebro-spinal Fever 3 1 Puerperal Sepsis — 1 Total132 150 The year 1949, on the whole, showed a lower incidence of infectious disease than 1948. The number of cases of measles notified was 1,663 as compared with 2,937 the previous year. (a) Smallpox.—No cases were notified during 1949. Notifications regarding 43 persons who had been in contact with cases of Smallpox on board ship were received. These were visited by the Sanitary Inspectors, 489 visits being paid. The following gives particulars as to Vaccination during 1949: — Certificates of Successful Vaccination 831 Re-Vaccination 264 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 26 of the National Health Service Act, 1948. (b) Scarlet Fever.—402 cases were notified in 1949. 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. 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 1949 402 196 2 1.0 186 3 1.6 (Ten cases were admitted to Isolation Hospitals outside the district during 1949.) 37 (c) Diphtheria.—One case only was notified in 1949. On further investigation in the Ilford Isolation Hospital it was not confirmed. (d) Ophthalmia Neonatorum.—One case was notified during 1949. The patient was removed to the Ilford Isolation Hospital. Cases Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 1 — 1 1 — — — (e) Enteric Fever.—One case only was notified during the year, a girl of 13 years. The case proved to be one of Paratyphoid fever " B." The patient was admitted to the Ilford Isolation Hospital and made a good recovery. (f) Acute Anterior Poliomyelitis and Acute Polio-Encephalitis.—Thirtyone cases of the former and two cases of the latter diseases were notified during 1949. Thirty-two patients were admitted to Hospital as follows: — Ilford Isolation Hospital, 20; King George Hospital, 3; Rush Green Hospital, 6; Chingford Isolation Hospital, 1; Plaistow Fever Hospital, 1; London Hospital, 1. One case was nursed at home. Under I—5 5—15 15—25 25 years Totals i year years years years and over Males - 6 8 4 2 20 Females 1 3 5 1 3 13 Residual paralysis 1 6 4 3 3 17 Transferred to special Orthopaedic Units - 1 1 1 1 4 Referred to Orthopaedic Clinics for Physiotherapy 1 5 3 2 2 13 Treated in " Iron Lung " — — 1 1 2 4 Fatal — 1 1 1 1 4 One case was referred to an Ophthalmic Clinic. Twelve cases recovered with no residual paralysis. The first case was admitted to Hospital on 22nd July. In view of the possibility of further cases occurring local doctors were circulated with details of the facilities available for diagnosis and treatment. Precautions were taken in Day Nurseries, Schools, Infant Welfare Centres and Treatment Clinics. The operations for the removal of tonsils and adenoids were suspended for a period of approximately three months. A statement for the guidance of the public was issued in the local press. A Day Nursery Nurse, aged 22 years, contracted the disease, but despite admission to the Ilford Isolation Hospital and treatment in the " Iron Lung," died two days later. The epidemic of 1949 was locally as severe as that of 1947 and considerably exceeded those of pre-war years. From a national standpoint the incidence was not so severe as that of 1947. Arrangements were made with the Central Office for Information for the Ministry of Health film "His Fighting Chance," dealing with Acute Poliomyelitis, to be shown to the members of the Public Health Committee and others on the 10th October. Table showing Incidence of Infectious Disease, 1949, 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 402 1 6 17 35 42 246 30 11 7 4 2 1 216 - Diphtheria 1 - — — — — — — - — — 1 - 1 - Enteric Fever (including Para-typhoid) 1 - — — — — — 1 - — — — - 1 - Pneumonia 241 6 3 4 5 1 18 9 3 20 42 71 59 104 62 Puerperal Pyrexia 35 — — — — — — — — 31 4 — — 33 1 Cerebro-spinal Fever 1 — — — — — — — — — 1 — — 1 1 Acute Poliomyelitis 31 1 1 3 4 1 6 5 2 5 3 — — 30 4 Acute Polio-Encephalitis 2 — — — — — 1 1 — — — — — 2 — Encephalitis Lethargica - - - - - - - - - - - - - - - Dysentery 1 - - - - - - - - - - 1 — 1 — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — 1 — Erysipelas 49 - - - - - 1 — 3 8 7 19 11 17 — Anthrax - - - - - - - - - - - - - - - Malaria believed to be contracted in this country - - - - - - - - - - - - - - - Malaria believed to be contracted abroad 1 - - - - - - - - - - - - 1 — Pemphigus Neonatorum — — — — — — — — — — — — — — — Acute Rheumatism 13 - - - - - 6 7 — — — — — 13 2 Food Poisoning 82 — 2 1 1 — 2 3 3 14 13 33 10 13 — Measles 1,663 66 168 275 214 248 652 20 9 8 3 — — 22 1 Whooping Cough 566 42 54 100 89 56 213 6 - 5 - 1 - 12 1 * F.xcludes cases occurring at Barnardo's Homes, Claybury Hospital and Goodmayes Hospital. 39 Influenza and Pneumonia.—These diseases showed a higher incidence in 1949 as compared with 1948. The incidence of influenzal and primary pneumonia throughout the year is shown by the following table. Month, 1949 Acute Primary Pneumonia Acute Influenzal Pneumonia Hospital Admissions Nursed at Home Hospital Admissions Nursed at Home Cases Deaths Cases Deaths Cases Deaths Cases Deaths January 6 — 12 2 3 — 3 1 February 16 2 13 3 5 — 19 5 March 9 1 17 - 18 2 8 — April 4 — 6 - 2 — 5 — May 3 — 3 1 — — 4 — J une 4 — 3 — 1 — — — July 7 1 1 1 — — 1 1 August 4 — 3 — — — 1 — September 6 — 2 — — — 1 — October 3 — 2 — 2 — 3 — November 1 — 11 — 3 — 3 — December 8 1 7 — 6 1 2 — Totals 71 5 80 7 40 3 50 7 It will be seen from the above figures that of 151 persons notified as suffering from acute primary pneumonia there were 12 deaths, equal to 7'9 per cent.; and in the case of acute influenzal pneumonia 90 notifications with 10 deaths, equal to 11.1 per cent. 3. Tuberculosis.—During the year 1949 there was 159 new notifications of Pulmonary Tuberculosis and 25 of other forms of Tuberculosis. 19 cases of Pulmonary and 9 cases of Non-Pulmonary Tuberculosis were transferred to Ilford. Notifications and Deaths from Tuberculosis of Ilford residents during 1949: — Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year — — — 1 — - — — 1-5 years 2 2 — 1 — — — — 5-15 3 2 3 2 1 - 1 — 15-25 30 24 3 3 2 - — 1 25-35 22 20 1 2 4 10 1 1 35-45 15 10 4 3 9 2 - - 45-55 16 5 1 - 5 2 - - 55-65 6 — - - 4 3 1 - Over 65 2 — 1 — 5 1 — — Totals 96 63 13 12 30 18 3 2 40 Of the foregoing new cases, the following were notified from Institutions in the district: — Non- Respiratory Respiratory Tuberculosis Tuberculosis King George Hospital 1 4 Claybury Hospital 2 — Goodmayes Hospital 4 — Ilford Isolation Hospital and Sanatorium 2 1 Dr. Barnado's Village Homes 1 — Of the 53 deaths which occurred of Ilford residents, notification had previously been made of 44 of the cases. Of the other nine, the presence of tuberculosis was discovered at post mortem examination in five instances, and as a result of bacteriological investigation following the death of the patient in one instance; one death was that of a soldier in an institution having no fixed abode, and in two instances notification had been overlooked (3'8 per cent.). During the year 1949 the following deaths occurred from Tuberculosis: — Pulmonary Non-Pulmonary Ilford Residents 48 5 Non-Residents— Claybury Hospital 10 — Goodmayes Hospital 4 — Ilford Isolation Hospital 20 — King George Hospital 2 1 Non- Pulmonary Pulmonary Total Number of cases on register, 1st January, 1949 1,159 209 1,368 Number of cases entered on register during the year 178 34 212 Number of cases removed from the register during the year: — NonPul. Pul. Recovered 39 22 Deceased 57 4 Left District 69 10 Lost sight of 7 — Diagnosis not established 12 3 184 39 223 Number of cases remaining on register on 31st December, 1949 1,153 204 1,357 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Nurses. 1,183 of the cases of longer standing were visited by the Sanitary Inspectors during the year, a visit being made to each patient every six months. The following reports were obtained : — Pulmonary Other Cases. Cases. Condition good 609 136 „ poorly 229 35 In sanatoria 93 7 No information as to present condition 24 5 Removed from district, etc. 35 10 990 193 41 The treatment of Tuberculosis is now under the control of the Regional Hospital Board. On the 31st December, 1949, there were 1,227 patients on the register of the Ilford Clinic. The Dentist treated 34 tuberculosis patients from the Ilford Sanatorium. They paid 145 visits to the Clinic. Thirteen were provided with dentures, and four patients had dentures repaired. The number of patients from Ilford sent to Institutions under the Tuberculosis Scheme during 1949 was as follows: — Pulmonary Non-Pulmonary Total Males Females Males Females Adults 76 61 5 6 148 Children 3 1 3 4 11 Tuberculosis Care Association.—This Association has assisted 105 cases with extra nourishment, clothing, and in other ways. Public Health Act, 1936 (Section 163).—One certificate in respect of the death of a patient at the Ilford Isolation Hospital was issued, stating that the body should not be removed from hospital except for the purpose of being buried forthwith. 4. Venereal Diseases.—In the following table are classified the deaths notified as due to (1) Syphilis; (2) Locomotor Ataxy and General Paralysis of the Insane, which are certainly due to Syphilis; and (3) Aortic Aneurysm, which is very frequently caused by this disease: — Ilford Residents—Ages Non-Residents in Institutions Total 0—1 1—5 5—15 15—25 25—35 35—45 45—55 55—65 65—75 75—85 85 up Syphilis 1 1 __ 2 Locomotor Ataxy - - - - - - - - 1 - - - 1 General Paralysis of the Insane - - - - - - 1 - - - - 4 5 Aortic Aneurysm - - - - - - - - - - - - - The deaths in Institutions of Ilford non-residents occurred chiefly at Claybury and Goodmayes Hospitals; 2'2 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:—1945, 3; 1946, 5; 1947, 11; 1948, 4; 1949, 1. It is to be remembered that many cases of ophthalmia neonatorum are not due tc gonorrheal infection. The treatment of patients is now the responsibility of the Regional Hospital Board. 42 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 to 6.30 p.m. Thursday, 12.30 to 3 p.m. Whitechapel.—Whitechapel Clinic, Turner Street, Mile End, London, E.l : — 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. Saturday, 2.30 to 4.30 p.m. (Females) Monday, 6 to 8 p.m. Thursday, 11 a.m. to 1 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. 43 SECTION G.—FACTORIES. The Factory and Workshop Act, 1901, was superseded by the Factories Act, 1937, which came into operation on 1st July, 1938. There are 429 factories with mechanical power on the register. There are 318 factories without mechanical power on the register. There are 285 outworkers on the register. 1.—INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by Sanitary Inspectors. Premises (1) Number of Inspections Written Notices Occupiers prosecuted (2) (3) (4) Factories with Mechanical Power 1,144 9 - Factories without Mechanical Power 290 4 - Other premises (not including Outworkers' premises) 28 — — Total 1,462 13 — 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) - - - - Overcrowding (S.2) - — - — Unreasonable Temperature (S.3) 1 - - - Inadequate Ventilation (S.4) — — - — Ineffective Drainage of Floors (S.6) - - - - Sanitary Conveniences (S.7) :— Insufficient 3 4 - — Unsuitable or Defective 9 11* - — Not Separate for Sexes — — - — Other Offences — — - — Total 13 15* — — * Includes compliances of defects found in 1948. 44 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 1949 was 2,027 (1,030 males and 997 females). Of these, 140 (65 males and 75 females) took place in Ilford, the ordinary place of residence of the parents being outside the district. In addition, 754 notifications of birth (385 males and 369 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, 4 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 Area Clerk. The percentage of live births occurring in Ilford, notified by the various responsible persons, was as follows: — By Medical Practitioners .12 By Certified Midwives .98.63 By Parents and Others 1.25 In addition, 53 stillbirths (27 males and 26 females) were notified. The notifications of 9 stillbirths (3 males and 6 females) which took place outside the district, although the ordinary residence of the parents is in Ilford, were transferred to this district. Care of Premature Infants.—Of the 2,027 live births occurring in Ilford during 1949, 87 weighed 5½ lbs. or less at birth; 19 of these babies were born at home and 68 in Hospital (including 4 in Private Nursing Homes). The number of those born at home— (i) who were nursed entirely at home18 (ii) who died during the first 24 hours — (iii) who survived at the end of one month 19 The number of those born in Hospital— (i) who died during the first 24 hours 11 (ii) who survived at the end of one month 55 Infant Mortality.—The number of infants dying within the first year of life was 53, the total number born being 2,630. 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 20.1 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 33 deaths of infants under four weeks of age during 1949 and the rate for the year was 12.5 per 1,000 live births. 45 The figures for the past 44 years were as follows: — Year Number Rate Year Number Rate 1949 33 12.5 1927 32 19.3 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 46 The following table gives the deaths of infants under one year of age, classified according to age : — Infant Deaths—1949. 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 oedema of lungs, Meningocele (congenital) _ 1 _ _ 1 _ _ _ _ 1 Acute Purulent Bronchitis — _ _ _ _ 1 _ _ 1 Anoxia--associated with Bronchopneumonia _ _ _ _ _ 1 _ _ 1 Anoxia—due to Atelectasis 1 _ _ 1 _ 1 Asphyxia 3 _ _ — 3 3 Asphyxia due to drowning — _ _ — 1 1 Atelectasis 10 _ 10 _ _ _ _ 10 1 Cerebral Haemorrhage — _ _ 1 Congenital Atresia of small intestine 1 _ _ 1 1 Congenital disease of the heart 1 _ _ _ 1 _ _ _ _ 1 Erythroblastosis Foetalis 1 _ _ — 1 1 Exhaustion ; Persistent vomiting— Congenital hypertrophy of suprarenal glands _ _ _ _ _ _ _ 1 _ 1 Failure to breathe ; Obstructed labour 1 _ _ _ 1 _ _ _ _ 1 Gastro-enteritis — Nephrocalcinosis _ _ _ _ _ _ _ 1 1 Heart failure—Congenital heart disease _ _ _ _ _ 1 _ _ _ 1 Marasmus, due to hypertrophic pyloric stenosis _ _ _ _ _ 1 _ _ _ 1 Myelomeningocele—Hydrocephalus _ _ _ _ _ _ 1 _ _ 1 Myocardial failure—Prematurity 1 _ _ — 1 _ 1 Non-viable foetus—26 weeks gestation 1 _ _ _ 1 _ _ _ _ 1 Pertussis _ 1 _ _ 1 Pneumonia—all forms 1 2 3 5 1 3 1 13 Prematurity 6 — _ — 6 — _ _ 6 Pulmonary collapse due to operative shock for repair of oesophageal atresia 1 _ _ _ 1 _ _ _ _ 1 Pyaemia due to infective arthritis of right shoulder _ _ 1 _ 1 _ _ _ _ 1 Respiratory obstruction following inflammation of respiratory passages after ingestion of silver nitrate stick _ 1 _ _ 1 _ _ _ _ 1 Totals 28 4 1 _ 33 8 3 7 2 53 47 The comparative figures for the past 10 years are as follows: — No. of Deaths Rate per 1,000 Year under 1 year Registered Live Births 1949 53 201 1948 62 217 1947 82 243 1946 102 296 1945 81 327 1944 102 368 1943 92 351 1942 74 306 1941 67 409 1940 63 328 The mean average Infant Mortality rate for the past 10 years is therefore 30'4 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 1949 20.1 32 29 37 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 Illegitimate Births and Deaths.—63 of the live births registered (30 males and 33 females) were illegitimate, that is 2'4 per cent, of the births registered. Two illegitimate children died under one year of age from the following causes:— Acute purulent bronchitis, aged 7 months. Anoxia due to atelectasis, aged 30 minutes. The infant mortality rate of illegitimate children was 31'7 per 1,000, compared with the infant mortalitv rate of 19 9 for legitimate children. The following table shows the birth and death rates of legitimate and llegitimate 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 1949 2,567 97.6 51 19.9 63 2.4 ?, 31.7 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 48 There is 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's 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 73, Caernarvon Road, Stratford. 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 in 1947. 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. The Essex County Council have inaugurated a Training Scheme for Health Visitors in conjunction with the S.E. Essex Technical College. The trainees are allocated to the Health Areas for practical instruction, and it is hoped this scheme will help to relieve the shortage. At the end of the year there were only 8 qualified Health Visitors and School Nurses in addition to the Superintendent Health Visitor, and 3 Clinic Nurses. The following is a summary of the home visits made by the Health Visitors and Clinic Nurses during 1949 as far as the Maternity and Child Welfare work is concerned. First visits to newly-born infants 2,949 Subsequent visits to children under 1 year of age 4,699 Subsequent visits to children over 1 year of age and under S 11,187 Visits to expectant mothers 49 Home visits for other reasons 2,751 Total visits paid 21,635 Day Nurseries. (a) Becontree Day Nursery.—Work commenced on the erection of the new Nursery in Stevens Road in April, 1949, but was not completed by the end of the year. 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 new building, with accommodation for 50 children, was, however, available for occupation in March, 1950, the premises in Becontree Avenue being closed down on 13th March and the Nursery re-opening at the Stevens Road premises on 16th March, 1950. 49 (6) Seven Kings 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, which will replace the present Nursery in Green Lane. Formal approvals to proceed were, however, awaited at the end of the year. In April, 1950, a further tender of £1,486 was accepted for the carrying out of additional works to comply with certain variations requested by the Ministry of Health. (c) The charge of 1s. per day for the care of children in the Nurseries was continued during the year. (d) With the exception of the Sunshine House Day Nursery, the Nurseries were closed on Saturday mornings as from 29th August, 1949, and the hours of opening at all the Nurseries altered to 7.30 a.m. to 6 p.m. (e) The training of Students at the Nurseries for the certificate of the National Nursery Examination Board continued. Six Students (two from the Becontree Avenue Nursery, one from the Ley Street Nursery, one from the Sunshine House Day Nursery and two from the Green Lane Day Nursery) entered for the examination during the year, five of whom obtained the certificate. D 50 (/) The following is a table showing the attendances, etc., at the four Day Nurseries during 1949: — Situation Date of Opening Accommodation (Children) Average Dail durin Including Saturday y Attendance g 1949 Excluding Saturday No. of Days in Quarantine Reasons for Quarantine No. on Waiting List at 31st Dec., 1949 Sunshine House, Girls' Village Homes, Barkingside 17.8.42 45 27 32 64 4 Cases of S. Fever 132 1 „ „ Mumps 16 „ „ Measles 359-381, Green Lane, Seven Kings 5.5.43 50 32 38 158 4 Cases of W. Cough 84 9 „ „ Mumps 16 „ „ Measles 2 ,, „ Polio. 226-236, Ley Street, Ilford 16.8.43 50 33 34 134 10 Cases of Mumps 186 13 ,, ,, Measles 8 „ „ C. Pox Becontree Avenue, corner Winding Way, Dagenham 17.1.44 40 27 28 60 3 Cases of S. Fever 42 1 „ „ Mumps 1 „ „ Measles 1 „ „ C. Pox 2 „ „ Polio. 51 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. The following shows the position regarding registrations under the Act:- (a) (b) Premises Child-minders Number on register at 31/12/48 Nil Nil Number registered during 1949 Nil S Number on register at 31/12/49 Nil 5 Number of children provided for at 31/12/49 Nil 30 Infant Welfare Centres.—-88 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1949. During the year the following attendances were recorded: — Total number of attendances of infants 43,668 First attendances 2,621 Attendances of children from 1 to 5 years 12,834 Total number of children on roll, December 31st, after omission of all those who had not attended for six months 3,697 The attendances at the Infant Welfare Centres decreased during 1949 by 1167 per cent, compared with the attendances for 1948. 671 sessions were held during the year; the average attendance at each session being 65 mothers with their infants. The following are the figures for each Centre: — Sessions Average Attendance Percentage Attendance Barkingside 48 76 81 Chadwell 48 65 69 Becontree 48 58 84 Downshall 48 76 86 Woodford Avenue 48 83 75 Seven Kings 48 68 77 Cecil Hall (Wednesday) 47 59 77 Cecil Hall (Thursday) 48 53 70 Newbury Hall 48 49 82 Goodmayes 48 72 95 Grosvenor Road 48 75 78 Ilford Lane 48 65 85 Valentines 48 59 77 Fairlop 48 48 62 *This represents the number of Ilford children under 1 year of age who attended Clinics. D* 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 1949 43,668 2,621 3,697 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 52 Paediatric Clinic.—Dr. Warren, the Consultant Paediatrician, continued to attend the Clinic at Valentines Mansion during the year. 21 session were held and 74 new cases were referred from the Infant Welfare Centre and Maternity Hospital for the reasons set out in the following table; a total of 133 attendances were made. Diagnosis Discharged, Improving Discharged with advice and for other reasons Discharged, no Treatment Discharged, Cured Referred to Dr., Hospital or Clinic Still attending Total Angioma - - - - - 2 2 Asthma - — 1 - - — 1 Behaviour problem - 5 - - 1 1 7 Congenital cranial defect - — 1 - - — 1 Congenital heart disease - — 1 - 1 — Congenital hydrocele - 1 - - - — 1 Congenital spastic diplegia - - - - - 1 1 Constipation 2 4 - - 1 — 7 Debility — — - - 1 — 1 Eczema — — - - 2 — 2 Epilepsy - - - - - 1 1 Facial palsy — — 1 1 — — 2 Feeding problem 1 3 - - — 1 5 Fracture of skull - — - - — 1 1 Genu valgum — — 1 - 1 — - Geographical tongue — — 1 - — — 1 Hydrocephalus — — - - 1 — 1 Hypoplasia of external genitals - - 1 - - - 1 Hypospadias — — 1 - — — 1 Lymphadenoma — — 1 - — — 1 Mentally retarded — 1 - - — 3 4 Mongol - - - - - 1 1 Normal child—nil abnormal discovered - - 3 - - - 3 Prematurity — — — - 1 — 1 Prolapse of rectum — 1 — - — — 1 Purpura — — 1 - — — 1 Respiratory sequelae of measles - - - - 1 - 1 Rumination 1 4 2 - — 1 - Speech defect - - - - - 1 1 Talipes varus — — 1 - — — 1 Teething — — — - 2 — 2 Umbilical hernia — 1 1 - 1 1 4 Upperrespiratory infection — 2 — 1 2 — 5 T otals 4 22 17 2 15 14 74 Ophthalmic Clinic.—95 children under 5 years of age were treated by the Oculist during 1949; 44 pairs of spectacles were supplied. Orthopaedic Clinic. (i) Newbury Hall Clinic.—47 sessions were held during 1949, 419 children under 5 years of age being examined, making 1,045 attendances. (ii) Mayesbrook Clinic.—24 sessions were held during 1949, 184 children under 5 years of age being examined, making 468 attendances. 53 The 603 children were found by the Orthopaedic Surgeon to be suffering from the following defects: — Diagnosis New Cases Old Cases A B A B Paralysis :— A.P.M. 2 3 1 — Hemiplegia — — 1 — Scoliosis — — 1 — Deformity of hips 1 — — 2 Deformity of chest 1 — — — Genu valgum 97 41 75 41 O.C.T. 21 2 33 25 Genu varum 1 — 6 5 Pes valgo planus 39 15 46 15 Valgus ankles 15 7 22 13 Talipes calc. valgus 3 — 4 2 Congenital talipes E.V. 2 — 1 — Congenital defect — — 4 — Intoeing 3 2 — 2 Deformity of toes 6 1 7 1 Torticollis 2 1 2 1 N.A.D. 7 1 5 1 Spastic Diplegia 2 — — — Orthopaedic defect nected with birth injury — 1 2 1 Traumatic condition 1 — — — Other conditions 1 1 5 — Totals 204 75 215 109 A—Newbury Hall. B—Mayesbrook. 75 pairs of Valgus Insoles, 1 pair surgical shoes, 2 metatarsal bars, and 16 G.V. night splints were supplied during 1949. One child was admitted to Black Notley Hospital and 3 to Harold Wood Hospital. At the Newbury Hall Clinic, 34 children under five years of age were treated by the Physiotherapist during the year, and 510 attendances were made by these children. Treatment was also given to 16 children who made 260 attendances at the Mayesbrook Clinic. Aural Clinic.—The Aural Surgeon attended at 74 sessions during 1949 and 112 attendances were made by 82 children of pre-school age. 4 children were operated upon for removal of tonsils and adenoids at St. Mary's Hospital, Plaistow. Rheumatism Clinic.—29 sessions were held during the year at Newbury Hall, at which 38 children under 5 years of age, 16 being new cases, made 62 attendances. The following is a summary of the cases treated: — Condition New Old. Total Congenital heart disease 6 8 14 No active rheumatic disease 4 3 7 Functional heart murmur 4 9 13 Pains—other than rheumatic 1 2 3 Allergic type 1 — 1 Totals 16 22 38 54 Number of cases referred to Ear, Nose and Throat Surgeon 1 „ „ „ „ „ General Hospital 2 „ „ „ „ for X-ray and Electrocardiograph 30 Artificial Sunlight Clinic.—45 sessions were held at the Newbury Hall Clinic and 48 at Mayesbrook Clinic. 71 children in all were treated, making 1,046 attendances. The conditions treated were as follows: — Conditions Cases A B Anaemia, Debility and Malnutrition 16 12 Genu valgum 4 Old Rickets 7 3 O.C.T. (Bow legs) 5 6 Other conditions 7 11 Totals 39 32 A—Newbury Hall. B—Mayesbrook. 38 cases were still attending at the end of the year; of the remainder 4 had removed from the district, 10 were discharged, having shown improvement, 15 were discharged having made a satisfactory recovery, 13 were discharged due to absence and 1 was discharged having made no progress. Speech Clinic.—7 children of pre-school age attended, making 41 attendances. The following is a summary of the cases: — Classification of Defects : Stammering 3. Dyslalia 4. 1 child was discharged with normal speech and in 2 cases the parents refused treatment. 55 Diphtheria Immunisation.— Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1949, to 31st December, 1949. 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 3 3 3 Negative 15 — 15 11 — 11 26 Numbers inoculated (full course) 79* 688 767 34* 395 429 1,196 Positive after full course of inoculations, and re-inoculated _ 2 2 _ _ _ 2 Negative after full course of inoculations 46 603 649 30 390 420 1,069 Re-inoculations (one only) 1,034 49 1,083 508 24 532 1,615 Awaiting re-test 10 129 139 3 115 118 257 Not re-tested after inoculation (on account of leaving District, etc.) - 4 4 1 2 3 7 Positive after re-test, but not inoculated for same reason ... - 1 1 - - - 1 Final Schick Test in 1949 (1948 Cases) :— Positive after full course of inoculations, and re-inoculated - - - - - - - Negative 3 201 204 2 170 172 376 * Schick + 1949 = 21 ; Not Tested = 18. * Schick + 1949 = Tested = 20 7 ; Not During 1949, a total number of 3,218 children attended at the Diphtheria Prevention Clinics (2,074 at Valentines Clinic and 1.144 at Mayesbrook), making a total number of attendances of 11,414 (7,535 and 3,879) with an average per session of 73 and 74 respectively. 56 During 1949 53 private doctors were supplied with prophylactic for the immunisation of 1,548 children and record cards were received from general practitioners as follows: — Under 5 Over 5 Inoculations (full course) 1,228 55 Re-inoculations (one only) — 265 An Exhibition Display Stand in regard to Diphtheria Immunisation was on view for one week each at the Public Health Office, Mayesbrook Clinic and Newbury Hall. Vaccination.-—During 1949 record cards were received from general practitioners as follows: — Ages up to 14— No. of children primarily vaccinated 794 No. of children revaccinated 38 Ages 15 and over— No. of adults primarily vaccinated 89 No. of adults revaccinated 227 Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. 25 belts were supplied to infants suffering from hernia during 1949. 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 1949 twelve sessions were held. 37 expectant and nursing mothers were referred from either the ante-natal or post-natal clinics, making a total of 82 attendances. The following is a summary of the cases examined by Dr. K. Playfair: — Post- Ante- Condition. Natal. Natal. Collapse of Lung 1 — Congenital Cardiac lesion — 1 Extrasystoles 1 4 Functional Cardiac Disorders 3 13 Thyrotoxicosis — 1 Valvular Disease of the Heart 1 12 Totals 6 31 17 of these patients were, however, referred to Queen Mary's Hospital for X-Ray and electrocardiograph. Midwives.—There were 19 State certified midwives (including the Superintendent, Deputy Superintendent and 13 domiciliary midwives and 2 part-time midwives), resident and practising in the district. In addition there were at the end of the year 20 State certified midwives at the Ilford Maternity Hospital, 2 at Wilnett Lodge post-natal home and 2 at a private nursing home in Ilford. Supervision of the midwives practising on the district and of those at the private nursing home, including regular inspections by the Medical Supervisor of Midwives, was carried out as in previous years, and general supervision, in accordance with the Rules of the Central Midwives Board, was exercised over the midwives practising at the Ilford Maternity Hospital and the Wilnett Lodge Hostel. Suspension from Practice.—No midwives were suspended from practice during the year. 57 Medical Aid.—Medical aid was sought in 2 instances where the infant was found to have inflamed or discharging eyes. In both cases the condition of the eyes cleared satisfactorily. Domiciliary Midwifery Service.—At the end of the year there were 13 Domiciliary Midwives employed wholetime and 2 part-time midwives, in addition to the Superintendent and Deputy Superintendent. During the year 726 cases were attended. In 565 cases the midwives were engaged to attend as midwives and in 161 as maternity nurses. The patients resided in the following wards: — Barkingside 49; North Hainault 51; Cranbrook 53; Park 51; Seven Kings 70; South Hainault 76; Loxford 77; Clementswood 65; Goodmayes 13; Fairlop 90; Clayhall 60; Mayfield 71. 5,190 ante-natal visits were made during the year. A Doctor was called in to 165 of the 565 cases in which a midwife had been engaged. Of the infants born there were 15 stillbirths ascribed to the following causes:— Abnormal presentation 1 Ante-partum haemorrhage at 5th month and toxaemia of pregnancy 1 Cord presentation—asphyxia 1 Hydramnios 1 Thin umbilical cord—severed during labour 1 Umbilical cord round body 2 Umbilical cord round neck3 Unknown 5 In 1 of the cases the midwife was engaged as a maternity nurse only. There were 6 deaths of infants during the first year of life from the following causes: - Acute oedema of lungs, meningocele (congenital) 1 Acute suppurative pneumonia 1 Broncho-pneumonia 1 Cerebral haemorrhage, thrombo-cytopaenic purpura 1 Congenital heart disease 1 Heart failure—congenital heart disease 1 In 2 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 21 infants attended by them during 1949. Salvation Army Midwifery Service.—63 cases were attended by the Salvation Army Midwives during the year, 58 as a midwife and 5 as a maternity nurse. A Doctor was called in to 27 of the 58 cases in which a midwife had been engaged. 58 There were 2 deaths of infants during the first year of life from the following causes: — (1) Respiratory obstruction following inflammation of respiratory passages after ingestion of silver nitrate stick—accidental. (2) Broncho-pneumonia—mongolism. Notifications were received that it was proposed to substitute artificial feeding in respect of five infants. Gas and Air Analgesia.—During 1949 gas and air analgesics were administered in 356 cases, of which 299 were attended by the Domiciliary Midwives (254 when acting as midwives and 45 when acting as maternity nurses) and 57 were attended by the Salvation Army midwives (52 when acting as midwives and 5 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. 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. 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 1,202 302 Subsequent attendances 9,329 2,751 Totals 10,531 3,053 Number of sessions 404 103 Average attendance at each session 26 29 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. The Consulting Obstetrician or his Deputy visited the Ante-Natal Clinic once each week during 1949 until the middle of November, when the visits were increased to twice weekly. During the year 58 sessions were held and a total of 1,360 examinations were made. X-Ray Examination of Ante-Natal Patients.—230 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. During 1949 clinics were held at the Maternity Hospital weekly and at Mayesbrook Clinic once monthly. The following attendances were recorded: — 59  Maternity Hospital Mayesbrook Clinic First attendances 844 188 Subsequent attendances 347 70 Totals 1,191 258 Number of sessions 52 13 Average attendances each session 23 19 Supply of Sheets for Expectant Mothers—In accordance with circular 154/44 of the Ministry of Health of the 3rd November, 1944, amended by circular 25/1947 of February, 1947, women holding R.B.2 expectant mother's ration books 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. The issue of the certificates ceased on the 14th March. During 1949 279 certificates were issued to 96 expectant mothers. Maternal Mortality.—During 1949 2 deaths of Ilford mothers were recorded by the Registrar-General as due to or in consequcnce of childbirth. Domestic Help Service.—During 1949 there was a considerable increase in the demand for this service, and it was necessary to increase the number of Domestic Helps employed. At the end of the year there were 150 part-time domestic helps on the register and an establishment of 60 full-time and 120 part-time domestic helps had been approved. Early in 1950, 27 of the part-time helps were appointed to full-time posts. 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 1949: — Number of applications received for assistance 1,484 Number of cases where Domestic Helps were provided (including 149 who were having service at the commencement of the year) 808 Number of cases which on investigation were either not eligible for assistance or did not require the service 382 Number of cases referred to other sources, e.g., W.V.S. I.S.S.C. "Help-all" 141 Cases booked but subsequently cancelled 153 Number of cases where, at the end of the year, a domestic help was booked to attend in future months (maternity cases) 87 Other cases awaiting help at end of year 39 Enquiries incomplete at end of year 23 Convalescent Facilities.—The following tables show the number of persons sent away for convalescence during 1949, and the number of cases in which the Invalid Children's Aid Association arranged the placing of children in suitable convalescent homes. (a) Under Section 22 of the National Health Service Act.—i.e., nursing mothers and young children. 60 Name of Home No. of weeks' stay Remarks 1 2 3 4 5 6 7 Highfield Residential Nursery, Canterbury. - - - - - 1 - Unaccompanied child (arranged by I.C.A.A.) Hartsleap, Sandhurst - - - - - - 1 Unaccompanied child (arranged by I.C.A.A.) Manor House, Burgh Castle, Gt. Yarmouth - - - - - 1 - Unaccompanied child (arranged by I.C.A.A.) Grange Maternity Home, Hindhead. - 1 - - - - - Mother and infant Ardmore Hostel, Buckhurst Hill. 1 - - - - - - Mother and infant Tapley Park, Iveston, Devon. - - - 1 - - - Unaccompanied child (arranged by I.C.A.A.) Mrs. Whyte's Home, Merryday Cottage, Ongar Road, Dunmow. - - - 1 - - - Unaccompanied child (arranged by Almoner, Gt. Ormond Street Hospital) Totals 1 1 - 2 - 2 1 2 mothers with infants 5 unaccompanied children. (b) Under Section 28 of the Act.—i.e., other persons requiring " a change of air and surroundings to aid recovery and rehabilitation." Name of Home No. of weeks' stay Total Cases I 2 3 4 5 6 Essex Convalescent Home 2 5 11 2 - - 20 St. Raphael's, Torquay — — — 1 — — 1 Hermitage Convalescent Home, Hastings - - - 1 - - 1 Bell Memorial Convalescent Home, Lancing ... - 1- 1 1 - - 3 Margaret House Ltd., Barley, Herts. — — 1 — — — 1 Thatched Cottage, Godden Green, Sevenoaks 1 - - - - - 1 All Saints' Convalescent Home, Eastbourne - 1 1 - - - 2 St. Michael's Convalescent Home, Clacton - 1 - - - - 1 Hunstanton Convalescent Home — 1 1 — — — 2 Samuel Lewis Recuperative Holiday Home, Walton-on-Naze - 1 - - - 1 2 Limpsfield Convalescent Home __ — 1 — — — 1 Armitage House, Worthing 1 - - - - - 1 Rustington Convalescent Home, Littlehampton — — — 1 — — 1 Totals 4 10 16 6 — 1 37 61 Loan of Sickroom Equipment.—During the year 1949 few enquiries were received for the loan of items of sickroom equipment and it was found that the British Red Cross Loan Depots, of which there are four in Ilford, were able to meet most requirements. Where this was not possible, the articles were obtained and issued on loan from the Public Health Offices, as shown below: — Number of articles on loan at 31.12.48 Nil „ „ „ loaned in 1949 5 „ „ „ on loan at 31.12.49 5 List of items obtained for loan: — 1 Sorbo mattress. 1 Air ring. 1 Set of fracture boards. 1 Bedrest. 1 Pair crutches. It has been found in 1950 that this loan scheme has become more widely known and applications for articles have increased considerably. Tuberculosis Visitors.—Three Tuberculosis Visitors were employed in the Area during 1949, making a total of 2,355 visits to homes in the Borough. Rehabilitation of Tuberculosis Cases.—Assistance in the maintenance charges of cases at the Papworth Hall Settlement was given as follows: — Number of cases being assisted at 31.12.48 2 „ „ „ newly assisted in 1949 1 „ „ „ for whom responsibility ceased 1 „ „ „ being assisted at 31.12.49 who at that date had been assisted for: — (a) Between 1 and 2 years 1 (b) Over 2 years 1 Open-Air Shelters for Tuberculosis Cases.—One open-air shelter was supplied for a tuberculosis patient during 1949 and at the end of the year two such shelters, supplied by the County Council, were in use in Ilford. Boarding-out of Children (Tuberculosis Contacts).—No applications were received in 1949 for assistance in the boarding-out of child contacts of tuberculosis patients under the scheme commenced in the County in December, 1949. Ilford Tuberculosis Care Association.—Owing to the resignation of the Secretary of this Association, at the request of the County Medical Officer arrangements were in hand at the end of the year for Mr. H. R. Stanbridge, a member of the Ilford Health Area Office Staff, to take over the secretarial work as from the 1st January, 1950. Home Nursing.—The Home Nursing Service in Ilford is undertaken by Nurses under the supervision of the Superintendent of the Beachcroft Training Home at Leytonstone. As soon as suitable premises are acquired, however, it is proposed that a Branch Home will be set up in Ilford. 62 The work undertaken by Home Nurses operating in the Ilford area in 1949 was as follows: — Cases attended Visits paid Medical 1,351 26,043 Surgical 182 6,556 Tuberculosis 19 865 Out-patient (medical) 4 29 „ „ (surgical) 1 9 Midwifery (Live birth) 1 19 Miscarriages (emergency) 2 14 Post-Natal 3 12 Last offices — 40 Casual — 35 1,563 33,622 Dental Treatment.—Mr. E. V. Haigh, the Senior Dental Officer has submitted the following report: — In 1949 the dental treatment of expectant and nursing mothers, and children under 5, was transferred to the Mayesbrook Dental Clinic as it was considered advisable to centralise this treatment rather than for it to be divided amongst the part-time dental officers. This procedure inevitably caused an increase in the waiting time of patients, but by devoting two or three sessions per week I have found it possible to keep the waiting list down, so that patients have only a comparatively short time to wait for an appointment. This is essential for expectant mothers, as the sooner the treatment can be completed prior to the confinement the better. Dentures are supplied to expectant and nursing mothers whenever they are required. In cases where many teeth are extracted, temporary dentures are fitted should the patient's health suffer if she were to be without them. When the healing process is complete, permanent acrylic dentures of first quality are supplied. During 1949 a Sterling X-ray apparatus was supplied but owing to the difficulties of obtaining dark room equipment and films the apparatus was not brought into use until 1950. Henceforth all expectant and nursing mothers and children under S requiring X-ray examination will be able to receive it at the Mayesbrook Dental Clinic. During the same year patients were sent to King George Hospital for X-rays and the films sent to me in a few days. By overcoming this delay, suffering in many cases can be avoided. Children under school age referred from the Infant Welfare Centres receive the necessary treatment at the Mayesbrook Dental Clinic. Usually this consists of conservative work and extractions by general anaesthetic. Examined Needing Treatment Treated Made Dentally Fit Expectant and nursing mothers 277 276 313 169 Children under 5 193 182 183 131 63 Extractions Anaesthetics Fillings Scaling or Scaling and Gum treatment Silver Nitrate treatment Dressings Radiographs Dentures provided Local General Complete Partial Expectant and nursing mothers 795 74 185 428 109 3 101 7 41 38 Children under 5 552 2 184 63 1 — 76 — — — Total number of sessions held—192. 65 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 VIIA. and B. shows no appreciable change. (b) Incidence of Pediculosis and Scabies. (i) Pediculosis.—This shows a decrease on last year, 33 children being found to be infected with living hair vermin as against 56 in 1948, 49 in 1947, 46 in 1946 and 65 in 1945. (ii) Scabies.—This shows a decrease, 5 cases as compared with 19 in 1948, 43 in 1947, 76 in 1946, 104 in 1945. School Premises.—There are 32 schools, with 61 departments, 21,123 children were actually on the rolls on 21st December, 1949, as compared with 20,267 in December 1948. The figure 21,123 includes Barking Abbey (388) and Ursuline County Placed pupils (241). The number of children in average attendance at school for the year ended 20th December 1949 = 18,328. The Sanitary Inspectors have paid the usual monthly visits to the elementary schools (1) to enquire as to the milk supplies, (2) to inspect the sanitary arrangements. 451 visits have been made during the year. Medical Inspection.—In accordance with the Handicapped Pupils and Medical Services Regulations, 1945 (para. 49), this is carried out as follows :— (a) Every pupil who is admitted for the first time to a maintained school shall be inspected as soon as possible after the date of his admission. (b) Every pupil attending a maintained primary school shall be inspected during the last year of his attendance at such a school. (c) Every pupil attending a maintained secondary school shall be inspected during the last year of his attendance at such a school. During 1949 5,056 parents, or 77 per cent., attended the full routine medical inspections. Infectious Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1945 :— Scarlet Fever. Diphtheria. Measles and German Measles Chicken Pox. Mumps. Whooping Cough. 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 1949 262 — 641 75 224 210 *Of this number 639 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 VI shows the incidence of infectious disease in the Ilford schools during 1949. 310 home visits were paid by the School Nurses to cases of minor infectious disease. In addition the Sanitary Inspectors paid 639 visits to measles cases, and 210 visits to whooping-cough cases. E 66 RINGWORM :— No. of cases at beginning of 1949. No. of cases reported during 1949. Total. Remedied during 1949. No. of cases under observation at end of 1949. Scalp 1 1 1 Body — 3 3 3 _ 4 4 4 The case of ringworm of the scalp received X-Ray treatment at the Queen Elizabeth Hospital for Children (Glamis Road Branch), London, E.l. Following Up.—During 1949, 1,892 home visits by the School Nurses were paid for the purpose, and 3,427 re-examinations of children (some on several occasions) were carried out by the doctors at school ; 101 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 1949, were as follows :— Newbury Hall. Mayesbrook. Number of individual children seen 1,519 1,502 Number of attendances of children 2,680 2,615 Number of exclusion certificates granted 256 320 Number of certificates of fitness to attend school granted 246 310 The following table shows the conditions dealt with at both the Clinics during the year :— Subnormal Nutrition 645 Debility 5 Uncleanliness Head 175 Body 1 Skin :— Ringworm :— Head 1 Body 3 Scabies 5 Impetigo 43 Dermatitis 2 Urticaria 20 Furunculosis 45 Eczema 8 Other Skin Diseases (Non-Tuberculous) 302 Eye :— Blepharitis 22 Conjunctivitis 42 Defective Vision (excluding Squint) 160 Squint 27 Other conditions 80 Ear :— Defective Hearing 31 Otitis Media 29 Other Ear Diseases 92 67 Nose and Throat:— Chronic Tonsillitis only 46 Adenoids only 3 Chronic Tonsillitis and Adenoids 48 Nasal Catarrh 36 Nasal Obstruction 18 Other conditions 83 Enlarged Cervical Glands (Non-Tuberculous) 26 Defective Speech 35 Teeth—Dental Diseases 602 Heart and Circulation :— Functional 10 Organic 1 Anaemia 30 Infectious Diseases :— German Measles 1 Measles 2 Whooping Cough 2 Chicken Pox 2 Mumps 1 Colds and Coughs 184 Influenza 2 Lungs :— Asthma 21 Bronchitis 48 Pulmonary Catarrh 14 Other Non-Tubercular Diseases 2 Tuberculosis:— Pulmonary—Definite — —Suspected (Referred to T.B. Officer)4 Developmental :— Hernia 3 Other 1 Psychological :— Development1 Stability32 Nervous System :— Nervous Debility 33 Habit Spasm 11 Chorea 6 Petit Mal 1 Enuresis 34 Other Conditions 10 Deformities :— Genu Valgum 20 Posture 25 Pigeon Chest 4 Flat Feet 36 Valgus Ankles 54 Other forms 29 Minor Injuries 86 Rheumatism 68 Other Defects and Diseases 113 Total number of ailments 3,525 68 SPECIAL CLINICS. Ophthalmic Clinic. During the year 1949, the School Oculist held 179 sessions for the refraction of children suffering from defective vision (125 at Valentines and 54 at Mayesbrook). Full details of the work are given in Table IV, Group II. 2,726 attendances (1,697 at Valentines Clinic, 1,029 at Mayesbrook Clinic) were made by 1,265 schoolchildren (803 at Valentines Clinic, 462 at Mayesbrook Clinic), as compared with 1,464 schoolchildren in 1948. The 1,265 children were not all suffering from grave defects of vision. The following table shows the vision in the worst eye, as tested by Snellen's Type 6/6 6/9 6 6/18 6/24 6/36 6/60 less than 6/60 206 200 12 199 159 145 110 16 230 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 1,265 children were found to be suffering from the following defects :— Diagnosis. New Cases. Old Cases. A B A B Myopia 71 39 112 62 Myopic Astigmatism 14 4 25 10 Hypermetropia 65 26 121 67 Hypermetropic Astigmatism 5 8 43 25 Anisometropia 6 2 5 7 Hypermetropia with Squint 6 - 31 10 Squint 42 45 140 97 Blepharitis 4 1 13 7 Chalazion — — 2 — Congenital Cataract — — — 1 Congenital Coloboma 1 — 2 3 Corneal nebulae — — 3 1 Conjunctivitis 10 2 3 5 Nystagmus 1 1 10 5 Other conditions 6 6 11 8 N.A.D. 23 15 28 5 Totals 254 149 549 313 A—Valentines B—Mayesbrook. Under the National Health Service Executive Council for Essex, 898 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 264 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, 1948, but that the treatment of children already referred would continue. Particulars of children seen during the year are as follows :— Number of cases treated, 13 6 were discharged cured. 5 referred for operation. 6 transferred to other Clinics. Total number of attendances for the year, 47. 69 Dr. J. Kennedy the Ophthalmic Surgeon, reports on squint cases in general as follows :— " During the last three months of the year, it was found that a large number of children suffering from various forms of squint were very much in need of orthoptic treatment. This had in many cases been carried out at the orthoptic Clinic at Walthamstow, but in addition to the fact that no more cases from Ilford could be taken at this Clinic, there were many which had had to be passed over in favour of those more urgently in need. Some of the worst cases have been taken on for treatment at Moorfield's and other Hospitals in London, but it is economically impossible for many parents to undertake a weekly journey to London with its cost and loss of working hours. I very much hope that it will be possible to make the establishment of a whole-time Orthoptic Clinic in Ilford an urgent priority." A room in the Mayesbrook Clinic has been set aside for an Orthoptic Clinic and the Essex County Council are now negotiating for the purchase of equipment. Orthopaedic Clinic. (i) Newbury Hall Clinic.—47 sessions were held during 1949, 254 children of school age were examined for the first time during the year and 400 children were seen who had previously attended the clinic. These 654 children made 1,431 attendances. (ii) Mayesbrook Clinic.—24 sessions were held during 1949, 125 children of school age were examined for the first time during the year and 195 children were seen who had previously attended the clinic. These 320 children made 689 attendances. The 974 children were found by the Orthopaedic Surgeon to be suffering from the following defects :— Diagnosis. New Cases. Old Cases. A B A B Paralyses :— A.P.M 2 2 10 8 Hemiplegia 1 — 3 1 Paraplegia — — 1 — Monoplegia - - 1 — Spastic deplegia 1 - 1 — Scoliosis 6 7 10 1 Kyphosis 1 2 3 — Slack posture 29 11 22 8 Deformity of hips — — 1 1 Depressed sternum 1 Deformity of chest — — 1 — Genu valgum 76 24 125 74 70 Diagnosis. New Cases. Old Cases. A B A B O.C.T 3 1 21 11 Genu varum 7 1 1 2 Pes valgus-planus 45 28 65 35 Valgus ankles 59 31 63 25 Talipes calcaneo-valgus — — 4 5 Congenital talipes E.V. — - 4 2 Congenital defect — 1 8 4 Intoeing — — 4 1 Pes cavus 1 1 2 2 Hallux valgus 3 — 9 2 Deformity of toes 6 3 17 3 Traumatic condition 3 8 2 1 Rickets - 1 Torticollis 3 1 N.A.D 3 2 2 1 Other conditions 8 3 16 5 Ortho : defect connected birth injury — — 1 1 Totals ... 254 125 400 195 A—Newbury Hall. B—Mayesbrook. 13 children of school age were admitted to Hospitals. Particulars as follows No. of Cases. Hospital. Defect. 1 Royal National Orthopaedic Torticollis. 2 Harold Wood Torticollis. 10 Black Notley Talipes Equinus. Arthritis. Old Erb's palsy. Torticollis. Amputation of toe. Clawing of toes. Tenotomy Tendo Achilles (2 cases). Dislocation of hip. Congenital Discoid Cartilage. During the year 70 pairs of valgus insoles, 6 pairs of surgical boots or shoes, 11 pairs Genu Valgum splints, 1 toe spring for drop foot, 2 metatarsal bars and 3 repairs to artificial limbs were supplied to school-children. 310 cases were discharged from the Orthopaedic Clinic, 29 as cured, 136 discontinued attendance and were kept under observation at school, 113 were showing improvement and were kept under observation at school, and 32 cases left school or left the district. The Physiotherapist 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 190 sessions were held by the Physiotherapist for treatment during 1949 (96 at Newbury Hall Clinic and 94 at Mayesbrook Clinic). 71 At Newbury Hall Clinic 135 individual children of school age were treated by the Physiotherapist during the year and 1,765 attendances were made by these children. Treatment was also given to 75 children, who made 1,136 attendances at the Mayesbrook Clinic. Artificial Sunlight Clinic.—The Physiotherapist attends the Newbury Hall Clinic on Monday morning and the Mayesbrook Clinic on Tuesday morning for artificial sunlight treatment, 45 sessions were held at Newbury Hall Clinic and 48 at Mayesbrook Clinic. At the Newbury Hall Clinic 62 children of school age were treated, making 904 attendances for treatment. At the Mayesbrook Clinic 36 children of school age were treated, making 626 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 23 12 Pulmonary Fibrosis 4 1 Bronchitis 13 10 Bowlegs — 1 Alopecia 3 — Asthma 2 2 Knock Knees — 1 Old Rickets 1 1 Chilblains 2 Flat feet 1 Psoriasis 2 2 Posture 1 1 Other Conditions 10 5 62 36 A—Newbury Hall Clinic. B—Mayesbrook Clinic. Of the 36 cases treated at the Mayesbrook Clinic, 3 were Open Air schoolchildren. At Newbury Hall Clinic, 34 children of school age were discharged from the Artificial Sunlight Clinic, 12 were cured, 8 were showing considerable improvement, and 14 were discharged due to absence. 54 children were still receiving treatment at the end of the year. At Mayesbrook Clinic, 15 children of school age were discharged from the Artificial Sunlight Clinic, 5 were showing considerable improvement, 7 were cured, and 3 were discharged due to absence. 35 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 up to the end of July, and one session weekly to the end of the year. 74 sessions were held during 1949 and 1,324 attendances were made by 637 children of school age, of whom 365 were new cases. The following table shows the work of the Clinic :— 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 (1) Acute Suppurative Otitis Media - - - - - 1 - - - - - - - - - 1 - 2 (ii) Acute Catarrhal Otitis Media 1 — 6 3 2 - - - - - - - - - 1 1 10 4 (iii) Chronic Suppurative Otitis Media due to :— - - - - - - - - - - - - - - - - - - 1. Tympanic Sepsis 1 4 9 — 1 1 - - - - - - - - - 1 11 6 2. ,, and Granulations — 4 — 1 — — — — — — — — — — — — — 5 3. Other Causes 1 — — — — 2 — — — — — — — — — — 1 2 (iv) Mastoid Disease (previous operation) - - - - - - - - - - - 1 - - - - - 1 (v) Partial Deafness due to :— 1. Nerve Deafness — — 3 — — 1 — — — — — — — — — — 3 1 2. Tonsils and Adenoids — 7 3 3 — 2 - - - - - - - - - - 3 12 3. Retraction of Membrana Tympani 5 2 3 3 1 4 - - - - - - - - 2 2 11 11 4. Scarring of Membrana Tympani — 1 1 - - 1 - - - - - - - - - 1 1 3 5. Other causes 2 3 2 3 — 4 - - - - - - - - - - 4 10 (vi) Opinion on Tonsils - 7 227 28 9 64 - - 1 1 3 - - - 3 4 243 104 (vii) Rhinitis 2 3 8 1 - 1 - 1 - 1 - - - - - 1 10 8 (viii) Other diseases or defects 14 44 40 12 5 29 1 2 4 - 1 — — 3 3 13 68 103 Totals 26 75 302 54 18 110 1 3 5 2 4 1 - 3 9 24 365 272 Rheumatism Clinic. The Physician attended 29 morning sessions during the year, and 252 children (110 of these being new cases) made 450 attendances. The 252 children were found to be suffering from the following conditions :— Defects Found. New Cases. Old Cases. Totals. History of Rheumatism (observation) 10 11 21 „ Chorea 1 — 1 Rheumatic Carditis 5 6 11 Other forms of Carditis 1 — 1 Tachycardia of Nervous origin 3 — 3 Congenital Heart Disease 4 30 34 Rheumatism 7 1 8 Chorea 1 3 4 Habit Spasm 1 1 2 Anaemia, Subnormal-nutrition and Debility 2 1 3 No active Rheumatic disease 21 26 47 Heart Murmur functional 22 33 55 Acidosis, metabolic disturbance of Alimentary origin 6 3 9 Pains due to Orthopaedic condition 11 14 25 Allergic Type 1 — 1 Arrhythmia 1 1 2 Other Conditions 13 12 25 Totals 110 142 252 Number of cases referred to Convalescent Home ... ... ... 4 „ „ „ General Hospital (In-patients) ... ... 16 „ „ „ Isolation Hospital ... ... ... 3 „ „ „ Ear, Nose and Throat Surgeon ... 21 „ „ „ Orthopaedic Surgeon ... ... ... 29 „ „ „ for X-ray and Electro-Cardiogram ... 83 „ „ ,, Blood Sedimentation Rate ... ... 15 ,, ,, ,, Psychiatrist ... ... ... ... 2 ,, ,, ,, Open Air School... ... ... ... 3 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.—The Clinic was closed for January and February and reopened in March. Mrs. C. H. MacIntyre commenced on a part-time sessional basis of 5 half-days weekly. Miss P. M. Lough, in May, returned on a part-time basis of 5 sessions weekly. By the end of the year, 125 individual children of school age had received speech therapy at this Clinic, making a total of 1,688 attendances. The defects treated were as follows Stammering 53 Dyslalia 52 Cleft Palate 4 Post Operative (Tonsillectomy)14 Neurological 2 48 children of school age were discharged from the Clinic during the year. In 28 cases the speech was normal. Of the remaining 20 cases, 10 ceased to attend for treatment, 8 left school or left the district. In one case the treatment proved ineffective and in one "other treatment was not necessary. F 74 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. School Dental Service.—Mr. E. V. Haigh, Senior Dental Officer, reports as follows:— "Since March 1949, the School Dental Service has been served by one full-time dental officer and two part-time; the two part-time officers between them have worked three sessions per week, approximately a total of 7½ hours. My time at Mayesbrook Dental Clinic as full-time dental officer is divided between children under school age, children of school age and tuberculosis cases, and it is becoming increasingly difficult to visit the schools and inspect the children, and at the present rate, owing to serious shortage of dental officers, it will be four or five years between each visit. This lack of visits is responsible for more gross decay and toothache. Urgent cases of toothache are given priority, and conservative, including orthodontic treatment, is carried out when possible, but in the existing conditions it is clearly impossible to provide an adequate and satisfactory service." Of 3,757 inspections by the Dentists (including special cases) 3,310 (or 88 per cent.) were found to require treatment, compared with 7,887 (or 68.7 per cent) in 1948, 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. In addition to the ordinary dental work of fillings and extractions, 138 regulation plates, 2 crowns, and 15 dentures were supplied. 2,481 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 5 624 536 85 6 583 469 80 7 492 415 84 8 459 401 87 9 367 345 94 10 346 315 91 11 303 277 91 12 198 183 92 13 178 172 96 14 137 128 93 15 70 69 98 Total 3,757 3,310 88 Full details of the dental work are shown in Table V. Open-air School.—During 1949, 32 children were admitted, 34 ceased attendance, and on the 31st December, 1949, 81 children were on the school roll, 4 vacancies remaining unfilled. Those admitted were recommended for examination from the following sources:— School Medical Officer 24 Tuberculosis Officer 3 Rheumatism Clinic 1 Others 4 The above 32 children were admitted for the following reasons:— School Medical Officer:— Asthma and Bronchitis 5 Bronchitis, Asthma, and Subnormal nutrition 1 75 Chronic Bronchitis 1 Poor nutrition and Pulmonary Catarrh 1 Undernourished, Recurrent Bronchitis and History of Erythema Nodosum 1 Debility and Malnutrition 3 Spastic Paraplegia and Congenital Dislocation of Hips 1 Recurrent Rheumatic Carditis 1 Spastic Diplegia 1 Muscular Atrophy 1 Recurrent Pneumonia and Bronchiectasis 1 Healed Primary Tuberculosis 1 Perthé's Disease 1 Delicate 1 Poor Physique 1 Anæmia and Debility 1 Kypho-Scoliosis, Poor General Condition and Nerves 1 Mild Chorea 1 Tuberculosis Officer:— T.B. Spine 1 Arrested T.B. Hip 1 Debility following T.B. Adenitis 1 Rheumatism Clinic:— Minor Congenital Lesion of Heart 1 Others:— T.B. Spine 1 Congenital Heart 1 Wasting of Calf Muscles 1 Asthma 1 The 34 children not now on the school roll ceased attendance for the following reasons:— Parents request 1 Admission to Hospital 3 Admission to Ogilvie School of Recovery 1 Resumed attendance at ordinary school 20 Left school—overage 5 Admission to convalescent home 1 Admission to residential Open Air School 2 Admission to Spurgeon's Orphanage 1 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 26 Administration of Cod-liver Oil Emulsion 26 Administration of Malt and Oil, Parrish's Food, etc. 4 Referred to Ophthalmic Surgeon 6 „ Orthopaedic Surgeon re Remedial Exercises, etc. 8 „ Dental Surgeon 6 „ Aural Surgeon 1 „T.B. Officer 1 Recommended Asthma exercises 2 Recommended Convalescent Home treatment 10 A course of Asthma Injections has been given to 26 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. 4 children received Artificial Sunlight treatment during the year. F* 76 Treatment for Unclcanliness.—The School Nurses paid 187 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 Number Per of Children. Infected. cent. 50,034 *499 0.9 *33 of this number were found to be infected with living vermin; the remainder with nits only. A child with any nits in the hair at all is included in these figures. The percentages for the past 5 years were as follows:— 1945 3.3 1946 2.6 1947 1.7 1948 1.3 1949 0.9 Other Ailments.—During 1949, 162 children were operated on for the removal of enlarged tonsils and adenoids, under the agreement with Queen Mary's Hospital, Stratford, as in-patients. (53 at Queen Mary's Hospital and 109 at St. Mary's Hospital, Plaistow.) Under the agreement with the King George Hospital, 29 children were operated on at that Hospital, all as in-patients, for the removal of enlarged tonsils and adenoids. By special arrangement, 7 children were operated on at Rush Green Hospital and 5 at Ilford Isolation Hospital for removal of 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 1949 was 2,527,097 approximately. There are 21 kitchens in the Borough, established at the following schools:— Barking Abbey, Beal, Becontree, Benton, County High Boys, County High Girls, Cleveland, Dane, Fairlop, Gearies, Goodmayes, Gordon, Loxford, Mayfield, Newbury Park, Parkhill, 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, 1949, 18,267 children were receiving milk in school. Work done by the N.S.P.C.C.—The following 39 cases were investigated:— (1) Neglect 24 (2) Ill-treatment cases 5 (3) Other cases 10 (1 case was reported from the Public Health Department for neglecting medical advice; 23 were reported from other sources for general neglect.) 95 children (54 boys and 41 girls) were involved, 52 being of school age. In addition to this work, 151 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.— 1. Number of Ilford School-children sent to Convalescent Homes = 64. (а) Fees paid by Parents 1 (b) „ „ „ Voluntary Funds 3 (c) „ „ „ Education Committee 41 (d) „ „ „ Essex Education Committee 15 (e) „ „ „ Regional Hospital Board 4 2. Other work on behalf of Ilford School-children. (a) Loan of six invalid chairs. (b) Escorting children to Clinics, Hospitals and Convalescent Homes. (c) Supply of Clothing in 8 cases. (d) Temporary loan of fares to Convalescent Homes. (e) Home Visits regarding home and social conditions, 18. (f) Number of cases referred for advice only, 24. (g) Number of home visits paid, 340. 77 Handicapped Children. Section 33 of the Education Act, 1944, and the regulations made thereunder have placed on the Local Education Authorities new responsibilities for the provision of suitable education for children suffering from disability of mind or body. A record of all such children is revised annually from returns submitted by all Head Teachers, and any new cases attending local maintained schools are reported to me with a view to medical examination and ascertainment of their suitability or otherwise of attendance at an ordinary school. The several categories of pupils requiring special educational treatment are defined as follows:— (а) Blind Pupils, that is to say, pupils who have no sight or whose sight is or is likely to become so defective that they require education by methods not involving the use of sight. (b) Partially Sighted Pupils, that is to say, pupils who by reason of defective vision cannot follow the ordinary curriculum without detriment to their sight or to their educational development, but can be educated by special methods involving the use of sight. (c) Deaf Pupils, that is to say, pupils who have no hearing or whose hearing is so defective that they require education by methods used for deaf pupils without naturally acquired speech or language. (d) Partially Deaf Pupils, that is to say, pupils whose hearing is so defective that they require for their education special arrangements or facilities but not all the educational methods used for deaf pupils. (e) Delicate Pupils, that is to say, pupils who by reason of impaired physical condition cannot, without risk to their health, be educated under the normal regime of an ordinary school. (f) Diabetic Pupils, that is to say, pupils suffering from diabetes, who cannot obtain the treatment they need while living at home and require residential care. (g) Educationally Subnormal 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. (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, 1949, are tabulated hereunder:— 78 Return of Handicapped Pupils in the Area on 31st December, 1949 (Aged 2-16 Years.) handicapped pupils. Blind, Partially Blind, Deaf. Partially Deaf. Delicate. Physically Handicapped. Educationally Subnormal. Maladjusted. Epileptic. 1 2 3 4 5 6 7 8 9 Total A. Newly placed in 1949 — — 1 — 19 9 20 4 — 53 B. Newly ascertained in 1949 — — 2 1 26 20 32 4 - 85 C. (i) Attending Special Schools— Day 2 9 3 61 22 73 170 Boarding 2 3 4 — 5 7 23 12 — 56 (ii) Boarded in homes — — — — 1 — — — — 1 (iii) Attending assisted Schools — — — — — — — — — — D. Unplaced— (i) At no school — 1 2 — 3 16 30 1 2 55 (ii) At ordinary school — — — 1 15 7 14 8 4 49 (iii) At Newbury Park Special class — — — — — — 1 — — 1 E. Receiving home tuition (including those in D). — — 1 — 1 2 F. Attending Special Schools Speech = Nil. Diabetes = Nil. Boarded in Homes Speech = Nil. Diabetes = Nil. Physically Handicapped Children.—During 1949, 48 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 1 Delicate or Physically Handicapped. Open Air School 38 Residential Special School 8 48 Children Examined for Disability of Mind.—During 1949 the following numbers of children were medically examined and reported upon under the Education Act, 1944:- 79  Initial Examination Reexamination (a) Maladjusted 9 5 (b) Educationally Subnormal 63 108 (c) Unfit for Education within the school system 4 3 Total number examined 76 116 Children coming within heading (b) are, where necessary, 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. Child Guidance Clinic.—The Child Guidance Clinic was opened on 3rd January, 1949, at Loxford Hall, Loxford Lane, Ilford. Dr. Burton was appointed Psychiatrist, Miss M. Bailey as Educational Psychologist and Miss E. L. Batkin as Psychiatric Social Worker. The Psychiatrist undertakes 3 sessions weekly, whilst the Educational Psychologist and Psychiatric Social Worker are in full-time employment. Dr. A. Maberly, the Essex County Psychiatrist, attended at regular intervals as Consultant and throughout 1949 averaged one session weekly. In March 1949, Miss Batkin terminated her employment for domestic reasons and Mrs. I. Seglow was appointed to fill the vacancy in October 1949. Miss Bailey also resigned in September 1949, consequent upon her marriage and Mr. K. Pickett took over her appointment as Educational Psychologist on 1st November, 1949. During the year 179 new cases were referred to the Clinic and of these 19 were referred from the Courts. The following is a table of work undertaken at the Clinic:— Psychiatrist:— Cases diagnosed 125 Treatment interviews 252 Other interviews 38 Psychologist:— Cases tested 161 Treatment interviews 180 Other interviews 39 School visits on Clinic cases 60 Psychiatric Social Worker:— Cases interviewed at Clinic 278 Other interviews at Clinic 9 Home and other visits 71 Number of cases recovered or sufficiently improved to warrant discharge 23 Diagnosis and advice only 38 Discharged—non-co-operative 7 80 Employment of School-children and Young Persons.—From special inquiries made at the various schools during 1949 it was found that 142 children were employed out of school hours. 142 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 140 Employment of Children in Entertainments Provisional Amending Rules, 1945.—23 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 19 Staff Sickness Regulations 5 Total 26 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 1947 and 1948. 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 1948 1947 1948 1. Measles .06 — 1000 — 2. Scarlet Fever — — — — 3. Whooping Cough .12 — — — 4. Diphtheria .06 — 10.0 — 5. Influenza 1.20 0.6 — — 6. Tuberculosis 4.31 4.5 10.0 20.0 7. Rheumatic Fever — — — — 8. Bronchitis, Pneumonia and other respiratory diseases 11.39 10.2 — 9. *Meningitis and Nervous system 12.19 15.5 — 6-6 10. Heart Diseases 30.88 32.6 — 6-6 11. Acute and Chronic Nephritis 2.93 1.4 — — 12. Violence 4.19 4.1 40.0 13.3 13. Other causes 32.67 31.1 30.0 53.5 100.0 100.0 100.0 100.0 *Excludes Meningococcal infections. (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 11a. (3) Total individual pupils. (4) Entrants 53 556 598 Second Age Group 168 222 372 Third Age Group 247 517 691 Total (Prescribed Groups) 468 1,295 1,661 Other Periodic Inspections — — — Grand Total 468 1,295 1,661 81 Deaths of School-children. Ilford.—The deaths of children of School Age during 1948 represent 0.98 per cent. of the Total Deaths registered (all ages), and during 1947 represent 0.6 per cent. Ministry of Education. MEDICAL INSPECTION RETURNS. Year Ended 31st December, 1949. TABLE I. Medical Inspection of pupils attending maintained Primary and Secondary Schools. A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,746 Second Age Group 1,602 Third Age Group 2,234 Total 6,582 Number of other Periodic Inspections — Grand Total 6,582 B.—Other Inspections. Number of Special Inspections 3,537 Number of Re-inspections 9,219 Total 12,756 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). 82 TABLE II. A.—Return of Defects found by Medical Inspection. (All defects noted as requiring treatment are included in this return.) Periodic Inspections. Special Inspections. Number of Defects. Number of Defects. Defect Code No. Defect or Disease. Requiring Treatment. Requiring to be kept under observation, but not requiring treatment. Requiring Treatment. Requiring to be kept under observation, but not requiring treatment. (1) (2) (3) (4) (5) 4 Skin 83 51 3 1 5 Eyes—a.Vision 468 348 3 2 b. Squint 46 24 1 1 c. Other 27 42 1 1 6 Ears—a. Hearing 46 52 1 1 b. Otitis Media 26 23 c. Other 19 20 7 Nose or Throat 360 639 6 7 8 Speech 24 57 — — 9 Cervical Glands 23 220 — 2 10 Heart and Circulation 72 227 1 11 Lungs 71 262 — 1 12 Developmental— a. Hernia 12 16 — — b. Other 17 62 2 13 Orthopaedic— a. Posture 233 189 2 7 b. Flat foot 223 163 2 6 c. Other 339 419 — 7 14 Nervous System— a. Epilepsy 2 3 — — 6. Other 6 46 — 15 Psychological— a. Development 3 21 — — b. Stability 14 118 — — 16 Other 89 195 1 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 2,746 560 20.43 2,127 77.46 58 2.11 Second Age Groups 1,602 302 18.85 1,250 78.03 50 3.12 Third Age Groups 2,234 277 12.75 1,901 85.09 56 2.51 Other Periodic Inspections - - - - - - - Total 6,582 1,140 17.32 5,278 80.19 164 2.49 83 TABLE III. Infestation with Vermin. (i) Total number of examinations in the Schools by the School Nurses 50,034 (ii) Total number of individual pupils found to be infested 499 (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. TREATMENT TABLES. TABLE IV. 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 III). (a) Skin. Number of defects treated, or under treatment during the year Ringworm—Scalp:— (i) X-Ray treatment 1 (ii) Other treatment — Ringworm—Body 3 Scabies 5 Impetigo 43 Other skin diseases 377 Eye Disease (External and other, but excluding errors of refractions, squint and cases admitted to Hospital.) 144 Ear Defects (Treatment for serious diseases of the ear (e.g., operative treatment in Hospital) are not recorded here but in the body of this Report.) 152 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 533 Total 1,258 (b) Total number of attendances at the Authority's Minor Ailments Clinics 5,295 84 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) 1,265 Other defects or disease of the eyes 125 Total 1,390 Number of Pupils for whom spectacles were:— (a) Prescribed 890 (b) Obtained 639 Group III.—Treatment of Defects of Nose and Throat. Received Operative Treatment:— Total number treated. (a) For Adenoids and Chronic Tonsillitis 313 (b) For other nose and throat conditions 20 Received other forms of treatment 252 Total 585 Group IV.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in Hospitals or Hospital Schools 13 (b) Number treated otherwise, e.g., in Clinics or out-patients department 1,282 Group V.—Child Guidance Treatment and Speech Therapy. Number of Pupils treated:— (a) Under Child Guidance arrangements 142 (b) Under Speech Therapy arrangement 125 TABLE V. Dental Inspection and Treatment. umber 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 210 229 196 207 131 129 112 40 35 27 1 — — 1,317 Specials 414 354 296 252 236 217 191 158 143 110 69 — — 2,440 Total (Routine and Specials) 3,757 (2) Number found to require treatment 3,310 (3) Number actually treated 4,728 (4) Attendances made by children for treatment 8,273 (5) Half-days devoted to Inspection 9 Total 636 Treatment 627 6) Fillings Permanent Teeth 1,756 Total 2,858 Temporary Teeth 1,102 Total 7,109 (7) Extractions Permanent Teeth 1,289 Tern nnrarv Teefrh s 820 f (8) Administrations of general anaesthetics for extractions 2,259 (9) Other operations Permanent Teeth 6,029 Total 7,357 Temporary Teeth 1,328 85 Table VI.-Summary of Cases ok Inkectious Diseases among School Children, and ok Contacts ok such Cases, excluded from School Attendance during the Year ended the 31st December, 1949 DISEASES AND CONTACTS SCHOOLS No. on Roll Scarlet Fever Diphtheria Measles and German Measles Whooping Cough Chickenpox Polioencephalitis or Poliomyelitis Mumps Pneumonia Rheumatism. Totals. Cases Contacts Cases Contacts Cases Contacts Cases jContacts Cases Cases Contacts Cases Cases Cases Cases Contacts Beal Modern 651 2 3 - - - - - - - - - - 1 — 3 3 Becontree 1,328 7 18 — — 8 — 3 1 — 1 - — - 1 20 19 Benton (Open Air) 85 — — — — 1 — — - — - - — - - 1 — Chadwell 722 10 3 — — 26 2 1 1 33 - 30 4 1 105 6 Christchurch 736 5 6 — — 3 — 16 2 1 - 2 12 1 1 39 10 Cleveland 875 13 8 — — 7 — 12 2 4 - - - - 36 10 County High 1,255 5 3 — — 1 — — — — - — 1 — - 7 3 Dane 749 — 5 - 1 — 1 2 3 6 Downshall 1,243 6 2 — — 32 2 11 1 11 3 2 20 2 — 85 7 Fairlop 1,689 29 20 — — 23 5 11 2 — 1 1 4 — 1 69 28 Gearies 1,229 10 7 — — 51 6 8 1 1 — — 1 5 — 76 14 Goodmayes 628 6 6 — — 2 — 2 — — — 3 1 — 1 12 9 Gordon 235 19 5 — — 38 2 5 — 2 — — 22 — 1 87 7 Highlands 756 16 5 — — 53 8 14 3 — 1 1 1 1 — 86 17 Loxford 371 1 5 — — 1 — — — — 1 — — — — 3 5 May field 915 1 6 — — 2 — 1 — 2 — — — 2 — 8 6 Mossford (Fairlop) 301 6 5 — — 33 4 2 — — — — 1 — 1 43 9 Mossford (G.V.H.) 89 — — — — 1 — 1 — — — — — — — 2 — Newbury Park 280 3 3 — — 14 1 22 6 1 — — 3 — — 43 10 Parkhill 761 8 1 — — 15 2 14 2 11 — 1 6 — — 54 6 St. Augustine's 249 4 1 — — — — 1 — 1 — — 4 — — 10 1 SS. Peter and Paul's 619 5 9 — — 6 — 10 2 1 — — 14 — — 36 11 St. Vincent's 397 — 1 - - - - - - - - - - 2 — 2 1 South Park 986 12 12 — — 6 — 7 — — 1 — 5 1 — 32 12 The Glade 529 34 13 — — — — 7 — 2 1 1 30 — — 74 14 The John Bramston 359 11 6 — — — — 4 — — 1 — 26 — 1 43 6 The Mount 311 1 6 — — — — — — — — — — — — 1 6 The Redbridge 523 8 3 — — 92 11 18 3 3 — — 3 3 — 127 17 The William Torbitt 907 11 4 — — 86 7 19 3 1 — — 25 2 — 144 14 Uphall 360 1 1 — — 27 2 4 1 - - - - - - 32 4 Ursuline 241 1 — — — 1 — 2 — — — — — 1 1 6 — Woodlands 315 12 6 — — 58 5 10 1 1 — — 13 1 — 95 12 Private — 15 7 — — 54 9 5 — — — — 2 1 — 77 16 Totals 20,735 262 180 — — 641 66 210 31 75 10 12 224 28 11 1,461 289 Erysipelas : one case at Gordon. 87 88 Table VIIA.—Table Showing the Average Heights and Weights of the BOYS Examined. Age Groups. Age Groups. 5—6 Years 6—7 Years 7—8 Years 8—9 Years 9—10 Years 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years 17—18 Years School 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) Number of Children Examined Average Height (in Centimetres) Average Weight (in Kilogrammes) Beal Modern — — - — - - - - - - - — - - - - - - 2 149 37.4 12 150 40.9 - - - 3 170 57.8 26 171 58.8 20 172 62.1 2 171 61.6 Becontree 78 117 21.1 14 113 20.8 5 115 22.5 1 128 25.2 4 137 31.7 19 137 32.2 65 141 34.0 4 141 33.6 3 144 37.3 49 159 48.9 12 159 50.9 - — - - - - Benton (Open Air) 6 106 17.8 10 116 21.9 14 120 22.3 11 122 21.8 9 132 29.6 — — — 4 142 30.9 6 144 34.5 4 143 36.0 5 148 35.6 2 152 41.3 - - - - - - Chadwell 58 114 20.7 33 118 21.8 4 125 25.4 3 135 30.8 3 131 30.1 17 138 32.9 44 145 36.1 - - - - - - - - - - - - - - - - - - Christchurch 29 113 20.4 8 110 19.8 5 115 23.0 1 141 32.4 — — — 9 141 34.0 38 143 35.1 - - - - - - - - - - - - - - - - - - Cleveland 36 113 21.2 15 117 21.8 6 123 26.7 1 122 23.0 — — — 26 138 31.9 87 142 35.5 - - - - - - - - - - - - - - - - - - County High — — — — — — — — — — — — — — — — — — 11 143 37.9 6 147 41.6 3 151 44.0 17 164 55.2 113 166 57.0 7 172 60.6 1 178 61.6 Dane — — — — — — — — — — — — — — — — — — 4 141 34.0 4 152 42.7 4 164 47.0 35 163 53.0 22 167 56.4 — — — — — — Downshall 66 113 21.0 26 115 22.2 4 121 22.6 1 132 28.0 1 134 28.4 15 140 32.6 70 144 35.1 4 149 39.6 3 147 42.1 24 163 51.1 3 160 47.6 - - - - - Fairlop 33 111 20.0 6 117 22.7 1 123 27.0 1 124 26.0 3 134 29.7 5 137 32.1 53 144 34.9 1 137 31.0 2 151 35.0 76 159 50.0 5 162 54.5 - — — - - - Gearies 56 112 21.0 11 115 20.7 1 127 24.5 2 130 28.7 2 135 32.2 11 140 33.4 72 145 36.3 5 149 36.7 2 154 45.0 43 158 49.2 11 165 56.5 - - — - - - Goodmayes 35 114 21.2 15 116 20.9 5 122 23.8 1 123 22.7 1 130 25.8 7 140 33.0 36 143 33.9 - - - - - - - - - - - - - - - - - - Gordon 17 112 20.3 15 114 21.2 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 80 113 21.4 36 116 23.0 6 127 25.7 6 129 26.2 7 135 31.3 6 142 37.4 38 140 35.0 - - - - - - - - - - - - - - - - - - Loxford — — — — — — — — — — — — — — — — — — 1 152 44.4 3 146 38.7 1 141 34.6 41 158 49.5 22 161 51.6 — — — — — — Mayfield - - - - - - - - - - - - - - - - - - - - 8 151 41.0 15 154 43.3 71 162 52.1 20 161 52.3 - - - - - - Mossford 4 111 20.7 18 117 21.5 3 120 21.9 1 126 24.1 1 143 31.2 2 138 29.3 16 141 33.2 - - - - - - - - - - - - - - - - - - Mossford G.V.H. 10 109 19.7 5 109 20.0 4 118 22.6 1 126 26.2 1 128 25.5 - - - - - - - - - - - - - - - - - - - - - - - - Newbury Park 11 113 20.4 3 119 23.4 4 121 23.8 — — — — — — 5 139 32.1 17 143 34.3 - - - - - - - - - - - - - - - - - - Parkhill 32 113 21.0 13 118 23.6 2 119 23.0 5 133 29.3 2 133 29.0 4 143 32.4 36 145 35.7 - - - - - - - - - - - - - - - - - - St. Augustine's 11 116 19.7 17 118 21.9 5 126 25.9 1 130 24.8 2 139 32.1 2 135 32.1 4 143 34.4 - - - - - - - - - - - - - - - - - - SS. Peter & Paul 20 113 21.6 14 120 24.6 — — — 1 128 28.8 2 132 26.8 10 140 33.4 13 143 33.9 1 129 27.5 3 155 42.7 17 163 55.5 10 161 51.0 - - - - - - South Park 71 126 20.4 33 119 23.0 10 125 25.5 3 128 28.1 7 133 27.9 16 140 32.8 67 145 35.3 - - - - - - - - - - - - - - - - - - St. Vincent's 5 112 18.9 10 115 20.3 3 120 22.1 — - — — — — 5 139 33.1 17 140 33.1 - - - - - - 11 157 48.6 1 157 47.0 - - - - - - The Glade 26 114 20.3 16 117 20.0 1 128 24.0 1 128 24.2 1 132 24.7 4 144 34.7 17 140 33.6 - - - - - - - - - - - - - - - - - - The John Bramston 22 107 20.2 27 115 22.1 6 119 24.0 2 121 23.7 3 126 27.1 3 141 33.0 16 141 36.6 - - - - - - - - - - - - - - - - - - The Redbridge 28 112 20.2 16 117 21.3 1 126 25.6 3 126 23.3 1 137 29.3 3 138 34.1 38 143 34.8 - - - - - - - - - - - - - - - - - - TM Wm. Torbitt 90 113 20.8 29 117 22.1 4 129 27.3 3 127 28.2 3 135 28.9 6 141 33.9 31 145 35.2 - - - - - - - - - - - - - - - - - - Uphall 26 111 19.7 15 119 23.5 - - - 2 123 24.6 1 120 23.5 2 147 37.2 25 140 32.0 - - - - - - - - - - - - - - - - - - Woodlands 41 113 20.5 28 117 21.5 5 124 23.5 1 126 26.3 1 115 21.6 - - - - - - - - - - - - - - - - - - - - - - - - Ilford Boys—Averages for 10 years:— 1949 891 113 20.6 433 117 21.9 99 122 24.1 52 127 25.8 55 133 29.2 177 139 32 9 822 143 34.5 54 147 38.9 40 152 41.9 392 160 50.7 247 165 55.3 27 171 61.7 3 173 61.6 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 - - - - - - - - - - - - 89 90 Table VI1B.—Table Showing the Average Heights and Weights of the GIRLS Examined. Age Groups Age Groups 5—6 Years 6—7 Years 7—8 Years 8—9 Years 9—10 Years 10—11 Years 11—12 Years 12—13 Years 13—14 Years 14—15 Years 15—16 Years 16—17 Years 17—18 Years School 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 (iD 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 - - - - - - - - - - - - - - - - - - 3 146 40.2 4 148 37.0 2 156 41.6 26 157 49.0 27 162 54.2 25 162 55.1 - - - Becontree 68 110 19.0 15 112 20 4 119 22.7 3 127 26.5 6 129 25.8 10 136 31.0 66 142 34.9 2 141 34.6 4 151 41.2 47 155 48.0 19 157 48.9 - - - - - - Benton (Open Air) 4 102 15.1 9 116 21.5 10 118 20.3 10 119 23.0 13 128 27.0 8 134 27.2 6 134 25.8 4 127 23.1 9 148 37.9 2 137 - - - - - - - - - - Chadwell 53 113 20.3 18 114 20.1 1 116 21.8 1 140 31.0 1 137 33.0 15 141 35.1 33 144 36.2 - - - - - - - - - - - - - - - - - - Christchurch 29 112 20.4 20 115 21.3 1 125 25.0 — - — 2 136 32.0 7 142 38.9 43 145 35.8 - - - - - - - - - - - - - - - - - - Cleveland 31 111 20.0 23 114 21.5 4 121 24.9 2 133 28.7 1 136 34.2 13 138 29.9 65 144 35.4 — - - - - - - - - - - - - - - - - - County High — — — — — — — — — — — — — — — — — — 16 146 38.3 5 146 41.7 3 154 48.1 8 158 53.7 66 163 55.4 19 161 55.3 2 164 58.3 Dane Central - - - - - - - - - - - - - - - - - - 9 144 37.6 2 151 47.8 3 152 48.6 59 160 50.4 13 162 54.9 - - - - - - Downshall 66 112 20.5 13 115 19.7 5 120 23.6 — — — 3 134 31.2 17 142 35.1 61 144 35.9 1 160 54.5 — — — 32 159 50.7 6 161 49.3 - - - - - - Fairlop 28 112 18.9 8 116 21.1 2 120 22.7 2 131 25.5 — — — 4 143 34.2 57 144 35.5 4 146 42.8 7 147 38.0 54 158 49.4 17 162 53.2 - - - - - - Gearies 58 111 20.1 23 117 22.2 4 122 24.2 3 130 28.1 5 132 29.4 15 136 33.0 57 144 37.0 7 149 42.1 9 152 48.6 44 159 50.9 6 158 - - - - - - - Goodmayes 36 113 20.1 10 114 21.3 3 123 24.7 1 121 24.0 2 133 30.0 8 140 35.7 42 142 35.5 — - — — — — — — - - - - - - - - - - Gordon 27 112 19.9 11 113 21.3 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Highlands 57 112 20.4 33 116 21.6 9 121 22.9 3 133 31.4 2 128 27.4 21 139 32.4 30 143 36.6 — — - — — — - - - - - - - - - - - - Mayfield - - - - - - - - - - - - - - - - - - 5 143 34.5 3 159 45.3 4 157 43.1 59 158 49.7 29 162 55.6 - - - - - - Mossford 12 111 19.8 16 114 21.1 1 125 23.8 2 129 27.6 — — — 1 132 30.2 15 143 35.4 - - - - - - - - - - - - - - - - - - Mossford G.V.H. 10 107 18.4 5 114 21.0 7 123 25.1 4 130 28.1 6 135 29.4 8 140 34.8 2 140 36.6 — — — — — — - - — - - - - - - - - - Newbury Park 14 112 20.0 4 114 21.4 2 123 21.7 - - - - - - 1 138 31.5 16 144 35.3 - - - - - - - - - - - - - - - - - - Parkhill 31 111 20.1 24 116 21.7 3 117 21.6 1 129 23.6 1 136 37.4 6 144 38.8 36 145 35.7 — — — — — — - - - - - - - - - - - - St. Augustine's 11 113 20.2 13 117 21.5 3 135 32.7 3 125 22.0 1 107 27.8 4 133 32.9 5 144 37.0 — — - — — — - - - - - - - - - - - - S.S. Peter & Paul 12 114 21.1 9 116 21.0 2 119 24.4 — — — — — — 13 137 31.4 18 143 33.8 1 150 41.5 2 160 52.0 17 159 52.6 5 157 48.1 - - - - - - South Park 72 112 19.7 24 115 20.5 4 122 23.6 1 125 23.2 3 133 28.8 25 141 34.5 57 143 36.1 — — — — — — - - - - — - - - - - - - St. Vincent's 9 113 19.0 8 112 19.3 2 119 21.1 1 129 23.0 1 132 25.2 3 137 33.1 17 125 30.2 2 147 39.9 — — — 9 160 52.8 3 161 48.1 - - - - - - The Glade 22 115 20.7 5 116 20.7 — — — 1 124 24.5 — — — 5 139 33.7 12 145 35.5 - - - - - - - - - - - - - - - - - - The John Bramston 15 108 19.2 19 112 20.9 1 116 19.2 3 125 27.9 2 132 28.9 4 135 32.1 14 147 36.0 — — — — — — — — — — - — - - - - - — The Mount - - - - - - - - - - - - - - - - - - 3 148 43.5 2 144 35.9 1 161 45.0 62 158 50.2 13 161 52.5 - - - - - - The Redbridge 28 111 20.0 15 117 21.4 3 119 24.6 1 130 27.4 2 133 30.3 6 142 34.0 32 145 37.8 - - - - - - - - - - - - - - - - - - The William Torbitt 80 111 19.6 42 117 21.5 6 125 24.4 — — — 4 129 24.9 15 141 33.9 34 143 35.1 - - - - - - - - - - - - - - - - - - Uphall 19 110 19.2 24 114 20.9 4 120 23.1 4 126 26.8 1 118 21.6 7 145 35.7 29 144 35.6 - - - - - - - - - - - - - - - - - - Ursuline — — — — — — — — — — — — — — — — — — 32 146 39.7 20 151 42.8 5 160 50.9 2 154 43.9 53 160 54.1 3 159 62.9 1 160 49.0 Woodlands 31 112 20.1 27 117 22.2 1 124 23.9 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Ilford Girls—Averages for 10 years:— 1949 823 111 19.9 418 115 21.2 82 121 23.5 46 126 26.0 56 130 28.3 216 139 33.4 815 143 35.8 57 147 40.7 49 152 44.0 421 158 50.0 257 161 53.8 47 161 55.7 3 163 55.2 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 - - - - - - - - - - - -