P.C. Ach. 27.10.55. ? 1LF 29 Borough of Ilford Health Report FOR THE YEAR 1954 I. GORDON M.D., Ch.B., M.R.C.P., D.P.H. Medical Officer of Health, etc. . 1 ILFORD BOROUGH COUNCIL Municipal Year 1954/55 Alderman C. A. Headley, J.P., Mayor. Alderman C. I. Gibson, Deputy Mayor. Aldermen: Barker, John, J.P. Faning, Percy Victor (E.C.C.). Bryan, William Allen Vernon, J.P. Gibson, Cyril Irving (Deputy Mayor). Colvin, Gilbert, C.B.E., F.C.I.S. Headley, Cecil Aubrey, J.P. (Mayor). Cowan, Harold Douglas, Pearson, Frederick Thomas. F.A.C.C.A., F.C.C.S. _ Woods, Sidney Charles Victor. Daniels, Russell Stearn. Young, Major Alexander, T.D.. J.P., Fallaize, Mrs. Lilian, J.P. (E.C.C.) C.A., (E.C.C.). Councillors: Aly, Harry Reginald Bertram. James, Francis Herbert Bennett, Mrs. Florence Edith. Littlejohn, Mrs. Ruth Constance, M.A. Bysouth, Henry Albert, A.I.A.C. Loveless, Sydney Frank. Caunt, George Louis. Manders, Ralph James David. Martin, Robert. Chapman. Mrs. Ceinwen, M.B.E. Masters, Frank Robert. Cunningham-Snell, Robert, F.C.I.I. Natzler, Isaac Bernard. Davies, David Samuel. Parfitt, John Howard. Drew, Leslie Victor. Root, Harold Goldstone, M.S.M. East, John, A.M.Inst.Mech. Shaw, Arnold John, B.A. Gleed, Sydney George. Sherrell, Albert Reginald (E.C.C.). Gooch, Lionel Archer Scott. Slater, Frank (died 12.3.55). Green, Cecil Frederick Herbert Smith, Mrs. Lily Maude, S.R.N. (E C C) Terry, Miss Anne Sylvia. GrosiJohn Stanley. Tullett, Mrs. Ethel Ross. Harris, Edgar Frank. Waters, Owen Francis. Hewitt, Reginald. Watts, Mrs. Mabel Lucy. Hodson, Harold. Westley, Ronald Francis. Hughes, Thomas Bernard. Woodham, Leonard Victor. 2 PUBLIC HEALTH COMMITTEE Municipal Year 1954/55 Councillor Mrs. L. M. Smith, S.R.N., Chairman. Councillor Miss A. S. Terry, Vice-Chairman. Alderman G. Colvin, C.B.E., F.C.I.S. Councillor J. S. Grose. Alderman R. S. Daniels. Councillor T. B. Hughes. Alderman C. I. Gibson (Deputy Mayor). Councillor Mrs. R. C. Littlejohn, M.A. Alderman C. A. Headley, J.P. (Mayor). Councillor A. J. Shaw, B.A. Councillor Mrs. C. Chapman, M.B.E. Councillor A. R. Sherrell (E.C.C.). Councillor J. East, A.M.Inst.Mech. Councillor Mrs. E. R. Tullett. Councillor C. F. H. Green (E.C.C.). Councillor Mrs. M. L. Watts. ILFORD HEALTH AREA SUB-COMMITTEE OF THE HEALTH COMMITTEE OF THE ESSEX COUNTY COUNCIL Municipal Year 1954/55 Ilford Borough Council Representatives'. Aldermen Barker, Colvin, Gibson (Deputy Mayor), Headley (Mayor), Woods; Councillors East, Gleed, Grose, James, Mrs. Littlejohn, Masters, Sherrell, Mrs. Smith (Vice-Chairman), Miss Terry, Mrs. Watts (Chairman). Essex County Council Representatives: Aldermen Mrs. Ball and Young; Councillors Mrs. Banthorpe, Mrs. Fallaize, Green, Mrs, Paige. The Executive Council for Essex Representative : Dr. H. N. Rose. Local Medical Committee Representative: Dr. S. J. Allen. Hospital Management Committee Representative: Mrs. D. L. Belchambef. Voluntary Organisations' Representatives: Mrs. M. Armitage, Mrs. B. Butcher (died 14.4.55), Miss N. L. Odell and Mrs. A. M. Pearce. 3 ILFORD COMMITTEE FOR EDUCATION Municipal Year 1954/55 Alderman G. Colvin, C.B.E., F.C.I.S., Chairman. Councillor R. J. D. Manders, Vice-Chairman. Alderman J. Barker, J.P. Alderman P. V. Faning (E.C.C.). Alderman Mrs. L. Fallaize, J.P. (E.C.C.). Alderman C. I. Gibson (Deputy Mayor). Alderman F. T. Pearson. Alderman Major A. Young, T.D., J.P., C.A. (E.C.C.). Councillor Mrs. F. E. Bennett. Councillor A. J. Shaw, B.A. Councillor Mrs. C. Chapman, M.B.E. Councillor T. B. Hughes. Councillor Mrs. L. M. Smith, S.R.N. Councillor Mrs. R. C. Littlejohn, Councillor Miss A. S. Terry. M.A. Councillor O. F. Waters. Councillor S. F. Loveless. Councillor F. R. Masters. Councillor Mrs. M. L. Watts. Councillor J. H. Parfitt. Councillor L. V. Woodham. Co-opted Members: Mr. S. Baker. Rev. K. A. Bear, B.A. Rev. M. Hancock. Mr. H. S. Kenward, M.A. Mr. C. E. Loveless Mr. E. R. Lower, B.A. Miss H. S. Rich. Mr. C. G. Rolfe. County Nominated Members: Mr. W. R. Spencer (died 28/3/55). County Councillor A. F. J. Chorley. 4 OFFICERS OF THE PUBLIC HEALTH SERVICES Ilford Borough Council. Medical Officer of Health, Divisional School Medical Officer, Area Medical Officer, Ilford Health Area Sub-Committee : I. Gordon, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. (Edin.). Deputy Medical Officer of Health: (Part Time) D. M. B. Gross, M.D., Ch.B., (Leeds). M.M.S.A., D.P.H. (Lond.). Chief Sanitary Inspector: S. R. Daly, LL.M., B.Sc., D.P.A. (Lond.), Barrister-at-Law. Deputy Chief Sanitary Inspector: P. W. English. Sanitary Inspectors: A. C. R. Neale. J. Cook. G. W. Newman. F. Nau. R. E. Smallev. D.E.Scott. T. F. Johnson. C. Broomfield. Chief Administrative Assistant (I.B.C. and E.C.C.): F. J. Hocking. Welfare Officer for Old Folk : Miss E. A. Workman, B.A. (to 28.8.54) Miss M. J. Copping (from 1.10.54) Administrative Assistant. J. J. Holland. Essex County Council. Assistant County Medical Officers: D. M. B. Gross, M.D., Ch.B. (Leeds), M.M.S.A., D.P.H. (Lond.) (Part Time). 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). H. B. Grange, M.B., B.S. (Lond.). J. M. Pooley, M.B.. B.S. (Lond.), D.C.H. J. W. McConachie, M.R.C.S., L.R.C.P. (Lond.), D.P.H. (Eng.) (to 11.9.54). R. M. Noordin, M.R.C.S., L.R.C.P. (from 11.10.54) .Senior Dental Officer: E. V. Haigh, L.D.S., R.C.S. (Eng.). Educational Psychologists : Miss J. Reed, B.A. (Hons. Psych.) (to 30.9.54) Miss E. A. Wicks, B.A. (Hons.). Miss B. S. Gascoyne, B.A. (Hons.. Psych.) (from 1,2.55). Psychiatric Social Workers : Miss I. Zaphiriou (to 30.4.55). Miss C. Moffatt. Speech Therapist: Mrs. M. Walker, L.C.S.T. 5 Officers of the Public Health Services—continued. Superintendent of Midwives: Miss C. Blockley. Superintendent Health Visitor: Miss M. Preston (to 25.9.54). Miss J. M. Oliver (from 22.11.54). Health Visitors and School Nurses: Miss A. L. Drinkwater Miss D. Lowenberg (to 31.12.54) (to 11.8.55) miss C. Oldham. Miss E. M. P. Collins Miss P. M. Leavett Miss A. N. Bowmer Miss E. M. Brown „ „ (from 29.12.54) Miss M. G. Duguid Mrs. J. M. Weston Miss H. Arnold Miss I. L. Mobbs (Part-time) Tuberculosis Visitors: Miss J. E. Dent (to 30.9.54) Mrs. T. Ivanauskas Miss C. McDonald Miss M. Forde (from 22.11.54) Matrons of Day Nurseries: Sunshine House Miss I. E. Sandall. Green Lane Mrs. E. Drower. Ley Street Miss G. M. Gross Administrative Assistants: Miss H. Nunn (Part III Services). A. G. Hubbard (School Health Services) (to 31.5.55). E. S. Jenkins (School Health Services) (from 1.6.55). Domestic Help Organiser: Mrs. L. G. Lawrence. Part Time:— Regional Hospital Board. Consulting Obstetrician (Puerperal Pyrexia Regulations): R. C. Percival, F.R.C.S. (Eng.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), M.R.C.O.G. Surgeon in charge of Orthopaedic Clinic : H. G. Korvin, D.M., F.R.C.S. Ophthalmologist: H. J. R. Thorne, M B., B.S., D O., D.O.M.S. A. B. MacClancy, L.R.C.P.(I.), L.R.C.S.(L), L.M., D.O. 6 Officers of the Public Health Services—continued. Surgeon in charge of Aural Clinic: Margaret M. Mason, M.A., 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 Paedialric Clinic: T. R. Savage, M.A., B.M.. M.R.C.P. (to 31.5.54). A. Russell, O.B.E.. M.D., M.R.C.P. (from 1.6.54) Child Guidance Clinic: Consultant Psychiatrists: H. M. S. Davidson, M.B., B.S., M.R.C.S., D.P.M. J. Vincenzi, M.R.C.S., L.R.C.P., D.P.M. Psychiatrist: H. J. Altschulova, M.D. Orthoptist: Mrs. M. J. Mindell, D.B.O. (to 29.12.54). Miss C. Hazell, D.B.O. (from 4.1.55). Physiotherapist: A. Brand, M.C.S.P. (from 21.6.54). Essex County Council. Assistant Dental Officers (Part-time): E. M. Sycamore, M.R.C.S., L.R.C.P., L.D.S., R.C.S. (Eng.). R. J. Newman, M.B.E., L.D.S., R.C.S., J.P. J. T. Hutchins. D. O'Connell, B.D.S., R.C.S. (1). Mrs. 1. N. Bravo, L.D.S., R.C.S. L. P. Henry, L.D.S., R.F.P.S. J. Tighe, B.D.S. (to 6.8.54). T. P. Taylor. V. H Foy, L.D.S., R.C.S. M. F. Marshall, B.D.S. (Sydney) (from 13.12.54). F. Summers, L.D.S., R.C.S. (Eng.) (from 11.12.54). Child Psycho-Therapist (Non Medical): Miss M. L. Harries, M.A. (to 14.5.55). Miss M. E. Bergen, M.A., B.Sc. (from 16.12.54). Play Therapist (Part-time): Mrs. M. Henschel, B.A. (Dip. Psych.) (to 31.10.54). Speech Therapist (Part-time): Mrs. F M. Hatfield, L.C.S.T. Ilford Borough Council. Public Analysts: George Taylor, F.R.I.C. J. Hubert Hamence,, M.Sc., Ph.D. 7 Preface Public Health Offices, Ilford. July, 1955 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 1954. It is very gratifying indeed to report that the infant mortality rate of 18 69 is the lowest we have ever had, it is considerably lower than that of the rest of England and Wales; also, in spite of the increase in age of our population, the death rate has fallen to 10.50. Prevalence of Infectious Disease. During the year there was one case of poliomyelitis notified in the Borough. He made an excellent recovery. Unfortunately one Ilford resident contracted polio elsewhere and died in a South Coast Hospital. For the third year in succession there was no notification of any case of diphtheria. However, we must still remain on the watch for this disease, particularly as in recent months there have been several cases in a nearby borough. There were three outbreaks of what is sometimes known as "winter vomiting." Two of these were in schools. The cause of this disease is not known, but it is assumed to be due to a virus, and usually the disease is quite mild. Its importance is that unless care is taken the cases might be considered to be due to food poisoning contracted from school meals. In the cases mentioned many of the children had had no school meals and no causative organism was ever discovered. More detailed information is presented in the body of the Report. The March of Measles. The last winter has been notable because one of the largest measles epidemics was prevalent, not only in Ilford. but throughout the country. In six months in Ilford 3,421 cases of measles were notified. For various reasons, such as neglect of some doctors to notify the condition, and perhaps of more import, the fact that in many cases a doctor was not called in, the true incidence of the epidemic is unknown. Head Teachers are requested to notify the Department of any known cases of measles amongst their pupils, but this source of information is quite unreliable. A hint of the extent of the epidemic may be given when it is stated that in our three Day Nurseries 61 cases of measles occurred during these months, of which 26, i.e., 42% were notified In the school age group an even smaller percentage would be notified, as the older children are less likely to be seen by the doctor. However, if the assumption that 42% of all cases are notified is correct for the whole age range, this would mean that during the six months there were 8,550 cases of measles. There are approximately 25,000 children under the age of 10 in the town—measles 8 is of course very rare above that age—so a very rough calculation would mean that about one-third of all children from birth to 10 years had measles during the last winter. Welfare of the Aged. This topic must take a foremost place in the work of every Health Department and there need be no excuse for mentioning it again in this year's preface. Here I would like to draw attention to the excellent work of the Housing Committee in providing accommodation for old people. Accommodation for approximately 86 single old people and 44 married couples has already been provided and a new venture is at present under construction— Stoneleigh Court—where accommodation is to be provided for a further group of old people, who, in addition, suffer from some physical handicap. The Public Health Department will be made responsible for selecting the people to occupy these flats and it is hoped that by the time this Annual Report is published, the selection will have been completed. In this connection I would also like to mention the venture at present being considered for the employment of the aged, where the initiative belonged to Toc H. Many people have complained of the division of the National Health Service into three parts—hospitals, general practitioners and local authorities—each of which is concerned with the welfare of old people and often working independently of each other. There is actually, of course, a fourth part, the voluntary services. We are fortunate in this town in having a Committee run by a section of the fourth part, the Ilford Social Service Association, which concerns itself with the welfare of the aged. On this Committee, are Mrs. East of the I.S.S.A. (as Secretary), representatives of the Borough Council, Ilford and Barking Group Hospital Management Committee, National Assistance Board, local general practitioners, Essex Welfare Committee, voluntary societies, the old people themselves, and myself as Chairman. This Committee has met regularly for some years, and is doing excellent work. It has one main defect, however; there is no representative on it of any hospital that caters mainly for the aged and chronic sick, for the simple reason that these hospitals are not in Ilford and do not really feel that we are part of their catchment area. The 22 beds for women under the control of the Ilford and Barking Group Hospital Management Committee are of course quite inadequate for the local demand I have heard the Minister of Health state that it was often said that the strange thing about the National Health Service is that while theoretically it should not work, nevertheless, in practice it does. May I suggest here that the reason why it does work is that local people, who know local needs, and feel strongly on the matter, join together to patch up its defects, by arrangements that do not appear in the National Health Service Act, 1946. Examples of this are the many services that are subsidised by the Metropolitan Boroughs, for instance Chiropody Services, employment of welfare workers for the aged and sheltered employment for them. This Ilford Committee that I have mentioned is but another example. Health Visitors. After some troubled years, the Health Visiting section now appears to be settling down, with numbers more adequate and personnel more contented. We have tried to increase their possibilities of co-operation with other medical and social workers in the town and have had our second annual meeting between the health visitors and the general practitioners, which was as successful as the first. A great disadvantage of this type of meeting with the doctors, however, is that we repeatedly meet the more interested members of the medical profession at such "get-togethers," but never seem to see a large number who do not feel the need for such co-operation, 9 The health visitors now visit the Ilford Maternity Hospital regularly, to see cases from their own districts before they are discharged. This arrangement is being made easy by the co-operation of a far-sighted Matron. For some years I have been trying to make it possible for our health visitors to visit the Children's ward and Out-patient Department of King George Hospital, not only to maintain contact with children from their district who may be under treatment, but also to bring social information to the hospital staff and take medical information, if necessary, to the family doctor. This project has so far met with no success. When the health visiting staff was very depleted, we were compelled to cease the relaxation exercises for expectant mothers. I am glad to be able to state that these have been re-started at the Mayesbrook and Manford Way Clinics. Mental Health. It may be considered strange that such a heading should appear in the Annual Report of the Medical Officer of Health of a Municipal Borough, as officially Mental Health lies entirely within the province of the Local Health Authority and is not in any way delegated, and institutional and specialist treatment is conducted by the Regional Hospital Board. However, it is inescapable for Ilford, as for almost any other Local Authority, or Health Sub-Area, to enter into this field in its preventive aspects. For some years, of course, the Child Guidance Clinic has been functioning under the aegis of the Ilford Committee for Education, but many people are now beginning to think that the time for prevention is before mothers and children have to be referred to this Clinic. It is the Health Visitor and the Infant Welfare Centre that are much concerned with this early aspect. Every attempt is now being made locally to interest our doctors and health visitors in this topic. It is of course quite impossible to insist that any individual should have an interest in the prevention of mental disease. It is only possible to encourage it. One of the school medical officers, Dr. Pooley, has accordingly attended the Annual Conference of the National Association for Mental Health held during March, 1955, and in the autumn the Central Council for Health Education are giving for us in Ilford a two-day course on "Human Relations" at which our doctors, health visitors and sanitary inspectors will attend. In addition to this, co-operation between the Public Health staff and the staff of the Child Guidance Clinic is being made more intimate, case conferences are being held, and it is hoped to have periods when principles may be discussed. While mentioning this course to be given by the Central Council for Health Education, I would also like to mention another two-day course which they gave us on Health Education earlier in the year, and which health visitors and sanitary inspectors attended. It proved a most excellent and stimulating series of discussions. Health and Home Safety Week. In April, 1955, a Health and Home Safety Week was held in the town, run by the Ilford Borough Council, the Essex County Council and the Women's Voluntary Services. A more complete description will be found elsewhere in the Report, but without a doubt the various aspects provided a most instructive, and often entertaining, episode for those who managed to take part or attend. I think, for example, that those who listened to Dr. Grantly Dick Read's talk on "Childbirth without Fear," and saw his extraordinary film at the Little Theatre, received an impression which they will not easily forget. I would like to thank everybody who took part, and Messrs. Harrison Gibson for the loan of their premises for the Exhibition. 10 New Ventures. (a) B.C.G. Vaccination of school children commenced in 1954. It was offered to those between their 13th and 14th birthdays. Just under half accepted. It is interesting to note that according to the tuberculin test, 17%—19% of Ilford children were tuberculin positive, i.e., had been exposed to tuberculosis before they were tested. (b) Cerebral Palsy Unit. After many years of negotiations a Cerebral Palsy Unit has been opened in the summer term of 1955 in the premises of what was once Stevens Road Day Nursery. At the moment there is only a nucleus of 9 children who have been transferred from the Open Air School, but in the autumn term of 1955, it is hoped that the school will be functioning at its full capacity with its complete staff. It will of course take children from the surrounding districts as well as Ilford. (c) Foot Survey. One of the school medical officers, Dr. O'Connor, has commenced a survey of the feet of all school children aged 9 years. This experiment has just started and it is impossible to give any indication of the final results at the moment. It is aimed, not only at finding early stages of foot defects, such as hammer toes, bunions and flat feet, but also to investigate the incidence of inadequate footwear. Publications. Four papers have been published by members of the staff in the pas! year, also the report on the working of the Enuresis Clinic has been mentioned in a publication of the Ministry of Education, entitled " Health of the School Child," and we have had a number of enquiries as a result. Marriages. It will be noted that statistics no longer appear with respect to the number of marriages solemnised within the Borough; this is because the Registrar General has decided not to supply us with this information any more. These figures have some Public Health value, in that an indication is given as to the possible future requirements of the Maternity and Child Welfare Services, although this must not be exaggerated. Nevertheless it is very annoying that a community can be told from a central source that it will not be given in future certain social data of some importance. This kind of thing will happen as long as the office of the Local Registrar of Births, Deaths and Marriages does not come under the supervision of the Local Authority. Reports of Specialists and other officers will be found in the body of the report. I wish once more to thank those who have helped me during the past year, my staff who, as always, have given first-class service, and I wish to acknowledge the full co-operation of the Chief Officers and their staffs in other Departments; the Ilford Federation of Women Voluntary Welfare Workers, the Ilford Social Service Association and the Women's Voluntary Services have all helped us greatly and their continued co-operation is much appreciated. I would like to express my thanks to the Members of the Council, especially to the Chairmen, Vice-Chairmen and Members of the Committees and Sub-Committees of the Ilford Borough Council and Essex County Council with whom I work. I have the honour to be Your obedient servant, I. GORDON, Medical Officer of Health. 11 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in Acres) Land and Inland Water 8,4251 8,432 Tidal Water 7 Population (Census 1921) 85,194 „ (Census 1931) 131,061 „ (Census 1951) 184,706 Registrar-General's Estimate of resident Population: — June 30th 1951 181,600 „ 1952 182,200 „ „ 1953 181,200 „ „ 1954 182,700 Number of inhabited houses (April 1st, 1954) according to Rate Books (approx.) 51,554 Rateable Value—April 1st, 1954 (Houses and Land) £1,692,244 Sum represented by a penny rate, April 1st, 1954 (approx.) £6,900 Education Rate— 1953-54 9s. 0.60d in the £ 1954-55 9s. 7.3d. in the £ (E.C.C.) Combined Rate (all services) 23s. 4d. in the £ 23s. 4d. in the £ The following figures as to unemployment were supplied by the Ministry of Labour: — Males Females As at January, 1954 606 205 As at January, 1955 401 113 Live Births— 1954 1953 Total M. F. Birth rate per 1,000 population. Legitimate 2,145 1,099 1,046} Crude Rate 12.00 12.31 Illegitimate 48 26 22 J Adjusted rate 11.64 11.94 Rate per 1,000 total (live and still) births Stillbirths 56 28 28 24-89 26-61 Death rate per 1,000 population. Deaths 1,864 963 901 Crude rate 10.20 10.71 Adjusted rate 10.50 11.03 Percentage of total deaths occurring in public institutions 41.88 41.05 Maternal mortality (heading 30 of the Registrar-General's Short List): — No. of Deaths. Rate per 1,000 total (live and still) births. 1954 1953 1954 1953 Pregnancy, childbirth and abortion 1 0 0-4A 0 Death-rate of Infants under one year of age: — All infants per 1,000 live births 18.69 20.17 Legitimate infants per 1.000 legitimate live births ... 18.64 19.87 Illegitimate infants per 1.000 illegitimate live births 20.83 29.85 Deaths from Cancer (all ages) 354 354 „ „ Measles (all ages) - — „ „ Whooping Cough (all ages) - 1 „ „ Diarrhœa (under 2 years of age) 1 1 12 1. Rainfall. Total rainfall registered in the district during the year was 23 25 inches; the greatest fall in 24 hours was registered on 8th December, -76 of an inch. November was the wettest month. 2. Registrar General's Memorandum on Transfer of Births. Deaths and Stillbirths, dated 17th October, 1952. The Registrar General supplies each town with figures known as the "comparability factor" in connection with the birth and death rates. To make an approximate allowance for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole, the crude birth and death rates for the area are multiplied by the appropriate area comparability factor. The figures for llford are .97 for the birth rate and 1.03 for the death rate, and these are used in calculating these rates in Table la. When local crude birth and death rates have been so adjusted, they are comparable with the crude rate for England and Wales or with the corresponding adjusted rate for any other area. 3 Births. The number of births registered during the year was 2,193. Males Females Legitimate 1,099 1,046 Illegitimate 26 22 i.e., 2 2 per cent. of the births registered were illegitimate. The percentage of illegitimate births registered in the previous 10 years was 3.0 (1953); 3.9, 2.9, 3.1, 2.4, 3.2, 3.3, 3.1, 5.5, 4.2. The adjusted birth-rate, calculated on the estimated population of 182,700 is 11-64 per 1,000. 4. Deaths. The total number of deaths of Ilford residents was 1,864. This is obtained by taking the total number of deaths registered in the district (1,552), subtracting the deaths of non-residents occurring in the district (164), and adding the deaths of llford residents registered as having died in other districts (476). The number of deaths of non-residents registered in the district was as follows: — King George Hospital 93 llford Isolation Hospital and Sanatorium 35 Other Non-residents 36 Total 164 13 The number of deaths of Ilford residents registered as having died in other districts during the year was as follows, and includes deaths at the following Institutions: — Oldchurch Hospital, Romford 75 St. Margaret's Hospital, Epping 8 Wanstead Hospital 39 Langthorne Hospital 35 London Hospital and Brentwood Annexe 75 St. Bartholomew's Hospital 7 Rush Green Hospital 23 Plaistow Hospital 5 St. Joseph's Hospice, Hackney 9 Queen Mary's Hospital, Stratford 6 East Ham Memorial Hospital 4 Harold Wood Hospital 5 Whipps Cross Hospital 33 St. Thomas Hospital 4 London Chest Hospital 2 In other Hospitals, Institutions and residences outside the Ilford district 146 Total 476 The adjusted death rate, calculated on the estimated population of 182,700 is 10-50 per 1,000. Inquests.—During the year. 61 inquests were held on deaths occurring in Ilford. 47 on Ilford residents, and 14 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 2 — 1 1 2 9 22 24 Death Rates from Tuberculosis and Cancer, 1954 The following Table shows the death-rates for 1954 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 .142 .160 Other Tuberculosis .005 .019 Cancer of lung and bronchus .405 .369 Cancer, other forms 1.532 1.656 5. Tables of Vital Statistics.—Table I gives a comparative statement of the birth-rate and death-rate for the past five years. Table 1a gives a comparison of the vital statistics of Ilford with England and Wales, and other towns. Table II gives a classified statement of the causes of death in 1954, arranged according to the age groups at which deaths occurred. 14 TABLE I.—Vital Statistics of Whole District During 1954 and Previous Years Year Resident 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 (a) of Non-Residents registered in the District of Residents not registered in the District Under 1 year of Age At all Ages Number Rate Number Rate (ft) Number Rate per 1,000 Net Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1950 186,200 1,933 2,403 13.2 1,707 9.2 455 511 45 187 1,763 9.7 1951 181,600 1,677 2,376 13.3 1,789 9.9 483 529 50 21.0 1,835 10.3 1952 182,200 1,830 2,323 13.0 1,728 9.4 431 512 44 18.9 1,809 10.1 1953 181,200 1,689 2,231 12.3(c) 1,688 9.3 172 426 45 20.1 1,942 10.7(c) 1954 182,700 1.580 2,193 12.0(c) 1,552 8.5 164 476 41 18.7 1,864 10.2(c) (a) 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. (b) Calculated on the estimated resident population. (c) Crude rate. 15 TABLE Ia Table showing comparison between the Birth-rate, Death-rate, etc., of Ilford, other Towns, and of England and Wales for the Year 1954 (Provisional figures) Rate per 1,000 Population Rate per 1,000 Total (Live and Still) Births Rate per 1,000 Population Rate per 1,000 Related Live Births Death rate per million Population Rate per 1,000 Live Births Whooping Cough Diphtheria Influenza Acute Poliomyelitis Pneumonia Enteritis and Diarrhoea (under 2 years) Live Births Stillbirths Deaths (all ages) Deaths under 1 year England and Wales 15.2 23.4 11.3 25.5 2.7 0.2 47 2.7 482 .8 Great Towns 16.8 25.6 12.0 29.1 3.5 0.3 41 3.2 502 .9 Smaller Towns 15.4 22.3 11.3 23.8 3.0 0.2 47 4.5 493 .5 ILFORD (Estimated Population mid-1954= 182,700) 11.6 24.9 10.5 18.7 — — 44 5.5 421' .4 A dash (—) signifies that there were no deaths. 8 deaths. *1 death. '*77 deaths. 16 Registrar-General's Short List of Deaths and Causes TABLE II Causes of, and Ages at, Death during the year 1954 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 1864 41 3 6 8 4 20 55 173 316 482 756 1 Tuberculosis, respiratory 26 - - - - - 2 5 5 7 6 1 2 Tuberculosis, other 1 - - - - - - - 1 - - - 3 Syphilitic disease 8 - - - - - - - 2 2 1 3 4 Diphtheria - - - - - - - - - - - - 5 Whooping cough - - - - - - - - - - - - 6 Meningococcal infections - - - - - - - - - - - - 7 Acute poliomyelitis 1 - - - 1 - - - - - - - 8 Measles - - - - - - - - - - - - 9 Other infective and parasitic diseases 4 1 - - - - 1 - - - - 2 10 Malignant neoplasm, stomach 49 - - - - - - - 3 15 17 14 11 Malignant neoplasm, lung, bronchus 74 - - - - - - 1 19 22 19 13 12 Malignant neoplasm, breast 37 - - - - - 1 1 6 11 11 7 13 Malignant neoplasm, uterus 12 - - - - - - - 1 5 2 4 14 Other malignant and phatic neoplasms 182 - - 1 - 1 2 15 19 47 37 60 15 Leukaemia, aleukaemia 8 — — — 1 - 1 - - 3 2 1 16 Diabetes 8 — 1 - - - - - 1 — 1 5 17 Vascular lesions of nervous system 216 - - - - - 2 2 20 28 69 95 18 Coronary disease, angina 303 - - - - - - 7 33 68 97 98 19 Hypertension with heart disease 30 - - - - - - - - 2 8 20 20 Other heart disease 307 - - - 1 - 1 3 12 20 64 206 21 Other circulatory disease 98 - - - - - - - 7 6 33 52 22 Influenza 8 — — — 1 - — — 1 1 3 2 23 Pneumonia 77 6 2 — — — 1 — 3 14 15 36 24 Bronchitis 98 1 - - - - - - 4 20 32 41 25 Other diseases of respiratory system 19 - - - 1 - - 3 3 3 7 2 26 Ulcer of stomach and duodenum 24 - - - - - - 1 1 6 10 6 27 Gastritis, enteritis and diarrhoea 5 1 - - - - - - - 1 1 2 28 Nephritis and nephrosis 22 - - - - - - - 3 3 6 10 29 Hyperplasia of prostate 15 - - - - - - - - 2 2 11 30 Pregnancy, childbirth, abortion 1 - - - - - 1 - - - - - 31 Congenital malformations 14 8 — 1 — — — 3 — 1 — 1 32 Other defined and ill-defined diseases 154 23 - 4 2 2 4 10 12 21 25 51 33 Motor vehicle accidents 15 - — — 1 - - 1 2 3 4 4 34 All other accidents 23 - - - - 1 1 - 6 2 5 8 35 Suicide 24 - - - - - 3 3 9 3 5 1 36 Homicide and operations of war 1 1 - - - - - - - - - - Special Causes (included 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 1954 will be found in Part III Services section. (iii) Laboratory Facilities.—Pathological specimens are now sent to the Bacteriological Laboratory, Oldchurch Hospital, Romford, for examination. (iv) Byelaws exist for: — Prevention of Nuisances. Cleansing of footways and pavements, and cleansing of earth closets, privies, ashpits and cesspools. Dealing with common lodging houses and houses let in lodgings. Houses let in lodgings or occupied by members of more than one family. (Sec. 84, Ilford Act, 1937.) Slaughterhouses and humane slaughtering of animals. Pleasure Fairs. (Sec. 59, Essex C.C. Act, 1952). Tipping of Dust, Spoil and Refuse. (Sec. 85, Ilford Act, 1937.) 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. (Sec. 53, Ilford Improvement Act, 1898.) Nuisances in connection with the removal of offensive or noxious matter. Depositing of Rubbish, etc. (Sec. 249, Local Government Act., 1933.) Establishments for Massage and Special Treatment. (Essex C.C. Act, 1933, Part IV.) Inspections of licensed establishments are carried out quarterly. During 1954 twenty-nine applications for renewal of licences were received. The Council renewed the licences in respect of these establishments. Three new applications were received, which were granted. The licences expire on 31st March of each year. Hairdressers' and Barbers' Premises. (Essex C.C. Act 1933, Part VI). During 1954, 61 visits of inspection were made by the Sanitary Inspectors to these premises. Camping Grounds and Moveable Dwellings. (Essex C.C. Act 1933, Part IX.) (v) 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. (vi) Essex County Council Act. 1952. This Act came into operation in 1953. Reference is made in this Report in appropriate sections as to action taken under the Act, 18 (vii) 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. 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 Deputy are authorised under Part 2, Section 9 (2) to enter and inspect any such licensed premises in the Borough. No application for a licence was received during 1954. (viii) National Assistance Act, 1948.—The County Welfare Officer has kindly supplied me with the following information. "The County Welfare Committee is responsible to the County Council for functions under Part III of the National Assistance Act, 1948, the main aspects being: — (a) the provision of residential and temporary accommodation, and (b) welfare arrangements for blind and other handicapped persons. The following statistics show the extent to which the main services provided by the County Welfare Committee under the National Assistance Act, 1948. have been afforded to persons residing within the Borough of Ilford during the year 1954: — (1) Residential and Temporary Accommodation. (a) Aged persons admitted to hostels and other residential establishments:—33. (b) Other classes (admitted to temporary accommodation):— Adults 5, Children 8.—13. (2) Blind Persons. The numbers of registered blind, partially sighted and defective sighted persons resident in the Borough as at 31st December, 1954, were as follows: — (i) Registered as blind 283 (ii) Partially sighted 46 (iii) Defective sighted 17 all of whom were under the supervision of the County Council's Home Teachers. During the year four blind persons participated in the Home Workers' Scheme operated through the agency of the Royal London Society for the Blind, and one was employed in the Workshops for the Blind. In addition, 28 blind and 9 partially sighted persons were employed in open industry. During 1954 three blind persons from the Borough were admitted to homes for the blind. The County Council's Schemes for welfare services for other handicapped persons, including the deaf and dumb and hard of hearing, are now operating with the co-operation of voluntary organisations specialising in this field of work although, at this early stage, it is not possible to provide detailed statistical information. In Ilford the scheme for other handicapped persons has been delegated to a Sub-Committee of the Ilford Social Service Association, of which the Medical Officer of Health is a member. 19 National Assistance Act, 1948. (a) Section 47. Two persons were dealt with under this section during the year, both females, aged 80 and 83 years. They were unable to devote to themselves or receive proper care and attention and were living in insanitary conditions. Both were removed to hospital. (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. The burial of five persons was dealt with during the year. They were: — (1) A male, 79 years, lived in lodgings. (2) A newly-born female child (murdered) found in a telephone kiosk. (3) A male, 85 years, patient in a nursing home. (4) A male, 46 years, lived in lodgings with a brother. (5) A male, 76 years, collapsed in a public convenience. Miss M. J. Copping, the Welfare Officer for Old People, reports as follows: — "During 1954, 227 new cases were dealt with. Visits paid numbered 680, and in addition many interviews were given to relatives and a large number of telephone calls and much correspondence was involved. Cases were referred by Doctors, Hospital Almoners, National Assistance Board Officers, other social agencies, relatives and neighbours. Occasionally the initial step was taken by the old person concerned, but this was rare. Many were in difficulties which could have been anticipated and almost certainly prevented had they been known of earlier. Of the cases referred approximately 90% were chronic sick or mentally confused persons for whom no hospital beds were available, and who were either inadequately cared for in their homes, or who were well cared for by relatives who ultimately broke down under the strain. Cases referred by Almoners were usually old persons being discharged home after an acute illness, operation or accident; or out-patients whose symptoms were thought to be due to their social environment. Domiciliary services were arranged for most of those persons. During the year 51 of the cases dealt with were admitted to Hospital; of these 23 died. Seven of the cases concerned were admitted to Essex County Council Part 3 accommodation and twelve to Private Homes for the aged or to Nursing Homes. Visits were paid to 43 persons who ultimately died in their own homes. The average wait for admission to Essex County Council accommodation was 1 year. Many applicants deteriorated to such an extent during the waiting period that they had to be re-classified as chronic sick before a vacancy occurred. As much of the deterioration appeared to be due to damp rooms, awkward staircases, inadequate cooking facilities, etc., earlier admission would undoubtedly have prevented much of it. Shortage of chronic sick beds was by far the gravest problem, and in many cases the life of a whole family including young children, was disorganised or a daughter's valuable services lost to the community when she gave up a post because a chronic sick person had to be nursed at home. Some of the saddest cases were related to the general nursing shortage. Younger persons, desperate for accommodation purchased property with old persons in residence as protected tenants. Problems inevitably arose. Other old folk own large houses which they can no longer maintain in a reasonable state of repair and decoration. In many of these cases an Old Age Pensioner's Flat would solve the problem. A great deal of my work now involves the selection of old people for the new flats at Stoneleigh Court." The laundry service for cleansing of soiled bed linen and personal clothing continued to operate throughout the year, proving of invaluable assistance in the care of very difficult cases. During the year 37 persons were assisted and 3,570 articles were laundered. 20 (ix) Hospitals, Etc. Isolation Hospital.—188 beds are provided Maternity Hospital.—51 beds for the reception of maternity cases are maintained at the Ilford Maternity Hospital. King George Hospital.—The following is a return in respect of bed accommodation: — Total number of Beds at 31st December 1954 Pay Beds 14 Amenity Beds 7 Other Patients Children Medical Surgical Male Female Male Female 211 21 26 18 55 55 36 The above three hospitals are included in the Ilford and Barking Group. (Group 12 N.E. Metropolitan Regional Hospital Board). Mental Hospitals.—There are two large Mental Hospitals in the district, the Goodmayes Hospital, with 97 Resident Staff and 1,353 patients (males 621, females 732), and Claybury Hospital, with 191 Resident Staff and 2,293 patients (males 1,010, females 1,283) in residence on 30th June, 1954. (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 94 beds in the Hospital and on 30th June, 1954, there were 41 Resident staff and 35 patients. Maternity and Nursing Homes.—There are 3 private registered Nursing Homes in the distrirt for medical and senile cases. All Nursing Homes in the district are visited by the Medical Officer of Health and the Chief Sanitary Inspector (or their deputies) quarterly and at other times when necessary. (x) Ambulance Facilities: County Ambulance Service. A Central Ambulance Control has now been established by the Essex County Council at Ilford to deal with all requests for Ambulance transport arising in the whole of the Metropolitan area of Essex. The Control is manned continuously, is in direct contact with all other Ambulance Stations in the Metropolitan area of the County and with the Divisional Control at Chelmsford. In cases of emergency it is only necessary to dial 999. All other requests for ambulance transport should be made, preferably in writing, to the Controller, Ilford Ambulance Control, High Road, Ilford, or in cases of urgency by telephone (Ilford 3311). Requests for Ambulance transport, other than emergency requests, are only accepted from Doctors. Midwives, Duly Authorised Officers and the medical staff of hospitals. If any difficulty should arise in obtaining an Ambulance a call may be made direct to the Controller, Ilford Ambulance Control, Ilford 3311, or to the County Medical Officer of Health, County Hall, Chelmsford. Chelmsford 3231. 21 (xi) Clinics and Treatment Centres: Maternity and Child Welfare.—Infant Welfare Centres are held at the following premises: — Parish 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. Manford Way Clinic, Hainault (for residents of the Ilford portion of L.C.C. estate) 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 east side of Cranbrook Road) Wednesday, 2 p.m. Cecil Hail, Granville Road, Ilford (for residents of the west 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. Parish Hall, Mossford Green, Barkingside (for residents of Fairlop area) Friday, 2 p.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 Manford Way Clinic, Hainault, every Wednesday morning and on Friday mornings as and when required. Midwives Ante-Natal Clinics are held at the Public Health Offices, each Monday afternoon; at Mayesbrook Clinic on alternate Wednesday afternoons; at Manford Way Clinic on alternate Thursday afternoons. 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 Manford Way Clinic, Hainault, on the first Friday morning of each month. 22 School and other Clinics.—Clinic sessions are held at Health Services Clinics as under: — (i) Public Health Offices, Valentines Mansion for— Diphtheria and Whooping Cough Immunization. Aural. Ophthalmic treatment. Paediatric. Infant Welfare. Midwives Ante-Natal. Enuresis. (ii) Newbury Hall, Perryman's Farm Road, for— Minor Ailments. Orthopaedic and Remedial Exercises treatment. Rheumatism. Artificial Sunlight treatment. Infant Welfare. Cardiac Clinic. B.C.G. Vaccination. (iii) Mayesbrook Clinic, Goodmayes Lane, for— Minor Ailments. Dental (Children and Expectant Mothers). Ophthalmic treatment. Artificial Sunlight treatment. Ante-Natal and Post-Natal. Ante-Natal Relaxation Exercises. Diphtheria and Whooping Cough Immunization. Orthopaedic and Remedial Exercises treatment. Infant Welfare. Speech Therapy. Midwives Ante-Natal. Orthoptic. B.C.G. Vaccination. (iv) Valentines School, Beehive Lane, for— Dental (Children). Speech Therapy. (v) Loxford Hall, Loxford Lane, for— Child Guidance Clinic. (vi) Manford Way Clinic, Hainault, for— Ante-Natal and Post-Natal. Ante-Natal Relaxation Exercises Infant Welfare. Diphtheria and Whooping Cough Immunization. Midwives Ante-Natal. Dental (Children only). Ophthalmic treatment. Orthopaedic treatment. (xii) Chest Clinic.—A clinic for the diagnosis and treatment 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 4 p.m. For Children—Wednesday, 10 to 12 noon. A Refill Clinic is held on Monday morning, Tuesday afternoon and Thursday afternoon. 23 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. The Chief Sanitary Inspector reports as follows: — Housing Repairs and Rents Act, 1954. This Act came into operation on 30th August, 1954. Part I contains provisions for clearance and re-development, reconditioning of unfit houses, and other amendments of Housing Acts. Part II provides for repairs increase of controlled dwelling-houses and other amendments of the Rent Acts, etc. Part III contains miscellaneous and general provisions. Part 1.—In accordance with Section 1 of the Act, the Council was required to submit to the Minister of Housing and Local Government proposals for dealing, under Parts 11 and III of the Housing Act, 1936, with houses in the Borough which appeared to the Council to be unfit for human habitation, and with any other houses which are, or ought to be, included in clearance areas. A survey of the Borough was carried out in order that the Council could formulate its proposals to comply with the Act. 291 houses were found to be unfit for human habitation within the meaning of Section 9 of the Housing Repairs and Rents Act, 1954, and suitable for action under Sections 11 or 25 of the Housing Act, 1936. The Council proposed to the Minister that these houses should be demolished within the next five years, and this proposal was approved. Of these, three small areas suitable for clearance procedure have been inspected in detail and will form the subject of a report and representation to the Council in the near future. 32 of the houses are already included in the Ilford Lane Clearance Area. Part //.—This part of the Act provides for certain increases, termed repairs increases, in rents of dwelling-houses which are let under controlled tenancies or are occupied by statutory tenants, and the landlord is responsible, wholly or in part, for the repair of the dwelling-house, where— (i) the dwelling-house is in good repair; and (ii) that it is reasonably suitable for occupation having regard to the stability, freedom from dampness, natural lighting, ventilation, water supply, drainage and sanitary conveniences, and the facilities for storage, preparation and cooking of food and for the disposal of waste water. If the conditions justifying an increase of rent are fulfilled and the landlord has served a notice in the statutory form on the tenant requiring the payment of the permitted increase of rent and furnishing details as to the value of the repairs carried out on the dwelling-house during the specified period, the tenant may, if he disputes the right to the increase on the grounds that the house has not been made to satisfy conditions (i) and (ii) aforementioned, apply to the Local Authority for a Certificate of Disrepair which shall stipulate that either or both of the conditions justifying an increase in rent have not been fulfilled. When these items have been made good to the satisfaction of the Local Authority, the Certificate of Disrepair is revoked on the application of the landlord. During 1954, 53 applications for Certificates of Disrepair were made. 47 were granted, of which 8 were subsequently revoked. In 6 instances the applications were refused. Air Pollution. It is with great satisfaction that the serious jjrit nuisance which was reported on last year has now been abated and little objection can now be taken on the operation of the particular plant concerned. This can be 24 used as an illustration of the usefulness of voluntary co-operation between the Council and its officers, e.g., Sanitary Inspectors and the Industrialists together with the able assistance of officers from the recently disbanded London Regional Fuel Advisory Office. During the year the Committee on Air Pollution under the Chairmanship of Sir Hugh Beaver, M.Inst.C.E.. M.I.Chem.E., made its Report. The main recommendations of the Committee consist of: — 1. The emission of dark smoke from any chimney should be made illegal. 2. Pulverised fuel plants burning 10 tons or more per hour should be fitted with efficient grit and dust arresting appliances and the owner or occupiers of premises containing such plant ought to measure grit emission and inform Local Authority of the results on request. In the case of other solid fuel burning plants, all reasonable practicable steps should be taken to prevent emission of grit and dust. 3. Certain industrial processes in which the prevention of dark smoke, grit and dust emission presents a special technical difficulty, the supervision should be vested in the Alkali Works Act Inspectors. (This is another method of removing some of the duties from the purview of local authorities.) 4. Certain Private Act powers to regulate design of new industrial furnaces should be made of general application. (See Section 95 Essex County Council Act, 1952). 5. Legislation relating to emission of smoke from railways and pollution from spoilbanks should be brought up to date and control of these vested in Local Autho ities. 6. That the appropriate Ministers have power to approve by Confirmed Orders schemes submitted by Local Authorities to create (1) smokeless zones prohibiting entirely the emission of smoke from any chimney; (2) smoke control areas in which the use of bituminous coal for domestic purposes would be restricted. 7. To empower the Treasury and Local Authorities to financially assist house owners to convert appliances in these two special areas. 8. Approved appliances only should be used for domestic heating. 9. Recommends the removal of the existing purchase tax on electric room and water heaters. 10. Responsibility for the enforcement of legislation controlling smoke and grit emission should vest in Local Authorities, subject to the provision relating to special industrial processes as indicated in note 3 above. 11. Reports on smoke abatement progress by Local Authorities to be submitted to Minister annually. 12. Penalties for smoke offences ought to be increased. It may be that the Government will implement these recommendations by legislation in the near future. Recruitment, Training and Qualification of Sanitary Inspectors. As a result of the Report by the Working Party on this aspect of Public Health work, the Council decided to implement the recommendation for training of sanitary inspectors not by means of a paid pupillage system but by offering clerkships in the Sanitary Section of the Public Health Department to suitable candidates. Full facilities were to be afforded these prospective inspectors to attend preliminary training in building construction, office routine and practical and theoretical training in the practice of sanitation in its broadest aspects. This system does not entail a contract of service containing a term that the successful student remains with the Borough Council should he be successful. As a result of this policy two members of the staff are pursuing a course of studies with a view of securing the statutory qualification as a Sanitary Inspector." 25 (i) Water Supply.—The district is served by the Metropolitan Water Board and 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 Lee which, after passing through the storage reservoirs at Walthamstow, is filtered and chlorinated at Lee Bridge works and Ferry Lane works and then pumped into supply. An additional amount of water is supplied to this area from Wanstead Well. Contact tanks are now in operation at these works in which the dose of chlorine is able to exert its full effect before the water passes into the distribution system. Samples of the water in all stages of purification are analysed daily at the laboratories of the Water Board. Dr. E. Windle Taylor, Director of Water Examination of the Board has kindly supplied me with the information that 1,444 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 to confirm that the quality of the water is up to that normally supplied. The water is not plurnbo-solvent. The length of mains laid by the Metropolitan Water Board in Ilford during 1954 was 129 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, and were invariably satisfactory. Mains were extended by the Company as follows: — 20 yards of 12 inch, 526 yards of 6-inch, 588 yards of 4-inch and 92 yards of 3-inch. There are now no public wells in existence. There are a few private wells for domestic and commercial purposes. 3 samples of piped water supply (2 South Essex Waterworks Co. and 1 Metropolitan Water Board) were taken for Chemical and Bacteriological examination, and all gave satisfactory analyses. (ii) Drainage and Sewerage.—The Borough Engineer has kindly supplied me with the following statement: — Main Drainage—Sewerage Schemes and Ilford Corporation (Drainage) Act. Two sewer contracts which were placed in 1953 were completed during 1954, viz., a 45-inch dia. Storm Relief Sewer in Henley Road and a short experimental length of reconstructed soil sewer in Horns Road. The cost of these two works was approximately £74,000. While these schemes were under construction, the detailed scheme for the Mayes Brook which included the culverting of the stream from Goodmayes Park to the Marks Gate Estate and for the construction of the Balancing Lake in Goodmayes Park, was prepared. A tender for £211,228 5s. 11d. was accepted for this work in August 1954 and construction began in October. The culverting of the Mayes Brook was part of the work authorised by the Drainage Act, the balancing lake being constructed under the 26 Council's general powers under the Public Health Acts. A section of the Mayes Brook is sited within the Borough of Dagenham and the basis of contributions towards the cost of the work were agreed with that Authority. In connection with the Roden Street Pumping Station, quotations were received and accepted by the Council for the supply of the pumps, motors, etc., and for the supply of diesel-alternator, switchgear, valves, rising mains, etc., in March and August respectively. Orders were placed for this equipment amounting to approximately £31,000. Flooding of Streams. No serious flooding of streams occurred during the year. Pollution of Streams. There was no serious instance of pollution of watercourses during the year. As from 1st October, 1952, the functions relating to the prevention of river pollution were transferred, under the provisions of the River Boards Act, 1948, to the Essex River Board, (iii) Collection and Disposal of Refuse.—The Borough Engineer also kindly supplied the following information:— Tons Total amount of refuse collected and disposed of 52,535 Collection of Salvage:— Tons Income Wastepaper 1,101 £8,756 Rags, etc. 12¾ £481 (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 35,169 Houses and premises reinspected (work in progress) 22,801 Visits during disinfection 593 Houses in which nuisances were detected 1,363 Houses in which nuisances were abated 1,328* Premises disinfected 422 Premises from which articles only disinfected 177 Articles disinfected 1,164 Premises disinfested for verminous conditions 37 *Includes 217 nuisances detected before 1st January, 1954. Notices served:— Served Complied with Statutory:— Public Health Act, 1936 89 46 Housing Act, 1936 2 1 Factories Act, 1937 — — Shops Act, 1950 2 1 Provide Dustbin (Ilford Urban District Council Act, 1904) 52 44 Food and Drugs Act, 1938 14 10 Cleanse Water Storage Cistern (Byelaws) — — Cover Water Storage Cistern (Byelaws) — — Informal 1,492 1,218 1,651 1,320 In addition to the above, 307 notices (51 statutory and 256 informal) served previous to 1st January, 1954, were also complied with. Complaints.—During the year 3,696 complaints of nuisances were received and investigated. 27 The following is a summary:— Accumulation of manure and refuse 53 Animals improperly kept 19 Bad smells 50 Dampness of premises 99 Defective drains, w.c.'s and fittings 410 Defective roofs, gutters, downpipes, etc. 100 Defective water fittings 78 Dirty and verminous houses 29 Dirty condition of rearway 4 flooding of premises 6 Overcrowding 87 Smoke nuisances 83 Defective or no provision of dustbin 1,615 Rats and mice 505 Miscellaneous 558 Total 3,696 (v) Shops Act, 1950 (Section 38).—Since this Act came into operation the Sanitary Inspectors have made inspections in accordance with Section 38. During the year 190 inspections were made, 2 Statutory Notices were served, and one was complied with; 3 Preliminary Notices were served, all of which were complied with. In addition, 4 Preliminary Notices served prior to 1954 were complied with. No Certificates of Exemption from the provisions of Section 38 were granted in 1954. (vi) Swimming Baths and Pools.—Samples of water for examination were taken from the open air swimming bath from April to September (6). The samples were satisfactory, but in 3 cases the chlorine content was above, and in 2 cases the chlorine content was below the prescribed standard. Samples were also taken from the two indoor baths during March, April, May, June, July, August, September and November (14); all the samples were satisfactory but in 13 samples (6 from the first and 7 from the second class), the chlorine content was above the prescribed standard. (vii) Eradication of Bed Bugs:— Houses found to be infested 37 „ Disinfested 37 (viii) Slaughter of Animals Acts, 1933 to 1954.—The Slaughter of Animals (Amendment) Act, 1954, came into operation on 1st October, 1954. Its main provisions concern the licensing of premises for the slaughter of animals the making of regulations for securing humane conditions and practices in connection with the slaughter of animals at slaughterhouses and knackers yards, the licensing of slaughtermen and the extension to all animals of the provisions of Section 1 of the 1933 Act which provides that certain animals shall be instantaneously slaughtered or rendered insensible to pain by stunning. Two licences to act as slaughterman were granted during the year. (ix) 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 during 1954. (x) Rag, Flock and Other Filling Materials Act, 1951.—Registration has been granted in respect of 15 premises, where filling materials, as specified in the Act, are used. The occupier of registered premises may only obtain "rag flock" from premises licensed under the Act, either for the manufacture of rag flock or as a rag flock store. One licence was renewed in 1954 in respect of premises used as a rag flock store. 28 (xi) Smoke, etc., Abatement.—Complaints were received of alleged smoke nuisance from 11 factories in the Ilford Lane, Green Lane, Roding Lane, Grove Road and Newbury Park areas. Regular observations were maintained and investigations carried out. In 5 instances no emission was noted which would have enabled action to be taken under the Public Health Act, 1936, but three informal notices were served in the other instances. (xii) Land Charges Act, 1925.—During the year 3,848 enquiries were dealt with under this act. SECTION D—HOUSING. (i) Overcrowding.—No notices were served during 1954. (ii) Clearance Areas.—No areas were declared by the Council to be Clearance Areas, in 1954. (iii) HOUSING STATISTICS. 1. Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,582 (b) Number of inspections made for the purpose 17,849 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 3 (b) Number of inspections made for the purpose 317 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 1,363 2. Remedy of defects during the year without service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,145* 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 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 1* (b) By local authority in default of owners — 29 b. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 141 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 131* (b) By local authority in default of owners 1* c. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses demolished as a result of formal or informal procedure under Section 11 1 (2) Number of dwelling-houses closed in pursuance of an undertaking given by the owners under Section 11 and still in force 1 d. Proceedings under Section 12 of the Housing Act, 1936:— Number of separate tenements in respect of which Closing Orders were made — 4. Housing Act, 1936, Part IV—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 216 (ii) Number of families dwelling therein 314 (iii) Number of persons dwelling therein 810 (b) Number of new cases of overcrowding reported during the year 51 (c) (i) Number of cases of overcrowding relieved during the year 94 (ii) Number of units concerned in such cases 326½ (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 1954 of Notices served prior to 1st January, 1954. HOUSING ACT, 1936. During the year 1954 the work of receiving applications, calling for calculations for the "permitted number" was continued with a view to the issue of housing certificates. 9 certificates, in respect of 20 houses, were issued during the year, making a total of 18,314 certificates, in respect of 25,117 houses, issued to the end of 1954. As new premises were constructed and placed upon the rating lists, "permitted number" certificates were issued as required. 30 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. 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 and Dairies Regulations, 1949, the Milk (Special Designation) (Raw Milk) Regulations, 1949, the Milk (Special Designation) (Pasteurized and Sterilized Milk) Regulations, 1949, the Food and Drugs (Milk, Dairies and Artificial Cream) Act, 1950, and any Regulations which might hereafter be made under the last named Act. The Milk (Special Designations) (Specified Areas) Order, 1951, which came into operation on 1st October, 1951, specified an area, including Ilford. in which the compulsory use of special designations for retail sales of milk shall operate. (i) Milk and Dairies Regulations, 1949 to 1954.—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 ceases to be so used. Persons and premises registered as at 31st December, 1954:— Persons registered as distributors of milk 101 Premises registered as dairy premises (other than dairy farms) 13 201 inspections of dairy premises were carried out during the year. (ii) Milk (Special Designation) (Raw Milk) Regulations, 1949 to 1954:— As from 1st October, 1954. the special designation "Accredited" is no longer permitted to be used. The following licences were granted during 1954:— Tuberculin Tested 40 do. (Supplementary) 9 (iii) Milk (Special Designation) (Pasteurised and Sterilized Milk) Regulations, 1949 to 1953:— The following licences were granted during 1954:— Pasteurized (Dealer's) 66 do. do. (Supplementary) 10 do. (Pasteurizer's) 1 Sterilized (Dealer's) 86 do. do. (Supplementary) 13 do. (Sterilizer's) 1 Two licences, granted by the Essex County Agricultural Executive Committee, in respect of the production of Tuberculin Tested milk at farms in the Borough, are also in operation. The licence previously in force in respect of Accredited milk ceased as from 1st October, 1954. (iv) Sampling.—The following is the routine practice adopted:— Designated Milks (Raw and Heal treated).— These are sampled bi-monthly and after unsatisfactory reports. Biological Tests.—Samples of all raw milks, are submitted for biological test for T.B. quarterly. Repeat samples if positive after clearance by the Divisional Inspector of the Ministry of Agriculture and Fisheries. Milk Supplies to Maintained Schools.—These are sampled monthly and after unsatisfactory results. 81 The following results were obtained:— Grade of Milk Total Satisfactory Unsatisfactory Remarks on unsatisfactory results Tuberculin Tested (Pasteurized) Milk 34 33 1 The sample from milk as supplied by a dairy farm outside the Borough failed to satisfy the Methylene Blue Reduction test. The retailer was communicated with, and further samples proved satisfactory. Tuberculin Tested Milk (Farm bottled) 22 18 4 The samples of milk produced at farms outside the Borough failed to satisfy the Methylene Blue Reduction test. The County Agricultural Executive Committee was communicated with and further samples proved satisfactory Accredited 1 1 - - Pasteurized Milk 95 93 2 One sample failed to satisfy the Methylene Blue Reduction test and the other failed to satisfy the phosphatase test. In both instances the milk came from outside suppliers, who were communicated with and re-sampling ordered at a later date. Further samples proved satisfactory. Sterilized 33 33 - - (v) Biological Tests.—14 samples of milk were submitted to a biological test for tuberculosis, all of which were found negative. (vi) Milk and Dairies Orders, 1926 and 1938: Inspection of Dairy Herds.—One examination was 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. (vii) Legal Proceedings.—11 complaints of the presence of foreign bodies in milk were received and investigated. No legal proceedings were taken, but warnings were sent in two cases and representations were made to the retailers in all other cases. (viii) Registration.—No application for registration was refused during the year. 32 Ice Cream. (i) Registration. Section 158 of the Essex County Council Act, 1933, 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. In 1948, the Council delegated to the Public Health Committee its powers and duties 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. 30 applications for registration in respect of 30 premises were considered during the year 1954. The Council decided to refuse registration, as a manufacturer and vendor, to one applicant on account of the fact that the plant did not comply with the standard requirements of the Council under the Ice Cream (Heat Treatment, Etc.) Regulations. The applicant appeared before the Public Health Committee and gave an undertaking to provide the necessary equipment. This was done and registration was subsequently granted. Registration was also granted to 29 applicants in respect of the sale only of ice cream. (ii) Ice Cream (Heat Treatment Regulations) 1947 to 1952. The Ice Cream (Heat Treatment, Etc.) Amendment Regulations, 1951 appointed the 1st March. 1951, as the date from which local authorities may require the use of thermometers to indicate and record temperatures to which ice cream mixture is subjected in the manufacture of ice cream. The Council decided, in accordance with the recommendations of the Minister of Health, that 4 thermometers should be provided of the following types:— A recording thermometer at the heat treatment stage; An indicating thermometer at the heat treatment stage; An indicating thermometer at the cooling stage; An indicating thermometer at storage stage. (iii) Sampling. Samples for bacteriological examination are taken monthly from April to September and at regular intervals during the winter months as supplied bv all manufacturers to tricvcle salesmen and local retailers. Samples are repeated alter unsatisfactory results. In 1954, 32 samples were submitted for examination with the following results:— No. of Samples Ministry of Health Provisional grade. % of Total Unsatisfactory Samples. 29 I 90.6 1 2 II 6.3 — — III — — 1 IV 3.1 — 32 100.0 1 The unsatisfactory sample contained organisms of faecal origin. The Sanitary Inspector visited the manufacturer's premises to check the arrangements for manufacture, storage and sale. Further available samples proved satisfactory. The Food Standards (Ice Cream) Order 1952 prescribed standards for ice cream. During 1954, 4 samples were submitted for chemical analysis, all of which complied with the Order. Meat and Other Foods. (i) Inspection and Supervision. The Council has made bye-laws under Section 15, Food and Drugs Act, 1938 for securing the observance of sanitary and cleanly conditions and practices in connection with the handling, wrapping and delivery of food 33 sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. The Essex County Council Act, 1952, Section 105, requires that as from 2nd April, 1953, any person intending to use premises which were not used immediately before that date for the sale, storage, or preparation for sale of any food (other than milk) intended for human consumption shall give not less than 14 days' notice to the Council of his intention so to do. The whole-time services of two Sanitary Inspectors are utilised to deal with food preparing premises, factory canteen premises and food and drugs sampling. During 1954, they made 14,975 inspections of food shops and food preparing premises and copies of the bye-laws were supplied where necessary and the implications of them were made known to all persons concerned. 180 informal and 14 formal notices were served under the Food & Drugs Act, and 16 formal and 184 informal notices were complied with, including 6 formal and 35 informal notices served prior to 1954. (ii) Food Hygiene. The following gives the numbers of food premises in the area by the type of business:— Cafes and Restaurants 129 Factory canteens 26 Butchers' shops 125 Grocers' shops 279 Fruiterers' and Greengrocers' shops 124 Fishmongers' and Fishfryers' shops 55 Bakehouses 26 Bakers' shops 52 Confectioners' shops 181 997 The practice of inculcating interest in the proprietors, directors and staffs of food handling organisations was continued in 1954, and it is satisfactory to note that the catering industry, as a whole, continues to cooperate admirably. The Ministry of Education made representations to Local Education Authorities on the need for constant vigilance and the observance of hygienic practices by staff engaged in school canteens. Similar representations were made by the Ministry of Health to the Hospital Authorities, in respect of kitchen staff. Full co-operation was maintained. Six lectures, and demonstrations with film strips and films were given, resulting in a total attendance of 248. Education in food hygiene has now been extended to the senior schools and to study groups of various local organisations. (iii) Sampling. The Council has delegated to the Public Health Committee power to institute legal proceedings under the Act. 220 samples (214 formal and 6 informal) were obtained during the year 1954; 5 formal and 3 informal samples were not satisfactory as follows:— (a) Slice of Bread (informal).—Contained rodent excreta. A warning letter was sent to the retailer. (b) Buttermints (formal).—Contained only 0.62% of butter fat and therefore misdescribed as "butter." Letters of warning were sent to the retailer, and to the manufacturer. 84 (c) and (d) Shredded Beef Suet (formal)—3% and 7% deficient in fat, respectively. The manufacturers were communicated with. (e) and (f) Vinegar (formal)—Consisted of dilute and coloured acetic acid of full strength but misdescribed as vinegar. Letters of warning were sent to the retailers. (g) Milk (informal)—Contained blackish gritty material which included coal dust and a few fragments of quartz sand, the whole being cemented together by dried milk. A letter of warning was sent to the dairy firm. (h) Slice of bread (informal).—Contained compact masses of mould growth. A letter of warning was sent to the retailer. (iv) Hawkers of Food. Section 103 of the Essex County Council Act. 1952, came into operation on 2nd April, 1953, and provides that hawkers of any food, and premises used for the storage of such food, shall be registered by the local authority. Registration was granted to 14 persons (concerning 4 premises), during 1954. Registration was refused in one case on account of unsatisfactory storage accommodation. (v) 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. Section 80 of the Ilford Corporation Act, 1937, requires registration of such premises. 23 applications for registration were received, and granted, during 1954. (vi) Articles of Food Surrendered. During the year the following articles were surrendered and condemned as being unfit for the food of man:— Bacon, 7 lbs.; Beverage, 1 pkt.; Biscuits, 201 lbs. 6 ozs.; Butter, 7 lbs.; 6 tins; Cake, 24 lbs.; Cereals, 13 pkts.; 58 lbs.; Cheese, 407¾ lbs., 643 pkts.; Chocolate, 23 lbs.; 72 rolls, 1,675 bars, 206 pkts.; Confectionery, 150 lbs., 905 pkts.; 600 crumpets; Cream, 41 tins; Eggs, 1,025; Fats, 2½ lbs.; Fish (Wet and Dry), 80 st. 4 lbs.; Fish (Tinned), 255 tins; Fish (Shell), 1 pt.; Fish (Cakes), 96; Fish Paste, 9,028 jars; Flavouring, Colouring, etc., 4 bottles; Flour, 12 lbs.; Foods (Medical and Baby), 2 tins; Fruit (Tinned), 7,150 tins; Fruit (Fresh), 80 lbs., 54 banana stems; Fruit (Dried), 63 pkts, 119½ lbs.; Fruit Juice, 10 tins; Ice Cream, 372 bars; Jam, Preserves, etc., 127 tins; Meat (Fresh), 5,172ilbs.; Meat (Tinned); 2,555 lbs. 11 ozs.; Meat Pies, 15; Milk (Tinned), 1,270; Milk (Dried), 3 tins; Nuts, 14½ lbs.; Pastry and Pudding Mixtures, 9 pkts.; Pickles, 41 jars; Poultry, 5 lbs., 3 tins; Puddings 28; Rabbits, 30 lbs., 2 tins; Sauces, Salad Cream, etc., 15 bottles, 506 jars; Sausages, 19 tins, 651 lbs. 3 ozs.; Soups, 192 tins; Tomatoes, 261 tins; Vegetables, 910 tins. In all cases, the food is inspected by the Sanitary Inspectors at the premises and after condemnation is collected by the Department and conveyed to the Refuse Collection Depot where it is disposed of under supervision. The necessary certificates of condemnation are then issued. (vii) Foreign Bodies in Food. 15 complaints were received during 1954 of the presence of foreign bodies in foodstuffs. All were investigated and legal proceedings were taken in two cases. Fines of £10, plus £2 2s. costs, and £5, plus £2 costs, respectively, were imposed. Letters of warning were also sent in two other cases. (viii) Food Poisoning. By virtue of Section 82 of the Ilford Corporation Act, 1927, food 35 poisoning became compulsorily notifiable in Ilford as from 1st October, 1937. It is also notifiable under Section 17, Food and Drugs Act, 1938. Twenty-five notifications were received during the year. There were no serious outbreaks of food poisoning. Two outbreaks occurred involving six persons, but the cause was not discovered. There were also nineteen single cases reported; the agent being identified in nine instances as Salmonella Typhi-murium. Seven other suspected instances were investigated but no specific cause was discovered and no notifications were received. A Report on Winter Vomiting (1955) by Dr. D. M. Gross. "There have been 3 known outbreaks of 'Winter Vomiting' during the early spring. At Parkhill School in February, 29 children and 2 members of the staff are known to have been affected. At Highlands School in March, 28 children and 2 members of the staff had symptoms and at the Ilford Maternity Hospital a slight outbreak involved 1 patient and 5 staff. These outbreaks followed closely the usual pattern. Children and grown-ups complained of sudden nausea and vomiting occasionally accompanied by diarrhoea. The illness lasted a few hours or at most a day, many children waking in the night to be sick but being well enough to attend school the next day. In a few cases (6 at Parkhill) other members of the family were affected. All pathological examinations were negative and food was not incriminated anywhere (only 16 children at Parkhill had school dinners). The short duration of symptoms made investigation difficult as the patients had recovered by the time the epidemics were reported, but it would appear that a mildly spreading infection was responsible. At Highlands it seems likely that it was introduced by the Head Teacher's secretary who was the first affected and who, from the nature of her work, could have handed it on to the other children and staff. At the Maternity Hospital, it is possible that the patient was already infected on admission and in turn infected the staff. At Parkhill School the 31 cases complained of vomiting only and no hint of a possible source of infection was obtained. No family contacts were involved." (ix) Bakehouses.—There are 26 bakehouses in the district, all of which use motive power. 517 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 16 instances, and the requests were complied with in all but one case, where work was in progress. Diseases of Animals Act, 1950. (i) Foot and Mouth Disease (Infected Areas) Special Order No. 7, 1954. This Order came into operation on 21.2.54 and restricted the movement of animals, except under licence, to and from parts of Bedfordshire, Buckinghamshire and Hertfordshire. Licences were issued for the removal to Herts. from Ilford of 5 pigs. The Order was revoked on 15.3.54. (ii) The Foot and Mouth Disease (Controlled and Infected Areas) (Modification of Restrictions) (Revocation) Order. 1954.—This Order revoked the Foot and Mouth Disease (Controlled and Infected Areas) (Modification of Restrictions) Orders of 1941 and 1943, which authorised the movement of animals under licence to collecting centres in Infected Areas and from collecting centres in Controlled and Infected Areas to slaughterhouses and bacon factories for immediate slaughter. As from 1.7.54 there are no longer any collecting centres authorised by the Minister of Food. (iii) Regulation of Movement of Swine Order, 1950.—One licence was received for entry into the Borough of 10 pigs. The animals were satisfactorily isolated. (iv) Regulation of Movement of Swine Order, 1954.—This Order prescribes that no sale of swine shall be held in any market, fairground or saleyard unless it is authorised by the Local Authority and places restrictions on the movement of swine from any live weight certification centrc, 36 market, fairground or saleyard or from the premises of any pig dealer. (v) The Horses (Landing from Northern Ireland and the Republic of Ireland) Order, 1954.—This Order requires that horses imported into Great Britain from Ireland must, with certain exceptions, be examined on landing by a veterinary inspector and, for this purpose, prohibits the landing of such horses except at ports approved by the Minister of Agriculture and Fisheries. (vi) The Atrophic Rhinitis (Compensation) Order, 1954.—This disease, which has been discovered in pigs in this country is believed to have been introduced by the importation of Landrace pigs from Sweden. Precautions are being taken to prevent the spread of the disease and to this end compensation is to be paid for pigs slaughtered under the Diseases of Animals Act, 1950, on account of this disease. (vii) Prohibition of Landing of Swine from the Channel Islands Order, 1954, and Prohibition of Landing of Swine from Northern Ireland Order, 1954—These Orders prohibited the landing in Great Britain of swine from the Channel Islands and Northern Ireland respectively, unless intended for slaughter, and regulated their movement to a slaughterhouse or bacon factory. The latter Order was revoked as from 9.8.54. (viii) The Importation of Carcases and Animal Products Order, 1954.—This Order regulates the import into Great Britain of meat and animal products which may introduce animal diseases. (ix) Fowl Pest Order, 1936. Live Poultry (Restrictions) Order, 1954. Live Poultry (Movement Records) Order, 1954. These Orders deal with the requirements necessary to prevent the spread of fowl pest by controlling the movement of live poultry in certain areas, the licensing of markets, fairs and sales of poultry, and the laying down of conditions under which poultry and day-old chicks may be sold by auction. No case of fowl pest occurred in Ilford in 1954. (x) The Virus Hepatitis Order, 1954.—This Order extends the definition of the expression "disease" for the purposes of the Diseases of Animals Act, 1950, to include the disease known as "virus hepatitis." The Order also provides for the detention and isolation of birds affected, or suspected of being affected, with this disease, and for the cleansing and disinfection of premises and utensils used for such birds. It also applies the provisions of the Animals (Miscellaneous Provisions) Orders of 1927 and 1938 in respect of the disease. (xi) The Sheep Scab (Amendment) (Revocation) Order, 1954.—This Order revoked the Sheep Scab (Amendment) Order. 1951, which permitted sheep to be moved, in certain instances, without a licence under the Sheep Scab Order, 1938. (xii) The Tuberculosis (Area Eradication) Amendment Order, 1954. The Tuberculosis (South-West Wales Attested Area) Order. 1954. The Tuberculosis (Central and South-West Scotland Attested Area Order, 1954. These Orders declare areas in Scotland and Wales to be attested areas for the control of tuberculosis. The first-named Order revokes the 1952 Order and amends the 1950 Order insofar as movement licences issued in respect of cattle to be moved unto the scheduled areas are concerned. Prevention of Damage by Pests Act, 1949.—This Act, which repealed the Rats and Mice (Destruction) Act, 1919, came into operation on 31st March, 1950. All Local Authorities are required to take all necessary steps to keep their districts free from rats and mice. To this end inspections must be made and, where rats or mice are found on premises to serve notice on the occupier to carry out specified treatment and works to exterminate them and to enforce the duties imposed by the Act on owners and occupiers of land. Where an owner or occupier fails to comply with a notice served by the Local Authority under the Act. the Local Authority may carry out the work and recover the costs incurred. Failure to comply 37 with the notice renders the owner or occupier liable to a penalty. It is the duty of all occupiers of land to notify infestations of rats and mice in order that the Local Authority may carry out their duties under the Act. The Council has appointed a whole-time Rodent operative, who commenced his duties on 1st January, 1951. The following is a statement of the work carried out during 1954:— Type of Property Total Local Authority Dwelling Houses Agricultural All other (including Business and Industrial) I. Total No. of properties in District 215 51,975 41 5,124 57,355 II. No. of properties inspected as result:— (a) of notification 65 479 3 91 638 (b) survey under the Prevention of Damage by Pests Act, 1949 48 47 2 4 101 (c) otherwise — — — 814 814 III. Total No. of inspections and re-inspections carried out 319 1,409 15 15,215 16,958 IV. No. of properties found to be infested by rats:— Major - - - - - Minor 68 326 2 24 420 V. No. of properties found to be infested by mice:— Major - - - - - Minor 21 140 1 43 205 VI. No. of infested properties (under III and IV) treated by the Local Authority 70 394 9 62 535 VII. No. of notices served under Section 4:— (1) Treatment - - - - - (2) Structural works (i.e., Proofing) - - - - - VIII. No. of cases in which default action was taken by Local Authority following issue of notice under Section 4 - - - - - IX. Legal proceedings — — — — — X. No. of "block" control schemes carried out Nil 38 Petroleum (Consolidation) Act, 1928.—The Sanitary Inspectors made 1,227 visits to premises where petroleum is stored, or in conjunction with the installation of such storage, and the testing of petroleum appliances or fittings. The number of Licences issued was 138, and the fees paid to the Council for such Licences was £101. One Licence was issued for the storage of calcium-carbide, the fee payable being 5s. Pet Animals Act, 1951.—This Act came into force on 1st April, 1952, and the Council is the Local Authority for the Borough. The Act provides that no person may keep a pet shop, or carry on a business of selling animals as pets in premises of any nature (including private dwellings), or keep animals with a view to their being sold in the course of such a business, with certain exemptions, unless he obtains a licence from the Local Authority on payment of a fee not exceeding 10s. 0d. In deciding whether to grant a licence the Local Authority is required to have regard to the need for securing that the accommodation shall be suitable as to size, temperature, lighting, ventilation, cleanliness, that there will be an adequate supply of suitable food and drink, that the animals will not be sold at too early an age. that all reasonable precautions will be taken to prevent the spread of infectious diseases and that appropriate steps will be taken in cases of fire or other emergency. It is an offence to sell animals as pets in any part of a street or public place, except at a stall or barrow in a market or to sell pets to children under 12 years of age. In accordance with the requirements of the Act the Council adopted a set of conditions for application to licences granted under the Act and decided that the licence fee payable should be 10s. Od. The Chief Sanitary Inspector is designated as the officer responsible for the administration of the Act and he and his Deputy are authorised to inspect any premises in the Borough where licences are in force. Licences were granted in respect of 13 premises during 1954. 39 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. The following diseases are notifiable to the Medical Officer of Health: 1. Under Section 144 and 343, Public Health Act, 1936. Smallpox. Enteric fever (Typhoid and Para- Cholera. typhoid). Diphtheria. Relapsing Fever. Membranous Croup. Anthrax (made notifiable by the Local Erysipelas. Authority as from 1/4/22). Scarlatina or Scarlet Fever. Pemphigus Neonatorum (made notifiable Typhus Fever. by Local Authority as from 29/6/29). 2. Under Regulations of the Ministry of Health. Plague L.G.B. Order, 19/9/1900. Puerperal Pyrexia The Puerperal Pyrexia (Amendment) Regulations, 1954. Ophthalmia Neonatorum P.H. (Ophthalmia Neonatorum) Regulations, 1926. Acute Primary and Acute Influenzal Pneumonia Dysentery Malaria P.H. (Infectious Diseases) Regulations, 1953. Tuberculosis P.H. (Tuberculosis) Regulations, 1952. Acute Rheumatism (up to 16 The Acute Rheumatism Regulations, 1953. years) Measles and Whooping Cough The Measles and Whooping Cough Regulations, 1940. Acute Poliomyelitis Acute Encephalitis Meningococcal Infection P.H. (Acute Poliomyelitis, Acute Encephalitis and Meningococcal Infection) Regulations, 1949. 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. The total number of deaths of Ilford residents from the following infectious diseases during 1953 and 1954 were as follows:— 1953 1954 Scarlet Fever — — Enteric Fever — — Diphtheria — — Acute Poliomyelitis — 1 Measles — — Whooping Cough 1 — Influenza 22 8 Tuberculosis—Pulmonary 27 26 Other forms 1 1 Pneumonia (all forms) 95 77 Diarrhoea (under 2 years) 1 1 Meningococcal Infections 1 — Totals 148 114 40 TABLE III.—Corrected Notifications of Infectious Diseases for the Year 1954 NOTIFIABLE DISEASE At all Ages Number of Cases Notified At Ages—years Total Cases Notified in each Ward *Total Cases Admitted to Hospital *Total Deaths 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 288 2 54 219 6 5 1 1 18 13 16 20 16 16 57 31 17 32 28 24 65 - Diphtheria, including Membranous Croup - - - -- - - - - - - - -- - - - - - - - - - - Enteric Fever (Typhoid and Para-Typhoid) 1 - - - - 1 - - - - - - - - - 1 - - - - 1 - Pneumonia 148 5 8 13 5 23 58 36 10 16 12 18 7 8 11 17 10 10 18 11 30 77 Puerperal Pyrexia 65 - - - 25 40 - - - - - - - 1 2 1 - 61 - - 62 - Acute Poliomvelitis 1 - - 1 - - - - - - - - - - - - - - - 1 1 1 Acute-Encephalitis 1 1 - - - - - - - - - - - - - - - 1 - - 1 - Meningoccocal Infection 4 1 2 - - 1 - - - - - - - 1 - - - 1 - 2 3 - Dysentery 39 2 6 15 5 6 4 1 8 - 1 - - 13 4 1 4 - 2 6 - - Ophthalmia Neonatorum - - - - - - - - - - - - - - - - - - - - - -- Erysipelas 21 - - - - 2 14 5 4 4 1 1 2 2 2 1 1 2 - 1 2 - Pemphigus Neonatorum - - - - - - - -- - - - - - - - - - - - - - - Tuberculosis Pulmonary 158 - 3 11 49 53 33 9 8 12 12 14 17 19 16 7 17 8 10 18 132 26 Other Forms 24 - 1 7 6 5 5 - 1 - 3 - 2 1 3 3 6 3 2 - 7 1 Anthrax - - - - - - - - - - - - - - - - - - - - - - Malaria—Believed contracted in this country - - - - - - - - - - - - - - - - - - - - - - Believed contracted abroad 1 - - - - - 1 - - - - - - - - 1 - - - - 1 - Acute Rheumatism 10 - - 10 - - - - 3 - - 1 - 1 - 1 3 - - 1 7 - Measles 963 13 325 616 4 5 - - 52 176 109 124 68 11 80 24 26 54 214 25 22 - Whooping Cough 271 19 124 123 1 2 2 - 17 16 13 25 25 20 37 37 19 21 13 28 4 - Food Poisoning 25 1 3 5 5 5 5 1 1 1 1 3 - 3 - 3 2 2 4 5 8 - Typhus Fever - - - - - - - - - - - - - - - - - - - - - - Totals 2,020 44 526 1,020 106 148 123 53 122 238 168 206 137 96 212 128 105 195 291 122 346 105 *Included in the figures in these columns are cases notified in previous years an well as 1954. 41 The year 1954, on the whole, showed a lower incidence of infectious disease than 1953. The number of cases of measles was 963 as compared with 1,231 the previous year. Whooping cough cases numbered 271 as compared with 820 in the year 1953. (a) Smallpox.—No cases were notified during 1954. The following gives particulars as to vaccination during 1954:— Primary vaccination 1,359 Re-Vaccination 465 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.—288 cases occurred in 1954. There were no deaths from this disease. Ten cases were admitted to Isolation Hospitals outside the district. (c) Diphtheria.—No cases occurred in 1954. This is the third successive year in which it has been possible to record a clean " bill of health" for this disease in Ilford. (d) Ophthalmia Neonatorum.—No cases occurred in 1954. The following figures show the number of cases of Ophthalmia Neonatorum notified during the past five years: 1950, 2; 1951, 3; 1952, nil; 1953, nil; 1954, nil. It is to be remembered that many cases of ophthalmia neonatorum are not due to gonorrheal infection. (e) Enteric Fever.—One case was reported during 1954. This occurred in a female of 38 years who had visited the River Rhine with a party for a holiday. The organism discovered in the case was one of Salmonella Para-typhoid "B." (f) Acute Poliomyelitis. Only one case of this disease occurred in Ilford during the year—a boy of thirteen years. The case proved to be one of the paralytic type. The patient was removed to the Ilford Isolation Hospital and made a good recovery. One death from this disease occurred of a boy of eight years in a South Coast hospital, but had normally been resident in Ilford. (g) Acute Encephalitis. Only one case of this disease occurred—a female child of nine weeks old. The patient was admitted to the Ilford Isolation Hospital but died twelve days afterwards from Encephalitis associated with chicken pox. (h) Meningococcal Infection. Four cases of this disease occurred— males of 33 years and 3 years and females of 12 days and 3 years. All the cases were removed to hospital. The male child of three years died two days after admission to hospital from pneumococcal meningitis. (i) Pneumonia—Influenzal and Primary. This disease was less prevalent in 1954 than in 1953, the number of notifications being 148 and 219 respectively. (j) Tuberculosis. During 1954 there were 158 new notifications of Pulmonary Tuberculosis and 24 of other forms of Tuberculosis. There were in addition 24 pulmonary and 1 non-pulmonary cases transferred to the Ilford district. The population of the town has altered little during the past five years and it is interesting to compare the figures of the persons added to the list and the deaths which have occurred during the same period:— Year Population No. of Persons added to list (all forms) Deaths (all forms) 1950 186,200 268 46 1951 181,600 260 41 1952 182,200 188 21 1953 181,200 190 28 1954 182,700 207 27 42 Notifications and Deaths from Tuberculosis of Ilford residents during 1954:— Age Periods New Cases Deaths Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F Under 1 year - - - - - - - - 1-5 years 1 2 1 - - - - - 5-15 6 5 6 1 - - - - 15-25 20 29 5 1 - - - - 25-35 14 18 3 2 1 1 - - 35-45 10 11 - - 4 1 - - 45-55 13 6 4 1 2 3 1 - 55—65 13 1 - - 6 1 - - Over 65 8 1 - - 6 1 - - Totals 85 73 19 5 19 7 1 - Of the foregoing new cases, the following were notified from Institutions in the district:— Respiratory Tuberculosis NonRespiratory Tuberculosis King George Hospital 1 3 Claybury Hospital 4 — Goodmayes Hospital 5 1 Ilford Isolation Hospital 2 1 Dr. Barnardo's Village Homes 4 2 Of the 27 deaths which occurred of Ilford residents, notification had previously been made of 21 of the cases. In the remaining six cases the cause of death was only discovered as a result of post-mortem, in five instances, one being notified after death. The other case was not notified, the presence of tuberculosis having been ascertained only one week prior to death. Pulmonary NonPulmonary Total Number of cases on register, 1st January, 1954 1,276 152 1,428 Number of cases entered on the register during the year 182 25 207 Number of cases removed from the register during the year Pul. NonPul. Recovered 40 7 Deceased 22 2 Left District 99 9 Lost sight of - - Diagnosis not established 2 1 163 19 182 Number of cases remaining on register on 31st December, 1954 1,295 158 1,453 43 Cases of Tuberculosis, on notification, are visited by the Tuberculosis Visitors. Cases of longer standing are visited by the Sanitary Inspectors once during the year; 1,247 persons were visited during the year. The following reports were obtained:— Pulmonary Cases Other Cases Condition good 750 76 Condition fairly good 172 18 Condition poorly 28 1 In sanatoria 121 7 No information as to present condition 20 3 Removed from district, etc. 50 1 1,141 106 The treatment of Tuberculosis is now under the control of the Regional Hospital Board. On the 31st December, 1954, there were 1,126 patients on the register of the Ilford Clinic. The number of patients from Ilford sent to Institutions under the Regional Hospital Board Tuberculosis Scheme during 1954 was as follows: Pulmonary Non-Pulmonary Total Males Females Males Females Adults 80 44 5 3 132 Children — 2 — 5 7 Mass Radiography. During the year, in March and October, the Mass Radiography Unit of the North East Metropolitan Regional Hospital Board operated from centres set up within the Borough situated at the Thompson Rooms, Manford Way Clinic, the Drill Hall, Horns Road, and at two factories. Dr. Hugh Ramsay, the Medical Director, kindly supplied me with particulars as follows:— Number of films taken:— Miniature Large Male Female Male Female Organised Groups (including Factory Staffs) 2,941 2,135 125 71 School Children 1,049 1,013 31 32 School Staff 104 109 3 3 General Public 3,426 5,745 222 318 7,500 9,002 381 424 Totals 16,522 805 Findings with regard to Tuberculosis in the above groups:— Active Pulmonary Tuberculosis:— Males Females Organised Groups 2 1 School Children — 1 General Public 5 5 Totals 7 7 Inactive Pulmonary Tuberculosis:— Organised Groups 37 14 School Children 1 — General Public 58 89 Totals 96 103 44 Other abnormalities which were found included:— Bronchiectasis 6 Pneumonitis 4 Pneumoconiosis 4 Spontaneous pneumothorax 1 Unresolved pneumonia 1 Cystic Lung 1 Carcinoma of Bronchus 5 Non Malignant Fibroma 1 Intrathoracic new growth (? carcinoma under observation) 1 Cardiovascular lesion (Congenital) 3 Cardiovascular lesion (Acquired) 67 Pleuro pericardial Cyst 1 Congenital Cystic Disease 1 Lipoma 2 Retrosternal Thyroid (Benign) 1 Sarcoidosis 1 Tuberculosis Care Association.—This Association has assisted 77 cases with extra nourishment, clothing, and in other ways. (k) Venereal Diseases.—Treatment of these diseases is now the responsibility of the Regional Hospital Board. The following are the V.D. Treatment Centres situate nearest to Ilford:— Romford.—The Annexe, Oldchurch Hospital, Waterloo Road, Romford:— Consultations: Males Monday and Tuesday 4 to 6.30 p.m. Thursday 12.30 to 3 p.m. Females Monday and Tuesday 4.30 to 6.30 p.m. Thursday 12.30 to 3 p.m. Treatments: Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 6 p.m. Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 6 p.m. Whitechapel.—Whitechapel Clinic, Turner Street, Mile End, London E.l:— Consultations: Males Monday to Friday 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. Females Monday to Friday 10 a.m. to 7 p.m. Saturday 10 a.m. to 3 p.m. Treatments: Monday to Friday 7 a.m. to 7 p.m. Saturday 7 a.m. to 3 p.m. Monday to Friday 9 a.m. to 7 p.m. Saturday 9 a.m. to 3 p.m. West Ham.—Queen Mary's Hospital, West Ham Lane, Stratford, London, E.15:— Consultations: Males Monday 3 to 6 p.m. Thursday 11 a.m. to 1 p.m. and 6 to 8 p.m. Saturday 2.30 to 4.30 p.m. Females Monday 6 to 8 p.m. Thursday 11 a.m. to 1 p.m. and 3 to 6 p.m. Saturday 2.30 to 4.30 p.m. Treatments: Monday 9 a.m. to 6 p.m. Tuesday 9 a.m. to 5 p.m. Wednesday 9 a.m. to 1 p.m. Thursday 9 a.m. to 8 p.m. Friday 9 a.m. to 5 p.m. Saturday 9 a.m. to 4.30 p.m. Monday 9 a.m. to 8 p.m. Tuesday 9 a.m. to 5 p.m. Wednesday 9 a.m. to 1 p.m. Thursday 9 a.m. to 6 p.m. Friday 9 a.m. to 5 p.m. Saturday 9 a.m. to 4.30 p.m. 45 Albert Dock Seamen's Hospital, Alnwick Road, London, E.16. Consultations: Males Monday, Wednesday and Friday 2 to 4.30 p.m. Females No female clinic. Treatments: Monday to Friday 9.30 a.m. to 5 p.m. Saturday 9.30 a.m. to 12 noon. Publicity and Propaganda, Etc. 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. Health and Home Safety Week, 18th—23rd April, 1955 The week was organised jointly by the Ilford Borough Council, the Essex County Council, and the Women's Voluntary Services, and was officially opened by His Worship the Mayor. An Exhibition was held at Messrs. Harrison Gibson's Store and a series of lectures was given in the Borough's Little Theatre. The space kindly allotted by Messrs. Harrison Gibson was divided into five rooms—a good and a bad kitchen, a good and a bad living room —good and bad from the point of health and home safety. The fifth room was set apart as a Clinic and was used for nine sessions through the week, and included vaccination, diphtheria immunisation, B.C.G. vaccination, two dental sessions, a school medical inspection, an infant welfare centre, a physiotherapy session and a session devoted to publicising and serving welfare foods. Apart from the school medical inspection and the infant welfare centre, everything was an actual demonstration of what occurs in normal circumstances. The infant welfare centre and the medical inspection, in view of the nature of the work involved, were of course " put up " jobs, and merely meant to attract. It is estimated that some 3,000 people attended the Exhibition. At the Little Theatre the lectures were held on four afternoons and dealt with swimming and diving (illustrated by films); a demonstration by the Women's League of Health and Beauty; a talk by Dr. Grantly Dick Read on "Childbirth without Fear" (illustrated by film); and a Brains Trust Panel dealing with the prevention of accidents in the home. The Panel included the well-known Home Office Pathologist, Dr. Camps. Many models constructed by the Health Visitors and Women's Voluntary Services to illustrate various aspects of home safety were on view at the Exhibition and at the Little Theatre. A third feature of the week was a film competition, to which local people, including school children, were invited to submit a script dealing with some aspect of prevention of accidents in the home. The response was good and the resultant film will be most useful to illustrate future lectures. Examination of Officers and Servants. The following medical examinations were carried out during 1954:— Officers Servants New Appointments 65 75 Under Sickness Regulations 1 42 Superannuation Allocation 1 — Totals 67 117 46 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 423 factories with mechanical power on the register. There are 189 factories without mechanical power on the register. There are 253 outworkers on the register. 1— INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by Sanitary Inspectors. Premises (1) Number of Inspections (2) Written Notices (3) Occupiers prosecuted (4) Factories with Mechanical Power 2,184 19 - Factories without Mechanical Power 153 - - Other premises (not including Outworkers' premises) 56 - - Total 2,393 19 - 2.—DEFECTS FOUND IN FACTORIES. Particulars Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness (S.1) 16 15 - - Overcrowding (S.2) - - - - Unreasonable Temperature (S.3) - - - - Inadequate Ventilation (S.4) - - - - Ineffective Drainage of Floors (S.6) - - - - Sanitary Conveniences (S.7):— Insufficient 1 4 - - Unsuitable or Defective 4 4 - - Not Separate for Sexes - - - - Other Offences - - - - Total 21 23* - - *Includes compliances of defects found in 1953. 47 PART III.—SERVICES. National Health Service Act, 1946. Births.—In accordance with the provisions of the Public Health Act, 1936, all live births and all stillbirths of twenty-eight weeks gestation and over must be notified within 36 hours to the Medical Officer of Health of the area in which the birth took place. The number of live births notified in Ilford under this Act during 1954 was 1,571 (790 males and 781 females), of which there were 116 (57 males and 59 females) where the ordinary place of residence of the parents was outside Ilford. In addition 755 notifications of live births (397 males and 358 females) which took place outside the district, although the ordinary residence of the parents was in Ilford, were transferred to this district. During the year there were no cases in which there was default in complying with the requirements of the Public Health Act relating to the Notification of Births. The percentage of live births occurring in Ilford, notified by the various responsible persons, was as follows:— By Medical Practitioners Nil By Certified Midwives 99.75 By Parents and others .25 There were also 50 stillbirths (27 males and 23 females) notified in Ilford including 5 (2 males and 3 females) where the home address of the parents was outside the district, and notifications of 10 stillbirths (4 males and 6 females) which took place outside the district, although the ordinary residence of the parents was in Ilford, were transferred to this district. This represents a total of 55 where the home address was in Ilford, whereas the Registrar-General has allocated 56 stillbirths to Ilford. The following table shows the causes of the 55 stillbirths notified where the usual residence of the parents was in Ilford:— Stillbirths, 1954 Cause of Stillbirth Delivery in Nursing Home Delivery by County Council Midwife at Home Delivery in Hospital Total Adrenal haemorrhage - - 2 2 Anencephalic - - 2 2 Atelectasis and Asphyxia - - 19 19 Hydrocephalus - - 1 1 Hydrops foetalis - - 1 1 Hypertension due to early pre-eclampsia toxaemia - - 1 1 Intra uterine death—cause unknown - - 2 Intra uterine death—obstructed labour - - 1 1 Loop cord prolapsed round neck - 1 - 1 Malpresentation - 1 1 2 Multiple Abnormalities - - 3 3 Placenta praevia - - 1 1 Placental insufficiency - - 3 3 Prematurity - 1 - 1 Rh. factor incompatibility - - 1 1 Unknown - 6 8 14 Totals - 9 46 55 48 Care of Premature Infants.—Of the 1,571 live births occurring in Ilford during 1954, 89 weighed 5ilbs. or less at birth; 22 of these babies were born on the district and 67 in Hospital (including 13 where the home address of the parents was outside Ilford). Of the 22 babies born at home:— 19 were nursed entirely at home; 3 were transferred to hospital; 20 survived at the end of one month; 2 died between the ages of one day and one month. Of the 67 babies born in hospital:— 6 died during the first 24 hours (including 2 where the home address of the parents was outside Ilford); 7 died between the ages of one day and one month (including 3 where the home address of the parents was outside Ilford); 54 survived at the end of one month (including 8 where the home address was outside Ilford). In addition 50 notifications were received of births outside the district where the ordinary residence of the parents was in Ilford and the weight of the infant at birth was 5½ lb. or less. Of these there were:— 1 who died within the first 24 hours (in hospital); 6 who died between the ages of one day and one month (all in hospital); 43 who survived at the end of one month. Infant Mortality.—The number of infants dying within the first year of life was 41, the total number born being 2,193. 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 18 69. The following table gives the deaths ot infants under one year ot age, classified according to age: — Infant Deaths—1954 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 Laryngo Tracheo Bronchitis - - - - - - 1 - - 1 Acute Suppurative Broncho-Pneumonia - 1 - - 1 1 - - - 2 Atelectasis 7 - - - 7 - - - - 7 Broncho Pneumonia 2 - - - 2 - 2 - - 4 Cerebral Haemorrhage 4 - - - 4 - - - - 4 Congenital Abnormalities 4 - - - 4 1 1 1 - 7 Cystic Hydroma - - - - - - - - 1 1 Encephalitis associated with Chicken Pox - - - - - 1 - - - 1 Erythroblastosis Foetalis 1 - - - 1 - - - - 1 Gastro-Enteritis - - - - - - 1 - - 1 Haemorrhagic disease of the newborn 2 - - - 2 - - 2 - 4 Murder 1 - - - 1 - - - - 1 Prematurity 5 2 - - 7 - - - - 7 Totals 26 3 - - 29 3 5 3 1 41 49 The comparative figures for the past 10 years are as follows:— Year No. of Deaths under 1 year Rate per 1,000 Registered Live Births 1954 41 18.7 1953 45 20.2 1952 44 18.9 1951 50 21.0 1950 45 18.7 1949 53 20.1 1948 62 21 .7 1947 82 24.3 1946 1945 102 81 29.6 35.7 The mean average Infant Mortality rate for the past 10 years is therefore 22.6 per 1,000 live births. The following table shows the comparison for Ilford, England and Wales and London for the past 10 years:— Year. Ilford England and Wales London 1954 18.7 25 21 1953 20.2 27 25 1952 18.9 28 24 1951 21.0 30 26 1950 18.7 30 26 1949 20.1 32 29 1948 21.7 34 39 1947 24.3 41 47 1946 29.6 43 41 1945 32.7 46 53 Neonatal Mortality.—The death-rate of infants under four weeks of age is known as the Neonatal Mortality. There were 29 deaths of infants under four weeks of age during 1954 and the rate for the year was 13.2 per 1,000 live births. The figures tor the past 49 years were as follows:— Year Number Rate Year Number Rate 1954 29 13.2 1953 34 15.2 1929 48 27.4 1952 32 13.8 1928 41 23.6 1951 40 16.8 1927 32 19.3 1950 32 13.3 1926 32 21.2 1949 33 12.5 1925 37 24.9 1948 37 12.9 1924 28 19.5 1947 51 15.1 1923 34 21.2 1946 74 21.5 1922 40 27.1 1945 49 19.8 1921 38 25.5 1944 64 23.1 1920 45 27.0 1943 54 20.6 1919 36 30.8 1942 49 20.3 1918 32 30.4 1941 36 22.0 1917 29 24.7 1940 43 22.3 1916 43 28.8 1939 57 25.8 1915 54 35.1 1938 50 21.8 1914 43 28.7 1937 52 23.0 1913 37 24.6 1936 59 26.7 1912 45 30.2 1935 51 24.8 1911 34 21.4 1934 37 18.8 1910 54 32.2 1933 48 25.9 1909 56 34.0 1932 41 20.6 1908 55 33.2 1931 64 32.3 1907 54 31.5 1930 31 16.8 1906 57 33.5 50 Illegitimate Births and Deaths.—48 of the live births registered (26 males and 22 females) were illegitimate, that is 2 2% of the births registered. One illegitimate child (a female) died under one year of age. The following table shows the birth and death rates of legitimate and illegitimate infants for the past ten years:— Legitimate Infants Illegitimate Infants Year Live Births Percentage of Registered Births Deaths Rate per 1,000 Legitimate Live Births Live Births Percentage of Registered Births Deaths Rate per 1,000 Illegitimate Live Births 1954 2,145 97.8 40 18.6 48 2.2 1 28.8 1953 2,164 97.0 43 19.9 67 3.0 2 29.9 1952 2,232 96.1 44 19.7 91 3.9 - - 1951 2,306 97.1 49 21.2 70 2.9 1 14.3 1950 2,332 96.9 41 17.6 74 3.1 4 54.0 1949 2,567 97.6 51 19.9 63 2.4 2 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 The Chelmsford Diocesan Moral Welfare Association continued in 1954 to undertake the care of the unmarried mother and her child on behalf of the County Council and there has been direct co-operation through their Moral Welfare Worker for this district. In addition, all cases are followed up by the Health Visitors. Health Visitors and School Nurses.—The shortage of health visiting staff continued and Clinic Nurses continued to be employed to relieve the Health Visitors of certain duties. The Essex County Council's Training Scheme for Health Visitors, in conjunction with the S.E. Essex Technical College, has continued and one trainee was allocated to Ilford for practical instruction during 1954. Two trainees, on completing the course in 1954 and passing the examination for the Health Visitors' Certificate of the Royal Sanitary Institute, were appointed as Health Visitors and School Nurses here. At the end of the year there were 10 full-time and 1 part-time qualified Health Visitors and School Nurses in addition to the Superintendent Health Visitor, and 5 Clinic Nurses. Although this shows an increase from the beginning of the year, the health visiting staff is still well below the approved establishment of 18. 61 In addition there were 4,682 visits paid where no reply was received. With a view to increasing the degree of co-operation between the Health Visitors and the local General Medical Practitioners arrangements were made for the Health Visitors to meet the Doctors at the Town Hall, Ilford, on an afternoon in April, 1954. Day Nurseries. (a) The hours of opening at all the Nurseries during 1954 continued to be 7.30 a.m. to 6 p.m., Monday to Friday only. (b) The standard charge for accommodation at the Day Nurseries continued during 1954 to be 7/6 per child per day, with provision for this charge to be reduced according to scale when the means of the parents do not justify the full fee. The marked decrease in the daily attendances at the Nurseries noted last year has continued to be evident and accommodation has continued to be made available to neighbouring Areas for children who can more conveniently attend an Ilford Nursery than one in their own Area, particularly those residing on the Hainault (L.C.C.) Estate. In view of the low attendances, the Health Area Sub-Committee decided that the staff at each Nursery should be reduced by one. The appointments of two of the Deputy Matrons and one Nursery Nurse were therefore terminated early in May, 1954, and the remaining Deputy Matron is now transferred to the other two Day Nurseries, when required, to take charge in the absence of the Matron. (c) Stevens Road Day Nursery.—The premises occupied by this Day Nursery until July, 1953, have now been transferred to the Ilford Committee for Education, as from the 1st March, 1955, for use as a Cerebral Palsy Unit which opened on the 2nd May, 1955. (d) The training of Students at the Nurseries for the Certificate of the National Nursery Examination Board continued. Three Students (one from the Ley Street Nursery, one from the Sunshine House Nursery and one from the Goodmayes Lane Nursery) entered for the examination during the year all of whom obtained the Certificate. The arrangements for young students to attend part-time courses (on one day a week) at day continuation classes whilst awaiting enrolment for the Nursery Nurses' Course at a Technical College in the September following their sixteenth birthday also continued; this enables them to pursue their studies in general subjects and so improve their general educaintional standard during this pre-nursery course period. Three students (one from each of the three Day Nurseries) attended such a course at the St. George's Day Release Centre. Dagenham. in 1954. 52 (e) The following is a table showing the attendances, etc., at the Day Nurseries during 1954:— Situation Date of Opening Accommodation (Children) Average Daily Attendance during 1954 No. of Days in Quarantine Reasons for Quarantine with Number of Cases No. on Waiting List at 31st Dec. Chicken Pox Whooping Cough Mumps Measles Diarrhoea and Vomiting Sunshine House, Girls' Village Homes, Barkingside 17.8.42 45 31 36 5 - - - - - Goodmayes Lane, Goodmayes (Replaced Green Lane Nursery, open from 5.5.43 to 9.11.51) 14.11.51 50 25 27 1 2 - - - - 226-236, Ley Street, Ilford 16.8.43 50 34 61 - - 1 18 5 - 53 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) Premises (b) Child-minders Number on register at 31/12/53 3 5 Number registered during 1954 1 — Number removed from register during 1954 — 2 Number on register at 31/12/54 4 3 Number of children provided for at 31/12/54 100 27 With regard to the two child-minders whose names were removed from the register during the year, one was a cancellation of registration on the instructions of the Health Area Sub-Committee under Section 5 of the Act and in the other case the person concerned did not wish to continue as a child-minder. Clinic Premises. Barkingside and Fairlop Infant Welfare Centres.—As reported last year, these Centres, which had been held at the Methodist Church Hall, Fremantle Road, Barkingside, since December, 1952, were transferred back to the Barkingside Parish Hall as from the 1st March, 1954. Health Services Clinic, Heathcote Avenue.—Mention was made last year of the inclusion in the Programme of Capital Buildings Proposals for the year 1953 /54 of the erection of a Health Services Clinic on part of the site reserved in Heathcote Avenue (Couchmore Avenue area) for a health centre, plans for which had been prepared. Formal consent has now been received from the Minister of Health and it is hoped to proceed with the project during the financial year 1955/56. It is proposed that the building should provide accommodation for the Local Health Authority's services (infant welfare, ante-natal, postnatal and immunisation clinics and facilities for Health Education) and School Health Services (school clinics and special medical inspection of school children) and should be so designed as to form an integral part of the future Health Centre when this is ultimately built. The Clinic will meet a real need in the north-west area of Ilford which is a considerable distance from the existing Clinics. Health Services Clinic, Kenwood Gardens.—With reference to my report last year that the County Council had approved for inclusion in the Capital Buildings Proposals for 1954/55 the erection of a Health Services Clinic on part of the site reserved for a Health Centre in Kenwood Gardens, the Minister of Health has indicated that he accepts the need for this Clinic but at the time of writing this report his formal approval is still awaited. It is intended that this Clinic will replace that at present housed at the Public Health Offices, Valentines Mansion, and certain of the services at present carried on at Newbury Hall will also be transferred there. In addition, it is proposed to make provision for the Main Distribution Centre. Office and Store for Welfare Foods, to replace rented premises. As in the case of the Heathcote Avenue Clinic, this building also will be so designed as to form an integral part of the future Health Centre. 54 Infant Welfare Centres.—98 voluntary lady helpers were engaged in the work at the Infant Welfare Centres at the end of December, 1954. At the end of 1954, Mrs. Armitage, who had been a voluntary helper at the Welfare Centres for many years and was the then Chairman of the Ilford Federation of Voluntary Welfare Workers, resigned on leaving the district. In April, 1955, Mrs. Butcher, who had also been a voluntary worker for many years, died. During the year the following attendances were recorded:— Total number of attendances of infants 38,392 First attendances 1,858 Attendances of Children from 1 to 5 years 11,433 Total number of children on roll. December 31st, after omission of all those who had not attended for six months 3,565 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 1954 38,392 1,858 3,565 1953 39,294 1,924 3,629 1952 42,033 1,947 3,701 1951 44,419 1,998 4,887 1950 43,402 2,490 3,894 713 sessions were held during the year, the average attendance at each session being 53 mothers with their infants. The following are the figures for each Centre:— Sessions Average Attendance Chadwell 48 53 Becontree 48 60 Downshall 48 59 Manford Way 48 41 Woodford Avenue 48 88 Seven Kings 48 54 Cecil Hall (Wednesdays) 48 51 Cecil Hall (Thursdays) 47 56 Newbury Hall 48 37 Goodmayes 48 49 Grosvenor Road 48 59 Ilford Lane 49 53 Valentines 49 53 *Barkingside and Fairlop (to 25/2/54) 8 51 †Barkingside (from 1/3/54) 40 63 †Fairlop (from 5/3/54) 40 24 *Combined session at Methodist Church Hall, Fremantle Road. †Separate sessions at Barkingside Parish Hall. Orthopaedic Clinic. (i) Newbury Hall Clinic.—40 sessions were held during 1954, 147 children under 5 years of age being examined, making 241 attendances. 55 (ii) Mayesbrook Clinic.—24 sessions were held during 1954, 83 children under 5 years of age being examined, making 121 attendances. (iii) Manforu Way Clinic.—7 sessions were held during 1954, 27 Ilford children under 5 years of age being examined, making 36 attendances. The 257 children were found by the Orthopaedic Surgeon to be suffering from the following defects:— Diagnosis New Cases Old Cases A B c A B C Paralysis:— Cerebral Palsy — — — — 1 — A.P.M. 3 Deformity of hips 2 3 — — 1 — Genu valgum 40 15 7 23 12 6 O.C.T. 2 — — 3 4 1 Genu varum 4 — — 5 2 1 Pes valgo planus 11 2 3 10 8 1 Valgus ankles 3 9 2 5 4 — Talipes calc. valgus — — — 1 — — Congenital talipes E.V. — 2 — — — 2 Intoeing 3 1 1 1 2 — Deformity of toes 1 2 — 5 1 — Slack posture — 2 — — — — N.A.D. 1 — — 1 1 1 Other conditions 6 5 2 10 3 — Torticollis 1 1 — — — — Metatarsal varus 2 — — 4 2 — Totals 79 42 15 68 41 12 A—Newbury Hall. B—Mayesbrook. C.—Manford Way. 20 pairs of Valgus Insoles, 1 pair surgical shoes, 2 Metatarsal bars and toe springs, 5 G.V. night splints, 194 wedges to shoes and 3 calipers and leg instruments were supplied during 1954. 3 repairs to calipers and surgical shoes were also carried out. At the Newbury Hall Clinic, 33 children under five years of age were treated by the Physiotherapist during the year, and 152 attendances were made by these children. Treatment was also given to 15 children who made 88 attendances at the Mayesbrook Clinic, and to 10 children who made 76 attendances at the Manford Way Clinic. Paediatric Clinic.—Dr. T. Savage, the Consultant Paediatrician, continued to attend the Clinic at Valentines Mansion up to the 31st May, 1954, and Dr. a. Russell took his place from the 1st June, 1954. 25 sessions were held and 141 new cases were examined, having been referred from the Infant Welfare Centres, Schools and Maternity Hospital for the reasons set out in the following table; a total of 293 attendances were made. 56 Diagnosis Discharged Improved Discharged with Advice or for Other Reasons Discharged no Treatment Discharged Cured Referred to Hospital, Dr. or Clinic Still attending Total Abdominal pain — — — — 1 1 2 Acrocyanosis — — — — — 1 1 Adenopathy — — — 1 — — 1 Anaemia — — — — — 1 1 Anal spasm — — — 1 — — 1 Asthma — — — — 1 — 1 Behaviour difficulties — 2 2 — 1 1 6 Birth trauma — — 3 — — 2 5 Cold abscess and fistula — — — — — 1 1 Congenital deformities — — 1 — 2 4 7 Congenital heart disease — — — — 1 1 2 Congenital laryngeal stridor — 1 1 — — — 2 Constipation — — — — 1 — 1 Delayed speech — — 1 — — — 1 Dyslalia — — — — 1 — 1 Enuresis — — 1 — 2 — 3 Epilepsy — — — — — 2 2 Feedirig problem — 8 1 — — 1 10 Gastro enteritis — — — — — 1 1 Glycosuria — — — — 1 — 1 Haemolytic disease of newborn — — — — 1 1 2 Hernia 1 1 — — 6 — 8 Hydrocele — — — — 1 — 1 Hypospadias — — 2 — 2 — 4 Infective hepatitis — — 1 — — — 1 Mongol — — — — — 1 1 Mucous polyp of lip — — — — 1 — 1 Naevus — — — — 3 3 Normal child—N.A.D. 1 7 9 — 2 3 22 Obesity — 1 3 — — 1 5 Petit mal — 1 — — — 1 Plantar wart — — — 1 — — 1 Prematurity — 12 — — — 5 17 Scoliosis — — — — 1 — 1 Talipes varus — — — — 1 1 2 Tonsillitis — — — 1 — 3 4 Uncertain 2 3 — — 2 2 9 Upper respiratory infection — 2 1 — 2 1 6 Vaginitis — 1 — — — — . 1 Vulvo-Vaginitis — 1 — — — — 1 4 40 26 4 33 34 141 Ophthalmic Clinics.—Attendances of children under school age for treatment by the Oculist during 1954 were as follows:— Valentines Mansion Mayesbrook Clinic Manford Way Clinic Total Number of children who attended 80 47 13 140 Number of pairs of spectacles prescribed 20 16 2 38 Total number of attendances made 133 118 21 272 57 Aural Clinic.—The Aural Surgeon attended at 48 sessions during 1954 and 71 attendances were made by 50 children of pre-school age. 82 children were operated upon for removal of tonsils and adenoids, 10 at Ilford Isolation Hospital and 72 at King George Hospital, Ilford. Rheumatism Clinic.—33 sessions were held during the year at Newbury Hall, at which 24 children under 5 years of age, 15 being new cases, made 27 attendances. The following is a summary of the cases treated:— Condition New Old Total 2 — 2 No active rheumatic disease 1 1 2 5 4 9 Other forms 7 4 11 Totals 15 9 24 Number of cases referred for Blood Sedimentation Rate 1 „ „ „ „ „ X-ray and Electrocardiograph 8 Artificial Sunlight Clinic.—46 sessions were held at the Newbury Hall Clinic and 45 at Mayesbrook. In all, 40 children under 5 years of age were treated, making 546 attendances. The conditions treated were as follows:— Conditions Cases A B Anaemia, Debility, Malnutrition and Catarrh 15 8 Wide Fontanelle 4 1 Old Rickets 1 — O.C.T. (Bow legs) — 3 Bronchitis 1 — Alopecia — 2 Other conditions 3 2 Totals 24 16 A.—Newbury Hall. B.—Mayesbrook. 14 cases were still attending at the end of the year; of the remainder, 16 were discharged having made a satisfactory recovery and 10 were discharged due to absence. Speech Clinic.—13 children of pre-school age attended, making 338 attendances. The following is the classification of the defects found by the speech therapist:— Dyslalia 7 Stammering 2 Dyslalia and Hyperrhinophonia 3 Cleft Palate 1 58 Diphtheria Immunisation.— Tabular Statement as to Number of Children Schick Tested and Immunised at the Diphtheria Clinics from 1st January, 1954, to 31st December, 1954. Valentines Clinic Mayesbrook Clinic Manford Way Clinic Grand Totals All Clinics School Children (Various Schools) Children under 5 years of age Total 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 — — — — — — — — — — Negative — — — 6 1 7 — — — 7 Numbers inoculated (full course) 14 251 265 4 186 190 1 59 60 515 *Positive after full course of inoculations and further inoculated 1 6 7 1 1 2 — — — 9 *Negative after full course of inoculations 5 327 332 6 270 276 — 43 43 651 Re-inoculations (one only) 334 119 453 156 84 240 76 3 79 772 *Awaiting re-test 12 221 233 1 100 101 3 35 38 372 *Not re-tested after inoculation (on account of leaving District, etc.) 49 315 364 35 277 312 12 136 148 824 *Positive after re-test but not further inoculated for same reason as above — — — — 4 4 — — — 4 Re-tested& Schick Tested in 1954 (1953 cases): *Positive after full course of inoculations, and further inoculated — — — — — — — — — — *Negative 10 175 185 20 167 187 38 38 410 During 1954, a total number of 2,079 children attended at the Diphtheria Prevention Clinics, (1,103 at Valentines Clinic, 794 at Mayesbrook and 182 at Manford Way), making a total number of attendances of 5,765 (2,913, 2,332 and 520), with an average per session of 54, 45 and 11 respectively. During 1954, 67 private doctors were supplied with prophylactic for the immunisation of 2,453 children and record cards were received from general practitioners as follows:— Under 5 Over 5 Inoculations (full course) 1,235 106 Re-inoculations (one only) 254 858 (* These figures include cases inoculated by general practitioners who made subsequent attendances at the Diphtheria Clinics). 59 Diphtheria Immunisation (Continued). The following table is submitted to show the figures over the past five years:— 1950 1951 1952 1953 1954 No. of primary inoculations:— At Clinics 778 794 793 594 515 By General Practitioners 866 1,007 1,263 1,425 1,341* Totals 1,644 1,801 2,056 2,019 1,856 No. of re-inoculations:— At Clinics 1,318 1,473 1,198 918 772 By General Practitioners 144 541 1,025 918 1,112† Totals 1,462 2,014 2,223 1,836 1,884 No. of live births in Ilford ... 2,406 2,376 2,323 2,231 2,193 *Includes 628 combined Diphtheria and Whooping Cough inoculations, †Includes 129 combined Diphtheria and Whooping Cough inoculations. Whooping Cough Immunisation. The following are the details of the number of children immunised against whooping cough at the three Ilford clinics held for this purpose together with records of such courses completed by general practitioners. Valentines Clinic Mayesbrook Clinic Manford Way Clinic *General Practitioners Inoculations (full course) Reinoculations (one only) Attendances Inoculations (full course) Reinoculations (one only) Attendances Inoculations (full course) Reinoculations (one only) Attendances Inoculations (full course) Reinoculations (one only) Children under 5 years of age 374 — 1042 217 — 670 100 1 287 825 5 Children 5 years of age and over 22 — 62 8 — 20 3 — 8 73 14 Totals 396 — 1104 225 — 690 103 1 295 898 19 *For comparison, as it is not the policy of the County Council to use a combined diphtheria/pertussis vaccine, only plain pertussis injections carried out by general practitioners are entered in the above table. The figures for records received of combined diphtheria/pertussis courses of injections are as follows:— Inoculations 628 Re-inoculations 129 60 Vaccination.—During 1954 record cards were received from general practitioners and various hospitals as follows:— Ages up to 14— No. of children primarily vaccinated 1,189 No. of children revaccinated 57 Ages 15 and over— No of adults primarily vaccinated 170 No. of adults revaccinated 408 The following table shows the figures over the past five years:— 1950 1951 1952 1953 1954 No. of primary vaccinations 1,198 1,583 1,428 1,439 1,359 No. of revaccinations 373 771 435 469 465 Totals 1,571 2,354 1,863 1,908 1,824 No. of live births in Ilford 2,406 2,376 2,323 2,231 2,193 Treatment of Minor Ailments.—Children suffering from simple dietetic ailments are treated at the Infant Welfare Centres. A certain number of infants were, however, brought to the Clinics at Newbury Hall and Mayesbrook Clinic to receive treatment for minor ailments. Cardiac Clinic.—During 1954, 12 sessions were held. 55 expectant and nursing mothers were referred from either the ante-natal or post-natal clinics, and with 19 old cases made a total of 107 attendances. The following is a summary of the new cases examined by Dr. K. Playfair:— Condition PostNatal Ante- Natal Anaemia 1 2 Congenital Cardiac lesion — 2 Exocardial Murmur — 1 Functional Cardiac disorder — 35 No lesion — 4 Still being investigated — 2 Valvular disease of the heart — 8 1 54 10 of these patients were referred to Queen Mary's Hospital for X-ray and/or electrocardiograph. Midwives.—There were 13 State certified midwives (including the Superintendent Deputy Superintendent, 8 domiciliary midwives and 2 parttime midwives employed by the County Council), resident and practising in the district at the end of the year. In addition there were 20 State certified midwives at the Ilford Maternity Hospital, 61 Supervision of the midwives practising on the district, 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. Suspension from Practice.—No Midwives were suspended from practice during the year. Medical Aid.—Medical aid was sought in 2 instances where the infant was found to have inflamed or discharging eyes. The condition of the eyes cleared satisfactorily. Domiciliary Midwifery Service.—At the end of the year there were 8 Domiciliary Midwives employed by the County Council whole-time and 2 part-time, in addition to the Superintendent and Deputy Superintendent. During the year 512 cases were attended. In 459 cases the midwives were engaged to attend as midwives and in 53 cases as maternity nurses. The patients resided in the following wards:— Barkingside 32, North Hainault 64, Cranbrook 35, Park 39, Seven Kings 46, South Hainault 54, Loxford 40, Clementswood 42, Goodmayes 14, Fairlop 63, Clayhall 49, Mayfield, 34. A Doctor was called in to 91 of the 459 cases in which a midwife had been engaged. Of the infants born there were 7 stillbirths. In 4 of these cases the midwife was engaged as a maternity nurse only. There were 9 deaths of infants during the first year of life where the birth had been attended by a Domiciliary Midwife, 6 of these occurring during the first two weeks of life. Notices were received from the Domiciliary Midwives stating that artificial feeding had been substituted in respect of 34 infants attended by them during 1954. During 1954 Ante-Natal Clinics conducted by the Domiciliary Midwives were held weekly at Valentines Mansion and fortnightly at Mayesbrook Clinic and Manford Way Clinic. The following is a summary of the attendances at these Clinics during the year:— Valentines Clinic Mayesbrook Clinic Manford Way Clinic First attendances 275 108 66 Subsequent attendances 781 354 229 Totals 1,056 462 295 Number of sessions 49 24 25 Average attendance at each session 22 19 12 In addition 2,380 home ante-natal visits were made during the year. The scheme introduced last year, providing for the doctor and the midwife to have a consultation about their patient on three occasions (at specified intervals) during the pregnancy, continued. The examinations take place at the patient's home, the doctor's surgery or at the Local Health Authority's Clinic, as mutually agreed, but in practice the joint 62 consultation is held in the majority of cases in the doctor's surgery, although in a few cases it takes place in the patient's home. Salvation Army Midwifery Service.—One Salvation Army Midwife served in Ilford during the year. 48 cases were attended by her, all as a midwife. A Doctor was called in to 10 of the 48 cases in which the midwife had been engaged. Of the infants born there were 2 stillbirths. Notifications were received from the Salvation Army Midwife that it was proposed to substitute artificial feeding in respect of 1 infant. Gas and Air Analgesia.—During 1954 gas and air analgesia was administered in 419 cases, of which 376 were attended by the Domiciliary Midwifes (344 when acting as midwives and 32 when acting as maternity nurses) and 43 were attended by the Salvation Army midwife. All the domiciliary midwives employed at the end of the year were qualified to administer gas and air analgesia and the one Salvation Army midwife was also so qualified. During 1954, four sets of apparatus for the purpose of the administration of gas and air analgesia were stored at the Ambulance Station, the machines being transported to the house of the patient by an ambulance vehicle on the request of the midwife. With a view to effecting an economy in the use of ambulance vehicles, however, since the 6th May, 1955, arrangements have been made for the midwives using cars in the course of their duties each to hold a machine at their respective homes to take with them to their own cases and only three machines are now stored at the Ambulance Station for the use of the remaining midwives. With regard to the latter, the relatives of the patient are requested to collect a machine, where possible, but when they cannot do this, arrangements are made for a machine to be transported from the Ambulance Station to the house by a hired car. The Salvation Army midwives also have two machines which are 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 1954: — Maternity Hospital Mayesbrook Clinic Manford Way Clinic Doctors Midwives First attendances 1,086 — 300 162 Subsequent attendances 6,174 4,226 2,456 1,306 Totals 7,260 4,226 2,756 1,468 Number of sessions 309 *253 130 71 Average attendance at each session 23 16 21 20 *Includes 201 running concurrently with Doctors' Clinics. 63 All patients booked for admission to the Maternity Hospital are medically examined at the Ante-Natal Clinics. As reported last year, following consultations with the Consultant Obstetrician arrangements were made as from January, 1954, for the first examination to be brought forward to the 10th week of pregnancy, or as soon as possible after that time if the booking for hospital admission is not made until after the 10th week. Further, arrangements are made for all hospital booked patients to see the Obstetric Registrar at either the Ilford Maternity Hospital or the Mayesbrook Ante-Natal Clinic at about the 35th week of pregnancy. 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 1954 clinics were held at the Maternity Hospital weekly, at Mayesbrook Clinic fortnightly, and at Manford Way Clinic monthly. The following attendances were recorded:— Maternity Hospital Mayesbrook Clinic Manford Way Clinic First attendances 795 176 99 Subsequent attendances 306 83 8 Totals 1,101 259 107 Number of sessions 52 26 12 Average attendance at each session 21 10 9 Consultant Clinic.—The Consulting Obstetrician, or his Deputy, continued to hold a Clinic twice weekly for ante-natal and post-natal cases. During the year 103 sessions were held and a total of 1,150 examinations were made. Maternal Mortality.—During 1954 there was one death of an Ilford mother recorded by the Registrar-General as due to or in consequence of pregnancy or childbirth. Domestic Help Service.—During 1954 the heavy demand for this service continued. A full-time Organiser controls the service, under the general direction of the Area Medical Officer, and at the end of the year there were 11 full-time, 108 regularly-employed part-time and 23 casual Helps employed. The following is a summary of the cases dealt with in 1954:— Number of applications received for assistance 1,309 Number of cases where Domestic Helps were provided (including 437 who were having service at the commencement of the year) 1,371 Number of cases which on investigation were either not eligible for assistance or did not require the service 213 Cases booked but subsequently cancelled 67 Number of cases where, at the end of the year, a domestic help was booked to attend in future months (maternity cases) 60 Other cases awaiting help at end of year 22 Enquiries incomplete at end of year 13 Cases being served at 31st December, 1954 480 64 In February, May and October, 1954, 3 two-weeks training courses for domestic helps were held by the' County Council at the Mid-Essex Technical College, Chelmsford. Three domestic helps from Ilford attended and were found to be entirely satisfactory. Convalescent Facilities.—The following tables show the number of persons sent away for convalescence during 1954. (a) Under Section 22 of the National Health Service Act, i.e., nursing mothers and young children. Name of Home No. of week's stay Remarks 3 4 John Horniman Home, Worthing 1 — Arranged by Invalid Children's Aid Association Beach Court, Lancing 1 — Arranged by Invalid Children's Aid Association Milton Lodge, Bognor Regis 1 Arranged by Hospital for Sick Children, Gt. Ormond St., W.l. Totals 2 1 3 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 week's stay Total Cases 1 2 3 4 5 Barnsley, The Vale, Broadstairs — 1 — — — 1 Bell Memorial Convalescent Home, Lancing 1 14 6 — — 21 Mrs. Brooks' Home, 49, Stone Road, Broadstairs — — 1 — — 1 Church Army Home, Bexhill — — 1 — — 1 Devonia Hall, Cliftonville — 2 — — — 2 Mrs. Dilley's Home, 12, Freeland Road, Clacton — 1 — — — 1 Essex Convalescent Home, Clacton 2 16 11 — — 29 "Gatley," Mount Pleasant Road, Hastings — 1 — — — 1 Hunstanton Convalescent Home — 4 2 — — 6 Mrs. Kirk's Home, 47, Stone Road, Broadstairs — — 1 — — 1 Leconfield, Bonchurch, Isle of Wight — — 1 — — 1 Lennox House, Southsea — 1 1 — — 2 Samuel Lewis Home, Walton-on-Naze — 13 — — — 13 Orchard Home, 48, Hall Lane, N.W.7. — 1 — — — 1 Rustington Convalescent Home, Littlehampton — 3 4 — — 7 "Waynflete," Hayling Island — — — — 1 1 Totals 3 57 28 — 1 89 65 Loan of Sick Room Equipment.—The increasing demand for equipment continues and the following table shows the issues from the Public Health Offices during 1954: — Articles Loaned Number of Articles Articles in store at 31.12.54 on loan at 31.12.53 loaned or reloaned in 1954 on loan at 31.12.54 Mattress (Dunlopillo) 10 4 11 1 Mattress (Hair) 1 1 2 — Invalid Chairs 23 35 29 8 Air Pillows 2 3 4 1 Air Rings 48 185 91 6 Cushions (Dunlopillo) — 22 9 6 Back Rests 32 114 60 7 Beds 2 1 3 — Commode Chairs 13 30 21 1 Crutches 1 1 2 — Fracture Boards (Sets) 2 2 3 1 Pillows 6 5 11 — Pillow Slips *8 *3 *11 — Sheets (Pairs) *2 — *2 — Rubber Sheeting 78 275 132 6 Medical Sandbags (Sets) — 1 — 1 Spinal Carriages 1 — 1 — Bed Cradles 12 16 14 1 Air Beds — 14 1 4 Bed Pans 42 167 74 19 Diabetic Scales 5 — 5 — Feeding Cups — 8 2 9 Urinals 27 79 41 20 Sputum Mugs 1 3 3 2 Douche Cans — 2 — 2 Water Beds 1 2 1 — Water Pillows 1 — 1 — Bed Blocks (Sets) 1 — 1 — Pails — — — 2 Bowls — — — 2 Bedsteads Sides (Pair) 1 — 1 — Lifting Pole and Chain — 1 1 — Commode Sorbo Cushion — 1 1 — Totals 320 975 538 99 1953 Details 161 698 320 54 1952 Details 86 326 161 66 1951 Details 27 162 86 30 *Provided through special funds. Tuberculosis Visitors.—Three Tuberculosis Visitors were employed in the Area during 1954 making a total of 4,085 visits to homes in the Borough. Domiciliary Occupational Therapist.—As reported last year, a Domiciliary Occupational Therapist was appointed in May, 1954, to serve both the Ilford and Romford Health Areas. After preparation work, involving the ordering of the necessary equipment, she commenced visiting in the homes of patients suffering from tuberculosis in August 1954. The following shows the visits undertaken by her in Ilford to the 31 st December, 1954:— Number of visits to new patients 14 „ „ revisits to patients 103 „ „ other visits (to Chest Clinics, etc.) 8 66 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 31.12.53 1 „ „ „ newly assisted in 1954 1 „ „ „ for whom responsibility ceased Nil „ „ „ being assisted at 31.12.54 2 Open-Air Shelters for Tuberculosis Cases.—One open-air shelter was supplied for a tuberculosis patient during 1954 and at the end of the year this shelter was still in use. Provision of Free Milk for Tuberculosis Cases.—The County Council's scheme for supplying to tuberculosis patients one pint of milk free of charge, on the recommendation of the Chest Physician, again showed progress during 1954 and the increase in the number of beneficiaries under the scheme still continues. Particulars of the grants made in 1954 are given below:— No. of cases in receipt of free milk at 31.12.53 132 „ „ new grants made during 1954 103 „ „ grants discontinued during 1954 76 „ „ cases in receipt of free milk at 31.12.54 159 Boarding-out of Children (Tuberculosis Contacts).—No applications were received in 1954 for assistance in the boarding-out of child contacts of tuberculosis patients under the County Council's scheme. Ilford Tuberculosis Care Association.—Mr. H. R. Stanbridge. a member of the Ilford Health Area Office staff, continued to undertake the secretarial work of this Association during 1954. The following shows the assistance given by the Association during the year:— No. of persons Assisted Total No. of Grants made Extra nourishment (grants made usually for periods of one month and renewed as required) 74 600 (including renewals) Other grants (clothing, etc.) 3 3 Travelling Expenses of Relatives Visiting Hospital Patients.— As in previous years, the County Medical Officer was able to give financial assistance in 1954 only in very special cases to enable them to visit relatives who were in hospital and no Ilford persons were assisted under this scheme. Examination of Officers and Servants.—The following medical examinations of Essex County Council staff were carried out during 1954:— Officers Servants New Appointments 9 4 Other purposes 5 6 Invalid Night Attendant Service.—The scheme operating in conjunction with the Ilford Social Service Association for the provision of 67 night attendants to provide some relief for those people who are called upon to sit up constantly all night with sick relatives or friends, or to help those who are sick and have no-one to whom they can turn for such assistance, has continued, the County Council making agreed payments to the Association in respect of approved cases where need in meeting the cost of the service provided by the Association's night attendants has been proved. The following are the details of the cases dealt with under the County Council's scheme during 1954:— No. of cases being attended at 31.12.53 Nil „ „ new cases attended during 1954 20 „ „ cases discontinued during 1954 17 „ „ „ being attended at 31.12.54 3 Total nights' attendance given 520 Home Nursing.—The Home Nursing Service in Ilford is undertaken by Nurses under the supervision of the Superintendent of the Lady Rayleigh Training Home at Leytonstone but operating from the Branch Home "Abury House" in Aldborough Road, Ilford. The work undertaken by Home Nurses in the Ilford area in 1954 was as follows:— Cases attended 2,729 Visits paid 78,385 Health Education.—Posters covering various aspects of Health were displayed at the Public Health Offices and the Mayesbrook, Manford Way and Newbury Hall Clinics throughout the year, and an exhibition stand which has become a permanent feature in the entrance hall of the Public Health Offices was used for the display of illustrative material covering three different subjects, viz., The Sanitary Inspector, Care of the Teeth and Foot Health. As part of the national publicity campaign on the subject of diphtheria immunisation, advertisements were inserted in the local press in March, 1954. Slides were also shown in three local cinemas, through the helpful co-operation of the managements, throughout one week of that month. During the year a total of 26 lectures on various Health subjects were given by members of the medical staff of the Department, 7 to mothers attending Infant Welfare and Ante-Natal Clinics, 15 to various organisations in the town, 3 to Medical Officers and Health Visitors and 1 to Head Teachers. In addition, 7 lectures were given by the County Health Education Officer to mothers attending Infant Welfare Centres. Dental Treatment.—Mr. E V. Haigh, the Senior Dental Officer, has submitted the following report:— "Expectant and nursing mothers and children under the age of five years continued to receive dental treatment at Mayesbrook Clinic only, an average of three sessions weekly being devoted to this service. These patients were referred from the ante-natal, post-natal and child welfare clinics. Generally extractions were performed under general anaesthesia, using nitrous oxide and oxygen, and always given by a doctor. Conservative treatment, such as fillings, scaling and gum treatment, was carried out on all patients who required such treatment. 68 Dental X-ray facilities, available at the Clinic, were used when required, often saving the patient pain and inconvenience by a much quicker diagnosis. Dentures were provided for expectant and nursing mothers when considered necessary. These were made at a local dental laboratory under an arrangement that has been in operation many years. The work has been very satisfactory." The number of cases treated at the clinic during 1954 is as follows:— ] Examined Needing Treatment Treated Made Dentally Fit Expectant and nursing mothers 175 175 216 150 Children under 5 147 145 152 139 The forms of dental treatment provided were:— Extractions Anaesthetics Fillings Scaling or Scaling and Gum treatment Silver Nitrate treatment Dressings Radiographs Dentures Provided, repaired and remade Local General Complete Partial Expectant and nursing mothers 721 62 148 389 78 - 195 19 60 46 Children under 5 370 — 120 155 — — 101 — — — In addition there were 530 prophylactic treatments and other operations carried out in the case of expectant and nursing mothers. The total number of sessions held for expectant and nursing mothers and children under five years of age was 138½. Distribution of National Welfare Foods. Owing to the closure of the local Food Offices, the distribution of national welfare foods (National Dried Milk, orange juice, cod liver oil and vitamin tablets) to beneficiaries became the responsibility of the local health authorities under the National Health Service and this transfer became effective on the 28th June, 1954. The take-over was accomplished smoothly and the majority of the distribution centres in Ilford were unaltered, the County Council becoming responsible for the renting of the premises and for the employment of the necessary paid staff. The arrangements adopted in the first instance were regarded as temporary, to allow for such adjustments as proved necessary from our experience in operating the scheme, but a permanent scheme was finally adopted by the County Council in May, 1955. 69 At the time of the transfer, the Voluntary Helpers were distributing the foods at the Infant Welfare Centres whilst sessions were in progress there and ccrtain members of the Women's Voluntary Services were issuing the foods from their homes. These ladies very kindly agreed to continue to give their services in this work. Further, the Women's Voluntary Services have, since the 10th March, 1955, brought a Mobile Depot into operation on the Padnall Estate, fortnightly visits being made there. The following shows the distribution centres in Ilford, with the days and times they are open:— (a) Main and Branch Centres. Main Distribution Centre, 279 Cranbrook Road, Ilford. Monday to Friday Saturday 9.15 a.m.—4.45 p.m. 9.15 a.m.—12.30 p.m. Methodist Church Hall, High Road (entrance in Cleveland Road), Ilford. Tuesday, Wednesday and Friday Saturday 9.15 a.m.—1 p.m. 2 p.m.—4.45 p.m. 9.15 a.m.—12 noon Methodist Church Hall, Fremantle Road, Barkingside. Tuesday and Friday Saturday 9.15 a.m.—1 p.m. 2 p.m.—3.30 p.m. 9.15 a.m.—12 noon Goodmayes Methodist Church Hall, Blythswood road (next to Seven Kings Library), Goodmayes. Tuesday and Friday Saturday 9.15 a.m.—1 p.m. 2 p.m.—3.30 p.m. 9.15 a.m.—12 noon (b) Infant Welfare Centres. Barkingside Monday 2—4 p.m. Fairlop Friday 2—4 p.m. Chadwell Monday 2—4 p.m. Manford Way Monday 2—4 p.m. " " Tuesday 2—4 p.m. " " Friday 2—4 p.m. Becontree Tuesday 2—4 p.m. Goodmayes Thursday 2—4 p.m. Downshall Tuesday 2—4 p.m. Woodford Avenue Wednesday 2—4 p.m. Cecil Hall Wednesday 2—4 p.m. Thursday 2—4 p.m. Seven Kings Wednesday 2—4 p.m. Newbury Hall Thursday 2—4 p.m. Grosvenor Road Thursday 2—4 p.m. Ilford Lane Friday 2—4 p.m. Valentines Friday 2—4 p.m. (c) Private Houses (W.V.S.). Mrs. Taylor, 31, Lime Grove, Hainault. Monday to Friday 9 a.m.—5 p.m. Mrs. Peacock, 15, Culpepper Close, Hainault. Evenings and Weekends only. (d) Mobile Depot (W.V.S.). Operating on Padnall Estate. Alternate Thursdays 2 p.m.—3.30 p.m. With a view to effecting economy and cohesion in the service, the work with regard to the national welfare foods has been fully integrated with that of the distribution of nutrients and medicaments which has been in operation in the maternity and child welfare service for many years. 70 SCHOOL HEALTH SERVICE. Nutrition. The summary of heights and weights over 10 years which is printed at the end of this Report in Table V11A. and B. shows no appreciable change. Incidence of Pediculosis and Scabies. (i) Pediculosis.—4 children were found to be infected with living hair vermin as against 5 in 1953, 13 in 1952, 7 in 1951 and 5 in 1950. (ii) Scabies.—There were no cases reported during the year, as compared with none in 1953, none in 1952, 1 in 1951 and none in 1950. School Premises.—There are 34 schools, with 63 departments, 24,256 children were actually on the rolls on 21st December, 1954, as compared with 24,267 in December, 1953. The figure 24,256 includes Barking Abbey (375) and Ursuline County Placed pupils (335). The number of children in average attendance at school for the year ended 21st December, 1954 = 21,977. 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. 973 visits have been made during the year. Medical Inspection.—As from the 4th August, 1953, the medical inspection has been in accordance with the School Health Service and Handicapped Pupils Regulations, 1953, as follows:— Paragraph 10.—(1) The arrangements made by the Authority for the medical (including dental) inspection of pupils attending schools maintained by the Authority shall ensure— (a) a general medical inspection of every pupil on not less than three occasions at appropriate intervals during the period of his compulsory school age and other medical inspections of any pupil on such occasions as may be necessary or desirable: Provided that there may be fewer than three general medical inspections for any pupil who attends schools maintained by the Authority for less than the period of his compulsory school age or, if the Minister approves, for all pupils; 71 (b) a dental inspection of every pupil who is admitted for the first time to a maintained school as soon as possible after admission and on such later occasions as may be practicable and necessary; and (c) that the attention paid to the general health and welfare of any pupil who is suffering from a disability of mind or body shall include particular attention to his disability. (2) So far as practicable, the parent of every day pupil shall be given the opportunity of being present at any general medical inspection and first dental inspection of his child. (3) Medical and dental records in approved form shall be kept for every pupil attending a maintained school. During 1954 5,346 parents, or 74 per cent., attended the full routine medical inspections. Infectious Disease.—The following table shows the incidence of infectious diseases in the Ilford schools since 1949:— Scarlet Fever Diphtheria Measles and German Measles Chicken Pox Mumps Whooping Cough 1950 252 1 766 80 25 466 1951 202 1 1,316 320 28 389 1952 294 — 2,242 624 612 316 1953 276 — 664 44 10 368 1954 218 — *630 130 104 113 *Of this number 626 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 1954. 55 home visits were paid by the School Nurses to cases of minor infectious disease. In addition the Sanitary Inspectors paid 415 visits to measles cases, and 91 visits to whooping-cough cases. Ringworm.—There were no cases of ringworm during the year. Following Up.—During 1954, 2,940 home visits by the School Nurses were paid for the purpose, and 3,023 re-examinations of children (some on several occasions) were carried out by the doctors at school; 145 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 1954 were as follows:— Newbury Hall Mayesbrook Number of individual children seen 981 616 Number of attendances of children 1.584 1,146 Number of exclusion certificates granted 35 30 Number of certificates of fitness to attend school granted 45 32 72 The following table shows the conditions dealt with at both the Clinics during the year:— Subnormal Nutrition 364 Debility 16 Uncleanliness:— Head 59 Body Skin:— Ringworm:— Head — Body — Scabies — Impetigo 13 Dermatitis 2 Urticaria 3 Furunculosis 18 Eczema 6 Athletes Foot 12 Warts 107 Other Skin Diseases (Non-Tuberculous) 84 Eye:— Blepharitis 17 Conjunctivitis 12 Defective Vision (excluding Squint) 130 Squint 20 Other conditions 66 Ear:— Defective Hearing 26 Otitis Media 14 Other Ear Diseases 25 Nose and Throat:— Chronic Tonsilitis only 17 Adenoids only 2 Chronic Tonsilitis and Adenoids 48 Nasal Catarrh 20 Nasal Obstruction 9 Other conditions 19 Enlarged Cervical Glands (Non-Tuberculous) 32 Defective Speech 28 Teeth—Dental Diseases 178 Heart and Circulation:— Functional 2 Organic — Anaemia 8 Infectious Diseases:— German Measles 1 Measles 1 Chicken Pox 1 Mumps 1 Colds and Coughs 69 Influenza 1 Lungs:— Asthma 12 Bronchitis 5 78 Pulmonary Catarrh 4 Other Non-Tubercular Diseases 1 Tuberculosis:— Pulmonary—Definite — —Suspected (Referred to Chest Physician) 16 Developmental:— Hernia 1 Other 3 Psychological:— Development 2 Stability 5 Nervous System:— Nervous Debility 2 Habit Spasm 2 Chorea 1 Petit Mal 1 Enuresis 17 Other Conditions 23 Deformities:— Genu Valgum 7 Posture 9 Pigeon Chest 1 Flat Feet 25 Valgus Ankles 16 Other forms 55 Minor Injuries 16 Rheumatism 7 Other Defects and Diseases 88 Total number of ailments 1,631 SPECIAL CLINICS. Ophthalmic Clinic. During the year 1954, the School Oculist held 209 sessions for the refraction of children suffering from defective vision (103 at Valentines, 96 at Mayesbrook and 10 at Manford Way). Full details of the work are given in Table IV, Group II. 3,647 attendances (1,584 at Valentines Clinic, 1,896 at Mayesbrook Clinic and 167 at Manford Way Clinic) were made by 1,837 schoolchildren (939 at Valentines Clinic, 807 at Mayesbrook Clinic and 91 at Manford Way) as compared with 1,730 schoolchildren in 1953. The 1.837 children were not all suffering from grave defects of vision. The following table shows the vision in the worst eye, as tested by Snellen's Type:— 6/6 6/9 6/12 6/18 6/24 6/24 6/60 less than 6/60 399 357 344 264 165 169 88 51 The children who saw 6/6 (practically normal vision) were suffering from symptoms such as headaches, inflamed eyelids, etc., which rendered further examination necessary. 74 The 1,837 children were found to be suffering from the following defects:— Diagnosis New Cases Old Cases A B C A B C Myopia 83 66 18 202 140 19 Myopic Astigmatism 4 5 — 5 3 — Hypermetropia 110 85 12 236 236 22 Hypermetropic 3 3 — 3 7 — Astigmatism Mixed Astigmatism 13 12 5 34 28 3 Squint 37 30 6 169 134 11 Blepharitis 1 2 — 5 3 — Congenital Coloboma — — — — 3 — Congenital Cataract — — — — — — Conjunctivitis — 3 — — — — Nystagmus 2 — — 2 4 — Other conditions 3 5 — 1 3 — N.A.D. 18 17 — 8 18 — Totals 274 228 36 665 579 55 A—Valentines. B.—Mayesbrook. C—Manford Way. 969 complete pairs of spectacles were provided, some of these being renewals after breakages. In addition, in 283 cases the lenses of spectacles were replaced or repairs of frames were carrid out. Mr. H. J. R. Thorne, M.B.. B.S., D.O., D.O.M.S,, the Ophthalmic Surgeon at Valentines Ophthalmic Clinic, makes the following report:— "Work at Valentines Ophthalmic Clinic has continued smoothly and satisfactorily throughout the year and the cases dealt with were of much the same types as in previous years. The majority of children were, as in the past, seen because of defective vision in one or both eyes, usually detected during routine school medical examinations, and due to refractive errors. Of these cases, a not inconsiderable number also had a squint. In addition many cases of true or apparent squint were referred for examination, advice and treatment. All these cases are seen at regular intervals and kept under observation as necessary throughout their school life. A much smaller number of cases was seen because of:— (i) Congenital abnormalities of the eyes and adnexae. (ii) Acute inflammatory, infective, allergic and traumatic affections of the eyes. Partially sighted (or blind) children—fortunately few in number— were seen at regular intervals, reported on (on Form B.D.8) and advice given as to schooling and treatment. 75 Good liaison is maintained with, and active co-operation obtained from various London Eye Hospitals to which cases were referred as necessary for operation (e.g., for squint) or further detailed (hospital) examination and investigation. The Orthoptist has continued to work at the Orthoptic Clinic at Mayesbrook on three days a week. This is an indispensable part of a School Eye Clinic to enable the necessary full treatment and observation of squint cases (pre- and post-operative) to be satisfactorily carried out. The Orthoptic Clinic has functioned efficiently. The arrangements for the fitting and supply of spectacles have, in the hands of the attending Optician, been satisfactory." Mayesbrook Orthoptic Clinic. Mrs. M. J. Mindell, D.B.O., the Orthoptist, makes the following report: "The Orthoptic Clinic for Ilford has been held for six sessions each week during 1954, at Mayesbrook School Clinic, Goodmayes Lane, Ilford. During 1954, 84 cases seen the previous year have continued their treatment, and 142 new cases have been seen. The total number of attendances per month can be seen in the table below, which is divided into two groups for convenience, those patients under five years of age and those over. Month Number of Sessions New Cases Under Over 5 years Old Cases Under Over 5 years Total Attendances Under Over 5 years January 18 - 9 - 5 8 86 February 20 2 9 1 6 7 101 March 29 1 17 — 9 11 157 April 20 3 12 1 6 8 105 May 26 3 9 2 6 20 137 June 25 3 9 1 12 15 158 July 22 3 12 1 6 8 120 August 26 2 10 2 3 11 146 September 19 1 8 — 4 6 114 October 23 1 9 — 7 7 117 November 26 1 9 1 7 13 141 December 22 1 8 — 4 4 103 Totals 276 21 121 9 75 118 1485 New Cases. 142 new cases were seen during the year, 21 under 5 years old, and 121 over 5. Of these patients, 29 were seen for one diagnostic report to be made only, and only attended the Clinic once. This figure includes 4 cases of apparent squint during the year. Treatment. Orthoptic treatment and occlusion were continued with 84 patients who attended in 1953, where necessary, in addition to 142 patients who started treatment. 76 Surgery. During the past year 13 patients have been operated on at various hospitals (Moorfields. Royal Westminster, Royal Eye, Oldchurch), to help overcome their squints. In some cases the Surgeon wished the patient to remain under his hospital for post-operative treatment, in others the patients were referred back to Mayesbrook Orthoptic Clinic immediately after their operation for treatment. Various patients are still awaiting their operation. Discharges. During the year 13 patients were discharged as orthoptically satisfactory; 16 as improved. In the latter case it was considered unlikely that the patient would benefit further from additional orthoptic treatment, either because of age, poor binocular vision, early onset of squint and/or various economic factors. 10 patients were transferred to other orthoptic clinics. 9 patients were discharged after failure to keep any of three or more consecutive appointments. 3 patients were discharged with intractable amblyopia, which failed to improve with prolonged occlusion. There was one patient who failed to improve at all orthoptically who was discharged. 1 report only 29 Orthoptically satisfactory 13 Improved 16 Intractable amblyopia 3 Transferred 10 Failure to improve 1 Failure to attend 9 Total discharged 81 Attendance. Attendance has improved on the whole this year, although constant reminders are needed by patients during school holidays. Patients who live in the extreme north of Ilford find it difficult to attend, especially where several other children have to accompany mother and patient to the Clinic. It is believed that the increase in London Passenger Transport fares has prevented some patients from attending and also the inaccessibility of the Mayesbrook Clinic for those patients from Fairlop, Barkingside and Hainault. Total number of patients still attending the Orthoptic Clinic on 31st December, 1954=145, 77 Orthopaedic Clinic. Mr. H. G. Korvin, F.R.C.S., the Orthopaedic Surgeon, makes the following report:— "The orthopaedic clinics were running very smoothly during the year 1954. The appointments system worked well and attendances were at a satisfactory level. The Physiotherapist, Mr. Hunt, resigned, after only one year's service, for financial reasons but was instrumental in securing in Mr. Brand a successor who could take over immediately. During the year several small items of equipment were purchased for the Newbury Hall Clinics. X-ray investigations were again done at King George Hospital, Ilford. while operative treatment was carried out at East Ham Memorial Hospital. Admission there presented no difficulties for children under twelve but for those aged twelve and over, who have to go to an adults' ward there is unfortunately a long waiting list. Surgical appliances were again provided by Messrs. Pryor and Howard, alterations to footwear were done by Remploy Ltd. Many parents, however, preferred to have these done at their own expense by a local cobbler because this caused them less loss of time. I wish to thank all those concerned in the running of these clinics for their valuable help and kind co-operation." (i) Newbury Hall Clinic.—40 sessions were held during 1954, 142 children of school age were examined for the first time during the year and 271 children were seen who had previously attended the clinic. These 413 children made 614 attendances. (ii) Mayesbrook Clinic.—24 sessions were held during 1954, 68 children of school age were examined for the first time during the year and 127 children were seen who had previously attended the clinic. These 195 children made 266 attendances. (iii) Manford Way Clinic.—7 sessions were held during 1954. 1 child of school age was examined for the first time during the year and 31 were seen who had previously attended a clinic. These 32 children made 42 attendances. The 640 children were found by the Orthopaedic Surgeon to be suffering from the following defects:— 78 Diagnosis New Cases Old Cases A B C A B C Paralyses:— A.P.M. 3 — — 7 6 — Hemiplegia — — — 6 2 — Monoplegia - - - - - - Spastic diplegia — — — 1 — — Spastic Quadriplegia — — — 1 1 — Scoliosis 4 1 — 4 1 — Kyphosis 3 — — — 1 — Slack posture 9 — — 11 5 1 Deformity of hips 2 1 — 5 1 — Deformity of Chest — — — 2 — — Genu valgum 27 13 1 79 38 18 O.C.T. 1 — — 9 8 1 Genu varum 3 1 — 5 5 1 Pes valgus-planus 6 5 — 41 23 4 Valgus ankles 16 8 — 21 8 1 Talipes calcaneo-valgus 1 — — 1 2 — Congenital talipes E.V. 1 — — 4 — — Congenital defect - - - - - - Intoeing 5 1 — 5 — — Pes cavus — 1 — 1 — — Hallux valgus 13 8 — 12 8 1 Deformity of toes 9 4 — 12 3 2 Torticollis — — — 4 — — N.A.D. 5 — — 6 2 1 Other conditions 28 22 — 22 11 1 Foot strain 4 3 — 7 — — Metatarsal varus 1 — — 2 2 — Spastic foot - - - - - - Cerebral Palsy 1 — — 1 — — Spina Bifida — — — 1 — — Totals 142 68 1 271 127 31 A—Newbury Hall. B—Mayesbrook. C—Manford Way. 10 Children of school age were admitted to hospitals. Particulars as follows:— No. of Cases Operation Hospital 1 Spike Arthrodesis left toe. St. Margarets, Epping. 1 Destapling. do. 1 Open tenotomy L. sterno mastoid. East Ham Memorial. 1 Transplant Tibialus Anticus to outerside. do. 1 Removal of supernumerary toes. do. 1 Osteotomy gt. toes and bunionectomy. do. 2 Osteotomy both great toes. do. 2 Stapling femur and tibia. do. During the year 58 pairs of valgus insoles, 14 pairs of surgical boots or shoes, 7 pairs Genu Valgum splints, 3 metatarsal bars, 10 calipers and inverting irons. 5 toe springs for drop foot, 21 repairs to Calipers and shoes, and 162 pairs wedges to shoes were supplied to school-children. 78 318 cases were discharged from the Orthopaedic Clinic, 116 as cured, 30 due to absence and were kept under observation at school, 138 were showing improvement and were kept under observation at school, 34 cases left school or left the district. Minor Orthopaedic Defects. One of the school medical officers has under supervision and attends weekly one of the following Clinics conducted by the Physiotherapist:— Exercises Massage Sunlight The doctor supervising these Clinics attended the Seminar on Foot Health in London, arranged by the Central Council for Health Education from 23rd to 27th February. 1954. The Physiotherapist attends the Newbury Hall Clinic for orthopaedic treatment on Monday and Thursday mornings, and the Mayesbrook Clinic on Tuesday and Friday mornings. A total number of 178 sessions were held by the Physiotherapist for treatment during 1954 (87 at Newbury Hall Clinic and 91 at Mayesbrook Clinic). At Newbury Hall Clinic 194 individual children of school age were treated by the Physiotherapist during the year and 1,318 attendances were made by these children. Treatment was also given to 69 children, who made 669 attendances at the Mayesbrook Clinic, and at the Manford Way Clinic to 23 Ilford children who made 176 attendances Artificial Sunlight Clinic.—The Physiotherapist attends the Newbury Hall Clinic on Tuesday afternoon and the Mayesbrook Clinic on Thursday afternoon for artificial sunlight treatment, 46 sessions were held at Newbury Hall Clinic and 45 at Mayesbrook. At the Newbury Hall Clinic 33 children of school age were treated, making 590 attendances for treatment. At the Mayesbrook Clinic 27 children of school age were treated, making 310 attendances for treatment. The lamp used at each Clinic is a Centrosol Unit. The conditions treated were as follows:— Defects Treated. Cases A B 15 20 Bronchitis 5 - Bowlegs 1 Alopecia 2 1 Asthma 1 1 Psoriasis 2 1 Posture — — Acne 1 — Chilblains 1 2 Eczema — 1 Other Conditions 5 1 33 27 A—Newbury Hall Clinic. B—Mayesbrook Clinic. Of the 33 cases treated 6 were Open Air school-children. 80 At Newbury Hall Clinic. 22 children of school age were discharged from the Artificial Sunlight Clinic, 15 as cured, 7 showing considerable improvement. 11 children were still receiving treatment at the end of the year. At Mayesbrook Clinic, 12 children of school age were discharged from the Artificial Sunlight Clinic, 11 as cured, 1 discharged due to absence. 25 children were still receiving treatment at the end of the year. Aural Clinic. The Aural Clinic is held at Valentines Mansion, the Surgeon attending one session weekly. 48 sessions were held during 1954 and 950 attendances were made by 536 children of school age, of whom 300 were new cases. The Consulting Oto-Rhino-Laryngologist (Miss Margaret Mason) submits the following report:— "The attendance at this Clinic in 1954 has maintained about the same rate as that of the year 1953; 300 new patients and 236 old patients made, between them, a total of 950 attendances. 176 children were recommended for operations, as compared with 180 the previous year. The vast majority of these were for tonsil and adenoids operations, some with antral lavage also. We again had the use of the Theatre block at the Isolation Hopsital for the latter six months of the year, and were enabled to get so far on with these operations that the waiting list at the end of the year had diminished to 92, from 260 the year before. However, we are still dependent on a low incidence of respiratory diseases for the use of these beds; if they could be made available regularly, the waiting time before admission could be cut to a very few months. The position has been further eased, however, by my having been appointed to the staff of King George Hospital as well as to the School Health Service, and so we have enjoyed a much closer coordination with the hospital than was possible before. Urgent operation cases can be admitted to the hospital if necessary, when the Isolation hospital beds are not available, and daily out-patient treatment for cases of, say, otitis media is now easy to arrange. We have also come to a most helpful agreement with Mr. Scott, of Whipps Cross Hospital, whereby pure-tone audiometry can be done for our children if required. 1 have been impressed by the extreme usefulness of the routine School Gramophone Audiometer testing. Several cases of advanced chronic mastoid disease have been picked up by this means, when the accompanying otorrhoea and earache had been left quite untreated, due either to negligence or ignorance on the part of parents. These cases, together with those for such procedures as intranasal astrostomy, have been treated at King George Hospital. During the year the Theatre at the Isolation Hospital, already a most efficient unit, has been further improved by such means as the provision of spark proof switches, and anti-static equipment, laryngoscopes. an efficient suction pump, etc., so that its safety is enhanced, and that we are well equipped to deal with any emergency such as post-operative haemorrhage on the spot, rather than having to transfer the patient to King George Hospital, which was the previous arrangement. I should like to pay tribute to the Head Teachers of schools in the borough; they have in almost all cases given me helpful information about their pupils, and have done their best to see that any advice as to the care of children in school has been implemented." The following table shows the work of the Clinic:— 81 AURAL CLINIC Nature of Disease Still under treatment Recommended Hospital treatment Discharged as cured Discharged as improved Discharged as no treatment required Discharged as left district Discharged as left school Discharged Children whose parents refused to continue attendance or treated elsewhere Totals New Old New Old New Old New Old New Old New Old New Old New Old New Old (i) Acute Suppurative Otitis Media 1 - 1 - 2 1 - 1 - - - - - - - - 4 2 (ii) Acute Catarrhal Otitis Media — — — — — 1 — — — — — — — — — 1 — 2 (iii) Chronic Suppurative Otitis Media due to:— 1. Tympanic Sepsis - - - 1 - 2 - - 1 - - - - - - - 2 3 2. „ Sepsis and Granulations - - - - - - - - - - - - - - - - - - 3. Other Causes — 1 - - - 1 - 1 - - - - - - - - — 3 (iv) Mastoid Disease - - - 1 - 3 - - - - - - - - - - - 4 (v) Partial Deafness due to:— 1. Nerve Deafness - - - - 1 - - - - 1 - - - - - - 1 1 2. Tonsils and Adenoids 1 1 - - 4 2 - - - - 1 - - - 1 - 7 3 3. Retraction of Membrana Tympani 3 - 2 - 3 2 - 1 2 1 - - - - - - 10 4 4. Scarring of Membrana Tympani - - - - - - - - 1 1 - - - - - - 1 1 5. Other causes 5 3 3 2 4 6 — — 8 2 — — — — 3 1 23 14 (vi) Opinion on Tonsils 18 3 56 21 80 89 1 - 20 13 - - - - 4 3 179 129 (vii) Rhinitis 6 1 2 3 7 12 3 - 2 2 - - - - 2 2 22 20 (viii) Other diseases or defects 11 12 6 2 17 31 1 - 15 4 - - - - 1 1 51 50 Totals 45 21 70 30 119 150 5 3 49 24 1 - - - 11 8 300 236 82 Rheumatism Clinic. The Physician attended 33 morning sessions during the year, and 162 children (80 of these being new cases) made 285 attendances. The 162 children were found to be suffering from the following conditions:— Defects Found New Cases Old Cases Totals Rheumatic Carditis 1 1 2 Other forms of Carditis 8 7 15 Tachycardia of Nervous origin 2 1 3 Congenital Heart Disease 1 18 19 Rheumatism — 1 1 No Active Rheumatic Disease 7 12 19 Heart Murmur Functional 50 33 83 Pains Due to Orthopaedic condition 3 5 8 Allergic type 3 2 5 Other conditions 5 2 7 Totals 80 82 162 Number of cases referred to General Hospital (In-patients) 17 „ „ „ Ear, Nose and Throat Surgeon 18 „ „ „ Orthopaedic Surgeon 10 „ „ „ For X-ray and Electro-Cardiogram 58 „ „ „ Blood Sedimentation Rate 16 Speech Clinic. Mrs. M. Walker, L.C.S.T., the Senior Speech Therapist, makes the following report:— "In 1953 the number of sessions per week at Valentines Speech Clinic was increased from 7 to 8 and a part-time Therapist appointed at Mayesbrook Clinic for 3 sessions per week, to cope with increased intake. Nevertheless in 1954-5 it was found necessary to increase part-time work at Mayesbrook to 6 sessions per week, thus leaving a Therapist free to work full-time at Valentines Speech Clinic. Although we have these extra sessions, waiting lists are as high as ever in both areas, due partly to the fact that school teachers are referring the cases earlier. Were it possible for more speech training in general to be carried out in the schools, many of the milder cases would not need to be seen at a Speech Clinic at all. As the situation is at the moment, however (1—2 names being added to the waiting list weekly) there would certainly be more than sufficient work for two full-time Therapists in the Ilford area. We have not had the use of a Tape Recorder this year and have found this a great handicap in some treatments. The benefits derived from its use in 1953 were such that we feel strongly that this instrument should be in regular use as an integral part of Speech Therapy. In last year's report we referred to the need to 'treat' the underfives who suffer not from a speech defect but from the parents' anxiety in relation to speech; and we would stress again that it is most important that such cases should be referred as early as possible; so few parents will accept the common-sense statement that the child will ' grow out of it,' and the tendency is to worry the child into a speech difficulty." 83 The defects treated were as follows:— Stammering 62 Dyslalia 91 Cleft Palate 4 Dysphonia 8 Others 6 67 children of school age were discharged from the Clinics during the year. In 48 cases the speech was normal. Of the remaining 19 cases, 3 ceased to attend for treatment, 14 left school or left the district, 1 refused treatment, 1 was referred elsewhere and in one case treatment was not needed. School Dental Service.—Mr. E. V. Haigh, Senior Dental Officer, reports as follows:— "During 1954, the dental facilities for school children increased steadily. At the beginning of the year there were only the equivalent of 1-10/11 full time dental officers. By the end of December, 1954, there were 11 part time dental officers and myself (full time), which made the equivalent full time officers 3-8/11 employed on school dental work. In addition I carried out Maternity and Child Welfare dental service. Full dental treatment was given to school children, nursing and expectant mothers, and children under 5 years of age. This treatment consisted of conservative dentistry in all branches, extractions which were mainly carried out under general anaesthesia, orthodontics, and the supplying of dentures when necessary. With the increased number of officers it was possible to see more children at school dental inspections and by the end of the year more than twice the number of children had been seen at school than in 1953. In 1954 a form of emergency treatment was started at Mayesbrook Clinic when on two mornings a week any child can attend from any school in Ilford without an appointment and receive emergency treatment. This has saved many children waiting with tooth-ache having to attend the school clinic and then a further delay whilst a dental appointment is sent to them. X-ray facilities are available at Mayesbrook Clinic for patients attending either Valentines or Mayesbrook Dental Clinics. Manford Way Clinic has a separate X-ray Unit." It was possible for the Dentists to visit some of the schools for the purposes of inspection. 8,988 children were inspected at schools of which 5,694 required treatment. Children seen by the doctors at routine medical inspections and at the School Clinics, who are found to require dental treatment are referred to the Dental Clinics. In addition to the 5,694 children referred for treatment by the Dental Surgeons at School Inspections there were 2,381 children specially referred by parents, teachers and School Doctors. Health Education in Schools. Arrangements have been made for the Oral Hygienist at Leyton to give Dental Health Lectures to the Senior Pupils at the Schools in Ilford. Two sessions weekly are being given, commencing on 8th March, 1955. 84 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 Dental Officers:— Age Groups (in years) No. of Children inspected at School No. of Children referred for treatment No. of Children specially inspected at the Clinic Total number of Children referred for treatment 5 705 359 217 576 6 820 566 331 897 7 1027 713 350 1063 8 868 597 309 906 9 884 560 274 834 10 761 460 255 715 11 877 523 233 756 12 864 544 154 698 13 763 494 114 608 14 805 540 97 637 15 409 213 42 255 16 155 104 5 109 17 35 18 — 18 18 15 3 — 3 8988 5694 2381 8075 In addition to the ordinary dental work of fillings and extractions, 26 dentures and 295 regulation plates were supplied. Further, 124 X-ray examinations of the teeth of children of school age were carried out at the Mayesbrook Dental Clinic. Full details of the dental work are shown in Table V. Open Air School. During 1954 the number of children on roll varied from 110 on 31.12.53 to 108 on 31.12.54. The number of admissions was 35 and of discharges 37. Only 3 children were admitted for debility with no other defect; and the trend towards a school for physically handicapped children, as opposed to an open air school is again emphasised. This has been recognised by the recent installation of heating throughout the school. The general work of the school has continued along previous lines and there has again been the closest co-operation between teaching and medical staff. Recommendations for admission were received from the following sources:— School Medical Officers 24 Borough Education Officer 3 Tuberculosis Officer 2 Others 6 The diagnoses of the admissions were:— School Medical Officers:— Asthma 8 Bronchiectasis 1 Cerebral Palsy 3 Meningocele 1 Habit spasm 1 85 Debility 3 Heart Disease 1 Defective speech 1 Old poliomyelitis 2 Pseudo hypertrophic myopathy 1 Hydrocephalus and repaired spina bifida 1 Poor physique 1 24 Borough Education Officer:— Spastic hemiparesis 1 Catarrhal condition of lungs 1 Asthma 1 3 Tuberculosis Officer:— T.B. lungs 1 Asthma 1 2 Others:— Ectopia vesicae and transplantation of ureters 1 Debility 1 Recurrent pulmonary infection 1 Bronchitis and asthma 1 T.B. lungs 2 6 The 37 children not now on roll left for the following reasons:— Fit for ordinary school 18 Left school over age 4 Admitted to residential O.A.S. 1 Admitted to other schools 5 Left district 7 Discharged at parents' request 1 Unsuitable (severely maladjusted) 1 37 The Spastic Class continued along previous lines and consisted of 9 children. In addition 1 boy was in the grammar school group and 4 were in the ordinary classes of the school, making a total of 14 altogether. One child aged 5 years is awaiting a vacancy in the Spastic Class. During the year a start has been made in recommending admission to the new Spastic Unit which, it is hoped, will soon be opened. So far 7 children have been so recommended and neighbouring boroughs have been asked to submit the names of suitable children for vetting with a view to admission when the time comes. As a result of the medical officer's periodic examinations, children have been recommended for treatment as follows:— Extra milk in school 34 Cod liver oil emulsion in school 34 Referred to Orthopaedic Surgeon 2 „ „ Speech Clinic 1 „ „ Enuresis Clinic 1 „ „ Rheumatism Clinic 1 „ „ Ophthalmic Clinic 2 „ „ Aural Clinic 2 „ „ Child Guidance Clinic 2 „ „ Dental Clinic 2 86 Six children received artificial sunlight treatment during the year. The provision of extra cod liver oil and malt continues and children with lung diseases were given daily deep breathing exercises. The Dental Surgeon has carried out one complete inspection of the children at the Open Air School. The dental work carried out was as follows:— Number of children examined 92 „ „ „ referred for treatment 62 „ „ actually treated 60 Treatment for Uncleanliness.—The School Nurses paid 227 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 Individual Children Examined Number of Examinations of Children Number Infested Per cent. 21,491 61,683 *138 0.22 *Four 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:— 1950 0.5 1951 0.4 1952 0.4 1953 0.3 1954 0.2 Other Ailments.—During 1954, 861 children were operated on for the removal of enlarged tonsils and adenoids as follows:— King George Hospital 376 Ilford Isolation Hospital 114 Mile End Hospital 1 East Ham Memorial Hospital 2 Others 368 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 1954 was 2,091,085 approximately. There are 21 kitchens in the Borough, established at the following schools:— Barking Abbey, Barley Lane, Beal, Benton, County High Boys, County High Girls, Cleveland. Dane. Fairlop, Goodmayes, Gordon. Loxford. Mayfield Boys, Mayfield Girls. Newbury Park, Parkhill, Redbridge. The Glade, The John Bramston, 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 1954, 19.499 children were receiving milk in school. Work done by the N.S.P.C.C.—The following 39 cases were investigated:— (1) Neglect 22 (2) Ill-treatment cases 6 (3) Other cases 11 (One case was reported from the Public Health Department for neglecting medical advice: 38 were reported from other sources for general neglect.) 87 89 children (39 boys and 50 girls) were involved, 59 being of school age. In addition to this work, 210 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.— Number of Ilford school children:— Sent to Recuperation Holiday Homes 18 Loaned television set 2 Loaned push chair 1 Loaned invalid chair 6 Loaned tricycle 2 Supplied with clothing 2 Numerous escorts provided to London or to Convalescent Homes by Voluntary Workers. 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 of 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 as defined in the Handicapped Pupils (Certificate) Regulations, 1953, which came into operation on 16th December, 1953, are 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 normal regime of ordinary schools 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 who have some naturally acquired speech and language but whose hearing is so defective that they require for their education special arrangements or facilities though not necessarily all the educational methods used for deaf pupils. (e) Educationally Sub-Normal Pupils, that is to say, pupils who, by reason of limited ability or other conditions resulting in educational retardation, require some specialised form of education wholly or partly in substitution for the education normally given in ordinary schools. (f) Epileptic Pupils, that is to say, pupils who by reason of epilepsy cannot be educated under the normal regime of ordinary schools without detriment to themselves or other pupils. (g) 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. 88 (h) Physically Handicapped Pupils, that is to say, pupils not suffering solely from a defect of sight or hearing who by reason of disease or crippling defect cannot, without detriment to their healh or educational development, be satisfactorily educated under the normal regime of ordinary schools. (i) Pupils suffering from Speech Defect, that is to say, pupils who on account of defect or lack of speech not due to deafness require special educational treatment. (j) Delicate Pupils, that is to say pupils not falling under any other category in this Regulation, who by reason of impaired physical condition need a change of environment or cannot, without risk to their health or educational development, be educated under the normal regime of ordinary schools. The number of children coming within these categories and their disposition as on the 31st December, 1953, are tabulated in the following table in accordance with the Handicapped Pupils Regulations, 1953. Return of Handicapped Pupils in the Area on 31st December, 1954 (Aged 2-16 Years) HANDICAPPED PUPILS. Blind, Partially Blind, Deaf Partially Deaf. Delicate. Physically Handicapped. Educationally Subnormal. Maladjusted. Epileptic. Total 1 2 3 4 5 6 7 8 9 A. Newly placed in 1954 3 — 1 — 29 15 28 13 — 89 B. Newly ascertained in 1954 — 1 — — 31 17 22 13 — 84 C. (i) Attending Special Schools— Day — 3 9 5 58 48 63 2 — 188 Boarding 8 — 5 5 6 3 12 7 1 47 (ii) Boarded in homes - - - - - - - 2 — 2 (iii) Attending assisted Schools - - - - - 3 4 20 — 27 D. Unplaced— (i) At no school 1 4 — — 1 5 2 — — 13 (ii) At ordinary school — 3 — — 4 2 9 5 — 23 E. Receiving home tuition (including those in D). — - - - - 3 - 1 - 4 Attending Special Schools Speech = Nil Diabetes = Nil Boarded in Homes Speech = Nil Diabetes = 1 Mental Health Service. The Occupation Centre for Mentally Defective Children and Adult Female Patients, was opened on 8th September, 1953, at the Methodist Church Hall, Bennett's Castle Lane, Becontree. It is known as the Ilford Junior Occupation Centre, 89 Full medical inspection is carried out once a year, by one of the School Medical Officers, also a survey visit is made quarterly. Child Guidance Clinic.—The Child Guidance Clinic was opened on 3rd January, 1949, at Loxford Hall, Loxford Lane, Ilford. Dr. H. M. S. Davidson, the Consultant Psychiatrist, reports as follows:— "This year has again seen many changes of staff. Mrs. Guttsman left to take up an appointment nearer her home, and Miss Moffatt took her place as Psychiatric Social Worker in April. Miss Reed (Mrs. Allen) left at the end of July as her husband had a year's appointment in New York, and we had a long gap when Miss Wicks has been the only psychologist in the Clinic, but Miss Gascoigne has been appointed and will come to us in February. When our Child Psycho-Therapy sessions were increased to 11 sessions a week Miss Harries was appointed to take on the additional sessions and came to us in February, and when Mrs. Henschel left at the end of October Miss Bergen took her place, so that we now have 2 highly trained Lay Psycho-Therapists to undertake most of the treatment of children in the Clinic. There have been some changes in the Psychiatric sessions: as owing to pressure of other work I had to give up 2 sessions, and Dr. Vincenzi gave up 1, but Dr. Altschulova took on 3 more so that the total number remained the same. Our waiting list has again increased, partly because of a larger number of referrals, especially in the last quarter, and partly because of the smaller number of cases diagnosed, though more treatment has been carried out. The smaller number diagnosed has depended on several factors: Dr. Mtschulova was ill for several weeks in the Spring, the long period with only one Psychologist, and some increase in the number of cases who failed to turn up to complete the diagnostic survey, and thereby waste a considerable amount of time. I would like to stress here how important it is to make certain that the mother is really willing to co-operate before the case is referred. Since the majority of cases diagnosed will need weekly treatment it is necessary to strike a balance between the number seen for diagnosis, and the number we are capable of absorbing into treatment, since long delay between the initial interview and the beginning of treatment has a deleterious effect, so this again may at times influence the number of whom we give diagnostic interviews. We are still very short of room, but we hope to have the Annexe adapted so as to provide a large room for groups. The monthly Conference with the Barking Health Visitors, the Medical Officer of Health, and the School Medical Officer of the child whose case we discuss have continued throughout the year, and has again proved of great value to all of us." No. of cases referred to Clinic 201 No. of cases diagnosed at Clinic 122 Psychiatrists. Diagnostic interviews 122 Cases taken on for treatment 113 Treatment interviews 688 Other interviews 50 No. of Psychiatric Sessions per week 9 Psychologists. Clinic cases tested 109 Cases given remedial education 11 Treatment interviews (remedial education) 178 School visits on behalf of Clinic cases 95 Other interviews 25 90 School Psychological Service. Individual cases seen 241 No. referred to Clinic 35 Child Psychotherapists. Cases treated 47 Treatment interviews 672 Psychiatric Social Workers. Interviews at Clinic (Treatment and Social Histories) 1,012 Interviews elsewhere (Home Visits) 23 Waiting List. Last year 52 This year 96 Cases for diagnosis 17 Awaiting treatment 43 Employment of School-children and Young Persons.—From special inquiries made at the various schools during 1954, it was found that 140 children were employed out of school hours. 138 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 138 Employment of Children in Entertainments Provisional Amending Rules, 1945.—12 Certificates were granted during the year. Medical Examination of Teachers, Officers and Servants.—The following examinations were carried out during 1954:— Officers Servants Teachers Intending Teachers Total New Appointments 13 17 18 58 106 Under Sickness Regulations - 2 — — 2 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. The Causes of Death among Children of School Age (i.e., from 5—15 Years) in Ilford, during 1954, were:— Acute Isolated Cerebral Myocarditis 1 Ruptured Cerebral Haemangioma 1 Acute Anterior Poliomyelitis 1 Acute Membranous Laryngitis 1 Niemann—Picks Disease 1 Leukaemia 1 Fractured Skull—Road death 1 Acute Influenzal Pneumonia 1 8 91 Ilford Enuresis Clinic. Dr. J. Pooley, School Medical Officer, makes the following report for the 12 months ended 31st December, 1954. "The Clinic continues to be held at the Public Health Offices, Emerson Road, on Wednesday mornings and attendances have continued to be fairly good. 1. Appointment List.—During the 12 months ended December 31st, 1954, there have been 77 new cases made up as follows:— Recommended by Under 5 yrs. Over 5 yrs. Total Boys Girls Boys Girls Parents — 2 7 — 9 Private Practitioners 2 — 3 1 6 Infant Welfare Officers 2 4 — — 6 School Medical Officers — — 30 18 48 Health Visitors 2 — 4 — 6 M.O.H., Barking — — 1 — 1 Speech Therapist — — 1 — 1 6 6 46 19 77 Total attendances Old and New Cases 420 Number of Sessions 32 2. Procedure.—At each clinic the original procedure has been adhered to and is as follows:— (a) Examination of urine is carried out by Health Visitor (for sugar, albumin reaction and specific gravity). (b) History of enuresis is taken (including that of any relevant illnesses). (c) Physical examination. This has sometimes been left until the second interview if the child has been particularly nervous or ill at ease. (d) The approachability of the child and the parent is noted. (e) General advice to the child and parents is given, and in particular, discussion is directed towards individual problems. At these interviews, more time is spent talking to the child and gaining his or her confidence, than in talking to the parent. It has been noted also that suggestions given to the child, have often been acted upon more faithfully than when more general advice has been given to the mother. The mother has invariably been a very attentive listener, and has more easily caught the atmosphere intended. (/) Charting of all dry nights is explained by use of pencil and paper for older children, and by the use of gummed coloured paper shapes for younger children. (g) Medicinal treatment is issued or prescribed (vide No. 3) 92 3. Treatment.—The treatment issued or prescribed is as follows:— Cases (a) Amphetamime sulphate (either 5 mgms., 75 mgms. or 10 mgms.) at night, at a time decided upon for each individual child 57 (b) Phenobarbitone grs.½ at night or during the day 8 ( + phenobarbitone for cases failed under (a) above) (4) (c) Ephedrine gr. ½ at night (first treated with amphetamine sulphate and included under (a) above) (1) (id) Advice and charting only 12 (e) Cases referred to hospital or Child Guidance Clinic (first treated and included under (a) above) (6) 77 (N.B.—As before, only the amphetamine sulphate was issued by the Area Health Office). 4. Analysis of Results :— 1954 Cases 1953 1952 (i) Completely dry 32 30% 22% = 41-6% (ii) Very marked improvement less than 5 wet in 28 nights) 4 (iii) Marked improvement (less than 14 wet in 28 nights) 15 (iv) Some improvement (more than 14 wet in 28 nights) 11 (v) No improvement 7 (vi) Not yet re-attended 8 77 (vii) Of the cases referred to the clinic during 1953 and who were still receiving treatment in 1954, a further 30 cases were discharged completely dry. Further analysis and comparison of cases:— 1954 1953 1952 Number % of total Number % of total Number %of total Number of boys dry 21 27.3 23 24 21 14 Number of girls dry 11 14.3 6 6 13 8 Average age of boys 10 years 8.6 years 7 years Average age of girls 7 years 7 years 9 years Average number of visits (made by girls and boys until discharged dry) 3.5 4 4 5. Conclusions.—The cases which have been slow to improve have fallen into five main groups, namely:— (a) Those with some frustration either at home or at school. (b) Overcrowding in the home—often resulting in two or three children sleeping in one bed. 98 (c) Mismanagement by one or both parents. (d) Those with some physical defect. (e) Backward children. In those children where it has been possible to show frustration either at home or at school, the mother has usually been glad to consult the Child Guidance Clinic; in other cases, the co-operation of the School Head Teacher has been readily obtained. The home background is invariably important in the etiology of intractable cases, and where it has been possible to alter environment or circumstances, again there has often been a corresponding improvement in the child's enuretic condition. In an enuretic "only child," "over-mothering" has been found to be a frequent cause. There still remain the few cases in which the etidlogy has remained obscure and treatment has not helped—in these cases one can only presume there to be some autonomic disharmony or an infantile type of bladder. The six-year-old child has proved to be the most approachable and amenable to treatment in this series of cases, possibly because the feeling of " shame," so often found in older children, has not yet become manifest. The early waking routine for the Pre-waking Enuretic has been continued. A number of cases have been filed to re-attend the clinic and on subsequent questioning have been found to be no longer enuretic, but on the whole, the attitudes of both parents and children have continued to be of interest and co-operation. Considerable interest in the running of the Enuresis Clinic has been shown by another Borough within the County and also by the University Health Centre of the Manchester University and the Berkshire Child Guidance Clinic." B.C.G. Vaccination of School Children. The County Council agreed to extend B.C.G. Vaccination to school children in the thirteen year age group and the following is a summary of the work from the inception of the scheme, 2nd July, 1954, to the end of that year, including those cases whose investigations were completed early in 1955. The B.C.G. Clinics are held at Newbury Hall and Mayesbrook Clinics and the tests and vaccinations are carried out by the School Medical Officers. No. of pupils to whom B.C.G. was offered 908 No. of pupils whose parents consented to treatment 482 No. of pupils undergoing tuberculin test 431 Positive: 79 Negative: 352 No. of pupils who received B.C.G. 332 (16 absentees, 3 contacts, 1 with asthma) No. of pupils post-tested 327 Converted to Positive 311 Negative 13 Absentees from readings 3 94 Ministry of Education. MEDICAL INSPECTION RETURNS. Year Ended 31st December, 1954. TABLE I. Medical Inspection of pupils attending maintained Primary and Secondary Schools including (Special Schools). A.—Periodic Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 2,623 Second Age Group 2,665 Third Age Group 1,800 Total 7,088 Number of other Periodic Inspections 24 Grand Total 7,112 B.—Other Inspections. Number of Special Inspections 2,208 Number of Re-inspections 6,172 Total 8,380 C.—Pupils Found to Require Treatment. Number of Individual Pupils found at Periodic Medical Inspection to Require Treatment (Excluding Dental Diseases and Infestation with Vermin). (No individual pupil is recorded more than once in any column of this Table, and therefore the total on column (4) will not necessarily be the same as the sum of columns (2) and (3).) Group (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table HA (3) Total individual pupils (4) Entrants 103 638 710 Second Age Group 319 636 868 Third Age Group 272 273 502 Total (prescribed groups) 694 1547 2080 Other Periodic Inspections 3 10 12 Grand Total 697 1557 2092 85 TABLE II. A.—Return of Defects Found by Medical Inspection in the Year Ended 31st December, 1954. Note.—All defects noted at medical inspection as requiring treatment are included in this return, whether or not this treatment was begun before the date of the inspection. Defect Code No. Defect or Disease (1) Number of Defects Requiring Treatment Number of Defects Requiring Observation but not Treatment Periodic Inspection (2) Special Inspection (3) Periodic Inspection (4) Special Inspection (5) 4 Skin 115 243 59 8 5 Eyes— a. Vision 697 133 217 1 b. Squint 98 20 17 — c. Other 38 100 47 5 6 Ears— a. Hearing 38 27 66 1 b. Otitis Media 12 14 8 c. Other 14 27 61 5 7 Nose or Throat 249 122 589 13 8 Speech 56 28 68 — 9 Cervical Glands 8 32 167 — 10 Heart and Circulation 65 11 176 1 11 Lungs 58 15 307 1 12 Developmental— a. Hernia 12 — 33 — b. Other 25 4 125 — 13 Orthopaedic— a. Posture 280 11 80 3 b. Flat foot 398 24 69 2 c. Other 304 62 249 7 14 Nervous system— a. Epilepsy 1 — 2 — b. Other 6 47 24 — 15 Psychological— a. Development 2 2 14 b. Stability 43 6 141 — 16 Other 75 184 185 37 96 B.—Classification of the General Condition of Pupils Inspected During the Year in the Age Groups (See Note (ii) on Table 1). Age Group Number of Pupils Inspected A—(Good) B.—(Fair) C—(Poor) No. % of Col. 2 No. % of Col. 2 No. % of Col. 2 (1) (2) (8) (4) (5) (6) (7) (8) Entrants 2623 1243 47.3 1330 50.9 44 1.6 Second Age Groups 2665 1109 41.6 1495 56.1 61 2.3 Third Age Groups 1800 470 26.1 130) 72.2 30 1.6 Other Periodic Inspections 24 1 4.2 16 66.0 7 29.2 Totals 7112 2823 397 4147 58.3 142 1.9 TABLE III. Infestation with Vermin. All cases of infestation, however slight, are recorded. This return relates to individual pupils and not to instances of infestation. (i) Total number of pupils examined in the schools by school nurses or other authorized persons 21,491 (ii) Total number of individual pupils found to be infested 138 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 4 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) (v) Number of individual pupils disinfested:— By Local Authority 59 By parents 79 TABLE IV. Treatment of Pupils Attending Maintained Primary and Secondary Schools (Including Special Schools). Notes:—(a) Treatment provided by the Authority includes all defects treated or under treatment during the year by the Authority's own staff, however brought to the Authority's notice, i.e., whether by periodic inspection, special inspection, or otherwise, during the year in question or previously. (b) Treatment provided otherwise than by the Authority includes all treatment known by the Authority to have been so provided, including treatment undertaken in school clinics by the Regional Hospital Board. 97 Group 1.—Diseases of the Skin (Excluding Uncleanliness, for which see Table III). Number of New Cases Treated during the year By the Authority Otherwise Ringworm (i) Scalp — - (11) Body — — Scabies — — Impetigo 13 1 Other Skin Diseases 229 32 Group 2.—Eye Diseases, Defective Vision and Squint. Number of cases dealt with By the Authority Otherwise External and other, excluding errors of refraction and squint 95 19 Errors of Refraction (including squint) — 1,853 Total 95 1,872 Number of pupils for whom spectacles were (a) Prescribed — 956 (6) Obtained — 989 Group 3.—Diseases and Defects of Ear, Nose and Throat. Number of cases treated By the Authority Otherwise Received operative treatment (a) for diseases of the ear — 12 (6) for adenoids and chronic tonsillitis - 861 (c) for other nose and throat conditions ... - 31 Received other forms of treatment 163 220 Total 163 1,124 Group 4.—Orthopaedic and Postural Defects. (a) Number treated as in-patients in hospitals 10 By the Authority Otherwise (b) New cases treated otherwise, e.g., in clinics or out-patients departments - 222 98 Group 5.—Child Guidance Treatment. Number of cases treated In the Authority's Child Guidance Clinics Elsewhere Number of individual pupils treated at child Guidance Clinics 118 6 Group 6.—Speech Therapy. By the Authority Otherwise Number of pupils treated by Speech Therapists for the first time. 78 4 Group 7.—Other Treatment Given. New cases treated By the Authority Otherwise (a) Miscellaneous minor ailments 377 460 (b) Other (1) Heart and Rheumatism - 170 (2) Sunlight Treatment — 33 (3) Massage and Remedial Exercises - 172 (4) Enuresis 77 - (5) Hernias - 32 (6) Major Respiratory Diseases — 9 (7) Major Digestive Diseases — 95 (8) Major Injuries — 47 (9) Other Major Diseases — 28 Total 454 1,046 TABLE V. Dental Inspection and Treatment Carried Out by the Authority. (1) Number of pupils inspected by the Authority's Dental Officers:— (a) Periodic age groups 8,988 (b) Specials 2,381 Total (1) 11,369 (2) Number found to require treatment 8.075 (3) Number referred for treatment 8,075 (4) Number actually treated 4,904 99 (5) Attendances made by pupils for treatment 14,601 (6) Half-days devoted to: Inspection 54 Treatment 1,445 Total (6) 1,499 (7) Fillings Permanent Teeth 5,102 Temporary Teeth 2,627 Total (7) 7,729 (8) Number of teeth filled: Permanent Teeth 4,346 Temporary Teeth 2,280 Total (8) 6,626 (9) Extractions: (i) Permanent Teeth:— (a) On account of Caries 596 (b) For other purposes 159 (ii) Temporary Teeth:— (a) On account of Caries 3,900 (b) For other purposes 269 (10) Administration of general anaesthetics for extraction 2,071 (11) Other operations: Permanent Teeth 6,132 Temporary Teeth 1,913 Total (11) 8,045 100 SCHOOL HEALTH SERVICE STAFF AND SCHOOL CLINICS AS AT 31st DECEMBER, 1954. 1.—Staff of the School Health Service. Divisional School Medical Officer: 1. Gordon, M.D., Ch.B., M.R.C.P. (Lond.), D.P.H. Senior Dental Officer: E. V. Haigh, L.D.S., R.C.S. Number Aggregate staff in terms of full-time officers employed in the School Health Service (a) Medical Officers: (i) Whole time School Health Service - - (ii) Whole time School Health and Local Health Services 7 2.97 (iii) General Practitioners working part-time in the School Health Service - - (b) Speech Therapists 2 1.55 (c) School Nurses including Superintendent *12 (Combined posts, H.V. and S.N.) 5.2 (d) Nursing Assistants 5 (Clinic Nurses) 2.75 (e) (i) Senior Dental Officer 1 0.75 (ii) Dental Officers (PartTime) 10 2.82 (iii) Orthodontists — — (iv) Dental Attendants 5 3.89 *All hold Health Visitor's Certificate. II.—Number of School Clinics (i.e., premises at which Clinics are held for school-children) provided by the L.E.A. for the medical and/or dental examination and treatment of pupils attending maintained primary and secondary schools. Number of School Clinics 5 101 III.—Type of Examination and/or Treatment provided at the School Clinics returned in Section II, either directly by the Authority or under arrangements made with the Regional Hospital Board for examination md/or treatment to be carried out at the Clinic. Examination and/or Treatment (1) Number of School Clinics (i.e. premises) where such treatment is provided Directly by the Authority (2) Under arrangements made with R.H.B.&c. (3) A. Minor ailment and other non-specialist examination or treatment 2 - B. Dental 3 — C. Ophthalmic — 3 D. Ear, Nose and Throat — 1 E. Orthopaedic — 3 F. Paediatric — 1 G. Speech Therapy 2 — H. Rheumatism and Heart — 1 I. Artificial Sunlight 2 — J. Remedial Exercises 2 — K. Enuresis 1 — L. Orthoptic - 1 IV.—Child Guidance Centres. (i) Number of Child Guidance Centres provided by the Authority = 1 Staff Number Aggregate in terms of the equivalent number of whole-time officers Psychiatrists 3 0.82 Educational Psychologists 2 2 Psychiatric Social Workers 2 2 Others:— Play Therapist 2 1 Clerk/Typist 2 2 The Psychiatrists are employed by arrangement with the Regional Hospital Board. Table VI.—Summary of Cases of Infectious Diseases among School Children, and of Contacts of such Cases, excluded from School Attendance during the Year ended the 31st December, 1954. SCHOOLS No. on Roll DISEASES AND CONTACTS Scarlet Fever Diphtheria Measles and German Measles Whooping Cough Chickenpox Poliomyelitis Mumps Pneumonia Rheumatism SonneDysen tery Totals Cases Cases Contacts Cases Contacts Cases Contacts Cases Cases Cases Cases Cases Cases Cases Contacts Barley Lane 613 8 — — — — 10 2 1 — — — — — 19 2 Beal Modern 826 — — — — — — — — — — — — — — — Becontree 1171 6 — — — — 5 — 2 — 1 1 — 2 17 — Benton (Open Air) 115 — — — — — — — — — — — — — — — Chadwell 721 4 — — — — — — 3 — 5 — — — 12 — Christchurch 840 9 — — 95 12 2 1 1 — 1 — 1 — 109 13 Cleveland 1097 22 — — 71 6 — — 4 — 1 — 1 1 100 6 County High 1251 4 — — — — 1 — — — — — — — 5 — Dane 654 3 — — — — — — 1 — 1 1 1 — 7 — Downshall 1344 21 — — 150 20 — — 8 — 2 2 1 — 184 20 Fairlop 1912 24 — — 4 1 1 1 — — — — 1 — 30 2 Gearies 1373 3 — — 1 — — — 77 — 48 — — — 129 — Goodmayes 795 15 — — — — 18 1 1 — — — — — 34 1 Gordon 246 2 — — 1 — 3 — — — 1 — — — 7 — Highlands 1087 8 — — 6 1 5 1 2 — 3 — — 3 27 2 Loxford 374 1 — — — — — — 1 — — — — — 2 — Mayfield 955 3 — — — — 1 — — — — — 1 — 5 — Mossford (Fairlop) 355 11 — — — — — — — — 1 — — — 12 — Mossford (G.V.H.) 210 6 — — — — 1 — — — 1 — 2 — 10 — Newbury Park 429 6 — — 43 2 2 — 1 — 1 1 — — 54 2 Parkhill 906 5 — — 4 — 7 2 — — — — 2 — 18 2 St. Augustine's 293 2 — — 15 — — — 1 — 1 — — — 19 — SS. Peter and Paul's 709 — — — 36 — — — 6 — — 1 1 3 47 — St. Vincent's 201 1 — — — — — — — — — — — — 1 — South Park 964 4 — — 41 4 7 2 5 — 2 1 — — 60 6 The Gilbert Colvin 551 14 — — 2 — 11 1 1 — — — — — 28 1 The Glade 529 6 — — — — 1 — 1 — — — — — 8 — The John Bramston 644 11 — — 58 9 13 3 4 — 33 — — — 119 12 The Mount 289 1 — — — — — — — — — — — — 1 — The Redbridge 612 1 — — — — 1 — 8 — 1 1 — — 12 — The William Torbitt 989 8 — — 2 — 4 — 1 — 1 — — — 16 — Uphall 360 1 — — 6 1 — — — — — — — — 7 1 Ursuline 335 — — — 10 2 4 — 1 — — — — — 15 2 Woodlands 246 5 — — 31 2 2 — — — — — — — 38 2 Private — 3 — 54 7 14 — — — — — — — 71 7 Totals 23996 218 — — 630 67 1 13 14 130 — 104 8 11 9 1223 81 *Valentines—included in Fairlop. 102 103 104 Table VII.—Table Showing the Average Heights and Weights of Ilford Boys and 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 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 j (in Centimetres) Average Weight I (in Kilogrammes) Number of Children Examined Average Height j (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) BOYS 1954 561 113 20.4 718 117 21.8 124 123 23.8 73 128 26.6 52 132 29.2 325 141 34.5 863 144 34.9 63 147 38.5 33 153 42.5 485 162 48.3 203 167 57.2 75 171 60.2 43 176 64.1 1953 649 112 20.2 925 116 20.4 82 121 23.6 34 126 26.3 36 133 28.9 194 140 33.3 799 144 34.7 49 145 36.3 22 153 44.0 441 162 51.0 259 168 55.7 84 172 61.2 35 172 56.6 1952 820 113 20.2 799 116 21.2 65 123 24.8 52 127 26.2 44 132 28.6 110 140 32.8 766 143 35.3 46 146 36.2 52 154 41.3 372 161 49.8 226 167 55.9 47 172 60.3 1 176 56.2 1951 611 113 20.8 508 115 21.7 74 123 23.9 50 128 26.6 43 131 28.6 165 140 33.5 715 143 35.9 42 146 37.4 22 153 44.2 373 161 51.2 218 165 53.3 21 170 60.7 1 177 63.4 1950 574 112 20.4 538 116 21.9 100 122 24.1 49 128 26.8 48 130 29.2 203 141 33.9 875 144 35.3 58 149 40.7 34 151 41.1 390 161 50.7 231 167 55.7 14 171 60.4 1 174 73.4 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 51 147 38.9 40 152 41.9 392 16;) 50.7 247 165 55.3 27 171 61.7 3 173 61.6 1948 704 112 20.2 214 116 21.5 68 122 23.5 52 127 26.6 45 133 28.7 430 137 32.4 002 142 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 28.7 369 139 33.1 381 111 33.8 43 145 35.7 139 156 44.7 98 157 46.0 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 — — — — — — — — — GIRLS 1954 522 111 19.6 605 116 21.3 93 121 22.8 44 125 24.9 52 134 29.2 288 140 33.9 968 144 36.5 71 148 39.8 36 155 46.4 481 158 48.4 216 160 55.0 85 161 56.8 9 164 57.1 1953 657 112 20.0 827 117 21.3 81 119 22.8 38 127 25.8 37 133 28.9 173 140 32.5 841 143 35.5 59 150 39.9 49 156 47.1 374 156 50.9 212 160 53.6 49 162 54.9 5 164 55.6 1952 746 112 19.9 695 115 21.0 70 121 23.3 57 125 24.6 39 132 29.1 124 139 33.5 784 143 35.7 79 148 40.5 29 155 49.8 410 158 50.5 239 156 54.9 67 160 55.0 5 159 49.0 1951 526 112 20.0 542 116 21.0 60 119 22.8 53 128 26.9 36 132 28.4 166 138 32.7 811 14t 36.5 48 149 40.1 32 153 438 397 158 508 248 161 55.0 27 162 56.1 — — — 1950 553 112 20.0 536 115 21.3 76 121 23.3 51 127 26.1 54 132 29.2 194 140 33.2 857 144 37.0 61 148 41.2 35 152 43.1 401 157 50.8 140 159 53.0 22 163 5.2.4 4 163 55.6 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 1 11 25.8 58 130 27.8 391 118 32.4 569 142 35.0 38 149 39.9 35 154 45.9 803 157 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 32.2 356 1 11 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 — — — — — — — — —