ley 014 Leyton Urban District Council. THE ANNUAL REPORT on the Vital Statistics & Sanitary Circumstances of the URBAN DISTRICT OF LEYTON, TOGETHER WITH THE REPORT TO THE EDUCATION COMMITTEE and THE HOSPITAL REPORT FOR THE YEAR 1915, by ALFRED BALL, M.D.Lond., D.P.H., Deputy Medical Officer of Health. llford: SOUTH ESSEX RECORDERS, LIMITED, High Road, TO THE CHAIRMAN AND MEMBERS OF THE LEYTON URBAN DISTRICT COUNCIL. Mr. Chairman and Gentlemen, The Annual Report for 1915 on the Health and Vital Statistics of the district, which I beg herewith to present, is much briefer than usual for reasons connected with the war. Every man of military age in the Public Health Department has either joined the Army for foreign service or has offered himself under Lord Derby's Scheme. On the whole the year has been a healthy one; Scarlet Fever has been prevalent, but there have been no serious outbreaks of Infectious Disease. The continued absence of hospital accommodation for cases of Smallpox occurring in this district is a source of grave anxiety to your medical officers. May I once more draw the Council's attention to their responsibility in this matter? My best thanks are due to the Councillors and to my fellow officials for the consideration and kindness they have shown me on many occasions. I am, Mr. Chairman and Gentlemen, Your obedient Servant, ALFRED BALL. Leyton Urban District Council. ANNUAL HEALTH REPORT FOR 1915, by ALFRED BALL, M.D., D.P.H., Deputy Medical Officer of Health. ASSESSABLE AND RATEABLE VALUE. The present assessable value for general district purposes is £493,029 10s., and a rate of 1d. in the £1 produces £1,950. For poor rate purposes the rateable value is £526,898, and 1d. rate produces £2,055. AREA, INHABITED HOUSES, POPULATION. The district has a total area of 2,594 acres; at the end of June it contained 23,643 houses. The number of new houses erected in the district during the year was 41. The demand for houses in Leyton may be gauged from the return of uninhabited houses; these, which in 1912 numbered 921, have now dropped to 314. At the 1911 census the population numbered 124,736, which number divided among the inhabited houses gave an average of 5.63 persons per house. Calculated on this basis the population for the middle of 1915 would total 131,342. But it is clear that any estimate which does not take into account the withdrawal from the civil population of large numbers of men of military age will be too high. I have no information of the number of Leyton men who have enlisted, and I therefore take the Registrar-General's figure, his estimate of the civil population for the year 1915 being 124,497. The birth and death rates are calculated on this estimate of the population, but they cannot strictly be compared with the corresponding rates of previous years as they are vitiated by the 4 removal of a part of the healthiest section of the community, among whom in times of peace there would have been but few deaths. BIRTHS. The number of births continues to decline. 2,655 births were registered—1,372 males and 1,282 females—yielding a birthrate of 21.3 per 1,000 of the population. Of the above 68 were illegitimate births, 30 being males and 38 females. Illegitimate birth-rate, .55 per 1,000 of the population. Months. Wards. January 244 Leyton 137 February 209 Lea Bridge 419 March 229 Central 542 April 285 Forest 307 May 216 Leytonstone 140 June 203 Grove Green 270 July 231 Harrow Green 307 August 198 Cann Hall 257 September 186 Wanstead Slip 216 October 210 Ward not known *60 November 178 December 206 Transferable 60 2655 Total 2655 * Transferable. DEATHS. 1,237 deaths of Leyton residents* were registered during the year—643 males and 594 females. To these must be added 133 males and 140 females, being deaths ("transferable") received from the Registrar-General. 5 The deaths of members of the armed forces are not included in the above figures, or In the mortality tables, but as there were only 7 of these, their inclusion in the tables would have had an almost inappreciable effect on the rates. It must be understood then that the civil population has been reduced to 124,497 by the loss of the healthy young men, and the mortality rates are consequently raised. The death-rate for 1915 was 12T per 1,000 of the population. *Including one male—a Belgian refugee. ZYMOTIC DEATH-RATE. The deaths which occurred during the year from the seven principal Zymotic diseases were as follows:—Measles, 41; Scarlet Fever, 10; Diphtheria, 19; Whooping Cough, 28; Enteric Fever, 2; Diarrhoea and Enteritis, 28. The Zymotic death-rate for 1915 was 1.03 per 1,000 of the population. INFANTILE DEATH-RATE. The infantile mortality rate, i.e., the number of deaths of children under one year of age per 1,000 births, was 84.7, there being 225 deaths. NOTIFICATION OF BIRTHS (EXTENSION) ACT, 1915. This Act took effect on September 1st. Under its terms 654 notifications of births have been received—328 from medical practitioners, 288 from midwives, and 38 from relatives. The Health Visitor, who gives half her time to Infant Care, visited 328 of these babies and paid re-visits when necessary. The Council has decided to appoint a second Health Visitor as a part of a complete scheme for Maternity and Child Welfare which is now under consideration. INFECTIOUS DISEASE. No case of Plague, Cholera, Smallpox, Typhus or Dysentery has been notified during the year. 6 There has been since March, 1913, no provision for the isolation in hospital of cases of Smallpox occurring in Leyton. The Essex County Council has endeavoured to bring into being a joint hospital for the combined use of districts in SouthWest Essex, but hitherto without success. In the past, great wars have usually been succeeded by outbreaks of Smallpox, Cholera or other diseases. Should an epidemic of Smallpox arise in Leyton it will then be too late to set about providing hospital beds, and your sanitary officials will be placed at a serious disadvantage in their efforts to stem the outbreak. VACCINATION RETURNS. The following are the details received from the Vaccination Officer as to infant Vaccination for the past 7 years':— Number of Births. Vaccinated. Certificates of Insusceptibility. Exemptions. Died Unvaccinated under 1 year. 1908 3071 1756 12 487 199 1909 2979 1396 12 556 173 1910 3011 1241 10 730 140 1911 2931 976 11 658 180 1912 2797 1156 5 1069 154 1913 2925 1152 10 1192 169 1914 2752 1011 17 1238 142 ENTERIC FEVER. 8 cases were notified, of which 2 were not Leyton residents and were suffering from the disease when they came into the district. The death-rate from Enteric Fever was .06 per 1,000 of the population. Every case was visited, usually by the Medical Officer of Health, and in addition to giving suitable advice, etc., endeavour was made to trace the cause of the infection. The following table 7 shows conclusively that Leyton's sanitary condition, judged by the standard of Enteric Fever incidence, is satisfactory. Case. Sex. Age. Yrs. Where Treated. Result. Remarks. 1 F. 19 West Ham Infirmary Recovered Cause not traced. Widal- Positive. 2 M. 28 West Ham Infirmary Died Cause not traced. 3 M. '28 At home Recovered Had recently eaten oysters and watercress. 4 M. 18 London Fever Hospl. - Not a Leyton resident. Was sickening for the disease when he came into the district. 5 M. 48 West Ham Infirmary Recovered Proved to be a case of Paratyphoid. Not a Leyton resident. Was working in Woolwich where he partook of oysters and cockles. 6 F. 24 At home Recovered Cause not traced. 7 M. 33 Walthamstow Hospl. Died Patient had recently eaten oysters. 8 M. 26 West Ham Infirmary Recovered Cause not traced. SCARLET FEVER. Cases notified, 471. 10 deaths occurred. Case-fatality, 2.1 per cent. Death-rate per 1,000 of the population, .08. DIPHTHERIA. Cases notified, 170. 19 deaths occurred. Case-fatality, 11.2. Death rate per 1,000 of the population, .15. PUERPERAL FEVER. 6 cases of this disease were notified, but one proved to be suffering from pleurisy, and she subsequently died from empyema and cardiac failure. There were no deaths from Puerperal Fever. One case occurred in the practice of a midwife and another followed on a three months abortion, at which the woman was not attended by either a midwife or a doctor. The County is the authority for the administration of the Midwives Act, and the County Medical Officer of Health has been promptly notified of all cases coming under his jurisdiction. 8 Disinfection of premises and clothing has been systematically carried out. MEASLES. There were 41 deaths during the year, giving a death-rate of .32 per 1,000 of the population. The 41 deaths occurred in the months stated:— Jan. Feb. Mar. April May June July 3 4 16 10 4 2 2 35 deaths occurred in children under five years of age, i.e., in children who do not attend school, and 6 between five and fifteen years. I received from the school teachers informatior. in respect of 1,287 cases of Measles. The Health Visitor paid 1,107 visits to these cases, and 154 other visits to cases or suspected cases of German Measles. WHOOPING COUGH. There were 28 deaths during the year, giving a death-rate of .22 per 1,000 of the population. 12 of these deaths occurred in children under one year of age, 12 in those between one and two years, and 4 in those of two and under five years. The Health Visitor paid 270 visits to these cases. DIARRHŒA AND ENTERITIS. Diarrhoea and Enteritis caused 28 deaths, 24 of which were of infants under one year of age. Our death-rate from Diarrhoea and Enteritis under two years was 9.79 per 1,000 births. CEREBRO-SPINAL MENINGITIS. 4 cases of Cerebro-Spinal Meningitis have been notified during the year, of which 2 died. In addition, one case (not notified) died in a Children's Hospital. 9 The following are particulars of the cases:— Case Date of Notification Sex Age Result Remarks 1 15.2.15 Male 6 Recovered Typical form of disease. No contact with military. Stayed at Brighton about three weeks before illness. Room disinfected. No bacteriological examination. 2 1.3.15 Female 1 5/12 Died Had measles at Christmas and been ailing since. No bacteriological or P. M. examination. Room disinfected . 3 14.5.15 Female 6 Recovered Typical form of disease. Spinal puncture yielded no fluid. Room disinfected. 4 17.7.15 Female 1 6/12 Died Teething at onset of disease. No bacteriological examination. 5 — Female 3 Died 28.3.15 Died in Children's Hospital. ANTERIOR POLIOMYELITIS. 3 cases were notified, of which 1 died. The following are particulars of the cases:— Case. Date of Notification. Sex. Age. Result. Remarks. 1 26.7.15 Male l 7/12 Left arm paralysed Source of infection not traced. Case removed to Children's Hospital. 2 28.9.15 Female 1 4/12 Right foot paralysed „ „ 3 16.11.15 Female 9 Died Progressive paralysis with sudden death on the third day. Cause of illness not traced. It will be noticed that all the cases of Cerebro-Spinal Fever occurred in the first seven months of the year, while the cases of Poliomyelitis occurred in the last six months. 10 OPHTHALMIA NEONATORUM. 18 notifications were received (11 from doctors and 7 from midwives), referring to 17 cases. Of these, 2 were illegitimate children whose mothers were not Leyiton residents, and they are therefore not included in Table II. All the cases were visited and re-visited. At the end of the year, of the 15 Ley ton cases 11 were cured without damage to vision, 3 were dead, and 1 had left the district; 10 were treated by private practitioners, 3 at hospitals, and 2 in the infirmary. TUBERCULOSIS. 160 deaths occurred from all forms of Tuberculosis, representing a death-rate of 1.28 per 1,000 of the population. The corresponding figures for Pulmonary Tuberculosis were 114 and .92. Notifications of 235 cases of Pulmonary Tuberculosis and 70 of other forms of Tuberculosis were received during the year. These cases were visited by the Tuberculosis Officer or his staff and verbal and written instructions given as to the necessary precautions to be taken to prevent the spread of the disease. Dr. Ross, the Tuberculosis Officer, has been appointed by the Leyton Council, Assistant Medical Officer of Health for Tuberculosis purposes without salary. Close co-operation is maintained between the Tuberculosis Officer, who is appointed by the Essex County Council, and the Medical Officer of Health. The arrangements as set forth in last year's report have been continued. Notifications of cases of Tuberculosis have been received from the following Institutions:— 11  Pulmonary. Other forms. Total. West Ham Infirmary 102 12 114 Hospitals— Brompton 17 — 17 London 6 17 23 Victoria Park 35 — 35 Others 24 6 30 Sanatoria— Black Notley 20 — 20 Colchester 4 — 4 Halstead 8 — 8 Ilford 16 — 16 Lord Mayor Treloar's Home — 4 4 Maltings Farm 14 1 15 Others 26 9 35 Dispensaries- Leyton Tuberculosis 36 5 41 Others 3 1 4 311 55 366 BACTERIOLOGICAL DIAGNOSIS. The arrangements made with the County Medical Officer of Health for the examination of pathological specimens are still in force and continue to work satisfactorily. During the year the following numbers of samples have been sent for examination:— Diphtheria 149 Ringworm 133 Sputum 25 Miscellaneous 4 311 CANCER. There were 115 deaths during the year, giving a death-rate of .92 per 1,000 of the population. INQUESTS. The following verdicts were recorded at Inquests held in the district during the year:— Natural Causes 49 Accident 17 12 Overlying 1, Asphyxia 1, Suffocation 6 8 Suicide (1 wound of throat, 1 hanging) 2 Drowning 4 Misadventure 9 Want of proper attention at birth 1 ARMED FORCES OF THE CROWN. The Registrar-General excludes from his returns from local areas the deaths of all members of the armed forces. Information was received of 7 such deaths of men belonging to Leyton, viz., 1 from each of the following diseases:— Bronchitis, Tuberculosis, Pneumonia, Cerebro-Spinal Meningitis, Scarlet Fever, Diabetes, and Cancer. Amongst the Scarlet Fever notifications one man was found to be in the forces. This notification is not included in Table II. He was removed to our hospital, where he made a good recovery. No other notifications of infectious disease were received among the members of the forces. HOUSING. House-to-house inspection is regularly carried on, especially in the poorer neighbourhoods, in which it is found that houses tend to become more or less insanitary chiefly owing to the class of tenants occupying them. STATEMENT, required by Article V. of the Housing (Inspection of District) Regulations, 1910, in regard to the inspection of dwelling-houses under section 17 (1) of the Housing, Town Planning, &c., Act, 1909. Number of dwelling-houses inspected under and for the purposes of the section 1561 Number of such dwelling-houses which were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 Number of dwelli. g-houses in respect of which representations were made to the local authority with a view to the making of closing orders Nil. 13 Number of dwelling-houses in respect of which closing orders were made by the local authority Nil. Number of dwelling-houses the defects in which were remedied without the making of closing orders 1264 Number of dwelling-houses which, after the making of closing orders, were made fit for human habitation Nil. General character of the defects found to exist in the dwelling-houses inspected Leaking drains; broken ventilating pipes; w.c. (lushing cisterns and pipes out of order; cracked and broken w.c. pans; broken, cracked and porous scullery sinks and waste pipes; leaking roofs; absence of, or broken paving around houses; holes in plaster of ceilings and walls; damp walls; want of ventilation under ground floors; general uncleanly conditions. CUSTOMS AND INLAND REVENUE ACT, 1890. Section 26 (2). The Medical Officer of Health received applications in respect of 8 tenements. As formerly, insistence on the provision of suitable storage for food was made a condition for the granting of certificates. SITUATION OF TENEMENTS. Address. No. of Tenements. Certificates granted. Certificates not granted. Melbourne Road, 30, 32, 34, 36 4 — 4 Melford Road, 64, 66, 68, 70 4 4 — 14 SENILE MORTALITY AND MORTALITY FROM CERTAIN DISEASES. The following table is designed to illustrate the relationship of cold and dampness of the atmosphere to the deaths of old people and to certain diseases. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Totals 60 to 65 years 11 9 3 10 7 9 6 6 2 7 10 11 91 65 to 70 years 13 7 13 8 11 6 9 3 6 8 7 10 99 70 to 80 years 26 23 17 18 11 9 16 14 14 6 22 24 200 80 to 90 years 12 9 12 12 12 1 9 4 4 9 4 13 101 90 years and upwards 3 2 ... ... 2 ... ... ... 2 3 1 2 15 Totals 65 50 45 48 43 25 40 27 28 31 44 60 506 Influenza 3 8 2 2 1 ... ... 1 1 ... 1 3 22 Phthisis 13 4 10 12 4 5 4 9 8 9 10 10 98 Rheumatic Fever ... ... ... 1 ... ... ... ... ... 1 ... 1 3 Bronchitis 35 17 22 22 7 5 4 2 3 4 11 23 155 Pneumonia (all forms) 23 10 10 12 5 6 4 2 2 5 7 11 97 Other diseases of Respiratory Organs ... 2 4 4 1 1 2 ... 2 3 ... ... 19 Nephritis and Bright's Disease 3 2 1 2 1 1 8 3 6 2 7 6 42 Diphtheria (notifications) 14 10 12 10 11 19 12 16 14 14 20 18 170 Rainfall in inches in Leyton 3 80 2.74 .76 1.06 3.11 .80 1.63 2.13 1.75 1.21 1.94 4.18 25.11 Number of days on which Rain fell 17 15 13 13 8 7 10 13 5 6 8 21 136 15 FACTORIES, WORKSHOPS, LAUNDRIES, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories... (Including Factory Laundries.) 9 2 Workshops (Including Workshop Laundries.) 675 87 Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) Totals 684 89 16 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. Number of Defects. Found. Remedied. (1) (2) (3) Nuisances under the Public Health Acts:— Want of Cleanliness 81 81 Want of ventilation 3 3 Overcrowding 10 10 Want of Drainage of floors ... ... Other nuisances 87 87 Sanitary accommodation insufficient 2 2 unsuitable or defective 52 52 not separate for sexes 5 5 Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) ... ... Breach of special sanitary requirements for bakehouses (ss. 97 to 100) 40 40 Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) ... ... Total 280 280 17 3.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Ordinary Workshops 252 Laundries 15 Bakehouses 40 Total Number of Workshops on Register 307 I.—OTHER MATTERS. Class. (1). Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 33 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901)— Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspector 2 Other ... Underground Bakehouses (s. 101) :— Certificates granted during the year ... In use at the end of the year 6 18 5.—HOME WORK. NATURE OF WORK. outworkers' Lists, section 107. outwork in unwholesome premises, section 108. outwork in infected premises, secs. 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Instances. Notices served. Instances. Orders made (s. 110). Sending twice in the year. Sending once in the year. Outworkers.* Outworkers. Lists.* Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Wearing Apparel— Making, &c. 121 605 32 ... 67 114 449 261 14 14 Cleaning and washing ... ... ... ... ... ... ... ... ... ... ... Household linen ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets, &c. ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... 1 1 ... ... Electro-plate ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... 19 Military water bottles ... ... ... ... ... ... ... 5 4 ... ... Brass and brass articles ... ... ... ... ... ... ... ... ... ... ... Fur pulling, &c. ... ... ... ... ... ... ... ... ... ... ... Cables and chains ... ... ... ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... ... ... ... Cart gear and whips ... ... ... ... ... ... ... 1 ... ... ... Locks, latches and keys, &c. 2 ... 3 ... ... ... ... ... ... ... ... Umbrellas, &c. ... ... ... ... ... ... ... 2 2 1 1 Artificial flowers ... ... ... ... ... ... ... 2 2 l l Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... 4 3 ... ... Paper, etc., boxes, paper bags 1 ... 17 ... ... ... ... 2 1 ... ... Brush making 4 ... 9 ... ... ... ... 2 2 1 l Pea picking ... ... ... ... ... ... ... ... ... ... ... Feather sorting, &c. ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c. ... ... ... ... ... ... ... ... ... ... ... Stuffed toys and leather boxes ... ... ... ... ... ... ... 1 1 ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... Chocolates and sweetmeats ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas crackers, Christmas stockings, &c. ... ... ... ... ... ... ... ... ... ... ... Textile weaving ... ... ... ... ... ... ... ... ... ... ... Linen packing condensors ... ... ... ... ... ... ... 1 1 ... ... Total 128 ... 834 32 ... 67 114 470 278 17 17 * No prosecutions were necessary. 20 FACTORY AND WORKSHOP ACTS, 1901 and 1907. Section 132 of the Factory and Workshop Act, 1901, states that the Medical Officer of Health shall report specifically in his Annual Report on the administration of these Acts in workshops and workplaces in the district, and send such report to the Secretary of State. Factories.—As regards factories, the administration of these Acts is chiefly under the supervision of H.M. Inspector of Factories. 9 visits were made to factories during 1915, and nuisances dealt with and remedied in 2 instances. Workshops and Workplaces.—The workshops and workplaces have been inspected and re-inspected, and where any contravention of the Factory and Workshop Acts has been noted, or any nuisance remediable under the Public Health Acts discovered, the premises have been re-visited until the defects found have been abated. The cleanliness and general condition of the rooms are for the most part satisfactory. Frequently the ventilation of the rooms is not good, although the means of ventilation is sufficient if used fully and correctly; advice is then given to the occupier, which is generally all that is necessary to put the matter right. At the beginning of 1915 the number of workshops and workplaces on the register was 303 and at the end of the year 307. The workrooms are grouped as follows :— Manufacture of blouses, underclothing, &c. 91 „ „ boots, shoes, &c 14 „ „ ties, neckwear, &c. 15 „ „ leather goods 1 „ „ walking sticks 1 „ „ brushes 2 „ „ polishes 1 „ „ scales 1 „ „ fancy paper articles 2 „ „ heating apparatus 1 21 Manufacture of ether sprays 1 „ „ wooden boxes 1 „ „ mats 1 „ „ drawing instruments 6 Dressmaking 40 Millinery 12 Tailoring and alteration of costumes 18 Art-needlework and embroideries 3 Corset-making 1 Bakehouses 40 Laundries 15 Cabinet-making, &c. 5 Shop-fitting 1 Picture framing 1 Opticians 1 Chopping firewood 7 Rag-sorting 3 Cycle repairing and motor works 4 Wheelwrights and carriage painter 3 Printing and book-binding 3 Sheet steel and asbestos works 1 Glass-cutting 1 Cork-cutting 1 Manufacture of military clothing, &c. 5 Making firelighters 2 Furriers 2 307 71 workshops have been removed from the register during the year, and of these 37 are closed entirely. In 16 cases the occupiers re-opened at another address in the district, and in 18 instances it was found that the occupiers had left the neighbourhood. As required by Section 133 of this Act, H.M. Inspector of Factories was informed of 33 occupiers of workshops who had 22 failed to affix in their workrooms an Abstract of the Act in accordance with Section 128. 675 inspections of workshops have been made during the year, and defects numbering 280 were found to exist. On the necessary steps being taken the nuisances were remedied. Notices were received from H.M. Inspector of Factories of nuisances remediable under the Public Health Acts existing in factories and workshops, details of which I give below, with the result of the action taken:— Notice received. Description of Premises. Nuisance notified. Reply to Factory Inspector. Result of action taken. 1/3/15 Workshop One sanitary convenience males and females employed 26/4/15 Employment of females tinued 25/5/15 Factory Sanitary convenience opens direct to machine at which boy works 29/5/15 Nuisance abated Homework.—The Factory and Workshop Act, 1901, provides that we shall be notified of the addresses of outworkers (in certain specified trades), living in our district, twice yearly. A register is kept of the names and addresses of these outworkers, and the homes are regularly inspected. Powers under the Act are given to the District Council for controlling the conditions under which the work is done in the homes of the workers, and generally a hygienic standard is secured. All insanitary conditions found to exist are dealt with and the necessary action taken to abate nuisances. Infectious diseases occurred in the homes of 17 outworkers, but immediate steps were taken to prevent the spread of the disease; the outwork was disinfected by us, and the Medical Officer of the Council in whose district the employer resided was advised of the case. In instances where the patient was treated at home, further work was forbidden on the premises until all risk of the infection was over. Infectious diseases also occurred 23 in 5 other homes where work was being taken in (3 private dressmaking and 2 washing). Articles in the houses were disinfected before being returned to the owners. In 1915, 768 outworkers were notified by other Councils, and 18 other addresses sent to us in error were drafted to the proper authorities. Lists containing 330 names have been forwarded to other Councils in whose districts outworkers, employed by Leyton firms, reside. To Walthamstow 166 „ Hackney 51 „ West Ham 48 „ Stepney 28 „ Tottenham, Holborn, Guildhall, Enfield, Mile End (2 each) 10 „ Poplar 4 „ East Ham 3 „ Islington 5 „ Chingford 7 „ Shepherds Bush, Camberwell, Bethnal Green, Shoreditch, Bow, Stamford Hill, Woodford, Victoria Park (1 each) 8 330 Circular letters are sent out in February and August to employers who neglect to forward their lists of outworkers by the first day of these months, with the result that the necessary information is generally forthcoming on the receipt of these Reminder Notices without further trouble. 1,692 visits were paid to outworkers' premises and 1,437 inspections of their homees were made. In 255 cases it was found that the addresses returned on the list were incorrect, or that the outworker had removed since the previous visit. Every effort was made to trace removals. Uncleanly and insanitary conditions in 470 instances were found and dealt with. 24 ISOLATION HOSPITAL. The Temporary Isolation Hospital has accommodation for 70 Scarlet Fever and 22 Diphtheria patients. The nursing has been carried out satisfactorily under the supervision of the Matron, Miss Ryan. Minor changes have occurred in the personnel, but the number of the staff has remained the same as in previous years. A new floor composed of "Woodura" has been laid down and new bedsteads have been provided in the Male Scarlet Fever Ward. The whole of the corrugated iron roofs have been re-painted. PATIENTS. The total number of patients treated during the year was 433, which is the largest number admitted since 1907. The total number of patients' days in hospital was 18,474. The total amount expended on the Hospital was £3,539 17s. 8d., which gives an average cost of 3s. 9'9d. per patient per diem. The amount expended on provisions was £1,066 0s. 10d., which includes the cost of food for the Staff. This gives a daily average of 1s. l.8d. per patient. STATISTICAL RETURNS. Admissions. At all ages. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. Scarlet Fever 326 2 53 219 38 13 1 Diphtheria 107 1 33 66 1 5 1 Totals 433 3 86 285 39 18 2 25  Scarlet Fever. Diphtheria. Under treatment at beginning of year 52 17 Under treatment at end of year 50 13 Admitted during year 326 107 Discharged during year 319 99 Died during year 8 12 Sex of Patients Admitted. Males. Females. Scarlet Fever 158 168 Diphtheria 59 48 Tracheotomy was performed on seven occasions, in three of which it resulted in saving the life of the child. 59 cases of Scarlet Fever and 27 cases of Diphtheria were treated on the "barrier" system. SCARLET FEVER. The causes of death were: Malignant Scarlet Fever 1, Scarlatina Anginosa 3, Scarlet Fever complicated by Measles 2, Marasmus 1, Syncope 1. DIPHTHERIA. The causes of death were: Laryngeal 5, Syncope 2, Hæmorrhagic 2, Toxaemia 2, Paralysis 1. The amount of money expended on the Hospital during the year was £3,539 17s. 8d., and is divisible into the following items:—  £ s. d. Buildings—Repairs and maintenance of Buildings in General 205 14 6 Furniture and Repairs 37 6 9 Bedding, Linen, etc. 43 18 0 Domestic Utensils 18 9 2 Fuel, Light, Water, and Cleaning 523 16 8 Rates, Printing, Stationery, and Administrative Charges 272 0 0 Medicines, Drugs, and Surgical Appliances 81 14 7 Provisions 1066 0 10 Removal, etc., of Patients 210 15 11 Uniforms 47 11 8 Salaries, Wages, and Allowances 1032 9 7 £3539 17 8 26 REPORT OF SANITARY INSPECTOR. TO THE CHAIRMAN AND MEMBERS OF THE LEYTON URBAN DISTRICT COUNCIL. Gentlemen, I beg to submit to you my Twenty-fifth Annual Report for the year ending December 31st, 1915. INFECTIOUS DISEASE. 1,061 cases of Infectious Diseases were notified during the above-mentioned period. Under the direction and supervision of the Medical Officer of Health, the houses where cases of Infectious Diseases occur are visited, instructions given as to isolation of the patients, and in the cases of those treated at home subsequent visits are made to see that the isolation is being properly carried out. Enquiries are made as to schools attended, number of inmates, and how employed, and instructions are given as to the precautions to be adopted to prevent the spread of the disease. Appended is a summary of the work in connection therewith : Houses disinfected and the sanitary arrangements examined and tested: Tuberculosis Cases 145 Other Infectious Diseases 609 Loads of infected bedding removed to be disinfected at the Council's Steam Disinfector and returned 660 Books belonging to Public Institutions disinfected 57 Number of articles of wearing apparel disinfected 331 Number of Notices to Education Department, Schools and Public Libraries with regard to Infectious Diseases 1015 27 Disinfectants are supplied in cases of Infectious Disease, and can be obtained at the Town Hall at any time during office hours. INSPECTION OF THE DISTRICT AND ABATEMENT OF NUISANCES. Complaints received from the inhabitants of the district have been promptly dealt with, and, where necessary, notices have been served to remedy insanitary conditions found to exist. The House to House inspection has been carried out in different parts of the district. Insanitary conditions found to exist have been remedied and in many cases structural work was efficiently carried out. The House to House inspection has taken place in the following roads:— Skelton's Lane, Leyton. Chichester Road, Leytonstone. Burchell Road, Leyton. Sansom Road, Leytonstone. Sidmouth Road, Leyton. Matcham Road, Leytonstone. Sophia Road, Leyton. Napier Road, Leytonstone. Byron Road, Leyton. Scarborough Road, Leytonstone. Claude Road, Leyton. Cavendish Drive, Leytonstone. Shortlands Road, Leyton. Borthwick Road, Leytonstone. Dagenham Road, Leyton. Marlborough Road, Leytonstone. Norton Road, Leyton. Arundel Road, Leytonstone. Millicent Road, Leyton. Ravenstone Road, Leytonstone. Vicarage Road, Leyton. Davies Lane, Leytonstone. Rosebank Road, Leyton. Norman Road, Leytonstone. Myrtle Road, Leyton. Cowley Road, Leytonstone. Violet Road, Leyton. Russell Road, Leyton. 28 SUMMARY OF INSPECTIONS AND RESULTS Total number of houses and premises inspected 9478 „ „ houses and premises re-inspected 8461 Number of visits to slaughter houses 995 „ „ dairies, cowsheds and milkshops 510 „ „ food shops 1134 „ „ bakehouses 148 „ „ workshops 684 „ „ offensive trade premises 1016 Miscellaneous inspections 317 Complaints received 414 Nuisances detected without complaint 2620 Nuisances abated 3034 Notices served and letters written in reference to same 3873 Intimations to Metropolitan Water Board re waste of water 50 Defective drains remedied 173 Choked drains cleared 259 Drain manholes properly covered or sealed 33 Defective gullies or connections and percolation around same remedied 550 Air inlets provided to drains or repaired 58 Houses entirely re-drained with intercepting traps and manholes provided between the house drains and sewer and with efficient air inlet and outlet ventilators 83 Foul w.c.'s and drains cleansed 167 Defective w.c.'s repaired, new traps and straight backed pans provided where necessary 268 Defective w.c. flush cisterns and flush pipes renewed or repaired and water supply provided 211 Defective soil pipes repaired or renewed 17 Ventilating shafts repaired or provided to soil pipes and drains 107 29 Foul and defective sinks cleansed or renewed 150 Sink, bath and lavatory waste pipes and rain pipes trapped or disconnected 95 Defective sink, bath and lavatory waste pipes renewed or repaired 210 Defective rain pipes and gutters renewed or repaired 476 Defective house roofs repaired 364 Defective floors of sculleries or cellars repaired, paved or concreted 87 Yards around back additions of houses and forecourts paved or repaired 254 Yards cleansed 44 Houses in a general insanitary, dilapdidated or filthy condition repaired and cleansed 1196 Houses unfit for human habitation closed 2 Damp conditions in house or part of house remedied 652 Ventilation provided under ground floors 366 Nuisances arising from stagnant water in basement of houses abated 29 Nuisances arising from insanitary condition of stables abated 18 Manure reseptacles provided 20 Mews in filthy condition paved, drained and cleansed 14 Water supplies to houses restored and water fittings repaired 92 Domestic water cisterns removed from improper positions or cleansed or repaired 19 Covers to domestic water cisterns provided 66 Nuisances caused by overcrowding abated 17 Nuisances caused by fish, offal, manure and other refuse deposits abated 216 Nuisances caused by animals kept in an insanitary state abated 59 30 Smoke nuisances abated 8 Foul and defective urinals cleansed or repaired 9 Vacant plots of land fenced in 6 Insanitary conditions in slaughterhouse premises remedied 10 Insanitary conditions in bakehouse premises remedied 40 Insanitary conditions in dairy, cowshed and milk- shop premises remedied 30 Insanitary conditions in food shop premises remedied 61 Insanitary conditions in rag and bone premises remedied 27 DRAINAGE. The drainage of 83 houses has been reconstructed. In many cases the drains formed portions of combined systems of drainage, and in such instances the work has been done by the Council's workmen and the expenses incurred have been recovered from the owners. During the year 9 ventilating shafts were provided to the public sewers. LEGAL PROCEEDINGS. 54, Acacia Road, Leytonstone. 36, Birkbeck Road, Leytonstone. 3, Montague Road, Leytonstone. 118, Grange Park Road, Leyton. Proceedings were instituted against the owners of the above houses for non-compliance with notices requiring certain sanitary defects to be remedied. In three of the cases the necessary work was completed before being dealt with by the magistrates, and in the other instance an abatement order was made, the work required being then carried out and the costs paid by the owner. 31 MEAT AND FOOD INSPECTION. A large amount of time and attention has been given to the inspection of meat and other food in shops, stalls and slaughterhouses, also any uncleanly or insanitary conditions found on the premises being dealt with. In connection with the inspection a quantity of unsound food was destroyed. It consisted of :— 1 Bullock Carcase. 4 Pig Carcases. 3 Sheep Carcases. Forequarters of Bullock. Portion of Calf Carcase. „ Belly of Pork. „ Leg of Lamb. 5 Breasts of Mutton. 3 Scrags of Mutton. 14 lbs. of Beef. 17 Livers. 5 Beasts' Lungs. 1 Pig's Pluck. Viscera of 1 Heifer. „ 1 Bullock. 1 Pig- 2 boxes of Dabs. 8 stones of Haddock. 2 hampers of Haddock. 94 tins of Salmon. 1 basket of Mackerel. 1 case of Eels. 1 box of Soles. 5 stones of Codlings. 164 lbs. of Cod Fish. 14 cases of Oranges. 69 baskets of Strawberries. SLAUGHTERHOUSES. The Slaughterhouses are visited continually, and at any time when it is known that slaughtering is being carried on. We find that generally the bye-laws relating to them are well observed. Keepers of Slaughterhouses. Norwood, A. & Son, 650, High Road, Leytonstone. Wilson, W. H., 249, High Road, Leytonstone. Furze, E. R., 412, High Road, Leytonstone. Nichols, A. A., 710, High Road, Leytonstone. Woollard, T. F., 728, High Road, Leytonstone. Harmer, C. & Sons, 168, High Road, Leytonstone. Rumbal, J. H., 615, High Road, Leyton. Seagrave, W., 442, High Road, Leyton. Measures, J., 807, High Road, Leyton. 32 Smith, A. J., 48, Lansdowne Road, Leytonstone. Carr, A. H., 55, Hainault Road, Leytonstone. Abbott, E., Hainault Road, Leytonstone. Frost, S., 155, Ashville Road, Leytonstone. Gattrill, C. F., 177, Francis Road, Leyton. Wright, G., 540, Lea Bridge Road, Leyton. Smith, M., 467, High Road, Leytonstone. Stratford Co-operative and Industrial Society, Ltd., South Birkbeck Road, Leytonstone. DAIRIES, COWSHEDS, AND MILKSHOPS. The number of dairies, cowsheds, and milkshops on the register for the year ending December 31st, 1915, was 165. There are at present 6 cowsheds in use in the district; these, together with the dairies and milkshops, are visited periodically, special attention being given to the cleanliness of the premises and general sanitary conditions. BAKEHOUSES. The bakehouses in the district have been frequently visited during the year. The majority are kept in a very satisfactory condition; where necessary, notices have been served as regards uncleanly or other insanitary conditions. OFFENSIVE TRADES. The offensive trade premises in the district, including rag and bone dealers and fried fish shops, have been frequently visited, and where necessary steps have been taken to sec that the bye-laws relating to same were duly observed. MORTUARY. During the year the number of bodies received was 86. There were 57 post-mortems and 85 inquests held. PETROLEUM. 23 licenses were issued after inspection as to the suitability of the premises. 33 DUST COLLECTION. 21,123 tons of house refuse, comprising 17,017 loads, were removed in 1915 to the Destructor. During the year considerable difficulty has been experienced in the dust collection owing to the scarcity of labour due to the war. Leaflets have been posted in the district advising householders to burn as much of their refuse as possible and generally this has been observed. I am, Gentlemen, Your obedient Servant, H. MILLER. 34 TABLE I. Vital Statistics of Whole District during 1915 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1000 Nett Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1910 123300 — 3011 24.4 2125 17.2 1028 15 191 63.4 1112 9.0 1911 124736 2903 2931 23.5 2555 20.5 1250 168 327 111.6 1473 11.8 1912 126700 2776 2797 22.1 2302 18.2 1147 188 223 79.7 1343 10.6 1913 129366 2858 , 2904 22.4 2120 16.4 992 208 242 83.3 1336 10.3 1914 130847 2751 2800 21.4 2163 16.5 1034 234 219 78.2 1363 10.4 1915 124497 2595 2655 21.3 2462 19.8 1225 273 225 84.7 1510 12.1 Rates in columns 5, 7, and 13 calculated per 1000 of estimated gross population. Area of District in acres (land and inland water) 2594 Total population at all ages 124735 Total families or separate occupiers 27346 At census 1911. 35 Table II.—Cases of Infectious Disease Notified During the Year 1915, including Cases which OCCURRED in West Ham Union, Infirmary, &c., but NOT those Imported. NOTIFIABLE DISEASE. Number of Cases Notified. Total Cases Notified in each Locality— Wards. Total Cases removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 8 9 Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Leyton. Lea Bridge. Central. Forest. Leytonstone Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C) Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *Diphtheria (including Membranous Croup) 170 1 56 92 4 16 1 ... 12 42 37 16 11 7 16 17 12 128 †Erysipelas 78 ... 5 8 8 23 24 10 10 6 14 18 4 5 7 10 6 13 ‡Scarlet Fever 471 3 88 314 43 21 2 ... 38 68 126 49 17 23 65 52 33 325 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 8 ... ... ... 3 4 1 ... 1 ... 3 3 ... ... ... 1 ... 6 Relapsing Fever (R) Continued Fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 2 4 ... ... ... ... 1 ... 1 2 2 ... ... 6 Cerebro-spinal Meningitis 4 ... 2 2 ... ... ... ... 1 1 ... 1 ... 1 ... ... ... 2 Poliomyelitis 3 ... 2 1 ... ... ... ... ... 1 ... ... 1 ... ... ... 1 2 Ophthalmia Neonatorum 15 15 ... ... ... ... ... ... 1 2 ... 1 ... 3 4 3 1 3 §Pulmonary Tuberculosis 235 ... 1 36 48 103 42 5 19 40 46 21 18 16 32 25 16 51 Other forms of Tuberculosis 70 2 22 26 8 8 3 1 8 13 10 8 2 3 13 8 5 17 Totals 1060 21 176 479 116 179 73 16 90 173 237 115 54 60 139 116 74 553 *One case occurred in Bethnal Green Schools. †Two cases occurred in West Ham Workhouse, two in West Ham Infirmary, and one in "Forest House," James Lane. ‡One case occurred in Bethnal Green Schools. § Three cases occurred in West Ham Workhouse, one in Bethnal Green Schools—Two cases homeless. 36 TABLE III. DEATHS.—1915. Ages.—Whole Year. Wards.—Whole Year. CAUSES OF DEATH. 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 45 years. 45 and under 65 years. 65 and upwards. In Public Institutions in the District. Leyton. Lea Bridge. Central. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward not known. Totals. Not belonging to district. Belonging to district. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 All Causes Certified 1510 225 59 80 64 64 195 329 494 1225 266 111 •223 267 157 162 149 165 136 117 23 ... Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 2 ... ... ... ... ... 2 ... ... 3 1 1 ... ... 1 ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 41 8 9 18 6 ... ... ... ... 17 5 4 5 4 4 3 8 8 1 4 ... ... Scarlet Fever 10 ... 1 2 6 1 ... ... ... ... ... 2 2 3 1 ... ... 1 1 ... ... ... Whooping Cough 28 12 12 4 ... ... ... ... ... 11 6 2 5 2 3 2 3 4 2 5 ... ... Diphtheria and Croup 19 ... ... 13 5 ... ... 1 ... ... ... ... 6 6 ... ... 1 4 1 1 ... ... Influenza 23 ... ... 1 1 2 5 6 8 8 2 2 2 4 4 3 2 4 2 ... ... ... Erysipelas 7 ... ... ... ... 1 1 1 4 12 4 3 1 ... ... ... ... 1 1 1 ... ... 37 Phthisis (Pulmonary Tuberculosis) 114 ... 1 1 4 23 51 32 2 192 31 5 24 14 14 12 10 9 14 10 2 ... Tuberculous Meningitis 24 3 6 10 4 ... 1 ... ... 11 2 ... 2 5 2 ... 3 10 2 ... ... ... Other Tuberculous Diseases 22 4 3 5 3 2 4 1 ... 34 6 ... 2 5 2 1 1 4 5 2 ... ... Cancer, malignant disease 115 ... ... ... ... 3 9 52 51 73 14 9 13 20 12 21 5 14 15 2 4 ... Rheumatic Fever 3 ... ... ... 2 ... ... 1 ... 3 1 ... ... ... ... 2 ... 1 ... ... ... ... Meningitis 8 3 2 3 ... ... ... ... ... 7 3 ... 3 1 1 ... 1 2 ... ... ... ... Organic Heart Disease 136 ... ... 1 4 4 19 47 6i 110 23 13 19 19 13 22 15 10 10 13 2 ... Bronchitis 168 16 3 3 4 3 6 28 105 136 35 8 31 31 26 15 19 14 6 10 8 ... Pneumonia (all forms) 112 29 10 6 3 4 18 22 20 88 22 9 17 18 9 7 13 18 15 4 2 ... Other diseases of Respiratory Organs 27 ... 1 ... ... 1 6 7 12 25 2 2 6 2 3 2 3 1 2 5 1 ... Diarrhœa and Enteritis 28 24 2 1 ... ... ... ... 1 26 2 ... 4 7 ... 1 7 4 1 4 ... ... Appendicitis and Typhlitis 2 ... ... ... ... 1 ... 1 ... 2 1 ... ... ... ... 1 ... 1 ... ... ... ... Cirrhosis of Liver 14 ... ... ... ... ... 2 9 3 12 3 2 2 1 1 1 3 2 1 1 ... ... Alcoholism 3 ... ... ... ... ... 1 2 ... 4 2 1 ... 1 ... ... ... ... ... 1 ... ... Nephritis and Bl ight's Disease 46 ... 1 3 2 1 7 15 17 40 12 5 6 10 5 4 2 6 4 4 ... ... Puerperal Fever 1 ... ... ... ... ... 1 ... ... 2 1 ... ... ... ... ... ... ... ... 1 ... ... Other accidents and diseases of Pregnancy and Parturition 7 ... ... ... ... 1 6 ... ... 4 1 1 2 3 ... ... ... 1 ... ... ... ... Congenital Debility and Malformation, including Premature Birth 97 94 1 2 ... ... ... ... ... 57 16 7 13 20 12 4 14 10 6 11 ... ... Violent Deaths, excluding Suicide 49 6 3 4 4 3 8 4 17 48 8 2 6 13 6 6 7 3 1 4 1 ... Suicide 9 ... ... ... ... ... 4 4 1 2 ... ... 2 3 1 ... 3 ... ... ... ... ... Other Defined Diseases 311 26 4 3 16 14 44 93 111 197 43 27 44 52 30 42 23 27 36 30 ... ... Diseases Ill-defined or Unknown 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Old Age 83 ... ... ... ... ... ... 2 81 101 20 6 6 23 7 13 5 6 10 4 3 ... 1510 225 59 80 64 64 195 329 494 1225 266 111 223 267 157 162 149 165 136 117 23 ... Sub-Entries included in above figures— Cerebro spinal Meningitis 3 ... 2 1 ... ... ... ... ... 3 ... ... 2 ... ... ... ... 1 ... ... ... ... Poliomyelitis 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 38 Table No. IV. INFANTILE MORTALITY DURING THE YEAR 1915. Nett Deaths from Stated Causes at various Ages under One Year of Age. CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 Months and under 6 Months. 6 Months and under 9 Months 9 Months and underl2Months. Total Deaths under 1 Year. All Causes Certified 45 16 7 9 77 63 26 35 24 225 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... 1 ... ... 1 ... 1 1 5 8 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ... ... 1 1 2 2 5 2 12 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 1 3 Abdominal Tuberculosis ... ... ... ... ... 2 ... ... 1 3 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... 2 1 ... 3 39 Convulsions 3 ... ... ... 3 2 1 ... ... 6 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 2 1 2 5 4 3 1 3 16 Pneumonia (all forms) ... 1 ... ... 1 4 5 14 5 29 Diarrhœa ... ... 1 ... 1 4 ... 3 2 10 Enteritis ... ... ... ... ... 5 5 4 ... 14 Gastritis ... ... ... ... ... 2 ... ... ... 2 Syphilis ... ... ... ... ... 2 ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... 1 1 2 3 1 ... ... 6 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Atelectasis 7 ... 1 ... 8 ... ... ... ... 8 Congenital Malformations 4 1 ... 1 6 4 1 ... 1 12 Premature Birth 24 6 1 1 32 7 1 ... ... 40 Atrophy, Debility and Marasmus 4 4 2 2 12 20 4 4 2 42 Other Causes 2 1 ... 1 4 2 ... ... 1 7 Totals 45 16 7 9 77 63 26 35 24 225 Nett Births registered during] the calendar year Legitimate 2,587 Nett Deaths registered during the calendar year Legitimate infants 218 Illegitimate 68 Illegitimate infants 7 40 Table IVa. INFANTILE MORTALITY DURING THE YEAR 1915. Deaths from Stated Causes as they occurred in the various Wards under One Year of Age. CAUSE OF DEATH. Leyton. Lea Bridge. Central. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward not known. Total Deaths under 1 Year. All Causes Certified 11 37 46 28 7 32 26 16 21 1 225 Uncertified ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... Measles 1 1 2 1 ... ... 2 ... 1 ... 8 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... 4 1 1 1 1 ... 1 3 ... 12 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... 1 2 ... ... ... 3 Abdominal Tuberculosis ... ... ... 1 ... ... 1 1 ... ... 3 Other Tuberculous Diseases ... ... 1 ... ... ... ... ... ... ... 1 Meningitis (not Tuberculous) ... ... 1 1 ... 1 ... ... ... ... 3 Convulsions 1 1 2 ... ... 1 ... ... 1 ... 6 il Laryngitis ... ... ... ... ... ... ... ... ... ... ... Bronchitis 1 6 2 6 ... ... ... 1 ... ... 16 Pneumonia (all forms) 2 5 5 1 1 5 6 3 1 ... 29 Diarrhœa ... 3 3 ... ... 3 ... ... 1 ... 10 Enteritis ... ... 3 ... 1 2 4 1 3 ... 14 Gastritis ... 1 ... ... ... ... ... 1 ... ... 2 Syphilis ... ... ... 1 ... ... ... ... 1 ... 2 Rickets ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... 2 ... 4 ... ... ... ... 6 Injury at Birth ... ... ... ... ... ... ... ... ... 1 1 Atelectasis ... 1 4 2 ... ... ... l ... ... 8 Congenital Malformations 2 2 4 ... 1 1 1 ... 1 ... 12 Premature Birth 1 9 7 4 2 3 5 6 3 ... 40 Atrophy, Debility and Marasmus 3 2 9 8 1 10 4 ... 5 ... 42 Other Causes ... 2 2 ... ... ... 1 1 1 ... 7 Totals 11 37 46 28 7 32 26 16 21 1 225 Nett Births registered during, the calendar Year Legitimate 2,587 Nett Deaths registered during the calendar Year Legitimate Infants 218 Illegitimate 68 Illegitimate Infants 7 Leyton Urban District Council. ANNUAL REPORT to the EDUCATION COMMITTEE, embodying the EIGHTH ANNUAL REPORT on the MEDICAL INSPECTION OF SCHOOL CHILDREN Under the Education (Administrative Provisions) Act of 1907, For the Year 1915, by ALFRED BALL, M.D.lond., D.P.H. Deputy Medical Officer of Health. ILFORD: South Essex Recorders, Limited, High Road. 45 TO THE CHAIRMAN AND MEMBERS of the LEYTON EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I beg to present the Eighth Annual Report on the work of the School Medical Service in Leyton under the Education (Administrative Provisions) Act of 1907. In the Schools the medical inspection of "Entrants" and "Leavers" has been carried out, but with the consent of the Board of Education the examination of an intermediate group, consisting of 8 year old children, has been deferred for the duration of the war. The School Clinics at the Town Hall have dealt with children suffering from minor ailments, defective vision and dental defects, and have been maintained in full activity; the inspection clinic has also been held each morning. My best thanks are due to the members and officials of the Education Committee for the assistance which they have rendered me on many occasions. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, ALFRED BALL. 46 CHANGES DUE TO THE WAR. The work of the School Medical Department has been carried on under difficulties during 1915. Dr. Taylor has been absent on military service throughout the year. Both of the junior clerks have enlisted in the Army and their places have been taken by untrained substitutes, and in addition other members of the Staff have been away temporarily through illness. Medical inspection in the Schools was undertaken by Dr. Shannan until April, when she resigned, and from June 22nd by Dr. Alice Stalker, who was appointed Temporary Assistant Medical Officer in her place. Both of these ladies have had considerable previous experience in the work and they have rendered excellent service to the Council. SCHOOL ACCOMMODATION. In Leyton there are 20 Public Elementary Schools with 52 departments and accommodation for 22,851 children. The re-building of High Road School and the proposed extensions at Canterbury Road School have been postponed owing to the war. CHILDREN ON THE REGISTERS. The average number of children on the registers during the year ended 31st December, 1915, was 21,301. The number on the registers in 1910 was 20,337. MEDICAL INSPECTION: ARRANGEMENTS AND SCOPE. The co-ordination of the School Medical and Public Health services is complete, being carried out in the office of the Medical Officer of Health, who is also School Medical Officer. The actual inspections in the Schools are performed by the Assistant Medical Officer who is accompanied by a School Nurse. During the year two groups of children have been dealt with, viz., those newly admitted to school who are known as Entrants, and those who are due to leave school before the date of the next medical inspection, known as Leavers. The examination of 47 an intermediate group comprising all 8 year old children has been postponed until after the war with the consent of the Board of Education. Children who at previous inspection have been found in need of treatment have been re-examined, and others known as " Specials," on whom Head Teachers desired an opinion, have also been inspected. At the end of the vear GG children, who were due for examination as "Leavers," had not been seen. These were inspected this year, but for the sake of completeness they are included in the figures for 1915. Head Teachers have sent notices to the parents of children about to be inspected, informing them of the date and time when their children would be examined and inviting them to be present. These invitations were accepted as follows:—Of the Entrants, 86.3% of the boys and 90% of the girls; and of the Leavers, 44.5% of the boys and 76.5% of the girls were accompanied by a parent. All examinations have been conducted on school premises, usually in a class room and sometimes in a teacher's room. There have been but few objections by parents to the medical examination of their children. The objections were received at the following Schools:— Call Hall Road 8 Canterbury Road 4 Capworth Street 1 Church Road 1 Davies Lane 1 Farmer Road 3 Goodall Road 2 Kirkdale Road 4 Mayville Road 1 Newport Road 3 Norlington Road 7 48 Ruckholt Road 7 St. Joseph's 1 Trumpington Road 4 In the case of children found to be in need of treatment the defect was pointed out to the parent if present, or a note was sent home advising that treatment should be sought; in addition, the particulars were entered on a special "following up" card which was available for use at the next visit of the doctor to the School, when further notes were added, and the information thus obtained has been embodied in the table headed "Treatment of Defects of Children during 1915." Dental Inspection is carried out by the Dentist in the Schools and consists in the inspection of the teeth of all children who are six years of age. 49 Table 1.—Number of Children Inspected, 1915. A "Routine" Groups. Age. Entrants. 3 4 5 6 Other ages. Total. Boys 0 0 745 402 114 1261 Girls 0 0 645 408 117 1170 Totals 0 0 1390 810 231 2431 Leavers. Grand Total. 12 13 14 Other ages. Total. 105 856 9 2 972 2233 101 754 11 0 860 2036 206 1610 20 2 1838 4069 B Groups other than "Routine." Intermediate Groups. Special Cases. No. of Re-examinations. Boys None 119 1078 Girls 172 Totals 291 1078 50 CHILDREN ENTERING SCHOOL FOR THE FIRST TIME-" ENTRANTS." The number examined at each age and average height and weight were as follows:— BOYS. GIRLS. Ages. No. Examined. Height. Weight. No. Examined. Height. Weight. ins. lbs. ins. lbs. 5-6 745 41.5 37.9 645 41.1 36.5 6-7 402 42.3 41.9 408 39.3 41.2 7-8 103 46.1 46.5 98 45.5 45.2 8-9 11 48.2 52.7 17 47.7 51.1 9-10 0 0 0 2 48.7 53.2 The children had suffered previously from Infectious Diseases to the following extent:— Measles. Whooping Cough. Chicken Pox. Scarlet Fever. Diphtheria. Tuberculosis in family. Boys 5-6 551 355 264 39 9 40 „ 6-7 307 200 143 23 14 23 „ 7-8 87 61 45 13 4 5 „ 8-9 10 6 4 1 0 0 Girls 5-6 450 352 221 24 5 33 „ 6-7 316 245 165 17 6 24 „ 7-8 79 64 50 10 14 6 „ 8-9 16 16 10 0 0 0 „ 9-10 2 1 0 0 0 0 51 CHILDREN ABOUT TO LEAVE SCHOOL."LEAVERS." The number examined at each age and the average height and weight were as follows:— BOYS. GIRLS. Ages. No. Examined. Height. Weight. No. Examined. Height. Weight. ins. lbs. ins. lbs. 11-12 2 50.37 58.2 0 .0 .0 12-13 105 56.5 75.7 101 57.0 58.0 13-14 856 57.1 77.3 754 59.7 81.6 14-15 9 59.1 83.4 11 60.4 89.4 The children had suffered previously from Infectious Diseases to the following extent:— Measles. Whooping Cough. Chicken Pox. Scarlet Fever. Diphtheria. Tuberculosis in family. Boys 11-12 2 2 1 0 0 0 12-13 90 69 63 23 5 0 13-14 650 457 372 132 38 9 14-15 7 4 5 4 0 0 Girls 12-13 91 65 65 19 11 0 13-14 684 493 435 116 47 2 14-15 10 7 5 1 0 0 CONDITION AS TO VACCINATION REVEALED AT SCHOOL INSPECTION. Entrants. Leavers. Total. Percentage. Boys. Girls. Boys. Girls. Boys. Girls. No mark 515 496 246 190 761 686 33.9 One mark 74 64 60 58 134 122 6.0 Two marks 162 128 118 129 280 257 12.6 Three marks 74 79 134 117 208 196 9.5 Four marks 436 403 414 372 850 775 38.0 52 TABLE Return Showing the Physical Condition. Entrants. Boys. Girls. Total. Per Cent. Total Inspected. 1261 1170 2431 ... Clothing Satisfactory 1226 1142 2368 97.4 Unsatisfactory 35 28 63 2.5 Footgear Satisfactory 1212 1117 2329 95.8 Unsatisfactory 49 53 102 4.1 Cleanliness of head Clean 1175 838 2013 82.8 Nits 72 319 391 16.0 Pediculi 14 13 27 1.1 Cleanliness of body Clean 1177 1079 2256 92.8 Flea-bitten and Dirty 74 78 152 6.2 Pediculi 12 13 25 1.0 Nutrition Excellent 29 30 59 2.4 Normal 1055 1014 2069 85.1 Below Normal 162 111 273 1.1 Bad 15 15 30 1.2 Nose and Throat No defect 1000 915 1915 78.7 Mouth Breathers 15 4 19 0.7 Tonsils slightly enlarged 60 50 110 4.5 Tonsils much enlarged 117 99 216 8.8 Adenoids slight 28 15 43 1.7 Adenoids marked 41 38 79 3.2 Other affections 22 12 34 1.0 External Eye Disease No disease 1246 1150 2396 98.5 Blepharitis 10 13 23 0.9 Conjunctivitis 3 1 4 0.1 Corneal Opacity 3 2 6 0.2 Other disease 3 4 7 0.2 Ear Disease No disease 1254 1154 2408 99.0 Obstruction Right 2 3 5 0.2 Left 1 2 3 0.1 Otorrhœa Right 2 7 9 0.3 Left 3 4 7 0.2 Other disease 0 0 0 0.00 Teeth Sound 283 308 591 24.3 Less than four Decayed 520 459 979 40.2 Four or more Decayed 453 394 847 34.8 Sepsis 5 10 15 0.6 53 II. Condition of Children Inspected. Leavers. Total. Special Cases. Hoys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. 972 866 1838 ... 2233 2030 4269 ... 119 172 291 965 858 1823 99..1 2191 2000 4191 98.1 ... ... ... 7 8 15 0.8 42 36 78 1.8 ... ... ... 943 855 1798 97.8 2155 1972 4127 96.6 ... ... ... 29 11 40 2.1 78 64 142 3.3 ... ... ... 937 647 1584 86.1 2112 1485 3597 84.2 ... ... ... 26 207 233 12.6 98 526 624 14.6 ... 3 3 9 12 21 1.1 23 25 48 1.1 ... 3 3 892 799 1691 92.0 2069 1878 3947 92.4 ... ... ... 68 57 125 6.8 142 135 277 6.4 2 2 4 12 10 22 1.1 24 23 47 1.1 ... 2 ... 43 89 132 7.1 72 119 191 4.4 ... ... ... 879 739 1618 88.0 1934 1753 3687 86.3 ... ... ... 42 34 76 4.1 204 145 349 8.1 ... ... ... 8 4 12 0.6 23 19 42 0.9 ... 1 1 819 729 1548 84.2 1819 1644 3463 81.1 ... ... ... 6 4 10 0.5 21 8 29 0.6 1 ... 1 50 68 118 6.4 110 118 228 5.3 2 2 4 65 52 117 6.3 182 151 333 7.8 4 4 8 31 17 48 2.6 59 32 91 2.1 1 4 5 14 2 16 0.8 55 40 95 2.2 4 6 10 12 9 21 1.1 34 21 55 1.2 2 4 6 948 841 1789 97.3 2194 1991 4185 98.0 ... ... ... 10 11 21 1.1 20 24 14 1.0 3 6 9 7 6 13 0.7 10 7 17 0.3 ... 2 2 5 4 9 0.4 8 6 14 0.3 1 2 3 2 4 6 0.3 5 8 13 0.3 1 1 2 952 856 1808 98.3 2206 2010 4216 98.7 ... ... ... 3 2 5 0.2 5 5 10 0.2 1 ... 1 2 1 3 0.1 3 3 6 0.1 1 1 2 2 4 0.1 4 9 13 0.3 1 5 6 6 4 10 0.5 9 8 17 0.3 ... 2 2 9 2 11 0.5 9 2 11 0.2 1 ... 1 363 317 680 36.9 646 625 1271 29.7 ... ... ... 477 442 919 50.0 997 997 901 44.4 ... 1 1 132 107 239 13.0 585 501 108 25.4 5 1 6 4 — 4 0.1 9 10 19 0.4 1 ... 1 54 Condition. Entrants. Boys. Girls. Total. Per Cent. Heart and Circulation No disease 1190 1116 2312 95.1 Organic disease 34 28 62 2.5 Functional disease 11 13 24 0.9 Anaemia 20 13 33 1.3 Lungs No disease 1216 1127 2343 96.3 Chronic Bronchitis and Bronchial Catarrh 41 31 72 2.9 Tuberculosis 3 8 11 0.45 Tuberculosis suspected 0 3 3 0.1 Other disease 1 1 2 0.08 Nervous System No disease 1257 1166 2423 99.6 Epilepsy 2 1 3 0.1 Chorea 1 2 3 0.1 Other disease 1 1 2 0.08 Skin No disease 1230 1145 2375 97.6 Ringworm Body Head 1 0 1 0.04 3 3 6 0.2 Impetigo 2 0 2 0.08 Scabies 2 2 4 0.16 Other disease 23 20 43 1.7 Rickets No disease 1244 1163 2407 99.0 Rickets slight 9 a 14 0.5 Rickets marked 8 2 10 0.4 Deformities No disease 1238 1160 2398 98.6 Deformities present 23 10 33 1.3 Tuberculosis Non-Pulmonary No disease 1253 1166 2419 99.5 Glandular 7 3 10 0.4 Bones and Joints 1 1 2 0.08 Other forms 0 0 0 0.00 Speech No defect 1286 1159 2395 98.5 Defective articulation 22 10 32 1.3 Stammering 3 1 4 0.1 Mental Condition Normal 1252 1167 2419 99.5 Dull or Backward 9 2 11 0.4 Mentally Defective 0 1 1 0.04 Infectious Diseases 1 1 2 0.08 Other Conditions 28 23 51 2.09 55 Leavers. Total Special Cases. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. 929 803 1732 94.2 2125 1919 4044 94.7 ... ... ... 10 19 29 1.5 44 47 91 2.1 2 2 4 11 14 25 1.3 22 27 49 1.1 ... ... ... 22 30 52 2.8 42 43 85 1.0 1 3 4 950 851 1801 97.9 2166 1978 4144 97.0 ... ... ... 9 3 5 3 14 6 0.7 0.8 50 6 30 11 86 17 2.0 0.3 2 ... 2 7 7 14 0.7 7 10 17 0.3 ... ... ... 3 0 3 0.1 4 1 5 0.1 ... ... ... 961 861 1822 99.1 2218 2027 4245 99.4 ... ... ... 1 2 3 0.1 3 3 6 0.1 ... ... ... 2 0 2 0.1 3 2 5 0.1 2 3 5 8 3 11 0.5 9 4 13 0.3 ... 2 2 948 841 1789 97.3 2178 1986 4164 97.5 ... ... ... 0 0 0 0.00 1 0 1 0.01 1 ... 1 1 0 1 0.05 4 3 7 0.1 3 ... 3 2 1 3 0.1 4 1 5 0.1 3 ... 3 1 0 1 0.05 3 2 5 0.1 1 1 20 24 44 2.3 43 44 87 2.0 3 3 6 966 864 1830 99.5 2210 2027 4237 99.2 ... ... ... 6 1 7 0.3 15 6 21 0.4 ... ... ... 0 1 1 0.05 8 3 11 0.2 ... ... ... 946 851 1797 97.7 2184 2011 4195 98.2 ... ... ... 26 15 41 2.2 49 25 74 1.7 ... ... ... 970 864 1834 99.7 2223 2030 4253 99.6 ... ... ... 0 0 0 0.00 7 3 10 0.2 ... ... ... 0 2 2 0.1 1 3 4 0.09 ... ... ... 2 0 2 0.1 2 0 2 0.04 1 ... 1 948 856 1804 98.1 2184 2015 4199 98.3 ... ... ... 7 6 13 0.7 29 16 45 1.0 ... 2 2 17 4 21 1.1 20 5 25 0.5 ... ... ... 92,". 819 1744 94.8 2177 1986 4163 97.5 ... ... ... 42 45 87 4.7 51 47 98 2.0 3 1 4 5 2 7 0.3 5 3 8 0.1 11 3 14 0 0 0 0.00 1 1 2 0.04 2 ... 2 20 17 37 2.0 48 40 88 2.0 9 2 11 56 Condition. Entrants. Bojs. Girls. Total. Per Cent. Vision—6/6 both 11 12 23 13.6 0 6 R 2 11 13 7.7 L 5 2 7 4.1 6/8 R 39 28 67 39.8 L 35 32 67 39.8 0/12 R 26 26 52 30.9 L 29 31 60 35.1 6 18 R 4 3 7 4.1 L 2 5 7 4.1 6 24 R T 1 2 1.1 L 2 ... 2 1.1 6/36 R 3 1 4 2.3 L 1 ... 1 0.5 6/60 R ... ... ... ... L 1 ... ... 0.5 6/0 R ... ... ... ... L ... ... ... ... Squint 27 13 40 1.6 Hearing (Whisper)— 20 feet each ear (normal hearing) 1234 1138 2372 97.5 10 feet R 10 5 15 0.0 L 9 3 12 0.4 5 feet R 5 15 20 0.8 L 5 15 20 0.8 57 Leavers. Total. Special Cases. Boys. Girls. Total. Per Cent. Boys. Girls. Total. Per Cent. Boys. Girls. Total. 464 415 879 47.8 475 427 902 45.0 3 4 7 90 62 152 8.2 92 73 165 8.2 2 2 4 51 42 93 5.0 57 44 100 4.9 1 2 3 212 194 406 22.1 251 222 473 23.6 4 10 14 248 227 475 25.8 283 259 542 27.0 6 10 16 93 74 167 9.0 119 100 219 10.4 9 25 34 98 63 161 8.7 127 94 221 11.0 7 23 30 43 38 81 4.4 47 41 88 4.3 9 18 27 34 42 76 4.1 36 47 83 4.1 11 21 32 19 26 45 2.4 20 27 47 2.3 13 17 40 25 26 51 2.7 27 26 53 2.6 9 12 21 34 30 70 3.6 37 37 74 3.6 8 17 25 23 35 58 3.1 24 35 59 2.9 10 18 28 7 6 13 0.7 7 6 13 0.6 5 1 6 14 8 22 1.1 15 8 23 1.1 6 6 12 10 13 23 1.2 10 13 23 1.1 5 11 16 15 6 21 1.1 15 6 21 1.0 5 9 14 20 6 26 1.4 47 19 66 1.5 2 5 7 948 855 1803 97.0 2182 1993 4175 97.7 ... ... ... 9 3 12 0.6 19 8 27 0.6 5 4 9 8 2 10 0.5 17 5 22 0.5 5 3 8 14 7 21 1.1 19 22 41 0.9 ... 6 6 16 8 24 1.3 21 23 44 1.0 ... 6 6 58 TABLE III.—Numerical Return of all Exceptional Children in the area. Boys. Girls. Total. Blind (including partially blind) Attending Public Elementary Schools - - - Attending Certified Schools for the Blind 2 2 Not at School —— — — Deaf and Dumb (including partially deaf) Attending Public Elementary Schools — — — Attending Certified Schools for the Deaf 6 8 9 Not at School — — — Mentally Deficient Feeble Minded Attending Public Elementary Schools 24 12 36 Attending Certified Schools for Mentally Defective Children — — — Notified to the Local (Control) Authority during the year 4 — 4 Not at School 21 9 30 Imbeciles At School — — — Not at School — 3 3 Idiots — 2 — 2 Epileptics Attending Public Elementary Schools 4 1 5 Attending Certified Schools for Epileptics 1 2 3 Not at School 3 1 4 Physically Defective Pulmonary Tuberculosis Attending Public Elementary Schools 47 39 86 Attending Certified Schools for Physically Defective Children - - - Not at School 4 7 11 Other forms of Tuberculosis Attending Public Elementary Schools 56 27 83 Attending Certified Schools for Physicallv Defective Children — — — Not at School 7 3 10 Cripples other than Tubercular Attending Public Elementary Schools 7 3 10 Attending Certified Schools for Physically Defective Children — — Not at School — — — 59 TABLE IV.—Treatment ok Defects of Children during 1915. Condition. No. of defects found for which Treatment was considered necessary. No. of defects for which no report is available. No. of defects treated. Results of Treatment. No. of defects not treated. Percentage of defects treated. From previous year. New. Total. Remedied Improved. Unchanged. Nutrition — 9 9 6 2 — 2 — 1 22.2 Nose and Throat 172 256 428 98 138 119 10 9 192 32.2 External Eye Disease 4 16 20 5 13 11 — 2 2 65.0 Ear Disease 6 44 50 21 27 18 6 3 2 54.0 Teeth 12 15 27 7 7 7 — — 13 25.9 Heart and Circulation 16 134 150 69 23 6 6 11 58 15.3 I.ungs 8 40 48 22 16 1 11 4 10 33.3 Nervous System 2 12 14 6 2 1 — 1 6 14.2 Skin 1 15 16 4 12 11 1 .— — 75.0 Rickets — — — — — — — — — — Deformities — 9 9 4 3 — 2 1 2 33.3 Tubercu losis— Non-Pulmonary 1 10 11 6 5 — 4 1 — 45.4 Speech — 7 7 3 2 — — 2 2 28.5 Mental Condition 1 15 16 6 1 — — 1 9 6.2 Vision and Squint 142 420 562 86 371 367 — 4 105 66.0 Hearing 12 18 30 6 12 7 4 1 12 40.0 Miscellaneous 7 38 45 16 21 17 3 1 8 46.6 Totals 384 1,058 1,442 365 655 565 49 41 422 Cases of uncleanliness are referred to the Inspection Clinic. The above table includes a number of children who needed to be kept under observation, but whose defects not being acute or active were not in need of immediate treatment. To this extent the statement does not do full justice to the work carried out by the School Medical Officials. 60 FOLLOWING UP. A register is kept in every School showing the name and address of each child needing treatment, and Head Teachers arc asked to refer to this register and to use their influence in persuading the parents to procure treatment. When it is found on subsequent re-examination that defects have been allowed to go untreated, the School Nurse visits the home and explains to the mother the necessity of seeking medical advice. If necessary cases are re-visited. In addition the nurses visit the homes of children found to be verminous or neglected and give directions as to cleansing. Visits are also paid in cases of Scabies, Measles, Whooping Cough, and other.conditions occurring among school children. TREATMENT. The Council provides treatment at the clinics held at the Town Hall for school children suffering from (1) minor ailments such as sore eyes, running ears, ringworm, and simple skin diseases; (2) defective vision; (8) dental caries. Many large general hospitals are easily reached from Leyton. Parents can thus obtain skilled advice and treatment for any condition arising among their children ; in addition, chronic cases are received in the West Ham Infirmary. SCHOOL CLINICS. The Inspection and Minor Ailments Clinics are held every morning and are closely associated, children being transferred from one to the other as may be required. Records of attendances and treatment are entered on special cards. During the year 614 boys and 530 girls were dealt with and they registered 4,197 attendances in the Inspection Clinic and 4,498 in the Treatment Clinic. 61 The following table shows the conditions dealt with:— Boys. Girls. Vermin of head or body 52 132 Eczema, impetigo, and sores 183 95 Ringworm 110 60 Other skin diseases 69 57 Ear diseases 29 32 External eye diseases 55 62 Lung diseases 38 20 Heart diseases 3 3 Throat diseases 18 19 Miscellaneous 57 50 614 530 EYE CLINIC. On his work in the Eve Clinic during the year Dr. Cummings writes as follows:— I have the honour to present the Second Annual Report of the Ophthalmic Department. During the past year there has been a greater interest taken in the work of the eye clinic by the parents than in 1914, although in a few cases children have not been allowed to complete the course. The increase of mixed astigmatism compared with 1914 has been very marked in the 436 cases tested by me. There were 12 cases of corneal ulcer, and its resulting condition of irregular astigmatism, 6 cases of marked amblyopia, and several cases of choroiditis, nystagmus, conjunctivitis, etc. The following table shows numbet" of each variety of defective vision:— Long sight 34 Short sight 40 Long-sighted astigmatism 122 62 Short-sighted astigmatism 76 Mixed long and short-sighted astigmatism 82 Squint 50 Cases up for a second time 4 Cases in which no glasses were required 4 Cases which did not complete the course 93 Cases in which glasses were supplied 339 Cases, which are under treatment, hut arc not completed, and therefore are not included in the above table, number 54. ARTHUR P. CUMMINGS. DENTAL CLINIC. The Dentist visits each school in turn and inspects the mouths of all children who arc 6 years of age. The parents of those found suffering from dental caries are communicated with, and if they desire treatment at the clinic an appointment is made. The condition of the teeth of children who attend the Dental Clinic is recorded on cards and a note made of the treatment carried out. The object of the Dentist is to render the mouth in a healthy condition, which is done by filling all the teeth which can be saved and only extracting those which are unsavable ; in some cases dressings with silver nitrate are employed. Condition Found at Inspection. No. of children (aged 6) inspected. Percentage of children with No. of children with permanent teeth decayed. Sound teeth. 1-3 temporary teeth decayed. 4 or more temporary teeth decayed. 2443 12-9 320 54.9 267 Children Treated at School Clinic. Number of Children. Inspected in School. With Dental Caries. Received Treatment. Completed Treatment. 2443 2025 932 754 63 Treatment Carried Out. Fillings. Extractions. Dressings and Scalings. Local Anaesthetics. 2397 1134 251 9 In addition to the above, in which only six year old children were dealt with, 79 children of different ages at the request of the parents or teachers received treatment at the clinic. The following work was carried out :—Fillings 39, extractions 71, dressings and scalings 10, local anaesthetics 9 ; attendances, 107. The total number of children, both routine and other, treated at the clinic during the year, was 1,011. TUBERCULOSIS. School children whose condition suggests that they are possibly suffering from tuberculosis are referred by the School Medical Officer to the Tuberculosis Officer for his opinion. Those found to be affected with tuberculosis as a rule attend the dispensary for treatment; others whose condition cannot be determined at the first examination are kept under observation. OTHER DEFECTIVE CHILDREN. One blind child is maintained at the East London Home and School for Blind Children at Clapton. One defective blind child is resident in the Hastings and St. Leonard's Home. Seven children attend the Water Lane Deaf and Dumb Centre, West Ham, and two attend a similar centre at Gainsborough Road, Walthamstow. Epileptic children.—One girl is resident at Chalfont St. Peter's, and another has been sent to St. Elizabeth's Home at Much Hadham, Herts. 64 VERMINOUS AND OTHER CONDITIONS DUE TO NEGLECT. After the lapse of several weeks' exclusion from school, during which time they have been instructed and cautioned, the parents are summoned to attend before the various School Attendance Sub-Committees. The parents of 99 children were thus dealt with and prosecutions instituted in 26 instances, as a result of which 4 fines of 10s. and 22 fines of 5s. each were inflicted. EDUCATION (PROVISION OF MEALS) ACTS. Previous arrangements by which necessitous children attending elementary schools receive their meals at coffee shops have been continued. Frequent visits are paid by members of the Canteen Committee and bv officials of the Education Committee to ensure that the quality of the food and the management of the rooms are satisfactory. The following statement shows the marked diminution in the number of children requiring to be fed during the period 5th to 18th December, 1915, as compared with the similar period in 1914:— Period. Breakfasts. Dimers. Total. Average weekly No. of Children fed. 1915 1914 1915 1914 1915 1914 1915 1914 5th Dec. to 18th Dec. 238 1202 980 3366 1218 4568 90 312 LEYTON CHILDREN'S COUNTRY HOLIDAY FUND. The beneficent work of this voluntary fund, which was started in 1913 by a committee of ladies and gentlemen resident in the district, has been somewhat curtailed by the war. Nevertheless, boys and girls have been sent to Canvey Island in different parties, and the work of the Committee has been justified by the improvement of the children's condition on return. Great care is taken to ensure that none but suitable cases are helped, and every child is certified by the medical officer before being sent awav.