AC 4411 (B) LEYTON LEY 59 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 1917, by J. FRANCIS TAYLOR, m.r.c.s., d.p.h., Surgeon-Major, Honourable Artillery Company. Medical Officer of Health. Ford: SOUTH ESSEX RECORDERS, LIMITED, High Road. 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 1917, by J. FRANCIS TAYLOR, m.r.c.s., d.p.h., Surgeon-Major, Honourable Artillery Company. Medical Officer of Health. IIford: SOUTH ESSEX RECORDERS, LIMITED, High Road. 8150 TO THE CHAIRMAN AND MEMBERS OF THE LEYTON URBAN DISTRICT COUNCIL. Mr. Chairman and Gentlemen, I have the honour to submit my Annual Report on the health and vital statistics of the district for the year 1917. The same brevity as characterised the last two reports has been adhered to. The most important items of progress and change to which attention is particularly directed are the establishment of a scheme for Infant and Maternal Welfare, which includes three clinics, and the closure of the Temporary Isolation Hospital. The question of hospital accommodation for cases of Small Pox has been under consideration and the Council have agreed to a scheme for the provision of a joint hospital serving a certain section of the County. The health of the district during the year has been uniformly good. In conclusion, I desire to thank the Councillors and Officials for their invariable courtesy and help. I am, Mr. Chairman and Gentlemen, Your obedient Servant, J. FRANCIS TAYLOR. Leyton Urban District Council. ANNUAL HEALTH REPORT FOR 1917, BY J. FRANCIS TAYLOR, M.R.C.S., D.P.H, Medical Officer of Health. ASSESSABLE AND RATEABLE VALUE. The present assessable value for general district purposes is £485,964 10s. 0d., and a rate of 1d. in the £ produces £1,925. For poor rate purposes the rateable value is £520,002 10s. 0d., and 1d. rate produces £2,054 10s. 0d. AREA, INHABITED HOUSES, POPULATION. The district has a total area of 2,594 acres; at the end of June it contained 23,740 houses. The number of new houses erected in the district during the year was 2. 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. The Registrar-General gives two estimates of population for the year 1917. One is the estimate of the civilian population of the district in 1917 and is used for the calculation of the (civilian) death-rate. The other, which is used for the calculation of the birth-rate, is an estimate of the total population, based on the assumption that the ratio between total and civilian population is the same in the district as in England and Wales as a whole. Population for death-rates 112,452 Population for birth-rate 125,352 The death-rates and birth-rate in this report are calculated on these figures. BIRTHS. The number of births continue to decline. 1,920 births were registered—1,018 males and 902 females. To these must be added 42 male and 43 female births (transferable) received from the Registrar-General, which yields a birth-rate of I6.0 per 1,000 of the population. 4 Of the above 87 were illegitimate births, 44 being males and 43 females. Percentage of illegitimate births, 4'3. BIRTHS—1917. YEAR 1917. Names of Localities—Wards. Totals. Leyton. Lea Bridge. Central. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip Ward not known. January 14 32 30 24 11 14 19 12 13 … 169 February 12 30 47 20 12 14 19 13 11 … 178 March 12 37 37 21 6 28 25 15 16 … 197 April 14 29 31 22 7 12 14 18 12 … 159 May 11 24 35 18 13 23 13 22 11 1 171 Tune 15 28 50 16 13 17 29 15 20 … 203 July 8 22 35 16 6 26 14 11 12 … 150 August 5 14 22 14 13 11 13 13 17 … 125 September 12 23 29 21 14 18 12 15 14 … 158 October 10 31 24 9 13 18 9 8 14 … 136 November 10 22 26 21 10 15 15 17 12 *1 149 December 10 23 25 17 7 12 16 8 7 … 125 Births received from the Registrar-General (Wards unknown) 85 Totals 133 315 391 219 128 208 198 167 159 2 2005 * 1 Foundling, apparently 4 months old. DEATHS. 5 1,099 deaths of Leyton residents were registered during the year—553 males and 546 females. To these must be added 147 males and 168 females, being deaths (transferable) received from the Registrar-General. The deaths of members of the armed forces are not included in the above figures, or in the mortality tables, but as there was only 1 of these, its 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 112,452 by the loss of the healthy young men, and the mortality rates are consequently raised. The death-rate for 1917 was 12.6 per 1,000 of the population. ZYMOTIC DEATH-RATE. The deaths which occurred during the year from the seven principal Zymotic diseases were as follows:—Measles, 25; Scarlet Fever, 2; Diphtheria, 14; Whooping Cough, 13; Enteric Fever, 5; Diarrhoea and Enteritis, 21. The Zymotic death-rate for 1917 was .71 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 85.8, there being 172 deaths. NOTIFICATION OF BIRTHS (EXTENSION) ACT, 1915. This Act took effect on September 1st, 1915. Under its terms 1,621 notifications of births have been received during the year 1917—748 from medical practitioners, 828 from midwives, and 58 from relatives. 6 The Health Visitors visited 1,611 newly-born infants and paid 1,897 re-visits. INFANT WELFARE AND AN I E-NATAL CLINICS. The Infant Clinic, which is held at the Town Hall on Friday afternoons from 2 till 4, was commenced in February, 1917. On May 15th a new Clinic was opened at the People's Hall, Leytonstone, this Hall being kindly lent for the purpose every Tuesday from 2—4 p.m. by the Clergy and Churchwardens of the Leytonstone Baptist Church, the Council merely giving a small remuneration to the Caretaker and paying out-of-pocket expenses, e.g., light and warming. Dr. Elizabeth Sloan Chcsser was appointed to attend the Clinics for a fee of one guinea per session. Up to the 1st of June the Medical Officer of Health attended the Town Hall Clinic. Later in the year, September, on the recommendation of the Medical Officer of Health, the Public Health Committee sanctioned the establishment of a Clinic for Expectant and Nursing Mothers, and one was started at the People's Hall every Tuesday morning. In this work we have the valuable co-operation of Sister Alice, of the Essex County Nursing Association, whose midwives come into touch with so many of these mothers. Sister Alice herself attends the Clinics and gives useful information and help. In December the Medical Officer of Health drew up a scheme for providing dental treatment for mothers, making use of our School Dentist and Nurse; also of the school dental premises (Town Hall) and apparatus for the purpose. When the scheme is in full operation Monday and Thursday evenings, from 6—9 will be. devoted to this work. A start has been made (January, 1918) with one evening per week. The necessary anaesthetics, as in the case of school children, are administered by the Medical Officer of Health. 7 The Leyton Health Society, from whose ranks many of our useful voluntary helpers have been recruited, deserves much praise for the enthusiastic manner in which it has supported the Council's efforts to save infant life. It was through their instrumentality and influence that the People's Hall was obtained for the Clinics. Among much other useful work they have provided funds for purchasing Glaxo and Virol, serving tea to mothers waiting at the Clinics, etc. All these Voluntary Helpers attended a course of lectures on Infant Welfare. They assist at the weighing of Infants, and one of them, Mrs. Haslop, who is a trained nurse, undertakes some visiting to newly-born infants. Miss Lister is by general acquiescence the recognised leader, and her activities in manifold directions merit unstinted praise. Mention has already been made of the Essex County Nursing Association in connection with Anite-natal work. Sister Alice (the Matron) and her nurses are in close and intimate touch with the whole scheme. The nurses attend our Clinics for instruction, and assist, under Dr. Chesser's supervision, in following up the cases by home visiting. DR. E. SLOAN CHESSER'S REPORT. Major Taylor has asked me to write a short report of the work at the Infant and Ante-Natal Clinics under the Leyton Urban District Council. The Leytonstone Infant Welfare Centre was opened on May 15th, and since the opening I have attended the Centre on Tuesday afternoons. From May until the end of the year 700 children have been brought to the Centre, the average attendance being 20 an afternoon. With the assistance of Nurse Dodd and Nurse Holland, Sister Alice and her nurses, Miss Lister and other voluntary workers, it has been possible to organise the work on a sound basis, and to provide real help for the mothers. Health talks, and simple advice with regard to feeding and clothing the children and the hygiene of the home have been given. The 8 mothers are able to purchase dried milk, Virol, cod liver oil, etc., at cost price, Miss Lister having most kindly undertaken charge of this department. The babies are weighed by the nurses, and afterwards seen by me in the Consulting Room. In nearly every case the mother requires teaching with regard to feeding. Irregular meal times, too frequent feeds especially, account for a fair pro-portion of " ill nourished1 " babies. Until otherwise taught, night feeding is almost universal, and two-hourly feeds are far too frequent. Regulation of the infants' diet is often all that is required to give it a fair start and a fighting chance to survive the first year, when life is in great jeopardy. Every effort is made to encourage breast feeding, and when necessary, to supplement natural feeding by properly diluted cows' milk or dried milk, in order to avoid weaning. Test meals by careful weighings are carried out at the second attendance. The arrangement for Dental treatment of expectant and nursing mothers will influence considerably the question of breast feeding and the development of the children attending the Clinics. Whilst cases of severe Rickets are in a minority, a number of children suffer from Rickets to a certain extent. These cases improve after instruction with regard to hygiene and diet, and the facilities for obtaining cod liver oil at cost price. A fair number of cases have been referred to local doctors or hospitals for operative treatment, and a case of persistent " vomiting " or rumination—a very rare condition—was successfully treated at Great Ormond Street Hospital. We have found the mothers most appreciative and anxious to learn. I consider the work done in connection with encouraging breast feeding very important. Careful instruction is necessary to make the mother realise the part played by the baby in stimulating milk secretion by vigorous sucking, and to make her understand the importance of three-hour feed's from the first to ensure that the baby will be sufficiently hungry to take the breast properly. She is also informed on the question of mid-day rest and sleeping undisturbed at night, and told of the most suitable 9 foods. When necessary Lactagol is prescribed. I should like to arrange for periodical examinations of the milk of nursingmothers wihen the infant does not thrive satisfactorily. The bottle baby is regulated with regard to quantity of food week by week. In most cases, babies are put on four-hour meals about the fourth month; but no hard and' fast line is drawn. The attendance at each Centre, People's Hall, Leytonstone, and Town Hall, Leyton, is about the same. At Leyton 704 cases have been seen from May till December, the average attendance being 30 an afternoon. Mrs. Haslop who, whilst a voluntary worker, is a trained nurse, weighs the babies, which is a very important part oif the Clinic. The Ante-Natal Clinic is held on Tuesday mornings at the People's Hall. With the collaboration of Sister Alice, this Centre promises to be a very important part of the work on behalf of mothers and baibies. We have frequently five or six cases, which is about as many as can be dealt with in the morning, and arrangements are being made to provide classes for expectant mothers in sewing, etc. Average attendance, 3-4. Number of women on register, 30. I should like to express my appreciation of the invaluable assistance rendered to the Clinics by Miss Lister, Sister Alice and the voluntary workers connected with the Leyton Health Society, who help with the tea and the distribution of dried milk, etc. INFECTIOUS DISEASE. No case of Plague, Cholera, Smallpox, Typhus or Dysentery has been notified during the year. There has been since March, 1913, no provision for the isolation in hospital of cases of Smallpox occurring in Leyton. SMALLPOX. In November a letter was received from the Clerk to the Essex County Council intimating that the Public Health and 10 Housing Committee of the County Council have again had under consideration the question of the provision of isolation hospital accommodation for cases of smallpox in South West Essex, and that the Committee cannot regard the existing conditions in the Urban District of Leyton for dealing with smallpox as satisfactory and enquiring whether the District Council are prepared to take action to provide proper and efficient hospital accommodation for their district, and further that the County Council have received a suggestion from the Local Government Board that they should themselves provide the necessary accommodation under the powers of an Order to be made by the Board under Section 130 of the Public Health Act, 1875, as extended by the Public Health (Prevention and Treatment of Diseases) Act, 1913, but that the Committee 'had adjourned the (consideration of the question of proceeding in that manner in order to ascertain whether the District Council concerned were prepared to make satisfactory and definite proposals in the matter. The Urban District Council of Leyton thereupon expressed their opinion that the provision of a joint hospital by the County was the best method of dealing with the question. In March a letter was received from the Local Government Board intimating that it had been represented to the Board that it was desirable that further facilities should be provided for securing, on the occurrence of any case of smallpox, the prompt vaccination and re-vaccination of persons who have come in contact with the infection and that regulations have therefore been made empowering Medical Officers of Health to perform vaccination or re-vaccination of any such persons who are willing to be vaccinated, and intiimating that the Local Authorities should arrange to pay to the Medical Officer of Health such sum as is reasonable in respect of the extra work which he undertakes in pursuance of those Regulations, and that in the opinion of the Board such payment should not be less than two shillings and sixpence for every vaccination and re-vaccination performed. 11 The Council directed that the suggestion of the Local Government Board be agreed to. The Medical Officer of Health in his former reports has consistently pointed out to the Council the gravity of the situation in view of there being no hospital accommodation for smallpox. VACCINATION RETURNS. The following are the details received from the Vaccination Officer as to infant Vaccination for the past 8 years :— Number of Births. Vaccinated. Certificates of Insusceptibility. Exemptions Died Unvaccinated under 1 year. 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 1915 2572 1032 4 1037 162 1916 2603 965 4 1093 139 ENTERIC FEVER. 8 cases were notified. There were 5 deaths, including 4 cases which occurred in the Brentwood Asylum on the 11th, 15th and 22nd April, and 18th June. The death-rate from Enteric Fever was .04 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 shows conclusively that Leyton's sanitary condition, judged by the standard of Enteric Fever incidence, is satisfactory. 12 Case. Sex. Age. Yrs. Where Treated. Result. Remarks. 1 F. 36 West Ham Infirmary Recovered Taken ill beginning; of January. Husband died of Typhoid in London Hospital, 14/11/16, Had been queer since husband died. 2 M. 33 West Ham Infirmary Recovered Cause not traced. 3 F. 39 West Ham Infirmary Recovered Cause not traced. 4 F. 23 At home Recovered Cause not traced. 5 M. 12 West Ham Infirmary Recovered Had eaten a lot of raw carrots; also some fried fish. 6 M. 63 At home Recovered Cause not traced. 7 M. 47 West Ham Infirmary Died Had eaten some prawns. 8 M. 15 London Hospital Recovered Cause not traced. SCARLET FEVER. Cases notified, 190. There were 2 deaths, one at the Eastern Hospital, Homerton. Case-fatality, 1.05 per cent. Death-rate per 1,000 of the population, .02. DIPHTHERIA. Cases notified, 145. 14 deaths occurred, including 1 death from membranous croup, 6th November, at Thetford. Case-fatality, 9.6. Death-rate per 1,000 of the population, .12. PUERPERAL FEVER. 4 cases of this disease were notified. There were 4 deaths, including 1 on the 15th April, at the London Hospital, and the other at Gloucester Street, W., October 15th. The death-rate from Puerperal Fever was .03 per 1,000 of the population. 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. Disinfection of premises and clothing has been systematically carried out. 13 MEASLES. There were 25 deaths during the year, giving a death-rate of 22 per 1,000 of the population. The 25 deaths occurred in the months stated:— Jan. Feb. Mar. April May June July Aug. Oct. Nov. Dec. 4 5 6 2 3 0 1 1 1 1 1 18 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. One death occurred aged 23 years—female. The Health Visiitors paid 1,471 visits to these cases, and 19 other visits to cases of German Measles. 2,015 cases of Measles and 189 of German Measles were notified. 3 cases were nursed by nurses from the Essex County Nursing Association. WHOOPING COUGH. There were 13 deaths during the year, giving a death-rate of .11 per 1,000 of the population. 6 of these deaths occurred in children under one year of age, 2 in those between one and two years, and 5 between two and five years. The Health Visitors paid 127 visits to these cases. DIARRHCEA AND ENTERITIS. Diarrhoea and Enteritis caused 21 deaths, 19 of which were of infants under one year of age, and 2 between 1 and 2 years. Of these, 7 died at the following Hospitals:—Queen's Hospital, 2; St. Mary's Hospital, Plaistow, 1; East London Hospital, Shadwell, 1; Forest Gate Sick Home, 1; Children's Hospital, Great Ormond Street, 1; and Queen Mary's Hospital, 1. Our death-rate from Diarrhoea and Enteritis under two years was 10.9 per 1,000 births. 14 CEREBRO-SPINAL MENINGITIS. 4 cases of Cerebro-Spinal Meningitis have been notified during the year, all of which died. One case after post-mortem proved to be Tubercular Meningitis. The following are particulars of the cases :— Case Date of Notification Sex Age Result Remarks 1 19.2.17 Male 31 Died Removed to West Ham Infirmary 12.2.17. The man was formerly a soldier, but was discharged five months previously, being unfit for further service on account of rheumatism. Not been in contact with other cases or troops. House disinfected. 2 24.3.17 Male 10 months Died Removed to Queen's Hospital 22.3.17. Child had a fall on the 18th March and hit his head against a sewing machine, but did not seem to be much hurt. Taken ill 19th March. Had not been away nor in contact with any soldiers. Lumbar puncture positive. House disinfected. 3 20.4.17 Male 14 Died Taken ill 21.3.17 with pains in the lumbar region and a crop of herpes around mouth; no retraction of neck, but Kernig'e sign was present; has had rheumatism and rheumatic fever. His cousin, attached to the Military Police, from France, had visited patient on the 18th and 19th March. There was extreme wasting with eye symptoms, and patient died quite suddenly of heart failure. House disinfected. 4 7.8.17 Male 15 Died Autopsy proved the case to be one of Tubercular Meningitis. House disinfected. ANTERIOR POLIOMYELITIS. No case was notified. OPHTHALMIA NEONATORUM. 18 notifications were received—16 from doctors and 2 from midwives. 15 All the cases were visited and re-visited. At the end of the year, of the 18 cases 13 were cured without damage to vision. The remaining 5 cases removed to other districts, and no information as to their ultimate progress is obtainable. 12 were treated by private practitioners, 1 at hospitals and 2 in the infirmary. TUBERCULOSIS. 168 deaths occurred from all forms of Tuberculosis, representing a death-rate of 1.5 per 1,000 of the population. The corresponding figures for Pulmonary Tuberculosis were 132 and 1.2. Notifications of 227 cases of Pulmonary Tuberculosis and 72 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. Sorley was appointed Tuberculosis Officer in April, vice Dr. Ross, resigned. 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 :— 16 Pulmonary. Other forms. Total. West Ham Union Infirmary 77 26 103 Hospitals— Brompton 10 — 10 London 2 22 24 Mount Vernon, Northwood 5 — 5 Royal National, Ventnor 5 — 5 Victoria Park 19 — 19 Others 12 14 26 Sanatoria— Black Notley 21 2 28 Chingford 23 — 23 Colchester 11 — 11 Devon and Cornwall 2 — 2 Hahnemann Convalescent Home, Bournemouth 3 — 3 Halstead 5 — 5 Home Sanatorium, West Southbourne 4 — 4 Ilford 6 — 6 Ipswich 2 — 2 Maltings Farm 8 — 8 National Sanatorium, Benenden 3 — 3 Royal Sanatorium, Bournemouth 2 — 2 The Downs Sanatorium, Sutton 4 — 4 Others 5 2 7 West Ham Union 1 2 3 Dispensaries- Ley ton Tuberculosis 18 3 21 248 71 319 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 75 Ringworm 109 Sputum 19 Widal's Test 1 204 CANCER. There were 140 deaths during the year, giving a death-rate of 1.24 per 1,000 of the population. INQUESTS. The following verdicts were recorded at Inquests held in the district during the year:— Natural Causes 24 Accident 16 Suicide (1 gas poisoning, 1 bullet wound) 2 Drowning 1 Misadventure 2 17 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 1 death occurring in Leyton from Cancer. Four notifications of infectious disease among members of the forces were also received, viz.:— Pulmonary Tuberculosis, 3; and Cerebro-Spinal Meningitis, 1. These notifications are not included in Table II. 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 565 Number of such dwelling-houses which were considered to be in a stats so dangerous or injurious to health as to be unfit for human habitation Nil. Number of dwellirg-houses in respect of which representations were made to the local authority with a view to the making of closing orders Nil. 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 395 Number of dwelling-houses which, after the making of closing orders, were made fit for human habitation 1 General character of the defects found to exist in the dwelling-houses inspected Leaking drains; broken lating pipes; w.c. flushing 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. 18 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 8 7 10 8 7 2 4 2 4 6 8 4 70 65 to 70 years 9 17 9 9 10 6 8 9 10 8 5 7 107 70 to 80 years 19 26 28 20 13 18 13 10 18 13 19 19 216 80 to 90 years 13 13 7 6 8 6 7 1 13 7 7 7 95 90 years and upwards 2 1 … 1 … … … 1 1 1 … … 7 Totals 51 64 54 44 38 32 32 23 46 35 39 37 495 Influenza 1 3 3 … 1 2 … … … … … 2 12 Phthisis 7 12 9 5 11 13 9 10 5 11 8 8 108 Rheumatic Fever … … … … 1 1 1 … … 1 … … 4 Bronchitis 25 20 17 14 6 7 2 3 5 7 8 12 126 Pneumonia (all forms) 9 11 9 9 7 6 … … 6 5 1 7 70 Other diseases of Respiratory Organs 2 4 2 2 1 … 2 1 1 2 4 2 23 Nephritis and Bright's Disease 1 3 1 3 3 3 3 1 4 1 1 … 24 Diphtheria (notifications) 10 3 17 9 7 11 14 13 14 18 18 11 145 Rainfall in inches in Leyton 1.00 .67 1.23 1.87 4.69 1.97 4.01 4.28 1.45 3.07 1.48 .89 26.61 Number of days on which Rain fell 14 7 18 14 8 9 11 21 11 17 11 8 149 19 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.) 22 8 … Workshops (Including Workshop Laundries.) 509 91 … Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) Totals 531 99 … to o 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 64 64 Want of ventilation 5 5 Overcrowding 5 5 Want of Drainage of floors … … Other nuisances 95 95 Sanitary accommodation insufficient 1 1 unsuitable or defective 72 72 not separate for sexes … … 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) 18 18 Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) … … Total 260 260 21 3.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Ordinary Workshops 194 Laundries 11 Bakehouses 36 Total Number of Workshops on Register 241 4.—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) 11 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 1 Underground Bakehouses (s. 101):— Certificates granted during the year … In use at the end of the year 6 22 5.—HOME WORK. NATURE OK 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. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel Making, etc. 80 ... 316 25 ... 51 127 332 332 8 8 Lace, lace curtains, and nets, etc. ... ... ... ... ... ... ... 5 5 ... ... Furniture and upholstery 2 ... 3 ... ... ... ... 1 1 ... ... Locks, latches, and keys, etc 2 ... 2 ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... 1 1 ... ... Racquet and tennis balls ... ... ... ... ... ... ... 7 7 ... ... Paper, etc., boxes, paper bags ... ... ... ... ... ... ... 1 1 ... ... Brush making 2 ... 4 ... ... ... ... 20 20 ... ... Stuffed toys and leather boxes 2 ... 5 ... ... ... ... 1 1 ... ... Cosaques. Christmas crackers, etc. ... ... ... ... ... ... ... 3 3 ... ... Linen packing condensers 2 ... 7 ... ... ... ... 1 1 ... ... Total 90 ... 337 25 ... 51 127 372 372 8 8 N.B.—No home-workers were known to be engaged in the following occupations : Household linen ; Curtain and furniture hangings ; Electro-plate; File-making; Brass and brass articles; Fur-pulling; Cables and chains ; Anchors and grapnels; Cart-gear; Nets, other than wire nets; Tents; Sacks; pea-picking; Feather-sorting; Carding, etc., of buttons, etc. ; Basket-making; Chocolates and sweetmeats ; Textile-weaving. 23 FACTORY AND WORKSHOP ACTS, 1901 and 1907. Factories include all places in which mechanical power is used. During the year 22 inspections were made, and defects numbering 8 were dealt with and remedied. The duty devolving upon the Health Department in connection with factories is chiefly to deal with any nuisances remediable under the Public Health Acts, at the request of H.M. Inspector of Factories. One such notification was received during the year, upon which the factory was visited and the necessary sanitary defects dealt with and remedied; and in one instance H.M. Inspector was informed by us of an irregularity which did not come within the province of our Inspectors. Workshops include any premises (not being Factories) in which manual labour is exercised by way of trade or for the purposes of gain in, or incidental to, the making, altering, repairing, finishing or adapting for sale of any article, and to or over which the employer of the persons working there has the right of access or control. At the end of the year we have 241 workshops on the register as compared with 296 at the beginning of 1917. They are grouped as follows :— Manufacture of blouses, underclothing, &c. 60 ,, ,, boots, shoes, &c 12 ,, ,, ties, neckwear, &c. 9 ,, ,, leather and fancy goods 2 ,, ,, brushes 2 ,, ,, polishes, gums, &c. 2 ,, ,, scales 1 ,, ,, children's toys, &c. 1 ., ,, ether sprays 1 ,, ,, wooden boxes 1 ,, ,, mats 1 ,, ,, drawing instruments, &c. 2 24 Dressmaking 26 Milinery 18 Tailoring and alteration of costumes 18 Art-needlework and embroideries 1 Corset-making 2 Bakehouses 36 Laundries 11 Cabinet-making, &c 4 Picture framing 1 Opticians 1 Chopping firewood 5 Rag-sorting 3 Cycle repairing and motor works 4 Wheelwrights and carriage painter 5 Printing and book-binding 1 Sheet steel and asbestos works 1 Cork-cutting 1 Whalebone cutting 1 Manufacture of military clothing, &c. 2 Wire Workers 3 Furriers 2 Fibre works 1 241 509 inspections were made and defects numbering 260 were found to exist. Necessary steps were taken and the nuisances were remedied. As in other years a number of premises were visited to ascertain if they were workshops. 83 workshops have been removed from the register during the year, but in 10 cases the occupiers re-opened at other addresses within our district and in 11 cases it was found that the occupiers, although continuing to work themselves, had discontinued to employ hands. In 11 cases H.M. Inspector of Factories was informed (as required by section 133 of the Act) of occupiers of workshops who had failed to display in their workrooms an Abstract of the Act, in accordance with section 128. In one instance we were notified by 25 the Factory Inspector of a workroom requiring to be whitewashed. This work was promptly carried out. Notice received. Description of Premises. Nuisance notified. Reply to Factory Inspector. Result of action taken. 3/1/17 Workshop Workshop to whitewash 19/1/17 Workshop whitewashed 19/3/17 Factory Women's convenience in an insanitary state, cistern out of order and w.c. blocked. 19/5/17 Females' w. c. wh itewashed, drain cleared, efficient flush of water provided. Males' w.c. — new pan provided, screen provided to approach to convenience from workplace. Homework.—The Act also provides that employers shall notify twice yearly the Local Authority of the district from which they give out work of the names and addresses of all persons doing work of specified trades in their homes. On receipt of such notifications a register is compiled and the premises are systematically visited. Names of persons resident outside the district are forwarded to the proper Authorities. Lists containing 150 names were sent to other Councils during the year. Particulars as follows :— To Walthamstow 60 ,, Hackney . 12 ,, West Ham 35 ,, Stepney 18 ,, Stoke Newington 2 ,, Poplar 4 ,, East Ham 5 ,, Chingford 2 ,, Ilford 3 ,, Shoreditch 2 ,, Woodford 1 ,, Guildhall 6 150 26 614 outworkers were notified by other Councils. On examination of the lists it is often found that the addresses are already on the register as the workers are frequently employed by more than one firm and are notified two or three times from different Councils. The actual number of addresses only are counted. 1,581 visits were paid to the homes of the outworkers and 1,318 inspections were made. In 263 cases it was found that the addresses returned on the lists were incorrect or that the outworker had removed since the previous visit. Uncleanly and insanitary conditions in 372 instances were found and dealt with. Eight cases of infectious disease occurred in the homes of the workers. The usual immediate action was taken ,to prevent the spread of the disease. 27 ISOLATION HOSPITAL. On account of its vulnerability to missiles and splinters during air raids the Isolation Hospital was closed on 28th September, 1917. The buildings being of corrugated iron with only a light wood framework are not adapted for supporting any superstructure of a protective character. Since the closure the large majority of Scarlet Fever and Diphtheria cases have been treated in their own homes. The nurses from the hospital visit them constantly, and in a few urgent cases remain in the homes. Cases urgently requiring removal, e.g., where the mother's confinement is imminent, by arrangement with the Metropolitan Asylum's Board have been admitted to their hospitals. This arrangement, however, no longer now exists, as the M.A.B. found the pressure on their accommodation in present circumstances necessitated the exclusion of cases outside their own area. A substantially-built house, "Wrentham," therefore has been rented and temporarily fitted up as a hospital, to accommodate some twenty cases. The staff still live at the old hospital and go to and fro to " Wrentham." Also when an air raid warning is given they take refuge there. The experiment of treating patients in their own houses, under the supervision of the Matron and nurses, has worked exceedingly well and no spread of infection has occurred, in spite of, in many instances, other children residing in the infected houses. STATISTICAL RETURNS from 1st January to 28th September, 1917. Admissions :— At all ages. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 45. Scarlet Fever 89 0 26 59 4 0 Diphtheria 63 2 19 37 2 3 Totals 152 2 45 96 6 3 Scarlet Fever. Diphtheria. under treatment at beginning of year 14 14 Admitted during year 89 63 Discharged during year 79 49 Died during year 1 3 28 The Causes ok Death were :— Female, 5 years, Diphtheria Toxaemia, in hospital 11 days; male, 3 years, Diphtheria, 7 days, sudden syncope, in hospital 6 days; male, 4 years, Diphtheria, 14 days, heart failure, in hospital 13 days ; female, 1½years, Scarlet Fever, Meningitis, in hospital 21 days. Sex of Patients Admitted. males female, Scarlet Fever . 41 48 Diphtheria 27 36 Barrier Cases. Scarlet Fever 9 Diphtheria 8 (2 Tracheotomy cases—both recovered). The Hospital was closed on the 28th September and 11 Diphtheria and 4 Scarlet Fever cases were transferred to M.A.B. hospitals—4 Diphtheria cases to the North-Eastern Hospital, Tottenham; 7 Diphtheria cases to the Northern Hospital, Winchmore Hill; 4 Scarlet Fever cases to the Northern Hospital, Winchmore Hill. Five Scarlet Fever cases were sent home and there treated under our supervision. The amount of money expended on the Hospital during the year was £3,178 15s. 3d., and is divisible into the following items :— £ s. d. £ s. d. Buildings : Repairs and Maintenance. 167 11 8 Furniture and Repairs 4 16 8 Bedding, Linen, etc. 14 7 3 186 15 7 Domestic Utensils 8 8 8 Fuel, Light, Water and Cleaning 511 10 2 519 18 10 Rates, Printing, Stationery, etc. 178 17 1 Medicines, Drugs and Surgical Appliances Provisions 44 11 8 793 1 10 Removal of Patients 324 7 5 Uniforms 47 9 11 Salaries, Wages and Allowances 1,083 12 11 1,131 2 10 £3,178 15 3 29 REPORT OF SANITARY INSPECTOR. TO THE CHAIRMAN AND MEMBERS OF THE LEYTON URBAN DISTRICT COUNCIL. Gentlemen, I beg to submit to you my Twenty-seventh Annual Report for the year ending December 31st, 1917. INFECTIOUS DISEASE. 699 cases of Infectious Diseases (excluding Measles) 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 218 Other Infectious Diseases 319 Loads of infected bedding removed to be disinfected at the Council's Steam Disinfector and returned 469 Books belonging to Public Institutions disinfected 98 Number of articles, wearing apparel, military equipment, &c., disinfected 149 Number of Notices to Education Department, Schools and Public Libraries with regard to Infectious Diseases 720 30 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 :— Acacia Road, Leytonstone. Ashlin Road, Leytonstone. Burgess Road, Leytonstone. Carlisle Road, Levton. Cobden Road, Leytonstone. Crescent Road, Levton. Cecil Road, Leytonstone. Gilbert Street, Leytonstone. Junction Road, Ley ton. Lancaster Road, Leytonstone. Montague Road, Leytonstone. Park Road, Levton. Sansom Road, Leytonstone. Shaftesbury Road, Leyton. SUMMARY OF INSPECTIONS AND RESULTS Total number of houses and premises inspected 6469 ,, ,, houses and premises re-inspected 3913 Number of visits to slaughterhouses 614 ,, ,, dairies, cowsheds and milk- shops 338 ,, ,, food shops 1001 ,, ,, bakehouses 90 ,, ,, workshops 441 ,, ,, offensive trade premises 947 Miscellaneous inspections 2473 Complaints received 442 Nuisances detected without complaint 2054 31 Nuisances abated 2883 Notices served and letters written in reference to same 1957 Intimations to Metropolitan Water Board re waste of water 55 Defective drains remedied 43 Choked drains cleared 166 Drain manholes properly covered or sealed 13 Defective gullies or connections and percolation around same remedied 128 Air inlets provided to drains or repaired 36 Houses entirely re-drained with intercepting traps and manholes provided between the house drains and sewer and with efficient air inlet and outlet ventilators 22 Foul w.c.'s and drains cleansed 69 Defective w.c.'s repaired, new traps and straight backed pans provided where necessary 107 Defective w.c. flush cisterns and flush pipes renewed or repaired and water supply provided 271 Defective soil pipes repaired or renewed 6 Ventilating shafts repaired or provided to soil pipes and drains 53 Foul and defective sinks cleansed or renewed 28 Sink, bath and lavatory waste pipes and rain pipes trapped or disconnected 13 Defective sink, bath and lavatory waste pipes renewed or repaired 60 Defective rain pipes and gutters renewed or repaired 230 Defective house roofs repaired 310 Defective floors of sculleries or cellars repaired, paved or concreted 35 Yards around back additions of houses and forecourts paved or repaired 54 Yards cleansed 11 32 Houses in a general insanitary, dilapidated or filthy condition repaired and cleansed 609 Houses unfit for human habitation closed 1 Damp conditions in house or part of house remedied 244 Ventilation provided under ground floors 37 Nuisances arising from stagnant water in basement of houses abated 15 Nuisances arising from insanitary condition of stables abated 3 Manure receptacles provided Nil Mews in filthy condition paved, drained and cleansed 6 Water supplies to houses restored and water fittings repaired 122 Domestic water cisterns removed from improper positions or cleansed or repaired 12 Covers to domestic water cisterns provided 12 Nuisances caused by overcrowding abated 8 Nuisances caused by fish, offal, manure and other refuse deposits abated 48 Nuisances caused by animals kept in an insanitary state abated 24 Smoke nuisances abated 4 Foul and defective urinals cleansed or repaired 4 Vacant plots of land fenced in Nil Insanitary conditions in slaughterhouse premises remedied 8 Insanitary conditions in bakehouse premises remedied 10 Insanitary conditions in dairy, cowshed and milk- shop premises remedied 19 Insanitary conditions in food shop premises, remedied 7 Insanitary conditions in oftensive trade premises remedied 14 33 DRAINAGE. The drainage of 22 houses has been reconstructed. LEGAL PROCEEDINGS. Proceedings were instituted against two persons for slaughtering pigs on unlicensed premises. In the one case a fine of 20s. and 4s. costs was imposed, and in the other a fine of 14s., including costs. Under the Housing and Town Planning Act, 1909, proceedings were instituted against a tenant for occupying a house which had been ordered to be closed by the Council as unfit for human habitation. An Order was made by the Court for the occupier to quit the house within fourteen days. 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 :— 2 Pig Carcases. 3 Sheep Carcases. 1 Leg and Loin of Pork. 2 pieces of Beef. 2 Briskets of Beef. 56 lbs. of Beef. 43 Livers. 9 sets of Lungs. 1 Tripe. Viscera of 2 Heifers. 3 Pigs. 2 Pigs' Tongues. 2½ lbs. Bacon. 24 lbs. Sausage Meat. 36 lbs. Pork. 89 Rabbits. 22 lbs. Smoked Fish. . 4 Baskets of Mackerel. 6 stone of Dogfish. 13 stone of Cod. 1 box of Herrings. 1 barrel of Herrings. 2 boxes of Kippers. 11 tins of salmon. 6 lbs. of Sprats. 276 lbs. of Cheese. 6 cwt. of Bread. 2 barrels of Apples. 1 cwt. Swedes. 34 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. Smith, A. J., 48, Lansdowne Road, Leytonstone. Carr, A. H., 55, Hainauit Road, Leytonstone. Abbott, E., Hainauit 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. Simonds, T., Old Manor Farm, Capworth Street, Leyton. DAIRIES, COWSHEDS, AND MILKSHOPS. The number of dairies, cowsheds, and milkshops on the register for the year ending December 31st 1917, was 135. There are at present 4 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. 35 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 47. There were 37 post-mortems and 45 inquests held. PETROLEUM. 23 licences were issued after inspection as to the suitability of the premises. DUST COLLECTION. 14,313 loads were delivered to the Dust Destructor and Shoot. I am, Gentlemen, Your obedient Servant, H. MILLER. 36 TABLE I. Vital Statistics of Whole District during 1917 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 Nonres dents registered in the District. of Res dents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1916 132107 2558 2560 19.4 2387 19.6 1188 272 197 76.9 1471 12.1 1917 125352 1918 2005 16.0 2312 20.5 1213 315 172 85.8 1414 12.6 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. 37 I able II. Cases of Infectious Disease Notified During the Year 1917, including Cases which OCCURRED in West Ham Union, Infirmary, &c., but NOT those Imported. NOTIFIABLE DISEASE. Number of Cases Notified. Total Cases Notified in cach 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. 1 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) 145 2 39 86 4 12 2 ... 12 20 33 15 16 15 17 11 6 80 "Erysipelas 31 1 2 2 3 7 11 5 2 9 2 1 ? 1 5 7 9 8 Scarlet Fever 190 ... 38 135 13 4 ... ... 8 25 69 18 7 17 19 12 15 100 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 8 ... ... 1 2 3 2 ... 2 ... 2 1 9 1 ... ... ... 6 Relapsing Fever (R) Continued Fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 4 ... ... ... ... 4 ... ... ... 1 ... ... ... 1 1 ... 1 1 §Cerebro-spinal Meningitis 4 1 ... 1 1 1 ... ... 1 1 ... ... ... 1 ... 1 ... 3 Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... llPulmonary Tuberculosis 227 2 5 24 50 109 33 1 24 30 42 27 14 31 27 20 11 76 Other forms of Tuberculosis 72 4 16 22 15 11 4 8 12 13 4 5 9 9 6 6 24 Ophthalmia Neonatorum 18 18 ... ... 2, 3 ? 9 1 4 2 Measles.. 2015 72 717 1116 82 28 ... ... 99 339 447 324 158 130 207 145 171 30 „ (German) 189 8 33 104 31 13 ... ... 14 9 50 42 25 4 21 7 17 Totals 2903 108 850 1491 201 192 52 6 172 449 660 432 224 212 310 210 233 330 One case occurred in Bethnal Green Schools. One case occurred in West Ham Workhouse. One case proved not to be Scarlet Fever. P.M. proved in one case to be Tubercular Meningitis. One case removed from Bethnal Green Schools. One case admitted from Home of Good Shepherd. Three cases age not known. One case Ward not known One case occurred in West Ham Workhouse. 38 TABLE III. DEATHS.—1917. 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 j Certified ... 1406 169 28 57 58 76 190 319 509 1213 258 122 220 220 179 165 129 130 115 110 16 ... U ncertified 8 3 1 ... ... 1 ... 2 1 ... ... 1 1 1 1 ... 2 ... 1 1 ... ... Enteric Fever 5 ... ... ... ... 1 3 1 ... 4 1 ... 1 ... 1 1 ... 2 ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...... Measles 25 3 4 11 6 1 28 2 7 4 4 3 1 3 3 Scarlet Fever 2 ... 1 1 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... Whooping Cough 13 6 2 5 4 1 3 4 1 2 2 ... ... ... Diphtheria and Croup 14 ... ... 9 5 ... ... ... ... ... ... 1 •2 4 1 1 2 1 1 1 ... ... Influenza 12 1 3 2 4 2 1 ... 2 1 1 2 2 3 1 ... ... Erysipelas 1 ... ... ... ... ... ... 1 ... 2 ... 1 ... ... ... ... ... ... ... ... ... ... 39 Phthisis (Pulmonary Tuberculosis) 132 2 ... 5 7 37 51 27 3 196 43 18 22 21 15 16 12 10 8 7 3 ... Tuberculous Meningitis 14 4 2 2 5 ... 1 ... ... 17 5 1 1 2 1 ... 2 2 1 4 ... ... Other Tuberculous Diseases 22 2 2 3 3 6 3 2 1 25 5 4 3 3 4 4 1 1 1 1 ... ... Cancer, malignant disease 140 ... ... ... ... 27 69 44 102 31 8 27 21 22 21 10 7 11 12 1 ... Rheumatic Fever 4 1 ... ... 1 1 ... 1 ... 7 ... ... ... 1 1 ... 1 ... ... 1 ... ... Meningitis 13 3 2 3 3 I 1 ... ... 14 1 2 3 2 ... ... 2 1 2 1 ... ... Organic Heart Disease 134 ... ... ... 3 l 14 37 79 112 20 10 16 21 19 21 20 10 13 3 1 ... Bronchitis 140 13 2 l 4 I 2 34 83 121 31 13 27 16 11 16 16 11 14 16 ... Pneumonia (all forms) 79 15 6 8 2 2 8 13 25 47 10 7 12 14 11 8 9 7 ... 9 2 ... Other diseases of Respiratory Organs 28 1 1 2 1 4 9 10 6 4 3 3 4 4 4 1 4 2 2 1 ... Diarrhoea and Enteritis 21 19 2 ... ... ... ... ... ... 15 5 3 5 1 2 ... 4 2 3 1 ... ... Appendicitis and Typhlitis 9 1 ... ... 1 ... 3 4 ... 7 3 ... 1 3 2 1 ... 1 1 ... ... ... Cirrhosis of Liver 6 ... ... ... ... ... ... 5 1 10 ... ... 1 ... ... 4 ... ... ... 1 ... ... Alcoholism ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 39 ... ... 1 2 ... 6 16 14 26 5 4 8 3 8 5 2 5 4 ... ... ... Puerperal Fever 4 ... ... ... ... ... 4 ... ... 3 1 ... 1 2 ... ... 1 ... ... ... ... ... Other accidents and diseases of Pregnancy and Parturition 4 ... ... ... ... 1 3 ... ... 3 ... ... 1 ... ... ... ... 1 2 ... ... Congenital Debility and Malformation, including ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ture Birth 73 70 2 ... 1 ... ... ... ... 19 4 6 12 12 8 2 9 9 8 6 1 ... Violent Deaths, excluding Suicide 36 6 1 ... 4 2 11 4 8 27 7 2 6 8 4 4 4 5 2 1 ... Suicide 4 ... ... ... ... ... 1 3 ... ... ... ... 1 ... 2 ... ... ... 1 ... ... ... Other Defined Diseases 344 23 3 7 9 19 44 86 153 262 60 27 45 62 44 44 24 36 29 29 4 ... Diseases Ill-defined or Unknown 8 2 ... ... ... 1 1 4 ... 7 1 ... 2. ... ... 1 1 2 ... ... 2 ... Old Age 88 ... ... ... ... ... ... 1 87 145 19 10 8 12 14 10 4 11 8 11 ... ... 1414 172 29 57 58 77 190 321 510 1213 258 123 221 221 180 165 131 130 116 111 16 ... Sub-Entries included in above figures— Cerebro spinal Meningitis ... ... 1 ... ... 1 ... 1 ... ... 3 ... 1 ... ... ... ... 1 ... 1 ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 40 Table No. IV. INFANTILE MORTALITY DURING THE YEAR 1917. 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 37 11 15 3 66 35 28 20 21 172 Uncertified ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... 1 ... 2 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ......... ... ... ... 1 1 3 1 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 2 4 Abdominal Tuberculosis. ... ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... 1 1 ...... 1 3 Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... 2 3 4l Convulsions 1 1 1 ... 3 ... ... ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 ... ... 1 5 2 4 1 13 Pneumonia (all forms) ... 1 ... 1 2 ... 4 3 6 15 Diarrhoea ... ... ... ... ... 2 2 ... 4 8 Enteritis ... ... ... ... ... 5 2 2 2 11 Gastritis ... ... ... ... ... 1 ... 1 ... 2 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... 3 ... ... 3 3 ... ... ... 6 Injury at Birth 1 ... ... ... 1 ... ... ... ... I Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 6 2 1 ... 9 2 ... 2 ... 13 Premature Birth 18 3 7 ... 28 1 ... ... ... 29 Atrophy, Debility and Marasmus 4 ... 5 1 10 11 5 2 ... 28 Other Causes 6 ... 1 1 8 2 8 1 ... 19 Deaths received from the Registrar-General (cause of death not known)... 2 Totals 37 11 15 3 66 35 28 20 21 172 Nett Births registered during the calendar year Legitimate ... 1,918 Illegitimate 87 Nett Deaths registered during the calendar year Legitimate infants 165 Illegitimate infants 7 42 Table IVa. INFANTILE MORTALITY DURING THE YEAR 1917. Deaths from Stated Causes as they occurred in the various Wards under One Year of Age. CAUSE OK 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 17 27 26 14 7 25 22 15 15 2 172 Uncertified ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... Measles ... 1 ... 1 ... 1 ... ... ... 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Whooping-Cough 1 ... 2 ... ... 1 ... 2 ... ... 6 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis 1 ... 1 ... ... 1 1 ... ... ... 4 Abdominal Tuberculosis ... ... ... ... 1 ... ... ... ... ... 1 Other Tuberculous Diseases ... ... 1 ... ... 2 ... ... ... ... 3 Meningitis (not Tuberculous) 1 2 ... ... ... ... ... ... ... ... 3 Convulsions ... ... 1 ... ... 1 1 ... ... ...... 3 43 Laryngitis ... ... ... ... ... ... ... ... ... ... ... Bronchitis 2 2 ... 1 3 3 ... ... 2 ... 13 Pneumonia (all forms) 1 3 3 1 ... ... 4 ... 3 ... 15 Diarrhoea 1 2 1 ... ... ... 1 2 1 ... 8 Enteritis 2 1 ... 2 ... 3 2 1 ... ... 11 Gastritis ... ... 1 ... ... ... ... ... 1 ... 2 Syphilis ... ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... 3 ... ... ... 2 ... 1 ... ... 6 Injury at Birth ... ... ... ... ... ... 1 ... ... 1 Atelectasis ... ... ... ... ... ... ... 1 ... ... 1 Congenital Malformations 4 1 3 1 ... 1 3 ... ... ... 13 Premature Birth 2 5 5 3 1 4 2 5 2 ... 29 Atrophy, Debility and Marasmus 1 6 3 3 1 4 3 2 4 1 28 Other Causes 1 1 5 2 1 2 3 1 2 1 19 Deaths received from the Registrar-General (Wards not known) 2 Totals 17 27 26 14 7 25 22 15 15 2 172 Nett Births registered during the calendar Year Legitimate 1,918 Illegitimate 87 Nett Deaths registered during the calendar Year Legitimate Infants 165 Illegitimate Infants 7 Leyton Urban District Council. ANNUAL REPORT to the EDUCATION COMMITTEE, embodying the TENTH ANNUAL REPORT on the MEDICAL INSPECTION OF SCHOOL CHILDREN Under the Education (Administrative Provisions) Act of 1907, For the Year 1917, by J. FRANCIS TAYLOR, M.R.C.S., D.P.H. Surgeon-Major, Honourable Artillery Company, Medical Officer of Health. ILFORD: South Essex Recorders, Limited, High Road. 47 TO THE CHAIRMAN AND MEMBERS OF THE LEYTON EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I beg to present the Tenth Annual Report on the work of the School Medical Service in Leyton under the Education (Administrative Provisions) Act of 1907. For reasons set forth in the body of the Report the routine inspection at the Schools of "Entrants" and "Leavers." has been suspended, and only "Specials" have been dealt with. During the year we have lost the services of Dr. Alice Stalker and Dr. Cummings (School Oculist). The latter has been succeeded by Dr. H. Thompson, who practises only as an oculist. I desire to place on record my appreciation of the work done by Dr. Stalker and Dr. Cummings, and my regre.t at losing them as colleagues. One of the Board of Education's Medical Inspectors made an enquiry and inspection in connection with the work of your medical department, and thereon the Board issued a very favourable report. The Board recommended the appointment of an extra School Nurse, which recommendation I congratulate you on having acted upon (1918). Once more it is my pleasing duty to thank the members and officials of the Education Committee for their invariable courtesy and assistance. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, J. FRANCIS TAYLOR, School Medical Officer. 48 CHANGES SINCE 1916. Dr. Alice Stalker, who carried out the work of medical inspection, obtained another appointment and left us at the beginning of the year. The Council advertised for a successor but failed to get one so Dr. John Kennedy, a local practitioner, was appointed as a part-time officer. MEDICAL INSPECTION: ARRANGEMENTS AND SCOPE. It became impossible on account of the changes above outlined to continue routine inspection of the Entrants and Leavers, etc., so during this year only Special cases (ailing children and the like) have been inspected at the Schools. For this purpose Dr. Kennedy devotes three afternoons per week, accompanied by the School Nurse, to visiting the Schools in turn. The Head Teachers are notified of the visit and are asked to select cases for inspection and for re-examination. The Doctor inspects, refers cases for treatment to the Minor Ailments Clinic, hospital or private doctor, as the case may be, and where necessary directs the nurse to follow up the cases by visiting their homes. In addition to seeing these selected cases Dr. Kennedy looks at all the children and selects for detailed examination any child who appears to show any deviation from the normal. WORK OF THE SCHOOL NURSES. There are two School Nurses, one of whom devotes the whole of her time to the work of School medical inspection and treatment; the second Nurse devotes five-sixths of her time to School work and the remainder to visiting infants in connection with the Notification of Births Act. The whole-time Nurse assists with the medical inspection in the Schools, visits children's homes in order to "follow up" cases and to instruct the parents of verminous and neglected children, under the supervision of the Medical Officer. She carries out the treatment of children at the Minor Ailments Clinic, and assists daily at the Inspection Clinic and with the clerical work of the School Medical Department. The part-time Nurse assists the School Dentist and performs some clerical duties connected with the work of the Dental Clinic. 49 Visits are paid by the Health Visitors in cases of Scabies, Measles, Whooping Cough and other conditions occurring among School children. Weekly notifications of children absent from School through illness are received by the School Medical Officer from the Head Teachers. The appointment of another School Nurse in the near future is probable. TREATMENT AND SCHOOL CLINICS. TREATMENT CLINICS. The Council provides treatment for School children suffering from (1) minor ailments, such as inflamed eyes, discharging ears, and simple skin diseases; (2) defective vision; (3) dental caries; (4) ringworm of the scalp. The treatment, except in the case of severe ringworm, is provided at the School Clinics held at the Town Hall. MINOR AILMENTS. These cases are treated daily by the School Nurse under the supervision of the School Medical Officer. DEFECTIVE VISION. Dr. A. Henry Thompson, of 55a, Welbeck Street, who was appointed Oculist late in the year, in consequence of Dr. Cummings' resignation, on account of ill-health, attends at the Town Hall every Monday afternoon to prescribe for children with eye defects. His report is appended:— OPHTHALMIC SURGEON'S REPORT FOR THE YEAR 1917. 565 cases were asked to attend the clinic. Of these 105 failed to attend, or attended once only, thus not receiving an examination. The result of the examination of 460 cases is shown in the following tables:— Short sight 50 Long sight 56 Short sight astigmatism 61 50 Long sight astigmatism 151 Mixed astigmatism 79 Odd eyes 10 Various diseases 15 No glasses 38 There were 80 cases of squint amongst these. Dr. Cummings, who had done the work of the clinic since its inception, was taken suddenly ill in September. The present writer carried on the work for the remaining weeks of the year but he has not sufficient details of the year's work at his disposal to give any further analysis of the cases. A. HENRY THOMPSON. RINGWORM OF THE SCALP. Cases which are not severe are treated at the Minor Ailments Clinic. An arrangement was made in the latter part of 1916 to have severe cases treated by X-rays at the London Hospital, the Council paying £1 1s. 0d. per case for such treatment. Previous to this a certain number of children from the district suffering from ringworm had obtained gratuitous X-ray treatment at the hospital, but after September last the hospital authorities refused to give further treatment without payment. INSPECTION CLINIC. 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. Verminous cases and children in need of such treatment as is available at the School Clinics, and who are noted as requiring attention during the course of routine medical inspection, are referred to both Inspection and Treatment Clinics. Many large hospitals are easily reached from Leyton, and thus parents can easily obtain skilled advice and treatment for any condition arising among their children; in addition, cases are received into the West Ham Infirmary. 51 Records of attendances and treatment are entered in a daily register and upon special cards. During the year 781 boys and 773 girls were dealt with. The following table shows the conditions dealt with:— Boys. Girls. Vermin of head and body 31 144 Eczema, impetigo and sores 231 168 Ringworm 110 64 Other skin diseases 91 126 Ear diseases 35 24 External eye diseases 80 70 Lung diseases 21 7 Heart diseases 2 2 Throat diseases 19 19 Miscellaneous 161 143 781 773 MINOR AILMENTS CLINIC. Treatment:— For diseases of the eyes on 1,475 occasions. „ „ „ ears on 440 „ „ Ringworm on 684 „ „ Other affections on 3,076 „ Total 5,675 DENTAL CLINIC. The Dentist has visited each school in turn and inspected the mouths of all children who are 6 years of age. The parents of those found suffering from dental caries were communicated with, and if they desired treatment at the clinic an appointment was made. 52 During: the year 1917 the Dentist had also re-inspected at the Schools all children who received treatment at the Dental Clinic during the previous two years, and dealt with the children who were found to be in need of further dental treatment. 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. A local anaesthetic is employed whenever necessary and advisable. Chloroform or nitrous oxide was administered by the School Medical Officer to 69 children for extraction of teeth. Number of Children Treated at Dental Clinic. School. Inspected. 0Re-inspected. With Dental Caries. Received Treatment. Completed Treatment. Per cent. Completed Treatment. Church Road 1916 Report. 51 46 31.5 Cann Hall Road 112 79 162 80 77 40.3 Cobbold Road 70 39 99 45 42 38.5 Farmer Road 85 50 122 57 54 40.0 St. Joseph's 26 25 44 23 19 37.2 Capworth Street 95 94 165 106 97 50.5 High Road 31 22 43 14 11 20.7 Lea Bridge Road 49 34 76 53 53 63.8 Newport Road 132 134 234 121 112 42.1 Sybourn Street 83 63 125 76 73 50.0 Canterbury Road 101 77 147 79 72 40.4 Kirkdale Road 77 73 126 65 64 42.6 Norlington Road 170 147 263 157 140 44.1 Trumpington Road 96 61 133 62 58 36.9 Harrow Green 85 106 156 59 59 30.8 Goodall Road 149 201 287 177 167 47.7 Downsell Road 137 163 264 125 119 39.6 Ruckholt Road 47 83 119 61 60 46.1 Mayville Road 130 93 197 54 54 Not Finished Davies Lane 94 78 160 35 35 Church Road 90 89 160 9 9 Cann Hall Road 104 130 204 Not Commenced. 1966 1841 3286 1509 1421 42.0 53 Total number of children inspected in 1917, 3,807. Routine cases. Number of children treated 1,509 Ditto, brought forward from 1916 113 1,622 Number of casuals treated 565 Total number of children treated in 1917 2,187 Treatment Carried Out at School Clinic. School. Fillings. Extractions. Dressings and Scalings. Church Road 93 70 16 Cann Hall Road 156 107 29 Cobbold Road 67 48 12 Farmer Road 100 66 13 St. Joseph's 37 33 6 Capworth Street 190 159 8 High Road 15 20 1 Lea Bridge Road 78 81 14 Newport Road 165 152 21 Sybourn Street 137 81 24 Canterbury Road 128 74 16 Kirkdale Road 114 54 13 Norlington Road 290 142 47 Trumpington Road 93 50 25 Harrow Green 80 41 16 Goodall Road 307 133 41 Downsell Road 235 100 21 Ruckholt Road 124 32 16 Mayville Road 105 43 10 Davies Lane 48 26 5 Church Road 12 2 - 2554 1514 354 Included in the total of 1,514 extractions are 382 performed under nitrous oxide or chloroform—69 children. 5G5 casuals made 747 attendances; filings, 149; extractions, 711; dressings, 45. Brought forward from 1916: Fillings, 218, extractions, 171; dressings, 40. Full total of year's work: Filings, 2,921; extractions, 2,396; dressings, 439. 54 MENTALLY DEFECTIVE, BLIND AND DEAF CHILDREN. One blind child is maintained at the East London Home and School for Blind Children at Clapton. Two mentally defective children are resident in the Hastings and St. Leonard's Home, and one in Hopwell Hall, Derbyshire. One child attends the Walthamstow Centre for Mentally Defective Children. Seven children attend the Water Lane Deaf and Dumb Centre, West Ham, and three attend a similar centre at Gainsborough Road, Walthamstow. Epileptic Children.—Two girls are resident at Chalfont St. Peter's and one girl at Much Hadham, Herts. Two boys are resident at Littleton Home School, Cambridge. PROCEDURE IN VERMINOUS CASES AND OTHER CONDITIONS DUE TO NEGLECT. When children are found to be verminous they are sent to the Inspection Clinic and then excluded from School by the School Medical Officer. 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 87 children were thus dealt with, and prosecutions for non-attendance at School instituted in 54 instances, as a result of which fines and costs amounting to £12 10s. 0d. were inflicted. EDUCATION (PROVISION OF MEALS) ACT. Meals have continued to be provided during the year at three of the School Cooking Centres—Ruckholt Road, Mayville Road and Capworth Street Schools. The meals are prepared by the pupils attending for cookery lessons, under the supervision of the Instructress at each Centre. They are served by a woman assistant specially appointed for this purpose, who assists in 55 the preparation of the food, supervises the children at their meals, and is responsible for the cleanliness of the dining room and washing of dishes. The number of children for whom meals have had to be provided as compared with previous years is shown in the following table:— 1917. 1916 1915. 1914 Average weekly number of children fed (Dinners only are provided.) 72 54 90 312 STATISTICAL TABLES. TABLE I.—Number of Children Inspected 1st January to 31st December, 1917. B Groups other than "Code."* (1) Intermediate Group (other than 8 years). (2) Special Cases. (3) Re-examinations (i.e. No. of Children Re-examined). (4) Boys 885 1532 Girls Totals 885 1532 *In areas where routine inspections have been suspended and the "ailing children" basis adopted, the number of children inspected should be entered in column 3. 56 TABLE II.—Return of Defects found in the course of Medical Inspection in 1917. Defect or Disease. (1) Code Groups. Specials. Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment Number referred for Treatment Number requiting to be kept under observation, but not referred for Treatment (2) (3) (4) (5) Skin Malnutrition - - 19 - Uncleanliness— Head - - 18 - Body - - 7 - Skin Ringworm— Head - - - - Body - - - - Scabies - - 10 - Impetigo - - 15 - Other Disease - - 10 - Eye Defective Vision and Squint - - 486 76 External Eye Disease - - 36 2 Ear Defective Hearing - - 20 - Ear Disease - - 27 - Teeth Dental Disease (see N.B. (2) below) - - - - Nose and Throat Enlarged Tonsils - - 40 29 Adenoids - - 50 100 Enlarged Tonsils and Adenoids - - 185 50 Defective Speech - - 16 - Heart and Circulation Heart Disease— Organic - - 12 50 Functional - - 20 14 Anaemia - - 46 20 Lungs Pulmonary Tuberculosis— Definite - - - - Suspected - - 42 - Chronic Bronchitis - - 4 - Other Disease - - 6 - Nervou System Epilepsy - - 3 3 Chorea - - 18 - Other disease - - 5 - Non-pulmonary Tuberculosis— Glands - - 9 - Bones and Joints - - - - Other Forms - - - - Rickets - - 2 - Deformities - 7 8 Other Defects or Diseases - - 35 6 57 TABLE III.—Numerical Return of all Exceptional Children in the area. Boys. Girls. Total Blind (including partially blind) Attending Public Elementary Schools 1 - 1 Attending Certified Schools for the Blind - 1 1 *Not at School 1 2 3 Deaf and Dumb (including partially deaf) Attending Public Elementary Schools - - - Attending Certified Schools for the Deaf 6 3 9 *Not at School — — — Mentally Deficient Feeble Minded Attending Public Elementary Schools 47 18 65 Attending Certified Schools for Mentally Defective Children 1 2 3 Notified to the Local (Control) Authority during the year 12 5 17 *Not at School 3 5 8 Imbeciles At School .. - *Not at School 0 2 7 Idiots — 2 1 3 Epileptics Attending Public Elementary Schools 8 13 21 Attending Certified Schools for Epileptics 1 3 4 *Not at School 2 3 5 Physically Defective Pulmonary Tuberculosis Attending Public Elementary Schools 60 51 111 Attending Certified Schools for Physically Defective Children - - - *Not at School - - - Other forms of Tuberculosis (Cripples) Attending Public Elementary Schools 14 10 24 Attending Certified Schools for Physically Defective Children *Not at School 5 3 8 Cripples other than Tubercular Attending Public Elementary Schools 31 19 50 Attending Certified Schools for Physically Defective Children - - - *Not at School — — — *It is impossible to give accurate figures for the number of children not at school as the necessary enquiries could not be instituted on account of the depletion of the School Attendance Officers' Staff, 58 TABLE IV.—Treatment of Defects of Children during 1917. 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. Clothing - - - - - - - - - Footgear - - - - - - - - - - Cleanliness of Head 8 16 24 6 18 11 4 3 75.0 Cleanliness of Body 7 2 9 2 7 4 1 2 77.8 Nutrition 13 14 27 8 19 4 13 2 70.4 Nose and Throat 403 195 598 144 275 168 102 5 179 45.9 External Eye Disease 38 9 47 9 36 16 11 9 9 76.6 Ear Disease 36 9 45 18 27 17 6 4 60.0 Teeth - - - - - - - - - - Heart and Circulation 177 77 254 92 78 24 50 4 84 30.7 Lungs 60 16 76 24 52 39 11 2 68.4 Nervous System 29 13 42 13 26 8 15 3 3 61.9 Skin 33 82 65 30 35 29 4 2 53.9 Rickets 3 2 5 3 2 2 40.0 Deformities 29 6 35 20 7 1 5 1 8 ° 20.0 Tuberculosis — Non-Pulmonary 10 3 13 4 9 2 5 2 69.2 Speech 8 14 22 6 16 3 8 5 72.8 Mental Condition 27 22 49 4 45 24 21 91.8 Vision and Squint 580 406 986 424 486 475 2 9 70 49.3 Hearing 22 28 50 30 20 14 4 2 40.0 Miscellaneous 49 21 70 29 35 19 15 1 6 50.0 Totals 1,532 885 2,417 866 1,193 834 280 79 358 49.4 59 TABLE V.—Inspection, Treatment, &c., of Children during 1917. (1) The total number of children medically inspected (whether Code Group, special or ailing child) 2,417 (2) The number of children in (1) suffering from defects (other than uncleanliness or defective clothing or footgear) who require to be kept under observation (but not referred for treatment) 358 (3) The number of children in (1) who were referred lor treatment (excluding uncleanliness, defective clothing, etc.) 1,526 (4) The number of children in (3) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 1,168