LEY 015 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 1918, by J. FRANCIS TAYLOR, M.R.C.S., D.P.H. Surgeon-Major, Honourable Artillery Company. Medical Officer of Health. Word: SOUTH ESSEX RECORDERS, LIMITED, High Road. 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 for the year, 1918. Since the early part of 1916, when I returned from the East and Dr. Ball joined the Army, my time has been equally apporportioned between my duties as Surgeon-Major in the Honourable Artillery Company and those of the Council. I was demobilised in February, 1919. The Armistice, which brought the fighting period of the war to an end, not being signed until November, the period under review relates to a war period, and as such the report tells of matters dealt with under war conditions. In spite of these conditions it will be seen that a very large amount of work has been done in endeavouring to maintain our pre-war standard of sanitation. Our new duties in connection with Infant Welfare and Motherhood have been taken seriously, and show considerable development. With the exception of the terrible pandemic of influenza the health of the district has been maintained at its satisfactory level of excellence. My best thanks are due to the Councillors and Officials for their kindly help at all times, I am, Mr. Chairman and Gentlemen, Your obedient Servant, J. FRANCIS TAYLOR. Leyton Urban District Council. ANNUAL HEALTH REPORT FOR 1918, 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 £503,321 19s. 6d., and a rate of 1d. in the £ produces £1,925. For poor rate purposes the rateable value is £537,344 0s 0d., and 1d. rate produces £72,097 0s. 0d. AREA, INHABITED HOUSES, POPULATION. The district has a total area of 2,591 acres; at the end of June it contained 23,740 houses. No new houses were erected in the district during the year. 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. The two estimates of the population—one for the calculation of the death-rates, based on the returns furnished under the National Registration Act, 1915, and under the scheme for the rationing of sugar, is an estimate of the civilian population; the other, for the calculation of the birth-rate, is an estimate of the total population. The figures so arrived at for the year 1917 are used in calculating the rates in this report, because those for 1918. although they might now be used would necessarily differ more from the facts of the present time than the earlier estimates. The main change which occurred between mid-1917 and mid-1918, was further depletion of the male population by enlistment, and as this has now been more than made good by demobilisation it follows that the 1917 estimates, though they understate the present population, do so to a less extent than would those of 1918. Population for death rates 112,452 Population for birth-rate 125,352 BIRTHS. The number of births continue to decline. 1,687 births were registered—836 males and 851 females. To these must be added 58 male and 46 female births (transferable) received from the Registrar-General, which yields a birth-rate of 14.3 per 1,000 of the population. 4 Of the above 76 were illegitimate births, 42 being' males and 34 females. Percentage of illegitimate births, 4.2. BIRTHS—1918. YEAR 1918. Names of Localities—Wards. Totals. Leyton. Lea Bridge. Central. Forest. Leytonstone. Grove Green. Harrow Green. Cann Hall. Wanstead blip. Ward not known. January 5 25 30 27 2 12 21 11 14 ... 147 February 9 28 33 12 11 17 26 20 19 ... 175 March 6 24 24 16 4 11 14 25 6 ... 130 April 9 22 28 12 7 9 14 12 8 1* 122 May 6 35 32 10 11 18 24 21 14 ... 171 June 4 19 35 12 16 17 19 14 6 ... 142 July 6 20 26 10 6 13 15 7 9 ... 112 August 12 27 27 18 5 12 17 14 8 ... 140 September 9 19 34 16 11 14 9 9 11 ... 132 October 6 25 39 9 11 16 19 12 20 157 November 6 26 39 15 12 9 13 9 10 139 December 7 21 17 13 12 14 10 16 10 120 Births received from the Registrar-General (Wards unknown) 104 Totals 85 291 364 170 108 162 201 170 135 1 1791 * Living new-born found exposed 2/4/18 in Beulah Road—unknown. 5 DEATHS. 1,447 deaths of Leyton residents were registered during the year—685 males and 762 females. To these must be added 163 males and 113 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. 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 1918 was 15.3 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, 21; Scarlet Fever, 0; Diphtheria, 17; Whooping Cough, 14; Enteric Fever, 0; Diarrhoea and Enteritis, 21. The Zymotic death-rate for 1918 was .65 per 1,000 of the population. INFANTILE DEATH-RATE. The infantile mortality rate, i.e., the number of deaths or children under one year of age per 1,000 births, was 89.9, there being 161 deaths. NOTIFICATION OF BIRTHS (EXTENSION) ACT, 1915. This Act took effect on September 1st, 1915. Under its terms 1,548 births were notified during the year 1918—743 from medical practitioners, 768 from midwives, and 57 from relatives. The Health Visitors visited 1,568 newly-born infants and paid 4,210 re-visits. 6 INFANT WELFARE AND ANTE-NATAL WORK. This, the third anniversary of the inauguration of Baby Week, affords a good opportunity to review the history and present position of the campaign in Leyton directed to the preservation of infant life. Most of the facts herein set out are well known to many of you, but as each year happily brings us into contact with fresh people interested in the work, I have thought it desirable to repeat them. The great necessity for diminishing the number of deaths among infants and young children is due of course to the serious diminution in the number of infants born. To make this quite clear the following are a few figures affecting the area presided over by the Leyton Urban District Council:— In 1913 the births numbered 2,904 „ 1914 „ „ 2,800 ,, 1915 ,, ,, 2,655 ,, 1916 ,, ,, 2,560 ,, 1917 ,, ,, 1,920 ,, 1918 ,, ,, 1,791 So that it will be seen that in five years the number of births diminished from 2,904 to 1,791, a difference of 1,113. For many years it had been recorded in the reports of Medical Officers of Health and others whose duty it is to compile health statistics, that the death-rate among infants under one year of age was greatly out of proportion to deaths at other ages. The great improvements in sanitation generally have shown their effects on infant mortality, but in spite of these the infantile mortality rate, which expression is used to indicate the number of deaths of infants under one year of age per 1,000 births, is capable of further considerable reduction. Thus in Leyton our infantile mortality rate averages about 80. I should like to see it reduced to 50. In some towns in England and Wales this rate is 150 and over. 7 There is no doubt that a great many deaths among children are due to ignorance of mothers on the problems of feeding and general care of their infants. The visits of Health Visitors and the Infant Welfare Clinics are designed to help and assist the mothers on these points. Again, a considerable number of infants are prematurely born or are born so weakly as to seriously jeopardise their chance of life. The Ante-Natal Clinic, where expectant mothers may attend and obtain advice, is established to prevent the wastage of infant life which results from ante-natal conditions. The Notification of Births Act, which was made compulsory for the whole of England and Wales in September, 1915, provides for the notification to the Medical Officer of Health of any birth occurring within his district within 36 hours of the birth. Formerly he had to rely on the registrars' weekly returns, and as a birth need not be registered for six weeks it was no uncommon occurrence to receive the registration of the birth and the death of an infant in the same week. Now our Health Visitors pay their first visit to a newly born infant 10 days after its birth. We have now four full-time and one part-time Health Visitors, which brings our number up to that required by the Local Government Board, viz., one Health Visitor to 400 births. And we are able to look after all children up to five years of age, when they come under the supervision of the School Medical Service. Our first Infant Welfare Clinic was started in February, 1917, and is held every Friday afternoon at the Town Hall. A second Clinic was started at the People's Hall, Harrow Green, in May, 1917, and is held on Tuesday afternoons. The necessity for yet a third was recognised, and this was opened on 2nd October, 1918, at the Hall in connection with the Baptist Church in Vicarage Road. It is held on Wednesday afternoons. 8 An Ante-Natal Clinic is held at the People's Hall on Tuesday mornings and was first opened in September, 1917. Recognising the important part played in the health of the mother of a clean mouth and sound teeth, arrangements were made in January, 1918, for the dental treatment of expectant and nursing mothers. This treatment is carried out at the Town Hall, the services of the School Dentist and the School Dental Nurse being requisitioned for the purpose. Milk is supplied free to children and nursing mothers where, in the opinion of the Medical Officer of Health, it is necessary. Dr. Elizabeth Sloan Chesser attends all the Clinics and is assisted by the Health Visitors, Sister Alice and her Nurses of the Essex County Nursing Association and other lady Voluntary Helpers. The voluntary ladies, of whom Miss Lister is the acknowledged head, render help in many and various ways, by giving tea to the mothers, instructing them in making garments for the children, assisting in the clerical work, etc., etc. To the Ministers of the Baptist Church, Leytonstone, and the Baptist Church, Vicarage Road, and their workers, we owe a debt of gratitude for the use of their premises and for their invariable kindness, interest, and practical help. It will thus be seen that the Infant Welfare Campaign in Leyton is built upon a thoroughly sound foundation which will bear the super-structures which have been, and will be, added for years to come, without fear of any subsidence. INFECTIOUS DISEASE. No case of Plague, Cholera, Smallpox, Typhus or Dysentery has been notified during the year. SPECIAL REPORT ON INFLUENZA. The very fatal epidemic of Influenza which occurred at the latter period of the year affected Leyton from the middle of October till the end of the year, the maximum number of deaths occurring between October 12th and November 30th. During those seven weeks this disease caused 308 deaths. 9 Number of Deaths each week from Influenza:— [333]January. February. March. April. May. June. July. 5 12 I. 26 2 9 10 23 2 9 10 23 30 0 13 20 27 4 11 18 25 1 8 15 22 29 0 13 20 27 1 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 7 3 3 1 August. September October. November. December. TOTAL. 3 10 17 24 31 7 14 21 28 5 12 19 20 2 9 16 23 30 7 14 21 28 ... 1 ... ... ... ... 1 ... ... 1 4 23 62 39 73 30 19 ,3 12 5 7 3 364 By far the larger proportion of deaths (150) occurred in persons aged 25 to 45 years, the age period 45 to 65 years coming next with 64 deaths, and 15 to 25 years with 57 deaths. 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. 364 1 9 27 34 57 150 64 22 More females than males died, the number being 207 females against 157 males. The following is a list of the occupations followed by the 364 persons who died of Influenza during the year:— Housewives 106 Laundress 4 Commercial clerks, &c. 23 Piano makers 5 No occupation 20 Soldiers 2 Children 72 Postwoman 1 Munition workers 13 Surgical instrument maker 1 House agent 1 Farmer 2 Warehouseman 3 Tailor 3 Shop assistant 4 Baker 1 Tin worker 1 Printer 3 Electrician 2 Dairyman 2 Foreman P. L.A. 1 Greengrocer 1 Pensioner 2 Butcher 2 Sister of Mercy 1 Grocer 1 Silver polisher 1 Undertaker 1 Asbestos worker 1 Carpenter 1 Telegraphist 3 Cardboard box maker 1 Motorman (Trams) 1 Soot merchant 1 Chaff cutter 1 10 Machinist 2 Coal trimmer 2 Boot clicker 2 Land worker 1 Metal dealer 1 Paint maker 2 Tin smith 1 Dustman 1 Motor 'bus driver 3 Carmen 4 Labourer 12 Club steward 1 Wood turner 3 Tramway worker 1 Dressmaker 1 Painter 1 Furrier's assistant 1 Confectioner 1 Hairdresser 1 Railway workers 11 Nurse 4 Ban-Bon maker 1 Engineering 11 364 House decorator 1 Domestic servants 7 The suddenness with which the disease descended upon us made great demands upon the undertakers, whose staffs were seriously depleted through the war, but despite this difficulty through liberal use of the mortuary and visitation by the sanitary inspectors to the houses where corpses were lying, it was possible to make arrangements which largely minimised the evil. With regard to mortuary accommodation, much more might have been done had a larger and better equipped building been available. The district has outgrown the small building which has so long sufficed our needs. The Council would do well to take into consideration at an early date the building of a mortuary more adapted to the size and dignity of the district. It is impossible to give any idea as to the number of cases of Influenza that occurred in Leyton and therefore to estimate the case fatality. Many very mild cases occur which are difficult to differentiate from a common cold, and herein lies one of the greatest difficulties in dealing with the disease from the preventive aspect. It is chiefly through individual effort that the spread of this disease can be controlled. Crowded assemblies of people are to be avoided when the disease is present in order to avoid the chance of infection. The Influenza germ lives in the secretions of the throat and nose and is expelled in the acts of coughing and sneezing, and probably to a lesser extent in ordinary expiration. It follows therefore that holding a handkerchief 11 over the nose and mouth during coughing or sneezing is desirable, no less from a hygenIc point of view than from that of good manners. Any person on becoming infected even in a mild degree should isolate himself during the period of infectivity. Medical advice should in all cases be sought, and great care should be exercised during the period of convalescence as it is chiefly during this period that the dangerous sequæla Pneumonia, which causes so many deaths, is apt to supervene. A weak solution of permanganate of potash sniffed up the nostrils at intervals is recommended as a preventative. A most important point to remember is to increase one's natural resistence to its fullest extent, which means doing all possible to maintain a high standard of general health. Thus a good plain nourishing diet is best, and everything that tends to lower the general health is to be studiously avoided—worry, fatigue, long hours, and excess of all kinds, particularly alcoholic excess. Leaflets of instructions on the above lines were delivered at every house in the district. Kinemas, by reason of their long hours of continuous performance, were credited with perhaps more than their due share in propagating the disease, and in Leyton they were all compelled to close and thoroughly ventilate their halls in accordance with the Order of the Local Government Board. The Health Visitors and all the available nurses did their utmost in visiting and attending on cases. In particular the nurses of the Essex County Nursing Association did yeoman service. The medical practitioners of the district were worked to their utmost and did all in their power to cope with the disease, but their time was too fully occupied with the clinical side to allow of any researches into the bacteriological aspect. The Council, however, have made arrangements for bacteriological examinations, through the Medical Officer of Health, of any material the doctors desire 12 to have examined. The Local Government Board issued vaccine to the Medical Officer of Health for distribution to the doctors for prophylactic and treatment purposes, and notice was sent to all doctors residing in the district of the availability of this method of dealing with cases. However, only two doctors applied for vaccine, and subsequent enquiries revealed that of these only one used it. No particulars of the result could be obtained, as he was acting as a locum tenens for a doctor who was ill, and left the district without leaving any available records. I attribute the failure to make more use of the vaccine to a natural hesitation in using a remedy which was more or less in an experimental stage. The only special feature of this particular outbreak was the large number of cases in which Epistasis occurred as a symptom. SMALLPOX. I have to report that no further progress has been made in pro\iding a hospital for the accommodation of cases of this disease which may arise in Leyton. The scheme for a joint hospital serving several districts in South-West Essex, mentioned in last year's report, seems to have been shelved. Consequently Leyton is still without any hospital to which cases of Smallpox can be sent. I have drawn attention to this defect, which I regard as a most serious one, year by year since I was first appointed Medical Officer of Health, now some twelve years ago. The following is a report I made to the Public Health Committee on 9th April, 1918:— Smallpox has lately appeared in the East End of London. Stepney, Hackney and East Ham have reported cases. The proximity of these cases to Leyton arouses great anxiety, as Leyton has made no provision for hospital treatment of Smallpox. We are entirely dependent on the goodwill of the Metropolitan Asylums Board, who will certainly not admit our cases if any pressure on their accommodation exists in London. If vaccination and re-vaccination at intervals were universal, 13 the spread of Smallpox would be an impossibility. In order to be prepared to some extent to deal with the emergency should it arise in Leyton, I have addressed a circular letter to the medical practitioners warning them to be on the look- , out for a possible case of Smallpox, offering my services in consultation, and informing them that fresh Government lymph can be obtained at the Town Hall. These suggestions have, I am glad to say, met with approval. I have on several occasions visited suspicious cases of Chickenpox, which, while presenting points of resemblance to modified cases of Smallpox, I was able to satisfy myself were not cases of the latter disease. Fresh weekly supplies of lymph obtained free of expense from the Local Government Board are on hand in my office, and the doctors are availing themselves of this privilege. As the Public Health staff will be required in their various capacities to come more or less intimately into contact with any case of Smallpox should one arise, I have taken the precaution to vaccinate all my staff, including, the nurses and other employees at the hospital. 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 1917 1944 583 7 857 103 14 ENTERIC FEVER. 3 cases were notified. There were no deaths. Each 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. Case. Sex. Age. Yrs. Where Treated. Result. Remarks. 1 F. 7 Queen Mary's Hosptl., Stratford Recovered Cause not traced 2 F. 21 At home Recovered Onset of disease 13th Sept. after return from Westcliff. Had eaten oysters when away. 3 F. 33 West Ham Infirmary Recovered Unable to trace source of infection. Has occasionally eaten winkles and watercress. SCARLET FEVER. Cases notified, 121. There were no deaths. DIPHTHERIA. Cases notified, 157. 17 deaths occurred, including 1 death on the 25th November at the London Hospital. Case-fatality per cent., 10.8. Death-rate per 1,000 of the population, .15. PUERPERAL FEVER. 7 cases of this disease were notified. There were 5 deaths. The death-rate from Puerperal Fever was .06 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. 15 Disinfection of premises and clothing has been systematically carried out. MEASLES. There were 21 deaths during the year, including 1 at the S.E. Hospital, May 2nd. Death-rate .18 per 1,000 of the population. The 21 deaths occurred in the months stated:— Jan. Mar. Apiil May June July Aug. Oct. 2 2 4 7 3 l 1 I 16 deaths occurred in children under five years of age, i.e., in children who do not attend school, and 5 between five and fifteen years. 1,042 cases of Measles and 84 of German Measles were notified. The Health Visitors paid 947 visits to these cases. 2 cases were nursed by nurses from the Essex County Nursing Association. WHOOPING COUGH. There were 14 deaths during the year, including 1 on the 28th March, at St. Pancras Infirmary, Highgate. Death-rate per 1,000 of the population, .12. 2 of these deaths occurred in children under one year of age, 8 in those between one and two years, and 4 between two and five years. The Health Visitors visited 233 of these cases. DIARRHOEA AND ENTERITIS. Diarrhoea and Enteritis caused 21 deaths* 20 of which were of infants under one year of age, and 1 between 1 and 2 years. Of these 3 died at the following Hospitals :—Queen's Hospital, 1; London Hospital, 1; and Queen Mary's Hospital, 1. 1 death occurred at Chapel Lane, Stewkley, and another at 2, Kirby Cottages, Leigh-on-Sea. 16 Our death-rate from Diarrhoea and Enteritis under two years was 11.7 per 1,000 births. CEREBRO-SPINAL MENINGITIS. 1 case of Cerebro-Spinal Meningitis has been notified during the year. This case terminated fatally. The following are particulars:— Date of Notification Sex Age Yrs. Result. Remarks 22.4.18 Male 12 Died 22.4.18 Taken ill 15.4.18 with what was thought to be a chill and bilious attack, he later developed squint, took to his bed and became delirious, then comatose with unequal pupils and Cheyne-Stokes respiration. No rigidity, no Kernig, some chronicspasm. No history of being in contact with any case of C.-S.M. A brother-in-law, stationed at Aldershot, came home on leave on the 10th April, also March 13th. He had not heard of any cases at Aldershot. No bacteriological examination. House disinfected. ANTERIOR POLIOMYELITIS. 2 cases were notified. The following are particulars of the cases:— Case Date of Notification Sex Age Yrs. Result Remarks 1 20.9.18 Male 4½ Slight Paresis in left leg Was taken ill at the end of July. Attended as an outpatient at the Great Ormond Street Hospital at the end of August and was taken into hospital 18th Sept. Father a soldier, came home on leave after the child was taken ill and prior to then not for months. 2 22.10.18 Female 2 Paresis of left leg Removed to Great Ormond Street Hospital 12.10.18 17 OPHTHALMIA NEONATORUM. 18 notifications were received—11 from doctors and 9 from midwives. 2 of these cases were notified both by doctor and midwife. All the cases were visited and followed up. At the end of the year, of the 18 cases 16 were cured without damage to vision. The remaining 2 cases removed to other districts, and no information as to their ultimate progress is obtainable. 11 were treated by private practitioners and 7 at hospitals. TUBERCULOSIS. 188 deaths occurred from all forms of Tuberculosis, representing a death-rate of 1.7 per 1,000 of the population. The corresponding figures for Pulmonary Tuberculosis were 156 and 1.4. Notifications of 242 cases of Pulmonary Tuberculosis and 64 of other forms of Tuberculosis were received during the year. These cases were attended to 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. Bruce now attends at the Tuberculosis Dispensary, 180, High Road, Leyton :— Mondays 2.15—4.30 p.m. Wednesdays 2.30—4.0 ,, Thursdays 12.30—2.0 ,, Thursdays 6.0—8.0 ,, Fridays 9.30 a.m. to 12.0 p.m. Close co-operation is maintained between the Tuberculosis Officer, who is appointed by the Essex County Council, and the 18 Medical Officer of Health. The arrangements as set forth in the report' of the year 1913 have been continued. Notifications of cases of Tuberculosis have been received from the following Institutions:— Lungs. Other forms. Total. West Ham Infirmary 73 25 98 Hospitals— London — 22 22 Queen Mary's Hospital 3 3 6 Brompton 9 — 9 Victoria Park 19 — 19 Others 27 4 31 Sanatoria— Chingford 8 13 21 Ilford 7 2 9 Black Notley 34 1 35 Maltings Farm 17 1 18 Colchester 11 —. 11 Halstead 4 — 4 Benenden 4 — 4 Royal National 4 4 Others 20 4 24 Leyton Dispensary 8 1 9 248 76 324 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 39 Ringworm 345 Sputum 19 Gonococci 1 404 CANCER. There were 115 deaths during the year, giving a death-rate of 1.02 per 1,000 of the population. 19 INQUESTS. The following verdicts were recorded at Inquests held in the district during the year:— Natural Causes 23 Accident 12 Misadventure 2 Manslaughter 1 Murder 1 Suicide (2 run over by train, 2 selfinflicted wounds, 1 hanging, 1 strychnine poisoning, 1 morphia poisoning) 7 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 36 deaths occurring in Leyton from the following causes:— Gunshot Wound 17 Shrapnel Wound 3 Shell Gas and Burns 1 Morbus Cordis 1 Middle Ear Disease 1 Perforating Duodenal Ulcer 1 Perforating Atheromatous Ulcer of Aorta 1 Pulmonary Tuberculosis 1 Tumour Cerebellum 1 Acute Lobar Pneumonia 1 Influenza 8 Six notifications of infectious diseases among members of the forces were also received, viz.:—Pulmonary Tuberculosis, 1; Tuberculosis of Bladder, 1; Cerebrospinal Meningitis, 1; Scarlet Fever, 1; and Erysipelas, 2. 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 20 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 573 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 1 Number of dwellig-houses in respect of which representations were made to the local authority with a view to the making of closing orders 1 (No closing order made as premises were vacated.) 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 243 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. 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. 21 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 6 6 2 7 3 6 6 3 7 13 12 79 65 to 70 years 7 5 5 6 8 5 5 9 6 15 13 10 94 70 to 80 years 18 19 18 17 19 11 5 11 8 16 24 21 187 80 to 90 years 10 9 6 7 8 5 2 6 8 10 13 11 95 90 years and upwards 4 ... 2 2 ... 1 2 ... ... 3 ... 2 16 Totals 47 39 37 34 42 25 20 32 25 51 63 56 471 Influenza 3 1 ... 1 1 1 15 1 1 178 135 27 364 Phthisis 10 13 18 13 15 8 10 15 9 15 18 12 156 Rheumatic Fever ... ... ... ... ... ... ... 1 1 ... 1 ... 3 Bronchitis 24 10 16 15 7 4 4 3 4 16 31 27 161 Pneumonia (all forms) 12 10 11 6 7 4 17 3 5 39 33 9 156 Other diseases of Respiratory Organs 3 1 2 ... ... ... ... ... ... 1 4 3 14 Nephritis and Bright's Disease 8 3 7 1 3 2 ... 3 4 3 5 1 40 Diphtheria (notifications) 11 13 11 16 8 12 9 15 12 24 9 17 157 Rainfall in inches in Leyton 2.56 .78 .68 2.43 2.36 1.06 4.99 1.34 5.00 1.06 1.74 1.80 25.80 Number of days on which Rain fell 12 13 9 16 10 7 17 12 23 13 16 22 170 22 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.) 11 3 ... Workshops (Including Workshop Laundries.) Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 288 33 ... Totals 299 36 ... 23 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. Number of Defects. Found and Remedied. (1) (2) Nuisances under the Public Health Acts:— Want of cleanliness 29 Want of ventilation 4 Overcrowding 2 Want of Drainage of floors ... Other nuisances 58 Sanitary accommodation insufficient ... unsuitable or defective 28 not separate for sexes 1 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) 8 Other offences ... (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 130 24 3.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Ordinary Workshops 194 Laundries 10 Bakehouses 37 Total Number of Workshops on Register 241 4.—OTHER MATTERS. Class. Number. (1). (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 13 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 ... Reports (of action taken) sent to H.M. Inspector ... Other ... Underground Bakehouses (s. 101):— Certificates granted during the year ... In use at the end of the year 6 25 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 and Notices served. Instances and Orders made is. 110). Sending twice in the year. Sending once in the year. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel—Making, etc. 62 286 19 93 90 284 2 Lace, lace curtains, and nets, etc. ... ... ... ... ... ... ... 2 ... Furniture and upholstery 2 ... 11 ... ... ... ... 1 ... Artificial flowers ... ... ... ... ... ... ... 2 ... Racquet and tennis balls ... ... ... ... ... ... ... 4 ... Paper, etc., boxes paper bags ... ... ... ... ... ... ... 2 ... Brush making 2 ... 2 1 ... 5 ... 13 ... Stuffed toys and leather boxes ... ... ... 1 ... 2 ... 1 ... Cosaques and Christmas crackers ... ... ... ... ... ... ... 3 ... Linen packing condensers 2 ... 8 ... ... ... ... 1 ... Gas mantles ... ... ... ... ... ... ... 1 ... Pope making ... ... ... ... ... ... ... 1 ... Army Equipment ... ... ... ... ... ... ... 9 ... Totals 68 ... 307 21 ... 100 90 324 2 N.B.—No home-workers were known to be engaged during the year in the following occupations: Household linen; Furniture hangings; Electro-plate; File-making; Brass and brass articles; Fur-pulling; Cables and chains; Anchors and grapnels; Cart-gear; Locks, etc.; Umbrellas; Nets, other than wire nets; Tents; Sacks; Pea-picking; Feather-sorting; Carding of buttons; Basket-making; Chocolates and sweetmeats; Textile-weaving. 26 FACTORY AND WORKSHOP ACTS, 1901 and 1907. Factories include all places in which mechanical power is used, and are inspected by H.M. Inspector of Factories, and apart from dealing with any nuisances remediable under the Public Health Act that he may notify, our Inspectors do not interfere. It is the duty of,the District Council to secure proper provision of means of escape in case of fire and the enforcement of sufficient sanitary accommodation. This work is carried out by the Surveyor. One notification was received from H.M. Inspector in reference to a factory being without satisfactory means of escape in case of fire. This matter was referred to the Surveyor and dealt with by him. Eleven factories were visited and three notices served to remedy defects found. Workshops include any premises (not being Factories) in which manual labour is exercised by way of trade and for the purposes of gain in, and 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. 288 workshops were inspected during the year and 130 nuisances remediable under the Public Health Acts, or contravening the Factory and Workshops Acts, dealt with, and revisits made until the necessary work had been carried out. 211 workshops remain on the register. Grouping of Workshops. Manufacture of blouses, underclothing, &c. 63 „ „ boots, shoes, &c. 12 „ „ ties, neckwear, &c. 7 „ „ leather and fancy goods 2 „ „ brushes 2 27 Manufacture of polishes, gums, &c. 2 „ „ scales, tools, &c. 2 „ „ children's toys, &c. 1 „ „ ether sprays 1 „ „ wooden boxes 1 „ „ drawing instruments, &c. 3 Dressmaking 27 Millinery 17 Tailoring and alteration of costumes 18 Art-needlework and embroideries 1 Corset-making 1 Bakehouses 37 Laundries 10 Cabinet-making, &c. 4 Picture framing 1 Manufacture of paper articles 1 Chopping firewood 5 Rag-sorting 3 Cycle repairing and motor works 2 Wheelwrights and carriage painter and shoeing forges 7 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 2 Furriers 2 Fibre works 1 241 H.M. Inspector of Factories was informed by us of 13 cases of occupiers of workshops failing to display in their workrooms an abstract' of the Act, in accordance with section 128. Homework.—The District Council, under section 107-110 are given important powers for controlling the conditions under 28 which certain classes of work as specified from time to time by the Secretary of State, are done in the homes of the workers, and the Act further provides that employers shall notify twice yearly the Local Authority of the district from which they give out work, the names and addresses of all persons doing work of specified trades in their homes. Some employers are very dilatory in sending their lists, and notices have to 'be sent reminding them of their obligation. Other employers are not sufficiently careful in revising their lists, and names of outworkers who have given up or removed from the address supplied are sent in without correction year after year, thus causing a lot of unnecessary work. 423 outworkers were notified by other Councils and we forwarded 177 addresses to them. It is frequently found that the worker is employed by more than one firm, and the name is notified two or three times, but in the figures given only the actual addresses are counted. Enquiries are frequently made at shops and other places to ascertain whether workpeople are employed, and such visiting has resulted in the discovery of many unregistered workrooms, as well as employers of outworkers who had not supplied lists. 1,416 visits were paid to the homes of the outworkers and 1,076 inspections were made. In 340 cases it was found that the addresses were incorrect. Uncleanly and insanitary conditions in 324 instances were found and dealt' with. Two cases of infectious disease occurred in the homes of the workers. The usual immediate action was taken to prevent the spread of the disease. 29 ISOLATION HOSPITAL. The Hospital, which, as stated in last year's report, was closed on 28th September, 1917, was again opened for the reception of patients on 13th December, 1918. Consequently, this year's report deals with "Wrentham," the house which, during the aforementioned period, did duty for an Isolation Hospital. Compared with other years, a very small proportion of Scarlet Fever and Diphtheria cases received hospital treatment, the majority being treated in their own homes, where they were systematically visited and attended by our hospital nurses. The statistics given in the report bring out the wonderful success which has attended this method. In particular, the very small percentage of "complications " should be noted. Likewise the non-removal of these infectious cases from their homes, where they were kept under supervision, did not lead to any spread of these diseases, which was at one time feared might be the case. It is to the conscientious care with which the nurses carried out my instructions, under the supervision and direction of the Matron, that our success is largely due. It is my melancholy duty to record the death of one of the oldest members of our staff—Sister Pikeman—who succumbed to the effects of Inflaenza acting on a weak and fatty heart. STATISTICAL RETURNS:Admissions:— At all ages. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 and upwards. Scarlet Fever 10 0 2 7 1 0 Diphtheria 49 1 9 36 3 0 Totals 59 1 11 43 4 0 Sex of Patients Admitted. Males. Females Scarlet Fever Cases 4 ... 6 Diphtheria Cases 25 ... 24 30  Scarlet Fever. Diphtheria Under treatment at beginning of year 0 0 „ „ „ end of year 3 9 Admitted during year 10 49 Discharged „ „ 7 40 Died „ „ 0 8 (3 Tracheotomy cases.) The Causes of Death were:— Female, 5 years, Diphtheria 6 days, Toxaemia, in hospital 3 days. Male, 11 months, Diphtheria 10 days, Tracheotomy 6 days, in hospital 6 days. Female, 4 years, Diphtheria 15 days, Cardiac Paralysis 5 days, in hospital 11 days. Male, 6 years, Diphtheria 6 days, Toxremia, in hospital 1 day. Female, 1 years, Haemorrhagic Diphtheria 2 days, in hospital 1 day. Male, 3 years, Diphtheria 16 days, Toxaemia, in hospital 12 days. Male, 2 years, Diphtheria, 15 days, Tracheotomy 13 days, in hospital 13 days. Male, 6 years, Diphtheria, 22 days, Paralysis 7 days, in hospital 15 days. Cases Treated Outside from January to December, 1918— Males. Females. Scarlet Fever 43 54 Diphtheria 54 45 Complications— 6 Laryngeal. 3 Measles, following Diphtheria. 2 Pneumonia, following Scarlet Fever. 1 Nasal Discharge „ „ „ 1 Far „ „ „ „ 1 Erysipelas „ „ „ „ ,, 2 Measles „ „ „ 1 Chicken Pox „ „ „ Total number of cases visited 198 Deaths 3 31 The amount of money expended on the Hospital during the financial year was £3,002 4s., and is divisable into the following items:— Buildings: Repairs and Maintenance 118 11 1 Furniture and Repairs 68 1 9 Bedding, Linen, etc. 117 17 4 304 10 2 Domestic Utensils 17 13 1 Fuel, Light, Water and Cleaning 303 7 9 321 0 10 Rates, Printing, Stationery, etc. 303 1 4 Medicines, Drugs and Surgical Appliances 52 2 10 Provisions 582 13 3 Removal of Patients 274 4 6 Uniforms 35 1 5 Salaries, Wages and Allowances 1,129 9 8 1,164 11 1 £3,002 4 0 32 REPORT OF SANITARY INSPECTOR. TO THE CHAIRMAN AND MEMBERS OF THE LEYTON URBAN DISTRICT COUNCIL. Gentlemen, Owing to the death of the late Chief Sanitary Inspector, Mr. H. Miller, I beg to submit to you his 28th Annual Report for the year ending 31st December, 1918. INFECTIOUS DISEASE. 642 cases of Infectious Diseases (excluding Measles) were notified during the above-mentioned period. Appended is a summary of the work in connection therewith: Houses disinfected and the sanitary arrangements examined and tested: Tuberculosis Cases 221 Other Infectious Diseases 288 Loads of infected bedding removed to be disinfected at the Council's Steam Disinfector and returned 442 Books belonging to Public Institutions disinfected 49 Number of articles, wearing apparel, military equipment, &c., disinfected 137 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. 33 The House to House inspection has taken place in the following roads:— Atkins Road, Leyton. Belmont Park Road, Leyton. Knotts Green Road, Leyton. Leyton Green Road, Leyton. Lansdowne Road, Leytonstone. Melford Road, Leytonstone. Napier Road, Leytonstone. Park Grove Road, Leytonstone Southwell Grove Road, Leytonstone. St. Heliers Road, Leyton. William Street, Leyton. SUMMARY OF INSPECTIONS AND RESULTS:— Total number of houses and premises inspected 5052 „ „ houses and premises re-inspected 2534 Number of visits to slaughterhouses 860 „ „ dairies, cowsheds and milk- shops 186 „ „ food shops 1081 „ „ bakehouses 62 „ workshops 288 „ „ offensive trade premises 641 Miscellaneous inspections 2107 Complaints received 290 Notices served and letters written in reference to same 2119 Intimations to Metropolitan Water Board re waste of water 53 Defective drains remedied 32 Choked drains cleared 141 Drain manholes properly covered or sealed 6 Defective gullies or connections and percolation around same remedied 125 Air inlets provided to drains or repaired 22 Houses entirely re-drained with intercepting traps and manholes provided between the house drains and sewer and with efficient air inlet and outlet ventilators 20 Foul w.c.’s and drains cleansed 21 Defective w.c.'s repaired, new traps and straight backed pans provided where necessary 69 34 Defective w.c. flush cisterns and flush pipes renewed or repaired and water supply provided 175 Defective soil pipes repaired or renewed 2 Ventilating shafts repaired or provided to soil pipes and drains 52 Foul and defective sinks cleansed or renewed 28 Sink, bath and lavatory waste pipes and rain pipes trapped or disconnected 12 Defective sink, bath and lavatory waste pipes renewed or repaired 50 Defective rain pipes and gutters renewed or repaired 287 Defective house roofs repaired 335 Defective floors of sculleries or cellars repaired, paved or concreted 14 Yards around back additions of houses and forecourts paved or repaired 72 Yards cleansed 10 Houses in a general insanitary, dilapidated or filthy condition repaired and cleansed 699 Damp conditions in house or part of house remedied 217 Ventilation provided under ground floors 17 Nuisances arising from stagnant water in basement of houses abated 29 Nuisances arising from insanitary condition of stables abated Nil Manure receptacles provided Nil Mews in filthy condition paved, drained and cleansed Nil Water supplies to houses restored and water fittings repaired 66 Domestic water cisterns removed from improper positions or cleansed or repaired 20 Covers to domestic water cisterns provided 7 Nuisances caused by overcrowding abated 3 Nuisances caused by fish, offal, manure and other refuse deposits abated 26 35 Nuisances caused by animals kept in an insanitary state abated 7 Smoke nuisances abated Nil Foul and defective urinals cleansed or repaired Nil Vacant plots of land fenced in Nil DRAINAGE. The drainage of 20 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. 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 dealt with. In connection with the inspection a quantity of unsound food was destroyed. It consisted of:— 623 lbs. Beef. 3 Legs of Mutton. 27 Bullocks' Livers. 7 Sheep's Livers. 32 lbs. Pork. 1 Pig's Head. I Viscera of Pig. Offal of Cow. 5 pairs of Lungs. 14 lbs. Corned Beef. 1 Ham. 21 lbs. Bacon. 6 lbs. Dripping. 9 barrels Herrings. 9 cases Roe 2 boxes Bloaters 2 boxes Kippers. 20 lbs. Herrings. 5 stone Cod Roe. 56 lbs. Mackerel. 1½ bushel Winkles. 30 cases Onions. 2½ sacks Carrots. 30 lbs. Swedes. 16 tins Condensed Milk. 60 lbs. Butter. 5¼cwt. Jam. 36 SLAUGHTERHOUSES. The Slaughterhouses are visited regularly, and at any odd times 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, 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. Simonds, S. R., Old Manor Farm, Capworth Street, Leyton. DAIRIES, COWSHEDS, AND MILKSHOPS. The number of dairies, cowsheds, and milkshops on the register for the year ended December 31st, 1918, was 133. 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. 37 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 todies received was 82. There were 47 post-mortems and 55 inquests held. PETROLEUM. 18 licences were issued after inspection as to the suitability of the premises. DUST COLLECTION. 13,580 loads were delivered to the Dust Destructor and Shoot. I am, Gentlemen, Your obedient Servant, W. J. STEVENS. TABLE I. Vital Statistics of Whole District during 1918 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 Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 213 2462 19.8 1225 273 225 84.7 1510 121 1916 132107 2558 2560 19 4 2387 19.6 1188 272 197 76.9 1471 121 1917 125352 1918 2005 160 2312 20.5 1213 315 172 85.8 1414 12 6 1918 125352 1687 1791 14.3 2661 23.7 1214 268 161 89.9 1723 15.3 38 Area of District in acres (land and inland. 2594 water) Total population at all ages 1247361 Total families or separate occupiers 27346 At census 1911. 39 Table II.—Cases of Infectious Disease Notified During the Year 1918, 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) 157 ... 30 111 8 8 ... ... 7 39 22 9 8 25 18 17 12 58 † Erysipelas 27 ... ... 3 2 5 14 3 3 3 1 5 1 ... 8 6 ... 6 ‡Scarlet Fever 121 1 21 87 7 5 ... ... 8 6 26 17 4 1 23 15 15 20 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 ... ... 1 1 1 ... ... ... ... 1 ... 1 ... 1 ... ... 2 Relapsing Fever (R) Continued Fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 7 ... ... ... 3 4 ... ... 1 ... 1 1 ... 1 ... ... 3 6 Cerebro-spinal Meningitis 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Poliomyelitis ... 2 ... 2 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... '2 §Pulmonary Tuberculosis 242 ... 5 21 50 114 47 5 23 28 54 32 27 17 26 19 15 63 Other forms of Tuberculosis 64 2 17 21 8 10 4 2 5 4 19 6 4 5 6 11 4 22 Ophthalmia Neonatorum 18 18 ... ... ... ... ... ... ... 2 5 1 3 1 4 1 1 ... Measles 1042 2.5, 440 548 21 8 ... ... 74 209 250 76 89 126 96 57 65 2 „ (German) 84 ... 11 59 9 5 ... ... ... 19 12 7 12 4 5 10 15 ... Totals 1708 46 526 852 109 160 65 10 122 311 391 154 150 186 187 136 130 181 *One case from West Ham Workhouse and on.e case occurred in Bethnal Green Schools, † Two cases from West Ham Workhouse. t Two cases withdrawn and one case occurred in Bethnal Green Schools. § One case, Ward not known. 40 TABLE III. DEATHS.—1918. CAUSES OF DEATH. Ages.—Calendar Year. Wards.—Calendar Year. 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. j 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 1715 158 61 103 94 127 346 381 445 1214 270 133 264 296 214 154 164 186 154 130 20 ... Uncertified 8 3 ... ... ... ... ... ... 5 ... ... ... ... 2 1 1 1 ... 2 1 ... ... Enteric Fever ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 21 3 4 9 5 ... ... ... ... 16 2 1 2 6 2 1 4 1 1 2 1 ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 14 2 8 4 ... ... ... ... ... 18 3 1 3 1 1 ... 3 2 2 1 ... ... Diphtheria and Croup 17 1 ... 9 6 1 ... ... ... ... 1 ... 8 3 ... 2 2 1 ... 1 ... ... Influenza 364 1 9 27 34 57 150 64 22 142 44 33 49 63 44 24 33 42 33 41 2 ... Erysipelas 2 ... ... ... 1 ... 1 ... ... 1 ... .... 1 1 ... ... ... ... ... ... ... ... 41 Phthisis (Pulmonary Tuberculosis) 156 1 1 2 7 25 70 46 4 137 20 15 20 30 25 13 9 17 16 8 3 ... Tuberculous Meningitis 14 3 1 6 4 ... ... ... ... 10 4 ... 3 4 ... ... ... 2 4 1 ... ... Other Tuberculous Diseases 18 2 2 3 5 3 2 1 ... 16 8 3 3 4 1 ... 1 4 2 ... ... ... Cancer, malignant disease 115 ... ... ... ... 1 17 59 38 93 24 12 19 22 14 11 8 12 11 6 ... ... Rheumatic Fever 3 ... ... ... ... 1 1 ... 1 7 ... 1 ... ... ... ... ... 1 ... 1 ... ... Meningitis 10 3 ... 1 2 2 2 ... ... 3 ... 1 ... ... 1 3 3 1 1 ... ... ... Organic Heart Disease 109 1 ... ... 3 7 13 33 52 82 9 5 14 22 14 19 11 9 9 6 ... ... Bronchitis 161 14 14 5 1 1 6 36 84 105 26 15 23 27 18 15 15 23 15 9 1 ... Pneumonia (all forms) 156 13 16 23 11 10 39 28 16 86 24 6 37 21 20 9 17 13 16 17 ... ... Other diseases of Respiratory Organs 14 ... ... 1 ... 1 2 5 5 4 1 3 ... 3 2 1 3 ... 1 1 ... ... Diarrhoea and Enteritis 21 20 1 ... ... ... ... ... ... 13 1 2 1 3 ... ... 4 5 4 2 ... ... Appendicitis and Typhlitis 3 ... ... ... 2 ... ... 1 ... 7 ... ... ... 1 ... ... 1 ... 1 ... ... ... Cirrhosis of Liver 5 ... ... ... ... ... ... 4 1 5 1 ... 1 2 1 ... ... 1 ... ... ... ... Alcoholism ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Nephritis and Bright's Disease 40 1 ... ... 1 3 4 13 18 28 5 1 6 4 5 8 4 4 6 2 ... ... Puerperal Fever 5 ... ... ... ... 2 3 ... ... 3 5 1 ... 1 ... ... 1 ... ... 2 ... ... Other accidents and diseases of Pregnacy and Parturition 7 ... ... ... ... 2 5 ... ... 6 3 ... ... 2 2 ... 2 1 ... ... ... ... Congenital Debility and Malformation, including Premature Birth 69 69 ... ... ... ... ... ... ... 18 7 2 13 17 6 6 7 10 4 3 1 ... Violent Deaths, excluding Suicide 29 1 ... 3 2 1 3 8 11 14 8 4 3 2 2 5 3 3 4 2 1 ... Suicide 9 ... ... ... ... 1 2 5 1 2 ... ... ... 4 2 1 ... 2 ... ... ... ... Other Defined Diseases 252 18 5 10 10 9 26 76 98 203 42 22 37 39 38 27 27 27 17 17 1 ... Diseases III-detined or Unknown 8 8 ... ... ... ... ... ... ... 4 ... ... ... ... ... ... ... ... ... 8 ... Old Age 101 ... ... ... ... ... ... 2 99 188 32 5 21 16 17 10 7 5 9 9 2 ... 1723 161 61 103 94 127 346 381 450 1214 270 133 264 298 215 155 165 186 156 131 20 ... Sub-Entries included in above figures— Cerebro-spinal Meningitis 1 ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 42 Table No. IV. INFANTILE MORTALITY. CALENDAR YEAR 1918. 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 42 4 5 10 61 31 17 22 19 158 Uncertified 2 ... ... ... 2 1 ... ... ... 3 Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 2 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ... ... 1 1 ... ... ... 1 2 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 2 1 3 Abdominal Tuberculosis ... ... ... ... ... 2 ... ... ... 2 Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 1 Meningitis (not Tuberculous) ... ... ... ... ... ... ... 2 1 3 43 Convulsions 2 ... 1 ... 3 2 1 ... ... 6 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis 1 ... ... 1 2 4 2 1 5 14 Pneumonia (all forms) 1 ... ... ... 1 3 4 4 1 13 Diarrhœa ... ... ... ... ... 1 1 2 3 7 Enteritis ... ... ... ... ... 3 4 5 1 13 Gastritis ... ... ... ... ... ... ... 1 ... 1 Syphilis ... ... ... 1 1 ... 1 ... ... 2 Rickets ... ... ... ... ... ... ... ... 1 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ......... ... ... ... ... ... ... ... Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 7 ... ... ... 7 2 *2 ... 11 Premature Birth 19 1 1 1 22 5 1 ... ... 28 Atrophy, Debility and Marasmus 7 1 3 6 17 8 3 2 ... 30 Other Causes 6 2 ... ... 8 2 ... ... 1 11 Deaths received from the Registrar-General (cause of death not known) 8 Totals 44 4 5 10 63 32 17 22 19 161 Nett Births registered during the calendar year Legitimate 1,715 Illegitimate 76 Nett Deaths registered during the calendar year Legitimate infants 150 Illegitimate infants 11 * I case unknown, found in Leyton. Table IVa. INFANTILE MORTALITY. CALENDAR YEAR 1918. Deaths all from Stated Causes as they occurred in the various Wards under One Year of Age. CAUSE OF DEATH. Leyton. Lea Bridge. Central. Forest. Leyton stone. Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Ward not known. Total Deaths under 1 Year. All Causes Certified 6 21 3.2 13 10 14 25 18 10 9 158 Uncertified ... ... ... 1 ... 1 ... 1 ... ... 3 Small-pox ... ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... ... Measles ... ... 2 1 ... ... ... ... ... ... 3 Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... 1 ... ... ... ... 1 ... ... ... 2 Diphtheria and Croup ... 1 ... ... ... ... ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... 1 ... ... 2 ... ... 3 Abdominal Tuberculosis 1 ... ... ... ... ... 1 ... ... ... 2 Other Tuberculous Diseases 1 ... ... ... ... ... ... ... ... ... 1 Meningitis (not Tuberculous) ... ... ... ... 1 1 ... 1 ... ... 3 Convulsions ... ... ... 2 ... 1 1 ... 2 ... 6 44 >f»- C7T Laryngitis ... ... ... ... ... ... ... ... ... ... ... Bronchitis ... 1 3 2 ... 1 4 1 2 ... 14 Pneumonia (all forms) 1 2 3 1 1 1 1 3 ... ... 13 Diarrhoea 1 ... 2 ... ... ... 1 1 2 ... 7 Enteritis ... 2 1 ... ... 4 3 3 ... ... 13 Gastritis ... ... ... ... ... ... 1 ... ... ... 1 Syphilis ... ... 1 ... ... ... ... 1 ... ... 2 Rickets ... ... ... ... 1 ... ... ... ... ... 1 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... Injury at Birth ... ... ... ... ... ... ... ... ... ... ... Atelectasis ... ... ... ... ... ... 1 ... ... ... 1 Congenital Malformations 1 2 3 ... ... 2 ... 1 1 *1 11 Premature Birth ... 2 8 3 5 1 6 1 2 28 Atrophy, Debility and Marasmus 1 9 6 3 1 4 4 2 ... ... 30 Other Causes ... 1 3 2 ... ... 1 3 1 ... 11 Deaths received from the Registrar-General (Wards not known) 8 Totals 6 21 32 14 10 15 25 19 10 9 161 Nett Births registered during the calendar Year Legitimate 1,715 Illegitimate 76 Nett Deaths registered during the calendar Year Inkown-Found in Leyton. Legitimate Infants 150 Illegitimate Infants 11 Leyton Urban District Council. ANNUAL REPORT TO THE EDUCATION COMMITTEE, EMBODYING THE Eleventh Annual Report ON THE MEDICAL INSPECTION OF SCHOOL CHILDREN Under the Education (Administrative Provisions) Act of 1907, For the Year 1918, 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. 49 TO THE CHAIRMAN AND MEMBERS of the LEYTON EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I beg to present the Eleventh Annual Report on the work of the School Medical Service in Leyton under the Education (Administrative Provisions) Act of 1907. The work has been carried on on the same lines as last year. No routine inspections at the Schools have been attempted. Dr. Kennedy has visited the Schools three times a week for the purpose of discovering ailing children, whom the has directed into the proper channels for obtaining treatment. These have been followed up at his subsequent inspections and by visits of the School Nurse. The amount of work done during the year in attending to the health of the children, including the Oculist's and Dentist's reports, as well as the results obtained, will be evident on a perusal of the matter embodied in the report. My thanks are due and are hereby acknowledged to members and officials for their courtesy and help. I am, Mr. Chairman and Gentlemen, Your obedient Servant, J. FRANCIS TAYLOR, School Medical Officer 50 SCHOOL NURSES. On the 13ch May you appointed another School Nurse, so that we have now three School Nurses. It is row possible to do much more in the way of seeing to the cleanliness of the children. One of the Nurses is systematically and constantly engaged in this work. She visits the Schools and examines the children for verminous conditions, and in consequence I am able to report a distinct improvement in this direction. SCABIES. Scabies has given a considerable amount of trouble, and on account of the difficulty in many cases of carrying out efficient treatment in their own homes, arrangements have been made to have them treated at our Isolation Hospital. Any case coming to my notice is visited at home by the School Nurse who ascertains if any other member of the family is affected, when if such is the case they are all directed to attend at the Isolation Hospital, where they are bathed by the Nurses, and sulphur ointment thoroughly rubbed in all over the body. While the patients are undergoing this treatment their clothes are disinfected in the disinfector. After a few (3 or 1 treatments) the patients are cured and are returned to School. 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; (1) ringworm of the scalp. The treatment, except in the case of severe ring-worm, 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. 51 OPHTHALMIC SURGEON'S REPORT FOR THE YEAR 1918. • The selection of new cases for Ophthalmic examination is made from:— (1) Children found with defective vision by the School Medical Officer at the School. (2) Children suffering from obvious defects sent to the School Clinic by the teachers. 674 cases were seen at the Clinic. A further 149 were notified, but failed to attend. Of the 674 new cases, the defects were as follows:— Myopia 119 Myopic astigmatism 50 Hypermetropia 92 Hypermetropic astigmatism 93 Mixed astigmatism 39 Hypermetropia with squint 72 Myopia with squint 6 Squint only 48 Odd eyes 15 Various diseases 60 No defect 69 Refused treatment 3 VARIOUS DISEASES. These include nystagmus 6, optic atrophy 1, night blindness 1, artificial eye 1, and choroiditis 1. The remainder were cases of corneal ulcer, corneal opacity and ciliary spasm. Eight cases suffering from high myopia were excluded from School for varying periods. There is now a second section of the Clinic for any of the children who are found to be suffering from conditions requiring supervision, such as myopia and squint. These report at intervals of 3-9 months. A. HENRY THOMPSON. 52 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. Seventeen cases were selected for this treatment during the year. 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. Records of attendances and treatment are entered in a daily register and upon special cards. During the year 936 boys and 1,175 girls were dealt with. The following table shows the conditions dealt with:— Boys. Girls. Vermin of head and body 19 340 Ringworm of scalp 90 57 Ringworm, other parts of body 54 42 Other skin diseases 344 281 Ear diseases 33 26 External eve diseases 62 45 Lung diseases 16 6 Heart diseases 6 4 Throat diseases 26 26 Miscellaneous 286 348 936 1,175 53 MINOR AILMENTS CLINIC. Treatment:— For diseases of the eyes on 1,627 occasions. „ „ „ ears on 601 „ „ Ringworm on 1,289 „ „ Other affections on 4,352 ,, Total 7,869 DENTAL CLINIC. CONDITION OF CHILDREN'S TEETH AT INSPECTION. School. Number of Children Inspected. Percentage of Children with Percentage of Children with 1 or more Permanent Teeth Decayed. Sound Teeth. 1-3 Temporary Teeth Decayed. 4 or more Temporary Teeth Decayed. 1st Inspection. Re-Inspected. 1st Inspection. Re-Inspected. 1st Inspection. Re-Inspected. 1st Inspection. Re-Inspected. 1st Inspection. Re-Inspected. Cobbold Road 30 47 6.6 12.7 33.3 44.6 56.6 25.5 36.6 68.0 Farmer Road 118 62 10.1 11.2 29.6 59.6 57.6 19.3 34.7 62.9 High Road 28 36 7.1 8.3 35.7 50.0 57.1 25.0 35.7 63.8 St. Joseph's 19 34 21.0 20.5 42.1 41.1 36.8 20.5 36.8 61.7 Capworth Street 155 119 12.9 12.6 36.7 57.1 50.9 14.2 27.7 68.0 Lea Bridge Road 51 50 3.9 6.0 27.4 60.0 66.6 18.0 43.1 76.0 Newport Road 98 164 8.1 14.0 23.4 61.5 66.3 11.5 23.4 65.8 Sybourn Street 78 83 10.2 21.6 26.9 48.1 57.6 15.6 35.8 51.8 Canterbury Road 79 80 15.1 17.5 30.3 51.2 51.8 12.5 18.9 60.0 Kirkdale Road 88 86 14.7 15.1 27.2 62.7 57.9 5.8 17.0 74.4 Norlington Road 165 187 ... ... ... ... ... ... ... ... Trumpington Road 49 53 6.1 7.5 30.6 62.2 63.2 24.5 18.3 58.4 Harrow Green 57 122 10.5 22.1 47.3 53.2 43.8 7.3 15.7 51.6 Goodall Road 147 268 10.2 13.4 34.0 58.2 55.1 13.0 25.1 55.2 Downsell Road 93 175 10.7 14.2 34.4 50.8 50.5 8.0 17.2 731 Ruckholt Road 65 83 15.3 16.8 32.3 54.2 52.3 10.8 13.8 57. 8 Mayville Road 10.1 119 12.8 10.9 26.7 66.3 59.4 11.7 17.8 68.8 1365 1824 10.9 14.0 32.3 55.0 55 2 15.2 26.1 64.5 54 Number of Children Treated at Dental Clinic. School. Inspected. Re-inspected. With Dental Caries. Received Treatment. Completed Treatment. Per cent. Completed Treatment. Church Road 19 17 Re port. 85 76 42.4 Cann Hall Road 19 17 Re port. 118 107 45.7 Cobbold Road 30 47 69 39 39 50.6 Farmer Road 62 118 161 83 75 41.6 St. Joseph's 19 34 42 26 25 47.1 Capworth Street 155 119 239 143 135 49.2 High Road 28 36 59 30 27 42.1 Lea Bridge Road 51 50 96 59 54 53.4 Newport Road 98 164 231 143 136 51.9 Sybourn Street 78 83 135 71 66 40.9 Canterbury Road 79 80 133 84 82 51.5 Kirkdale Road 88 86 148 86 81 49.4 Norlington Road 165 187 298 199 179 50.8 Trumpington Road 49 53 95 65 62 60.7 Harrow Green 57 122 146 74 64 35.7 Goodall Road 147 268 364 184 184 44.3 Downsell Road 93 175 233 74 72 Not Ruckholt Road 65 83 124 23 23 Finished Mayville Road 101 119 195 Not Commerced. 1365 1824 2768 1586 1487 47.3 Number of children inspected in 1918, 3,189. Number of children treated:— Routine cases 1,586 Routine cases brought forward from 1917 156 Casuals 677 Total number of children treated in 1918 2,419 55 Treatment Carried Out at School Clinic. School. Fillings. Extractions. Dressings and Scalings. Church Road 153 115 3 Cann Hall Road 230 127 25 Cobbold Road 78 31 7 Farmer Road 159 104 19 St. Joseph's 57 32 2 High Road 61 35 3 Capworth Street 282 139 22 Lea Bridge Road 123 51 12 Newport Road 239 122 12 Sybourn Street 102 84 10 Canterbury Road 142 96 7 Kirkdale Road 152 114 23 Norlington Road 328 180 50 Trumpington Road 104 71 17 Harrow Green 100 72 13 Goodall Road 266 114 37 Downsell Road 79 47 13 Ruckholt Road 20 17 4 2675 1551 279 Brought forward from 1917: Fillings, 277; extractions, 256; dressings, 26. Casuals: Fillings, 91; extractions, 779; dressings, 53. Full total of year's work:Fillings, 3,043; extractions, 2,586; dressings, 358. 729 of the 2,586 extractions were performed under Nitrous Oxide. This was administered on 202 occasions, giving an average of 3.6 teeth per each administration. Chloroform was given on two occasions. DENTAL TREATMENT OF MOTHERS. 152 mothers of the Infant Welfare Clinic received dental treatment. Treatment carried out consisted of 224 fillings, 624 extraction.), and 24 scalings. 56 The 624 extractions were all performed under Nitrous Oxide anasthesia. Nitrous Oxide was administered on 155 occasions, which resulted in an average of four teeth for each administration. MENTALLY DEFECTIVE, BLIND AND DEAF CHILDREN. Two blind children are maintained at the East London Home and School for Blind Children at Clapton, and one attends the Morning Lane . Day Centre, Hackney. Two mentally defective children are resident in the Hastings aad St. Leonards Home, one in Hopwell Hall, Derbyshire, two in Littleton House School, Cambridge, and eight attend the Walthamstow Day Centre for Mentally Defective Children. Eight children attend the Water Lane Deaf and Dumb Centre, West Ham, three attend a similar centre at Gainsborough Road, Walthamstow, one is at Anerley Residential School, and one at the Royal Institution, Edgbaston. Epileptic Children.—Two girls are resident at Chalfont St. Peters, two at Mudh Hadham, Hertfordshire, and one at the Epileptic Colony, Lingfield. 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 151 children were thus dealt with, and prosecutions for non-attendance at School instituted in 48 instances, as a result of which fines and costs amounting to £15 15s. 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 57 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 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:— 1918. 1917. 1916. 1915. 1914. Average weekly number of children fed (Dinners only are provided.) 53 72 54 90 312 STATISTICAL TABLES. TABLE I.—Number of Children Inspected 1st January to 31st December, 1918. B Groups other than "Code."* Intermediate Group (other than 8 years). Special Cases. Re-examinations (i.e. No. of Children Re-examined). (1) (2) (3) (4) Boys 1545 2128 Girls 1859 Totals 3404 2128 *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. 58 TABLE II-—Return of Defects found in the Course of Medical Inspection in 1918. Defect or Disease. Code Groups. Specials. Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment Number referred for Treatment Number requiring to be kept under observation, but not referred for Treatment (1) (2) (3) (4) (5) Malnutrition - - 1 3 Uncleanliness— Head - - 366 — Body - - 14 — Skin „ Ringworm— Head - - 152 — Body - - 76 — Scabies - - 230 — Impetigo - - 354 — Other Diseases - - 85 — Eye ] Defective Vision and Squint - — 462 5 External Eye Disease - - 125 — Ear Defective Hearing - - 33 3 Ear Disease - - 65 1 Teeth Dental Disease (see N.B. (2) below) — - — — Nose and Throat Enlarged Tonsils - - 87 — Adenoids - - 231 2 Enlarged Tonsils and Adenoids - - 94 1 Defective Speech - — 5 16 Heart and Circulation Heart Disease— Organic - - 67 35 Functional - - 21 5 Anæmia - - 60 5 Lungs „ Pulmonary Tuberculosis— Definite — — 7 — Suspected - - 2 — Chronic Bronchitis - - 34 — Other Diseases - - — 5 Nervous System Epilepsy - — 7 3 „ Chorea - - 13 1 Other Diseases - - 10 - Non-pulmonary Tuberculosis— Glands - - 3 — Bones and Joints - - 3 — Other Forms - - 5 - Rickets — — 1 — Deformities - - 1 2 Other Defects or Diseases - - 216 15 59 TABLE III.—Numerical Return of all Exceptional Children in the area in 1918. Boys. Girls. Total. Blind (including partially blind) Attending Public Elementary Schools - - - Attending Certified Schools for the Blind 1 2 3 *Not at School 1 1 2 Deaf and Dumb (including partially deaf) Attending Public Elementary Schools - - - Attending Certified Schools for the Deaf 9 4 J3 *Not at School — — — Mentally Deficient Feeble Minded Attending Public Elementary Schools 31 13 44 Attending Certified Schools for Mentally Defective Children ... 8 5 13 Notified to the Local (Control) Authority during the year 9 10 19 *Not at School 4 6 10 Imbeciles At School - - - *Not at School 6 3 9 Idiots 3 2 5 Epileptics Attending Public Elementary Schools 5 10 15 Attending Certified Schools for Epileptics - 5 *Not at School 3 4 7 Pulmonary Tuberculosis Attending Public Elementary Schools 54 47 101 Attending Certified Schools for Physically Defective Children - - - *Not at School 7 5 12 Physically Defective Other forms of Tuberculosis (Cripples) Attending Public Elementary Schools 13 9 22 Attending Certified Schools for Physically Defective Children - - - *Not at School 6 4 10 Cripples other than Tubercular Attending Public Elementary Schools 25 17 42 Attending Certified Schools for Physically Defective Children - - - *Not at School 3 2 5 60 TABLE IV.—Treatment of Defects of Children during 1918. 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 nut treated. Percentage of defects treated. From previous year. New. Total. Remedied. Improved. Unchanged. Clothing - - - - - - - - - - Footgear - - - - - - - - - Cleanliness of Head 29 366 395 — 395 360 35 — — 100.0 Cleanliness of Body 12 14 26 1 25 24 1 — — 96.1 Nutrition 15 1 16 1 13 4 9 — 2 81.2 Nose and Throat 267 427 694 90 240 200 34 6 364 34.5 External Eye Disease 22 125 147 5 141 120 17 4 1 95.9 Ear Disease 13 65 78 4 73 58 12 3 1 93.5 Teeth - - - - - - - - - - Heart and Circu ation 54 88 142 28 103 44 44 15 11 72.5 Lungs 17 43 60 6 54 25 16 13 — 90.0 Nervous System 12 27 39 8 30 11 15 4 1 77 0 Skin 122 897 1019 6 1013 941 59 13 — 99.4 Rickets — 1 1 — 1 — 1 — — 100.0 Deformities 2 1 3 — — — — — 3 0 Tuberculosis — Non-Pulmonary 3 11 14 — 14 3 4 7 — 100.0 Speech 7 5 12 2 7 3 2 2 3 58.3 Mental Condition 22 41 63 5 37 — 13 24 21 58.7 Vision and Squint 338 462 800 41 615 430 2 183 144 77.0 Hearing 32 33 65 4 53 45 5 3 8 81.5 Miscellaneous 28 223 251 4 245 219 22 4 2 97.6 Totals 995 2,830 3,825 205 3,059 2,487 291 281 561 80.0 61 TABLE V.—Inspfxtion, Treatment, &c., of Children during 1918. (1) The total number of children medically inspected (whether Code Group, special or ailing child) 3,404 (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) 102 (3) The number of children in (1) who were referred lor treatment (excluding uncleanliness, defective clothing, etc.) 2,450 (4) The number of children in (3) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 1,960