Leyton Urban District Council. Telephone No. 425 Walthamstow. Public Health Department. Town Hall, Leyton. E.10. With the Medical Officer of Health's Compliments. Form 33 Ley 018 Leyton Urban District Couricil. 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 1921, 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. Leyton Urban District Council. PUBLIC HEALTH STAFF. MEDICAL OFFICERS. Whole Time: Taylor, John Francis, M.R.C.S. (Eng.), D.P.H. (London), etc., Medical Officer of Health, School Medical Officer, Medical Superintendent (actual medical attendant on patients) of Isolation Hospital, Supervisor and Organiser of Maternity and Infant Welfare Work, etc., etc. Martin, Cecilia McEwan, M.B., Ch.B. (Glasg.), Assistant Medical Officer of Health, and Assistant School Medical Officer Part Time: Kennedy, John, M B., Ch.B. (Glasg.), School Medical Inspection, Emergency Attendant at Isolation Hospital. Chesser, Elizabeth Sloan, M.D., Ch.B. (Glasg.), Medical Officer Infant Welfare and Ante-Natal Clinics. Shields, Charlotte Annie, M.B., B.S. (London), Medical Officer Infant Welfare and Ante-Natal Clinics. Smith-Clark, Lizzie, M.B., Ch.B. (Edin.), School Oculist. DENTISTS—Whole Time: Chandler, Percy Ernest, L.D.S., R.C.S. (Eng.) Horton, James Ernest, L.D.S., R.C.S. (Eng.) School Dentists. Mr. Chandler also does the dental work prescribed for the mothers in connection with the Maternity and Child Welfare Scheme. SANITARY INSPECTORS : Stevens, Wilfred John, Certificate R.S.I., Meat Inspector's Certificate R.S.I. Spencer, Thomas Henry, Certificate R.S.I., Meat Inspector's Certificate R.S.I. Moles, John Frederick, Certificate R.S.I., Meat Inspector's Certificate R.S.I. Smith, George Alfred, Certificate R.S.I., Meat Inspector's Certificate R.S.I. Steeden, Edward James, Certificate R.S.I. Miller, Agnes Mabel, Certificate R.S.I. HEALTH VISITORS : Holland, Edith, Trained Nurse, Certificate Sanitary Inspector's Examination Board (London), Health Visitor's Certificate R.S.I. Dodd, Lilian Sarah, Trained Nurse, Health Visitor's Certificate R.S.I. Clipstone, Bessie Helen, Trained Nurse, C.M.B. Bratton, Maud, Trained Nurse. Roake, Winifred, Trained Nurse, C.M.B., Health Visitor's Certificate R.S.I. Walling, Ethel Winifred, Trained Nurse, Health Visitor's Certificate R.S.I., one-sixth time Health Visitor, five-sixths time School Nurse. TO THE CHAIRMAN AND MEMBERS OF THE LEYTON URBAN DISTRICT COUNCIL. Mr. Chairman, Madam and Gentlemen, In a circular issued by the Ministry of Health, dated 28th December, 1921, on the subject of the annual reports of medical officers of health it is suggested, with a view to effecting a reduction both in the time required by medical officers of health for preparing the Reports and in the cost of printing them, that certain details which do not vary from year to year and the curtailment of the information asked for in certain years be omitted in ordinary annual reports, but that every five ye'ars a fuller report, which is referred to as a survey report, should be issued. The report of 1920 is to be regarded as a survey report. In conformity with this suggestion the roport for the year under review is considerably curtailed. Our death-rate was 10.04 per 1,000 of the population. Our infant mortality rate 67.94 per 1,000 births. Our Zymotic death-rate was .63 per 1,000 of the population. Scarlet Fever has been exceptionally prevalent, but of a mild type. I take this opportunity of offering my best thanks to Councillors and Officials for their courtesy and help. I am, Mr. Chairman, Madam and Gentlemen, Your obedient Servant, J. FRANCIS TAYLOR. Leyton Urban District Council. ANNUAL HEALTH REPORT FOR 1921, 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 £523,102 12s. 6d., and a rate of 1d. in the £ produces £2,100. For poor rate purposes the rateable value is £546,038 15s., and a 1d. rate produces £72,218. AREA, INHABITED HOUSES, POPULATION. The district has a total area of 2,594 acres; at the end of 1921 it contained 23,806 houses, 56 of which, including 45 under the Council's Housing Scheme, were erected during the year. At the 1921 census the population numbered 128,432, which number divided among the inhabited houses gives an average of 5.39 persons per house. At the 1911 census the number worked out at 5.63 persons per house. BIRTHS. 2,489 births were registered—1,296 males and 1,193 females. To these must be added 87 male and 103 female births (transferable) received from the Registrar-General, which yields a birthrate of 20..86 per 1,000 of the population. Of the above, 67 were illegitimate births, 35 being males and 32 females. Percentage of illegitimate births, 2.50. 5 DEATHS. 1,075 deaths of Leyton residents were registered during the year—489 males and 586 females. To these must be added 127 males and 88 females, being deaths (transferable) received from the Registrar-General. The death-rate for 1921 was 10'04 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, 3; Scarlet Fever, 5; Diphtheria, 27; Whooping Cough, 6; Enteric Fever, 1; Diarrhoea and Enteritis, 39. The Zymotic death-rate for 1921 was .63 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 67.94, there being 182 deaths, 171 legitimate and 8 illegitimate. NOTIFICATION OF BIRTHS (EXTENSION) ACT, 1915. This Act took effect on September 1st, 1915. Under its terms 2,359 births were notified during the year 1921—1,231 from medical practitioners, 1,096 from midwives, and 32 from relatives. The health visitors visited 2,624 newly-born infants and paid 19,642 re-visits. MATERNITY AND INFANT WELFARE WORK. The constitution of the Committee appointed for the conduct of this work necessarily varies each year. The names of the ladies and gentlemen appointed for the year under review are as follows :— Cairman: Councillor Clare. Members: Councillors Allanson, A. G. Cochrane, Courtney, Dolder, Griggs, Hubbard, Marlow, Mrs. Marshall, Mawer, Pennmgton, and Vernon. 6 Co-opted Members: Mrs. Rarsham, Mrs. Carr, Mrs. Daplyn, Mrs. Enever, Mrs. Turner, and Mrs. Under wood. The scheme of work detailed in last year's report has been carried out during this year without any material alteration. The health visitors have paid 23,033 visits, of which 9,557 were visits to new-born infants and 9,523 to children between the ages of one and five years. The three clinics have held two sessions each per week. The following figures represent the attendances at these clinics for the past three years :— 1919. 1920. 1921. Town Hall Clinic 2376 3361 3614 People's Hall ,, 2588 3288 5066 Vicarage Road ,, 2837 4868 4277 Totals 7801 11517 12957 The ante-natal clinic held 48 sessions and 164 new patients made 214 attendances. DENTAL TREATMENT OF NURSING AND EXPECTANT MOTHERS. Number treated, 101. Extractions under Nitrous Oxide, 215. Extractions under local anaesthetic, 52. Nitrous Oxide was administered by the medical officer of health on 58 occasions. Fillings, 69. MILK (MOTHERS AND CHILDREN) ORDERS, 1919 and 1921. In consequence of the latter Order, Recission Order 1921, no milk at all was given during May and only 198 pints during June. Certain alterations in the administration of the Order were then made, viz.: the interviewing of applicants and the granting 7 of milk was delegated to the ladies of the Infant Welfare Committee in place of the medical officer of health, on whom previously this duty devolved. The scale of necessity was also somewhat modified, and the following is the one now in force:— Weekly income per head after deducting rent:— 1 to 2 in family, 10s. 3 ,, 4 ,, 9s. 5 ,, 6 ,, 8s. 7 „ 8 „ 7,s. 9 ,, 12 ,, 6s. All the milk is given free and the arrangements for its supply are the same as those stated in last year's report. 117,960 pints were given during the year. CONVALESCENT HOME FOR NURSING MOTHERS AND BABIES. The Council have continued for another year the arrangement with the National League for Health, Maternity and Child Welfare whereby the League agree to place at the disposal of the Council one cot or bed in their Home at Shooter's Hill, or alternately a bed in their Home for toddlers at Maidenhead, for a period of one year, in consideration of a payment of £55. This arrangement dates from the 1st November, 1921. INFECTIOUS DISEASE. 2 cases of Dysentery and 1 of Malaria were notified during the year. No case of Smallpox, Plague, Cholera, or Typhus has been notified. SMALLPOX. We are still without any hospital accommodation for Smallpox. 8 VACCINATION RETURNS. Number of Births. Vaccinated. Certificates of Insusceptibility. Exemptions. Died Unvaccinated under 1 year 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 1918 1701 434 2 709 94 1919 2066 463 5 756 79 1920 2968 796 5 1274 115 1921 2465 553 2 1266 108 ENTERIC FEVER. 7 cases were notified. 1 death occurred. Each case was visited, and in addition to giving suitable advice, etc., endeavour was made to trace the cause of the infection. (See also hospital report.) SCARLET FEVER. Cases notified, 1,320. There were 5 deaths. Case-fatality per cent., .38. Death-rate per 1,000 of the population, .04. DIPHTHERIA. Cases notified, 332. 27 deaths occurred. Case-fatality per cent., 8.3. Death-rate per 1,000 of the population, .21 PUERPERAL FEVER. 6 cases of this disease were notified. 1 death occurred. The death-rate from Puerperal Fever was .008 per 1,000 of the population. 9 The County is the authority for the administration of the Mid wives Act, and the county medical officer of health has been promptly notified of all cases coming under h,is jurisdiction. Disinfection of premises and clothing has been systematically carried out. MEASLES. There were 3 deaths during the year. Death-rate, .02 per 1,000 of the population. 27 cases of Measles and 7 of German Measles were visited by the health visitors. WHOOPING COUGH. There were 6 deaths during the year. Death-rate per 1,000 of the population, .05. 3 of these deaths occurred in children under one year of age, 1 between one and two years, 1 between two and five years, and 1 between five and fifteen years. The health visitors visited 94 cases. DIARRHCEA AND ENTERITIS. Diarrhoea and Enteritis caused 39 deaths, 37 of which were of infants under one year of age, and 2 between one and two years. Of these, 9 died at the following Hospitals Queen's Hospital 2, London Hospital 1, East London Hospital (Shadwell) 1, Children's Hospital (Great Ormond Street) 3, Mildmay Hospital 1, and 1 at Walthamstow Hospital. Our death-rate from Diarrhoea and Enteritis under two years was 14.56 per 1,000 births. CEREBRO-SPINAL MENINGITIS. No notifications received. ANTERIOR POLIOMYELITIS. 1 case was notified. 10 ENCEPHALITIS LETHARGICA. 6 notifications were received. 1 death occurred. OPHTHALMIA NEONATORUM. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In hospital. 15 8 7 13 — nil 2 TUBERCULOSIS. 109 deaths occurred from all forms of Tuberculosis, 84 being notified cases, which represents a death-rate of '85 per 1,000 of the population. The deaths from Pulmonary Tuberculosis were 95 and the rate .74. Notifications of 171 cases of Pulmonary Tuberculosis and 40 of other forms of Tuberculosis were received during the year. Pulmonary- Males 91 Females 80 Total 171 Non-Pulmonary— Males 22 Females 18 Total 40 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. Charlotte Brown attends at the Tuberculosis Dispensary, 180, High Road, Leyton, on: Mondays: 2.30—4.30 p.m. 11 Dr. H. Vicars Crossfield: Tuesdays : 10.0 a.m.—12 p.m. Wednesdays: 10 a.m.—12 p.m. and 2—4 p.m. Dr. John Sorley : Thursdays: 10 a.m.—12 p.m. and 6—8 p.m. 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 the report of the year 1913 have been continued. BACTERIOLOGICAL DIAGNOSIS. The arrangements made by the County Council of Essex with Dr. John Beale, Essex Public Health Laboratory, 91, Queen Victoria Street, E.C.4, for the examination of specimens sent by any Authority throughout the County, is being continued. The following specimens were sent:— Diphtheria 465 Ringworm 116 Sputum 11 Widal's Test 2 CANCER. There were 149 deaths during the year, giving a death-rate of 116 per 1,000 of the population. INQUESTS. The following verdicts were recorded at Inquests held in the district during the year:— Natural Causes 45 Accident 16 Want of proper attention at birth 3 Accidental suffocation in bed with parents 1 Accidentally overlain 1 Suffocation while in state of intoxication 1 Suicide (1 self-inflicted wound, 1 hanging, 4 coal gas poisoning, 1 carbolic acid poisoning, 1 shock of corrosive poisoning, 1 jumping from balcony) 9 12 HOUSING. 45 houses erected under the Council's Scheme, all of Type B, are now in occupation. The need for an additional sanitary inspector, alluded to in last year's report, received further consideration, and Mr. E. J. Steeden, Certificate R.S.I., was appointed. He commenced duty on November 1st. 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 665 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 Nil. Number of dwelling-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 308 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 exiit 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. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACT, 1920. The medical officer of health issued 48 certificates during the year. 13 ISOLATION HOSPITAL. Scarlet Fever has been exceptionally prevalent during the year. There were notified 1,320 cases of scarlet fever and 332 cases of diphtheria. Of the scarlet fever cases 450 were admitted to our hospital and of the diphtheria cases 223 were admitted. The remainder, with the exception of a few received into other hospitals, were treated in their own homes. Supervision was maintained over those kept at home to ensure the best isolation possible, and the other occupants of the house were allowed to continue at their work. Experience has proved that the large majority of scarlet fever of the now prevalent mild type can be quite satisfactorily dealt with in this way. The necessity for providing hospital accommodation for enteric fever has become manifest during the year. This need has arisen in consequence of the general hospitals refusing to receive these cases as they have done hitherto. Other isolation hospital authorities, including the Metropolitan Asylums Board, have been approached with a view to receiving our cases, but so far without result. In last year's report reference was made to the contemplated provision of extra bedrooms for the staff. Some of the nurses have to share a bedroom owing to lack of accommodation, and this is very much resented by them. Extra bedroom accommodation is also required for the domestic staff (ward maids). After consideration of several alternatives, the Committee agreed to extend the nurses' dormitories to give the extra accommodation for the nurses, and in addition three rooms to be set apart for enteric fever cases. It was also agreed to provide the extra accommodation for the wardmaids by extending their dormitories. The total estimated cost necessitated by these proposed alterations amounts to £2,325, and an application to the Ministry of Health has been made for consent to borrow this sum. The statistics which follow are eloquent testimony of the good work done in this hospital, and the results are largely due to the nursing facilities provided under the able superintendence of the matron, who has occupied that position for nineteeen years. The medical staff of the hospital consists of the medical officer of health, who is medical superintendent, the assistant medical officer of health, and Dr Kennedy, who renders service in emergencies, 14 STATISTICAL RETURNS:— Admissions:— Male. Female. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 and upwards. Diphtheria 108 115 l 51 138 21 12 Scarlet Fever 175 284 0 66 345 26 22 Totals 283 399 l 117 483 47 34 Tracheotomy was performed on three children, and in two instances it was the means of saving their lives. Deaths—Diphtheria, 20; Scarlet Fever, 2. The Estimated amount of money expended on the hospital during the financial year ending 31st March, 1922, is £8,092 5s. 6d., divisible into the following items:— £ s. d. £ s. d. Buildings: Repairs and Maintenance 914 1 5 Furniture and Repairs 255 18 7 Bedding, Linen, &c. 194 0 0 1,364 0 0 Domestic Utensils 55 0 0 Fuel, Light, Water and Cleaning 810 0 0 865 0 0 Rates, Printing, Stationery, &c. 383 0 0 Medicines, Drugs & Surgical Appliances 134 0 0 Provisions 1,816 0 0 Removal of Patients 922 3 0 Uniforms and Dresses 137 0 0 Salaries, Wages and Allowances 2,399 2 6 Contributions to Other Authorities 72 0 0 5,863 5 6 £8,092 5 6 15 REPORT OF SANITARY INSPECTOR. TO THE CHAIRMAN AND MEMBERS OF THE LEYTON URBAN DISTRICT COUNCIL. Mr. Chairman, Madam and Gentlemen, I beg to submit to you my report for the year 1921. INSPECTION OF THE DISTRICT AND ABATEMENT OF NUISANCES. During the year, 1,573 complaints have been received and dealt with. An additional inspector was appointed towards the end of the year and commenced duty on November 1st, since when he has been exclusively engaged on house-to-house inspection. The total number of houses inspected was 4,845. 11,500 re-inspections were made, and notices and letters written in reference to them numbered 3,941, of which 71 were statutory notices. UNFIT DWELLING-HOUSES. I.—Inspection. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,845 Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 665 Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 3,435 II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 2,763 16 Proceedings under Public Health (1) Number of dwelling-houses in respect of which notices were served requiring- defects to be remedied 71 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 77 (b) by Local Authority in default of owners Nil The house-to-house inspections totalled 665, against 1,765 in 1914 and 46-1 in 1920. These inspections were carried out in the following roadis:— Harvey Gardens, Harvey Road, Leytonstone. Ashville Road, Leytonstone. Angle Street, Leytonstone. Holloway Road, Leytonstone. Denmark Street, Leytonstone. Wood Street, Leytonstone. Francis Road, Leyton. Beaumont Road, Leyton. Sophia Road, Leyton. Etloe Road, Leyton. Simonds Road, Leyton. DRAINAGE. The drainage of 73 houses has been reconstructed. In some cases the drains formed portions of combined systems of drainage, and in such instances on default of the owners the work has been done by the Council's workmen and the expenses incurred have been recovered from the owners. FACTORY AND WORKSHOP ACTS, 1901 and 1907. 40 visits were paid to factories and 438' workshops were inspected during the year and 208 nuisances remediable under the Public Health Acts, or contravening the Factory and Workshop Acts, dealt with, and re-visits made until the necessary work had been carried out. 277 workshops remain on the register. 17 433 outworkers were notified by other Councils and we forwarded 100 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. 1,310 visits were paid to outworkers' premises and 223 uncleanly and insanitary defects remedied. INFECTIOUS DISEASE. Appended is a summary of the work in connection therewith : Houses disinfected and the sanitary arrangements examined and tested 1527 Loads of infected bedding removed to be disinfected at the Council's Steam Disinfector and returned 1142 Books belonging to Public Institutions disinfected 424 Also various articles of wearing apparel. POLICE COURT PROCEEDINGS. 66 summonses were issued as follows:— Abatement of Nuisances 41 Non-compliance with Justices' Orders 22 Slaughtering on unlicensed premises and aiding and abetting same 2 Keeping Swine contrary to Bye-laws 1 Fines and costs amounting to £67 18s. 0d. were imposed. MEAT AND FOOD INSPECTION. 3,126 visits to slaughter-houses, butchers and other food shops have been made. The generally good condition of these has been well maintained. The following was found to be unfit for food of man and dealt with accordingly:— 26 Sheep Carcases 3 boxes Lemon Soles 1806 lbs. Beef 2 trunks Haddocks 489 lbs. Mutton (other than 7 boxes Kippers whole carcases) 2 kits Crabs 18 46 Ox Livers 6 Sheep Livers 2 Pigs' Heads 97 Rabbits 3 boxes Skate 83 lbs. Skate. 1 box Herrings 1 box Plaice 1 bag Mussels 23 cases Cucumbers 17 cases Milk Powder 4 boxes Apples 9 tins Tomatoes 1 tin Corned Beef 2 tins Salmon SLAUGHTER-HOUSES. There are 14 licensed slaughter-houses in the district, of which 9 are annual licences. The slaughter-houses generally are kept in a good condition and the bye-laws well observed. Number of carcases inspected:— Sheep 2591 Bullocks 1810 Pigs 941 Calves 141 Lambs 32 DAIRIES, COWSHEDS, AND MILKSHOPS. 207 visits have been made to dairies, cowsheds, and milkshops, of which there are 40 dairies, 5 cowsheds, and 9.2 milkshops on the register, and the requirements under the Dairies, Cowsheds, and Milkshops Orders have been complied with without any statutory proceedings being necessary. BAKEHOUSES. 90 visits have been made to bakehouses; the majority are kept in a satisfactory condition. Insanitary conditions have been dealt with where necessary and remedied by informal notices. MORTUARY. During the year the number of bodies received was 65, on 50 of which post-mortems were performed. 19 PETROLEUM ACTS. To store Petroleum. To store Carbide of Calcium Licences renewed 36 1 New Licences granted after inspection of storage arrangements 7 4 The work under the Petroleum Acts is rapidly growing, 8!) visits having been made during the year. PLACES OF PUBLIC ENTERTAINMENT. In accordance with the recommendation contained in the circular of the Ministry of Health, dated 25th August, 1920, 29 visits to cinemas and other places of public entertainment have been made and sanitary accommodation found to be satisfactory and apparently sufficient in all cases. No standard as to sufficiency has been laid down. I am, Mr. Chairman, Madam and Gentlemen, Your obedient Servant, W. J. STEVENS. 20 DEATHS. CALENDAR YEAR 1921. Ages. Wards. 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 tbe District. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone. Grove Green. Harrow Green. Cann Flail. 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 24 All Causes Certified 1290 182 24 27 52 63 137 321 484 1368 304 80 178 106 98 184 150 105 155 129 87 9 1290 Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 3 1 ... 2 ...... ... ... ... ......... 1 ... 1 ... 1 ... ... ... ... ... ...... ...... 3 Scarlet Fever 5 ... ... 2 3 ... ... ...... ... ...... ... 1 ...... 1 ......... ...... ... ......... 2 1 ... ... 5 Whooping Cough 6 3 1 1 1 ... ... ... ... 4 2 ... 3 ... ... ... 1 ... 2 ... ... ... 6 Diphtheria and Croup 27 ... 4 4 19 ... ... ... ... 1 1 ... 5 2 5 5 3 4 3 ... ... ... 27 Influenza 19 ... ... ... 1 2 8 6 2 11 7 2 2 1 1 2 3 2 2 1 3 ... 19 Erysipelas 4 1 ... 1 ... ... 1 1 ... 10 1 ... 1 ... ... ... ... 1 1 1 ... ... 4 Phthisis (Pulmonary Tuberculosis) 95 2 2 ... ... 24 34 30 3 115 23 4 17 8 6 14 12 2 13 9 10 ... 95 Tuberculous Meningitis 5 ... 1 2 ... 1 ... 1 ... 11 1 1 ... ... ... 1 1 ... 1 1 ... ... 5 Other Tuberculous Diseases 9 1 ... ... 2 1 3 2 ... 17 2 1 1 1 1 ... 1 3 ... 1 ... 9 Cancer, malignant disease 149 ... ... ... ... ... 8 69 72 172 33 7 20 12 9 21 22 10 17 18 13 ... 149 Rheumatic Fever 3 ... ... 1 ... ... 1 ... 1 11 ... ... ... 2 ... ... ... 1 ... ... ... ... 3 Meningitis 4 ... 1 ... 2 1 ... ... ... 4 ... 1 ... ... ... 1 1 ... ... 1 ... ... 4 Organic Heart Disease 135 ... ... ... 5 6 22 38 64 86 14 13 15 10 11 18 16 13 13 16 10 ... 135 Bronchitis 112 8 ... ... ... 1 2 28 73 113 34 6 9 7 11 23 11 11 14 14 6 ... 112 Pneumonia (all forms) 96 24 7 5 3 3 10 20 24 88 21 3 17 12 5 9 12 6 19 7 5 1 96 Other diseases of Respiratory Organs 22 2 ... 2 ... 2 1 6 9 26 7 1 2 2 2 4 3 2 2 4 ... ... 22 Diarrhoea and Enteritis 39 37 2 ... ... ... ... ... ... 35 8 2 9 3 2 5 1 7 7 3 ... ... 39 Appendicitis and Typhlitis 6 ... ... ... 1 3 ... 1 1 5 1 ... 1 1 ... 1 2 ... 1 ... ... 6 Cirrhosis of Liver 11 ... ... ... ... 1 2 6 2 9 3 1 2 1 1 ... 3 ... ... ... ... ... 11 Alcoholism 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 1 Nephritis & Bright's Disease 36 ... ... ... 3 2 6 10 15 53 13 3 7 ... 5 5 ... 3 1 5 3 ... 36 Puerperal Fever 1 ... ... ... ... ... 1 ... ... 4 ... ... 1 ... ... ... ... ... ... ... ... ... 1 Other accidents & diseases of Pregnancy & Parturition 10 ... ... ... ... ... 9 1 ... 5 2 1 2 1 1 3 ... 1 l ... ... ... 10 Congenital Debility and Malformation, including Premature Birth 74 73 ... 1 ... ... ... ... ... 27 2 5 13 5 10 15 4 3 9 2 7 1 74 Violent Deaths, excluding Suicide 33 3 2 2 2 7 5 5 7 32 13 2 4 4 3 2 4 3 4 4 2 1 33 Suicide 11 ... ... ... 1 3 6 1 6 1 ... 2 1 ... 3 1 ... 1 1 1 1 11 Other Defined Diseases 271 27 3 4 10 8 21 89 109 295 72 32 30 26 21 29 31 23 33 26 17 3 271 Diseases Ill-defined or Unknown 2 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 Old Age 100 ... ... ... ... ... ... ... 100 225 43 2 15 5 3 20 15 10 7 13 8 2 100 1290 182 24 27 52 63 137 321 484 1368 304 89 178 106 98 184 150 105 155 129 87 9 1290 Sub-Entries included in above figures— Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Lethargica ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 21 22 INFANTILE MORTALITY, CALENDAR YEAR 1921. 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 under l2 Months. Total Deaths under 1 Year. All Causes Certified 52 12 14 5 83 32 28 30 9 182 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 ... ... ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-Cough ... ... ... ... ... 1 1 1 ... 3 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... 1 ... 1 Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... ... ... ... ... ... 1 1 Other Tuberculous Diseases ... ... ... ... ... ... 1 ... 1 2 Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 ... ... ... 1 1 1 2 ... 5 Laryngitis ... ... ... ... ... ... ... 1 ... .1 Bronchitis ... ... 2 ... 2 5 ... 1 ... 8 Pneumonia (all forms) ... 3 1 ... 4 3 9 6 2 24 Diarrhoea ... ... ... 1 1 1 2 6 ... 10 Enteritis ... ... ... ... ... 7 11 8 1 27 Gastritis ... 1 1 ... 2 ... ... ... ... 2 Syphilis ... ... ... 1 1 ... ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... ... 1 1 ... ... ... 2 Injury at Birth ... ... ... ... ... ... ... ... ... ... Atelectasis 9 ... ... ... 9 ... ... ... ... 9 Congenital Malformations 4 ... 1 ... 5 3 1 ... 2 11 Premature Birth 29 4 6 1 40 6 ... 1 ... 46 Atrophy, Debility and Marasmus 3 3 3 ... 9 3 2 1 ... 16 Other Causes 5 1 ... 2 8 1 ... 2 2 13 Totals 52 12 14 5 83 32 28 30 9 182 Nett Births registered during the calendar year Legitimate 2,612 Nett Deaths registered during the calendar year Legitimate infants 174 Illegitimate 67 Illegitimate infants 8 2 newborn, unknown, found in Bushwood, Leytonstone, 1 on Leyton Marshes and 1 in Epping Forest, off Whipps Cross Road. 1 Wilful Murder. 24 Cases of Infectious Disease Notified During the Year 1921, including Cases which occurred in Central Home, Union Road, Whipps Cross Hospital, &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 Agas. At Ages—Years. 1 2 3 4 e 6 7 8 9 10 Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Leyton. Lea Bridge. Central North. Central South. Forest. Leytonstone Grove Green. Harrow Green. Cann Hall. Wanstead Slip. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Choiera (C) Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... *Diphtheria (including Membranous Croup) 332 3 71 204 27 24 2 1 10 60 37 43 38 28 43 30 29 14 251 †Erysipelas 54 1 2 3 4 15 21 8 8 12 5 8 7 ... 8 6 4 1 15 ‡Scarlet Fever 1320 4 171 996 100 48 1 ... 128 210 107 131 160 103 123 200 70 88 493 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 7 ... ... 2 1 3 1 ... ... 1 ... ... 1 1 2 1 1 6 Relapsing Fever (R) Continued Fever (C) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 6 ... ... ... 2 4 ... ... ... ... 1 ... ... 1 1 1 1 1 6 Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... §Encephalitis Lethargica. 6 ... 1 1 2 1 1 ... ... 3 1 2 ... ... ... ... 4 ||Pulmonary Tuberculosis 171 ... 2 23 51 58 34 3 8 19 19 16 29 14 15 30 15 5 31 ¶ther forms of Tuberculosis 40 1 4 14 10 6 5 ... 5 9 4 2 2 2 2 6 5 2 10 Ophthalmia Neonatorum 15 15 ... ... ...... ... ... ... 2 2 2 ... 3 ... 1 1 1 3 7 Pneumonia 68 1 5 15 10 19 14 16 5 15 1 3 2 4 9 3 4 28 **Dysentery 2 ... ... ... ... 2 ... ... ... ... ... 1 ... ... ... 1 ... ... 1 ††Malaria 1 ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Totals 2023 25 257 1258 208 180 79 16 173 321 190 208 245 153 197 286 129 119 852 • 2 cases occured in Central Home, 7 in Whipps Cross Hospital (Nurses) and 3 cases withdrawn. † 1 case occurred in Central Home. ‡ 11 cases occurred in Central Home, 4 in Whipps Cross Hospital (Nurses), 1 in Nurses' Home, Beachcroft Road, 6 in Bethnal Green Schools, 1 in West Ham Union Home, 58, Davies Lane, and 1 in Home of the Good Shepherd. Davies Lane. 4 cases withdrawn § 1 case proved not to be Encephalitis Lethargica. || 3 cases from Central Home, 1 in Forest House Cottages, James Lane. 1 case no fixed abode. ¶ 1 case homeless. ** 1 old military case. †† Old military case. Leyton Urban District Council. ANNUAL REPORT to the EDUCATION COMMITTEE, embodying the Fourteenth Annual Report on the MEDICAL INSPECTION OF SCHOOL CHILDREN Under the Education (Administrative Provisions) Act of 1907, For the Year 1921, by J. FRANCIS TAYLOR, M.R.C.S., D.P.H. Surgeon-Major, Honourable Artillsry Company, Medical Officer of Health. 26 TO THE CHAIRMAN AND MEMBERS OF THE LEYTON EDUCATION COMMITTEE. Mr. Chairman, Ladies and Gentlemen, I have the honour to present to you the 14th Annual Report of the School Medical Service in Leyton under the Education (Administrative Provisions) Act of 1907. In the interests of economy the Report is brief and is therefore largely in tabular form. As the result of your acquiescence in my recommendation to engage Dr. Kennedy for three sessions per week, in addition to Dr. McEwan Martin's whole time services, I have been enabled to complete the examination of the groups "Entrants," "Intermediates," "Leavers," and "Specials," as required by the Board of Education. I desire to acknowledge Dr. Martin's valuable help in compiling this report, and to thank her and the rest of the staff for their industry during the year. I also take this opportunity of thanking members and officials for their invariable courtesy and help. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, J. FRANCIS TAYLOR. 27 STAFF. School Medical Officer.—J. Francis Taylor, M.R.C.S. (Eng.), D.P.H. (London). Assistant School Medical Officers.—Cecilia McEwan Martin, M.B., Ch.B. (Glasgow); John Kennedy, M.B., Ch.B. (Glasgow) (part time). School Oculist.—Lizzie Smith-Clark, M.B., Ch.B. (Edinburgh). Dentists.—Percy E. Chandler, L.D.S., R.C.S. (Eng.); James E. Horton, L.D.S., R.C.S. (Eng.). School Nurses.—E. W. Walling, D. Crawford, M. Sykes, M. Maye. SCHOOL NURSES. There are three whole time school nurses, and one who is partly employed in the dental department and partly as a health visitor. One attends the Town Hall clinic in the mornings and attends school medical inspection or visits in the afternoons. One attends school medical inspection mornings and afternoons. One conducts "surveys of cleanliness," visits cases that require following up, and prepares the children in the school (weighing and measuring) prior to the visit of the school medical officer. Each whole time school nurse changes duties at the beginning of every month. Each nurse has a group of schools which she visits for "surveys of cleanliness" two or three times a year, as time and prevailing conditions permit. SCHOOL CLINIC. Children found with defects by the school medical officer, children found to have obvious defects by the teacher, and children found to be verminous bv the nurse at the "head inspection" in the school are given clinic cards and attend the school clinic which is held every morning at the Town Hall. Attendances and treatment are entered in a register and oa special record cards. 38 During 1921, 2,383 individual children attended the clinic. Cases that are unsuitable for clinic treatment are referred to the general hospitals within easy reach of Leyton. The following table is an analysis of the ailments treated at the clinic during the year:— No. of Children. Vermin of head and body 589 Ringworm of scalp 114 Ringworm of body 112 Scabies 135 Other skin diseases 685 Ear diseases 132 External eye diseases 205 Lung diseases 63 Heart disease 36 Throat diseases 171 Miscellaneous 141 Total 2,383 TREATMENT OE MINOR AILMENTS. Children attended for diseases of eyes on 1,776 occasions. „ „ „ „ ears on 941 „ „ „ „ Ringworm on 568 „ „ „ „ miscellaneous ailments on 4,359 „ Total 7,644 54 children suffering from Ringworm of the scalp were treated by X-rays (London Hospital and Queen's Hospital, Hackney Road). TREATMENT OF DEFECTS. All cases referred for treatment at the school medical inspection have a re-inspection card made out at the time. These cases are visited by the school nurses at short intervals till treatment is obtained, a report of the result of each visit being 29 made on the re-inspection card. The case is only closed when satisfactory treatment has been obtained. In 1921 the school nurses paid 1,696 visits to homes. The effect of the measures taken resulted in satisfactory treatment being obtained in 91 per cent. of the cases. TREATMENT OF CLEANLINESS. A group of schools is allotted to each whole time school nurse, and each school has been visited twice during the year. The total number of children examined by the nurses in the year was 34,015. The number of individual children found unclean was 3,798, of which 589 were referred to the clinic at the Town Hall. Children are given ointment and printed instructions for the cleansing of heads. Soaking the hair with solution and combing with Sacker's hygienic comb is a very effective method of removing nits. One of these combs is in use at the clinic. Some parents have purchased this comb from the patentee, but the cost is beyond the average parent. Possibly some scheme might be put in operation whereby the Council could supply these combs and parents hire them at a small fee per day. 115 cases were brought before the Attendance Sub-Committee. Twenty-two parents were prosecuted, and as a result of which fines and costs amounting to £5 10s. 0d. were inflicted. EXCEPTIONAL CHILDREN. Leyton has no special schools for these children. A proposal to set apart certain class-rooms in Harrow Green and Farmer Road Schools for mentally defective children failed to receive the assent of the Board of Education on the grounds of the need for economy at the present time. Arrangements have been made with other authorities for the accommodation of certain defective children:— 1 Mentally Defective—Forest Lane, West Ham. 1 „ „ —Lyttleton House School, Cambridge. 7 „ „ —Royal Eastern Counties Institute, chester. 6 „ „ —WalthamstO'W Day Centre. 30 1 Deaf and Dumb—Royal Institute, Edgbaston. 8 „ „ —Water Lane Centre, West Ham. 2 „ „ —Gainsborough Road Centre, Waltham- stow. 2 Epileptics—Chalfont St. Peters. 2 „ —Epileptic Colony, Lingfield. 1 „ —Royal Eastern Counties Institute, Colchester. 1 Physically Defective—Hollywick Institute, Winchmore Hi". 2 Blind—East London Home for Blind, Clapton. There are, of course, many defective children for whom no suitable accommodation has been provided. OPHTHALMIC SURGEON'S REPORT ON THE WORK OF THE EYE CLINIC. The selection of new cases for Ophthalmic examination is made from:— (1) Children found with defective vision by the school medical officer at the schools. (2) Children suffering from obvious defects sent to the school clinic by the teachers. VARIOUS DISEASES. 50 disease cases were seen. These included Corneal Ulcers, Stye, Conjunctivitis, Phlyctenular Ophthalmia, Blepharitis, Night Blindness, Optic Atrophy, Corneal Opacity, Zerosis, Nystagmus, Leucoma, Ptosis, Anophthalmia, Keratitis, Anterior Polar Cataract, Cataract, Asthenopia, Tarsal Cyst, Congenital Coloboma. Myopia and Squint cases requiring supervision are seen at intervals of from three to six months. The early treatment in squint cases is of prime importance if the sight in the squinting eye is to be preserved. EDUCATION (PROVISION OF MEALS) ACTS. Cookery centres have been established by the Education Committee at each of the following schools:—Mayville Road, Ruckholt Road, Capworth Street, and Cann Hall Road. During 31 the year all of these centres have been used for the provision of dinners for necessitous children. The meals are served under the supervision of women assistants specially employed for this purpose, and they are also responsible for the cleanliness of the dining room and the washing of the dishes, etc. The diet sheets are submitted to and approved by the school medical officer. Children are provided with free meals on the recommendation of the school medical officer or the head teacher. The number of children for whom meals have been provided as compared with previous years is as follows:— 1921. 1920. 1919. 1918. 1917. 1916. 1915. 1914. Average weekly number of chil- 276 55 42 53 72 54 90 312 dren fed (Dinners only are provided.) THE EMPLOYMENT OF CHILDREN IN ENTERTAINMENTS RULES, 1920. Under the provisions of the above rules made by the Board of Education under Section 3 of the Prevention of Cruelty to Children Act, 1904, as amended by Section 13 (2) of the Education Act, 1918, which require that the applicant for a licence must produce a certificate from the school medical officer certifying that the child may be employed in the manner proposed without detriment to health, physical development and education, 19 certificates have been issued. 32 STATISTICAL TABLES. TABLE I.—Number of Children Inspected from 1st January, 1921, to 31st December, 1921. A.—Routine Medical Inspection. Age Entrants 3 4 5 6 Other Ages Total Boys 2 662 138 73 875 Girls 3 601 140 27 771 Totals 5 1263 278 100 1646 Age Intermediate Group Leavers Other Ages Total Grand Total 8 12 13 14 Boys 1019 29 1004 63 1 2116 2991 Girls 847 36 950 98 2 1933 2704 Totals 1860 65 1954 161 3 4049 5695 B.— Special Inspections. Age Special Cases Re-examinations (i.e., No. of Children Re-examined) Boys 1532 2763 Girls 2139 2872 Totals 3671 5635 C.—Total Number of Individual Children inspected by M.O., whether as Routine or Special Cases (no Child being counted more than once in the Year). No. of Individual Children inspected 9366 33 TABLE II.—'Return of Defects found in the Course of Medical Inspection in 1921. Defect or Disease. Routine Inspections. Specials. Number referred for Treatment. Number requiring to be kept under observation, but not re ferred for Treatment. Number referred for Treatment. Number requiring to be kept under observation, but not referred for Treatment. (1) (2) (3) (4) (5) Malnutrition 2 - 2 - Uncleanliness— Head 59 521 582 — Body — 175 11 Skin Ringworm— Head 1 — 113 — Body 2 — 110 — Scabies 20 — 119 — Impetigo 22 — 362 — Other Diseases (Non-Tubercular) 15 1 286 — Eye Blepharitis 21 1 72 — Conjunctivitis 1 — 41 — Keratitis — — 16 — Corneal Ulcer 1 — 1 — Corneal Opacities 1 1 3 — Defective Vision 563 90 161 7 Squint 31 16 7 — Other Conditions 4 — 48 — Ear Defective Hearing 10 6 4 4 Otitis Media 17 1 81 — Other Ear Diseases 11 3 9 — Nose and Throat Enlarged Tonsils 193 27 7 3 Adenoids 196 83 30 2 Enlarged Tonsils and Adenoids Other Conditions 302 21 4 14 51 32 Enlarged Cervical Glands (Non-Tubercular) 18 10 9 — Defective Speech — 8 — — Teeth—Dental Diseases 286 (also see Dental Report Heart and Circulation Heart Disease— Organic 15 31 1 4 Functional 22 24 11 2 Anaemia 118 9 36 3 Lungs Bronchitis 61 26 9 2 Other Non-Tubercular Diseases Pulmonary— 11 9 2 2 Tuberculosis Definite 6 1 8 — Suspected — 13 35 1 Non-Pulmonary— Glands 1 2 — — Spine — — — — Hip — — — — Other Bones and Joints 1 — 2 1 Skin — — — — Other Forms — — 1 — Nervous System Epilepsy 1 3 1 — Chorea 6 4 9 — Other Conditions 6 15 3 5 Deformities Rickets 1 9 — — Spinal Curvature 3 1 1 — Other Forms 8 7 1 — Other Defects and Diseases 69 61 148 72 Number of Individual Children having Defects which required Treatment or to be kept under observation 4153 34 TABLE III.—Numerical Return of all Exceptional Children in the Area in 1921. — — Boys. Girls. Total. Blind (including partially blind), within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools 2 - 2 Attending Certified Schools for the Blind 2 - 2 Not at School - - - Deaf and Dumb (includ ing partially deaf), within the meaning of the Elementary Education (Blind and Deaf Children) Act, 1893. Attending Public Elementary Schools - 3 3 Attending Certified Schools for the Deaf 6 7 13 Not at School - - - Mentally Deficient. Feeble Minded. Attending Public Elementary Schools 58 22 80 Attending Certified Schools for Mentally Defective Children 5 9 14 Notified to the Local Control Authority by Local Education Authority during the year 1 1 2 Not at School 2 — 2 Imbeciles. At School - - - Not at School 11 4 15 Idiots. — — — — Epileptics. Attending Public Elementary Schools 10 5 15 Attending Certified Schools for Epileptics 1 2 3 In Institutions other than Certified Schools - - - Not at School — 1 1 Physically Defective. Pulmonary Tuberculosis. Attending Public Elementary Schools 26 20 46 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools 6 7 13 Not at School 10 3 13 Crippling due to Tuberculosis. Attending Public Elementary Schools 4 1 5 Attending Certified Schools for Physically Defective Children - - - In Institutions other than Certified Schools 1 - 1 Not at School 5 7 12 35 — — Boys. Girls. Total. Crippling due to causes other than Tuberculosis, i.e ., Paralysis, Rickets, Traumatism. Attending Public Elementary Schools 12 7 19 Attending Certified Schools for Physically Defective Children - 1 1 In Institutions other than Certified Schools - - - Not at School 3 4 7 Physically Defective— continued. Other Physical Defectives, e.g., delicate and other children suitable for admission toOpenAir Schools; children suffering from severe heart disease. Attending Public Elementary Schools 23 18 41 Attending Open-Air Schools — - - Attending Certified Schools for Physically Defective Children, other than Open-Air Schools 2 2 4 Not at School 3 7 10 Dull or Backward. Retarded 2 years 20 18 38 Retarded 3 years 5 11 16 TABLE IV.—Treatment of Defects of Children during 1921. A.—Treatment of Minor Ailments. Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Skin— Ringworm—Head 114 114 — 114 Ringworm—Body 112 112 — 112 Scabies 139 135 4 139 Impetigo 384 384 — 384 Minor Injuries 48 48 — 48 Other skin disease 301 301 301 Ear Disease— 132 132 — 132 Eye Disease (external and other) 208 205 3 208 Miscellaneous 945 163 782 945 36 B.—Treatment of Visual Defect. Number of Children. Referred for Refrac tion. Submitted to Refraction For whom Glasses were Prescribed For whom Glasses were Provided Recommended for Treatment other than by Glasses Received other Forms of Treatment For whom no Treatment was considered necessary Under Local Education Authority's Scheme, Clinicor Hospital By Private Practitioner or Hospital Otherwise Total 1067 771 46 31 848 754 746 77 77 17 TABLE IV.—C. Treatment of Defects of Nose and Throat. Referred for Treatment Number of Children.* Received Operative Treatment. Received other Forms of Treatment. Under Local Education Authority's Scheme Clinic or Hospital. By Private Practitioner or Hospital. Total 860 123 Scheme only in operation since 1/3/21. 403 526 72 37 TABLE IV.—D. Treatment of Dental Defects. 1.—Number of children dealt with. Age Groups. " Specials." Total. 6. 7. 8. 9. 10. 11 12. 13. 14. (a) Inspected by dentist 3,139 4,704 - 7,843 (b) Referred for treatment 2,360 3,621 - 5,981 (c) Actually treated 207 567 801 481 431 407 315 191 109 16 448 3,973 (d) Re-treated (result of periodical examination) - 14 200 305 329 353 272 176 85 16 — 1,750 2.—Particulars of Time given and of Operations undertaken. No. of Half Days devoted to Inspec tion No. of Half Days devoted to Treatment Total No. of Attendances made by the Children at the Clinic No. of Permanent Teeth No. of Temporary Teeth Total No. of Fillings No. of Administrations of General Anaesthetics included in (4) and (6) No of other Operations Extracted Filled Extracted Filed Permanent Teeth Temporary Teeth (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) 78 672 5,723 510 4,161 5,286 3,729 7,890 314 240 215 TABLE V.—Summary of Treatment of Defects as shown in Table IV. (A, B, C, D and F, but excluding E). Disease or Defect. Number of Children. Referred for Treatment. Treated. Under Local Education Authority's Scheme. Otherwise. Total. Minor Ailments 2383 1594 789 2383 Visual Defects 1067 771 143 914 Defects of Noseand Throat 860 123 475 598 Dental Defects 5981 3973 70 4043 Other Defects 149 27 122 149 Totals 10440 6488 1599 8087 38 TABLE VI.—Summary Relating to Children Medically Inspected at the Routine Inspections during the Year 1921. (1) The total number of children medically inspected at the routine inspections 5,695 (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) 320 (3) The number of children in (1) suffering from:— Malnutrition 2 Skin Disease 60 Defective Vision (including Squint) 594 Eye Disease 27 Defective Hearing 10 Ear Disease 28 Nose and Throat Disease 712 Enlarged Cervical Glands (non-tubercular) 18 Defective Speech — Dental Disease 286 Heart Disease— Organic 15 Functional 22 Anæmia 118 Lung Disease (non-tubercular) 72 Tuberculosis— Pulmonary definite 6 suspected — Non pulmonary 2 Disease of the Nervous System 13 Deformities 12 Other defects and diseases 69 (4) The number of children in (1) who were referred for treatment (excluding uncleanliness, defective clothing, etc.) 1,540 (5) The number of children in (4) who received treatment for one or more defects (excluding uncleanliness, defective clothing, etc.) 1,406 (91.3%)