ROMFORD RURAL DISTRICT COUNCIL Annual Report FOR THE YEAR 1925 BY THE Medical Officer of Health ALFRED BALL, M.D. (State Medicine), London University D.P.H. (London) ROMFORD: J. E. CASTLE, PRINTER, MARKET PLACE. 16a South Street, Romford. October 8th, 1926. To the Chairman and Members of the Romford Rural District Council. Mr. Chairman and Gentlemen, I beg to present my Annual Report for the year 1925 on the Vital Statistics and Sanitary circumstances of the District. This is the last annual report which will be presented for the district as it has hitherto been constituted. Petitions for the granting of Urban powers to the parishes of Dagenham and Hornchurch respectively having been drawn up, the Essex County Council ordered enquiries to be held in the month of May, 1925. As a result each parish was granted Urban powers as from the 1st April, 1926. For the year 1925 I have estimated the population of the whole district as 52,500 and have used this figure for calculating the birth and death rates. I desire to acknowledge the courtesy with which my colleagues on the staff have supplied me with information required for the compilation of this report, and to render thanks to the members of the Council for the manner in which they have received the statements and suggestions which I have put before them. ALFRED BALL, m.d., d.p.h. Medical Officer of Health. 2 Romford Rural District. Survey Report for year 1925. 1. Natural and Social Conditions of the Area Area of the District (viz.: the area of the land and inland water but exclusive of tidal water and foreshore) 29,720 acres Population (Census, 1921) 29,485 Population (estimated 1925; local figures) 52,500 Number of structurally separate dwellings (Census, 1921) 6,333 Number of families (Census, 1921) 6,634 Rateable value (1st April, 1925) £247,315 Sum represented by a Penny Rate £952 The following table shows the parishes which comprise the Rural District, together with their populations, as recorded at the census in the years stated. Year 1891 1901 1911 1921 Cranham 465 397 489 519 Dagenham 4324 6091 7907 9127 Great Warley 1609 1900 2051 2088 Havering 450 407 399 444 Hornchurch 3841 6402 9461 10891 Noak Hill 249 259 222 229 Rainham 1669 1725 1972 2196 Upminster 1409 1477 2468 3559 Wennington 310 360 364 432 Total 14,326 19,018 25,333 29,485 The district lies in the south-western portion of the County of Essex being bounded on the north by the Ongar Rural District; on the west by Epping Rural District, llford, and Barking; on the east by the Billericay and Orsett Rural Districts; and on the south by the river Thames. The northern portion of the district is hilly and undulating rising to a height of 300 feet at Havering. The southern portion is flat and near the river low lying, there being marsh land which is below the level of spring tides. The rivers Beam and Ingrebourne flow downwards from the north and emptv themselves into the Thames. 3 Nature of the Soil The deep formation in the whole district is London clay. The hills to the north are of clay with patches of gravel. In the middle and southern parts of the district the London clay is covered by river gravel. Along the river Thames is a broad belt of alluvial deposit just outside which the villages of Rainham and Wennington lie on the gravel. Rainfall during the year. I am indebted to the Surveyor, Mr. W. J. Grant, for the following statement of the rainfall as recorded at the Hornchurch Sewage Works. No. of Days on which rain fell. Amount in inches. January 12 1.55 February 16 2.23 March 14 079 April 16 1.29 May 15 1.49 June 2 0.19 July 15 2.86 August 17 2.07 September 17 2.06 October 13 2.33 November 12 1.07 December 14 2.31 Total 163 20.24 In the four previous years the records at the same Works were as follows:— Year No. of days on which rain fell. Amount in inches. 1921 108 11.52 1922 175 20.37 1923 177 20.32 1924 176 28.57 Social Conditions. The following are the principal occupations in the district as recorded at the 1921 Census:— Males. Females. Agricultural occupations. 1797 298 Clerks, Draughtsmen, Typists 954 461 Employed in Personal Service 173 1236 4 Males. Female. Transport Workers 1250 58 Commercial and Financial occupations 879 239 Builders, Bricklayers, etc. 833 1 Metal Workers 642 65 No. of persons aged 0-11 years 3363 3429 No. of persons aged 12 years and upwards 10897 11796 Housing of Private Families in Romford Rural District (Census, 1921). Percentage of structurally separate dwellings returned as private houses 94 Average No. of rooms per dwelling 5.30 Families per dwelling 1.05 Persons per family 4.30 Population living more than 2 persons to a room 1690 Percentage of total private family population living more than 2 persons to a room 5.9 Vital Statistics. M. F. Total Births: Legitimate 535 513 1048 Illegitimate 14 12 26 Birth rate per thousand population 20.4 Deaths: 213 204 417 Death rate per thousand population 7'9 No. of women dying in or in consequence of child birth :— (a)—from Sepsis 3 (b)—from other causes 4 Deaths of infants under one year of age per 1,000 births:— Legitimate 69.6 Illegitimate 230.7 Total 73.5 Deaths from Measles (all agesl 2 „ Whooping Cough (all ages) 8 ,, Diarrhoea (under 2 years of age) 14 In the following table which is supplied by the Registrar General the deaths are classified according to cause and sex. 5 Total Deaths —Civilians only. Causes of Death M. F. 1. Enteric Fever 1 2. Smallpox 3. Measles 2 4. Scarlet Fever 5. Whooping Cough 4 4 6. Diphtheria 1 3 7. Influenza 3 6 8. Encephalitis Lethargica 2 1 9. Meningococcal Meningitis 10. Tuberculosis, respiratory 26 19 11. Other Tuberculous diseases 1 2 12. Cancer, malignant disease 23 26 13. Rheumatic fever 14. Diabetes 2 2 15. Cerebral haemorrhage 5 12 16. Heart disease 36 29 17. Arterio-sclerosis 2 18. Bronchitis 15 12 19. Pneumonia 17 8 20. Other respiratory diseases 5 1 21. Ulcer of stomach or duodenum 1 1 22. Diarrhoea (under 2 years) 4 10 23. Appendicitis 2 2 24. Cirrhosis of liver 1 25. Acute and chronic nephritis 4 5 26. Puerperal Sepsis 3 27. Other accidents and diseases of Pregnancy and Parturition 4 28. Congenital Debility and Malformation, Premature Birth 17 14 29. Suicide 5 2 30. Other violence 13 4 31. Other defined diseases 24 31 32. Causes ill defined or unknown Totals 213 204 6 Deaths tabulated in age-groups. All causes M. F. Under 1 year 40 39 1- 4 2 2- 9 6 5- 1 3 15- 6 12 25- 29 31 45- 53 30 65 and upwards* 69 82 * Including 16 males and 21 females over 80 years of age and 3 males and 2 females over 90 years of age. Deaths of Infants under one year of age. Cause M. F. Prematurity 6 5 Marasmus 5 2 Congenital Malformation and diseases 2 4 Injuries or accident at birth 3 Penumonia, Bronchitis 11 6 Gastro-enteritis 4 9 Whooping Cough 3 2 Icterus 3 1 Other causes 3 8 Analysis in age-groups. M. F. Under 1 month 17 13 over 1 month and under 3 months 12 9 over 3 months and under 6 months 4 10 over 6 months 7 7 40 39 Deaths from Malignant Disease. Their were 49 deaths including 4 from Sarcoma. Table showing age groups. Age in 10 year groups M. F. 25- 0 2 35- 2 1 45- 4 5 55- 7 3 65- 9 9 75- 1 5 85- 0 1 7 Table showing localization and sex. M. F. Mouth, Tongue 1 1 Oesophagus 3 1 Stomach 3 5 Intestines 4 1 Rectum 2 3 Liver Gallbladder 1 2 Abdomen 1 Prostate 3 Testicle 1 Penis 1 Breast 5 Uterus 4 Ovary 2 Larynx 1 Sarcoma of Lung 1 Sarcoma of Brain 2 Lymphosarcoma 1 23 26 2. General Provision of Health Services in the area. Hospitals. Tuberculosis.— The Essex County Council provides beds for all forms of tuberculosis in various Hospitals and Sanatoria. One Sanatorium is situated in the district. Maternity and children— There is no provision by the local authority. Fever— The Romford Joint Hospital Board is the responsible authority for fever cases, and has provided a hospital for 42 beds at Rush Green, Dagenham. Scarlet Fever, Diphtheria and Enteric Fever are treated. The Board has obtained the sanction of the Ministry of Health for the erection of a ward-block of 10 beds on the cubicle system and for the provision of additional accommodation in the administrative quarters for the Nursing and Domestic staff. Smallpox— The Romford Joint Hospital Board, has entered into an agreement with the West Ham Corporation for the reception and treatment of cases of Smallpox. An annual payment is made by the Board based on the conbined populations of the Romford Urban and Rural Districts, and in addition charges are made for each case which is treated. Sporadic cases are to be admitted to the Orsett Smallpox Hospital, but for a large number of cases the Dagenham Hospital would be used. 8 The only Institutional provision for unmarried mothers, illegitimate infants and homeless children in the district is made by the Romford Guardians at their Institution. Ambulance Facilities. (a) Infectious cases— A motor Ambulance provided by the Joint Hospital Board is stationed at the hospital, Rush Green, and is available for infectious cases. (b) Non-infectious and accident cases.— The Romford Urban District Council maintains a motor ambulance which, under certain conditions, is available in the Rural district. The Rural Council have also agreements for the removal of Dagenham patients by the Barking and Ilford Councils' ambulances on payment of certain charges. Clinics and Treatment Centres. Maternity and Child Welfare Centres for consultation are maintained by the Council at the following:— 1. Becontree and Chadwell Heath Clinic meets at St. Thomas' Church Hall, Haydon Road evtery Friday afternoon. Average attendance, 55. 2. Dagenham (Village) Clinic meets at the Church Hall, Station Road, Dagenham, on Wednesday afternoons. Average attendance, 63. 3. Hornchurch Clinic meets at the Church Hall, Park Lane, Romford, on alternate Monday afternoons. Average attendance, 37. 4. Rainham Clinic meets at the Public Elementary School on alternate Thursday afternoons. Average attendance, 24. 5. Upminster Clinic meets at St. Lawrence Hall, on alternate Friday afternoons. Average attendance, 28. School Clinic, Tuberculosis Dispensary, treatment for Venereal diseases. These are dealt with by the Essex County Council. Public Health Officers of the Local Authority. Medical Officer of Health. The Medical Officer of Health holds a combined appointment and devotes the whole of his time to work under the three following authorities; Romford Rural District Council, Romford Urban District Council and Romford Joint Hospital Board. 9 Assistant Medical Officers— Part time. Two Lady Assistants—Dr. S. Pratt and Dr. V. Reade have been appointed respectively to attend the Becontree and the Dagenham Clinic on one afternoon in each week. There are four whole time officers, viz.; two Sanitary Inspectors and two Health Visitors. Name Office Qualification G. T. Carter Sanitary Inspector Certificate of the Royal Sanitary Institute, Meat Inspector's Certificate. H. Bousfield Sanitary Inspector Certificate of the Royal Sanitary Institute. E. H. Fawcett Health Visitor Certificated Nurse, (Mrs.) C.M.B., Health Visitors Certificate, Sanitary Inspector's Certificate. G. Ridley Health Visitor Certificated Nurse, C.M.B. Miss Ridley was appointed 22nd May. 1925 to undertake the whole of the Health Visitor's work in the parish of Dagenham, this being a temporary post pending the granting of Urban powers to the parish. Clerical Work.—No clerical assistance is provided by the Council in the Health Department. In each case contribution is made to the Officer's salary from the Exchequer. Professional Nursing in the Home. (a) General.— Local Nursing Associations have been formed in the following areas and each maintains a Nurse Midwife, supplied under the auspices of the Essex County Nursing Association. Dagenham. Great Warley. Havering and Noak Hill. Harold Wood. Hornchurch. Rainham and Wennington. Upminster and Cranham. The local Associations receive grants from the County Council, paid through the County Nursing Association for School and Tuberculosis Nursing, and for Health Visiting, (b) Infectious Diseases, e.g., Measles. No assistance is provided by the Council for the Nursing of such cases in their homes. 10 Midwives. The Rural Council makes no subsidy to midwives. There are 16 midwives practising in the district. Chemical Work. The Chemical Analysis of water, effluents, etc., is carried out in the County Laboratory, Queen Victoria Street, London. Legislation in force. List of Adoptive Acts, etc. Urban powers have been granted to the Rural Council by the Local Government Board, by virtue of the following Acts or sections of Acts, which are in force in some of the parishes. Public Health Act, 1875, sections 42-45, 66, 112-114, 149, 157, 160, 167, 170. Public Health Acts Amendment Act, 1890, sections 23, 26, 29, 30 and 31. Public Health Acts Amendment Act, 1907, part ii., sections 15-18 and 20-33; parts iii., sections 34-38, 43-46, 49-51 ; part iv., sections 52-60, 62-68. Public Health (Building in Streets) Act, 1888, section 3. Private Street Works Act, 1892. Infectious Disease Prevention Act, 1890. Bye-laws made by the Council. Public Health Act, 1875. With respect to: Date of confirmation by L.G.B. 1. Cleansing of footpaths Jan. 1885 2. Removal of house refuse ,, 3. Cleansing of earth closets, etc. „ 4. Common Lodging-houses Dec. 1901 5. Slaughterhouses May, 1902 6. Nuisances „ 7. Houses let in lodgings June, 1902 Public Health Acts Amendment Act, 1890, regulating the removal of fcecal matter April, 1899 Public Health (Interments) Act, 1872, Management of the Upminster Cemetery Feb., 1904 Housing of the Working Classes Act, 1885, with respect to Tents, Vans, Sheds, etc. Mar., 1908 Regulations with respect to Diaries, Cowsheds, etc. Feb., 1908 For the regulation of certain offensive Trades Aug., 1912 With respect to New Streets and Buildings July, 1925 11 3. Sanitary Circumstances of the Area. Water. Water is supplied to most parts of the district by the South Essex Waterworks Company, which maintains a constant supply of pure water, suitable for domestic purposes, and abundant in quantity. The Council take a bulk supply of water from the Company for the parish of Havering and maintain a pumping station at Chase Cross by which the water is so raised that it can flow to those parts of the village which are supplied. In the purely rural parts of the district well water in some instances is the only source available. Rivers and Streams. There does not appear to be any serious pollution of the streams in the district. Drainage and Sewerage. In the district there are the following main sewers:— a. Dagenham. 1. Main sewer commencing in Chad well Heath, proceeds southwards. 2. Another main sewer from Chadwell Heath passes through Becontree Heath to Dagenham village and joins the first sewer in Broad Street. 3- Main sewer passing through the Becontree Estate from Wood Lane, follows the Gores Brook to Gores Bridge and later becomes the principal sewer to the Riverside outfall works. b. Hornchurch. 1. Sewer from North-West Hornchurch to outfall works in Rainham Road— low level and therefore pumped at the works. 2. Sewer from Hornchurch village to same works but at high level. 3. Sewer in Harold Wood to outfall works near Ingrebourne River. 4. Sewer in Southend Road joins Riverside main sewer. c. Upminster. 1, Sewer from part of village to outfall works near bourne, also takes from Corbets Tye and Hacton. 2. Sewer from east of village also takes drainage from south part of Cranham and proceeds to Eastern Outfall works at; Bury Farm. d. Rainham and Wennington. The main sewer from these parishes extends to the Riverside works. e. Great Warley. North part of parisli is sewered, the main passing to the Harts Wood outfall works. Valleys to the north of the Woodman Road which are sewered are connected to the Billericay system. Closet Accommodation. In general the district is well sewered and the majority of the houses are provided with water closets which are connected to the sewers. In the populous parts the conservancy system is not in use but in the parts where the houses are more scattered, cesspools and pail closets are provided. Where new sewers have been extended owners of adjacent property are requested to have their houses connected. In the case of 92 houses, pail closets were converted to water closets. In 107 cases, closets were connected to sewers during the year 1925. Scavenging. The Council enter into contracts for the removal of house refuse and the contents of privy pails weekly. The Contractors provide horses and open carts for the removal of house refuse to tips in the district while the Council provide closed receptacles for the removal of night soil. Complaints as to irregularity of collection of house refuse are occasionally received and these are dealt with by the Surveyor who now has the supervision of the collection of house refuse. Cesspools are emptied by the Council, generally by motor cesspool emptiers. In the Hog Hill area a horse drawn emptier is used while in the case of some inaccessable cesspools in different parts of the district they have to be emptied by hand by contract. 13 Sanitary Inspection of the district. Report of the Sanitary Inspectors unher article 19 (12) of the Sanitary Officers' Order, 1922. (a) Nature and number of inspections— Bakehouses 116 Slaughter houses 415 Cowsheds, Dairies 176 W.C. connections to sewers 123 Insufficient flush to W.C. 54 Infectious Diseases enquiries 312 Disinfections 144 Smoke observations 6 (b) Number of notices served— Informal 15 Statutory 196 (c) Result— Informal notices complied with 15 Statutory notices complied with 146 Schools. Owing to the occurrence of many cases of Influenza and Whooping Ccugh among the children in the months of January and February, the following Schools were closed for periods of three weeks:— Havering, Chadweli Heath Infants, Whalebone, Becontree Heath Mixed and Infants, Fords, Dagenham, Green Lane, and Park Lane (Hornchurch.) Harold Wood Schools were closed for a fortnight in May owing to the occurrence of cases of Whooping Cough and Measles. Green Lane Infants School was closed for a fortnight in October on account of the prevalence of cases of Measles. 4. Housing. 1. General Housing conditions. There is a shortage of cottage property suitable to be let at a weekly rental to working class tenants; but the demand is mainly from persons coming from places nearer London. 14 The following table shows the number of houses erected by the Council since the war, the schemes being completed during 1922. Houses erected 1921-1922. Parish. Number. Cranham 14 Dagenham 358 Havering 3 Hornchurch 186 Rainham 108 Upminster 20 Wennington 16 705 Important changes in population. The London County Council having bought large tracts of land are building a new town known as Beoontree which lies mainly in the Romford Rural District in the parish of Dagenham. Building has been in progress since 1921, and on 31st December, 1925, the number of London County Council houses in Dagenham on the rate book was 5069. It is stated that the part of the estate in Dagenham already built or likely to be developed in the near future will contain 11,000 houses. These houses are reserved for people living in overcrowded or otherwise undesirable conditions in London, and they will therefore represent a large population coming from outside the district, and quite above and beyond its normal development. In view of these large figures it appears that the estimate of the population for the Rural District (38.680 for the middle of the year 1925) supplied by the Registrar General is of little value. 2. Overcrowding. There is overcrowding in some parts of the district caused through the shortage of small houses and in some instances accentuated by sub-letting 2 rooms in a house to another family coming from outside the district. 3. The general standard of housing is fairly good though there is some old property which is getting into a decayed condition but which it is difficult to deal with under present conditions. 4. No complaints have been received or representations made in regard to unhealthy areas. 15 Housing Statistics for the year 1925. The following table is required by the Ministry of Health. Nunber of new houses erected during the year :— (a) Total including (b.) 2959 (b) With State assistance under the Housing Acts. ( i. ) By the Local Authority 0 (ii.) By other bodies or persons 2692 1. Unfit dwelling houses— Inspection, (l) Total No. of houses inspected for housing defects (under Public Health or Housing Acts) 697 (2) No. of houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 or Housing Regulations 1925 422 (3) No. of houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (4.) No. of houses (exclusive of sub-heading 3) found not not to be in all respects reasonable fit for human habitation 430 2. Remedy of defects without service of formal notices— No. of defective houses rendered fit in consequence of informal action by the Local Authority or their Officers. 177 3. Action under Statutory Powers— A. Proceedings under section 3 Housing Act, 1925. (1) No. of houses in respect of which notices were served requiring repairs 0 (2) No. of houses which were rendered fit— (a) by owners 0 (b) by Local Authority in default of owners 0 (3) No. of houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intentions to close 0 B. Proceedings under Public Health Acts— (1) No. of houses in respect of which notices were served requiring defects to be remedied 193 (2) No. of dwelling houses in which defects were remedied— (a) by owners 96 (b) by Local Authority in default of owners 0 C. Proceedings under sections 11, 14 and 15 of the Housing Act, 1925. 16 (1) No. of representations made with a view to the making of closing orders 4 (2) No. of houses in respect of which closing orders were made 3 (3) No. of houses in respect of which closing orders were determined, the houses having been rendered fit 0 (4) No. of houses in respect of which demolition orders were made 0 (5) No. of houses demolished by owners 3 5. Inspection and Supervision of Food. (a) Milk Supply. 116 visits have been paid to Cowsheds and Dairies. Licences for sale of Graded.milk: — Two retailers are licensed to sell Grade A milk in the district and another firm holds a supplementary license for the same purpose being licensed by a neighbouring Authority. In another instance a producer of Grade A milk licensed by the County also retails this milk in the district apparently on the same certificate. Two licences for the sale of Pasterised milk have been issued. No retailers have been refused registration. (b) Meat. 415 visits have been paid to Slaughter houses for the perpose of inspection of carcases. Notices of slaughtering at times other than the regular ones are received from butchers and as far as possible additional visits have been paid. There is no system of marking meat in operation in the district. Diseased meat is disposed of by burying in the ground. Their are no public slaughterhouses in the district. The following table is required by the Ministry of Health. In 1920 In Jan. 1925 In Dec. 1925 Registered Slaughterhouses 11 11 11 Licensed do 2 4 4 17 6. Infectious Diserses. Notifications received during the years 1921-25. Year 1921 1922 1923 1924 1925 Smallpox 0 0 0 0 0 Scarlet Fever 91 56 72 64 59 Diphtheria 65 103 36 37 34 Enteric Fever 7 1 3 2 1 Puerperal Fever 1 4 3 2 4 Pneumonia 12 15 11 8 20 Erysipelas 9 9 6 10 7 Other 4 3 0 2 Diphtheria, Antitoxic serum is supplied to Medical Practitioners gratis for use in necessitous cases; most of the cases, however, are admitted to Hospital, therefore the serum is usually administered on admission. Bacteriological examinations are carried out at the Essex County Laboratory, Queen Victoria Street, London, where many throat swabs have been examined during the year. These arrangements have proved satisfactory. Most of the cases of Scarlet Fever, Diphtheria, and Enteric Fever have been removed to the Romford Isolation Hospital. Other diseases such as Puerperal Fever, Erysipelas, Encephalitis, etc., if requiring hospital treatment are removed to the Oldchurch Hospital. After cases have been removed to hospital or at the termination of the illness if they have been isolated at home the sickroom is fumigated with sulphur. In exceptional cases only is bedding removed to the Isolation Hospital to be put through a Washington Lyons apparatus. The Schick test and Dick test have not been employed nor have artificial methods of immunization against Diphtheria and Scarlet Fever. No vaccinations have been performed by the Medical Officer of Health. Intimations of non-notifiable infectious diseases occurring amongst children attending elementary schools have been received from Head Teachers and when it was considered desirable the children were visited by the Health Visitors. The numbers of persons who died from Influenza in 1921 were 5; in 1922 were 11; in 1923, 3; in 1924, 13; and in 1925 there were 9. No cases of Anthrax or Rabies have been notified. Facilities are not provided in the district for the disinfestation of verminous persons and their belongings. 18 Incidence of Notifiable Infectious Diseases during the year. Cases Notified Admitted to Hospital Total Deaths Scarlet Fever 59 53 1 Diphtheria 34 30 3 Enteric Fever 1 0 1 Puerperal Fever 4 3 3 Pneumonia 21 Erysipelas 7 1 0 Encephalitis Lethargica 7 5 3 Ophthalmia Neonatorum 6 1 0 Two cases of Scarlet Fever and 1 of Diphtheria occurred in the Shoreditch Cottage Homes, Hornchurch and were removed to Metropolitan Asylums Board Hospitals. The deaths from Scarlet Fever and Diphtheria were those of persons domiciled in the district but dying in hospitals outside the district and only 1 of these was notified. Tuberculosis. New Cases Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary Age Periods. M. F. M. F. M, F. M. F. 0 1 1 1 3 3 3 1 1 5 3 4 9 3 10 1 3 3 1 15 4 2 1 1 2 20 2 2 4 25 33 20 3 3 8 5 35 22 9 7 5 45 4 3 4 2 1 55 5 4 65 1 1 1 1 Public Health Regulations and Public Health Act, 1925, section 62. No action has been taken. Analysis of Cases under stated Age Groups. Year Scarlet Fever Diphtheria Erysipelas Under 1- 1 1- 1 2- 3 1 3- 5 2 4- 4 3 5-9- 24 12 10—14- 13 9 1 15—19- 7 4 20—34- 2 2 1 35—44- 1 45—6465- 3 1 19 7. Maternity and Child Welfare. Notification of Births Number Live births notified 1049 Still births notified 32 Notified by Doctors 314 Notified by Midwives 767 Infant deaths (figures supplied by Registrar General) Legitimate 73 Illegitimate 6 Work of Health Visitors— Visits paid to expectant mothers 350 Visits paid to infants under one year first visits 1178 do Total Visits 6863 Visits paid to children, of 1—5 years 5996 Municipal Homes, Hospitals and Day Nurseries none Maternal deaths from Sepsis 3 do from other causes 4 Ophthalmia Neonatorum Six cases were notified of which 5 were slight cases treated at home which recovered with vision unimpaired. The sixth case was admitted to hospital and after treatment recovered with some scarring of the corneae. Orthopadic cases. There are ample facilities for the treatment of such cases in the London Hospitals. In addition some cases are treated locally in the old church hospital. 8. On the Admii shop Act, 1901 nistration of the Factory and 1. Inspection. Premises Inspections Number of Written Notices Prosecutions Factories 23 1 0 Workshops 36 6 0 Workplaces 9 0 0 Totals 68 7 0 2. Defects. Nuisances under the Public Health Acts— Found. Remedied Want of Cleanliness 5 5 Other Nuisances 1 1 Sanitiary accommodation defective 1 1 Total 7 7 3. Outwork in unwholesome premises, Section 108. None.