WAL 87 Walthamstow Urban District Council REPORT by THE MEDICAL OFFICER OF HEALTH on the SANITARY CONDITION AND VITAL STATISTICS and REPORT OF THE SANITARY INSPECTOR, FOR THE YEAR 1910. waltbamstow: Printed by J. C. Phelp & Son, 62-64, Beulah Road. TABLE OF CONTENTS. page. Sanitary Area 8 Population 8 „ of Wards 9, 10 Sanitary Summary—Population, General District and other Rates 11 Elementary Schools — Capacity, Number on Books, etc. 12 Births14,22 In Wards 15 Rate 14, 18, 22 „ in Wards 16 Deaths 16, 22, 26 Rate 17 „ in Ward 18 Outer Zone of London 18 Certification of 17 Mortality in Wards 20 Inquests 20 Infantile Mortality 23 „ „ Rate 22, 23 Senile Mortality 26, 27 Zymotic Mortality 27, 28 „ „ Rate 22 Infectious & Other Diseases- Infectious Diseases notified 30,32 „ „ in Wards 31, 35 „ „ Sickness Rate 32 „ „ Deaths from 28, 29 „ „ Measures taken to prevent spreading 33 Removals to Hospitals 35 Small Pox 36 Scarlet Fever 30, 32, 36, 37, 39 Diphtheria 37, 38, 39, 40 Table of Drainage Defects found in relation to Infectious Disease 39 Isolation Hospital- No. of Patients admitted 42 Age of Patients admitted — Scarlet Fever 42 Diphtheria 43 Deaths in Hospital 43 Average Daily No. of Patients in Hospital 43, 44 PAGE. Infectious & Other Diseases(contd.)— Isolation Hospital (contd.)— Complications of Scarlet Fever and Diphtheria 44 Typhoid Fever 45, 46 „ „ in Wards 47 Summer Diarrhoea 47, 48 Measles & Whooping Cough 48, 49 Chart showing No. of Cases of Measles and Whooping Cough, 1889-1910 50 Influenza 51 Puerperal Fever 51 Phthisis or Consumption 52 Erysipelas 54 Cancer 54 Alcoholism 54 Water Supply 55 Cowsheds, Milkshops and Dairies 55, 72 Milksellers 56, 72 Slaughterhouses 56 Housing of the Working Classes 56 Offensive Trades 57 House Refuse, Removal of 57 Sewage Disposal 58 Factory and Workshop Act, 1901 58-62 74 Improvements required 62 Sanitary Inspector's Report. General Sanitary Administration. House-to-House Inspection 67 No. of Defects found on Inspections 68 Articles Disinfected 69 Overcrowding 70 Bakehouses, Inspection of 71 Slaughterhouses & Butchers' Shops 71 Meat Destroyed 72 Fishmongers 72 Coffee Houses 73 Ice Cream Vendors 73 Sale of Food and Drugs Act 75, 76 TO THE CHAIRMAN AND MEMBERS of the Walthamstow Urban District Council. Gentlemen, In accordance with Article XIX. of the recent order of the Local Government Board, governing the appointment and duties of Medical Officers of Health, I beg to submit to you my Annual Report "on the sanitary circumstances, the sanitary administration, and the vital statistics of the district," for 1910. "The Medical Officer of Health ought not to have any difficulty in making this report within two months " of the completed year, says the memorandum issued by the chief Medical Officer. This has not been my experience, and if the report had to be made in official hours it would never appear as all my time is fully occupied with the every day work of my position. The report can only be a summary of those issued to you monthly, and therefore most of the matter will be quite familiar to you, and were it not compiled for other reasons the trouble involved, and the expense incurred in its production would hardly be justified. In the report will be found evidences of a very satisfactory condition of the Public Health generally, and if the sanitary administration of your district might properly be judged by results it has been very efficient. To do so however, would show a lack of appreciation of the many other factors involved over which we have little control. No doubt efficient administration of the Public Health Statutes, and the adoption of the best means for the purpose, will in time "secture the home healthy, the house beautiful, the town pleasant," and all that improved physical well-being which these connote, but the work of any one year cannot rightly be judged by its apparent results. While your district as a whole can be regarded as a desirable and healthy place to live in and one of the healthiest of London's suburbs, certain areas within it require the constant care and watchfulness of the Sanitary Inspector in co-operation with the friendly administrations of the Health Visitor. 4 In this connection I would like to draw attention to my suggestions under the headings of Ward and Infantile Mortality. The year under review has been remarkable for the low birth, death and infantile mortality rates, and for an unprecedented freedom from the dangerous infectious diseases. The general death-rate for the year has been the lowest recorded and compares most favourably with other towns, and the country as a whole. It is less by 4 per 1,000 than that of England and Wales, lower than that of the "Smaller Towns," whose death rates were less by 1.5 than that of the 77 "Great Towns " among which we are classed. Compared with neighbouring districts of a similar character, we occupy an enviable position as may be seen from the comparative table on page 18. Our Zymotic death-rate, or that resulting from deaths caused by Measles, Scarlatina, Diphtheria, Whooping Cough, Typhoid and Diarrhoea, was "74 a figure never before reached, less than half that of the preceding five years, and about one-third that prevailing from 1900 to 1904. Under every heading of the Zymotics, our death-rate was as low as in 1909—an exceptionally favourable year—and lower than the corresponding rates for England and Wales and the 77 " Great Towns." Although Zymotic deaths are largely preventable, little credit is taken for our lessened mortality from Diarrhcea, Measles and Whooping Cough. Diarrhceal deaths largely depend upon summer-heat over which we claim no power, and Measles and Whooping Cough tend to occur in epidemic cycles, and so far no serious sustained efforts have been expended in their control. The lessened and comparatively small number of deaths from Scarlatina and Typhoid are worthy of note, and may be accepted as the result of the work carried out by others in searching out, and tracing the life history of these diseases, and showing that their incidence was independent of the mischances affecting drains and their surroundings, but the old time belief is still prevalent and the greater need for care of the personal unit is but slowly leavening the public conscience. The deaths from Diphtheria were the same as in 1909, and 33 per per cent. less than those in the most favourable of the preceding years. Its death-rate has shown a steady and continuous improvement since 1900 when it stood at .86, the rate for 1910 was T per 1,000 of the estimated population. 5 The deaths of children under 1 year of age to total births are greater than in 1909, but were not more than 95 per 1,000 born, a number less than that for rural England. An infantile mortality rate of 100 was a few years ago looked upon as an object to be achieved, and I have already drawn your attention to my remarks under this heading. For our lessened birth-rate I have no apology to make or explanation to give. In this connection the non-increase of illegitimates is a remarkable fact. The following tabular statement taken from the Registrar General's Fourth Quarterly Report, gives the data for the foregoing comparisons and remarks :— Birth-Rate, Death-Rate, and Analysis of Mortality in igio. - Annual Rate per 1,000 Living. Deaths under one year to 1,000 Births. Births Death-rate. Principal Epidemic Diseases Cols. 4-10. Small-Pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhoea. Crude. Corrected. Cols. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. England and Wales 24.8 13.4 13.4 0.99 o.oo 0.23 0.06 0.12 0.24 0.05 0.29 106 77 Great Towns 25.0 13.4 14.3 1.23 o.oo 0.31 0.08 0.12 0.29 0.05 0.38 115 136 Smaller Towns 23.7 12.4 12.9 0.88 o.oo 016 0.06 0.11 0.24 0.05 0.26 104 England and Wales less the 213 Towns 25.0 13.6 12.8 0.74 o.oo 0 15 0.05 0.12 0.17 0.05 0.20 96 Walthamstow '10 22.6 8.4 8.9 0.74 o.oo 0.14 0.03 0.10 0.22 0.01 0.22 95.0 „ 1909 24.66 8.8 9.3 0.98 o.oo 0.22 0.08 0.10 0.33 0.01 0.22 83.3 Closely associated with the death-rates and largely influencing them is the prevalence or absence of the dangerous Infectious Diseases. During the year we not only had fewer cases relatively to population, but we actually received fewer notifications than in any previous year 1890 and 1891 excepted. The decline in number was most marked for Scarlatina and Diphtheria and in consequence the Sanatorium was half empty during the Summer and Autumn months. 6 Although the actual number of persons who sickened with Typhoid was greater by 14 than in 1909, they were fewer by forty than the average of previous years, and since 1899, a continuous and steady decline has been shown in the incidence of this disease. During the year important Regulations and Orders have been issued by the Local Government Board. The Diphtheria Antitoxin (outside London) Order, issued under Section 133 of the Public Health Act, makes legal the gratuitous provision of Antitoxin for poor patients suffering from Diphtheria, as well as for contacts. The Order imposes upon the Council no fresh obligations, as they have been for years voluntarily undertaken by me. The expense incurred has never been questioned. The Sanitary Officers (outside London) Order, made also under the Public Health Act, 1875, rescinds the Order of March, 1891, and prescribes afresh the duties of the Medical Officer of Health, and Inspector of Nuisances. Articles 19 and 20 (3) prescribe for both officers the systematic inspection of the district at certain periods and at intervals as occasion requires. Systematic inspection by the Medical Officer of Health in a district employing five officers for the very purpose would be an impossible task, and how the duties laid down by Article 20 (16), for the Inspector of Nuisances can be of any value to the Medical Officer of Health in " advising the Council on all matters affecting the health of the district," is only known to the framers of the New Order. Were such a tabular statement as there referred to, rendered weekly, then the Medical Officer of Health, knowing his district, could readily appreciate what Sanitary work was being carried out, and how much his interference with the statutory duties of other officers might be of advantage to the Public Health. Frankly, systematic visiting—that is, house to house inspection— except for those premises requiring certificates under the Customs and Inland Revenue Act of 1890 has not been undertaken by me, but I can truly say that I am perfectly familiar with the existing sanitary conditions in every Ward and have been into one or more houses in every street during the year. The Regulations under Section 17 (1) of the Housing and Town Planning Act of 1909 have been issued in September. In the absence of other instructions, Mr. West has undertaken the duties under Articles II. and III. as the work to be carried out comes more within his sphere of duties than that of any other officer. 7 The statutory powers now enjoyed by Sanitary Authorities to efficiently safeguard the Public Health are ample, but the anomaly remains that in growing districts like yours, the whole salaries of all the the Assistant Sanitary Inspectors haye to be paid for by you. A simple clause in the Act might have relieved you of the penalties incurred for its efficient administration. Little change has occurred during the year in the personnel engaged in the Public Health work of the district. The office accommodation for those engaged in clerical work and for those engaged in the medical inspection of school children is totally inadequate, and in consequence the work is much hampered. Apart from the keeping of the various records and registers, etc., 6,697 letters were sent out and 3,372 persons called. I believe you are well served by all your officers, they are good and loyal workers, and my relations with them have been most cordial and I hope mutually agreeable, and on their behalf and my own, I offer our best thanks to the Council for the courtesy and consideration always shown to us. I beg to remain, Gentlemen, Your obedient Servant, J. J. CLARKE. 8 SANITARY AREA. POSITION AND LOCALITY. The Sanitary District of Walthamstow has an area of 4,355 acres, and is divided into five Wards for administrative purposes, but the character of the population is practically the same —the artisan and labouring classes predominating in all the Wards. It lies between the River Lea and Epping Forest from the west to the east, extending from Leyton on its south to Chingford on the north. The sub-soil is mainly gravel, the London clay showing itself in various parts on the surface, notably at Church Hill and portions of the Hoe Street and Northern Wards adjoining. The district has two small streams—the Ching and the Dagenham Brook. The former enters the district at Highams Park, and winds its very sluggish course through Hale End and Chapel End to the River Lea. The latter, the Dagenham Brook, is the outlet for the drainage of the district, and having received the effluent from the Sewage Farm, winds its course through the neighbouring parish of Leyton and joins the River Lea near Temple Mills. Neither stream, at any point, is used for drinking purposes. The whole district has a duplicate system of sewers, and practically every house water-closet accommodation. The drinking water is supplied by the Metropolitan Water Board, formerly East London Water Company, and is practically constant. The amount used per head per day is about 30 to 35 gallons. The five Wards into which the district is divided are :—St James Street, varying from 18 to 54 feet above ordnance datum ; High Street, 21 to 60 feet; Hoe Street, 50 to 140 feet; Wood Street, 50 to 170 feet; and the Northern Ward, 25 to 220 feet. The Sewage Farm, about 182 acres in extent, is situated in the St. James Street Ward, and the reservoirs of the Metropolitan Water Board, about 367 acres in extent, are in the High Street and Northern Wards. VITAL STATISTICS. POPULATION. The Registrar-General has estimated our mid-year, 1910, population as 141,748—an increase of 5,146 over that of 1909. The natural increase, or excess of births over deaths during 1910, was 2,011, or 3,135 less than the estimated total. 9 That the estimated and actual populations differ greatly may be accepted, and as the Census will be taken in April and the actual numbers ascertained, without giving any data for the statement, I estimate our population as not more than 132,000. The population assumed by the Registrar-General will be taken as the basis of the general birth and death-rates of the district, otherwise these rates would not be fairly comparable with those of other " Large Towns," whose populations are based on a like assumption, that their annual rates of growth since 1901, like ours, were similar to those prevailing in the intercensal period 1891-1901. To estimate with any degree of accuracy the populations of the five Wards within the district, is much more difficult than for the total population ; but in order that this report may be uniform with preceding ones, and that comparisons may be made and deductions drawn from facts revealed during the year, I assign to the Wards the following populations, giving also those allocated in 1909 :— WARD POPULATION. St. James St. High St. Hoe St. Wood St. Northern. Total. 1910 25,000 23,000 25,000 18,500 40,500 = 132,000 1909 24,500 22,500 24,500 18,000 40,000 During the year 242 new houses were certified by the Surveyor as fit for occupation, and the growth of the district has mainly taken place in the Northern Ward. The Overseers on their official returns for 1910 certified as empty the following:— Shops. Houses. Tenements. Total. 154 1,170 517 1,841 As compared with previous years :— Shops. Houses. Tenements. Total. 1909 180 1,268 574 2,022 1908 154 1,246 497 1,897 1907 117 1,268 352 1,737 The following Table, with slight alterations, is reproduced from last year's Report. It will be interesting to learn from the Census returns how the supposed and actual conditions differ. 10 TABLE I. Wards. Possible No. ot Houses fit for Occupation, 1909. New Houses certified as fit for occupation in 1910. Empty, Tune, 1910 (Overseers' Lists). Possible Occupied Midyear, 1910. Occupied Education Returns, January, 1910. Proportion empty in 1910. Proportion empty at Census, 1901. Average number per House Census. Assigned Population, 1910. St. James Street 4,300 11 310 4,001 4,118 1 in 13 1 in 21 6 25,000 High Street 3,465 9 220 3,254 3,617 1 in 15 1 in 24 63 23,000 Hoe Street 4,810 20 266 4,564 4,744 1 in 17 1 in 15 5.5 25,000 Wood Street 3,141 6 209 2,938 3,007 1 in 14 1 in 15 6 18,500 Northern 7,233 196 577 7,552 7,059 1 in 13 1 in 7 5.7 40,500 Whole District 23,694 242 1,582 22,309 22,545 1 in 15 1 in 13.8 5.9 132,000 (or 131,623, 5.9 persons to house). EDUCATION AUTHORITY'S FIGURES. Houses fit for Occupation. Houses Empty. Houses Occupied. Houses in Course of Construction. Population (at 5 9 per house) 24,036 1,491 22,545 53 133,015 Registrar-General's Estimate 141,748 11 The age constitution of our population at the 1901 Census, as compared with England and Wales, and the average death-rates at the different age periods may be seen from the following table :— TABLE II. All Ages. Under 5 years. Over 5 and under 10. Over 10 and under 15. Over 15 and under 20. Over 20 and under 25. Over 25 and under 35. Over 35 and under 45. Over 45 and under 55. Over 65 and under 65. Over 65 and under 75. 75 years and upwards. England and Wales. 1,000 129 119 110 100 90 149 114 85 58 33 13 England and Wales (assumed). 95,131 12,271 11,320 10,464 9,513 8,561 14,174 10,844 8,086 5,517 3,139 1,236 Walthamstow. 95,131 13,916 12,608 11,079 8,786 7,768 15,810 11,969 7,069 3,721 1,710 695 Average Death-rates England and Wales. 17.7 54.7 3.85 2.25 3.4 4.7 6.3 10.65 16.75 32.7 61.8 153.6 The following Summary of the Sanitary and other data of importance are given for easy reference:— WHOLE DISTRICT. Population. Rateable Value. General District Rate, Total Poor Rate, Education Rate, £. per £. per £. per £. 1881 Census 21,697 97,111 3/4 2/9 0/2 1891 „ 46,346 156,959 2/9 3/8 l/4¾ 1901 „ 95,131 328,756 3/8 4/10 1/11¾ 1904 Estimated 111,282 404,101 3/2 5/9 2/4¼ 1905 „ 116,300 423,241 3/10 5/10 2/5 1906 „ 121,334 426,703 4/1 6/5 2/7 1907 „ 126,397 431,937 4/1 5/5 1/8 1908 „ 131,486 437,127 4/1 5/3 1/8½ 1909 „ 136,602 444,582 4/1 5/1 1/9 1910 „ 141,748 444,850 4/- 5/11 2/3 12 The population was estimated to be 4,780 in 1851, 6,880 in 1861, and enumerated as 10,692 in 1871. Average for previous 10 years. Total Births registered, 1910 3,197 3,382 „ Deaths „ „ 1,186 1,275 Number of deaths of persons not belonging to this district 17 12 Natural increase of population 2,011 2,157 Birth-rate per 1,000 estimated population 22.6 305 Death-rate 8.4 11.3 Death-rate corrected for age and sex 8.9 11.9 Zymotic Death-rate .74 196 Infantile Mortality Rate 88.5 1193 Infectious Sickness Rate 3.4 10.0 Number of persons per house 5.9 „ „ „ acre (exclusive of Sewage Farm and Reservoirs) or Density of Population 35.0 ELEMENTARY SCHOOLS. Summary. Capacity. On Books. Present. Average. Perc'nt'ge. Refused. Schools. Original. Present. Ov'r 5. U'd'r 5. Total 17 Boys' 7294 7294 7212 6935 6634.3 91.9 — — — 18 Girls' 7477 7239 7190 6751 64309 89.4 — — — 19 Infants' 7443 7211 7249 6598 6238.4 86.0 20 27 47 10 Mixed 3490 3418 3404 3223 3111.0 91.3 — — — 25704 25162 25055 23507 22414.6 89.4 20 27 47 3 Special 150 150 107 104 97.4 91.0 — — — M'th end'g — — — — — — — — — Dec. 23,'10 25854 25312 25162 23611 22512.0 89.4 20 27 47 „ 23,'09 24797 24415 25310 22983 22057.0 87.1 29 36 65 Decrease — — 148 — — — 9 9 18 Increase 1057 897 — 628 455 2.3 — — — 18 SUB-DISTRICTS. TABLE III. WARDS.—Acreage, Estimated Population, Density, Birth and Death Rates, etc. Wards. Acreage. Acreage (excluding Farm & Reservoirs). Number of Houses, 1901. Estimated number of Houses occupied. Mid-year 1910. Estimated Population, 1910. Density (excluding Sewage Farm & Reservoirs). Birth Rate, 1910. Death Rate, 1910. Height in feet above Sea Level. St. James Street 489 307 3937 4001 25,000 81 26.3 11.6 18 to 54 High Street 6601/3 4151/3 3220 3254 23,000 55 24.6 8.2 21 to 60 Hoe Street 3471/3 3471/3 4084 4564 25,000 71 20.8 8.3 50 to 140 Wood Street 499 499 2716 2938 18,500 37 22.1 9.6 75 to 176 Northern 23591/3 22371/3 3377 7552 40,500 18 25.7 8.0 25 to 220 Whole District 4355 3806 17,334 22,309 132,000 34 24.2 9.0 14 BIRTHS AND BIRTH RATE. The total number of births registered during the year was 3,197, males 1,671, females 1,526. Twenty-one of these (males 11, females 10) were born at the Union Workhouse, and three males and two females elsewhere. Of the total births 53 were illegitimate; thirteen took place at the Workhouse, two elsewhere without, and the remainder within the district. The number of these births varies but little from year to year—about sixteen in every 1,000 registered births are non-legitimates. The total number of births since the last census was:—34,480 and there were actually fewer children born in 1910 than in 1901. The births registered yearly since 1891 are given on page 22. The birth-rate for the year is 22 6 per 1,000 of the estimated population of the Registrar-General, a rate lower than any yet recorded here, lower than that of the country as a whole, the 77 "Great" and the 136 " Smaller Towns " of England. A rate of 24.2 based on the population of 132,000 is likely to be much more consonant with the actual conditions than that given, but the fact remains that our birth-rate like the country generally, has been steadily diminishing within recent years. Accompanying this decline we have had a corresponding fall in the general death-rate, so the natural increase of the population continues. Our lowered birth-rate has also been compensated for largely by a lessened death-rate in children in the first year of life. The birth-rate for England and Wales in 1910 was 24.8; for the 77 "Great Towns" 25 0; and for the 136 "Smaller Towns" 23.7. The ratio of male to female births was as 100 to 91. 15 TABLE IV. The following table shows the births distributed over the various Wards for the four quarters of the year :— St. Tames Street. High Street. Hoe Street. Wood Street. Northern. Workhouse and others. Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1st quarter 76 73 85 53 57 61 57 46 134 104 4 1 413 338 2nd quarter 91 79 70 76 85 68 51 61 154 133 6 2 457 419 3rd quarter 79 94 67 76 56 59 54 43 143 125 2 7 401 404 4th quarter 88 74 60 73 64 66 55 37 131 113 2 2 400 365 334 320 282 278 262 254 217 187 562 475 14 12 1671 1526 Workhouse 2 3 1 3 2 3 4 0 2 1 Others 0 0 1 0 0 0 1 1 1 1 Totals 659 565 521 410 1042 — 3,197 Population 25,000 23,000 25,000 18,500 40,500 — 132,000 Birth-rate 1910 26.3 24.6 20.8 22.1 25.7 — 24.2 Do. 1909 29.4 27.4 21.4 23.6 27.0 — 26.0 16 The birth-rates for the various Wards from Census year onwards are as follows :— St. James Street. High Street. Hoe Street. Wood Street. Northern. 1901 33 35.7 28 28.4 39.8 1902 33.22 36.65 29.45 30 39.55 1903 31.6 39.1 29.24 27.45 38.1 1904 33.3 37 27 28.1 40.6 1905 29 30 25.07 24.9 31.8 1906 30.4 35 24.7 26.2 30.2 1907 29 33.3 25 25 31.6 1908 30.2 30.7 23.4 23.8 30.5 1909 29.4 27.4 21.4 23.6 27 1910 26.3 24.6 20.8 22.1 25.7 The decline in the birth-rate as compared with that of 1901 of the different Wards varies. That for St. James Street, Hoe Street, and Wood Street Wards shows a similar reduction, those for High Street and the Northern Wards are so marked that the explanation may probably be over-estimated populations. Since 1901, our general birth-rate has fallen from 33T to 22.6, that of the country as a whole 28.15 to 24.8. That our decline in birth-rate is three times greater than elsewhere is not probable, and it is more than likely that our true birth-rate is at least 25 per 1,000 of our actual population. DEATHS AND DEATH-RATES. WHOLE DISTRICT. During the year 949 deaths were registered within the district under the Council's authority—males 467, females 482. Seventeen of these (males 11, females 6) were of non-residents and have been excluded. Particulars of these deaths were transmitted to the appropriate localities, while the deaths of residents dying without the district, as far as I have been able to get the returns, are now added. These were 52 at the Workhouse, 175 at the Infirmary, 14 at the Isolation Hospital, and 13 transmitted from Health Officers elsewhere. These latter do not include all the deaths that have occurred among our people during the year, and hence the death-rate based on the above figures will be less than that subsequently to appear in the Registrar-General's Summary 17 This is the last year such a discrepancy will be possible, a notification having been given that in future the Registrar-General will supply the necessary missing numbers to make our birth and death statistics correct. The classification of the causes of death must also be accepted with some reserve. "It is difficult to bring medical men to realise the unreliability of the data which they themselves supply. All mortality statistics are based on the death certificate, and non medical statisticians generally regard the death certificate as of fixed interpretation. As a matter of fact, however, medical men seldom write a death certificate with any appreciation of its utility as a contribution to vital statistics." Seldom is a distinction made in the death certificates between Acute and Chronic Bronchitis, Lobar or Lobular Pneumonia, and deaths at 66 years of age from Senile Decay are quite frequent, and when three distinct diseases—any of which might be the cause of death—are registered, it is a matter of great difficulty to decide under which heading the death should be placed. The total deaths ascertained for the year were 1,186—males 602, females 584—and all with the exception of an infant under 1 week were certified by a doctor or the coroner. The registered cause of the uncertified death was given as " Patent Foramen Ovale." The deaths represent a crude death rate of 8.4 or a corrected rate for differences of age and sex in the population as compared with the whole country of 8.9 per 1,000 of the estimated population. This death-rate is of course based on the assumption, that, like other large towns, our rate of growth has been what the Registrar-General assumes, and " missing deaths " are not included. The death-rate for England and Wales was 13.4 and for the 77 "Great Towns " 14.3. The death-rate for the 136 " Smaller Towns " was 12.9 and excluding these and the "Great Towns" the rate for the country was 12.8. If my estimate of the population is correct and making due allowance for missing deaths, our death-rate would be 9.7 per 1,000, or 3.4 less than the mortality figure for England and Wales, and 4.3 less than that of the " Great Towns." The birth, death, and infantile mortality rates of the following districts of the outer zone of London, compared with your own, will be of interest. B 18  Population. Birth-Rate. Death-rate. Infantile Mortality rate or Proportion of Deaths of Children under one year to 1,000 Births Croydon 164,485 23.1 10.9 87.4 Willesden 166,088 22.9 9.1 82.1 Hornsey 98,561 13.9 7.6 69.7 Tottenham 132,803 27.8 11.4 86.3 West Ham 328,585 26.3 11.6 100.7 East Ham 156,208 21.8 8.8 94.1 Leyton 133,436 23.6 9.2 66.03 Walthamstow 141,748 22.6 9.08 95.0 The above figures are taken from the four quarterly returns of the Registrar-General, and include 102 more deaths and accounts for 9 fewer births for this district than have been returned to me. DEATHS AND DEATH-RATES. ACCORDING TO WARDS. The deaths allocated to the different Wards are those received from the local Registrar, and from others as already mentioned. The distribution of the deaths is correct but the populations are assumed, and no accuracy is claimed for the latter; inferences drawn therefore, must be accepted with this reservation. The deaths and death-rates for 1910 and the death-rates for previous years are as follows:— St. James St. High St. Hoe St. Wood St. Northern. Population, 1910 25,000 23,000 25,000 18,500 40,500 Deaths, 290 189 208 178 321 Death-rate 11.6 8.2 8.3 9.6 8 „ 1909 10 9.0 10.2 11.2 7.4 „ 1908 13.1 9.8 11 9.9 8.1 „ 1907 14.3 10.8 9.9 12.8 9 „ 1906 12.9 11.7 11 11.7 10.8 „ 1905 12.7 11.4 9.8 10.2 9.3 „ 1904 13.85 12 10.6 11.08 13.45 „ 1901 15.03 12.8 11.5 12.05 15.27 (Census year.) The above rates are based on a population of 132,000 and although Hoe Street and St. James Street Wards are assumed to have like populations the latter has one-third more deaths than the former and a higher death-rate than any of the Wards. 19 This I think is quite correct judging from the local circumstances and the general character of the population. The death-rates of all the Wards are very low ones and show an improvement on previous years, the rates given having been based on yearly populations assumed from local knowledge and not upon that of the Registrar-General. The higher death-rates of St. James Street and Wood Street Wards as compared with the other portions of your district are confirmatory of the generally accepted views that mortality figures are largely a reflex of the housing and social conditions of a people. In St. James Street and Wood Street Wards are to be found most of the older badly constructed houses put up at a time when Walthamstow began to change its rural character to become a dormitory for London's workers. As the district grew, the better class artisans and city clerk moved farther away from the older areas in the vicinity of railway stations, and their places were taken by a poorer, more ignorant, and less thrifty population, and gradually the houses originally built for one came to be occupied by two families, with consequent deterioration of property and its surroundings. These factors, joined to the Wards' unfavourable geographical conditions, largely account for the recorded differences. Contrasting two Wards with equal populations but differing greatly in their economic conditions, it is found that the deaths from Tuberculosis and other diseases of the lungs, are twice as many in St. James Street as in Hoe Street, and that Wood Street with 26 per cent, less people has actually more deaths from these diseases than its more favourably conditioned neighbour. Deaths from diseases from the lungs, whether associated with Measles, Whooping Cough or Tubercle, are always more numerous among the poor than among the well-to-do, and the increase is largely the result of ignorance and the bad conditions under which they live, and it is difficult to say that the excessive mortality among the poor and struggling workers can be reduced by measures short of betterment in their economic conditions. As the latter is not within the scope of a sanitary authority, a vigorous administration of Sections 14 and 15 of the Housing and Town Planning Act, 1909, in association with the teaching in our schools of Hygiene, and the value of fresh air and cleanliness within the home are measures upon which we must largely rely. The following table shows the mortality in the four quarters of the year for the various Wards:— 20  1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total. St. James Street 101 58 45 86 290 High Street 49 54 36 50 189 Hoe Street 51 49 49 59 208 Wood Street 52 44 34 48 178 Northern 87 72 68 94 321 It will be noticed how closely the figures approximate for all quarters in Hoe Street. Season has but little influence. In striking contrast with this are the figures for St. James Street. The first and fourth quarters mortality greatly exceed the second and third, showing that want of employment, and unfavourable climatic conditions are most keenly felt and have the most serious consequences for the poor. Were the summer unduly hot and dry the mortality in the third quarter would probably be as unfavourable for the poorer Ward owing to increased deaths from Diarrhoea among the infants. The following figures give the total deaths and the deaths of children under 5 years of age from Zymotic or preventable diseases in the five Wards:— St. James St. High St. Hoe St. Wood St. Northern. Births 659 565 521 410 1,042 Deaths—Total 290 189 208 178 321 Death-rate 11.6 8.2 8.3 9 6 8 Deaths under 5 years from Zymotic diseases 25 14 10 9 28 Percentage of total deaths— For 1910 8.6 7.3 5 5 8.7 For 1909 11.8 7.0 10.3 11.8 14.2 For 1908 9.7 11.7 4.5 7 8 For 1907 17.3 14.7 9.6 11.8 17.8 For 1906 19.6 15.9 9.5 14.1 21.5 The total deaths are fewer by one-half than in 1909 owing to the fewer deaths from Measles and Whooping Cough. The Diarrhœal deaths were similar in number. INQUESTS. During the year 113 inquests were held on persons belonging to and dying within, and 10 upon inhabitants dying without the district. The ages at which death took place and the causes are as follows:— 21 Under One Year: Want of attention at birth, 2; Pneumonia, 6; Conjestion of Lungs, want of attention, 1; Convulsions, 3; Malnutrition, 2; Improper food, 3; Gastro Enteritis, 1; Meningitis, 1; Suffocation in bed with mother, 6; General Tuberculosis, 1; Acute onset of Zymotic disease undetermined, 1; Strangulation of Intestine, 2; Accidental hanging, 1. Over One Year: 1-5 Years. 5-15 Years. 15-25 Years. 25-65 Years. 65 and upwards Total. Natural Causes 11 2 3 13 16 45 Syncope — Persistent Thymus Gland 1 1 ... ... ... 2 Do. Over distension of Stomach ... 1 ... ... ... 1 Do. After fit of Coughing ... ... ... 1 ... 1 Do. Haemophilia ... 1 ... ... ... 1 Cerebral Haemorrhage ... 1 ... 2 1 4 Intussusception 1 ... ... ... ... 1 Murder ... ... 1 ... ... 1 Suicide ... ... ... 2 ... 2 Do. Insane ... ... ... 3 ... 3 Burns and Scalds 8 1 1 1 ... 11 Accidents ... 1 1 5 3 10 Do. Injury to hand 1 1 ... 1 1 4 Suffocation—Accidental 2 ... ... ... ... 2 Do. by drowning 1 ... ... ... ... 1 Asphyxia—Oedema of Glottis ... ... ... ... ... 1 Septicœmia following accident ... 1 ... ... ... 1 Do. do. Pneumonia ... ... 1 ... ... 1 Totals 25 10 7 29 21 92 22 The following table gives the number of births and deaths, their rates, the Zymotic death-rate, Infantile Mortality rate, and natural increase of population for the past nineteen years, and the average in five yearly periods compared with 1910:— TABLE V. Year. Births. Deaths. B. Rate. D. Rate. Zymotic D. R. Infantile Mortality Rate. Natural Increase of Population 1891 1756 694 37.3 14.7 1.9 120 1062 1892 1717 915 34.75 18.0 3.9 145.6 802 1893 1809 809 34.78 15.55 2.43 133.2 1000 1894 1813 717 32 12.6 1.8 129.6 1096 1895 2021 965 33.2 15.8 3.5 1533 1056 1896 2101 817 32.3 12.5 2.4 127.5 1284 1897 2246 832 32.08 11.88 2.8 132 1414 1898 2294 1034 29.8 13.4 3.67 169.5 1260 1899 2835 1282 34.14 15.44 2.94 170.0 1553 Average for 5 years 1895-99 2299 986 32.30 13.80 3.06 150.4 1313 1900 3037 1254 33.37 13.78 2.8 158.7 1783 1901 3210 1296 33.1 13.35 2.82 147.6 1914 1902 3426 1154 33.81 11.38 1.3 115 2272 1903 3535 1178 33.25 11.08 1.9 113.7 2357 1904 3649 1330 32.79 11.95 2.89 135.9 2319 Average for 5 years 1900-04 3371 1243 33.26 12.30 2.34 134.1 2129 1905 3389 1249 29.14 10.7 1.69 104.4 2140 1906 3594 1447 29.60 11.90 2.54 129.7 2147 1907 3629 1376 28.55 10.88 1.83 104.7 2253 1908 3482 1258 26.48 9.56 .95 100.8 2224 1909 3369 1205 24.66 8.8 .98 83.4 2164 Average 5 years 3492 1307 27.68 10.36 1.59 104.6 2185 1910 3197 1186 22.5 8.3 .74 88.5 2011 Total natural increase of Population since 1891, 34,111. Total increase as shown by census, 1901, 48,785. Total increase as estimated to middle of the year 1910, 95,402. Total increase per cent. since 1891, 205. Total increase per cent. since 1901, 49. 23 INFANTILE MORTALITY. During the year 283 deaths occurred in children under one year of age, compared to 281 in 1909; 351 in 1908; 380 in 1907; 466 in 1906; 354 in 1905; 496 in 1904; 401 in 1903; 394 in 1902 and 481 in 1901. The infantile mortality rate for each year since 1891 is given on the preceding page. This rate is one of great interest and importance, since it is independent of correct or incorrect estimated population, being based on the deaths in children under one year of age as compared with the total births. If the total births and deaths are known the rate is not liable to error, but owing to faulty death returns the rate of 88.5 given is less than the actual rate, 95, ascertained from the figures of the four quarterly returns of the Registrar-General. The reason for giving the lesser rate is to make the figure comparable with preceding years, whose rates were ascertained from the returns actually received. It will be noticed that on page 22, by grouping the birth and infantile mortality rates into five-yearly periods, the average death-rate has fallen from 150 4 in 1895-1900, to 104.6 in 1905-1910, although the average number of births in the same period had increased from 2,299 to 3,493. The improvement in the latter period shows a yearly saving of 160 infant lives, and the improvement recorded in 1910 on the previous five years, shows a saving of 50 for the total born. The recorded rate of 95 per 1,000 children born for 1910, is a favourable one, and taken in association with that of 104.6 for the previous five years would bring the district within the category of the RegistrarGeneral of "Towns with low rates of Infantile Mortality," and without further analysis it would seem that our work in this respect has been very satisfactory. But that there is much scope for betterment will be seen by splitting up the district into its constituent parts. The following table shows the Infantile Mortality and other associated data for the various Wards. Whole District. St. James Street. High Street. Hoe Street. Wood Street. Northern Population 132,000 25,000 23,000 25,000 18,500 40,500 Births 3,197 659 565 521 410 1,042 Birth-rate 24.2 26.3 24.6 20.8 22.1 25.7 Deaths 1,186 290 189 208 178 321 Death-rate 9.7 11.6 8.2 8.3 9.6 8.0 Infantile Mortality Rate 88.5 126.0 83.2 65 0 80.0 82.5 Deaths under 1 year of age 283 83 47 34 33 86 24 It is at once apparent that assuming the total deaths had been received and distributed, the rate for each Ward would be proportionately augmented by 6.5, making the rates respectively 182.5; 89.7; 71.5; 865 and 89. In this way the St. James Street figures for a year with favourable climatic conditions show an excessive mortality, and the Hoe Street figure should be nearly possible in all the Wards. The importance of a low infant mortality has been specially noted by the Registrar-General, who points out in his 71st Annual Report that the conditions which tend to a high mortality in the first year of life operate with adverse effect during the succeeding years of life. The Chief Medical Officer of the Local Government Board has also demonstrated that excessive infant mortality implies excessive child mortality and excessive mortality right up to adult life, and in the supplement to his report for 1909-10, he shows in diagramatic form, that the superior prospects of life of those having lived under the conditions in which low infant mortality occurs persist right through life, and the conclusion is drawn that as each sanitary authority and the inhabitants of its district succeed in removing the conditions favouring high infant mortality they are removing the conditions producing a high rate of mortality in youth and throughout adult life. This is very important and worth remembering. The efforts made in recent years by various Sanitary Authorities in co-operation with voluntary agencies with a view to reducing the infant death-rate are justified by the highest and best authority, and the Notification of Births Act, 1907, enables those who believe that many infant deaths are due to ignorance on the part of the mothers, to appoint Health Visitors for the purpose of visiting the houses of the poor and instructing the mothers as to the best methods of rearing healthy children. In dealing with the general death-rate of the St. James Street Ward, I pointed out that its low-lying situation, the homes, and the economic conditions of the people were factors influencing adversely its mortality figures, and I suggested a vigorous administration of our latest and best Public Health Act. Since the medical inspection of school children has revealed conditions that call for new methods of sanitary administration and accentuated the importance of the personal unit, your Authority would be acting wisely in adopting the Act of 1907, and appointing a Health Visitor, whose time could be fully occupied in this work and that arising out of the medical inspection of our school children. To whatever causes the excessive mortality disclosed may be due you would then be enabled to supplement the work of the Sanitary Inspector by dealing with the removable personal factors concerned. TABLE VI. Causes of Deaths. Under 1 Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months 11-12 Months Total Deaths under One Year. All Causes Certified 72 23 9 15 119 29 24 14 16 16 8 11 14 8 11 12 282 Uncertified 1 — — — 1 — — — — — — — — — — 1 COMMON INFECTIOUS DISEASES. Small-Pox - - - - - - - - - - - - - - - - — Chicken-Pox - - - - - - - - - - - - - - - 1 1 Measles - - - - - - - - - - - - - - 3 - 3 Scarlet Fever - - - - - - - - - - - - - - - - - Diphtheria; Croup - - - - - - - - - - - - - - - - - Whooping Cough - - - - - 1 2 - 1 - - 1 3 - 1 2 11 DIARRHœAL DISEASES. Diarrhoea, all forms - - - - - - 1 1 1 1 1 2 — — — 1 8 Enteritis, Muco Enteritis, Gastro Enteritis - - 1 1 2 2 2 1 — 4 — — 1 — — 1 13 Gastritis, Gastrointestinal Catarrh - - - 1 1 2 - - 1 1 - - - - - - 5 WASTING DISEASES. Premature Birth 41 6 1 4 52 5 2 - - - - - - - - - 59 Congenital Defects 10 4 — — 14 1 2 - - - - - - - - - 17 Injury at Birth - - - - - - - - - - - - - - - - Want of Breast-milk — — 1 1 2 1 1 1 - - - - - - - - 5 Atrophy, Debility, Marasmus 3 3 3 2 11 5 7 1 3 2 2 2 5 3 — — 41 Asthenia: Inanition 10 5 — 1 16 — — — 1 — — — - - - - 17 TUBERCULOUS DISEASES. Tuberculous Meningitis - - - - - - - - 1 - - - - - 1 1 3 Tuberculous Peritonitis: Tabes Mesenterica - - - - - - - 1 — — — — — — — — 1 Other Tuberculous Diseases - - - - - - - 1 1 - - - - - - - 2 OTHER CAUSES. Erysipelas - - - - - - - - - - - - - - - - - Syphilis — 1 — — 1 — — — — — — — — - - 1 2 Rickets — — - - - - - - - - - 1 1 — - - 2 Meningitis (not Tubeiculous) - - - - - - - - - 1 2 — — — 1 — 4 Convulsions 2 1 2 1 6 1 1 1 — — — 1 — — — — 10 Bronchitis — — — 2 2 3 2 3 1 4 1 3 1 2 2 2 26 Laryngitis — — — — — — — — — — — — — — — - - Pneumonia — 1 — 1 2 4 2 3 5 2 2 1 2 3 2 1 29 Suffocation, overlaying 3 — 1 — 4 — — 1 1 - - - - - — — 6 Other Causes 4 2 — 1 7 4 2 — — 1 - - 1 - 1 - 18 73 23 9 15 120 29 24 14 16 16 8 11 14 8 11 12 283 District (or sub-division) of Walthamstow. Births in the year legitimate, 3144. illegitimate, 53. Deaths in the year of legitimate infants, 261. illegitimate infants, 22. Population. Estimated to middle of 1910, 141,748. Deaths from all Causes at all Ages, 1186. 25 Working in association with those responsible for mothers' meetings, a tactful and sympathetic woman would be capable of effecting immense good, by advice to the expectant mother and to those mothers revealed by the Act's operations, more particularly in those Wards, where the mothers need it most. The facing table (No. VI ), giving the deaths of children under 1 year of age, is in accordance with the requirements of the Local Government Board. The table is most instructive, and will help in forming a judgment as to the possible saving of infant life that may be effected if my suggestion is carried out. Of the 283 children so dealt with, 120 died within the first month of life. Prematurity and inanition—inability to live—account for 68, or more than half; congenital defects and inability to thrive account for 25 others ; convulsions and overlaying bring the total to 103. Within the next three months 53 others have died, mainly from Prematurity, Bronchitis and Pneumonia, and Wasting Diseases, and so on to the end of the year, the latter diseases seem to be the chief cause of death. In the formation of Table V. (L.G.B.), the deaths attributable to each Ward are indistinguishable. Dealing with the principal causes only, the following are the figures:— Deaths from Ward. No. of Births. Prematurity and Developmental. Disease of Lungs. Whooping Cough and Measles. Diarrhœa St. James Street 659 43 24 3 7 High Street 565 20 10 2 5 Hoe Street 521 20 6 3 1 Wood Stree 410 21 2 — 2 Northern 1042 40 14 6 11 The deaths from Diarrhœa were below the usual in all the Wards, those from Syphilis and overlying similar to 1909. The deaths certified as due to Syphilis are the most unreliable of all recorded, and it is quite safe to say that two deaths in no way represent the total : more probably many of those attributed to Prematurity and Inanition should be grouped under this heading. The influence of want of parental care upon Infantile Mortality could not be better exemplified than in the 22 deaths among the 53 illegitimates. These unwanted children are hardly ever breast-fed, being generally placed out to nurse and die. 26 The following; shows in tabular form the number and causes of deaths in children under five years in 1910, 1909, 1908, 1907, 1906, 1905 and 1904:— Diseases 1910 1909 1908 1907 1906 1905 1904 Measles 16 28 31 30 35 34 45 Scarlet Fever 3 4 7 13 9 9 7 Influenza — 1 - 2 1 0 1 Whooping Cough 31 45 2 72 18 31 29 Diphtheria 7 10 12 24 29 15 20 Croup — 2 2 1 3 - 2 Enteric Fever — - - - - 1 1 Diarrhœa 7 5 23 29 106 52 82 Zymotic Enteritis 2 9 14 15 49 26 99 Enteritis 18 7 7 6 11 12 4 Gastric-Enteritis — 5 8 12 - - 13 Septic Diseases 6 9 3 5 7 8 4 Tuberculosis of Meninges 18 12 12 26 13 13 13 Do Lungs 4 3 - - 4 4 3 Do other forms 7 11 11 16 20 13 22 Cancer 1 1 1 - - - 1 Premature Birth 59 60 65 68 83 56 62 Developmental Diseases 90 76 89 76 88 84 94 Meningitis 5 9 10 13 14 16 18 Acute Bronchitis 36 29 41 42 34 31 32 Lobar Pneumonia 9 9 14 23 15 19 18 Lobular Pneumonia 52 45 56 59 49 54 45 Diseases of Stomach 6 2 7 4 2 2 6 Obstruction of Intestines 3 2 2 1 2 2 - Bright's Disease 1 1 1 — 1 1 3 Accidents or Negligence 15 18 15 21 30 14 23 Congenital Syphilis 2 1 10 9 - - - All other causes 27 26 47 41 66 47 46 425 430 493 608 689 545 693 Four hundred and twenty-five deaths out of a total of 1,186 were of children under 5 years of age, and of the 425, 120 were in the first month and 283 within the first year of life SENILE MORTALITY Of the total deaths recorded, 280, or nearly 23 per cent, were 65 years and upwards, as compared with 22 per cent. for 1908, 19 in 1907, 17 in 1906, and 21 in 1905 TABLE VIII. Schedule B. Table of Deaths during the year 1910, in the Urban Sanitary District of Walthamstow, classified according to Diseases, Ages, and Wards. No. Causes of Deaths. All Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 & upwards St. James St. High Street Hoe Street Wood Street Northern Total Dealhs in Public Institutions (Workhouse and Infirmary included). l Small-Pox - - - - - - - - - - - - - 2 Measles 20 3 13 4 - — - 6 5 1 3 5 3 3 Scarlet Fever 4 — 3 1 - — - 1 1 1 — 1 — 4 Typhus Fever — — — — - — - — — — — — — 5 Epidemic Influenza 10 — — — - 3 7 1 2 3 4 — 2 6 Whooping Cough 32 11 20 1 - — — 10 5 5 1 11 8 7 Diphtheria, Membranous Croup 15 — 7 8 - — — 3 3 4 2 3 1 8 Croup — — — — - — — — — — — — — 9 Enteric Fever 2 — — 1 - 1 — — — 1 1 — 1 10 Asiatic Cholera — — — — - — — — — — — — — 11 Diarrhoea, Dysentery 8 7 — — - 1 — 3 2 — 2 1 — 12 Epidemic or Zymotic Enteritis 2 2 - - - - - - 1 - - 1 — 13 Enteritis 20 12 6 — - 1 1 6 3 1 1 9 8 14 Gastro Enteritis 1 - - - - - - - 1 - - - — 15 Other continued Fevers 1 1 1 - 16 Cerebro Spinal Meningitis - - - - - - - - - - - - — 17 Erysipelas 2 — — — 2 — — 1 - 1 — 1 18 Puerperal Fever 1 — - — - 1 — — — 1 — — — 19 Other Septic diseases 24 4 2 5 1 8 4 5 4 — 6 9 12 20 Intermittent Fever and Malarial Cachexia — — — — - — — — — — — — — 21 Tuberculosis of Meninges 24 3 15 4 2 — — 2 5 6 4 7 3 22 Tuberculosis of Lungs 88 — 4 3 15 61 5 25 12 14 16 21 34 23 Other forms of Tuberculosis 16 3 4 3 — 5 1 2 3 3 2 6 1 24 Alcoholism 5 — — — — 4 1 2 1 — 1 1 — 25 Cancer 74 1 — — — 50 23 16 10 21 4 20 19 26 Premature Birth 59 59 - — — — — 17 6 11 4 21 2 27 Developmental Diseases 90 85 5 — — — — 27 15 9 17 22 15 28 Old Age 63 — — — — — 63 9 9 17 13 15 22 29 Meningitis 9 3 2 — 1 2 1 2 — 2 — 5 1 30 Inflammation and Softening of Brain 2 — — — — — 2 — — 1 1 — — 31 Organic Diseases of Heart 67 1 — 8 4 37 17 12 5 18 12 20 19 32 Acute Bronchitis 55 22 14 — — 16 o 21 11 6 4 13 2 33 Chronic Bronchitis 64 — — 1 — 20 43 16 13 8 12 15 5 34 Lobar (Croupous) Pneumonia 53 3 6 2 3 34 5 15 11 5 8 14 10 35 Lobular (Broncho) Pneumonia 61 31 21 — — 4 5 22 8 8 7 16 6 36 Diseases of Stomach 14 5 1 — 1 4 3 4 3 — 2 5 3 37 Obstruction of Intestines 9 2 1 — — 1 5 — 3 — 4 2 3 38 Cirrhosis of Liver 10 - — — — 9 1 1 1 3 3 2 4 39 Nephritis and Bright's Disease 31 1 — — — 19 11 10 7 5 5 4 8 40 Tumours and other Affections of Female Genital Organs - - - - - - - - - - - - — 41 Accidents and Diseases of Parturition 1 — — — — 1 — - — — — 1 — 42 Deaths by Accident or Negligence 34 4 11 4 2 8 5 6 5 7 6 10 20 43 Deaths by Suicide 8 — — — 2 6 — 1 2 1 1 3 4 44 Deaths from Ill-defined Causes — — — — — — — — — — — — 45 Syphilis 3 2 — — — 1 — 2 — — — 1 1 46 Overlying 6 6 — — — — — — 1 2 - 3 - 47 All other Causes 198 12 7 11 12 82 74 43 29 39 30 57 42 All Causes 1,186 283 142 56 43 382 280 290 188 206 178 324 259 TABLE VII. Table showing deaths for the four quarters of the year, and the total deaths for the entire district and for the Wards. No. CAUSE OF DEATH. AT ALL AGES. UNDER 1 YEAR. 1 TO 5 YEARS. 5 TO 15 YEARS. 15 TO 25 YEARS. 25 TO 65 YEARS. 65 AND UPWARDS. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. 1st Qr. 2nd Qr. 3rd Qr. 4th Qr. Total. 1 Small Pox - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 2 Measles 2 12 3 3 20 2 1 — 3 1 9 2 1 13 1 1 — 2 4 - - - - - - - - - - - - - - — 3 Scarlet Fever — 3 — 1 4 — — — — — — 3 — — 3 — — — 1 1 - - - - - - - - - - - - - - - 4 Typhus Fever - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 5 Epidemic Influenza 8 - 1 1 10 - - - - - - - - - - — — — — - — — — — 2 — 1 — 3 6 — — 1 7 6 Whooping Cough 22 7 3 32 6 4 - 1 11 15 3 — 2 20 1 — - - - - - - - - - - - - - - - - - - 7 Diphtheria, Membranous Croup 3 1 4 7 15 — — — — — 2 — 2 3 7 1 1 2 4 8 - - - - - - - - - - - - - - — 8 Croup - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 9 Enteric Fever - - 1 1 2 - - - - - - - - - - - - - 1 1 - - - - - - - 1 - 1 - - - - — 10 Asiatic cholera - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11 Diarrhœa, Dysentery 3 1 2 2 8 2 1 2 2 7 — - - - - - - - - - - - - - - - - - - 1 - - - - - 12 Epidemic or Zymotic Enteritis 1 — 1 — 2 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 13 Enteritis 3 4 2 11 20 2 1 2 7 12 1 1 — 4 6 - - - - - - - - - - - - - - - - 1 - - 1 14 Other Continued Fevers 1 - - - 1 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 15 Gastro Enteritis 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 16 Erysipelas — — 1 1 2 — - - - - - - - - - - - - - - - - - - - - - 1 1 2 - — — - — 17 Puerperal Fever 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - 18 Other septic diseases 7 6 5 6 24 1 1 1 1 4 1 — 1 — 2 — 2 1 2 5 — — — 1 1 3 2 1 2 8 2 1 1 — 4 19 Intermittent Fever and Malarial Cachexia - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 20 Tuberculosis of Meninges 3 7 7 7 24 - - 1 2 3 3 5 4 3 15 — — 2 2 4 — 2 — 2 — — — — — — — — — — 21 Tuberculosis of Lungs 26 16 22 24 88 — — — — - 2 2 — — 4 1 — 2 — 3 6 2 5 2 15 15 12 13 21 61 2 — 2 1 5 22 Other Forms of Tuberculosis 3 2 5 6 16 2 — 1 — 3 — — 1 3 4 — 1 1 1 3 — - — — — — 1 2 2 5 1 — — — 1 23 Alcoholism 1 1 3 - 5 - - - - - - - - - - - - - - - - - - - - 1 1 2 — 4 — — 1 — 1 24 Cancer 11 21 24 18 74 - 1 - - 1 - - - - - - — — — - — — — — — 6 17 12 15 50 5 3 12 3 23 25 Premature Birth 13 13 15 18 59 13 13 15 18 59 - - - - - - - - - - - - - - - - - - - - - - - - - 26 Developmental Diseases 34 13 21 22 90 33 19, 20 20 85 1 1 1 2 5 - - - - - - - - - - - - - - - - - - - - 27 Old Age 2 10 10 23 63 - - - - - - - - - - - - - - - - - - - - - - - - - 20 10 10 23 63 28 Meningitis 1 2 4 9 9 1 1 1 - 3 - - 2 — 2 — — — — - — — 1 — 1 — — — 2 2 — 1 — — 1 29 Inflammation and Softening of Brain 1 1 2 - - - - - - - - - - — — — — - — — — — - — — — — — — 1 — 1 2 30 Organic Diseases of Heart 11 26 13 17 67 1 - - - 1 - - - - - — 5 1 2 8 1 1 — 2 4 3 16 7 11 37 6 4 5 2 17 31 Acute Bronchitis 25 4 4 22 55 11 3 - 8 22 6 1 3 4 14 — — — — - — — — — - 6 — 1 9 16 2 — — 1 3 32 Chroninc Bronchitis 21 9 9 25 64 - — - — - — — — — — — — 1 1 - - - - - 6 6 4 4 20 15 3 5 20 43 33 Lobar (Croupous) Pneumonia 14 17 8 14 53 1 1 1 3 1 2 1 2 6 — — 2 2 1 2 — 3 10 10 b 9 34 1 3 1 — 5 34 Lobar (Broncho) Pneumonia 25 8 7 91 61 13 3 4 11 31 9 3 3 6 21 — — - — - - - - - - 1 1 — 2 4 2 1 — 2 5 35 Diseases of Stomach 3 2 5 4 14 2 - 3 - 5 - - - 1 1 - — - — - - 1 - - 1 — 1 2 1 4 1 — — 2 3 36 Obstruction of Intestines 2 3 2 2 9 - 1 - 1 2 — 1 — - 1 — — — — — — — — - — — 1 — 1 2 1 1 1 5 37 Cirrhosis of Liver 9, 3 3 2 10 - - - - - — — — — - — - — — — — — — — — 2 2 3 2 9 — 1 — — 1 38 Nephritis and Bright's Disease 12 11 1 7 31 — 1 — — 1 - — — — — — — — — — — — — — — 9 5 1 4 19 3 5 — 3 11 39 Tumours and other Affections of Female Genital Organs - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — — — 40 Accidents and Diseases of Parturition - - 1 - 1 - - - - - - — - - - — — — — - — — — — - — — 1 — 1 — — — — — 41 Deasths by Accident or Negligence 9 9 8 8 34 1 2 — 1 4 1 3 3 4 11 2 1 1 — 4 2 — — — 2 1 2 4 1 8 2 1 — 2 5 42 Deasths by Suicide 1 1 4 8 - - - - - - - - - - - - - - - 1 1 — 1 2 1 1 1 3 6 43 Deaths from Ill-defined Causes - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 44 Congenital Syphilis 3 - - - 3 2 - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - 45 Respiratory Organs - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 46 Overlying 1 3 1 1 6 1 3 1 1 6 - - - - - — — — — — — — — — — — — — — — — — — — — 47 Marasmus - - - - - - - - - - - - - - - - - - - - - - - — — — — — — — — — — — — 48 All other Causes 47 60 38 53 198 1 5 3 7 21 1 2 2 2 7 4 1 3 3 11 5 3 1 3 12 19 27 16 20 82 17 22 12 23 74 All Causes 340 277 232 337 1,186 95 54 58 76 283 44 36 25 37 142 10 12 13 21 56 15 12 7 9 43 89 105 79 109 382 87 58 50 85 280 27 Of the 280 Seniles, 141, or nearly 40 per cent., were over 75 years and 21 of these were over 85 at the time of death. In the St. James Street Ward 23 were over 75, and 3 over 85 years. „ High Street Ward 21 „ 4 „ „ Hoe Street Ward 37 „ 9 „ „ Wood Street Ward 30 „ 1 „ „ Northern Ward 30 „ 4 „ The preceding tables show the numbers and causes of death for the whole district and the several Wards. Table VII. gives the deaths in quarters, and Table VIII. is a combination of Schedule B (Form of the Medical Officers' of Health Society) and Table IV. (Local Government Board Form). ZYMOTIC MORTALITY. Included under this heading are the deaths from the "Seven Principal Epidemic Diseases":-Small Pox, Measles, Scarlet Fever, Diphtheria, Whooping Cough, Enteric Fever and Diarrhoea. All the deaths attributable to Diarrhœa, certified as Enteritis and Gastro Enteritis are included. The rate based on the total is .74 per 1,000 of the population, which is less than that of 1909 by .24. The similar rate for the 77 "Great Towns" was 1.23, and for England and Wales, .99. The Zymotic Mortality is as low as rural England and as the death rates from the different diseases are separately discussed under their proper headings, it is needless to do more than to draw your attention to the number of deaths from Measles and Whooping Cough as compared with those from Scarlatina and Diphtheria and to refer to the table on page 5, which shows that for each individual disease of the Zymotics, our death rate was as low or lower than that for England and Wales. The following tabular statement shows the numbers of deaths from these diseases since 1898. 28 TABLE IX. Small-Pox. Scarlatina. Diphtheria. Croup. Typhoid. Measles. Whooping Cough. Diarrhoea. Zymotic Enteritis. Total. 1910 0 4 15 0 2 20 32 8 23 104 1909 0 11 14 3 2 30 46 7 10 123 1908 0 11 20 2 13 36 2 26 14 124 1907 0 22 35 1 5 22 76 56 15 232 1906 0 21 54 3 8 39 18 113 51 307 1905 0 17 28 0 8 35 31 52 26 197 1904 1 14 27 2 10 55 32 84 99 324 1903 0 6 17 0 19 52 34 28 37 193 1902 20 6 17 4 13 14 23 23 5 125 1901 1 13 38 12 43 26 131 10 274 GastroEnteritis. 1900 0 5 71 7 6 3 54 110 27 283 1899 0 6 64 9 19 33 34 144 309 1898 0 3 40 6 9 39 24 162 283 DEATHS FROM NOTIFIABLE INFECTIOUS DISEASES. The deaths under this heading include those arising from Erysipelas and Puerperal Fever, but exclude those due to Measles, Whooping Cough and Diarrhœa; with this difference the deaths are those usually classed as Zymotic. The deaths under both heads are from "Preventable Diseases," as in theory all diseases ought to be, and old age the sole cause of death; but in this connection we only refer to the diseases amenable to Public Health Administration and due to infection from person to person. There were 24 deaths registered from these diseases; 14 of them occurring at the Isolation Hospital. The deaths are fewer in number by 10 than in the preceding year, and the mortality from these diseases as compared with previous years has been very little. The following table shows these deaths for 1910 and 1909 for the whole district and for the Wards:— 20 TABLE X. Names of Diseases. Whole District. Wards, 1910. Deaths, 1910. Deaths, 1909. Increase + Decrease - St. James Street. High Street. Hoe Street. Wood Street. Northern. Small-Pox Scarlatina 4 11 - 7 1 1 1 — i Diphtheria 15 14 + 1 3 3 4 2 3 Membranous Croup Typhoid 2 2 — — - 1 1 — Erysipelas 2 7 - 5 — 1 — 1 — Puerperal Fever 1 — + 1 — — 1 — — Cholera - - - - - - - - Plague - - - - - - - - Total ... 24 34 -10 4 5 7 4 4 The deaths from the notifiable diseases in previous years were—54 in 1908; 71 in 1907 ; 96 in 1906; 60 in 1905; 65 in 1904; 55 in 1903; 72 in 1902; 74 in 1901; 103 in 1900; and 104 in 1899. Only one death occurred from Puerperal Fever. This fact is the more gratifying, considering that a large number of our mothers are attended in their confinements by midwives. With the operation of the Act of 1902 the old order of ignorant midwife is passing away and the trained obstetric nurse is taking her place, with the result that lying-in-women are now and will be in future in safer hands. The deaths registered under the heading of "Accidents and Diseases of Parturition "are also less than in previous years, as are the cases of Puerperal Fever notified. 30 DISEASES NOTIFIED DURING THE YEAR 1910. Infectious Diseases Act, 1889. The following table shows the number of cases of the various diseases certified each month during the year:— TABLE XI.—Cases of Infectious Disease notified during the Year 1910. 1910. Notifications. Jan. Feb. Mar. Apl. May June July Aug. Sept Oct. Nov. Dec. Total. Deaths. Small-Pox Under 5 years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Over „ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Scarlet Fever Under 5 years 5 3 8 2 4 9 6 4 9 10 1 6 67 4 Over „ 8 17 16 14 14 12 10 9 24 24 11 6 165 0 Diphtheria Under 5 years 5 3 5 7 2 0 0 2 3 4 1 9 41 Under5, 5 Over 5, 8 Over „ 4 4 11 4 10 3 8 5 13 8 7 20 97 Membranous Croup Under 5 years 0 0 0 0 0 0 0 0 0 0 0 0 0 Over „ 0 0 0 0 0 0 0 0 0 0 0 0 0 Enteric Fever Under 5 years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Over „ 4 0 0 1 1 0 1 1 5 8 3 2 26 2 Continued Fever Under 5 vears 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Over „ 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Puerperal Fever Under 5 years 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Over „ 0 1 0 2 0 0 0 0 0 0 0 0 3 2 Erysipelas Under 5 years 1 0 1 0 0 1 0 0 0 2 1 0 6 0 Over „ 5 10 4 12 5 4 5 7 10 11 9 11 93 0 Totals Under 5 yrs. 114 32 38 45 42 36 29 30 28 64 67 33 54 498 34 Over „ 385 31 The following table shows the distribution of Infectious Cases according to Wards, and the increase or decrease compared with 1909:- TABLE XII.—Distribution of Infectious Diseases according to Wards. WARDS. Estimated Population. Small-Pox Scarlet Fever. Diphtheria. Croup. Erysipelas. Enteric Fever. Puerperal. Totals. Increase+or Decrease on last year. St. James Street 25,000 0 45 44 0 21 8 0 118 - 64 High Street 23,000 0 36 22 0 15 7 1 81 - 62 Hoe Street 25,000 0 51 21 0 20 4 1 97 - 40 Wood Street 18,500 0 21 7 0 13 2 1 44 - 27 Northern 40,500 0 79 44 0 30 5 0 158 -123 Registrar General. 1910 141,748 0 232 138 99 26 3 498 - 316 1909 136,602 0 506 183 112 13 0 814 -200 1908 131,486 0 635 233 0 111 37 8 1,014 -187 1907 126,397 0 815 251 6 105 21 3 1,201 - 52 1906 121,334 0 809 287 6 107 Con. 1 33 10 1,253 + 65 1905 117,500 0 756 254 4 122 50 2 1,188 + 213 1904 108,000 49 527 177 13 143 56 10 975 + 328 1903 106,290 2 292 147 5 117 88 6 647 -436 1902 101,000 146 560 142 8 131 89 7 1,083 - 55 1901 97,000 3 608 322 11 111 73 10 1,138 + 82 32 The following table is of interest to show the estimated Population, number of cases of Infectious Diseases notified, with Infectious Sickness Rate for the years since (he Notification Act came into operation. The estimated Population is that of the Registrar-General :— TABLE XIII.—Estimated Population, Number of Infectious Diseases notified, with "Infectious Sickness Rate" and the Mean for the Years under consideration. Years. Population. Scarlet Fever. Small Pox. Diphtheria. Croup. Typhus Fever. Typhoid Fever. Continued Fever. Erysipelas. Puerperal Fever. Totals. Infectious Sickness Rate. 1890 46,500 129 0 160 3 1 117 3 31 0 444 9.5 1891 47,000 125 0 153 9 0 59 4 44 3 397 8.4 1892 49,400 399 6 137 17 0 28 0 94 3 684 13.8 1893 52,000 597 8 142 11 0 60 4 134 5 961 18.5 1894 57,000 247 11 129 15 0 66 0 75 3 546 9.5 1895 61,000 263 1 198 10 0 95 6 85 4 664 10.8 1896 65,000 315 0 124 6 0 193 2 122 5 767 11.8 1897 70,000 492 0 152 6 0 88 0 78 7 823 11.7 1898 77,000 293 0 225 9 0 75 0 82 3 688 8.9 1899 83,000 332 0 338 7 0 118 1 112 5 913 11.0 1900 91,000 347 0 516 11 0 86 1 87 8 1056 11.6 1901 97,000 608 3 322 11 0 73 0 111 10 1138 11.7 1902 101,318 560 146 142 8 0 89 0 131 7 1083 10.68 1903 106,290 292 2 147 5 0 88 0 117 6 657 6.2 1904 111,282 527 49 179 13 0 56 0 143 10 975 8.76 1905 116,300 756 0 254 4 0 50 0 122 2 1188 10.2 1906 121,334 809 0 287 6 0 33 1 107 10 1253 10.3 1907 126,397 815 0 251 6 0 21 0 105 3 1201 9.5 1908 131,486 635 0 220 3 0 37 0 111 8 1014 7.7 1909 136,602 506 0 183 0 0 13 0 112 0 814 5.9 1910 146,923 232 0 138 0 0 27 0 99 3 499 3.4 Average for previous years 452 12 212 8 0 72 1 100 5 843 100 Extreme High't 815 146 516 17 1 193 6 143 10 1253 18.5 Lowest 125 0 124 0 0 13 0 31 0 397 5.9 33 INFECTIOUS DISEASES AND MEASURES TAKEN TO PREVENT THEIR SPREADING. During the year 498 cases of Infectious Disease were notified ; they represent 447 infected houses. Following upon notification each house invaded was visited, and enquiries made as to the probable sources of infection. This work was mainly entrusted to Miss Lamb, an experienced nurse, holding the Sanitary Institute's Certificate. Cases of Erysipelas were undertaken by the Male Inspectors, as was the subsequent examination of all the premises. All the Scarlet Fever and Diphtheria patients isolated at the Sanatorium were removed under the care of the Nurse, as were many of the Typhoids. Typhoid patients were mainly accommodated at the Whipps Cross lnfirmary, or at the local General Hospital. Cases of Erysipelas are seldom removed to Hospital, except by the Poor Law Authorities. Full instructions, verbally and in writing as to the precautions to be taken against the spreading of infection, are given to the persons in charge of home-nursed cases. This is supplemented by re-visits by Miss Lamb to ensure that the instructions given are carried out. Where necessary or desirable, Medical Officers of other districts are notified of the possibility of infection spreading through other members of the family. Children from infected homes and contacts are not permitted to attend the day or Sunday Schools for varying periods. The Superintendents of the latter invariably co-operate in this exclusion. At the beginning of each school term the Head Teachers were advised to examine the children for any signs of recent illness indicative of Scarlet Fever or Diphtheria, and all suspects were excluded until seen by me. Graphic records are kept to show the incidence of diseases at each school, and when necessary particular class-rooms are visited, and children with suspicious symptoms are excluded. Disinfection of the cloak-rooms of the Elementary Schools is carried out during the holidays and at other times if considered necessary. The provisions as to work in infected dwellings are enforced in accordance with Factory and Workshop Act of 1901. Following removal or recovery, disinfection was carried out by the Council's employees, under the supervision of Mr. West, and all infected clothing, bedding, etc., were treated by steam under pressure. C 34 Outfits for early Diphtheria and Typhoid diagnoses are kept at the Public Health Offices, and anti-diphthiretic serum may be obtained at all hours from the Fire Station and during the day from the Town Hall. The serum is supplied gratuitously to those unable to pay for its cost or administration. During the year 21 local practitioners were supplied with 155 bottles, and of these 11 were paid for. The Phthisis notifications received in pursuance of the Public Health (Tuberculosis) Regulations Order, 1908, were dealt with on the same lines as last year, and disinfection of the rooms occupied by deceased consumptives was carried out whenever the consent of the householder could be obtained. This was effected in 58 instances. The non-notifiable diseases of Measles and Whooping Cough are dealt with by exclusion from the Infants' Schools of all contacts, and from the Senior Schools, of children from infected houses if the children have not already had the disease, or if the sufferers are not properly isolated. 35 The following table shows Infectious Diseases according to Wards, and the number removed to Hospital:— TABLE XIV.—Cases of Infectious Disease notified during the Year 1910. Name of District—Walthamstow. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in Each Locality. No. of Cases Removed to Hospital from Each Locality. Total Cases Removed to Hospital. At all Ages. At Ages—Years. St. James Street. High Street. Hoe Street. Wood Street. Northern. St. James Street. High Street. Hoe Street. Wood Street. Northern. Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards Small Pox - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - Diphtheria(including 138 - 40 83 6 8 1 44 22 21 7 44 34 15 20 6 36 111 Erysipeals 99 5 2 9 13 60 10 22 15 19 15 28 2 - 2 - 4 8 Scarlet Fever 232 4 63 141 20 4 — 45 37 49 22 79 38 33 44 17 57 189 Typhus Fever - - - - - - - - - - - - - - - - - - Enteric Fever 26 - — 10 8 8 — 8 7 4 2 5 6 5 3 1 4 19 Relapsing Fever - - - - - - - - - - - - - - - - - — Continued Fever - - - - - - - - - - - - - - - - - — Puerperal Fever 3 - — — 2 1 — — 1 1 1 — — 1 — — — 1 Plague - - - - - - - - - - - - - - - - - — Totals 498 9 105 243 49 81 11 119 82 94 47 156 80 54 69 24 101 328 Isolation Hospital—Walthamstow Sanatorium, Chingford. Total available beds—93. Number of Diseases that can be concurrently treated—4 at least. 36 SMALL POX. In a neighbouring district two persons were known to have been suffering from this disease, and three in London in the first quarter of the year, as were two in London in the second quarter. Owing to the system of voluntary notification, one to the other, by Medical Officers of Health, your authority was made aware of the facts and enabled to take the necessary precautions in so far as contacts were known. No case has arisen here since 1904. The agreement with the West Ham Corporation for the reception and treatment of all our Small Pox patients is still in operation, and were the disease to occur in our midst I fail to see how it could spread to any great extent provided every sufferer was known to your officials. Persons so suffering would gladly be removed to the Small Pox Hospital, and the housing conditions of our people are not those usually associated with the spreading of the disease. Were London generally to suffer then we should also, owing to the numbers of our people who would be exposed to infection, but no precautions on our part could prevent that and the remedy suggested by the majority of the medical profession should not be neglected. Personally, I believe that vaccination, if not an absolute preventative for all persons, is a perfectly safe operation and a precautionary measure that all of us should take whenever Small Pox is rife in the metropolis. SCARLET FEVER. Two hundred and thirty-two cases of this disease were notified in 1910, compared with 506 in 1909; 635 in 1908; 815 in 1907 ; 809 in 1906 and 756 in 1905. Since the Notification of Diseases Act came into operation in 1889, our freedom from Scarlet Fever was never so marked, and the total deaths from this disease were four, showing a case mortality of less than 2 per cent. and a death-rate of .03 per 1,000 of the population. Nearly 90 per cent. of those attacked were under 15 years of age and three of the four deaths were in children under five. The number of cases occurring in each Ward is given on page 35. The attack rate for the district was 1.7. The incidence in each Ward varied from 1.1 in Wood Street to 19 in Hoe Street and the Northern Wards. St. James Street and High Street had a rate of 1.8 and 1.6 respectively. 37 No death from this disease took place in Wood Street, but the other Wards had one each and the type of disease in all the Wards was mild. Of the 232 cases notified, 189 or 81 per cent. were removed to hospital. The number of cases removed from each Ward for 1910 and previous years with percentages of the total may be seen from the following:— St. James St. High St. Hoe St. Wood St. Northern. 1910 38 33 44 17 57 and for previous years— 1909 97 53 48 32 134 1908 78 55 83 26 168 1907 83 86 61 83 118 1906 57 65 50 73 68 1905 50 70 44 31 62 1904 50 36 50 37 30 1903 59 63 53 67 45 Per cent. removed— 1905 33 31 33 38 33 1906 41.6 37.5 38.4 42.2 34.7 1907 56 58 38 67 47 1908 68.4 78.5 63 42.5 65 1909 83 80 60 69 69 1910 84 90 90 77 72 DIPHTHERIA—MEMBRANOUS CROUP. During the year 138 cases of this disease were notified compared with 183 in 1909, 223 in 1908 and 251 in 1907. One hundred and eleven of the cases (80 per cent. of the total) were removed to Hospital. No undue incidence was apparent in any particular period of the year, the cases varying from two in June to 1.5 in September, with a maximum of 25 in December. The attack rate for the whole district was under one and the deathrate .1 per 1,000 of the estimated population, but as in previous years the Wards were affected differently. 38 The following tabular statement gives the necessary facts. St. James Street. High Street. Hoe Street. Wood Street. Northern. No. Notified 44 22 21 7 44 No. of Deaths 3 3 4 2 3 No. removed to Hospital 34 15 20 6 36 No. of Deaths in Hospital 3 1 3 1 2 Death-rate per cent. of those removed to Hospital 8.8 6.6 15. 16.6 5.5 No. remaining at home 10 7 1 1 8 No. of Deaths 1 1 0 0 1 Death-rate per cent. of those remaining at home 10 14 0 0 12.5 The freedom of Wood Street Ward from this disease is very noticeable and the comparatively large number of cases in St. James Street as compared with High Street and Hoe Street and the Northern Ward with nearly double the population, is evidence that the adverse conditions commented upon in previous reports and referred to on page 19, operate largely in promoting a high Diphtheria incidence. The influence of age upon the resulting mortality from Diphtheria may be appreciated by stating that seven deaths occurred among 40 sufferers under five years of age, eight deaths among 83 others between five and fifteen years, while no death occurred among the remaining fifteen over that age, that is, the death-rate in children under five is twice as great as that between five and fifteen, and over that age the prospects of recovery are quite good. The necessity for the early treatment of Diphtheria in children has been pointed out in previous reports and its insidious mode of onset referred to. The offer to provide serum gratuitously for injection in doubtful cases with the payment of a fee for provisional notification has not been availed of to any extent. During the year three provisional certificates were received. An order was issued in August by the Local Government Board, sanctioning the provision by urban authorities of a temporary supply of antitoxin serum. The order has been anticipated by you for at least ten years and happily the expense incurred has never been questioned. In a circular accompanying the order, the Board suggests that in notifying practitioners of your willingness to supply serum free, emphasis should be laid on the importance of prompt treatment by antitoxin of those attacked by Diphtheria or exposed to the infection of the disease. 39 Within six months of the issue of the order, Dr. Goodall, Superintendent of one of the Metropolitan Asylums Board's Hospitals, while making it quite clear that he was most firmly convinced of the value of antitoxin in the treatment of Diphtheria was equally strong in his aversion to its use as a prophylactic, and quite frankly stated that an indiscriminate use of serum as a prophylactic or preventative, is not only unnecessary but unjustifiable. That the general practitioner, and those to whom the carrying out of the order is entrusted can steer a safe course with such diverging opinion from experts seems impossible, but it is well that all agree as to the great value of antitoxin serum for curative purposes, while we are left to recognise that there is little room for dogma in medical science. The following figures taken from the Registrar-General's Quarterly Returns are of interest to show our position in reference to Scarlet Fever and Diphtheria, as compared with our immediate neighbours:— Population. No. Notified. Deaths. S.F. Diph. S.F. Diph. Tottenham 132,803 283 90 4 13 West Ham 328,585 993 357 19 49 East Ham 156,208 329 145 4 13 Leyton 133,436 553 164 16 20 Walthamstow 141,748 234 139 4 14 The following table will be of interest as showing the drainage and other defects in houses in which cases of infectious diseases occurred, and will help to show their relationship:— Total No. Notified. Disease. No. of Houses Invaded. No. showing defects as to:— Dirty Condition of the House. Percentage showing defects in:— Dirty Condition of Prem's. Drains. Traps, Fittings. etc. Drains. Sanitary Fittings. etc. 138 Diphtheria 132 7 33 24 5.3 25.0 18.2 99 Erysipelas 99 1 9 24 1.0 8.9 24.2 26 Typhoid Fever 22 3 6 6 13.6 27.2 27.2 3 Puerperal Fever 3 — — 1 — — 33.3 232 Scarlet Fever 191 13 36 58 6.8 18.8 30.3 498 447 24 84 113 40 The following table shows the estimated population, the number of cases of Diphtheria and Membranous Croup, the attack rate since 1890, and the death-rate since 1898. TABLE XV. Years. Population. Number of Diphtheria cases. Rate per 1,000. Membranous Croup cases. Diphtheria and Croup Death-rate per 1,000 population. 1890 46,500 129 2.5 3 — 1891 47,000 153 3.22 9 — 1892 49,400 137 2.77 17 - 1893 52,000 142 2.73 11 — 1894 57,000 129 2.26 15 — 1895 61,000 198 3.24 10 — 1896 65,000 124 1.9 6 — 1897 70,000 152 2.17 6 — 1898 77,000 225 2.9 9 .59 1899 83,000 338 4.0 7 .88 1900 91,000 516 5.6 11 .86 1901 97,000 322 3.4 11 .39 1902 101,318 142 1.40 8 .20 1903 106,290 147 1.38 5 .16 1904 111,282 177 1.59 13 .26 1905 116,300 254 2.18 4 .24 1906 121,500 287 2.3 6 .44 1907 126,397 251 2.0 6 .27 1908 131,486 220 1.6 3 .15 1909 136,602 182 1.3 0 .10 1910 146,923 138 0.93 0 .10 41 ISOLATION HOSPITAL. In last year's report I pointed out, that owing to the large capital expenditure involved and the heavy yearly expenditure—over £6,000— incurred in the maintenance and upkeep of the Sanatorium, further extension, under present conditions, was not necessary. I pointed out the difficulties experienced in the control of such a disease as Scarlet Fever, whose very mildness in some cases lead parents to ignore and the doctor to doubt its existence. I showed how it is not yet satisfactorily explained why it should occur at one time in an epidemic form and at another fails to spread even amongst the most susceptible persons—the general conditions being apparently alike—and I urged that to minimise the volume of Scarlet Fever infection what is needed is a strict supervision of our school children, the co-operation of the parents and teachers and a reasonable number of beds for first cases, rather than the provision of a large hospital with beds for every possible case that may arise. This view met with your approval. During the past year the number of cases of Scarlet Fever and Diphtheria were practically fewer than in any previous year, and this satisfactory record is no doubt largely due to the willing and intelligent co-operation of the teachers and the attendance officers with those to whom the public health work of the town is entrusted. As a result the Hospital accommodation was far beyond what was needed, and during several months of the year more than two pavilions were empty. The possibility of using the vacant beds for other purposes was discussed, but the risk was too great to assume that the favourable conditions of 1910 would be permanent, or that with a constant population of 26,000 school children, 30 per cent. of whom migrate yearly from and to other districts, our present Hospital accommodation could be curtailed. The report of the Resident Medical Officer will be read with interest, showing as it does the advantages and necessity of our Cubicle Block, and what an important part it plays in the efficient and economical management of the Hospital. We have now had five years' experience of the treatment of patients suffering from Scarlet Fever, Diphtheria, Measles, Whooping Cough and Chicken Pox, placed side by side and under the same roof, the same nurses and doctor in attendance, and in not a single instance has infection been conveyed from one patient to another. 42 SANATORIUM REPORT, 1910. ADMISSIONS, DISCHARGES, DEATHS. Scarlet Fever. Diphtheria. Diphth'a & W'ping Cgh. Total. Remaining on Dec. 31st, 1909 44 6 - 50 Admitted during 1910 193 111 1 305 Total 237 117 1 355 Discharged during 1910 221 83 - 304 Died during 1910 4 10 1 15 Remaining on Dec. 31st, 1910 11 24 — 35 The patients are entered in the above table and also in the following two tables, according to the disease notified from the Town Hall. The case of mixed infection, notified Diphtheria, and Whooping Cough were admitted from Leyton; it was at once isolated in the cubicles, so did not become source of infection to others. In some cases additional information was gained by the ambulance nurse regarding doubtful cases, or cases exposed to mixed infection, and these cases were also always isolated in the cubicles. One of the Diphtheria cases was admitted from Edmonton. The case above mentioned of Diphtheria and Whooping Cough was admitted from Leyton. One Diphtheria case was admitted from West Ham. Five Scarlet Fever cases were admitted from Loughton. One Scarlet Fever case was admitted from West Ham. AGES OF PATIENTS ADMITTED. Scarlet Fever. Under 5 years. From 5 to 10 years. From 10 to 15 years. 15 years and upwards. Total of Total. M F M F M F M F M F January 2 2 1 4 2 1 1 — 6 7 13 February 1 — 3 6 1 2 — 4 5 12 17 March 3 4 5 4 — 1 — 1 8 10 18 April — — 2 4 4 3 2 2 8 9 17 May 2 2 5 3 — 1 1 — 8 6 14 June 3 4 3 5 1 2 — — 7 12 18 July 2 4 4 3 1 1 1 — 8 8 16 August 3 1 5 — 2 2 1 1 — — 15 September 2 4 6 7 2 3 — — — — 24 October 4 4 6 6 1 1 1 1 12 12 24 November — — 3 5 2 — — — — — 10 December 2 2 1 1 — 1 — — 3 4 7 Total 23 27 44 48 16 18 7 9 65 80 193 50 (26.4%) 92 (47.6%) 34 (17.6%) 16 (8.2%) 145, 75.1% 43 AGES OF PATIENTS ADMITTED.—DIPHTHERIA. Under 5 years. From 5 to 10 years. From 10 to 15 years. 15 years and upwards. Total of Total. M F M F M F M F M F January 1 3 — 3 - - - - 1 6 7 February 2 1 — 2 1 — — — 3 3 6 March 4 2 3 2 — 1 1 1 8 6 14 April 4 2 - 2 - - - - 4 4 8 May — 1 1 4 — — — 1 1 6 7 June - - 2 - - - - - 2 - 2 July — — 3 — — 3 — 1 3 4 7 August 1 1 2 1 - - - - 3 2 5 September — 4 4 7 1 — — 1 5 12 17 October 4 — — 1 — 1 — 1 4 3 7 November 1 - 2 2 - - - 1 3 3 6 December 6 2 5 10 1 1 — 1 12 10 26 Total 23 16 22 34 3 6 1 7 49 59 112 39 (34.8%) 56 (50%) 9 (8.0%) 8 (7.1%) 108, 96.4% DEATHS. Disease. Under 5 years. From 5 to 10 years. From 10 to 15 years. 15 years and upwards. Total of Total. M F M F M F M F M F Diphtheria* 2 3 1 3 1 — — 1* 4 7 11 Scarlet Fev. 1 3 - - - - - - 1 3 4 Total 3 6 1 3 1 — — 1 5 10 15 9 4 1 1 15 * In case of one patient who was notified as Diphtheria, Lobar Pneumonia only was the cause of death. One of these deaths, due to Diphtheria, was that of a patient from Leyton—a case of mixed infection—notified Diphtheria and Whooping Cough; on admission there was also the complication of bronchopneumonia. Of the deaths due to Scarlet Fever, one was a case of mixed infection—Scarlet Fever and Measles—Measles Rash developed on third day after admission, and Broncho-Pneumonia followed. The average daily number of patients in Hospital was as follows:— January 44.41 February 42.21 March 41.54 April 44.60 May 35.96 44 June 25.46 July 32.38 August 31.06 September 29.70 October 49.45 November 38.36 December 24.80 Complications of Scarlet Fever:— Acute Nephritis 2 Adenitis 3 Adenitis (suppurative) 1 Albuminuria 2 Angina (late) 5 Arthritis 4 Bronchitis 2 Broncho-Pneumonia 1 Corneal ulcer 1 Endocarditis 1 Ear discharge (Otorrhœa) 14 Mastoid abscess 1 Meningitis 1 Nasal discharge 5 Relapse 4 Three patients notified as Scarlet Fever were also suffering from Diphtheria. One Scarlet Fever patient developed Measles Rash third day after admission, and Broncho-Pneumonia supervened. All these mixed cases were isolated in the cubicles, and no cases of infection followed. Complications of Diphtheria:— No. of Cases. Antitoxin rash 9 Anthritis accompanying rash 5 Albuminuria 10 Adenitis 9 Bronchitis 1 Cardiac complications 11 Diphtheritic paralysis 8 Ear discharge (Otorrhœa) 2 Epistaxis 5 (In one case very severe). Laryngeal cases 3 Nasal discharge 16 (One had extensive membrane in nasal passages). Recrudescence of Sore Throat 3 45 Four cases, notified Diphtheria, were suffering from Scarlet Fever only; these were isolated in cubicles, and no case of infection from them occurred. There were only three larygeal cases admitted during the year; they all recovered; none required tracheotomy. Over 470 bacteriological examinations from throats and noses were made during the year. Of the Diphtheria cases sent into Hospital, some which were undoubtedly Diphtheria failed to give bacteriological evidence of the disease. A slight outbreak of Chicken Pox occurred during the latter part of the summer; five patients in the Convalescent Scarlet Fever Block were affected. In December, three cases of German Measles occurred in the Diphtheria Block. Both of these groups of cases were isolated in the cubicles, and no other cases followed. During the summer one of the staff—a new probationer—contracted Scarlet Fever in a mild form; she was isolated for six weeks. The other cases of illness which have occurred amongst the staff have been few and slight; in only one of these cases did absence from duty extend to a fortnight. No other cases of infection amongst the patients or staff have occurred during the past year. TYPHOID FEVER. Twenty-six persons were notified as suffering from this disease in 1910. The number is smaller than in any previous year, 1909 and 1907 excepted, and considerably below the average (54) for previous ten years. Three of the cases were discovered by me, and were contacts from a previous case nursed at home. They were under treatment for Catarrh of Stomach, Influenza and Rheumatism respectively for some weeks previously. I reported the circumstances to the Public Health Committee, but the explanation for non-notification was accepted and no legal action was taken under the Act of 1889. The history of two cases arising in one house was as follows:— H. C., a male, aged 17 years, attended the local hospital for three weeks and was then admitted. 46 Four days subsequent to his discharge a brother, aged 13, fell sick and was removed to Whipps Cross Infirmary, and was within three days notified as suffering from Typhoid. There were nine inmates in the house and no other case arose. In September, E.P., male, aged 46, was nursed at home. No history was obtained as to how infection was contracted, but most probably it was from without the district. Within a month a son, aged 19, contracted the disease and was removed to hospital, the remaining three inmates escaping. One case notified on the 1st September was visited by his doctor on the following day, and the information given to the Inspector was that the patient was told that he had not had Typhoid, and that his illness was due to eating "tainted fish," and the man went to work within a week. I visited the home and was satisfied that in notifying the error was on the safe side and no disinfection was carried out, nor did any subsequent trouble arise. E. B., a female, aged 1410/12 years, was notified on the 30th of May— four weeks subsequent to first onset of illness—and died the next day. The notification was not withdrawn, but the death certificate given after a post-mortem was Endocarditis. The patient, M. C., female, aged 46 years, was notified on the 25th of April, eight days after onset of illness, and was removed to Whipps Cross Infirmary on the 27th, the premises were disinfected on the 28th. Upon subsequent enquiry I was told the illness was probably Pneumonia. H. L., aged 12 years, a male, was treated for Aæmia for two weeks prior to removal to West Ham Infirmary, and was in that Institution for two more weeks when notified as Typhoid. Careful investigation was made into every case as to the probable source of infection, but the alleged causes cannot be accepted as the true ones. Excluding the contacts and those diagnosed differently subsequent to notification, eating cockles and mussels may account for one and four respectively. One of the four who ate uncooked mussels died. Two of the seven home nursed cases also died, all the others recovered. The invaded premises revealed defective drains in three instances, and defective sanitary fittings in six; there were five of the houses dirty, and in four were uncovered water drinking cisterns. There can be no doubt there was no common origin in the great majority of cases, and drinking water has played a negligible part. Dirty premises in so far as they imply dirty habits of the inmates may be credited with the responsibility they deserve. 47 The distribution of cases as to Wards was as follows:— Wards :—St. James St. High St. Hoe St. Wood St. Northern. 8 7 4 3 5 And removals to Hospital were— 6 5 3 1 4 And the deaths occurring were— 0 0 110 The death from Endocarditis is not given, so that the death-rate for Typhoid was .01 per 1,000, similar to that of 1909 and compares very favourably with .05 for the 77 "Great Towns." SUMMER DIARRHŒA—EPIDEMIC OR ZYMOTIC ENTERITIS. During the year eight deaths were registered as due to Diarrhœa, two from Zymotic Enteritis, 20 from Enteritis and one from Gastro-Enteritis, or a total of 31 deaths from diseases whose prominent symptoms are Diarrhœa. All these deaths are grouped together as in previous years, and compare favourably with 31 in 1909, 67 in 1908, 178 in 1906, and 73 in 1905. The deaths from Summer Diarrhœa, or Zymotic Enteritis are of Public Health interest, from the belief that, occurring mainly in handfed children under one year of age, and under certain climatic and sanitary conditions, they are largely preventable. From the table of deaths, facing page 27, it will be noticed that 9 deaths can strictly be reckoned as due to Summer Diarrhoea, and that 12 of the deaths from Enteritis might also be due to preventable causes. Enteritis is a disease which mainly affects infants, and though more frequent in the summer months, is quite common at other periods of the year, more especially as a sequel to such diseases as Measles. It is quite likely then that seven of the deaths over one year of age under opposite conditions may be really due to a cause not at all mentioned in the death certificate, and thus the total possible preventable deaths may not have exceeded 22 at most. These numbers in a year with a cold and wet summer may readily become augmented five or ten fold under the opposite conditions of great heat and absence of rain, and all measures counteracting these unfavourable factors are worthy of our attention. I have so fully dealt with Summer Diarrhoea in young children in previous reports that to most of you its causes and remedies are well known. The importance of the subject is my excuse for repeating that the two main factors in its production are excessive summer heat and the improper feeding of infants. The first is unavoidable but the experience of Brighton and elsewhere as to feeding, may again with advantage be reproduced. 48 "It is twice as dangerous to feed babies on condensed milk as on fresh cows milk; it is 40 times as dangerous to feed a baby on cows milk and 70 times as dangerous to feed a baby on condensed milk as on mother's milk." The great danger to infant life from hand feeding is due to ignorance and inexperience on the part of the mothers, insanitary conditions within and around the home, and domestic uncleanliness. When these are in association with an unclean milk supply the life of the hand-fed baby is always in serious danger. What I said in 1907 is equally applicable in 1910. The importance of a clean milk supply for the food of children is all important, and the recent Notification of Births Act, if adopted, will give ample opportunity of imparting to those in need of it, a knowledge of healthy infant rearing. If a crusade against ignorance, dirt, want of fresh air. and unhealthy conditions generally in and about the house, can be organised through its adoption, the wastage of child life from Diarrhœal diseases will soon cease. Our death-rate from Diarrhœa is similar to that of 1909, .22 per 1,000 against .5 for 1908, 1.04 in 1906, and .67 in 1905. The corresponding rate in 1910 for the large towns was .38. MEASLES AND WHOOPING COUGH. There were 30 deaths registered during the year from Measles and 32 from Whooping Cough. The deaths were fewer than in 1907, but as in previous years, they were actually more than those from all the other Zymotic diseases combined. Sixteen of the deaths from Measles, and 31 of those from Whooping Cough were in children under five years of age and account for onefourth of all the deaths occurring at this age period. Unfortunately neither disease is looked upon by parents or the public as a dangerous infectious one. Parents assume they are inevitable and the public seem unwilling to incur any great expenditure in a serious effort to lessen their mortality while enormous sums are spent yearly in the isolation and hospital treatment of such a disease as Scarlet Fever, whose mortality is a negligible one compared with that of Measles. Excluding the years 1907 and 1909, the deaths from Whooping Cough have been pretty uniform during the past twenty years and averaged about thirty yearly. Measles caused 87 deaths in 1895, and 52 and 55 deaths in 1903 and 1904, the remaining 17 years showed an alternate rise and fall with an average mortality of thirty. 49 The two diseases therefore, are responsible for about one-twentieth of the total mortality and instead of being of little importance, they are the most serious and fatal of all the diseases of children between one and five years of age. In former reports I have pointed out that the measures possible against Measles and Whooping Cough are dissimilar to those undertaken on behalf of the so-called dangerous infectious diseases, and we rely upon exclusion from our infants scnools of sufferers and contacts, with occasional visiting to homes affected, and the distribution of leaflets of advice. Much more might be done with a larger staff of health visitors. Deaths from these diseases occur principally among the children of the poor owing to want of early treatment and a correct appreciation on the part of the parents of the seriousness of the diseases. Were first cases immediately dealt with, and home visits made and appropriate advice given to our poorest people, many lives could be saved. The death-rate from Measles was .14, and that from Whooping Cough was .22 per 1,000 of the population, the rate for each being considerably less than that for the "Great Towns." The deaths from Measles and Whooping Cough for the past 22 years may be seen from the following chart. D 50 Deaths from Measles and Whooping Cough, 1889-1910. The straight lines indicate Measles. The dotted lines indicate Whooping Cough. 51 The following figures are from those weekly supplied by the Education Committee's Superintendent of Attendance Officers, and show the number of children absent from school during the year, owing to Measles and Whooping Cough:— TABLE XVI. Sickness Return, from January, 1910, to December, 1910. Month Ending Measles. Whooping Cough. Total. January 18 405 423 February 114 479 593 March 335 465 800 April (Easter Holiday—1 week) 533 422 955 May (Whitsun Holiday—1 week) 573 226 779 June 626 145 771 July 525 152 677 August - - - (Midsummer Holiday—4 weeks) September 41 21 62 October 13 9 22 November 20 53 73 December (Christmas Holiday—2 weeks) 49 130 179 Total 2,847 2,507 5,354 The numbers for each month are the sum of the weekly returns, and therefore represent nearly four-fold the actual number affected. INFLUENZA. This disease was at no time of the year epidemic. As in previous years, in association with Bronchitis and Pneumonia in elderly people, it is a dangerous affection, and was the cause of 10 deaths. PUERPERAL FEVER. One death was registered from this disease, and in "The Table of Deaths" one also is given as due to "Accidents and Diseases of Parturition." The number of deaths attributable in any way to the lying-in state is very small, as was the number of women notified as suffering from Puerperal Fever. In fact the year was among the best on record, and considering that the home conditions of many of our poorer women are far from predisposing to safety, the result is remarkable. 52 This may in part be attributed to the work undertaken by the Essex Cottage Nursing Home, the Maternity Clubs associated with the Churches,.and to the effective supervision exercised by the County Authority in the administration of the Midwives' Act of 1902. The bad results of unskilled attendance upon lying-in women do not always show themselves in deaths from Puerperal Fever, and in spite of our favourable record for the year, for other reasons as well as for the safety of the mother, women during and shortly before and after confinement should be under the supervision of a doctor. Very few persons who train as midwives have the requisite skill or knowledge to undertake alone with safety the care of lying-in women, and more particularly the care of the new-born infant. The care of the latter requires great skill and knowledge, but unfortunately this is not always recognised, aud the consequences of certain affections, such as Ophthalmia Neonatorum, when unrecognised or improperly treated, are disastrous. It is asserted that 10 per cent. of all cases of blindness in the adult is the result of Ophthalmia in infancy, and the British Medical Journal has pointed out that the malign influence of this disease is not one whit less grave in its social effects than that of many of the maladies now included in the list of notifiable infectious diseases. As the tendency is for women to undertake midwifery without any supervision by a doctor, I would advise that Ophthalmia Neonatorum be added to those diseases already scheduled under the Notification Act of 1889. PHTHISIS OR CONSUMPTION. The deaths registered from this disease were 88, compared with 108 in 1909, 103 in 1908, 101 in 1907, 123 in 1906, 93 in 1905, and 96 in 1904. Twenty-four deaths were registered from Tuberculosis of Meninges, and 16 from other forms of the disease. The total deaths from Tuberculosis are, therefore, fewer by 14 than in 1909, and represent a death-rate of .9 per 1,000 of the population, or 11 per cent. of the total deaths. Assuming that these deaths and a third of those under 1 year of age are preventable under ideal conditions and were non-existent, our deathrate would be reduced to less than 7. That such a possibility is quite true, shows how much preventive work still lies within your power. A copy of the Memorandum by the Medical Officer of the Local Government Board on the Administrative Measures suggested to be taken against Tuberculosis in pursuance of the Public Health (Tuberculosis) 58 Regulation Order of 1908, was sent to all the resident practitioners in 1909. Apart from the Poor Law Medical Officers, who are under an obligation to notify cases of Phthisis among their Poor Law patients, only two notifications were received from private practitioners. The minimum number of Phthisical patients here may be reckoned at 350, and the total notifications received under the Order were 116. Thirty-one of these were from the three District Medical Officers, 66 from the Infirmary, 5 from the Workhouse, and 6 from the Medical Officers of other Unions. Sixty-three of the notifications were for persons coming for the first time under the notice of the medical officers, the remaining 53 were notified previously some as many as six times. On several occasions the consumptives gave wrong addresses when taking their discharge from the Infirmary, and judging by the time elapsing between notification and death in many instances, the Order has been largely honoured in its breach as well as in its observance. One notification arrived five days after, and six others one day before, the death of the patients. The class of persons dealt with by the Order may largely account for this, as well as for the repeated notifications already referred to. Apart from the friendly supervision exercised over the sufferers, and the educational value of the visits to those in charge of them, the subsequent disinfection of the premises must be of material use in checking the spread of the disease. Were notification of all cases of Consumption in force, I doubt if any real good effects would follow, unless adequate hospital provision was made for the treatment of early curable cases and for the isolation of advanced incurable ones. Among those whom I visited during the year was a man in the last stages of Phthisis, whose expectoration was most copious and offensive, and under the conditions of his existence no proper care was taken as to its disposal. He lived by day with his wife—who had a baby under a year old— and the other members of his family in a common room, without a window or door open, the air in the place being foetid and heated to an unbearable degree. The Health Visitor could effect no improvement by advice, and I was not surprised. Could one expect that a man "on the Parish," with wife and children in need of the necessaries of life and devoid of every comfort except that of a warm fire, would accept advice and appreciate the dangers run by those around him ? In September last, following the opening of the "Alfred Boyd Memorial Sanatorium" at Little Baddow, an influential meeting of Essex Citizens including representatives of Sanitary Authorities throughout 54 the County, was held at the Shire Hall, Chelmsford, to discuss ways and means for effecting "the conquest of Consumption throughout the County." An Association was subsequently formed, and the Lord Lieutenant of the County appealed for subscriptions to establish one or more central hospitals for dealing with Consumptives in the early stages and for the provision of "Lyster Shelters," which could be lent to patients for erection on ground at or near their own homes. The movement so far as I can gather from the Press has not yet had the financial support that it deserves, although designed as a memorial to our late King. It appeals to me that the provision of hospitals and shelters should be the duty of Sanitary Authorities, and to encourage them to undertake that duty, the County Council should contribute under the Isolation Hospitals Act; the funds from voluntary subscriptions being more usefully spent in assisting the families of consumptives while under treatment. Once adequate provision was made for the treatment of the disease, sufferers in the early stages would soon apply, particularly as those depending on them would be looked after, and within ten years Phthisis would become a rare disease. The West Ham Infirmary utilizes about one hundred beds for this disease. No other provision is made here. Diseases of the Respiratory Organs other than Phthisis.—These caused 233 deaths, as in 1909, compared with 213 in 1908, 299 in 1907, 208 in 1906, and 236 in 1905. OTHER DISEASES. Erysipelas.—Two deaths were registered from this cause, but 24 others were due to "other septic diseases." The deaths from Erysipelas are yearly a negligible quantity, and there seems no legitimate reason for classing it as a dangerous infectious disease, judging by the rarity with which a second case in the same house arises. Cancer. —Seventy-four deaths were returned as due as to this disease, as against 61 in 1909, 94 in 1908, and 75 in 1907. Twentythree of the deaths were in persons of 65 years of age. Alcoholism—Cirrhosis of the Liver. Ten deaths were attributed to Cirrhosis, and five to Alcoholism. The latter can hardly be looked upon as an expression of the facts as known by every-day experience, and must be accepted cum grano salis. Death certificates are seldom given with any idea of the part they play in directing public attention to social evils. 55 WATER SUPPLY. The whole district is served by the Metropolitan Water Board. The supply is constant and good ; no complaints have been received from householders, and no analyses have been made, as no occasion for the latter arose during the year. Particular attention has been paid by the Sanitary Inspector to water cisterns improperly kept, and during the year 352 of these have been dealt with in conformity with the Public Health Act of 1907. The Public Baths have been freely used by the Education Authority as in previous years, for the teaching of swimming to the boys and girls of our elementary schools. During the year there were 114,203 bathers, made up as to 77,689 men, 16,963 women, 11,770 boys, and 7,781 girls. COWSHEDS, MILKSHOPS, AND DAIRIES. During the year, in company with the Veterinary Surgeon and Sanitary Inspector, I twice visited all the cowsheds. There were 12 registered cowsheds, stabling 237 cows at my last visit. A marked improvement in the cleanly condition of the sheds and cattle was noticeable ; but there is still much room for improvement. The new bye-laws came into operation on January 1st, 1911, and as a consequence of their anticipated effectiveness, one of the worst premises has been abandoned. Among the cows inspected, the Veterinary Surgeon certified that of five "in process of fattening," four had advanced tuberculosis of udder. These were in a separate byre on premises where over one hundred cows were kept. In two other small premises, stabling 15 cows, there were four with tubercular udders. These undesirables were kept under observation until removed, but their destination could not be ascertained. It is quite simple to order the removal of diseased cows, and to tell the cowkeeper that he must not mix with other milk or sell for human food, that of cows with tuberculous udders, but there the simplicity ends ; to ensure it requires the co-operation of the cowkeepers and the present Dairies, Cowsheds, and Milkshops Order should read that a registered cowkeeper must at once remove from his premises—intimating their destination—tubercular cows, or have his name struck off the Register. The total number of cows kept in the district cannot supply more than a tenth of the milk consumed, and it may be accepted from the known conditions here and elsewhere, that a clean milk supply is impossible. Cleanliness is largely a matter of opinion, and the standard of the majority of cowkeepers is not that of the Public Health Official. Patting it mildly, it is inadequate, and no real improvement can be effected until some reasonable legalised standard is made. What applies to the cowkeepers is equally applicable to the milksellers. 56 There are 199 of these registered, and their premises are under the constant supervision of the Inspectors. Mr. West tells me that the small milk retailer—the keeper of a general shop—is one of the most difficult persons to deal with. Why such a person, if he chooses to sell milk, must be registered by the Local Authority without any regard to the suitability of his premises, and then cast the onus upon the Authority of taking proceedings against him for not complying with the Regulations, which no reasonable person ever expected he could carry out, is a fine example of putting the cart before the horse. To get a conviction at the Police Court against such a person, however dirty and unsuitable the premises, is a remote contingency, and the most your officers can do is to keep pegging away and educating all engaged in the milk trade up to a standard more in consonance with modern views. SLAUGHTER- HOUSES. There are 15 slaughter-houses in the District—14 registered and 1 licensed. None of the premises conform to the requirements suggested by the Local Government Board—as to site and structure—for the granting of new licenses and humane slaughtering in most of them is impossible. In the premises most frequently used the animals are driven in, fastened to a stake and slaughtered in an old building, with the smoking carcases of the recently killed in full view. There are 98 butchers' shops, and these and other premises—such as fish shops, etc.—are regularly visited by the Inspectors. The slaughter-houses and other premises where food is prepared and sold are generally well kept as to cleanliness, and supervision as far as possible is strict and effective in the prevention of diseased or unsound food being sold. In the Sanitary Inspector's report will be found a list of articles seized and the proceedings taken during the year in connection with tubercular meat. HOUSING OF THE WORKING CLASSES. There are no registered lodging houses within the district. There is ample housing accommodation in all the Wards at rentals well within the means of the ordinary working classes. Rents run from five to ten shillings weekly, small self-contained flats being procurable for a less sum. The houses generally are modern, convenient, and well built. They have all been erected by private enterprise, under the supervision of the building inspectors, and the air space round the dwellings exceeds that provided for in the Model Bye-Laws of the Local Government Board. 57 No action was necessary to be taken under the Housing of the Working Classes Act, all the necessary work being effected under the Nuisance Sections of the Public Health Act. A considerable amount of improvement has been effected under the New Building Bye-Laws, which provide for paving around existing buildings and the improved appearance and sanitary conditions of the houses so dealt with is very noticeable. Although the district is quite modern, the Sanitary Inspector has plenty to do in keeping up to a decent standard the houses occupied by those devoid of house pride. There is but little overcrowding, and when found is usually readily remedied, as stated elsewhere. Nuisances are dealt with by the Inspector, and a summary of these, and the work done in connection with drainage defects, will be found in his report. OFFENSIVE TRADES. None of the six statutory ones are carried on in the District. There are premises in the semi-rural portion of the Northern Ward where the cooking of offal with the extraction of the fats is carried out in connection with the feeding of pigs. No complaints from householders or others have been received as to any nuisance arising therefrom. The premises are not connected with the public sewer, and the overflow from the cesspool, which passes into neigbouring ditches, and ultimately into the Dagenham Brook, was very foul on two occasions when I visited. The Lee Conservancy's Engineer visited the premises, and the owner has been fined £20 for polluting the Brook- a tributary of the Lee. Neither the brook or the peccant effluent comes in contact or could possibly pollute any water used for drinking purposes. Premises «jusdem generis with the Offensive Trades require a deal of supervision, and application has been made to the Local Government Board for an Order under Section 51 of the Public Health Acts Amendment Act, 1907, to declare as offensive trades, among others, fried fish frier, fish curer, rag and bone dealer, and marine store dealer. HOUSE REFUSE REMOVAL AND SCAVENGING. The work under these headings is carried out under the supervision of the Surveyor, and no complaints have been received. There is a bi-weekly collection of house refuse throughout the District, and in the shopping areas a tri-weekly one. Approximately, 58 16,073 tons of house and trade refuse was collected, and almost the whole of it was burnt in the Destructor without any nuisance. The roads have been well maintained, and the cleansing and lighting are satisfactory. SEWAGE DISPOSAL. No complaints have been received as to nuisance on the Farm, or arising from the tanks, or the effluent. At my visits none existed. The negotiations that have been undertaken in connection with the admission of the sewage of the district into the main drainage system of the Metropolis are likely to be soon successful and a long standing difficulty satisfactorily solved. The existing drainage and sewerage systems are satisfactory and no complaints have been received from householders. FACTORY AND WORKSHOP ACT, 1901. The following Table filled in for your district gives the information as required by the Home Office:— Factories, Workshops, Laundries, Workplaces and Homework. 1.—INSPECTION Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries.) 83 — — Workshops (Including Workshop Laundries.) 486 — - Workplaces (Other than Outworkers' premises included in Part 3 of this Report.) 349 - - Total 918 — — 59 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts Want of cleanliness 71 71 - - Want of ventilation 3 3 — — Overcrowding — — - — Want of drainage of floors — — — — Other nuisances 54 54 — — †Sanitary accommodations insufficient 2 2 — — unsuitable or defective 29 29 - - not separate for sexes — — — — Offetices under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report). - - - - Total 159 159 — — *Including those specified in Sections 2, 3. 7 and 8, of the Factory Act as remediable under the Public Health Acts. †For districts not in London state here whether Section 22 of the Public Health Acts Amendment Act, 1890, has been adopted by the District Council; and if so what standard of sufficiency and suitability of sanitary accommodation for persons employed in factories and workshops has been enforced. 60 3.—HOME WORK. NATURE OF WORK* Outworkers Lists, Section 107. Inspections of Outworkers premises. Outwork in Unwholesome Premises Section 108 Outwork in Infected Premises, Sections 109, 110. Lists received from Employers. Addresses of Outworkers.§ Notices served on Occupiers as to keeping or sending lists. Prosecutions. Sending twice in the Year. Sending once in the Year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (s. 110). Prosecutions (ss. 109, 110. Lists.† Outworkers,† Lists. Outworkers. Contractors. Workmen. Contractors. Workmen. Wearing Apparel— (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) (1) making, &c 16 ... 171 23 ... 145 962 59 ... ... ... 380 16 ... ... 2 ... ... (2) cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial Flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and Upholstery ... ... ... ... ... ... 6 ... ... ... ... 6 ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... 11 ... ... ... ... 11 ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c ... ... ... ... ... ... 16 ... ... ... ... 16 ... ... ... ... ... ... Carding, &c., of buttons, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper Bags and Boxes ... ... ... ... ... ... 23 1 ... ... ... 23 ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... ... ... ... 96 21 ... ... ... 96 ... ... ... ... ... ... Racquet and Tennis Balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed Toys ... ... ... ... ... ... 3 ... ... ... ... 3 ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Electro Plate ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and Chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and Grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart Gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, Latches and Keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 16 ... 171 25 ... 189 1117 81 ... ... ... 535 16 ... ... 3 ... ... *If an occupier gives out work of more than one of the classes specified in column 1, and subdivides his list in such a way as to show the number of workers in each class of work, the list should be included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers should be assigned in column 3 and 4 (or 6 and 7) into their respective classes. A footnote should be added to show that this has been done. †The figures required in columns 2, 3 and 4 are the total number of lists received from those employers who comply strictly with the statutory duty of sending two lists each year and of the entries of names of outworkers in those lists. The entries in column 2 must necessarily be even numbers, as there will be two lists for each employer—in some previous returns odd numbers have been inserted. The figures in columns 8 and 4 will usually be (approximately) double of the number of individual outworkers whose names are given, since in the February and August lists of the same employer the same outworker's name will often be repeated. §In view of the wide discrepancies found to exist between the totals in the two columns when the returns are added together, it is desired that care may be taken to give exact figures. Only those addresses should be counted which have actually been received from or forwarded to other Councils during the year covered by the report. 61 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of 1910. Number. Private Workshops 74 Outworkers' Workshops 73 Men's Workshops 74 Laundries 49 Domestic Workshops 162 Bakehouses 54 Total Number of Workshops on Register 486 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 25 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5). Notified by H.M. Inspector — Reports (of action taken) sent to H.M. Inspector - Other - Underground Bakehouses (s. 101):— Certificates granted during this year — In use at the end of 1910 6 Note.—The Factory and Workshop Act, 1901 (s. 132), requires the Medical Officer of Health in his Annual Report to the District Council to report specifically on the administration of that Act in workshops and workplaces, and to send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State (Home Office). If the Annual Report is presented otherwise than in print, it is unnecessary to include in the copy sent to the Home Office the portions which do not relate to factories, workshops, workplaces or homework. The duties of Local Authorities and the Medical Officer of Health under the Act of 1901 are detailed in the Home Office Memorandum of December, 1904. A further Memorandum, on the Home Work Provisions of the Factory Act, was issued to all District Councils and Medical Officers of Health in October, 1906. Sections 2, 3, 7 and 8 of the Act, dealing with cleanliness of premises, overcrowding, ventilation, want of drainage of floors (laundries), have received due attention and no prosecutions were necessary. 62 Factories.—Section 22 of the Public Health Amendment Act, 1890, is in force, and the provisions under it have been carried out. The standard laid down by the Home Office under Section 9 of the Factory and Workshops Act, as to efficiency and suitability of sanitary accommodation, has been adopted and its conditions complied with. Workshops.—These are systematically visited. Failure to affix " Abstract of Factory and Workshops Act" in 25 instances was due more to ignorance than evasion of the provisions of the Act. Notice to comply was at once carried out. Bakehouses.—There are 54 of these premises, six of which are underground, and the standard adopted in 1902 has been maintained. They are regularly visited to ensure that the regulations as to cleanliness and wholesome conditions are carried out. Laundries.—Those classified as Registered Workshops are supervised by the Woman Inspector. Outworkers' Premises.—These generally cause but little trouble. They consist mainly of one or two rooms of the dwelling house used as a workplace, and were generally found satisfactory. They are supervised by the Woman Inspector and any defects found or nuisances discovered are remedied in the usual way. Air Space.—No overcrowding was found Home Work.—Sections 107 to 115 give powers for the prevention of work in (a) unhealthy dwellings, (b) in premises where there is dangerous infectious disease. Under the latter heading in two instances the provisions of the Act were enforced. All the wearing apparel found on the premises was disinfected, and no further work carried out until the premises were disinfected. IMPROVEMENTS REQUIRED. 1. More Public Sanitary Conveniences. 2. Improved Disinfecting Station, and provision of Shelter in accordance with Section 15 of the Infectious Diseases (Prevention) Act, 1890. 3. An extra Health Visitor. 4. More suitable and increased Office accommodation. APPENDIX. Statistical Tables, 63-66. Local Government Board Forms:— Tables I., II., III., IV., V. Chart Showing Birth, Death and Zymotic Death-Rates since 1880. Chart of Infectious Disease Notified, 1909-10. 63 Local Government Board Form.] TABLE I.—For Whole District. Year. 1 Population estimated to Middle of each Year. 2 Births. Deaths under One Year of Age. Deaths at all Ages. Total. Deaths in Public Institutions W'stow General Hospital 9 Deaths of Non. Residents registerec in District. 10 Deaths of Residents registerec beyond District. 11 Deaths at all Ages. Nett. Number. 3 Rate.* 4 Number. 5 Rate per 1,000 Births registered. 6 Number 7 Rate.* 8 Number 12 Rate.* 13 1897. 70,000 2246 32.08 306 132.0 795 11.41 28 4 37 832 11.88 1898. 77,000 2294 29.80 390 169.5 974 12.65 16 15 60 1034 13.4 1899. 83,000 2835 34.14 482 170.0 1220 14.70 28 8 62 1282 15.44 1900. 91,000 3037 33.37 482 158.7 1166 12.80 23 13 88 1254 13.78 1901. 97,000 3210 33.10 473 147.6 1191 12.27 42 4 114 1296 13.35 1902. 101,318 3426 33.81 394 115.0 1009 9.95 28 8 153 1154 11.38 1903. 106 290 3535 33.25 402 113.7 1065 10.19 39 10 123 1178 11.08 1904. 111,282 3649 32.79 496 135.9 1175 10.55 38 13 168 1330 11.95 1905. 116,300 3389 29.14 354 104.4 1046 8.9 33 16 219 1249 10.7 1906. 121,334 3594 29.60 466 129.7 1206 9.9 35 10 251 1447 11.9 1907. 126,397 3629 28.55 380 104.7 1129 8.9 36 16 263 1376 10.88 1908. 131,486 3482 26.48 351 100.8 1017 7.7 32 11 252 1258 9.56 1909. 136,602 3369 24.66 281 83.3 982 7.2 31 11 224 1205 8.8 Averages for years 1897.1909. 105,308 3207 30.82 404 128.1 1075 10.55 31 11 155 1223 11.85 1910. 141,748 3197 22.6 283 88.5 949 6.6 34 17 254 1186 8.4 *Rates calculated per 1,000 of estimated population. Area of district in acres (exclusive of area covered by water), 3,988 Total population at all ages, 95,131. Number of inhabited houses, 16,083. Average number of persons per house, 5.8.—At Census of 1901. 64 I. Institutions within the District receiving sick and infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which have been distributed among the several localities in the District Walthamstow, Leyton, and Wanstead Children's and General Hospital. The Asylum. Sanatorium, Chingford. Union Infirmary, Leytonstone. Union Infirmary, Whipp's Cross. Small-Pox Hospital Dagenham. Local Government Board Form.] TABLE II. Vital Statistics of separate Localities in 1910 and previous years. Year. Names of Localities. St. James Street Ward. High Street Ward. Hoe Street Ward. Wood Street Ward. Northern Ward. Whole District. Population estimated to middle of each year. Births registered Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all Ages. Deaths under 1 year. Population estimated to middle of each year by Registrar General. Births registered. Deaths at all Ages. Deaths under 1 year. 1897 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 70,000 2246 832 306 1898 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 77,000 2294 1034 390 1899 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 83,000 2835 1282 482 1900 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 91,000 3037 1254 482 1901 23218 772 349 124 19 886 714 255 105 21 500 604 247 79 15,512 443 187 68 16,884 677 258 105 97,000 3210 1296 481 1902 23,000 766 293 89 20 000 735 228 81 22,000 650 224 55 16,000 482 183 64 20,000 793 234 105 101,318 3426 1154 394 1903 23 600 747 281 98 20,000 781 230 90 22,500 658 226 64 16,500 453 187 50 23,500 896 236 99 106,290 3535 1178 401 1904 23 600 793 327 125 20,400 762 246 98 23,100 628 246 68 16,600 471 184 66 24,300 995 327 139 111,282 3649 1330 496 1905 24 000 705 305 90 21,000 640 240 82 23,500 589 232 45 17,000 429 173 46 32,000 1026 299 91 116,300 3389 1249 354 1906 24 000 735 317 110 21,000 734 247 97 24,000 595 273 65 17,500 465 212 67 35,000 1065 398 127 121,334 3594 1447 466 1907 24,000 697 344 100 22 000 733 238 68 24,000 601 238 38 17,000 426 219 65 37,000 1172 337 109 126,397 3629 1376 380 1908 23,500 711 308 88 21 500 660 212 66 24,000 563 264 57 17,500 417 173 46 37,000 1131 301 93 131,486 3482 1258 351 1909 24,500 722 253 75 22,500 618 202 46 24,500 524 251 40 18,000 426 220 40 40,000 1079 279 80 136,602 3369 1205 281 Averages of Years 1901-9 23,713 739 308 100 20,921 707 233 81 23,233 601 245 57 16,846 446 193 57 29,520 982 297 105 105,308 3207 1223 405 Average of Years 1897 to 1909 1910 25,000 659 290 83 23,000 565 189 47 25,000 521 208 34 18,500 410 178 33 40,500 1042 321 86 141,748 3197 1186 283 Local Government Board Form.] TABLE IV. Schedule B. Table of Deaths during the year 1910, in the Urban Sanitary District of Walthamstow, classified according to Diseases, Ages, and Wards. No. Causes of Deaths. All Ages Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 & upwards St. James St. High Street Hoe Street Wood Street Northern Total Deaths in Public Institutions (Workhouse and Infirmary included). l Small-Pox - - - - - - - - - - - - - 2 Measles 20 3 13 4 — — — 6 5 1 3 5 3 3 Scarlet Fever 4 — 3 1 — — — 1 1 1 — 1 — 4 Typhus Fever — — — — — — — — — — — — — 5 Epidemic Influenza 10 — — — — 3 7 1 2 3 4 — 2 6 Whooping Cough 32 11 20 1 — — — 10 5 5 1 11 8 7 Diphtheria, Membranous Croup 15 — 7 8 — — — 3 3 4 2 3 1 8 Croup — - - - - - - - - - - - — 9 Enteric Fever 2 — — 1 — 1 — — — 1 1 — 1 10 Asiatic Cholera — — — — — — — — — — — — — 11 Diarrhoea, Dysentery ... 8 7 — — — 1 — 3 2 — 2 1 — 12 Epidemic or Zymotic Enteritis 2 2 - - - - - - 1 — — 1 — 13 Enteritis 20 12 6 — — 1 1 6 3 1 1 9 8 14 Gastro Enteritis 1 — — — — 1 — — 1 — — — — 15 Other continued Fevers 1 1 - - - - - - - - 1 — — 16 Cerebro Spinal Meningitis - - - - - - - - - - — — — 17 Erysipelas 2 — — — — 2 — — 1 — 1 — 1 18 Puerperal Fever 1 — - — — 1 — — — 1 — — — 19 Other Septic diseases 24 4 2 5 1 8 4 5 4 — 6 9 12 20 Intermittent Fever and Malarial Cachexia — — — — — — — — — — — — — 21 Tuberculosis of Meninges 24 3 15 4 2 — — 2 5 6 4 7 3 22 Tuberculosis of Lungs 88 — 4 3 15 61 5 25 12 14 16 21 34 23 Other forms of Tuberculosis 16 3 4 3 — 5 1 2 3 3 2 6 1 24 Alcoholism 5 — — — — 4 1 2 1 — 1 1 — 25 Cancer 74 1 — — — 50 23 16 10 24 4 20 19 26 Premature Birth 59 59 - - - - - 17 6 11 4 21 2 27 Developmental Diseases 90 85 5 — — — — 27 15 9 17 22 15 28 Old Age 63 - - - - - 63 9 9 17 13 15 22 29 Meningitis 9 3 2 — 1 2 1 2 — 2 — 5 1 30 Inflammation and Softening of Brain 2 — — — — — 2 — — 1 1 — — 31 Organic Diseases of Heart 67 1 — 8 4 37 17 12 5 18 12 20 19 32 Acute Bronchitis 55 22 14 — — 16 3 21 11 6 4 13 2 33 Chronic Bronchitis 64 — — - 1 — 20 43 16 13 8 12 15 5 34 Lobar (Croupous) Pneumonia 53 3 6 2 3 34 5 15 11 5 8 14 10 35 Lobular (Broncho) Pneumonia 61 31 21 — — 4 5 22 8 8 7 16 6 36 Diseases of Stomach 14 5 1 — 1 4 3 4 3 — 2 5 3 37 Obstruction of Intestines 9 2 1 — — 1 5 — 3 — 4 2 3 38 Cirrhosis of Liver 10 — — — — 9 1 1 1 3 3 2 4 39 Nephritis and Bright's Disease 31 1 — — — 19 11 10 7 5 5 4 8 40 Tumours and other Affections of Female Genital Organs - - - - - - - - - - — — — 41 Accidents and Diseases of Parturition 1 — — — — 1 — — — — — 1 — 42 Deaths by Accident or Negligence 34 4 11 4 2 8 5 6 5 7 6 10 20 43 Deaths by Suicide 8 — — — 2 6 — 1 2 1 1 3 4 44 Deaths from Ill-defined Causes - - - - - - - - — — — — — 45 Syphilis 3 2 — — — 1 — 2 — — — 1 1 46 Overlying 6 6 — — — — — — 1 2 — 3 — 47 All other Causes 198 12 7 11 12 82 74 43 29 39 30 57 42 All Causes 1,186 283 142 56 43 382 280 290 188 206 178 324 259 Local Government Board Form.] TABLE V. Causes of Deaths. Under 1 Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. | 10-11 Months 11-12 Months Total Deaths under One Year. All Causes Certified 72 23 9 15 119 29 24 14 16 16 8 11 14 8 11 12 282 Uncertified 1 — — — 1 — — — — — — — — — — — 1 common infectious diseases. Small-Pox — — — — — — — — — — — — — — — — — Chicken-Pox — — — — — — — — — — — — — — — 1 1 Measles — — — — — — — — — — — — — — 3 — 3 Scarlet Fever — — — — — — — — — — — — — — — — — Diphtheria; Croup — — — — — — — — — — — — — — — — — Whooping Cough — — — — — 1 2 — 1 — — 1 3 — I 2 11 diarrheal diseases. Diarrhoea, all forms — — — — — — 1 1 1 1 1 2 1 8 Enteritis, Muco Enteritis, Gastro Enteritis — — 1 1 2 2 2 1 — 4 — — 1 — 1 13 Gastritis, Gastrointestinal Catarrh — — — 1 1 2 — — 1 1 — — — — — — 5 wasting diseases Premature Birth 41 6 1 4 52 5 2 — — — — — — — — — 59 Congenital Defects 10 4 — — 14 1 2 — — — — — — — — — 17 Injury at Birth — — — — — — — — — — — — — — — — — Want of Breast-milk — — 1 1 2 1 1 1 — — — — — — — — 5 Atrophy, Debility, Marasmus 3 3 3 2 11 5 7 1 3 2 2 2 5 3 — 41 Asthenia : Inanition 10 5 — 1 16 — — — 1 — — — — — — — 17 tubercu lous diseases. Tuberculous Meningitis — — — — — — — — 1 — — — — — 1 1 3 Tuberculous Peritonitis: Tabes Mesenterica . — — — — — — — 1 — — — — — — — — 1 Other Tuberculous Diseases — — — — — — — 1 1 — — — — — — — 2 other causes. Erysippelas — — — — — — — — — — — — — — — — — Syphilis — 1 — — 1 — — — — — — — — — — 1 2 Rickets — — — — — — — — — — 1 1 — — — 2 Meningitis (not Tuberculous) — — — — — — — — — 1 2 — — — 1 — 4 Convulsions 2 1 2 1 6 1 1 1 — — — 1 — — — — 10 Bronchitis — — — 2 2 3 2 3 1 4 1 3 1 2 2 2 26 Laryngitis — — — — — — — — — — — — — — — — — Pneumonia — 1 — 1 2 4 2 3 5 2 2 ] 2 3 2 1 29 Suffocation, overlaying 3 — 1 — 4 — — 1 1 — — — — — — — 6 Other Causes 4 2 — 1 7 4 2 — — 1 — — 1 — 1 2 18 73 23 9 15 120 29 24 14 16 16 8 11 14 8 11 12 283 District (or sub-division) of Walthamstow. Births in the year legitimate, 3144. illegitimate, 53. Deaths in the year of legitimate infants, 261. illegitimate infants, 22. Population. Estimated to middle of 1910, 141,748. Deaths from all Causes at all Ages, 1186. Chart shelving the Birth, Death and Zymotic Death-Rates, for the years 1880 to 1910. 65 The following table shows Infectious Diseases according to Wards, and the number removed to Hospital :— Local Government Board Form.] TABLE III.—Cases of Infectious Disease notified during the Year 1910. Name of District—Walthamstow. Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in Each Locality. No. of Cases Removed to Hospital from Each Locality. Total Cases Removed to Hospital. At all Ages. At Ages—Years. St. James Street. High Street. Hoe Street. Wood Street. Northern. SI. James Street. High Street. Hoe Street. Wood Street. Northern. Under 1 1 to 5 5 to 15 15 to 25 25 to 65 65 and upwards Small Pox - - - - - - - - - - - - - - - - - - Cholera - - - - - - - - - - - - - - - - - - Diphtheria(inclu ding Membranous Croup) 138 — 40 83 6 8 1 44 22 21 7 44 34 15 20 6 36 111 Erysipelas 99 5 2 9 13 60 10 22 15 19 15 28 2 — 2 - 4 8 Scarlet Fever 232 4 63 141 20 4 — 45 37 49 22 79 38 33 44 17 57 189 Typhus Fever — — — — — — — — — — — — — — — — — — Enteric Fever 26 — — 10 8 8 — 8 7 4 2 5 6 5 3 1 4 19 Relapsing Fever — — — — — — — — — — — — — — — — — — Continued Fever - — - - - - - - - - - - - - - - - - Puerperal Fever 3 — — — 2 1 — — 1 1 1 — — 1 — — — 1 Plague - - - - - - - - - - - - - - - - — Totals 498 9 105 243 49 81 11 119 82 94 47 156 80 54 69 24 101 328 Isolation Hospital—Walthamstow Sanatorium, Chingford. Total available beds—93. Number of Diseases that can be concurrently treated—4 at least. 66 TO THE CHAIRMAN AND MEMBERS OF THE Walthamstow Urban District Council. Gentlemen, In accordance with the regulations of the Local Government Board, I have the honour to present my customary report of the work done through your Sanitary Inspector's Department during the past year. The responsible work of supervising sanitary conditions in the various directions covered by my report under the provisions of the Public Health Acts has been in my hands for twenty-five years, the population meantime increasing from 30,000 to 130,000, and inhabited houses from 4,000 to more than 22,000, and I desire most gratefully to acknowledge the appreciative and encouraging reference to my work made by your chairman, Councillor H. Brown, J,P., in his annual report early in 1910. While, of course, in so large a population, insanitary conditions are continually arising to require our attention, the more serious structural defects are gradually being removed and more opportunity afforded for work in newer directions called for by new laws and higher modern sanitary ideals. Of these, perhaps, the most important is the supervision of our food supply, which year by year receives more of our attention with, I believe, useful results. Six hundred and thirty-six premises are under supervision in this connection. I feel confidence in saying that, thanks to the importance attached to all sanitary questions by the Council, Walthamstow will compare favourably in these respects with any similarly situated district. I would add that our work has been effected with a minimum of necessity for appeal to legal proceedings, thanks very largely to the interest and zeal displayed by my assistants at all times in their work. Intimation notices to the number of 1011 have been issued, and 50 statutory notices have secured compliance with our requirements. We have received 315 complaints of which 86 were anonymous, with reference to the existence of nuisances within the district, and only a few, 18, have been found to be without some foundation, although by no means always to the extent suggested in the complaint. I have the honour to remain, Gentlemen,. Your obedient servant, W. W. WEST. 67 House to House Inspection has been proceeded with in the undermentioned streets:— Back Road. Beaconsfield Road. Bedford Road. Billet Road. Brookscroft Road. Brunswick Street. Chapel End. Coleridge Road. Collard Road. Corbett Road. Cuthbert Road. Dudley Road. Forster Road. Hartington Road. Jeffries Square. King Edward Road. Markhouse Avenue. Marlowe Road. Milton Road. Oakfield Road. Parkstone Road. Raglan Road. Ritchings Avenue. Rosebank Road. St. Stephen's Road. Spring Gardens. Waverley Road. Woodlands Road. York Road. Sanitary improvements have been carried out in 2,176 premises out of a total of 5,529 which have been inspected. Drainage Work.—As is naturally to be expected, the need for reconstruction or serious repair of house drainage becomes gradually less in amount year by year owing to the newer houses having been built under more exact requirements and supervision, and the number reconstructed during the year is 171 as compared with 247 last year. Owing to the various legal decisions under the provisions of Sec. 41 of the Public Health Act, 1875, as amended by Sec. 19 of the Public Health Amendment Act, 1890, in the case of 13 blocks, comprising 38 separate premises, the main drains have been reconstructed by the Council at the public expense. These were situated in the following streets :— 4 and 6, West Street. 27 and 29, Collingwood Road. 14 to 20, Collard Road. 29 and 81, Colebrook Road. 4, 6 and 8, Willow Walk. 30 and 32, Springfield Road. Grove Road. 83 to 91, Oatland Rise. 0 and 8, Parkhurst Road. 201 and 203, Higham Hill Road. 26 and 28, Shernhall Street. 20 to 34, Beaconsfield Road. 13 and 15, Cottenham Road. Notwithstanding occasional differences of opinion between your officers and various owners as to the respective liability of the owners and the Council, little friction or delay has occurred in the remaining instances. In addition to single houses the undermentioned blocks of houses have been dealt with. 68 39 to 49, Albert Road. 55 and 57, Albert Road. 35 and 37, Arkley Road. 67 and 69, Arkley Road. 19 to 23, Arkley Crescent. 6 to 10, Beaconsfield Road. 20 to 38, Beaconsfield Road. 67 to 73, Beaconsfield Road. 6 and 8, Blackhorse Road. 55 and 57, Brown's Road. 16 and 18, Brunswick Street. 8, 9, 10 and 10a, Chapel End. 21 to 25, Clacton Road. 27 and 29, Collingwood Road. 14 to 20, Collard Road. 11 to 15, Collard Road. 9 to 15, Cottenham Road. 54 and 56, Downsfield Road. 40 to 44, Downsfield Road. 42 to 46, Gosport Road. 46 and 48, Haroldstone Road. 201 and 203, Higham Hill Road. 28, SO, 32 and 34, Lynmouth Rd. 83 and 85, Markhouse Avenue. 38 to 56, Markhouse Avenue. 60 to 74, Markhouse Avenue. 7 to 11, Newman Road. 98 and 100, Northcote Road. 101 and 103, Oakfield Road. 87 to 93, Oatland Rise. 7 and 8, Parkhurst Road. 25 and 27, Ritchings Avenue 33 to 39, Ritchings Avenue 65 and 67, Ritchings Avenue. 30 and 32, Somers Road. 38 and 40, Somers Road. 30 and 32, Springfield Road. 52 to 60, Springfield Road. 16 to 20. Tower Hamlets Road. 21 and 23, West Street. 4 and 6, West Street. 8 and 10, Willow Walk. 196 to 200, Wood Street. The following summary indicates the nature and variety of the works carried out to remedy insanitary conditions discovered in the course of inspection:— Drains tested 344 „ reconstructed 171 ,, repaired 123 „ cleared of obstruction 147 Inspection chamber and clearing eyes provided 121 Ventilation shafts provided 113 „ ,, repaired or heightened 97 Soil pipes repaired 29 ,, (new) provided 6 Rain-water pipes provided or repaired 186 „ „ disconnected from drains 63 Roofs repaired or renewed 233 Guttering repaired or renewed 249 New w.c. pans and traps 254 New gulley traps 238 Bell traps abolished 11 New water waste preventers to w.c. 55 W.c. floors concreted 144 W.c.'s repaired or cleansed 70 W.c. lighting and ventilation improved 33 69 W.c. flush disconnected from d.w. supply 10 W.c. flush repaired or renewed 120 New sinks provided 67 Sink and bath wastes repaired or renewed 246 „ „ trapped 103 Sink or food cupboards ventilated 19 Water supply reinstated or improved 61 Cisterns cleansed and covered 193 Cisterns abolished 23 Urinals specially cleansed 3 Sculleries paved 37 Yards and forecourts paved and drained. 419 Overcrowding abated 56 Dirty houses cleansed 131 Dirty rooms cleansed 1079 Floors repaired 93 Ventilation under floors provided 176 New damp-proof courses provided 10 Sites concreted 14 Stables paved, drained and cleansed 23 Offensive accumulations removed 153 Nuisance from keeping of animals abated 43 Manure receptacles provided or repaired 19 Rat infested places remedied 3 Infectious Disease. Five hundred and fifty-five houses have been disinfected after infectious disease and inspection made as to their sanitary condition, and 105 books in use belonging to the Council's Public Library were removed, disinfected and returned to the Chief Librarian. As a result of this inspection, insanitary conditions, mostly slight in nature, have been found in 133 premises. These have been remedied, in addition to the fumigation of the infected rooms and, where necessary, stripping, cleansing and whitewashing of the same. The bedding, clothing, etc., removed from infected premises have been disinfected at the Council's steam disinfecting chamber. The undermentioned articles have been dealt with :— Beds 457 Bolsters 344 Pillows 842 Blankets 819 Miscellaneous 4694 Rooms fumigated or sprayed 596 70 Schools throughout 9 „ cloak-rooms 19 Library books 105 Cases removed to the Chingford Sanatorium 291 „ „ „ Metropolitan Asylums Board Hospitals 6 ,, „ „ London Fever Hospital 2 Overcrowding.—It will be noticed that 56 cases of overcrowding have been met with in the course of our inspection. In some few cases, this has been caused by some kindly disposed person affording house room to an even poorer neighbour evicted from their home from inability to pay rent, in other cases from sheer inability to pay more rent than the parents were paying, and in still others from pure carelessness and non-recognition of possible ill results. In every case the overcrowding has been abated in the former cases by means of a liberal allowance of time to secure better accommodation, provided the premises were made and kept clean. Want of cleanliness is an almost invariable accompaniment to overcrowding. I have reason to believe that the abatement in each case has been real, and not merely a transference to similar conditions in another house. Dampness in House.—This condition usually arises from one or other of two causes, viz., the non-water-tight condition of roof and rain water pipes, or want of proper damp-proof courses to the walls, with dampness of the sites. The latter is found in the older houses and in 10 houses new damp-proof courses have been provided to remedy this defect. In almost all cases the remedy proposed by the owner is to face the wall inside with matched boarding or other material, but I invariably refuse to accept such a method of dealing with it as the effect is merely to hide the defect and is no remedy. In the former cases it will be seen that 249 gutters have been repaired or renewed, 233 roofs repaired or renewed, 185 rain water pipes renewed or repaired, 14 sites concreted and 419 yards and forecourts paved and drained. Stable Premises.—Special inspection has been made during the year of 233 premises in which horses are known to be kept, particularly with reference to the presence of rats which are frequently to be found in such premises, generally due to untrapped openings in the drains. It was satisfactory to find that only 10 places were so infested, and the drains being found defective, were at once repaired and the evil remedied. A second cause of frequent complaint associated with stable premises is the presence of flies, especially in warm weather. This is due to the fact that accumulation of refuse, especially stables manure, form a suitable breeding place, and the usual suggestion for remedy is to clear the refuse away at least once a week. It is, however, necessary that the place of deposit be so constructed as to permit an easy cleansing on each occasion of its being emptied, 71 which is rarely done owing to the unsuitable mode of construction A brick pit enclosed on four sides is in no way suitable. There should be merely an impervious platform, draining to a gully, with just a sufficient guard round it to keep the whole tidy, and the nearer we get to this form, the more suitable the place. My endeavour is to increase the number of these and abolish everything in the nature of a pit. In connection with our inspections the following works have been carried out:— Premises paved, drained and cleansed 28 Drains repaired 5 Premises limewashed 5 New drainage provided 2 Receptacles provided 4 Bakehouses.—There are 54 bakehouses under observation in the district, of which 6 are underground. The periodical cleansing required by Act of Parliament has been supervised and certain improvements effected. Special cleansing 4 Improper accumulations removed 3 Manure receptacles improved 1 Repairs to paving and floors 5 Drains repaired 4 Ventilation improved 2 Other repairs 8 Slaughter-houses and Butchers' Shops.—Fifteen slaughterhouses and 98 butchers' shops have been under constant supervision. In the case of slaughter-houses, an endeavour is made to visit them whenever slaughtering is in progress, as the only time at which a thoroughly satisfactory examination can be made of the animals slaughtered. In most cases every assistance is afforded to us and any abnormal conditions dealt with. In three instances, one in a slaughter-house and two in shops, seriously diseased meat has been found and prosecutions instituted. In the slaughter-house case a carcase of a tuberculous cow was found shortly after slaughter and on proceedings being taken, the owner was fined £20 and costs. The owner has appealed to quarter sessions against the conviction. In the butcher's shop, the carcase of a tuberculous cow recently removed from the slaughter-house was found hanging in portions round the shop, and a fine of £20 and costs inflicted by the bench. In the third case, portions of tuberculous meat were discovered in a safe in the rear of the butcher's shop, but on proceedings being taken the case was dismissed. 72 2 sheeps plucks. 3 ox livers. 1 carcase of cow. 1 pair ox lungs. 1 melt. 26 lbs. rump of beef. 3 sets beef lungs. 8 pieces of mutton. 1 carcase of beef. 6 breasts of mutton. 1 liver and meshling of ox. The following list will show the meat destroyed during the year:— 1 pair ox lungs. 1 ox head. 2 cow's lungs. 8 lbs. beef pieces. 1 pig's head and lungs. 1 cow's head, liver and lungs. 2 cows' heads. 3 ox livers. 1 carcase of cow. 6 pieces of beef. The following sanitary improvements have been made:— Special cleansing 20 Paving improved 5 Manure receptacles 2 Offal receptacles provided 2 Improper accumulations removed 4 Drainage repaired. 3 Other repairs 9 Cowkeepers and Milksellers.— There are now 12 cowkeepers in the district, and 199 milksellers. The new regulations submitted to the Local Government Board came into force on the 1st of January, 1911. I have, however, during the latter part of 1910, prepared the way for these and already considerable improvements have been made in many of the premises in anticipation of the requirements of the new regulations. The inspection made in company with the Council's Veterinary Surgeon has disclosed the presence of a certain number of animals affected with disease and on the fact being made known to the owners the animals affected have been removed from the herds. There are now about 240 cows kept in the district and the improvement in their condition is very marked. During the year the following improvements have been effected in the premises:— Drainage repaired 11 Paving repaired 27 Special cleansing 38 Water supply improved 5 Improper accumulation removed 4 Ventilation improved 1 Other improvements 22 Fishmongers.- Sixty-seven premises used by fishmongers have been supervised both with reference to the condition of the premises as well as the articles sold. In accordance with my practice for many years, fish found on arrival from market to be unsound and brought to me, has been destroyed and a certificate given to that effect, stating the 73 time at which it was bought, thus enabling the retailer in most instances to obtain the return of his money and relieving him of the temptation to recoup himself by offering it for sale. There have been destroyed the following, viz.:— 2 boxes of mackerel. 9 cole fish. 40 lbs. of skate. 1 box of herrings. 3 boxes of plaice. 3 stone mixed fish. 15 boxes of kippers. 1 box of plaice. 90 lbs. of skate. 1 cwt. 1 qr. cole fish. 2 trunks mixed fish. 1 box cole fish. The following improvements have also been effected in the premises:— Smoking and frying premises removed 3 Animals, improperly kept, removed 2 Drainage repaired 3 Drainage obstruction removed 1 W.c. flush improved 2 Other improvements 12 Coffee Houses.—Frequent visits have been paid to the 48 coffeehouses in the district, and our suggestions have been readily met when suggesting improvements desirable. In this way the following improvements have been obtained :— Special cleansing 23 Paving improved 3 ..Cisterns cleansed 5 Drains repaired 1 Receptacles for waste provided 1 Safes cleansed 3 Accumulation removed 7 Other improvements 6 Ice Cream Vendors.—One hundred and forty three premises where ice cream is made have been visited, more particularly in the summer months, with special reference to the sanitary conditions and the cleanliness exercised in the preparation of the article. No case of improper or unsound material has come before us but the following sanitary improvements have been secured:— Cleansing of premises 9 Yard paving improved 3 Storage receptacles provided 10 Water supply improved 4 Drainage repaired 3 W.c. flush improved 5 Other improvements 5 74 General supervision is also kept over articles sold in the streets, and the following articles besides those already mentioned have been surrendered and destroyed 1 sack of potatoes. 1 bag of potatoes. ½ bushel of greengages. 36 lbs. of brisket. 18 rabbits. 6 quarterns of bread. 1 barrel of peas. 1 box of bananas. Factories and Workshops.—In the visitation of these premises the undermentioned improvements have been directed Special cleansing 15 Additional w.c. accommodation provided 1 Improvements in w.c.'s affected 7 Urinals provided 1 W.c. flush improved 6 Drainage repaired 3 Paving repaired 3 Offensive accumulations removed 2 Ventilation improved 1 Manure receptacle provided 1 Other improvements 8 Outworkers.—The premises occupied under this description form a large proportion of those visited under the provisions of the Factories and Workshops Acts, and the variety of work carried on in them will be shown by the accompanying list of names sent in to us :— Aprons 50 Artificial flowers 13 Blouses 423 Bows 10 Boots 120 Belts 26 Brushes 96 Boxes 23 Baby linen 16 Books 4 Clothing, juvenile 132 Costumes, children's 9 Collars 6 Corsets 1 Coats 17 Dressing-gowns 14 Dress shields 1 75 Embroidery 9 Furrier 11 Flags 1 Hats 4 Fancy leather goods 5 Millinery 15 Mantles 18 Masonic ornaments 3 Shirts 36 Skirts 14 Shoe vamp beading 6 Shoe trimmings 8 Ties 136 Tailoring 45 Toys 3 Trimmings 9 Underclothing 148 Upholstery 5 Umbrellas 16 Waterproof goods 1 Waistcoats 3 It will be seen that the conditions under which the work is carried on in these premises are good, the list of sanitary improvements found necessary being small in comparison with the number of premises. They were :— Cleansing premises 6 W.c. improvements 6 Floor repairs 1 Offensive accumulations removed 4 Sundry repairs 8 Sale of Food and Drugs Acts.— I have submitted to Dr. Bernard Dyer, 189 samples of food for analysis under these Acts, of which 18 were certified to be adulterated, impoverished, or otherwise not in accordance with the law Description of Article. Number submitted. Adulterated, etc. Milk 97 8 Butter 82 8 Lard 7 — Coffee 2 2 Pepper 1 — 76 SALE OF FOOD AND DRUGS ACTS. Table showing how the samples found to be sold not in accordance with the law were dealt with : No. of Sample Description of Article. Offence. Fine Inflicted. Analyst's Fee. Costs. Remarks. £ s. d. £ s. d. £ s. d. 3 Milk 4 p.c. added water ... ... ... No proceedings. 14 Butter 25 p.c. margarine l 0 0 0 10 6 0 4 0 24 Butter 6 p.c. excess of water l 0 0 ... ... Including costs. 44 Milk 16 p.c. deficit in cream. ... ... ... Vendor emigrated before proceedings. 50 Milk 13 p.c. ditto ... ... ... 67 Milk 18 p.c. ditto ... ... ... Same vendor. 75 Milk 7 p.c. added water l 0 0 0 10 6 0 4 0 78 Milk 7 p.c. ditto l 0 0 0 10 6 0 4 0 88 Butter 8 p.c. boric acid ... ... ... Vendor cautioned. 115 Butter 50 p.c margarine ... ... ... Informal sample. 123 Butter 25 p.c. ditto 2 0 0 0 5 0 0 4 0 Same vendor as No. 115. 150 Milk 6 p.c. added water 5 0 0 0 5 0 0 4 0 Two previous convictions. 160 Butter Margarine 5 0 0 ... ... Informal. 161 Coffee Mixed with chicory ... ... ... ... Informal. 164 Coffee Ditto ditto ... ... ... Informal. 171 Butter Margarine ... ... ... Informal. 175 Butter Margarine ... ... ... Informal. 182 Milk 8 p.c. added water 2 0 0 0 5 0 0 4 0 REPORT TO THE EDUCATION COMMITTEE ON THE MEDICAL INSPECTION OF SCHOOL CHILDREN During the Year 1910. 78 INDEX. page General Information 82 Schools—Provided 82 ,, Non-Provided 82 ,, Special 82 Cost of Medical Inspection 82 Repairs to School Buildings 82 Hygienic Conditions in Schools 82,83 Co-relation of School and Public Health Work 84 Extent and Scope of Medical Inspection 85 Number of Children Inspected 85 ,, ,, ,, Daily 85 Directions to Parents 86 Heights and Weights of Children Inspected 86, 87, 88 Chief Defects Revealed by Medical Inspection 89 Tabular Statement of Defects for all School Children preceding 89 Clothing and Footgear 89,90 Nutrition, Cleanliness of Head and Body 90 Teeth, Tonsils, Adenoids, and Ear Diseases 91 External Eye Diseases, Vision 92 Speech Defects, Mental Condition 93 Heart and Lung Affections 93 Rickets—Deformities 94 Infectious and Skin Diseases 94 Mentally Defective, and Deaf and Dumb Children 95 Methods Employed or Available for Treatment. 96 Defects Remedied 96 School Nurse 98 Health Visitors 99 Children seen at Town Hall and Schools by M.O.H. 97, 98 Reports upon Teachers and Others 99 Boy Labour 99, 100 79 TO THE CHAIRMAN AND MEMBERS of the Walthamstow Education Committee. Gentlemen, I beg to present for your consideration my Annual Report, dealing with the Elementary Schools and children under your control, in accordance with the Regulations made under section 13 of the Education (Administrative Provisions) Act, 1907. The report is made mainly on the lines suggested in Circular 596 of the Board of Education. The close supervision of the school buildings by your Architect, Superintendent of Repairs, and Members of the Committee has been reflected in the excellent condition in which they have been at all times kept. A former Parliamentary Representative remarked that the Walthamstow Elementary Schools were a special feature of the district; they were similar to but better than high-class Grammar Schools. That description of ten years ago holds good to-day. My monthly reports to your Committee, dealing with the individual schools and scholars, have made you quite familiar with all the work of Medical Inspection, and it will be well within your memory that the remedying of the defects found was the principal objective of the work. The duty and obligation of the parents to their children in this respect was kept steadily before them, and generally the parents have responded well to our advice and instructions. The migratory character of the population, the want of local facilities (in the case of very poor parents) "for the amelioration of the evils revealed by medical inspection," and the impossibility, with the staff at my disposal, of " following up " the children as closely as is necessary, militated largely against results commensurate with the work undertaken and its importance. A step forward has been taken by the appointment, in November, of an Ophthalmic Surgeon, and he has already (April 3rd) dealt with a large number of the outstanding unremedied cases of defective vision which had accumulated during the year. In future we shall be able to treat directly all our school children who suffer from defects of vision, and thus the most serious of all the defects found in school children will be remedied. 80 The medical inspection of all the children (Article 58 Code) has been tully carried out, but the work arising out of it is of such magnitude that the present permanent Clerical and Health-Visiting Staff is inadequate and must be strengthened, and more office accommodation, with suitable rooms for school purposes, provided. Under existing conditions the work is hampered. With slight modifications of forms and schedules used in the Office and for the Schools, the organisation and routine of the work were similar to 1909. In all the Provided Schools new school registers are now in use, with spacing before each child's name for recording previous illnesses as well as defects found on medical inspection. The registers must facilitate the work of the teachers in selecting the children for examination, and in carrying out the instructions given as to individual scholars. It ought to be no longer possible to present the same child twice within a year to the doctor if the registers are properly kept—except, of course, for special reasons. There has been in 1910 a noticeable uniformity of co-operation on the part of all the head teachers in the work of medical inspection, and to the teachers and their influence with the parents we are indebted for much of the remedial work carried out. I think, in all future inspections, the head teachers, other duties permitting, should be present with the doctor. Heretofore they have not been invited, the examination being looked upon as private and confidential. The teacher occupies the position of parent in school hours, and there can be no objection to—in fact, there is much reason for —his or her presence. The teacher is the best coadjutor to the school doctor, and by becoming familiar with those conditions indicating, or suspicious of, disease, will be the more capable of exercising a useful supervision over the children in the absence of the doctor. The head teacher by being present at the inspections will be interested at the starting-point, and knowing the reason for the doctor's advice and instructions, will the more readily co-operate in the carrying out of them in the children's interests. In the girls' schools a nurse would hardly be then required, and that official thus relieved could visit or engage in other work. The number of parents present at the inspections was slightly less than in 1909, the falling off being at the boys' and girls' schools. Altogether 3,392 were present, and thus a great number of mothers had a useful object lesson in the work performed, and had the benefit of the doctor's advice regarding their children. 81 Only 304 parents of 6,781 invited refused to have their children inspected. The refusals show that some prejudice still exists on the part of certain parents to the work. This will decrease yearly with a fuller knowledge of the aims and objects of medical inspection and its results, and in time a refusal will be a rarity. No numerical count has been kept of the children inspected at the parents' request, but the number certainly more than counterbalanced the refusals. While respecting the parents' wishes, children suspected of pediculosis by the teachers were examined for this condition, but the number found so suffering was very small. Arising out of the 6,432 statutory inspections, the 354 made by me at the schools and the 2,434 attendances of children at my office, over 2,000 .visits were made to the homes of the children hy the Health Visitors and School Nurse, and 67 by the Sanitary Inspector. These latter were undertaken when the conditions of the children presupposed insanitary homes and surroundings. I have no doubt that the Medical Inspection and the work arising from it, as carried out, have been of the greatest service to our children and to the public health. I beg to remain, Gentlemen, Your obedient Servant, J. J. CLARKE. 82 GENERAL INFORMATION. SCHOOL ACCOMMODATION. Boys. Girls. Infants. Mixed. Provided Schools 16 16 16 9 Voluntary Schools 1 2 3 1 Special Schools. Mentally Defective 1 1 — — Deaf and Dumb — — — 1 18 19 19 11 Number of children on Registers at the end of the year 25,162 Number of School places provided 25,312 Average Attendance 22,512 Percentage present for December 89-4 Rateable value of the district was £444,850. The product of a penny rate approximates £1,700. The Education Rate for the year was 2s. 3d. in the pound, and the cost per child for education was £3 0s. 10d. The cost of Medical Inspection for the year was £467 4s. 4d. This includes supervising officer's salary as well as that paid to the inspecting doctor and nurse, clerk, and expenses of postage, printing, etc. SCHOOL BUILDINGS. Provided Schools.—All these are modern, well equipped, and in every way suited for the work carried on. They are mainly one storey buildings and each Department has a Central Hall. The playgrounds are tar paved and each contains a covered playshed. During the year repairs and improvements have been carried out at a total cost of £1,673 5s. Od. The Chief Medical Officer of the Board of Education gave on page 37 of his 1908 Annual Report, the cost of Medical Inspection as follows:— Cost of Salaries per child in average attendance. Cost as decimal of Id. rate. Counties 4.79 .15 County Boroughs 5.69 .19 Municipal Boroughs 7.64 .23 Urban Districts 7.56 .28 Walthamstow, 1910 4.8 .26 88 Non-Provided Schools.—During the year the playground of St. Saviour's (C. of E. Boys) has been tar paved, but no playshed for wet weather has yet been erected. The remarks in last year's report still apply to the other Schools, excepting that a slight improvement in the cloak room accommodation at St. Mary's Infant School has been effected. Much more of a necessary kind remains to be done. (a.) HYGIENIC CONDITIONS IN THE SCHOOLS. These are on the whole very good and the description given in last year's report as to lighting, heating, ventilation and sanitation will serve for 1910. I have visited the schools at various times throughout the year and invariably found that they were kept in a cleanly condition and that the caretakers carried out their duties as laid down in the Education Committee's Code of Regulations, These inter alia are :— (/>) To sweep and dust once every day all the rooms, staircases and passages, taking care to thoroughly ventilate the premises while this is being done. (d) To keep the W.C.'s and urinals thoroughly clean and disinfected and well flushed twice a day and oftener in hot weather, and to see that the seats, walls, etc., are kept perfectly clean. (f) To clean inside of school windows at the same time as the contractors are cleaning the outside. (i) To scrub out the school rooms once, at least, a month. (m) In order to keep the schools thoroughly disinfected and to prevent the accumulation of dust, damped sawdust mixed with turpentine and carbolic acid in the summer months is spread over all the floors every Friday evening. Sanitation.—During the year every school was visited and systematically inspected by one of the Sanitary Officers. The following defects were disclosed and referred to the School authority to be rectified. Shernhall Street Defective trap to drain by Girls W.C. St. Mary's Girls Defective flush cistern, Teachers W.C. Gamuel Road Infants Defective W.C. pans and traps, defective manhole cover. St. Saviour's Infants W.C. wanted cleansing, ventilation insufficient. St. George's Defective water supply to Boy's W.C. and urinals, seats of Girls W.C.'s dilapidated. 84 Disinfection.—All the rooms in nine schools, the cloakrooms of 15 schools and one classroom in another school were disinfected by Formalin during the year. The cloakrooms of three of the schools were twice disinfected. Surroundings of Schools.—Attention was drawn in last year's report to certain schools bordering on main roads, and the Education Committee have under consideration the provision at an early date of a cheap noiseless and dustless road surface in front of them. (b.) THE ARRANGEMENT FOR THE CO-RELATION OF THE SCHOOL MEDICAL SERVICE WITH THAT OF PUBLIC HEALTH. These are quite satifactory. The Medical Officer of Health is recognised as the School Medical Officer under the Code and has acted as Medical Officer to the Education Committee since July 1906. Dr. Hall, appointed in 1908 to carry out the statutory inspections continues to do so, and devotes the whole of her time to this work. She is assisted by a nurse who fills in her spare time visiting the homes of the children. The work arising out of the medical inspection coming within the province of Public Health is carried out by the Sanitary Inspector and Health Visitor so that the two services coming under the supervision of one person tends to economy of time and efficiency in its performance, and avoids the friction and the overlapping which might otherwise arise. The part time of one clerk has been deemed sufficient for carrying out the incidental clerical work. Were it not that all the clerical work of both services is carried out in the same office, one whole time clerk would be insufficient. In the near future probably the staffs of the Public Health, School Medical Service and School Attendance Departments will be housed in the same building and this arrangement would much facilitate and render more efficient the work undertaken by them. ( i. ) The Board's Schedule of Medical Inspection has been adopted with a few additional headings added for information as to occupation of parent, number of children in family, vaccination marks, etc. (ii.) The Teachers and Attendance Officers co-operate in the filling up of certain items on the cards and in their transference to the office and to the various schools to which the children migrate. (iii.) The parents are invited to all inspections and their co-operation is enlisted at the time and subsequently by visits from the School Nurse, Health Visitors or Sanitary Inspector. (iv.) The arrangements of all our schools are such that a class-room is given up to the doctor's use during the inspections and the Central Hall temporarily used as a class room, so there is little disturbance of the ordinary school work. 85 (c.) GENERAL STATEMENT OF THE EXTENT AND SCOPE OF MEDICAL INSPECTION DURING 1910. (i.) Visits to schools and departments. All the schools have been visited at least twice during the year and routine inspections have been carried out in all the departments. The number of visits made for the purpose of medical inspection corresponds to the number of times the schools were open. The time occupied at the different schools varied, most attention having to be devoted to the Infants schools and to the upper standards of the Boys and Girls schools. The average time for each individual inspection varies; about 35 children are inspected daily. (ii.) The principle on which children have been selected for inspection was primarily the carrying out of the Board of Education's requirements. Special care was taken that all entrants and leavers were inspected, and those between 7 and 8, and 12 and 13 years of age, as far as time would permit. These groups were selected as embracing children who were about to join the boys and girls schools and those that from any cause might leave school before they attained the age of 14 years. Taking the age group, 12 to 13 gives ample time for the remedying of the defects discovered, and will make their final examination merely formal. (iii.) The number of Children inspected.—The following table shows the number of children inspected, classified according to age and sex, and for each a complete schedule was filled up. Age. Males. Females. Total. 4-5 205 182 387 5-6 860 798 1658 6-7 217 278 495 7-8 676 695 1371 8-9 8 10 18 9-10 12 5 17 10-11 12 12 24 11-12 17 6 28 12-13 451 380 831 13-14 743 634 1377 14-15 89 81 170 15-16 31 28 59 16-17 1 1 2 3322 3110 6432 86 The largest age groups were those of 5-6 and 13-14 years of age. Excluding the 7-8 years and 12-13 years' groups, the remainder were selected for some special reasons by the teachers or the doctor. Those of the higher ages, 14 years and upwards, were children attending the Higher Elementary School, In addition to the 6,432 routine inspections, 354 children were specially examined at the request of the Head Teachers by me at the schools, and 2,434 children were seen by me at the Town Hall. The latter include those referred to me by the Attendance Committees, as well as those sent by the Teachers in response to circular letters sent them following the holidays. The tabular statement on page 97 shows the alleged defects for which these children were seen. Those coming under the Elementary Education (Blind and Deaf) Act, and Defective and Epileptic Act, 1899, have also been inspected, and the schools visited, by me at various times. The total number referred for further examination was 298. These include those who required special treatment for defects such as Adenoids or Defective Vision, as well as those whose condition was suspicious of Tuberculosis, Diphtheria, etc. GENERAL DIRECTIONS TO PARENTS. Written instructions were given or sent to the parents of 973 children, or 15 per cent, of those inspected, and to the 3,392 who accompanied their children friendly advice on many points was given. HEIGHTS AND WEIGHTS. The following tables give the average heights and weights for each age group of all the children inspected. In the weighing and measuring of the children the metric system is used, as it lends itself to more accuracy, and the averages are given in the English equivalents for comparison. There is but little difference in the heights recorded for the age groups 12-13 and 13 14 as compared with last year. The group 7-8 is also similar, but the 6 7 group (boys) shows a lesser height by 2 inches than the same group in 1909. The 6 7 group for girls was alike in both years. The average heights of our boys are below the general average of the population as given by the British Association, but up to the standard of the artisan class; those tor the girls are equal to the general population and above the artisan class. The weights of our children—boys and girls—are below those given for the general population and artisan class. This seems to be the general experience of Urban Districts. 87 AVERAGE HEIGHTS, 1910. Age. Boys. Girls. Total No. Measured, W'stow. Centimetres. Inches. British Association, 1883. Total No. Measured, W'stow. Centimetres. Inches. British Association, 1883. General Population. Inches. Class IV. Artizans. Inches. No. Measured. General Population. Inches. Class IV. Artizans. Inches. No. Measured. 4-5 205 101.1 40 38.46 37.63 107 182 100.9 39¾ 38.26 37-30 99 5-6 860 105.2 41½ 41.03 39.72 201 798 103.6 40¾ 40.55 39.77 157 6-7 217 104.5 41¼ 44 41.90 266 278 108.5 42¼ 42.88 41.84 189 7-8 676 114.2 45 45.97 44.60 307 695 113.9 44¾ 44.45 43.56 173 8-9 8 116.8 45¾ 47.05 46.46 1,523 10 116.5 45½ 46.6 45.55 432 9-10 12 125.2 49¼ 49.70 48.88 2,278 5 123.4 48¾ 48.73 47.36 499 10-11 12 126.8 49¾ 51.84 50.72 1,551 12 124.4 49 51.05 48.96 480 11-12 17 131.1 51½ 53.50 52.68 1,766 6 136.3 53½ 53.10 51.54 441 12-13 451 138.8 54½ 54.99 53.72 1,981 380 140.6 55¼ 55.66 53.98 222 13-14 743 143.3 56½ 56.91 55.81 2,743 634 139.5 54¾ 57.77 56.22 206 14-15 89 148.3 58¼ 59.33 58.61 3,428 81 149.8 58¾ 59.80 58.56 240 15-16 31 152.2 60 62.24 61.36 3,498 28 149.1 58½ 60.93 59.41 201 16-17 1 1480 58 1 154 60½ 88 AVERAGE WEIGHTS, 1910. Age. Boys. Girls. Total No. Weighed, W'stow. Kilos. Lbs. British Association, 1883. Total No. Weighed, W'stow. Kilos. Lbs. British Association, 1883. General Population. Lbs. Class IV. Artizans. Lbs. No. Weighed. General Population. Lbs. Class IV. Artizans. Lbs. No. Weighed. 4-5 205 16.6 36¾ 37.3 38.6 102 182 16.7 37 36.1 35.8 97 5-6 860 17.4 40 39.9 40.9 193 798 16.7 37 39.2 40.3 160 6-7 217 19.7 43 44.4 44.6 224 278 18.1 42 41.7 43.1 178 7-8 676 21.6 47 49.7 50.7 246 695 20.8 45½ 47.5 46.2 148 8-9 8 21.4 46¾ 54.9 54.3 820 10 20.7 45½ 52.1 51.8 330 9-10 12 26.7 58½ 60.4 58.3 1,425 5 25.5 56¼ 55.5 55.2 535 10-11 12 27 59½ 67.5 64 1,464 12 25.8 57 62 60.5 495 11-12 17 29.3 68¼ 72 69 1,599 6 29.8 60½ 681 66.8 456 12-13 451 32.7 72¼ 76.7 72 1,786 380 32.6 72 76.4 74.9 419 13-14 743 35.8 78½ 82.6 79 2,443 634 36.4 80 87.2 84.9 209 14-15 89 38.9 85½ 92 87.2 2,952 81 40.9 90 96.7 97.7 229 15-16 31 41.3 91 102.7 96.4 3,118 28 50.5 111 106.3 107.6 187 16-17 1 38.5 85 1 40 88 113.1 128 Table of Defects found on Medical Inspection. AGE. Number Examined. Parent Present. Clothing. Footgear. Head. Body. External Eye Disease. Vision. Nutrition. Teeth. Tonsils. Adenoids. Ear Diseases. Glands. Rickets. Speech. Heart Affection. Lung Affection. Tuberculosis. Mental Condition. Nervous System. Spinal Deformities. Infectious or Contagious Diseases. Other Diseases. Average Number in Family. Cleanliness. Other Particulars. Cleanliness. Oth'r P'rticlrs. Cleanliness. Decay. Good. Fair. Bad. Good. Fair. Bad. Clean. Somewhat Dirty. Very Dirty. Scurf. Nits. Lice. Clean. Somewhat Dirty. Very Dirty. Fleabites. Lice. Both Eyes Good. One Eye Good. „ ,, Slightly Defective. Both Eyes Slightly Defective. One Eye Good. „ „ Very Detective. One Eye Slightly „ ,, Very Defective. Both Eyes Very Defective. Good. Normal. Below Normal. Bad. Clean. Somewhat Dirty. Foul. Average Number of Decayed Teeth per Child. Slightly Enlarged. Considerably Enlarged. Urgently Requiring Removal. Probable. Mouth Breathing. Requires Operation. Cerumen in Excess. Otorrhoea. Perforation. Defective Hearing. Slightly Enlarged. Considerably Enlarged. Bright. Average. Dull. BOYS— 4-5 205 115 184 21 - 179 25 1 203 2 - 2 3 - 200 5 - 2 - 6 - - - - - - 72 131 9 - 65 135 5 1.4 30 8 1 1 - - - 2 - -- 4 - - - 23 18 - 53 151 1 3 - 2 - 4.4 5-6 860 562 756 99 5 752 86 22 814 46 - 8 33 5 788 72 - 33 2 47 - - - - - - 198 166 2 - 179 658 23 2.2 142 47 1 3 1 - - 8 - 4 18 5 3 10 76 114 3 232 622 6 2 - 8 13 4.0 6-7 217 126 171 43 3 172 40 5 203 14 - - 16 - 193 24 - 9 - 11 215 1 - - - 1 27 182 8 - 22 193 2 2.0 24 9 - 1 - - - 2 - - 6 - 1 8 24 26 2 43 164 10 2 - 3 7 3.9 7-8 676 378 575 99 2 561 103 12 652 23 1 3 31 - 632 44 - 25 - 28 585 26 23 13 7 22 107 565 4 - 111 563 2 2.3 10 27 - 3 2 - - 4 - 4 10 - 3 8 90 61 4 128 525 23 - 1 7 11 4.1 8-9 8 5 6 2 - 5 3 - 8 - - - 3 - 7 1 - 2 - - 6 1 1 - - - - 8 - - 1 7 - 3.0 3 - - - - - - - - - - - - - 1 - - - 8 - - - - - 5.3 9-10 12 4 10 1 1 10 2 - - 11 1 - - 1 - 10 2 - 1 2 - 7 2 2 - 1 - 11 1 - 2 8 2 2.4 4 - 1 1 - - - - - 2 - - - 1 4 1 1 - 11 1 1 - 1 - 5.0 10-11 12 7 9 3 - 8 2 2 12 - - - - - 11 1 - - - 2 8 - - 1 - 3 2 9 1 - 2 10 1 4.5 2 1 - - - - - 1 - 1 2 - - 1 1 - - 2 8 2 - - 1 - 5.4 11-12 17 5 16 1 - 15 1 1 16 1 - - - - 15 2 - - - 3 7 - 1 2 2 5 2 15 - - 4 10 3 2.0 - - 1 - - - - - - - - - - - 2 1 1 3 12 2 - - - 1 5.4 12-13 451 112 392 57 2 393 45 13 446 5 - 3 8 1 438 13 - 11 1 96 379 19 10 10 12 51 66 379 6 - 84 330 37 1.8 41 11 4 2 2 - 1 7 1 11 3 - - 10 67 11 1 59 380 12 - 1 2 4 5.3 13-14 743 146 627 105 11 644 77 22 719 24 - 5 8 1 707 36 - 9 - 19 625 40 13 33 5 27 158 583 1 1 145 549 49 2.0 82 21 2 1 1 - - 5 1 - 4 1 - 8 94 11 2 124 600 19 2 1 2 10 5.0 14-15 89 12 82 7 - 86 3 - 88 1 - - 1 - 88 1 - 1 - 6 72 7 2 4 - 4 22 65 2 - 27 55 7 2.0 3 4 - - - - - - - 3 2 - - 2 13 5 1 12 73 4 1 - - 4 5.0 15-16 (H. E. S.) 31 2 31 - - 31 - - 31 - - 1 - - 31 - - - - - 26 2 - - 1 2 15 16 - - 12 18 1 2.9 3 - - - - - - - - - - - - - - - - 10 21 - - - - 1 4.0 16-17 1 - 1 - - - - - 1 - - - - - 1 - - - - - 1 - - - - - - 1 - - - 1 - 3.0 - - - - - - - - - - - -- - - - -- - - 1 - - - - - 2.0 3322 1474 2860 438 24 2857 387 78 3204 117 1 22 104 7 3121 201 - 96 3 220 1931 98 52 63 27 86 669 2625 27 1 654 2536 132 2.4 434 128 10 12 6 - 1 29 2 25 49 6 7 48 395 248 15 666 2576 80 11 3 26 51 4.5 GIRLS— 4-5 182 124 155 27 - 150 31 1 177 5 - 3 28 5 179 3 - 6 6 6 - - - - - - 64 118 - - 52 127 3 .7 30 13 2 5 - - - - - - 1 - - 2 8 16 1 78 104 - 1 1 1 1 4.1 5-6 798 571 719 75 4 703 85 10 782 15 1 11 150 9 787 11 - 26 - 45 - - - - - - 157 637 4 - 179 611 8 1.5 142 36 2 4 2 - - 6 - 1 13 1 1 8 60 92 8 239 557 2 2 1 3 11 4.0 6-7 278 169 239 37 2 242 27 9 265 11 2 2 83 5 261 15 2 17 - 28 271 3 2 - 1 1 29 247 2 - 43 230 5 2.5 50 14 2 2 - - - 1 - 2 5 - 5 1 30 37 5 83 191 4 5 1 1 7 4.2 7-8 695 458 591 100 4 568 116 11 678 16 1 31 230 11 664 31 - 22 - 38 595 28 27 15 11 19 80 606 6 3 138 554 3 1.9 119 37 1 5 1 - - 4 - 3 5 2 - 3 69 58 3 145 541 9 2 - 6 5 4.9 8-9 10 5 5 3 2 6 2 2 9 1 - 1 4 1 8 2 - 1 - - 10 - - - - - - 9 1 - 2 8 - 3.2 2 - - - - - - - - - - - - - 1 - - 1 8 1 - - - - 5.2 9-10 5 1 4 1 - 4 1 - 5 - - - - - 5 - - 2 - - 5 - - - - - 1 4 - - 1 4 - 1-6 1 - - - 1 - - - - - 1 - - - - - - 2 1 2 - - - - 4.6 10-11 12 4 6 5 1 6 5 1 12 - - - 2 1 12 - - - - 2 3 1 1 2 - 5 - 12 - - 2 9 1 2.5 3 - - - - - - - - - 1 - - - 1 - 1 - 10 2 - - - - 5.2 11-12 6 2 5 1 - 5 - 1 6 - - - 1 - 6 - - - - 1 4 1 - - - 1 - 6 - - 1 4 1 1.6 - - - - - - - - - -- 1 - - - 2 3 — 1 4 1 - - - - 4.8 12-13 380 198 317 55 8 314 52 14 366 14 - 2 85 2 375 5 - 16 - 10 314 19 12 12 4 19 45 334 1 - 130 241 9 1.0 28 9 - 3 - - 1 4 1 4 5 1 - 4 64 11 2 49 325 6 3 1 1 6 4.6 13-14 634 282 487 137 10 494 116 24 633 1 - 21 208 2 678 6 - 13 - 25 533 28 13 20 10 29 173 454 6 1 205 410 19 3.4 53 29 3 3 3 - - 6 - 5 5 3 - 8 105 11 2 92 521 21 4 - 3 9 5.2 14-15 81 39 78 3 - 78 3 - 81 - - 4 11 - 81 - - 1 - 3 62 4 1 5 5 4 40 41 - - 48 30 3 1.5 8 3 - - - - - - - 1 - - 2 - 16 - 2 19 61 1 1 - - 3 4.8 15-16 28 19 28 - - 28 - - 28 - - 1 3 - 28 - - - - 1 26 - - 1 1 - 19 9 - - 19 9 - 2.0 2 - - - - - - 1 - 1 - - - - 1 - - 16 12 - - - - 2 6.1 16-17 1 1 1 - - 1 - - 1 - - - - - 1 - - - - - 1 - - - - - - 1 - - 1 - - 1.0 - - - - - - - - - - - - - - -1 - - - 1 - - - - - 9.0 3110 1873 2635 444 31 2599 438 73 3043 63 4 79 805 36 3035 73 2 104 - 159 1824 85 56 55 32 78 608 2478 20 4 821 2237 52 2.0 438 141 10 22 7 - 1 22 1 17 37 7 8 26 358 227 24 725 2336 49 18 4 15 44 5.0 TOTALS. BOYS 3322 1474 2860 438 24 2857 387 78 3204 117 1 22 104 7 3121 201 - 96 3 220 1931 98 52 63 27 86 669 2625 27 1 654 2536 132 2.4 434 128 10 12 6 - 1 29 2 25 49 6 7 48 395 248 15 666 2576 80 11 3 26 51 4.5 GIRLS 3110 1873 2635 444 31 2599 438 73 3043 63 4 79 805 36 3035 73 2 104 - 159 1824 85 56 55 32 78 608 2478 20 4 821 2237 52 2-0 438 141 10 22 7 - 1 22 1 17 37 7 & 26 358 227 24 725 2336 42 18 4 15 44 5.0 6432 3347 5495 882 55 5456 825 151 6247 180 5 101 909 43 6156 274 2 200 3 379 3755 183 108 118 59 164 1277 5103 47 5 1475 4773 184 2.2 872 269 20 34 13 - 2 51 3 42 86 13 15 74 753 475 39 1391 4912 129 29 7 41 95 4.7 Table of Defects—Three age groups in two selected Schools. Description of School. SCHOOLS. Age. Number Examined. Parent Present. Clothing. Footgear. Head. Body. Vision. Defective Hearing. Nutrition. Average Height. Average Weight. Teeth. Tonsils. Adenoids. External Eye Disease. Ear Diseases. Glands. Rickets. Speech. Heart Affection. Lung Affection. Tuberculosis. Mental Condition. Nervous System. Spinal Deformities. Infectious or Contagious Diseases. Other Diseases. Average Number in Family. Cleanliness. Other Particulars. Cleanliness. Oth'r P'rticlrs. Cleanliness. Decay. Good. Fair. Bad. Good. Fair. Bad. Clean. Somewhat Dirty. Very Dirty. Scurf. Nits. Lice. Clean. Somewhat Dirty. Very Dirty. Fleabites. Lice. Both Eyes Good. One Eye Good. „ „ Slightly Defective. Both Eyes Slightly Defective. One Eye Good. „ Very Delective. One Eye Slightly „ „ Very Defective. Both Eyes Very Defectixs. Good. Normal. Below Normal. Bad. Clea n. Somewhat Dirty. Foul. Average Number of Decayed Teeth per Child. Slightly Enlarged. Considerably Enlarged. Urgently Requiring Removal. Probable. Mouth Breathing. Requires Operation. Cerumen in Excess. Otorrhoea. Perforation. Slightly Enlarged. Considerably Enlarged. Bright. Average. Dull. BOYS— Poor Markhouse Road 5-6 62 88.7 82.2 17.7 - 79.3 14.5 6.1 88.7 11.2 - 1.6 9.6 3.2 75.8 24.1 - 11.2 - - - - - - - - 21.6 79.3 - - 101.3 17.3 9.6 88.7 1.6 1.6 16.1 1.6 1.6 - - 6.4 - - - - - - 1.6 16.6 30.9 - 14.1 85.4 - - - 1.6 - 4.8 Good Maynard Road 5-6 56 64.2 96.4 3.5 - 96.4 3.5 - 100.0 - - - 1.6 - 100.0 - - - - - - - - - - - 25.0 75.0 - - 103.3 17.5 23.2 71.4 5.3 2.2 21.4 8.9 - 1.7 - - 5.3 - 1.7 - 1.7 3.5 1.7 5.3 3.5 14.2 - 42.8 57.1 - - - 1.7 - 3.3 Poor Markhouse Road 7-8 42 33.3 76.1 23.9 - 73.8 14.2 11.4 90.4 9-5 - - 11.9 - 85.7 142 - 11.9 - 88.1 - 2.3 2.3 2.3 4.7 - 14.2 85.7 - - 112.7 212 7.1 92.8 - 1.1 21.4 - - - - - 7.1 - - - 2.3 - - - 19.4 14.2 2.3 23.9 76.1 - - - - -- 5.4 Good Maynard Road 7-8 60 58.3 90.0 10.0 - 93.3 6.6 - 100.0 - - - - - 100.0 - - - - 88.3 1.6 3.3 1.6 1.6 3.3 - 20.0 80.0 - - 117.1 21.5 30.0 70.0 - 2.4 6.6 5.0 - - - - - - - - - - - 1.6 13.3 5.0 - 26.6 68.3 5.0 - - 1.6 1.6 3.5 Poor Markhouse Road 13-14 17 29.6 82.3 17.6 - 58.8 29.4 11.7 100.0 - - - - - 94.1 5.8 - - - 82.3 5.8 - 5.8 - 5.8 - 17.6 82.3 - - 142.4 352 11.7 64.7 23.5 2.2 17.6 5.8 - - - - - - - - - - - - - - - 23.5 76.4 - - - - - 6.9 Good Maynard Road 13-14 67 1.4 85-1 13.4 1.4 100.0 - - 100.0 - - - - - 100.0 - - - - 86.5 4.4 1.4 4.4 - 2.9 - 20.8 79.1 - - 145.3 36.5 25.3 73.3 1.4 1.5 10.4 1.4 1.4 - - - - - ~ - - - - 4.4 13.4 - - 7.4 89.5 2.9 1.4 - - - 4.7 GIRLS— Poor Markhouse Road 5-6 44 54.5 86.3 11.3 2.2 84.1 11.3 4.5 93.1 6.8 - - 61.3 - 95.4 4.5 - 2.2 - - - - - - - - 15.9 84.0 - - 101.6 16.9 15.9 84.0 - 1.1 20.4 2.2 - - - - 4.5 - - - 2.2 - - - 4.5 13.6 - 45.4 54.6 - - - - 2.2 5.1 Good Maynard Road 5-6 46 76.0 97.8 2.1 - 97.8 21 - 100.0 - - 2.1 8.6 - 100.0 - - - - - - - - - - - 13.1 84.7 2.1 - 108.3 16.1 15.2 84.7 - 1.7 19.5 6.5 - 4.3 - - 2.1 - - - 6.5 - - - 15.2 19.5 - 26.0 73.9 - - - - - 3.5 Poor Markhouse Road 7-8 51 62.7 80.3 19.6 - 70.5 25.4 3.9 92.1 7.7 - 5.8 70.5 - 78.4 21.4 - 9.8 3.9 72.5 5.8 7.8 5.8 3.9 3.9 - 5.8 92.1 1.9 - 114.0 19.9 7.8 92.1 - 1.5 25.8 11.1 - 1.9 - - 9.8 - 3.9 - 1.9 - - - 13.7 14.7 - 21.5 74.5 3.9 1.9 - - - 5.4 Good Maynard Road 7-8 62 75.8 88.7 11.2 - 90.3 9.6 - 100.0 - - 1.6 14.5 - 100.0 - - - - 85.4 3.2 4.8 1.6 1-6 3.2 - 16.1 83.8 - - 113.0 21.8 27.4 72.5 - 1.7 16.1 16 - 1.6 - - - - - - 1.6 - - 11.2 4.8 3.2 16.1 83.8 - - - - - 4.2 Poor Markhouse Road 13-14 21 47.6 52.3 23.8 23.8 52.3 19.1 28.5 100.0 - - - 52.3 - 100.0 - - 9.5 - 80.9 4.7 - - 4.7 9.5 - 28.5 66.6 4.7 - 142.3 37.1 14.2 85.7 - 1.8 9.5 4.7 4.7 - - - - - 4.7 - 4-7 4.7 - 4.7 9.5 - 4.7 19.1 61.8 19.1 - - - 6.5 Good Maynard Road 13-14 44 20.4 95.4 4.5 - 88.6 9.1 2.2 100.0 - - 2.2 11.3 - 100.0 - - - - 81.8 4.5 - 2.2 2.2 9.1 - 29.5 70.4 - - 144.9 38.9 61.3 36.3 2.2 2.7 15.9 4.5 - - - - 4.5 - - - - " - 2.2 13.6 - - 13.6 84.1 2.2 - " - - 5.5 TOTAL PERCENTAGES. BOYS Poor 121 44.6 80.2 19.8 - 74.3 16.5 9.1 90.9 9.1 - 0.8 9.1 1.6 81.8 18.1 - 9.9 - 42.1 0.8 0.8 1.6 0.8 2.4 - 18.1 81.8 - - - - 9.1 86.7 4.1 1.6 18.1 1.6 - 0.8 - - 5.8 - - - 0.8 - - 0.8 12.4 15.7 0.8 19.0 80.9 - - - 0.8 - 5.7 Good 183 44.3 90.1 9.3 0.5 96.7 3.3 - 100.0 - - - 0.5 - 183.0 - - - - 60.6 2.1 1.6 2.1 0.5 2.1 - 21.8 78.1 - - - - 26.2 71.5 2.1 2.0 12.5 4.9 0.5 0.5 - - 1.6 - - - 0.5 1.0 0.5 3.8 10.3 6.0 - 24.5 72.7 2.7 0.5 - 1.0 0.5 8.8 GIRLS Poor 116 56.0 77.6 17.2 5.1 72.4 18.9 8.6 93.9 6.0 - 2.5 63.7 1.7 88.7 11.2 - 6.8 1.7 46.5 3.4 3.4 2.5 2.5 3.4 - 13.7 84.4 0.8 - - - 12.0 87.9 - 1.4 20.6 6.8 0.8 0.8 - - 6.0 - 2.5 - 2.5 0.8 - 0.8 9.4 12.0 0.8 30.2 64.6 5.1 0.8 - - 0.8 5.6 Good 152 59.2 93.4 6.5 - 92.1 7.2 0.6 152.0 - - 1.9 11.8 - 152.0 - - - - 58.5 2.6 1.9 1.3 1.3 3.9 - 19.1 80.2 0.6 - - - 33.6 65.7 0.6 2.0 16.4 3.9 - 1.9 - - 1.9 - - - 1.9 0.6 - 0.6 13.1 8.5 0.6 18.4 80.7 0.8 - - - - 4.4 89 STATEMENT OF THE CHIEF DEFECTS REVEALED BY INSPECTION. Defect or Disease. No. of Children. Percentage. Verminous condition (bad) 43 0.7 Pediculosis Nits 909 14.0 Defective Vision 632 9.8 External Eye Disease 379 6.0 Otorrhcea 51 0.8 Defective Hearing 42 0.7 Nutrition—below normal 47 0.8 ,, bad 5 Adenoids 34 0.7 Mouth Breathers 13 Considerably Enlarged Tonsils 269 4.5 Urgently requiring Removal 20 Defective Teeth requiring immediate attention 184 3.0 Tuberculosis 39 0.6 Lung or Bronchial Affections 475 7.3 Diseases of Nervous System 37 0.6 Spinal Deformities 7 0.01 Heart Affections 753 11.7 The large numbers returned as suffering from heart and lung affections are made up largely of those noted as "Cardiac Weakness" and "Bronchial Catarrh." SUMMARY OF DEFECTS. The preceding Tables give the Summary of defects for boys and girls at the different ages and for all schools, and for three age groups in two schools selected as representative of two classes of children —those mainly of well-to-do and poorer parents. (d) GENERAL REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION. Clothing and Footgear.—Fifty-five children were found to have bad clothing and 151 with bad boots, less than 1 and 2-5 per cent, of the total. In comparing the "good" and "bad'' schools, however, it is found that while the percentage with insufficient clothing and footgear is neglible for "good" schools, the "bad" ones rise to 5 and 9 per cent, respectively. This result is what one would expect. 90 As showing the influence that Head Teachers may exercise in this respect and how much good work on behalf of the poorer children some of them carry out, I may mention that of 148 children examined in one Infant School in a poor district only 1 child had bad boots. The remainder were classed as 137 "good," 10 "fair." In the school referred to a large boot club is run on provident lines and 300 pairs of boots were supplied to the children during 1910. The total sum expended was £53 3s. 7d , of which the Head Teacher provided £8 8s by means of entertainments and donations from friends. A central boot fund has recently been established under the control of the Education Authority, the funds for which will be procured by voluntary subscriptions and by the aid of entertainments, so that it is to be hoped our very poorest children everywhere will be in the future well cared for in this respect. NUTRITION. This is a relative condition and difficult to classify, and in drawing inferences from the findings the personal views of the inspecting doctor must be known as they largely influence the classification. Forty-seven children were found whose nutrition was below normal, and five badly nourished. These figures are very low ones, showing less than 1 per cent, badly nourished, and are a great contrast with those of last year and with what has been recorded elsewhere. All children likely to be insufficiently fed, owing to the non-employment of the parents are supplied daily with a good dinner at the Canteen Centre. CLEANLINESS OF HEAD AND BODY. Of the 6,432 children inspected, 46 (girls 39, boys 7) were found to be verminous, and 909 (girls 805, boys 104) had nits in the hair. The 909 evidently had recently suffered from vermin, and probably surprise visits to all schools would prove that a much larger percentage than that recorded of our poorer girls suffer more or less from head lice. Among the 354 children seen by me at the request of the Head Teachers, about 25 per cent, of them were presented for this condition. The children suspected by the class teachers to be so suffering were the poorest and most neglected looking, but a large proportion of them were found to be quite free. My own experience, as well as the recorded figures prove that there has been a marked improvement in the general cleanliness of the heads of all our children. Very few had vermin on their clothing or bodies. No prosecutions have been undertaken, and with tact and sympathy on the part of those engaged in dealing with the children all that is required can be accomplished. 91 TEETH. The condition of the mouth and teeth in 184 of the children was found to be foul and dirty, and the percentage with carious teeth varied according to the age of those examined. About 15 per cent, of those between 7 and 8 years and 6 per cent, of those between 13 and 14 had five or more carious teeth. A considerable amount of ill health is caused by bad teeth, but it is difficult to get the parents to realise this and seldom is any dental treatment procured further than the extraction of foul stumps. The poor have so many calls on their slender purses that one can hardly expect it. By advice and encouraging the children, a much larger proportion now use tooth brushes than heretofore as evidenced by the cleanly condition of the teeth of the great majority. TONSILS. Two hundred and sixty-nine children suffered from considerably enlarged tonsils, and twenty required urgent removal. The younger children were most affected, and the percentage (five) of all children whose condition would be improved by operation was similar to that found in the previous year. ADENOIDS. Thirty-four children were noted as likely sufferers and the thirteen others returned as mouth-breathers may be so considered. These figures cannot represent the total, as a very considerable number of those with enlarged tonsils have probably also growths in the nasopharynx. Without a digital examination, which is not undertaken, a correct diagnosis cannot be made, although the expression and characteristic appearance of these children are well known. Growths, whether to the back of the nose or in the tonsils, tend to mouth-breathing and partial deafness, and seriously interfere with the general physical and mental development of the child, and, next to defects of vision, they are the most serious among those found affecting our school children. The greater attention now paid at all our schools to drill and breathing exercises in the open air may account for the small number of those defects noted in older children, and it is well known that these growths tend to diminish with age. Indiscriminate operations for such conditions would be unwise. EAR DISEASE. Forty-one children were found to be suffering from discharging ears. 92 GLANDULAR ENLARGEMENTS. Eighty-six children suffered from slight and thirteen from considerably enlarged glands. These were generally the result of irritation from bad teeth or pediculosis. Those suffering from tubercular glands were few. EXTERNAL EYE DISEASES. These were generally of a simple nature, such as sore lids or styes; children with ulcers are referred to me by the teachers, and the parents are advised. VISION. Children unable to read and under six years of age are not subjected to anv vision test except for special reasons. The following tabular statement shows the vision of those inspected:— Boys. Girls. Good. Moderate. Bad. Ages. Good. Moderate. Bad. 215 1 1 6 to 7 271 5 2 585 49 42 7 to 8 595 55 45 6 2 - 8 to 9 10 - - 7 4 1 9 to 10 5 - - 8 - 4 10 to 11 3 2 7 7 1 9 11 to 12 4 1 1 379 29 43 12 to 13 314 31 35 625 53 65 13 to 14 533 42 59 72 8 9 14 to 15 62 5 14 26 2 3 15 to 16 26 - 2 1 - 16 to 17 1 - - 1931 149 177 1824 141 165 Good—6/6 or 6/9 in both eyes, or 6/6 in one and f in the other. Moderate—6/9 and 6/12 or 6/12 in both eyes. Bad—6/12 and over in one or both eyes. About 85.5 per cent, of the children examined have "good" vision, 6-5 per cent. "moderate," and 8 per cent. "bad," and the influence of School work upon vision is shown in the percentages for the different ages as follows:— Boys. Girls. 6 to 7 years 99 per cent. 97.4 per cent. 7 to 8 years 86.5 per cent. 85.6 per cent. 12 to 13 years 84 per cent. 82.6 per cent. 13 to 14 years 84.1 per cent. 84 per cent. 93 SPEECH DEFECTS. Eighty-four children were found to have defects of speech. Many of them suffered simply from defects due to habit and home associations, which are remedied in the normal course of school work ; those with stutter were shown how to overcome their difficulty, and the teachers' attention was drawn to the necessity of breathing exercises and patience in dealing with these children. A boy aged 11 years, with considerable stammer, assured me that his disability of three years' standing was entirely due to the impatience of his class teacher! This is possible, but it must be a very rare occurrence. MENTAL CONDITION. One hundred and twenty-nine of the 6,432 children inspected were returned as being of mental capacity below the average, 1,391 as bright, the remainder average. All children who in the judgment of the teachers are incapable of receiving benefit from the instruction given in the ordinary schools are referred to me. During the year 50 such children were examined, and 17 of them certified as coming under the Defective and Epileptic Act of 1899. They were transferred to the Special School. HEART DISEASE. The percentage of children with serious heart disease was very small. Seven hundred and fifty-three were suffering from cardiac weakness, which was mainly the result of debility or general weakness. The association of enlarged tonsils and unhealthy conditions of fauces with cardiac symptoms was looked on as due to rheumatism, and the parents were advised accordingly. Rheumatism in children is quite a common affection, but parents seldom look upon pains in the limbs as other than "growing pains." No greater mistake can be made by those having the care of children. PHTHISIS Thirty-nine children were found to have symptoms indicative of this disease; but it is not always easy to make a correct diagnosis. The majority of the children were under observation by their own doctors, or at the Hospitals, and when expectoration was present—which was very uncommon—a bacteriological examination was made. Unless a positive diagnosis was made, children were not excluded, but general and printed instructions were given to the parents. All the children will be visited at their homes during the holidays by the School Nurse, and those of them with wasting, cough, or expectoration, will be re-examined. 94 RICKETS—DEFORMITIES. Only 15 children were found to have symptoms of Rickets. This disease is seldom found in children of school age, and only in so much as its bad after-effects militate against the child's mental progress is it of importance. Rickety or bow-legs and knock-knee are quite a rarity among our school children. The observed prevalence of early decayed and defective teeth, and catarrhal conditions of the throat and naso-pharynx, would indicate that many of the children in infancy had suffered from the disease. SKIN DISEASES. Forty-one children were found suffering from skin affections. Most of them were of minor importance. All children suspected by the Head Teacher to be suffering from Ringworm, Scabies, and Impetigo are referred to me, and are seen on Mondays, Wednesdays, and Fridays at the Town Hall. Those found to have Scabies are few, and usually return to school within a week. Impetigo soon yields to suitable treatment, but Ringworm is a source of much loss of schooling to many children. An average of 70 children are absent from school throughout the year from this cause, and it is to be hoped that in the coming year some method will be devised for dealing more satisfactorily with those children. ACTION TAKEN TO PREVENT THE SPREAD OF INFECTIOUS DISEASES. The measures adopted are detailed on page 88 of my report to the Council. Arising out of the supervision of the schools, fourteen cases of Scarlet Fever and two of Diphtheria were discovered among the school children. No school has been closed during the year through infectious disease. Such a procedure could only be thought of for Measles and Whooping Cough, and the practice of exclusion adopted for years has been continued. The following instructions are carried out by the Attendance Officers:— "No child from a Measles infected house can attend any Infants' School. "No child under 10 years of age who has not had Measles can attend any school if coming from a Measles infected house. "Children who have had Measles, or are over 10 years of age, may attend a Junior Mixed or Boys' or Girls' School. RETURN showing the number of Cases of WHOOPING COUGH and MEASLES of Children attending the PUBLIC ELEMENTARY SCHOOLS. 1910. SCHOOL. DEPARTMENT. JAN. FEB. MAR. APRIL MAY. JUNE. JULY. AUG. SEPT. OCT. NOV. DEC. TOTALS. M. w.c. M. w. c. M. w.c. M. w.c. M. w. c. M. w.c. M. w.c. M. w. c. M. w. c. M. w.c. M. w. c. M. w.c. M. ] w.c. William Morris Boys — — — — — — — — — — — — — — MIDSUMMER VACATION. — — — — — — — — — — Girls — — — — Ope ned in J une. — — — — — — — — — — — — — — Mixed — — 6 — 8 — 2 — — — — — — — — — — — — — — — 16 — Pretoria Avenue Boys — — — — — — — — — — — — — — — — — — — — — — — — Girls — — — — — — 13 — 9 — 1 — — — — — — — — — — — 23 — Infants — 20 — 26 3 22 38 31 26 22 16 16 16 21 — — — — — — — 2 99 160 Deaf Centre Mixed — — — — 1 — — 1 — — — — — — — — — — — — — — 1 1 E. Maynard Road Boys — — — — — — 2 — — — — — — — 6 — — — — — — — 8 — Girls 3 — 6 — 36 — 2 — — — — — — — 6 — 2 — — — — — 55 — Infants 7 — 50 2 84 2 32 4 4 6 — 2 — — 8 — 5 — 2 — — — 192 16 St. Mary's Girls — — 2 — 6 — 4 — — — — — — — 2 — — — — — — — 14 — Infants 1 7 2 8 52 6 24 2 4 6 — 2 2 — 1 — — — — — — — 86 31 N.W. Blackhorse Road Boys — — — — 1 — — 3 1 3 1 4 — — — — — — — — — — 3 10 Girls — 1 — — — — 4 — 3 — 1 — 2 — — — — — — — — — 10 1 Infants — 23 — 26 2 24 64 27 92 13 16 18 6 3 — — — — — 31 — 68 80 233 H'gham Hill Boys — — — 1 — 1 — — — — — — — — — — — — — — — — — 2 Girls — — — 1 — — — — — — 3 — — — — — — — — — — — 3 1 Infants — 21 — 36 — 19 21 5 72 1 45 — 11 — — — — — — 8 — 16 149 106 Temp. Infants — 2 — — — — 1 — 2 — 6 — 4 — — — — — — — — — 13 2 Junior Mixed — 1 1 — — — — — 1 — 6 — 1 — — — — — 3 — 2 — 14 1 N.E. Wood Street Boys — — — — — — — — — — — — — — — — — — — — — — — — Girls — — — — — — — — — — — — — — — — — — — 2 1 — 1 2 Infants — — — — — — 3 5 3 4 21 — 3 — — — — — — — 5 — 35 9 Joseph Barrett Boys — — — — — — — — 1 — — — — — — — — — — — — — 1 — Girls — — — — — — — — — — — — — — — — — — — — — — — — Infants — — — — — — 67 — 51 — 3 — — — — — — — — — — — 121 — Shernhall Street Special (Boys) — — — — — — — — 1 — — — 2 — — — — — — — — — 3 — „ (Girls) — — — — — — — — — — — — — — — — — — — — — — — — St. George's Mixed — — — — — — — — — — — — — — — — — — — — — — — — C. Coppermill Lane Boys — — — — 4 -— 2 — 1 — — 3 — 4 — — — — — — — — 7 7 Girls — 1 2 — 1 — 4 2 — 3 1 2 2 8 1 — — — — — — 3 11 19 Infants 6 17 24 18 107 23 33 11 6 5 6 19 2 34 — 11 1 — — — 5 3 190 141 Junior Mixed — — — — — — — — — — — — — — — — — — — — — — — — Mission Grove Girls — — — 2 — — 2 1 — — — — 1 1 — 1 — — — — — — —— 5 Infants 17 3 30 11 25 13 14 8 10 14 9 10 5 — 1 — 7 — 4 — 5 59 127 N. Chapel End Boys — — — — — — — — — — 2 — — — — — — — — — — — 2 — Girls — — — 2 — 5 — 8 3 2 5 — — — — — — — — — — — 8 17 Infants — 18 — 71 — 118 9 123 51 52 119 10 — 4 — — — — — — — — 179 396 Junior Mixed — — — 3 — 3 3 2 7 — 23 — 3 — — — — — — — — — 36 8 Selwyn Avenue Senior Mixed — — — — — — 1 — 4 3 — 3 2 — 1 — — — — — — — 8 6 Junior Mixed — 2 — 10 — 46 1 122 4 61 89 23 150 20 6 — 1 — — — — — 251 284 S.W. St. Saviour's Boys — — — — — — — — — — — — — — — — — 1 — — — — — 1 Girls — — — — — 1 2 — — — 3 — 6 — — 4 — — — — — — 11 5 Infants — 27 — 24 — 28 — — 4 1 67 1 32 2 — — — — — — 4 1 107 84 Markhouse Road Boys — — — 1 — 1 — — — — — — 1 — — — — — 1 — 2 — 4 2 Girls 1 — 4 1 — — — — — — 2 — — — — — — — — — 4 — 11 1 Infants 60 6 40 5 25 12 11 65 3 60 1 3 — 2 — 2 1 11 4 22 12 188 157 Junior Mixed — 25 4 14 2 10 3 — 5 — 8 — 9 — — — 1 — 2 — 4 — 38 49 s. Queen's Road Boys — 1 1 4 — 3 — 1 — — — — — — — — — — 9 1 Girls — 3 — 2 2 1 8 — 7 2 2 — 2 — — — — — — — — — 21 8 Infants — 62 48 2 22 54 18 13 6 10 5 2 3 — 3 — — — 2 — 7 81 176 Gamuel Road Boys — 2 — 5 — — — 5 — 3 — — — — — — — — — — — — — 15 Girls — 12 — 6 — 3 — 1 — — — I 2 — — — — — — — — 1 2 24 Infants — 26 — 26 — 26 1 12 2 2 51 2 231 3 — 1 — — — 2 — 12 285 112 Marsh Street Boys — 2 — 2 2 1 3 1 3 1 2 — — — — — — — — — — — 10 7 Edinburgh Road Junior Mixed — 15 — 9 1 4 9 2 8 4 6 3 — 2 — — — — — — — — 24 39 E.C. Forest Road Boys — 3 — 4 — 3 — — — — — — — — — — — — — — — — 10 Girls — — — —- 3 — I — — — — — — — — — — — — — 4 — Infants — 36 — 55 2 38 76 6 86 4 13 1 7 7 — — — — — — — — 184 147 J Higher Elementary Boys — — — — — — — — — — — — — — — — — — — — — — — —— Girls — — — — — — — — — — — Winns Avenue Boys — — — — — — 12 2 — — — — — — 1 — — — — — — — 13 2 Girls — — — — — — — — — — — — — 3 — — — — — — — — — 3 Infants — 3 3 5 — 5 1 3 19 9 22 20 2 29 3 — 1 — 1 — — — 52 74 Junior Mixed — — 1 1 5 1 — — 3 — 1 — 11 3 2 — — — — — — — 23 5 TOTALS 18 406 114 479 338 464 533 422 573 226 626 145 525 152 - - 39 21 13 9 20 53 49 130 2848 2507 RETURN showing the number of Cases of SCARLET FEVER and DIPHTHERIA notified each month of Children attending the PUBLIC ELEMENTARY SCHOOLS. 1910. SCHOOL. DEPARTMENT. JAN. FEB. MAR. APRIL MAY. JUNE. JULY. AUG. SEPT OCT. NOV. DEC. TOTALS. s f. D. s.f. D. s.F. D. s.F. D. s.f. D. s.f. D. s.F. D. s.f. D. s.F. D. s.f. D. s.f. D. s.f. D. s. f. D. W.C. William Morris Boys — — — — — — — — — — — — — — — 1 1 1 — — 1 — — — 2 2 Girls — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — Mixed — — — — — — — — 1 — — — — — — — — — — — — — — — 1 — Pretoria Avenue Boys 1 — — — — — 1 — — — — — — — — — — — 1 — — — — — 3 — Girls — — 1 — — 1 — — — 1 — — — — — — — — — 1 — — — — 1 3 Infants — 1 — — — — — — — — — — — — — — — — — — — 1 — 2 — 4 Deaf Centre ... — — — — — — — — — — — — — — — — — — — — — — — — — — E. Maynard Road Boys — — — — — — — — — — — — — — — — 1 — 1 — Girls — — — — — — — — — — — — — — — — 1 — — 1 — — — — 1 1 Infants — — — — — — — — 1 — 1 — — — — — 1 — — — — — — 3 3 3 St. Mary's Girls — — — — — — 1 — — — — — — — — — — — — 1 1 2 — 2 2 5 Infants — — — 1 — — — — — 1 — — — — — — 1 — 2 1 — — 2 1 5 4 N.W Blackhorse Road Boys — — — — 1 — — — 1 — 1 — — 1 1 — — — — — — — — — 4 1 Girls — — 1 — — — 1 — — — 1 — 1 — — — — — — 1 — — — — 4 1 Infants — — — — 1 1 — — — 1 — — — — 1 — — — 2 — — — — 1 4 3 Higham Hill Boys — — 1 — — — — — — — — — — — 1 — — — — — — — — — 2 0 Girls — — — — 1 — — — — — 1 — 1 — — — — — — — — — — — 3 0 Infants 1 — — — — — — — — — — — — — — — — 1 — — 2 — — — 3 1 Junior Mixed — — — — — — — — — — — — — — — — — — — — — — — — — — Temp. Infants — — — — — — 1 — — — — — — — — — — —— — — — — — — 1 — N.E. Wood Street Boys — — — — — — — — — — — — — — — — — — — — — — — — — — Girls — — 1 — — — — — — — — — — 2 — — — — — — — — — — ] 2 Infants — — 2 — — — — — 2 — — 1 — — — — — — — — — — — — 4 1 Joseph Barrett Boys — — — — — — — — — — — — — — — — — — — — — — — — — — Girls — — — — — — — — — — — — — — — — — — — — — — — — — — Infants — — — — — — — — — — — — 1 — — — — — 1 — — — — — 2 — Sliernhall Street Special (Girls) — — — — — — — — — — — — — — — — — — — — — —— — — — — (Boys) — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — St. George's Mixed — — — — — — — — — — — — — — — — — — — — — — — — — — C. Coppermill Lane Boys 1 — — — — — 1 — — — — — — — — — — — — — — — — — 2 — Girls — — — — 1 — — — — — — — — — — — — — — — —— — — — 1 — Infants — — — — — 2 — — — — — — 1 — — — — — — — — — 1 — 2 2 Junior Mixed — — — — — —— — — — — — — — — — — — — — — — — — — — — Mission Grove Girls — — — — — — — — — — — — — — — — 7 — 1 — — — — — 8 — Infants — — — — — — — — — — — — 1 — — 4 — 2 — — — 1 1 8 1 N. Chapel End Senior Boys — — — — — — — — — — — — — — — — — — — — — — — — — — Senior Girls — — 2 — — — — — — — — — — — — — — — — — — — — — 2 — Infants — — 1 — — — — — — — — — — — — — — — 1 1 1 — — — 3 1 Junior Mixed — — — — — — — — — — — — — — — — — — — — — — — — — — Selwyn Avenue Senior Mixed — — — — — — — — — — 1 — — 1 — — — 1 —— — — — — 1 1 3 Junior & Infants — — — — 2 — — — — — — — — — — — — 3 1 — 1 — — 1 4 4 S.W St. Saviour's Boys — — — — — — — — — — — — — 1 — — — — — — — — — — — 1 Girls — — — — 1 — — — — — — — — 1 1 — — — — — — —— — — 2 1 Infants — — 1 — — — — — — 1 — — — — — — — 1 — 1 — — — 1 1 4 Markhouse Road Boys 1 — — — — — — — — — — — — — — — — — — — — — — — 1 — Girls — — — — — — — — — — — — — — — — — — — — — — — — — — Infants — — 1 — — — — — 1 — — — — — — — —— 1 — — — 1 — 2 2 Junior Mixed — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — s. Queen's Road Boys — — — — — — — — — — — — — — — — — — — — — — — — — — Girls 1 — — — 1 2 — — 1 - — — — — — — — — — — — — — 4 1 Infants 1 1 — 1 — — — 3 — 2 1 — — — — — — 1 1 1 — 1 — 1 3 11 Gamuel Road Boys — — — 1 — — — — — — — — — — — — — — — — — — —— — — 1 Girls — — — — — — — — — — — — — — — — — —— — — — — — — — — Infants — — — — — 2 1 — — 1 — — — — — — — — 1 — 1 — — — 3 3 Marsh Street Boys — — — — — — — — — — — — — — — — 2 1 — — — — — — 2 1 Edinburgh Road Junior Mixed — — — — — — — — 1 — — — — — — 1 1 — 1 — — — — — 3 1 E.C. Forest Road Boys — — — — 1 — — — — — — — — — — 1 — — — — — — — 2 — Girls — — — — — — — — — — — — — — — — — — — — — 1 — 1 — Infants — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — J Higher Elementary Boys — — — — — — —. — — — — 1 — — — — — 1 — — — — — 2 - Girls — — — — — 1 — — — — — — — — — — — — — — — — — 1 — Winns Avenue Boys — — — — — — — — — — — — — — — — — — — — — — — — — — Girls — — — — — 1 — — — — 1 — — — — — 1 — — — — — — — 2 1 Infants — 1 — — 1 — — — — — — — — 1 1 1 1 — — — — — 2 1 5 4 Junior Mixed — — — — — — — — — — — — — — — — 1 — — — — — — — 1 — TOTALS 6 3 11 3 10 7 9 3 7 8 7 1 6 7 5 3 24 10 18 8 7 5 7 15 117 73 Cases Notified 13 9 20 7 24 16 16 11 18 12 21 3 16 8 13 7 33 16 34 12 12 8 12 29 232 138 95 "Special care should be taken that no child attends school from a Measles infected house, unless the sufferer is properly isolated." The same regulations apply to Whooping Cough. The preceding tables show the numbers of children who were affected with Scarlet Fever, Diphtheria, Measles, and Whooping Cough at the different Schools MENTALLY DEFECTIVE CHILDREN. These attend the Shernhall Street Centre, and have been individually examined during the year, the parents being usually present by invitation. The Centre has accommodation for 65 boys and 65 girls, with an average attendance of 84. The children are of very poor social status, and many of them live at long distances from the Schools. In consequence irregular attendance is common, although the children are provided with free passes on the Municipal trams, and Attendance Officers supervise their coming and going to and from the School. Heretofore the standard adopted for differentiating the feeble-minded from the normal child was not high, and in consequence a number of children were admitted that proved eventually unsuitable for the Schools. At my examination of the children in September, I advised the exclusion of 17 of those in attendance, but pending an expected visit of Dr. Eicholtz this recommendation was not carried out until January of this year. In 1909 an effort made to establish an After-Care Committee was unsuccessful, but the Head Teacher of the Girls' School has during 1910 held weekly a social evening for those girls who have left the school, and thus keeps in touch with them. Twelve of the former pupils attend more or less regularly, and Miss Firman has been so far fairly successful in her efforts on their behalf. In November she had a sale of the articles made by the children, which realized £1 19s. 9d. Sixteen shillings profit made was distributed among the girls. With the help of friends the Head Teacher was also able to give two "treats "—one in the Forest and one at the School—which were much appreciated by the girls. Only a small percentage of children admitted to Special Schools can be expected to do well in after life. So far about 40 per cent, of our boys and 12 per cent, of our girls are "dcing well." Feebleminded children remain so permanently, and only with kindly supervision can they be expected in after life to become self-supporting. DEAF AND DUMB CHILDREN. The average number of these children in attendance is 21. They are taught at a Special Centre under the care of a master and mistress, and the work of that School is excellent in its results. 96 The children are certified for by me, and were inspected during the year. METHODS EMPLOYED OR AVAILABLE FOR TREATMENT. As already recorded, an Ophthalmic Surgeon now deals with all vision defects, and sanction to an expenditure up to £25, if necessary, for the gratuitous provision of spectacles has been obtained. There is a local Children's Hospital and General Dispensary voluntarily supported, but neither makes any provision for dealing with the defects common to school children, and treatment at the Hospital, except in the case of accidents, can only be obtained by letter and recommendation. In the 1910 report of that institution I notice that among the outpatients treated were 149 for eye, ear and nose diseases, 626 for dental trouble, and presumably 96 were operated upon for Tonsils and Adenoids. Following upon inspection, the parents of all children with serious defects are advised personally or by letter to seek advice and treatment from the family doctor and in many instances this is carried out. Very poor parents and those with large families are persuaded with difficulty as to the necessity for the removal of conditions which do not make their children obviously ill, and a small percentage of them fail to do anything, but the great majority take their children to the London Hospitals and have treatment for such conditions as Adenoids and Ringworm. To keep the children under observation, until a remedy is effected, the procedure detailed in last year's report was carried out, and to the teachers a great deal of credit is due for the trouble entailed in supervising the children and for the results obtained. Summarised, the percentage of the commoner defects remedied was as follows:— Schools. Cleanliness of Head & Body. Nose and Throat. Teeth. Tonsils and Adenoids. External Eye Disease. Vision. Discharging Ears. Various. Boys 100 50 40.5 53.8 66.6 46.07 40 51.06 Girls 65.8 14.2 23.8 31.5 50 55.9 44.4 47.6 Infants 75 37 33 43.5 57 80 44 64 The following tables show, for individual schools, the numbers of children found with defects, the nature of them and the number remedied, as shown from the schedules returned by the Head Teachers MEDICAL INSPECTION OF SCHOOL CHILDREN. Summary of Teacher's Returns of Forms Nos. 1, 2, 3 and 4. BOYS' SCHOOLS. SCHOOL. Number Examined. Number with defects. NATURE OF DEFECT. Percentage of cases remedied. Left School. Still unremedied. Visits arising out of. Cleanliness. Nose and Throat. Teeth. Tonsils and Adenoids. External Eye Disease. Vision. Discharging Ears. Various. Head & Body. No. No. Remd. No. No. Remd. No. No. Remd. No. No. Remd. No. No. Remd No. No. Remd. No. No. Remd No. No. Remd. Winns Avenue 178 16 1 1 - - 3 - 1 - 1 - 8 2 - - 3 2 40.4 12 12 29 22 - - - - 4 1 - - - - 18 10 - — 3 1 4 13 Chapel End 106 5 - - - - 2 2 - - - 2 1 - - 2 — 61.5 2 3 13 7 1 1 - - 2 1 - - 2 1 1 1 - - 1 1 — 2 Blackhorse Road 39 5 - - - - 1 - - - 2 1 4 2 — — — — 37.5 2 4 3 1 - - - - 1 - - - - - - - - - - - 1 1 Higham Hill 34 8 3 3 - - 2 1 2 2 - - - - - - 1 — 75.0 7 2 2 Markhouse Road 19 5 1 1 — - 2 - - 2 2 3 2 — — — — 62.5 3 3 4 Coppermill Road 18 1 1 1 - - - - - - - - - - - - - - 33.3 - - 6 2 - - - - - - - - - - 1 - - - - - 2 2 Gamuel Road 50 12 2 2 — — 2 — — — — — 5 2 — — 3 3 53.5 — 5 15 2 - - - - - - - - - - 1 - - - 2 1 2 2 Pretoria Avenue 23 4 - - - - - - - - - - - - - - 4 2 50.0 2 2 3 Queen's Road 34 1 — — — — 1 — — — — — — — — 1 — 33.3 1 1 4 8 - - - - - - - - - - 6 3 — — 1 — 1 5 St. Saviour's 15 4 - - - - - - - - 2 1 - - - - 2 1 50.0 1 2 2 Marsh Street 42 5 1 1 - - 2 - - - - - 2 1 — — - — 28.5 — 3 11 2 - - - - - - - - - - 1 - - - 1 2 2 Maynard Road 177 20 3 3 - - 4 3 - - 2 2 8 4 2 1 4 2 65.2 2 8 26 Joseph Barrett 92 13 — — - - 2 1 1 1 — — 5 3 — — 5 3 60.0 — 5 13 4 - - 1 1 - - 1 - - - 3 3 - - 2 — — 3 Higher Elementary . 149 23 2 2 1 1 2 2 2 1 1 - 11 5 2 - 3 2 54.1 7 11 15 William Morris 96 17 2 2 - - 4 1 2 - - - 7 1 3 1 1 — 26.3 8 14 18 Wood Street 153 22 4 4 - - 3 3 2 2 2 2 11 5 2 1 2 2 73.0 1 7 17 Forest Road 89 15 2 2 2 — - - 2 1 4 3 5 2 1 1 5 4 61.9 2 8 11 Totals 1314 224 23 23 4 2 37 15 13 7 18 12 102 47 10 4 47 24 — 62 120 194 Percentage remedied— 100.0 50.0 40.5 53.8 66.6 46.07 40.0 51.06 MEDICAL INSPECTION OF SCHOOL CHILDREN. Summary of Teacher's Returns oj Forms Nos. 1, 2, 3 and 4. GIRLS' SCHOOLS. SCHOOL. Number Examined. Number with defects. NATURE OF DEFECT. Percentage of cases remedied. Left School. Still unremedied. Visits arising out of.- Cleanliness. Nose and Throat. Teeth. Tonsils and Adenoids. External Eye Disease. Vision. Discharging Ears. Various. Head &Body. No. No. Remd. No. No. Remd. No. No. Remd. No. No. Remd. No. No. Kemd. No. No. Remd. No. No. Remd. No. No. Kemd. Winns Avenue 108 11 6 5 - - 2 - - - - - 1 1 1 - 2 - 63.6 2 6 13 20 9 9 1 — 3 1 2 1 1 1 5 3 — — — — 4 6 Chapel End 106 19 17 12 - - 2 - - - 1 - 3 1 - - 2 1 51.5 8 11 11 32 24 13 1 - 3 - 1 - 1 - 6 4 1 - 2 2 9 20 Blackhorse Road 77 25 9 4 - - 2 - 2 1 1 - 6 4 1 - 7 3 58.9 5 16 16 9 5 5 - - 1 1 - - 1 1 2 2 - - 2 - 4 2 Higham Hill 42 16 14 14 - - - - - - 1 1 1 1 - - 3 3 90.3 9 6 8 4 4 - - - - - - 1 - 6 4 - - 1 1 5 3 Markhouse Road 21 3 3 - - - 1 - - - - - - - - - - - All Left. 3 3 34 11 8 — — — — — 2 — — — 3 — 1 — — — 11 11 Coppermill Road 36 7 2 - - - - - 1 — 1 1 5 2 — — — — 25 5 6 11 7 3 — — - 2 — — - — - — - — 2 1 6 — Gamuel Road 36 13 10 9 - - 1 1 - - 1 1 2 2 1 1 - - 86.3 2 1 6 5 2 2 - - 2 1 1 1 - - 1 - - - 1 1 2 2 Pretoria Avenue 36 9 6 2 2 1 1 - - - - - 1 - - - 1 - 38.4 5 8 5 2 1 1 — — — — — — — — 1 1 — — — — — — Queen's Road 24 4 3 — — — 2 — — — — — — — — — — — All left except 4 4 3 4 3 - - - 1 - - - - - 1 - - - - - 3 4 Mission Grove 31 15 14 14 — — 1 — — — 1 — 1 — — — — — 70 — 3 6 2 2 - - - - - - - - - 1 - - - - - 2 2 St. Saviour's 8 3 2 1 - - - - 1 - - . - 1 1 - - - - 50 2 5 Maynard Road 122 25 12 11 1 - 2 - 1 1 1 1 7 3 2 1 2 2 67.8 5 9 23 St. Mary's 70 23 12 6 1 — 3 — 2 — — — 6 5 - - 4 — 39.2 — 17 18 Joseph Barrett 96 32 21 15 — — — 1 1 — 10 3 7 1 48.7 9 20 21 Higher Elementary 44 12 6 3 1 - 3 1 1 1 - — 3 1 - - - - 42.8 5 8 14 William Morris 91 30 19 9 — - 2 2 1 - 1 1 8 4 - - 3 3 55.8 7 15 15 Wood Street 109 54 44 35 — — 2 2 1 - - — 9 8 2 2 3 2 80.3 5 12 26 Forest Road 77 22 14 7 — — 6 1 2 1 1 — 3 2 — — — — 42.3 6 15 5 Totals 1134 423 275 181 7 1 42 10 19 6 14 7 93 52 9 4 42 20 126 206 238 Percentage remedied— 65.8 14.2 23.8 31.5 50 55.9 44.4 47.6 MEDICAL INSPECTION OF SCHOOL CHILDREN. Summary of Teacher's Returns of Forms Nos. 1, 2, 3 and 4. INFANTS' SCHOOLS. SCHOOL. Number Examined. Number with defects. NATURE OF DEFECT. Percentage of cases remedied. Left School. Still unremedied. Visits arising out of. Cleanliness. Nose and Throat. Teeth. Tonsils and Adenoids. External Eye Disease. Vision. Discharging Ears. Various. Head & Body. No. No. Remd. No. No. Remd. No. No. Remd. No. No. Remd. No. No. Kemd. No. No. Remd. No. No. Remd No. No. Remd. Winns Avenue 296 51 24 19 - - 5 5 2 1 9 7 2 1 - - 12 12 76.3 2 9 25 22 5 4 1 - 2 1 3 1 5 3 2 1 — 4 3 1 9 Chapel End 321 57 34 28 1 1 2 1 1 - 2 2 1 1 — 1 — 68.6 2 9 25 44 16 14 2 1 6 1 4 2 8 4 - — 1 — 7 4 — 18 Blackhorse Road 196 35 19 14 1 1 5 1 1 - 4 2 1 — 1 — 5 2 50.8 3 14 11 21 11 6 - - 2 - 2 - 1 1 — — - — 7 4 4 9 Higham Hill 230 58 35 27 - - 8 2 2 1 5 3 — — - — 9 8 63.5 16 28 12 36 18 17 1 - 5 - 3 1 4 — — — - — 6 2 1 17 Higham Hill Temp. 29 11 4 4 - - 4 1 3 1 - — 1 1 — 2 1 57.1 4 6 4 Markhouse Road 201 50 37 35 - - 4 4 1 1 1 1 5 5 1 1 6 5 83.8 4 3 25 37 22 16 1 - 3 1 1 - 6 2 — — 1 1 10 6 2 18 Coppermill Road 249 24 10 10 1 - 3 1 2 1 3 - 2 2 - — 5 2 64.7 2 10 11 23 12 9 1 1 4 1 - - 6 4 — — 1 1 1 1 8 8 Gamuel Road 209 54 41 25 - - 6 2 3 1 4 3 4 3 1 — 3 2 48.3 2 26 26 25 15 2 2 1 4 1 1 1 3 1 — — — 2 1 2 20 Pretoria Avenue 215 26 16 11 - - 6 3 4 2 2 2 3 3 — 1 1 59.2 13 10 11 22 6 5 - - 4 2 1 - 3 2 — — 1 — 7 1 — 12 Queen's Road 293 46 19 18 - - 8 7 6 4 3 2 7 5 2 2 2 2 84.1 1 7 19 16 6 6 - - - - 6 4 1 1 — — 1 — 2 2 — 3 Mission Grove 210 51 21 20 3 2 8 - 7 2 3 1 6 5 2 — 5 2 48.8 18 23 9 22 10 8 2 - 3 - 5 - 5 1 — — — — 5 1 2 20 St. Saviour's 76 17 10 9 1 - 1 - 2 1 3 3 1 1 1 1 2 1 62.1 1 5 7 11 3 1 1 - 5 2 4 1 1 1 1 1 — — 1 1 9 Maynard Road 253 30 9 8 - - 5 2 3 3 1 1 7 6 1 1 2 2 63.8 1 5 31 19 6 2 1 1 6 - 1 - 3 3 — — 1 — 1 1 - 12 St. Mary's 90 7 2 1 - - - - - - 2 2 2 1 — — — — 26.9 2 2 14 8 12 1 2 1 3 - 1 - — — — — 1 — 1 1 - 7 Joseph Barrett 196 39 23 18 - - 4 2 2 1 2 1 6 4 1 — 6 6 61.9 5 12 21 22 10 7 1 - 5 - 5 3 3 1 — — — — 3 1 1 15 Wood Street 79 34 27 20 - - 4 2 1 - 4 3 — — — — 3 2 69.2 1 12 15 Forest Road 344 42 22 9 1 — 11 3 1 1 2 — — — 1 1 1 1 38.5 - 24 25 Totals 3487 960 505 374 23 9 136 45 78 33 99 57 51 40 18 8 122 78 98 382 291 Percentage remedied— 75.0 37.0 33.0 43.5 57.0 80.0 44.0 64.0 97 The following table shows the schools visited and the children inspected at the request of the Head Teachers:— Schools visited and numbers of children inspected by the Medical Officer of Health at the request of the Head Teachers for the reasons alleged. Name of School. Dirty Heads & Bodies. Defective Vision. Heart Weakness. Otorrhœa. Defective Hearing. Enlarged Tonsils & Adenoids. Tuberculosis. General Weakness. Chorea. Various. Totals. Winns Avenue 1 8 1 2 3 5 - 1 - 5 26 Chapel End 1 8 4 — 2 — — — 1 2 18 Blackhorse Road 1 6 — 2 2 — — — — 1 12 Higham Hill 14 2 - — 3 4 — — 4 27 Markhouse Road 12 11 — — — 2 1 2 — 11 39 Coppermill Road 1 — — — — — — — — — 1 Gamuel Road 1 5 — — — — — — — 4 10 Pretoria Avenue — 16 1 2 3 2 1 2 1 7 35 Queen's Road 7 - - - 1 — — — - 1 9 Mission Grove — 1 1 — 2 5 — — - 2 11 St. Saviour's 5 13 2 1 2 2 1 — - 4 30 Edinburgh Road — 1 1 — — 1 — — - 1 4 Maynard Road — 4 — 1 — 4 1 1 1 4 16 St. Mary's — 1 1 — 1 3 — — - 6 12 Joseph Barrett 21 2 - — 1 - — — - 2 26 Higher Elementary - 3 - - - 1 — - 1 1 6 William Morris 10 7 — — 8 1 — 1 - 1 28 Wood Street 5 3 — — — 1 — — - — 9 Forest Road 8 6 — — 1 1 — — — 4 20 Selwyn Avenue - 9 - - 2 1 - 1 - 2 15 Totals 87 106 11 8 31 33 4 8 4 62 354 98 Arising out of the statutory and other inspections of school children, a good deal of home visiting was undertaken by the School Nurse and other members of the Public Health Staff. Visits made in connection with Medical Inspection of School Children by the School Nurse. Result. Defective Vision. Strabismus. Blepharitis. Nose and Throat. Otorrhœa. Other Reasons. Totals. Secured Treatment 202 41 16 39 19 24 341 Promised „ 110 51 — 27 1 8 197 Refused „ 3 1 — — — 1 5 Cannot afford „ 39 10 — — — — 49 Nothing done 55 3 — 12 1 2 73 Left the District 26 12 — 6 — 3 47 Not at Home 34 8 — 6 — 1 49 469 126 16 90 21 39 761 Children seen by the Medical Officer of Health at the Town Hall during 1910. Defects. Number. Totals. Allowed to go to School. Excluded. Ringworm 191 404 595 Impetigo 43 79 122 Scabies, Eczema and Skin Diseases 59 90 149 Dirty and Verminous Heads 58 70 128 Chorea 6 19 25 Discharging Ears 14 14 28 Sore Throats and Adenoids .. 69 144 213 Mumps 4 38 42 Cold and Bronchitis 29 77 106 Whooping Cough 6 28 34 Defective Vision and Sore Eyes 36 61 97 Rheumatism 21 45 66 Heart and Anæmia 11 10 21 Tuberculosis 5 26 31 Various 454 323 777 1006 1428 2434 The numbers given represent attendances and not individual children in many instances. For example, those children suffering from Ringworm average about 70, but these children, once excluded, had to be repeatedly seen before their readmittance to school. 99 Visits made by the Women Inspectors and Others in connection with Medical Inspection, and Children seen by the Medical Officer of Health at the Town Hall during 1910. Miss Davis. Miss Lamb. Others. Otorrhœa — 47 — Blepharitis — 28 - Malnutrition 4 3 — Pediculosis and Nits 12 142 3 Defective Vision 3 69 — Ringworm 5 49 88 Sore Throat 6 38 81 Weak Chest and Anæmic — 4 — Adenoids 16 10 — Impetigo 2 22 - Scabies 2 12 — Whooping Cough 115 55 27 Bad Teeth — 12 - Phthisis (?) 11 — - Enlarged Tonsils — 25 - Measles 76 21 119 Chorea — 2 — Deafness — 3 — Generally Dirty — 9 — Chicken Pox — 47 — Various — 27 — Totals 252 625 318 Total 1195. EXCLUSION OF CHILDREN FROM SCHOOL. During the year 113 children were excluded under Article 53 (6) of the code. Ninety of them were the result of the routine inspections, and 23 from those carried out by me. The numbers are for those inspected at the Schools, and do not include children seen and dealt with by me at the Town Hall. The exclusions were as follows:—Ringworm, 18; Impetigo, 24; Dirty Heads and Body, 22; Mumps, 4; Scabies, 3; Sore Throat, 32; Scarlet Fever (?), 6 ; Various, 4. REPORTS ON TEACHERS AND OTHERS. Upon instructions from the Education Committee I visited, at their homes or saw at the Town Hall, 49 of the staff absent from duty, owing to illness—Teachers, 46 ; Caretakers, 3. EMPLOYMENT OF BOYS OUT OF SCHOOL HOURS. Of the 1,206 boys over 12 years of age inspected, 155 or 13 per cent, were at work out of school hours for varying periods. Twenty-eight per cent, of these worked for 20 hours or over during school days, and 40 per cent, of these worked for 10 hours or more on Saturdays. The following table gives the information in full:— 100 BOY LABOUR, 1910. SCHOOL. 12 years and upwards. Number examined. Number engaged out of School hours. Percentage engaged outside School hours of those examined. Boys engaged out of School hours whose parents are skilled workmen. Boys engaged out of School hours whose parents are unskilled workmen. Boys with Father dead. Number of boys engaged 20 hours and over during School days. Number of boys engaged 10 hours and over on Saturday. Number of boys engaged on Sunday. Number. Average number in family. Boys with defects. Number. Average number in family. Boys with defects. Number. Average number in family. Boys with defects. Winns Avenue 166 33 19.8 15 6.2 1 15 5.3 1 3 5.6 - 12 11 14 Chapel End 106 2 1.8 2 5.0 - - - - — — — - - 1 Higham Hill 34 7 20.5 2 8.5 — 5 7.0 — — — — 2 3 - Gamuel Road 37 7 18.9 3 5.6 1 2 5.5 1 2 10.0 — 1 3 1 Markhouse Road 17 4 23.5 2 6.0 1 2 7.0 2 — — — 2 3 1 Blackhorse Road 37 4 10.8 2 4.5 — 1 6.0 1 1 4.0 — - 3 1 Marsh Street 40 10 25.0 5 7.4 1 5 6.2 — — — — 3 5 2 Maynard Road 171 15 8.7 10 5.0 — 5 4.4 1 — — — 3 3 5 Higher Elementary St. George's 149 8 5.3 5 4.7 1 2 4.0 — 1 3.0 — 1 7 1 28 2 7.1 — — — 2 10.5 — — — — 1 - - Joseph Barrett 84 7 8.3 4 6.7 — 3 7.6 — — — — 2 1 2 Wood Street 153 32 20.9 19 6.7 4 11 5.9 — 2 6.0 — 12 13 11 Forest Road 87 13 14.9 9 5.3 — 4 5.5 1 — — — 4 7 1 Selwyn Avenue 39 7 17.9 3 4.0 — 3 7.6 — 1 9.0 — — 1 3 Queen's Road 28 1 3.5 1 7.0 - - - - - - - - 1 1 Coppermill Road 13 1 7.6 1 5.0 — — — — — — — — — — Pretoria Avenue 17 2 11.7 2 4.5 - - - - - - - 1 - 2 Totals 1206 155 12.8 85 5.0 9 60 6.0 7 10 6.0 — 44 61 46