MED. LIBRARY Malthamstow Urban district Council. REPORT by the MEDICAL OFFICER OF HEALTH on the SANITARY CONDITIONS AND VITAL STATISTICS also REPORT TO THE EDUCATION COMMITTEE on the MEDICAL INSPECTION OF SCHOOL CHILDREN, FOR THE YEAR 1925. Cottenbam: Crusha & Son, Ltd., 821-3, High Road, And at Enfield and Wood Green. Malthamstow Urban District Council. REPORT OF THE MEDICAL OFFICER OF HEALTH AND SCHOOL MEDICAL OFFICER FOR THE YEAR 1925. Cottenbam: Crusha & Son, Ltd., 821-3, High Koad, And at Enfield and Wood Green. INDEX. Page Natural and Social Conditions of the District 13 General Provision of Health Services in the Area 35 Sanitary Circumstances of the Area 38 Housing 44 Inspection and Supervision of Food 52 Prevalence of, and Control over, Acute Infectious Diseases 55 Maternity and Child Welfare 67 School Medical Service 78 TABLE OF CONTENTS. Page Officers and Staff 4 Statistical Summary 12 Physical Features 13 Drainage 13 Character of Population 15 Hospitals and Poor Law Relief 22 Population 25 „ of Wards 28 Births 27 Rate 27,33 In Wards 28 Deaths 29 Rate 29, 33 Outer Zone of London 30 In Wards 30 Inquests 32 Senile Mortality 32 Zymotic Death-rate 33 Infantile Mortality Rate 33 Health Services 35 Ambulance Facilities 36 Clinics and Treatment Centres 36 Legislation in Force 37 Midwives 37 Chemical Work 37 Sanitary Administration— Sewage Disposal 13 Water Supply 38 Drainage 39 Scavenging 39 Sanitary Inspection of Area 39 Smoke Abatement 43 Elementary Schools 43 Factory and Workshop Act. 1901 49 Page Housing 44 Overcrowding 44 Fitness of Houses 45 House-to-House Inspection 46 Unhealthy Areas 46 Statistics for Year 47 Unfit Dwelling-Houses 47 Food— Milk Supply 52 Meat Inspection 53 List of Unsound Food Destroyed 54 Infectious and Other Diseases— Prevalence of, and control over 55 Smallpox 35 Encephalitis Lethargica 74 Tuberculosis 74 Bacteriological Work 60 Diseases Isolated— Enteric. Fever 61 Diphtheria 61 Scarlet Fever 62 Isolation Hospital — Accommodation 60 Admissions, Discharges & Deaths 63 Scarlet Fever 64 Diphtheria 65 Maternity and Child Welfare 67 Council's Centre 67 Ante-Natal Clinic 67 Infant Consultations 68 "Brookscroft" Voluntary Centre 70 Puerperal Fever 71 Ophthalmia Neonatorum 71 Measles and Whooping Cough 71 STATISTICAL TABLES. No. Page I Birth-rate, Death-rate and Analysis of Mortality during 1925 9 II Wards—Acreage, Population, Density, Birth and Death-rates, 1925 14 III Buildings, Dwellings, Rooms and Families—Census 1921 17 IV Private Families, Rooms Occupied and Density of Occupation— Census 1921 18 V Occupation—Males 20 VI „ Females 21 VII Vital Statistics of Whole District—1925 and Previous Years 26 VIII Births Distributed in Wards and Birth-rates for 1925 28 IX Causes of, and Ages at Death—Whole District and Wards (facing) 30 X Summary of Causes of Death of Children under 1 Year of Age (Following Table IX) XI Birth, Death and other Rates since 1891 33 XII Deaths from Zymotic Diseases since 1898 34 XIII Number of Infectious Diseases Notified and "Infectious Sickness Rate" (follows) 57 XIV Cases of Infectious Disease Notified during 1925 (following Table XIII) XV Drainage and Other Defects found in Relation to Infectious Diseases 59 XVI Tabular Statement of Outdoor Work of Health Visitors 69 Chart showing Birth, Death and Zymotic Death-rates for Years 1880 to 1925 (Facing Page 34) Chart showing Deaths from Measles and Whooping Cough, 1889 to 1925 73 OFFICERS and STAFF. Clerks: H.T.Ckisp. R.C.Bland. G.W.Phillips. L. R. W.Kemp. G. W. West. R. Rose. H. J. Smith. Chief Clerk: H. Butters. Health Visitors: * Miss A. C. Keenan. * Mrs. Ryley. *Miss O. J. Panther. Sanitary and Food Inspectors: *T. Vaughan. *F. W. Kemp. *H. A. Whipp. *T. J. Barnes. *F. G. Sendell. Senior Sanitary Inspector, Food Inspector and Petroleum Officer: *M. E. Duncan. Matron, Isolation Hospital: Miss L. Pratchett. R. M. O. Isolation Hospital: Dr. S. Moore. Assistant Medical Officer, Medical Officer for Maternity and Child Welfare: *Dr. Mary. C. Sheppard. Medical Officer of Health, School Medical Officer, and Medical Superintendent, Isolation Hospital: *J. J. Clarke. * Proportion of Salary contributed under Public Health Acts or by Exchequer Grants. 5 TO THE CHAIRMAN AND MEMBERS of the Walthamstow Urban District Council. Ladies and Gentlemen, I beg to present to you my Annual Report for 1925. This is the twenty-eighth which I have had the privilege of presenting to your Authority. Unlike the four previous ones this is a "Survey Report" and contains information which no doubt is quite familiar to most of you, but is given by request of the Ministry of Health. The Report is compiled on the lines and under the headings as suggested in Circular 648 issued by the Ministry of Health. The first printed Annual Report of the Medical Officer of Health for the District was that for 1889 and consisted of six pages of printed matter and five statistical tables. Prior to my appointment in 1898 and on to 1906, the Medical Officer of Health was a part time Officer whose work was mainly consultative and mildly supervisory of that of the Inspector of Nuisances and his Assistants who devoted their time and energies to defective drains and similar nuisances. The Notification of Infectious Diseases Act was passed in 1889, and since that time the man in the street and those who govern him have completely changed their outlook on Public Health matters and have been gradually educated to realise that whilst the house and its surroundings play no unimportant part in the well being of the community, the citizen, individually and collectively, is the centre round which all Public Health work now revolves. In 1901, the Isolation Hospital, with accommodation for 42 beds was opened, with the result that to-day we have fewer cases of Scarlet Fever and Diphtheria with a population of 130,800 than we had at that period when the population was 95,000. In 1905, the first woman Health Visitor was appointed and in 1906 "an office" and a part time Clerk was provided for the Medical Officer of Health and in 1909 the Medical Inspection of School Children was undertaken. 6 To-day there are six Sanitary Inspectors, eight Clerks, four Health Visitors, six School Nurses, four Doctors and a Dentist engaged in the work of Public Health. The citizen of to-day is under medical supervision from the cradle to the grave! An extra ten years' longevity is claimed as the result of general Public Health work throughout the country, but how much of this can be legitimately claimed for our citizens by your Authority is difficult to estimate. Owing to the character of our population the District is heavily rated, our leisured classes are few and Voluntary Public Health services—apart from the excellent work carried out at Brookscroft —is minimal. As a result our Maternity and Child Welfare work is less than the needs of the Community warrant and below that which your Authority is anxious to give. In all other respects the services rendered our citizens will compare favourably with those in the other extra Metropolitan Districts. Judging by results as evidenced by the Statistics given by the Registrar General we can legitimately claim a favoured place even among the very best administered Urban Districts and large Towns throughout the country From a perusal of the body of the Report it will be seen that the year 1925 was a favourable one. The figures supplied by the Registrar General are for the calendar year and are taken as the basis of all rates. Our Birth-Rate at 17.9 per 1,000 of the population was greater than in 1924 and only slightly less than that of London or the Great Towns. It will be noticed from Table XI on page 33 that our Birth-rate taken out for five-yearly periods shows a steady decline from 37.3 in 1891 to 17.4 in 1924. The average from 1891-95 was 34.4; that for 1921-25 was 19.2. In 1891, one in eight children born died within the year, whereas in 1925 only one in twenty born failed to survive; in other words our natural increase of population—that is, excess of births over deaths—in 1925 was only 20 less than in 1891. Taking the period 1891-95 the average Birth-rate was 34.4 and the natural increase of population 1,003. The Birth-rate of 1921-25 was 19.2 and the natural increase of population 1,144, or a gain in the later period of 141, in spite of the lowered birth-rate. 7 As in previous years the birth-rates of the various Wards differ— Hoe Street has a rate of 13.3; Hale End, 15.6; St. James' Street, 16.6; High Street, 17.5; Higham Hill, 17.9; and Wood Street, 18.0. Compared with 1924, St. James' Street shows a decrease of 2 per 1,000, Hoe Street 1, Wood Street and Higham Hill an increase of nearly 2, and High Street and Hale End have practically the same rates. Our Death-rate, was 10.0 per 1,000 of the population, compared with 12.2 for England and Wales and the "Great Towns," 11.2 for the "157 Smaller Towns," and 11.7 for London. It is slightly less than in 1924 and 0.5 and 1.0 greater than 1921 and 1923. The total recorded deaths were 31 less than in 1924. Tuberculosis, Cancer and Heart Disease had practically the same mortality in both years; diseases of the respiratory system and Influenza were less. From these five "causes of death" more than half our people succumbed. Deaths in the new-born from Congenital Debility and Prematurity were numerically greater than in 1924. This might be expected as our births were 60 more than in the previous year. Taking the age periods, fewer persons died within the age groups 25-65 than in 1924, and a larger number in the group 65 and upwards. The only Cause of Death in a very large number in the later period was given as Senile Decay. A more definite reason might be given for those under 70 years and the careless way many deaths are certified makes classification a difficult matter with the result that however closely one follows the Rules laid down by the Registrar General slight variations occur between the numbers given by him and me. The Zymotic Death-rate, or that resulting from deaths caused by Diphtheria, Erysipelas, Scarlatina, Typhoid Fever, Diarrhoea, Measles and Whooping Cough, was .34, or nearly double that of the previous year. The rate is given for comparative purposes, but is of little value as an index to the good or bad administration of an Area. All the diseases are theoretically preventable, but so far no Authority has had much success in preventing epidemics of Measles and Whooping Cough. Measles in in epidemic form was present during the first half of 1924, followed by Whooping Cough which continued right up to the middle of 1925 and was the cause of 26 deaths—25 of them in children under 5 years of age. 8 These deaths account for the increased rate. Diarrhoea as a cause of death in young children is now negligible . Infantile Mortality Rate. This rate is based on the deaths of children under 1 year of age as compared with the births taking place within the year and was, on the Registrar General's figures, 51.4—the lowest on record, except that of 1923—as compared with 64.1 in 1924. It was 24 less per 1,000 than that of England and Wales, 27 less than that of the Great Towns and less than London by 15. Whilst the total number of infants dying in their first year has become yearly less there has been no improvement in the Mortality from causes operating before confinement and during the first four weeks of life. A further reduction in this respect may be looked for when Medical Science has unlocked the secrets which lie behind these deaths and can apply a remedy. Meantime we must hope for improvement in a more extended use of the Ante-Natal Clinic and the education of our Senior Girls while in School, in the art of healthy living. On page 30 is given a table based on the Registrar General's four quarterly Returns. The Population, Birth-rate, Death-rate and Infantile Mortalityrate of nine extra Metropolitan Districts with that of Walthamstow is shown. Excluding West Ham, Edmonton and Croydon our birth-rate was higher than in the other Districts whereas our Infantile Mortalityrate was lower with the exception of Croydon, Edmonton, Ilford and Hornsey. The low birth-rate and the economic conditions of the Borough of Hornsey would apparently explain its favourable position, but not satisfactorily in view of the fact that Edmonton, a less favoured District than Walthamstow, with the highest birth-rate of all Districts, has the lowest Infant Mortality, in fact only 60 per cent. of that of Willesden, a wealthy, well administered District, where Ante-Natal and Child Welfare Work is carried out energetically and on the most up-to-date methods. On page 28, it will be seen from the Table given, that Hoe Street Ward socially one of the best parts of the District, has the lowest Birth-rate and the highest Infantile Mortality-rate of all the Wards, a contrast as strongly marked as that between Willesden and Edmonton, which goes to show that my previous remarks as to diminution of the Infantile Mortality-rate is little affected by the methods now in operation. The following Tabular Statement issued by the Registrar General will serve to show our relative position compared with the Country and the "Great" and "Smaller" Towns as regards general Death and Infantile Mortality rates and those from the principal Infectious Diseases. 9 TABLE I. Birth-rate, Death-rate, and Analysis of Mortality during the Year 1925. (Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1925, while those for the towns have been calculated on populations estimated to the middle of 1924. The mortality rates refer to the whole population as regards England and Wales but only to civilians as regards London and the groups of towns.) - BirthRate per 1,000 Total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Births Percentage of Total Deaths. All Causes. Enteric Fever. Small-Pox. Measles. Scarlet Fever. Whooping Cough Diphtheria. Influenza. Violence. Diarrhoea and Enteritis | (under 2 years). Total Deaths under 1 year. Causes of Death Certified by Registered Medical Practitioners Inquest Cases. Uncertified Causes of Death. England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 0.32 0.47 8.4 75 92.1 6.9 1.0 105 County Boroughs and Great Towns including London 18.8 12.2 0.01 0.00 0.17 0.03 0.18 0.09 0.30 0.43 10.8 79 92.1 7.3 0.6 157 Smaller Towns (1921 Adjusted Populations 20,000—50,000) 18.3 11.2 0.01 0.00 0.15 0.02 0.14 0.06 0.31 0.38 7.6 74 93.0 5.9 1.1 London 18.0 11 .7 0.01 0.00 0.08 0.02 0.19 0.11 0.23 0.46 10.6 67 91.1 8.9 0.0 Walthamstow 17.9 10.00 0.01 0.00 0.04 0.007 0.19 0.05 0.23 0.25 3.4 51 .9 100.0 8.0 0.0 10 Comparing the Table with that given for 1924 all our Mortality rates are less—those for Whooping Cough and Diphtheria with a slight increase excepted—and in every case more favourable than those for the Country or the Great Towns. Over 45 per cent. of our Deaths occurred without the Area, mainly in Public Institutions, but in every case the Cause of Death was certified by a Doctor or Coroner. Our Infantile Mortality-rate is very low when compared with that of the Country or those of the Towns. Although the number of cases of Scarlet Fever was double that of 1924 only one death occurred, whereas with 30 per cent, less cases of Diphtheria we had three more deaths. The increased mortality occurred in children aged 2 to 5 years. Three of these deaths occurred within twenty-four hours of removal to Hospital. From the Table given on page 58 it will be seen that of the Areas given West Ham and Willesden only had a smaller Diphtheria Death-rate than here. Our Infectious Sickness Rate, based on the proportion of cases notified to total population, was 4.6 per 1,000 compared with 3.9 in 1924. The increase is accounted for partly by a large number of cases of Rotheln being notified as Scarlatina. In estimating this rate the only diseases counted are those notifiable prior to 1914. Upon this basis the rate is only a third of that prevalent prior to the opening of the Isolation Hospital. Although no extension has been made to the Institution since 1906 the accommodation provided was sufficient for all purposes. Ninety per cent. of the notified cases of Diphtheria and over 80 per cent. of the Scarlet Fever cases were removed from their homes. The natural advantages enjoyed by Walthamstow—its close proximity to Epping Forest and the number of open spaces in the shape of Parks and unbuilt-on areas—account largely for the favourable position it occupies from a Public Health standpoint. Within a few years our Sewage Farm will have disappeared, and the future prospects of the District as a residential area, will thereby be enhanced. 11 The section of the Report dealing with the Sanitary Circumstances of the Area is largely the work of Mr. Duncan, the Senior Inspector, and the School Report has been compiled by Dr. Broderick. I am pleased to record that the Members of the Public Health and School Medical Staff have made the fullest use of their opportunities to serve their respective Authorities well and I much appreciate their unvarying loyalty and willing co-operation. I beg to remain, Ladies and Gentlemen, Your obedient Servant, J.J. CLARKE. 12 STATISTICAL AND OTHER INFORMATION. Total Area of District 4343 acres. Area of land upon which houses are erected 1814 „ Population—1901 Census 95,131 1911 Census 124,580 1921 Census 129,395 „ „ per acre (Registrar General) 29.8 „ 1925 Estimated do 130,800 No. of separate occupiers, 1921 Census 29,461 No. of persons per "occupation" 4.3 No. of houses (including shops, inns, etc., inhabited 24,616, uninhabited 455) 25,071 Births registered within area 2,131 „ „ without area 220 Birth-rate per 1,000 of the population 17.9 Deaths registered within area, excluding non-residents 716 Deaths registered without area 589 Death-rate 10.0 Death-rate corrected for age and sex 10.59 Deaths of Infants under 1 year of age 121 Infantile Mortality Rate 51.9 Zymotic Death-rate .34 Infectious Sickness Rate 4.6 Rateable Value £529,956 „ 1901 £328,756 General District Rate, 1925 7s. Od. „ 1901 3s. 7d. Total Poor Rate, 1925 17s. 4d. „ 1901 4s. l0d. Education Rate, 1925 2s. 3d. „ 1901 1s. 9½d. 13 SECTION I. NATURAL AND SOCIAL CONDITIONS OF THE DISTRICT. The Urban District of Walthamstow has an area of 4,343 acres, and lies between the River Lea on the west and Epping Forest on the east, extending from Leyton on its south to Chingford on the north. The area built upon is approximately 1,814 acres, and the land as yet undeveloped is 987 acres. The remainder is made up as follows, in acres:— Schools 52|, Reservoirs 361, Railways 110, Allotments 231, Epping Forest 359, Marsh Land 100, Municipal Depots 13, Parks and Recreation Grounds 70, Cemetery 12, River Ching 251 Playing Fields 425, Xylonite Factory 41, London Genera, Omnibus Works 9 and the Sewage Farm 238. The 987 acres termed "undeveloped" include a large proportion of the land now used as allotments and playing fields. The District is divided into six Wards for administrative purposes ; they vary in altitude from 18 feet above ordnance datum in the St. James' Street Ward, to 230 feet in the Hale End Ward. The subsoil is mainly gravel, the London clay showing itself in various parts on the surface, more particularly in the Wood Street and the Northern Wards. There are two small streams within the District—the Ching and the Dagenham Brook, and the River Lea flows past the western boundary. The Ching, a small brook, enters the District at Highams Park in the northern area, and winds its course through Hale End and Chapel End to the River Lea. The Dagenham Brook, rising within the District, is the outlet for our drainage, and having received the effluent of the Sewage Farm, situated in the western or St. James' Street Ward, winds its course through the neighbouring parish of Leyton and joins the River Lea at Temple Mills, near Stratford. Neither stream, at any point, is used for domestic purposes, nor likely to be a source of pollution to potable waters. The whole District has a duplicate system of sewers, and practically every house water-closet accommodation. The average daily flow of sewage is 2,500,000 gallons. The sewage is received into precipitating tanks, treated with lime and alum, the solids removed, and the effluent subsequently passed over the Farm before finally passing out of the District. In addition there are in operation at the Farm large filter beds of clinker for dealing with storm water. 14 TABLE II. SUB-DISTRICTS. WARDS.—Acreage, Population, Density, Birth and Death Rates, 1925. Wards. Acreage. Area actually built upon. Number of Private Families Census, 1921. Structurally separate dwellings occupied, 1921. Census Population, 1921. Houses built 1921-1925 Estimated mid-year population, 1925. Density of Area built upon 1925. Birth-Rate, 1925. Death-Rate, 1925. Height in feet of Ordnance Datum. Cols. (1). (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) St. .Tames' Street 488 186 5364 4384 24,936 2 24,946 134 16.6 11.5 18 to 54 High Street 672 174 4697 3730 20,480 4 20,500 118 17.5 9.3 23 to 60 Hoe Street 359 318 5869 4651 23,895 11 23,955 75 13.3 11.1 52 to 145 Wood Street 515 240 3890 3102 17,589 24 17,689 73 18.0 10.0 75 to 176 Hale End 1328 334 4128 3638 18,072 329 19,717 59 14.8 8.0 46 to 230 Higham Hill 981 274 5513 5105 24,423 502 26,933 98 16.3 7.9 25 to 80 Whole District 4343 1526 29461 24610 129,395 872 133,740 87 17.9 10.0 — In column 3, the area is arrived at. by excluding Reservoirs, Railways, Schools, Sewage Farm, Recreation Grounds, Cemetery, etc. The number of separate occupations is arrived at by adding to Columns 4 and 6 the proportionate increased number of houses now occupied as compared with 1921. 15 Comparing the different Wards, the average number of persons per acre at the Census varies from 13.6 in Hale End to 51.3 in St. James' Street, and 67.3 in Hoe Street, with an average for the whole area of 29.8 This compares with 1.5 for the County. The numbers on the previous Table refer to the Wards as actually built upon. The average density is not an index as to overcrowding as may be seen from column 9. Hoe Street, with a population of 75 per acre, has a greater room capacity per unit of its population than Hale End with 59 persons per acre. Of the six Wards the housing and general conditions favourable to health are best in Hoe Street and Hale End Wards. The greater portion of the unbuilt on land lies in the Higham Hill and Hale End Wards or the Northern part of the District. All the other Wards are built over and an amount of cheap, badly kept property, is to be found in all the Wards. Around or in close proximity to the Wood Street and St. James' Street railway stations are mean streets, peopled largely by the casual or unskilled type of worker. Many of these tenants appear to have no interest in the houses they occupy nor exhibit a desirable civic or domestic pride and are largely to blame for the unwholesome conditions requiring the constant supervision of the Sanitary Inspectors. In very many instances the landlords are no less guilty by failing to expend on their property even the proportion of rent exempted from taxation. As a consequence there are hundreds of houses on or in which not a pound of paint or a yard of paper has been used for the past twelve years. The Inland Revenue Authorities should insist that either this money is spent on the property or it pays its proportion of taxation. According to.the Census for the County of Essex for 1921 it appears Walthamstow is, in population, the third largest District in the County. The increase of population over that in 1911 was 4,815 persons, equal to 3.9 per cent, compared with 8.8. for the County as a whole. Leyton excepted, our intercensal increase was less than that of any of the other large areas in the County. Between 1911 and 1921 our natural increase of population— that is excess of births over deaths—was actually 14,630, showing 16 that we lost by migration alone 9,815. The District remains as heretofore a London Dormitory. Between 1911 and 1921 certain marked changes took place. The District became more industrialized and the middle classes of the population have become fewer or poorer as evidenced by the fact that in 1921 only 5 per cent. of private families employed domestic helps as against 10 per cent. in 1911. The following two Tables are taken from the last Census Returns, the first gives the housing and the second gives families classified by size of the rooms occupied and density of occupation. 17 TABLE III. Buildings, Dwellings, Rooms and Families. Buildings. Population . 1921. Dwgs. occupied by non-private Families. Structurally Separate Dwellings occupied by Private Families or Vacant. In Course of Erection Completed Vacant on \ Census night Occupied by Caretaker. 1-3 Rooms 4-5 Rooms. 6-8 Rooms. 9 or more Rooms. Total Dwgs. Total Rooms. Not Contg. Dwgs. Containing Dwgs. 447 - 22142 116195 I. Undivided Private Houses 3 392 - 908 12637 8256 338 22139 117618 — — 6 36 II. Structy. Divided Private Houses - 1 - 3 8 2 - 13 55 — — 583 5094 III. Blocks of Flats, Tenements, etc. - 26 - 577 710 33 - 1320 4857 — 204 1550 6893 IV. Shops 7 36 — 133 888 489 33 1543 7947 4 263 71 1177 V. Others 15 — 2 9 29 13 5 56 293 451 467 24352 129395 Total 25 455 2 1630 14272 8793 376 25071 130770 Principal B uildings in Group V (others) above :— Vacant on Census Night 43 247 156 9 455 2351 Dwellings occupd. by 1 Private Family 1574 12984 5228 263 20049 100963 3 109 24 112 Offices, Factories, Warehses. Workshops Dwellings occupd. by 2 Private Families 11 1006 3217 86 4320 25830 Dwellings occupd. by 3 or more Private Families 2 35 192 18 247 1626 — — — — Hotels. Institutions Places of Worship. Places of Amusement. Total Dwellings occupied by No. 1587 14025 8637 367 24616 128419 — 1 10 754 Private Families % 6 57 35 2 100 — — 55 5 20 — 7 — — Total Private Families therein 1602 15103 12256 500 29461 — 18 TABLE IV. Private Families classified by Size of Family, Rooms occupied and Density of Occupation. No. of Persons in Family. Number of private families occupying the following number of Rooms. Total Private Families. Population in Private Families. Rooms occupied. Average number of Rooms per Person. Density of Occupation. Population at lollowing densities of occupation (rooms per person ) 1 2 3 4 5 6-7 8-9 10 and over No. % under .3 .3 and under .5 5. and under .7 .7 and under 1.0 1 443 239 216 129 112 71 2 2 1214 4.1 1214 3126 2.57 — — - - 2 233 748 1271 842 772 482 43 13 4404 14.9 8808 16270 1 .85 — — 466 2 3 165 551 1445 1320 1444 814 76 23 5838 19.8 17514 24022 1.37 — 495 1653 3 4 45 226 1310 1254 1870 1066 79 22 5872 20.0 23488 26325 1.12 180 — 904 5240 5 10 98 858 938 1663 853 87 36 4543 15.4 22715 21301 0.94 50 490 4290 4695 6 1 44 515 615 1230 636 53 24 3118 10.6 18708 14934 0.80 12 258 6780 7380 7 — 14 306 376 801 416 47 19 1979 6.7 13853 9665 0.70 98 2142 2632 7903 8 — 4 138 234 511 256 20 10 1173 4.0 9384 5782 0.62 32 1104 5960 2048 9 — 2 55 112 300 172 17 8 666 2.3 5994 3421 0.57 18 1503 3852 531 10 — 2 28 70 175 98 7 5 385 1.3 3850 1976 0.51 20 980 2500 300 11 - 1 4 26 86 48 7 1 173 0.6 1903 918 0.48 55 1232 528 88 12 — — 2 11 38 13 2 3 69 0.2 828 388 0.47 24 588 180 — 13 - — - 1 10 4 — — 15 0.1 195 78 0.40 - 195 - - 14 — - — 1 2 3 — 1 7 0.0 98 46 0.47 14 56 14 14 15 & over — — — 1 — 3 — 1 5 0.0 75 37 0.49 15 45 - 15 Total Private Families 897 1929 6148 5930 9014 4935 440 168 29461 100.0 - - - - - - - Population in Private Families 1640 5225 23802 25841 44868 24133 2198 920 — — 128627 — — 518 9088 29759 28219 Rooms occupied 897 3857 18443 23720 45069 30757 3620 1926 — — — 128289 1.00 — — — — 3.0 6.5 20.9 20.1 30.6 16.8 1.5 0.6 100.0 1921 Percentage of families living in various units of occupation. 2.5 4.1 18.8 20.4 30.3 21.2 1.9 0.8 100.0 1911 „ „ „ „ 19 All the dwellings below the dark lines are overcrowded according to the standard of the Registrar General. These total 1,287 compared with 882 in 1911. The greatest overcrowding was found in "occupations" of three rooms, then comes those of four rooms, followed by those of one, two and five rooms. The percentage of families living in the various units of occupation, i.e., the number of rooms to a family, shows little change from 1911, in habitations of four rooms and over; in those with fewer rooms a considerable change has taken place. In 1921, 3 per cent. of our "families" lived in one room, 6.5 per cent. in 2 rooms and 20.9 in 3 rooms as against 2.5, 4.1 and 18.8 per cent. in 1911. In other words, in 1911, 666 families lived in one room, 1,092 in two rooms and 4,945 in three roomed tenements as against 897, 1,929 and 6,148 in 1921. Although the average number of rooms per "dwelling" is shown to be 5.2 the number of 4 to 5 roomed houses, occupied by two private families was 1,006 and the number of 6 to 8 roomed houses occupied by two or more families was 3,409 or nearly 42 per cent, of the whole. Little change has taken place in this respect since 1921 and need of suitable housing accommodation for our people is still urgent. The occupations of the people according to the Classification of the Registrar General were in proportion to 1,000 of the population —aged 12 years and over—as follows:— 20 TABLE V. Occupation.—Males. Essex Administrative County (with associated County Boroughs). East Ham C.B. Southend-on-Sea C.B. West Ham C.B. IIford U.D. Leyton U.D. Walthamstow U.D. Aggregate of Rural Districts. 1. Orders and Sub-Orders. Agricultural Occupations 82 3 17 2 18 4 5 338 Chemical Workers, Makers of Paints, Oils, etc. 8 11 2 19 6 5 3 3 Metal Workers (not Electro Plate or Precious Metals) 82 89 42 105 52 90 99 53 Electrical Apparatus Makers and Fitters, Electricians 14 21 12 15 15 17 18 6 Makers of Textile Goods and Articles of Dress 15 16 21 12 15 23 21 7 Makers of Foods 13 11 10 23 7 11 9 13 Workers in Wood 37 42 29 35 26 48 68 30 Printers, Bookbinders and Photographer 17 25 16 15 20 26 2 4 Builders, Stone and Slate Workers; Contractors 38 36 34 31 33 33 39 49 Painters and Decorators (not Pottery) 18 21 21 20 13 27 24 11 Railway Transport Workers 22 17 11 26 20 43 23 16 Road Transport Workers 37 34 37 46 31 42 42 31 Water Transport Workers 50 84 22 100 21 20 13 21 Other Transport Workers (not Railroad or Water) 30 40 25 33 38 39 50 14 Commerce, Finance and Insurance (not Clerks) 90 93 180 68 136 109 94 55 Public Administration 24 33 34 20 48 30 24 13 Defence 11 4 7 4 5 5 5 10 Professional Occupations (excluding Clerical Staff) 22 17 36 11 40 21 16 20 Persons employed in Entertainment and Sport 4 4 13 3 4 4 4 2 Personal Service (including Institutions, Clubs, Hotels, etc.) 24 21 38 22 16 22 25 22 Clerks (not Civi Service or Local Authority) 74 93 125 51 177 115 81 32 Warehousemen, Storekeepers and Packers 19 29 11 24 19 27 38 6 Stationary Engine Drivers, Dynamo and Motor Attendants 10 12 4 18 5 7 6 8 Other and Undefined Workers (mainly Labourers) 74 79 45 122 35 49 61 57 Unoccupied and Retired 142 22 65 128 175 135 132 149 21 TABLE VI. Occupation—Females. Essex Administrative County (with associated County Boroughs). East Ham C.B. Southend-on-Sea C.B. West Ham C.B. Ilford U.D. Leyton U.D. Walthamstow U.D. Aggregate of Rural Districts. Occupied Females per 1,000 aged 12 and upwards 294 298 310 313 292 316 325 235 1. Orders. Agricultural Occupations 13 3 1 — 7 1 1 63 Chemical Workers, Makers of Paints Oils, etc. .. 7 8 - 17 2 4 2 3 Metal Workers, not Electro Plate or Precious Metals 12 9 1 19 4 10 18 9 Electrical Apparatus Makers and Fitters, Electricians 13 19 - 15 7 32 19 9 Makers of Watches, Clocks and Scientific Instruments 2 1 - 1 1 1 12 - Workers in Skins and Leather and Makers of Leather and Leather Substitute Goods 5 5 2 9 4 8 11 1 Textile Workers 13 5 2 19 4 5 7 19 Makers of Textile Goods and Articles of Dress 120 166 69 137 83 158 197 64 Makers of Food, Drinks and Tobacco 22 24 5 66 3 14 12 9 Workers in Wood and Furniture .. 6 5 1 10 4 6 14 1 Workers in Paper; Printers, Bookbinders, etc. 28 40 9 54 15 29 46 8 Workers in other Materials 14 8 1 27 4 10 46 2 Workers in Mixed or Undefined Materials (not elsewhere enumerated) 7 12 2 8 6 11 16 1 Workers in Transport and Communication 17 26 11 19 27 19 18 12 Commerce, Finance and Insurance (not Clerks) 101 112 128 89 106 102 92 82 Persons employed in Public Administration (and Defence) 20 25 21 13 27 23 17 25 Professional Occupations (excluding Clerical Staff) 78 51 85 53 118 80 46 101 Persons employed in Entertainments and Sport 5 16 13 4 6 5 3 3 Personal Service (including Institutions, Clubs, Hotels, etc). 307 186 472 193 251 207 165 493 Clerks, etc. (not Civil Service or Local Authority) 161 226 163 137 300 232 189 79 Warehousemen, Storekeepers and Packers 33 48 4 83 15 36 30 7 Other and Undefined Workers 13 14 8 25 4 3 18 9 22 The Tables as given by the Registrar General are reproduced for comparative purposes. Fuller information as to the employment of our people will be found at page 76, County of Essex Census, 1921. It will be seen that Walthamstow has the largest percentage, 32.5 of occupied females, and Ilford the lowest, 29.2 as compared with the County as a whole with 29.4. The Registrar General notes that Walthamstow has the lowest proportion of domestic servants of any of the area sgiven, followed closely by West and East Ham; and like West Ham, Walthamstow is the most industrial in type of those areas given. A larger proportion of the people here is engaged in Scientific Instrument making, Sewing, Tailoring, Celluloid and Brush making, than in the other large Districts of the County. Comparing 1911 with 1921, on the surface the masses seem to be better clothed and better fed, and the physique of our School Children has improved. A noted contrast between the periods is the number of girls now employed in clerical work—3,247 as against 750 in 1911. HOSPITALS AND POOR-LAW RELIEF. The Walthamstow, Wanstead and Leyton Children's and General Hospital, containing 50 beds, situated in the Hoe Street Ward is conveniently accessible to all the inhabitants. At present considerable extensions are being carried out, and when completed will make possible a much more efficient service to the Public than heretofore. A Casualty Ward, quarters for two Resident House Surgeons, a Nurses' Home and New Ward Block of 40 beds are in course of construction and will probably be functioning within the year. During 1925 all cases sent from the School Clinics requiring special treatment were readily admitted to the Hospital or were dealt with in the Out-patients' Department. The extent to which the Hospital has been used may be inferred from the following 23 In-patients in Hospital (31-12-24) 50 Admitted during 1925 944 Out-Patients from 1924 continuing treatment in 1925 297 New Out-Patients in 1925 9,938 Out-Patients' Attendance in 1925:— Medical 8,531 Surgical 25,832 The only contribution made to the Hospital by the Local Authority is a retaining fee of £15 15s. for two beds reserved for the treatment of Typhoid patients. The patients are paid for at the rate of 30s. per week. Reference has previously been made in my Annual Reports to causes which militated against a maximal usefulness of the Hospital and while these have to some extent disappeared, co-operation of the Hospital's work with that of the Dispensary, the Child Welfare Clinics and the School Clinics is lacking. Combination of the Public Health Authority—which has powers to contribute any necessary funds to the Hospital—with the Governors and Subscribers, might make it as efficient to cater for the needs of the sick inhabitants as is the Isolation Hospital for the needs of those suffering from Infectious Disease. Walthamstow Dispensary.—This is situated like the Hospital in the Hoe Street Ward, but is more centrally placed as regards the District as a whole. In addition to the useful medical work which the Staff of this Institution undertake on behalf of the Subscribers, they also carry out the surgical treatment of enlarged Tonsils and Adenoids and the X-ray treatment of Ringworm on behalf of the Education Committee. A member of the Staff attends for a few hours daily for the routine work of the Dispensary, and that for the Education Committee is carried out at definite times on specified days. The Dispensary is popular and well patronised and has a good reputation among the Public. Patients require a Subscriber's letter and each pays 4d. per week while under treatment to cover the cost of the physic supplied. During 1925, 1,216 patients, making 3,829 attendances, received treatment. All the operative work undertaken for the Education Committee has been satisfactorily carried out and during 1925, 234 children were successfully operated on for the removal of Tonsils and Adenoids. 24 There are no beds attached to the Dispensary and although so far nothing untoward has arisen, the removal of children to their homes within a few hours after operation can only be justified by necessity. The premises are by no means ideal for the work carried on and they do not lend themselves except at great cost to much improvement or extension. With the enlargement of the Out-Patients' Department of the General Hospital, the Dispensary will probably be less patronised as time goes on and for many reasons this Institution should join forces or agree to absorption by the General Hospital. The latter should then form the centre for all the Medical and Surgical work of the District. By a complete linking up of all the Agencies concerned—Hospital, Dispensary, Orthopaedic Hospital, Child Welfare Societies and Essex Cottage Nursing Association—a complete and satisfactory service could be rendered to the Public at a reduced cost and with an increased efficiency. Whipps Cross Hospital, under the management of the West Ham Guardians is just outside the borders of the District. The Surgical and Medical work carried out there is similar to and equally as good as that of the large Hospitals in London and no difficulty has been experienced to get admission for patients from this area. The Essex Cottage Nursing Association. A Branch of this Association has its quarters in the High Street Ward and is well placed to serve a large working class population. The resident Staff consists of a Sister-in-Charge—a qualified and experienced nurse midwife, holding a certificate for massage and electrical treatment—assisted by nine others, four of whom are qualified Midwives. The Association has been carrying on its work for the past 22 years and its inception was mainly the outcome of local effort. The work carried out is mainly attendance on the poorer women during confinement and the lying-in period, and nursing the sick poor in their own homes. The midwifery work is invariably well done and the Rules of the Midwives Board are strictly observed. A very useful feature of this work of the Association is the large amount of Ante-Natal visiting undertaken—359 such visits were paid from July to December, 1925. During the year 262 Midwifery cases were attended by the Midwives, and 67 others in conjunction with a Doctor. 25 At the request of various London Hospitals, the Association visited, at their homes, 140 children following removal of Tonsils and Adenoids, and in addition 31 other cases were visited and the necessary prescribed treatment carried out. The amount of general nursing entailed 13,152 visits, and 3,091 massage treatments were given to 55 patients. In addition to the work referred to, probation nurses attend the School, Child Welfare and Ante-Natal Clinics, and while thus enjoying facilities to acquire a fuller knowledge, are a great help to the Local Authority in the work undertaken for Child Welfare. POOR LAW RELIEF. For the following details I am indebted to the Clerk to the West Ham Guardians. The numbers of Walthamstow Residents admitted during the year to the Institutions named were as follows:— The Central Home 434 Whipps Cross Hospital 1,419 Forest Gate Sick Home 92 Children's Homes 47 Margate Convalescent Home 19 The average number of Walthamstow Residents in receipt of out-relief during the year was as follows:— Cases 3,508, comprising 8,870 persons. Cost per week £3,270. VITAL STATISTICS. In 1911 the enumerated population was 124,580 and in 1921, 129,395. Between 1911 and 1921 the natural increase of the population was 14,144 and since 1921, 4,840. The latter figure added to the enumerated population of 1921, would be 134,235 or 3,435 more than our mid-year 1925 population as given by the Registrar General. Looking at the Table headed "Sub-Districts" it will be noticed that from local knowledge I estimate our present-day population as 133,740, and there is reason to believe this is more nearly correct than the figure given by the Registrar General. Upon the basis of a population of 130,800, the general birth and death rates of the District are ascertained, otherwise these rates would not be fairly comparable with those of other ' 'Large Towns" whose populations, like our own, are based on data known at Somerset House. The discrepancies in Ward populations under Sub-Districts and those given on page 30 are thus accounted for. The following Table gives a summary of the Vital Statistics of the area for 1925 and the years previously on to 1911:— 26 table vii. Vital Statistics of Whole District during 1925 and previous Years. Year. Population estimated to Middle of each Year Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number Nett. Number. Rate. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 year of age At all ages. Number. Rate. Number. Rate per 1000 Nett Births. Number. Rate. 1911 125334 3107 3182 25.36 1018 8.1 33 471 340 108.30 1456 11.70 1912 128480 3104 3150 24.40 876 6.8 22 413 243 77.10 1267 9.80 1913 131636 3210 3261 24.77 943 7.1 17 408 256 78.47 1334 10.13 1914 131980 3072 3134 23.74 946 7.1 21 503 243 77.50 1428 10.70 1915 131718 2826 2867 21 .70 1091 8.2 20 502 267 93.10 1573 11.90 1916 131718 2779 2854 20.50 925 7.2 39 490 196 69.30 1376 10.70 1917 126140 2167 2228 16.70 867 7.2 29 492 152 70.00 1330 11.10 1918 119307 1980 2034 15.90 1299 10.8 31 524 166 81.10 1792 15.7 1919 127684 2218 2301 17.20 869 6.9 35 439 160 69.50 1273 9.90 1920 132771 3142 3286 24.70 834 6.2 20 479 198 59.90 1293 9.70 1921 129800 2814 2673 21.20 801 6.1 25 461 173 61.40 1237 9.50 1922 129700 2405 2545 18.80 917 7.0 28 513 155 62.80 1402 10.70 1923 130000 2314 2529 18.12 719 5.5 35 481 116 45.80 1165 8.78 1924 131100 2104 2291 16.10 786 5.9 39 581 146 64.10 1328 10.01 1925 130800 2152 2351 17.9 758 5.7 42 589 121 51.4 1309 10.00 27 BIRTHS AND BIRTH-RATES. The number of births registered within the District during the year was 2,131—males, 1,076; females, 1,055. The total births as given by the Registrar General were 2,351, showing that 220 were born and registered without the area. Of the total births, 56 were illegitimate as compared with 43 in 1924 and 70 in 1914. In other words 2.2 per cent. of the children born in 1914 were illegitimate compared with 2.3 per cent. in 1925, a proportion not differing materially from that in pre-war days. The birth-rate for the year was 17.9 per 1,000 of the population as estimated by the Registrar General. This rate is an improvement on the previous year, but less by .4 than that of the Country as a whole and by .9 than that of the 105 County Boroughs and Great. Towns. The 157 Smaller Towns had only .4 greater rate than Walthamstow and London a rate of .1 only. The following Table (page 28) shows the births distributed in Wards, with birth-rates for 1924 and 1925, on populations estimated by the Registrar General:— 28 table viii. Births distributed in Wards—with populations (1921), and Birth-rales for 1925 St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1st quarter 29 34 28 32 21 28 19 30 24 24 34 26 165 174 2nd quarter 53 53 42 44 41 42 44 34 43 40 53 51 276 264 3rd quarter 50 45 53 43 43 46 51 43 42 36 71 54 310 207 4th quarter 58 82 63 54 42 56 44 52 41 33 77 73 325 350 200 214 186 173 147 172 158 159 150 133 235 204 1076 1055 Totals 414 359 319 317 283 439 2131 Number of Births as given by R.G. — — — — — — 1180 1171 2351 Population (Census, 1921) 24936 20480 23895 17589 18072 24423 129395 Population (assumed, 1925) — — — — — — 130800 Birth-rate 1925 16.6 17.5 13.3 18.0 15.6 17.9 17 9 Birth-rate 1924 18.8 15.7 14.3 16.2 15,4 16,2 17.4 Infantile Mortality Rate 1925 53.1 61.2 72.1 66.2 49.9 45.5 51.4 Infantile Mortality Rate 1924 61.4 79.6 75.8 77.7 56.1 68.8 64.1 29 The populations of the Wards are those of Census year and the total is slightly less than that assumed for the whole District by the Registrar General for 1925, but there is no reason to think that any great changes have occurred in the Wards, except those of Hale End and Higham Hill. Probably the Birth and Death-rates of these Wards are actually less than those given. At any rate, the figures, though not accurate, are based on like data as in previous reports, and to this extent will serve for conclusions to be drawn as to the relative improvement or otherwise noticed from year to year in the constituent parts of the area. The birth-rates for the various Wards for Census years 1901 and 1911, and for 1920, 1922, 1923, 1924 and 1925 were as follows:— St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Whole District. 1901 33.0 35.7 28.0 28.4 39.8 33.1 1911 26.4 26.9 20.0 23.5 27.0 25.3 1920 25.0 24.9 20.0 23.7 21.5 25.0 1922 18.0 19.0 15.3 18.4 19.3 17.0 19.6 1923 19.8 18.3 15.7 17.5 15.0 19.5 19.4 1924 18.8 15.7 14.3 16.2 15.4 16.2 17.4 1925 16.6 17.5 13.3 18.4 15.6 17.9 17.9 I am unable to give the rates for 1921, and those for 1922 are shown for comparison as the year following Census and when the known populations of the Wards were fairly correct. The decline in the birth-rate for the whole District in the last 25 years was nearly 40 per cent.; that for St. James' Street and High Street 50 per cent., and Hoe Street nearly 54 per cent. Hale End and Higham Hill Wards were in 1901 known as the Northern Ward, but taking the mean for both as 16.7 the decrease is even greater than in Hoe Street. DEATHS AND DEATH-RATES. WHOLE DISTRICT. During the year 758 deaths—males, 400; females, 358—were registered within the District. Forty-two of these—males, 25; females, 17—were of non-residents and are now excluded. The deaths of those dying without the District numbered 586, or nearly 45 per cent, of the whole. The great majority of these occurred in Hospitals. Two hundred and fifty took place at Whipps Cross Hospital, and 138 at the Central and Sick Homes—Institutions under the Poor Law—120 died in London Hospitals, 23 in Mental Hospitals, 11 at Sanatoria and 44 elsewhere. 30 The total deaths given by the Registrar General for the Calendar year were 1,309, or 6 more than I account for. These represent a death-rate of 10.0 per 1,000 on a total population of 130,800. Corrected for age and sex, that is allowing for differences in the age and sex constitution of our population and that for the Country as a whole as found at the Census, the rate is increased to 10.59. All deaths registered within the District were certified by the Coroner or a registered Practitioner. The death-rate for England and Wales was 12.2; that of the 105 County Boroughs and Great Towns 12.2; that of the 157 "Smaller Towns" 11.2 and for London 11.7. The birth, death, and infantile mortality rates of the following districts of the outer zone of London compared with Walthamstow, are as follows:— District. Population. Birthrate. Deathrate . Deatns of Children under 1 year to 1 000 Births. West Ham 317,400 24.7 10.6 58 Willesden 169,100 15.1 9.8 67 Tottenham 153,100 14.9 10.2 62 Hornsey 87,240 12.1 10.9 47 Leyton 133,500 12.5 9.9 66 Croydon 196,000 17.9 10.9 52 East Ham 146,900 14.6 9.9 61 Ilford 92,400 15.3 9.2 53 Edmonton 70,450 28.0 9.5 39 Walthamstow 131 100 16.4 9.9 57 The preceding figures are those given by the Registrar General in his four quarterly Reports. The figure 57 as the Walthamstow Infantile Mortality Rate is now found to be 51.4 and probably that for each of the other Districts may be lowered when the final corrections are made. ACCORDING TO WARDS. The number of deaths and their distribution into Wards is as ascertained, but the populations are those as enumerated in 1921, with slight, adjusted variations. These will not vitiate to any extent the true death-rates:— St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill. Population 25,000 20,500 24,000 17,600 18,000 25,000 Deaths 287 191 267 187 161 210 Death-rate (1925) 11.5 9.3 11.1 10.0 8.9 8.9 (1921) 10.5 9.8 11.0 9.8 9.9 7.9 (1914) 12.3 11.1 11.0 11.4 9.2 8.2 The causes of death for the Whole District and for the Wards are given in the Table following page 31. 31 The highest rates are those of St. James' Street, Hoe Street and Wood Street Wards, but the Mortality in all the Wards is less than in 1914—Higham Hill excepted, with a minimal increase. The Hale End and Higham Hill Wards with a high general level over ordnance datum, are still largely unbuilt on and are surrounded by open country or the Forest—advantages not enjoyed to the same extent by the other portions of the District—and may account for their low Mortality rates. St. James' Street with the highest rate lies from 18 to 50 feet above sea level, is built over and inhabited largely by semi-skilled or casual workers who have a constant struggle to keep over the poverty line. My remarks on page 15, as to the inhabitants and the conditions in this Ward are emphasised in the proportionally greater number dying from Tuberculosis, Respiratory and Heart Diseases, as compared with the other Wards. Hoe Street's high death-rate is accounted for by quite the reverse conditions. The Ward has a large proportion of well-to-do people living under favourable economic conditions tending to longevity. This is attained, and the causes of death include those associated with old age, namely Cancer, Senile Decay and diseases of the Heart and circulating organs. Under the heading of Senile Mortality it will be seen that over 27 in every 100 dying in this Ward were over 75 years of age. An unsatisfactory feature in the Mortality of this Ward, however, is the excessive number of deaths in children under 1 year of age. With the lowest birth-rate the Ward has the highest Infantile Mortality rate. One usually associates infant mortality with ignorance of the laws of health and feeding and poor economic conditions, and yet with 100 more births, the poorer mothers of St. James' Street had to their credit fewer deaths than their well-to-do sisters in Hoe Street. The large number dying in Hoe Street from Prematurity and Convulsions within the first month of life is significant and leads one to think that Ante-natal conditions are more artificial in the one Ward than in the other. 32 INQUESTS. During the year 105 inquests were held concerning the deaths of Residents. The ages at death and the causes assigned were as follows:— 65 yrs. and Under lyr. 2-5 yrs. 5-15 yrs. 15-25 yrs. 25-45 yrs. 45-65 yrs. upwards. 14 2 3 11 9 37 29 Under One Year.—Tubercular Meningitis, 1; Atelectasis Neonatorum, 2; Broncho-Pneumonia, 1; Lobar-Pneumonia, 1; Congenital Malformation, 1; Whooping Cough, 1; Convulsions, 1 Heart Failure, Patent foramen ovale, 1; Syncope Status Lymph aticus, 1; Accidental shock following concussion of brain and partial asphyxiation by Water, 1; Accidental Asphyxia through inhalation of vomited food into bronchi, 1; Accidental syncope pressure of overloaded Stomach on Heart, 1; Accidental Asphyxia while in bed with parents, 1. Over One Year.—There were 56 returned as due to Natural Causes, 4 to mis-adventure, 33 to accidents and 8 were suicides. SENILE MORTALITY. Of the total deaths recorded in the District 517 or 39 per centwere of persons aged 65 and upwards compared with an average in 1920 of 30 per cent. Two hundred and seventy-four were over 75 years of age,. 34 over 85, and 17 over 90 at the time of death. Hoe Street Ward contained the largest number, 125; followed by St. James' Street with 105, Wood Street, 78, Higham Hill, 76, High Street, 70 and Hale End 63. Apart from old age the chief causes of death in the latest stages of life were Cancer and diseases of the Heart and Lungs. The figures relating to the Wards were as follows:— In St .James St. Ward,57 were 75 yrs. or over; of these,5 were 85 yrs. or over. „ High Street „ 32 „ „ „ „ 5 „ „ Hoe Street „ 71 „ „ „ „ 4 „ Wood Street „ 43 „ „ „ „ 7 „ „ „ Hale End „ 33 „ „ „ 4 „ „ Higham Hill „ 38 „ „ „ „ 9 „ The following table (page 33) gives the number of births and deaths, their rates, the Zymotic Death-rate, Infantile Mortalityrate, and natural increase of population for the past 35 years, and the average in five-yearly periods. The rates for 1925 are based on similar data to preceding years:— TABLE IX Causes of and Ages at Death during the year 1925. Whole District and Wards. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the district. Wards. All Ages Under l'year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and upwards St. James Street High Street Hoe Street Wood Street Hale End Higham Hill No. 1 2 3 4 5 6 7 8 9 10 1 Enteric Fever 2 - - - - 1 - 1 - 2 - - - - - 2 Small Pox - - - - - - - - - - - - - - - 3 Measles 6 — 3 3 - - - - - 3 1 1 - - 1 4 Scarlet Fever 1 — — 1 — — — — — — 1 - - - - 5 Whooping Cough 26 10 9 6 1 — — — — 7 5 5 4 1 4 6 Diphtheria 7 — 1 4 1 1 — — — 2 2 - 2 - 1 7 Influenza 31 — 1 — 1 4 1 9 15 7 1 6 10 3 4 8 Encephalitis Lethargica 3 — — 1 — — — 1 1 1 1 1 - - - 9 Meningococcal Meningitis 2 — 1 1 — — — — — 1 - - - - - 10 Tuberculosis of Respiratory System 112 — — 3 6 25 42 32 4 22 20 17 15 13 25 11 Other Tuberculous Diseases 26 3 5 5 7 2 2 2 — 7 3 7 2 5 2 12 Cancer, malignant disease 155 — — — 1 2 12 76 64 26 23 39 28 15 24 13 Rheumatic Fever 3 — — — — 1 — 2 — — 1 1 1 - - 14 Diabetes 9 — — - — — — 4 5 1 - 1 2 2 3 15 Cerebral Haemorrhage, etc. 69 — — — — — 3 22 44 13 8 22 7 6 13 16 Heart Disease 168 1 — 1 4 4 9 55 94 39 34 35 20 16 24 17 Arterio-sclerosis 22 - — - — — 2 5 15 6 3 2 3 4 4 18 Bronchitis 150 9 2 - 2 1 4 31 101 39 17 33 21 23 17 19 Pneumonia (all forms) 99 15 12 5 3 5 8 23 28 26 18 15 9 12 19 20 Other Respiratory Diseases 17 1 — — — 1 — 7 8 4 1 7 2 2 1 21 Ulcer of Stomach or Duodenum 9 - - - - - 1 6 2 2 2 2 1 1 1 22 Diarrhoea, etc. (under 2 years) 6 6 — — — — — — — 1 1 3 - 1 - 23 Appendicitis and Typhlitis 10 — — 1 4 — 2 3 — 1 1 - 1 5 2 24 Cirrhosis of Liver 5 - - - - - 1 3 1 1 - - 1 1 2 25 Acute and Chronic Nephritis 40 — — — 3 2 7 16 12 10 7 4 5 7 7 26 Puerperal Sepsis 1 - - - - - 1 — — — — — — — 1 27 Other accidents and diseases of Pregnancy and Parturition 6 - - - - - 6 — 1 2 2 — 1 — 28 Congenital Debility and Malformation, Premature Birth 63 62 1 - - - — — — 10 12 11 11 7 12 29 Suicide 8 — — — — 3 — 3 2 2 1 1 2 1 1 30 Other Deaths from Violence 35 3 — 1 1 3 3 11 13 5 1 11 5 7 6 31 Other Defined Diseases 147 11 3 6 11 8 16 40 52 38 19 22 24 21 23 32 Causes ill-defined or unknown 1 1 — — — — — — — — - - - - 1 Special Causes (included above) - - - - - - - - - - - - - - - Poliomyelitis - - - - - — — - - - - - - - - Polioencephalitis - - - - - - - - - - - - - - - Senile Decay 64 - - - - - - - 64 10 7 18 11 6 12 Totals 1303 122 38 38 45 63 120 352 525 287 191 267 187 161 210 TABLE X. SUMMARY, 1925. Causes of Death of Children under 1 year of age. Cause of Death. Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3 Months and under 6 Months 6 Months and under 9 Months 9 Months and under 12 Months Total Deaths under One Year. Wards . St. James Street High Street Hoe Street Wood Street Hale End Higham Hill All Causes Certified 40 5 16 6 67 17 22 10 6 122 Uncertified - - - - - - - - - - Influenza - - - - - - - - - - - - - - - - Small-Pox — - - - - - - - - - - - - - - - Chicken-Pox - - - - - - - - - - - - - - - - Measles — - - - - - - - - - - - - - - - Scarlet Fever — - - - - - - - - - - - - - - - Whooping Cough - - - - - 2 3 2 3 10 2 2 3 1 - 2 Diphtheria and Croup - - - - - - - - - - - - - - - - Erysipelas - - - - - - - - - - - - - - - - Tuberculous Meningitis — - - - - - 1 — — 1 - - - - 1 - Abdominal Tuberculosis (b) - - - - - - - - - - - - - - - - Other Tuberculous Diseases — - - - - - - - - - - - - - - - Phthisis - - - - - - - 1 — 1 - 1 - - - - Meningitis (not Tuberculous) - - - - - - - - - - - - - - - - Convulsions 1 1 3 — 5 — — 1 — 6 - 1 4 - - 1 Laryngitis — — — — — — — — — - - - - - - - Bronchitis 1 1 1 — 3 4 3 - - 10 4 2 - 2 2 - Pneumonia (all forms) 1 — 1 — 2 3 6 2 2 15 3 2 2 2 2 4 Diarrhoea — — — — — — — — — — - - - - - - Enteritis — — 2 1 3 — 3 1 — 7 1 i 3 - 1 1 Gastritis — - - - - - - - - - - - - - - - Syphilis — — 1 — 1 1 — — — 2 - - - 2 - - Rickets - - - - - - - - - - - - - - - - Inattention at Birth, wilful neglect — — — 1 1 — — — — 1 1 - - - - - Suffocation, overlying — - - - - - - - - - - - 1 - - - Injury at Birth 1 — — — 1 — — — — 1 - - 1 - - - Atelectasis 6 — — — 6 — — — — 6 1 1 - 2 1 1 Congenital Malformations 3 — 1 1 5 1 2 1 — 9 2 1 1 1 2 2 Premature Birth 25 2 4 3 34 3 — — - 37 4 10 8 5 4 6 Atrophy, Debility and Marasmus 2 — 1 — 3 1 2 — — 6 3 - - 1 - 2 Cerebro-Spinal Meningitis — — — - - - - - - - - - - - - - Encephalitis — — — — — — — — — - - - - - - - Other Causes — 1 2 - 3 2 2 2 1 10 I 1 1 5 1 1 Totals 40 5 16 6 67 17 22 10 6 122 22 22 23 21 14 20 TABLE XI. 33 Birth, Death, and other Rates since 1891. Year. Births. Deaths. B. Rate. D. Rate. Zymotic D. R. Infantile Mortality Rate. Natural Increase of Population 1891 1756 694 37.3 14.7 1.9 120.0 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 32.0 12.6 1.8 129.6 1096 1895 2021 965 33.2 15.8 3.5 153.3 1056 1823 820 34.4 15.33 2.7 136.3 1003 1896 2101 817 32.3 12.5 2.4 127.5 1284 1897 2246 832 32.08 11.88 2.8 132.0 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 1900 3037 1254 33.37 13.78 2.8 158.7 1783 Average for 5 years 1891-1895 2502 1043 32.33 13.4 2.92 151.5 1458 1901 3210 1296 33.1 13.35 2.82 147.6 1914 1902 3426 1154 34.82 11.73 1.3 115.0 2272 1903 3535 1178 34.97 11.65 1 .9 113.7 2357 1904 3649 1330 35.14 12.81 3.1 135.9 2319 1905 3389 1249 31.76 11.71 1.8 104.4 2140 Average for 5 years 1901-1905. 3341 1241 33.94 12.25 2.18 123 3 2200 1906 3594 1447 32.79 13.20 2.9 129.7 2147 1907 3629 1376 32.23 12.22 2.0 104.7 2253 1908 3482 1258 30.10 10.87 1.0 100.8 2224 1909 3369 1205 28.35 10.14 1.0 83.4 2164 1910 3197 1186 26.18 9.71 0.8 88.5 2011 Average for 5 years 1906-1910.. 3454 1294 29.93 11.22 1.5 101.4 2159 1911 3182 1456 25.36 11.70 1.58 108.4 1726 1912 3150 1267 24.40 9.80 0.87 78.9 1883 1913 3261 1334 24.76 10.13 0.84 79.5 1926 1914 3134 1428 23.24 10.50 0.98 77 .5 1706 1915 2826 1573 21.7 11.9 1.06 93.1 1253 Average for 5 years 1911-1915.. 3110 1411 23.89 10.8 1.06 87.4 1698 1916 2854 1376 20.5 10.7 0.72 693 1478 1917 2228 1330 16.7 11.1 0.75 70.0 898 1918 2034 1792 15.9 15.7 0.79 81.1 252 1919 2215 1273 17.2 9.9 0.61 69.5 1028 1920 3286 1293 24.7 9.7 0.45 59.9 1993 Average ^ for 1 5 years [ 1916-1920. J 2523 1413 19.0 11 4 0.66 69.9 1130 1921 2673 1237 21.7 9.5 0.52 61.4 1436 1922 2479 1402 19.6 10.8 1.07 62.8 1077 1923 2529 1165 19.4 8.96 0.30 45.8 1364 1924 2291 1328 17.4 10.01 0.19 64.1 963 1925 2351 1309 17.9 10.00 0.34 51.4 1042 Average for 5 year8 1921-1925 2464 1288 19.2 9 85 0.48 57.1 1144 34 TABLE XII. Since my appointment the numbers of deaths from the Zymotic diseases named were as follows:— Small-Pox. Scarlatina. Diphtheria and Croup. Typhoid. Measles. Whooping Cough. Diarrhoea. Zymotic Enteritis. Total. 1898 0 3 46 9 39 24 162 283 1899 0 6 73 19 33 34 144 309 1900 0 5 78 6 3 54 110 27 (GastroEnteritis 283 1901 0 13 38 12 43 26 131 10 274 1902 20 6 21 13 14 23 23 5 125 1903 0 6 17 19 52 34 28 37 193 1904 1 14 29 10 55 32 84 99 324 1905 0 17 28 8 35 31 52 26 197 1906 0 21 57 8 39 18 113 51 307 1907 0 22 36 5 22 76 56 15 232 1908 0 11 22 13 36 2 26 14 124 1909 0 11 17 2 30 46 7 10 123 1910 0 4 15 2 20 32 8 23 104 1911 0 5 30 3 32 19 130 219 1912 0 2 23 2 22 37 27 113 1913 0 2 21 2 21 18 47 111 1914 0 7 29 4 21 17 48 126 1915 0 7 12 1 54 31 46 151 1916 0 3 19 0 24 21 24 91 1917 0 2 24 4 24 11 25 90 1918 0 o 16 2 19 32 20 91 1919 0 2 20 1 9 5 41 78 1920 0 1 19 1 5 10 24 60 1921 0 5 12 0 3 8 45 73 1922 0 8 26 1 40 39 23 137 1923 0 0 6 2 1 3 16 28 1924 0 1 4 0 11 17 9 42 1925 0 1 7 0 6 26 6 46 Birth Rate General Death Rate 35 SECTION II. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals Provided or Subsidised by the Local Authority or County Council. 1. Tuberculosis.—In 1914 the Council erected a pavilion of 14 beds for Tuberculosis patients, on land adjoining the Isolation Hospital in the Chingford Area. Since then, by arrangement with the County Council of Essex, these beds have been continuously in occupation by patients of the pulmonary type, until mid-year 1923, when surgical cases were admitted. 2. Maternity.—Many unsuccessful attempts have been made to establish a Maternity Hospital and at the present moment an application is before the Ministry for sanction to purchase a House considered suitable for this purpose. 3. Children.—Apart from the General Hospital already referred to the Voluntary Child Welfare Society has established six beds for the treatment of children suffering from developmental defects and malnutrition. The Council contributes £50 yearly and any children sent there for treatment by me are paid for at the rate of thirty shillings a week. 4. Infectious Disease.—The Isolation Hospital provided by the Local Authority and situated without the Area is referred to on page 60. In addition two beds are retained by the Local Authority for the treatment of cases of Typhoid and these have, so far, been quite sufficient for the purpose. 5. Small Pox.—No provision has yet been made for the treatment of patients who may contract this disease. In 1902 the Council paid a large sum to West Ham, and up to the year 1919 also paid yearly a retaining fee of £100 to ensure treatment for patients from this Area at the Dagenham Hospital. These sums have been largely wasted and the Council refused to enter into a later scheme formulated by West Ham, primarily from a feeling that the original agreement when entered into was considered to be permanent, but mainly owing to a belief that the County Council of Essex is the Authority which can adequately and economically provide for the Metropolitan Areas of the County such a Hospital under the Isolation Hospitals Act of 1893. There is no Institutional provision made by the Authority for unmarried mothers, illegitimate infants and homeless children. 35 AMBULANCE FACILITIES. (a) Two motor Ambulances for Infectious Diseases are maintained by the Local Authority and the St. John's Ambulance Association hires its Motor Ambulance for the removal to Hospital of cases of serious illness and deals with accidents without payment. (b) The Council has had under consideration the provision of an Ambulance for night and day service to be kept at the Fire Station and available for serious street accidents occurring within the Area and requiring removal to Hospital. No final decision has yet been made, CLINICS AND TREATMENT CENTRES. These embrace the following:— Situation. Accommodation. By whom provided. Description. Brookscroft, Forest Road. Waiting rooms, weighing room, consulting room class rooms. Voluntary Association . Infant consultations, wards for observation and treatment. Truro Hall, High Street. Waiting, weighing and consulting rooms. Urban District Council. Infant consultations, AnteNatal Clinic. Lloyd Park, Walthamstow Waiting, consulting and treatment rooms. Walthamstow Education Committee . Minor ailments, Dental Clinic, Eye Clinic. Hoe Street, Walthamstow Do. Voluntary. X-ray treatment for School children by arrangement . Do. Do. Essex County Council. Tuberculosis Dispensary . Lloyd Park, Walthamstow Waiting and consulting rooms. Walthamstow Education Com. Orthopaedic Consultation . Cripple School Barrett Road. Consulting and treatment rooms. Do. Consultation and Treatment. Venereal Diseases are treated at the London Hospitals by arrangements made by the Essex County Council. There is no arrangement for home nursing of any kind apart from that undertaken by the Walthamstow Branch of the Essex Cottage Nursing Association, described on page 24. Public Health Officers of Local Authority.—These are given on page 4. 37 Midwives.—There are 12 Midwives practising within the Area in addition to those of the Essex Cottage Nursing Association, mentioned on page 24. During 1925 they attended 927 confinements on their own account and the work carried out was quite satisfactory. In addition they acted as Midwifery Nurses in 111 other cases. Until 31st December, 1925, the Council acted as Supervising Authority, when the County Council resumed its powers under the Midwives Act, 1918. Chemical Work.—By arrangement with the County Council of Essex the Public Analyst for that Body carries out at a fixed fee all the necessary analyses under the Sale of Food and Drugs Acts. During 1925, 89 samples—mainly Milk—were analysed for your Authority and 86 proved genuine. There was such slight variation from normal in the others that no legal action was deemed necessary. Legislation in Force.—The following Legislative Enactments are in force :— ADOPTIVE ACTS. BYE-LAWS AND REGULATIONS. Relating to Public Health in force in the District. Adopted Acts. The Infectious Disease (Notification) Act, 1889. The Public Health Acts (Amendment) Act, 1890. Parts II, III & V. The Infectious Disease (Prevention) Act, 1890. The Public Libraries Act, 1892. Baths and Washhouses Act, 1846, and the Acts amending the same. The Burials Acts, 1852 to 1885. The Public Health Acts (Amendment) Act, 1907. Parts II, III. IV, V, VI, and X. The Public Health Act, 1925. Parts II, III. IV and V. Bye - Laws. Bye-laws with respect to Common Lodging Houses. Bye-laws with respect to Slaughter-houses. Bye-laws with respect to Nuisances. 38 Bye-laws with respect to Houses let in Lodgings or occupied by members of more than one family. Bye-laws as to Nuisances in connection with the Removal of Offensive or Noxious Matters. Bye-laws as to the Decent Conduct of Persons using Sanitary Conveniences provided and maintained by the Local Authority for Public Accommodation. Bye-laws for Imposing on the Occupier of any Premises duties in connection with the Removal of House Refuse so as to facilitate the work of collection. Bye-laws for the Prevention of Nuisances from Filth, Ashes and Rubbish. Bye-laws with respect to New Streets and Buildings and the Alteration of Buildings. Bye-laws with respect to the Provision of Means of Escape in case of Fire in certain Factories and Workshops. Bye-laws for the Regulation of Offensive Trades. Bye-laws re Employment of Children. Regulations. Regulations to be observed by Occupiers of Bakehouses. Regulations with respect to the Management of Sanitary Conveniences provided and maintained by the Local Authority. Regulations with respect to Dairies, Cow-sheds and Milk Shops. SECTION III. SANITARY CIRCUMSTANCES OF THE AREA. Water.—The whole District is served by the Metropolitan Water Board, and the supply is constant. During the year 12 houses had the water supply reinstated or improved; 84 cisterns were cleansed and covered, and in 13 instances were abolished. Since the adoption of the Public Health Acts (Amendment) Act of 1907, a considerable amount of improvement in this latter direction has taken place yearly. No complaint has been made as to pollution of streams within the area. 39 Drainage and Sewerage.—The whole District has a duplicate system of sewers and practica lly every house water-closet accommodation. Work will be commenced in May, 1926, and finished within 18 months, when all the sewage of the Area will be delivered into the London County Council Sewers. There has been difficulty at times, under existing arrangements, for the production of a satisfactory effluent, but no serious complaints have been made nor any action taken by the Dagenham Commissioners for pollution of the stream through which the effluent flows. Scavenging.—This has been efficiently carried out and the large number of private streets now tar-macadamed or asphalted and flanked by flowering and other trees give a general appearance of cleanliness and freshness to our roadways. A weekly collection of house refuse is carried out over the whole District and disposed of at the Destructor. In the Shopping and Market Areas collections are more frequent. In conformity with the Bye-laws galvanised dust-bins are supplied by the landlords to all tenants. Considerable difficulty is experienced in maintaining this provision, especially when renewals are necessary. Sanitary Inspection of the Area.—The following indicates the nature and amount of work carried out during the year:— Number of Inspections made 9,395 Number of nuisances detected 7,978 Number of complaints received 1,704 Informal Notices served 2,299 Informal Notices complied with 2,223 Statutory Notices served 99 Total number of visits from all causes 18,398 The number of complaints received were less than in 1924 and shows that we are slowly returning to more normal conditions. Of the 99 Statutory Notices served 91 were complied with within the year. The nature and variety of the work carried out is shown in the following tables:— Drains tested 295 reconstructed or repaired 400 „ obstructions removed 309 „ means of access provided 34 „ ventilation provided or improved 65 „ ventilation repaired 113 manholes repaired and resealed 55 40 Soil pipes repaired 36 „ new provided 9 Gully traps provided 136 W.c. pans and traps provided 148 Rain water pipes repaired 255 „ „ „ disconnected from drains 9 Roofs repaired or renewed 702 W.c. flush cisterns provided 122 „ „ repaired 373 W .c. floors concreted 82 W.c.'s repaired and cleansed 423 W.c.'s, light and ventilation improved 11 Waste pipes renewed or trapped 270 „ „ repaired 23 New sinks provided 28 Water supply reinstated 12 „ „ taken off main 13 Drinking water cisterns cleansed and covered 84 Conveniences cleansed and repaired 27 Sculleries paved 408 Yards and forecourts paved.. 418 Dirty houses cleansed 151 Dirty rooms cleansed 3,936 Floors repaired 259 Ventilation under floors provided 167 New Damp-proof courses provided 48 Sites concreted 2 Rooms ventilated 2 Offensive accumulations removed 67 Animals improperly kept, removed 10 Manure receptacles provided 8 Stables cleansed, paved and drained 85 Other cases of dampness remedied 357 Separate Sanitary Conveniences provided to shops where both sexes are employed 2 Miscellaneous repairs 1,006 Dampness in Houses. Sites concreted 2 Damp-proof courses provided 48 Yards and forecourts paved and drained 418 41 Roofs made water-tight 702 Rain-water pipes made good 264 Guttering repaired or renewed 365 Other cases of dampness remedied 357 Ventilation under floors provided 167 House-to-house Inspections 429 Premises and Occupations which can be controlled by Bye-laws and Regulations:— Number. Visits paid. Slaughter-houses 15 599 Butchers' Shops 74 851 Bakehouses 45 113 Fishmongers (fish frying & curing), etc. 60 443 Eating-houses and coffee stalls 63 76 Ice cream vendors 125 119 Cowsheds 4 41 Milkshops 123 248 Laundries 31 37 Rag and bone dealers 7 33 Elementary Schools 27 111 Private Schools 13 Piggeries 11 98 Street Stalls Numerous 138 Greengrocers „ 123 Factories „ 234 Workshops „ 253 Outworkers „ 371 As a result of the regular periodical visiting of the Special Premises the following works were carried out:— Butchers' Shops and Slaughter-Houses. Special cleansings, 55; Pavings repaired, 4; Floors repaired and ventilated, 2; Accumulations removed, 3; Drains cleared of obstruction and repaired, 2; Roofs repaired, 2; Coppers renewed, 2; W.c.'s cleansed and Cisterns renewed, 5; Shop fittings improved and blinds renewed, 3; Light and Ventilation improved, 1; New galvanised iron receptacles provided, 7. \ 42 Bakehouses. Special cleansings, 69; Drains repaired, 3; W.c.'s cleansed and doors repaired, 2; Yards repaved, 2; Obstructions from drains removed, 1; W.c. cisterns repaired, 4; New W.c. pans and traps provided, 3; floors repaired, 2; New ceiling fixed, 1; New W.c. provided, 1. Fishmongers . Special cleansings, 38; Drains cleared of obstruction, 3; Yards repaved, 11; W.c.'s repaired and cleansed, 2 ; Access to drains provided, 1; W.c. cisterns repaired, 4; New W.c. cisterns provided, 2; New W.c. pans and traps fixed, 2; Accumulations removed, 4; Floorings repaired, 2; Drains repaired, 3; Other improvements, 2. Coffee and Eating Houses. Special cleansings, 20; Drains cleared of obstruction, 2; W.c.'s repaired and cleansed, 2; Yard pavings repaired, 3; Food Store Ventilation improved, 2; Drains repaired, 3; W.c. Cisterns repaired, 3. Ice Cream Vendors. Special cleansings, 19; Special cleansing of Utensils, 7; Yard pavings repaired, 2; W.c. Ventilation improved, 1; Obstruction from drains removed, 2. Cowsheds and Milkshops. Special cleansings, 36; Pavings relaid, 2; Drains repaired, 3; New W.c. provided, 1; W.c.'s cleansed, 2. Stable Premises. Cleansings, 51; Accumulations removed, 17; Gutters repaired, 2; Roofs repaired, 5 ; Pavings repaired, 4 Manure receptacles repaired, 2 ; New Manure receptacles provided, 8. Laundries . Special cleansings, 26; Roofs repaired, 2; Floors repaired, 1; W.c. Cisterns repaired, 1; Other improvements, 2. Rag and Bone Dealers. Cleansings, 12; New roof provided, 1. Private Schools. W.c. repaired and cleansed, 1; Flush Cistern repaired, 1. Piggeries. Cleansings, 9; Paving relaid, 2; Re-drained, 1. In addition to the foregoing 39 Public' Houses and 51 Off Licensed Premises were inspected which resulted in the following works being carried out:— Cellars cleansed, 21 ; Cellars and floors rendered in Cement, 2; Dampness remedied, 2; Ventilation improved, 5; Flooding of Cellars abated, 2; Light improved, 2; Drains repaired, 4. 43 Smoke Abatement. Observation is kept from time to time on Factory Chimneys, and no legitimate cause of complaint was found. Considerable difficulty was experienced during the year owing to complaints from residents as to the offensive and irritating vapours given off from a manufacturing premises in the Wood Street area. A special report was given by two of the Ministry s Officers and certain improvements were effected. I made several visits to the premises and saw a number of those who believed they were suffering as a result of emitted vapours, but I failed to satisfy myself that this was really so. The workpeople and staff numbering over 300 had practically a clean bill of health throughout the year. Complaints have ceased to be made for the past seven months. Elementary Schools. A systematic survey of all these have been made. Few defects were found and upon representation to the Education Committee they were remedied. The School buildings are nearly all modern and the sanitary fittings up-to-date; ventilation and lighting is invariably good and the water supply—off the main—ample. The action taken in relation to the health of the Scholars and for the prevention of the spreading of disease is detailed under the heading of ''Infectious Diseases." 44 SECTION IV. HOUSING. Table IV. given on page 18 shows that at the Census there were 1,287 overcrowded "occupations." The population since that period has increased only by 1,405 persons. In the meantime 872 houses were erected—608 by the Council and 264 by private enterprise. Fifty-three of the latter were "subsidised." Assuming five in a family per house 4,360 persons have been provided for as against an increase of 1,405 in population. In other words approximately 5,000 persons were living in over-crowded conditions at the Census as against half that number to-day. A considerable number of houses are in course of construction on the border of the District and the Council has in course of construction at the moment (April) 50 houses in the Northern Area. These, in conjunction with the houses being built by private enterprise (97 and 36 Tenements) will tend to relieve at an early date the more serious conditions of present day overcrowding. The number of instances of gross overcrowding discovered in the course of inspection numbered 31. These were to some extent relieved, more particularly the objectionable features of want of separation of the sexes by a different allocation of the sleeping arrangements. The number found by the Sanitary Inspectors is no index to actual conditions. The following list of applications for houses submitted to the Housing Committee in the mid-year shows more fully the extent of gross overcrowding which has not come under the Inspectors' knowledge:— Applicants living in— One room—two adults with two to four children 283 Two rooms—two adults with three to seven children 129 Three rooms—two adults with four to eight and eleven children 559 The causes of overcrowding were the obvious ones—want of sufficient accommodation and in many cases inability to pay for it and the unwillingness of landlords to re-let, preferring to sell their houses as they became vacant. No legal action was taken against occupants for overcrowding, but in many instances the Council or the ''Warner Estate Company" helped by the granting of a house or "Flat." 45 Fitness of Houses. The general standard is lower than in 1914. The defects are largely due to "wear and tear" and the failure to carry out the ordinary repairs during the period 1914-1919. The older houses and those of the "field ranging" type suffered most as they are owned largely by the small men who prior to 1909 bought this class of property, and now find that owing to increased cost of repairs they are financially unable to do justice to their tenants or maintain their property adequately. Decorative repairs are most difficult to get effected, and the necessary painting neglected. The houses under management are probably better than those directly supervised by the class of owner referred to. The number of Statutory Notices served—99 compared with 27 in 1913—shows the difficulty experienced in maintaining anything like a proper housing standard. Owing to failure of landlords the Council carried out repairs under Section 3, Housing Act, 1925, to the extent of £265 on 15 houses. Unlimited action in this respect by the Council is seriously checked by the fact that the Governing Body, like the landlord, has but a limited purse. Years must elapse before the Council can recover the money already expended and naturally many members of the Council hesitate to incur further liability in this way. Prior to 1914 the general standard of fitness of houses was good. How far this standard has fallen is apparent by a perusal of the following table:— Year. No. of complaints received. No. of Informal Notices served. No. of Statutory Notices served. No. of Dirty Rooms cleansed. No. of House-tohouse Inspections 1913 179 1306 27 1224 1326 1920 1847 2532 46 2863 415 1921 2188 2617 32 4567 110 1923 1717 2533 65 5115 1214 1924 1794 2265 75 4097 660 1925 1704 2299 99 3936 429 The number of house-to-house inspections made is influenced by the number of complaints received, although this was not entirely so in 1923, when an endeavour was made to deal with certain areas in the District. The result of this is shewn in the reduction of complaints in 1924 and 1925. 46 House-to-House Inspection, and the general character of defects found to exist in unfit houses recorded under Section 17, Housing, Town Planning Act, 1909, is as follows:— (1) Number of houses inspected 429 (2) Number of houses found not to be in all respects fit 329 (3) Number of representations made to Local Authority Nil. (4) Number of Closing Orders made Nil. (5) Number of defects which were remedied without Closing Orders 329 (6) General character of the defects found to exist in the dwelling houses inspected Drainage. Uncleanliness. Dampness. The conditions were found as follows:— Good. Fair. Bad Conditions regarding:— (1) Arrangements for preventing the contamination of the Water Supply 412 11 3 (2) Closet Accommodation 381 33 12 (3) Drainage 382 36 8 (4) Condition of house in regard to light, free circulation of air, dampness and cleanliness 221 186 19 (5) Paving, drainage and Sanitary condition of Yard and Outhouses 291 104 31 (6) Arrangements for deposit of refuse and ashes 417 - 9 (7) Any room so dangerous or injurious to health as to be unfit for human habitation 350 72 4 (8) Any other defects which may tend to render house dangerous and injurious to health of any inhabitant 315 101 10 Unhealthy Areas. No part of the District could be described as coming under this heading. There are a few old dilapidated houses in cul-de-sacs in the Wood Street Ward which, under favourable conditions, might be condemned as unfit for habitation. The present Bye-laws as to Houses let in Lodgings are dated 1883. There are no registered premises under this heading and no necessity for a revision of these Bye-laws at present. General and Miscellaneous. Under this heading may be mentioned that 28 sinks of the old and worn out type of soft stone were replaced by those of modern pattern and in no instance was replacement due to the outcome of misuse by tenants. 47 The number of water closets and their fittings replaced was considerable. The improvements in these were mostly on account of the worn out condition of the fittings and to the furred up condition of water closet traps. Many of the latter were found, after removal, to be of an irregular shape and would tend towards corrosion. Such matters as these can hardly be attributable to misuse by tenants. Housing Statistics for the Year 1925. Number of new houses erected during the year— No. of Houses erected (private enterprise) 107 No. of Houses erected (building scheme) 60 Total 167 1.—UNFIT DWELLING HOUSES. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health and Housing Acts) 5,507 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 429 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 329 II.—Remedy of Defects with Service of Informal Notices. Number of defective dwelling-houses rendered fit in consequence of formal action by the Local Authority or their Officers 2,223 III.—Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919, and Section 3 of the Housing Act, 1925. (1) Number of dwelling-houses in respect of which notices were served requiring repair 87 (2) Number of dwelling-houses which were rendered fit— (a) by owners 67 (b) by Local Authority in default of owners 12 48 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declaration by owners of intention to close Nil. B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 12 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 3 (b) by Local Authority in default of owners 9 C. Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders Nil. (2) Number of dwelling-houses in respect of which Closing Orders were made Nil. (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling house having been rendered fit Nil. (4) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 49 FACTORY AND WORKSHOP ACT, 1901 Factories, Workshops, Laundries, Workplaces and Homework. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (i) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries.) 234 7 — Workshops (Including Workshop Laundries.) 253 1 — Workplaces (Other than Outworkers' premises.) 171 - - Total 658 8 — 50 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:—* Want of cleanliness 19 19 - - Want of ventilation I 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 24 24 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 4 4 - - not separate for sexes 2 2 — — Offences 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). - - - - Total 52 52 — — *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act 1901, as remediable under the Public Health Acts. 51 3.—OUTWORK IN UNWHOLESOME PREMISES. Nature of Work. Instances. Notices served. Prosecutions . (1) (2) (3) (4) Wearing Apparel— Making, etc. 34 — — Cleaning and washing — — - Household linen — — — Lace, lace curtains and nets — — - Curtains and furniture hangings — — - Furniture and upholstery — — — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, etc. — — — Artificial flowers 2 — — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags — — — Brush making 6 — — Pea picking — — — Feather sorting — — — Carding, etc., of buttons, etc. — — — Stuffed toys — — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, etc. — — — Textile weaving — — — Total 42 — — 52 SECTION V. INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—The average number of Cows kept in the Area is only 24 as compared with 30 in 1920 and 228 in 1911. (1) The Milk produced in the Area is quite negligible. (2) Cowsheds are under the constant supervision of the Sanitary Inspectors and systematic visits are made quarterly by the Senior Sanitary Inspector accompanied by the Veterinary Surgeon, and any cows found to be tubercular are removed from the herd. The byres are generally well kept and the cows' udders and flanks are kept fairly clean by grooming and washing; in fact, the cowkeepers' standard of cleanliness has advanced considerably within the last few years. The grading of Milk and its pasteurization, now largely practised, has changed the outlook of those engaged in its handling. The milk supplied within the Area must be considered satisfactory as no illnesses have been traced to its consumption. (3) Six of the eleven principal distributors of milk in the Area have installed fairly extensive machinery for the purpose of clarifying and cooling milk, and in some instances plant for the pasteurising by the "Flash" process. One dairyman has installed plant for pasteurising milk by the "Holding" process and is licensed in respect thereof. (4) There are 123 milk sellers registered, the majority of whom carry on a general business. The quantity of milk distributed by the latter is small. No revocation of registration took place during the year, and in one instance only the Council refused to register a would-be milkseller in consequence of the unsuitability of his premises. No appeal was made from this decision. Subsequently the applicant was placed on the register upon giving an undertaking not to deal with milk in any way except in sealed bottles as delivered by the wholesaler to the premises. The number of licences granted for the sale of milk under Special Designations classified as in the Fourth Schedule to the Milk (Special Designations) Order, 1923, was 15. Of these, two are in respect of Bottling Grade A milk and one in respect of Licence for Pasteurizing milk; the other twelve are in respect of Licences to retail Grade A and Pasteurized milk. 53 The type of apparatus licensed in connection with Pasteurised milk is that known as the "Holding" process, fitted with an automatic time and temperature recording chart. Meat Inspection.—During the year 599 visits were paid to the 15 slaughterhouses in the area and as far as possible inspection of all animals has been carried out during slaughter. Notification of the intention to slaughter is invariably given bv occupiers of slaughterhouses. The slaughtering of animals in the early morning and at nighttime caused a considerable amount of overtime to be worked by the Sanitary Inspectors, and some provision should have been made in the Meat Regulations, 1924, that all slaughtering should be done within sunrise and sunset. There has been no request from Meat Traders in the Area for the marking of Meat, and the Council made no application to the Ministry for this purpose. All meat and foods condemned as unfit for human consumption are taken to Low Hall Farm and placed in the Destructor. The administration of the Meat Regulations with regard to Shops has not come up to expectations, although in some instances a considerable improvement is noted. In the absence of definite instructions in the Regulations as to all Butchers' Shops being provided with glass fronts, difficulty is experienced to justify such provision in one instance and not in another. There are comparatively few Meat Stalls, other than those placed immediately outside the owners' shops and little or no difficulty in this respect has been experienced in effecting improvements along the lines indicated in the Regulations. Too much has not been attempted under the Regulations; the important thing—proper supervision of slaughtered animals—has been attained, the remaining objects will gradually be achieved. There are no Public Slaughterhouses in the area. The following Table shows the private Slaughterhouses now in use:— 1920. January, 1925. December, 1925. Registered 13 13 13 Licensed 1 2 2 54 Unsound Food.—The foods condemned were partly discovered in the course of inspections, but the majority were brought to the notice of the Sanitary Inspectors, and no prosecutions have been found necessary. There has been no case of Food-poisoning in the area and the existing powers for dealing with foods appear to be adequate. The following articles were condemned and destroyed:— *1 Oxhead, tongue, liver and lungs. *1 set ox lungs, liver and spleen *2 pigs. heads and offal. *2 sows heads. *2 sets ox lungs and livers. *2 sets ox lungs and heart. *1 pigs head and one liver. *3 ox livers. *2 pigs heads. *2 ox heads. *1 ox kidney and fat. *5 ox heads. *1 beef carcase, all organs and offal. *8 ox livers. *2 sets ox lungs and 1 set gut fat *1 pigs pluck. *1 pigs liver. *1 beef carcase, all organs and offal. 20 lbs. beef and mutton pieces. 5 ox livers. 3 pigs livers. 2 legs of pork. 1 pigs pluck, spleen and intestines . 1 ox tongue. 1 set pigs lungs. 5 ox livers. 25 lbs. salt beef. 1 set sheeps lungs. 3 sheeps plucks. 1 ox liver. 3 stones of beef. 2 cases livers. 1 case frozen rabbits. 10 stones dabs. 8 stones skate. 8 stones cat fish. 5 stones plaice. 1 trunk haddocks. 1 trunk plaice. 1 trunk codling. 147 lbs. fresh water eels. 34 gallons whelks. 1 sack winkles. 21 cases oranges. 10 boxes apples. 2 barrels grapes. 4 sacks peas. 1 lb. macaroni. *Affected with Tuberculosis. 55 SECTION VI. PREVALENCE OF, AND CONTROL OVER, ACUTE INFECTIOUS DISEASES. During the year 997 cases of Infectious Diseases were notified. Each house invaded was visited, and enquiries were made as to the probable sources of infection. All the Scarlet Fever and Diphtheria patients isolated at the Sanatorium were removed under the care of a Nurse, and Typhoid patients are received into the local General Hospital, where two beds are at the disposal of your Authority. The cases of Acute Pneumonia went to the Hospital or Infirmary. Cases of Erysipelas are seldom removed to Hospital except by the Poor-Law Authorities. In many instances persons are notified as suffering from this disease, and when visited are surprised to learn that they are suffering from an illness necessitating a visit from the Public Health Authority. 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 revisits, to ensure that the instructions given are carried out. When 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. It would be an advantage if compulsory powers were in force to prevent such children going to parties and cinemas and to maintain segregation in their own homes until the incubation period was passed. At the beginning of each school term the Head Teachers are advised to examine the children for any signs of recent illness indicative of Scarlet Fever or Diphtheria, and to exclude all suspects until seen by me. Records are kept to show the incidence of these and other diseases at each School, and, when necessary, particular class-rooms are 56 visited, and children with suspicious symptoms are excluded. Disinfection of the cloak-rooms of the Elementary Schools is on rare occasions carried out at the request of the Head Teachers and is only done to allay fear as no useful purpose is served by such a procedure. The provisions as to work in infected dwellings are enforced in accordance with the Factory and Workshop Act, 1901. Following removal or recovery, disinfection of premises was carried out by the Council's employees, and infected clothing, bedding, etc., were treated by steam under pressure. Outfits for early Diphtheria, Phthisis and Typhoid diagnoses are kept at the Public Health Offices, and anti-diphtheritic serum may be obtained during the day at Lloyd Park, and at all hours from the Fire Station. The serum is supplied gratuitously to those unable to pay for its cost or administration, and during the year the local practitioners were supplied with 80 bottles of 4,000 Units each for injection of poorer patients, and 93 injections for prophylactic or curative purposes were made by me or one of the School Doctors. Arrangements have been made for the removal of Scarlet Fever and Diphtheria patients at any hour in case of urgency and the medical practitioners have been given instructions as to the procedure to be adopted. The Regulations issued for the better control of infectious diseases among school children have been strictly carried out. All contacts are seen by me as are the patients discharged from the Isolation Hospital, and children are not re-admitted to School until I satisfy myself that they are free from infection. This practice has been followed for the past fourteen years and no difficulty is now experienced in procuring the attendance of contacts at the Public Health Offices. There is little doubt that the procedure is a wise one, and the work entailed, though considerable, is worth doing, more particularly in connection with Diphtheria . Resulting from this procedure 42 cases of Scarlet Fever and 53 of Diphtheria have been brought to light during the year and many cases notified as primary were found to be really secondary. Scarlet Fever is less amenable to control in this way as many mild cases of this disease go undetected and are never notified. 57 The Schick and Dick tests have not been used, nor has artificial immunization been attempted. The practice of gratuitous distribution of disinfectants to ratepayers is still maintained although very considerably curtailed. When I first became Medical Officer of Health the yearly outlay under this heading was between one and two hundred pounds; probably now it does not exceed ten. It should be discontinued; it costs money and is useless if not dangerous by giving a false sense of security to persons who still believe that Diphtheria, Typhoid, etc., are the results of bad smells from drains or foul sinks. The disinfection by the Public Health Authority of rooms occupied by persons who contract Scarlet Fever or Diphtheria has very little more to recommend it. These infections are personal, and nothing is really needed but free ventilation of the room and its thorough cleansing by the householder. The bedding and clothing of the patient perhaps might be steamcleansed, as it requires more courage than the ordinary official possesses to ignore entirely the practices of our grandparents and the prejudices of the public. There is no provision for the cleansing and disinfection of verminous persons and their belongings. The non-provision of "a cleansing station" was much felt on three occasions in dealing with old persons under Section 48, Public Health Act, 1925, who refused removal from surroundings that were extremely repugnant. From the following Table giving the Notifications since 1890, it will be seen that the Infectious Sickness Rate for Scarlet Fever and Diphtheria has been an improving one since 1900 with the exception of Scarlet Fever in the epidemic years 1921 and 1922. In 1925 with 130,000 people there are only 196 cases of Diphtheria compared with 516 in 1900 with a population of 91,000. 58 The following Table shows for London and certain large Metropolitan areas the number of cases of Scarlet Fever and Diphtheria notified in 1925 to the Ministry of Health, with the number of deaths as ascertained from the Registrar-General's returns and the case death-rate per 100 attacked:— Number notified. Deaths. Case rate per 100. S.F. Dip. S.F. Dip S.F. Dip. London 12,287 12,583 100 481 .8 3.8 Croydon 343 102 1 9 .3 8.8 Willesden 264 304 2 10 .7 3.2 Tottenham 428 248 — 9 - 3.6 Edmonton 112 208 — 26 - 12.5 West Ham 478 766 5 19 1.0 2.4 East Ham 219 251 4 11 1.8 4.3 Leyton 206 289 — 14 — 4.8 Walthamstow 350 198 1 7 .3 3.5 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. Years. Population. Number of Diphtheria Cases. Rate per 1,000 Membranous Croup Cases. Diphtheria and Croup Death-rate per 1,000 population 1890 46500 129 2.50 3 - 1891 47000 153 3.22 9 - 1892 49400 137 2.77 17 - 1893 52000 142 2.73 11 - 1894 57000 129 2.26 15 - 1895 61000 198 3.24 10 - 1896 65000 124 1.90 6 - 1897 70000 152 2.17 6 - 1898 77000 225 2.90 9 .59 1899 83000 338 4.00 7 .88 1900 91000 516 5.60 11 .86 1901 95131 322 3.40 11 .40 1902 97700 142 1.50 8 .21 1903 100400 147 1 .46 5 .16 1904 103200 177 1.70 13 .28 1905 106000 254 2.40 4 .26 1906 108500 287 2.70 6 .52 1907 111500 251 2.20 6 .32 1908 114900 220 1.90 3 .19 1909 117800 182 1.50 — .14 1910 121280 138 1.10 — .12 1911 124597 287 2.20 — .23 1912 128480 233 1.80 — .17 1913 131636 319 2.40 — .15 1914 131980 318 2.40 — .21 1915 131718 199 1.51 — .09 1916 139425 412 2.95 - .14 1917 132994 382 2.87 — .20 1918 127701 239 1.87 — .14 1919 133008 425 3.19 — .14 1920 132771 375 2.82 — .14 1921 127441 380 2.98 - .09 1922 129800 300 2.31 — .20 1923 129700 212 1.63 — .04 1924 130000 257 1.97 — .03 1925 130800 196 1.5 — .05 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. Smallpox . Diphtheria . Croup. Typhus Fever. Enteric Fever. Continued Fever. Erysipelas. Puerperal Fever. Totals. Infectious Sickness Rate per l000Pop. 1890 46500 129 0 160 3 1 117 3 31 0 444 9.5 1891 47000 125 0 153 9 0 59 4 44 3 397 8.4 1892 49400 399 6 137 17 0 28 0 94 3 684 13.8 1893 52000 597 8 142 11 0 60 4 134 5 961 18.5 1894 57000 247 11 129 15 0 66 0 75 3 546 9.5 1895 61000 263 1 198 10 0 95 6 85 4 664 10.8 1896 65000 315 0 124 6 0 193 2 122 5 767 11.8 1897 70000 492 0 152 6 0 88 0 78 7 823 11.7 1898 77000 293 0 225 9 0 75 0 82 3 688 8.9 1899 83000 332 0 338 7 0 118 1 112 5 913 11.0 1900 91000 347 0 516 11 0 86 1 87 8 1056 11.6 1901 95131 608 3 322 11 0 73 0 111 10 1138 11.9 1902 97700 560 146 142 8 0 89 0 131 7 1083 11.1 1903 100400 292 2 147 5 0 88 0 117 6 657 6.5 1904 103200 527 49 179 13 0 56 0 143 10 975 9.4 1905 106000 756 0 254 4 0 50 0 122 2 1188 11.0 1906 108500 809 0 287 6 0 33 1 107 10 1253 11.5 1907 111500 815 0 251 6 0 21 0 105 3 1201 10.7 1908 114900 635 0 220 3 0 37 0 111 8 1014 8.8 1909 117800 506 0 183 0 0 13 0 112 0 814 6.9 1910 121280 232 0 138 0 0 27 0 99 3 499 4.1 1911 124597 387 0 289 0 0 23 0 114 4 815 6.5 1912 128480 287 0 233 0 0 13 1 79 10 623 4.8 1913 131636 450 0 247 0 0 12 0 80 10 799 6.0 1914 131980 399 0 318 0 0 16 0 97 2 833 6.3 1915 131718 320 0 199 0 0 11 0 72 3 605 4.5 1916 128146 344 0 412 0 0 5 0 71 4 836 6.5 1917 119307 187 0 382 0 0 13 0 39 2 623 5.2 1918 113973 124 0 239 0 0 4 0 38 2 407 3.5 1919 131718 319 0 425 0 0 4 0 74 6 828 6.4 1920 132771 670 0 375 0 0 3 0 68 7 1123 8.9 1921 127441 983 0 380 0 0 3 0 58 5 1429 11.2 1922 129800 578 0 300 0 0 1 0 36 4 919 7.1 1923 129700 351 0 212 0 0 5 0 48 6 622 4.8 1924 130000 185 0 257 0 0 6 0 53 3 504 3.9 1925 130800 358 0 196 0 0 2 0 50 4 610 4.6 TABLE XIV. Cases of Infectious Disease notified during the Year 1925. The following table shows the numbers and the Infectious Diseases notified for the whole District and for the Wards, and the number removed to Hospital:— Notifiable Disease. Cases Notified in Whole District. Total Cases Notified in each Locality. Total Cases Removed to Hospital. All Ages. At Ages—Years. St. James Street. High Street. Hoe Street. Wood Street. Hale End. Higham Hill Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards. Smallpox — - - - - - - - - - - - - - — Cholera — - - - - - - - - - - - - - - Plague — - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 196 3 62 106 14 10 1 — 82 16 20 32 14 32 170 Erysipelas 50 — 2 4 5 13 25 1 13 11 2 6 6 12 19 Scarlet Fever 358 2 93 230 28 5 — — 81 79 51 40 30 77 289 Typhus Fever — - - - - - - - - - - - - - - Enteric Fever 2 — — — 1 — 1 — 2 — — — — — 2 Relapsing Fever — - - - - - - - - - - - - - - Continued Fever — - - - - - - - - - - - - - - Puerperal Fever 4 — — — 1 3 — — — 1 — 1 1 1 4 Cerebro-spinal Meningitis - - - - - - - - - - - - - - - Poliomyelitis 1 — — 1 — - - - - - - - - 1 1 Ophthalmia Neonatorum 14 14 - - - - - - 2 2 3 1 1 5 — Pulmonary Tuberculosis 209 1 2 25 51 95 31 4 54 34 31 26 25 39 — Other forms of Tuberculosis 58 — 13 23 11 10 1 — 14 6 7 7 9 15 — Encephalitis Lethargica 4 — 1 — — 1 1 1 1 2 — — — 1 3 Malaria (Imported) — - - - - - - - - - - - - - - Dysentery — - - - - - - - - - - - - — — Pneumonia 101 1 9 19 13 24 30 5 35 20 11 6 7 22 35 Totals 997 21 182 408 124 161 90 11 284 171 125 119 93 205 523 59 TABLE XV. The following Table shows the drainage and other defects in houses from which cases of Infectious Diseases were notified, and will help to show their relationship. Total Number Notified. Disease. No of houses invaded. No. with Defects. No. showing Defects as to Dirty Condition of House. Dirty or uncovered Drinking Water Cisterns. Defective Roofs, etc. Defective Paving, etc. Dampness. Percentage showing Defects in— Dirty Condition of House. Dirty or uncovered Drinking Water Cisterns. Defective Roofs, etc. Defective Paving, etc. Dampness. Drains. Traps, Fittings. etc. Drains. Sanitary Fittings, etc. 358 Scarlet Fever 304 167 29 16 87 19 21 14 11 9.5 5.2 26.6 6.2 6.9 4.6 3.6 196 Diphtheria 156 112 24 9 57 6 11 8 5 15.3 5.7 36.5 3.8 7.0 5.1 3.2 2 Enteric Fever 2 1 - - 1 - - - - - - - - - - - 50 Erysipelas 48 18 — 2 8 — — 5 2 — 25.0 16.6 — — 10.5 4.1 4 Puerperal Fever 4 1 - - 1 - - - - - - - - - - - 610 Totals 514 299 53 27 154 25 32 27 18 10.3 5.2 29.9 4.8 6.2 5.2 3.5 60 Bacteriological Work.—The work carried out under this heading during the year was less than in 1924. This is due to the arrangements made by the County Council of Essex under which practitioners in the Area can have all their pathological specimens examined gratuitously at the County Laboratory. Our work, therefore, was limited to the examination of Diphtheria swabs. The following shows the bacteriological work carried out:— At the Public Health Offices. County Laboratory. Diphtheria Swabs 2,008 127 Sputa specimens — 1,014 Typhoid ,, — 40 Ringworm specimens — 2 Miscellaneous — 28 The number of contacts swabbed was 193 and 28 of these were found to be positive. The number of School children swabbed was 838, and the examinations made for the local doctors were 625. Isolation Hospital.—This institution is situated in the Chingford Parish, and is about three miles from the centre of our District. It provides for 85 beds on the 2,000 cubic feet basis, and is used mainly for the isolation and treatment of patients suffering from Scarlet Fever or Diphtheria . Upon occasions, bad cases of Ophthalmia Neonatorum are removed—the mother accompanying the baby—and a few cases of Chicken Pox and Measles, for whom Hospital treatment could not be obtained otherwise, have been treated in the cubicle block. The Staff consists of a Resident Medical Officer, Matron, twentysix Nurses, a Cook, Needlewoman, Storekeeper, in addition to seventeen Maids engaged in the administrative and hospital blocks, and 4 Maids in the Laundry. The Hospital is self-contained, with producer gas and electrical plant for heating and lighting. There are fifteen acres of land attached to the Hospital, five acres of which are enclosed by a 6 ft. close-boarded fence. About eight acres are under cultivation for the production of potatoes and vegetables used in the Hospital. A gardener and assistant are constantly employed, and in season additional hands are taken on. 61 In January, 1914, a pavilion of 14 beds for the treatment of Phthisical patients was opened. This is built on land adjoining, but separated from the enclosed grounds of the Hospital. The Administrative Block is not sufficiently large for the Staff necessary when the Hospital is running at its maximum capacity, and the block known as the "Observation Ward" of four beds has been converted into eight cubicles and provides sleeping accommodation for eight members of the Staff. This much needed extra accommodation has been most helpful, although, by no means, can it be a substitute for the extensions proposed in 1914. That further hospital accommodation will be demanded by the public in the near future is probable, considering the large number of houses now in course of erection and the changed view point of our people in the presence of infectious illness in the home. The cost of building at present seems prohibitive and since the upkeep of the existing Hospital is now £13,000 yearly, compared with £7,500 in 1914, it will be a matter of considerable difficulty to decide on what is the best course to take—to extend the existing buildings and provide for all cases, or give Hospital treatment to those only who are unable to be nursed in their own homes. The value of Isolation Hospitals in the reduction of Scarlet Fever and Diphtheria incidence has been challenged and the universal opinion is that they have failed to do what was expected of them. Within the next three years the total capital expended will be paid off and relief to the extent of over £2,000 yearly will be experienced. The County Council of Essex make a grant of £5 per bed yearly towards the upkeep of the Hospital, but the sum received is quite negligible compared with total expenses. DISEASES ISOLATED. Enteric Fever.—By an agreement entered into in March, 1912, with the Walthamstow General Hospital, the Council have two beds for the isolation and treatment of this disease. Two cases occurred during the year, and both were in Hospitals for some time prior to notification. Diphtheria.—Twenty-eight beds nominally—at times extended to forty—are provided in two pavilions for this disease. 62 In addition there are twelve beds in the Cubicle Block which, at times, are used for this purpose. At no period of the year were all the beds occupied. The greatest monthly number of notifications (25) was in September and the least (7) in June—the average throughout the year being 16. In September 13 of the cases were discovered by me or members of the Medical Staff, and were mainly School children. I have previously ventured to state that our children in attendance at School are less liable to contract this disease than at other times, and many years experience shows that the careful supervision of the children by the Teachers is a very important factor in our control of the disease. By way of the School Clinics were discovered 57 suffering with Clinical Diphtheria and 53 children with the disease in a nonclinical form. Scarlet Fever.—In normal times 38 beds—14 for acute and 24 for convalescent cases—are provided for this disease. Although a smaller number than usual of the cases admitted were found to have Diphtheria bacilli in the Throat and Nose, or both, their stay in Hospital was in consequence prolonged, and the accommodation in the cubicles very materially helped in dealing successfully with these cases. Throughout the year the number failing with this disease was fairly uniform, the minimum number in any month was 14 in February and the maximum 41 in November. These were followed by 31 in March and 33 in December, but at no period of the year was there any difficulty in isolating and treating the patients in Hospital. Although the type of case was generally mild, and the number isolated small, the "return cases" were numerous in spite of the precautions taken and their isolation well over the accepted normal safe period. Length of stay in Hospital nor completion of desquamation has any influence in the prevention of "Return Cases," but the association of these with patients who suffered from a mixed infection was marked. The following particulars show the month of discharge of infecting cases, the duration of illness, the interval between discharge and 63 "Return" case and the number of susceptible children in the house:— Date of Discharge. Duration of illness. Interval from Discharge to ' 'Return" case No. of susceptible Children in house . under 15 years. Remarks. 15th Mar., 1925 6 weeks 9 days 4 — 17th Mar., 1925 8 weeks 18 days o — 3rd Sept., 1925 7 weeks 14 days 3 — 2nd Dec., 1925 8 weeks 14 days 4 — 7th Dec1925 8 weeks 9-15-39 days 2 — 29th Nov., 1925 8 weeks 16 days 2 *The infecting case was discharged from M.A.B. 18 days later was found to have nasal diphtheria. *3rd Dec., 1925 8 weeks 18 days 2 9th Dec1925 7 weeks 20 days 3 The Resident Medical Officer has furnished me with the following report:— SANATORIUM REPORT, 1925. ADMISSIONS, DISCHARGES AND DEATHS. Scarlet Fever. Diphtheria . Whooping. Cough. Tuberculosis . Other Diseases. Total. Remaining on Dec. 31, 1924 21 56 11 13 2 103 Admitted during 1925 293 173 5 36 9 516 Total 314 229 16 49 11 619 Discharged during 1925 277 209 16 34 10 546 Died during 1925 1 5 — 1 — 7 Remaining on Dec. 31, 1925 36 15 — 14 1 66 Total 314 229 16 49 11 619 64 SEX AND AGES OF PATIENTS ADMITTED. 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 38 21 25 31 15 20 9 14 87 86 173 Scarlet Fever 39 33 64 72 20 36 11 18 134 159 293 Whooping Cough 2 3 - - - - - - 2 3 5 Chicken Pox 1 - - - - - - - 1 - 1 Scarlet Fever and Measles - - 1 2 - - - - 1 2 3 Scarlet Fever and Whooping Cough - 1 - - - - - - - 1 1 Scarlet Fever and Chicken Pox - - - 1 - - - - - 1 1 Diphtheria & Measles - - - 1 - - - - - 1 1 Diphtheria & Whooping Cough - 1 - - - - - - - 1 1 Acute Rheumatism — — — — — — 1 — 1 — 1 Tuberculosis - - - - - - - 36 - 36 36 Totals 80 59 90 107 35 56 21 68 226 290 516 139 197 91 89 516 SEX AND AGE AT DEATH. Disease. Under 5 yea: s. From 5 to 10 years. From 10 to 15 years. 15 years & upwards. Total. M F M F M F M F Diphtheria 3 1 — 1 — - - — 5 Scarlet Fever 1 - - - - - - - 1 Tuberculosis - - - - - - — 1 1 Totals 4 1 - 1 — — — 1 7 DAILY AVERAGE. The average number of patients in Hospital during each month was as follows:— January 69 February 58 March 42 April 48 May 47 June 41 July 38 August 33 September 46 October 49 November 57 December 50 Scarlet Fever.—One hundred and seventy-three cases were admitted during the year compared with 151 in 1924, 277 in 1923, and 444 in 1922. 65 MONTHLY ADMISSION OF SCARLET FEVER CASES. Under 5 years. From 5 to 10 years. From 10 to 15 years. 15 years & upwards. Total M F M F M F M F January 4 2 8 2 3 3 2 2 26 February — — 5 4 1 2 1 — 13 March 2 4 4 4 3 3 1 1 22 April 1 4 5 7 1 5 1 3 27 May 4 2 5 8 2 4 1 — 26 June 3 2 5 1 3 4 — 2 20 July 4 — 5 4 1 1 — 2 17 August 4 3 2 7 - 2 — — 18 September 2 1 4 8 3 2 — 2 22 October 8 3 5 12 — 2 1 3 34 November 7 8 10 9 2 7 1 1 45 December — 4 6 6 1 1 3 2 23 Totals 39 33 64 72 20 36 11 18 293 In addition to the cases of Scarlet Fever complicated by Chicken Pox, Measles and Whooping Cough included in the group "Other Diseases," six cases proved to be incubating Chicken Pox and three cases developed Measles shortly after admission. Seven cases proved on bacteriological examination to be infected with Klebs Loeffler Bacilli though showing no clinical signs of Diphtheria. One death occurred as a result of Scarlet Fever, giving a case Mortality of 0.34 per cent. The chief complications were as follows:- Otorrhoea, 7; Simple Arthritis, 4; Suppurative Adenitis, 2; Endocarditis, 2. Diphtheria.—One hundred and seventy-three cases of Diphtheria were admitted during the year, compared with 232 in 1924, 170 in 1923, and 222 in 1922. MONTHLY ADMISSION OF DIPHTHERIA CASES. Under 5 years. From 5 to 10 years. From 10 to 15 years. 15 years & upwards. Total. M F M F M F M F January 2 1 3 2 3 1 — 1 13 February 5 2 5 2 2 1 1 1 19 March 2 1 3 2 — 2 1 2 13 April 4 2 1 2 4 1 — — 14 May 3 2 2 4 1 3 1 1 17 June 2 2 — 1 1 2 — 2 10 July 2 1 3 3 1 4 2 2 18 August 3 2 1 2 1 2 — 1 12 September 6 4 4 4 1 2 1 1 23 October 2 3 — 5 1 — — — 11 November 5 — 1 3 — 1 1 1 12 December 2 1 2 1 — 1 2 2 11 Totals 38 21 25 31 15 20 9 14 173 66 In addition to those cases of Diphtheria complicated by Measles and Whooping Cough already shown, one case was found to be suffering from Diphtheria and Mumps, and one case had Measles as a concurrent infection on admission. Two cases proved to be incubating Chicken Pox and three cases developed Rubella, Mumps and Whooping Cough respectively within a week of admission. Of the 173 cases treated, five proved fatal, equal to case Mortality of 2.89 per cent. The chief complications were:—Cardiac Paralysis, 7; Strabismus, 3; Palatal Paralysis, 7; Albuminuria, 4. Staff.—Two Nurses contracted Scarlet Fever and one developed Tonsilitis. Swabs.—One thousand, five hundred and eighty-nine swabs were taken and examined during the year. 67 SECTION VII. MATERNITY AND CHILD WELFARE. Following the Notification of Births (Extension) Act, 1915, a modest Scheme for Maternity and Child Welfare was brought into operation and in 1919 a more ambitious one embracing all the activities made possible by the passing of the Maternity and Child Welfare Act, 1918, outlined in Circular M. & C.W. 4, was formulated . Without the provision of a lying-in Hospital or day Nurseries, a considerable amount of work is carried out under all the other headings embraced by the Regulations issued for paying of Grants. There are now in operation two Centres for Child Welfare work and one for Ante-Natal. Five whole time fully qualified nurses are employed and two doctors give at least seventeen hours weekly to consultations and treatment. Home Helps are paid for by the Council and Milk supplied to necessitous Mothers and Children. The Council's Centre—situated in a turning off the main Street in the High Street Ward is convenient and accessible for the majority of those attending. The Premises are not very suitable for the work carried out. A large Church Hall of corrugated iron, indifferently constructed, very draughty and used for all kinds of social services does not lend itself to conversion on three half-days weekly for the work carried out by the Council, even were the accommodation ample. The room used for consultation is a mere lobby and the whole place, as to cleanliness and the makeshift arrangements for dressing, undressing and weighing babies, creates a bad impression on the mothers, and complaints from the Voluntary Workers are constant. It is to be hoped that at the very earliest date, the Ministry will give its sanction to the erection and equipment of a place which will be suitable in all respects for the work already in operation and that adumbrated in previous reports. Ante-Natal Clinic.—During the year the number of pregnant women seeking advice was 242; these making 360 attendances. The number of births coming to the knowledge of the Medical Officer of Health, under the Notification of Births Act, 1915, was 914 by Midwives, 880 by Doctors and 49 by Parents, and the Stillbirths were—12 notified by Midwives and 21 by Doctors. The total births within the Area were 2,131, so that the requirements of the Act were primarily 86 per cent. fulfilled. 68 In 1924, 47 still-births were notified, so presumably the AnteNatal Clinic may take some credit for a reduction in this mortality. Although only 11 per cent. of our pregnant mothers sought advice, 43 per cent. of the Midwives' cases did. Home Helps were provided for 7 of the 10 applications made. This provision is well known to our Mothers and the few applications is an indication that the economic conditions generally of our poorer people are not bad. Infant Consultations.—The following are the quarterly attendances of children throughout the year:— New Cases. Old Cases. First quarter 161 2,278 Second quarter 230 2,662 Third quarter 202 2,538 Fourth quarter 201 2,637 Totals 794 10,115 Of these, twenty were operated on for the removal of Tonsils and Adenoids, three were sent to Brookscroft with excellent results, four were referred to the Orthopaedic Surgeon for Surgical treatment, and Dental treatment was given to 108 children in addition to 36 mothers. The Home visits made by the Health Visitors numbered 1,834 for children born in 1924, 1,104 born prior to 1924 and 2,818 to those born during the year. Six hundred and sixty-three families were and 35,556 pints were distributed as follows:— assisted wi th milk Free. At ½d. per pt. At 1d. per pt. At l½d.per pt. At 2d.per pt. At ½-cost 98 2,856 4,816 416 — 140 182 1,792 1,952 1,288 28 56 84 2,940 4,732 252 — 168 140 3,948 3,360 28 — 280 504 11,536 20,860 1,984 28 644 The following tabular statement of the out-door work of the Health Visitors is interesting. How seriously handicapped many of our mothers are can be seen under the heading "Housing Accommodation." The parents of a third of the children born during the year lived in one room and another third in two rooms. In this respect the mothers of the St. James' Street Ward suffered the greater handicap and the contrast made between this and Hoe Street Wards on page 31 must be noted. 69 TABLE XVI. Ward. How Fed. Sleeping Accommodation. Condition of Baby. House Accommodation. Breast. Breast and Hand. Hand. With Mother. Cot or Cradle. Good. Fair. Bad. Whole House. Flat. Half-House. 1 Room. 2 Rooms. 3 Rooms. St. James Street 306 18 36 234 126 348 10 2 91 38 86 79 46 20 High Street 220 8 23 139 112 243 5 3 42 68 51 39 38 13 Hoe Street 250 8 27 118 167 272 10 3 78 29 71 33 59 15 Wood Street 248 13 39 116 184 276 21 3 65 14 106 61 54 — Hale End 216 10 34 83 177 242 17 1 104 11 73 27 42 3 Higham Hill 348 11 61 188 232 411 5 4 140 109 32 65 68 6 70 "Brookscroft" Voluntary Centre.—The Walthamstow Child Welfare Society was founded by Dr. Elliott in 1914 and has since worked in co-operation and on the most friendly and helpful terms with the Public Health Authority. The original intentions of the Society—"Infant Consultations, a school for mothers and home visiting" —have long since been exceeded and the activities of the Society include "Observation Wards" containing 6 beds for the treatment of children suffering from nutritional and allied disorders on the usual lines, in addition to a special clinic for treatment by Artificial Sunlight. Some excellent results have followed the latter under Dr. Elliott's personal supervision. The paid staff employed for this work consists of a Matron, Sister and three Probationers. Among the 82 Voluntary Workers at the Centre, 32 hold the Certificate of the Society qualifying them to take part in Clinical work, and 11 have been working with the Society since its initiation. All the workers are certified by Dr. Elliott as having attained a high standard of efficiency, having been trained under his personal supervision. The following is extracted from the last Annual Report of the Society:— "The Value of the Observation Wards.—I cannot too often repeat that these are for educational purposes. The mothers are asked to attend regularly to see what is done for their babies. There is no such provision at Hospitals. Infant Consultations and Home Visiting are insufficient to overcome sheer incapability— one of the chief reasons for the admission and long stay of many of the babies in the Wards. The successful results obtained in the Wards are in no small measure due to the skilled attention and untiring devotion of our Matron, Nurse Miller. "The Actino-Therapeutic Department.—The number of outpatient cases receiving Sunlight Treatment during the past year was 66, and the number of baths given 898. The 27 babies in the Wards had 625; these babies are treated three times a week, while out-patients are done twice. In addition to the three Carbon-Arc and six Murray-Levick lamps installed eighteen months ago, the Department has now a Hewittic-Levick-Ulviarc lamp, which is the latest, and by far the best type of mercury arc lamp. Ventilating fans and a large exit ventilator have also been added. The possession of the mercury arc lamp makes it possible to widen the range of treatment, and has led to considerable speeding up of the work. "Among the cases treated were rickets, various forms of malnutrition, enlarged glands (tuberculous and other), tabes mesenterica 71 (so called 'consumptive bowels'), anaemia, bronchitis, functional, mental and nervous disorders, mental deficiency, rheumatism, skin diseases, coelic diseases and convalescence from various illnesses." The general work of the Society summarised was as follows:— Attendance on Consultation Days 6,942 New Cases, (in addition) 572 Average Weekly Attendance on Consultation days 144 (There was no consultation day in Christmas week.) Attendance of old cases between consultation days 1,686 Attendance at Actino-Therapeutic Department 898 Cases seeking advice from Matron between days at Centre 221 Total attendances at Centre 10,305 Homes Visited 2,487 Children seen 3,102 Puerperal Fever.—Four cases were notified and one death was recorded under this heading. The woman was attended by a doctor and the labour was apparently normal. Ophthalmia Neonatorum.—The cases notified were of a very mild type and the details are as follows:- Cases. Vision unimpaired . Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 14 13 1 14 — — Measles and Whooping Cough.—There were six deaths registered from Measles and 26 from Whooping Cough. In 1924, there were 11 and 17; in 1923, 1 and 3; in 1922, 40 and 39; in 1921, 3 and 8; in 1920, 5 and 10, the previous year of greatest mortality being 1915, when 54 deaths occurred from Measles and 31 from Whooping Cough, following a series of years of small mortality. As neither disease is notifiable, the incidence is known only through the notifications received from the Head Teachers in accordance with the "Regulations as to Infectious Diseases in Schools." In this way the following were notified during the year:— Measles 1,177 Whooping Cough 421 All primary cases were visited by the School Nurses who gave appropriate advice and left printed instructions as to isolation, general treatment and nursing. 72 For this purpose 1,270 visits were made—861 to children with Measles and 409 with Whooping Cough. Whooping Cough was epidemic in January, when 248 cases arose, followed by 69 and 43 in February and March, disappearing in August, rising again to 18 in November. The deaths were mainly in the first months of the year and in children under 5 years of age. Ten occurred in children under one year, nine in those under two years and six between two and five years of age. The School Nurses have done what was possible in the circumstances by impressing on the Mothers the importance of safeguarding their young children from exposure to either disease, but the belief that Measles and Whooping Cough are trivial ailments dies hard and many Mothers still act on the erroneous views held—once either disease is introduced in the house, it is just as well that all the susceptible children should suffer and get it over. No conduct can be more stupid, for the incidence and fatality of these diseases vanish with age and children under five years should never willingly be exposed to these infections. The following chart gives the deaths from Measles and Whooping Cough since my appointment:— 73 Deaths from Measles and Whooping Cough, 1889—1925. Straight lines indicate Measles. Dotted lines indicate Whooping Cough. 74 Encephalitis Lethargica.—Six Notifications of this disease were received. Two of the cases were subsequently found to be not Encephalitis, but were suffering from symptoms that closely similated the disease in its early manifestations. One of the sufferers was living out of the District at the time of notification. Of those notified a child aged 4 years died within 14 days and an adult aged 43 years some months following onset of symptoms. On visiting the others only one—a boy, aged 9 years—has any post encephalitis symptoms. Tuberculosis.—The deaths registered from this disease were 138 compared with 140 in 1924; 129 in 1923; 127 in 1922; 144 in 1921; 127 in 1920; 111 in 1919; 165 in 1918; 149 in 1917; 115 in 1916; 147 in 1915 and 133 in 1914. The deaths from Pulmonary Tuberculosis represent a rate of .85 per 1,000 of the population and over 6 per cent. of those were not notified during life. Less than 40 per cent. of those dying from Non-pulmonary Tuberculosis were notified prior to death. Of the 138 deaths from Tuberculosis 46 were of persons notified during the year in conformity with the Tuberculosis Regulations. Twenty-four patients died within three months of notification; 15 within six months and 51 within twelve months. Nine notifications were received subsequent to the deaths of the patients. The Public Health (Tuberculosis) Regulations, 1921, have been complied with and the local Tuberculosis Officer sends regularly the names of those who cease to reside in the District. There were at the end of the year 2,480 names on the Register of persons suffering from Tuberculosis in its various forms. Of these, 806 are of the non-pulmonary type. Proportionately to population the numbers show no increase on previous years. The cases are distributed as follows:— St. James Street 585 High Street 401 Hoe Street 409 Wood Street 305 Hale End 312 Higham Hill 468 Total 2,480 75 Following the receipt of a notification every house is visited and a sanitary survey made. The result of this, with a copy of the Notification Form, is sent to the Tuberculosis Officer, and with the exception of disinfection of the rooms following death or removal—when the latter is known —the care of the patient passes on to the County Council. The principal defects usually favouring the disease, as found in the homes inspected, were as follows:— Overcrowding 4 Defective roofs and gutters 20 Dampness 19 Dirty premises 49 Other Defects 41 No Defects 155 (Two of these were empty.) No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, nor under Section 62, Public Health Act, 1925, as the need did not arise. NEW CASES AND MORTALITY DURING 1925. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M F M F M F M F 0— — 1 — — — — — 3 1— 0 — 9 4 2 1 8 2 5— 7 5 8 4 2 — 1 1 10— 8 5 7 4 1 3 2 3 15— 6 10 4 5 5 3 — 1 20— 17 18 1 1 10 7 — 1 25— 30 22 2 5 14 15 — 1 35— 24 19 2 1 9 4 1 — 45— 15 6 — — 12 8 1 — 55— 6 4 1 — 8 4 — 1 65 and upwards 3 1 - - 2 2 - - Totals 118 91 34 24 65 47 13 13 SCHOOL MEDICAL SERVICE. 79 TO THE CHAIRMAN AND MEMBERS of the Walthamstow Education Committee. Ladies and Gentlemen, I beg to submit the Annual Report on the work of the School Medical Service as carried out in your District during 1925. With the exception of the Statistical Tables, prepared under my supervision, and the section dealing with Defective Vision by Dr. Sheppard, the Report has been prepared by Dr. Broderick The work of Medical Inspection and that of the Clinics was of the usual routine character, but it will be noticed from a perusal of the Statistical Tables that the numbers medically inspected at the Schools were considerably greater than in 1924, and the reinspections somewhat less. The proportion of defects found to the total examined varied little from that of previous years, while the numbers dealt with for minor ailments at the Clinics were considerably greater. It is difficult to estimate how greatly for the better the afterlives of our children must be influenced by this work; undoubtedly, it is of great value. In previous Reports, I drew your attention to the lack of Specialist treatment for children suffering from Otorrhœal conditions, and I trust the Committee will, at the earliest moment, make the provision suggested by me in 1923 and 1924. In other respects, I think the School Medical Service has been very efficient. Towards the end of the year, provision was made for the special teaching of stammering children. I have visited the classes, and your Director of Education concurs with me that the work has been a success. As in previous years, effective co-operation and cordial relations have existed between Teachers, Attendance Officers and Medical Staff. Mr. Longman has most willingly co-operated in every measure taken for the betterment of the physical condition of the childien under your care. I beg to remain, Ladies and Gentlemen, Your obedient Servant, J.J. CLARKE, 80 FINANCIAL STATEMENT. £ s. d. £ s. d. 1924 1925 Rateable value of District 520,754 0 0 529,956 0 0 The average cost of education per child:— (1) In the ordinary school 12 1 0 12 17 0¼ (2) Mentally Defective Centre 38 6 0¾ 37 0 6½ (3) Deaf and Dumb Centre 28 10 1¼ 30 15 0¾ (4) Myope Centre 24 9 6½ 30 2 10½ (5) Physically Defective Centre - 63 13 2¾ The education rate for— The half year ending March 31st 0 1 9 0 2 0¾ „ „ „ Sept. 30th 0 2 1¼ 0 2 1¾ „ „ „ March 31st, 1926 0 2 1¼ - Total cost of medical inspection for year 4,624 3 01 4,867 9 8 Grant towards the above for year ending March, from Board of Education 2,170 12 9 2,209 16 7 Other receipts:— Medical treatment 24 3 9 23 5 11 Spectacles 46 14 0 50 0 0 Amount spent on repairs, improvements, etc., to schools for the year 3,954 19 0 5,938 12 1 81 NUMBER OF SCHOOLS AND ACCOMMODATION. Boys Girls Infants Mixed Seating Accommodation. Boys Girls Infants Mixed Provided 17 17 16 7 6862 6666 6006 2622 Non-provided 1 2 2 1 244 472 437 314 Special Schools— Mentally Defective — — — 1 — — — 130 Deaf and Dumb — — — 1 — — — 20 Blind and Myope Centre — — — 1 — — — 65 Physically Defective Centre — — — ] — — — 75 Total 18 19 18 12 7106 7138 6443 3226 1925 1924 1923 Number of Children on Register, December 31st 20,962 21,087 21,325 Average Attendance 18,348 18,541.9 19,026.2 Percentage Attendance 87 87.9 90.6 Population (Registrar General's Estimate) 130,800 130,000 130,000 Percentage of School Children to population 16 16.2 16.4 82 REPORT OF THE WORK OF THE SCHOOL MEDICAL SERVICE. Arranged according to the Suggestions made by the Board of Education, November. 1925. 1. STAFF. The whole-time Medical Staff consists of the Medical Officer of Health (who is also School Medical Officer and in this capacity supervises the work of the School Medical Service), three Assistant School Medical Officers, one of whom is engaged in Ophthalmic and also Child Welfare work for the Council, a part-time Ophthalmic Surgeon, a part-time Orthopaedic Surgeon, four local Practitioners who undertake Nose and Throat work, a whole-time Dental Surgeon, five School Nurses and a Dentist's Assistant. 2. CO-ORDINATION. (a) As the work of the Ante-Natal Clinic and Child Welfare Centre is undertaken by one of the Assistant School Medical Officers—under the supervision of the Medical Officer of Health— it follows that there is close co-ordination between this branch of the Health Service and the School Medical Service. (b) There are no Nursery Schools in the Area. (c) The care of debilitated children under school age is undertaken by the Welfare Centres in the Town. Dental and Orthopaedic cases are referred to the special clinics, swabs are examined at the Municipal Laboratory, and Virol, Parrish's Food, etc., are supplied to the necessitous cases at reduced cost. Massage is given by a voluntary Masseuse. 3. THE SCHOOL MEDICAL SERVICE IN RELATION TO PUBLIC ELEMENTARY SCHOOLS. School Hygiene.—The cleanliness of the schools is well maintained, the surroundings being quite good, with one or two exceptions where the buildings are quite close to the main roads, making for noise and dust. The playgrounds are tar paved and have play sheds. There are in all cases receptacles for refuse. All the schools are well ventilated and lighted. In the older schools the warming is by means of open fires, the newer schools having Central Heating on the low pressure system. The heating 83 of several of the older schools has been improved by installing short circulations of hot-water pipes and radiators supplied by a boiler fixed at the back of the fire. Now and again it is found difficult to keep the classrooms up to a satisfactory temperature owing to temporary failures in the working of the apparatus. Dual desks are provided; blackboards are adjusted so as to receive the available maximum of light. In many cases the walls of the classrooms are tastefully decorated with instructive prints and pictures hung at a suitable height. In the more recently built schools the sanitary conveniences are on the separate pan system and are flushed by hand or automatically. The trough system with automatic flushing is in use in some of the older schools. Two sanitary surveys were made during the year, the minor defects found being reported to the Council's Architect. An adequate supply of water is laid on to the schools. The cloakrooms, though well lighted and ventilated, are not, in many cases, warmed. The amount spent on repairs, improvements, etc., to the schools for the year was £5,938 12s. 1d. 4. MEDICAL INSPECTION. Descriptions of arrangements made and methods adopted for the Medical Inspection of the Children. The sessions are of three hours in the morning and two in the afternoon, an average of nine children being seen per hour. The parents are encouraged to attend these inspections and willingly do so. When defects exist, After-Care Cards are made out for the purpose of following up by the Doctors and School Nurses. Reference to Table 1 will show the numbers of children inspected during the year. The Board's schedule of Medical Inspection has been carried out fully. Arising out of medical inspection during the past year, 101 children were excluded under Article 53 (b) for varying periods for the following causes:— 84 Desquamation 1 Sore Throat 30 Rheumatism 2 Bronchitis 13 Bronchial Catarrh 8 Impetigo 4 Cold 5 Ringworm 2 Otorrhoea 4 Heart 1 Influenza 3 Puffy Eyes 1 Pyrixia 1 German Measles 1 Mumps 5 Septic Toe 1 Whooping Cough 2 Measles 2 Earache 1 Chicken Pox 4 Tonsilitis 1 Boils 1 Glands 2 Sickness 1 Diarrhoea 1 Rash 1 Scabies 1 Various 2 5. REVIEW OF THE FACTS DISCLOSED BY MEDICAL INSPECTION. Heights and Weights of children inspected. Boys. A. Age. Average Height (inches). Average Weight, (pounds), Anthropometric Height. Standard Weight. 5—6 yrs. 41.75 40.0 40.44 37.74 8—9 yrs 45.5 49.25 46.94 49.95 12—13 yrs 55.5 73.0 55 48 73.86 B 5—6 yrs 40.5 39.5 40.44 37.74 8—9 yrs 47.75 54.0 46.94 49.95 12—13 yrs 55.0 73.25 55.48 73.86 Girls. b 5—6 yrs. 41.75 37.75 40.68 36.68 8—9 yrs. 49.0 53.0 47.39 52.05 12—13 yrs. 55.75 71.75 54.88 72.66 B. 5—6 yrs. 41.25 38.5 40.68 36.68 8—9 yrs. 47.75 47.5 47.39 52.05 12—13 yrs. 55.75 74.0 54.88 72.66 A—represents a school serving a clean area. B.—One whose children are largely drawn from poor homes in mean streets. 85 6. CLOTHING, FOOTGEAR and NUTRITION. Entrants. Clothing. Footgear. Nutrition. Satisfactory. per cent. Unsatisfactory. per cent. Satisfactory. per cent. Unsatisfactory. per cent. Excellent. per cent. Normal, per cent. A.—Girls 98 2 98 2 22 78 B.—Girls 97 3 97 3 62 38 A.—Boys 97 3 98 2 23 77 B.—Boys.. 96 4 96 4 57 43 Intermediate. A.—Girls 98 2 97 3 26 74 B.—Girls 93 7 86 14 71 29 A.—Boys 100 — 100 — 23 77 B.—Boys 93 7 93 7 35 65 Leavers. A.—Girls 96 4 97 3 39 61 B.—Girls 100 — 88 12 58 42 A.—Boys 100 — 100 — 35 65 B.—Boys 93 7 95 5 64 36 Uncleanliness.—The above is discovered at routine medical inspection and re-inspections—at the clinics and by the visits made by the School Nurses. During the year the latter paid on an average, 9 visits per school, examining 93,496 children; of these 2,687 were in an unclean condition or 2.87 per cent. of those examined by them. These cases are treated promptly at the clinics, instructions also being given to the parents for treatment at home. They are not re-admitted to the school until certified by the Medical Staff to be in a clean state. Children nowadays are better clothed and more attention is paid in the homes to skin, hair and scalp conditions. There is no cleansing station in the Area. Minor Ailments.—Reference to Official Table 2 attached to this Report will give a summary of these defects. Here it may be noted that in 1925 there were only 0.4 per cent. cases of Ringworm of the scalp, as compared with 0.8 per cent. in 1924; 0.3 per cent. cases of Scabies, as compared with 0.2 per cent. in 1924; 0.5 per cent. cases of Impetigo, as compared with 0.6 per cent. in 1924; 0.2 per cent. cases of External Eye Diseases, as compared with 0.2 per cent in 1924; 0.3 per cent. cases of Ear Diseases, as compared with 0.4 per cent. in 1924. 86 Tonsils and Adenoids.—During 1925, five hundred and eighty cases of enlarged Tonsils and Adenoids, or both, were discovered at medical inspection, or 6.3 per cent. of the children examined, as compared with 7.1 per cent. last year. Nowadays the incidence of Tonsils and Adenoids is diminishing in the higher-age groups, because of the attention given to children from birth, when at the Child Welfare Centres preventative measures under medical supervision is carried out by the mothers to keep the mouths and nasal passages healthy. Tuberculosis.—Rarely one finds children of school age suffering from Pulmonary Tuberculosis. The following is the Statistical Table furnished to me by the Tuberculosis Officer:— (a) Total number of children seen during 1925 151 Sent by School Medical Officer 43 Sent by Private Doctors 80 Contacts 28 (b) Classification:— Sent by School Medical Officer. Boys. Girls. Pulmonary 4 1 Hip 1 1 Glands 1 1 Spine 0 1 Indefinite 19 14 25 18 Sent by Private Doctors. Boys. Girls. Pulmonary 6 (1 died) 6 (1 died) Glands 4 1 Peritonitis 2 3 (1 died) Indefinite 31 27 43 37 Contacts. Boys. Girls. Glands i — Indefinite 12 15 13 15 87 Skin Diseases.—Ringworm, Scabies and Impetigo are the outstanding skin diseases met with. The first two named are a diminishing quantity, the last is still fairly prevalent. External Eye Diseases.—2.3 per cent. children were found to be suffering from Blepharitis, Conjunctivitis, Corneal Opacities, Keratitis, etc., as compared with 3.1 per cent. in 1924. Badly lighted, ill-ventilated living and sleeping rooms as well as dusty surroundings contribute to the two first-named. Defective Vision.—During 1925, 5.78 per cent. of the children examined at routine medical inspection were found to be suffering from defective vision; 4.46 per cent. being treated at the Clinic under the Authority's Scheme. The following table gives the percentage and sex incidence of those cases seen at Lloyd Park and found to be suffering from errors of refraction:— Girls per cnt. Boys per cent. Total per cent. Hypermetropia 74 33.18 40 25.48 114 30.00 Hypermetropic Astigmatism 53 23.77 23 14.65 76 20.00 Myopia 39 17.49 52 33.12 91 23.95 Myopic Astigmatism 22 9.87 14 8.92 36 9.47 Mixed ,, 32 14.35 24 15.28 56 14.74 Odd Eyes 3 1.34 4 2.55 7 1.84 223 100.00 157 100.00 380 100.00 By grouping the first two under Hypermetropia and the four latter Myopia and analysing this Table we find that 50 per cent. are Hypermetropes and 50 per cent. Myopes; that the girls are in the majority accounting for 58 per cent. of all cases, and that the percentage of Myopes is lower among the girls, being 42.05 per cent. to the boys' 59.87 per cent. Nineteen children, 8 girls and 11 boys, on refraction were found to be suffering from no error, their symptoms, headaches, etc., being due to other causes. 88 The following were found to be suffering from defects other than errors of refraction:— Diseases or Defects. Boys. Girls. Old Interstitial Keratitis - 1 Double Coloboma of the Iris - 1 Nystagmus with double Congenital Cataract - 1 Retino Choroiditis and Nystagmus 1 — Double Lamillar Cataract 1 — Right Coloboma and Pupil filled with Calcareous Deposit 1 - Double Ptosis — 1 3 4 Also one girl apparently physically healthy whose vision was 6/24 on Snellin's Type with a low degree of Hypermetropic Astigmatism, the correction of which did not bring the vision up to normal. However, on being given Thyroid ¼ grain daily for a fortnight she recovered 6/6 vision, only to return to 6/24 on discontinuing the Thyroid. She has now left our School and gone under the County Authority. External Diseases of the Eye. Disease. Boys. Girls. Totals. Nebulae 5 5 10 Blepharitis 20 36 56 Styes 7 9 16 Conjunctivitis (Phlyctenular) 10 20 30 ,, (Catarrhal) 6 11 17 Meibomian Cyst — 1 1 48 82 130 Squint. Boys. Girls. Convergent R 8 10 L 13 21 Divergent R 1 1 L — 1 Occasional L 6 — Alternating 5 6 All children suffering from Squints are submitted to refraction, and suitable glasses ordered, and at the same time the mothers are 89 advised to cover the non-squinting eye from 1 to 2 hours daily to begin with and eventually to keep it covered all the time the child is in the house. In this way a great improvement in the vision of the squinting eye has been obtained in a number of cases, and where, when first seen the child was 7 years or under, the vision in the majority of cases returned to normal. Operations by Mr. Lindsay Rea at Western Ophthalmic Hospital. Boys. Girls. Converging Squint L — 3 „ R 1 — Alternating „ 1 — Needling for Cataract 1 1 Ptosis — 1 The work of the clinic also includes the following-up of cases until school attendance ceases. In this way, 1,072 children making 2,558 attendances, were seen as per following table. Fifty-seven children from the Myope Centre made 105 attendances. In addition, 706 attendances were made by children requiring treatment. In all, the attendances at the Clinic totalled 3,369. Diseases. No. of Children. No. of Attendances. Average No. of attendances per child. Boys. Girls. Boys. Girls. Boys. Girls. Myopia 113 86 221 223 2.00 2.60 Hypermetropia 92 100 176 236 1.91 2.30 Myopic Astigmatism 31 54 86 157 2.77 2.90 Hypermetropic „ 83 118 157 325 1.90 2.70 Mixed „ 30 53 91 140 3.00 2.60 Squints 81 89 209 232 2.57 2.60 Other defects such as Nystagmus, Corneal Opacities, etc. 22 27 47 52 2.00 2.00 Odd Eyes 29 21 40 46 1.40 2.00 Glasses not required 19 24 62 58 3.00 2.40 500 572 1089 1469 2.3 2.5 Myope School.—During 1925 Mr. Lindsay Rea paid 7 visits to Walthamstow, and as well as seeing each child at the Myope Centre he passed one girl and two boys for admission there. Oil December 31st there were 27 boys and 30 girls on the school register, 19 of these being Blind within the Act, and being taught Braille. 90 A full account of this school will be found elsewhere in the Report. Ear Disease and Hearing.—Accumulation of wax and foreign bodies in the cavity of the external ear impair hearing. Bad teeth, unhealthy and septic conditions of the mouth and naso-pharynx tend to infect the Eustachian tube, through which infection reaches the middle ear where an inflammatory condition is set up, often leading to a perforation of the drum and discharge. As some zymotic diseases, notably Scarlet Fever, Diphtheria and Measles attack the Tonsils, Adenoids and accessory sinuses Of the nose, it will be seen that the incidence of these fevers bears a direct relation to the occurrence of this troublesome and intractable affection, and that it will always of a necessity be present to a greater or less degree. Dental Defects.—The good physique of the present day elementary school child due to judicious dietary, rich in vitamines, is reflected in the improved dentures now so noticeable. There are fewer debilitated children, too, requiring less prolonged treatment courses with iron which tends to discolour and erode the teeth. Crippling Defects.—Crippling defects of all kinds are dealt with under their various headings. Sixteen children suffering from Rickets and Spinal Curvature were discovered at medical inspection. 6. INFECTIOUS DISEASES. All children found suffering or suspected to be suffering from any infectious disease are at once excluded from school, and are not re-admitted until certified by the School Medical Officer to be free from infection. All contacts are kept under observation, all suspicious throats, nasal and ear discharges are swabbed. Two thousand and eight swabs were examined during the year and 235 contained Diphtheria Bacilli. All cases of Scarlet Fever and Diphtheria are sent to the Council's Isolation Hospital for Infectious Diseases at Chingford if proper isolation cannot be carried out at home. 1,833 children were excluded under Article 53 (b) during the year. Of these, 837 were sufferers from infectious or contagious disease or suspects. Whooping Cough appeared in epidemic form in the first quarter of the year, and Measles in the second quarter. 91 The following gives the notifications under the Infectious Diseases Notification Act, received in respect of the diseases named, occurring amongst children of School age: — Scarlet Fever. Diphtheria. Nonclinical Diphtheria. Measles. Whooping Cough. January 21 11 10 1 248 February 14 10 7 8 69 March 18 10 6 58 43 April 22 8 5 132 17 May 17 9 1 419 14 June 16 4 4 218 9 July 12 12 4 165 1 August 8 6 — 3 — September 20 12 6 21 — October 27 7 4 57 2 November 34 7 1 54 13 December 24 5 — 61 5 233 101 49 1197 421 7. FOLLOWING UP. Whether parents are present or not at routine inspection, defects found thereat and requiring treatment are explained to them and also the existing facilities for remedying same. Not only are these noted on the inspection cards but also After-Care Cards are made out. If at re-inspection the doctor finds that no treatment or remedy has been carried out and a reasonable explanation is not given, the School Nurse visits the home, to urge the parents to comply with the recommendation and to break down any objections that may exist. The tactful Nurse invariably meets with success. In addition, the School Medical Officer and School Doctors, aided by the Attendance Officers and Head Teachers, help largely in this important work. During the year, the Nurses paid 3,054 visits to the homes in connection with the following:— Defective Vision 82 External Eye Dis 1 Defective Teeth 132 Otorrhoea and Deafness 21 Ringworm 26 Tonsils and Adenoids 359 Pediculosis 6 Mumps 490 Chicken Pox 453 Impetigo 32 Sore Throat 7 Rash 8 Colds 7 Diphtheria 1 Whooping Cough 409 Measles 885 Various 135 92 Total number of visits to Schools 396 Average number of visits for the year to each school 8.8 Total number of examinations for Uncleanliness (Sect. 87 Education Act, 1921) 93,496 Number of notices sent to parents under above Act 122 Number of children found unclean 2,687 8. MEDICAL TREATMENT. Minor Ailments.—The children are seen at the parents' request or on the advice of the teachers or school attendance officers, or as a result of medical inspection. Each child has a record card kept at the Clinic on which is entered the defect and treatment, and a small clinic card kept at the school on which is noted the time the child spends at the clinic and any information such as exclusion from school or special treatment, such as "no drill," necessary for the guidance of the teachers. This card is brought to the Clinic by the child at each attendance, and; in this way a complete record of the individual child's ailments is preserved. During the year, 14,989 attendances were made at the Clinic, making an average of 96 per session. Tonsils and Adenoids.—Operation is only undertaken when other measures have failed. When a child is found suffering from these defects with no obvious attendant symptoms—adenoids facies, deafness, or ill-developed chest—conservative means are first employed such as breathing exercises, astringent gargles and nasal douches. If operation is found to be necessary, it is not undertaken until all oral sepsis has been cleared up and until the child, if debilitated, is got into a better state of health. Operations are carried out at the Dispensary in Hoe Street, by general practitioners practising in the town, one afternoon weekly, a school nurse being in attendance. Previous to operation, notices are sent to the parents giving full directions for the preparation of the child and its after-care. A Sanitary Inspector visits the home, and if the conditions there are not satisfactory the operation is carried out at the Council's Sanatorium, where the child is kept for a few days to convalesce. No child is operated upon unless a parent or other responsible person is present in the building. The child is detained until all bleeding has ceased and the anaesthetic recovered from. If necessary it is sent home by taxi-cab. 93 All children are visited next day by the School Nurse and seen in a week's time by one of the Medical Staff. During the year 235 children received operative treatment, or 40 per cent. of those found to be suffering from these defects—226 under the Authority's Scheme (of these 37 were done at the Sanatorium)—and 9 by private practitioners or hospital. Tuberculosis.—It is very rare to find a child suffering from definite Pulmonary Tuberculosis. All suspected cases are sent to the Tuberculosis Officer for examination and, if necessary, he keeps them under observation and gives treatment such as Cod Liver Oil, Milk, etc. A report is always sent to the Doctor who sends the case. A " green " after-care card is made out for such children, and this enables the assistant School Medical Officer to give special attention. A similar coloured card is also made out for a Tubercular Contact. Nineteen children are at present in Sanatoria or Sanatorium Schools approved by the Board. We have 14 active nonpulmonary cases attending at Sanatoria or Hospital Schools approved by the Ministry. In Brookfield Hospital School we have 1 Tubercular Hip and 1 Tubercular Spine. Skin Diseases.—A special Ringworm Clinic is held one afternoon weekly. Other skin affections are treated at the Minor Ailments Clinic. Forty-two cases of Ringworm of the Scalp and 69 cases of Ringworm of the body received treatment under the Authority's Scheme, and 5 had X-ray treatment. Thirty-cases of Scabies and 524 of Impetigo were treated at the Clinic as well as 199 other skin cases. The Nurses instruct the parents how to carry on the treatment in the interval between the Clinic sessions. Bad cases are brought to the Clinic daily. External Eye Diseases.—These are seen at the general Clinics and also, if necessary, at the special Eye Clinic. Vision.—See special Eye Report. Ear Diseases and Hearing.—Sessions are held at Lloyd Park on two afternoons weekly for the treatment of Otorrhoea and Deafness. During 1925, three hundred and fifteen children suffering from these defects were treated at this Clinic and 12 elsewhere. Otorrhoea forms the bulk of such cases and is a very troublesome condition. A great number of the cases become chronic and have 94 to attend bi-weekly for months before clearing up, and, occasionally, in spite of treatment, partial deafness results. In some cases it was observed that the hearing was relatively more acute when the ear was discharging than when it was dry. Many of the discharges are found to contain Diphtheria Bacilli. Local antiseptics and dusting powder are applied, with gentle irrigation. In that way the external ear is kept clean, and free discharge is allowed to take place through the perforated drum. Dampness contributes to the continuance of running ears, and such cases often dry up in the summer weather only to recur in the winter months. Of those attending the Clinic for deafness a number were completely cured on removing an accumulation of wax. Others showed great improvement after operation for Tonsils and Adenoids. In the case of partially deaf children, the teachers are instructed that these should sit on the front benches, otherwise they cannot possibly benefit by the same teaching as a child with normal hearing. Dental Defects.—A Dental Surgeon devotes four mornings and five afternoons weekly to the treatment of these defects, a fifth morning being taken up by inspecting Infants' teeth at the schools. A detailed account of the work done will be found on Table IV, Group IV. Crippling Defects and Orthopaedics.—See paragraphs on special Cripple School and Brookfield Orthopædic Hospital. 9. OPEN AIR EDUCATION. Drill classes are taken in the playgrounds all the year round, weather permitting. Classes for ordinary school subjects are also taken there in summer weather but only to a limited extent. Such classes should be encouraged and developed. School journeys and educational visits were made to the British Museum, London and Bethnal Green Museums, Kew Gardens, Mint, Colonial Institute, Australia House, Docks and occasionally to factories and other places of interest. Nature study rambles are made to Epping Forest, to which we are in close proximity. The children are very interested in these excursions. About £'200 a year is spent in Educational visits. During the time the British Empire Exhibition was opened, 7,394 of our school children in charge of teachers visited Wembley, at a total cost of £493 9s. 1d. 95 School Camps and Day Open Air Schools.—There are none in connection with the schools in this town. Open Air Classrooms in Public Elementary Schools.—There are two open-air classrooms; one in Coppermill Road J.M. School, and the other at Forest Road Girls' School. Weakly and debilitated children are usually selected for these classes. The Head Teachers speak very favorably of the general improvement, and some of the parents are very reluctant to have their children transferred to other classes. Residential Open Air Schools.—There are none here, but where delicate children require residential open-air treatment, they are usually sent to schools certified by the Board of Education. 10. PHYSICAL TRAINING. The Board of Education Regulations for physical training in the schools are carried out by the teachers. Organised games too, are under their supervision. Where children with weak hearts or undue debility exist they are forbidden to take part in these exercises by the school doctors, otherwise the school medical service is not associated with physical training. There is a physical instructor for the boys in both Central Schools, and a lady instructress for the girls. Both are full-time officials. 11. PROVISION OF MEALS. Canteens on the school premises have been established, at three of the special schools for the supply of dinners to the scholars. Necessitous children attending the ordinary schools are supplied with dinners at three Centres on 6 days a week including holidays. The number of meals provided for this class of child during 1925. was 15,760. The daily average number of children fed is 59. For debilitated children, milk meals have been supplied for 107 children, on the recommendation of the Medical Staff. 12. SCHOOL BATHS. Lessons in swimming, at the Public Baths, are given to the girls by the lady instructress, the male teachers undertaking the work for the boys. There is a school bath at the Physically Defective Centre, at Joseph Barrett School. 96 13. CO-OPERATION OF PARENTS. Parents avail themselves to a large extent of the opportunity of being present at routine medical inspection and the doctors welcome their presence. Defects, if any, are explained to them and suggestions for regaining and maintaining good health are given. During the past year, parents attended at the routine inspection of:— Boys. Girls. Entrants 80.8 68.6 Intermediate 56.8 65.7 Leavers 25.5 44.1 14. CO-OPERATION OF TEACHERS. A gratifying feature is the willing help given by the teachers. For this reason the work of the School Medical Service is made more fruitful and pleasant than it would otherwise be. The Head Teachers always assist at routine medical inspection and re-inspections, and give every assistance to the Nurses at their periodical visits for head inspection and cleanliness. By their untiring efforts, too, the children keep their appointments punctually, the consent of difficult parents for treatment is obtained, and spectacles are worn according to directions, and any cases of illness or suspected illness is referred to the Clinics. 15. CO-OPERATION OF SCHOOL ATTENDANCE OFFICERS. The School Medical Service is particularly indebted to the School Attendance Officers. Owing to their intimate knowledge of the children's home conditions their assistance is invaluable in advising the medical staff of cases requiring treatment, and in persuading parents with prejudices against treatment to have same carried out. They help also to bring abnormal children in the area under medical supervision. Fees for spectacles, fees for children in residential institutions and fees for those having orthopaedic treatment are collected by them. 16. CO-OPERATION OF VOLUNTARY BODIES. By an arrangement between the Education Committee and the Invalid Children's Aid Association, 17 children have been provided with treatment in convalescent homes for varying periods. This Association also assists in providing surgical requisites. 97 The Central Boot Fund Committee (a Sub-Committee of the Education Committee) succeeded in providing 664 pairs of boots for needy school children. The local Inspector of the National Society for the Prevention of Cruelty to Children has furnished the following report " During the year ending December 31st, 1925, the following cases have been forwarded by the Walthamstow School Officials and dealt with by me:— Number of Cases. Nature of Offence. How dealt with. 28 Neglect 25 By warning and Illtreatment 1 supervision. Exposure 2 Number of children involved:—Boys, 35; Girls, 27. In connection with the 28 cases, after the first visit of inquiry, I paid 147 supervision visits to see that the promised! improvement in the condition of the home and children took place, and in the majority of cases the parents realised we were out for the good of the children and responded to the appeal made to them and took necessary steps to effect a general improvement in the condition of children and home." 17. BLIND, DEAF, DEFECTIVE, AND EPILEPTIC CHILDREN. A system of scheduling all children in the area exists in the School Attendance Department. When they reach the age of 5 years they are notified to attend school, and any physical or mental defect then noted or suspected is referred to the School Medical Officer who makes an examination. The School Doctors, with the assistance of the Head Teachers, at the routine medical inspection of the entrants, pick out any children suspected of coming within the above classification. A record of those defective is kept. Myope and Blind Centre.—This school is situated in Wood Street and has a total capacity for 70 children. It is staffed by a Head Teacher and two assistants. There are three mixed classes. On December 31st, 1925, there were 27 boys and 30 girls in attendance. The types of visual defects found are High Myopia, Keratitis, Choroiditis, Cataract, Congenitial dislocation of the Lens Nystagmus, etc. 98 Mr. Lindsay Rea, F.R.C.S., Surgeon to the Western Ophthalmic Hospital, gave six sessions during the year in connection with these children. When possible, the ordinary school subjects are taught— arithmetic, history and geography—by means of large type combined with myope desks, a reversible arrangement with table on top and blackboard underneath, designed by Bishop Harmon. Lessons are also written out by the teachers to provide reading and information to be learned. Twelve boys and seven girls, blind within the Act, were taught Braille. Books from the National Lending Library for the Blind, are now obtainable for use of children in the school. This is an advantage as they get a much wider range of literature. The children show great aptitude for this method of reading. Besides the ordinary alphabet there are between 300 and 400 abbreviations in which they become very proficient. The " Braille frame" for writing is completed quickly enough and is pretty accurate. The "Arithmetic frame" is so made that each hole is octagonal and the type used makes 16 characters. All sums can be done by means of this contrivance; moreover, it is found to be a good training for developing memory. There is a plot of ground adjoining the School where gardening is taught to all classes. Up to March, 1925, this used to be done by the Guild of Blind Gardeners, but since then it is done on pretty much the same lines by the existing teaching staff. Basket, bent iron work and printing are done by the boys, whilst both boys and girls do handwork, raffia, printing, drawing and typewriting. The girls, in addition, do cookery, laundry, knitting, and cardboard modelling, whilst the younger children do plasticine, clay modelling, paper-folding and weaving. A cantata was held at Christmas in which all the children took part, when there was an exhibition of their work and a prize distribution. The mentality of the children is about average. In spite of their great handicap the aim of the teaching in this school tends to bring them round to the status of the normal child. 99 A substantial two-course dinner is served on the premises. On surveying the working of the school one is struck by the training. care and attention given to the children by the Head Teacher and her assistants, and by the happiness the children take in their work. It is interesting to note that of the 4 boys and 6 girls who left during the year, 1 boy was found unfit for further training, owing to total blindness; 1 girl was likewise unfit for work owing to deficient mentality and great impairment of vision. Of the others. 1 boy is engaged in a garage. 1 at wireless instruments, 1 a. French polisher. Of the girls, 2 are employed in camera works, 1 a packer, 1 a greengrocer's help, and 1 in general service. The children made an average of 85 per cent. attendance during the year. They go to and from school on the Council's Tramway Cars under the supervision of Attendance Officers. Deaf Centre.—This school has a capacity for 20 children and is in charge of a Head Teacher and an Assistant. On December 31st there were 18 on the register—3 aphasic and 15 deaf. One is taught by finger spelling. They are taught lip-reading, speech and handwork, comprising cardboard modelling, leather work, basket-making, and raffia on canvas. The boys are also taught woodwork and boot repairing. Three boys and 2 girls left during the period under review. The two girls were apprenticed to dressmaking. Of the boys, two went to cabinet-making and one to tailoring. Very comlimentary reports were received by the Head Teacher from the employers of one boy and one girl as to their progress, conduct and diligence. Mentally Defective Centre.—This Special School is situated in Shernhall Street and has a capacity for 65 boys and 65 girls. The staff consists of a head teacher and two assistants and a cook. On December 31st there were 31 boys and 34 girls on the register. Also in the Area there are 6 feeble-minded children, 3 boys and 3 girls at no school, as well as three imbeciles, 2 girls and 1 boy, and 1 idiot, a boy, making in all 75 mentally defectives in the area, or 0.3 per cent. of the children of school age. During the past year the children attending the school have been re-graded into three classes. 100 The nursery type might with advantage be divided into a separate class to be taught all round general work, e.g., cookery and elementary domestic work. The Montessori system is followed as far as possible, the scholars making their own apparatus. The scholars are taught manual work, simple metal work, raffia, housework, gardening, carpentery, and boot repairing. The Head Teacher selects the pupils for their subjects according to their mental suitability. Good dinners are supplied at the School at the cost of 3d. per head. The children are conveyed on the Council's trams free of charge and are met at all points by the Attendance Officers. At their annual Christmas Tree, exhibitions of dancing and singing were given which reflected great credit on their teachers. All cases are certified by the School Medical Officer before admission. Family history is in a number of the cases, low grade, several members of the same family attending the school. There is a voluntary After-Care Committee, which, assisted by the Head Teacher, follows up cases after leaving school. There would not be much difficulty in finding employment for these children under 16, but after that age they are usually only engaged for casual work. Physically Defective Centre.—This Centre was opened in 1924, a part of the Infant's Department, at Joseph Barrett School, being used for the purpose.—The staff consists of a head teacher, two assistant teachers, one nurse, two masseuses, and an ambulance driver. The number of children on the register on December 31st, 1925, was 75, 42 being admitted during the year. A dining-room and kitchen was built during the year, giving more space for class and exercise rooms. A midday meal is served on the premises under the supervision of the Head Teacher. Mr. Whitchurch Howell, F.R.C.S., who has the surgical care of the children, holds two clinics monthly, one at Joseph Barrett 101 Physically Defective Centre, and the other at Lloyd Park. At the latter clinic, all fresh cases are seen and all physically defective children in the area are kept under observation. Two masseuses attend at the Centre every afternoon. There is a school bath on the premises. Ventilation, lighting and heating is satisfactory. Decided mental and physical improvement is noticeable in the children. Besides the ordinary elementary school curriculum subjects, woodwork, drawing, rug making and raffia are done by the boys and girls, whilst needlework is done by the girls. The children show great aptitude for handicraft. Rest is ordered when necessary. Recreation consists in indoor games: draughts and cards; the outdoor games; football, cricket, and skipping for the girls. Badminton was introduced during the year. The medical equipment is adequate, a massage couch, high plinth massage stools, slings and other medical sundries. The following table shows the defects in the year:— the childre n during Diagnosis. Bovs. Girls. Pseudo Hypertrophic Paralysis 3 2 Infantile Paralysis 8 17 Hemiplegia 3 3 Diplegia 1 1 Paraplegia — 2 Erbs Paralysis 1 1 Ataxia 1 — Congenital Club-foot 1 1 Flat-foot 1 — Polio-Encephalitis 1 — Congenital Dislocation of Hip — 2 Tubercular Spine 4 3 „ Hip 8 1 „ Knee 1 — „ Ankle 1 — „ Shoulder — 1 Scoliosis 1 3 Perthe Hip 1 — Injury Cervical Spine 1 — Heart 6 6 The Education Committee's ambulance, supplemented by local motor agents, make three journeys daily to carry the children to and 102 from school, the times of arrival being 8.45 to 9.45 a.m. They commence leaving school at 3 p.m., the last lot leaving at 4 p.m. There is a midday interval of 1¼ hours. The children are very happy in the school, and whilst such children are probably indulged more by the general public by reason of their defects, there is little doubt but that the establishment of such a centre, whilst freeing them from the competitive strain of more active playmates, gives them a better chance to get equipped for the battle of life. They also have the advantage that their instruments are kept properly adjusted. The average attendance for the year was 78 per cent. As the school has been opened only since 1924 it is too soon to give a review of the after careers of the children. Brookfield Orthopaedic Hospital.—This is a voluntary hospital school recognised by the Board of Education, situated at Oak Hill. Walthamstow, amid pleasant surroundings on a healthy site and with such possibilities that an extension is proposed. Children from the Walthamstow Area have the prior right of admission. Our Committee sent during 1925, thirteen school children, 6 boys and 7 girls, to this school. Walthamstow children under school age are also admitted. During the year 19 children in all were treated, suffering from the following defects:— Tubercular Hip 1 Infantile Paralysis 8 Hemiplegia Spastic 1 Scoliosis 2 Rickets 4 Congenital Deformity of feet 2 Torticollis 1 Fifteen operations, as under, were performed :— Tenotomy of Tendo Achilles 4 Stoffels Median Nerve 1 Transplantation of Flexor Pollicis for Opponens paralysis 3 Tenotomy of Extensors of toes and plantor fascia 1 Fomorah Osteotomy 1 Osteoclasis Torticollis 1 Mid-tarsal Arthrodesis 1 Amputation of toe 1 103 A charge of 42s. per week is made, the parents contributing according to their means. Ultra Violet Rays are in use. 18. NURSERY SCHOOLS. There are no nursery schools in the Area, but the Board of Education have sanctioned the plans for building one, and we are awaiting the sanction of the Ministry of Health for a loan. 19 and 20. SECONDARY CONTINUATION SCHOOLS. The organisation of Secondary and Continuation Schools in the Area is carried on under the supervision of the Essex County Council. 21. EMPLOYMENT OF CHILDREN AND YOUNG PERSONS. During 1925, one hundred and ninety-eight children made application for employment cards and were medically examined for the purpose of the Employment of Children and Bye-laws. Of these, 196 were found lit and 2 were rejected. Generally speaking the employers meet the requirements of the Bye-laws and provide waterproof clothing during inclement weather. Some cases are called up periodically for examination. No ill-effects have been noticed from such occupations which consist chiefly in milk and newspaper deliveries and general errands. 22. SPECIAL ENQUIRIES. There were none made during the year. 23. MISCELLANEOUS. Thirty-three reports were made on teachers and other staff on prolonged absences from school through illness, and 64 medical examinations were made on 64 new appointments. In September, 1925, a class was formed in Marsh Street School for 10 of the most pronounced cases of stammering boys known in the District. Satisfactory progress is being made. 104 24. STATISTICAL TABLES. The above tables required by the Board of Education are given at the end of this Report. In them are shown in summary form the defects found, the treatment received and the abnormal children in the Area. TABLE I. Return of Medical Inspections. A.—Routine Medical Inspections. Number of Code Group Inspections. Number of other Routine Inspections. Entrants. Intermediates. Leavers. Total. 3086 2311 3466 8863 250 B.—Other Inspections. Number of Special Inspections. Number of Re-Inspections. Total. 2831 21,573 24,404 TABLE II. Return of defects found in course of Medical Inspection in 1925. Defects or Disease. Routine Inspections. Special Inspections. Number of Defects. Number of Defects. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. Requiring Treatment. Requiring to be kept under observation but not requiring Treatment. 1 2 3 4 5 Malnutrition 2 1 — — Uncleanliness, Scalp (See Table IV., Group V.) — — — — Skin. Ringworm, Head 2 — 42 — „ Body 1 — 69 — Scabies 2 — 28 — Impetigo 17 2 505 — Other Diseases (Non-Tuberculous) 47 3 191 — Eye. Blepharitis 25 3 53 — Conjunctivitis 5 1 51 — Keratitis — — 1 — Corneal Opacities 2 1 — — Defective Vision (excluding Squint) 326 1 147 1 Squint 42 5 5 — Other Conditions 15 1 61 — Ear. Defective Hearing 17 7 57 — Otitis Media 23 5 161 — Other Ear Diseases 10 3 93 — Nose and Throat. Enlarged Tonsils only 101 263 2 — Adenoids only 10 21 10 — Enlarged Tonsils and Adenoids.. 40 41 92 — Other Conditions 32 12 — — Enlarged Cervical Glands (Non-Tuberculous) 10 28 36 — Defective Speech 15 16 7 — Teeth—Dental Diseases (See Table IV., Group IV.) 1678 — — — Heart and Circulation. Heart Disease, Organic 11 32 2 — „ „ Functional 9 333 17 — Anaemia 26 2 22 — Lungs. Bronchitis 191 77 8 — Other Non-Tuberculous Diseases 10 18 — — Tuberculosis. Pulmonary, Definite — 1 1 — „ Suspected 14 12 — — Non-Pulmonary Glands 3 6 — — „ Spine — 1 — — „ Hip — — — — „ Other Bones & Joints — — — — Skin — — — — „ Other Forms 2 1 — — Nervous System. Epilepsy 1 2 3 — Chorea 1 3 5 — Other Conditions 9 7 — — Deformities. Rickets — 5 — — Spinal Curvature 2 1 1 — Other Forms 4 8 — — Other Defects and Diseases 59 53 684 — Number of Individual Children having Defects which required Treatment (Excluding Uncleanliness and Dental Diseases.) Group. Number or Children. Percentage of Children found to require Treatment. Inspected. Found to require Treatment. 1 2 3 4 Code Groups:— Entrants 3086 945 30.6 Intermediates 2311 738 31.9 Leavers 3466 854 23.2 Total (Code Groups) 8863 2537 28.6 Other Routine Inspections 250 143 57.2 105 TABLE III. Numerical Return of all Exceptional Children in the Area in 1926. Boys. Girls. Totals. Blind including partially blind). (i) Suitable for training in a School or Class for the totally blind. Attending Certified Schools or Classes for the Blind 10 7 17 Attending Public Elementary Schools — — — At other Institutions 1 1 2 At no School or Institution (ii.) Suitable for training in a School or Class for the partially blind. Attending Certified Schools or Classes for the Blind 16 22 38 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution Deaf (including deaf and dumb and partially deaf). (i.) Suitable for training in a School or Class for the totally deaf or deaf and dumb. Attending Certified Schools or Classes for the Deaf 9 4 13 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution (ii.) Suitable for training in a School or Class for the partially deaf Attending Certified Schools or Classes for the Deaf 3 2 5 Attending Public Elementarv Schools — — — At other Institutions — — — At no School or Institution Mentally Defective. Feebleminded (cases not notifiable to the Local Con trolAuthority) Attending Certified Schools for Mentally Defective Children 35 30 65 Attending Public Elementary Schools — — — At other Institutions — — — At no School or Institution .. Notified to the Local Control Authority during the year. Imbeciles 1 9 3 Idiots 1 — 1 106  Boys. Girls. Totals. Epileptics. Suffering from severe epilepsy. Attending Certified Special Schools for Epileptics 3 2 5 In Institutions other than Certified Special Schools – – – Attending Public Elementary Schools – – – At no School or Institution 3 4 7 Suffering from epilepsy which is not severe. Attending Public Elementary Schools 2 3 5 At no School or Institution – – – Physically Defective Infectious pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 5 4 9 At other Institutions — — — At no School or Institution — — – Non-infectious but active pulmonary and glandular tuberculosis. At Sanatoria or Sanatorium Schools approved by the Ministry of Health or the Board 3 7 10 At Certified Residential Open Air Schools – – – At Certified Day Open Air Schools – — — At Public Elementarv Schools 62 73 135 At other Institutions — — — At no School or Institution 1 1 2 Physically Defective (continued) Delicate children (e.g.. pre - or latent tuberculosis, malnutrition, debility, anaemia. etc). At Certified Residential Open Air Schools – – – At Certified Day Open Air Schools 25 65 90 At Public Elementary Schools — — — At other Institutions 3 6 9 At no School or Institution 6 7 13 Active non-pulmonary tuberculosis. At Sanatoria or Hospital Schools approved by the Ministry of Health or the Board 11 3 14 At Public Elementary Schools — — — At other Institutions — — — At no School or Institution — — — Crippled Children (other than those with active tuberculous disease), e.g., children suffering from paralysis, etc. and including those with severe heart disease. At Certified Hospital Schools 5 3 8 At Certified Residential Cripple Schools 2 2 4 At Certified Day Cripple Schools 40 35 75 At Public Elementary Schools – – – At other Institutions – – – At no School or Institution 1 2 3 107 TABLE IV. Disease or Defect. Number of Defects treated, or under treatment during the year. Under the Authority's Scheme. Otherwise. Total. Skin— Ringworm—Scalp 37 5 42 Ringworm—Body 69 — 69 Scabies 29 1 30 Impetigo 521 3 524 Other skin diseases 196 3 199 Minor Eye Defects (external and other, but excluding cases falling in Group II.) 182 5 187 Minor Ear Defects 315 12 327 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.) 595 109 704 Total 1944 138 2082 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding minor Eye Defects treated as Minor Ailments—Group I.). Defect or Disease. No. of Defects dealt with. Under the Authority's Scheme. Submitted to refraction by private practioner or at hospital, apart from the Authority's Scheme. Otherwise. Total. Errors of Refraction (including Squint) (Operations for squint should be recorded separately in the body of the Report) 550 34 584 Other Defect or Disease of the Eyes (excluding those recorded in Group I.) 10 — — 10 Total 560 34 — 594 108  Under the Authority's Scheme. Otherwise. Total number of Children for whom spectacles were prescribed 672 10 Total number of children who obtained or received spectacles 660 10 Group III.—Treatment of Defects of Nose and Throat. Number of Defects. Received other forms of Treatment. Total number treated. Received Operative Treatment. Under the Authority's Scheme, in Clinic or Hospital. By Private Practitioner or Hospital, apart from the Authority's Scheme. Total. 226 9 235 — 235 Group IV.—Dental Defects. (1) Number of Children who were:— (a) Inspected by the Dentist: Aged: Routine Age Groups 5 837 Total 3318 6 1313 7 1084 8 55 9 29 10 – 11 – 12 – 13 – 14 – Specials 2955 Grand Total 6273 (b) Found to require treatment 5691 (c) Actually treated 4092 (d) Re-treated during the year as the result of periodical examination 1205 109 (2) Half-days devoted to:— Inspection 37 Treatment 395 Total 432 (3) Attendances made by children for treatment 5297 (4) Fillings:— Permanent teeth 428 Temporary teeth 2470 Total 2898 (5) Extractions:— Permanent teeth 924 Temporary teeth 5294 Total .. 6218 (6) Administrations of general anaesthetics for extractions 2712 (7) Other operations:— Permanent teeth 11 Temporary teeth 406 Total 417 Inspection is also made of Urgent Cases at the Dental Clinic on Monday, Tuesday, Wednesday and Friday Mornings. Group V.—Uncleanliness and Verminous Conditions. (i.) Average number of visits per school made during the year by the School Nurses 9 (ii.) Total number of examinations of children in the Schools by School Nurses 93496 (iii.) Number of individual children found unclean 2687 (iv.) Number of children cleansed under arrangements made by the Local Education Authority — (v.) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 192 — (b) Under School Attendance Byelaws 2 NON-NOTIFIABLE INFECTIOUS DISEASES. Walthamstow Education Committee's "Regulations as to Infectious Diseases in Schools." Notifications received from Head Teachers during period from January 1st to December 31st 1925. District. School. Department. Measles. Whooping Cough. Mumps. Chicken Pox. Ringworm. Sore Throat. Impetigo and Pediculosis External Eye Disease. Totals. N.W. Blaokhorse Road Boys 1 — 1 — — — — — 2 Girls 1 — — — — — — — 1 Infants 90 27 1 17 — 1 1 — 137 W. E. Whittingham Boys 1 — 2 — — — — — 3 Higham Hill Girls 4 — 1 — — 3 — — 8 Infants 119 8 24 50 2 3 5 — 211 Junior Mixed — — — — 1 — 2 — 3 Temporary Infants 5 10 13 — 1 1 — — 30 C. Pretoria Avenue Boys — — — — — — — — — Girls — 1 — — — — — — 1 Infants 101 54 11 2 1 — 3 — 172 Higher Elementary Boys — — — — — — — — — Girls — — — — — — — — — Coppermill Road Boys 1 — — — — — — — 1 Girls — — — 2 — — — — 2 Junior Mixed 103 23 3 78 1 — — — 208 Infants 50 5 1 26 1 2 — — 85 N.E. Wood Street Boys — — — — — — — — — Girls — — — — — — — — — Infants 29 11 6 9 — — — — 55 Joseph Barrett Boys — — — — — — — — — Girls 2 3 6 6 1 4 — — 22 Infants 6 17 12 23 — 23 3 1 85 E. Maynard Road Boys 3 — 4 6 1 — — — 14 Girls 3 — 2 — — 2 — — 7 Infants 35 43 107 59 4 17 23 2 290 St. Mary's Girls — — 4 — — — — — 4 Infants 31 49 11 9 — — 2 — 102 St. George's Mixed — — 2 — — — — — 2 Shernhall Street Boys — — — — — — — — — Girls — — — — — — — — — W.C. William Morris Boys — — — — — — — — — Girls — — — — — — — — — Junior Mixed 10 1 1 4 — — 1 — 17 Marsh Street Boys — — — — — — — — — Mission Grove Girls 3 — — 2 — — — — 5 Infants 76 8 5 38 — 1 — — 128 Deaf and Dumb Mixed — — — — — — — — — S.W. Edinburgh Road Junior Mixed — — — — — 2 — — 2 Markhouse Road Boys — — — — — — 1 — 1 Girls 11 2 — — — — — — 13 Infants 75 — — 1 — — — — 76 Junior Mixed — — — — — — — — — 1st. Saviour's Boys — — — — — — — — — Girls — — — — — — — — — E.G. Infants 81 22 2 20 — 6 2 — 133 Forest Road Boys — — — — — — — — — Girls — — — — — — — — — Infants 95 68 17 70 4 4 4 — 262 Winns Avenue Boys — — — — — — — — — Infants 14 8 59 92 1 1 — — 175 Junior Mixed 6 2 92 13 4 1 1 — 119 N. Chapel End Boys — — — — — — — — — Girls — — — — — — — — — Infants 28 47 58 42 — — — — 175 Junior Mixed 8 3 3 6 1 — — — 21 Selwyn Avenue Boys — — — — — — — — — Girls — — — — — — — — — Infants 60 8 71 36 1 — 1 — 177 S. Gamuel Road Boys — — — — — — — — — Girls 23 — 1 3 — — — — 27 Infants 94 — 6 9 — — 1 — 110 Queen's Road Boys — — — — — — — — — Girls — — — — — — — — — Infants 28 1 — 17 1 — — — 47 TOTALS 1197 421 526 640 25 71 50 3 2933 RETURN showing the number of Cases of SCARLET FEVER and DIPHTHERIA notified in each month of Children attending the PUBLIC ELEMENTARY SCHOOLS, 1925. 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. N.W. Blackhorse Road Boys — — — — — — 1 — — — — — — — — — — — — — — — — — 1 — Girls — — — — — — 1 — 1 — 1 1 — — 1 — — 1 1 — — — — — 5 2 Infants 1 — — — 1 — 2 — 2 — — — — — — — — — 1 — 2 — 2 — 11 — W. E. Whittingham. Boys 1 — — — — — — — — — — — 1 — — — — — — — — — — — 2 — Girls — — — — — — — — — — — — 1 — — — — — — — — 1 — — 1 1 Higham Hill Infants 1 — 3 1 2 — — — — — — — 1 — — — 4 — 1 — 1 — 1 — 14 1 Junior Mixed 1 — — — — — — — — — — — — — — — — — — — — — — — 1 — Temp. Infants — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — C. Pretoria Avenue Boys 1 — — — — — — — 1 — — — — — — — — — — — — — — — 2 — Girls 1 — 1 — — — 3 — 1 — 1 1 — — — — — — — — — — — — 7 1 Infants 1 — — — 2 — 2 — 1 — 1 — — 1 — — — — 2 — 2 — 2 — 13 1 Higher Elementary Boys 1 — — — — — — — 1 — — — — — — — — — — — — — — — 2 — Girls — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — Coppermill Road Boys — — — — — — — — — — 1 1 — — — — — — — — 1 — — — 2 1 Girls — — — — — — — — 1 1 — — — — — — — — — — — — — — 1 1 Infants 1 — — — — — — — — — 1 — 2 — 1 — 2 1 3 — 2 — 2 — 14 1 Junior Mixed — — — — 1 — — — — — — — — — — — — — 1 — 2 — — — 6 — N.E. Wood Street Boys — 1 — — — — — — — — — — — — — — — — — — 2 — 1 — 3 1 Girls — — — — — — — l — — — — — — — — 2 — — — 2 — — — 4 1 Infants — — — l — — — — 1 — — — — — — — — — 1 — 2 — — — 4 3 Joseph Barrett Boys 1 — — — — 1 — — — — — — — — — 1 — — — — — — — — 1 2 Girls — — — — — 1 — — — — — — — — — — — 1 — — — — — — 2 Infants — 1 — i — 1 1 i — 1 1 — — — — — — — 3 — — — 1 — 6 0 E. Maynard Road Boys — — — — — — — — — — — — — — — — — — 1 — — — — — 1 — Girls — — — — — — — — — — — — — — — — — — — — 1 — 1 — 2 — Infants — — — — — — — 1 1 — — — 1 — 2 — — — — — 1 — 1 — 6 1 St. Mary's Girls — — — — — — — — — — — — — — — — — — — — — — — — — — Infants — — — — — — — — — — 1 — — — — — 1 — — — — — — — 2 — St. George's Mixed — — — — — — — — — — — — — — — — — — — — 1 — — — 1 — Shernhall Street Boys — — — — — — — — — — — — — — — — — — — — — — — — — — Girls — — — — — — — — — — — — — — — — — — — — — — — — — — W.C. William Morris Boys 1 — — — — — — — — — — — — — — — I — — — — — — — 2 — Girls — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — Junior Mixed — 1 — — — — 1 — — — — — — — 1 — 2 — 1 — — — — — 5 1 Marsh Street Boys — — — — — — — — — — — — — — — — — 1 — — 1 — — — 1 1 Mission Grove Girls — — — — 1 — — — — — 1 — — — — — — 1 1 1 — — — — 3 2 Infants — — 1 — — — — — — — 2 — — — 1 — — 1 1 — 1 — — — 6 1 Deaf and Dumb Mixed — — — 1 — — — — — — — — — — — — — — — — — — — — 1 s.w. Edinburgh Road Junior Mixed — — — — — 2 — — 1 — 1 — — — — — — 1 — — 1 — — — 3 3 Markhouse Road Boys 1 — — — — — — l — — — — — 1 2 — — — — — 1 — — — 4 2 Girls 1 — — — — — — — — — 1 — — 1 — — — — — 3 — — — 5 1 Infants — — — — — 1 — — 1 2 — — 1 — — — 1 2 1 3 2 — 1 1 7 9 Junior Mixed — — — — — — — — — — — — 1 — — — — — — — — 1 — — 1 1 St. Saviour's Boys — — — — — — — 1 — — — — — — — — — — — — — — — — — 1 Girls — 1 1 — — — — — — — — 2 — — — 1 — — — — — — 1 4 Infants 1 — — — — — — — — 1 — — — — — 1 — — 1 — — — — — 2 2 E.C. Forest Road Boys — — — — — — 1 — — 1 — — — — — — — — — — — — — — 1 1 Girls — — 2 — — — — — — — — — — — — — — — 2 — — 1 2 1 6 2 Infants 2 1 2 — — — 1 — — — — — — — — 2 — — 1 — — 1 2 1 8 5 Winns Avenue Boys — — 1 l 2 — — l — — — — — — — — — — — — — 1 — — 2 3 Girls — 1 — l 2 2 2 — — 2 — — 2 2 — 2 — — — — — — — — 6 10 Infants — 1 — — 3 1 — l — 1 — — 1 — — — 1 — — — 2 1 — — 7 5 Junior Mixed 1 — 2 — — — — — — — — — 1 — — — 1 — — — — — — — 5 — N. Chapel End Boys 1 — — — 1 — — — — — — — — — — — — 1 — — — — — — 2 1 Girls — — — — — — — — — — — 1 — — — — — — — — — — —1 — 1 1 Infants 2 — — — — — — 1 — — — — — — — — — — — 1 — 2 — 6 — Junior Mixed — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — Selwyn Avenue Boys — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — Girls — — — — — — — — — — — — — — — — — — — — — — — — — — S. Infants — — — — 1 — 1 — — — — — — — — — 1 — — — 1 — 2 — 6 — Gamuel Road Boys — 1 — 1 1 1 — I 1 — — — — — — — — — — — — — — — 2 4 Girls — 2 — l — — 2 — — — — — — — — — — 1 — 1 — — 1 — 3 5 Infants 1 1 — l — — 1 — 3 — 1 — — 1 — — 1 — 1 1 1 — — 1 9 5 Queen's Road Boys — — 1 — — — — — — — — — — — — — 1 — 1 — — — — — 3 — Girls — — — — — — — — — — 1 — — — — — — — — — 1 — — — 2 — Infants — — — — — — 1 — — — — — — 2 — — 2 — 2 1 — 1 — 1 6 5 N.E. Myope Centre Mixed — — — l 1 — — — — — — — — — — — — — — — — — — — 1— 1 TOTALS 21 11 14 10 18 10 22 8 17 9 16 4 12 12 8 6 20 12 27 7 34 7 24 5 233 101 Total Cases Notified 32 17 18 23 31 18 34 17 29 18 22 7 20 17 22 15 28 25 43 12 46 15 33 12 358 196