BARK 67 Urban District of Barking Town. THE ANNUAL REPORT OF THE Medical Officer of Health AND SANITARY INSPECTOR For the Year 1908. BARKING. Wilson & Whitworth Ltd., Printers, 5, Linton Road. BARK 67 PART I. GENERAL SUMMARY OF HEALTH STATISTICS. 1908 1907. Average for Ten years 1898—1907. The Birth Rate 30.8 29.4 34.1 The Death Rate 12.4 10.8 14.5 Zymotic Death Rate 2.1 1.2 2.5† Zymotic Case Rate 8.2 7.9 8.8† Marriage Rate 10.8 9.8 Infantile Mortality Rate 117 112 155* Infectious cases treated in Hospital 198 190 163 *Per 1000 Births registered. †Average for 5 years only. 5 THE Annual Report of the MEDICAL OFFICER OF HEALTH FOR THE URBAN DISTRICT OF BARKING TOWN, For the Year Ended December 31st, 1908. To the Chairman and Members of the Barking Town Urban District Council. Gentlemen, The population of the Urban District of Barking Town, estimated up to the middle of 1908, was 30,000 persons. This number, compared with the population as given by the census of 1901, shews an increase of 8,473 persons. The number of inhabited houses at the end of 1908 was 5,380 and the number of empties 203, leaving the nett number of inhabited houses as 5,177. The number of inhabited houses in March, 1901 (census), was 3,851, which shews therefore an increase of 1,326 houses. 6 Natural Increase of Population. Deaths. Births. Increase. 1900 398 783 385 1901 383 799 416 1902 336 817 481 1903 357 856 499 1904 385 896 511 1905 397 900 503 1906 360 873 513 1907 320 868 548 1908 376 924 548 It seems to me that since 1900 the steady increase in the natural increase of the population is worthy of remark. In 1900 the nett gain was 385, in 1906 513, and in 1907 and 1908 548. Water Supply. I insert here a recent chemical analysis of the water supply of the town. data " Respecting a sample of water from Barking Urban District Council, Labelled : From tap at No. 54, Harpour Road, Barking. Taken by H. Long. Physical Examination. Turbidity : Clear and bright. A mere trace of deposit of sand and vegetable debris. Colour : Greenish yellow tint. Odour: None. 7 Results in Determinations. Grains. per Gallon Parts. per 100,000 Total Solid Matter dried at 180° C 33.6 48.0 Chlorine 2.8 4.0 Equivalent to Chlorides (60 % Cl.) 4.7 6.7 Nitric Nitrogen 0.23 0.33 Equivalent to Nitrates (17 % N) 1.38 l.98 Nitrites Absent Hardness : Permanent 4 (leg.; Temporary 2.5 deg.; Total 65 9.8 Lead, Copper, Zinc, Iron Absent Free Ammonia 0.0006 0.0008 Organic Ammonia 0.0022 0.0032 Oxygen absorbed at 98° in 3 hours 0.0238 0.0340 The water is evidently derived from a deep source as it resembles the waters from deep Essex wells. It is of great organic purity, and there is nothing to indicate any contamination. The trace of fine sand and vegetable debris is doubtless derived from the mains. December 10th, 1908. John C. Thresh." Bacteriological Examination. Report on the examination of two samples of water from Barking Urban District Council, by John C. Thresh. No. 1. From main at 24, King Edward Road. No. 2. From main at 69, Morley Road. 8 The bacteriological examination of the above waters shows the absence of the Bacillus Coli and the Bacillus Enteritidis. A special search was also made for the Bacillus Typhosus, but in neither sample was its presence detected. The number of organisms in the sample No.1 is very excessive, otherwise both samples are of a satisfactory character. PUBLIC HEALTH LABORATORIES. " Report on the Bacteriological Examination of a sample of water received on September 11, 1908, from Barking Urban District Council. Source i., from main at 24, King Edwards Road, 2.30 p.m., September 11. ii., from Main at 69, Morley Road, 2 p.m., September 11. Number of organisms per cubic centimetre capable of growing on alkaline nutrient jelly at 20°C. in 4 days. Counted by aid of pocket lens; No. i., 16,000 in 3 days, liquified 4th day; No. ii., 510 Smallest quantity of water in which growth occurred, with production of acid and gas in bile-salt glucose broth. (1, 5, 10, or 20cc); No. i., acid in 1 cc, gas in 1 cc; No. ii., Acid in 5 cc, gas in 5 cc. Nature of organisms found in this growth : No Bacillus Coli, or Bacillus Typhosus found in either sample. Reaction of the bacillus enteritidis sporogones; No. i., in 250 cc., negative; No. ii., in 250 cc., negative. 9 I am glad to say that no case of disease has been definitely traced to drinking water during the year. I am doing all I can to get the supply of drinking water to every house from the rising main and not through a cistern. Many domestic supplies have been altered during the year from a cistern, to a direct, constant supply. I again urge that the Council should not allow houses to be erected without this provision. In 1900 there were 198 houses in the Town not connected with the main water supply— at the present time there are only . 6 remaining unconnected. Property. Source & Condition. Two Cottages adjoining Longbridge Farm Shallow well Bush Grove Farm „ Parsloes Lodge „ Scratton's Farm „ Starling's Hall „ Nos. 1, 2, 3, Lodge Lane „ Lodge Farm House „ Cottage adjoining „ Parsloes Farm House „ Two Cottages in Gale Street „ Great Porters „ Mogg's Farm „ Nos. 1 to 6, Ripple Hall Cottages „ Alpha Cottage „ Magazine Cottage No supply. Magazine Cottage, Ripple Marsh „ Davey's Tar Works (Cottage) „ 10 Bacteriological Analyses were made of Water from several shallow wells but no specific germ was discovered. Food Supply. Several parcels of fish and fruit have been condemned by me, but as they were not exposed for sale or intended for the food of man no prosecution could follow. I am quite sure small allotment holders could find a ready market for their surplus goods if a little more accommodation were offered them for this purpose, in the Broadway. Milk Supply. The condition of this important industry has occupied a large amount of my attention during the year. It seems almost impossible to impress, as one would wish, upon the producers and vendors of this article the absolute necessity for cleanliness in the minutest details, and care in preventing pollution. Still, as public opinion advances, so will the methods of the trade advance to meet its demands. The condition of the cowsheds has improved, but we have not at present any power in this district to enforce adequate examination of cows as to their fitness, or otherwise, to be milk suppliers. The resolutions passed at the recent Conference of Health Authorities would meet this difficulty, and have my cordial approval. Taken as a whole the dairies have improved, though in this 11 case, as in the cow-sheds, I find the greatest difficulty in getting any structural improvement carried out. The dairyman is usually poor, and only rents his premises for a short period so that the owner is not disposed to lay out capital to render the premises suitable for the storage of milk, especially necessary in the summer months. The churns are usually kept uncovered, and all kinds of dirt and germs are freely accessible. The rail-borne milk is subjected also to storage in hot ill-ventilated vans, and is often allowed to stand on a dusty station platform in the sun, and is thoroughly well shaken up several times during the journey from the producer to the consumer. No real reform in our milk supply will be effected until this " go as you please " style is abolished, and uniform methods insisted upon all over the country for the carriage and handling of milk. With regard to the milk shops I have succeeded, with the co-operation of the Public Health Committee, in enforcing covered receptacles in every case. This is some advance, but I fear this precaution is very much on a par with the shutting of the stable door when the horse has gone. The already grossly contaminated milk is carefully shielded from less harm than it has already received. Another serious defect in the local dealing with the milk supplies is the inability of the local authority to protect its own milk supply. I estimate that only about one quarter of the milk supplied in the town is produced therein, so that although we may exercise the most careful supervision over the milk produced in the district this supervision is rendered almost useless by the rail-borne milk imported from elsewhere. I am quite sure the control of our milk supplies should he in the hands of a central authority so as to insure uniformity of aotion all over the country. I reproduce here the resolutions, above referred to, passed at a reoent Conference of Health Authorities, and adopted by the Council:— 12 Resolutions with regard to Milk Supply and Bovine Tuberculosis. 1. That the adoption and enforcement of the regulations under the Dairies, Cowsheds and Milkshops Orders should be made compulsory on all Sanitary Authorities throughout the Kingdom, and that in the event of any Urban or Rural District Authority failing to carry out the Order or Regulations made under it, the County Councils be empowered to act. 2. That instead of the present system of Registration of Cowkeepers, a system of annual licenses should be substituted, renewable only if the premises are kept in sanitary condition—as in the case of slaughterhouses—and as provided in the Liverpool Improvement Act, 1867, and the Public Health (London) Act, 1891. 3. That throughout the Dairies, Cowsheds and Milkshops Orders and the Regulations made under them the responsibility of carrying out all structural alterations should be placed upon the owner. 4. That similar powers to those given to the large towns with regard to Tuberculosis and the milk supply be extended to the whole country, and that a national scheme should be undertaken for the purpose of reducing the prevalence of Bovine Tuberculosis. ft 5. That a copy of the foregoing resolutions be forwarded to the Prime Minister, the President of the Local Government Board, and the President of the Board of Agriculture. COWSHEDS IN THE DISTRICT. Number in Register. Amount of cubic space allotted to each cow. Condition as to light when doors are closed Ventilation, whether adequate or not. General cleanliness of shed and cows. 1 495 Good Improved Improved 360 Fair do. do. 410 Fair do. do. 360 Fair do. do 3 850 Fair Good Very Clean 600 Good do do. 84 1000 Good Good Very Clean DAIRIES IN THE DISTRICT. Number in Register Position and condition of Premises where Milk is stored. Are the Vessels containing the Milk covered ? What are the methods adopted for cleaning churns and cans ? 1 Ground floor of house, paved and ventilated Covered with muslin Boiling water from copper 2 Dairy, specially fitted Do. Copper for cleaning utensils 4 At rear of shop Metal cover in shop Boiling water from copper 11 Shed in yard paved and ventilated Do. Do. 15 Dairy at rear of shop Ordinary churns Special apparatus for boiling water and washing cans 17 Shop Muslin cover Cleaned at No. 31. 22 Do. Metal cover Boiling water from copper 26 Shed in yard paved and ventilated. Muslin cover Do. 26 Do. do. Do. Do. 27 Do. do. Kept in churn 29 Dairy at rear of shop Shop pail, metal cover Portable copper for washing cans. 31 Do. Do. Special apparatus as at No. 15 32 Shed in yard paved and ventilated Muslin cover Boiling water from copper 33 Dairy at rear of shop Do. Do. MILKSHOPS IN THE DISTRICT. (No Milk stored on premises except on the counters.) Number in Register. Description of the Vessel in which the Milk is stored. Description of covering to the Vessel. Other articles sold in the Shop. 6 Enamelled pan Metal cover Grocery 7 Jug Muslin cover General 8 Enamelled pan Do. Do. 9 Do. Do. Do. 10 Milk jug Do. Do. 12 Enamelled pan Do. Grocery 13 Do. Do. General 14 Do. Do. Grocery 16 Do. Do. Bread 18 Enamelled jug Do. General 19 Do. Do. Do. 20 Enamelled pan Do. Do. 21 Do. Do. Do. 23 Do. Do. Grocery 24 Do. Do. General 28 Do. Do. Do. 30 Do. Metal cover Grocery. 16 Bakehouses. There are now 18 bakehouses registered in the district. These have been kept under observation during the year and the regulations adopted by the Council under the Factory and Workshop Acts enforced. These regulations relate to:— a. Overcrowding (amount of cubic space per head required.) b. Ventilation. c. Light (in several instances the amount of light is not satisfactory.) d. Communication with bedroom. e. Communication with w.o., ashpit, or privy. t. Cleanliness and whitewashing. g. Drain openings. h. Water supply. There are no underground bakehouses in the district. Slaughter Houses. Only one registered slaughter house now remains. This is kept in very fair condition and all the requirement of the bye-laws are complied with. There are two licensed houses both of which are kept in excellent order. 17 As I have pointed out many times, there is no obligation on butchers and others to notify when killing is proposed to take place, so that the public may be safeguarded as to the condition of animals killed. The bye-laws have respect to the premises only. Knacker's Yard, Creeksmouth.—I have received complaints as to smells arising from these premises. Other and absolutely up-to-date premises close at hard are in course of erection, when the nuisances complained of will cease as all the work hitherto carried on in the premises complained of will be transferred to the new erection. Offensive Trade. Several manufactories of this description have been established during the year where fat extracting and blood drying are carried on. A good deal of nuisance has arisen from one factory but new plant is now in course of erection which will effectively stop all complaint. Other nuisances, arising from offensive smells in the course of various manufactures have been successfully dealt with during the year. Bye-Laws with regard to these trades are now in force. Rivers and Streams. Neither the Roding River nor the Loxford water have been the cause of much complaint during the year. 18 The water courses 011 the Marshes, with one exception, have not been complained of. Scavenging. This is carried out by the Council's men. Their operations have lately been extended, by arrangement with the owners, to localities which have not yet been taken over by the Local Authority. There are still several courts which should be attended to. General Inspection of District. A house to house inspection has been made during the year, as the work in the department will allow. A summary of the work done in the sanitary department, and nuisances detected, will he found hy reference to the Sanitary Inspector's report. I append a list, as usual, of those courts and alleys of the town which require speoial and constant attention. In all cases of Infectious disease special inspections are made, and in connection with all complaints. 19 Name of Property. Sanitary Improvements required. St. John's Retreat The drain 1 to 4 needs re-laying. Partially re-drained The surface of the court has been improved. Red Lion Place Has been re-drained. Requires paving in front of houses. Houses empty, owner promises to pave when let Alma Place Has been re-drained. The surface of the court should be drained and repaired where necessary. It has been suggested to cut up the surface of the court with gardens for the houses. Back Reform Place ... The main drain which receives the drain age from these houses, and also from Reform Place, North Street, has been re-laid and ventilated. The house connections have been attended to. Back Lane The drains of Nos. 1 to 11 and 15 to 17 need re-laying Bifron's Square The drains belonging to this property have been re-constructed and ventilated. A w.c. has been provided for each house. The surface of the square has been made up with a road, curbed and channelled. The houses themselves have been modernised in appearance, and thoroughly renovated inside, and are let at a rental of 4s. 6d. per week inclusive. 20 Name of Property. Sanitary Improvements required. Linsdell's Court The surface of the court has been made up under the 150th section of the Public Health Act, 1875, and the houses are now let at a rental of 4s. per week inclusive. Orchard Avenue The houses have been put in good repair and are now all occupied. Morgan's Yard The sewer has been relaid and ventilated and the court paved. Morgan's Quay The main sewer has been relaid and ventilated, and the road made up. The paving at the back of the houses has been laid. The road and footways need scavenging. The back ways have been separated with good effect. Factory Road and Emily Cottages These drains have been re-constructed and ventilated. The houses have been modernised, thoroughly cleansed and renovated. The back yards have been concreted and divided off in Factory Road. In Emily Cottages the back yards have been concreted but not divided. Park Terrace New water service has been laid on. Property in good order. Albert Terrace Collier Row The sewers belonging to these properties need ventilating and re-constructing. It would probably prove a great advantage if the back ways to these properties were abolished. 21 Name of Property. Sanitary Improvements required. Collier Place The drains belonging to this property have been re-constructed and ventilated. The back ways have been done away with, which has been a great improvement. Barking Place The sewer has been relaid and ventilated. The Council do the scavenging by special arrangement- Garden Place These properties, all situated in Axe Wellington Buildings Street, have been re-sewered, fresh w.c. Parson's Row accommodation, and flushing cisterns Padnell Place provided. The yards are now partially Suffolk Place I paved. They need scavenging badly. New water service laid on for Suffolk place. Arthur Cottages, This property is now in the possession of East Street the Railway Company. In fairly good order. Bridge Street. Streets repaved, curbed, and channelled. London Road Roofs attended to. Houses now in fair condition. Over-the-Gates This property have been thoroughly inspected, and any defect found remedied. Holly Square Fair condition. Main drain defective. Tanner Square Drain not ventilated, probably defective. 22 Drains found to be defective but not yet dealt with Northbury Cottages— Defective and should be relaid North Street— 90-92, require ventilating and repairing 109-119, need relaying 85-103, need ventilating 105-7-9 need relaying (? private drain) 4-6, need relaying 14-16, need relaying 52-60, need relaying Broadway— 29-31, need ventilating, etc. 10-12, need ventilating and relaying 41-43, need relaying and ventilating. 45, need relaying ( ? private drain) 33, need ventilating, etc. Heath Street— 5, need relaying 1-3, need relaying Axe Street— 49-59, need ventilating and possibly relaying 23 Chief Industries of District, 1. Beckton Gas Works.—This includes all kinds of labour, skilled and unskilled, coal porters, general labourers, stokers, engineers, etc. 2. Chemical Manure Works.—Including— (a) Manufacture of Manure and Disinfectants. (b) Manufacture of Sheep Dip. (No complaint of arsenical poisoning). 3. Tar Works, Muriatic Acid Works, Varnish and Paint Works and other manufactories of a similar nature. 4. Glass Bottle Manufacture. 5. India Rubber Mills. 6. Agriculture. 7. Iron Foundry Works. 8. All classes of workers, male and female, employed in London. 9. Manufacture of various light goods. 10. Various offensive trades and manufactures. 24 Collection of House Refuse. Very few complaints have been received during the year as to the non-collection of house refuse once weekly. This means that about 800 houses are visited daily, or 400 for each gang. The arranging of the work is in the hands of the Public Health Department. The cost of the work up to the year ending March 31st was £1201 6s. 4d. The number of houses from which dust is now collected is about 5,300, therefore the cost per house is just one penny per week. In my opinion the price is very reasonable. Sewerage and Sewage Disposal. No further steps have bean taken during the year with respect to linking up Creeksmouth with the main sewerage system. In my opinion the question should be dealt with at the very earliest opportunity. A small portion of the district (London Road) has been added to the main sewerage system, and the Upney Valley sewer, which is intended to drain the Faircross Estate now being developed, is now completed and ready for use. The same process of chemical precipitation is in use at the Sewage works, and no complaint has been received during the year as to the effluent. A good deal of the sludge has been removed from the works both by barge and by carting, but there is still a large quantity remaining. 25 The emptying of cesspools by means of an exhauster is a great advance on the old method, and the cost is much more reasonable. Fish Otfal Collection. The contractor still does the Work without any complaints coming to hand. Housing of the Working Classes. Never to my knowledge has house accommodation been so cheap in the town. The rent at which a good house can be obtained is 5s. 6d. per week, which is inclusive of rates. That is the sum for which a man can get a sanitary cottage, which includes of course education fees and all the usual sanitary advantages of a modern township These houses contain 4 rooms and a washhouee, and the rooms are somewhat small. There is a back garden 70ft. long and small forecourt. The roads are 40ft. in width with paved footways. I know of no district where houses of this description can be obtained at the price. I should like to see more facilities for obtaining small parcels of land at a reasonable cost, where fowls, pigs, etc., may be kept, and vegetables and fruit cultivated. The cottages owned by the Council continue to let fairly well, and are practically self supporting. On the whole I think the accommodation for the working class was never so good as it is now. The number of houses now letting in the town at 5s. 6d. per week, and under, is 2,326. 26 Infantile Mortality, 1908 (INCLUDING INFANTILE DIARRHŒA). This period is interesting as being the first complete year of working of the Notification of Births Act, 1907. The Notification began on January 1st, and up to December 31st 757 births were notified out of 924 registrations. The Notification Act was exceptionally well received by the general public. As far as I know, no objections have been raised to the notification of the births, and no one has refused admission to the Lady Inspector though, in several instances, as there appeared to be some hesitation, it was not pressed. With regard to the Midwives and Nurses in the district I have received the heartiest co-operation, and only one or two of the Medical profession have omitted to notify cases occurring in their practice. I feel sure, however, that when they see that in practice the objections that have been raised vanish into nothing they will also assist the Public Health Authority by notifying. The number of illegitimate births registered during the year was 21, and out of their number 16 were notified. I think the first visit after notification might be usually preliminary. It is not always wise or necessary to see either the mother or the child, unless there is some special reason for doing so, such as neglect, starvation or filthy surroundings. Later on, after the doctor in attendance and the monthly nurse have finished, a visit is most useful, and, in many instances, essential, as it is then that the breast milk may fail and the mother is looking about for some suitable substitute. Revisiting is often required so 27 that the mother may be encouraged and instructed with regard to cleanliness of bottles and teats, and warned against continually changing the food at the suggestion of kindly, but often ignorant, friends and relations. It is in this connection that I have found the instituting of some sort of milk depot most valuable. Most of the children can be brought to the depot and are weighed and inspected from time to time, and supplied with a preparation of pure fresh waterless milk. The particular form I have been using is called "Glaxo," and my results have been very satisfactory indeed. I append a list of cases which have been fed npon it, giving ages, reasons for feeding and results. Age of Infant. How Fed, Reasons for hand Feeding. First Weighing. Last Weighing 10 wks. No breast milk. Tried in succession cow's milk and barley water, and various patent foods At 10 wks. put on dried milk 7th Sept. 6lbs. 8ozs. 4th Jan. 10lbs. 3oz. 9 wks. Breast fed till 9th week, progress unsatisfactory; put on dried milk to supplement breast milk, from 3 months dried milk only 31st Aug. 8lbs. 12ozs. 1st Feb. 12lbs. 4oz. 3 wks. Hand fed (dried milk) entirely owing to condition of mother's health 15th Oct. 7lbs. 8oz. 18th Jan. 11lbs. 6oz. 5 mths. Breast fed, unsatisfactory progress; put on dried milk to supplement breast milk 14th Nov. 8lbs. 80z. 2nd Jan. 9lbs. 12oz. 28 Age of Infant. How Fed, Reasons for Hand Feeding. First Weighing. Last Weighing. 3 mths. Breast fed first two months, various patent foods, not thriving, put on dried milk at 3rd month 20th Oct. 7lbs. 13oz. 1st. Feb. 10lb. 2oz. 5 mths. A twin; under hospital treatment, on cow's milk and barley water, and condensed milk, no progress; put on dried milk at 5th month 21st Nov. 7lbs. 12oz. 1st. Feb. 10lbs. 2oz. 9 mths. 7 months' child. Under hospital treatment for heart disease. Breast fed first 6 weeks, subsequently cow's milk & barley water, at 9th month on dried milk 14th Sept. 10lb. 4oz. 25th Jan. 14lbs. 2oz. wks. No breast milk, 9th child, none having previously survived infancy. Put on dried milk from birth 14th Feb. 11lbs. 2oz. 30th Dec. 21lbs. 4oz. 3 mths. No breast milk, cow's milk and barley water, at 3 months put on dried milk 23rd March 61bs. l4oz. 4th Jan. 13;lbs. 12oz. 6 wks. Hand fed entirely from 6 months, since mother's death 4th Mar. 1llbs. 7oz. 2nd Dec. 16lbs. 6oz. 5 mths. Breast fed entirely first 6 weeks, condensed milk and barley water 4 months, wasting; put on dried milk at 5th month 1st Oct. 8lbs. 10oz. 3rd Feb. 12lbs. 4oz. 29 Age of Infant. How Fed, Reasons for Hand Feeding. First Weighing. Last Weighing. 1 mth. Breast feeding but no progress, put on dried milk at 1 month to supplement breast milk 2nd Dec. 6lbs 8oz. 1st Feb. 8lbs. 3oz. 6 mths. Breast fed entirely 7 weeks, cow's milk and barley water, patent food till 6 months, unsatisfactory progress, put on dried milk 17th June 13lbs. 4oz. 15th Dec. 21lbs. 12 mths. Breast fed 11 months, wasting, put on dried milk in addition to ordinary diet 19th Oct. 13lbs. 14oz. 15th Dec. 15lbs. 8oz 12 mths. Breast fed 11 mths., no progress, on Nestle's and sops, put on dried milk 7th Dec. 14lbs. 12oz. 1st Feb. 16lbs. 8oz 12 mths. Breast fed and patent foods, wasting, put on dried milk 8th Oct. 10lbs. 8oz. 16th Dec. 13lbs. 3 mths. Insufficient breast milk, using various patent foods, put on dried milk at 3 months 24th June 9lb. 10oz. 24th Nov. 14lb. 10oz. 2 mths. Breast fed entirely first mouth, supplemented with cow's milk, 2nd month lost breast milk, entirely hand fed on dried milk 8th Dec. 11lbs. 2oz. 5th Feb. 14lbs. 3 mths. Put on patent food first 3 months, progress very slow, if any, symptoms of rickets, put on dried milk 17th June 8lbs. 23rd Oct 11lb. 8oz. 30 Age of Infant. How Fed, Reasons for Hand Feeding. First Weighing. Last Weighing. 2 mths. Breast fed first 6 weeks, cow's milk to supplement breast milk. At 2 months, put on dried milk in place of cow's milk, after 3 months no breast milk 22nd Sept 9lbs. 2nd Feb. 15lbs. 7oz. 12 mths. Breast milk and cows' milk 12 months, wasting, put on dried milk with ordinary diet for two months 8th Oct. 10lbs 8oz. 16th Dec. 13lbs. 3 mths. Breast fed 6 weeks, condensed milk and barley water 4 weeks, since using dried milk entirely 26th Mar. 7lb. 14th Sept. 9lbs. 6oz. 3 mths. Breast milk failed after 3 months, put on dried milk entirely 23rd Mar. 11lbs 2oz. 19th Oct. 22lbs. 4oz. 9 mths. A twin. Breast fed 1 month, condensed milk, progress unsatisfactory, put on dried milk at 9 mths. 6th April 13lbs. 8oz. 6th Oct18lb. 12oz. 4 mths. No breast milk after 6 weeks, tried various patent foods, put on dried milk at 4 months 19th May 7lbs. 1oz. 5th Oct. 9lbs. 11oz 10 wks. Insufficient breast milk 20th May 8lbs. 6th Aug. 13lb. 8oz. 6 wks. No breast milk after 5 weeks, hand fed entirely on dried milk 25th May 9lbs 2oz. 9th Sept. 15lbs. 8oz. 10 wks Insufficient breast milk, 3 feedings of dried milk daily 17th May 9lbs. 9th Oct. 13lbs. 8oz. 31 Age of Infant. How Fed, Reasons for Hand Feeding. First Weighing. Last Weighing. 10 wks. Breast feeding and patent food, dried milk to replace it 24th June 9lbs. 2oz. 5th Oct. 12lbs. 12oz. 6 wks. No progress on breast milk, dried milk to supplement 14th June 6lbs. 2oz. 4th Sept. 8lbs. 4ozs. 2 mths. Breast fed first three weeks, in hospital 2 weeks, since hand fed entirely on dried milk 21st June 8lbs. 4oz. 21st Sept. 11lbs. In regard to the deaths among infants fed entirely upon "Glaxo" we had 2 in 42 cases, or 4.7 per cent. I am rather doubtful whether I ought really to count one of the deaths as the food was only given as a remedial measure when the case was practically hopeless. The death rate among the whole of the infants of the town is about 11.7 per cent. Of course the numbers are rather small for comparison, but under the peculiar circumstances, viz.: that all these children were brought to the depot suffering from some defect, either in themselves or. the mother, or were weakly, or the natural food was not available, the result is prima facie a good one. The following tables will show the number and character of the principal infantile deaths from various causes during the year, and two previous years. 32 This result is the more encouraging as Epidemic Diarrhœa was very prevalent, and very fatal, during the summer quarter of the year. 1906 1907 1908 Premature Birth 12 19 9 Atrophy, etc. 21 18 24 Bronchitis and Pneumonia 7 14 17 Diarrhœa 41 11 25 Enteritis and Gastritis 9 — — Convulsions 16 7 4 The Infantile Mortality rate for the year 1908 was 117, and the rate for the 10 years 1908 to 1907 was 155 per 1000 births registered. In 1907 the rate was 112, and that in a very cool summer, whereas in 1908 the summer was hot and the deaths from epidemic diarrhoea were more than double, but in spite of this the rate only rose 5 points. This is, to my mind, most encouraging. Half the infantile mortality appears to be due to premature birth, atrophy, bronchitis and convulsions, and most of these deaths are admittedly caused by the inability of the infant to digest and assimilate its food. Another third of the deaths were registered as due to diarrhoea in all its forms, so that improper food, want of care, &c., account for a large proportion of the mortality rate. The work of the Lady Health Visitor and the provision of sound, healthy, food is, I feel convinced, making a difference already in the town, and in a few years the infantile mortality rate which has been for so long the one bad item in our mortality returns will have been reduced to a normal and reasonable level. INFANTILE MORTALITY DURING THE YEAR 1908. Death from. stated Cauas In Weeks and Months under One Year of Age. Cause of Death Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 1 month 1-2 months 2-3 months 3-4 months 4-5 months 5-6 months 6-7 months 7-8 months 8-9 months 9-10 months 10-11 months 11-12 months Total Deaths under One Year. All Causes—Certified 19 4 2 2 27 12 9 10 5 7 8 7 6 4 9 6 110 Common Infectious Diseases— • Measles — — — — — — — — — — — — — — 1 1 2 Whooping Cough — — — — — — — 1 — — — — — — — — 1 Diarrhœal Diseases-Diarrhœa, all forms– — — — 1 1 — 2 — 2 4 2 5 1 3 3 2 25 Wasting Diseases—Premature Birth 7 1 — — 8 1 — — — — — — — — — — 9 Congenital Defects 2 1 — — 3 — — l — 1 — — — — — — 5 Atrophy, Debility, Marasmus 7 2 — — 9 9 2 — 1 — 1 — 1 — — 1 24 Tubercular Diseases— Tubercular Meningitis — — — — — — — l 1 — 1 — 2 — — — 5 Tubercular Peritonitis: Tabes Mesenterica — — — — — — — — — 1 — — — — — — 1 Other Tubercular Diseases — — — — — — 1 — — — 1 — — — — — 2 Other Causes— Syphilis — — — 1 1 1 — l — — — — — — — — 3 Meningitis (not Tubercular) — — — — — — — — — — 1 — 1 1 — 1 4 Convulsions 2 — — — 2 — 1 1 — — — — — — — — 4 Bronchitis — — 1 — 1 — — 2 — — — 1 — — 1 1 6 Pneumonia — — — — — — — 2 1 1 2 — 1 — 4 — 11 Suffocation, overlying 1 — — — 1 1 1 — — — — — — — — — 3 Other causes — — 1 — 1 — 2 1 — — — 1 — — — — 5 19 4 2 2 27 12 9 10 5 7 8 7 6 4 9 6 110 Births in the year, legitimate 903, illegitimate 21. Deaths in the year of legitimate infants 100, illegitimate infants 10. Population, estimated to middle of 1908, 30,000. Deaths from all Causes at all ages 376. 34 Factory and Workshop Act, 1901, Annual Report of the Medical Officer of Health for the year 1908, on the administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces, and Homework in the District. 1.—INSPECTION. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Number of Written Premises Inspections Notices. Factories (including Factory Laundries) 16 4 Workshops (including Workshop Laundries) 109 7 Workplaces (other than Outworker's premises included in part 3 of this report) 14 2 Total 139 13 2.—DEFECTS FOUND. Number of Defects. Found. Remedied. Nuisances under the Public Health Acts— Want of Cleanliness 6 6 Want of drainage of floors 2 2 Sanitary accommodation insufficient 3 3 Sanitary accommodation unsuitable or defective 3 3 Total 14 14 3.—HOME WORK. Nature of Work. Lists received from Employers. Addresses of Outworkers. Twice in the year. Once in the year. Received from other Councils. Forwarded to other Councils. Inspections of Outworkers' premises. Lists. Outworkers. Workmen. Lists. Outworkers. Workmen. Wearing apparel— (1) making, etc. 16 16 10 11 19 6 30 Sacks 2 8 l 5 9 — 17 Paper Bags and Boxes — — 2 2 2 — 2 Brush Making 2 2 — — 1 — 2 Total 20 26 13 18 31 — 51 35 36 4.—REGISTERED WORKSHOPS. Workshops on the Register at the end of 1908— Workshops 50 Workplaces 11 Bakehouses 16 77 5.—OTHER MATTERS. Matters notified to H.M. Inspector of Factories— Failure to affix abstract of the Factory and Workshop Act 5 Action taken in matters notified by H.M. Inspector 7 Reports (of action taken) sent to H.M. Inspector 7 19 Common Lodging Houses. I have paid a good deal of attention to these during the year. The ventilation of the rooms at night needs some attention, otherwise all the houses are kept in an orderly and clean condition. The following resolutions with regard to Houses-let-in-lodgings and Common Lodging Houses were passed at a Conference of Public Health Authorities, held on November 8th, 1908, and subsequently affirmed by the Council:— 1. That owing to the fact that Houses-let-in-Lodgings in our great towns are as a rule inhabited by the poorest class of the community, and that the present 37 bye-laws give no facilities for the night inspection of such houses, it is urgently necessary that means for the better supervision of Houses-let-in-lodgings be provided. 2. That owing to the fact that the keeper of what is virtually a Common Lodging House may escape supervision and have his house registered as a "House-let-inlodgings," provided that his lodgers pay by the week, it is urgently necessary that a proper definition of a "Common Lodging House" be provided by law. 3. That copies of the foregoing resolutions be forwarded to the Prime Minister and the President of the Local Government Board. Mortuary. I think the time has arrived for some attention in the arrangement at the Mortuary so that better accommodation might be offered for the performing of post-mortem examinations. Receptacles should be placed at the end of each of the slabs to catch the drainings, and suitable overalls and washing basins should be provided. Accident Ambulance. This has proved a very great boon to many. Fifty cases of accident and disease have been removed during the year. 38 Medical Inspection of School Children. The following is a copy of my report as submitted to the Education Committe on the medical inspection of school children during the year:— "To the Chairman and Members ot the Education Committee of the Barking Town Urban District Council. Gentlemen, As far as practicable, I have medically inspected all children in the Public Elementary Schools of your district who were admitted during the period beginning January 1st and ending December 31st, 1908, and also those leaving up to the same date. Altogether I have inspected 949 infants, 197 girls and 140 boys; and in submitting the tables of the various schools, which have been obtained from the cards used at the time of inspection. I venture to point out a few items which I think are worthy of your immediate attention. With regard to regularity of attendance, of course if the exact figures and percentages were required it would be necessary to make a digest of the attendance registers. This is not required for purposes of medical inspection. INFANTS I found that about 576 infants attended well, and 376 only fairly. I divided the clothing and footgear into three divisions, and I found 641 were good, 235 fair, and only 73 were bad. 39 I will not go into details as to the heights and weights, which are all set out in the tables, but will just remark that they work out very satisfactorily indeed. These statistics are most valuable as indicating year by year the physical development, or otherwise, of the rising generation. With regard to nutrition, I found 633 well nourished, 300 were fair, and only 16 showed signs of decided mal-nutrition. Many of these cases were investigated and dealt with—some provided with tickets for the free meals, and others visited at their own homes. I found much less want of cleanliness than perhaps one expected—741 were clean, 166 fair, 42 bad. As far as possible, the worst of these were visited at their own homes and the cause of their condition investigated. The question whether it is necessary to pay much attention to the condition of the teeth in the infants' department is, to my mind so obviously in the affirmative that I will not discuss it here— 322 needed attention out of 949. Cases of Tonsillar and Glandular enlargements were numerous, and open up a wide field for further elucidation. Adenoids were probable in 187 cases. Sections dealing with external eye disease, vision, ear disease and hearing, call for no particular remark, except that the figures are very low. Probably the low sickness rate of scarlet fever of late years has had something to do with the comparative absence of serious ear disease. 40 Section 21 (Rickets) reflects, I think, the condition of infant life as it exists in the modern urban population, and the numbers n the column will probably diminish if the efforts now going on all over the country, and in Barking too, with regard to infant feeding and management are persisted in. Home surroundings total up fairly well—only 67 out of the total are said to be unsatisfactory. BOYS AND GIRLS. With regard to the boys and girls I do not propose to weary you with details—they are set out fully in the tables both as to age and schools. I will refer only to the question of the teeth and eyes. Out of 140 boys examined I find 29 had abnormal vision. This does not mean that of necessity these 29 need spectacles; that point and the spectacles required can only be settled by a qualified oculist—not optician. I have myself attended to some of the worst cases and procured the spectacles, and a few have gone to the Hospital. The number remaining for attention should be ascertained. I found 53 cases amongst the girls, and what I have said with respect to the boys applies equally to the girls. They were all tested with Snellen's types at 6 metres, and my own glasses were used. The condition of the teeth in many cases was bad, but I feel bound to say not nearly so bad as I expected. 77 boys out of 140, and 116 girls out of 197, needed attention. 41 Whenever possible, I showed the parents the condition, and urged upon them the necessity for some action being taken. It is for the Committee to decide what further action should be taken in this important matter. SANITAEY AND GENERAL CONDITION OF THE SCHOOLS. The Schools have been inspected during the year and any sanitary defects discovered have been reported to the Committee. I think the question of sweeping the schools nightly is fraught with danger, especially in epidemic seasons, unless the floors are thoroughly wetted. Personally, I should prefer a different system altogether The lighting arrangements I found most inadequate—luckily artificial light is not often required. INFECTIOUS DISEASE Scarlet Fever has caused some trouble during the year. On many occasions I have examined whole classes to detect, if possible, any mild uurecognised case. This year I have not discovered any. The School Attendance Officer was suspicious that there was a case where the parents had not called in medical advice. He asked me to visit, and I found it was well marked Scarlet Fever. 42 The following table shows the distribution and number of infectious diseases during the year in the Public Elementary Schools of the district. Schools. Scarlet Fever. Diphtheria. Total. North School 56 4 60 Gascoigne Road 8 6 14 Westbury 16 5 21 Church of England 12 5 17 Roman Catholic 0 1 1 Creeksmouth 0 0 0 Castle 1 0 1 93 21 114 In concluding my first report to you I cannot forget the cordial support I have received from all the Head Teachers, without exception. Their assistance and co-operation has been most ungrudgingly given. The parents of the children have responded in a way most unexpected by me, and have given all information asked for, I think only one case objected, to which objection I made no demur. I am confident that, if tactfully and conscientiously carried out, medical inspection of school children will prove of the greatest utility in advancing the physical well-being of the nation. I am, Gentlemen, Your obedient Servant, (Signed) C. F. Fenton. P.S.—In dealing with defects discovered—(a) If the parent was present the conditions were explained and the proper course indicated; (b) If the parent was not present, either the Head Teacher sent for one of the parents to attend at some future time and explained my opinion, or the Lady Inspector visited the home for the same purpose.—C.F.F." PART II. INFECTIOUS DISEASE, STEPS TAKEN TO PREVENT INFECTION, ETC. 44 Infectious Disease. STEPS TAKEN TO PREVENT INFECTION. On the receipt of a notification of infeotious disease the residence of the sufferer is at once visited by a member of the sanitary staff with a view to obtain particulars as to means of isolation, cause of infection, condition of the premises, overcrowding, cleanliness, &c. If considered advisable the case is then removed to the Isolation Hospital, and the bed, bedding and room disinfected. If the patient remains at home instructions are given and disinfectants supplied. A postcard is left at the house to be filled up by the doctor attending when the case is ready for disinfection. Notices are sent from the Public Health Department to the schools at which the patient was attending, or those who may have been in contact with infection. The Attendance Officers, the Librarian, and Pawnshops are also notified. In case of Scarlet Fever, in addition to the disinfection by means of formalin spray, the rooms are stripped, re-papered and whitewashed where essential. The following tables show the distribution, age, and place of treatment of the cases notified during 1908:— Disease North Ward. South Ward. East Ward. WestWard Total Scarlet Fever 29 14 79 23 145 Diphtheria 5 11 15 13 44 Enteric Fever 4 1 10 7 22 Erysipelas 1 11 11 6 29 Membranous Croup 2 0 0 3 5 Puerperal Fever r 0 0 1 0 1 Totals 41 3 116 52 246 45 Table showing ages at which notified cases of Infectious Disease occurred during the year 1908:— Disease. All ages. Under 1. l to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upward. Scarlet Fever 145 0 32 101 11 1 0 Diphtheria 44 0 19 18 3 4 0 Enteric Fever 22 0 2 3 11 6 0 Erysipelas 29 2 1 3 2 17 4 Membranous Croup 5 0 3 2 0 0 0 Puerperal Fever 1 0 0 0 0 1 0 Totals 246 2 57 127 27 29 4 Table showing where the notified cases of Infectious Disease occurring in the year 1903 were treated:— Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Membranous Croup. Puerperal Fever. Total. Upney Hospital 114 36 11 0 3 0 164 London „ 0 0 2 0 0 0 2 St. Barts. „ 0 0 1 0 0 0 1 Romford Infirmary 0 0 0 l 0 0 1 Home 31 8 8 28 2 1 78 Totals 145 44 22 29 5 1 246 The total number of notified eases of Infectious Disease (excluding Phthisis) during 1908 was 246 against 234 in 1907, and 242 in 1906. 1908. 1907. Zymotic Case Rate 8.2 7.9 Zymotic Death Rate 2.1 1.2 46 The case rate is about the same for Notifiable Diseases, but the death rate is higher on account of an increased mortality in Epidemic Diarrhœa in the summer months. The deaths from Notifiable Infectious Diseases numbered II, or a rate per cent. of 4.4. Out of the total number of notified cases 114 occurred in children attending school or 46 per cent. against 45 per cent. last year. Scarlet Fever. Year. No. of Cases No. treated in Hospital. Percentage treated in Hospital. Deaths Death Rate per 1,000 of population 1900 67 51 76 1 .04 1901 134 92 68 3 .13 1902 96 82 85 0 .00 1903 73 57 81 1 .00 1904 94 71 75 3 .1 1905 98 77 78.5 0 0.00 1906 136 110 80 4 0.14 1907 127 110 86.6 1 0.03 1908 145 114 78.6 0 0.00 The number of cases were more than the year before, indeed more than in any year since 1900. On the other hand there were no deaths to record either in or out of the Hospital. 47 Diphtheria. INCLUDING MEMBRANOUS CROUP. I append the following table for comparison with former years:— Year No. of Cases. Deaths. No. treated in Hospital. Percentage treated in Hospital. Death Rate per cent. Death Rate per 1,000 of population 1908 49 11 39 79 22 .26 1907 51 6 42 82.3 11.17 .2 1906 69 9 56 81 13 .31 1905 116 14 91 78.4 12.0 .5 1904 145 9 113 77 6.2 .33 1903 194 19 149 76.8 9.7 0.76 1902 75 6 20 28.0 8.0 0.25 1901 80 3 41 51.2 3.7 0.13 1900 75 5 33 44.4 6.5 0.23 The number of cases again shews a decrease. The deaths are heavy, 8 having occurred during the year, which is equal to an annual death rate of the estimated population of 3, which is 1 per 1,000 more than for 1907. The death rate per cent of those attacked was 22 Seventy-nine per cent. of the cases were treated at the Hospital where the death rate was 20 per cent. This high death rate was due to two causes: 1. Small number of cases. 2. Several cases brought to Hospital in extremis, and others died in:— (1) 15 minutes in Hospital (2) 2½ hours „ (3) 36 hours „ (4) 48 hours „ 48 Deducting these cases the death rate in Hospital works out about 10 per cent., and of course the outside rate proportionately higher. I should like again to draw the attention of the Council to the following resolution passed by the London County Council with regard to the prevention of Diphtheria in Schools:— "That the Education Committee be authorised to refuse, during the presence of Diphtheria in any district, re-admission to school of children excluded on account of Diphtheria or Sore Throat until such children shall have obtained a medical certificate of freedom from infection, based on a bacteriological examination.'' I also recommend that a further resolution be passed that no child should be allowed to return to school until two weeks have elapsed after he or she has been discharged from Hospital, or certified as "clear" when treated at home. Enteric Fever. The number of notified cases dropped this year to 22, 6 less than last year. As in last year I found it difficult in many cases to assign the exact means of infection. The water in every case being examined chemically and in several cases bacteriologically as well, but in no instance was there any sign of the Bacillus Typhosus. The milk supplies were numerous, viz.: 6 from one milkman. 9 condensed. 7 various. 49 The water supplies were:— 19 main supply. 2 main supply per covered cistern. 1 shallow well (water analysed, no Bacillus Coli or Typhosus found) (See Report on Water Supply.) As far as I was able to get at the causation I have classified the probable causes as follows:— Employed at Sewage Works 1 Employed at Dust Shoot 1 Eating Shell Fish 2 Probably Contracted out of District 8 Drinking Water from a Polluted Ditch 1 Unascertained 9 22 All defects to house drains were remedied. The sewer ventilators in Morley and Howard Roads were erected early in the year. There have been no fresh cases in that locality during the year. I should recommend very strongly that more of these ventilators be erected. I append a list of Enteric Fever cases occurring during 1908, shewiug the localities in which they reside. West Ward. Bennington Avenue 2 Back Reform Place 2 Morley Road 1 Park Terrace 1 Gascoigne Road 1 Total West Ward 7 d 50 I add the usual list for comparison with former years :— No. Treated in Percentage treated in Death Rate Per cent, of Death rate per 1000 of Year of Cases. Death. Hospital Hospital. Notification. tion. 1908 22 3 14 63 13 1 1907 28 3 22 78 10 •10 North Ward. Linton Road 2 William Street 1 Broadway 1 Total North Ward 4 South Ward. Morley Road 1 There were 19 cases in the South Ward last year, against one this year. East Ward. Ripple Road 2 Victoria Road 1 Harpour Road 1 Fanshawe Avenue 1 St. Awdry's Road 1 King Edward's Road 1 Gordon Road 1 Priory Road 1 Lodge Farm 1 Total East Ward 10 51 Year. No. of cases. Treated in Hospital. Percentage treated in Hospital. Death Rate per cet of Notification Death Rate per 1000 of Population. 1906 11 1 8 73 9 .03 1905 14 0 9 64.2 0 .00 1904 18 5 12 65 27 .18 1903 16 4 7 43.7 25.0 .16 1902 42 6 30 71 14.2 — 1901 68 3 35 51 4.1 — 1900 50 7 38 76 14.0 — 1899 52 3 33 63.4 5.7 — 1898 31 2 23 74.1 6.2 Phthisis. The number of deaths from this disease, during the year 1908, was 36, which is equal to an annual death rate of 1.2 per 1,000 of the estimated population. In 1907 the rate was 1.3. Voluntary notification is still in force, and 41 cases have been notified during the year, as against 45 notifications in 1907 All the cases have been visited and instructed as to ventilation, infection, method of dealing with sputum, &c. Ten were receiving out-patient treatment at one of the London Hospitals, or had been doing so. Six were removed to Romford Union Infirmary. 52 The weakness of the notification system is the inability to relieve the cases when they come to light. Out-patient letters for one of the London Hospitals are sometimes obtained—a course which, in my opinion, does more harm than good. In some cases an in-patient letter is obtained, the patient improves—comes out, gradually gets worse, goes into the Union Infirmary and dies. I have no doubt a local dispensary for Tuberculosis—a small Hospital for the advanced cases—combined with systematic visiting, on the same lines as the Children's depot, would soon make a great reduction in the Phthisis case rate and mortality rate. Age of persons at which the cases occurred. Under one 1 1 and under 5 6 5 „ 15 1 15 „ 25 8 25 „ 65 25 41 Cancer. The number of deaths registered from this disease during 1908 was 16; 1907, 8; 1906, 12. This gives a crude death rate for the year of .53, as against .27 for the previous year. The number varies much from year to year. 53 Measles. No serious epidemic has visited the town for several years. No Schools or portion thereof have been closed. I am more than ever convinced that it is unnecessary to exclude children in the upper standards from school where their younger brothers or sisters have contracted the disease. Number of deaths, 9. Rate per 1,000 of the estimated population, 3. Whooping Cough. Very little of this disease has been notified during the year. Four deaths only have been registered. Death rate per 1,000 of the estimated population, 13. Erysipelas. One death has been registered from this disease and 29 cases notified. Puerperal Fever. One case only has been notified, and not one death. Considering there were over 900 births this record seems to me very good indeed. 54 Small Pox. No case has been notified. Vaccination. The total number of Primary Vaccinations performed during the past four years is as follows:— No. of Primary. Vaccinations. No. of Births. 1908 716 925 1907 786 868 1906 768 873 1905 761 900 1904 769 896 1903 907 866 Rainfall in 1908. Observer: Mr. T. Booton. January 1.09 inches February 1.35 „ March 2.09 „ April 2.31 „ May l.64 „ June 1.21 „ 55 July 4.59 inches August 2.75 „ September 1.28 „ October 1.91 „ November 0.69 „ December 1.75 „ Total rainfall 22.66 inches The rainfall for the year 1907 was 21.11. Pauperism and Unemployed in 1908. There can be no doubt that there was a large amount of genuine unemployment in the town during the year. This by producing poverty no doubt re-acts on the mortality and sickness returns—especially the infantile mortality rate. The amount of ordinary pauperism does not appear to increase. Further Sanitary Requirements of the District. 1. An improved method of dealing with the sludge at the Sewerage Works. 56 2. New Nursing Home and administration block at Hospital. 3. Suitable means of sewage disposal at the Hospital. 4. More sanitary conveniences should be erected in various parts of the town, e.g. at the back of the Public Offices, and at Loxford Tram Terminus. Vital Statistics. THE DEATH RATE. The nett death rate for the year is 12.4 of the estimated population. This rate is not so low as last year, but taking the various items which have combined to make the year under review less healthy than the preceding one, I think the result is excellent. The gradual increase in persons dying out of the district on account of illness is worth remark. There were 53 during the year. The total number of deaths was 376, the average number for the 10 years, 1898—1907, being between 370 and 380. Divided according to the different age periods the number of deaths is as follows: 1908 1907 Under 1 year 110 98 1 year and under 5 years 65 46 Total under 5 years 175 144 57  1908 1907 5 years and under 15 years 17 14 15 years and under 25 years 16 11 25 years and under 65 years 109 108 65 years and upwards 59 43 Total 376 320 AS TO CAUSATION, The largest items are Infantile Diarrhœa, with 38; Phthisis, 36; Respiratory Diseases, 64; Heart Disease, 25; Accidents and Suicides, 18. I trust no effort will be spared to lower the summer diarrhœa, and I feel sure the remedy lies in clean milk for the infant. The number of Phthisis cases should be reduced considerably, and in time obliterated altogether. Probably heart disease will increase. Cancer accounts for 16, which is a heavy increase. It will probably decrease next year. The Birth Rate. The number of births registered in 1908 was 924, which is equal to an annual birth rate of 30.8 of the estimated population. Last year it was 29.4. This is the first time for many years when the birth rate has shewn any appreciable increase. I do not think that it is likely to continue. 1900 36.4 1901 36.7 1902 34.7 1903 34.2 1904 33.8 1905 32.1 1906 30 1907 29.4 1908 30.8 58 ZYMOTIC DEATH RATE. 1908 Per 1.000 persons living 2.1 1907 1.2 1006 3.22 1905 2.7 1904 3.66 1903 2.24 1902 2,55 The increase this year is due to Epidemic Diarrhœa. ZYMOTIC CASE RATE. 1908 Per 1000 persons living 8.2 1907 7.9 1906 8.19 1205 9.2 1904 10.7 1903 13.6 1902 14.5 The small rise here is due to a few more cases of Scarlet Fever. Marriages. 1908 1907 Church of England 133 Otherwise 30 Total Number 163 144 Rate per 1,000 persons living 10.9 9.8 VITAL STATISTICS OF WHOLE DISTRICT DURING 1908 AND PREVIOUS YEARS Year. Population estimated to middle of each Year. Births. Total Death Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Nonresidents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at all Ages belonging to the District. Number. Rate. Under 1 year of Age. At all Ages. Number Rate per 1,000 Births registered Number Rate. Number Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1898 20,000 724 36.2 129 178 321 16.0 6 — — — — 1899 21,500 798 37.0 137 172 389 17.5 2 — 15 — — 1900 21,500 783 36.4 159 203 384 17.8 8 — — 399 18.5 1901 21,730 799 36.7 150 198 347 15.9 6 — 36 383 17.6 1902 23,500 817 34.7 110 134 299 12.6 7 — 38 336 14.2 1903 25,000 856 34.2 97 113 322 12.8 18 — 35 357 14.2 1904 26,500 896 33.8 129 143 356 13.0 11 — 29 385 14.5 1905 28,000 900 32.1 128 142 337 12.0 18 — 42 397 13.5 1906 28,500 873 30.6 143 162 322 11.2 7 — 38 360 12.7 1907 29,500 868 29.4 98 112 271 9.1 7 — 49 320 10.8 Averages for years 1898-1907 24,573 831 34.1 128 155 334 13.7 9 — 35 367 14.5 1908 30,000 924 30.8 110 117 323 10.7 11 — 53 376 12.4 *Rates in Columns 4, 8, and 13 calculated per 1,000 of estimated population Area of District in acres (exclusive of area covered by water). 3,797. Total population at all ages 21,547 Number of inhabited houses. 3,851 Average number of persons per house 5.6 At Census of 1901 CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1908. Notifiable Diseases. At all Ages, Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65 65 and upwards. No. of Cases removed to Hospital Diphtheria (including Membranous Croup) 49 — 22 20 3 4 — 39 Erysipelas 29 2 1 3 2 17 4 1 Scarlet Fever 145 — 32 101 11 1 — 114 Enteric Fever 22 — 2 3 11 6 — 14 Puerperal Fever 1 — — — — 1 — — Phthisis (voluntary) 41 1 6 1 8 25 — 13 Totals 287 3 63 128 35 54 4 181 60 61 CAUSES OF, AND AGES AT, DEATH DURING YEAR 1908. Causes of death Death at the subjoined ages of "Residents" whether occurring in or beyond the District. Total deaths whether of Residents or Non "Residents" in Public Institutions in the District. All ages Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 65 65 and upwards Measles 9 2 7 .. .. .. .. .. Whooping Cough 4 1 3 .. .. .. .. .. Diphtheria including membranous croup 11 .. 10 1 .. .. .. 8 Enteric Fever 3 .. 1 . . . . 2 . . 3 Epidemic Influenza 7 .. .. 1 .. 3 3 .. Diarrhœa 38 25 13 .. .. .. .. .. Enteritis 1 .. .. 1 .. .. .. .. Erysipelas 1 .. .. .. .. 1 • • .. Phthisis (Pulmonary Tubercular) 36 2 2 1 7 23 1 .. Other tubercular diseases 13 6 2 3 .. 2 .. .. Cancer, malignant disease 16 .. .. .. 1 11 4 .. Bronchitis 27 6 6 .. .. 6 9 .. Pneumonia 35 11 9 .. 2 13 .. .. Pleurisy 1 .. 1 .. .. .. .. .. Other diseases of Respiratory organs 1 .. 1 .. .. .. .. .. Alcoholism, Cirrhosis of liver 5 .. .. .. .. 4 1 .. Venereal diseases. 4 3 1 .. .. .. .. .. Premature birth 9 9 .. .. .. .. .. .. Diseases & accidents of parturition 1 .. .. .. .. 1 .. .. Heart diseases 25 2 .. 4 .. 12 7 .. Accidents 11 2 3 1 1 3 1 .. Suicides 7 .. .. .. 2 5 .. .. All other causes 111 41 6 5 3 23 33 .. All causes 376 110 65 17 16 109 59 11 62 Isolation Hospital. The number of cases receiving attention at the Hospital during the year 1908 was as follows:- Diphtheria and Croup 41 Scarlet Fever 114 Enteric Fever 14 169 Cases remaining in Hospital from 1907 29 198 The total number of deaths was 11, which is equal to a death rate per cent. of 5.5 of the number of cases admitted. This is very low, but I hardly think it fair to include one case whioh lived 15 minutes, one case which lived 2 hours, and another 5 hours. Deducting these a death rate of 4 per cent. remains. As regards Diphtheria I have not seen a well marked case of paralysis during the year. The death rate comes out at about 11 per cent., much higher than last year, when it was only 7.6 Scarlet Fever—114 cases have been admitted without one fatal case. Some have been very severe, but eventually all recovered. 63 Four examples of return eases have oocurred. Enteric Fever.—Fourteen cases of this disease have been admitted with 2 deaths. There has been sufficient accommodation for all cases requiring isolation in all three diseases during the year. A Convalescent Home has been erected so that the recovering cases will not be mixed with those in the acute stage. The present staff consists of— Matron. Staff Nurse. Two Assistant Nurses. Three Probationers. Three Ward Maids. Cook. Laundry Maid (with part time Assistant). Caretaker. The total cost of the Hospital from March, 1907 to March 1908 was £1474 17s. 5d., or about £7 per patient. The cost per patient per diem was 3s 2½d. The matter of accommodation for the Nursing Staff, kitchen and food storing accommodation are receiving the attention of the 64 Council, and during the coming year no doubt .some action will be taken on the basis of a permanent hospital. I take this opportunity to thank all my colleagues very heartily for the co-operation and support they have always afforded me whilst holding the office of Medical Officer of Health. I am, Gentlemen, Your Obedient Servant, C. F. FENTON. 65 Annual Report OF THE SANITARY INSPECTOR. Public Health Department, Barking. To the Chairman and Members of the Barking Town Urban District Council. Gentlemen, I have pleasure in presenting my Annual Report of the work carried out in the Public Health Department for the year ended December 31st, 1908. Inspections. Tha number of inspections made during the year was 2592, these include house to house inspections, houses in which Infectious disease occurred, workshops, houses which have been the subject of complaint, and miscellaneous inspections. In 1864 of the houses inspected, sanitary defects were discovered, and to effect the remedying of these defects it was necessary E 66 to serve 869 preliminary notices and 105 statutory notices, but in no case was it necessary to have recourse to legal proceedings. These figures do not include the reinspection of premises which takes up a great deal of time in supervising work in progress. House to House Inspections. During the year a systematic inspection was made of the following streets, roads, etc.— Over the Gates James Street Barking Place Emily Cottages Union Street Bennington Avenue Back Reform Place St. John's Retreat Harpour Road Fanshawe Avenue Priory Road Rosslyn Road Kennedy Road St. John's Road Gascoigne Road Devon Road Eldred Road Sparsholt Road Rippleside Morgan Yard Lindell's Court Holly Square Suffolk Place Parson's Row The number of premises inspected under this head was 901, and in 551 of the houses sanitary defects were discovered. 67 Complaints. The number of complaints received and entered in the register are as follows:— Main drains choked 37 W.C. and branch drains choked & defective 31 No water to closet 15 Cesspools full 12 Animals improperly kept 4 Overcrowding 6 Non-removal of dust 4 Gripsy vans 3 Offensive accumulations 8 Defective cisterns 7 Dirty and defective premises 8 Sundry 7 142 All were immediately investigated and steps taken to remedy or abate the nuisance discovered. 68 House Drainage. The number of drains tested with smoke or chemical was 131. In 6 instances the main combined drains were found in a defective condition, and on reporting to the Public Health Committee, instructions were given to the Surveyor to deal with them under Section 41 of the Public Health Act. The main drain at the rear of premises was found in 87 cases to be choked; these were reported to the Surveyor's Department and immediately cleared by the Council's workmen. Common Lodging Houses. The following are the registered houses in the district:— Situation of Premises. No. of Rooms. No. of Lodgers. 8 to 12 Fisher Street 13 44 29, Fisher Street 7 34 18, Fisher Street 2 12 14, Back Lane 7 20 50, Heath Street 6 13 27, Heath Street 3 19 15-17 Heath Street 8 36 46 178 Three new premises were registered during the past year. 69 All have been periodically inspected, and found to be generally well kept, and the cleansing and limewashing carried out in conformity with the bye-laws. No case of infectious disease occurred in any of the houses. Infectious Disease. During the year 261 cases of Infectious Disease were notified to the Medical Officer of Health. Each house was at once visited and enquiries made respecting the milk and water supply, schools attended, the sanitary arrangements, etc., with a view to ascertaining any possible source of infection, and measures taken to remedy any insanitary condition discovered. After the removal or recovery of the patient the room is fumigated and closed for six hours, and all bedding, clothing, etc. likely to retain infection removed to the disinfecting chamber. 281 rooms have been fumigated, 322 lots of bedding, etc., disinfected, and 55 rooms stripped, stopped, etc., after cases of Scarlet Fever. The Head Teachers of day-schools, Superintendent of Sunday Schools, and School Attendance Officers are notified of all cases occurring in houses in which scholars reside who are attending school, and requested not to allow children from infected houses to attend school for a stated period. Notice is also sent to the Public Library and Pawnbrokers. 70 Mortuary. The number of bodies received into the Mortuary was 31, viz: 18 males, and 13 females. Inquests were held on 30 of the bodies, and one was admitted on sanitary grounds. 7 post-mortem examinations were made. Petroleum. The premises licensed by the Council for the storage of Petroleum have all been visited, 5 licenses have been renewed, and 2 new ones granted. Factory and Workshop Act. There are 77 Workshops on the Register, and during the year 139 inspections have been made in order to secure observances of the provisions of the law in regard to cleanliness, ventilation, etc. On 5 occasions breach of regulations were discovered which were reported to the Home Office. Seven notices were received from H.M. Inspector of Factories as to unsuitability, and no proper closet accommodation in factories 71 Outworkers. Lists of outworkers residing in this district have been received in 31 instances from other authorities. A record is kept of their addresses, these lists are referred to upon rcceipt of a notification of infectious disease in order to stop any work being sent to an infected house, but in no instance has a case occurred in the house of an outworker. All the premises have been inspected and found in a satisfactory condition. Van Dwellers. Van Dwellers have again given considerable trouble during the year. As many as 81 vans had to be removed and on several occasions I had to forcibly remove them with the assistance of the police. These people will always annoy us until the vacant land is built upon, or fenced in. The Council have, I believe, power, under the Act which came into force on the 1st January, 1909, to call upon the owners to fence in vacant building land. Dairies, Cowsheds, and Milkshops. There are now only three Cowsheds in the district, accommodating about 80 cows, they have been frequently visited ; 72 improvements effected from time to time, and the cleansing and lime-washing regularly carried out. There are 32 Milksellers on the register, all have been constantly visited and attention given to the arrangements for storing the milk, the cleanliness of the utensils and the protection of the milk from dust, etc. Sale of Food and Drugs Act. During the first two months of the year 15 samples of Butter were taken, and submitted to the Public Analyst for analysis, who reported that all were genuine. Early in March the Council decided to discontinue the taking of samples under the above Acts, and forwarded a request to the Essex County Council that they should instruct their Inspectors to take a certain number of samples per annum, (not to be less than in the ratio of 3 samples per 1,000 of the estimated population) within the district of Barking. This the County Council agreed to do. At this point it may be of interest to record the number of samples taken by me and submitted to the Analyst since my appointment in 1901, as Inspector under the before-mentioned Acts, which were as follows:— 73 No. of Samples submitted. Found genuine. Found adulterated. Butter 182 172 10 Milk 191 175 16 Margarine 4 2 2 Cheese 5 5 — Vinegar 5 5 — Lard 5 4 1 Coffee 4 4 — Pepper 3 3 — 399 370 29 As a result of proceedings taken in the eases of those samples found to he adulterated, fines and costs amounting in the aggregate to £56 2s. Od. were imposed. Bakehouses. There are in the district 18 bakehouses. All have been systematically inspected, and found on the whole to be kept in a satisfactory condition, and the cleansing required by the regulations properly carried out. f 74 Slaughter Houses. The 4 slaughter houses (3 licensed and 1 registered 1 have been frequently inspected, the cleansing and limewashing carried out in accordance with the bye-laws. Removal of Refuse. The number of loads of refuse removed during the year was 3,878, which averages 3.17 loads per cart per day. The capacity of the cart is about 3½ cubic yards, and on an average a load of refuse weighs 30cwt. The total number of loads represent in weight about 5,817 tons. Disinfectants. For the convenience of the inhabitants disinfectants are given out daily between the hours of 9 and 10 a.m. During the year 6 tons of carbolic powder and 850 gallons of disinfecting fluid have been distributed In conclusion I append summary of work carried out during the year. 1 am, Gentlemen, Your obedient servant, H. WOOD, Sanitary Inspector. 75 Summary of Nuisances Detected and Work done during the year 1908. Number of Inspections, 2,592. House to House 901 Complaints 142 Infectious Disease 246 Workshops, &c. 123 Miscellaneous 1,180 Re-inspections of all kinds 3,371 Preliminary notices served 869 Statutory notices served 105 Drains, main choked 87 „ tested „ 131 „ branch defective 55 ,, „ choked 123 Water closet, defective flushing apparatus 337 „ defective connections 152 „ defective and dirty walls, floors, etc. 52 Insufficient water supply to houses 49 Dustbins, none 134 „ dilapidated 174 Sink waste pipes stopped and defective 81 Yard gullies defective and choked 40 Walls stripped after cases of Scarlet Fever 58 Eaves guttering and downspouts defective and choked 166 Draw taps a nd service pipes defective 64 76 Downspouts direct with drains 5 Yards not paved and defective 219 Roofs defective 74 Vent pipes defective 16 Walls and ceilings defective and dirty 122 Floors defective, dirty, and damp 77 Drinking water improperly stored and cisterns foul 135 Storage cisterns defective 67 Gipsy Vans removed 81 Accumulation of manure 30 Overcrowding 10 Animals improperly kept 10 Offensive accumulations 14 Samples of water 11 Cesspools full 22 Yards and passages dirty 24 Privies altered to water closets 5 Other nuisances 95