BARK 9 Urban District of Barking Town. THE Annual Report OF THE Medical Officer of Health, SCHOOL MEDICAL OFFICER, and INSPECTOR OF NUISANCES For the Year 1912. stratford: Wilson & Whitworth, Ltd., Broadway. PUBLIC HEALTH COMMITTEE. Chairman: Councillor A. Edwards. Councillor H. Berry. „ A. J. Blake. ,, R. H. Carter. „ S. Cooper. ,, J. W. Garland. ,, W. Gibbard. ,, A. E. Martin. ,, J. Ransom. ,, W. B. Reidie. ,, A. Whiting. ,, J. Wilson. ,, T. Young. ,, W. A. Thomas. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health and School Medical Officer: R. J. Ewart, M.D., F.R.C.S., D.P.H. Sanitary Inspector: H. Wood, Certified Sanitary Inspector, Meat Inspector and other Foods. Assistant Sanitary Inspector: W. Clayden, Certified Sanitary Inspector, Meat Inspector and other Foods. Female Assistant Sanitary Inspector and School Nurse: Miss M. C. Atkinson, Certified Sanitary Inspector and Midwife. Matron Isolation Hospital: Miss Taylor. SUMMARY FOR 1912. Population.—Calculated to the middle of the year— 32,521 Increase during year 1,008 No. of inhabitants per occupied house 5.1 Marriages 295 Annual rate of persons married per 1,000 of Population 9.0, Males 502 Births Females 462 Total 964 Annual Rate of Births per 1,000 of Population 29.0. Deaths Males 187 Females 139 Total 326 Annual rate of Mortality per 1,000 10.0. Total deaths from Zymotic Diseases 30 Annual Rate of Mortality from Zymotic Diseases 0.9 Infantile Mortality Rate per 1,000 born 93.3 Area of Urban District 3,803 acres land, 303 tidal waters. Population per acre 8.3 Houses „ „ 1.74 ANNUAL REPORT of the Medical Officer of Health for the Urban District of Barking Town, in the County of Essex. For the Year ended December 31st, 1912. To the Chairman and Members of the Urban District Council of Barking Town. Gentlemen, I have the honour to submit to you the Annual Report upon the Sanitary condition of your district for the year 1912. Viewing the year as a whole. I am glad to be able to state that the prevalence of all epidemic and other diseases was below the average, except in the case of whooping cough. The general death-rate was extremely low, only on one previous occasion has the figure been so low. The birthrate, whilst showing a fall when compared with the previous year, tends to become a fixed rate when a group and not single years are considered. The most pleasing feature is, however, the fact that the rate of Infantile Mortality is the lowest on record. The meteorological conditions to some extent no doubt were favourable, as the winter and autumn were mild, the summer wet and somewhat cold, and hence these diseases of infantile life peculiar to these times show a low rate of mortality. It will be seen in the following: table that the rainfall in the month of August established a record. 6 Rainfall. Year. Jan. Feb. Mar. April May June 1909 .71 .74 2.77 1.56 1.36 2.55 1910 1.44 2.26 .87 1.45 2.01 1.92 1911 1.07 .99 1.37 1.40 .80 1.90 1912 3.16 1.46 2.09 .05 .90 249 Year. July Aug. Sep. Oct. Nov. Dec. 1909 2.94 1.66 1.90 3.86 .84 2.58 1910 2.37 1.93 .82 1.92 3.00 2.77 1911 .39 .62 1.39 3.16 3.03 3.47 1912 1.16 3.88 2.01 1.55 1.43 2.19 Total 1909, 23.47 ; 1910, 26.76; 1911, 19.59 ; 1912, 22.37. The economic position was, however, very unsettled. The Coal Strike which occurred during the spring does not seem, however, to have caused as much disturbance as might have been expected. The Dock Strike, which lasted over the months of July and August, was the cause of much distress, though little, if any, effect can be detected either in the rate of Infantile Mortality or increase in number plying from causes either directly or indirectly associated with insufficient and unsuitable food. The cost of living has increased during the year, and though the improved rates of wages, in what may be termed the middle and upper strata of the working classes, more than compensate this, it is to be feared that the lowest strata is in much the same position if not actually worse off, though there is reason to believe that this section of our population is a relatively smaller proportion of the whole than of former years. The most important economic feature of the year, bearing on the national health, was the inauguration of the Insurance Act with its ancillary schemes for the control of Tuberculosis, 7 maternity and unemployment benefits. Considerable improvement in the National stamina is to be expected from these causes. The facilities for communication with London have been much improved, both by means of rail and car, with the result that the type of population tends to change in character. The most noticable features which seem in some measure to be associated with this cause are a shrinkage in the birth and death rates. In order to foster the increase of this section of our population, a high ideal of sanitation should be maintained, and care taken in laying out of new districts so as to achieve some degree of architectural beauty not only in the houses themselves, but also in the way they are arranged. It is of great importance in every district that is likely to grow to any extent, that every facility should be used to direct this growth along such channels as will avoid the errors of the past. The Housing and Town Planning Act m some measure meets this need, and use should be made of its provisions. The ratable value has increased from £179,599 to £190,330 which is due partly to an increase in the number of houses built and partly to a re-assessment of existing properties. Vital Statistics. The population at the last census taken at the end of the first quarter in 1911, was 31,294, an increase of 9,647 on that taken in 1901. Assuming that the rate of increase has been maintained, the population at the middle of the year ought to be 32,521. The distribution in the various wards is given in the following table. The full particulars with respect to age distribution are not yet obtainable. CENSUS, 1911. Urban and Rural Districts, Municipal Wards and Civil Parishes. Area in Statute Acres (Land and Inland Water). Families of Separate Occupiers. Population. Institutions. Large Establishments, Vessels, &c., 1911, (included in Cols. 4 and 6). 1901. 1911. 1901. 1911. Persons. Persons. Males. Females. No. Population. Cols. 1. 2 3. 4. 5. 6. 7. 8. 9. 10. BARKING TOWN U. D.* (191 : 3) 3,805 4,260 6,291 21,547 31,294 15,686 15,608 30 319 Civil Parish : Barking Wards : East 2,560 12,210 6,052 6,158 22 114 North 830 4,181 2,082 2,099 1 26 South 1,479 7,049 3,514 3,535 — West 1,422 7,854 4,038 3,816 7 179 * By the East Ham, Barking Town and Ilford Order. 1907, which came into operation on the 9th November, 1907, Part of Barking Town Urban District was transferred to East Ham Municipal Borough and part of East Ham Municipal Borough to Barking Town Urban District, 8 9 The history of the district for the last 22 years is given in the following table, and shows a steady and rapid growth of the population, a marked decline in the birth and death rates, and an improvement in the rate of Infantile Mortality since 1907. Year. Population estimated to middle of each Year. Births. Deaths under 1 year. Deaths all ages. Natural increase of population. No. Rate. No. Rate. No. Rate. *1891 14,301 640 44.7 96 150 282 17.7 358 1892 15,115 652 43.1 99 151.8 281 18.5 371 1893 15,829 629 39.1 98 156.6 288 18.1 331 1894 16,000 693 43.3 85 122.4 207 13.0 486 1895 16,000 693 43.3 112 162.6 312 19.5 381 1896 16,500 698 43.3 104 148.9 250 17.1 448 1897 18,500 771 41.6 138 178. 360 21.2 411 1898 20,000 724 36.2 129 178. 321 16. 423 1899 21,500 798 37. 137 172. 389 17.5 409 1900 21,500 783 36.4 159 203. 384 17.8 399 *1901 21,730 899 41.3 155 172. 347 15.9 552 1902 23,500 817 34.7 — 134. 336 14.2 481 1903 25,100 856 34.1 — — 357 14.2 499 1904 26,500 896 33.8 129 143. 385 14.5 511 1905 28,000 900 32.1 128 142. 397 14.1 503 1906 28,500 873 30.6 143 162. 360 12.6 513 1907 29,500 868 29.4 98 112. 320 10.8 548 1908 30,000 924 30.8 110 117. 376 12.5 548 1909 33,136 865 28.5 93 107. 339 12.8 526 1910 32,502 900 27.6 88 97.7 325 9.9 475 *1911 31,513 1,005 31.8 158 157. 508 16.1 497 1912 32,521 964 29.6 90 95.1 326 10. 638 * Census years. Note.. Population up to 1911, for intercensus years is estimated on number of occupied house. That for 1912 is calculated on the decennial rate of increase. The figures from 1907 to 1910 probably considerably overestimate the number of persons resident in the district, 10 hence the corrected birth and death rates are larger than those given for these years, for example: the rate of 9 9 for 1910 should be 111. The number of inhabited houses as returned by the overseers was 6,277 in 1911 and 6,342 for 1912, which gives a mean of 4 9 inhabitants per bouse for the former year and 5.1 for the latter. The return made in the year 1901 was 5.6, so that, although the number of occupants per house had decreased in the 1901-11 period, still the suggestion from the figures would be, that a scarcity existed in 1912, or that the earning power of the population had decreased. The latter consideration for obvious reasons is not the correct explanation. It is a point of interest to note, that except for the census year, the population in the above table was calculated on the number of houses occupied, and not on the basis of a rate of increase. At the beginning of the 1901-11 period, the number per house was 5 6 and 4.9 at the end, so that the populations for those years have been over-estimated, hence the birth and death rates should be bigger by 12 per cent. from 1906 onwards. If this correction is applicable then the death-rate for the year 1912 becomes the lowest on record for the district. Certain other possible sources of error have already been referred to in the report for 1911. The following figures would seem to show the demand for house accommodation is more pressing in the West Ward than in the other districts. The populations are calculated on the decennial rate of increase as given by the census for the whole district. 1912. North. South. East. West. Total. Inhabited houses 857 1,508 2,655 1,322 6,342 Population 4,348 7,331 12,671 8,171 32,521 Density per house 5.0 4.8 4.7 6.1 5.1 11 1911. North. South. East. West. Total. Inhabited houses 830 1,479 2,546 1,422 6,277 Population 4,181 7,050 12,182 7,856 31,513 Density per house 5 4.7 4.7 5.5 4.9 The natural increase—that is access of births over deaths— for the year is 638, and for the 21 previous years is 10,208. The increase of population in the corresponding period is 18,220, so that practically half of our increase must have arisen through immigration. Births. 946 births were registered, and 18 were returned as of mothers ordinarily resident in Barking and registered in other districts. The total number was 964, and of these 31 were illegitimate, 15 being males and 16 females. The relative number of the sexes was 502 males and 462 females, and the rate per 1,000 population was 29 0. The births were distributed in the various wards as follows:— North. South. East. West. Outside. No. births 138 256 295 257 18 Population 4,348 7,331 12,671 8,171 — Rate per 1,000 31.2 33.4 21.3 30.0 — In the table previously given of the history of the last 25 years it is seen that the district is no exception to the general rule, in fact, the fall in the birth-rate is even greater than has occurred in the country generally. The decrease equals approximately 35 per cent. of the rate registered for the decade 1891-1901, though it is of some moment to note that the rate of fall as previously mentioned does not seem to be maintained. 12 The following table gives the birth-rates in the various wards of the district, which show fairly clearly what is now a well appreciated fact, namely, that the size of family varies in inverse proportion to the ability of the parents to maintain them :— Birth Rates for four preceding years. North. South. East. West. 1912 31.2 33.4 21.3 30.0 1911 29.1 38.6 27.1 32.3 1910 21.9 25.4 23.2 41.6 1909 19.3 24.5 24.7 39.4 Average for four years 25,37 5 30.47 24.07 35.82 Marriages. There were 295 marriages registered in the district. Of these 270 were solemnised in the Church of England. The rate per 1.000 was nine as compared with 15 for the previous year. Deaths. There were 260 deaths registered in the district, but to these must be added 66 reported from other districts as belonging to Barking, giving a total of 326. The death-rate worked out at 10 per 1,000. Of the total number of deaths there were 187 males and 139 females, and the distribution in various wards was as follows:— 1912. North. South. East. West. Not stated. Total Deaths 44 94 65 96 27 Population 4,348 7,331 12,671 8,171 — . Rate per 1,000 10.1 12.8 5.1 11.7 — 13 1911. North. South. East. West. Not stated. Rate per 1,000 14.3 14.6 10.4 18.2 — Average death rate for the two years 12.2 13.2 7.7 14.9 Comparing these rates with those given for birth, it is seen that there is a strong relationship between these two factors. When it is remembered that a high birth-rate means the relative predominance in that population of immature and feeble life, the association is easily understood. It would be quite unjustifiable to connect the high death-rate in certain wards with bad environment or other defect in sanitary surroundings until this factor is allowed for, but the relative paucity of the number of deaths would not warrant such an analysis. A statistical table of the causes to which the deaths were attributed will be found on page 40. Inquests and Uncertified Deaths. Total number, 1912 19 Post-mortem examination 7 „ „1911 32 „ „ 17 „ „ 1910 31 „ „ 13 „ „ 1909 28 Accident—Injury 2 Drowning 4 Suffocation 1 Burns 2 Natural causes 10 Deaths from Tuberculosis and Respiratory Diseases. 14 The deaths registered as due to Phthisis and other tubercular diseases were 35, giving a rate of 11 per 1,000, which is lower than that recorded in any of the previous three years; the details being as follows:— 1912. 1911. 1910. 1909. Respiratory diseases 64 55 68 89 Phthisis 28 40 25 36 Other Tubercular Disease 7 12 11 28 Kate per 1,000 of Population for deaths from Tuberculosis 1.1 16 11 1.8 Although the death-rate from Tuberculosis has decreased, it is a point of some moment that the ratio between the Phthisis death-rate and the general death-rate has not materially altered, that is to say, the chance of any individual dying from a Tuberculosis complaint is the same to-day as in any previous year, though the event is delayed somewhat. The figures of this district are so small that it would be absurd to draw any conclusion were it not for the fact that the same deduction can be drawn from England as a whole. Infantile Mortality. There were 90 deaths registered of Infants, under one year, as compared with 158 in 1911, 88 in 1910, and 93 in 1909. The rate per 1,000 of births being 93 3. They were distributed as follows it- North. South. East. West. Total. Rate per 1,000 Births Registered. 9 30 18 33 90 65.2 117.1 61.0 128.4 93.3 15 The history of each ward for the last four years was:— North. South. East. West. Total. Rate per 1,000 Total. Rate per 1,000 Total. Rate per 1,000 Total. Rate per 1,000 1912 9 65.2 30 117.1 18 61.0 33 128.4 1911 17 139.3 50 180.5 35 104.7 53 205.4 1910 4 40.0 25 122.5 17 57.4 36 120.0 1909 11 122.2 17 86.7 19 66.5 46 160.2 Total for four years. 366.7 506.8 289.6 614.0 Average for four years. 91.675 126.7 72.4 153.5 The chief causes of death as compared with the three previous years were:— Atrophy or Wasting. Premature Births. Congenital Malformation. Bronchitis. 1912 16 15 10 11 1911 28 21 5 4 1910 15 9 2 12 1909 22 11 — 14 Pneumonia (all forms). Whooping Cough. 1912 10 10 1911 4 l 1910 4 6 1909 8 — As already has been said, it would be hardly safe to associate the high rate of mortality in the West directly to surroundings until due allowance had been made for the high birth-rate, as I have shown elsewhere, when the birth interval falls below two years the death-rate amongst the children rises enormously, irrespective of all other considerations, and until this factor can be allowed for it would be hardly safe to say 16 how much of the rate of infantile mortality is due to the bad surroundings, some is of course, but it is impossible to say, even approximately, how many are tabled in this way. Deaths from Zymotic Diseases. There were 24 deaths from the seven principal Zymotic diseases, which gave a rate of 0 7 per 1,000—that for the previous year being 4 9. This figure was dependent on the number of deaths from Infantile Diarrhoea. In the years 1909 and 1910, the figures were 19 and 0.7 respectively. No particular lesson can be drawn from these figures, bearing on sanitary administration. The details are as follows:— 1912. 1911. 1910. 1909. Scarlet Fever — 2 1 2 Diphtheria 2 2 2 9 Measles 1 45 1 10 Diarrhœa 5 95 7 24 Enteric Fever 1 9 1 2 Whooping Cough 15 1 11 0 The deaths from cancer for the last four years were 23, 18, 16, 23, respectively. These figures, owing to their smallness, cannot be considered to be of any significance as an argument in favour of the rising incidence of this disease. Prevention of Infectious Diseases. There were 301 notifications of the compulsorily notifiable diseases received in 1912, compared with 253 in 19.11. and 195 in 1910. 17 The comparative figures were as follows:- 1912. 1911. 1910. 1909. 1908. Scarlet Fever 95 132 116 188 145 Diphtheria 35 34 41 54 49 Enteric Fever 10 44 7 9 22 Puerperal Fever 2 0 Erysipelas 42 43 Tuberculosis 104 71 41 59 The following cases of notifiable infectious diseases occurred in school children attending the public elementary schools:- Mem. Croup. Scarlet Fever. Diphtheria. Enteric Fever. Westbury Boys 0 6 2 0 Girls 0 7 0 l Infants 0 1 4 0 Gascoigne Road Boys 0 3 0 0 Girls 0 4 1 0 Infants 1 3 0 0 North Street Boys 0 4 0 0 Girls 0 4 0 0 Infants 0 1 0 0 National Boys 0 1 0 0 Girls 0 0 0 0 Infants 0 0 0 0 Roman Catholic Mixed 0 2 1 0 Infants 0 0 0 0 Creeksmouth 0 0 0 0 Castle 0 1 0 0 1 37 8 1 18 The number of notifications of infectious diseases during each month of the year was as follows:— Scarlet Fever. Diphtheria. Phthisis. Enteric. Erysipelas. January 4 3 9 0 l February 8 2 7 l 4 March 4 2 4 0 4 April 5 3 9 2 4 May 7 4 5 0 2 June 4 3 10 0 1 July 4 5 10 1 2 August 8 4 11 1 6 September 8 4 6 1 3 October 7 2 12 3 3 November 15 0 13 1 6 December 21 1 8 0 6 Ophthalmia. Poliomyelitis. Puerperal. Mem. Croup January 0 0 0 0 February 0 0 0 0 March 0 0 0 0 April 1 0 0 0 May 3 2 0 0 June 2 0 0 0 July 1 0 1 0 August 0 0 0 0 September 2 0 0 0 October 1 1 1 0 November 0 0 1 0 December 0 0 0 1 It is interesting to note that there is an apparent tendency for Scarlet Fever to decline, the attack rates per 1,000 of population are:—1912, 2.9; 1911, 4.2; 1910, 3.5; 1909, 5.6; 19 1908, 4.8; and it is a point for congratulation that for the whole five years the case mortality was about one per 100, and even this rate may become less. There can be no doubt that in the last 20 years considerable modification has occurred in this disease. Whether this is due to systematic isolation or to other causes outside our present knowledge cannot be definitely decided. Still it must be a suggestive fact, that the period during which isolation has been in force, corresponds fairly closely with the decrease in the virulence of the disease. No definite relationship between school holidays and the prevalence before, during and after that period, can be detected. The figures are, however, much too small when distributed according to the month during which the notifications have occurred to base any conclusion on. Diphtheria is a little below the mean, and Enteric Fever, after a period of increased incidence during the last year, has fallen to a figure approaching the mean for the previous five years. There were three cases of Poliomyelitis (Tooth-Stroke) notified under the modified regulations. There was no feature in common in these three instances which in any way indicated where the infection had arisen. One death occurred from Measles, as compared with 45 for the previous year, and one only from Enteric Fever. There were 15 deaths from hooping Cough, a number which indicate an excessive prevalence of that disease, 11 of these occurred amongst infants of under one year. The sequence of an epidemic of whooping cough following measles is a phenomenon frequently observed. 20 Supply of Anti-toxin. Five supplies of Anti-toxin were issued from the Fire Station for the use of medical men for cases of Diphtheria in the district during the year. Tuberculosis. There were 104 cases of Pulmonary Tuberculosis notified during the year, and in 85 of these cases visits were made to the homes. The distribution of the deaths in the four wards was as follows:— North. South. East. West. Not Stated. Total. 1912 4 6 13 5 0 28 1911 1 4 9 14 12 40 1910 5 11 9 5 0 30 1909 5 1 16 14 0 36 Total 15 22 47 38 12 134 Average rate 4 years: 0.85, 0.75, 0.97, 1.1. The figures even when the four years are grouped are hardly large enough to say that any one of the districts is more liable to this complaint than the other. The distribution according to age of the notified cases which were visited, and such as subsequently died during the year were as follows:— Under 5. 5-15. 15-25. 25-35. 35-45. 45-65. Over 65. No. Notified Male 0 3 5 9 19 24 3 Female 1 4 10 12 6 8 0 Deaths Male 1 1 4 2 5 3 0 Female 0 0 0 0 0 2 0 21 According to these figures the average period between the notification of a case of Phthisis and the death of that case would be somewhere between three and four years. All the above deaths were not notified during the year, though over 25 per cent. were. The occupations were as follows Notifications. Deaths Notifications. Deaths. Bar-maid 1 l Docks 2 9 Park-keeper 1 0 Coalie 1 0 Hawker 3 0 Machinist 1 0 Shoemaker 3 0 Gas Labourer 5 2 Gasworker 6 1 Factory Foreman 2 1 Rubber 2 0 Porter 2 1 Glass-blower 1 0 Farrier 1 0 Housewife 19 2 Plumber 1 0 School 5 0 Stoker 1 0 Service 4 0 Chemical Works 0 1 Fields 3 1 Carman 0 1 Coffee Stall 1 0 Shopman 0 1 Laundry 2 0 Druggist 0 1 Clerk 1 1 The kind of houses occupied was as follows:— Three-roomed houses 5 Four-roomed „ 32 Five-roomed „ 15 Six-roomed „ 9 Seven-roomed „ 7 Common Lodging Houses 4 Not stated 32 Total 104 22 Out of 80 enquiries, the average number of occupants per house, in which a phthisical case occurred was 5 8, as compared with 51 for the town generally. As it is a well-known fact that phthisical stock tend to be more prolific than the average, it would be hardly fair to draw from this the conclusion that overcrowding favours this disease. The question of the relative influence of an hereditary diathesis and contact with a previous case in the same house was also inquired into. The figures are as follows:— All Notifications. Contacts with a known Home Contacts. previous case. With an Hereditary Without an With an Hereditary Without an Diathesis. Hereditary Diathesis. Diathesis. Hereditary Diathesis. 14 9 13 26 The deaths classed in this way were as follows:— 3 2 1 3 These figures would seem to suggest that actual contact (living in the same house with) strongly disposes towards infection. The figures are much too small and other considerations relative to the accuracy of the information vitiate any deduction of this kind. Hospital. (In-patients' Department.) No material alteration has occurred in the arrangements since the report of last year, though progress has been made to the extent of formulating a scheme which has been approved, and is still waiting the sanction of the Local Government Board. 23 The total number of cases admitted to the hospital during the last five years was as follows:— Number of cases at beginning of year:— 1912. 1911. 1910. 1909. 1908. 16 17 15 15 29 Total number admitted during year:— Scarlet Fever 89 106 99 162 145 Diphtheria 24 17 24 40 49 Enteric Fever 9 40 4 7 22 Phthisis 3 3 1 0 0 Total 125 166 128 209 198 Deaths. The causes of death were:— 1912. Diphtheria 1 Enteric Fever 1 Laryngeal Obst 1 Phthisis 1 Ophthalmia Neonatorum 2 Total 6 1912. 1911. Duration of stay for Scarlet Fever 39.5 52.44 days. ,, Diphtheria 32.1 40.8 „ „ „ Enteric Fever 41.2 40.0 ,, „ Phthisis 347 — „ „ Ophthalmia 17 — „ 24 The average duration of stay for Scarlet Fever has been reduced by 13 days, and as far as can be judged no increase in return cases was noted. The total cost of hospital for the year ended March 31st:— 1912. 1911. 1910. 1909. £1,971 3s. 8d. £1,387 18s. 6d. £1,826 3s. 9d. £1,428 2s. 1d. The cost of food:- 1912. 1911. 1910. £ s. d. £ s. d. £ s. d. Butchers' Meat 111 13 6 94 2 0 122 7 6 Groceries. 159 14 6 137 12 0 149 6 3 Bread and Flour 48 8 8 43 18 6 56 8 5 Milk and Eggs 104 5 2 88 8 6 113 6 8 Wine and Spirits 4 11 0 1 19 0 3 4 0 Fish 23 13 11 21 19 9 25 13 6 Vegetables & Fruit 31 8 10 28 8 7 33 16 5 £483 15 7 £416 8 4 £504 2 9 The cost for food per week for patients and staff inclusive was:— 1912. 1911. 1910. 6s. 5d. 5s. l0d. 5s. 4d. The steady increase is mainly, if not wholly, accounted for by the increase in the price of food materials generally. (Out-Patients' Department). 25 There were 717 children under school age, and 259 adults who attended the Out-Patients' Department. The illnesses for which they sought advice were as follows:— Defects. Under School Age. Over School Age. Mumps 2 — Scarlet Fever 1 — Chicken Pox 25 l Suspect Diphtheria 3 l „ Phthisis 3 8 Influenza 1 — Whooping Cough 19 — Erysipelas — 1 Sore Head 1 — Eczema Scalp 6 1 Ringworm 24 6 Skin Disease (Impetigo) 74 7 Itch 8 1 Sore Foot 6 9 Sore Toe 3 — Ulcer Leg 3 8 Sores 17 5 „ Finger 7 7 ,, Hands 4 8 ,, Face 4 4 Herpes 4 1 Erythema 2 1 Boils 1 3 Vermin 3 — Def. Eyes (vision) 19 2 ,, (conjunct) 33 15 Cornea Ulcer 5 1 Squint 9 6 Sore Ears 14 5 Ophthalmia 2 — Lupus 1 — Tonsils and Adenoids 55 7 26 Defects. Under School Age. Over School Age. Ear Discharge 7 3 Deaf 4 l Sore Throat 3 7 Enlarged Glands 6 1 Nasal Discharge — 1 Stomatitis 2 — Defective Teeth 21 6 Headache 5 6 Burn 15 14 Scald 6 1 Diarrhœa and Debility 20 — Bronchitis 7 2 Worms 3 — Chorea 1 3 Cough 5 2 Fits 1 — Indigestion 1 Constipation 1 — Heart Disease — 2 Kidney ,, 1 2 Inflammation — 1 Breast — 2 Vomiting 3 1 Naevus 6 1 Circumcision 7 — Nervous diseases 2 — Hernia 5 — Gout — 1 Rheumatism — 4 Rupture 6 — Abdominal Pain 1 2 Abscess 10 6 27 Defects. Under School Age. Over School Age. Ulcer 3 2 Varicose Veins — 7 Warts — 4 Whitlows 3 5 Defective Nutrition 26 — Examination — 1 Defective Boots — 2 General Cond. 1 3 Illdefined 137 31 Flat Foot 1 — Wry Neck 3 — Rickets 9 — Deformities 2 2 Dog Bite — 1 Accident 1 0 Cuts 2 1 Injury 22 22 Total 717 259 There were about 2,000 to 3,000 re-attendances. The question as to whether these people really required assistance or not is one which is almost impossible to decide, especially when we remember the spirit in which the assistance is given and the attempt to avoid anything of the nature of an inquisitorial examination as to the means and ability to provide the necessary medical advice. The scheme under consideration at present should in some measure prevent any pauperising effort on the people who wish to use the facilities offered. 28 Care of Infant Life. There were 938 births notified during the year, and 964 were registered. In the 16 cases who failed to comply with the law, satisfactory answers were obtained in all cases. In the previous year out of 885 notifications there were 63 defaulters. The procedure relative to cases attended by doctors and midwives were continued, the proportions were 382 by the former and 556 by the latter, thus only a little over one-third of the births were attended by fully qualified medical assistance. Practically the whole number were visited, the figure worked out to 91 per cent. of the number notified. The age of the mother at birth in relation to the sex and power of survival of the child is given in the following table, based on the experience of the last two years. The general conclusion is that these born about the 30th year seem to have the greatest chance of living one year. 29 BIRTH SEQUENCE. Age of Mother. 1st. 2nd. 3rd. 4th. 5 th. 6 th. 7th. 8th. 9th. 10 th. 11th. 12th & over. Totals. No. dying in first year. 20 and under 41 m. 4 m. m. f. 21 F. 4 F. 45 25 4 21 to 25 63 m. 36 m. 35 m. 11 m. 1 M. 2 m. 60 f. 36 f. 19 f. 7 f. 1 F. 1 f. 148 124 22 26 to 30 27 m. 28 m. 40 m. 28 m. 18 m. 16 m. 4 m. 2 m. — m. 26 f. 39 f. 37 f. 27 f. 16 F. 18 f. 6 f. 1 f. 2 f. 163 172 22 31 to 35 6 m. 9 m. 14 m. 15 m. 18 m. 18 m 25 m. 13 m. 8 m. 7 m. 4 m. 2 m. 4 f. 5 f. 10 f. 20 f. 26 f. 24 f. 31 f. 11 f. 4 f. 5 f. 1 f. 2 f. 138 143 16 36 to 40 2 m. 2 m. 5 m. 7 m. 8 m. 11 m. 12 m. 12 m. 17 m. 13 m. 8 m. 10 m. 1 f. 2 f. 4 f. 5 f. 9 f. 13 f. 10 f. 15 f. 17 f. 10 f. 5 f. 5 f. 107 96 21 41 and over — m. 1 m. 2 m. — m. 1 m. 4 m. 1 m. 6 m. 2 m. 4 m. 6 m. 18 m. 3 f. — f. — f. 3 f. 3 f. 2 f. 7 f. 2 f. 4 f. 5 f. 7 f. 9 f. 45 46 10 Totals 138 m. 80 m. 96 m. 61 m. 46 m. 51 m. 42 m. 33 m. 27 m. 21 m. 18 m. 30 m. 115 f. 86 f. 71 f. 62 f. 55 f. 58 f. 54 f. 29 f. 27 f. 20 f. 13 f. 16 f. 646 606 30 The following table gives a comparison between the two years' work:— 1911. 1912. Total Number Registered 1,005 964 Total Number Notified 885 908 Neglect to Notify 120 56 Attended by Doctors — 382 Attended by Midwives — 556 Number Visited 779 936 In 140 cases revisits were necessary, 32 of these required a third, 18 a fourth, and 7 a fifth visit. The reasons why a second or further visit was considered necessary were as follows:—93, first children; 7, twins; 35, poverty; 4, dirty; 14, artificial feeding; and 30, other causes. At the time of the visit, out of 803, 746 were being entirely fed at the breast, 13 mixed, and 44 artificial feeding. Some improvement is shown in the method of artificial feeding by the following : — 1911. 1912. Boat Shaped Bottles Other Styles 28 6 36 3 In only 16 cases was the mother employed as compared with 23 the previous year. A rather surprising figure when the trade disturbances of the year are considered. Defects noted in the mother number eight, and in the baby two. In 1910 Opthalmia, due in all probability to Gonorrhoea Infection was found in six cases, whilst in 1912 the figure had risen to 16. In 243 cases a cradle was used, this compares very well with 130 for the previous year and demonstrates that the visits do have a tangible result. As a natural sequence the deaths registered as from over-lying should diminish. 31 The age at which the last child was weaned is given in the following table :— 1 mth. 2 mths. 3 mths. 4 mths. 5 mths. 6 mths. 7 mths. 1911 32 8 9 4 4 12 7 1912 34 14 17 9 12 13 11 8 mths. 9 mths. 10 mths. 11 mths. 12 mths. over 12 mths. 1911 3 59 14 13 228 46 1912 17 72 33 16 96 127 The following gives some idea as to the reason of death in the first year other than its immediate cause. The figures are not strictly comparable, as the deaths that occur in one year in some cases refer to births that occurred in the previous year:— Total number. No. dying within first year. Attended by Doctors 382 45 Attended by Midwives 556 35 Mother Defective or Ill 12 12 Opthalmia Neonatorum 16 3 Breast Fed 746 41 Artificial Feeding 44 2 Mixed 13 1 Mother Employed 16 1 Cradle Used 243 9 Dirty Houses 61 8 Illegitimates 9 2 In the present instance it would hardly fulfil a useful purpose to deduce any conclusion from the above except that the death-rate is apt to be very high amongst illegitimates, those reared in dirty houses, and such in whom eye troubles develop in the course of the first week or so. These are, however, such as common sense would have led us to expect. 32 It is a point of some interest to note that out of 31 cases where the supply of milk was completely absent in eight of these, on a previous occasion, there was no possibility of any attempt being made to feed naturally, as that function remained in abeyance, and in eight cases where the mother was in feeble health, all the children eventually died. These facts suggest that in order to fully analyse the cause of Infantile Mortality the mother and her characteristics must not be overlooked lest we fall into the same errors as have appeared in certain authoritative documents. The Babies' Welcome. As an ancillary scheme to the visiting, as narrated above, which is of course mainly inspection, there has been established for the last two years' a Babies' Welcome. The atmosphere of such an institution is very different from the organisation under the Birth Notification Act, as in this case something positive is attempted. The mothers are encouraged to bring up their babies, whether ailing or not, so that a record of their weight may be obtained and the development of the child discussed. This institution is not an Out-patient Department for ailing infants, in fact, such are out of place, as it concerns itself mainly with the child whilst it is well, and its object is to keep them well. All children, when artificially feed, should be brought each week so that an indication can be obtained as to whether the food supplied is suiting the child or not and thereby much risk to life avoided. It is to be regretted that 40 out of 161 only attended once, but we hope to devise some means during the year whereby the occasion of each meeting may be made somewhat of a social function. 33 The details are as follows:— Number on Books at the end of year 1912 140 Average Attendance per week 18 Glaxo Tickets at reduced rate were supplied to 32 mothers where the natural source of milk had failed and the financial position of the parents needed help. In 24 of these, the infant thrived well, and in eight it was not suitable. In 23 cases dried machine skimmed milk and fats was supplied, in 18 cases there was improvement, and in five it had no obvious effect. Vaccination Statistics. It is with regret that I have to report that the number of infants vaccinated is becoming less each year The figure for the year ended September, 1912, is as follows:— Successfully Vaccinated 420 Insusceptible — Conscientious Objections 343 Died Unvaccinated 71 Postponed by Medical Certificate 6 Removed to places unknown 53 To be dealt with (not 6 months old) 8 Total Births Registered 901 It is to be noted, however, that the figures of Births Registered and Successfully Vaccinated are not for absolutely corresponding periods, though the error is not very material. The figures for the previous years are:— 1912. 1911. 1910. 1909. Successfully Vaccinated 420 549 537 573 Insusceptible — 3 3 4 34  1912. 1911. 1910. 1909. Conscientious Objections 343 170 171 152 Died Unvaccinated 71 64 63 49 Postponed by Medical Certificate 6 — 5 7 Removed to places unknown 53 59 66 66 Unaccounted for Births Registered 964 1005 900 865 Administration of Food and Drugs Act. Summary of samples taken in Barking during the year ended 1912:— Article. No. Taken. No. Genuine. No. Adulterated. No. Prosecutions. No. Cautions given. Milk 59 53 6 2 4 Butter 32 30 2 1 — Margarine 2 2 — — — Whisky 1 1 — — — Coffee 1 1 — — — Totals 95 87 8 3 4 Results of prosecutions Milk.—One vendor was fined 20s., and costs 9s. One case was withdrawn owing to bursting of the third portion. Butter.—One vendor was fined 20s., and costs 9s. The remaining adulterated sample of butter was taken informally from an itinerant vendor of whom nothing more has been heard. 35 Dust Collection. Household refuse is collected by the Council at following cost:— Cost £1,538 6s. 5d. for year ending March 31st, 1912. „ £1,408 16s. 5d. ,, ,, ,, „ 1911. „ £1,301 15s. 10d. ,, 1910. ,, £1,196 15s. 9d. ,, ,, ,, 1909. New Buildings, etc. The Surveyor reports the following with reference to the buildings in the district for the year ended 31st December, 1912:— 1912. 1911. Number of Houses demolished 4 — ,, ,, completed 103 286 ,, Shops „ 16 23 ,, Temporary Buildings completed 4 — ,, Factories ,, 5 4 ,, Additions to Buildings ,, 32 — Ambulance Service. An ambulance provided by public subscriptions is horsed by the Council for the removal to the Hospital of accidents and serious cases of illness. Two bath chairs were also provided from the same fund and were lent to 47 persons during 1912. 36 The ambulance journeys were as follows:—25 accidents, 56 private cases; as compared with 24 accidents, and 22 private cases in 1911. Removing patients to the following institutions or places of residence:— London Hospital 27 Shadwell 2 Poplar Hospital 21 St. Barts, 1 Plaistow Hospital 5 Fulham Road 1 West Ham Hospital 4 Seaman's 1 Romford Infirmary 4 Mildmay 1 Private Homes 5 Royal Free 1 King's College 2 — Gt. Ormond St. 2 81 Metropolitan 2 — Queen's, Hackney 2 General Sanitation. The supervision of the sanitation of the Town has improved considerably during the year, due mainly to the time of the Inspectors being devoted to outdoor work. The clerical part is now undertaken by a special assistant, and as a direct consequence the number of inspections were practically doubled during the year, and much benefit has arisen. The number of Preliminary Notices served nearly doubled, and the Statutory Notices were four times as numerous as in the previous year. It is surprising to observe that no prosecutions followed the Statutory Notices. It is usual to find that at least 4 37 to 5 per cent. of the people concerned require resort to the courts to enforce compliance. The nature of the defects that occurred were much the same as noted in the preceding year's report, only on a more amplified scale. Considerable progress has been made with the House to House Inspection necessitated by the Housing and Town Planning Act; 1,132 dwellings being dealt with as compared with 396-1911, 385-1910. This would make a total for the three years of 1,913, that is about one-third of the houses in the district. The inspections should be completed during the next two years. There were 19 houses certified as unfit for human habitation, and 13 of these were closed. During the year 10 houses were demolished and structural alterations were made in 192. The number of Common Lodging Houses in the district is now five, two licenses having ceased. The Dairies, Milkshops, etc., have been maintained in a satisfactory condition. I am, Your obedient servant, (Signed) E. J. EWART, Medical Officer of Health. 38 TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1912 AND PREVIOUS YEARS. Year. Population estimated to middle of each Year. Births Total Deaths Registered in the District. Transferable Deaths. Net Deaths belonging to the District. Uncorrected Number. Nett Of Non-residents registered in the District. Of residents not Registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1907 29,500 868 29.4 271 9.1 38 98 112. 320 10.8 1908 30,000 924 30.8 323 10.7 49 110 117. 376 12.4 1909 30,351 864 28.5 339 11.1 50 93 107. 389 12.8 1910 32,502 900 27.6 276 8.4 57 88 97.7 325 9.9 1911 31,513 992 31.8 420 13.3 91 158 15.7 508 16.1 1912 32,521 946 29.0 321 9.8 55 90 93.3 326 10.0 Total population at all ages at Census 1911—31,294. Number of inhabited houses—6,291. Average number of persons per house—4.9. 39 TABLE 11. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1912. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Locality. Total Cases Removed to Hospital At all Ages. At Ages—Years. North. South. East. West. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) .. .. .. .. .. .. .. .. .. .. .. .. .. Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 35 1 17 12 1 4 .. .. 3 8 20 4 24 Erysipelas 42 .. 1 4 6 20 6 5 4 7 26 8 .. Scarlet Fever 95 .. 30 54 9 1 1 .. 9 29 49 8 89 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 10 .. .. 5 3 2 .. .. .. .. 3 7 9 Relapsing fever (R) .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 2 .. .. .. .. 2 .. .. 1 .. 1 .. .. Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. Poliomyelitis 3 .. 2 1 .. .. .. .. 1 .. 1 .. .. Pulmonary Tuberculosis 104 .. 3 7 18 45 29 2 22 15 31 36 3 Ophthalmia Neonatorium 10 10 .. .. .. .. .. .. .. 1 2 7 3 Totals 301 11 53 83 37 74 36 7 40 60 130 71 128 Name and situation—Isolation Hospital, Upney. Total available beds—50. No. of diseases that can be concurrently treated —4. ■ ' 40 TABLE III. CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1912. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of "Residents" or " non-Residents " in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. 1 2 3 4 5 6 7 8 9 10 11 Enteric Fever 1 .. .. .. .. .. 1 .. .. 1 Small-pox .. .. .. .. .. .. .. .. .. .. Measles 1 .. 1 .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough 15 11 3 1 .. .. .. .. .. .. Diphtheria and Croup 2 .. .. 2 .. .. .. .. .. 1 Influenza 6 1 .. .. .. .. 1 1 3 .. Erysipelas 2 .. .. .. .. .. .. 2 .. .. Phthisis (Pulmonary Tuberculosis) 28 .. 1 .. 3 8 9 7 .. 1 Tuberculous Meningitis 1 .. .. 1 .. .. .. .. .. .. Other Tuberculous Diseases 6 2 .. 1 1 .. 1 .. .. .. Cancer, malignant disease 23 .. .. .. .. 2 4 8 9 .. Rheumatic Fever 5 .. .. .. 1 1 1 1 1 .. Meningitis 3 2 1 .. .. .. .. .. .. .. Organic; Heart Disease 43 .. .. 3 4 2 5 20 9 .. Bronchitis 26 12 .. 1 .. .. 1 2 10 .. Pneumonia (all other forms) 36 10 6 1 3 4 3 7 2 .. Other diseases of Respiratory Organs 2 .. .. .. 1 .. .. 1 .. .. Diarrhoea and Enteritis 5 1 2 .. .. .. 1 1 .. .. Appendicitis and Typhlitis 1 .. .. .. 1 .. .. .. .. .. Cirrhosis of Liver 2 1 .. .. .. .. .. .. 1 .. Alcoholism 1 .. .. .. .. .. .. .. 1 .. Nephritis and Blight's Disease 8 .. .. .. .. .. 1 4 3 .. Puerperal Fever 3 .. .. .. .. 1 2 .. .. .. Other accidents and diseases of Pregnancy and Parturition 1 1 .. .. .. .. .. .. .. .. Congenital Debility and Malformation, including Premature Birth 42 41 .. .. .. 1 .. .. .. 3 Violent Deaths, excluding Suicide 9 1 .. 1 .. 1 2 4 .. .. Suicides 1 .. .. .. .. .. .. .. .. .. Other Defined Diseases 52 3 .. .. 1 3 4 15 26 .. Diseases ill-defined or unknown 2 .. .. 2 .. .. .. .. .. .. Totals 326 86 14 13 15 23 36 74 65 6 41 TABLE IV. INFANT MORTALITY DURING THE YEAR 1912. Nett Deaths from stated causes at various Ages under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total Deaths under 1 year. All causes Uncertified .. .. .. .. .. .. .. .. .. .. Certified .. .. .. .. .. .. .. .. .. .. Small-pox .. .. .. .. .. .. .. .. .. .. Chicken pox .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. 2 .. 5 3 10 Diphtheria and Croup .. .. .. .. .. .. .. .. .. .. Erysipelas .. .. .. .. .. .. .. .. .. Tuberculous Meningitis .. .. .. .. .. 1 .. 1 .. 2 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. .. Other Tuberculous Diseases .. .. .. .. .. .. .. 1 .. 1 Meningitis (not- lous) .. .. .. .. .. .. .. 1 .. 1 Convulsions .. 2 1 .. 3 .. .. 2 .. 5 Laryngitis .. .. .. .. .. .. .. .. .. .. Bronchitis 1 .. .. 1 2 3 6 .. .. 11 Pneumonia (all forms) .. .. .. .. .. 2 1 3 4 10 Diarrhœa .. .. .. .. .. .. .. .. 1 1 Enteritis .. .. .. .. .. .. .. .. .. .. Gastritis .. .. 1 .. 1 .. .. .. .. 1 Syphilis .. .. 1 .. 1 1 .. .. .. 2 Rickets .. .. .. .. .. .. .. .. .. Suffocation, overlying .. .. .. .. .. 1 .. .. .. l Injury at Birth .. .. .. .. .. .. .. .. .. .. Atelectasis .. 1 .. .. 1 .. .. .. .. 1 Congenital Malformation .. 1 2 2 5 2 1 1 1 10 Premature Birth 11 1 .. .. 12 .. 2 1 .. 15 Atrophy, Debility and Marasmus 3 4 2 1 10 3 3 .. 16 Other causes .. .. .. .. .. .. 2 .. .. 3 Totals. 15 9 7 4 35 15 15 10 9 90 Nett. Births in the Year Legitimate, 933. Illegitimate, 31. Nett Deaths in the Year of Legitimate Infants, 89. Illegitimate Infants, 1. 42 SUMMARY FOR YEAR, 1912. Total number of Schools 7 Departments 16 Number of Provided Schools 5 Number of Non-Provided Schools 2 Total accommodation 6,595 Number of children on register 6,449 Total average attendance 5,649 Percentage attendance 87% Total number on register under 5 years 11 Average attendance under 5 years 11 £ s. d. Rateable value (for Poor Rate) 189,919 0 0 Grant relative to necessitous areas 954 15 8 Education Rate 0 1 8½ Product of one penny rate 740 0 0 Cost of School Medical Inspection for last completed financial year 146 11 0 Salary for School Medical Officer 100 0 0 Salary for Nurse 39 16 11 Printing and Stationery 6 14 0 Estimated expenditure for current year (includes extra expenditure for treatment, etc.) 230 0 0 43 ANNUAL REPORT FOR 1912. To the Chairman and Members of the Education Committee. Mrs. Drake and Gentlemen, I beg to submit to you the report for the year ending December 31st, 1912. Routine Inspection. During the year the Board drew attention to the fact that the number of inspections in each period did not approximate to the number of children of a particular age in school attendance. The numbers for the past year as compared with 1911 are as follows:— 1911. 1912. Boys. Girls. Total. Boys. Girls. Total. Between 5 and 6 years 280 229 509 343 262 605 „ 7 „ 8 ,, 173 197 370 237 277 514 „ 12 „ 13 „ 252 241 493 298 251 549 Total Number of Inspections 1,372 1,668 If we consider the entrants and leavers only, the numbers inspected each year during the last five years are, in 1908-1,286, 1909-1,338, 1910-770, 1911-1,002, 1,912-1154. So that the number of children missed has considerably decreased, and it is hoped that during the present year it will be still less. Besides the above, 224 boys and 276 girls—a total of 500—were examined at the request of the head teachers. In the previous year 361 were similarly selected. 44 The mean stature of each of the above groups was found to be:— Boys. Height in Centimetres. Height in Inches. Comparison with England and Wales. Weight in Kilo's. Between 5 and 6 years and born in 1907 10422 41 04 41.0 17.30 Between 7 and 8 years and born in 1904 116.68 45.94 47.0 21.26 Between 12 and 13 years and born in 1899 141.47 55.97 57.0 34.60 Girls. Height in Centimetres. Height in Inches. Comparison with England and Wales. Weight in Kilo's. Between 5 and 6 years and born in 1907 104.75 41.24 40.5 17.42 Between 7 and 8 years and born in 1904 119.21 46.98 46.5 22.98 Between 12 and 13 years and born in 1899 140.11 55.92 58.0 33.79 The anthropometrical history since the beginning of Medical Inspection is as follows:— Entrants (children in 5th year of life only). Boys and Girls. Height (Metres). Weight (lbs.) 1908 4112 38.1 1909 4075 37.08 1910 4064 36.6 1911 4075 39.28 1912 4125 37.53 It must be noted that little significance can be attached to these figures for the simple reason that the mean age in 45 years and months has not been obtained, hence it would be unsafe to assume that the children of this age have increased in stature since 1909, as the figures might indicate. The significance of this will be easily understood when it is bered that on an average a child of school age grows 2½ inches per year. For "leavers" children in 13th year the figures are as follows:— Boys. Girls. Height (Metres). Weight (lbs.) Height (Metres). Weight (lbs.) 1908 55.50 74.5 54.58 72.2 1909 56.28 77.95 56.33 75.55 1910 57.31 75.12 56.6 76.03 1911 55.70 75.76 55.68 74.53 1912 56.42 74.60 56.42 75.76 The co-operation of the parents with the objects of inspection—namely, the amelioration of defect, and the enhancement of the standard of parental care can be judged in two ways, either by the percentage of mothers attending the examination, or by the absence of vermin or evidence of such. The first of these is satisfactory, for we find that taking all inspections together, on 43.43 per cent. of the occasions the child was accompanied by some responsible person. The figures for the previous years are:— 1908. 1905. 1910. 1911. 1912. 44.5 36.2 35.1 38.9 43.43 So that even after the first curiosity had worn off the attendance was maintained, and latterly has tended to improve. 46 With respect to the second criteria the evidence is hardly so favourable, for we find the following:— Percentage of children showing evidence of infection with lice. Infants. Boys. Girls. Head. Body. Head. Body. Head. Body. 1908 15.8 8.7 3.5 3.5 24.3 4.5 1909 11.7 5.8 3.6 5.5 30.1 1.7 1910 20.1 0.4 2.0 1.6 45.9 0.4 1911 12.9 1.2 0.7 0.8 39.8 — 1912 1603 0.2 0.5 0.3 42.0 0.4 Looking at these figures I cannot help but feel that in both 1910 and 1912 there must have been some alteration in the standards as to what constituted a verminous child. Still, on the whole, the bodies of the children have much improved, though the fact that 42 per cent. of the girls. show evidence of this insect in their hair can hardly be pleasant reading, especially as the figures seem to indicate an increase. It is, I think, desirable that more stringent measures be taken to remedy this deplorable state of affairs. Turning to the more medical aspect, it should be possible to demonstrate statistically what the effect of this work is by comparing the defects noted during the last five years. Unfortunately the figures show a variability which is hard to explain, as it is much beyond the fluctuations of random sampling. It would seem as though the standard changed materially in 1910, and that even from year to year it has varied somewhat. It would hardly be safe and certainly unfair to deduce anything either for or against from the statistics at our disposal. Bearing this reservation in mind we can take each heading seriatim. 47 Nutrition. During the past year 1.0 per cent. of the boys and 0.56 of the girls showed marked malnutrition. All these were apparently due to disease elsewhere, and hence appear under another heading. It is a point, however, for congratulation—in view of the disturbed trade conditions of the year—that so little evidence of under-feeding was observed. Taking all those who were below normal amongst the entrants and leavers, the percentages for the last five years are:— Infants. Boys. Seniors. Girls. 1908 33.29 18.5 21.3 1909 17.00 14.7 13.8 1910 23.50 44.0 37.8 1911 16.10 36.8 32.7 1912 20.90 24.4 18.4 These figures are so variable that it is impossible to read anything into them, but such as is suggested by the bias or keenness of the observer. Footgear. Considering all age periods, it was found that in 3 per cent. of the children the footgear was in a very bad state, so bad that in wet weather they would have been better without any. Unfortunately, the absence of boots is looked upon by all as a kind of social stigma, and hence, children in this state are either kept at home or sent to school shod in an apology for boots. For previous years the condition was as follows for all children examined Boys. Girls. 1908 — – 1909 — – 1910 1.3 0.4 1911 3.11 3.49 1912 3.99 3.00 48 It is of interest to note that the disturbed trade conditions of the year had little, if any, effect on the way the children were shod. On the whole the improvement has been continuous. Teeth. Compared with the standard for the country generally the teeth of the children of the district are above the average, though there is much room for improvement. Unfortunately the decay is by no means wholly or even mainly attributable to want of cleanliness or even unsuitable food. The question is an important one, and much more information than is at present known is desirable. For the past year the figures are as follows:— Boys. All age periods. Teeth sound. 3 and 4 bad. Over 4 bad. 57.03 per cent. 34.34 per cent. 8.63 per cent. Girls All age periods. Teeth sound. 3 and 4 bad. Over 4 bad. 60.71 per cent. 31.58 per cent. 7.71 per cent. Considering the previous years and taking entrants and leavers separately on a basis of three or more decayed, we have:— Infants. Boys. Girls. 1908 33.9 58.0 58.8 1909 20.9 35.3 53.6 1910 31.1 62.0 50.5 1911 29.0 38.8 40.6 1912 29.7 43.4 49.8 These figures, though variable, certainly seem to indicate an improvement, and suggest that the employment of a dentist should be followed by beneficial results. 49 Nose and Throat. Again grouping all the age periods together the amount of defect revealed by the inspection during 1912 expressed as percentages of the number examined was:— Boys. Girls. Nasal Obstruction 17.69 13.89 Enlarged Tonsils 10.07 9.94 Enlarged Glands of the Neck 14.97 17.54 These figures are certainly very large and seem to suggest some amount of bias on the part of the observer. The figures for previous years are as follows:— Tonsils only. Seniors. Infants. Boys. Girls. 1908 23.7 20.0 25.8 1909 15.6 13.1 14.5 1910 9.7 5.3 6.6 1911 9.6 5.6 10.8 1912 12.4 4.09 4.6 Eye Defects. Taking all periods together for the past year, amongst the boys 0.73 per cent. were found to be suffering from external eye defects, such as inflammation of the lids or conjunctivae, 1.54 per cent. squinted, and in 6.26 per cent. one or both eyes were defective. Amongst the girls 0.84 per cent. suffered from external eye defects, 1.59 per cent. squinted, and in 7.04 per cent the vision was defective. Note.-- Any child unable to read 6/18—Snellen's test type—in one or both eyes, is classed as being defective. 50 The figures for visual defects only for the last five years expressed as percentages of children examined were:— Seniors. Boys. Girls. 1908 20.7 26.8 1909 9.5 14.1 1910 12.5 28.8 1911 24.4 30.1 1912 10.8 15.6 No significance can be placed on these figures as they certainly suggest that the comprehensive nature of the survey must have varied from year to year. Hearing and Ear Disease. Amongst the boys in 1.45 per cent the hearing was defective, and in 0.73 per cent., that is half the total number, there was a purulent and offensive discharge. Amongst the girls the percentage was 0.84 and 1.31 respectively. The percentage of those in whom the hearing was below normal was very low, and I can hardly believe that it fairly represents the actual number. The test. applied was the whispered voice. In the five years there appears to have been little change in the number reported as suffering from defect in this area. The actual figures are given in the table at the end of the report. (Table IV.). Other Conditions. The number of defects in the remaining sub-divisions are small, and comparisons would be hardly justifiable. Unfortunately there are no definite records of the distribution of Tuberculosis amongst the children. 51 It is to be noted that approximately 1 per cent. of the children are reported year by year as being feeble-minded, which means that there are close on 50 children in the district of school age who are quite incapable of benefiting from the instruction offered. Allowing 10 of these to be of a hopeless type, and another 10 under seven, it leaves 30 for whom no provision is made under the existing Acts. In all probability this duty will become obligatory on all authorities in the near future. Special Work. During the year the nurse made periodic inspections at the various schools to examine such children as were considered likely to be unclean or verminous. In all 58 visits were made and 1,417 children examined. 810 of these were found to be unclean, and 561 notices were sent to the parents intimating the condition and requiring that immediate attention be given to it. In 249 cases the condition necessitated the exclusion of the child for a couple of days. The teachers subsequently reported that these children returned much improved. Exclusion from School. Beyond the above, the following children on the report of the School Attendance Officer were excluded on account of minor infectious ailments:— Mumps 16, Measles 4, Chickenpox 86, Whooping Cough 175, Ringworm 5, Verminous 11. To these must be added children suffering from the more serious infectious diseases, such as Scarlet Fever, Diphtheria, etc., and those in contact with them. 52 In all 731 children were excluded from school for varying periods. Unfortunately there was no means of re-examining these children when the period of exclusion expired to verify their fitness to return. Some presented themselves at the Clinic, but these only totalled a small percentage of the whole. A closer supervision of all children excluded is desirable. Treatment. It is gratifying to note that the parents on being informed that treatment was necessary, carried out the instructions in a fairly satisfactory manner. The following table is compiled from the returns made by the teachers:— 53 / SUMMARY OF RESULTS OF TREATMENT OF DEFECTS FOUND ON MEDICAL INSPECTION, 1912. Schools. Nose and Throat. Teeth. Defec. Sight. Squint. Ears. Other Defects. No. of Notices. No. Treat. Treat. obtain Ineff. Treat. Out stand. No. of Notices. No. Treat. Treat. obtain Ineff. Treat. Out stand. No. of Notices. No. Treat. Treat. obtain Ineff. Treat. Out stand. No. of Notices. No. Treat. Treat. obtain Ineff Treat. Out stand. No. of Notices. No Treat. Treat. obtain Ineff. Treat. Out stand. No. of Notices. No. Treat. Treat, obtain Ineff. Treat. Out stand. No. of Notices. No. Treat. Treat. obtain Insff. Treat. Out stand. Castle : Creeksmouth : National : Girls 6 5 1 – – 1 1 – – – 7 2 5 – – – – – – – – – – – – 1 – 1 – – – – – – – Boys 9 2 6 1 – – – – – – 14 3 10 1 – 4 3 1 – – 1 – 1 – – – – – – – – – – – – Gascoigne Rd. : Girls 10 5 4 1 – 10 7 2 – 1 6 – 5 1 – 5 1 4 – – 1 – 1 – – 5 – 4 – 1 – – – – – Boys 14 7 6 1 – 5 2 3 – – 9 2 7 – – 9 2 7 – – 1 – 1 – – 4 – 4 – – – – – – – North Street: Girls 12 9 2 1 – 1 1 – – – 26 4 20 – 2 1 – 1 – – – – – – – 2 – 2 – – – – – – – Boys 6 2 4 – – 3 3 – – – 7 – 5 1 1 2 1 1 – – – – – – – – – – – – – – – – – Westbury: Girls 8 3 4 1 – 3 3 – – – 15 2 13 – – – – – – – – – – – – 4 2 2 – – – – – – – Boys 13 6 7 – – 4 1 3 – – 25 4 20 – 1 1 1 – – – 4 1 3 – – 1 – 1 – – – – – – – Roman Cath: Girls 1 – 1 – – 3 3 – – – 1 – – – 1 – – – – – – – – – – 1 – 1 – – – – – – – Boys 1 – 1 – – – – – – – 1 – – – 1 – – – – – 2 1 1 – – – – – – – – – – – – Totals - 270 Girls 130—Boys 140 80 39 36 5 – 30 21 8 – 1 111 17 85 3 6 22 8 14 – – 9 2 7 – – 18 2 15 – 1 – – – – – 54 The percentages are as follows:— Nose and Throat 45 per cent. Teeth 26 ,, ,, Defective Eyesight 78 ,, ,, Squint 60 ,, ,, Ear disease 77 ,, ,, Other defects 80 ,, ,, Taking eyesight as a standard the figures for previous years are:— Reported. Treated. Percentage. 1909 48 10 20.8 1910 96 46 47.9 1911 61 30 49.0 1912 111 85 77.0 It is a point of some satisfaction to note that the parents treat the intimations received from the School as to the condition of their children with more respect than they seem to have given in the initial years. The accompanying table gives in detail the nature of the ailments dealt with at the School Clinic amongst children between the ages of five and fourteen years. Some of the items are of interest as they give a better idea of the total amount of defect amongst our school population than is discoverable even at the routine inspection:— 55 SCHOOL CHILDREN—CLINIC TREATMENT. Defect. School Age. Defect. School Age. Defect. School Age. Mumps 3 Nose Obstruction 1 Rheumatism 1 Scarlet Fever 3 Tonsils & Adenoids 98 Chicken Pox 16 Ear Discharge 34 Abdominal Pain 2 Suspect: Diphtheria 5 Deaf 16 Abscess 22 ,, Phthisis 14 Sore Throat 60 Ulcer 19 Influenza 2 Enlarged Glands 29 Cysts 6 Whooping Cough 15 Nasal Discharge 1 Stomatitis 1 Warts 8 Sore Head 3 Defective Teeth 94 Whitlow 9 Eczema Scalp 4 Defective Speech 3 Malnutrition 15 Ringworm 99 Headache 7 Examination (no defect found) 2 Skin Disease (Impetigo) 121 Burns 25 Boots 54 Itch 9 Scalds 6 General Cond: 15 Sore Foot 39 Diarrhoea and Debility 11 Ill—Defined 184 Sore Toe 5 Bronchitis 1 Flat Foot 13 Ulcer. Leg 26 Wry Neck 2 Sores 143 Chorea 5 Rickets 2 ,, Finger 44 Cough 4 Deformities 3 ,, Hands 27 Anæmia 1 Dog-bites 4 ,, Face 12 Fit 5 Fractures 2 Herpes 14 Indigestion 1 Erythema 1 Cuts 3 Scars 2 Heart Disease 6 Injuries 40 Boils 8 Kidney 1 Vermin 7 Inflammation 1 Def: eyes (Vision) 39 Breast – „ ,, (Conjunct) 177 Vomiting 1 Cornea Ulcer 6 Nævus 7 Squint 101 Sore Ears 41 Opthalmia 3 Paralysis 1 Stye 3 Hernia 1 Total 1819 The number of re-attendances for treatment was 21,478. Divided by the total number of cases we get an average of 12 attendances per child for each ailment; a figure which indicates that the treatment given must have been fairly conscientiously carried out. A number of operations under an anaesthetic were performed for the removal of Tonsils and Adenoids, and 91 children had one or more teeth extracted. 56 Provision of Meals. On October 21st, 1911, the Education Committee took over the provision of meals, which up to that date had been provided by voluntary enterprise. The meals are supplied at the Baths, where a kitchen has been installed. Simple dinners are supplied consisting of bread and rice, and a stew, made with meat, and potatoes. The average number of children supplied per day was 220, and the cost per meal worked out to l.8d. R. J. EWART, M.D. School Medical Officer. 57 SUMMARY OF RESULTS OF MEDICAL INSPECTION, 1912. GIRLS Total Number. Percentage. 1899. 1904. 1907. SPECIALS. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Catholic. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Catholic. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Catholic. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Catholic. Number Exam. Routine, 790 1066 .. 9 5 29 65 69 63 22 4 6 48 51 83 75 10 5 4 28 100 58 44 12 .. .. 38 52 86 100 .. Special, 276 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Av. Height, cm. 2561.66 .. 149.88 151.1 141.91 139.75 141.72 145.38 139.58 117.5 120.5 118.03 117.94 115.98 114.51 117.43 106.2 101 .65 101.28 106.0 104.33 103.07 107.92 .. .. .. .. .. .. .. „ Weight, Kgm 520.79 .. 37.31 39.2 34.93 33.83 34.12 36.34 33.75 21.25 22.0 22.91 21.36 19.81 20.81 21.91 18.1 16.65 16.87 16.73 17.01 17.59 18.31 .. .. .. .. .. .. .. Nutrition, 2 223 20.91 .. .. 7 8 13 13 6 1 1 14 17 21 26 3 .. 1 7 26 7 .. 3 .. .. 9 13 .. 27 .. ,, 3 6 56 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. 2 .. .. .. .. .. .. .. .. 1 .. Live Vermin, Head 13 1.22 .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. .. 2 2 .. .. .. .. .. 1 2 .. 3 .. ,, Body 8 .75 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 4 1 1 .. Nits 386 36.21 .. 4 10 31 31 23 11 2 4 22 20 34 15 4 1 3 17 32 12 10 5 .. .. 18 24 21 32 .. Flea Bites 32 3.00 .. .. .. .. .. .. l 1 .. 4 .. 2 2 .. .. .. 2 3 .. l 2 .. .. 3 4 3 4 .. Underclothing, Wool .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Flannelette .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Cotton .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Boots, 3 32 3.00 .. .. .. 5 .. .. .. .. .. 2 3 5 .. .. .. .. .. 2 2 .. .. .. .. 13 .. .. .. .. Teeth, Sound 608 57.03 2 3 17 39 32 28 12 1 3 33 24 40 39 2 4 4 24 72 41 28 9 .. .. 28 27 50 46 .. ,, 3.4 bad 366 34.34 7 2 18 24 36 31 9 2 3 12 19 31 27 8 1 .. 4 27 10 12 3 .. .. 7 18 25 36 .. ,, over 4 bad 92 8.63 .. .. .. 3 1 4 1 1 .. 3 8 12 9 .. .. .. .. 1 7 4 .. .. .. 2 7 11 18 .. Attendance, 2 79 7.41 .. .. 8 6 5 8 .. .. .. 8 .. 1 5 .. .. .. 4 .. .. .. 1 .. .. 9 .. 19 5 .. „ 3 26 2.44 .. .. 1 5 2 3 .. .. .. .. .. 1 8 .. .. .. 2 .. .. .. .. .. .. 2 .. .. 2 .. Unvaccinated 185 17.36 3 1 7 7 14 10 4 .. 1 13 8 22 20 .. 2 .. 3 19 16 2 .. .. .. 2 13 20 .. .. Deformities 8 .75 .. .. .. .. 1 2 .. .. .. 1 1 .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. Paralysis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deformities due to Rickets 16 1.50 .. .. .. 1 .. 1 .. .. .. .. .. 1 1 .. .. .. .. 1 .. 1 1 .. .. .. 1 3 5 .. Skin Disease, contag. 10 .94 .. .. .. l .. .. .. .. .. .. 1 .. 3 .. .. .. .. .. 2 1 .. .. .. .. .. .. 2 .. ,, non.contag 37 3.47 .. .. .. 10 3 4 1 .. .. 1 3 1 8 .. .. .. .. 2 .. .. .. .. .. 1 1 1 1 .. Heart Defects 34 3.19 .. 1 1 3 3 4 .. .. .. 1 2 1 1 .. .. 1 1 3 1 .. .. .. .. .. 3 4 4 .. Lungs 7 .66 .. .. .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. .. 1 .. 1 .. .. .. .. .. 1 1 .. Nose Obstruction 148 13.89 1 .. 5 13 16 7 1 1 .. 12 15 9 8 3 .. .. 6 20 2 6 .. .. .. 5 2 5 11 .. Tonsils, Enlarged 106 9.94 1 1 2 4 1 3 .. 1 .. 7 4 9 9 1 .. .. 1 13 7 8 3 .. .. 3 5 14 9 .. Glands, ,, 187 17.54 .. .. 1 13 12 12 2 .. 1 8 16 22 12 2 .. .. 2 16 10 6 2 .. .. 4 5 27 14 .. Defective Sight 75 7.04 .. .. .. .. 24 8 9 .. 1 2 .. 10 11 1 .. .. .. .. .. .. .. .. .. 4 .. .. 5 .. Squint 17 1.59 .. .. .. .. .. .. .. .. .. .. 2 .. 2 .. .. .. .. 4 1 2 1 .. .. .. 2 1 2 .. External Eye Disease 9 .84 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. 2 2 .. .. .. .. .. .. l 2 .. Defective Hearing 9 .84 .. .. 1 4 .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. Ear Discharge 14 1.31 .. .. .. 3 1 .. .. .. .. .. .. 1 .. .. 1 .. 2 .. .. .. 1 .. .. .. 2 2 1 .. Defective Speech 3 .28 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 .. Mental Defects 7 .66 .. .. .. 1 2 1 .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. Other ,, 54 5.07 .. .. .. 1 4 2 .. 1 .. 2 1 5 4 1 .. .. .. 5 .. 6 1 .. .. .. 1 4 16 .. Parents Attended 527 49.43 5 3 .. 23 37 34 4 2 .. 1 35 47 42 3 4 2 14 61 27 34 6 .. .. 16 29 35 63 .. Notices Issued 187 17.51 1 .. 2 34 26 11 5 1 1 6 29 11 15 2 1 2 3 7 1 5 .. .. .. 2 8 4 10 .. Figures 2 and 3 before a defect are a measure of its magnitude. 58 SUMMARY OF RESULTS OF MEDICAL INSPECTION, 1912. BOYS. Total Number. Percentage. 1899. 1904 1907. SPECIALS. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Catholic. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Cathlolic. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Catholic. Castle. Creeks mouth. National. Gascoigne Road. West bury. North Street. Roman Catholic. Number Exam. Routine, 878 1102 .. 7 3 49 82 96 91 15 4 5 44 34 84 52 14 5 6 40 118 69 47 13 .. .. 33 34 70 87 .. Special, 224 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Av. Height, cm. 2564.4 .. 141.21 151.83 140.84 142.09 140.56 138.76 138.33 126.5 118.6 118.89 120.16 118.5 121.86 116.64 104.8 102.08 102.26 105.72 104.96 105.81 104.0 .. .. .. .. .. .. .. ,, Weight, kgm 523.55 .. 33.57 38.17 34.62 34.2 33.07 34.35 32.72 25.88 22.0 22.82 23.16 22.35 22.26 22.30 17.95 16.83 17.77 16.84 17.27 17.98 17.44 .. .. .. .. .. .. .. Nutrition, 2 (Fair) 294 26.68 .. 1 17 28 .. 33 3 .. 2 12 8 29 11 4 1 2 2 38 11 13 1 .. .. 15 9 21 33 .. „ 3 (Poor) 11 1.00 .. .. .. 2 .. .. .. .. .. 2 .. 2 1 .. .. .. .. 1 .. 1 .. .. .. .. .. 1 1 .. Live Vermin, Head .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Body 3 0.27 .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. Nits 15 1.36 .. .. .. .. 1 1 .. .. .. .. 1 .. .. .. .. 1 4 2 .. .. 1 .. .. 2 1 .. 1 .. Flea Bites 31 2.81 .. .. 3 2 1 5 .. .. .. 4 .. .. .. 1 .. .. 1 4 1 2 .. .. .. 2 2 .. 3 .. Underclothing, Wool .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. „ Flannelette .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ,, Cotton .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Boots, 3 (Very bad) 44 3.99 .. .. 2 5 .. .. 1 .. .. .. 2 5 .. .. .. .. 10 .. .. .. .. .. .. 18 .. 1 .. .. Teeth, sound 669 60.71 4 2 26 48 52 53 9 2 2 32 22 52 16 10 3 6 35 75 53 29 13 .. .. 18 22 41 44 .. ,, 3—4, bad 348 31.58 3 1 22 31 43 34 6 2 2 6 10 20 24 2 2 .. 3 34 12 12 .. .. .. 14 8 26 31 .. ,, over 4 ,, 85 7.71 .. .. 1 3 1 4 .. .. 1 6 2 12 12 2 .. .. 2 9 4 6 .. .. .. 1 4 3 12 .. Attendance, 2 55 4.99 .. .. 6 11 22 3 .. .. .. .. 3 1 1 .. .. .. 6 .. .. .. 1 .. .. .. .. .. 1 .. ,, 3 35 3.18 .. .. 5 5 4 1 .. .. .. .. .. .. 4 .. .. .. 5 .. .. 2 1 .. .. .. .. .. 8 .. Unvaccinated 196 17.78 4 .. 14 13 18 28 5 1 .. 11 6 11 15 6 .. .. 2 21 8 3 2 .. .. .. 12 16 .. .. Deformities 9 0.82 .. .. .. .. 1 2 1 .. .. 1 .. l .. .. .. .. .. 1 .. .. .. .. .. .. 2 .. .. .. Paralysis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Deformities due to Rickets 35 3.18 .. .. .. 2 3 1 .. .. 1 1 1 .. 1 1 .. 1 2 3 1 3 .. .. .. 4 1 5 4 .. Skin Disease, con tag. 3 0.27 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. ,, non..contag 53 4.81 .. .. 8 9 6 6 1 .. .. 2 .. 3 1 .. .. .. 5 3 1 .. .. .. .. 2 3 .. 3 .. Heart Defects 52 4.72 1 .. 3 3 9 8 2 .. .. .. 3 2 1 .. .. .. .. 3 2 1 1 .. .. 2 2 3 6 .. Lungs 13 1.18 2 .. 1 .. 2 .. .. .. .. .. l .. 1 .. l .. .. 1 .. l .. .. .. 1 .. .. 2 .. Nose Obstruction 195 17.69 .. 1 10 16 15 13 1 1 1 17 4 19 8 1 1 1 5 22 10 6 2 .. .. 7 8 12 14 .. Tonsils, Enlarged 112 10.07 .. .. 3 3 3 5 .. .. .. 1 1 1J 7 .. 3 1 3 17 5 7 2 .. .. 3 7 12 16 .. Glands, ,, 165 14.97 .. .. 4 10 3 7 .. 1 1 7 4 12 7 3 1 .. 4 29 15 8 6 .. .. 4 9 15 15 .. Defective Sight 69 6.26 1 .. 5 .. 15 16 .. 1 1 10 .. 7 8 3 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. Squint 18 1.54 .. .. 1 1 .. .. .. .. .. 1 .. 1 1 .. .. .. .. 3 1 1 1 .. .. 1 2 2 2 .. External Eye Disease 8 0.73 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 2 1 .. 1 .. .. .. 1 .. 1 .. Defective Hearing 16 1.45 .. .. 2 1 2 4 .. .. .. .. .. 2 2 .. 1 .. 1 1 .. .. .. .. .. .. .. .. .. .. Ear Discharge 23 2.09 .. .. 4 .. .. .. .. .. 1 1 .. 2 1 2 .. .. 1 4 2 2 .. .. .. 1 .. 2 .. .. Defective Speech 8 0.73 .. .. .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 .. .. .. 1 .. 1 .. .. Mental Defects 9 0.82 .. .. .. .. 1 .. .... .. .. .. .. 4 .. .. .. .. .. 1 .. .. .. .. .. .. .. 2 1 .. Other Defects 67 6.08 .. .. .. 3 4 4 .. .. .. .. 1 7 5 .. .. .. 1 8 5 6 .. .. .. 2 .. 11 10 .. Parents Attended 412 37.39 1 1 17 .. 27 26 2 .. 4 13 .. 50 26 2 1 4 15 41 50 30 1 .. .. 12 16 29 44 .. Notices Issued 132 29.22 1 .. 4 11 21 15 .. 1 1 11 4 7 7 2 2 .. 3 11 2 4 1 .. .. 6 5 2 11 .. Figures 2 and 3 before a defect are a measure of its magnitude. 59 COMPARISON BETWEEN ENTRANTS AND LEAVERS FOR FIVE TEARS. Year of Inspection. Departments. Number Examined. Average Height. . Average Weight. Nutrition. Cleanliness, &c. Teeth. Nose and Throat. Adenoids & Glands of Neck. Tonsils. Eternal Eye disease. Vision. Ear Disease. Hearing. Deformities. Due to Rickets, Spinal Disorders, &c. Rickets. Head. Body. Bad. Per Cent. Unclean. Per Cent. Unclean. Per Cent. Defective, Per Cent. Obstruction, &c. Per Cent, Enlarged. Per Cent. Present. Per Cent, Abnormal. Per Cent. Discharge. Per Cent. Defective. Per Cent. Present. Per Cent. Present. Per Cent. 1908 Infants 949 41.12 38.1 316 33.29 150 15.8 83 8.7 322 33.9 201 21.1 225 23.7 32 3.3 – – 28 2.9 35 3.6 22 2.3 251 26.4 1909 „ 562 40.75 37.08 96 17.0 66 11.7 33 5.8 118 20.9 110 19.5 88 15.6 11 1.9 – – 3 0.5 5 0.88 4 0.71 – – 1910 „ 225 40.64 36.6 53 23.5 45 20.0 1 0.4 70 31.1 69 30.6 22 9.7 – – 1 – 4 1.8 5 2.3 3 1.3 7 3.1 1911 „ 509 40.75 39.28 72 16.1 76 12.9 6 1.2 149 29.0 184 36.0 49 9.6 9 1.8 5 – 14 2.8 3 0.6 24 4.8 4 0.8 1912 „ 549 41.25 37.53 115 20.9 88 16.03 1 0.2 163 29.7 180 32.7 68 12.4 9 1.6 – – 9 1.6 4 0.72 2 0.3 13 2.3 1908 Girls 197 54.58 72.2 42 21.3 48 24.3 9 4.5 116 58.8 35 17.7 51 25.8 10 5.0 53 26.8 9 4.5 19 9.6 3 1.5 9 4.5 1909 „ 289 56.33 75.55 40 13.8 87 30.1 5 1.7 155 53.6 32 11.0 42 14.5 7 2.3 43 14.1 5 1.7 12 4.08 3 0.11 – – 1910 „ 259 56.6 76.03 98 37.8 119 45.9 1 0.4 131 50.5 34 13.1 17 6.6 2 0.8 23 8.8 2 0.8 1 0.4 4 1.6 1 0.4 1911 „ 241 55.68 74.53 79 32.7 96 39.8 – – 98 40.6 63 26.1 26 10.8 1 0.42 73 30.1 4 1.6 11 0.46 1 0.4 – – 1912 „ 262 56.42 75.76 48 18.4 110 42.0 1 0.4 130 49.8 83 31.6 12 4.6 1 .4 41 15.6 4 1.6 6 2.3 3 1.1 2 0.8 1908 Boys 140 55.50 74.5 24 18.5 5 3.5 5 3.5 77 55.0 12 8.5 28 20.0 2 1.4 29 20.7 3 2.1 3 2.1 3 2.1 15 10.6 1909 „ 487 56.28 77.90 72 14.7 18 3.6 27 5.5 172 35.3 49 10.0 64 13.1 2 .04 46 9.5 2 0.4 12 2.4 – – – – 1910 „ 286 57.31 75.12 126 44.0 6 2.0 4 1.6 178 62.0 57 19.9 15 5.3 – – 37 12.5 2 0.7 3 1.1 2 0.7 3 1.08 1911 „ 252 55 70 75.76 93 36.8 2 0.7 2 0.8 98 38.8 118 46.8 14 5.6 3 1.2 61 24.4 3 1.2 6 2.4 4 1.6 2 0.8 1912 „ 343 55.42 74.60 84 24.4 2 0.5 2 0.3 149 43.4 80 23.3 14 4.09 – – 37 10.8 – – 9 2.6 4 1.2 6 1.7 60 ANNUAL REPORT OF THE Sanitary Inspector. Public Health Department, Barking. March, 1913. To the Chairman and Members of the Barling 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, 1912. Inspections. The number of Inspections made during the year was 5,584. These include house to house inspections, houses in which infectious disease occurred, houses which have been subject to complaint, factories, workshops, etc., and miscellaneous inspections, to effect the remedying of defects, etc., it was necessary to serve 1,687 preliminary notices, and 374 statutory notices. In a large number of instances defects were remedied (without serving any notice) after personal interview with the owner concerned. 61 Housing and Town Planning, etc. Act, 1909. House to house inspection have been made in the following streets and roads, etc.:— Boundary Road West Ward Howard Road ,, ,, Morley Road „ ,, Gascoigne Road ,, ,, St. Paul's Road ,, ,, Bifron Street „ ,, North Street (part of) West Ward Shaftesbury Road Clarkson Road Abbey Road (part of) Bridge Street Emily Cottages Factory Road Bifron Square Hart Street Hardwicke Street Romford Street (part of) Cowbridge Lane Northbury Cottage Bennington Avenue Alma Place Orchard Avenue Parsons Road Wellington Buildings Padnall Place Back Reform Place Barking Place The number of houses inspected was 1,132, and in most instances informal notices were subsequently served to remedy defects and abate nuisances. Generally, the defects discovered were dirty and dilapidated walls and ceilings, defective roofs and spouting, insufficient supply of drinking water, and defective fittings to closets. The following statement shows the action taken under the Act during the year:— Representation to the Council of houses unfit for habitation 19 Closing orders made 13 Houses demolished 10 62 Wash houses built and fitted with coppers, sinks, and water from main 15 New water closets built and old one's rebuilt 10 Separate water supply provided inside houses with sinks, waste pipes, etc. 167 Summary of Nuisances detected and Work done during the year 1912. Inspections:— House to House 1,132 Complaints 113 Infectious Disease 184 Workshops, etc. 269 Miscellaneous 3,886 Total number of Inspections 5,584 Re-inspections of all kinds 6,541 Preliminary notices served 1,687 Statutory notices served 374 Main drains choked 55 Branch drains defective 29 ,, choked 65 Water closet, defective flushing apparatus 724 ,, defective connections 147 ,, defective pans, walls, floors and seats 365 Dustbins, none 111 ,, dilapidated 224 Sink waste pipes stopped and defective 149 Yard gullies defective and choked 66 Walls stripped after cases of Scarlet Fever 56 Eaves guttering and downspouts defective and choked 472 Yards not paved and defective 327 Roofs defective 309 Ventilation pipes defective 42 Walls and ceilings defective and dirty 599 63 Floors defective and filthy 327 Drinking water improperly stored and cisterns foul 81 Storage cisterns defective 65 Gipsy vans removed 149 Windows, frames, and sashes defective 127 Overcrowding 28 Animals improperly kept 17 Offensive accumulations 50 Damp walls 42 Other nuisances 176 House Drainage. The number of drains tested with smoke and chemical was 57, and 41 were found defective. Notices were served to remedy same. In three instances the main combined drains were found in a defective condition, and on reporting the matter to the Public Health Committee instructions were given to the Surveyor to deal with them under Section 41 of the Public Health Act, 1875. The main drain at the rear of premises was found in 55 cases to be choked; and on report to the Surveyor's Department, they were immediately cleared by the Council's workmen. Common Lodging Houses. The following are the registered Houses in the district:— Situation of Premises. No. of Room 8. No. of Lodarern. 8 to 12, Fisher Street 13 44 29, 7 34 18, 2 12 14, Back Lane 7 20 15-17, Heath Street 8 36 37 146 64 102 visits were made during the year, and the houses generally were kept in a satisfactory condition, the bye-laws observed, and the lime-washing and cleaning carried out in conformity with the bye-laws. No case of infectious disease occurred in any of the houses. Complaints. The number of complaints received and entered in the register are as follows:— Main drains choked 46 W.C. and branch drains choked and defective 22 No water to closet 7 Roofs and gutters defective 8 Animals improperly kept 4 Overcrowding 4 Offensive accumulation 3 Dirty, defective and damp premises 9 Sundry 10 113 All were immediately investigated and steps taken to remedy or abate the nuisance discovered. Infectious Disease. During the year 184 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., inspected with a view to ascertaining the probable source of infection, and measures taken to remedy any insanitary condition discovered. All these particulars are entered in the Infectious Disease Register. 65 After removal, or recovery of the sick person, the room is fumigated and closed for six hours, and all bedding, clothing, etc., removed to the disinfecting chamber. Two hundred and thirty rooms have been fumigated, 264 lots of bedding, etc., disinfected, 56 rooms stripped, stopped, etc., after cases of Scarlet Fever. The Head Teacher 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 requesting them not to allow children from infected houses to attend school for a stated period. Xotice is also sent to the Public Library and pawnbrokers. Mortuary. The number of bodies received into the Mortuary was 22, viz., 18 males, 4 females. Inquests were held on 19 of the bodies, and two were admitted on sanitary grounds. Eight post-mortem examinations were made. Petroleum. The premises licensed by the Council for the storage of petroleum have all been visited. Ten licences renewed and two new ones granted. Dairies, Cowsheds and Milkshops. There are two cowsheds in the district; they have been frequently visited, and the cleansing and lime-washing regularly carried out. There are 45 milksellers on the register, the majority are small dealers, and keep the milk in the shop. Particular attention has been given to the arrangements for storing the 66 milk, the cleanliness of the utensils, and the protection of the milk from dust, flies, etc. Bakehouses There are 16 bakehouses in the district. 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. Slaughterhouses. There are three slaughterhouses in the district, two of which are licensed by the Council, the other having been established prior to the passing of the Public Health Act, only requiring to be registered. During the past year 334 visits of inspection have been made, generally at a time when slaughtering was in progress, the premises generally speaking are well kept, the provisions of the bye-laws with regard to lime-washing, removal of offal, and humane slaughtering, etc., carried out. The following were delivered up upon the butchers' noticing the diseased condition: One cow; 7 diseased livers. 4 diseased lungs. Food Inspection. During the year special attention was paid to the inspection of meat, fish, and other food stuffs exposed for sale. 67 The following articles were destroyed at tlie request of the owners:— Six stone skate; Box haddocks; Trunk whiting. Factory and Workshops Acts. The number of Workshops and Workplaces, including Bakehouses, now on the Register is 81. All have been periodically inspected, and, as a rule, the general conditions of the Act are well observed. Five notices were received from H.M. Inspector of Factories as to insufficient closet accommodation and insufficient fasteners to women's closets in factories. Outworkers. Lists of Outworkers residing in this district have been received in 34 instances from other authorities. A record is kept of their addresses. These lists are referred to upon receipt of a notification of infectious disease, in order to stop any work being sent to an infected house. One case of Scarlet Fever occurred in the house of an Outworker. Full precautions were taken against the spread of the disease. The names and addresses of five outworkers living outside the district have been forwarded to the authorities of the district in which they reside. 68 Van Dwellers. A great deal of nuisance and trouble was caused by itinerant gipsies and van dwellers during the year under review, as many as 149 vans being removed (in many instances forcibly, with the assistance of the Police). Removal of Refuse. The number of loads of refuse removed during the year was 4,500, which averages loads per cart per day. The total number of loads represent in weight about 6,300 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 5 tons of carbolic powder and about 1,200 gallons of disinfecting fluid have been distributed. In conclusion, I append summary of work carried out during the year. I am, Gentlemen, Your obedient Servant, H. WOOD, Sanitary Inspector. 69 FACTORIES, WORKSHOPS, WORKPLACES, AND HOMEWORK. 1.—INSPECTION OF FACTORIES, WORKSHOPS, AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Inspections. Number of Written Notices. Prosecutions. (1) (2) (3) (4) Factories (including Factory Laundries) 39 6 .. Workshops (including Workshop Laundries) 217 6 .. Workplaces (other than Outworkers' premises included in Part 3 of this report) 13 .. .. Total 269 12 .. 70 2.-DEFECTS FOUND IN FACTORIES, WORKSHOPS, AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred toH.M. Insp'tor (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 4 4 .. .. Want of ventilation 1 1 .. .. Overcrowding .. .. .. .. Want of drainage of floors .. .. .. .. Other nuisances .. .. .. .. Sanitary accommodation insufficient unsuitable or defective not separate for sexes 3 3 .. .. 4 4 .. .. .. .. .. .. 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 which are included in Part 3 of this report.) .. .. .. .. Total 12 12 .. • • 71 3.—HOMEWORK. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES, SECTIONS 109, 110 Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Sending Twice in the year. Sending Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Outworkers. Outworkers. Lists, Contractors. Workmen. Lists. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing Apparel— (1) making, &c. 22 32 23 26 2 2 (2) 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, &c. Artificial flowers Nets, other than wire nets Tents Sacks Racquet and tennis balls Paper, etc., boxes, paper bags 1 1 Brush making 2 2 Pea picking Feather sorting Carding, &c., of buttons, &c. Stuffed toys Basket making Chocolates and sweetmeats Total 24 34 24 27 2 2 72 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Workshops 54 Workplaces 11 Bakehouses 16 Total number of workshops on Register 81 5.—OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspeotor of Factories:— Failure to affix Abstract of the Factory and Workshop Aot (s. 133) 3 Action taken in matters referred by H.M. Inspector as remediable under the Public Health., Acts,but not under the Factory and Workshop Act (s. ft) Notified by II.M. Inspector 5 Reports (of action taken) sent to . H.M. Inspector 5 Other .. Underground Bakehouses (s. 101):— Certificates granted during the year .. In use at the end of the year ..