2 TABLE OF CONTENTS SECTION 1—GENERAL. FAC[ Staff 4 Statistical Summary 7 Comparative Statistical Table 8 Table of \ ital Statistics from 1921 to 1926 'j Summary of Nuising Arrangements 10 Clinic and Treatment Centres 11 Ambulance Facilities 12 Laboratory Work 12 Local flve-Laws, Regulations and Adoptive Acts 13 Deaths 14 Inquests 16 Causes of Death (Table) 17 Causes of Death at Various Ages under 1 year 1* Marriages I'' Births I!' SECTION 2 SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply 20 Rivers and Streams 20 Rainfall 20 Sewerage 20 Scavenging 21 Housing Statistics 21 Sanitary Inspection of the Area 23 Summary of Sanitary Work carried out 24 Notices Served 26 S;noke Abatement 27 Offensive Trades 27 Common Lodging Houses 28 Tents, Vans, Sheds, ctc 28 Houses Let in T.odgings 28 Inspection and Supervision of Food :— (a) Milk 29 (b) Meat 30 (c) Unsound Food 31 3 SECTION 2—Continued. page Sale of Food and Drugs Act 32 Overcrowding 32 Improvement of Existing Housing Conditions 32 The (Parsons Row) Improvement Scheme 33 Schools 33 Factories, Workshops, Workplaces, etc. 34 Health Propaganda 38 SECTION 3—NOTIFIABLE INFECTIOUS DISEASES. Table of Cases of Infectious Diseases notified and removed to Hospital 40 Cases Classified According to Age Groups and Wards 42 Monthly Summary of Rcceipt of Notifications 43 Scarlet Fever 44 Smallpox and Vaccination 44 Diptheria 45 Puerperal Fever 46 Acute Primary and Acute Influenzal Pneumonia 46 Pneumonia Supervening upon Measles 46 Non-notifiable Diseases 47 Table of Admissions and Discharges from Hospital 47 Tuberculosis 48 Tuberculosis After-care 52 SECTION 4—MATERNITY AND CHILD WELFARE. Notification of Births Acts. 1907-1915 55 Ante-Natal Clinic 55 Post-Natal Cases 57 Maternity Ward 57 Puerperal Fever and Puerperal Pyrexia 59 Maternal Mortality 59 Neonatal Mortality 60 Still Mirths 61 Opthalmia Neonatorum 61 Work of Health Visitors and Infant Welfare Centres 62 The Pre-School Child 64 Foster Children 65 Infantile Mortality 66 Breast Feeding 68 Dental Clinic 68 Orthopaedic Clinic 69 Artificial Sunlight Clinic 69 Provision of Meals and Fresh and Dried Milk 70 4 STAFF, 1926. * Medical Officer of Health, School Medical Officer, Medical Superintendent. Isolation Hospital, and District Tuberculosis Officer. *K. SIMPSON. M.D., Ch.B., M.R.C.P., D.P.H. Asst. Medical Officer of Health and Asst. School Medical Officer : *MURIEL J. LOUGH, M B., B.S., B.Sc.. M.R.C.S., L.R.C.P., D.P.H Orthopaedic Surgeon (Part Time) : *B. WHITCHURCH HOWELL, M B., B.S., F.R.C.S. School Dentist : *W. W. F. DAWE, L.D.S., R.C.S (Eng.). Sanitary Inspectors : *N. BASTABLE (Chief Sanitary Inspector) (b, c and f). *H. WOOD (Sanitary Inspector) (b and c). *H. CARR (Sanitary Inspector (b, c and e). Health Visitors : *MRS. G. STOKES (i). *MRS. M. W. WALION (a, h. and 1). *MISS G. ELLIOTT (a, h and 1). Matron, Isolation Hospital : MISS M. J. HEDGCOCK (h, i and j). Masseuse, Orthopaedic Clinic (Part Time) : *MISS A. E. FINDLAY, C.S.M.M.G. (k). Clerical Staff. E. W. WINCHESTER (Chief Clerk) (a, c and d). MISS A. SHAW. MISS V. SHEAD. MISS B. INGHAM. Disinfector and Mortuary Keeper: H. LONG. (a) Sanitary Inspector's certificate of Sanitary Inspectors' Examination Board. (b) Sanitary Inspector's certificate of Royal Sanitary Institute. (c) Meat, etc., Inspector's certificate of Royal Sanitary Institute (d) Meat, etc., Inspector's certificate of Sanitary Inspectors' Examination Board. (e) Building Inspector's certificate of Worshipful Company of Carpenters (f) Sanitary Science Certificate of Royal Sanitary Institute (g) Health Visitor's certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives' Board. (i) General Hospital Training. (j) General Fever Training. (k) Certificate M.E. ar.'l S.R.E. (i) Health Visitor's Diploma of Boanl of Education. *Proportion of salary contributed under I'ublic Health Acta or by Exchequer grants. 5 ANNUAL REPORT OF THE Medical Officer of Health for the Urban District of Barking Town, in the County of Essex, for the Year ended 31st December, 1926. PUBLIC HEALTH OFFICES, BARKING, ESSEX. To the Chairman and Members of the Urban District Council of Barking Town. Mr. Chairman and Gentlemen, I beg to submit my Annual Report on the Public Health Services of the District for the year ended 31st December, 1926, in accordance with the requirements of the Ministry of Health. A report on the work of the School Medical Service has already been issued. The estimated population in June, 1920, was 3S.920, giving an increase of 470 over 38,450 in 1925, while the excess of births over deaths was 452. The birth rate for the year was 21.01 while the death rate was 9.4. In connection with the general death rate of the district it is noteworthy that a decline since 1924 has taken place in the mortality of those diseases which more particularly depend upon the efficiency of the Health services, the death rate, e.g., from Tuberculosis, and the Infantile and Zymotic Mortalities being 1.2, 85.1 and 0.95 respectively in 1924 compared with the figures for 1926 which were ' 6 0.8, 59.9 and 0.66. This improvement, without further comment, has unquestionably resulted from a more efficient Public Health Service. It is unnecessary to review the old ground which has been elaborated upon during the past three years. Suffice it to repeat that personal and municipal cleanliness, better hygienic conditions in the home and workshop, and cleaner food, form the lines generally along which further progress should be made. It is of interest to note that the percentage of patients admitted to hospital suffering from scarlet fever who developed complications was 64.3, a figure generally accepted as affording a useful index of the efficiency or otherwise of the isolation accommodation of any district. Unfortunately a proportion of those complications are of a more permanent character which may seriously handicap the sufferer in after-life. Attention was directed in my Report of last year, inter alia. to the question of the sanitary collection and disposal of municipal refuse, the facilities, etc., for the more efficient segregation and treatment cf infectious disease, and, in connection with the School Medical Service, more suitable premises for the work of the Jlinor Ailments and other clinics, which need not be further dilated upon now. Much has been done since the end of 1923 to create a Public Health and School Medical Service better fitted for the due preserve tion of the life and health of the district, and, (although that effort is still imperfect), some of it as may be seen has already begun to bear fruit; and, personally, I shall feel that my labours have not been altogether in vain if they have but the effect of affording my successor a less arduous and difficult course than lias been mint to follow. I am, Mr. Chairman and Gentlemen, Your obedient Servant, KERR SIMPSON, Medical Officer of Health 7 SUMMARY Of PARTICULARS REQUIRED BY CIRCULAR 743 OF THE MINISTRY OF HEALTH, DATED 20th DECEMBER. 1026. 1. General Statistics. Area (acres) 4,106 Ward areas 3,806 Tidal Water H.W.M. Thames 240 Rodiug 58 Loxford Water 2 - - 300 4,106 Population (Census, 1921) 35,523 Population (June, 1926) (Registrar General's estimate) 38,920 Number of inhabited houses (1921) 6,762 Number of Families or separate occupiers (1921) 7,594 Population Density, i.e., No. of persons per acre 9.4 Rateable Value—Houses. Buildings, etc. £26S,258 0 0 Lands £3.008 10 0 Sum represented by a penny rate £1,082 0 0 Education rates :— Elementary 3 1½ Secondary 1½ Assessable Value £248,663 5 0 General District Rate 8 0 Poor Rate 9 2. Extracts from Vital Statistics lor the Year. Births :— Males. Females. Total. Birth Rate. Legitimate 409 383 792 20.349 Illegitimate 15 11 26 0.668 Total 424 394 818 21.017 Deaths:— Male. Female. Total. Death Rate. Standard Death Rate (Factor 1,049 205 161 366 9.4 9.8 Number of deaths of women during, or in consequence of, childbirth :— From Sepsis. From other causes. Total. — 1 1 Number of deaths of infants under one year of age : — Total Infantile Death Death Males. Females. Total. Rate. Rate. Legitimate 30 15 45 56.8 59.9 "legitimate 3 1 4 153.8 Number of deaths from Measles (ail ages) 7 . ,, Whooping Cougli (all ages) 1 Diarrhoea (under 2 years of age 15 8 3. BIRTH RATE, DEATH RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR. Birth Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Births. Percentage of Total Deaths. All Causes. Entcric Fever. Small Pox Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under Two years). ; Total Deaths under One year. Causes of Deaths Cer. tified by Registered Medical Practitioners Inquest Cases. Uncertified Causes of Death. England and Wales 17.8 11.6 0.01 0.00 0.09 0.02 0.10 0.07 0.22 0.47 8.7 70 91.8 7.2 1.0 105 County Eorougha and Great Towns including Loudon 18.2 11.6 0.01 0.00 0.12 0,02 0.10 0.10 0.22 0.43 11.8 73 92.0 7.5 05 † 158 Smaller Towns (1921 Adjusted Populations 20,000 50 000) 17.6 10.6 0.01 0.00 0.07 0.02 0.11 0.06 0.23 0.40 6.6 67 92.6 6.3 1.1 London 17.1 11.6 0.01 0.00 0.20 0.02 0.05 0.12 0.17 0.48 11.8 64 SO.f. 9.4 . 0.0 BARKING 21.01 9.4 0.02 — 0.17 - 0.02 0.05 0.41 0.41 18.3 59 91.8 8.2 — Hanwe.l U. 1. having been added to Ealing M. B. on the 1st October. 1926. the figures relate to 158 towns for the first nine months, and to 157 towns for the rest of the year. ■ 9 VITAL STATISTICS OF WHOLE DISTRICT FROM 1921 to 1926. Year. 1 Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths bejoiiging to the District. Nett. Number. P.ate. Of Nonresidents registered in the District. Of residents registered out of the District. Under One year , of age. At all Ages. Number. Rate. Number. Ratf per 1.000 Nett Births. Number Kate. 1 2 3 4 5 6 7 8 9 10 11 12 1921 36 250 968 26.0 297 7.1 — 97 74 74.1 394 10.8 1922 36,680 882 24.0 308 8.1 — 56 49 55.5 364 9.9 1923 37,210 862 23 1 234 6.2 5 86 *43 *49.8 *318 *8.5 1924 37,890 846 22.3 273 7.2 3 109 72 85.1 379 10.0 1925 38,450 825 21.4 287 7.4 8 107 66 80.0 386 10.0 1926 38,920 818 21.0 259 6.6 11 118 49 59.9 36ti 9.4 *Registrar General's Figures. 10 5. CAUSES OF SICKNESS. No special causes of sickness fall to be discussed. 6. SUMMARY (FOR REFERENCE) OF NURSING ARRANGEMENTS, HOSPITALS, AND OTHER INSTITUTIONS AVAILABLE FOR THE DISTRICT. (a) Nursing in the Home. (i) The Plaistow Maternity Charity provide a staff of nurses, who attend at the homes of the sick once or twice a day, carry out such skilled nursing as is required, and offer instructions where advisable in hygienic heme practices in relation to the sick. (ii) For infectious diseases. In the event of an epidemic, the Council can provide nurses for such cases as ma\ require to be nursed in their own homes. Of late year* this has not been necessary. No other provision of home nursing is carried out by the Department, but Health Visitors and School Nurses regularly advise parents as to the nursing and general care of children (b) District Midwifery Provision. By agreement dated January 1st, 1924 with the Plaistow Maternity Charity, the Council annually subsidise the Charity on any deficit from £300 in respect of '$0 District Midwifery cases attended b\' the Charity reckoned at the rate of /I per case. The takings of the Charity for the financial year endw 31st March, 1927, amounted to £230, leaving a balance due to the charity from the Council of £70, such sum ranking for grant. The number of cases attended 233, but in three instances it was impossible to col!*t the fees. (c) CLINIC AND TREATMENT CENTRES. Name and Situation. Nature of Accommodation. By Whom Provided. I. Maternity and Child Welfare :— (a) Centres Clinic premises, East Street. Accommodation for consultations, weighing of babies, waiting room, etc Local Authority. Greatfields Centre, Movers Lane. „ „ .. Alexandra Centre St. Pauls Road. „ „ (b) Ante-natal clinic Clinic promises, Kast Street. Accommodation for consultations. " " (c) School Nurseries Nil. Nil. Nil. (d) Day Nurseries Nil. Nil. Nil. II. School Medical Service :— (a) Inspection Clinic and treatment of minor ailments Clinic premises, East Street. Three rooms. Local Authority. (b) Eye Clime „ „ One room. „ „ (c) Dental Clinic „ „ Two rooms. „ „ (d) Orthopa-Uic Clinic Faircross School. One room. „ „ III. Tuberculosis 37, Linton Road. Three rooms. Essex County Council. IV. Venereal Diseases London Hospitals, etc. - By arrangement with Essex County Council. 12 (d) Hospitals provided or subsidised by the Local Authority : (i) Smallpox.—An arrangement exists with the neighbouring County Borough of West Ham whereby an unlimited number of beds are available at Dagenham for the reception and treatment of cases of smallpox which may occur in the Barking area. (ii) The only hospital provided by the Local Authority is that for the isolation and treatment of infectious diseases situated in Upney Lane, where 40 beds are available for such cases. Twelve additional beds are available for maternity cases in a separate portion of the hospital buildings. (e) Ambulance Facilities :— (i) A horse ambulance is provided for the removal of infectious cases to the Isolation Hospital, Upney Lane. (ii) For non-infectious and accident cases, two motor ambulances are kept at the Fire Station, the ambulance and fire services being run in conjunction under the Chief Fire Officer. 7. LABORATORY WORK. The necessary laboratory work of the district is carried out by arrangement with the Essex County Council at the Counties' Laboratory, situated in Queen Victoria Street, London, E.C.4. particulars of the number of specimens submitted for examination being supplied by the following table :— Specimen Number examined Diphtheria 365 Sputa 227 Typhoid 7 Ringworm 4 MisceUancous 2 8. List of Adoptive Acts, Bye-laws, and Local Regulations relating to Public Health in force within the district. (i) Local Acts: Barking Town Wharf Act, 1893, Barking Parish Act, 1888. 13 (ii) General Adoptive Acts : Local Government and other Officers' Superannuation Act, 1922. Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5. Public Health Act, 1925. Baths and Washhouses Acts, 1847, etc. Infectious Diseases (Prevention) Act, 1S90. Public Health Acts Amendment Act, 1907, Parts 2, 3, 4, 5, 6 and 9, and Section 95 of Part 10. (iii) Regulations : Regulations as to Dairies, Cowsheds and Milkshops, 1900 (revised 1924). Regulations as to Cemetery, 1902. Barking Town (Pneumonia) Regulations, 1924. (iv) Bye-laws with respect to : Nuisances, 1884. Common Lodging Houses, 18S4. Offensive Trades, 1907 (revised 1924). Houses let in lodgings, or occupied by members of more than one family, 1924. Public Baths, 1900. Tents, Vans, Sheds and similar structures, 1909. Paving of Open Spaces, 1901. Nuisances in connection with the removal of offensive matter, 1908. Employment of Children and Young Persons, 1921 revised (1924). (v) Among the Special Acts and Orders in force within the district, and important from a Public Health Standpoint, are :— 1910.—Orders declaring the trades of fish-skin scraper, fish fryer, dealer by retail in rags, bones., skins, fat or other like articles in an offensive condition, blood drier, tanner, leather dresser, fat melter or fat extractor, glue maker, size maker, gut scraper, and oil boiler to be offensive trades, the last being so declared in 1925. 14 9. DEATHS. There were 259 deaths registered in Barking in 1926. Of these 11 were deaths of non-residents. Barking residents to the number of 118 died elsewhere during the year. Including the latter and excluding the deaths of visitors, the net number of deaths were as follows :— Males. Females Total 205 161 366 The death rate for 1926 was 9.4 per 1,000, compared with 10.0 in 1925, calculated on the Registrar-General's estimated population and number of deaths, compared with 11.6 for England and Wales, 11.6 for the hundred and five Great Towns, 10.6 for the hundred and fifty eight Smaller Towns, and 11.6 for London. Sex Mortality. —The 366 deaths of 1926 were divided as follows :- 205 males, equal to a death rate of 5.26 per 1,000 population. 161 Female, equal to a death rate of 4.13 per 1,000 population. Age Mortality.—The deaths in various age groups, according to the figures obtained locally, were as follows:— Age Group. No. of Deaths. Death Rate per 1,000 Population. Under 1 year 49 1.25 1 to 2 years 17 0.43 2 to 5 years 9 0.23 5 to 15 years 8 0.20 15 to 25 years 13 0.33 25 to 45 years 41 1.05 45 to 60 years 102 2.62 Over 60 years 127 3.26 Causes of death in 1926.—The table on page 17 shows the principal Causes of death at various ages. Those diseases, etc., 15 causing most deaths or important from a public Health aspect were as follows :— Disease. No. of Deaths. Percentage of total net deaths registered. Cardio vascular system 47 12.84 Cancer 64 17.48 Tuberculosis (all forms) 35 9.83 Pulmonary affections, (exclusive of tuberculosis), viz., Bronchitis 28 7.65 Pneumonia 27 7.37 Other respiratory disease 4 1.09 Zymotic Diseases 26 7.10 Of the total deaths, tuberculosis caused one in every 10.4, heart diseases one in every 7.7, bronchitis one in every 13.0, cancer one in every 5.7, pneumonia one in every 13.5, suicide and violence one in every 22.8, other respiratory diseases one in every 91.5, and zymotic diseases one in every 14.0. Deaths from Zymotic Diseases.—These diseases caused 7.1 per cent, of the total deaths, such deaths being caused in the following proportions :— Enteric Fever 0.27 Measles 1.91 Whooping Cough 0.27 Scarlet Fever — Diphtheria 0.54 Diarrhæa 4.09 Smallpox — 16 INQUESTS.—Coroner's inquests were held on 30 deaths. The ages at death and causes assigned were as follows:— Causes of Death. Under one year. 1-2 years. 2—5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. Over 65 years. Total. Accident 2 — 1 3 1 2 3 l 13 Suicide — — — — — — 2 — 2 Cirrhosis of Liver — — — — — — 1 — 1 Status Lymphaticus — l — — — — — — 1 Heart Disease — — — — _ — 3 2 5 Hemorrhage from Carcinoma of Gullet — — — — — — — 1 1 Cerebral Hæmorrhage — — — — — — 1 — 1 Lobar Pneumonia — — — — — — 1 — 1 Chronic Bright's Disease — — — — — — 1 — 1 Cancer of Rectum — — — — — — — 1 1 Atelectasis 2 — — — — — — — 2 Atheroma of Aortic Valves of Heart — — — — — — 1 — 1 Totals 4 l 1 3 1 2 13 5 30 18 INFANT MORTALITY DURING THE YEAR 1926. The following table gives the actual causes of death of children dying under one year of age. Net deaths from stated causes at various ages under one year : Causes of Death. (All causas certified.) Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total under one year. Small Pox — — — — — — — — — — Chicken Pox — — — — — — — — — — Measles — — — — — — — — 1 1 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tubercular Meningitis — — — — — — — — — — Other Tubercular diseases — — — — — — — — — — Meningitis (not tubercular) — — — — — — — — 2 2 Convulsions 1 — — — 1 — — — — 1 Laryngitis — — — — — — — — — — Bronchitis — 1 — — 1 — 1 1 — 3 Pneumonia (all forms) — — — — — 1 2 1 3 7 Diarrhæa — — — — — 1 6 5 3 15 Gastritis — — — — — — — — — — Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation, overlaying — — 1 — 1 — — — — 1 Injury at birth — — — — — — — — — — Atelectasis 4 — — — 4 — — — — 4 Congenital malformation — 1 — — 1 — 2 — — 3 Premature Birth 3 — 1 — 4 1 — — 6 Atrcphy debility and Marasmus 2 — 1 — 3 2 — — — 5 Other causes — — — — — — 2 — — 2 Totals 10 2 3 — 15 5 13 7 9 49 Nett Births in the year :— Legitimate 792 Illegitimate 26 Nett Deaths in the year :— Legitimate 46 Illegitimate 4 19 10. MARRIAGES. There were 249 marriages registered in the district in 1926. This is equal to a marriage rate of 6.3 per 1,000 population. In 1922, there were 208 marriages, equal to a rate of 5.6, in 1923, 219 marriages, equal to a rate of 5.9 per 1,000, in 1924, 208 marriages, equal to a rate of 5.4, and in 1925, 258 marriages equal to a rate of 6.7. 11. BIRTHS. The net number of births registered in 1926 was 818, affording an annual birth rate of 21.01 per 1,000 population, compared with 21.4 in 1925 and 22.3 in 1924. Of all births, 26 were illegitimate, or a proportion to total births of 3.1 per cent. Notification of Births Act, 1907-1915.—Of the total births recorded in the district during 1926, all except 33 or 4.1 per cent, of the total, were notified to the Medical Officer of Health. 529 being notified by midwives and 241 by parents and doctors. 22 still-births were notified, 14 being notified by midwives and 8 by doctors and others. 20 SECTION 2. SANITARY CIRCUMSTANCES OF THE DISTRICT. i WATER SUPPLY. Water is supplied by the South Essex Water Company from deep wells in the chalk at Dagenham, Chadwell Heath, Ilford and Barkingside. Analytical particulars of a sample appeared in my Report for 1923. RIVERS AND STREAMS. The Rivers and Streams of the district come within the jurisdic tion of the Essex Sewers Commissioners (who are the Tidal Flush and Flood Water Drainage Authority), and the Port of London Authority, who are the recognised Navigation Authority for the Thames, as defined by the Port of London Consolidation Act, 1920 and who have also certain powers as to the fouling of streams, etc. RAINFALL. The rainfall for the year ended December 31st was 28.97 inches Rain fell on 174 days throughout the period in question. SEWAGE. A water-carriage system is general, except at Rippleside, Over the greater part of the area there is a separate sewage and storm water system. 21 Sewage is treated within the district by precipitation and sedimentation. the resulting effluent being discharged into the River Roding. During the year, 18 premises were sewered, leaving 104 premises -till unconnected. SCAVENGING. The question of scavenging (which is closely linked with that of sewage disposal in several respects) comes under the control of the Engineer. Domestic and trade refuse is collected weekly in horsedrawn two-wheeled vehicles, and deposited on low-lying land. CESSPOOLS, PRIVYMIDDENS AND PAIL-CLOSETS. For cesspool emptying, a tank vehicle is employed, the contents being pumped out and afterwards discharged into the sewers. 1'rivymiddens are emptied into tumbrils and the contents buried ; the same remark being applicable to pail-closets. Housing Statistics for the year 192G 1. GENERAL. Number of new houses erected during the year :— (i) Total 289 (ii) As part of a municipal housing scheme 47 (iii) Others (including private enterprise and subsidy houses) 242 2. UNFIT DWELLING HOUSES. I.—Inspection. (i) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3,896 . 22 (ii) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 771 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (iv) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,080 II.—Remedy of Defects without Service of Formal Notices Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 1,409 III.—Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing Act, 1925. (i) Number of dwelling houses in respect of which notices were served requiring repairs 197 (ii) Number of dwelling houses which were rendered fit— (a) by owners 194 (b) by Local Authority in default of owners 3 (iii) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations of owners of intention to close Nil B.—Proceedings under Public Health Act. (i) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 474 23 (ii) Number of dwelling houses in which defects were remedied :— (a) by owners 460 (b) by local Authority in default of owners 14 C.—Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 :— (i) Number of representations made with a view to the making of Closing Orders 3 (ii) Number of dwelling houses in respect of which Closing Orders were made 2 (iii) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit 1 (iv) Number of dwelling houses in respect of which Demolition Orders were made .. — (v) Number of dwelling houses demolished in pursuance of Demolition Orders — SANITARY INSPECTION OF THE AREA. (Work of Sanitary Inspectors.) 1. Inspection of Dwelling Houses. Total under Public Health or Housing Aces 3,896 Housing (Inspection of District) Regulations 771 After Infectious Disease 462 Defects Found 6,324 Notices Served (Preliminary) 2,080 Re-inspections re Notices Served 3,275 24 2. Premises Controlled, by Bye-Laws and Regulations. Houses Let in Lodgings 60 Comrron Lodging Houses 95 Offensive Trades 297 Tents, Vans and Sheds l55 Dairies, Cowsheds and Milkshops 299 Slaughterhouses 155 3. Factories, Workshops and Workplaces. Factories 142 Laundries 11 Bakehouses 84 Other Workshops 132 Other Workplaces 203 Outworkers' Rooms 62 Butchers'Premises 616 Fishmongers 73 Restaurants and Dining Rooms 136 Markets 79 Stables and Stable Yards 100 Piggeries 90 4. Miscellaneous. Smoke Observations 50 Rats and Mice (Destruction) Act, 1919 71 Vacant Land and Refuse Dumps 82 Public Lavatories 65 Schools 72 Petroleum Stores 85 SUMMARY OF SANITARY WORK CARRIED OUT. (a) Drainage. Choked drains, opened, repaired, and cleansed 275 Drains reconstructed 26 New Drains 12 Ventilation Shafts repaired or new fixed 26 New Inspection Covers 14 25 (4) Closet Accommodation. Roofs W.C. structures repaired 107 Floors Doors Seats Fixed 46 New Pans Fixed or Cleansed 107 Flushing Apparatus Repaired or Relieved 336 Privies to Water Closets 7 Privies to Pail Closets 14 Additional W.C. Provided 1 (c) Sinks. New Fixed 79 New Sink Wastepipes 133 New Gullies 46 (d) Dampness. Roofs 686 Eavesgutters 449 Rainwater Pipes 157 Damp Walls Remedied 109 (e) Water Supply. Storage Cisterns Abo'ished 65 Defective Water Fittings Repaired and Supply Reinstated 1ll Supply provided inside houses 21 (f) Yard Paving. Yard paving repaired or relaid 157 (g) Dustbins. New ones provided 536 26 (A) General Repairs. House floors repaired 254 Windows repaired or renewed 214 Window sills repaired or renewed 103 Fixed windows made to open 14 Sashcords renewed 265 Stoves or coppers repaired or renewed 254 House doors repaired or renewed 107 Stairs repaired 37 Chimney stacks rebuilt 3 Chimney pots renewed 38 Dirty or defective rooms repaired, cleansed and redecorated 1,263 External walls repaired 43 (i) Miscellaneous. Offensive accumulations removed 112 Animals kept so as to be a nuisance 26 Verminous rooms and persons disinfected 20 Stables cleansed 9 NOTICES SERVED. Informal Notices 2,080 Statutory Notices 704 Section 36, Public Health Act, 1875 92 Section 94, Public Health Act, 1875 373 Section 41, Public Health Act, 1875 6 Section 5, Infectious Disease (Prevention) Act, 1890 28 Section 3, Housing Act, 1925 197 Section 46, Public Health Act, 1875 3 Section 22, Public Health Act (A) Act 1890 4 Rats and Mice (Destruction) Act. 1919 1 704 27 SMOKE ABATEMENT. Owing to the coal strike, when factory boilers were heated with all qualities of fuel, no satisfactory control could be exercised over smoke emission. With the advent of the new Smoke Abatement Act, I am hopeful of an improvement. During the year under review fifty observations were recorded, and in seven instances, where there was an aggregate emission of black smoke exceeding six minutes in the hour, appropriate action was taken. It is interesting to note that the chief offenders are smaller factories where the economic production of steam receives the least consideration. OFFENSIVE TRADES. The following shows the nature of trades carried on and the number of premises registered:— Fish Fryers 19 19 Fish-skin Scrapers 2 Dealers in Rags and Bones 10 Fat Melters and Extractors 2 Gut Scrapers 1 Oil Boilers 1 These premises received 297 visits. Fourteen notices were served for various breaches of the bye-laws. Two fish-fryers and one dealer in rags and bones were newly registered during the year. 28 COMMON LODGING HOUSES. The two common lodging houses in the district received 95 visits. Notices were served for sanitary defects found and in respect of three breaches of the bye-laws. It was necessary during the year to secure the disinfestation of one of the houses. TENTS, VANS, SHEDS. Owing to house shortage there are still 16 such premises occupied in the district, and even in some of these temporary dwellings serious overcrowding exists. Constant visits are paid by the sanitary inspectors to enforce the bye-laws and to secure the best possible conditions as far as possible. HOUSES LET IN LODGINGS. These continue to be a source of anxiety. The houses so used were originally intended for one family and are now so worn out that any adaptation to meet the needs of the several families in occupation would be impracticable and unreasonable. As a result we find:— (1) Insufficient water-closet accommodation. (2) Insufficient accommodation for cleanliness, i.e., domestic or personal. (3) Lack of sink accommodation. (4) Lack of proper cooking accommodation. Further, the moral aspect, not necessarily a matter for the health officer, cannot be entirely ignored. I am satisfied that private enterprise will never provide for these, the poorest of our homeless families, and that their satisfactory housing will only be achieved by the erection of modern tenement 29 dwellings. Failing such provision by the Local Authority, it may be passible to form a Housing Improvement Society whose funds would be raised voluntarily. I commend the suggestion to the various religious bodies in the district in the hope that such a society might be formed with this object in view. INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. With the exception of one cowshed still in occupation in Rippleside, where conditions are generally satisfactory, no milk is produced within the district. Of the total the bulk is pasteurised, being received from large wholesale factories and distributed by retail dairymen. Including three whose premises are situated outside the district, there are 32 registered retail purveyors. These are frequently inspected, particular attention being paid to facilities for the cleansing of utensils. There continues an improvement in the methods of distribution, unsatisfactory metal cans previously used by householders being gradually withdrawn, and the glass bottle fitted with cap, proving more satisfactory both for service and storage. No action was taken under the tuberculosis clause: of the Milk and Dairies (Consolidation) Act, 1915. The following table shows the number of licences granted for the sale of graded milk under the Milk (Special Designations) Order, 1923, during the year:— (a) "Certified " Milk 1 (b) "Grade A (Tuberculin Tested) " Milk 2 (c) "Grade A" Milk 2 (d) "Pasteurised " Milk 1 30 A licence was granted to a local firm for the bottling of "Grade A" milk. During the year 5 samples of "Grade A" milk were submitted for examination, four of which were satisfactory. I communicated with the County Medical Officer in respect of one unsatisfactory sample, who later informed me that matters had been remedied. The one sample of "Grade A" (Tuberculin Tested) milk was found to be satisfactory. MEAT INSPECTION. Owing to proximity to the Central Meat Markets, the district receives almost entirely the whole of its supply from this source. The inspectors visit the two slaughter-houses in use when carcases and viscera are examined for evidence of disease. During the year 109 notifications to slaughter were received, and 3 beasts, 86 pigs, 611 sheep and 156 calves examined. Diseased meat weighing 9 cwt. 25 lbs. as set out in the table below was condemned and destroyed :— DISEASED MEAT. Description. Weight. Disease. 2 Beef Briskets 52 lbs. Tuberculosis 2 Beasts' Heads 56 „ Tuberculosis 9 Beasts' Lungs 72 „ Tuberculosis 6 Beasts' Livers 84 „ Distoma Hepaticum 1 Beast Liver 14 „ Tuberculosis 2 Beasts' Plucks 46 „ Tuberculosis 150 Sheeps' Lungs 450 „ Parasites 50 Sheeps' Livers 200 „ Distoma Hepaticum 3 Pigs' Plucks 21 „ Tuberculosis 2 Pigs' Heads 26 „ Tuberculosis 4 Pigs' Lungs 12 „ Parasites 31 ADMINISTRATION OF THE PUBLIC HEALTH (MEAT) REGULATIONS, 1924, AS REGARDS STALLS, SHOPS, STORES AND VEHICLES. Experience has shown how increasingly difficult the administration of these Regulations has become since the issue of Circular 604. The inspectors have persistently endeavoured to get butchers to conform with the spirit of the Regulations, but in the absence of compulsion, the result has been unsatisfactory. After continual warnings, one prosecution in respect of dirty meat exposed for sale at a lock-up shop, which had an open front extending from floor to ceiling and occupying a position in narrow, dusty and busy street, was instituted. At the local police court a fine of £5 was imposed. On appeal to Quarter Sessions the conviction was upheld with costs. The principle involved was the provision of a glass front, and this was strenuously contested by the London Retail Meat Traders' Federation. UNSOUND FOOD. The following is a list of unsound food destroyed dur 'ng the year:— Commodity Quantity. Condition. Result of Action taken. Meat 28 lbs. Decomposed Surrendered Fish— Hake 8 stones ditto ditto Skate 25 „ ditto ditto Roker 5 ditto ditto Rippers 6 „ ditto ditto Lobsters 50 lbs. ditto Seized Haddock 11 ditto ditto Rock Salmon 9 „ ditto ditto Fruit— Strawberries ½ Bushel ditto Surrendered Peas 4 Bushels ditto ditto Cherries A Bushel ditto ditto Pears 1 „ ditto ditto Tinned Foods— Kipp'd Her'gs. 300 lbs. ditto ditto Various 119 tins ditto ditto Rabbits One case 144 lbs. ditto ditto In view of subsequent explanations no proceedings were instituted in respect of the three seizures. 32 SALE OF FOOD & DRUGS ACTS. I am indebted to Mr. H. C. Card, Chief Food and Drugs Officer of the Essex County Council for the following particulars of samples purchased and submitted for analysis during the year:— Milk. Butter. Miscellaneous. Total. Prosecutions. Fines. 68 62 44 174 2 £16 Proceedings were taken in the case of one sample of cream, the vendor being fined £15. And one sample of coffee found adulterated; proceedings were instituted against the vendor, who was fined £1. OVERCROWDING. During the year a number of serious cases were reported to the Health Committee, but owing to absence of suitable accommodation within the scope of the wage-earners income nothing could be done. In one case proceedings were instituted. The magistrates made in order to abate overcrowding, but, on an attempt to comply, confirmation could not be obtained from the County Court. Appeals against the decision of the Judge were futile. IMPROVEMENT OF EXISTING HOUSING CONDITIONS. Despite much progress and general improvement as a resulte of the activities of the sanitary staff, there is still very considerable work to be done before many of the houses in the district could by described as satisfactory, improvement lying in the removed of unsatisfactory dwellings not capable of being rendered fit without reconstruction. Every house in the district has separate closed accommodation, and with 20 exceptions, a separate water supply inside the premises. The question of overcrowding is still an urggent one, and accounts for much discontent. The Barking Town (Parson's Row) Improvement Scheme, 1926. 33 It has been stated that: "If unrest is to be converted into Contentment, the provision of good houses may prove one of the most potent agents in that conversion. If a healthy race is to be reared, it can be reared only in healthy homes; if infant mortality is to be reduced, and tuberculosis to be stamped out, the first essential is the improvement of housing conditions." A reference to pages 24-26 will show the work of the sanitary inspectors in regard to housing conditions generally. PARSONS ROW IMPROVEMENT SCHEME. Upon my representation in December, 1925, the Council decided to schedule a group of 51 houses described as the Parsons Row area, as an unhealthy area. An improvement scheme to deal with acquisition of the site, demolition of the houses, and rehousing of the displaced tenants at a cost of £34,000 was agreed upon. The Minister of Health instituted a local public enquiry in October, 1926. Official sanction to proceed with the scheme had not been granted at the end of the year, but favourable outcome is anticipated. Photographs are given illustrating the type of premises dealt with in the scheme. SCHOOLS. All the schools in the district are regularly inspected, when any defect in the sanitary arrangements or water supply are dealt with. With one exception, the whole of the schools are connected with the sewer. Castle School,. Rippleside, is cesspool drained. Six of the eight elementary schools have spring-bib fountains with metal cups attached, fixed in the playgrounds, for drinking purposes. The remaining two schools are without fountains of any sort, the children having recourse to taps above the wash-basins. 34 A distinct improvement from the hygienic standpoint would be the abolition of existing arrangements and the provision of spring bib fountain jets in every school. FACTORY AND WORKSHOP ACT, 1901. Factories, Workshops, Laundries, Workplaces and Homework. 1. Inspections (including inspections made by Sanitary Inspectors.) Number of Premises. Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 142 10 i 2 — Workshops 132 6 2 — Workplaces 297 14 0 ■ — Total 571 30 6 — 35 2. DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Ins. *Nuisances under the Public Health Acts:— Want of cleanliness 3 3 — — Want of ventilation 2 2 — — Overcrowding — — — — Want of drainage of floors 1 1 — — Other nuisances 8 8 — — Sanitary accommodation:— Insufficient 14 14 - — Unsuitable or Defective 6 6 — — Not separate for sexes 5 5 - — Unscreened for Sexes 3 3 - — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (S.101) - - - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 9 9 - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 51 51 - — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. HOME WORK. Nature of Work. Outworkers' Lists (Section 107). Outwork in Unwholesome Premises (Section 108). Outwork in Infected Premises (Sees. 109, 110). List received from Employers. Notices served on occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 110). Prosecutions (Sees. 109. 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contrac tors. Workmen. Contrac tors. Workmen. Wearing Apparel:— Making, etc. 2 7 18 - - - 4 - - - - - - - - Total 2 7 18 - - - 4 - - - - - - - - 36 37 REGISTERED WORKSHOPS. Workshops on the Register (Sec. 131) at the end of the year. (1) Number. (2) Bakehouses (including seven factory bakehouses) 15 Other Workshops 45 Total number of Workshops on Register 60 OTHER MATTERS. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (Sec. 133) 4 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (Sec. 5) 2 Other — Underground Bakehouses (Sec. 101):— Certificates granted during the year — In use at the end of the year - OUT-WORKERS. The following list shows the nature of the homework carried out in this district by 22 out-workers:— Wearing apparel 10 Tles 2 Umbrella makers 2 Boot makers 1 Paper bag makers 2 Life belt covering 7 During the year 17 lists of out-workers were received from other Authorities in respect of addresses in Barking. 4 lists were received from employers within the district. In all instances the premises of out-workers were kept in a satisfactory state. 38 HEALTH PROPAGANDA. Health Week was celebrated in the district by holding a Health and Clean Food Exhibition from September 14th to 18th, inclusively. St. Margarets Hall the largest in Barking being secured for the purpose. The exhibition was organised on approved exhibition lines, the stands, numbering twenty-eight, being erected by a professional firm of exhibition-stand fitters. Twenty-two stands were let to selected business firms of repute, who guaranteed to provide exhibits of public health interest, whilst the remaining six stands were occupied by the Public Health Department, The United Kingdom Dental Board, The Health and Cleanliness Council, the Institute of Hygiene, etc. It is of interest to record that, although at a preliminary meeting of exhibitors it was unanimously decided that no sale of goods should take place, the desire of the public to purchase samples, etc., was so great that the decision had to be waived, one firm recording a turnover of more than £50. The Exhibition was open daily from 10 a.m. to 10 p.m., advantage being taken of the smaller morning attendances to conduct organised parties of school children around the Exhibition : 1,559 children so attending. Health Lectures, by well known lecturers, Cooking Deinonstra tions, by Messrs. The Gas, Light and Coke Co., and Demonstrations in the Use of Milk, by the Milk Publicity Council, were held daily, being all exceptionally well attended. More than 35,000 pamphlets, covering such subjects as Infantile Diarrhœa, Scarlet Fever. Diphtheria, Whooping Cough, Measles, Danger from Flies, etc., were distributed during the run of the Exhibition. An orchestra rendered musical selections every afternoon and evening. Seven health propaganda films were shown at the local cinemas during the week. 15,642 persons, exclusive of children attended the Exhibition, the attendance on three days being over 3,000. The total cost of the Exhibition was £256 9s. 2d., but, on account of payments made by exhibiting business firms, the expense borne, by the Council was only £16 16s. l0d. 39 The Exhibition was an unqualified success and proved to be a valuable medium for health propaganda. Although much has been written to the contrary since the holding of the Exhibition, I venture to express the opinion that the arrangement whereby stands wen let to selected business firms was a correct one, creating as they did, life, variety and brightness, and incidentally a public demand for admission, more people attending, and in consequence hearing the lectures, seeing the exhibits, and taking away pamphlets, etc. than otherwise might have been the case. Apart from the foregoing considerations, I would mention that in my judgment no finer medium exists for guiding the public in purchasing products of known purity and production—a point obviously within the province of the sanitarian—than the invitation to manufacturers of such goods to display their wares at Health Exhibitions organised by Local Sanitary Authorities. 40 SECTION 3. NOTIFIABLE INFECTIOUS DISEASES. The following table shows the number of notifications of infectious disease received during 1926:— TABLE I. Males Females. Total Total cases rem'd to Hos. Deaths. Scarlet Fever 61 74 135 121* — Diphtheria 25 30 55 52 2 Puerperal Septicemia — 3 3 2† Pneumonia (Acute primary and influenzal & following Measles) 47 28 75 8 27 (All Forms) Erysipelas 11 26 37 2 2 Ophthalmia Neonatorum 9 7 16 2‡ — Puerperal Pyrexia — 1 1 — — Enteric 1 2 3 2 1 Cerebro Spinal Fever — 1 1 — 1 Anterio Poliomyelitis 2 — 2 — — Totals 156 1,2 328 189 33 * Includes 6 cases removed to Ilford Isolation Hospital, † Includes case of woman confined in Maternity Ward of Hospital. ‡ Includes 1 case removed to St. Margaret's M.A.B. Hospital. 41 The following diseases were notifiable in 1326 under the original Infectious Disease (Notification) Act, 1889, and 1899 :— Smallpox, diphtheria, relapsing fever, cholera, erysipelas, typhus, plague, puerperal fever, enteric fever, scarlet fever and continued fever. and by Orders or Regulations framed under Section 180, Public Health Act, 1875 Tuberculosis (all forms), opthalmia neonatorum, cerebrospinal fever, acute polio-myelitis, encephalitis lethargica, influenzal pneumonia, acute primary pneumonia, malaria, dysentery, trench fever, and puerperal pyrexia. The Barking Town (Pneumonia) Regulations, 1924, provides for the notification of Pneumonia supervening upon Measles. The total notifications of infectious disease numbered 328, exclusive of tuberculosis, compared with 230 the previous year. During 1926 the number of notifications of tuberculosis (all forms) was 133 compared with 80 in 1925. 42 TABLE II. Notifiable Disease. No. of cases notified at age groups. Cases classified according to Wards. Under one year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. 5 to 10 years. 10 to 15 years. 16 to 20 years. 20 to 35 years. 35 to 45 years. 45 to 65 years. Over 65 years. Abbey. Gascoigne. Central. Ripple. Longbridge. Westbury. Scarlet Fever 3 3 6 6 19 67 20 5 6 27 15 15 42 19 17 Diphtheria — 1 5 3 4 27 9 2 3 I — — 7 19 2 10 10 7 Puerperal Septicaemia — — — — — — — — — 3 — — 1 1 — — — 1 Pneumonia (primary, influenzal and following Measles) 5 11 3 4 7 7 1 3 14 3 9 8 26 15 17 1 10 6 Erysipelas — — 1 — — — — 1 3 6 19 7 9 5 6 4 5 8 Ophthalmia Neonatorum 16 — — — — — — — — — — — 5 5 1 2 1 2 Puerperal Pyrexia — — — — — — — — 1 — — — — — — — — 1 Enteric — — — — — — 2 — — — 1 — 1 1 1 — — — Cerebro Spinal Fever — — — — — — — — 1 — — — — 1 — — — — Anterio Poliomyelitis 1 1 — — — — — — — — — — 1 1 — — — — Totals 25 16 15 13 30 101 32 11 28 13 29 15 77 63 42 59 45 42 43 TABLE III Monthly summary of notifications of infectious disease:— Month. Scarlet Fever. Diphtheria. Puerperal Fever. Pneumonia. Erysipelas. Ophthalmia Neonatorum. Enteric Fever. Anterio Poliomyelitis Cerebro Spinal Meningitis. Encephalitis Lethargica. Totals. January 3 4 — 2 4 — — — — — 13 February 7 4 — 1 4 1 — — — — 17 March 3 2 — 12 2 1 — — 1 — 21 April 5 4 — 16 1 — — — — — 26 May 6 1 — 6 5 2 — — — — 20 June 25 4 2 2 o 3 — 1 — — 39 July 19 9 — 4 3 1 — — — — 36 August 4 5 1 2 5 — 1 — — — 18 September 17 8 — 1 2 1 1 1 — — 31 October 15 6 — 7 4 1 — — — — 33 November 16 2 — 9 3 6 — — — 1 37 December 15 6 — 13 2 — 1 — — — 37 Totals 135 55 3 75 37 16 3 2 1 1 328 44 (a) Scarlet Fever.—The number of cases notified was 130, compared with 60 the previous year. No fatal cases occurred. 115 cases were isolated at the local Infectious Hospital, and 6 at the Ilford Isolation Hospital. The average stay of scarlet fever cases in hospital was 34.4 days, compared with 40.6 days in 1925. The longest period of detention was 66 days and the shortest 17 days. Seventy-four cases treated in hospital developed complication', as follows:— Adenitis (uncomplicated) 24 Adenitis, Rhinorrhœa and Albuminuria 1 Rhinorrhœa 7 Adenitis & Otorrhœa 6 Rhinorrhœa, Pharyngitis and Adenitis 2 Rhinorrhœa & Adenitis 9 Albuminuria & Adenitis 3 Endocarditis & Arthritis 1 Septic Areas, Rhinorrhœa and Adenitis 10 Albuminuria 1 Adenitis, Albuminuria and Rheumatism 1 Abrasions (septic) 3 Adenitis & Pharyngitis 5 Bronchitis, Otorrhœa and Conjunctivitis 1 Of all cases notified, 5 were found to be mistaken diagnoses as follows:— Nephritis 1 Septic Sores 1 Bronchitis 1 Nil diagnosed 2 Of cases treated in hospital, the age incidence was as follows:— Under one year 3 5—10 years 59 1—2 years 3 10—15 years 17 2—3 years 6 3—4 years 6 15—20 years 5 4—5 years 17 20—35 years 5 Sex.—61 cases were male and 74 female. (b) Small Pox.—No case of Small Pox occurred in 1926, Notifications of two persons who had been in contact with cases of Small Pox were received and kept under supervision for the. usual periods. 45 The following particulars are appended of vaccinations during 1926:— Certificates of successful vaccinations 304 Postponed 4 Conscientious objections 463 Left District 16 The vaccination rate per 1,000 births was therefore 371.6, compared with 394.8 for the preceding year (c) Diphtheria.—55 cases were notified, compared with 75 the preceding year. Of cases notified, 52 were removed and treated in hospital. Two deaths from diphtheria occurred, one in hospital and the other in an outside institution. A child admitted the previous year diagnosed as diphtheria died in January, 1926 from Tuberculous Broncho-Pneumonia. The average stay of clinical diphtheria in hospital was 35.2 days, the longest stay being 76 and the shortest 16 days. Two cases of laryngeal diphtheria were admitted to hospital, in both instances tracheotomy being necessary. One patient died four days after admission, while the other made a satisfactory recovery. The type of diptheria present on examination was as follows Faucial 28 Naso-Pharyngeal 8 Laryngeal 2 Eight admissions were on purely bacteriological grounds. Of cases notified as diphtheria and removed to hospital six on examination were found to be mistaken diagnosis, as follows:— Tonsilitis 4 Nil Diagnosed 2 Twenty cases of diptheria admitted to hospital developed complications, as follows:— Adenitis 9 Albuminuria & Neuritis 1 Adenitis & Myocarditis 1 Albuminuria & Adenitis 1 Boils 5 Abscesses—Various 2 Otorrhoea, Adenitis & Rhinorrhœa 1 46 Of diptheria patients treated in hospital the age incidence was as follows:— 1—2 years 1 10—15 years 8 2—3 years 4 15—20 years 2 3—4 years 2 20—35 years 3 4—5 years 4 35—45 years 1 5—10 years 27 Sex.—25 cases were male and 30 female. (d) Enteric Fever.—Three cases of enteric fever were notified during the year, two of which were removed to hospital. The diagnosis of enteric fever was, however, confirmed in one instance only, the patient dying after a stay of 29 days. The other case proved to be pneumonia, making a satisfactory recovery. (e) Puerperal Fever.—Three cases were notified during the year, two of which were admitted to hospital, one being transferred from the Maternity Ward. All of the cases recovered. (f) Erysipelas.—37 cases were notified during the year compared with 18 during 1925. Two patients were removed to hospital, both dying two and three days respectively after admission. (g) Malaria and Trench Fever.—No cases were notified during the year. (h) Acute Primary and Acute Influenzal Pneumonia.—62 cases were notified during 1926, compared with 58 for the preceding yea'. Three patients were admitted to hospital, two of whom d<ed nine hours and seven days respectively after admission. (i) Pneumonia Supervening upon Measles.—13 cases were notified under the Larking Town (Pneumonia) Regulation, 1924, Five patients being removed to hospital, one of whom died twelve days after admission. (j) Encephalitis Lethargica.—No cases of encephalitis lethargica occurred in 1920. 47 (II) NON-NOTIFIABLE INFECTIOUS DISEASES. The most important of these are measles, whooping cough and summer diarrhoea. There were no serious epidemics of these diseases, and the deaths registered were as follows:— Measles 7 Whooping Cough 1 Summer Diarrhœa 15 Measles and Whooping Cough.—Cases amongst school children are reported to the School Medical Officer by school teachers, attendance officers and nurses, appropriate action being taken as regards exclusion and supervision of contracts. ISOLATION HOSPITAL. The following is the table of admissions, etc., in respect of infectious diseases during 1926:— Disease. in Hospital January. 1st, 1926. Admitted during the year. Died. Discharged In Hospital Dec. 31st. 1926. Scarlet Fever 10 115 — 115 10 Diphtheria 15 52* 2 60 5 Pneumonia — 8 3 4 1 Puerperal Fever 1‡ 21 — 3 — Measles — — — — — Chicken Pox — — — — — Mumps — — — — — Epidemic Diarrhœa — 2 1 1 — Enteric Fever — 2 1 1 — Ophthalmia Neonatorum — 1 — 1 — Erysipelas — 2 2 — — Cerebrospinal Meningitis — — — — — Tuberculosis — 1 1 — — * I death certified due to Tb. Broncho Pneumonia, † I case transferred from Maternity Ward, ‡ Case diagnosed as Phthisis. 48 Four cases of mixed infection were admitted to hospital, ar..i no instance of cross-infection occurred during the year. TUBERCULOSIS. Administrative Arrangements.—Under the Essex County Council (the responsible authority for the treatment of tuberculosis), the Medical Officer of Health of Barking continued as Tuberculosa Officer for the district during the year. The administrative arrangements for dealing with tuberculosis in the area include:— (a) A dispensary used on two half-days per week, (b) Garden shelters for suitable cases, (c) Sanatorium accommodation for surgical tuberculosis, (d) Sanatorium accommodation for suitable early pulmonary cases, and in some instances the more advanced, (e) Accommodation for a number of bedridden and advanced cases at St. Joseph's Hospice, Hackney, and Liverpool Road Hospital, Islington. A suggestion made towards the end of 1925 that certain cubicles at the Infectious Hospital be set apart by arrangement with the County Council for the segregation of advanced cases of pulmonary tuberculosis where home conditions were unsatisfactory was declined approval during the following year. The number of notified cases on the register on December 31st. 1926, was 896, compared with 793 for the corresponding period the preceding year. During the year 1926 133 notifications were received of all forms of tuberculosis—pulmonary 113, and non-pulmonary 20— representing a notification rate of 3.41 compared with 2.08 for 1925. Information was received of the removal into the district of five tuberculoid persons. 49 Twenty-nine deaths of notified cases occurred (including one certified due to appendicectomy). Six cases left the district or could not otherwise be traced, leaving 896 on the register on December 31st, 1926, 443 being male and 453 female. Particulars of new cases of tuberculosis notified and of deaths the disease during 1926 is afforded by the following table:— New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 year — — — — — — — — 1 to 5 years 2 2 2 2 1 — 1 2 5 to 10 years 19 11 4 1 — — — — 10 to 15 years 3 5 3 2 — — — — 15 to 20 years 3 3 1 1 1 3 — — 20 to 25 years 4 9 — — — 3 — — 25 to 35 years 0 10 1 1 — 4 1 — 35 to 45 years 11 4 1 — 3 5 I — 45 to 55 years 7 4 — — 7 — — — 55 to 65 years 3 2 — 1 2 — — — 65 yrs. & upwards — 1 — — — 1 — — Totals 62 51 12 8 14 16 3 2 PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These regulations, which came into force on July 31st, 1925, give power to a local authority to prevent any person suffering from tuberculosis of the respiratory tract entering upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk. Any person who deems himself aggrieved by a requirement under these regulations may appeal to a Court of Summary Jurisdiction, and may. under certain circumstances, be compensated for any damage sustained. In no instance was it found necessary to take action under these regulations. 50 PUBLIC HEALTH ACT, 1925, SECTION 62. In no instance was it found necessary to take action under this section to secure the compulsory removal to hospital of a tuberculous person in an infective state. As regards the occupations of notified cases during the year the following table is of interest:— Waiters 1 Gatekeepers 1 Clerks 3 Errand Boys 1 School Children 50 Bakers 1 Publicans 1 Policemen 1 Housewives 16 Messengers 1 Nurses 1 Draughtsmen 1 Saleswomen 1 Warehousemen 1 Printers 4 Display Card Makers 1 Machinists 2 Cigarette Packers 1 Labourers 12 Crane Drivers 1 Shop Assistants 4 Blacksmiths 1 Match Factory Workers 1 Lightermen 1 School Cleaners 1 Barmen 1 Factory Hands 3 Engineers 1 Newsagents 1 Turners 2 Charwomen 1 Surgical Instrument Makers 1 Factory Cleaners 2 Slaters 1 Seamen 2 No occupation 9 The following figures indicate for the four quarters of the year the percentage attendances of cases per 10,000 population at the Tuberculosis Dispensary and of those admitted to sanatoria under the County Council:— Attendances at Dispensary. Admission to Sanatoria. No. Rate per 10,000 population. No. Rate per 10,000 population 1st Quarter 331 85.0 13 3.3 2nd Quarter 329 84.5 21 5.3 3rd Quarter 310 79.6 20 5.1 4th Quarter 372 95.5 18 4.6 51 the average for the year being 86.1 and 4.5 compared with 92.6 and 4.3 for the preceding year, and 100.9 and 4.92 respectively for 1924. The proportion of sanatoria admissions to cases notified was 54.1 per cent., and the incidence of tuberculosis per 10,000 population in respect of notified cases 230.2. The following are particulars of cases notified under Forms C and D during the year :— Form C. Form D. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. 42 35 5 6 33 23 1 6 Thirty-five deaths occurred from tuberculosis (all forms), 31 of these being pulmonary cases. The number of deaths in institutions was 18. The death rate for tuberculosis (all forms) during 1926 was 0.8, compared with 1.09 for the previous year. During 1926 seven deaths from tuberculosis were registered of persons not previously notified as suffering from the disease. The importance of notification is that the necessary steps can be taken with regard to the care of patients and contacts and the prevention of spread of the disease. Delay in notification is bad for both patients and pablic. Of deaths registered due to tuberculosis, notifications received by the Medical Officer of Health were as follows:— Number not notified at time of death 7 Number notified less than 3 months before death 11 Number notified 3 to 6 months before death 5 Number notified 6 to 9 months before death 2 Number notified 9 to 12 months before death 4 Number notified 12 to 18 months before death 1 Number notified 18 to 24 months before death — Number notified more than 24 months before death 5 52 597 patients made 1,342 attendances at the dispensary durirg the year for the purpose of medical examination, 147 being ntn cases. Of new cases attending during the year, 66 were notified as suffering from tuberculosis. The following table gives in tabular form the number of patienfaremoved from the Dispensary Register during the year:— No. on Dispensary Register during 1926. Numbers removed from the Dispensary Register. Number on Dispensary Register 31-12-126 Died. District. Discharged (Non Tb.i Discharged " Cured ' Trans' ferre i to another Dispensary Total 597 20 7 62 19 31 139 458 At the end of the year, 390 cases on the Dispensary Register were definitely diagnosed as suffering from tuberculosis, whilst in 68 cases the diagnosis still remained in abeyance. AFTER-CARE. Tuberculosis in the great majority of instances is a curable infection provided the patient is seen sufficiently early, undergoes sanatorium treatment and subsequently is able to pass his life under reasonably hygienic conditions. It is with regard to the latter that the activities of the After-care Association in this district particularly exist consisting inter alia in providing special splints, clothing, boots, nourishment, etc., for necessitous cases and in obtaining if possible suitable homes and employment for the tuberculous. During the year 25 new cases were so assisted, whilst 17 old cases were further assisted from the previous year. The funds of the Association are mainly dependent upon:— (a) Essex Insurance Committee. (b) Romford Board of Guardians. (c) Annual donations from certain Friendly Societies end Trade Unions. 53 (d) Donations from various local Sports Clubs. (e) Donations from private individuals and from proceeds raised at Whist Drives and Dances organised by the Social Sub-Committee. Equally important in the matter of after-care is that of dealing with the large number of advanced cases who are, in the majority of instances, in a highly infectious condition and not infrequently living under overcrowded home conditions. For these practically no remedy hitherto existed, except the workhouse, but by virtue of Section 62 of the Public Health Act, 1925, local health authorities have become vested with powers where, in the opinion of the Medical Officer of Health the conditions of a tuberculous patient at home are inimical to the best interests of his or her dependents to secure such patient's removal compulsorily or otherwise to a suitable institution and to there detain him or her until circumstances have changed. It only remains to point out that where such steps become necessary, local institutional arrangements should be available. Compulsory disinfection of all houses after death from tuberculosis is now practised throughout the district under Section 5 of the Infectious Disease (Prevention) Act, 1890. DISINFECTION. This subject was discussed at considerable length in my report for 1924. 54 SECTION 4. MATERNITY AND CHILD WELFARE. The Council's Scheme under the Maternity and Child Welfare Act, 1918 has been extended during the year. The institution of an additional medical session at each of the Welfare Centres following the additional appointment of a part-time medical officer, will be a factor in furthering the efficiency of the Scheme. The use of the Artificial Sunlight Clinic, working in co-operation with the Infant Welfare Clinics, is already being attended with good results. During the latter part of the year an attempt was made to reorganise this section of the department by putting into operation a number of reforms long overdue, although certain existing difficulties had continued to prevent their adoption. An improvement in the position generally was obvious by the end of the year. REGISTRATION AND NOTIFICATION OF BIRTHS. By the Registration Act, 1836, all live births must be registered within a period of six weeks. The actual number of live births within the district during the year was 803, the net total of 818 being obtained by adjustment of inward and outward transfers, etc. The births registered included 424 males and 394 females. Tbens were 26 illegitimate births, or 3.1 per cent, of the total. In comparison with 1925, 7 fewer births were registered during the year a fall equivalent to 0.8 per cent. 55 By the Notification of Births Act, all live births and still-births of seven months and over are required to be notified to the Medical Officer of Health within 30 hours. Of the total live births all cxcept 33 or 4.1 per cent, were notified. The following table gives details of the notifications received :— By whom notified. Live Births. Still Births Medical Practitioners 117 4 Certified Midwives 529 14 Parents and Others 124 4 The percentage of still-births was 2.6. Of the total live births during the year 511, or 63.6 per cent, were attended by midwives, the remainder being attended by medical practitioners. BIRTH RATE. The birth rate for the year was 21.01, compared with 17.8 for England and Wales. MATERNITY AND INFANT WELFARE. The Ante-Natal Clinic. The work of the Clinic was carried on as in previous years. Briefly its aims are as follows:— (1) By maintenance of the maternal health during pregnancy to reduce the foetal and neonatal mortality; to produce healthier babies at birth, and to reduce failures in breast feeding. (2) By the detection and removal of foci of infection in the mother, viz., septic conditions of the mouth and throat, and of the genital tract to reduce the incidence of puerperal sepsis and of contagious conditions such as opthalmia neonatorum in the infant. 56 (3) To arrange for suitable institutional treatment for cases in which difficulty during labour is anticipated, and thereby to avert injury to infant and mother during parturition. The attendances during the year again show an increase. The number of primary attendances was 346, compared with 325 for 1925. Reattendances numbered 659 in 1926, and 640 during 192.5 One hundred sessions were held during the year, making an average attendance of 10 mothers per session. Of the mothers attending, 127 were pregnant for the first time. Expectant mothers attending the Ante-natal Clinic are drawn from the following classes:— (a) Patients intending to enter the Upney Maternity Ward for confinement. (b) Those engaging with the midwives of the Plaistow Maternity Charity. (c) Patients engaging with private midwives. From the figures given at the beginning of this section of the report it will be seen that 511 of the live births were attended by midwives, and of these 346 mothers availed themselves of the facilities provided by the Clinic, that is, two-thirds of the cases attended by midwives are under supervision during pregnancy But in spite of this growing recognition on the part of some of the mothers of the value of ante-natal supervision, there still remains a great deal of prejudice which will only be broken down by unremitting efforts of the health visitors, together with the active co-operation of the midwives. The following table gives particulars of cases referred from the Ante-natal Clinic for hospital or other treatment:— Syphilis 2 (1 post natal case) Albuminuria 1 Pyelonephritis 1 Rheumatism I Pleurisy 1 Chronic Bronchitis 1 Small Pelvis 1 57 A new development towards the end of the year at the Antenatal Clinic was the attendance of one of the health visitors at one session weekly for the purpose of giving advice and instruction in ante-natal hygiene and other appropriate subjects. The number of mothers attending this class at any time is not large, so that it is possible for the health visitor in many cases to give individual instruction. These talks are of especial value to the younger mothers. Post Natal Cases. Thirteen cases attended by midwives were referred by them or by the health visitors for examination at the Ante-natal Clinic owing to the presence of defects following childbirth. Seven of these cases were found to be in need of special medical treatment, for which they were referred to hospital or elsewhere, according to the defect found. MATERNITY WARD. The admission to the Maternity Ward of the Municipal Hospital numbered 206, the total being the same as for 1925. Of these 37 cases were admitted for ante-natal treatment, and 169 for confinement. Corresponding figures for 1925 were 39 cases for ante-natal treatment, and 167 for confinement. The number of cases confined in the Ward represents 20.4 per cent, or approximately 1 in 5 of the total births of the district, a proportion which it is hoped will increase still further. There is no doubt that the ward is greatly appreciated by the mothers who make use of it, as is shown by the number of readmissions of patients who have previously been confined there. Of the patients confined in 1926, 75 were mothers of first babies, and in these cases the two weeks' stay at Upney Hospital has a definite educational effect in emphasising the importance of breast feeding and in instilling the first principles of infant care. The return of cases as required by the Ministry of Health is given below. It will be seen that the results obtained in the ward continue to be satisfactory. 58 (1) Number of cases admitted 206 (37 of which Ante-natal) (2) Average duration of stay 12.3 days (3) Number of cases delivered by:— (a) Midwives 167 (b) Doctors 2 (4) Number of cases in which medical assistance was sought by the midwife with reason for requiring assistance:— (a) Ante-natal 2 1 Cardiac 1 Miscarriage 1 A.P.H. (b) During Labour 3 Adherent Placenta 1 High Temperature (c) After Labour 8 Ruptured Perineums (d) For Infant 1 Prematurity (5) Number of cases notified as puerperal sepsis with result of treatment in each case 1 (recovered) (6) Number of cases notified as puerperal pyrexia with result of treatment in each case Nil (7) Number of cases of pemphigus neonatorum Nil (8) Number of cases notified as opthalmia torum with result of treatment in each case Nil (9) Number of cases of " inflammation of the eyes," however slight 1 (10) Number of infants not entirely breast fed while in the Institution, with reasons why they were not breast fed 4 (a) Weakness of mother 2 (b) Prematurity 2 (11) Number of maternal deaths Nil (12) Number of foetal deaths (a) stillborn, and (b) within 10 days of birth and their causes—and the results of the post mortem examination if obtainable:— (a) Stillborn 5 (b) Within 10 days of birth 69 PUERPERAL FEVER AND PUERPERAL PYREXIA. On October 1st, 1926, the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, came into force. These regulations require the notification of puerperal pyrexia (according to the definition given in the regulations), in addition to those cases previously notifiable as puerperal fever under the Infectious Diseases Notification Act, 1899. In a circular accompanying the Regulations, the Minister of Health urges local authorities to exercise the powers conferred on them under the Maternity and Child Welfare Act for provision of facilities for diagnosis, skilled nursing at home, or institutional treatment, if in the opinion of the medical practitioner in charge of the case any one of these is necessary. In accordance with this direction, arrangements have been made by the Council for nursing of the patient at home, or in the isolation hospital as desired. In addition, Dr. A. Kennedy has been engaged as consultant for those cases in which a second opinion is required by the medical attendant. Three cases of puerperal fever were notified as compared with 4 in 1925, two of which were admitted to the Isolation Hospital. Two of the cases were attended by midwives. One case occurred in the Municipal Maternity Ward. The patient was isolated immediately on the onset of pyrexia, and no further cases occurred. In addition to the cases of puerperal sepsis, one case of puerperal pyrexia was notified. All the patients recovered. No definite cause of infection was found in any of the cases, although it was noted by the health visitors in the routine investigation, that in three out of four patients foci of infection were present before labour. MATERNAL MORTALITY. One maternal death occurred during 1926, due to excessive vomiting of pregnancy. There were no deaths from puerperal sepsis. The puerperal mortality for the year is therefore the same as for 1925, 1.3 per thousand, and continues to be much below the average for England and Wales, viz., 3.06 for 1925. 60 NEONATAL MORTALITY. It is gratifying to note a considerable reduction in the neonatal mortality during the year. The number of deaths of infants under four weeks of age was 15, giving a rate of 18.3 per thousand, compared with 30.3 for the previous year in Barking, and 32.2 for England and Wales during 1925. It is hoped that, with the extension of ante-natal care, this low rate will be maintained. Deaths Under Four Weeks. Under seven days. Under fourteen days. Under twentyone days. Under twentyeight days. Total. Bronchitis — 1 — — 1 Atelectasis 4 — — — 4 Congenital Malformation — 1 — — 1 Premature Birth 3 — 1 — 4 Debility 2 — — — 2 Convulsions 1 — — — 1 Marasmus — — 1 — 1 Accidental Suffocation — — 1 — 1 61 STILL-BIRTHS. Of the total notifications received under the Notification of Births Act, 22 related to stillborn children, giving a percentage of 2.6, compared with 3.2 in 1925. In addition, two Barking women were delivered of stillborn infants in institutions outside the district, so that the total number for the year was 24. One case was that of twin pregnancy—both infants being stillborn. Investigation of the health visitors elicited the following information :— (1) Duration of pregnancy:— (a) Less than seven months 2 (b) More than seven months 22 (2) Presentation:— (a) Vertex 19 (b) Breech 3 (c) Transverse 1 (d) Not elicited 1 (3) Supposed cause of stillbirth:— (a) Abnormal presentation 2 (b) Overwork 4 (c) Accident, etc. 4 (d) Not known 6 (e) I11 health 7 (4) Occupation of mother :— All the mothers were engaged in household duties at home. In addition, one woman did an occasional day's cleaning elsewhere, whilst one was engaged in dressmaking at home. OPTHALMIA NEONATORUM. There was again an increase in the number of .cases of opthalmia neonatorum, notifications bein? 16, compared with 12 in 1925. Thirteen of the cases occurred in the practice of midwives, the remainder being attended by medical practitioners. 62 Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths Notified Treated. At Home. At Hosptl. Under 3 weeks 16 14 0 15 1 — — The growing appreciation among midwives of the seriousness of the condition and of the value of early treatment makes for a greater readiness on their part to call in medical help to the slighter cases of discharge which previously may have escaped notification altogether. OPTHALMIA NEONATORUM REGULATIONS, 1926. These regulations came into force on October 1st, 1926. Under them it is no longer the duty of the midwife to notify cases. In accordance with the rules of the C.M.B. the midwife is under obligation to call in medical aid for any inflammation of the eyes, however slight, and the onus is now with the medical man called in to notify if, in his opinion, the case is one of opthalmia neonatorum For the effective supervision and treatment of such cases, close co-operation between the Local Supervising Authority and the Local Sanitary Authority is essential, and suggestions are made in a circular accompanying the Regulations as to how this co-operation may best be secured. INFANT AND CHILD WELFARE. Work of the Health Visitors and the Infant Clinics. This branch of the work was greatly handicapped during the first part of the year under consideration by repeated changes in the personnel of the visiting staff. From May until August the work was assisted by the appointment of a temporary health visitor, but it was not until September 1st that the third permanent health visitor commenced her duties. 63 The use of Empress Mall as an Infant Welfare Clinic was discontinued on the 3rd May, 1926, and the Greatfield Welfare Centre in Movers Lane opened on the 31st of that month for the Ripple and Westbun Wards. This centre is a decided improvement on the premises previously in use, providing as it dors a suitable room for weighing and also a separate room for the medical officer. The accommodation in the waiting room is, however, insufficimt, and interferes to some extent with the efficient working of the sewing stall. The Clinic, in addition, has the disadvantage of not being centrally situated for the area which it serves. The premises at East Street are not suitable for the purposes of an Infant Welfare Centre, and have a detrimental effect on the work of this Centre. An analysis of the attendance at the Infant Welfare Centres is given in the following table:— Infant Welfare Centres. Clinic Premises Alex. Centre Movers Lane Total No. of sessions 97 100 93 290 No. of attendances of children under one year:— (a) New cases 140 206 152 498 (b) Old cases 1585 2221 1599 5405 No. of attendances of children 1 to 5 years of age :— (a) New cases 11 13 7 31 (b) Old cases 1010 1671 1220 3901 Average number of attendances per session 28 41 32 33 No. of sessions attended by medical officers 61 61 57 179 No. of children seen by medical officers (a) Under one year 860 998 931 2789 (b) Over one year 419 409 445 1273 Average number of children seen by medical officer per session 21 23 24 22 64 The total attendances during the year were 10,125 as compared with 11,525 in 1925. There is no reason to anticipate that this reduction is other than a temporary one; it being probably accounted for by the changes in the staff mentioned above. Particulars of the home visits paid by the health visitors is given in the following table:— No. of ante-natal visits 221 No. of first visits to children under one year No. of subsequent visits to children under one year:— 826 (a) Attending a Centre 659 (b) Not Attending a Centre 2,671 No. of visits to children 1 to 5 years of age:— (a) Attending a Centre 300 (b) Not Attending a Centre 1,511 No. of special visits in connection with Ophthalmia Neonatorum 44 Ditto Deaths of children up to 3 years of age 59 Ditto Still-births 24 Ditto Puerperal sepsis and Pueperal Pyrexia 3 Ditto Foster Children 28 Other visits (not specified) 65 65 Moreover, owing to the additional medical session at each of the centres, it is now possible for the medical officer to devote a satisfactory proportion of her time to the older children, and mothers are encouraged to continue to attend at the ccntres until the children attain school age. so that the latter may be kept under observation and submitted to routine medical inspection as often as is necessary. The more complete supervision of the pre-school child, as outlined above, leading to detection and treatment of disease in its earliest stages, together with utilisation of the special facilities available for such children under the provisions of the Maternity and Child Welfare Act, will, it may reasonably be hoped, lead to an improvement in the physical condition of the child when he comes for the first time within the purview of the School Medical Officer. Treatment may be obtained for children attending the infant welfare clinics as follows Minor Ailments.—Treatment is given at the School Clinic by arrangement with the Education Committee. Dental and orthopaedic treatment, and treatment of septic tonsils and adenoids are available as in the case of school children. Convalescent Treatment.—This is provided for under the Scheme, and is of value for children suffering from debility following acute illness. FOSTER CHILDREN. All cases of foster children resident in the district are notified by the Guardians to the Medical Officer of Health under the Children Act, Part 1. 66 Four of the foster children were resident in Barking for less than one month ; but of the others, twenty-three were in regular attendance at the Infant Welfare Clinics. This satisfactory result is due in great part to the active co-operation of the Infant Life Protection Visitor with the work of the Maternity and Child Welfare department. INFANTILE MORTALITY. The total number of deaths of infants during the year was 49, giving an infant mortality rate of 59.9 per thousand registered births, compared with 80 per thousand for 1925. The number of infant deaths in the first two quarters of the year was exceptionally low, and may be accounted for in part by the low incidence of measles and whooping couph, diseases which an? particularly fatal to infant life and which in general arc associated with an increased incidence in respiratory disease. A disquieting feature towards the end of the third quarter was the occurrence of an epidemic of summer diarrhoea, which caused 15 deaths, all of children under 12 months of age, and of these deaths 9 occurred in infants resident in the Abbey Ward. Diseases of the respiratory system, bronchitis and pneumonia were responsible for 10 of the infant deaths. An analysis of the distribution of the deaths of infants under 1 vear of age, according to wards, is of interest, and is given in the table following:— Ward. Notified Births. Deaths. 1926 rate per 1000 notified births Abbey 187 19 101.6 Gascoigne 113 7 61.9 Central 94 7 74.4 Longbridge 134 7 52.2 Westbury 145 6 41.3 Ripple 113 3 26.5 67 In considering these figures it must be borne in mind that whilst overcrowding and insanitary environment have a direct influence in inducing a high infant death rate, vet the high rate in the Abbey Ward is in part due also to the economic and social conditions obtaining in that area. The increased incidence of diarrhoea during the year was disappointing and indicates the need for persistent vigilance on the part of the Maternity and Child Welfare staff in the elimination of what is, after all, a preventable disease where adequate standards of cleanliness and mothercraft are maintained. Disease of the respiratory system continue to take their toll on infant life. It will be noted that pneumonia and bronchitis together were the cause of mere than 20 per cent. of the infant deaths in Barking during the year. Moreover, pneumonia is probably responsible for an even greater proportion of the deaths of children from one to five years of age—either as a primary condition or as a complication of measles or whooping cough. In dealing with the causes of respiratory disease, atmospheric pollution is a factor of primary importance, but so far as prevention is concerned, much may be achieved by improved domestic cleanliness and ventilation. INFANT MORTALITY AND SEX. An excessive male death rate again occurred during the year, the rate being 77.8 per thousand for male, and 40.6 for female children. ILLEGITIMACY. Twenty-six illegitimate children were born during the year, and in the same period 4 deaths of illegitimate infants occurred ; the infantile mortality rate among these children was therefore 153.8 ; while that for legitimate infants was 50.8 68 BREAST FEEDING. The importance of breast feeding in increasing the resistance of the infant to all forms of disease has been dealt with in previous reports. An investigation into the feeding of infants at the end of the sixth month of life was carried out in cases visited from July to December. The following percentages were obtained :— Wholly breast fed 62.5 Partially breast fed 7.7 Entirely artificially fed 29.8 per cent. DENTAL CLINIC. A steady expansion in this branch of the work has been taking place, and during 1926 the attendances of expectant and nursing mothers and of children referred from the Maternity and Child Welfare Clinics were as follows:— (1) Number of children treated .. .. .. .. £0 (2) Number of mothers treated:— (a) New cases119 (b) Old cases 556 (3) Number of dentures supplied51 Forty-four sessions were held. Here it must be observed that the aim of the Maternity and Child Welfare Service is the prevention of the onset of dental caries in the child, and, for this purpose, the improvement of the health of the mother and of her diet during pregnancy, the encouragement of breast feeding and the use of suitable dietaries for the young child, together with the practice of mouth hygiene, are all factors which must be dealt with by the Maternity and Child Welfare staff, in order to bring about an improvement in the structure of the teeth, and delay in the onset of caries. 69 ORTHOPAEDIC CLINIC. Seventeen children under school age were referred from the Infant Welfare Clinics or by the local medical practitioners for examitation by the Orthopaedic Surgeon during the course of the year, and, in addition, 20 cases attended for re-examination. Four of the children received in-patient treatment at Orthopaedic Hospitals, and surgical instruments were provided for 4 patients liter their discharge from hospital. The cases dealt with for the first time during 1926 were referred for the following conditions:— Rickets:— (a) With deformities 6 (b) Without deformities 4 Congenital deformities 2 Poliomyelitis 2 Erbs-palsy 1 Tuberculous spine 1 Adenitis 1 ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was begun in October, 1926. Cases are referred by the medical officers in charge of the Infant Welfare Clinics, and the children attending are kept under constant medical supervision during their course of treatment. The majority of the children referred for treatment were suffering from early rickets and malnutrition. In addition, cases were referred for the following conditions—chilblains, prematurity, general debility, and anaemia. In all, 25 children received treatment during 1926. One session per week was devoted to these cases, and 89 treatments were given. Although it is not possible at this early stage to make a detailed Analysis of the results obtained, yet there is no doubt that benefit has accrued in individual cases, particularly those of malnutrition and rickets. 70 MEALS TO EXPECTANT AND NURSING MOTHERS. Greater advantage has been taken during 1926 01 this provision under the Act, 18 necessitous mothers having been provided with dinners as compared with 12 during the previous year. The total number c.f dinners supplied was 710. The nutrition of the mother during pregnancy and in the lying-in period has a very important bearing on the well being of the infant, and it is at these times that necessitous mothers are particularly encouraged to avail themselves of the Council's scheme. PROVISION OF FRESH MILK. Particulars of the amounts of wet milk supplied free and at reduced rates to necessitous mothers and children are given in the following table:— No. of pints supplied at reduced price. No. of pints supplied free. Total. Total cost of milk supplied. Council's liability in respect of fresh milk supplied. f. 9. d. f. s d. 2,692 15,438 18,130 244 1 8 225 11 11 71 purpose. The result, as will be observed from the subjoined table, has been a considerable reduction in the quantity of dried milk issued. Cost Price. (lbs ) Reduced Price. (lbs.) Free. (lbs.) Total. (lbs.) Glaxo (Full Cream) 1,104 35 142 1,281 Glaxo (Half Cream) 16 — 2 18 Glaxo (Humanised) 93 — 5 98 Ambrosia 746 102 173 1,021 Cow and Gate 5,120 412 1,698 7,230 Almata 117 — — 117