BARK 22 Barking Town Urban District Council. REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1928. C. LEONARD WILLIAMS, B.Sc. Hons. (Lond.) M.R.C.S. (Eng.), D.P.H. (Camb.) 75150 BARK 22 3 TABLE OF CONTENTS SECTION 1—GENERAL. page Staff 5 Statistical Summary 12 Comparative Statistical Table 13 Table of Vital Statistics from 1922 to 1928 14 Summary of Nursing Arrangements 17 Clinic and Treatment Centres 19-20 Ambulance Facilities 21 Laboratory Work 22 Local Bye-Laws, Regulations and Adoptive Acts 23 Deaths 24 Inquests 25 Causes of Death (Table) 26 Causes of Death at Various Ages under 1 year 27 Marriages 28 Births 28 SECTION 2—SANITARY CIRCUMSTANCES OF THE DISTRICT. Water Supply 29 Rivers and Streams 29 Rainfall 30 Sewerage 30 Scavenging 31 Housing Statistics 31 Sanitary Inspection of the Area 34 Summary of Sanitary Work carried out 35 Notices Served 37 Smoke Abatement 37 Offensive Trades 39 Common Lodging Houses 39 Stables 39 Tents, Vans, Sheds, etc. 39 Piggeries 39 Houses Let in Lodgings 39 Inspection and Supervision of Food:— (a) Milk 40 (b) Meat 41 (c) Unsound Food 42 4 SECTION 2—Continued. page Sale of Food and Drugs Act 42 Schools 42 Factories, Workshops, Workplaces, etc. 43 Improvement of Existing Housing Conditions 46 Overcrowding 47 SECTION 3—NOTIFIABLE INFECTIOUS DISEASES. Table of Cases of Infectious Diseases notified and removed to Hospital 49 Cases Classified According to Age Groups and Wards 51-52 Monthly Summary of Receipt of Notifications 53 Scarlet Fever 53 Smallpox and Vaccination 53 Diphtheria 55 Puerperal Fever 55 Acute Primary and Acute Influenzal Pneumonia 56 Pneumonia Supervening upon Measles 56 Non-notifiable Diseases 56 Table of Admissions and Discharges from Hospital 56 Tuberculosis 56 Tuberculosis After-care 60 Asbestosis 60 SECTION 4—MATERNITY AND CHILD WELFARE. Notification of Births Acts, 1907-1915 61 Ante-Natal Clinic 62 Post-Natal Cases 62 Maternity Ward 63 Puerperal Fever and Puerperal Pyrexia 64 Maternal Mortality 65 Neonatal Mortality 65 Still Births 65 Ophthalmia Neonatorum 66 Work of Health Visitors and Infant Welfare Centres 67 The Pre-School Child 68 Foster Children 68 Infantile Mortality 68 Dental Clinic 68 Orthopaedic Clinic 69 Artificial Sunlight Clinic 70 Provision of Meals and Fresh and Dried Milk 71 5 STAFF, 1928. Medical Officer of Health, School Medical Officer, Medical Superintendent, Isolation Hospital, and District Tuberculosis Officer. *C LEONARD WILLIAMS, B Sc. Hons. (Lond.) M.R.C.S. (Eng.) D P.H. (Carnbs.) 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: *H. S. SMYTH, 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 (g). *MRS. M. W. WALTON (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. HILL (Chief Clerk) (Commenced June, 1928). E. W. WINCHESTER (Chief Clerk) (Resigned May, 1928). D. G. TONKIN. MISS V. SHEAD. MISS H. NUNN MISS H. KING. Disinfector and Mortuary Attendant: 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. and S.R.E. (l) Health Visitor's Diploma of Board of Education. *Proportion of salary contributed under Public Health Acts or by Exchequer grants. 7 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, 1928. Public Health Offices, Barking, Essex. To the Chairman and Members of the Urban District Council of Barking Town. Mr. Chairman, Mrs. Jackson and Gentlemen, Herewith I beg to submit for your favourable consideration the annual report on the Public Health Services for the year ending 31st December, 1928. Although last year I was responsible for and signed a report for the year ending 31st December, 1927, this is really my first annual report to you, because, having only joined your Services in September, 1927, I was last year only able to speak personally of a small portion of the year then under review. The first year in the important office to which you elected me has of necessity been spent largely in stock-taking and enquiry, and, equally of necessity, this stock-taking and enquiry has been somewhat of the nature of an inspection. It will, I feel sure, be interesting and gratifying to you to hear the very favourable opinion I have formed of your Public Health Services. 8 There can be but few Councils in England with resources comparable to your own who have made provision for carrying on Public Health Services in the same way and to the same extent as you have done, and I am happy in my belief that you yourselves recognise this good work you have already accomplished is essentially the foundation of good work which still remains to be carried out. The Clinics you have established for Maternity and Child Welfare, Dentistry, Ante-Natal Supervision, Ultra Violet Light Treatment, etc., all show promise of an increasing reward in health and contentment. This work throughout the whole of the country is even yet in a pioneer phase, and one of the greatest lessons we are learning is the vast amount of work which still remains to be done. With particular reference to Barking, it may be said that, even without any increase of population, an extension of these Services would be desirable; with the increase in population which is taking place and which is likely to take place, this extension is inevitable. If criticism can indeed be offered to these Services, it is only such as can be given to all such progressive Services. These Services grow from small beginnings, and from different beginnings. There is, therefore, at first, during the growing stage, of necessity a certain uncouthness about them and a certain lack of co-ordination between them. It will be my endeavour to advise you how to train your adolescent Services so that they may retain the present vigour of their youth and yet fit, as it were, into a united family life in which each part promotes the welfare of the whole. This task requires time, not only the months and years necessary to accomplish so desirable an end, but also time for personal administrative work to achieve this end. During the year under review I personally have not had the time and opportunity I could have wished to devote to this object. 9 Daring the year much has been done with regard to your proposals for rebuilding and extending your present hospital accommodation for infectious fevers and for maternity cases. The year 1928 has been a heavy one from the standpoint of infectious diseases, and the accommodation at present available has been strained to the uttermost. The situation has been met generally by cutting down the period of isolation in individual cases to the minimum, and on one occasion by opening an auxiliary infectious fever hospital at Creeksmouth. In my opinion it is better to cut down the period of isolation in scarlet fever than so to overcrowd infectious fever wards that complications are likely to arise, the which they are wont to do under overcrowded conditions. The danger to the community by cutting away the factor of safety by curtailing the period of isolation is less than the personal danger to the patients of possibly developing complications in overcrowded wards. Special mention must be made of the auxiliary hospital at Creeksmouth. The Chairman of the Health Committee, Councillor Mr. A. Edwards, authorised opening up Creeksmouth School for this purpose late one afternoon. Patients were admitted early the next evening. This was not just a stunt of the Public Health Department. It represented the united efforts of every department of the Council and is a very fine testimony of the team spirit I am so happy to meet in Barking. In all my recommendations to you I have not so much the present needs of Barking before me as the needs of Barking a few years hence, when without question or doubt the population will have doubled itself, and I do urge you very seriously to take time by the forelock, to build the necessary clinics and office 10 accommodation and to make all the necessary foundations for the provision of staff before this, which is almost a threatened invasion, actually takes place. During the year there has been a lot of substantial work done in committee with reference to the drainage of the town as a whole. There have been numerous conferences with Ilford and with Dagenham and with other authorities, and it seems that at last— what Barking urged so many years ago—we shall have a system whereby the greater part of the town drains into the Northern Outfall Works. The London County Council will no doubt proceed almost immediately with the erection of houses adjoining those they have already built within the district of Dagenham, the drainage from which no doubt will be dealt with by arrangement, together with that from the houses on the Becontree Estate already erected. Considerable work too has been done in committee with reference to the provision of further and more up-to-date hospital accommodation for infectious diseases. I am strongly of opinion that every Local Authority should be, as far as possible, autonomous, and that each Local Authority should provide for the isolation of its own infectious diseases unless the Local Authority is so small as to make it a particular economic disadvantage to do so. With Barking a town of about 40,000 population I am of opinion that we can economically undertake our own obligations. You have further had under consideration the provision of more suitable and hygienic vehicles for the collection of refuse, and this work will be undertaken in the New Year under much more advantageous circumstances than have obtained hitherto. Altogether the year has been one of steady progress and I sincerely trust that in the year that is coming we shall show an 11 equally creditable record of achievement, and at the same time lay a substantial foundation on which to build the extensions in public services which must take place in the immediate future. It can only be with regret that Mr. Wood terminated his services to the Corporation on December 31, 1928, retiring on superannuation. As an officer of the Health Department he had served for 31 years. His services, I know, have been appreciated and he takes into retirement the well wishes of the Council and his colleagues in the Public Health Department and no less I feel confident that of his colleagues in the whole of the Corporation services. Mr. E. Winchester, too, resigned his post as chief clerk to take up another appointment elsewhere, and these positions have been filled. I am, Mr. Chairman, Mrs. Jackson and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 12 SUMMARY OF PARTICULARS REQUIRED BY CIRCULAR 834 OF THE MINISTRY OF HEALTH, DATED I5th DECEMBER, 1927. 1. General Statistics. Area (acres) 4,106 Ward areas 3,806 Tidal Water H.W.M. Thames 240 Roding 58 Loxford Water 2 300 4,106 Population (Census, 1921) 35,523 Population (June, 1928) (Registrar General's estimate) 40,870 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 9.9 Rateable Value—Houses. Buildings, etc. £305,493 0 0 Lands £2,738 0 0 Sum represented by a penny rate £1,178 0 0 Education rates:— Elementary 3 1 Secondary 6¼ Assessable Value £280,851 0 0 General District Rate 7 0 Poor Rate 9 2 2. Extracts from Vital Statistics for the Year. Births:— Males. Females. Total. Birth Rate. Legitimate 409 376 785 19.2 Illegitimate 11 9 20 0.48 Total 420 385 805 19.7 Deaths:— Male. Female. Total. Death Rate. Standard Death Rate (Factor 1.049) 230 184 414 10.1 10.5 Number of deaths of women during, or in consequence of, childbirth:— From Sepsis. From other causes. Total. 0 2 2 Number of deaths of infants under one year of age :— Males. Females. Totai. Totai Infantile Death Rate. Death Rate. Legitimate 20 25 45 57.3 63.3 Illegitimate 3 3 6 300.0 Number of deaths from Measles (all ages) 13 „ Whooping Cough (all ages) 6 „ Diarrhoea (under 2 years of age) 6 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. Enteric 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 Certified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes j of Death. England and Wales 16.7 11.7 0.01 0.00 0.11 0.01 0.07 0.06 0.19 0.53 7.0 65 90.9 6.7 1.4 1.0 107 County Boroughs and Great Towns including London 16.7 11.6 0.01 0.00 0.15 0.02 0.09 0.09 0.17 0.48 9.6 70 91.0 6.5 1.9 0.6 155 Smaller Towns (1921 Adjusted Populations 20,00050,000) 16.6 10.6 0.01 0.00 0.08 0.01 0.06 0.08 0.21 0.41 4.8 60 92.6 5.7 0.5 1.2 London 15.9 11.6 0.01 0.00 0.30 0.02 0.09 0.09 0.13 0.55 10.2 67 88.7 7.6 3.7 0.0 BARKING 19.7 10.1 0.00 0.00 0.31 0.00 0.14 0.00 0.17 0.44 7.4 63 87.4 10.1 0.72 0.0 VITAL STATISTICS OF WHOLE DISTRICT FROM 1922 to 1928 Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Nett. Number. Rate. Of Nonresidents registered in the District. Of residents registered out of the District. Under One year of age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number Rate. 1 2 3 4 5 6 ' 8 9 10 11 12 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 7.4 107 66 80.0 386 10.0 1926 38,920 818 21.0 259 6.6 11 118 49 59.9 366 9.4 1927 39,900 710 17.7 251 6.2 7 162 47 66.1 406 10.1 1928 40,870 805 19.7 276 6.7 6 144 51 63.3 414 10.1 * Registrar General's Figures 15 5. CAUSES OF SICKNESS. Amongst things prejudicial to health must be counted the condition of the Underground Railway to Barking. The fatigue of strap-hanging from the City after a day's work is not inconsiderable. That this has to be accomplished in a fetid atmosphere adds to its difficulties and dangers and certainly tends to undermine the vitality of the poor travellers. Under these conditions, to jostle cheek by jowl with all sorts of conditions and persons is to invite infection, and it may safely be assumed that our dormitory population bring down with them every infection prevalent in the City and the East End. During the year, my work at the Chest Clinic in Linton Road has drawn my attention to a particular disease, which, whilst resembling consumption in many ways, is not due, I feel sure, to the germ of tuberculosis (i.e., consumption). As Medical Officer of Health, the possible association of this disease with industrial life has had my attention, and certain steps have been taken in the matter. I am hopeful that our experience in Barking when correlated with that in other similar towns may help to clear up the somewhat difficult and serious problem. A careful enquiry was held into the origin of an outbreak of scarlet fever at Creeksmouth. It appears that there must have been one or two minor undetected cases which occurred some little time before the outbreak and which were discovered during the outbreak in the later stages of the disease. It appears also that the explosion, if I may so term this outbreak, was due to food poisoning, although there were a few cases no doubt directly due to the undetected cases of scarlet fever and not due to such food poisoning. 16 I am happy to be able to put on record that we had no difficulty whatsoever in dealing with the food aspect of the outbreak and this no doubt materially helped in preventing any further spread of the epidemic. Diphtheria and scarlet fever have been prevalent more or less throughout the whole of the year, and these cases, together with those which occurred during the special outbreak, have made what is perhaps a record year for infectious fevers in Barking. These disastrous years come in cycles, and I am happy to be able to say I hopefully expect that the next few years will show a very considerable decline in the incidence of infectious disease. May I once again take an opportunity of pointing out that ultimately the control of infectious disease is in the hands of the public themselves. Scarlet feVer, diphtheria and kindred complaints are not so much spread by the bad cases, which are immediately detected and isolated, as they are spread by the mild cases, so mild that medical attention is not even procured. These cases are nursed for a minor illness at home, the nature of which is sometimes guessed but oftentimes not known, and they give rise to the disease in others, oftentimes of a severe type. 17 6. SUMMARY (FOR REFERENCE) OF NURSING ARRANGE MENTS, 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 home 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 may require to be nursed in their own homes. This course of action has been taken in some areas with special reference to scarlet fever, but it will be, I believe, a long time before such action becomes general. It has been stated that ailments such as scarlet fever and measles, to which so much attention has been given, have received the attention they have more because of the rash with which they are accompanied than because of their intrinsic powers of disablement, and certainly it must be said that other infectious diseases, such as rheumatic affections of the throat, are equally important by reason of the complications which are involved and are equally deserving of isolation and of special hospital treatment. It seems to me, therefore, fairly evident that, whilst there may be a re-distribution of the classes of cases which are to be isolated in the future, the actual need for such hospital beds is likely to increase rather than diminish. 18 (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 300 District Midwifery cases attended by the Charity reckoned at the rate of £1 per case. The takings of the Charity for the year ending 31st December, 1928, amounted to £228, leaving a balance due to the charity from the Council of £72, such sum ranking for grant. (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 premises. East 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) Eve Clinic „ ,, One room. „ ,, (c) Dental Clinic „ ,, Two rooms. „ ,, (d) Crthopædic 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. 21 (d) Hospitals provided or subsidised by the Local Authority: (i) Smallpox.—By arrangement with West Ham, sporadic cases of smallpox are treated at Orsett Smallpox Hospital, whilst in the event of an epidemic, cases would be sent to Dagenham Smallpox Hospital, which is now used by West Ham as a Sanatorium and which can be vacated at short notice. Orsett Smallpox Hospital is situated at Stifford in the Orsett Rural District, and has accommodation for twenty-two patients. Before leaving this question of smallpox I cannot help contrasting the work expended in this direction with the services we have available for other commoner diseases, which certainly, so far as our present circumstances are concerned, are even more important. It is such diseases as scarlet fever and diphtheria which arc not only causing a drain on public resources but are causing a considerable amount of invalidity and permanent disability. If a commensurate amount of time were spent on these diseases you would require a very extended service. (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 motor 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. 22 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 1,708 Sputa 364 Typhoid 22 Ringworm 22 Miscellaneous 6 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. (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 Wash-houses Acts, 1847, etc. Infectious Diseases (Prevention) Act, 1890. 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. 23 (iv) Bye-laws with respect to : Nuisances, 1884. Common Lodging Houses, 1884. 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. 24 9. DEATHS. There were 274 deaths registered in Barking in 1928. Of these 4 were deaths of non-residents. Barking residents to the number of 144 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 230 184 414 The death rate for 1928 was 10.1 per 1,000, compared with 10.1 in 1927, calculated on the Registrar-General's estimated population and number of deaths, compared with 11.7 for England and Wales, 11.6 for the hundred and seven Great Towns, 10.6 for the hundred and fifty-six Smaller Towns, and 11.6 for London. Sex Mortality.—The 414 deaths of 1928 were divided as follows: 230 males. 184 females. Age Mortality.—The deaths in various age groups, according to the figures obtained locally, were as follows:— Age Group. No. of Deaths. Under 1 year 51 1 to 2 years 15 2 to 5 years 9 5 to 15 years 14 15 to 25 years 31 25 to 45 years 52 45 to 65 years 112 Over 65 years 130 25 Causes of death in 1928.—The table on page 26 shows the principal causes of death at various ages. Those diseases, etc., 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 94 22.7 Cancer 45 10.8 Tuberculosis (all forms) 48 11.6 Pulmonary affections, (exclusive of tuberculosis), viz., Bronchitis 16 3.8 Pneumonia 23 5.5 Other respiratory disease 4 0.9 Zymotic Diseases 25 6.0 Deaths from Zymotic Diseases.—These diseases caused 6.0 per cent, of the total deaths, such deaths being caused in the following proportions:— Enteric Fever — Measles 3.1 Whooping Cough 1.4 Scarlet Fever — Diphtheria — Diarrhoea 1.4 Smallpox — INQUESTS.—Coroner's inquests were held on 42 deaths. 26 CAUSES OF AND AGES OF DEATH DURING YEAR, 1928. (Nett Deaths.) Causes of Death. Deaths at the subjoined ages of "Residents " whether occurring in or beyond the district. Under one year 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Total Encephalitis Lethargica — — — — — — — — Influenza — 1 — — — 2 4 7 Scarlet Fever — — — — — — — — Small Pox — — — — — — — — Measles 3 8 2 — — — — 13 Whooping Cough 2 4 — — — — — 6 Epidemic Influenza — — — — — — — — Diarrhoea and Enteritis (under 2) 5 1 — — — — — 6 Diphtheria — — — — — — — — Enteric Fever — — — — — — — — Puerperal Fever — — — — — — — — Phthisis (Pulmonary Tuberculosis) — — 2 11 19 12 2 46 Other Tubercular Diseases — — — — — — 2 Cancer, Malignant Disease — — — — 5 22 18 45 Bronchitis 2 2 — — — 1 11 16 Pneumonia 7 4 2 — 1 5 4 23 Other Respiratory Diseases — — — — — 3 1 4 Alcoholism (Cirrhosis of Liver) — — — — — — — Premature Birth, Malformation and Debility 23 — — — — — — 23 Accidents 1 1 3 5 2 2 — 14 Suicides — — — — 2 2 — 4 Rheumatic Fever — — 1 1 — — — 2 Diabetes — — — — — 3 1 4 Cerebral Haemorrhage — — — — 1 9 12 22 Heart Disease 1 1 1 6 8 28 49 94 Arterio-Sclerosis — — — — — 2 7 9 Ulcer of stomach or duodenum — — — 2 1 3 — 6 Appendicitis and typhlitis — — — — 2 2 — 4 Acute and Chronic Nephritis — — — 1 2 6 7 16 Other accidents and diseases of pregnancy and parturition — — — — 2 — — 2 Other defined diseases 7 2 3 3 7 10 14 46 Causes ill-defined or unknown — — — — — — — — Totals 51 24 14 31 52 112 130 414 27 INFANT MORTALITY DURING THE YEAR 1928. The following table gives the actual causes of death of children dying under one year of age. Nett deaths from stated causes at various ages under one year:— s of Death. (All causes 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 — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 1 1 — — 2 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tubercular Meningitis — — — — — — — — — — Other Tubercular diseases — — — — — — — — — — Meningitis (non tubercular) — — — — — — — — — — Convulsions 1 — — — 1 1 1 1 — 4 Laryngitis — — — — — — — — — — Bronchitis — — — — — — 1 — 2 3 Pneumonia (all forms) — — — 1 1 2 5 — 1 9 Diarrhœa — — — — — — — 3 3 Gastritis — — — — — — — — — — Syphilis — — — — — — — — — Rickets — — — — — — — — — — Suffocation, overlaying 1 — — — l 1 — — — 2 Injury at birth — — — — — — — — — — Atelectasis 1 — — — l — — — 1 Congenital malformation — — — — — 1 — 1 — 2 Premature Birth 9 3 — — 1.2 2 1 — 15 Atrophy, debility and Marasmus 3 — 2 — 5 — — — 1 6 Other causes 1 1 1 — 3 — — — — 3 Totals 16 4 3 1 24 8 8 4 7 51 Nett Births in the year :— Nett Deaths in the year:— Legitimate 785 Legitimate 45 Illegitimate 20 Illegitimate 6 28 10. MARRIAGES. There were 311 marriages registered in the district in 1928. This is equal to a marriage rate of 7.6 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, 20S marriages, equal to a rate of 5.4; in 1925, 258 marriages equal to a rate of 6.7; in 1926, 249 marriages equal to a rate of 6.3; and in 1927, 304 marriages equal to a rate of 7.6. 11. BIRTHS. The net number of births registered in 1928 was 805, affording an annual birth rate of 19.7 per 1,000 population, compared with 17.7 in 1927 and 21.01 in 1926. Of all births, 20 were illegitimate, or a proportion to total births of 2.4 par cent. Notification of Birihs Act, 1907-1915.—Of the total births recorded in the district during 1928, 703 were notified to the Medical Officer of Health, 493 being notified bv midwives and 210 by parents and doctors. 14 still-births were notified, 9 being notified by midwives and 5 by doctors and others 4 still-births, which took place in the district, were not notified. 29 SECTION 2. SANITARY CIRCUMSTANCES OF THE DISTRICT. WATER SUPPLY. The water supplied to the area by the South Essex Waterworks Co., comes from various sources, principally from the Company's wells in the chalk at Ilford, Seven Kings, and Dagenham. The water is untreated and varies in hardness from 10 to 20 degrees, according to the source from which it is obtained. The supply is periodically analysed and is always reported on as of the highest degree of bacteriological and chemical purity. RIVERS AND STREAMS. The Rivers and Streams of the district come within the jurisdiction 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. In the early hours of the morning of January 7th there was an exceptionally high tide when the River Roding overflowed its banks with subsequent flooding and damage to properties situate in the vicinity of the river. The level to which the previous highest recorded tide had reached was 16.75 feet above ordnance datum. The tide on January 7th reached 17.80 feet above ordnance datum. 30 About 250 houses were flooded, those in Bridge Street to a height of 3 feet. In addition, serious damage was caused at the Council's sewage disposal works through portions of the river wall giving way under the pressure of the water, and admitting tidal water to 40 acres of land. At Westbank, Little West Marsh was flooded, and to relieve this condition it was necessary to make a cutting communicating with the river. RAINFALL. The rainfall for the year ended December 31st was 23.73 inches. Rain fell on 201 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. Sewage is treated within the district by precipitation and sedimentation, the resulting effluent being discharged into the River Roding. Sewage Disposal-—General. Since the latter part of the year 1927, meetings and discussions have taken place between the Urban District Council of Barking and the Corporation of Ilford with a view to preparing a scheme for the reception and treatment of the sewage of the two districts at the Northern Outfall Works of the London County Council. Such a scheme has now been agreed, the capital cost of which is estimated at approximately £162,000; preliminary steps have been taken and it is anticipated that the work will commence at the earliest opportunity. Sewage Disposal West of the River Roding. A Local Inquiry was held on the 4th April into the raising of a loan for £7,420 to lay a new sewer from Over-the-Gates to Hertford Road, where a new pumping station will be erected 31 fitted with centrifugal pumps of a capacity sufficient to lift the whole of the sewage from Hertford Road and Over-the-Gates through a rising main along London Road to the main sewer on the east side of the River Roding. SCAVENGING. Street cleansing, together with the collection and disposal of the domestic refuse, is under the control of the Engineer and Surveyor. The method of collection by antiquated and unsuitable vehicles which has occasioned adverse criticism in the last two Annual Reports is shortly being ended, and vehicles of the freighter type introduced. Crude refuse continues to be dumped on low-lying land at Mayesbrook. During the summer, residents in that locality complained of nuisance from flies. Tipping is carried on entirely in accordance with the recommendations of the Ministry of Health CESSPOOLS, PRIVYMIDDENS AND PAIL-CLOSETS. In the unsewered portion of the district there remains 54 premises with cesspools, 41 with pail-closets and 6 with privies. So soon as the sewerage scheme which is now in preparation is completed, these premises will be connected with the sewer it is proposed to provide. For cesspool emptying, a tank vehicle is employed, the contents being pumped out and afterwards discharged into the sewers. Privymiddens are emptied into tumbrils and the contents buried; the same remark being applicable to pail-closets. Housing Statistics for the year 1928. 1. GENERAL. Number of new houses erected during the year :— (i) Total 375 (ii) As part of a municipal housing scheme 40 (iii) Others (including private enterprise and subsidy houses) 270 32 2. UNFIT DWELLING HOUSES. I.—Inspection. (i) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 4.151 (ii) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 739 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 2,182 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. 1,676 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 129 (ii) Number of dwelling houses which were rendered fit— (a) by owners 123 (b) by Local Authority in default of owners 6 33 (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 377 (ii) Number of dwelling houses in which defects were remedied :— (a) by owners 377 (b) by local Authority in default of owners Nil 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 2 (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 Nil (iv) Number of dwelling houses in respect of which Demolition Orders were made Nil (v) Number of dwelling houses demolished in pursuance of Demolition Orders Nil 34 SANITARY INSPECTION OF THE AREA. (Work of Sanitary Inspectors.) 1. Inspection of Dwelling Houses. Total under Public Health or Housing Acts 4,151 Housing (Inspection of District) Regulations 735 After Infectious Disease 647 Defects Found 7,852 Notices Served (Preliminary) 2,182 Re-inspections re Notices Served 3,042 2. Premises Controlled by Bye-Laws and, Regulations. Houses Let in Lodgings 23 Common Lodging Houses 90 Offensive Trades 268 Tents, Vans and Sheds 108 Dairies, Cowsheds and Milkshops 307 Slaughterhouses 120 3. Factories, Workshops and Workplaces. Factories 108 Laundries 19 Bakehouses 40 Other Workshops 129 Other Workplaces 127 Outworkers' Rooms 26 Butchers' Premises 490 Fishmongers 53 Restaurants and Dining Rooms 145 Markets 63 Stables and Stable Yards 116 Piggeries 199 35 4. Miscellaneous. Smoke Observations 196 Rats and Mice (Destruction) Act, 1919 83 Vacant Land and Refuse Dumps 132 Public Lavatories 88 Schools 81 General Shops 249 Ice-Cream Vendors 90 Petroleum Stores 86 SUMMARY OF SANITARY WORK CARRIED OUT. (a) Drainage. Choked drains, opened, repaired, and cleansed 331 Drains reconstructed 80 New Drains nil Ventilation Shafts repaired or new fixed 14 New Inspection Covers 19 (b) Closet Accommodation. Roofs Walls Floors Doors W.C. structures repaired 182 Seats Fixed 91 W.C. Pans Fixed or Cleansed 183 Flushing Apparatus Repaired or Renewed 304 Privies to Pail Closets 6 (c) Sinks. New Fixed 121 New Sink Wastepipes 136 New Gullies 67 (d) Dampness. Roofs 715 Eavesgutters 471 Rainwater Pipes 175 Damp Walls Remedied 150 36 (e) Water Supply. Storage Cisterns Abolished 26 Defective Water Fittings Repaired and Supply Reinstated 108 Supply provided inside houses 8 Existing supplies increased 10 (f) Yard Paving. Yard paving repaired or relaid 247 (g) Dustbins. New ones provided 281 (/») General Repairs. House floors repaired 366 Windows repaired or renewed 200 Window sills repaired or renewed 213 Sashcords renewed313 Stoves or coppers repaired or renewed 387 House doors repaired or renewed 230 Stairs repaired 112 Chimney pots renewed and stacks rebuilt 76 Dirty or defective rooms repaired, cleansed and redecorated 1,678 External walls repaired 175 Insufficient floor ventilation 51 External painting 23 Wash-houses added 7 (») Miscellaneous. Offensive accumulations removed 80 Animals so kept as to be a nuisance 21 Verminous rooms and persons disinfected 37 Smoke nuisances 70 Drains tested 167 37 NOTICES SERVED. Informal Notices 2,182 Statutory Notices 506 Section 36, Public Health Act, 1875 38 Section 94, Public Health Act, 1875 334 Section 41, Public Health Act, 1875 4 506 Section 5, Infectious Disease (Prevention) Act, 1890 1 Section 3, Housing Act, 1925 129; SMOKE ABATEMENT. During the year 196 observations were made of factory chimneys in the district and in 70 instances there were emissions of black smoke in excess of the permissible period of 2 minutes in each 30-minute observation. Most of the offences occurred at a factory where the processes have since been electrified, with a consequent decrease in black smoke emission from the chimney. The question of "grit" discharge from the super-power station at Creeksmouth has received attention and the station kept under observation. A considerable amount of grit escapes into the atmosphere, causing nuisance to workmen in the locality, and would undoubtedly be a serious matter if the station was situated other than in its present position of isolation. The demand for higher and higher efficiency in steam raising installations, with consequent increasing popularity of high temperature air pre-heating and the rapid increase in the capacity of boiler units designed for a high rate of evaporation per square foot of heating surface have brought about many new problems, the most serious of which from the public health point of view are the discharge of sulphur fumes and very fine grit from the chimneys of modern electric power houses where there is a concentration of a large amount of power in a relatively small space. How serious these discharges are can best be gauged when it is realised that the modern furnace is designed to burn any class of fuel, and that the average fuel contains 2 per cent. of sulphur and 14 per cent ash. 38 The super stations which are now being erected, of which Barking station is one, will have a coal consumption of 2,000 tons per day containing 40 tons of sulphur which passes out into the air as sulphur gases and 280 tons of ash of which 140 tons will be discharged into the atmosphere in such a finely divided state that until saturated with moisture will remain suspended in the air. So far, engineers have been unable to design any equipment satisfactorily to deal with the problems arising from the new methods of steam raising. Pure water supplies and pure food supplies have been established, but we are still without a pure air supply. It is now accepted that smoke and other items of air pollution fill the atmosphere with acrid, poisonous compounds and soot particles which irritate the sensitive membranes of the eyes, nose, throat, lungs and gastro-intestinal tract, increasing the susceptibility to gastro-intestinal, pulmonary and naso-pharyngeal disorders and so lessening the working capacity and well-being of the individual. Any improvement in air pollution depends upon :— 1. A campaign of education aiming at acquainting the general public with the gravity of the air polution evil. 2. The extension of smoke control to all classes of buildings now exempt, including dwelling-houses. 3 (a) Provision of facilities to permit control of visible smoke to the limit physically possible. (b) Research by the chemist, physician and engineer to cover thoroughly the field of air pollution. The marketing of a smokeless fuel suitable for all purposes now served by coal at a price the public can afford will be an important move forward, and with the completion of the factory, which is to be erected at Creeksmouth, I am hopeful that such a fuel will be available to Barking inhabitants. 39 OFFENSIVE TRADES. The 35 registered premises received 268 visits and 27 breaches of the bye-laws were found. The business of fat melter carried on by Mr. Hornett at Manor Farm, Clap Gates Lane, was discontinued in October. He does, however, still carry on the business of fish-skin scraper at these premises. The isolated position of the piggeries at Jenkins Lane mitigates any serious nuisance, but conditions at these piggeries are far from the standard we would wish to obtain. The 60 stables in the district received 116 visits during the summer months. COMMON LODGING HOUSES. Ninety visits were paid to the two common lodging houses. At the end of the year the licence granted to the keeper of the Heath Street house was terminated owing to his unsatisfactory methods. The other lodging house continues to be kept in good order. TENTS, VANS, SHEDS and HOUSES LET IN LODGINGS. Until such time as homes can be obtained at rentals which the poorest of the poor can afford to pay, premises of the above type will be found occupied. The best one can say of them is that they are a habitation. In Barking there are about 55 families living in such dwellings, all hopeful of obtaining a house. The premises need constant supervision to secure maintenance of anything like decent home conditions. 40 INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. Including five whose premises are situated outside the district, there are 34 retail purveyors. The premises are frequently inspected. Generally speaking, the cleanliness of the milk supplied is of a high standard. Of the samples examined during the year it is interesting to note that whilst all the samples of raw milk submitted were satisfactory, 3 samples of pasteurised milk (although not retailed under that designation) were found below the standard of cleanliness. During the year two dairymen were prosecuted and fined for the bottling of milk in the street, since which time the larger retailers have gradually discontinued the distribution of loose milk, a policy which it is hoped will be extended. Whilst the sanitary inspectors are always on the alert for instances of street bottling, they cannot be aware of every offence. Below are particulars of samples submitted for bacteriological examination:— Type of Sample. Satisfactory Unsatisfactory Total. Grade A (T.T.) Milk 4 — 4 Grade A Milk 1 — 1 Raw Milk 8 — 8 Pasteurised Milk 10 3 13 Sterilised Milk 3 — 3 26 3 29 The following table shows the number of licences granted during the year for the sale of graded milks' under the Milk (Special Designations) Order, 1923:— (a) "Certified" Milk 1 (b) Grade A Milk 3 (c) "Pasteurised" Milk 2 (d) Grade A (T.T.) 3 41 Licences were granted to 2 local firms for the bottling of Grade A (T.T.) Milk. There are in the district 45 retailers and 9 wholesale distributors of sterilised milk. MEAT INSPECTION. Slaughtering is still carried on at the one licensed premises in the town. The occupier slaughters good class animals in a satisfactory manner. During the year 126 notifications to slaughter were received and 40 beasts, 409 pigs, 815 sheep and 71 calves were examined. Diseased meat was destroyed as under:— Description Disease Weight 2 Beasts Heads Tuberculosis 56 lbs. 4 „ Lungs „ 19 lbs. 1 „ Pluck Echinococcus 20 lbs. 5 „ Livers Distoma Hepaticum 70 lbs. 3 „ „ Cirrhosis 42 lbs. 1 „ Mesentery Tuberculosis 1 lb. 11 Sheep Plucks Parasites 77 lbs. 11 „ Livers „ 44 lbs. 87 „ Lungs „ 261 lbs. 3 Pigs Heads Tuberculosis 29 lbs. 13 „ Plucks „ 104 lbs. 2 „ Congestion 12 lbs. 7 „ Livers Cirrhotic 35 lbs. 10 „ Lungs Tuberculosis 60 lbs. 2 „ Congestion 7 lbs. 2 „ Pneumonia 7 lbs. 9 „ Stronglyus Paradoxus 34 lbs. 2 Legs of Mutton Caseous Lymphadenitis 10 lbs. Total weight 888 lbs. 42 UNSOUND FOOD. The following list gives particulars of the unsound food destroyed during the year:— 5 stone of Dabs. One bushel of Winkles. One Loin of Pork. One Sirloin of Beef. SALE OF FOOD AND 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:— During the year ended 31st December, 1928, the following articles of food were taken in Barking and submitted to the Public Analyst for analysis:— Milk. Butter. Other Samples. Total. 62 50 72 184 Proceedings were instituted in one case and were withdrawn. 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. A distinct improvement from the hygienic standpoint would be the abolition of existing arrangements and the provision of springbib fountain jets in every school. 43 FACTORY AND WORKSHOP ACT, 1901. Factories, Workshops, Laundries, Workplaces and Homework. 1. Inspections (including inspections made by Sanitary Inspectors.) Premises. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 108 3 — — Workshops 129 19 1 — Workplaces 212 4 — — Total 449 26 1 — 44 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 15 15 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 12 12 — — Sanitary accommodation Insufficient — — — — Unsuitable or Defective 10 10 — — Not separate for sexes — — — — Unscreened for Sexes — — — Offences under the Factory and Workshop Acta:— Illegal occupation of underground bakehouse (S.101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 4 4 — — Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) — — — — Total 42 42 — — * 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. Four notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of six contractors and 24 workpeople engaged on making wearing apparel in their homes. 45 REGISTERED WORKSHOPS. Workshops on the Register (Sec. 131) at the end of the year. Number. (1) (2) Bakehouses (including seven factory bakehouses) 13 Other Workshops 58 Total number of Workshops on Register 71 OTHER MATTERS. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factor)' and Workshop Act (Sec. 133) 2 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 38 out-workers:— Box Makers 2 Wearing apparel 16 Ties 5 Umbrella makers 2 Life belt covering 10 Boot Repairers 1 Art. Flowers 1 Brush Maker 1 During the year 23 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. 46 HOUSING CONDITIONS. Two events of importance occurred during the year, viz., the rehousing of the tenants from the Parsons Row area, and the commencement of building operations in connection with the 198 houses to be erected as the first section of the Upney estate. In regard to the rehousing of displaced tenants from the condemned area it was highly gratifying to find every one of them so eager to move into the new accommodation provided, as this has not been the happy experience of every Local Authority. It was not possible to proceed with the clearance scheme until some fresh accommodation was available for use as a housing decant. Even when provided, it frequently happens that the new accommodation is of such a character that the persons moved from slum property are incapable of taking advantage of it and paying the normal rent. To avoid this the Council was at pains to design such accommodation as would meet the needs of the incoming tenants in every respect,- and what is equally important, was persistent in a demand for a rent such tenants could afford to pay—hence the alacrity to change. All this involved considerable time. Further, clearance could only be made in sections and this factor has materially hindered the progress of the rehousing. Prior to the occupation of the new houses, the belongings of the proposed tenants were disinfested, and in some cases destroyed, before occupation was allowed. The wisdom of this precaution was proved by an inspection of the premises after an interval of nine months, when no instance of vermin infestation was discovered. The reaction to their improved conditions by 90 per cent., of the residents has fully justified the Council in its action. 47 It has been the considered aim of the Council in erecting new houses to relieve overcrowding to build these new houses substantially, to equip them with all modern improvements and, nevertheless, to carry out the scheme in such a way that these houses can be let at a rental the proposed tenants are able to afford. Our unfortunate experience is that many families who are living under overcrowded conditions find it difficult to pay for the accommodation and amenities which are necessary for their numbers, and to meet this difficulty the Council had recourse in its recent schemes to a simplified form of accommodation which it was possible for such families to rent. It is refreshing to find how gladly a large number of persons have responded to the improved environment of their new accommodation, but undesirable tenants are to be found everywhere. Obviously, these tend to gravitate into houses where overcrowding occurs, and the rehousing of these people can only be an economic proposition if close supervision is maintained. Bearing in mind all the circumstances, the general condition of the houses in the district indicates the thorough supervision the sanitary inspectors give, and the fact that every house is provided with separate water supply, sink and w.c. accommodation is very pleasing. In an effort to prevent the decay of houses into slums, owners are continually advised of necessary repairs, but many desired improvements are hindered by financial difficulties. 49 SECTION 3. NOTIFIABLE INFECTIOUS DISEASES. The following table shows the number of notifications of infectious disease received during 1928:— TABLE I. Males. Females. Total Total cases rcm'd to Hos. Deaths. Small Pox 1 4 5 5† — Scarlet Fever 126 117 243 230* — Diphtheria 46 61 107 104 — Puerperal Septicæmia 2 2 2 — Pneumonia (Acute primary and influenzal & following Measles) 41 33 74 5 23 (All Forms) Erysipelas 16 10 26 4 — Ophthalmia Neonatorum 8 7 15 — — Puerperal Pyrexia — 6 6 — Enteric — 4 4 3 — Anterio Poliomyelitis — 1 1 1 — Totals 238 245 483 354 23 * Includes 28 cases removed to Creeksmouth Isolation Hospital, † These were removed to Orsett. 50 The following diseases were notifiable in 1928 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), ophthalmia neonatorum, cerebro-spinal fever, acute poliomyelitis, 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 483. exclusive of tuberculosis compared with 461 the previous year. During 1928 the number of notifications of tuberculosis (all forms) was 93 compared with 108 in 1927. ->1—5:2 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. 15 to 20 years. 20 to 35 years. 35 to 45 years. 45 to 65 years. 1 Over 65 years. Abbey. Gascoigne. Central. Ripple. Longbridge. Westbury. Small Pox — — — 1 — — 1 3 — — — — 4 1 — — — — Scarlet Fever 1 7 4 10 12 81 62 30 23 — 7 — 32 40 20 38 32 81 Diphtheria 1 3 3 10 9 54 10 6 3 2 — — 20 23 14 12 27 11 Puerperal Septicæmia — — — — — — — — 2 — — — — — — 1 1 — Pneumonia (primary, influenzal and following Measles) 3 14 3 3 3 7 1 7 8 5 12 8 18 18 11 8 8 11 Erysipelas 1 — 1 2 — 1 1 1 1 6 10 2 3 7 6 2 6 2 Ophthalmia Neonatorum 15 — — — — — — — — — — — 3 6 2 2 2 — Puerperal Pyrexia — — — — — — — — 3 3 — — 2 2 — 1 1 — Enteric Fever — — — — — 1 1 — 1 1 — — 2 — — — 2 — Anterio Poliomyelitis — — — 1 — — — — — — — — — — 1 — — — Totals 21 24 11 27 24 144 82 53 41 17 29 10 84 97 54 64 79 105 53 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1928: Scarlet Fever. Diphtheria Total. January 13 8 21 February 8 10 18 March 9 15 24 April 5 9 14 May 3 13 16 June 9 15 24 July 68 4 72 August 17 6 23 September 22 10 32 October 18 7 25 November 44 4 48 December 27 6 * 33 Total 243 107 350 (a) Scarlet Fever.—The number of cases notified was 243 compared with 184 the previous year. No fatal cases occurred. 230 cases were isolated at the local Infectious Hospital, including 28 at Creeksmouth. The average stay of scarlet fever cases in the Municipal Hospital was 31.48 days, compared with 36.5 days in 1927. The longest period of detention was 123 days and the shortest 12 days. Sex.—126 cases were male and 117 female. (b) Smallpox.—There were five cases of smallpox during the year under review. X They were all of a mild type and the situation was dealt with along orthodox lines. 54 It is a curious thing to see numbers of people waiting about the Town Hall to get their vaccination exemption certificates signed on the same evenings that the Health Committee is meeting to take measures—such as the notification of chickenpox, etc.—for the prevention of smallpox. Our experience in Barking is that smallpox at the present time is a very minor disability and that the disability of vaccination is quite comparable with smallpox itself, in which circumstance the general public, who can hardly be expected to weigh impersonal altruism in the scales against maternal love, can both be understood and appreciated even where their decision may be misguided. It is also a curious thing in this country that people will swallow excessive amounts of nauseous liquids and other preparations at great personal inconvenience and sometimes to their own detriment, and yet they have an ill-founded antipathy to the more scientific medicaments which can only be efficiently administered through that most dreaded of all sugical instruments—a hollow needle. There is no doubt that drugs in a bottle are looked upon with superstitious awe and the public are not prepared yet to receive the results of much painstaking scientific research where these require anything other than a dose of nasty physic. Objection to vaccination as such is due to superstition, and it cannot be too often emphasised that this is unreasonable and that vaccination does prevent smallpox. The best means of carrying out vaccination and the degree of protection it is most desirable to obtain and other questions are certainly before the country for very serious debate, and I do hope these questions will be explored from every possible point of view, and I am happy to believe that whatever may be the public's decision in the future it will be based on information rather than on the ignorance which has hitherto directed the present antipathy to vaccination. That vaccination is not without some danger has been known for a very long time. We are beginning to know exactly what that danger is and perhaps it will be possible to prevent it. 55 Whenever such cases arise they get a wide publicity, in which circumstance this danger is exaggerated, and whilst I do not wish to say anything to minimise the reality of this unfortunate aspect of vaccination I do want to say quite frankly that this danger is nothing comparable to the present dangers from traffic, so that to be logical those who are so bitterly opposed to vaccination ought also to promote legislation making it a penal offence for anyone to engage in methods of travel which have been introduced within the last century. I feel sure that the crux of the matter is an economic one and unless we do something to deal with smallpox we shall find that our export commerce is adversely affected, and I am sufficiently sceptical to believe that when once this is realised we shall not hear a lot more against vaccination. (c) Diphtheria.—107 cases were notified, compared with 77 the preceding year. Of cases notified, 104 were removed and treated in the local isolation hospital. No deaths from diphtheria occurred. The average stay of clinical diphtheria in hospital was 36.08 days, the longest stay being 111 and the shortest 13 days. Sex.—46 cases were male and 61 female. (d) Enteric Fever.—Four cases of enteric fever were notified during the year, 3 of which were removed to hospital. In one case the diagnosis was not confirmed. (e) Puerperal Fever.—Two cases were notified during the year, and both were admitted to hospital. The cases recovered. (f) Puerperal Pyrexia.—Six cases were notified during the year. All of the cases recovered. (g) Erysipelas.—26 cases were notified during the year compared with 30 during 1927. Four patients were removed to hospital. (h) Malaria and Trench Fever.—No cases were notified during the year. 56 (i) Acute Primary and Acute Influenzal Pneumonia.—74 cases were notified during 1928, compared with 111 for the preceding year. Five patients were admitted to hospital. (j Encephalitis Lethargica.—No cases were notified during the year. (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, a: d the deaths registered were as follows :— Measles 13 Whooping Cough 6 Summer Diarrhoea 6 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 contacts. ISOLATION HOSPITAL. The following is the table of admissions, etc., in respect of infectious diseases during 1928 :— Disease. in Hospital January, 1st. 1028. Admitted during the year. Died. Discharged In Hospital Dec. 31st. 1928. Scarlet Fever 20 230 — 222 28 Diphtheria 18 104 — 112 10 Pneumonia 1 5 4 2 — Puerperal Fever — 2 — 2 — Ant: Poliomyelitis — 1 — 1 — Enteric Fever 2 3 — 5 — Erysipelas — 4 — 4 — Miscellaneous — 1 1 — — 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 Tuberculosis 57 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. The number of notified cases on the register on December 31st, 1928, was 990, compared with 946 for the corresponding period of the preceding year. During the year, 93 notifications were received of all forms of tuberculosis—pulmonary 67, and non-pulmonary 26. Information was received of the removal into the district of four tuberculous persons. Forty-seven deaths of notified cases occurred. Particulars of new cases of tuberculosis notified and of deaths from the disease during 1928 is afforded by the following table :— New Cases. Deaths. Pulmonary. NonPuhnonary. Pulmonary. NonPulmonary. Male. Female Male Female. Male. Female Male. Female. Under 1 year 1 2 — — — — 1 to 5 years — — 3 3 — — — ' — 5 to 10 years 3 1 4 2 1 — — — 10 to 15 years — 1 2 2 — 1 — — 15 to 20 years 4 4 2 4 1 2 — — 20 to 25 years 3 7 — — 3 5 2 — 25 to 35 years 4 15 — 1 7 7 — — 35 to 45 years 6 5 — — 8 — — 45 to 55 years 6 2 — — 5 1 — — 55 to 65 years 3 2 — — 2 2 — — 65 yrs. & upwards 1 — — — 1 — — Totals 30 37 12 14 27 19 2 — 58 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. 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. 21 37 6 6 15 16 1 6 Forty-eight deaths occurred from tuberculosis (all forms,) 46 of these being pulmonary cases. The number of deaths in institutions was 21. The death rate for tuberculosis (all forms) during 1928 was 1.1, compared with 1.1 for the previous year. 964 attendances were made at the dispensary during the year for the purpose of medical examination, 187 being new cases. Of new cases attending during the year, 61 were subsequently notified as suffering from tuberculosis, 10 had been previously notified, while 4 were inward transfers. 59 The following table gives in tabular form the number of patients removed from the Dispensary Register during the year :— No. on Dispensary Registcr 31-12-27. Numbers removed from the Dispensary Register. Number on Dispensary Register 31-12-28 Died. Left District. Discharged (Non Tb.) Discharged " Cured " Transferred to another Dispensary. etc. Amended Diagnosis Total 494 36 18 90 3 20 3 170 511 At the end of the year, 439 cases on the Dispensary Register were definitely diagnosed as suffering from tuberculosis, whilst in 72 cases the diagnosis still remained in abeyance. REGISTER OF TUBERCULAR PERSONS. This register is, I am of opinion, misleading. It appears to be probable that there are a large number of patients whose names appear on this register who are either definitely cured or in whom it might be possible, after careful scrutiny, to decide that the present evidence does not support the diagnosis. In order that this register may be brought more up to date a very great amount of work will be necessary. This work should be undertaken forthwith, because it is obviously wrong to have a person's name appearing on such a register unless the evidence on which it is so included is conclusive. It is my hope that in my annual report for next year I shall be able to give you an assurance that a large amount of work has been done in this direction, that a large number of people have benefited by having their names removed and that the registers are proportionately a more reliable index of the grave situation which obtains in Barking with reference to tuberculosis. This de-notification of tuberculosis entails not only a large amount of work by your staff, it entails also a large amount of work by the general practitioners who are practising, and who have 60 practised In your area, and I do feel that, called upon as they are to co-operate in this work, they should have some financial remuneration for the work they undertake. It is for me to place on record my very high appreciation of the help I have already received in this direction on all hands without which it would have been impossible for this work to have been started, and equally impossible for it to be carried on. 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. ASBESTOSIS. During the year, my work at the Chest Clinic has drawn my attention to a particular disease which, whilst resembling consumption in many ways, is not due, I feel sure, to the germ of Tuberculosis, that is consumption. As Medical Officer of Health, the possible association of this disease with industrial life has had my attention, and certain steps have been taken in the matter. I am hopeful that our experience in Barking when correlated with that in other similar towns may help to clear up a somewhat difficult and serious problem. 61 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 use of the Artificial Sunlight Clinic, working in co-operation with the Infant Welfare Clinics, continues to be attended with good results. 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 790, the net total of 805 being obtained by adjustment of inward and outward transfers, etc. The births registered included 420 males and 385 females. There were 20 illegitimate births, or 2.5 per cent, of the total. In comparison with 1927, 95 more births were registered during the year, a rise equivalent to 11.8 per cent. 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 36 hours. Of the total live births all except 30 or 3.7 per cent, were notified. In addition 4 still births were not notified. The following table gives details of the notifications received By whom notified. Live Birihs. Still Births Medical Practitioners 129 5 Certified Midwives 509 9 Parents and Others 122 — The percentage of still-births was 1.7 62 Of the total live births during the year 470, or 59.5 per centwere attended by midwives, the remainder being attended by medical practitioners. BIRTH RATE. The birth rate for the year was 19.7, compared with 16.7 for England and Wales. MATERNITY AND INFANT WELFARE. The Ante-Natal Clinic. The work of the Clinic was carried on as in previous years. _ The attendances during the year were well maintained. The number of primary attendances was 398, compared with 340 for 1927. Reattendances numbered 1,063 in 1928, and 872 during 1927. One hundred and two sessions were held during the year, making an average attendance of 14 mothers per session. 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) Thoseengaging with the midwives of the Plaistow Maternity Charity. (c) Patients engaging with private midwives. Post Natal Cases. Seventeen 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. 63 MATERNITY WARD. The admission to the Maternity Ward of the Municipal Hospital numbered 200, compared with 221 in 1927. Of these 29 cases were admitted for ante-natal treatment, and 171 for confinement. Corresponding figures for 1927 were 45 cases for ante-natal treatment, and 176 for confinement. (1) Number of cases admitted 200 (29 of which Ante-natal) (2) Average duration of stay 15.3 days (3) Number of cases delivered by :— (a) Midwives 166 (b) Doctors 5 (4) Number of cases in which medical assistance was sought by the midwife with reason for requiring assistance:— (a) Ante-natal 2 (b) During Labour 9 1A.P.H. 1 Prolapse 1 Extended Breech 2 Abnormal Presentations 5 Uterine Inertia l Collapse after 3rd Stage (c) After Labour 14 (d) For Infant — Torn Perineum (5) Number of cases notified as puerperal sepsis with result of treatment in each case 1 (Cured) (6) Number of cases notified as puerperal pyrexia with result of treatment in each case None (7) Number of cases of pemphigus neonatorum None (8) Number of cases notified as ophthalmia neonatorum with result of treatment in each case None (9) Number of cases of " inflammation of the eyes," however slight None (10) Number of infants not entirely breast fed while in the Institution, with reasons why they were not breast fed 8 (a) Weakness of mother (suffering from Phthisis) 3 (b) Premature Infant 1 (c) Partially fed—delirate mother 4 64 (11) Number of maternal deaths None (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) Still-born 6 (b) Within 10 days of birth (Premature twin) 1 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. \ Two cases of puerperal fever were notified as compared with 8 in 1927. 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, 6 cases of puerperal pyrexia were notified, the confinement in 1 case being attended by a midwife. All the patients recovered. No definite cause of infection was found in any of the cases.. 65 MATERNAL MORTALITY. Two maternal deaths occurred during 1928, the deaths being certified as follows :— (a) Post partum haemorrhage .. .. .. 1 (b) Puerperal Eclampsia .. .. .. .. 1 NEO-NATAL MORTALITY. The number of deaths of infants under four weeks of age was 24, compared with 18 for the previous year in Barking. STILL-BIRTHS. Of the total notifications received under the Notification of Births Act, 18 related to stillborn children, giving a percentage of 1.7 compared with 2.7 in 1927. In addition, 2 Barking women were delivered of stillborn infants in institutions outside the district, so that the total number for the year was 20. Investigation of the health visitors elicited the following information :— (1) Duration of pregnancy :— (a) Less than seven months 1 (b) More than seven months 18 (c) Not elicited 1 (2) Presentation :— (a) Vertex 11 (b) Breech 5 (c) Transverse 2 (d) Not elicited 2 (3) Supposed cause of stillbirth:— (a) Abnormal presentation 1 (b) Overwork — (c) Accident, etc. 1 (d) Not known 13 (e) Ill health — (f) Shock 2 (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 two were engaged as clerks. 66 OPHTHALMIA NEONATORUM. There was a decrease in the number of cases of ophthalmia neonatorum, notifications being 15, compared with 24 in 1927. 11 of the cases occurred in the practice of midwives, the remainder being attended by medical practitioners. Cases. Age Group. Notified Treated. At Home. At Hosptl. Vision unimpaired. Vision impaired . Total Blindness. Deaths. Under 3 weeks 15 15 - 15 - - - 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. OPHTHALMIA 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. 67 INFANT AND CHILD WELFARE. Work of the Health Visitors and the Infant Clinics. 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 101 99 100 300 No. of attendances of children under one year:— (a) New cases 175 150 155 480 (b) Old cases 2014 1427 1715 5156 No. of attendances of children 1 to 5 years of age:— (a) New cases 34 39 28 101 (b) Old cases 792 1215 817 2824 Average number of attendances per session 29 28 27 28 No. of sessions attended by medical officers 99 99 99 297 No. of children seen by medical officers (a) Under one year 1493 1082 1188 3763 (b) Over one year 525 778 550 1853 Average number of children seen by medical officer per session 20 18 17 18 The total attendances during the year were 8,561 as compared with 8.592 in 1927. Particulars of the home visits paid by the health visitors is given in the following table:— No. of ante-natal visits 121 No. of first visits to children under one year 777 No. of subsequent visits to children under one year:— (a) Attending a Centre 296 (b) Not Attending a Centre 2,897 No. of visits to children 1 to 5 years of age:— (a) Attending a Centre 243 (b) Not Attending a Centre 2,987 No. of special visits in connection with Ophthalmia Neonatorum 29 Ditto Deaths of children up to 3 years of age 64 Ditto Still-births 17 Ditto Puerperal sepsis and Pueperal Pyrexia 6 Ditto Foster Children 27 Other visits (not specified) 283 68 THE PRE-SCHOOL CHILD. 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. Twenty-seven notifications were received during the year, and special visits were made by the health visitors to these children, who are also kept under supervision by the Infant Life Protection Visitor. INFANTILE MORTALITY. The total number of deaths of infants during the year was 51, giving an infant mortality rate of 63.3 per thousand registered births, compared with 66.1 per thousand for 1927. ILLEGITIMACY. Twenty illegitimate children were born during the year, and in the same period 6 deaths of illegitimate infants occurred; the infantile mortality rate among these children was therefore 300.0; while that for legitimate infants was 57.3. DENTAL CLINIC. A general increase in this branch of the work has been taking place, and during 1928 the attendances of expectant and nursing 69 mothers and of children referred from the Maternity and Child Welfare Clinics were as follows:— (1) Number of children treated 102 (2) Number of mothers treated:— (a) New cases 167 (b) Old cases 501 (3) Number of dentures supplied 41 Eighty-one 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. ORTHOPAEDIC CLINIC. Twenty-two children under school age were referred from the Infant Welfare Clinics or by the local medical practitioners for examination by the Orthopaedic Surgeon during the course of the year, and, in addition, 67 cases attended for re-examination. Three of the children received in-patient treatment at Orthopaedic Hospitals. The cases dealt with for the first time during 1928 were referred for the following conditions :— Deformities—Bones and. Joints— (a) Congenital: (i) Abnormal Skull 1 (b) Acquired : (i) Rickets 7 (ii) Genu Valgum 3 11 70 Muscular Deformities— (a) Congenital: (i) Talipes 5 (ii) Torticollis 3 (iii) Hemihypertrophy 1 (iv) Hypotonia 1 (6) Acquired: (l) Pes Planus Valgus 2 12 Paralysis— (a) Congenital: Nil. (b) Acquired : Double Erb’s 1 1 Congenital Deformities—Nil. Total 24 ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was continued during 1928. 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, 81 children received treatment during 1928. One session per week was devoted to these cases, and 757 treatments were given. 71 MEALS TO EXPECTANT AND NURSING MOTHERS. Advantage has been taken during 1928 of this provision under (he Act, 7 necessitous mothers having been provided with dinners as compared with 8 during the previous year. The total number cf dinners supplied was 214. 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. 1,091 7,825 8,916 £ s. d. £ s d. 123 5 8½ 115 18 7½ PROVISION OF DRIED MILK, Etc. Particulars of the amount of Dried Milk, etc., supplied free and at reduced rates, are as follows :— Ccst Price, (lbs.) Reduced Price, (lbs.) Free, (lbs.) Total, (lbs.) Glaxo (Full Cream) 46 8 17 71 Glaxo (Humanised) 822 41 120 983 Ambrosia 531 35 145 711 Cow and Gate 2,562 354 779 3,695 Ostelin 53 — — 53 Lactogol 138 — — 138 Virol 369 - — 369 Parrish’s 106 — - 106 Parraffin 186 186 Malt and Oil 399 399 Vitoleum Cream 795 — — 795