BARK 23 Barking Town Urban District Council. OF THE MEDICAL OFFICER OF HEALTH For the Year 1929. C. LEONARD WILLIAMS, B.Sc. Hons. (Lond.) M.R.C.S. (Eng.), D.P.H. (Camb.) 3 TABLE OF CONTENTS PAGE SECTION 1—GENERAL. Ambulance Facilities 17-18 Births 26 Causes of Death (Table) 24 Causes of Death at Various Ages under I year 25 Causes of Sickness 11-12 Clinic and Treatment Centres 15-16 Comparative Statistical Table 9 Deaths 22-23 Inquests 23 Laboratory Work 19 Local Bye-Laws, Regulations and Adoptive Acts 19-21 Marriages 26 Staff 3 Statistical Summary 8 Summary of Nursing Arrangements and Hospital Provision 13-17 . Table of Vital Statistics from 1923 to 1929 10 SECTION 2—SANITARY CIRCUMSTANCES OF THE DISTRICT. Common Lodging Houses 36 Factories, Workshops, Workplaces, etc. 42-45 Housing Statistics 29-31 Houses Let in Lodgings 36 Improvement of Existing Housing Conditions 45-48 Inspection and Supervision of Food :— (a) Milk 37-38 (b) Meat 38-40 (c) Unsound Food 40 Notices Served 34 Offensive Trades 36 Overcrowding 46 Piggeries 36 Kainfall 27 Kivers and Streams 27 Sale of Food and Drugs Act 40 Sanitary Inspection of the Area 31-32 Scavenging 28 4 SECTION 2—Continued. PAGE Schools 41 Sewerage 28 Stables 36 Summary of Sanitary Work carried out 32-34 Smoke Abatement 34-36 Tents, Vans, Sheds, etc. 36 Water Supply 27 SECTION 3—INFECTIOUS DISEASES. Acute Primary and Acute Influenzal Pneumonia 55 Asbestosis .. .. .. .. .. 62-64 Cases Classified According to Age, Groups and Wards 51-52 Chicken-pox 55 Diphtheria 55 Encephalitis Lethargica 55 Enteric Fever 55 Erysipelas 55 Malaria. 55 Measles and Whooping Cough 56 • Monthly Summary of Receipt of Notifications 53 Non-notifiable Diseases 55-56 Puerperal Fever 55 Scarlet Fever 53 Small-pox and Vaccination 54 Table of Admissions and Discharges from Hospital 56 Tuberculosis 56-62 Tuberculosis After-care 62 Table of Cases of Infectious Diseases notified and removed to Hospital 49 SECTION 4—MATERNITY AND CHILD WELFARE. Ante-Natal Clinics 66 Artificial Sunlight Clinic 74 Dental Clinic 72, 73. 76, 77, 78 Foster Children 72 Illegitamacy 73 Infantile Mortality 72 Maternal Mortality 69 Maternity Ward 67-68 Neo-Natal Mortality 69 Notification of Birth Acts, 1907-1915 65 Ophthalmia Neonatorum 70 Orthopaedic Clinic 73-74 Post-Natal Cases 66 Provision of Meals and Fresh and Dried Milk 75 Puerperal Fever and Puerperal Pyrexia 68 Still Births 69 The Pre-School Child 72 Work of Health Visitors and Infant Welfare Centres 71 ECONOMICS 79-80 5 STAFF, 1929. 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. (Cambs.) 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. (Died Mav, 1929.) *J. GWEN BEVAN, B.Sc., M.R.C.S., L.R.C.P. Orthopaedic Surgeon (Part Time) : *B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Dental Surgeon : *H. S. SMYTH, L.D.S., R.C.S. (Eng.). (Resigned August, 1929.) *W. H. FOY, L.D.S., R.C.S. (Eng.). (Commenced November, 1929.) Sanitary Inspectors : *N. BASTABLE (Chief Sanitary Inspector) (b, c, d and f). *H. CARR (Sanitary Inspector) (b, c and e). *C. S. COOK (Sanitary Inspector) (b). 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). 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) Smoke Inspector's Certificate of Royal Sanitary Institute. (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. (1) 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, 1929. Public Health Offices, Barking, Essex. To the Chairman and Members of the Urban District Council of Barking Town. Mr. Chairman, Mrs. Jackson and Gentlemen, The year 1929 has been a very energetic one so far as the whole of the Council's Services are concerned, and the Public Health Department has shared these activities. The development of the Becontree Estate has made it necessary to lay the foundations of an extended medical service. The present Report, being chiefly a record of technical work completed, will not, of course, show the amount of spade work which has been done during the year. This Report is unavoidably late. The circumstances which have helped to make it so are not likely to recur. I am, Mr. Chairman, Mrs. Jackson and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 8 SUMMARY OF PARTICULARS REQUIRED BY CIRCULAR 834 OF THE MINISTRY OF HEALTH, DATED 15th DECEMBER, 1927. 1. General Statistics. Area (acres) 4,106 Ward areas Tidal Water H.W.M. Thames 240 Roding 58 Loxford Water 2 3,806 300 4,106 Population (Census, 1921) 35,523 Population (June, 1929) (Registrar General's estimate) 42,160 Number of inhabited houses (1921 Census) 6,762 Number of Families or separate occupiers (1921 Census) 7,594 Population Density, i.e.. No. of persons per acre 10.3 Rateable Value—General £354,229 0 0 Sum represented by a penny rate /1,500 19 0 Education rates :— Elementary Secondary .. Included in General Rate Figure 3 0J 6 Assessable Value—Revaluation of District under the Rating and Valuation Acts, 1925 and 1928 General Rate 12.11 2. Extracts from Vital Statistics for the Year. Births :— Males. Females. Total. Birth Rate. Legitimate 391 382 773 18.3 Illegitimate 7 7 14 0.33 Total 398 389 787 18.7 Deaths:— Male. 221 Female. 214 Total 435 Death Rate. 10.3 Standard Death Rate (Factor 1.049) 10.8 Number of deaths of women during, or in consequence of, childbirth :— From Sepsis. 0 From other causes. 2 Total. 2 Number of deaths of infants under one year of age :— Total Infantile Death Death Males. Females. Total. Rate. Rate. Legitimate 21 16 37 47.9 53.4 Illegitimate 2 3 5 357.1 Number of deaths from Measles (all ages) — ., Whooping Cough (all ages) 3 Diarrhoea (under 2 years of age) 9 H KMt, AMJ AJJALHtlt !_>*• MUKIAUIY DURIN*.. 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 Cause9 of Death. England and Wales 16.3 13.4 0.01 0.00 0.08 0.02 0.15 0.08 0.74 0.55 8.1 74 91.5 6.1 1.5 0.9 107 Count;- Boroughs and Great Towns including London 10.6 13.7 0.01 0.00 0.12 0.02 0.19 0.09 0.76 0.50 10.9 79 91.8 5.8 1.9 0.5 157 Smaller Towns (1921 Adjusted Populations 20,00050,000) 16.0 0.71 0.01 0.00 0.06 0.02 0.15 0.07 0.71 0.45 5.9 69 92.6 5.4 1.0 1.0 London 15.7 13.8 0.01 0.00 0.04 0.02 0.26 0.08 0.69 0.56 10.7 70 89.5 6.8 3.7 ; o.o BARKING 18.7 10.3 0.00 0.00 0.00 0.07 0.07 0.09 0.47 0.45 11.4 42 93.1 3.7 3.2 0.0 VITAL STATISTICS OF WHOLE DISTRICT FROM 1923 to 1929. 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 7 8 9 10 11 12 1923 37,210 S62 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 59.9 366 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 1929 42,160 787 18 7 291 6 9 8 152 42 52.4 435 10.3 * ??? 11 5. CAUSES OF SICKNESS, Last year I called your attention to the fact that amongst things prejudicial to health must be counted the condition of the District Railway to Barking. My information is that certain steps have been taken to mitigate this nuisance, but I myself have been unable to see any change for the better. It is not only bad from a public health standpoint but bad economically for people to have to spend no inconsiderable part of their working day under the unhygienic circumstances which obtain on this railway. 11 Last year also, I called to your notice that my attention had been drawn to a particular disease which, whilst resembling consumption in many ways, was not due, I felt sure, to tuberculosis. At that time, too, I expressed the opinion that there was possibly some association between this disease and industrial life. During the year under review I have had the greatest help from my colleague, Dr. Burton Wood, and also from Dr. Gloyne, who is the pathologist at the Victoria Park Chest Hospital, and we have established that many people in Barking are suffering from disease of the lungs due to the inhalation of asbestos dust. Somewhat late, the Home Office on 17th March, 1930, issued a memorandum on this subject, after you, on the findings of our personal experience, had made representations to them. The incidence of diphtheria and scarlet fever has been heavy, and diphtheria has been severe in type. It is interesting to contrast the relative severity of diphtheria in this coastwise town of Barking with the relative mildness of the disease on the uplands of Yorkshire. 12 It cannot be too often emphasised that diphtheria is easy to treat if detected early, and so very difficult to treat if only detected late. It therefore behoves everybody having the charge of children to treat sore throats seriously. • Overcrowding is still a serious feature, and although you have done magnificently in erecting houses in the past, there is yet heroic work to be done. Enthusiasts, as you know, spoil all schemes by declaring that their pet nostrum will cure the world of all its ills. I cannot advise you that housing the people can solve all the problems of public health, but I am perfectly persuaded that these problems will never be solved until the people are re-housed under proper circumstances. 13 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 required, and offer instructions where advisable in hygienic home practices in relation to the sick. I understand that this Charity is willing to entertain the possibility of extending its activities to cover the whole of Barking, i.e., to include the Gale Street area. (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. The provision of adequate hospital accommodation for in- ' fectious diseases is the best way of dealing with these cases. It would not be economic to build every house in such a way that there would be readily available accommodation for isolating the inmates. Further, if such structural amenities were present, it is not to be supposed that actual nursing facilities would be generally available. * My own personal opinion is that all infectious cases should more and more be treated in hospital, and that, therefore, you have been very wise in deciding, in planning your new infectious fever hospital, to have available sufficient ground for 50 per cent, more than the one bed per thousand of population which is the present generally accepted standard for such hospitals. 14 (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, 1929, amounted to £280, leaving a balance due to the charity from the Council of £20, such sum ranking for grant. 15—10 (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. „ „ Alexandra Centre „ „ (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 Clinic „ „ One room. „ „ (c) Dental Clinic „ „ Two rooms. „ „ (d) Orthopedic Clinic Faireross School. One room. „ „ III. Tuberculosis 37, Linton Road. Three rooms. Essex County Council. IV. VeDereal Diseases London Hospitals, etc. – By arrangement with Essex County Council. 17 (d) Hospitals provided or subsidised by the Local Authority:— (i) Small-pox:—By arrangement with the West Ham Authorities, small-pox cases occurring within the Council's area are treated at Orsett Hospital, but in the event of that hospital having its full complement of small-pox patients, provision would be made for these cases to be sent to the Dagenham Small-pox Hospital, which is now used by West Ham as a Sanatorium and which can be vacated at short notice. Orsett Small-pox Hospital is situated at Stifford, in the Orsett Rural District, and has accommodation for twenty-two patients. (ii) You, as a corporation, have provided two hospitals. They are both situated in the Upney Lane, one for the isolation and treatment of infectious diseases and the other for maternity cases. (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. On September 19th, 1929, you took delivery of a Du Cros Ambulance, similar to that used by the M.A.B., except that the following structural differences had been incorporated, namely :— * * ]. That the ends of the stretchers to which the spring mattresses are attached had been curved in accordance with modern hospital practice, and 18 2. Provision was made for bucket seats to replace one stretcher, so that abdominal cases returning from hospital could sit up more comfortably than they could lie on a stretcher. The ambulance is run by firemen, who have attained a very high degree of efficiency in carrying out this work, but the necessity of having a nurse always in attendance is a matter for your consideration, and in the case of removal of women patients this is most desirable. Up to the present our firemen have always found that the relatives or friends of the patient have carried out this duty, or, where necessity has demanded it, the doctor in charge of the case has himself travelled in the ambulance to the hospital, but you will no doubt wish to put the whole matter on a more satisfactory basis. 19 7. LABORATORY WORK. The necessary laboratory work of the district is carried out bv 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 1,509 Sputa 511 Typhoid 22 Ringworm 6 Miscellaneous 6 The work carried out by the Counties' Laboratories of Queen Victoria Street is of a very high order, and it is not open to criticism, except in so far as that, of course, it is difficult to get reports through sometimes so quickly as one would wish. This criticism deals specially with diphtheria swabs. You may decide, as and when your new hospital is open for infectious diseases, to make provision to carry out a certain number of these bacteriological examinations yourself in cases of suspected diphtheria. 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. (iil General Adoptive Acts: Baths and Wash-houses Acts, 1847, etc. Infectious Diseases (Notiiication) Act, 1889. 20 Public Health Acts Amendment Act, 1890, Parts 2, 3 and 5. Public Health Acts Amendment Act, 1907, Parts 2, 3, 4, 5, 6 and 9, and Section 95 of Part 10. Local Government and other Officers' Superannuation Act, 1922. Pubiic Health Act, 1925. (iii) Regulations: Regulations as to Cemetery, 1902. Barking Town (Pneumonia) Regulations, 1924. (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). 21 New Streets and Buildings, 1926. Slaughter Houses, 1890. Hospitals, 1S97. Sanitary Conveniences, 1924. Pleasure Grounds, 1902. Mortuary, 1901. (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. 22 9. DEATHS. There were 291 deaths registered in Barking in 1929. Of these 8 were deaths of non-residents. Barking residents to the ♦ number of 152 died elsewhere during the year. * Including the latter and excluding the deaths of visitors, the net number of deaths was as follows :— Males. Females Total 221 214 435 The death rate for 1929 was 10.3 per 1,000, compared with 10.1 in 1928, calculated on the Registrar-General's estimated population and number of deaths, compared with 13.4 for England and Wales, 13.7 for the hundred and seven Great Towns, 12.3 for the hundred and fifty-seven Smaller Towns, and 13.8 for London. 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 46 1 to 2 years 8 2 to 5 years 13 5 to 15 years 12 15 to 25 years 20 25 to 45 years 53 45 to 65 years 123 Over 65 years 160 23 Causes of death in 1929.—The table on page 24 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 50 11.5 Cancer 33 7.6 Tuberculosis (all forms) 38 8.7 Pulmonary affections, (exclusive of tuberculosis), viz., Bronchitis 62 14.3 Pneumonia 55 12.6 Other respiratory disease 4 0.9 Zymotic Diseases 17 3.9 Deaths from Zymotic Diseases.—These diseases caused 3.9 per cent, of the total deaths, such deaths being caused in the following proportions :— Enteric Fever — Measles — Whooping Cough — Scarlet Fever 3 Diphtheria 4 Diarrhoea 10 Smallpox — INQUESTS.—Coroner's inquests were held on 16 deaths. 24 CAUSES OF AND AGES OF DEATH DURING YEAR, 1929. (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 — — — — — 1 — 1 Influenza — — 1 — — 3 2 6 Scarlet Fever — 1 2 — — — — 3 Small Pox — — — — — — — Measles — — — — — — — Whooping Cough — — — — — — — — Epidemic Influenza — — — — — — — — Diarrhoea and Enteritis (under 2) 8 2 — — — — — 10 Diphtheria — 2 2 — — — — 4 Enteric Fever — — — — — — — — Erysipelas — — — — — — 1 1 Puerperal Fever — — — — — — — — Other accidents and diseases of pregnancy and parturition 1 1 Phthisis (Pulmonary Tuberculosis) — 1 — 10 14 9 i 35 Other Tubercular Diseases — 1 — 2 — — — 3 Asbestos — — — — 1 1 — 2 Cancer (Malignant Disease) — — — — 4 14 15 33 Bronchitis 3 1 1 — 3 14 40 62 Pneumonia 2 13 — 4 9 11 16 55 Other Respiratory Diseases — — — — 2 2 — 4 Alcoholism (Cirrhosis of Liver) 1 — — — — — — 1 Premature Birth, Malformation and Debility 16 _ _ 16 Accidents — 3 — 2 4 2 4 15 Suicides — — — 1 1 3 — 5 Rheumatic Fever — — — — — — — — Diabetes — — — — — — — — Cerebral Haemorrhage 1 — — — 2 8 14 25 Heart Disease — 1 — 1 2 19 18 41 Arterio-Sclerosis — — — — — — 6 6 Ulcer of stomach or duodenum — — — — 2 4 1 7 Asthma — — — — — 4 4 Anaemia — — — — — 1 2 3 Arthritis — — — — — — 1 1 Meningitis (non-Tubercular) 4 — — — — — — 4 Appendicitis and Typhlitis — — — — — — — — Acute and Chronic Nephritis — — — — 3 3 2 S Other defined diseases 4 1 4 5 6 18 38 76 Causes ill-defined or unknown 3 — — — — — — 3 Totals 42 26 10 25 54 113 165 435 25 INFANT MORTALITY DURING THE YEAR 1929. 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:— Causes 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 — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — Tubercular Meningitis — — — — — — — — — — Other Tubercular diseases — — — — — — — — — — Meningitis (non tubercular) — — — — — — 2 — 1 3 Convulsions 9 — 1 — 3 — — — — 3 Laryngitis — — — — — — — — — — Bronchitis — — — — — 1 — 1 — 9 Pneumonia (all forms) — 1 — — 1 1 2 Diarrhoea — — — — — — 9 1 — 3 Gastritis — 1 1 — 9 2 — 1 — 5 Acute supra Renal — — — — — — 1 — — 1 Deficient inherent vitality 2 — 1 — 3 — — — — 3 Jaundice — 1 — _ — 1 Cerebral Haemorrhage — 1 — — 1 — — — — 1 Congenital malformation — — — — — — — — — — Premature Birth 9 1 2 — 12 — — — — 12 Atrophy, debility and Marasmus 1 1 — — 9 — — — — 2 Want of attention at birth 9 — — — 9 _ — 2 Other causes 2 — — _ 9 — — — — 2 Totals 18 5 5 — 28 4 5 4 1 42 Nett Births in the year :— Legitimate 773 Illegitimate 14 Nett Deaths in the year :— Legitimate 37 Illegitimate 5 26 10. MARRIAGES. There were 276 marriages registered in the district in 1929. This is equal to a marriage rate of 6.5 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 ; in 1925, 258 marriages equal to a rate of 6.7 ; in 1926, 249 marriages equal to a rate of 6.3; in 1927, 304 marriages equal to a rate of 7.6, and in 1928, 311 marriages equal to a rate of 7.6. 11. BIRTHS. The net number of births registered in 1929 was 787, affording an annual birth rate of 18.7 per 1,000 population, compared with 19.7 in 1928 and 17.7 in 1927. Of all births, 14 were illegitimate, or a proportion to total births of 1.8 per cent. Notification of Births Act, 1907-1915.—Of the total births recorded in the district during 1929, 733 were notified to the Medical Officer of Health, 503 being notified bv midwives and 230 by parents and doctors. 20 still-births were notified, 17 being notified by midwives and 3 by doctors and others. 6 still-births, which took place in the district, were not notified. 27 SECTION 2. SANITARY CIRCUMSTANCES OF THE DISTRICT. WATER SUPPLY. Water is supplied to the area by the South Essex Waterworks Company. During the year there has been much ado about the cost of water. Apparently the Waterworks Company have exercised certain rights to increase their charges, and the operation of the new Rating and Valuation Act has again varied the assessment of the water rate. It cannot be too strongly emphasised that a bountiful supply of pure water is one of the very foundations of a sound public health service and must be obtained at whatever cost, and by the same token a cheap supply of pure water is one of the essentials -of public health. RIVERS AND STREAMS. The Rivers and Streams of the district come w'thin 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. RAINFALL. The rainfall for the year ended December 31st was 18.17 inches. Rain fell on 221 days throughout the period in question. 28 SEWAGE. It is gratifying to note that progress has been made and that at the time of this Report, work has been started on the comprehensive scheme to deal with the sewage of Ilford and Barking. The present scheme is in its essence one proposed by Barking now many years ago and provides for the reception of the sewage into the Northern Outfall Works. It appears that if the London County Council had accepted this principle when it was first put forward by Barking, many of the present difficulties in dealing with our sewage, particularly with the sewage from the Becontree Estate, would have been obviated. SCAVENGING. Street cleansing, together with the collection and disposal of the domestic refuse, is under the control of the Engineer and Surveyor. It is gratifying to be able to report that the method of collection, which previously has been somewhat antiquated and unsuitable,, has now been brought up to date, S.D. freighters being used. During the year 54,172 loads of refuse were collected, the average weight per load being 1 ton 4 cwt. Crude refuse is still dumped on the low-lying land at Mayesbrook. Certain improvements are being carried out in the methods of tipping, but nothing short of " controlled tipping " as carried out at Bradford can be looked upon as satisfactory. CESSPOOLS, PRIVYMIDDENS AND PAIL-CLOSETS. In the unsewered portion of the district there remain 46 premises with cesspools, 45 with pail-closets and 7 with privies. So soon as the sewerage scheme which is now in preparation is completed, these premises will be connected with the sewer it isproposed to provide. 29 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 1929. 1. GENERAL. Number of new houses erected during the year :— (i) Total 700 (ii) As part of a municipal housing scheme— (a) Barking 206 (b) L.C.C 257 (iii) Others (including private enterprise and subsidy houses) 237 2. UNFIT DWELLING HOUSES. I.—Inspection. (i) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) .. .. .. 4.413 (ii) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulation ;, 1910 1,148 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to . health as to be unfit for human habitation .. .. .. .. .. 10 r (iv) Number of dwelling houses (exclusive of 1 those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation .. .. .. .. .. 2,420 30 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. 2,191 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 112 (ii) Number of dwelling houses which were rendered fit— . (a) by owners 109 (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 379 (ii) Number of dwelling houses in which defects were remedied:— (a) by owners 379 (b) by local Authority in default of owners Nil 31 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 9 (ii) Number of dwelling houses in respect of which Closing Orders were made 9 (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 SANITARY INSPECTION OF THE AREA Work of Sanitary Inspectors. 1. Inspection of Dwelling Houses. Total under Public Health or Housing Acts 4,413 Housing (Inspection of District) Regulations 1,148 After Infectious Disease 573 Defects Found 8,435 Notices Served (Preliminary) 2,420 Re-inspections re Notices Served 3,108 2. Premises Controlled by Bye-Laws and Regulations. Houses Let in Lodgings 33 Common Lodging Houses 63 Offensive Trades 190 Tents, Vans and Sheds 76 Dairies, Cowsheds and Milkshops 267 Slaughter-houses 98 32 3. Factories, Workshops and. Workplaces. Factories 116 Laundries 22 Bakehouses 42 Other Workshops 87 Other Workplaces 81 Outworkers' Rooms 22 Butchers' Premises 382 Fishmongers 114 Restaurants and Dining Rooms 80 Markets 120 Stables and Stable Yards 136 Piggeries 120 4. Miscellaneous. Smoke Observations 133 Rats and Mice (Destruction) Act, 1919 149 Vacant Land and Refuse Dumps 209 Public Lavatories 48 Schools 46 General Shops 160 Ice-Cream Vendors 100 Petroleum Stores 83 Small-Pox Contacts Visited 307 SUMMARY OF SANITARY WORK CARRIED OUT. (a) Drainage. Choked drains, opened, repaired, and cleansed 192 Drains reconstructed 82 New Drains nil Ventilation Shafts repaired or new fixed 27 New Inspection Covers 6 33 (b) Closet Accommodation. Roofs Walls Floors Doors W.C. structures repaired 103 Seats Fixed 83 W.C. Pans Fixed or Cleansed 157 Flushing Apparatus Repaired or Renewed 319 Privies to Pail Closets nil (c) Sinks. New Fixed 130 New Sink Wastepipes 1ll New Gullies 144 (d) Dampness. Roofs 909 Eavesgutters 482 Rainwater Pipes 170 Damp Walls Remedied 403 (e) Water Supply. Storage Cisterns Abolished 11 Defective Water Fittings Repaired and Supply Reinstated 136 Existing supplies increased 14 (f) Yard Paving. Yard paving repaired or relaid 255 (g) Dustbins. New ones provided 533 34 (h) General Repairs. House floors repaired 353 Windows repaired or renewed 160 Window sills repaired or renewed 174 Sashcords renewed 460 Stoves or coppers repaired or renewed 470 House doors repaired or renewed 263 Stairs repaired 100 Chimney pots renewed and stacks rebuilt 106 Dirty or defective rooms repaired, cleansed and redecorated 1,709 Insufficient floor ventilation 160 External painting 31 (i) Miscellaneous. Offensive accumulations removed 53 Animals so kept as to be a nuisance 27 Verminous rooms and persons disinfected 35 Smoke nuisances 44 Drains tested 468 Dangerous structures reported 64 NOTICES SERVED. Informal Notices 2,420 Statutory Notices 491 Section 36, Public Health Act, 1875 48 491 Section 94, Public Health Act, 1875 329 Section 41, Public Health Act, 1875 1 Section 5, Infectious Disease (Prevention) Act, 1890 1 Section 3, Housing Act, 1925 112 SMOKE ABATEMENT. During the year 139 smoke observations were carried out on factory chimneys and action taken with respect to the 44 offences registered. 35 The question of atmosphere pollution and its attendant evils is still receiving the earnest attention of health research workers, but so far, owing to the absence of legislation with respect to domestic chiemneys. the general improvement in the purity of the air is unsitisfactory. Smokeless fuel for open grates is not yet produced in sufficient quantity to prove a solution of our troubles. It seems to me, however, that smokeless fuel may well become in the future one of our chief methods of smoke abatement. Such smokeless fuel is being produced in Barking, and I hope that improved methods of production will improve the quality of the product and that increased production will enable it to be marketed at an economic figure. I should certainly like to see smokeless fuel used extensively as comprehensive experiment. Factory chimneys are now rarely found offending for any length of time, largely due to the use of improved methods in the application of coal, the utilisation of waste heat and the extended use of gas and electricity. The problem of smoke abatement as it affects the electricity generating station at Creeksmouth is a very difficult one. We know that the officials at that station are constantly endeavouring to obtain satisfactory combustion conditions and we hope that the}' will shortly overcome the many difficulties which up to the present have not been satisfactorily solved. The question of adopting a bye-law limiting black smoke comission, is in abeyance pending the result of an application made to the Ministry of Health with respect to the Greater London Area. With reference to the general question of the smoke problem Set before you in my last Annual Report, it is unfortunate that chemists and engineers have not provided a suitable alternative to the. common coal lire for domestic purposes. 36 The practice of sending poisonous gases through more or less leaky tubes will be looked upon in time as one of the farcical incongruities of our age, and the cost of electricity for heating when the need for adequate ventilation is taken into account makes it impracticable to use electricity for general domestic heating. OFFENSIVE TRADES. The 36 registered premises received 190 visits and 31 breaches of the bye laws were found. 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 68 stables in the district received 136 visits during the summer months. COMMON LODGING HOUSES. Sixty-three visits were paid to the two common lodging houses. 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 a number of 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. 37 INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. Including five whose premises are situated outside the district, there are 37 retail purveyors. The premises are frequently inspected. Generally speaking, the cleanliness of the milk supplied is of a satisfactory standard. Of the samples examined during the year it is interesting to note that 6 samples of raw milk submitted were unsatisfactory, 4 samples of pasteurised milk, and 1 sample of Grade A (T.T.) milk were found below the standard of cleanliness. During the year one dairyman was prosecuted for the bottling of milk in the street. 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 . Grade A (T.T.) Milk 6 1 7 Grade A Milk — — - Raw Milk 17 6 23 Pasteurised Milk 4 4 8 Sterilised Milk — — — 27 11 38 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 1 (c) " Pasteurised " Milk 3 (d) Grade A (T.T.) 9 38 Licences were granted to 2 local firms for the bottling of Grade A (T.T.Milk. There are in the district 44 retailers and 9 wholesale distributors of sterilised milk. A considerable amount of milk is sold in Barking as ordinary milk, which, to our knowledge, has been pasteurised. This, I believe, is not an offence at law. The unfortunate thing is that if this milk which has been pasteurised were sold as pasteurised milk instead of as ordinary milk, we could demand a much higher standard of bacterial purity than oftentimes obtains. The law very rightly demands a higher standard for pasteurised milk than for ordinary milk, because pasteurised milk is a more vulnerable food product than ordinary milk. I recommend to you that you endeavour to promote legislation to enforce that any milk which has been pasteurised shall be so designated and shall be subject to the standards governing pasteurised milk at the present time. 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 72 notifications to slaughter were received and 64 beasts, 137 pigs, 426 sheep, and 10 calves were examined. 39 Diseased meat was destroyed as under:— Description. Disease. t. 2 Beasts, Lungs Tuberculosis 24 lbs. 1 „ Lung Echinococcus 10 lbs. 1 „ Pluck Tuberculosis 24 lbs. 17 „ Livers Distomatosis 238 lbs. 2 „ Livers Tuberculosis 8 lbs. 1 „ Mesentic fat „ 2 calves, Plucks ,, 14 lbs. 2 sheeps, Plucks Parasites 14 lbs. 16 „ Livers Distomatosis 64 lbs. 61 „ Lungs Parasites 183 lbs. 9 Pigs, Heads Tuberculosis 126 lbs. 17 „ Plucks ,, 119lbs. 2 „ Livers Angioma 10lbs. 8 „ Livers Tuberculosis 24 lbs. 12 „ Lungs Parasites 36 lbs. 1 „ Lung Inflammation 3 lbs. 7 „ Mesenteries and fats Tuberculosis 3 „ Carcases and offal. ,, 300 lbs. Total weight 1,197 lbs. The following table gives particulars of notifications received, and the animals slaughtered, during the period April 1st, 1925, to December 31st, 1929. Year 1925 1926 1927 1928 1929 Total. Notifications Received 110 109 150 126 72 567 Cuttle 102 3 97 40 64 306 Pigs 74 86 204 109 137 910 Sheep 519 611 786 815 426 157 Calves — 156 137 71 10 3374 Totals 695 856 1224 1315 637 4747 40 The question of providing a public abattoir has been mooted during the year 1929. The above table shows the amount of slaughtering which has gone on in the town during the past five years. It will, of course, be agreed that this amount of slaughtering does not justify public expenditure on the erection of an abattoir and the case for a public abattoir must rest on how much extra work of this nature would be undertaken if the facilities were afforded. UNSOUND FOOD. The following list gives particulars of the unsound food destroyed during the year:— One pig's pluck, and one half pig's head. 3½ dozen escollops. During the year one butcher was prosecuted and fined £10 for exposing for sale diseased meat. 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, 1929, the following articles of food were taken in Barking and submitted to the Public Analyst for analysis:— Milk. Butter. Other Samples. Total. 64 75 65 204 One prosecution for adulterated pepper resulted in a fine of 10s. and 6s. costs. 41 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. The schools of the district were built, as I have said on many occasions, not wisely but too well. With the development of the Becontree Estate an exceptional opportunity presents itself for school construction on hygienic principles. The Council, through the Education Committee, is responsible for seeing that the schools are provided, and of course it is expected that the schools would be suitable, and the Council, through the Public Health Committee, is responsible for seeing that the schools are suitable. Where, as in Barking, the Medical Officer of Health is School Medical Officer, a lot of unnecessary duplicating of actual work is avoided and there is not the need for conferences between the Education Committee and the Health Committee which there would otherwise be, but in order to emphasize the importance of the hygienic principles of school construction it might be wise that on the Committee dealing with school construction there should be members definitely representing the Health Committee. This matter is not of such pressing moment now when most of the members of the Council sit on both Committees, but it may well become very important when in the future, owing to the large amount of work which is being transacted the actual number of members sitting on each individual Committee would be restricted. 42 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 116 8 — — Workshops 87 20 — _ Workplaces 167 6 — — Total 370 34 — _ 43 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 clean! iness 12 12 — — Want of ventilation 1 1 — — Overcrowding — — — Want of drainage of floors — — — — Other nuisances 23 23 — — Sanitary accommodation :— Insufficient 6 6 Unsuitable or Defective 15 15 — - Not separate for sexes — — — — Unscreened for Sexes — — . — - 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) 4 4 - - Other offences (excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 61 61 — — * 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 17 workpeople engaged on making wearing apparel in their homes. 44 REGISTERED WORKSHOPS. Workshops on the Register (Sec. 131) at the end of the year. (I) Number. (2) Bakehouses (including six factory bakehouses) 13 Other Workshops 66 Total number of Workshops on Register 79 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) - 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) 5 Other 1 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 40 outworkers :— Box Makers 2 Wearing Apparel 16 Ties 5 Umbrella mnkers 2 Life belt covering 9 Boot Repairers 1 Art. Flowers 1 Brush Makers 2 Upholsterer 1 Christmas Cracker Maker 1 During the year 30 lists of out-workers were received from other Authorities in respect of addresses in Barking. Four lists were received from employers within the district. In all instances the premises of out-workers were kept in a satisfactory state. 45 It is unfortunate that there is not a closer co-operation between the Home Office on the one hand and Local Authorities on the other hand in the matter of the inspection of factories. Indeed it is even more unfortunate that when the Ministry of Health was created, the medical inspection of factories was not delegated to the Minister of Health, who could very well have made regulations delegating his powers and responsibilities to Local Authorities whose organisations made them competent to carry out the work. This has been very amply illustrated in the case of asbestosis in Barking. In a later part of this Report I am dealing more particularly with asbestosis as a separate subject. HOUSING. The urgency of meeting the post-war shortage of houses resulted not only in municipal enterprise and state aid to private builders but also in a general improvement in the layout of the sites, reduced density of the dwellings and the provision of open spaces in connection with them. The houses erected in Barking are of the typical town street type with minimum frontage but substantial improvement in their character and design over pre-war buildings. An occasional touch of emphasis and variety, however, would have done much to relieve the monotony of vista in some of the new streets. Of all the changes which have taken place in house design, that with respect to the heating of the dwelling is the most noticeable and important. The growing realisation of the evil effects of the smoke and waste resulting from the use of raw coal in domestic fires is stimulating the adoption of alternative methods. 46 In this regard it is important for those erecting new houses to decide how far it is wise to commit themselves to one or another of the alternative methods of heating. Whilst gas and electricity have advantages for temporary heating and local application, the general demand in future for continuous heating of rooms will be some form of improved smokeless fuel. The building of all gas or all electric houses is to be seriously deplored. The omission to provide flues to carry off the products of combustion, is unwise, and further, the absence of such flues leaves much to be desired in the matter of ventilation. In connection with gas heaters, particularly where it is imperative for safety that some form of direct outlet or flue should be provided, the sensible thing would be to build the flue so that it would equally well serve a coal fire. The year 1929 saw the erection of the first house on the Gale Street Section of the London County Council Estate, and the provision of a further 206 houses by the Barking Council. There was also an extension in the provision of houses for owner-occupiers to the extent of 237 erected. Whilst the erection of 206 houses by the Local Authority meant relief to many poor families living in overcrowded conditions, it was far from dealing adequately with the full situation. It is impossible, without taking a special census of the district, to estimate accurately the extent of overcrowding existing at the present time, but that it is extensive is borne out by information resulting from inspections by health officials and by receipt of complaints. The major reason for the overcrowding is the total absence in the district of accommodation for the poorer of the working classes, such as two or three-room tenements. 47 The result of the absence of such accommodation is that these families are compelled to occupy one room shut off from the rest of the house. Virtually one-roomed back-to-back houses, which are sometimes worse than the unfit houses scheduled for demolition. In this one room all the occupations of the day and night are performed. Parents and family have to rise, dress, wash, cook and cat their meals, etc. A fire burns all day, winter and summer, as this is the only means of cooking and heating water. By the time night comes the whole family crowds itself again into one or two beds and attempts to secure what refreshing sleep it may in an atmosphere fouled and vitiated by the day's occupations. Many of these families consist of man, wife and children of mixed sexes and adolescent age. Under these conditions the preservation of cleanliness and bodily health are as difficult as the maintenance of modesty. Further, much of the good work which could be achieved with regard to child welfare must be largely thwarted and rendered abortive by the hopelessness of the surroundings into which so many of our babies are born. This may be reiteration of what has previously been written but I must repeat and emphasise it. Although the Council has done such fine work in providing so large a quota of houses for the working classes, it is very urgent and imperative that much additional accommodation should be provided for the poorest of the poor, and it is my earnest hope that the Council will take advantage of the passing of the Housing Bill No. 2 to make an extension of their activities in this direction. GENERAL STANDARD OF HOUSING. The general standard of housing in the district is good for an industrial area. Apart from the old houses situated in certain parts of Abbey and Central Wards the dwellings are of a type and structure which permit of adequate lighting and ventilation, and were it 48 not for the growth of overcrowding referred to above, schemes for dealing with the small amount of slum property in the town could have been formulated. * The working-class houses in the district have the advantages of good wide streets and adequate back garden area, giving better external ventilation than is usually found in old industrial towns. The defects which are most frequently met with are indicated in the summary of sanitary work carried out. Our experience during recent years is that owners will not, owing to the altered economic conditions, carry out any major maintenance works, such as repairs to the external walls and woodwork of the houses, with the result that considerable decay of the structures of working-class houses is taking place and would inevitably lead to further slum dwellings but for the application of the Housing Act. There is not the slightest doubt, however, that many of the internal defects in houses are largely contributed to by the misuse and carelessness of the tenants, whose personal and environmental cleanliness is much to be deplored. There is ample scope for self-help in health, and the application of this by many of the citizens of Barking would enhance the general health of the community and stimulate the Local Authority to further efforts on their behalf. 49 SECTION 3. NOTIFIABLE INFECTIOUS DISEASES. The following table shows the number of notifications of infectious disease received during 1929 :— TABLE I. Males. Females. Total Total cases rem'd to Hos. Deaths. Small Pox 4 7 11 11* — Scarlet Fever 129 148 277 238 3 Diphtheria 43 52 95 89 4 Puerperal Septicaemia _ 1 1 — _ Pneumonia (Acute primary and influenzal & following Measles) 52 50 102 6 42 (All Forms) Erysipelas 21 15 36 5 Ophthalmia Neonatorum 12 2 14 Puerperal Pyrexia — 4 4 — — Enteric 3 — 3 3 — Anterio Poliomyelitis 2 1 3 1 — Cerebro Spinal Fever 1 1 1 1 Totals 266 281 547 354 50 These were removed to Orsett. One case was returned after one week, the diagnosis not being confirmed. , 50 The following diseases were notifiable in 1929 under the original Infectious Disease (Notification) Act, 1889, and 1899 Small-pox, 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, cercbro-spinal fever, acute poliomyelitis, encephalitis lethargica, influenzal pneumonia, acute primary pneumonia, malaria, dysentery, trench fever, and puerperal pyrexia. An order was made under the Infectious Disease (Notification) Act, 1889, making chicken-pox a notifiable disease throughout the district. The Barking Town (Pneumonia) Regulations, 1924, provides for the notification of Pneumonia supervening upon Measles. The total notifications of infectious disease numbered 547 exclusive of tuberculosis and chicken pox compared with 483 the previous year. During 1929 the number of notifications of tuberculosis (all forms) was 73 compared with 93 in 1928. 51—52 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. Over 65 years. Abbey. Gascoigne. Central. Ripple. Longbridge. Westbury. Small Pox - - - - - 1 2 3 3 2 - - 1 1 6 3 — Scarlet Fever 3 11 15 17 14 119 56 19 20 2 1 - 44 28 23 60 58 64 Diphtheria 2 5 7 6 15 37 9 6 4 4 — - 19 27 10 14 15 10 Puerperal Septicaemia — — — — — — - — 1 — - - — - 1 - - — Pneumonia (primary, influenzal and following Measles) 2 5 7 3 3 11 4 7 16 16 24 4 24 19 11 12 24 12 Erysipelas — — — — — 3 1 2 6 7 12 5 1 9 6 4 9 7 Ophthalmia Neonatorum 14 - - - - - - - - - - - - 3 4 4 2 1 Puerperal Pyrexia — — — — — — 1 3 — — — — 1 1 1 — I Enteric Fever - 1 — 1 — — 1 — — — 1 1 1 — Anterio Poliomyelitis 1 — 2 - - - - - - - - - - - - - - - Cerebro Spinal Fever 1 — — - — — — — — — - — - - 1 - - - Totals 23 21 31 26 32 172 72 39 53 29 40 9 88 90 59 103 112 95 53 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1929 : Scarlet Fever. Diphtheria Total. January 37 6 43 February 21 6 27 March 21 2 23 April 11 3 14 May 11 5 16 June 8 3 11 July 19 4 23 August 22 7 29 September 26 9 35 October 42 9 51 November 38 18 56 December 21 23 44 Total 277 93 372 (a) Scarlet Fever.—The number of cases notified was 277 compared with 243 the previous year. Three fatal cases occurred. 238 cases were isolated at the local Infectious Hospital. The average stay of scarlet fever cases in the Municipal Hospital was 39 days, compared with 31.48 days in 1928. The longest period of detention was 119 days and the shortest 17 days. Sex.—129 cases were male and 148 female. It is the practice to accept not only diphtheria but scarlet fever into the hospital at any time of the day or night at the request of the medical practitioners. 54 It is our intention, so far as practicable, still to carry out this general principle, but I do think that in cases of scarlet fever, where the retention of a case in the home until morning will not seriously increase the already very considerable possibility of other cases having been infected, medical men should always reflect before removing cases late at night. , Cases cannot be so removed Without incurring some danger to the patient, and unless this danger is compensated by the need for immediate treatment or on public health grounds, removals at night-time are difficult to justify. (b) Small-pox.—There were 11 cases of small-pox notified during the year under review. In one case the diagnosis was not upheld and the patient returned from hospital after one week. The rest were of a mild type and the situation was dealt with along orthodox lines. In conformity with the usual practice, details of cases of small-pox have been consistently forwarded not only to the Ministry but also to neighbouring Authorities and to the County Council. It is curious that the County Council have taken upon themselves the onus of re-distributing this information over the name of the County officer. That the County officer would, naturally, wish to advise the officers under his direction and supervision is obvious, but his wholesale distribution of this information is less obvious. One would, naturally, expect the County Council to step in and carry out the work of a Local Authority if any question of default were to arise, and because this is so the present County practice appears to be difficult to explain. We still experience the curiosity of 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 chicken-pox, etc.— to prevent the spread of smallpox. Vaccination does prevent small-pox. I regret my experience teaches me it is necessary to reiterate this truth. 55 (c) Diphtheria.—95 cases were notified, compared with 107 the preceding year. Of cases notified, 89 were removed and treated in the local isolation hospital. 4 deaths from diphtheria occurred. The average stay of clinical diphtheria in hospital was 40 days, the longest stay being 98 and the shortest 3 days. Sex.—43 cases were male and 52 female. (d) Enteric Fever.—Three cases of enteric fever were notified during the year, all of which were removed to hospital. (e) Puerperal Fever.—One case was notified during the year, and was not admitted to hospital. The case recovered. (f) Puerperal Pyrexia.—Four cases were notified during the year. All of the cases recovered. (g) Erysipelas.—36 cases were notified during the year compared with 26 during 1928. Five patients were removed to hospital. (h) Malaria and Trench Fever.—No cases were notified during the year. (i) Acute Primary and Acute Influenzal Pneumonia.—102 cases were notified dur ng 1929, compared with 74 for the preceding year. Six patients were admitted to hospital. (j) Encephalitis Lethargica.—].12 No cases were notified during the year. (k) Chicken-Pox.—In view of the prevalence of small-pox in surrounding districts, chicken-pox was made a notifiable disease in the district in April, 1928, and continued to be notifiable throughout 1929. A total of 414 cases were notified during the year, compared with 303 during 1928. Sex.—213 were male and 201 female. (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 Whooping Cough Summer Diarrhoea 10 56 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 1929 :— Disease. In Hospital January, 1st, 1929. Admitted during the year. Died. Discharged In Hospital Dec. 31st. 1929. Scarlet Fever 28 238 2 242 22 Diphtheria 10 89 5 63 31 Pneumonia - 4 2 2 - Puerperal Fever - - - - - Arthritis 1 - - 1 - Enteric Fever - 2 - 2 - Erysipelas - 3 - 3 - Miscellaneous - 9 2 7 - TUBERCULOSIS Adminstrative Arrangements.—The policy of your Medical Officer of Health acting also as Tuberculosis Officer for your district under the County has been continued during 1929. Towards the end of that year a conference was held at Black Notley, at which, amongst other things, the question of if and whether this is the best policy was discussed. The alternative to your present practice is for a whole-time Tuberculosis Officer to be appointed for a larger area. Dr. Williamson, of the Ministry of Health, who appeared rather to favour this alternative, made out the strongest case I have ever heard for the combination of duties. 57 In outlining his conceptions of the duties of a Tuberculosis Officer, Dr. Williamson laid great stress on the necessity of the Tuberculosis Officer making himself conversant with all the social, economic and industrial factors which play such an important part in the lives of their patients, and, as I pointed out at the conference, to all intents and purposes Dr. Williamson was demanding that each Tuberculosis Officer should be in fact a Medical Officer of Health, which, of course, is the same thing as saying that a Medical Officer of Health should be the Tuberculosis Officer. It is obvious that for any Medical Officer to establish contact with all the various activities and social influences which affect the health of the people under his care, he must be in a position to have personal knowledge of the other work which is being undertaken in public health, such as housing, inspection of workshops, maternity and child welfare, etc., and it is essentially the Medical Officer of Health who unites in one office a direct personal interest in all these various activities. It may reasonably be assumed that this work will double itself in the next three years, so that we shall then have enough work for two-thirds of the time of a whole-time Medical Officer. My experience is that this work is best undertaken by a parttime Medical Officer. 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, 1920, was 737, compared with 990 for the corresponding period of the preceding year. 58 During the year, 64 notifications were received of all forms of tuberculosis—pulmonary 48, and non-pulmonary 16. Information was received of the removal into the district of six tuberculous persons, included in number of notifications received. Forty two deaths of notified cases occurred. Particulars of new cases of tuberculosis notified and of deaths from the disease during 1929 is afforded by the following table New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male . Female. Male. Female. Male. Female. Male. Femals. Under 1 year — — — — — — — — 1 to 5 years — — 3 — 1 — 1 — 6 to 10 years 1 — 4 4 — — - — 10 to 15 years — 1 — 1 — — — — 15 to 20 years 3 6 — 2 1 2 — — 20 to 25 years 3 3 — — — 7 1 — 25 to 35 years 5 10 1 — 1 3 — — 35 to 45 years 7 1 1 — 9 1 1 — 45 to 55 years 2 1 — — 4 1 — — 55 to 65 years 4 1 — — 3 1 — — 65 yrs. & upwards — — — — — 1 — — Totals 25 23 9 7 19 16 3 — PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. These regulations came into force on the 31st July, 1925 Under certain circumstances you can, in accordance with Section 62, isolate by compulsion persons who are likely to spread tuberculosis. 59 During the year it has not been found necessary to take action under these Regulations, but your expressed intention to use Section 62 of the Public Health Act, 1925, has been helpful to us on several occasions and fortunately we have been able to deal with many cases on a voluntary basis. It cannot be over emphasised that the control of the tuberculous subject is at the present time your most powerful weapon in combatting consumption. 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. 27 18 3 4 17 20 1 2 Thirty-eight deaths occurred from tuberculosis (all forms,) 35 of these being pulmonary cases. The number of deaths in institutions was 17. The death rate for tuberculosis (all forms) during 1929 was 0.9, compared with 1.1 for the previous year. There were 944 attendances at the dispensary during the year for the purpose of medical examination, 221 being new cases. Of new cases attending during the year, 37 were subsequently notified as suffering from tuberculosis, 56 had been previously notified, while 6 were inward transfers. It will appear from the figures quoted that the number of new cases seen at the Dispensary for the first time and which have been previously notified is considerable, and unless this is explained it "light perhaps lead one to suppose that the Dispensary is dealing with cases already notified and is not being used largely as a consultative centre where cases are seen previous to notification. 60 As a matter of fact, of the really new cases, the vast majority are seen at the Dispensary before notification, but there are a lot of old cases notified years ago which are only coming to the Dispensary for the first time now, and their numbers swell the number of, new cases previously notified attending for the first time, although in reality they are not new cases at all from the standpoint of the patients themselves. These old new cases, if I may call them so, are attending the Dispensary in large numbers because we are following them up intensively with the object, where possible, of removing their names from the Notification Register. The following table gives in tabular form the number of patients removed from the Dispensary Register during the year :— No. on Dispensary Register 31-12-28. Numbers removed from the Dispensary Register. Number on Dispensary Register 31-12-20 Died. Left District. Discharged (Non Tb.) Discharged " Cured" Transferred to another Dispensary, etc. Amended Diagnosis Total 511. 35 20 166 47 12 50 330 423 At the end of the year, 397 cases on the Dispensary Register were definitely diagnosed as suffering from tuberculosis, whilst in 26 cases the diagnosis still remained in abeyance. REGISTER OF TUBERCULAR PERSONS. Last year I said " This register, I am of opinion, is misleading." It has been my very best endeavour to do what I can to bring this register up to date, and, although much work remains to be done, the following table shows that much has been done and the register is far more valuable now than it was a year ago. 61 On Regst. 31-12-28. New cases during year, Died. Cured. Left district. Amend. diagnosis. Other. Total rem. from reg. On Reg. 31-12-29 Pulmonary— 669 48 86 41 46 39 1 213 504 Non-Pul.— 321 16 9 35 40 20 - 104 233 Total 990 64 95 76 86 59 1 317 737 At the inception of the Tuberculosis Service in England the scientific diagnosis of this complaint had already reached a remarkable level of attainment, but the years that have passed since then have so very considerably increased our knowledge that already the data on which these diagnoses were made are looked upon as out of date. The whole situation is further complicated, as I have pointed out elsewhere, by the fact that from a strictly scientific standpoint a very large proportion of the whole population have at some time or another suffered from tuberculosis of one form or another, whilst consumption from a practical standpoint is not nearly so common as such a scientific survey would indicate, because when we speak of consumption from an administrative standpoint we mean that the health of the patient is or is likely to become bankrupt by reason of this disease. It will not therefore be surprising for me to say that in going over the Tuberculosis Register we have found a large number of persons who have been notified on evidence we should not now look upon as conclusive. The register, too, has now been going a sufficient number of years for a large number of persons very happily to have been cured. Work has been done during the year 1929 removing such persons from the register. It is necessary to be very sure such removals are quite proper before they are made, and these removals involve a lot of time administratively and in correspondence. 62 There have been 317 removals this year, so that although the population has on the whole grown, the number of persons on the Tuberculosis Register has declined from 990 to 737. 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 1929 research has been continued into the question of fibrosis of the lungs due to the inhalation of particles of asbestos. In June 1929 an interim report was circulated to members of the Council at the request of the Juvenile Employment SubCommittee. In this interim report a table was given, showing that of nineteen cases of persons suffering from some pulmonary disability and who had been exposed to asbestos dust, there was sufficient evidence to warrant a diagnosis of asbestosis in eight, no sufficient evidence to warrant a then present diagnosis in nine, whilst there were two cases at the time in question awaiting further examination. The same report included five conclusions, which in my opinion had been established up to that time, viz. :— (1) That people working in asbestos factories inhale asbestos dust, which can be found in the substance of the lung proper and in the sputum which is exuded from the bronchi of the lungs. 63 (2) That the presence of this asbestos dust in the lungs produces a definite disability, adversely affecting earning capacity and decreasing the expectation of life. (3) That it is possible for an exposure to asbestos dust over a period of six months to produce a definite disability lasting over man}' years. (4) That there is not sufficient evidence to warrant an opinion on the question of the possible increased incidence of tuberculosis in persons who are suffering from asbestosis. (5) That these conclusions indicate that the conditions under which certain of these cases have been working have been such as to permit the inhalation of asbestos dust, with consequent pulmonary disability. From the time of the interim report to the end of the year the research into this matter has been continued, so that, amending the table of persons investigated, we have at the end of the year 23 cases investigated, 9 of which showed sufficient evidence to warrant a diagnosis of asbestosis, 10 of which showed no sufficient evidence at that time to warrant a diagnosis of asbestosis, and 4 of which were awaiting further investigation. At about the beginning of December one of the cases included in this table died. On the instruction of the coroner an inquest was held with a jury, and the jury brought in a verdict of death from "asbestos poisoning." It may almost be considered that if the report of June was an interim report, as suggested then, the coroner's verdict was a final report, because the case was one of the earliest, and the verdict rested upon the evidence which had been collecting for two years. Since writing this Report on asbestosis in June 1929 I have had the advantage of consultations with other people who are interested in this work, and whilst it is still true that our own series 64 of cases does not afford sufficient evidence to warrant an opinion on the possible increased incidence of tuberculosis in persons who are suffering from asbestosis, I understand from my conversations it is true that the evidence as a whole suggests that persons suffering from asbestosis are more likely than other people to suffer from tuberculosis. The work I have been carrying on in this connection convinces me more than ever we shall never get an efficient complete medical service in England until the whole of the public medical services are united under one Ministry. The fact that the health of workers in factories is under one Ministry and the health of these same workers outside the factories is under another Ministry is essentially bad. During the year 1929 there have been three deaths in Barking attributed to asbestosis. Two cases were well known to us, and the deaths of these persons were the subject of an enquiry by the Coroner. Another case of asbestosis died during 1929, and the cause of death was given as " Bronchitis." Of course this notification is quite correct, but in my opinion it does not represent the whole of the truth. 65 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 766, the net total of 787 being obtained by adjustment of inward and outward transfers, etc. The births registered included 398 males and 389 females. There were 14 illegitimate births, or 1.8 per cent. of the total. In comparison with 1928, 18 less births were registered during the year, a fall equivalent to 2.2 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 16 or 2.2 per cent. were notified. In addition 6 still births were not notified. The following table gives details of the notifications received :— By whom notified. Live Births. Still Births Medical Practitioners 136 2 Certified Midwives 486 17 Parents and Others 91 1 The percentage of still-births was 2.8 66 Of the total live births during the year 414, or 56.8 per cent. were attended by midwives, the remainder being attended by medical practitioners. BIRTH RATE. The birth rate for the year was 18.7, compared with 16.3 for England and Wales. MATERNITY AND INFANT WELFARE. The Ante-Natal Clinics. The work of the Clinics was carried on as in previous years, and one extra session was commenced at the Alexandra Clinic in August, 1929. The attendances during the year were well maintained. The number of primary attendances was 386, compared with 398 for 1928. Reattendances numbered 1,180 in 1929, and 1,063 during 1928. One hundred and twenty-three sessions were held during the year, making an average attendance of 12.5 mothers per session. Expectant mothers attending the Ante-natal Clinics 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. Post Natal Cases. Twenty-three cases attended by midwives were referred by them or by the health visitors for examination at the Ante-natal Clinics owing to the presence of defects following childbirth. 67 MATERNITY WARD. The admissions to the Maternity Ward of the Municipal Hospital numbered 180, compared with 200 in 1928. Of these 36 cases were admitted for ante-natal treatment, and 144 for confinement. Corresponding figures for 1928 were 29 cases for ante-natal treatment, and 171 for confinement. (1) Number of cases admitted 180 (36 of which Ante-natal) (2) Average duration of stay 14.26 days (3) Number of cases delivered by :— (a) Midwives 142 (b) Doctors 2 (4) Number of cases in which medical assistance was sought by the midwife with reason for requiring assistance:— (a) Ante-natal 1 Unsatisfactory condition of mother (b) During Labour 1 Uterine Inertia (c) After Labour 6 Torn Perineum (d) For Infant — (5) Number of cases notified as puerperal sepsis with result of treatment in each case Nil (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 ophthalmia neonatorum with result of treatment in each case Nil (9) Number of cases of " inflammation of the eyes," however slight Nil (10) Number of infants not entirely breast fed while in the Institution, with reasons why they were not breast fed 2 (a) Weakness of mother 2 (b) Premature Infant Nil (c) Partially fed—delicate mother Nil 68 (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) Still-born 5 (b) Within 10 days of birth (Premature) 1 (Died 14 hours after birth) 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. One case of puerperal fever was notified as compared with 2 in 1928. The patient was isolated immediately on the onset of pyrexia, and no further cases occurred. In addition to the cases of puerperal sepsis, 4 cases of puerperal pyrexia were notified, the confinement in 2 cases being attended by a midwife. All the patients recovered. 69 MATERNAL MORTALITY. Two maternal deaths occurred during 1929, the deaths being certified as follows:— (a) Cardiac failure 1 (b) Syncope 1 NEO-NATAL MORTALITY. The number of deaths of infants under four weeks of age was 28, compared with 24 for the previous year in Barking. STILL-BIRTHS. Of the total notifications received under the Notification of Births Act, 20 related to stillborn children, giving a percentage of 2.8 compared with 1.7 in 1928. In addition, 6 still-births were not notified. Investigation of the health visitors elicited the following information (1) Duration of pregnancy:— (a) Less than seven months 2 (b) More than seven months 19 (c) Not elicited 5 (2) Presentation:— (a) Vertex 9 (b) Breech 7 (c) Transverse – (d) Not elicited 8 (e) Footling 1 (f) Monster 1 (3) Supposed cause of stillbirth:— – (a) Abnormal presentation – (b) Overwork – (c) Accident, etc. 5 (d) Not known 16 (e) Ill health 3 (f) Shock 1 (g) Worry 1 (4) Occupation of mother:— All the mothers were engaged in household duties at home. 70 OPHTHALMIA NEONATORUM There was a decrease in the number of cases of ophthalmia neonatorum, notifications being 14, compared with 15 in 1928. 8 of the cases occurred in the practice of midwives, the remainder being attended by medical practitioners. Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified Treated. At Home. At Hosptl. Under 3 weeks 14 14 – 14 – – – 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, 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. 71 INFANT AND CHILD WELFARE. Work of the Health Visitors and the Infant Clinics. An analysis of the attendance at the Infant Welfare Centres is piven in the following table:— Infant Welfare Centres. Clinic Premises Alex. Centre Movers Lane Total No. of sessions 104 100 100 304 No. of attendances of children under one year:— (a) New cases 206 138 126 470 (b) Old cases 2530 1835 1693 6058 No. of attendances of children 1 to 5 years of age:— (a) New cases 37 29 20 86 (b) Old cases 953 1554 1043 3550 Average number of attendances per session 36 35 29 33 No. of sessions attended by medical officers 104 100 100 304 No. of children seen by medical officers (a) Under one year 1588 1179 1063 3830 (b) Over one year 619 818 774 2211 Average number of children seen by medical officer per session 21 20 18 20 The total attendances during the year were 10,164 as compared with 8.561 in 1928. Particulars of the home visits paid by the health visitors is given in the following table No. of ante-natal visits 106 No. of first visits to children under one year 730 No. of subsequent visits to children under one year:— (a) Attending a Centre 281 (b) Not Attending a Centre 2,943 No. of visits to children 1 to 5 years of age (a) Attending a Centre 225 (b) Not Attending a Centre 3,523 No. of special visits in connection with Ophthalmia Neonatorum 19 Ditto Deaths of children up to 3 years of age 49 Ditto Still-births 23 Ditto Puerperal sepsis and Pueperal Pyrexia 5 Ditto Foster Children 24 Other visits (not specified) 117 72 THE PRE-SCHOOL CHILD. Treatment may be obtained for children attending the infant welfare clinics as follows :— Minor Ailments.—Treatment is given at the Central Clinic. Dental and orthopaedic treatment, and treatment of septic tonsils and adenoids are available. Convalescent Treatment.—This is provided for under the Schcme, and is of value for children suffering from debility following acute illness. During the year a Refraction Clinic for toddlers has been inaugurated and is doing useful work. 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-four 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. Fortunately for many years accurate records have been kept in the Public Health Department of all foster children in the district, so that the work devolving on us in 1930 (under the Children Act, 1908), will not be new to the department. INFANTILE MORTALITY. The total number of deaths of infants during the year was 42, giving an infant mortality rate of 53.4 per thousand registered births, compared with 63.3 per thousand for 1928. ILLEGITIMACY. Fourteen illegitimate children were born during the year, and in the same period 5 deaths of illegitimate infants occurred; the infantile mortality rate among these children was therefore 357.1; while that for legitimate infants was 47.9. DENTAL CLINIC. A general increase in this branch of the work has been taking place, and during 1929 the attendances of expectant and nursing 73 mothers arid of children referred from the Maternity and Child Welfare Clinics were as follows:— (1) Number of children treated 238 (2) Number of mothers treated :— (a) New cases 117 (b) Old cases 425 (3) Number of dentures supplied 65 Ninety 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-seven 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, 86 cases attended for re-examination. Two of the children received in-patient treatment at Orthopaedic Hospitals. The cases dealt with for the first time during 1929 were referred for the following conditions:— Deformities—Bones and Joints— (a) Congenital: (i) Digits of Hand 1 (b) Acquired: (i) Genu Varum 1 (ii) Genu Valgum 3 (iii) Hallux Valgus 1 (iv) Digitis Varus 1 (v) Bow Legs 1 8 74 Muscular Deformities— (a) Congenital: (i) Talipes 4 (ii) Torticollis 3 (iii) Subluxation of Shoulder Joints 1 (iv) Lower Limb, short and small 1 (v) Outward Rotation of Humerus 1 (b) Acquired: (i) Pes Planus Valgus 6 (ii) Abnormal Gait 1 17 Paralysis— (a) Congenital: (i) Spastic Hemiplegia 1 (ii) Spastic Diplegia 1 (iii) Erb's 1 (b) Acquired: (i) Paresis of Neck Muscles 1 4 Congenital Deformities—Nil. Total 29 ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was continued during 1929. 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, 95 children received treatment during 1929. One session per week was devoted to these cases, and 725 treatments were given. 75 MEALS TO EXPECTANT AND NURSING MOTHERS. Advantage has been taken during 1929 of this provision under the Act. The total number of dinners supplied was 371. 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. 1,881 8,880 10,761 149 3 7½ 136 1. 8 PROVISION OF DRIED MILK, Etc. Particulars of the amount of Dried Milk, etc., supplied free and at reduced rates, are as follows :— Cost Price, (lbs.) Reduced Price, (lbs.) Free, (lbs.) Total, (lbs.) Glaxo (Humanised) 595 31 92 718 Ambrosia 641 164 610 1,415 Cow and Gate 2,497 517 1,251 4,265 Ostelin 3 Nil Nil 3 Lactogol 125 Nil Nil 125 Virol 663 9 13 685 Parrish's 147 Nil Nil 147 Paraffin 136 Nil Nil 136 Malt and Oil 385 1 88 474 Vitoleum Cream 1.163 Nil 4 1,167 Pure Oil 276 Nil 11 287 Trufood 2 Nil 2 4 76 To the Medical Officer of Health. From the Public Dental Officer. Sir,— I have the honour to submit the Report on the Dental Service for the Maternity and Child Welfare Scheme for the year ending December 31st, 1929. During the year the administration of the service has been under the care of three consecutive dental officers, but the changes apparently have not disturbed the efficiency of the scheme. Professional views differ in the matter of dental treatment as in other branches of the healing profession, and where some are insistent on conservative treatment their colleagues are equally insistent that radical treatment is the only effective method of protecting the health of the patient. Both are right, and it is the judicious combination of the best of both methods with due consideration of the patient's environment and habits, that makes for the greatest success at the present stage of public dental education in this country. An expectant mother, careless in personal habits, already possessing a family of size, usually will not tolerate conservative treatment, and unfortunately her own wish for the removal of affected teeth is the only possible line of treatment that is of any healthful service to her. On the other hand a young mother who still retains the influence of the lessons in hygiene now given in school will consent to aid the Dental Surgeon in an endeavour to clear up an unhealthy mouth by faithfully following advice as to home treatment. As the girl children of to-day are the potential mothers of tomorrow the greatest aid to any maternity and child welfare scheme is to teach hygiene, and to teach NOW, while the future mother is of school age. 77 It has been the custom at this Clinic in the past to allow 6 months to elapse after multiple extractions before the fitting of dentures. Thus patients receiving treatment in the latter half of the year will not be shown as receiving dentures in the figures below. There has been considerable increase in the number of under-age children treated, the number being doubled as compared with last year. The administration of nitrous oxide gas by nasal apparatus has proved of considerable advantage both to the patient and the operator. In conclusion, the improvement of the service and the gratifying improvement in the number of patients is in no small measure due to the sympathetic activities of the medical officers concerned, the Health Visitors and the Nursing Staff; but it should be borne in mind that the service to be complete should be one in which dental treatment is a compulsory benefit for those seeking the other advantages offered by the Maternity and Child Welfare Scheme. I have the honour to be, Sir, Your obedient servant, W. H. FOY, L.D.S., R.C.S., (Eng.). 78 DENTAL CLINIC. Maternity and under-age Cases. 1929. 1. Number of children treated 238 2. Number of mothers treated:— (a) New Cases 117 (b) Old Cases (Clinic Attendances) 425 *3. Number of dentures supplied 65 4. No. of Fillings Mothers 19 40 Children 21 5. Number of sessions held 80 *In addition to the 65 Dentures actually supplied, 18 were recommended for such treatment, which was not obtained for the following reasons:— Apparently not wanted 10 Lack of money 5 Left District 3 Total 18 79 SOME ECONOMICS RE INVALIDITY AMONGST RE-HOUSED POPULATION. The establishment of a dormitory population in Barking under the advantageous circumstances of recent housing development by the London County Council and otherwise, represents a phase of one of the greatest experiments of all time. The benefits of these people living in houses which can be well ventilated, which houses themselves are in well-ventilated areas, are beyond estimation, but a note of warning must be raised depreciating any highly optimistic views which may be held as to the purely economic value of this improved health. Whilst it is confidently expected that the average number of periods of invalidity amongst the re-housed population will be less than when they were housed under their previous adverse circumstances, it will nevertheless obtain that the period of each individual invalidity may be longer than a comparable invalidity when the patient was living, so to speak, right on top of his work. Whereas with people living near their work it is conceivable that they return to work so soon as their physical condition enables them to carry out that work, it will be necessary amongst the re-housed population that they shall not only be able to undertake the physical strain of the work itself but the very considerable strain also of the daily journey to and from their work. This places the Health Insurance at an economic disadvantage, which cannot well be controlled by the regional medical officer. because in each individual case the few days or weeks involved can hardly come within the purview of his work and can hardly be the subject of a deposition by him. The case of a person suffering from tuberculosis is an extreme example of the way in which re-housing people in suburban dormitories is likely to influence adversely the funds of Health Insurance. 80 The regional officers responsible for determining the continuance or otherwise of monetary benefits already take into their province not only the medical aspect of the case but the nature of the work the person habitually carries out. In this latter consideration it will now be necessary for them to take into their consideration the distance the person has to travel in order to obtain suitable work, and although this factor has been more or less ruled out of order in the past it is one which will have to be very seriously considered in the future. In November of 1929 I had the pleasure of a consultation with Dr. Cross of the Ministry of Health on this very question, and I am hopeful that the question of where work can be obtained will in future be given as great a prominence as the question of what work can be obtained.