BARK24 Borough of Barking REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 19301 C. LEONARD WILLIAMS, B.Sc. Hons. (Lond.) M.R.C.S. (Eng.) D.P.H. (Camb.) L.R.b.P. 2 TABLE OF CONTENTS Page STAFF 8 INTRODUCTION 9 SECTION I.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Age Mortality 13 Asbestosis 19,20 Births 10.11.12. 17 Births, Notifications 17 Deaths 10,16 Deaths, Causes of. (Tables) 14, 15, 16 Diphtheria 20 General Statistics 10 Illegitimate Births 17 Industries17,18 Infantile Mortality 10,11,12 Infantile Mortality (Table) 16 Inquests 14 Marriages 17 Overcrowding 20 Poisonous.Gas 20 Postal Arrangements 18 Psittacosis 18,19 Rheumatic Affections ??? Sickness, Causes of 18, 19. 20 Smallpox 20 Social Conditions 17, 18 Stillbirths 10,17 Transport 19 Vaccination 20 Vital Statistics 10,11.12 Zymotic Diseases, Deaths from 14 SECTION 2.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Adoptive Acts 24 Ambulance Attendant 98 Ambulance Facilities 33 Bye-laws 25 Clinic and Treatment Centres 34,35,36 Counties' Laboratory 23,24 Homeless Children, Institutional provision for 32,33 Hospital Services 21,26,31 Hospital Services, Tables of 27,30 3 SECTION 2—Continued Page Infectious Diseases Nursing 21 Illegitimate Infants, Institutional provision for 32, 33 Investigation Department 37, 38 Joyce Green Hospital 26 King George V Hospital 21,31 Laboratory Facilities 23, 24 Legislation Relating to Public Health 24, 25 Local Acts 24 Local Government Act, 1929 37, 38 Maternal Mortality 32 Maternity Cases 22 Maternity Homes 31 Maternity Ward, Municipal Hospital 22, 26, 31 Mental Defectives, Institutional provision for 33 Midwifery 21,22 Midwives, Supervision of 22 Municipal Hospital 26 National Health Insurance 22, 23 Nursing Homes 31 Nursing in the Home 21 Oldchurch Hospital 23 Plaistow Maternity Charity 21,22,32 Poor Law Medical Out-Relief 23 Private Medical Practitioners, Co-operation of 22,23 Public Assistance Committee 37,38 Public Hospital Services 27-30 Puerperal Fever and Pyrexia 32 Regulations 24 Smallpox Hospital Arrangements 26 Special Acts and Orders 25 Specimens submitted to Laboratory for Examination 23 Unmarried Mothers, Institutional provision for 32, 33 Voluntary Hospitals. Co-ordination with 31 Voluntary Hospital Services 27-30 SECTION 3—SANITARY CIRCUMSTANCES OF THE AREA. Cesspools 41, 42 Closet Accommodation 41, 42, 45 Common Lodging Houses 51 Counties' Laboratory 39 Creekmouth Generating Station 50, 51 Dampness 45 Defects found under the Factory and Workshops Act, 1901 48 Drainage and Sewerage 41,42,45,54 Dustbin Maintenance 42, 46 Dwelling Houses, Inspection of 43 Essex Sewers Commissioners 40 4 SECTION 3—Continued Page Factories, Inspection of 44,47 Factory and Workshops Act, 1901 47-41 Fouling by Dogs 43 Home Work 48 Houses Let in Lodgings 51 Miscellaneous Sanitary Inspections 44 Miscellaneous Sanitary Work carried out 46 Northern Outfall Sewage Works 41 Notices Served 47 Offensive Trades 52 Out-workers 49 Pail Closets 41 Parks and Open Spaces 53 Piggeries 52 Port of London Authority 41 Premises Controlled by Bye-laws and Regulations 44 Premises and Occupations controlled by Bye-laws and Regulations 51, 52 Privies 41 Rag Flock Acts, 1911 and 1928 54 Rainfall 41 Refuse Disposal 43 Refuse Storage and Collection 42 Refuse Tips 52 Registered Workshops 49 Rent Restriction Act 51 Repairs, General 46 Rivers and Streams 40, 41 Sanitary Inspection of the Area 43-49 Sanitary Work, Summary of 45, 46, 48 Scavenging 42,43 Schools 53, 54 School Closure and Exclusion of Scholars 54 Schools, Drinking Fountains 53 Schools, Drying Facilities 53 Schools, Sanitary Inspection of 53, 54 Sinks 45 Smoke Abatement 50, 51 Stables 52 Stour Water Supply Scheme 39, 40 Street Cleansing 43 Tents, Vans and Sheds 51 Trade Refuse 43 Underground Sleeping-rooms 51 Water Supply 39, 40, 45 Workplaces, Inspection of 44,,47 Workshops, Inspection of 44,,47 Yard Paving 46 5 SECTION 4— HOUSING. Page Closet Accommodation .. .. .. .. .. .. 62 Closing and Demolition Orders .. .. .. .. 51,57 Fitness of Houses .. .. .. .. .. .. 61, 62 Food Storage Accommodation .. .. .. .. .. 62 Houses Built in the District, 1926—1930 .. .. .. 60,61 Houses Erected during the Year .. .. .. .. .. 55 Housing Conditions .. .. .. .. .. .. .. 57-62 Housing Defects Remedied .. .. .. .. .. 56, 61, 62 Housing Inspections .. .. .. .. .. .. .. 55 Housing Statistics .. .. .. .. .. .. .. 55-62 Housing Supply and Demand .. .. .. .. ..59-61 Inhabited Houses, Number of .. .. .. .. .. 57 Land, Reclamation of .. .. .. .. .. .. 60 Proceedings under Public Health Acts .. .. .. .. 56 Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 57 Proceedings under Section 17 of the Housing Act 1930 .. .. 56 Proceedings under Section 19 of the Housing Act, 1930 .. .. 57 Shed Structures .. .. .. .. .. .. 58, 59 Slum Clearance Programme .. .. .. .. .. .. 62 Small Dwellings Acquisition Act .. .. .. .. .. 57 Unfit Dwelling Houses .. .. .. ... .. .. 55 Unhealthy Areas .. .. .. .. .. .. .. 62 Water Supply .. .. .. .. .. .. .. 62 SECTION 5—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food .. .. .. .. .. 67, 68 Animals Slaughtered .. .. .. .. .. .. .. 65 Bacteriological Examination of Ice Cream .. .. .. .. 67 Bacteriological Examination of Milk .. .. .. 03, 64 Bottl-ng of Milk .. .. .. .. .. .. .. 64 Chemical Examination of Food .. .. .. .. .. 68 Diseased Meat Destroyed .. .. .. .. .. .«. 65 Food and Drugs (Adulteration) Act, 1928 .. .. 67, 68 Foodstuffs Legislation .. .. .. .. .. .. 66, 67 Graded Milk Licences Granted .. .. .. .. .. 64 Ice Cream • .. .. .. .. .. .. .. 66, 67 Meat and Other Foods .. .. .. .. .. .. 64-68 Milk (Special Designations) Order, 1923 .. .. .. 63, 64 Milk Supply .. .. .. .. .. .. .. 63, 64 Nutrition .. .. .. .. .. .. .. 68, 69 4 Prosecutions .. .. .. .. .. .. .. 64, 68 Slaughter-houses .. .. .. .. .. .. .. 64 Tuberculous Milk .. .. .. .. .. .. 63,64 Unsound Food Destroyed .. .. .. .. .. .. 68 SECTION 6—PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. * Admissions to Isolation Hospital (Table) .. .. .. .. 91 6 SECTION 6—Continued. Page "After-care" of Tuberculosis 83 Asbestosis 90 Boots for the Bairns 86 Cancer 88 Cancer, Occupations of Fatal Cases (Table) 89 Chickenpox 85 Compulsory Segregation of Tuberculous Persons 78 Diphtheria 75,92 Diphtheria Notifications (Monthly Summary Table) 75 Diseases Notifiable 72 Dysentery 76 Encephalitis Lethargica 78 Enteric Fever 85 Erysipelas 85 Hospital Accommodation for Infectious Diseases 91, 92 Houses for Tuberculous Patients 83, 84 Infectious Diseases 71-90 Infectious Diseases (Tables) 71, 73-75,79 Influenza 88-90 Isolation Hospital 91, 92 London Fever Hospital 91 Malaria 76 Measles 85, 86, 92 Mosquitoes 94 Natural History Society 94 Non-notifiable Acute Infectious Diseases 85-90 Notifiable Infectious Diseases 71-85 Notifications classified according to Wards (Table) 73, 74 Pathological Specimens, Examination of 92 Pneumonia 76, 88 Psittacosis 87 Puerperal Fever and Pyrexia 76, 85 Rats 93 Rheumatic Fever 86 Scarlet Fever 76, 86, 92 Scarlet Fever Notifications (Monthly Summary Table) 75 Schick and Dick Tests .. .. .. .. .. .. 92 School Intimations of Disease .. .. .. .. .. 86 Section 62, Public Health (Prevention of Tuberculosis) Regulations, 1925 .. .. .. .. .. .. .. .. 7» Smallpox .. .. .. .. .. .. .. 77, 92, 93 Summer Diarrhoea .. .. .. .. .. .. .. 35 Tuberculosis .. .. .. .. .. .. .. .. 78-85 Tuberculosis Dispensary .. .. .. .. .. .. "9 Tuberculosis Register .. .. .. .. .. .. 84, »5 Tuberculosis Service in Barking .. .. .. .. .. 80-8.1 Unnotified Fatal Cases of Tuberculosis .. .. .. .. 7 SECTION 6—Continued Page Vaccination 92 Verminous Persons, Cleansing and Disinfection of 93 Whooping Cough 85, 86 SECTION 7—MATERNITY AND CHILD WELFARE. Ante-Natal Clinics 97 Artificial Sunlight Clinic 108,109 Baths for Expectant Mothers 09 Birth Notifications 96, 97 Birth Rate 97 Children Act, 1908, Part I 104 Convalescent Treatment 103 Dental Clinic 106, 107, 111-113 Dental Treatment 103, 106, 107, 111-113 Eye Defects 104 Facilities for Treatment 103. 104 Foster Children 104 General Practice and the Clinic System 95, 96 Health Visitors, Work of 102, 103 Illegitimacy 106 Infantile Mortality 104-106 Infantile Mortality, Years 1891-1930 (Table) 105 Infant Welfare Clinics, Work of 102 Maternal Mortality 99, 100 Maternal Mortality, Years 1926-1930 99 Maternity Ward. Municipal Hospital 97-99 Meals to Expectant and Nursing Mothers 109 Minor Ailments 103 Neo-Natal Mortality 100 Non-Notified Births 96 Ophthalmia Neonatorum 98, 101,102 Ophthalmia Neonatorum (Table) 102 Orthopaedic Clinic 107 Orthopaedic Treatment 103,107,108 Plaistow Maternity Charity 97 Provision of Dried Milk, etc. 110 Provision of Fresh Milk 109 Puerperal Fever and Pyrexia 98, 99 Registration and Notification of Births 96, 97 Report of the Dental Surgeon 111-113 St.Alban's Clinic 95 Still Births 101 Toddler's Refraction Clinic 104 Tonsils and Adenoids 103 SCHOOL MEDICAL SERVICE. Table of Contents will be found on pages 116-117 8 STAFF, 1930. Medical Officer of Health, School Medical Officer, Medical Superintendent, Isolation Hospital, and District Tuberculosis Officer. C. LEONARD WILLIAMS. B.Sc. Hons. (Lond.) M.RC.S (Eng) D P.H. (Cambs.) Asst. Medical Officers of Health and Asst. School Medical Officers: J. GWEN BEVAN, B.Sc., M.R.C.S.. L.R.C P HILDA C. DEAN, M B., B.S., M.R.C.S., L.R.C.P.. D.P.H. Orthopaedic Surgeon (Part Time): B. WHITCHURCH HOWELL M.B.B.S.. F.R.C.S Denial Surgeon: W. H. FOY, I.D.S., R.C.S (Eng.). Sanitary Inspectors : N. BASTABLE (Chief Sanitary Inspector) (b. c, d and: H CARR (Sanitary Inspector) (b, c, e and m). C. S. COOK (Sanitary Inspector) (b and c). Health Visitors : MRS. G. STOKES (g and i). MRS. M. W. WALTON (a. h and I). MISS G. ELLIOTT (a. h and 1). MISS E. M. CROSS (g, h and i). 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. Chief clerk: E. W. HII.L (Resigned February, 1930). Clerk: F.READ (Comraenetd June, 1930). D. G. TONKIN. MISS V. SHEAD. MISS H. NUNN MISS H. KING. A. J. STOKER. 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 Koyal 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. (m) Smoke Inspector's Certificate, L.C.C. School of Engineering. 9 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, 1930. Public Health Offices, Barking, Essex. June, 1931. To the Chairman and Members of the Urban District Council of Barking Town. Mr. Chairman, Mrs. Jackson and Gentlemen, Herewith I beg to submit for your favourable consideration my Report as Medical Officer of Health for the year ended December 31st, 1930. This Report is drawn up in accordance with Circular 1119, 1930, from the Ministry of Health. The Annual Report for the year 1930 is not a special Survey Report within the meaning of the Regulations of the Ministry of Health, but it does, in accordance with the requirements of the Ministry, contain information on certain matters in more detail than has been given in the Reports for the last four years. • I am, Mr. Chairman, Mrs. Jackson and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 10 SECTION 1. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 1. General Statistics. Area (acres) 4,106 Ward areas 3,808 Tidal Water H.W.M. Thames 240 Roding 58 Loxford Water 2 300 4,106 Population (1921, Census) 35,523 Population (June, 1929) (Registrar General's estimate) 42,169 Population (June, 1930) (Estimated) 45,000 Number of inhabited houses (1921 Census) 6,762 Number of inhabited houses, March, 1931, according to Rate Books 10,941 Number of Families or separate occupiers (1921 Census) 7,594 Population Density, i.e. No. of persons per acre 10.9 Rateable Value—General £419,003 0 0 Sum represented by a penny rate £1,538 16 9 Education rates:— Elementary | Included in General Rate Figure 3 4 Secondary 6½ General Rate 14 4 2. Extracts from Vital Statistics for the Year. Live Births:— Total. Males. Females. Birth Rata. Legitimate 777 399 378 17.3 Illegitimate 22 15 7 0.5 Total 799 414 385 17.8 Still Births Rate per 1,000 total births:— Legitimate 33 18 15 39.7 Illegitimate — — — Deaths 435 218 217 Death Rate 9.7 Standard Death Rate (Factor 1.049) 10.2 Percentage of total deaths occurring in public institutions, 27.8 Number of women dying in, or in consequence of, childbirth:— From Sepsis. From other causes. Total. 0 3 3 Number of deaths of infants under one year of age :— Total Infantils Death Death Males. Females. Total. Rate. Rate Legitimate 23 23 46 59.2 61.3 Illegitimate 1 2 3 136.4 Number of deaths from Measles (all ages) " ,, ,, Whooping Cough (all age3) „ „ Diarrhoea (under 2 years of age *The estimated population at June, 1930, has been taken for the purpose of arriving at the Vital Statistics, in accordance with-Circular 1119, of the Ministry of Health, dated 18th June, 1930. THE YEAR. Birth Kate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Kate 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 Cer. tified by Registered Medical Practitioners Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England and Wales 16.3 11.4 0.01 0.00 0.10 0.02 0.05 0.09 0.12 0.55 6.0 60 90.4 6.9 1.7 1.0 107 County Boroughs and Great Towns including London 16.0 11.5 0.01 0.00 0.15 0.02 O.Ou 0.10 0.1 1 0.50 8.3 64 90.6 6.6 2.3 0.5 169 Smaller Towns (1921 Adjusted Populations 20,00050,000) 16.2 10.5 0.00 0.00 0.08 0.01 0.05 0.07 0.13 0.43 4.4 55 91.8 5.9 1.2 1.1 London 15.7 11.4 0.01 0.00 0.2:5 0.02 0.03 0.10 0.08 0.55 9.9 59 88.3 7.4 4.3 0.0 BARKING 17.8 9.7 0.00 0.00 0.42 0.04 0.04 0.29 0.00 0.60 8.76 61 86.6 8.3 4.8 0.04 4. VITAL STATISTICS OF WHOLE DISTRICT FROM 1924 to 1930. 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 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 42,160 781 18.7 291 6.9 8 152 42 53.4 435 10.3 1930 45,000 799 17.75 250 186 7 186 49 61.3 435 9.7 13 5. DEATHS (a) General.—There were 256 deaths registered in Barking in J 930. Of these 7 were deaths of non-residents. Barking residents to the number of 186 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 218 217 435 The death rate for 1930 was 9.7 per 1,000, compared with 10.3 in 1929, 11.4 for England and Wales, 11.5 for the hundred and seven Great Towns, 10.5 for the hundred and fifty-nine Smaller Towns, and 11.4 for London. (6) 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 49 1- to 2 years 16 2 to 6 years 15 5 to 15 years 24 15 to 2o years 29 25 to 45 years 55 45 to 65 years 101 Over 65 years 147 14 (c) Causes of death in 1930.—The table on page 15 shows the principal causes of death at various ages. Those diseases, etc. causing most deaths or important from a Public Health a spec! were as follows :— Disease. No. of Deaths. Percentage of total net deaths registered. Cardio-vascular system 58 13.3 Cancer 48 11.03 Tuberculosis (all forms) 37 8.5 Pulmonary affections, (exclusive of tuberculosis), viz.. Bronchitis 29 6.6 Pneumonia (all forms) 24 5.5 Other respiratory diseases 5 1.1 Zymotic Diseases 43 9.8 (d) Deaths from Zymotic Diseases.—These diseases caused 9.8 per cent, of the total deaths, such deaths being caused in the following proportions:— Enteric Fever — Measles 19 Whooping Cough 2 Scarlet Fever 2 Diphtheria 13 Diarrhoea 7 Smallpox — (e) Inquests.—Coroner's inquests were held on 34 deaths, eleven being held within the District and 23 outside the District. 15 (f) Causes of and ages of death during the year 1930. (Nett Deaths.) Causes of Death Deaths at the subjoined ages of "Residents" whether occurring in or beyond the district. Under one year I and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Total Acute Encephalitis 1 - - - - - - 1 Influenza - - - - - - - - Scarlet Fever - 1 1 - - - - 2 Smallpox - - - - - - - - Measles 15 4 - - - - 19 Whooping Cough - 2 - - - - - 2 Epidemic Influenza - - - - - - - - Diarrhoea and Enteritis (under 2) 6 1 - - - - - 7 Diphtheria - 1 12 - - - - 13 Enteric Fever - - - - - - - - Erysipelas - - - 1 - 2 1 4 Puerperal Fever - - - - - - - - Other accidents and diseases of pregnancy and parturition - - - 2 1 - - 3 Phthisis (Pulmonary Tuberculosis) 1 - 1 12 14 4 2 34 Other Tubercular Diseases - 2 - - - 1 - 3 Asbestosis - - - - 1 - - 1 Cancer (Malignant Disease) - - - - 4 21 23 48 Bronchitis 1 - - - 2 4 22 29 Pneumonia (all forms) 10 4 2 1 2 2 3 24 Other Inspiratory Diseases - 1 1 - - 3 - 5 Alcoholism (Cirrhosis of Liver) - - - - - - - - Premature Birth. Malformation and Debility 25 - - - - - - 25 Accidents 1 - 1 4 1 5 6 18 Suicides - - - - 3 5 1 9 Rheumatic Fever - - - - 1 - - 1 Diabetes - - - - - 3 2 5 Cerebral Hæmorrhage - - - - 3 6 7 16 Heart Disease - 1 1 3 5 14 24 48 Arterio-Sclerosis - - - - - - 9 9 Ulcer of stomach or duodenum - - - - 1 3 - 4 Asthma - - - - - 1 - 1 Anaemia - - - - 1 - - 1 Arthritis - - - - - - - - Meningitis (non-tubercular) 1 - - - - - - 1 Appendicitis and Typhlitis - - - - 1 - - 1 Acute and Chronic Nephritis - - - 2 4 11 6 23 Other defined diseases 3 2 1 4 10 15 41 76 Causes ill-defined or unknown - - - - 1 1 - 2 Totals 49 30 24 29 55 101 147 435 16 (g) Infant mortality during the year 1930. 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. Acute Encephalitis — — — — — 1 — — — 1 Atelectasis 3 — — — 3 — — — — 3 Bronchitis — — — — — 1 — — — 1 Congenital Debility 3 — — — 3 1 — — — 4 Congenital malformation 2 — 1 2 5 1 — — — 6 Convulsions 1 — — — 1 — — — 1 Deficient inherent vitality 1 — — — 1 — — — — 1 Diarrhoea and Enteritis — — 1 — 1 2 1 2 — 6 Mastoid Disease — — — — — — — 1 — 1 Meningitis(non-tubercular) — — — — — — — — 1 1 Miliary Tuberculosis — — — — — — — — 1 1 Peritonitis — — 1 — 1 — — — — 1 Pneumonia (all forms) — — — 1 1 2 1 3 3 10 Premature Birth 7 — — — 7 3 — — — 10 Pyonephrosis — — — — — — — 1 — 1 Want of attention at birth 1 — — — 1 — — — — 1 Totals 18 — 3 3 24 11 2 7 5 49 Nett Births in the year:— Legitimate 777 Illegitimate 22 799 Nett Deaths in the year:— Legitimate 46 Illegitimate 3 49 17 6. MARRIAGES. The following table shows the number of marriages registered in the district and the marriage rate per 1,000 population for the years 1922 to 1930. Year. No. of Marriages. Rate per 1,000 Population. 1922 208 5.6 1923 219 5.9 1924 208 5.4 1925 258 6.7 1926 249 6.3 1927 304 7.6 1928 311 7.6 1929 276 6.5 1930 287 6.4 7. BIRTHS. The net number of births registered in 1930 was 799, affording an annual birth rate of 17.8 per 1,000 population, compared with 18.7 in 1929, 19.7 in 1928 and 17.7 in 1927. Of all births, 22 were illegitimate, giving a percentage of 2.7 of the total births. Notification of Births Acts, 1907-1915.—During 1930 there were 798 births notified to the Medical Officer of Health, 612 being notified by midwives and 186 by parents and doctors. Twentythree still-births were notified, 19 being notified by midwives and 4 by doctors. Ten still-births were not notified. 8. SOCIAL CONDITIONS. (a) Industrial. Barking has practically a 99 per cent. industrial population. The chief industries are:— The production of gas at the Gas Light and Coke Company's Works at Beckton. 18 The production of electricity at the County of London Electric Supply Company's generating station at Creekmouth. The manufacture of asbestos goods, rubber elastic, matches, paint, varnish and wood paving. The storage, etc., of petrol and timber. Whilst a large number of people are engaged in these industries, a very large number work out of Barking, travelling to and fro on trams, omnibuses and the railway. The influence of occupation on public health is dealt with in a later part of this Report. (b) Postal Arrangements.—The work of the department is to a certain extent hampered by the Post Office, who have a futile arrangement whereby a large part of the Barking area is designated " Dagenham " for postal purposes. Much of our correspondence reaches us through my colleague in Dagenham, with consequent delay and unnecessary duplication of work. 9. CAUSES OF SICKNESS. (a) Psittacosis.—During the year there were three deaths from psittacosis, a disease transmitted to man from birds of the parrot type. The disease is so simple to prevent that, however deplorable these deaths may have been, they do not represent a serious public health problem. It is only for people to refrain from buying birds that are known to transmit this disease, and so far as we know the incidence of the disease is arrested. Research workers in curative medicine are trying to find a serum that will cure the disease, but as a Public Health authority we advocate the prevention of the disease by the simple means I have suggested. It wants to be clearly understood that there is no need for people who have had birds of this sort for many years to anticipate 19 trouble; there is no need for people to do away with birds which have become family pets of long standing. (b) Rheumatic Affections.—Barking was chosen, so I am given to understand, to be the site of the Abbey which has made it famous by reason of the fact that it was reasonably secure from hostile attack, because it was then surrounded by marshes. This low lying site, which was an advantage in the far off days of hostile incursions, is now of course a disadvantage, and Barking suffers from rheumatic affections, like many other places in the Thames valley. We cannot make Barking any higher than it is, but people can, by careful attention to diet, increase their resistance to the microbes provoking rheumatism, and particularly in children by keeping the nose and throat healthy they can prevent the entry of these microbes into the body. This matter is discussed in my Annual Report on the School Medical Services in this area, both for this year and for last year. (c) Transport.—The conditions of transport to and from Barking are still much to be deplored. Many pioneers are now renowned for undergoing hardships and difficulties of travel hardly worse than those met heroically day after day by the people of Barking. Some improvement has, I believe, been made in the number of electric trains coming in and out of Barking, but any such increase does not appear materially to have improved the situation, owing probably to an increase in the number of the travelling public, consequent on the development of the Becontree Estate. I look upon this as a very serious matter, and am surprised that the public have tolerated the present conditions so long as they have. (d) Asbestosis.—The passing of the Workmen's Compensation (Silicosis and Asbestosis) Act, 1930, should in time do much to mitigate the lung trouble from which many persons in Barking 20 suffer, and which is provoked by the inhalation of asbestos dust. It will, however, take years for any substantial improvement to be felt. It is not unreasonable to suppose that for the next fifteen years we shall be getting deaths from asbestosis-amongst those people whose lungs are already affected. (e) Diphtheria.—The nature of diphtheria still continues to be serious, and during the year under review we have had many cases of mixed infection. This experience has, I believe, been shared by neighbouring authorities. There were a large number of cases of diphtheria—to wit, 358—and they came from all parts of the town. (f) Poisonous Gas.—From time to time in the neighbourhood of the railway station, hydrogen sulphide gas can be smelt. This is a poisonous gas and may, so we believe, come from an industrial process carried on outside the boundaries of this district. The attention of the Medical Officer of Health for the area concerned has been called to this matter from time to time. (g) Overcrowding.—It is impossible to leave this section of the report without once again referring to overcrowding. I know what you are doing, and I know that what you are doing is very good indeed, but the need there is for more houses and for better houses is so imperative that I cannot but feel impatient of any delay whatsoever. I want to reiterate that good housing will not solve all our public health problems, but that our public health problems will never be solved without good housing. (h) Smallpox.—Equally it is difficult for me to close this section without speaking of smallpox, although one is getting rather resigned to smallpox in these days. Smallpox can be prevented by vaccination, and it does seem futile to spend a lot of money on smallpox (for instance, smallpox recently cost Barking £1,000 in six months) when there are other things on which this money could be spent to advantage, if only smallpox were wiped out. 21 SECTION 2. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 10. NURSING IN THE HOME. (a) General.—The Plaistow Maternity Charity provides 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. My information is that this organisation does not receive from the public in Barking financial assistance comparable with the amount of work they are carrying out, and that, to put it bluntly, Barking is not paying its way. This is not at all surprising. The appeal for the King George Hospital is so strong and the need for this hospital so urgent, that we are apt to overlook the equally pressing need there is for nursing in the home. In recognising the insistent demand for raising funds for the King George Hospital, we must not forget an organisation which has looked after the sick in Barking these very many years. (b) 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, but, as you know (vide page 13 of my Report for 1929), I favour hospital accommodation for these cases rather than nursing in the home. 11. MIDWIFERY. 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. 22 The takings of the Charity for the year ended December 31st, 1930, in respect of 219 cases, amounted to £224 9s., leaving a balance due to the Charity from the Council of £75 11s. According to information obtained from ihe County Medical Officer, at the end of 1930 there were eight midwives practising in the District, three of which were employed by you at your Maternity Ward at Upney Lane, two under the Plaistow Maternity Charity, and three practising privately. During 1930 there were 811 maternity cases. 205 of these were conducted by the Plaistow Maternity Charity, 172 of them were conducted by your own midwives at Upney Hospital, leaving 434, which were dealt with by medical practitioners, private midwives or otherwise. It will be seen, therefore, that roughly one half of the midwifery is already under your supervision, because not only is your Medical Officer of Health, Medical Superintendent of the maternity ward at Upney, but he is also on the Committee of Management of the Plaistow Maternity Charity. It is this circumstance which makes it very curious indeed that the Ministry have not been willing for you to become the authority for the supervision of midwives. I advise that you make further representations to the Ministry, asking them that the authority for the supervision of midwives shall be delegated to you. 12. NATIONAL HEALTH INSURANCE. The fact that general medical practitioners are called in by the midwives at Upney, who practise as midwives under the rules of the Central Midwives' Board, and the fact that your Medical Officer of Health, as Tuberculosis Officer, is in constant touch with the general medical practitioners practising in the area, and the further fact that your Medical Officer is similarly in touch with these general medical practitioners in consultation over cases of 23 smallpox and other infectious diseases, link up the National Health Insurance work with the technical medical work carried out by you. There is a very real spirit of co-operation, for which I am particularly indebted to my colleagues in private practice, and nowhere has this been shown more readily than in the way they have assisted me to revise the Tuberculosis Registers, which—as I have said elsewhere—were in need of revision. 13. POOR LAW MEDICAL OUT-RELIEF. Similarly, in the case of poor law medical relief, both for inpatients and out-relief, we have been in constant touch with the Superintendent of Oldchurch Hospital, to whom I am indebted for many courteous considerations. It is our object to get cases of tubercle admitted to Oldchurch, and, where necessary, retained in Oldchurch so long as possible, and Dr. O'Loughlin, the Medical Superintendent, has been at great pains to co-operate with us in this important matter. 14. LABORATORY FACILITIES. The necessary laboratory work of the district is carried out by arrangement with the Essex County Council at the Counties' Laboratory, situated in Queen Victoria Street, London, E.C.4, particulars of the number of specimens submitted for examination being supplied by the following table:— Specimen Number examined Diphtheria 5,460 Sputa 466 Typhoid 18 Ringworm 5 Miscellaneous 19 In addition there were 51 biological examinations. 24 The work carried out by the Counties' Laboratories of Qeen Victoria Street is of a very high order, but I do wish that some arrangements could be made, either for getting swabs quickly to Queen Victoria Street over the week-end, or, alternatively, for these swabs to be examined in Barking. As and when we have a laboratory at the new hospital at Upney, no doubt you will entertain the possibility of undertaking a part at least of this work, with the particular object of avoiding the present difficulty we have of getting swabs to Queen Victoria Street during the week-end. It is to be noted that there is no difficulty when once the swabs are at the laboratory, because they are examined forthwith, and the reports can be sent through by telephone. 15.—LEGISLATION RELATING TO PUBLIC HEALTH. (a) Local Acts: Barking Town Wharf Act, 1893. Barking Parish Act, 1888. (b) General Adoptive Acts : Batns and Wash-houses Acts, 1847, etc. Infectious Diseases (Notification; Act, 1889. Public Health Act (Amendment Act), 1890, Parts 2, 3 and 5. Public Health Act (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. Public Health Act, 1925. (c) Regulations: Regulations as to Cemetery, 1902. Barking Town (Pneumonia) Regulations, 1924. 25 (d) 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). New Streets and Buildings, 1926. Slaughter Houses, 1890. Hospitals, 1897. Sanitary Conveniences, 1924. Pleasure Grounds, 1902. Mortuary, 1901. (e) 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 1926. 26 16. HOSPITALS. Hospitals provided or subsidised by the Local Authority: (a) Smallpox.—By arrangement with West Ham, smallpox cases are dealt with at Orsett or at the London County Council hospital at Joyce Green. This arrangement with West Ham is about to terminate, and I advise you to make an arrangement with the London County Council for the admission of your cases to Joyce Green. One suggestion has been made of building, somewhere in Essex, a hospital similar to the one at Joyce Green, Dartford. I believe, however, that such a hospital would prove a white elephant, and with the present perfected methods of transport, Dartford is not really a very long way off. (b) Hospital Provision at Upney Lane.—You, as a corporation, have provided two hospitals. They are both situated in Upney Lane, one for the isolation and treatment of infectious diseases, and the other for maternity cases. You are building a new isolation hospital, and the time has come for building a new maternity hospital, to which should be added a separate ward for the treatment of ailing infants, particularly those under the age of one year who are suffering from errors of diet. Although the actual number of beds for which there is space at the hospital is 38, if judged by the standard of 144 square feet per bed, as laid down by the Ministry of Health in Circular 1119, dated June 18th, 1930 (See Table I, Pages 27 and 28), the various wards at the hospital are designed to accommodate more beds than this number, and larger numbers than 38 have been accommodated when necessary. (c) General Provision of Hospital Services for the District.— A special report has been prepared, and is here included, which shows in tabular form the hospital services available, public ar.d voluntary, for the people of Barking. HOSPITAL SERVICES, public or voluntary, within or without the District, which are used by the inhabitants of the Harking Town Urban District. Name of Hospital. Situation. Purpose. Total number of beds available. Management. Men Women Children Centrolled bv the Harking Town Urban District Council 1. Maternity Ward, Municipal Hospital Upney Lane, Barking, Essex Maternity — 12 — Barking Town U.D.C. 2. Municipal Hospital Upney Lane, Barking, Essex Isolation of general infectious diseases (excluding smallpox) 38 Barking Town U.D.C. Not con/rolled by the Barking Town Urban District Council 3. Brentwood Mental Hospital Brentwood, Essex Mental 716 1054 — Essex County Council 4. Brookfield Orthopaedic Hospital. Hale End, Woodford Green, Essex. Orthopaedic — — 30 Voluntary 5. City of London Hospital for Diseases of Heart and I ungs Victoria Park, E.2 Heart and Lung Diseases 85 88 8 Voluntary 6. East Ham Memorial Hospital Shrewsburv Road, E. 7 General Medical and General Surgical. 38 38 20 Voluntary 7. East London Hospital for Children Glamis Road, Shadwell, E.l Children — — 140 Voluntary 8. Golden Square Throat, Nose and Ear Hospital Golden Square, Piccadilly Circus, W.l. Ear, Nose and Throat 33 32 11 Voluntary 9. Guy's Hospital London Bridge, S.E. 1 General Medical and General Surgical, etc. 299 285 64 Voluntary. 10. Hospital for Sick Children Great Ormond Street, W.C.1 General Medical and General Surgical and Isolation (Children only). — — 252 Voluntary. 11. Joyce Green Hospital Dartford, Kent Isolation of Smallpox (information not available) London County Council 12. King George Hospital Ilford, Essex General Medical and General Surgical. 16 20 22 Voluntary 13. London Hospital Whitechapel Road, E.l General Medical and General Surgical. 377 373 89 Voluntary 14. London Lock Hospital and Home 283, Harrow Road, W. 9 Maternity, Genito-Urinary and Venereal Diseases. 38 123 44 Voluntary 15. London Skin Hospital 40, Fitzroy Square, W.l Skin. (No in-patients.) — — — Voluntary 16. Orsett Joint Smallpox Hospital Stifford Long Lane, Grays, Essex. Smallpox 11 11 — West Ham County Borough Council 17. Poplar Hospital for Accidents East India Dock Road, E.14 General Medical and General Surgical. 56 30 26 Voluntary 18. Public Assistance Hospital OldChurch Road, Romford, Essex. General Medical, General Surgical, Children, Maternity, Tuberculosis, Chronic Sick, Mental and Orthopaedic. 260 311 100 Essex County Council 19. Queen's Hospital for Children Hackney Road Bethnal Green, E.2. Children — — 160 Voluntary 20. Queen Mary's Hospital for the East End Stratford, E.15 Geneial Medical and Surgical, Children, Maternity. 61 111 45 Voluntary 20. Royal London Ophthalmic Hospital (Moorfields Eye Hospital) City Road, E.C.1 Ophthalmic 66 50 19 Voluntary 21. Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex. Orthopaedic. 45 70 345 Voluntary 22. St. Bartholomew's Hospital Smithfield, E.C.1 General Medical and Surgical, Children, Maternity, etc., Ophthalmic, Orthopaedic, Ear, Nose and Throat, and Septic, etc. 287 344 65 Voluntary 23. St. Hospital for Women and Children Upper Road, Plaistow, E.13 General Medical and Surgical, Children, etc. — 27 44 Voluntary 24. Sever??? Mental Hospital Mile End, Colchester Mental 717 1064 Essex C.C. and Colchester B. C. 25. Westminister Hospital Broad Sanotuary, minister, S.W.1. Genera! Medical and Surgical. Maternity. Ear, Nose and Tho??? 109 132 26 Voluntary 29—30 TABLE II. HOSPITAL SERVCES showing the number of beds for each purpose, and other facilities available. Name of Hospital Niumber of beds for the following purposes:— Other facilities available Arrangements for pathological work Accident Chest (nontub.) & Heart Children Chronic Sick Dental Dermatological Ear, Nose Throat General Medical General Surgical Genito-urinary Gynaccological Infectious Diseases Isolation Observation Maternity Mental Neurological Opthalmic Orthopaedic Radium Septic Smallpox 'tuberculosis Venereal Diseases Centrolled by the Barking Town U.D.C. Maternity Ward, Municipal Hospital — — — — — — — — — — — — — 12 — — — — — — — — — Operative surgery, Dental, Nursing of Puerperal l ever and Pyrexia. Carried out at the Counties' Laboratory, Queen Victoria Street, E.C.4. Manicipal Hospital — — — — — — — — — — — 38 — — — — — — — — — — — Operative surgery, Dental, Ear, Nose and Throat, Orthopaedic, Maternity, Puerperal Eever and Pyrexia, Ophthalmia Neonatorum. ??? centrolled by the Barking Town U.D.C. Brentwood Mental Hospital — — — — — — — — — — — — — — 1770 — — — — — — — — All specialised treatment available. Own Laboratory. Brookfield Orthopaedic — — — — — — — — — — — — — — — — — — — — — — — Operative Surgery, Ultra-violet Light, Dental, Massage. No information City of London Hopital for Diseases of Heart and Lungs 72 8 — — — — — — — — — — — — — — — — — — 101 — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Nose and Throat, Radium. Own Laboratory. East Ham Memorial — — — — — — 4 40 49 — 8 — — — — — 4 — ~~ — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Electrical, Massage. Carried out at Queen Mary's Hospital, Stratford, E. East London for Children — — 140 — — — — — — — — — — — — — — — — — — — — All specialised treatment available. Own Laboratory. Golden Square Throat, Nose and Ear — — — — — — 76 — — — — — — — — — — — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic, Radium. Carried out by a Pathologist outside the Institution. Gut's 58 — 14 — 4 6 33 179 150 10 24 — 39 21 4 9 24 19 8 — — — 9 All specialised treatment available Own Laboratories. Hospital for Sick Children — — — — — — — 96 119 — — — 37 — — — — — — — — — — All specialised treatment available. Own Laboratory. Joyce Green Hospital (Isolation of Smalllpox.). No information available from the London County Council.) . (No information available from the L.C.C.) No information available. King George Hospital — — 22 — — — — — 27 — — — — — — — — — — — 1 — — Operative surgery. X rays. Dental (as cav.alty), Ophthalmic, Massage, Ear Nose and Throat, Radium, Gynaecological, Neurological, Dermatological. Work at present sent out, but Pathological Block is being. erected. The London — — — — — — 28 306 338 — 28 — 94 21 — — 24 — — — — — — All specialised treatment available. Own Laboratories. London Lock Hospital — 7 — — — — — — — 20 — — — 55 6 — — — — — — — 124 Operative surgery, Ultra-violet light, Dental, Ophthalmic, Massage, Ophthalmia Neonatorum. Own Pathologist. London Skin Hospital — — — — — — — — — — — — — — — — — — — — — — — Skin diseases only. (No in-patients). Ultra-violet light. Own Laboratory. Orsett Joint Smallpox — — — — — — — — — — — — — — — — — — — — — — — Smallpox Only. - Poplar Hospital for Accidents — — — — — — — 34 78 — — — — — — — — — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Radium by arrangement with the London Hospital. Carried out at the London Hospital. Public Assistance Hospital — — 100 141 — — 120 120 — — — — 30 32 — — 00 — — — 68 — All specialised treatment available with the exception of Ophthalmic and Radium. Carried out at the Counties' Laboratory, E.C.4. Queen's Hospital for Children — — 160 — — — — — — — — — — — — — — — — — — — — All specialised treatment available with Own Laboratory. Queen Mary's Hospital for the East End.. — — 45 — — — 4 66 61 — 3 — — 50 — — 4 2 — — — — — the exception of Radium. All specialised treatment available. Own Laboratory. Royal London Ophthalmic (Moorfields Eye Hospital.) — — — — — — — — — — — — — — — — 153 — — — — All specialised treatment available with the exception of Operative surgery, Massage and Radium. Own Laboratory. Royal National Orthopaedic — — — — — — — — — — — — — — — 460 — — — — — Operative surgery, X-rays, Ultraviolet Light, Massage. Own Pathologist. St. Bartholomew's Hospital — — 16 — — 6 24 234 250 — 44 — 10 17 — — — 18 — 55 — — — All specialised treatment available. Own Laboratories. St. Mary's Hospital for Women and Children — — — — — — — 26 33 — 8 — — — — 4 — — — — — — Operative surgery, X-rays, Ultraviolet light. Dental, Massage, Ear, Nose and Throat, Orthopacdic . Part-time Pathologist in conjunction with other Hospitals Severalls Mental Hospital — — — — — — — — — — — — — — 1781 — — — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic. Own Laboratory. Westminister Hospital 10 — 13 6 — 2 7 64 88 — 10 — 8 12 — — 6 5 15 — — — — All specialised treatment available. Own Laboratories. t In the case of Hospilali under the control of the JJurkint: Town Urban District Council:— Number and classification of Medical Staff Maternity Ward | Municipal Hospital The Medical Officer of Health is also the Medical Supt and is assisted in this work by the Assistant M.O.'s H Number and classification of Nnno g S'aff: Matron — 1 fister 1 — \.ss:»tant Nurses.. — 6 Midwives .. 2 — Probationer Nurses 4 9 Arrangements for the emfoymcut of consultants Consultants are engaged when necessary In addition to the above Institutions, there are a number of Sanatoria to whih tuberculous persons resident in Barking are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis. 31 Barking has hitherto been very well served by the hospital in London and the other hospitals within the metropolitan area, so well as by hospitals in the extra metropolitan area, but with the great increase in population in the Gale Street area, there is very real need for further hospital accommodation. This further accommodation we hope will be provided by the King George Hospital, but if it is to be provided at the King George Hospital, the scheme which has been envisioned by those, who realise the necessity, must become an accomplished fact. There must be a unit of 400 to 500 beds, and one way or another, the money must be provided. There is no difficulty in getting cases into voluntary hospitals, apart from that which generally obtains in London and the extra metropolitan districts, owing to the general lack of accommodation. We are always very happy to co-ordinate our work with that of voluntary hospitals, where they have a scheme for following up their patients. We know that if they are to do this, it is almost essential it should be done by correspondence, whereas we can achieve a personal touch by our health visitors undertaking this work. Various hospitals, particularly the Hospital for Sick Children, Great Ormond Street, have availed themselves of our help. 17. MATERNITY AND NURSING HOMES. Up to December, 1930, there were r.o maternity or nursing homes in Barking, excepting of course the Maternity Ward maintained by the Council. Since the end of the year, however, one small Home has been established, and I recommend you to apply for powers to be the supervising authority for these Homes. 32 18. MATERNAL MORTALITY. Cases of deaths due to pregnancy or childbirth are investigated, and during the year two confidential reports have been submitted to the Ministry of Health. The small number of such deaths precludes the possibility of my advancing any hypothesis on this vexed problem. Similarly, cases of puerperal fever and puerperal pyrexia are the subject of investigation, and any necessary steps are taken to secure adequate nursing and hospital facilities for the patients. If necessary, cases are nursed in the infectious fever hospital, and although there have been three cases of puerperal fever and ten cases of puerperal pyrexia, there have fortunately been no fatalities. The work of the Plaistow Maternity Charity is carried out with such meticulous accuracy that I should suppose, in areas in which they operate, the number of cases of pyrexia notified will be rather higher than elsewhere. 19. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS, ILLEGITIMATE INFANTS AND HOMELESS CHILDREN. We have not, in Barking, any institutions which make provision for unmarried mothers, illegitimate infants and homeless children, other than those provided by the Public Assistance Committee and the various voluntary agencies, with which we are constantly in touch. The competent sub-committee responsible for recommending admissions to Upney, wherever practicable, take a very kindly view with reference to unmarried expectant mothers. 33 The problem of illegitimate infants and homeless children is not a serious one in Barking, and the fact that we do not find it a serious problem indicates that the various agencies which are operating in the area meet the demands of the area. The unmarried pregnant woman is quite another problem, which is seriously dealt with in a later part of this Report. 20. INSTITUTIONAL PROVISION FOR THE CARE OF MENTAL DEFECTIVES. Institutional provision for the care of mental defectives does not come within the scope of the Council's activities, but great interest is taken in this problem, particularly in so far as it relates to children and young persons, and members of the Committee have visited the Royal Eastern Counties' Institution at Colchester. 21. AMBULANCE FACILITIES. (a) A motor ambulance is provided for the removal of infectious cases to the Isolation Hospital, Upney Lane. (b) 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. Last year I called your attention to the fact that it would be an advantage to have a nurse in attendance, at least sometimes, when the ambulance is used. From time to time it would be desirable that such a nurse snould be in attendance, and I hope that you will make the necessary arrangements. 34 22. CLINICS AND TREATMENT CENTRES. The following table shows the various out-patient departments under the control of the Local Authority. The proper housing of these various activities is, I know, a matter which is having your very serious consideration, and I do hope that the forthcoming year will show some definite steps taken towards securing suitable buildings for the multifarious activities you are carrying on. 35—36 CLINIC AND TREATMENT CENTRES. Name and Situation When held Nature of Accommodation By whom Provided 1 MATERNITY AND CHILD WELFARE— (a) Centres Clinic Premises, East Street. Tuesdays and Fridays, 2 p.m. Accommodation for consultations, weighing of babies, waiting room, etc. Local Authority. Great fields Centre, Movers Lane. Mondays, 2 p.m., and „ „ „ „ „ Alexandra Centre, St. Pauls Road Thursdays, 2 p m. „ „ „ „ „ *St. Albans Centre, Urswick Road. Wednesdays, 2 p.m. „ „ „ „ „ (b) Ante-natal Clinic Clinic premises, East Street. Wednesdays, 2 p.m. ; Fridays, 10.30 a.m. to 12 noon. Accommodation for consultations. „ „ Alexandra Centre, St. Pauls Road. Tuesdays, 2 p.m. „ „ „ „ „ *St. Albans Centre, Urswick Road. Wednesdays, 10.30 a.m. to 12 noon. „ „ „ „ „ (c) School Nurseries Nil Nil Nil Nil (d) Day Nurseries Nil Nil Nil Nil 2 SCHOOL MEDICAL SERVICE— (a) Inspection Clinics and treatment of minor ailments. †St. Albans Centre, Urswick Road. Daily, 8.30 a.m. to 12 noon. Large Hall. Local Authority. Clinic premises. East Street. Daily, 8.30 a.m. to 12 noon. Three rooms. „ „ (b) Eye Clinic „ „ Saturdays, 10 a.m. to 12 noon. One room. „ „ (c) Dental Clinic „ „ Daily, 9 a.m. to 12 noon and 2 to 4 p.m. Two rooms. „ „ (d) Orthopaedic Clinic Faircross School. Mondays, 9 a.m. to 12 noon, and 2 to 4 p.m. Wednesdays, Pitto. Fridays, Ditto. One room. „ „ 3 TUBERCULOSIS— 37, Linton Road Mondays, 3 to 5 p.m. Thursdays, 10.30 a.m. to 12 noon. Three rooms. Essex County Council. 4 VENEREAL DISEASES— London Hospitals, etc. - - By arrangement with Essex County Council. *Commenced 3rd December, 1930 †Commenced 5th November, 1930 37 23. LOCAL GOVERNMENT ACT, 1929. The operation of the Local Government Act, 1929, has not affected Barking very much, because, although the duties of the former Poor Law services have been transferred to the County Council, the actual position remains very much as it was before. It seems to me that much fuller co-operation and co-ordination is required, if we are to realise the benefits which represent the ideals which were actually the primary moving factor in this recent legislation. In Barking there is an investigation department, which has been brought to a very high level of efficiency. It seems a very great pity, with this efficient organisation at hand, that no use is made of it in distributing the various forms of relief controlled by the County, as well as those for which it is already used and which are controlled by the Town. It seems to me that there ought to be a unified system for distributing the various forms of benefit which are controlled by different authorities—not only those controlled by the Local Council and the Public Assistance Committee, but also those controlled by the Public Health Committee of the County, etc. This would do away with such incongruities as we have at present. Thus the provision of dentures under the County scheme may mean that the patient is asked to contribute a much higher sum than could possibly be asked under the scheme organised by the Town Council. Altogether the whole situation demands a round table conference. It is obvious that, with your highly developed social services, you could very well take over much of the work carried out by the County, particularly the work carried out by the Public Assistance Committee. 38 It is incongruous that you have officers examining infants and children, who are referred for medical treatment, which in manv cases the parents can ill afford and can obtain only through thr Public Assistance Committee. • This disjointed state of affairs is most unsatisfactory,and means sometimes that the children do not get the medical attention thi-v need. For my part, I do not hesitate to express the view that wher.-, through your activities, you have discovered conditions requiring treatment at home, the responsibility for providing such treatment, where necessary, should fall on you, with of course any necessary financial re-arrangement. 39 SECTION 3. SANITARY CIRCUMSTANCES OF THE AREA. 24. WATER. Water is supplied to the area by the South Essex Waterworks Company, from the Company's wells in the chalk at Ilford, Seven Kings and Dagenham. The water is untreated, and is hard in character. The supply is periodically examined by the Counties' Public Health Laboratories, and is always found to be of the highest degree of bacteriological and chemical purity. With the completion of the Company's scheme to bring water supplies from the River Stour, the work upon which is proceeding very rapidly, an increased quantity will be available. The Council will, of course, be aware that the increased rate for water supply in the district was in connection with the River Stour scheme. The following is a short description of the Stour Supply Scheme, as supplied to me by the Engineer of the South Essex Waterworks Company :— " The Scheme is authorised under the powers contained in the South Essex Waterworks Act, 1928. " The source of supply is the River Stour, from which water will be abstracted at an Intake situated near Langhain Mill, and will flow by gravity through a 40-in. diameter pipe to the sump of the Langham Low Lift Pumping Station. 40 "The water will be pumped thence through a 40-in. diameter main, about 650 yards in length, to a Sedimentation Reservoir, and will flow by gravity from the reservoir, through a 40-in. diameter main about 400 yards in length, to the Primary Filters, where a preliminary process of rapid filtration will ensue. A by-pass main will be provided around the reservoir to allow of the water being pumped direct from the Low Lift Station to the Primary Filters if required. " Alter leaving the Primary Filters, the water will flow (by gravity) to six sand filter beds of the ordinary type, and after being again filtered and chlorinated, will pass into the Filtered Water Reservoir. An outlet main of 40-in. diameter will carry the water from the latter reservoir to the suction branches of the three sets of pumping plant situated at the Langham High Lift Pumping Station. "The water will then be pumped through a main, 32 inches in diameter and slightly over 14 miles in length, into a covered reservoir placed in close proximity to the Tiptree Pumping Station, from which it will be carried to the suction branches of the three pumping units by a short length of main of 36-in. diameter. "TheTiptree Pumping Plant will pump the water thus received, through a main of 32-in. diameter and 94 miles in length, to the Danbury Reservoir, the top water level of which will be about 358 O.D. "From the latter reservoir, thewaterwill flow by gravity through a main of 34-in. diameter and about 13J miles in length to the Company's Herongate Reservoir, from which it will be supplied to the Company's District. " The whole of the mains will bo constructed of steel coated internally with a bitumen lining applied centrifugally." 25. RIVERS AND STREAMS. The various rivers and streams that run through the area are controlled by the Essex Sewers Commissioners, whilst of course, 41 the River Thames is a law unto itself. One of its tributaries, the River Roding, which flows through Barking, is also under the control of the Port of London Authority. We have not received any complaints during the year with respect to river pollution. 26. RAINFALL. The rainfall for the year ended December 31st was 22.47 inches. Rain fell on 290 days throughout the period in question. 27. DRAINAGE AND SEWERAGE. There has been considerable progress in the work of sewering the district, to convey the sewage of Ilford and Barking to the Northern Outfall Works of the London County Council for necessary treatment. The abolition of the existing treatment works of the Ilford Corporation will be much appreciated by Barking residents in the near vicinity of these offensive works, and the amenities of the Longbridge Park more thoroughly enjoyed. The new system of sewerage and sewage disposal, which will be fully in operation during the next two years, will unquestionably be an important advance in the public health services of the town. 28. CLOSET ACCOMMODATION. * In the unsewered portion of the district,there remain 43 premises with cesspools, 51 premises with pail closets and 7 with privies. The sewering of this particular area is nearing completion, and it is expected that the majority of these premises will be connected to the sewerage system during next year. 42 During the year several complaints were received with respect to the cleansing of the cesspools, but the conditions to which complaints related were quickly remedied. 29. SCAVENGING. (a) Storage and Collection.—The collection and disposal of domestic refuse is controlled by the Engineer and Surveyor. Every house is provided with a dustbin, the contents of which are removed weekly in S.D. freighters of the dustless loading type. During the year the provision of dustbins has been receiving our serious consideration. The procedure now in force is to call upon the owners of premises to provide a sufficient dustbin for the storage of domestic refuse. The enforcement of such order places considerable work upon the sanitary inspectors, whilst it does not always secure the provision of the most suitable container so expeditiously as we would like. It is therefore suggested that the Council themselves should accept the responsibility of dustbin maintenance, and meet the expenditure out of the general rate, in accordance with the provisions of the Public Health Act, 1875. This suggestion has not previously been made, in view of the fact that the rate levy would have been out of proportion to the service rendered. The operation of the Rating and Valuation (Apportionment) Act, 1928, has largely removed this objection, and the removal of trade refuse, free or at reduced charges, would satisfy any grievance occupiers of shop premises might hold. Complete control by the Council of the maintenance of dustbins should result in:— (1) Standard type of dustbin. (2) Definite economy in collection costs. (3) Improved storage of domestic refuse at the home. (4) No troublesome investigations,and no worrying notices to owners. (5) Cheaper dustbin maintenance for the owner, contributed in a fractional rate increase. 43 During the year 5,868 loads of refuse were collected, with an average weight of 1 ton 14 cwts. A charge of five shillings per load is made for the removal of trade refuse, but no charge is made for the use of the public tips by tradesmen, who make their own provision for transport. (b) Disposal.—There has been considerable improvement in the disposal of the crude refuse upon the low-lying land at Mayesbrook: Salvage of certain materials is carried out by controlled labour, whilst tipping trimming and covering is based upon Bradford methods. There is in consequence less need for criticism than heretofore. (c) Street Cleansing.—The streets of the town are generally kept in a very satisfactory state of cleanliness, but much could be done to assist the Council and reduce the cost of cleansing services if the public and tradesmen would co-operate by greater use of the domestic storage available for much of the litter which finds its way into the streets. (d) Fouling by Dogs.—The fouling of footpaths and premises by dogs calls for comment. I recommend that regulations be drawn up and enforced to prevent this nuisance. 30. SANITARY INSPECTION OF THE AREA. (a) Work of Sanitary Inspectors. (1) Inspection of Dwelling Houses. Total Houses Inspected under Public Health or Housing Acts 3,204 Total number of Inspections made 4,577 Housing (Consolidated) Regulations 659 After Infectious Disease 832 Defects Found 7,616 Notices Served (Preliminary) 2,497 Re-inspections re Notices Served 2,922 44 (2) Premises Controlled by Bye-Laws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings 16 7 3 Common Lodging Houses 62 5 1 Offensive Trades 173 21 5 Tents, Vans and Sheds 53 11 7 Dairies, Cowsheds and Milkshops 191 3 - Slaughter-houses 101 1 - (3) Factories, Workshops and Workplaces. Inspections. Defects. Notices Factories 97 32 20 Laundries 8 — — Bakehouses 35 2 2 Other Workshops 126 19 11 Other Workplaces 123 31 29 Outworkers' Rooms 13 — — Butchers' Premises 241 34 9 Fishmongers 41 13 5 Restaurants and Dining Rooms 36 2 — Stables and Stable Yards 77 12 5 Piggeries 66 1 1 45 (6) Summary of Sanitary Work Carried Out. (]) Drainage. Choked drains, opened, repaired, and cleansed 270 Drains reconstructed 68 New Drains Nil Ventilation Shafts repaired or new fixed 55 New Inspection Covers 26 (2) Closet Accommodation. Roofs W.C. structures repaired 63 Walls Floors Doors Seats Fixed 78 W.C. Pans Fixed or Cleansed 93 Flushing Apparatus Repaired or Renewed 203 (3) Sinks. New Fixed 55 New Sink Wastepipes 128 New Gullies 54 New Sink Waste-channels 2 (4) Dampness. Roofs and Flashings 1063 Eavesgutters 533 Rainwater Pipes 143 Damp Walls Remedied 552 (6) Water Supply. Defective Water Fittings Repaired and Supply Reinstated 87 46 (6) Yard Paving. Yard paving repaired or relaid 134 (7) Dustbins. New ones provided 632 (8) General Repairs. House floors repaired 183 Windows repaired or renewed 206 Window sills repaired or renewed 187 Sashcords renewed 274 Washing coppers repaired or renewed 175 Stoves repaired or renewed 217 House doors repaired or renewed 154 Stairs repaired 37 Handrails fixed 4 Chimney pots renewed and stacks rebuilt 183 Dirty or defective rooms repaired, cleansed and redecorated 1,414 Insufficient floor ventilation 12 Insufficient ventilation and light 3 External painting 90 Locks and Fastenings 8 Fences renewed 2 (9) Miscellaneous. Offensive accumulations removed 68 Animals so kept as to be a nuisance 15 Verminous rooms and persons disinfected 46 Dirty premises cleansed 5 Stagnant water 1 Drains tested 528 Dangerous structures reported 57 Overcrowding 54 Water in Cellar 1 47 (c) Notices Served. Informal Notices 2,497 Statutory Notices 670 Section 36, Public Health Act, 1875 55 Section 94, Public Health Act, 1875 497 670 Section 41, Public Health Act, 1875 1 Section 5, Infectious Disease (Prevention) Act, 1890 — Section 3, Housing Act, 1925 Section 17, Housing Act, 1930 117 (d) Factory and Workshops Act, 1901, Factories, Workshops and Workplaces. (1) Inspections (including inspections made by Sanitary Inspectors.) Premises. Number of Inspections. Written Notices. cutions. Intimations. Statutory. Factories 97 20 — — Workshops 126 13 — — Workplaces 166 29 — — Total 389 62 — — 48 (2) Defects found. Particulars. Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Ins. * Nuisances under the Public Health Acts:— Want of cleanliness 16 16 — — Want of ventilation 3 3 — — Overcrowding — — — — Want of drainage of floors. — — — — Other nuisances 13 13 — — Sanitary accommodation:— Insufficient 18 18 — Unsuitable or Defective 31 31 — — 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) — — — — Other offences 3 5 — — Totals 84 84 — — * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. (3) Home Work. Five notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 42 workpeople engaged on making wearing apparel, etc. in their homes. 49 (4) Registered workshops. Workshops on the Register (Sec. 131) at the end of the year. (1) Number. (2) Bakehouses (including five factory bakehouses) 13 Other Workshops 63 Total number of Workshops on Register 76 (5) 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) 3 Other - Underground Bakehouses (Sec. 101):— Certificates granted during the year In use at the end of the year — (6) Out-workers. The following list shows the nature of the homework carried out in this district by 42 outworkers:— Belt and brace maker 1 Box maker 1 Brush makers 2 Life belt covering 16 The making 3 Umbrella making 1 Wearing Apparel (various) 17 Christmas Cracker making 1 During the year 27 lists of out-workers were received from other Authorities in respect of addresses in Barking. Five lists were received from employers within the district. In all instances the premises of out-workers were kept in a satisfactory state. 50 31.. SMOKE ABATEMENT. Conditions prevailing in the factories of the district are so improved by the introduction during recent years of better methods, and the greater application of gas, electricity and what was previously waste heat, that, except for mechanical breakdowns or faulty stoking, there are few occasions for complaint. Also, the knowledge that any offence is likely to be the subject of a notice from the Local Authority acts as a deterrent. During the year 115 smoke observations were carried out on factory chimneys and notices were served with respect to the 24 offences registered. The question of grit emission from the chimneys of the generating station at Creekmouth continues to cause anxiety. The trouble is of a serious character, bristling with technical difficulties. The grit emanating from the pulverised fuel plant of the undertaking is of so fine and impalpable a nature as to be difficult to distinguish from ordinary fumes, and therefore difficult to arrest with the usual type of grit arrestor. It is estimated that, working under the best conditions and with fuel of low ash content, at least one half ton of this fine dust is discharged into the atmosphere every hour. Most of this falls over the site of the generating station, but, given unfavourable winds, neighbouring properties and the Creekmouth cottages do at times suffer from this emission. Experiments are proceeding with a view to remedying or mitigating the nuisance. The question of gas washing is receiving consideration. In view of the difficulty of introducing to a large existing plant equipment for this purpose, the possibility of a solution on these lines is unlikely unless engineering research finds some way of dealing with the gases during the high velocity flow. The enormous storage chambers required whilst the gases are being reduced from high to low velocity make impracticable the provision of gas washing plant in any building not specially designed to accommodate such chambers. 51 The Local Authority is aware of the whole circumstances, keeps in touch with the electricity undertaking, and expects all reasonable works to be carried out which are likely to remedy or mitigate the nuisance from sulphur or grit. As to whether these products of combustion can be dealt with satisfactorily is a problem which we hope will be solved when the projected station at Battersea, which is being equipped with plant for such purposes, is in operation. Enquiries so far made have not shown that any works carried out at existing large installations for this purpose have been successful. 32. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS OR REGULATIONS. (a) Houses Let in Lodgings.—Owing to the operation of the Rent Restriction Act it has been found difficult to deal with the small number of tenements by registering them in accordance with the bye-laws. Supervision is exercised over them and reasonable home conditions obtain. During the year three tenement houses were the subject of Closing Orders, the tenants re-housed and the premises demolished. (b) Common Lodging Houses.—Sixty-two visits were paid to the two common lodging houses, four of the visits being made at night. Five defects were discovered and one notice served. (c) Tents, Vans and Sheds.—There are still 8 occupied van dwellings, which are located in yards where water supply and sanitarv accommodation are provided. ‘Generally speaking, these vans are kept in a cleanly condition. The only complaints received were from occupiers of houses in the neighbourhood of one yard, in respect of a smoke nuisance. (d) Underground Sleeping Rooms.—There are no such occupied rooms in the district. 52 (e) Offensive Trades.—The following is a summary of the offensive trade premises registered:— Fish Fryers 25 Dealers in Rags and Bones 9 Gut Scraper 1 Fat Melters 2 Fish Skin Scraper 1 Oil Boiler 1 Total 39 One hundred and seventy-three visits were paid to these 39 premises, and 21 contiaventions of the bye-laws were discovered and any necessary action taken. During the year the Council approved two applications to commence the business of soap boiler. Although these applications were granted, the firms concerned had not commenced operations at the end of the year. (f) Refuse Tips.—Situated at West Bank are certain privately owned tips, which were the subject of complaint. Proceedings were instituted in respect of two contraventions of the bye-laws relating to the outbreak of fires, the offenders being fined £5 on each information. Since that date discussions between the Local Authority and the tip owners have taken place, and it is hoped that there will not be any repetition of the conditions which were the subject of complaint. (g) Piggeries.—The few remaining piggeries in the district are removed from occupied dwellings, but their presence on the marsh 'and is not satisfactory because of the difficulties in drainage. (h) Stables.—Seventy-seven visits were paid during the yea' to the stable premises in occupation and 5 notices were served respect of various unsatisfactory conditions. 53 33. PARKS AND OPEN SPACES. The Council of an industrial town like Barking is to be congratulated not only upon the fine parks and open spaces it has provided but also upon the provision of added opportunities for enjoyment. During the year there has been added to the Longbridge Park an extension of the boating lake, a paddling pool for toddlers and a large open-air swimming bath. This latter was not ready for service at the end of the year but is expected to be completed in time for next swimming season. When open it should be the finest bath in the south-east of England. The monotony of vista in several of the new streets has been greatly relieved by the planting of shrubberies on the verge of the footpaths. All these contributions not only add to the amenities of the town but definitely assist the well-being of the community by promoting that interest in " out doors " which results in improved health. 34. SCHOOLS. There are 10 elementary schools in the district, together with the Park Modern School and the Abbey Secondary School. With the exception of the Abbey Secondary School, sanitary inspections are regularly carried out in order that any unsatisfactory conditions may be remedied. Upon complaints being made, any necessary work is usually carried out forthwith. I have previously directed attention to the absence of sufficient and suitable facilities for the drying of clothes after inclement weather and also to the absence of proper drinking fountains at the older schools. These conditions have not so far been dealt with. 54 Of the elementary schools, that of the Church of England, situated in the older part of the town, is of a type we do not regard as being in conformity with our present standards. The Castle School at Rippleside remains unconnected with the public sewer, but it is anticipated that on the completion of the drainage of this area proper arrangements will be made. In connection with the prevention of infectious disease exclusion of contacts is carried out in accordance with the Memorandum drawn up by the Ministry of Health and the Board of Education. It has not been tound necessary to close any department of the schools as a result of infectious disease, but during the year, owing to certain instances of smallpox occurring amongst the scholars at the Cambell School, there was a considerable fall in the school attendance. All necessary disinfection and other precautions were adopted to prevent the spread of the disease. 35. RAG FLOCK ACTS, 1911 AND 1928. There are two premises where upholstery repairs are carried out and these premises are regularly inspected. The general practice at both establishments is to use fibre or wood wool for the purpose of repairs. On no occasion has rag flock been found in use. 55 SECTION 4. HOUSING. 36. STATISTICS. (a) General. Number of new houses erected during the year:— (1) Total 1,064 (2) As part of a municipal housing scheme— (a) Barking 59 (b) L.C.C. 970 (3) Others (including private enterprise and subsidy houses) 35 (b) Unfit Dwelling Houses. Inspection. (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 4,577 (2) Number of dwelling houses which were inspected and recorded under the Housing (Consolidated) Regulations, 1925 659 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 2,486 56 Remedy of Defects without Service of Formal Notices. (5) Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 1,827 Action under Statutory Powers:— Proceedings under Section 17 of the Housing Act, 1930. (6) Number of dwelling houses in respect of which notices were served requiring repairs 117 (7) Number of dwelling houses which were rendered fit— By owners 107 By Local Authority in default of owners 10 (8) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations of owners of intention to close Nil Proceedings under Public Health Acts. (9) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 553 (10) Number of dwelling houses in which defects were remedied:— By owners 553 By local Authority in default of owners Nil 57 Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925, and Section 19 of the Housing Act, 1930:— (11) Number of representations made with a view to the making of Closing Orders 8 (12) Number of dwelling houses in respect of which Closing Orders were made 8 (13) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil (14) Number of dwelling houses in respect of which Demolition Orders were made 4 (15) Number of dwelling houses demolished in pursuance of Demolition Orders 4 37. HOUSING CONDITIONS. (a) General Observations.—The total number of inhabited houses in the district is 10,941, which, compared with the total of 6,762 at the census of 1921, gives an indication of the growth of the town during the past decade, the greatest increase having taken place during the immediate past two years. Of the total of 10,941 dwelling houses, 1,216 are owned by the Council and approximately 2,000 have been erected in the area by the London County Council since the year 1929. It is interesting to note that 1,499 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. The houses in the area are of the typical town street terrace type of cottage. Apart from the old houses situated in the Abbey and Centra) Wards, together with a few cottages of a rural character on the outskirts of the district, the dwellings are of a vype and structure which permit of adequate lighting and ventilation, with reasonable back garden area. 58 The provision of a sufficient open space at the rear of all occupied buildings is a primary consideration in modern housing schemes, whether municipal or private. Further, very few houses are now erected with a back addition building likely to obstruct sunshine or the free circulation of air. Having these essential amenities in mind, it is particularly unfortunate that householders should erect the shed structures which are to be seen in the back gardens of many of the houses in the town. A large number of such structures are erected without any regard to the law upon the ma matter. It is to be deplored that laws introduced to provide a sanitary environment should be broken and made of no avail by the very people such laws were designed to protect. It is estimated that there are 7,000 houses (70 per cent.) in the district where temporary buildings have been erected in the back gardens of the premises. Many of these are used for the dumping of household litter, most are ugly and mis-shapen, and almost all are open to objection. They encroach on the limited open space available and oftentimes harbour rats. Among the types of structures which should never be allowed in the small gardens of cottage dwellings are:— Poultry houses and fowl runs. Large wringer slieds. Tool sheds and workshops. Motor cycle sheds. Lean-to additions with insufficient roof lightandventilation. As the Council is aware, the most satisfactory method of dealing with the problem is to make greater use of its powers for the control of temporary buildings. 59 With the advent of a large new population to the district and the erection of so many new houses, the time appears to be opportune for the prohibition of anything but a standard type of structure, the site to be not within 15 feet distance from any window of the dwelling house. The average rent in Barking of the two-bedroomed houses, of which there are a large number, is 8s. l0d. per week inclusive. There are in the Abbey Ward several decayed residences, now let in tenements. The Council's practice of demanding a reasonable standard of housing is reflected over the area as a whole and the public now look for and expect a good type of accommodation. There is, however, a tendency on the part of some owneroccupiers to convert what is essentially a self-contained house into separate apartments on the ground floor and first floor respectively. This in many instances means sharing closet and washing accommodation, whilst food storage is provided by means of a temporary box arrangement. There does not appear to be much objection to such a practice where the occupying families are small in number, but there is a potential danger of overcrowding as the families increase. (b) Sufficiency of Supply of Houses and Overcrowding.—The sub-letting by owner-occupiers is a feature the Council should have in mind when considering housing schemes, particularly as, owing to the operations of the London County Council and private builders, the available land now free for development is totally insufficient for the needs of the existing population. Applications by residents for houses in the Council's ownership have recently been sifted, and as a result it has been found that there remains a total of 1,115 live applications, to which total additions are still being made. It will be seen that a programme of 100 new houses per annum must fail completely to meet so large a need. 60 Apart from the existing overcrowding, as shown by the number of current applications, the influx of new industries to the area which is expected to follow upon present activities is bound to bring new residents. These residents, after a short domicile, will expect proper housing accommodation. In view of the absence of suitablesites it appears that any accommodation provided must be in the form of tenements or by the erection of houses outside the boundary of the district. I do not think the Council should dismiss too lightly the possibility of reclaiming parts of the extensive marsh land, with a view to future building use. Modern methods of reclamation obviate many of the objections previously properly sustained. It is understood that on the completion of the building programme of the London County Council in the year 1932 there will have been erected a total of approximately 7,000 houses by that Authority within the Barking area, giving an added population estimated at 33,000. The following summary shows the number of dwelling houses erected during the quinquennium. HOUSES BUILT IN DISTRICT. 1926—1930. Total. . As part of Municipal Housing Scheme. Others (including private enterprise and subsidy houses.) 1926 289 47 242 1927 358 30 328 1928 375 40 335 1929 700 (Barking) 206 237 (L.C.C.) 257 1930 1,064 (Barking) 59 35 (L.C.C.) 970 Totals 2,786 1,609 1,177 Of the 1,609 houses shown above as part of Municipal Housing Scheme, 382 were provided by the Barking Town U.D.C. and 1,227 by the London County Council. 61 It will be observed from those figures that the Local Authority has in the last five years provided 382 dwellings, which have been let to persons living in overcrowded conditions. As a result of people from outside the district crowding into houses situated in Barking, it was found necessary to introduce a residential qualification in order that applications from such new residents should not receive prior consideration. Proceedings were instituted in two cases of overcrowding. The families concerned each occupied one room in a tenement house. In one instance there were eight persons in family and in the other six persons. The magistrate made an Order in each case. There is at the present time considerable demand for houses of the two bedroom, non-parlour type. There is no doubt that this small house is favoured rather on account of its low rent than on account of its social amenities. It does, however, appear that a reasonable social standard can be maintained by many small families in such houses, and because this is so we favour the building of houses of this sort. It is obvious that people cannot afford to pay more than onesixth of their income as rent and rates, so that even for people earning so much as £3 per week a maximum of ten shillings only can be allotted for this purpose. (c) Fitness of Houses.— The defects existing are as indicated in the summary of sanitary work carried out. Under the present restricted rent conditions owners are unwilling to carry out even minor repairs without notices. Much of the maintenance repair work follows the issue of informal notices, but in many instances where major repairs are required it is necessary to serve formal notices. During the past year we have been successful in getting carried out extensive re-pointing of brickwork to whole terraces of houses and considerable painting of external woodwork where 62 decay was, commencing. This work is more often the result of convincing owners of the economic advantage to be gained by the preservation of the structure than by the service of formal notice. Where owners are not financially able to carry out forthwith the required repairs it has been found necessary either to allow ample time for completion, or alternatively where the work is urgent, for the Council to do the work in default, the owner making repayment by instalments in accordance with the Housing Acts. In one instance the two-storied back addition of a house was so rebuilt by the Council, the owner paying for such by instalments. With the exception of twelve houses, which have been included in clearance schemes, every house in the district is provided with water supply inside the premises. In only two instances is closet accommodation shared, and here again the houses concerned are the subject of representation as unfit dwellings. Owing to the architectural arrangement it has been found impracticable to provide suitable food storage accommodation to many houses already erected. For this reason some owners have not been called upon to provide such accommodation. (d) Unhealthy Areas.—With a view to action under the Housing Act, 1930, a five-year programme of slum clearance has been prepared. In the schedule are included many of the old properties which require constant supervision because of their decayed and worn out condition. It may also be said that the accommodation existing in these properties is inadequate for family life. It is proposed to demolish 297 houses in clearance areas and 43 individual unfit houses outside clearance areas. Representations in respect of such areas were pending at the end of the year. 63 SECTION 5. INSPECTION AND SUPERVISION OF FOOD. 38. MILK SUPPLY. Registered with the Authority are 41 retail purveyors, of whom 12 occupy premises outside the district. In addition there are 2 cow keepers, with a total of approximately 40 milch cows. The following table sets out the results of the bacteriological examination of various samples, from which it will be seen that out of a total of 46, five were found to be unsatisfactory:— Type of Sample. Satisfactory. Unsatisfactory. Totals. Grade "A" (T.T.) Milk 8 — 8 Grade "A" Milk 1 — 1 Raw Milk 13 1 14 "Pasteurised" Milk 18 4 22 Grade "A" Milk Pasteurised 1 — 1 Totals 41 5 46 Whilst 18 of the samples examined are described as pasteurised milk, the majority of the samples represent supplies which, although pasteurised, were not retailed as such, a condition to which I drew your particular attention in my Report for the year 1929. There were during the year 14 samples of milk submitted to biological examination for the presence of tubercle. Of this number one sample was found to be infected. The source of infection was discovered and the animal destroyed. The bacteriological examination of all milk samples is carried out for this Authority by the Counties Public Health Laboratories of 91, Queen Victoria Street, London, whilst the examination of 64 samples of milk for the presence of tubercle is carried out by Professor R. T. Hewlett of the Seamen's Hospital, Greenwich, by animal inoculation. 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:— "Certified" Milk 1 Grade "A" Milk 1 "Pasteurised" Milk 3 Grade "A" (T.T.) Milk 10 Grade "A" Milk, Pasteurised 1 Licences were granted to two local firms for the bottling of Grade "A" (T.T.) Milk. There are in the district 46 retailers and 11 wholesale distributors of sterilised milk. One dairyman was prosecuted for bottling milk in the street. The provision during the year of steam raising equipment for the cleansing of their utensils and bottles, was an improvement for which dairymen in the district should be given every credit. Bacteriological examination of milk taken subsequent to the installation of such equipment indicated the improvement in the conditions of cleanliness. 39. MEAT AND OTHER FOODS. (a) Meat.—The one licensed slaughter-house continued in the occupation of the same person and has not given cause for complaint during the year. 65 The following table gives particulars of notifications received, and the animals slaughtered, during the five years ended December 31st, 1930. Year 1926 1927 1928 1929 1930 Total. Notifications Received 109 160 126 72 64 521 Cattle 3 97 40 64 80 284 Pigs 86 204 409 137 93 929 Sheep 611 786 815 426 332 2970 Calves 156 137 71 10 11 385 Totals 856 1224 1335 637 516 4568 Diseased meat was destroyed as under:— Description. Disease. Weight. 1 beast's pluck Tuberculosis 25 lbs. 11 beasts' lungs „ 65 ,, 2 „ lungs Pleurisy 12 „ 6 „ lungs Pneumonia 36 „ 9 „ lungs Parasites 54 „ 16 „ livers „ 224 „ 4 „ livers Distomatosis 56 ,, 1 beast's liver Tuberculosis 14 „ 4 beasts' livers Cirrhosis 56 „ 2 ,, mesenteries Tuberculosis 6 „ Hindquarters of bobby calf Necrosis 27½„ Portion of leg of veal Contusion 4 „ 3 sheeps' plucks Parasites 21 „ 68 „ lungs „ 184 „ 6 „ livers „ 24 „ 1 sheep's liver Cirrhosis 4 „ 11 pigs' lungs Parasites 33 „ 8 „ livers „ 40 „ 1 pig's liver Cirrhosis 6 ,, 2 pigs' heads Tuberculosis 20 „ Total weight 91½ lbs. 66 We do not regard present legislation as being sufficiently stringent in its application to the sale of foodstuffs. Unless the condition of the food exposed for sale is so bad as to be definitely unfit within the meaning of the Public Health Act, 1875, little action can be taken. We think that legislation should be introduced which would provide the Local Authority with power to exercise such control over the display, preparation and distribution of food supplies as would prevent such food becoming exposed to the many forms of contamination to which it is now subjected. The inadequacy and ambiguity of the Public Health (Meat) Regulations, 1924, as applied to stalls and shops is an example of the type of legislation to avoid. (b) Ice-cream.—In this country ice-cream is still regarded as a luxury rather than a food, although, following upon improved methods of manufacture and distribution, the demand for this product is now becoming more continued. So far the only powers for control of this trade are included in local acts, national legislation being non-existent, except from the point of view of probable contamination. Unlike other and kindred products such as milk, butter, etc., no standard of chemical composition or cleanliness of the product has been set up. The wholesomeness of ice-cream, as with most prepared foodstuffs, is influenced chiefly by:— (1) Purity and storage of ingredients. (2) Method of preparation. (3) Storage and distribution of the finished product. The chief constituent of ice-cream should be cream or milk, whether fresh, dried or condensed. In the absence of legal standards, it is not surprising that many ice-creams show variations in the milk fat content between 1 per cent and 20 per cent, the retail prices of 67 the product often being the same. It has been suggested that a minimum of 8 per cent butter fat and not less than 18 per cent total milk solids should be the standard of composition. In view of the increasing general consumption, I am of opinion the time has arrived when standards of cleanliness and chemical composition should be enacted, together with the registration of producers and distributors, as in the case of milk supplies. Such legislation would increase public confidence in the article and would enable Authorities to remove from business the unscrupulous and dirty trader, and would materially assist the conscientious vendor in distributing a safe and valuable foodstuff. I earnestly advise the Council to initiate or support any action directed to this purpose. Herewith I submit the results of bacteriological examinations of ice-cream during the year. Sample No. B. Count. B. Coli 83 20,100 Absent in 1 c.c. 84 19,400 ditto 85 12,600,000 Present in 0.00001 c.c. 86 27,000 Absent in 0.1 c.c. In view ol the fact that ice-cream is prepared in a manner similar to that of pasteurised milk, I see no reason why a similar standard of cleanliness should not be instituted. Pasteurised milk should not contain more than 100,000 bacteria per cubic centimetre, with an absence B. Coli in a like quantity. This is the standard adopted by large manufacturers in this country and recommended in the United States of America. 40. ADULTERATION, ETC. The Food and Drugs (Adulteration) Act, 1928, and kindred Acts and Regulations are administered in this district by the Essex County Council. 68 I am indebted to Mr. H. C. Card, Chief Food and Drugs Officer for the Metropolitan Area of the Essex County Council, for the particulars of samples purchased and submitted for analysis during the year. These samples are submitted for chemical examination to Dr. Bernard Dyer, the County Analyst. Other Milk. Butter. Samples. Total. 81 86 86 253 No proceedings were instituted in relation to these samples during the period covered. 41. UNSOUND FOOD. The following list gives particulars of the unsound food destroyed during the year :— 1 ½ sheeps' livers. Part of breast of lamb. 1½ bushels plums. Two cases of haddocks. One bushel two gallons whelks. 42. NUTRITION. Through the schools, through the various clinics and by the quiet teaching in the home by the health visitors and school nurses, a lot of useful work is being done in making available for the general public the results of recent work in the value of different foods. The chief trouble we experience is that the principles are very simple and that carrying out these principles is fraught with many difficulties, both social and economic. There is no doubt that much of the money at present spent on food is spent to economic disadvantage and that those people who are least able to afford it, pay most in many cases for their food. 69 In many of the homes in Barking facilities are lacking for preparing food under suitable conditions, and it is not to be wondered that when the circumstances are such that the proper preparation of food is a matter of great difficulty, people resort to expediencies which are not altogether to be commended. The greatest difficulty is a lack of variety. For my part, I deprecate a good housewife thinking in terms of calories and vitamins just as I should not expect a great artist to think in terms of the latest scientific enquiries into the theories of colour vision. If good, plain, straightforward food is made available for the public at a price the public is able to pay, and if that food is as widely variable as possible, and if the public arc taught to avail themselves of these amenities, they will, without any scientific knowledge, prepare foods wnich are scientifically accurate. 71 « SECTION 6. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 4:5.—NOTIFICATION TABLES. The following table shows the number of notifications of infectious diseases received during 1930 :— TABLE I. Diseases. Males. Females. Total Total cases rem'd to Hos. Deaths Small-pox 18 27 45 45 - Scarlet Fever 80 98 178 151 2 Diphtheria 165 193 358 350 13 Puerperal Septicaimia - 3 3 2 — Pneumonia: Acute Influenzal 16 8 Following Measles 3S 26 12 4 8 Other Forms 36 8 Erysipelas 17 23 40 6 - Ophthalmia Neonatorum 12 — 12 1 - Puerperal Pyrexia — 10 10 4 — Enteric 4 1 5 4 — Epidemic Cerebro-Spinal Meningitis 1 1 1 - Chicken-pox 132 156 288 2 - Totals 467 537 1004 570 39 72 The following diseases were notifiable in 1930 under the original Infectious Disease (Notification) Acts, 1889, and 1899:— Small-pox, diphtheria, relapsing fever, cholera, erysipelas, typhus, plague, puerperal fever, enteric fever, scarlet fever and continued fever, and hy Orders or Regulations framed under Section 180, Public Health Act, 1875:— Tuberculosis (all forms), ophthalmia neonatorum, cerebro-spinal fever, acute poliomyelitis, encephalitis lethargica, influenzal pneumonia, acute primary pneumonia, malaria, dysentery, trench fever, and puerperal pyrexia. 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 diseases numbered 1,004 exclusive of tuberculosis and inclusive of chicken-pox, compared with 547 the previous year. During 1930 the number of notifications of tuberculosis (all forms) was 95 compared with 64 in 1929. 73—74 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 6 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 35 years. 36 to 45 years. 45 to 65 years. Over 65 years. Totals. Abbey. | Gascoigne. Central. Ripple. Longbridge. Westbury.  Small-pox 2 3 1 1 21 5 1 8 1 2 45 2 2 34 1 6 Scarlet Fever 1 6 12 15 17 68 30 12 12 5 — - 178 13 30 22 39 43 31 Diphtheria I 13 20 21 34 171 45 19 25 6 3 - 358 48 61 30 84 44 91 Puerperal Septicaemia — — — — — - - — 3 — — - 3 — — — 2 1 - Pneumonia (primary, influenzal and following Measles) 4 10 6 3 1 11 2 2 5 4 12 4 64 10 12 8 14 10 10 Erysipelas 1 — 1 — — 2 — 3 6 4 16 7 40 4 7 4 9 8 8 Ophthalmia Neonatorum 12 - - - - - - - - - - - 12 2 3 - 5 2 - Puerperal Pyrexia — - — — — — — — 9 1 — — 10 — 2 1 4 3 — Enteric Fever - - - - - 1 1 1 2 — — — 5 1 — — 1 2 1 Cerebro Spinal Meningitis - - - - - - - - 1 - - - 1 - - - - - 1 Chicken-pox 9 25 23 12 22 149 36 3 6 2 1 — 288 20 63 39 66 50 50 Totals 28 56 65 52 75 423 119 41 77 23 34 11 1004 100 178 106 258 164 198 75 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1930 :— Scarlet Fever. Diphtheria. Total. January 30 24 54 February 15 20 35 March 9 38 47 April 18 31 49 May 16 24 40 June 11 22 33 July 10 31 41 August 11 26 37 September 10 21 31 October 26 49 75 November 12 47 59 December 10 25 35 Totals 178 358 536 44. NOTIFIABLE INFECTIOUS DISEASES. (a) Diphtheria.—358 cases were notified, compared with 95 the preceding year. Of cases notified, 337 were removed and treated in the local isolation hospital. 13 deaths from diphtheria occurred. The average stay of clinical diphtheria in hospital was 48 days, the longest stay being 253 and the shortest 7 days. Sex.—165 cases were male and 193 female. To a certain extent this number is explained by the activity of general practitioners and of your own officers, who have been at great pains to try to round up every possible case of diphtheria, but after allowing for this, it must be admitted with regret that the year has been a bad one from the standpoint of the incidence of diphtheria. 76 All parts of the town have been affected and although several investigations have been set on foot it has been found impossible to find any common factor explaining the incidence of the disease. The diphtheria has been of a serious type and the paralyses which are a feature of the later stages of diphtheria have been pronounced and have required very long and careful convalescences. There were 13 deaths out of a total number of 358 cases, making a percentage death rate of 3.6. Anti-toxin is readily available for all cases. This is kept at the Fire Station and may be obtained at the hospital, but in most cases (as is shown by the table on page 71), patients requiring anti-toxin are removed to hospital. (b) Scarlet Fever.—The number of cases notified was 178 compared with 277 the previous year. Two fatal cases occurred. 141 cases were isolated at the local Infectious Hospital. The average stay of scarlet fever cases in the Municipal Hospital was 44 days, compared with 39 days in 1929. The longest period of detention was 191 days and the shortest 11 days. Sex.—80 cases were male and 98 female. Evidence in Barking is not sufficiently extensive to warrant any opinion as to the correlation between scarlet fever and puerperal fever. (c) Pneumonia, Malaria and Dysentery.—The following table shows the incidence during the year of pneumonia, malaria and dysentery, which are notifiable under the Public Health (Infectious Diseases) Regulations, 1927 :— Diseases. No. notified. No. of deaths. Malaria None None Dysentery None None Pneumonia 64 24 77 (d) Smallpox.—There have been 45 cases of smallpox during the year 1930. Not one case proved fatal, but one case was of a very severe order and left permanent injury to one eye of the patient. This case is interesting by reason of the fact no contact could be proved with any similar serious case, in which circumstance we have once more evidence for believing that the serious type of smallpox and the lesser types of smallpox are all one, the only real difference between modern epidemics and epidemics of olden days being that, whereas in olden days a relatively small number of cases were mild and the majority of cases were severe, at the present time the larger number of cases are mild and only a few cases are severe. The system of persons being admitted to an hospital from which they can be and are discharged without even a consultation with the Medical Officer is bad. One case stands out in my memory during the past year of a man in whom the signs were, and were known to be, equivocable. Every consideration was given to the question, and the diagnosis rested to a certain extent not only on the actual physical signs but also on the epidemicological evidence. This man was admitted one day, we got in touch with the hospital and fouNd that they too confirmed the signs and they, with us, thought they were very suggestive, and then on the fourth day the man was discharged without even a consultation. Of course, it is quite possible that your Medical Officer would have changed his mind if he similarly had had an opportunity of observing the case in hospital for four days, but on the other hand, the question was one of such difficulty and one in which a personal opinion is likely to vary, that it does seem unfortunate that a Medical Officer should have returned to his area a patient who may after all, so far as he knows, very well be suffering from smallpox. The County Medical Officer still continues to duplicate the circulars we send out to neighbouring authorities with reference to cases of smallpox which occur in Barking. f 78 I have had no satisfactory explanation of this procedure, although I have been in touch with the County Medical Officer. * You will remember I brought this matter up in my Report for the year 1929. (e) Encephalitis Lethargica.—There was one death from encephalitis during 1930, the diagnosis being made post mortem. The case was an acute one of unknown origin ; there was oedema of the brain, but microscopical sections failed to reveal anything further. (/) Tuberculosis.—Particulars of new cases of tuberculosis and of all deaths from the disease in the area during 1930 are given in this Report in the following form:— New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 year 1 1 1 to 5 years — — 4 2 — — 1 1 5 to 10 years — — 3 3 — 1 — - 10 to 15 years 2 — 4 2 — — — - 15 to 20 years 2 5 1 2 1 6 — - 20 to 25 years 6 7 — 1 9 4 — - 25 to 35 years 7 16 — — 2 6 — - 35 to 45 years 3 7 — 1 1 4 — - 45 to 55 years 6 4 — — 2 - 1 - 55 to 65 years 3 — — — 2 - — - 65 yrs. & upwards — 2 — 1 1 1 — - Totals 30 41 12 12 12 22 2 1 No action has been takEn in any court of summary jurisdiction under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 62 of the Public Health Act. 1925, but you have from time to time, on the representation of your officers, given instructions for such action to be taken if necessary. On the one hand a more enlightened public opinion in Barking and on the other hand the knowledge that you are prepared to enforce isolation have made it possible for us to arrange on a voluntary basis isolation which could be enforced after application to the magistrates. 79 Daring the year, 95 notifications were received of all forms of tuberculosis—pulmonary 71, and non-pulmonary 24. Information was received of the removal into the district of 21 tuberculous persons, included in number of notifications received. Once again I want to call attention to the large number of inward transfers. This is due in large part to the expansion and development of the district. 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 43 7 6 24 28 5 5 There were 842 attendances at the dispensary during the year for the purpose of medical examination, 188 being new cases. Of new cases attending during the year, 27 were subsequently notified as suffering from tuberculosis, 51 had been previously notified, while 15 were inward transfers. The following table gives in tabular form the number of patients removed from the Dispensary Register during the year :— No. on Dispensary Register 31-12-29. Numbers removed from the Dispensary Register. Number on Dispensary Register 31-12-30. Died. Left District. Discharged (Non Tb.) Discharged " Cured " Transferred to another Dispensary. etc. Amended Diagnosis Total 423 22 11 108 16 9 105 271 355 At the end of the year, 341 cases on the Dispensary Register were definitely diagnosed as suffering from tuberculosis, whilst in 14 cases the diagnosis still remained in abeyance. 80 Thirty-seven deaths occurred from tuberculosis (all forms), 34 of these being pulmonary cases. The number of deaths in institutions was 18. The death rate for tuberculosis (all forms) during 1930 was 0.82 per 1,000 population, compared with 0.9 for the previous year. Of the 37 deaths from tuberculosis 3 had not been notified to us before death—i.e., 8.1 per cent. of the total deaths from tuberculosis. No action has been taken for wilful neglect or refusal to notify, because none of the 3 cases comes within such category. The figures in Barking in any one year are not sufficiently large for us to express any opinion as to if and whether there is evidence of any excessive incidence of, or mortality from, tuberculosis in any particular occupation in the area, but the association of tuberculosis with asbestosis is well known, and I understand that the figures for the nation as a whole show that there is an increased incidence of tuberculosis amongst these workers in asbestos. During the year 1930 your Medical Officer of Health has continued to be Tuberculosis Officer, and this fact has mitigated to a large extent the disability of divorcing work associated with the detection of tuberculosis from the general duties of the Medical Officer of Health. With the development of Barking some variation in our present plan of operation is necessary, and a review of the situation would not be out of the way here, particularly so in view of the fact that the situation in Barking has been interesting as an experiment. It must be remembered that a Tuberculosis Service consists essentially of three more or less distinct factors. These of course overlap to a certain extent. First of all we have prevention, then we have detection and then we have treatment. It is obvious that of these three factors 81 prevention is by far the most important, and everything else should be subordinated to secure the efficiency of the Tuberculosis Service as a preventive service. In London this is done by linking up prevention and detection, giving to the Medical Officers of Health full comprehensive knowledge of the whole of the problem so far as it affects their area. Outside London, unfortunately, except in the case of County Boroughs, this happy state does not obtain. Detection is linked up with treatment. In the past there has been something to be said for this. The prevention of tuberculosis has never been so seriously entertained generally throughout the country as it should have been. Nor has there been in the past evidence that any activity by a Local Authority which had for its object the prevention of tuberculosis would obtain such a measure of public support as to make it efficient. On this account it has been in a measure wise to link up detection with treatment, so as to increase the efficiency of treatment, in the hope of indirectly helping prevention ; but the people of England are becoming more interested than ever in the prevention of tuberculosis, and particularly have I noticed this in Barking. Where Local Authorities have such an intelligent and enlightened public opinion behind them it is obvious that everything should be done, as I have said, to increase the efficiency of direct prevention, and the benefit of combining prevention and detection outweighs any minor advantage of combining detection and treatment. It is only when a Medical Officer has—as the Medical Officers of the Metropolitan Areas have—a comprehensive knowledge of the whole of the problem that this prevention can be really efficient. It is to be hoped that in the future, where Athorities responsible for prevention are able to undertake the responsibility of detection, this responsibility shall be conferred upon them. 82 I am persuaded that to such a measure as this, rather than to any special curative measure, we must look if we want to eradicate tuberculosis. These remarks particularly apply to Barking, because Barking, in its position as an extra metropolitan area, is very well served, so far as treatment is concerned, by the large London hospitals, and treatment does not loom so largely in the work of the Tuberculosis Dispensary in Barking as it does in a Tuberculosis Dispensary in a remote part of the country. The Tuberculosis Dispensary in Barking is essentially a clearing house. A certain amount of treatment is of course carried on, but this is a very minor function of the Dispensary. Even the association of prevention and detection will not be sufficient unless there is still closer co-operation between the various sanatoria of the country and Local Authorities. Sanatorium authorities must go out of their way to achieve co-ordination if a truly efficient system is to be built up. No man nor woman should be discharged from sanatorium unless or until there have been conversations between the superintendent of the sanatorium and the Medical Officer of Health. The mere formal chit as required by law is by no means sufficient. Incidentally it is unfortunate that, whilst superintendents of public sanatoria are bound to notify the Medical Officer of Health of the admission and discharge of patients, no such obligation rests upon voluntary hospitals, and I do hope that voluntary hospitals will themselves make arrangements for this very necessary transfer of information. There remains one more thing for me to say under this heading and that is the need there is for persons to be admitted to sanatorium much more quickly than they are at present. To those of us who are mixed up with suffering and disease the plain straightforward thing that must be done appears quite obvious, and it appears to us that it ought to be quite easy for the patient to make up his or her mind. We know, however, by experience that this is not so. 83 Shakespeare wrote:— "Between the acting of a dreadful thing And the first motion, all the interim is Like a phantasma, or a hideous dream." Shakespeare was quite right, and we find in cases of tuberculosis that, however much we sympathise, we cannot enter into the awful confusion and mental rebellion that agitate a patient. I want to emphasize the point that, often unconsciously, many people when once they realise they are suffering from tuberculosis are in open rebellion, and this is one of the worst things which could possibly happen to them. There is only one thing which we can do to deal with these people, and that is to cut the period of waiting for admission to sanatorium as short as possible. It should never be more than a matter of a few days, because this period of mental disturbance is a very trying one and mental disturbance has but a line that divides it from mental instability. When once a fiat has gone forth that a patient must enter sanatorium, the patient should be admitted forthwith. From time to time I have stressed the importance of after care in respect of patients returning from sanatorium and have pointed out how frequently the beneficial effect of the stay is nullified by the home conditions to which they return. The "after care" of tuberculosis patients is linked up inevitably with prevention and sanatorium treatment, and it would therefore appear that the provision of suitable housing accommodation for the patients would be a logical development of any Tuberculosis Service. Several Local Authorities have recognised the importance of this and have in their housing developments allocated a small quota of dwellings for this purpose. 84 Such houses are usually of the non-parlour type, erected in pairs. The large bedroom is divided by a glazed sliding screen, that a portion of the room can be utilised as an open sleeping cubicle, with casement windows opening the full width of the room. The houses are so placed that the sleeping cubicle overlooks a large open space providing for a free current of air and the free admission of sunlight—conditions similar to those existing in sanatorium. The extra cost of these houses, 26 of which have been erected at Wakefield, is £20 per house. It is unnecessary for me to stress the many advantages this offers to the ex-sanatorium patient and the definite gain to public health arising from less risk of infection to the family. From this arrangement would result also the improved health of any members of the family who may be in a pre-tubeicular condition. In previous years I have called attention to the fact that the Tuberculosis Register in Barking is misleading—that a large number of names appear on its columns which need not be there. The following table shows the present position of the Tuberculosis Register compared with that in 1929. On Reg. 31-12-29. New cases during year. Died. Cured. Lett district. Amend, diagnosis. Other. Total rem. from reg. On Reg. 31-12-30 Pulmonary— 504 71 34 10 23 101 2 170 405 Non-Pul.— 233 24 2 16 12 39 1 70 187 Totals 737 95 36 26 35 140 3 240 592 It will be seen that, whereas we started the year with 737 on the Register, we ended the year with only 592, in spite of the fact that there has been a very considerable increase in population. 85 This figure of 592 is, I am persuaded, higher than it should be, and I hope that the introduction of an evening clinic will enable us to deal with many cases who cannot attend during the day and enable us still further to reduce this figure. For comparative purposes it is interesting to note that when I came to Barking in 1927 there were 946 cases on this Register. (g) Enteric Fever.—Five cases of enteric fever were noticed during the year, four of which were removed to hospital. (h) Puerperal Fever.—Three cases were notified during the year; two were admitted to hospital and recovered. (i) Puerperal Pyrexia.—Ten cases were notified during the year. All of the cases recovered. (j) Erysipelas.—40 cases were notified during the year computed with 36 during 1929. Six patients were removed to hospital. (k) Chicken-Pox.—In view of the prevalence of smallpox in surrounding districts, chicken-pox was made a notifiable disease in the district in April, 1928, and continued to be notifiable throughout 1930. A total of 288 cases were notified during the year, compared with 414 during 1929. Sex.—132 were male and 156 female. 45. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES, (a) Measles, etc.—The most important of these are mesles, whooping cough and summer diarrhoea. There were no serious epidemics of these diseases, and the deaths registered were as follows:— Measles 19 Whooping Cough 2 Summer Diarrhoea 7 86 The teachers in the schools keep the Public Health Department well advised of any little outbreaks of non-notifiable infectious diseases which take place amongst the school children, but we have no similar organised help with reference to the adult population. Intimate touch, however, is maintained with the private practitioners working in the area and we confidently believe that almost all such outbreaks are in one way or another brought to the notice of the Public Health Department. A comprehensive system obtains whereby intimations of disease received from the schools or through the investigation officers are utilised so far as practicable. Cross references are made for the use of the health visitors and school nurses, who follow up cases of whooping cough, mumps, measles and other similar nonnotifiable infectious diseases. (b) Rheumatic Fever.—It is very difficult in Barking to deal with rheumatic fever. The condition is very prevalent, and unfortunately, so far as symptoms are concerned, rather mild, although the number of cases of disorderly action of the heart found, particularly amongst young people, clearly indicates that the condition is by no means so trivial as the symptoms would lead one to believe. Rheumatic fever, as a public health problem, differs from scarlet fever, with which it is closely allied, because it has no rash. This is the most unfortunate thing about the condition. If there were only some such significant sign much more notice would be taken of it. In this connection it is happy to recall the painstaking endeavours of the Boots Minor Sub-Committee of the Education Committee of the Council to provide boots for the bairns, and although certain members have, I believe, incurred the possibility of disciplinary action in a court of law, they have, I am confident, done a very considerable amount of work in decreasing the incidence of rheumatism, because unquestionably children who are dry shod are less likely to contract the disease and are certainly likely to be less seriously affected by it. 87 (c) Psittacosis.—I have dealt elsewhere with psittacosis as a public health problem (see page 18) and have shown how easily it is dealt with. It remains for me here to say a few words on the general characteristics of the disease as we met with it in Barking. Taking one case as representative of the whole, I may say that on January 10th, 1930, the parrot was bought at Spitalfields Market. The parrot appeared to be ailing and was looked after with commendable humanity until it died on January 21st. The patient, aged 30 years, first felt ill on January 23rd, and first consulted medical opinion on January 25th, on which date another member of the same family first felt ill. Both the first and the second patients were removed to the London Hospital on January 28th. On January 25th, it was obvious that the girl was ill. There was a temperature of 101.6 and a pulse of 108; there was an intractable headache of the forehead, which did not radiate elsewhere; there was an intense fear of light; there was vomiting; the respirations were about 24; the heart showed no signs of disease other than those associated with the high temperature; the lung gave an ordinary note all over on being percussed, but with the stethoscope very fine signs of moisture could be heard over the lower parts of the lungs and the hila. The patient was on this day lying in bed in a semi-unconscious condition, from which it was difficult to arouse her. During the time the patient was in Barking the condition was progressive, the temperature became higher, the vomiting continued and the catarrh of the chest became more serious, so that on January 27th, the temperature was 103.8 and the pulse 120. The patient was clammy, hot and perspiring and the general conditions of the lung were those of a diffuse pneumonia. On January 28th, this patient was removed to the London Hospital, where I understand the condition remained unfortunately very much as when she left Barking, and the patient died on February 2nd. 88 There are certain interesting features in this small outbreak. Firstly, it would appear from the evidence we have gathered that some of the patients contracted the disease from the parrot, and some of them contracted it from the patients who had contracted it from the parrot—in other words, the disease is communicable not only from parrots to man but from man to man. A second line of thought this epidemic brings forward is the possibility that many cases labelled, quite rightly, under that more general heading "influenza" may really be, like psittacosis, derived from the animal world. Thus psittacosis, as we have seen it, may be likened very closely to a case of influenzal pneumonia with cerebral complications, and it may be that we shall find that many cases of pneumonia of the influenzal variety are similarly due to predisposing causes, which, as in the case of psittacosis, should be looked upon as the primary condition. This opens up a vast field for research, both from the purely medical standpoint and from the public health standpoint. (d) Cancer.—There have been 48 deaths from cancer, 25 below the age of 65 years and 23 over the age of 65. It will be seen, therefore, that over half the cases of cancer which have proved fatal this year have affected people who may be looked upon as still members of the working community and therefore still of economic value to the country—that is, they are people with duties and responsibilities, which, if and when they are removed, will probably, in a town such as Barking, have to be shouldered by the State. On October 8th, 1930, I presented you with a report on Circular 1136 issued by the Ministry of Health, and I still hope that something will be done to meet the various suggestions I have laid before you. 89 The following table shows the occupations of the 48 persons who died from cancer during the year 1930. Male. Female. Gas workers 4 Spinsters 2 General labourers 3 Wives 15 Painters 2 Widows 9 Master Hairdresser 1 Master Builder 1 Master Mariner 1 Fisherman 1 Cooper 1 Warehouse Carman 1 Lead Burner 1 Farm Foreman 1 Schoolmaster 1 Hawker 1 Coal Porter 1 Night Watchman 1 Clerk 1 22 26 The above table shows that cancer is distributed throughout the whole of the population. The largest number appears amongst gas workers, but then of course Beckton is a very big works and we are dealing with one year only. It would, however, be interesting from a national standpoint to see whether cancer is more prevalent amongst gas workers than persons of other occupations. (e) Influenza.—Your Medical Officer has been in constant touch throughout the year with the medical practitioners in the town, and at the end of the year sent out a questionnaire as to nonnotifiable acute infectious diseases, notably influenza. From the information available it appears that influenza was the only such non-notifiable disease of any considerable incidence, that this influenza was prevalent at various seasons throughout 90 the year, and that a large percentage of cases were really ill, but that there were relatively few deaths and these deaths occurred for the most part amongst elderly people. 46. ASBESTOSIS. Following up my remarks for the past two years on this disease, which is prevalent amongst asbestos workers, I would like to say how indebted I have been to Dr. Burton Wood and to Dr. Gloyne, both of the Victoria Park Hospital, for their unfailing help in our work on this question. A good word too must be said for the patients who have voluntarily submitted themselves to examination and re-examination, without which we could not have compiled the evidence that has been so helpful in preparing our reports on this disease. The helpfulness of the patients in this matter has been most disinterested and therefore all the more deserving of praise, because unfortunately there is so little that can be done for them individually when once their lungs are damaged by the inhalation of asbestos dust. We still continue to keep the dossiers of these patients up to date, in order intensively to study the progress of the disease, with the object of finding out everything possible. It will readily be recognised that it can only be by finding out everything possible that we can hope to build securely a scheme for preventing the future incidence of asbestosis. 91 47. ISOLATION HOSPITAL. (a) Admissions. The following is the table of admissions, etc., in respect of infectious diseases during 1930:— Disease. In Hospital January, 1st, 1930. Admitted during the year. Died. Discharged In Hospital Dec. 31st. 1930. Scarlet Fever 22 141 3* 149 11 Diphtheria 31 337 14* 312 42 Pneumonia — 2 1 1 Puerperal Fever — — — — — Puerperal Pyrexia — 3 — 3 — Enteric Fever | - 1 — 1 — Erysipelas - — — — — Chicken-pox - 2 — 2 — •Not the primary cause of death in two cases. (b) Hospital Accommodation.—In February, 1930, a temporary building was erected within the precincts of the hospital to increase the number of beds available, and this ward has proved invaluable. The building is 120 feet by 20 feet, and for the most part has been devoted to dealing with cases of diphtheria. During November, 1930, in order to avoid overcrowding the hospital beyond a safety point, cases were sent by the Town to the London Fever Hospital, at an approximate cost of £350. I am asked by the Ministry of Health to refer to any action which has been taken or advised with the object of securing that the hospital accommodation available for cases of infectious disease is utilized to the best advantage, and I am to refer to any action "to replace hospital treatment in suitable instances by nursing and supervision at home. The people of Barking have long been used to expect the amenities which have been provided in your infectious fever hospital, and, as I have expressed myself elsewhere from time to time, I am of opinion that the nursing these cases require is far better carried out in a suitable institution than at home. 92 I am conscious of the fact that in many towns where the social circumstances of the people are happily more fortunate than the circumstances of the majority of the people of Barking, it may be possible to treat mild cases of scarlet fever and diphtheria at home, but with such a highly industrial population as you have in your area, the possibility of a large number of cases being suitably treated at home is very remote indeed. It has been for a long time now the custom to take in cases of measles, when such cases are complicated by broncho-pneumonia or any other serious complication, and when beds are available, and it is hoped that when the new hospital is opened we shall have more beds available for the admission of these very serious cases. 48. VACCINATION. No primary vaccinations or re-vaccinations have been carried out by your Medical Officer of Health, but your Medical Officer works in the closest co-operation with the Public Vaccinator. Dr. McDonald, who is early notified of any persons who, in tinopinion of the Public Health Department, should be vaccinated. 49. EXAMINATION OF PATHOLOGICAL SPECIMENS, Etc. In a previous table I have shown the use that has been made of the facilities provided for the examination of pathological and bacteriological specimens, but I am to report that no use has been made of the Schick and Dick tests in diphtheria and scarlet fever respectively, or of the artificial methods of immunization against these diseases. My own feeling is that any parent who wishes his child to be immunized against diphtheria or scarlet fever ehould be afforded facilities for this to be carried out, but at the same time I think it is to be remembered that by immunizing only a small percentage of the population we may be increasing the number of potential carriers of the disease—i.e., persons who may have become infected and show none of the ordinary signs of the malady. I have already advised you along these lines, and hope that the time will soon come when you will be prepared for Schick and Dick testing to be carried out at the request of parents and for any necessary immunization to be effected. 93 50. CLEANSING AND DISINFECTION OF VERMINOUS PERSONS. In Barking there is no particular station which is known as the Cleansing and Disinfecting Station, but at the Central Clinic there is a small steam disinfector, in which the clothing of children is disinfested, and, to make security double sure, blankets, etc., which are returned to us from the summer camps, are disinfected in the large steam disinfector at Upney Hospital. With these facilities available we could undertake the disinfestation and/or disinfection of any person. The Council are willing to do so on request and a public notice to this effect has been posted. The disinfection of premises is carried out by routine. Where any serious verminous condition of premises is found as a result of inspection or complaint, the Authority arrange for the most effective disinfestation to be carried out, and for this purpose any fitments in the room which might provide habitat for the vermin are removed and the room sprayed with a suitable vermicide. In many of the old houses which have become seriously infested it is entirely impossible to disinfest the premises so as to remove all vermin. 51. RATS. Owing to an unfortunate smallpox epidemic which was prevalent during Rat Week we were unable to undertake any special activities in this regard. However, the general public, as a result of propaganda over a number of years, are now very much alive to the fact that the presence of rats should forthwith be reported to this department, so that we are now throughout the whole of the year dealing, when occasion arises, with this pest. 94 There were 161 inspections made in respect of rat infested premises and a large amount of the drainage reconstruction resulted. It is a practice of the Engineer and Surveyor to provide poison baits in the manholes of the Council's sewers and upon land within his jurisdiction. Posters are exhibited in various parts of the town, drawing attention to the purposes of the Rats and Mice (Destruction) Act and advising affected householders what steps to take. 52. MOSQUITOES. The prevalence of mosquitoes in the area is still at certain periods of the year particularly evident, although of course not nearly so much as it must have been when the marshes were not drained so well as they are to-day. It is a wise old saying that "the marsh bailiff (i.e., ague) died in a ditch." It is to proper drainage that we must look for this suppression of the mosquito pest, and from this standpoint we could wish that the Essex Sewers Commissioners had much more money available and more power in order to bring about a happier state of affairs than exists on the marshes of Barking. The Natural History Society have taken up this matter and indeed have spent field days studying mosquito life in Barking. The industrial development of the riverside lands in Barking will do much to do away with the mosquito problem, but we find that many people who complain of mosquitoes have really themselves to blame—as is so often the case—and that if they were themselves to see that there were no pools of stagnant water in the precinctof their own houses they would not be so troubled with mosquitoesas they are to-day. It is not likely that the mosquitoes which actually breed between the Thames and Ripple Road affect any other than the houses in the immediate vicinity of their breeding places. 95 SECTION 7. MATERNITY AND CHILD WELFARE. 53. GENERAL. The Council's Scheme under the Maternity and Child Welfare Act, 1918, has been extended during the year. On December 3rd, 1930, an Infant Welfare Clinic was held in the St. Alban's Hall in the Gale Street Area, and on the same day an Ante-Natal Clinic was held in those premises. Since this date one ante-natal session and one infant welfare session have been held weekly in the St. Alban's Hall. This is only a temporary arrangement and it is hoped that a permanent Clinic will soon be provided in this area. We have now two systems of medical practice, which are not directly in competition one with another, but which nevertheless are essentially different and which one cannot help comparing, economically and otherwise. On the one hand we have a system of general practice, where medical men are available for practically the whole of the twentyfour hours and are called in as and when they are required and oftentimes at the whim of those who are responsible for the patient concerned. . On the other hand we have a system of clinics, where medical practitioners attend for definite periods. It is obvious that the clinic system is capable of a degree of organisation which we can hardly expect to find in general practice, and it is this possibility of organisation which gives it certain peculiar advantages. On the other hand, general practice has certain advantages. 96 My point is that unless attendances at these clinics are so organised they lose in efficiency, to their disadvantage when compared with general practice. It is obvious that if a clinic is planned for half a dozen, a dozen or a score of appointments, those appointments must be kept, because it is impossible to arrange for the practitioner to be available for the whole of the twenty-four hours as in general practice. Every time, therefore, that a member of the public is given an appointment and does not keep it, he or she is decreasing the efficiency of the service retained by them, and it behoves everybody who is interested in the development of a sound economic clinic system to see that once appointments are made they are kept. 54. 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 786, the net total of 799 being obtained by adjustment of inward and outward transfers, etc. The births registered included 414 males and 385 females. There were 22 illegitimate births, or 2.7 per cent of the total. In comparison with 1929, 12 more births were registered during the year, an increase equivalent to 1.5 per cent. By the Notification of Births Act, 1907, 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 11 or 1.4 per cent. were notified. In addition 10 still births were not notified. The following table gives details of the notifications received:— By whom notified. Live Births. Still Births Medical Practitioners 110 4 Certified Midwives 593 19 Parents and Others 72 The percentage of still-births was 2.9 97 Of the total live births within the district during the year, 519, or 66.03 per cent were attended by midwives, the remainder being attended by medical practitioners. 55. BIRTH RATE. The birth rate for the year was 17.8, compared with 16.3 for England and Wales. 56. ANTE-NATAL CLINICS. The work of the Clinics was carried on as in previous years, and one extra session was commenced at the St. Albans Clinic on the 3rd December, 1930. The attendances during the year were well maintained. The number of primary attendances was 432 compared with 386 for 1929. Reattendances numbered 1,536 in 1930, and 1,180 during 1929. One hundred and sixty sessions were held during the year, making an average attendance of 12.3 mothers per session. The total number of births including transfers was 832, and the number of first attendances at the Ante-Natal Clinics was 432. It would therefore appear that 51.9 per cent. of these cases availed themselves of our Ante-Natal Service. 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. Thirty-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. 98 57. MATERNITY WARD. The admissions to the Maternity Ward of the Municipal Hospital numbered 202, compared with 180 in 1929. Of these 27 cases were admitted for ante-natal treatment, and 175 for confinement. Corresponding figures for 1929 were 36 cases for antenatal treatment, and 144 for confinement. (a) Number of cases admitted 202 (27 of which were Ante-natal) (b) Average duration of stay - 14.6 days (c) Number of cases delivered by:— Midwives 171 Doctors 3 (d) Number of cases in which medical assistance was sought by the midwife, with reason for requiring assistance:— Torn Perineum 14 Delayed second stage 1 Uterine Inertia 1 High Temperature 1 Complicated Breach 1 Unsatisfactory condition Heart Disease 1 of patient 1 Albuminuria 3 — Miscarriage 1 26 Collapse after Labour 1 — Delayed first stage 1 (e) Number of cases notified as puerperal sepsis, with result of treatment in each case Nil (/) Number of cases notified as puerperal pyrexia, with result of treatment in each case (recovered) 2 (g) Number of cases of pemphigus neonatorum Nil (h) Number of cases notified as ophthalmia neonatorum, with result of treatment in each case Nil (i) Number of cases of " inflammation of the eyes," however slight Nil (j) Number of infants not entirely breast fed while in the Institution, with reasons why they were not breast fed 5 Weakness or illness of mother 4 Deformed nipples 1 (k) Number of maternal deaths Nil 99 (I) Number of foetal deaths (i) stillborn, and (ii) within 10 days of birth, and their supposed causes— and the results of the post-mortem examination:— (i) Still-born 6 Twin presentation 2 Worry 1 Accident 1 Not known 2 (ii) Within 10 days of birth 1 Feeble—3 days old. 58. PUERPERAL FEVER AND PUERPERAL PYREXIA. Three cases of puerperal fever were notified as compared with one in 1929. Two cases were admitted to Hospital. In addition to the cases of puerperal sepsis, 10 cases of puerperal pyrexia were notified, the confinement in 5 cases being attended by a midwife. All the patients recovered. 59. MATERNAL MORTALITY. Three maternal deaths occurred during 3930, the deaths being certified as follows:— (a) Eclampsia of pregnancy 1 (b) Rupture of Uterus 1 (c) Toxic jaundice of pregnancy 1 The following table shows the number of maternal deaths occurring in Barking during the past five years. Year. No. of Maternal Deaths. 1926 1 1927 3 1928 2 1929 2 1930 3 100 The number of these deaths is still too high. The figures compare favourably with those for the rest of England, but then the figures for the whole country are too high. It is to be noted that two of the three maternal deaths occurring in 1930 were of young, unmarried, pregnant women of the age of 17 years, and one cannot help feeling that if Society were readier . to help rather than to ostracise these unmarried pregnant women, they would not be so likely to conceal their pregnancies. It is obvious that a concealed pregnancy is a more risky one both for the mother and for the child, so that this concealment, which takes place often for the want of a helping hand, becomcs a crime on the part of the mother, not only against herself but against her unborn child. GO. NEO-NATAL MORTALITY. Of the 49 children who died under the age of one year, no less than 24 of these died under the age of one month—i.e., 48.9 per cent. Of these 24 children, 16 were female and 8 male. Of the 24 deaths 10 were due to premature birth and debility and 8 were due to congenital malformations, the remaining G being due to various causes. Your activities in maternity and child welfare have not had the profound influence on the number of deaths of infants under the age of four weeks that they have had on the number of deaths of infants between one month and twelve months of age. It is now generally believed that these neo-natal deaths can only be materially influenced by more intensive and efficient antenatal work, and these 24 deaths show you that you have realms to conquer in this direction. 101 61. STILL-BIRTHS. Of the total notifications received under the Notification of Births Act, 23 related to stillborn children, giving a percentage of 2.9 compared with 2.8 in 1929. In addition, 10 still-births were not notified. Investigation of the health visitors elicited the following informs tion:— (a) Duration of pregnancy :— Less than seven months 1 More than seven months 22 Not elicited 10 (b) Presentation :— Vertex 12 Breech 5 Not elicited 15 Footling 1 (c) Supposed cause of stillbirth:— Overwork 1 Accident, etc. 4 Not known 17 111 health 6 Shock 2 Worry 1 Twin presentation 2 (d) Occupation of mother:— Household duties at home 31 Shorthand Typist 1 Rag Sorter 1 62. OPHTHALMIA NEONATORUM. There was a decrease in the number of cases of ophthalmia neonatorum, notifications being 12, compared with 14 in 1929. 102 Seven 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. Treated. Notified At Home. At Hosptl. Under 3 weeks 12 11 1 12 — — 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. 63. WORK OF THE HEALTH VISITORS AND THE INFANT CLINICS. An analysis of the attendance at the Infant Welfare Centres is given in the following table :— Infant Welfare Centres. Clinic Premises Alex. Centre Movers Lane St. Albans Totals No. of sessions 101 100 100 5 306 No. of attendances of children under one year :— (a) New cases 213 144 163 30 550 (b) Old cases 2496 2064 1967 45 6572 No. of attendances of children I to 5 years of age :— (a) New cases 46 60 59 41 206 (b) Old cases 1132 1322 905 30 3389 Average number of attendances per session 38 36 31 29 3 6 No. of sessions attended by medical officers 101 100 100 5 308 No. of children seen by medical officers :— (a) Under one year 1519 1064 1123 46 3752 (b) Over one year 754 763 654 49 2220 Average number of children seen by medical officer per session 23 18 18 19 19 The total attendances during the year were 10,717 as compared with 10,164 in 1929. 103 Particulars of the home visits paid by the health visitors are given in the following table :— No. of ante-natal visits :— First visits 99 Subsequent visits 77 No. of first visits to children under one year 1,076 No. of subsequent visits to children under one ye?r:— (a) Attending a Centre 221 (b) Not attending a Centre 3,079 N o. of visits to children 1 to 5 years of age :— (a) Attending a Centre 211 (b) Not attending a Centre 5,139 No. of special visits in connection with Ophthalmia Neonatorum 11 Ditto Deaths of children up to 3 years of age 52 Ditto Still-births 27 Ditto Puerperal sepsis and Puerperal Pyrexia 2 Ditto Foster Children 46 Other visits (re infectious diseases) 387 Total home visits of all kinds 10,427 (54. FACILITIES FOR TREATMENT. (a) Minor Ailments.—Treatment is given at the Central Clinic and the St. Albans Clinic. (b) Dental Treatment.—Treatment is given at the Central Clinic. (See later section of this Report.) (c) Orthopaedic Treatment.—Treatment is given at the Orthopaedic Clinic at Faircross School. (See later section of this Report.) (d) Tonsils and Adenoids.—Operative treatment is undertaken at the O'Jeen Mary's Hospital, Stratford, and the St. Mary's Hospital, Plaistow, under the Council's scheme. During the year 54 such operations were carried out in respect of children under the age of five years. (e) Convalescent Treatments—This is provided under theCouncil's scheme, and during the year five toddlers and seven mothers and babies received treatment in various convalescent homes. 104 (/) Eye Defects.—The Refraction Clinic for toddlers, which was established in 1929, has continued to do useful work. During the year spectacles were provided for two children under this scheme. 65. FOSTER CHILDREN. Prior to the 1st April, 1930, all cases of foster children resident in the district were reported by the Guardians to the Medical Officer of Health under Part I of the Children Act, 1908. On 1st April, 1930, the powers under this Act were transferred to you by the Local Government Act, 1929, and notifications are now received by your Medical Officer direct from the foster parents. During the year 46 notifications were received through the Guardians and from the foster parents, and these children have been kept under special observation by the Health Visitors, who are also Infant Life Protection Visitors. 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 which devolved on us in 1930 under the Local Government Act, 1929, was not new to the department. 66. INFANTILE MORTALITY. The total number of deaths of infants under the age of one year during the year was 49, giving an infant mortality rate of 61.32 per thousand registered births, compared with 53.4 per thousand for 1929. The average infant mortality rate for the whole of the country for 1930 was 60, for London 59 and for the 107 County Boroughs and Great Towns including London, of over 50,000 inhabitants, the infant mortality rate was 64. It will therefore be seen that our infant mortality figure for this year was very average. 105 It must, however, be remembered that for last year it was only 53.4, so that for the last two years, taking everything into consideration, I think we may say it is rather better than average. The following table shows the infant mortality figure for Barking from 1891 to 1930. Year 1 Number of . : deaths under one year. Infantile Mortality Rate per 1000 live births. Year. Number of deaths under one year. Infantile Mortality Rate per 1000 live births. 1891 96 150.0 1911 158 157.0 1892 99 151.8 1912 90 95.1 1893 98 156.6 1913 116 113.3 1894 85 122.4 1914 104 106.4 1895 112 162.6 1915 108 115.0 1896 104 148.9 1916 70 75.0 1897 138 178.0 1917 89 117.4 1898 129 178.0 1918 60 82.4 1899 137 172.0 1919 54 65.0 1900 159 203.0 1920 92 83.0 1901 155 172.0 1921 74 74.1 1902 112 134.0 1922 49 55.5 1903 97 113.0 1923 43* 49.8* 1904 129 143.0 1924 72 85.1 1905 128 142.0 1925 66 80.0 1900 143 163.0 1926 49 59.9 1907 98 112.0 1927 47 66.1 1908 110 117.0 1928 51 63.3 1909 93 107.0 1929 42 53.4 1910 88 97.7 1930 49 61.3 * Kegistrar-Ueneral s figures. In comparing the figures from this table it should be remembered that many people are agreed that it will be impossible to reduce the infant mortality rate to less than 30 per 1,000 births, so that we should really use these figures comparatively by taking away 30 from each one. The result in each case then more clearly indicates the value of the work which has been done. Thus in 1920 the infant mortality figure was 83, which, less 30, is 53, and in 1930 the figure was 61.3, which, less 30, is 31.3, which means to say that we have brought down the possible reduction of infant mortality by 21.7. 106 It will be clearly understood that it is the final reduction of the last remaining death it is possible to prevent, which is going to be the most difficult. Of the 49 deaths of infants under the age of one year, five were due to broncho-pneumonia following measles, of which we had an epidemic in the earlier part of the year. Of particular interest to me were the four deaths from gastro enteritis following eczema of the scalp. In view of the fact that eczema of the scalp in a mild form is fairly common amongst children, parents should lose no time in seeking medical advice for this condition. 67. ILLEGITIMACY. Twenty-two illegitimate children were born during the year, and in the same period three deaths of illegitimate infants occurred; the infantile mortality rate among these children was therefore 136.4, while that for legitimate infants was 59.2. This difference between 59.2 and 136.4 shows how hopelessly illegitimate children are handicapped from birth, and although I have said elsewhere that " The problem of illegitimate infants ... is not a serious one in Barking, and the fact that we do not find it a serious problem, indicates that the various agencies which are operating in the area meet the demands of the area," and although Barking must be considered to be fairly well off in so far as these facilities are concerned, it is obvious that a lot yet remains to be done. 68. DENTAL CLINIC. A general increase in this branch of the work has been taking place, and during 1930 the attendances of expectant and nursing mothers and of children referred from the Maternity and Child Welfare Clinics were as follows:— (a) Number of treatments of children 519 107 (b) Number of mothers treated:— New cases 128 Old cases 386 (c) Number of dentures supplied 77 (d) Sessions held 76 Here it must be observed that the aim of the Maternity and Child Welfare Service is the prevention of the onset of dental caries in the child, and, for this purpose, the improvement of the health of the mother and of her diet during pregnancy, the encouragement of breast feeding and the use of suitable dietaries for the young child, together with the practice of mouth hygiene, are all factors which must be dealt with by the Maternity and Child Welfare staff, in order to bring about an improvement in the structure of the teeth, and delay in the onset of caries. 69. ORTHOPAEDIC CLINIC. Forty-three 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, 83 cases attended for re-examination. Eight of the children received in-patient treatment at Orthopaedic Hospitals. The cases dealt with for the first time during 1930 were referred for the following conditions, some children having more than one defect:— (a) Deformities—Bones and. Joints— (1) Congenital: Webbed Digits of Feet 1 (2) Acquired: Genu Varum 1 Genu Valgum 15 Bow Legs 9 26 108 (b) Muscular Deformities— (1) Congenital: Talipes 1 Torticollis 2 Haematoma-Sterno-Mastoid 5 (2) Acquired: Pes Planus 13 21 (c) Paralysis— (1) Congenital: Spastic Hemiplegia 1 Cerebellar Ataxia 1 (2) Acquired: Paresis of Thigh Muscles 1 Anterior Poliomyelitis 3 6 (d) Congenital Deformities—Nil. Total defects found 53 70.—ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was continued during 1930. 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, 114 children received treatment during 1030. One session per week was devoted to these cases, and 1066 treatments were given. 109 This work continues to be attended with good results. The accommodation and apparatus at this Clinic, however, are not sufficient to cope with the work, and I have prepared and submitted to you a report indicating the lines along which I would suggest development. 71. BATHS FOR EXPECTANT MOTHERS. During the year free baths at the Public Baths have been inaugurated for expectant mothers who have no facilities for bathing at home, and who cannot afford to pay the usual charge for the use of the Public Baths. There were 52 baths granted free of charge during 1930. 72. MEALS TO EXPECTANT AND NURSING MOTHERS. Advantage has been taken during 1930 of this provision under the Act. The total number of dinners supplied was 430. 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. 73. 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. £ s. d. £ s. d. 3,407 10,055 13,462 197, 1 8½ 172 2 3¼ 110 74. 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.) Totals. (lbs.) Glaxo (Humanised) 683 148 164 995 Ambrosia 365 93 249 707 Cow and Gate (Full Cream) 1,807 906 802 3,515 Cow and Gate (Half Cream) 106 5 68 179 Emulsion 1,430 14 42 1,486 Ostelin 2 Nil Nil 2 Lactogol 353 Nil 17 370 Virol 646 10 44 700 Parrish's 84 Nil 4 88 Paraffin 103 Nil 4 107 Malt and Oil 279 6 115 400 Vitoleum Cream 460 Nil 5 465 Pure Oil 141 Nil 6 147 Trufood 103 3 12 118 Totals 6,562 1,185 1,532 9,279 111 June, 1931. To The Medical Officer of Health, Barking. From the Public Dental Officer. Sir, I have the honour to submit the Report on the Dental Service of the Maternity and Child Welfare Scheme for the year ended December 31st, 1930. During the period under review there has been an increase in the number of treatments compared with the corresponding period last year, by 100, and of this increase 50 per cent represents additional conservative work. This may be interpreted as a more enlightened aspect among patients and that the age of the patients attending is younger than in the past. The younger the mother attending for treatment the more manifest is the desire for prompt attention of a conservative nature during pregnancy, while the older mother, with an existing family, is too willing to accept with fatalism that " for every child a tcoth is lost," so much so that after her third or fourth child, her desire is that the trouble she has experienced with teeth, dependent or independent of child bearing, be finished and artificial substitutes supplied. ♦ No cases of unique professional interest have been presented for treatment, broken appointments are few and usually due to some domestic cause. 112 Regarding " under age " children, this is rapidly becoming one of the most successful of the Dental Services in Barking, 51!) attendances being made during the year, an increase of 281 over last year. Recognition is due to the invaluable assistance given by the Medical Officers, the Health Visitors and the nursing staff, and to their efforts to make known to mothers the advantages the Dental Service of Barking has to offer mothers and children under school age. I have the honour to be, Sir, Your obedient servant, W. H. FOY, L.D.S., R.C.S. (Eng.). 113 DENTAL CLINIC. Maternity and Under Age Cases. Extractions 752 Scalings 17 Dressings 2 Inspections 49 Fillings 49 Dentures supplied 77 Anaesthetics— General 151 Local 60 Patients— Old 386 New 128 "Under age" children— Treatments 519 Number of Sessions held 76