Bark 25 BOROUGH OF BARKING REPORT OF THE MEDICAL OFFICER. OF HEALTH For the Year 193 1 C.LEONARD WILLIAMS, B.Sc. Hons. (Lend.), M.R.C S. (Eng.) LJR.C.P., D.P.H. (Camb.) 2 TABLE OF CONTENTS. Page STAFF 8 INTRODUCTION 9 SECTION 1.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Age Mortality 14 Asbestosis 17 Births 10, 11, 12, 17 Births, Notification of 17 Deaths 10-16 Deaths, Causes of (Tables) 14, 15, 16 Death Certificates 13 General Statistics 10 Illegitimate Births 10, 17 Industries 17 Infantile Mortality 10, 11, 12, 16 Infantile Mortality (Table) 16 Inquests 14 Marriages 16 Overcrowding 17 Poisonous Gas 17 Psittacosis 17 Rheumatic Affections 17 Sickness, Causes of 17 Smallpox 17 Social Conditions 17 Still-births 10, 17 Transport 17 Vital Statistics 10, 11, 12 Zymotic Diseases, Deaths from 14 SECTION 2.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Adoptive Acts 21 Ambulance Attendant 29 Ambuluncc Facilities 29 Bye-Laws 22 Clinic and Treatment Centres30, 31, 32 Counties' Laboratory 21 Homeless Children, Institutional provision for 29 Hospital Services 22-28 Hospital Services, Tables of 23-26 3 SECTION 2—Continued Page Infectious Diseases Nursing 19 Illegitimate Infants, Institutional provision for 29 Laboratory Facilities 21 Legislation Relating to Public Health 21, 22 Local Acts 21 Local Government Act, 1929 30 Maternal Mortality 28, 29 Maternity Cases 9 Maternity Homes 28 Maternity Ward, Municipal Hospital 22, 27, 28 Mental Defectives, Institutional provision for 29 Midwifery 19, 20 Midwives, Supervision of 19,20 Municipal Hospital 22, 27, 28 National Health Insurance 20 Nursing Homes 28 Nursing in the Home 19 Plaistow Maternity Charity 19 Poor Law Medical Out-Relief 20 Private Medical Practitioners, Co-operation of 20 Public Assistance Committee 20 Public Hospital Services 23-20 Puerperal Fever and Pyrexia 29 Regulations 21 Smallpox Hospital Arrangements 22 Special Acts and Orders 22 Specimens submitted to Laboratory for Examination 21 Unmarried Mothers, Institutional provision for 29 Voluntary Hospital Services 23-26 SECTION 3.—SANITARY CIRCUMSTANCES OF THE AREA. Cesspools 34 Closet Accommodation 34, 37 Common Lodging Houses 42 Creekmouth Generating Station 42 Dampness 37 Defects found under the Factory and Workshop Act, 1901 40 Drainage and Sewerage 34, 37 Dustbin Maintenance 37 Dwelling Houses, Inspection of 35 Factories, Inspection of 36, 39 Factory and Workshop Act, 1901 39, 40, 41 Fouling by Dogs 35 Home Work 40 Houses Let in Lodgings 42 Miscellaneous Sanitary Inspections 36 Miscellaneous Sanitary Work carried out 38 4 SECTION 3—Continued Page Northern Outfall Sewage Works 34 Notices Served 38 Offensive Trades 43 Old Clothes 44 Out-workers 41 Pail Closets 34 Parks and Open Spaces 44 Piggeries 43 Port of London Authority 33 Premises Controlled by Bye-laws and Regulations 42, 43, 44 Premises and Occupations controlled by Bye-;aws and Regulations 36 Privies 34 Rag Flock Acts, 1911 and 1928 44 Rainfall 33 Refuse Disposal 34, 35 Refuse Storage and Collection 34, 35 Refuse Tips 43 Registered Workshops 41 Repairs, General 38 Rivers and Streams 33 Sanitary Inspection of the Area 35-41 Sanitary Work, Summary of 37, 38, 40 Scavenging 34, 35 Schools 44 School Closure 44 Schools, Sanitary Inspection of 44 Sinks 37 Smoke Abatement 42 Stables 44 Street Cleansing 35 Tents, Vans and Sheds 42 Trade Refuse 35 Underground Sleeping-rooms 42 Water Supply 33, 37 Workplaces, Inspection of 36, 39 Workshops, Inspection of 36, 39 Yard Paving 37 SECTION 4.—HOUSING. Closing and Demolition Orders 46, 47 Fitness of Houses 49 Houses Built hi the District, 1926—1931 48 Houses Erected during the Year 45 Housing Conditions 47 Housing Defects Remedied 46 Housing Inspections 45 Housing Statistics 45-50 5 SECTION 4.—Continued Page Housing Supply and Demand 49 Inhabited Houses, Number of 47 Proceedings under Public Health Acts 46 Proceedings under the Housing Act, 1925 46,47 Proceedings under the Housing Act, 1930 46 Shed Structures 47 Small Dwellings Acquisition Act 47 Unfit Dwelling Houses 45 Unhealthy Areas 49, 50 SECTION 5.—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food 55 Animals Slaughtered 53 Baeteriogical Examination of Ice-cream 53 Bacteriological Examination of Milk 51,52 Bottling of Milk 52 Chemical Examination of Food 55 Diseased Meat Destroyed 54 Food and Drugs (Adulteration) Act, 1928 55 Graded Milk Licences Granted 52 Ice-cream 53 Meat and Other Foods 53, 54 / Milk and Dairies Amendment Act, 1922 51 Milk (Special Designations) Order, 1923 52 Milk Supply 51, 52 Nutrition 55 Prosecutions 52 Slaughter-houses 53 Tuberculous Milk 52 Unsound Food Destroyed 54 SECTION 6.—PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Admissions to Isolation Hospital (Table) 68 Cancer 65, 66 Cancer, Occupations of Fatal Cases (Table) 66 Cancer, Organs affected in Fatal Cases of (Table) 66, 67 Chicken-pox 65 Diphtheria 61 Diphtheria, Immunization against 70 Diphtheria Notifications (Monthly Summary Table) 61 Diseases Notifiable 58 Dysentery 62 Encephalitis Lethargies 62 Enteric Fever 64 Erysipelas 65 6 SECTION 6—Continued Page Hospital Accommodation for Infectious Diseases 68, 69 Infectious Diseases 57-68 Infectious Diseases (Tables) 57, 59, 60, 61 Influenza 67 Isolation Hospital 68, 69 , Malaria 62 Measles 65, 69 Mosquitoes 71 Natural History Society 71 Non-notiliable Acute Infectious Diseases 65, 66, 67 Notifiable Infectious Diseases 57-65 Notifications classified according to Wards (Table) 59, 60 Pathological Specimens, Examination of 70 Pneumonia 62 Psittacosis 65 Puerperal Fever and Pyrexia 64, 65 Rat Repression 71 Rheumatic Fever 65 Scarlet Fever 62 Scarlet Fever Notifications (Monthly Summary Table) 61 Small-pox 62 Summer Diarrhoea 65 Tuberculosis 62, 63, 64 Tuberculosis Dispensary 63 Tuberculosis Register 64 Tuberculosis, New Cases and Deaths (Table) 62 Unnotified Fatal Cases of Tuberculosis 64 Vaccination 70 Verminous Persons, Cleansing and Disinfection of 70 Whooping Cough 65 SECTION 7.—MATERNITY AND CHILD WELFARE. Ante-Natal Clinics 74 Artificial Sunlight Clinic 84 Baths for Expectant Mothers 84,87 Birth Notifications 73 Birth Rate 74 Children Act, 1908, Part 1 81 Convalescent Treatment 81, 87 Dental Clinic 82, 93 . Dental Surgeon, Report of 92, 93 Dental Treatment 81,87 Eye Defects 81 Facilities for Treatment 81 Foster Children 81, 82 Health Visitors, Work of 30 Illegitimacy 82 Infantile Mortality 76-77 7 SECTION 7.—Continued Page Infantile Mortality, Years 1891-1931 (Table) 77 Infant Welfare Clinics, Work of 73, 80 Maternal Mortality 70 Maternal Mortality, Years 1926-1931 70 Maternity Ward, Municipal Hospital 74, 75 Meals to Expectant and Nursing Mothers 84, 85, 87 Minor Ailments 81, 87 Neo-Natal Mortality 78 Non-Notified Births 73 Ophthalmia Neonatorum 79 Ophthalmia Neonatorum (Table) 79 Orthopaedic Clinic 82, 83 Orthopaedic Treatment 81, 87 Provision of Dried Milk, etc. 80,87 Provision of Fresh Milk 85,87 Provision of Spectacles 87 Puerperal Fever and Pyrexia 70 Registration and Notification of Births 73 Services provided for Mothers and Children under five years 87 St. Albans Clinic 73 Still Births 78, 79 Toddlers' Refraction Clinic 81 Tonsils and Adenoids 81, 87 Ultra Violet Light Treatment 87 RECOMMENDATIONS, SUMMARY OF (1927-1931) 88-91 8 STAFF, 1931. Medical Officer of Health, School Medical Officer, Medical Superintendent, Isolation Hospital, and District Tuberculosis Officer : C. LEONARD WILLIAMS, B.Sc. Hons. (Lond.), M.R.C.S. (Eng.), L.R.C.P., 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. (Resigned 13th July, 1931.) HILDA C. DEAN, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. EDITH A. WHITNEY, M.B., Ch.B., D.P.H. (Commenced 1st August, 1931.) Orthopaedic Surgeon (Part Time): B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Dental Surgeons: W. H. FOY, L.D.S., R.C.S. (Eng.). H. HAZELL, L.D.S., R.C.S. (Eng.). (Commenced 1st April, 1931.) Sanitary Inspectors: N. BAST ABLE (Chief Sanitary Inspector) (b, c, d and f). II. CARR (Sanitary Inspector) (b, c, c and m). C. S. COOK (Sanitary Inspector) (b and c). R. II. WIGMORE (Sanitary Inspector) (b and c). (Commenced 14th April, 1931.) Health Visitors: Mrs. G. STOKES (g and ???). Mrs. M. W. WALTON (a, h and l). Miss G. ELLIOTT (a, h and I). Miss E. M. CROSS (b, g, h and i). Matron, Isolation Hospital: Miss M. J. HEDGCOCK (h, i and j). Masseuse, Orthopcedic Clinic (Part Time): Miss A. E. FINDLAY, C.S.M.M.G. (k). Clerical Staff: Chief Clerk. F. READ. C. G. EAGLESFIELD (Commenced 1st June, 1931.) D. G. TONKIN. Miss V. SIIEAD. Miss II. NUNN. Miss II. KING. A. J. STORER. .T. LACEY (Commenced 16/1/31.) (Resigned 16/6/31.) E. A. ELLIS (Commenced 5th October, 1931). Disinfector and Mortuary Attendant: H. LONG. (a) Sanitary Inspector's Certificate of Sanitary Inspectors Examination Board. (b) Sanitary Inspector's Certificate of Royal Sanitary Institute. (c) Meat, etc., Inspector's Certificate of Royal Sanitary Institute. (d) Smoke Inspector's Certificate of Royal Sanitary Institute. (e) Building Inspector's Certificate of Worshipful Company of Carpenters. (f) Sanitary Science Certificate of Royal Sanitary Institute. (g) Health Visitor's Certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives' Board. (i) General Hospital Training. (j) General Fever Training. (k) Certificate M.E. and S.R.E. (l) 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 Borough of Barking, in the County of Essex, for the Year ended 31st December, 1931. PUBLIC HEALTH OFFICES, BARKING, ESSEX. July, 1932. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Mrs. Jackson and Gentlemen, Herewith I beg to submit for your favourable consideration my Report as Medical Officer of Health for the year ended 31st December, 1931. This Report is drawn up in accordance with Circular 1206, 1931, from the Ministiy of Health. There is a growing tendency for some matters affecting the health of the town to be referred to a joint sub-committee comprised of members of the Health Committee and the Education Committee. This, so far as it goes, is a welcome step towards unification, but I do suggest to you that the time is approaching when all these matters relating to health should be under one Committee. This Report will show the increase which has taken place in the work of the Health Sn vices, and I do hope that suitable increases in the staff, particularly the medical staff, will enable us to maintain the satisfactory services you have carried out in the past. I am, Mr. Mayor, 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 3,806 Tidal Water H.W.M. Thames 240 Hoding 58 Loxford Wa???er 2 300 4,106 Population (1931 Census) 51,277 Population (June, 1931) (Registrar-General's Estimate) 51,830 Number of Inhabited Houses, March, 1932, according to Rate Hooks:— Houses 13,396 Shops 975 Total 14,371 Population Density, i.e., No. of persons per acre 12.6 Rateable Value—General £466,090 0 0 Sum represented by a penny rate £1,784 0 0 Education rates:- Elementary Secondary Included in General Rate Figure 3 10½ 6 ½ General Rate 14 0 2. Extracts from Vital Statistics for the Year. Live Births:— Total. Males. Females . Birth Rate. Legitimate 926 475 451 17.9 Illegitimate 21 13 8 8.4 Total 947 488 459 18.3 Still Births:— Rate per 1,000 total births:— Legitimate 32 17 15 34.7 Illegitimate 2 — 2 Deaths 536 278 258 — Death Rate 10.3. Percentage of total deaths occurring in public institutions, 41.6. Number of women dying in, or in consequence of, childbirth:— From Sepsis. From other causes. Total. 13 4 Number of deaths of infants under one year of age:— Males. Females. Total. Death Rate. Total Infantile Deatn Rate. Legitimate 32 27 59 63.7 64.4 Illegitimate 1 1 2 95.2 Number of deaths from Measles (all ages) 1 „ „ Whooping Cough (all ages) 4 „ „ Diarrhoea (under 2 years of age) 6 11_12. 3. BIRTH RATE, DEATH RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1931. (Provisional figures.) (The mortality rates for England and Wales refer to the whole population but for London and the towns to civilians only.) — Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Percentage of Total Deaths. Live Births. Still-births. 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. Certified by Registered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England and Wales 15.8 0.67 12.3 0.01 0.00 0.08 0.01 0.00 0.07 0.36 0.54 6.0 66 91.18 6.17 1.70 0.95 107 County Boroughs and Great Towns, including London 16.0 0.67 12.3 0.00 0.00 0.10 0.01 0.07 0.08 0.33 0.48 8.4 71 91.43 5.84 2.24 0.49 159 Smaller Towns (1921 Adjusted Populations,20,00050,000) 15.6 0.73 11.3 0.00 0.00 0.07 0.01 0.05 0.05 0.36 0.43 4.0 62 92.17 5.49 1.25 1.09 London 15.0 0.50 12.4 0.01 0.00 0.03 0.02 0.07 0.06 0 .26 0.57 9.7 65 89.52 6.23 4.24 0.01 BARKING 18.3 0.66 10.33 0.02 0.00 0.02 0.02 0.08 0.14 0.59 0.62 6.34 64 79.3 7.5 13.2 0.00 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows per 1,000 Live Births „ „ Total Births 1.60 1.59 2.45 2.35 4.11 3.95 4. VITAL STATISTICS OF WHOLE DISTRICT FROM 1925 TO 1931. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths Net Deaths belonging to the District. Nett. 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. Number. Rate per 1,000 Net Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 1925 38,450 825 21.4 287 7.4 8 107 66 80.0 386 10.0 1926 38,920 818 21.0 259 6.6 11 118 49 59.9 366 9.4 1927 39,900 710 17.7 251 6.2 7 162 47 66.1 406 10.1 1928 40,870 805 19.7 276 6.7 6 144 51 63.3 414 10.1 1929 42,160 787 18.7 291 6.9 8 152 42 53.4 435 10.3 1930 45,000 799 17.75 256 3.68 7 186 40 61.3 435 9.7 1931 51,830 947 18.3 328 6.3 7 213 61 64.4 536 10.3 13 5. DEATHS. (a) General.—There were 328 deaths registered in Barking in 1931. Of these 7 were deaths of non-residents. Barking residents to the number of 215 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. 278 258 536 The death rate for 1931 was 10.3 per 1,000, compared with 9.7 in 1930, 12.3 for England and Wales, 12.3 for the hundred and seven Great Towns, 11.8 for the hundred and fifty-nine Smaller Towns, and 12.4 for London. In the year 1926, the Government of the day set to work and brought in a Bill to deal with the registration of deaths. The Bill was passed and the Act conferred certain powers on Coroners. Thus Coroners may now order a post-mortem to be carried out and a report to be made to them without of necessity, as heretofore, holding an open inquest on such a case. In accordance with the Act, the form of certification of death has been altered and the list of approved diagnoses which it is permissible to use on death certificates has been brought more up to date and provision was supposed to have been made for such certification to be secret. It is obvious that unless certification is secret the hands of the certifying doctor are tied. He can hardly be expected to write on a piece of paper that an affectionate husband and devoted father actually died from syphilis or some similar complaint, and there are other ways in which practitioners are likely to find themselves in similar difficulties which their own humanity and delicacy constrain them to evade in one way or another. The curious thing is that interests somewhere have brought the whole purpose of this secrecy to no avail, because whereas under the new Act the people themselves are only officially given a note to the registrar, assuring the registrar that a detailed certificate is on the way, these same relatives can—and at the instigation 6f some business companies often do—go to the registrar and for a small sum of money obtain a copy of the detailed certificate, which, when the Bill was before Parliament, was originally intended to be secret. Until these certifications of death are really secret the actual value of statistics prepared from them is doubtful from any public health standpoint. 14 (b) 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 61 1 to 2 years 8 2 to 5 years 15 5 to 15 years 17 15 to 25 years 26 25 to 45 years 86 45 to 65 years 129 Over 65 years 194 (c) Causes of death in 1931.—The table on the next page shows the principal causes of death at various ages. Those diseases, etc., causing most deaths or important from a Public Health aspect were as follows:— . Disease. No. of Deaths. Percentage of total net deaths registered. Cardio-vascular system 115 21.5 Cancer 55 10.3 Tuberculosis (all forms) 45 8.4 Pulmonary affections (exclusive of tuberculosis), viz., Bronchitis 33 6.2 Pneumonia (all forms) 32 6.0 Other respiratory diseases 8 1.5 Zymotic Diseases 20 3.7 (d) Deaths from Zymotic Diseases.—These diseases caused 3.7 per cent, of the total deaths, such deaths being caused in the following proportions:— Enteric Fever 1 Measles 1 Whooping Cough 4 Scarlet Fever 1 Diphtheria 7 Diarrhoea 6 Smallpox – (e) Inquests.—Coroner's inquests were held on 40 deaths. 15 (f) Causes of and ages of death during the year 1931. (Net Deaths.) Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the district. Under one year 1 and under 5. 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Total Typhoid and paratyphoid fevers — — — — 1 — — 1 Measles — 1 — — — — — 1 Scarlet Fever — 1 — — — — — 1 Whooping Cough 3 1 — — — — — 4 Diphtheria — 5 2 — — — — 7 Influenza 2 — — 1 3 10 15 31 Encephalitis Lethargica — — — — — — — — Cerebro-Spinal Fever — — — — — — — — Tuberculosis of Respiratory System — — 1 10 22 6 1 40 Other Tuberculous Diseases 2 2 1 — — — — 5 Syphilis — — — — — 1 — 1 General Paralysis of the Insane, etc. — — — — 1 3 — 4 Cancer — — — — 5 29 21 55 Diabetes — — — — — 1 3 4 Cerebral Haemorrhage — — — — 1 12 19 32 Heart Disease — — 1 1 8 22 65 97 Aneurysm — — — — — 1 2 3 Other Circulatory Diseases — — — — — 4 14 18 Bronchitis 3 2 — 1 3 3 21 33 Pneumonia 9 7 1 — 8 5 2 32 Other Respiratory Diseases — 1 — — 3 3 1 8 Peptic Ulcer — — — — 1 2 2 5 Diarrhoea, etc. (under two years) 5 1 — — — — — 6 Appendicitis — 2 2 — — — — 4 Cirrhosis of Liver — — — — — 1 1 2 Other Diseases of Liver — — — — 2 — 1 3 Other Digestive Diseases — — — 1 2 5 5 13 Acute and Chronic Nephritis — — 1 — 4 5 8 18 Puerperal Sepsis — — — 1 — — — 1 Other Puerperal Causes — — — — 3 — — 3 Congenital Debility, Premature Birth, etc. 31 — — — — — — 31 Senility — — — — — — — — Suicide — — — — 3 4 — 7 Other Violence 1 1 3 4 7 4 5 25 Other Defined Diseases 5 — 4 8 8 7 9 41 Causes ill-defined or unknown — — — — — — — — Totals 61 24 10 27 85 128 195 536 16 (g) Infant mortality during the year 1931. The following table gives the actual causes of death of children dying under one year of age. Net deaths from stated causes at various ages under one year:— Causes of Death. (All 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. Bronchitis — 1 1 — 2 — 1 — — 3 Congenital Debility — — — 1 1 1 — — — 2 Congenital Malformation 2 — — 2 4 1 2 — — 7 Convulsions 1 — — — 1 — — — — 1 Deficient inherent Vitality 2 — — — 2 — — — — 2 Diarrhoea and Vomiting — — — — — — — — 1 1 Gastro Enteritis 1 — — — 1 — 1 3 — 5 Influenza — — — — — — 1 — 1 2 Injury at Birth 1 — — — 1 — — — — 1 Marasmus — — — 1 1 1 — — — 2 Meningitis — — — — — 1 — 1 — 2 Operation — — — — — — — — 1 1 Pneumonia — 1 — — 1 2 3 1 2 9 Premature Birth 12 2 2 — 16 1 — — — 17 T B. Meningitis — — — — — — 1 1 2 Want of Proper Attention at Birth 1 — — — 1 — — — — 1 Whooping Cough — — — — —• 2 — 1 — 3 Totals 20 4 3 4 31 9 9 6 6 61 Net Births in the year:— Legitimate 926 Illegitimate 21 947 Net Deaths in the year:— Legitimate 59 Illegitimate 2 61 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 1923 to 1931. Y ear. No. of Marriages. Rate per 1,000 Population. 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 1931 338 6.5 17 7. BIRTHS. The net number of births registered in 1931 was 947, affording an annual birth rate of 18.3 per 1,000 population, compared with 17.8 in 1930, 18.7 in 1929 and 19.7 in 1928. Of all births, 21 were illegitimate, giving a percentage of 2.2 of the total births. Notification of Births Acts, 1907-1915.—Daring 1931 there were 901 births notified to the Medical Officer of Health, 696 being notified by midwives and 205 by parents and doctors. Twenty-three still-births were notified, 18 being notified by midwives and 5 by doctors and parents. Five still-births were not notified. 8. SOCIAL CONDITIONS. Barking has an industrial population, and this of course you will take into your consideration when arranging for your social services. The Industrial Exhibition held during the Charter celebrations showed the diversity of industries which are carried on in Barking. 9. CAUSES OF SICKNESS. With the exception that this year there have been ho cases of psittacosis, (Parrots Disease) the causes of sickness with which I dealt in detail last year apply equally truly for this year. There are considerable rheumatic affections in Barking ; transport is so bad as to be a serious nuisance ; the passing of the Workmen's Compensation (Silicosis and Asbestosis) Act, 1930, has not had time to make itself seriously felt; we still have from time to time poisonous hydrogen sulphide wafted into Barking from outside; overcrowding is still with us; and the public will not be protected against small-pox. Fortunately, what are commonly known as the ordinary infectious diseases have been lighter during the year under review. From time to time I have pointed out the deplorable condition under which the people travel in the electric trains from Barking, and equally deplorable are the conditions under which people queue up for 'buses, often in the rain, for long periods of time. The whole question of transport to and from Barking is one that does not brook delay. The arterial road can hardly be classed as one of the causes of sickness because the dangers lurking on this road so often lead to sudden death, but I do fecl that no report on the well-being of the people of the town would be complete if I did not call your attention to the large number of accidents which occur on this road. 19 SECTION 2. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 10. NURSING IN THE HOME. (a) General.—Last year I called attention to the fact that nursing in the home is carried out by the Plaistow Maternity Charity, and mentioned my information that this organisation does not receive from the public in Barking financial assistance comparable with the amount of work they are carrying out. Nursing in the home is equally important as other branches of nursing, and it is a sorry state of affairs that, owing to lack of support, this organisation has not been able to extend its activities to cover the increased population in Barking. (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. 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. The takings of the Charity for the year ended December 31st, 1931, in respect of 240 cases, amounted to £249 19s. Od. leaving a balance due to the Charity from the Council of £50 1s. Od. According to information obtained from the County Medical Officer, at the end of 1931 there were ten 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 five practising privately. During 1931 there were 931 maternity cases. 220 of these were conducted by the Plaistow Maternity Charity, 163 of them were conducted by your own midwives at Upney Hospital, leaving 548 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. 20 The whole question of providing an efficient midwifery service is a very difficult one in Barking, as indeed it is throughout the whole country. We have large, well-endowed hospitals, which are further supported by voluntary subscriptions and which conduct midwifery at an uneconomic price. Similarly, we have large training schools which are anxious to get cases to demonstrate midwifery to their pupils and at which midwifery is conducted at an uneconomic price. It is in these circumstances that people have come to value midwifery in terms of this uneconomic price, so that frankly it is difficult for a well-trained midwife to make a paying proposition of her profession. You very wisely in your admissions to your Maternity Home say that people who can afford to pay the actual cost shall be asked to pay the actual cost, and I feel that until all other organisations charge an economic rate to people who can afford to pay, the profession of midwifery will never attract a sufficient number of highly educated and well-trained women. It is very beautiful to think that there have been so many women who have sacrificed themselves in order to provide this necessary service for other women, but I doubt very much whether a business nation can afford to try to run such an important service largely on a voluntary basis. 12. NATIONAL HEALTH INSURANCE. You, as a Council, have nothing to do with National Health Insurance, but your Medical Officer is in personal touch with almost every medical practitioner in Barking, and this promotes a spirit of co-operation between the work of the National Health Insurance Commissioners and other departments of public medicine. 13. POOR LAW MEDICAL OUT-RELIEF. Similarly, your Medical Officer is in touch with the medical services maintained by the Public Assistance Committee, and once again I wish to thank Dr. O'Loughlin for the very courteous way in which he has co-operated with me on many occasions. 21 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 3,304 Sputa 420 Typhoid 26 Ringworm 7 Miscellaneous 13 Total 3,770 In addition there were 22 biological examinations. 15. LEGISLATION RELATING TO PUBLIC HEALTH. (a) Local Acts: Barking Town Wharf Act, 1893. Barking Parish Act, 1888. (b) General Adoptive Acts : Baths an 1 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, Pails 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. 22 (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 1925. 16. HOSPITALS. Hospitals provided or subsidised by the Local Authority : (a) Small-pox.—By arrangements with West Ham, small-pox cases have been dealt with at Orsett. This agreement with West Ham has terminated since the end of the year under review and alternative arrangements have been made. (b) Hospital Provision at Upney Lane.—You have two hospitals at Upney Lane—a maternity hospital and infectious diseases hospital—and you are building a new infectious diseases hospital. The maternity hospital is a galvanized iron building, and its outside is not unlike that of the well-known "Old Cottage," but, within, again like the same old cottage, everything is wondrous neat and clean. 23–24. TABLE I. Hospital Services, Public or voluntary within the District, which are used by the inhabitants of the Borough of Harking. Name of Hospital. Situation. Purpose. Total number of beds available. Management. Men Women Children Controlled by the Council of the Borough of Barking 1 Maternity Ward, Municipal Hospital Upney Lane, Barking, Essex Maternity — 12 — Borough of Barking 2 Municipal Hospital Upney Lane, Barking, Essex Isolation of general infectious diseases (excluding small-pox) 38 Borough of Barking Not controlled by the Council of the Borough of Harking 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 Lungs Victoria Park, E.2 Heart and Lung Diseases 85 88 8 Voluntary 6 Last Ham Memorial Hospital Shrewsbury Road, E.7 General Medical and General Surgical 34 34 20 Voluntary 7 Hast London Hospital for Children Glamis Road, Shadwell, E.1 Children — — 135 Voluntary 8 Golden Square Throat, Nose and Ear Hospital Golden Square, Piccadilly Circus, W.1 Ear, Nose and Throat 33 32 11 Voluntary 9 Guy's Hospital London Bridge, S.E.1 General Medical and General Surgical, etc. 299 287 63 Voluntary 10 Hospital for Kick 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 Small-pox (Information not available) London County Council 12 King George Hospital Ilford, Essex General Medical and General Surgical 39 43 22 Voluntary 13 London Hospital Whitechapel Road, E.1 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 36 78 44 Voluntary 15 London Skin Hospital 40, Fitzroy Square, W.1 Skin. (No in-patients) — — — Voluntary 16 Orsett Joint Small-pox Hospital Stifford Long Lane, Grays, Essex Small-pox 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 General Medical and Surgical, Children, Maternity 61 111 45 Voluntary 21 Royal London Ophthalmic Hospital (Moorfields Eye Hospital) City Road, E.C.1 Ophthalmic 66 50 19 Voluntary 22 Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex Orthopaedic 45 70 345 Voluntary 23 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 24 St. Mary s Hospital for Women and Children Upper Road, Plaistow, E.l3 General Medical and Surgical, Children, etc. — 27 44 Voluntary 25 Severalls Mental Hospital Mile End, Colchester Mental 717 1113 — Essex C.C. and Colchester B.C. 26. Westminster Hospital Broad Sanctuary, Westminster, S.W.1 General Medical and Surgical, Maternity, Ear, Nose and Throat, etc. 95 126 20 Voluntary In addition to the above Institutions, there are a number of Santoria to which tuberculous persons resident in Barking are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis. ^ In the case of isolation and small-pox hospitals the bed accommodation has been given on the basis of 454 square feet per bed. 25—26 TABLE II. HOSPITAL S SERVICES, showing the number of beds for each purpose, and other facilities available. Name of Hospital 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 Gynaecological Infectious Diseases Isolation & Observation Maternity Mental Neurological Ophthalmic Orthopaedic Radium Septic Small-pox Tuberculosis Venereal Diseases Controlled by the Council of the Borough of Barking. Operative surgery, Dental, Nursing of Puerperal Fever and Pyrexia. Carried out at the Counties' Laboratory, Queen Victoria Street, E.C.4. 1 † Maternity Ward, Municipal Hospital – – – – – – – – – – – – – 12 – – – – – – – – – 2† Municipal Hospital – – – – – – – – – – – 38 – – – – – – – – – – – Operative surgery, Dental, Ear, Nose and Throat, Orthopaedic, Maternity, Puerperal Fever and Pyrexia, Ophthalmia Neonatorum. Not controlled by the Council of the Borough of Barking. 3 Brentwood Mental Hospital – – – – – – – – – – – – – – 1770 – – – – – – – — All specialised treatment available. Own Laboratory. 4 Brookfield Orthopaedic — – – – – – – – – – – – — – – – – 30 – – – – – Operative Surgery. Ultra-violet light Dental,Massage, X-rays, Ophthalmic No information. 5 City of London Hospital for Diseases of Heart and Lungs – 72 8 – – – – – – – – – – – – – – – – – – 101 – Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Nose and Throat, Radium. Own Laboratory. 6 East Ham Memorial – – – – – – 4 40 36 – 8 – – – – – 4 – – – – – – Operative surgery, X-rays, Ultraviolet light, Dental, Electrical, Mas- Carried out at Clinical Research Association. 7 East London for Children – – 135 – – – – – – – – – – – – – – – – – — – – All specialised treatment available. Own Laboratory. 8 Golden Square Throat, Nose and Ear – – – – – – 76 – – – – – – – – – – – – – – – – Operative surgery, X-rays, Ultraviolet light,. Dental, Ophthalmic, Radium. Carried out by a Pathologist outside the Institution. 9 Guy's 58 – 14 – 4 6 33 179 150 10 24 – 40 21 4 9 24 19 8 – – – 9 All specialised treatment available. Own Laboratories. 10 Hospital for Sick Children – – – – – – 18 106 121 – – – – – – – – – – – – – 7 All specialised treatment available. Own Laboratory. 11 Joyce Green Hospital (Isolation of Smallpox). No information available from the London County Council. (No information available from the L.C.C.) No information avail- 12 King George Hospital – – 22 – – – – 27 55 – – – – – – – – – – – – – – Operative surgery, X-rays, Dental (as casualty), Ophthalmic, Massage, Ear, Nose and Throat, Radium, Gynaecological, Neurological, Dermatological. Own Laboratory. 13 The London – – – – – – 28 306 338 – 28 – 94 21 – – 24 – – – – – – All specialised treatment available. Own Laboratories. 14 London Lock Hospital – – 41 – – – – – – 18 – – – 11 6 – 5 – – – – – 77 Operative surgery, Ultra-violet light, Dental, Ophthalmic, Massage, Ophthalmia Neonatorum. Own Pathologist. 15 London Skin Hospital – – – – – – – – – – – – – – – – – – – – – – – Skin diseases only. (No in-patients.) Ultra-violet light, X-rays. Own Laboratory. 16 Orsett Joint Smallpox – – – – – – – – – – – – – – – – – – – – 22 – – Small-pox only. 17 Poplar Hospital for Accidents – – – – – – – 34 78 – – – – – – – – – – – – – – Operative surgery, X-rays, Ultraviolet light, Dental. Massage, Radium by arrangement with the London Hospital. Own Laboratory. 18 Public Assistance Hospital – – 100 141 – – – 120 120 – – – – 30 32 – – 6 – – – 68 – All specialised treatment available with the exception of Ophthalmic and Radium. Carried out at the Counties' Laboratory, E.C.4. 19 Queen's Hospital for Children – – – – – – – – – – – – – – – – – – – – – – – All specialised treatment available with the exception of Radium. Own Laboratory. 20 Queen Mary's Hospital for the East End – – 45 – – – 4 66 61 – 3 – – 50 – – 4 2 – – – – – All specialised treatment available. Own Laboratory. 21 Royal London Ophthalmic (Moorfields) Eye Hospital) – – – – – – – – – – – – – – – – 153 – – – – – – All specialised treatment available with the exception of Operative surgery, Massage and Radium. Own Laboratory. 22 Royal National Orthopaedic – – – – – – – – – – – – – – – – – 460 – – – – – Operative surgery, X-rays, Ultraviolet light, Massage. Own Pathologist. 23 St. Bartholomew's Hospital – – 18 – – 6 24 232 250 – 44 – 10 17 – – 22 18 – 55 – – – All specialised treatment available. Own Laboratories. 24 St. Mary's Hospital for Women and Children – – – – – – – 20 33 – 8 – – – – – 4 – – – – – – Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Part-time Pathologist in conjunction with other Hospitals. 25 Severalls Mental Hospital – – – – – – – – – – – – – – 1830 – – – – – – – – Operative surgery-, X-rays, Ultraviolet light, Dental, Ophthalmic. Own Laboratory. 26 Westminster Hospital 10 – 13 5 – 2 7 56 77 – 10 – 8 12 – – 6 4 15 – – – – All specialised treatment available. Own Laboratories. †In the case of Hospitals under the control of the Borough of Barking:— Maternity Ward Municipal Hospital Number and classification of Medical Staff 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 Nursing Staff: Matron – 1 Sister 1 – Assistant Nurses — 6 Midwives 2 – Probationer Nurses 4 9 Arrangements for the employment of consultants j Consultants are engaged when necessary. In addition to the above Institutions, there are a number of Sanatoria to which tuberculous persons resident in Barking are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis. 27 Much good work has been done in it, but the building—as I have said—has outlived its usefulness and it is not the best advertisement for such a progressive town as Barking that nothing more suitable is provided for the little strangers who come amongst us, and who, after all, are the most important visitors the town can ever hope to have. I feel sure that a more suitable building, would attract even larger numbers than at present avail themselves of the amenities you offer. Your infectious fever hospital comprises as wards three blocks of buildings. These are commonly known as the diphtheria ward, the scarlet fever ward and the new ward. The diphtheria and the scarlet fever blocks are built upon the same pattern as the maternity block—of galvanized iron with matchboard lining. The new ward is a temporary structure and is a large hut built in sections. The diphtheria and scarlet fever wards have outlived their usefulness. Good work has been done in them, and, failing anything better being provided, good work will continue to be done in them, but they hardly comply with reasonable standards of buildings for infectious fever hospitals of today. The new ward could be used as a convalescent ward, but even as such it does not provide highly satisfactory accommodation in winter time. The new hospital which is being built to provide accommodation for fifty-eight beds is a really first-class, up-to-date building. It is being built in such a way that future extensions can be made according to plan and at a cost less than would be the case if the essential units had not been built of the dimensions they have been built. The question as to how many beds should be provided by any town for the reception of infectious diseases is one which can only be answered when the special circumstances of any such town are carefully explored. It is obvious, where houses are small and no provision can be made at home even for nursing, leave alone isolation, there is a larger demand for infectious beds than where the housing conditions are far better. It is also obvious that, where a town has a large child population housed under average conditions, they will want a larger number of beds than a town with a small child population, such as a residential resort for people who have retired. 28 The occupation, too, of the parents must be taken into account. In certain occupations it is most undesirable that the breadwinner should live in a house in which there is a case of infectious disease. Having regard to all these and similar circumstances, I have formed the opinion that in Barking you should have one and a-quarter beds per thousand population—i.e., you will want one hundred beds for a population of eighty thousand and you will want one hundred and twenty-five beds for a population of one hundred thousand. (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 and voluntary, for the people of Barking. 17. MATERNITY AND NURSING HOMES. With the exception of the maternity ward maintained by you at Upney, there is only one house in Barking used as a nursing home. During 1931, two births have been notified from this address. It appears to me necessary and desirable that you as a Council should be the Authority for the registration of nursing homes under the Nursing Homes Registration Act, 1927. At the present time the County Council carry out these duties, but it is obvious that you as a Council, with all the information your officers are able to put before you, are in the best position of any Authority to decide as to the desirability or otherwise of registering premises under this Act. That this information is of the utmost value is shown by the fact that the County as a matter of routine send letters to the Medical Officers of Health of Sanitary Districts in which it is proposed to establish a new nursing home, asking them for their observations and advising them that perhaps they may think it desirable to discuss the matter with the Chief Officer of the Fire Brigade. 18. MATERNAL MORTALITY. Cases of deaths due to pregnancy or childbirth are investigated, and during the year four confidential reports have been submitted to the Ministry of Health. 29 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 seven cases of puerperal pyrexia, there have fortunately been no fatalities. 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. 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. 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. It is desirable it should be known so widely as possible that, although only one attendant is sent with the ambulance as a rule, two attendants will be sent whenever necessary, and that it is only for the general medical practitioner interested in the case to indicate that such are necessary for them to be available. For my part, I have elsewhere pointed out the advisability of a nurse travelling with certain cases, and I hope that this will not be lost sight of. 30 22. CLINICS AND TREATMENT CENTRES. The table on pages 31-32 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. 23. LOCAL GOVERNMENT ACT, 1929. The operation of the Local Government Act, 1929, has not affected Barking very much, and I have nothing to add to my comments of last year. 31—32 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. Greatlields Centre, Movers Lane. Mondays, 2 p.m., and 99 99 99 99 99 Alexandra Centre, St. Pauls Road J Thursdays, 2 p.m. 99 99 99 99 99 St. Albans Centre, Urswick Road. Wednesdays, 2 p.m., and Fridays, 2 p.m. 99 99 99 99 99 (b) Ante-natal Clinics Clinic premises, East Street. Wednesdays, 2 p.m.; Fridays, 10.30 a.m. to 12 noon. Accommodation for consultations. 99 99 Alexandra Centre, St. Pauls Road. Tuesdays, 2 p.m. 99 99 99 99 99 St. Albans Centre, Urswick Road. Wednesdays, 10.30 a.m. to 12 noon. 99 99 99 99 99 (c) School Nurseries Nil Nil Nil Nil (d) Day Nurseries Nil Nil Nil Nil . 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. 99 >» (b) Eye Clinic 99 99 • Saturdays, 10 a.m. to 12 noon. One room. 99 99 (c) Dental Clinic 99 99 Daily, 9 a.m. to 12 noon and 2 to 4 p.m. Two rooms. 99 99 (d) Orthopaedic Clinic Faircross School. Mondays, 9 a.m. to 12 noon, and 2 to 4 p.m. Wednesdays, ditto. Fridays, ditto. One room. 99 99 TUBERCULOSIS— 37, Linton Road. Mondays, 3 to 5 p.m. Thursdays, 10.30 a.m. to 12 noon. Three rooms. Essex County Council. VISYMEAL DISEASES— London Hospitals, etc By arrangement with Essex County Council 33 SECTION 3. SANITARY CIRCUMSTANCES OF THE AREA. 24. WATER. Water is supplied to the area by the South Essex Waterworks Company. It is hard, clear and palatable, and we have from time to time received reports as to satisfactory purity. The Stour Supply Scheme was not in operation during the year. 25. RIVERS AND STREAMS. The rivers and streams running through the area are controlled by the River Roding Catchment Board, whilst the River Thames, your southern boundary, and one of its tributaries, the River Roding, which flows through Barking, is under the control of the Port of London. During the year complaints were received from residents with respect to the waterlogged condition of the back gardens of their houses in Victoria Road. From our enquiries we found amongst other perhaps more important matters, that, owing to the considerable increase of the traffic using the River Roding, the water in the river was kept at a much higher level than formerly, by the more frequent use of the lock gates. The attention of the River Roding Catchment Board was directed to the possible increase in the general level of the subsoil water in this area. From time to time the Council has had under consideration the filling of the arm of the Loxford Water where it flows through Berry's Marsh and at the rear of Bridge Street. This watercourse does not appear to serve any useful purpose, and, if arrangements can be made, the filling of such watercourse would considerably improve the amenities in this part of the district. 26. RAINFALL. The rainfall for the year ended December 31st, 1931, was 21.77 inches. Rain fell on 162 clays throughout the period in question. 34 27. DRAINAGE AND SEWERAGE. Further considerable progress has been made 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 at Barking. The Barking Sewage Disposal Works, situated at Gascoigne Road, Barking, continued in operation during the year. It is not my intention to report on these sewage works as such because it has long been recognised that they are inadequate, and the steps which are being taken jointly with Ilford to drain into the Northern Outfall Works mean that they will be closed altogether. 28. CLOSET ACCOMMODATION. In the unsewered portion of the district there remain 13 premises with cesspools, 37 premises with pail closets and 6 with privies. During the year, 8 premises have been connected with the sewers and other conversions are in hand. During the year the newly erected and occupied houses in Park View Gardens were drained temporarily to a cesspool, and complaints were received as to the insufficiency of the disposal arrangements. In order to deal with the problem it became necessary to empty the cesspool daily. The houses were later connected with the sewer. Whilst the present means of dealing with cesspool and pail closet contents is not ideal, it is anticipated that with the provision of the sewer at Rippleside the need for such will soon cease. 29. SCAVENGING—HOUSE REFUSE. (a) Storage, Collection and Disposal.—The collection and disposal of domestic refuse is controlled by the Engineer and Surveyor. The Corporation have provided hygienic collection vehicles and taken steps to prevent undue exposure during disposal of the rubbish at the tips, but we still have the problem of unsatisfactory storage at the house. May I call your attention to my observations last year that the provision of dustbins by the Council would be an economy in collection costs whilst improving domestic storage pending removal ? 35 During the year, 6,563 loads of refuse were collected, with an average weight of 1 ton 14 cwts. This figure shows a yield of 11.8 cwts. per 1,000 of the population per day, as against the average figure of 14.3 cwts. per day for non-mining towns. There is no question that the character of house refuse is changing to a much lighter material, with much less wastage of good fuel. 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. The disposal of refuse in Barking is undertaken by a modified form of controlled tipping, and it is with pleasure I have noted the improvement in the tip situated at Mayesbrook subsequent to our visit to Bradford. There is also a smaller dump in Jenkins Lane. (b) Street Cleansing.—The streets of the town are kept in a satisfactory state of cleanliness', but once again I want to emphasise that much can be done to assist the Council and reduce the cost of cleansing services if the public and tradesmen will co-operate by greater use of the domestic storage available for much of the litter which finds its way into the streets. So far the Corporation have not provided any mechanical means for cleansing the street gullies. I know it may be argued that the time is inopportune for the displacement of the unskilled labour engaged on this work with the existing primitive, inefficient methods in use, but there can be no question that, as now operated, this branch of cleansing is definitely below the town's general standard of demising services. (c) Fouling of Footpaths by Dogs.—Once again I recommend that regulations be drawn up and enforced to prevent this nuisance. 30. SANITARY INSPECTION OF THE AREA. (a) Work of Sanitarv Insnectors. (1) Inspection of Dwelling Houses. Total Houses Inspected under Public Health or Housing Acts 3,114 Total number of Inspections made 4,831 Housing (Consolidated) Regulations 841 After Infectious Disease 677 Defects Found 9,873 Notices Served (Preliminary) 2,632 Re-inspections re Notices Served 5,439 36 (2) Premises Controlled by Bye-Laws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings 10 1 1 Common Lodging Houses 120 18 11 Offensive Trades 231 24 8 Tents, Vans and Sheds 195 12 3 Dairies, Cowsheds and Milkshops 282 12 6 Slaughter-houses 89 2 — (3) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 190 45 23 Laundries 15 8 3 Bakehouses 58 6 3 Domestic Workshops 29 2 2 Other Workshops 122 28 14 Other Workplaces 175 41 19 Outworkers' Rooms 22 — — Butchers' Premises 640 45 22 Fishmongers 77 4 2 Restaurants and Dining Rooms 81 3 2 Stables and Stable Yards 131 29 21 Piggeries 79 8 3 (4) Miscellaneous. Inspections. Defects. Notices. Rats and Mice (Destruction) Act, 1919 132 8 4 Vacant Land and Refuse Dumps 203 24 9 Public Lavatories 77 4 3 Schools 76 6 1 Markets and General Shops 393 4 3 Ice-Cream Vendors 131 7 4 Petroleum and Celluloid Stores 160 13 3 Waterlogged Ground 12 — — Fair Grounds 13 — — Other Miscellaneous 145 2 2 Visits to Small-pox Contacts 858 37 (b) Summary of Sanitary Work Carried Out. (1) Drainage. Choked drains, opened, repaired, and cleansed 378 Drains reconstructed 114 New drains (conversions) 8 Ventilation shafts repaired or new fixed 50 New inspection covers 18 (2) Closet Accommodation. Roofs Walls Floors Doors W.C. structures repaired 43 Seats fixed 103 W.C. pans fixed or cleansed 93 Flushing apparatus repaired or renewed 247 (3) Sinks. New fixed 23 New sink wastepipes 132 New gullies 63 (4) Dampness. Roofs and flashings 1,004 Eavesgutters 625 Rainwater pipes 255 Damp walls remedied 829 (5) Water Supply. Defective water fittings repaired and supply reinstated 87 (6) Yard Paving. Yard paving repaired or relaid 213 (7) Dustbins. New ones provided 850 38 (8) General Repairs. House floors repaired 277 Windows repaired or renewed 456 Window sills repaired or renewed 412 Sashcords renewed 448 Washing coppers repaired or renewed 184 Stoves repaired or renewed 310 House doors and frames repaired or renewed 191 Stairs repaired 66 Handrails fixed 9 Chimney pots renewed and stacks rebuilt 198 Dirty or defective rooms repaired, cleansed and redecorated 1,688 Insufficient floor ventilation 112 Insufficient ventilation and light 8 External painting 108 Fences renewed 2 (9) Miscellaneous. Offensive accumulations removed 92 Animals so kept as to be a nuisance 11 Verminous rooms and persons disinfested 22 Dirty premises cleansed 6 Flooding 2 Drains tested 426 Dangerous structures reported 25 Overcrowding 59 Washing accommodation provided 1 Nuisance from burning refuse 10 Offensive fumes 1 (c) Notices Served. Informal Notices 2,632 Statutory Notices 508 Section 36, Public Health Act, 1875 57 Section 94, Public Health Act, 1875 271 Section 41, Public Health Act, 1875 16 Section 49, Public Health Act, 1907 1 Section 5, Infectious Disease (Prevention) Act, 1890 2 Section 17, Housing Act, 1930 161 508 89 {d) Factory and Workshop Act, 1901. Factories, Workshops and Workplaces. (1) Inspections (including inspections made by Sanitary Inspectors). Premises. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 218 26 — — Workshops 196 19 — — Workplaces 175 19 — — Total 589 64 — — 40 (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 27 27 — — Want of ventilation 3 3 — — Overcrowding — — — — Want of drainage of floors 2 2 — — Other nuisances 39 39 — — Sanitary accommodation:— Insufficient 15 15 — — Unsuitable or defective 37 37 — — 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 2 2 — — Totals 125 125 — * 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. Six notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 18 workpeople engaged on making wearing apparel, etc., in their homes. 41 (4) Registered Workshops. Workshops on the Register (see. 131) at the end of the year. Number. (1) (2) Bakehouses (including five factory bakehouses) 12 Other Workshops 72 Total number of Workshops on Register 84 (5) Other Matters. Class. (l) 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 Act (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 35 outworkers :— Overall making 1 Mattress maker 1 Shoe and slipper maker 1 Life-belt covering 2 Tie making 2 Artificial flower maker 1 Wearing apparel (various) 25 Christmas cracker making 1 Fancy goods making 1 During the year, 32 lists of out-workers were received from other Authorities in respect of addresses in Barking. Five lists were received from employers within the district. 42 81. SMOKE ABATEMENT. During the year, 130 smoke observations were earned out on factory chimneys and notices were served with respect to the 19 offences registered. We have continued to take an interest in the special difficulties of the electricity generating station at Creekmouth and confidently hope that a solution of the present difficulties will be found. A special Chimney Emissions Committee of the Electricity Commission has been investigating the grit emission problem, and we hope that the report will indicate how conditions may be improved. The two additional 75,000 kilowatt sets now in course of construction will be fitted with chain grate stokers and grit arresting equipment. With these operating we hope there will not be any increase in the grit emission from this generating station. The chimney stacks to this new boiler house are to be 250 feet high. Further, the stacks to the pulverized fuel installation are to be increased in height by 75 feet, to a total height of 185 feet. This will, we expect, lead to greater diffusion of the gases. Experiments with a high velocity gas-washer have been in progress, and, as a result, we are advised that a complete unit to be installed on two pulverized fuel boilers will be in operation by the summer of 1932. 32. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS OR REGULATIONS. (a) Houses Let in Lodgings.—Supervision is exercised over the small number of tenements in the town and reasonable home conditions obtain. (b) Common Lodging Houses.—One hundred and twenty visits were paid to the two common lodging houses, four of the visits being made at night. Eighteen defects were discovered and eleven notices served. (c) Tents, Vans and Sheds.—There are 10 occupied van dwellings, which are located in yards where water supply and sanitary accommodation are provided. (d) Underground Sleeping Rooms.—There are no such occupied rooms in the district. 43 (e) Offensive Trades.—The following is a summary of the offensive trade premises registered :— Fish Fryers 22 Dealers in Rags and Bones 9 Gut Scraper 1 Fat Melters 2 Fish Skin Scraper 1 Oil Boiler 1 Soap Makers 3 Total 39 Two hundred and thirty-one visits were paid to these 39 premises, and 24 contraventions of the bye-laws were discovered and any necessary action taken. During the year the Council approved three applications to carry on the business of soap boiler. The premises of a fish fryer became disestablished during the year and were removed from the register. From time to time complaints are received with respect to objectionable odours arising from the Roding Works (oil boiling) situated in Bridge Street. During the year reconstruction of these premises took place. The old plant was scrapped and more up-to-date equipment, incorporating modern fumereducing devices, provided. Whilst there has been a very considerable reduction in the objectionable odours emitted, they have not been entirely removed. (f) Refuse Tips.—Situated at West Bank are certain privately owned tips, which have been the subject of representations to you from time to time. The supervision of these tips has token up an unwarrantable amount of the time of your inspectors. The art of tipping has, in skilled hands, reached such a high level of efficiency that there is no excuse for tips being a nuisance. I advise you to see that your bye-lawrs are complied with and to strengthen your bye-laws where this has been found to be necessary. (g) Piggeries.—The seven remaining piggeries in the district are removed from occupied dwellings, but the premises are not entirely satisfactory because of the difficulties in drainage. 44 (h) Stables.—One hundred and thirty-one visits were paid during the year to the stable premises in occupation and 21 notices were served in respect of various unsatisfactory conditions. 33. PARKS AND OPEN SPACES. The open spaces of Barking continue to be not only a source of delight but also happy places for recreation for many of the people of Barking. The large open air swimming bath of which I spoke last year has been used very considerably, and I c in think of no better way of investing public money to promote health than by the provision of these open spaces, swimming baths, tennis courts, cricket pitches and other amenities for healthy recreation. The people of Barking are to be congratulated on the very real contribution they have made in this direction towards the promotion of health. 34. SCHOOLS. There are fourteen elementary schools, in addition to the Park Modem School, the Faircross Special School, and the Abbey Secondary School. With the exception of the Abbey Secondary School, which is not within the district, 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. It has not been found necessary to close any department of the schools as a result of infectious disease. 35. RAG FLOCK ACTS, 1911 AND 1028. There are three premises where upholstery repairs are carried out and these premises are regularly inspected. The general practice at all establishments is to use fibre or wood wool for the purpose of repairs. On no occasion has rag flock been found in use. 36. OLD CLOTHES. There is no legislation, so far as we are advised, dealing with second-hand clothing exposed for sale, and much of this which is sold may be verminous, and, of course, some of it may have come from infectious persons. I would suggest that you entertain the possibility of promoting legislation to enforce disinfection of all such second-hand clothing sold in Barking and that, immediately, you take steps to see that no one should be afforded an opportunity of selling such old clothes in the Corporation market unless the clothing has been so disinfected. 45 SECTION 4. HOUSING. 37. STATISTICS. (a) General. Number of new houses erected during the year :— (1) Total (2) As part of a municipal housing scheme— (a) Barking (b) L.C.C (3) Others (including pi irate enterprise and subsidy houses) 2,557 26 2,410 121 (b) Unfit Dwelling-houses. 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) (b) Number of inspections made for the purpose (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 (b) Number of inspections made for the purpose (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation... 2. Remedy of Defects during the Year without Service of formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 3,114 4,831 841 907 80 2,632 2,097 46 3. Action under Statutory Powers during the Year :— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs 161 (2) Number of dwelling-houses which were rendered fit after service of formal notices (a) By owners 156 (b) By local authority in default of owners 5 B.—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 374 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 356 (b) By local authority in default of owners 18 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930 : (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under section 20 of the Housing Act, 1930 : (1) Number of separate tenements or underground rooms in respect of which Closing. Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil E.—Proceedings under section 3 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices :— («) By owners Nil (b) By local authority in default of owners Nil (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil 47 P.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which Closing Orders were made Nil (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which Demolition Orders were made . Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders *10 * Formal Demolition Orders were not served : the houses being demolished subsequent to Closing Orders becoming operative. 38. HOUSING CONDITIONS. (a) General Observations.—The total number of inhabited houses in the district is 14,371 (including 975 shops), 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 three years. Of the total of 13,396 dwelling houses, 1,240 are owned by the Council and approximately 4,000 have been erected in the area by the London County Council since the year 1929. It is interesting to note that 1,595 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. It will be seen that Barking has made a remarkable contribution to the solution of the housing problem, and there can be but few towns in England where such a high percentage of the houses are either owned by public authorities or are being purchased through the assistance of a public authority. I am still perturbed at the number of sheds to be found in the back gardens of houses in Barking. May I refer you to the considerable comments made in my report for last year ? I do hope that the competent Committee which deals with this matter will consider how undesirable the.-.c sheds arc, when called upon to pass the very large number of applications which come before them every month. 48 HOUSES BUILT IX DISTRICT. 1926—1931. 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 1931 2,557 (Barking) 26 121 (L.C.C.) 2,410 Totals 5,343 4,045 1,298 Of the 4,045 houses shown above as part of Municipal Housing Scheme, 408 were provided by the Borough of Barking and 3,637 by the London County Council. It will be noted that the number of new houses erected as the result of private enterprise is small. The houses so erected are of the town terrace type, with a gridlike layout. There is little variety of design and but slight difference in mode of treatment. May I hope that the rest of such houses to be erected will be much more suitably laid out, and thus compare favourably with the layout of the estates the Council themselves have developed ? 49 (b) Sufficiency of Supply of Houses and Overcrowding.—During the year the erection of li t houses on the Corporation Upney Estate was in progress as the first portion of the five years' programme of building. The houses to be erected are chiefly of the two-bedroom, non-parlour type, let at an inclusive rental of 10s. 6d. per week. This type of house provides what is regarded as minimum amenities at a reasonable rent. Unfortunately, even this low rent is more than some of the families living in overcrowded circumstances are able easily to pay. Economic conditions force such families to find accommodation in the cheapest of rooms, usually in houses with low rents and below the general standard of fitness. The owner of such houses, with a low rent income and increased maintenance repairs, finds himself unable economically to keep the houses in repair. In my view the Corporation would be meeting a very great need if a small block of tenements could be provided to house families in indigent circumstances, at a rent not exceeding 7s. 6d. per week. I believe that such accommodation would do much to remove the sordid conditions under which some families live, and assist considerably the development of good citizenship among the younger members of the families. It should be remembered that a house cannot be condemned because it is overcrowded. The remedy should be to remove the overcrowding, and I must emphasize that this can only be done in many instances where houses are available at very cheap rents. (c) Fitness of Houses.—With the exception of the houses situated in the older and poorer quarter of the town, the standard of fitness and the amenities available are good. The older houses occupy much of the time of the sanitary inspectors in securing the maintenance of habitable conditions. (d) Unhealthy Areas.—In March, 1931, official representations were made to the Council that 69 premises (62 of which were occupied), housing 75 families, were unfit for occupation and should be demolished. 50 The Council, in accordance with section 1 of the Housing Act, 1930, declared that the areas composed of the following premises were unhealthy areas and should be dealt with as clearance areas :— 227-235, North Street 1-11, Holly Square 114-150, North Street 1-1, Tanner Square known as the Holly Square Area. 1-6, Red Lion Place 1-4, St. John's Retreat 70-76, North Street known as the Red Lion Place Area. 2-18, Bifron Square 1-27, Bifron Square 2-14, Axe Street 49-59, Broadway 1, White Court Shaftesbury Hall School known as the Bifron Square Area. During the year little progress could be made with these clearance schemes owing to pressure of other work. This delay is regrettable, not only in so far as it affects the occupiers of the houses concerned, but because it further postpones action with respect to other areas scheduled for treatment in the period 1930-1935. 51 SECTION 5. INSPECTION AND SUPERVISION OF FOOD. 39. MILK SUPPLY AND ICE-CREAM. (a) 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. During the year one dairyman was removed from the register in accordance with section 2 of the Milk and Dairies Amendment Act, 1922. It is unfortunate that legislation does not give power to prohibit the use of premises as a dairy when the occupier is removed from the register as unsatisfactory, and so avoid the possibility of applications for the use of the premises from persons who are essentially his nominees. There are two occupied cowshcd premises, with a total of 40 milch cows. One is of recent construction, whilst the other is of the old-fashioned type but provided with the statutory requirements. 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 52, seven were found to be unsatisfactory Type of Sample. Satisfactory. Unsatisfactory. Totals. Grade "A" (T.T.) Milk 3 3 Raw Milk 20 4 24 "Pasteurised " Milk 22 3 25 Totals 45 7 52 Whilst 25 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 Reports for the years 1929 and 1930, 52 There were during the year 12 samples of milk submitted to biological examination for the presence of tubercle. Of this number three samples were found to be infected. 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 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 gran'.ed 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 5 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, and one for the treatment and sale of milk as " pasteurised." There are in the district 45 retailers and 11 wholesale distributors of sterilised milk. One dairyman was prosecuted for bottling milk in the street. It will be seen that a considerable amount of work has been done in endeavouring to maintain a satisfactory standard of food value and purity, but considerable work yet remains to be done. I hope you will take every step you can to see that all milk which is pasteurised shall be sold as pasteurised milk. This, I think, is the first important step to take in promoting a cleaner milk supply. As Medical Officer of Health I am anxious to promote the sale of milk, and I rejoice in the co-operation I have had from many milk retailers towards this end. It is, however, to be regretted that 7 samples out of the 52 examined baeteriologically were found to be unsatisfactory, whilst, of course, to find 3 out of 12 samples of milk examined for tuberculosis to be infected, clearly indicates the magnitude of the task before us in obtaining a milk supply which we can assure the public is quite safe. 53 (b Ice-cream.—The following results of the bacteriological examination of ice-cream samples show wide variation in the cleanliness of the product. Sample No. B. Count. B. Coli. 32 1,500,000 .Absent in 1 c.c. 33 180,000 ditto 34 210,000 Present in 1 c.c. 35 320,000 Present in 0.01 c.c. 36 42,000 Present in 1 c.c. 37 410,000 Present in 0.0001 c.c. 38 4S0,000 ditto 39 350,000 ditto 40 3,200 Present in 1 c.c. 42 3,600 Absent in 1 c.c. 43 720 ditto Samples 36, 40, 42 and 43 were taken from supplies of the large manufacturers distributing in the district and indicate the high standard of cleanliness obtaining at the factories. I must again emphasize the need for larger powers to control the manufacture and distribution of this food product. 40. MEAT AND OTHER FOODS. Meat.-—The one licensed slaughter-house continued in the occupation of the same person and has not given cause for complaint during the year. The following table gives particulars of notifications received, and the animals slaughtered, during the five years ended December 31st, 1931. Year 1927 1928 1929 1930 1931 Total. Notifications Received 150 126 72 64 39 451 Cattle 97 40 64 80 12 293 Pigs 204 409 137 93 200 1,043 Sheep 786 815 426 332 17.3 2,532 Calves 137 71 10 11 1 230 Totals 1224 1335 637 516 386 4098 54 Diseased meat was destroyed as under:— Description. Disease. Weight. 1 beast's lung Congestion 10 lbs. 3 beasts' livers Distomatosis 42 „ 1 beast's liver Angioma 14 „ 1 „ mesentery Tuberculosis 3 „ 24 sheep's lungs Parasites 72 „ 17 „ livers Distomatosis 68 „ 12 pigs' lungs Pneumonia 48 „ 12 „ lungs Parasites 60 „ 8 „ lungs Congestion 32 „ 2 „ lungs Tuberculosis 7 „ 12 „ livers Cirrhosis 72 „ 1 pig's liver Tuberculosis 5 „ 9 pigs' heads Tuberculosis 126 „ 4 pigs (portion of carcasses) Tuberculosis 160 „ 4 pigs' mesenteries Tuberculosis 8 „ Total 727 lbs. In addition there were surrendered, 3 pigs' offals and one beast's offals affected with Tuberculosis. 41. UNSOUND FOOD. The following list gives particulars of the unsound food destroyed during the year:— Meat Tinned Foodstuffs. 13 pigs' heads. 33 tins meat products. 10 lbs. beef. 21 tins milk products. 8 lbs. pork. 22 tins fruit and vegetable products. 4 lbs. mutton. 14 tins syrup. 5 tins fish products. Fish. Confectionery. 112 lbs. winkles. 140 lbs. skate. 33 lbs. mixed sweets. 30 lbs. shrimps. 55 42. ADULTERATION, ETC. The Food and Drugs (Adulteration) Act, 1928, and kindred Acts and Regulations arc administered in this district by the Essex County Council. 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. 52 64 88 204 No proceedings were instituted in relation to these samples during the period covered. 43. NUTRITION. Once again I want to say that I do not think there is any need for a lot of scientific training of the public in the nutritive value of various foods, and to repeat that if good, plain, straightforward food is made available for the public at a price the public are able to pay, and if that food is as widely variable as possible, and if the public are taught to avail themselves of these amenities, they will, without any scientific knowledge, prepare foods which are scientifically accurate. 57 SECTION 6. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. 44. NOTIFICATION TABLES. The following table shows the number of notifications of infectious diseases received during 1931:— TABLE I. Diseases. Males. Females. Total. Total eases removed to Hospital. Deaths. Small-pox 3 2 5 5 - Scarlet Fever 71 90 161 148 1 Diphtheria 122 119 241 238 7 Puerperal Septiæmia - 3 3 2 1 Pneumonia: Acute Influenzal 63 46 69 12 22 Following measles - - Other forms 40 4 Erysipelas 10 15 25 5 - Ophthalmia Neonatorum 7 10 17 1 - Puerperal Pyrexia - 7 7 6 - Para-typhoid Fever 1 2 3 3 1 Acute Anterior Poliomyelitis 1 - 1 1 - Chicken-pox 151 182 333 1 - Totals 429 476 905 422 36 58 The following diseases were notifiable in 1931 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 by Orders or Regulations framed under section 180, Public Health Act, 1875 Tuberculosis (all forms), ophthalmia neonatorum, cerebro-spinal fever, acute poliomyelitis, encephalitis lethargica, influenzal pneumonia, acute primary pneumonia, malaria, dysentery, trench fever, and puerperal pyrexia. An order was made under the Infectious Disease (Notification) Act, 1880, making chicken-pox a notifiable disease throughout the district. The Barking Town (Pneumonia) Regulations, 1921, provides for the notification of Pneumonia supervening upon Measles. The total notifications of infectious diseases numbered 905 exclusive of tuberculosis and inclusive of chicken-pox, compared with 1,004 the previous year. During 1931 the number of notifications of tuberculosis (all forms) was 123 compared with 95 in 1930. 59—60 TABLE II. Notifiable Disease. No. of cases notified at age groups. Cases classified according to Wards. Under one year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 35 years. 35 to 45 years. 45 to 65 years. Over 65 years. Totals. Abbey. Gascoigne. Central. Ripple (West). Ripple (East— L.C.C. Est.) Westbury. Longbridge (West). Longbridge (East—L.C.C. Eat.). Small-pox — — — — — — 2 — 2 1 — — 5 3 — — — — — 2 — Scarlet Fever 3 6 15 18 11 61 27 9 10 1 — — 161 6 15 2 29 36 15 22 36 Diphtheria 3 4 19 18 17 99 48 14 18 1 — — 241 35 39 14 43 28 45 21 16 Puerperal Septicaemia — — — — — — — — 2 1 — — 3 — 1 — 1 — 1 — — Pneumonia (primary, influenzal and following measles) 7 7 4 5 4 8 2 3 28 13 18 10 109 24 11 12 10 2 10 29 11 Erysipelas — — 1 — — 4 2 — 6 2 7 3 25 3 3 2 7 — 5 5 — Ophthalmia Neonatorum 17 — — — — — — — — — — — 17 3 3 1 4 1 2 2 1 Puerperal Pyrexia — — — — — — — — 5 2 — — 7 1 — — 1 1 — 2 2 Enteric Fever — — — — — — 1 — 2 — — — 3 — — — — — — 3 — Acute Anterior Poliomyelitis — — 1 — — — — — — — — — 1 — — 1 — — — — — Chicken-pox 14 20 24 24 23 188 30 7 3 — — — 333 43 50 14 72 15 62 64 13 Totals 44 37 64 65 55 360 112 33 76 21 25 13 905 118 122 46 167 83 140 150 79 61 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1931:— Scarlet Fever. Diphtheria. Total. January 13 33 46 February 11 24 35 March 9 13 22 April 7 19 26 May 11 26 37 June 2 23 25 July 13 18 31 August 19 18 37 September 15 16 31 October 18 18 36 November 24 18 42 December 19 15 34 Totals 161 241 402 45. NOTIFIABLE INFECTIOUS DISEASES. (a) Diphtheria.—241 cases were notified, compared with 35S the preceding year. Of cases notified, 240 were removed and treated in the local isolation hospital. 7 deaths from diphtheria occurred. The average stay of diphtheria in hospital was 45.2 days, the longest stay being 128 days. Sex.—122 cases were male and 119 female. The death rate from diphtheria has shown a decline over the last thirty years. A quarter of a century ago the death rate from diphtheria over an average of four years was 0.335 per 1,000 population; at the present time, over an average of five years, it is only 0.114. There were 7 deaths out of a total number of 241 cases, making a percentage death rate of 2.9. 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 patients requiring anti-toxin are removed to hospital. 62 (b) Scarlet Fever.—The number of cases notified was 161 compared with 178 the previous year. One fatal case occurred. 145 cases were isolated at the local Infectious Diseases Hospital. The average stay of scarlet fever cases in the Municipal Hospital was 42.3 days, compared with 14 days in 1930. The longest period of detention was 88 days and the shortest 16 days. One case was detained in an L.C.C. Hospital for 129 days. Sex.—71 cases were male and 90 female. (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 109 26 (d) Small-pox.—There have been 5 cases of small-pox during the year 1931. This figure compares favourably with that of 45 for 1930. (e) Encephalitis Lethargica.—There were no deaths from encephalitis during 1931. (f) Tuberculosis.—Particulars of new cases of tuberculosis and of all deaths from the disease in the area during 1931 are given in this Report in the following form:— New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NouPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 year — 1 1 — — — 1 1 1 to 5 years 1 — 3 3 — — 1 1 5 to 10 years 1 — 6 5 — — — — 10 to 15 years 3 1 3 4 1 — — 1 15 to 20 years 3 4 2 3 1 2 — — 20 to 25 years 8 7 1 2 4 3 — — 25 to 35 years 15 l6 3 — 6 8 — — 35 to 45 years 10 6 1 — 4 4 — — 45 to 55 years 4 2 1 — 2 1 — — 55 to 65 years 1 1 — — 3 — — — 65 years and upwards 1 — — — — 1 — — Totals 47 38 21 17 21 19 2 3 63 During the year, 123 notifications were received of all forms of tuberculosis— pulmonary 85 and non-pulmonarv 38. Information was received of the removal into the district of 37 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 I and II during the year:— Form I. Form II. Pulmonary. Non-Pulmonary. Pulmonary. Non -Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. 31 35 7 6 27 23 7 6 There were 789 attendances at the dispensary during the year for the purpose of medical examination, 333 being made by new cases. Of new cases attending during the year, 18 were subsequently notified as suffering from tuberculosis, 39 had been previously notified, while 36 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 31-12-30. Numbers removed from the Dispensary Register. Number on Dispensary Register 31-12-31. Died. Left District and L.S.O. Discharged (Non Tb.) Discharged " Cured " Amended Diagnosis. Total. 355 38 22 119 39 38 256 306 At the end of the year, 295 cases on the Dispensary Register were definitely diagnosed as suffering from tuberculosis, whilst in 11 cases the diagnosis still remained in abeyance. Forty-five deaths occurred from tuberculosis (all forms) 40 of these being pulmonary cases. The number of deaths in institutions was 19. 64 The death rate for tuberculosis (all forms) during 1931 was 0.87 per 1,000 population, compared with 0.82 for the previous year. Of the 45 deaths from tuberculosis 4 had not been notilied to us before death— i.e., 8.9 per cent. of the total deaths from tuberculosis. The following table shows the position of the Tuberculosis Register on 31/12/31 compared with 31/12/27. Number on Register, 31/12/27 946 Number since admitted to Register 382 Number since discharged from Register: Cured 131 Died 230 Amended Diagnosis 238 Left district or lost sight of 167 Duplicate notification 14 780 Number on Register 31/12/31 548 It will be seen that in 1927 there were 946 persons on the Register. At that time Barking had a population of approximately 40,000. At the end of 1931, although the population was then estimated to be nearly 60,000, there were only 548 persons on the Register. This means to say that four years ago the Register was entirely misleading. There were many names on it which ought not to have been on it. The revision of this Register has been a work of great interest to me, and I am sorry I was not able to complete it before I gave up the clinical tuberculosis work in Barking. (g) Enteric Fever.—Three cases of enteric fever were notified during the year, all of which were removed to hospital. In addition, there was a case of para typhoid, where the patient died and the diagnosis was made on pathological findings after death. (h) Puerperal Fever.—Three cases were notified during the year; two were admitted to hospital and recovered. 65 (i) Puerperal Pyrexia.—Seven cases were notified during the year, of which six were removed to hospital ; all of the cases recovered. (j) Erysipelas.—25 cases were notified during the year compared with 40 during 1930. Five patients were removed to hospital. (k) Chicken-Pox.—In view of the prevalence of small-pox in surrounding districts, chicken-pox was made a notifiable disease in the district in April, 1928, and continued to be notifiable throughout 1931. A total of 333 eases were notified during the year compared with 288 during 1930. Sex.—151 were male and 182 female. 46. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES. (a) Measles, etc.—The most important of these are measles, whooping cough and summer diarrhoea. There were no serious epidemics of these diseases, and the deaths registered were as follows:— Measles 1 Whooping Cough 4 Summer Diarrhœa 6 (b) Rheumatic Fever.—Rheumatic fever is a very serious problem in Barking. I am persuaded it is even more important than scarlet fever and I hope the time will come when both rheumatic fever and measles are treated in hospital. (c) Psittacosis.—I am happy to be able to say there has been no recurrence of the outbreak of psittacosis noted last year. As I have pointed out elsewhere, prevention of the disease is very easy and now that the people have been warned that they should not buy birds which are likely to be infected I think we may reasonably expect that we shall not have a recurrence. (d) Cancer.—There have been 55 deaths from cancer, 34 below the age of 65 years and 21over 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 arc 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. 66 The following table shows the occupations of the 55 persons who died from cancer during the year 1931. Male. Female. Gas workers 4 Spinsters 3 General labourers 4 Wives 16 Painters 2 Widows 9 Master fishmonger 1 Marine engineer 1 Journeyman 1 Chemical workers 2 Storeman 1 Foreman, tar factory 1 Stevedore 1 Maltster 1 Mechanical engineer 1 Watchman 1 Printer's engineer 1 Motor guard 1 Boiler coverer 1 Donkeyman 1 Packers. 2 27 28 The following table shows the organs affected, according to the returns of certified causes of death. Organ. Male. Female. Bladder 1 1 Breast - 4 Bronchus 1 - Cervix - 1 Colon 4 4 Glands of neck 1 - Larynx 2 - Liver 3 - Lungs 2 2 Mouth 1 - Oesophagus 1 2 67 Organ. Male. Female. Pancreas 1 - Pelvic colon 1 1 Peritoneum - 1 Pleura - 1 Prostate 2 - Rectum 3 2 Stomach - 4 Thyroid 1 - Tongue 3 - Uterus - 3 Vagina - 1 Ventriculi - 1 27 28 (e) Influenza.—There were no less than 31 deaths from influenza during the year 1931. This shows how serious influenza can be. Almost all the cases had definite pneumonic symptoms and therefore come within the group of respiratory diseases which are so fatal in England. There is no doubt that the general public look upon influenza far too lightly, and, by keeping at work when they ought to be in bed, they not only aggravate their own disability, and in many cases provoke fatal complications, but also spread the disease. For some time now I have felt that hospital accommodation should be available for cases of influenza which cannot reasonably be nursed at home. 68 47. ISOLATION HOSPITAL. (a) Admissions. The following is the table of admissions, etc., in respect of infectious diseases during 1931:— Disease. In Hospital January, 1st, 1931. Admitted during the year. Died. Discharged. In Hospital Dec. 31st, 1931. Scarlet Fever 11 145 1 127 28 Diphtheria (including 1 case admitted as Laryngeal Croup) 42 240 *8 252 20 Pneumonia 1 1 1 1 - Puerperal Fever - - - - - Puerperal Pyrexia - 1 - 1 - Enteric Fever - 3 - 3 - Mumps - 1 - 1 - Meningitis - 1 1 - - Rheumatism - 1 - 1 - Tonsilitis - 1 - - 1 Others - 2 - 2 - *The case of laryngeal croup died. It was not a case of diphtheria but a case of pneumonia, with rickets, involving amongst other things the cartilages of the voice box. (b) Number of lied Days.—The total number of bed days in the infectious diseases hospital during 1931 was 16,905—that is to say, an average of -16 patients were in hospital throughout the 365 days in the year. It is generally recognised that 100 beds, even when not fully occupied, represent sufficient work for a whole-time medical officer, so that during 1931 the amount of work undertaken at the hospital was equal to about half the time of a whole-time officer. (c) Hospital Accommodation.—The problem of using the hospital accommodation available to the very best advantage is one to which I have made reference in previous reports, and I would refer you particularly to my remarks on the hospitalisation of scarlet fever in my Annual Report for the year 1928. From these 69 remarks it will be seen that uncomplicated cases of scarlet fever are removed from hospital so soon as is practicable, but there is still a very real prejudice on the part of the public against persons with any form of peeling being discharged, and, whilst I believe it would be quite possible to save a certain amount of time by discharging patients from hospital before they have quite finished peeling, I am persuaded that the time is not yet ripe for such action to be taken. The possibility in Barking of replacing hospital treatment in certain instances by nursing and supervision at home is remote. With what may be termed an essentially industrial population and with so many employers hesitating to employ persons from houses where there is infectious disease—indeed there are some such employers who refuse to do so—the nursing of infectious diseases in the homes of Barking is not likely substantially to diminish the needs of the Borough for hospitalisation. In a town the size of Barking there has hitherto been no need to set up any special organisation to deal with the selection of cases for admission to your own hospital, the more so because of the personal association between your own Medical Officer and the other doctors practising in the area, with whom on very numerous occasions throughout the year your officer has been in consultation prior to the admission of eases to hospital. It has always been your custom to admit cases of measles to hospital when they are complicated by broncho-pneumonia and when such accommodation is available. I hope it will be possible to make such accommodation more readily available in the future than it has been in the past, and the opening of the new hospital will materially help towards this end. It is impossible this year to complete a report of this nature without saying something of the old infectious fever hospital, which is now overshadowed, literally and metaphorically, by the new infectious fever hospital which is being erected on an adjacent site. It is to be hoped that the spirit of service and sacrifice which has characterised this hospital in the past will follow it into the new buildings in which it will be housed in the future. There has been an enormous amount of good work done in what has now come to be known as the old isolation hospital, and because it has been found necessary to build a more up-to-date building we should none the less think with pride and respect of those who gave to Barking this first isolation hospital. If we have climbed on the backs of those who first saw the need for succouring the diseased in their distress and if from this higher position we have a clearer view of what is necessary to carry out their ideals, we must be thankful to them for the work which they have done and on no account belittle their efforts because we, with the help of their foundations, are able to do something better. 48. VACCINATION. 70 Your Medical Officer has carried out no primary vaccinations or re-vaccinations. He works in the closest co-operation with the Public Vaccinating Officer, who carries out such vaccinations if and when it is necessary and possible. 49. EXAMINATION OF PATHOLOGICAL SPECIMENS, ETC. In a previous table on page 21 I have shown the use which has been made of the facilities provided for the examination of pathological and bacteriological specimens. Some people are born immune for all practical purposes to certain diseases, and in certain diseases, such as diphtheria, where a person is not born immune, this immunity can be provoked artificially. It seems to me right and proper that the Authority should make available for all persons facilities for them or their dependents to be tested to see if they are immune to diphtheria, and, if they are not immune, for this immunity to be provoked. How far the immunisation of a certain part of the population is likely materially to influence the incidence of diphtheria is another question, but I do feel strongly that, where parents are anxious to avail themselves of these latest benefits, the opportunity of taking such advantage should be denied to no one. 50. CLEANSING AND DISINFECTION OF VERMINOUS PERSONS. In Barking, as I have said previously, there is no particular station which is known as the Cleansing and Disinfecting Station, although of course a large amount of steam disinfection is carried out at the Upney Hospital. It seems to me that the time has come when the Council might well entertain the possibility of setting up a Cleansing Station at the lower end of the site on which the infectious fever hospital is built. Such a station would be in close proximity to the laundry and the disinfector and would therefore be conveniently situated. If it should prove practicable to get a right of way into the grounds at this point it would not be necessary for persons who seek to have themselves or their clothes cleansed to enter the hospital grounds. 71 51. RAT REPRESSION. No extra special activities were undertaken during Rat Week, except the exhibition of posters directing attention to the matter and advising affected householders what steps to take. The extensive propaganda which has taken place in past years has taught the general public to give notice to this department so soon as any evidence of rat infestation is found. During the year, there were 101 applications for the free supply of raticides, and 132 visits were paid by the sanitary inspectors to infested premises. 52. MOSQUITOES. The prevalence of mosquitoes in Barking is well known for a month or two in summer, and this matter has received the attention of the Natural History Society. The result of the investigations which have been carried out tend to show that the greater part of any nuisance which exists arises from mosquitoes which breed, not down in the marshes, but in the back gardens of the houses in the town itself, and that if persons would see that there were no collections of stagnant water left in old cans and in other places where these mosquitoes could breed we should have but little trouble from these irritating insects. 73 SECTION 7. MATERNITY AND CHILD WELFARE. 33. GENERAL. The Council's Scheme under the Maternity and Child Welfare Act, 1918, has been extended during the year, by the opening early in 1931 of a further session at the St. Albans Clinic. The question of clinie accommodation is one which you have at present before you and is one in which I know you are deeply interested. I hope it will be possible to arrange at an early date for all the clinic work to be done in permanent buildings. 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 905, the net total of 947 being obtained by adjustment of " transferred " notifications. The births registered included 488 males and 459 females. There were 21 illegitimate births, or 2.2 per cent, of the total. In comparison with 1930, 148 more births were registered daring the year, an increase equivalent to 18.5 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 27 or 2.9 per cent. were notified. In addition, 5 still-births were not notified. The following table gives details of the notifications received::— By whom notified. Live Births. Still-Births. Medical Practitioners 116 3 Certified Midwives 678 18 Parents and Others 84 2 0f the total live births within the district during the year, 634 or 70.05 per cent, were attended by midwives, the remainder being attended by medic al practitioners. 74 55. BIRTH RATE. The birth rate for the year was 18.3, compared Math 15.8 for England and Wales. 56. ANTE-NATAL CLINICS. The work of the Clinics was carried on as in previous years. The attendances during the year were well maintained. The number of primary attendances was 527, compared with 432 for 1930. Re-attendances numbered 1,840 in 1931, and 1,536 during 1930. Two hundred and six sessions were held during the year, making an average attendance of 11.5 mothers per session. The total number of births including transfers was 975 and the number of first attendances at the Ante-Natal Clinics was 527. It would therefore appear that 54 per cent. of these cases availed themselves of our Ante-Natal Service. Twenty-seven 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. 57. MATERNITY WARD. The admissions to the Maternity Ward of the Municipal Hospital numbered 196, compared with 202 in 1930. Of these, 27 cases M ere admitted for ante-natal treatment, and 169 for confinement. Corresponding figures for 1930 were 27 cases for ante-natal treatment, and 175 for confinement. (a) Number of eases admitted 196 (27 of which were Ante-natal) (b) Average duration of stay 14.5 days (c) Number of cases delivered by :— Midwives 163 Doctors 6 (d) Number of cases in which medical assistance was sought by the midwife, with reason for requiring assistance :— Torn Perineum 18 High Temperature ... ... 2 Uterine Inertia 1 Slight Inflammation of Breast 1 Heart Attack 1 Patient strange in manner 1 Prolonged Labour 3 Ante-natal 2 29 75 (e) Number of cases notified as puerperal sepsis, with result of treatment in each case Nil (f) 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 infants not entirely breast fed while in the Institution 3 (J) Number of maternal deaths Nil (k) Number of foetal deaths (i) still-born, and (ii) within 10 days of birth, and their supposed causes—and the results of the postmortem examination :— (i) Still-born 9 (ii) Within 10 days of birth 3 Twins months—Feeble—12 hours old 2 Premature—9 days old 1 I know how difficult it is to assess fees for admission to the Maternity Ward months before the expected date of confinement, the more so in view of the present economic situation, but I do hope we shall be able to expedite advising women of the proposed charges for such hospital treatment. It is not unnatural that the expectant mother wants to have everything ready and prepared months beforehand, so that she may have this weight off her mind, the more so because she feels that if she is not going into Upney she must be busy making alternative arrangements. A suggestion which has occurred to me and which might commend itself to the Council is that the Chairman be authorised, as and when these cases arise, to fix a charge, which chargc will be made on the assumption that the man will be in his normal employment at the date of the confinement, that the woman be advised of this charge and that only cases where some extra concession is wanted be brought individually before the Committee. At the present time there must in some cases be four or five weeks between the application being received and the woman being informed as to what the charge will be. These four or five weeks are a long time to wait, and the method I have suggested would get over this difficulty in a number of cases. 76 58. PUERPERAL FEVER AND PUERPERAL PYREXIA. Three cases of puerperal fever were notified as compared with three in 1930. Two cases were admitted to hospital. In addition to the cases of puerperal sepsis, 7 cases of puerperal pyrexia were notified, the confinement in 4 cases being attended by a midwife. All the patients recovered. 59. MATERNAL MORTALITY. Four maternal deaths occurred during 1931, the deaths being certified as follows :— (a) Adherent Placenta (with complications) 1 (b) Placenta Praevia 2 (c) Hyperemesis Gravidarum 1 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. 60. INFANTILE MORTALITY. The total number of deaths of infants under the age of one year during the year was 61, giving an infant mortality rate of 64.4 per thousand registered births, compared with 61.32 per thousand for 1930. The average infant mortality rate for the whole of the country for 1931 was 66, for London 65, and for the 107 County Boroughs and Great Towns, including London, of over 50,000 inhabitants, the infant mortality rate was 71. It will therefore be seen that our infant mortality figure for this year was not above the average. The following table shows the number of maternal deaths occurring in Barking during the past six years Year. No. of Maternal Deaths. 1926 1 1927 3 1928 2 1929 2 1930 3 1931 4 77 The following table shows the infant mortality figure for Barking from 1891 to 1931:— Year. 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 1898 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 1906 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 1931 61 64.4 * Registrar-General'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 1931 the figure was 64.4 which, less 30, is 34.4, which means to say that we have brought down the possible reduction of infant mortality by 35 per cent. 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 61 deaths of infants under the age of one year, none was due to bronchopneumonia following measles. 78 61. NEO-NATAL MORTALITY. Of the 61 children who died under the age of one year, no less than 31 of these died under the age of one month—i.e., 50.8 per cent. Of these 31 children, 14 were female and 17 male. Of the 31 deaths, 20 were due to premature birth and debility and 4 were due to congenital malformations, the remaining 7 being due to various causes. Giving approximate figures, it may be said that the neo-natal mortality rate for 1930—i.e., the number of children dying under the age of four weeks per 1,000 births—was 30 and for 1931, 32.5. The corresponding figure for the whole of England for the five years ending December, 1930, was 31.8. It will therefore be seen that Barking has an average figure. The Barking figure is higher than the average for London, which is 25, and lower than that for County Boroughs, which is nearly 34. As I said last year, it is now generally believed that these neo-natal deaths can only be materially influenced by more intensive and efficient ante-natal work, and these 31 deaths show you that you have realms to conquer in this direction. 62. STILL-BIRTHS. Of the total notifications received under the Notification of Births Act, 23 related to still-born children. In addition, 5 still-births were not notified, making a total of 28. The Registrar-General expresses this figure as a ratio between the number of still-births and the number of live births, per 1,000 live births. In this way we get a rate of 26.5 for 1931. This is a very low figure compared with the figure of 41 for all England and Wales. Investigation of the health visitors elicited the following information .— (a) Duration of pregnancy :— Less than seven months 2 More than seven months 21 Not elicited 5 79 (b) Presentation:— Vertex 12 Breech 5 Footling 1 Anencephalus 1 Not elicited 9 (c) Supposed cause of still-birth :— Overwork 1 Accident, etc. 1 Strain 2 Shock 2 Mal-developed 1 Difficulties during labour and delivery 3 Extended breech 1 Not known17 (d) Occupation of mother:— Household duties at home 25 Shop worker 1 Unknown 2 53. OPHTHALMIA NEONATORUM. There was an increase in the number of cases of ophthalmia neonatorum, notifications being 17, compared with 12 in 1930. Six of the cases "occurred in the practice of midwives, the remainder being attended by medical practitioners. Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. At Hospital. under 3 weeks 17 16 1 17 — — — I do not look upon this small increase as significant, especially in view of the fact that in no case has the vision been impaired. 80 64. 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 102 100 100 91 393 No. of attendances of children under one year:— (a) New cases 226 152 127 249 754 (b) old cases 2676 2009 1449 2319 8453 No. of attendances of children 1 to 5 years of age :— (a) new cases 61 37 26 238 362 (b) old cases 1216 1471 876 1532 5095 Average number of attendances per session 41 37 25 48 37 No. of sessions attended by medical officers 101 100 100 91 392 No. of children seen by medical officers :— (a) Under one year 1528 1063 869 1098 4558 (b) Over one year 760 721 680 915 3076 Average number of children seen by medical officer per session 23 18 15 22 19 The total attendances during the year were 14,664 as compared with 10,717 in 1930. Particulars of the home visits paid by the health visitors are given in the following table :— No. of ante-natal visits :— First visits 143 Subsequent visits 41 No. of first visits to children under one year 1,417 No. of subsequent visits to children under one year :— (a) Attending a Centre 225 (b) Not attending a Centre 2,788 No. of visits to children 1 to 5 years of age :— (a) Attending a Centre 119 (b) Not attending a Centre 4,908 No. of special visits in connection with Ophthalmia Neonatorum 20 Ditto Deaths of children up to 3 years of age 49 Ditto Still-births 20 Ditto Puerperal Sepsis and Puerperal Pyrexia 4 Ditto Foster Children 57 Other visits (re infectious diseases) 178 Total home visits of all kinds 9,969 81 65. 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 Queen Mary's Hospital, Stratford, and the St. Maiy's Hospital, Plaistow, under the Council's scheme. During the year 95 such operations were carried out in respect of children under the age of five years. (e) Convalescent Treatment.—This is provided under the Council's scheme, and, during the year, seven toddlers and three mothers and babies received treatment in various convalescent homes. (f) 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 twelve children under this scheme. 66. FOSTER CHILDREN. The following is an abstract of a table compiled and returned to the Ministry of Health by the 30th January, 1932, relating to the administration of Part 1 of the Children Act, 1908, during the year 1931 :— 1. Notification:— (i) Number of foster parents on the Register:— (a) at the beginning of the year 36 (b) at the end of the year 41 (ii) Number of children on the Register:— (a) at the beginning of the year 47 (b) at the end of the year 52 (c) who died during the year 3 (d) on whom inquests were held during the year— 82 2. Visiting:— (i) Number of Visitors holding appointments under section 2 (2) at the end of the year:— (a) Health Visitors 4 (b) Female, other than Health Visitors — (c) Male 1 67. ILLEGITIMACY. Twenty-one illegitimate children were born during the year, and in the same period two deaths of illegitimate infants occurred ; the infantile mortality rate among these children was therefore 95.2, while that for legitimate infants was 63.7. 68. DENTAL CLINIC. A general increase in this branch of the work has been taking place, and during 1931 the attendances of expectant and nursing mothers and of children referred from the Maternity and Child Welfare Clinics were as follows:— (а) Number of treatments of children 714 (b) Number of mothers treated:— New cases 152 Old cases 539 (c) Number of dentures supplied 80 (d) Sessions held 97 69. ORTHOPAEDIC CLINIC. Ninety-five 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, 106 cases attended for re-examination. 88 Seven of the children received in-patient treatment at Orthopaedic Hospitals. The eases dealt with for the first time during 1931 were referred for the following conditions; some children having more than one defect:— (a) Deformities—Bones and Joints— (1) Congenital : Multiple Deformities 1 (2) Acquired : Genu Varum 2 Genu Valgum 45 Bowed Tibiae 23 Bowed Femora 2 73 (b) Muscular Deformities— (1) Congenital: Talipes 2 Torticollis and Haematoma-Sterno-Mastoid 9 Webbed Digits 1 (2) Acquired : Pes Piano Valgus 36 Scars (following scalds) 1 Rachitic Gait 1 50 (c) Paralysis— (1) Congenital : Hemiplegia 2 Tetraplegia 1 (2) Acquired : Anterior Poliomyelitis 1 — 4 Total defects found 127 84 70. ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was continued during 1931. 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 anæmia. In all, 99 children received treatment during 1931. One session per week was devoted to these cases, and 691 treatments were given. The Committee have had under their consideration certain alterations in the provision of amenities for ultra violet light treatment, and I hope it will soon be possible for work of a wider scope than at present undertaken to be carried out in premises more suitable than those at present used for this work. 71. BATHS FOR EXPECTANT MOTHERS. During the year, free baths at the Public Baths have been continued 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 sixteen baths granted free of charge during 1931. 72. MEALS TO EXPECTANT AND NURSING MOTHERS. Advantage has been taken during 1931 of this provision under the Act. The total number of dinners supplied was 168. The nutrition of the mother during pregnancy and in the lying-in period has a very important bearing on the wellbeing of the infant, and it is at these times that necessitous mothers are particularly encouraged to avail themselves of the Council's scheme. It is obvious that this service is not being used to the extent that one would expect, and after consultation with my colleagues I am of opinion that the main difficulties militating against mothers availing themselves of the amenities you have provided are:— 1. That, where the conditions at home are bad, no doubt the father is out of work, and then the mother prefers to remain at home to get her husband's dinner and have her own dinner with her family. 85 2. That mothers generally who have two or three children under school age find it difficult to come up for the dinners. 3. That, although everything is done to ensure the comfort of these mothers at the Restaurant, they do not feel at ease there unless they have changed into their walking clothes, which oftentimes they find it difficult to do. 4. That unfortunately many of the women whom one would wish to have dinners are not breast feeding their babies and are therefore not eligible for free dinners. 5. That, with reference to persons in the Gale Street area, it is not practicable for them to attend at the Municipal Restaurant for dinners. My own opinion is that a nursing or expectant mother requires looking after more than an ordinary woman, and that this might most economically be met by some special co-ordination between the Local Authority and the Public Assistance Committee of the County Council. It would be an advantage in these cases if automatically, where the Medical Officer of Health to the Municipal Borough said it was neccssai-y, the normal scale of relief to which any family is entitled were augmented by half-a-crown a week or by special grants in kind—particularly vegetables and so forth—to the value of this sum of money. This would, I believe, do away with a great part of the difficulties we encounter, and we could, in the light of our experience of such an arrangement, come forward later with any necessary further proposals. 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. 5,761 15,010 20,771 £ s. d. £ s. d. 316 4 7½ 272 4 4½ 86 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 Reduced. Free. Total. Ostermilk 616 322 164 1,102 Ambrosia (Half-Cream) 8 2 — 10 Ambrosia 650 478 619 1,747 Cow and Gate 1,975 560 1,031 3,566 Cow and Gate (Half-Cream) 157 45 28 230 Ostelin — — — — Lactogal 330 8 54 392 Virol 619 8 73 700 Parrish's Food 216 — 15 231 Liquid Paraffin 177 — 10 187 Malt and Oil 234 11 96 341 Vitoleum Cream 82 — 12 94 Pure Cod Liver Oil 131 — 10 141 Trufood 5 — 1 6 Cod Liver Oil Emulsion 1,813 12 171 1,996 Colactogal 8 — 8 11 Totals 7,021 1,446 2,287 10,754 87 SERVICES PROVIDED FOR MOTHERS AND CHILDREN UNDER THE AGE OF FIVE YEARS. Service. Provided for. Provision of Milk:— (a) Grade A (T.T.), free and at Expectant and nursing mothers and half-price. babies. (b) Dried milk, free, at half-price Babies, and at cost price. Provision of free dinners. Expectant and nursing mothers and toddlers. Provision of free baths. Expectant and nursing mothers. Convalescent treatment. Mothers and children under the age of five years. Orthopaedic treatment. Children under the age of five years. Ultra violet light treatment. ditto. Provision of spectacles. ditto. Surgical treatment for tonsils and ditto, adenoids. Treatment for minor ailments. ditto. Dental treatment. Expectant and nursing mothers and children under the age of five years. The way in which anyone can avail herself of any of these services is to ask the Health Visitor for the district, or to attend at an Infant Welfare Centre, or, where this is not practicable or there is any emergency, to make an enquiry at the offices of the Public Health Department—Central Hall Chambers, East Street, Barking. 88 RECOMMENDATIONS MADE BY MEDICAL OFFICER OF HEALTH IN HIS REPORTS FOR THE YEARS 1927-1931 INCLUSIVE. Subject. Page Reference. Ambulance Service: 1927 1928 1929 1930 1931 That it is desirable arrangements should be made for a nurse to accompany the ambulance — — 18 33 29 Cleansing Station: That the Council might well entertain the possibility of setting up a Cleansing Station at the lower end of the infectious diseases hospital site — — — — 70 Clinics: That arrangements should be made for Clinics to be housed in suitable buildings — — — 34 95 30 73 Co-ordination: That there is need for greater measure of cooperation and co-ordination between the County activities and those of the Local Authority — — — 37 — Dustbin Maintenance: That it is suggested the Council should accept the responsibility of dustbin maintenance __ — 42 34 Food Supplies: That legislation should be introduced which would provide the Local Authority with power to exercise fuller control over the display, etc., of food supplies — — — 66 — Fouling of Footpaths by Dogs: That regulations be drawn up and enforced to prevent the fouling of footpaths by dogs — — — 43 35 89 Subject. Page Reference. 1927 1928 1929 1930 1931 Ice-cream: That legislation should be introduced to provide for the registration of producers and distributors of ice-cream and that standards of cleanliness and chemical composition should be enacted — — — 67 53 Infectious Diseases : That arrangements should be made for Schick and Dick testing to be carried out at the request of parents and for any necessary immunization to be effected — — — 92 70 Laboratory Facilities: That consideration be given to the question of the establishment of a laboratory at the new hospital — — 19 24 — Maternity Hospital: That a new maternity hospital be built, with a separate ward for the treatment of ailing infants — — — 26 27 Midwives, Supervision of: That further representations be made to the Ministry, asking for the authority for the supervision of midwives to be delegated to the Local Authority — — — 22 — Milk: That endeavours be made to promote legislation to enforce that milk which has been pasteurised shall be sold as such — — 38 63 52 Nursing Homes, Supervision of: That the Local Authority apply for powers to be the supervising authority for Nursing Homes — — — 31 28 90 Subject. Page Reference. 1927 1928 1929 1930 1931 Overcrowding: That housing schemes be extended in order to abate overcrowding — — 47 20 49 Provision of Free Meals: That it is suggested this matter might most economically be dealt with by some special co-ordination between the Local Authority and the Public Assistance Committee of the County Council — — — — 85 Sale of Second-hand Clothing: (a) That it is suggested the Council should entertain the possibility of promoting legislation to enforce the disinfection of all second-hand clothing sold in Barking — — — — 44 (b) That it is suggested the Council should immediately take steps to see that no one should be afforded an opportunity of selling old clothes in the Corporation market unless such clothing has been disinfected — — — — 44 Schools: That spring bib fountain jets be provided in all schools 33 42 — 53 — Sheds in Back Gardens: That greater use be made by the Council of powers for the control of temporary buildings — — — 58 47 59 Street Cleansing: That it is suggested the Council should eritertain introducing mechanical means for cleansing street gullies, to replace the present inefficient methods — — — — 35 91 Subject. Page Reference. Tuberculosis: 1927 1928 1929 1930 1931 That consideration be given to the question of providing suitable housing accommodation for tuberculous patients — — — 83 — 84 Ultra Violet Light Therapy: That it is hoped it will soon be possible for work of a wider scope than that at present undertaken to be carried out in premises more suitable than those at present used for this work — — — — /' 84 92 May, 1932. To the Medical Officer of Health, Barking. From the Public Dental Officer. Sir, I have the honour to present the Report of the Dental Service under the Maternity and Child Welfare Scheme for the year ended .31 st December, 1931. In all branches there has been an increase of work, due to the development at the outer areas of the Borough, for the most part, and also doubtless to the popularity of a service so advantageous to mothers attending the various clinics under the control of the Health Services. Conservative work has been more than doubled and the number of patients increased by over a hundi'ed, a very fine increase indeed for a service maintained on a basis of two sessions a week. Most commendable of all, however, has been the increase of children under school age attending for treatment, the number having risen from 519 last year to 714 this year. With the advent of branch clinics to overcome the inconvenience and expense of travelling to a central clinic, it seems assured that the growth of the service will reach proportions that will not be gratifying only to the Borough but exemplary wherever a similar service be maintained. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, L.D.S., R.C.S. (ENG.). 93 DENTAL CLINIC. Maternity and Under Age Cases. Extractions 1,226 Scalings 22 Dressings 14 Inspections 68 Fillings 110 Dentures supplied 80 Anaesthetics— General 259 Local 23 Patients— Old 539 New 152 "Under age" children— Treatments 714 Number of Sessions held 97