BARK 26 BOROUGH OF BARKING REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1932 C. LEONARD WILLIAMS, B.Sc. Hons. (Lond.), M.R.C.S. (Eng.) L.R.C.P., D.P.H. (Camb.) 2 TABLE OF CONTENTS. Page STAFF 8 INTRODUCTION Administration 10, 11 Disposal of the Dead 9, 10 Office Accommodation 10, 11 Population Estimates , 9 SECTION 1.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Age Mortality 15 Births 12-14,18 Births, Notification of 18 Deaths 12-17 Deaths, Causes of (Table) 15-17 General Statistics 12 Grit Emission 18 Illegitimate Births 12, 18 Industries 18 Infantile Mortality 12-14, 17 Infantile Mortality (Table) 17 Inquests, 16 Marriages 17 Measles 19 Measles and Pneumonia 19 Obnoxious Odours 18 Rheumatic Affections 19 Sickness, Causes of 19 Social Conditions 18 Still-births 12-14, 18 Travelling Facilities 19 Typhoid Fever 19 Vialls Disease 19 Vital Statistics 12-14 Zymotic Diseases, Deaths from 15 SECTION 2.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Adoptive Acts 22 Ambulance Facilities 29 Barking Corporation Bill 23 Barking (Infectious Diseases) Hospital 24,28 3 SECTION 2—Continued Page Bye-Laws 23 Clinic and Treatment Centres 30-32 Counties' Laboratory 22 Homeless Children, Institutional provision for 29 Hospital Services '24-28 Hospital Services, Tables of 25-28 Infectious Diseases Nursing 21, 24 Illegitimate Infants, Institutional provision for 29 Laboratory Facilities 22 Legislation Relating to Public Health 22, 23 Local Acts 22 Local Government Act, 1929 30 Maternal Mortality 29 Maternity Cases 21 Maternity Homes' 24 Mental Defectives, Institutional provision for 29 Midwifery 21 Midwives, Supervision of 21 National Health Insurance 22 Nursing Homes 24 Nursing in the Home 21 Plaistow Maternity Charity 21 Private Medical Practitioners, Co-operation of 22 Public Assistance Committee 22 Public Assistance Medical Out-Relief 22 Public Hospital Services 25-28 Puerperal Fever and Pyrexia 29 Regulations 23 Smallpox Hospital Arrangements 24 Special Acts and Orders 23 Specimens submitted to Laboratory for Examination 22 Unmarried Mothers, Institutional provision for 29 Upney (Maternity) Hospital 21, 24-28 Voluntary Hospital Services 25-28 SECTION 3.—SANITARY CIRCUMSTANCES OF THE AREA. Bathing in the River Roding 33, 34 Cesspools 35 Closet Accommodation 35,38 Common Lodging Houses 43 Creckmouth Generating Station 42 Dampness 38 Defects found uuder the Factory and Workshop Act, 1901 40 Drainage and Sewerage 35,37 Dustbin Maintenance 35, 38 Dwelling Houses, Inspection of 36 Enteric Fever 33, 34 4 SECTION 3—Continued Page Factories, Inspection of 37, 39 Factory and Workshop Act, 1901 39-41 Home Work 40 Houses Let in Lodgings 43 Miscellaneous Sanitary Inspections 37 Miscellaneous Sanitary Work carried out 39 Northern Outfall Sewage Works 35 Notices Served 39 Offensive Trades 43 Out-workers 41 Pail Closets 35 Parks and Open Spaces 44 Piggeries 43 Pollution of the River Roding 33, 34 Port of London Authority 33 Premises and Occupations controlled by Bye-laws and Regulations 36,43, 44 Privies 35 Public Cleansing 35, 36 Rag Flock Acts, 1911 and 1928 44 Rainfall 34 Refuse Disposal 35, 36 Refuse Storage and Collection 35, 36 Refuse Tips 86, 43 Registered Workshops 41 Repairs, General 38, 39 Rivers and Streams 33 Sanitary Inspection of the Area 36-41 Sanitary Work, Summary of 37-39 Schools 44 School Closure 44 Schools, Sanitary Inspection of 44 Sinks 38 Smoke Abatement 42 Stables 44 Street Cleansing 36 Tents, Vans and Sheds 43 Trade Refuse 36 Typhoid Fever 33, 34 Ultra Violet Light Radiation 34, 35 Underground Sleeping-rooms 43 Water Supply 33,38 Workplaces, Inspection of 37, 39 Workshops, Inspection of 37, 39 Yard Paving 38 SECTION 4.—HOUSING. Clearance Areas 49 Closing and Demolition Orders 46, 47, 49 5 SECTION 4.—Continued Page Houses Built in the District, 1920-1932 48 Houses Erected during the Year 45 Housing Conditions 47-49 Housing Defects Remedied 45, 46 Housing Inspections 45 Housing Statistics 45-49 Housing Supply and Demand 48, 49 Individual Unfit Houses 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 Rehousing 49 Small Dwellings Acquisition Act 47 Temporary Buildings 47, 48 Unfit Dwelling Houses 45, 49 SECTION 5.—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food 55 Animals Slaughtered 53 Bacteriological 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 Order, 1926 52 Milk (Special Designations) Order, 1923 52 Milk Supply 51, 52 Nutrition 55 Prosecutions 52, 55 Slaughter-houses 53 Tuberculous Milk 51, 52 Unsound Food Destroyed 54 SECTION 6.—PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES. Admissions to Barking (Isolation) Hospital (Table) 68 Barking (Isolation) Hospital 68, 69 Cancer 66, 67 Cancer, Occupations of Fatal Cases (Table) 66 Cancer, Organs affected in Fatal Cases of (Table) 66, 67 Chicken-pox 58, 65 Diphtheria 61 6 SECTION 6—Continued Page Diphtheria Notifications (Monthly Summary Table) 61 Diseases Notifiable 58 Dysentery 02 Encephalitis Lethargica 62 Enteric Fever 64 Erysipelas 65 Hospital Accommodation for Infectious Diseases 69 Infectious Diseases 57-69 Infectious Diseases (Tables) 57, 59-62 Influenza 67 Malaria 62 Measles 65 Measles and Pneumonia 58,62,65 Mosquitoes 70 Non-notifiable Acute Infectious Diseases 65-68 Notifiable Infectious Diseases 57-65 Notifications classified according to Wards (Table) 59, 60 Pathological Specimens, Examination of 69 Pneumonia 62 Puerperal Fever and Pyrexia 62,64,65 Rat Repression 70 Rheumatic Fever 65 Scabies 68 Scarlet Fever 62 Scarlet Fever Notifications (Monthly Summary Table) 61 Smallpox 62 Summer Diarrhoea 65 Tuberculosis 58,63,64 Tuberculosis Register 64 Tuberculosis, New Cases and Deaths (Table) 63 Unnotified Fatal Cases of Tuberculosis 63, 64 Vaccination 69 Verminous Persons, Cleansing and Disinfection of 69 Whooping Cough 65 SECTION 7.—MATERNITY AND CHILD WELFARE. Ante-Natal Clinics 72, 83 Artificial Sunlight Clinic 81 Baths for Expectant Mothers 81, 83 Birth Notifications 71 Birth Rate 71 Children Act, 1908, Part 1 78 Clinic Accommodation 71 Convalescent Treatment 83 Dental Service 79,83,86,87 Dental Surgeon, Report of 86 Eye Defects 84 7 SECTION 7.—Continued Page Foster Children 78 Health Visitors, Work of 77,78,85 Illegitimacy 79 Infantile Mortality 74 Infantile Mortality, Years 1891-1932 (Table) 74 Infant Welfare Clinics, Work of 77,83 Maternal Mortality 73 Maternal Mortality, Years 1926-1932 73 Meals to Expectant and Nursing Mothers 81, 83 Minor Ailments 84 Neo-Natal Mortality 75 Non-notified Births 71 Ophthalmia Neonatorum 76 Ophthalmia Neonatorum (Table) 76 Ophthalmic Service 84 Orthopædic Service 79-81,84 Provision of Dried Milk, etc. 82, 84 Provision of Fresh Milk 82, 84 Provision of Spectacles 84 Puerperal Fever and Pyrexia 73 Registration and Notification of Births 71 Services provided and Facilities for Treatment 83-85 Still-births 75, 76 Tonsils and Adenoids 84 Ultra Violet Light Treatment 84 Upney (Maternity) Hospital 72,73, 83 Visiting in the Home 77, 78, 85 X-Ray Treatment for Ringworm 85 8 STAFF, 1932. Medical Officer of Health, School Medical Officer, Medical Superintendent, Isolation Hospital. C. LEONARD WILLIAMS, B.Sc. Hons. (Lond.), M.R.C.S. (Eng.), L.R.C.P., D.P.H. (Camb.). Asst. Medical Officers of Health and Asst. School Medical Officers : 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. Ortliopædic Surgeon (Part Time) : B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Radiologist : ANGUS E. KENNEDY, M.R.C.S., L.R.C.P., L.S.A. Denial Surgeons : W. H. FOY, L.D.S., R.C.S. (Eng.). H. IIAZELL, L.D.S.. R.C.S. (Eng.). (Resigned 14th February, 1932.) R. N. HINES, L.D.S., R.C.S. (Eng.). (Commenced 1st November, 1032.) Sanitary Inspectors: N. BASTABLE (Chief Sanitary Inspector) (6, c, d and f). H. CARR (Sanitary Inspector) (b, c, e and m). C. S. COOK (Sanitary Inspector) (b and c). R. H. WIGMORE (Sanitary Inspector) (o and c). Health Visitors : Mrs. G. STOKES (g and i). Mrs. M. W. WALTON (a, h and I). Miss G. ELLIOTT (o, h and I). Miss E. M. CROSS (b, g, h and i). (Resigned loth February, 1932.) *Miss C. COURT (h, i and n). (Commenced 29th February, 1932.) *Miss W. PARKER (h, i and »). (Commenced 29th February, 1932.) Miss G. GEDEN (Dental Nurse). Miss R. LLEWELLYN (Dental Nurse) (h and i). Matron, Isolation Hospital: Miss M. W. HEDGCOCK (A, i and j). Masseuse, Orthopædic Clinic (Part Time): Miss A. E. FINDLAY, C.S.M.M.G. (k). Clerical Staff: Chief Clerk. F. READ. C. G. EAGLESFIELD. D. G. TONKIN. Miss V. SHEAD. .Miss II. NUNN. Miss H. KING. A. J. STORER. E. A. ELLIS. Dixinfeclor 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. (/) 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.Ii.E. (l) Health Visitor's Diploma of Board of Education. (m) Smoke Inspector's Certificate, L.C.C. School of Engineering. (n) Health Visitor's Certificate of Royal Sanitary Institute. (o) Sanitary Inspectors' Certificate of Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (*) Combined pppointment—Health Visitor and School Nurse. 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, 1932. PUBLIC HEALTH OFFICES, BARKING, ESSEX. July, 1933. 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, 1932. This Report is drawn* up in accordance with Circular 1269, 1932, from the Ministry of Health. With reference to the population of Barking, I would like to say that the Registrar-General estimates the population at mid-year 1932 as 60,330. Our estimate for 30th June, 1932, is 63,852. It is very difficult to estimate the population of Barking at any one date. Possibly the true figure is somewhere between the two estimates, but I have confidence that our figure is not far wrong. One of the greatest problems you have before you at the present time is that of slum clearance. It must, however, be remembered that man hunted his food long before he built cities, and to the end of the chapter what he eats will be of more importance to him than where he lives. You will, I know, have always in front of you that it is of no use for people to live in houses they cannot afford at the cost of proper food, without which they cannot live. 10 With the extension of London to Barking and miles beyond, the question of the disposal of the dead has become a very serious matter. Cremation is, of course, the most hygienic method. I hesitate to advocate cremation so insistently as some people do, because I value highly the sentimental attachments of so many people to our national method of burial. It cannot, however, be too widely known that cremation can be undertaken at the Garden of Rest, the crematorium maintained by the City of London at Little Ilford. The question of office accommodation for your staff is at the moment one of your pressing problems. In May, 1931, the staff of the Public Health Department moved from offices over Barclay's Bank at 41, East Street, to a suite of offices in the Central Hall, but, such has been the development of the work, that these new offices are already inadequate for the present staff. I know that you have under your consideration the whole question of accommodation for the Council and its staff, and I would like to say, with reference to the staff of the Public Health Department, that it would be desirable not only to have accommodation at the centre of the town but also on the Becontree Estate. The Council will immediately see that there would be an economy in sanitary inspectors, health visitors, school nurses, etc., having a centre on the Becontree Estate. Working from such a centre would be more economical of time than working from the main offices. In the same way the Council have already decided that a dental officer shall operate on the Becontree Estate. This, of course, will entail some accommodation for the dental officer, for the dental nurse, for the records necessary in this work, and for the necessary clerical assistance. It will not be so immediately obvious, but it will, I think, be found by those who enquire closely into it, that similarly a saving of time will accrue from medical records and statistics of the children on the Becontree Estate being housed in that part of the town. 11 It is not, of course, suggested that the administration should in any wise be split. It is suggested that there is a good deal of medical, dental and clerical work which can most economically be conducted from a second office, situated where tie work is actually being carried on. I am, Mr. Mayor, Mrs. Jackson and Gentlemen. Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 12 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 Roding 58 Loxford Water 2 300 4,106 Population (1931 Census) 51,277 Population (June, 1932) (Registrar.General's Estimate) 60,330 Number of Inhabited Houses, March, 1933, according to Rate Books :— Houses 15,183 Shops 1,049 Total 16,232 Population Density, i.e., No. of persons per acre 14.7 Rateable Value—General £498,931 0 0 Sum represented by a penny rate .. £1,950 0 0 Education rates Elementary Included in General Rate Figure 3 8¼ Secondary 6¼ General Rate 13 8 2. Extracts from Vital Statistics for the Year. Live Births :— Total Males. Females. Birth Rate. Legitimate 1,085 563 522 18.0 Illegitimate 20 11 9 0.3 Totals 1,105 574 531 18.3 Still Births :— Rate per 1,000 total births :— Legitimate 30 15 IS j. 27.3 Illegitimate 1 1 Deaths 505 (506) 267 (209) 238 (237) — Death Rate 8.4. Percentage of total deaths occurring in public institutions, 47.3. Number of women dying in, or in consequence of, childbirth :— From sepsis. From other causes. Total. — — (1) — (1) Number of deaths of infants under one year of age :— Total Infantile Death Rate. Death Rate. Males Females. Total. Legitimate 28 25 53 48.8 (47.0) 53.4 (51.6) Illegitimate 4 2 6 300.0 Number of deaths from Measles (all ages) 15 „ „ Whooping Cough (all ages) 9 „ „ Diarrhœa (under 2 years of age) 11 (10) (N.B.—Where the Registrar.General's figures and rates differ from those prepared locally, the former are shown separately in brackets.) IV/ 4 3. BIRTH. RATE, DEATH.DEATH.RATE, AND ANALYIS OF MORTALITY DURING THE YEAR 1932 (England & Wales, 118 County Boroughs, 126 smaller Towns, and BARKING.) The rates for England and Wales and Harking have been calculated on a population estimated to the middle of 1932, have been calculated on populations estimated to the middle of 1931. 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. Xo Inquest. Uncertified Causes of Death. England and Wales 15.3 0.66 12.0 0.01 0.00 0.08 0.01 0.07 0.06 0.32 0.53 6.6 6.5 91.1 6.2 1.8 0.9 118 County Boroughs and Great Towns, including London 15 .4 0.70 11.8 0.00 0.00 0.11 0.01 0.08 0.07 0.28 0.48 8.9 69 91.3 5.9 2.3 0.5 126 Smaller Towns (Estimated resident populations, 25,000 to 50,000 at Census, 1931) 15 .4 0.69 10.8 0.00 0.00 0.06 0.01 0.06 0.03 0.31 0.42 4.5 58 91.9 5.8 1.3 1.0 London 14.2 0.51 12.3 0.00 0.00 0.19 0.02 0.08 0.07 0.27 0.53 12.6 66 89.4 6.2 4.4 0.0 BARKING 18.3 0.51 8.4 0.07 0.00 0.25 0.02 0.03 0.08 0.23 0.46 9.95 53 86.73 8.32 4.95 0.00 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows : per 1,000 Live Births 1 .61 2 .63 4.24 „ „ Total Births 1 .54 2.52 4.06 4. VITAL STATISTICS OF WHOLE DISTRICT FROM 1925 TO 1932. 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 Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 1925 38,450 825 21.1 287 7.4 8 107 66 80.0 386 10.0 1926 39,920 818 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 40,370 805 10.7 270 0.7 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 17.7 256 5.7 7 186 49 61.3 435 9.7 1931 51,830 947 19.3 328 6.3 7 215 61 64.4 536 10.3 1992 60,330 1105 18.3 283 4.7 17 239 39 53.1 505 8.4 15 5. DEATHS. (a) General.—There were 283 deaths registered in Barking in 1932. Of these 17 were deaths of non-residents. Barking residents to the number of 239 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. 267 238 505 The death rate for 1932 was 8.4 per 1,000, compared with 10.3 in 1931, 12.0 for England and Wales, 11.8 for the hundred and eighteen County Boroughs and Great Towns, including London, 10.8 for the one hundred and twenty-six smaller towns, and 12.3 for London. (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 59 1 to 2 years 21 2 to 5 years 21 5 to 15 years 20 15 to 25 years 27 25 to 45 years 71 45 to 65 years 112 Over 65 years 174 (c) Causes of death in 1932.-—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 129 23.8 Cancer 59 11.7 Tuberculosis (all forms) 55 10.9 Pulmonary affections (exclusive of tuberculosis), viz., Bronchitis 19 3.8 Pneumonia (all forms) 36 7.1 Other respiratory diseases 8 1.6 Zvmotic Diseases 38 7.5 (d) Deaths from Zymotic Diseases.—These diseases caused 7.5 per cent. of the total deaths, such deaths being caused in the following proportions :— Enteric Fever 4 Measles 15 Whooping Cough 2 Scarlet Fever 1 Diphtheria 5 Diarrhœa 11 Smallpox — 16 (e) Inquests.—Coroner's inquests were held on 50 deaths. (f) Causes of and ages of death during the year 1032. (Net Deaths.) Causes of Death. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the district. Registrar-General's Figures. 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 — — — 2 1 1 — 4 3 Measles 1 12 2 — — — — 15 15 Scarlet Fever — 1 — — — — — 1 1 Whooping Cough 1 1 — — — — — 2 2 Diphtheria 1 3 1 — — — — 5 5 Influenza 3 — — — — 5 6 14 14 Encephalitis Lethargica — — — — — — — — 1 Cerebro-Spinal Fever — — — — — — — — — Tuberculosis of Respiratory System 2 1 1 10 22 9 — 45 46 Other Tuberculous Diseases 1 5 2 1 1 — — 10 10 Syphilis — — — — — 1 — 1 1 General Paralysis of the Insane, etc. — — — — 1 8 — 4 4 Cancer — 4 — — 8 20 27 59 60 Diabetes — — — — 1 1 2 4 4 Cerebral Haemorrhage — — 1 — 3 5 6 15 16 Heart Disease — — 3 2 10 19 69 103 103 Aneurysm — — — — I — 1 2 3 Other Circulatory Diseases — — — — 1 7 9 17 16 Bronchitis — — — — ' — 2 17 19 19 Pneumonia 11 5 3 3 3 5 7 36 37 Other Respiratory Diseases — — — 1 1 2 4 8 6 Peptic Ulcer — — — 1 2 2 — 5 6 Diarrhoea, etc. (under two years) 8 3 — — — — — 11 10 Appendicitis — — 1 — 1 2 — 4 6 Cirrhosis of Liver — — — — — 1 — 1 1 Other Diseases of Liver — — — — — 1 — 1 1 Other Digestive Diseases — — — 3 1 2 6 4 Acute and Chronic Nephritis — — — — 2 5 7 14 14 Puerperal Sepsis — — — — — — — — Other Puerperal Causes — — — — — — — — 1 Congenital Debility, Premature Birth, etc. 28 — — — — — — 28 25 Senility — — — — — — 5 5 5 Suicide — — — 1 1 3 1 6 6 Other Violence 3 — 4 5 3 5 2 22 22 Other Defined Diseases — 8 2 1 6 12 8 37 38 Causes ill-defined or unknown — — — — — — 1 1 1 Totals 59 42 20 27 71 112 174 505 506 17 (g) Infant mortality during the year 1932. 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 0 months and under 9 months. 9 months and under 12 months. Total under one year. Accidental Asphyxia 1 — — — 1 — — — — 1 Accidental Burns — — — — — — 1 — — 1 Congenital Debility 3 2 — — 5 — 1 — — 6 Congenital Heart Disease — 1 1 — 2 — — — — 2 Congenital Malformation 1 — — — 1 — — — — 1 Diarrhœa — — — l — — 5 1 2 8 Diphtheria — — — — — — 1 — 1 Inanition — — — — — 1 — — — 1 Influenza — — — — — 1 1 1 — 3 Injury at Birth 2 — 1 — 3 — — — — 3 Marasmus 1 1 1 — 3 2 — — — 5 Measles — — — — — — — — 1 1 Pneumonia — — 2 1 3 1 5 1 1 11 Premature Birth 7 — 1 1 9 — — — — 9 Pyloric Stenosis — — — — — 1 — — — 1 Tuberculosis (Pulmonary) — — — — — — — 2 — 2 T.B. Meningitis — — — — — — — 1 — ] Want of Attention at Birth 1 — — — — — — — — 1 Whooping Cough — — — — — — 1 — — l Totals 16 4 6 2 28 6 14 7 4 59 Net Births in the year :— Legitimate 1085 Illegitimate 20 1105 Net Deaths in the year:— Legitimate 53 Illegitimate 6 59 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 1932. Year. 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 1932 334 5.5 18 7. BIRTHS. The net number of births registered in 1932 was 1,105, affording an annual birth rate of 18.3 per 1,000 population, compared with 18.3 in 1931, 17.8 in 1930, 18.7 in 1929 and 19.7 in 1928. Of all births, 20 were illegitimate, giving a percentage of 1.8 of the total births. Notification of Births Acts, 1907-1915.-—During 1932 there were 1,095 live births notified, excluding 35 cases transferred from the district. In addition, notifications of stillbirths belonging to the district totalled 29. Eighteen live births and two stillbirths were not notified, and these cases are not included in the totals of notified births given above. 8. SOCIAL CONDITIONS. Some of the chief industries carried on in the area are as follows :— The production of electricity and gas. The manufacture of asbestos goods, ice-cream, letter files, mineral waters, marine lights, disinfectants, printing ink, oil fuel, sausage skins, cabinets, nautical instruments, paint, iron goods, tin boxes, lifebelts, etc., and rubber goods. The storage of petrol and timber. Electrical welding and structural engineering. The Ministry's circular on the compilation of this report instructs me to discuss the influence of any particular occupation on public health. Grit emission from factory chimneys, obnoxious odours and other matters have had my consideration during the year. The population of Barking is almost entirely industrial. Barking is becoming a dormitory. 19 9. CAUSES OF SICKNESS. In my previous reports I have told you of the incidence of rheumatism in Barking, and I have also told you the dangers attending travelling in the overcrowded carriages of the District Railway. This year I would particularly call your attention to typhoid. For many years we have known the Roding is a dirty river ; this year we have reason to know that its waters have been impregnated with typhoid and people who bathed in it have contractcd this disease. I would wish also to speak of measles, because this year fifteen children died of measles and its complications. It is unfortunate that even now people do not take measles sufficiently seriously. It cannot be too widely known that you are prepared to admit to your isolation hospital cases of measles complicated by broncho-pneumonia. Late in the year a considerable number of young persons complained of abdominal pain and vomiting, followed at varying intervals by jaundice. In the absence of notification I was not able to follow up these cases, which I believe to have been Vialls Disease. Although in many eases the symptoms were severe, we know of no case where there was any real permanent disability. 21 SECTION 2. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. 10. NURSING IN THE HOME. (a) General.—The Plaistow Maternity Hospital and District Nurses' Home carry out general district nursing in a part of Barking. Last year I called your attention to the fact that nursing in the home is equally important as other branches of nursing, particularly when all our hospitals have long waiting lists. This matter is presently engaging your attention. (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 1932, in respect of 196 cases, amounted to £201 9s. 6d. leaving a balance due to the Charity from the Council of £98 10s. 6d. According to information obtained from the County Medical Officer, at the end of 1932 there were twelve midwives practising in the district, four of which were employed by you at your Upney (Maternity) Hospital, two under the Plaistow Maternity Charity, and six practising privately. During 1932 there were 1,105 maternity cases. 179 of these were conducted by the Plaistow Maternity Charity, 214 of them were conducted by your own midwives at Upney (Maternity) Hospital, leaving 712 which were dealt with by medical practitioners, private midwives or otherwise. It will be seen, therefore, that roughly forty per cent of the midwifery is already under your supervision, because not only is your Medical Officer of Health, Medical Superintendent of the Upney (Maternity) Hospital, but he is also on the Committee of Management of the Plaistow Maternity Charity. 22 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. PUBLIC ASSISTANCE 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. 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, P2.C.4, particulars of the number of specimens submitted for examination being supplied by the following table Specimen. Number examined. Diphtheria 1,222 Sputa 264 Typhoid 59 Ringworm 2 Miscellaneous 20 Total 1,567 In addition there were 3 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 and Wash-houses Acts, 1847, etc. Infections Diseases (Notification) Act, 1889. Public Health Acts (Amendment Act), 1890, Parts 2, 3 and 5. Public Health Acts (Amendment Act), 1907, Parts 2, 3, 4, 5, 6 and 9, and section 95 of Part 10. Local Government and Other Officers' Superannuation Act, 1922. Public Health Act, 1925. 23 (c) Regulations : Regulations as to Cemetery, 1902. Barking Town (Pneumonia) Regulations, 1924. (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. (f) Barking Corporation Bill.—The Barking Corporation Bill promoted by the Council, to be heard in Session 1932-33, deals with many health matters. 24 16. HOSPITALS. Hospitals provided or subsidised by the Local Authority. (a) Smallpox.—The arrangement with West Ham having terminated, a new agreement was made with the Orsett Joint Hospital Board. The Joint Board have a smallpox hospital of 22 beds at Grays, and the agreement provides that so long as accommodation is available, patients from this area suffering with smallpox shall be admitted to the hospital. The contracting authorities to the agreement pay to the Joint Board a retaining fee, of which the Barking quota (based on population) is £30 per annum, and in addition a charge of 18s. 0d. per day per patient is made to the authority concerned. Arrangements have also now been made for the use of the Joint Board ambulance for the conveyance of patients to and from the hospital. From the inception of the agreement to the end of the year, no Barking cases were admitted, but one man normally resident in Barking was admitted from the Romford district. (b) Infectious Fever Hospital.—Barking Hospital in Upney Lane provides accommodation for fifty-eight patients. This Hospital is one of the most up-todate hospitals in the country. It was opened on the 29th September, 1932, by Councillor A. Blake, the Chairman of the Public Health and Maternity Committee., (c) Maternity Home.—Upney Hospital consists of two galvanised iron buildings. You are contemplating replacing these with a permanent hospital. (d) 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 Upney Hospital, there is only one house in Barking used as a nursing home. During 1932, six births have been notified from this address. 25-26 HOSPITAL SERVICES, public or voluntary, within or without the District, which are used by the inhabitants of the Borough of Barking. Name of Hospital. Situation. Purpose. Total number of beds available. Management. Men Women Children Controlled by the Council of the Borough of Harking 1 Upney (Maternity) Hospital Upney Lane, Barking, Essex Maternity — 20 — Borough of Barking 2 Harking (Isolation) Hospital Upney Lane, Barking, Essex Isolation of general infectious diseases (excluding smallpox) 58 Borough of Barking Not controlled by the Council of the Borough of Barking 3 Brentwood Mental Hospital Brentwood, Essex Mental 764 1037 — Essex County Council 4 Brookfield Orthopædic Hospital Hale End, Woodford Green, Orthopædic — — 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 East Ham Memorial Hospital Shrewsbury Road, E.7 General Medical and General 34 84 20 Voluntary 7 Golden Square Throat, Nose and liar Hospital Golden Square, Piccadilly Circus, W.1 Surgical Ear, Nose and Throat ... 30 87 11 Voluntary 8 Guy's Hospital London Bridge, S.E.1 General Medical and General Surgical, etc. 299 287 03 Voluntary 9 Hospital for Sick Children Great Ormond Street, W.C.1. General Medical and General Surgical and Isolation (Children only) — — 252 Voluntary 10 Joyce Green Hospital Hartford, Kent Isolation of Smallpox ... (Information not avaiiable) London County Council 11 King George Hospital Ilford, Essex General Medical and General 41 61 22 Voluntary 12 London Hospital Wliitechapel Road, E.l Surgical General Medical and General 379 375 89 Voluntary 13 London Lock Hospital and Home 283, Harrow Road, W.9 Surgical Maternity and Venereal Diseases 10 30 16 Voluntary 14 London Skin Hospital 40, Fitzrov Square, W.l Skin. (No in-patients) — — — Voluntary 15 Orsett Joint Smallpox Hospital Stifford Long Lane, Grays, Essex Smallpox 11 11 Orsett Joint Hospital Board 16 Poplar Hospital for Accidents East India Dock Road, E.14 General Medical and General 56 30 26 Voluntary 17 Princess Elizabeth of York Hospital for Children Glamis Boad, Shadwell, E.l ... Surgical Children ... ... ... ... — — 135 Voluntary 18 Public Assistance Hospital ... Oldehurch Road, Bomford, Essex General Medical, General Surgical, Children, Maternity, Tuberculosis, Chronic Sick, Mental and Orthopaedic 288 302 124 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, 54 106 47 Voluntary 21 Royal London Ophthalmic Hospital (Moorfields Eye Hospital) City Road, E.C.I Children, Maternity Ophthalmic 66 50 19 Voluntary 22 Royal National Orthopædic Hospital Broekley Hill, Stanmore, Middlesex Orthopaedic 45 70 . 345 Voluntary 23 St. Raitholomew's Hospital Smithfield, E.C.I General Medical and Surgical, Children, Maternity, etc., Ophthalmic, Orthopiedic, Ear, Nose and Throat, and Septic, 287 344 65 Voluntary 24 St. Mary's Hospital for Women and Children Upper Boad, Plaistow, E.13 etc. General Medical and Surgical, Children, etc. — 33 38 Voluntary 25 Sevralls Mental Hospital Mile End, Colchester Mental 717 1109 Essex C.C. and Colchester B.C. 26 Westminster Hospital Broad Sanctuary, Westminster. S.W.1 Cenaiul Medical and Surgical. Maternity, Ear, Nose and Throst. etc. 92 128 22 Voluntary ??? at the instance of the Latex County Council, under their scheme for the ??? ??? of 144 square feet per bed. 27—28 TABLE II. HOSPITAL SERVICES, showing the number of beds for each purpose, and other facilities available. Name of Hospital Accident Chest (nontub.) 8c Heart Children Chronic Sick Dental Dermatological Ear, Nose 8c Throat General Medical General Surgical Genito-urinary Gynaecological Infectious Diseases Isolation & Observation Maternity Mental Neurological Ophthalmic Orthopedic Radium Septic Small-pox Tuberculosis Venereal Diseases Other facilities available Arrangements for pathological work 1† Controlled by the Council of the Borough of Barking. Upney (Maternity) Hospital — — — — — — — — — — — — — 26 — — — — — — — — — Operative surgery, Dental, Nursing of Puerperal Fever and Pyrexia. Carried out at the Counties' 2† Barking (Isolation) Hospital Not controlled by the Council of the Borough of Burking. — — — — — — — — — — — 58 — — — — — — — — — — Operative surgery, Dental, Ear, Nose and Throat, Orthopedic, Maternity, Puerperal Fever and Pyrexia, Ophthalmia Neonatorum. tory, Queen Victoria Street, E.C.4. 3 Brentwood Mental Hospital — — — — — — — — — — — — — — 1801 — — — — — — — — Allspecialised 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. 8 East Ham Memorial — — — — — 3 4 37 30 — 8 — — — — — 4 4 — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Electrical, Massage. Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic, Radium. Own Laboratory. 7 Golden Square Throat, Nose and Ear — — — — — — 84 — — — — — — — — — — — — — — — — Carried out by a Pathologist outside the Institution. 8 Guy's 58 — 14 — 4 6 33 179 150 10 24 — 40 21 4 9 21 19 8 — — — 9 All specialised treatment available. Own Laboratories. 9 Hospital for Sick Children — — — — — — 18 100 121 — — — — — — — — — — — — — 7 All specialised treatment available. Own Laboratory. 10 Joyce Green Hospital (Isolation of Smallpox). No informatioln available from the London County Council. (No information available from the L.C.C.) No information available. 11 King George Hospital — — 22 — — — — 34 08 — — — — — — — — — — — — — — Operative surgery, X-rays, Dental (as casualty), Ophthalmic, Massage, Ear, Nose and Throat, Gynecological, Neurological, Dermatological. Own Laboratory. 12 London Hospital — — — — — — 28 300 338 — 28 — 97 22 — — 24 — — — — — — All specialised treatment available. Own Laboratories. 13 London Lock Hospital — — 15 — — — — — — — — — — 6 2 — 2 — — — — — 31 Operative surgery, Ultra-violet light, Dental, Ophthalmic, Massage, Ophthalmia Neonatorum. Own Pathologist. 14 London Skin Hospital — — — — — — — — — — — — — — — — — — — — — — Skin diseases only. (No in-patients.) Ultra-violet light, X-rays. Own Laboratory. 15 Orsett Joint Smallpox — — — — — — — — — — — — — — — — — — — — 22 — — Small-pox only. — 16 Poplar Hospital for Accidents — — — — — — — 34 78 — — — — — — — — — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Radium by arrangement with the London Hospital. Own Laboratory. 17 Princess Elizabeth of York Hospital for Children — — 135 — — — — — — — — — — — — — — — — — — — — All specialised treatment available. Own Laboratory. 18 Public Assistance Hospital — — 124 160 — — — 120 120 — — — — 30 32 — — 60 — — — 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 — — 160 — — — — — — — — — — — — — — — — — — — — All specialised treatment available with the exception of Radium. Own Laboratory. 20 Queen Mary's Hospital for the East End — — 47 — — — 2 46 54 — 3 — — 50 — — 3 2 — — — — — All specialised treatment available. Own Laboratory. 21 Royal London Ophthalmic (Moorfields Eye Hospital) — — — — — — — — — — — — — — — — 135 — — — — — All specialised treatment available with the exception of Operative surgery, Massage and Radium. Own Laboratory. 22 Royal National Orthopa-dic — — — — — — — — — — — — — — — — — 400 — — — — — 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 & Children 22 37 — 8 — — — — 4 — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Massage. Ear, Nose and Throat, Orthopædic. Part-time Pathologist in conjunction with other Hospitals. 25 Severn lis Mental Hospital — — — — — — — — — — 1886 — — _ — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic. Own Laboratory. 26 Westminster Hospital 10 — 13 5 — 2 7 64 85 — 10 — 8 12 — — 6 4 16 — — — All specialised treatment available. Own Laboratories. † In the case of Hospitals under the control of the Borough of Barking :— Upney (Maternity) Hospital Barking (Isolation) Hospital Number and classification of Mcdical Staff Number and classification of Nursing Staff: Matron Sisters Assistant Nurses Mid wives Probationer Nurses Arrangements for the emolovment of consultants The Medical Officer of Health is also the Medical Supt. and is assisted in his work by the Assistant M.O.'s H. 1 3 3 3 4 13 Consultants are engaged when necessary. ??? 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 tor the treatment of tuberculosis. 29 18. MATERNAL MORTALITY. Cases of deaths due to pregnancy or childbirth are investigated. During the year two confidential reports have been submitted to the Maternal Mortality Committee on mothers, one of whom died during pregnancy and the other shortly after the birth of her child. In both cases the medical practitioners have given their opinions that the deaths were not due to pregnancy or childbirth. 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 two cases of puerperal fever and seven eases 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, but we are constantly in touch with the Public Assistance Committee and the various voluntary agencies which deal with these cases. 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 Barking Hospital. (b) lor 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. 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. 23. LOCAL GOVERNMENT ACT, 1929. In my Report for 1930, I wrote of the possibilities in the operation of this Act. It will, I know, be years before the full benefits can be developed. I do, however, feel strongly that, by means of a joint conference between Local Authorities and the Essex County Council, we ought to achieve that co-ordination and cooperation made possible under this comprehensive legislation. 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. Greatflelds Centre, Movers Lane. Mondays and Thursdays, 2 p.m. ,, ,, ,, ,, ,, Alexandra Centre, St. Paul's Boad J ,, ,, ,, ,, ,, St. Alban's Centre, Urswick Road. Wednesdays and Fridays, 2 p.m. ,, ,, ,, ,, ,, (b) Ante-natal Clinics Clinic premises, East Street. Wednesdays, 2 p.m. ; Fridays, 10.30 a.m. to 12 noon. Accommodation for consultations. ,, ,, Alexandra Centre, St. Paul's Road. Tuesdays, 2 p.m. ,, ,, ,, ,, ,, St. Alban's Centre, Urswick Road. Wednesdays, 10.30 a.m. to 12 noon. ,, ,, ,, ,, ,, (c) School Nurseries Nil Nil Nil Nil (d) Day Nurseries Nil Nil Nil Nil 2. SCHOOL MEDICAL SERVICE— (a) Inspection Clinics and treatment of minor ailments. Clinic premises, East Street. Daily, 8.30 a.m. to 12 noon. Three rooms. Local Authority. St. Alban's Centre, Urswick Road. Daily, 8.30 a.m. to 12 noon. Large Hall. ,, ,, (b) Eye Clinic Clinic premises, East Street. Approximately twice weekly. One room. ,, ,, (c) Dental Clinic ,, ,, Daily, 9 a.m. to 1 p.m. and 2 to 5 p.m. Two rooms. ,, ,, (d) Orthopedic Clinic Faircross School. Mondays, 9 a.m. to 12 noon, and 2 to 4 p.m. Wednesdays, ditto. Fridays, ditto. One room. ,, ,, TUBERCULOSIS— 37, Linton Road. Mondays, 3 to 5 p.m. Thursdays, 10.30 a.m. to 12 noon. Three rooms. Essex County Council. VENEREAL DISEASES— London Hospitals, etc. - - By arrangement with Essex County Council. S3 SECTION 3. SANITARY CIRCUMSTANCES OF THE AREA. 24. WATER. Water is supplied to the area by the South Essex Waterworks Company. During the month of April, 1932, there was considerable alteration in the general supply to the district, arising from the Company taking supplies from the River Stour. This alteration occasioned a reversal of flow through main supply pipes, with consequent disturbance of silt, and many complaints were received from residents pending the complete washing-out of the mains. It is to be noted that the total hardness of the new supplies is 31 degrees, as compared with a hardness of 18 degrees in our previous supplies. The water is of satisfactory purity. 25. RIVERS AND STREAMS. The rivers and streams running through the area are controlled by the River lioding 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 months of August and September bathing took place in the tidal limits of the River Roding. Such bathing was followed by a minor epidemic of enteric fever. Two samples of water obtained from different locations in the river were submitted for examination. The bacteriologist reported on these samples as follows :— 1. This is a grossly contaminated river water, having the bacterial composition of sewage eflluent. 2. This is a grossly contaminated river water, having the bacterial composition of sewage eflluent. In addition, typhoid bacilli could be isolated. ithin the tidal limits the River Roding receives the sewage effluents from the works of three authorities, and higher upstream the effluents from the works of three further authorities. 34 Publicity was given to the danger of bathing in the river, and the Port of . London Authority was advised of the circumstances. It is to be deplored that a river should run through Barking so foul as to give typhoid to people who unfortunately swim in it. 26. RAINFALL. The rainfall for the year ended December 31st, 1932, was 22.47 inches. Rain fell on 196 days throughout the period in question. 27. ULTRA-VIOLET LIGHT RADIATION. One of the most significant facts that the public arc learning is that the ultraviolet rays in sunlight are the vital rays. It is further becoming more generally recognised that measurement of such light rays gives an indication of any atmospheric pollution. With the very kindly co-operation of the Borough Librarian—Mr. F. W. McLaren—who undertook the actual work, I am able to supply particulars of the measurements recorded :— Month. Daily Average. January 1.0 units. February 0.6 „ March 0.84 „ April 15 „ May 0.7 „ June 1.12 „ July 1.07 „ August 1.51 „ September 1.4 „ October 1.25 „ November 0.56 „ December 1.0 „ The apparatus used was that designed by Professor Leonard Hill, known as the " test by fading " instrument. The biologically active ultra-violet rays are measured by the fading of a standard solution of acetone and methylene blue. 35 It was found on examining the measurements recorded at Southend that, with the exception of the month of August, our results compared favourably. 28. 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. In the Abbey Ward, at certain low-lying parts of the district, flooding took place in times of heavy rainfall. It is anticipated that when the new works are completed any repetition of this trouble will be avoided. The Barking Sewage Disposal Works, situated at Gascoigne Road, Barking, continued in operation during, the year. 29. CLOSET ACCOMMODATION. At the end of the year there remained a total of 45 premises unconnected with the sewer. Ten of these were factory premises. Of these 45 premises, 12 have cesspools, 27 have pail closets and 6 have privies. Forty-six premises were connected to the sewer during the year without cost to the Corporation. Further conversions were proceeding at the end of the year. 30. PUBLIC CLEANSING. (a) Storage, Collection and Disposal.—The collection and disposal of domestic refuse is controlled by the Borough 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. I would wish once more to submit my opinion that the provision of dustbins by the Council would, on the whole, prove an economy, and I hope the Corporation will shortly arrange for the hire-purchase system to be put into operation. 36 During the year, 7,609 loads of refuse were collected, with an average weight of 1 ton 12 cwts. This figure shows a yield of 11.1 cwts. per 1,000 of the population per day, as against the average figure of 14.3 cwts. per day for non-mining towns. 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 refuse tips at Mayesbrook and Jenkins Lane have continued in use during the year. Now that Barking is becoming such an important town, and so much of the land is now built on, tipping requires to be a more scientific operation than it need otherwise be, and, so long as we have tips in or near the centre of the town, "controlled tipping" is the only form of refuse disposal which we, as a Public Health Department, can advise. (b) Street Cleansing.—The streets of the town arc kept in a satisfactory state. As you know, I hold the opinion that street gullies should be emptied and cleansed by mechanical means. 31. SANITARY INSPECTION OF THE AREA. (a) Work of Sanitary Inspectors. (1) Inspection of Dwelling-Houses. Total Houses Inspected under Public Health or Housing Acts 3,155 Total Number of Inspections made 4,981 Housing (Consolidated) Regulations 952 After Infectious Disease 746 Defects Found 8,812 Notices Served (Preliminary) 2,376 Re-inspections re Notices Served 4,582 Inspection of Works in Progress 833 (2) Premises Controlled by Bye-Laics and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings 4 1 — Common Lodging Houses 103 8 3 Offensive Trades 230 20 13 Tents, Vans and Sheds 78 10 7 Dairies, Cowsheds and Milkshops 302 7 3 Slaughter-houses 73 1 — 37 (3) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 190 18 6 Laundries 15 — — Bakehouses 52 2 — Domestic Workshops 37 1 1 Other Workshops 118 21 9 Other Workplaces 116 21 11 Outworkers' Rooms 136 — — Butchers' Premises 631 36 15 Fishmongers 25 2 1 Restaurants and Dining Rooms 112 30 14 Stables and Stable Yards 163 25 19 Piggeries 40 6 6 (4) Miscellaneous. Inspections. Defects. Notices. Rats and Mice (Destruction) Act, 1919 267 20 6 Vacant Land and Refuse Dumps 191 42 17 Public Lavatories 93 12 9 Schools 56 12 6 Markets and General Shops 366 23 9 Ice-Cream Vendors 146 13 6 Petroleum and Celluloid Stores 149 15 3 Waterlogged Ground 2 — — Fair Grounds 2 — — Foul Condition of Ditches 3 — — Drainage Inspections 244 — — Milk Sampling 70 — — Rippleside Conversions 122 — — Other Miscellaneous 34 — — Visits to Smallpox contacts ... ... 761 (b) Summary of Sanitary Work Carried Out. (1) Drainage. Choked drains, opened, repaired, and cleansed 393 Drains reconstructed 79 New drains (conversions) 46 Ventilation shafts repaired or new fixed 26 New inspection covers 23 38 (2) Closet Accommodation. Roofs Walls W.C. structures repaired 29 Floors Doors Scats fixed 67 W.C. pans fixed or cleansed 73 Flushing apparatuses repaired or renewed 207 (3) Sinks. New fixed 38 New sink and bath wastepipes 87 New gulley traps 32 (4) Dampness. Roofs and flashings 867 Eavesgutters 503 Rainwater pipes 172 (5) Water Supply. Defective water fittings repaired and supply reinstated 84 (6) Yard Paving. Yard paving repaired or relaid 219 Gulley dishing repaired or renewed 40 (7) Dustbins. New ones provided 906 (8) General Repairs. External walls repointed 736 House floors repaired 262 Windows repaired or renewed 493 Window and door reveals repaired 181 Window sills repaired or renewed 340 Sashcords renewed 594 Washing coppers repaired or renewed 278 Stoves repaired or renewed 372 House doors and frames repaired or renewed 169 Stairs repaired 56 Handrails fixed 4 Chimney pots renewed and stacks rebuilt 242 Dirty or defective rooms repaired, cleansed and redecorated 1743 39 (8) General Repairs—continued. Insufficient floor ventilation 151 Insufficient ventilation and light 2 External painting 129 Weatherboards fixed 6 Door sills repaired or renewed 18 (9) Miscellaneous. Offensive accumulations removed 97 Animals so kept as to be a nuisance 10 Verminous rooms and persons disinfested 65 Dirty premises cleansed 3 Flooding 37 Drains tested 405 Dangerous structures reported 30 Overcrowding 54 Accumulation of water in cellar 4 Offensive fumes 9 Other conditions 4 (c) Notices Served. Informal Notices 2,376 Statutory Notices Scction 23, Public Health Act, 1875 27 Section 36, Public Health Act, 1875 65 Section 41, Public Health Act, 1875 15 534 Section 94, Public Health Act, 1875 277 Section 17, Housing Act, 1930 150 (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 232 6 — — Workshops 280 10 — — Workplaces 116 11 — — Totals 628 27 — — 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 13 12 1 — Want of ventilation 2 2 — — Overcrowding — — — — Want, of drainage of floors — . — — — Other nuisances 19 19 — — Sanitary accommodation:— Insufficient 4 4 — — Unsuitable or defective 27 27 — — 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 7 4 3 — Totals 72 68 4 — ""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 7 workpeople engaged on making wearing apparel, etc., in their homes. 41 (4) Registered Workshops. Workshops on the Register (sec. 131) at the end of the year. (1) Number. (2) Bakehouses (including nine factory bakehouses) 14 Other Workshops 46 Total number of Workshops on Register 60 (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) 4 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) — 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 33 outworkers:— Box maker 1 Overall making 1 Mattress case maker l Boot and shoe maker 3 Life-belt covering 1 Tie making 3 Artificial flower maker 1 Millinery 1 Wearing apparel (various) 17 Christmas cracker making 2 Fancy goods making 1 Quilt maker 1 During the year, 31 lists of out-workers were received from other Authorities in respect of addresses in Barking. Four lists were received from employers within the district. 42 32. SMOKE ABATEMENT. During the year, 164 smoke observations were carried out on factory chimneys, and notices were served with respect to the 18 offences registered. At the present time, bye-laws are not in operation in the district, but the permissible limit recognised generally is two minutes black smoke in every observation of thirty minutes duration. In June, 1930, the Electricity Commissioners appointed a Committee "To consider and report upon the measures which have been taken both in this eountiy and in others to obviate the emission of soot, ash, grit and gritty particles from the chimneys of electric power stations." The Committee took evidence so far as power station practice in this country is concerned, and visited twenty power stations in Germany and France. In December, 1932, the Committee reported "Where it is possible to carry out the recommendations contained in this Report, the creation of a dust nuisance will be avoided. The Committee appreciate, however, that at some existing stations there may be considerations which render it impossible to give full effect to the recommendations." The generating station at Creeksmouth is one of two stations in this country having a capacity of over 200,000 kilowatts. The plant includes stoker-fired and pulverised fuel-fired installations. The grit extraction plant fitted is of the Cyclone type. The dust extraction plant recommended by the Committee of the Electricity Commissioners is one consisting of electrostatic precipitators. Our information is that there would be very considerable difficulty in incorporating such plant with existing installations. The two additional 75,000 kilowatt sets referred to in my Report for last year have not yet commenced operation. The new chimneys are 250 feet high, the chimneys of the pulverised fuel plant are 185 feet high, and the chimneys of the old stoker-fired plants are at present being extended 60 feet in height. 43 33. PREMISES AND OCCUPATION'S 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 three visits were paid to the two common lodging houses, four of the visits being made at night. Eight defects were discovered and three notices served. (c) Tents, Vans and Sheds.—There are 12 occupied van dwellings, which are located in yards where water supply and sanitary accommodation arc provided. 7S \ isits were paid and 7 notices were served in respect of 10 defects discovered. (d) Underground Sleeping Rooms.—There are no such occupied rooms in the district. (c) Offensive Trades.—The following is a summary of the offensive trade premises registered:— Fish Fryers 21 Dealers in Rags and Bones 9 Gut Scraper 1 Fat Melters 2 Fish Skin Scraper 1 Oil Boiler 1 Soap Makers 3 Total 41 Two hundred and thirty visits were paid to these 41 premises, and 20 contraventions of the bye-laws were discovered and any necessary action taken. (f) Refuse Tips.—During the year, the occupiers of the privately owned tips at West Bank were prosecuted for infringement of the bye-laws. Fines and costs amounting to £9 were imposed. The tip owners gave an undertaking that the tips would be closed. (jl) Piggeries.—The seven remaining piggeries in the district are removed from occupied dwellings, but the premises are not entirely satisfactory because of the [???] culties in. drainage. 44 (h) Stables.—Owing to the changing circumstances of the district, many of the old stables have been demolished. The result is that various hawkers and dealers in the district who need a pony and cart have been driven in colonies to unsuitable premises. There is a need in the district for a number of stables constructed in a sanitary manner, to provide accommodation for these poor people, who themselves have insufficient means and who depend for their livelihood upon horse transport. One hundred and sixty-three visits were paid during the year to stable premises, and 19 notices were served in respect of various unsatisfactory conditions. 34. PARKS AND OPEN SPACES. You have three hundred acres of parks and open spaces in Barking, including the western and southern open belts, and you are making wonderful use of them. Your large open air swimming bath is marvellous, and I know that you are laying out the open belt which separates the Becontree Estate from the rest of Barking. Once again I can only say I can 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 facilities for healthy recreation. 35. SCHOOLS. There are fourteen elementary schools, in addition to the Park Modern 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. 36. RAG FLOCK ACTS, 1911 AND 1928. 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. 45 SECTION 4. HOUSING. 37. STATISTICS. (a) General. Number of new houses erected during the year (1) Total 1,993 (2) As part of a municipal housing scheme:— (а) Barking 109 (б) L.C.C 1,707 (3) Others (including private enterprise and subsidy houses) 177 (b) Unfit Dwelling-houses. I. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,155 (b) Number of inspections made for the purpose 10,396 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 952 (b) Number of inspections made for the purpose 1,075 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 158 (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 2,376 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 1,776 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 150 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 148 (b) By local authority in default of owners 2 B.—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 384 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 357 (b) By local authority in default of owners 27 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 15 (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 1 (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. 47 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By ownersNil (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 1.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925 : (1) Number of dwelling-houses in respect of which Closing Orders came operative 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 became operative Nil (4) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 38. HOUSING CONDITIONS. (a) General Observations.—The total number of inhabited houses in the district is 161,232 (including 1,049 shops), which, compared with the total of 10,965 at the census of 1931, gives an indication of the growth of the town. Of the total of 15,183 dwelling-houses, 1,361 are owned by the Council and approximately 5,700 have been erected in the area by the London County Council since the year 1929. It is interesting to note that 1,699 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. During the year 1932, no less than 392 temporary buildings were approved for erection in the back gardens of dwelling-houses in the district. In my Report for the year 1930, I said " With the advent of a large new population to the district and the erection of so many new houses, the time appears to 48 be opportune for the prohibition of anything but a standard type of structure, the site not to be within fifteen feet distance from any window of the dwelling-house." It is to be seriously deplored that, when in the design of dwellings everything is planned to avoid back additions likely to interfere with the free circulation of air or to obstruct sunshine, the occupiers for whom these benefits are provided should be allowed to erect the unsightly structures so common in the district. HOUSES BUILT IN DISTRICT. 1926—1932. Year 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 1932 1,993 (Barking) 109 177 (L.C.C.) 1,707 Totals 7,336 5,861 1,475. Of the 5,861 houses shown above as part of Municipal Housing Scheme, 517 were provided by the Borough of Barking and 5,344 by the London County Council. It will be noted that the number of new houses erected as the result of private enterprise is small. (b) Sufficiency of Supply of Houses and Overcrowding.—The Council is aware that the land available for building purposes is likely to be taken up completely for rehousing purposes subsequent to action under the Housing Act, 1930. 49 This means that there will not be available in the district any houses for the people living in overcrowded circumstances or for the newly married members of the community. It must therefore be concluded that the practice of members of the family marrying and remaining in the same house with their parents will be intensified. I regard a separate house for every family as being an essential, if the wellbeing of the family is to be maintained in every respect. The Council, I know, arc giving serious consideration to this problem. (c) Individual Unfit Houses.—During the year a total of fifteen houses were represented as incapable of repair and Demolition Orders were made. In addition the Council considered the properties Nos. 67-81, East Street, in their ownership, and decided to demolish. Arrangements have been made to rehouse all displaced tenants. The premises in respect of which Demolition Orders were made are as follows:— Nos. 2-8, Mayesbrook Cottages. Nos. 1-5, Manor Way Cottages. Nos. 1 and 2, Ivy Cottages. Toll-Gate House. Of the total of 43 premises scheduled for action in the period 1930-1935, there arc 7 premises remaining to be dealt with. (d) Clearance Areas.—In December last, the public enquiry was held with respect to the Bifron Square area, the Holly Square area and the St. John's Retreat area, consisting in all of 63 premises. The Orders were duly confirmed, and at the time of writing this Report most of the families have been rehoused on the Upney Estate. In September, 1932, representations were made in respect of three areas:— (1) Nos. 1-36, Bridge Street. (2) Nos. 6-31, Back Lane. (3) Nos. 2 and 4, Broadway, Nos. 1 and 2, Church Path, and Nos. 2 and 3, Market House Buildings. In the three areas there were 70 premises, housing 86 families. These families are to be rehoused on a site at Movers Lane. 51 SECTION 5. INSPECTION AND SUPERVISION OF FOOD. 39 MILK SUPPLY AND ICE-CREAM. (a) Milk Supply—Registered with the Authority are 47 retail purveyors, of whom 13 occupy premises outside the district. In addition there are two cowkeepers. There are two occupied cowshed premises, with a total of 40 milch cows. One is of recent construction. 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 47, six were found to be unsatisfactory:— Type of Sample. Satisfactory. Unsatisfactory. Totals. Grade " A " (T.T.) Milk 6 1 7 Raw Milk 19 4 23 " Pasteurised " Milk 16 1 17 Totals 41 6 47 Whilst 17 of the samples examined are described as pasteurised milk, the majority of the samples represent supplies which, although pasteurised, were not retailed as such. There were during the year 18 samples of milk submitted to biological examination for the presence of tubercle. Of this number, four samples were from supplies produced in the district, and one of these samples was found to be infected. A further sample of milk from the infected source was submitted for examination and the affected cow eventually slaughtered. 52 The County Medical Officer took two other samples from supplies produced in the district and these were both negative. 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. In addition to the foregoing, arising out of complaints received, two " informal " samples of milk were submitted to the Public Analyst, who reported that both were genuine samples of milk. The following table shows the number of licences granted during the year for the sale of graded milks under the Milk (Special Designations) Order, 1923:— " Certified " Milk 1 Grade " A " Milk 1 " Pasteurised " Milk 5 Grade " A " (T.T.) Milk 12 Grade " A " Milk, Pasteurised 2 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 46 retailers and 11 wholesale distributors of sterilised milk. Two milk roundsmen were prosecuted in respect of three contraventions of Article 31 (2) of the Milk and Dairies Order, 1926. 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. 53 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. I am glad to note that legislation may be introduced soon to control the sale of all treated milk, a matter to which I have referred in my reports for the last three years. (b) Ice-cream.—The following results of the examination of three samples of ice-cream show that the product was not so clean as might reasonably be expected. Sample No. B. Count. B. Coli. 39 160,000 Absent in 0.0001 c.c. 40 112,000 „ 0.01 c.c. 41 720,000 „ 0.0001 c.c. In the Barking Bill application is being made for power to register all ice-cream vendors, and this will enable us to obtain greater control of the sanitary condition of the premises. 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, 1932. Year 1928 1929 1930 1931 1932 Totals. Notifications Received 126 72 64 39 57 358 Cattle 40 64 80 12 10 206 Pigs 409 137 93 200 84 923 Sheep 815 426 332 173 270 2016 Calves 71 10 11 1 9 102 Totals 1335 637 516 386 373 3247 54 Diseased meat was destroyed as under:— Description. Disease. Weight. 1 beast's head Tuberculosis 28 lbs. 2 beasts' lungs Tuberculosis 20 „ 2 „ livers Distomatosis 32 „ 1 beast's liver Tuberculosis 16 „ 3 beasts' livers Cirrhosis 48 „ 3 ,, mesenteries Tuberculosis 9 „ 6 sheeps' lungs Parasites 18 „ 1 sheep's pluck Parasites 10 „ l½ ,, livers Distomatosis 6 „ 2 pigs' lungs Pneumonia 8 „ 2 „ spleens Tuberculosis 1 „ 3 „ internal organs Tuberculosis 120 „ 1 pig's lung Tuberculosis 3½ „ 1 „ liver Cirrhosis 6 „ 1 „ liver Tuberculosis 6 „ 13 pigs' heads Tuberculosis 182 „ 2 ,, carcasses Tuberculosis 160 „ 7 „ mesenteries Tuberculosis 14 „ 41. UNSOUND FOOD. The following list gives particulars of the unsound food destroyed during the year. Meat. 1 rabbit. 78½ lbs. mutton and lamb. 3½ lbs. pigs' kidneys. 20 lbs. pork. 24 lbs. beef. 5 lbs. ox tails. 84 lbs. bacon. Tinned Foodstuffs. 36 1 -lb. tins tomatoes. 2 2-lb. tins tomatoes. 15 small tins peaches. 9 large tins peaches. 1 large tin raspberries. 10 small tins loganberries. 3 1-lb. tins evaporated milk Fish. 1 halibut (15 lbs.). 1 hake (7 lbs.). 1 case large cod. 1½ bushels winkles. 14 lbs. fillet of cod. 1 case dabs (3½ stones). Other Foods. 16 casks gherkins (4 tons). 42 barrels gherkins. 183/4 lbs. mixed dried fruits. 55 42. ADULTERATION, ETC. The Food and Drugs (Adulteration) Act, 1928, and kindred Acts and Regulations are administered in this district by the Essex County Council. I am indebted to Mr. II. 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, Great Tower Street, London. Other Milk. Butter. Samples. Total. 43 68 112 223 Four proceedings were instituted in relation to these samples during the period covered. 43. NUTRITION. You are particularly interested in the education of the public with reference to nutrition, but I think, as I told you last year, that there need not be a lot of scientific training of the public in the nutritive value of various foods, if, by administration, a straightforward food is made available for the public at a price the public arc able to pay and if that food is as widely variable as possible. We find there is need to teach people that it is not always the most expensive foods which are the most nutritious. By the courtesy of the Director of Education, I am able to say that this is done in ail your schools, and on our part we are constantly advising this at your health centres and when your Health Visitors visit the mothers in their own homes. So long as we have people living in rooms, with no proper cooking apparatus, we must suffer as a race, so far as nutrition is concerned, and also so long as we have houses with no proper accommodation for the storage of food, we must similarly suffer. We find that young mothers are positively anxious to avail themselves of all information that we can give, and I feel confident that, if they are given reasonable opportunities of buying the food and cooking the food, the old reproach of families being fed from a frying pan and with a tin opener will be a very stale joke indeed. 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 1932:— TABLE I. Diseases. Males. Females. Total. Total cases removed to Hospital. Deaths. Smallpox 3 2 5 5 — Scarlet Fever 88 90 178 161 1 Diphtheria 45 57 102 101 5 Puerperal Septicaemia — 2 2 — — Puerperal Pyrexia — 7 7 1 — Pneumonia: Acute Influenzal 63 65 34 14 9 Acute Primary ... 50 14 Following measles 44 15 Erysipelas 14 23 37 6 — Ophthalmia Neonatorum 3 10 13 1 — Enteric Fever 11 6 17 17 4 (including Typhoid and Para-typhoid Fever) — — Acute Anterior Poliomyelitis 2 — 2 2 — Cerebro-spinal Meningitis 2 1 3 3 — Encephalitis Lethargica — 2 2 2 — Chicken-pox 251 224 475 — — Totals 482 489 971 313 48 58 The following diseases were notifiable in 1932 under the original Infectious Disease (Notification) Acts, 1889 and 1899 :— Smallpox, diphtheria, relapsing fever, cholera, erysipelas, typhus, plague, puerperal fever, cnteric 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, 1889, making chicken-pox a notifiable disease throughout the district. The Barking Town (Pneumonia) Regulations, 1924, provides for the notification of Pneumonia supervening upon Measles. The total notifications of infectious diseases numbered 971 exclusive of tuberculosis and inclusive of chicken-pox, compared with 905 the previous year. During 1932 the number of notifications and transfers of tuberculosis (all forms) was 169 compared with 123 in 1931. 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. Gaseoigne. Central. Ripple (West). Ripple (East— L.C.C. Est.) Westbury. Longbridge (West). Longbridge (East—L.C.C. Est.), Smallpox — — — — — 1 1 — 1 1 — 1 5 — — — — — 5 — Scarlet Fever 1 9 22 22 11 77 21 6 8 1 — — 178 15 15 8 16 52 13 29 30 Diphtheria 5 4 14 8 10 28 16 3 11 3 — — 102 12 8 6 8 28 9 23 8 Puerperal Septicemia — — — — — — — — 2 — — — 2 — — — — 1 — — 1 Puerperal Pyrexia — — — — — — — — 6 1 — — 7 — 1 1 2 1 — — 2 Pneumonia (Ac. primary, Ac. influenzal & following measles) 5 19 14 9 9 25 3 5 14 10 8 7 128 24 12 12 11 10 9 24 26 Erysipelas — — — — — 1 — 2 4 7 14 9 37 2 8 4 2 1 7 2 11 Ophthalmia Neonatorum 13 — — — — — — — — — — — 13 4 3 1 3 — — — 2 Enteric Fever — — — — 1 3 7 3 1 2 — 17 8 3 — — — 3 3 Acute Anterior Poliomyelitis 1 1 1 Ccrebro Spinal Fever 1 2 1 Kncephalitis Lethnr«icu — — — — — 1 — — — 1 — — 2 — — 1 — 1 — — Chicken-pox 13 24 23 29 39 306 34 3 4 — — — 475 62 40 44 96 121 33 41 38 Totals 38 56 73 69 70 443 75 28 53 25 24 17 971 127 90 77 138 217 79 121 122 61 Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1932 :— Scarlet Fever. Diphtheria. Total. January 15 13 28 February 10 11 21 March 11 . 2 13 April 7 9 16 May 17 5 22 June 12 5 17 July 10 9 19 August 9 8 17 September 22 6 28 October 20 8 28 November 23 16 39 December 22 10 32 Totals 178 102 280 45. NOTIFIABLE INFECTIOUS DISEASES. (a) Diphtheria.—102 cases were notified, compared with 241 the preceding year. Of eases notified, 96 were removed and treated in the local isolation hospital. Five deaths from diphtheria occurred. The average stay of diphtheria in hospital was 41.1 days, the longest stay being 128 days. Sex.—45 cases were male and 57 female. Diphtheria, on the whole, was relatively mild during the year, although some very bad cases were admitted to your hospital. 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 178 compared with 1C1 the previous year. One fatal ease occurred. 158 cases were isolated at the local Infectious Diseases Hospital. The average stay of scarlet fever cases in the Barking Hospital was 49.5 days, compared with 42.3 days in 19.31. The longest period of detention was 120 days and the shortest 20 days. The length of treatment necessary for scarlet fever is a question which has received my consideration during the year. I feel that, whilst we have such a large number of cases who cannot hojie to go away to recuperate after leaving the Hospital, we are well advised not to shorten the period of hospital treatment too much ; so too I feel that the number of homes in Barking where scarlet fever can be conveniently nursed arc so few that we have little opportunity of nursing these cases or supervising them at home. Sex.—88 cases were male and 90 female. No relationship has been traced between cases of scarlet fever and puerperal fever. (c) Pneumonia, Malaria and Dysentery.—The following table shows the incidence during the year of pneumonia, malaria and dysentery, which are notifiable under the Public Health (Infectious Diseases) Regulations, 1927 — Diseases. No. Notified. No. of Deaths. Malaria _ _ Dysentery _ _ Pneumonia Acute Influenzal. 34 84 37 Acute Primaiy 50 In addition, 44 cases of pneumonia supervening upon measles were notified under the Barking Town (Pneumonia) Regulations, 1924. (d) Smallpox.—There have been 5 cases of smallpox during the year 3 932. This figure is the same as that for 1931. All 5 cases were of a mild type. (e) Encephalitis Lethargica.—Two cases of encephalitis lethargica were notified during the year. 63 (f) Tuberculosis.—Particulars of new cases of tuberculosis and of all deaths from the disease in the area during 1932 are given in this Report in the following form :— New Cases. 1 Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female Under 1 year 1 1 — — 1 1 1 — 1 lo 5 years 1 — 7 3 1 — 2 3 5 to 10 years 4 — 7 5 — — — — 10 lo 15 years 3 2 7 6 1 — 2 — 15to 20 years 8 6 3 3 2 1 1 — 20 to 25 years 9 17 1 1 3 4 — — 25 to 35 years 17 17 1 3 6 0 — 1 35 to 45 years 15 8 1 — 6 4 — — 45 to 55 years 9 5 — — 2 2 — — 55 to 65 years 7 3 — — 4 1 — — 65 years arid upwards — — — — — — — — Totals 74 50 27 21 26 19 6 4 During the year, 169 notifications were received of all forms of tuberculosis— pulmonary 125 and non-pulmonary 44, and there were 12 deaths of un-notified cases (8 pulmonary and 4 non-pulmonary), making a total of 181 new cases during the year. Information was received of the removal into the district of 55 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 on Forms I and II during tiic year:— Form I. Form II. Pulmonary. N on-Pulmonary. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. 89 23 11 9 21 22 7 9 64 Fifty-five deaths occurred from tuberculosis (all forms) 45 of these being pulmonary cases. The number of deaths in institutions was 29. The death rate for tuberculosis (all forms) during 1932 was 0.91 per 1,000 population, compared with 0.87 for the previous year. I regret to inform you that twelve of the cases which died from tuberculosis had not previously been notified to me as suffering from that disease. We have written to the certifying practitioners in many of these cases and find that some of the reasons for the non-notification of these cases are as follows :— 1. That some of the medical men do not yet understand that, even though a cate nas been notified in another, district, it must again be notified when permanent residence is taken up in this district. 2. That some people who have removed into the district have only called in a doctor just prior to death. 3. That in several cases the diagnosis has only been established after death. I am to advise you that this figure, which would appear to be quite unsatisfactory, is by no means so unsatisfactory in the light of the enquiries we have made. The following table shows the position of the Tuberculosis Register on 31/12/32 compared with 31/12/27. Number on Register, 31/12/27 946 Number since admitted to Register 562 Number since discharged from Register: Cured 139 Died 288 Amended Diagnosis 260 Left district or lost sight of 195 Duplicate notification 15 897 Number on Register, 31/12/32 611 (g) Enteric Fever.—Seventeen cases of cnteric fever (including typhoid and paratyphoid fever) were notified during the year, all of which were removed to hospital. Four of the cases proved fatal. (h) Puerperal Fever.—Two cases were notified during the year and both of them recovered. 65 (i) Puerperal Pyrexia.—Seven cases were notified during the year, of which one was removed to hospital; all of the cases recovered. (j) Erysipelas.—37 cases were notified during the year compared with 25 during 1931. Six patients were removed to hospital. (k) Chicken-pox.—In view of the prevalence of smallpox in surrounding districts, chicken-pox was made a notifiable disease in the district in April, 1928, and continued to be notifiable throughout 1932. A total of 475 cases were notified during the year compared with 333 during 1931. Sex.—251 were male and 221 female. Ki. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES. (a) Measles, etc.—The most important of these are measles, whooping cough and summer diarrhoea. Deaths registered were as follows :— Measles 15 Whooping Cough 2 Summer Diarrhoea 11 It will be seen that the deaths from measles number fifteen, i.e., over a quarter of the number of deaths from tuberculosis. Three times the number of children died from measles than died from diphtheria, and these fifteen deaths from measles contrast very unfortunately with the one only death we had from scarlet fever. I have come to the conclusion that measles, whenever there is any doubt on the issue as to if and whether it can or cannot be nursed at home, should always lx' nursed in hospital. As you know, it is not the actual measles which is the killing disease but the broncho-pneumonia which complicates it. \ou are willing to admit to Barking Hospital cases of measles complicated with broncho-pneumonia. (b) Rheumatic Fever.—Rheumatic fever, as I said last year, is a serious problem in Barking. 66 (e) Cancer.—There have been 59 deaths from cancer, 32 below the age of 65 years and 27 over the age of 65. The following table shows the occupations of the 59 persons who died from cancer during the year 1932. Male. Female. Bargeman 1 Infants 2 Coal merchant 1 Music teacher (spinster) 1 Electrician 1 Widows 12 Foreman, contractors' works 1 Wives 20 Gas workers 3 Glass blower 1 Infants 2 Insurance agents 2 Invoice clerk' 1 Labourers 4 Licensed victuallers' representative 1 Machine minder 1 Mechanical engineer 1 Night watchman 1 Plasterer 1 Retired (no occupation) 2 24 35 The following table shows the organs affected, according to the returns of certified causes of death. Organ. Male. Female. Bladder 1 – Breast – 2 Cervix – 2 Colon 3 4 Larynx 1 – Liver 2 6 Lungs 2 3 Mouth 1 – Ovary – 3 Peritoneum 1 – Prostate 1 – Pylorus 1 – Rectum 1 3 67 Organ. Male. female Scrotum 1 – Sigmoid 1 1 Spine .... – 1 Stomach 6 3 Tongue 2 – Uterus – 5 Vulva – 1 Not stated – 1 24 35 These tables show the prevalence of cancer, the occupations and sex of the patients and the organs affected. It is difficult for us to educate the public in the need there is for early treatment without at the same time alarming them. In Barking, however, there is not so great a need for this special education as there is in some towns, because, being an industrial town, a large part of the population is either insured or otherwise under medical supervision, and also because, on account of the nearness of the great London hospitals, it is possible to get an opinion without unduly alarming the patient. Persons in Barking are quite used to attending these hospitals, and there is no need in every case to represent the situation as dramatic in order to warrant such a journey. (d) Influenza.—There were 14 deaths from influenza during the year 1932. May 1 repeat 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. I do think in time we shall create a public opinion sufficiently alive to the danger of influenza that anyone needlessly exposing himself or herself whilst suffering from this disease will be looked upon as a public nuisance and a common danger. W e have but little information as to the incidence of influenza. We know, of eourse, that it was very prevalent, and the fourteen deaths show that it was a serious danger during the year. N ith the opening of Barking Hospital we have taken in serious cases of uilluenza complicated with pulmonary trouble, but, because the Hospital was only i>|H iicd in October, the number admitted was not large. 68 (e) Scabies.—Fifty-eight cases of scabies were brought to the notice of the department during the year. Disinfection of bedding and blankets was carried out in all but seventeen cases, where the parents declined the services offered. (f) General.— Non-notifiable infectious diseases amongst school-children arcmuch more easily traced than the diseases amongst adults. As you know, the School Attendance Officers of the Education Committee are General Inquiry Officers, and we have a lot of reliable information on which we can act so far as infectious diseases amongst school-children are concerned. 47. BARKING HOSPITAL. (a) Admissions. The following is the table of admissions, etc., in respect of infectious diseases during 1932 :— Disease. In Hospital January, 1st, 1932. Admitted during the year. Died. Discharged. In Hospital Dec. 31st, 1932. Scarlet Fever 28 161 *2 156 31 Diphtheria (including Membranous Croup) 20 93 3 99 11 Whooping Cough and Convulsions _ 1 1 - _ Puerperal Pyrexia _ 1 _ 1 _ Enteric Fever _ 14 _ 11 3 Pneumonia _ 6 3 2 1 Pneumonia pnd Measles _ 2 1 1 _ Pneumonia and Whooping Cough _ 1 _ 1 _ Pneumonia and Croup _ 2 _ 2 _ Tonsillitis 1 3 _ 4 4 Erysipelas _ 6 _ 6 _ Measles _ 1 _ 1 _ Measles and Laryngeal Croup _ 1 _ 1 _ Others _ 3 _ 2 1 *Hospital diagnosis—Encephalitis and broncho-pneumonia. 69 (b) Number of Bed Days.—The total number of bed days in the infectious diseases hospital during 1932 was 13,741—that is to say, an average of 38 patients were in hospital throughout the 366 days in the year. (c) Hospital Accommodation.—You have now Barking Hospital, with fifty-eight beds and I know that you are entertaining extending this. As I have reported elsewhere, I hold that 1¼ beds are required in Barking per 1,000 population. The problem of using hospital accommodation to the best advantage is a difficult one. The twelve cubicles you have provided have proved their worth, and I am of opinion that, although it is certainly more costly to nurse any one particular patient in any one particular cubicle, we are by reason of the number of cubicles you have, able to carry out our duties on the whole more economically than we could without them. It is my intention, when the second portion of the Hospital is being built, to advise you on the question of cubicle blocks. 48. VACCINATION. Your Medical Officer has carried out no primary vaccinations or re-vaccinations. He works in the closest co-operation with the Public Vaccination Officer. EXAMINATION OF PATHOLOGICAL SPECIMENS, ETC. In a previous table on page 22 I have shown the use which has been made of the facilities provided for the examination of pathological and bacteriological specimens. 50. CLEANSING AND DISINFECTION OF VERMINOUS PERSONS. Last year, I suggested you might well entertain the possibility of setting up a cleansing station. I hope this matter will have your early consideration. 70 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 111 applications for the free supply of raticides, and 267 visits were paid by the sanitary inspectors to infested premises. 52. MOSQUITOES. The prevalence of mosquitoes in Barking for a month or two in summer is well known. 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. 71 SECTION 7. MATERNITY AND CHILD WELFARE. 53. GENERAL. The question of clinic 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 1,080, the net total of 1,105 being obtained by adjustment of "transferred" notifications. The live births registered included 574 males and 531 females. There were 20 illegitimate births, or 1.8 per cent. of the total. In comparison with 1931, 158 more births were registered during the year, an increase equivalent to 16.7 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 18 were notified. In addition, 2 stillbirths were not notified. The following table gives details of the notifications received:— By whom notified. Live Births. Still-Births. Medical Practitioners 137 5 Certified Midwives 855 18 Parents and Others 69 1 Of the total live births within the district during the year, 808 or 74.8 per cent. were attended by midwives, the remainder being attended by medical practitioners. 55. BIRTH RATE. The birth rate for the year was 18.3, compared with 15.3 for England and Wales. 72 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 580, compared with 527 for 1931. Re-attendances numbered 1,902 in 1932, and 1,840 during 1931. Two hundred and seven sessions were held during the year, making an average attendance of 12.0 mothers per session. The total number of births including transfers was 1,153 and the number of first attendances at the Ante-Natal Clinics was 580. It would therefore appear that 50.3 per cent. of these cases availed themselves of our Ante-Natal Service. Sixteen 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 child birth. 57. UPNEY (MATERNITY) HOSPITAL. The admissions to the Upney (Maternity) Hospital numbered 238, compared with 196 in 1931. Of these 20 cases were admitted for ante-natal treatment, and 218 for confinement. Corresponding figures for 1931 were 27 cases for ante-natal treatment, and 169 for confinement. (а) Number of cases admitted 238 (20 of which were Ante-Natal) (б) Average duration of stay 14.4 days (c) Number of cases delivered by:— Midwives 214 Doctors 4 (d) Number of cases in which medical assistance was sought by the midwife, with reason for requiring assistance :— Torn Perineum 19 Prolapse of Cervix 1 Rigor with rise of temperature 1 Collapse after 3rd stage 1 Delayed 2nd stage 2 Unsatisfactory condition of patient 13th day 1 Feeble infant 1 • 26 (c) Number of cases notified as puerperal sepsis, with result of treatment in each case (recovered) 1 73 (f) Number of cases notified as puerperal pyrexia, with result of treatment in each case Nil (g) Number of cases of pemphigus neonatorum Nil (j) 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 2 (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 5 (ii) Within 10 days of birth Nil 58. PUERPERAL FEVER AND PUERPERAL PYREXIA. Two cases of puerperal fever were notified as compared with three in 1931. In addition to the cases of puerperal sepsis, 7 cases of puerperal pyrexia were notified, the confinement in 3 cases being attended by a midwife. All the patients recovered. 59. MATERNAL MORTALITY. No maternal deaths occurred during 1932. The following table shows the number of maternal deaths occurring in Barking during the past seven years:— Year. No. of Maternal Deaths. 1926 1 1927 3 1928 2 1929 2 1930 3 1931 4 1932 — 74 60. INFANTILE MORTALITY. During 1932, fifty-nine children died under the age of one year. This is at the rate of 53.4 per 1,000 live births. This is a satisfactory figure, and, although it is not safe to depend too much on the figure in any one year, it is a figure on which you can nevertheless congratulate yourselves. In these 59 deaths, there were the usual number of inevitable deaths, so that I have no reason to suppose it was an exceptionally lucky year. The corresponding figure for the whole of England was 65, for the County Boroughs and Great Towns (including London) 69, for the Smaller Towns 58 and for London 66. The following table shows the infant mortality figure for Barking from 1891 to 1932:— 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 1912 90 95.1 1892 99 151.8 1913 116 113.3 1893 98 156.6 1914 104 106.4 1894 85 122.4 1915 108 115.0 1895 112 162.6 1916 70 75.0 1896 104 148.9 1917 89 117.4 1897 138 178.0 1918 60 82.4 1898 129 178.0 1919 54 65.0 1899 137 172.0 1920 92 83.0 1900 159 203.0 1921 74 74.1 1901 155 172.0 1922 49 55.5 1902 112 134.0 1923 43* 49.8* 1903 97 113.0 1924 72 85.1 1904 129 143.0 1925 66 80.0 1905 128 142.0 1926 49 59.9 1906 143 163.0 1927 47 66.1 1907 98 112.0 1928 51 63.3 1903 110 117.0 1929 42 53.4 1909 93 107.0 1930 49 61.3 1910 88 97.7 1931 61 64.4 1911 158 157.0 1932 59 53.4 * Registrar-General's figures. Of the 59 deaths of infants under the age of one year, one was due to bronchopneumonia following measles. 75 61. NEONATAL MORTALITY. Of the 59 children who died under the age of one year, no less than 28 of these died under the age of one month—i.e., 47.5 per ccnt. Of these 28 children, 12 were female and 16 male. Of the 28 deaths, 14 were due to premature birth and debility and 3 were due to congenital malformations, the remaining 11 being due to various causes. Giving approximate figures, it may be said that the neo-natal mortality rate for 1931—i.e., the number of children dying under the age of four weeks per 1,000 births—was 32.5 and for 1932, 25.3. The corresponding figure for the whole of England for the year ended December, 1931, was 31.59. It will therefore be sem that Barking has a low figure. The Barking figure is lower than that for Creater London, which is 25.63, and lower than that for County Boroughs, which is 33.67. The rate as applicable to children between the ages of one and twelve months works out at 28.05. As I have said for the last 2 years, it is now generally believed that these neonatal deaths can only be materially influenced by more intensive and efficient ante-natal work, and these 28 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, 24 related to still-born children, 2 of whom belonged to other districts. In addition, 2 still-births were not notified. In addition, 7 still-births occurred in Hospitals outside the Borough. It will therefore be seen there were 31 still-births belonging to the district. The Registrar-General expresses this figure as a ratio between the number of still-births per 1,000 total births. In this way we get a rate of 27.3 for 1932. 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 — More than seven months 25 Not elicited 8 76 (b) Presentation:— Twins 2 Extended breech 2 Vertex 9 Breech 7 Footling 1 Anencephalus 2 Not elicited 6 Cæsarean section 1 Face 1 P.O.P. 1 R.O.A. 1 (c) Supposed cause of still-birth:— Large baby 1 Accident, etc. 3 Baby's position 2 Shock 2 Difficulties during labour and delivery 10 Not known 15 (d) Occupation of mother:— Household duties at home 20 Shop worker 1 Unknown 2 Tailoress 1 Waitress 1 Clerk 1 Field worker 1 63. OPHTHALMIA NEONATORUM. There was a decrease in the number of cases of ophthalmia neonatorum, notifications being 13, compared with 17 in 1931. Four of the cases occurred in the practice of midwives, the remainder (with one exception) being attended by medical practitioners. Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. At Hospital. Under 3 weeks 13 12 1 13 — — — In no case has the vision been impaired. 77 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. Alban's. Totals. No. of sessions 103 99 99 104 405 No. of attendances of children under one year (a) New cases 252 141 154 380 927 (b) old cases 2362 2195 1942 2493 8992 No. of attendances of children 1 to 5 years of age:— (a) new cases 89 37 41 252 419 lb) old cases 1568 1456 929 1905 5858 Average number of attendances per session 41 39 31 48 40 No. of sessions attended by medical officers 103 97 96 104 400 No. of children seen by medical officers:— (a) Under one year 1262 1113 1058 1149 4582 (6) Over one year 955 642 630 956 3183 Average number of children seen by medical officer per session 21 18 18 20 19 The total attendances during the year were 16,196, as compared with 14,664 in 1931. Particulars of the home visits paid by the health visitors are given in the following table:— No. of half-days devoted to visiting 1,275 No. of ante-natal visits:— First visits 280 Subsequent visits 91 No. of first visits to children under one year 1,323 No. of subsequent visits to children under one year:— (a) Attending a Centre 295 (b) Not attending a Centre 3,296 No. of visits to children 1 to 5 years of age:— (a) No. of visits 5,304 (b) No. of children seen 8,782 No. of special visits in connection with Ophthalmia Neonatorum 10 Ditto Deaths of children up to 3 years of age 75 Ditto Still-births 27 Ditto Puerperal Sepsis and Puerperal Pyrexia 11 Other visits (re infectious diseases) 300 Total home visits of all kinds 11,012 78 Reference to the second table on page 77 will show that nearly five thousand visits were paid to children under the age of one year and nearly eight thousand eight hundred to children between the ages of one and five years. This shows that there is in Barking a very real amount of work done in connection with the visitation of toddlers and children up to the age of five years. It is obvious from these comparative figures that more visitaticn is carried out in the case of children under the age of one year than over the age of one year, and this is rightly so, because it is during the first year that the foundations of health are being laid. I feel, however, that we should have an economic return if—not only in Barking, but throughout the country—we had an extension of staff to pay more attention to children between the ages of one and five years. 65. FOSTER CHILDREN. The following is an abstract of a table compiled and returned to the Ministry of Health by the 30th January, 1933, relating to the administration of Part 1 of the Children Act, 1908, during the year 1932:— 1. Notification:— (i) Number of foster parents on the Register:— (a) at the beginning of the year 41 (b) at the end of the year 46 (ii) Number of children on the Register:— (a) at the beginning of the year 52 (b) at the end of the year 54 (c) who died during the year Nil (d) on whom inquests were held during the year Nil 2. Visiting:— (i) Number of Visitors holding appointments under section 2 (2) at the end of the year:— (a) Health Visitors 5 (b) Female, other than Health Visitors — (c) Male 1 Arrangements are made for notification to the Medical Officer by the fosterparents, and for visiting by the Health Visitors. 79 66. ILLEGITIMACY. Twenty illegitimate children were born during the year, and in the same period six deaths of illegitimate infants occurred ; the infantile mortality rate among these children was therefore 300.0, while that for legitimate infants was 48.8. Previously I have written upon the question of illegitimacy, and again I must ask you to contrast the very high infantile death rate among illegitimate children with the relatively favourable rate among legitimate children. You will note that this rate is over six times as high as that among legitimate children. To deal with this problem requires co-operation amongst all the organisations that are interested in moral and social welfare. As I have said, the twenty births of illegitimate children showed six deaths ; twenty corresponding legitimate children showed an average of only one death. 67. DENTAL CLINIC. A general increase in this branch of the work has been taking place, and during 1932 the attendances of expectant and nursing mothers and of children referred from the Maternity and Child Welfare Clinics were as follows:— (a) Number of treatments of children 785 (b) Number of mothers treated:— New cases 148 Old cases 702 (c) Number of dentures supplied 149 (d) Sessions held 96 68. RTHOPÆDIC CLINIC. Seventy-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, 118 cases attended for re-examination. There of the children received in-patient treatment at Orthopaedic Hospitals. 80 The cases dealt with for the first time during 1932 were referred for the following conditions, some children having more than one defect:— (a) Deformities—Bones and Joints— (1) Congenital: Asymmetry—skull 2 Prominent Ziphoid Sternum 1 Bowed Tibia; 1 Abnormality—Digit II—hand 1 (2) Acquired: Genu Valgum 21 Genu Varum 2 Bowed Tibiae 27 Bowed Femora 1 Fracture—Clavicle 1 57 (b) Muscular Deformities— (1) Congenital: Talipes 4 Torticollis and Hematoma 12 Webbed Digits—feet 2 (2) Acquired: Pes Plano-valgus 35 Weakness—back and neck muscles 1 (c) Paralysis— 54 (1) Acquired: Anterior poliomyelitis 1 1 Total defects found 112 The prevention of crippling is a matter to which Barking has given serious attention. Arrangements are sometimes made for children, so soon as they are born, to see the Orthopaedic Surgeon. This is not a mere figure of speech—it is actually true. In Barking, where a very large percentage indeed of the children are known to your staff, it is, I am happy to say, only exceptional that a child grows up with any serious deformity. 81 I was very happy the other day, when called upon to show our cripples to the efficer of an organisation interested in these children, to find myself asked at the end of the inspection, " But where are your real cripples ? " It nevertheless docs obtain that in a very small minority of cases, owing to prejudice, we are not able to obtain the results we quite reasonably expect. I am verv "lad indeed to be able to tell you that these cases form a very small minority. 69. ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was continued during 1932. Cases are referred by the medical officers in charge of the Infant Welfare Clinics, and the children attending are kept under constant medical supervision during their course of treatment. The majority of the children referred for treatment were suffering from early rickets and malnutrition. In addition, cases were referred for the following conditions—chilblains, prematurity, general debility and anaemia. In all, 108 children received treatment during 1932. One session per week was devoted to these cases, and 1,016 treatments were given. 70. 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 eight baths granted free of charge during 1932. 71. MEALS TO EXPECTANT AND NURSING MOTHERS. Advantage has been taken during 1932 of this provision under the Act. The total number of dinners supplied to mothers was 428 and in addition, 372 meals were supplied to children. The nutrition of the mother during pregnancy and in the lying-in period has a very important bearing on the well-being of the infant, and it is at these times that necessitous mothers are particularly encouraged avail themselves of the Council's scheme. It is obvious that this service is not being used to the extent that one would wish. May I call your attention to my comprehensive remarks on this question in my last Annual Report ? 82 72. PROVISION OF FRESH MILK. Particulars of the amounts of wet milk supplied free and at reduced rates to necessitous mothers and children are given in the following table :— No. of pints supplied at reduced price. No. of pints supplied free. Total. Total cost of milk supplied. Council's liability in respect of fresh milk supplied. £ s. d. f s. d. 5,029 33,300 38,329 588 16 7 550 8 0¾ 73. PROVISION OF DRIED MILK, ETC. Particulars of the amount of Dried Milk, etc., supplied free and at reduced rates, arc as follows :— Cost Price (pkts.) Reduced (pkts.) Free (pkts.) Total, (pkts.) Ostermilk 453 214 272 939 Ambrosia (half-cream) — — 4 4 Ambrosia 192 97 606 895 Cow and Gate 1,417 754 1,808 3,979 Cow and Gate (half-cream) 178 60 34 272 Colaet 8 — - 8 Haemolac 8 — 45 53 Ostelin — — — — Laetogal 199 8 42 244 Virol 494 3 53 550 Parrish's Food 119 — 11 130 Liquid Paraffin 110 — 9 119 Malt and Oil 102 4 58 164 Vitoleum Cream 74 — 3 77 Pure Cod Liver Oil 150 — 22 172 Trufood — — — — Cod Liver Oil Emulsion 848 29 168 1,045 Totals 4,852 1,164 3,135 8,651 83 74. SERVICES PROVIDED AND FACILITIES FOR TREATMENT. Ante-Natal Clinics Ante-Natal Clinics are held each week at three different Centres. (For particulars of attendances, etc., see page 72 of this Report.) Baths In certain necessitous cases, free baths are provided for expectant and nursing mothers at the East Street Baths. (Sec page 81 for further particulars.) Convalescent Treatment "Convalescent treatment is provided for toddlers and for mothers and babies, on the recommendation of Medical Officers at the Infant Welfare Clinics. Charges are made to the parents in accordance with the Council's scale. During 1932, ten toddlers and three mothers and babies received treatment under this scheme. Dental Treatment Dental treatment for toddlers and expectant and nursing mothers is carried out at the Central Clinic. (See the report of the Dental Surgeon at the back of this Report for further particulars.) Dinners Free dinners are supplied to necessitous nursing- and expectant mothers and to toddlers, on the recommendation of Medical Officers at the Infant Welfare Clinics. (See page 81 for further particulars.) Infant Welfare Clinics Infant Welfare Clinics are held twice weekly at four different Centres. These Clinics are available for all children under the age of five years. (See page 77 for further particulars.) Mati-mity Home Upney Hospital is a maternity home run by the Corporation. Applications for admission are made at the Ante-Natal Clinics and the charges are in accordance with the Council's scale. (See page 72 for particulars of admissions, etc., during 1932.) 84 Milk Grade " A " (T.T.) milk is supplied free of charge and at half-price in certain necessitous cases of expectant and nursing mothers and babies, on the recommendation of the Medical Officers at the Clinics. Certain dried milks are similarly supplied free, at half-price and at cost price. (Sec page 82 for further particulars.) Minor Ailments Treatment is given daily at the Central Clinic and the St. Alban's Clinic to children under the age of five years. Ophthalmic Service A Refraction Clinic for toddlers is held at the Central Clinic as and when required. The scheme includes the provision of spectacles at a very low charge, and in some cases, where the family income is below a certain scale, at no chargc. During the year, two children under the age of five years were provided with spectacles under this scheme. Orthopaedic Service The Orthopaedic Service includes treatment at the Orthopaedic Clinic, the provision of splints and treatment at hospital in the case of children under the age of five years. (See page 79 for further particulars.) Tonsils and Adenoids Surgical treatment for tonsils and adenoids is carried out at two local hospitals under an agreement with the Council. A small charge is made to the parents, except in certain necessitous cases, when no charge is made. During the year, 100 such operations were carried out in respect of children under the age of five years. Ultra-Violet Light Treatment Ultra-violet light treatment is given to children under the age of five years at the Orthopaedic Clinic. (Sec page 81 for further particulars.) 85 Visiting in the Home Periodic visits are paid by the Health Visitors to all children under the age of five years and to all foster-children under the age of nine years. Visits are also paid in certain cases to expectant mothers. (See page 77 for further particulars.) X-Ray Treatment Where necessary, ringworm is treated by X-ray. No charge is made for this treatment; During the year one child under the age of five years was so treated. 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. 86 REPORT OF THE DENTAL SURGEON. July, 1933. The Medical Officer of Health, Barking. Sir, I have the honour to present the Annual Report of the Dental Service of the Maternity and Child Welfare Scheme for the year ended 31st December, 1932. Reference to the figures will show that 149 dentures were supplied to patients as against 80 for the preceding year and that the total number of visits made by adult patients was 850 as against 691 for the preceding year. These figures are convincing enough to show an appreciation of the scheme by those able to benefit by it. The under-age patient is seen any time. This arrangement is both fortunate and necessary, fortunate inasmuch as the tiny ones are able to obtain immediate relief from pain, and necessary because so many are brought along with a dental condition that has long passed the possibility of conservative treatment. New arrivals into the Barking area over the recent two or three years do not seem aware that any child of pre-school age can receive attention. Whether this lack of treatment is usual elsewhere or whether the parents maintain that traditional lack of interest in the deciduous teeth so detrimental to an adequate service and so unfortunate for the child it is not possible to say, but the regrettable fact remains that an appalling number of extractions are undertaken because the first visit of the average under-age child is made much too late and only when the patient is suffering. It is distressing that children of the tender age of 3 and 4 are constantly to suffer pain and loss of teeth because of the apathy of parents, but it is anticipated that the work of the coming year will be of greater conservative value to the toddlers than the year under review. I have the honour to be Sir, Your obedient Servant, W. H. FOY, Public Dental Officer. 87 DENTAL CLINIC. Maternity and Under-Age Cases. Extractions 978 Scalings 27 Dressings 13 Inspections 92 Fillings 92 Dentures supplied 149 Anaesthetics— General 206 Local 28 Patients— Old 702 New 148 Number of Sessions held 96 " Under-age " children— Treatments 785