16 BARK 27 BOROUGH OF BARKING REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1933 C. LEONARD WILLIAMS, B.Sc. Hons. (Lond.), M.R.C.S. (Eng.) L.R.C.P., D.P.H. (Camb.) BARK 27 BOROUGH OF BARKING REPORT OF THE Medical Officer of Health For the Year 1933 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 7, 8 INTRODUCTION 9 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Age Mortality 13 Area 10 Births 10-12, 16 Births, Notification of 16 Deaths 10-16 Deaths, Causes of (Table) 13-15 General Statistics 10 Illegitimate Births 10, 16 Industries 16 Infantile Mortality 10-12, 15, 16 Infantile Mortality (Table) 15 Inhabited Houses 10 Inquests 14 Neo-natal Mortality 15, 16 Population 10 Rateable Value 10 Social Conditions 16, 17 Stillbirths 10-12, 16 Unemployment 17 Vital Statistics 10-12 Zymotic Diseases, Deaths from 13 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Ambulance Facilities 9 Ante-natal Clinics 33 Artificial Sunlight Clinic 35 Barking (Infectious Diseases) Hospital 23-26 Baths for Expectant Mothers 34 Children Act, 1908, Part I 27 Children and Young Persons Act, 1932 27,28 Clinics and Treatment Centres 20-22 Convalescent Treatment 34 Dental Service 34, 37, 38 3 SECTION B—Continued Page Dental Surgeon, Report of 37 Difficult Labour, Consultations in 27, 34 Eye Defects 35 Foster Children 27, 28 Health Visitors 27 Hospital Services 20, 23-27 Hospital Services, Tables of 23-26 Infant Life Protection 27, 28 Infant Welfare Clinics 21, 22, 34 Laboratory Facilities 19 Maternity Cases 20 Maternity Homes 27 Midwifery 20 Minor Ailments 35 Nursing Homes 27 Obstetrics and Gynaecology, Consultations in 27, 33 Opthalmic Service 35 Orthopaedic Service 28-32, 35 Plaistow Maternity Charity 20 Provision of Dinners 34 Provision of Dried Milk, etc.33, 35 Provision of Fresh Milk 33, 35 Provision of Spectacles 35 Public Hospital Services 20, 23-26 Puerperal Fever and Puerperal Pyrexia, Consultations in 27, 34 Services Provided and Facilities for Treatment 33-36 Specialist-Consultant Ante-Natal Clinic 27, 33 Specimens Submitted to Laboratory for Examination 19 Tonsils and Adenoids 35 Ultra Violet Light Treatment 35 Upney (Maternity) Hospital 23-27, 34 Visiting in the Home 27, 36 Voluntary Hospital Services 20, 23-26 X-ray Treatment for Ringworm 36 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. Barking Sewage Disposal Works 39 Bathing in the River Roding 39 Cesspools 39 Closet Accommodation 39, 42 Common Lodging Houses 46 Creeksmouth Generating Station 47 Dampness 42 Defects found under the Factory and Workshop Act, 1901 44 Drainage and Sewerage 39, 42 Dustbin Maintenance 40, 42 Dwelling Houses, Inspection of 40 Factories, Inspection of 41 4 SECTION C—Continued Page Factory and Workshop Act, 1901 44 Home Work 45 Houses Let in Lodgings 46 Miscellaneous Sanitary Inspections 41 Miscellaneous Sanitary Work carried out 43 Northern Outfall Sewage Works 39 Notices Served 43 Offensive Trades 46 Out-workers 45 Pail Closets 39 Parks and Open Spaces 48 Piggeries 46 Port of London Authority 39 Premises and Occupations controlled by Bye-laws and Regulations 41, 46, 47 Public Cleansing 40 Rag Flock Acts, 1911 and 1928 47 Rainfall 39 Refuse Disposal 40 Refuse Storage and Collection 40 Refuse Tips 40 Registered Workshops 45 Repairs, General 43 Rivers and Streams 39 Sanitary Inspection of the Area 40, 41 Sanitary Work, Summary of 42, 43 Schools 48 School Closure 48 Schools, Sanitary Inspection of 48 Sinks 42 Smoke Abatement 47 Stables 46, 47 Street Cleansing 40 Tents, Vans and Sheds 46 Trade Refuse 40 Ultra Violet Light Radiation 48 Underground Sleeping-rooms 46 Water Supply 39, 42 Workplaces, Inspection of 41 Workshops, Inspection of 41 Yard Paving 42 SECTION D — HOUSING. Clearance Areas 52 Closing and Demolition Orders 50, 51 Houses Built in the District, 1926-1933 Houses Erected during the Year 49 Housing Conditions 50-52 Housing Defects Remedied 49, 50 5 SECTION D—Continued Page Housing Inspections 49 Housing Statistics 49-52 Housing Supply and Demand 51 Individual Unfit Houses 51 Inhabited Houses, Number of 50 Proceedings under Public Health Acts 50 Proceedings under the Housing Act, 1930 49, 50 Rehousing 52 Small Dwellings Acquisition Act 50 Temporary Buildings 50 Unfit Dwelling Houses 49 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food 56 Animals Slaughtered 55 Bacteriological Examination of Ice-cream 54 Bacteriological Examination of Milk 53 Barking Corporation Act, 1933 54 Bottling of Milk 53 Chemical Examination of Food 56 Diseased Meat Destroyed 55 Food and Drugs (Adulteration) Act, 1928 56 Graded Milk Licences Granted 53 Ice-cream 54 Meat and Other Foods 54-57 Milk and Dairies (Amendment) Act, 1922 54 Milk (Special Designations) Order, 1923 53 Milk Supply 53, 54 Nutrition 56, 57 Prosecutions 56 Slaughter-houses 54 Unsound Food Destroyed 56 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Acute Anterior Poliomyelitis 60-62 Admissions to Barking (Isolation) Hospital (Table) 64 Artificial Immunisation 65 Barking (Isolation) Hospital 64 Cancer 65, 66 Cancer, Occupations of Fatal Cases of (Table) 65 Cancer, Organs affected in Fatal Cases of (Table) 66 Cerebral-spinal Meningitis 60 Chicken-pox 60-62 Diphtheria 59-65 Diphtheria Notifications (Monthly Summary Table) 63 Encephalitis Lethargica 60-62 6 SECTION F—Continued Page Enteric Fever 60-62, 64 Erysipelas 60-62, 64 Hospital Accommodation for Infectious Diseases 59 Infectious Diseases 59-68 Infectious Diseases (Tables) 60-64 Influenza 63 Measles 63, 64 Measles and Pneumonia 60-62 Non-notifiable Acute Infectious Diseases 63, 64 Notifiable Infectious Diseases 59-63 Notifications classified according to Wards (Table) 61, 62 Ophthalmia Neonatorum 60-62, 67 Pneumonia 60-62, 64 Prevention of Blindness 67 Public Health Act, 1925, Section 62 68 Public Health (Prevention of Tuberculosis) Regulations, 1925 68 Puerperal Fever and Pyrexia 60-62, 64 Rheumatic Fever 63 Scabies 64 Scarlet Fever 60-64 Scarlet Fever Notifications (Monthly Summary Table) 63 Smallpox 60-62 Summer Diarrhæa 63 Tuberculosis 67, 68 Tuberculosis, New Cases and Deaths (Table) 67 Unnotified Fatal Cases of Tuberculosis 67 Whooping cough 63 SCHOOL MEDICAL SERVICE. Table of Contents will be found on Pages 70-71. 7 STAFF, 1933. Medical Officer of Health, School Medical Officer, Medical Superintendent, Barking and Upney Hospitals. C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. Senior Asst. Medical Officer of Health and Senior Asst. School Medical Officer : PATRICK J. O'CONNELL, M.D., B.Hy., B.S., D.P.H. (Commenced 11th September, 1933) 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. (Resigned 31st March, 1933) EDITH A. WHITNEY, M.B., Ch.B., D.P.H. Orthopædic Surgeon : B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Specialist Consultant in Obstetrics and Gynecology : ALAN BREWS, M.D., M.R.C.P., F.R.C.S., M.S. Radiologist : ANGUS E. KENNEDY, M.R.C.S., L.R.C.P., L.S.A. (Died 11th January, 1933) Dental Surgeons : W. H. FOY, L.D.S., R.C.S. R. N. HINES, L.D.S., R.C.S. Sanitary Inspectors : N. BASTABLE (Chief Sanitary Inspector), (b, 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), (c and n). Matron, Barking and Upney Hospitals : Miss M. W. HEDGCOCK (h, i and j). 8 Health Visitors : *Miss C. COURT (g, h and i). Miss G. ELLIOTT (a, h and l). Miss A. E. FINDLAY (Masseuse) (k and o). Miss G. GEDEN (Dental Nurse). Miss S. E. W. GIBSON (j). Miss R. LLEWELYN (Dental Nurse) (h and i). *Miss W. PARKER (g,h and i). *Miss F. G. ROXBURGH (g,h and i) (Commenced 25th October 1933). Mrs. G. STOKES (g and i). Miss L. F. SWAIN (h and i). Mrs. W. WALTON (a, h and l)• Clerical Staff : Chief Clerk—F. READ. C. G. EAGLESFIELD. Miss V. SHEAD H. R. CHANDLER (Commenced 13th March, 1933). (Resigned 2nd September, 1933) D. G. TONKIN (n). Miss H. NUNN. A. J. STORER. Miss H. KING. E. A. ELLIS. Miss E. TASKER G. H. RUFF (Commenced 22nd May, 1933). (Commenced 1st August, 1933). Miss A. LIGGINS (Commenced 2nd October, 1933). Disinfector and Mortuary Attendant : H. LONG. (а) Sanitary Inspector's Certificate of Sanitary Inspectors' Examination Board. (b) Sanitary Inspector's Certificate of Royal Sanitary Institute. (c) Meat, etc., Inspector's Certificate of Royal Sanitary Institute. (d) Smoke Inspector's Certificate of Royal Sanitary Institute. (e) Building Inspector's Certificate of Worshipful Company of Carpenters. (f) Sanitary Science Certificate of Royal Sanitary Institute. (g) Health Visitor's Certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives 'Board. (i) General Hospital Training. (j) General Fever Training. (k) Certificate of Medical Electricity and Swedish Remedial Exercises. (l) Health Visitor's Diploma of Board of Education. (m) Smoke Inspector's Certificate, L.C.C. School of Engineering. (n) Sanitary Inspector's Certificate of Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (o) Certificate of Chartered Society of Massage and Medical Gymnastics. (*) Combined appointment—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, 1933. PUBLIC HEALTH OFFICES, BARKING, ESSEX. July, 1934. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, Herewith I beg to submit, for your favourable consideration, my Report as Medical Officer of Health for the year ended 31st December, 1933. One sad matter to which I feel I must call your attention is the death of Dr. Angus Kennedy. Dr. Angus Kennedy had been associated with the work of the Corporation for many years, and when we lost him we all of us felt that we had lost a personal friend as well as a wonderful colleague. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 10 SECTION A. 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, 1933) (Registrar-General's Estimate) 68,840 Number of Inhabited Houses, March, 1934, according to Rate Rooks :— Houses 16,695 Shops 1,213 Total 17,908 Population Density, i.e., No. of persons per acre 16.8 Rateable Value—General £624,039 0 0 Sum represented by a penny rate £2,140 0 0 Education rates : — Elementary Secondary Included in General Rate Figure 4 0 General Rate 13 8 2. Extracts from Vital Statistics for the Year. Live Births :— Total. Males. Females. Birth Rate. Legitimate 1,175 616 559 17.0 Illegitimate 29 9 20 0.4 Totals 1,204 625 579 17.4 Stillbirths :— Rate per 1,000 total births :— Legitimate 44 25 19 Illegitimate 1 1 Deaths 524 284 240 Death Rate 7.6. Percentage of total deaths occurring in public institutions, 46.7 37.2 Rate per 1,000 total Deaths from puerperal causes :— Deaths, (live and still) births. Puerperal sepsis 5(4) 3.31 Other puerperal causes Totals 5(4) 3.31 Number of deaths of infants under one year of age :— Total Infantile Death Death Males. Females. Total. Rate. Rate. Legitimate 39 27 66 56.1 Illegitimate 1 — 1 34.4 55 6 Number of deaths from Measles (all ages) ,, ,, Whooping Cough (all ages) 2(3) ,, ,, Diarrhoea (under 2 years of age) 17 (N.B.—Where the Registrar-Geneial's figures and rates differ from those prepared locally, the former are shown separately in brackets.) 11—12 3. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1933. (England & Wales, 118 County Boroughs, 132 smaller Towns, and BARKING.) (Provisional figures. The rates for England and Wales, London and Barking have been calculated on a population estimated to the middle of 1933, but the other rates have been calculated on populations estimated to the middle of 1932. 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 byRegistered Medical Practitioners. Inquest Cases. Certified by Coroner after P.M. No Inquest. Uncertified Causes of Death. England and Wales 14.4 0.62 12.3 0.01 0.00 0.05 0.02 0.05 0.06 0.57 0.54 7.1 64 90.9 6.3 1.9 0.9 118 County Boroughs and Great Towns, including London .. 14.4 0.67 12.2 0.00 0.00 0.00 0.02 0.06 0.08 0.55 0.49 9.4 67 91.0 6.0 2.5 0.5 132 Smaller Towns (Estimated resident populations, 25,000 to 50,000 at Census, 1931) 14.5 0.63 11.0 0.00 0.00 0.04 0.02 0.04 0.04 0.53 0.44 4.9 56 91.7 5.8 1.6 1.0 London 13.2 0.45 12.2 0.00 0.00 0.02 0.02 0.08 0.08 0.51 0.58 11.6 59 88.3 6.3 5.4 0.0 BARKING 17.4 0.65 7.6 0.00 0.00 0.01 0.01 0.03 0.04 0.30 0.37 14.11 55 81.1 7.8 10.9 0.2 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows : per 1,000 Live Births 1.79 2.63 4.42 „ „ Total Births 1.71 2.52 4.23 4. VITAL STATISTICS OF WHOLE DISTRICT FROM 1925 TO 1933. Year. 1 Population estimated to Middle of each Year. 2 Births. Nett. Total Deaths Registered in the District. Transferable Deaths. Net Deaths belonging to the District. Of Nonresidents registered in the District. 7 Of residents registered out of the District. 8 Under One year of age. At all Ages. Number. 3 Rate. 4 Number. 5 Rate. 6 Number. 9 Rate per 1,000 Net Births. 10 Number. 11 Rate. 12 1925 38,450 825 21.4 287 7.4 8 107 66 80.0 386 10.0 1926 38,920 818 21.0 259 6.6 11 118 49 59.9 366 9.4 1927 39,900 710 17.7 251 6.2 7 162 47 66.1 406 10.1 1928 40,870 805 19.7 276 6.7 6 144 51 63.3 414 10.1 1929 42,160 787 18.7 291 6.9 8 152 42 53.4 435 10.3 1930 45,000 799 17.7 256 5.7 7 186 49 61.3 435 9.7 1931 51,830 947 18.3 328 6.3 7 215 61 64.4 536 10.3 1932 60,330 1105 18.3 283 4.7 17 239 59 53.4 505 8.4 1933 68,840 1204 17.4 290 4.2 13 247 67 55.6 524 7.6 13 5. DEATHS. (a) General.—There were 290 deaths registered in Barking in 1933. Of these 13 were deaths of non-residents. Barking residents to the number of 247 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. 284 240 524 The death rate for 1933 was 7.6 per 1,000, compared with 8.4 in 1932, 12.3 for England and Wales, 12.2 for the hundred and eighteen County Boroughs and Great Towns, including London, 11.0 for the one hundred and thirty-two smaller towns, and 12.2 for London. (b) Age Mortality.— I he deaths in various age groups, according to the hgures obtained locally, were as follows :— Age Group. No. of Deaths. Under 1 year .. .. .. .. . .. .. 67 1 to 2 years .. .. .. .. .. .. .. 12 2 to 5 years .. .. .. .. .. .. .. 12 5 to 15 years .. .. .. .. .. .. .. 17 15 to 25 years .. .. .. .. .. .. .. 33 25 to 45 years .. .. .. .. .. .. .. 68 45 to 65 years .. .. .. .. .. .. .. 123 Over 65 years .. .. .. .. .. .. .. 192 (c) Causes of death in 1933.—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 126 24.0 Cancer 67 12.7 Tuberculosis (all forms) 50 9.5 Pulmonary affections (exclusive of tuberculosis), viz., Bronchitis Pneumonia (all forms)0 43 8.2 Other respiratory diseases 10 1.9 Zymotic Diseases 24 4.6 (d) Deaths from Zymotic Diseases.-—These diseases caused 4.6 per cent. of the total deaths, such deaths being caused in the following proportions :— Enteric Fever - Measles 1 Whooping Cough 2 Scarlet Fever 1 Diphtheria 3 Diarrhoea 17 Smallpox 14 (e) Inquests.—Coroner's inquests were held on 41 deaths. (f) Causes of and ages of death during the year, 1933. (Net Deaths). Cause of Death. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the district. RegistrarGeneral'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 - - - - - - - - - Measles 1 - - - - - - 1 1 Scarlet Fever — 1 — — — — 1 1 Whooping Cough 1 1 - - - - - 2 3 Diphtheria — 1 2 — — — — 3 2 Influenza 1 3 — 1 6 4 6 21 22 Encephalitis Lethargica - - - - - 1 — 1 1 Cerebro-Spinal Fever - - - - - - - - - Tuberculosis of Respiratory System - - - 17 15 10 2 44 44 Other Tuberculous Diseases 1 3 1 — 1 — — 6 6 Syphilis - - - - - - - - - General Paralysis of the Insane, etc. - - - - - 2 - 2 2 Cancer — — — — 8 35 24 67 68 Diabetes — 1 — 1 — — 2 4 3 Cerebral Haemorrhage - - - - - 1 12 13 16 Heart Disease — 1 2 2 7 20 72 104 103 Aneurysm — — — — — — — — — Other Circulatory Diseases - - - - - 5 17 22 20 Bronchitis 1 — — — 3 7 18 29 26 Pneumonia 10 5 3 1 5 11 8 43 34 Other Respiratory Deseases 1 — — 2 4 1 2 10 7 Peptic Ulcer - - - - - - - - 7 Diarrhoea (under two years) 16 1 - - - - - 17 17 Appendicitis — 1 3 1 — 1 — 6 6 Cirrhosis of Liver - - - - - 1 — 1 1 Other Diseases of Liver 1 — — — 1 1 - 3 3 Other Digestive Diseases — — 2 — 2 2 3 9 7 Acute and Chronic Nephritis — — 1 — 2 7 4 14 14 Puerperal Sepsis — — — 2 3 — — 5 4 Other Puerperal Causes - - - - - - - - - Congenital Debility, Premature Birth, etc. 32 - - - - - - 32 34 Senility - - - - - - 12 12 10 Suicide — — — — 2 5 — 7 7 Other Violence — 2 3 5 4 2 3 19 21 Other Defined Diseases 2 4 — 1 5 7 7 26 34 Causes ill-defined or unknown — — — — — — — — — Totals 67 24 17 33 68 123 192 524 524 15 (g) Infant Mortality during the year 1933. 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 :— INFANTILE DEATHS—1933. ]Causes of Death. (All causes certified.) Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total under one year.  Atelectasis of Lung - - - - - - 1 - - 1 Congenital Heart Disease 2 - - - 2 - - - - 2 Congenital Malformation 1 - 2 - 3 - - - - 3 Convulsions 1 - - — 1 — 1 - — 2 Diarrhoea - — — — - 1 3 - - 4 Gastro-Enteritis - - - - - 3 4 2 2 11 Iceterus gravis - - - - - 1 - - - 1 Iceterus Neonatorum 1 — - — 1 - - - - 1 Influenza - - - - - — - - 1 1 Injury at birth 1 - - - 1 - - - - 1 Insufficient inherent vitality - — - 1 4 - - - - 4 Measles - — — — - 1 — - - 1 Marasmus 1 1 - - 2 2 1 — 5 Meningitis - - - - - 1 1 - 1 3 Pneumonia 1 1 — - 2 - 1 1 2 8 Premature birth 12 - 1 - 13 1 - - - 14 Pyloris stenosis - - - - - 1 1 - - 2 Tubercular perforation of Stomach - - - - - - - - 1 1 Whooping Cough - - - - - 1 - - - 1 Bronchitis - - - - - 1 - - - 1 Totals 23 2 3 1 29 13 14 4 7 67 Net Births in the year :— Legitimate 1175 Illegitimate 29 1204 Net Deaths in the year:— Legitimate 66 Illegitimate 1 67 (h) Neo-natal Mortality during the year 1933. From the preceding table it will be seen that 29 out of the 67 infant deaths were of children under the age of four weeks—i.e., approximately 40 per cent, of those who died were under the age of four weeks. You will note the relatively large number of deaths which have been attributed to premature birth. 16 The following table shows the comparative figures of infant mortality and neonatal mortality for the past seven years :— Infantile and Neo-natal Mortality and Rates for the years 1927-1933 :— ]Infantile Mortality Infantile Mortality Rate Neo-natal Mortality Neo-natal Mortality Rate Year 1927 .. .. .. 47 66.1 18 12.8 1928 .. .. .. 51 63 24 19.3 1929 .. .. .. 42 53.4 28 18.9 1930 .. .. .. 49 61 24 19.2 1931 .. .. .. 61 64 31 29.4 1932 .. .. .. 59 53 28 25 1933 .. .. .. 67 55.6 29 24 6. BIRTHS. The net number of births registered in 1933 was 1,204, affording an annual birth rate of 17.4 per 1,000 population, compared with 18.3 in 1932, 18.3 in 1931, 17.8 in 1930,18.7 in 1929 and 19.7 in 1928. Of all births, 29 were illegitimate, giving a percentage of 2.4 of the total births. Notification of Births Acts, 1907-1915.—During 1933 there were 1,185 live births notified, excluding 37 cases transferred from the district. In addition, notifications of stillbirths belonging to the district totalled 38. Twenty three live births and 5 stillbirths were not notified, and these cases are not included in the totals of notified births given above. 7. SOCIAL CONDITIONS. (a) Industries.-—Some of the chief industries carried on in the area are as follows The production of electricity, gas, benzole and naptha. The manufacture of asbestos goods, ice-cream, letter files, mineral waters, marine lights, disinfectants, printing ink, sausage skins, cabinets, nautical instruments, paint, iron goods, tin boxes, lifebelts, rubber goods, wireless equipment and batteries, matches, soap, and chemical manure. The storage of petrol oil, fuel and timber. Electrical welding, structural engineering, saw-milling and joinery. The population of Barking is almost entirely industrial. Barking is becoming a dormitory. 17 (b) Unemployment.—The following table is compiled from information kindly supplied by the Manager of the Ministry of Labour Employment Exchange, Barking; these figures include persons receiving transitional benefit :—- Return to 25th December, 1932. Wholly Unemployed Temporarily Stopped Casually Employed Total Men 1,832 44 297 2,173 Women 318 89 3 410 Totals 2,150 133 300 2,583 Return to April, 1933. Men 1,840 46 292 2,178 Women 329 64 1 394 Totals 2,169 110 293 2,572 Return to 25th December, 1933. Men 1,665 37 325 2,027 Women 273 73 1 347 Totals 1,938 110 326 2,374 Arising out of the question of unemployment, I am asked by the Ministry to state any evidence we may have, statistical or otherwise, as to whether unemployment has had any effect on the health or physique of children or adults. The figures on malnutrition, published by me in my Report as School Medical Officer, show that malnutrition as a disablement does occur in Barking to some extent, and wherever such cases are found strict enquiry is made and every possible help given. These figures are as follows:— Of 5,284 children examined by routine at school medical inspection, 81 were found to be suffering from malnutrition ; of these, 3 were referred for treatment and 78 for observation. In addition, 32 children were specially examined from the standpoint of malnutrition ; of these, 6 were referred for treatment and 26 for observation. We have no statistical evidence as to malnutrition in the adult population. 19 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. GENERAL HEALTH SERVICES. (a) Laboratory Facilities.—The necessary laboratory work of the district is carried out by arrangement with the Essex County Council at the Counties' Public Health Laboratories, situated in Queen Victoria Street, London, E.C.4. Particulars of the number of specimens submitted for examination are supplied by the following table:— Specimen. Number examined Diphtheria 1,483 Sputa 236 Typhoid 31 Ringworm 11 Miscellaneous 14 Total 1,775 In addition there was 1 biological examination. (b) Ambulance Facilities.—There have been no definite changes in the ambulances during the year 1933. The usual reciprocal agreements with neighbouring authorities have been maintained. One interesting addition is that our ambulances now carry a "Novox" resuscitation apparatus for the administration of 7 per cent. carbon dioxide in oxygen, and this apparatus is at the service of general practitioners who may require it. 20 (c) Clinics and Treatment Centres.—The table on pages 21-22 shows the various out-patient departments under the control of the Local Authority. (d) Hospitals (Public and Voluntary).—There have been no material changes since last year, but for reference the report prepared last year is here included, which shows in tabular form the hospital services available, public and voluntary, for the people of Barking. In an important town like Barking, with a large industrial population, the question of your indebtedness to the local hospitals is bound to arise very forcibly. It seems to me unsatisfactory to deal with this question piecemeal. I would recommend that a definite total sum be set apart each year—say £250— and that this be distributed in proportion to the work done. I would recommend that no notice be taken whatsoever of Barking patients attending for ordinary out-patient treatment, but that hospitals who apply for a donation be invited to supply, not necessarily exact, but approximate, details of the number of in-patients treated, of the number of bed-days these patients have been in hospital, and of the number of out-patients in whose case a report has been sent from the consultant to the general practitioner attending the patient. I believe this information could be abstracted, if absolute accuracy were not insisted upon, in a few minutes from the records of any hospital. 2. MATERNITY AND CHILD WELFARE SERVICES. (a) 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, 1933, in respect of 206 cases, amounted to £217 0s. 6d., leaving a balance due to the Charity from the Council of £82 19s. 6d. According to information obtained from the County Medical Officer, at the end of 1933 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 the year 1933 there were 1,181 maternity cases in the district. 196 of these were conducted by the Plaistow Maternity Charity, 264 of them were conducted by your own midwives at Upney Hospital, leaving 721 which were dealt with by medical practitioners, private midwives or otherwise. 21—22 CLINIC AND TREATMENT CENTRES. Name and Situation. When held. Nature of Accommodation. By whom Provided. 1 MATERNITY AND CHILD WELFARE— (a) Infant Welfare Centres •Clinic Premises, East Street. Tuesdays and Fridays, 2 p.m. Accommodation for consultations, weighing of babies, waiting-room, etc. Local Authority. Greatfields Centre, Movers Lane. Alexandra Centre, St. Paul's Road Mondays and Thursdays, „ „ „ „ „ 2 p.m. „ „ „ „ „ †St Alban's Centre, Urswick Road. Wednesdays and Fridays, 2 p.m. „ „ „ „ „ (6) 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. „ „ „ „ „ Specialist-Consultant Clinic, Alexandra Centre, St. Paul's Road. Last Friday in each month, except August and December, 2 p.m. „ „ „ „ „ (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. „ „ (6) Eye Clinic •Clinic premises, East Street. Approximately three times weekly. One room. „ „ (c) Dental Clinic „ „ Daily, 9 a.m. to 1 p.m. and 2 to 5 p.m. Two rooms. „ „ (d) Orthopaedic Clinic ‡Faircross School. Mondays, 9 a.m. to 12 noon, and 2 to 4 p.m. Wednesdays, ditto. Fridays, ditto. One room. „ „ 3. TUBERCULOSIS— 37, Linton Road. Mondays, 3 to 5 p.m. Thursdays, 10.30 a.m. to 12 noon. Three rooms. Essex County Council. 4. VENEREAL DISEASES— London Hospitals, etc. – – By arrangement with Essex County Council. * Since the end of 1933 these services carried on at the East Street Clinic have been transferred to the Central Clinic, Vicarage Drive, †Since the end of 1933 these services carried on at the St. Alban's Clinic have been transferred to the Shaftesbury Clinic, Stamford Road, and the sessions for Infant Welfare have been altered to Tuesday and Friday afternoons, †Since the end of 1933 no session has been held on the first Friday of each month ; this has been changed to the first Thursday of the month, when the surgeon attends for consultations. 23—24 TABLE 1. 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 Barking— 1 Upney (Maternity) Hospital Upney Lane, Barking, Essex Maternity — 26 — Borough of Barking 2 Barking (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 Orthopaedic Hospital Hale End, Woodford Green, Essex. Orthopaedic — 30 Voluntary 5 City of London Hospital for Diseases of Heart and Lungs Victoria Park, E.2 Heart and Lung Diseases 85 88 8 Voluntary 6 East Ham Memorial Hospital Shrewsbury Road, E.7 General Medical and General Surgical 34 34 20 Voluntary 7 Golden Square Throat, Nose and Ear Hospital Golden Square, Piccadilly Circus, W.I Ear, Nose and Throat 36 37 11 Voluntary 8 Guy's Hospital London Bridge, S.E.I General Medical and General Surgical, etc. 299 287 63 Voluntary 9 Hospital for Sick Children Great Ormond Street, W.C.I. General Medical and General Surgical and Isolation (Children only) 252 Voluntary 10 Joyce Green Hospital Dartford, Kent Isolation of Smallpox (Information not a vailable ) London County Council 11 King George Hospital Ilford, Essex General Medical and General Surgical 41 61 22 Voluntary 12 London Hospital Whitechapel Road, E.I General Medical and General Surgical 379 375 89 Voluntary 13 London Lock Hospital and Home 283, Harrow Road, W.9 Maternity and Venereal Diseases 10 30 16 Voluntary 14 London Skin Hospital 40, Fitzroy Square, W.I 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 Surgical 56 30 26 Voluntary 17 Princess Elizabeth of York Hospital for Children Glamis Road, Shadwell, E.I Children 135 Voluntary 18 Public Assistance Hospital Oldchurch Road, Romford, 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, Children, Maternity 54 106 47 Voluntary 21 Royal London Ophthalmic Hospital (Moorfields Eye Hospital) City Road, E.C.I Ophthalmic 66 50 19 Voluntary 22 Royal National Orthopsedic Hospital Brockley Hill, Stanmore, Middlesex Orthopaedic .. .. 45 70 345 Voluntary 23 St. Bartholomew's Hospital Smithfield, E.C.I General Medical and Surgical, Children, Maternity, etc., Ophthalmic, Orthopedic, Ear, Nose and Throat, and Septic, 287 344 65 Voluntary 24 St.Mary's Hospital for Women and Children Upper Road, Plaistow, E.13 etc. General Medical and Surgical, Children, etc. — 33 38 Voluntary 25 Severalls Mental Hospital Mile End, Colchester Mental 717 1169 — Essex C.C. and Colchester B.C. 26 Westminster Hospital Broad Sanctuary, Westminster, S.W.I General Medical and Surgical, Maternity, Ear, Nose and Throat, etc, 92 128 22 Voluntary In addition to the above Institutions, there are a number of Sanatoria to which tuberculous persons resident in Barking are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis. In the case of isolation and smallpox hospitals, the bed accommodation has been given on the basis of 144 square feet per bed. 25—26 TABLE II. HOSPITAL SERVICES, showing the number of beds for each purpose, and other facilities available. Name of Hospital Number of beds for the following purposes :— Other facilities available Arrangements for pathological work Accident Chest (nontub.) & Heart Children Chronic Sick Dental Dermatological Ear, Nose & Throat General Medical General Surgical Gen i to-urinary Gynaecological Infectious Diseases Isolation & Observation Maternity Mental Neurological Ophthalmic Orthopaedic Radium Septic Small-pox Tuberculosis Venereal Diseases i Controlled by the Council of the Borough of Barking. 1† Upney (Maternity) Hospital – – – – – – – – – – – – – 26 – – – – – – – – – Operative surgery, Dental, Nursing of Puerperal Fever and Pyrexia. Carried out at the Counties' Laboratory, Queen Victoria Street, E.C.4. 2† Barking (Isolation) Hospital Not controlled by the Council of the Borough of Barking. – – – – – – – – – – – 58 – – – – – – – – – – – Operative surgery, Dental, Ear, Nose and Throat, Orthopaedic, Maternity, Puerperal Fever and Pyrexia, Ophthalmia Neonatorum. 3 Brentwood Mental Hospital – – – – – – – – – – – – – – 1801 – – – – – – – – All specialised treatment available. Own Laboratory. 4 Brookfield Orthopædic – – – – – – – – – – – – – – – – – – – – – – – Operative Surgery, Ultra-violet light, Dental, Massage ,X-rays,Ophthalmic. No information. 6 City of London Hospital for Diseases of Heart and Lungs — 72 8 – – – – – – – – – – – – – – – – – – 101 — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Nose and Throat, Radium. Own Laboratory. 6 East Ham Memorial – – – – – 3 4 37 36 — 8 — — — — — 4 4 — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Electrical, Massage. Own Laboratory. 7 Golden Square Throat, Nose and Ear – – – – – – – – – – – – – – – – – – – – – – – Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic, Radium. Carried out by a Pathologist outside the Institution. 8 Guy's 58 — 14 — 4 6 33 179 150 10 24 — 40 21 4 9 24 19 8 — — — 9 All specialised treatment available. Own Laboratories. 6 Hospital for Sick Children – – – – – – 18 106 121 — — — — — — — — — — — — — 7 All specialised treatment available. Own Laboratory. 10 Joyce Green Hospital (Isolation of Smallpox). No information available from the London County Council. (No information available from the L.C.C.) No information available. 11 King George Hospital – – 22 – – – – 34 68 – – – –– – – – – – – – – – – Operative surgery, X-rays, Dental (as casualty), Ophthalmic, Massage, Ear, Nose and Throat, Gynaecological, Neurological, Dermatological. Own Laboratory 12 London Hospital — — — — — — 28 306 338 — 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. 16 Orsett Joint Smallpox — — — — — — — — — — — — — — — — — — — — — — — 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. IV Princess Elizabeth of York Hospital for Children – – – – – – – – – – – – – – – – – – – – – – – 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 Opthhalmic (Moorfields Eye Hospital) — — — — — — — — — — — — — — — — 135 — — — — — — All specialised treatment available with the exception of Operative surgery, Massage and Radium. Own Laboratory. 22 Royal National Orthopaedic – – – – – – – – – – – – – – – – – – – – – – – 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. Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Nose and Throat, Orthopaedic. Own Laboratories. Part-time Pathologist in conjunction with other Hospitals. 24 St. Mary's Hospital for Women & Children — — — — — — — 22 37 — 8 — — — — — 4 — — — — — — 25 Severalls Mental Hospital – – – – – – – – – – – – – – – – – – – – – – – Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic. Own Laboratory. Westminster Hospital 10 — 13 5 — 2 7 64 85 — 10 — 8 12 — — 6 4 16 — — — | — All specialised treatment available. Own Laboratories. t In the case of Hospitals under the control of the Borough of Bar kins :— Number and classification of Medical Staff Number and classification of Nursing Staff : Matron Sisters Assistant Nurses Midwives Probationer Nurses Arrangements for the employment of consultants Upney (Maternity) Hnstiital Barking (Isolation) Hospital. The Medical Officer of Health is also the Medical Supt. and is assisted in this work by the Assistant M.O.'s H. 1 3 3 1 3 14 10 Consultants are engaged when necessary. In addition to the above Institutions, there are a number of Sanatoria to which tuberculous persons resident in Barking are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis 27 (b) Maternity and Nursing Homes.—During the year it has been necessary to use the increased accommodation you provided in the Upney Hospital for maternity cases in December, 1932. There is one house in Barking used as a nursing home. During the year 1933, 14 births have been notified from this address. (c) Consultations in Obstetrics and Gynecology.—An important development during the year in the midwifery and maternity services maintained by the Corporation is the appointment of Mr. Alan Brews as Consultant Obstetrician and Gynaecologist. Mr. Brews attends ten times during the year to hold consultative out-patient departments, to which patients are referred by the medical practitioners in the area, including your own officers. Mr. Brews also undertakes all consultation work, etc., in connection with cases of puerperal fever and puerperal pyrexia, and in addition may be consulted by medical practitioners in cases of abnormal or difficult labour. (d) Health Visitors.—During the year your health visiting staff has been increased in that part of Barking east of Lodge Avenue, generally known as the Becontree Estate. On this Estate the work of health visitor and school nurse is combined, and, whereas to begin with there were only two such visitors covering the area, towards the end of 1933 two further visitors were appointed. (e) Infant Life Protection (under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932).—Work under the Children Act, 1908, has been progressing steadily in Barking these several years, and the Act of 1932 has still further strengthened your powers for the protection of these children. We received from the Town Clerk a synopsis of the new Act, setting out our obligations, and these we have discharged. Month by month I have called your notice to such irregularities which have arisen with reference to notification by foster-parents, and I am wondering if and whether a regulation could be enforced insisting that, where a foster-child is handed over from one foster-parent to another or is handed over to anybody who may reasonably be 28 expected to understand the obligations under the Act, it shall be necessary for the person handing over the child to explain to the person receiving this child his or her obligations. I hold the view that no foster-parent is exercising that due care on which we can insist unless he or she provides any necessary fire-guard. In this connection I think that when you are building houses it would be wise to see either that there are suitable fixtures in the wall beside the fire place to support a standard fire-guard or that special precautions are taken so that these can be fixed without damage to the property. (f) Orthopcedic Treatment.—The following tables, which are prepared on lines similar to those previously used, show the work which has been carried out at the Orthopaedic Clinic amongst children under school age. No. of primary examinations by Orthopaedic Surgeon 98 No. of re-examinations by Orthopsedic Surgeon 153 The cases dealt with for the first time during 1933 were referred for the following conditions, some children having more than one defect:— (a) Deformities—Bones and Joints:— (1) Congenital : Asymmetry—skull 2 Subluxation—shoulder-joints 1 Dislocation—hip 1 Abnormality—digits:— (a) hand 1 (b) foot 3 (2) Acquired: Genu varum 1 Genu valgum 35 Bowed tibiae 30 Bowed femora 1 – 75 29 (b) Muscular:— (1) Congenital: Talipes 10 Torticollis and Hematoma sterno-mastoid 12 Hypo-thyroidism 1 (2) Acquired : Kyphosis 1 Pes plano-valgus 52 Superficial burn—hand 1 Baker's cyst 1 78 (c) Paralysis:— (1) Congenital: Spastic diplegia 1 1 Total defects found 154 During the year, twelve children under school age received in-patient treatment at orthopaedic hospitals (Brookfield Hospital or Queen's Hospital for Children). 1 he following operations were carried out in these case:— Osteoclasis 3 McEwan's osteotomy 3 Tenotomy Tendo-Achilles and Plaster 1 Manipulations—feet—and plaster 10 Mr. Whitchurch Howell, the Orthopaedic Surgeon, has called my attention to the increase in the number of attendances of children under five years of age. 1 his is an important development, because attendances under the age of five years, when any disability can be put right much more easily than later, are far more important than attendances later in life, when remedial measures are more difficult in themselves and cannot be expected to be quite so satisfactory. 31—32 PARTICULARS OF WORK DONE IN CONNECTION WITH ORTHOPÆDIC CLINIC. No. of visits by Orthopaedic Surgeon No. of visits by Masseuse ATTENDANCES Primary Examination Re-Examination For Treatment Total School Children Under School Age School Children Under School Age School Children Under School Age School Children Under School Age 11 230 92 98 215 153 2,427 951 2,734 1,202 TREATMENTS. Massage Electricity Remedial Exercises Ultra Violet Therapy Radiant Heat Dressings and Splintage No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatment School Children 9 136 2 16 89 1,521 25 750 — — 35 120 Under School Age 13 139 – — 4 26 62 580 — — 70 289 Admission to Hospitals On waiting List for Admission 31/12/33 School Children Under School Age Total School Children Under School Age Total 10 12 22 – – – (8 under Council's Orthopaedic Scheme) 33 (g) 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. 4,221 32,752 36,973 £ s. d. i s. d. 573 13 10½ 541 19 1½ (h) Provision of Dried Milk, etc.—Particulars of the amounts of dried milks, etc., supplied free and at reduced rates are as follows:— Cost Price (pkts.) Reduced (pkts.) Free (pkts.) Total (pkts.) Ostermilk 517 148 161 826 Ambrosia 645 334 848 1,827 Ambrosia (half-cream) 6 — 3 9 Cow and Gate 1,767 827 2,408 5,002 Cow and Gate (half-cream) 210 84 78 372 Colact 57 3 25 85 Hæmolac 18 8 39 65 Lactogal 348 2 29 379 Virol 543 15 116 674 Parrish's Food 151 — 16 167 Liquid Paraffin 143 — 21 164 Malt and Oil 246 15 100 361 Vitoleum Cream 23 — 7 30 Pure Cod Liver Oil 177 — 26 203 Cod Liver Oil Emulsion 1,529 52 185 1,766 Totals 6,380 1,488 4,062 11,930 (i) Services Provided and Facilities for Treatment. Ante-Natal Clinics Ante-Natal Clinics are held each week at three different Centres. (For particulars of sessions see pages 21-22 of this Report.) Ante-Natal Clinic (Specialist-Consultant) The Specialist-Consultant in Gynaecology and Obstetrics holds one session per month during ten months of the year. (See pages 21-22 of this Report for further particulars). 34 Baths In certain necessitous cases, free baths are provided for expectant and nursing mothers at the East Street Baths. During 1933, 9 baths were granted free of charge. 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 accordancc with the Council's scale. During 1933, 18 toddlers, one mother, and 5 mothers with 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 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. During 1933, 913 dinners were supplied to mothers and 1,032 to children under this scheme. 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 pages 21-22 for further particulars.) Maternity Services Maternity 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. Consultations.—There is a Specialist-Consultant available for consultations in cases of puerperal fever and puerperal pyrexia and in cases of difficult labour. 35 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. (See page 33 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 charge. During the year, ten 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 pages 28-32 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, 107 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. During 1933, 233 children were treated, a total number of 580 treatments being given. 36 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. X-Ray Treatment for Ringworm Where necessary, ringworm is treated by X-ray. No charge is made for this treatment. No child under the age of five years was so treated during the year 1933. 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. 37 REPORT OF THE DENTAL SURGEON. July, 1934. To the Medical Officer of Health, Borough of Barking. Sir, I have the honour to submit the Dental Report for the Maternaty and Child Welfare service for the year ended December 31st, 1933. There is a general increase in the treatments undertaken, and the popularity of the scheme as maintained by the Council is evidenced by the figures in the appended table. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, L.D.S., R.C.S. (Eng.) Public Dental Officer. 38 DENTAL CLINIC Maternity and Under-Age Cases. Extractions 1528 Scalings 38 Dressings 12 Inspections 159 Fillings 60 Dentures supplied 143 Anaesthetics— General 341 Local 22 Patients— Old 884 New 171 Number of Sessions held 93 "Under-age" children— Treatments 1487 39 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. 1. WATER. Water is supplied to the area by the South Essex Waterworks Company, and, generally speaking, is drawn from the River Stour. The water is of satisfactory purity. Four samples of water were taken during the year from various services. 2. RAINFALL. The rainfall for the year ended December 31st, 1933, was 17.23 inches. This compares with 13.88 inches in the very dry year of 1921. Rain fell on 158 days in the year 1933. 3. DRAINAGE AND SEWERAGE. Further considerable progress has been made in the work of sewering the district, to convey the sewage of Ilford and Barking to the Northern Outfall Works of the London County Council at Barking. The Barking Sewage Disposal Works, situated at Gascoigne Road, Barking, continued in operation during the year. 4. RIVERS AND STREAMS. The rivers and streams running through the area are controlled by the River Roding Catchment Board, whilst the River Thames, your southern boundary, and one of its tributaries, the River Roding, which flows through Barking, is under the control of the Port of London . Within 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. I wish once more to say that on no account should anyone bathe in the River Roding. 5. CLOSET ACCOMMODATION. At the end of the year there remained a total of 22 premises unconnected with the sewer. Ten of these were factory premises. Of these 22 premises, 12 have cesspools and 10 have pail closets. Seven premises were connected to the sewer during the year, without cost to the Corporation. The premises still unconnected are isolated properties, some of which are likely to be demolished soon. Cleansing is carried out by means of covered vehicles and suction pumps. 40 6. 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. By the operation of the Barking Corporation Act, which came into force at July, 1933, a standard type of dustbin is being brought gradually into general use. During the year, 8,556 loads of refuse were collected, with an average weight of 1 ton 14 cwts. This figure shows a yield of 11.5 cwts. per 1,000 of the population per day. 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. I am glad to be able to say that during the year the Corporation tips have been kept in a better condition than formerly. (b) Street Cleansing.—The streets of the town are kept in a satisfactory state. As you know, I hold the opinion that street gullies should be emptied and cleansed by mechanical means. 7. SANITARY INSPECTION OF THE AREA. (a) Work of Sanitary Inspectors. (1) Inspection of Dwelling-Houses. Total Houses Inspected under Public Health or Housing Acts 3,125 Total Number of Inspections made 11,710 Housing (Consolidated) Regulations 912 After Infectious Disease 924 Defects Found 10,836 Notices Served (Preliminary) 2,614 Re-inspections re Notices Served 4,439 Inspection of Works in Progress 809 41 (2) Premises Controlled by Bye-Laws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings 2 — — Common Lodging Houses 103 2 2 Offensive Trades 139 5 1 Tents, Vans and Sheds 78 8 1 Dairies, Cowsheds and Milkshops 293 6 2 Slaughter-houses 44 — — (3) Factories, Workshops and Workplaces. tions. Defects. es. Factories 252 35 13 Laundries 15 2 1 Bakehouses 43 1 — Domestic Workshops 12 — — Other Workshops 76 — — Other Workplaces 81 4 3 Outworkers' Rooms 70 — — Butchers' Premises 614 10 7 Fishmongers 35 12 1 Restaurants and Dining Rooms 115 13 8 Stables and Stable Yards 172 14 6 Piggeries 32 — — (4) Miscellaneous. tions. Defects. Notices. Rats and Mice (Destruction) Act, 1919 187 6 3 Vacant Land and Refuse Dumps 142 14 7 Public Lavatories 57 — — Schools 46 1 1 Markets and General Shops 318 4 1 Ice-Cream Vendors 115 1 1 Petroleum and Celluloid Stores 97 1 1 Waterlogged Ground 2 — 1 Drainage Inspections 204 — — Milk Sampling 73 — — Rippleside Conversions 18 — — Other Miscellaneous 144 — — Visits to Smallpox contacts 662 Inspection of Meat from Outside District 196 — — 42 (b) Summary of Sanitary Work Carried Out. (1) Drainage. Choked drains, opened, repaired, and cleansed 246 Drains reconstructed 47 New drains (conversions) 7 Ventilation shafts repaired or new fixed 46 New inspection covers 12 (2) Closet Accommodation. Roofs Walls Floors Doors W.C. structures repaired 16 Seats fixed 72 W.C. pans fixed or cleansed77 Flushing apparatuses repaired or renewed 211 (3) Sinks. New fixed 51 New sink and bath wastepipes 125 New gulley traps 22 (4) Dampness. Roofs and flashings 861 Eavesgutters 490 Rainwater pipes 212 (5) Water Supply. Drawtaps provided 2 Defective water fittings repaired and supply reinstated 71 Disconnected from storage tanks 14 (6) Yard Paving. Yard paving repaired or relaid 227 Gulley dishing repaired or renewed 115 (7) Dustbins. New ones provided 722 43 (8) General Repairs. External walls repointed 853 House floors repaired 245 Windows repaired or renewed 433 Window and door reveals repaired 153 Window sills repaired or renewed 393 Sashcords renewed 534 Washing coppers repaired or renewed 180 Stoves repaired or renewed 323 House doors and frames repaired or renewed 147 Stairs repaired 38 Handrails fixed 37 Chimney pots renewed and stacks rebuilt 433 Dirty or defective rooms repaired, cleansed and redecorated 1,894 Damp walls remedied 243 Insufficient floor ventilation 186 Insufficient ventilation and light 2 External painting 276 Weatherboards fixed 14 Door sills repaired or renewed 75 Defective brickwork repaired 8 Food storage provided 1 Fences repaired 1 Window fasteners fixed 17 (9) Miscellaneous. Offensive accumulations removed 71 Animals so kept as to be a nuisance 17 Verminous rooms disinfested 64 Flooding 1 Drains tested 292 Dangerous structures reported 24 Overcrowding 64 Shed erections 6 Other conditions 116 (c) Notices Served. Informal Notices 2,614 Statutory Notices:— Section 23, Public Health Act, 1875 11 Section 36, Public Health Act, 1875 36 Section 41, Public Health Act, 1875 2 Section 94, Public Health Act, 1875 187 Section 17, Housing Act, 1930 175 401 44 (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 290 14 - - Workshops 109 — — — Workplaces 81 3 — — Totals 480 17 — - (2) Defects Found. Particulars. Number of Defects. Found Remedied Referred to H.M. Ins. Number of Prosecutions. *Nuisances under the Public Health Acts:— Want of cleanliness 8 8 — — Want of ventilation — — — — Overcrowding — — Want of drainage of floors 1 1 — — Other nuisances 14 14 — — Sanitary accommodation:— Insufficient 3 3 — — Unsuitable or defective 17 17 — — 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 1 1 - — Totals 44 44 - - * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. 45 (3) Home Work. Four notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 7 workpeople engaged on making wearing apparel, etc., in their homes. (4) Registered Workshops. Workshops on the Register (sec. 131) at the end of the year. (1) Number. (2) Bakehouses (including nine factory bakehouses) 15 Other Workshops 50 Total number of Workshops on Register 65 (5) Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (sec. 133) 1 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 37 outworkers:— Box maker 1 Boot and shoe maker 1 Life-belt covering 1 Tie making 2 Millinery 2 Wearing apparel (various) 28 Furrier 1 Umbrella covering 1 During the year, 36 lists of out-workers were received from other Authorities in respect of addresses in Barking. Four lists were received from employers within the district. 40 (?) Premises and Occupations which can be Controlled by Bye-laws or Regulations. (1) Houses Let in Lodgings.—Supervision is exercised over the small number of tenements in the town. Those remaining are scheduled for demolition. (2) Common Lodging Houses.— One hundred and three visits were paid to the two common lodging houses, four of the visits being made at night. Two defects were discovered and two notices served. (3) Tents, Vans and Sheds.—There are 10 occupied van dwellings, which are located in yards where water supply and sanitary accommodation are provided. 78 visits were paid and 1 notice was served in respect of 8 defects discovered. (4) Underground Sleeping Rooms.—There are no such occupied rooms in the district. (5) Offensive Trades.—The following is a summary of the offensive trade premises registered:— Fish Fryers 19 Dealers in Rags and Bones 9 Gut Scraper 1 Fat Melters 2 Fish Skin Scraper 1 Oil Boiler 1 Soap Makers 3 Total 36 One hundred and thirty-nine visits were paid to these 36 premises, and 5 contraventions of the bye-laws were discovered and any necessary action taken. (6) Piggeries.—The eight remaining piggeries in the district are removed from occupied dwellings, but the premises are not entirely satisfactory because of the difficulties in drainage. (7) 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. 47 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 seventy-two visits were paid during the year to stable premises, and 6 notices were served in respect of various unsatisfactory conditions. (/) 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 these establishments is to use fibre or wood wool for the purpose of repairs. On one occasion rag-flock was found in use, but this was discontinued after interview. 8. SMOKE ABATEMENT. During the year, 148 smoke observations were carried out on factory chimneys, and notices were served with respect to the 22 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 my report for the year 1933, I referred to the recommendation of the Electricity Commissioners with respect to the emission of soot, ash, grit and gritty particles from the chimneys of electric power stations, and said that, so far as the Generating Station at Creeksmouth was concerned, there would be considerable difficulty in incorporating the equipment recommended. Whilst it has been found impossible to provide electrostatic precipitators, I am glad to say that the residual dust emitted into the atmosphere has during the year been reduced considerably by improved operating conditions, but even in this respect finality has not so far been reached. When originally opened in 1925, the capacity of this Generating Station was 100,000 kilowatts; in 1931 it was increased to 240,000 kilowatts; during the year 1933 the Station was further increased to 390,000 kilowatts, and became the largest generating station in Europe. The new stoker-fired furnaces brought into service are fitted with multiple cyclonic grit arresters, which have so far proved satisfactory. The total consumption of coal for the year was approximately 500,000 tons. 48 9. ULTRA-VIOLET LIGHT RADIATION. The following table shows comparatively the ultra-violet light readings for 1932 and 1933; for comparative purposes we have included corresponding figures for Southend for the year 1933:— Month Daily Average for Barking Daily Average for Southend 1932 1933 1933 Units Units Units January 1.00 0.76 0.68 February 0.60 0.78 0.82 March 0.84 0.92 1.74 April 1.50 1.50 2.20 May 0.70 4.00 2.74 June 1.12 (Reading not taken) 4.00 July 1.07 4.74 4.03 August 1.51 5.45 4.52 September 1.40 4.06 3.90 October 1.25 1.48 1.68 November 1.56 0.86 0.50 December 1.00 0.96 0.33 The apparatus we 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. 10. 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. 11. PARKS AND OPEN SPACES. Last year, with reference to the three hundred acres of parks and open spaces in Barking, I said I could 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. I am happy to be able to tell you that the public of Barking have very fully availed themselves of the facilities you have provided. 49 SECTION D. HOUSING. 1. STATISTICS. (a) General. Number of new houses erected during the year:— (1) Total 1,884 (2) As part of a municipal housing scheme:— (a) Barking 154 (b) L.C.C1,386 (3) Others (including private enterprise and subsidy houses) .. .. 304 (b) Unfit Dwelling-Houses. 1. Inspection of Dwelling-houses during the Year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,125 (b) Number of inspections made for the purpose 9,425 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 912 (b) Number of inspections made for the purpose 1,060 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 90 (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 1,943 2. Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,591 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 172 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 162 (b) By local authority in default of owners Nil 50 B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 208 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 175 (b) By local authority in default of owners 1 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 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 14 D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 2. HOUSING CONDITIONS. (a) General Observations.—The total number of inhabited houses in the district is 16,695 (including 1,213 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 15,482 dwelling-houses, 1,446 are owned by the Council- and approximately 7,100 have been erected in the area by the London County Council since the year 1929. It is interesting to note that 1,816 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. During the year 1933, no less than 453 temporary buildings were approved for erection in the back gardens of dwelling-houses in the district. May I repeat what I called to your notice last year—that in my Annual 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 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. 51 HOUSES BUILT IN DISTRICT. 1926—1933. 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 1933 1,844 (Barking) 154 304 (L.C.C.) 1,386 Totals 9,180 7,401 1,779 Of the 7,401 houses shown above as part of Municipal Housing Scheme, 671 were provided by the Borough of Barking and 6,730 by the London County Council. (b) Sufficiency of Supply of Houses and Overcrowding.—I know that the Council is fully aware that the land available for building purposes is likely to be taken up completely for rehousing subsequent to action under the Housing Act, 1930, but I must emphasise once more that this means there will not be available in the district the necessary houses for people living in overcrowded circumstances, etc. (c) Individual Unfit Houses.—During the year a total of five houses were represented as incapable of repair, and Demolition Orders were made. The premises in respect of which Demolition Orders were made are as follows :— "Lousehall," Gale Street; Nos. 2 and 4, Gas Yard; No. 50, Lindsell Road; No. 34, Broadway; 52 (d) Clearance Areas.—In response to Circular 1331 of the Ministry of Health, the programme prepared showed that it was proposed to demolish during the period 1933—1938 a total of 430 houses, the estimated number of persons to be rehoused being 2,060. In May, 1933, a Public Inquiry was held with respect to the undermentioned (i) Bridge Street Clearance Order ; (ii) Back Lane (Nos. 6-31) Compulsory Purchase Order ; (iii) Church Path and Market House Buildings Compulsory Purchase Order. Confirming Orders have been made. During the year, representations were made to the Council, who duly resolved that the following areas should be cleared:— (1) Park Terrace, Collier Row, etc. (Compulsory Purchase Order); (2) Abbey Road No. 1 (Clearance Order); (3) Abbey Road No. 2 (Clearance Order); (4) Abbey Road No. 4 (Clearance Order). In these areas is a total of 93 premises, housing 478 persons in 108 families. These families are to be rehoused in the second portion of the Movers Lane Estate. It is interesting to note that under the Housing Act, 1930, the programme of the Council is larger than that of any other district in the administrative County of Essex. 53 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. MILK SUPPLY AND ICE-CREAM. (a) Milk Supply.—Registered with the Authority are 70 retail purveyors, of whom 16 occupy premises outside the district. In addition there are two cow-keepers. 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 61, eleven were found to be unsatisfactory:— Type of Sample. Satisfactory. Unsatisfactory. Totals. Grade "A" (T.T.) Milk 2 1 3 Grade "A" Milk 1 — 1 "Pasteurised" Milk 21 3 24 "Sterilized" Milk 2 — 2 Purified (Homogenised) Milk 1 — 1 Raw Milk 23 7 30 Totals 50 11 61 Whilst 24 of the samples examined are described as pasteurised milk, the majority of these samples represent supplies which, although pasteurised, were not retailed as such. There were during the year 12 samples of milk submitted to biological examination for the presence of tubercle. Of this number, two samples were from supplies produced in the district. None of these samples was found to be infected. 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." 54 There are in the district 52 retailers and 12 whosesale distributors of sterilised milk. During the year the Council and your officers have been occupied on many occasions in an attempt to carry out your statutory duties with respect to the quality, storage and distribution of milk supplies by the London and Suburban Dairies, Limited, and their successors. This work has largely been frustrated by the provisions of Section 2 of the Milk and Dairies (Amendment) Act, 1922, and by the formation of a chain of companies by the company in question. The penalties awarded in the Courts could not be collected, and for this reason prosecution proved abortive. The most recently formed company was continuing to sell milk in the district at the end of the year. Representations have been made to the departments of the Ministry of Health and the Public Prosecutor. 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 four samples of icecream show that the product was not so clean in all cases as might reasonably be expected. Sample No. B. Count. B. Coli. 46 3,300 Absent in 1 c.c. 47 72,000 „ 1 c.c. 48 280,000 ,, 0.001 c.c. 49 250,000 ,, 1 c.c. The Barking Corporation Act, 1933, came into operation at the end of July, 1933. We were not able forthwith during the ice-cream season of 1933 to effect any radical changes, but I am to advise you that we are doing so for 1934 and that at the time of writing this Report the matter is well in hand. 2. MEAT AND OTHER FOODS. (a) Meat.—-The one licensed slaughter-house continued in the occupation of the same person and has not given cause for complaint during the year. 55 The following table gives particulars of notifications received, and the animals slaughtered, during the six years ended December 31st, 1933. Year 1928 1929 1930 1931 1932 1933 Totals. Notifications Received 126 72 64 39 57 34 392 Cattle 40 64 80 12 10 41 247 Pigs 409 137 93 200 84 18 941 Sheep 815 426 332 173 270 241 2257 Calves 71 10 11 1 9 1 103 Totals 1335 637 516 386 373 301 3548 Diseased Meat was destroyed as under:— Description. Disease. Weight. 30 beasts' lungs Tuberculosis 300 lbs. 6 „ livers Cirrhosis 84 „ 12 „ livers Distomatosis 168 „ 6 ,, livers Tuberculosis 84 „ 4 ,, livers Angioma 56 „ 2 ,, livers Fatty Infiltration 28 „ 1 beast's liver Fatty Degeneration 14 „ 1 „ liver Cystic 14 „ 13 beasts' heads Tuberculosis 364 „ 1 beast's tongue Actinomycosis 7 „ 4 beasts' mesenteries Tuberculosis 12 „ 1 brisket of Beef Tuberculosis 28 „ 1 beast's carcase Dropsical 378 „ 1 stirk carcase Dropsical 194 „ 24 sheeps' lungs Parasites 72 „ 10 pigs' lungs Tuberculosis 35 „ 4 „ lungs Pneumonia 16 „ 4 „ lungs Congestion and Pleurisy 16 „ 3 „ livers Tuberculosis 15 „ 7 ,, livers Cirrhosis 42 „ 1 pig's liver Cystic 5 „ 16 pigs' heads Tuberculosis 224 „ 13 „ mesenteries Tuberculosis 26 „ 4 calves' lungs Tuberculosis 16 „ 1 calf's liver Tuberculosis 5 Total 19 cwts. 2 qr. 19 lbs. 56 (b) Unsound Food.—The following list gives particulars of the unsound food destroyed during the year:— Meat. Tinned Foodstuffs. 2 pigs' heads; 1 pig's spleen; 9 tins condensed milk; 84 lbs. beef ; 4 rabbits. 13 tins fruit products. Fish. Fruit. 2 bags winkles; 4 lbs. "Polish" nuts; 30 lbs. skate; 254 lbs. walnuts. 78 lbs. kippers. 3. 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. H. C. Card, Chief Food and Drugs Officer for the Metropolitan Area of the Essex County Council, for the particulars of samples purchased and submitted for analysis during the year. These samples are submitted for chemical examination to Dr. Bernard Dyer, the County Analyst, Great Tower Street, London. A total of 180 samples were examined during the year 1933. Three proceedings were instituted in relation to these samples during the period covered. 4. CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The bacteriological examination of all milk, ice-cream and water 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. 5. NUTRITION. As you know, I am never very willing to discuss nutrition in terms of "calories," a matter which has been much in evidence in the public eye quite recently. The significant thing is that twenty-five years ago Chittenden, in America, carried out an experiment on himself, his assistants, a number of students and a squad of soldiers. He reduced first-class proteins to forty-one grams, and, although many of the people who lived on this diet claimed that they felt the better for it, it is significant that, so far as was known in England, they all gave it up so soon as they were outside Chittenden's own personal influence. 57 More humorous stories are told of these backslidings, which all prove that, when left to themselves, ordinary people such as ourselves do need more than forty-one grams of first-class protein to maintain a sense of wellbeing. Personally, what I would like to see is legislation that would promote the sale in your markets of the widest variety of foods; I would like to see that people have proper cooking apparatus on which to prepare it; and I would like to see that people—anyhow, those who cannot afford it—are not enveigled by wonderful advertisements to buy at enhanced prices proprietary foods which only represent the same food value as ordinary foods which can be bought for a relatively small amount of money. One great difficulty I have found, particularly in my association with children, is that they are so impatient that they will not eat foods which require mastication, and turn with zest to sloppy foods. The time has come when we must call a halt in the rush and the hurly-burly of modern life, and sufficient time must be given to feeding to make it a social event in the day, with, if necessary, for those in advancing years, an opportunity for a quiet siesta afterwards. 59 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. 1. NOTIFIABLE INFECTIOUS DISEASES. The prevalence of notifiable infectious diseases in Barking during the year has been due, to some extent, to the fact that there has been a large influx of a population new to the area. For reasons difficult to explain, large schemes of rehousing seem to bring about conditions favourable to the incidence of infectious disease. Amongst other causes I think should be mentioned that persons so rehoused travel very considerably between their old friends and associates in the area where they formerly lived and new friends in the new area; this means that the people, particularly the children, are exposed to an increased number of possible sources of infection. Towards the end of 1933 diphtheria increased in severity. In Barking you are very fortunate in having an Infectious Diseases Hospital of your own. It is possible to achieve much closer co-ordination between treatment and prevention where this is so. It is also possible to link up the hospital work with the other medical activities you carry on, such as the maternity and child welfare and the school medical services. My personal relationship, too, with the medical practitioners practising in the area means that oftentimes, by consultation, we are able to discharge persons who, although completely recovered from the infectious disease, as such, are nevertheless disabled by reason of the recurrence of some previous disability or by reason of some disabling complication. 60 2. NOTIFICATION TABLES. The following table shows the number of notifications of infectious diseases (other than Tuberculosis) received during 1933:— TABLE I. Disease. Males. Females. Total. Total cases removed to Hospital. Deaths. Smallpox 1 1 2 2 Scarlet Fever 148 149 297 278 1 Diphtheria 64 71 135 129 3 Enteric Fever (including Paratyphoid Fever) 3 3 3 Puerperal Fever — 3 3 2 1 Puerperal Pyrexia — 18 18 5 1 Pneumonia : Acute Influenzal 60 35 42 25 10 Acute Primary 52 4 Following Measles 1 - Erysipelas 19 19 38 15 1 Ophthalmia Neonatorum 7 7 14 — — Acute Anterior Poliomyelitis 1 2 3 3 — Cerebro-spinal Meningitis — — — — — Encephalitis Lethargica 1 1 1 1 Chicken-pox 287 292 579 — — Totals 590 598 1,188 463 22 61—62 TABLE 11. Notifiable Disease. No. of cases notified at age groups. Cases classified according to Wards. Under one year. 1 to 2 years. 2 to 3 years. 3 to 4 years. 4 to 5 years. 5 to 10 years. 10 to 15 years. 15 to 20 years. 20 to 35 years. 35 to 45 years. 45 to 65 years. Over 65 years. Totals. Abbey. Gascoigne. Central. Ripple (West). Ripple (East— L.C.C. Est.) Westbury Longbridge (West). Longbridge (East—L.C C. Est. Smallpox — — 1 — — — 1 — — — — — 2 — 1 — — — — — l Scarlet Fever — 12 19 25 29 125 51 12 21 2 1 — 297 28 22 10 30 88 24 19 76 Diphtheria 2 11 10 11 14 55 16 4 8 4 — — 135 7 14 6 8 48 11 8 33 Enteric Fever — — — — — 1 — 2 — — — — 3 — 1 — 1 — — 1 — Puerperal Fever — — — — — — — — 2 1 — — 3 — — 1 — 1 — 1 — Puerperal Pyrexia — — — — — — — 2 12 4 — — 18 2 1 1 2 5 1 2 4 Pneumonia (Ac. primary, Ac. influenzal and follow- ing maesles 5 11 2 4 2 16 5 2 18 15 11 4 95 14 14 7 5 12 9 12 22 Erysipelas 2 1 1 — 1 3 1 2 8 7 7 5 38 1 4 2 9 6 6 5 5 Ophthalmia 14 — — — — — — — — — — — 14 3 — 1 3 — 3 2 1 Acute Anterior — — — — 1 91 — — — — — — 3 — — — — 2 — — 1 Encephalitis Lethargica — — — — — — — — 1 — — — 1 — — — 1 — — — — Chicken Pox 18 36 31 37 46 335 65 8 2 1 — — 579 15 57 25 51 80 143 60 148 Totals 41 71 64 77 93 537 139 32 72 34 19 9 1188 70 114 53 110 242 197 110 292 63 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1933:— Scarlet Fever. Diphtheria. Total. January 21 3 24 February 10 6 16 March 13 14 27 April 15 6 21 May 16 14 30 June 17 2 19 July 13 13 26 August 12 9 21 September 27 8 35 October 60 10 70 November 60 20 80 December 33 30 63 Totals 297 135 432 3. 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 1 Whooping Cough 2 Summer Diarrhoea17 (b) Rheumatic Fever.—Rheumatic fever, as I have said previously, is a serious problem in Barking. (c) Influenza.—There were 21 deaths from influenza during the year 1933. This contrasts unfavourably with 14 deaths in the year 1932. I feel I must repeat that the general public look upon influenza far too lightly. It is wrong for people to keep at work and otherwise to mix freely with other people when they are likely to spread disease. 64 (d) Scabics.—Forty-two 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 fourteen cases, where the parents declined the services offered. (e) General.—Non-notifiable infectious diseases amongst school-children are much 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. 4. BARKING HOSPITAL. (a) Admissions.—The following is the table of admissions, etc., in respect of infectious diseases during 1933 :— Disease. In Hospital January, 1st, 1933. Admitted during the year. Died. Discharged. In Hospital Dec. 31st, 1933. Scarlet Fever 31 204 1 176 58 Diphtheria (including Membranous Croup) 11 107 2 77 39 Enteric Fever 3 3 — 6 — . Puerperal Fever — 1 — — 1 Puerperal Pyrexia — 2 — 2 — Pneumonia 1 22 2 21 — Erysipelas — 14 1 9 4 Measles and Mastoiditis — 1 — 1 — Anterior Poliomyelitis — 1 — — 1 Others 1 16 — 16 — (b) Number of Bed Days.—The total number of bed days in the infectious diseases hospital during 1933 was 18,641—that is to say, an average of 51 patients were in hospital throughout the 365 days in the year. 65 5. ARTIFICIAL IMMUNISATION. Artificial immunisation is carried on in Barking against diphtheria. A few people only are anxious to have this carried out. The following table shows what has been done under this scheme:— Total number of cases treated 8 Number of first attendances for treatment 6 „ second ,, ,, 14 „ final " Schick " tests 7 6. CANCER. There have been 67 deaths from cancer, 43 below the age of 65 years and 24 above the age of 65. The following table shows the occupations of the 67 persons who died from cancer during the year 1933. Male. Female. Caterer 1 Children's Nurse (Spinster) 1 Clerks 5 Spinster 1 Confectioner and Tobacconist 1 Widows 13 Driller, Ship Building 1 Wives 16 Factory Managers 2 Foreman, Wholesale Fruiterers 1 Ganger 1 Gas Workers 3 Hatter's Assistant 1 House Decorator 1 Labourers 7 Licensed Victualler 1 Locomotive Fireman 1 Retired (no occupation) 3 Scaffolder 1 Ship's Steward 1 Steel Fixer 1 Stoker Engineer 1 Wine Merchant's Cellarman 1 Waterman and Lighterman 1 Wood Turner 1 36 31 66 The following table shows the organs affected, according to the returns of certified causes of death. Organ. Male. Female. Abdomen — 1 Arm — 2 Axilla 1 — Bladder 2 — Bowel 2 — Brain 1 — Breast — 5 Cervical glands 1 — Cervix — 1 Colon 2 1 Heel 1 — Jaw and Tongue 1 — Kidney 1 — Larynx 1 — Liver 3 — Lung 5 2 Maxilla 1 — Mediastinum 2 1 Neck 1 1 Oesophagus 2 — Omentum — 1 Ovaries — 1 Peritoneum — 1 Prostate 1 — Pylorus 1 — Rectum 2 7 Sigmoid 1 — Stomach 3 4 Tongue 1 — Uterus — 3 36 31 These tables show the prevalence of cancer, the occupations and sex of the patients, and the organs affected. 67 7. PREVENTION OF BLINDNESS. The prevention of blindness has become largely a measure of dealing with inflammation of the eyes soon after birth. We receive, of course, the ordinary notification in cases where the condition has developed to ophthalmia neonatorum, and, also, your nurses come across minor cases. The following table shows that the number of cases of ophthalmia neonatorum during 1933 was approximately the same as during 1932, being 14 compared with 13 in 1932. All of these 14 cases were treated at home, and in no case was the vision impaired. Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. At Hospital. Under 3 weeks 14 14 — 14 — — — 8. TUBERCULOSIS. Particulars of new cases of tuberculosis and of all deaths from the disease in the area during 1933 are given in this Report in the following form :— New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 year 1 1 1 to 5 years 1 2 7 2 — — 1 2 5 to 15 years 7 1 8 5 — — 1 — 15 to 25 years 20 16 4 4 11 6 — — 25 to 35 years 14 25 1 2 4 3 1 — 35 to 45 years 22 9 3 1 4 4 — — 45 to 55 years 8 4 — — 8 1 — — 55 to 65 years 1 1 1 1 — 1 — — 65 years and upwarus 2 — — — 2 — — — Totals 75 58 25 15 29 15 4 2 During the year, 160 notifications were received of all forms of tuberculosis— pulmonary 122 and non-pulmonary 38 and there were 13 deaths of un-notified cases (11 pulmonary and 2 non-pulmonary), making a total of 173 new cases during the year. 68 Information was received of the removal into the district of 58 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 the year Form I. Form II. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. 24 29 7 11 15 20 6 9 Fifty deaths occurred from tuberculosis (all forms) forty-four of these being pulmonary cases. The number of deaths in institutions was thirty-one. The death rate for tuberculosis (all forms) during 1933 was 0.72 per 1,000 population, compared with 0.91 for the previous year. I regret to inform you that thirteen of the cases which died from tuberculosis had not previously been notified to me as suffering from that disease. Last year I explained the circumstances under which so many cases were not notified, and the same conditions have been operating this year. It was unnecessary during the year to take any action under the Public Health (Prevention of Tuberculosis) Regulations, 1925 (relating to persons suffering from pulmonary tuberculosis employed in the milk trade), nor was any action taken under Section 62 of the Public Health Act, 1925 (relating to the compulsory removal to a hospital of persons suffering from tuberculosis). BOROUGH OF BARKING THE ANNUAL REPORT OF THE School Medical Officer For the Year 1933 C. LEONARD WILLIAMS, B.Sc.,M.R.C.S.,D.P.H. 70 TABLE OF CONTENTS. Pages ADENOIDS 79, 83, 94 ARRANGEMENTS FOR TREATMENT 81-84, 93-94 BLIND CHILDREN 91, 93 CLINIC ATTENDANCES 82, 85-86 CO-OPERATION OF PARENTS, TEACHERS, ETC 90 CO-ORDINATION OF SERVICES 75, 91 DEAF CHILDREN 91, 93 DEFECTIVE HEARING 79, 83 DELICATE CHILDREN 91-93 DENTAL DEFECTS 79. 83-84, 93-94, 100-102 DIPHTHERIA IMMUNISATION 82, 94 DRYING FACILITIES 76, 89 EAR DISEASE 79. 83 EMPLOYMENT OF SCHOOL CHILDREN 95 EPILEPTIC CHILDREN 91, 93 EXCLUSION FROM SCHOOL 87 EYE DISEASE 78, 82-83 FAIRCROSS SPECIAL SCHOOL 91-93 FOLLOWING UP WORK 80 HEALTH EDUCATION 94 HEART DISEASE AND RHEUMATISM 79, 84 HOSPITAL SAVINGS ASSOCIATION 94 INFECTIOUS DISEASES 84, 87 INTRODUCTION 73 MALNUTRITION 78, 81 MEDICAL INSPECTION AND FINDINGS 76-80 MENTALLY DEFECTIVE CHILDREN 91-92 MINOR AILMENTS 78, 81, 82, 94 NATIONAL ASSOCIATION FOR PREVENTION OF CRUELTY TO CHILDREN 90 NATIONAL INSTITUTE OF INDUSTRIAL PSYCHOLOGY 95 NOSE AND THROAT DEFECTS 79, 83, 94 71 Fages NURSERY SCHOOLS 93 OPEN-AIR EDUCATION 87 OPEN-AIR CLASSROOMS 87 OPEN-AIR SCHOOLS 91-93 ORTHOPAEDIC AND POSTURAL DEFECTS 79, 81, 85-86, 94, 98-99 PARENTS' PAYMENTS 93-94 PHYSICAL TRAINING 88 PLAYGROUND CLASSES 87 PROVISION OF MEALS 78, 81, 88-90, 94-95 REPORT OF THE DENTAL SURGEON 100-102 REPORT OF THE ORTHOPAEDIC CLINIC 85-86, 98-99 RHEUMATISM 79, 84 RINGWORM 78, 81, 94 SCHOOL BATHS 76, 81 SCHOOL CAMPS 87 SCHOOL HYGIENE 76, 94 SCHOOL JOURNEYS 87 SCHOOL LAVATORIES 76 SCHOOL POPULATION 76 SECONDARY SCHOOLS 93 SERVICES PROVIDED, LIST OF 96-97 SKIN DISEASES 78, 81 SPECIAL ENQUIRIES 95 SPECIAL SCHOOLS 91-93 STAFF 72, 75, 76, 81, 95 STATISTICAL TABLES 103-116 TEACHERS, MEDICAL EXAMINATIONS OF 95 TONSILS AND ADENOIDS 79, 83, 94 TUBERCULOSIS 79, 80, 84 ULTRA-VIOLET LIGHT TREATMENT 84, 85-86, 94 UNCLEANLINESS 78, 81 VISUAL DEFECTS 78, 82-83, 94 72 STAFF, 1933. School Medical Officer: C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. Senior Assistant School Medical Officer: PATRICK J. O'CONNELL, M.D., B.Hy., B.S., D.P.H. (Commenced 11.9.33). Assistant School Medical Officers: HILDA C. DEAN, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Resigned 31.3.33) EDITH A. WHITNEY, M.B., Ch.B., D.P.H. Orthopadic Surgeon: 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. (Died 11.1.33). Dental Surgeons: W. H. FOY, L.D.S., R.C.S. R. N. HINES, L.D.S., R.C.S. Nurses: *Miss C. COURT (g), (h) & (i). *Miss W. PARKER (g), (h) & (i). Miss A. E. FINDLAY, (Masseuse) (k) & (o). *Miss F. G. ROXBURGH (g), (h) & (i) Miss G. GEDEN (Dental Nurse). (Commenced 25.10.33). Miss S. E. W. GIBSON (j). Miss L. F. SWAIN (h) & (i). Miss R. LLEWELYN (Dental Nurse) (h) & (i). Clerical Staff: Chief Clerk: F. READ. C. G. EAGLESFIELD Miss V. SHEAD H. R. CHANDLER (Resigned 2.9.33). (Commenced 13.3.33). Miss H. NUNN. D. G. TONKIN (n). Miss H. KING. A. J. STORER. Miss E. TASKER, E. A. ELLIS. (Commenced 1.8.33). G. H. RUFF, Miss A. LIGGINS, (Commenced 22.5.33). (Commenced 2.10.33). (g) Health Visitors' Certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives' Board. (i) General Hospital Training. (j) General Fever Training. (k) Certificate of Medical Electricity and Swedish Remedial Exercises. (n) Sanitary Inspectors' Certificate of Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (0) Certificate of Chartered Society of Massage and Medical Gymnastics. •Combined Appointment—Health Visitor and School Nurse. 73 Borough of Barking. PUBLIC HEALTH DEPARTMENT, BARKING, ESSEX. June, 1934. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Ladies and Gentlemen, Herewith I beg to submit my report for the year ended 31st December, 1933. This report has been drawn up to meet the requirements outlined in the circular of the Board of Education issued in January, 1934. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, School Medical Officer. 75 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year 1933. (1) STAFF. A list of the personnel of the "Service" is given on a separate page at the beginning of this report. (2) CO-ORDINATION. As the Medical Officer of Health is also School Medical Officer, the Health Services in Barking show a corporate entity and co-ordinated activity which is the ideal for the efficient conduct of such health schemes. Some Health Visitors are also School Nurses, and are already familiar with the parents and children and their home conditions through home visiting and conducting Maternity and Child Welfare Clinics, by the time the children reach school age. Your Medical Officers also conduct Maternity and Child Welfare Clinics in the areas where the schools are situated, and have a personal contact and interest in the children from before school age. They visit the children from time to time in the Barking Hospital, and follow throughout, the course of infectious disease and its possible interference through complications with the scholars' subsequent school curriculum. These contacts produce harmony in operation and unification of purpose in the Services. Even the Ante-Natal work in Barking is under the control of the same Medical Officers, and complications during pregnancy and parturition with their possible detrimental influence on the children's school development (both mental and physical) are observed from the beginning. 76 (3) SCHOOL HYGIENE. Among the new schools recently erected by the Corporation, the hygienic conditions are a matter for congratulation. In many ways, particularly in lighting and ventilation, a high ideal has been attained. The lavatories, cloakrooms and sanitary conveniences in these schools are better designed and easier to maintain in a condition of cleanliness than in older schools. One regrets that in so comprehensive a school building scheme baths were not included. If ordinary baths cannot be installed, could some Shower Baths be put in ? Bathing is highly desirable as an essentia! part of education, but it is necessary in certain cases, particularly after the children have undertaken heavy exercises in the summer. The arrangements for drying wet clothes and boots (details on page 21 of this report) show room for improvement, and I would like to see a rule enforced for changing wet foot-gear on arrival at school. One disadvantage I would like to see remedied in schools of two or more storeys is the provision of children's lavatories on each floor for the use of delicate children, who, though not sufficiently debilitated to attend Faircross Special School, require little added amenities while attending ordinary elementary schools. (4) MEDICAL INSPECTION. The year under review has seen changes among the professional staff and I am happy to be able to say that during the time this report has been in course of preparation the Corporation have taken steps to increase the permanent medical staff. The number of children on the school registers on the 31st December, 1933 was 14,773 compared with 13,112 on the 31st December, 1932. The following summary shows the growth in the school population during the past few years:— December 1927 7,001 December 1932 13,112 1930 7,906 „ 193 14,773 1931 10,905 The rapid growth in the school population between 1930 and 1931 was due to the increasing population in the Becontree area consequent on the completion of some Sections of the new Estate. The population continued to grow throughout 1932 and 1933, although not to the same extent. Stability has not yet been reached, and we may have to look forward to further growth in the school population. The following table shows the number of children examined at school at routine and special inspections during 1933, classified according to the schools attended, the number of inspections held in each school, and the number of parents or guardians present 77 School No. of Inspection Sessions Numbers Inspected No. of Parents present (Routine and Special Exams.) Routines and Specials Re-Exams. Cambell 69 1,036 1,025 541 Church of England 16 313 193 116 Dawson 23 364 283 352 Dorothy Barley 17 360 160 323 Eastbury 39 701 593 378 Erkenwald 23 729 1,220 54 Gascoigne 33 398 506 227 Monteagle 21 408 320 325 Northbury 27 384 494 254 Park Modern 12 254 106 108 Ripple 34 473 685 343 Roding 53 716 981 526 St. Ethelburga's St. Joseph's 9 168 152 34 10 143 135 96 Westbury 28 404 469 455 Totals 414 6,851 7,322 4,132 Of the 6,851 examinations at ordinary elementary schools, 4,728 were routine examinations of children in the specified age groups, which figure may be compared with 5,051 for the previous year. In addition, there were 556 routine examinations of children of ages outside the three specified age groups, and 1,567 examinations of children specially referred to your Medical Officers. Re-Inspections in ordinary elementary schools numbered 7,322, an increase of 3,252 over the previous year. The percentage of the children examined in the ordinary elementary schools who were accompanied by their parents or guardians is shown by the following table:— Year Percentage of Children Examined who were Accompanied by Parents. Year Percentage of Children Examined who were Accompanied by Parents 1928 64.8 1931 67.3 1929 65.7 1932 68.1 1930 66.3 1933 61.8 During 1933, the parents were present at 4,132 routine and special medical examinations conducted at school out of a total of 6,851 such examinations. 78 (5) FINDINGS OF MEDICAL INSPECTION. Table II on pages 36-38, gives in detail a return of defects found during the course of routine and special inspection at ordinary elementary schools and at the Clinics. (a) Malnutrition.—Out of the total of 5,284 children examined at routine inspections, three suffered from malnutrition to such an extent as to require treatment. This figure is very important, and I know will be of interest to members of the Authority. Its significance is this;—the 5,284 children examined were chosen for examination solely by the reason of their age group, and not for any other reason whatsoever. These children, therefore, so far as is practical are representative children. There were, of course, many children under observation for malnutrition who were granted free milk or free meals by the Authority. (b) Uncleanliness.—The following table shows the results of cleanliness inspections compared with similar figures for 1932:— 1932 1933 Number of examinations of children in the schools by School Nurses 32,419 37,762 Number of individual children found unclean 1,210 1,571 Number of uncleanliness findings 1,862 2,184 During the year, 92 children were cleansed by the Local Authority, and in five cases legal proceedings were taken under Section 43 of the Education Act, 1921. (c) Minor Ailments and Diseases of the Skin.—Few cases of Minor Ailments present themselves at routine medical inspections. Such cases are usually discovered earlier by teachers and School Nurses, and are treated at the Minor Ailments Clinics. The Minor Ailments Clinics also deal effectively with cases of minor diseases of the skin such as impetigo, ringworm of the body, scabies, and any other skin disease which presents itself. (d) Visual Defects and External Eye Disease.—Defects of vision found in school children continue to increase. In 1933, we had an increase of 131 cases over the previous year. I drew your attention to this increase in visual defects last year, and also in 1931. The time has come for you to consider this matter of defective vision as one requiring further action both from the point of view of prevention, and treatment. I recommend the appointment of an Ophthalmic Surgeon. During the year, there was one operation for squint which was carried out by private arrangement at the Royal London Ophthalmic Hospital, Moorfields, E.C. Cases of external eye disease are to a large extent dealt with at the Minor Ailments Clinics. 187 such cases received treatment at the Clinics during the year. 79 (e) Nose and Throat Defects.—Cases of enlarged tonsils and adenoids continue to bulk largely in the School Medical Inspection returns. The Medical Officers however, do not refer these cases for operative treatment unless they are of the opinion that the child is suffering ill-health because of the throat condition. The Specialists at Queen Mary's Hospital and St. Mary's Hospital, to which most of your cases go, corroborate the opinion of your Medical Officers before an operation is performed. (f) Ear Disease and Defective Hearing.—The number of cases of ear disease found at routine medical inspection does not show any significant variation from the figures for 1932. (g) Dental Defects.—Dental defects are noted by the School Medical Officers at routine medical inspection, the notice of the Dental Surgeons being drawn to urgent cases. Cases requiring the teeth made regular or straight or other special treatment are also referred to the School Dentist. The report of the School Dental Surgeon will be found on pages 32-34 of this report. (h) Orthopcedic and Postural Defects.—A number of children are seen at routine medical inspection who present varying degrees of Postural Defects such as round shoulders, crooked spine, and bad stance. The more serious of this group are sent to the Orthopasdic Surgeon under the Authority's scheme. In addition to this group of cases, various Orthopaedic conditions are seen which have existed from birth, or have arisen following an illness such as Infantile Paralysis. All such cases are seen by the Orthopaedic Surgeon, and where necessary, attendance at the Faircross Special School is recommended. (i) Heart Disease and Rheumatism.—A number of cases of chronic heart disease attend the elementary schools, and are seen at re-inspections by your Medical Officers. Some of these are still suffering from rheumatic affection, and are attending at hospitals serving the area. Some of these cases are so bad as to require transference to the Faircross Special School, and can only be classified as cardiac cripples. Cases of acute Rheumatism are rarely seen at the inspection, these being treated by practitioners of the district, a number being sent as in-patients in the hospitals. We have no special Rheumatic Clinic. (j) Tuberculosis.—The number of cases found at routine medical inspections appears small, but is not a true figure of the amount of Tuberculosis in children of school age. These children are frequently absent from school for long periods, and are seldom present at school when routine medical inspections are being held. Nine cases of Tuberculosis amongst children of school age were notified to the Medical Officer of Health during the year. Of these, three were pulmonary, and six were non-pulmonary. In addition, eleven notified cases of Tuberculosis amongst school-children were transferred to this area. Of these, five were pulmonary, and six non-pulmonary. 80 The following table shows the position with regard to notification of Tuberculosis amongst children of school age during 1933:— Notified during 1933 (including transfers) Pulmonary 8 Non-Pulmonary 12 Total 20 De-notified (of the above) Pulmonary 3 (1 death) Non-pulmonary — Total 3 (k) Other Defects and Diseases.—A few cases of other defects and diseases, not included in the above, were also seen at school medical inspection, e.g., some children were found to be suffering from kidney trouble and one or two from deficiency in the activity of the glands of the body. (6) FOLLOWING UP. The School Nurse who attends the routine medical inspection also carries out the following up work arising from the inspection. The parents are visited in their homes, and the attention of the parents is drawn to the need for treatment, and parents who were not able to be present at the medical inspection are interviewed at home by the School Nurse, who emphasises the necessity for having treatment and advises them in what way the treatment may be obtained. A summary of the following up work undertaken by your School Nurses is given herewith:— Number of visits to schools re medical inspection 520 Total number of visits to schools 653 Number of home visits in connection with:— 1929 1930 1931 1932 1933 (a) Routine medical inspections 3,549 4,759 4,480 4,817 6,610 (b) Infectious disease 520 660 295 408 230 (c) Uncleanliness inspections 80 119 181 119 284 (d) Non-attendance for treatment (Minor Ailments, etc.) 124 406 86 82 35 (e) Dental inspections 460 406 477 1,082 — (f) Miscellaneous — — — — 126 81 (7) ARRANGEMENTS FOR TREATMENT. Many of the conditions found at school medical inspection are able to be treated in Barking. Some conditions, however, of necessity require hospital treatment. (a) Malnutrition.—Cases of malnutrition are given milk either free or on payment of one penny for one third of a pint of milk at school. More necessitous cases are given free meals at special feeding centres. The children are weighed and specially examined on the visit of the School Medical Officer to the School, and a review is made of the progress of under-nourished children. A special report is completed by the School Nurse in every case of malnutrition. This report discloses the home conditions, and arising out of the visit, advice is given where necessary for an improved diet. (b) Uncleanliness.—Children found in school suffering from uncleanliness of the head or body are excluded by special form which is forwarded to the parents in a sealed envelope, particulars also being given of measures to cleanse the head. Cases of vermin and nits in the head are provided with special soap on attendance at the Clinics. Special nit combs are also kept at the Clinics, and are loaned on payment of a deposit, to parents who find difficulty in removing nits. In obstinate or difficult cases, the cleansing of a head is undertaken by a School Nurse at the Minor Ailments Clinic. Baths, if provided at Clinics and Schools, as I have already advised, would be of great assistance not only in preventing uncleanliness amongst school children, but also in treating children found to be dirty. (c) Minor Ailments and Diseases of the Skin.—For the treatment of minor ailments two Clinics are provided at present. Both Clinics are equipped to treat successfully most cases of skin disease and other minor diseases and injuries which occur among school children. The School Nurses do not carry out the work of the Minor Ailments Clinics, however. These are conducted by arrangement by nurses of the Plaistow Nursing Charity. Since October, 1933, it has been found possible to provide more medical supervision at the Minor Ailments Clinics on the Becontree Estate. A Medical Officer now attends at 9 a.m. daily, six times a week. Until the death of Dr. Angus Kennedy, of Plaistow, on the 11th January, 1933, the treatment of Ringworm of the scalp by X-rays was undertaken by him on your behalf. An arrangement has since been made with the London Hospital whereby this treatment is undertaken by Dr. W. J. O'Donovan of that Hospital. During the year, six school-children were treated under this arrangement with the London Hospital. 82 A summary of the work of the Clinics is appended in the following tabies (a) Minor Ailments Clinics. Central Clinic St. Alban's Clinic 1931 1932 1933 1931 1932 1933 No. of days clinic was open 345 330 349 323 321 319 Total No. of attendances 10,529 14,785 13,379 8,319 13,472 12,671 39.7 Daily average attendance 30.5 44.8 38.3 25.7 41.9 No. of cases treated 2,074 2,166 2,315 1,129 1,966 1,649 (b) All Clinics. Clinic No. of first attendances of school children Total No. of attendances of school children 1932 1933 1932 1933 Minor Ailments:— (a) Central 2,166 2,315 14,785 13,379 (b) St. Alban's 1,966 1,649 13,472 12,671 Ophthalmic 234 493 1,077 1,627 Dental 2,970 3,134 7,601 8,337 Orthopaedic— FOR EXAMINATION 98 92 2,579 2,734 FOR TREATMENT 145 160 Diphtheria Immunisation - 1 1 — 2 (d) Visual Dejects and External Eye Disease.—Visual defects are treated by your Medical Officers at special Refraction Clinics. The routine procedure consists of the application of a mydriatic twice a day on the three days prior to an objective test. Three weeks later patients attend again for the subjective test carried out in the light of the findings of the objective test. A prescription for lenses is then given and the patient instructed to attend at the Optician approved by the Authority, who makes up the glasses in a frame selected by the parent, on an approved scale of charges. When the spectacles are complete the Optician forwards them to the Refraction Clinic, where the Medical Officer puts them on the patient and satisfies himself that the lenses are in accordance with the prescription and that the frame is suitable for the patient. 83 Severe cases of visual defect, or cases in which there is an element of doubt in prescribing suitable lenses are referred to the Royal London Ophthalmic Hospital. 455 cases of visual defect were dealt with under the Authority's Scheme. Of this number, 400 were provided with spectacles ; 93 cases obtained spectacles from other sources. The Optician approved by the Authority carried out a number of minor repairs to spectacles which had already been provided. Cases of external eye disease, such as conjunctivitis and blepharitis, are treated at the Authority's Minor Ailments Clinics. 187 cases were thus treated during the year as compared with 207 during 1932. (e) Nose and Throat Defects.—An arrangement has been made between the Authority and two local Hospitals (Queen Mary's Hospital, Stratford, and St. Mary's Hospital, Plaistow), for the removal of tonsils and adenoids, this being by far the commonest surgical nose and throat condition found at school medical inspection. Specialists attend at these Hospitals twice weekly and see cases referred by your Medical Officers. If an operation is found necessary, the patient is given a form to present at the Public Health Department ; this form is exchanged for an operation voucher. The scheme for payment is outlined on page 26 of this report. In ordinary cases the patients are brought home by the Barking Ambulance, the Public Health Department being notified by telephone of the operations performed. The School Nurses visit all cases the day of their return home, to see that the patient's condition is satisfactory and to give appropriate advice for the after-care. Special cases are retained in Hospital for as long as the Surgeon considers necessary, the expense being met by the Authority. On recovery, and before returning to School, the patients' throats are examined by one of your Medical Officers at the Minor Ailments Clinic. In Group III of Table IV on page 46, will be found a complete analysis of the ascertained results of the treatment of nose and throat defects. (f) Ear Disease and Defective Hearing.—Barking is so near the large London hospitals, particularly the Queen Mary's Hospital, Stratford, that the treatment of ear disease at your Clinic has been restricted to just the ordinary medical treatment, to which a number of ears respond readily, the remainder being sent, where necessary, to the special ear department of these hospitals. (g) Dental Defects.—The treatment of dental defects is dealt with specially in a part of this report prepared by Mr. Foy, the Dental Surgeon. In reviewing the work of the Dental Clinic, I must again draw the attention of the Authority to the laxity shown by some parents in keeping Clinic appointments,—not only those appointments made during term, but particularly appointments given during periods of school closure. 84 Children seem to be under the impression that holiday from school absolves them from attendance at the special Clinics, with a great loss of time both to themselves and the dentists. Children who are not actually away from home should always keep Clinic appointments. (h) Orthopadic and Postural Defects.—The Authority's scheme for treating Orthopaedic cases continues to be a valuable service. Mr. Whitchurch Howell attends once a month at the Faircross Clinic, and the Masseuse attends three times a week to carry out treatment. A summary of the work done appears on pages 17-18 and 30-31 of this Report, an analysis being given under Group IV of Table IV on page 46. (i) Heart Disease and Rheumatism.—As mentioned previously under " Findings of Medical Inspection " (page 11), we have no Special Clinic for the examination and treatment of heart and rheumatic cases. In an area so near the large London hospitals, this is not a hardship on the children. (j) Tuberculosis.—The appropriate Authority for the treatment of Tuberculosis is the Essex County Council. Their Tuberculosis Officer attends at the Chest Clinic, Linton Road, Barking. (k) Other Defects and Diseases.—Children presenting conditions requiring treatment not mentioned under the previous special headings are, where necessary, referred to local practitioners or to hospitals serving the Area. Ultra Violet Light Treatment.—Ultra Violet Light Treatment has been carried out at the Faircross Clinic during the year, the total cases treated being twenty-five. The period of treatment of these cases varied from one month to twelve months and the total number of applications was 750. Children diagnosed as suffering from Tuberculous Glands, Alopaecia, Rheumatism, Anasmia, Debility and Cervical Adenitis are among those who have derived benefit from this treatment. (8) INFECTIOUS DISEASES. The following table shows briefly the number of children notified and reported suffering from some of the commoner infectious diseases:— 1929 1930 1931 1932 1933 Scarlet Fever 164 91 75 88 169 Diphtheria 44 202 128 43 71 Measles and German Measles 191 283 1 188 4 Chicken-pox 378 166 187 335 390 Whooping Cough 89 35 48 69 Mumps — — — 8 23 85—86 PARTICULARS OF WORK DONE IN CONNECTION WITH ORTHOPEDIC CLINIC. No. of visits by Orthopaedic Surgeon No. of visits by Masseuse ATTENDANCES Primary Examination Re-Examination For Treatment Total School Children Under School Age School Children Under School Age School Children Under School Age School Children Under School Age 11 230 92 98 215 153 2,427 951 2,734 1,202 TREATMENTS. Massage Electricity Remedial Exercises Ultra Violet Therapy Radiant Heat Dressings and Splintage No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatments No. of Children No. of Treatment School Children 9 136 2 16 89 1,521 25 750 — — 35 120 Under School Age 13 139 — — 4 26 62 580 — — 70 289 Admission to Hospitals On waiting List for Admission 31/12/33 School Children Under School Age Total School Children Under School Age Total 10 (8 under Council's Orthopedic Scheme) 12 22 — — — 87 Barking has been no exception to the epidemics of the commoner infectious diseases which have prevailed in profusion in the London Area during the past year. The number of children suffering from such conditions as Scarlet Fever, Diphtheria, and Chicken Pox will be seen from the table to show a large increase over those for the previous year. Where the attendance of a school falls below 60 per cent. and in the opinion of the Medical Officer this low attendance is directly due to the prevalence of infectious disease, the school sessions so affected are not counted in estimating the average attendance for the purpose of grant. During 1933, three such certificates were granted for this purpose. Arrangements are made for the ascertainment and exclusion from school of individual children whose exclusion is desirable in order to prevent the spread of disease, and for this purpose the Exclusion Periods contained in the Appendix to The Memorandum on Closure of and Exclusion from School, issued jointly by the Ministry of Health and the Board of Education in 1925 have been accepted. (9) OPEN-AIR EDUCATION. Open-Air Classrooms.—In those schools built since 1931, ample provision has been made for admitting open-air to the classrooms. A quadrangle arrangement has been adopted in these schools, and the windows on the outer and inner sides of all classrooms may be thrown open. Playground Classes.—In the older schools however, conditions are not so favourable, and I must continue to strongly advocate holding open-air classes in suitable weather, whenever possible. School Journeys and Camps.—School Camps are run during the week-ends from Friday to Monday evening. The camp is of a permanent nature, and is situated at Hainault. Fifteen camps were held during the year, in which 708 scholars participated. During the summer holidays too, there are additional camps where children are taken for a fortnight at a time to the same huts at Hainault, 96 children taking part in the two such camps. These camps have been very much appreciated by the school population, and parents have been very pleased to have these opportunities for their children to have a holiday. In selecting children for these camps, a medical and cleanliness inspection is held, and for the summer camps those children are selected in whom a debilitated physical condition is found, or in whom straightened family circumstances make a holiday desirable. 88 (10) PHYSICAL TRAINING. The Local Education Authority have no Organiser of Physical Training in the schools in Barking. Liaison does, however, exist between the School Medical Service and the physical instructors appointed to the various schools. The School Medical Officer when visiting the ordinary elementary schools takes every opportunity of seeing both boys and girls taking part in physical instruction, comments upon the clothing worn during the exercises, and confers with the instructor upon any difficulty arising in the course of his duties. Children in whom physical training is unsuitable because of some physical defect or intercurrent invalidism are examined and debarred from taking part in the classes. The Secretary of the Barking Schools' Sports Association refers all boys who have been selected for bouts in the boxing tournaments for a medical inspection previous to the contests. If for any reason boys are unsuitable, they are warned not to box. I would like to again offer my congratulations to this very able Association for the successful organisation and conduct of the various tournaments, games and sports in Barking throughout the year. (11) PROVISION OF MEALS. Free meals are provided daily in necessitous cases. 135,726 such meals were provided during the year 1933, and the following table shows the numbers of free meals which have been provided during the past five years:— 1929 33,991 1930 31,556 1931 46,803 1932 74,531 1933 135,726 During 1933, the Authority extended the scope of its scheme for providing meals for necessitous school children. One new centre was opened at an elementary school, and has been of great service. The Municipal Restaurant, St. Paul's Room, and the Baths Concert Hall have ceased to be used for the serving of free meals; the school children now attend at St. Margaret's Hall, Vicarage Drive, where the accommodation is more suitable. The following table summarises the arrangements which exist where mid-day meals are taken at schools. It will be noticed that meals can be heated at some of the schools, and the children are supervised during meal-times. The table also shows what arrangements there are for the drying of children's clothes and boots. Dietaries are submitted for approval to the School Medical Officer, and where meals are provided free of charge on the recommendation of one of your Medical Officers, children are re-inspected, and any increase in weight and improvement in general condition noted on subsequent visits to the school. 89 School No. of children who remain at school for mid-day meal Whether facilities exist for heating of children's meals Whether facilities exist for the drying of children's clothes and boots Cambell— Senior Boys — No Cloakrooms heated (in winter only) Senior Girls — Yes, at domestic science centie ,, Junior Mixed — No ,, Infants — ,, ,, C. of E.— Boys — ,, School fires (in winter only) Girls — ,, „ Infants — ,, ,, Dawson— Junior Mixed 15 Yes, at Meals Centre Cloakrooms heated (in winter only) Infants — No „ Dorothy Barley— Junior Boys — ,, ,, Junior Girls — ,, ,, Infants — Yes, for small number ,, Eastbury—Senior Boys — No ,, Senior Girls — Yes, at domestic science centre Yes Infants — No Cloakrooms heated (in winter only) Erkenwald— Senior Boys — ,, Senior Girls — Yes, at domestic science centre ,, Faircross—Mixed All children stay at school for mid-day meal, the food being supplied from Municipal Kitchen Yes Yes Gascoigne—Senior Boys 12 Yes, for small number School fires (in winter only) Junior Mixed — No ,, Infants — ,, ,, Monteagle—Junior Mixed — ,, Cloakrooms heated (in winter only) Infants — ,, ,, Northbury— Senior Girls — ,, School fires (in winter only) Junior Mixed — ,, ,, Infants — ,, ,, Park Modern—Senior Mixed 80 Yes Cloakrooms heated (in winter only) Ripple—Junior Boys — No ,, Junior Girls — .. .. Infants .. ,, Roding—Junior Boys — .. .. Junior Girls — .. .. Infants .. .. St. Joseph's—Infants Junior Mixed 2 Yes School fires (in winter only) SS. Mary & Ethelburga— Senior Mixed 15 No „ Westbury—Junior Boys — .. Cloakrooms heated (in winter only) Junior Girls — .. School fires (in winter only) Infants — .. .. 90 There are no schemes in Barking organised by voluntary agencies for the provision of milk or meals. The Authority have a scheme for the provision of milk and meais which has already been outlined. (12) CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. During the year, parents have shown an ever increasing interest in the work done by the Medical Inspectors in the Schools. Parents attendances at the routine inspections are a matter for congratulation, and the spirit in which recommendations for treatment has been received has been good. Teachers in all departments have co-operated well with the School Nurses and Medical Inspectors, not only in the preparation of the available accommodation and the notification of parents of the examiner's visit, but also in maintaining a high standard of orderly behaviour among the children during the examination. The work of the Dentists has also been facilitated by the active co-operation of the teaching staff; and largely owing to the assiduity of the teachers' efforts in persuading children to keep appointments, good average attendances at the Dental Clinic have been maintained. The School Attendance Officers have assisted in seeing that children with minor ailments or uncleanliness attend the Clinics provided; and they have also helped in encouraging parents to obtain special treatments which have been recommended. I am informed that the National Society for the Prevention of Cruelty to Children have dealt with 33 cases. have dealt with 33 cases. The following table shows the way in which these cases have been dealt with:— Total number of cases investigated 33 (a) Prosecutions nil (b) Warnings 24 (c) Otherwise dealt with 9 Of the 33 cases inquired into, 25 have been closed as satisfactory, the remaining 8 still being under supervision. In addition to the above, the local inspector, so I am advised, has paid 133 supervisory visits. 91 (13) BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. (a) You are naturally anxious to know if and whether all the defective children in your area are ascertained and brought to your notice. I think I can assure you that this is so. A unified health service means that all the health visitors, school nurses, sanitary inspectors and doctors work together, discuss their work together, and bring to one another's notice anything of such importance as a blind, deaf or otherwise defective child. So, also, the Infectious Diseases Hospital and the Maternity Hospital are constantly supplying information on this and allied questions. In addition, the head teachers of the schools and the investigation officers are in constant touch with us. I am also indebted to my colleagues in general practice and at the hospitals in London and nearby for the very helpful information and advice they have given me on numerous occasions. Your next concern is the method of dealing with these children when they are ascertained. ascertained. The following table shows the number of children who have attended at the Faircross Special School—in the Open-Air, Physically Defective and Mentally Defective Sections—and, in addition, in other parts of the Report will be found figures as to how many children have been admitted to the Brookfield Orthopaedic Hospital and elsewhere for orthopaedic conditions:— Open-Air Section Physically Defective Section Mentally Defective Section No. on Register on 31.12.32 125 40 65 No. admitted during 1933 67 13 44 No. discharged during 1933 95 15 20 No. on Register on 31.12.33 97 38 89 Hereunder are particulars of the number of children maintained by the Authority in special schools outside the district as at December 31st, 1933:— Particulars of School. No. of Cases. Frederick Road Deaf Centre (Day), West Ham 3 Barclay School for Blind (Residential), Brighton 1 Bigod's Hall School for Mentally Defective Children (Residential), Dunmow 1 St. Patrick's Open-Air School (Residential), Hayling Island 1 92 (b) Mentally defective children are dealt with at Faircross Special School and, in certain cases, in residential schools, and children whose misfortune it is not to be able to receive benefit from instruction in a special school or class under Section 56 of the Education Act, 1921, are notified to the County Council. After notifying these children to the County, we do not officially take any further action, but close co-operation is maintained with the County and any help which we are able to give informally is placed at the disposal of the County. The County Council co-operate with a voluntary organisation in the care of these defective children, and, whenever possible, we, also, have co-operated with this organisation. (c) At the end of 1933, there were 240 places in Faircross Special School. One hundred were in the Open-Air Section for delicate children, 40 in the Physically Defective Section, and 100 in the Mentally Defective Section. I am, however, to advise you that subsequently, after discussions with the Board of Education, certain adjustments have been carried out. It seems to me that the time is ripe for general discussions on a national basis about the future of these special schools. The idea of keeping delicate children at open-air schools until the age of sixteen years was undertaken, I believe, in the hope that, although the children have had an interrupted school life, they might reasonably, by that time, attain approximately the standard of an ordinary child of fourteen years. This idea is very good and works out in practice, but, if ever any similar idea was entertained with regard to mentally defective children, I can only say from my experience that it is the exceptions which work out in practice. In practice it is becoming less and less common to send mentally defective children into special schools unless they are at least two-and-a-half to three years retarded at the age of ten years, or retarded pro rata at any other age, and I find that such children have completed their mental expansion at quite an early age and that, although they may add such experience as they are able to understand to their mental equipment, they do not develop mentally much after ten to twelve years of age. I sometimes doubt whether this form of education has realised the expectation of those who embarked on it. The following table gives information in respect of medical inspection at the Faircross Special School during the year 1933:— Number of inspection sessions 36 Number of children inspected:— (a) Routines 79 (b) Specials 53 (c) Re-examinations 347 479 93 Number of defects referred:— (a) For treatment 39 (b) For observation 27 66 Number of defects found treated 22 Number of parents present at inspections 290 I am indebted to Mr. Compton, the Director of Education, who has very kindly called my attention to the Ninth Annual Report of the Juvenile Employment SubCommittee—for the year ended July 31st, 1933. This Report, inter alia, deals with after-care in connection with the Faircross Special School, and points out that this work is fortunately diminishing. This Report also gives details of interesting cases, indicating the pursuits in which the children are now employed. (14) FULL-TIME COURSES OF HIGHER EDUCATION FOR BLIND, DEAF, DEFECTIVE AND EPILEPTIC STUDENTS. The Local Education Authority do not maintain any courses of training for Blind, Deaf. Defective and Epileptic students. (15) NURSERY SCHOOLS. Up to the present the Barking Authority have not established Nursery schools in the area under their control. (16) SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. The Barking Education Authority is not empowered to provide secondary education for its scholars, but children for whom this type of education is demanded do attend the Barking Abbey School, situated on the boundary of the Borough. This school is under the Essex County Council, and medical inspection and treatment of children attending it is in the hands of that Council. (17) PARENTS' PAYMENTS. There has been no change during the year in the arrangements for recovering the cost of treatment from parents of children attending Public Elementary Schools. These arrangements are, briefly, as follows:— Dental Treatment.—There is a nominal charge for treatment of sixpence per patient. Dentures, regulation plates, etc., are supplied at cost price, or at reduced cost or free of charge in certain necessitous cases. No charge is made for a Dental X-ray examination. 94 Diphtheria Immunisation, Treatment of Minor Ailments, X-ray Treatment of Ringworm, and Ultra-violet Light Treatment.—No charge is made for these forms of treatment. Milk in School.—One-third of a pint of milk is supplied daily to children attending school on payment of one penny per day. Where the Medical Officer considers milk is desirable on medical grounds no charge is made in necessitous cases. Ophthalmic Service.-—Eye testing and the prescription of glasses is carried out free of charge in all cases. Lenses, mounted in white metal ("Clinic") frames, complete with case, are supplied at a maximum charge of 2s. 1d., irrespective of the cost to the Authority, or free of charge in certain necessitous cases. Where the parent selects other than "Clinic" frames, the actual cost price is charged. Repairs to "Clinic" spectacles are carried out at cost (maximum charge 2s. 1d.), or free of charge in certain necessitous cases. Repairs to other than "Clinic" spectacles are charged at cost price. Arrangements are made with the Optician for the acceptance of the vouchers of the Hospital Savings Association towards the cost of spectacles. Orthopadic Treatment.—No charge is made for treatment at the Authority's Orthopaedic Clinic. Surgical Instruments are supplied at cost price, or at reduced cost or free of charge in certain necessitous cases. Necessitous cases are admitted to Orthopaedic Hospitals free of charge ; other cases are dealt with on their merits. No charge is made for an X-ray examination or for a clinical photograph. Arrangements are made whereby the vouchers of the Hospital Savings Association are accepted towards the cost of surgical instruments and hospital treatment. Tonsils and Adenoids.—A nominal fee of 5s. is charged in respect of an operation for the removal of tonsils and/or adenoids. In certain necessitous cases the treatment is provided free of charge. A voucher of the Hospital Savings Association is accepted in lieu of the fee of 5s. (18) HEALTH EDUCATION. I am asked by the Board of Education to give an account of the relation of the School Medical Service to any health teaching specially designed for the school children of the area, and I am to report that although we have been unable to do anything on the lines we would wish, this matter has not been lost sight of. With the extensions that are going on as the result of the increase in the population of Barking, it has been difficult enough to keep up with the ordinary work, but we hope that when we have a stable population, we will undertake work in this important direction. My own personal opinion is that a "health bias" in the school curriculum is more important than a course of hygiene, and that health and habits can be inculcated quite apart from lessons on physiology and kindred sciences. 95 (19) SPECIAL INQUIRIES. No special inquiries have been initiated by the School Medical Staff during 1933, but we were very pleased to be of help to the National Institute of Industrial Psychology, who, with the permission of the Authority, carried out a series of experiments at one of the Infants' Schools on the effect of diet upon the mental and physical growth of children. Thirty children were provided with special breakfasts at school, and their response compared with thirty other children receiving ordinary breakfasts at home. The Authority undertook provision of these meals. (20) MISCELLANEOUS. (a) Examination of Teachers.—During the year, seventy-eight medical examinations were carried out of applicants for teaching posts under the Local Education Authority. (b) Part-time employment of school-children.—Milk and newspaper deliveries, general errands, etc., are the usual forms of employment of children. In accordance with the bye-laws of the Education Authority, 16 applicants of school age submitted themselves for examination prior to employment, of which number it was necessary to refuse one applicant on medical grounds. 96 SERVICES PROVIDED FOR SCHOOL CHILDREN. Boots Free boots are provided in certain necessitous cases. Camps Week-end camps are held every week-end during the summer months, and in addition two holiday camps, each of a fortnight's duration, are held during the summer holidays. Cleansing Special soap is issued from the Minor Ailments Clinics and special combs are loaned, on payment of a deposit. In certain cases, arrangements are made for the children to be cleansed at the Clinic by the School Nurses. Dental Treatment Dental treatment—including orthodontic treatment—is carried out daily at the Corporation's Dental Clinic, East Street. Dinners Free dinners are provided for children attending school, where the family income is below a certain scale. Diphtheria Immunisation Immunisation against Diphtheria is carried out at the Central Clinic. No charge is made for this treatment. Medical Inspection Arrangements are made for each child to be medically examined at school three times during the period of school life, and at such other times as the medical officer considers necessary. Milk One-third of a pint of milk is supplied daily to children attending school on payment of 1d. per day. Where the family income is below a certain scale and where the medical officer considers milk desirable on medical grounds, no charge is made. Minor Ailments Children suffering from minor ailments are treated daily at the Corporation's Central Clinic, and at the St. Alban's Clinic. Ophthalmic Service A Refraction Clinic is held at the Central Clinic, and 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 charge. 97 Orthopedic Treatment Orthopaedic treatment—including the provision of splints and any necessary hospital treatment—is provided through the Orthopaedic Clinic, Faircross Special School. Special School The Faircross Special School is divided into three sections— a Physically Defective Section, a Mentally Defective Section and a Section for Delicate Children. When considered desirable, the children are conveyed to and from school by motor ambulance. Tonsils and Adenoids Surgical treatment for tonsils and adenoids is carried out at two local hospitals under an agreement with the Corporation. A small charge is made to the parents, except in certain necessitous cases, when no charge is made. Ultra Violet Light Treatment Ultra violet light treatment is given at the Orthopaedic Clinic, Faircross Special School. No charge is made. X-Ray Treatment for Ringworm of the Scalp. Where necessary, Ringworm is treated by X-Ray. No charge is made for this treatment. 98 REPORT ON THE WORK OF THE ORTHOPEDIC CLINIC. The following tables, which are prepared on lines similar to those previously used, show the work which has been carried out at the Orthopaedic Clinic amongst children of school age:— Number of primary examinations by Orthopaedic Surgeon 92 Number of re-examinations by Orthopedic Surgeon 215 The cases dealt with for the first time during 1933 were referred for the following conditions, some children having more than one defect:— (a) Deformities—Bones arid Joints— (1) Congenital: Dislocation—hip 1 (2) Acquired: Injury—elbow joint 2 Genu varum 1 Genu valgum 9 Bowed tibiae 1 Tibial deformity—foot 1 Hallux valgus 1 Hæmophyliac ankle 1 17 (b) Muscular— (1) Congenital: Talipes 1 Torticollis 1 Webbed digits—hand 1 Webbed digits—feet 1 (2) Acquired: Kypho-Lordosis 16 Kyphosis 23 Pes plano-valgus 22 Torticollis 1 Scoliosis 2 Winged scapulae 1 Pes cavus 1 70 99 (c) Paralysis— (1) Congenital: Hemiplegia 1 Spastic diplegia 1 (2) Acquired: Anterior Poliomyelitis 2 Facial paralysis 1 Ulnar paralysis 1 Paresis of lower limbs 1 7 Total defects found 94 During the year, nine children of school age received in-patient treatment at orthopaedic hospitals (Brookfield Hospital or Queen's Hospital for Children). orthopaedic hospitals (Brookfield Hospital or Queen's Hospital for Children). The following operations were carried out in these cases:— Tenotomy sterno-mastoid (for Torticollis) 2 Plastic operation—webbed digits, hand 1 Open elongation—Gastrocnemius with plastic operation 1 Amputation digit, foot 1 Removal of Baker's cyst from knee 1 Hernia—radical cure 1 Plaster bed (for Scoliosis) 1 Investigation 3 100 REPORT OF DENTAL SURGEON. To the Medical Officer of Health, June, 1934. Borough of Barking. Sir, I have the honour to present the report of the School Dental Service for the year ended December 31st, 1933. It has not been possible to inspect and treat the school population during the year under review. The most formidable hindrances to more frequent routine inspection and treatment are:— (1) The large number of patients requiring more than average treatment; (2) The increased number of casual patients who present a condition, the treatment for which is the immediate extraction of teeth under nitrous oxide anaesthesia. The former does not apply in any calculable degree to the pupils of the older schools of Barking, but is represented mainly by newcomers to the recently erected schools, especially new senior pupils who arrive with one or two years to go before reaching the school leaving age. These pupils, being impressed by the necessity of leaving school with sound teeth, bring for attention the accumulation of neglect, and six to nine fillings involving at least a corresponding number of visits is not infrequent. Against the casual, nothing can be said while a system exists which permits an unwilling parent to refuse conservative treatment for the child and to re-visit the Clinic at a later period with the child as a casual patient needing extractions. It should not be considered harsh nor unreasonable if a rule be introduced to the effect that refusal of treatment after inspection and advice should mean refusal for the year, and that treatment required as the result of such refusal be obtained from sources other than the Clinic. Preventive or prophylactic treatment is of the greatest benefit both to the patient and the operator, and should form a definite part of any campaign concerned with dental hygiene. Unfortunately, with the staff at its present strength, practical chairside work absorbs the whole of the professional service to the exclusion of lectures to children approaching school leaving age, especially girls, women's organisations, and any undertaking, the members of which can be approached on the subject of children's welfare. The dissemination of simple knowledge and its practical adoption would prove far more economic than the time spent in the surgery by the operator engaged in the expensive correction of dental errors. I cannot speak too highly of the energetic co-operation of the operative and nursing staff at the Clinic, the interest and kindly assistance of the Heads of schools, and the helpful consideration of the Health Visitors during the year, and I would like to record my appreciation of their unstinted service. 101 Graph " A " This graph is submitted not only to show the dramatic rise in annual attendances at the Dental Clinic from 2,478 to 9,824 in a period of six years and an equally dramatic rise in the number of extractions, but to show that these totals have depressed a desired progressive rise of conservative treatment, which remains almost constant to an average of 1,600 fillings per annum. The operative staff was increased in April, 1931, to cope with the rapidly growing school population of about that time, but unfortunately the time of the staff is occupied mainly in rendering the school population dentally fit by extractions than by the ideal of conservation, the achievement of which calls for further operative assistance. 102 Graph "B" The increase in administration of anaesthetics must be expected to correspond to the increased number of extractions. The growth of the casual from one hundred attendances in 1927, to 1,219 attendances in 1933, fully establishes the comments made earlier in this report. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, l.d.s., r.c.s (eng ), Public Dental Officer. 103 SCHOOL MEDICAL SERVICE. Statistical Tables—Public Elementary Schools. TABLE I.—RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups : Entrants 2,239 Second Age Group 982 Third Age Group 1,507 Total 4,728 Number of other Routine Inspections 556 B.—Other Inspections. Number of Special Inspections 5,483 Number of Re-Inspections 12,694 Total 18,177 104 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER, 1933. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring T reatment Requiring Treatment Requiring to be kept under observatio, but not requiring Treatment (1) (2) (3) (4) (5) Malnutrition 3 78 6 26 Skin Ringworm—Scalp 2 — 25 — Body — 5 Scabies 10 — 55 Impetigo 4 — 92 1 Other Diseases (NonTuberculous) 37 13 248 3 Eye Blepharitis 11 7 47 1 Conjunctivitis 7 2 103 — Keratitis — — 1 Corneal Opacities — 2 — Defective Vision (excluding Squint) 487 160 203 35 Squint 57 22 25 4 Other Conditions 4 4 36 6 Ear Defective Hearing 10 6 9 11 Otitis Media — — 3 Other Ear Diseases 34 12 168 9 Nose and Throat f Chronic Tonsillitis only 419 398 133 74 Adenoids only 25 23 5 11 Chronic Tonsillitis and Adenoids 103 50 35 63 Other Conditions 55 54 138 95 Enlarged Cervical Glands (NonTuberculous) 11 107 63 66 Defective Speech 3 12 3 6 Heart and Circulation Heart Disease Organic 1 32 4 14 Functional 1 125 1 42 Anaemia 4 42 2 16 Lungs Bronchitis 7 24 11 8 Other Non-Tuberculous Diseases 10 162 79 114 105 TABLE II.—continued. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Requiring Treatment Requiring to be kept under observation, but not requiring Treatment (1) (2) (3) (4) (5) Tuberculosis Pulmonary: Definite - 1 — 3 Suspected Non-Pulmonary: Glands 1 3 7 Bones and Joints - 1 1 2 Skin - — — — Other Forms - 2 — — Nervous System Epilepsy 1 2 1 Chorea 1 8 4 17 Other Conditions 2 28 10 40 Deformities Rickets - 2 - - Spinal Curvature 27 15 12 4 Other Forms 32 19 47 30 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 85 309 1722 301 106 TABLE II.—continued. (B.)—NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). Group Number of Children Percentage of Children found to require Treatment Inspected Found to require (1) (2) (3) (4) PRESCRIBED GROUPS: Entrants 2,239 436 19.5 Second Age Group 982 184 18.7 Third Age Group 1,507 255 16.9 Total (Prescribed Groups) 4,728 875 18.5 Other Routine Inspections 556 107 19.2 107 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA Children Suffering from Multiple Defects. No. of Cases Defects School 3 Mentally Defective and Physically Defective Certified School for Mentally Defective Children 1 Physically Defective and Epileptic Certified School for Physically Defective Children Blind Children At Certified Schools for the Blind At Public Elementary Schools At other Institutions At no School or Institution Total 1 — — 1 2 Partially Blind Children. At Certified Schools for the Blind At Certified Schools for the Partially Blind At Public Elementary Schools At other Institutions At no School or Institution Total - — 11 1 — 12 Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total 3 1 — 2 6 108 TABLE III.—continued Partially Deaf Children. At Certified Schools for the Deaf AT Certified Schools for the Partially Deaf At Public Elementary Schools At other Institutions At no School or Institution Total — — - — — — Mentally Defective Children. Feeble-Minded Children. At Certified Schools for Mentally Defective Children At Public Elementary Schools At other Institutions At no School or Institution Total 54 (32) 1 — 55 (32) Figures in brackets denote children at present under observation but not yet certified. Epileptic Children. Children Suffering from Severe Epilepsy. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 3 (4) - - 2 5 (4) Figures in brackets denote additional cases at present under observation re epilepsy—not yet certified, 109 TABLE 111.—continued. Physically Defective Children. A.—Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 1 (-) 1 (7) 2 (-) - (-) 4 (7) II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in (I) above.) At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 6 (3) 16 (25) 7 (-) 2 (-) 31 (28) EXPLANATORY NOTE. Physically Defective Children—Tuberculous. Attendance at a Tuberculosis Dispensary, subsequent to active treatment, has been looked upon as preventive treatment, and therefore treatment within the meaning of the Table. The figures in brackets under this section denote children who are notified cases of Tuberculosis and are therefore attending a Tuberculosis Dispensary, but in whose case the disease has been declared "arrested" although the children cannot yet be said to be "recovered." B.—Delicate Children. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 64 6 — 2 72 110 TABLE III.—continued. C.—Crippled Children. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 21 - - 4 25 D.—Children with Heart Disease. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 34 3 — 3 40 111 FORM 307M.—STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1933, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total No. of Children Notified 7 Analysis of the above Total. Diagnosis. Boys. Girls. 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots — — (b) Imbeciles — 1 (c) Others 3 1 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) Others 1 — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 1 — 3. Feeble-minded children notified under Article 3, i.e., " special circumstances " cases — — 4. Children who in addition to being mentally defective were blind or deaf — — GRAND TOTAL 5 2 112 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1933. GROUP I.—Minor Ailments (excluding Uncleanliness, for which see Group VI). Disease or Defect Number of Defects treated, or under treatment during the year Under the Authority's Scheme Otherwise Total (1) (2) (3) (4) Skin — Ringworm—Scalp 27 (6 of these 1 by X- Rays) 28 (6 of these by X-Rays) Ringworm—Body 5 - 5 Scabies 47 5 52 Impetigo 91 7 98 Other skin disease 225 22 247 Minor Eye Defects 187 15 202 (External and other, but excluding cases falling in Group II.) Minor Ear Defects 192 17 209 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 1,717 65 1,782 Totals 2,491 132 2,623 113 TABLE IV.—continued. GROUP II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Defect or Disease Number of Defects dealt with Under the Authority's Scheme By Private Practitioner or at Hospital, apart from the Authority's Scheme Otherwise Total (1) (2) (3) (4) (5) Errors of Refraction (including Squint) 455 138 — 593 Other Defect or Disease of the Eyes (excluding those recorded in Group I) - - Totals 455 138 — 593 Number of children for whom spectacles were prescribed:— (a) Under the Authority's Scheme 370 (b) Otherwise 138 Number of children who obtained spectacles:— (a) Under the Authority's scheme 400 (b) Otherwise 93 114 TABLE IV.—continued. GROUP III.—Treatment of Defects of Nose and Throat. Number of Defects. Defect. Received Operative Treatment Total number treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Totals Received other forms of Treatment (1) (2) (3) (4) (6) (6) Tonsils only 349 45 394 227 724 Adenoids only 6 3 9 T's and A's 65 7 72 Other 19 3 22 Totals 439 58 497 227 724 GROUP IV.—Orthopasdic and Postural Defects. Under the Authority's Scheme Otherwise Total number treated Residential treatment with education Residential treatment without education Non-residential treatment at an orthopaedic clinic Residential treatment with education Residential treatment without education Non-residential treatment at an orthopedic clinic Number of children treated 2 6 133 - - 1 134 115 TABLE IV.—continued. GROUP V.—Dental Defects. • (1) Number of Children who were:— (i) Inspected by the Dentist: Aged: Routine Age Groups 5 332 6 378 7 370 8 405 9 449 10 324 11 338 12 490 13 377 14 110 Total 3,573 Specials 1,220 Grand Total 4,793 (II) Found to require treatment 3,922 (III) Actually treated 3,134 (2) Half-days devoted to:— Inspection 27 Treatment 790 Total 817 (3) Attendances made by children for treatment 8,337 (4) Fillings—Permanent teeth 1,395 Temporary teeth 22 Total 1,417 116 (5) Extractions—Permanent Teeth 1,325 Temporary teeth 7,335 Total 8,660 (6) Administrations of general anesthetics for extractions 3,470 (7) Other Operations—Permanent teeth 4,933 Temporary teeth GROUP VI. Uncleanliness and Verminous Conditions. (i) Average number of visits per school made during the year by the School Nurses 3 (ii) Total Number of examinations of children in the schools by School Nurses 37,762 (iii) Number of individual children found unclean 1,571 (iv) Number of children cleansed under arrangements made by the Local Education Authority 92 (v) Number of cases in which legal proceedings were taken:— (a) Under the Education Act, 1921, (Section 43) 5 (b) Under School Attendance Byelaws -