BOROUGH OF BARKING REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1934 ■ C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. BARK 28 BOROUGH OF BARKING REPORT OF THE Medical Officer of Health For the Year 1934 C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. 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 10-12,17 Births, Notification of 17 Deaths 10-17 Deaths, Causes of (Table) 13-16 General Statistics 10 Housing 19 Illegitimate Births 10,17 Industries 18 Infantile Mortality 10-12,15-17 Infantile Mortality (Table) 15 Inhabited Houses 10 Inquests 14 Malnutrition 19 Neo-Natal Mortality 15-17 Population 10 Rateable Value 10 Social Conditions 18,19 Still-births 10-12,17 Travelling Facilities 19 Unemployment 18,19 Vital Statistics 10-12 Zymotic Diseases, Deaths from 13 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Ambulance Facilities 21 Ante-Natal Clinics 23,24,29,38 Ante-Natal Supervision 29 Artificial Immunisation 23,24,34,35,39 Artificial Sunlight Clinic 34,40 Barking Infant Welfare Society 22 Barking (Infectious Diseases) Hospital 25-28 Baths for Expectant and Nursing Mothers 38 Children Act, 1908, Part I 35,36 Children and Young Persons Act, 1932 35,36 Clinics and Treatment Centres 21-24 3 SECTION B—Continued Page Convalescent Treatment 33,38 Dental Surgeon, Report of 45,40 Dental Treatment 34,39,45,46 Difficult Labour, Consultations in 39 Eye Defects 33,34,40 Foster Children 35,36 Gynaecological Clinic 23,24,31,39 Health Visitors 22 Hospital Services 21,22,25-28 Hospital Services, Tables of 25-28 Illegitimate Children 32,33 Infant Life Protection 35,36 Infant Welfare Clinics 23,24,36,37,39 Laboratory Facilities 21 Maternal Mortality 31,32 Maternity Cases 30 Maternity and Child Welfare Services 22-24,29-46 Maternity Homes 36,39 Midwifery 30 Minor Ailments 23,24,35,39 Nursing Homes 36 Obstetrics and Gynaecology, Consultations in 29,39 Ophthalmia Neonatorum 32 Ophthalmic Service 33,34,40 Orthopaedic Clinic, Report of Work Done 41-44 Orthopaedic Service 40-44 Pemphigus Neonatorum 31 Plaistow Maternity Hospital and District Nurses'Home 30 Post-Natal Care 31 Provision of Dinners 39 Provision of Dried Milk, etc. 38,39 Provision of Fresh Milk 37,39 Provision of Spectacles 40 Public Hospital Services 21,22,25-28 Puerperal Fever and Puerperal Pyrexia, Consultations in 39 Services Provided and Facilities for Treatment 38-40 Specialist-Consultant Ante-Natal Clinic 23,24,29,38 Specimens Submitted to Laboratory for Examination 21 Still-births 29 Supervision of Midwives 30 Tonsils and Adenoids 33,40 Ultra Violet Light Clinic 34,40 Upney (Maternity) Hospital 30,39 Visiting in the Home 37,40 Voluntary Hospital Services 21,22,25-28 X-ray Treatment for Ringworm 40 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. Barking Sewage Disposal Works 48 Bathing in the River Roding 48 4 SECTION C—Continued Page Cesspools 48 Closet Accommodation 48,51 Common Lodging Houses 56 Creeksmouth Generating Station 57,58 Dampness 52 Defects found under the Factory and Workshop Act, 1901 54 Drainage and Sewerage 47,48,51 Dustbin Maintenance 52 Dwelling Houses, Inspection of 50 Factories, Inspection of 50,53 Factory and Workshop Act, 1901 3-55 Fat Melting 57 Home Work 54 Houses Let in Lodgings 56 Miscellaneous Sanitary Inspections 51 Miscellaneous Sanitary Work carried out 53 Notices Served 53 Offensive Trades 56,57 Out-workers 55 Pail Closets 48 Parks and Open Spaces 59 Piggeries 57 Port of London Authority 48 Premises and Occupations controlled by Byelaws and Regulations 50, 56,57 Public Cleansing 48,49 Rag Flock Acts, 1911 and 1928 57 Rainfall 47 Refuse Disposal 48,49 Refuse Storage and Collection 48,49 Refuse Tips 49 Registered Workshops 55 Repairs, General 52 Rivers and Streams 48 Sanitary Inspection of the Area 50,51 Sanitary Work, Summary of 51-53 Schools 59 School Closure 59 Schools, Sanitary Inspection of 59 Sinks 51 Smoke Abatement 57,58 Stables 57 Street Cleansing 49 Tents, Vans and Sheds 56 Trade Refuse 49 Ultra Violet Light Radiation 58,59 Underground Sleeping-rooms 56 Water Supply 47,52 Workplaces, Inspection of 50,53 Workshops, Inspection of 50,53 Yard Paving 52 5 SECTION D.—HOUSING. page Clearance Areas 64,65 Closing and Demolition Orders 65 Disinfestation 65 Houses Built in the District, 1926-1934 63 Houses Erected during the Year 61 Housing Act, 1930 65 Housing Act, 1935 64 Housing Conditions 62-65 Housing Defects Remedied 61,62 Housing Inspections 61 Housing Statistics 61-64 Housing Supply and Demand 64,65 Inhabited Houses, Number of 62 Proceedings under Public Health Acts 62 Proceedings under the Housing Act, 1930 62 Rehousing 64,65 Small Dwellings Acquisition Act 63 Temporary Buildings 63 Unfit Dwelling Houses 61,62 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food 70 Animals Slaughtered 69 Bacteriological Examination of Ice-Cream 68,70 Bacteriological Examination of Milk 67,70 Barking Corporation Act, 1933 68 Bottling of Milk 68 Chemical Examination of Food 70 Diseased Meat Destroyed 69 Food and Drugs (Adulteration) Act, 1928 70 Graded Milk Licences Granted 67 Ice-Cream 68 Meat and Other Foods 68-70 Milk (Special Designations) Order, 1923 67 Milk Supply 67,68 Nutrition 71 Prosecutions 68,70 Slaughter-houses 68 Unsound Food Destroyed 70 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Acute Anterior Poliomyelitis 74-76,78 Acute Polio-Encephalitis 74-76 Admissions to Barking (Isolation) Hospital (Table) 78 Artificial Immunisation 78,79 Barking (Isolation) Hospital 73,78 6 SECTION F—Continued Page Cancer 79,80 Cancer, Occupations of Fatal Cases of (Table) 79 Cancer, Organs affected in Fatal Cases of (Table) 80 Cerebro-spinal Fever 73 Chicken-pox 74-76 Diphtheria 73-79 Diphtheria Anti-Toxin 73 Diphtheria Notifications (Monthly Summary Table) 77 Encephalitis Lethargica 74-76 Enteric Fever 74-76,78 Erysipelas 74-76,78 Food Poisoning 74-76 Hospital Accommodation for Infectious Diseases 73 Infectious Diseases (Tables) 74-78 Influenza 74,77 Measles 77 Measles and Mastoiditis 78 Measles and Pneumonia 74-76 Non-Notifiable Acute Infectious Diseases 77,78 Notifiable Infectious Diseases 73-77 Notifications classified according to Wards (Table) 75,76 Ophthalmia Neonatorum 74-76,80,81 Pemphigus Neonatorum 74-76 Pneumonia 74-76,78 Prevention of Blindness 80,81 Psittacosis 74 Public Health Act, 1925, Section 62 82 Puerperal Fever and Pyrexia 74-76,78 Rheumatic Fever 73,77 Scabies 77 Scarlet Fever 73-78 Scarlet Fever Notifications (Monthly Summary Table) 77 Smallpox 73-76 Summer Diarrhoea 77 Tuberculosis 81,82 Tuberculosis, New Cases and Deaths (Table) 81 Unnotified Fatal Cases of Tuberculosis 81,82 Whooping Cough 77 SCHOOL MEDICAL SERVICE. Table of Contents will be found on Pages 84-85. 7 STAFF, 1934. Medical Officer of Health, School Medical Officer, Medical Superintendent, Barking and Vpney 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. Asst. Medical Officers of Health and Asst. School Medical Officers : R. H. CLAYTON, M.B., B.S., B.Hy., D.P.H. (Commenced 15th July, 1934.) EDITH A. WHITNEY, M.B., Ch.B., D.P.H. (Resigned 30th Sept., 1934.) Orthopaedic Surgeon : B. WHITCHURCH HOWELL, M.B., B S., F.R.C.S. Specialist-Consultant in Obstetrics and Gynaecology : ALAN BREWS, M.D., M.R.C.P., F.R.C.S., M.S. 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/). 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). (Resigned 14th April, 1934.) W. E. COLSTON (Sanitary Inspector) (c and n). (Commenced 1st July, 1934.) W. CUE (Sanitary Inspector) (m and n). (Commenced 9th July, 1934.) Matron, Barking and Upney Hospitals : Miss M. W. HEDGCOCK (ft, i and j). 8 Health Visitors : *Miss M. BAERLOCHER (g, h and n). *Miss C. COURT (g, h and i). Miss G. ELLIOTT (a, h and I). Miss A. E. FINDLAY (Masseuse) (k and o). (Resigned 31st December, 1934.) Miss G. GEDEN (Dental Nurse). Miss S. E. W. GIBSON (j). Miss R. LLEWELYN (Dental Nurse) (h and t). *Miss W. PARKER (g, h and i). *Miss F. G. ROXBURGH (g, h and i). Mrs. G. STOKES (g and i). Miss L. F. SWAIN (ft and i). Mrs. W. WALTON (a, ft and I). Clerical Staff : Chief Clerk—F. READ. C. G. EAGLESFIELD. D. W. OSMOND. (Commenced 30th July, 1934.) R. II. CHANDLER. (Resigned 3rd May, 1934.) Miss H. NUNN. D. G. TONKIN (n). Miss H. KING. A. J. STORER (n). Miss E. TASKER. E. A. ELLIS. Miss A. LIGGINS. G. H. RUFF. Disinfeclor and Mortuary Attendant : H. LONG. (a) Sanitary Inspector's Certificate of Sanitary Inspectors' Examination Board. (b) Sanitary Inspector's Certificate of Royal Sanitary Institute. (c) Meat, etc., Inspector's Certificate of Royal Sanitary Institute. (d) Smoke Inspector's Certificate of Royal Sanitary Institute. (e) Building Inspector's Certificate of Worshipful Company of Carpenters. (/) Sanitary Science Certificate of Royal Sanitary Institute. (g) Health Visitor's Certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives' Board. (i) General Hospital Training. (j) General Fever Training. (k) Certificate 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, 1934. PUBLIC HEALTH OFFICES, BARKING, ESSEX. June, 1935. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Mrs. Hobday and Gentlemen, Herewith I beg to submit, for your favourable consideration, my Report as Medical Officer of Health for the year ended 31st December, 1934. I am, Mr. Mayor, Mrs. Hobday 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) 72,290 Number of Inhabited Houses, March, 1934, according to Rate Books :— Houses 17,132 Shops 1,250 Total 18,382 Population Density, i.e., No. of persons per acre 17.6 Rateable Value—General £642,319 0 0 Sum represented by a penny rate £2,559 0 0 Education rates:—- Seeomiary Included in General Rate Figure 3 4¾ General Rate 13 0 2. Extracts from Vital Statistics for the Year. Live Births :— Total. Males. Females. Birth Rate. Legitimate 1,226 616 610 17.0 Illegitimate 26 13 13 0.4 Totals 1,252 629 623 17.4 Still-births :— 1 Rate per 1,000 total births Legitimate 55 27 28 42.8 Illegitimate 1 1 — Deaths 590 315 275 Death Rate 8.2. Percentage of total deaths occurring in public in stitutions, 51.7. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.76 Other puerperal causes 5 (4) 3.82 (3.06) Totals 6 (5) 4.58 (3.82) Number of deaths of infants under one year of age :— Total Infantile Death Rate. Males. Females. Total. Death Rate. Legitimate 42 23 65 53.0 56.7 Illegitimate 5 1 6 230.8 Number of deaths from Measles (all ages) 13 (14) „ „ Whooping Cough (all ages) ... „ „ Diarrhoea (under 2 years of age) 6 (N.B.—Where the Registrar-General's figures and rates differ from those prepared locally, the former are shown separately in brackets.) 13 5. DEATHS. (a) General.-—There were 311 deaths registered in Barking in 1934. Of these 9 were deaths of non-residents. Barking residents to the number of 288 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. 315 275 590 The death rate for 1934 was 8.2 per 1,000, compared with 7.6 in 1933, 11.8 for England and Wales, 11.8 for the hundred and twenty-one County Boroughs and Great Towns, including London, 11.3 for the one hundred and thirty-five smaller towns, and 11.9 for London. (b) Age Mortality.—The deaths in various age groups, according to the figures obtained locally, were as follows :— Age Group. No. of Deaths. Under 1 year 71 1 to 2 years 16 2 to 5 years 23 5 to 15 years 37 15 to 25 years 25 25 to 45 years 96 45 to 65 years 141 Over 65 years 181 (c) Causes of death in 1934.—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 113 19.1 Cancer 74 12.5 Tuberculosis (all forms) 56 9.5 Pulmonary affections (exclusive of tuberculosis), viz., Bronchitis 26 4.4 Pneumonia (all forms) 56 9.5 Other respiratory diseases 3 0.5 Zymotic Diseases 46 7.8 (d) Deaths from Zymotic Diseases.—These diseases caused 7.8 per cent. of the total deaths, such deaths being caused in the following proportions :— Enteric Fever — Measles 13 Whooping Cough — Scarlet Fever 5 Diphtheria 22 Diarrhoea 6 Smallpox — 14 (e) Inquests.—Coroner's inquests were held on 46 deaths. (f) Causes of and ages of death during the year 1934. (Net Deaths). Causes 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 4 8 1 - 13 14 Scarlet Fever — — 5 - 5 5 Whooping Cough — — — - - Diphtheria — 5 15 2 — 22 19 Influenza — 3 — — i 1 7 12 17 Encephalitis Lethargica — — — 1 1 2 2 Cerebro-Spinal Fever 1 — — 1 1 Tuberculosis of Respiratory System - - 2 9 27 13 1 52 52 Other Tuberculous Diseases — 1 1 1 1 - 4 5 Syphilis — — — — - - - - General Paralysis of the Insane, etc. - - - - - - - - 1 Cancer — 2 — 1 8 26 37 74 78 Diabetes — — — 1 1 2 4 4 Cerebral Haemorrhage — — — 2 1 6 13 22 19 Heart Disease — 2 1 — 6 29 60 98 99 Aneurysm — — — — 1 1 2 2 Other Circulatory Diseases — — — 3 10 13 14 Bronchitis 3 — 1 1 7 14 26 24 Pneumonia 14 9 1 1 11 12 8 56 54 Other Respiratory Diseases — — — 1 1 1 3 1 Peptic Ulcer — — — - 1 1 3 Diarrhoea (under 2 years) 4 2 — 6 6 Appendicitis — 1 2 1 2 2 8 8 Cirrhosis of Liver — - - - 1 Other Diseases of Liver 1 - 2 - 3 4 Other Digestive Diseases — — 1 1 4 3 6 15 15 Acute and Chronic Nephritis 1 — 1 1 4 11 3 21 16 Puerperal Sepsis — — — 1 - 1 1 Other Puerperal Causes — — — 5 5 4 Congenital Debility, Premature Birth, etc. 34 - - - - - - 34 34 Senility — — - 13 13 10 Suicide — — - - 6 2 8 8 Other Violence — 3 1 2 9 5 2 22 23 Other Defined Diseases 9 2 5 3 7 13 3 42 45 Causes ill-defined or unknown 1 — — — — 1 - 2 1 Totals 71 39 37 25 96 141 181 590 590 15 (g) Infant Mortality during the year 1934. The following table gives the actual causes of death of children dying under one year of age. Causes of deaths under 1 year of age, year 1934:— 0-1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total under 1 year. Atelectasis Neonatorum 2 — — — — 2 Bronchitis 1 1 — — 1 3 Cerebral Diplegia 1 — — — — 1 Cerebro-spinal Fever — — 1 — — 1 Congenital Debility 7 — — — — 7 Congenital Malformation 2 1 1 — — 4 Convulsions 1 — — — — 1 Dermatitis 1 — — — — 1 Enteritis — — — 1 — 1 Gastritis — — 1 — 2 3 Icterus Neonatorum 2 — — — — 2 Inanition 2 — — — — 2 Injury at birth 1 — — — — 1 Marasmus 2 — — — — 2 Measles — 1 — 1 2 4 Meningitis — — — 1 — 1 Nephritis — 1 — — — 1 Pemphigus Neonatorum 1 — — — — 1 Pneumonia 1 5 3 3 2 14 Prematurity 12 — — — — 12 Septicaemia 2 — — — — 2 Thymus enlarged — — 1 — — 1 Toxaemia. — 2 1 — — 3 Unascertainable—decomposed 1 — — — — 1 Totals 39 11 8 6 7 71 Net Births in the year :— Legitimate 1226 Illegitimate 26 1252 Net Deaths in the year:— Legitimate 65 Illegitimate 6 71 16 (h) Neo-Natal Mortality during the year 1934. Causes of Neo-Natal deaths :— Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total. Atelectasis Neonatorum 1 1 - 2 Bronchitis — 1 — - 1 Cerebral Diplegia 1 — — — 1 Cerebro-spinal Fever — — — — — Congenital Debility 6 — — 1 7 Congenital Malformation — 1 1 — 2 Convulsions 1 — — — 1 Dermatitis — — — 1 1 Enteritis — — — — Gastritis — — — — — Icterus Neonatorum 1 1 — — 2 Inanition 1 1 — — 2 Injury at Birth 1 — — — 1 Marasmus 1 — — 1 2 Measles — — — — — Meningitis — — — — — Nephritis — — — — — Pemphigus Neonatorum — — 1 — 1 Pneumonia — — 1 — 1 Prematurity 9 2 1 — 12 Septicaemia — — 2 — 2 Thymus enlarged — — — — — Toxaemia — — — — — Unascertainable—decomposed 1 — — — 1 Totals 23 6 7 3 39 Points of note in the preceding table are the large numbers of deaths occurring in the first four weeks of life and the frequency with which prematurity is the cause of death especially in the first four days of life. A closer survey of the data available shows the frequent association of marasmus and congenital debility with prematurity. It will be seen that there are seventy-one deaths under the age of one year, of which no less than thirty-nine were four weeks of age or under, and that prematurity is given as the causc of death for no less than twelve babies who died within the first four weeks of life. During the remaining eleven months of life it will be seen that bronchitis and pneumonia account for nearly half the deaths and I am persuaded that some of these deaths are due to environment. We have noted too that the second and third years of life have a considerable mortality due to bronchitis and pneumonia which are frequently complications of measles. There can be no doubt that measles is taking the place of scarlet fever as a killing disease and I hope that measles will be regarded more and more as a serious disease requiring hospital treatment. 17 I am glad to report that the incidence of gastro-enteritis (summer diarrhoea) was much less than during the preceding year. There were six such deaths, under the age of two years, during 1934 as compared with seventeen during the previous year. The following table shows the comparative figures of infant mortality and neo-natal mortality for the past eight years Infantile and Neo-Natal Mortality and Rates for the years 1927-1934 :— Year. Infantile Mortality Infantile Mortality Rate Neo-natal Mortality Neo-natal Mortality Rate 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 1934 71 56.7 39 31.15 6. BIRTHS. The net number of births registered in 1934 was 1,252, affording an annual birth rate of 17.4 per 1,000 population, compared with 17.4 in 1933, 18.3 in 1932, 18.3 in 1931, 17.8 in 1930, 18.7 in 1929 and 19.7 in 1928. Of all births, 26 were illegitimate, giving a percentage of 2.08 of the total births. Notification of Births Acts, 1907-1915.—During 1934 there were 1,228 live births notified, excluding 38 cases transferred from the district. In addition, notifications of still-births belonging to the district totalled 48. Thirty-one live births and 6 still-births were not notified, and these cases are not included in the totals of notified births given above. 18 7. SOCIAL CONDITIONS. (a) Industries.—Some of the chief industries carried on in the area are as follows :— The production of electricity, gas, benzole, naphtha and zinc oxide. The manufacture of asbestos goods, joinery, ice-cream, letter files, mineral waters, marine lights, disinfectants, printing ink, sausage skins, cabinets and furniture, nautical instruments, paint, iron goods, tin boxes, lifebelts, rubber goods, wireless equipment and batteries, matches, soap, chemical manure, wood-paving and concrete paving. The storage of petrol, oil, fuel and timber. Electrical welding, structural engineering and saw-milling. The population of Barking is almost entirely industrial. Barking is becoming a dormitory. (b) Unemployment.—The following table is compiled from information kindly supplied by the Manager of the Ministry of Labour Employment Exchange, Barking :— Copy of comparative statement of local unemployed by industries, as at December, 1933 and December, 1934 :— Men. Dec., 1933 Dec., 1934 Women. Dec., 1933 Dee., 1934 Building 043 401 Engineering 2 3 Saw-milling 16 8 Construction of Vehicles 3 — Constructional Work 45 45 Electrical Apparatus 11 6 Shipbuilding 20 17 Miscellaneous Metal Goods 13 10 Construction of Vehicles 1 15 Chemicals 6 2 Engineering 128 103 Rubber 57 70 Cabinet Making 17 19 Leather 3 4 Iron and Steel 2 6 Domestic Service 70 00 Electrical Apparatus 13 19 Commercial 33 40 Precious Metal 7 5 Road and Water Transport 25 20 Bricks 6 4 Agriculture 10 12 Chemicals 11 19 Paper, Printing, etc. 12 12 Rubber 18 30 Clothing 20 25 Leather 4 13 Other Textiles 6 — Baskets 1 2 Food 19 34 Domestic Scrvice 38 45 Tobacco, etc. 8 8 Commercial 53 05 M iscellaneous 45 52 Railway Transport, 8 15 Government and Professional 4 5 Boad and Water Transport 163 206 Agriculture 6 2 Mining 2 1 Paper and Printing 8 14 Clothing 24 31 Tobacco, etc. 2 9 Food 12 12 Gas, Water, etc. 12 12 Misc. (including unskilled) 584 790 Professional 6 12 Dock Workers 107 90 Total 1,957 2,076 Total 347 363 19 Adverting to the question of unemployment existing in the area and what effect, if any, we can trace to such unemployment on the health and physique of children and adults, the fact that you as an authority give free milk and free meals to children of persons who are unemployed and do this with the consent of the Board of Education shows that there is a general understanding that the present financial provisions made for ordinary unemployed persons are not in many instances adequate. I look forward to the time when the nutrition of people who are unemployed and their dependants will be completely co-ordinated, when the amount of relief will be adequate and be dispensed by one authority only and when it will be only necessary for your special services to call the attention of that authority to any special circumstances for a sufficient financial adjustment to be made. (c) Housing.—With particular reference to environment the considerable programme you have in housing is a measure towards overcoming your housing problem, but you have before you sufficient evidence that hundreds of houses are required in Barking to overcome the evil of overcrowding. I do most sincerely hope that the problem will not be regarded only from its local aspcct. Only a limited number of people can live in Barking and having regard to the fact that Barking is already a dormitory it seems to me to be unwise to overcrowd the area as a whole when there must be hundreds of people who could travel equally well to the City and elsewhere and live other than in Barking itself. (d) Travelling Facilities.—Arising out of the question of the way in which your industrial population travel, I have repeatedly said that the conditions under which these poor people travel calls for adverse comment. These people travel cheek by jowl in the fetid atmosphere of crowded trains. These conditions are deplorable. The irregularity of the bus services has been the subject of comment. On this, however, I have not sufficient evidence, but certainly to see a large crowd of people, tired after a day's work, waiting in long queues, in inclement weather, on uncovered pavements is a sight which cannot commend itself to one who is interested in public health. (e) Malnutrition.—With reference to malnutrition our statistics only deal with school-children and are as follows :— Of 4,117 children examined by routine at school medical inspection, 74 were found to be suffering from malnutrition ; of these, ten were referred for treatment and 64 for observation. In addition, 21 children were specially examined from the standpoint of malnutrition; of these, three were referred for treatment and 18 for observation. 21 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. r examined. Diphtheria 3,905 Sputa 257 Typhoid 33 Ringworm 1 Miscellaneous 36 Total 4,232 In addition there were 41 biological examinations for virulence. (b) Ambulance Facilities.—There have been no definite changes in the ambulances during the year 1934. The usual reciprocal argeements with neighbouring authorities have been maintained. (c) Clinics and Treatment Centres.—The table on pages 23-24 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 table presented last year is submitted for this year also. Last year I directed your attention to the question of financial assistance to voluntary hospitals and I beg to submit for your favourable consideration my observations of 1933 :— "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. 22 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. The work in connection with Maternity and Child Welfare is carried on under powers given in the following Acts :— Notification of Births Act, 1907. Notification of Births (Extension) Act, 1915. Maternity and Child Welfare Act, 1918. Part 1 of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932. Four Health Visitors are also School Nurses. With the object of obtaining continuity of service every endeavour is made to see that Doctors and such Health Visitors who are School Nurses, who attend at certain clinics, continue the supervision of children under their charge when they become of school age. During 1934 the Central Clinic was opened, and in the new building the Clinics, formerly held in the East Street Centre, run smoothly and are growing in size. The other Maternity and Child Welfare Clinics are held at the Alexandra, Shaftesbury and Greatfields (Infant Welfare only) Centres. During the year the setting up of a new centre in the north-eastern part of the Borough has been under consideration and next year I shall be reporting that Infant Welfare and Ante-Natal Clinics are being held at the Methodist Church, Porters Avenue. I look forward to the time when clinic premises will be erected in this northern area similar to those being built in the southern section of the Becontree Estate. In connection with the Welfare Clinics, the help given by the ladies of the Barking Infant Welfare Society is much appreciated and gratefully acknowledged. 23—24 CLINIC AND TREATMENT CENTRES Name and Situation When Held Nature of Accommodation By Whom Provided 1. Maternity and Child Welfare. (a) Infant Welfare Centres :— Central Clinic, Vicarage Drive, Ripple Road Tuesdays and Fridays, 2 p.m. Modern clinic premises with accommodation for consultations, weighing of babies, waiting rooms, etc. Local Authority. Greatfields Centre, Movers Lane Mondays and Thursdays, 2 p.m. Accommodation for consultations, weighing of babies, waiting rooms, etc. do. Alexandra Centre, St. Paul's Road Mondays and Thursdays, 2 p.m. do. do. Shaftesbury Centre, Stamford Road Tuesdays and Fridays, 2 p.m. do. do. (b) Ante-Natal Clinics :— Central Clinic, Vicarage Drive, Ripple Road Wednesdays, 2 p.m. Fridays, 10 a.m. Modern clinic premises with accommodation for consultations, etc. do. Alexandra Centre, St. Paul's Road Tuesdays, 2 p.m. Accommodation for consultations, etc. do. Shaftesbury Centre, Stamford Road Wednesdavs,10 a.m do. do. Specialist-Consultant Clinic at Alexandra Centre, St. Paul's Road. Last Friday in each month, 2 p.m., except August do. do. (c) Gynaecological Clinic:— Central Clinic, Vicarage Drive, Ripple Road and December. As and when required. Modern clinic premises with accommodation for consultations, etc. do. (d) School Nurseries:—Nil Nil Nil Nil (e) Day Nurseries:—Nil Nil Nil Nil '2. School Medical Service. (a) Inspection Clinics and Treatment of Minor Ailments :— Central Clinic, Vicarage Drive, Ripple Road Daily, 8.30 a.m. Modern clinic premises with inspection, waiting, and treatment rooms, etc. Local Authority. Shaftesbury Clinic, Stamford Road do. Large hall and two rooms do. (b) Eye Clinic :— Central Clinic, Vicarage Drive, Ripple Road Three sessions weekly Modern clinic premises do. (c) Dental Clinics :— Central Clinic, Vicarage Drive, Ripple Road Daily, 9 a.m. and 2 p.m. Modern clinic premises with waiting and treatment rooms, etc. do. East Street Clinic Daily, 9 a.m. and Waiting and treatment rooms do. (d) Orthopaedic Clinic:—Faircross School 2 p.m. First Thursday in each month at 2 p.m. One room do. (i) Remedial Exercises Clinic Daily, 9 a.m. and One room do. (ii) Ultra-Violet Light Therapy 2 p.m. 3. Diphtheria Prevention Immunisation Clinic. Central Clinic, Vicarage Drive, Ripple Road ... Mondays, 10 a.m. Modern clinic premises with waiting and treatment rooms. do. 4. Tuberculosis. 37, Linton Road Mondays, 3-5 p.m. Thursdays, 10.30 Three rooms Essex County Council. 5. Venereal Diseases. London Hospitals, etc. a.m.-12 noon Ry arrangement with Essex County Council. N.B.—Since the end of 1934, Infant Welfare Clinics and Ante-Natal Clinics have been opened at the Wesleyan Methodist Church premises in Porters Avenue and are held as follows :— Infant Welfare Clinics Mondays and Wednesdays at 2 p.m. Ante-Natal Clinic .Thursdays at 9.30 a.m. 25—26 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— 8 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, F..7 General Medical and General Surgical 34 34 20 Voluntary 7 Golden Square Throat, Nose and Ear Hospital Golden Square, Piccadilly Circus, W.l 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 available ) London County Council 11 King George Hospital Ilford, Essex General Medical and General Surgical 41 61 22 Voluntary 12 London Hospital Whitechapel Road, E.l 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.l Skin. (No in-patients) — — — Voluntary 15 Orsett Joint Smallpox Hospital Stifford Long Lane, Grays, Essex Smallpox 11 11 — Orsett Joint Hospital Board 16 Poplar Hospital for Accidents East India Dock Road, E.14 General Medical and General Surgical 56 30 26 Voluntary 17 Princess Elizabeth of York Hospital for Children Glamis Road, Shadwell, E.l Children — 135 Voluntary 18 Public Assistance Hospital Oldchurch Road. Romford. Essex General Medi"al, 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, 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 Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex Orthopaedic 45 70 345 Voluntary 23 St. Bartholomew's Hospital Smithfield, E.C.l General Medical and Surgical, Children, Maternity, etc., Ophthalmic, Orthopaedic,Ear, Nose and Throat, and Septic, etc. 287 344 65 Voluntary 24 St. Mary's Hospital for Women and Children Upper Road, Plaistow, E.l3 General Medical and Surgical, Children, etc. — 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. 27—28 TABLE II. HOSPITAL SERVICES, showing the number of beds for each purpose, and other facilities available. Number of beds for the following purposes Name of Hospital. Accident Chest (nontub.) & Heart Children Chronic Sick Dental Dermatological Ear, Nose & Throat General Medical General Surgical Genito-urinary | Gynaecological Infectious Diseases Isolation & Observation Maternity Mental Neurological Ophthalmic Orthopaedic Radium Septic Small-pox Tuberculosis Venereal Diseases Other facilities available Arrangements for pathological work Controlled by the Council of the Borough of Barking. 1† Upney (Maternity) Hospital — — — — — — — — — — — — — 26 — — — — — — — — — Operative surgery, Dental, Nursing of 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 Brookfleld Orthopaedic — — — — — — — — — — — — — — — — — 30 — — — — — Operative Surgery, Ultra-violet light, Dental,Massage,X-rays,Ophthalmic. No information available. 5 City of London Hospital for Diseases of Heart and Lungs — 72 8 — — — — — — — — — — — — — — — — — — 101 — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Nose and Throat, Radium. Own Laboratory. 6 East Ham Memorial — — — — — 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 — — — — — — 84 — — — — — — — — — — — — — — — — 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. 9 Hospital for Sick Children — — — — — 18 106 121 — — — — — — — — — 7 All specialised treatment available. Own Laboratory. 10 Joyce Green Hospital (Iso lation of S mallp ox) No infor matio n ava ilable from the Lond on C ounty Cou ncil. (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, Own Laboratory. 12 London Hospital — — — — — — 28 306 338 — 28 — 97 22 — — 24 — — — — — — cological, Neurological, Dermatological. All specialised treatment available. Own Laboratories. 13 London Lock Hospital — — 15 — — — — — — — — — — 6 2 — 2 — — — — 31 Operative surgery, Ultra-violet light, Dental, Ophthalmic, Massage, Ophthalmia Neonatorum. Own Pathologist. 14 London Skin Hospital — — — — — — — — — — — — — — — — — — — — — — — Skin diseases only. (No in-patients.) Ultra-violet light, X-rays. Own Laboratory. 15 — — — — — — — — — — — — — — — — — — — — — — — 16 Poplar Hospital for Accidents —- — — — — — — 34 78 — — — — — — — — —- — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Radium by arrangement with the London Hospital. Own Laboratory. 17 Princess Elizabeth of York Hospital for Children — — 135 — — — — — — — — — — — — — — — — — — — — All specialised treatment available. Own Laboratory. 18 Public Assistance Hospital — — 124 160 — — — 120 120 — — — — 30 32 — — 60 — — — 03 — All specialised treatment available with the exception of Ophthalmic and Radium. Carried out at the Counties' Laboratory, E.C.t. 19 Queen's Hospital for Children — — 160 — — — — — — — — — — — — — — — — — — — — All specialised treatment available with the exception of Radium. Own Laboratory. 20 Queen Mary's Hospital for the East End — — 47 — — — 2 46 54 — 3 — — 50 — — 3 2 — — — — — All specialised treatment available. Own Laboratory 21 Royal London Ophthalmic (Moorfields Eye Hospital) — — — — — — — — — — — — — — — 135 — — — — — — All specialised treatment available with the exception of Operative surgery, Massage and Radium. Own Laboratory. 22 Royal National Orthopaedic — — — — — — — — — — — — — — — — — 460 — — — — — Operative surgery, X-rays, Ultraviolet light, Massage. Own Pathologist. 23 St. Bartholomew's Hospital — — 18 — — 6 24 232 250 — 44 — 10 17 — — — 18 — — — — All specialised treatment available. Own Laboratories. 24 St. Mary's Hospital for Women & Children — — — — — — — 22 37 — 8 — — — — — 4 — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Nose and Throat, Orthopaedic. Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic. All specialised treatment available. Part-time Pathologist in conjunction with other Hospitals. Severalls Mental Hospital — — — — — — — — — — — — — — 1886 — — — — — — — — Own Laboratory. 26 Westminster Hospital 10 13 5 2 7 64 85 10 8 12 6 4 16 — — — — Own Laboratories + In the case oj Hospitals under the control of the Borough of Barking :— Upney (Maternity) Barking (Isolation) Hosbital HospitaL Number and classification of Medical Staff The Medical Officer of Health is also the Medical Supt. and is assisted in this work by the Assistant M.O.'s H. Number and classification of Nursing Staff: Matron — 1 Sisters 1 4 Assistant Nurses — 4 Midwives 4 — Probationer Nurses 4 21 29 (a) Ante-Natal Supervision.—Ante-Natal Clinics are held at three centres—two sessions weekly at the Central Clinic, and one session weekly at the Alexandra and the Shaftesbury Clinics. the Shaftesbury Clinics. The following table shows the work carried out at these clinics during the year :— Central Clinic. Alexandra Clinic. Shaftesbury Clinic. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. 102 425 1323 2248 51 99 657 756 51 197 721 918 Total rirst Attendances 721 „ Re-Attendances 3,201 ,, Attendances 3,922* ,, Sessions 204 * In addition there were 12 Post-Natal Attendances. A large number of the expectant mothers who attend your Ante-Natal Clinics are those who desire to be confined in Upney Hospital or those who have made arrangements for their forthcoming confinement with the Plaistow Maternity Hospital and District Nurses' Home. Certain cases who have engaged private midwives are also seen at your Ante-Natal Clinics. I hope that the midwives practising privately in Barking will more and more avail themselves of the facilities that are available in this direction. It is satisfying to note that a large proportion of the women who avail themselves of the services at your Ante-Natal Clinics are women approaching their first pregnancy, and attend regularly. The Ante-Natal Services carried out are based upon the suggestions which have been issued by the Ministry of Health, and the members of your staff who are engaged in this work consult Mr. Alan Brews at the Consultant Ante-Natal Clinic held monthly at the Alexandra Clinic, so that they may have the helpful advice of his large fund of information on this subject, in which he has specialised. The whole of the work is carried out in a spirit calculated to impress pregnant women, especially those pregnant for the first time, that pregnancy is a normal and ordinary event and that provided due care and attention is given it may be approached without fear. Details of the milk and meals supplied to expectant mothers are given on pages 37-39. (b) Still-births.—During the year 1934, there were no less than 56 still-births ; that number is too high. Only in approximately one-fifth of the eases was any cause discovered which could be looked upon as reasonably covering the whole of the facts. In no less than 39 cases the cause of the still-birth was definitely stated to be unknown. Our chief difficulty, in my opinion, is that the controlling factors are so private and personal that the particulars we get are too scanty to give data on which to base any sound judgment. This matter is receiving our serious consideration and I hope to be able to report further next year. 30 (c) Midwifery.-—The number of midwives who are engaged in practice in the Borough is as follows :— At Upney Hospital At the District Nurses' Home of the Plaistow Maternity 5 Hospital 2 In private practice 7 The Essex County Council is at present the Local Supervising Authority for Midwives, but these duties will be carried out by you from the 1st April, 1935. By agreement, dated 1st January, 1924, with the Plaistow Maternity Hospital and District Nurses' Home, the Council annually subsidise the Hospital on any deficit from £300 in respect of 300 District Midwifery cases attended by their midwives, reckoned at the rate of £1 per case. The takings of the Hospital for 1934 in respect of 185 cases amounted to £228 8s. Od. leaving a balance payable to the Hospital by the Council of £71 12s. Od. During the year 1934 there were 1,227 maternity cases in the district. 163 of these were conducted by the Plaistow Maternity Charity, 317 of them were conducted by your own midwives at Upney Hospital, leaving 747 which were dealt with by medical practitioners, private midwives or otherwise. (d) Upney Hospital.—The admissions to the Maternity Home during 1934 numbered 334 of which 16 were admitted for ante-natal treatment. During the past year the average number of beds occupied was thirteen. The present hospital building is of a temporary nature, but in spite of this the results obtained testify to the efficiency and care of the nursing staff. This building is about to be replaced by a permanent building and it is hoped that 1935 will see the complete transfer of your Maternity Home to a modern and well-equipped building which I am persuaded will be one of the most wonderful in the country. It is impossible to see this old building swept away without a pang of regret and whilst we look forward with pleasure to the new Maternity Home which is about to be built we remember with gratitude the men and women who had sufficient foresight to build the old hospital, which has served a wonderful purpose. It must be remembered that "stone walls do not a prison make " and bricks and mortar are only a very small part of a hospital, and we trust to carry forward in the new home the same spirit of service and devotion which has been the foundation of your maternity work in Barking. 31 (e) Post-Natal Care.—Following the birth of a child efforts are made to see that the mother is left with no residual disability which would affect her health or any subsequent confinement. (f) Gynaecological Clinic.—During 1934 facilities have been afforded for the gynaecological examination of women. Up to now, the existence of these facilities and the scope of their application have not been fully realised. When more extensive use is made of this service it is suggested that a weekly session be held. The primary object of the clinic is to enable ordinary women who believe themselves to be in ordinary health to have a complete overhaul so that they may rest assured that there are no signs of commencement of any serious conditions from which women suffer. These conditions are often only apparent to the ordinary average person in the later stages but can be detected by a trained person in the early stages when they are usually easy to deal with. At this clinic we hope that many women who have been delivered of their babies will come some six or eight weeks after the baby has been born so that they too may have the assurance that their pregnancy and parturition have left no disability which might be aggravated as the years go by. (g) Pemphigus Neonatorum.—It was proposed on the 11th May, 1934, that you should make Pemphigus Neonatorum a notifiable infectious disease under the Infectious Disease (Notification) Act, 1889, and the Council on the 29th May, 1934, decided that this should be so, and the necessary steps were taken. We have received two notifications of Pemphigus Neonatorum, which have been dealt with ; both cases recovered. One other case which came to our notice prior to the date of compulsory notification unfortunately died. Pemphigus Neonatorum is a disease of the newly-born in which there is a characteristic eruption of the skin. (h) Maternal Mortality.—According to the return of the Registrar-General there were during the year 1934 five deaths from puerperal causes—one death from puerperal sepsis and four deaths from other puerperal causes. This gives a rate of 3.82 per 1,000 total births. 32 The following table gives you similar information for the last eleven years :— Maternal Mortality—Statistics. Year. Barking. England and Wales Rate per 1,000 births. Deaths from Rate per 1,000 births. Puerperal Sepsis. Other Puerperal Causes. 1924 1 2 3.66 *3.90 1925 — 1 1.21 *4.08 1926 — 1 1.22 *4.12 1927 2 1 4.23 *4.11 1928 — 2 2.48 4.25 1929 — 2 2.54 4.16 1930 — 3 3.72 4.22 1931 1 3 4.08 3.95 1932 — 1 0.88 4.06 1933 4 — 3.2 4.23 1934 1 4 3.82 4.41 *Rate per thousand live births—figure not available in respect of rate per thousand total births. Whenever there is a case of maternal mortality, and even in cases where the death is following abortion or where death is associated with pregnancy or childbirth but primarily due to intercurrent diseases such as nephritis, tuberculosis, heart disease, etc., full investigations are carried out and confidential reports communicated to the Ministry of Health. (i) Ophthalmia Neonatorum.—During the year twenty cases of Ophthalmia Neonatorum were notified. Nineteen of these cases recovered with unimpaired vision and in the remaining case we have no reason to believe that the vision would have been impaired had the child lived ; unfortunately it died from some intercurrent disease. (j) Illegitimate Children.—Special attention is paid by the Health Visitors to all illegitimate children. Twenty-six illegitimate children were born during the year, and six died. The illegitimate mortality rate is more than four times the mortality rate for legitimate children. 33 Although our figures in Barking are too small in themselves to warrant a considered opinion, the similar figures throughout the country tell the same story of this high mortality rate among illegitimate children. The whole question bristles with difficulties of which the purely medical ones are by no means the greatest. Those people who are interested in the social and other sides of the question must deal with it, for where we have such a high mortality rate it is only fair to assume that there is a generally lowered resistance of a large number of these children to the disabilities which are common to infants. (k) Tonsils and .Adenoids.—Children who are found to require surgical treatment for enlarged tonsils are in most eases sent to Queen Mary's Hospital, Stratford, with whom you have a scheme for treatment; they are sometimes sent to other hospitals. It is to be noted that these children are seen by a surgeon for his opinion as to whether surgical treatment is necessary, so that they are seen by at least two medical practitioners before the operation is performed. I have commented elsewhere upon the desirability of looking upon this treatment of tonsils and adenoids as more than a minor operation and I confidently believe that the practice will grow for these children to be retained in hospital after the operation, for at least two or three days, and I hope the custom will eventually be that they will be admitted to hospital a day before the operation so that they may settle down before going to the operating theatre. (1) Convalescent Treatment.—During 1934 a number of mothers and children were recommended for convalescent treatment, (m) Ophthalmic Clinic.—As with other disabilities, every effort is made to remedy ophthalmic defects as early as possible. The appointment of an Ophthalmic Surgeon has been found advisable, and those cases referred from Infant Welfare Centres to the Ophthalmic Clinic will in future be directly under his care. The following table shows the number of mothers and children who have been treated :— No. treated. Mothers 1 Mothers and toddlers 11 Toddlers (under 5 years of age) 14 34 The advantages of early correction of deformities is particularly noticeable in the case of squint in young children, where regular use of glasses can correct the deviation. The fetish of the squint " curing " itself is one of the most tragic in medicine and although there are exceptions to everything, even in medicine, it can be stated that the squint only " cures " itself at the expense of the loss of useful sight in the squinting eye. (n) Ultra-Violet Light Clinic.—This clinic has continued to serve its useful function in providing an antidote to the effects of our comparatively sunless winters. We find that ultra-violet light treatment is useful in summer time, for by using an appropriate lamp we can give gradual doses under expert supervision. One of the difficulties of exposing children to natural light for treatment is that it so often happens that they are given too much in the early stages. This is particularly seen when children go for a holiday by the sea, where without any previous exposure they are allowed to run about in the sunshine to which they are not accustomed. Children who might be expected to benefit from this form of therapy are referred by the Medical Officers, and during their course of treatment are kept under medical supervision. Rickets, malnutrition and chilblains are the conditions which derive the greatest benefit. (o) Dental Treatment.—The provision of dental facilities for children of pre-school age under the supervision of the Medical Officers in charge of the Welfare Centres is beginning to show very marked results on the growth and development of the infants' teeth. The value of persistent teaching of hygiene and dietetics by both departments and the early eradication and arrest of minor decay in the toddlers is being shown in the great improvement in the teeth of children seen on admission to the Infants' Departments of the Elementary Schools. Mothers throughout the Borough are showing themselves very appreciative of this service and with their continued co-operation we may look forward to a time when long lists of extractions for these toddlers will be a thing of the past. (p) Diphtheria Immunisation.—Facilities have been afforded during the year for the immunisation of children against diphtheria. Rapid and safely produced immunity can be induced by means of injections, and nineteen children were immunised during the year. 35 Whilst we have every reason to believe that this procedure will free the individuals so treated from the risk of contracting diphtheria, it is of course apparent that immunity produced in so small a number will not materially affect the attack rate, that is, the number of people who will contract diphtheria. Thus, whilst having the satisfaction of knowing we have protected those who have availed themselves of this service, we deplore the fact that we cannot look for prevention in any material degree to the whole community, without first persuading a considerable percentage of the school population, and more especially of the toddlers or pre-school age children, to submit themselves to this treatment. (q) Minor Ailments.—Your Minor Ailments Clinics have been held at two centres and here babies and toddlers have been treated whenever necessary; so also have certain conditions in nursing mothers. The following table shows the work which has been carried out at your Minor Ailments Clinics :— Central Clinic. Shaftesbury Clinic. No. of cases seen by medical officers :— (a) New cases 233 495 (b) Old cases 670 1,346 No. of attendances for treatment 1,114 1,550 (r) Infant Life Protection (under Part I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932).—Your Health Visitors and Chief Sanitary Inspector are all Infant Life Protection Visitors, and regular visits are paid to all children coming within the meaning of the Act. I am perturbed both at the number of irregularities among foster-mothers and at the small importance which is attached to such irregularities. It is the duty of every foster-parent to inform the Council in writing at least seven days before receiving a child, under the age of nine years, to keep for reward, and similar notice is required for each additional child kept for payment. Fosterparents are also obliged to give seven days' notice to the Authority of intention to change residence. In the case of the removal of an infant, notice must be sent within twenty-four hours of the name and address of the person to whom the child is being sent. 36 These regulations we find are constantly being ignored and I myself would like to see the laws and regulations governing foster-mothers punctiliously obeyed and even extended to include women who receive children not to keep for personal gain. These latter should be obliged also to inform the Authority of the receipt of such children so that we may be able to trace all children within the Borough and keep a continuous record of all children passing to the care of any persons not their own parents. (s) Maternity and Nursing Homes.—During the year no less than 315 children were born in your Maternity Home and 14 births have been notified from one house in Barking which has been used as a nursing home. (t) Infant Welfare Clinics.—The following table shows the work carried out at your various Infant Welfare Clinics during the year :— Central. Greatfields. Alexandra. Shaftesbury. Totals. No. of sessions 102 102 102 102 408 No. of attendances of children under one year :— (a) new cases 222 148 172 429 971 (b) old cases 2,644 1,687 2,149 4,720 11,200 No. of attendances of children 1-5 years of age :— (a) new cases 65 32 70 326 493 (b) old cases 1,675 1,222 1,517 3,574 7,988 Average No. of attendances per session 45 30 38 87 50 No. of sessions attended by Medical Officers 102 102 102 102 408 No. of children seen by Medical Officers other than at above sessions :— (a) new cases 235 — — 497 732 (b) old cases 670 — — 1,346 2,016 Average No. of children seen by Medical Officer per session 19 16 19 24 19 The total attendances during the year were 20,652 as compared with 17,554 in 1933. 37 The information which is brought out by this table is that there were 971 individual children (new cases), under the age of one year, who attended your clinics. You will remember that the total number of live births was 1,252 which means that approximately 77 per cent, of the children born in Barking attended at your centres. (u) Home Visiting.—The home visits carried out by your Health Visitors are shown in detail in the following table :— No. of half-days devoted to visiting 1,927 No. of ante-natal visits :— First visits 362 Subsequent visits 67 No. of first visits to children under one year 1,543 No. of subsequent visits to children under one year :— (a) attending a centre 608 (b) not attending a centre 5,812 No. of visits to children 1 to 5 years of age :— (a) No. of visits 9,347 (b) No. of children seen 12,773 No. of special visits in connection with ophthalmia neonatorum 52 „ „ ,, deaths of children up to 3 years of age 82 „ ,, „ still-births 41 „ „ „ peuperal sepsis and puerperal pyrexia 3 Other visits (re infectious diseases) 368 Total home visits of all kinds 18,285 (v) Provision of Fresh Milk.—Particulars of the amounts of wet milk supplied free and at reduced rates to necessitous mothers and children are given in the following table :— No. of pints supplied at reduced price. No. of pints supplied free. Total. Total cost of milk supplied. Council's liability in respect of fresh milk supplied. £ s. d. £ s. d. 6,885 44,058½ 50,943½ 805 5 2½ 751 11 2 38 (w) 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 1 935 283 425 1,643 Ostermilk 2 579 337 317 1,233 Cow and Gate 1,663 904 1,542 4,109 Cow and Gate (half cream) 121 65 30 216 Ambrosia 974 464 1,591 3,029 Colact 10 1 6 17 Haemolac 69 9 58 136 Lactogal 530 9 71 610 Virol 874 54 390 1,318 Parrish's Food 247 15 140 402 Liquid Paraffin 149 2 9 160 Malt and Oil 372 44 420 836 Vitoleum Cream 22 — — 22 Pure Cod Liver Oil 163 —r 35 198 Cod Liver Oil Emulsion 2,489 7 640 3,136 Totals 9,197 2,194 5,674 17,065 (x) Services provided and Facilities for Treatment.—It is convenient to set these out in tabular form, although of course some of them are mentioned elsewhere in the Report. Ante-Natal Clinics Ante-Natal Clinics are held each week at three different centres, and a Specialist-Consultant holds one session per month during ten months of the year. Baths ... ... ... ... In certain necessitous cases, free baths are provided for expectant and nursing mothers at the East Street Baths. During 1934 no baths were granted free of charge. Convalescent Treatment Convalescent treatment is provided for toddlers for mothers and babies, on the recommendation of Medical Officers at the Infant Welfare Clinics. Charges are made to the parents in accordance with the Council's scale. During 1934, 14 toddlers, one mother, and 11 mothers with babies received treatment under this scheme. 39 Dental Treatment Dental treatment for toddlers and expectant and nursing mothers is carried out at the Central Clinic and at the East Street Dental Clinic. 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 1934, 927 dinners were supplied to mothers and 1,235 to children under this scheme. Diphtheria Immunisation A Diphtheria Immunisation Clinic is held every Monday morning at the Central Clinic. Gynaecological Clinic Gynaecological Clinics are held as and when required. 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. 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. 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. Minor Ailments Treatment is given daily at the Central Clinic and the Shaftesbury Clinic to children under the age of five years. 40 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, six 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. 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, 125 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 Orthopredie Clinic. During 1934, 50 children were treated, a total number of 335 treatments being given. 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 Ring- Where necessary, ringworm is treated by X-ray. worm No charge is made for this treatment. No child under the age of five years was so treated during the year 1934. 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. 41 REPORT ON THE WORK OF THE ORTHOPAEDIC CLINIC Mr. B. Whitchurch Howell, Orthopaedic Surgeon, has taken this opportunity to pay Miss A. E. Findlay a well-deserved compliment for her expert service since the foundation of the Clinic in 1925. He would also like to add that her courtesy, tact and mature judgment, the result of years of administrative and orthopaedic experience elsewhere, made her one of the most valuable members of the orthopaedic team, not only in Barking, but in the County of Essex. On first attendance at an Infant Welfare Clinic, each child is carefully scrutinised for any deformities or disabilities which require the care of the Orthopaedic Snrgeon. Also cases showing developmental deformities during their attendance at the Centres are referred to his Clinic for advice and treatment at the earliest possible opportunity. Other cases are sent by the local medical practitioners. During the year sixteen children received orthopaedic treatment as in-patients in hospitals approved under the Council's Orthopaedic Scheme. The results show the value of early and thorough treatment, the less serious deformities being restored to perfect function and even more advanced crippling defects being materially assisted and improved. 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 84 No. of re-examinations by Orthopaedic Surgeon 169 42 The cases dealt with for the first time during 1934 were referred for the following conditions, some children having more than one defect:— (a) Deformities—Bones and Joints. (1) Congenital: Asymmetry—skull 1 (2) Acquired: Genu valgum 30 Bowed tibiae ... 20 Bowed femora 1 Genu varum 1 53 (b) Muscular. (1) Congenital: ? Torticollis and Hsematoma sterno-mastoid 9 Talipes 3 (2) Acquired: Pes piano-valgus 40 Deformity of digits—foot 3 Contracture-—hand and digits (burn) 1 (c) Paralysis. JU Amyotonia—neck muscles 1 Anterior poliomyelitis 1 Also Spinal weakness with kypho-lordosis 1 3 Total defects found 112 During the year, five children under school age were admitted to hospital and the following operations were carried out in these cases :— Osteoclasis—right and left feet—with plaster 1 Manipulation—left foot—and plaster 1 Plastic operation—hand-—skin graft 1 Plaster bed and splintage 1 43—44 PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1934. 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 11 241 112 84 249 169 1,889 670 2,250 923 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 Treatments School Children 15 240 2 31 76 1,415 15 317 64 239 Under School Age 13 42 — — 4 13 50 335 — — 58 324 Admissions to Hospitals On Waiting List for Admission 31 /12 /34 School Children Under School Age Total School Children Under School Age Total 11 (10 under Council's 5 16 2 1 3 45 REPORT OF THE DENTAL SURGEON June, 1935 To the Medical Officer of Health, Borough of Barking. Sir, I have the honour to present the report of the dental service under the Maternit; and Child Welfare Scheme for the year ended 31st December, 1934. It is encouraging to note that there is a general increase in figures except ii the case of treatments to toddlers. This latter is attributable to the lessening ii silver nitrate treatments and to children passing from the Maternity and Chi b Welfare Scheme to the School Dental Service. In silver nitrate treatments, si many mothers attend from the distant parts of the town that at present it is no reasonable to expect their interest in one or more deciduous teeth to survive th expense, both in time and money, of a series of visits. Apart from this the evidence of opinion is that the Council's Dental Service i beneficial and considerably in favour with the mothers to whom it is intended ti apply. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, l.d.s., r.c.s. (eng.), Public Dental Officei 46 DENTAL CLINIC. Maternity and Under-Age Cases. Extractions 1465 Scalings 65 Dressings 28 Inspections 183 Fillings 72 Dentures supplied 149 Anaesthetics— General 416 Local 15 Patients— Old 1144 New 205 Number of Sessions held 118 " Under-age " children— Treatments 1090 47 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. Two samples of water were taken during the year. 2. RAINFALL. The rainfall for the year ended 31st December, 1934 was 18.02 inches as compared with 17.23 inches for the previous year. Rain fell on 147 days in the year 1934. 3. DRAINAGE AND SEWERAGE. The London County Council (Ilford and Barking Drainage) Act, 1928 of August of that year gave powers to the Boroughs of Ilford and Barking to discharge into the London Main Drainage sewage system. It also provided for conveyance to, and treatment and disposal at the outfall works of the London County Council, of the sewage from these districts. In October, 1929 an agreement was entered into for carrying out the scheme. The constructional work commenced in April, 1930. The works on completion will be sufficient for a future population of 270,000 for Ilford and 100,000 for Barking. It is expected that the new system will be in operation about the middle of 1935. In addition to the above work which has been proceeding on behalf of the Joint Authorities considerable reconstruction of the main sewers of the district has been carried out by the Barking Corporation. 48 When the whole of these works are completed the disposal of the sewage of the district should be satisfactory for very many years. The Barking Sewage Disposal Works, situated at Gascoigne Road, 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. On no account should anyone bathe in the River Roding. 5. CLOSET ACCOMMODATION. At the end of the year there remained a total of 14 premises unconnected with the sewer. Seven of these were factory premises. Of these 14 premises, 8 have cesspools and 6 have pail closets. Five premises were connected to the sewer during the year, without cost to the Corporation. The premises still unconnected are isolated properties. Cleansing is carried out by means of covered vehicles and suction pumps. 6. PUBLIC CLEANSING. (a) Storage, Collection and Disposal.—The collection and disposal of domestic refuse is controlled by the Borough Engineer and Surveyor. By the operation of the Barking Corporation Act, which came into force in July, 1933, a standard type of dustbin is being brought gradually into general use. 49 During the year, 9,263 loads of refuse were collected, with an average weight of 1 ton 14 cwts. This figure shows a yield of 11.2 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. The site of the Mayesbrook Tip is 1,000 feet distant from the nearest occupied house and was formerly a large ballast pit. It forms part of an area of land now being laid out as a park so that the filling of this land is work of a valuable character. Notwithstanding the distance from houses, complaints of fly infestation were received from householders. Barking is now regarded as a built-up area and the problem of refuse disposal will soon become acute unless the Corporation decide upon reclamation of marsh land, which is considerable in area but which is now set aside for industrial development. (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. REFUSE DISPOSAL—PRIVATE TIPS. There are a number of small tips in the district where landowners are increasing the level of low-lying land. These tips are controlled by the provisions of the Essex County Council Act of 1933 which superseded the Corporation's byelaws, in operation since 1926. One hundred and forty visits were paid to such tips during the year, chiefly to offer advice as to the methods of disposal. At one tip an infestation of crickets was a source of trouble to neighbouring houses. The nuisance was dealt with by the use of hessian, creosote and an additional closely packed cover of earth. 50 8. SANITARY INSPECTION OF THE AREA, (a) Work of Sanitary Inspectors. (1) Inspection of Dwelling-Houses. Total Houses Inspected under Public Health or Housing Acts ... 3,323 Total Number of Inspections made 11,351 Housing (Consolidated) Regulations 841 After Infectious Disease 1,768 Defects Found 8,942 Notices Served (Preliminary) 2,107 Re-inspections re Notices Served 4,363 Inspection of Works in Progress 953 (2) Premises Controlled by Byelaws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings 2 — — Common Lodging Houses 80 4 1 Offensive Trades 162 35 17 Tents, Vans and Sheds 36 1 1 Dairies, Cowsheds and Milkshops 330 31 9 Slaughter-houses 236 4 2 (3) Factories, Workshops and Workplaces. tions. Defects. Notices. Factories 219 43 22 Laundries 3 1 1 Bakehouses 51 28 19 Domestic Workshops 16 — — Other Workshops 95 8 8 Other Workplaces 74 6 3 Outworkers' Rooms 113 1 1 Butchers' Premises 812 34 21 Fishmongers 36 3 2 Restaurants and Dining Rooms 176 18 14 Stables and Stable Yards 77 8 5 Piggeries 9 — — 51 (4) Miscellaneous. Inspections. Defects. Notices. Rats and Mice (Destruction) Act, 1919 180 6 6 Vacant Land and Refuse Dumps 140 7 1 Public Lavatories 83 8 3 Schools 43 5 2 Markets and General Shops 508 21 26 Ice-Cream Vendors 245 9 4 Petroleum and Celluloid Stores 115 8 1 Drainage Inspections 279 — — Milk Sampling 33 — — Rippleside Conversions 5 — — Other Miscellaneous 567 — — Visits to Smallpox contacts 20 Inspection of Meat from Outside District 256 3 — (b) Summary of Sanitary Work Carried Out. (1) Drainage. Choked drains, opened, repaired and cleansed 178 Drains reconstructed ... 65 New drains (conversions) 5 Ventilation shafts repaired or new fixed ... 24 New inspection covers 13 (2) Closet Accommodation. Roofs W.C. structures requried 3 Walls Floors Doors Seats fixed 103 W.C. pans fixed or cleansed ... 97 Flushing apparatuses repaired or renewed ... 221 (3) Sinks. New fixed 68 New sink and bath wastepipes 74 New gulley traps 18 (4) Dampness. Roofs and flashings 613 Eavesgutters 371 Rainwater pipes 140 (5) Water Supply. Drawtaps provided 5 Defective water fittings repaired and supply reinstated 44 (6) Yard Paving. Yard paving repaired or re-laid 198 Gulley dishing repaired or renewed 74 (7) Dustbins. New ones provided 602 (8) General Repairs. External walls re-pointed 635 House floors repaired 234 Windows repaired or renewed 290 Window and door reveals repaired 150 Window sills repaired or renewed 270 Sashcords renewed 331 Washing coppers repaired or renewed 159 Stoves repaired or renewed 232 House doors and frames repaired or renewed 173 Stairs repaired 28 Handrails fixed Chimney pots renewed and stacks rebuilt 357 Dirty or defective rooms repaired, cleansed and redecorated 2,412 Damp walls remedied 137 Insufficient floor ventilation 132 External painting 249 Weatherboards fixed Door sills repaired or renewed 78 Defective brickwork repaired Window fasteners fixed 21 53 (9) Miscellaneous. Offensive accumulations removed 75 Animals so kept as to be a nuisance 17 Verminous rooms disinfested 112 Drains tested 606 Dangerous structures reported 19 Overcrowding 34 Shed erections 1 Other conditions 117 (c) Notices Served. Informal Notices 2,107 Statutory Notices:— Section 23, Public Health Act, 1875 - 332 Section 36, Public Health Act, 1875 42 Section 41, Public Health Act, 1875 1 Section 94, Public Health Act, 1875 192 Section 17, Housing Act, 1930 97 (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 262 38 — — Workshops 122 12 — — W orkplaces 74 3 — — Totals 458 53 — — 54 (2) Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found Remedied Referred to H. M. Ins. * Nuisances under the Public Health Acts :— Want of cleanliness 33 33 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 50 50 — — Sanitary accommodation:— Insufficient 3 3 — — Unsuitable or defective 18 18 — — 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 — — — — Totals 104 104 — — *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act as remediable under the Public Health Acts. (3) Home Work. Six notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 15 workpeople engaged on making wearing apparel, etc., in their homes. 55 (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 42 Total number of Workshops on Register 57 (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 1 Underground Bakehouses (sec. 101):— Certificates granted during the year In use at the end of the year (6) Outworkers. The following list shows the nature of the homework carried out in this district by 53 outworkers :— Box makers 2 Flag maker 1 Life-belt covering 2 Tie making 1 Millinery 2 Wearing apparel (various) 43 Furrier 1 Umbrella covering 1 During the year, 34 lists of outworkers were received from other Authorities in respect of addresses in Barking. Six lists were received from employers within the district. 56 (e) Premises and Occupations which can be Controlled by Bye-laws or Regulations. (1) Houses Let in Lodgings.—The demolition of the tenement houses in Abbey Road means virtually the end of this type of dwelling in the district. The census of 1931 showed that 66 dwellings were occupied by three or more families. (2) Common Lodging Houses.—Eighty visits were paid to the two common lodging houses, four of the visits being made at night. Four defects were discovered and one notice served. One of the two common lodging houses was included in a clearance area in respect of which a confirming order has been made. In view of the amount of casual work which is carried out in the district by unskilled labour, I think the Council should consider the provision of a Municipal Hostel at an early date. In a report dated September, 1933, I directed attention to this need. (3) Tents, Vans and Sheds.—There are seven van dwellings situated in five yards in various parts of the district where water supply and sanitary accommodation are provided. Thirty-six visits were paid and one notice was served in respect of three defects discovered. The Barking Corporation Act provides that approval is now necessary before this type of dwelling can be established in the district. (4) Underground Sleeping Rooms.—There are no such occupied rooms in the district. (5) Offensive Trades.—The number of premises used for this purpose remains the same :— 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 fifty-two visits were paid to these 36 premises, and 35 contraventions of the byelaws were discovered and any necessary action taken. 57 The Corporation removed an old type of fish-frying premises from the register but a newly built shop was added. Similarly a new factory was erected for soap making at Rippleside whilst another old factory at North Street was closed down. Fat Melting.—Summonses were issued in respect of 3 contraventions of the byelaws and fines of £7 10s. Od. imposed. (6) Piggeries.—'There are eight remaining piggeries in the district. (7) Stables.—These premises continue to be a source of trouble. The occupiers are invariably unable financially to carry out any improvements. 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. Seventy-seven 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 two premises where upholstery repairs are carried out and these premises are regularly inspected. We have not found rag flock in use at either of these establishments. 9. SMOKE ABATEMENT. Arising from 109 observations made, 11 offences were registered and necessary action taken. At one factory where a special type of furnace is used for manufacturing purposes it was necessary to build an additional chimney stack to remedy the smoke nuisance. When offences are discovered it is usually found on visiting the factory that there has been a mechanical breakdown, which accounts for the trouble. There has been no increase in the kilowatt capacity at the Creeksmouth Generating Station during the year. I am glad to be able to report that the reduction in the emission of residual dust has continued. We have not received any complaints of nuisance. 58 The Engineers at the Generating Station are unable at present, owing to the complexity of the problems, always to comply with the limit of 2 minutes black smoke in every 30 minutes duration. The Company arrange for a constant watch to be kept upon the chimneys and as soon as any excess smoke is observed the Boiler House Engineer is informed, and any necessary adjustments made. There are 13 chimneys of about 15 feet diameter connected with 34 furnaces. The station serves an area of 3,000 square miles. When seen from the River or when indeed seen from one of several vantage points in Barking the smoke issuing from these chimneys is enormous. The amount of smoke however must be considered in relation to the large amount of coal which is consumed and which is, we understand, approximately 500,000 tons per year. At the same time there is another aspect to this question and that is that unless these large concerns show that they can consume these large amounts of fuel without any undue smoke emission there is a case against them except when they are situated in remote districts. 10. ULTRA-VIOLET LIGHT RADIATION. Ultra-violet light radiation is measured in Barking at the Barking Hospital. The apparatus used is 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. The following table shows the comparative ultra-violet light readings for the years 1933 and 1934:— Month. Daily average for Barking 1933 1934 Units. Units. January 0.76 0.48 February 0.78 0.82 March 0.92 1.41 April 1.50 1.99 May 4.00 2.93 June (Reading not taken) 3.66 July 4.74 4.77 August 5.45 5.93 September 4.06 6.83 October 1.48 5.35 November 0.86 2.20 December 0.96 1.03 59 The figures for the two years under consideration show that there is a very considerable amount of sunshine in Barking and that this sunshine is biologically active. 11. SCHOOLS. There are fifteen elementary schools, in addition to the Park Modern School, and the Faircross Special School. Sanitary inspections are regularly carried out in order that any unsatisfactory conditions may be remedied. Upon complaints being made, any necessary work is usually carried out forthwith. Eleven of the 15 elementary schools are of recent construction. Two of the remaining four schools compare very unfavourably with the general standard of accommodation in the district. It has not been found necessary to close any department of the schools as a result of infectious disease. 12. PARKS AND OPEN SPACES. The excellent summer weather experienced in 1934 allowed the residents of Barking to make full use of the parks and open spaces and the facilities provided for sport and recreation by the Council. The Mayesbrook Park tennis courts were opened to the public during the season. The work of laying out the remainder of the park continues. I am very much afraid that people will come forward with very specious arguments urging you to use your open spaces for purposes for which they were not intended, urging you to build this or that public building. There are not enough parks and open spaces in Harking at present and I do hope that under the present circumstances the Council will not curtail these very necessary places for out-of-door recreation. 61 SECTION D. HOUSING. 1. STATISTICS. (a) General. Number of new houses erected during the year :— (1) Total 730 (2) As part of a municipal housing scheme:— (а) Barking 96 (б) L.C.C 275 (3) Others (including private enterprise and subsidy houses) 359 (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) 3,323 (b) Number of inspections made for the purpose 9,583 (2) (a) Number of dwelling-houses (included under sub-head (T) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 841 (b) Number of inspections made for the purpose 2,304 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 79 (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 1,730 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 1,392 62 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 134 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 109 (b) By local authority in default of owners Nil B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 170 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 140 (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 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 6 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 18,382 (including 1,250 shops), which, compared with the total of 10,965 at the census of 1931, gives an indication of the growth of the town. 63 Of the total of 17,132 dwelling-houses, 1,596 are owned by the Council and approximately 7,375 have been erected in the area by the London County Council since the year 1929. It is interesting to note that 1,887 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. During the year 1934, no less than 347 temporary buildings were approved for erection in the back gardens of dwelling-houses in the district. In connection with the Corporation estate at Movers Lane, the Council decided to erect a standard type of shed for each house. This conforms with the view I have expressed continuously since 1930. HOUSES BUILT IN DISTRICT. 1926—1934. 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 1934 730 (Barking) 96 359 (L.C.C.) 275 Totals 9,910 7,772 2,138 64 Of the 7,772 houses shown above as part of Municipal Housing Schemes, 767 were provided by the Borough of Barking and 7,005 by the London County Council. (b) Sufficiency of Supply of Houses and Overcrowding.—The census of 1931 revealed that 349 families were living in one room and that of this number 232 families had more than 2 persons in family. Out of the total of 1,267 families living in two rooms 237 families had 2 or more persons per room. Between 1931 and 1934 the Council erected 185 houses to let to persons living in overcrowded circumstances and 219 houses to rehouse persons from clearance areas. In the absence of control over further sub-letting after a sub-tenant has been moved from an overcrowded house it is considered that the position shown to exist in 1931 has not been improved. The Housing Bill now before Parliament will become law during 1935 and it will then be necessary for the Council (1) to provide new accommodation for families living in overcrowded circumstances, (2) secure that no further overcrowding takes place. In determining the extent of overcrowding it is regretted the survey must regard the use of living rooms as bedrooms. It would appear that where rooms are not normally used in the locality as bedrooms or living rooms the Loral Authority need not include such rooms in assessing the accommodation in any house. In my last two reports I have directed attention to the fact that all available building land in the district will be taken up for rehousing persons from clearance areas. The passing of the Housing Act, 1935 will place a further obligation on the Council to rehouse persons living in overcrowded circumstances. It is estimated that the number of new houses required for this purpose will be at least 400. Hitherto the Council has confined its building operations to the provision of cottage dwellings as distinct from flat dwellings. 65 Whilst realising the difficulty of providing a sufficient number of new dwellings within the boundaries of the district I do hope that Barking will not depart from its present high standard of housing accommodation. (c) Housing Act, 1930—Part 1.—Further progress was made during the year in dealing with clearance areas. In July, 1934 a representation of the Medical Officer of Health was made in respect of North Street (No. 1) Clearance Area, consisting of 72 houses and housing 307 persons. A Public Enquiry took place and confirming orders have been made in respect of:— Abbey Road Nos. 1, 2, 3 and 4, Clearance Areas ; Park Terrace and Collier Row Clearance Area ; and North Street No. 1 Clearance Area. In these areas is a total of 167 houses, housing 753 persons. (d) Housing Act, 1930—Part 2.—Three demolition orders were made during the year. One house was demolished in anticipation of formal action. A total of 841 houses were inspected and particulars recorded. Reference to the summary of the work carried out is shown on pages 61-62 and indicates the type of defects found and dealt with. The policy of the Council in administering the " Repair " section of the Housing Act, 1930 in conjunction with the provisions of the Barking Corporation Act, 1933 is reflected in the general well-kept appearance of the working-class property in the district. Steady improvement in this respect continues. (e) Disinfestation.—The rehousing of families from clearance areas has been proceeding during the year. Prior to taking over the tenancy of new accommodation the whole of the tenants' effects have been fumigated with hydro-cyanic acid gas. The contract was let in respect of a total of 265 families. 67 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. MILK SUPPLY AND ICE-CREAM. (a) Milk Supply.—Registered with the Authority are 72 retail purveyors, of whom 16 occupy premises outside the district. There are no eowkeepcrs in the district. 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 32, three were found to be unsatisfactory :— Type of Sample. Satisfactory. Unsatisfactory. Totals. Grade" A "(T.T.)Milk — — — Grade " A " Milk — — — " Pasteurised "Milk 5 1 6 " Sterilized " Milk — — — Purified (Homogenised) Milk — — — Raw Milk 24 2 26 Totals 29 3 32 There were during the year 24 samples of milk submitted to biological examination for the presence of tubercle. Of this number, three samples were from supplies produced in the district. Two of the 24 samples were found to be infected and the necessary action taken. 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 15 Grade " A " (T.T.) Milk 11 Grade " A" Milk, Pasteurised 1 68 A licence was granted to one local firm for the bottling of Grade " A " (T.T.) Milk, and one for the treatment and sale of milk as " pasteurised." In my report for 1933 I referred to the operations of the London & Suburban Dairies and their successors. Further changes of ownership continued and at the end of the year we were still dissatisfied with the sale of milk from this source. By co-operation with the Essex County Council a successful prosecution was instituted when the defendant was fined a total of £40 and £10 17s. Od. costs for fat deficiency. This conviction was later upheld on appeal to Quarter Sessions. Another defendant was fined a total of £12 2s. Od. for selling milk without being registered. (b) Ice-Cream—Barking Corporation Act, 1933—Section 160.—During the year 1934, 88 vendors were registered, in accordance with this Act, of which number 35 were manufacturers with premises in Barking. Nine vendors had premises outside the district. Twenty-one samples were submitted for bacteriological examination, 8 of which were unsatisfactory. These 8 samples were taken from 5 vendors, 4 of whom received warning cautions. The remaining unsatisfactory vendor was brought before the appropriate Committee to show cause why he should not be removed from the register. Four applicants were refused registration. The administration of the appropriate sections of the Barking Corporation Act, 1933 which came into force in July, 1933, has already had a salutary effect upon the unsatisfactory vendor. 2. MEAT AND OTHER FOODS. (a) Meat.—There was a considerable increase during the year in the use of the one licensed slaughterhouse. This licence is renewable annually. The premises are situated in the centre of the town and in view of the changing circumstances and developments taking place it may be that the Council will be considering the continuance of slaughtering at these premises. The slaughterhouse was well conducted during the year. 69 The following table gives particulars of notifications received, and the animals slaughtered, during the seven years ended December 31st, 1934. Year 1928 1929 1930 1931 1932 1933 1934 Notifications Received 126 72 64 39 57 34 205 Cattle 40 64 80 12 10 41 350 P'gs 409 137 93 200 84 18 502 Sheep 815 426 332 173 270 241 1038 Calves 71 10 11 1 9 1 140 Totals 1335 637 516 386 373 301 2030 Diseased meat was destroyed as under :— Description. Disease. Weight. 262 beasts' lungs Tuberculosis 2620 lbs. 4 „ lungs Abscess 40 „ 4 „ lungs Distomatosis 40 „ 9 „ livers Tuberculosis 126 „ 31 „ livers Distomatosis 434 „ 14 „ livers Cirrhosis 196 „ 2 „ livers Cystic 28 „ 2 „ livers Angioma 28 „ 3 „ livers Fatty degeneratio 42 „ 8 „ livers Abscess 112 „ 34 ,, heads Tuberculosis 952 „ 1 beast's tongue Actinomycosis 6 „ 49 beasts' mesenteries Tuberculosis 147 „ 1 beast's spleen Abscess 1 „ 4 beasts' carcases and offals and one part (round and flank) Tuberculosis 4026 „ 3| „ forequarters Tuberculosis 700 „ 42 sheeps' lungs Parasites 126 „ 12 „ livers Parasites 18 „ 2 pigs' heads Tuberculosis 28 „ 4 „ lungs Tuberculosis 14 „ 6 „ livers Cirrhosis 36 „ 2 „ livers Tuberculosis 10 „ 3 „ livers Necrosis 12 „ 20 „ mesenteries Tuberculosis 40 „ 4 calves' lungs Tuberculosis 16 „ 1 calf and offal Tuberculosis 210 „ Total—4 tons 9 cwts. 40 lbs. 70 (b) Unsound Food.—The following list gives particulars of unsound food destroyed during the year :— 32 lbs. oatmeal. 48 lbs. chilled beef. 3 stones herrings. 1 tin of biscuits. 53 cartons of table jellies. 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. II. C. Card, Chief Food and Drugs Officer for the Metropolitan Area of the Essex County Council, for the particulars of samples purchased and submitted for analysis during the year. These samples are submitted for chemical examination to Dr. Bernard Dyer, the County Analyst, Great Tower Street, London. The following samples were examined during the year :— Milk 48 Butter 35 Other 95 Total 178 Proceedings were instituted in relation to five samples during the period covered and fines and costs amounted to £52 17s. Od. 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. 71 5. NUTRITION. Last year when dealing with this subject I introduced to your notice the discussion which was going on as to the amount of first-class proteins which is necessary for maintaining health and strength and what was more important, that I would like to see that people—anyhow those who cannot afford it—are not inveigled 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. 73 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. 1. NOTIFIABLE INFECTIOUS DISEASES. During 1934 there has been a considerable amount of notifiable infectious disease in Barking. As I have pointed out previously this may be due to the fact that large rehousing schemes seem to bring about conditions favourable to the incidence of infectious disease. It must be remembered that Barking today has a very high percentage of child population and it is of course amongst these children that infectious disease is most common. I cannot see any reason for suggesting that the percentage of children and young people will become smaller and I do believe that you will always have as one of your serious problems the prevention of diseases which come during childhood. Having this in your minds you have commenced the Second Portion of the Barking Hospital which will bring the total number of beds up to 96, and I hope that it will soon be possible to proceed with one further cubicle block of 12 beds. My experience during the last few years enables me to say that 108 beds are certainly required for the work you are called upon to carry out. Fortunately we have had no cases of smallpox and no cases of cerebro-spinal fever. Diphtheria anti-toxin is administered quite early in this disease. This is largely due to the very cordial relationship which exists between your Medical Officers and private practitioners. Consultations are held constantly and admissions to your hospital are expedited in every way. In your Hospital when the second portion is fully completed, when you will have 108 beds, there will be no less than 36 beds in separate cubicles. This should enable the Hospital to be used to a much greater advantage and to cater for a larger number of infectious diseases than if you had large wards. It will allow you to treat dual diseases ; this is very necessary in cases of scarlet and rheumatic fever, a condition which is by no means as uncommon as we should wish it to be. It should be clearly stated for future reference that the second portion of the Barking Hospital is not an extension in the ordinary sense of the term but is a partial completion of the hospital according to plan. 74 During the year 1930 we had no less than three deaths from psittacosis ; there have been none since. This is a wonderful illustration of the fact that the health of the public is in the hands of the public ; it was only necessary for them to refrain from buying the imported birds and the epidemic died a natural death. By the same token when people, suffering from influenza and other infectious diseases, refrain from travelling in crowded trains the country will be healthier, to a degree. 2. NOTIFICATION TABLES. The following table shows the number of notifications of infectious diseases (other than Tuberculosis) received during 1934 TABLE I. Disease. Males. Females. Total. Total eases removed to Hospital. Deaths. Smallpox — — — — — Scarlet Fever 242 283 525 487 5 Diphtheria 179 219 398 397 22 Enteric Fever (including Para-typhoid Fever) 1 3 4 4 — Puerperal Fever — 2 2 2 — Puerperal Pyrexia — 10 10 8 2 Pneumonia : Acute Influenzal 98 85 33 60 10 Acute Primary 88 10 Following Measles 62 L 5 Erysipelas 18 26 44 22 — Ophthalmia Neonatorum 11 9 20 3 1 Acute Anterior Poliomyelitis 1 1 2 2 — Encephalitis Lethargica 1 — 1 — — Chicken-pox 241 210 451 — — Food Poisoning 2 2 4 — — Acute Polio-Encephalitis 1 — 1 1 — Pemphigus Neonatorum 1 1 2 — — Totals 796 851 1647 986 56 75—76 TABLE II. Notifiable Disease No. of cases notified at age groups Cases classified according to Wards Under one year 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 10 years 10 to 15 years 15 to 20 years j 20 to 35 years 35 to 45 years 45 to 65 years Over 65 years Totals Abbey Cambell Eastbury Gascoigne Longbridge Manor Park Parsloes Smallpox — — — — — — — — — — — — — — — — — — — — — Scarlet Fever 3 19 39 42 50 247 83 15 19 7 1 — 525 47 131 87 70 23 84 29 54 Diphtheria ... — 14 31 25 32 187 69 8 21 10 1 — 398 22 113 79 32 9 68 22 53 Enteric Fever — — — — — — 1 — — 2 — 1 4 1 — 2 1 — — — — Puerperal Fever — — — — — — — — 2 — — — 2 — — 1 — — — — 1 Puerperal Pyrexia — — — — — — — — 6 3 — — 9 1 5 — 1 — 1 — 1 Pneumonia (ac. primary, Ac. influenzal & following measles) 8 17 15 16 5 47 5 4 18 15 24 9 183 25 27 19 32 9 39 16 16 Erysipelas 2 1 — — — 2 3 1 6 6 17 6 44 10 11 3 10 1 3 3 3 Ophthalmia Neonatorum 20 — — — — — — — — — — — 20 2 3 3 1 2 6 1 2 Acute Anterior Poliomyelitis — — 2 — — — — — — — — — 2 — — — — — — 2 Encephalitis Lethargica — — — — — — — 1 — — — — 1 — — 1 — — — — — Chicken Po 11 30 19 36 30 262 56 4 3 — — — 451 68 54 115 65 22 47 59 21 Food Poisoning — — — — — — — — 3 1 — — 4 — 2 — — — 1 — 1 Acute Polio Encephalitis — 1 — — — — — — — — — — 1 — — 1 — — — Pemphigus Neonatorum 2 — — — — — — — — — — — 2 — 1 1 — — — — — Totals 46 82 106 119 117 745 217 33 78 44 43 16 1646 176 347 312 212 66 249 130 154 77 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1934:— Scarlet F ever. Diphtheria. Total. January 51 25 76 February 34 24 58 March 26 36 62 April 36 33 69 May 59 22 81 June 44 35 79 July 39 28 67 August 33 26 59 September 51 30 81 October 49 41 90 November 47 38 85 December 56 60 116 Totals 525 398 923 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:— Measles13 Whooping Cough - Summer Diarrhoea 6 (b) Rheumatic Fever.—Rheumatic fever, as I have said previously, is a serious problem in Barking. (c) Influenza.—There were 12 deaths from influenza during the year 1934. This contrasts favourably with 21 deaths in the year 1933. 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. (d) Scabies.—Twenty-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 six cases, where the parents declined the services offered. 78 (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 1934:— Disease. In Hospital January, 1st, 1934. Admitted during the year. Died. Discharged. In Hospital Dec. 31st, 1934. Scarlet Fever 58 479 5 463 69 Diphtheria (including Membranous Croup) 39 397 21 347 68 Enteric Fever — 2 — 2 — Puerperal Fever 1 1 — 2 — Puerperal Pyrexia — 4 2 2 — Pneumonia — 38 6 32 — Erysipelas 4 15 — 18 1 Measles and Mastoiditis — 1 1 — — Anterior Poliomyelitis 1 — — 1 — Others 27 4 22 (b) Number of Bed Days.—The total number of bed days in the infectious diseases hospital during 1934 was 39,976—that is to say, an average of 109 patients were in hospital throughout the 365 days in the year. 5. ARTIFICIAL IMMUNISATION. Our efforts to promote artificial immunisation against diphtheria may be said to have failed. I hold the opinion that unless very large numbers of people are immunised, immunisation has but little influence on the incidence and death rate from diphtheria, so that I look for no public benefit from the amount of diphtheria immunisation which has been carried out. 79 Wise parents who dread diphtheria, as they have every right to do, will take advantage of your offer and have their children immunised. Children who have been immunised have little risk of catching diphtheria and if they do catch it there is only a remote chance of it being serious. The following table shows what has been done under this scheme:— Total number of cases treated 19 Number of first attendances for treatment 17 ,, subsequent attendances for treatment 33 „ final " Schick " tests 12 6. CANCER. There have been 74 deaths from cancer, 41 below the age of 65 years and 33 above the age of 65. The following table shows the occupations of the 74 people who died from cancer during the year 1934:— male. Female. Bootmaker 1 Wives 27 Bottler 1 Spinster 1 Bricklayer 1 Widows 11 Carpenters 2 Civil Servant 1 Cleaner 1 Coppersmith 1 Cook 1 Enameller 1 Fishmonger 1 Flusher 1 Labourers 10 No occupation 2 Porter 1 Porter (house) 1 Postman 1 Printer 1 School Attendance Officer 1 Scaffolders 2 Travellers 2 Warehouseman 1 35 39 80 The following table shows the ages of the persons who died from cancer and the organs affected:— Organ. Under 1 year. 1-5 years. 5-15 years. 15-25 years. 25—45 years. 45-65 years. Over 65 years. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Bladder - - - - - - - - - - - - 1 - 1 - Bowel - - - - - - - - - - - 1 - - - 1 Breast - - - - - - - - - - - '2 - 1 - 3 Caecum - - - - - - - - - - - - - 1 - 1 Cervix - - - - - - - - - 1 - - - 1 - 2 Colon - - - - - - - - - - 1 1 2 3 3 4 Femur - - - - - - - - - - - 1 - - - 1 Humerus - - - - - - 1 - 1 - - - - - 2 - Kidney - - 1 - - - - - - - - - - - 1 - Larynx - - - - - - - - - - - - 1 - 1 - Liver - - - - - - - - - - - - 1 2 1 2 Lung - - - - - - - - - 2 3 - - - 3 2 Mediastinum - - - - - - - - - - - 1 - - - 1 Neck - - - - - - - - 1 _ - - 2 _ 3 _ Oesophagus - - - - - - - - - - 1 - 1 - 2 - Ovaries - - - - - - - - - 1 - 1 - - - 2 Pancreas - - - - - - - - - . - - 1 - 1 - 2 Peritoneum - - - - - - - - - 1 - - - - - 1 Prostate - - - - - - - - - - 1 - 2 - 3 - Rectum - - - - - - - - 1 - 1 2 - 4 2 6 Sigmoid - - - - - - - - 1 - - 1 - - 1 1 Spleen - - - - - - - - - - 1 - - - 1 - Stomach - - - - - - - - - - 5 2 5 2 9 4 Tongue - - - - - - - - - - - - 1 - 1 - Tonsil - - - - - - - - - - 1 - - - 1 - Uterus - - - - - - - - - 1 - 2 - 2 - 5 Ventriculi ... 1 1 Totals - - 1 - - - 1 - 4 6 13 16 16 17 35 39 The various Government Publications dealing with cancer have been circularised amongst the local practitioners; this together with the liaison which exists between the local practitioners and the expert pathologists and surgeons of the large London Hospitals has made it unnecessary for any local activity on the part of the Council. 7. PREVENTION OF BLINDNESS. Blindness is being prevented in Barking; it is being prevented by the co-operation of the whole of the services. One of the chief causes of blindness is Ophthalmia Neonatorum, which is a purulent discharge from the eyes of an infant, commencing within twenty-one days of its birth. 81 Your Consultant Gynaecologist draws up approved hygiene for the eyes at birth, your Consultant Ophthalmic Surgeon draws up our approved treatment for Ophthalmia Neonatorum, and your Inspector of Midwives takes up each case as it should arise and your Health Visitors follow up each case and encourage parents to carry out any necessary treatment. It is years ago since we had a case where vision has been impaired by reason of Ophthalmia Neonatorum. The following table shows that the number of cases of Ophthalmia Neonatorum during 1934 was 20, compared with 14 in 1933. Seventeen 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 20 17 3 19 — — 1 8. TUBERCULOSIS. Particulars of new cases of Tuberculosis and of all deaths from the disease in the area during 1934 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 to 5 years — — 2 — — — 1 — 5 to 15 years 4 4 8 6 2 — 1 — 15 to 25 years 14 16 4 1 5 3 — — 25 to 35 years 25 15 — 6 6 10 — 1 35 to 45 years 12 9 — —. 6 5 — — 45 to 55 years 13 7 1 3 6 3 55 to 65 years 7 1 1 — 5 — 1 — 65 years and upwards 2 1 — — 1 — — — Totals 77 53 16 16 31 21 3 1 During the year, 162 notifications were received of all forms of Tuberculosis— pulmonary ] 30 and non-pulmonary 32 and there were 10 deaths of un-notified cases (6 pulmonary and 4 non-pulmonary), making a total of 162 new cases during the year. 82 Information has been received of the removal into the district of 26 tuberculous persons, included in number of notifications received. This compares with 58 received for the previous year. 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. 43 40 9 6 32 30 12 9 Fifty-six deaths occurred from Tuberculosis (all forms) fifty-two of these being pulmonary cases. The number of deaths in institutions was thirty-two. The death rate for Tuberculosis (all forms) during 1934 was 0.77 per 1,000 population, compared with 0.72 for the previous year. I regret to inform you that ten of the cases which died from Tuberculosis had not previously been notified to me as suffering from that disease. The compulsory removal to hospital of persons suffering from Tuberculosis is practically a dead letter in Barking. My own opinion is that although it was right and proper at one time to link the detection of Tuberculosis with the treatment of Tuberculosis, the time has come when the detection of Tuberculosis should be linked up with its prevention and be undertaken by the Local Authorities. Personally I found, when I was Tuberculosis Officer, that section 62 of the Public Health Act, 1925, which confers the compulsory powers to which I have referred, was of the utmost value, particularly when it was kept in the background. BOROUGH OF BARKING THE ANNUAL REPORT OF THE School Medical Officer For the Year 1934 G.LEONARD WILLIAMS, B.Sc., M.R.C.S., D.P.H. 84 TABLE OF CONTENTS Pages ADENOIDS 94.100-101 ARRANGEMENTS FOR TREATMENT 97-103 AURAL CLINIC 101 BLIND CHILDREN 110-11 BOXING 105 BROOKFIELD ORTHOPAEDIC HOSPITAL 102,111 CLINIC ATTENDANCES 93,99-100,102 CLINIC SERVICES 98,99,102,114-117 CONVALESCENT TREATMENT 104 CO-OPERATION OF PARENTS, TEACHERS, ETC 90,103,109-110 CO-ORDINATION OF SERVICES 89,97,103 DEAF CHILDREN 110-112 DEFECTIVE HEARING 94,101 DENTAL DEFECTS 94-95,100,102,113,122-124 DIET 98,109,113 DIPHTHERIA IMMUNISATION 100 DRYING FACILITIES 90,100-107 EAR DISEASE94,101 EMPLOYMENT OF SCHOOL CHILDREN 114 EPILEPTIC CHILDREN 110-112 EXCLUSION FROM SCHOOL 103 EYE DISEASE 94,100 FAIRCROSS SPECIAL SCHOOL 111-112 FEEDING OF SCHOOL-CHILDREN 98,100-109 FOLLOWING-UP WORK 96,97,101 HEALTH EDUCATION 113 HEART DISEASE AND RHEUMATISM 95,102 HIGHER EDUCATION 112,113 INFECTIOUS DISEASES 103 INTRODUCTION 87 MALNUTRITION 93, 97-98,108 MEALS 106-109 MEDICAL INSPECTION AND FINDINGS 90,91,92-96,112 MENTALLY DEFECTIVE CHILDREN 111-112 MILK 108-109 MINOR AILMENTS 93,99-100 NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN 110 NOSE AND THROAT DEFECTS 94,100-101 85 Paget NURSERY SCHOOLS 112 OPEN-AIR EDUCATION 104,111-112 OPEN-AIR CLASSROOMS 104 OPEN-AIR SCHOOLS111-112 OPHTHALMIC SERVICE 94,100 ORTHOPAEDIC AND POSTURAL DEFECTS 95,102,118-121 PARENTS' PAYMENTS 113 PHYSICAL TRAINING 104-106 PLAYGROUND CLASSES 104 PLAYING FIELDS AND GROUNDS 106 PROVISION OF MEALS AND MILK 106-109 REMEDIAL CLINIC 89,102 REPORT OF THE DENTAL SURGEON 122-124 REPORT ON THE WORK OF THE ORTHOPAEDIC CLINIC 118-121 RHEUMATIC FEVER 95 RHEUMATISM95,102 RINGWORM 99 SCHOOL BATHS 90,105 SCHOOL CAMPS 104 SCHOOL HYGIENE 90 SCHOOL JOURNEYS 104 SCHOOL LAVATORIES 90 SCHOOL POPULATION 91 SECONDARY SCHOOLS 113 SERVICES PROVIDED, LIST OF 114-117 SKIN DISEASES 93,99 SPECIAL INQUIRIES 114 SPECIAL SCHOOLS 111-112 SQUINT94,100 STAFF 86,89 STATISTICAL TABLES 125-138 SWIMMING 105 TEACHERS, MEDICAL EXAMINATIONS OF 114 TONSILS AND ADENOIDS 94,100-101 TUBERCULOSIS 96,102 ULTRA-VIOLET LIGHT TREATMENT102-103 UN CLEANLINESS 93,98-99 VISUAL DEFECTS 94,100 86 STAFF, 1934 School Medical Officer : C. LEONARD WILLIAMS, R.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. Assistant School Medical Officers : R. H. CLAYTON, M.B., B.S., B.Hy., D.P.H. (Commenced 15th July, 1934.) EDITH A. WHITNEY, M.B., Ch.B., D.P.H. (Resigned 30th September, 1934.) Ortlhopœdic Surgeon : B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Dental Surgeons: W. H. FOY, L.D.S., R.C.S. R. N. HINES, L.D.S., R.C.S. Nurses: *Miss M. BAERLOCHER (g), (h) and (n). (Commenced 1st January, 1934.) *Miss C. COURT (g), (h) and (i). Miss A. E. FINDLAY (Masseuse) (k) and (0). (Resigned 31st December, 1934.) 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). Miss L. F. SWAIN (h) and (i). Clerical Staff: Chief Clerk—F. READ. C. G. EAGLESFIELD. D. W. OSMOND. R. H. CHANDLER. (Commenced 30th July, 1934.) (Resigned 3rd May, 1934.) Miss H. NUNN. D. G. TONKIN (n). Miss H. KING. A. J. STORER (n). Miss E. TASKER. E. A. ELLIS. Miss A. LIGGINS. G. H. RUFF. (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. (o) Certificate of Chartered Society of Massage and Medical Gymnastics. * Combined Appointment—Health Visitor and School Nurse. 87 Borough of Barking PUBLIC HEALTH DEPARTMENT, BARKING, ESSEX. June, 1935. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Mrs. Hobday and Gentlemen, Herewith I beg to submit my report for the year ended 31st December, 1934. 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, Mrs. Hobday and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, School Medical Officer. 89 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year 1934. (1) STAFF. Although a list of the personnel of the staff is given in a separate page at the beginning of the report, I would like to mention here some of those changes and additions in staff which have taken place during the year and which the growth of the service has made necessary. The Authority having decided to increase the number of professional staff, Dr. R. H. Clayton, formerly of Gateshead, was appointed as an Assistant Medical Officer, on 29th May, 1934, and commenced duty on 15th July, 1934. Dr. E. A. Whitney resigned her position as Assistant Medical Officer on 30th September, 1934, and Dr. C. B. McArthur was appointed in her place in December. Mr. R. N. Hines, Assistant Dental Surgeon, resigned his post in December, an advertisement for another Dental Surgeon being circulated in the usual channels. Because of the increased amount of orthopaedic work it has been found necessary to appoint a full-time Masseuse, in charge of the Remedial Clinic at Faircross School. The completion of the Dorothy Barley School late in 1933, and the building of the Bifrons School, have added more departments for the care of your Medical Officers. (2) CO-ORDINATION. The favourable measure of co-operation between the various medical activities of the Corporation which you have already achieved has been maintained during the year 1934. The majority of your staff have joint appointments and I hope that as time and opportunity present themselves this principle will be extended. The appointment of a Joint Clinics (Staffing) Sub-Committee is a step in the right direction towards unification and co-operation and I hope that more and more the whole of the medical services in the town will be unified. 90 (3) SCHOOL HYGIENE. A high degree of sanitation has been achieved in your new schools. I have previously called your attention to the need for baths in your schools and look upon the promotion of healthy habits as one of the highest ideals of education. Particularly where strenuous games are played, children should be able to have at least a shower-bath. I do not recommend the extensive use of soap—for the use of too much soap dissolves the natural fats which protect the skin—but I do believe that a bath should be taken to remove perspiration from the skin before it is covered with clothes again and that this should be inculcated as a habit. I find it still necessary to discuss the arrangements for drying wet clothes and boots (details on page 107 of this report) for which adequate provision should be made and I would like to see a rule enforced for the changing of wet foot-gear on arrival at school. So also I find myself called upon to discuss the provision of lavatories on each floor where the schools are of two or more stories ; I cannot help feeling that the long journeys these children have to make on occasions may be detrimental to their best interests. The provisions you have made in your modern schools, built on the pavilion principle, show the incongruity of the out-of-date factory type of premises and everything should be done to bring these older schools as up-to-date as possible. (4) MEDICAL INSPECTION. The age groups inspected are those laid down by the Board of Education and arrangements by which these inspections are carried out are as follows : a medical officer and nurses attend at the school. In your new schools they are accommodated in a medical inspection room and in your older schools accommodation is arranged as best it may be in some classroom or other. I am wishful to pay a tribute in regard to the pains which have been taken by the head-masters and head-mistresses, who have given us the best accommodation they could, and I feel that if your older schools are to be retained proper provision should be made for medical inspection to be carried out in a proper medical inspection room. 91 The number of children on the school registers on the 31st December, 1934 was 14,825 compared with 14,773 on the 31st December, 1933. The following summary shows the growth in the school population during the past few years:— December, 1927 7,001 December, 1932 13,112 99 1930 7,906 99 1933 14,773 99 1931 10,905 99 1934 14,825 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, 1933 and 1934, 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 1934, classified according to the schools attended, the number of inspections held in each school, and the number of parents or guardians present:— School. No. of Inspection Sessions. Numbers Inspected. No. of Parents present (Routine and Special Exams.) Routines and Specials. Re-Exams. Bifrons 8 252 113 41 Cambell 32 589 499 326 Church of England 15 307 230 91 Dawson 20 443 194 347 Dorothy Barley 20 392 274 297 Eastbury 26 587 362 274 Erkenwald 15 327 197 64 Gascoigne 31 539 477 263 Monteagle 23 411 286 337 Northbury 19 324 353 177 Park Modern 8 198 149 58 Hippie 22 366 295 300 Roding 25 430 320 351 St. Ethelburga's 5 119 95 13 St. Joseph's 4 47 88 33 Westbury 19 295 231 211 Totals 292 5,626 4,163 3,183 92 Of the 5,626 examinations at ordinary elementary schools, 3,315 were routine examinations of children in the specified age groups, which figure may be compared with 4,728 for the previous year. In addition, there were 802 routine examinations of children of ages outside the three specified age groups, and 1,509 examinations of children specially referred to your Medical Officers. 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. 1929 65.7 1932 68.1 1930 66.3 1933 61.8 1931 67.3 1934 56.6 During 1934, the parents were present at 3,183 routine and special medical examinations conducted at school out of a total of 5,626 such examinations. (5) FINDINGS OF MEDICAL INSPECTION. Table II on pages 126 to 128 gives in detail a return of defects found during the course of routine and special inspections at ordinary elementary schools and at the clinics. The following table is similar to Table II (B) of the Returns to the Board of Education (given on pages 125 to 138 of this report), except that it shows the percentage of children found to require treatment:— Group. Number of Children. Percentage of children found to require Treatment. Inspected. Found to require Treatment. PRESCRIBED GROUPS : Entrants 1,590 243 15.3 Second age group 720 104 14.4 Third age group 1,005 127 12.6 Totals (prescribed groups) 3,315 474 14.3 OTHER ROUTINE INSPECTIONS 802 136 16.9 93 The fact that amongst "Leavers" (the Third Age Group) 12.6 per cent. were found to require treatment is an expression of the inevitable fact that we are human and that we are prone to develop defects, and is not proof whatsoever that you have not spent any money on these children or that the money you have spent has been wasted. The same may be said of the Second Age Group. Equally well the fact that 16.9 per cent. of the "Entrants" do require treatment is not proof of inadequate or inefficient care and attention given to these children up to five years of age. There must of necessity, so long as we are human, be people who need treatment. (a) Malnutrition.—In estimating to what extent there is malnutrition among school children, the most reliable figures that I know are those relating to cases of malnutrition found during the course of routine and special inspections. Routine inspections are carried out solely by reason of the age of the children and have nothing to do with whether or not we know there is anything wrong with the children. During the last year in Barking there were 4,117 children so examined and amongst these it was found that 10 were suffering from malnutrition to such an extent as to require treatment. Amongst these children examined solely by the reason of their age group there were also found 64 cases of malnutrition who were kept under observation and who were not at the time of the examination requiring treatment. This makes a total of 74 or approximately 1.8 per cent. of the children examined. (b) Uncleanliness.—The following table shows the results of cleanliness inspections compared with similar figures for 1933 1933 1934 Number of examinations of children in the schools by School Nurses 37,762 41,499 Number of individual children found unclean 1,571 1,583 Number of uncleanliness findings 2,184 2,553 During the year, five children were cleansed by the Local Authority, and in seven cases legal proceedings were taken under Section 43 of the Education Act, 1921. (c) Minor Ailments and Diseases of the Skin.—With over thirty thousand attendances at the Minor Ailments Clinics you have established there should not be a large number of minor ailments discovered among the children who are examined at routine medical inspections, who, as I have said above, are examined in age groups, whether their health is good or bad, and I am happy to say this is so. 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. 94 (d) Visual Defects and External Eye Eye Disease.—Details of the findings at routine and special inspections will be found on pages 126 and 127 of this Report. It will be seen that 534 children were referred for treatment for defective vision (including squint). In addition 347 children were found to require treatment for external eye conditions. The findings of the medical inspections, so far as the condition of the eyes is concerned, are hardly comparable over a number of years. When eye work was first undertaken in Barking, refraction was carried out in a dark corner of the stairs of the old Town Hall, which had been standing for hundreds of years. Naturally only the more pressing cases were dealt with. As the years went by it was possible to deal with more cases because more suitable accommodation was available, and with the appointment of an ophthalmic surgeon of consultant rank we shall be able to deal, locally, with a wider variety of cases than heretofore. With increasing facilities for treatment we naturally include those cases which in the early years were looked upon as minor ones. Our experience has shown that it is these minor cases which pay very well for treatment. (e) Nose and Throat Defects.—I am happy to report a reduction in the number of cases of tonsils and adenoids which routine examinations have found to need treatment. 794 children were found at routine and special inspections who required treatment for nose and throat defects, as against 913 in 1933. Once again I claim that one year's findings are not sufficient to form an opinion but I do believe that on the whole we are accepting a sounder conception of what constitutes an enlarged tonsil from the standpoint of requiring treatment. I have deprecated the wholesale slaughter of tonsils and have advised you repeatedly about the care we have taken in Barking to avoid unnecessary operations. After being seen by at least one doctor children are sent to see a surgeon, but only in the first instance for his opinion as to the necessity for treatment. I do not believe that the improved statistics imply any radical change in the conditions of the noses and throats of your children but I do think it represents an improved standard of diagnosis amongst professional men who deal with these matters. (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 1933. (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 122 to 124 of this report. 95 The findings of routine inspections, with reference to dental defects (detailed on page 137, and further commented upon by Mr. W. H. Foy in his report on pages 122 to 124), cannot be used for comparative purposes except with reservations. Thus there is some difficulty in using them to assess the improvement you have made in recent years and equally the same difficulty for them to be used in assessing the efficiency of your services, relative to those of other towns. Mr. W. H. Foy, your Dental Surgeon, has reported adversely on the condition of the teeth of those children who have come in large numbers from the London County Council Area, and has cited the apparent lack of previous treatment as one of his reasons for the large number of extractions which have to be undertaken in the case of these children. Until, therefore, you have a more or less stable population these figures are not very reliable in indicating the progress which you are undoubtedly making. (h) Orthopaedic and Postural Defects.—111 children seen at routine medical inspection presented varying degrees of Postural Defects such as round shoulders, crooked spine, and bad stance. The more serious of this group were sent to the Orthopaedic Surgeon under the Authority's scheme. In addition to this group of cases, various orthopaædic conditions were seen which have existed from birth, or have arisen following an illness such as Infantile Paralysis. All such cases were seen by the Orthopaædic Surgeon, and where necessary, attendance at the Faircross Special School was recommended. In dealing with the figures which have to do with the findings of medical inspections with reference to orthopaedic and postural defects, we must at the present time discuss them with many reservations because so far as comparisons from year to year are concerned they have lost much of their significance. Ten years ago we dealt with the grosser cases of this nature. Today this work is becoming more the detection and treatment of minor disabilities, although of course there are still cases where major surgery is necessary. Although we applaud the results of major surgery it must be remembered that in the majority of cases the successful operation by the surgeon is an indication of some previous minor disability which in this way or that has failed to have the necessary attention. (i) Heart Disease and Rheumatism.—Out of upwards of four thousand children who were examined at routine inspections 19 were found to be suffering from heart disease sufficiently to require treatment, whilst 154 children had heart defects requiring to be kept under observation. The commonest cause of heart trouble among children is Rheumatic Fever. Rheumatic Fever is as important as Scarlet Fever and has to be treated in very much the same way. Unfortunately it is not attended by any rash. Large numbers of these cases do not come under medical attention and very many of them are difficult to diagnose whilst yet the disease is in an early stage. 96 (j) Tuberculosis.—As I have said in previous years the figures relating to Tuberculosis are small but this is not a true figure for indicating the amount of Tuberculosis in children of school age. These children are frequently absent from school for long periods and may be away from school when the inspections are held. Seventeen cases of Tuberculosis amongst children of school age were notified to the Medical Officer of Health during the year. Of these, five were pulmonary, and twelve were non-pulmonary. In addition, two notified cases of Tuberculosis amongst school-children were transferred to this area. Both of these were pulmonary. The following table shows the position with regard to notification of Tuberculosis amongst children of school age during 1934:— Notified during 1934 (including transfers) Pulmonary 7 Non-Pulmonary 12 Total 19 De-notified (of the above) Pulmonary 5 (2 deaths) Non-pulmonary 1 Total 6 (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. 97 A summary of the following-up work undertaken by your School Nurses is given herewith:— Number of visits to schools re medical inspection 350 Total number of visits to schools 479 Number of home visits in connection with:— 1930 1931 1932 1933 1934 (a) Routine medical inspections 4,759 4,480 4,817 6,610 6,786 (b) Infectious disease 660 295 408 230 1,022 (c) Cleanliness inspections 119 181 119 284 827 (d) Non-attendance for treatment (Minor Ailments, etc 406 86 82 35 51 (e) Dental inspections 406 477 1,082 — — (/) Miscellaneous — — 126 418 The mere summary that the above shows is but an imperfect picture of the full story of how your cases are what is commonly known as "followed-up." The fact that Mr. F. Goodaker, Chief Investigation Officer, works for the Maternity and Child Welfare Sub-Committee as well as for the Education Committee has led to considerable unification. You have your own Infectious Diseases Hospital and notes from this hospital are transferred to your school records. Mr. N. Bastable, Chief Sanitary Inspector, and the other Sanitary Inspectors are constantly collaborating with the Health Visitors and School Nurses so that between one and the other there are few children in Barking who are not known to the Department. (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 may be (i) normal children in abnormal environment, (ii) abnormal children in ordinary environment. 98 Where the environment is wrong, it is usually found that the causes may be divided into two classes: (i) where the diet is insufficient, (ii) where the diet is improper. Where the diet is insufficient you provide free milk in the schools and free meals at special feeding centres and your nurses investigate to see that the parents of the children avail themselves of all the facilities for obtaining a sufficient diet for them. Cases of inefficient diet are usually more difficult to deal with ; necessary advice is given and where of course the circumstances of the case demand it you would undertake to feed such children. Cases of abnormal children in ordinary environment are very difficult to deal with. These cases can be divided into two classes : there are those where the abnormality has existed from birth and those where the abnormality has developed since birth. Where the disability was present when the child was born, that is, any congenital cause, the disability may be due to hereditary causes or to disease contracted before birth. Every case has to be dealt with on its own merits. So also where the abnormality is acquired by the child after birth. Each case is a difficult one and has to be dealt with on its own merits. In Barking any child who in the estimation of the Medical Officer is 10 per cent. below weight is submitted to special enquiry. The school nurse pays a social visit and the case is studied from almost every possible angle. It is, however, to be remembered that the English are a conglomeration of diverse races and that it is more than difficult to lay down any precise standard of weights and it is often found that small children are by no means ill-nourished. Experiments have been carried out upon sheep to show that there is a definite relationship between diet and vulnerability to disease and I have no doubt that the same exists among human beings, but with this chief difference, that in our crowded communities we have every opportunity for mass infection and when infection is massive enough, the influence of diet is reduced correspondingly. (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. 99 Speaking paradoxically, the only proper way of treating uncleanliness is to prevent it. I do believe that it is quite right for girls to be taught in school the proper use of the kitchen and that it is clearly right for boys and girls to be taught the proper use of the bathroom. There can be no doubt that much of the bathing carried out in the home is at such infrequent intervals that the troubles and difficulties of ablution present a definite interruption in what may be regarded as the ordinary routine of life. Going to the bathroom to bathe should be regarded as an uneventful part of the ordinary work of the day. (c) Minor Ailments and Diseases of the Skin.—During the year under review there were no less than 22,420 attendances for such treatment in Barking. There may be one or two cases where such attendances represent an interference with school life, out of proportion to the necessity of the case. These cases are fortunately very few indeed; unfortunately, however, when they do occur they are very obvious. It may be said that the treatment of minor disabilities helps very considerably in maintaining average school attendances. Untreated, many of these minor disabilities become major ones and entail long absences from school. Treatment is undertaken at your Central Clinic under favourable conditions ; a doctor attends at 9 a.m. and the nurses carry on throughout the whole of the morning. These nurses are provided by the Plaistow Maternity Hospital District Nurses' Home. A similar clinic is held in the Greig Hall, Stamford Road, next to which you are building a second permanent clinic along the same lines of the Central Clinic, to which I have already referred. As I have previously reported, the treatment of Ringworm of the scalp is undertaken at the London Hospital by Dr. W. J. O'Donovan. Under this arrangement eight school-children were treated during the year. A summary of the work of the Clinics is included in the following tables:— (a) Minor Ailments Clinics. Central Clinic. Shaftesbury Clinic. 1933 1934 1933 1934 No. of days clinic was open 349 354 319 321 Total No. of attendances 13,379 14,414 12,671 16,578 Daily average attendance 38.3 40.7 39.7 51.6 No. of cases treated 2,315 2,572 1,649 2,182 100 (b) All Clinics. Clinic. No. of first attendances of school children. Total No. of attendances of school children. Minor Ailments:— 1933 1934 1933 1934 (a) Central 2,315 2,572 13,379 14,414 (b) Shaftesbury 1,649 2,182 12,671 16,578 Ophthalmic 493 384 1,627 1,607 Dental 3,134 2,671 8,337 7,220 Orthopaedic FOR EXAMINATION . 92 112 2,734 2,250 FOR TREATMENT 160 162 Diphtheria Immunisation 1 13 2 46 (d) Visual Defects and External Eye Disease.—Visual defects during the year have been treated by your Medical Officers as heretofore and I do not intend to give details but refer you to my remarks of previous years. Next year it will be our pleasant duty to inform you that the whole scheme has been revised under the direction of Mr. W. A. Gray, F.R.C.S., of Moorfields and Queen Mary's Hospitals. 384 cases of visual defect dealt with under the Authority's Scheme. Of this number, 335 were provided with spectacles ; 49 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. 338 cases were thus treated during the year as compared with 187 during 1933. During the year, there were two operations for squint which were carried out by private arrangements, one at the Royal London Ophthalmic Hospital, Moorfields, E.C.I, and the other at St. Bartholomew's Hospital, Smithfield, E.C.I. (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. 101 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 136 will be found a complete analysis of the ascertained results of the treatment of nose and throat defects. From time to time I have pointed out to you my private opinion that the surgical treatment of tonsils and adenoids with its hemorrhage and possible shock is by no means the simple operation that many people imagine it is, and I think that as time goes on we shall find larger and larger numbers of cases being retained at Queen Mary's Hospital. I do believe that the time is ripe for Local Authorities so to subsidise hospitals which undertake this work, that they may be in a position to build and equip sufficient wards so that every case can be taken in at least a night before and be retained for at least two days after the operation. If it should be impossible to do this at ordinary voluntary hospitals it should be possible for such a hospital for Extra Metropolitan cases to be built on an economic basis, although of course not so cheaply as it is done today in our voluntary hospitals, where the fees paid only represent a part of the actual cost. (f) Ear Disease and Defective Hearing.— Ordinary cases of ear disease and defects of hearing are dealt with medically at your clinics. The natural extension of your service would be the appointment of an aural surgeon to hold a special clinic. This natural development has not taken place in Barking because the proximity of Barking to the large London hospitals has made the question less pressing than it otherwise would have been. The Corporation has already an Aural Surgeon in attendance, when necessary, at the Barking Hospital, where of course it is mostly children who are seen by him. The question arises as to if and whether the time has come when an aural clinic run by an aural surgeon of consultant rank should not be held on similar lines to the eye clinic. I myself am much in favour of this proposition because I believe that setting up such a clinic will in time reduce the very large number of surgical operations which are carried out on tonsils and adenoids of children. 102 (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. It is with regret I find myself constrained to call your attention to the fact that a large number of the appointments made by us are not kept. It is difficult to maintain any economic system unless the parents of children make sure they do attend at the proper time. All these cases which have been asked to attend have given their consent and surely it is not too much to ask that having given their consent, they will keep the appointments. (h) Orthopcedic and Postural Defects.— Mr. B. Whitchurch Howell, Orthopaedic Surgeon, attends at the Orthopedic Clinic once a month and you have decided to employ a whole-time Masseuse instead of a part-time one. You have arrangements for children requiring surgical treatment to be received in Brookfield Hospital and other hospitals where orthopaedic surgery is carried out. The time has come when Joint Authorities should consider the future of Brookfield Orthopedic Hospital. A summary of the work done appears on pages 118-121, an analysis being given under Group IV of Table IV on page 136. (i) Heart Disease and Rheumatism.— The treatment of heart disease and rheumatism is a very difficult problem; cases of long standing are easy to diagnose and when necessary you send such cases away to special institutions providing the necessary accommodation, but the diagnosis of acute rheumatism is fraught with many difficulties and its treatment is by no means so easy. I am considering this problem in another aspect from the standpoint of infection and hospitalisation. (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.—As you will see from the tables, very full use is made of the Clinics you have established and children who present themselves, who do not come within their purview, are referred to local practitioners or a suitable hospital out-patient department. Ultra Violet Light Treatment.—The use of ultra-violet light for medicinal purposes has been carried out to a limited extent at the Faircross Clinic. During 1934, fifteen children were dealt with and 317 treatments given as against the 750 treatments given to 25 children last year. During 1934 you had only a part-time nurse at the Faircross Clinic and an old tungsten arc lamp and next year I shall report to you how the new mercury vapour lamp and the appointment of a full-time nurse has enabled you to undertake ultra-violet light treatment more seriously than heretofore. 103 Children diagnosed as suffering from Tuberculous Glands, Alopaecia, Rheumatism, Anaemia, 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 :— 1930 1931 1932 1933 1934 Scarlet Fever 91 75 88 169 313 Diphtheria 202 128 43 71 247 Measles and German Measles 283 1 188 4 467 Chicken-pox 166 187 335 390 320 Whooping Cough 89 35 48 69 87 Mumps — — 8 23 39 Whenever doctors and nurses attend at schools to investigate the incidence of infectious disease, the headmasters, headmistresses and other teachers are always ready to co-operate. The fact that the Medical Officers who act as School Medical Officers are from time to time in attendance at the Infectious Diseases Hospital enables them to keep track of infectious disease in the town in a way which would otherwise be impossible. 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 1934, seven such certificates were granted for this purpose. Generally speaking, with reference to the exclusion from school of individual children whose exclusion is desirable in order to prevent the spread of disease, 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, is our accepted standard and only in exceptional circumstances do we depart from it, but there must of necessity be a number of cases which have to be dealt with on their own merits. 104 (9) OPEN-AIR EDUCATION. Open-Air Classrooms and Playground Classes.— The possibility of education being carried on in the open-air has limits. I do however feel that the fullest possible use should be made of playgrounds for such lessons as can be undertaken outside the school premises. This is particularly necessary in your older schools, which we speak of as the factory type, where the classrooms have not the advantages found in modern buildings. In your newer schools the classrooms may be said to be of the open-air type and there are many occasions during the heat of the summer when their refreshing shade is to be preferred to the intense heat of the playground. It has been well said that we should shun the heat and love the light. School Journeys and Camps.—As you know, school camps are run very satisfactorily at Hainault Forest. During 1934, fifteen week-end camps were held in which 1,008 scholars participated. In addition to these, during the summer holidays there were two camps held at which children attended for a whole fortnight at a time. Ninety-six children took part in these two camps. In selecting children for these week-end 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. I wish to speak very highly of these school camps. I look upon them as much to be preferred to indiscriminate convalescent treatment. Organised as they are on sound lines I am sure that they give a better return for the money expended than if the same amount of money were spent in sending odd children to convalescent homes. This does not imply that I disagree with convalescent homes but that I think that your way of spending money is to be preferred. (10) PHYSICAL TRAINING. (a) Physical Training.—There is no Organiser of Physical Training in the schools of Barking, but nowhere have I found a keener appreciation of the benefits of physical training. The teachers of Barking are doing wonderful work and your Medical Officers are deeply and personally interested in the work. It is of course unfortunate that your officers have not sufficient time for even closer co-operation. I would wish to put in a special plea for physical training to be undertaken in proper clothing. On one occasion one of your Headmistresses asked me to make this the theme of a few remarks I made at a meeting of parents on what is known as an " Open Day," and I would wish my remarks to have a wider publicity. 105 It is very highly desirable that, generally speaking, children should change into clothes which are especially suitable when they undertake physical exercises. These clothes should certainly be light in weight; they should give every freedom of action to the limbs, and what is more they should afford an opportunity for air getting to the surface of the body. I have definitely said light in weight because there is an advantage in having at least some of the clothes dark in colour : both girls and boys in some exercises are called upon to sit on the floor, and white clothes are not perhaps best suited to this purpose. (b) Swimming.— I am very interested in swimming because I believe it to be an excellent form of physical exercise. The occasion of children visiting public swimming baths is an excellent opportunity for teachers to get an idea of the general physique of the individual children, and it has occurrcd to me that, if some simple exercises were undertaken— particularly breathing exercises—while the children are undressed, the teacher could more readily distinguish between those children who are standing correctly and those who are not, than he can when the children are fully clothed. So, also, with regard to chest expansion. Many children merely uncover their chest by pulling back their shoulders. This does not expand the chest, although the chest looks very prominent. As a matter of fact, it limits the proper expansion of the chest. Here again is a circumstance under which teachers exercising children while unclothed at the baths could make a note of those individual children who are not profiting by the exercises which form part of the ordinary school curriculum. Visits to baths, also, can be used as a very important part of education, if the children are regularly constrained to use the facilities which are provided for being quite clean before they enter the water, and if each child is constrained to see that he leaves the baths if possible even in a better state than when he enters the building. In this connection it is highly desirable that I should mention a very objectionable practice which we all know does take place in baths ; it is obvious that the teacher cannot control the children in this matt r of fouling the water, but by repeated precept we might obtain a higher standard than unfortunately obtains in so many public baths at the present time. (c) Boxing.—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. 106 (d) Facilities for Other Sports and Games.—There is no need for me in Barking to urge the need for more playing fields, but an authoritative statement here would not be out of place, and I would like to support those who already are doing so much in this direction. These playing fields should be at or near the schools, and no school can now be looked upon as efficient if it has not such a playing field nearby. The paved playing grounds where play is conducted in wet weather and where the more organised drill is usually carried out should not be situated, as so often happens, near the schools or, as I would put it, just under the school windows. They should be situated so far away as is reasonably possible, so that they may be used at any time and used so fully as possible without interfering with the ordinary work of the school. In this connection it is perhaps advantageous to remember that if these paved playing grounds were situated remote from the school buildings it would, at least in some instances, be possible for them to be used by children other than during school hours, and so give to them a much wider sphere of usefulness than they have at present. (11) PROVISION OF MEALS AND MILK. (a) Meals.—Free meals are provided daily in necessitous cases. 113,173 such meals were provided during the year 1934, and the following table shows the numbers of free meals which have been provided during the past five years :— 1930 31,556 1931 46,803 1932 74,531 1933 135,726 1934 113,173 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. 107 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. Bifrons— Senior Boys — — Cloakrooms heated (in winter only) Senior Girls — Yes, at domestic science centre „ Cambell— Senior Boys No „ Senior Girls Yes, at domestic science centre „ Junior Mixed No „ Infants „ C. of E.— Boys »> School fires (in winter only) Girls „ Infants ,, „ Dawson— Junior Bovs 20 Yes, at Meals Centre Cloakrooms heated (in winter only) Junior Girls 14 >> „ Infants — No „ Dorothy Barley— Junior Boys — >> „ Junior Girls — » J „ Infants — 99 „ Eastbury— Senior Boys — 99 „ 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 — No School fires (in winter only) Junior Mixed — „ „ Infants — „ „ Monteagle— Junior Boys — „ Cloakrooms heated (in winter only) Junior Girls — „ „ 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) St. Ethelburga's— Senior Mixed 15 No „ Westbury— Junior Boys — „ Cloakrooms heated (in winter only) Junior Gills — „ „ Infants 1 „ „ 108 Strictly speaking, the selection of school-children for free meals should at present be made by a system of selection by the Authority's medical officers, who, of course, would select any child who showed any symptoms, however slight, of sub-normal nutrition. Evidence of sub-normal nutrition can only be detected and investigated by a fairly complete medical examination, and the cost of this service would be considerable. Moreover, your medical officers are trained especially in the promotion of health, and naturally look upon the provision of free meals from this standpoint rather than from the standpoint of correcting sub-normal nutrition when it has become established, however slightly. The question to my mind might become one of finance. The extra cost of medical service would perhaps be found to be far more costly than the cost of a few meals which under a means test may be given to children who do not demonstrate evidence of sub-normal nutrition. The provision of meals is a very gratifying aspect of the school life of the modern child. It is over fourteen years ago that I first began to take a personal interest in school-children. It has been my privilege to work together with head teachers who have been dealing with them for forty years, and I find that the nutrition of the children is better today than ever it was and this is not only reflected in the increased heights and weights of the children but also in their increased vitality in the playground and, as I am told, their increased keenness in the classroom. (b) Milk.—In addition to free meals as such, free milk is given in certain cases and in this way 52,064 bottles of milk have been distributed. It may be thought that where we have an efficient scheme for providing mid-day meals the provision of free milk should not be necessary. As a matter of fact, I myself could not concur with such an opinion. You have made provision for any child to have one-third of a pint of milk in the middle of the morning at a cost of one half-penny. These arrangements have been made because we are positively persuaded that this one-third of a pint of milk is very highly desirable, even in cases where children come from a good breakfast and go to a good mid-day meal. If the provision of this milk is highly desirable in such cases, how much more desirable must it be in cases where we are doubtful whether the children have come from a good breakfast, even if we know they are going to a good mid-day meal ? 109 The amount of milk to be taken by each child per day is a matter of opinion. Generally speaking, children get far too little milk, but there are cases where I myself have found it necessary to point out the children are taking too much milk, and at propaganda meetings it is our misfortune to find ourselves speaking to the converted where as often as not it is necessary to advocate the limitations of the use of milk rather than its increased consumption. In this connection, it may be pointed out that the main experiments which have proved so clearly the value of supplementary milk feeding, have all been carried out by the administration of not less than threequarters of a pint of milk per child per day. We may take it, therefore, that a child can take three-quarters of a pint of milk per day without interfering with its healthy appetite for other food of a more mixed variety, and I think that at the present time we may well take three-quarters of a pint as an average, if we are dealing with all ages of school-children, say from five to sixteen years. On the 1st October, 1934, the scheme of the Milk Marketing Board to supply milk at half-price, viz.: one-halfpenny instead of one penny per third of a pint came into operation. It was a condition of the scheme that the Milk Marketing Board should be satisfied that the milk supplied did have the approval of your Medical Officer, as to source and quality, and further that if pasteurised supplies were available the milk should be of such quality. Your Medical Officer did satisfy himself that the milk supplies were being taken from approved sources and were of the proper quality. (12) CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. During the year, parents have continued to show an 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 have 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 visits, but also in maintaining a high standard of orderly behaviour among the children during the examination. The work of the Dentists too has also been facilitated by the active co-operation of the teaching staff. 110 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. It would be impossible for me to close my remarks on co-operation without expressing my personal indebtedness to my colleagues in general practice, who at no small inconvenience to themselves have on numerous occasions assisted me materially in cases which have shown some medical or social difficulty. I have on all occasions received the greatest courtesy and the kindliest co-operation and the help which they have given to me has been offered most generously and in the highest spirit of public enterprise. The following table shows the work which has been undertaken by the National Society for the Prevention of Cruelty to Children during the last three years :— 1932 1933 1934 Total number of cases investigated 16 33 24 (a) Prosecutions nil nil nil (b) Warnings 13 24 18 (c) Otherwise dealt with 3 9 6 (d) Supervisory visits 97 133 131 (e) Cases closed as satisfactory 12 25 17 The National Society for the Prevention of Cruelty to Children have carried out their work in a very estimable way and have maintained a high level of co-operation with your officers. It may be that the Society does not carry out an enormous amount of work in Barking; this I think is a tribute to the success achieved by your own work, but by the same token the cases with which they do deal must be more difficult than they otherwise would be, because so far as your officers are concerned, cases are usually only turned over to the Society after all other available resources have been exhausted. (13) BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. I find that I cannot add to my report of last year in which I stated that in this way or another through your multifarious activities defective children in your area are ascertained and brought to your notice. 111 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 31.12.33 97 38 89 No. admitted during 1934 34 15 11 No. discharged during 1934 47 13 24 No. on Register on 31.12.34 84 40 76 Hereunder are particulars of the number of children maintained by the Authority in special schools outside the district as at December 31st, 1934 :— Particulars of School. No. of Cases. (a) Certified Schools for the Blind : East Anglian School for the Blind (Residential), Gorleston 1 Barclay School for Blind Girls (Residential), Brighton 1 (b) Certified School for the Deaf: Frederick Road Deaf Centre (Day), West Ham 5 (c) Certified School for Mentally Defective Children : Royal Eastern Counties Institution (Residential), Colchester 1 (d) Certified Schools for Physically Defective Children : St. Dominic's Open-Air School (Residential), Hambledon, Surrey 1 St. Patrick's Open-Air School (Residential), Hayling Island 1 White Oak Ophthalmic Hospital School (Residential), Swanley, Kent 2 Where children are found to be so defective mentally as not to be able to receive any useful instruction in a special school or class they are notified to the County Council. 112 The following table gives information in respect of medical inspection at the Faircross Special School during the year 1934 :— Number of inspection sessions 21 Number of children inspected :— (a) Routines 101 (b) Specials 25 (c) Re-examinations 269 395 Number of defects referred :— (a) For treatment 18 (b) For observation 27 45 Number of defects found treated 31 Number of parents present at inspections 234 (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. There are no Nursery Schools in Barking. These schools are found necessary in many districts on account of unsatisfactory home conditions or where mothers go out to work. They are also necessary in certain selected cases where, unless the mother can place the child with safety at such a centre, she cannot possibly live any individual life of her own and tend to her own needs which, of course, are equally the needs of her child. You have in Barking large new housing estates where the housing conditions are satisfactory, but there will of course always remain the few selected cases of which I have spoken which from time to time, although perhaps not all the time, will require the provision of some sort of creche or class. The problem is primarily one of the mother and indirectly one of the child. 113 (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. The dental inspection and the treatment of the children at this school is about to be undertaken by you and I do hope that the time is not far distant when all the children who attend this school will have the advantages of all the multifarious activities you carry on on behalf of the children in ordinary schools. (17) PARENTS' PAYMENTS. From time to time you have had under consideration an arrangement for the recovery of cost of treatment from parents of children attending public elementary schools. Certain alterations have been made during the year 1934. (18) HEALTH EDUCATION. In respect of what is commonly known as "Health Education," I confessed last year that 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 ordinary work, but we hope that when conditions are more stable to undertake work in this direction. This does not imply that I believe in any set lessons but rather that the children should be taught to realise that the things that they have been taught to do are based on sound principles; thus it is teaching children how to do such things which is the important thing. Children should be so taught to clean their teeth that they feel uncomfortable if the teeth have not been brushed at least twice a day. It is proper that the senior scholars should understand that they have been taught to clean their teeth for some basic reasons but no knowledge of dental caries is so likely to urge them to clean their teeth as the discomfort experienced by people who do clean their teeth regularly, when for some reason or other they are precluded from doing so. In the same way, I hope the time will come when routine habits will be firmly established amongst the school-children and the child who suffers from intestinal stasis, a condition so prevalent today, will feel uncomfortable. Here again, amongst the older children the basic principles might be taught of how important it is for them to rely on proper diet and proper exercises rather than upon laxatives, which should be looked upon as quite out of date. 114 (19) SPECIAL INQUIRIES. No special inquiries have been undertaken during the year. (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 byelaws of the Education Authority, five applicants of school-age submitted themselves for examination prior to employment and were passed. 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 Clinics in Vicarage Drive and 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. 115—116 CLINIC AND TREATMENT CENTRES Name and Situation When Held Nature of Accommodation By Whom Provided 1. Maternity and Child Welfare. (a) Infant Welfare Centres :— Central Clinic, Vicarage Drive, Ripple Road Tuesdays and Fridays, 2 p.m. Modern clinic premises with accommodation for consultations, weighing of babies, waiting rooms, etc. Local Authority. Greatfields Centre, Movers Lane Mondays and Thursdays, 2 p.m. Accommodation for consultations, weighing of babies, waiting rooms, etc. do. Alexandra Centre, St. Paul's Road Mondays and Thursdays, 2 p.m. do. do. Shaftesbury Centre, Stamford Road Tuesdays and Fridays, 2 p.m. do. do. (b) Ante-Natal Clinics :— Central Clinic, Vicarage Drive, Ripple Road Wednesdays, 2 p.m. Fridays, 10 a.m. Modern clinic premises with accommodation for consultations, etc. do. Alexandra Centre, St. Paul's Road Tuesdays, 2 p.m. Accommodation for consultations, etc. do. Shaftesbury Centre, Stamford Road Wednesdays, 10 a.m do. do. Specialist-Consultant Clinic at Alexandra Centre, St. Paul's Road. Last Friday in each month, 2 p.m., except August and December. do. do. (c) Gynaecological Clinic :— Central Clinic, Vicarage Drive, Ripple Road As and when required. Modern clinic premises with accommodation for consultations, etc. do. (d) School Nurseries :—Nil Nil Nil Nil (e) Day Nurseries :—Nil Nil Nil Nil 2. School Medical Service. (a) Inspection Clinics and Treatment of Minor Ailments Central Clinic, Vicarage Drive, Ripple Road Daily, 8.30 a.m. Modern clinic premises with inspection, waiting, and treatment rooms, etc. Local Authority. Shaftesbury Clinic, Stamford Road do. Large hall and two rooms do. (b) Eve Clinic :— Central Clinic, Vicarage Drive, Ripple Road Three sessions weekly Modern clinic premises do. (c) Dental Clinics :— Central Clinic, Vicarage Drive, Ripple Road Daily, 9 a.m. and 2 p.m. Modern clinic premises with waiting and treatment rooms, etc. do. East Street Clinic Daily, 9 a.m. and 2 p.m. Waiting and treatment rooms do. (d) Orthopaedic Clinic :—Faircross School First Thursday in each month at 2 p.m. One room do. (i) Remedial Exercises Clinic Daily, 9 a.m. and 2 p.m. One room do. (ii) Ultra-Violet Light Therapy Diphtheria Prevention Immunisation Clinic. Central Clinic, Vicarage Drive, Ripple Road Mondays, 10 a.m. Modern clinic premises with waiting and treatment rooms. do. 4 Tuberculosis. 37, Linton Road Mondays, 3-5 p.m. Thursdays. 10.30 Three rooms Essex County Council. 5. Venereal Diseases. a.m.-12 noon London Hospitals, etc. — — By arrangement with Essex County Council. Since the end of 1934, Infant Welfare Clinics and Ante-Natal Clinics have been opened at the Wesleyan Methodist Church premises in Porters Avenue and are held as follows :— Infant Welfare Clinics Mondays and Wednesdays at 2 p.m. Ante-Natal Clinic Thursdays at 9.30 a.m. 117 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 one halfpenny 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 Shaftesbury 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. Orthopaedic 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 T reatment for Ringworm, of the Scalp Where necessary, Ringworm is treated by X-Ray. No charge is made for this treatment. 118 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 Orthopedic Clinic amongst children of school age :— No. of primary examinations by Orthopaedic Surgeon 112 No. of re-examinations by Orthopaedic Surgeon 249 The cases dealt with for the first time during 1934 were referred for the following conditions, some children having more than one defect:— (a) Deformities—Bones and Joints— (1) Congenital Nil (2) Acquired : Injury—elbow-joint 3 „ hip-joint 1 „ knee 1 Arthritis with dislocation—hip 1 Old fracture— femur 1 Genu valgum 18 Genu varum 3 Hallux valgus 1 Shoemaker's chest 2 31 (b) Muscular — (1) Congenital: Torticollis 3 Absence of pectoralis— major R. 1 Talipes 2 Flexion deformity digits (hand) R. and L. 1 (2) Acquired : Kypho-lordosis 4 Kyphosis and pigeon chest 22 Pes plano-valgus 46 Deformity—digits—foot 5 „ „ hand 1 85 119—120 PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1934. 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 11 241 112 84 249 169 1,889 670 2,250 923 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 Treatments School Children 15 240 2 31 76 1,415 15 317 — — 64 239 Under School Age 13 42 — — 4 13 50 335 — — 58 324 Admissions to Hospitals On Waiting List for Admission 31/12/34 School Children Under School Age Total School Children Under School Age Total 11 (10 under Council's Orthopaedic Scheme) 5 16 2 1 3 121 (c) Paralysis— (1) Acquired : Anterior poliomyelitis 5 5 Also Recurrent synovitis—knee 1 Baker's cyst 1 2 Total defects found 123 During the year, eleven children were admitted to hospital and the following operations were carried out in these cases:— Tenotomy— sterno-mastoid 1 Arthrodesis— wrist (right) Manipulation—elbow and "collar and cuff " 1 Steindler's operation— foot Excision—scar—knee 1 Excision—Baker's cyst 1 Tenotomy— tendo achillis and plaster right and left 1 Manipulation and plaster—right and left feet 1 Amputation—digit 5—right and left feet 1 Plaster bed (for scoliosis) 1 122 REPORT OF DENTAL SURGEON. June, 1935. To the Medical Officer of Health, Borough of Barking. Sir, I have the honour to submit the report of the Dental Services for the year ended December 31st, 1934. The number of inspections, fillings, extractions and other operations remains substantially the same as for the year 1933, but during the latter part of the year under review a re-arrangement of the sessional programme was introduced to approximate more closely the figures anticipated by the Board of Education in the matter of fillings and extractions. This necessitated a narrowing of the field for orthodontic treatment, regarded as a welcome addition to the dental service but secondary in importance to general conservation work and oral cleanliness. It is hoped that in the near future the progressive improvement in the dental condition of Barking school-children will permit the time to renew orthodontic treatment on generous lines. Dental sepsis, so general and widespread in this country is best combated at its outset, namely, during the period of pre-school and school life. The pre-school child is the subject of another report to your Council, and it is the purpose of this report to treat only with the child of school-age. Dealing, as the service does, with children at the outset of their school life, they can be brought under observation and attention at an early age. The opportunity of impressing upon the young child the necessity of mouth hygiene is fully exploited and, in the numerous inspections carried out over the past five years, it has been gratifying to note the large number of children who have grown up dentally conscious and willing to attend the Clinic for treatment at any time in a spirit of great friendliness. Regrettably, many children are not seen until a firmly established condition of oral unhealthiness is present. This may be due to parental unwillingness, fear on the part of the child due to a misformed conception as to treatment, and new arrivals to the district. With all of these the staff is optimistic, although such optimism is not always rewarded. These three classes form that body of individuals known as "refusals" who hinder both actively and passively the good work of the service, but it is undeniable that they are a weakening body, every year sending recruits to march under the banner of dental health. 123 Another matter of great satisfaction is to see the steadily improving dental condition of children who have been included in the dental scheme for a period of years. Undoubtedly some good work has been nullified by indifference on the part of the patient after skilled treatment has been given, and again in the changeover from infant to junior schools and junior to senior schools a number of children unfortunately have joined their new schools after those schools have been finished, and so missed inspection and treatment for too long a period. The filling of temporary teeth is always of value and repays both the operator and the patient, but, although so worth while, one is compelled to regard such work as of lesser importance when a large school population needing dental attention to permanent teeth is calculated to occupy fully the time of the staff. Also it should be borne in mind that failure in the filling of a questionably saveable temporary tooth can produce a prejudicial outlook in the mind of a parent in the choice of filling permanent teeth later in the school life. The teaching of dental hygiene in schools to children of twelve and over, especially to girls, is earnestly advocated. In some cases where a few children remain for the last day of a dental examination the privilege of addressing the children has been sought from the Headmaster or Headmistress, and the results provoke the greatest enthusiasm. Refusals of treatment have been minimised and the children have attended for treatment with an enlightened and collected outlook that has greatly assisted chair-side work. This policy should be furthered. Again, where the teaching staff have personally reminded the scholars at frequent intervals on the merits of regular use of the toothbrush, results have been remarkably good. These methods are most economic. Less time is required in examining a school where a percentage of sound mouths is high, the treatment of the school occupies much less time at the Clinic and more frequent inspections are possible. It is too early yet to be able to state what dental benefit the supply of milk to the school-children has produced, but the generally favourable results interest considerably the outlook of those engaged in school dental work. The modern school with its light airy rooms, pleasant internal arrangements, and an educational system with greater mental freedom, in aiding to produce a fitter child, does so in a general sense, and it is reasonable to expect that an improvement in the dental condition has been closely related to such fitness. In this matter of schools and service, Barking is singularly well placed, and it will be of the greatest professional interest to follow during the next few years the progress which should present itself. 124 There is one matter, however, in which the child attending the schools of a Local Education Authority is at a disadvantage, and that is in the matter of rest. Children inmates of institutions are compelled to observe a stricter discipline in early retirement at night than the child who is free to run the streets and parks. These latter often do not go to bed until well after 9.30 o'clock, and undue strain and tiredness are the results. I am of opinion that, although recognising the balanced diet most institution children receive, the matter of rest plays an extremely important role in the possession of a sound dentition and it has been my experience that the teeth of children attending institutions are sounder than those children attending elementary schools. In terminating, may I quote from Sir George Newman's report on "The Health of the School-child (1933) " with reference to dental lectures and exhibits. "It would almost appear that (in London) all persuadable people have already been converted to the practice of dental hygiene and that a cohort of angels even would fail to make an impression on those who obstinately remain outside the scheme. Nevertheless the useful purpose served by these administrators in propagating knowledge relating to the care of the teeth and dental hygiene generally cannot be gainsaid; even the faithful require reinforcement of the faith from time to time." To the dental staff at the Clinic, the medical, nursing and teaching staff, full thanks should be given for their kindness, interest and assistance, and the recognition that their co-operation contributes very considerably to the success of the dental scheme. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, l.d.s., r.c.s. (eng.), Public Dental Officer. 125 SCHOOL MEDICAL SERVICE. Statistical Tables—Public Elementary Schools, I934 TABLE I.— RETURN OF MEDICAL INSPECTIONS. A.— Routine Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 1,590 Second Age Group 720 Third Age Group 1,005 Total 3,315 Number of other Routine Inspections 802 B.— Other Inspections. Number of Special Inspections 6,296 Number of Re-Inspections 9,524 Total 15,820 126 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER, 1934. 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 je kept under observation, but not requiring Treatment (1) (2) (3) (4) (5) Malnutrition 10 64 3 18 Skin Ringworm—Scalp 47 Body — 1 3 — Scabies 5 — 23 — Impetigo 1 — 118 — Other Diseases (Non- Tuberculous) 9 2 205 2 'Blepharitis 14 5 50 — Conjunctivitis 2 2 173 1 Keratitis — — 4 — Eye , Corneal Opacities — — — — Defective Vision (excluding Squint) 299 78 192 14 Squint 38 12 5 1 Other Conditions 5 3 99 3 'Defective Hearing 3 7 4 5 Ear Otitis Media — 1 4 — _ Other Ear Diseases 38 4 198 4 " Chronic Tonsillitis only 179 195 218 90 Nose and Throat Adenoids only 11 8 7 3 Chronic Tonsillitis and Adenoids 69 42 43 109 Other Conditions 11 20 256 28 Enlarged Cervical Glands (NonTuberculous) 5 57 104 17 Defective Speech 3 17 4 4 Heart and Circulation 'Heart Disease : Organic 2 31 1 10 Functional — 52 1 42 Anaemia 2 17 13 2 Lungs Bronchitis 4 20 26 12 Other Non-Tuberculous Diseases 2 33 44 35 127 TABLE II. (A).—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 1 Suspected — — — — Non-Pulmonary : Glands 2 Bones and Joints — — — 1 Skin — — 1 — Other Forms — 2 — 1 Nervous System Epilepsy — 2 — — Chorea 5 6 5 14 Other Conditions 4 19 19 19 Deformities Rickets 8 2 - 1 Spinal Curvature 4 5 7 3 Other Forms 64 27 28 6 Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 47 108 1,578 622 Totals 844 843 3,485 1,068 128 TABLE II.—continued. (B)—NUMBER OF INDIVIDUAL CHILDREN FOUND AT ROUTINE MEDICAL INSPECTION TO REQUIRE TREATMENT (EXCLUDING UNCLEANLINESS AND DENTAL DISEASES). Group. (1) Number of Children. Inspected. (2) Found to require Treatment. (3) PRESCRIBED GROUPS: Entrants 1,590 243 Second Age Group 720 104 Third Age Group 1,005 127 Total (Prescribed Groups) 3,315 474 Other Routine Inspections 802 136 Grand Totals 4,117 610 129 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Children Suffering from Multiple Defects. No. of Cases. Combination of Defects. School Attended. 1 Mental Defect and Crippling (right spastic hemiplegia). Certified School for Mentally Defective Children. 1 Mental Defect and Crippling (spastic diplegia). Certified School for Mentally Defective Children. 2 Mental Defect and Active Tuberculosis (glands). Certified School for Mentally Defective Children. 1 Mental Defect and Epilepsy Certified School for Mentally Defective Children. 1 Epilepsy and Crippling (congenital talipes equino-varus). 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 2 — — — 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 — 7 1 8 130 TABLE III.—continued. Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total 5 — — 3 8 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 73 3 — — 76 Epileptic Children. Children Suffering from Severe Epilepsy. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 2 (3) — — 2 4 (3) Figures in brackets denote additional cases at present under observation re epilepsy—not yet certified. 131 TABLE III.—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) 2 (4) - (-) - (-) 2 (5) 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 2 (4) 12 (25) 8 (-) 2 (—) 24 (29) 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 1 1 — 66 132 TABLE III.—continued. C.—Crippled Children. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 19 — — 1 20 D.—Children with Heart Disease. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 32 — 1 5 38 133 FORM 307M.—STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1934, 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 — — (c) Others — 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 2 3 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 TOTALS 3 4 134 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1934. GROUP I.—Minor Ailments (excluding Uncleanliness, for which see Group VI). Number of Defects treated, or under treatment during the year. Disease or Defect. Under the Authority's Scheme Otherwise Totals (1) (2) (3) (4) Skin— Ringworm—Scalp : (i) X-Ray Treatment 8 — 8 (ii) Other 39 — 39 Ringworm—Body 2 — 2 Scabies ... 11 — 11 Impetigo 107 1 108 Other skin disease 180 5 185 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 338 1 339 Minor Ear Defects 238 5 243 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 1,687 41 1,728 Totals 2,610 53 2,663 185 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 Otherwise Totals (1) (2) (3) (4) Errors of Refraction (including Squint) 384 77 461 Other Defect or Disease of the Eyes (excluding those recorded in Group I) Totals 384 77 461 Number of children for whom spectacles were prescribed :— (a) Under the Authority's Scheme 349 (b) Otherwise 77 Number of children who obtained spectacles :— (a) Under the Authority's scheme 335 (b) Otherwise 49 136 TABLE IV.—continued. GROUP III.—Treatment of Defects of Nose and Throat. Number of Defects. Defect (1) Received Operative Treatment Received other forms of Treatment (5) Total number treated (6) Under the Authority's Scheme, in Clinic or Hospital (2) By Private Practitioner or Hospital, apart from the Authority's Scheme (3) Totals (4) Tonsils only 196 18 214 259 562 Adenoids only 14 — 14 T's and A's 65 5 70 Other 3 2 5 Totals 278 25 303 259 562 GROUP IV.—Orthopaedic 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 orthopedic clinic Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopaedic clinic Number of children treated 10 132 1 143 137 TABLE IV.—continued. GROUP V.—Dental Defects. (1) Number of Children who were :— (i) Inspected by the Dentist: Routine Age Groups Aged : 5 126 6 192 7 158 8 180 9 175 10 346 11 326 12 281 13 259 14 2 Total 2,045 Specials 1,865 Grand Total 3,910 (ii) Found to require treatment 3,363 (iii) Actually treated 2,671 (2) Half-days devoted to :— Inspection 18 Treatment 799 Total 817 (3) Attendances made by children for treatment 7,220 138 TABLE IV.—continued. (5) Extractions—Permanent teeth 1,283 Temporary teeth 6,276 Total 7,559 (6) Administrations of general anaesthetics for extractions 3,152 (7) Other Operations—Permanent teeth 3,460 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 41,499 (iii) Number of individual children found unclean 1,583 (iv) Number of children cleansed under arrangements made by the Local Education Authority 5 (v) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 7 (b) Under School Attendance Byelaws