AC 4411 (1) BARRING Esser BARK 29 M BOROUGH OF BARKING REPORT OF THE Medical Officer of Health AND School Medical Officer For the Year 1935 C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. BARK 29 BOROUGH OF BARKING REPORT OF THE Medical Officer of Health For the Year 1935 C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. 3 TABLE OF CONTENTS. Page STAFF 7, 8 INTRODUCTION 9 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Age Mortality 18 Area 10 Births 10-12, 17 Births, Notification of 17 Deaths 10-17 Deaths, Causes of (Table) 13-16 General Statistics Housing 19 Illegitimate Births 10, 17 Industries Infant Mortality 10-12, 15-17 Infant Mortality (Table) Inhabited Houses 10 Inquests 14 Malnutrition Neo-Natal Mortality 15—17 Population Rateable Value 10 Social Conditions 17—19 Still-births 10-12, 17 Travelling Facilities 10 Unemployment 1®> 10 Vital Statistics 10-12 Zymotic Diseases, Deaths from 18 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Ambulance Facilities 21 Ante-Natal Clinics 27, 28, 32, 33 Ante-Natal Supervision 32, 33 Artificial Immunisation 27, 28, 41, 45—47 Artificial Sunlight Clinic 41, 45 Barking (Infectious Diseases) Hospital 23-26 Baths for Expectant and Nursing Mothers 45 Children Act. 1908, Part I 42 Children and Young Persons Act, 1932 42 Clinics and Treatment Centres 22,27-31,32 Convalescent Treatment 40, 45 Dental Surgeon, Report of 54 Dental Treatment 41, 45–47, 55 Difficult Labour, Consultations in 46 Eye Defects 41, 46, 48-49 Foster Children 42 Gynaecological Clinic 27-28, 36, 45 Home Nursing 22, 32 Hospital Services 21, 23-26 Hospital Services, Tables of 23-26 Illegitimate Children 40 Infant Life Protection 42 Infant Welfare Clinics 27, 28, 43, 46 Laboratory Facilities 21 4 SECTION B—Continued Page Maternal Mortality 38, 30 Maternity and Child Welfare Services 32-55 Maternity Homes 42, 46 Midwifery 33-35 Minor Ailments 27, 28, 41-42 Nursing Homes 42 Obstetrics and Gyna:cology, Consultations in 45 Ophthalmia Neonatorum 40 Ophthalmic Service 41,48-49 Orthopaedic Clinic, Report of Work Done 50-53 Pemphigus Neonatorum 36 Plaistow Maternity Hospital and District Nurses'Home 35 Post-Natal Care 35 Provision of Dinners 45 Provision of Dried Milk, etc. 44 Provision of Fresh Milk 44 Provision of Spectacles 46 Public Hospital Services 21, 22, 23-26 Puerperal Fever and Puerperal Pyrexia, Consultations in 46 Senior Health Visitor 32 Services Provided and Facilities for Treatment 45-47 Specialist-Consultant Ante-Natal Clinic 27-28, 45 Specimens Submitted to Laboratory for Examination 21 Still-births 33 Supervision of Midwives 33-35 Tonsils and Adenoids 40, 47 Ultra Violet Light Clinic 41, 47 Upney (Maternity) Hospital 35, 37, 38 Visiting in the Home 43-44 Voluntary Hospital Services 21-22, 23-26 X-ray Treatment for Ringworm 47 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. Cesspools 58 Closet Accommodation 58,62 Common Lodging Houses. 66 Creeksmouth Generating Station 67 Dampness 62 Defects found under the Factory and Workshop Act, 1901 64 Drainage and Sewerage 57, 62 Dustbin Maintenance 62 Dwelling Houses, Inspection of 60 Factories, Inspection of 61 Factory and Workshop Act, 1901 64—65 Home Work 65 Houses Let in Lodgings 66 Miscellaneous Sanitary Inspections 61 Miscellaneous Sanitary Work carried out 63 Notices Served 63 Offensive Trades 66 Out-workers 65 Pail Closets 58 Parks and Open Spaces 70 Piggeries 66 Port of London Authority 57 Premises and Occupations controlled by Byelaws and Regulations 60, 66 Public Cleansing 59 Rag Flock Acts, 1911 and 1928 67 Rainfall 57 Refuse Disposal 59, 60 Refuse Storage and Collection 59 5 SECTION C—Continued Page Refuse Tips 60 Registered Workshops 65 Repairs, General 63 Rivers and Streams 57—58 Sanitary Inspection of the Area 60-67 Sanitary Work, Summary of 62-63 Schools 70 School Closure 70 Schools, Sanitary Inspection of 70 Shops Act, 1934 67 Sinks 62 Smoke Abatement 67-68 Stables 67 Street Cleansing 59 Swimming Baths 68-69 Tents, Vans and Sheds 66 Trade Refuse 59 Ultra Violet Light Radiation 69-70 Underground Sleeping-rooms 66 Water Supply 57, 62 Workplaces, Inspection of 61,64 Workshops, Inspection of 61, 64 Yard Paving 62 SECTION D.—HOUSING. Clearance Areas 75 Houses Built in the District, 1926-1935 73—74 Houses Erected during the Year 71 Housing Act, 1930 75-76 Housing Act, 1935 74-75 Housing Conditions 72-76 Housing Defects Remedied 71-72 Housing Inspections 71 Inhabited Houses, Number of 72 Overcrowding 74–75 Proceedings under Public Health Acts 72 Proceedings under the Housing Act, 1930 72 Redevelopment 76 Rehousing 75, 76 Small Dwellings Acquisition Act 73 Temporary Buildings 73 Unfit Dwelling Houses 71-72 SECTION E—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food 80 Animals Slaughtered 78 Bacteriological Examination of Ice-Cream 78, 80 Bacteriological Examination of Milk 77,80 Barking Corporation Act, 1933 78 Bottling of Milk 78 Chemical Examination of Food 80 Diseased Meat Destroyed 78—79 Food and Drugs (Adulteration) Act, 1928 80 Graded Milk Licences Granted 77 Ice-Cream 78 Meat and Other Foods 78-80 Milk (Special Designations) Order, 1923 77 Milk Supply 77-78 Nutrition 81 Prosecutions 80 Slaughter-houses 78 Unsound Food Destroyed 80 6 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Page Acute Anterior Poliomyelitis 84-86 Acute Polio-Encephalitis 84-86 Admissions to Barking (Isolation) Hospital (Table) 88 Artificial Immunisation 88-89 Barking (Isolation) Hospital 88 Cancer 89-90 Cerebro-spinal Fever 83 Diphtheria 84—88 Diphtheria Notifications (Monthly Summary Table) 87 Encephalitis Lethargica 85-86 Enteric Fever 84-86, 88 Erysipelas 84-86, 88 Food Poisoning 84—86 Infectious Diseases (Tables) 84—88 Influenza 87 Measles 87 Measles and Pneumonia 84—86 Non-Notifiable Acute Infectious Diseases 87-88 Notifiable Infectious Diseases 83-87 Notifications classified according to Wards (Table) 85-86 Ophthalmia Neonatorum 84-86, 88, 90-91 Pemphigus Neonatorum 84—86 Pneumonia 84—86, 88 Prevention of Blindness 90-91 Puerperal Fever and Pyrexia 84—86, 88 Rheumatic Fever 87 Scabies 88 Scarlet Fever 84—88 Scarlet Fever Notifications (Monthly Summary Table) 87 Smallpox 83-87 Summer Diarrhoea 87 Tuberculosis 91-92 Tuberculosis, New Cases and Deaths (Table) 91 Unnotified Fatal Cases of Tuberculosis 91 Whooping Cough 87 SCHOOL MEDICAL SERVICE. Table of Contents will be found on Pages 96—97. 7 STAFF, 1935. Medical Officer of Health, School Medical Officer, Medical Superintendent, Harking and Upney Hospitals : C. LEONARD WILLIAMS, B.Se., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer of Health and Deputy 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. CATHERINE B. McARTHUR, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Commenced 2nd January, 1935.) Ophthalmic Surgeon : WILLIAM ADAMSON GRAY, M.B., Ch.B., F.R.C.S., Ph.D. (Commenced 14th May, 1935.) Orthopaedic Surgeon : B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Specialist Consultant in Obstetrics and Gynecology : ALAN BREWS, M.D., M.R.C.P., F.R.C.S., M.S. Dental Surgeons : W. H. FOY, L.D.S., R.C.S. R. N. HINES, L.D.S., R.C.S. (Resigned 9th February, 1935.) H. S. SARSON, H.D.D., R.C.S., L.D.S., R.C.S. (Commenced 20th May, 1935.) Sanitary Inspectors : N. BASTABLE (Chief Sanitary Inspector) (b, c, d and /). H. CARR (b, c, e and m). C. S. COOK (b and c). W. E. COLSTON (c and n). (Resigned 13th May, 1935.) W. CUE (m and n). (Resigned 1st November, 1935.) E. G. TWEEDY (a and c). (Commenced 23rd July, 1935.) Matron, Barking and Upney Hospitals—Inspector of Midtcives : Miss M. W. HEDGCOCK (h, i and j). 8 Health Visitors : Miss P. M. FAWCETT (Senior Health Visitor and School Nurse) (g, ft and i). (Commenced 1st December, 1935.) *Miss M. BAERLOCHER (g, A and n). *Miss C. COURT (g, ft and i). Miss G. ELLIOTT (a, ft and I). Miss G. GEDEN (Dental Nurse) (r). Miss S. E. W. GIBSON (j). *Miss G. JONES (g, ft and i). (Commenced 12th August, 1935.) Miss R. LLEWELLYN (Dental Nurse) (ft and i). *Miss W. PARKER (g, ft and i). Miss A. K. ROE (Masseuse) (o). (Commenced 1st April, 1935). *Miss F. G. ROXBURGH (g, A and i). (Resigned 10th August, 1935.) 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 (Senior Assistant). D. G. TONKIN (n). (Resigned 4th February, 1935.) H. C. DAVIS. (Commenced 1st May, 1935.) A. J. STORER («). I'. YATES (q). (Commenced 1st May, 1935.) E. A. ELLIS. G. H. RUFF. D. W. OSMOND. (Resigned 17th May, 1935.) E. INGS (p). (Commenced 12th August, 1935.) Miss H. NUNN. Miss H. KING. Miss A. LIGGINS. Miss D. FOULSHAM. (Commenced 1st April, 1935.) Miss I. CAST. (Commenced 13th May, 1935.) Miss G. COOPER. (Commenced 4th December, 1935.) Disinfector and Mortuary Attendant: H. LONG. (а) Sanitary Inspector's Certificate of Sanitary Inspectors' Examination Board. (б) 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. (ft) Certificate of Central Midwives Board. (i) General Hospital Training. (j) General Fever Training. (I;) Certificate of Medical Electricity and Swedish Remedial Exercises. (I) 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, Medical Electricity, Light and Electro-Therapy. (p) Inter. B.Sc., University of London. (</) Final Examination of the National Association of Local Government Officers. (r) Registered Sick Children's Nurse. (*) 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, 1935. PUBLIC HEALTH OFFICES, BARKING, ESSEX. June, 1936. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, Herewith I beg to submit, for your favourable consideration, my Report as Medical Officer of Health for the year ended 31st December, 1935. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 10 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 1. General Statistics. Area (acres) 4,174 Ward areas 3,874 Tidal Water H.W.M. Thames 240 Roding 58 Loxford Water 2 300 4,174 Population (1931 Census) 51,277 Population (June, 1935) (Registrar-General's Estimate) 72,650 Number of Inhabited Houses, March, 1936, according to Rate Books:— Houses 17,235 Shoos 1.202 Total 18,497 Population Density, i.e., No. of persons per acre 17 -4 Rateable Value—General £651,458 0 0 Sum represented by a penny rate £2,038 5 10 Education rates :— Elementary Included in General Rate Figure 3 6 Secondary General Rate 13 6 2. Extracts from Vital Statistics for the Year. Live Births:— Total. Males. Females. Birth Rate. Legitimate 1,214 634 580 16.7 Illegitimate 12 7 5 0.2 Totals 1,226 641 585 16.9 Still-births :— Rate per 1,000 total births :— Legitimate 29 14 15 23.9 Illegitimate 1 1 - Deaths 558 (563) 284 (288) 274(275) Death Rate 7.7 Percentage of total deaths occurring in public institutions, 54.3. Deaths from puerperal causes :— Deaths. Rate per 1.000 total (live and still) births. Puerperal sepsis 3 2 -39 Other puerperal causes 1 0-79 Totals 4 3 18 Number of deaths of infants under one year of age :— Total Infantile Death Death Males. Females. Total. Rate. Rate. Legitimate 31 30 61 50.2 52.2 Illegitimate 1 2 3 250.0 Number of deaths from Measles (all ages) 1 „ „ Whooping Cough (all ages) 2 „ „ Diarrhoea (under 2 years of age) 7(5) (N.B.—Where the Registrar-General's figures and rates differ from those prepared locally, the former are shown separately in brackets.) 11—12 3. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1935. (England & Wales, London, 121 Great Towns, and 140 Smaller Towns and BARKING.) Rate per 1,000 Total Population. Annual Death Rate per 1,000 Population. Rate per 1,000 Live Births. Live Births. Still-births. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Violence. Diarrhoea and Enteritis (under two years). Total Deaths under one year. England and Wales 14.7 0.02 11.7 0.00 0.00 0.03 0.01 0.04 0.08 0.18 0.52 5.7 57 121 County Boroughs and Great Towns, including London 14.8 0.08 11.8 0.00 0.00 0.04 0.01 0.04 0.09 0.10 0.45 7.9 02 140 Smaller Towns (Estimated resident populations, 25,000 to 50,000 at Census, 1931) 14.8 0.04 11.2 0.00 0.00 0.03 0.01 0.03 0.07 0.17 0.41 3.8 55 London 13.3 0.52 11.4 0.00 0.00 0.00 0.01 0.04 0.00 0.11 0.51 11.2 58 BARKING 10.9 0.41 7.7 0.00 0.00 0.01 0.01 0.03 0.19 0.12 0.28 5.71 54.2 The maternal mortality rates for England and Wales are as follows : per 1,000 Live Births „ „ Total Births Puerperal Sepsis. 1.08 1.01 Others. 2.42 2.32 Total. 1.10 3.93 4. VITAL STATISTICS OF WHOLE DISTRICT FROM 1925 TO 1935. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Net Deaths belonging to the District. Nett. Of Nonresidents registered in the District. Of Residents registered out of the District. Under One year of age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Net Births. Number. Rate. 1 2 3 4 5 0 7 8 9 10 11 12 1925 38,450 825 21.4 287 7.4 8 107 66 80.0 386 10.0 1926 38,920 818 21.0 259 6.6 11 118 49 59.9 366 9.4 1927 39,900 710 17.7 251 6.2 7 162 47 66.1 406 10.1 1928 40,870 805 19.7 276 6.7 6 144 51 63.3 414 10.1 1929 42,160 787 18.7 291 6.9 8 152 42 53.4 435 10.3 1930 45,000 799 17.7 256 5.7 7 186 49 61.3 435 9.7 1931 51,830 947 18.3 328 6.3 7 215 61 64.4 536 10.3 1932 60,330 1105 18.3 283 4.7 17 239 59 53.4 505 8.4 1933 68,840 1204 17.4 290 4.2 13 247 67 55.6 524 7.6 1934 72,290 1252 17.4 311 4.3 9 288 71 56.7 590 8.2 1935 72,650 1226 16.9 270 3.7 13 301 64 52.2 558 7.7 13 5. DEATHS. (a) General.—There were 270 deaths registered in Barking in 1935. Of these 13 were deaths of non-residents. Barking residents to the number of 301 died elsewhere during the year. Including the latter and excluding the deaths of visitors, the net nurpber of deaths was as follows :— Males. Females. Total. 284 274 558 The death rate for 1935 was 7.7 per 1,000, compared with 8.2 in 1934, 11.7 for England and Wales, 11.8 for the hundred and twenty-one County Boroughs and Great Towns, including London, 11.2 for the one hundred and forty Smaller Towns, and 11.4 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 64 1 to 2 years 7 2 to 5 years 7 5 to 15 years 29 15 to 25 years 26 25 to 45 years 97 45 to 65 years 127 Over 65 years 201 (c) Causes of death in 1935.—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 135 24.2 Cancer 71 12.7 Tuberculosis (all forms) 45 8.1 Pulmonary affections (exclusive of tuberculosis), viz., Bronchitis 16 2.9 Pneumonia (all forms) 45 8.1 Other respiratory diseases 9 1.6 Zymotic Diseases 25 4.5 (d) Deaths from Zymotic Diseases.—These diseases caused 4.5 per cent, of the total deaths, such deaths being caused in the following proportions :— Enteric Fever — Measles 1 Whooping Cough 2 Scarlet Fever 1 Diphtheria 14 Diarrhoea 7 Smallpox — 14 (e) Inquests.—Coroner's inquests were held on 43 deaths. (f) Causes of and ages of death during the year 1935. (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 1 – – – – – – 1 1 Scarlet Fever – – – – 1 – – 1 1 Whooping Cough 1 1 – – – – – 2 2 Diphtheria – 4 9 1 – – – 14 15 Influenza – 1 — — – 2 6 9 13 Encephalitis Lethargiea – — — — – — — — — Cerebro-Spinal Fever – — — — 1 — — 1 1 Tuberculosis of Respiratory System — 5 24 11 1 41 40 Other Tuberculous Diseases — — — 2 1 1 — 4 6 Syphilis 1 — 1 — — 1 — 3 3 General Paralysis of the Insane, etc. — — — — — — — — — Cancer — — — — 10 27 34 71 73 Diabetes — — 1 — — 2 3 6 7 Cerebral Haemorrhage 1 — — — 1 4 18 24 19 Heart Disease — — 1 2 15 25 75 118 120 Aneurysm — — — — — 2 — 2 1 Other Circulatory Diseases — — 1 — 1 4 9 15 20 Bronchitis 2 — — — — 5 9 16 13 Pneumonia 11 2 3 2 10 7 10 45 43 Other Respiratory Diseases 1 1 1 — 3 1 2 9 9 Peptic Ulcer — — — — — 2 2 4 5 Diarrhoea (under 2 years) 7 — — — — — — 7 5 Appendicitis — — 1 1 1 — 1 4 7 Cirrhosis of Liver — — — — — — — — — Other Diseases of Liver — — — — — 1 1 2 3 Other Digestive Diseases 1 — 1 — 6 4 2 14 15 Acute and Chronic Nephritis — — — 1 — 3 10 14 11 Puerperal Sepsis — — — — 3 — — 3 3 Other Puerperal Causes — — — 1 — — — 1 1 Congenital Debility, Premature Birth, etc. 31 1 1 — — — — 33 38 Senility — — — — — — 10 10 10 Suicide — — — 1 2 4 1 8 8 Other Violence 1 1 4 3 5 5 1 20 28 Other Defined Diseases 6 3 5 7 13 16 6 56 42 Causes ill-defined or unknown — — — . — — — — — — Totals 64 14 29 26 97 127 201 558 568 15 (g) Infant Mortality during the year 1935. 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 1935 :— 0-1 month. 1-3 months. 3-0 months. 6-9 months. 9 12 months. Total under 1 year. Atelectasis of Lung 3 3 Bronchitis — 1 1 — — 2 Cerebral Cyst — — — 1 — 1 Cerebral Haemorrhage 1 — — — — 1 Congenital Heart Disease 4 — 1 — — 5 Enteritis — 2 — — — 2 Fractured Skull 1 — — — — 1 Gastritis — 3 2 1 — 8 Hydrocephalus — — — 1 — 1 Haemorrhage into Spinal Cord — 1 — — — 1 Insufficient Inherent Vitality 2 — — — — 2 Laryngitis — 1 — — — 1 Marasmus 2 — 2 — — 4 Measles — — — 1 — 1 Paralytic Ileus 1 — — — — 1 Pneumonia 4 4 1 2 — 11 Prematurity 15 1 — — — 16 Septicaemia 1 — — — — 1 Specific 1 — — — — 1 Toxaemia — — — 1 1 2 Whooping Cough — — — — 1 1 Totals 35 13 7 7 2 64 Net Iiirths in the year : Legitimate 1214 Illegitimate 12 1226 Net Deaths in the year :— Legitimate 61 Illegitimate 3 64 16 (h) Neo-Natal Mortality during the year 1935. Causes of Neo-Natal deaths:— Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under 4 weeks. Atelectasis of Lung 3 3 Bronchitis — — — — Cerebral Cyst — — — Cerebral Haemorrhage 1 — — — 1 Congenital Heart Disease 3 1 — — 4 Enteritis — — — — — Fractured Skull 1 — — 1 Gastritis — — — — — Hydrocephalus — — — — — Haemorrhage into Spinal Cord — — — — — Insuflicient Inherent Vitality 2 — — — 2 Laryngitis — — — — — Marasmus 1 — — 1 2 Measles — — — — — Paralytic Ileus — — — 1 1 Pneumonia — — 1 3 4 Prematurity 14 — 1 — 15 Septicaemia — — 1 — 1 Specific — — — 1 1 Toxaemia — — — — — Whooping Cough — — — — — Totals 25 1 3 6 35 It will be seen from the tables that of the sixty-four deaths under the age of one year, no less than thirty-five were four weeks of age or under, and prematurity is given as the cause of death in the cases of fifteen babies, who died within the first four weeks of life. The fact that thirty-five died within the first month, leaving only twenty-nine deaths for the remaining eleven months of the first year of life, shows that our chief problem at the present time is the mortality among the newly born. Out of the thirty-five babies who died under the age of one month, no less than twenty-five died within the first week. This would seem to indicate to me that your chief means of dealing with this problem must lie along the lines of increasing care and attention to the lying-in period and the ante-natal period. Your activities in this direction, which will be considerably strengthened by pending legislation, would seem to me to be a direct approach to this problem. In the year 1933 there were no less than seventeen deaths from gastro-enteritis (summer diarrhoea), but during 1935 we have continued with the relatively favourable position established in 1934. 17 The following table shows the comparative figures of infant mortality and neo-natal mortality for the past nine years :— 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 1935 64 52.2 35 28.5 6. BIRTHS. The net number of births registered in 1935 was 1,226, affording an annual birth rate of 16.9 per 1,000 population, compared with 17.4 in 1934, 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, 12 were illegitimate, giving a percentage of 0.98 of the total births. Notification of Births Acts, 1907-1915.—During 1935 there were 1,201 live births notified, excluding 11 cases transferred from the district. In addition, notifications of still-births belonging to the district totalled 29. Twelve live births and 3 still-births were not notified, and these cases are not included in the totals of notified births given above. 7. SOCIAL CONDITIONS. (a) Industries.—Some of the chief industries carried on in the area are as follows :— The production of electricity, gas, benzole, 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 and food products. The storage of petrol, oil, fuel and timber. Electrical welding, structural engineering and saw-milling. 18 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, 1934 and December, 1935 :— Men. Women. Dec. Dec. Dec. Dec. 1934 1935 1934 1985 Building 305 226 Constructional Work 151 69 — — General Engineering 39 19 3 3 Electrical Engineering 2 1 — — Motor Engineering 22 21 3 1 Cabinet Making 9 5 3 1 Electrical Apparatus 39 54 28 42 Hotel Service 30 20 33 41 Commercial 4 1 3 2 Road Transport 31 23 — — Dock Workers 171 84 — — Paper Making 1 — — 1 Printing 20 18 6 6 Tailoring 12 8 16 11 Dressmaking and Millinery 4 6 9 14 Hat and Cap Manufacture 3 3 10 5 Blouse and Underclothing Manufacture 2 1 7 6 Boots and Shoes 1 1 — — Distributive 149 107 21 38 Miscellaneous (including unskilled) 1,076 896 219 133 Stationery and Cardboard Box Manufacture ... 4 3 2 2 2,075 1,566 363 301 Members of the Council will want to know if there is any evidence, statistical or otherwise, that unemployment has exercised any significant influence on the health or physique of children or adults. It is my duty to report there is no statistical evidence available. My personal opinion is that the level of nutrition is higher than it has been for many years, but this does not mean to say I am satisfied with the present situation. Personally, I believe that a very good index of nutrition is the number of cases of external eye disease found among the child population. Such statistical evidence as we have, and this is shown in my Annual Reports as your School Medical Officer, would appear to indicate that there is no ground for alarm. At the same time, as I have shown elsewhere, we know that the children of English parentage, born under favourable circumstances in the Colonies, do develop in a way which is uncommon in England, showing that the conditions under which children are reared in the home country can be improved upon. 19 Last year I pointed out that I looked forward to the time when the nutrition of people who were unemployed and their dependants would be completely co-ordinated, when the amount of relief would be adequate and be dispensed by one authority only and when it would 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. Food supplies may now enter our houses from several different channels— from different authorities who have little or no opportunity of co-ordinating their efforts. If this leads to overlapping it is of course bad, but if it leads to a deficiency in the service it must of course be even worse. (c) Housing.—In previous years I have called attention to the considerable programmes which you have designed and carried out to overcome your housing problems, and I know that you are at the present time addressing yourselves to the possibility of dealing with overcrowding under the powers you have under the Housing Act, 1935. I have, however, to point out that only a limited number of people can live in Barking, and I do sincerely hope and trust that in re-housing people you will see that so far as is practicable twelve houses to the acre will be looked upon as standard. Barking is largely a dormitory and in a dormitory town there is not the excuse for overcrowding that obtains in some places where local industry requires a large number of the industrial population to be housed in a relatively small area. (d) Travelling Facilities.—Year after year I criticize adversely the conditions under which your dormitory population travel to and from work. The overcrowded condition of the trains and the long queues wait ing in the rain for buses—these would be bad enough for a holiday population, but for people, tired and weary, at the end of a day's work, they represent a condition of affairs which can only be detrimental to the health of the public. Dr. C. F. Fenton, who preceded me as medical officer of health, tells of having found and diagnosed a case of smallpox in a train travelling to Barking. How many people there must be who, if not suffering with smallpox, are suffering with other conditions, particularly catarrhal conditions of the nose and throat, and who stand in overcrowded trains, cheek by jowl with other people ! 20 There is a suggestion to improve travelling facilities to districts north of Barking. So far as I know, no evidence has been brought forward that these improved facilities will in turn improve the conditions at Barking. (e) Malnutrition.—With reference to malnutrition our statistics only deal with school-children and are as follows :— Of 6,895 children examined by routine at school medical inspection, 24 were found to be suffering from malnutrition, 192 were found to have slightly sub-normal nutrition, 4,390 normal nutrition, and 2,289 with excellent nutrition. 21 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. GENERAL HEALTH SERVICES. (a) Laboratory Facilities.—'The following table shows the routine work which has been carried out by arrangement with the Essex County Council at the Counties' Public Health Laboratories, situated in Queen Victoria Street, London, E.C.4 :— Specimen. Number examined. Diphtheria ... 2,792 Sputa 186 Typhoid 21 Ringworm ... 2 Miscellaneous 35 Total 3,036 In addition to the above, 20 biological tests were carried out to test the virulence or otherwise of germs of the diphtheria group. In another section of the Report mention is made of similar biological work carried out in respect of the presence of tubercle baccilli in milk. (b) Ambulance Facilities.—During the year the old Infectious Disease Ambulance has been relegated to carry any infected clothing, etc., and whilst it is so retained it will serve as a stand-by for emergency work. A new ambulance has been obtained for the transport of patients. It is an Austin 16 and the specifications were carefully thought out. The whole of the interior arrangements have been made as simple as possible to help necessary disinfection which takes place between its use for different cases. You have, therefore, two ambulances, one ambulance for infectious disease cases and one as a stand-by for such cases. (c) Hospitals (Public and Voluntary).—At the end of 1935 the larger part of the Second Portion of the Barking Hospital was entered into occupation. This added an extra 38 permanent beds to the Hospital and as you know a further 12 beds are contemplated in the immediate future. The provision of these 12 cubicles will complete the Second Portion of the Barking Hospital. These portions are not additions in the ordinary sense of the word. The Barking Hospital has been planned for 150 beds and the work which has been completed during 1035 is an important step towards the completion of the Hospital. Last year I commented on the question of financial assistance to voluntary hospitals and I advised you that I would recommend that a sum of money should be distributed according to work carried out for Barking residents. You did set aside a sum of £200 for the year in question, which has been distributed in accordance with this suggestion. 22 The following Hospitals benefited under this scheme :— City of London Maternity Hospital. East Ham Memorial Hospital. King George Hospital, Ilford. Princess Elizabeth of York Hospital for Children, Shad well. Queen Mary's Hospital, Stratford. St. Mary's Hospital, Plaistow. Hospital for Sick Children, Great Ormond Street. London Hospital. Poplar Hospital. (d) Clinics and Treatment Centres.—The table on pages 27-30 shows the various out-patient departments under the control of the Local Authority. The Woodward Clinic was opened to the public on the 12th October, 1935. This clinic has been built of just sufficient size to meet the requirements of the population on the Becontree Estate, south of the railway line. At the time this clinic was being built there was some talk of making it larger so that it might cater for the population on the whole of the Becontree Estate in Barking, that is, both north and south of the railway line, but after hearing evidence you decided to build one clinic of the present size and to leave to the future the building of a similar clinic on the Northern Section. By the courtesy of the Architects, Messrs. H. H. Dawson and H. YV. Allardyce, I am privileged to include in this report a plan of this building. The fact that the main entrance is at the right-hand side of the building and that the windows of the waiting hall are large means that the waiting hall is well lit and cheerful. The position of the Medical Officers' rooms and dental rooms is such that a measure of quiet and privacy is obtained, whilst the fact that there are doorways opening out from both wings on to a garden at the back of the building means that the staff of different departments have access to one another and to the office, without of necessity using the waiting hall. (e) Nursing in the Home.—Nursing is still a pressing problem in Barking. The East Barking District Nursing Association has had an uphill fight and I am happy to record it has obtained a measure of success. The funds of this Association, however,only make it possible for them to avail themselves of the services of one permanent nurse, with some occasional extra and relief service. I myself am of the opinion that if the district is to be served adequately it would warrant the appointment of four nurses. The Plaistow Maternity Hospital and District Nurses' Home have still continued to undertake their work, as they have done in the past, in Barking. This work however is not self-supporting and I hope that notwithstanding this the work will be continued. 23—24 TABLE 1. HOSPITAL SERVICES, public or voluntary, within or without the District, which are used by the inhabitants of the Borough of Barking, Name of Hospital. Situation. Purpose. Total number of beds available. Management. Men Women Children Controlled by the Council of the Borough of Barking— 1 Upney (Maternity) Hospital Upney Lane, Barking, Essex Maternity — 18 — Borough of Barking 2 Barking (Isolation) Hospital Upney Lane, Barking, Essex Isolation of general infectious diseases (excluding smallpox) 96 Borough of Barking Not controlled \nj the Council of the Borough of Barking— 3 Brentwood Mental Hospital Brentwood, Essex Mental 764 1037 — Essex County Council 4 Brookfield Orthopaedic Hospital Hale End, Woodford Green, Essex. Orthopaedic — — 30 Voluntary 5 City of London Hospital for Diseases of Heart and Lungs Victoria Park, E.2 Heart and Lung Diseases 85 88 8 Voluntary 6 City of London Maternity Hospital 102, City Road, E.C.I Maternity — 79 — Voluntary 7 East Ham Memorial Hospital Shrewsbury Road, E.7 General Medical and General Surgical 34 34 20 Voluntary 8 Golden Square Throat, Nose and Ear Hospital Golden Square, Piccadilly Circus, W.l Ear, Nose and Throat 36 37 11 Voluntary 9 Guy's Hospital London Bridge, S.E.I General Medical and General Surgical, etc. 299 287 63 Voluntary 10 Hospital for Sick Children Great Ormond Street, W.C.I General Medical and General Surgical and Isolation (Children only) 252 Voluntary 11 Joyce Green Hospital Dartford, Kent Isolation of Smallpox ... In formatio n not available) London County Council 12 King George Hospital Ilford, Essex General Medical and General Surgical 41 61 22 Voluntary 13 London Hospital Whitechapel Road, E.l General Medical and General Surgical 379 375 89 Voluntary 14 London Lock Hospital and Home 283. Harrow Road, W.9 Maternity and Venereal Diseases 10 30 16 Voluntary 15 London Skin Hospital 40, Fitzroy Square, W.l Skin. (No in-patients) — — — Voluntary 16 Orsett Joint Smallpox Hospital ... Stifford Long Lane, Grays, Essex Smallpox 11 11 — Orsett Joint Hospital Board 17 Poplar Hospital for Accidents East India Dock Road, E.14 General Medical and General Surgical 56 30 26 Voluntary 18 Princess Elizabeth of York Hospital for Children Glamis Road, Shadwell, E.l Children — — 135 Voluntary 19 Public Assistance Hospital Oldchurch Road, Romford, Essex General Medical, General Surgical, Children, Maternity, Tuberculosis, Chronic Sick, Mental and Orthopaedic 288 302 124 Essex County Council 20 Queen's Hospital for Children Hackney Road, Bethnal Green, E.2 Children ... — — 160 Voluntary 21 Queen Mary's Hospital for the East End Stratford, E. 15 General Medical and Surgical, Children, Maternity ... 54 106 47 Voluntary 22 Royal London Ophthalmic Hospital (Moorfields Eye Hospital) City Road, E.C.I Ophthalmic 66 50 19 Voluntary 23 Royal National Orthopaedic Hospital ... Brockley Hill, Stanmore, Middlesex Orthopaedic 45 70 345 Voluntary 24 St. Bartholomew's Hospital Smithfield, E.C.I General Medical and Surgical, Children, Maternity, etc., Ophthalmic, Orthopaedic, Ear, Nose and Throat, and Septic, etc. 287 344 65 Voluntary 25 St. Mary's Hospital for Women and Children Upper Road, Plaistow, E.13 General Medical and Surgical, Children, etc. — 33 38 Voluntary 26 Severalls Mental Hospital Mile End, Colchester Mental ... 717 1169 — Essex C.C. and Colchester B.C. 27 Westminster Hospital Broad Sanctuary, Westminster, S.W.I General Medical and Surgical, Maternity, Ear, Nose and Throat, etc. 92 128 22 Voluntary In addition to the above Institutions, there are a number of Sanatoria to which tuberculous persons resident in Barking are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis. In the case of isolation and smallpox hospitals, the bed accommodation has been given on the basis of 144 square feet per bed. 25—26 TABLE II. HOSPITAL SERVICES, showing the number of beds for each purpose, and other facilities available. 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 — — — — — — — — — — — — — 18 — — — — — — — — — Operative surgery, Dental, Nursing of Puerperal Fever and Pyrexia. Carried out at the Counties' Laboratory, Queen Victoria Street, E.C.4. 2t Barking (Isolation) Hospital Not controlled by the Council of the Borough of Barking. — — — — — — — — — — — 96 — — — — — — — — — — — Operative surgery, Dental, Ear, Nose and Throat, Orthopaedic, Maternity, Puerperal Fever and Pyrexia, Ophthalmia Neonatorum. 3 Brentwood Mental Hospital — — — — — — — — — — — — — — 1801 — — — — — — — — All specialised treatment available. Own Laboratory. 4 Brookfield 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 City of London Maternity Hospital — — — — — — — — — — — — — 79 — — — — — — — — — Operative Surgery, Dental. Nursing of Puerperal Fever and Pyrexia. Own Pathologist. 7 East Ham Memorial — — — — — 3 4 37 36 — 8 — — — — — 4 4 — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Electrical, Massage. Own Laboratory. 8 Golden Square Throat, Nose and Ear — — — — — — 84 — — — — — — — — — — — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Ophthalmic, Radium. Carried out by a Pathologist outside the Institution. 9 Guy's 58 — 14 4 6 33 179 150 10 24 — 40 21 4 9 24 19 8 — — — 9 All specialised treatment available. Own Laboratories. 10 Hospital for Sick Children — — — — — — 18 106 121 — — — — — — — — — — — — — 7 All specialised treatment available. Own Laboratory. 11 Joyce Green Hospital (Isolation of Smallp ox) No information ava ilable from the Lond on County Cou ncil. (No information available from the L.C.C.) No information available. 12 King George Hospital — — 22 — — — — 34 68 — — — — — — — — — — — — — — Operative surgery, X-rays, Dental (as casualty), Ophthalmic, Massage, Ear, Nose and Throat, Gynaecological, Neurological, Dermatological. Own Laboratory. 13 London Hospital 28 306 338 28 — 97 22 — — 24 — — — — — — All specialised treatment available. Own Laboratories. 14 London Lock Hospital — — 15 — — — — — — — — — — 6 2 — 2 — — — — — 31 Operative surgery, Ultra-violet light, Dental, Ophthalmic, Massage, Ophthalmia Neonatorum. Own Pathologist. 15 London Skin Hospital — — — — — — — — — — — — — — — — — — — — — — — Skin diseases only. (No in-patients.) Ultra-violet light, X-rays. Own Laboratory. 16 Orsett Joint Smallpox — — — — — — — — — — — — — — — — — — — — 22 — — Small-pox only. - 17 Poplar Hospital for Accidents — — — — — — — 34 78 — — — — — — — — — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Radium by arrangement with the London Hospital. Own Laboratory. 18 Princess Elizabeth of York Hospital for Children — — 135 — — — — — — — — — — — — — — — — — — — — All specialised treatment available. Own Laboratory. 19 Public Assistance Hospital — — 124 160 — — — 120 120 — — — — 30 32 — — 60 — — — 68 — All specialised treatment available with the exception of Ophthalmic and Radium. Carried out at the Counties' Laboratory, E.C.4. 20 Queen's Hospital for Children — — 160 — — — — — — — — — — — — — — — — — — — — — All specialised treatment available with the exception of Radium. Own Laboratory. 21 Queen Mary's Hospital for the East End — — 47 — — — 2 46 54 — 3 — — 50 — — 3 2 — — — — — All specialised treatment available. Own Laboratory. 22 Royal London Ophthalmic (Moorfields Eye Hospital) — — — — — — — — — — — — — — — — 135 — — — — — — All specialised treatment available with the exception of Operative surgery, Massage and Radium. Own Laboratory. 23 Royal National Orthopaedic — — — — — 460 — — — — — Operative surgery, X-rays, Ultraviolet light, Massage. Own Pathologist. 24 St. Bartholomew's Hospital — — 18 — — 6 24 232 250 — 44 — 10 17 22 18 55 — — All specialised treatment available. Own Laboratories. 25 St. Mary's Hospital for Women & Children — — — — — — 22 37 — 8 — — — — — 4 — — — — — — Operative surgery, X-rays, Ultraviolet light, Dental, Massage, Ear, Nose and Throat, Ophthalmic. Part-time Pathologist in conjunction with other Hospitals. 26 Severalls Mental Hospital — — — — — — — — — — — — — — 1886 — — — — — — — — Operative surgery, X-rays, Ultra- violet light, Dental OPhthalmic. Own Laboratory. 27 Westminster Hospital 10 — 13 5 — 2 7 64 85 — 10 — 8 12 — — 6 4 16 — — — — All specialised treatment available. Own Laboratories. † In the case of Hospitals under the control of the Borough of Barking :— Number and classification of Medical Staff Number and classification of Nursing Staff : Matron Sisters Assistant Nurses Mid wives Probationer Nurses Arrangements for the employment of consultants Upney (Maternity) Barking (Isolation) Hospital Hospital The Medical Officer of Health is also the Medical Supt. and is assisted in this work by the Medical Staff. 1 4 — 6 4 — 4 18 Consultants are engaged when necessary. 27—28 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. Woodward Clinic, Woodward Road Tuesdays, Thursdays and Fridays, 2 p.m. do. do. 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 do. do. do. Porters Avenue Centre, Porters Avenue Mondays and Wednesdays, 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. Woodward Clinic, Woodward Road Wednesdays, 10 a.m. do. do. *Alexandra Centre, St. Paul's Road Tuesdays, 2 p.m. Accommodation for consultations, etc. do. Porters Avenue Centre, Porters Avenue Thursdays, 9.30 a.m. do. do. †Specialist-Consultant Clinic at Alexandra Centre, St. Paul's Road Last Friday in each month, 3.30 p.m., except August and December. do. do. (c) Gynaecological Clinics :— Central Clinic, Vicarage Drive, Ripple Road ... As and when required. Modern clinic premises with accommodation for consultations, etc. do. Woodward Clinic, Woodward Road do. do. do. (d) School Nurseries :—Nil Nil Nil Nil (e) Day Nurseries :—Nil Nil Nil Nil N.B.—*Since the end of 1935 this Clinic has been transferred to the Central Clinic Premises, Vicarage Drive, Ripple Road. †Since the end of 1935 this Specialist-Consultant Clinic has been transferred to the Central Clinic Premises, Vicarage Drive, Ripple Road, and is held on the third Tuesday in each month at 3.30 p.m. (except August and December.) 29—30 CLINIC AND TREATMENT CENTRES. Name and Situation. When Held. Nature of Accommodation. By Whom Provided. 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. Woodward Clinic, Woodward Road do. do. do. (b) Ophthalmic Clinic :— Central Clinic, Vicarage Drive, Ripple Road Tuesdays and Fridays, 10 a.m. Modern Clinic premises do. Woodward Clinic, Woodward Road Thursdays, 2 p.m. do. 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. Woodward Clinic, Woodward Road do. do. do. (d) Orthopaedic Clinic :—Faircross School:— (i) Specialist's Clinic First Thursday in each month, 9 a.m. One Room do. (ii) Remedial Exercises Clinic, Ultra Violet Light Therapy, etc. Daily, 9 a.m. and 2 p.m. do. do. 3. Diphtheria Prevention Immunisation Clinic. Central Clinic, Vicarage Drive, Ripple Road Mondays, 10 a.m. Modern clinic premises with waiting and treatment rooms. Local Authority. 4. Tuberculosis. 37, Linton Road Mondays, 3-5 p.m. Tuesdays, 7-8 p.m. Thursdays, 10.30 a.m.-12.30 p.m. Three rooms Essex County Council. 5. Venereal Diseases. London hospitals, etc. - By arrangement with Essex County Council. 31 32 Towards the end of 1935 the Council made it possible for a sum of 1s. 6d. per visit to be paid to both these Associations, when they undertook the nursing of acute primary and acute influenzal pneumonia in the home in cases where the Medical Officer of Health, in consultation with the general practitioner concerned, is of the opinion that domiciliary nursing represents the best hope of recovery for the patient. 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 I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932. Midwives Acts 1902-1926. Maternity and Child Welfare work has been carried on in Barking these many years. It began in quite a small way and it has grown to the proportions outlined in this Report. In this connection I am very happy to state that in December, 1935, Miss P. M. Fawcett was appointed as senior health visitor and also as senior school nurse. This appointment will in my opinion lead to a fuller measure of cohesion within the section itself and will co-ordinate the work of this section and the work of the other sections of the Public Health Department. During 1935 the Woodward Clinic was opened, and in the new building the Clinics, formerly held at the Shaftesbury Centre, Stamford Road, run smoothly and are growing in size. The other Maternity and Child Welfare Clinics are held at the Alexandra, Central, Greatfields and Porters Avenue (Methodist Church) Centres. (a) Ante-Natal Supervision.—Ante-Natal Clinics are held at four centres—two sessions weekly at the Central Clinic, and one session weekly at the Alexandra, Woodward and Porters Avenue Clinics. The following table shows the work carried out at these clinics during the year :— 33 Central Clinic. Woodward Clinic. No. of Sessions. First attendances. Reattend- ances. Total attendances. No. of Sessions. First attendances. Reattend ances. Total attendances. 102 351 1823 2174 51 186 808 994 Alexandra Clinic. Porters Avenue Clinic. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. 53 110 711 821 26 62 350 412 Total first Attendances 709 „ Re-Attendances 3,692 „ Attendances 4,401* ,, Sessions 232 * In addition there were 38 Post-Natal, and 96 Gynaecological Attendances. It is by no means unsatisfactory that out of about 1,200 births, somewhat over 700 women attended at your Ante-Natal centres, but in the absence of evidence that the remaining 500 cases were under adequate supervision, the figure of 709 first attendances must be regarded as one on which to improve. My opinion is that the Midwives Bill at present before Parliament will lead to a fuller measure of co-ordination and co-operation in this work, and this figure will improve. It is, however, satisfying to note that a large number of the women who avail themselves of the facilities offered at ante-natal clinics are approaching their first pregnancy, and that these women on the whole attend regularly. Details of the milk and meals supplied to expectant mothers are given on pages 14-16. (b) Still-births.—Last year I was in the unhappy position to state that there were no less than 56 still-births. This year I am happy to be able to say the figure has dropped to 30, but even this, is in my opinion, too high. In no less than 19 of these cases the cause of death was definitely stated to be unknown. It is of course a very difficult task indeed to get reliable information on which to base an opinion which would justify me in advising you of the steps necessary to deal with the difficulty. (c) Midwifery.—The Council became the Local Supervising Authority for Midwives as from the 1st April, 1935. 34 Thirty-four midwives notified the Local Supervising Authority of their intention to practise within the Borough during the period 1st April, 1935 to the 31st December, 1935, and the number who were engaged in practice in the Borough at the end of the year was as follows :— At Upney Hospital 5 At the District Nurses' Home of the Plaistow Maternity Hospital 2 In private practice 10 The number of visits of inspection paid by the Inspector of Midwives was 51. The following is a summary of notifications received from midwives :— Medical Help 178 Deaths of Mother or Child 9 Laying out the Dead 5 Still-births 9 Liability to be a source of Infection 9 Artificial Feeding . 5 215* * Of these, 58 notifications were received from the Upney Maternity Hospital. The following is a summary of the 178 cases in which medical help was sought:— Mother :— Anaesthetic 13 Fit 2 Haemorrhage—Ante-partum 6 Post-partum 5 Malpresentations 7 Miscarriage 1 Prolonged labour 22 Rise of temperature 12 Retained placenta 4 Ruptured perineum 36 Uterine inertia 5 Miscellaneous causes 15 128 35 Child :— Convulsions 4 Discharging eyes 30 Miscellaneous causes 6 Pustular rash 1 Spina bifida 1 Unsatisfactory condition of infant 8 50 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 1935 in respect of 161 cases amounted to £203 9s. 0d., leaving a balance payable to the Hospital by the Council of £96 l1s. 0d. During the year 1935 there were 1,135 maternity cases in the district. 146 of these were conducted by the Plaistow Maternity Charity, 350 of them were conducted by your own midwives at Upney Hospital, 178 were conducted by the midwives of the Salvation Army Organisation, leaving 461 which were dealt with by medical practitioners, private midwives or otherwise. (d) Upney Hospital.—The admissions to the Maternity Home during 1935 numbered 373 of which 23 were admitted for ante-natal treatment. During the past year the daily average number of beds occupied was fourteen. The total number of bed-days was 5,132. It was hoped to have replaced the temporary maternity home in the year under review, but owing to several circumstances this was impracticable. It is opportune here, however, to lay before you a sketch plan of the New Maternity Pavilion, supplied by courtesy of the Architects, Messrs. H. H. Dawson and II. W. Allardyce. Some interesting features of this building are that the greater part of the ordinary nursing is congregated at one end, that no ward has more than four beds and that there are a number of single bed wards for the reception of patients just after they have been delivered of their babies. The Labour Suite is an entity of its own and so also is the Admission Wing. (e) Post-Natal Care.—In this connection I feel that more use should be made of the gynæcological clinics and that it should be a rule of all women to be examined say six weeks after their confinements. 36 (f) Gynaecological Clinics.—The primary object of these clinics is, as I pointed out last year, 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 easily dealt with. It is unfortunate that so far the primary object of this clinic has not been sufficiently recognised. It is of course uphill work to get ordinary people who believe themselves to be in ordinary health to consult a doctor, but the small beginnings which have been made in this direction will I hope grow. It is I am sure a step in the right direction. (g) Pemphigus Neonatorum.—Pemphigus Neonatorum is in Barking an infectious disease within the meaning of the Infectious Disease (Notification) Act, 1889, and six such notifications were received during the year. (h) Maternal Mortality.—According to the return of the Registrar-General there were during the year 1935 four deaths from puerperal causes—three deaths from puerperal sepsis and one death from other puerperal causes. This gives a rate of 3.18 per 1,000 total births. The following table gives you similar information for the last twelve years :— • Maternal Mortality—Statistics. Barking. England and Wales Year. Deaths from Rate per 1,000 births. 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 1935 3 1 3.18 3.93 *Rate per thousand live births—figure not available in respect of rate per thousand total births. 39 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. After many years experience I cannot very well but hold the opinion that maternal mortality is a term very difficult to define, and that its interpretation may vary in different areas. This of course invalidates statistical information so far as its value for comparison is concerned. The problem of maternal mortality continues to be one which, though tackled from many sides, has not been solved. It is indeed complex, and though each advance in knowledge is in turn applied in the effort to reduce the unfortunately large number of maternal deaths the level remains approximately unchanged, Is it possible that the "advance" of civilisation also undermines in one way or another the constitution of those who "enjoy" its benefits? And can the Great War, with the inevitable nervous strain and the shortage of some essential foods, be held to contribute to the mortality of those young mothers who were born or who were young children during these years ? That some accidents are inevitable is accepted by all, and in analysing the cause of deaths, just under 60 per cent, have been classed as "avoidable" (Scottish Enquiry): the term avoidable is here used in a wide sense and represents a probability rather than a certainty. One-third of these cases are attributed to negligence or ignorance of the patient. Nearly half the avoidable deaths were attributed to lack of care or to not seeking, or ignoring advice given during pregnancy, and half to faults arising during delivery. The proportion of deaths attributed to midwives and doctors cannot be used in general condemnation— a proportion of the patients are accident-prone. It is regrettable that there still are women who do not avail themselves of the facilities provided, who only seek help when they find that some abnormal condition has arisen, or who will not act upon advice given. The maternal mortality rate includes deaths due to causes associated with pregnancy, parturition or the puerperium but not directly due to this state, and so may prove at first sight misleading. The risk to mothers varies widely with age and the number of previous pregnancies : adverse home conditions seem to have a definite association with the death rate. Puerperal sepsis accounts for about half the cases of maternal mortality, and is very little lower since aseptic technique has been introduced. Epidemic puerperal sepsis is on the wane, but sporadic cases continue to arise. 40 (i) Ophthalmia Neonatorum.—During the year fifteen cases of Ophthalmia Neonatorum were notified. All of these cases recovered with unimpaired vision. (j) Illegitimate Children.—Special attention is paid by the Health Visitors to all illegitimate children. Twelve illegitimate children were born during the year, and three died. The illegitimate mortality rate is more than four times the mortality rate for legitimate children. Last year I pointed out that the illegitimate mortality rate was higher throughout the country than the mortality rate among legitimate children. This is a social question of the first magnitude. Indeed, I feel it is social rather than medical, and I do hope that together with other authorities you may be able to examine the question and to make any necessary recommendations. (k) Tonsils and Adenoids.—In previous years I have pointed out the desirability of looking upon the surgical treatment of tonsils and adenoids as more than a minor operation. It is my opinion that where practicable the child should be admitted to hospital a day before the operation so as to settle down and be retained at least two or three or even four days after the operation. I think also the whole question of the treatment of tonsils and adenoids should be reviewed and that a special out-patient department should be set up for ear, nose and throat conditions, where these can be studied intensively and where by means of special treatment it may be possible to prevent what may be termed the wholesale slaughter of tonsils and adenoids which goes on at the present time. May I make it quite clear that before any child is sent to a hospital, it is seen by one or even two doctors and even then it is not referred for the operation to be performed, but for the independent opinion of the surgeon concerned. (1) Convalescent Treatment.—During 1935 a number of mothers and children were recommended for convalescent treatment. The following table shows the number of mothers and children who have been treated :— No. treated. Mothers and toddlers 10 Toddlers (under 5 years of age) 3 41 (m) Ophthalmic Clinic.—In May, 1935, Mr.W. Gray, of Queen Mary's Hospital, was appointed Consulting Ophthalmic Surgeon, and with this appointment the treatment of eye conditions is now placed on a thoroughly satisfactory basis. It is possible to say that all out-patient treatment which is and which can be conducted at a special eye hospital or in the special department of a general hospital is now available at your clinic. (n) Ultra-Violet Light Clinic.—Very useful work is done at this clinic, because as I pointed out last year it is possible by means of artificial light to graduate the doses according to the individual need of each person. The chief problem here is one of accommodation and the time has come when the classroom at Faircross School cannot be regarded as suitable for ultra-violet light work and the other remedial work which is carried on in the classroom. (o) Dental Treatment.—Last year I was able to report favourably, not only of the facilities you have provided for infants and toddlers, but also upon the interest which many parents are showing in this work. There used to be, particularly on the part of mothers, apprehension that dental work among toddlers was not suitable for their tender years. Although it is too early to say this apprehension does not exist, we can say mothers and fathers are much more ready than they were in the past to avail themselves of your dental service on behalf of their young children. (p) Diphtheria Immunisation.—Last year I pointed out that too small a number had been immunised to influence the number of cases of diphtheria in Barking. A considerable proportion of the child population, particularly toddlers, would have to be immunised before there would be any appreciable falling off in the number of cases of diphtheria. Rapid and safely produced immunity can be induced by means of injections, and 192 children were immunised during the year. (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. 42 The following table shows the work which has been carried out at your Minor Ailments Clinics :— No. of cases seen by medical officers :— Central Clinic. Woodward Clinic. (a) New cases 276 619 (b) Old cases 828 1,804 No. of attendances for treatment 1,380 1,857 It will be seen that the total number of medical inspections has grown from 728 in 1934 to 895 in 1935, and the total number of attendances for treatment from 2,664 to 3,237. (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 not satisfied that present legislation is sufficient to enable you to carry out all the work which you would like to do. There is relatively little difficulty with the foster mother who is approved and who receives a foster child for a period of time, but there is difficulty with foster children who are constantly moving from one foster parent to another and from one local sanitary area to another. Medical officers generally take this matter very seriously and notify one another confidentially of the movement of foster children, but there is this difficulty—a foster child may be passed from A, through B, to C and, so long as the intermediary B does not keep the child for more than twenty-four hours or does not receive the child for gain, there is no obligation on him or her to notify anybody, and so the chain of notifications, which is so necessary for the safety of these children, is broken. It may, of course, be urged that C must notify the reception of an infant, but it is not so readily possible for the local authorities to check up on one another as is so commonly done in other cases. (s) Maternity and Nursing Homes.—During the year no less than 356 children were born in your Maternity Home. 43 (t) Infant Welfare Clinics.—The following table shows the work carried out at your various Infant Welfare Clinics during the year :— Central. Greatfields. Alexandra. Woodward. Porters Avenue. Totals. No. of sessions 104 99 99 104 70 476 No. of attendances of children under 1 year:— (a) New Cases 205 138 198 328 221 1,090 (6) Old Cases 2,900 2,052 2,208 4,189 3,266 14,681 No. of attendances of children 1-5 years of age :— (a) New Cases 55 27 88 204 157 531 (b) Old Cases 1,677 1,099 1,494 3,368 2,886 10,524 Average No. of attendances per session 47 33 41 78 93 56 No. of sessions attended by Medical Officers 104 99 99 104 70 476 No. of children seen by Medical Officer other than at above sessions :— (a) New Cases 276 — — 619 — 895 (6) Old Cases 828 — — 1,804 — 2,632 Average No. of children seen by Medical Officer per session 20 17 18 24 27 21 The total attendances during the year were 26,826 as compared with 20,652 in 1934. The information which is brought out by this table is that there were 1,090 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 1,226 which means that approximately 88 per cent, of the children born in Barking attended at your centres. (u) Home Visiting.—lhe home visits carried out by your Health Visitors are shown in detail in the following table :—- No. of half-days devoted to visiting 1,683 No. of ante-natal visits :— First visits 277 Subsequent visits 102 No. of first visits to children under 1 year 1,625 No. of subsequent visits to children under 1 year :— (a) Attending a Centre 456 (b) Not attending a Centre 5,061 No. of visits to children 1 to 5 years of age :— (a) No. of visits 7,553 (b) No. of children seen 9,565 44 No. of special visits in connection with ophthalmia neonatorum 21 „ „ „ deaths of children up to 3 years of age.. 48 „ ,, „ stillbirths 28 „ „ „ puerperal sepsis and puerperal pyrexia 4 Other visits (re infectious diseases) 251 No. of visits to foster children 193 Total home visits of all kinds 15,619 (v) Provision of Fresh Milk.—Particulars ot 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. 16,770 74,434½ 91,2041 1,457 13 1½ 1,323 4 7 (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 1 733 341 498 1,572 Ostermilk 2 743 469 642 1,854 Cow and Gate 1,944 1,164 1,924 5,032 Cow and Gate (half cream) 216 100 83 399 Ambrosia 668 327 1,356 2,351 Colact 15 3 2 20 Hæmolac 358 100 355 813 Lactogal 414 21 107 542 Virol 827 92 921 1,840 Parrish's Food 190 41 341 572 Liquid Paraffin 144 10 69 223 Malt and Oil 261 109 627 997 Vitoleum Cream 1 — — 1 Pure Cod Liver Oil 224 15 96 335 Cod Liver Oil Emulsion 3,283 135 1,365 4,783 Totals 10,021 2,927 8,386 21,334 45 (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 four different centres, and a Specialist-Consultant holds one session per month during ten months of the year. During 1935. 76 cases attended the clinics held by the Specialist-Consultant. In addition there were 8 post-natal attendances. Baths In certain necessitous cases, free baths are provided for expectant and nursing mothers at the East Street Baths. During 1935, 146 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 1935, 3 toddlers, and 10 mothers with babies received treatment under this scheme. Dental Treatment Dental treatment for toddlers and expectant and nursing mothers is carried out at the Central Clinic and at the Woodward 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 1935, 1,764 dinners were supplied to mothers and 2,488 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. 46 Home Helps Although home helps as such are not provided by you under any particular scheme, you do make financial provision in cases of maternity which are aided by you, because your scale of charges in all such cases is drawn up so as to leave an amount of money in the family exchequer sufficient for this purpose. Infant Welfare Clinics Infant Welfare Clinics are held each week at five 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 Woodward Clinic to children under the age of five years. Ophthalmic Service Ophthalmic Clinics for expectant and nursing mothers and toddlers are held at the Central Clinic and Woodward Clinic. 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 four mothers and sixteen children under the age of five years were provided with spectacles under this scheme. 47 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, 107 such operations were carried out in respect of children under the age of five years. Ultra-Violet Light Treatment Ultra-violet light treatment is given to children under the age of five years at the Orthopaedic Clinic. During 1935, 81 children were treated, a total number of 747 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. Three children under the age of five years were so treated during the year 1935. 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. 48 REPORT ON THE WORK OF THE OPHTHALMIC CLINICS. The Clinics held by Mr. W. A. Gray, F.R.C.S., began on the 14th May, 1935. The following is a summary of the work carried out during the year in respect of toddlers and nursing and expectant mothers :— Toddlers. Tests under atropine 22 Other attendances 37 Spectacles prescribed 16 Spectacles supplied 16 External Diseases of the Eye treated at the Clinics. Conjunctivitis 5 Photophobia 2 Cataract (right) 1 Glioma (bilateral) (subsequently admitted to Moorfields Eye Hospital) 1 Dacrocystitis 2 Blepharitis 2 Ophthalmia Neonatorum (admitted to Queen Mary's Hospital, Stratford, E.15) 1 Cases listed for squint training 4 Expectant and Nursing Mothers. Tests 15 Other attendances (corneal nebulae) 1 Spectacles prescribed 10 Spectacles supplied 4 49 No record of the Ophthalmic Clinic would be complete without some reference to children under 5 years of age. In them, squint and congenital disabilities are chiefly found. It is especially desirable that these defects should be treated as soon as they have become apparent. In cases of squint, the provision of glasses prevents the development of a " lazy " eye. The youngest to be given spectacles was eight months old. Congenital malformations often mimic inflammatory diseases, such as incomplete development of the tear passages. In new-born babies an acute ophthalmia is especially dangerous to sight, but if this disease is treated early, complete recovery can be hoped for in every case. Expectant mothers form a special series of cases. During pregnancy, headaches are sometimes frequent. These may be due to simple eyestrain or they may herald the onset of a toxaemia of pregnancy. It need hardly be pointed out how necessary it is to differentiate between these two conditions, one mild and of no great consequence, while the other is fraught with danger to life. The more severe cases of toxaemia sometimes show the first signs of their gravity by affecting the interior of the eyes. Hence in Barking, every expectant mother who complains of headaches is sent to the Eye Clinic. 50 REPORT ON THE WORK OF THE ORTHOPÆDIC CLINIC In submitting his statistical report, Mr. B. Whitchurch Howell, Orthopaedic Surgeon, has taken the opportunity of drawing attention to the fact that the work at the Orthopaedic Clinic is more efficiently carried out owing to the appointment of a whole-time masseuse. As the Committee know, Miss A. K. Roe was appointed to this post in May, 1935. It is of course impossible to present a statistical report in popular language. I am, however, happy to be able to assure you that it does show a relatively favourable state of affairs. The welcome advice and helpful treatment of the Orthopaedic Surgeon in the earlier years of life does, we can say from experience, mean that minor disabilities are dealt with in a way which prevents major disabilities arising. It is only persons of my years, who like myself have had a long experience on which to draw, who can appreciate the enormous advancements which have been made in preventing deformities. 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 toddlers. No. of primary examinations by Orthopaedic Surgeon 97 No. of re-examinations by Orthopaedic Surgeon 170 The cases dealt with for the first time during 1935 were referred for the following conditions:— 51 PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPÆDIC CLINIC DURING 1935. No. of visits by Orthopaedic Surgeon No. of visits by Masseuse ATTENDANCES. Primary Examination Re-examination For Treatment Total School Children Toddlers School Children Toddlers School Children Toddlers School Children Toddlers 11 430 118 97 359 170 2,004 1,635 2,481 1,902 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 7 187 2 56 118 1,256 53 523 8 86 53 364 Toddlers 35 479 2 6 10 37 81 747 — — 54 384 Admissions to Hospitals On Waiting List for Admission 31/12/35 School Children Toddlers Total School Children Toddlers Total 6 (Under Council's Orthopaedic Scheme) 7 13 2 3 5 53 (a) Deformities of Bones and Joints. (1) Congenital: Deformed digit 5—hand right and left 1 Deformed digit 4—foot right and left 1 Deformed digit 5—foot left 1 3 (2) Acquired : Injury—old fracture Tibia 2 old fracture lower end Radius and Ulna 1 Genu Valgum 22 Genu Varum 5 Bowed Tibiae 7 Hammer Toe 1 Rickets 3 41 (b) Muscular. (1) Congenital: Torticollis 11 Talipes Calcaneo Valgus 7 Talipes Equino Varus 5 23 (2) Acquired: Pes Planus 23 (c) Paralysis. (1) Congenital: Spastic Tetraplegia 1 Hemiplegia 3 Monoplegia 1 5 Total defects found 95 During the year seven toddlers were admitted to hospital and the following operations were carried out in these cases:— Amputation digit varus—foot left 1 Femoral Osteotomy—right and left 1 Tenotomy Tendo-Achilles 1 Splintage 2 Manipulation and plaster 2 Total 7 54 REPORT OF THE DENTAL SURGEON June, 1936. To the Medical Officer of Health, Borough of Barking. Sir, I have the honour to present the Annual Report of the Dental Services under the Maternity and Child Welfare Scheme for the year 1935. There has been a high increase in all branches of the work accomplished for the year under review and it is particularly gratifying that fillings have increased from 72 to 250. The supply of dentures has risen from 149 to 261 and there has been an increase from 205 new patients to 477. The number of visits made by old patients has increased from 1,144 to 1,643. Anaesthetics have increased from 416 to 672 and the number of teeth extracted from 1,465 to 2,783. The increase in the number of fillings is coincident with the attendance of a large number of patients who attend under the Maternity and Child Welfare Scheme at a much earlier age than in the past, and these patients are very desirous that their teeth should be saved. Fortunately the dental condition of these patients permits conservative work to be carried out. During the year, the Barking Abbey Secondary School-children received dental treatment from the Authorities of this Borough for the first time, by arrangement with the County. This proved to be an exceptionally heavy task for the staff concerned, presumably because the school have not received a visit from a Dental Surgeon for some considerable time. Approximately 400 fillings, most of which were very extensive, were completed and it is worth noting that some patients required from ten to eighteen fillings before the mouth could be regarded as dentally satisfactory. It is to be hoped that on the next inspection the dental condition of the pupils of this school will minimize considerably the number of sessions that were occupied in their interest during the year under review. I have to thank all those engaged in the Maternity and Child Welfare Services for their support and also the Nurses and members of the Dental Staff for the efforts they have made to maintain the popularity of the Dental Clinics. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, L.D.S., R.C.S. (ENG.), Public Denial Officer. 55 DENTAL CLINIC. Mothers and Toddlers. Extractions 2,783 Scalings 127 Dressings 29 Inspections 225 Fillings 250 Dentures supplied 261 Anaesthetics— General 672 Local 35 Patients— Old 1,643 New 477 Number of Sessions held 206 Toddlers— Treatments 947 57 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. Samples are regularly examined by the Counties' Public Health Laboratories. In addition, one sample was submitted specially and found to be of satisfactory purity on examination. Two samples were also taken from the well supplies of a factory, and found to be in order. 2. RAINFALL. The rainfall for the year ended 31st December, 1935 was 20.26 inches as compared with 18.02 inches for the previous year. Rain fell on 156 days in the year 1935. 3. DRAINAGE AND SEWERAGE. The joint drainage scheme for the Boroughs of Ilford and Barking, commenced in April, 1930, was completed during the year ; and now the whole of the sewage of the district is dealt with at the disposal works of the London County Council. An immediate result of this improvement was the removal of the very serious nuisance occasioned by the use of the old sewage disposal works of the two Boroughs. Residents in the neighbourhood of these works will have noted their dismantlement with the greatest relief. Users of the Longbridge Recreation Park can now enjoy this amenity free from the obnoxious effluvia formerly created by the Ilford sewage works. 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. 58 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. During the past five years much work has been done to improve the ditches and streams in the district. The culverting of streams by the local authority, extended cleansing of water courses, carried out by the River Roding Catchment Board, and the reclamation of marsh land by private tipping—each of these has contributed to a steady improvement. There is much low-lying land in Barking which is marshy in character, intersected by small ditches and which offers ample scope for very profitable reclamation. This is of particular importance in view of land values in the district. I commend a scheme towards this end. Existing powers safeguard the district from the evils usually associated with crude tipping. Loxford Water Closing.—Of special note is the diversion of the arm of Loxford Water which during the year was diverted into a stream running into the River Roding at a point immediately north of the Metropolitan Water Board Pumping Station, the point of diversion being approximately 230 yards east from the junction of this stream with the River Roding. The closing of this watercourse has been advocated by my Department for a number of years and power was taken in the Barking Corporation Act, 1933 to enable this to be done. It is with the greatest pleasure that I record the scheme reaching fruition. It makes possible the reclamation of Berry's Marsh, removes a public nuisance and adds land and land values to various sites in its immediate neighbourhood. 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. The premises still unconnected are isolated properties. Cleansing is carried out by means of covered vehicles and suction pumps. 59 6. PUBLIC CLEANSING. (a) Storage, Collection and Disposal.—-'The collection and disposal of domestic refuse is controlled by the Borough Engineer and Surveyor. During the year, 9,263 loads of refuse were collected, with an average weight of 1 ton 12 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. During the year the land available for tipping at Mayesbrook was used up ; this necessitated the disposal of the whole of the refuse at Jenkins Lane. At this site the land available is sufficient for 6 months only. In my Report for the year 1934, I referred to the reclamation of marsh land by tipping and earlier in this report I have commended such a scheme. Our dustless loading vehicles purchased in the early days of this type of collection are I am pleased to say shortly to be replaced with more up-to-date models. The present weekly collection of refuse will be more satisfactory when the Corporation's dustbin scheme inaugurated in 1934 becomes general throughout the district. (b) Street Cleansing.—In my earlier reports I have ventured to protest against the disposal of waste paper and similar matter in the streets by the general public. I am pleased to report an improvement in this respect but regret that I must register my disappointment with the misuse of small vacant plots of land abutting upon streets. The disposal of rubbish on such plots is a constant source of trouble to this Department and the owners. Fencing and prohibition notices fail to act as deterrents. I can only hope that better habits of life will prevail. The year 1935 saw the employment of the Council's first mechanical gully cleanser. I am hopeful that this will be followed by the employment of further mechanical cleansing machines for street-sweeping, etc. 60 7. REFUSE DISPOSAL—PRIVATE TIPS. There continues in the district reclamation of low lying land by private owners, and during the year 216 visits were paid to tips to see that no nuisance was committed, and to give advice as to methods of disposal. When the potential rateable value of land so recovered is realised, I am sure that such schemes will be more welcome. 8. SANITARY INSPECTION OF THE AREA. The number of complaints received and recorded in the register of complaints was 855, as compared with 551 in 1934 and 927 in 1933. The premises were inspected forthwith and any necessary action taken. The total number of visits paid by sanitary inspectors to various premises for all purposes was 15,108 and are summarised below, together with the number of defects found arising from those visits. The housing defects dealt with numbered 9093. It will be remembered that for various reasons you were short of sanitary inspectors during the year. (a) Work of Sanitary Inspectors. (1) Inspection of Dwelling-Houses. Total Houses Inspected under Public Health or Housing Acts 3,437 Total Number of Inspections made 10,398 Housing (Consolidated) Regulations 837 After Infectious Disease 1,668 Defects Found 9,093 Notices Served (Preliminary) 2,585 Re-inspections re Notices Served 4,570 Inspection of Works in Progress 723 (2) Premises Controlled by Byelaws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings — — — Common Lodging Houses 79 2 2 Offensive Trades 77 15 7 Tents, Vans and Sheds 80 6 1 Dairies, Cowsheds and Milkshops 211 6 5 Slaughter-houses 288 4 4 61 (8) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 255 33 13 Laundries — — — Bakehouses 37 16 13 Domestic Workshops 15 — — Other Workshops 40 2 2 Other Workplaces 85 21 12 Outworkers' Rooms 110 — — Butchers' Premises 571 24 16 Fishmongers 64 2 — Restaurants and Dining Rooms 123 8 3 Stable and Stable Yards 73 2 1 Piggeries 26 — — (4) Miscellaneous. Inspections. Defects. es. Rats and Mice (Destruction) Act, 1919 64 2 2 Vacant Land and Refuse Dumps 214 24 19 Public Lavatories 44 4 3 Schools 21 4 1 Markets and General Shops 477 61 32 Ice-Cream Vendors 127 1 1 Petroleum and Celluloid Stores 102 — — Drainage Inspections 246 - — Milk Sampling 27 — — Other Miscellaneous 514 — — Inspection of Meat from Outside District 258 — — Shops Act, 1934 552 65 38 Water Sampling 10 — — 62 (b) Summary of Sanitary Work Carried Out. (1) Drainage. Choked drains, opened, repaired and cleansed 239 Drains reconstructed 22 Ventilation shafts repaired or new fixed 39 New inspection covers 10 (2) Closet Accommodation. Roofs W.C. structures repaired 11 Walls Floors Doors Seats fixed 108 W.C. pans fixed or cleansed 109 Flushing apparatus repaired or renewed 248 (3) Sinks. New fixed 71 New sink and bath wastepipes 97 New gully traps 23 (4) Dampness. Roofs and flashings 819 Eavesgutters 381 Rainwater pipes 178 (5) Water Supply. Drawtaps provided 18 Defective water fittings repaired and supply reinstated 46 (6) Yard Paving. Yard paving repaired or relaid 180 Gully dishing repaired or renewed 114 (7) Dustbins. New ones provided 509 63 (8) General Repairs. External walls repointed 561 House floors repaired 226 Windows repaired or renewed 347 Window and door reveals repaired 136 Window sills repaired or renewed 283 Sasheords renewed 328 Washing coppers repaired or renewed 240 Stoves repaired or renewed 228 House doors and frames repaired or renewed 210 Stairs repaired 22 Handrails fixed 20 Chimney pots renewed and stacks rebuilt 315 Dirty or defective rooms repaired, cleansed and redecorated 2,331 Damp walls remedied 146 Insufficient floor ventilation 174 External painting 210 Weatherboards fixed 4 Door sills repaired or renewed 63 Defective brickwork repaired 3 Window fasteners fixed 20 (9) Miscellaneous. Offensive accumulations removed 30 Animals so kept as to be a nuisance 4 Verminous rooms disinfested 88 Drains tested 605 Dangerous structures reported 10 Overcrowding 29 Shed erections 2 Flooding 3 Other conditions 82 (c) Notices Served. Informal Notices 2,585 Statutory Notices:— Section 23, Public Health Act, 1875 - 644 Section 36, Public Health Act, 1875 180 Section 41, Public Health Act, 1875 29 Section 94, Public Health Act, 1875 267 Section 17, Housing Act, 1930 168 64 (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 257 23 Workshops 87 14 — — Workplaces 78 11 — — Totals 422 48 — — (2) Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found Remedied Referred to H. M. Ins. * Nuisances under the Public Health Acts:— Want of cleanliness 16 16 Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors 3 3 — — Other nuisances 30 30 — — Sanitary accommodation:— Insufficient 3 3 Unsuitable or defective 15 15 — — 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 10 10 — — Totals 78 78 — *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 65 (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. (4) Registered Workshops. Workshops on the Register (sec. 131) at the end of the year. Number. (1) (2) Bakehouses (including nine factorv bakehouses) 15 Other Workshops 42 Total number of Workshops on Register 57 (5) Other Matters. Class. Number. (1) (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) 1 Other — 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 49 outworkers:— Box makers 2 Machinery 1 Life-belt covering 2 Tie making 4 Millinery 3 Wearing apparel (various) 37 During the year, 42 lists of outworkers were received from other Authorities in respect of addresses in Barking. Six lists were received from employers within the district. 66 (e) Premises and Occupations which can be Controlled by Byelaws or Regulations. (1) Houses Let in Lodgings.—Action under the Housing Act, 1935 has revealed that accommodation over many of the larger shop premises in the district is becoming used for living purpose, and as the Council is aware we are seeking new byelaws for the control of such premises. (2) Common Lodging Houses.—There remains one common lodging house in the district and this is included in a clearance area now awaiting confirmation. I have on other occasions and in other reports referred to the need for a municipal hostel for the use of the casual labourers in the district. (3) Tents, Vans and Sheds.—There are nine van dwellings situated in five yards in various parts of the district where water supply and sanitary accommodation are provided. Eighty visits were paid and one notice was served in respect of six 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 are as follows:— Fish Fryers 19 Dealers in Rags and Bones 8 Gut Scraper 1 Fat Melters 2 Fish Skin Scraper 1 Oil Boiler 1 Soap Makers 3 Total 35 Seventy-seven visits were paid to these 35 premises, and 15 contraventions of the byelaws were discovered and any necessary action taken. (6) Piggeries.—There are eight remaining piggeries in the district. 67 (7) Stables.—These premises continue to be a source of trouble. The occupiers are invariably unable financially to carry out any improvements. The Council is proceeding to make byelaws for the control of these premises. Seventy-three visits were paid during the year to stable premises, and 2 notices were served in respect of unsatisfactory conditions. (f) 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. SHOPS ACT, 1934. Inspections carried out for the purposes of Section 10 of this Act numbered 552. In 38 instances notices were served requiring additional sanitary accommodation, washing facilities or improved heating. One unfortunate aspect of the administration of this Section is in relation to the provision of suitable accommodation for taking meals. It will be remembered that it is obligatory for employers to provide such accommodation where their employees take meals on the premises. Our experience was in a number of instances that when the employer was called upon to provide such accommodation he promptly forbade his employees to take meals upon the premises. 10. SMOKE ABATEMENT. Arising from 191 observations made, 40 offences were registered and necessary action taken. Including the Creeksmouth Generating Station there are three factories which frequently emit large quantities of smoke. The other two factories are one for the production of zinc oxide, where special type furnaces are employed and the other is a sawmill where joinery is produced on an extensive scale. Here again an unusual type of furnace has been installed for the purpose of consuming the wood refuse arising from the factory processes. In each of the three instances the operation of the furnaces gives rise to difficulties not only to the management but also to your officers. 68 The advent to the district, owing to the river facilities available for handling timber, of several large joinery and wood-block manufacturers adds to our smoke troubles. Manufacturers are unable to dispose of their wood waste commercially and have decided to incinerate it at their factories. The powers taken in the Barking Corporation Act relative to noise nuisances enabled us to deal successfully with the nuisance from a steam exhaust at a factory in Abbey Road. The consumption of coal at the Creeksmouth Generating Station for the year 1935 was over 900,000 tons. It may be safely assumed that ten per cent. of this is ash, and perhaps we are not far wrong in saying that one-tenth of this ash may find its way out as smoke and grit at the top of the chimneys. This means that some 9,000 tons of grit came out of the chimneys of this generating station during the course of the year, or in other words 1 lb. per square yard for the whole of Barking. 11. SWIMMING BATHS. The present buildings in East Street were erected in 1898, when the population was approximately 19,000 : it is now 80,000. This is a covered single bath with a capacity of 90,000 gallons and is only open during the summer season. The demand for up-to-date municipal baths in every town has become very marked in recent years. The type of building and the facilities now provided bear very little likeness to buildings erected in 1898 under the same description. Today large tanks with facilities for mixed bathing, for spectators, for refreshment and for exercise are considered necessary. In a modern municipal bath the swimming tanks form by far the principal feature. The demand for slipper baths in Barking, contrary to what is experienced generally, continues to increase. There are at present no facilities for Russian, Turkish or foam baths. In the average town with reasonable transport facilities a central position for baths has many advantages. Swimming is one of the finest exercises, but owing to the climate in this country it is not possible to indulge in it in the open air except for a short period of the year, therefore it is necessary to provide a covered swimming bath for swimming for all the year round. 69 Longbridge Park Swimming Pool.—This is an open air bath with a capacity of 500,000 gallons ; built in the year 1931. The improvements effected during the year included the construction of a sun-bathing area, with a children's paddling pool, a rest enclosure and beach rests. The pool itself was enclosed and trip-baths or wading pools were provided. This provision prevented the spectators from fouling the bathers' platform and ensured that the bathers' feet were reasonably clean when entering the water. Water Purification.—Considerable attention has been directed to this matter and the standards of purification to be maintained in swimming baths has been laid down by the Ministry of Health. Your East Street bath is designed for a four-hourly turnover. On a peak day the bathers number 1,000. Its capacity is 90,000 gallons. The Longbridge Park Pool is designed for a six-hourly turnover with a capacity of 500,000 gallons. On the peak day in 1935 there were 4,390 bathers. In both instances filtration is effected by the use of rapid sand filters with a filtration rate of 200 gallons per square foot per hour. Unfortunately it was not possible in the absence of a flow meter to say whether this turnover period was being maintained. Obviously, the degree of purity depends upon the bathing load during the turnover period. At the East Street bath the ordinary bathing load pollution is increased considerably by the out-of-date construction of the bath which permits bathers prior to bathing having access to the bath platform. Whilst samples of water submitted for examination were found to be of satisfactory condition, there were occasions when the clarity of the water owing to the lack of pre-cleansing facilities was not so good as can be readily obtained in a modern bath. At both baths chlorination is used for sterilization purposes, and samples of water submitted for examination were found bacterially pure. Modern practice is for the water in swimming baths to be changed every three hours and to provide ample facilities for bathers to carry out pre-cleansing. 12. ULTRA-VIOLET LIGHT RADIATION. Ultra-violet light radiation is measured in Barking at the Barking Hospital. The apparatus used in 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. 70 The following table shows the comparative ultra-violet light readings for the years 1933, 1934 and 1935 Month. Daily average for Barking. 1933 Units. 1934 Units. 1935 Units. January 0.76 0.48 0.13 February 0.78 0.82 0.75 March 0.92 1.41 1.68 April 1.50 1.99 2.40 May 4.00 2.93 3.42 June (Reading not taken) 3.66 4.93 July 4.74 4.77 8.16 August 5.45 5.93 7.97 September 4.06 6.83 7.60 October 1.48 5.35 5.48 November 0.86 2.20 1.70 December 0.96 1.03 0.65 The figures for the three years under consideration show that there is a very considerable amount of sunshine in Barking and that this sunshine is biologically active. 13. 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. 14. PARKS AND OPEN SPACES. The improvement of your parks and open spaces continued throughout the the year, but the facilities avaliable for sport and recreation are still insufficient. There is an increasing demand by the general public for this comparatively new branch of social service. 71 SECTION D. HOUSING. 1. STATISTICS. (a) General. Number of new houses erected during the year:— (1) Total 563 (2) As part of a municipal housing scheme:— (a) Barking 168 (b) L.C.C 162 (3) Others (including private enterprise and subsidy houses) 233 (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) 3,437 (b) Number of inspections made for the purpose 8,730 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 ... 837 (b) Number of inspections made for the purpose 2,404 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 47 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,191 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 1,790 72 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 170 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 143 (b) By local authority in default of owners 2 B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 231 (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 21 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 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 18,497 (including 1,262 shops), which, compared with the total of 10,965 at the census of 1931, gives an indication of the growth of the town. 73 Of the total of 17,235 dwelling-houses, 1,733 are owned by the Council and 7,520 have been erected in the area by the London County Council since the year 1929. It is interesting to note that 2,018 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. During the year 1935, no less than 292 temporary buildings were approved for erection in the back gardens of dwelling-houses in the district. The standard type of shed provided by the Corporation for their tenants has been in great demand and is a structure of which I approve. I would, however, reduce the height of the roof. HOUSES BUILT IN DISTRICT. 1926—1935. 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 1935 563 (Barking) 168 233 (L.C.C.) 162 Totals 10,473 8,102 2,371 74 Of the 8,102 houses shown above as part of Municipal Housing Schemes, 935 were provided by the Borough of Barking and 7,167 by the London County Council. (b) Housing Act, 1935—Overcrowding.—A postal census was taken of 17,649 houses in the district. The method employed produced replies from over 90 per cent, of the occupiers without reminders. In only 60 instances was it necessary to visit for the purpose of the preliminary survey. The degree of intensity of the overcr6wding is shown in the following tables:— TABLE 1. No. of houses. No. of persons in excess. 157 ½ person. 129 1 „ 48 1½ „ 45 2 „ 22 2½ 6 3 9 3½ „ 4 4 „ 1 4½ „ Overcrowded 421 TABLE 2. WARD COMPARISONS. Ward. No. of houses and shops. Overcrowded. Houses Sublet. Occupied by families. Total. 2. 3. 4. Abbey 2,251 52 355 343 11 1 Cam bell 2,863 77 23 23 – – Eastbury 2,957 93 229 212 17 – Gascoigne 2,340 105 242 239 3 – Longbridge 1,324 4 153 145 8 – Manor 2,871 46 11 11 – – Park 1,676 11 340 329 11 – Parsloes 2,100 33 14 14 – – 18,382 421 1,367 1,316 50 1 75 TABLE 3. No. Percentage Overcrowded. Average No. of Occupiers per house. Houses in the district:— (a) Owned by the London County Council 7,520 2 4.17 (b) Owned by the Barking Borough Council 1,733 5.83 5.16 (c) Privately owned 8,546 1.9 3.98 TABLE 4. Barking. Total Population 80,000 Structually Separate Houses 18,982 In Survey 17,654 Families in Separate Houses 16,287 Number of Houses:— Overcrowded 421 Occupied fully 348 „ within ½ unit 418 ,, within 1 unit 788 „ within l½ units 997 „ within 2 units 1,673 From these figures it will be seen that for an industrial town such as Barking, there is very little overcrowding on the standard in operation ; the percentage figure being 2.4. New Houses Proposed:— 3-Bedroom Houses 60 Larger Type Houses (4 bedrooms †) 154 (c) Housing Act, 1930—Paii 1.—The programme of clearance was continued in accordance with schedule. Eldred Road and Union Street Areas were dealt with. An inquiry was held and the Orders later confirmed. Houses. Persons. Eldred Road Clearance Order 3 8 Union Street Compulsory Purchase Order 44 191 76 (i) Rehousing.—Since the Housing Act, 1930 came into force the Upney Estate No. 3 and the Movers Lane Estate have been completed, providing a total of 378 houses. From the clearance areas and individual unfit houses demolished a total of 1,678 persons have been displaced. (ii) Housing Act, 1935—Redevelopment.—The removals referred to above have materially altered the appearance of the older part of Barking, which unquestionably needed reconstruction. The old and historic parish church has been brought into view and with the removal of the "Workhouse" premises, as North Street No. 1 Clearance Area was known, there is now an opportunity for replanning on modern lines. I know the Council is anxious for this to be done and will make full use of the powers so recently granted. (d) Housing Act, 1930—Part 2.—Your officers have continued to actively administer the repair sections of the Act with considerable benefit to the town and the occupiers of the houses. 77 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. MILK SUPPLY AND ICE-CREAM. (a) Milk Supply.—Registered with the Authority are 76 retail purveyors, of whom 17 occupy premises outside the district. There are no cowkeepers 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 63, nine were found to be unsatisfactory:— Type of Sample. Satisfactory. Unsatisfactory. Totals. Grade "A" (T.T.) Milk 2 – 2 "Pasteurised" Milk 34 6 40 Raw Milk 18 3 21 Totals 54 9 63 There were during the year 32 samples of milk submitted to biological examination for the presence of tubercle. Two of the 32 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 2 Grade "A" Milk 1 "Pasteurised" Milk 14 Grade "A" (T.T.) Milk 14 Grade "A" Milk, Pasteurised 1 78 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." (b) Ice-Cream—Barking Corporation Act, 1933—Section 160.—There are 94 vendors registered, in accordance with this Act, of which 35 are manufacturers with premises in Barking. Twelve vendors had premises outside the district. Twenty-one samples were submitted for bacteriological examination, one of which was unsatisfactory. This one sample was taken from a vendor, whose premises are situated outside the district. 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. The following table gives particulars of notifications received, and the animals slaughtered, during the eight years ended December 31st, 1935. Year 1928 1929 1930 1931 1932 1933 1934 1935 Notifications Received 126 72 . 64 39 57 34 205 236 Cattle 40 04 80 12 10 41 350 447 Pigs 409 137 93 200 84 18 502 1131 Sheep 815 420 332 173 270 241 1038 1346 Calves 71 10 11 1 9 1 140 157 Totals 1335 637 516 386 373 301 2030 3081 Diseased meat was destroyed as under:— Description. Disease Weight. 255 beasts' lungs Tuberculosis 2550 lbs. 6 „ lungs Echinococcus Vet. 60 „ 2 „ lungs Parasitic 20 „ 8 „ lungs Adhesions 80 „ 2 „ lungs Abscesses 20 „ 2 „ lungs Aspirated 20 „ 2 „ lungs Abscess & Cirrhosis 20 „ 29 „ livers Cirrhosis 406 „ 79 Description. Disease. Weight. 26 beasts' livers Distoma Hepaticum 364 lbs. 13 „ livers Abscess 182 „ 16 „ livers Tuberculosis 224 „ 5 „ livers Fatty Degeneration 70 „ 1 beast's liver Peritonitis 14 „ 1 „ liver Tuberculosis & Cavernous Angioma 14 „ 1 „ head & tongue Tuberculosis 24 „ 1 „ liver Hepatitis 14 „ 1 „ diaphragm Abscess 5 „ 1 „ spleen Tuberculosis 1 „ 1 „ shin & shoulder Bruised 55 „ 36 beasts' heads Tuberculosis 648 „ 4 „ livers Angiomatosis 56 „ 38 „ mesenteries Tuberculosis 114 „ 7 ,, carcases & organs Tuberculosis 7650 „ 11 „ forequarters Tuberculosis 2110 „ 1 portion of beast's hind-quarter Tuberculosis 150 „ 2 pigs' plucks Tuberculosis 32 „ 4 „ plucks Parasitic 64 „ 7 „ livers Necrosis 42 „ 17 „ livers Cirrhosis 102 „ 2 „ livers Fatty Degeneration 12 „ 12 „ heads Tuberculosis 168 „ 31 „ mesenteries Tuberculosis 62 „ 8 „ lungs Cirrhosis & Congestion 28 „ 8 „ lungs Congestion 28 „ 2 „ lungs Tuberculosis 7 „ 16 „ lungs Aspirated 56 „ 3 „ spleens Tuberculosis 4 „ 2 „ loins Tuberculosis 24 „ 2 „ legs Tuberculosis 22 „ 21 sheep's livers Parasitic 32 „ 2 „ livers Cirrhosis 3 „ 6 „ livers Fatty Degeneration 9 „ 1 „ liver Abscess 2 „ 24 „ lungs Parasitic 72 „ 9 „ plucks Parasitic 63 „ 1 „ pluck Congestion & Abscess 7 „ 2 calves' plucks Tuberculosis 20 „ Total 7 tons 0 cwts. 50 lbs. 80 (b) Unsound Food.—The following list gives particulars of unsound food destroyed during the year :— 83 lbs. cherries. 74 lbs. of beef. 60 lbs. chilled beef. 420 bottles of sauce. 6 lbs. corned beef. 1 case of apples. 5 stones skate wings. 54 lbs. of tinned vegetables. 2 tins of meat and fish products. 10 bags of cabbages and spring greens (mixed). 3. ADULTERATION, ETC. The Food and Drugs (Adulteration) Act, 1928, and kindred Acts and Regulations are administered in this district by the Essex County Council. I am indebted to Mr. H. C. Card, Chief Food and Drugs Officer for the Metropolitan Area of the Essex County Council, for the particulars of samples purchased and submitted for analysis during the year. These samples are submitted for chemical examination to Dr. Bernard Dyer, the County Analyst, Great Tower Street, London. The following samples were examined during the year :— Milk 9 Butter 24 Other 124 Total 157 No proceedings were instituted during the period covered. 4. CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The bacteriological examination of all milk, ice-cream and water samples is carried out for this Authority by the Counties' Public Health Laboratories, of 91, Queen Victoria Street, London, whilst the examination of samples of milk for the presence of tubercle is carried out by Dr. S. R. Gloyne, of the Victoria Park Hospital, Hackney. 81 5. NUTRITION. Once again I would like to point out that I am not particularly interested in propaganda work as to the scientific values of foods, whether expressed as calorific values, as vitamin contents or other scientific data. It appears to me of primary importance that by legislation, direct and indirect, there shall be a sufficient amount of food, of sufficient variation, for all people with ordinary tastes to obtain by natural selection all that is necessary in a first-class diet. It will be remembered that the Corporation during the year gave over 110,000 meals to necessitous children, whilst at your Hospitals it is by no means uncommon to provide over 700 meals a day. All these meals provided can and should be of very considerable value in educating the public. 83 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. 1. NOTIFIABLE INFECTIOUS DISEASES. The statistical tables for 1935 do show that there has been a considerable amount of notifiable infectious disease in Barking. Infectious diseases occur largely among young people, and because we have a young population, who form an unusually high percentage of the population in Barking, there will naturally be on the average more infectious disease than in a population where the age distributions can be looked upon as ordinary. It must also be remembered that there are large movements of population in London. These also tend to vary the amount of infectious disease. Fortunately we had no cases of smallpox and no cases of cercbro-spinal fever during the year. The control of infectious disease is a matter of team work between the general medical practitioners and your medical officers, who deal with the cases which are brought to their notice largely by the general medical practitioners. In this connection, I am happy to be able to state that during the year under review most cordial relationships have existed between the general practitioners on the one hand and your own medical officers on the other, and this, I say unhesitatingly, does materially influence not only the early treatment of individual cases but the actual control over infectious disease. As elsewhere, so here also, I would like to thank my colleagues in general practice for the very valuable assistance they have given me from time to time. In particular this co-operation is shown by the fact that up to the present we have always worked together and it has only been necessary for general practitioners to ring up the Hospital when cases have been admitted without loss of time. I look forward with confidence to the continuation of these happy relationships which have tended so much to help the smooth working of the Infectious Diseases Hospital. 84 2. NOTIFICATION TABLES. The following table shows the number of notifications of infectious diseases (other than Tuberculosis) received during 1935 :— TABLE I. Disease. Males. Females. Total. Total eases removed to Hospital. Deaths. Smallpox – – – – – Scarlet Fever 210 238 448 409 1 Diphtheria 138 140 278 276 14 Enteric Fever (including Para-typhoid Fever) 2 3 5 5 – Puerperal Pyrexia – 8 8 7 – Pneumonia: Acute Influenzal 44 49 21 24 4 Acute Primary 67 11 Following Measles 5 – Erysipelas 13 25 38 21 1 Ophthalmia Neonatorum 10 5 15 4 – Acute Anterior Poliomyelitis – 3 3 2 – Food Poisoning 2 1 3 – – Acute Polio-Encephalitis – – – – – Pemphigus Neonatorum 3 3 6 – – Totals 422 475 897 748 31 85-86 TABLE 11. Notifiable Disease No. of cases notified at age groups Cases classified according to Wards Under one year 1 to 2 years 2 to 3 years 3 to 4 years 4 to 5 years 5 to 10 years 10 to 15 years 15 to 20 years 20 to 35 years 35 to 45 years 45 to 65 years Over 65 years Totals Abbey Cambell Eastbury Gascoigne Longbridge Manor Park Parsloes Smallpox – – – – – – – – – – – – – – – – – – – – – Scarlet Fever – 12 25 32 34 211 84 22 21 4 3 – 448 33 99 78 73 21 59 41 44 Diphtheria – 4 14 15 21 135 54 11 12 11 1 – 278 17 83 71 20 10 36 12 29 Enteric Fever – – – – – – – 1 4 – – – 5 1 1 – 1 – – 2 – Puerperal Fever – – – – – – – – – – – – – – – – – – – – – Puerperal Pyrexia 8 – – – – – – – – – – – 8 – 1 1 1 1 1 – 3 Pneumonia (ac. primary, ac. influenzal & following measles) 5 6 3 4 1 17 5 4 11 13 13 11 93 17 16 16 18 2 11 4 9 Erysipelas – 1 1 – – – 5 2 2 8 13 6 38 9 6 9 7 1 1 3 2 Ophthalmia Neonatorum 15 – – – – – – – – – – – 15 2 1 5 1 1 4 – 1 Acute Anterior Poliomyelitis – – – – – 2 1 – – – – – 3 1 – – – 1 – – 1 Encephalitis Lethargica – – – – – – – – – – – – – – – – – – – – – Food Poisoning – – – – – – – – – 1 2 – 3 – – 2 – – 1 – – Acute Polio Encephalitis – – – – – – – – – – – – – – – – – – – – – Pemphigus Neonatorum 6 – – – – – – – – – – – 6 2 2 – – – – 1 1 Totals 34 23 43 51 56 365 149 40 50 37 32 17 897 82 209 182 121 37 113 63 90 87 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1935:— Scarlet Fever. Diphtheria. Total. January 56 39 95 February 25 43 68 March 35 35 70 April 37 19 56 May 29 14 43 June 19 4 23 July 20 21 41 August 20 14 34 September 43 27 70 October 56 24 80 November 53 20 73 December 55 18 73 Totals 448 278 726 3. NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES. (a) Measles, etc.—The most important of these are measles, whooping cough and summer diarrhoea. Deaths registered were as follows:— Measles 1 Whooping Cough 2 Summer Diarrhœa 7 Chicken-pox – (b) Rheumatic Fever.—Rheumatic fever, as I have said elsewhere, is a serious problem in Barking. (c) Influenza.—There were 9 deaths from influenza during the year 1935. This contrasts favourably with 12 deaths in the year 1934, and 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 people when they are likely to spread disease. 88 (d) Scabies.—Forty-eight cases of scabies were brought to the notice of the department during the year. Disinfection of bedding and blankets was carried out in all but six cases, where the parents declined the services offered. (e) General.—Non-notifiable infectious diseases amongst school-children are much more easily traced than the diseases amongst adults. As you know, the School Attendance Officers of the Education Committee are General Inquiry Officers, and we have a lot of reliable information on which we can act so far as infectious diseases amongst school-children are concerned. 4. BARKING HOSPITAL. (a) Admissions.—The following is the table pf admissions, etc., in respect of infectious diseases during 1935:— Disease. In Hospital January, 1st, 1935. Admitted during the year. Died. Discharged. In Hospital Dec. 31st, 1935. Scarlet Fever 69 409 – 417 61 Diphtheria (including Membranous Croup) 68 273 14 294 33 Enteric Fever – 3 – 3 – Puerperal Pyrexia – 3 *1 2 – Pneumonia – 13 1 9 3 Erysipelas 1 16 1 15 1 Ophthalmia Neonatorum – 3 – 3 – Others – 34 2 25 7 * Cause of Death:—Puerperal Pyaemia. (b) Number of Bed Days.—The total number of bed days in the infectious diseases hospital during 1935 was 32,550—that is to say, an average of 89 patients were in hospital throughout the 365 days in the year. 5. ARTIFICIAL IMMUNISATION. I can only repeat what I said last year that 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. 89 Wise parents who dread diphtheria, as they have every right do 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 192 Number of first attendances for treatment 157 „ subsequent attendances for treatment 412 „ final "Schick" tests 114 6. CANCER. There have been 71 deaths from cancer, 41 below the age of 65 years and 30 above the age of 65. The following table shows the occupations of the 71 people who died from cancer during the year 1935:— Male. Female. Blacksmiths 2 Wives 18 Bookbinder 1 Spinsters 2 Brewer's Drayman 1 Widows 13 Bricklayers 2 Carpenter 1 Chairmaker 1 Chemical Worker 1 Civil Servant 1 Clerks 2 Coffee House Keeper 1 Cooper 1 Draper 1 House Decorator 1 Labourers 12 Master Farrier 1 No occupation 4 Porter (fish) 1 School Teacher 1 Tinsmith 1 Vehicle Washer 1 Warehouseman 1 38 33 90 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 05 years. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Bladder – – – – – – – – – – 1 – – 1 1 1 Breast – – – – – – – – – 3 – 2 – 1 – 6 Cervix – – – – – – – – – 1 – 1 – 1 – 3 Colon – – – – – – – – – 2 1 1 2 2 3 5 Inguinal Gland – – – – – – – – – – – – 1 – 1 – Liver – – – – – – – – – – 1 – 3 1 4 1 Lung – – – – – – – – – – 6 1 – 1 6 2 Oesophagus – – – – – – – – – – 2 – – 1 2 1 Pancreas – – – – – – – – – 1 – – 1 – 1 1 Peritoneum – – – – – – – – – 1 – – – – – 1 Prostate – – – – – – – – – – – – 1 – 1 – Rectum – – – – – – – – – – 1 1 2 2 3 3 Stomach – – – – – – – – 1 1 8 2 4 3 13 6 Tongue – – – – – – – – – – – – 1 – 1 – Thyroid Gland – – – – – – – – – – – 1 1 – 1 1 Uterus – – – – – – – – – 1 – 1 – – – 2 Ventriculi – – – – – – – – – – – – 1 – 1 – Totals – – – – – – – – 1 10 20 10 17 13 38 33 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. 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 Mid wives 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 1935 was 15, compared with 20 in 1934. Twelve cases were treated at home, and in no case was the vision impaired. 91 Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. At Hospital. Under 3 weeks 15 12 3 15 – – – 8. TUBERCULOSIS. Particulars of new cases of Tuberculosis and of all deaths from the disease in the area during 1935 are given in this Report in the following form:— New Cases Notified. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. Male. Female. Male. Female. Male. Female. Male. Female. Under 1 year – – – – – – – – 1 to 5 years 1 – 3 2 – – – – 5 to 15 years 1 1 4 4 – – – – 15 to 25 years 10 10 4 5 1 4 1 1 25 to 35 years 10 9 3 5 4 5 1 – 35 to 45 years 17 9 2 2 8 7 – – 45 to 55 years 9 2 – – 0 1 – – 55 to 05 years 5 – – – 4 – 1 – 65 years and upwards 1 1 – – 1 – – – Totals 66 32 10 18 24 17 3 1 During the year, 132 notifications were received of all forms of Tuberculosis— pulmonary 98 and non-pulmonary 34 and there were 3 deaths of un-notified cases (pulmonary), making a total of 135 new cases during the year. Information has been received of the removal into the district of 39 tuberculous persons, included in number of notifications received. This compares with 26 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. 92 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. 59 23 5 7 37 30 9 9 Forty-five deaths occurred from Tuberculosis (all forms) forty-one of these being pulmonary cases. The number of deaths in institutions was twenty-six. The death rate for Tuberculosis (all forms) during 1935 was 0.62 per 1,000 population, compared with 0.77 for the previous year. The compulsory removal to hospital of persons suffering from Tuberculosis is practically a dead letter in Barking. BOROUGH OF BARKING THE ANNUAL REPORT OF THE School Medical Officer For the Year 1935 C. LEONARD WILLIAMS, B.Sc., M.R.C.S., D.P.H. 96 TABLE OF CONTENTS Pages ADENOIDS 107-108, 116 ARRANGEMENTS FOR TREATMENT 111-119 AURAL CLINIC 108, 116 BLIND CHILDREN 125-126 BOXING 121 BROOKFIELD ORTHOPAEDIC HOSPITAL 117 CLINIC ATTENDANCES 106, 114 CLINIC SERVICES 131-134 CO-OPERATION OF PARENTS, TEACHERS, ETC 124-125 CO-ORDINATION OF SERVICES 102,119,124 DEAF CHILDREN 125-126 DEFECTIVE HEARING 108,116 DENTAL DEFECTS 108, 116-117, 140-141 DIET 112 DIPHTHERIA IMMUNISATION 114 DRYING FACILITIES 102,122-123 EAR DISEASE 108,116 EMPLOYMENT OF SCHOOL CHILDREN 129 EPILEPTIC CHILDREN 125-126 EXCLUSION FROM SCHOOL119 EYE DISEASE 107,115-116,142-144 FAIRCROSS SPECIAL SCHOOL 125-126 FEEDING OF SCHOOL-CHILDREN 111-112,122-124 FOLLOWING-UP WORK 110 HEALTH EDUCATION 128 HEART DISEASE AND RHEUMATISM 109,117-118 HIGHER EDUCATION 127 INFECTIOUS DISEASES 119 INTRODUCTION 99 MALNUTRITION 104, 105, 111-112, 124 MEALS 120, 122-124 MEDICAL INSPECTION AND FINDINGS 103,104-110,126 MENTALLY DEFECTIVE CHILDREN 125-126 MILK 120,124 MINOR AILMENTS 106-107, 112-114 MYOPIC CHILDREN 115-116,143 NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN 125 NOSE AND THROAT DEFECTS 107-108,116 97 Pages NURSERY SCHOOLS 127 OPEN-AIR EDUCATION 120 OPEN-AIR CLASSROOMS 120 OPEN-AIR SCHOOLS 101, 125-126 OPHTHALMIC SERVICE 115, 142-144 ORTHOPÆDIC AND POSTURAL DEFECTS 108, 117, 136-139 PARENTS' PAYMENTS 127 PHYSICAL TRAINING 120-121 PLAYGROUND CLASSES 120 PLAYING FIELDS AND GROUNDS 121 PROVISION OF MEALS AND MILK 123-124 REMEDIAL CLINIC 118 REPORT OF THE DENTAL SURGEON 140-141 REPORT ON THE WORK OF THE OPHTHALMIC CLINICS 142-144 REPORT ON THE WORK OF THE ORTHOPÆDIC CLINIC 136-139 RESEARCH 128 RHEUMATIC FEVER 117 RHEUMATISM 109, 117 RINGWORM 114 SCHOOL BATHS 102, 121 SCHOOL CAMPS 120 SCHOOL HYGIENE 102, 103 SCHOOL JOURNEYS 120 SCHOOL LAVATORIES 102 SECONDARY SCHOOLS 127 SERVICES PROVIDED, LIST OF 129-135 SKIN DISEASES 107, 112 SPECIAL INQUIRIES 128 SPECIAL SCHOOLS 125-126 SQUINT 116, 142-143 STAFF 98, 101, 116 STATISTICAL TABLES 145-157 SWIMMING 121 TEACHERS, MEDICAL EXAMINATIONS OF 128-129 TONSILS AND ADENOIDS 107-108, 116 TUBERCULOSIS 109, 118 ULTRA-VIOLET LIGHT TREATMENT 118 UNCLEANLINESS 108, 112 VISUAL DEFECTS 107, 115-116, 142-144 WOODWARD CLINIC 112-113 98 STAFF, 1935 School Medical Officer : C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. Deputy 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. CATHERINE B. McARTHUR, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Commenced 2nd January, 1935.) Ophthalmic Surgeon: WILLIAM ADAMSON GRAY, M.B., Ch.B., F.R.C.S., Ph.D. (Commenced 14th May, 1935.) Orrhopœdic 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. (Resigned 9th February, 1935.) H. S. SARSON, L.D.S., R.C.S. (Commenced 20th May, 1935.) Nursing Staff: *Miss P. M. FAWCETT (Senior Nurse) (g, h and i). (Commenced 1st December, 1935.) *Miss M. BAERLOCHER (g, h and n). *Miss C. COURT (g, h and i). Miss G. GEDEN (Dental Nurse) (r). Miss S. E. W. GIBSON (j). *Miss G. JONES (g, h and i). (Commenced 12th August, 1935.) Miss R. LLEWELLYN (Dental Nurse) (h and i). *Miss W. PARKER (g, h and i). Miss A. K. ROE (Masseuse) (o). (Commenced 1st April, 1935.) *Miss F. G. ROXBURGH (g, h and i). (Resigned 10th August, 1935.) Miss L. F. SWAIN (h and i). Clerical Staff: Chief Clerk: F. READ. C. G. EAGLESFIELD (Senior Assistant). D. G. TONKIN (n). (Resigned 4th February, 1935.) H. C. DAVIS. (Commenced 1st May, 1935.) A. J. STORER (n). F. YATES (q). (Commenced 1st May, 1935.) E. A. ELLIS. G. H. RUFF. D. W. OSMOND. (Resigned 17th May, 1935.) E. INGS (p). (Commenced 12th August, 1935.) Miss H. NUNN. Miss H. KING. Miss A. LIGGINS. Miss D. FOULSHAM. (Commenced 1st April, 1935.) Miss I. CAST. (Commenced 13th May, 1935.) Miss G. COOPER. (Commenced 4th December, 1935.) (g) Health Visitors' Certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives' Board. (i) General Hospital Training. (j) General Fever Training. (n) Sanitary Inspectors' Certificate of Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (o) Certificate of Chartered Society of Massage and Medical Gymnastics, Medical Electricity, Light and Electro-Therapy. (p) Inter. B.Sc., University of London. (q) Final Examination of the National Association of Local Government Officers. (r) Registered Sick Children's Nurse. * Combined Appointment—Health Visitor and School Nurse. 99 Borough of Barking PUBLIC HEALTH DEPARTMENT, BARKING, ESSEX. June, 1936. 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, 1935. 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. 101 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year 1935. (1) STAFF. In the forefront of this Report will be found a list of your officers who, in this way or in that, carry out the work you have entrusted to their charge. There have, of course, been some changes in the staff—Mr. R. N. Hines relinquished his appointment as Dental Surgeon, having accepted a post elsewhere, and Mr. H. F. Sarson took his place on the 20th May, 1935. So, similarly, did Miss G. F. Roxburgh, who was both Health Visitor and School Nurse, relinquish her appointment, and her place was taken by Miss G. Jones on the 12th August, 1935. Upon the resignation of Miss A. E. Findlay, part-time Masseuse, in December, 1934, it was decided that the post of Masseuse should be a whole-time one, and Miss A. K. Roe, who was appointed, commenced her duties on 1st April, 1935. The post of Senior Health Visitor and School Nurse was designated during the year, and Miss P. M. Fawcett, who was appointed to this post, took up her duties on 1st December, 1935. The chief alteration to which I wish to call your attention is the appointment of Mr. W. A. Gray, F.R.C.S., as Consulting Ophthalmic Surgeon. Mr. Gray took up his duties on 14th May, 1935, and with his appointment the ophthalmic work in the town has been placed on a more sure foundation. This appointment demonstrates the measure of co-ordination which is found throughout the whole of your medical services because Mr. Gray not only undertakes ophthalmic work for children of school-age but also deals with toddlers, and with their mothers when they come within the purview of the Maternity and Child Welfare Scheme. He also visits, as and when necessary, the Barking Hospitals, and his appointment has been of great value in reference to superannuation work. 102 This co-operation which is found throughout the service does away with much overlapping and ensures continuity of medical supervision. (2) CO-ORDINATION. The very happy relationships I have the pleasure to enjoy with my colleagues, including the head-masters and head-mistresses of your various schools, enables us to co-ordinate your medical services with the other work which is carried on by you. Here we find the work of the Investigation Officers very helpful, particularly because they investigate matters which have to do not only with children of school-age but also with other children and persons who come within our purview, but who are not of school-age. (3) SCHOOL HYGIENE. The schools of Barking illustrate both ancient and modern architecture. The ancient schools are of the factory type—great three-decker buildings, each floor built on the lines of an old Sunday school with a central hall and classrooms on three sides of it. The modern schools are well laid out, either in quadrangles or in sun-traps and are so built that they can be used virtually as open-air schools. I am naturally disappointed that the modern schools have not been built with baths. Baths are necessary ; firstly, because physical exercises with the older children should, at times, be pushed to a point where by reason of perspiration and other conditions a bath is necessary, and secondly, because bathing is an acquired taste and if the baths supplied in your houses are to be used properly the habit of bathing must in certain cases be inculcated in the children. Again I find it necessary to discuss the arrangements for drying wet clothes and boots. As you know I want to see a rule enforced for the changing of wet foot-gear on arrival at school, and I hope that in the forthcoming year this difficult question will be solved. The provision of lavatories on each floor where the schools are of two or more storeys is a matter I have previously called to your attention. 103 The standard to which children become accustomed at school, is the standard by which they will judge their homes, their workplaces, and their transport, in their later life—schools therefore should be of a high order of sanitary attainment. The simple lesson of ordinary life in the school of some sanitation is a continuous influence, transcending even the wonderful lessons on hygiene which form part of the curricula of your schools. In this connection I would wish to call your particular attention to the conditions under which so many medical inspections are carried out. In your older schools we have nothing but admiration for the efforts which are made for medical inspection to be carried out under the best possible conditions, but the circumstances are such that what should be a lesson in hygiene and instruction in the art of sanitation is oftentimes only a tribute to those who are doing their best under most discouraging circumstances. The visiting doctor should be looked upon as a disciple of Hygeia, as an apostle of fresh air, sunlight and sanitation, instead of which some children are examined without proper accommodation and those parents who wish to be present in consultation with the doctor have no proper place to wait. Referring in particular to proper accommodation for the parents who are waiting, I would call your attention to the fact that in many of your modern schools it would be an advantage to entertain providing better accommodation than obtains at the present time. The time has come when, together with your Architects, your Medical Officers should be permitted to draw up a design which may be considered an essential minimum and that all schools should be designed or re-designed to meet this obligatory minimum. (4) MEDICAL INSPECTION. The age groups inspected are those laid down by the Board of Education. The arrangements by which these inspections are carried out are the same as in previous years. The time has come when medical inspection plays a far more important part that it has done heretofore. In the beginning, routine medical inspection had for its primary object the census of the health of children of school-age, to enable local authorities to form some conception of the tasks which lay before them, and their magnitude. Generally speaking, routine medical inspection has now completed its first great work of showing the various tasks which must be approached if the health of the school-child is to be safeguarded and maintained. Ancillary services to this end have already been set up so that the routine inspection of school-children, whilst still maintaining its essential principles of investigation, has today the added necessity of watching the operation of the ancillary services—referring children to special departments, and then, after treatment has been completed, closing if possible, the note on the defect, with the happy statement that all is now satisfactory. 104 In addition, today there are nutrition surveys and there should, of course, be other special surveys from time to time as necessity arises, or alternatively if there are no nutrition surveys then routine medical inspections should be more numerous than they have been in the past. It is unnecessary further to labour the fact that medical inspection does play a far more important part today than it did twenty years ago and that arrangements which were more or less adequate in those early days are now hopelessly out of date. The following table shows the number of children examined at school at routine and special inspections during 1935, 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 22 598 239 189 Cambell 63 1279 836 722 Church of England 14 253 171 88 Dawson 32 556 440 406 Dorothy Barley 43 753 672 594 Eastbury 23 568 219 295 Erkenwald 30 668 353 267 Gascoigne 25 625 269 371 Monteagle 38 653 504 516 Northbury 24 625 199 381 Park Modern 8 132 99 95 Ripple 26 490 352 399 Roding 39 666 491 497 St. Ethelburga's 7 181 60 29 St. Joseph's 6 110 49 75 Westbury 28 449 440 328 Totals 428 8,606 5,393 5,252 Of the 8,606 examinations at ordinary elementary schools, 6,071 were routine examinations of children in the specified age groups, which figure may be compared with 3,315 for the previous year. In addition, there were 824 routine examinations of children of ages outside the three specified age groups, and 1,711 examinations of children specially referred to your Medical Officers. 113 WOODWARD CLINIC WOODWARD ROAD. 114 A doctor is in attendance every day at these Clinics and the nursing service is provided by the Plaistow Maternity Hospital and District Nurses' Home. The whole question as to the adequacy of the present nursing service available is at present before you for your consideration, and if this service is to stand the increasing work which is being placed upon it, the question of staff will be found an important one. The question of nursing staff for the treatment of minor ailments is linked up with the nursing staff for other activities maintained by the Education Committee and by other Services of the Corporation. The treatment of Ringworm of the Scalp is still undertaken by Dr. W. J. O'Donovan at the London Hospital. Under this arrangement 8 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. Woodward Clinic. 1934 1935 1934 1935 No. of days clinic was open 354 352 321 330 Total No. of attendances 14,414 18,425 16,578 19,236 Daily average attendance 40.7 52.3 51.6 58.3 No. of cases treated 2,572 2,218 2,182 2,117 (b) All Clinics. Clinic. No. of first attendances of school children. Total No. of attendances of school children. Minor Ailments:— 1934 1935 1934 1935 (a) Central 2,572 3,031 14,414 18,425 (b) Woodward 2,182 3,650 16,578 19,236 Ophthalmic 384 832 1,607 2,144 Dental 2,671 3,817 7,220 7,951 Orthopaedic FOR EXAMINATION 112 118 2,250 477 FOR TREATMENT 162 194 2,004 Diphtheria Immunisation 13 96 46 407 115 (d) Visual Defects and External Eye Disease.—The most remarkable step achieved during the year 1935 was the appointment of a Consulting Ophthalmic Surgeon, Mr. W. A. Gray, F.R.C.S., of 137, Harley Street, W.1, and of Queen Mary's Hospital, Stratford, E.15. Mr. W. A. Gray took up his appointment under the Corporation on the 14th May, 1936. This side of your work is now on a thoroughly satisfactory basis. Save only with reference to the treatment of squint, this service you have provided during the year has been strictly comparable with the out-patient department of a large hospital or the out-patient department of a large London hospital, and this question of the treatment of squint is at the present time before you. Next year, I confidently hope to be able to tell you that this treatment is being carried out on lines comparable with work of the out-patient departments of our best hospitals. A report on the work of the Ophthalmic Clinics, from the time he commenced duty until the end of the year, has been prepared by Mr. Gray, and will be found on pages 142-144. 767 cases of visual defect were dealt with under the Authority's Scheme. Of this number 593 were provided with spectacles. These figures compare with 384 and 335 respectively for the previous year, and show the strides which have been made in this work. The relatively larger number of cases not provided with spectacles is an indication of other eye defects which are now dealt with satisfactorily in your own Clinics. With reference to the necessity, or otherwise, of providing special schools or classes for myopic children, I would like to say personally, from the general standpoint, that I never recommend any child who would, of necessity, have to sell his labour in the ordinary markets, to be educated in any other than an ordinary elementary school, unless the circumstances demand that he must be educated in a special school. Arising out of correspondence I have had with Mr. Gray on this matter he wrote on the 3rd March, 1936:— "I do not think there are enough cases of progressive myopia in Barking to need a special class. So far as I have been able to judge the present system of limiting near work—sewing, reading, etc.—has worked well. This limitation of near work is, of course, quite consistent with ordinary classes and is, in the main, directed to out-of-school reading, e.g., library books, etc." 116 This advice by Mr. Gray must, of course, be subject to revision in the light of fuller experience. 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. 447 cases were thus treated during the year as compared with 338 during 1934. During the year, there was one operation for squint which was carried out by private arrangement at the Royal London Ophthalmic Hospital, Moorfields, E.C.I. (e) Nose and Throat Defects.—The treatment of nose and throat defects remains as in previous years. Whereas, when Barking was much smaller our arrangements with Hospitals for treatment were satisfactory, the time has come when, together with the other Services of the Corporation, you may well entertain the appointment of a Consultant in this branch of your work. This Consultant would not only study the problem among school-children and carry out any necessary treatment, but he would also be the Consultant at the Barking Hospital and would, amongst toddlers, carry out the same work that he would for the children of school-age. I am persuaded that the treatment of catarrh of the upper air passages will materially benefit the children, and will lead to a diminution of those periods of absence from school which are due to what is commonly known as catarrh. In Group III of Table IV on page 155 will be found a complete analysis of the ascertained results of the treatment of nose and throat defects. (f) Ear Disease and Defective Hearing.—The treatment of ear disease and defective hearing remains similar to last year, and what I have said for the further advances of the treatment of nose and throat defects applies equally to the treatment of ear disease and defective hearing. There can be little doubt that much of the money spent on education does not reap its fullest reward owing to minor degrees of deafness, and it is just these minor degrees which are most amenable to treatment. (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. 117 During the year 1035 you have, together with the Public Health and Maternity and Child Welfare Committee, decided that a third dental officer is necessary. I look forward in my next Annual Report to be able to record an increase in the scope of this important work. There can be no doubt that the treatment of dental defects is now recognised to be more important than it was at one time considered, but even yet sufficient importance is not attached to this branch of work. As and when the public realise how necessary it is for every child to leave school with clean and healthy teeth, that is as and when the increased demand for this service grows, I know that you will meet that demand. Speaking, however, from the standpoint of preventive medicine, I cannot help feeling that, side by side with this curative work, and even dominating the curative work, we ought to preach and teach the care of the teeth. Even now a very large number of people object to such things as fillings to save teeth, and are only willing for dental work to be carried out when extractions are needed. (h) Orthopcedic and Postural Defects.—Mr. B. Whitchurch Howell, Orthopaedic Surgeon, attends at the Orthopaedic 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. A summary of the work done appears on pages 136 to 139, an analysis being given under Group IV of Table IV on page 155. (i) Heart Disease and Rheumatism.—The treatment of Heart Disease and Rheumatism is not in all respects satisfactory. To a certain extent this is because medical officers have not sufficient evidence on this important problem ; to a certain extent it is because the problem is a very difficult one indeed, and to a certain extent it is because the symptoms of Rheumatism are so vague and fleeting that the public do not appreciate the importance of the question. If only children suffering from Rheumatism had a rash like those who are suffering from Scarlet Fever the diagnosis would be easy, the attention of the public would be called dramatically, and I have no doubt that with a larger experience medical officers would know far more than they know today. Rheumatic Fever is allied to Scarlet Fever, but its signs are less distinguishing, and its results unfortunately are conspicuously worse. It is, I think, safe to say when once a child has suffered from Rheumatic Disease of the Heart 118 that such a child never completely recovers—there must always be a residual disability. In this somewhat gloomy picture there is the bright side—that you have made provision for a large number of special children at your Special School, and because this is so, these special children do get care and attention which would not otherwise be practicable. I do, however, feel that here we have a problem which illustrates very fully the advantage of a Residential Open-Air School over a Day Open-Air School, because amongst other things these children should be under constant professional supervision, and wherever necessary accurate four-hourly temperature charts should be taken, and the child confined at times to bed in an atmosphere that does not suggest invalidity. I also trust the time will come when Rheumatic Fever will be looked upon for what it is, that is, an infectious disease capable of producing serious after-effects, and the more serious cases will be dealt with in your own Hospital. (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 treatment of children by ultra-violet light comes down to us as you know from the times of the ancient Greeks, who no doubt learned they needed it from early age. Since these days the introduction of lamps such as the mercury lamp enables us to graduate our doses with greater accuracy than heretofore, so that we are able to avoid that over-exposure, which is just as detrimental as too little ultra-violet light. A new lamp combining ultra-violet light with infra-red rays was installed at the Faircross Clinic in April of 1935. Up to the present time we have carried out this work by giving individual doses to separate children and not on the group system, which whilst it enables a number of cases to be undertaken at the same time cannot possibly give the desirable individual treatment to each child. Although the apparatus we have is satisfactory the accommodation for this work is poor and tends to decrease the usefulness of this work. I know you have this matter at present before you and trust it will not be long before you provide alternative and more suitable accommodation. 119 (8) INFECTIOUS DISEASES. The following table shows briefly the number of children notified and reported suffering from some of the commoner infectious diseases:— 1931 1932 1933 1934 1935 Scarlet Fever 75 88 169 313 274 Diphtheria 128 43 71 247 174 Measles and German Measles 1 188 4 467 29 Chicken-pox 187 335 390 320 178 Whooping Cough 35 48 69 87 79 Mumps — 8 23 39 30 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 1935 no certificates were granted for this purpose. The detection of infectious diseases among children of school-age, and the prevention of same, is attempted in Barking along lines of co-ordination, which are practicable in a town the size of Barking, perhaps more so than in larger communities. There is personal contact between the medical officers of your staff and medical men engaged in private practice, and the whole-time members of your staff have at all times access to and from time to time duties in your Infectious Diseases Hospital. In addition lists are supplied from the Director of Education of children who are of school-age and the reasons or alleged reasons for such absences from school. Your School Nurses and Sanitary Inspectors, whenever necessary, follow up these clues, and although one hundred per cent, efficiency cannot possibly be claimed— such would indeed be very costly, and also present a very serious interference to the domestic lives of the people of Barking—it may be said that in this way and in that a very reasonable measure of control is maintained over infectious diseases. Barking, however, is a small part of a large area and there are continual movements of population to and fro. I am referring to daily travel, and to the relatively large movement of population so far as residence is concerned, and whilst these interchanges continue it is frankly impossible to talk very seriously of the possibility of stopping the spread of disease. 120 (9) OPEN-AIR EDUCATION. Open-Air Classrooms and Playground Classes.—Once more I must call attention to this particular problem which is related to your older schools rather than to your modern schools. These are, to all intents and purposes, built on open-air lines. The difficulty appears to be that of following a set curriculum both during the winter, with its inclement weather, and the summer when the open-air classes, etc., are possible. In your new schools you have broken away from the age-old tradition that study can only be undertaken in the shadows and seclusion of the cloisters but, of course, you have still many factory-type schools, and in these every attempt should be made to see that during the summer every lesson shall be taken in the open-air unless circumstances make it impossible to do so. School Journeys and Camps.—As you know, school camps are run very satisfactorily at Hainault Forest. During 1935, thirteen week-end camps were held in which 936 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. One hundred and forty-four children took part in these two camps. (10) PHYSICAL TRAINING. (a) Physical Training.—In previous years I have to confess there was no organised physical training and whilst technically speaking this was so for 1935, I am happy to be able to forecast that for the next Annual Report it will be possible to advise you of the work the recently appointed physical training organisers will be undertaking in Barking. I should like to correlate my remarks on this subject with some others on the provision of meals and milk. A number of children who take part in competitive games with credit and distinction to themselves and their schools, have at one time or another been in receipt of free meals. It must be a matter of satisfaction to the Committee to find that these children, whom they have looked after, are able to compete, and that successfully, with children who from many standpoints are looked upon as more fortunately placed. More and more, I am happy to state, physical exercises are being undertaken in suitable clothing. This movement is in the right direction and will, I am sure, extend under the able and enthusiastic leadership of your educationalists who are so up to date in this matter. 121 In this bright picture, however, there is one dark spot, and that is you have not provided-proper bathing facilities except in one or two of your schools. Physical exercises among the ordinary boys, which include just that proper degree of rough and tumble, makes subsequent bathing a necessary refinement, or perhaps I may be permitted to say from my standpoint an obligatory measure. Amongst the older girls, and indeed amongst many of the younger children, bathing should be looked upon as a natural finale to physical exercises. May I hope this matter will be one to which you will give your earnest attention ? (b) Swimming.—With reference to swimming, I have previously stated that I look upon it as an excellent form of physical exercise, and in addition, it is an opportunity for teachers to see the children unclothed, and to form a better opinion than they otherwise could, of the degree of physical training required in individual cases. (c) Boxing.—With reference to 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 such contests. The whole of the work is undertaken by the Association with meticulous care. Your medical officers, where practicable, attend at these contests, and confirm or correct their findings in the light of their own personal knowledge of how the boys stand the strain of these interesting contests. (d) Facilities for Other Sports and Games.—Much has been done, and very much more is being done in Barking in this connection, but it still remains for you to safeguard its future. There can be no doubt that soon all the land adjoining the Boundary of Barking to the West, North and East will be covered by buildings in East Ham, Ilford and Dagenham, so that Barking to all intents and purposes will be hedged in, whereas but a few years ago it had a relatively large acreage of vegetable gardens and other natural open spaces. With London extending so distant as Hornchurch, and with the event of the Thameside Development, it is imperative that young and adolescent persons should have ample accommodation at home for healthy recreation. Particularly, I would call attention to the need for open playing grounds at some distance from the schools themselves, so that exercises may be undertaken freely with no thought of attendant noise interfering with the ordinary class-work of the children. 122 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 Boys 19 ” Cloakrooms heated (in winter only). Junior Girls 18 ” ” Infants — ” ” Dorothy Barley— Junior Boys 1 ” ” Junior Girls — ” ” Infants — ” ” Eastbury—Senior Boys — ” ” Senior Girls — Yes, at domestic science centre. Yes, at domestic science centre. Cloakrooms heated (in winter only). Infants 12 No Erkenwald—Senior Boys — ff ” Senior Girls — Yes, at domestic science centre. Yes, at domestic science centre. Cloakrooms heated (in winter only). 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 and central heating (in winter only). Junior Mixed — ” ” Infants — ” ” Monteagle—Junior Boys — ” Cloakrooms heated (in winter only). Junior Girls — ” ” Infants — ” ” 123 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 Northbury—Senior Girls - No School fires and central heating (in winter only). Junior Mixed - ” ” Infants - ” ” Park Modern—Senior Mixed 80-100 Yes, at domestic science centre. Cloakrooms heated (in winter only). Ripple—Junior Boys — No ” Junior Girls — ” ” Infants — ” ” Roding—Junior Boys — ” ” Junior Girls — ” ” Infants 90-100 ” ” St. Joseph's—Infants Junior Mixed 5 Yes School fires and central heating (in winter only). St. Ethelburga's— Senior Mixed 20 No ” Westbury—Junior Boys - ” ” Junior Girls - ” ” Infants - ” ” (11) PROVISION OF MEALS AND MILK. (a) Meals.—Free meals are provided daily in necessitous cases. During the year 1935, 112, 125 meals were provided, and the following table shows the numbers of free meals which have been provided during the past six years :— 1930 31,556 1931 46,803 1932 74,531 1933 135,726 1934 113,173 1935 112,125 The Table on pages 122-123 summarises the arrangements which exist where mid-day meals are taken at schools. 124 It will be noticed that facilities exist at some schools for the heating of meals, and where the children are supervised during meal-times. The table also shows what arrangements there are for the drying of children's clothes and boots. During the year, a lot has been heard of the selection of school-children for free meals. It may perhaps suffice, if I state I am happy to record that heretofore the aims of your activities have been the prevention of malnutrition, and that I hope, at a not far distant time, it will not be necessary to look upon these from any other aspect. Personally, I believe that money spent on the special nutrition surveys which have been talked about, could more profitably be spent on shortening the intervals at which ordinary inspections are undertaken. Once more I would like to put on record the measure of co-operation there is in Barking. Doctors, Health Visitors, School Nurses and Sanitary Inspectors, all form one large but not too large family, and on the other hand the School Attendance and Investigation Officers, under the direction of Mr. Compton, are in the closest contact with these officers, so that altogether there is always a unit at the disposal of head-teachers and others who are responsible for seeing that children who may or do require free meals are brought within the purview of the Services you have provided to this end. (b) Milk.—In addition to free meals as such, free milk is given in certain cases and in this way 44,100 bottles of milk were distributed during 1935. The milk provided is subject, from time to time, to bacteriological and other analysis, and during the year has been found invariably of standard quality. In my last Annual Report I dealt with this subject from two or three aspects, and find it unnecessary to add to what I wrote on that occasion. (12) CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. I have already referred to the large measure of co-ordination which has been achieved in Barking by the ready co-operation of the various officers, etc., who are interested in the health of school-children. I can only repeat how much, personally, I owe to the head-teachers and their staffs, and to the other officers who, working together, have enabled the work to be carried out, not only with a measure of success, but also with that smoothness of running which is an indication of efficiency. 125 Once again I would wish to put on record the expression of my personal indebtedness to my medical colleagues in general practice who have, at no small inconvenience to themselves, on numerous occasions helped in cases which have shown some medical or social difficulty. The ready co-operation which has been received on all hands has enhanced the value of your serv ices, and has made the part your officers have to play in them far easier than it could possibly be without this help. The National Society for the Prevention of Cruelty to Children still continues to carry out its valuable work. That there is not more work for them to do is a tribute to the services you yourselves have set up. However efficient yours and similar services may be, I think there is still room for this valuable National Society, which stands in a peculiarly favoured position and is able to step in where officials find themselves in some difficulty. On account of the Services you yourselves have set up and the measure of success you have achieved, it must of necessity obtain that cases not dealt with by you and referred to the National Society for the Prevention of Cruelty to Children are of some considerable difficulty ; so that although the cases dealt with by them are not large in number they are of some considerable importance. The following table shows the work which has been undertaken by the National Society for the Prevention of Cruelty to Children during the last four years:— 1932 1933 1934 1935 Total number of cases investigated 16 33 24 35 (a) Prosecutions nil nil nil nil (b) Warnings 13 24 18 29 (c) Otherwise dealt with 3 9 6 6 (d) Supervisory visits 97 133 131 180 (e) Cases closed as satisfactory 12 25 17 29 (13) BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. 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:—- 126 Open-Air Section Physically Defective Section Mentally Defective Section No. on Register on 31.12.34 84 40 76 No. admitted during 1935 60 9 18 No. discharged during 1935 47 18 15 No. on Register on 31.12.35 97 31 79 Hereunder are particulars of the number of children maintained by the Authority in special schools outside the district as at December 31st, 1935:— Particulars of School. No. of Cases. (a) Certified School for the Blind: East Anglian School for the Blind (Residential), Gorleston 1 (b) Certified School for the Deaf: Frederick Road Deaf Centre (Day), West Ham 10 (c) Certified School for Physically Defective Children: St. Patrick's Open-Air School (Residential), Hayling Island 1 (d) Certified School for Epileptic Children : Lingfield Epileptic Colony (Residential), Lingfield 1 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. The following table gives information in respect of medical inspection at the Faircross Special School during the year 1935:— ]Number of inspection sessions 27 Number of children inspected :— (a) Routines 83 (b) Specials 43 (c) Re-examinations 382 508 Number of defects referred:— (a) For treatment 37 (6) For observation 19 56 Number of defects found treated 31 Number of parents present at inspections 278 127 (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. The problem of nursery schools is one I have dealt with in previous Reports and I find there is nothing to add to the remarks then made. (16) SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. Secondary education is maintained in Barking by the County Council, but the dental inspection and treatment of the children in attendance at the Barking Abbey School is undertaken by you at a certain charge. This work has been much appreciated, and its success indicates the urgent need there is for the medical and other allied services you provide to be extended to these children. It is obvious that a compact and progressive town such as Barking has a different system of administration from the County, and is in a position to afford facilities which would be difficult, if not impossible, for the County Authority to provide. Further, the children in attendance at the Barking Abbey School come largely, if not altogether, from the same homes as those children who attend your own schools, and in the past if a child with a distinguished career at school has won a place at the Barking Abbey School he has thereby been cut off from the services which are available to the age of 14 years to those who do not achieve success. (17) PARENTS' PAYMENTS. From time to time you have had under consideration arrangements for the recovery of cost of treatment from parents of children attending public elementary schools. Certain alterations have been made during the year 1935. 128 (18) HEALTH EDUCATION. When dealing with one section of my Report, which has to do with the dental services, I stressed the need there is for health education, and there can be no doubt that education, particularly in the case of children, is the keynote of preventive medicine. As I pointed out in previous years, I do not believe so much in special lessons in health as that as many lessons as possible should be given with a bias in the direction of health, and that by routine, healthy habits should be formed in the scholars. Much has been done in the general standard of cleanliness, so much so indeed, that the outstanding cases of uncleanliness are more and more obvious. The idea of coming to school with unclean teeth should be impossible, and the cleanliness of the body and feet should be looked upon as more important than the cleanliness of the hands and face. Regular habits as I have stated in a previous Report should be looked upon as essential. It will be, I think, recognised on all hands that correct habits, once formed, are far more important than such rudimental knowledge as it is possible for your highly trained teachers, even with the very best will in the world, to inculcate into children of minor years. (19) SPECIAL INQUIRIES. A perusal of this Report will, I think, convince anyone that there is a large amount of material being handled which should, if time were available, lead to such research as would help you materially in laying your plans for the future, and that with the staff you have available at the present there is naturally not enough time to get through the ordinary routine work let alone for them to be engaged in special enquiries, without which progress cannot be maintained. I am of opinion that the time for earnest research is now ripe and that every important and progressive Local Authority should set aside definitely a service to undertake that research which is the only proper foundation for future achievement. I do hope that by securing an adequate staff with continuity of service, we shall be able in Barking to meet the hundred and one problems which are facing school medical services at the present time. I would wish to emphasise that the clinical work in the school medical service is so important that every effort should be made to secure continuity of service. It is only continuous service which leads to sound judgment and it is only this sound judgment which in turn leads to fuller development along economic lines. (20) MISCELLANEOUS. (a) Examination of Teachers.—During the year, 42 medical examinations were carried out of applicants for teaching posts under the Local Authority. 129 I am persuaded there are serious grounds for suggesting the necessity of co-ordinating the medical examination of entrants to Training Colleges with those of other examinations. (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, 24 applicants of school-age submitted themselves for examination prior to employment. Of this number 21 were passed as being medically fit for employment. (c) After-employment.—In September, 1935, the Board of Education issued Administrative Memorandum No. 137 dealing with the question of co-operation between the School Medical Service and Juvenile Employment and Advisory Committees. The Board requested that procedure should be initiated whereby the Juvenile Employment Officer should be advised as to the specific unsuitability of certain children for particular types of work, this information being made available by your medical officers at the last routine examination of the children. Up to the end of 1935 the following recommendations by your medical officers were forwarded to the Juvenile Employment Officer:— 37 Children unsuitable for severe manual work. 1 „ ,, „ sedentary occupation. 28 „ „ „ exposure to bad weather. 50 „ ,, „ work in a dusty atmosphere. 5 „ ,, „ work near moving machinery. 14 „ „ „ work involving prolonged standing. 12 „ „ „ work causing eye strain. 27 „ ,, „ work requiring acute distant vision. 7 „ „ „ work requiring acute hearing. The above recommendations relate to 114 school-children. 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. 130 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 Woodward Road. Dinners ... ... ... Free dinners are provided for children attending school, where the family income is below a certain scale. Diphtheria Immunisation Immunisation against Diphtheria is carried out at the Central Clinic. No charge is made for this treatment. Medical Inspection ... Arrangements are made for each child to be medically examined at school three times during the period of school life, and at such other times as the medical officer considers necessary. Milk ... ... ... * One-third of a pint of milk is supplied daily to children attending school on payment of 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 Woodward Clinic. Ophthalmic Service ... Refraction Clinics are held at the Central and Woodward Clinics, 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 Orthopa;dic Clinic, Faircross Special School. 131—132 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 Clinie, Viearage Drive, Ripple Road Tuesdays and Fridays, 2 p.m. Modern clinic premises with accommodation for consultations, weighing of babies, waiting rooms, etc. Local Authority. Woodward Clinic, Woodward Road Tuesdays, Thursdays and Fridays, 2 p.m. Mondays and Thursdays, 2 p.m. do. do. do. Greatfields Centre, Movers Lane Accommodation for consultations, weighing of babies, waiting rooms, etc. do. Alexandra Centre, St. Paul's Road do. do. Porters Avenue Centre, Porters Avenue Mondays and Wednesdays, 2 p.m. do. do. (6) Ante-Natal Clinics :— Central Clinic, Vicarage Drive, Ripple Road Woodward Clinic, WToodward Road *Alexandra Centre, St. Paul's Road Wednesdays, 2 p.m. P'ridays, 10 a.m. Wednesdays, 10 a.m. Tuesdays, 2 p.m. Modern clinic premises with accommodation for consultations, etc. do. Accommodation for consultations, etc. do. do. do. Porters Avenue Centre, Porters Avenue Thursdays, 9.30 a.m. do. do. †Specialist-Consultant Clinic at Alexandra Centre, St. Paul's Road Last Friday in each month, 3.30 p.m.. except August and December. do. do. (c) Gynaecological Clinics :— Central Clinic, Vicarage Drive, Ripple Road As and when required. Modern clinic premises with accommodation for consultations, etc. do. Woodward Clinic, Woodward Road do. do. do. (d) School Nurseries :—Nil Nil Nil Nil (e) Day Nurseries :—Nil Nil Nil Nil N.B.—*Since the end of 1935 this Clinic has been transferred to the Central Clinic Premises, Vicarage Drive, Ripple Road. •fSince the end of 1935 this Specialist-Consultant Clinic has been transferred to the Central Clinic Premises, Vicarage Drive, Ripple Road, and is held on the third Tuesday in each month at 3.30 p.m. (except August and December.) 133—134 CLINIC AND TREATMENT CENTRES. Name and Situation. When Held. Nature of Accommodation. By Whom Provided. 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. Woodward Clinic, Woodward Road do. do. do. (b) Ophthalmic Clinic :— Central Clinic, Vicarage Drive, Ripple Road Tuesdays and Fridays, 10 a.m. Modern Clinic premises do. Woodward Clinic, Woodward Road Thursdays, 2 p.m. do. do. (c) Dental Clinics :— Central Clinic, Vicarage Drive, Ripple Road Woodward Clinic, Woodward Road Daily, 9 a.m. and 2 p.m. do. Modern clinic premises with waiting and treatment rooms, etc. do. do. do. (d) Orthopaedic Clinic :—Faircross School:— (i) Specialist's Clinic First Thursday in each month, 9 a.m. Daily, 9 a.m. and 2 p.m. One Room do. (ii) Remedial Exercises Clinic, Ultra Violet Light Therapy, etc. do. do. 3. Diphtheria Prevention Immunisation Clinic. Central Clinic, Vicarage Drive, Ripple Road Mondays, 10 a.m. Modern clinic premises with waiting and treatment rooms. Local Authority. 4. Tuberculosis. 37, Linton Road Mondays, 3-5 p.m. Tuesdays, 7-8 p.m. Thursdays, 10.30 a.m.-12.30 p.m. Three rooms Essex County Council. 5. Venereal Diseases. London hospitals, etc. By arrangement with Essex County Council. 135 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. Vltra-Violet Light Treat- Ultra-violet light treatment is given at the Orthopaedic ment ... ... ... Clinic, Faircross Special School. X-Ray Treatment for Where necessary, Ringworm is treated by X-Ray. Ringworm of the Scalp. No charge is made for this treatment. 136 REPORT ON THE WORK OF THE ORTHOPÆEDIC CLINIC. The following tables, which are prepared on lines similar to those previously used, show the work which has been carried out at the Orthopaedic Clinic amongst children of school age :— No. of primary examinations by Orthopaedic Surgeon 118 No. of re-examinations by Orthopaedic Surgeon 359 The cases dealt with for the first time during 1935 were referred for the following conditions, ond child having two defects :— (a) Deformities—Bones and Joints— (1) Congenital: Deformed digits (foot) R. & L 1 (2) Acquired : Injury—elbow-joint 4 „ shoulder-joint 1 „ ankle-joint 2 „ knee (cartilage) 1 „ fibula 1 Pes planus 42 Genu valgum 23 Genu varum 2 Hallux valgus 3 Hammer toe 3 Pes cavus 2 Rachitic chest 3 88 137—138 PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1935. No. of visits by Orthopsedic Surgeon No. of visits by Masseuse ATTENDANCES. Primary Examination Re-examination For Treatment Total School Children Toddlers School Children Toddlers School Children Toddlers School Children Toddlers 11 430 118 97 359 170 2,004 1,635 2,481 1,902 TREATMENTS. Massage Electricity Remedial Exercises Ultra-Violet Therapy Radiant Heat Dress Split ings and itage 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 7 187 2 56 118 1,256 53 523 8 86 53 364 Toddlers 35 479 2 6 10 37 81 747 — — 54 384 Admissions to Hospitals On Waiting List for Admission 31/12/35 School Children Toddlers Total School Children Toddlers Total 6 (Under Council's Orthopaedic Scheme) 7 13 2 3 5 139 (b) Deformities—Muscular— (1) Congenital (2) Acquired: Kyphosis Lordosis Kypho-lordosis Scoliosis Shortening of arm (R) Winged scapulae Torticollis (c) Paralysis— (1) Congenital (2) Acquired : Erb's paralysis Spastic diplegia Spastic monoplegia Muscular dystrophy (d) Miscellaneous—- Osteomyelitis Baker's Cyst Growth under toe-nail Synovitis—knee Total defects found Nil 7 2 3 4 1 1 3 Nil 1 1 2 1 2 1 1 1 21 5 5 119 During the year, six children were admitted to hospital, one for investigation, and five for operations as follows :— Removal—exostosis 2 Femoral osteotomy (R. & L.) 1 Excision—external semi-lunar cartilage (knee) 1 Manipulation and plaster to feet 1 The above report for 1935 shows the details of the Orthopaedic work and an increase in the attendances for treatment. The treatments have been much more efficiently carried out owing to the fact that the appointment of the Masseuse is now a whole-time one. 140 REPORT OF DENTAL SURGEON. June, 1936. To the School Medical Officer, Barking Borough Council. Sir, I have the honour to submit the School Dental Report for the year 1935. In February, 1935, Mr. Hines (L.D.S., R.C.S., Eng.), the Assistant Dental Surgeon, resigned his appointment with the Borough to take up an appointment with the Worcester County Council and a series of locum tenens replaced him until the appointment of Mr. Sarson (L.D.S., R.C.S., Eng.), who took over duty in May, 1935. The work of the first few months of the year thus was somewhat disturbed. Of the 5,520 children inspected during the year, 4,471 required treatment, the percentage of children with dental lesions being approximately 81 per cent. Of the 4,471 children requiring treatment, 3,817 accepted treatment and were treated— a percentage of approximately 85. The percentage of treated cases in comparison with the number inspected is high and was obtained by the system of treating a school before proceeding with the inspection of another school, allowing always a margin of treatments to breach over the period occupied by administration work, such as sending out consent forms, etc., connected with any inspection. There has been over 100 per cent, increase in the number of fillings completed for the year, the figure for 1935 being 3,606 in permanent teeth and 16 in temporary teeth as against 1,723 and 9 for 1934. Extractions are also high for 1935, being 10,436 as against 7,559 for 1934, but the comparable figure of extractions per treated case being 2.7 this year as against 2.8 last year. The administration of general anaesthetics is 627 more than last year, the figure being 3,729, with local anaesthetics totalling 222. 141 Work under the heading of "other operations" shows a decline of 492, the total being 2,968. The number of sessions shown as devoted to treatment is 732 and is less than the total for 1934 as this figure does not include those sessions occupied in the treatment of the Abbey School scholars, reference to which is given in another report. The general improvement in the dental condition of the Barking Elementary School child permits an increase in all types of work. More schools are inspected, and operative work is accelerated owing to the falling off of gross dental conditions. Marked dental neglect is now seen but rarely, and a much greater interest is displayed by parents in conservative work, an interest in no small way due to the desire of the child to have a tooth saved rather than lost. This is particularly noticeable with senior girls and an acceptance figure of over 80 per cent, confirms the popularity of the dental service. Nevertheless, the necessity of lectures to children of twelve years old and over is still a matter of great importance, and it is hoped that arrangements will be made for these lectures to be given as an integral part of every inspection. In cases where this has been undertaken, the acceptances from the school have been extremely gratifying. The assistance of Head-Masters and Head-Mistresses at inspections has greatly facilitated this work, and the teaching staff as a whole have rendered a great service during the year in advising both pupils and parents. I wish to offer to the Medical and Nursing staff and the Dental staff at the Clinics full recognition and thanks for their assistance and willingness to co-operate in the furtherance of the dental service. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, (i..d.s., r.c.s. eng.), Public Dental Officer. 142 REPORT ON THE WORK OF THE OPHTHALMIC CLINICS. The Clinics held by Mr. W. A. Gray, F.R.C.S., began on the 14th May, 1935, and seventy sessions were held during the year. Cases referred to the eye clinic can be divided into two groups :— (1) Visual Defects. (2) External Eye Diseases. The latter group is the smaller but none the less important because some of these cases are contagious and prompt treatment limits spread of the disease. Daily treatment at the clinic ensures quick recovery and prevents cases becoming chronic, a not infrequent sequel of inadequate attention. Minor operations are performed at the clinic while more serious conditions requiring in-patient treatment are admitted to Queen Mary's Hospital. Visual defects in children consist chiefly of long sight and short sight. Each condition entails some disadvantage or even danger of permanent disability. Many cases are remedied by the wearing of suitable glasses but in others the visual symptoms are due to disease elsewhere. In hypermetropia or long sight the wearing of glasses may remedy the visual defect equally in both eyes. Frequently, however, it is found that although both eyes are normal the vision is unequal. In other words, one eye is used to a much greater extent than the other. Such children are potential "squinters." Measures must be taken to restore the vision of the neglected eye while there is yet time, for neglect to do so will produce permanent loss of good vision. Where an actual squint is present, treatment should be instituted forthwith. A special record of all such cases is kept and frequent attendance at the clinics is arranged. In addition, the co-operation of parents and teachers must be obtained if the best results are to be hoped for; in Barking I have been much impressed by the eagerness with which this scheme has been adopted by all concerned. 143 In 1036 a fully equipped squint training department will be instituted. Preliminary to the actual training, all eases of squint and of defective vision in one eye must first be carefully prepared. Various measures are adopted to restore the vision of the "lazy eye." These consist in the administration of drops to the second eye which make the child use the squinting eye while reading and doing other close work. If this is insufficient an occluder is worn. Detailed instructions are given to the parents and the child is seen once a month at the Clinic when its progress is recorded. The other type of visual defect is short sight and here the danger lies in the rapid increase of this condition rendering the wearing of powerful glasses permanent. Much may be done to mitigate this risk by special attention being given to the child at school. In all such cases a letter advising easy treatment is sent to the parents and teachers. This "easy treatment" naturally varies with the individual case. Our aim is to do everything possible to retard the increase in the short sight while not interfering too much with normal education. It is only in severe cases that all reading, etc., is stopped. Children suffering from short sight are examined at least every twelve months and in some cases as often as every term. It may be asked to what extent the visual defects found in school children are inevitable and does environment play any part in their production. Of those defects which can be classed as inevitable, squint and short sight must both be included. Of course, many parents tell you that the squint was only noticed after some illness, e.g., Measles, and while this illness may, from its weakening effect generally, have caused the squint to develop, the underlying factors were already present. Thus, during the past year, I have seen at Barking Hospital two cases of squint following Diphtheria. Both patients were cured by simple treatment in the course of some 12-14 days, because no factor other than Diphtheria was present. The factors producing the common type of squint are either an excessive degree of long sight or some hereditary predisposition. Such cases of squint require long and patient treatment if the vision of both eyes is to become normal. As regards short sight this often runs in families. It is the aim of all our treatment to limit the degree of short sight, for in the lesser degrees it hardly forms any disability. Children with a tendency to short sight often get worse from an environment which they themselves create. Instead of playing games they are always reading. This constant use of the eyes for near vision is to be deprecated. It will be seen that much may be done in an Ophthalmic Clinic to prevent disability which, after all, is the aim of all work in public health. 144 STATISTICS RELATING TO OPHTHALMIC CLINICS DURING 1935. TABLE 1. No. of refractions under atropine 497 No. of post-mydriatic tests 169 No. of spectacles prescribed 466 No. of letters (in the case of "myopes") sent 88 No. of squint cases 23 All spectacles were checked before being issued at the Clinics. TABLE 2. External Diseases of the Eye treated at the Clinics :— Conjunctivitis and Rlepharitis 33 Hordeolum 8 Phylectenular Keratitis 7 Injuries 8 Foreign body in eye 5 Corneal nebulae 5 Dacrocystitis 3 Meibomian Cyst 2 Artificial eye 2 Dermoid of cornea 1 TABLE 3. Total No. of Attendances 1,539 Percentage attendance of appointments made 93 145 SCHOOL MEDICAL SERVICE. Statistical Tables—Public Elementary Schools, 1935 TABLE I.— RETURN OF MEDICAL INSPECTIONS. A.— Routine Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 1,866 Second Age Group 1,901 Third Age Group 2,304 Total 6,071 Number of other Routine Inspections 824 Grand Total 6,895 B.—Other Inspections. Number of Special Inspections 8,373 Number of Re-Inspections 15,405 Total 23,778 C.—Children found to require Treatment. Number of individual children found at Routine Medical Inspection to require Treatment (excluding Uncleanliness and Dental Diseases). Prescribed Groups :— Entrants 181 Second Age Group 288 Third Age Group 320 Total Prescribed Groups 789 Other Routine Inspections 137 Grand Total 926 146 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER, 1935. 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) Skin _ (!) Ringworm—Scalp — — 15 — (2) Body 2 — 10 — (3) Scabies 9 — 69 — (4) Impetigo 4 — 155 — (5) Other Diseases (NonTuberculous) 31 22 370 5 Totals (Heads 1-5) 46 22 619 5 Eye (6) Blepharitis 39 6 111 1 (7) Conjunctivitis 29 2 247 1 (8) Keratitis 1 — 4 1 (9) Corneal Opacities 1 — 4 (10) Other Conditions (excluding Defective Vision and Squint) 4 8 135 2 Totals (Heads 6-10) 74 16 501 5 (11) Defective Vision (excluding Squint) 542 103 208 22 (12) Squint 41 12 16 6 Ear '(13) Defective Hearing 6 5 4 4 (14) Otitis Media 3 5 10 1 (15) Other Ear Diseases 54 30 256 3 Nose and Throat (16) Chronic Tonsillitis only 156 421 301 44 (17) Adenoids only 9 12 5 3 (18) Chronic Tonsillitis and Adenoids 33 40 28 10 (19) Other Conditions 30 42 448 27 (20) Enlarged Cervical Glands (NonTuberculous) 4 73 110 10 (21) Defective Speech 24 8 6 3 Heart and Circu- lation Heart Disease: (22) Organic — 100 2 20 (23) Functional 1 101 — 52 (24) Anaemia 5 60 15 15 Lungs '(25) Bronchitis 12 63 94 15 (26) Other Non-Tuberculous Diseases 2 63 57 15 147 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: (27) Definite — 1 — — (28) Suspected — — — 1 Non-Pulmonary: — — — — (29) Glands — 2 2 (.30) Bones and Joints — — 1 1 (31) Skin — — — — (32) Other Forms — 1 — — Totals (Heads 29-32) — 3 1 3 Nervous System (33) Epilepsy — — — 2 (34) Chorea 3 17 9 20 (35) Other Conditions 3 37 31 30 Deformities - (36) Rickets 5 4 (37) Spinal Curvature 12 12 6 1 (38) Other Forms 68 48 23 22 (39) Other Defects and Diseases (excluding Uncleanliness and Dental Diseases) 113 357 2,496 185 Totals 1,246 1,655 5,246 524 148 TABLE II. (B)—CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Age-groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. o/ /o No. o/ /o No. °/ /o No. % Entrants 1,866 528 28.3 1,218 65.3 106 5.7 14 0.7 Second Age-group 1,901 496 26.1 1,349 70.9 51 2.7 5 0.3 Third Age-group 2,304 919 39.9 1,357 58.9 24 1.0 4 0.2 Other Routine Inspections 824 346 42.0 466 56.6 11 1.8 1 0.1 Total 6,895 2,289 33.2 4,390 63.7 192 2.8 24 0.3 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Blind Children. At Certified Schools for the Blind At Public Elementary Schools At other Institutions At no School or Institution Total 1 — — — 1 Partially Sighted Children. At Certified Schools for the Blind At Certified Schools for the Partially Sighted At Public Elementary Schools At other Institutions At no School or Institution Total — — 5 1 2 8 149 TABLE III.—continued. Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no Sehool or Institution Total 10 — — — 10 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 75 2 — — 77 Epileptic Children. Children Suffering from Severe Epilepsy. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 1 — — 2 3 150 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 - (-) - (4) 2 (-) - (-) 2 (4) 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 Klementary Schools At other Institutions At no School or Institution Total 2 (5) 4 (27) 7 (-) 1 (-) 14 (32) 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 70 — — 3 79 151 TABLE III.—continued. C.—Crippled Children. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 12 — 1 1 14 D.—Children with Heart Disease. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 38 — — 1 39 Children Suffering from Multiple Defects. Combination of Defect At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total Feeble-minded and Tuberculous 2 — — — 2 Feeble-minded and Crippled 2 — — — 2 Feeble-minded and Epileptic 1 — — — 1 Crippled and Epileptic 1 — — — 1 Crippled and Deaf — — — 1 1 Tuberculous and Heart — — — 1 1 152 FORM 307M.—STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1935, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total No. of Children Notified 10 Analysis of the above Total. Diagnosis Boys Girls I. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School: (a) Idiots 1 — (b) Imbeciles — — (c) Others 2 — (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 6 1 3. Feeble-minded children notified under Article 3, i.e., " special circumstances " cases — — 4. Children who in addition to being mentally defective were blind or deaf — — GRAND TOTALS 9 1 153 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31ST DECEMBER, 1935. GROUP I.—Minor Ailments (excluding Uncleanliness, for which see Table VI). I)ofeet or Disease Number of Defects treated, or under treatment during the year Under the Authority's Scheme Otherwise Totals (1) (2) (3) (4) Skin— Ringworm—Scalp : (i) X-Ray Treatment 6 — 6 (ii) Other 9 — 9 Ringworm—Body 11 1 12 Scabies 67 2 69 Impetigo 157 2 159 Other skin disease 237 9 246 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 447 2 449 Minor Ear Defects 274 7 281 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 2,078 72 2,150 Totals 3,286 95 3,381 154 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) 767 65 832 Other Defect or Disease of the Eyes (excluding those recorded in Group I) Totals 767 65 832 Number of children for whom spectacles were prescribed :— (a) Under the Authority's Scheme (b) Otherwise Total 613 65 678 Number of children who obtained spectacles :— (a) Under the Authority's scheme (b) Otherwise Total 593 60 653 155 TABLE IV.—continued. GROUP III.—Treatment of Defects of Nose and Throat. Number of Defects. Defect Received Operative Treatment Received other forms of Treatment Total number treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Totals (1) (2) (3) (4) (5) (6) Tonsils only – 20 20 211 543 Adenoids only 2 2 4 T'sandA's 294 12 306 Other — 2 2 Totals 296 36 332 211 543 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 orthopaedic clinic Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopædic clinic Number of children treated 4 1 243 — 2 2 252 156 TABLE V. DENTAL INSPECTION AND TREATMENT. (1) Number of Children who were :— (a) Inspected by the Dentist: Aged : Routine Age Groups 5 207 6 323 7 481 8 502 9 469 10 629 11 500 12 643 13 383 14 65 Total 4,202 (b) Specials 1,318 (c) Grand Total (Routine and Specials) 5,520 (2) Found to require treatment 4,471 (3) Actually treated 3,817 (4) Attendances made by children for treatment 7,951 (5) Half-days devoted to :— Inspection 23 Treatment 732 Total 755 (6) Fillings :— Permanent teeth 3,606 Temporary teeth 16 Total 3,622 157 TABLE V.—continued. (7) Extractions :— Permanent teeth 1,673 Temporary teeth 8,763 Total 10,436 (8) Administrations of general anaesthetics for extractions 3,779 (9) Other Operations :— Permanent teeth 2,968 Temporary teeth Total 6,747 TABLE 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 45,169 (iii) Number of individual children found unclean 1,315 (iv) Number of children cleansed under arrangements made by the Local Education Authority 39 (v) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 6 (b) Under School Attendance Byelaws — 105 (5) FINDINGS OF MEDICAL INSPECTION. Table II (A) on pages 146 and 147 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 I (C) of the Returns to the Board of Education (given on page 145 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 1,866 181 9.7 Second age group 1,901 288 15.1 Third age group 2,304 320 13.9 Totals (prescribed groups) 6,071 789 13.0 OTHER ROUTINE INSPECTIONS 824 137 16.6 (a) Malnutrition.—Last year I pointed out that, in estimating to what extent malnutrition exists among school-children, the most reliable figures are those relating to cases found during routine and special inspections. Last year out of 4,117 children so examined it was found that 4,107 children were satisfactorily nourished. This year the figures are arranged somewhat differently, and out of 6,895 children examined, it was found that in 6,871 cases nutrition was satisfactory. It is very difficult indeed to assess nutrition in terms " excellent," " normal," " slightly subnormal " and " bad," and of course, the personal factor of the examining medical officer is an important one. It must of necessity be some time before a reasonably stable standard of values is available to compare one year with another and one part of the country with another. It is a matter of congratulation that for every child whose nutrition is said to be " bad " there are 100 children who are said to be " excellent." 106 (b) Uncleanliness.—As the Committee already know, I hold the opinion that for a boy's head to be verminous is so unnecessary that it is by the same token disgraceful, and the parents and guardians of these boys should be dealt with severely. There is no justification whatsoever for a boy being absent from school for a dirty head, and I do believe that if these cases were dealt with severely we should get a higher standard of cleanliness, not only among the boys but among the girls also. The Sisters, not only in your Hospital but elsewhere, all have the same tale to tell, that one of the first duties is to clean up the heads of these infested children, when they are admitted to hospital for one reason or another. It is curious to see what change comes over school-girls soon after they leave school—the number of verminous heads becomes relatively small when compared with the number found among girls of school-age. It is no doubt not due to the fact that they have left school but that they have grown into the age when they begin to preen themselves and take pride and joy in making themselves beautiful. Perhaps the most advantageous way of dealing with girls is by frank encouragement, and although this Report will be read by many who have a far clearer insight into the mental make-up of girls than I have, I would like, tentatively, to put forward a possible basis of discussion—the possibility of making girls conscious of their hair as an adornment at an earlier age than obtains at the present time. The following table shows the results of cleanliness inspections compared with similar figures for 1934 :— 1934 1935 Number of examinations of children in the schools by School Nurses 41,499 45,169 Number of individual children found unclean 1,583 1,315 Number of uncleanliness findings 2,553 2,110 During the year, 39 children were cleansed by the Local Authority, and in six cases legal proceedings were taken under Section 43 of the Education Act, 1921. (c) Minor A ilments and Diseases of the Skin.—With over thirty-seven t housand 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. 107 The Minor Ailments Clinics also deal effectively with cases of minor diseases of the skin such as impetigo, ringworm of the body scabies, and any other skin disease which presents itself. (d) Visual Defects and External Eye Disease.—Details of the findings at routine and special inspections will be found on pages 146 and 147 of this Report. Readers of this Report will have noted that there were 6,895 children examined by routine inspection. Of these 6,088 were found to have normal vision and the remaining 807 were referred for treatment for this defect. Of the total number of children examined by routine inspection 99 per cent. were free from any external eye disease and in the remaining 1 per cent. the majority were minor and incidental inflammations, not likely to lead to any residual disability. The chief value of examining eyes for visual defects and other diseases is to compute how far education in school is favourable to eyesight, and how far it is prejudicial to good vision. With such a large floating population as we have in Barking, and the great difficulties which we have experienced subsequent to the large increase in population, it is not possible to give statistical evidence one way or another, but I have asked your consulting ophthalmic surgeon to advise me should he find any evidence that the environment of school-life is prejudicial to the maintenance of normal vision. From such observations as I have been able to make, I have not, however, been able to trace any detrimental effect of school-life on normal vision, but your ophthalmic work is now being carried out much more thoroughly than heretofore, and future reports will, I hope, be able to speak with assurance on this matter. (e) Nose and Throat Defects.—Last year I was in the happy position to report a reduction in the number of cases of tonsils and adenoids which routine examinations found to need treatment. This year your officers have examined a much larger number of children, and there is an increase in the number of children requiring treatment and observation for these defects, but I am in the happy position to be able to report further that the 671 children found with such defects represent in proportion to the number examined, a slight decrease to the previous year. 108 It still obtains, however, that only 6,224 children were found satisfactory as far as tonsils and adenoids are concerned and in my opinion this is not a sufficiently high number. As the Committee knows I am anxious that the co-ordinated medical services of the Council should have an Ear, Nose and Throat Clinic. Its first duty would be to investigate the whole problem in the hope of bringing about a happier state of affairs. That such a Clinic of course would have to indicate remedial measures goes without saying, but I do hope it will lead to a large measure of prevention. (f) Ear Disease and Defective Hearing.—So far as hearing and the health of the ear are concerned, it is found that quite a high percentage of the children are normal. Of the children examined, 96 per cent. were found to be normal, but contrasting this with what I have said about external eye disease, which is usually slight and transient, the 4 per cent. children who have trouble with their ears oftentimes present medical difficulties of some magnitude. What I have said about the establishment of an Ear, Nose and Throat Clinic in the preceding section, can be repeated here with emphasis, because undoubtedly defective hearing does militate against the development and happiness of the child in later life. (g) Dental Defects.—Details of the healthfulness of your children's teeth are dealt with, in detail, in that section of this Report for which I am indebted to Mr. W. H. Foy, your Senior Dentist. I would further emphasise that the large incoming school population seems to have had somewhat less dental service than your own, and the relatively large floating school population makes it difficult for me to compare from year to year the value of the work you are doing in maintaining oral hygiene. (h) Orthopa'dic and Postural Defects.—The findings of routine medical inspection show a condition of affairs which is, on the whole, satisfactory. The years which you have given to the study of this problem, and the work which you have carried out through your officers, particularly Mr. B. Whitchurch Howell who is your Consulting Orthopaedic Surgeon, have borne fruit. Of the children examined 99.2 per cent. were found to be quite normal from this aspect, and the 114 children who were found not quite normal were mostly suffering from relatively minor defects. In saying these were relatively minor defects I am speaking from the surgical standpoint. These minor defects are oftentimes of the utmost importance to the child—flat feet for instance, whilst by no means a major surgical defect, can lead to a degree of tiredness and consequent nervous exhaustion which militates against the health and happiness of the individual. Minor degrees of a crooked spine can alter the poise of the body and the position of the internal organs with resultant impairment of health and comfort. 109 (i) Heart Disease and Rheumatism.—Of approximately seven thousand children examined at routine inspections all save 267 were found to be what is considered normal. I believe, however, that here we have a vast field for research, and I fear the results of such an investigation would be to show that we are so used to listening to hearts which have been affected by rheumatism, and which have somewhat less than fully recovered, that we look upon these cases as usual, and for all practical purposes the word " usual " may be looked upon as the word " normal." Now that the scientific experts have made instruments which can accurately measure noises, I am sure that an investigation could be carried out on the relative intensities of the first and second heart sounds among ordinary children in different parts of England, and I am inclined to believe we should find in Barking, which is in the Thames Valley, that generally speaking the second heart sound is accentuated. (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. Seven cases of Tuberculosis amongst children of school age were notified to the Medical Officer of Health during the year. Of these, one was pulmonary, and six were non-pulmonary. In addition, four notified cases of Tuberculosis amongst school-children were transferred to this area. Of these one was pulmonary, and three were non-pulmonary. The following table shows the position with regard to notification of Tuberculosis amongst children of school-age during 1935 :— Notified during 1935 (including transfers) Pulmonary 2 Non-Pulmonary 9 Total 11 De-notified (of the above) Pulmonary Non-Pulmonary 2 Total 2 110 (k) Other Defects and Diseases.—A few cases of other defects and diseases, not included in the above, were also seen at school medical inspection, e.g., some children were found to be suffering from kidney trouble and one or two from deficiency in the activity of the glands of the body. (6) FOLLOWING-UP. The School Nurse who attends the routine medical inspection also carries out the following-up work arising from the inspection. The parents are visited in their homes, and the attention of the parents is drawn to the need for treatment, and parents who were not able to be present at the medical inspection are interviewed at home by the School Nurse, who emphasises the necessity for having treatment and advises them in what way the treatment may be obtained. A summary of the following-up work by your School Nurses is given herewith :— Number of visits to schools re medical inspection 506 Total number of visits to schools 640 Number of home visits in connection with :— 1931 1932 1933 1934 1935 (a) Routine medical inspections 4,480 4,817 6,610 6,786 5,605 (b) Infectious disease 295 408 230 1,022 475 (c) Cleanliness inspections 181 119 284 827 454 (d) Non-attendance for treatment (Minor Ailments, etc.) 86 82 35 51 33 (e) Miscellaneous — — 126 418 216 It has been pointed out in previous Reports that this summary is only an imperfect picture of the whole of your work in Barking. It is not necessary for me to go into detail, but as you know the Hospital and the Maternity and Child Welfare work and other work you carry on is all linked up together, and still further co-ordination has just been achieved by the appointment of the Senior Health Visitor and School Nurse. 111 (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.—One-third of the children examined during the year were found to be of excellent nutrition, and at first sight it would appear that such are in need of no treatment whatsoever. A curious thing, however, is that oftentimes when such children as these are grown-up and go abroad to the Colonies, they in turn have children who are often better nourished than their parents. Much will have to be done before we can say these children, excellent according to our standards today, are really excellent in the sense that they have achieved in health and stature all of which they are capable. What I have said with reference to treatment in regard to those of excellent physique can, of course, be said with even greater emphasis of those of normal physique. With regard to those of indifferent and bad nutrition it is difficult to speak of treatment. You do give free milk in your schools, you do arrange for free meals by the thousand, you do arrange for these puny people to be admitted, where necessary, to your special school and, together with other children, they have the advantage of your Holiday and Summer Camps. Whenever they come to your notice, and I think there are very few which do not, each is the subject of a special enquiry, but all this notwithstanding it is unsatisfactory to find even 3.1 per cent. children whose nutrition is considered to be below normal. First, however, I want to dissociate myself from the gloomy pessimists and to point out the 2,250 of excellent nutrition, as well as speaking of the 192 who were of poor nutrition, and the 24 whose nutrition was bad. Secondly, I want to say that we do not know enough about nutrition to be able to speak authoritatively ; thirdly, to point out that your arrangements in Barking are such that the cases of poor nutrition which are simple, are generally speaking, adequately dealt with, so that all the remaining cases are difficult; and fourthly, these latter cases are cases of really bad nutrition and usually present a very complex problem, in which social conditions, heredity and disease all play their respective parts. From what I have heard of emigrants to Canada it would appear they compare unfavourably in physique with the fine upstanding men who are both born and reared in the wide open spaces of the great farms of Western Canada. 112 It would appear the whole problem of nutrition is largely linked up with dynamic forces rooted in the ante-natal life and the life of the newly born. When once the chance of these dynamic forces has been missed all other attempts to vary nutrition are bound to be difficult and are likely to be, at the most, incompletely successful. Nor must we look for success from direct frontal attacks ; to achieve success it would be necessary to alter many ingrained habits. Already you have made a start in getting grown-up children to believe that milk is no longer infants' food. This beginning must be extended—eggs and butter might very well, even at a price, find their way much more commonly than at present in the free meals you provide. Not only is it a means of making these meals better in themselves but as a means of educating children to like dairy produce, and to come to regard it as a part of their everyday life. So also with fruit and vegetables. Here, however, I come up against problems of transport and distribution of which I am not qualified to speak, but the 2½d. per day which is said to be the average amount spent on fruit in the poorer houses now should be materially increased. When I say materially increased I am not thinking in terms of merely doubling it. After the food has been purchased, and when it has been properly cooked, even after proper mastication there still remains the problem of digestion, and it is quite open to doubt as to if and whether we can expect the best when your school-children have to snatch a meal in between two strenuous courses of study during the day. (b) Uncleanliness.—So far as uncleanliness is concerned it has, hitherto, been your policy that the right place for this to be treated is the home, and where it is found practicable uncleanliness is dealt with in this way. As I have pointed out in previous years, however, in obstinate and difficult cases the cleansing of heads is undertaken by School Nurses at your Clinics. It is also undertaken by them in cases where, owing to illness, the home circumstances make it impracticable for the parents to carry out the necessary cleansing. (c) Minor Ailments and Diseases of the Skin.—Your arrangements for the treatment of minor ailments and diseases of the skin remain essentially the same as last year. These cases are dealt with every morning at the Central Clinic but whereas they were also dealt with at the Greig Hall, Stamford Road, this latter work was transferred on the 12th October, 1935, to the new Woodward Clinic, Woodward Road. This new Clinic, together with a Branch Library, has been erected on a site of about a quarter of an acre at the corner of Stamford and Woodward Roads. The whole of the accommodation is provided on the ground floor. By the courtesy of the Architects, Messrs. H. H. Dawson and H. W. Allardyce, a sketch plan of the Clinic will be found on page 113.