BOROUGH OF BARKING REPORT OF THE Medical Officer of Health For the Year 1936 C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.G.P., D.P.H. 3 TABLE OF CONTENTS. Page STAFF 7, 8 INTRODUCTION 0 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Age Mortality 13 Area 10 Births 10-12, 18 Births, Notification of 18 Deaths 10-17 Deaths, Causes of (Table) 13-16 General Statistics 10 Housing 20 Illegitimate Births 10,18 Industries 18 Infant Mortality 10-12, 15-17 Infant Mortality (Table) 15 Inhabited Houses 10 Inquests 14 Malnutrition 21 Mortality, Epidemics, etc. 17,18 Neo-Natal Mortality 15-17 Population 10 Rateable Value 10 Social Conditions 18-21 Still-births 10-12, 18 Travelling Facilities 20 Unemployment 19,20 Vital Statistics 10-12 Zymotic Diseases, Deaths from 13 SECTION B.- GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Ambulance Facilities 24,25 Ante-Natal Clinics 31-32, 30, 37 Ante-Natal Supervision 30,37 Artificial Immunisation 33-34, 42, 43, 46 Artificial Sunlight Clinic 42,48 Burking (Infectious Diseases) Hospital 25, 27-30 Baths for Expectant and Nursing Mothers 40 Children and Young Persons Act, 1932 43 Clinics and Treatment Centres 26, 31-35 Convalescent Treatment 42,46 Dental Surgeon, Report of 55 Dental Treatment 42, 46, 56 Difficult Labour, Consultations in 47 East Barking District Nursing Association 35 Eye Defects 42,47,49-50 Foster Children 43 Gynæcological Clinic 31-32, 39, 46 Home Nursing 35 Hospital Services 25—26, 27-30 Hospital Services, Tables of 27-30 Illegitimate Children 41 Infant Life Protection 43 Infant Welfare Clinics 31,32,44,47 Laboratory Facilities 23-24 4 SECTION B—Continued Page Maternal Mortality 40—11 Maternity and Child Welfare Services 36-56 Maternity Homes 43,47 Midwifery 37-39 Midwives Acts 30-39 Minor Ailments 33-34, 43 Nursing Homes 43 Obstetrics and Gynaecology, Consultations in 40 Ophthalmia Neonatorum 41 Ophthalmic Service 42, 49-50 Orthopaedic Clinic, Report of Work Done 51-54 Pathological Unit 23-24 Pemphigus Neonatorum 40 Plaistow Maternity Hospital and District Nurses' Home 35,39 Post-Natal Care 39 Provision of Dinners 40 Provision of Dried Milk, etc 45 Provision of Fresh Milk 45 Provision of Spectacles 47 Public Hospital Services 23-20, 27-30 Puerperal Fever and Puerperal Pyrexia, Consultations in 47 Services Provided and Facilities for Treatment 40-48 Specialist-Consultant Ante-Natal Clinic 31-32, 40 Specimens Submitted to Laboratory for Examination 23 Still-births 37 Supervision of Midwives 37-39 Tonsils and Adenoids 41, 48 Ultra Violet Light Clinic 42,48 Upney (Maternity) Hospital 25,39 Visiting in the Home 44-45 Voluntary Hospital Services 25-20, 27-30 X-ray Treatment for Ringworm 48 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. Bed Bugs, Eradication of 73 Cesspools 59 Closet Accommodation 59,02 Common Lodging Houses 07 Creeksmouth Generating Station 70 Dampness 03 Defects found under the Factory and Workshop Act, 1901 05 Drainage and Sewerage 58,02 Dustbin Maintenance 33 Dwelling Houses, Inspection of 60, 601 Factories, Inspection of 61 Factory and Workshop Act, 1901 64-65 Home Work 65 Houses Let in Lodgings 67 Miscellaneous Sanitary Inspections 62 Miscellaneous Sanitary Work carried out 64 Noise Nuisances 71 Notices Served 61 Offensive Trades 67 Out-workers 66-61 Pail Closets Paving PiggeriesPort of London Authority Premises and Occupations controlled by Byelaws and Regulations 61 67-68 Public Cleansing 59 5 SECTION C—Continued Page Rag Flock Acts, 1911 and 1928 68 Rainfall 57 Refuse Disposal 60 Refuse Storage and Collection 59 Refuse Tips 60 Registered Workshops 66 Repairs, General 63 Rivers and Streams 58 Sanitary Inspection of the Area 60-67 Sanitary Work, Summary of 62-64 Schools 72 School Closure 72 Schools, Sanitary Inspection of 72 Shops Act, 1934 68-69 Sinks 62 Smoke Abatement 69-70 Stables 68 Street Cleansing 59 Swimming Baths 71 Tents, Vans and Sheds 67 Trade Refuse 59 Ultra Violet Light Radiation 72 Underground Sleeping-rooms 67 Water Supply 57, 63 Workplaces, Inspection of 61,64 Workshops, Inspection of 61,64 SECTION D.—HOUSING. Clearance Areas 79 Houses Built in the District, 1926-1936 76,77 Houses Erected during the Year 75 Housing Act, 1935 78 Housing Conditions 76-79 Housing Defects Remedied 75-76 Housing Inspections 75 Inhabited Houses, Number of 70 Overcrowding 78 Proceedings under Public Health Acts 76 Proceedings under the Housing Act, 1930 78 Redevelopment 79 Rehousing 78 Small Dwellings Acquisition Act 77 Temporary Buildings 77 Unfit Dwelling Houses 75-76 SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food 84-85 Animals Slaughtered 82 Bacteriological Examination of Ice-Cream 82,85 Bactcriological Examination of Milk 81,85 Barking Corporation Act, 1933 82 Bottling of Milk 82 Chemical Examination of Food 85 Diseased Meat Destroyed 82-84 Food and Drugs (Adulteration) Act, 1928 84 Graded Milk Licences Granted 81-82 Ice-Cream 82 6 SECTION E.—Continued. page Meat and Other Foods 82-81 Milk and Dairies Order, 1926 82 Milk (Special Designations) Order, 1923 81-82 Milk Supply 81-82 Nutrition 85-86 Prosecutions 82,84, 85 Slaughter-houses 82 Unsound Food Destroyed 84 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Acute Anterior Poliomyelitis 88-90,92 Admissions to Barking (Isolation) Hospital (Table) 92 Artificial Immunisation 93 Barking (Isolation) Hospital 92 Cancer 93-95 Cerebro-spinal Meningitis 88-90,92 Diphtheria 87-92 Diphtheria Notifications (Monthly Summary Table) 91 Enteric Fever 98-90,92 Erysipelas 88-90,92 Infectious Diseases (Tables) 88-91 Influenza 92 Measles 91 Measles and Pneumonia 88-90 Non-Notifiable Acute Infectious Diseases 91-92 Notifiable Infectious Diseases 87-91 Notifications classified according to Wards (Table) 89-90 Ophthalmia Neonatorum 88-90, 92, 95-90 Pemphigus Neonatorum 88-90 Pneumonia 87,88-90,92 Prevention of Blindness 95-96 Puerperal Fever and Pyrexia 87,88-90,92 Rheumatic Fever 91 Scabies 92 Scarlet Fever 87-92 Scarlet Fever Notifications (Monthly Summary Table) 91 Smallpox 88-90 Summer Diarrhoea 91 Tuberculosis 96-98 Tuberculosis, New Cases and Deaths (Table) 96 Unnotified Fatal Cases of Tuberculosis. 90 Whooping Cough 91 7 STAFF, 1936. Medical Officer of Health, School Medical Officer, Medical Superintendent, Barking and Upney Hospitals: C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. 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. (Resigned 30th June, 1936.) J. MERVYN THOMAS, M.D., B.Sc., D.M.R.E., L.R.C.P., D.P.H. (Commenced 7th Sept., 1936.) CATHERINE B. McARTHUR, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Ophthalmic Surgeon: WILLIAM ADAMSON GRAY, M.B., Ch.B., F.R.C.S., Ph.D.* Orthopedic Surgeon: B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Specialist Consultant in Obstetrics and Gynecology: JAS. VINCENT O'SULLIVAN, M.D., F.R.C.S. Consultant Ear, Nose and Throat Surgeon: CYRIL R. SANDIFORD, M.D., F.R.C.S. Resident Medical Officer, Barking Hospital: Miss ENID L. WEATHERHEAD, M.B., B.S., M.Sc., D.C.H. Consultant Pathologist: Miss EDITH A. STRAKER, M.B., B.S., D.P.H. Dental Surgeons: W. H. FOY, L.D.S., R.C.S. H. S. SARSON, H.D.D., L.D.S., D.P.D. M. COHN, L.D.S., R.C.S. (Commenced 2nd November, 1936.) Scientist: Miss EVELYN M. HILL, Ph.D., Dip. Bact. Sanitary Inspectors: N. BASTABLE (Chief Sanitary Inspector) (b, c, d, amd /). H. CARR (b, c, e and I). C. S. COOK (b and c). E. G. TWEEDY (a and c). H. H. MADAMS (a and c). (Commenced 16th March, 1936.) Matron, Barking and Upney Hospitals—Inspector of Midivives: Miss M. W. HEDGCOCK (h, i and j). 8 Health Visitors: Miss P. M. FAWCETT (Senior Health Visitor and School Nurse) (g, h and i). *Miss M. BAERLOCHER (g, h and i). *Miss C. COURT (g, h and i). Miss G. ELLIOTT (a, h and k). (Resigned 18th July, 1936.) Miss G. GEDEN (Dental Nurse) (q). Miss S. E. W. GIBSON (j). *Miss G. JONES (g, h and i). Miss R. LLEWELYN (Dental Nurse) (h and i). *Miss W. PARKER (g, h and i). Miss A. K. ROE (Masseuse) (n). Mrs. G. STOKES (g and i). Miss L. F. SWAIN (h and i). Mrs. W. WALTON (a, h andk). *Miss M. F. WHALLEY (g, h and i). (Commenced 28th September, 1936.) Clerical Staff: Chief Clerk—F. READ. C. G. EAGLESFIELD (Senior Assistant). Miss H. NUNN. H. C. DAVIS. Miss H. KING. A. J. STORER (m). (Resigned 4th April, 1936.) Miss A. LIGGINS. F. YATES (p). Miss D. FOULSIIAM. G. H. RUFF. Miss I. CAST. E. A. ELLIS. Miss G. COOPER. E. INGS (o). (Resigned 5th September, 1936.) Miss I. W. MATIIIESON. D. F. W. SCOTT. (Commenced 13th July, 1936.) (Commenced 13th July, 1936.) L. J. DEXTER. (Commenced 5th October, 1036.) Disinfector and Mortuary Attendant: H. LONG. (а) Sanitary Inspector's Certificate of Sanitary Inspectors' Examination Board. (b) Sanitary Inspector's Certificate of Royal Sanitary Institute. (c) Meat, etc., Inspector's Certificate of Royal Sanitary Institute. (d) Smoke Inspector's Certificate of Royal Sanitary Institute. (e) Building Inspector's Certificate of Worshipful Company of Carpenters. (/) Sanitary Science Certificate of Royal Sanitary Institute. (g) Health Visitor's Certificate of Royal Sanitary Institute. (h) Certificate of Central Midlives Board. (i) General Hospital Training. (j) General Fever Training. (k) Health Visitor's Diploma of Board of Education. (/) Smoke Inspector's Certificate of L.C.C. School of Engineering. (m) Sanitary Inspector's Certificate of Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (n) Certificate of Chartered Society of Massage and Medical Gymnastics, Medical Electricity, Light and Electro-Therapy. (o) Inter B.Sc., University of London. (p) Filial Examination of the National Association of Local Government Officers. (q) Registered Sick Children's Nurse. (r) 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, 1936. PUBLIC HEALTH OFFICES, BARKING, ESSEX. May, 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, 1936. 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, 1936) (Registrar-General's Estimate) 7,000 Number of Inhabited Houses, March, 1937, according to Rate Books:—- Houses 17,892 Shops 1,288 Total 19,180 Population Density, i.e., No. of persons per acre 18.2 Rateable Value—General £667,741 0 0 Sum represented by a penny rate £2,642 10 3 Education rates:— Elementary *Secondary Included in General Rate Figure 3 71 81 General Rate 14 0 * Including County Precept. 2. Extracts from Vital Statistics for the Year. Live Births:— Total. Males. Females. Birth Rate. Legitimate 1,175 568 607 15.40 Illegitimate 20 11 9 0.26 Totals 1,195 579 616 15.72 Rate per 1,000 total births:— Still-births:— Legitimate 31 19 12 26.1 Illegitimate 1 — 1 Deaths 608 (60-1) 300 (299) 308 (305) Death Rate 8.0 (7.9) Percentage of total deaths occurring in public institutions, 54.3. Deaths. Rate per 1,000 total (live and still) births. Deaths from puerperal causes:— Puerperal sepsis 1 0.81 Other puerperal causes 2 1.63 Totals 3 2.44 Number of deaths of infants under one year of age:— Total Infantile Death Rate. Males. Females. Total. Death Rate. Legitimate 31 34 65 55.3 56.07 Illegitimate 1 1 2 100.0 Number of deaths from Measles (all ages) 14 „ „ Whooping Cough (all ages) 7 (8) 8(6) ,, „ Diarrhoea (under 2 years of age) (N.B.—Where the Registrar-General's figures and rates differ from those prepared locally, * the former are shown separately in brackets.) 3. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1936. (England & Wales, London, 122 Great Towns, and 143 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 14.8 0.01 12.1 0.01 0.00 0.07 0.01 0.05 0.07 0.14 0.52 5.9 59 122 County Boroughs and Great Towns, including London 14.9 0.07 12.3 0.01 0.00 0.09 0.01 0.06 0.08 0.14 0.45 8.2 63 143 Smaller Towns (Estimated resident populations, 25,000 to 50,000 at Census, 1931) 15.0 0.04 11.5 0.00 0.00 0.04 0.01 0.04 0.05 0.15 0.39 3.4 55 London 13.6 0.53 12.5 0.01 0.00 0.14 0.01 0.06 0.05 0.14 0.52 14.4 66 BARKING 15.72 0.42 8.0 0.03 0.00 0.18 0.01 0.09 0.04 0.09 0.22 6.7 56.07 Puerperal Sepsis. Others. Total. The maternal mortality rates for England and Wales are as follows : per 1,000 Live Births ,, „ Total Births 1.40 1.34. 2.41 2.31 3.81 3.65 4. VITAL STATISTICS OF WHOLE DISTRICT FROM 1926 TO 1936. 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 Live Births. Number. rate. 1 2 3 4 5 6 7 8 9 10 11 12 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 50,330 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 13 801 64 52.2 558 7.7 1936 76,800 1 195 15.72 313 4.1 13 308 67 56.07 608 8.0 13 5. DEATHS. (a) General.—There were 313 deaths registered in Barking in 1936. Of these 13 were deaths of non-residents. Barking residents to the number of 308 died elsewhere during the year. Including the latter and excluding the deaths of visitors, the net number of deaths was as follows:— Males. Females. Total. 300 308 608 The death rate for 1936 was 8.0 per 1,000, compared with 7.7 in 1935, 12.1 for England and Wales, 12.3 for the hundred and twenty-two County Boroughs and Great Towns, including London, 11.5 for the one hundred and forty-three Smaller Towns, and 12.5 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 67 1 to 2 years 13 2 to 5 years 13 5 to 15 years 26 15 to 25 years 20 25 to 45 years 94 45 to 65 years 132 Over G5 years 243 (c) Causes of death in 1936.—The table on the next page shows the principal causes of death at various ages. 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 187 30.75 Cancer 74 12.17 Tuberculosis (all forms) 44 7.24 Pulmonary affections (exclusive of tuberculosis), viz., Bronchitis 27 4.44 Pneumonia (all forms) 33 5.43 Oilier respiratory diseases 0 1.48 Zymotic Diseases 35 5.75 (d) Deaths from Zymotic Diseases.—These diseases caused 5.75 per cent. of the total deaths, such deaths being caused in the following proportions:— Enteric Fever 2 Measles 14 Whooping Cough 7 Scarlet Fever 1 Diphtheria 3 Diarrhoea 3 Smallpox — 14 (e) Inquests.—Coroner's inquests were held on 31 deaths. (f) Causes of and ages of death during the year 1936. (Net Deaths). Causes of Death. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the district. RegistrarGenaral'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 1 1 — — 2 2 Measles 3 8 3 — — — 14 14 Scarlet Fever — 1 1 1 Whooping Cough 4 3 7 8 Diphtheria — 1 2 — — — 3 3 Influenza — 1 — 2 1 3 7 7 Encephalitis Lethargica — — — — — — — — Cerebro-Spinal Fever — 1 — — 1 — 2 2 Tuberculosis of Respiratory System — 1 — 8 21 5 2 37 37 Other Tuberculous Diseases — 1 1 1 3 1 — 7 7 Syphilis — — 1 — — 2 — 3 2 General Paralysis of the Insane, etc — — — — — 1 1 2 2 Cancer — — 1 — 9 27 37 74 70 Diabetes — — — — 1 2 4 7 8 Cerebral Hæmorrhage 1 — — — 2 11 14 28 20 Heart Disease 2 — 2 2 15 31 111 163 153 Aneurysm — — — — 2 — — 2 7 Other Circulatory Diseases — — 1 — 3 5 13 22 19 Bronchitis 3 1 — — 1 5 17 27 20 Pneumonia 8 2 3 2 3 9 6 33 30 Other Respiratory Diseases 1 — — — 3 3 2 9 4 Peptic Ulcer — '— — — 1 6 1 8 0 Diarrhoea (under 2 years) 8 — — — — — — 8 0 Appendicitis — — 1 — 1 2 — 4 5 Cirrhosis of Liver — — — — — — — — 1 Other Diseases of Liver 1 — — — 1 — 1 3 5 Other Digestive Diseases — — — — 3 3 2 8 10 Acutcand Chronic Nephritis 1 — 1 — 3 5 8 18 1U Puerperal Sepsis — — — 1 — — — 1 1 Other Puerperal Causes — — — 1 2 — — 3 2 Congenital Debility, Premature Birth, etc. 31 — — — — — — 31 38 Senility — — — — — — 13 13 11 Suicide — — — 1 2 1 2 0 0 Other Violence — 3 3 — 7 1 3 17 20 Other Defined Diseases 4 3 7 3 8 10 3 38 40 Causes ill-defined or unknown — — — — — — — — - Totals 67 26 26 20 94 132 243 608 604 15 (g) Infant Mortality daring the year 1936. The following table gives the actual causes of death of children dying under one year of age. Causes of death under 1 year of age, year 1936:— 0-1 month. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total under 1 year. Abscess of Chest Wall — — 1 — — 1 Anencephalus 1 — — — — 1 Bronchitis 2 1 — — — 3 Cerebral Degeneration — — — — 1 1 Congenital Debility 4 — — — — 4 Congenital Deformities 3 1 — — — 4 Congenital Heart Disease 2 — — — — 2 Convulsions and Asphyxia at Birth 2 — — — — 2 Deficient Inherent Vitality 1 — — — — 1 Diarrhoea and Vomiting — — — — 1 1 Gastro-Enteritis 1 3 2 1 — 7 Hiemolytic Jaundice 1 — — — — 1 Hemorrhagic Disease of the Newly Born — 1 — — — 1 Hydrocephalus and Spina Bifida 1 — — — — 1 Icterus Gravis — 1 — — — 1 Icterus Neonatorum 2 — — — — 2 Marasmus 2 1 — — — 3 Measles 1 1 1 3 Nco-Natal I'yæmia 1 — — — — 1 Nephritis — — 1 — — 1 Pneumonia 3 2 2 1 — 8 Prematurity 12 1 — — — 13 Spina Bifida — — 1 1 Whooping Cough — 1 1 — 2 4 Totals 38 12 8 3 6 67 Net Births in 'be year:— Legitimate 1,175 Illegitimate 20 1,195 Net Deaths in the year:— Legitimate 65 Illegitimate 2 67 16 (h) Xeo-Xaial Mortality during the year 1936. Causes of Neo-Natal deaths Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total. Anencephalus 1 — — 1 Bronchitis 1 1 — — 2 Congenital Debility 4 — — — 4 Congenital Deformities 3 — — — 3 Congenital Heart Disease — — 2 — 2 Convulsions and Asphyxia at Birth 1 1 — — 2 Deficient Inherent Vitality 1 — — 1 Gastro Enteritis — — 1 1 Hæmolytic Jaundice 1 — — — 1 Hydrocephalus and Spina Bifida 1 — — — 1 Icterus Neonatorum — 1 1 — 2 Marasmus — 1 1 2 Neo-Natal Pyaemia — — 1 — 1 Pneumonia — 1 1 1 3 Prematurity 10 2 12 Totals 23 7 7 1 38 It will be seen from the tables that of the sixty-seven deaths under the age of one year, no less than thirty-eight were four weeks of age or under, and prematurity is given as the cause of death in the cases of twelve babies, who died within the first four weeks of life. The fact that thirty-eight 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-eight babies who died under the age of one month, no less than twenty-three died within the first week. My comments on this table are word for word the same as my comments last year, save only that necessary alterations have been made in the numbers. Once more I want to emphasise that of the babies who died under the age o! one month, more than fifty per cent. died within the first week. There is of coursc no opportunity in this one week to turn a weak and ailing baby into a strong and healthy one, and so the only way in which we can attack this problem is by still further activities in ante-natal work. We must have sufficient workers, not only to carry out routine work, but also to undertake research and in the forefront of research must come the problem of nutrition. It is gratifying to note that the number of deaths from respiratory diseases (bronchitis and pneumonia) is decreasing. 17 The following table shows the comparative figures of infant mortality and neo-natal mortality for the past ten years:— Infantile Infantile Mortality Neo-natal Neo-natal Mortality Year. Mortality Rate 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 1936 67 56.07 38 31.8 (i) Mortality, Epidemics, etc.—A minor epidemic of acute anterior-poliomyelitis, i.e., infantile paralysis, was one of the outstanding epidemiological features of the ' year. There were several cases which were mild, but as usual some of the cases were severe. The severe cases were those which are known as acute anterior-poliomyelitis of the ascending type and which are also known as cerebro-poliomyelitis. One curious thing emerged. In one family a patient was found to be suffering from acute anterior-poliomyelitis of the ascending type and a child from acute anterior-poliomyelitis of the ordinary type. The possibility of two infections being present in one house like this is so very remote that it would appear that the two manifestations are one and the same disease—variation from person to person being due to something intrinsic in the person. There were six sporadic cases of typhoid fever, one of which was definitely known to have been contracted elsewhere. During 1936 there was unfortunately an epidemic of measles and no Jess than fourteen cases in Barking died from measles. It cannot be too well noted that you yourselves are willing to take into your Hospital complicated cases of measles. It is distressing to find how hard popular prejudice is dying, and the expression "it is only measles" is one of the tragedies of today. The trouble is that the child with measles wants the best nursing in order to prevent complications arising, because, for instance, when broncho-pneumonia supervening upon measles becomes serious, expert nursing is often too late. 18 It is undesirable that ordinary health visiting staff should go into homes to play any part in the personal nursing of cases of measles, but you might wish to explore-the possibility of domiciliary visits being paid by members of the staff of the Barking Hospital, whose visits would not only be for investigation and report, but would also include such nursing as could be undertaken on the district, having regard to all the circumstances of each particular case. 6. BIRTHS. The net number of births registered in 1936 was 1,195, affording an annual birth rate of 15.72 per 1,000 population, compared with 16.9 in 1935, 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, 20 were illegitimate, giving a percentage of 1.67 of the total births. Notification of Births Acts, 1907-1915.—During 1936 there were 1,183 live births notified, excluding 2 cases transferred from the district. In addition, notifications of still-births belonging to the district totalled 32. Seventeen live births and 2 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 joinery works. The population of Barking is almost entirely industrial. Barking is a dormitory. 19 (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, 1935 and December, 1936:— Dec. 1935. Dec. 1936. Men. Women. Men. Women. Food 11 — 5 1 Electrical and Wireless 10 — 7 — Building Trade and Painters 234 1 117 — Works of Construction 56 — 19 — Engineering 39 2 8 1 Domestic 16 36 16 28 Rubber Workers 25 17 14 11 Commercial 8 5 4 2 Road and Water Transport and Seagoing 77 — 56 — Clothing 14 22 10 19 Distributive Trades 32 17 21 17 Government and Professional 2 — 1 — Tin Box Manufacture 4 10 3 9 Matches 10 4 8 1 Chemicals 15 7 12 6 Printing 7 2 6 1 Asbestos - 4 4 2 2 Woodworking and French Polishing 9 — 11 — Agriculture — — 2 21* General Labourers and Factory Hands 915 134 769 107 Mineral Water Manufacture — 8 — 7 Clerical 14 13 6 4 Leather Trades 5 2 3 1 Other Workers 59 17 47 18 1,566 301 1,147 256 * Agricultural workers were unregistered in 1935. Members of the Council have always been interested in any evidence, statistical or otherwise, that unemployment has exercised any significant influence on the health or physique of children and adults. There is no such statistical evidence available in Barking. I am of the opinion that nutrition in this Country is better now than it has been for centuries, but I am by no means satisfied with the level we have achieved. I am concerned with our ignorance of the whole problem of nutrition, and as I have said elsewhere the subject is so important that those who are doing routine work this connection must be reinforced by such numbers that some can undertake actual research work. A matter which is causing me a little anxiety is the number of cases of Barking women who come to my notice, in whose blood the amount of red colouring matter is significantly below what it ought to be. 20 Your officers who are interested in ante-natal work, and particularly your Pathologist, are giving attention to this matter, and I do hope that we shall be able to put certain suggestions before you, but work of this nature takes time. Administratively, I must still flog the obvious point which from year to year I put before you, which is that the nutrition of people who are unemployed, and their dependants, must be properly co-ordinated. At the present time we have in Barking the Public Assistance Committee, the Maternity and Child Welfare Committee, the Education Committee, the Tuberculosis After-Care Committee and several voluntary agencies who in their own way are doing something to improve the common standard of diet of people who are in this way, or in that, necessitous. Nutrition, it is my submission, is one of the most serious, if not the most serious of all problems. It is even more important than housing, and I do submit that it is so serious that it should be tackled by one body, and should not be a sideline of four or five separate bodies. (c) Housing.—Elsewhere in this Report I am showing that during the year six Compulsory Purchase Orders were confirmed, involving 163 houses and 828 persons. This means that we have completed our Housing Programme for the period 19331938, save only for a modest number of houses, i.e., under 50. In turn this means you have improved the whole standard of housing in Barking, and because you are allowed to take into account the general level of housing in the area, it must mean that in any of your schemes from 1938 onwards, you can have, and you will have a different sense of values than obtained in the past. Nevertheless, may I make it clear that, however good it is to pull down the old properties which have outlived their usefulness, it is a far better thing to plan a new town where people can live under conditions in which they can maintain their efficiency and their health. So far as housing is concerned, I know of no one factor which takes pride of place over the necessity of having a population properly spaced, and I am persuaded that 60 persons per acre is not the ideal at which we should aim—it is an obvious standard which we should always attain. (d) Travelling Facilities.—What I have said about housing refers, of course, very aptly to those houses on wheels which we call trains. I think we should look upon trains as houses upon wheels, because then overcrowding in trains would be recognised as the undoubted nuisance it is. It is intolerable that our standards in travelling facilities have lagged 100 years behind our standards in housing, in schools, in factories, in cinemas and other places where men and women are wont to congregate together. Those who are jointly responsible for the present conditions of passenger traffic serving Barking live in a bygone age. 21 (e) Malnutrition.—I have commented upon nutrition, and I would like here to deal with one or two subsidiary points in regard to malnutrition. Firstly, I would wish to point out that although lack of food may certainly be the chief cause in some cases, it is not the only cause from which malnutrition arises. An unbalanced diet is quite capable of bringing about malnutrition, and, of course, there are some people who by reason of some physical peculiarity are unable to assimilate all the constituents of a proper diet. Secondly, I would point out that lack of sleep is also a cause of malnutrition. It is during sleep that growth and repair take place, in contrast to the daytime when energy is being expended at the maximum rate. In this connection noise nuisances cannot be over-estimated. Wireless sets can cheat many children of their proper sleep, and the more children there are who are out of bed when they should be in bed and the more the streets are turned into playgrounds, so will the quality of the sleep of those who do go to bed early be impaired. Although you have done a considerable amount to promote the consumption of milk in Barking, I refer, of course, chiefly to the distribution of milk through your Maternity and Child Welfare Scheme and to the Education Committee who arrange for the distribution of milk in the schools, there is not nearly enough milk consumed in Barking. I would like to see the amount at least doubled. Fresh vegetables too should be more easily available and should be fresher than they are in Barking. It is surprising to find that peas which are picked just a few miles out of Barking are taken all the way to the London markets, and then brought all the way back to Barking, and no doubt this happens with other vegetables too. Everybody knows that vegetables which have been recently picked and carefully handled are altogether different in taste from those which have undergone such a journey. It would be to the good if in this way or in that, probably by joint action with other authorities, a wholesale market for perishable commodities could be built somewhere near Barking. Our statistics in regard to malnutrition only deal with school-children and are as follows:— Of 6,242 children examined by routine at school medical inspection, 9 were found to be suffering from malnutrition, 164 were found to have slightly sub-normal nutrition, 4,087 normal nutrition, and 1,982 with excellent nutrition. 23 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 2,082 Sputa 230 Typhoid 29 Milk 78 Water 7 General 163 Total 2,589 In addition to the above, 11 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. The laboratory facilities which have been available in previous years have been available throughout the year under review, and in some cases these have been extended by agreement between the County Council and those who undertake this work for the County Council. There has, however, been a very real need for several years past for a local pathological unit and in the autumn of 1935 a beginning was made towards this end. There have been many local units set up in Public Health Departments which have never functioned efficiently, and so in order that we should start in the proper way, I steadfastly set my face against any unsatisfactory measures. 4 24 After consultations with colleagues, who are learned in this work, we made certain recommendations to you, as a result of which Dr. E. A. Straker, a research pathologist at the London School of Hygiene and Tropical Medicine, was appointed to a part-time post to look after this work and to co-ordinate it with the rest of the work of the Department. Dr. E. M. Hill, who obtained a degree in BioChemistry and who holds a Diploma in Bacteriology, was appointed by you as a Scientist in the laboratory. Dr. Hill obtained her training in bacteriology at the London School of Hygiene and Tropical Medicine, and in addition, you appointed a laboratory attendant, who again prior to coming to you had been on the staff at the London School of Hygiene and Tropical Medicine. I would like, personally, to thank Professor Topley, who outlined to me suggestions on which to found a pathological unit on a sound basis. I wish to thank him, not only for his helpful advice, but also for the ready way in which he put me in touch with people personally known to him, who could fill the various roles his own suggestions required. Although we have started a Pathological Unit in a very small way, it has been established with the traditions of a great School behind it. This means that we have, not only its traditions, but also its associations, and I hope our associations with the London School of Hygiene and Tropical Medicine will remain as they are today. The work which is undertaken at the laboratory is work which cannot be so efficiently and so expeditiously undertaken under the County's Scheme, but in addition to this the pathological unit is responsible for seeing that we use the County's Scheme to the greatest advantage. I look upon this development as one of the most important you have undertaken for many years. There is a tendency for much of the medical work undertaken in a medical department to become routine, and the establishment of such an essentially scientific section in the Department must keep myself and other members of the Staff much more in contact with the scientific side of medicine than we should otherwise be. (b) Ambulance Facilities.—There are now no less than four ambulances in Barking. Two ambulances are for general and accident cases; another is used only for cases of infectious diseases and the fourth is the old infectious disease ambulance which is kept for the conveyance of bedding, but which can in an emergency be used as a standby ambulance. 25 Arrangements are made for one or two attendants on each ambulance as occasion requires, and in other than ordinary cases, where a medical attendant so advises, nurses from the Hospital may be employed. Needless to say, it is the routine practice for a nurse or nurses to be employed on the infectious diseases ambulance. There are reciprocal agreements with adjoining Local Authorities, and the whole ambulance service has attained considerable efficiency. (c) Hospitals (Public and Voluntary).—There are no voluntary hospitals in Barking. There are two public hospitals in Barking—the Barking Hospital and Upney Hospital. The Barking Hospital is reserved for the treatment of cases of infection and this term is generously interpreted. The Barking Hospital has 108 beds, of which 36 are in cubicle blocks and 2 are separate side wards. The Barking Hospital was first opened in 1933. There is now a Resident Medical Officer, who also does a certain amount of clinical work in your out-patient departments at your various clinics. . The Upney Maternity Pavilion has 24 beds of which 8 are cubicles. One of these cubicles is situated at the distant end of the reception wing and can be and is completely isolated. The Admission Wing has been kept away from the rest of the pavilion, and we can say that so far as is practicable every care is taken to see that people admitted to the nursing wards are not suffering from coughs, colds, influenza, etc., which they are likely to communicate to the other patients. Including the sister who is in charge of the Pavilion, there are three sisters. The number of midwives varies from time to time but on the average there are three on the staff. There art; also probationers, but the professional nursing work is carried out entirely by sisters and midwives, all of whom, of course, are qualified. At this Hospital too there is a Resident Medical Officer, under whose supervision gas can be administered in suitable cases. It is fortunate you have this Hospital, so wonderfully planned, so efficiently equipped and so adequately staffed. It will form a convenient nucleus in the future for midwifery in Barking. This is particularly important in view of recent legislation which is coming into operation in about the middle of 1937. 26 Although not situated in Barking, there are many voluntary hospitals catering for the needs of the people of Barking. A sum of money is set aside by you each year for distribution among these hospitals. The following table shows the amount of money which has been contributed to each hospital, and represents roughly the use to which they are put by the people of Barking:— £ City of London Hospital for Diseases of the Heart and Lungs 12 East Ham Memorial Hospital 38 King George Hospital, Ilford 55 Princess Elizabeth of York Hospital for Children, Shadwell 8 Queen Mary's Hospital, Stratford 35 St. Mary's Hospital, Plaistow 11 Hospital for Sick Children, Great Ormond Street 3 Poplar Hospital 20 London Hospital 68 Total £250 The County Hospital is at Romford. Further County hospital accommodation is being provided. The Brookfield Orthopædic Hospital, near Woodford, in which you have been personally interested and which has received the greater number of your orthopædic cases requiring hospital treatment, has, during the year, been taken over by the Essex County Council. The County Council are, I think, making alternative accommodation in the near future which will replace the old Brookfield Hospital. The Brookfield Hospital has served a wonderful purpose, and though the time may have come for it to be replaced, it does not in the least detract from its honourable history. (d) Clinics and Treatment Centres.—During the year the Central Clinic and the Woodward Clinic, whilst pre-eminently fulfilling the purpose for which they were erected, have been so overcrowded (and this relates especially to the Woodward Clinic) that you have been seriously considering the erection of a further clinic, following the general plan of those already in existence. If this clinic was erectcd in the Northern portion of the Becontree Estate in Barking, overcrowding at the Woodward Clinic would probably cease, and people living in this part of the Estate would be very much better served than heretofore. 27-2 8 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. Number of beds available. Other beds available. Total. Management. Men Women Children Controlled by the Council of the Borough of Bar/ring— Upney (Maternity) Hospital Upney Lane, Barking, Essex Maternity — 23 — One Isolation Cubicle 24 Borough of Barking Barking (Isolation) Hospital Upney Lane, Barking, Essex Isolation of general infectious diseases (excluding smallpox) — 108 — ... ... ... ... ... ... 108 Borough of Barking Not controlled by the Council of the Borough of Barking— Brentwood Mental Hospital Brentwood, Essex Mental 853 1155 — ... ... ... ... ... ... 2008 Essex C.C. and Colchester B.C. Brookfield Orthopaedic Hospital Hale End, Woodford Green, Essex. Orthopaedic — 30 ... ... ... ... ... ... 30 Essex County Council City of London Hospital for Diseases of Heart and Lungs (London Chest Hospital) Victoria Park, E.2 Heart and Lung Diseases 89 91 8 ... ... ... ... ... ... 188 Voluntary City of London Maternity Hospital 102, City Road, E.C.1 Maternity — 79 — ... ... ... ... ... ... 79 Voluntary East Ham Memorial Hospital Shrewsbury Road, E.7 General Medical and General Surgical 40 40 20 ... ... ... ... ... ... 100 Voluntary Golden Square Throat, Nose and Ear Hospital Golden Square, Piccadilly Circus, W.1 Ear, Nose and Throat 37 32 12 20 Single Rooms (unassigned) 101 Voluntary Guy's Hospital London Bridge, S.E.1 General Medical and General Surgical, etc. 264 292 59 76 Private Beds (unassigned) 691 Voluntary Hospital for Sick Children Great Ormond Street, W.C.1 General Medical and General Surgical and Isolation (Children only) — — 257 115 at the Country Branch Hospital, Tadworth Court, for continuation of treatment and for convalescence. 372 Voluntary King George Hospital Eastern Avenue, Ilford, Essex General Medical and General Surgical 66 88 32 Private block of 21 beds (unassigned) 207 Voluntary London Hospital Whitechapel Road, E.1 General Medical and General Surgical 357 408 84 ... ... ... ... ... ... 849 Voluntary London Lock Hospital and Home 283, Harrow Road, W.9 Venereal Diseases 10 49 15 ... ... ... ... ... ... 74 Voluntary London Skin Hospital 40, Eitzroy Square, W.1 Skin. (No in-patients) — — ... ... ... ... ... ... — Voluntary Oldchurch Hospital Oldchurch Road, Romford, Essex General Medical, General Surgical, Children, Maternity, Tuberculosis, Chronic Sick, Mental and Orthopaedic 300 334 260 34 Isolation and Observation Beds (unassigned) 928 Essex County Council Poplar Hospital for Accidents East India Dock Road, E.14 General Medical and General Surgical 51 39 27 6 Private Wards (unassigned) 123 Voluntary Princess Elizabeth of York Hospital for Children Glamis Road, Shadwell, E.1 Children — — 135 ... ... ... ... ... ... 135 Voluntary Queen's Hospital for Children Hackney Road, Bethnal Green, E.2 Children — — 160 ... ... ... ... ... ... 160 Voluntary Queen Mary's Hospital for the East End Stratford, E. 15 General Medical and Surgical, Children, Maternity 58 108 46 ... ... ... ... ... ... 212 Voluntary Royal London Ophthalmic Hospital (Moorfields Eye Hospital) City Road, E.C.1 Ophthalmic 84 65 21 30 Private Rooms (unassigned) 200 Voluntary Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex Orthopaedic 10 23 284 ... ... ... ... ... ... 317 Voluntary St. Bartholomew's Hospital Smithfield, E.C.1 General Medical and Surgical, Children, Maternity, etc., Ophthalmic, Orthopaedic, Ear, Nose and Throat, and Septic, etc. 270 342 71 26 beds (unassigned) 709 Voluntary St. Mary's Hospital fur Women and Children Upper Road, Plaistow, E.13 General Medical and General Surgical, Children, etc. — 27 44 ... ... ... ... ... ... 71 Voluntary Severalls Mental Hospital Mile End, Colchester Mental 857 1309 — ... ... ... ... ... ... 2166 Essex C.C. and Colchester B C. Westminster Hospital Broad Sanctuary, Westminster. S.W.1 General Medical and General Surgical, Maternity, Ear, Nose and Throat, etc. 86 120 13 38 beds for observation and isolation, etc. (unassigned) 257 Voluntary In addition to the above institution, 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 tuberculous. 29—30 TABLE II. HOSPITAL SERVICES, showing the number of beds for each. purpose, and other facilities available. Name of Hospital. Number of beds for the following purposes Total Other facilities available Arrangements for pathological work Accident Chest (nontub.) & Heart | Children Chronic Sick Dental Dermatological Ear, Nose & Throat General Medical General Surgical Grnito-urinnry Gynaecological Infectious Diseases Isolation & Observation Maternity Mental Neurological Ophthalmic Orthopaedic Radium Septic Tuberculosis Venereal Diseases Unassigned Controlled by the Council of the Borough of Barking. 1† Upney (Maternity) Hospital — — — — — — — — — — — — 1 23 — — — — — — — — — 24 Operative surgery, Dental, Nursing of Puerperal Fever and Pyrexia. Carried out at the Counties' Laboratory, Queen Victoria Street, E.C.4, and at own tory. 2† Barking (Isolation) Hospital — — — — — — — — — — — 108 — — — — — — — — — — — 108 Operative surgery, Dental. Ear, Nose and Throat, Orthopaedic, nity, Puerperal Fever and Pyrexia, Ophthalmia Nconatorum. Not controlled by the Council of the Borough of Barking. 3 Brentwood Mental Hospital — — — — — — — — — — — — — — 2008 — — — — — — — — 2008 All specialised treatment available. Own Laboratory 4 Brookfield Orthopædic — — — — — — — — — — — — — — — — — 30 — — — — — 30 Operative Surgery, Ultra-violet light, Dental, Massage, X-rays, Ophthalmic. Carried out at the Counties' tory, Queen Victoria Street, E.C.4. 5 City of London Hospital for Diseases of Heart and Lungs (London Chest Hospital) — 82 — — — — — — — — — — — — — — — — — — 106 — — 188 Operative surgery, X-rays, Ultra-violet light, Denial, Massage, Ear, Nose and Throat, Radium. Own Laboratory. 6 City of London Maternity Hospital — — — — — — — — — — — — — 79 — — — — — — — — — 79 Operative Surgery, Dental, Nursing of Puerperal Fever and Pyrexia. Own Pathologist. 7 East Ham Memorial — — — — — 3 4 37 33 — 8 — — — — — 4 4 — — — — 4 100 Operative surgery, X-rays, Ultra-violet light, Dental, Electrical, Massage. Own Laboratory. 8 Golden Square Throat, Nose and Ear — — — — — — 101 — — — — — — — — — — — — — — — — 101 Operative surgery, X-rays, Ultra-violet light, Dental, Ophthalmic, Radium. Carried out by a logist outside the Institution. 9 Guy's 36 — 14 — 4 6 33 179 147 11 20 9 5 50 4 9 24 19 8 22 — 9 82 691 All specialised treatment available. Own Laboratory. 10 Hospital for Sick Children — — — — — — 18 101 119 — — — 12 — — — — — — — — 7 — 257 All specialised treatment available. Own Laboratory. 11 King George Hospital 6 — 32 — — — 6 54 72 — 13 — — — — — 3 — — — — — 21 207 Operative surgery, X-rays, Dental (as easualty), Ophthalmic, Massage, Ear, Nose and Throat, Gynaecological, Neurological, Dermatological. Own Laboratory. 12 London Hospital — 15 84 — — 13 26 234 301 — 33 37 7 31 — — 23 — — — — — 45 849 All specialised treatment available. Own Laboratory. 13 London Lock Hospital — — — — — — — — — — — — — — — — — — — — — 74 — 74 Operative surgery, Ultra-violet light, Dental, Ophthalmic, Massage, Ophthalmia Neonatorum. Own Laboratory. 14 London Skin Hospital — — — — — — — — — — — — — — — — — — — — — — — — Skin diseases only. (No in-patients.) Ultra-violet light, X-rays, etc. Own Laboratory. 15 Oldchurch Hospital — — — — — — — 400 460 — — — 34 — — — — — — — 34 — — 928 All specialised treatment available with the exception of Ophthalmic and Radium. Carried out at the Counties tory, E.C.4. 16 Poplar Hospital for Accidents — — — — — — — 34 73 — 5 — 1 — — — — — — — — — 10 123 Operative surgery, X-rays, Ultra-violet light, Dental, Massage, Radium by arrangement with the London Hospital. Own Laboratory. 17 Princess Elizabeth of York. Hospital for Children — — 135 — — — — — — — — — — — — — — — — — — — — 135 All specialised treatment available. Own Laboratory. 18 Queen's Hospital for Children — — — — — 6 14 92 24 — — — — — — — 6 18 — — — — — 160 All specialised treatment available with the exception of Radium. Own Laboratory. 19 Queen's Mary's Hospital for the East End — — — — — — 3 68 72 5 4 — — 50 — — 6 4 — — — — — 212 All specialised treatment available. Own Laboratory. 20 Royal London Ophthalmic (Moorfields Eye Hospital) — — — — — — — — — — — — — — — — 200 — — — — — — 200 All specialised treatment available with the exception of Operative surgery, Massage and Radium. Own Laboratory. 21 Royal National Orthopædic — — — — — — — — — — — — — — — — — 317 — — — — — 317 Operative surgery, X-rays, Ultra-violet light, Massage. Carried out by a logist outside the Institution. 22 St. Bartholomew's Hospital — — — — — 6 20 264 250 — 44 — — 17 — — 22 20 — 55 — — 11 709 All specialised treatment available. Own Laboratory. 23 St. Mary's Hospital for Women & Children 5 — 16 — — — 2 13 23 — 8 — — — — — 4 — — — — — — 71 Operative surgery, X-rays, Ultra-violet light, Dental, Massage, Ear, Nose and Throat, Orthopaedic. Part-time Pathologist in conjunction with other Hospitals. 24 Severalls Mental Hospital — — — — — — — — — — — — — — 2166 — — — — — — — — 2166 Operative surgery, X-rays, Ultra-violet light, Dental, Ophthalmic. Own Laboratory. 25 Westminster Hospital 10 — 13 — — 2 7 56 71 — 10 — 4 12 — — 6 10 22 — — — 34 257 All specialised treatment available. Own Laboratories. In the case of Hospitals under the control of the Borought of Barking:— Upney (Maternity) Hospital Barking (Isolation) Hospital Number and classification of Medical Staff The Medical Officer of Health is also the Medical Supt. In addition there is a Resident Medical Officer at each Hospital. Number and classification of Nursing Staff: Matron — 1 Sisters 3 7 Assistant Nurses — 8 Midwives 3 — Probationer Nurses 4 17 Arrangements for the employment of consultants A Consultant Staff is available. In addition to the above Institutions, there are a number of Sanatoria to which tuberculous persons resident are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis. 33—34 CLINIC AND TREATMENT CENTRES. Name and Situation. When Held. . Nature of Accommodation. By Whom Provided. 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. East Street Clinic do. Waiting and treatment rooms do. (d) Orthopedic Clinic:— (i) Specialist's Clinic, Faircross School First Thursday in each month, 9 a.m. One room do. (ii) Remedial Exercises Clinic, Ultra Violet Light Therapy, etc., Faircross School Daily, 9 a.m. and 2 p.m. do. do. 3. Immunisation Clinic (Diphtheria, Scarlet Fever and Whooping Cough):— Central Clinic, Vicarage Drive, Ripple Road Mondays, 10.30 a.m. Modern clinic premises with waiting and treatment rooms. Local Authority. 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. Venereal Diseases. London hospital, etc. — —' By arrangement with Essex County Council. 31—32 CLINIC AND TREATMENT CENTRES. Name and Situation. When Held. Nature of Accommodation. By Whom Provided. l, 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 Tuesdays and Wednesdays, 2 p.m., and Fridays, 10 a.m. Modern clinic premises with accommodation for consultations, etc. do. Woodward Clinic, Woodward Road Wednesdays, 10 a.m. do. do. Porters Avenue Centre, Porters Avenue Thursdays, . 9.30 a.m. Accommodation for consultations, etc. do. Specialist-Consultant Clinic at Central Clinic, Vicarage Drive, Ripple Road. Third Tuesday in each month 3.30 p.m., except August and December. Modern clinic premises with accommodation for consultations, etc. do. (c) Gynæcological 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 * Since the end of 1936 additional Infant Welfare Clinic has been commenced at the Porters Avenue Centre and is held on Friday afternoons at 2 p.m. 35 The arrangements for treating orthopædic cases, whilst by no means unsatisfactory leave much to be desired, insofar that the classroom in which treatment is conducted is too small and has none of the amenities which are necessary for such work. The inauguration, too, of an Ear, Nose and Throat Clinic will mean the erection of suitable accommodation. It is my submission that these special services, together with Orthoptics, i.e., the correction of squint, all require the establishment of a central out-patient department where they can be carried on under satisfactory conditions. In writing on Clinics and Treatment Centres, I am asked to include clinics solely for diagnosis or consultation. The work in Barking is so intimately co-ordinated that it is difficult to say that any certain clinic is set aside for consultation or diagnosis, but, of course, the Maternity and Child Welfare Clinics are essentially for diagnosis, consultation and helpful advice, rather than for treatment. Other clinics also, it may be said, are held for diagnosis and consultation. Thus we have a Consultative Obstetrical and Gynaecological Clinic where Mr. J. V. O'Sullivan visits, and a Consultative Orthopaedic Clinic where Mr. B. Whitchurch Howell attends. (e) Nursing in the Howe.—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 that a further measure of success has been achieved. It is still difficult at times to obtain sufficient funds to carry on all the work the Association would like to undertake, but it is pleasing to record that the Association have succeeded in augmenting their nursing staff, so that two full-time nurses are now employed as against only one nurse in the year 1935. During the year the Council decided to make a donation of £100 per annum to this body and the Executive committee of the Association have expressed their grateful thanks for the Council's decision. 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. 36 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—1936. 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. It is with regret that I have to record that Miss G. Elliott resigned her appointment during the year as Health Visitor, and Mrs. W. Walton has also decided to terminate her engagement in this capacity. Both these officers have given many years satisfactory service. The Maternity and Child Welfare Clinics are held at the Alexandra, Central, Greatfields, Porters Avenue (Methodist Church) and Woodward Centres. (a) Ante-Natal Supervision.—Ante Natal Clinics are held at three centres— three sessions weekly at the Central Clinic, and one session weekly at the Woodward and Porters Avenue Clinics. The following table shows the work carried out at these clinics during the year:— Central Clinic. Woodward Clinic. No. of Sessions. First attendances. Reattend ances. Total attendances. No. of Sessions. First attendances. Re- attendances. Total attendances. 144 370 2022 2392 53 206 951 1157 Alexandra Clinic. Porters Avenue Clinic. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. 9 11 59 70 53 129 773 902 37 Total First Attendances 716 „ Re-Attendances 3,805 „ Attendances 4,521* „ Sessions 259 * In addition there were 53 Post-Natal, and 101 Gynæcological 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 716 first attendances must be regarded as one on which to 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 confinement, and that these women on the whole attend regularly. Details of the milk and meals supplied to expectant mothers are given on pages 45—47. (b) Still-births.—On examining the records of cases of still-births occurring during the past year, an analysis of the causes to which the death of the baby is attributed by the mother or which have been found during the computation of records may be made as in the table given below:— Maternal toxaemia 3 Baby died before labour 4 Baby died during labour 3 (1 premature) Ante-partum hæmorrhage 3 Shock and worry 1 Difficult labour 6 Cord round neck 1 B.B.A. 2 Unknown 9 Death of the baby before or during labour took place in just over one-quarter of the cases, when apparently there was no difficulty in the labour. The babies born to mothers suffering from toxaemia are usually weaker and less able to withstand the stress of labour than those whose mothers are in good health. Some of these toxæmic infants die in the womb before labour starts. Ante-partum hæmorrhage in some cases is also attributable to maternal toxaemia. Careful and frequent ante-natal supervision, with treatment where necessary, will enable the cases of still-birth due to toxaemia and difficult labour to be minimised, and it is noteworthy that many of the cases instanced in the table above had not received regular ante-natal supervision. (c) Midwifery.—The Council became the Local Supervising Authority for Midwives as from the 1st April, 1935. 38 Thirty-seven midwives notified the Local Supervising Authority of their intention to practise within the Borough during the period 1st January, 1036 to the 31st December, 1936, and the number who were engaged in practice in the Borough at the end of the year was as follows :— At Upney Hospital 6 At the District Nurses' Home of the Plaistow Maternity Hospital 2 In private practice 14 The number of visits of inspection paid by the Inspector of Midwives was 63. The following is a summary of notifications received from midwives :— Medical Help 277 Deaths of Mother or Child 8 Laying out the Dead 4 Still-births 15 Liability to be a source of Infection 13 Artificial Feeding 6 323* * Of these, 124 notifications were received from the Upney Maternity Hospital. The following is a summary of the 277 cases in which medical help was sought:— Mother :— Anæsthetic 25 Hfemorrhage—Antepartum 10 Post-partum 2 Malpresentations 8 Miscarriage 3 Prolonged labour 36 Rise of temperature 9 Retained placenta 4 Ruptured perineum 77 Small pelvis 2 Uterine inertia 3 Miscellaneous causes 31 210 39 Child :— Bronchitis 2 Convulsions 1 Discharging eyes 32 Rash 1 Spina bifida 1 Unsatisfactory condition of infant 22 Miscellaneous causes 8 67 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 1936 in respect of 187 cases amounted to £237 4s. 6d., leaving a balance payable to the Hospital by the Council of £62 15s. 6d. During the year 1936 there were 1,092 maternity cases in the district. 145 of these were conducted by the Plaistow Maternity Charity, 362 of them were conducted by your own midwives at Upney Hospital, 175 were conducted by the midwives of the Salvation Army Organisation, leaving 410 which were dealt with by medical practitioners, private midwives or otherwise. (d) Upney Hospital.—The admissions to the Maternity Home during 1936 numbered 397 of which 35 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 5,211. (e) Post-Natal Care.—In this connection I feel that more use should be made of the gynaecological clinics and that it should be a rule of all women to be examined say six weeks after their confinements. (f) Gynæcological Clinics.—The numbers attending these clinics show an increase, but the majority of the women who attend have been referred by a medical officer at an infant welfare clinic or have been urged to attend by a health visitor, as a result of her observations and enquiries during routine district visiting. 40 (g) Pemphigus Neonatorum.—Pemphigus Neonatorum is in Barking an infectious disease within the meaning of the Infectious Disease (Notification) Act, 1889, and two such notifications were received during the year. (h) Maternal Mortality.—According to the return of the Registrar-General there were during the year 1936, three deaths from puerperal causes—one death from puerperal sepsis and two deaths from other puerperal causes. This gives a rate of 2.44 per 1,000 total births. The following table gives you similar information for the last thirteen years :— Maternal Mortality—Statistics. Year. Barking. England and Wales Rate per 1,000 births. Deaths from Rate per 1,000 births. Puerperal Sepsis. Other Puerperal Causes. 1924 1 2 3.66 *3.90 1925 — 1 1.21 *4.08 1926 — 1 1.22 *4.12 1927 2 1 4.23 *4.11 1928 — 2 2.48 4.25 1929 — 2 2.54 4.16 1930 — 3 3.72 4.22 1931 1 3 4.08 3.95 1932 — 1 0.88 4.06 1933 4 — 3.2 4.23 1934 1 4 3.82 4.41 1935 3 1 3.18 3.93 1936 1 2 2.44 3.65 Rate per thousand live births—figure not available in respect of rate per thousand total births. Previously, I have pointed out how difficult it is to define the term "maternal death." The official definition is "a death due to or in consequence of childbirth," but in some cases, however, it is all but impossible to say whether the death does actually and definitely come within the terms of this definition. Because the term is so difficult to define in practice, it is impracticablc to compare the figures of today with the figures of 25 and 100 years ago, and it is equally difficult to compare the figures of one part of the Country with another part of the Country. The figures I have given are those of the Registrar-General. 41 You are making determined efforts to reduce maternal mortality in Barking, and I am happy to be able to tell you that of the total number of births last year, namely 1,227, a total of 716 mothers attended your ante-natal clinics during the year. This total represents roughly sixty per cent, of the total births. We ourselves are looking to the problem of nutrition to explain some of the complications of pregnancy and childbirth. It seems positive that sepsis after childbirth is related amongst other things to some error in diet. Therefore, if only the diet is right the patient may in some cases reasonably resist, without hurt, the invasion of germs which takes place. Of course, nothing which I have said about nutrition is applicable where there is a massive invasion of germs which will overcome the resistance of anyone. All eases where any abnormality arises or is anticipated are referred to the Consultant Ante-Natal Clinic, where they are under the care of Mr. J. V. O'Sullivan. Mr. O'Sullivan also sees certain cases when complications arise during or after the confinement, and both his services and hospital beds are available for cases delivered at home, when such specialist treatment is required. (i) Ophthalmia Neonatorum.—During the year ten cases of Ophthalmia Neonatorum were notified. All of these cases recovered with unimpaired vision. It is gratifying to note that this disease, which if neglected is the chief cause of "blindness from birth," continues to decrease. This may be regarded as a sign of increasing cfTiciency in the midwifery service. Every case of Ophthalmia Neonatorum notified is visited by the Inspector of Midwives, and in cases where treatment cannot satisfactorily be given at home both mother and baby arc brought into Barking Hospital, where they are under the care of your Consultant Ophthalmic Surgeon. (j) Illegitimate Children.—Special attention is paid by the Health Visitors to all illegitimate children. Twenty illegitimate children were born during the year, and two died. The illegitimate mortality rate is approximately double the mortality rate for legitimate children. (k) Tonsils and Adenoids.—I have reported at length upon this matter in previous years. I have nothing to add. 42 (1) Convalescent Treatment.—During 1936 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 tiddlers 9 Toddlers (under 5 years of age) 12 (m) Ophthalmic Clinic.—On pages 49 to 50 will be found the Report of your Consulting Ophthalmic Surgeon upon the work of the Ophthalmic Clinics during the year. During the year a squint training clinic was commenced and details of the work of this clinic will be found in the above Report. (n) Ultra-Violet Light Clinic.—Special advantage has been taken of the increased facilities for ultra-violet light treatment, and during the year no less than 2,462 treatments were given to toddlers as compared with 747 treatments for the previous year. (o) Dental Treatment.—Details of the work of the Dental Clinics will be found in the Dental Surgeon's Report on page 55, and I am still in a position to report favourably upon the work of these Clinics. (p) Immunisation Clinic.—The scope of this clinic has been extended during the year. So far the numbers who have been immunised against diphtheria are too small to influence the number of cases occurring 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 without any unpleasant effects—173 children were immunised during the year. Immunisation against scarlet fever has also been started and 18 children completed their course of injections. It is hoped soon to offer immunisation against whooping cough. Not only is this a particularly distressing complaint but the death returns show that last year it was fatal in the cases of 4 children under one year of age. 43 The question of immunisation against measles is being considered and the various methods and results obtained are being reviewed by your Consultant Pathologist. (q) Minor Ailments.—Your Minor Ailments Clinics have been held at two centres and here babies and toddlers have been treated whenever necessary; so also have certain conditions in nursing mothers. The following table shows the work which has been carried out at your Minor Ailments Clinics :— No. of cases seen by medical officers :— Central Clinic. Woodward Clinic. (a) New cases 273 822 (b) Old cases 299 607 No. of attendances for treatment 807 2,191 It will be seen that the total number of new cases medically examined has grown from 895 in 1935 to 1,095 in 1936. (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. To further the work of your Infant Life Protection Visitors, arrangements are being made for foster parents to be visited at the time when supervision of the children is most important, i.e., at night. (s) Maternity and Nursitig Homes.—During the year no less than 366 children were born in your Maternity Home. The Upney (Maternity) Hospital is under the supervision of your Medical Officer of Health, and in addition your Deputy Medical Officer of Health pays regular visits. Visits are also made by your specialist Consultant in Obstetrics and Gynaecology, Mr. J. V. O'Sullivan. Although for the year 1936 there was no Resident Medical Officer at this Hospital, I shall be in a position to relate in my next year's Report that a Resident Medical Officer was appointed at the beginning of January, 1937. No nursing homes are maintained in the Borough. 44 (t) Infant Welfare Cliiiics.—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 102 100 100 155 102 559 No. of attendances of children under 1 year:— (a) New Cases 182 128 198 312 241 1,056 (b) Old Cases 2,248 1,585 1,906 4,205 4,055 14,059 No. of attendances of child: en 1-5 years of age :— (a) New Cases 53 24 95 187 161 520 (b) Old Cases 1,819 1,279 1,679 4,426 5,045 14,248 Average No. of attendances per session 42 30 39 58 93 53 No. of sessions attended by Medical Officers 102 100 100 155 102 559 Average No. of children seen by Medical Officer per session 20 16 17 22 28 20 No. of children seen by Medical Officer other than at above sessions (a) New Cases 273 — — 822 — 1,095 (b) Old Cases 290 — — 607 — 906 The total attendances during the year were 29,883 as compared with 26,826 in 1935. The information which is brought out by this table is that there were 1,056 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 1,195 which means that approximately 88 per cent, of the children born in Barking attended at your centres. (u) Home Visiting.—The home visits carried out by your Health Visitors are shown in detail in the following table :— No. of half-days devoted to visiting 1,495 No. of ante-natal visits :— First visits 239 Subsequent visits 118 No. of first visits to children under 1 year 1,399 No. of subsequent visits to children under 1 year :— (a) Attending a Centre 587 (b) Not attending a Centre 3,942 No. of visits to children 1 to 5 years of age :— (a) No. of visits 6,494 (b) No. of children seen 8,403 45 No. of special visits in connection with ophthalmia neonatorum ... 16 „ „ „ deaths of children up to 3 years of age 53 „ „ „ stillbirths 15 „ „ „ puerperal sepsis and puerperal pyrexia 5 Other visits (re infectious diseases) 434 No. of visits to foster children 196 Total home visits of all kinds 13,448 (v) Provision of Fresh Milk.—Particulars of the amounts of wet milk supplied free and at reduced ra;es 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. 36,104 104,581 140,685 £2,248 12 8 £1,960 19 5 (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.) Half Price (pkts.) Free (pkts.) (pkts.) Ostcrmilk No. 1 765 242 536 1,543 Ostermilk No. 2 1,497 777 1,225 3,499 Ambrosia 205 248 457 910 Cow and Gate 2,445 906 2,083 5,434 Cow and Gate (half cream) 389 95 81 565 Colact 59 23 44 126 Hemolac 140 47 140 327 Lactagol 253 28 148 429 Virol 1,032 312 1,313 2,657 Parrish's Food 147 31 386 546 Liquid Paraffin 113 33 181 327 Malt and Oil 307 207 1,191 1,705 Vitoleum Cream 8 — 5 13 Pure Cod Liver Oil 363 32 193 588 Cod Liver Oil Emulsion 3,762 378 2,604 6,744 Allergilac 26 — — 26 Glaxo "O" Brand 1 — — 1 Trufood 3 — 1 4 Totals 11,515 3,359 10,588 25,462 46 (x) Services provided and Facilities for Treatment.—It is convenient to set these out in tabular form, although of course some of them are mentioned elsewhere in the Report. Ante-Natal Clinics Ante-Natal Clinics are held each week at three different centres, and a Specialist-Consultant holds one session per month during ten months of the year. During 1936, 111 cases attended the clinics held by the Specialist-Consultant. In addition there were 21 post-natal attendances. Baths In certain necessitous cases, free baths are provided for expectant and nursing mothers at the East Street Baths. During 1936, 101 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 1936, 12 toddlers, and 9 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 1936, 1,277 dinners were supplied to mothers and 1,092 to children under this scheme. Prevention of Diphtheria, An Immunisation Clinic is held every Monday Scarlet Fever and Whooping morning at the Central Clinic. Cough. Gynaecological Clinic Gynaecological Clinics are held as and when required. 47 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. Application 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 abnormal pregnancy, puerperal fever and puerperal pyrexia and in cases of difficult labour. Milk Tuberculin Tested 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, etc., 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 nine mothers and fourteen children under the age of five years were provided with spectacles under this scheme. 48 Orthopaedic Service The Orthopaedic Service includes treatment at the Clinic, the provision of splints, and treatment at hospital in the case of children under the age of five years. The service also provides for treatment at the Orthopaedic Clinic for expectant and nursing mothers. 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, 132 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 expectant and nursing mothers and to children under the age of five years at the Orthopaedic Clinic. During 1936, 221 cases were treated, a total number of 2,462 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 Ringworm. Where necessary, ringworm is treated by X-ray. No charge is made for this treatment. 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 oifices of the Public Health Department—Central Hall Chambers, East Street, Barking. 49 report on the work of the ophthalmic clinics. 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 30 Other attendances 109 Spectacles prescribed 23 Spectacles supplied 14 External Diseases of the Eye treated at the Clinics: Blepharitis and Conjunctivitis 8 Injury to Eye 1 Ingrowing lashes 2 Dacrocystitis 3 Hordeolum 1 Corneal Ulcer 1 Meibomiam cyst 1 Choroiditis 1 Cases listed for Squint Training 19 Expectant and Nursing Mothers. Tests 11 Other Attendances (Blepharitis and Conjunctivitis 4, Hordeolum 1, Corneal nebulæ 1, Meibomiam cyst 1) 19 Spectacles prescribed 11 Spectacles supplied 9 50 Treatment of Children under 5 years of age at the Orthoptic (Squint Training) Clinic. (1) Cases treated: (a) Cured 1 (b) Under treatment at end of year 3 (c) Treatment commenced but discontinued on account of removal from district 1 Number of cases being prepared for treatment 19 (2) Treatments: (a) Case cured—(length of treatment 5½ months) 1 (b) Cases still under treatment: After 8 months treatment showing a diminution of squint 1 After 8 months treatment showing no diminution of squint 1 After 6 months treatment showing no diminution of squint 1 Number of treatments given 70 In this section of the Ophthalmic Clinic, the majority of the eye tests were required not on account of defective vision but because of squint. In children under five years of age, it is quite possible to secure the co-operation necessary to begin orthoptic training and such cases usually do well. The vision of the squinting eye has not usually deteriorated and no preliminary treatment is required. Training with pictures can thus be instituted immediately. It is our aim to cure those children before schooling begins. Expectant mothers attend the eye clinic complaining chiefly of headache. In none of them were found any of the signs of toxsemia of pregnancy affecting the eyes. Superficial inflammation of the eyes was present in some cases and it was important that this should be remedied lest their infants should become infected. 51 report on the work of the orthopædic clinic Orthopaedic treatment in Barking provides massage, medical electricity, plasters, splints, remedial exercises, including those for flat feet, etc., etc. In 1935 the old ultra-violet light apparatus was replaced by a modern duo-therapy lamp, and this year I am able to report that an up-to-date therapeutic switch table has been added to the equipment of the Orthopaedic Clinic. During the year also you have employed two full-time masseuses, and altogether the work has enlarged in scope. In one or two cases people have even been visited in their own homes to complete some necessary treatment, and the work at the Orthopaedic Clinic has been linked up with that of the Hospital—one of the masseuses attending at the Hospital to treat cases of acute anterior-poliomyelitis, and to treat difficult posture in cases recovering from diphtheria. It is well known that children recovering from diphtheria are oftentimes very weak indeed upon their legs, and I am very appreciative of the co-operation which has been achieved between the Hospital Staff and the Orthopaedic 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 toddlers. No. of primary examinations by Orthopaedic Surgeon 102 No. of re-examinations by Orthopaedic Surgeon 145 The cases dealt with for the first time during 1936 were referred for the following conditions:— (a) Deformities of Bones and Joints. (1) Congenital: Rickets 1 Deformity—toes 3 Deformed digit 1 (2) Acquired: Pes planus 10 Genu valgum 17 Bowed tibiae 30 Kohler's disease 1 53 52 (b) Muscular. (1) Congenital: Torticollis 6 Hæmatoma torticollis l Talipes 13 (2) Acquired: Pes planus 10 Inturned foot l Kyphosis 3 34 (c) Paralysis. Anterior poliomyelitis 4 Erb's paralysis 1 Hemiplegia 1 6 (d) Miscellaneous. Webbed toes 2 Re gait 1 3 Total defects found 96 During the year ten toddlers were admitted to hospital and the following operations were carried out in these cases:— Splintage 3 Manipulation and plaster 1 Tenotomy and plaster (Torticollis) 2 Tenotomy Tendo Achilles and plaster 2 Plaster 1 Femoral osteotomy and plaster 1 Observation 1 Total 11 53—54 PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1936. No. of sessions held by Orthopedic Surgeon No. of sessions held by Masseuses ATTENDANCES. Primary Examination Re-examination For Treatment Totals School Children Toddlers and Expectant & Nursing Mothers School Children Toddlers and Expectant & Nursing Mothers School Children Toddlers and Expectant & Nursing Mothers School Children Toddlers and Expectant & Nursing Mothers 11 580 123 102 227 145 . 4,408 4,008 4,758 4,255 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 30 394 3 85 200 1,477 201 2,472 3 60 144 579 Toddlers and Expectant & Nursing Mothers. 56 808 5 43 25 358 221 2,402 5 88 127 748 Admissions to Hospitals On Waiting List for Admission 31/12/36 School Children Toddlers Total School Children Toddlers Total (Under Council's (Orthopædic Schemc) 10 30 1 3 4 55 report of the dental surgeon. May, 1937. To the Medical Officer of Health, Borough of Barking. Sir, I have the honour to present the Annual Report for the Dental Service of the Maternity and Child Welfare work for 1936. There is an increase in numbers in all branches of the Dental Service for the year under review, and there seems to be a favourable reaction towards the conservation of teeth by the younger mothers. Many mothers between 37 and 40 years of age present themselves for treatment in which a few teeth could be regarded as saveable if one was sure that some care would be taken of the oral condition. Each of these cases has to be judged upon the type of patient and the patient's environment, and it is an unfortunate but true fact that if many of these saveable teeth were left in good faith, the patient would presert herself for treatment within two years for the removal of such teeth. This would involve both the patient and the Council in an uneconomic course of treatment, and in these circumstances such teeth are removed. With the younger mothers of course the question rarely arises. I have to I hank the Medical and Nursing Staff and the Health Visitors for their very generous help for without their support it is obvious that the Dental Work for the Maternity and Child Welfare Scheme would not meet with the success it does. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, L.D.S., R.C.S. (ENG.), Public Dental Officer. 56 DENTAL CLINIC. Mothers and Toddlers. Extractions 3,636 Scalings 135 Dressings 51 Inspections 209 Fillings 362 Dentures supplied 362 Anaesthetics— General 813 Local 38 Patients— Old 2,064 New 450 Number of Sessions held 205 Toddlers— Treatments 970 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, two samples were submitted specially and found to be of satisfactory purity on examination. Three samples were also taken from the well supplies of a factory, and found to be in order. The Engineer of the South Essex Waterworks Company informs me that the undermentioned engineering works have been carried out:— "A covered service reservoir at Ileaton Grange, Romford, holding 15 million gallons to safeguard the supply generally to the western district, including Barking, has been constructed, and the construction of the embankment to the Abberton Reservoir (near Colchester) is proceeding satisfactorily. The laying of various trunk pipe lines is also proceeding and contracts will be let shortly for the machinery, buildings, filtration plant, etc." Complaints continue to reach me from industrial users of the hardness of the water. 2. RAINFALL. The rainfall for the year ended 31st December, 1936 was 16.57 inches as compared with 20.26 inches for the previous year. Rain fell on 175 days in the year 1936. 58 3. DRAINAGE AND SEWERAGE. The joint drainage of the Boroughs of Ilford and Barking provides for the whole of the sewage of the district to be dealt with at the disposal works of the London County Council. The scheme was completed at June, 1035, and is functioning satisfactorily. 4. RIVERS AND STREAMS. The rivers and streams running through the area are controlled by the River Roding Catchment Board, whilst the River Thames, your southern boundary, and one of its tributaries, the River Roding, which flows through Barking, is under the control of the Port of London. Within the tidal limits the River Roding receives the sewage effluents from the works of three authorities, and higher upstream the effluents from the works of three further authorities. On no account should anyone bathe in the River Roding. When it is remembered that the general level in Barking is about 27 ordnance datum, it will be appreciated that in order to prevent local flooding it is imperative that surface water drainage should be effectual. As most of the surface water is discharged into streams and ditches it becomes urgent that the levels of such streams should be regulated, and that choking or silting should be remedied where this occurs. In order to avoid trouble from these causes the culverting of watercourses in the district is to be recommended, As the reclamation of low-lying land continues and the minor ditches are filled in, it would be helpful if the Corporation required builders when laying out land for this purpose to culvert any streams which it is felt should be retained. The very wet weather we have experienced during the year has given prominence to this aspect of housing development with the rise of subsoil water into sub-floor spaces. It is with satisfaction that I refer to the reclamation of a large area of the " saltings " to the River Roding at the rear of Westminster Gardens. This should lessen the nuisance from mosquitoes in that neighbourhood. 59 5. CLOSET ACCOMMODATION. At the end of the year there remained a total of 13 premises unconnected with the sewer. Seven of these were factory premises. Of these 13 premises, 8 have cesspools and 5 have pail closets. The premises still unconnected are isolated properties. Cleansing is carried out by means of covered vehicles and suction pumps. 6. PUBLIC CLEANSING. (a) Storage, Collection and Disposal.—The collection and disposal of domestic refuse is controlled by the Borough Engineer and Surveyor. During the year, 9,510 loads of refuse were collected, with an average weight of 1 ton 12 cwts. 2 qtrs. This figure shows a yield of 10.6 cwts per 1,000 of the population per day. Difficulty is being experienced in the disposal of trade refuse. So long as there remains a fixed charge of 5s. per load, without provision for the removal of smaller quantities at pro rata charges, we shall find traders hoarding refuse at the rear of their shop premises or alternatively awaiting a suitable opportunity to unload it upon the nearest available piece of waste land for later collection by the local authority. I strongly urge the institution of a system of collection of trade refuse at a fixed price per basket or bin. From a purely public health standpoint, I should welcome the free removal of such refuse but I know this is likely to be opposed on economic grounds. (b) Street Cleansing.—The Council has not yet introduced mechanical streetsweepers, relying upon manual sweeping for this service. With the construction of so many concrete roads in the district, the provision of a mechanical sweeper to remove the litter from this type of road would obviate much drudgery from an uninteresting task. 60 7. REFUSE DISPOSAL. At one time the Corporation had under consideration the question of barging refuse down the Thames, but finally decided to reclaim a low lying strip of land, together with an area of "saltings" on the north bank of the Roding, adjoining the sewage works. This should provide ultimately a valuable piece of river frontage, and if for no other reason is to be commended. Hardly had tipping commenced, before complaints were received from nearby residents. These were investigated and found to be without serious import. Private Tips.—The reclamation of low lying land by private owners continues. In no instance is the material tipped, domestic refuse, or of organic origin, but is largely excavated or demolition debris with quantities of factory refuse. Residents in the neighbourhood of such tips have the greatest objection to their formation under any circumstances, notwithstanding the fact that in many instances such reclamation is often of considerable value to the area. In connection with such tips the Corporation administer the relevant section of the Essex County Council Act, and '245 visits were paid by your officers to such tips during the year to see that no nuisance was committed, and to offer advice as to methods of disposal. 8. SANITARY INSPECTION OF THE AREA. The number of complaints received and recorded in the register of complaints was 759, as compared with 855 in 1935, 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 13,975 and are summarised below, together with the number of defects found arising from those visits. The housing defects dealt with numbered 7.950. 61 (a) Work of Sanitary Inspectors. (1) Inspection of Direlling-Houses. Total Houses Inspected under Public Health or Housing Acts 3,181 Total Number of Inspections made 9,666 Housing (Consolidated) Regulations 1,116 After Infectious Disease 956 Overcrowded Premises 421 Defects Found 7,950 Notices Served (Preliminary) 2,137 Re-inspections re Notices Served 4,509 Inspection of Works in Progress 635 (2) Premises Controlled by Byelaws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings 1 — — Common Lodging Houses 38 — — Offensive Trades 107 10 7 Tents, Vans and Sheds 75 3 2 Dairies, Cowsheds and Milkshops 219 18 13 Slaughter-houses 199 1 1 Hairdressers' & Barbers' Premises 46 10 6 Smoke Observations 220 40 38 (3) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 327 34 8 Laundries 10 14 2 Bakehouses 68 38 16 Domestic Workshops 4 — — Other Workshops 75 9 6 Other Workplaces 120 9 5 Outworkers' Rooms 113 3 3 Butchers' Premises 317 82 64 Fishmongers 45 15 9 Restaurants and Dining Rooms 185 43 25 Stable and Stable Yards 90 31 25 Piggeries 34 7 6 62 (4) Miscellaneous. Inspections. Defects. Notices. Rats and Mice (Destruction) Act, 1919 52 5 5 Vacant Land and Refuse Dumps 245 19 16 Public Lavatories 51 6 12 Schools 67 12 8 Markets and General Shops 493 115 60 Ice-Cream Vendors 220 18 16 Petroleum and Celluloid Stores 108 — — Drainage Inspections 273 — — Milk Sampling 99 — — Other Miscellaneous 272 — — Inspection of Meat from Outside District 186 — — Shops Act, 1934 126 20 15 Water Sampling 10 — — Food Manufacturers 32 4 2 Picturedromes 2 4 1 (b) Summary of Sanitary Work Carried Out. (1) Drainage. Choked drains, opened, repaired and cleansed 345 Drains reconstructed 50 Ventilation shafts repaired or new fixed 27 New inspection covers 7 (2) Closet Accommodation. Roofs Walls W.C. structures repaired 7 Floors Doors Seats fixed 77 W.C. pans fixed or cleansed 120 Flushing apparatus repaired or renewed 160 (8) Sinks. New fixed 83 New sink and bath wastepipes 100 New gully traps 21 63 (4) Dampness Roofs and flashings 676 Eavesgutters 350 Rainwater pipes 155 (5) Water Supply. Defective water fittings repaired and supply reinstated 88 (6) Paving. Forecourt paving repaired or relaid 31 Yard paving repaired or relaid 113 Gully dishing repaired or renewed 126 (7) Dustbins. New ones provided 185 (8) General Repairs. External walls repointed 506 House floors repaired 186 Windows repaired or renewed 335 Windows reglazed 54 Windows and door reveals repaired 113 Window sills repaired or renewed 121 Sashcords renewed 247 Washing coppers repaired or renewed 110 Stoves repaired or renewed 216 House doors and frames repaired or renewed 180 Stairs repaired 29 Handrails fixed 5 Chimney pots renewed and stacks rebuilt 361 Dirty or defective rooms repaired, cleansed and redecorated 2,030 Damp walls remedied 157 Insufficient floor ventilation 105 External painting 274 Internal painting 3 Weatherboards fixed 21 Door sills repaired or renewed 42 Defective brickwork repaired 1 64 (9) Miscellaneous. Offensive accumulations removed 43 Animals so kept as to be a nuisance 19 Verminous rooms disinfested 55 Drains tested 184 Dangerous structures reported 12 Overcrowding 29 Obstructive buildings 2 Other conditions 12 (c) Notices Served. Informal Notices 2,137 Statutory Notices:— Section 23, Public Health Act, 1875 - 331 Section 36, Public Health Act, 1875 18 Section 41, Public Health Act, 1875 11 Section 94, Public Health Act, 1875 208 Section 17, Housing Act, 1930 94 (d) Factory and Workshop Act, 1901. Factories, Workshops and Workplaces. (1) Inspections (including inspections made by Sanitary Inspectors). Premises. Number of I nspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 337 10 — — Workshops 143 22 — — Workplaces 120 5 — — Totals 600 87 — — 65 (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 31 31 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors 4 4 — — Other nuisances 41 41 — — Sanitary accommodation:— Insufficient 7 7 — — 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 — — — — Totals 99 99 — — *Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. (3) Home Work. Six notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 14 workpeople engaged on making wearing apparel, etc., in their homes. 66 (4) Registered Workshops. Workshops on the Register (sec. 131) at the end of the year. Number. (1) (2) Bakehouses (including nine factory bakehouses) 14 Other Workshops 45 Total number of Workshops on Register 59 (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) — 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 91 outworkers:— Wearing apparel 58 Millinery 3 Tie-making 4 Life-belt covering 2 Machinery 1 Box makers 3 Boot repairs 1 Artificial flowers 2 Paper hats, Christmas crackers and novelties 7 Cushions and runners 1 Flags 4 Handbags 1 Infants' bibs 2 Fancy leather goods 1 Ladies' umbrellas 1 67 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. (e) Premises and Occupations which tan 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, which has received confirmation and will therefore be demolished at an early date. 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 six van dwellings situated in three yards in various parts of the district where water supply and sanitary accommodation are provided. Seventy-five visits were paid and two notices were served in rcspect of three defects discovered. The Barking Corporation Act provides that approval is now necessary before this type of dwelling can be established in the district. (1) 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 21 Dealers in Rags and Bones 7 Gut Scraper 1 Fat Melters 2 Fish Skin Scraper 1 Oil Boiler 1 Soap Makers 1 Total 34 One hundred and seven visits were paid to these 34 premises, and 10 contraventions of the byelaws were discovered and any necessary action taken. 68 (6) Piggeries.—There are eight remaining piggeries in the district. (7) Stables.—These premises continue to be a source of trouble. The occupiers are invariably unable financially to carry out any improvements. The Council has made byelaws for the control of these premises. Ninety visits were paid during the year to stable premises, and 25 notices were served in respect of unsatisfactory conditions. (/) Rag Flock Acts, 1911 and 1928. There are two premises where upholstery repairs are carried out and these premises are regularly inspected. We have not found rag flock in use at either of these establishments, which are quite small repair shops. 9. SHOPS ACT, 1934. Inspections carried out for the purposes of Section 10 of this Act numbered 126. In 15 instances notices were served requiring additional sanitary accommodation, washing facilities or improved heating. In the administration of sections dealing with sanitary provisions, difficulties were met in practice with respect to what is a reasonable temperature and how it can be maintained in the following types of shops:— (1) Shops with open fronts; (2) Shops with open fronts also taking in forecourts under temporary roof coverings for sale of foods; (3) Shops for the sale of foodstuffs; (4) Shops for the sale of wet fish. Conferences were held with representatives of the London Retail Meat Traders' Federation and the National Federation of Fishmongers, when it was found that there was a large measure of agreement between your- officers and the representatives of these Associations. 69 Shops with open fronts present their own particular problems to which your officers have given much attention in consultation with the owners of such properties, and a considerable measure of agreement has been achieved. Many difficulties would be obviated if forecourt trading could be abolished. Apart from the removal of discomfort from exposure of employees to inclement weather, there would be considerable improvement in the standard of food distribution. The remedy is in the hands of the purchasing public, who should refuse to buy foodstuffs exposed in the open air. 10. SMOKE ABATEMENT. Domestic.—The general public is inclined to overlook the fact that the domestic fire contributes largely to the dirt and drab conditions found in towns, in addition to injury to health. We like to see the houses in Barking freshly painted but we object to the results being spoilt shortly afterwards by smoke and soot, and so far as domestic smoke is concerned, needlessly. The Council will shortly be erecting some 400 houses, and so will have an opportunity of contributing to the smoke abatement problem. It is now accepted, without question, that the modern housewife prefers to do her cooking by gas or clcctricity. In fact gas or electricity is found practicable for all purposes, except for long period heating. From a hygienic standpoint it is urgent that there shall be one open fire at least in the house. Having agreed on this the problem is as to how this open fire can be provided without smoke. You may say we cannot make any tenant burn a smokeless fuel. This may be so but you can in respect of your own houses provide and fix grates which are capable of burning coke as well as coal. There are now several kinds of low temperature coke and there is also good quality gas-coke which is growing in popularity on account of its relative cheapness. The manufacturers of grates have produced many types in which coke will burn brightly and freely. These grates are usually provided with a good air supply to the fuel bed and some form of gas ignition. 70 The Council controls approximately 1,800 houses in the district and the tenants are now being offered facilities for abolishing the coal-burning cooking range for a more suitable open fire. The new houses and blocks of flats are being designed to last a long time and great developments are taking place as regards the supply of gas and electricity. There are t\vo essentials in connection with the successful use of either :— (1) Instruction in the proper use of the apparatus ; (2) The collection of charges in a manner suitable for weekly wage-earners. It is found a convenient practice to collect the fixed charge and hire of apparatus weekly with the rent, and in the case of electricity the tenant paying his |d. or fd. per unit through the slot meter for the current he uses. In the case of gas by the operation of the two-part tariff, the tenant paying a fixed charge in the case of small houses of 7s. 6d. or 10s. Od. per quarter, and getting all the gas he uses at a low cost per therm, would make a considerable saving for the lower paid tenants who would then be able to get water-heating in addition to present facilities. I hope at an early date the Council may consider granting their tenants an opportunity of meeting their fixed charges weekly with their rent. Industrial.—Arising from 220 observations made, 40 offences were registered and necessary action taken. The number of factories in the district continues to increase, but most of them are for the light industries, and their steam requirements are met by the provision of small boiler units—in some eases gas fired. At the Creeksmouth Generating Station there has not been any material change, the pulverised fuel furnaces being the ones most productive of nuisance. The smelting furnaces of the zinc oxide factory continue to be a source of trouble, but as these furnaces are exempt from the operation of the Smoke Abatement Act we are unable to take any legal action. 71 11. NOISE NUISANCES. During the year our attention has been called to nuisances and discomfort arising from the scream of circular saws, the grind of a cyclone used in a sawmill, electric hum from machinery and similar noises. Whilst your officers have been able to secure reduction in the noises of which complaint has been made, the provisions of the Barking Corporation Act are intended to deal only with avoidable noise and do not give the Council power to prohibit the use of the offending plant. The defence available to the factory owners under the above Act may not be a good defence at common law, and therefore in some cases the injured party would have a remedy in the civil courts. 12. SWIMMING BATHS. There are no privately owned swimming baths or pools in the district. In my Report for the year 1935, I described fully the Corporation swimming baths and pool, and made certain observations. Swimming Pool.—During the year there were no structural or plant alterations at the pool affecting the condition of the bath water, but the bathing amenities were further improved. The Baths Superintendent has commented upon the reduction of the hours of sunshine in 1936 as compared with 1935, and referred also to the fall in the number of bathers at the Pool. I am anxious to see greater use of the Swimming Pool and would support any recommendation for heating the water here. I am advised that the sun-bathing area laid down in 1935 proved the most popular addition to the Pool amenities during the year under review. Swimming Baths.—There were two pre-cleansing rooms added to the amenities, and these were found helpful in ensuring satisfactory conditions of bath water. Examination of Bath Water.—The samples of water submitted for examination from the Pool and Baths were found safe and suitable for swimming purposes. There still appears some difficulty, however, in keeping a correct chlorine dosage. 72 13. ULTRA-VIOLET LIGHT RADIATION. Ultra-violet light radiation is measured in Barking at the Barking Hospital. The apparatus used is that designed by Professor Leonard Hill, known as the " test by fading" instrument. The biologically active ultra-violet rays are measured by the fading of a standard solution of acetone and methylene blue. The following table shows the comparative ultra-violet light readings for the years 1933, 1934, 1935 and 1936 Month. Daily average for Barking. 1933 1934 1935 1936 Units. Units. Units. Units. January 0.76 0.48 0.13 0.32 February 0.78 0.82 0.75 0.75 March 0.92 1.41 1.68 1.78 April 1.50 1.99. 2.40 2.40 May 4.00 2.93 3.42 3.45 June (Reading not taken) 3.66 4.93 4.57 July 4.74 4.77 8.16 6.97 August 5.45 5.93 7.97 8.19 September 4.06 6.83 7.60 7.87 October 1.48 5.35 5.48 6.09 November 0.86 2.20 1.70 3.10 December 0.96 1.03 0.65 1.83 The figures for the four years under consideration show that there is a very considerable amount of sunshine in Barking and that this sunshine is biologically active. 14. SCHOOLS. In the case of Gascoigne and Northbury Schools, attention was called to the unsatisfactory sanitary conveniences for the infants and junior boys. These are shortly to be re-modelled. Twelve of the sixteen elementary schools are of recent construction and two are out-of-date. It has not been found necessary to close any department of the schools as a result of infectious disease. In this connection I am at present reviewing the position with regard to the exclusion of contacts with the commoner infectious diseases. 73 15. ERADICATION OF BED-BUGS. We find the general public are becoming more conscious of this pest and more anxious to eradicate it. Our experience during the year showed that where the infestation was of a minor character the affected tenants were able to deal with the trouble themselves, the Corporation providing the insecticide free, and instructing the tenants in its application. In 15 instances formal notices were served upon private owners to disinfest rooms. In one case by arrangement the house was vacated and fumigated by a contractor with hydrogen cyanide gas, as was also a public room. The Corporation at present do not provide temporary shelters, so that it is usual to carry out fumigation with one of the sulphur products in the case of tenanted houses after the necessary work of preparation has been carried out. We have not used orthodichlorbenzine or naphthalene as both arc in experimental stages. We found 6 cases of minor infestation in London County Council houses which were dealt with successfully by the tenants. 20 cases were referred to the Housing Manager in respect of Barking Corporation houses, and in addition 24 houses were disinfested as the result of his own investigation. In one instance a Barking Corporation house was vacated and fumigated under contract with hydrogen cyanide gas. In all other cases Corporation workmen carry out the work using a liquid insecticide of the paraffin and phenol group. Where removals to Corporation houses are from clearance areas fumigation of the tenants' effects is carricd out by contractors in the removal vans, whilst bedding and soft goods are steam disinfested at the Barking Hospital. Similar action is taken in respect of removals from other properties where circumstances warrant. Whenever and wherever practicable we advocate the use of hydrogen cyanide gas as its use causes the least disturbance of the premises and is the most effective fumigant available. The grave danger arising from its use unfortunately prevents its wider application. 75 SECTION D. HOUSING. 1. STATISTICS. (a) General. Number of new houses erecled during the year:— (1) Total 401 (2) As part of a municipal housing scheme:— (a) Barking Nil (b) L.C.C 132 (3) Others (including private enterprise and subsidy houses) 269 (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) 3,181 (b) Number of inspections made for the purpose 9,666 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 1,116 (b) Number of inspections made for the purpose 2,383 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 167 (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 2,472 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 tlieir officers 1,749 76 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 repairs112 (2) Number of dwrelling-houses which were rendered fit after service of formal notices:— (a) By cvners 132 (b) By local authority in default of owners 6 B.—Proceedings under Public Health Acts : (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 244 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 241 (b) By local authority in default of owners 7 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders weremade 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D.—Proceedings under section 20 of the Housing Act, 1930 : (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 2. HOUSING CONDITIONS. (a) General Observations.—The total number of inhabited houses in the district is 19,180 (including 1,288 shops), which, compared with the total of 10,965 at the census of 1931, gives an indication of the growth of the town. Of the total of 17,892 dwelling-houses, 1,726 are owned by the Council and over 7,000 have been erected in the area by the London County Council since the year 1929. 77 It is interesting to note that 2,104 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. During the year 1936, no less than 345 temporary buildings were approved for erection in the back gardens of dwelling-houses in the district. I approve the shed now provided by the Corporation for their tenants, but would be glad to see more care exercised in its location at the rear of the houses. I would further prohibit the erection of any other shed on the premises, and would refuse permission to a tenant to erect any type of shed other than this. HOUSES BUILT IN DISTRICT. 1926—1936. 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 1936 401 (Barking) Nil 269 (L.C.C.) 132 Totals 10,874 8,234 2,640 78 Of the 8,234 houses shown above as part of Municipal Housing Schemes, 935 were provided by the Borough of Barking and 7,299 by the London County Council. (b) Bousing Act, 1935.—Overcrowding :— (a).— (i) Number of dwellings overcrowded at the end of the year ... 297 (ii) Number of families dwelling therein 331 (iii) Number of persons dwelling therein 2,062J units (b).—Number of new cases of overcrowding reported during the year ... 45 (c).— (i) Number of cases of overcrowding relieved during the year 169 (ii) Number of persons conccrned in such eases ... 1,355 units (d).—Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding ... Nil (e).—The known cases of overcrowding were reviewed at the end of the year when it was found that the total of 421 at the beginning of the year had been reduced to 252, to which number was added 45 new cases, making a total of 297 at the end of the year. The Barking Corporation were unable to make any active progress in rehousing, however, owing to difficulties met in the acquisition of building land. The original proposal to erect 250 houses is now proceeding because negotiations with the London County Council for the acquisition of land for this purpose are nearing completion. Changes in overcrowding in houses owned by Local Authorities :— London County Council. Barking Corporation. January, 1936 154 101 January, 1937 80 83 79 (c) Clearance Areas.—The clearance of insanitary properties was continued during the year. Six compulsory purchase orders were made, viz :— North Street, No. 2; Heath Street, No. 1; St. Paul's Road, No. 1; St. Paul's Road, No. 2; Axe Street & Broadway; Grove Place. The total number of properties affected in the six schemes was 163 and the number of persons to be displaced 828. In order to make the scheme efficient the Corporation decided to include a large number of " grey " properties. At the inquiry held in September there was considerable opposition from property owners and other interested persons but the schemes have now been confirmed. The ultimate effect of this clearance together with schemes already concluded means that in the period 1933—1938 the entire appearance of the centre of Barking will have changed, and the Corporation have an opportunity of rebuilding it to their own design as the sites are being acquired compulsorily. 81 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. MILK SUPPLY AND ICE-CREAM. (a) Milk Supply.—Registered with the Authority are 81 retail purveyors, of whom 15 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 50, five were found to be unsatisfactory :— Type of Sample. Satisfactory. Unsatisfactory. Totals. " Sterilized " Milk 1 — 1 " Pasteurised " Milk 21 — 21 Raw Milk 22 5 27 " Homogenised " Milk 1 — 1 Totals 45 5 50 There were during the year 46 samples of milk submitted to biological examination for the presence of tubercle. Three of the 46 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 2 " Pasteurised " Milk 14 Grade " A " (T.T.) Milk 13 Grade " A " Milk, Pasteurised 1 82 A licence was granted to one local firm for the bottling of Grade V A " (T.T.) Milk, and one for the treatment and sale of milk as " pasteurised." (b) Milk and Dairies Order, 1926.—One dairyman was prosecuted for filling a bottle with milk at other than a registered dairy and was fined £2. (c) Ice-Cream—Barking Corporation Act, 1933—Section 160.—There are 99 vendors registered, in accordance with this Act, of which 35 are manufacturers with premises in Barking. Twelve vendors had premises outside the district. Thirty-seven samples were submitted for bacteriological examination, four of which were unsatisfactory. 2. MEAT AND OTHER FOODS. (a) Meat.—There is one licensed slaughterhouse in the district. 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 nine years ended December 31st, 1936. Year 1928 1929 1930 1931 1932 1933 1934 1935 1936 Notifications Received 126 72 64 39 57 34 205 236 195 Cattle 40 64 80 12 10 41 350 447 340 Pigs 409 137 93 200 84 18 502 1131 474 Sheep 815 426 332 173 270 241 1038 1346 748* Calves 71 10 11 1 9 1 140 157 77 Totals 1335 837 516 386 373 301 2030 3081 1639 * Includes 404 Lambs. Diseased Meat was destroyed as under :— Description. Disease. Weight. 84 beasts' lungs Tuberculosis ... 840 lbs. 1 ,, lungs Adhesions 10 „ 2 „ lungs Encysted Distoma Fasciola 20 lbs. 83 Description. Disease. Weight. 1 beasts' lungs Cysts 10 lbs. 1 „ lungs Adhesions 10 „ 17 „ livers Cirrhosis 238 „ 18 „ livers Distoma 252 „ 24 „ livers Abscesses 336 „ 10 „ livers Tuberculosis 140 „ 7 „ livers Cavernous Angioma 98 „ 1 „ liver Hepatitis & Cirrhosis 14 „ 2 „ livers Distoma & Angioma 28 „ 2 „ stomachs Abscesses 6 „ 2 „ udders Mastitis 14 „ 1 „ kidney Nephritis 1J „ 1 „ head Actinomycosis 18 „ 1 „ head Abscess 18 „ 1 „ spleen Adhesions 2 „ 1 „ spleen Malformation 2 „ 17 „ heads Tuberculosis 306 „ 8 „ mesenteries Tuberculosis 24 „ 7 „ carcases & organs Tuberculosis 4992 „ 1 „ flank Abscess 20 „ 2 „ tongues Actinomycosis 12 „ 1 „ tongue Abscesses 6 „ 4 pigs' plucks Tuberculosis 64 „ 1 „ pluck Tuberculosis & Cirrhosis 16 „ 1 „ pluck Pericarditis & Cirrhosis 16 „ 3 „ livers Hepatitis & Cirrhosis 18 „ 4 „ livers Cirrhosis 24 „ 1 „ liver Tuberculosis 6 „ 2 „ kidneys Hydro-nephrosis i » 5 „ heads Tuberculosis 70 „ 14 „ mesenteries Tuberculosis 28 „ 3 „ lungs Cysts & Congestion 10 „ 5 „ lungs Congestion 17 „ 1 „ lungs Pneumonia 4 „ 3 „ lungs Engorged 10 „ 5 „ lungs Aspirated 17 „ 1 „ lungs Adhesions 4 „ 1 „ mesentery Localised Melanosis 2 „ 84 Description. Disease. Weight. 1 pig's mesentery Cystic 2 lbs. 1 „ spleen Abscess 1 » 1 „ loins Abscess 3 „ 9 sheep's livers Cirrhosis 14 „ 1 „ liver Distoma 2 „ 5 „ livers Strongylus Rufeseens 8 » 2 „ plucks Strongyli & Distoma 14 „ 1 „ pluck Pneumonia & Adhesions 7 „ 1 lamb's liver Strongylus 4 „ 1 „ liver Distoma fasciola 4 „ 1 calf's pluck Tuberculosis 10 „ 1 pig's mesentery Abscess 2 „ 1 set pig's organs Fevered 7 „ Total 3 tons, 9 cwts, 74 lbs. (b) Unsound Food.-—The following list gives particulars of unsound food destroyed during the year:— 6 legs of lamb. 2 sheep's livers. 6 rabbits. 1 leg of pork. 19 lbs. bovine liver. 800 lbs. chestnuts. 1 pig's head. 3 stones skate wings. 4 lbs. lambs' liver. 14 lbs. sprats. 123 loaves of bread. 6 lbs. corned beef. 210 bread rolls. 7½ozs. chicken and ham roll. 12 custard tarts. 1 female fowl. 1 pair sheep's lungs. A retail butcher was prosecuted for exposing for sale 6 legs of imported lamb, when a fine of £2 was imposed. A firm of multiple grocers were summoned on two informations with respect to the sale and exposure for sale of chicken and ham roll. There was a fine of £2 on each information. 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. 85 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 27 Other 99 Total 135 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. 5. NUTRITION. The dissemination of knowledge on nutrition is a particularly difficult subject. W e are indebted to our teachers who are bringing lip a generation who will have a much sounder knowledge of food values than had their fathers and mothers. As I have said elsewhere, if the right kinds of food in sufficient quantity and variation are placed before the public at the right prices, it is not likely that there will be much, if any, deficient nutrition. I do, however, deprecate the use by people who can ill afford them of patent foods, whose essential values can be obtained in the ordinary market at much less cost than of the patent foods themselves. Personally, I always make a point of avoiding these foods in hospital treatment, not only because they are not value for money, but because I think it is a wise education for people to realise that the best feeding does not include these foods. 86 Last year you supplied over 100,000 meals to necessitous children, and each of these meals is not only a meal in itself, but is a glorious opportunity to educate the young people in the foods all should eat. It is with regret I have noted how well grounded are the complaints of those who have to deal with this work that children do not favour the meals they ought to eat, but rather those meals which may reasonably be said to require little or no mastication. Perseverance, however, with these children, even though it requires patience on the part of those undertaking the work and extra money on account of the extra work involved, should be pursued, until children appreciate the meals they ought to eat. At your Public Restaurant many meals are served each day to the public. Here is another opportunity of making each meal a lesson in itself. 87 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. 1. NOTIFIABLE INFECTIOUS DISEASES. The statistical tables in regard to notifiable infectious diseases during the year will be found on pages 88 to 92. These tables show that there was a considerable falling off in the number of cases of notifiable diseases in Barking, but contrariwise it should be noted that last year I reported there had been a considerable amount of notifiable infectious disease in Barking. The cases of scarlet fever notified declined from 487 to 345, and the number of cases of diphtheria from 397 to 162. With regard to diphtheria, I am happy to report that this year there were only 3 deaths due to diphtheria as against 22 for 1934. As I have pointed out elsewhere Barking has a relatively high percentage of young people, which in turns means that there must be a high incidence of the infectious diseases which arc commonly found amongst young people. It is obvious from examining the statistical tables that the diphtheria during the year was of a less virulent type than heretofore. The number of streptococcal infections, the chief of which are scarlet fever, sore throat without a rash and puerperal fever, remain about the same as in the previous year. Your officers are endeavouring to observe the differences between various forms of streptococcal infection. This work is being carried out at the pathological laboratory, but it is far too early to be able to make any statement upon this matter. With regard to pneumonia, malaria and dysentery, we fortunately had no cases of malaria or dysentery. Generally speaking the incidence of pneumonia was less than in the previous year, save in the case of pneumonia following upon measles, a matter I have written upon elsewhere. The period of stay of cases of scarlet fever in hospital when the cases are uncomplicated is kept as short as is possible, save sometimes in the summer, when in the case of debilitated children it is of definite advantage to keep these children in for convalescence. There is, however, little possibility of replacing hospital treatment by nursing and supervision at home, bccause the character of the district militates against this. 88 2. NOTIFICATION TABLES. The following table shows the number of notifications of infectious diseases (other than Tuberculosis) received during 1936 :— TABLE I. Disease. Males. Females. Total. Total cases removed to Hospital. Deaths. Smallpox — — — — — Scarlet Fever 178 201 379 345 1 Diphtheria 61 101 162 162 3 Enteric Fever (including Para-typhoid Fever) 2 4 6 6 2 Puerperal Fever — 4 4 4 1 Puerperal Pyrexia — 12 12 9 — Pneumonia : Acute Influenzal 86 61 26 56 — Acute Primary 75 12 Following Measles 46 — Erysipelas 19 27 46 25 2 Ophthalmia Neonatorum 4 6 10 4 — Acute Anterior Poliomyelitis 9 5 14 13 — Pemphigus Neonatorum 2 3 2 — — Cerebro-Spinal Meningitis — 3 3 3 2 Totals 361 424 785 627 23 89—90 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 1 13 20 36 40 179 51 18 13 5 3 — 379 23 89 23 33 22 111 18 60 Diphtheria 2 4 11 14 14 65 26 5 14 4 3 — 162 17 34 23 20 4 39 12 13 Enteric Fever — — — — — 1 1 3 — 1 — — 6 — 1 — — 4 — 1 — Puerperal Fever — — — — — — — — 4 — — — 4 — — — 1 1 1 — 1 Puerperal Pyrexia — — — — — — — — 10 2 — — 12 3 1 — 1 — 3 — 4 Pneumonia (ac. primary, ac. influenzal & following measles) 8 10 12 9 12 30 13 4 15 10 15 9 147 22 15 25 15 10 29 14 17 Erysipelas — — 2 1 — — 1 2 5 7 19 9 46 6 12 8 8 2 2 7 1 Ophthalmia Neonatorum 10 — — — — — — — — — — — 10 1 — 4 1 2 — — 2 Acute Anterior Poliomyelitis — 1 1 1 1 7 2 1 — — — — 14 4 3 — — 1 6 — — Pemphigus Neonatorum 2 — — — — — — — — — — — 2 — — — — — 1 1 — Cercbro-spinal Meningitis — — — — — 1 1 — — — 1 — 3 1 — 2 — — — — — Totals 23 28 40 61 67 283 95 33 61 29 41 18 785 77 155 85 79 40 192 53 98 91 TABLE III. Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1936 :— Scarlet Fever. Diphtheria. Total. January 35 20 55 February 33 13 46 March 38 14 52 April 20 8 28 May 30 12 42 June 35 12 47 July 26 6 32 August 33 17 50 September 26 23 49 October 33 7 40 November 36 13 49 December 34 17 51 Totals 379 162 541 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 14 Whooping Cough 7 Summer Diarrhœa 8 Chicken-pox — There have been no new decisions as to the admission of such diseases as measles to the Barking Hospital, but it is to be noted that with the extensions to the Hospital during the past few years, it has been more possible to deal with these cases than heretofore. (b) Rheumatic Fever.—Rheumatic fever in Barking is more prevalent than it is in other parts of the Country, but then this is true for all parts of the Thames Valley. It is one of the problems which I hope will in time be attacked more strenuously than it is today. It is possible to set up special rheumatic clinics, and a rheumatic clinic if set up is of greatest usefulness if it works in association with a hospital which provides special beds for these patients. Our work in scarlet fever is entirely linked up with research in rheumatism, and I hope the time will come when we shall have a special pavilion at the Barking Hospital for cases of rheumatic fever. 92 (c) Influenza.—There were 7 deaths from influenza during the year 1936. This contrasts favourably with 9 deaths in 1935, 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 freeoly with people when they are likely to spread disease. (d) Scabies.—Forty-three 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 one case, 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. (a) Admissions.—The following is the table of admissions, etc., in respect of infectious diseases during 1936 :— Disease. In Hospital January, 1st, 1936. Admitted dining the year. Died. Discharged. In Hospital Dec. 31st, 1930. Scarlet Fever 61 340 1 365 35 Diphtheria (including Membranous Croup) 33 157 3 164 23 Enteric Fever — 4 1 3 — Puerperal Fever — 2 1 1 — Puerperal Pyrexia — 9 — 9 — Pneumonia 3 55 14 40 4 Erysipelas 1 23 2 20 2 Ophthalmia Neonatorum — 2 — 1 1 Others 7 83 4 81 5 Acute Anterior Poliomyelitis — 7 — 6 1 Cerebro-Spinal Meningitis — 3 1 2 — (b) Number of Bed Days.—The total number of bed days in the infectious diseases hospital during 1930 was 27,939—that is to say, an average of 76 patients were in hospital throughout the 366 days in the year. 4. BANKING HOSPITAL. 93 5. ARTIFICIAL IMMUNISATION. The provision of artificial immunisation against diphtheria remains as it has been for the last few years—there is little or no demand for this in Barking. We are trying to make up for this apathy on the part of the public by the closest co-operation with medical men engaged in general practice, and we are watching with interest the results achieved in this way, compared with those where artificial immunisation is readily accepted by the population. Although there has been no specific local action taken with regard to the use of measles serum for prophylaxis or attenuation, steps are being taken towards this end, and it is hoped to set up a service whereby measles serum will be at least available in necessary cases in your hospital. Steps are also being taken to provide facilities for immunisation against whooping cough, and I hope to be able to write more fully upon this question next year, when we have had an opportunity of observing the results obtained. The following table shows what has been done under the immunisation scheme:— Diphtheria Scarlet Fever. Total number of cases treated 173 18 Number of first attendances for treatment 131 18 „ subsequent attendances for treatment 307 70 ,, final " Schick " tests 83 — ,, final " Dick " tests — 13 6. CANCER. There have been 74 deaths from cancer, 38 below the age of 65 years and 36 above the age of 65. The following table shows the occupations of the 74 people who died from cancer during the year 1936:— 94 Male. Bricklayer 1 Carpet & Linoleum Planner 1 Chauffeur 1 Clerks 2 Coal Porter 1 Coal Trimmer 1 Draper 1 Draughtsman 1 Electrician 1 Engine Drivers 2 Estate Agents 2 Fish Fryer 1 Flusher 1 Furnace Fireman 1 General Dealer . 1 Harness Maker (Retired) 1 Labourers 14 Newsagents & Tobacconists 2 Night Watchman 1 Police Constable 1 Porters 2 Shipwright 1 Shops Act Inspector (Retired) 1 Stokers (Gas Works) 2 Stevedore 1 Upholsterer 1 Wheelwright 1 46 Female. Wives 13 Spinsters 5 Widows 10 28 95 The following table shows the ages of the persons who died from cancer and the organs affected:— Organ. Under 1 year. 1-5 years. 5-15 years. 15-25 years. 25-45 years. 45-65 years. Over 65 years. Total. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Bladder — — — — 1 — — — — — 1 — 2 — 4 — Breast — — — — — — — — — 1 — — — 2 — 3 Caecum — — — — — — — — 1 — — — — 1 1 1 Colon — — — — — — — — — — 1 4 — 2 1 — Disseminated — — — — — — — — — 2 — — — 2 — DuraMata — — — — — — — — — — — 1 — — — 1 Kidney — — — — — — — — — — 1 — 1 — 2 — Larynx — — — — — — — — — — 1 — 1 — 2 Liver — — — — — — — — — — 2 1 3 — 5 1 Lung — — — — — — — — 1 1 2 — — — 3 1 Mouth — — — — — — — — — — — — 3 — 3 Oesophagus — — — — — — — — 1 — 1 1 1 1 3 Ovaries — — — — — — — — — — — — — 1 — 1 Pancreas — — — — — — — — — — — — 1 1 1 1 Peritoneum — — — — — — — — — — 1 — — — 1 — Prostate — — — — — — — — — — — — 6 — 6 — Rectum — — — — — — — — — — — — 1 1 1 1 Stomach — — — — — — — — 4 — 2 — 3 3 9 — Tongue — — — — — — — — — — — 1 — — — 1 Thyroid Gland — — — — — — — — — — — — 1 — 1 — Uterus — — — — — — — — — — — 4 — 1 — — Ventriculi — — — — — — — — — — — — 1 1 1 1 Totals — — — — 1 — — — 7 2 14 12 24 14 46 28 7. PREVENTION OF BLINDNESS. Blindness is being prevented in Barking ; it is being prevented by the cooperation 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 Midwives takes up each case as it should arise and your Health Visitors follow up each case and encourage parents to carry out any necessary treatment. It is years ago since we had a case where vision has been impaired by reason of Ophthalmia Neonatorum. 96 The following table shows that the number of cases of Ophthalmia Neonatorum during 1936 was 10, compared with 15 in 1935. Six cases were treated at home, and in no case was the vision impaired. Age Group. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At Home. At Hospital. Under 3 weeks 10 6 4 10 — — — 8. TUBERCULOSIS. Particulars of new cases of Tuberculosis and of all deaths from the disease in the area during 1936 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 — — 3 3 — — 1 1 5 to 15 years 3 — 8 4 — — — 1 15 to 25 years 19 17 2 2 4 4 1 — 25 to 35 years 16 13 1 — 6 4 1 — 35 to 45 years 5 15 — — 4 8 — 1 45 to 55 years 6 4 — 3 2 1 — 1 55 to 65 years 3 4 — — 2 — — — 65 years and upwards — — 1 — 2 — — — Totals 52 53 15 12 20 17 3 4 During the year, 132 notifications were received of all forms of Tuberculosis— pulmonary 107 and non-pulmonary 27 and there were 9 deaths of un-notified cases (4 pulmonary and 5 non-pulmonary), making a total of 141 new cases during the year. Information has been received of the removal into the district of 50 tuberculous persons, included in number of notifications received. This compares with 39 received during 1935 and 26 for 1934. 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. 97 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. 57 33 4 10 34 16 7 10 Forty-four deaths occurred from Tuberculosis (all forms) thirty-seven of these being pulmonary cases. The number of deaths in institutions was thirty-seven. The death rate for Tuberculosis (all forms) during 1936 was 0.58 per 1,000 population, compared with 0.62 for the previous year. The Public Health (Prevention of Tuberculosis) Regulations, 1925, give you power to deal with persons suffering from tuberculosis who are employed in the milk trade. There has been no need for any such action during the year under review. Section 62 of the same Act deals with the compulsory removal to hospital of persons suffering from tuberculosis. Many years ago when the whole of the tuberculosis work in Barking was co-ordinated in my office, by virtue of the fact that in addition to being Medical Officer of Health I was District Tuberculosis Officer to the County, I found that discreet reference to the powers you had under this Act were useful in dealing with patients who might otherwise not have been so willing to enter institutions, where they would of course be segregated and harmless. With the tuberculosis work divided as it is, I am afraid this Section must largely be a dead letter. We did not avail ourselves of its powers at any time during the year. The treatment of tuberculosis requires that the Authority responsible for such treatment shall cover a very wide area. Most County Councils are too small. It is desirable to divide persons suffering from tuberculosis into surgical and medical. Then again it is desirable to divide them into children, adolescents and adults, and it is also desirable to divide them into males and females. Further, it is of advantage to be able to provide separate institutions for early, intermediate and advanced cases. 98 The desirability and necessity of these various things means that only an authority covering many millions of population could hope to provide adequate and suitable institutions. The detection of tuberculosis, however, in the Metropolitan Areas is very wisely left to the Local Authority who must have their fingers on its pulse if they are to fulfil their duty of preventing the spread of tuberculosis. I am of the opinion the time has come when representations might be made that the duties of detecting tuberculosis shall be delegated from County Councils to those Local Sanitary Authorities who are equipped to carry out this work. 27