Dr. Williams BOROUGH OF BARKING Rec'd 2 6 FEB 1945 Public Health Dept. BARK 31 BOROUGH OF BARKING REPORT OF THE Medical Officer of Health For the Year 1937 C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. # % # % f-5^ £/ vt 3 TABLE OF CONTENTS. Page STAFF 7-9 INTRODUCTION 11 SECTION A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Age Mortality 15-16 Area 12 Births 12—14,21 Births, Notification of 21 Deaths 12—21 Deaths, Causes of (Tables) 15-18 General Statistics 12 Housing 23 Illegitimate Births12,21 Industries 22 Infant Mortality 12-14,18-19 Infant Mortality (Table) 18 Inhabited Houses 12 Inquests 17 Malnutrition 24 Mortality, Epidemics, etc. 20-21 Neo-Natal Mortality 18-19 Population. 12 Post Mortem Examinations 20 Rateable Value 12 Social Conditions 21-24 Still-births 12-14, 21 Travelling Facilities 23-24 Unemployment. 22-23 Vital Statistics 12-14 Zymotic Diseases, Deaths from 16 SECTION B.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Ambulance Facilities 26 Ante-Natal Clinics 33-34,38-39, 55 Ante-Natal Supervision 38-39 Artificial Immunisation'35-36,48-49, 56 Artificial Sunlight Clinic 48, 58 Barking (Infectious Diseases) Hospital 26,29-32 Baths for Expectant and Nursing Mothers 55 Birth Control Service ... 37,55 Children and Young Persons Act, 1932 49-50 Clinics and Treatment Centres 27-28, 33-37 Convalescent Treatment 47,55 Dental Clinics 35-36 Dental Surgeon, Report of 65 Dental Treatment 48, 55, 66 Difficult Labour, Consultations in 56 East Barking District Nursing Association 37 Eye Defects 47, 57, 59-60 Foot Clinic 37 Foster Children 49-50 Gynaecological Clinic 33-34, 44, 56 Health Visiting Staff 38 Home Helps 56 4 SECTION B.—Continued Page Home Nursing 37 Hospital Services 26-27,29-32 Hospital Services, Tables of 29-32 Illegitimate Children 47 Infant Life Protection 49-50 Infant Welfare Clinics 33-34, 51-52, 56 Laboratory Facilities 25-26 Maternal Mortality 44-46 Maternity and Child Welfare Services 37-66 Maternity Homes 50,56 Medicines, Supply of 52, 57 Midwifery 40-43,56 Midwives Acts 40-43 Minor Ailments 35-36,49,57 Mothercraft Circles 54-55 Nursing Homes 50 Obstetrics and Gynaecology, Consultations in 56 Ophthalmia Neonatorum 46—47 Ophthalmic Servic 35-36,47,57, 59-60 Orthopaedic Clinics 35-36 Orthopaedic Clinic, Report of Work Done 57,61-64 Pathological Unit 25-26 Pathological Unit, Report of Scientist 67-70 Pemphigus Neonatorum 44 Plaistow Maternity Hospital and District Nurses Home 37,42,43 Post-Natal Care 44 Provision of Dinners 55 Provision of Dried Milk, etc. 53-54,57 Provision of Fresh Mil 53,57 Provision of Spectacles 57 Public Hospital Services 26-27,29-32 Puerperal Fever and Puerperal Pyrexia, Consultations in 56 Salvation Army 42,43 Services Provided and Facilities for Treatment 55-58 Specialist-Consultant Ante-Natal Clinic 33-34,38,56 Specimens Submitted to Laboratory for Examination 25 Still-births 39-40 Supervision of Midwives 40-42 Tonsils and Adenoids 47, 57 Ultra Violet Light Clinic 48, 58 Upney (Maternity) Hospital 26—27,29—32,43—44,56 Visiting in the Home 53,58 Voluntary Hospital Services 26,27,29-32 X-ray Treatment for Ringworm 58 SECTION C.—SANITARY CIRCUMSTANCES OF THE AREA. Bed Bugs, Eradication of 92 Cesspools 74 Closet Accommodation 74,78 Common Lodging Houses 83 Creeks mouth Generating Station 87-88 Dampness 78 Defects found under the Factory and Workshop Act, 1901 81 Disinfestation 92 Drainage and Sewerage 72,78 Dustbin Maintenance 79 Dwelling Houses, Inspection of 76 Earth Closets 74 Factories, Inspection of 77,80 Factory and Workshop Act, 1901 80-83 Hairdressers' and Barbers' Premises 87 Home Work 81 5 SECTION C.—Continued Page Houses Let in Lodgings 83 Infirm and Diseased Persons, Removal of 85-86 Miscellaneous Sanitary Inspections 77-78 Miscellaneous Sanitary Work carried out 79 Notices Served 80 Offensive Trades 83-84 Out-workers 82-83 Parks and Open Spaces 90-91 Paving 79 Piggeries 84 Premises and Occupations controlled by Byelaws and Regulations 77, 83-84 Public Cleansing 74-75 Rag Flock Acts, 1911 and 1928 85 Rainfall 72 Rats and Mice Destruction Act, 1919 84-85 Refuse Disposal 75-76 Refuse Storage and Collection 74-75 Refuse Tips 75-76 Registered Workshops 82 Repairs, General 79 River Roding 72, 73-74 Rivers and Streams 73-74 Sanitary Inspection of the Area 76-86 Sanitary Work, Summary of 78-79 School Closure 91 Schools, Sanitary Inspection of 91 Shops Act, 1934 86-87 Sinks 78 Smoke Abatement, etc. 87-89 South Essex Waterworks Company Supplies 71-72 Stables 84 Street Cleansing 75 Swimming Baths and Pools 89-90 Tents, Vans and Sheds 83 Trade Refuse 75 Ultra Violet Light Radiation 91 Underground Sleeping-rooms 83 Water Sampling 71-72,73-74 Water Supply 71-72, 79 Wells 72 Workplaces, Inspection of 77,80 Workshops, Inspection of 77,80 SECTION D.—HOUSING. Clearance Areas 96-101 Clearance Areas (Table) 99-100 Houses Built in the District, 1926-1937 94-95 Houses Erected during the Year 93 Housing Act, 1936 96-101 Housing Conditions 94-101 Housing Defects Remedied 93-94 Housing Inspections 93 Inhabited Houses, Number of 94 Overcrowding 96 Proceedings under Barking Corporation Act, Section 148 94 Proceedings under Public Health Acts 94 Proceedings under the Housing Act, 1930 94 Redevelopment 97-98 Rehousing 96 Small Dwellings Acquisition Act 95 Temporary Buildings 95 Unfit Dwelling Houses 93-94 fi SECTION E.—INSPECTION AND SUPERVISION OF FOOD. Adulteration of Food 108-109 Animals Slaughtered 104,105 Bacteriological Examination of Ice-Cream 104,100 Bacteriological Examination of Milk 103, 109 Bakehouses 106 Barking Corporation Act, 1933 104,100 Biological Examination of Milk 103,109 Bottling of Milk 104 Chemical and Bacteriological Examination of Food 103, 104, 109 Diseased Meat Condemned 105 Food and Drugs (Adulteration) Act, 1928 108-109 Food Byelaws 106-107 Food Poisoning 107-108 Food Preparing Premises, Supervision of 105-106 Graded Milk Licences Granted 104 lee-Cream 104 Meat and Other Foods 104-107 Milk (Special Designations) Order, 1936 104 Milk Supply 103-104 Nutrition 109 Prosecutions 106,107,108 Slaughter-houses 101-105 Unsound Food Destroyed 107 SECTION F.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Acute Anterior Poliomyelitis 112,113-114,117 Admissions to Barking (Isolation) Hospital (Table) 117 Artificial Immunisation 118 Barking (Isolation) Hospital 117 Cancer 118-120 Diphtheria 111, 112,113-114,115,117 Diphtheria Notifications (Monthly Summary Table) 115 Dysentery 111, 112,113-114 Enteric Fever 112,113-114,117 Erysipelas 112,113-114,117 Food Poisoning 112,113-114,117 Infectious Diseases (Tables) 112-115 Influenza 116 Malaria Fever 111,112,113-114 Measles 115,121 Measles and Pneumonia 112,113-114 Non-Notifiable Acute Infectious Diseases 115-116 Notifiable Infectious Diseases 111-115 Notifications classified according to Wards and Age Groups (Table) 113-114 Ophthalmia Neonatorum 112,113-114,117,120-121 Pathological Laboratory 111 Pemphigus Neonatorum 112,113-114,117 Pneumonia 112,113-114,117 Prevention of Blindness 120-121 Puerperal Fever and Pyrexia 112,113-114,117 Rheumatic Fever 115-116 Scabies 116 Scarlet Fever 111,112,113-114,115,117 Scarlet Fever Notifications (Monthly Summary Table) 115 Smallpox 112,113-114 Summer Diarrhœa 115 Tuberculosis 121-122 Tuberculosis, New Cases and Deaths (Table) 121 Unnotified Fatal Cases of Tuberculosis 122 Whooping Cough 115 SCHOOL MEDICAL SERVICE. Table of Contents will be found on Pages 126 and 127. 7 STAFF, 1937. 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.IIy., B.S., D.P.H. (Resigned 31st March, 1937.) J. MERVYN THOMAS, M.D., B.Sc., D.M.R.E., L.R.C.P., D.P.H. (Appointed 1st April, 1937.) Asst. Medical Officers of Health and Asst. School Medical Officers : WILLIAM HOGG, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Commenced 15th July, 1937.) CATHERINE B. MeARTHUR, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Resigned 30th November, 1937.) MARGARET A. GLASS, B.Sc., M.B., Ch.B., D.P.H. (Commenced 23rd August, 1937.) Ophthalmic Surgeon : Orthopwdic Surgeon : WILLIAM ADAMSON GRAY, B. WHITCHURCH HOWELL, M.B., Ch.B., Ph.D., F.R.C.S. M.B., B.S., F.R.C.S. Specialist Consultant in Obstetrics and Gynaecology: Consultant Ear, Nose and Throat Surgeon : JAS. VINCENT O'SULLIVAN, M.D., F.R.C.S. CYRIL R." SANDIFORD, M.D., F.R.C.S. Resident Medical Officer—Barking Hospital: Resident Medical Officer—Upney Hospital: ENID L. WEATHERHEAD, JANE L. McNEILL, M.D., B.Ch., B.A.O., L.M. M.B., B.S., M.Sc., D.C.H. (Commenced 7th January, 1937.) (Resigned 11th December, 1937.) (Resigned 1st June, 1937.) Consultant Pathologist: CALVIN 1'. BAMPFYLDE-WELLS, EDITH A. STRAKER, M.B., B.S., D.P.H. M.R.C.S L.R.C.P. (Resigned 31st July, 1937.) (Commenced 16th November, 1937.) Scientist : EVELYN M. HILL, Ph.D., (Lond.),'Dip. Bact. Dental Surgeons : W. H. FOY, L.D.S., R.C.S. H. S. SARSON, H.D.D., L.D.S., D.P.D. (Resigned 31st October, 1937.) M. COHN, L.D.S., R.C.S. 8 Sanitary Inspectors : N. BASTABLE (Chief Sanitary Inspector) (b, c, d and /). H. CARR (ft, c, e and I). C. S. COOK (6 and c). E. G. TWEEDY (a and c). H. H. MADAMS (a and c). Matron, Barking and Upney Hospitals—Inspector of Midwives : Miss M. W. HEDGCOCK (ft, i and j). Health Visitors : *Miss P. M. FAWCETT (Senior Health Visitor and School Nurse) (g, ft and i). ♦Miss M. BAERLOCHER (a, ft and k). Miss P. M. BARNS (Masseuse) (n). (Commenced 1st May, 1937.) ♦Miss C. COURT (g, ft and i). Miss E. FISHER (g, h and i). (Commenced 6th September, 1937.) Miss G. GEDEN (Dental Nurse) (q). Miss S. GIBSON (j). Miss L. GOODACRE (g, ft and i). (Commenced 18th October, 1937.) ♦Miss G. JONES (g, h and i). Miss R. LLEWELYN (Dental Nurse) (ft and <). ♦Miss M. McALISTER (g, ft, i and j). (Commenced 7th June, 1937.) Miss M. R. MeCANDIE (g, ft and i). (Commenced 6th September, 1937.) ♦Miss J. McGILVRAY (g, ft and i). (Commenced 12th July, 1937.) ♦Miss W. PARKER (g, ft and i). (Resigned 19th June, 1937.) Miss E. PARRY (g, ft and i). (Commenced 6th September, 1937.) Miss A. K. ROE (Masseuse) (n). Mrs. G. STOKES (g and i). Miss L. F. SWAIN (ft and i). Mrs. W. WALTON (a, ft and fc). (Resigned 19th March, 1937.) ♦Miss M. F. WHALLEY (g, ft and i). (Resigned 6th April, 1937.) ♦Miss C. M. WILLIAMS (g, ft and i). (Commenced 7th June, 1937.) District Municipal Midwives : Mrs. L. BACK (ft and i). (Commenced 1st November, 1937.) Mrs. E. BISHOP (ft). (Commenced 1st December, 1937.) Miss K. C. HAND (ft and i). (Commenced 1st November, 1937.) Miss G. THOMAS (ft). (Commenced 18th November, 1937.) Miss G. M. VERNEY (A). (Commenced 1st November, 1937.) 9 Clerical Staff: Chief Clerk—F. READ. C. G. EAGLESFIELD (Senior Assistant) (r). H. C. DAVIS. F. YATES (o). G. H. RUFF. K. F. CALWAY (p). (Commenced 1st July, 1937.) E. A. ELLIS (m). D. SCOTT. L. J. DEXTER. Miss H. NUNN. Miss H. KING. Miss A. LIGGINS. Miss D. FOULSHAM. Miss I. CAST. Miss G. COOPER. Miss I. MATHIESON. (Resigned 20th February, 1037.) Miss J. WILKINSON. (Commenced 8th March, 1937.) Miss G. MacLEAN. (Commenced 30th August, 1937.) Disinfector and Mortuary Attendant : H. LONG. In addition to the foregoing, there are sisters and nurses and other staff at the Barking Hospital and at the Upney Maternity Pavilion. It is to be noted also that the Minor Ailments Clinics at Central Clinic and Woodward Clinic and Ante-Natal Clinics are staffed by the nurses of the Plaistow Maternity Hospital and District Nurses' Home. (а) Sanitary Inspector's Certificate of Sanitary Inspectors' Examination Board. (б) Sanitary Inspector's Certificate of Royal Sanitary Institute. (c) Meat, etc., Inspector's Certificate of Royal Sanitary Institute. (d) Smoke Inspector's Certificate of Royal Sanitary Institute. (e) Building Inspector's Certificate of Worshipful Company of Carpenters. (f) Sanitary Science Certificate of Royal Sanitary Institute. (i) Health Visitor's Certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives Board. (i) General Hospital Training. (j) General Fever Training. (k) Health Visitor's Diploma of Board of Education. (I) 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) Final Examination of the National Association of Local Government Officers. (p) Inter. Examination of the National Association of Local Government Officers. (q) Registered Sick Children's Nurse. (r) Inter. Examination of the Incorporated Secretaries Association. (*) Combined appointment—Health Visitor and School Nurse. 11 ANNUAL REPORT OF THE Medical Officer of Health for the Borough of Barking, in the County of Essex, for the Year ended 31st December, 1937. PUBLIC HEALTH OFFICES, BARKING, ESSEX. May, 1938. 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, 1937. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 12 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 240 300 Roding 58 Loxford Water 2 4,174 Population (1931 Census) 51,277 Population (June, 1937) (Registrar-General's Estimate) 76,470 Number of Inhabited Houses, March, 1938, according to Rate Books :— Houses 18,150 19,441 Shops 1,291 Total Population Density, i.e., No. of persons per acre 18.3 Rateable Value—General £676,1 95 0 0 Sum represented by a penny rate £2,7 39 0 0 Education rates :— Elementary Included in General Rate Figure 3 9 ♦Secondary 8½ General Rate 14 2 * Including County Precept. 2. Extracts from Vital Statistics for the Year. Live Births :— Total. Males. Females. Birth Rate. Legitimate 1,115 541 574 14.58 Illegitimate 18 8 10 0.24 Totals 1,133 549 584 14.82 Rate per 1,000 Still-births:— total births Legitimate 30 25 11 30.8 Illegitimate — — — Heaths 600 324 276 Death Rate 7.8. Percentage of total deaths occurring in public institutions, 52.3. Heaths from puerperal causes :— Heaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.86 Other puerperal causes 4 3.42 Totals 5 4.28 Number of deaths of infants under one year of age :— Total Infantile Males. Females. Total. Heath Rate. Heath Rate. Legitimate 40 20 60 53.8 53.8 Illegitimate 1 — 1 55.5 Number of deaths from Cancer (all ages) 86 (87) „ „ Measles (all ages) — „ „ Whooping Cough (all ages) 1 „ „ Diarrhœa (under 2 years of age) 9 (8) (N.B.—\\ here the Registrar-General s figures and rates (liner from those prepared locally, the former are shown separately in brackets.) 13—14 3. BIRTH-RATE, DEATH-RATE, AND ANALYSIS OF MORTALITY DURING THE YEAR 1937. (England & Wales, London, 125 Great Towns, and 148 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 14.9 0.60 12.4 0.00 0.00 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 125 County Boroughs and Great Towns, including London 14.9 0.67 12.5 0.01 0.00 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 148 Smaller Towns (Estimated resident populations, 25,000 to 50,000 at Census, 1931) 15.3 0.64 11.9 0.00 0.00 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 0.54 12.3 0.00 0.00 0.01 0.01 0.06 0.05 0.38 0.51 12.0 60 BARKING 14.82 0.47 7.8 0.03 0.00 0.00 0.00 0.01 0.07 0.22 0.26 7.9 53.8 Puerperal Sepsis Others. Total. The maternal mortality rates for England and Wales are as follows: per 1,000 Live Births 0.97 2.26 3.23 Total Births J 0.94 2.17 3.11 4. VITAL STATISTICS OF WHOLE DISTRICT FROM 1927 TO 1937. 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 1927 39,900 710 17.7 251 6.2 7 162 47 66.1 406 10.1 1928 40,870 805 19.7 276 6.7 6 144 51 63.3 414 10.1 1929 42,160 787 18.7 291 6.9 8 152 42 53.4 435 10.3 1930 45,000 799 17.7 256 5.7 7 186 49 61.3 435 9.7 1931 51,830 947 18.3 328 6.3 7 215 61 64.4 536 10.3 1932 60,330 1105 18.3 283 4.7 17 239 59 53.4 505 8.4 1933 68,840 1204 17.4 290 4.2 13 247 67 55.6 524 7.6 1934 72,290 1252 17.4 311 4.3 9 288 71 56.7 590 8.2 1935 72,650 1226 16.9 270 3.7 13 301 64 52.2 558 7.7 1936 76,000 1195 15.72 313 4.1 13 308 67 56.07 608 8.0 1937 76,470 1133 14.82 302 3.9 8 306 61 53.8 600 7.8 15 5. DEATHS. (a) General.—There were 302 deaths registered in Barking in 1937. Of these 8 were deaths of non-residents. Barking residents to the number of 306 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. 324 276 600 The death rate for 1937 was 7.8 per 1,000, compared with 8.0 in 1936, 12.4 for England and Wales, 12.5 for the hundred and twenty-five County Boroughs and Great Towns, including London, 11.9 for the one hundred and forty-eight Smaller Towns, and 12.3 for London. The above rate is commonly spoken of as "the crude death rate." It is of little use for comparative purposes. Some towns inevitably have a high percentage of elderly people, and here of course the crude death rate is bound to be high, whilst in other towns there is a gradual exodus of people as they get towards middle age, and this factor tends to reduce the crude death rate. The Registrar-General gives us a factor whereby we can correct the crude death rate, and this corrected death rate for Barking is 9.75 per thousand population, which represents what the death rate in Barking would be if we had a standard population. This may be compared with the rate of 12.4 for England and Wales, but it should not be compared with the uncorrected rates for any particular section of the Country. It is, of course, to be noted that the relatively small population of Barking means that we are likely to have wider fluctuations in our death rate than in larger areas, but it is a matter of satisfaction that the death rate in Barking has been consistently low over a period of six years. (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 61 1 to 2 years 3 2 to 5 years 8 5 to 15 years 24 15 to 25 years 19 25 to 35 years 37 35 to 45 years 40 45 to 55 years 69 55 to 65 years 83 65 to 75 years 126 Over 75 years 121 16 It is to be noted with satisfaction that over one-fifth of the deaths were in respect of persons of 75 years and over, and that the age group 65 to 75 years, likewise, accounts for over a fifth. (c) Causes of death in 1937.—The table on the next page shows the Principal causes of death at various ages. Those diseases, etc., causing most deaths or important from a public health aspect were as follows:— Disease. No. of Deaths. Percentage of total net deaths registered. Cardio-vascular system 165 27.50 Cancer 86 14.33 Tuberculosis (all forms) 43 7.17 Pulmonary affections (exclusive of tuberculosis), viz., Bronchitis 25 4.17 Pneumonia (all forms) 31 5.17 Other respiratory diseases 10 1.66 Zymotic Diseases 17 2.83 (d) Deaths from Zymotic Diseases.—These diseases caused 2.83 per cent, of the total deaths, such deaths being caused in the following numbers Enteric Fever 2 Measles — Whooping Cough 1 Scarlet Fever — Diphtheria 5 Diarrhœa 9 Smallpox — I should like to comment upon the 5 deaths from diphtheria, because I do feel that, where we have such a readily available and an effective method of reducing the number of deaths, the public ought to take a greater interest than they do in diphtheria immunisation. At the same time I want to make it quite clear that Barking does not stand in an unfavourable position. The death rate for diphtheria in Barking, per thousand population, is exactly the same as that for England and Wales as a whole, which having regard to the fact that Barking has a relatively large child population is a matter for satisfactory comment. The reason why it is so satisfactory is, I believe, because on the whole you get diphtheria admitted to your hospital, not of course so early as could be wished, but at least relatively early, when compared with other areas. However satisfactory this condition may be, I cannot help feeling that it is not really satisfactory, whilst any stone is left unturned which could reduce this death rate. 17 (e) Inquests.—Coroner's inquests were held on 33 deaths. (f) Causes of and ages of death during the year 1937. (Net Deaths). Causes of Death. Deaths at the subjoined ages of " Residents " whether occurring in or beyond the district. RegistrarGeneral's Figures. Under one year. 1 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards Total Typhoid and Paratyphoid Fevers — — — — 2 — — 2 2 Measles — — — — — — — — — Scarlet Fever — — — — — — — — — Whooping Cough — 1 — — — — — 1 1 Diphtheria — 1 4 — — — — 5 5 Influenza 1 1 1 2 1 5 6 17 17 Encephalitis Lethargica — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — — Pulmonary Tuberculosis — — — 7 22 7 1 37 37 Non-Pulmonary Tuberculosis — 1 2 — 2 — 1 6 6 Syphilis 1 — — — — — — 1 1 General Paralysis of the Insane, etc. — — — — — — — — — Cancer — — 2 — 12 34 38 86 87 Diabetes — — — — 2 1 2 5 6 Cerebral Hæmorrhage — — — — — 4 25 29 28 Heart Disease — 1 1 3 10 45 81 141 141 Aneurysm — — — — — 1 — 1 1 Other Circulatory Diseases — — 1 — 2 4 16 23 20 Bronchitis 3 — — — — 8 14 25 26 Pneumonia (all forms) 11 1 3 — 1 4 11 31 32 Other Respiratory Diseases — — — — 2 6 2 10 5 Peptic Ulcer — — — — 1 1 2 4 9 Diarrhoea (under 2 years) 9 — — — — — — 9 8 Appendicitis — — 1 — — 1 — 2 5 Cirrhosis of Liver — — — — — — — — 1 Other Diseases of Liver — — — .— 1 1 2 2 Other Digestive Diseases — — — — 3 1 3 7 7 Acute and Chronic Nephritis — — — — 2 8 6 16 11 Puerperal Sepsis — — — — 1 — — 1 1 Other Puerperal Causes — — — 1 3 — — 4 4 Congenital Debility, Premature Birth, etc. 32 — — — — — — 32 32 Senility — — — — — — 24 24 25 Suicide — — — 2 5 2 9 9 Other Violence 1 1 4 2 6 3 3 20 22 Other Defined Diseases 3 4 5 4 11 14 9 50 49 Causes ill-defined or unknown — — — — — — — — — Totals 61 11 24 19 80 152 247 600 600 18 (g) Infant Mortality during the year 1937. 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 1937 :— 0-1 month. 1-3 months. 3-6 months. 0-9 months. 9-12 months. Total under 1 year. Accident 1 1 Bronchitis 1 1 1 3 Cerebral Injury 3 — — — — 3 Congenital Deformities 1 — — — 1 Congenital Debility 3 — — — — 3 Congenital Heart Disease 3 — — — — 3 Congenital Lues — 1 — — — 1 Gastro-Enteritis — 3 4 1 1 9 Hydrocephalus — 1 — — — 1 Influenza — — 1 1 Marasmus 2 1 3 Myocardial Failure 1 — 1 — — 2 Pneumonia 1 8 1 — 1 11 Prematurity 14 2 — — — 16 Pyelonephritis — — — — 1 1 Respiratory Failure — — 1 — — 1 Toxaemia — — — — 1 1 Totals 30 15 9 2 4 61 Net Births in the year:— Net Deaths in the year:— Legitimate 1,115 Legitimate 60 Illegitimate 18 Illegitimate 1 1,133 61 (h) Neo-Natal Mortality during the year 1937. Neo-Natal Mortality means deaths among the newly born. Causes of Neo-Natal deaths, year 1937:— Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total. Accident — — — 1 1 Bronchitis — — 1 — 1 Cerebral Injury — 3 — — 3 Congenital Deformities 1 — — — 1 Congenital Debility 3 — — — 3 Congenital Heart Disease 2 1 — — 3 Marasmus 2 — — — 2 Myocardial Failure 1 — — — 1 Pneumonia — — — 1 1 Prematurity 11 3 — — 14 Totals 20 7 1 2 30 19 It will be seen from the tables that of the sixty-one deaths under the age of one year, no less than thirty were four weeks of age or under, and prematurity is given as the cause of death in the cases of fourteen babies, who died within the first four weeks of life. The fact that thirty died within the first month, leaving only thirty-one deaths for the remaining eleven months of the first year of life, shows that our chief problem at the present time is still the mortality among the newly born. Out of the thirty babies who died under the age of one month, no less than twenty died within the first week. It is to be noted that although the comments in my 1936 Report still apply, I am glad to say there has been a significant drop from thirty-eight to thirty babies who died within the first month of life. This is a step in the right direction. The high percentage of the number of deaths during the first week of life continues, and I am persuaded that continued ante-natal care among the majority of mothers, together with more consultative work with your Consultant Gynaecologist and Obstetrician, in the more difficult cases, will lead to a decrease in this number, but this aim cannot be achieved when the actual cause of death is still ill defined in so many cases. When the time arrives that routine post mortem examination in all still-births is undertaken, then and then only will direct evidence be ascertainable upon the causes of infant mortality. The number of deaths from respiratory diseases, I am still pleased to say, has shown a slight decline. The following table shows the comparative figures of infant mortality and neo-natal mortality for the past ten years:— Year. Infantile Mortality Infantile Mortality Rate Neo-Natal Mortality Neo-Natal Mortality Rate 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 1937 61 53.8 30 26.5 20 (i) Post Mortem Examinations.—Today there is a trend towards more post mortem examinations being carried out. This is as it should be, because to my mind a post mortem examination ought to be carried out in the case of every death. I am sure that if post mortem examinations were carried out in the case of all infantile deaths, we should obtain much useful data whereby we could reduce the number of these unfortunate deaths. By the same token this would apply equally well to the deaths occurring in other age groups, and also to stillbirths. Another factor in support of this procedure is the ever increasing use of cremation. I confidently expect that in my next Annual Report it will be possible to advise you of the steps which have been taken towards securing some post mortem examinations amongst still-births and neo-natal deaths. (j) Mortality, Epidemics, etc.—During the first few months of 1937 there was an epidemic of paratyphoid fever in South-Eastern Essex, and Barking in common with its neighbours had cases occurring within its boundaries. In all, there were 17 cases notified in Barking. Most of these cases were admitted to your hospital, and in addition to these a number of patients were also admitted as suspected paratyphoid fever. At your Hospital a diagnosis of paratyphoid fever was confirmed in 14 cases, and it is to be mentioned here that in this connection your pathological laboratory was found to be of the greatest benefit in aiding and confirming diagnosis. Several cases were nursed in Hospitals outside the Borough. As each case or suspected case was brought to our notice, intensive enquiries were made as to the possible source of infection, but in all cases our efforts were unavailing and the source of infection was never found, so far as the cases in Barking were concerned. During the year five cases of acute anterior poliomyelitis were notified. Most of these were of a mild character. Two were admitted to the Barking Hospital, two to London hospitals and one was treated at home. Three of the cases were placed under the care of Mr. B. Whitchurch Howell. At the end of the year, four cases had fully recovered and one was progressing favourably. Acute anterior poliomyelitis is the name given to a disease commonly known as infantile paralysis. 21 The fact that these cases can be dealt with at your own hospital ; can be dealt with as orthopaedic cases in your beds at the Brookfield Orthopaedic Hospital, and can later, if necessary, be dealt with at your Special School, means that you have continuity of supervision which is, in my opinion, the circumstance which is likely to diminish the residual disability of this distressing condition. There are few diseases in which treatment has made such progress during my lifetime, and it is a constant source of satisfaction to me to see children getting better, who in my student days could not possibly have had this chance of recovery which they have today. 6. BIRTHS. The net number of births registered in 1937 was 1,133, affording an annual birth rate of 14.82 per 1,000 population, compared with 15.72 in 1936, 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, 18 were illegitimate, giving a percentage of 1.59 of the total births. Notification of Births Acts, 1907-1915.—During 1937 there were 1,088 live births notified, excluding 13 cases transferred from the district. In addition, notifications of still-births belonging to the district totalled 40. Seventeen live births and 1 still-birth were not notified, and these cases are not included in the totals of notified births given above. 7. SOCIAL CONDITIONS. (a) General.—The growth of population in Barking has been due essentially to the exodus of population from London. London for a number of years has had what may be termed a hospitalised population, i.e., a population which has been accustomed to have a hospital on its own doorstep, which has looked upon an attendance at an hospital, equally with attendance at the consulting rooms of a private doctor, as a means of obtaining necessary advice and treatment. This characteristic point of view of Londoners has been reflected in the very considerable number of attendances which have been made at your various outpatients' departments during the year. In London the people are catered for dually by the London County Council and by Voluntary Hospitals, and where-ever you get such a dual service it is difficult to achieve the same uniformity as you find in Barking, where of necessity the services are unified under your single control. 22 (b) 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, concrete paving, collapsible tubes, tin foil 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. (c) 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, 1936 and December, 1937:— Dec. 1936. Dec. 1937. Men. Women. Men. Women. Food 5 1 12 5 Electrical and Wireless 7 — 26 46 Building Trade and Painters 117 — 178 — Works of Construction 19 — 141 — Engineering 8 1 23 3 Domestic 16 28 18 18 Rubber Workers 14 11 17 21 Commercial 10 6 3 — Road and Water Transport 56 — 21 1 Clothing 10 19 4 38 Distributive Trades 21 17 68 18 Government and Professional 1 — 13 2 Tin Box Manufacture 3 9 5 11 Matches 8 1 2 13 Chemicals 12 6 25 1 Printing 6 1 11 7 Asbestos 2 2 4 4 Woodworking and French Polishing 11 — 14 6 Agriculture 2 21 7 31 General Labourers and Factory Hands 769 107 762 110 Mineral Water Manufacture — 7 6 3 Leather Trades 3 1 4 2 Other Workers 47 18 54 18 Gas and Water — — 60 1* 1,147 256 1,478 359 * Gas and Water not previously shown separately. 23 I have no statistical evidence to offer in regard to the result of unemployment upon the health and physique of children and adults in Barking. It is, however, a matter of concern that a number of Barking women still present themselves at the ante-natal clinics, in whose blood the amount of red colouring matter is significantly below normal. A scientific enquiry into this problem has been undertaken at your pathological laboratory, and you are referred to pages 67 to 70 which deal with the work of this laboratory. It would be rash at the present time to associate directly the incidence of this form of anaemia with unemployment, indeed, it should be stated quite clearly that the factors leading to this anæmia are still obscure, but I cannot help feeling that a more generous diet, even if we do not know the precise item it would supply, would be likely, materially, to alter the incidence of these cases of anaemia. During the later months of pregnancy this falling off in the amount of haemoglobin, as the red colouring matter is named, is met with even in fine, upstanding and well fed athletic women, and of course where you have this abnormal drain upon the resources of the expectant mother it is not to be expected that some added nourishment during the later months of pregnancy is likely, at one and the same time, to arrest this added drain and augment significantly the amount of haemoglobin in the blood. (d) Housing.—In continuing these remarks upon social conditions, I want to say how happy I am that the Council have stated that they are unprepared to look favourably upon any scheme or development, which would mean that more than sixty persons would be housed per acre. I am persuaded that the number of persons per acre, rather than an arbitrary number of houses is the right way in which we should assess density. There can be no doubt, particularly with regard to "catching diseases" that the more densely people are herded together, the less opportunity will there be for limiting any minor outbreak of infection. I am the more persuaded in this opinion, owing to the fact that Barking is a dormitory town, where there is no present need that some people should of necessity live in Barking. (e) Travelling Facilities.—I look upon this problem as one to be linked up with housing, and to be considered parallel with it. Travelling facilities to and from Barking are generally bad. The trains at rush hours are overcrowded, sometimes the standard of cleanliness is less than one would desire and altogether I find it difficult to believe that any one factor, likely to spread diseases which are catching, in Barking, can compare to the circumstances under which so many travel to and from the City. 24 Tired after a day's work, strap hanging cheek by jowl with all and sundry, anybody is likely on the one hand to spread anything infectious and on the other hand to catch anything infectious, and, of course, a tiring journey at the end of a long day is in itself something which must be prejudicial to health. Historians of the future, who come to review the way in which we travel today, will I hope be shocked to find how we have too long complacently looked upon as inevitable the circumstances under which we travel. (f) Malnutrition.—I would refer you to the comments upon nutrition in my last Report, which in effect still remain the same. There can be no doubt that our rising population is inches taller and pounds heavier than the young population of the past generation—this is one of the happy thoughts which must encourage you and all those who are interested in the promotion of the general health of the public. Our statistics in regard to malnutrition only deal with school-children and are as follows:— Of 5,374 children examined by routine at school medical inspection, 4 were found to be suffering from malnutrition, 225 were found to have slightly sub-normal nutrition, 3,180 normal nutrition, and 1,965 with excellent nutrition. 25 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 1,309 Sputa 265 Typhoid 26 Milk 48 Water 11 General 49 Total 1,768 In addition to the above, 3 biological tests were carried out to test the virulence or otherwise of germs of the diphtheria group, and similarly 2 biological tests were carried out to test the presence or otherwise of tubercle bacilli. 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. The Pathological Unit at the Barking Hospital, inaugurated in the autumn of 1935, has met a very real need. In my previous Report I mentioned that this unit was in the charge of Dr. E. A. Straker, your Consulting Pathologist, and that in addition Dr. E. M. Hill had been appointed as a full-time Scientist. Dr. E. A. Straker resigned her appointment during the year to take up another elsewhere, and I am happy to say that Dr. Hill has ably carried on since. She has been in constant touch with the London School of Hygiene and Tropical Medicine, acting as a liaison between that body and ours. Since its inauguration the scope and work undertaken by this unit has increased, and new channels of co-operation have been opened. I am thus happy to say this unit has fulfilled the purpose for which it was started. 26 It is to be noted that a certain amount of research work is carried out in this department which would not otherwise be possible, e.g. work relative to such items as cross infections in wards, the degree and severity of any particular form of disease, etc. Finally, I would refer you to Dr. Hill's Report upon pages 67 to 70. (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 diseases ambulance which is kept for the conveyance of bedding, but which can in an emergency be used as a standby ambulance. In commenting upon ambulance facilities, it must be emphasised once again that one or two attendants accompany each ambulance as occasion requires, and that where requested a nurse from the Hospital may be employed. It is to be noted that a nurse always accompanies the infectious disease 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 care is taken to see that patients so admitted are not themselves suffering from any of the communicable diseases. There are three sisters at the Pavilion, and, on an average, a similar number of midwives are in attendance. As previously stated the professional nursing is entirely carried out by sisters and midwives, whilst probationers are allowed only to do minor duties, 27 There is a resident medical officer in attendance at the hospital, and under his supervision all forms of analgesia are administered in suitable cases. I am happy to say that full use has been made of this maternity hospital during the year, and the trouble would seem to be not how to obtain patients for admission but how to control their admission. It is possible that now the time has come for you to consider increasing the number of beds available at this hospital, and, of course, this would in effect mean the extension of the present premises. 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 16 East Ham Memorial Hospital 36 King George Hospital 74 Princess Elizabeth of York Hospital for Children, Shadwell 26 Queen Mary's Hospital, Stratford 30 St. Mary's Hospital, Plaistow 13 Hospital for Sick Children, Great Ormond Street 5 Poplar Hospital 24 London Hospital 76 Total £300 The County Hospital is at Romford. Further County hospital accommodation is being provided. (d) Clinics and, Treatment Centres.—During 1937 the total attendances at Infant Welfare, Ante-Natal and Minor Ailments Clinics have increased—see tables on pages 38, 49 and 51. The rate of increase in attendances was much greater in 1937 than in 1936, i.e., total infant welfare attendances have gone up by 4,619 in 1937, compared to a rise of 2,057 in 1936. These figures are very gratifying especially in a year when Public Health services have been getting so much publicity in the Press, 28 It is too early yet for results of the "Better Health Campaign" to show themselves in the statistics of clinic attendances, though possibly a slight proportion of the increase may have resulted from leaflets and posters displayed in the last two months of the year. Overcrowding at the Woodward Clinic was mentioned in last year's Report, and it has become progressively severe with the increase in numbers attending there for the minor ailments and infant welfare sessions. It is expected that something favourable may be said about this question of overcrowding at the Woodward Clinic in my next Report. Since the end of last year a minor ailments clinic has been opened at the Porters Avenue Centre. Although it is too early to state precisely, it would appear that the numbers attending the Porters Avenue Centre will not mean a commensurate falling off in the number attending the Woodward Clinic. It would seem that the Porters Avenue Clinic is only in part relieving the Woodward Clinic, and is in part meeting a new demand of its own. The room at Faircross School in which orthopaedic treatment, massage, ultraviolet light, postural exercises, splinting are carried out is too small for the work which has to be done in it and for the numbers attending. Arrangements for increasing this accommodation have become urgent, and you are at the present time considering this question. Although it does not strictly come within the purview of this Annual Report, you, together with the Education Committee, have taken steps, temporarily, to deal with the situation, by opening up a similar centre at the Manor School. This lack of accommodation has meant that the numbers of children referred for ultra-violet light treatment have had to be limited to a certain extent, and as we had been getting very good results with artificial sunlight therapy this is to be deplored. It is still my submission that the solution of your various difficulties in overcrowding can best be met, when you receive the necessary sanctions, by the building of your proposed clinic in Porters Avenue and the Central Out-Patients' Department in Upney Lane. The centralisation of your special departments under one roof would do much to achieve co-ordination, and would enable fuller co-operation to exist between your specialist medical officers, 29—30 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 Barking— Upney (Maternity) Hospital Barking (Isolation) Hospital Upney Lane, Barking, Essex Upney Lane, Barking, Essex Maternity Isolation of general infectious diseases (excluding smallpox) — 23 — One Isolation Cubicle 24 Borough of Barking 108 108 Borough of Barking Not controlled by the Council of the Borough of Barlnng— Brentwood Mental Hospital Brentwood, Essex Mental 823 1168 — 1991 Essex C.C. and Colchester B.C. Brookfield Orthopaedic Hospital Hale End, Woodford Green, Essex. Orthopaedic — — 30 30 Essex County Council 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. 253 303 58 77 Private Beds (unassigned) 691 Voluntary hospital for Sick Children Great Ormond Street, W.C.1 General Medical and General Surgical and Isolation (Children only) — — 241 115 at the Country Branch Hospital, Tadworth Court, for continuation of treatment and for convalescence. 356 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 Chest Hospital Victoria Park, E.2 Heart and Lung Diseases 90 92 8 190 Voluntary London Hospital Whitechapel Road, E.l General Medical and General Surgical 350 392 84 59 Beds (unassigned) 885 Voluntary London Lock Hospital and Home 283, Harrow Road, W.9 Venereal Diseases — 49 15 64 Voluntary London Skin Hospital 40, Fitzroy Square, W.l Skin. (No in-patients) — — — — Voluntary OIdchurch 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 26 6 Private Wards (unassigned) 122 Voluntary Princess Elizabeth of York Hospital for Children Glamis Road, Shadwell, E.l Children — — 135 30 at Convalescent Home, Bognor Regis, for continuation of treatment and for convalescence. 165 Voluntary Queen's Hospital for Children Hacknev Road, Bethnal Green, E.2 Children — 3 160 44 at Branch Hospital 207 Voluntary Queen Mary's Hospital for the East End Stratford, E.15 General Medical and Surgical, Children, Maternity 56 109 63 228 Voluntary Royal London Ophthalmic Hospital b (Moorfields Eye Hospital) City Road, E.C.1 Ophthalmic 99 80 21 200 Voluntary Royal National Orthopaedic Hospital Brockley Hill, Stanmore, Middlesex Orthopaedic 6 30 284 320 Voluntary Bartholomew's Hospital Smithfield, E.C.1 General Medical and Surgical, Children, Maternity, etc., Ophthalmic, Orthopaedic, Ear, Nose and Throat, and Septic, etc. 295 350 60 15 beds (unassigned). 720 Voluntary St. Mary's Hospital for Women and Children Upper Road, Plaistow, E.13 General Medical and General Surgical, Children, etc. — 34 37 71 Voluntary Severalls Mental Hospital Mile End, Colchester Mental 857 1309 — 2166 Essex C.C. and Colehester B.C Westminster Hospital Broad Sanctuary, Westminster, S.W.1 General Medical and General Surgical, Maternity, Ear, Nose and Throat, etc. 92 129 22 16 Single Rooms (unassigned) 259 Voluntary In addition to the above Institutions, there are a number of Sanatoria to which tuberculous persons resident in Barking are admitted at the instance of the Essex County Council, under their scheme for the treatment of tuberculosis. 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 Cardiac Chest (nontub.) & Heart Children Chronic Sick Dental Dermatological Ear, Nose & Throat General Medical General Surgical Genito-urinary Gynaecological Infectious Diseases Isolation & Observation Maternity Mental Neurological Ophthalmic Orthopaedic Plastic Psychological 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. Operative surgery, Dental, Ear, Nose and Throat, Orthopaedic, Maternity, Puerperal Fever and Pyrexia, Ophthalmia Neonatorum. Carried out at the Counties' Laboratory, Queen Victoria Street, E.C.4, and at own Laboratory. 2† Barking (Isolation) Hospital — — — — — — — — — — — — 108 — — — — — — — — — — — — — 108 Not controlled by the Council of the Borough of Barking. 3 Brentwood Mental Hospital — — — — — — — — — — — — — — — 1991 — — — — — — — — — — 1991 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' Laboratory, Queen Victoria 5 City of London Maternity Hospital — — — — — — — — — — — — — — 79 — — — — — — — — — — — 79 Operative Surgery, Dental, Nursing of Puerperal Fever and Pyrexia. Operative surgery, X-rays, Ultra-violet light, Dental, Electrical, Massage. Operative surgery, X-rays, Ultra-violet light, Dental, Ophthalmic, Radium. Street, E.C.4. Own Pathologist. 6 East Ham Memorial — — — 20 — — 2 4 28 28 — 8 — — — — — 4 2 — — — — — — 4 100 Own Laboratory. 7 Golden Square Throat, Nose and Ear — — — — — — — 101 — — — — — — — — — — — — — — — — — — 101 Carried out by a Pathologist outside the Institution. 8 Guy's 40 — 18 — 4 9 33 170 140 14 18 9 5 50 — 9 24 19 — 5 10 22 — 9 83 691 All specialised treatment available. Own Laboratories. 9 Hospital for Sick Children — — — — — — — 18 84 119 — — — 13 — — — — — — — — — — 7 — 241 All specialised treatment available. Own Laboratory. 10 King George Hospital — — — 32 — — — — 54 88 — 12 — — — — — — — — — — — — — 21 207 Operative surgery, X-rays, Dental (as casualty), Ophthalmic, Massage, Ear, Nose and Throat, Gynaecological, Neurological, Dermatological. Own Laboratory. 11 London Chest Hospital — — 70 8 — — — — — — — — — — — — — — — — — — — 102 — 10 190 Operative surgery, X-rays, Ultra- violet light, Dental, Massage, Ear, Nose and Throat, Radium. Own Laboratory. 12 London Hospital — 15 — 75 — 15 30 239 301 — 33 — 10 31 — — 20 — — — — 23 — — 93 885 All specialised treatment available. Own Laboratories. 13 London Lock Hospital — — — — — — — — — — — — — — — — — — — — — — — — 64 — 64 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' Laboratory, E.C.4. 16 Poplar Hospital for Accidents — — — — — — — — 34 73 — 6 — 1 — — — — — — — — — — — 8 122 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 — — — — — — — — 86 49 — — — — — — — — — — — — — — — — 135 All specialised treatment available. Own Laboratory. 18 Queen's Hospital For children — — — 204 — — — — — — — — — — — — — — — — — — — — — 3 207 All specialised treatment available with the exception of Radium. Own Laboratory. 19 Queen Mary's Hospital for the East End — — — — — — — — 69 91 3 4 — 3 47 — — 6 3 — — — — — — 2 228 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 London Ophthalmic (Moorfield Eye Hospital) — — — — — — — — — — — — — — — — — — 320 — — — — — — — 320 Operative surgery, X-rays, Ultra-violet light, Massage. Carried out by a Pathologist outside the Institution. 22 St. Bartholomew's Hospital — — — 18 — — 6 20 238 250 — 44 — 18 17 — 6 22 20 6 — 55 — 720 All specialised treatment available. Own Laboratory. 23 St. Mary's Hospital for Women & Children 5 — — — — — — — 10 26 — 8 — — — — — 4 — — — — — — — 12 71 Operative surgery, X-rays, Ultra-violet- light, Dental, Massage, Ear, Nose and Throat, Orthopaedic. 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 — — 4 7 54 71 — 11 — 3 12 — — 6 10 — — 17 — — — 41 259 All specialised treatment available. Own Laboratories. In the case of Hospitals under the control of the Borough of Barking:— Upney (Maternity) Hospital Barking (Isolation) Hospital Number and classification of Medical Staff The Medical Officer of Health is also the Medical Supt. Number and classification of Nursing Staff: In addition there is a Resident Medical Officer at each Hospital. Matron — l Sisters 3 7 Assistant Nurses — 4 Mid wives 4 — Probationer Nurses 5 14 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 in Barking 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. . 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, Accommodation for consultations, weighing of babies, waiting rooms, etc. do. Alexandra Centre, St. Paul's Road 2 p.m. do. do. do. Porters Avenue Centre, Porters Avenue (b) Ante-Natal Clinics:— Mondays, Wednesdays and Fridays, 2 p.m. do. do. 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 Tuesdays and Wednesdays, 9.30 a.m. do. do. Porters Avenue Centre, Porters Avenue Thursdays, 9.30 a.m. Accommodation for consultations, etc. do. Humphrey Ward (near Maternity Pavilion), Upney Lane. Mondays, Tuesdays, Wednesdays, and Fridays, 10.30 a.m. do. do. Specialist-Consultant Clinic at Central Clinic, Vicarage Drive, Ripple Road. (c) Gynaecological Clinics:— Third Tuesday in each month 3.30 p.m., except August and December. Modern clinic premises with accommodation for consultations, etc. do. 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. 35—36 CLINIC AND TREATMENT CENTRES. Name and Situation. When Held. Nature of Accommodation. By Whom Provided. 2. School Medical Service. *(a) Inspection Clinics and Treatment of Minor Ailments:— Central Clinic, Vicarage Drive, Ripple Road Daily, 8.30 a.m. Modern clinic premises with inspection, waiting and treatment rooms, etc. Local Authority. Woodward Clinic, Woodward Road do. do. do. (b) Ophthalmic Clinic:— Central Clinic, Vicarage Drive, Ripple Road Tuesdays and Fridays, 10 a.m. do. 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. do. do. Woodward Clinic, Woodward Road do. do. do. East Street Clinic do. Inspection, waiting and treatment rooms do. (d) Orthopaedic Clinic:— (i) Specialist's Clinic, Faircross School First Thursday in each month, 9 One room do. (ii) Remedial Exercises Clinic, Ultra Violet Light Therapy, etc., Faircross School a.m. 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 inspection, waiting and treatment rooms. Local Authority. 4. Tuberculosis. 37, Linton Road Mondays, 3-5 p.m. Tuesdays, 7-8 p.m. Thursdays, 10.30 a.m.-12.30 p.m. Three rooms Essex County Council. 5. Venereal Diseases. London hospitals, etc. — By arrangement with Essex County Council. * Since the end of 1937 an additional Out-Patients' Department for the inspection and treatment of Minor Ailments has been commenced at the Porters Avenue Centre, Porters Avenue, and clinics are held daily at 8.30 a.m. 37 During the year a special clinic for mothers was set up in the Humphrey Ward, a building adjoining the Upney Maternity Pavilion. The numbers here are steadily increasing and although the attendances from the area in which the clinic is situated were expected to be higher, it does fulfil a need, in as much as difficult cases about to enter the maternity hospital and cases after confinement at the hospital are seen at this clinic by the resident medical officer. Also, the clinic is used once a month as a birth control centre, a service you have set up this year. Foot Clinic.—During the year under review you have considered the question of setting up a Municipal Foot Clinic, and you have decided that such a clinic shall be set up. (e) Nursing in the Home.—During the year two full-time nurses were employed by the East Barking District Nursing Association, as against only one nurse in the year 1935, and these have now become permanent—thus the first objective of the Association has been attained. Another step which was made was the setting up of a home, fully equipped, for the use of these nurses. This I might say now forms a nucleus of a progressive service. The Council make an annual donation to this body and the Executive Committee of the Association very much appreciate this donation. I myself am of the opinion that for the district to be adequately served requires the appointment of four nurses. The Plaistow Maternity Hospital and District Nurses' Home still continue to undertake their work, as they have done in the past, in Barking. This Home is paid by you for various work which it undertakes on your behalf, but the Council does not make a contribution towards the general district work of these nurses. I do hope and trust that in this way or in that the district work undertaken by the Plaistow Nurses will be supported more generously than it has been in the past. 2. MATEBNITY AND CHILD WELFABE SEBVICES. 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. Public Health Act, 1936. 38 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. Pursuant to Circular 1550, dated 29th May, 1936, from the Ministry of Health, you appointed four additional Health Visitors, in order that the recommendations of this Circular, regarding the supervision of children under school age, might be met. 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 four centres—three sessions weekly at the Central Clinic, two sessions weekly at the Woodward Clinic, one session weekly at the Porters Avenue Clinic, and four sessions weekly at the Humphrey Clinic. The following tables shows the attendances at these clinics during the year:— Central Clinic. Woodward Clinic. No. of Sessions. First attendances. Reattend ances. Total attendances. No. of Sessions. First attendances. Reattend ances. Total attendances. 154 436 2373 2809 66 205 998 1203 Humphrey Clinic. Porters Avenue Clinic. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. No. of Sessions. First Attendances. ReAttend ances. Total Attendances. 60 35 54 89 53 149 741 890 Total First Attendances 825 „ Re-Attendances 4,166 „ Attendances 4,991* „ Sessions 333 * In addition there were 169 Post-Natal, and 173 Gynaecological Attendances. Mr. O'Sullivan, the Specialist Consultant, holds a special consultant ante-natal clinic monthly at the Central Clinic, and the following table shews the attendances made during the yea:— Number of sessions10 First attendances 67 Re-attendances 28 Total attendances 95 In addition there were 77 Post-Natal and Gynaecological Attendances. 39 It is by no means unsatisfactory that out of about 1,150 births, somewhat over 800 women attended at your Ante-Natal centres, but in the absence of evidence that the remaining 350 cases were under adequate supervision, the figure of 825 first attendances must be regarded as one on which to improve. The number of women attending for the first time at the ante-natal centres was 825, compared to 716 in 1936. This gives an increase of 14 per cent. approximately of the number of newly confined mothers who attend ante-natal clinics in Barking. This is a satisfactory figure. The average number of attendances per expectant mother is 5.1 and this is a big figure for ante-natal attendances, because a considerable number of the mothers did not come for the first time until late in pregnancy. In connection with this it is worth while to note that some mothers are beginning to take advantage of the ante-natal centres early in pregnancy. This is most noticeable amongst young mothers expecting their first baby. At the ante-natal clinics, mothers attending for the first time are seen firstly by the sister in attendance, who, if the mothers have not made arrangements for the confinement, gives them information about obtaining the services of a midwife and about admission to the Upney Hospital. After a few routine tests every mother is seen by the medical officer in charge of the clinic, and in the case of mothers attending for the first time a full history is taken, including any previous illness and the course of any previous pregnancies. Enquiries are made about the present health of the mother, and then she is examined and measured. Any abnormality is noted and steps taken to meet the situation. Abnormalities may vary from a slight physical disability, such as dyspepsia or foot trouble, to gross pyorrhoea or a gross gynaecological defect. The minor troubles can be treated at once by medical prescription or by local application, more severe complaints can be referred to the appropriate clinics, and where any obstetric or gynaecological complaint is sufficiently severe it can be referred to the Consultant Gynaecologist and Obstetrician at his special clinic. Some of the mothers who attend are found to be suffering from a greater or lesser degree of malnutrition and after enquiry these cases may obtain help from you in the form of free milk, free dinners, and free tonics. The ultimate effect of this extra nutrition upon maternal mortality has not been ascertained clearly, but there is no doubt about the immediate effect it has and the benefit it gives to the mother. (b) iStill-births.—In 1926 the Medical Research Council published the results of close investigation into still-births. 40 Now, as then, many of the underlying factors remain obscure. Maternal illhealth during pregnancy, and perhaps also before the occurrence of pregnancy, has been shown to be a factor which is probably of great importance in relation to the occurrence of dead births. It is presumed that maternal morbidity is closely related, both to foetal and to maternal mortality. It is certain that an intra-cranial lesion, with its accompanying haemorrhage, is at least an important contributory cause of death, although it is impossible to ascertain the precise cause that extinguished the life of the foetus. The suggestion is, therefore, that a proportion of intra-natal deaths are associated with manipulation of some kind or another. It is not supposed that such manipulation is unnecessary, but rather that efforts be directed towards the reduction of the need for such obstetric interference. The inference is that more and oftener ante-natal supervision would lead to the discovery of abnormal conditions at a time when they could be rectified by relatively simple measures, and closer co-operation between doctors and midwives, etc. is stressed. Closer attention is now given to this whole question in the teaching schools, particularly in respect of post graduate courses, and periodical revision courses for midwives are now insisted upon by the Central Midwives Board. (c) Midwifery.—The Council has been the Local Supervising Authority for Midwives since the 1st April, 1935. Fifty-four midwives notified the Local Supervising Authority of their intention to practise within the Borough during the period 1st January, 1937 to the 31st December, 1937, and the number who were engaged in practice in the Borough at the end of the year was as follows:— At Upney Hospital 5 Municipal District Midwive 5 At the District Nurses' Home of the Plaistow Maternity Hospital 2 At the Salvation Army District Nurses' Home 2 In private practice 11 The number of visits of inspection paid by the Inspector of Midwives was 43, 41 The following is a summary of notifications received from midwives:— Medical Help 191 Deaths of Mother or Child 10 Laying out the Dead 6 Still-births 19 Liability to be a source of Infection 16 Artificial Feeding 3 245* *of these, 34 notifications were received from the Upney Maternity Hospital. This figure is considerably smaller than for previous years on account of the fact that, on 7th May, 1937, approval was obtained for the Upney Maternity Pavilion, to be recognised for the purposes of the Central Midwives Board Rule E.2. Rule E.2 exempts a midwife who is exercising her calling under the supervision of a duly appointed resident medical officer within a hospital approved by the Central Midwives Board from certain rules, including the one which requires her to send for medical aid in certain circumstances, to which she would otherwise be subject. The following is a summary of the 191 cases in which medical help was sought Mother:- Anaesthetic 23 Engorged Breast 2 Haemorrhage-—Ante-partum 5 Post-partum 6 Malpresentations 19 Miscarriage 1 Prolonged labour 19 Rise of temperature 9 Retained placenta 2 Ruptured perineum 27 Uterine inertia 3 Miscellaneous causes 22 138 42 Child :— Discharging eyes 23 Prematurity 10 Spina bifida 1 Unsatisfactory condition of infant 16 Miscellaneous causes 3 53 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 the district midwifery work of their midwives in Barking. Their takings for 1937 amounted to £170 2s. 0d., leaving a balance payable to the Hospital by the Council of £129 18s. 0d. During the year 1937 there were 1,057 maternity cases in the district. 120 of these were conducted by the Plaistow Maternity Charity, 411 of them were conducted by your own midwives at Upney Hospital, 174 were conducted by the midwives of the Salvation Army Organisation, leaving 352 which were dealt with by medical practitioners, private midwives or otherwise. (d) Midwives Act, 1936.—Pursuant to Section 1 of the Midwives Act, 1936, the Council submitted their scheme to the Ministry of Health in January, 1937. For the purpose of the scheme the Borough was divided into four areas. The Becontree South Area included that part of the Barking section of the Becontree Estate, south of the District Railway Line, and the scheme provided for the employment of two midwives by the Salvation Army, who for many years have maintained a centre within this area, from which their midwives have practised. The Becontree North Area included that part of the Barking section of the Becontree Estate, north of the District Railway Line, and to practise in this area three midwives were to be directly employed by the Barking Council. In the Barking Abbey Area, which included the Abbey, Eastbury and Gascoigne wards, except that part of the Borough between the District Railway Line and the Tilbury Railway Line, two midwives were to be employed by the Plaistow Maternity Hospital and District Nurses' Home, whose midwives have for some long time, been practising in the Borough, and [(possibly)] one midwife was to be employed directly by the Council. 43 For the remaining part of the Borough—termed the Barking Upney Area— two midwives were to be employed directly by the Council. In July, 1937, a communication was received from the Ministry of Health which gave the Council authority to put into operation their proposals regarding the Becontree North and the Barking Upney Areas, and five midwives were duly appointed and took up their appointments towards the end of the year. The two voluntary organisations concerned,—the Plaistow Maternity Hospital and District Nurses' Home and the Salvation Army—lodged certain objections to the Council's proposals, with the Ministry of Health, and negotiations were still pending at the end of the year. Subsequent negotiations belong properly to my next year's Report. I can, however, state that agreement has been reached, that the negotiations pending at the end of last year have been successful, and that it is anticipated that the Plaistow Maternity Hospital and District Nurses' Home and the Salvation Army will be conducting their part of the scheme in the near future. (e) Upney Hospital.—The admissions to the Maternity Home during 1937 numbered 474 of which 63 were admitted for ante-natal treatment. During the past year the daily average number of beds occupied was nineteen. The total number of bed-days was 7,040. From the above figures it is clear that the admissions to the above hospital are still increasing, and particularly is this so regarding cases admitted for ante-natal treatment. This part of your service is obviously a feature which is becoming very popular amongst mothers and once again the extension of the facilities you provide becomes an urgent problem. I regret that during the year we have had the resignation of " Sister " of the Maternity Hospital. Sister Ethel Jones carries into her retirement the very best wishes of all those who knew her and knew the good work which she consistently carried out. It is significant that Sister Jones came to the hospital at a time when it was anticipated that 12 cases would be the average admissions per year, and that at the time she left the cases numbered approximately 400 per year. 44 During the 18 years Sister Jones has been with us she has laid the traditions of the hospital, and her foundations will carry the stoutest super-structures on the work she has so well begun, and her name will remind thousands of the devout care with which she carried out what to her was a high calling. (f) Post-Natal Care.—It is not sufficient for the mother to receive all the attention possible prior to and during her confinement, because full attention should also be given to the mother after the confinement. Here, I am glad to say, fuller use is being made of the Humphrey Ward, where, as I have stated previously, the resident medical officer of the Upney Hospital is in attendance. The more mothers claim the advantage of this clinic the better will be their health and happiness. (g) Gynæological Clinics.—The numbers attending these clinics are steadily, if slowly, increasing and provision is made at all clinics for these examinations, when arranged by your health visitors, etc. It is now possible for women who wish to have advice on any matter associated with their womanhood to have that advice. I want to make two points quite clear. Firstly, this means that women are entitled to advice, whether they think there is anything wrong or not, and if these periodical examinations are carried out women can have the security and satisfaction of knowing that everything is right, or alternatively anything which is wrong can be dealt with whilst it is in its earliest stages, when probably treatment may be only of a minor character. In the second place, this means that these clinics are definitely intended for examinations from one standpoint only and that is woman's womanhood. These clinics are not intended for questions of general medicine, which apply equally to all men and women. (h) 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. (i) Maternal Mortality.—According to the return of the Begistrar-General there were during the year 1937, five deaths from puerperal causes—one death from puerperal sepsis and four deaths from other puerperal causes. This gives a rate of 4.28 per 1,000 total births. 45 The following table gives you similar information for the last fourteen years:— Maternal Mortality—Statistics. Year. Barking. England and Wales Deaths from Rate per 1,000 births. Rate per 1,000 births. Puerperal Sepsis. Other Puerperal Causes. 1924 1 2 3.66 *3.90 1925 — 1 1.21 *4.08 1926 — 1 1.22 *4.12 1927 2 1 4.23 *4.11 1928 — 2 2.48 4.25 1929 — 2 2.54 4.16 1930 — 3 3.72 4.22 1931 1 3 4.08 3.95 1932 — 1 0.88 4.06 1933 4 — 3.2 4.23 1934 1 4 3.82 4.41 1935 3 1 3.18 3.93 1936 1 2 2.44 3.65 1937 1 4 4.28 3.11 *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 impracticable 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. There were five maternal deaths during the year—i.e., deaths due to or in consequence of pregnancy or parturition. One of these was due to very early pregnancy and would not have been looked upon as a maternal death years ago. This case illustrates what I have said above, and what I have said previously, that it is impracticable to compare the figures of today with the figures of 25 and 100 years ago. 46 None of these cases occurred in the Upney Maternity Pavilion, but one of them was a patient who was in the Upney Maternity Pavilion for ante-natal treatment, discharged herself and was re-admitted to another hospital. One other death I find was only technically a Barking case. She only acquired a Barking residence just before her death and was neither seen nor attended by any of the officers of your services. Three of these five deaths must, in the present state of our knowledge, be described as inevitable. 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 1,169, a total of 825 mothers attended your ante-natal clinics during the year. This total represents roughly seventy per cent. of the total births. During the year Circular 1622, dealing with Maternal Mortality, was received from the Ministry of Health. Most of the recommendations contained in this Circular were already in operation and, after consideration of the Circular, you set up an emergency unit, i.e., a "flying squad" at your Maternity Pavilion, to be available for the domiciliary treatment of maternity patients whose conditions are too grave to justify their removal to hospital. It is not anticipated that this " flying squad " will carry out much work in the homes of Barking, that is unless your present policy should ever be altered. Your present policy is to try and anticipate all difficulties, and even where a difficulty occurs which could not have been anticipated you arrange for the person to be removed, if possible, to the Upney Maternity Pavilion where only can the more serious surgical treatment be carried out under suitable conditions. All cases 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 when such specialist treatment is required. (j) Ophthalmia Neonatorum.—During 1937 five cases of ophthalmia neonatorum were notified and all of these cases recovered with unimpaired vision. In last year's Beport a decrease in this figure was noted and again this year's figure shows a decline in the number of cases of ophthalmia neonatorum. 47 All cases of ophthalmia neonatorum notified are visited in their homes and if treatment cannot be carried out at home both mother and baby are taken into the Barking Hospital under the care of your Consulting Ophthalmic Surgeon. Only one of the five notified cases required hospital treatment. Elsewhere, I have pointed out with what satisfaction I have been able to note over many years the improvement in the treatment of infantile paralysis. I cannot but help feeling equally happy over the way in which ophthalmia neonatorum as a disabling disease is being overcome. Two generations ago this eye affection was frequently so severe that it led to much impairment of vision and in many cases to blindness. It is a long time ago that I knew of a case of blindness due to this eye disease in the newly born, and it is a rare occurrence for one to be able to say that after treatment vision has been impaired. This improvement is largely due to improved technique in midwifery. (k) Illegitimate Children.—Special attention is paid by the Health Visitors to all illegitimate children. Eighteen illegitimate children were born during the year, and one died. (1) Tonsils and Adenoids.—I have reported at length upon this matter in previous years. I have nothing to add. (m) Convalescent Treatment.—During 1937 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 1 Mothers and toddlers 10 Toddlers (under 5 years of age) 11 (n) Ophthalmic Clinic.—On pages 59—60 will be found the Report of your Consulting Ophthalmic Surgeon upon the work of the Ophthalmic Clinics during the year. The inauguration of a squint training clinic has been much appreciated, the numbers are increasing and the results obtained have proved the benefit of such a service. I would refer you to the statistics upon the work of this clinic on page 60. 48 (o) 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 3,982 treatments were given to toddlers and expectant and nursing mothers as compared with 2,462 treatments for the previous year. The increase in the numbers attending this clinic has been so marked that I would refer you again to my remarks in an earlier part of the Report, where I have pointed out the urgency for increasing the accommodation at this clinic. (p) Dental Treatment.—It is my contention that dental hygiene should start when indeed the teeth first make their appearance, and an attempt was made during the year to get toddlers to attend for dental inspection only; thus trying to inaugurate what would be a regular service for toddlers. I regret to say that out of a large number of appointments made only one attended. These appointments, however, were made during a holiday period and although we did not expect the experiment to be a great success we did not anticipate such a failure. I am also informed that it is difficult to get toddlers to attend for dental treatment at all, but perhaps the nursery classes which you propose to set up will help in this matter. The Senior Dental Officer's Report will be found on page 65. (q) 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—152 children were immunised during the • year. Immunisation against scarlet fever has also been started and 44 children completed their course of injections. 49 Immunisation against whooping cough was commenced last year, but the numbers so immunised were comparatively few and it is, therefore, not yet possible to give a considered opinion on this service. It is now possible to immunise for measles, but this is not practicable upon a large scale, and as yet can only be undertaken in a relatively few selected cases. (s) 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 264 892 (b) Old cases 248 497 No. of attendances for treatment 952 2,354 The number of new cases medically examined in 1937 totalled 1,156. (t) Infant Life Protection (under Part I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932).—Infant Life Protection Officers pay visits to foster parents during the day and during the evening. During the year there was one prosecution of a woman who had undertaken for reward the nursing and maintenance of a certain infant under the age of nine years apart from its parents, and who was a person who was required to give notice to the Barking Corporation that she had changed her address, and had failed to give this notice within the requisite forty-eight hours. It cannot be too clearly understood that anybody who undertakes for reward the nursing and maintenance of an infant under the age of nine years, apart from its parents or having no parents, must notify the local authority in writing seven days before the receipt of the infant in the case of the first infant proposed to be received and forty-eight hours before receipt in the case of any other infant, unless the infant is received in an emergency, which makes it impossible for so long a notice to be given. Notice must be given to the Authority too when the foster-parent changes his or her address, when the child is removed to the care of another person, or if the child should die. 50 It is to be noted that the above requirements do not apply to persons keeping children for reward if the children are under their legal guardianship, or are related to them as grandchildren, brothers, sisters, nephews or nieces. The meaning of " reward " is very comprehensive, and means any payment or gift of money or money's worth, or any promise to pay or give money or money's worth, whether there is any intention of making profit or not. This includes, therefore, the receipt of lump sums as well as of payments at intervals. You do, I think, look upon your special care of these little foster-children as one of your most serious obligations. In my opinion the general legislation dealing with foster-children requires to be strengthened, and, until it is so strengthened, the only thing that can be done is to enforce present legislation in every way possible. May I hope that everyone who reads this Report will look upon it as a moral obligation to see that it is so widely known as possible that people who take upon themselves the responsibility of being foster-parents must comply with the requirements of the acts dealing with foster-children. It is a happy thought that baby farming, in the sense in which these awful words were known a generation ago, does not, so far as I am aware, exist today, but the price of this is constant vigilance. (u) Maternity and Nursing Homes.—During the year no less than 414 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 Gynæcology, Mr. J. V. O'Sullivan. During the year a resident medical officer has been appointed to the Upney Maternity Pavilion and the duties also couple those of medical officer to the Humphrey Ward, a clinic I have already mentioned. He is also the medical officer for the birth control clinic. No nursing homes are maintained in the Borough. 51 (v) Infant Welfare Clinics.—The following table shows the work carried out at your various Infant Welfare Clinics during the year:— Central. Greatfields. Alexandra. Woodward. Porters Avenue. Totals. No. of sessions 104 100 99 156 148 607 No. of attendances of children under 1 year:— (a) New Cases 256 113 132 285 243 1,029 (6) Old Cases 3,252 1,674 1,856 4,875 4,691 16,348 No. of attendances of children 1-5 years of age:— (a) New Cases 68 20 61 155 160 464 (6) Old Cases 1,754 1,225 1,670 5,644 6,368 16,661 Average No. of attendances per session 51 30 37 70 76 57 No. of sessions attended by Medical Officers 104 100 99 156 148 607 Average No. of children seen by Medical Officer per session 22 16 19 22 23 21 No. of children seen by Medical Officer other than at above sessions:— (a) New Cases 264 — — 892 — 1,156 (b) Old Cases 248 — — 497 — 745 The total attendances during the year were 34,502 as compared with 29,883 in 1936. The information which is brought out by this table is that there were 1,029 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 1,133 which means that approximately 90 per cent. of the children born in Barking attended at your centres. Mothers attend very regularly at the infant welfare centres with their babies, more especially when they are under one year of age. They do not, however, attend so regularly as the child grows a little older. All the children are weighed and advice is given by the health visitors on infant feeding, hygiene, etc. When the numbers permit, infants are referred to the medical officer in attendance about once every four weeks, whether they are well or ill, and at each clinic all ailing children are referred to the medical officer for advice and treatment. 52 Severe cases of illness are referred to the family doctor, except in urgent instances where they may have to be sent to hospital direct. In necessitous cases and where the illness is not severe, prescriptions for necessary medicines can be supplied at the infant welfare clinics. This widens the scope of these clinics considerably. All mothers attending the infant welfare clinics can obtain supplies of dried milk and tonics at cost price, or in necessitous cases at half price or free of charge. Children with postural defects, dental caries, visual defects or debility, necessitating ultra-violet light treatment, are referred by the medical officer to the appropriate clinic for treatment. Mothers too, with children under 2 years of age, are able to have dental treatment, ophthalmic treatment, including prescription for spectacles, radiant heat treatment, etc., and a greater number of mothers have taken advantage of these services than heretofore. More and more you are achieving co-ordination in your medical services, and there are scarcely any watertight compartments left, which is of course a good thing. As a single illustration, I may perhaps be permitted to draw a picture of your eye service, at any one of which sessions it might be possible to find expectant mothers, nursing mothers, toddlers, elementary school children, children from the Abbey School and the South-East Essex Technical College, candidates to be appointed to designated posts and other employees of the Council on whom it has been found necessary, under some special circumstances, to present a report upon their eyes. It is not suggested, of course, that representatives of all these types arrive at every clinic, but they do come up from time to time, and they are not only examined but also receive treatment where necessary, and this treatment includes everything which can be and which is undertaken at the out-patient department of any hospital especially devoted to eye cases. What may be said of the ophthalmic work in Barking may be said also of all the other departments which cater for all those people who have a claim upon your services. In the massage department for instance, women come up post-natally for abdominal muscle massage, where it is considered necessary by Mr. J. V. O'Sullivan, by Dr. Bampfylde-Wells, or by one of your other medical officers. 53 (w) 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 1,550 No. of ante-natal visits:— First visits 394 Subsequent visits 190 No. of first visits to children under 1 year 1,186 No. of subsequent visits to children under 1 year:— (a) Attending a Centre 1,651 (b) Not attending a Centre 2,077 No. of visits to children 1 to 5 years of age:— (a) No. of visits 6,902 (b) No. of children seen 8,811 No. of special visits in connection with ophthalmia neonatorum 16 ,, ,, ,, deaths of children up to 3 years of age 43 ,, „ „ stillbirths 29 „ ,, „ puerperal sepsis and puerperal pyrexia 9 Other visits (re infectious diseases) 135 No. of visits to foster children 279 Total home visits of all kinds 12,911 (x) Provision of Fresh and Dried Milk.—Particulars of the amounts of wet milk supplied free and at reduced rates to necessitous mothers and children are given in the following table:— No. of pints supplied at reduced price. No. of pints supplied free. Total. Total cost of milk supplied. Council's liability in respect of fresh milk supplied. 51,878 142,047 193,925 £2,853 18 0 £2,476 14 0 Pursuant to the receipt of Circular 1519 from the Ministry of Health, Pasteurised milk was supplied as from the 1st May, 1937. 54 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.) Total (pkts.) Ostermilk No. 1 596 148 248 992 Ostermilk No. 2 1,840 655 1,132 3,627 Ambrosia 155 39 109 303 Cow and Gate 4,418 1,063 2,476 7,957 Cow and Gate (half cream) 1,104 149 370 1,623 Colact 110 69 303 482 Hemolac 24 1 36 61 Lactogal 154 38 121 313 Glaxo " O " Brand 2 10 28 40 Trufood 69 4 19 92 Lactogen No. 1 93 2 40 135 Lactogen No. 2 154 — 56 210 Virol 1,133 313 2,124 3,570 Parrish's Food 262 60 554 876 Liquid Paraffin 158 59 238 455 Malt and Oil 737 320 2,187 3,244 Pure Cod Liver Oil 758 71 289 1,118 Cod Liver Oil Emulsion 3,084 524 2,522 6,130 Totals 14,851 3,525 12,852 31,228 (y) Mothercraft Circles.—I wish to write on a matter which strictly speaking does not come within the purview of this Report. I refer to mothercraft circles. Since January, 1938, weekly meetings have been held at the Porters Avenue Centre for mothers attending your clinics in the Barking Section of the Becontree Estate. The mothers are encouraged to bring knitting and sewing to the meeting and are given help with patterns and material (by courtesy of the Barking Infant Welfare Society) and advice on making up garments. Talks on health, hygiene and other subjects of interest are given and occasionally there will be cinematograph and other practical demonstrations. If this undertaking proves successful, it is hoped to inaugurate a similar scheme for mothers in the other half of Barking, possibly at the Greatfields Clinic. 55 Next year I shall be in a position to report more fully upon this matter. (z) Services provided and Facilities for Treatment.—It is convenient to set these out in tabular form, although of course some of them are mentioned elsewhere in the Report. Ante-Natal Clinics Ante-Natal Clinics are held each week at four different centres, and a Specialist-Consultant holds one session per month during ten months of the year. During 1937, 95 cases attended the clinics held by the Specialist-Consultant. In addition there were 77 post-natal and gynaecological attendances. Baths In certain necessitous cases, free baths are provided for expectant and nursing mothers. During 1937, 127 baths were granted free of charge. Birth Control Clinic In September, 1937 you decided to set up a Birth Control Clinic and to hold monthly sessions. The first clinic was held in November 1937 and each month a session is held at the Humphrey Clinic in the Hospital grounds. Women attending this Clinic must fall within the limits laid down by the Ministry of Health. 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 1937, 11 toddlers, and 10 mothers with babies, and one mother received treatment under this scheme. Dental Treatment Dental treatment for toddlers and expectant and nursing mothers is carried out at the Central Clinic, the Woodward Clinic, and the East Street 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 1937, 1,237 dinners were supplied to mothers and 832 to children under this scheme. 56 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. Home Helps Although home helps as such are not provided by you under any particular scheme, you do make financial provision in cases of maternity which are aided by you, because your scale of charges in all such cases is drawn up so as to leave an amount of money in the family exchequer sufficient for this purpose. Infant Welfare Clinics Infant Welfare Clinics are held each week at five different Centres. These Clinics are available for all children under the age of five years. Maternity Services Maternity Home.—Upney Hospital is a maternity home run by the Corporation. Applications for admission are made at the Ante-Natal Clinics, and the charges are in accordance with the Council's scale. District Maternity Service.—Pursuant to the Midwives Act, 1936 you have appointed five midwives to practise in the district, and you are also entering into agreements with the Plaistow Maternity Hospital and District Nurses' Home and the Salvation Army with a view to establishing an adequate service of domiciliary midwifery throughout the Borough. Application for the services of the midwives may be made at the midwives' homes or 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. 57 Medicines, Supply of During the course of the year a scheme was formulated, and arrangements were made with local chemists by which prescriptions are dispensed free in necessitous cases for mothers and children attending the Maternity and Child Welfare Centres. Milk Pasteurised 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 seven mothers and seventeen children under the age of five years were provided with spectacles under this scheme. 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, 90 such operations were carried out in respect of children under the age of five years. 58 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 1937, 381 cases were treated, a total number of 3,982 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 offices of the Public Health Department—Central Hall Chambers, East Street, Barking. 59 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 34 Other attendances 77 Spectacles prescribed 23 Spectacles supplied 17 External Diseases of the Eye treated at the Clinics : Blepharitis and Conjunctivitis 5 Injury to Eye 1 Ingrowing lashes 1 Daerocystitis 5 Hordeolum 1 Cases listed for Squint Training 9 Expectant and Nursing Mothers. Tests 21 Other Attendances (Blepharitis and Conjunctivitis 3, Meibomiam cyst 1) 29 Spectacles prescribed 14 Spectacles supplied 7 In these clinics the two groups of cases, i.e., expectant and nursing mothers on the one hand, and toddlers and infants on the other, differ markedly from each other but have this in common—they are both subject to mild inflammatory diseases and, in some cases, the disease has been transmitted from one to the other. In children under five years of age the chief complaint is squint, while in mothers, headache is common. 60 While headache is important in pregnancy it has, also, a special significance during the post-natal stage. It has been noted in some cases that the apparent need for glasses only arises after pregnancy. In the majority of such patients there is a small error found on testing the eyes and the cause of the headache is probably due to the general health being somewhat lowered. Fatigue of the eyes is then easily produced. This, fortunately, is only a temporary condition and many such cases find that after some little time the headache disappears. It is our custom to recommend glasses only in cases in which symptoms of eye strain have persisted for some months. No case of injury or disease of the eye which could be attributed to pregnancy has been seen during the year under review. Treatment of Children under 5 years of age at the Orthoptic (Squint Training) Clinic. No. of cases treated 6 No. of cases under treatment at end of year 2 Treatment commenced but transferred to Education Scheme on account of child becoming of School Age 4 No. of treatments given 49 61 REPORT ON THE WORK OF THE ORTHOPAEDIC CLINIC. Orthopaedic treatment in Barking provides massage, medical electricity, plasters, splints, remedial exercises, including those for flat feet, etc. As I have reported before there is a modern duo-therapy lamp and an up-to-date therapeutic switch table at the Orthopaedic Clinic. During the year you have employed two full-time masseuses, and as and when the occasion arises these masseuses even visit people in their own homes, in order that some necessary treatment may be completed. The work at the Orthopaedic Clinic is linked up with that of your 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 oftentime 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 130 No. of re-examinations by Orthopaedic Surgeon 175 The cases dealt with for the first time during 1937 were referred for the following conditions :— (a) Deformities—Bones and Joints. (1) Congenital: Flexion deformity—digit-—hand 1 Deformed toes 3 Deformed cranium 1 (2) Acquired: Pes planus 9 Genu valgum 35 Bowed tibiae 16 Hallux valgus 2 Genu varum 6 73 62 (b) Deformities—Muscular. (1) Congenital: Torticollis 4 Talipes 6 (2) Acquired: Pes planus 25 Intoeing 6 Scar—hand 1 42 (c) Paralysis. Anterior poliomyelitis 1 Facial paresis 1 ? Old hemiplegia 1 Hemihypertrophy 1 4 (d) Miscellaneous. Eversion right lower limb 1 Pain in hip joint 1 Re gait 8 No diagnosis 1 11 Total defects found 130 During the year six toddlers were admitted to hospital, five for operations and one for observation, as follows:— Operations : Manipulation and plaster 3 Tenotomy Tendo Achilles and plaster 2 Supernumerary thumb—removal 1 Osteoclasis and plaster 2 Median stoffel 1 Observation 1 Total 10 63—64 PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1937. No. of sessions held by Orthopaedic 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 11 834 146 130 263 175 8,084 6,301 8,493 6,606 TREATMENTS. Massage Electricity Remedial Exercises U Itra-Violet Therapy Radiant Heat Dressings and Splintage Totals. 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 No. of Children No. of Treatments School Children 28 1,180 14 446 207 2,333 328 4,635 9 182 166 1,143 752 10,609 Toddlers and Expectant & Nursing Mothers. 40 1,093 7 120 54 807 381 3,982 5 186 205 1,659 692 7,847 Admissions to Hospitals School Children Toddlers Total School Children Toddlers Total 16 (Under Council's Orthopaedic Scheme) 6 22 — — — On Waiting List for Admission 31/12/37 65 REPORT OF THE DENTAL SURGEON. May, 1938. To the Medical Officer of Health, Borough of Barking. I have the honour to present the Annual Report of the Dental Work under the Maternity and Child Welfare Scheme for the year ending 31st December, 1937. Figures are comparable with those of last year, an increase of approximately one hundred dentures supplied being the most noticeable variation. The number of patients attending for treatment at the Woodward Clinic is larger than that which can be adequately handled and to overcome this, a certain percentage now attend the East Street and Central Clinics for prosthetic work to relieve the pressure that is experienced with this part of the treatment. No patients for extractions attend the Central Clinic from the Woodward area except in emergency, as a journey following extractions under nitrous oxide anaesthesia is not considered advisable. Considerable prejudice still exists against the filling of temporary teeth and it is difficult to convince parents that very little discomfort is experienced by children of six years of age and under while such work is carried out. I have to thank the Medical and Nursing Staff and the Health Visitors for their very generous assistance and to assure them that the effect of their good offices really is noticeable in the attitude that parents and expectant mothers are now taking towards dental treatment. I have the honour to be, Sir Your obedient Servant, W. H. FOY, L.D.S., R.C.S. (ENG.), Senior Dental Officer. 66 DENTAL CLINIC. Mothers and Toddlers. Extractions 3,669 Scalings 125 Dressings 31 Inspections 203 Fillings 278 Dentures supplied 467 Anaesthetics— General 774 Local 66 Patients— Old 2,247 New 470 Number of Sessions held 228 Toddlers— Treatments 879 67 REPORT UPON THE WORK OF THE PATHOLOGICAL LABORATORY For the Year 1937 I include herewith in this Annual Report a special report by Dr. E. M. Hill, who has done much admirable work at the Pathological Unit attached to the Barking Hospital. The Report speaks for itself. It cannot, however, be other than a source of satisfaction to me that this development I so earnestly recommended has proved itself to be a success beyond any hopes I held out, and has been of more benefit to the people of Barking than I could see at the time I recommended it. It is strictly speaking unnecessary for me to add to Dr. Hill's thanks to Dr. Camps of Chelmsford, but I would like to say how heartily I agree with her, and how particularly fortunate are the people of Barking that Dr. Camps' Laboratory is relatively near by, and that Dr. Camps has been so untiring in his kindness. "As was stated in last year's Report, a pathological unit was opened in the grounds of the Barking Isolation Hospital late in 1936, in order to extend to the Barking Public Health Services, some of the most recent advances in pathological methods. This laboratory is not intended in any way to replace the services of the Counties Public Health Laboratory, nor to be used as a routine laboratory. In every Public Health Service, problems arise which cannot be submitted to a routine laboratory, but must be dealt with on the spot: if no laboratory is available, such problems are left unsolved to the detriment of the service. If a laboratory is available, the Medical Officers are brought closely into touch with the scientific aspects of medical problems, and the pathologist is able to come into personal contact with the patients, a state of affairs which has much to commend it. 68 Not the least valuable advantage of having a local laboratory is the time factor which is so important in medicine. In many cases it is of vital importance to produce the result of a pathological examination within a few minutes or at the most, an hour or two; with only a distant laboratory to rely on there is inevitably a delay bf many hours, which may be fatal. One of the most widely examined fluids in Pathology is urine, which is a notoriously perishable liquid and in most cases must be examined immediately after voiding to obtain reliable results. Further, there are a number of organisms which die out within an hour or two of leaving the body and which would not therefore survive long enough to be transported by post. Numbers of patients have already experienced the advantage of being able to have tests carried out near their homes, instead of suffering the fatigue and expense of journeys to London Hospitals. There has been prepared a comprehensive catalogue of all the tests which can be carried out in this Laboratory, and which has been circulated to all the Medical Officers. It would be superfluous to print this in a report of this nature. In the space available it is only possible to give a bare outline of some of the lines of enquiry which have been examined. A constant source of problems is the pregnant woman. It is becoming increasingly apparent that there is a very large incidence of anæmia among the women in industrial districts, and we have found by wholesale blood tests that Barking is no exception to this rule. Such anaemia if untreated may become very severe and is definitely a great source of danger during pregnancy. It is not necessarily due to acute illness but arises chiefly through continuous malnutrition or multiple pregnancies or both. Sufficient work has been done here and elsewhere to show that the administration of iron to expectant mothers as a routine precaution should be an important part of ante-natal supervision. Whenever the anaemia becomes severe enough to cause distressing clinical symptoms, full blood tests are carried out in order to determine the type of anaemia present, and the patients are given suitable treatment. Whenever it is considered advisable, such patients are followed up post-natally. The toxaemias of pregnancy provide another source of pathological examinations which must be carried out in order to help determine the severity of the toxaemia, and also to trace the patient's progress under treatment. Incidentally, workers in this field have found that the anaemic woman is much more liable to toxaemia than the woman who has been treated for anaemia with iron. 69 A very interesting and important piece of work is being carried on here at the laboratory in collaboration with the Pathologist of the Chelmsford and Essex Hospital in connection with Streptococcus pyogenes. This rather formidably named creature is no less formidable than its name. It is the germ which is common to scarlet fever, tonsillitis, mastoiditis, erysipelas, cellulitis and a host of other suppurative conditions, not least of which is puerperal septicaemia. When it is realised that there are nearly thirty so-called " types " of this germ which are dangerous to man, no one of which gives complete immunity to any other, it must be apparent that this germ is a very grave menace. These types are strictly permanent, in other words one type can never be transmuted into any other type. Briefly what is being done here is to isolate the germs from the throats, nasal discharges or ear discharges of scarlet fever patients or from other likely sources ; these strains are sent to the Pathologist at Chelmsford for typing (a process which requires special materials which are not on the market). In common with other workers, we have found that in a high percentage of cases the complications commonly attending scarlet fever, viz., otitis media, rhinorrhæa and so-called secondaries, are due to streptococci of a different type from those which caused the initial symptoms. It is noteworthy that a person who has had scarlet fever in childhood through infection with one type of streptococcus is not safeguarded against streptococcal diseases of other descriptions caused by a different type, although it is rarely that the clinical syndrome designated “scarlet fever ”appears more than once in the same person. A demonstration of the usefulness of typing occurs in the event of a possible return case of scarlet fever. If the type of Streptococcus in the throat of the new case is of the same type as that in the throat of the discharged patient with which it has been in contact, then the chances are that it is a true return case. In the event of the types being different then it is quite out of the question that the new case has been infected by the late patient and it is not a return case. In the field of midwifery the source of the infecting organism in a case of streptococcal puerperal septicaemia can often be traced. This may be the patient's own throat or the throat of one of her attendants. 70 It has of course only been possible to develop gradually and development is still proceeding. Although the laboratory has been open for a little over a year, this is far too brief a period in which to discover all the material on which investigations can be carried out. Fresh problems crop up every week and it will only be in the fullness of time that the whole vast field of possible scientific enquiry will become apparent. In conclusion, I should like personally to express my deepest thanks to Dr. F. E. Camps, the Pathologist of the Chelmsford and Essex Hospital, for his kindness in typing over 300 strains of Streptococcus pyogenes for us during the past year. The materials for such typing are only available to very few laboratories and we are extremely fortunate to have the opportunity of working in co-operation with such a prominent pathologist as Dr. Camps. E. M. HILL, Ph.D., Dip., Bact., Scientist." 71 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. 1. WATER. South Essex Waterworks Company Supplies.—The Engineer of the South Essex Waterworks Company informs me of the following facts:— " During the year 1935 the Company obtained an Act of Parliament for the abstraction of a further supply of water from the River Stour (Essex and Suffolk), and constructional work is proceeding satisfactorily. The Company is empowered to abstract additional water up to a maximum of 35 million gallons per day from the river, and to construct a reservoir in the neighbourhood of Abberton which will hold over 5,000 million gallons. The water will be normally abstracted from the river from November to May, when a large amount of surplus water is available, and the large reservoir is for the purpose of storing the water so abstracted for use at other times of the year. The scheme further authorises the construction of three pumping stations, filtration plant and about 26 miles of pipe lines. It is not anticipated that the scheme will come into supply before 1940. Extension of mains in your Borough:— 3” 104 yards. 4” 2,620 ,, 6” 207 ,, 9” 676 ,, 12” 2,582 ,, There was no form of contamination for the year 1937. The supply has been satisfactory in quality and in quantity. During the year 1937 about 200 samples of water were submitted for chemical examination and a like number for bacteriological examination; analytical reports in respect of all water supplied were that the water was pure and wholesome for the purpose of public supply.” 72 Additional to the examinations which are mentioned above, three samples were submitted to the Public Health Laboratories for chemical and bacteriological examination, and all three were found to be satisfactory. Consumers continue to complain of the hardness of the water supplied. Our examinations show the number of degrees of total hardness on Clark's Scale to vary from 19 to 24. The Company point out that they are prepared to reduce the hardness, provided consumers will suffer an increase in the charges. It is the permanent hardness which fluctuates. Supplies from local wells.—There are in the district seven wells, one of which is operated by the Metropolitan Water Board with a yield of 1,000,000 gallons per day. Of the remaining wells, two are operated by a mineral water company for the purposes of their business, and notwithstanding the fact that these two wells are comparatively shallow and near the River Roding (to which I give special mention on pages 73 and 74) they continue to yield a perfect water. One deep well at factory premises is used for drinking purposes and again yields a good water. The three remaining wells are used for industrial purposes only. Where well supplies are used for drinking purposes, arrangements have been made for monthly examinations of the supplies. 2. RAINFALL. The rainfall for the year ended 31st December, 1937 was 23.25 inches as compared with 16.57 inches for the previous year. Rain fell on 181 days in the year 1937. 3. DRAINAGE AND SEWERAGE. The joint drainage arrangements between Ilford and Barking have functioned satisfactorily during the year. 73 4. RIVERS AND STREAMS. The rivers and streams running through the area are tidal in character and are not controlled by the Corporation. A Joint Advisory Committee was set up by the Minister of Health and the Minister of Agriculture and Fisheries with the following terms of reference:— "To consider and from time to time to report on the position with regard to the pollution of rivers and streams, and on any legislative, administrative or other measures which appear to be desirable for reducing pollution." This Committee issued its report in July, 1937. I note that under present legislation tidal waters of a stream are exempt from the operation of the Rivers Pollution Prevention Acts, unless otherwise determined by an Order made by the Ministry of Health. River Roding.—In the Annual Report of the Medical Officer of Health for Barking for the year 1898, he referred to the River Roding in the following terms "Of course in times of drought, such as prevailed during the summer of 1898, the river's channel is converted into a stinking sewer, not much to the credit of modern sanitary science or sanitary authorities." In the year 1932 I referred to an outbreak of typhoid fever arising from conditions in the River Roding in the following terms:— "During the months of August and September bathing took place in the tidal limits of the River Roding. Such bathing was followed by a minor epidemic of enteric fever. Two samples of water obtained from different locations in the river were submitted for examination. The bacteriologist reported on these samples as follows:— 1. This is a grossly contaminated river water, having the bacterial composition of sewage effluent. 2. This is a grossly contaminated river water, having the bacterial composition of sewage effluent. In addition typhoid bacilli could be isolated." 74 I want now again to express my horror and alarm at the conditions prevalent in this river. Recent analyses have shown that in times of drought the water in the river is almost completely sewage effluent. The discharge of sewage or factory effluent is not an offence, if the best practical and available means are used to render the effluent harmless. In view of the fact that a number of sewage works discharge their effluents into the River Roding and that at times the Roding is a carrier of disease, it is, in my opinion, imperative that every possible precaution should be taken to make quite sure that these effluents comply with the conditions referred to in my previous paragraph. Even with this precaution, I think the Roding may still be contaminated other than from sewage works owned by local authorities. All these points of possible contamination require investigation and supervision. I note that the Essex County Council have eight representatives on the River Roding Catchment Board and am hopeful that progress will be made in the direction I have indicated. 5. CLOSET ACCOMMODATION. At the end of the year there remained a total of 17 premises unconnected with the sewer. Eleven of these were factory premises. Of these 17 premises, 7 have cesspools, 9 have earth closets, and one has a sewage disposal plant (septic tank and percolating filter). 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, 75 During the year, 7,440½ loads of refuse were collected, with an average weight of 1 ton 12 cwts. This figure shows a yield of 8.2 cwts per 1,000 of the population per day. When the present standard bin was introduced in 1934, I felt that a capacity of 1.7 cubic feet for a week's storage was less than would be sufficient for some households. It is however for me to report that we have had but little complaint outside the estate of the London County Council at Becontree, where the tenants were accustomed to a much larger bin. Standards however are generally rising and people today are becoming more interested in and critical of the public services. During the year the question has been raised of a more frequent refuse removal service. Naturally, so far as we are concerned, it is scarce possible to think of a service that would be too frequent. I feel, however, it is difficult to put forward convincing arguments in support of a proposition that the much increased collection costs would be offset by any substantial increase in comfort, convenience or health to the householder, particularly where the householder uses the sanitary dustbin with discrimination. (b) Trade Refuse.—During the year nuisance was occasioned by occupiers of shop-premises, with multiple flat dwellings above, burning refuse in their small back yards. Arrangements were made for more frequent removals and easier charges in the removal costs. (c) Street Cleansing.—The Council still relies upon manual sweeping. I would remind members of the Council that speedier cleansing with mechanical sweepers would mean more frequent cleansing, also releasing manual labour for the cleansing of streets where mechanical sweeping cannot be operated effectively. 7. REFUSE DISPOSAL. Refuse tipping has been carried on throughout the year by the Corporation on land being reclaimed on the north bank of the Roding, adjoining the sewage works. 76 There has been a gradual improvement in the operations but there is still much to criticise in the tipping methods, and these criticisms have been brought to the notice of the Borough Engineer and Surveyor from time to time. The only complaint we have received from residents during the year relates to an infestation of crickets. Private Tips.—In connection with such tips the Corporation administers the relevant section of the Essex County Council Act, and '261 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 659, as compared with 759 in 1936, 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 15,054 and are summarised below, together with the number of defects found arising from those visits. The housing defects dealt with numbered 6,801. (a) Work of Sanitary Inspectors. (1) Inspection of Dwelling-Houses. Total Houses Inspected under Public Health or Housing Acts ... 3,695 Total Number of Inspections made 10,644 Housing (Consolidated) Regulations 981 After Infectious Disease 844 Overcrowded Premises 1,416 Defects Found 6,801 Notices Served (Preliminary) 2,349 Re-inspections re Notices Served 3,942 Inspection of Works in Progress 599 (2) Premises Controlled, by Byelaws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings – – – Common Lodging Houses 29 – – Offensive Trades 143 18 12 Tents, Vans and Sheds 97 16 13 Dairies, Cowsheds and Milkshops 123 15 6 Slaughter-houses 175 – – Hairdressers' & Barbers' Premises 42 7 6 Smoke Observations 225 53 49 77 (3) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 245 15 10 Laundries 3 – – Bakehouses 35 14 7 Domestic Workshops 20 2 1 Other Workshops 107 11 4 Other Workplaces 126 16 8 Outworkers' Rooms 110 – – Butchers' Premises 250 76 54 Fishmongers 54 15 13 Restaurants and Dining Rooms 123 47 28 Stables and Stable Yards 37 10 9 Piggeries 13 – – (4) Miscellaneous. Inspections. Defects. Notices. Rats and Mice (Destruction) Act, 1919 66 4 4 Vacant Land and Refuse Dumps 261 21 18 Public Lavatories 26 3 3 Schools 41 4 1 Markets and General Shops 303 36 35 Ice-Cream Vendors 166 19 18 Petroleum and Celluloid Stores 69– – –– Drainage Inspections 308 – – Milk Sampling 90 – – Other Miscellaneous 279 3 3 78 Inspections. Defects. Notices. Inspection of Meat from Outside District 162 – – Shops Act, 1934 466 21 17 Water Sampling 9 – – Food Manufacturers 28 5 5 Picturedromes 2 – – Street Traders 126 1 1 Food Byelaws 40 23 23 Boilers 24 – – Obstructive Outbuildings 127 – – Pleasure Grounds 4 – – Noise Nuisance 1 – – (b) Summary of Sanitary Work Carried Out. (1) Drainage. Choked drains, opened, repaired and cleansed 276 Drains reconstructed 83 Ventilation shafts repaired or new fixed 27 New inspection covers 12 (2) Closet Accommodation. W.C. structures repaired:— Roofs Walls Floors Doors 11 Seats fixed 51 W.C. pans fixed or cleansed 75 Flushing apparatus repaired or renewed 137 (3) Sinks. New fixed 58 New sink and bath wastepipes 53 New gully traps 25 (4) Dampness. Roofs and flashings 575 Eavesgutters 325 Rainwater pipes 154 79 (5) Water Supply. Defective water fittings repaired and supply reinstated 48 (6) Paving. Forecourt paving repaired or relaid 31 Yard paving repaired or relaid 104 Gully dishing repaired or renewed 119 (7) Dustbins. New ones provided 695 (8) General Repairs. External walls repointed 315 House floors repaired 125 Windows repaired or renewed 319 Windows reglazed 22 Window and door reveals repaired 100 Window sills repaired or renewed 128 Sashcords renewed 176 Washing coppers repaired or renewed 81 Stoves repaired or renewed 158 House doors and frames repaired or renewed 141 Stairs repaired 34 Handrails fixed 1 Chimney pots renewed and stacks rebuilt 274 Dirty or defective rooms repaired, cleansed and redecorated 1,727 Damp walls remedied 162 Insufficient floor ventilation 93 External painting 162 Internal painting 1 Weatherboards fixed 16 Door sills repaired or renewed 54 (9) Miscellaneous. Offensive accumulations removed 86 Animals so kept as to be a nuisance15 Verminous rooms disinfested 46 Drains tested 159 Dangerous structures reported 14 Overcrowding 21 Flooding19 Dust Nuisances 9 Other conditions 9 80 (c) Notices Served. Informal Notices 2,349 Statutory Notices:— Public Health Act, 1875:— Section 23 – Section 36 11 Section 41 5 Section 94 176 Public Health Act, 1925:— Section 46 1 Public Health Act, 1936:— Section 39 17 Section 44 1 Section 45 1 Section 46 1 Section 93 65 Housing Act, 1936:— Section 9 150 Section 10 1 Other Acts:— Shops Act, 1934, Section 10 1 Smoke (Abatement) Act, 1926, Section 1 1 431 (1) Inspections (including inspections made by Sanitary Inspectors). Premises. Number of Inspections. Written Notices. Prosecutions. Intimations. Statutory. Factories 276 15 – – Workshops 142 11 – – Workplaces 126 8 – – Totals 544 34 – – (d) Factory and Workshop Act, 1901. Factories, Workshops and Workplaces. 81 (2) Defects found. Particulars. Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Inspector *Nuisances under the Public Health Acts:— Want of cleanliness 23 23 – – Want of ventilation – – – – Overcrowding – – – – Want of drainage of floors 1 1 – – Other nuisances 12 12 – – Sanitary accommodation:— Insufficient 8 8 – – Unsuitable or defective 11 11 – – Not separate for sexes 1 1 – – 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) 1† 1† – – Other offences – – – – Totals 57 57 – – * Including those specified in Sections 2, 3, 7 and 8, of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. † Bakehouse demolished. (3) Home Work. Eight notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 25 workpeople engaged on making wearing apparel, etc., in their homes. 82 (4) Registered Workshops. Workshops on the Register (sec. 131) at the end of the year. Number. Bakehouses (including eight factory bakehouses) 11 Other Workshops 45 Total number of Workshops on Register 56 (5) Other Matters. Class. Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (sec. 133) – 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 61 outworkers:— Wearing apparel 31 Millinery 3 Tie-making 3 Life-belt covering 4 Machinery 1 Box makers 3 Paper hats, Christmas crackers and novelties 5 Flags 4 Handbags 1 Infants' bibs 1 Fancy leather goods 1 Umbrellas 2 Christmas cards 1 Brushes 1 83 During the year, 54 lists of outworkers were received from other Authorities in respect of addresses in Barking. Eight lists were received from employers within the district. (e) Premises and Occupations which can be controlled by Byelaws or Regulations. (1) Houses Let in Lodgings.—Action under the Housing Act, 1936 has revealed that accommodation over many of the larger shop premises in the district is becoming used for living purposes, and as the Council is aware we are awaiting confirmation of 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 this common lodging house 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 seven van dwellings situated in two yards in the district where water supply and sanitary accommodation are provided. Ninety-seven visits were paid and thirteen notices were served in respect of sixteen defects discovered at these and other temporary van sites. The Barking Corporation Act, 1933 provides that approval is now necessary before this type of dwelling can be established in the district. (4) Underground Sleeping Rooms.—There are no such occupied rooms in the district. (5) Offensive Trades.—The number of premises used for this purpose are as follows:— Fish Fryers 23 Dealers in Rags and Bones 7 Gut Scraper 1 Fat Melters 2 Fish Skin Scraper 1 Oil Boiler 1 Soap Makers 1 Total 36 84 One hundred and forty-three visits were paid to these 36 premises, and 18 contraventions of the byelaws were discovered and any necessary action taken. At the oil boiling factory the installation is of modern design, and the general supervision is careful. Notwithstanding this there has been emission of noxious odours due no doubt, amongst other things, to acrolin. Your officers have consulted with H.M. Inspector of Alkali etc. Works and the County Analyst. Certain suggestions have been put forward, and although the present position is unsatisfactory, it can be said that steps are being taken to try to deal with the situation. (6) Piggeries.—There are three 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. Thirty-seven visits were paid during the year to stable premises, and 9 notices were served in respect of unsatisfactory conditions. (/) Rats and Mice Destruction Act, 1919. There were 66 visits made to premises under this Act. The location of the source of infestation is of the greatest importance, and little can be achieved to prevent re-infestation unless this is discovered. Usually infestation is found to be directly due or associated with defective or disused drains, particularly where the premises are subject to interior infestation. At some houses in Romford Street, abutting upon open land, we were unable to discover the source of infestation and unfortunately re-infestation has occurred. The matter is being dealt with by the use of baits. Repressive Measures.—Occupiers are encouraged to carry out the trapping of rats themselves, and the owners are called upon to effect rat-proofing where the source of the infestation is other than defective drains. Advice is given by the sanitary inspectors and a free issue of suitable raticides is made to householders. 85 Rat Week Propaganda.—In connection with Rat Week the following action was taken by the Corporation:— (1) Large illustrated posters were exhibited at 28 stations in the district inviting co-operation and giving advice to the general public. (2) The attention of the Borough Engineer and Surveyor was directed to the Corporation properties and sewers. (3) Special applications of raticides were made at the Corporation Hospitals. (4) The Corporation had available for free issue four different kinds of raticides. Again there was indifferent support by the public and during the week only three applications were made to the local authority for assistance. Although it is my duty to report this indifferent support by the public during the particular week which was given to this propaganda, I think that in some small measure this redounds to your credit, because in my opinion, this means that, at least to a considerable extent, you are dealing continuously throughout the year with the rat problem, and that all those who are concerned with this problem are more or less in constant touch with the Department. It may be that this experience may have some bearing on any future decisions you make with regard to propaganda. In the first place, I have to say that the only real propaganda is efficient service, and in the second place I should like to say as a result of Rat Week that where the service is efficient, propaganda is of only very limited value. (g) 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. (h) Removal of Infirm and Diseased Persons. The Barking Corporation Act, 1933, empowers the Medical Officer of Health to certify that a person is infirm or diseased, and is incapable of taking care of himself, and is not receiving proper care and attention from others. The certificate enables the justices to grant an order for the compulsory removal to hospital of the person concerned. 86 Two cases of such infirm persons were reported during the year. One was persuaded to enter hospital and the other was kept under observation at home, after increased attention and medical care had been provided, until death. 9. SHOPS ACT, 1934. Inspections carried out for the purposes of Section 10 of this Act numbered 466. In 17 instances notices were served requiring additional sanitary accommodation, washing facilities or improved heating. For the purposes of administration a temperature of 55°F. has been regarded as a suitable minimum, and the shops have been divided into three classes:— (1) Shops for the sale of non-perishable articles. (2) Shops for the sale of perishable articles. (3) Open shops and Forecourt Traders. The problem of heating in respect of the three types of shops has been dealt with in the following manner:— (1) General heating for the whole shop ; (2) Local heating by gas or electricity from ceiling fires at the positions where the assistants are on duty; and (3) Local heating with coke-bucket fires and withdrawal rooms where heating is provided for the assistants when disengaged in the shop. The purchasing public are accustomed to the open shop door and I am afraid rarely give a thought to the discomfort of the shop assistants arising from this "convenience." The maintenance of a reasonable temperature in a shop with an open door is another of our problems. Several instrumental methods of measuring the standard of warmth and ventilation have been carried out by research workers and most have agreed that a dry kata-thermometer reading within the limits of D.K. 5.0 and D.K. 7.0 indicates a zone of comfort which can be obtained in most shops. 87 We have not experienced any serious difficulty in relation to the provision of sanitary conveniences or washing facilities. Hairdressers' and Barbers' Premises.—There are 36 premises where this type of business is carried on. They are subject to control by byelaws made under the Essex County Council Act, 1934. There are 36 premises where this type of business is carried on. They are subject to control by byelaws made under the Essex County Council Act, 1934. We were disappointed with the code of byelaws as approved finally, but have found they are of value in the matter of cleanliness. Although the introduction of these byelaws did not meet with approval from all quarters of the trade, it was, in reality a charter to all the members of the trade who were running their establishments satisfactorily, and we have found that there is a tendency for those shops who do not maintain a sufficiently high standard to close down. Generally speaking, the saloons catering for women are cleaner and better managed than those for men, and here I should confidently suggest that the public themselves can do a lot of useful work. It is only for men to demand the same high standard that their women-folk do, and I have no doubt that the trade will see that their requirements are supplied. 10. SMOKE ABATEMENT, &c. A considerable portion of your sanitary officers' time has been taken up by the investigation of smoke and grit nuisances. In some instances the evidence necessary to definitely name an offender is very difficult to obtain. During the year 225 smoke observations were made in respect of factories, 53 offences were registered and necessary action taken. Grit Emission from Coal Combustion.—During the year a petition was received from residents in the neighbourhood of the Generating Station at Creeksmouth, and the grit emission from the chimneys of the Station was the subject of questions in Parliament. 88 In December, I issued to the Council a special report which set out in detail particulars of the Station (which is the largest generating station in Europe and will shortly have a capacity of 540,000 kilowatts) and also of modern practice for the prevention of grit and sulphur emission. The coal consumed is 20,000 tons weekly. We have been in conference with the Engineers of the Company, with a view to reducing the grit emission, particularly from the pulverized fuel installation. Grit Emission from Wood Fuel.—Complaints of grit emission were received from 260 residents in the neighbourhood of a wood-block factory, where the wood refuse was being burned in the furnace of a Lancashire Boiler. Considerable nuisance was being caused. The Company in the autumn installed a new furnace, but the nuisance continued. A gas-producer furnace was later placed on order but at the time of writing we are unable to say with what success this will be operated. The cost of the installation is £3,200. A summons was issued against the Company and at present stands adjourned. Grit Emission from Mechanically Fired Vertical Boiler.—At a small factory near Abbey Road grit was emitted and deposited in nearby houses. A grit arrestor of the centrifugal type has been fixed. Stone-dust Emission.—In the industrial area at River Road, we have experienced trouble from the operations of road material hauliers and manufacturers. In the one case the nuisance arises from the discharge from the steamer to the road lorry of fine granite and similar dusty material and in the second case from the grading and screening plant. Although de-dusting screens were in operation the nuisance was considerable. Whilst alterations in handling have been effected this has only mitigated the nuisance. It is clear that an elaborate and expensive electro-static precipitation plant would effect a cure, but the cost of this on such a small plant would be considerable. 89 Sawdust Emission.—At some large sawmills in Abbey Road a nuisance was created by the emission of sawdust from electrically operated cyclones. The offending cyclones have now been totally enclosed, thus reducing the nuisance considerably, but not entirely. Smoke Abatement Byelaws.—For a number of years now the Corporation has been issuing warning notices when black smoke has been emitted in excess of 2 minutes in the aggregate in any observation of 30 minutes duration, excluding bursts of less than 25 seconds. It was felt, therefore, with the coming into force of the Public Health Act, 1936, that the time was opportune for the Corporation to make byelaws on these lines, and at the end of the year such byelaws were awaiting confirmation. There are in the district 105 chimneys which would be subject to the byelaws and 16 which are exempted, owing to the special processes with which they are connected. Soot Deposit Gauges.—From what has been said about grit emission it appears that there is in the atmosphere of Barking an excess of suspended matter and it would be of value if this could be measured and compared with standards elsewhere. The measurement could be carried out with soot deposit gauges and I propose to ask for authority to install such equipment at suitable points in the district. 11. SWIMMING BATHS AND POOLS. There are no privately owned swimming baths in the area. Corporation Swimming Pool at Barking Park.—The. total number of bathers was 70,054 or 12,000 more than in 1936. The number of bathers on the peak day of the season was 3,680. 90 The sun-bathing area continues to be one of the most popular amenities. Criticism is directed to the present condition of the pre-cleansing arrangements and this is receiving the consideration of the appropriate committee. Corporation Baths, East Street.—In my earlier Reports I have called attention to the age of these baths and their deficiencies when compared with modern standards. The total number of bathers was 66,669 with a peak day of 1,039 bathers or an increase in the total of 2,500. Projected Bath at Becontree.—The scheme consists of a large plunge bath with provision for water heating, a smaller bath for school children and a gymnasium. There is also to be a sun-bathing terrace on one side. Examination of Bath Water.—Four samples from each bathing establishment were submitted to chemical and bacteriological analysis. In one instance the sample was unsatisfactory bacteriologically, because of special circumstances. The information as to this unsatisfactory sample was communicated to the Borough Engineer and Surveyor and dealt with forthwith. 12. PARKS AND OPEN SPACES. In earlier Reports I have referred to the parks and open spaces which are under the control of the Corporation. I now want to refer to one which is not so controlled. We have along the Thames river frontage, extending from the Barking Generating Station to Dagenham Dock, a stretch of undeveloped land, low-lying but dry. It is in private ownership and is industrial land. At flood tide there is a wide stretch of water between the Essex and Kent shores, where there is also to be seen a passing pageant of ships to and from the London Docks. Parallel to this frontage but at some distance of about one and a half miles is the large Becontree Estate of the London County Council. 91 It is with pleasure that I have noted how popular the stretch of open land is with the residents of that area, who in the summer spend most of the warm weekends sitting about or playing games there. The children too seem to enjoy the use of the land, by bringing with them small tents and preparing picnic meals. The owners of the land have at present made no attempt to prevent this trespass. It may be possible for part of the land to be acquired as an open space, and I commend any such proposal. 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 figures which have been obtained show that there is a considerable amount of sunshine in Barking, and the sunshine is biologically active. 14. SCHOOLS. Thirteen of the seventeen 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. During the year forty-one visits were paid by the sanitary inspectors and four defects discovered in connection with sanitary conveniences. These defects were dealt with inter-departmentally. 92 15. ERADICATION OF BED BUGS. We have continued our practice of issuing free, small quantities of contact insecticides to householders with minor infestations. In addition the following houses have been disinfested:— Barking Council Houses 15 London County Council Houses 5 Privately Owned Houses 27 Total 47 The Corporation call upon the owner of the house to disinfest the dwelling and where necessary the occupier to disinfest the furniture, the Corporation carrying out steam disinfestation of bedding free. In three instances we were notified by contractors carrying out fumigation with cyanide on the orders of private owners, and attended the premises whilst the work was in progress. Corporation workmen carry out the disinfestation of Corporation houses with contact insecticides. The practice of using sulphur products and contact insecticides has been continued where the houses are tenanted. The rather complicated method of using naphthalene has not become popular with contractors for private owners. Where removals to Corporation houses are from clearance areas the tenant's effects are fumigated by hydrogen cyanide, this process being carried out by contractors in the removal vans. The bedding and soft goods from the houses are steam disinfested at the Barking Hospital. The Corporation has not so far appointed any officer specially to supervise or educate tenants in the prevention of infestation, but the sanitary inspectors do what is required in this respect whenever an infested house is discovered or whenever transfers are being made from clearance areas. Although there is not at present any routine following up of those once cleansed, the general sanitary supervision of the district is such that your officers would be readily aware of any re-infestation. 93 SECTION D. HOUSING. 1. STATISTICS. (a) General. Number of new houses erected during the year:— (1) Total 413 (2) As part of a municipal housing scheme (а) Barking 107 (б) L.C.C 79 (3) Others (including private enterprise and subsidy houses) 227 (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) 3,695 (b) Number of inspections made for the purpose 10,644 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 & 1932 981 (b) Number of inspections made for the purpose 2,177 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 60 (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 2,349 2. Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 1,608 94 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 151 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 156 (b) By local authority in default of owners 5 B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 278 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 272 (b) By local authority in default of owners 9 C.—-Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 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 E.—Proceedings under section 148, Barking Corporation Act, 1933: Number of dustbins supplied by local authority in default of owners 66 2. HOUSING CONDITIONS. (a) General Observations.—The total number of inhabited houses in the district is 19,441 (including 1,291 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 18,150 dwelling-houses, 1,826 are owned by the Council and over 7,000 have been erected in the area by the London County Council since the year 1929. 95 It is interesting to note that 2,199 houses have been purchased by occupiers with assistance under the Small Dwellings Acquisition Act. During the year 1937, no less than 323 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 THE DISTRICT. 1926—1937. 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 1937 413 (Barking) 107 227 (L.C.C.) 79 Totals 11,287 8,420 2,867 96 Of the 8,420 houses shown above as part of Municipal Housing Schemes, 1,042 were provided by the Borough of Barking and 7,378 by the London County Council. (b) Housing Act, 1936.—Overcrowding:— (a).— (i) Number of dwellings overcrowded at the end of the year 190 (ii) Number of families dwelling therein 190 (iii) Number of persons dwelling therein 1,408 units (b).—Number of new cases of overcrowding reported during the year 49 (c).— (i) Number of cases of overcrowding relieved during the year 156 (ii) Number of persons concerned in such cases 1,014½ 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 297 at the beginning of the year had been reduced to 141, to which number was added 49 new cases, making a total of 190 at the end of the year. The delay occasioned in the acquisition of suitable building land has prevented the completion of the proposed houses at Scrattons Farm, but it is hoped that a number will be ready at the end of December, 1938. Changes in overcrowding in houses owned by Local Authorities:— London County Council. Barking Corporation. January, 1936 154 101 January, 1937 80 83 January, 1938 45 61 (c) Clearance Areas—Removal of Insanitary Properties. The opening of the London Road continuation marks, I think, a year of progress in the development of Barking, and the present Annual Report, therefore, presents an opportune time for you to reflect on the clearances which have been effected since the Housing Act, 1930, came into operation. 97 In order to get the proper perspective, however, it must be recalled that Barking was a progressive housing authority before the Act of 1930. So long ago as the year 1890, the Barking Council erected their first Municipal Estate. It will also be recalled that in 1926 they succeeded in clearing an unhealthy area known as Parsons Row, consisting of 52 dwellings, so that the standard of housing in the district has been one of increasing values for many years. The war created a definite boundary between past and future ideas of working class houses, and now the minimum standard house in rehousing schemes is one which is not only fit from the point of view of the structure, but provides:— (1) A bedroom for the parents and sufficient sleeping rooms to accommodate and separate the sexes of the children as they grow to maturity. (2) Bath accommodation for every family. In addition the house should contain such conveniences and amenities as will tend to promote to the full a healthy and contented home life. Throughout their activities your officers have had in mind the dictum that there is a minimum standard of health, decency and convenience which should be expected, before additions and conversions in existing houses can be considered worth while, and in this they know they have the support of the whole of the members of the Council. We are anxious to remove the drab streets of mean and inconvenient houses and much has already been accomplished. The most general improvement is to be noticed in the arrangement or lay-out of the new housing sites, the reduced density of the dwellings (with one notable exception), and the provision of open spaces in connection with them. In referring to these open spaces, I want to stress the fact that the abuse now given, and the destruction of the shrubs, is I feel sure just a passing phase, due to the lack of education of the people in the use of these amenities. I should be sorry to see the Council return to the asphalted and concreted common yards or forecourts reminiscent of earlier communal development. What I do say is that during this phase protect the amenities provided in such a way as to reduce the damage to the minimum and take steps to educate, if necessary by punishment of the offenders. 98 There is one criticism I would like to make, and this has particular relation to the Movers Lane Estate—it is that the backs of the houses are overlooked and lack that sense of privacy which has been achieved on other estates. The feeling of being overlooked results in the erection by the tenants of many unsightly screens and sheds, which not only prevent the free movement of air and reduce the available daylight, but spoil the whole appearance of the estates. The table on pages 99—100 shows that 604 houses, occupied by 2,962 persons, have been dealt with in seven years, notwithstanding the difficulty of finding suitable building land. The removal of these houses from the oldest and most congested part of Barking provides what must be a welcome opportunity for rebuilding your town centre upon more attractive and imposing lines, with buildings in more pleasing relationship, orderly grouping and true variety. In this way, I feel sure the Corporation will merit the commendation of the burgesses. The pleasing treatment of the open spaces at the road junctions at North Street and Linton Road, etc., are indications in a small way of what can be achieved in streets previously drab and featureless. At the Public Health and Maternity Committee, held on the 14th May, 1937, I submitted the following report:— " HOUSING ACT 1936—SECTION 90—LOANS BY LOCAL AUTHORITIES FOR THE IMPROVEMENT OF HOUSING ACCOMMODATION. A recent inspection has shown that, in connection with many non-parlour houses situated in the streets set out below, the tenants have added to their accommodation by the erection of badly constructed wooden outbuildings, which are obstructive to light and in other respects insanitary. In most cases the outbuildings are so bad as to warrant demolition, but this would entail hardship as the tenants have placed in such outbuildings a sink, washing-copper and gas-cooker, and in a few instances a bath. It is suggested therefore that the Corporation should offer the financial assistance, provided in the above section, and that your officers should be instructed to confer with owners with a view to the erection of properly constructed sculleries. 99—100 CLEARANCE AREAS. Area. Date of Representation Aereage Dwelling Houses Shops Total Premises Total Persons Date of Inquiry Date of Confirmation Premises Excluded Final Date for Vacation Date of Demolition Subsequent Use of Site North Street, Holly Square and Tanner Square 10/3/31 .549 25 — 25 146 15/12/32 22/3/33 6/5/33 9/33 Rehousing St. John's Retreat 2/32 .338 14 — 14 67 15/12/32 7/2/33 — 8/11/33 30/6/33 Vacant Bifron Square 10/2/31 .713 19 11 30 124 20/12/32 22/3/33 — C.P.O. 31/3/34 Rehousing Church Path, etc. 13/9/32 .06 4 1 5 25 2/5/33 13/9/33 — C.P.O. between 30/6/35 and 26/7/35 Car Park Back Lane 13/9/32 .45 28 — 28 134 2/5/33 13/9/33 — C.P.O. between 6/35 and 11/35 Open space—additional to Parish Churchyard. Bridge Street 19/7/32 1.09 36 — 36 221 2/5/33 13/9/33 — 18/6/34 between 31/12/34 and 31/3/35 Industrial Abbey Road (No. 1) 13/11/33 .144 11 — 11 53 None held 12/4/34 — 12/7/34 31/3/35 Industrial Park Terrace, Collier Row, etc. 10/10/33 1.4 53 (including 1 shopdwelling and 1 beerhouse) 53 256 3/5/34 31/7/34 — C.P.O. 8/35 Rehousing Abbey Road (No. 2) 13/11/33 .18 18 — 18 83 24/9/34 4/1/35 — 8/4/35 7/8/35 Industrial Abbey Road (No. 3) 13/11/33 .061 4 — 4 22 24/9/31 4/1/35 — 8/4/35 12/35 Rehousing Abbey Road (No. 4) 13/11/33 .09 7 — 7 65 24/9/34 4/1/35 — 8/4/35 12/35 Industrial North Street (No. 1) 4/7/34 2.05 56 (and 5 lock-up shops, 10 shop-dwellings and 1 common lodging-house) 72 307 24/9/34 1/1/35 14, North St. 25/8/35 between 12/35 and 3/36 London Road Extension and Commercial Development. Union Street 17/5/35 .82 41 3 44 191 31/12/35 7/3/36 — C.P.O. 9/37 Rehousing Roden Yard 18/1/35 .04 2 — 2 8 5/9/35 9/35 — C.P.O. 12/35 Industrial North Street (No. 2) 14/2/36 .357 7 (and 4 shop-dwellings) 11 60 23/9/36 25/3/37 — C.P.O. 3/38 London Road Extension and Commercial Development. Eldred Road (No. 1) 16/11/34 .04 3 — 3 8 31 /12/37 7/3/36 — 14/9/86 6/38 Ribbon Development Act. Heath Street (No. 1) 14/2/36 1.69 49 (including common lodging house and synagogue) 49 302 (including 39 inmates of common Lodging House) 23/9/36 25/3/37 Synagogue to be "grey" C.P.O. not yet demolished Rehousing St. Paul's Road (No. 1) 28/2/37 .49 18 — 18 155 23/9/36 25/3/37 — C.P.O. do. Rehousing St. Paul's Road (No. 2) 28/2/37 .143 6 — 6 23 23/9/36 25/3/37 — C.P.O. do. Rehousing Grove Place 17/4/36 .3 18 — 18 70 23/9/36 25/3/37 — C.P.O. do. Town Redevelopment. Broadway and Axe Street 17/4/36 2.09 40 21 (shopdwellings) 61 216 23/9/36 25/3/37 19 & 21, Axe St. 31, Broadway to be "grey," also various garages and outbuildings C.P.O. do. Town Redevelopment. St. John's Retreat (No. 2) 4/3/37 .16 9 — 9 42 — 15/11/37 — 4/38 do. Commercial Development Eldred Road (No. 2) 4/3/37 .23 11 — 11 55 12/10/37 17/11/37 — 4/38 do. — Cowbridge Lane 8/12/37 .25 12 — 12 50 Action in respect of these areas not yet complete. North Street (No. 4) 8/12/37 .33 12 — 12 50 North Street (No. 5) 8/12/37 .16 6 — 6 22 Smiths Lane 15/6/37 .06 4 — 4 24 TOTALS 569 2,779 INDIVIDUAL UNFIT HOUSES 35 183 GRAND TOTALS 604 2,962 N.B.—The abbreviation C.P.O. stands for Compulsory Purchase Order. 101 The number of houses concerned in the present review is 187. It is estimated that the capital cost would be £9,500, and that the owners would increase rentals from 8s. l1d. to 10s. 6d. per week. There are 19 owner-occupiers. Street. Shaftesbury Road Clarkson Road Boundary Road Howard Road Eldred Road No. of Houses Concerned. 51 49 40 40 7 Number without Outbuildings. 5 7 9 10 5 187 36 This additional accommodation would increase the permitted number of each house from 5 to 7 persons." 103 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. MILK SUPPLY AND ICE-CREAM. (a) Milk Supply.—There are no cowkeepers in the district, and the rationalisation of distribution has become so extensive that in Barking we have now only one dairy, where milk is handled or treated, that is, in the accepted sense. On our register there are 87 purveyors, 20 of whom occupy premises outside the district and the remainder retail pre-packed supplies. As I have foreshadowed elsewhere, the operation of the Milk and Dairies Orders has tended to eliminate the small dairyman. The following table sets out the results of the bacteriological examination of various samples, from which it will be seen that, out of a total of 47, one was found to be unsatisfactory:— Type of Sample. Satisfactory. Unsatisfactory. Totals. "Sterilised" Milk - "Pasteurised" Milk 24 - 24 Raw Milk 20 - 20 "Homogenised" Milk 2 1 3 Totals 46 1 47 There were during the year 42 samples of milk submitted to biological examination for the presence of tubercle. Two of the 42 samples were found to be infected and the necessary action was taken. The two samples of milk found to contain tubercular germs were taken from country farm supplies prior to pasteurisation. It is satisfactory to know that over 99 per cent. of the milk supplied in Barking is pasteurised. 104 The following table shows the number of licences granted during the year for the sale of graded milks under the Milk (Special Designations) Order, 1936:— Tuberculin Tested 11 Pasteurised 16 A licence was granted to one local firm for the bottling of Tuberculin Tested Milk, and one for the treatment and sale of milk as "pasteurised." (b) Ice-Cream—Barking Corporation Act, 1933—Section 160.—There are 114 vendors registered, in accordance with this Act, of which 35 are manufacturers with premises in Barking. Fourteen vendors had premises outside the district. There was an increase of 15 in the number of registered premises, but the increase was confined to shops from which ice-cream is sold but not manufactured. Many of the shops are supplied from one source with pre-packed containers and sampling is therefore directed to control the main supplies, rather than the individual vendors. The general standard of cleanliness has been good. Forty samples were submitted for bacteriological examination, five 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 ten years ended December 31st, 1937. Year 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Notifications Received 126 72 64 39 57 34 205 236 195 179 Cattle 40 64 80 12 10 41 350 447 340 365 Pigs 409 137 93 200 84 18 502 1,131 474 457 Sheep 815 426 332 173 270 241 1,038 1,346 748* 500† Calves 71 10 11 1 9 1 140 157 77 38 Totals 1,335 637 516 386 373 301 2,030 3,081 1,639 1,360 * Includes 404 lambs. † Includes 199 lambs. 105 The following additional table gives information as to carcases inspected and condemned during the year 1937:— Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed 195 170 38 500 457 Number Inspected 195 170 38 500 457 All diseases except Tuberculosis:— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 1 40 — 17 3 Percentage of Number inspected affected with disease other than Tuberculosis .51 23.5 — 3.4 .65 Tuberculosis only:— Whole carcases condemned — — — — 1 Carcases of which some part or organ was condemned 7 123 — — 8 Percentage of the number inspected affected with Tuberculosis 3.0 72.3 — — 2 This table is given because it has been asked for in Section E (b) of Ministry of Health Circular 1650. I should like to add to this table by saying that none of this food was exposed for sale. It is necessary for the butchers to work in the closest co-operation with the Sanitary Inspectors, and this we find they readily do. (b) Supervision of Food Preparing Premises.—The number of premises in the district at the end of the year at which the following foods are prepared were:— Sausages 30 Potted Meat and Brawn 5 Roast and/or Boiled Ham 7 Pressed, Pickled, Cooked, etc., Beef and Tongue 43 Roast Pork 5 Bacon l Boiled Crabs and Lobsters 2 Pickled Fish 10 Pickled Onions l Smoked Fish 9 106 A difficulty in registration is encountered because Section 159 of the Barking Corporation Act, 1933, does not apply to any premises occupied as a factory or workshop. Most small shops come within this description and the restriction imposed is very wide in its effect. Many representations have been made to remove this bar and we are hopeful that the new Act relating to food will do so. The number of inspections made during the year was 581. It is found that where uncleanly conditions exist these are most often remedied after verbal caution, but in one instance a butcher was summoned on two charges, and fined the maximum penalty with costs. (c) Bakehouses.—The same process of rationalisation which has been taking place in the milk industry has been operating also in the bread industry. The large multiple bakeries are gradually eliminating the small baker. There remain eleven bakehouses in the district. One bakehouse was demolished as the result of action by the department, another was entirely remodelled and in respect of two others the occupiers have been warned that statutory action will take place unless some very necessary improvements are effected. It is unfortunate that the present law places the duty of making the bakehouses fit, upon the occupier. The small man usually lives a hand to mouth existence and cannot meet the cost of the structural and equipment alterations required. (d) Food Byelaws.—These byelaws were made under the Barking Corporation Act, 1933, and when drafted provided for most of our requirements. The advent of a new market ground has shown us the inadequacy of our byelaws in relation to:— (1) Ablution facilities. (2) Sanitary conveniences. (3) Refuse containers. (4) Paving and drainage of site. (5) Storage of food. If such markets are to become a feature of the district it is desirable that our existing byelaws should be amended to deal with the above-mentioned matters. 107 There was one prosecution under the existing byelaws. (e) Unsound Food.—The following list gives particulars of unsound food destroyed during the year:— 14 lbs. Sugar. 6 tins Damsons. 6 lbs. Corned beef. 178 pkts. Crystallised fruit. 17 Cabbages. 8§ lbs. Pressed beef and tongue. 6 lbs. (tins) Preserved ox tongue. 2 lbs. Pressed veal. ½ lb. tin Salmon. 1¼ lbs. Veal brawn. 41 jars Lemon curd (1 lb. each). 5 lbs. Raisins. 48 jars Orange curd (1 lb. each). 76 Eggs. 22 tins Peeled plum tomatoes (2½ lbs. each). 7 pkts. Biscuits. 83 tins Pineapple. 2 jars Bramble jam. 12 tins Tomatoes. 1 tin Pilchards. 2 tins Pears. 1 tin Mixed fruits. 17 tins Raspberries. 3 tins Pineapple chunks. 3 tins Skimmed milk. 11 tins Grapefruit. 2 tins Peas. 1 tin Condensed milk. 4 jars Raspberry jam (2 lb. each). 20 lbs. Eels. 6 jars Mixed pickles. 1 (tin) Ham (weight 13½ lbs.). 7 jars Gherkins. 1 carton Cream (4 ozs.). 5 jars Onions. 58 Rabbits. A retail butcher was summoned on two informations with respect to cleanliness of premises and prevention of contamination of meat. A fine of one pound and one guinea costs were imposed on each information. A retail grocer was cautioned with regard to the sale of unsound brawn. 3. FOOD POISONING. There were three cases of food poisoning notified. Only in one case was bacterial infection, viz., B. Aertryke, found. It would appear that there is still some difficulty in coming to a decision as to whether a certain clinical case is, or is not, food poisoning. Some people have what is termed an idiosyncrasy, by virtue of which certain foods, however pure and wholesome, disagree with them. In certain other cases, ordinary normal food disagrees with the individual not by reason of the food itself, but due to some disability in the individual. Neither of these cases constitute food poisoning. 108 In April there was a minor outbreak of illness among children taking meals at the Faircross Special School and at other school centres. The bacteriological examinations carried out failed to discover any organisms of pathogenic significance. The meal which was the cause of the illness had been prepared and cooked at the Municipal Kitchen. 4. ADULTERATION, ETC. The Food and Drugs (Adulteration) Act, 1928, and kindred Acts and Regulations are administered in this district by the Essex County Council. I am indebted to Mr. H. C. Card, Chief Food and Drugs Officer for the Metropolitan Area of the Essex County Council, for the particulars of samples purchased and submitted for analysis during the year. These samples are submitted for chemical examination to Dr. Rernard Dyer, the County Analyst, Great Tower Street, London. The following samples were examined during the year:— Milk 50 Rutter 26 Other 121 Total 197 In one case proceedings were instituted during the period covered. For your information I give particulars of samples taken by the Essex County Council in this district since 1931:— Year. 1931 1932 1933 1934 1935 1936 1937 Number of Samples. 204 223 180 178 157 135 197 No. of samples per 1,000 population. 4.0 3.7 2.65 2.5 2.2 1.8 2.5 109 The yearly figure since 1932 has fallen to a lower standard than we regard as adequate. 5. 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. 6. NUTRITION. No particular steps have been taken this year to increase the knowledge of the public, as such, on the subject of nutrition, but the domestic science courses that are undertaken by the schools in the town are a very happy feature of your educational system, and must bring forth full return in the near future, because, not only are the children themselves educated in these important matters, but they spread knowledge in their own homes. Without suggesting the work we have done in the pathological laboratory can in any way be called a special investigation, the work we have done on the iron content of the blood, particularly in pregnant women, supports the conclusion of other people, that in many instances there is considerable lack of iron. I am apprehensive that in most cases the diet is at fault, but I am persuaded that this is not the whole of the story, and that although I have no evidence on the point, there must be in some cases an unnecessary and excessive excretion of iron, thus draining the body of this necessary mineral. I am anxious that more fresh vegetables and fresh fruit, particularly vegetables of the salad variety, are put on the market at prices which would tempt people to make them a regular and substantial part of their diet. The mere consumption of food, however, is not sufficient to achieve nutrition. An adequate amount of rest and sleep is necessary for these foods to be built up into the body proper. Anxiety, too, militates against proper nutrition, and in this connection it has been brought to my notice that irregular employment, and its consequent periods of unemployment, is not consistent with healthy nutrition. 111 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 112 to 115. These tables show that there was still a considerable falling off in the number of cases of notifiable diseases in Barking. The cases of scarlet fever notified declined from 345 to 245 and the number of cases of diphtheria from 162 to 155. It is to be mentioned here that the type of diphtheria notified was not of the virulent form of diphtheria, known as the gravis type. There were five deaths from diphtheria during the year as against twenty-two for 1934. Although, of course, I am very glad to be able to say there have been fewer cases of scarlet fever and diphtheria, I would like to say that in my opinion this is only the ebb and flow of disease. We do not look upon it as highly satisfactory, and we shall not look upon a reverse swing of the pendulum with too much concern. What we do hope is that these periods of remission when the incidence of infectious diseases is light will in time become lengthened, and the alternative periods when it is heavy will be decreased in length. During the year a certain amount of research work was carried out at the Pathological Laboratory in regard to streptococcal infections, and an account of this work is given in the Report of the Scientist upon pages 67 to 70. It is curious to note that during the year two cases of malaria fever were notified. In both cases, however, the fever was contracted abroad. During the year I have to report the commencement of a widespread epidemic of dysentery, but fortunately in Barking there were but two cases notified. 112 2. NOTIFICATION TABLES. The following table shows the number of notifications of infectious diseases (other than Tuberculosis) received during 1937 :— TABLE I. Disease. Males. Females. Total. Total cases removed to Hospital. Deaths. Smallpox — — — — — Scarlet Fever 124 121 245 230 — Diphtheria 69 86 155 155 5 Enteric Fever (including Para-typhoid Fever) 8 9 17 17 2 Puerperal Fever — 2 2 2 — Puerperal Pyrexia — 10 10 6 — Pneumonia: Acute Influenzal 57 50 24 65 — Acute Primary 76 7 Following Measles 7 — Erysipelas 16 14 30 22 1 Ophthalmia Neonatorum 2 3 5 1 — Acute Anterior Poliomyelitis 1 4 5 4 — Pemphigus Neonatorum 2 — 2 1 — Malaria 2 — 2 — — Dysentery 2 — 2 2 — Food Poisoning 2 1 3 1 Totals 285 300 585 506 15 113—114 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 3 7 22 21 18 122 37 5 6 4 — — 245 16 84 28 11 6 53 9 38 Diphtheria 4 6 5 4 11 78 35 3 8 — 1 — 155 8 27 22 14 4 47 3 30 Enteric Fever — — — — — 5 2 3 3 3 1 — 17 1 6 3 2 1 2 — 2 Puerperal Fever — — — — — — — — 2 — — — 2 — — — — — 2 — — Puerperal Pyrexia — — — — — — — — 8 2 — — 10 1 2 1 1 1 — 2 2 Pneumonia (ac. primary, ac. influenzal & following measles) 7 9 3 5 3 23 3 5 11 15 18 5 107 12 11 20 11 9 13 15 16 Erysipelas 1 1 — — — 2 1 2 2 7 8 6 30 2 8 6 2 1 3 6 2 Ophthalmia Neonatorum 5 — — — — — — — — — — — 5 — 2 1 1 — — — 1 Acute Anterior Poliomyelitis — — — — — 1 3 1 — — — — 5 1 2 2 — — — — — Pemphigus Neonatorum 2 — — — — — — — — — — — 2 — 1 — — — — — 1 Malaria — — — — — — — — 1 1 — — 2 — — 2 — — — — — Dysentery — — — — 2 — — — — — — — 2 — — 1 1 — — — — Food Poisoning — — — — 1 1 1 — — — — — 3 — 1 — — — 2 — — Totals 22 23 30 30 35 232 82 19 41 32 28 11 585 41 144 86 43 22 122 35 92 115 Monthly summary of notifications of Scarlet Fever and Diphtheria received during 1937 :- Scarlet Fever. Diphtheria. Total. January 17 12 29 February 18 8 26 March 33 13 46 April 26 10 36 May 21 7 28 June 31 5 36 July 25 14 39 August 7 12 19 September 27 19 46 October 15 21 36 November 14 18 32 December 11 16 27 Totals 245 155 400 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 — Whooping Cough 1 Summer Diarrhoea 9 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.—In the past I have advocated the setting up of a rheumatic clinic, and the possibility of a form of in-patient treatment for this condition. This I still hope will come to pass, because rheumatic fever, as I have stated previously, is more prevalent in Barking than it is in other parts of the Country, and this is true for all parts of the Thames Valley. 116 What I envision is that you will set up something to take the place of the rheumatic clinics held elsewhere. To my mind you could very well entertain the possibility of making suitable financial provision for the appointment of a specialist. It would appear to me that this specialist could very well be working in Barking for a minimum period of a year, studying the problems peculiar to the town by taking part in the ordinary activities of the Department, and in other ways informing himself of all the circumstances of the problem. It would only be at the end of this year that I should be prepared to come forward with proposals and recommendations, but I would like to say that if this service is initiated you may be facing the financial problem of providing hospital accommodation for these oases of rheumatism and sub-acute rheumatism in children, who do not do well at special schools and for whom there is not adequate hospital provision in the ordinary hospitals of the Country. (c) Influenza.—I regret to report that during 1937 there were 17 deaths from influenza. This contrasts with 7 deaths in 1936, 9 deaths in 1935, 12 deaths in 1934, and 21 deaths in 1933. The time has not yet arrived when influenza can be treated specifically, and I must repeat, as before, that the general public regard the disease far too lightly, and that advice and treatment should be sought always at an early stage. (d) Scabies.—Fifty-five cases of scabies were brought to the notice of the department during the year. Disinfection of bedding and blankets was carried out where desired. (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. 117 4. BARKING HOSPITAL. (a) Admissions.—The following is the table of admissions, etc., in respect of infectious diseases during 1937:— Disease. In Hospital January 1st, " 1937. Admitted during the year. Died. Discharged. In Hospital Dee. 31st, 1937. Scarlet Fever 35 227 — 248 14 Diphtheria (including Membranous Croup) 23 147 5 140 25 Enteric Fever — 16 2 13 1 Puerperal Fever — 2 — 2 — Puerperal Pyrexia — 4 — 4 — Pneumonia 4 32 4 25 7 Erysipelas 2 18 1 17 2 Ophthalmia Neonatorum 1 2 — 2 — Others 5 136 1 121 19 Acute Anterior Poliomyelitis 1 2 — 3 — Pemphigus Neonatorum — 1 — 1 — Food Poisoning — 1 — 1 — (b) Number of Bed Days.—The total number of bed days in the infectious diseases hospital during 1937 was 20,105—that is to say, an average of 55 patients were in hospital throughout the 365 days in the year. 118 5. ARTIFICIAL IMMUNISATION. Last year I mentioned that steps were being taken to provide facilities for immunisation against whooping cough, and during the year such facilities were offered to the public. This service, however, has met with little support from the public, and in all but twenty-four cases have been treated, and of these only eighteen completed the course of treatment. It will be seen, therefore, that the numbers treated are far too small for any considered opinion to be given upon the efficiency of this treatment. Efforts were also made, during the year, to commence a scheme whereby measles serum would be available to the public, especially for certain cases in your hospital. Unfortunately, last year was not a " measles year " and it was not found possible to obtain blood from convalescing cases for the necessary serum to be prepared. We are, however, making further endeavours in this direction. The following table shows what has been done under the immunisation scheme Diphtheria Scarlet Fever. Whooping Cough. Total number of cases treated 152 44 24 Number of first attendances for treatment 88 34 24 „ subsequent attendances for treatment 283 161 41 ,, final " Schick " tests 114 — — „ final" Dick " tests — 29 — „ final attendances for treatment — — 18 6. CANCER. There have been 86 deaths from cancer, 48 below the age of 65 years and 38 above the age of 65, 119 The following table shows the occupations of the 86 people who died from cancer during the year 1937 *Male. Female. Brewery Stoker 1 Wives 30 Cafe Proprietor 1 Spinsters 1 Car Examiner 1 Widows 8 Carpenter 1 Children 2 Chemical Workers 2 Fitters 3 Gas-work Workers 5 House Decorator 1 Labourers 10 Master Cooper 1 Night Watchman 1 Painter 1 Park-keeper 1 Plumber 1 Police Constables 2 Printer's Assistant 1 Private-hire Car Owner 1 Railway Inspector 1 Road Foreman 1 Rubber Worker 1 Schoolmasters 2 Stone Breaker 1 Stevedore 1 Tackleman 1 Telephone Operator 1 Tram Driver 1 Warehouseman 1 45 41 * Where the person had retired, his occupation prior to his retirement is given. 120 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. Abdomen - - - - - - - - - 1 - - 1 1 1 2 Bile Duct - - - - - - - - 1 - - - - - 1 - Bladder - - - - - - - - - - - - 2 - 2 - Bowel - - - - - 1 - - - - - - - - - 1 Breast - - - - - - - - - 2 - 2 1 1 1 5 Bronchus - - - - - - - - 1 - 1 - 1 - 3 - Caecum - - - - - - - - - - - - - 2 - 2 Chest - - - - - 1 - - - - - - - - - 1 Cervix - - - - - - - - - 1 - - - 1 - 2 Colon - - - - - - - - - - - 1 3 1 3 2 Disseminated - - - - - - - - 1 - - 2 - - 1 2 Kidney - - - - - - - - - - 1 - - - 1 - Liver - - - - - - - - - - 1 - 3 - 4 - Lungs - - - - - - - - 1 - 3 4 2 1 6 5 Oesophagus - - - - - - - - - - - 1 2 - 2 1 Ovary - - - - - - - - - - - 1 - - - 1 Pancreas - - - - - - - - - - 1 - 1 - 2 - Peritoneum - - - - - - - - - 1 - 1 - 1 - 3 Pleura - - - - - - - - - - - 1 - - - 1 Prostate - - - - - - - - - - 1 - 5 - 6 - Rectum - - - - - - - - 1 - 2 1 3 1 6 2 Stomach - - - - - - - - 1 - 2 - 3 2 6 6 Thyroid Gland - - - - - - - - - - - 1 - - - 1 Uterus - — - - - - - - - 1 - 3 - - - 4 Totals - - - - - 2 - - 6 6 12 22 27 11 45 41 7. PREVENTION OF BLINDNESS. Blindness is being prevented in Barking; it is being prevented by the co-operation of the whole of the services. During the year Circular 1621 was received from the Ministry of Health, dealing with the Prevention of Blindness. The recommendations and observations of this Circular were carefully considered by you, in conjunction with the new powers given to you by the Public Health Act, 1936—Scction 176, which gives added powers in connection with the arrangements for the prevention of blindness. One of the items dealt with by the Circular was the treatment of ophthalmia neonatorum, and in this connection all local general medical practitioners were reminded that you were willing to take babies who were suffering from ophthalmia neonatorum, together with their mothers, into the Barking Hospital, where they would be under the care of your Consultant Ophthalmic Surgeon. 121 It is to be mentioned too that 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 does arise while your Health Visitors follow up each case and encourage parents to carry out any necessary treatment. It is years ago since we had a case where vision has been impaired by reason of ophthalmia neonatorum. The Circular also points out the need for hospital treatment in cases where there is a possibility of serious eye trouble accompanying or resulting from certain infectious diseases, especially measles, and here again you re-affirmed your policy to the local medical practitioners by advising them that you were willing to take into your hospital eases of non-notifiable infectious diseases, where complications were present, especially complications involving the eyes. The following table shows that the number of cases of Ophthalmia Neonatorum during 1937 was 5, compared with 10 in 1936. Four 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 5 4 1 5 — — — 8. TUBERCULOSIS. Particulars of new cases of Tuberculosis and of all deaths from the disease in the area during 1937 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 — 2 2 — — — 1 — 5 to 15 years — 1 8 8 — — 1 1 15 to 25 years 12 18 1 3 5 2 — — 25 to 35 years 16 10 3 2 5 5 1 — 35 to 45 years 13 6 — 1 8 4 1 — 45 to 55 years 8 3 1 2 5 — — 55 to 65 years 4 2 — — 1 1 — — 65 years and upwards — — — — — 1 — 1 Totals 53 _ 42 15 11 24 13 4 2 122 During the year, 121 notifications were received of all forms of Tuberculosis— pulmonary 95 and non-pulmonary 26 and there were 6 deaths of un-notified cases (3 pulmonary and 3 non-pulmonary), making a total of 127 new cases during the year. Information has been received of the removal into the district of 36 tuberculous persons, included in number of notifications received. This compares with 50 received during 1936 and 39 for 1935. Once again I want to call attention to the large number of inward transfers. This is due in large part to the expansion and development of the district. The following are particulars of cases notified on Forms I and II during the year :— Form I. Form II. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Male. Female. Male. Female. 37 39 5 7 39 21 6 5 Forty-three deaths occurred from Tuberculosis (all forms) thirty-seven of these being pulmonary cases. The number of deaths in institutions was thirty. The death rate for Tuberculosis (all forms) during 1937 was 0.56 per 1,000 population, compared with 0.58 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. We did not avail ourselves of its powers at any time during the year. BOROUGH OF BARKING THE ANNUAL REPORT OF THE School Medical Officer For the Year 1937 C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. 126 TABLE OF CONTENTS. Pages. ADENOIDS 135,139,163 AUDIOMETER 135,158 BLIND CHILDREN 152-153 BROOKFIELD ORTHOPÆDIC HOSPITAL 152,164 CENTRAL CLINIC 137,138,139 CERTIFIED SCHOOLS 153 CLEANLINESS INSPECTIONS 133-134 CLEANSING 134,158 CLINICS AND ATTENDANCES AT 137,138,139,140 CLINIC SERVICES, LIST OF 159-162 COD LIVER OIL AND MALT, ETC 138,151,158 COMMUNICABLE DISEASES 141 CO-OPERATION OF PARENTS, TEACHERS, ETC. 131,151-152,170 CO-ORDINATION OF SERVICES 131,137,152, 155,171 DEAF CHILDREN 152-153 DENTAL INSPECTION AND TREATMENT 135,140,158,169-170 DENTAL OFFICER, SENIOR, REPORT OF 169-170 DRYING FACILITIES 131,148-149 EAR DISEASE 135,140 EAR, NOSE AND THROAT DEPARTMENT 140,141 EMPLOYMENT, JUVENILE 157 EMPLOYMENT OF SCHOOL-CHILDREN, PART-TIME 157 EPILEPTIC CHILDREN 152-153 ESSEX VOLUNTARY ASSOCIATION FOR MENTAL WELFARE 154,155 EXCLUSION FROM SCHOOL 141 EYE DISEASE 134,139,173 FAIRCROSS CLINIC 140 FAIRCROSS SPECIAL SCHOOL 153-154,156,163,171-172 FOLLOWING-UP WORK 136-137,138,140,150 HEALTH EDUCATION 156 HEARING 135,140,158 HEART DISEASE 136,140 HIGHER EDUCATION 155-156 IMMUNISATION AGAINST DIPHTHERIA, SCARLET FEVER AND WHOOPING COUGH 138,141,163 INFECTIOUS DISEASES 140,141 INTRODUCTION 129 IONISATION 140 MALNUTRITION 133,138 MEALS 138,142,148-150,158 MEDICAL INSPECTION, ACCOMMODATION FOR 132 MEDICAL INSPECTION AND FINDINGS OF 132-136,150,154,155-156,158 MENTALLY DEFECTIVE CHILDREN 152-154 MILK IN SCHOOL 138,150-151,158 MINOR AILMENTS 134,138-139,163 MYOPIA 172 -173 127 Pages. NATIONAL SOCIETY FOR THE PREVENTION OF CRUELTY TO CHILDREN 152 NOSE AND THROAT DEFECTS 135,139 NURSERY CLASSES 155,156 NUTRITION AND NUTRITION SURVEYS 33,150 OCCUPATION CENTRE 154-155 OPEN-AIR EDUCATION 141-142 OPEN-AIR CLASSROOMS 141-142 OPEN-AIR SCHOOL 152-154 OPHTHALMIA NEONATORUM 171 OPHTHALMIC SERVICE 134,139,163,171-174 OPHTHALMIC SURGEON, REPORT OF 171-174 ORTHOPÆDIC AND POSTURAL DEFECTS 135-136,140 ORTHOPÆDIC CLINIC 138,140,163,165-166 ORTHOPÆDIC SURGEON, REPORT OF 164-168 ORTHOPTIC TREATMENT 163,173-174 PARENTS' PAYMENTS 156 PHYSICAL TRAINING, AND REPORT OF ORGANISERS 142-147 PLAYGROUND CLASSES 141-142 PORTERS AVENUE CLINIC 138 POSTURAL DEFECTS 135-136,140 RESIDENTIAL SCHOOLS 140,153,155 RHEUMATISM 136 RINGWORM 134,139,163 SCHOOL BATHS 132 SCHOOL CAMPS 142,158 SCHOOL HYGIENE 131 SCHOOL JOURNEYS 142 SCHOOL LAVATORIES 131 SECONDARY SCHOOLS 155-156,169 SERVICES PROVIDED, LIST OF 158-163 SKIN DISEASES 134,138,139 SPECIAL INQUIRIES 156 SPECIAL SCHOOLS 152-155,163 SPECTACLES 139,163 SPEECH DEFECTS, AND TRAINING OF 140,155 SQUINT 163,173-174 STAFF 128,131 STATISTICAL TABLES, BOARD OF EDUCATION Public Elementary Schools 175-187 Secondary and Technical Schools 188-196 TEACHERS, MEDICAL EXAMINATIONS OF 157 THROAT DEFECTS 135,139,163 TONSILS AND ADENOIDS 135,139,163 TREATMENT, ARRANGEMENTS FOR 137-141 TREATMENT CENTRES, LIST OF 159-162 TUBERCULOSIS 136,140 ULTRA-VIOLET LIGHT TREATMENT 163,165-166 UNCLEANLINESS 133-134,138 VISUAL DEFECTS 134,139 VITAMIN DEFICIENCY DISEASE 171 WOODWARD CLINIC 137,138,139 128 STAFF, 1937. School Medical Officer: C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. Deputy School Medical Officer : PATRICK J. O'CONNELL, M.D., B.Hy., B.S., D.P.H. (Resigned 31st March, 1937.) J. MERVYN THOMAS, M.D., B.Sc., D.M.R.E., L.R.C.P., D.P.H. (Appointed 1st April, 1937.) Assistant School Medical Officers : WILLIAM HOGG, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Commenced 15th July, 1937.) CATHERINE B. McARTHUR, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. (Resigned 30th November, 1937.) MARGARET A. GLASS, B.Sc., M.B., Ch.B., D.P.H. (Commenced 23rd August, 1937.) Ophthalmic Surgeon : WILLIAM ADAMSON GRAY, M.B., Ch.B., F.R.C.S., Ph.D. Orthopœdic Surgeon : B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Dental Surgeons : W. H. FOY, L.D.S., R.C.S. H. S. SARSON, H.D.D., L.D.S., D.P.D. (Resigned 31st October, 1937.) M. COHN, L.D.S., R.C.S. Nursing Staff: *Miss P. M. FAWCETT (Senior Nurse) (g, h and i). *Miss M. BAERLOCHER (a, h and k). Miss P. M. BARNS (Masseuse) (n). (Commenced 1st May, 1937.) *Miss C. COURT (g, h and i). 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). (Resigned 19th June, 1937.) *Miss M. McALISTER (g, h, i and j). (Commenced 7th June, 1937.) *Miss J. McGILVRAY (g, h and i). (Commenced 12th July, 1937.) Miss A. K. ROE (Masseuse) (n). Miss L. F. SWAIN (ft and i). *Miss M. F. WHALLEY (g, h and i). (Resigned 6th April, 1937.) *Miss C. M. WILLIAMS (g, ft and i). (Commenced 7th June, 1937.) Clerical Staff: Chief Clerk : F. READ. C. G. EAGLESFIELD (Senior Assistant) (r). Miss A. LIGGINS. H. C. DAVIS. Miss D. FOULSHAM. F. YATES (O). Miss I. CAST. G. H. RUFF. Miss G. COOPER. K. F. CALWAY (p). (Commenced 1st July, 1937.) Miss I. MATHIESON. E. A. ELLIS (m). (Resigned 20th February, 1937.) D. SCOTT. Miss J. WILKINSON. L. J. DEXTER. (Commenced 8th March, 1937.) Miss H. NUNN. Miss G. MacLEAN . Miss H. KING. (Commenced 30th August, 1937.) (a) Sanitary Inspector's Certificate of Sanitary Inspectors' Examination Board. (g) Health Visitor's Certificate of Royal Sanitary Institute. (h) Certificate of Central Midwives Board. (i) General Hospital Training. (j) General Fever Training. (k) Health Visitor's Diploma of Board of Education. (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) Final Examination of the National Association of Local Government Officers. (p) Inter. Examination of the National Association of Local Government Officers. (q) Registered Sick Children's Nurse. (r) Inter. Examination of the Incorporated Secretaries Association. (*) Combined appointment—Health Visitor and School Nurse. 129 Borough of Barkig PUBLIC HEALTH DEPARTMENT, BARKING, ESSEX. May, 1938. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Ladies and Gentlemen, Herewith I beg to submit my report for the year ended 31st December, 1937. This report has been drawn up to meet the requirements outlined in the circular of the Board of Education issued in January, 1934. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, School Medical Officer. 131 ANNUAL REPORT of the SCHOOL MEDICAL OFFICER For the Year 1937. (1) STAFF. Full particulars of the staff engaged in connection with your School Medical Service are given on page 128. There have been some changes in the staff during the year and the chief of these was the resignation of Dr. P. J. O'Connell, Deputy School Medical Officer. Dr. J. M. Thomas, who was previously an Assistant School Medical Officer, was appointed in Dr. O'Connell's place. (2) CO-ORDINATION. I am happy to say the same spirit of co-operation between the head teachers of your schools and your medical officers has been maintained throughout the year under review, and in this respect a similar technique to that of previous years has been carried out. (3) SCHOOL HYGIENE. The general sanitary conditions of the elementary schools in the area, such as sanitary arrangements, heating, lighting and ventilation, etc., remain as in previous years. The chief items to which I have drawn your attention are:— 1. That there should be adequate provision for drying wet clothes and boots ; 2. That in your older schools there should be adequate lavatory accommodation on each floor ; 132 3. That at all your schools there should be adequate provision for the children to have baths, and 4. That there should be adequate accommodation for medical inspection. These matters have been dealt with in several previous Reports, and in particular I call your attention to my Report of 1935. (4) MEDICAL INSPECTION. The age-groups inspected are those laid down by the Board of Education. All routine medical inspections are carried out at the schools, the parents of the children to be examined being notified beforehand and invited to be present. Children outside the routine age groups who are regarded by head teachers as requiring special attention are presented for inspection at the time routine inspections are taking place, although many of the special inspections are conducted at your school clinics. The following table shows the number of medical examinations conducted at school at routine and special inspections during 1937 classified according to the schools, the number of inspections held in each school, and the number of parents or guardians present:— School. No. of Inspection Sessions. Numbers Inspected. No. of Parents present (Routine and Special Exams.) Routines and Specials. Re-Exams. Bifrons 18 512 198 135 Cambell 56 986 747 494 Church of England 14 235 209 96 Dawson 34 564 428 378 Dorothy Barley 37 571 650 447 Eastbury 38 547 430 270 Erkenwald 26 595 420 230 Faircross Speech Classes 1 — 5 — Gascoigne 31 587 454 284 Manor 16 212 247 179 Monteagle 31 424 273 243 Northbury 26 398 371 213 Park Modern 10 210 93 96 Ripple 24 408 507 328 Roding 49 710 660 503 St. Ethelburga's 8 118 83 48 St. Joseph's 9 88 129 81 Westbury 26 373 487 267 Totals 454 7,538 6,391 4,292 133 Of the 7,538 examinations at ordinary elementary schools, 4,812 were routine examinations of children in the specified age groups. In addition, there were 562 routine examinations of children of ages outside the three specified age groups, and 2,164 examinations of children specially referred to your Medical Officers. (5) FINDINGS OF MEDICAL INSPECTION. Table II (A) on pages 176 and 177gives in detail a return of defects found during the course of routine and special inspections at ordinary elementary schools and at the clinics. The following table is similar to Table I (C) of the Returns to the Board of Education (given on page 175 of this report), except that it shows the percentage of children found to require treatment:— Group. Number of Children. Percentage of children found to require Treatment. Inspected. Found to require Treatment. PRESCRIBED GROUPS : Entrants 1,751 293 16.7 Second age group 1,653 315 19.0 Third age group 1,408 195 18.8 Totals (prescribed groups) 4,812 803 16.6 OTHER ROUTINE INSPECTIONS 562 126 22.4 (a) Malnutrition.—The Board of Education's classification of nutrition into the groups " excellent," "normal," " slightly sub-normal " and " bad," introduced in 1935, has been continued. The personal factor amongst school medical officers must be allowed for in interpreting the table dealing with nutrition, but reference to the table which is on page 178 will show that malnutrition in its worst sense is infrequent amongst the children attending the elementary schools of your town. (b) Uncleanliness.—Systematic examination of children at routine cleanliness inspection was carried out by school nurses throughout the year. 134 The following tabic shows the results of cleanliness inspections for the past two years:— 1936 1937 Number of examinations of children in the schools by School Nurses 39,645 39,978 Number of individual children found unclean 1,174 1,327 Number of uncleanliness findings 2,173 2,289 During the year, 10 children were cleansed by the Local Authority, and in eight cases legal proceedings were taken under the Education Act, 1921. (c) Minor Ailments and Diseases of the Skin.—Children suffering from minor ailments are referred by school medical officers, school nurses, teachers and in some cases by private medical practitioners to the minor ailments clinics. The following is the number of cases of skin diseases referred for treatment during the year:— Ringworm (Scalp) 21 Ringworm (Body) 26 Scabies 126 Impetigo 309 Other Skin Diseases: Non-tuberculous 475 Tuberculous 1 Total 958 (d) Visual Defects and External Eye Disease.—Details of the findings at routine and special inspections will be found on pages 176 and 189 of this Report, and on pages 171 to 174,184 and 193 will also be found a record of the work carried out by the Consulting Ophthalmic Surgeon. Readers of this Report will have noted that there were 5,374 children examined by routine inspection. Of these 4,852 were found to have normal vision and 384 were referred for treatment for defective vision. Of the total number of children examined by routine inspection 98.7 per cent, were free from any external eye disease and in the remaining 1.3 per cent, the majority were minor and incidental inflammations, not likely to lead to any residual disability. 135 (e) Nose and Throat Defects.—The number of nose and throat defects referred for treatment at medical inspection at schools and clinics shows a small increase over the figures for 1936. The figures for 1937 are as follows:— Chronic Tonsillitis only 527 Adenoids only 11 Chronic Tonsillitis and Adenoids 68 Other Nose and Throat conditions 319 Total 925 (f) Ear Disease and Defective Hearing.—Ear diseases of both minor and major types still give rise to a certain amount of concern to your medical officers who are engaged upon school medical work. 434 cases of ear disease were referred for treatment during 1937, compared with 315 cases during 1936. With regard to defective hearing, of the children examined at routine medical inspection 98.2 per cent. were found to have normal hearing and to be free from any ear defects. In future it will be possible to state accurately the degree of defective hearing in all your school children. This will be possible by means of an Audiometer which is being introduced. An Audiometer is an electrical instrument for ascertaining the exact pitch and intensity of sound that a person can hear. By such means the alleviation of deafness can be more accurately attained and the possible elimination of some causes of retarded mentality separated from definite mental defectiveness. (g) Dental Defects.—Details of the findings of school dental inspections and the work of the dental clinics will be found on pages 186 to 187 and 195 to 196, and the report of your Senior Dental Officer, Mr. W. H. Foy, will be found on pages 169 and 170. (h) Orthopædic and Postural Defects.—Of all the children examined at routine medical inspection 96.7 per cent. were found to be free from orthopædic and postural defects, and the 175 children who were found to be not quite normal were suffering for the most part from postural defects. Of this group of 175 children, 78 only required to be kept under observation. 136 Details of the work carried out at your Orthopaedic Clinic will be found on pages 165 and 166, and on pages 164, 167 and 168 will be found the report of the Consulting Orthopaedic Surgeon, Mr. B. Whitchurch Howell. (i) Heart Disease and Rheumatism.—Out of 5,374 children examined at routine medical inspection, 183 were found to be suffering from some defect associated with these diseases. (j) Tuberculosis.—Nine cases of Tuberculosis amongst children of school-age were notified to the Medical Officer of Health during the year. Of these, one was pulmonary, and eight were non-pulmonary. In addition, one notified case of Tuberculosis amongst school-children was transferred to this area. This case was non-pulmonary. The following table shows the position with regard to the notification of tuberculosis amongst school-children during 1937, and also the number removed from the "register" during this period:— Notified during 1937 (including transfers) Pulmonary 1 Non-Pulmonary 9 Total 10 Removed from Register during 1937 Pulmonary 5 Non-Pulmonary 14 Total 19 (k) Other Defects and Diseases.—A few cases of other defects and diseases, not included in the above, were also seen at school medical inspection. (6) FOLLOWING-UP. A summary of the following-up work by your School Nurses is given herewith:— Number of visits to schools re medical inspection 586 Total number of visits to schools 806 Number of home visits in connection with:— 1933 1934 1935 1936 1937 (a) Routine medical inspections 6,610 6,786 5,605 3,731 2,951 137 (b) Cleanliness inspections 284 827 454 326 315 (c) Infectious disease 230 1,022 475 955 644 (d) Non-attendance for treatment at Minor Ailments Clinics, etc. 35 51 33 10 42 (e) Miscellaneous 126 418 216 125 396 (f) After operations for removal of enlarged tonsils and/or adenoids — — — 292 298 The above summary is an imperfect picture of the whole of your work in Barking, because as I have outlined in my previous Reports all your other medical services, including even your hospitals, are linked up in the important work of following-up. (7) ARRANGEMENTS FOR TREATMENT. Many of the conditions found at school medical inspection are able to be treated in Barking. Certain conditions of necessity still require hospital treatment. A summary of the work of the Clinics is included in the following table :— All Clinics. Clinic. No. of first attendances of school children. Total No. of attendances of school children. 1936 1937 1936 1937 Minor Ailments:— (a) Central 2,589 2,927 14,635 14,485 (b) Woodward 4,640 5,283 22,154 26,726 Ophthalmic 792 1,044 2,485 05 Dental 5,100 3,586 10,608 10,683 Orthopædic for examination 123 146 350 409 for treatment 416 531 4,408 8,084 Immunisation:— Diphtheria 69 53 277 305 Scarlet Fever 19 22 95 150 Whooping Cough — — — — 138 Apart from the increased numbers at the Woodward Clinic and at the Orthopaedic Clinic, I wish to call your attention to the fact that immunisation treatment now includes whooping cough. On pages 171 to 174 will be found a report by the Council's Consulting Ophthalmic Surgeon, Mr. W. A. Gray, upon the work carried out during the year at the ophthalmic clinics. Details of the work carried out at the dental clinics during the year will be found in the report of the Senior Dental Officer, Mr. WT. H. Foy, on pages 169 and 170. (a) Malnutrition.—Cases of malnutrition are found at routine examinations and are referred for special inspection at the school clinics or followed up by school nurses, and parents are advised as to the suitable methods of treatment. Free meals and milk are provided in necessitous cases and cod-liver oil and malt, etc., are also provided free in necessitous cases and are sold at the clinics at cost price. (b) Uncleanliness.—Special attention is given by the school nurses to cases of uncleanliness. Full printed instructions are sent to parents as to the method of destroying vermin and nits, and special nit combs are available at the clinics on deposit of a small charge, which is returnable. I have already said in past Reports that the condition is preventable and would again emphasise that other than trivial absence from school for such a condition is quite unnecessary with the facilities you provide. (c) Minor Ailments and Diseases of the Skin.—The treatment of minor ailments and diseases of the skin is undertaken at the school clinics. Details of the treatment carried out during the year 1937 are given in the statistical tables on pages 183 and 192. Last year I drew your attention to the overcrowding at the Woodward Clinic. This year I do so again and emphasise the fact that whereas 4,640 children were treated in 1936, 5,283 were treated in 1937, whilst the number at the Central Clinic has but slightly changed. In all there were over forty-one thousand attendances at the minor ailments clinics during the year. Some of this congestion may be relieved by your policy to maintain a temporary minor ailments clinic at the Porters Avenue (Methodist Chapel) Centre, which in effect may later become a permanent clinic. 139 A summary of the work of the Minor Ailments Clinics is included in the following table:— Minor Ailments Clinics. Central Clinic. Woodward Clinic. 1936 1937 1936 1937 No. of days clinic was open 308 306 308 306 Total No. of attendances 14,635 14,485 22,154 26,726 Daily average attendance 47.5 47.3 71.9 87.3 No. of cases dealt with 2,589 2,927 4,640 5,283 Children still continue to attend the Clinics, suffering from skin diseases of both acute and chronic types. The results of treatment have been satisfactory, but it is still the practice to send the more chronic cases to the Skin Department of the London Hospital with whom we co-operate, and we have reason to be satisfied with these results. The treatment of Ringworm of the Scalp is still undertaken by Dr. W. J. O'Donovan at the London Hospital. Under this arrangement four school-children were treated during the year. (d) Visual Defects and External Eye Disease.—Visual defects and external eye diseases are treated at your school clinics, and in this connection Mr. W. A. Gray, F.R.C.S., continued as your consulting ophthalmic surgeon during the year. Spectacles are provided through the Department at contract prices and in necessitous cases are provided free of charge. Particulars of the treatment of visual defects will be found on pages 171 to 174 and on pages 184 and 193. This year it has been possible to see that every child referred for ophthalmic attention to your Consulting Ophthalmic Surgeon was again seen before the expiration of twelve months, and I hope that this close co-operation will continue, because I am persuaded that the development of the children from year to year takes place not only in relation to the general physique, but in such localised parts as the eye, etc., and consequently lenses may have to be changed frequently. (e) Nose and Throat Defects.—During the year 318 school-children received operative treatment for tonsils and/or adenoids, and of these 294 were carried out under the Authority's Scheme. 140 (f) Ear Disease and Defective Hearing.—The treatment of simple ear conditions is still undertaken at the clinics under the supervision of your medical officers, but the more difficult cases are still sent to Queen Mary's Hospital. Many of these ear conditions are chronic, either as primary diseases in themselves or as the result of one of the infectious fevers, and the treatment must be frequent and carried over a period of perhaps weeks. Zinc ionisation is the accepted form of treatment for such cases and I trust that the inauguration of a full-time Ear, Nose and Throat Department, as one of your special services, will meet a need which has been felt by your medical officers for some time. (g) Dental Defects.—Dental inspection and treatment are carried out by three full-time dentists. Children are inspected periodically at school, and treatment is undertaken at the dental clinics. Details of the work carried out will be found on pages 186 to 187 and 195 to 196. (h) Orthopwdic and Postural Defects.—Where children are examined at school and clinics and are found to need treatment for orthopaedic and postural defects this treatment is undertaken by a special staff, under the guidance of Mr. B. Whitchurch Howell, F.R.C.S., your specialist consultant in this work, at the Faircross Clinic. The arrangements at the Faircross Clinic, as I have stated previously, are inadequate for the ever-increasing amount of work. (i) Heart Disease and Rheumatism.—Cases of heart disease and rheumatism are not treated as separate entities under your present scheme, and the time is approaching when you may wish to consider the provision of suitable accommodation for the treatment of such cases, whereby prolonged rest and education can go hand in hand. (j) Tuberculosis.—Cases of tuberculosis or suspected tuberculosis are referred to the County Tuberculosis Dispensary, because the County is responsible for the treatment of tuberculosis in Barking. (k) Speech Training.—There is a special class for speech training attached to the Faircross School and children considered eligible for admission are examined for physical or organic defects by your medical officers prior to their admission. (l) Other Defects and Diseases.—Many children suffering from minor defects and diseases, not already mentioned, are examined at the school clinics, where appropriate treatment is advised. Others, for the treatment of whom no special provision has been made, are followed up by school nurses, who urge upon the parents the importance of obtaining treatment. 141 Finally, as I have said earlier in this Report, it is hoped that by the time of the next Report an Ear, Nose and Throat Clinic will have been set up in your Town and that also at some not far distant date you may have one Central Out-Patients' Department, where all your special services, including orthoptics, i.e., the correction of squint, and audiometry, i.e., the estimation of hearing, may all be united in one main building. (8) INFECTIOUS DISEASES. The section of the Department concerned with the control of infectious or communicable diseases co-operates closely with the school medical service section. Certificates regarding the exclusion from and readmission to school of children suffering from notifiable infectious diseases, non-notifiable communicable diseases and of contacts are sent to head teachers and school attendance officers. The names and addresses of children who are absent from school on account of nonnotifiable communicable diseases are supplied by the school attendance officers on forms specially provided for the purpose and the homes of the cases are visited by officers of the Department. The following table shows briefly the number of children notified and reported suffering from some of the commoner infectious diseases during the past five years:— 1933 1934 1935 1936 1937 Scarlet Fever 169 313 274 224 158 Diphtheria 71 247 174 86 110 Measles and German Measles 4 467 29 570 62 Chicken-pox 390 320 178 132 220 Whooping Cough 69 87 79 149 39 Mumps 23 39 30 18 180 In connection with the above, it has not been necessary to close any school or school department during the year. Immunisation Treatment.—Your service includes immunisation for diphtheria, scarlet fever and whooping cough, and although attendance is fairly good at these clinics, I should be glad to see more parents taking advantage of this service, particularly in the case of children within the early school age-group. (9) OPEN-AIR EDUCATION. Open-Air Classrooms and Playground Classes.—You have 14,089 schoolchildren in Barking. 142 I can only emphasise once again that a large proportion of these children are accommodated in what may be called open-air classrooms, these places numbering approximately 10,000 out of 15,000. Where the old factory type of school still remains classes out of doors are still recommended and the fullest use is made of the playgrounds for class purposes. School Journeys and Camps.—Educational excursions are arranged by most of the junior and senior schools to places of interest in various parts of the Country. Arrangements are also made for educational visits to certain local institutions and buildings. The school camps were again used for the health of your school children during the year, and these, as you are aware, are now a permanent feature in Barking. It was not possible to hold a full quota of week-end camps on account of the Coronation Celebrations and the extended Whitsun Holiday. The thirteen camps held, however, were attended by 871 children. During the summer there was a fortnight's holiday camp for 72 girls and 72 boys, and the arrangements as usual were highly commendable. These organised holiday camps are exceptionally well planned, and the forethought and energy of those responsible for the amusement and entertainment of the children is to be noted. Food was again supplied from the Municipal Kitchen for the fourteen days summer camp, whilst for the week-end camps it was again provided by Mr. W. P. Lucas, of Foxburrows, Chigwell Row, Essex. All the food was of a high standard. (10) PHYSICAL TRAINING. There are two organisers of physical training, one for boys and one for girls, and they are responsible for the organisation and supervision of physical training in your schools. Special attention is given to the arrangement of organised games, such as netball and rounders, the teaching of swimming and national folk dancing. Each year the organisers of physical training, Miss C. M. Hawkes and Mr. L. E. Last, submit an annual report to the Local Education Authority through the Director of Education, by whose courtesy I have received a copy of their Report for 1937. 143 The following is a copy of this Report:— "ANNUAL REPORT OF THE ORGANISERS OF PHYSICAL TRAINING, 1937. To the Chairman and Members, Harking Education Committee. Ladies and Gentlemen, We have pleasure in submitting the following report on Physical Education in Barking schools during 1937. In 1930 the development of sound physical education in the schools received tremendous stimulus by the declaration of official policy in the Board of Education circulars 1445 and 1450, and in 1937 emphasis on the necessity for physical fitness has been transferred to those of post school age. The publication in February of a White Paper on Physical Training and Recreation, the subsequent passing of the Physical Training and Recreation Act, and the establishment of the National Fitness Council, assisted by twenty-two area committees, together with the intense publicity accorded the Government scheme, have already done much to awaken the national conscience to the urgent need for improving and extending the facilities for physical training and recreation for persons over school age. The development of sound, healthy physical recreation as part of the social life of the nation will not necessarily follow the mere provision of adequate facilities. The choice of leisure activity will largely depend upon the kind of education people have received and we should therefore ensure that physical education in our schools is laying a sound foundation of appreciation of good physique and of practice in joyous physical activity. In spite of the fact that the national scheme for physical fitness contains no element of compulsion and no insistence upon the efficiency of any system of physical exercises, its unfortunate announcement coincident with the Government's rearmament programme has aroused deep and understandable suspicion in the minds of many people and has done much to hinder the progress of a thoroughly commendable piece of social service. It is hoped that the physical training and dancing display given on the Vicarage Field as part of the town's Coronation Celebrations proved to an interested audience that modern physical education in the schools has little in common with early semi-military systems of drill. The importance attached to individual training should convince anyone that there is no military aspect behind modern pedagogical physical training. Education is the guidance of growth which must take place not only physically and mentally, but spiritually as well, and we are convinced that the self respect engendered by the healthy functioning of a fit body is a vital factor in sound character formation. 144 Physical Education in the Schools. (a) Standard of Work.—A spirit of enjoyment, with continuous activity on the part of the children, now pervades the physical training lessons in the majority of schools. In some cases, however, the presentation of the valuable corrective formal exercises is still too mechanical and indicates a lack of appreciation of the specific aims of these exercises. The stock of physical training apparatus has been increased but is not always readily available for use during playground lessons, and we should welcome a more liberal use of apparatus for these lessons in Junior and Infants' Schools. The games lessons are now probably the weakest feature of the work in most schools, but it is hoped that special games courses for teachers will help to make this training more definite and purposeful. (b) Facilities.—The general adoption of the recommendations made in our last report regarding the allocation of time for physical training has led to an increased use of the school halls in the Senior Schools where the provision of gymnasia is a matter of some urgency and we are therefore particularly pleased to learn of the proposed provision of gymnasia for two of these schools. (c) Playgrounds.—The absence of permanent marking throws unnecessary work on the teacher and children every time a lesson is taken, and the generous allowance made for the effective marking out of playgrounds is much appreciated. We would suggest, however, that the present scheme is very costly and it has been difficult to get the work carried out within a reasonable time. (d) Playing Fields.—Through the co-operation of the Parks Committee facilities have been extended for regular organised games in Greatfields Park, Mayesbrook Park, and on the Abbey and Lodge Avenue Playing Fields ; and as a result the majority of children in Senior Schools are now given the opportunity of enjoying one weekly period of games on grass. In some cases this necessitates the use of adult pitches, but until more ground is definitely reserved for school use this difficulty cannot be overcome. Owing to the lack of alternative accommodation the Faircross Playing Field is subject to excessive wear and more playing fields reserved, planned and marked for children's games are urgently required. Changing rooms, with facilities for washing, separate offices for both sexes, a drinking fountain, and storage for games materials should be provided on these fields. It is increasingly evident that in order to obtain full economic value from the small fields attached to some of the schools extra provision should be made for their maintenance. We have submitted a special report dealing with the problem. The development of the Cannington Road site as a playing field would do much to relieve the excessive wear on these small, badly turfed fields. Additional playing field accommodation is urgently required by the Cambell Schools. 145 (e) Clothing.—It is pleasing to record that in the Junior and Infants' Schools real progress has been made in the adoption of a more rational form of dress enabling movements to be carried out with the necessary vigour and precision. The recommendation made in our last report that senior children should be encouraged to change into vests and shorts or knickers has been generally put into effect in spite of the lack of suitable changing accommodation or provision for the storage of gymnasium kit. (f) Shoes.—The generous experiment made last year by the Committee in supplying 96 pairs of shoes to every school has only served to emphasise the fact that the only satisfactory solution of this problem is that proper gymnastic shoes should be regarded as a necessary part of every child's equipment. The discreet issue of these shoes to deserving cases has presented teachers with a very difficult problem and many parents who previously were providing shoes now say that they are unable or unwilling to do so. (g) Teachers' Courses.—We acknowledge with thanks the continued permission to hold these classes during school hours. These classes often demand strenuous physical effort from teachers, some of whom are not accustomed to regular vigorous activity. We much appreciate the sympathetic attitude of the Committee regarding the release of teachers to enable them to attend special courses. In order to make safe and effective use of the extended facilities provided in a fully equipped gymnasium the teacher will require a high degree of technical training impossible to provide by means of local courses. Last year 16 teachers sacrificed holidays to attend vacation courses in physical training and this is a pleasing indication of growing interest and enthusiasm. (h) Swimming.—Swimming instruction is rightly regarded as a very important activity in physical education and we regret that approximately fifty per cent, of the children leave the Barking schools without receiving swimming instruction. It is, however, very encouraging to know that definite steps are being taken to provide additional accommodation and in the meantime we should be pleased if further consideration could be given to recommendations made last year, viz.:— (1) To employ at the Public Baths and the Park Pool a qualified specialist instructor for boys as well as for girls. This would enable units of forty children to attend the bath in charge of one qualified teacher from the school. (2) To limit the number of children actually in the water to forty. This is very necessary in the case of non-swimmers. 146 (3) To devote the whole of the limited time at the bath to definite progressive class methods of instruction in water practices. The necessary "land drills" should be carried out as part of the normal physical training at school. Number of attendances and certificates gained:— Year. Attendances. Certificates. Public Baths. Park Pool. 100 yds. 50 yds. 30 yds. 1935 22,366 1,468 318 435 624 1936 23,672 1,763 358 483 564 1937 21,646 1,519 300 428 528 The serious drop in attendances and consequently in the number of distance certificates gained was probably due to the following causes—the prolonged 'bus strike in May, the special Coronation holiday, and the indifferent summer weather. The swimming section of the Schools' Central Sports Association continues to do valuable work and enthusiastic teachers devote much of their leisure coaching children in Life Saving and more advanced swimming. (i) Out-of-School Activities.—The splendid voluntary service rendered by members of the Barking Schools' Central Sports Association deserves commendation and support and we feel that their work is seriously handicapped by the present lack of adequate facilities. The effective organisation and control of competitions, particularly the inter-school competitions, in the major field games and athletics does much to stimulate healthy rivalry between the schools, fosters the development of individual school spirit and generally raises the standard of play. Suitable facilities, however, cannot be provided and reserved solely, or even mainly, for the activities of the Central Schools' Sports Association, but if, as has been suggested, further playing field accommodation be secured for the regular organised school games, suitable amenities should be provided to enable the Association to stage important inter-school and district matches and entertain visiting teams in a manner befitting the dignity of the occasion and worthy of the hospitality of the town. 147 Physical Training for Adolescents and Adults. We realise that our primary duty concerns the development of physical education in the elementary schools, but we should welcome the views of the Education Committee regarding the extension of our work to include the supervision and development of physical training for young people and adults in accordance with the Board's suggestions in circular 1445. There is no doubt that the club movement and social work generally would gain much in force and effectiveness through the co-ordinating work of a Juvenile Organisations Committee. At a meeting of club representatives held on the 28th November, 1936, it was agreed to take the necessary steps to form a committee but no further meeting has been held. There is a definite demand for Recreative Physical Training in Barking on the part of women and girls but little has been done to stimulate or satisfy this need, and only one " Keep Fit " class, viz., that arranged for the East Barking Townswomen's Guild, has been formed. At present there are no facilities other than school halls, and few teachers trained in recreative work. In concluding this report we wish particularly to thank the Director of Education for the careful and sympathetic consideration given our proposals during the past year, the office staff for their very willing and efficient service, and the teachers whose ready co-operation has made our work so pleasant. C. MONICA HAWKES, L. E. LAST, Organisers of Physical Training 148 School No. of children who remain at school for mid-day meal Whether facilities exist for heating of children's meals Whether facilities exist for the drying of children's clothes and boots Bifrons—Senior Boys Senior Girls Cambell—Senior Boys Senior Girls Junior Mixed Infants C. of E.—Boys Girls Infants Dawson—Junior Boys Junior Girls Infants Dorothy Barley— Junior Boys Junior Girls Infants *Eastbury—Senior Boys Senior Girls Infants Erkenwald—Senior Boys Senior Girls *Faircross—Mixed Gascoigne—Senior Boys Junior Mixed Infants Manor—Junior Mixed Infants All children stay at school for mid-day meal, the food being supplied from Municipal Kitchen in special containers. Yes, Gas Cooker. Yes, at domestic science centre. No Yes, at domestic science centre. No „ „ „ „ „ „ „ „ „ „ „ Yes, at domestic science centre. No „ Yes, at domestic science centre. Yes No „ „ „ „ Cloakrooms heated (in winter only). „ „ „ „ „ School fires (in winter only). „ „ Cloakrooms heated (in winter only). „ „ „ „ „ „ Yes, at domestic science centre. Cloakrooms heated (in winter only). „ Yes, at domestic science centre. Cloakrooms heated (in winter only). Yes School fires and central heating (in winter only). „ „ Cloakrooms heated (in winter only). School No. of children who remain at school for mid-day meal Whether facilities exist for heating of children's meals Whether facilities exist for the drying of children's clothes and boots Monteagle—Junior Boys Junior Girls Infants Northbury—Senior Girls Junior Mixed Infants Park Modern—Senior Mixed Ripple—Junior Boys Junior Girls Infants *Roding—Junior Boys Junior Girls Infants St. Ethelburga's— Senior Mixed St. Joseph's—Infants and Junior Mixed Westbury—Junior Boys Junior Girls Infants 120 43 8 No „ „ „ „ Yes, at domestic science centre. No „ „ „ „ „ Yes No „ „ Cloakrooms heated (in winter only). „ „ School fires and central heating (in winter only). „ „ Cloakrooms heated (in winter only). „ „ „ „ „ „ School fires and central heating (in winter only). „ „ „ „ * Meal Centres have been established at these Schools, in addition to the Centres at St. Margaret's Hall and Woodward Hall. (11) PROVISION OF MEALS, MILK AND COD LIVER OIL AND MALT, ETC. (a) Meals.—Free meals are provided daily in necessitous cases. During the year 1937, 102,077 free meals were provided, and the following table shows the numbers of free meals which have been provided during the past five years:— 1933 135,726 1934 113,173 1935 112,125 1936 100,859 1937 102,077 150 The Table on pages 148 and 149 summarises the arrangements which exist where mid-day meals are taken at schools. Where nutrition plays a part in the health of the school child, your medical officers carry out special examinations and your school nurses carry out home enquiries when the weight of the child drops appreciably from one examination to another. In these cases re-examination at each school medical inspection automatically controls the supervision of each case. It is in such circumstances that every endeavour is made to ensure milk in school and when occasion arises attendance at your feeding centres. Medical inspection is carried regularly into these centres, where the daily menus are inspected. The following are specimen menus of the dinners supplied:— (1) Monday Roast beef, butter beans, baked potatoes, macaroni pudding. Tuesday Liver and bacon, greens, potatoes, apples and custard. Wednesday Boiled beef, carrots, potatoes, tapioca pudding. Thursday Fried fish, greens, potatoes, baked fruit pudding and custard and a raw apple. Friday Roast beef, greens, potatoes, fruit salad and custard. (2) Monday Roast beef, greens, potatoes, tapioca pudding. Tuesday Fried fish, bread, greens, potatoes, baked sultana pudding. Wednesday Boiled beef, carrots, potatoes, macaroni pudding. Thursday Stewed rabbits, sprouts, dumplings, potatoes, apples and custard. Friday Liver and bacon, greens, potatoes, rice and prunes. It will be obvious that nutrition surveys as such are unnecessary in Barking. I have previously mentioned that it would be necessary to employ greater medical staff for such nutrition surveys, but nutrition surveys are less necessary than ever since school medical inspection has tended to become more frequent. (b) Milk.—In addition to free meals as such, free milk is given in certain cases and in this way 55,969 bottles of milk were distributed during 1937. The milk provided is subject, from time to time, to bacteriological and other analysis, and during the year has been found invariably of standard quality. In my Annual Report for 1934, I dealt with this subject from two or three aspects, and find it unnecessary to add to what I wrote on that occasion. 151 During 1937, ½d. bottles of milk were again issued during the school holidays. Thirteen centres covering all schools with the exception of Faircross, Park Modern, Manor, St. Joseph's and St. Ethelburga's, were arranged with voluntary helpers in charge of each centre. During the summer holidays 3,200 free bottles of milk were issued and 52,609 bottles purchased. (c) Cod Liver Oil and Malt, etc.—On the 1st March, 1937 the Board of Education approved the arrangements you had proposed for the issue of Cod Liver Oil and Malt and similar preparations to ordinary elementary school-children. These preparations are issued from the Central and Woodward Clinics and from the Alexandra, Greatfields and Porters Avenue Centres. Each case is selected by one of your Medical Officers before an issue is made and reviewed before an extension is granted. In addition, each case is re-inspected at school medical inspection. The following table shows the issues made since the inception of the scheme:— Issues of Cod Liver Oil and Malt and similar preparations during 1937. Cost price (packets) Free (packets) Total (packets) Cod Liver Oil (Pure) 3 1 4 Cod Liver Oil Emulsion 62 47 109 Cod Liver Oil and Malt 238 280 518 Liquid Paraffin 3 18 21 Parrish's Chemical Food 157 128 285 Virol 59 28 87 Totals 522 502 1,024 (12) CO-OPERATION OF PARENTS, TEACHERS, SCHOOL ATTENDANCE OFFICERS AND VOLUNTARY BODIES. The Board of Education ask me to write on co-operation of parents, teachers, school attendance officers and voluntary bodies. I trust that throughout this Report, time and time again, I have expressed thanks for the considerable degree of co-operation which obtains in Barking. 152 The co-operation of parents, teachers, school attendance officers and voluntary bodies and the medical service in Barking is very high, and in expressing once again my thanks to these members I cannot speak too highly of their valued service. It is such a liaison between the departments that makes for an efficient health service. The attendance of parents with their children at school medical inspections, clinics, etc., still continues to be satisfactory and I can only offer my thanks to these parents for the increasing interest they show in their children. School attendance officers as such do not exist, but are investigation officers, as stated in my previous Report. With their co-operation it is possible to eliminate difficulties arising from altered home circumstances. Finally I would mention the National Society for the Prevention of Cruelty to Children and other voluntary bodies which work actively in the above connection. The following table shows the work which has been undertaken in Barking by the National Society for the Prevention of Cruelty to Children during the last five years:— 1933 1934 1935 1936 1937 Total number of cases investigated 33 24 35 28 25 (a) Prosecutions nil nil nil nil nil (b) Warnings 24 18 29 23 16 (c) Otherwise dealt with 9 6 6 5 9 (d) Supervisory visits 133 131 180 127 156 (e) Cases closed as satisfactory 25 17 29 14 19 Although co-operation in Barking itself is high it is difficult to eliminate some of the barriers which must arise between Local Authorities on the one hand and the large London hospitals on the other hand. A systematic and uniform arrangement of correspondence between the large London hospitals would be a distinct improvement, because some difficulty does arise when patients are referred from hospital to hospital and when there is no interchange of notes. (13) BLIND, DEAF, DEFECTIVE AND EPILEPTIC CHILDREN. The following table shows the number of children who have attended at the Faircross Special School—in the Open-Air, Physically Defective and Mentally Defective Sections—and, in addition, in other parts of the report will be found figures as to how many children have been admitted to the Brookfield Orthopaedic Hospital and elsewhere for orthopaedic conditions:— 153  Open-Air Section Physically Defective Section Mentally Defective Section No. on Register on 31.12.30 99 24 69 No. admitted during 1937 43 14 16 No. discharged during 1937:— (a) Decertified 38 7 3 (b) Left district, admitted to Hospital, etc. 19 6 17 No. on Register on 31.12.37 85 25 65 Hereunder are particulars of the number of children maintained by the Authority in special schools outside the district as at December 31st, 1937:— Particulars of School. No. of Cases. (a) Certified Schools for the Blind and Partially-Sighted: East Anglian School for the Blind (Residential), Gorleston 1 Brighton School for Blind Boys (Residential), Brighton 2 Barclay School for Blind Girls (Residential), Brighton 1 Monega Road School for the Partially-Sighted (Day), East Ham 1 (b) Certified Schools for the Deaf: Frederick Road Deaf Centre (Day), West Ham 12 (c) Certified Schools for Mentally Defective Children: Royal Eastern Counties Institution, Colchester 1 (d) Certified Schools for Physically Defective Children: St. Michael's Orthopaedic Hospital-School, Clacton-on-Sea 1 Cheyne Hospital, Chelsea 1 Edgar Lee Heart Home, Willesden 1 Lancing Heart Home, Lancing 1 154 The following table gives information in respect of medical inspection at the Faircross Special School during the year 1937:— Number of inspection sessions 29 Number of children inspected:— (a) Routines 61 (b) Specials 62 (c) Re-examinations 424 — 547 Number of defects referred:— (a) For treatment 48 (b) For observation 22 — 70 Number of defects found treated 28 Number of parents present at inspections 356 In addition 58 special examinations for assessment of intelligence were carried out in respect of children attending the Faircross Special School. Mentally defective children are, after consultation, transferred to Faircross School (Mentally Defective Section), but before certification takes place a sufficient time must elapse and investigations must be made to lead up to the necessary action being taken. It is during this probationary period that the question of any physical insufficiency becomes a matter of pertinent enquiry, and it is at this stage I am persuaded that the advice of the medical officer should be obtained. The introduction of A, B and C streams in the schools has unquestionably helped considerably towards the problem of giving each child a course of education specially suitable to his or her needs. If a child under the age of sixteen years is certified incapable, by reason of mental defect, of receiving benefit or further benefit from education in a special school, it is necessary to notify the County Authority. In these cases the parents are usually offered an opportunity of sending the child to an Occupation Centre run by the Essex Voluntary Association for Mental Welfare in the Central Hall, Barking. It is maintained that some people do not like their children to attend this Centre as they consider it places a stigma on the child, and it is suggested that this difficulty might be met by holding this Occupation Centre at Faircross School. 155 It has occurred to me that, should the Speech Defect Class be removed from the premises it at present occupies in the precincts of the Faircross Special School, this would be a suitable building to offer the Essex Voluntary Association for use as an Occupation Centre for these children. Residential Schools.—The time has come when you are considering the upkeep and maintenance of a few places at such a residential school as the Ogilvie School of Recovery, whereby cases so ill that attendance at school is impossible may yet receive treatment and education relative to their individual needs. I do trust that during 1938 something will be done towards this end. (14) FULL-TIME COURSES OF HIGHER EDUCATION FOR BLIND, DEAF, DEFECTIVE AND EPILEPTIC STUDENTS. The Local Education Authority do not maintain any courses of training for Blind, Deaf, Defective and Epileptic students. (15) NURSERY CLASSES. This year you have decided to set up nursery classes in certain of your schools, and in my next Report you will probably have more detail as to the working and management of these classes from the health point of view. (16) SECONDARY SCHOOLS AND OTHER INSTITUTIONS OF HIGHER EDUCATION. The prophecy outlined in my previous Report of the unification of your medical services with those of the Essex County Council has come to pass and now your medical service undertakes the routine medical examination of the children attending the Barking Abbey School and the Day School of the SouthEast Essex Technical College. Routine inspection of these children for dental defects is also similarly undertaken. The service is in itself much the same as that carried out at your elementary schools and includes the employment of your special treatment services, e.g., orthopædic, ophthalmic, dental, etc. 156 On pages 188 to 196 will be found tables showing the routine inspections, treatments, etc., carried out during the year at these Secondary Schools. What would appear to be a decrease in the number of children so examined and treated at your elementary schools will thus be explained and in effect it will be seen that the total numbers actually undertaken show an increase. Many of the children attending these schools are from outlying districts of Essex whose services would be difficult to compare with those services, which have been outlined, for elementary school children in Barking. (17) PARENTS' PAYMENTS. From time to time you have had under consideration arrangements for the recovery of cost of treatment from parents of children attending public elementary schools. No alterations have been made during the year 1937. (18) HEALTH EDUCATION. The inculcation of habits, rather than the academic teaching of abstruse principles amongst children is a matter I still reiterate. A fact which must obviously commend itself is that you are setting up nursery classes in the new year when it will be possible for habits to be inculcated into children at an earlier age than has been possible heretofore. At these classes the children will be taught habits of cleanliness—teeth cleaning, washing, etc. Up till now the children at your Special School were the only ones supplied with a tooth brush of their own and who had tooth brush drill as part of their curriculum, but this will now be part of the system to be commenced in the nursery classes. The Senior Dental Officer does from time to time give lectures on oral hygiene. At the end of the year there has been a National Health Campaign and posters and pamphlets have been supplied to schools, encouraging the call to a " Fitter and Healthier Britain." (19) SPECIAL INQUIRIES. No special inquiries were carried out by your staff during the year 1937. 157 (20) MISCELLANEOUS. (a) Examination of Teachers.—During the year, 39 medical examinations were carried out of applicants for teaching posts under the Local Authority. I am still persuaded there are serious grounds for suggesting the necessity of co-ordinating the medical examination of entrants to Training Colleges with those of other examinations. (b) Part-time Employment of School-children.—Milk and newspaper deliveries, general errands, etc., are the usual forms of employment of school-children. In accordance with the byelaws of the Education Authority, 51 applicants of school-age submitted themselves for medical examination prior to employment. Of this number 47 were passed as being fit for employment. (c) Juvenile Employment.—In September, 1935, the Board of Education issued Administrative Memorandum No. 137 dealing with the question of co-operation between the School Medical Service and Juvenile Employment and Advisory Committees. The Board requested that procedure should be initiated whereby the Juvenile Employment Officer should be advised as to the specific unsuitability of certain children for particular types of work, this information being made available by your medical officers at the last routine examination of the children. During 1937 the following recommendations by your medical officers were forwarded to the Juvenile Employment Officer :— 50 Children unsuitable for severe manual work. — „ „ „ sedentary occupation. 36 „ „ „ exposure to bad weather. II „ „ „ work in a dusty atmosphere. 11 „ „ „ work near moving machinery. 22 ,, „ ,, work involving prolonged standing. 19 ,, ,, ,, work causing eye strain. 27 „ „ „ work requiring acute distant vision. 3 ,, „ „ work requiring acute hearing. The above recommendations relate to 98 school-children. 158 SERVICES PROVIDED FOR SCHOOL-CHILDREN. Camps Week-end camps are held every week-end during the summer months, and in addition two holiday camps, each of a fortnight's duration, are held during the summer holidays. Cleansing Special soap is issued from the Minor Ailments Clinics and special combs are loaned, on payment of a deposit. In certain cases, arrangements are made for the children to be cleansed at the Clinic by the School Nurses. Cod Liver Oil, etc. These products are provided on the recommendation of the Council's medical officers at cost price. In necessitous cases no charge is made. Deafness Special investigations, using the Audiometer, will in future be undertaken. (See description of an Audiometer on page 135.) Dental Treatment Dental treatment—including orthodontic treatment- is carried out daily at the Corporation's Clinics in Vicarage Drive, Woodward Road and East Street. Dinners Free dinners are provided for children attending school, where the family income is below a certain scale. Medical Inspection Arrangements are made for each child to be medically examined at school three times during the period of school life, and at such other times as the medical officers considers necessary. Provision is also made for the periodical and regular examination of children's teeth. Milk One-third of a pint of milk is supplied daily to children attending school on payment of one halfpenny per day. Where the family income is below a certain scale and where the medical officer considers milk desirable on medical grounds, no charge is made. 159—160 CLINIC AND TREATMENT CENTRES. Name and Situation. When Held. Nature of Accommodation. By Whom Provided. 1. Maternity and Child Welfare. (a) Infant Welfare Centres:— Central Clinic, Vicarage Drive, Ripple Road Tuesdays and Fridays, 2 p.m. Modern clinic premises with accommodation for consultations, weighing of babies, waiting rooms, etc. Local Authority. Woodward Clinic, Woodward Road Tuesdays, Thursdays and Fridays, 2 p.m. do. do. Great fields 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 (b) Ante-Natal Clinics:— Mondays, Wednesdays and Fridays, 2 p.m. do. do. 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 Tuesdays and Wednesdays, 9.30 a.m. do. do. Porters Avenue Centre, Porters Avenue Thursdays, 9.30 a.m. Accommodation for consultations, etc. do. Humphrey Ward (near Maternity Pavilion), Upney Lane. Specialist-Consultant Clinic at Central Clinic, Vicarage Drive, Ripple Road. (c) Gynaecological Clinics:— Mondays, Tuesdays, Wednesdays, and Fridays, 10.30 a.m. Third Tuesday in each month 3.30 p.m., except August and December. do. Modern clinic premises with accommodation for consultations, etc. do. do. Central Clinic, Vicarage Drive, Ripple Road Woodward Clinic, Woodward Road As and when required, do. Modern clinic premises with accommodation for consultations, etc. do. do. do. 161—162 CLINIC AND TREATMENT CENTRES. Name and Situation. When Held. Nature of Accommodation. By Whom Provided. 2. School Medical Service. *(a) Inspection Clinics and Treatment of Minor Ailments:— Central Clinic, Vicarage Drive, Ripple Road Daily, 8.30 a.m. Modern clinic premises with inspection, waiting and treatment rooms, etc. Local Authority. Woodward Clinic, Woodward Road do. do. do. (b) Ophthalmic Clinic:— Central Clinic, Vicarage Drive, Ripple Road Tuesdays and Fridays, 10 a.m. do. 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. do. do. Woodward Clinic, Woodward Road do. do. do. East Street Clinic do. Inspection, waiting and treatment rooms do. (d) Orthopaedic 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 inspection, waiting and treatment rooms. Local Authority. 4. Tuberculosis. 87, Linton Road Venereal Diseases. Mondays, 3-5 p.m. Tuesdays, 7-8 p.m. Thursdays, 10.30 a.m.-12.30 p.m. Three rooms Essex County Council. 5. London hospitals, etc. — By arrangement with Essex County Council. *Since the end of 1937 an additional Out-Patients' Department for the inspection and treatment of Minor Ailments has been commenced at the Porters Avenue Centre, Porters Avenue, and clinics are held daily at 8.30 a.m. 163 Minor Ailments Children suffering from minor ailments are treated daily at the Corporation's Central Clinic, and at the Woodward Clinic. Ophthalmic Service Refraction Clinics are held at the Central and Woodward Clinics, and the scheme includes the provision of spectacles at a very low charge, and, in some cases, where the family income is below a certain scale, at no charge. Provision is also made for training the eyes of children suffering from squint. Orthopaedic Treatment Orthopaedic treatment—including the provision of splints and any necessary hospital treatment—is provided through the Orthopaedic Clinic, Hulse Avenue. Prevention of Diphtheria, Immunisation against Diphtheria, Scarlet Fever and Scarlet Fever and Whoop- Whooping Cough is carried out at the Central ing Cough. Clinic. No charge is made for this treatment. Special School The Faircross Special School is divided into three sections—a Physically Defective Section, a Mentally Defective Section and a Section for Delicate Children. When considered desirable, the children are conveyed to and from school by motor ambulance. Tonsils and Adenoids Surgical treatment for tonsils and adenoids is carried out at two local hospitals under an agreement with the Corporation. A small charge is made to the parents, except in certain necessitous cases, when no charge is made. Ultra-Violet Light Treat-Ultra-violet light treatment is given at the Orthopaedic merit. Clinic, Hulse Avenue. X-Ray Treatment for Where necessary, Ringworm is treated by X-Ray. Ringworm of the Scalp. No charge is made for this treatment. 164 REPORT ON THE WORK OF THE ORTHOPÆDIC CLINIC. May, 1938. To the School Medical Officer, Barking Borough Council. Dear Sir, The statistical returns show the type of cases treated and a marked increase in the numbers attending for consultation and treatment. Several cases of acute anterior poliomyelitis have been seen in consultation with the medical staff, and have been treated by the orthopaedic masseuses, Miss Roe and Miss Barns, at the Barking (Infectious Diseases) Hospital and, later, either at the Brookfield Orthopaedic Hospital, or 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 children of school age:— No. of primary examinations by Orthopaedic Surgeon 146 No. of re-examinations by Orthopaedic Surgeon 263 The cases dealt with for the first time during 1937 were referred for the following conditions:— (a) Deformities—Bones and Joints— (1) Congenital: Cervical rib 1 Deformed scapula 1 Deformed digits (foot) 1 Deformed digits (hand) 1 165—166 PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPÆDIC CLINIC DURING 1937. No. of sessions held by Orthopaedic 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 11 834 146 130 263 175 8,084 6,301 8,493 6,606 TREATMENTS. Massage Electricity Remedial Exercises Ultra-Violet Therapy Radiant Heat Dressings and Splintage Totals. 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 No. of Children No. of Treatments School Children 28 1,180 14 446 207 2,333 328 4,635 9 182 166 1,143 752 10,609 Toddlers and Expectant & Nursing Mothers. 40 1,093 7 120 54 807 381 3,982 5 186 205 1,659 692 7,847 Admissions to Hospitals On Waiting List for Admission 31/12/37 School Children Toddlers Total School Children Toddlers Total 16 (Under Council's Orthopædic Scheme) 6 22 — — — 167 (2) Acquired: Pigeon chest 6 Rachitic chest 12 Pes planus 11 Genu valgum 22 Genu varum 6 Injury to metatarsal bone 1 Injury to thumb 1 Injury to tibia 1 ? Femoral abscess 1 ? Osteochondritis of spine 1 ? Internal derangement of knee joint 1 Old fracture of arm 2 Hallux valgus 6 Hammer toes 1 76 (b) Deformities—Muscular— (1) Congenital: Talipes 1 Torticollis 1 (2) Acquired: Pes planus 36 Kyphosis 3 Scoliosis 2 Lordosis 1 Bad posture 11 Round shoulders 4 Intoeing 3 62 (c) Paralysis— 3 3 Anterior poliomyelitis (d) Miscellaneous— Re gait 2 Baker's cyst 2 ? Shortening of leg 1 5 Total defects found 146 168 During the year, sixteen children were admitted to Hospital, fifteen for operations and one for observation, as follows:— Operations: Manipulation and plaster 3 Arthrodesis and plaster 4 Removal of Baker's cyst 1 Excision of exostosis 1 Cuneiform osteotomy digit 1 and plaster 2 Steindler operation and plaster 2 Draining abscess and plaster 1 Splintage and re-education 5 Observation and splintage 1 20 Observation 1 Total 21 B. WHITCHURCH HOWELL, F.R.C.S. Orthopædic Surgeon. 169 REPORT OF SENIOR DENTAL OFFICER. To the School Medical Officer, May, 1938. Barking Borough Council. Sir, I have the honour to submit the School Dental Report for the year 1937. In the months from January to September inclusive, only two Clinics were available owing to the fire which completely immobilised the East Street Dental Clinic. An endeavour to overcome the handicap was made by introducing three sessions per diem at the Central and Woodward Clinics, the third session in each case being an evening one. These evening sessions were sparsely attended during the winter months as parents were against journeys in the dark, and in the summer months there was a disinclination to spend time at a Clinic after school hours. Also it was noticeable that patients, even those who were known to be regular and friendly, were not so amenable to treatment after spending a day at school studies. Tiredness, and lack of resistance to discomfort were evident nnd the scheme, an emergency one, in the matter of returns and popularity was not a success. During the year under review, the dental treatment of the Day School of the South-East Essex Technical College was taken over by arrangement with the Essex County Council and although the dental work of this school is dealt with elsewhere in this Report (pages 155 to 156 and 195 to 196) it is relevant to state that the extensive work required to render the pupils of this school dentally fit, much being of a heavy exacting type, has occupied much of the time previously devoted to Barking elementary schools. Extraction of temporary teeth show a welcome decrease, the comparable figures being 10,702 in 1936, and 8,233 in 1937. The extraction of permanent teeth also shows a decline, 2,046 being the figure for 1936, and 1,741 for 1937. Fillings are on the increase, the figure of 6,284 being 1,629 higher than for 1936. The number of other operations remains approximately the same but casual patients at 906 show a regrettable increase of 200. The very fine total of 6,284 fillings together with a reduction in extractions of approximately 2,500 must impress the Committee of the more enlightened attitude of parents and children in respect of 170 dental treatment and as this occurred in a year not stimulated by a National Health Campaign it would go to show that the popularity of the Services provided by the Council is established and the professional efforts of the Staff appreciated both in operative work and considered advice. It now remains for a comprehensive scheme for the dental treatment of adolescents to be started, either nationally or by local government, to prevent the years following school years from being the lean years of dental health for those willing to accept treatment, but finding no existing scheme within their financial scope. There is still a rigid wall of objection to the filling of deciduous teeth. It can be breached, but only slowly, for it is cemented with hereditary and traditional disregard which is expressed in the constant reiteration of "I don't believe in it. They are only first teeth after all." Patience and a younger generation with a more enlightened outlook should solve the problem. The orthodontic treatment is still gaining in popularity and much good work is accomplished. The Head-Masters, Head-Mistresses and their staff have proved very valuable allies during the year and I desire to record the able assistance rendered to the Dental Service by the Medical, Nursing and Dental staff in their whole-hearted co-operation and kindness. I have the honour to be, Sir, Your obedient Servant, W. H. FOY, (l.d.s., r.c.s., eng.), Senior Dental Officer. 171 REPORT ON THE WORK OF THE OPHTHALMIC CLINICS. May,1938. To the School Medical Officer, Barking Borough Council. Dear Sir, Probably it is true to say that in no other department of Medicine is there more scope for the prevention of disability than in Ophthalmology. At the present time, much is said about general fitness and the importance of physical training and games. Good vision is a necessity for all this. During the age period covered by the school clinics, several eye diseases are liable to occur, some of which are disabling, some disfiguring but all of them can in great measure be prevented. In newly-born infants inflammation of the eyes is not uncommon. It varies from stickiness of the eyes to a severe infection destructive of vision. This is Ophthalmia Neonatorum. It is rare in Barking, for elaborate precautions are taken to prevent its occurrence. It is common knowledge that the general body health, if undermined by disease or unsuitable feeding, can affect the eyes. In children up to school leaving age a superficial affection of the eyes may result. This is especially common when the diet is lacking in essential vitamins. It is not so much the lack of nourishment as a bad choice in food—fresh fruit and fats being inadequate in quantity. In Barking there is a special scheme for dealing with such cases. Here they are called V.D.D. which means Vitamin Deficiency Disease, and when such a case is seen, the home conditions are investigated and the diet adjusted. Where cure is delayed because of poor general health the child is sent to Faircross Open-Air School and extra nourishment in the form of free dinners, milk or cod liver oil is given. The combination of fresh air and good food is generally effective. In winter the lack of sunshine is remedied by the artificial sunlight clinic. At the same time the child is examined for any septic condition which may be helping to lower its health and well-being. Many years ago it was pointed out that such cases had frequently bad teeth and enlarged tonsils. This however is rare in Barking and I believe that the condition is chiefly due to faulty feeding. Such a scheme as has been outlined above provides for continuity of treatment and is superior to convalescent homes 172 in that respect. It also does not interfere with education. No child is discharged from Faircross Special School unless for the preceding six months the eyes have been free from all inflammation. Each child is subsequently examined at the clinic once every three months. There remains short sight or myopia as it is called. This is in its worst degrees a crippling disease and causes much disability. It begins in childhood and is sometimes hereditary. Though the cause of myopia is unknown, some conditions seem to produce a gradual increase in severity. These indicate the line of treatment. Thus, excessive reading, knitting and other close work are deleterious to myopes. This year, I have examined 226 cases of short sight, and the parents of those children have been asked how often the child reads. The answer has nearly always been "The child is always reading." So invariable has been the reply that it seems desirable that every school child who is always reading should be discouraged from too much study. The method adopted for dealing with myopia is first the provision of suitable glasses. A letter is then sent to the parent giving advice as to limiting the amount of close work out of school, and to encourage open-air pursuits. At the same time the Head Teacher is informed. Each case is re-examined at the Clinics—usually every six months—so that myopic children are under supervision throughout their whole school career. Myopia, however, is relatively common and would not justify interference with schooling in the average case of mild degree, so in the first instance such children take the ordinary school curriculum. If it is found that the myopia is increasing quickly, a scheme of what is called "easy schooling" is instituted. This involves the curtailment of the amount of reading, etc. As this is usually sufficient it is in only a small percentage of cases that "special schooling" is found necessary. A reference to Table II on page 173 brings out some interesting facts. In the first place the success of giving ordinary education to myopic children has been established, for out of 226 cases only 37 increased in severity and only four were of such degree that "special schooling" was necessary. When increase in short-sight occurs it is usually within six months. This might at first suggest that the provision of glasses, the special letters and other measures had not sufficed but it must be remembered that no statistics are available of children when no treatment has been undertaken. It is thus a deduction more apparent than real and the large numbers of myopes whose condition has remained stationary lends support to this view. It is frequently asked if the child is better say after twelve months. Of course, there is no question of this because myopia is a permanent condition and the aim of all control methods must be to prevent the short sight increasing. I believe that this is possible in the majority of cases, but it necessitates co-operation on the part of the children themselves, the parents and the educational authorities. 173 STATISTICS RELATING TO THE WORK OF THE OPHTHALMIC CLINICS DURING 1937. TABLE 1. No. of refractions under atropine 792 No. of post-mydriatic tests 28 No. of spectacles prescribed 611 No. of cases listed for squint training 75 All spectacles were checked before being issued at the Clinics. TABLE II. MYOPIA. TABLE SHOWING WORK CARRIED OUT DURING 1937 IN CONNECTION WITH SCHOOL-CHILDREN SUFFERING FROM MYOPIA. Individual Cases. Spectacles. No. of Cases reviewed within:— Recommendations to Head Teachers for:— Ordered for first time. Changed. No Change. Months. Ordinary Routine. "Easy Treatment." "Special" Treatment. 3 4 6 9 12 226 129 37 60 7 5 193 16 5 216 6 4 TABLE III. External Diseases of the Eye treated at the Clinics:— Conjunctivitis and Blepharitis 59 Corneal Nebulae 2 Corneal Ulcer 2 Phlyctenular-Conjunctivitis 15 Injury 4 Meibomiam Cyst 3 Foreign body in eye 3 Dacryocystitis 4 Hordeolum 13 Ingrowing eyelash 1 Keratitis 4 Phlyctenular Keratitis 2 Cataract 1 Keloid of lower lid 1 Supra-orbital abscess 1 Stenosed lacrimal duct 1 174 TABLE IV. Total No. of Attendances 2,635 Percentage attendance of appointments made 83 TABLE V. TREATMENT OF ELEMENTARY SCHOOL CHILDREN AT THE ORTHOPTIC (SQUINT TRAINING) CLINIC. No. of sessions given to Squint Training 161 (1) Cases treated:— (a) Cured 11 (b) Under treatment at end of year 73 (c) Treatment commenced but discontinued for various reasons, i.e., left district, left school, etc. 9 Total 93 Cases still under treatment:— Over 12 mths. After treatment for Under 3 mths. 9-12 mths. 6-9 mths. 3-6 mths. No. of cases 18 23 20 7 5 Average fusion 5.1° 2.8° 3.3° 0.8° 1.6° No. showing definite diminution of squint 11 12 8 — — No. showing improvement 16 20 15 3 2 Percentage showing improvement 88.8 86.9 75 42.8 40 No. showing no improvement 2 3 5 4 3 No. of treatments given 1,188 Wm. A. GRAY, f.r.c.s., Ophthalmic Surgeon. (2) Treatments:— Cases cured—average length of treatment 7½ months. 175 SCHOOL MEDICAL SERVICE. Statistical Tables—Public Elementary Schools, 1937• TABLE 1.—RETURN OF MEDICAL INSPECTIONS. A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups:— Entrants 1,751 Second Age Group 1,653 Third Age Group 1,408 Total 4,812 Number of other Routine Inspections 562 Grand Total 5,374 B.—Other Inspections. Number of Special Inspections 10,318 Number of Re-Inspections 19,128 Total 29,446 C.—Children found to require Treatment. Number of individual children found at Routine Medical Inspection to require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Group. For defective vision (excluding squint). For all other conditions recorded in Table II A. Totals. Entrants 17 281 293 Second Age Group 170 161 315 Third Age Group 86 116 195 Totals (Prescribed Groups) 273 558 803 Other Routine Inspections 65 69 126 Grand Totals 338 627 929 176 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31ST DECEMBER, 1937. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Requiring Treatment Requiring to be kept under observation, but not requiring Treatment. Skin (1) Ringworm—Scalp 1 — 20 — (2) Body 2 1 24 — (3) Scabies 15 — 111 — (4) Impetigo 9 — 300 — (5) Other Diseases (Non- Tuberculous) 20 20 455 12 Totals (Heads 1-5) 47 21 910 12 Eye (6) Blepharitis 29 9 72 2 (7) Conjunctivitis 18 3 193 — (8) Keratitis — 1 3 — (9) Corneal Opacities — — 4 — (10) Other Conditions ing Defective Vision and Squint) 7 6 217 2 Totals (Heads 6-10) 54 19 489 4 (11) Defective Vision (excluding Squint) 338 119 215 33 (12) Squint 46 19 47 6 Ear (18) Defective Hearing 5 7 10 4 (14) Otitis Media 2 3 9 — (15) Other Ear Diseases 53 27 370 11 Nose and Throat (16) Chronic Tonsillitis only 232 303 295 41 (17) Adenoids only 7 5 4 2 (18) Chronic Tonsillitis and Adenoids 25 14 43 4 (19) Other Conditions 31 42 288 19 (20) Enlarged Cervical Glands (NonTuberculous) 22 73 145 34 (21) Defective Speech 21 23 24 12 Heart and Circulation Heart Disease: (22) Organic 5 50 1 7 (23) Functional 2 68 4 38 (24) Anaemia 27 31 14 8 Lungs (25) Bronchitis 41 64 67 12 (26) Other Non-Tuberculous Diseases 22 51 134 30 177 TABLE II. (A).—continued. Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Tuberculosis Pulmonary: (27) Definite — 1 — — (28) Suspected — 1 1 — Non-Pulmonary: (29) Glands — 1 — 2 (30) Bones and Joints — — — 1 (31) Skin — — 1 — (32) Other Forms — — — 1 Totals (Heads 29-32) — 1 1 4 Nervous System (33) Epilepsy — — 1 1 (34) Chorea 3 11 10 14 (35) Other Conditions 24 38 51 67 Deformities (36) Rickets 3 2 1 1 (37) Spinal Curvature 9 2 — 2 (38) Other Forms 85 74 55 15 (39) Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 96 235 3,433 193 Total number of defects 1,200 1,304 6,622 574 178 TABLE II. (B)—CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. Age-groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly subnormal) D (Bad) No. % No. % No. % No. % Entrants 1,751 600 34.3 1,057 60.3 93 5.3 1 0.1 Second Age-group 1,653 546 33.0 1,018 61.6 86 5.2 3 0.2 Third Age-group 1,408 645 45.8 734 52.1 29 2.1 — — Other Routine Inspections 562 174 31.0 371 66.0 17 3.0 — — Totals 5,374 1,965 36.6 3,180 59.1 225 4.2 4 0.1 TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA. Blind Children. At Certified Schools for the Blind At Public Elementary Schools At other Institutions At no School or Institution Total 2 — — 1 3 Partially Sighted Children. At Certified Schools for the Blind At Certified Schools for the Partially Sighted At Public Elementary Schools At other Institutions At no School or Institution Total — 3 — — 1 4 179 TABLE III.—continued. Deaf Children. At Certified Schools for the Deaf At Public Elementary Schools At other Institutions At no School or Institution Total 11 — — — 11 Partially Deaf Children. At Certified Schools for the Deaf At Certified Schools for the Partially Deaf At Public Elementary Schools At other Institutions At no School or Institution Total — — — — — — Mentally Defective Children. Feeble-Minded Children. At Certified Schools for Mentally Defective Children At Public Elementary Schools At other Institutions At no School or Institution Total 63 3 — 3 69 Epileptic Children. Children Suffering from Severe Epilepsy. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 3 — — 1 4 180 TABLE III.—continued. Physically Defective Children. A.—Tuberculous Children. I.—Children Suffering from Pulmonary Tuberculosis. (Including pleura and intra-thoracic glands.) At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Totals —(1) 1(3) 1 (—) —(—) 2(4) II.—Children Suffering from Non-Pulmonary Tuberculosis. (This category includes tuberculosis of all sites other than those shown in I. above.) At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Totals 4(3) 2(15) 3(—) 2(1) 11(19) EXPLANATORY NOTE. Physically Defective Children—Tuberculous. Attendance at a Tuberculosis Dispensary, subsequent to active treatment, has been looked upon as preventive treatment and therefore treatment within the meaning of the Table. The figures in brackets under this section denote children who are notified cases of Tuberculosis and are therefore attending a Tuberculosis Dispensary, but in whose case the disease has been declared "arrested" although the children cannot yet be said to be " recovered." B.—Delicate Children. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 61 8 — 1 70 181 TABLE III.—continued. C.—Crippled Children. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 13 — — 7 20 D.—Children with Heart Disease. At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Total 82 5 1 1 39 Children Suffering from Multiple Defects. Combination of Defect At Certified Special Schools At Public Elementary Schools At other Institutions At no School or Institution Totals Mental Defect (feebleminded) and Crippling 2 2 Mental Defect (feebleminded) and Heart Disease 1 1 Deafness and Crippling 1 — 1 182 FORM 307M.—STATEMENT OF THE NUMBER OF CHILDREN NOTIFIED DURING THE YEAR ENDED 31st DECEMBER, 1937, BY THE LOCAL EDUCATION AUTHORITY TO THE LOCAL MENTAL DEFICIENCY AUTHORITY. Total No. of Children Notified 5 Analysis of the above Total. Diagnosis Boys Girls 1. (i) Children incapable of receiving benefit or further benefit from instruction in a Special School : (a) Idiots ... — — (b) Imbeciles — 1 (c) Others — 1 (ii) Children unable to be instructed in a Special School without detriment to the interests of other children : (a) Moral defectives — — (b) Others — — 2. Feeble-minded children notified on leaving a Special School on or before attaining the age of 16 ... 2 1 3. Feeble-minded children notified under Article 3, i.e., "special circumstances" cases — — 4. Children who in addition to being mentally defective were blind or deaf — — GRAND TOTALS 2 3 183 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1937. GROUP 1.—Minor Ailments (excluding Uncleanliness, for which see Table VI). Defect or Disease Number of Defects treated, or under treatment during the year Under the Authority's Scheme Otherwise Totals Skin— Ringworm—Scalp : (i) X-Ray Treatment 4 — 4 (ii) Other 10 7 17 Ringworm—Body 20 3 23 Scabies 94 13 107 Impetigo 287 6 293 Other skin disease 357 64 421 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 450 36 486 Minor Ear Defects 319 25 344 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 2,495 214 2,709 Totals 4,036 368 4,404 184 TABLE IV.—continued. GROUP II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Number of Defects dealt with Under the Authority's Scheme Otherwise Totals Errors of Refraction (including Squint) 1,020 14 1,034 Other Defect or Disease of the Eyes (excluding those recorded in Group I) Totals 1,020 14 1,034 Number of children for whom spectacles were prescribed :— (a) Under the Authority's Scheme 611 (b) Otherwise 14 Total 625 Number of children who obtained spectacles :— (a) Under the Authority's Scheme 619 (b) Otherwise 14 Total 633 185 TABLE IV.—continued. GROUP III.—Treatment of Defects of Nose and Throat. Number of Defects. Defect Received Operative Treatment Received other forms of Treatment Total number treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Totals Tonsils only ... — 17 17 452 770 Adenoids only Tonsils and 1 2 3 Adenoids 293 3 296 Other — 2 2 Totals 294 24 318 452 770 GROUP IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme Otherwise Total number treated Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopedic clinic Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopedic clinic Number of children treated 10 2 424 — 9 5 439 186 TABLE V. DENTAL INSPECTION AND TREATMENT. (1) Number of Children who were :— (a) Inspected by the Dentist: Routine Age Groups Aged: 5 501 6 487 7 518 8 497 9 529 10 630 11 1,016 12 1,270 18 779 14 240 Total 6,416 (b) Specials 902 (c) Grand Total (Routine and Specials) 7,318 (2) Found to require treatment 5,693 (3) Actually treated 3,586 (4) Attendances made by children for treatment 10,683 (5) Half-days devoted to :— Inspection 50 Treatment 994 Total 1,044 (6) Fillings :— Permanent teeth 6,177 Temporary teeth 18 Total 6,195 187 TABLE V.—continued. (7) Extractions :— Permanent teeth 1,712 Temporary teeth 7,280 Total 8,992 (8) Administration of general anaesthetics for extractions 3,746 (9) Other Operations :— Permanent teeth 3,142 Temporary teeth Total 6,888 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (i) Average number of visits per school made during the year by the School Nurses 3 (ii) Total number of examinations of children in the schools by School Nurses 39,978 (iii) Number of individual children found unclean 1,327 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 10 (v) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 8 (6) Under School Attendance Byelaws — 188 SCHOOL MEDICAL SERVICE. Statistical Tables—Secondary Schools in Barking, 1937 (i.e., BARKING ABBEY SECONDARY SCHOOL AND THE DAY SCHOOL OF THE SOUTH-EAST ESSEX TECHNICAL COLLEGE). TABLE I.—RETURN OF MEDICAL INSPECTIONS. (Secondary Schools only.) A.—Routine Medical Inspections. Number of Inspections in the prescribed Groups :— Entrants 435 Second Age Group 91 Third Age Group ... 73 Total 599 Number of other Routine Inspections Grand Total 599 B.—Other Inspections. Number of Special Inspections 57 Number of Re-Inspections 207 Total 264 189 C.—Children found to require Treatment. Number of individual children found at Routine Medical Inspection to require Treatment (excluding Defects of Nutrition, Uncleanliness and Dental Diseases). Group. For defective vision (excluding squint). For all other conditions recorded in Table IIA. Totals. Entrants 50 60 105 Second Age Group 14 6 19 Third Age Group 17 3 19 Totals (Prescribed Groups) 81 69 143 Other Routine Inspections — — — Grand Totals... 81 69 143 TABLE II. (A)—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION IN THE YEAR ENDED 31st DECEMBER, 1937. (Secondary Schools only.) Defect or Disease Routine Inspections Special Inspections No. of Defects No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Skin (1) Ringworm—Scalp — (2) Body — — — (3) Scabies 1 — — (4) Impetigo — — 1 — (5) Other Diseases (NonTuberculous) 3 1 6 — Totals (Heads 1-5) 4 1 7 — Eye (6) Blepharitis 1 3 1 (7) Conjunctivitis — — 3 (8) Keratitis — (9) Corneal Opacities — — — (10) Other Conditions (excluding Defective Vision and Squint) — 1 2 Totals (Heads 6-10) 1 4 6 — (11) Defective Vision (excluding Squint) 81 32 9 1 (12) Squint 2 1 — Ear (13) Defective Hearing — — (14) Otitis Media — (15) Other Ear Diseases 3 2 2 190 TABLE II. (A).—continued. (Secondary Schools only.) Defect or Disease Routine Inspections Special Inspections No. of Defects i No. of Defects Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Requiring Treatment Requiring to be kept under observation, but not requiring Treatment Nose and i Throat '(16) Chronic Tonsillitis only ... 3 9 1 (17) Adenoids only (18) Chronic Tonsillitis and Adenoids (19) Other Conditions ... — 2 — — (20) Enlarged Cervical Glands (NonTuberculous) 4 (21) Defective Speech — — — — Heart and Circulation Heart Disease : (22) Organic — 1 — (23) Functional — 8 — 1 (24) Anaemia ... 3 1 — — Lungs 1 '(25) Bronchitis... ___ (26) Other Non-Tuberculous Diseases 4 5 — — Tuber- _ culosis 'Pulmonary : (27) Definite — — — — (28) Suspected — — — — Non-Pulmonary : (29) Glands — — — — (30) Bones and Joints — — — — (31) Skin — — — — (32) Other Forms — — — — Totals (Heads 29-32) — — — — Nervous System (33) Epilepsy — — — — (34) Chorea — — — — (35) Other Conditions — 3 2 1 Deformities (36) Rickets (37) Spinal Curvature 12 8 1 — (38) Other Forms 37 32 2 — (39) Other Defects and Diseases (excluding Defects of Nutrition, Uncleanliness and Dental Diseases) 10 24 20 1 Total number of defects 160 137 49 5 191 TABLE II. (B)—CLASSIFICATION OF THE NUTRITION OF CHILDREN INSPECTED DURING THE YEAR IN THE ROUTINE AGE GROUPS. (Secondary Schools only.) Age-groups Number of Children Inspected A (Excellent) B (Normal) C (Slightly) subnormal) D (Bad) No. o/ /o No. °/ /o No. % No. °/ /o Entrants 435 128 29.4 290 66.7 17 3.9 — — Second Age-group 91 24 26.4 63 69.2 4 4.4 — — Third Age-group 73 25 34.3 46 63.0 2 2.7 — — Other Routine Inspections — — — — — — — — — Totals 599 177 29.6 399 66.6 23 3.8 — — TABLE III. RETURN OF ALL EXCEPTIONAL CHILDREN IN THE AREA, 1937. (Secondary Schools only.) NONE. 192 TABLE IV. RETURN OF DEFECTS TREATED DURING THE YEAR ENDED 31st DECEMBER, 1937. (Secondary Schools only.) GROUP 1.—Minor Ailments (excluding Uncleanliness, for which see Table VI). Defect or Disease Number of Defects treated, or under treatment during the year Under the Authority's Scheme Otherwise Totals Skin— Ringworm—Scalp : (i) X-Ray Treatment — — — (ii) Other — — — Ringworm—Body — — — Scabies — — — Impetigo 1 — 1 Other skin disease 4 4 8 Minor Eye Defects (External and other, but excluding cases falling in Group II.) 5 — 5 Minor Ear Defects 2 — 2 Miscellaneous (e.g., minor injuries, bruises, sores, chilblains, etc.). 16 2 18 Totals 28 6 34 193 TABLE IV.—continued. (Secondary Schools only.) GROUP II.—Defective Vision and Squint (excluding Minor Eye Defects treated as Minor Ailments—Group I). Number of Defects dealt with Under the Authority's Scheme Otherwise Totals Errors of Refraction (including Squint) 48 31 79 Other Dcfect or Disease of the Eyes (excluding those recorded in Group I) — — — Totals 48 31 79 Number of children for whom spectacles were prescribed :— (a) Under the Authority's Scheme 19 (b) Otherwise 31 Total 50 Number of children who obtained spectaclcs :— (a) Under the Authority's Scheme 13 (b) Otherwise 31 Total 44 194 TABLE IV.—continued. (Secondary Schools only.) GROUP III.—Treatment of Defects of Nose and Throat. Number of Defects. Defect Received Operative Treatment Received other forms of Treatment Total number treated Under the Authority's Scheme, in Clinic or Hospital By Private Practitioner or Hospital, apart from the Authority's Scheme Totals Tonsils only — 1 2 Adenoids only — — — Tonsils and Adenoids — 1 1 Other — — — Totals — 1 1 1 2 GROUP IV.—Orthopaedic and Postural Defects. Under the Authority's Scheme Otherwise Total number treated Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopaidic clinic Residential treatment with education Residential treatment without education Non-Residential treatment at an orthopaedic clinic Number of children treated — — 14 — — 3 17 195 TABLE V. DENTAL INSPECTION AND TREATMENT. (Secondary Schools only.) (1) Number of Children who were :— (n) Inspected by the Dentist: Aged : Routine Age Groups 10 9 11 240 12 220 13 135 14 55 15 41 Total 700 (b) Specials 95 (c) Grand Total (Routine and Specials) 795 (2) Found to require treatment 619 (3) Actually treated 621 (4) Attendances made by children for treatment 978 (5) Half-days devoted to :— Inspection 5 Treatment 120 Total 125 (6) Fillings :— Permanent teeth 664 Temporary teeth — Total 664 (7) Extractions :— Permanent teeth 99 Temporary teeth 38 Total 137 196 (8) Administrations of general anaesthetics for extractions 78 (9) Other Operations :— Permanent teeth 91 Temporary teeth Total 169 TABLE VI.—UNCLEANLINESS AND VERMINOUS CONDITIONS. (Secondary Schools only.) (i) Average number of visits per school made during the year by the School Nurses — (ii) Total number of examinations of children in the schools by School Nurses 599 (iii) Number of individual children found unclean 6 (iv) Number of individual children cleansed under Section 87 (2) and (3) of the Education Act, 1921 — (v) Number of cases in which legal proceedings were taken :— (a) Under the Education Act, 1921 — (b) Under School Attendance Byelaws —