PUBLIC HEALTH DEPARTMENT mr. H. illiet. BARK 33 BOROUGH OF BARKING. THE ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH. FOR THE YEAR 1939 (War Edition) C. LEONARD WILLIAMS, B.Sc., H.R.C.S., L.R.C.P., D.P.H. BOROUGH of BARKING. ANNUAL REPORT of the Medical Officer of Health for the Borough of Barking? in the County of Essex, for the Year ended 31st December, 1939. (War Edition). Public Health Department, Barking, Essex. August, 1940. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting my report as Medical Officer of Health for the year ended 31st December, 1939. At the suggestion of the Ministry of Health an interim report only is being issued this year, although suitable arrangements are being made for the preservation of all records in order that, at the termination of the war, a report could be issued dealing more fully with the period from the beginning of 1939. This report is confined mainly to essential and urgent matters which have affected the public health during the year; it deals inter alia with matters arising from, or connected with, the war. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. - 2 - ANNUAL REPORT of the MEDICAL OFFICER of HEALTH for the YEAR 1959 (War Edition). STAFF. The following indicates the many changes that have taken place in the staff of the Public Health Department during the year 1939:- Deputy Medical Officer of Health and Deputy School Medical Officer. J. Mervyn Thomas, M.D., B.Sc., D.M.R.E., L.R.C.P., D.P.H. (Resigned 9th December, 1939). Assistant Medical Officers of Health and Assistant School Medical Officers. T. M. Clayton, M.B., B.S., B.Hy., D.P.H. (Resigned 23rd September, 1939). Margaret A. Glass, B.Sc., M.B., Ch.B., D.P.H. (Resigned 31st March, 1939). Muriel M. Osborn, M.R.C.S., L.R.C.P. (Resigned 28th August, 1939). T. A. Cockburn, M.D., D.P.H. (Commenced 13th March, 1939). Phoebe I. McKernan, L.R.C.P., L.R.C.S., L.L.M. (Commenced 28th August, 1939). Resident Medical Officer, Barking Hospital. Phoebe I. McKernan, L.R.C.P., L.R.C.S., L.L.M. (Commenced 15th March, 1939). - Transferred to post of Assistant Medical Officer, 28th August, 1939). Resident Medical Officer, Upney Hospital. C. P. Bampfylde Wells, M.R.C.S., L.R.C.P. (Resigned 28th August, 1939). Dental Surgeons. R. O. Borgars, L.D.S., R.C.S. (Resigned 31st January, 1939). Eileen F. Gawn, L.D.S., R.C.S. (Resigned 20th May, 1939). J. Angelman, L.D.S. (Commenced 1st July, 1939). J. R. Watson, L.D.S., R.C.S. (Commenced 10th July, 1939). Sanitary Inspectors. Miss J. Urquhart, (h and t). (Commenced 28th August, 1939). Health Visitors etc. + Miss E. Fisher, (g, h and i). (Resigned) 30th November, 1939). + Miss R. Hobbs, (g, h and i). (Resigned 2nd November, 1939). + Miss M. McAlister, (g, h, i and j). (Resigned 14th March, 1939). Miss S. E. Ware, (Chiropodist) (s). (Commenced 2nd January, 1939. Resigned 13th November, 1939). - 3 - District Municipal Midwives. Mrs. L. Back, (h and i). (Resigned 31st July, 1939). Miss G. Thomas, (h). (Transferred to Hospital Staff 28th January, 1939). Mrs. W. Wild, (h and i). (Commenced 1st August, 1939). Clerical Staff. Mr. E. A. Ellis, (c and m). (Resigned 26th May, 1939). Miss D. Foulsham. (Resigned 29th July, 1939). Miss I. Cast, (Resigned 31st August, 1939). Mr. L. J. Dexter. (Military Service as from 1st September, 1939). Mr. G. Stokes. (Commenced 28th February, 1939). Mr. H. Garrod. (Commenced 23rd May, 1939). Miss D. House. (Commenced 14th August, 1939). Miss E. Clark. (Commenced 28th August, 1939). (c) Meat etc., Inspector's Certificate of the Royal Sanitary Institute. (g) Health Visitor's Certificate of the Royal Sanitary Institute. (h) Certificate of the Central Midwives' board. (i) General Hospital Training. (j) General Fever Training. (m) Sanitary Inspector's Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (s) Certificate of Chiropody of the Chelsea School of Chiropody, (t) Sanitary Inspector's Certificate and Certificate of Meat Inspection, (Scotland). + Combined appointment - Health Visitor and School Nurse. At the outbreak of war your four district midwives went to Bishops Stortford with those expectant mothers whose confinements were imminent; by the end of the year two of these midwives had returned and the others came back early in 1940. No other staff was transferred to reception areas. During the latter months of 1939 members of the staff were designated to posts in connection with Civil Defence, but, when things became more settled, the staff were for the most part released from Civil Defence work and returned to their normal duties; the majority, however, continue to take part in the Civil Defence Scheme on a voluntary basis. 4 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. (See also Page 26) (1) GENERAL STATISTICS. Area (acres) 4,174 Population (1931 Census) 51,277 + Population (June, 1938) (Registrar- General's Estimate) 76,790 Number of Inhabited Houses, March, 1940, according to Rate Books;- Houses 18,906 Shops 1,377 Total 20,283 Rateable Value - General £732,526 0 0 Sum represented by a penny rate £2,984 11 4 General Rate 15s. 6d. + This figure has been affected considerably by evacuation, etc. (2) VITAL STATISTICS. Net deaths belonging to the district 569 Death Rate 7.41 Net live births belonging to the district 1,009 Birth Rate 13.14 Net still-births belonging to the district 34 Still-birth rate per 1,000 total births 32.6 Number of deaths of infants under one year of age 38 Infantile Death Rate 37.66 Number of maternal deaths 2 Maternal Mortality Rate 1.92 N. B. The official figures had not been received from the Registrar-General at the time this report was prepared. The figures quoted are purely local figures and may be subject to correction. 5 (3) DEATHS. (a) General. There were 303 deaths registered in Barking during 1939. Of these, 10 were deaths of non-residents. Barking residents to the number of 276 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. 323 246 569 The following table shown the principal causes of death during 1939:- (Net Deaths). Causes of Death. Total Diphtheria 2 Influenza15 Pulmonary Tuberculosis 48 Non-Pulmonary Tuberculosis 3 Syphilis 1 Cancer 90 Diabetes 4 Cerebral Haemorrhage 23 Heart Disease 138 Other Circulatory Diseases 23 Bronchitis 23 Pneumonia (all forms) 33 Other Respiratory Diseases 9 Peptic Ulcer 7 Diarrhoea (under 2 years) 7 Appendicitis 3 Cirrhosis of Liver 1 Other Digestive Diseases 2 Acute and Chronic Nephritis 22 Other Puerperal Causes 2 Congenital Debility, Premature Birth, etc. 22 Senility 10 Suicide 13 Other Violence 18 Other Defined Diseases 50 Total 569 (b) Infant Mortality. Once again I have pleasure in drawing your attention to the infant mortality rate, which at 37.66 is the lowest figure yet reported to you. That such a splendid result should be obtained in so difficult a year reflects much credit on your health visiting staff. The following table gives the actual causes of death of the 38 children who died under one year of age 6  0-1 mth. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under 1 year Acute Bronchitis 1 I 1 2 Acute Influenzal BronchoPneumonia 1 1 Acute Primary Broncho-pneumonia 1 1 Asphyxia (Natural) due to Acute Suppurative Bronchitis 1 1 Atelectasis Neonatorum & Premature Birth 1 1 Bronchitis & Marasmus 1 1 Broncho-Pneumonia & Infantile Eczema 1 1 Broncho-Pneumonia & Suprarenal Haemorrhage 1 1 Cerebral Haemorrhage, Birth Injury & Congenital Heart Disease 1 1 Convulsions, Cerebral Injury, Instrumental Delivery 1 1 Gastro-Enteritis 1 Gastro-Enteritis & Maternal Eclampsia 1 1 Haemorrhagic Diathesis of Newborn 1 1 Heart Failure & Multiple Congenital Deformities incompatible with life 1 1 Hydrocephalus & Spina Bifida Inanition & Premature Birth Induction & Prematurity 4 1 1 1 4 1 Intercranial Haemorrhage due to Birth Tears of the Dura Mata 1 1 Intercranial Haemorrhage 1 1 Meningitis & Acute Lobar Pneumonia 1 1 Pneumonia 1 1 Pneumococcal Peritonitis, Pneumococcal Pyaemia & Broncho-Pneumonia 1 1 Prematurity 5 Prematurity & Atelectasis of the Lungs 1 1 Prematurity & Toxaemia of Pregnancy 1 1 Purulent Meningitis & Hydrocephalus 1 1 Septicaemia & Cerebral Haemorrhage. Infected Haematoma of Scalp 1 1 Toxaemia & Gastro-Enteritis 1 2 3 Totals 21 8 5 1 3 38 (c) Maternal Mortality. At the time of preparing this report the official maternal mortality figures had not been received, but we think we are advised sufficiently of the situation to afford you some information. 7 There were four deaths of Barking women associated with pregnancy or childbirth. Two women died in the early months of pregnancy, before they came under your Maternity and Child Welfare Scheme; one only of these can be classified strictly as a maternal death. One woman was evacuated and died out of the town and her death is not allocated to Barking; of all the cases delivered under your schemes, numbering approximately 960, one only died. Though it cannot be said statistically, I am persuaded the damage due to childbirth is today slight indeed compared with a generation ago. (4) SOCIAL CONDITIONS. (a) General. The outbreak of hostilities considerably affected the social conditions of the Borough during 1939 5 many women and children were evacuated to reception areas. A large proportion of these, particularly the women, returned to Barking before the end of the year. A serious thing I have noticed since the outbreak of war is that the public is less and less interested in preventive medicine than they have been heretofore. Curative medicine captures the public imagination; it is difficult for parents to think seriously of conditions such as defective teeth, eyes, tonsils, etc., which are detrimental to their children or more likely will be detrimental to them some years hence, when their immediate concern is that they may be safe say for the next 24 hours. War of necessity limits ones vision to the immediate future; this, so far as I can see, is a most harmful influence at the present time. (b) Schemes of Relief. There is no doubt that in drawing up schemes of relief, Public Assistance Committees must have had in their minds other forms of relief which are available. For necessitous persons such forms of relief include, among many others, free meals for children of school age. Children in necessitous households will almost invariably be living on a diet which is deficient in the necessary protective food stuffs and a certain number of them will share with other children the danger of eating foods which have been improperly cooked and thereby less digestible than they otherwise would be. If such children be given one proper meal a day, the appetite of these children will be increased because it has been found that one good meal deserves another. Not only will the appetite be increased, as such, but the proper meal a day will increase the rate of growth so that consequently from this standpoint also the child would require more food. Households, therefore, where the family income is less than the standard rate and whose children are given a well balanced, properly prepared meal, should be subsidised by an allowance, rather than the free meal provided being regarded as a form of relief which may be taken into account when assessing scales of relief. 8 (c) Unemployment. Barking is a dormitory town and the employment has "been changed considerably by the war. The following table shows a comparative statement of local unemployed by industries as at December, 1938, and December, 1939 Dec. 1939. Dec. 1938. Men Women Men Women Pood 14 12 8 3 Electrical and Wireless 33 29 2 1 Building Trade and Painters 147 1 179 1 Works of Construction 100 - 145 - Engineering 41 7 31 2 Domestic 9 77 18 50 Rubber Workers 9 13 34 19 Commercial 3 6 3 3 Road and Water Transport 27 2 43 1 Clothing 11 53 12 35 Distributive Trades 141 90 133 52 Government and Professional 7 8 1 - Tin Box Manufacture 5 5 7 9 Matches 3 9 3 3 Chemicals 22 8 26 4 Printing 22 21 17 13 Asbestos 8 21 7 14 Woodworking and French Polishing 53 4 7 2 Agriculture 6 19 7 25 General Labourers and Factory Hands 334 65 633 185 Mineral Water Manufacture 4 7 - 1 Leather Trades - 2 4 - Gas and Water 51 2 42 - 1,050 1+61 1,363 423 (d) Travelling Facilities. Once again I regret to report that there has been no improvement in the standard of travelling conditions to and from Barking; in fact the reduction in the number of trains and buses at the beginning of the war meant that the travelling facilities deteriorated. Black-out conditions, too, tended to make travelling more irksome. - 9 - SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (1 ) GENERAL HEALTH SERVICES. (a) Laboratory Facilities. Our laboratory facilities have suffered considerably from the absence, owing to illness, of Dr. E. M. Hill, the Scientist. During the time Dr. Hill was in Barking, not only ourselves,but other organisations and authorities she contacted, learned to value highly the way in which she undertook her work in the Laboratory in the Barking Hospital precincts. (b) Ambulance Facilities. On the outbreak of War your ambulance service became virtually a part of the Air Raid Precautions Service, and has so continued. (c) Hospitals (Public and Voluntary). Not only your Hospitals, but certain voluntary and County Hospitals were taken over wholly or in part, and became emergency hospitals at the beginning of September; some two months later your Maternity Hospital reverted to its normal use. As in previous years you allocated a sum of £300 to be distributed to certain voluntary hospitals catering specially for the needs of the people of Barking. Your proposal to build a second maternity pavilion has had to be deferred on account of the war. (d) Clinics and Treatment Centres. On the outbreak of war both the Central and the Woodward Clinics were taken over and adapted for use as First Aid Posts. For a few weeks clinic sessions were curtailed, but, by the end of the year, a more normal programme of work was being carried out at all Clinics, excepting Porters Avenue, where the Minor Ailment Sessions were cancelled. The number of sessions at the Foot Clinic were reduced. (e) Nursing in the Home. In consequence of the outbreak of war many patients were discharged from hospitals and many hospitals reduced their out-patient activities. This of necessity led to the utmost demands being made on the Home Nursing Services which have been provided in the Borough. This work is at present done by the Plaistow Maternity Hospital and District Nurses' Home and the East Barking District Nursing Association, both of whom now receive substantial grants from the Corporation. (2) MATERNITY AND CHILD WELFARE SERVICES. (a) Ante-Natal and Post-Natal Supervision. Although the ante-natal clinics were interrupted at the commencement of the war, by the end of the year our - 10 - programme was again normal. In spite of the evacuation of many expectant mothers the number of attendances at your clinics amounted to 6,726, a slight increase on the figure for the previous year; the number of post-natal attendances (392) and gynaecological attendances (332) were much the same as for the previous year. (b) Midwifery. (1) Supervision. There were 18 midwives practising in the Borough at the end of the year, seven of which were employed at the Upney Maternity Pavilion. During the year 1939s midwives sought medical assistance in 261 cases; 65 of these were on behalf of babies, (2) Midwives Act, 1936. The arrangements made by the Council pursuant to the Midwives Act, 1936, worked very smoothly until the outbreak of war when some 240 expectant mothers were evacuated under the Council's Scheme. About 170 of these were sent to various reception areas in the West of England; the remaining 70, whose confinements were imminent, were sent to Bishops Stortford. A large house was converted for use as an emergency maternity hospital; your four district midwives were temporarily transferred. The arrangements at Bishops Stortford were most successful, and it is hoped to use the same emergency hospital should evacuation again be ordered for expectant mothers. Upwards of six-hundred mothers were delivered in Barking under your district midwifery scheme during the year 1939. (c) Upney Maternity Pavilion. The Maternity Hospital became part of the Emergency Hospital Scheme just prior to the outbreak of war and those patients who were fit for discharge were discharged on the order of the Ministry; some two months later it was re-opened as a Maternity Hospital. As a result of this temporary closure, the evacuation scheme and the policy of limiting the number of admissions, there was a reduction in the number of cases dealt with. Pour-hundred and four patients were admitted, 50 of which were for ante-natal treatment; the corresponding figures for the year 1938 were 504 and 44 respectively. (d) Infant Welfare Centres. The number of attendances at infant welfare centres decreased on account of evacuation and also because at the outbreak of hostilities some of the clinic sessions were curtailed. 32,163 attendances were made during 1939s compared with 37,925 during 1938. (e) Home Visiting. The gradual return of many evacuated mothers and babies made home visiting all the more important and difficult since the outbreak of war. Your Health Visitors were unable to devote so much time to this work during 1939, and the number of visits paid was 17,696, as compared with 21,936 in the previous year. - 11 - - SECTION C SANITARY CIRCUMSTANCES OF THE AREA. (1) RAINFALL. The rainfall for the year ended 31st December, 1939s was 24.05 inches, as compared with 14.42 inches for the previous year. Rain fell on 172 days in the year 1939. (2) DRAINAGE AND SEWERAGE. Drainage arrangements continue as heretofore. (3) RIVERS AND STREAMS. The rivers and streams running through the area are tidal in character and are not controlled by the Corporation. Attention is directed to the continued unsatisfactory condition' obtaining in the River Roding. (4) CLOSET ACCOMMODATION. At the end of the year there remained a total of 16 premises unconnected with the sewer, nine of which 'ere factory premises. (5) PUBLIC CLEANSING. During the year, 9,190 loads of refuse were collected, with an average weight of 1 ton 19 cwts. (6) REFUSE DISPOSAL. All the refuse collected in the Borough was deposited at the Corporation tip which is situated on the North Bank of the Roding, near the Kingsbridge Wharf. (7) SANITARY INSPECTION OF THE AREA. Emergency and war conditions have interfered seriously. with the routine work of the Department. (a) WORK OF SANITARY INSPECTORS. (1) Inspection of Dwelling-Houses. Total Houses Inspected under Public Health or Housing Acts 1,680 Total Number of Inspections made 4,350 Housing (Consolidated) Regulations 545 After Infectious Disease 727 Overcrowded Premises 63 Defects Found 2,066 Notices Served (preliminary) 925 Re-inspections re Notices Served 2,670 Inspection of Works in Progress 1 60 Slum Clearance Property 1 44 - 12 - (2) Premises Controlled "by Byelaws and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings — — — Common Lodging Houses 3 1 1 Offensive Trades 25 15 6 Tents, Vans and Sheds 28 5 2 Dairies, Cowsheds and Milkshops 39 9 5 Slaughter-houses 69 — — Hairdressers' & Barbers' Premises 19 4 3 Smoke Observations 61 1 2 12 (3) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 70 — — Bakehouses 11 — — Workplaces 73 9 7 Outworkers' Rooms 54 — — Butchers' Premises 106 41 25 Fishmongers 19 17 8 Restaurants and Dining Rooms & Canteens 72 43 19 Stables and Stable Yards 10 4 3 Piggeries 2 — — (4) Miscellaneous. Inspections. Defects. Notices. Rats and Mice (Destruction) Act, 1919 34 8 7 Vacant Land and Refuse Dumps 72 8 4 Public Lavatories 30 1 1 Schools 23 1 1 Markets and General Shops 136 4 3 Ice-Cream Vendors 32 13 7 Petroleum and Celluloid Stores 30 3 1 Drainage Inspections 99 — — Milk Sampling 47 — — Other Miscellaneous 41 — — Inspection of Meat from Outside District 74 — — Shops Act, 1934 231 36 26 Water Sampling 8 — — Food Manufacturers — — — Street Traders 5 — — Food Byelaws 10 7 6 - 13 - (b) NOTICES SERVED. Informal Notices 925 Statutory Notices:- Public Health Act, 1936 :- Section 39 6 Section 45 28 Section 83 8 Section 93 239 Housing Act, 1936 :- Sections 9 & 10 40 Section 24 2 Section 32 1 324 (c) FACTORIES ACT, 1937. (1) Inspections (including inspections made by Sanitary Inspectors). Premises. Number of Inspections. . Written Notices. Prosecutions. Intimations. Statutory. Factories 70 — — — Workplaces 73 7 — — Totals 143 7 — — (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 3 3 — — Inadequate ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Sanitary accommodation Insufficient 1 1 — — Unsuitable or defective 5 5 — — Not separate for sexes — — — — Other offences 1 1 — — Totals 10 10 — — 4- Including those specified in Sections of the Factories Act, 1937, as remediable under the Public Health Acts. - 14 - ( 3) Home Work. Sight notices were issued to the occupiers of premises in the district where outworkers are employed, who supplied lists twice during the year of 30 workpeople engaged on making wearing apparel, etc. , in their homes. (4) Other Matters. Class Number. Matters notified to H.1-. Inspector of Factories :- Failure to affix Abstract of the Factory and Workshop Act — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act 1 Other — Underground Bakehouses Certificates granted during the year —- In use at the end of the year — (5) Outworkers. The Register of Outworkers contains the names and addresses of 67 persons carrying out work at their homer on "behalf of other people. (d) PREMISES AND OCCUPATIONS WHICH ARE CONTROLLED BY BYELAWS OR REGULATIONS. The following is a list of the above type of premises:- (1) Houses Let in Lodgings. (2) Common Lodging Houses. (3) Tents, Vans and Sheds. (4) Underground Sleeping Rooms. (5) Offensive Trades. (61 Piggeries. (7) Stables. (e) RATS AND MICE DESTRUCTION ACT, 1919. There were 34 visits made to premises under this Act, and any necessary work arising has been carried out. (f) REMOVE OF INFIRM AND DISEASED PERSONS. Three eases were reported during the year. In two cases arrangements were made for the persons to have institutional treatment, and in the third case it was found that suitable arrangements were in force for the person to have the necessary medical and nursing attention at home. (8) ERADICATION OF BED BUGS. The following houses have been disinfested Barking Council Houses 37 London County Council Houses 9 Privately Owned Houses 6 Total .52 - 15 - SECTION D. HOUSING. (1 ) STATISTICS. (a) General. Number of new houses erected during the year;- (1) Total 501 (2) As part of a municipal housing scheme;- (a) Barking 178 (b) L.C.C. 56 (3) Others (including private enterprise and subsidy houses) 267 (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) 1,680 (b) Number of inspections made for the purpose 4,350 , (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations 545 (b) Number of inspections made for the purpose 1,154 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 51 (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 925 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 700 3. Action under Statutory Powers during the Year; - A. - Proceedings under sections 9, 10 and 16 of the Housing Act, 1936; (1) Number of dwelling-houses in respect of which notices were served requiring repairs 40 - 16 - (2) Number of dwelling-houses which were rendered fit after service of formal notices:- (a) By owners 95 (b) By local authority in default of owners 1 B. - Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 281 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:- (a) By owners 86 (b) By local authority in default of owners Nil C. - Proceedings under sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which Demolition Orders were made, 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders, 3 D. - Proceedings under section 12 of the Housing Act, 1936: (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 114-8, Barking Corporation Act, 1933: Number of dustbins supplied by local authority in default of owners 165 - 17 - SECTION E. INSPECTION AND SUPERVISION OF FOOD. (1 ) MILK SUPPLY AND ICE-CREAM. (a) Milk Supply. There are no cowkeepers in the district and we have only one dairy where milk is handled or treated. The remaining 77 premises on the register retail pre-packed supplies. In addition there are 15 milk purveyors who occupy premises in other districts, but retail in Barking. The following table sets out the results of the bacteriological examination of various samples, from which it will be seen that, of the total of 36, all were satisfactory- Type of Sample. Satisfactory. Unsatisfactory. Totals. "Sterilised" Milk — — — "Pasteurised" Milk 18 — 18 Raw Milk 14 — 14 "Homogenised" Milk 2 — 2 Tuberculin Tested Milk 2 — 2 Totals 36 — 36 There were during the year 6 samples of milk submitted to biological examination for the presence of tubercle, none of which were found to be infected. The following table shows the number of licences granted during the year for the sale of graded milks under the Milk (Special Designations) Order, 1936:- Tuberculin Tested 6 Pasteurised 13 (b) Ice-Cream - Barking Corporation Act, 1933 - Section 160. There are 113 manufacturers and vendors registered, in accordance with this Act. This is a decrease of four in the number of registered premises. 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. Six samples were submitted for bacteriological examination, one of which was unsatisfactory. (2) MEAT AND OTHER FOODS. (a) Meat. There is one licensed slaughterhouse in the district, the licence of which is renewable annually. - 18 - - 19 - Statistics show the work carried out in this slaughterhouse during the year. The following table gives particulars of notifications received, and the animals slaughtered, during the twelve years ended December 31st, 1939. Year. 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 Notifications Received 126 72 61+ 39 57 34 205 236 195 179 184 112 Cattle 40 64 80 12 10 41 350 447 340 365 340 234 Pigs 409 137 93 200 84 18 502 1,131 474 457 212 77 Sheep 815 426 332 173 270 241 1038 1,346 748x 500+ 936* 545# Calves 71 10 11 1 9 1 140 157 11 38 3 2 Totals 1,335 637 516 386 373 301 2030 3081 1,639 1,360 1,491 857 x Includes 404 lambs. + Includes 199 lambs. x Includes 597 lambs. # Includes 257 lambs. The following additional table gives information as to carcases inspected and condemned during the year 1939 — Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number Killed 209 25 2 545 77 Number Inspected 209 25 2 545 77 All diseases except Tuberculosis:- Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 31 3 — 8 — Percentage of Number inspected affected with disease other than Tuberculosis 14.83 12.0 — 1.46 — Tuberculosis only:- Whole carcases condemned 6 3 — — — Carcases of which some part or organ was condemned 55 12 — — — Percentage of the number inspected affected with Tuberculosis 26.31 48.0 — — — - 20 - (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 26 Potted Meat and Brawn 4 Roast and/or Boiled Ham 6 Pressed, Pickled, Cooked, etc., Beef and Tongue 39 Roast Pork 5 Bacon 1 Boiled Crabs and Lobsters 1 Pickled Fish 8 Pickled Onions 1 Smoked Fish 7 Bakehouses 9 (c) Unsound Food. The following list gives particulars of unsound food destroyed during the year;- 70 Ibs. Frozen Ox Cheeks. 70 lbs. Kippers (5 boxes @ 14 lbs.) 7 lbs. Cooked Gammon Bacon. 1 lb. 2 ozs. Pears. 200 lbs. Chicken. 265 lbs. Beef. 195 lbs. Mutton and Lamb. 5 stone Coley. 20 lbs. Lambs Livers. 203 lbs. Beef. 60 lbs. Beef. 60 lbs. Ox Livers. (3) FOOD POISONING. There were 5 cases of food poisoning notified during the year. These were investigated and any necessary action taken. (4) ADULTERATION, ETC. I am indebted to Mr. A. Horsnell, 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 period 1st January to 30th September, 1939. These samples were submitted for chemical examination to Dr. Bernard Dyer, the County Analyst Great Tower Street, London, with the following results - Milk 15 Butter 24 Other 102 Total 141 At the 1st October, 1939, the Council became the administrative authority for the purposes of the Food and Drugs Act (1938). The first quarterly report of the Public Analyst, who continues to be Dr. Bernard Dyer, as - 21 - above mentioned, shows that the following action was taken;- Samples examined. Milk 1 Butter 2 Other 27 Total 30 all of which were found to be unadulterated, and no case was found of any infringement of the regulations relating to the use or the presence of preservatives in any of the samples submitted. (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. - 22 - SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (1) Notification. The evacuation scheme meant that we had a smaller population vulnerable to infectious diseases after the outbreak of war, and the notification figures show a significant decline. In October the Measles and Whooping Cough (Provisional) Regulations, 1939, were introduced, making these diseases notifiable. The following table shows the number of notifications of infectious diseases (other than Tuberculosis) received during 1939 Disease Total Total cases removed to Hospital Deaths Smallpox — — Scarlet Fever 192 170 — Diphtheria 91 91 — Enteric Fever (including Para-Typhoid Fever) 2 2 — Puerperal Pyrexia 10 4 — Pneumonia Acute Influenzal (18) 34 4 Acute Primary (59) 3 Following Measles (—) — Erysipelas 28 18 — Ophthalmia Neonatorum 3 3 — Acute Anterior litis 1 1 — Pemphigus Neonatorum 2 2 — Dysentry 2 1 — Food Poisoning 5 — — xMeasles 2 +5 — xWhooping Cough 4 +6 — Totals 419 337 7 X Notified during the period 29th October to 31 st December only, under the Measles and Whooping Cough (Provisional) Regulations, 1939. + Total for year. (2) HOSPITALISATION. On the 1st September the Barking infectious Diseases) Hospital was completely evacuated of all its cases, in order that it should fulfil its functions as a hospital under the Emergency Medical Service Scheme. Cases which were in the Hospital on the 1st September and which were at that time still in need of hospitalisation were sent to the Isolation Hospital of the Waltham Joint Hospital Board, with whom arrangements had been made for the treatment of infectious cases during wartime. The following table shows the cases dealt with at the Barking (infectious Diseases) Hospital until the beginning of September Disease In Hospital December 31st, 1938. Admitted during the year. Died Discharged. In Hospital September 1st, 1939. Scarlet Fever 32 158 — 174 16 Diphtheria (including Membranous Croup) 40 68 — 99 9 Puerperal Pyrexia 2 — — 2 — Pneumonia 4 24 1 27 — Erysipelas 2 15 — 17 — Ophthalmia Neonatorum — 2 — 2 — Others 10 82 1 90 1 Acute Anterior Poliomyelitis — 1 — 1 — Pemphigus Neonatorum — 2 —" 2 — Bed Days.- The number of bed days in respect of infectious disease cases, until the 1st September, 1939s was 12,197 - that is to say, an average of approximately 50 patients in hospital per day. The following table shows details of Barking cases admitted to the Waltham Cross Isolation Hospital during the period 1st September to the 31st December, 1939. The figures, given in the first column denote the number of cases which y/ere transferred direct from the Barking Hospital : - Disease in Hospital September 1st, 1939. Admitted Died Discharged. In Hospital December 31st, 1939. Scarlet Fever 10 11 — 18 3 Diphtheria (including Membranous Croup) 5 20 — 20 5 Enteric Fever — 1 — 1 — Cerebro-spinal Fever — 1 — 1 — Puerperal Pyrexia — 2 — 1 1 Erysipelas 3 — 3 — Others — 3 — 2 1 - 23 - (3) INFLUENZA. In November, 1939, Circular 1906 was received from the Ministry of Health, together with Memo. 2/Med, dealing with influenza. As a result of your considerations of this circular and memorandum, you approved a scheme for the domiciliary medical treatment of influenza, including the dispensing of doctors' prescriptions. This scheme, should the occasion arise, can be put into operation. (4) TUBERCULOSIS. Particulars of new cases of Tuberculosis and of deaths from the disease in the area during 1939, are given below :- New Cases Notified. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 year 1 to 5 years — — 3 1 — — — — 5 to 15 years — 2 2 2 — — — — 15 to 25 years 7 17 1 2 2 6 — 2 25 to 35 years 7 15 2 3 7 6 — — 35 to 45 years 8 4 1 — 7 3 1 — 45 to 55 years 9 3 — — 7 2 — — 55 to 65 years 3 1 — 1 6 — — — 65 years and upwards — — — — 2 — — — Totals 34 42 9 9 31 17 1 2 During the year, 94 notifications were received of all forms of Tuberculosis - pulmonary 76, and non-pulmonary 18, and there were 2 deaths of un-notified cases, making a total of 96 new cases during the year. Information has been received of the removal into the district of 22 tuberculous persons, included in number of notifications received. This compares with 44 received during 1938, and 36 for 1937. Many of the patients in sanatoria at the outbreak of war were discharged to their homes, in order that the beds in the sanatoria could be re-grouped to meet the national emergency. Towards the end of the year, however, most of these cases had been re-admitted. (3) CANCER. During the year 1939, the Cancer Act was passed; the purpose of this Act is to establish a cancer service, under which, in every part of the country, modern facilities for diagnosis and treatment will be available. So far as Barking is concerned, the Essex County Council is responsible for this service. - 24 - V . :■ -:-U (6) ARTIFICIAL IMMUNISATION. Weekly immunisation clinics were held in Barking prior to the war; these were cancelled at the commencement of war, tut were recommenced in October. - 25 - SUPPLEMENTARY ADDENDUM to the Annual Report of the Medical officer of Health for the Borough of Barking, for the Year ended 31st December, 1939. oooOooo (Having particular relationship to Section 'A') (See Page 5) Based on Annual Returns and Statistics received from the Registrar-General after the Report had been completed. oooOooo 1. GENERAL STATISTICS, Resident Population:- (a) For calculation of Birth Rates - 77,500. (b) For calculation of Death Rates or the incidence of notifiable diseases 73,880. 2. VITAL STATISTICS. Deaths 562. Death Rate. 7.6l Live Births ( (B.R.) - for calculating Birth Rates) 1,141 Birth Rate. 14.72 Still Births 40 Still Birth Rate per 1,000 total Births 33.87 Live Births ( (I.M. &c.) - for calculating Infant and Maternal mortalities) 1,091 Number of deaths of infants under one year of age 37 Infantile Death Rate 33.91 Number of maternal deaths 3 Maternal Mortality Rate 2.65 oooOooo - 26 -