BARK 74 BOROUGH OF BARKING. THE ANNUAL REPORT of the SCHOOL MEDICAL OFFICER FOR THE YEAR 1939 (War Edition). C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. B0ROUGH of BARKING Public Health Department, Barking, Essex. August 1940. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Ladies and Gentlemen, I beg to submit my Report for the year ended 51st December 1939. At the special request of the Board of Education, this Report does not describe in detail, as in former years, the work of the Special Services of Barking, but I am to advise you that up to the Declaration of War your Special Services functioned normally and were as set forth in my Report for the year 1958. This particular Report deals with the changes in the Special Services brought about by the war. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, School Medical Officer. 2 ANNUAL REPORT of the SCHOOL MEDICAL OFFICER for the YEAR 1959 (War Edition). (1) STAFF of the SCHOOL MEDICAL SERVICE. There have been considerable changes during 1959 in the staff of the School Medical Service. These changes are set out below:- 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 School Medical Officers. T.M. Clayton, M.B., B.S., B.Hy., D.P.H. (Resigned 25rd September, 1959). Margaret A. Glass, B.Sc., M.B., Ch.B., D.P.H. (Resigned 51st March, 1939). Muriel M. Osborn, M.R.C.S., L.R.C.P. (Resigned 28th August, 1959) T.A. Cockburn, M.D., D.P.H. (Commenced 15th March, 1939) Phoebe I. McKernan, L.R.C.P., L.R.C.S., L.L.M. (Commenced 28th August, 1939) Dental Surgeons. R.O. Borgars, L.D.S., R.C.S. (Resigned 31st January, 1959). Eileen F. Gawn, L.D.S., R.C.S. (Resigned 20th May, 1959). J. Angelman, L.D.S. (Commenced 1st July, 1939) J.R. Watson, L.D.S., R.C.S. (Commenced 10th July, 1959). Nursing Staff. x Miss E. Fisher, (g, h and i). (Resigned 50th November, 1939) x Miss R. Hobbs, (g, h, i and i). (Resigned 2nd November, 1959) x Miss M. McAlister, (g, h, i and j). (Resigned 14th March, 1939). Miss S.E. Ware (chiropodist) (s) (Commenced 2nd January, 1959). (Resigned 15th November, 1959). (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. (s) Certificate of Chiropody of the Chelsea School of Chiropody. * Combined appointment - Health Visitor and School Nurse. 3 No medical, dental, nursing or clerical staff has been transferred to the Evacuation Reception Areas; no requests for such transfers were received from Reception Areas during 1939. During the latter part of the year, immediately subsequent to the Declaration of War, all the members of the staff were designated to posts in connection with Civil Defence, but math the consequent re-organisation of the School Medical Services the staff has been released from Civil Defence work. The majority, however, continue to take their parts in the Civil Defence Scheme, on a voluntary basis. (2) EVACUATION. At the outbreak of war 8,039 Barking schoolchildren were evacuated to areas of greater safety. The arrangements for the evacuation of these children were conducted by the Barking Education Authority as a unit of the London County Council's Scheme, and the staff of your School Medical Services accorded every possible co-operation. The children attending the Faircross Special School were dealt with separately - the mentally defectives and the physically defectives going to different centres. These centres were adapted to meet the particular needs of these special children. The physically defective children were accompanied by your Senior Masseuse and the mentally defective children were accompanied by one of your School Nurses. These Officers only remained in the Reception Areas for a few days. Later on in the year, visits were paid by members of the Council and its Officers to the Reception Areas. These visits were much appreciated by the Reception Authorities, and although much could be written upon the observations made as a result of these visits, it is proposed merely to say that undoubtedly Reception Authorities were faced with far greater problems than were the Authorities in the Evacuation Areas, and that unquestionably these problems will be discussed in detail in the Annual Reports of the Medical Officers for the districts concerned, if indeed they are not discussed before, at special meetings called for the purpose of co-ordinating the various schemes. I should, however, like to mention the general tribute which has been paid by visitors to the Reception Areas to the admirable way in which these Areas have tackled the problems arising from the sudden influx of evacuated people thereto. The first Evacuation Plan made no provision for the special medical examination of children before departure to the Reception Areas, but in Barking arrangements were made for your Health Visitors & School Nurses to be present at entraining stations, for the purpose of giving treatments for minor injuries, cuts, sores and bruises etc. Subsequently, the closest co-operation has been established with the School Medical Authorities in the various Reception Areas, and some hundreds of school medical inspection records have been temporarily transferred. 4 J. J. 'W- The Essex County Council, who are responsible for the treatment of Tuberculosis in Barking, have made arrangements for their case records in respect of evacuated children to be sent to the Reception Areas and the names of these children are temporarily removed from your Register. At the end of the year, Barking in common with other Evacuation Areas found that children were drifting back from the Reception Areas, and that therefore Services which had been curtailed at the beginning of the war would have to be re-organised. (3) THE EXTENT TO WHICH THE SCHOOL MEDICAL SERVICES HAVE, FUNCTIONED DURING 1939 As I have said in my introductory letter, your School Medical Services functioned normally until the Declaration of War, when the Schools were closed and the first Evacuation Plan was operated. This, naturally, disrupted the whole of your Special Services, but the following pages will attempt to show the way in which these Services were affected and the way in which they were re-organised to deal with the special problems which have since arisen. (4) HYGIENE. It must be assumed, on general principles, that the state of tension which has prevailed for the greater portion of 1939, the "black-out" and the abnormal movements of the population during the last four months, must have had a disturbing influence on children generally. On the other hand, the movement of a large number of children to country districts and the added freedom which the children have enjoyed on account of the closure of the schools - a matter which must be taken into account - makes me feel justified in saying that, generally speaking, the health of the child population did not suffer during the months of war in 1939. On the contrary, many of them benefitted by their "holiday" in the country. It may be possible in my next Annual Report to assess to some extent the effect of war conditions on the health of the children. As the war had been in progress for four months only during 1939 we have been unable to gather sufficient data for a considered opinion at this stage; neither were the Services sufficiently active to enable us to obtain the necessary data. (5) MEDICAL INSPECTION. School Medical inspection ceased on the closing of the schools for evacuation. Towards the end of the year, however, the Local Education Authority had under consideration a scheme for the re-opening of some of the schools in the Area, for short periods of education, and this scheme will provide for the medical inspection of all children whilst at school. During November and December 1939, 274 of the schoolchildren remaining in the Area were specially medically inspected in connection with "trickle evacuation" under the original Evacuation Plan. 5 : > : • ■-!: ' ■ , ' (6) FOLLOWING-UP Following-up work by your Health Visitors & School Nurses was obviously interfered with by the events immediately prior to and subsequent to the outbreak of war, and by vacancies on your staff, recorded on this page. Nevertheless, considerable following-up has been accomplished and this accounts to some extent for the relatively high attendances at the Clinics. It cannot be said with too great an emphasis how the following-up visits of the Health Visitors & School Nurses materially help in maintaining, and indeed improving, the general level of health of your school-children. It is, therefore, essential that an adequate number of health visitors and school nurses should be available for this work. At the beginning of the year you had on your staff two school nurses and ten officers holding the joint appointment of health visitor & school nurse. At the end of 1939 these figures were respectively two and seven. I do urge that these vacant posts should be filled. (7) ARRANGEMENTS FOR TREATMENT. (a) Minor Ailments. Normally there are three Minor Ailments Clinics in Barking, at each of which six sessions per week have been held until the commencement of hostilities i.e., Central Clinic, Woodward Clinic and the temporary Clinic in Porters Avenue. The Central and Woodward Clinics are now First Aid Posts in connection with the Civil Defence Scheme and both of these Clinics were closed for a few days in September 1939 They were both re-opened when the works of adaptation and protection had been completed and since then the full six sessions per week have been held at both Clinics. In December 1939 there were 539 attendances of school-children for treatment at the Central Clinic, compared with 1,110 in December 1939, and at the Woodward Clinic there were 8l7 compared with 1,589 in December 1938. In other words, the attendances at Central and Woodward Minor Ailments Clinics in December 1939 were approximately half those of a normal pre-war month. The temporary Minor Ailments Clinic in the Church Premises at Porters Avenue was discontinued in September 1939 and it has not been thought desirable to re-open this temporary Clinic. The children who normally attended at Porters Avenue Clinic now attend at Woodward Clinic. One of the reasons for discontinuing the Clinic in Porters Avenue was the lack of protected accommodation or shelter in the immediate vicinity. A small number of special cases are now attending at the Humphrey Centre (First Aid Post), in the grounds of the Barking Hospital, Upney Lane. (b) Ophthalmic Service. Prior to the war the Specialist Consultant (Mr. W.A. Gray, F.R.C.S.) attended for three sessions per week in Barking. On the outbreak of war this service was temporarily discontinued and did not recommence until the 31st October 1939, since when until the close of the year raider review some twenty-two sessions have been held. 6 - ' 'i• • .. .!■;;■ ;•■■■■ • ' • •' I'. • ' : y ■ ■ : ■. . . < I t - r- i . At the actual close of the year one session per week was being held, alternating between Central and Woodward Clinics, but it is anticipated that if the drift back of children from the Reception Areas continues it will be necessary to increase the number of sessions. This is almost certain to be the case as it is anticipated that some school medical inspection will be commenced early in 1940, with a corresponding increase in the number of cases referred for visual defects and external eye disease. Squint training - using a synoptophore - was temporarily discontinued until the 8th December 1939, since when five sessions have been held up to the end of 1939. Contact has been established with the Reception Areas, with the result that children who are refracted in the Reception Areas can, if the parents so wish, obtain their glasses from Barking, at special contract prices or, in necessitous cases, free of charge. This is found to be a convenience to all concerned as most often, in rural areas, the provision of a pair of spectacles necessitates correspondence with a contractor in a relatively distant town or, in fact, a visit to the contractor's premises. On account of the need for economy, the usual Report of your Specialist Consultant has been omitted this yeari (c) Ear. Nose & Throat Service. Before the war the Council's Consultant Ear, Nose & Throat Surgeon (Mr.C. Ratcliffe Sandiford, F.R.C.S.) attended at the Woodward Clinic for two sessions per week. This service was temporarily discontinued until the 8th December 1939, when Ear, Nose & Throat Clinics were recommenced, one session per week being held until the close of the year. The arrangements for the admission of cases to the Queen Mary's Hospital, Stratford, and the St. Mary's Hospital, Plaistow, under the Authority's approved scheme, were naturally interrupted by the war, but were resumed in December 1939, when ten cases were operated upon at these Hospitals. With regard to the operative treatment of enlarged tonsils and adenoids, in April 1939 the Board of Education approved the Authority's scheme for operative treatment to be carried out at the Barking Hospital in Upney Lane. Under this scheme it was proposed to set aside a Ward at the Barking Hospital, during the summer months, and the operative treatment would have been undertaken by Mr. Sandiford, your Consultant Ear, Nose & Throat Surgeon. The chief advantages of the scheme were that journeys by ambulance would be obviated and the children could be admitted to Hospital prior to the operation taking place, and so allow them to become settled down, and it would also be possible for them to be kept in the Hospital after the operation. Unfortunately, it was not possible to operate this scheme prior to the outbreak of the war and since then, of course, the Barking Hospital has become an important unit in the Ministry of Health's Emergency Hospital Scheme. I am still hopeful, however, that arrangements may shortly be made for this work to commence at the Barking Hospital, even if on a restricted basis, unless the exigencies of war make it absolutely impossible. 7 . ■ x ' -v , -K, . .... In this Abridged Report it is not possible to give the usual Reports of all your Consultants, but the following extracts from the Report for 1939 of your Consultant Ear, Nose & Throat Surgeon are given because of their particular interest :- "The most interesting feature noticed during this year's work in the Ear, Nose & Throat Clinic was the discovery, made on the resumption of work in December, after the temporary suspension caused by the course of events in September, of the very marked improvement in the state of health of the patients. This was particularly noticeable amongst the nasal cases, many of whom had been receiving treatment for such conditions as Infected Antra, Hypertrophic Turbinitis, Infected Tonsils and Adenoids, and it was found possible in December to discharge many of these cases as cured. Searching around for the most likely explanation of this phenomenon, one has concluded that the improvement has been due to two factors :- (a) Lack of re-infection owing to non-attendance and herding together at school, and (b) An increased amount of sunshine and fresh air owing to the increased time spent in the streets and open spaces." In connection with evacuation, much has been done to continue your Ear, Nose & Throat work, in the Reception Areas. Many special medical records have been sent to the School Medical Officers in the Reception Areas and in a number of cases, arrangements have been made, with the parents' consent, for operative treatment to be carried out at Hospitals in the Reception Areas. (d) Dental Inspection and Treatment. With the exception of the first week in September 1939 dental treatment has been continued at two of the three Dental Clinics authorised by the Board. During the first week in September 1939 it was impossible to continue dental treatment, as works of adaptation and protection were being undertaken to render the Central Clinic and the Woodward Clinic suitable for First Aid Posts under the Civil Defence Scheme. It is still extremely difficult to carry out dental treatment at these two Clinics. So much so that the Central Dental Clinic has been temporarily closed and the Local Education Authority intend to submit to the Board of Education proposals for transferring the work of the Central and Woodward Dental Clinics to the medical inspection suites at two of the Schools of the Authority. With the closure of the schools for evacuation, it naturally followed that school dental inspection, as such, ceased, but now that the children will shortly be assembled at the schools, in small groups, for partial education, arrangements are being made for school dental inspection to be resumed. The following shows, briefly, the extent to which school-children are utilising the Dental Service, compared with a year ago Dec. 1938. Dec. 1939. Total number of treatments given to school-children 802 437 8 / The prevention of Diphtheria, Scarlet Fever and Whooping Cough, by immunisation, is one of your normal services, but no Immunisation Clinics were held during September and October 1939 From the l8th November 1939 onwards, one Immunisation Clinic was held weekly at the Humphrey Centre (First Aid Post), in Upney Lane. Prior to the war, one session per week was held at both the Central and the Woodward Clinic. 9 (e) Orthopaedic Treatment. The usual monthly attendance of the Consultant Orthopaedic Surgeon (Mr. B. Whitchurch Howell, F.R.C.S.), discontinued on the outbreak of war, was resumed in December 1939, when 28 school-children were seen by him, as compared with an average monthly attendance of 36 school-children. With the exception of a few days early in September 1939 Remedial Exercises and other treatments have continued to the close of the year. (f) Ultra Violet Light Treatment. Ultra Violet Light Treatment has been continued, with the exception of a few days early in September 1939. (g) X-ray Treatment for Ringworm of the Scalp. There is little demand for this Service, but no child who required this form of treatment has been deprived of it on account of the war. t (h) Speech Training. With the closing of the schools at the outbreak of the war, the Speech Training Centre was closed and has not been re-opened up to the close of the year. (i) Foot Clinic. The services of the Municipal Foot Clinic, commenced in July 1938 for the treatment of minor foot troubles, were made available to school-children, but this Clinic ceased to function on the outbreak of war. This service was recommenced on the 11th December 1939, when it was made available, once again, to school-children. 8. INFECTIOUS DISEASES. There was a decrease in the number of notifiable infectious diseases during the year, and in the latter part of the year there was a still further decrease. Towards the end of the year we should, in the normal way, have expected to receive information of the occurrence of a large number of cases of measles amongst the school population, but owing to the large exodus of children from London, it was the Reception Areas who reported many cases of measles occurring in their districts. It was found that as the children commenced to return home the number of cases of measles notified in this area increased. In October the Measles and Whooping Cough (Provisional) Regulation, 1939, was introduced, making these diseases notifiable, and although these Regulations are a great help in bringing to our notice cases occurring amongst toddlers and young adults, in normal times it is not anticipated the Regulations would help us so much where school-children are concerned. This is because we have always received up-to-date information from School Attendance Officers of cases of acute non-notifiable infectious diseases occurring in school-children. It was unnecessary during the year to close any School or School Department on account of infectious disease. 9. OPEN-AIR EDUCATION. The week-end School Camps, held at Hainault Forest, and which have been a permanent feature of the Committee's work for so many years, were held as usual until the Summer Recess, when they were discontinued on account of the national emergency. The Holiday Camps, each of a fortnight's duration, have not been held during 1939* 10. PHYSICAL TRAINING. I have received no report from the Organisers of Physical Training (Miss C.M. Hawkes and Mr. L.E. Last) but it is with pleasure I append the following extract from their Report to the Education Committee, as this extract has particular reference to physical education in Barking from September to December 1939:_ "The two new gymnasia at the Manor Central School were used from the beginning of December onwards as physical training centres to which 40 boys and 40 girls from each of the five areas in which the Barking schools were organised, were brought once a week by the Committee's omnibuses for an hour's physical training. In addition, those children who were within reasonable walking distance of the school attended for two additional periods per week. The enthusiasm and enjoyment shown by these children in the facilities afforded by well-equipped gymnasia and showers is an indication of the need for such conditions in every senior school. Periods of physical training were also included in the time-table of all schools when these re-opened for an hour's daily instruction for older children in November. It was even more satisfactory to note that teachers expected the same effort and standard of work from the children as in normal times." 11. PROVISION OF MEALS. MILK AND COD LIVER OIL & MALT, etc. The provision of solid meals and milk ceased on the 1st September 1939. Meals were recommenced on the 6th November 1939, and milk on the l8th December 1939. The supply of Cod Liver Oil & Malt, and other special preparations were interrupted for a few days only, whilst the Clinics were closed for purposes of Civil Defence works. In view of the Committee's close interest in the question of malnutrition, I set out below figures extracted from Board of Education Statistical Return (Form 8 a.M.) :- Classification of the Nutrition of Children Inspected during the year in the Routine Age Groups, up to 31st August 1939. AgeGroups. No. of children inspected. A (Excellent) . B (Normal). c (Slightly subnormal). D (Bad). No. % No. % No. % No. % Entrants 6 77 202 29.8 440 65.O 34 5.0 1 0.2 Second Age- Group 8l8 186 22.7 587 71.8 45 5.5 — - Third Age- 448 Group 595 133 22.3 75.3 14 2.4 — - Other Routine Inspections — - - - - - - - TOTALS 2,090 521 24.9 1,475 70.6 93, 4.45 1 0.05 10 12. PROVISION OF SCHOOL MEDICAL SERVICES FOR SECONDARY and TECHNICAL SCHOLARS IN THE AREA. The scheme whereby you carry out the medical examinations for the Essex County Council in connection with the Barking Abbey School and the Day School of the South-East Essex Technical College, was discontinued at the outbreak of the war, as these Schools were evacuated. The school medical inspection records of these children have very largely been transferred to the Reception Areas. 13. SPECIAL SCHOOLS. On the 1st September, 1939, parties left Faircross School by buses for adapted holiday camps. Of the Physically Defective Children attending school in July, 1939, 49% were evacuated and of the Mentally Defective children 53% were evacuated. In November 1939 the Physically Defective Children were moved to an L.C.C. School Camp. The Faircross School was not re-opened for special children during the year. 14. UNCLEANLINESS. Routine cleanliness inspections were carried out by Health Visitors & School Nurses during the year, until the closing of the schools for evacuation. In spite of the efforts which have been made in regard to housing accommodation, invigilation and treatment there still remains approximately five per cent of the normal school population in Barking who are found unclean. Although no special complaints have been received in respect of Barking children, many Reception Areas have registered the fact that many children sent to their areas, under the Government Evacuation Scheme, were found to be unclean. We must, in these days of war, ensure that everything possible is done to ensure the maintenance of the good health of our children, and every effort will be made to see that the number of children found unclean is reduced. Although school cleanliness inspections must of necessity cease until the schools re-open, the Health Visitors & School Nurses are ever watchful for cases of uncleanliness, during their following-up work, and cases are being sent to the Clinics for appropriate treatment, where this cannot, or will not be, given by the parents themselves. 15. STATISTICS. The Statistical Tables required by the Board of Education have been completed and despatched. The Board have specially suggested that these Tables should not be reproduced in this Report, in view of the present urgent need for economy in the use of paper. For the same reason I have abstained from giving the usual mass of statistics on the work of the School Medical Services during 1939, but the bulk of these statistics are available in the office for any member of the Committee to study, should he or she wish to do so. In the interests of further economy, this Report appears in a new guise on this occasion. 11