BARK 75 BOROUGH OF BARKING. THE ANNUAL REPORT of the SCHOOL MEDICAL OFFICER. FOR THE YEAR 1940 (War Edition) C. LEONARD WILLIAMS, B.Sc., M.B.C.S., L.R.C.P., D.P.H. BOROUGH OF BARKING. ANNUAL REPORT of the School Medical Officer for the Borough of Barking, in the County of Essex, for the year ended 31st December, 1940. (War Edition). Public Health Department, Barking, Essex. December, 1941. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Ladies and Gentlemen, I have pleasure in submitting my report for the year ended 31st December, 1940. 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 1940 (War Edition). (1) STAFF of the SCHOOL MEDICAL SERVICE. The following indicates the many changes that have taken place in the staff of the School Medical Service. during the year 1940:- Deputy Medical Officer of Health and Deputy School Medical Officer. Violet Spiller, M.D., M.R.C.S., L.R.C.P., D.P.H. (Appointed 1st December, 1940.) Consultant Orthopaedic Surgeon. B. Whitchurch Howell, F.R. C. S. (Service as Consultant Surgeon to the Ministry of Health as from July, 1940) A.M.A.Moore, F.R.C.S. (Commenced 17th October, 1940) Consultant Ear, Nose and Throat Surgeon. Cyril R. Sandiford, F.R.C.S. (Deceased 22nd August 1940) F. Courtenay Mason, F.R.C. S. (Commenced 2nd December, 1940). Health Visitors etc. +Miss M.G.Bennett (g.h and I).(Commenced 12th August, 1940. Temporary - transferred to Permanent Staff 1.11.40) +Miss U.K.Crotty (g,h and I). (Commenced 12th August, 1940. Temporary - transferred to Permanent Staff 1.11.40) +Miss C. Court (g.h and i). (Service in H.M.Forces as from 1st March, 1940). Miss L.B.S.Davies (Masseuse) - Temporary, (n) (Commenced 15th October, 1940 + Miss E.C.Everett (Temporary), (g and h) (Commenced 11th August, 1940). +Mrs. F.E.Fenna (Temporary). (g, h 1) (Commenced 15th April, 1940) Miss J. Harris (Masseuse), (n) (Resigned 14th September, 1940). +Miss R. McCandie (g.h and i) (Resigned 13th August, 1940). Mrs. H. Sachs, M.B.A.Ch. (Chiropodist) - Temporary part-time. (Commenced 8th April, 1940). +Mrs. Sutherland (g,h and i) Temporary. (Commenced 10th June, 1940). Miss L.F.Swain (School Nurse), (h and i) (Retired 30th September, 1940). Miss M. Thompson (Masseuse), (n) Resigned 5th October, 1940. (g) Health Visitor1 s Certificate of the Royal Sanitary Institute. fh) Certificate of the Central Midwives Board. fi) General Hospital Training. (n) Certificate of the Chartered Society of Massage and Medical Gymnastics, Medical Electricity, Light and Electro-Therapy +Combined appointment - Health Visitor and School Nurse. - 3- The year has seen many comings and goings. Some of my colleagues have been drafted into the Forces and. other people have come to take their places and amongst those who have left us I would particularly wish to mention Mr. C.R.Sandiford, F.R.C.S. who passed away on the 22nd August, 1940. He laid the foundations of your Ear, Nose and Throat Out-Patient Department; was beloved by everybody, and those of us who1 were privileged to work together with him felt deeply the loss of such a sincere friend. Those for rhom he worked and amongst whom he worked felt his loss no less. During the year members of the staff have continued to participate in the Civil Defence Scheme, but for the most part they have been engaged upon their normal duties in connection with the Public Health and Medical Services. -4- (2) EVACUATION. (a) Madical arrangements. The Committee will recall that in my Annual Report for 1939 I commented on the fact that no provision was made in the first evacuation plan for the soecial medical examination of children before departure to the Reception Areas. Early in 1940 the Minister of Health issued to Evacuation Authorities some recommendations on this subject. The London County Council convened a conference of School Medical Officers of Authorities included in the Metropolitan Evacuation Scheme and, as your representative, I attended this conference on the 11th March 1940. Detailed arrangements were agreed upon for the medical examination of children registered for evacuation and I had the honour to be nominated to serve on a Sub-Committee appointed to discuss this aspect of evacuation with medical representatives of the Reception Authorities. This Sub-Committee met in London on the 23rd May, 1940, and coming away from the conference I was satisfied:- (i) That all possible steps had been taken in Barking; (ii) That direct contact should be maintained between the Evacuating and Reception Authorities, both by visits by His Worship the Mayor and representative Councillors and by Officers of the Authority. In this connection I learnt from the Medical Officer representing Somerset that the visit of His Worship the Mayor was still remembered, by reason of the keen interest he took in the evacuees from Barking.- The Authority has continued this policy of visits of its members to the Reception Areas; (iii) That apart from medical inspection more care should be taken to see that all evacuees are properly clothed, and especially that not only do they have good footwear but footwear suitable for the country and (iv) That so far as be practicable children who have not been registered for evacuation should be kept under medical review in order to ensure their medical fitness for evacuation. (b) Plan IV Movement. Notwithstanding the comparatively large number of late registrations, all of the 2,352 children who left Barking during June 1940, under Plan IV, for Wiltshire, Oxfordshire, Gloucestershire, Somersetshire, Devonshire and South Wales, were medically inspected and every label aporopriately marked in accordance with the approved Code of symbols. The "initial" inspections were conducted by the Authority's medical staff but with regard to the "Pinal" inspections, sixteen general medical practitioners agreed to hold themselves in readiness to assist your medical staff, if -5- necessary, and a Memorandum on the examination and labelling of the children was drawn up and issued to these doctors. The final arrangements made it unnecessary for us to engage more than four general practitioners for a total of 19 hours, but I would like to take this opportunity of expressing my thanks to the general practitioners of the district for their keen co-operation. The following statistics show the number of inspections of various types carried out under Plan IV:- "initial" medical examinations 2,748 Re-Inspections by nurses 2,258 "Final" medical examinations 2,378 The results of the 2,378 "Final" medical examinations and the markings of the labels are set out below:- No. marked with a red cross (Passed "Fit - no defect") 2,083 No. marked with a red circle (for a hostel):"A" - on account of Impetigo 5 "B" - " " " Scabies 17 "C" - " " " Live Vermin None 22 No. marked with a red square (For Special Consideration):"D" - on account of Nits 94 (Of this number the majority were subsequently cleansed by School Nurses and were free from nits on departure, and some were cleansed at home) "E" - on account of Enuresis 87 "F" - on account of Infectious Disease contact None "G" - on account of other conditions 89 270 No. marked "Unfit for evacuation" at this stage 3 2,378 The Nutritional State of these children was as follows "A" - Excellent 9.0 % "B" - Good 73.7 % "C" - Slightly subnormal 16.1 % "D" - Bad 1.2 % (c) Subsequent Movements. From the time of the completion of Plan IV to the end of the year 1940, 853 medical examinations were conducted in connection with evacuation under subsequent Plans. -6- (d) Overseas Evacuation. 58 medical examinations were conducted in respect of children registered for overseas evacuation and special reports were completed for the Children's Overseas Reception Board. (a) Cleansing Facilities in connection with evacuation. As the Committee is aware, the re is no Public Cleansing Station in Barking but in order that, if possible, any dirty children should be cleansed before departure to the Reception Areas, you did contemplate making certain minor adaptations to existing lavatory suites at two schools- one at each end of the town. It was proposed that adequate supplies of hot water would be available, delivered through shampoo fittings of a simple nature, over existing lavatory basins. Electric hair dryers were also to be installed. Under this scheme children found to have nits or live vermin would have been referred to these places for a special shampoo. Parents would have been expected to give the 3hampoo, under trained supervision; special soap and nit combs would have been available . However, the large movement under Plan IV took place before these adaptations were put in hand and we were fortunately able to deal with the dirty cases with the existing facilities; some children were also cleansed at home. (See page 6 of this Report). (3) HYGIENE. Nutrition and vitality are factors it is almost Impossible to standardise. It Is therefore obviously diffcult to say at this stage what, if anything, has been the effect of the War on the Health of the school population. It is further heartening to find that no significant variation from normal has been noted by your medical officers and this observation will, I feel sure, be accepted with satisfaction. (a) The food problem was only at its inception in 1940 and during that year there was little cause for any significant variation in nutrition. Alternative foods, throughout 1940, wore comparatively casy to obtain and In some schools a substantial midday meal was served daily to which children could go either free or on payment of a small fee. (b) The comparatively poor hygienic conditions in shelters had, of course, little or no influence until August, 1940, and although it was anticipated there would have been some considerable spread of infectious diseases, it was found that apart from scabies (dealt with later) and the common cold, very little effect on the health of children was noted due to this particular factor. (c) So far as the possiblity of nervous strain due to constant day and night raids is concerned there is again little evidence. The lost hours of sleep were often made up by lato mornings in bed so that schooling was more likely to suffer than the child's health. The actual -7- element of fear appears to have been a minor one many children sleeping through the worst raids or regarding the whole as an exciting adventure. The majority of the more nervous children were evacuated by their parents, thus leaving only a small number of nervous children who may have suffered but showed no obvious signs of deterioration in health by the end of 1940. (4) MEDICAL INSPECTION. In Barking it was found practicable to carry out quite frequent routine medical inspection, indeed an attempt was made to carry out full routine medical inspections on every child in your schools once a term and as a matter of fact this attempt proved successful. I am convinced that this took up no more time than normal medical inspections and carrying out flying nutritional surveys and so far as my information goes these frequent routine medical inspections not only achieve all that can be done by nutritional surveys but also help to expedite the treatment of outstanding disabilities. In making this statement I want to make it quite clear I express no adverse opinion whatsoever on the value of nutritional surveys under certain circumstances. It was your good fortune that you had already set up a service which could be intensified, in the way you determined and which it is my submission has proved highly successful. If the number of children inspected appears to be small it is to be remembered that a large number of children were evacuated and it is also to be noted that during 1940 the amount of time taken over these inspections is longer than it would have been during peace time because, of course, the air raids and threatened air raids interfered with the work of your officers by reason of the fact that the children were being, from time to time, shepherded in and out of shelters. (a) Routine Medical Inspections: Number of Inspections in the prescribed Groups:- Entrants 1,120 Second Age Group 1,206 Third Age Group 945 Total 3,271 Number of other Routine Inspectionos 3,005 Grand Total 6,276 (b) Other Inspections: Number of Special Inspections and Re-Inspections 17,210 -8- (5) FOLLOWING - UP. This has been carried out successfully under particularly trying conditions, partly due to interruptions by frequent day raids, partly owing to the number of evacuating and returning families and partly owing to the number of damaged houses which people were obliged to evacuate and despite the considerable help we have had from the billeting authorities it has taken time to trace these people at their new addresses. In spite of these obstacles much valuable work has been done by your Health Visitors and School Nurses. (6) ARRANGEMENTS FOR TREATMENT. (a) Minor Ailments. These have befen carried on at Woodward and Central Clinics, both of them also being used simultaneously as First Aid Posts. It was not thought (during 1940) that the demand was sufficiently great to re-open your third Minor Ailments Clinic at Porters Avenue, and children who would otherwise have attended there were seen at Woodward Clinic. The full six sessions por week were held at both clinics. MINOR AILMENTS CLINICS, YEARS 1938, 1959 and 1940. The following Table summarises the work of the Minor Ailments Clinics in respect of public elementary school-children, and gives a comparison with the years 1938 and 1939i- Year. Clinic. No. of days Clinic was open. No.of Attendances. Daily Average Attendance . No.of cases dealt with. Total no. of Attendances. Total No. of cases dealt with. 1938 CENTRAL 307 14,961 48.7 3,316 49,594 9,985 HUMPHREY - - - - WOODWARD 307 25,843 84.1 5,099 PORTERS 203 8,790 43.3 1,570 1939 CENTRAL 321 8,035 25.0 2,376 34,781 7,158 HUMPHREY 122 15 0,1 4 WOODWARD 307 16,033 52.2 3,182 PORTERS 206 10,698 51.9 1,596 1940 CENTRAL 321 4,863 15.1 1,380 14,827 2,930 HUMPHREY 365 331 0.9 100 WOODWARD 306 9,633 31.4 1,450 PORTERS - - - - Humphrey Clinic was opened for Minor Ailments purposes on 3.9.39. Porters Avenue Minor Ailments Clinic was closed on 2.9.39. -9- (b) Ophthalmic Service. This service has carried on throughout 1946, mostly with 2 or 3 sessions a week - some held at Woodward Clinic, and come at Central Clinic. Actually 82 sessions we re held in all during the year, and the following table gives a rough summary of work done. TREATMENT OF DEFECTIVE VISION AND SQUINT. (Excluding Minor Byo Defects treated as Minor Ailmonts)• Number of Defects dealt with Under the Authority' s Scheme. Otherwise. Totals 1938 1939 1940 1938 1939 1940 1938 1939 1940 Errors of refraction (including squint). 1045 758 525 21 3 48 1066 761 573 Other Defects or Disease of the Eyes (excluding those recorded in Group I) - - - - - - - - TOTALS 1045 758 525 21 3 48 1066 761 573 Number of children for whom spectacles were:- (a) Prescribed 387 255 271 18 3 38 405 258 309 (b) Obtained 394 262 284 18 3 4 412 265 288 During 1940 we were still sending spectacles to the Reception areas in cases where the children had been refracted away from Barking and the parents wished to obtain spectacles from Barking at special contract prices or, in necessitous cases, free of charge. The total number of spectaclcs thus supplied was 49. Squint training has been resumed and 126 sessions were held during the year. A considerable amount of valuable work was done there as will be seen by the following table. -10- ORTHOPTIC CLINIC. 1940. No. children attended 44 No. new cases 16 No. old cases 28 No.attendances 532 No. discharged cured 2 No. evacuated 20 No. left school 2 No. discontinued 7 No. of sessions 126 The average attendance per session is very low on account of air raids. (c) Ear, Nose and Throat Service. Owing to the sad loss sustained by you in the death of Mr. C.R. Sandiford, there was an interval in the weekly Ear, Nose and Throat sessions held at Woodward Clinic between the 9th August and the 2nd December, 1940 when Mr. Courtenay Mason took over as our Consultant Specialist for diseases of the Ear, Nose and Throat. Actually as a result of this only forty sessions were held during the year. Most of the cases which received operative treatment through the Corporation's scheme were dealt with at Queen Mary's Hospital. TREATMENT OP DEFECTS OP NOSE AND THROAT. Number of Defects. 1938. 1939. 1940. Received Operative Treatment:- (i) Under the Authority's Scheme in Clinic or Hospital 235 98 77 (ii) By Private Practitioner or Hospital, apart from the Authority's Scheme 32 21 3 Received other forms of Treatment 230 109 133 Total number treated 497 228 213 In December a consultation was held with Mr. Courtenay Mason so as to elaborate final arrangements for the admission of patients for tonsil operations at the Barking Hospital. In spite of the difficulties of war conditions and the shortage of nursing staff, the Authority's original scheme approved by the Board of Education was not amended and thus it was arranged that the tonsils patients be kept in Hospital from the afternoon of the day before that of operation up till the third day after operation. -11- (d) Dental Inspection and Treatment. Dental Clinics were held at Woodward Clinic and at East Street Clinic (instead of Central Clinic) during this year. As the children gradually flowed back from Reception Areas, the demand for this service became so great that a third clinic was opened on the 23rd July, in the Medical Inspection rooms at Manor School. At the same time dental inspections in schools were started again on the 10th February, and have been continued ever since. The following table gives an idea as to the amount of work carried out:- (1) Number of children inspected by the Dentist:- (a) Routine age-groups:- 1938 1939 1940 Age 5 (and 4) 515 267 174 6 627 500 296 7 606 469 322 8 564 426 433 9 657 299 456 10 599 326 627 11 621 339 342 12 885 426 443 13 550 440 250 14 (and 15) 151 100 157 TOTALS 5775 3592 3500 (b) Specials 1375 1116 716 (c) TOTAL (Routine and Specials) 7150 4708 4216 (2) Number found to require T/ment 5917 4052 3486 (3) Number actually treated 4666 3014 2096 (4) Attendances made by children for treatment 2647 8047 6251 (5) Half-days devoted to Inspection 27 33 28 Treatment 1123 914 735 Total 1150 947 763 (6) Fillings - Permanent Teeth 6623 3772 3702 Temporary Teeth 91 131 213 Total 6714 3903 3915 (7) Extractions - Permanent Teeth 1559 966 823 Temporary Teeth 8443 4020 3073 Total 10002 4986 3896 (8) Administrations of general anaesthetics for extractions 3844 2323 2157 (9) Other operations Permanent Teeth) 4744 32 96 2670 Temporary Teeth ) -12- (e) Report on the Work of the Orthopaedic Clinic. Work in this department was carried on in a comparatively normal manner during 1940, as will be seen by the number of sessions held by the Orthopaedic Surgeon and by the Masseuses as compared with previous years. Mr. Whitchurch Howell left us in July, 1940, and Mr. A.M.A. Moore has taken over his work for the duration of the war. The High Frequency Inductotherm Apparatus has been in use throughout the year and has proved invaluable in the treatment of many painful conditions; all other forms of work associated with electrical treatment, exercises, massage and appliances etc., have been carried on as usual. It will be noticed that the proportion of children seen per session has decreased considerably, contrasting thus very markedly with the attendances of "Toddlers" and Adults which have remained on a level with 1938 and 1939. The following tables show the work which has been carried out in the various branches of orthopaedic work. . -13- PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1940. No. of Sessions held by Orthopaedic Surgeon 9 No. of Sessions held by Masseuses 1,353 School Children. Toddlers & Adults ATTENDANCES Primary Examination by Surgeon 84 52 Re-examination by Surgeon 87 89 For treatment 2,505 5,816 TOTALS 2,676 5,957 TREATMENTS Number of Children 377 1,023 Number of Treatments 3,145 8,248 TOTALS 3,522 9,271 HOSPITAL TREATMENT Admissions to Hospitals 2 3 On Waiting List for admission - - TOTALS 2 3 Cases dealt with for the first time during 1940 - by the Orthopaedic Surgeon - were referred for the following defects:- a.DEFORMITIES OF BONES & JOINTS 1. Congenital 5 15 2. Acquired 70 32 b .MUSCULAR 1. Congenital 1 7 2. Acquired 38 16 c.PARALYSIS 1 4 d. MISCELLANEOUS 7 8 -14- (f) X-Ray Treatment for Ringworm of Scalp. This service is still available, for appropriate cases, but none such have come to our notice during the year. (g) SpeechTraining. This service was not re-opened in 1940. Foot Clinic . The Municipal Foot Clinic was opened on 11.7.38, its services having been available to school-children throughout 1940, and during that year the poor attendance is presumably due to evacuation. Attendances of O.E.S, scholars. 1938 1939 1940 49 284 19 (7) INFECTIOUS DISEASES. It can be stated at the outset that the amount of notifiable infectious disease in 1940 was negligible, certainly very much less than in 1939 or 1938. There were none of the usual epidemics of measles or whooping cough and none of the schools or school departments were obliged to close on account of infectious diseases. There was very little demand for Immunisation Clinics and only 20 patients were completely inoculated against diphtheria during 1940. At the end. of the year, however, numbers were already rising and it can be stated here that the figures for 1941 will be more satisfactory. Immunisation against Scarlet Fever and Whooping cough was also carried out on a small scale. (8) SKIN DISEASES. There is no doubt at all that Impetigo, ringworm and skin diseases in general have all decreased, probably in proportion to the number of scholars evacuated. By contrast, Scabies has very markedly Increased and the spread of this troublesome complaint has been particuifarly difficult to control, mainly for two reasons - (a) the disease is not notifiable and (b) more than one member of the family is usually infected and there are no facilities in the area for treatment of other than school children and children under five. Even when the children are cleared by the treatment which is provided for them at your clinics, there remain a number of untreated and possibly undiagnosed cases which are a constant source of fresh outbreaks. The crowded, shelter problem was particularly propitious to the spread of scabies from one person to another and from one family to another; soldiers coming home on leave often either brought scabies with them or took it back when they returned. In this way the complaint has become widespread, throughout the country. -15- The following shows the number of defects treated, or under treatment, in respect of elementary scholars:- 1938. 1939. 1940. Ringworm (Scalp) 5 3 1 Ringworm (Body) 36 10 11 Scabies 132 83 135 Impetigo 390 244 100 Other Skin Diseases 415 389 155 Totals 978 729 402 (9) NUTRITION. The method of assessment of nutrition in school children has been set out in Administrative Memorandum 124 - December 31st 1934 - of the Board of Education. In this medical officers are asked to classify the nutrition of children under - "A" Excellent. "B" Normal "C" Slightly subnormal "D" Bad taking into account not only their weight and height but also their general appearance, their posture, their colour, etc. This must of necessity lead to considerable variations in opinions and standards between different examining officers and in interpreting the results in the following table some allowance must be made for personal variations. Even so, judging by these figures it appears, as I have hinted elsewhere, there are grounds for satisfaction in the nutrition of our school population. One may discount comparison with 1939 as the number of children examined during that year was much smaller than in 1938 and 1940; but the numbers examined in 1940 are comparatively high and in all groups they seem to indicate a diminution in the cases of poor nutrition and an increase in those of excellent nutrition. To what extent this is due to the possibility that the healthier members of the school population remained in Barking whilst their less healthy brothers and sisters were evacuated is difficult to assess. It is also possible that the housewives, having had their attention constantly drawn to the importance of certain foods and the different food values of proteins, fats, carbohydrates, vitamins, etc., may have made a special effort to see that their children went short of nothing, and indeed probably fed them better in the light of the advice given. -16- Table showing the number of children inspected in the Routine Age-Groups during the years 1938, 1939 and 1940, and the Classification of the Nutrition of such children. Entrants Second Age-Group Third Age-Group Other Routine Inspections. Totals 1938 1939 1940 1938 1939 1940 1938 1939 1940 1938 1939 1940 1938 1939 1940 1938 1940 (inc) No. of children inspected. 1639 677 1120 1419 818 1206 1249 595 945 409 - 3005 4716 2090 6276 13,082 No. of children with Nutrition:- (A) Excellent 400 202 430 413 186 472 261 133 416 107 - 1126 1181 521 2444 4,146 Percentage 24.40 29.8 38.4 29.11 22.7 39.1 21.0 22.3 44.0 26.16 - 37.5 25.04 24.9 38.9 31.69 (B) Normal 1122 440 626 897 587 676 949 448 509 275 - 1786 3243 1475 3597 8,315 Percentage 68.46 65.0 55.9 63.21 71.8 56.0 75.9 75.3 53.9 67.24 - 59.4 60.76 70.6 57.3 63.56 (C) Slightly 115 34 64 106 45 58 39 14 20 27 - 90 287 93 232 612 sub-normal Percentage 7.02 5.0 5.7 7.47 5.5 4.9 3.1 2.4 2 .1 6.60 - 3.0 6.09 4.45 3.7 4.68 (D) Bad 2 1 - 3 - - - - - 1 - 3 5 1 3 9 Percentage 0.12 0.2 - 0.21 - - - - - - - 0.09 0.11 0.05 0.05 0.07 -17- (10) PROVISION OP SCHOOL MEDICAL SERVICES FOR SECONDARY AND TECHNICAL SCHOLARS IN THE AREA. The scheme whereby you carry out medical examinations for the Essex County Council in connection with the South East Essex Technical College (the Barking Abbey School having been evacuated since the beginning of hostilities) is still in force, and below are figures for the inspection and treatment of puoils in this category The service is the same as that carried out at your elementary schools and includes the specialist treatment services - orthopaedic, ophthalmic, dental, ear, nose and throat etc. Medical Inspection. Routine examinations 209 Re-inspections 71 Special evacuation examinations 430 Ophthalmic Clinics. Number of attendances 42 Number of attendances for squint training 22 Number of pairs of spectacles prescribed 11 issued 5 collected after repair or alteration 9 Ear, Nose and Throat. Attendances for examination by specialist-consultant 2 Ultra-violet light treatment No. of children treated 8 No. of treatments given 28 Orthopaedic Treatment. No. of children seen by Orthopaedic Surgeon 9 No. of treatments given by Masseuses 41 Minor Ailments Clinics. No. of attendances 21 Dental Inspection and Treatment. No. of children inspected 107 Percentage of children found with defective teeth 68.2% Total number of treatments given 254 Unit figure 25.9 -18- (11) SPECIAL SCHOOLS. Paircross School, which had been closed since September, 1939, was re-opened on 22.4.40., owing to the gradual return of many of the evacuated children. 33 Physically Defective children were admitted at this time and 21 Mentally Defective, and by the end of the year these numbers had increased respectively to 47 and 22. School Medical Inspections were started on 30.4.40., and 14 sessions were held during the year. (12) UNCLEANLINESS. Systematic examination of children at routine cleanliness inspections has been carried out by the school nurses throughout 1940. The following table records the results of cleanliness inspections for the past three years 1938. 1939. 1940. Number of examinations of children in the schools by School Nurses. 39,521 22,539 13,657 Number of individual children found unclean. 1,008 777 413 Number of uncleanliness findings. 2,044 1,038 632 Number of individual children cleansed under Section 87(2) and (3) of the Education Act, 1921. 4 7 83 Percentage of uncleanliness findings. 5.1% 4.6% 4.7% There is no evidence that the percentage of uncleanliness is increasing to any extent. (13) OPEN-AIR EDUCATION, No week-end school camps or Holiday Camps were held during 1940, but on 15th June, 181 children were evacuated to Hydon Heath Camp School near Godalming, which had been allocated to Barking by the National Camps Corporation. The children sent were mostly between the ages of 10 - 13 years. In December, 1940, there were still 184 children on the roll. -19- (14) CO-OPERATION, Co-operation and assistance from many quarters has been afforded us throughout the year, this being especially evident in the arrangements for the evacuation of a very large number of children which took place in June, and I desire to place on record my thanks to the members of the Council, the staff of my department, the Head Teachers and School Attendance Officers, the staff of other departments, also to private medical practitioners, voluntary bodies and pa rents for the continuation of their co-operation which has helped us in no small measure in carrying out our work in connection with the various services provided by the Authority. -20-