BARK 76 BOROUGH OF BARKING. THE ANNUAL REPORT of the SCHOOL MEDICAL OFFICER. FOR THE YEAR 1941 (War Edition) C. LEONARD WILLIAMS. B .Sc. , M.R.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, 1941. (War Edition). Public Health Department, Barking, Essex. August, 1942. 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, 1941. 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 1941. (War Edition). (1) STAFF. The following indicates the changes that have taken place in the Staff during the year 1941. Assistant Medical Officers. L.M.M. Beadnell, M.R.C.S., L.R.C.P. (Commenced 10.3.41). T.A. Cockburn, M.D. , D.P.H. (Resigned 10.2.41). M. Lewis, M.R.C.S., L.R.C.P. (Commenced 17.3.41). + Miss J. Egan (Temporary). (g, h and i). (Commenced 27.10.41 - Terminated 15.12.41). Miss P. Nichols - Assistant to Camp Matron at Hydon Heath. (Commenced 10.4.41 - Resigned since close of year). + Miss M. Simpson (Temporary). (g, h and i) (Commenced 29.9.41 - Terminated 19.12.41). Miss K.B.Walker (Chiropodist) - Temporary part-time. (Commenced 9.5.41 - Resigned 26.9.41). Mrs. I.V. Race-Wardell (Chiropodist) - Temporary part-time. (Commenced 4.9.41 - resigned since close of year). (g) Health Visitor's Certificate of the Royal Sanitary Institute. (h) Certificate of the Central Midwives Board. (i) General Hospital Training. + Combined Appointment - Health Visitor and School Nurse. 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. -3- (2) EVACUATION -GOVERNMENT. (a) Medical Arrangements. Due, no doubt to the immunity from air attacks which was experienced for the greater part of the year, the number of children evacuated in 1941 diminished considerably from those sent to Reception Areas in 1940. In 1940 out of a total of 2,378 examined 87.6 per cent (2,083) were found to be without defect, the remainder requiring treatment before being sent to the Reception Areas. During the year ended 31st December, 1941, the number examined fell to 370, 80 per cent of which number were passed as fit and without defect, as shown in the following tablet- Number examined and passed fit without defect. 296 Number requiring special consideration and treatment before evacuation. 58 Number declared unfit - for various reasons. 16 370 (b) School Medical Inspection. The question arose early in 1941 respecting the seconding of School Medical Inspectors for duty in the Reception Area; the Evacuating Authority becoming liable for salary whilst the Receiving Authority bore the expenses of travel. The matter was settled, however, in April 1941, by the appointment of additional Medical Officers in the Reception Area, whose salaries and expenses are to be apportioned according to the Davidson Report. (3) HYGIENE. It is again satisfactory to record that in spite of rationing, the increased cost of living and the growing difficulty in obtaining certain vital food stuffs, the general health of our Barking school-children does not appear to have deteriorated during the year 1941. A hot mid-day meal has been served in all the schools at a very moderate price and in certain cases free, since February 1941. This has, no doubt, assisted considerably with the problem of nutrition. The shelter problem still existed although in a gradually relaxing manner, until May, but again scabies was and still remains the only major difficulty to which this problem has contributed. In spite of the early persistent raids there was no undue sign of nervous strain in the school population as will be seen from the following. In January 1941 the Government brought in a Compulsory Evacuation Scheme under which children who were suffering (a) in mind or body as a result of hostile attacks, or (b) in such a state of health as to be likely to suffer if they remained in the area, should be examined and if necessary, evacuated for the benefit of their health. These children were to be brought forward from school medical inspections, teachers, school nurses and others. Three school-children were examined under this Scheme but none were found suffering in health to such an extent that they were compulsorily evacuated. -4- (4) MEDICAL INSPECTION. Routine medical inspections have been carried out at frequent intervals during 1941 and I am pleased to report that the total number of such inspections increased considerably on the figures of the previous year. I would like to stress here once again that I am convinced that these frequent medical inspections are the most practical method of detecting medical defects at an early stage and ensuring that the appropriate treatment be expeditiously carried out. (a) Routine Medical Inspections. Number of Inspections in the prescribed Groups Entrants 1,2 85 Second Age-Group 927 Third Age-Group 1,041 Total 3,253 Number of other Routine Inspections 5,016 Grand Total 8,269 (b) Other Inspections. Number of Special Inspections and Re-inspection3 17,766 (c) Control Series of Heights & Weights of Children Living in Marking. A request was received in June from the Chief Medical Officer of the Board of Education acting in conjunction with the Ministry of Health, for a return of heights and weights of those children remaining behind in Barking during the "blitz" periods and included in Routine Medical Inspection. The particulars were required in connection with anthropometric investigation regarding the rate of growth of such children. A comprehensive statement was therefore prepared showing the heights and weights of a number of children ranging from 8 to 13 years of age, who had all been subjected to medical inspection during the summer term of 1940 and 1941. AVERAGE HEIGHT & WEIGHT. Boys. Girls . Number Examined. 1940. 1941. 1940. 1941. Boys . Girls. H. W. H. W. H. W. H. W. 8 & 8+ 96 74 49½" 56½lb. 52" 61lb 49½" 55½lb 51½" 6¼lb 9 & 9+ 38 39 5l¾ 62¼ 53¾ 67 52 60½ 53½ 65½ 12 & 12+ 49 43 58 79 60 89½ 59 83½ 61 97 13 & 13+ 7 11 58½ 88 61 100¼ 61 92 621/3 100½ This summarised table shows the average progress made between the years 1940 and 1941 and is a fair indication of the increase in both height and weight of the children included in the survey. -5- (5) FOLLOWING UP. This was made particularly difficult during the early months of the year by heavy raids. Many were the non-access visits and attempts to locate the whereabouts of bombed-out families. Towards the close of the year fortunately, living conditions became more normal and much valuable work has been done by your Health Visitors and School Nurses in this direction. (6) ARRANGEMENTS FOR TREATMENT. (a) Minor Ailments. On January 11th, 1941, Woodward Clinic had to be closed owing to enemy action and your Services there wore almost immediately transferred to Porters Avenue Clinic which carried on full Minor Ailment Sessions in its place from January 13th until February 3rd, 1941. On this latter date Greig Hall, situated within a few yards of Woodward Clinic, was opened in order to take over the Services originally carried on at Woodward Clinic. It has remained open for this purpose ever since. Meanwhile during the three weeks that Porters Avenue Clinic was open as a Minor Ailment Clinic it was found that there was an influx of minor ailment cases from the Porters Avenue Area which had not attended at the original Woodward Clinic, and as a trial Porters Avenue Minor Ailment Clinic was kept open for one further month. The attendances there increased to such an extent that it was deemed wise to keep this clinic open for the benefit of school-children attending the three nearby schools. The figures further on show how much this service was needed. It should be added that the First-Aid Post from Woodward was transferred to Porters Avenue at the same time as the Minor Ailment Clinic. The First-Aid Post at Central Clinic was transferred to Broadway First-Aid Post on 6.3.41. -6- MINOR AILMENT CLINICS, YEARS 1959, 1940 & 1941. The following table summarises the work of the Minor Ailment Clinics in respect of public elementary school-children, and gives a comparison with the years 1939 and 1940:- Year. Clinic. No. of days Clinic was open. No. of attendances. Daily Aver- age Attendance. No. of cases dealt with. Total No. of Attendances. Total No. of cases dealt with. 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 - - - - 1941 CENTRAL 307 6,033 19.6 1,468 20,057 4,475 GREIG HALL 278 7,137 25.6 1,488 HUMPHREY 13 3 0.3 2 WOODWARD 10 150 15.0 33 PORTERS 297 6,734 22.7 1,484 Humphrey Clinic was closed for Minor Ailment purposes on 15.1.41. -7- (b) Ophthalmic Service. This service has been carried out entirely at Central Clinic during 1941, owing to the damage done to ophthalmic equipment at Woodward Clinic. At first only 2 sessions per week were held, but later this number was increased to 3 sessions per week. During the year 104 sessions were held at the Central Clinic as compared with 82 in 1940, TREATMENT OF DEFECTIVE VISION AND SQUINT. (Excluding Minor Eye Defects treated as Minor Ailments). Number of Defects dealt with. Under the Authority's Scheme. 0therwise. Totals. 1939 1940 1941 1939 1940 1941 1939 1940 1941 Errors of refraction (including squint). 758 525 551 3 48 51 761 573 602 Dther Defects Dr disease of the Eyes. - - - - - - - - - TOTALS 758 525 551 3 48 51 761 573 602 Number of children for whom spectacles were:- (a) Prescribed 255 271 270 3 38 51 258 309 321 (b) Obtained 262 284 294 3 4 2 265 288 296 During 1941 we were still sending spectacles to the Reception Areas in cases where 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 spectacles thus supplied as 51. Squint training has been resumed and 93 sessions were held during the year. A considerable amount of valuable work was done there as will be seen by the following table. ORTHOPTIC CLINIC. 1941. No. children attended 28 No. new cases 11 No. old cases 17 No. attendances 511 No. discharged cured 4 No. evacuated 1 No. left school 1 No. discontinued 3 No. of sessions 93 -8- (c) Ear, Nose and Throat Service. 61 sessions were held during the year by your Consultant Specialist, Mr. F. Courtenay Mason. 28 of these were operative sessions at the Barking Hospital and 33 were out-patient sessions held at Central Clinic. Pinal arrangements were completed for the admission of patients to Barking Hospital for tonsil operations. Members of the Civil Defence and Emergency Medical Service's nursing and medical staff, were allowed to give all co-operation in this work to members of the Public Health Staff, and I would like here to record my appreciation for their help without which the Scheme could never have been put into action. The first session arranged for 24th March, 1941, had to be cancelled owing to enemy action, but on 6th April, 1941, the first operative session was held at Barking Hospital and thereafter the scheme proceeded without incident until the end of the year. Children were admitted the day before operation and discharged two days after operation. In May, 1941, this scheme was extended to cover all operative procedures of the ear, nose and throat. Actually 196 school-children were operated on at the Barking Hospital during 1941. TREATMENT OF DEFECTS OP NOSE AND THROAT. Number of Defects. 1939. 1940. 1941. Received Operative T/ment: • (i) Under the Authority's Scheme in Clinic or Hospital 98 77 277 (ii)By Private Practitioner or Hospital, apart from the Authority's Scheme 21 3 2 Received other forms of T/ment. 109 133 114 Total number treated 228 213 393 (d) Dental Inspection and Treatment. On January 11th the Dental Clinic held at Woodward was of necessity transferred and it opened at Manor Clinic on 12th January, 1941. where it worked in conjunction with the original Manor Clinic. Here it remained until arrangements could be made to open a Dental Clinic at Bifrons School. This was achieved on the 12th August, 1941., and thereafter clinics in three different buildings in widely separated areas of Barking were being held again. Dental Inspections at schools were carried out in the usual manner. The following table gives an idea as to the amount of work carried out:- -9- (1) Number of children inspected by the Dentist:- (a) Routine age-groups:- 1939. 1940. 1941. Age 5 (and 4) 267 174 431 6 500 296 470 7 469 322 677 8 426 433 646 9 299 456 784 10 326 627 747 11 339 342 400 12 426 443 604 13 440 250 541 14 (and 15) 100 157 119 TOTALS 3,592 3,500 5,419 (b) Specials 1,116 716 607 (c) TOTAL (Routine & Specials) 4,708 4,216 6,026 (2) Number found to require T/ment 4,052 3,486 5,001 (3) Number actually treated 3,014 2,096 1,911 (4) Attendances made by children for treatment 8,047 6,251 6,114 (5) Half-days devoted to:- Inspection 33 28 44 Treatment 914 735 690 TOTAL 947 763 734 (6) Fillings - Permanent Teeth 3,772 3,702 3,410 Temporary Teeth 131 213 137 TOTAL 3,903 3,915 3,547 (7) Extractions Permanent Teeth 966 823 1,021 Temporary Teeth 4,020 3,073 3,099 TOTAL 4,986 3,896 4,120 (8) Administrations of general anaesthetics for extractions 2,323 2,157 1,767 (9) Other operations Permanent Teeth 3,296 2,670 3,189 Temporary Teeth (e) Report on the Work of the Orthopaedic Clinic. On the whole the work in all branches In this department has increased quite appreciably during the last year. Prom June 1941 to September 1941 the Sunlight Clinic was temporarily interrupted except for very special cases as it was thought that natural sunlight and fresh air would be of greater benefit than artificial light. As the schools closed at 3.30 p.m. (actually 1.30 p.m.) it will be appreciated that school children had every opportunity of enjoying outdoor recreation and sunlight. Much work was done by your masseuses during this time on massage, exercises, electrical treatment, etc. -10- It was unfortunately necessary to Immobilise the High Frequency Inductotherm Apparatus early in March 1941 following a Government Circular which pointed out that under the Defence Regulations 1939 such electrical apparatus could not be used unless an earth-screened room was provided. It was put Into commission again in September 1941, when arrangements had been made to screen off the apparatus. PARTICULARS OF THE WORK DONS IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURlNG 1941. No. of Sessions held by Orthopaedic Surgeon 11 No. of Sessions held by Masseuses 1,052 School Children. ATTENDANCES Primary Examination by Surgeon. 73 Re-examination by Surgeon. 101 For treatment. 4,751 TOTAL 4,925 TREATMENTS Number of Children 724 Number of Treatments 5,514 TOTAL 6,238 HOSPITAL TREATMENT Admissions to Hospitals - on Waiting List for admission — TOTAL - Cases dealt with for the first time during 1941-by the Orthopaedic Surgeon-were referred for the following defects:- a. DEFORMITIES OF BONES & JOINTS 1. Congenital - 2. Acquired 41 b. MUSCULAR 1. Congenital 1 2. Acquired 40 c. PARALYSIS 5 d. MISCELLANEOUS 6 -11- (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) Speech Training. This service has not re-opened in 1941. (h) Foot Clinic. This Service has been used to a greater extent during 1941 than during the previous year, largely owing to the return of children from reception areas. Added to this there is no doubt that residents of Barking are taking more advantage of the facilities offered. A comparative table showing the attendances of scholars at the clinic during the past 3 years is given below :- 1939. 1940. 1941. Attendance of O.E.S. Scholars. 284 19 277 (7) INFECTIOUS DISEASES. During February, March and April of this year there was a measles epidemic, mostly in the Becontree Area. The maximum number of cases notified in any one month was 206 in February. By May this number had gone down to 49 and thereafter cases were very few. Coinciding with this subsidence of measles, whooping cough appeared and remained with us to the end of the year in a mildly epidemic form. At no time were the cases notified per month, higher than 39 and the form of the disease was not severe * From September onwards a very minor but persistent out-break of scarlet fever occurred, and again the disease took on a very mild form. This mildness of the disease probably accounted for the Persistence with which cases kept cropping up, presumably because certain children were so slightly affected that their complaint remained undiagnosed and they thus contributed to the spread of the infection. It was thought that a child who had recently returned from evacuation may have been the originator of the out-break. No school or school departments were obliged to close on account of infectious disease. In May 1941 the Government sent out circulars stressing the dangers of diphtheria and pressing Local Authorities to carry out Diphtheria Immunisation in an extensive manner. As a result of this, numbers attending Immunisation Clinics rose, and the number of sessions per week increased from one to nine. 1,370 school-children were inoculated against diphtheria during the year as compared with 20 in 1940. Immunisation against whooping cough and scarlet fever was carried out simultaneously, the number of children inoculated against these two complaints being respectively 135 and 339. (8) SKIN DISEASES. There appears to be a general increase in the number of cases of skin disease as compared with 1940. On the other hand apart from scabies, which is still increasing, the 1941 figures compare very favourably with those of 1938 and 1939. In other words one is led to assume, as I stated in my last year's report, that the sudden decrease in the incidence of skin disease in 1940 was more artificial than real, and probably due to evacuation One can only suppose that with the subsidence of air activity children are returning to Barking, and the figures are again ris ing. -12- Scabies. The incidence of scabies increased gradually during the year and by October numbers became so significant that it was felt some firm move must be made to limit the spread of this comolaint. Discussions were held on the possibility of opening cleansing centres so as to treat persons infested, and a letter was sent to the Ministry of Health suggesting that the disease should be made notifiable. The Minis try, however, did not feel that this would be an appropriate method of dealing with the problem. In November the Scabies Order 1941 was issued. This empowered the Medical Officer of Health or his representative to inspect persons and premises where they had reason to believe that cases of scabies might be present, and if necessary to treat or cleanse such persons and any infested articles on these premises. As a result further more elaborate plans were made to open cleansing centres at an early date and the aid of the personnel at First-Aid Posts was enlisted to assist in staffing these centres. None of the stations were opened before the end of the year. The following shows the number of defects treated or under treatment, in respect of elementary scholars:- 1939. 1940. 1941. Ringworm (Scalp) 3 1 4 Ringworm (Body) 10 11 17 Scabies 83 135 403 Impetigo 244 100 191 Other Skin Diseases. 389 155 397 TOTALS 729 402 1,012 (9) NUTRITION. As I pointed out last year the assessment of nutrition must of necessity vary with the opinions and the standards of the examining Medical Officers, and yet even making allowance for this variation it appears that the general nutrition of our school children is not suffering from war conditions. In all age-groups the children whose nutrition is assessed as excellent have increased and the total percentage of those assessed as sub-normal or bad has slightly decreased. No doubt the provision of a mid-day meal in all schools (mentioned earlier) has been largely instrumental in bringing about this satisfactory result. The population as a whole have probably also been rendered food-conscious and they have made special efforts to counteract the evil effects of certain food deficiencies by substituting adequate equivalents. So far it appears that their efforts are being well rewarded. -13- -14- Table showing the number of children inspected in the Routine Age-Groups during the years 1939, 1940 and 1941, and the Classification of the Nutrition of such children. Entrants Second Age-Group Third Age-Group . Other Routine Inspections. Totals. 1939 1940 1941 1939 1940 1941 1939 1940 1941 1939 1940 1941 1939 1940 1941 1939-1941 (inclu). No. of children inspected 677 1120 1285 818 1206 927 595 945 1041 - 3005 5016 2090 6276 8269 16,635 No. of children with Nutrition:- (A) Excellent 202 430 609 186 472 383 133 416 485 - 1126 2266 521 2444 3743 6708 Percentage 29.8 38.4 47.4 22.7 39.1 41.3 22 .3 44.0 46.6 - 37.5 45.1 24.9 38.9 45.26 40.3 (B) Normal 440 626 638 587 676 512 448 509 516 - 1786 2566 1475 3597 4232 9304 Percentage 65.0 55.9 49.7 71.8 56.0 55.2 75.3 53.9 49.5 - 59.4 51.1 70.6 57.3 51.17 55.9 (C) Slightly sub-normal 34 64 38 45 58 32 14 20 39 - 90 182 93 232 291 616 Percentage 5.0 5.7 3.0 5.5 4.9 3.4 2.4 2.1 3.7 - 3.0 3.6 4.45 3.7 3.52 3.7 (D) Bad 1 - - - - - -- - 1 - 3 2 1 3 3 7 Percentage 0.2 - - - - - - - .09 - 0.09 .04 0.05 0.05 0.036 0.04 (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 pupils 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. It appears clear from the rise in the number of children examined, compared with 1940 figures, that a gradual return to Barking of the secondary school population is taking place. Medical Inspection. 1941. Routine examinations. 256 Re-inspections. 118 Special evacuation examinations. 10 Ophthalmic Clinics. Number of attendances. 112 Number of attendances for squint training. 1 Number of pairs of spectacles - prescribed. 21 issued. 41 collected after repair or alteration. 17 Ear, Nose and Throat. Attendances for examination by specialist-consultant. 17 Ultra-violet light treatment. No. of children treated. 9 No. of treatments given. 25 Orthopaedic Treatment. No. of children seen by Orthopaedic Surgeon. 9 No. of treatments given by Masseuses. 30 Minor Ailments Clinics. No. of attendances. 141 Dental Inspection and Treatment. No. of children inspected. 232 Percentage of children found with defective teeth. 90.95 Total number of treatments given. 126 Unit figure. 27.5 Foot Clinic. No. of attendances for treatment. 94 -15- (11) SPECIAL SCHOOLS. Faircross School remained open throughout 1941, the number of physically defective children on the roll "being 37 and mentally defective 16. Thirteen sessions of school medical inspection were carried out during the year. (12 ) UNCLEANLINESS . Systematic examination of children at routine cleanliness inspections has been carried out by the school nurses throughout 1941. The following table records the results of cleanliness inspections for the past three years:- 1939. 1940. 1941. Number of examinations of children in the schools by School Nurses. 22,539 13,657 15,342 Number of individual children found unclean. 777 413 538 Number of uncleanliness findings. 1,038 632 782 Number of individual children cleansed under Section 87(2) and (3) of the Education Act, 1921. 7 83 22 Percentage of uncleanliness findings. 4.6% 4.7% 5.1% This small increase in the percentage of uncleanliness can hardly be said to be of any significance. (13) OPEN-AIR EDUCATION. No week-end school camps or holiday camps wore held during 1941. Hydon Heath Camp School which had been allocated to Barking by the National Camps Corporation in June 1940., continued to function satisfactorily. The figures in attendance dropped from 184 in December 1940, to 158 in December 1941, no doubt due to the fact that air raids practically ceased towards the middle of the year. Those children who remained kept in good health and no epidemics or undue illhealth was reported from the Camp during this year. One of your Health Visitors is stationed at Hydon Heath permanently and two of the local doctors are attached to the Camp. The following table shows the amount of work done in this section:- -16- Inspections by Medical Officers. Number of Attendances. 1st Insp. Re-Insp. Total number of treatments. 8,931 202 214 12,722 Number of defects treated Scabies. 12 Impetigo. 6 Plantar Warts . 15 Errors of Refraction & Squint. 24 Nosq & Throat Cases . 13 Miscellaneous. 4,725 Parents were allowed to visit their children in the Camp at week-ends, being conveyed by coach from Barking . * Diphtheria Immunisation. The question arose in January 1941 regarding the personnel to be employed at the Camp in carrying out the task of immunising those children who had not been inoculated before leaving Barking, and whose parents had consented to this being done. On your instructions arrangements were made with the doctors carrying out the medical services at the Camp to proceed with immunisation where necessary. During the year 104 children were completely immunised and 125 primary and 101 final Schick tests were performed in this period. Hospitalisation. In-patient treatment of scholars at the Camp was kindly undertaken by the Medical Committee and Governors of St. Thomas's Hospital evacuated from London to Godalming, who also placed at our disposal all the facilities of the out-patients and special departments of the hospital. In consequence of their kind offer and of the fact that the Council were not to be called upon to pay for such facilities you decided to add them to the list of hospitals participating in the annual grant made to hospitals serving the public of Barking. Inspection of Camp. Dr. J. Alison Glover of the Board of Education and Dr. M.S. Harvey of the Ministry of Health visited the Camp School on 15th July 1941. (14) CO-OPERATION. During the year it has been a source of satisfaction to myself and the members of my staff, that the help and co-operation which has again been afforded during the year has greatly assisted us in carrying out the work connected with the various services undertaken by the Council for improving the general health and physical fitness of children attending schools in the Barking Area. This was particularly emphasised early in 1941 when the Woodward Clinic was destroyed and it became necessary to establish temporary clinics nearby. The additional work and v/orry involved in such process of transfer was to a considerable extent lightened by the ready assistance afforded my department by many of the members of the Council, the Head Teachers affected, and other officers of the Council, to all of whom I proffer my sincere thanks. -17-