BARK F Read BOROUGH OF BARKING. THE ANNUAL REPORT of the SCHOOL MEDICAL OFFICER. FOR THE YE A R 1942 (War Edition) C. LEONARD WILLIAUS. B.Sc., M.R.C.S., L.R.C.P., D.P.H. BOROUGH OF BARKING A N N U A L REPORT of the School Medical Officer for the Borough of Barking, in the County of Essex, for the year ended 31st December, 1942. (War Edition). Public Health Department, Barking, Essex. August, 1943 To the Chairman & Members of the Local Education authority. Mr. Chairman, Ladies and Gentlemen, I have pleasure in submitting my report for the year ended 3lst December, 1942, This year is a part of the third year and part of the fourth year of the war and from this standpoint this report, amongst others of a similar nature, will stand out as documents of historic interest and value. First it will show that the services you established before the war have stood the test of war-time conditions, that they were sufficiently well founded to stand the stress of war and at the same time, sufficiently adaptable to meet the chanced conditions brought about by the war. I believe that you will find, as the historians of the future will find, that this report shows that the children of school-age who have lived into the fourth year of this war have maintained their health, their strength and their vitality, that they have not been adversely affected by war-weariness nor by food-rationing. As a matter of fact with the exception of tuberculosis, the increase in which is a matter for disquiet, continued over-leaf. - 2 - the standards "by which the health of the school population can be judged indicate what I believe you will decide is a fortunate and favourable condition of affairs. I use the word "fortunate" advisably because I cannot help feeling that the school-children and indeed the rest of us also, may have fared almost better than we dared to hope and that because this is so, the present favourable situation demands increased vigilance in order that it may be maintained in the years of struggle which lie ahead. In the same way as members of the general public have availed themselves of the Medical Services provided locally, so also this same public (such as the parents of the schoolchildren) have availed themselves of the services which you have so thoughtfully put at their disposal, the more so because the other medical services, such as the large voluntary hospitals have not been so available as heretofore particularly because of the difficulties of travel. If, therefore, for no other reason, this is some justification for the way in which you have maintained your services and I do hope that after the war we shall have less of the indiscriminate wandering to and fro in search of something new in the way of treatment, and that more and more of the necessary medical treatment which can be undertaken locally will be undertaken locally. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, - 3 - Medical Officer of Health. ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER, for the YEAR 1942. (War Edition). (1) STAFF. The following indicates the changes that have taken place in the Staff daring the year 1942. MEDICAL STAFF. Dr. Violet Spiller - Deputy Medical Officer of Health. (Temporary). (Resigned 15.7.42. ) Dr. C.J. de Vcre Shortt - Deputy Medical Officer of Health. (Temporary - Commenced 23.9.42). DENTAL SURGEONS. W.H. Foy - Senior Dental Surgeon - Deceased 2.11.42. J. Angelman - Assistant Dental Surgeon - Service in H.r. For cos from 4.3.42. Dr. R. Null - Temporary Assistant Dental Surgeon (Commenced 21.5.42. Resigned 4.12.42). A.F. Smith - Temporary Assistant Dental Surgeon (Commenced 9.11.42). HEALTH VISITORS &c. Miss P.M. Rodwell (Temporary Health Visitor) (Commenced 10. 8.42). Miss P Nicholls - Assistant to Camp Matron at Hydon Heath - Resigned March, 1942. Miss N.M. Jolly (Chiropodist) - Commenced 8.6.42. 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 - GOVERNMENT. Under the Government Scheme evacuation ceased towards the latter end of the year and the last party was evacuated from Barking on November 19th, 1942. During the year ended 31st December, 1942, the number examined fell to 70, 8if. 3 Per cent of which number were passed as fit and without defect. The following comparative table shows the decline in the number of evacuation cases dealt with during the year 1942 as against the previous year: 1942. 1941. Number examined and passed fit without defcct. 59 296 Number requiring special consideration and treatment before evacuation. 3 58 Number declared unfit - for various reasons. 8 16 70 370 3. HYGIENE. The general health of all school children in Barking shows no deterioration during the year 1942. Hot meals have continued to be served in all the schools at a small cost, and in certain cases free. An increasing number of children have taken advantage of this service during the year and this has, no doubt, helped considerably in keeping up the standard of nutrition. Owing to the absence of air raids during the year, there was no difficulty experienced regarding shelter conditions. - 5 - 4. FOLLOWING UP. Much valuable work has been done by Health Visitors and School Nurses in this direction and every case. where treatment is offered and not taken advantage of, is followed up in an endeavour to get such treatment carried out. In the period under review School Nurses and Health Visitors paid no less than 4,672 visits to homes against 3,800 in 1941. 5. MEDICAL INSPECTION. During the year 1942, inspections have been carried out at each school. (a) Routine Medical Inspections. Number of Inspections in the prescribed Groups show an increase of 914 over and above that of 1941:— 1942. 1941. Entrants. 1,888 1,285 Second Age-group 1,790 927 Third Age-group 1,330 1,041 Total. 5,008 3,253 Number of other Routine Inspections. 4,175 5,016 Grand Total. 9,183 8,269 (b) Other Inspections. Re-inspe ctions. In this category the Special Inspection figure shows an increase of 3,783 children re-inspected over the number in the previous year. 1942. 1941. Number of Special Inspections and Ho-inspections. 21,549 17,766 These mainly consist of children examined in Minor Ailment Clinics to which they were referred following the discovery of defects at School Medical Inspections. - 6 - 6. CONTROL SERIES OF HEIGHTS AND WEIGHTS OF CHILDREN LIVING IN BARKING. The Chief Medical Officer of the Board of Education was again supplied with particulars of the heights and weights of selected children who remained in Barking during the 1940/41 "blitz". The following table summarises the progress maintained "by these children. AVERAGE HEIGHT AND WEIGHT. BOYS. AgeGroup. Number of individual children examined. 1940 1941 1942. Height. Weight. Height. Weight. Height. Weight. (ins. ) (lbs.) (ins.) (lbs.) (ins.) (lbs.) 8 & 8+ 96 49.5 56.5 52 61 53.2 66.7 9 & 9+ 38 51. 8 62.2 53.8 67 55. 3 71.3 12 & 12+ 49 58 79 60 89.5 61 92.5 x GIRLS. AgeGroup. Number of individual children examined. 1940 1941 1942. Height. Weight. Height. Weight. Height. Weight. (ins.) (lbs.) (ins.) (lbs.) (ins.) (lbs.) 8 & 8+ 74 49.5 55.5 51.5 60. 2 53.4 67.2 9 & 9+ 39 52 60. 5 53.5 65.5 55.2 72.4 12 & 12+ 43 59 83- 5 61 97 62. 5 100. x x Of the original 49 "boys and 43 girls in the 12+ age-group, only 18 and 10 respectively were available for charting in 1942. - 7 - 7. ARRANGEMENTS FOR TREATMENT. (a) Minor Ailments. Minor Ailment Cliniee have been held daily at the porters Avenue, Greig Hall and Central Clinics. You will observe from the following comparative table that the total number of cases treated at these clinics show an increase of 2,487 over the previous year, the increase being greatest at Porters Avenue. MINOR AIIMENT CLINICS, YEARS 1940, 1941 & 1942. The following table summarises the work of the Minor Ailment cinics in respect of public elementary school-children, and gives a comparison with the years 1940 and 1941:- 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. 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 1942 CENTRAL 307 9,357 30.48 2,265 30,011 6,962 GREIG HALL. 306 9,159 30.25 2,520 PORTERS. 307 11,495 37. 44 2,177 - 8 - (b) Ophthalmic Service. This service has, during 1942 been carried out entirely at Central Clinic, three sessions being held weekly. During the year 154 sessions were held as compared with 104 in 1941. It will "be noticed in the table below that the work in this Service has increased. TREATMENT OF DEFECTIVE VISION AND SQUINT. (Excluding Minor Eye Defects treated as Minor Ailments). Number of Defects dealt with. Under the Authority's Scheme. Otherwise, Totals. 1940 1941 1942 1940 1941 1942 1940 1941 1942 Errors of refraction (including squint). 525 551 686 48 51 - 573 602 686 Other Defects or disease of the Eyes. - - - - - - - - - 525 551 686 48 51 - 573 602 686 Number of children for whom spectacles were:- (a) Prescribed. 271 270 381 38 51 - 309 321 381 (b) Obtained. 284 294 363 4 2 - 288 296 363 ORTHOPTIC CLINIC. Squint training has been carried out at Central Clinic daring the year where a considerable amount of valuable work was done as will be seen by the following table:- 1941. 1942. Number of Children attended. 28 38 Number of New Cases. 11 20 Number of Old Cases. 17 18 Number of Attendances. 511 686 Number Discharged cured. 4 1 Number Evacuated. 1 2 Number left School. 1 2 Number Discontinued. 3 4 Number of Sessions. 93 110 - 9 - (c) Ear, Hose and Throat Service. Mr. F. Courtenay Mason, your Consultant Specialist held 28 sessions at the Central Clinic. No operative sessions were held at Barking Hospital, the treatment of such cases being carried out at Queen Mary's Hospital, King George Hospital and St. Mary's Hospital. There was a slight decrease during the year in the number of children treated for defects of the Nose and Throat. TREATMENT OF DEFECTS OF NOSE AND THROAT. Number of Defects. Received Operative Treatment:- 1940 1941 1942 (1) Under the Authority's Scheme in Clinic or Hospital. 77 277 171 (3) By Private Practitioner or Hospital, apart from the Authority's Scheme 3 2 1 Received other forms of Treatnent. 133 114 198 Total number treated 213 393 370 (d) Dental Inspection and Treatment. The work of this service was considerably interrupted owing largely to the fact that Mr. Angelinan was called to serve with H.M. Forces and later owing to the regrettable death of Mr, Foy, your Senior Dental Officer, whose work was so much appreciated. We were fortunate, however, in being able to obtain the services of other Dental Surgeons especially so in the ease of Captain Angus Smith, who now operates at the Central Clinic. It will be seen that although the dental inspections at school decreased, the actual amount of treatment work carried out at the various clinics compares not unfavourably with previous years. In this connection it night- be added that during the greater part of the year under review, your dental work was carried out at Bifrons Dental Clinic, Manor Dental Clinic and East Street Dental Clinic, but that in October it was found possible to re-open the Central Dental Clinic in Vicarage Drive, Ripple Road, and transfer the work originally carried out at the East Street Clinic to these premises. - 10 - The following table gives a summary of the work done for the twelve months ended 31st December, 1942, together with a comparative table for the years 1940 and 194I. (1) Number of children inspected by the Dentist:- (a) Routine age-groups 1940 1941 1942 Age 5 ( and 4) 174 431 174 6 296 470 130 7 322 677 244 8 433 646 279 9 456 784 296 10 627 747 299 11 342 400 451 12 443 604 516 13 250 541 358 14 (and 15) 157 119 138 TOTALS 3,500 5,419 2,885 (b) Specials 716 607 875 (c) TOTAL (Routine & Specials). 4,2l6 6,026 3,760 (2) Number found to require Treatment. 3,486 5,001 3,229 (3) Number actually treated. 2,096 1,911 1,821 (U) Attendances made by children for treatment. 6,251 6,114 7,069 (5) Half-days devoted to:- Inspection 28 44 18 Treatment 735 690 797 TOTAL 763 734 815 (6) Fillings- Permanent Teeth. 3,702 3,l4l0 3,8147 Temporary Teeth. 213 137 227 TOTAL. 3,915 3,547 4,074 (7) Extractions- Permanent Teeth. 823 1,021 1,306 Temporary Teeth. 3,073 3,099 2,962 3,896 4,120 4,268 (8) Administrations of general anaesthetics for extractions. 2,157 1,767 1,892 (9) Other operations- Permanent Teeth. 2,670 3,189 4,470 Temporary Teeth. - 11 - (e) Report on the work of the Orthopaedic Clinic. Mr. A.M. A. Koore continued to be your Consultant Orthopaedic Surgeon during 1942, and the work in this department was carried out normally, your Masseuses undertaking considerable treatment, such as Artificial Sunlight, Massage, Exercises and Electrical Treatment. PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1942. Number of Sessions held by Orthopaedic Surgeon. 12 Number of Sessions held by Masseuses. 1,031 School Children. ATTENDANCE S . Primary Examination by Surgeon. 104 Re-examination by Surgeon. 150 Por treatment. 5,856 TOTAL 6,110 TREATMENTS. Number of Children. 800 Number of Treatments. 7,668 TOTAL 8,468 HOSPITAL TREATMENT. Admissions to Hospitals. - On Waiting list for admission. 2 TOTAL 2 Cases dealt with for the first time during 1942 - by the Orthopaedic Surgeon - were referred for the following defects:- a. DEPORflTIES OP BONES & JOINTS. 1. Congenital. 4 2. Acquired. 83 b. MUSCULAR. 1. Congenital. 1 2. Acquired. 10 c. PARALYSIS. 4 d. MISCELLANEOUS. 7 - 12 - (f) X-ray Treatment for Ringworm of Scalp. This service is still available for appropriate cases, but only one case was treated during the year. It is a matter for rejoicing that only one case of ringworm had to be treated throughout the whole year, but instead of moaning that we can relax our vigilanoe, it means that we must actually increase our watchfulness because ringworm when it gets a grip on a school population increases with compound interest. Incidentally it is pleasing to note that it has decreased in the same way. (g) Speech Training. This service was not available Six 1942. (h) Foot Clinic. The Municipal Foot Clinic was held at Central Clinic until October 1942 when it was transferred to East Street. This coincided with the re-opening of the Central Clinic, Ripple Road, for use as a dental clinic. The Foot Clinic was transferred to East Street after being temporarily housed for one week in the Broadway First-Aid Post. A comparative table showing the attend emcee of scholars at the clinic during the past three years is given below. It will be noticed that there is a great increase compared with previous years in the number of school-children treated. 1940. 1941. 1942. Attendance of O.E. S. Scholars. 19 277 436 8. INFECTIOUS DISEASES. (a) Scarlet Faver. During the year 211 school-children were notified as suffering from scarlet fever. The majority of these cases occurred between September and December and during the months of October and November the weekly total averaged 14 cases. During October a slight outbreak occurred and investigations were duly carried out. No school had to be closed for this or any other type of infectious disease. The cases as in the previous year were of a mild type. During the months of October and November, hospital accommodation was taxed to its utmost and great difficulty was experienced in getting children admitted to hospital and it was even necessary to send ease's as far distant as Billericay and Enfield. In November the Ministry of Health agreed to your Council providing a temporary supply of medicine and medical assistance as well as nurses, for the poor inhabitants of the district in cases where hospitalisation could not be provided. - 13 - (b) Whooping Cough. One hundred and four cases of whooping cough in school-children were notified during the year. These cases were spread evenly over the course of the 12 months, and no epidemic was recorded. Whooping Cough can he a disease very difficult to diagnose. Children can have this complaint without "whooping" even once^ and not all cases who "whoop" are definitely suffering from whooping cough. Figures, therefore, must always he looked upon with reserve. (c) Measles. Cases of this disease were notified during the whole year, 661 of which were school-children. This number was spread evenly over the year. The highest incidence of this disease occurred during the months of May and June. (d) Diphtheria. Twenty two cases were notified during the year. With the increased number's of children now being immunised the danger of "this disease amongst school-children will no doubt be diminished. In November a cfenpaign against diphtheria amongst school-children Was started, an& after talks in each school parents were circularised and given an Opportunity to have their children immunised against diphtheria. Up to Dccember 31st, 635 children had been completely immunised and mainly as a result of the campaign 5>069 children had received their first injections. All the children at Hydon Heath Camp have been protected against diphtheria and the final figures proved most satisfactory. Immunisations against scarlet fever and whooping cough as well as diphtheria were carried out regularly at your various clinics. 9» SKIN DISEASES. Scabies. The incidence of scabies showed an increase and in March special arrangements were made for out-patient treatment of this complaint. Up to December 31st, 144 children received treatment. Skin Clinic. On Tuesday, 8th December, 1942, a Skin Clinic was opened at the Barking Hospital for thetxeatment of skin cases with one of the Hospital Medical Officers in charge. Owing to the short period of time between the opening of the Clinic and my Report nothing of real value can be recorded except that I fully anticipate the success of the venture. The following shows the number of skin defects treated or under treatment, in respect of elementary scholars:- 1940. 1941. 1942. Ringworm (Scalp). 1 4 6 Ringworm (Body). 11 17 13 Scabies. 135 403 659 Impetigo. 100 191 301 Other Skin Diseases. 155 397 1060 TOTALS. 432 1,012 2,039 - 14 - 10. NUTRITION. For the year ended 31st December, 1942, it may be estimated that there were approximately 10,600 children in your schools, Of these just over 9,000 individual children were examined at school by routine. Your Medical Staff had some 18,000 other.consultations in respect.of schoolchildren. This feature is important for two, reasons:- (a) It shows the completeness of your Service. (b) Arising from this it would appear that you are justified in not holding Special Nutritional Surveys, because not only do your routine examinations cover a very large number of your children, but your special examinations more than likely cover most, if not indeed, all cases which are likely to require investigation from the standpoint of nutrition Talking about nutrition leads me to the results of the ciassification of the 9,000 odd pases which We have specially investigated from this standpoint. Our difficulty is of course, that there are no satisfactory standards of nutrition and only people of long experience have the necessary background to Undertake this work - of course owing to the war much of this work has had to be undertaken by people who have not had .this necessary background. Whilst therefore, it might bp a .matter. for supreme congratulation that none of your children are found to be "bad" so far as nutrition is concerned, I do not think that we should stress this point very much, nor do I stress particularly the fact that no less than 99% of your-children were classified as either "excellent" or "normal". I cannpt help thinking as I did before the war, that the. general standard of development of nutrition in Barking is better than it is in many other places, and that the doctors who have ccme to us from these other places have been guided by their previous experience in nutritional development and have accordingly placed some of the children in a higher category than those of us might who have had. more experience of your.standards in Baricing - 15 - - 16 - Table showing the number of children inspected in the Routine Age-Groups during the years 1940, 1941 and 1942, and the Classification of the Nutrition of such Children. Entrants. Second Age-Group. Third Age-Group. Other Routine Inspections. Totals. 1940 1941 1942 1940 1941 1942 1940 1941 1942 1940 1941 1942 1940 1941 1942 1940-1942 (inclusive) Number of children inspected. 1120 1285 1888 1206 927 1790 945 1041 1330 3005 5016 4175 6276 8269 9183 23,728 Number of children with Nutrition:- (A) Excellent 430 609 846 472 383 761 416 485 683 1126 2266 2091 2444 3743 4381 10,568 Percentage. 38.4 47.4 44.8 39.1 41.3 42.5 44.0 46.6 51.3 37.5 45.1 50.1 38.9 45.26 47.7 44.5 (B) Normal 626 638 1028 676 512 1015 509 516 644 1786 2566 2064 3597 4232 4751 12,580 Percentage 55.9 49.7 54.4 55.0 55.2 56.7 53. 9 49.5 48.4 59.4 51.1 49.4 57.3 51.17 51.72 53.0 (C) Slightly sab-normal 64 38 14 58 32 14 20 39 3 90 182 20 232 2.91 51 574 Percentage. 5.7 3.0 0.74 4.9 3.4 0.8 2.1 3.7 0.22 3.0 3.6 0.47 3.7 3.52 0.56 2.4 (D) Bad - - - - - - - 1 - 3 2 1 3 3 - 6 Percentage. — — - - - - - 0.09 - 0.09 .04 - 0.05 0.036 - 0.02 11. PROVISION OF SCHOOL MEDICAL SERVICES FOR SECONDARY AND TECHNICAL SCHOLARS II' THE AREA. The Scheme whereby you carry out medical examinations for the Essex County Council in connection with the South East Essex Technical College and the Barlcing Abbey School (which has returned to Barking Area) Is still in force, .and below are the figures for the past two years 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. The increase in the figures over 19l4l is due to the return of Barking Abbey School. Medical Inspection- 194l. 1942. Routine examinations. 256 556 Re-inspections. 118 118 Special evacuation examinations. 10 Ophthalmic Clinics. Number of attendances. 112 93 Number of attendances for squint training. 1 Number of pairs of spectacles;- prescribed. 21 63 issued. 1]1 52 collected after repair or alteration. 17 23 Ear, Nose and Throat. Attendances for examination by Specialist Consultant. 17 20 Operative treatment in hospital. - 3 Ultra-violet Light treatment. Number of children treated. 9 9 Number of treatments given. 25 58 Orthopaedic Treatment. Number of children seen by Orthopaedic Surgeon. 9 28 Number of treatments given by Masseuses. 30 172 Minor Ailment Clinics. Number of attendances. l4l 214 Dental Inspection and Treatment. Total number of children inspected. 232 722 Percentage of children found with defective teeth. 90.95 81.5 Total number of treatments given. 126 1178 Unit figure. 27.5 28.8 Foot Clinic. Number of attendances for treatment. 94 116 - 17 - 12. SPECIAL SCHOOLS. Faireross School remained open throughout the year 1942, the number of physically defective children on the roll being sixty-two and mentally defective thirtythree. Thirteen sessions of school medical inspection were carried out. 13. UNCLEANLINESS. Systematic examination of children at routine cleanliness inspections has been carried out "by the school nurses throughout the year 1942. The following table records the results of cleanliness inspections for the past three year:- 1940. 1941. 1942. Number of examinations of children in the schools by School Nurses. 13,657 15,342 21,311 Number of individual children found unclean. 413 538 746 Number of individual children cleansed under Section 87(2) and (3) of the Education Act, 1921. 83 22 7 Number of uncleanliness findings. 632 782 1,023 Percentage of uncleanliness findings. 4.7% 5.l% 4.8% 14. OPEN-AIR EDUCATION. (a) No week-end school camps or holiday camps were held during the year 19*4 2. (b) No.5 National School Camp, H.ydon Heath. Hydon Heath Camp School continued to function. The number of children on the school roll at 31st December, 194l, was 158, but many children returned to Barking during the year 1942 and on 31st December, the number fell to 125. The children who remained in this camp kept in good health and no epidemics or undue ill health was reported. The medical arrangements at the camp continued as during the year 194l. - 18 - The following table shows the amount of work done as compared with the previous year, and additional information as to Dental and Orthopaedic services ia also included:- INSPECTION BY MEDICAL OFFICERS. Number of Attendances. 1st Inspection. Re-Inspection. Total number of Treatments. 1941 1942 1941 1942 1941 1942. 1941 1942. 8931 8940 202 358 214 424 12722 11127 Number of defects treated:- 1941. 1942. Scabies. 12 8 Impetigo. 6 1 Plantar Warts. 15 18 Errors of Refraction and Squint. 24 15 Nose & Throat cases. 13 14 Miscellaneous. 4725 3974 (Including Minor Ailments). Dental Treatment. (a) Number of Children Inspected. 154 (b) " " " referred for treatment. 64 (c) " " " treated. 51 Orthopaedic Treatment. (a) Number of cases referred. 12 (b) " " " treated:- Hospital 8 Camp 3 Hospitalisation. The number of children who received treatment under our arrangement with the St, Thomas's Hospital is as follows:- Godalming 30 London 1 Until September, 1942, parents were allowed to visit their children at the Camp at week-ends, being conveyed by coach from Barking. This arrangement was cancelled owing to the Minister of War Transport issuing an instruction that all excursions by road would be discontinued, To replace such excursions by road a new scries of combined rail-road excursions were installed. The first was arranged for the 1st October, 1942, and thereafter at monthly intervals, giving parents and others who wished to visit the Camp, an opportunity to do so. - 19 - 15. CO-OPERATION. It has been a source of satisfaction to myself and the members of my staff5 that the help and co-operation which has again been afforded 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. The additional work which has been carried out was considerably aided by the ready assistance afforded my Department by many of the members of the Council, the Head Teachers, and other officers of the Council to all of whom I proffer iny sincere thanks. - 20 -