BARK 38 BOROUGH OF BARKING THE Annual Report OF THE Medical Officer of Health FOR THE YEAR 1944 (War Edition) C. LEONARD WILLIAMS B.Sc., M.R.G.S., L.R.C.P., D.P.H. ADELPHI PRESS LTD., BARKING. BOROUGH OF BARKING THE Annual Report OF THE Medical Officer of Health FOR THE YEAR 1944 (War Edition) C. LEONARD WILLIAMS B.Sc., M.R.G.S., L.R.C.P., D.P.H. 3 TABLE OF CONTENTS Page Introduction 7 Staff 8-9 Section A.—Statistics and Social Conditions of the Area. Births 11 Deaths 11-15 Deaths, Causes of (Tables) 12,13 Infant Mortality 13—15 Infant Mortality (Table) 13 Maternal Mortality 15 Population 17 Scales of Assessment 16 Social Conditions 15—17 Social Services 15 Still-births 11 Travelling Facilities 17 Unemployment 16,17 Section B.—General Provision of Health Services for the Area. Adoption of Children (Regulation) Act, 1939 28 Ambulance Facilities 19 Analgesia in Domiciliary Midwifery 25 Ante-Natal Supervision 24,25 Barking Hospital 20,22,23,26,31 Castle Green Nursery 28,29 Chiropody Clinic 21 Circumcision Clinic 27 Clinics and Treatment Centres 20-23 Dental Inspection and Treatment 33 District Nursing 23 Ear, Nose and Throat Services 31 East Barking District Nursing Association 23 Eastbury House Nursery 28,29 Education 24 Emergency Medical Services 20 Evacuation 25,26 Eye Defects 31,32 Expectant Mothers, Priority Dockets for Sheets 27 Foot Clinics 21 Home Helps 27 Home Visiting 27 Hospital Facilities 20 Infant Welfare Clinics 27 Lodge Farm Nursery 28,29 Maternity and Child Welfare Services 24-29 Midwifery 25 Milk, Dinners and Subsidiary Foods (Provision of) under Maternity and Child Welfare Scheme 28 B 4 Section B.—Continued Page Ophthalmic Nurse 31,32 Ophthalmic Services and Clinics 31,32 Orthopaedic Clinic 29,30 Plaistow Maternity Hospital and District Nurses Home 23 Post-Natal Supervision 24 Public Hospital Services 20,31 Scabies 22, 23 Scales of Assessment 28 Skin Clinics 22 Specialist Consultant in Skin Diseases 22 Spectacles, Provision of 32 Squint Training 32 Upney Maternity Pavilion 25 Voluntary Hospital Services 20 War-time Nurseries 28,29 X-Ray Treatment for Gynaecological Patients 28 Section C.—Sanitary Circumstances of the Area. Bed Bugs, Eradication of 40 Closet Accommodation 35 Drainage and Sewerage 35 Dwelling Houses, Inspection of 37 Factories, Inspection of 38 Housing 37 Miscellaneous Sanitary Inspections 38 Notices Served 39 Premises and Occupations controlled by Bve-laws or Regulations 37, 39 Public Cleansing 36 Rainfall35 Rats and Mice Destruction Act, 1919 40 Refuse Disposal 36 Rivers and Streams 35 Sanitary Inspection of the Area 36-40 Sanitary Work, Summary of 37-41 Water Sampling 35 Water Supply 35 Workplaces, Inspection of 38 Workshops, Inspection of 38 Section D.—Housing. Dustbins Supplied 46 Houses Erected during the Year 43 Housing Defects Remedied 44 Housing Inspections 43,44 Proceedings under Housing Act, 1936 45, 46 Proceedings under Public Health Acts 45 Unfit Dwelling Houses 43 5 Section E.—Inspection and Supervision of Food. Page Bacteriological Examination of Milk 47 Biological Examination of Milk 48 Chemical and Bacteriological Examination of Food 52 Food and Drugs Act, 1938 50,51 Food Poisoning 50 Food Preparing Premises, Supervision of 49 Food Sampling 50,51 Graded Milk Licences Granted 48,49 Meat and Other Foods 49 Milk Distribution 47,48 Milk Sampling 47,48 Milk Marketing Board 47 Milk (Special Designations) Order 1936 and 1938 48,49 Milk Supply 47-49 Prosecutions 51 Slaughtering 49 Unsound Food Surrendered 50 Section F.—Prevalence of, and Control over, Infectious and other Diseases. Artificial Immunization 58 Cerebro-Spinal Meningitis 55 Diphtheria 53,54,57 Dysentery 53,54 Erysipelas 53,54 Hospital Admissions 53, 54 Infectious Diseases Notified 53 Infectious Diseases (Tables) 53,54 Measles 53,54,57 Ophthalmia Neonatorum 53,54 Paratyphoid 54 Pneumonia 53-55 Puerperal Pyrexia 53,54 Scarlet Fever 53, 54,57 Tuberculosis 55-57 Tuberculosis, New Cases and Deaths (Table) 55 Tuberculosis Statistics, Years 1940 to 1944 (Table) 56 Unnotified Fatal Cases of Tuberculosis 55 Venereal Diseases 58 Whooping Cough 53, 54, 57 7 ANNUAL REPORT of the Medical Officer of Health for the Borough of Barking, in the County of Essex, for the Year ended 31st December, 1944 (War Edition). Public Health Department, Barking, Essex. November, 1945. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Major, Ladies and Gentlemen, I beg to submit herewith my Report for 1944—1 am sorry it is so late. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, Medical Officer of Health. 8 STAFF, 1944 The following indicates the changes that have taken place in the staff of the Public Health Department during the year 1944:— Medical Staff: Dr. A. E. SELIGMANN, Temporary Senior Assistant Medical Officer of Health.—Commenced 17th April, 1944. Dr. M. LEWIS, Assistant Medical Officer of Health.—Resigned 28th October, 1944. Dr. V. SPILLER, Temporary Assistant Medical Officer of Health.— Appointed 23rd February, 1944.—Resigned 30th November, 1944. Denial Staff Mr. J. WATSON, Assistant Dental Surgeon.—Resigned 30th September 1944. Health Visitors, etc.: Miss D. Day, Temporary Health Visitor.—Commenced 7th February, 1944 Miss M. O. Harrison, Temporary Health Visitor.—Commenced 18th September, 1944. Miss E. McSweeney, Temporary Health Visitor.—Resigned 25th July, 1944. Mrs. E. BiSHor, District Municipal Midwife.—Resigned 18th September, 1944. Miss K. Roe, Physiotherapist.—Resigned 6th April, 1944. Miss. V. J. R Sarson, Physiotherapist.—-Commenced 10th July, 1944. Mrs. B. Wheeler, Temporary Physiotherapist.—Resigned 29th July, 1944. Miss N. N. Jolly, Chiropodist.—Resigned 12th February, 1944. Miss M. Ryan, Temporary Chiropodist.—Resigned 12th April, 1944. Miss M. Woodhouse, Chiropodist.—Commenced 11th April, 1944. 9 Matron—War-time Nurseries: Miss M. E. Caygill.—Commenced 3rd April, 1944. Maintenance Engineer-Barking Hospital: Mr. V. Graville.—Resigned 7th August, 1944. Clerical Staff: Mrs. D. M. Benbow, Temporary.—Resigned 30th November, 1944. Mrs. G. M. Bird, Temporary.—Commenced 22nd September, 1944. Mrs. k. Field, Temporary.—Commenced 7th November, 1944. Mr. D. Flude, Temporary.—Commenced 27th December, 1944. Mrs. D. Hill, Temporary.—Commenced 31st January, 1944.—Resigned 30th November, 1944. Mr. J. C. McCarthy, Temporary.—Commenced 22nd May, 1944. Mrs. D. Servantes, Temporary.—Resigned 23rd August, 1944. 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 norma! duties in connection with the Public Health and Medical Services. Mrs. Bishop, Municipal Midwife, continued to serve at the Battlers Green Emergency Maternity Home, Radlett, until the 8th January. 1944. 11 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. 1. Births. The number of live births during the year 1944 shows an increase over the previous year. There were 1,270 live births compared with 1,236 in 1943. There were 31 still births—the figure for the previous year being thirty-six. 2. Deaths. (a) General. Three hundred and fifty-nine deaths were registered in Barking and the number in the year 1943 was 316— of these deaths nineteen were of non-residents compared with eight in the year 1943 and Barking residents who died elsewhere numbered 304 (325 in 1943). Taking into account residents who died elsewhere and excluding the deaths of visitors we get a net figure of:— Males. Females. Total. 360 284 644 12 The principal causes of deaths are shown in the following tables, supplied by the Registrar General. (NET DEATHS) Causes of Death. Total. Cerebro Spinal Fever 1 Scarlet Fever 1 Whooping Cough 4 Pulmonary Tuberculosis 43 Non-Pulmonary Tuberculosis 5 Syphilitic Diseases 1 Influenza 4 Acute Inf. Encephalitis 1 Cancer (all forms) 115 Diabetes 3 Intra-cranial Vascular Lesions 51 Heart Disease 133 Other diseases of circulatory system 19 Bronchitis 25 Pneumonia 42 Other respiratory diseases 9 Ulcer of Stomach or Duodenum 10 Diarrhoea (under 2 years) 1 Appendicitis 2 Other digestive diseases 14 Nephritis 9 Other Maternal causes 1 Premature Birth 8 Congenital Malformations, birth injury, infantile diseases 15 Suicide 7 Road traffic accidents 9 Other violent causes 71 All other causes 40 Total 644 (b) Infant Mortality. Thirty-six children under the age of one year died during the period under review, there being 46 such 13 deaths in the year 1943. A table showing the actual causes of death of these children under one year of age is set out hereunder 0-1 mth. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under 1 year Atelectasis 1 1 Acute Bronchitis and Actelectasis Neonatorum 1 - - - - 1 Atelectasis due to Prematurity 1 — — — — 1 Broncho Pneumonia — — 1 — 1 Broncho Pneumonia, Severe Anaemia, Haemolytic Jaundice - 1 - - - 1 Broncho Pneumonia, Whooping Cough - 1 1 - - 2 Cardiac Failure, Prematurity 4 — — — — 4 Cardiac Failure, Pneuomonia — 1 — — 1 Cardiac Failure due to Broncho Pneumonia - 2 1 - - 3 Cardiac Failure due to Suprarenal Haemorrhage 1 - - - - 1 Cardiac Failure A.P.H., Asphyxia Palida 1 - - - - 1 Cardiac Failure due to Acute Streptococcal Pneumonia - 1 - - - 1 Cardiac Failure due to Cerebral Haemorrhage due to Tentorial Tear 1 - - - - 1 Enteritis, Op. for Hypertrophic Pyloric Stenosis - 1 - - - 1 Failure of Respiration 1 — — — — 1 Failure of Respiration, Prematurity 1 — — — — 1 Gangrene of small intestine, Ileocolic intussesception _ 1 1 Gastro Enteritis — 1 — — 1 Haemorrhage disease of the newborn leading to Renal Haemorrhage 1 - - - - 1 Haemolytic disease of newborn 1 — — 1 Heart Failure, due to Toxaemia of Pregnancy 1 - - _ - 1 Hydrocephalus — — — 1 1 Icterus Gravis of the newborn 1 — — 1 Lobar Pneumonia - - 1 - - 1 Pneumonia - 2 Prematurity 1 — — — 1 Prematurity, Multiple Deformities 1 — — — 1 Toxaemia, Staphylococcal Septicaemia 1 - - - - 1 War Operations — 1 — — — 1 T otals 21 9 4 - 2 36 14 The Infant Mortality Rate for 1944 is 28.35. The infant mortality rate is the ratio between the number of births and the number of deaths under one year. It is expressed as " so many " per thousand. This rate for 1924 was 85.1 This rate for 1904 was 143 and the rate for the past five years is 33.99. The factors influencing this rate are many, amongst others:— 1. Education. 2. Nutrition. 3. Housing 4. Attention at birth:— Total number of births 1,301 Upney 488 Midwives on District 454 Doctors on District 27 Radlett, etc. 250 Others (Class A) 5 Others (Class B) 77 1,301 5. Ante-Natal Supervision and Hospital treatment:— Births as above 1,301 Visits to expectant mothers 1,955 Visits to children under one year 6,759 Total number of women who attended Ante-Natal Clinics 2,029 15 6. Child Welfare:— Total number of children who first attended Centres during the year who at their first attendance were under one year 1,062 7. Other Special Services:— Dental, Ryes, Ears, Skin, Chiropody and Orthopaedics. (c) Maternal Mortality. One Barking woman died owing to or in consequence of pregnancy or childbirth during 1944. There were two such deaths in the year 1943. The Maternal Mortality Rate for 1944 is 0.77 This rate is the ratio between the number of births and the number of women who died in childbirth, expressed as " so many " per thousand. 3. Social Conditions. (a) Social Services. Your Social Services cover a very wide field and are extensively used by the public, which in itself gives a true indication of their popularity, necessity and efficiency. d 16 (b) Scales of Assessment. The major change in your scales has been the adoption of another Scale for the provision of Milk, Dinners, and Subsidiary food products. This change is more particularly dealt with in the Maternity and Child Welfare Section of this Report. (c) Unemployment. There has been consultation with the Manager of the Barking branch of the Ministry of Labour and National Service on this question, who informs me that unemployment in this area during the year 1944 has been practically "Nil" in both the Men and Women's Sections. The demand for Labour still considerably exceeds the supply, with the result that any labour becoming available has to be directed to work of the utmost National importance. First aid damage repair work is still carrying a high priority and suitable labour is still being directed to this class of work. In stating that there is practically no unemployment the Ministry of Labour refer to the small number of workpeople (civilians) with physical and/or mental defects, who are very difficult placing propositions and are more or less always in and out of work. The employment of part-time female labour referred to in last year's report continues to be satisfactory and in this connection it might be stated that the setting up of day nurseries to look after the children during the time the mothers are at work continues to be serving a very useful purpose. 17 The changes and curtailment of labour in the munitions programme which would appear to be occurring in some other areas, is not materially affecting Barking so far, nor are there any immediate signs of it doing so. One noteworthy feature of the work this year has been the success attending efforts in placing discharged disabled service men. (d) Travelling Facilities. Sly views on the conditions of travel on the Electric Railway to and from Barking are well known; and it is my opinion that this matter must be dealt with as soon as the housing situation permits. (e) Population. The Ministry of Health in their official communication dealing with the method of preparation of Annual Reports for the year 1944, indicate that the restrictions on the grounds of national security previously imposed on the publication of population figures, have now been removed. Vital Statistics and other Statistical information have been received from the Registrar General, whose Estimate of population is 63,350, for the year under review. 19 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. General Health Services. (a) Ambulance Facilities. The extent of the use of the normal Ambulance Service during the year 1944, is shown by the 4,502 patients conveyed by ambulance, and reciprocal arrangements with other Authorities are still in operation. The Ambulance Service of the Borough is comprehensive and the " no-charge " scheme is in being. Our experience in the war years has taught us that an Ambulance Service must be an integral part of your health service, and with the transfer from the fire service of your peace-time ambulances unified control of all forms of ambulance work—accidents, hospital removals, and infectious patients—was achieved. The White Paper on the National Health Service in a reference to ambulances which is incidental, does postulate that the future ambulance service will be a health function. Any long term consideration of the service must have cognisance of the changes in hospital service 20 envisaged in the White Paper, when some alteration in the distribution of vehicles must be expected. (b) Hospital Facilities. In my Report for the year 1937, I spoke of the then difficulties in the interchange of medical opinion between the large London Hospitals and the local Authority. Those difficulties exist today. Optimistically, we can believe they are in part due to the war, but I am quite sure that to a large extent they are due to the infortunate lines on which this work has developed in the large London hospitals. In particular, hospital staffs waste a lot of time writing letters which express opinions of medical importance without naming the medical practitioner who is responsible for the opinion, and, of course, such nameless opinions are all but valueless. There is no general hospital in the Barking area except that of the Barking Emergency Hospital which is operating the Emergency Medical Service Scheme, and which, of course, deals only with certain types of cases for which H.M. Government is financially responsible. As in previous years, however, the Corporation has again allocated the sum of £300 which has been distributed to the hospitals in London and in the neighbourhood of Barking for their services in connection with out-patient and other attendances of children from the Barking area. (c) Clinics and Treatment Centres. Your Clinics and Out-patient Departments are always in great demand and the attendances in the 21 year we are now dealing with totalled it3,989. This compares with 126,500 in the year 1943 and 118,000 in 1942. The fall in the total attendances is no doubt due to the fact that manv mothers and children were evacu- J ated from Barking during the latter half of the year. (d) Chiropody Clinic. The Statistics for the Chiropody Clinic show that the number of treatments for 1944 has been slightly lower than 1943, due in part to the reduced number of sessions owing to staff shortage. The patients were seen in rotation (except for urgent cases) which made, with the increasing demand, the interval of treatments for regular patients over three months instead of 4-6 weeks. In October, the waiting list had nearly 3,000 names but by intensive work, it was reduced to just under 2,000 at the end of the year. It is apparent to me that the public are becoming more conscious of the benefit of chiropody and that the demands for treatment will increase. Your arrangements for evening sessions continue. Statistics are given hereunder which shows how the activity of this clinic have progressed. Year 1943 Year 1944 1. Treatment Sessions 1,346 1,307 2. Total Individual Patients 1,895 2,006 3. New Patients 1,269 1,233 4. Total treatments given 8,568 8,537 5. Infra-red treatments (included in 4) 255 578 22 (e) Skin Clinic. Your Specialist Consultant in Skin Diseases, Dr. Arthur Burrows, has continued to hold his weekly session at the Barking Hospital, and in addition the two treatment sessions have been held throughout the year. The following statistics illustrate the extent of the use of this service for the years 1943 and 1944. Consultations. Treatments. Year ended 31st Dec., 1943 Year ended 31st Dec., 1944 Year ended 31st Dec., 1943 Year ended 31st Dec., 1944 Sessions 38 43 79 102 Attendances Children under 5 years 163 134 255 295 185 175 549 383 Ante Natal & Post Natal Cases 57 61 132 97 Other categories (including Public Adult Scheme) 100 57 149 142 (f) Scabies. Scabies is at present notifiable within the Borough, in accordance with an order approved by the Minister of Health under Section 147 (1) of the Public Health Act of 1936. You have continued to provide baths and outpatient treatment. 23 There has been a decrease in new cases when compared with the year 1943. Statistics of the cases reported and treated during the year under review are as follows:— New Cases Recurring Cases Total Total number of patients 671 128 799 Adults 286 35 321 Children 385 93 478 Referred from:— Clinics 416 96 512 Other sources 255 32 287 Adults 242 32 274 Children 338 86 424 Of the remaining 101 who were not cleansed at the Barking Hospital, 17 were treated at the clinics, and 84 were otherwise dealt with. In addition on request 141 contacts (79 adults, 62 children) were given baths at the Barking Hospital. (g) General District Nursing. The Plaistow Maternity Hospital and District Nurses Home and the East Barking District Nursing Association provide skilled nursing in the home for all people in the Borough. The work is carried out efficiently by these organisations and the Council give considerable financial aid. During the year 1944, the District Nursing visits for the whole of the Borough totalled 18,031 and for the year 1943 this figure was 18,838. E 24 (2) Maternity and Child Welfare Services. (a) Education. Sir George Newman in a speech many years ago stressed how advancements in public health always lagged a generation behind great advancements in education. This must of necessity be so in a country where the growth and development of social services is more than gradual and where the young generation demand services before they are ultimately developed. I wish to express my high appreciation of the way in which children of yesterday have been educated to avail themselves of the services provided today and what I can see of the schools of today leads me forward to tomorrow with every confidence so far as further developments in our services are concerned. (b) Ante-Natal and Post-Natal Supervision. There has been a decrease in the number of attendances at your Ante-Natal, Post-Natal and Gynaecological Clinics, and the reason for this decrease, I feel sure, will be well recognised in view of the abnormal circumstances prevailing during the last six months of the year 1944. Statistics in relation to these attendances for the years 1943 and 1944 are given below:— Attendances. Year Year 1943 1944 Ante-Natal II,955 11,000 Post-Natal 855 671 Gynaecological 1,242 734 25 (c) Midwifery. (i) Supervision. —There were fourteen midwives practising in the Borough at the end of the year, eight of whom were employed at the Upney Maternity Pavilion. During the year 1944 midwives sought medical assistance in 157 cases; 31 of these were on behalf of babies. (ii) Domiciliary Midwifery.—Four hundred and fifty four domiciliary cases were delivered in Barking during the year 1944. In addition 27 mothers were delivered by doctors with district midwives in attendance. (iii) Analgesia in Domiciliary Midwifery.—All of the six domiciliary midwives practising in Barking at the end of the year were qualified to administer gas, and air analgesia. Analgesia was administered in 105 domiciliary confinement cases. (d) Upney Maternity Pavilion (and Barking Emergency Hospital). At the Upney Maternity Pavilion during 1944, 488 patients were confined, 47 patients were admitted for ante-natal treatment, 11 for post-natal treatment, and there were four miscarriages. The Upney Maternity Hospital has been doing its usual work, and has remained open despite "blitzing" and bombs. Owing to increased evacuation there was a time when the number of patients admitted fell below normal but at the end of the year the Hospital was busy and admitting normally. 26 At the Barking Emergency Hospital 150 expectant mothers spent a total of 1,697 bed days, and in addition the following cases were dealt with at this Hospital:— Gynaecological 35 Miscarriages 1 Post-Miscarriages 2 Abortions 5 Post-confinement cases 23 making a total of 66 who spent 1,110 bed days. Seventeen babies were also admitted with their mothers, included in the post-confinement cases figure. (e) Evacuation. Evacuation of expectant mothers in the last month of pregnancy to Radlett and to other areas has continued, the calls on this service having increased considerably. In addition, expectant mothers left Barking, under the Government's plan for the evacuation of such cases, some of whom were confined in safe areas. In the latter part of the year, many expectant mothers were evacuated to private billets in reception areas, and assistance has been given by your Officers in making suitable arrangements for their confinement where such help has been sought. A total of 250 expectant mothers were confined in reception areas, during the year 1944. 27 (f) Home Helps. The service inaugurated last year to assist women in their homes at the time of their confinement has become established. At the end of the year 1944, there were three home helps on the Council's panel and a home help had been provided in 32 confinement cases. This Scheme has been extended to cover households where help is required on account of the illness of an expectant mother, also a nursing mother or a child under five years of age. (g) Infant Welfare Centres. There were 26,345 attendances at the Council's Infant Welfare Clinics, the figure for the year 1943 being 33,083. (h) Home Visiting. Home Visiting is an important part of a Maternity and Child Welfare Scheme, and it is pleasing to record that there has been an increase in this work, the total home visits paid being 18,859 as compared with 17,308 in the year 1943 and 17,950 in 1942. (i) Circumcisian Clinic. This Clinic was held regularly during the year and 143 cases received treatment. (j) Priority Dockets for Sheets. In November, 1944, we commenced to operate the Government Scheme for the supply of sheets to expectant mothers to be confined in their own homes, and up to the 31st December a total of 47 dockets had been issued to a total of 18 expectant mothers. 28 (k) Provision of Milk, Dinners and Subsidiary Foods. The Scale of charges in operation for Maternity treatment and other allied sendees, has been adopted for the provision of Milk, Dinners and subsidiary food products. Previously the National Scale in use for the issue of Government milk and vitamins had been applied, and with this change a uniform scale is now in operation for all our Maternity and Child Welfare Services. During the year the demand for the supply of Milk, Dinners, etc., has greatly increased. (1) X-Raj Treatment jor Gynaecological Patients. An arrangement has been made for the treatment at the London Hospital by X-Rav therapy of certain conditions in patients coming within the purview of vour Gynaecological Scheme. (m) Adoption of Children. The coming into operation of the adoption of Children (Regulation) Act, 1939, was referred to in my Annual Report for last year. Section 7 of this Act requires all persons participating in any arrangements for the placing of children, to notify the Welfare Authority in writing.—No such notifications were received in the year 1944. (n) War-time Day Nurseries. The three Nurseries in the Borough are at Castle Green, Eastbury House and Lodge Farm; the most recently established being the Castle Green Nursery, which was opened in mid-January, 1944. 29 The average daily attendances during the year (excluding Saturdays) were as follows Castle Green 20 Eastbury House 43 Lodge Farm 32 Some difficulty has been encountered on account of shortage of staff, particularly at the Castle Green Nursery. The scarcity of suitable staff, and in fact of -all Nursing Staff, in these abnormal times is generally recognised, but the best possible results have been achieved under all the circumstances. (3) ORTHOPAEDIC SERVICES. Twelve Consultation sessions were held during the year by Mr. A. M. A. Moore, your Specialist Consultant. The standard of treatment and the scope of your schemes have been maintained satisfactorily, but there has been a fall in the attendances for treatment, one cause being the scarcity of qualified Physiotherapists. You have established three such posts, but for some months of the year 1944, only two physiotherapists were employed, and this is the position at the time of writing. The official channel for the supply of candidates is the Appointments Branch of the Ministry of Labour, and your officers are in constant touch with the Ministry, in an endeavour to fill the existing vacancies. PARTICULARS OF THE WORK DONE IN CONNECTION WITH THE ORTHOPAEDIC CLINIC DURING 1944. Number of Sessions held by the Orthopaedic Surgeon12 Number of Sessions held by the Masseuses 1,138 Toddlers & Adults School Children ATTENDANCE Primary Examination by Surgeon 112 56 Re-examination by Surgeon 87 100 For treatment 5,808 5,359 Totals 6,007 5,515 Treatments. Number of Cases 725 982 Number of Treatments 8,767 6,370 Hospital Treatment. Admissions to Hospitals — 1 On waiting List for Admission — — Totals — 1 Cases dealt with for the first time during 1944— by the Orthopaedic Surgeon—were referred for the following defects:— Toddlers & Adults School Children (a) Deformities of Bones & Joints:— 1. Congenital 8 1 2. Acquired 89 50 (b) Muscular:— 1. Congenital 3 — 2. Acquired 5 — (c) Paralysis 4 2 (d) Miscellaneous 11 6 31 (4) EAR, NOSE AND THROAT SERVICE. There were somewhat less Consultations and Attendances for treatment at your Specialist Consultant Clinic when compared with the year 1943— with a consequent decrease in the number of sessions, the number being 41, whereas 44 sessions were held in the previous year. We have continued our arrangements with the Queen Mary's, King George and St. Mary's Hospitals, for the operative treatment of ear, nose and throat defects. Our Barking Hospital Scheme is still in abeyance. Statistics, in relation to the Ear, Nose and Throat Scheme are set out hereunder:— Mothers & Toddlers Adults— Public Scheme School Children Total Year 1943 Year 1944 Year 1943 Year 1944 Year 1943 Year 1944 Year 1943 Year 1944 Number of Attendances at the Ear, Nose and Throat Clinic 274 208 26 36 838 772 1,138 1,016 Number of cases which received operative treatment 97 34 — — 353 214 450 248 Number of cases which received other forms of treatment 51 61 11 14 561 296 623 371 (5) OPHTHALMIC SERVICES. The Council have established the post of Ophthalmic Nurse, but the actual appointment is still in abeyance because we have not succeeded in obtaining a suitable candidate despite the efforts of the 32 ments Branch of the Ministry of Labour, who are responsible for the nomination of applicants. The statistics of the work of your Ophthalmic Clinics given below, show that less cases have been dealt with than in the previous year. (a) Treatment of Defective Vision and Squint— Table of Statistics. Mothers & Toddlers jvdults— Public Scheme School Children Total Year 1943 Year 1944 Year 1943 Year 1944 Year 1943 Year 1944 Year 1943 Year 1944 Errors of Refraction, etc. requiring treatment 246 221 281 260 900 663 1,427 1,144 Number for whom spectacles were:— 83 68 211 206 585 519 879 793 (h) Obtained 76 35 186 163 507 356 769 554 (b) Squint Training. Under all the circumstances this Clinic in my opinion has been well attended in spite of the drop of nearly ioo in the total attendances, as compared with the number in the year 1943. Statistical data of this Service is given hereunder :— Year 1943 Year 1944. Number of Sessions 122 102 Number of Children Attended 40 44 Number of New Cases 8 13 Number of Old Cases 32 31 Number of Attendances 703 610 Number Discharged—Cured 2 3 Number Evacuated Nil 11 Number Left School 2 3 Number Discontinued 2 8 33 (6) DENTAL INSPECTION AND TREATMENT. The Dental Services, amongst others, have been considerably affected by the available man power, and although all possible steps have been taken to make-up for this deficiency, it has been necessary to curtail these services, with a consequent fall in the number of patients dealt with. There were 6,649 attendances under your public Adult Dental Scheme, the number in the previous year being 8,019—somewhat over one half of these 6,649 attendances were at evening sessions. Statistics as to the cases dealt with in the years 1943 and 1944, under your Public Adult and Maternity and Child Welfare Dental Schemes are as follows:— Scheme Year ended 31st Dec., 1943 Year ended 31st Dee., 1944 (a) Number of Visits of Patients to Clinics 10,266 7,977 {b) Number of Dentures Supplied 1,670 1,363 35 \ SECTION C. SANITARY CIRCUiMSTANCES OF THE AREA. (x) RAINFALL. The rainfall for the year ended 31st December, 1944, was 19.66 inches, as compared with 19.50 for the previous year. Rain fell on 150 days in the year 1944. (2) WATER SUPPLY. There was no extension of mains during the year 1944. Samples are drawn from the domestic supplies and submitted half-yearly for chemical examination, and monthly for bacteriological examination. All samples were reported pure and wholesome and suitable for drinking and domestic purposes. (3) DRAINAGE AND SEWERAGE. Drainage arrangements continue as heretofore. (4) RIVERS AND STREAMS. The position remains as in previous years. (5) CLOSET ACCOMMODATION. At the end of the year there remained a total of 13 premises unconnected with the sewer, 9 of which were factory premises; none were dwelling houses. 36 (6) PUBLIC CLEANSING. During the year 3,400 loads of refuse were collected with an average weight of 2.83 tons per load. The practice of a daily collection of waste food and a fortnightly collection of other domestic refuse continued. (7) REFUSE DISPOSAL. The refuse of the Borough, by arrangement with the County Borough of East Ham, was taken to the destructor works of that Authority. (8) SANITARY INSPECTION OF THE AREA. The serious damage and destruction to property in the Borough caused by flying bombs and rocket missiles called for the diversion of your sanitary inspectors to the task of assessing and co-ordinating building repairs, throughout the greater part of the year. We were glad to be able to make this contribution to the welfare of the town, whilst at the same time carrying out other essential duties. During the year 1,538 complaints were registered by the public. 37 (a) Work of Sanitary Inspectors. (i) Inspection of Dwelling Houses (including War Damage classifications). Total Houses inspected under Public Health or Housing Acts 4,300 Total Number of Inspections made 6 785 Housing (Consolidated) Regulations 667 After Infectious Disease and Scabies 1,123 Overcrowded Premises 68 Defects Found 2,280 Notices Served (Preliminary) 1,5 53 Re-inspections re Notices Served 2,675 Inspection of Works in Progress 218 War Damage Classifications 967 (ii) Premises Controlled bj Bjelam and Regulations. Inspections. Contraventions. Notices served. Houses Let in Lodgings.. — — — Common Lodging Houses — — — Offensive Trades 40 28 Tents, Vans, Sheds and Fairgrounds 12 1 1 Dairies, Cowsheds and Milkshops 8l 18 13 Hairdressers' and Barbers' Premises 37 28 14 Smoke Observations 1 1 1 38 (iii) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 119 7 5 Bakehouses 18 4 4 Workplaces 41 6 4 Outworkers Rooms 82 7 4 Butchers Premises no 59 37 Fishmongers 47 29 19 Restaurants and Dining Rooms and Canteens . 105 100 42 Stables and Stable Yards. 32 8 8 Piggeries 62 12 11 (iv) Miscellaneous. Inspections. Defects. Notices. Rats and Mice (Destruction) Act, 1919 1,709 160 142 Vacant Land and Refuse Dumps 69 13 13 Public Lavatories 54 7 7 Schools 17 7 7 Shops Act, 1934 and Markets 302 75 45 Ice Cream Vendors 1 3 1 Drainage Inspections 194 — — Milk Sampling 157 — — Other Miscellaneous 118 10 10 Food and Drugs Act, 1938 931 143 82 Water Sampling 34 — — Street Traders — — — Food Byelaws 153 — — Watercourses 11 — — 39 (b) Notices Served Informal Notices:— 1,553 Statutory Notices:— Public Health Act, 1936: Section 39 2 Section 45 33 Section 83 3 Section 93 208 Housing Act, 1936: Sections 9 and 10 9 Section 24 — Section 32 — Dustbins: Public Health Act, 1936, Section 75(3) 418 673 (c) Premises and Occupations which are Controlled by Byelaws or Regulations. The following is a list of the above type of premises:— (1) Houses let in lodgings. (2) Common Lodging Houses. (3) Tents, Vans and Sheds. (4) Underground sleeping rooms. (5) Offensive Trades. (6) Piggeries. (7) Stables. 40 (d) Rats and Mice Destruction Act, 1919. There is developing an increasing consciousness Of the serious damage to foodstuffs and property caused by rodent infestations. The relation between sewer and surface infestations is recognised. Owing to demands upon the services of the Corporation arising from enemy action it was not possible to co-ordinate treatment on the ' block ' system. A start was made upon sewer treatment but this had to be discontinued owing to more urgent calls upon the technical labour and staff of the Council. Continuous treatment of major infestations and potential reservoirs was however maintained. The total number of complaints received during the year were 265. Many related to minor infestations and were dealt with by the issue of suitable raticides. In other cases appropriate action was taken by your officers, using new methods. (9) ERADICATION OF BED BUGS. The following houses have been disinfested:— Barking Council Houses 4 Privately owned Houses 7 Evacuation and shelter-dwelling reduced the incidence of infestations. 41 Damage to property by enemy action prevented the use of gas as a fumigant. Such action as was possible consisted of treatment with one of the recognised insecticides. We found it necessary on several occasions to use Civil Defence premises as a temporary hostel whilst treatment of infested premises was carried out. 43 SECTION D. HOUSING. (I) STATISTICS. (a) General. Number of new houses completed during the early part of 1944. (1) Total Nil (2) As part of a municipal housing scheme:— (a) Barking Nil (b) L.C.C. Nil (3) Others Nil (b) Unfit Dwelling-Houses. I. Inspection of divelling-houses during the year (including War Damage Classifications):— (1) (a) Total number of dwellinghouses inspected for housing defects (under Public Health or Housing Acts) 4,300 (b) Number of inspections made for the purpose 6,785 44 (2) (a) Number of dwelling-houses (included under sub-head No. 1 above) which were inspected and recorded under the Housing Consolidated Regulations 667 (b) Number of inspections made for the purpose 947 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,520 2. Remedy of Defects during the Year without Service of Formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 760 3. Action under Statutory Powers during the Year:— A.—Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 9 45 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 24 (b) By local authority in default of owners 3 B.—Proceedings under Public Health Acts (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 246 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : (a) By owners 158 (b) By local authority in default of owners 24 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936 (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — 46 D.—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which closing orders were made — (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit E.—Number of dustbins supplied by local authority in default of owners 499 47 SECTION E. INSPECTION AND SUPERVISION OF FOOD. (1) MILK SUPPLY. There are no cowkeepers in the district and we have only one dairy where milk is handled or treated. The remaining 44 premises on the register retail pre-packed supplies. In addition there are five milk purveyors who occupy premises in other districts, but retail in Barking. The following table sets out the results of the bacteriological examination of various samples. Type of Sample Satisfactory Unsatisfactory Totals " Sterilised " Milk 7 - 7 " Pasteurised " Milk 42 9 51 " Homogenised " Milk 3 6 9 Tuberculin Tested Milk 17 9 26 Totals 69 24 93 The nationalisation of distribution carried out by the Milk Marketing Board has not been free from trouble to the consumer. Since the introduction of the one delivery daily scheme, there has been a noticeable increase in the complaints of milk-souring. The wartime difficulties at the milk-processing plants, distribution problems, and delay at the home in "taking in" the day's supply owing to the absence 48 from home of the housewife, have all contributed to the loss of valuable supplies. If the one delivery practice is to be maintained it will be essential for all homes to be fitted with refrigerated storage and for long-distance retail delivery prams and vans to be designed to protect supplies from the heat of the sun. It is to be regretted that the control of war-time labour supply to the milk industry did not permit the retention of the skilled employees at the processing plants. In every case when complaints were investigated it was found the trouble was due to lack of the right quality of labour in key positions. I look forward to important changes for the better in 1946. There were, during the year, 60 samples of milk submitted to biological examination for the presence of tubercle. In two cases the guinea-pig died prematurely. In no case was there a positive result. I am glad to record that, apart from the Tuberculin Tested Milk retailed under that designation, the whole of the supplies in Barking have been treated either by Pasteurisation or Sterilisation. The following table shows the number of licences granted during the year for the sale of graded milks 49 under the Milk (Special Designations) Orders, 1936 and 1938:— Tuberculin Tested 6 Pasteurised 10 (2) MEAT AND OTHER FOODS. (a) Meat. Since the outbreak of war slaughtering in Barking has been discontinued. (b) Supervision of Food Preparing Premises. The number of premises in the district at tne end of the year at which the following foods are prepared were:— Sausages 24 Potted Meat and Brawn 2 Roast and/or Boiled Ham 2 Pressed, Pickled, Cooked, etc. Beef and Tongue 36 Roast Pork — Bacon — Boiled Crabs and Lobsters 2 Pickled Fish 2 Pickled Onions, etc. 1 Smoked Fish 8 Bakehouses 10 50 (c) Unsound Food. The War-time control has resulted in an increase in the amount of food surrendered. The following list can be regarded as representing the whole of the food handled or retailed in the district found unfit for consumption. Bacon 1,014½ lbs. Provisions 970½ lbs. Sugar 189 cwt. 51 lbs. Sweets 149½ lbs. Meat 5,291 lbs. Cereals, Dried Fruits, etc 4,780 lbs. Fish 2,429½ lbs. Rabbits 61½ lbs. Various Fillings 4,041 tins, jars, etc. Eggs 1,773 Tea 374 lbs. Sauces and Pickles 1,216 gallons (3) FOOD POISONING. There were three cases of food poisoning notified during the year. (4) FOOD AND DRUGS ACT, 1938, SAMPLING. During the year, your authorised officers have submitted a total of 179 samples, divided as follows:— Milk 43 Butter and Margarine 3 Others 133 179 51 The reports of the Borough Analysts show that of this total, eighteen were found not genuine. Of the unsatisfactory samples two related to canned "broth" As the definition was not clear the reports were forwarded to the Ministry of Food for any necessary action. In six cases examination of samples showed deterioration of food products due to age and long storage. Action was taken by the seizure of the goods as unfit for food. In seven instances milk producers were warned with respect to deficiencies which on check were found to be due to feeding or labour difficulties. In relation to a further two unsatisfactory milks the producer was prosecuted and convicted. The evidence given in this case was most interesting as indicating how infection could be transmitted in raw milks. A boy employee on the farm stated that on a number of occasions he had removed the short hosepipe from the water cooler, inserted one end into the milk and sucked out a "good drink" from the other end which he placed in his mouth. One sample of dandelion coffee purchased from a herbalist was found to be in a dirty condition. The producer and vendor were warned. 52 (5) CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The bacteriological examination of all milk and water samples is carried out for this Authority by the Counties Public Health Laboratories, of Gidea Park College, Essex, whilst the examination of samples of milk for the presence of tubercle is carried by out Dr. A. L. Sheather, of Chorleywood, Herts. The Borough Analysts are Dr. B. Dyer and Dr. J. H. Hamence, Peek House, Eastcheap, London, E.C. 53 SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (1) NOTIFICATION. The following is a summary of our four quarterly returns, to the Ministry of Health, in respect of the Notification of Infectious Diseases. These Returns are final numbers, after subsequent corrections by the notifying Medical Practitioners or by the Medical Superintendent of the Hospital. Removals to Hospital and deaths are also given. Disease Total Total Cases Removed to Hospital Deaths Diphtheria 9 9 Dysentery 23 23 — Erysipelas 36 17 1 Measles 151 5 — Ophthalmia Neonatorum 5 5 — Pneumonia 45 15 7 Puerperal Pyrexia 5 2 — Scarlet Fever 153 119 1 Whooping Cough 479 13 — Totals 906 208 9 (2) HOSPITALISATION. Our Infectious Diseases have been hospitalised at the Ilford Isolation, Plaistow Fever, Rush Green Isolation, Billericay, Grays, Waltham Cross, Dartford, 54 Enfield Isolation and also Hospitals of the London County Council. The following is a table relating to the Infectious Diseases dealt with at Hospitals in the year ended 31st December, 1944. In Hospital 31st Dec., 1943 Admitted during the year 1944 Died Discharged In Hospital 31st Dec., 1944 Diphtheria 5 9 12 2 Dysentery — 23 — 23 — Erysipelas 1 17 1 16 1 Measles — 5 — 4 1 Ophthalmia Neonatorum 1 5 — 6 — Pneumonia 2 15 *7 12 1 Puerperal Pyrexia 1 2 — 3 — Scarlet Fever 24 119 1 139 3 Whooping Cough 1 13 — 14 — Other Infectious Diseases 1 7 — 7 1 * Three cases of Pneumonia died at home. (3) PARATYPHOID FEVER. No cases have occurred in the Borough during the current year, and a table of the cases in Barking, for the past eight years is given hereunder :— Year Number of Cases Notified Admitted to Hospital 1937 17 17 1938 8 8 1939 2 2 1940 22 22 1941 1 1 1942 — — 1943 1 1 1944 — — 55 (4) PNEUMONIA. There were 45 notifications of all forms of Pneumonia which means that there were considerably less cases than in the year 1943, when the total number was 113. (5) CEREBRO SPINAL MENINGITIS. In the years 1942 and 1943, there were 6 and 18 notifications respectively, whereas no cases have occurred in the year 1944. (6) TUBERCULOSIS. Particulars of new cases of tuberculosis in the area during 1944 are given below:— New Cases Notified Pulmonary Non-Pulmonary M. F. M. F. Under 1 year 1 to 5 years — 1 4 — 5 to 15 years 4 4 4 1 15 to 25 years 14 29 1 3 25 to 35 years 10 11 — — 35 to 45 years 15 4 — — 45 to 55 years 7 1 — — 55 to 65 years 3 3 — 1 65 years and upwards 2 — — — 55 53 9 5 One hundred and twenty-two notifications were received of all forms of tuberculosis—pulmonary 108 and non-pulmonary 14 and there was one death of an un-notified case making a total of 123 new cases. Information has been received of the removal into the district of twenty tuberculous persons, 56 included in the number of notifications received— five of these are old cases returned to Barking. This compares with 19 received during 1943 and 28 for 1942. Statistics in relation to Tuberculosis for the years 1940 to 1944 are given below:— Year 1940 Year 1941 Year 1942 Year 1943 Year 1944 New Cases Notified— Pulmonary 117 113 107 106 108 Non-Pulmonary 15 28 30 21 14 Total of New Cases Notified 132 141 137 127 122 Deaths from Tuberculosis— Pulmonary 41 48 37 42 43 Non-Pulmonary 2 8 7 4 •5 Total deaths from Tuberculosis . . 43 56 44 46 48 The Tuberculosis Officer advises me that there was actually an increase in availability of methods of diagnosis, namely a separate weekly children's session. He does not think that any apparent increase in the incidence of tuberculosis could be attributed to this slight increase in availability of methods of diagnosis. The Tuberculosis Officer also states that there does appear to have been an increased use during the year 1944, as compared with the preceding year, by the practitioners in the area, of the services available for diagnosis. It may be that any apparent increase in the incidence of tuberculosis is due to this increased use of the facilities, indirectly owing to greater public attention being directed to matters 57 connected with tuberculosis, but he does not think it is possible to speak with any assurance on this point. (7) SCARLET FEVER. A considerable decrease has taken place in the incidence of Scarlet Fever, there being only 15 3 cases in the current year, the figures for 1942 and 1943 being 334 and 398 respectively. One hundred and nineteen of the cases occurring this year were admitted to Hospital. (8) WHOOPING COUGH. The figure for the year 1943 was 277, and 290 for the year 1942. The year under review shows a considerable increase in the incidence of Whooping Cough when 479 cases occurred. (9) MEASLES. The decrease in measles is very large and the incidence for the past three years is as follows:— Year. Notifications. 1942 1,260 1943 797 1944 . 151 (10) DIPHTHERIA. There has again been a fall in the number of cases of Diphtheria, the notifications being:— Year. Notifications. 1942 57 1943 35 1944 9 58 (II) ARTIFICIAL IMMUNISATION. In the year 1944, 688 children were inoculated against Diphtheria, the number in 1943 being 7,089. our Diphtheria Immunisation campaign was commenced in November, 1942, and at the end of this year over 14,000 children under 15 years of age had been immunised against Diphtheria, this being the major portion of the child population of the Town. of this 14,000, approximately one quarter is in respect of children of five years of age and under. Immunisation against Whooping Cough and Scarlet Fever has continued, the inoculations for the year being 56 (whooping cough) and 3 (scarlet fever). Table of Statistics—Years 1943 and 1944. Year 1943 Year 1944 Inoculations against Diphtheria 7,089 688 Inoculations against Scarlet Fever 49 3 Inoculations against Whooping Cough. 136 56 (12) VENEREAL DISEASE. The Essex County Council is responsible for this service, and treatment facilities are provided at General Hospitals, including the County Hospital at Oldchurch, and the London Hospital (Turner Street Clinic).