BARK 40 The HEALTH of BARKING 1946 1946 The Annual Report of the Medical Officer of Health, Borough of Barking: C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. BOROUGH OF BARKING THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1946 C.LEONARD WILLIAMS, b.sc., m.r.c.s., l.r.c.p., d.p.h. CORPORATION OF BARKING TOWN HALL, BARKING ESSEX October, 1947. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, The form of my Report, for the year 1946 has been designed to appeal not only to the members of the Council, who have an inside knowledge of the working of the services, but also to a wider public. Too often the valuable statistical work it is my duty to submit to you, is read only by yourselves and a small number of technical people. There is a very real field of usefulness for an Annual Report amongst members of the public generally and I earnestly trust that my attempt this year to make the report popular will mean that it will be a force in developing health consciousness. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. iii TABLE OF CONTENTS Page Page INTRODUCTION iii ORGANISATION CHART i SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Page Birth Rate 2-3 Deaths 3-5 Employment 6 Infant Mortality 3-5 Maternal Mortality 3 Neighbourhood Units 6 Page Nurses Act, 1943 7 Nutrition 7 Old Age 2 Social Services 5 Still Births 3-4 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Page Ambulance Service 27 Analgesia in Domiciliary Midwifery 16 Ante-Natal Clinics 15 Barking Hospital 26 Breast Feeding 11 Broncho-Pneumonia 13-14 Chiropody Clinic 21-23 Day Nurseries 17-18 Dental Service 24-25 Ear, Nose and Throat Service 20 General District Nursing 27 Home Helps 27-28 Home Visiting 8-11 Hospital Facilities 25-27 Infantile Mortality Rate 8 Page Infant Welfare 8-11 Infant Welfare Clinics 8-10 Maternity Service 14-17 Midwifery 14-15 Neo-Natal Mortality 11 Ophthalmic Service 25 Orthopaedic Service 18-20 Pain in Childbirth 15-17 Prematurity 11-13 Scabies 24 Skin Clinic 23 Squint Training 25 Tight Shoes 21-22 Upney Hospital 26-27 Vitamins 12 SECTION C PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Page Cerebro-Spinal Meningitis 35 Diarrhoea in New Born 38 Diphtheria 29-31 Immunisation 29, 31 Measles 34 Paratyphoid 35 Page Pneumonia 35 Scarlet Fever 32 Tuberculosis 36-37 Typhoid 35 Venereal Diseases 38 Whooping Cough 33 V SECTION D ENVIRONMENTAL HEALTH SERVICES. Page Atmospheric Pollution 42-43 Bacteriological Examination of Milk 48 Bed Bugs 41 Biological Examination of Milk 48 Chemical and Bacteriological Examination of Food 50 Clearance Areas 44,46 Drainage and Sewerage 39 Dustbins, Disinfection of 40-41 Food and Drugs Act, 1938 49-50 Food Poisoning 49 Graded Milk Licences Granted 48 Housing 44-48 Ice Cream 49-50 Inspection and Supervision of Food 48-50 Loxford Arm 40 Meat 49 Milk Supply 48 Page Post-War Housing 44-47 Public Cleansing 40-41 Rainfall Rats and Mice Destruction Act, 1919 41-42 Refuse Disposal 41 Rehousing Programme 44 River Roding 40 Rivers and Streams 40 Sanitary Circumstances of the Area 39-44 Slaughtering 49 Smoke Byelaws 43 Squatters 47-48 Standards of Housing 44-47 Tips-41 Unsound Food 49 Water Supply Wells TABLES APPENDIX A—STATISTICS AND SOCIAL CONDITIONS OF THE AREA page Table I —DEATHS (NET)—1946 (Causes and Totals) 51 Table II —INFANTILE MORTALITY—1946 52 Table III —NEO-NATAL MORTALITY—1946 52 Table IV —COMPARATIVE INFANT MORTALITY RATES 53 APPENDIX B—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA Table V —NATURE OF ATTENDANCE AT CONFINEMENT 54 Table VI —ORTHOPAEDIC SERVICE—1946 55 Table VII —NEW CASES SEEN BY THE ORTHOPAEDIC SURGEON —1946 55 Table VIII— EAR, NOSE AND THROAT SERVICE 56 Table IX —CHIROPODY SERVICE 57 Table X —SKIN CLINIC 57 Table XI —SCABIES—1946 57 Table XII —OPHTHALMIC SERVICE—Treatment of Defective Vision 58 Table XIII—OPHTHALMIC SERVICE—Squint Training 58 APPENDIX D—ENVIRONMENTAL HEALTH SERVICES (A) SANITARY INSPECTION 59-60 (B) HOUSING STATISTICS 61-62 (C) INSPECTION AND SUPERVISION OF FOOD 63-64 vi ORGANISATION CHART Page 1 THE HEALTH OF BARKING SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Birth Rate and Old Age. Although the birth rate has gone up very considerably during the past few years, the population of Barking still reflects the effects of the falling birth rate which obtained for so many years previously. It is not anticipated that the birth rate will be maintained at its present high level of 20.6. I have no doubt that not only Barking but other towns in the country also, and, indeed, most civilised countries, will be faced with the problem of an increasing number of old people. The expectation of life has increased during the last half century, due, amongst other factors, to the growth of scientific medical knowledge and also to improvements in the social conditions under which the majority of people live. As at present advised, I believe that old age pensioners have a very considerable increased expectation of life and I have been told that by reason of this the financial cost of their pensions proved, even in the early days, more than had been anticipated. This ever-increasing proportion of old people brings many problems in its train and for this reason I particularly welcome the attention focussed by the Nuffield Report and elsewhere on this aspect of our future. I think the Barking population may probably be less affected at the present day, for this reason, that even before the war you had begun to grapple with some aspects of the problem and made a start by providing some variety of houses suitable for old people; further, you have made some provisions for the aged in your future housing programme. The problem of providing homes suitable for people of advanced years is linked up with the need for hospital beds for people, who, by reason of infirmity or chronic ill-health cannot be suitably accommodated under existing conditions I feel sure that the more these old people are suitably accommodated, the less will be the demand on such hospital and institutional beds. Already in the town you have made a good start with regard to alleviating the loneliness from which so many old people genuinely suffer, and too much attention cannot be focussed on the very good start which has been made with the intent that this movement shall grow and flourish. Page 2 THE HEALTH OF BARKING It is interesting to speculate on the factors which lead to a high birth rate. Social economists have written extensively on this subject, but there can be no doubt that in addition to the factors which have been discussed by these able economists, fashion has something to do with the birth rate and, although the upward trend in the number of babies being born is likely to be temporary, it may not be quite so temporary as some of us have been inclined to think. In this connection, it is interesting to record that during the year 1946, the number of live births was 1,591, showing the large increase of 447 or 28.1% over the previous year. This large number of births has placed a heavy burden on your midwives, nurses and doctors and I would refer you to the remark of the Chief Medical Officer of the Ministry of Health quoted below. In 1945 there were 33 still births in 1,144 total births, whilst in 1946 there were 46 still births in 1,637 total births. This gives a rate of 28.0 still births per 1,000 total births in 1945 and 28.1 in 1946. For comparison the combined England and Wales figure was 28.0 for each year. The problem of still births is bound up with the problem of premature births which I discuss later. Maternal Mortality. The maternal mortality rate for 1946 is 1.8 deaths per thousand total births. The previous year this figure was 3.3 and in 1944 it was as low as 0.7. Such fluctuations are inevitable when dealing with statistically small numbers. The general rate for England and Wales for 1946 was 1.43 and in 1945 it was 1.8 per thousand total births. Commenting on this latter figure, the Chief Medical Officer of the Ministry of Health remarks that the figure is "most creditable to the maternity services especially when the high pressure on available beds, shortage of staff and difficult conditions generally are considered." Deaths. During the year 601 Barking residents died. Heart disease and cancer were the commonest causes (see Appendix A—Table I). Infant Mortality. There is a section of these deaths which is always of great interest—that is the deaths of children under one year of age. In 1946, 52 infants died, giving an Infantile Mortality Rate of 32.79 deaths per 1,000 live births. The general rate for England and Wales for 1946 was 43. No figure is of more interest to me than this rate, because it forms perhaps the most sensitive index we have of the social and sanitary condition of an area. Gibbon, the great historian, in his Autobiography, wrote," The death of a new born child before that of its parents may seem an unnatural but it is strictly a probable went; since of any given number the greater part are extinguished before the ninth Page 3 THE HEALTH OF BARKING INFANTILE MORTALITY Page 4 THE HEALTH OF BARKING year.” Gibbon's world was clearly no world for babies but we have not to go so far back as the 18th Century. The Medical Officer of Health for Barking in his Annual Report for 1903 records a death rate of babies under 1 year of age of 113 per 1,000 live births and contrasts this favourably with the general rate for England and Wales of 132. He had reason for satisfaction; since the Barking rate for 1897 was 178! The steady improvement shown through the century is very gratifying but it must never give rise to a sense of complacency. Much remains to be done to discover the fundamental causes of death in infancy: to discover them and to annihilate them. In Appendix A, Tables II and III set out the certified causes of death of these babies and Table IV compares the Infantile Mortality Rates of Barking with those of England and Wale generally and with the County Boroughs and Great Towns in particular, over a number of years. The favourable position occupied by Barking will be noted. The chief causes of death are recorded graphically on this page. Mark the precedence which prematurity takes and note the grim toll of broncho-pneumonia. In 1946 as many as 63.4% of those babies who died in the first year of life did so in the 4 weeks following birth and 87.8% of these babies died in the first week. This is no freak incidence; it is our common experience year after year. I have set out the facts in Table II in Appendix A and tried to represent the core of the matter pictorially for I am most anxious to point this out. When the woman (and man) in the street understand these things then fewer babies will die. Social Services. General. Your social services remain unchanged since last year and it is not proposed to discuss them at length in this year's Report. Page 5 THE HEALTH OF BARKING Neighbourhood Units. The possibility of building a town as a number of neighbourhood units is a grand idea which sprang up during the war. The battle on the home front depended fundamentally upon the neighbourliness of people. It was this neighbourliness which enabled the Civil Defence and other Services to function without regimentation and I have no doubt it was the success of these schemes and the possibility of founding them upon the intrinsic neighbourliness of people which gave rise to the proposal of building the ideal town as a number of such neighbourhood units. The possibility of attaining this idea in a new town is fraught with difficulties but these difficulties can be overcome. The possibility of dividing existing towns into neighbourhood units brings much greater difficulties, difficulties which can only be overcome if we say relentlessly they shall be overcome and are willing to work patiently for many years in order to attain this end. The whole idea of a neighbourhood unit, founded upon the intrinsic neighbourliness of people, demands that such a unit shall only be so large that the people within it look upon themselves as neighbours. At the same time, if those neighbours are to run their day to day affairs and promote their own cultural and social life it is obviously wise to make each unit as large as possible, always providing it is only so large as to ensure that the spirit of neighbourliness is spread over the whole unit I feel sure it will be found impracticable to create neighbourhood units of less than 5,000, unless we are dealing with a small village in the country. On the other hand, 15,000 represents the largest number of people who can live together to ensure that all the people throughout the area are, in fact, neighbours. If, in a town, units of larger than 15,000 were unfortunately created, I feel sure it will be found that these units naturally split themselves into smaller units which would be contrary to what it to be understood by a neighbourhood unit. Fortunately in Barking there are two such areas which can be neighbourhood units, to wit the Becontree Estate in Barking north of the railway and the Becontree Estate in Barking south of the railway. Yet they lack one of the fundamental advantages of a neighbourhood unit, that is that there should be a balanced industrial ‘set up’ in each unit so that the bulk of the people who live there also work locally. No one could have seen my reports over a number of years without getting the impression that I was extremely unhappy about the travelling facilities to London If balanced industries were set up in these units it would greatly relieve the travelling congestion, do away with much unnecessary fatigue so unpleasant to bear and so damaging to vital production and improve the health of the citizens by reducing respiratory diseases. Lastly it would save expense on travel fares which are often a serious item on the working man's budget. Employment. It is gratifying to be able to report to you that the Manager of the Barking Employment Exchange tells me that unemployment has remained at a very low level, for its effects, admittedly deleterious to bodily welfare, are sometimes catastrophic to mental health. Page 6 THE HEALTH OF BARKING During the year the constructional work on the new Government Training Centre at Thames Road for training building operatives was almost completed. This Centre accommodates 600 trainees. Nutrition. It is my opinion that an authoritative statement on the question of the standard of nutrition to-day has still to be made. Unfortunately a lot of the statements have occurred in the course of heated debate; even where factual, these have sometimes been open to misinterpretation. There is no doubt in my mind that the fall in the maternal mortality and infant mortality rates can be ascribed to a general improvement in nutrition, but figures hereon must be interpreted in the light of recent advances in medicine, among which may be quoted the discovery of penicillin; such advances in medical treatment are an important factor in the reduction of these mortality rates. The favourable reports we have been able to submit from time to time on the rate of growth of school children must, I think, indicate a general improvement in nutrition, but these figures must be critically analysed, because the fact that the nutrition in children has been maintained, does not of necessity mean that the nutrition of the mothers of these families has been equally maintained. Further, we cannot assume that the nutritional factor is the only factor, because it was known to me by personal contact that people who had to deal with children in large numbers both in the East End of London and in Barking found they had to assess children differently in Barking so far as mental development was concerned, by reason of this fact, that, by the time the child was 10 or 11 he or she was, on the average, in a physical group at least a year older than was expected of children who came from the more crowded parts of the East End of London. From this it would appear quite clear to those of us who know the difference in the housing conditions, that housing is a most important factor and, in this connection, I believe the provision of better facilities for sleeping is very important. It may be interesting to record that some time ago I was called upon to consider the question as to whether women are or are not able to stand the pains of childbirth so well as they could pre-war and I believe this difficult question was submitted to me by reason of the fact some people thought that women were not able to bear so well the pains of childbirth because of defective nutrition. I am not in a position to say whether women do or do not stand the strain of gestation and of looking after their young children better or worse than before the war—that is to say I have no reliable measure of information—but as at present advised I believe it reasonable on general observation to come to the conclusion that women do not quite so well stand the troubles of gestation and do not stand up to the duties of motherhood so well as before the war. I am told that women who come back to your post-natal clinics about two months after the baby is born are not so physically fit as they were during the time they were carrying. Nurses Act, 1943, Part II. No applications have been received under this section of the Nurses Act for licences during 1946. Page 7 THE HEALTH OF BARKING SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Infant Welfare. In his Annual Report for the year 1906, Dr. C. F. Fenton, the Medical Officer of Health for Barking, well aware of the fact that the majority of infants who died did so in the first month of life, proposed that “a register of all births be kept in the Public Health Department,” a necessary first step, because, after all, you can't do much to save a child if you don't even know that it exists. He went on to recommend the appointment of a "Lady Inspector"—the forerunner of your Health Visitor service of today. He preferred the idea of a " Lady Inspector " to the alternative of voluntary "Lady Helpers" to "visit the houses" and "advise and help the mothers," for he seemed fearful that it might be "a little difficult to rise above personalities, such as social status." Evidently the good Dr. Fenton knew a thing or two about human nature! The following year gave him his chance with the passing of the Notification of Births Act, 1907, which permitted the Medical Officer of Health to hear of net births within 36 hours and Barking was among the first districts to adopt this Act A Lady Health Visitor was appointed on 9th April, 1907, and it is recorded that "mothers of all classes accorded her a hearty welcome, except a very few who refused her admittance into their houses and contemned any suggestions she might have to make." Dr. Fenton ends his report for 1907 thus, "In conclusion, one feels that to pull down the infantile mortality rate a tough piece of work has to be undertaken, but it we are on the right road, and I believe we are, we shall in time be rewarded by some measure, perhaps a large measure of success." In that year, the Infantile Mortality Rate stood at 112 (this "low rate " he called it)—today it stands at 32.79. The following year 1908 saw the dawn of the Infant Welfare Clinics with the setting up of an Infants Clinic “where the mother is encouraged to bring the child regularly to the Public Offices on a Tuesday afternoon for it to be weighed” and advice was given "as to the care and feeding of the baby." For some years a great Page 8 THE HEALTH OF BARKING Home Visiting is the backbone of the Service. point was made in the Annual Reports of the fact that model baby clothes were shown to the mothers. “The numbers attending vary from 12 to 20 per week and the institution becomes increasingly popular." By 1911, "from 20 to 25 babies are brought regularly.... to be weighed and interview the Medical Officer or the Woman Inspector," and the Medical Officer of Health began to worry about "an increasing number of mothers who seek advice in reference to diseases peculiar to women and connected with child birth," thus foreshadowing the development of the gynaecological consultant service which is now enjoyed. About this time the scope of the service was expanded to cover all children under school age. Page 9 THE HEALTH OF BARKING INFANT WELFARE CLINIC.—Waiting made easy. By 1919 the Health Visitors were making hundreds of visits to homes each year and the 'Babies Welcome' as the clinics came to be called was a very popular institution. "A cup of tea is provided for each mother" and, although the report does not mention it, the meeting clearly became an excuse, inter alia, for a good old 'chin wag.' By 1923, there were three flourishing Infant Welfare CentresEast Street, Kennedy Hall and Abbey Road. Today, there are 5 centres for Infant Welfare Clinics in Barking. Three sessions weekly are held in each of them and the number of attendances was 37, 132 for the year. If the greatest possible number of infant lives are to be saved then there must be continuity and integration between the ante-natal care, the post-natal and infant welfare services. Today, this is a feature of your service to which particular attention is paid. Under the National Health Service Act, 1946, two authorities will be concerned with the administration of these services and it is greatly to be hoped that this will not interfere with the smooth dovetailing of these interrelated services. One of the great difficulties is that those mothers who need the advice most do not attend the clinic regularly. Others may come because they "see a doctor for nothing," disclosing by their attitude that they only bring the child to the clinic when it is ill. These mothers do not understand the purpose of the service. The centres are run so that all mothers may be helped to bring up their children in the healthiest way possible. Page 10 THE HEALTH OF BARKING From the first it was realised in this country that if the infants who needed the care most were to be helped the service must be brought to the door; so that the ' Lady Inspector' of 1907 becomes the ' Lady Health Visitor' of 1908. Home visiting is the chief duty of your Health Visitors today and in 1946 they made 15,904 such visits. Breast Feeding. Few factors make for a safe and happy infancy more surely than successful breast feeding. Not only do breast fed infants appear to be markedly less likely to contract infections but if they do the result is less likely to be serious than in bottle fed children. Moreover, psychologists believe that during this period an emotional relationship is built up which may be deeply significant to the child's future development. It is for this reason that I particularly welcome the investigations of Dr. G. S. Wigley, one of your Medical Officers, into this subject. His work is published as a Supplement to this Report. Neo-Natal Mortality. I have remarked in an earlier Annual Report that it would be a great help towards the solution of the riddle of neo-natal mortality (babies dying within the first month of life) if more post mortem examinations were made. The fact is that diseases in the first month of life can sometimes be quite impossible to diagnose in life. If regular post mortems are carried out then we find that many more deaths are due to infection than we were able to diagnose at the bedside. The majority of these infants who die from infections are born prematurely. It is, therefore, necessary to protect newly born children all we can from infection. The greatest care should be taken to wash thoroughly the hands after changing babies' napkins and before feeding. Mothers should cuddle little babies of course— it is good for the baby and the mother—but they should avoid breathing in their faces and excessive kissing. They should prevent others from doing these things too. Although such great strides have been made through the century in reducing deaths in infancy, this improvement has been most marked in those aged from one to twelve months. The under one month group (neo-natal group) has not shown the same improvement. Prematurity. As you will see on page 52, of 52 who died in 1946, 19 or 37% were born prematurely. Prematurity is the gravest menace of all to the life of an infant and. moreover, stillbirths are about ten times as frequent in premature as in full-time deliveries. What then are the causes of prematurity—that we may avoid them ? Some are due to multiple pregnancy, some to toxaemia of the mother, but the bulk are due to causes unknown. However, we do know that regular and careful ante-natal care helps to reduce the incidence. Page 11 THE HEALTH OF BARKING We can make a good guess too that nutrition is very important in this respeci and there is evidence to show that this is so. I believe excessive strain and fatigue and, in particular, strain involving the use of the hands above the head, such as occurs when you hang curtains on tiptoe, may bring on premature birth. It is most important that expectant mothers should take up and drink their cod liver oil and orange juice or vitamin tablets supplied at the clinics and through the Food Office. If not for their own sakes they should do it for the sake of the baby. It is also necessary that children under five should take their's regularly. Babies and toddlers are really partial to cod liver oil, but, of course, if the mother shudders every time she puts a spoonful in the child's mouth, he will soon learn to do the same. Compared with other boroughs, the take-up of these vitamin supplements in Barking is above the average but it is still far too low and I am not satisfied with the position. The Chief Medical Officer of the Ministry of Health recently wrote of the conditions generally in England and Wales, " The take-up of these vitamin supplements was, however, very disappointing in spite of all the efforts to make mothers realise the importance of obtaining these supplements for themselves aid their children." Full take-up of these vitamins might have a real effect on prematurity. In some of your clinics, Food Office officials sell cod liver oil and orange juice on the spot, although the transaction must be carried out by means of postage stamps In other clinics, where the Food Office is closer to hand, no such arrangement exists. As a result the mother must, on leaving the clinic, go to the Post Office to buy stamps and thence to the Food Office to collect the cod liver oil and orange juice. She may well have to queue in both places. This rather clumsy machinery is, I think, in pat resulting in a lower take-up of vitamin supplements than would be the case if they were on sale at all clinics for cash rather than for stamps. In this connection, the local Food Officer has given all possible assistance. The other side of the coin is the problem of the premature infant once it has arrived. To deal with this an addition to the birth notification card was made in February, 1945, so that rapid action could be taken in the case of premature births. Not all babies who are born early require to be nursed in hospital. Where home conditions are good they are often better off there. Your Children's Specialist, Dr. Doyne Bell, can visit the home, if necessary, and the mother is lent the special equipment sometimes required for these babies. At other times, it is safer for the premature infant to be nursed in hospital. To meet this need you have set up a special nursery with 4 cots in Upney Hospital, because these ' early' babies have to be nursed in a hot, wet atmosphere. I well remember a distinguished baby doctor telling me that he once had a special nursery of this type in which a leaky hot water tap was always spitting out clouds of steam : the babies thrived. Afto Page 12 THE HEALTH OF BARKING The special nursery for premature babies. much delay the tap was repaired and after this he had nothing but trouble ! In your nursery special care is taken to ensure that the atmosphere is kept moist and warmed. Where possible, we like to take the mother into hospital too. This helps with the feeding and is nowadays regarded as the best possible scheme. Sometimes it is necessary, if life is to be saved, for the child to be rushed to hospital immediately after birth. In these cases the ambulance carries a specially heated cot and other equipment,-including a supply of oxygen, and a nurse travels with the child to hospital. The children are carefully followed up after their discharge from hospital by your Health Visitors, because the high death rate in premature infants remains a threat throughout the whole of the first year of life. Broncho-pneumonia. As you have seen, pneumonia is a very serious cause of death in infants, causing 21% of all these deaths in 1946. There are special types of pneumonia which are peculiar to the first month of life. The chief of these usually affects lungs which, as a result of birth stress, have not fully opened up with air (atelectasis), so that good handling during birth seems the best line in preventing death from this cause. Nevertheless, the bulk of these pneumonia cases in the first year of life are due to what we call an autogenous infection, that is the germ is present in the throat of Page 13 THE HEALTH OF BARKING The midwife arrives: the anxious father carries the apparatus that will save his wife pain. healthy infants where it does no harm under normal conditions. When conditions are adverse for the child; when nutrition is poor, or clothing unsuitable ; housing is bad or where there is lack of fresh air and sunlight; or when, above all, proper parental care is lacking, then the child's resistance is lowered and the germs are free to spread and cause pneumonia in the lung. The great improvement in the incidence of pneumonia is to be expected along these general lines but it is likely that infected ears and tonsils play a part and that iron deficiencies in infants causes a lowered resistance to respiratory infections too. Maternity Service. Midzvifery. Until 1936, there was no statutory duty laid on ' supervising authorities' to secure an adequate midwifery service. In Barking, however, to which ' supervising authority' has been delegated, midwives have been employed since 1919, and in 1923 an agreement was entered into with the Plaistow Maternity Charity to undertake this work for the Council. Long before this, the passing of the Midwives Act, 1902, laid a duty on the authorities to control the practice of midwifery; a duty not always easy to perform. "One woman was prosecuted for practising without being registered and was bound over not to practice," wrote the Medical Officer of Health so long ago as 1911. Page 14 THE HEALTH OF BARKING Today, there 17 midwives practising in Barking and 11 of them are employed in your midwifery scheme. The nature of attendance on mothers over the last few years is shown in Table V, Appendix B. Ante-Natal Service. Today, ante-natal clinics are held in five centres thrice weekly and, in addition, an evening clinic is held weekly at the Upney Clinic for mothers who cannot conveniently attend afternoon sessions. At the very start of her ante-natal care examination is carried out to see whether the future mother's health is sound enough in all respects to carry the extra burden of pregnancy. At the same time steps are taken to ascertain her social circumstances and to decide whether the baby should be born at home or in hospital; and to make sure she understands all that she is entitled to, such as insurance, rations, including milk and vitamins, extra sheets in some cases and so on. At her later visits her general health will be supervised, minor ailments will be treated and she will be taught about how she should care for herself. Taught, for example, that bathing should not be in water which is too hot; that her teeth need especial care at this time ; that all that is needed for the care of the breasts is that they should be washed daily with the rest of the body; that clothing should be loose and should hang from the shoulders ; that garters should not be worn, as should not high heeled shoes (about 1½ inches is right) and that she should take a walk in the open every day. Pain in Childbirth. During ante-natal visits it is most important to get the patient to adopt a healthy attitude towards the confinement so that she looks forward to it as the climax of a time of happy preparation which will bring forth her baby and not dread it as a terrible ordeal. I don't mean to say that mothers don't often suffer great pain in childbirth, but this pain is largely due to excessive 'wind up' which makes them clench every muscle in the body and this, of course, prevents the natural passages from opening up and stops the baby being born. Under these circumstances, when the womb is pushing the baby out and the mother is holding the baby in, is it to be wondered that suffering is caused ? This is a matter in which mothers, and grandmothers, can help a lot, for if those who have had a 'bad time' themselves for this reason go round telling expectant mothers that they must be prepared to suffer the pains of the damned then even placid healthy girls will panic and screw themselves up so that the same thing happens to them. I am sorry to say that people not only do this but do it with apparent relish. Mothers will do it to their daughters—could anything be more cruel? It will be seen that a great advance in painless childbirth can be made by the mothers themselves. Let us then regard it as a social sin, a breach of good manners Page 15 THE HEALTH OF BARKING and an unkindness to tell these harrowing stories and deal with it as such : snub those who start to scare others in this silly way. The relaxed, confident attitude of mind is most important but it is not the only thing, of course, which can be done to make childbirth less painful. The child can be born under general anaesthesia (when the mother is quite unconscious) or under analgesia (when the mother is awake but feels no pain). The trouble is that, in general, the more effective the method, the greater the risk to mother and child. The search for an agent at once fully effective, absolutely safe, and simple to administer goes on. Ever since Queen Victoria was given chloroform during childbirth, experiments have been made and our store of knowledge has grown but we have not yet found the perfect drug. One of the best measures is to use the Mlnnitt Gas and Air Apparatus. This can be used in the home as well as in hospitals because it is portable and midwives can use it alone after they have been trained in its use. It is safe and it is simple, but it is not always fully effective in pain prevention, also, though portable, it is heavy. Nevertheless, it is a very valuable weapon against pain in childbirth. At the end of 1946, you had 8 midwives in domiciliary practice and 6 of these held the certificate in gas and air analgesia administration. Not all cases require this relief but during the year it was administered to 304 mothers. Since July, 1946, training in gas and air analgesia is to form part of the training of all midwives. It looks to me as if the policy of the future will be that every birth shall be attended both by the midwife and the doctor. When this policy is fully operative, its wisdom will be tested by the Maternal and Infantile Mortality figures. Comment before these become available would be premature but it would, of course, simplify the problem of pain in childbirth. Before the pregnancy becomes advanced, the midwife calls at the mother's home and advises upon its suitability for domiciliary confinement. A set of the special equipment needed at the time of the baby's delivery is given free to each mother. It will be interesting to watch the development of the Maternity Services in the future. In the past many of these services have grown up as part of the Public Health Departments. Pregnancy and delivery have been looked upon as normal functions and treated as such save only in those cases where it has been necessary to treat them otherwise by reason of some definite abnormality. So far as I can see the modern tendency, quite apart from recent legislation, has been for this work more and more to fall into the hands of specialists. This is an excellent idea so far as abnormal cases are concerned, but I doubt very much Page 16 THE HEALTH OF BARKING HISTORIC EASTBURY HOUSE.—Playtime in a day nursery. whether, taking it by and large, we are going to gain, because there will be a tendency to look upon pregnancy as a clinical state rather than a natural phenomenon and delivery as a surgical operation rather than a natural process. It cannot be too often emphasised, as I have done above, that pregnancy and delivery; re perfectly natural functions. The fact that sometimes they go wrong no more rakes them otherwise than that the hundred and one other functions of the body which are natural also sometimes go wrong. Day Nurseries. These were set up during the war all over the country in order to release women for industry and it is still the Government's intention to encourage them during the present shortage of labour. You aintain three of these nurseries—one is at Castle Green, another is in Eastbury House and the third is at Lodge Farm. The average daily attendances during the year were 30, 50 and 29 respectively. Day nurseries are not, as many people believe, purely a product of the war. There were many day and residential nurseries in badly housed areas before the war, but it was not until the call to women for National Service during the last drastic upheaval of the world that their necessity was generally appreciated. The work of the nurseries covers a wide range of social service. The duties are many and varied and there is the closest co-operation between the local health Page 17 THE HEALTH OF BARKING and welfare services, particularly through the health visitor, who connects the two services with the home. The primary duty of the nurseries is the care of infants and young children while their mothers are at work. The majority of these mothers go out to work because they have to and not only to help the national effort. Housing is difficult and conditions make it impossible for mothers who would, under more normal conditions, be able to care for their own children. Where social and home conditions are difficult, it is often essential for the children to attend a nursery while their mothers work to supplement their income, unless, of course, the children are to be adopted or cared for by foster mothers. A day nursery is greatly to be preferred to complete separation from the mother. There are many children admitted to the nurseries on medical advice. A child that is backward may improve rapidly under expert attention and by mixing with little people in their own familiar world. There are babies who come because of feeding difficulties—a few weeks of carefully measured feeds, given at regular times, and they soon grow into happy, normal healthy babies. The regular routine life of a nursery makes for contented children. The Toddlers, aged 3 to 5 years, under the care of a trained warden, assisted by nursery nurses and students, teach simple methods of hygiene, which includes washing hands before meals, cleaning teeth and regular nose drill. The care of heads is important too in a mixed community. They also have set times for organised and free play. All these things, plus the friendly relationship between mother and nursery, tend to give a child an added feeling of security and love. Tweenies, aged 2 to 3 years, and Babies, under 2 years, have their own routine and attention, their own rooms, bathrooms, toys, etc., and the daily guidance of a helping nurse. But an important duty of a nursery and one of the most important is very often overlooked. The training of girls in nursery work is a great social asset to the community. These girls are not trained just to fill staff vacancies in nurseries, they are trained in housework, cooking, needlework and the care of young children, to become good wives and mothers. When all girls are encouraged to take a training of this type, whether the course be short or long, then much neglect and unhappiness fostered by ignorance, will not exist. When this is accomplished nurseries will only be required for one purpose, to make a happy playground for babies and toddlers while tired and harassed mothers have a few hours of well earned rest. Orthopaedic Service. If a person is so unlucky as to develop acute appendicitis, then the offending organ will be deftly removed and recovery will usually follow uneventfully. But if he suffers from one of those crippling troubles of the joints or muscles which send him to an orthopaedic surgeon the case is very different. Page 18 Canned sunshine—glows vigour into young bodies in the winter. Here the operation is only the start of a long voyage of treatment—the push from the shore which gives the boat a start—but it is the long patient pull which gets the vessel to the opposite shore. The operation may be completed but unless the patient follows his course of massage, exercises, special heat or electrical treatment, whichever it may be, then the surgeon might just as well have saved his time, because the result will not be satisfactory. If a person is operated upon in a great London Hospital, the chances are that the long journey to and from Barking will discourage him from completing this allimportant after-care. It was this consideration which led you to decide that the proper solution was to bring the treatment to the patient. This service was started as long ago as 1925. Not only does it serve the children under 5 years and the children 0 school age, but it is available to all Barking residents on the recommendations of their private doctors. Since the early days the equipment and facilities of this service have grown and today you have a large ultra-violet light lamp for mass artificial sunlight treatment, an infra-red treatment lamp, various electrical apparatus for special uses and a short wave machine which has recently been installed at considerable expense and which is proving of great use in those cases where the doctor requires heat applied below the surface of the skin. Page 19 THE HEALTH OF BARKING Remedial exercises form a vital part of the service, especially in children. With a highly trained and really enthusiastic staff, wonders can be worked on the child with poor posture, chronic bronchitis, bandy or knock knees, or weak feet. You have probably noticed how, a little while after having a baby, a woman's figure often tends to become less shapely. She will carry herself badly and her feet may turn out. This unhappy change is preventable and to this end you extended your orthopaedic service to cover a post-natal course of exercises. This extension could not be carried on during the war but has recently been started again. Of course, to get first-class results the mother must drink her extra milk, take her vitamin supplements and pay real attention to her feeding and general health during pregnancy. In the near future, it is hoped to go further and to start again, as before the war, treatment to mothers while still in the Maternity Unit. Your Orthopaedic Specialist, Mr. A. M. A. Moore, has continued to direct the work of this department and we are lucky to have two very skilled physiotherapists to carry out the treatment. Three further physiotherapists are required but it has not been found possible to fill these vacancies, a circumstance which greatly hampers this important service. The clinic where this work is carried out is situated in the Manor School, but. where necessary, treatment can be carried out in the patient's own home Statistics in relation to the work of this service are given in Tables VI and VII of Appendix B. Ear, Nose and Throat Service. It was in 1938 that a special Ear, Nose and Throat Service was launched in Barking, partly for the convenience of residents and pardy, and principally, because it has been found that where services are not readily accessible the public will neglect to get treatment even for severe maladies. A session is held weekly in the Central Clinic by Mr. Courtney Mason. School children are treated (including operative treatment) free of charge and there are special rates for cases coming within the ambit of the Maternity and Child Welfare Scheme. The general public are treated under a special Public Scheme. Before the war, arrangements were made to operate on tonsils and adenoids in a ward set aside to that end in the Barking Hospital, but hostilities prevented the operation of this scheme until 1941. Once it started it proved a great success but unfortunately the necessities of war have prevented its continuation. Statistics in relation to this service are given in Table VIII in Appendix B. Page 20 THE HEALTH OF BARKING Comfortable feet make happy families. Chiropody Clinic. This service was started in 1938 for the treatment of those minor foot ailments which are so crippling and painful. The wearing of tight shoes and shrunken socks can produce shocking deformities. As a matter of fact these deformities are shocking in every sense of the word ; they not only shock the person who examines the feet but they are a shock to the patient every time he or she puts them on the ground. The trouble is that our boot and shoe manufacturers find themselves constrained to pander to the vanity of people, not all of whom, by any means, are women, and I should suppose they are faced, on the one hand, with selling people shoes that are quite unsuitable, or alternatively going out of business. Is it too much to hope th it by arranging for properly fitted shoes to be coupon free, and those chosen tor purpos es of vanity taking more coupons than at present, people may in the end be brought 11 wear properly fitting shoes ? The sack too is as important as the shoe. Socks and stockings require to be Made right and left, just as it is necessary to produce boots right and left. Just as elsewhere I have said that no child in any classroom should be put to sit in a place where you would not put a plant and in this simple way have applied a Page 21 THE HEALTH OF BARKING simple test to an important matter, so I would strive to find some simple way by which the public can decide whether their boots or shoes are sufficiently free and comfortable. This I have not been able to do up to the present and the best advice I am able to offer is that people should be able when wearing their shoes to use their toes as though they were able to type with them. There is no doubt whatsoever that the public are becoming foot-conscious and appreciate this essential service, but in these days, when there is such a heavy demand on our women folk, who are by far the greater sufferers, it is very difficult for them to stand up to the strain put upon their feet. Space will not allow me to go into this matter in detail, but I should like the public to realize that the treatment given at the clinic is palliative and not curative: the cure depends entirely upon the progressive improvement of the condition, which in turn depends entirely upon the patient giving care and attention to the feet in the interval between treatments. I have always found the public most anxious to assist, if only they know what to do. One very common complaint is callosity and pain in the ball of the foot from which so many people suffer—again chiropodial treatment is only palliative consisting of paring and applying a felt pad. The provision of a metatarsal bar to the footwear redistributes weight, relieves pressure and obviates the disability. Another factor of which we must not lose sight is that although many women are just as heavy as men and are on their feet quite as much, if not more, yet the soles of their shoes are very much thinner and their stockings are very flimsy, so that they have less protection between the ground and the foot and between the shoe and the skin. This causes them to suffer more severely than men. The wearing of a thick soft socklet would benefit many foot sufferers, provided they bought their shoes while the socklet was on the foot. We must remember that women are naturally softer than men in muscle texture and therefore weaker. Splay or spread foot is very common to young women; this is a weak foot condition and is the predecessor of the other many complaints due to the foot working with a concertina-like action inside the shoe. Constitutional conditions are often the cause of a weak foot: putting weight on the feet too soon after an illness, long standing when tired or unwell or putting on weight suddenly, are sometimes responsible and again a few words of advice to the public would prevent much suffering. Male foot sufferers are, compared with women, few and far between, and in the case of men usually there is a natural abnormality, deformity or trauma connected with the complaint. Page 22 THE HEALTH OF BARKING This service is very popular and whilst every effort is being made to cope with the ever-increasing demands upon it, a shortage of qualified staff makes it unavoidable for patients to wait comparatively long periods for treatment. As I have said before, I anticipate that when this service is provided in the different localities of the town the demand will be even greater than it is today. The activities of the clinic, which is held in the East Street Clinic (behind the Town Hall), are demonstrated in Table IX in Appendix B. Skin Clinic. This clinic was started in 1942 and Dr. Arthur Burrows was soon afterwards appointed as your Specialist Consultant in Skin Diseases. Dr. Burrows holds weekly consultant sessions at the Barking Hospital and in addition treatment sessions are held. Skin conditions which resist treatment can be baffling to the doctor and cause much misery and loss of morale to the sufferer; to have such a service locally, therefore, is a source of great satisfaction to me. A comparative record of the work of the clinic is shown in Table X in Appendix B. Scabies. "Scabies," remarks the Chief Medical Officer of the Ministry of Health, "ever a war disease, increased enormously during the war of 1914-1918, alike among the troops and the civil population. After 1919 there was a rapid decrease and scabies, reaching its nadir about 1926, became almost a rare disease, especially in the South of England. About 1930, a rise began, probably largely periodic in character as it was observed in other countries about the same time. Judging by the medical examination of London elementary school children, the incidence was once again as high in 1938 as in 1919, and was rising fast. Thus a rapid increase was in progress when war began, and fanned first by evacuation and mobilization, and, later, by overcrowding, industrial shifting of population, and the ever ncreasing shortage of laundry facilities and of soap, towels, underclothing and bedding, a severe epidemic of scabies blazed up." To cope with this situation, the Scabies Order, 1941, was made and this gave local aut orities the opportunity of using effective measures for controlling the disease. Where special facilities existed in a Borough for treatment, the Minister permittee the disease to be locally notifiable and this step was taken in Barking. It is not possible, owing to wartime shifts in population to follow the picture of how this general increase affected Barking but it certainly gave rise to a big problem. The crux of the problem lies in the realisation that this is a family disease spread by close contact, most commonly by the sharing of a bed. It is useless, therefore, to treat one member of a family without being sure that the other members are not Page 23 THE HEALTH OF BARKING If you want good teeth look after them while you're young. affected. As there is a long incubation period and as symptomless carriers occur, it is wise to treat all close contacts whether they have a rash or complain of itching at night or not. Treatment by the modern method is simple and most effective. The work of scabies control throughout the year is given in Table XI in Appendix B. Dental Service. Your Dental Service covers treatment, including orthodontic (special corrective treatment of school children, with particular reference to the educational side of this work, of toddlers, expectant and nursing mothers and on to this is grafted a general public service. In view of the nation-wide shortage of dentists, to cart)' out so wide a service is a bold action. It does mean that resources are stretched but your dental officers assure me, and I concur with their opinion, that as a result the public of Barking are definitely more "dentally minded" than the public generally. This makes me very happy for it means we are well on the way to successful education of the public about the care of teeth. A dental service in the future should be judged not by the number of fillings or extractions completed but by the number of fillings and extractions avoided as a result of sound education. Page 24 THE HEALTH OF BARKING. There were 4,926 attendances under your Public Adult Scheme, the number in the previous year being 5,957. The number of visits paid under the Maternity and Child Welfare Service was 2,821, as compared with 1,748 in 1945. Ophthalmic Service. I think most would agree that of the sense perceptions which keep us in touch with the outside world, none is more treasured than the ability to see. The eye is a delicate organ and commonly enough is unable to permit vision as clear as we would wish, or only does so under strain which may cause headaches. It is well established that such care of the eyes as is desirable requires the services of an eye specialist. Mr. W. A. Gray, your Consultant Ophthalmic Surgeon, has held clinical sessions throughout the year 1946. Squint training forms an interesting branch of this service. By means of a synoptophore, a complex and expensive piece of apparatus, the movements of a child's eyes can be trained so that weak muscles are made strong and the squint I corrected. What indian clubs will do for the development of the bicep muscles of I the arms, so will the synoptophore do for weak eye muscles which are the cause of I squint. The ophthalmic service which naturally is particularly directed towards school children, for whom no charges are made, also covers mothers and toddlers at token rates, and other members of the public under the Public Adult Scheme. Statistics in relation to the work of this service are given in Tables XII and XIII in Appendix B. Hospital Facilities. Hospital facilities remain a thorn in our flesh. The fact is there are not sufficient hospital beds in the country ; most hospital buildings are far too old and quite out of keeping with the possibilities of modern medicine. Moreover, their organisation and co-ordination are not satisfactory; a point recognised by the setting up of the new Hospital Regions. Oldchurch County Hospital takes the bulk of our cases, but considerable numbers are admitted to the London Hospital, King George Hospital and other hospitals in London. The difficulty in finding accommodation for the chronic sick is notorious. Nor is the type of accommodation, when at last secured, always of a satisfactory nature. Delay before admission is particularly tragic in the case of the person suffering from tuberculosis, because this is a disease where ' delay is dangerous ' indeed. The Council has allocated the sum of £300 to the hospitals which have served Barking residents during the year. Page 25 .THE HEALTH OF BARKING The lack of hospital facilities gives your preventive and specialist services; special significance and value, because they already do what the hospital service of the future is to attempt: they bring the service to the doorstep of the patient. In 1946 attendances at your various clinics and out-patient departments totalled 147,254, which represents an increase of more than 30,000 over the total for 1945 Barking Hospital. Barking Hospital made its debut in 1885 in modest enough fashion for it started as a tent erected, as a temporary measure, for the treatment oi cases of infectious disease. In April, 1893, the Local Board of Health (as it was then called) accepted the tender of Messrs. Humphry's, Ltd. for the erection of an Infectious Diseases Hospital on Upney Meadow at a cost of £401. Later on in the year, the hospital was duly opened and Dr. F. Gibbens, the then Medical Officer of Health, was appointed as Medical Superintendent. The hospital contained 30 beds, but it had no nurses' home, because in 1904, Dr. C. F. Fenton, the Medical Officer of Health, reported that " the cottage at which the nurses are accommodated is scarcely habitable." The 1914-1918 war deferred plans for the erection of a permanent hospital. After the war, the Minister of Health declined to sanction the necessary loan, but, at last, a start was made on the first portion of a new hospital in 1931 and this was formally opened in September, 1932. The second portion was completed in 1935, bringing the total bed complement to 108. Upney Maternity Pavilion. Whilst the origin of the fever hospital in the 19th Century had arisen, not so much from a desire to alleviate the sufferings of man, as from the fear that unless the infectious cases were removed from the community the contagion might strike down the influential, the origin of the maternity hospital was due to the flowering of that humanitarianism which had been gaining strength for the past hundred years. You started your maternity home in 1918 on humanitarian grounds because there were so many people, particularly towards the end of the war, who simply had not the accommodation at home suitable for confinement. As a matter of fact, as I have written elsewhere, at the start of the war the building which was used previously used for typhoid fever cases and it was here that the foundations were laid of the maternity work which has been carried out at the Barking Maternity Unit ever since. It was not, however, until the passage of the Local Government Act, 1929» that express permission was given to Authorities to provide maternity hospitals for the accommodation of normal as well as complicated cases of pregnancy In 1935, the Corporation became the local supervising authority for midwives and in October, 1936, you-r new Pavilion was opened. This building is generally recognised as one of the finest in the country. I know of much excellent child welfare work which is carried out in unsuitable converted buildings all over the Page 26 THE HEALTH OF BARKING country, but a maternity unit is particularly dependent, if results are to be uniformly good, upon a building with a first class layout. The danger of infection is always present and only a rigid nursing technique combined with a good layout can make the maternity hospital as safe from this standpoint as the patient's own home. General District Nursing. The less adequate the local hospital service, the more important becomes the provision of a service of skilled nursing in the home; this is especially true of the nursing of the aged for whom hospital accommodation is so scanty. The work is carried out in Barking by the Plaistow Maternity Hospital and District Nurses Home and the East Barking District Nursing Association to whom you give considerable financial aid. During the year 1946, the visits paid by nurses on this service totalled over 20,000. Ambulance Service. Your ambulance service, for the use of which no charge is made to residents of the Borough, consists of three stretcher ambulances and two sitting case cars. Altogether 9,045 patients were conveyed during the year, representing over 3,000 more than those conveyed during 1945. We have now had two years' experience of this service since it became available to the public without charge. During this period the number of calls has increased progressively and it does not appear that the peak has yet been reached. At the introduction of such a service, it was reasonably expected that the calls would not be so large as to prevent us from having one vehicle out of commission for repairs, whilst we operated with the remainder. This, unfortunately, has not been possible, with a result that there has been difficulty in maintaining the service at all scheduled times. This is particularly so with regard to the out-patient services at the London Hospitals. The fact that delay, however, rarely exceeds 30 minutes must be regarded as a compliment to the efficiency of the service, when it is remembered that the vehicles in use have to operate for a full 24 hours each day and havt been in service for many years. With this continuous rise in the number of calls, a point must soon be reached when it will be necessary for the Council to consider their policy on this matter, in order to determine the type of case for which a free ambulance service should be available, or alternatively so to augment the number of vehicles and personnel that no restriction need be imposed. Home Helps. In view of the increased demand for home helps, during the year you decided to appoint 6 full-time home helps who, when not required to work in private homes, Page 27 THE HEALTH OF BARKING He only came into the world an hour ago—born prematurely he is taken to hospital for special treatment. would be available for domestic work in your hospitals, nurseries or clinics. In addition, you decided to retain and extend so far as possible your panel of casual home helps who were prepared to undertake duty as and when required. At the end of 1946, you were employing 5 full-time home helps and you had 7 casual workers on your panel. A total of 73 cases were attended by these home helps during the year. These were chiefly home confinement cases but in a few instances a home help was sent to assist in a home where there was a case of illness. Pending the building up of a sufficiently large panel to meet the demand for home helps, a scheme had been introduced in 1945 for the payment by you of private home helps attending at confinement cases where a Council home help was not available. This arrangement continued during 1946 and 175 cases were so dealt with during the year. Page 28 THE HEALTH OF BARKING SECTION C. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. DIPHTHERIA. The graph on the opposite page shows strikingly the decline in the incidence of diphtheria from 1928 to 1946 when only 7 notifications were confirmed. One child, who was not immunised, died. Until the beginning of the war, large epidemics would break out at intervals (see 1930—358 cases and 1934—398 cases); evacuation came in 1939 and artificially reduced the number of cases and from 1940 only cases where the notification was confirmed by hospital diagnosis are counted, which again artificially lowers the curve. But through the years 1939 to 1942 an increasing number of people were having their children immunised and in 1942 a large campaign was launched. This campaign has been pressed home year after year until the disease is now well on the way to being stamped out. Below I have set out the number of cases and deaths in England and Wales from 1940 to 1945 :— 1940 46,281 cases with 2,480 deaths 1941 50,797 cases with 2,641 deaths 1942 41,404 cases with 1,827 deaths 1943 34,662 cases with 1,371 deaths 1944 29,949 cases with 934 deaths !945 18,596 cases with 722 deaths The value of mass immunisation hits the reader in the eye, though this picture is a statistical over-simplification. But there is further evidence for " it has been shown that out of every five children suffering from diphtheria during the years 1942, 1943 and 1944, four were children who had not been immunised and of Page 29 Page 30 THE HEALTH OF BARKING Why have diphtheria when prevention is so safe and easy ? every 30 deaths, 29 were of unimmunised children, although the total populations of immunised and non-immunised children at risk were roughly equal. The evidence that immunisation is a protection against infection and death is plain."* The first aim was to protect school children but now activity has been switched to immunsing children under the age of 1 year. There is yet much work to be done and much prejudice to be overcome. Out of a population of 18,280 children, under the age of 15 years, in the Borough, 12,377 or 67.7% had been immunised at the end of 1946. Naturally few of the 1,591 children born during the year were immunised as most of them were not sufficiently old by the end of the year to have completed the injections. Thus a higher percentage of children at the most vulnerable ages were protected than appears superficially. *0n the State of the Public Health during Six Years of War.—His Majesty's Stationery Office. Page 31 THE HEALTH OF BARKING SCARLET FEVER. The incidence of scarlet fever over the last few years in Barking has followed closely year by year that generally experienced over the whole of the country. It has now become clear that the disease which we call scarlet fever differs in no essential from tonsilitis or sore throat caused by the streptococcus germ. In some cases the germ causes sore throat with a rash, in others sore throat alone. Thus a child with sore throat and no rash can infect another child who will develop full scarlet fever. If the one case is notifiable then so should the other from the point of view of control. The child with the rash is perhaps the luckier of the two for he is more likely to receive proper attention. Page 32 THE HEALTH OF BARKING WHOOPING COUGH. This disease became notifiable in 1940. It is, as a disease, rather underrated by the public for it is responsible for a large number of deaths of children under five and unlike most infectious diseases is not uncommonly seen in infants. Protective injections have been given for a number of years against this disease but it is not yet possible to show that they are of real value. Researches being carried out at the moment may reveal more information. There were 243 cases notified during the year. The graphic record showing The incidence in Barking since 1941 should not be read as evidence that the incidence of the disease is showing anything but a temporary decline. Page 33 THE HEALTH OF BARKING MEASLES. Like whooping cough, measles became generally notifiable in 1940. The idea is that an opportunity is thus presented for ' follow up ' of cases. This follow up is desirable because the complications of measles, particularly running ears, can be a serious drag in later life and only energetic measures directed to their :reatment until the patient is quite whole once more can reduce their ill effects. Many Medical Officers of Health suggest that, since it has not yet proved possible, owing to the war, to carry out fully this' follow up,' notification should be discontinued. I do not share this view: better to hold before ourselves the reason for notification and to implement its indications as soon as we can. There is as yet no agent which will protect children for more than two or three weeks against this disease. While the incidence remains unchanged in its pattern, the mortality has generally become much less in the last few years. Page 34 THE HEALTH OF BARKING PNEUMONIA. There were 72 notifications of all forms of pneumonia during the year. In 1938 there were 165 notifications but since 1939 the annual fluctuations have been remarkably small. PARATYPHOID AND TYPHOID. No cases of paratyphoid were notified in 1946. Only one case of typhoid was notified. The source of the infection could not be traced though at the critical time the patient ate a few ices from 'barrow boys.' CEREBRO SPINAL MENINGITIS. Since the big epidemic, affecting the whole country in 1940-1941, the incidence of this disease has declined. There were only two cases notified in 1946. Page 35 THE HEALTH OF BARKING TUBERCULOSIS. Below is set out a table of notifications of new cases of tuberculosis in the are during 1946 :— New Cases Notified Pulmonary Non-Pulmonary M. F. M. F. Under 1 year 1 - - - 1 to 5 years 1 — — — 5 to 15 years 2 1 3 2 15 to 25 years 17 15 — 3 25 to 35 years 9 12 2 — 35 to 45 years 12 3 — 1 45 to 55 years 11 3 — 1 55 to 65 years 3 2 — — 65 years and upwards 3 1 — — 59 37 5 7 One hundred and eight notifications were received of all forms of tuberculosis, of these 96 were of the lung (pulmonary) and 12 of other parts of the body (nonpulmonary). In this total is included 27 cases who have removed into the district, and of these cases 3 are old cases returned to Barking. The overall position over the last few years is shown graphically opposite. Of 37 deaths in 1946, 34 were of the lung (pulmonary) and 3 of other parts of the body (non-pulmonary). It is always difficult in a disease like tuberculosis, where so many cases remain for a long time undetected to judge its prevalence or incidence from the notifications, for clearly the keener and the more expert the diagnosis the more cases will be found and notified. Although they only tell of the incidence of the disease indirectly, deaths more readily indicate our measure of control over the disease. In 1938 there were 36 deaths and in 1946 there were 37 so that we seem to have overcome the wartime increase in mortality. The use of Mass Miniature Radiography, a means of x-raying chests rapidly and cheaply, if developed and expanded and applied at intervals to the whole of the population would greatly assist in reducing the scourge of this disease. Lesser measures will bring lesser results. Page 36 Page 37 THE HEALTH OF BARKING THE HEALTH OF BARKING DIARRHOEA IN THE NEW BORN. In September, 1946, there occurred an outbreak of diarrhoea among newly born babies at the Upney Maternity Pavilion. Appropriate steps were taken immediately but, by October 2nd, it was obvious to me there was only one thing to be done and that was to close the Maternity Pavilion at once. This outbreak at the hospital was only part of a widespread outbreak which occurred not only throughout Barking but throughout many parts of Essex. Some of our own staff were affected and these we examined most carefully, with negative results so far as finding out that there was any particular germ to account for the outbreak. Taking time by the forelock seems to have been of advantage because, although 22 babies were affected, none of these died except one and that from a different cause, i.e. broncho-pneumonia. When I report that on enquiry among my medical colleagues and others I came to the conclusion that nearly one person in ten was affected in Barking, it will be seen it was impossible to run any communal enterprise but that at sometime, someone, somewhere, would be found suffering from the condition. VENEREAL DISEASES. 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). Page 38 THE HEALTH OF BARKING SECTION D. environmental health services. (A) sanitary circumstances of the area. RAINFALL. The rainfall for the year ended 31st December, 1946, was 24.50 inches, as compared with 17.99 for the previous year. Rain fell on 160 days in the year 1946. WATER SUPPLY. With the building of new dwellings, there has of necessity been an extension of mains during the year of a total length of 2,507 yards. Samples are drawn from the domestic supplies and submitted quarterly for chemical and monthly for bacteriological examination. All samples have been found to he pure and wholesome. There are in the district 8 wells which are on factory premises. In two instances these wells are used to supply water for drinking purposes to the employees; samples drawn from such supplies are examined and during the year have been found satisfactory. The bore holes of these wells are sunk to a depth of from 200 to 400 feet. Their real purpose when constructed was to supply water for industrial purposes. During the war they were scheduled to provide an alternative supply of water for civil defence needs. DRAINAGE and sewerage. Apart from 8 premises unconnected with the sewer, owing to their remote position, the whole of the district is drained to the Northern Outfall Works of the London County Council. The drainage of surface water is separated from that of sewage. The disposal of sewage is the concern of the Ilford and Barking Joint Sewerage Committee. Page 39 THE HEALTH OF BARKING RIVERS AND STREAMS. The River Roding is the main river passing through the district, receiving water from a tributary stream known as the Loxford Arm. In other reports, I have referred to the water of the River Roding and the condition of that River remains unaltered. The fact that the River Roding is tidal influences its tributary, the Loxford Arm, and this reacts upon the level of the water table of the district. Our attention has for a number of years been drawn to the operations of a firm of chemical manufacturers, whose premises are situated just over the Borough boundary. It is the practice of this firm to discharge into a pit situated on the site of their premises considerable quantities of their effluent. The site of this pit is six feet above the level of Victoria Road and it is to be noted that flooding and the water-logged condition of the land in this neighbourhood remained constant during the year. It is anticipated that with the removal of this chemical process, some fall in the level of the water table is likely. At the end of the war we looked forward to operations by the River Roding Catchment Board and the Essex Rivers Catchment Board to improve the minor rivers and streams in the district. We are disappointed so far that nothing substantial has been effected. Continuously, I call attention to the large area of low-lying land in the Borough which would be made more suitable for use and in some instances reclaimed by major improvements in drainage. PUBLIC CLEANSING. During the year 6,930 loads of refuse were collected with an average v eight of 1.91 tons per load. It is with satisfaction that I record that from the 20th May, 1946, Barking again returned to the practice of making at least one collection of refuse per week, in addition to the more frequent collection of waste food. In addition to the increased collection, there has been a much better supply of dustbins to dwellings Too much stress cannot be placed upon the importance of cleanly conditions around the home. To secure satisfaction in this regard the co-operation of the occupier is necessary. On the question of disinfecting dustbins I have advised the Borough Engineer and Surveyor that in my opinion I know of nothing in the realms of preventive medicine, so far as dustbins are concerned, to take the place of thorough cleansing and properly fitting lids, properly applied. Further, as at present advised, I believe that if this were carried out, there would be no nuisance demanding attention. Page 40 THE HEALTH OF BARKING It is a curious thing that, whereas this generation is definitely conscious, so far as hygiene of sanitary fittings is concerned, they have not yet appreciated the need there is to concentrate on the hygiene of the dustbin, and, personally, I would not recommend any temporary expedient which might mitigate against the development of this consciousness. If people have dirty dustbins then, of course, the use of D.D.T. to prevent fly nuisance could be entertained. At the same time, D.D.T. will only mitigate the fly menace so long as the dustbin is empty, and I know of no research which has been carried out which will enable me to say that D.D.T. at the bottom of a dustbin would be of any use when it was half full, and, so far as I know, even a quarter full. It is still true that" by fire all things are purified " and so far as may be practicable, people should be encouraged to destroy by fire so much as they possibly can. REFUSE DISPOSAL. For some years it had been the practice for the whole of the refuse of Barking to be taken to the destructor works of our neighbours, the County Borough of East Ham. This was no longer possible and arrangements were made for the refuse to be deposited on land remote from occupied dwellings. The controlled tipping carried out by the Corporation has proceeded without nuisance and has made possible further improvements of the low-lying land adjoining the River Roding. A further area of land in the vicinity of the present tip at Jenkins Lane is anticipated to be available for the use of the Corporation. The provisions of the Essex County Council Act, 1933, with regard to tips, are in operation. ERADICATION OF BED BUGS. It is pleasing to report that the calls upon the Corporation's service for assistance in the removal of bed bugs is not frequent. It was brought to our notice that in two instances bugs had been introduced into newly erected bungalows as the result of the purchase by the occupiers of secondhand furniture. The public, unfortunately, are faced with a shortage of new furniture and in desperate need they take risks of vermin infestation. We believe that the Corporation's assistance in the past and the wide knowledge the people of the Borough have of the services available result in most of the cases of infestation being brought to the notice of the Department. RATS AND MICE DESTRUCTION ACT, 1919. The national rodent destruction campaign had its inception during the year at 'he instance of the Ministry of Food. In this connection, the Minister called for the co-operation of all local authorities throughout the Country in a well planned Page 41 THE HEALTH OF BARKING vigorous onslaught on the rat population. Your support to this campaign was immediately given and a directive was issued on behalf of the Minister of Food for the remedying of infestation in sewers and drains administered by the Council, The work of surveying and mapping of all the manholes in the area and the loosening of manhole covers, the fitting of trays in certain circumstances for the reception of bait was carried out by the Borough Engineer. The initial sewer treatment commenced in May and during a period of six days, 1,100 manholes received treatment. These were re-treated one month later. The results obtained were extremely good. The second treatment was carried out in December and it is estimated that 12,000 rats were exterminated. It is worthy of note that in one instance where it became necessary to open a choked main drain, forty rat carcasses were found to have caused the blockage. Later, the Minister instituted the block control system whereby the whole of the suspected infested areas of the Borough would be covered by a staff of trained operatives and investigators. The co-operation of the managements of all factories and business premises was invited and readily given and the work, which will occupy a period of nine months, will commence in January, 1947. ATMOSPHERIC POLLUTION. There is evidence that during the past half century the amount of smoke produced nationally has lessened and its ill effects on health diminished. This, unfortunately, is less true of Barking. We have in Barking the two largest public utility coal-consuming plants in the country, with an annual consumption of 3,000,000 tons. These are the Generating Station of the County of London Electricity Supply Company at Creekmouth and the Beckton Gasworks of the Gas Light and Coke Company. The fact that they are public utility undertakings places their control outside the jurisdiction of the ordinary nuisance statutes and, therefore, any representations made must be to the appropriate Central Government Department. It is sufficient for me to say that with the present difficulties in the fuel and power supply it lS unlikely that there can be any immediate improvement. The Council received a report at the end of 1945 upon the condition of the plant at the Generating Station in which special reference was made to the condition ot the pulverised fuel plant, which, built in 1926, had completed its useful economic life. In February, 1946, the Council were further advised that the Central Electricity Board, with the approval of the Electricity Commissioners, had issued a directive to extend the Barking Generating Station. The extension would include the installation of three 75,000 kw. turbo-alternators, together with six 405,000 lbs./hour boilers and ancillary works ; the boilers to be pulverised fuel fired and equipped Page 42 THE HEALTH OF BARKING with electrostatic precipitators to ensure the maximum efficiency of grit extraction from the flue gases. The approximate height of the boiler house would be 150 feet to the conveyor house roof and that of the chimneys 375 feet above the existing ground level. The new installation will be constructed in accordance with the recommendations of the special commission appointed by the Government who reported upon the best type of construction for works of this character. The Report is dated November, 1932. It will be noted, however, it is not proposed in relation to this new plant to introduce gas washing. The evidence at present available of the amount of sulphur dioxide in the atmosphere of Barking is insufficient for me to express more than a general opinion that any such atmospheric pollution is harmful. It is hoped that, when conditions become more settled and staff is available, a special study will be made both as to the quantity of grit deposited in the area and the amount of sulphur dioxide present in the atmosphere. The geographical position of the two stations referred to is on the boundary of the Borough at the south-east corner, and, with a prevailing wind from the southwest, it is likely that the maximum pollution will be outside the Borough boundary. So far as the smaller factories in the area are concerned, nuisance does occur, but this is due in the first place to the many varieties of coal supplied to the operators and is associated with the lack of skilled labour and the need for the replacement of defective equipment. Smoke byelaws have been adopted and attention of the factory occupier is called when nuisance arises. In addition, we have, as occasions required, called in the spedalist services of the Ministry of Fuel to give advice as to the best use that can be made of the coal available. Prosecutions have not been instituted, because it is felt that most good will be achieved by such practical assistance as referred to above. SANITARY INSPECTION OF THE AREA. It has not yet been possible to carry out the sanitary inspection of the area with the thoroughness of pre-war days. The number of sanitary inspectors available has been four whereas the establishment provides for six. It is further found in practice that to secure repairs many more visits are necessary, owing to the serious building difficulties arising from manpower and material shortage. That your officers have been able to maintain a standard of maintenance which has sufficed to prevent a sanitary breakdown is to be recorded as an achievement but does not Page 43 THE HEALTH OF BARKING give your officers the satisfaction they would like from seeing a job properly completed. Within one year of the end of the war, it was our experience in Barking that our housewives began to expect a return to normality in matters of housing and this is shown in the number of complaints received during the year which were 4,482, as compared with 2,654 for the previous year. Statistics in relation to the work of the Sanitary Inspectors are given in Appendix D. (B) HOUSING. STATISTICS. These will be found in Appendix E. POST-WAR HOUSING. From the statistics given, it will be noted that in just over a year after the end of the war a total of 355 dwellings had been provided. The demand for new accommodation, measured in terms of applications made to the Borough, was in respect of 4,500 families. The Council had during the war years taken such preliminary steps as were available to them to provide accommodation at the earliest date possible and the proposals were for the erection of 1,080 dwellings in the first two years after the war, as follows :— Permanent Housing 727 Rebuilding of Corporation Houses 57 Temporary Housing 285 St. Paul's Depot 11 Total 1,080 There are in the district 146 houses which were included in confirmed clearance areas under the Housing Act, 1936, but still remain occupied. Our condemned houses are today more fully occupied than ever before, and more dilapidated. The war lowered the standard of housing just as it did the standard of living. Nothing is more likely to create slums than the serious reduction Page 44 THE HEALTH OF BARKING A typical Barking Council housing estate. in repairs and maintenance which has followed. Another important cause of dilapidation has been the uneven and phenomenal spread of population, with increased room density in some towns, whilst in others dwellings have been left empty and uncared for. Again, rent restriction, social and necessary as it may be, has left owners only a minim m amount to spend upon maintenance. One of the vague concepts of the present time is the establishment of an equal minimum standard of life for all. This standard of life must inevitably have relation t the standard of comfort in the home. The coming of municipal houses for the working classes rang the death-knell of the small, cramped, two-bedroom house, lacking basic conveniences, built in earlier years. Today, to lighten the burden of labour by the use of labour-saving devices is regarded as an essential part of any plan to raise the standard of living. Our men and women have returned from the forces fully conscious of the deficiencies in their homes and their relation to them. The Ridley Report of December, 1937, made the same point, and added : "The change of outlook .... may well result in a number of old houses being put out of use which will falsify all previous estimates." Page 45 THE HEALTH OF BARKING " Prefabs." With the growing house consciousness of the people, the demand for what are known as modern conveniences is insistent and peremptory. The Council has met this demand by providing a house of a high standard of convenience. With regard to the obsolescent houses in the district, an estimate was made in 1944, when it was found that of the total dwellings in the Borough, 12,353 were provided between the two wars, leaving a balance of 6,200 houses which were of pre-1914 construction. Of the latter 3,400 are without bathrooms. Every house in the district is provided with separate w.c. accommodation, in most cases inside the main building, and a separate water supply which is readily accessible. A list of premises, which it is proposed should be dealt with in clearance areas so soon as building conditions permit, has been prepared and is in respect of a total of 502 properties. One of the most serious aspects of the housing question, to my mind, is the fact that more than one family so often must live together in the same house under conditions denying privacy and independence and perpetually expose the member; to inevitable friction. The fact that the families are often related by blood or by marriage is little or no mitigation. Page 46 THE HEALTH OF BARKING So often in infant welfare clinics it is thrust home that a baby is not thriving because the young mother, educated in child care, is dominated by an old-fashioned mother-in-law, or that the baby is picked up each time it cries, although this is very undesirable, because the others sharing the house object to the noise. On top of this, there is the difficulty of two women sharing a kitchen; a feat impossible without friction in all but the rarest cases. Official standards of overcrowding are measured in terms of floor area per person and in terms of the number of rooms in the house relative to the number of occupants and yet, apart from extreme cases, the attainment of a standard of one family to one house or flat would give more happiness and good health to the community than the relief of overcrowding on any standard of floor area or of number of rooms. SQUATTERS. Squatting, which became a national practice, took place in Barking during the months of July and August, when 3 former gunsite camps and 2 hutted camps belonging to the Ministry of Works were occupied. The total number of families was 98, consisting of 207 adults and 99 children. Of the total families, 35 had applications lodged with this authority for rehousing and 45 were not residents of the Borough. The camps at Barking Park and Parsloes Park and the hutments of the Ministry of Works were later in the year taken over and are being managed by the Corporation for the Ministry of Health. It was regarded as essential that families should be provided with all the facilities which could be reasonably supplied, because it was anticipated that the occupation would be for more than 2 years. Each family now has gas cooking facilities, a washing copper, sink and water supply, with a small portable hard fuel stove for heating purposes. In addition, electric lighting is installed. The campers use in common the sanitary conveniences left by the troops, but it is pleasing to report that the arrangements made for the joint use of these conveniences, as also the cleansing of footpaths and open spaces in the camps, has proceeded on an organised basis without any serious trouble. The Liaison Officers in the employ of the Council report upon conditions existing in the camps and help camp organisation. The camp at Creekmouth which was not taken over by the Corporation is situated near the River Thames and 3 miles from the nearest occupied dwelling. It is without main drainage but has water supply and electricity service. There are now 10 families in residence who have been advised that the camp is not Page 47 THE HEALTH OF BARKING suitable for occupation. As soon as any hut becomes vacant it is demolished. In the meantime, steps are taken to secure that there shall not be any sanitary breakdown. The absence of outbreaks of sickness in the camps was no doubt largely due to the prompt measures taken in the early stages of the movement. (C) INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. There are no cowkeepers in the district and we have no dairies where milk is handled or treated. There are 38 premises on the register for the retail of pre-packed supplies. In addition, there are six milk purveyors who occupy premises in other districts, but who retail in Barking. In Appendix F a table is given which sets out the results of the bacteriological examination of various samples. Barking's milk supply is now provided by three multiple companies who bring their milk from processing depots, after heat treatment, in other districts. In earlier Reports, I have called attention to the difficulties which have arisen since the rationalisation of distribution. It can be stated that during the past year, the delivery at the home in the summer has been better and there were less complaints of souring in consequence. With milk in short supply, souring to the householder becomes a serious matter when replacement milk is not available and anything which can be done to safeguard our supplies is to be supported. 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. The following table shows the number of licences granted during the year for the sale of graded milks under the Milk (Special Designations) Orders, 1936 and 1938 :— Tuberculin Tested 10 Pasteurised 13 Page 48 THE HEALTH OF BARKING MEAT AND OTHER FOODS. Meat. During the year the large depot which was used for the distribution of meat to the County Boroughs of East Ham and West Ham and the Boroughs of Barking and Poplar, ceased to operate as No. 3 Meat Depot upon its return to Smithfield Market. Throughout the period of its operation in Barking, our relations with the management were good and it was our experience that the conduct of the Depot was in every way satisfactory. Unsound Food. The conservation of food continued to be of the greatest importance and any condemnation which was made was only after searching examination. In Appendix F a table is given which sets out the total quantity of food condemned and which can be taken to represent the total for the Borough, because it has become the established practice for all food unfit for human consumption to be dealt with by the Department. FOOD POISONING. Only two cases of food poisoning were notified during the year. FOOD AND DRUGS ACT, 1938—SAMPLING. During the year, your authorised officers have submitted a total of 355 samples for examination. Details of these samples are given in Appendix F in tabular form. The Public Analyst was asked to comment upon the quality of ice cream retailed in the Borough and has stated that a considerable improvement has been noted in fat content, although only approximately one half of the samples submitted were found to contain more than 8 per cent, of fat, the amount which he regards as being the minimum fat content proper to ice cream. He irther states that all samples of ice cream were submitted to bacteriological examine.-'on for both the number of total colonies or organisms in one gramme of the sample, and, additionally and more particularly, for the number of B. Coli organisms, because, in his opinion, B. Coli organisms are invariably associated with unclean conditions and, therefore, the presence of such organisms is a useful indicator of the cleanliness of the preparation. The standard which has been adopted by the Analyst for judging the results of bacteriological examination is one which was prescribed before the war for certain graded milks, namely, that B. Coli should be absent in 0.01 gramme. The Analyst continues by stating that, whilst in view of the present world shortage of fats, there may be some justification for not making an official standard for fat content, nevertheless he can see no reason why a standard for cleanliness Page 49 THE HEALTH OF BARKING should not be laid down based upon bacteriological examination, particularly on the B. Coli content of a sample. He concludes by saying that he understands the Ministry of Health are introducing a compulsory heat treatment for ice cream and that, whilst this is undoubtedly a step in the right direction, he feels that this should be supported by some form of bacteriological standard, because, in his opinion, the value of the heat treatment process is seriously diminished if subsequent operations are not conducted under clean conditions. Of the 47 samples which were submitted for examination, 23 were reported as being unsatisfactory in so far as the standard given above is concerned, i.e. they contained B. Coli organisms in 0.01 gramme or less. CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The bacteriological examination of all milk and water supplies and the chemical examination of water supplies is carried out for this Authority by the Counties Public Health Laboratories, 66, Victoria Street, London, S.W.i, whilst the examination of samples of milk for the presence of tubercle is carried out by Dr. A. L. Sheather, of Chorleywood, Herts. The Borough Analysts are Dr. B. Dyer and Dr. J. H. Hamence, Peak House, Eastcheap, London, E.C. Page 50 THE HEALTH OF BARKING APPENDIX A. STATISTICAL AND SOCIAL CONDITIONS OF THE AREA. TABLE I DEATHS (NET)—1946 Causes and Totals. Causes of Death. Total. Cerebro Spinal Fever — Scarlet Fever — Diphtheria 1 Pulmonary Tuberculosis 34 Non-Pulmonary Tuberculosis 3 Syphilitic Diseases 4 Influenza 3 Measles — Acute Inf. Encephalitis — Cancer (all forms) 115 Diabetes 3 Intra-cranial Vascular Lesions 56 Heart Disease 142 Other Diseases of Circulatory System 24 Bronchitis 38 Pneumonia 31 Other Respiratory Diseases 7 Ulcer of Stomach or Duodenum 9 Diarrhoea (under 2 years) 2 Appendicitis 2 Other Digestive Diseases 11 Nephritis 15 Maternal Causes 3 Premature Birth 15 Congenital Malformation, Birth Injury, Infantile Diseases 23 Suicide 4 Road Traffic Accidents 5 Other Violent Causes 6 All Other Causes 45 Total 601 Page 51 THE HEALTH OF BARKING TABLE II INFANTILE MORTALITY—1946. 0-1 mth. i-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under 1 year. Asphyxia — 1 — — — 1 Atelectasis 5 — — — — 5 Bronchitis — — 1 — — 1 Broncho-pneumonia .. 1 5 3 — 2 11 Congenital Malformations 2 3 — — — 5 Cerebral Haemorrhage 4 — — — — 4 Enteritis and Diarrhoea — 1 1 1 — 3 Haemolytic Disease 1 — — — — 1 Intestinal Obstruction — — 1 — — 1 Lung Abscess 1 — — — — 1 Prematurity 19 — — — — 19 Totals 33 10 6 1 2 52 TABLE III NEO-NATAL MORTALITY—1946. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total. Atelectasis 4 1 — — 5 Broncho-pneumonia 1 — — — 1 Congenital Malformations 1 1 — — 2 Cerebral Haemorrhage 4 — — — 4 Haemolytic Disease 1 - - — 1 Lung Abscess — I — I Prematurity 18 I — — 19 Totals 29 4 — — 33 Page 52 THE HEALTH OF BARKING TABLE IV COMPARATIVE INFANT MORTALITY RATES. Year. Barking. County Boroughs and Great Towns, including London. England and Wales. 1926 59 73 70 1927 66.1 71 69 1928 63.3 70 65 1929 53-4 79 74 1930 61.3 64 60 1931 64.4 71 66 1932 53-4 69 65 1933 55.6 67 64 1934 56.7 63 59 1935 52.2 62 57 1936 56.07 63 59 1937 53.8 62 58 1938 39-5 57 53 1939 33-91 53 50 1940 32.98 61 56 1941 36.3 71 60 1942 35.68 59 49 1943 37.2 58 49 1944 28.35 52 46 1945 38.56 54 46 1946 32.79 46 43 Page 53 Page 54 THE HEALTH OF BARKING APPENDIX B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. TABLE V NATURE OF ATTENDANCE AT CONFINEMENT (Compiled from Forms M.C.W. 96). 1940 1941 1942 1943 1944 1945 1946 No. % No. % No. % No. % No. % No. % No. % DOCTOR & MIDWIFE 62 6.4 24 2.5 44 3.7 26 2.1 27 2.2 15 1.3 49 3.1 MIDWIFE 411 42.4 307 32.2 417 35.0 477 39.5 454 37.1 471 42.5 713 45.4 INSTITUTIONAL Upney Hospital 454 46.9 424 44.5 469 39.4 508 42.1 488 39.5 476 43.0 767 48.8 Evacuated 41 4.3 197 20.8 258 21.9 195 16.3 255 20.9 145 13.2 41 2.7 Total 495 51.2 621 65.3 728 61.3 703 58.4 743 60.7 621 56.2 808 51.5 TOTAL 968 100.0 952 100.0 1,189 100.0 1,206 100.0 1,224 100.0 1,107 100.0 1,570 100.0 THE HEALTH OF BARKING TABLE VI ORTHOPAEDIC SERVICE—1946. T oddlers and Adults School Children ATTENDANCES. Primary Examination by Surgeon 102 53 Re-examination by Surgeon 191 135 For treatment 5,864 5,062 Totals 6,157 5,250 TREATMENTS. Number of Cases 861 892 Number of Treatments 9,640 5,820 HOSPITAL TREATMENT. Admissions to Hospitals 1 3 On waiting List for Admission - - TABLE VII NEW CASES SEEN BY THE ORTHOPAEDIC SURGEON—1946 Toddlers and Adults School Children (a) DEFORMITIES OF BONES & JOINTS 1. Congenital 5 1 2. Acquired 81 46 (b) MUSCULAR 1. Congenital 4 2. Acquired 2 3 (C) PARALYSIS 3 1 (D) MISCELLANEOUS 7 2 Page 55 THE HEALTH OF BARKING TABLE VIII EAR NOSE AND THROAT SERVICE. Mothers & Toddlers Adults— Public Scheme School Children TOTAL Year 1945 Year 1946 Year 1945 Year 1946 Year 1945 Year 1946 Year 1945 Year 1946 Number of Attendances at the Ear, Nose and Throat Clinic 267 258 64 30 770 897 1,101 1,185 Number of cases which received operative treatment 85 54 — — 263 251 348 305 Number of cases which received other forms of treatment 52 127 27 20 353 236 432 383 TABLE IX CHIROPODY SERVICE. Year 1944 Year 1945 Year 1946 1. Treatment Sessions 1,307 1,530 1,755 2. Total Individual Patients 2,006 2,475 2,649 3. New Patients 1,233 1,179 1,071 4. Total treatments given 8,537 10,222 13,934 5. Infra-red treatments (included in 4) 578 595 641 Page 56 THE HEALTH OF BARKING TABLE X SKIN CLINIC. Consultations. T reatments. Year 1945 Year 1946 Year 1945 Year 1946 Sessions 48 47 IOI 100 Attendances :— Children under 5 years 139 212 300 472 Children 5-15 years 277 351 975 1505 358 325 Ante Natal and Post Natal Cases 126 191 114 Other categories (including Public Adult Scheme) .. 167 184 171 TABLE XI SCABIES—1946. New Cases Recurring Cases TOTAL Total number of patients 662 49 711 Adults 357 18 375 Children 305 31 336 Referred from :— Clinics 267 25 292 Other sources 395 24 419 Number of cases cleansed at the Barking Hospital:— Adults 233 15 248 Children 273 30 303 Page 57 THE HEALTH OF BARKING TABLE XII OPHTHALMIC SERVICE. Treatment of Defective Vision. Mothers & Toddlers Adults— Public Scheme School Children TOTAL Year 1945 Year 1946 Year 1945 Year 1946 Year 1945 Year 1946 Year 1945 Year 1946 Errors of Refraction, etc. requiring treatment 222 215 416 407 903 794 1,541 1,416 Number for whom spectacles were :— (a) Prescribed 109 93 239 298 485 492 833 881 (fc) Obtained 37 36 194 236 438 600 669 872 TABLE XIII OPHTHALMIC SERVICE. Squint Training. Year 1945 Year 1946 Number of Sessions 86 91 Number of Children Attended 29 26 Number of New Cases 8 9 Number of Old Cases 21 17 Number of Attendances 467 582 Number Discharged—Cured 3 2 Number Left School 4 — Number Discontinued 5 2 THE HEALTH OF BARKING APPENDIX D. ENVIRONMENTAL HEALTH SERVICES. (A) SANITARY INSPECTION. (i) Inspection of Dwelling-Houses. Total Houses inspected under Public Health or Housing Acts 4,731 Total Number of Inspections made 10,273 Housing (Consolidated) Regulations 257 After Infectious Disease and Scabies 802 Overcrowded Premises 488 Defects Found 3,807 Notices Served (Preliminary) 2,190 Re-inspections re Notices Served 4,035 Inspection of Work in Progress 1,265 (ii) Premises Controlled by Bye-laws and Regulations. Inspections. Contraventions. Notices served. Offensive Trades 39 37 15 Tents, Vans, Sheds and Fairgrounds 9 — — Dairies, ( owsheds and Milkshops 50 12 10 Hairdressers' and Barbers' Premises 47 35 20 Smoke Observations 15 - - (iii) Factories, Workshops and Workplaces. Inspections. Defects. Notices. Factories 59 24 15 Bakehouses 16 33 12 Workplaces 2 1 1 Outworkers' Rooms 3 — — Page 59 THE HEALTH OF BARKING  Inspections. Defects. Notices. Butchers' Premises 90 57 33 Fishmongers 66 43 23 Restaurants and Dining Rooms and Canteens 103 91 52 Stables and Stable Yards 1 — — Piggeries 3 — — (iv) Miscellaneous. Rats and Mice (Destruction) Act, 1919 800 55 36 Vacant Land and Refuse Dumps 29 5 4 Schools 12 1 — Shops Act, 1934, and Markets 353 141 80 Ice Cream Vendors 70 30 19 Drainage Inspections 89 59 47 Milk Sampling 143 — — Other Miscellaneous 185 5 1 Food and Drugs Act, 1938 689 169 115 Water Sampling 46 — — Street Traders 20 1 1 Food Bye-laws 334 — — Watercourses 7 — — (v) Notices Served. Informal Notices 2,190 Statutory Notices :— Public Health Act, 1936 : Section 39 17 Section 45 28 Section 83 — Section 93 130 Housing Act, 1936: Sections 9 and 10 139 Section 24 — Section 32 — Dustbins: Public Health Act, 1936: Section 75 (3) 880 Total 1,194 Page 60 THE HEALTH OF BARKING (B) HOUSING STATISTICS. (a) General. Number of dwellings provided in Barking during 1946 :— (i) By the Barking Corporation : New houses 16 Rebuilt houses 3 Prefabricated bungalows 158 Total 177 (ii) By the London County Council: Rebuilt houses 106 Prefabricated bungalows 7i Total 177 (iii) By Private Enterprise : Rebuilt houses 1 (iv) Total dwellings provided 355 (b) Unfit Dwelling-Houses. 1. Inspection of dwelling-houses during the year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,731 (b) Number of inspections made for the purpose 10,273 GO (a) Number of dwelling-houses (included under sub-head No. 1 above) which were inspected and recorded under the Housing Consolidated Regulations 257 (b) Number of inspections made for the purpose 452 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 3,070 Page 61 THE HEALTH OF BARKING 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 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 139 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 95 (b) By local authority in default of owners 22 B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 175 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 188 (b) By local authority in default of owners 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 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 under Dustbin Maintenance Scheme:— Initial Issues Renewals 441 Total 1,321 Page 62 THE HEALTH OF BARKING (C) INSPECTION AND SUPERVISION OF FOOD. MILK SAMPLES—BACTERIOLOGICAL EXAMINATION—1946. Type of Sample Satisfactory Unsatisfactory Totals " Pasteurised" Milk 36 4 40 " Homogenised" Milk - 1 1 Tuberculin Tested Milk 13 3 16 Tuberculin Tested (Pasteurised) Milk 19 19 Totals 68 8 76 Page 63 UNSOUND FOOD CONDEMNED—1946. Bacon 54 lbs. Bread and Flour 544 lbs. Butter 102 lbs. Cheese 412 lbs. Eggs 720 Fish 1,041½ lbs. Fruit 89½ lbs. Lard 5½ lbs. Margarine 2½ lbs. Meat 3,843 lbs. Milk 1,217 tins Preserves 202 lbs. Rabbits 50½ lbs. Sauce, Pickles, etc. 13 pints Sugar 141½ lbs. Sweets 106½ lbs. Various Fillings 1,289 tins, jars, etc. Vegetables 720 lbs. THE HEALTH OF BARKING FOOD AND DRUGS ACT, 1938—SAMPLES SUBMITTED FOR EXAMINATION—1946. Baking Powder 8 Beer 14 Beverages (Cocoa, etc.) 7 Bread and Flour 8 Butter 11 Cooking Fat 6 Custard Powder 5 Fish Paste 4 Ice Cream 47 Lard 10 Margarine 13 Medicinal Products 82 Milk 7 Milk Powder 2 Mineral Waters and Cordials 10 Other Provisions 46 Pickles 3 Preserves 19 Pressed Meat 2 Sausages and Sausage Meat 9 Spirits 8 Spices 4 Sugar 1 Sweets 2 Vinegar 7 Total 335