BARK 41 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. CORPORATION OF BARKING TOWN HALL, BARKING ESSEX October, 1948 To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, This Report is a mass of facts and figures. The most I can expect of it is that it shall be readable and that it shall be read by ordinary people. To this end I have tried to write it in what of old-time was spoken of as "the language of the common people." This report is of historic interest—it is my last under the old order of things. Having regard to my age, I cannot expect to do very much towards building the brave new world. I do sincerely trust, however, that those on whose shoulders will fall the responsibility of building this brave new world will at least do as well as the people of my age—I charge them that they do no worse. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Medical Officer of Health. i TABLE OF CONTENTS SECTION A STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Page Birth Rate 1 Deaths 1 Employment 5-6 Head Lice 6 Infant Mortality 2-3 Maternal Mortality 1-2 Page Neo-Natal Mortality 2 Nurses Act, 1943 6 Parks and Open Spaces 4-5 Population 1 Social Conditions 4-6 Still Births 2 and 4 SECTION B GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Alphabetical Summary of Services Provided with Sketch Plan Pages 7-14 Page Ambulance Service 25-26 Analgesia in Domiciliary Midwifery 17 Ante-Natal Service 17 Attendances at Clinics 14,20 Barking Maternity Unit 20 Chiropody Clinic 20-22 Clinics and Treatment Centres 20 Day Nurseries 18-19 Dental Service 22-23 Ear, Nose ; nd Throat Service 23 Health Visaing 15 Home Helps 26-28 Hospital Facilities 19-20 Page Infant Life Protection 15 Infant Welfare 14-15 Maternity Service 16-18 Midwifery 16-17 Ophthalmic Service 24 Orthopaedic Service 24 Paediatric Clinic 24-25 Post-Natal Clinics 17 Scabies 25 Skin Clinic 25 Squint Training 24 Vitamins 15 SECTION C PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Page Acute Anterior Poliomyelitis (Infantile Paralysis) 29,31 Cerebro-Spinal Fever 29 Diphtheria 29,30 Dysentery 29 Encephalitis 29 Erysipelas 29 Food Poisoning 29 Immunisation 29—30 Mass Radiography 32 Page Measles 29,30-31 Ophthalmia Neonatorum 29 Paratyphoid Fever 29 Pemphigus Neonatorum 29 Pneumonia 29,31 Scarlet Fever 29, 30 Tuberculosis 31-32 Venereal Diseases 32 Whooping Cough 29, 30 iii SECTION D ENVIRONMENTAL HEALTH SERVICES. Page Atmospheric Pollution 36-38 Bacteriological Examination of Milk 44 Bed Bugs 36 Biological Examination of Milk 43 Chemical and Bacteriological Examination of Food 46 Clearance Areas 43 Climatic Conditions 33 Drainage and Sewerage 34 Factories Act, 1937 40 Food Markets 46 Food and Drugs Act, 1938 45 Food Poisoning 46 Graded Milk Licences Granted 44 Housing 40-43 Hutted Camps 43 Ice Cream 45 Pitt Inspection and Supervision of Food 43-44 Loxford Arm Milk Supply 43-44 Post-War Housing 41-42 Public Cleansing 35-36 Rats and Mice Destruction Act, 1919, and Infestation Order, 1943 38-39 Refuse Disposal Rehousing Programme 41-42 Rivers and Streams 34-3; Sanitary Circumstances of the Area 33-40 Secondary Streets 35-36 Street Trading 46 Swimming Baths and Pools 39-40 Unsound Food 44-4; Water Supply 33-34 Wells 33-34 TABLES APPENDIX A—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Table I —DEATHS (NET)—1947 (Causes and Totals) Page 47 Table II —COMPARATIVE INFANT MORTALITY RATES 48 Table III —INFANTILE MORTALITY—1947 49 Table IV —NEO-NATAL MORTALITY—1947 49 APPENDIX B—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA Table V —NATURE OF ATTENDANCE AT CONFINEMENT 50 Table VI —ORTHOPAEDIC SERVICE—1947 51 Table VII —NEW CASES SEEN BY THE ORTHOPAEDIC SURGEON —1947 51 Table VIII—EAR, NOSE AND THROAT SERVICE 52 Table IX —CHIROPODY SERVICE 52 Table X —SKIN CLINIC 53 Table XI —SCABIES 53 Table XII —OPHTHALMIC SERVICE—Treatment of Defective Vision 54 Table XIII—OPHTHALMIC SERVICE—Squint Training 54 Table XIV—DENTAL SERVICE 55 APPENDIX C—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES Table XV —NOTIFICATION OF TUBERCULOSIS—1947 56 APPENDIX D—ENVIRONMENTAL HEALTH SERVICES (A) SANITARY INSPECTION 57-58 (B) FACTORIES ACT, 1947 59-fo (C) HOUSING 60-62 (D) INSPECTION AND SUPERVISION OF FOOD 63-64 iv THE HEALTH OF BARKING SECTION A STATISTICS AND SOCIAL CONDITION^ OF THE AREA. Population. The Registrar-General gives the estimated population of Barking for mid-year 1947 as 77,660. Birth Rate. The birth rate in Barking over the last few years has increased—the same is true in the country as a whole and the same was true, of course, after the Great War This is not only due to the fact there have been more marriages but that the people getting married have been younger than in pre-war days. This is a good thing, fo; it means that families will be larger ; there can be no doubt there have been too nmv' only children.' a ing 1947,1,850 live births were registered, i.e., 23.8 per thousand population whic is even higher than it was in 1946, when this figure was 20.6. Deaths. The chief causes of death are shown in Appendix A, Table I. Cancer as a cause of death is second only to heart disease. More people living longer and better diagnosis no doubt account for some of the rise which has occurred in the cancer rate over recent years but it is not enough to explain the whole of the problem Early diagnosis is essential and something must be done to educate the people to overcome their natural fear of knowing the worst and consulting a doctor so soon as possible. Maternal Mortality. I particularly difficult this year to talk about maternal mortality because officially we have no death whatsoever, whereas, of course, friends and relatives of a cert ragic case know in fact one woman did die during the year. The special circumstances in which the death is not recorded during the year is thai the are was an associated condition which meant that certain investigations had to be indertaken before it was possible for the Coroner to close the case; so Page 1 THE HEALTH OF BARKING it came about a woman who died in December was not certified, so far as the cause of death was concerned, by the Coroner until January, 1948. It is, of course, a noteworthy achievement to have a year where officially there are no maternal deaths and you will all be sorry to hear of the reservation I have put on this official figure. I always feel very diffident about boasting of such matters as this, but the fact that we had no maternal death in nearly two thousand births must, I think, be regarded at least as a step in the right direction. Infant Mortality. This is defined as the deaths under one year of age registered in the calendar year divided by the total live births so registered. In 1947 there were 1,850 live births and 58 deaths under 1 year. This gives a rate of 31.35 per 1,000 births as against a general rate of 41 for England and Wales as a whole. The 1946 rate in Barking was 32.79. The number of births in Barking is not sufficient to make the infant mortality rate for one year a reliable guide, but the same index taken over five years can be looked upon as reasonably reliable and on the opposite page is given a diagram showing the rates for the five year periods since 1927. In Appendix A, Table IV shows the comparative Infant Mortality Rates for Barking and the rest of the Country since 1926. Neo-Natal Mortality. Of the 58 babies under one year of age who died in 1947 as many as 33, or 57 per cent., died in the first month of life. Even more striking is the fact that 27 of these 33 babies died within seven days of birth. As is usual prematurity was the greatest single cause of death. Stillbirths. During the year there were 31 stillbirths in 1,881 total births. This gives a rate of 16.4 per 1,000 total births. The 1946 figure for Barking was 28.1, compared with 28 for England and Wales. The causes of death in the neo-natal and stillbirth groups are largely due to pre-natal or natal influences, whilst home environment is a significant factor in the deaths occurring in the age group one month to one year. As I have mentioned, prematurity is the commonest cause of death in the neo-natal period. In addition more than half of stillbirths are premature The Page 2 THE HEALTH OF BARKING Page 3 THE HEALTH OF BARKING He weighed 2 lbs. when he was born—look at him now. causes of prematurity itself are not fully known, but about half are associate 1 with recognisable obstetric conditions, particularly toxaemia of pregnancy and twins. It is much more commonly met with among the less well-to-do. The best nswer to prematurity, in the light of our present knowledge, is good ante-nat il and obstetric care combined with good maternal nutrition. Social Conditions. General. Your social services remain unchanged since last year and it is not proposed to discuss them at length in this year's Report. Parks and Open Spaces. In the year 1898 there was opened in the Lon; bridge Road a recreation ground, and the Council were very wise to name this a rec reation Page 4 THE HEALTH OF BARKING ground. As a matter of fact the late Alderman Edwards always corrected anybody who called it " The Park." There is, of course, no reason why a recreation ground should not be made beautiful by plantations separating one particular part of the ground from another, but it should always be remembered the grounds are primarily places of recreation. You have the recreation ground in Longbridge Road ; you have the Mayesbrook and Greatfields Parks, and altogether you have made a very real step towards dealing with the problem of recreation, but what we want in addition, are recreation grounds which are more readily available for little children without the need for them to cross main roadways. Little girls and little boys go through various stages in their development. When they are three years old they are complete exhibitionists and then it is "Daddy see how I can do this," and "Daddy see how I can jump over that." There is no harm in this, providing of course the child grows out of it. The curious thing about children is that, whilst they are normally and properly boastful at a certain age, at the same time they are very nervous, because the world contains so many things which are unknown quantities to them. When an antelope runs away from a lion it is not cowardice, it is realism and so with hese little children when they want always to be able to run home to mother, it is not cowardice, it is appreciation of the reality of the situation. The fact is that these young children must have their recreation grounds as near their own doorstep as possible. I Know there are exceptions amongst children, and I know what I have written cannot be applied in every case. It is true of a vast majority of children that to them their own doorstep and their own hearth spells security and that they cannot be expected to be happy when they are far away from such security. I do urge we want open air places for children, small enough for us to afford one in every street or so. If anybody wants any confirmation of what I have said you have only to go round some of of our housing estates and see to what use the children have put the "banjus". Quite frankly the children are nuisance in these places, but with a little re-arangement they could have been made places where children could play to their hearts content, without disturbing the peace of the nearby houses. Employment. The manager of the Barking Employment Exchange has kindly told me that the level unemployment in Barking has remained very low except during the electricity switch-off in February when approximately seven thousand persons were u employed for periods varying from one to three weeks. Page 5 THE HEALTH OF BARKING In December, 1947, only 246 persons or 1.2 per cent, of the working population of the area were unemployed. In general unemployment is only of short duration. Employers have been extremely helpful in connection with problems arising from the employment of disabled persons and a large number of Barking employers are employing a number of registered disabled persons in excess of the quota requirements of the Disabled Persons (Employment) Act, 1944. While we must welcome the Employment and Training Bill published on the 23rd March, 1948, which embodies those recommendations of the recent Ince report on the reform of the Juvenile Employment Service which need legislative authority, it is understood that we shall still have no authority to visit factories after a child is placed to see whether the medical recommendations as to the type of employment suitable to the child are indeed carried out. Nor is there provision for medical examinations at intervals afterwards, so that the effect on the juvenile of the work chosen can be checked. Nurses Act, 1943, Part II. No applications have been received under this section of the Nurses Act for licences during 1947. Head Lice. This essentially preventable condition remains with us, although its incidence as judged by inspections of school children appears to be lower in 1947 than in the previous year. This condition, like scabies, is a family disease and there are certain families who are rarely, if ever, quite free from infestation. These families form foci which spread the infestation to those whose personal standards are higher. As might be expected the incidence is higher amongst females than males. This is not only because the hair is longer but because elaborate ' hair dos ' discourage frequent washings and brushing. The ' snood ' from which elegant curls are all too infrequently removed is, I am happy to observe, a dying fashion. Page 6 THE HEALTH OF BARKING SECTION B GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Summary of Services Provided. In other parts of this Report will be found special comment on some of the services provided by you, but for easy reference a brief summary of them all is listed here:— Addresses :— (a) Clinics. Bifrons Clinic (Bifrons School), Bromhall Road Seven Kings 3738 Central Clinic, Vicarage Drive, Ripple Road Rippleway 2412 East Street Clinic, East Street Rippleway 3880 jreatfields Clinic, 133, Movers Lane Rippleway 2033 vlanor Clinic (Manor School), Sandringham Road Seven Kings 1845 Porters Avenue Clinic, Porters Avenue Seven Kings 2678 Upney Clinic (Nr. Upney Hospital), Upney Lane Rippleway 2750 Voodward Clinic, Woodward Road Rippleway 3193 (b) trict Midwives. , Wykeham Green Seven Kings 4959 51, Hedgmans Road Rippleway 3141 lurses' Home, Upney Lane—Flat No. 1 Rippleway 2938 „ 2 Rippleway 2806 „ 3 Rippleway 2124 „ 4 Rippleway 2035 „ 10 Rippleway 1675 Ambulance Service. This is free to residents of the Borough. Sitting case cars avalilable for the conveyance of patients to hospitals and clinics for outpatient treatment. The Service is operated from the Fire Station, Alfred's Way (Ripple way 2634). Page 7 THE HEALTH OF BARKING Page 8 THE HEALTH OF BARKING Ante-Natal Clinics. At these clinics expectant mothers are given advice. Clinical sessions are held as under:— Central Clinic Monday and Wednesday afternoons, Friday morning. Greatfields Clinic Monday morning and Friday afternoon. Porters Avenue Monday, Wednesday and Thursday mornings. Upney Clinic Monday, Wednesday and Friday mornings and Tuesday evening. Woodward Clinic Tuesday, Wednesday and Thursday mornings. Clinic of Specialist Consultant in Obstetrics and Gynaecology, Upney Clinic Tuesday afternoons. Baths. In certain necessitous cases, free baths are provided for expectant and nursing mothers at the East Street Baths. Birth Control Clinic. Cases are referred to this clinic, when necessary, on medical grounds and are seen at Upney Clinic on Thursday afternoons, by appointment only. Children's Specialist Clinic. A Consultant Specialist in the Diseases of Children holds a session once a fortnight at Upney Clinic on Thursday afternoons. Convalescent Treatment. Such treatment is provided for children and mothers on the recommendation of your Medical Officers. At present, however, this service has had to be curtailed, owing to the lack of sufficient accommodation in convalescent homes. Day Nurseries. Three such nurseries are maintained by you, viz.:— Gale Street Day Nursery, Goresbrook Road, Dagenham. Eastbury House Day Nursery, East bury House, Barking. I odge Farm Day Nursery, Rugby Road, Dagenham. Children from six months to five years of age are eligible for admission where the mother is at work or due to be confined and in certain other cases where there are difficult home circumstances. Dental Treatment. Clinical sessions are held daily at Bifrons Clinic, Central Clinic, Manor Clinic, Porters Avenue Clinic and Woodward Clinic. Evening sessions are also held at Central Clinic, Manor Clinic and Woodward Clinic on certain days. Comprehensive treatment including the provision of dentures is afforded at these clinics to all members of the public. Orthodontic treatment (correction of irregularities of teeth) is also undertaken in the case of children. Dentures are Page 9 THE HEALTH OF BARKING processed at the Dental Workshop maintained by the Corporation in the precincts of the Central Clinic. Dinners. Free dinners are supplied from School Meals Centres and the Municipal Restaurant to necessitous expectant and nursing mothers and children under five years of age, on the recommendation of your Medical Officers. Disinfection. In cases of infectious disease, disinfection of premises and bedding, etc., is carried out, where necessary, free of charge. In certain other cases of non-notifiable diseases, disinfection is carried out on request. Arrangements are also made for the destruction of badly soiled mattresses, etc., on request. District Nursing Service. Comprehensive facilities exist for nursing in the home of members of the public on the recommendation of general medical practitioners. The District Nurses' Home at 261/3, Porters Avenue, Dagenham, caters for that part of the town East of Upney Lane. Ear, Nose and Throat Clinic. Treatment and advice is given to all members of the public under the direction of a Specialist Consultant who holds a clinical session each week. This session is held on Monday afternoons alternately at the Central Clinic and the Woodward Clinic. With regard to deafness, special investigations are undertaken by ising an audiometer, an electrical instrument which measures the exact pitch and intensity of sound that a person can hear. Foot Clinic. Comprehensive treatment is afforded daily to all members of the public at East Street Clinic, Porters Avenue Clinic and Woodwar 1 Clinic Certain evening sessions are also held at each clinic. For adults treated under the Public Adult Scheme, a charge of 1/- per visit is made, except in the case of unemployed persons and old age pensio lers who are treated free of charge. Gynaecological Clinics. At these clinics women may obtain advic: on any matter associated with conditions relating only to women. Clinical se sions are held at Upney Clinic on Wednesday afternoons and Friday mornings. Where necessary, in-patient hospital treatment is arranged. Home Helps. Full-time and part-time home helps are available to assist women in their homes at the time of their confinement and in other selei ted cases. Applications for this service should be made to the Public Health Department, Town Hall. Immunisation Treatment. Inoculations are given for diphtheria, sc trlet fever and whooping cough at Central Clinic, Porters Avenue Clinic, Upney -linic and Page 10 THE HEALTH OF BARKING Treatment of minor ailments prevents major diseases. Woodward Clinic. In addition, treatment is given to toddlers at any of the Infant Welfart iessions and at the Day Nurseries. ALL PARENTS ARE URGED TO HAVE THEIR CHILDREN IMMUNISED AGAINST DIPHTHERIA. BABIES CAN BE IM INISED FROM THE AGE OF 8 MONTHS. Inf Welfare Clinics. At these clinics advice is given upon the welfare of babies and toddlers. Clinical sessions are held as under :— Central Clinic Tuesday, Thursday and Friday afternoons. Greatfields Clinic Monday, Wednesday and Thursday afternoons. Porterts Avenue Clinic Monday, Wednesday and Friday afternoons. Upney Clinic Monday, Wednesday and Friday afternoons. Woodwards Clinic Tuesday, Thursday and Friday afternoons. Maternity Services:— maternity Home. The Barking Maternity Unit consists of the Upney Maternity Pavilion and beds in Jenner and Harvey Wards of the Barking Hospital District Maternity Service. An adequate domiciliary midwifery service operators throughout the whole of the Borough. A maternity outfit is provided free to each patient. Page 11 THE HEALTH OF BARKING 1 Consultations. There is a Specialist Consultant available for consultation in cases of abnormal pregnancy, puerperal pyrexia and in cases of difficult labour. Supply of Medicines. Arrangements exist with local chemists by which prescriptions are dispensed free for mothers and children attending clinics under the Maternity and Child Welfare Scheme. Minor Ailments Clinics. These clinics are held primarily for children suffering from minor ailments. A doctor is in attendance at each sessions, under whose direction advice and necessary treatment is given. Clinical sessions are held as under:— Central Clinic Porters Avenue Clinic Upney Clinic Woodward Clinic Each weekday at 9 a.m Nutrients—Dried Milk Foods. Cod Liver Oil, etc. These products are sold or issued free in necessitous cases, during appropriate clinic sessions, on the recommendation of your Medical Officers. Ophthalmic Service.—A Specialist Consultant Ophthalmic Surgeon attends for the treatment, including the provision of spectacles, of all members of the public. Clinical sessions are held as under:— Central Clinic Tuesday and Friday mornings. Woodward Clinic Wednesday and Thursday afternoons. Treatment for children suffering from squint is also provided under the direction of the Consultant Ophthalmic Surgeon (see Squint Clinic). Orthopaedic Treatment. Advice and treatment is provided under the direction of the Specialist Consultant for all members of the public. Clinical sessions are held daily at the Manor Clinic. Pathological Service. A pathological laboratory is maintained at the Barking Hospital which supplements the facilities offered by the Essex County Council. At this laboratory those examinations which can only be, or which can better be carried out locally are undertaken. Post-Natal Clinics. An opportunity is given to every mother, after her confinement, to attend one of these clinics for a concluding examination. Any necessary treatment, including in-patient hospital treatment, is arranged and the advice of the Specialist Consultant in Obstetrics and Gynaecology is obtained, if required. Clinical sessions are held at the Upney Clinic on Tuesday mornings and Thursday afternoons. Scabies. This is a notifiable disease within the Borough and baths and outpatient treatment under the direction of the Skin Specialist are provided freeo: Page 12 THE HEALTH OF BARKING Pathological laboratory, Barking hospital. charge to all members of the public at the Barking Hospital on the production of a doctor's certificate. Sheets. Coupon equivalent certificates for sheets are supplied under the Government Scheme to expectant mothers who are to be confined in their own homes and are genuinely in need of additional sheets for the confinement. Skin Clinic. Under the supervision of a Specialist Consultant in Skin Diseases treatment is provided for all members of the public. Clinical sessions are held as under:— Clinic of Specialist Consultant, Paget Ward, Barking Hospital Tuesday afternoons. Paget Ward, Barking Hospital Tuesday and Friday mornings. Central Clinic Monday to Friday at 10 a.m. Speech Therapy. Treatment for speech defects is given to children on the recommendation of your Medical Officers. Clinical sessions are held as under:— Paget Ward, Barking Hospital Tuesday and Thursday—morning and afternoon. Squint Training Clinic. Under the direction of the Specialist Consultant Ophthalmic Surgeon, treatment is given to children for the correction of squint. Clinical sessions are held as follows:— Central Clinic Tuesday afternoons and Wednesday mornings. Page 13 THE HEALTH OF BARKING These mothers don't wait for their babies to fall ill, they believe in learning how o keep 1 them well. Tonsils and Adenoids. Arrangements exist with Queen Mary's Hospital, St. Mary's Hospital and King George Hospital for children to undergo operative treatment for tonsils and adenoids. Ultra-Violet Light Treatment. Such treatment is provided for all ir embers of the public on the production of a doctor's certificate. Clinical sessnns are held as under:— Manor Clinic Daily. The way in which the public can avail themselves of these services is to seek information from the Health Visitor for the District, or to attend at on of the Clinics or Centres, or to make an enquiry at the Public Health Departmen , Town Hall, Barking (Telephone No. Rippleway 3880). It should be noted that from time to time there may be alteration in the programme of clinical sessions as given. Infant Welfare. Infant Welfare Clinics. There are five infant welfare clinics in Bar ng and three sessions weekly are held in each of them. During the year 1947, the number of attendances was 42,962. Page 14 THE HEALTH OF BARKING It would be natural to expect that during the year 1947 more children under the age of one year attended the clinics, because more children were born, but an 1 even higher percentage of these children attended your clinics than they did in the previous year. Out of a total number of 1,850 births during the year, 1,720 children attended your clinics which means that only a small percentage of children born in Barking have not at some time or another attended your clinics as babies. In this connection, I am happy to be able to say that the number of children who attended over the age of one year has also shown an increase this year. This figure of 3,130 is one on which I feel sure we could improve if we had sufficient staff and if we had adequate premises. You will no doubt in considering this figure have regard to the fact that some children between the ages of one and five are in Day Nurseries and of course some of them are in Nursery Classes. Infant Life Protection. On one occasion only during the year were proceedings taken or an Order applied for under the Public Health Act, 1936, Sections 206-220, and this is the first one in ten years. The case was dismissed under the Probation of Offenders Act, on payment of twenty shillings costs We do use our every endeavour to see people are well informed of their duties and responsibilities and your Officers are well advised you would not take proceedings until you had satisfied yourselves that the offence was not merely one of ignorance. Health Visiting. During the year your health visitors made 13,863 home visits. This figure shows a decrease on last year and is due to two factors—(a) we have not had the same staff and (b) the demand for the staff at the clinics grew during 1947. You have done everything within your power during the year to bring your staff up to complement, but it has been impossible to get the requisite number of health visitors. This is a very sorry state of affairs, because the fullest value of your clinic services can only be obtained where there is constant liaison between I clinic and home. Vitamins. In my last report I expressed concern over the poor take-up of vitamin supplements for both ante-natal mothers and children under five. Sincc that time steps ha 0 been taken to make it easier for mothers to obtain these without queueing and its anendant irritation. At the same time your clinic teams have made a special point of :mphasising their importance. A lot of mothers seem to think that cod liver oil is' heating to the blood ' if taken in the si mmer. I wish to emphasise that this oil with its valuable vitamin content should be taken all the year round. Page 15 THE HEALTH OF BARKING This sturdy family never misses its Cod Liver Oil or Orange Juice. Maternity Services. Midwifery. At the end of the year there were 19 midwives practising in Barking. Of these 11 were employed in your hospital and the remainder, including two from the Plaistow Maternity Hospital and District Nurses' Home, were engaged in your district midwifery scheme. Early in the year the Salvation Army had intimated that they would be unable to continue supplying district midwives to undertake work in Barking after the middle of the year. Their midwives were withdrawn at the end of July but to help us over our difficulties they were able to arrange for two pupil midwives to come Page 16 THE HEALTH OF BARKING to Barking to work under the supervision of one of your sister-midwives. For twenty years the Salvation Army have played their part in providing a midwifery service in the eastern part of the Borough and I should like to record our appreciation of their work. Under the National Health Service Act, 1946, all district midwives in the County Area will be employed directly by the Essex County Council from the 5th July, 1948. This will mean we shall have to say goodbye also to the Plaistow Maternity Hospital and District Nurses' Home who since 1923 have undertaken midwifery work in Barking and I should like to place on record our deep gratitude for the work they have carried on during the past twenty-five years. Until the last quarter of the year, the difficulties of obtaining sufficient midwives meant serious overwork to your staff. In the light of this the maternal mortality figure reflects great credit on your midwives. Of the 909 cases delivered on the district during 1947, 315 cases were helped through the birth by gas and air. This compares with 304 cases in 1946. Other cases were given different types of pain relieving medicaments. The nature of attendance on mothers since 1940 is shown in Appendix B, Table V. From this table it will be seen that the majority of mothers are attended either by a midwife on the district or are admitted to Upney Hospital. Ante-Natal Service. This service sets out firstly to promote the general health of the expectant mother and secondly to deal with any social or medical difficulties in the way of her having a baby. Everything is done to ensure that the mother gains in knowledge and confidence through her visits so that at the time of the confinement she, knowing what is going to happen and why, will have an infinitely smoother, less painful and safer labour. Cases are not infrequently taken into the Barking Hospital for a few days rest and treatment during pregnancy and this facility greatly assists in making an efficient ind safe service. Post-Natal Clinics. I regret to say that only just under one thousand women attended your post-natal clinics. This, of course, is well over half of all women confined during the year but it is still not enough. It is difficult to understand why there is prejudice against being examined post-natally. The fact is that the women if Barking are so keenly alive to the interests of their expected children and of their children, they will go out of their way to obtain the services you have made available. For themselves, however, they are not prepared to make the same sacrifice and there can be no doubt, if we are to win these people, the post-natal service must be made even more available than it is to-day. We must have better facilities for these people to be examined expertly under conditions which will attract them, which of course is not practicable to-day having regard to the difficulties relating to premises and establishment. Page 17 THE HEALTH OF BARKING The clinic of the future must be sufficiently spacious to have running at one and the same time a child welfare clinic, a creche and a post-natal clinic. The mothers are willing to take their children to the infant welfare clinic and if there were a creche at every clinic and a post-natal clinic running at the same time I believe a much larger number of women would avail themselves of post-natal examinations, Day Nurseries. You have three such nurseries—Castle Green, Eastbury House and Lodge Farm. The average daily attendance during the year was 40, 60 and 36 respectively The demand for places has been much greater than the accommodation available. To relieve this situation permission has been obtained to convert the Castle School at Rippleside into a further nursery. At the same time I am hopeful it will become possible to erect a further prefabricated nursery. There has been much discussion as to the value of day nurseries. The amount of woman power released for industry is not as great as might at first appear, since the number of mothers who go into industry must be balanced against the staff required to run the nursery and the work involved in building or conversion and maintenance. A certain proportion of cases are admitted on medical grounds, for examplechildren not uncommonly tease anxious parents by eating very poorly. How they love to watch their parents' consternation, in consequence of which they occupy the centre of the stage ! If these children are admitted to a day nursery, the sight of others eating heartily is too much for them and they soon join in. Most medical officers are agreed that the incidence of respiratory infections is higher among children attending day nurseries than in children of the same age groups generally. At the same time these nursery children are somewhat above the average in weight. With regard to the mental development of nursery children, it is felt that there is a definite advantage in that they learn how to mix socially at an early age. On the other side, it may be that this easy social intercourse is achieved at the expense of the development of the individual personality. If a child is to be happy, it must learn discipline. The right way to discipline a child is to give as few orders as possible. Think if it really matters before saying "No" or "Stop it" to a child. Make sure your order is within the child's capabilities. But once an order has been given see that it is carried out however inconvenient it may be for you to do this. Now if a mother has a house to run and say two small children to care for at the same time she will usually find herself very harassed and will forget the simple rules of discipline upon which a fair measure of her children's emotional development depends. I cannot but feel that when economic pressure no longer makes it necessary for mothers to go out to work there will be a very real need for nurseries where a mother can leave her children for say three hours daily. This relief would make it possible for a mother to take her Page 18 THE HEALTH OF BARKING Operating Theatre—Barking Maternity Unit. duties much more seriously in this respect—it would make her a more, not a less, responsible mother. Hospital Facilities. As 1 recorded last year, there are insufficient hospital beds in the country and few hospitals are designed and equipped, as yet, to make full use of the possibilities of modem medicine. The position remains unchanged—Oldchurch County Hospital taking most of the cases locally, while considerable numbers are admitted to the London Hospital, King George Hospital and other hospitals hereabout. Page 19 THE HEALTH OF BARKING The major difficulty remains in finding suitable accommodation for the aged sick. A bed of any kind is very difficult to obtain for these cases; suitable accommodation almost impossible. The home helps service and the district nursing associations do much to help in these circumstances. The hospital service of the future envisages that specialists will hold clinics in health centres as well as in hospitals so as to make the service as convenient as possible to the patient. Your specialist services may be regarded as already largely fulfilling this function. Barking Maternity Unit. In the middle of the year you revised your system of bookings for the Barking Maternity Unit to provide for priority categories. Priority No. i was medical grounds, No. 2 was social grounds and No. 3 was for women having their first babies, the last mentioned cases being booked in the order of application. It has been found generally that this order of priority has worked very well. The number of cases sent during the year to maternity institutions outside the Borough was 45. Clinics and Treatment Centres. A list of the centres at which clinical sessions are held is given on page 7. The services which were previously held in the Greig Church Hall, Stamford Road, have now been transferred to Woodward Clinic which has been adapted from the ad hoc first aid post. It will be remembered this first aid post was built on to the remaining structure of the original Woodward Clinic which was almost completely destroyed by enemy action in the early part of the war. Arrangements were also completed for the adaption of the Porters Avenue First Aid Post for clinic purposes. Below are given the total attendances at your various clinics and out-patients departments for the past three years:— Year. Total Attendances. 1945 115,000 1946 I47,254 1947 155,852 Chiropody Clinics. During the year, chiropody was undertaken at the East Street Clinic as heretofore, but it is anticipated that in the New Year either one or two chairs will be provided at the Woodward Clinic, making this service more readily available to the residents living in the Barking portion of the Becontree Estate. Statistics relating to this service will be found in Appendix B, Table IX. Page 20 THE HEALTH OF BARKING Chiropody Clinic. At other times I have spoken of ill-fitting shoes and now I would wish to put yet another point of view before you. Father comes home from work and finds his sloppy slippers already by the fireside He takes off his boots; he puts on his slippers and he stretches his legs with eased content and gets the impression slippers are a very nice thing and wishes he could wear them all day. Anyhow, if father does not go so far as this, mother does. Now I have nothing whatsoever against father stretching his feet comfortably in front of the fire in a pair of slippers many sizes too large for him, but I do say these same slippers would be very bad for him if he wore them all the time. Page 21 THE HEALTH OF BARKING What I have to say about slippers could also be said about other things, and not only about father and mother, but about Tommy too. For women to go shopping in flexible sandals is bad, and it is equally bad for children to go running about all day in flexible sandals. Some "bright young things" go about in such sandals, and I am to advise you that the constant wearing of such footgear can only result in deformed feet. Dental Service. Although 1947 did not mark your final achievement in dental services, it did show a definite forward step in this direction. By the end of the year you had increased your dental staff to five full-time dental surgeons ably assisted by five dental nurses. The number of clinics was increased to five, with the opening first of Porters Avenue Dental Clinic, and then later of Woodward Road Clinic. Further schemes for the doubling of Porters Avenue Clinic and for the reopening of East Street Clinic as a double dental unit were also put forward and the preliminaries dealt with. In common practice with most other authorities you operated your dental scheme for expectant and nursing mothers and you went further than such other authorities by including in your scheme mothers of children up to five years of age ; you also fulfilled your obligations in the treatment of toddlers or children of under school age. Further to your Maternity and Child Welfare dental scheme you have operated your Public Scheme which from a comparatively small beginning during the war years has become one of the largest of such schemes in the country. You are, therefore, one of the pioneers of a future National Dental Service. One of the dental tragedies of the old school dental service as such was the lapse of continuity of treatment after the child left school. So much good work done by the school dentists was wasted, in that, once the child had left school, until such time as he or she qualified for treatment under the National Health Insurance, any treatment had to be paid for by the adolescent or the parent. You encouraged your adolescent by making only a nominal charge per annum for such treatment as might be necessary, and then under your public scheme a definite continuity of treatment was possible. Thus the general population of Barking can be said to be more dentally minded than the average citizen. At the same time it should be pointed out that there are far too many dentures being made, especially for comparatively young people, which stresses the need for such an increase in dental staff and dental education that far more conservative dental treatment can be carried out. Although statistics are no guide to the quality of work being carried out, the figures given in Appendix B, Table XIV, do indicate the amount of work which is Page 22 THE HEALTH OF BARKING Ear, Nose and Throat Clinic. being done in your dental clinics. The annual report of the School Dental Service is given elsewhere but some of the figures in respect of this service are repeated in Table XIV, to give the overall picture in figures of your complete dental services. Ear, Nose and Throat Service. This is an important service, since an expert opinion is so often required upon the tonsils and adenoids of children and because of the large number of children who suffer from running ears. In he past the tendency has been to remove tonsils and adenoids without sufficient cause. Tonsils are normally enlarged during childhood because they play a big part in building the body's defences against germs met with for the first time in childhood. When that task is largely completed they shrink back to the size normal for an older child or adult. On the whole the mothers attending your clinics are still rather too anxious for this operation to be carried out in cases where it is not desirable. On the other hand running ears are a serious condition leading to deafness in many cases and may give rise to more serious infections. Yet mothers are apt to treat them with less concern than they merit. Treatment must be thorough and regular and persisted with until the ear is dry and for this the enthusiastic aid of the mother is invaluable. Statistics in relation to this service are given in Appendix B, Table VIII. Page 23 THE HEALTH OF BARKING Ophthalmic Service. Your ophthalmic service is an important one to which your consultant surgeon devotes four sessions each week. The majority of cases seen are school children and there is a special clinic for those who suffer from squint. I must record with regret the resignation of Mr. W. A. Gray, your Consultant Ophthalmic Surgeon, who has gone to Canada. He served the people of Barking very faithfully and they, for their part, had a warm feeling for him. In his place, it is a pleasure to welcome Mr. J. E. M. Ayoub, F.R.C.S., Assistant Ophthalmic Surgeon to the London Hospital. Statistics relating to this service will be found in Appendix B, Tables XII and XIII. Orthopaedic Service, Your orthopaedic service, as I reported last year, continues to be restricted by reason of shortage of staff despite repeated advertising. This has meant that we have not been able to send physiotherapists out to do domiciliary work. Those too severely crippled by rheumatism and other complaints to leave their own homes would greatly benefit had we sufficient staff to do treatments in the home. Again we have not yet found it possible to spare a physiotherapist to teach relaxation to ante-natal mothers. On the other hand a rather special effort has been started during the year to re-educate children born with cerebral palsy. For the best results we must learn to diagnose this condition much earlier than has been the case in the past and start intensive treatment before deformity becomes apparent. We have in Barking 10 children attending Faircross Special School with this disease. There seems to be a belief that the number of these children in the country as a whole who are educable is very small. I write this to suggest that the number of oducable 'spastics' may not be so small as is generally thought and that with early ascertainment and intense physiotherapy it may become greater in the future. Post-natal cases continue to receive a course of exercises and, where appropriate, electrical treatment. This is proving a great help in preventing backache flat feet and other conditions which so often follow pregnancy unless suitable action is taken. Statistics in relation to the work of this service are given in Appendix B. Tables VI and VII. Paediatric Clinic. Dr. A. Doyne Bell, M.R.C.P., D.C.H., is your consultant children's physician and difficult cases are referred by your medical officers to him. He is also available for domiciliary consultation if necessary. Page 24 THE HEALTH OF BARKING Dr. Doyne Bell works closely with the consulting obstetrician in overseeing the health of the infants in Upney Hospital. Skin Clinic. The misery which skin diseases cause is often out of proportion to the economic distress or morbid changes which accompany them. Often puzzling in their origin and resistant to treatment, it is important to have a frequent consultative service locally. The further a patient has to go for advice or treatment the less likely is he to get that advice or treatment. A comparative record of the work of the clinic is shown in Appendix B, Table X. Scabies. This disease, as I pointed out last year, is essentially a family disease spread by close contact, most commonly by the sharing of a bed. As most will be aware scabies gave rise to a serious wartime problem, being at that time of serious epidemic proportions. I am glad to be able to report to you that the notifications of the disease fell to forty-two per cent. of the 1946 figure. All close contacts whether they have a rash or complain of itching at night or not should accept treatment which is simple, safe and sure. Relevant statistics appear in Appendix B, Table XI. Ambulance Service. It is of interest to call attention to the fact that three years before the operation of the National Health Service Act, 1946, the Corporation have provided a free ambulance service. An examination of the number of calls for each of the years given in the table below will show that during the first year of the free service the increase in the number of calls was not substantial, but as this free service became better known there was an upsurge so that during the last year under review the increase represented an additional demand of two hundred per cent. over the year immediately preceding the introduction of the free service. This information will be instructive to many authorities who are for the first time giving similar service. Year Calls Year Calls 1944 4,502 1946 9,045 1945 5,532 1947 12,660 In addition to the ambulance service, the Council added to the vehicle strength of the ambulance station one sitting case car for the transport of midwives when Page 25 THE HEALTH OF BARKING attending confinements. The establishment of personnel and vehicles to provide the service required is:— Personnel—Station Officer 1 Deputy Station Officer 1 Driver/Attendants 22 Vehicles —Stretcher Ambulances 4 Sitting Case Cars 4 During the year there were periods when the number of vehicles available was reduced by mechanical breakdowns due to the age of the ambulances. An order was placed for two new Daimler ambulances with Lomas bodies but unfortunately the shortest delivery period which could be given for these vehicles was eighteen months and they will not be in service until early 1949. The following is an analysis of the calls received at the Ambulance Station, showing the allocation of calls by hospitals:— Name of Hospital Proportion of total cases Type of cases London 40% All Types. Oldchurch 30% Dressings and Examinations. King George 10% Fractures. Barking Maternity Unit and Clinics 8% Maternity, Massage, etc. St. Mary's 5% Electrical Treatment, Tonsils and Adenoids. East Ham Memorial 2% Fractures, Diabetics. Miscellaneous 5% Examinations, Special Treatments. It is to be expected, after three years' experience of a free ambulance service, that an opinion could be expressed upon its value to the public. The general impression obtained is that because it is free, the service becomes very much of a taxi service and is no doubt abused by some persons. Any control can only be effected by more judicious issue of permits through medical practitioners and hospitals. I call attention to this factor because it does appear to me that unless calls are restricted to those actually needy, the tendency will be for everyone who has to visit a hospital or clinic to use the ambulance service, in many cases when other forms of public conveyance would be suitable. Home Helps. First priority for the services of home helps is given to mothers who are to be confined at home. When this priority has been met other cases such as illness, old age and infirmity are dealt with according to their merits. In addition to six full-time home helps employed by you, efforts were made to increase the panel of casual home helps, in view of the very heavy demand for Page 26 THE HEALTH OF BARKING She looks after the children, cooks for the family and keeps the house clean. this sen ice. I am happy to be able to say that whereas at the beginning of the year there were only seven casual home helps on the panel, by the end of 1947 this number had increased to 25. It will be remembered that in 1945, in view of the shortage of home helps, a scheme was introduced for the payment by you of private home helps attending at confinement cases where one of your home helps was not available. This scheme continued during 1947 but, having regard to the increased number of home helps Page 27 THE HEALTH OF BARKING taken on the panel towards the end of the year, it was possible to discontinue the employment of these private home helps. In order that it may be fully appreciated how this service has grown the following figures are given relating to the cases dealt with during the past three years 1945 1946 1947 Cases attended by Council Home Helps 50 73 210 Cases attended by Private Home Helps paid by the Corporation 19 175 156 I anticipate the demand for this service will increase still further and it will become a very important social service. Page 28 THE HEALTH OF BARKING SECTION C PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFICATIONS. Below is given a summary of the various notifications received during the year:— Measles 742 Whooping Cough 203 Scarlet Fever 139 Pneumonia 57 Puerperal Pyrexia 24 Erysipelas 19 Diphtheria 7 Acute Anterior Poliomyelitis 5 Dysentery 4 Ophthalmia Neonatorum 4 Pemphigus Neonatorum 3 Food Poisoning 2 Cerebro-spinal Fever 1 Encephalitis Lethargica 1 Paratyphoid Fever 1 DIPHTHERIA. During the year, seven notifications of this disease were confirmed. This figure is the same as for 1946. There were I am happy to say no deaths. From the beginning of the war, an increasing number of people became conscious of the value of immunisation and in 1942 a big national campaign made the people of this country still further conscious of the value of this measure. We have now reached a stage in this Borough when the total elimination of this disease seems imminent, but there are still far too many parents who refuse this life saving measure. One of the difficulties is that when the disease was raging all round the people of Barking they did not need to be convinced of the dangers of the Page 29 THE HEALTH OF BARKING disease although they were far from being convinced of the value of immunisation in preventing it. Now something like the reverse is true, the local public are on the whole well convinced of the powers of immunisation but are less alive to the dangers of the disease. Out of a population of 18,970 children, under the age of 15 years, in the Borough, 12,563 or 66.3% had been immunised at the end of 1947. SCARLET FEVER. This is a disease which for reasons unknown, if not unguessed at, varies periodically in its severity. Young adults today think of it as mild, their parents as severe and their grandparents as mild again. Although mild in its manifestation today the position must be watched because it may once more become severe. The sulpha-group of drugs and penicillin are particularly suited to the treatment of this disease. WHOOPING COUGH. This disease is peculiar in being particularly common in infants and, of course, it can be deadly. Thus it should be noted that in Barking, although its incidence is less than that of measles, it nevertheless killed four times as many children as measles in 1947. Although its value is not yet fully established, protective immunisation against whooping cough is carried out in Barking. These inoculations have given a little trouble but careful attention to the required technique has eliminated most reactions. There were 203 cases notified during the year but the natural fluctuations in the incidence of the disease from year to year are such that the small decline over the figure for last year when there were 243 cases cannot be ascribed with confidence to immunisation. MEASLES. In Day Nurseries from time to time outbreaks of measles occur and it would be of the greatest help, both administratively and having regard to the welfare ot the children, if passive protection could be carried out. Such protection is simple and safe to give but it is virtually impossible to obtain the necessary material. It is to be hoped that supplies of serum for the temporary protection of children against measles, since permanent protection is not yet possible for technical reasons, should be made available on a much wider scale than is the case at the present time. Measles is unfortunately a condition where the maximum infectivity is in the short period between the onset of cold-like symptoms and the blossoming forth ot the full rash. Any technique allowing us to make a diagnosis in this short but dangerous period would be most welcome since it might then be possible to isolate Page 30 THE HEALTH OF BARKING the infected child at the only time when isolation is really effective. In this connection, I understand that photographic plates may be sensitive to changes in the skin before such changes become apparent to the naked eye. PNEUMONIA. There were 57 notifications of all forms of pneumonia during the year. Notifications of this disease are probably not an accurate guide to its prevalence since the value of its notification is not very clear to the medical practitioner. INFANTILE PARALYSIS. The summer and autumn of 1947 was marked by the severest epidemic of infantile paralysis recorded in this country. In Barking, six cases were confirmed and amongst these were two deaths. This incidence cannot be held to be heavy when compared with the rest of the country as a whole. Following notification, a visit was paid to every patient's household ; sometimes it became necessary to advise close contacts, as a result of such visits, of the possible danger to the public of their continuing their business for a while. This outbreak is thought to be associated with a widespread and silent carrier epidemic. There is evidence that for each person who develops the full disease there are many who harbour the germ for a while and who are capable of transmitting it to others. Add to this a second factor that Barking is part of the continuous urban stretch reaching to the heart of London and thousands of its citizens leave the borough daily to work outside and it will be seen that however carefully and conscientiously cases are followed up and contacts traced it is very difficult to spot the likely source of infection. Your Health Department played a part in collecting evidence as to the causation of this disease for Dr. McFarlan of Cambridge who is conducting an elaborate investigation on behalf of the Ministry of Health. Amongst the measures taken to check the spread of infantile paralysis in the borough was a high level of chlorination of the water in local swimming baths; the closure of children's paddling pools, and measures generally to prevent large gatherings of children. It was not thought desirable to close schools generally. TUBERCULOSIS. From Table XV in Appendix C, it will be noted that 171 notifications of all forms of tuberculosis were received during the year. Of this total, 156 were of the longs (pulmonary) and 15 of other parts of the body (non-pulmonary). Included in these figures are 49 cases who have removed into the district, of which four were old cases returning to Barking. Page 31 THE HEALTH OF BARKING During 1947 there were 56 deaths from tuberculosis, 51 being pulmonary and 5 non-pulmonary. During the year negotiations initiated by the Essex County Council were completed for the transference of the Tuberculosis Dispensary from 37 Linton Road to the Barking Hospital, where a part of Lister Ward will be taken over for this purpose. Mass Radiography. At the end of the year a survey was conducted in Barking by the Mass Radiography Unit of the Essex County Council and 7,355 persons were examined. Of this number no less than 6,875 were found to have normal films, which means there were 480 cases not in all respects normal. Of this 480, 263 were suffering from tubercle of the chest of some kind or another, but again of this number 247 cases were inactive, which means that some 16 cases were found to have active lesions. In a survey of this nature it is difficult to deduce quite clearly the position of the people of Barking as such, because many firms were encouraged, quite properly, to send up to the Unit employees who did not live in Barking. Further, in the cases of two large firms, each employing a considerable number of people of whom only a proportion live in Barking, surveys were actually carried out in the works and the results of such surveys are not included in the figures quoted above. It is, however, possible to come to some general conclusions, the most important of which perhaps is that it would appear the position in Barking is about average and that whilst one cannot regard the situation as other than serious, there is no need for undue anxiety in Barking compared with other places. VENEREAL DISEASES. The Essex County Council is responsible for this service. Treatment facilities are provided at General Hospitals, including the County Hospital at Oldchurch and the London Hospital (Turner Street Clinic). Page 32 THE HEALTH OF BARKING SECTION D ENVIRONMENTAL HEALTH SERVICES. (A) SANITARY CIRCUMSTANCES OF THE AREA. CLIMATIC CONDITIONS. The climatic conditions of the area will be remembered by residents for the long spell of severe and cold weather which continued from 4th December, 1946, until the end of March, 1947. During this period frost persisted, snow fell on no less than 20 days. Fortunately the summer was sunny and the rainfall over the rest of the year totalled 15.92 inches, compared with 24.5 inches for the previous year. Notwithstanding the heavy snowfalls, the amount of flooding when the warmer weather came was relatively slight, affecting some houses in the vicinity of the Barking Park Pool and the arm of the Loxford Water. WATER SUPPLY. The whole of the water supplied to domestic dwellings is drawn from the main supply of the South Essex Waterworks. All the samples submitted, monthly for bacteriological examination and quarterly for chemical examination, have been found to be pure and wholesome. The following is an extract of the information forwarded to the Ministry of Health in relation to the bore holes of industrial supplies drawn from wells :— "Excluding the works of the Metropolitan Water Board at London Road, there are eight wells in use situated at the industrial premises listed below, with a total pumping capacity of 837,000 gallons per day. In addition, there are five wells, also situated at industrial premises, which have been sealed satisfactorily and are now out of use. A well at the factory premises of Ibbetson and Co., River Road, is temporarily sealed only and can produce 480,000 gallons per day. Page 33 THE HEALTH OF BARKING Bacteriological and chemical examinations of the well supplies in use have been made and in all cases the supplies have been found to be of satisfactory organic quality and bacteriological purity and to be soft in character. Situation of Wells Type Estimated yield in gallons per day W. Warne & Co., Ltd., Abbey Road: (No. 1) Deep 216,000 (No. 2) Deep 84,000 Sherwood Paints Ltd., Jenkins Lane: (No. 1) Deep 144,000 (No. 2) Deep 85,000 Acme Flooring & Paving Co. Ltd., River Road: (No. 1) Deep 40,000 Chemical Supply Ltd., Abbey Road: (No. 1) Deep 48,000 (No. 2) Deep 100,000 Cape Asbestos Co., Ltd., Harts Lane: (No. 1) Deep 120,000" DRAINAGE AND SEWERAGE. Apart from the premises mentioned below, 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 is controlled by the Ilford and Barking Joint Sewerage Committee who have a pumping station within the Borough. The attention of the Highways and Building Plans Committee of the Council was drawn to the establishment along the frontage of Ripple Road at Rippleside of a number of small one-man businesses in which sanitary accommodation consisted of a pail closet or was non-existent. The present decision of the Council provides for all these premises to be supplied with a chemical closet for a period of two years, i.e. until the future planning of this particular portion of the district has been settled. The total number of premises unconnected with the sewer is now 20. RIVERS AND STREAMS. On page 40 of my Annual Report for 1946, I referred to the conditions in the district. At the end of 1947, the position remains the same. Negotiations proceeded throughout the year with the chemical manufactures whose premises abut Victoria Road and which were referred to in my previous Page 34 THE HEALTH OF BARKING Report. Owing to the difficulties met with in the supply of steel and building materials the offending chemical process was still operating at the end of the year. In addition, delay was increased by the proposals of the River Roding Catchment Board for major reconstruction of the Loxford Arm. The relation of the floor levels of the houses in Victoria Road to the height of the sub-soil water is such that relief for the occupiers can only be provided by filling in the sub-floor spaces and raising the general level of the back land within the curtilage of the premises. Further progress in this direction I believe will be achieved in the near future. PUBLIC CLEANSING. During the year 8,580 loads of refuse were collected with an average weight of 2.25 tons per load. In my Annual Report for 1946, I dealt at some length with the question of cleansing dustbins. I regard the removal of offensive matter from the precincts of an occupied dwelling as a primary requisite of all public health work. It is also important that the offensive material should be disposed of finally by a sanitary operation. The present arrangement in Barking is for the whole of the domestic refuse to be discharged on low lying land which is being reclaimed for the construction of playing fields. In this work the Council is to be commended because if carried out in a sanitary manner, it is work of practical value. Whilst it is true that the most important aspect of public cleansing relates to the removal of offensive matter from the precincts of houses, much useful work is carried out by the cleansing of streets by the removal of trade waste from shops, canteens and factories. There is need for improvement in Barking in the present method of dealing with what is generically described as ' trade refuse.' The fact that this is a service for which the user must pay a fee acts as a deterrent and consequently is less efficient in operation. As your Medical Officer, I advocate the same service for the removal of trade waste, consisting of organic matter, as I do for domestic refuse. If the present system of removal prevents shop-keepers and other traders using the service freely then such changes as are necessary in the operation of the service should be made. The streets of the town are kept in a noticeable clean condition but in a town like Barking where there are so few features worthy of attention by the passer-by, much could be achieved in dispelling gloom by the painting of street furniture, such as kiosks, litter bins, lighting columns, etc. in fresh and bright colours. I have noted too with pleasure in some of our adjoining boroughs tasteful gardens laid out at road junctions with ornamental seats upon which some of the older residents sit and meditate. Anything which tends to beautify and add colour to the ordinary life makes its contribution to the public health. Secondary Streets. Shortly before the war a programme was drawn up which scheduled for early paving and drainage a number of the access passages at the rear of terraced houses, built about 50 years ago and mostly in Gascoigne Ward. Page 35 THE HEALTH OF BARKING Unfortunately this work has not been commenced. I regard the paving, drainage and lighting of these streets as a matter likely to contribute to the general well-being of the town and commend it to the early attention of the Council. Wherever a passage is used in common by a number of occupiers sanitary conditions can only be achieved when such passage is controlled by the Council. REFUSE DISPOSAL. Refuse Tips—Privately Controlled. The fact that there are extensive areas of low lying land is an invitation to private contractors to take such land for the purpose of tipping. This work creates serious nuisance unless it is well planned and controlled. Where the land is being reclaimed by the owner it is usual for greater interest to be taken in the type of filling and the general level of the filling material but where the land is rented by the contractor, such contractor has little regard for the ultimate condition and is opposed to any control work. In such circumstances, tips so constructed require the constant care and attention of your sanitary inspectors. There is an area, at present being developed, on the north bank of the River Roding and another area north of the Tilbury Railway at Rippleside. Both sites are being filled with material brought into the district and the land is therefore subject to the operation of the Essex County Council Act, 1933. It is necessary that such land should be filled and the level raised in order to make it more suitable for use but this will only be secured by constant supervision. ERADICATION OF BED BUGS. In another part of my Report I referred to the general housing position in the district. Examination of this report will show that the general sanitary conditions existing are such that it should not be difficult for the average householder to keep his house free from vermin. Such difficulties that do exist, however, have been aggravated by the increased density of persons living in each house and the problems associated with dual occupation. Whilst there has been an increase in the number of cases reported, such increase has not been significant and the facilities available, free to householders, have been adequate for the demand. The Housing Manager reports that in connection with Barking Corporation houses the number of premises found infested and treated was 40. The method of treatment provides for the use of insecticide containing DDT. In the present acute house shortage there is serious difficulty in using hydrocyanic gas. ATMOSPHERIC POLLUTION. At the end of 1947, the proposed extension of the generating station of the County of London Electric Supply Company, Creekmouth, did not proceed sufficiently for new furnaces to be in operation. In consequence the expected improvement in the operation of the existing furnaces was not achieved. Page 36 THE HEALTH OF BARKING A summary of the boiler installations in the district and the likely causes of atmospheric pollution are set out below:— Nature of Industry, etc. No. of Chimneys. Public Utility Undertakings:— Electricity 17 Gas Water Chemical Industries 26 Wood Processing Factories 8 Metallurgical Furnaces 4 General Manufacturing 10 Central Heating (Schools and Hospitals) 17 Commercial Buildings 3 Total 85 You did agree during the year to the setting up of three observation stations for the measurement of atmospheric pollution. These stations are to be sited at Barking Park, Greatfields Park and Parsloes Park. Arrangements have been made for the supply of the necessary apparatus and for the chemical examination of the deposits. When the results of such examinations are known more authoritative statements can be made as to the condition of Barking air. Barking has long been known as a town where offensive trades of varied character have been established but owing to the absence of town planning control little could be effected to prevent any increase. In addition to the scheduled offensive trades mentioned in the Public Health Act, 1936, we have a number of factory premises where chemical processes registerable under the Alkali Works Act are carried out and a small number of other premises controlled by special byelaws. With industries of this type it is inevitable that there must be at one time or another complaints of offensive emissions and the discharge of grit and gritty particles from chimneys. This has been true of the year 1947 and the Department has spent a significant number of man-hours in making observations and visits to offending processes. In regard to a factory area in a built up part of the district there are no less than nine chimneys in continuous use for steam generation. These chimneys can emit black smoke for an aggregate period of 18 minutes in every 30 without contravening Page 37 S THE HEALTH OF BARKING the byelaw. Such an emission has demoralising effects on the residents in the area and is a constant source of irritation. Owing to the development of the river frontage for timber storage and processing, the use of wood waste as a fuel for steam generation is a common practice. Unless the furnaces are specially designed and the operatives skilled, the burning of this waste can cause serious nuisance. Complaints were received in respect of a furnace consuming wood waste and, although the Ministry of Fuel and Power were called in, the operation continued to offend. There is a conflict of opinion between the Management of the firm in question and the Ministry of Fuel and Power, in that the Ministry charge the Management with neglect of furnace operation and the Management contend that the supply of graded fuel is necessary for furnace improvement. In such case the solution appears to require a Court of Summary Jurisdiction to arbitrate. It is necessary, however, to realise that to remedy any smoke nuisance a factory occupier is faced with many practical difficulties outside his control. It is fitting, therefore, that a local authority should assist wherever possible when the offender is willing to be helped—this I know is your wish. RATS AND MICE DESTRUCTION ACT, 1919, AND INFESTATION ORDER, 1943. The disinfestation of sewers throughout the known infested area of the Borough was carried out in the months of June and December. The treatments were in progress over a period of six days and the results showed cause for satisfaction. In connection with the general surface infestation, you appointed two operatives and two investigators for a period of nine months for the purpose of carrying out a survey and disinfestation of the scheduled area, including private dwellings, factories, business premises, refuse tips and open spaces. The Borough was divided into seven areas with sub-sections and the whole of the Borough was systematically surveyed by the investigators who preceded the operatives and advised them of their findings. The following is a summary ot the investigations and treatments which took place during the period 1st January to the 30th September:— Suspected Premises Surveyed 6,841 Premises Infested 1,115 Premises Treated 1,115 Bodies Found 446 Estimated Kill 4,048 I must express my appreciation of the cordial co-operation of the managements of the many factories and business premises in the town, which added considerably Page 38 THE HEALTH OF BARKING to the success of the operation. It was found that the Rodent Service scheme which the Council inaugurated for the assistance of occupiers of industrial and commercial premises was welcomed. The charge made by the Corporation for this Service was at the rate of 3s. 3d. per man-hour. During the year the Infestation Control Division of the Ministry of Food was transferred to the Ministry of Agriculture and Fisheries. SWIMMING BATHS AND POOLS. The facilities in the district for swimming are inadequate and the Council looks forward to the early consideration of the model bathing station for which plans were completed before the outbreak of war. Open Air Pool. The Report of the Baths Superintendent for the Season 1947 in relation to the swimming pool at Longbridge Road shows that over 109,000 bathers attended—this represents an increase of 44,000 over the previous year's total. In addition to these bathers, no less than 17,000 people were present as spectators and therefore benefited by exposure to the sunshine. The peak day was the 1st June when 4,846 bathers were recorded. The capacity of the bath is 500,000 gallons and the total water used during the season was 4,547,600 gallons. Thirteen examinations were made of the water in the bath and reported upon by the public analyst as being satisfactory. In connection with school classes, 10,104 children attended and of these 726 qualified for swimming certificates during the year. It is indicative of the times in which we live that although the cafe facilities are not those of the most modern establishment, no less than 21,000 meals were served. Owing to the infantile paralysis outbreak, it was considered desirable to cancel competitive events and accordingly all school galas ceased. Children were, however, allowed to continue their swimming lessons with the results mentioned. Swimming Bath, South-East Essex County Technical College. This bath continued in use throughout the year and a constant check is made by sampling. The results showed that at no time was the water unfit for bathing. East Street Swimming Bath. The covered swimming bath was open during the summer months and during this period was attended by 52,334 bathers. The operation of this bath is associated with the slipper baths which were used by 50,000 persons. This bathing establishment was constructed in 1898 and in its general scope is inadequate for present needs or varied enough in the facilities it offers to meet the present day practice. I cannot leave the use of swimming baths without referring to the need for school children to be practised in the duty of using the lavatories before entering Page 39 THE HEALTH OF BARKING the bath. Some of the difficulties met with during the year in keeping the water in a satisfactory condition have arisen from the neglect of this hygienic practice. FACTORIES ACT, 1937. In Appendix D will be found statistics in relation to the administration of this Act. SANITARY INSPECTION OF THE AREA. During the year every endeavour has been made to establish the sanitary inspection of the area at the pre-war level of efficiency. Good progress was made in this direction but we were still unable to carry out the schedule drawn up. This was in part due to the number of sanitary inspectors being two below establishment. In addition, there continued throughout the year a shortage of building labour and materials, preventing the repair work which had become so necessary after the war years with the consequent decay arising from excessive room occupation. The need for permits to carry out this or that item of work absorbed time and energy often resulting in irritation and frustration. Where repairs were achieved the work was done always after a battle of opposing forces. Two years after the end of the war housewives reasonably expected the worst discomforts of housing accommodation to have been removed, and it is easy to understand the irritation felt when the ordinary minor repairs and redecorations which so appreciably affect the life of the housewife could not be carried out. Such defects as exist have been emphasised because so often the occupier of the house must again suffer the occupation by workmen to make good, in some instances for a second or third time, work which had been inadequately attempted under that general description of war damage repairs.' In blitzed areas, such as Barking, the twin discomforts of overcrowding and war damage repairs have made a heavy drain upon the nervous and physical strength of the women of the household. In an effort to make the lives of the Barking tenants more cheerful wherever substantial repairs and redecorations could be effected everything was done towards this end Not only was this process in operation in the homes but also in all public buildingspicture-dromes, public houses, clubs, shops and canteens. At the end of the year an improvement was noticeable but at the present rate of progress it is expected that at least another two years will elapse before conditions become normal. Statistics in relation to the work of the Sanitary Inspectors are given in Appendix D. (B) HOUSING. STATISTICS. Your Chief Sanitary Inspector, who is Rehousing Officer for the Borough has supplied the statistics, to be found in Appendix E, which show the detailed position in the Borough at the end of the year. Page 40 THE HEALTH OF BARKING An interior view of a post-war house. POST-WAR HOUSING. The statistics relating to new building tell you the number of new dwellings which have been provided during the year, namely 490. The fact that the work of rehousing is carried out in the Public Health Department enables me to be better informed of the position than if the work Page 41 THE HEALTH OF BARKING Post-war houses—Mayesbrook Estate. was discharged elsewhere. The allocation of accommodation is decided, as is well known, on the basis of a points scheme which gives due regard to the public health aspects of the housing problem and it is proper, therefore, that the operation of such a scheme should be by public health officers. Throughout the year I have been visited by families in desperate need and have been consulted as to the award of special points for medical reasons. I know it is necessary to have regard to all aspects of the housing problem and in particular to the claims of those families who have been long in residence in the district; I cannot, however, as your medical officer overlook the fact that the present requirements in respect of residence qualification does in a number of cases operate harshly. It will be noted that whilst the number of new units of accommodation available have been small compared with the number required, headway was made in the reduction of overcrowding by using each new unit of accommodation to serve the needs of three families by operating an extensive system of transfers. This exchange of accommodation between large, small and medium sized families was not only effected amongst Council tenants but, with the co-operation of private owners, amongst tenants of privately owned dwellings also. Page 42 THE HEALTH OF BARKING CLEARANCE AREAS AND REHOUSING. The period 1926 to 1938 saw the commencement and completion of schemes providing for the demolition of 615 properties and the consequent rehousing of approximately 2,949 persons. In addition, confirming orders were made in respect of 142 properties but, owing to the outbreak of war, action was suspended and the properties remain occupied. The total of unfit properties demolished includes a number of houses destroyed by enemy action. There were also 38 individual unfit houses dealt with, from which 201 persons were rehoused. HUTTED CAMPS. The total number of families remaining in occupation of temporary dwellings in hutted camps and on gun sites throughout the year was 118. In the majority of cases these families have been in occupation since August, 1946. These temporary dwellings, though occupied, deteriorated and raised new problems of maintenance, especially as Nissen huts could not be repaired. At the end of the year a contractor who had been authorised to reconstruct the defective huts had been unable to secure the materials with which to carry out the work, as the asbestos sheets needed to provide a new outer skin to the Nissen huts was not obtainable. The drainage and other domestic conveniences were maintained in a satisfactory condition. (C) INSPECTION AND SUPERVISION OF FOOD. MILK SUPPLY. Th ere are no cowkeepers in the district and we have no dairies where milk is handled or treated. Th ere are 28 premises on the register for the retail of pre-packed supplies. In addition, there arc 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. Page 43 THE HEALTH OF BARKING There were, during the year, 60 samples of milk submitted to biological examination for the presence of tubercle. In three 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 10 FOOD HYGIENE. Unsound Food. In Appendix F, a table is given showing the total quantity of food condemned. During the war years, the meals habits of the people underwent a revolutionary change. No longer does the breadwinner return home for the midday meal or take his food for such meal with him from the home. A survey of the catering services in the Borough shows the distribution to be as follows:— School Meals Service 9 kitchens Factory Canteens 40 kitchens Licensed Houses 11 kitchens Dining Rooms 56 Food Manufacturing Premises 31 General Food Shops 131 Street Food Stalls:— Sweets 3 Packed Foods 6 Greengrocery 14 Fish 8 Fishmongers 25 (including 17 fryers Ice Cream:— Vendors 70 Manufacturers 4 Sweet Shops 75 Bakehouses 10 Butchers 46 (Horseflesh 1) The term conservation of food used in its widest sense includes any action taken to prevent contamination and spoilage and this work has become the primay function of your sanitary inspectors engaged upon food hygiene. The analytical examinations carried out by the public analyst show that metallic contamination is nowadays fairly rare but there has been an increase in the sickness due to food Page 44 THE HEALTH OF BARKING handling because of the greater communal feeding taking place. To avoid any extension, and to bring about a reduction of such food poisoning by bacteria, a campaign was started to reduce contamination due to the lack of cleanliness. The need for cleanliness and the need for strict personal hygiene was strongly emphasised. FOOD AND DRUGS ACT, 1938—SAMPLING. During the year, your authorised officers have submitted a total of 308 samples for examination. Details of these samples are given in Appendix F in tabular form. It is indicative of the value of publicity on health matters that the public frequently bring to the notice of the Department any food and sometimes cooking utensils, felt to be harmful to the individual, with a view to examination by the analyst. Under this heading we submitted steam pudding mixtures, baby food, an aluminium bowl and peppermint chocolates. Our attention was also called to the sale of mineral oil intended for frying purposes. The report of the analyst on this material showed it to be liquid paraffin. The fact that the sale of any form of oil is so easily made shows only too clearly that the resources of the housewife have been reduced to the last extremity in the matter of frying fat. This is further emphasised when one knows that the price of the oil ranges between four and eight shillings per pint. Ice Cream. During the year a deputation from the Local Food Executive Committee waited upon the Parliamentary Secretary to the Ministry of Food with respect to the chemical quality of ice cream with a view to the institution of controlled prices. Evidence by the Department showed that pre-war the large manufacturer was able to provide ice cream with a fat content so rich as 14% and retailed this product in wafer form at a price of 3d., having a thickness of from 5/6" to ¾" and with a coating of chocolate or at 2d. without any coating, whereas at present the ice cream produced by the large bulk manufacturers contained from 8 to 10 per cent. fat and that of the small producer retailers contained from 1 to 4 per cent. (sometimes lev than 1 per cent.) of fat, but with a large proportion of farinaceous material, chiefly wheaten in origin. As the price of both qualities is uncontrolled, it would appear that the general public is paying excessive prices for the inferior article. It is suggested, therefore, that the products should be divided into two groups (1) Ice Cream (over 8 per cent. fat) and (2) Water Ice (under 2 per cent. fat), both of which would need to be legally defined. Smoked Herring Spread. On bacteriological examination a tin of this material was found to contain a large number of micro-organisms showing that the contents of the tin were not sterile. Appropriate action was taken and in consequence it was found necessary by the London Packers to call in the bulk of this material which had been distributed nationally. Page 45 THE HEALTH OF BARKING FOOD POISONING. Only two cases of food poisoning were notified during the year, but I do not feel that this represents the whole of the persons affected. With more general recognition by the public of the causes of minor diarrhoea and sickness, more action can be taken towards prevention and control. STREET TRADING. The demand for increase in food supplies has been emphasised in Barking by the inadequate number of retail shops sited on the London County Council Estate. Owing to the shortage of" off ration " foods the Council decided to allow trading from street stalls to commence. This departure from the normal practice in Barking was undertaken reluctantly and arose from the insistent demand of the consumer residents. It is not suggested that even with the strict operation of the Street Trading Bye-laws the same standard of hygiene can be maintained as in established shops. I look forward to the time when available food supplies distributed from the established shops will be sufficient for all purposes. FOOD MARKETS. There are two covered markets established in the district in which the majority of the shops retail food. The sanitary conveniences and washing facilities are provided in a unit building for use by the whole of the traders. This is not ideal, but under the present legislation must be accepted. Our aim is to secure the provision of sanitary accommodation and washing facilities immediately available to all food retailing premises. 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.1, 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 Analyst is Dr. J. H. Hamence, Peak House, Eastcheap, London, E.C. Page 46 THE HEALTH OF BARKING APPENDIX A. STATISTICAL AND SOCIAL CONDITIONS OF THE AREA. TABLE I DEATHS (NET)—1947 Causes and Totals. Causes of Death. Total. Enteric Fever — Cerebro-sninal Fever 2 Scarlet Fever – Whooping Cough 4 Diphtheria – Pulmonay Tuberculosis 51 Non-Pulmonary Tuberculosis 5 Syphilitic Diseases 5 Influenza 3 Measles 1 Acute Polipmyelitis and Polio-encephalitis 2 Acute In Encephalitis 2 Cancer (all forms) 122 Diabetes 5 Intra-cranial Vascular Lesions 56 Heart Diseases 155 Other Diseases of Circulatory System 19 Bronchitis 61 Pneumonia 27 Other Respiratory Diseases 11 Ulcer of Stomach or Duodenum 6 Diarrhoea under 2 years) 5 Appendicitis 5 Other Digestive Diseases 13 Nephritis 15 Maternal Causes – Prematura 15 Congenita Malformation, Birth Injury, Infantile Diseases 25 Suicide 2 Road Traffic Accidents 10 Other Violent Causes 11 All Other Causes 39 Total 677 Page 47 THE HEALTH OF BARKING TABLE II 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 1947 31.35 47 41 Page 48 k THE HEALTH OF BARKING TABLE III INFANTILE MORTALITY—1947. 0-1 mth. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under 1 year. Acute Cerebrospinal Fever — — 1 — — 1 Atelectasis 5 — — — — 5 Broncho-pneumonia 3 2 2 5 — 12 Cerebral Haemorrhage 2 — — — — 2 Cerebral Thrombosis — — — 1 — 1 Congenital Malformations 6 3 1 — — 10 Enteritis and Diarrhoea — 1 — 2 — 3 Haemolytic Disease 1 — — — — 1 Intestinal Obstruction — — 2 — — 2 Lobar Pneumonia — 1 — — — 1 Myocardial Degeneration — — 1 — — 1 Poliomyelitis — — — 1 — 1 Prematurity 16 — — — — 16 Pulmonary Congestion — 1 — — — 1 Tuberculosis — — — — 1 1 Totals 33 8 7 9 1 58 TABLE IV NEO-NATAL MORTALITY—1947. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total. Atelectasis 5 — — — 5 Broncho-pneumonia 1 1 — 1 3 Congenital Malformations 3 2 1 — 6 Cerebral Haemorrhage 2 — — 2 Haemolytic Disease 1 — — — 1 Prematurity 15 1 — — 16 Totals 27 4 1 1 33 Page 49 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 1947 No. °/ /o No. 0/ /o No. 0/ /o No. °/ /o No. % No. % No. 0/ /o No. O/ /O DISTRICT :— Doctor and Midwife 62 6.4 24 2-5 44 3-7 26 2.1 27 2.2 15 i-3 49 3-1 46 2.6 Midwife 411 42.4 307 32.2 417 35-0 477 39-5 454 37-1 47i 42.5 713 45-4 909 52.3 INSTITUTIONAL Upney Hospital 454 46.9 424 44-5 469 39-4 508 42.1 488 39-5 476 43.0 767 48.8 74i 42.7 Evacuated 4i 4-3 197 20.8 258 21.9 195 16.3 255 20.9 145 13.2 41 2.7 42 2.4 Total 495 51.2 621 65.3 728 61.3 703 58.4 743 60.7 621 56.2 808 5i-5 783 45.1 TOTAL 968 100.0 952 100.0 1,189 100.0 1,206 100.0 1,224 100.0 1,107 100.0 1.57° 100.0 1.738 100.0 Page 50 THE HEALTH OF BARKING TABLE VI ORTHOPAEDIC SERVICE—1947. Toddlers and Adults School Children ATTENDANCES. Primary Examination by Surgeon 112 56 Re-examination by Surgeon 170 154 For treatment 6,003 6,681 Totals 6,285 6,891 TREATMENTS. Number of Cases 894 908 Number of Treatments 10,012 6,681 HOSPITAL TREATMENT. Admissions to Hospitals 2 3 Or Waiting List for Admission — — TABLE VII NEW CASES SEEN BY THE ORTHOPAEDIC SURGEON—1947. Toddlers and Adults School Children DEFORMITIES OF BONES & JOINTS 1. Congenital 8 — 2. Acquired 80 43 MUSCULAR:— 1 Congenital 7 1 2. Acquired 3 5 PARALYSIS 5 2 MISCELLANEOUS 9 4 Page 51 THE HEALTH OF BARKING TABLE VIII EAR, NOSE AND THROAT SERVICE. Mothers & Toddlers Adults— Public Scheme School Children TOTAL Year 1946 Year 1947 Year 1946 Year 1947 Year 1946 Year 1947 Year 1946 Year 1947 Number of Attendances at the Ear, Nose and Throat Clinic 258 309 30 35 897 767 1,185 1,111 Number of cases which received operative treatment 54 41 — — 251 223 305 264 Number of cases which received other forms of treatment 127 151 20 23 236 308 383 482 TABLE IX CHIROPODY SERVICE. Year 1944 Year 1945 Year 1946 Year 1947 1. Treatment Sessions 1,307 1,530 1,755 1,113 2. Total Individual Patients 2,006 2,475 2,649 3,205 3. New Patients 1,233 1,179 1,071 943 4. Total treatments given 8,537 10,222 13,934 10,995 5. Infra-red treatments (included in 4) 578 595 641 558 Page 52 THE HEALTH OF BARKING TABLE X SKIN CLINIC. Consultations. Treatments. Year 1946 Year 1947 Year 1946 Year 1947 Sessions 47 52 100 104 Attendances :— Children under 5 years 212 238 472 643 Children 5-15 years 351 467 1,505 1,785 Ante Natal and Post Natal Cases 191 198 358 460 Other categories (including Public Adult Scheme) 184 126 325 292 TABLE XI SCABIES New Cases Recurring Cases TOTAL Year 1946 Year 1947 Year 1946 Year 1947 Year 1946 Year 1947 Total number of patients 662 277 49 10 711 287 Adults 357 140 18 1 375 141 Children 305 137 31 9 336 146 Referred from:— Clinics 267 139 25 9 292 148 Other sources 395 138 24 1 419 139 Number of cases cleansed at the Barking Hospital:— Adults 233 96 15 1 248 97 Children 273 124 30 9 303 133 Page 53 THE HEALTH OF BARKING TABLE XII OPHTHALMIC SERVICE. Treatment of Defective Vision. Mothers & Toddlers Adults— Public Scheme School Children TOTAL Year 1946 Year 1947 Year 1946 Year 1947 Year 1946 Year 1947 Year 1946 Year 1947 Errors of Refraction, etc. requiring treatment 215 243 407 410 794 749 1,416 1,402 Number for whom spectacles were:— (a) Prescribed 93 102 298 290 492 414 883 806 (i) Obtained 36 65 236 251 600 503 872 819 TABLE XIII OPHTHALMIC SERVICE. Squint Training. Year 1946 Year 1947 Number of Sessions 91 76 Number of Children Attended 26 81 Number of New Cases 9 55 Number of Old Cases 17 26 Number of Attendances 582 416 Number Discharged—Cured 2 — Number Left School — — Number Discontinued 2 1 Page 54 THE HEALTH OF BARKING TABLE XIV DENTAL SERVICE—1947. Mothers & Toddlers Adults— Public Scheme School Children TOTAL Number of patients treated 1,583 2,868 2,548 6,999 Attendances for treatment 3,888 9,724 10,511 24,123 Extractions 2,200 7,537 6,769 16,506 Administrations of Gas 609 1,649 3,089 5,347 Fillings 764 1,453 4,997 7,214 Other Operations 2,249 7,782 2,873 12,904 Dentures supplied 199 1,186 54 1,439 Sessions (equivalent of) 294 772 966 2,032 Page 55 THE HEALTH OF BARKING APPENDIX C. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. TABLE XV NOTIFICATION OF TUBERCULOSIS—1947. New Cases Notified TOTAL Pulmonary N on-Pulmonary M. F. M. F. Under 1 year 1 — — — 1 1 to 5 years 1 — — 1 18 5 to 15 years 8 5 3 2 15 to 25 years 23 33 4 3 63 25 to 35 years 23 13 2 1 39 35 to 45 years 9 13 — — 22 45 to 55 years 8 7 — — 15 55 to 65 years 9 1 — — 10 65 years and upwards 1 1 — — 2 Totals 82 74 9 6 171 Page 56 THE HEALTH OF BARKING APPENDIX D. ENVIRONMENTAL HEALTH SERVICES. (A) SANITARY INSPECTION. (i) In pection of Dwelling-Houses. Total Houses inspected under Public Health or Housing Acts 4,342 Total Number of Inspections made 10,662 After Infectious Disease and Scabies 667 Overcrowd ;d Premises 658 Defects Found 2,540 Notices Served (Preliminary) 1,458 Re-inspections re Notices Served 4,951 Inspection of Work in Progress 1,300 (ii) Premises Controlled by Bye-laws and Regulations. Inspections. Contraventions. Notices served. Offensive Trades 34 28 13 Tents, Vans , Sheds and Fairgrounds 7 1 1 Dairies, Cowsheds and Milkshops 7 7 4 Hairdressrs' and Barbers' Premises 38 10 7 Smoke Observations 35 7 7 (iii) Miscellaneous. Inspections. Defects. Notices. Bakehouse 16 10 3 Butchers' Premises 103 49 33 Drainage Inspections 172 318 60 Fishmongers 58 33 19 Food and Drugs Act, 1938 613 171 102 Food Sampling 308 — — Ice Cream Vendors 108 37 23 Page 57 THE HEALTH OF BARKING  Inspection. Defects. Notices. Milk Sampling 122 — — Other Miscellaneous 201 7 2 Piggeries 14 — — Public Lavatories 32 1 — Rats and Mice (Destruction) Act, 1919 237 46 40 Restaurants, Dining Rooms and Canteens 86 69 31 Schools 44 — — Shops Act, 1934, and Markets 357 117 65 Stables and Stable Yards 16 — — Street Traders 150 2 1 Vacant Land and Refuse Tips 47 1 1 Watercourses 2 1 1 Water Sampling 62 — — (iv) Notices Served. Informal Notices 1,458 Statutory Notices:— Public Health Act, 1936: Section 39 26 Section 45 57 Section 83 — Section 93 256 Housing Act, 1936: Sections 9 and 10 37 Section 24 — Section 32 — Dustbins: Public Health Act, 1936 : Section 75 (3) 836 Total 1,212 Page 58 THE HEALTH OF BARKING (B) FACTORIES ACT, 1937. 1.—.Inspections for purposes of provisions as to health (including inspections made by Sanitary Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 77 32 3 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 157 85 26 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) — — — — Total 234 117 29 — 2.—Cases in which Defects were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.1) — — — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 1 — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient 8 — — 1 — (b) Unsuitable or defective 16 1 — 2 — (c) Net separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) 11 6 — — — Total 36 7 — 3 — Page 59 THE HEALTH OF BARKING OUTWORK. Section 110: Number of out-workers in August List required by Section no (i) (c) 135 Nature of work carried out by out-workers:— Making of wearing apparel 114 Cleaning and washing of wearing apparel 1 Umbrellas, etc. 1 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 7 Brush making 1 Cosaques, Christmas Crackers, Christmas Stockings, etc. 11 Number of cases of default in sending in lists to the Council Nil Section III:— Number of instances of work in unwholesome premises Nil Number of notices served Nil Number of prosecutions in respect of out-workers' premises Nil (C) HOUSING (a) General. (i) Number of dwellings provided in Barking during 1947:— By the Barking Corporation: New houses 57 Rebuilt houses 18 Prefabricated bungalows 127 Total 202 By the London County Council: Rebuilt houses 62 Prefabricated bungalows 205 Total 267 By Private Enterprise: New houses 17 Rebuilt houses 4 Total dwellings provided 490 Page 60 THE HEALTH OF BARKING (ii) Number of applications for rehousing outstanding at 31st December, 1947 3,370 (iii) Number of dwellings provided in Barking since the war:— By the Barking Corporation: New permanent houses 73 Prefabricated bungalows 285 Rebuilt houses 21 St. Paul's Flats (Conversion of Civil Defence Depot) 11 Hutments for homeless 50 Requisitioned properties 428 Rebuilt requisitioned properties 12 880 By the London County Council: Rebuilt houses 168 Prefabricated bungalows 297 465 By Private Enterprise: New houses 17 Rebuilt houses 5 22 (iv) Post-war housing programme of the Barking Corporation:— Prefabricated bungalows 285 (all erected and let) New permanent dwellings 773 (73 erected and let) Rebuilding of properties 63 (21 erected and let) Rebuilding of requisitioned properties 12 (all completed and — let) 1,133 (b) Unfit Dwelling-Houses. I. Inspection of dwelling-houses during the year. (I) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,342 (b) Number of inspections made for the purpose 10,662 Page 61 THE HEALTH OF BARKING (2) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (3) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,572 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 1,164 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 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 45 (b) By local authority in default of owners B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 339 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 246 (b) By local authority in default of owners (c) By local authority on behalf of owners C.—Proceedings under Sections n 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 836 Renewals 337 Total 1,173 Page 62 THE HEALTH OF BARKING (D) INSPECTION AND SUPERVISION OF FOOD. MILK SAMPLES—BACTERIOLOGICAL EXAMINATION—1947. Type of Sample Satisfactory Unsatisfactory Totals "Pasteurised" Milk 32 — 32 Heat Treated — 2 2 Tuberculin Tested Milk 6 6 12 Tuberculin Tested (Pasteurised) Milk 20 — 20 Totals 58 8 66 UNSOUND FOOD CONDEMNED—1947. Bacon 33 lbs. Bread and Flour 185 lbs. Butter 24 lbs. Cheese 398 lbs. Eggs 992 Fish 3,274 lbs. Fruit 173 lbs. Lard 9 lbs. Margarine 28 lbs. Meat 351 lbs. Milk 2,081 tins Preserves 594 lbs. Rabbits 60 lbs. Sauce, Pickles, etc. 80 pints Sugar 41 lbs. Sweets 74 lbs. Various Fillings 1,774 tins, jars, etc. Vegetables 7¾ tons Page 63 THE HEALTH OF BARKING FOOD AND DRUGS ACT, 1938—SAMPLES SUBMITTED FOR EXAMINATION—1947. Baking Powder 3 Beer 2 Beverages (Cocoa, etc.) 9 Bread and Flour 14 Butter 17 Cooking Fat 11 Custard Powder 3 Edible Oil 2 Fish Paste 9 Ice Cream 54 Lard 4 Margarine 16 Medicinal Products 21 Milk 11 Milk Powder 2 Mineral Waters and Cordials 6 Other Provisions 41 Pickles 7 Preserves 25 Pressed Meat 7 Sausages and Sausage Meat 8 Spirits 7 Spices 8 Sweets 8 Vinegar 13 Total 308 Page 64