Bark 42 AC4411 JOHN and MARY THE ANNUAL REPORT FOR THE YEAR 1948 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. TOWN HALL, BARKING, ESSEX November, 1949 To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, We are now nearly half way through a century, a century which so far as health is concerned has been distinguished for the improvements which have been made. This the present century is very different from the latter half of the previous century, when the accent was upon environment, that is, the conditions under which people are living, rather than upon the personal lives of these same people. It is to emphasise the spirit of the present age that I have made this a personal report in which I want to tell you something of the lives of John and Mary, of the problems which they brought to me, and, what is more, of their difficulties and something of their conversations with me. There are thousands and thousands of Johns and Marys in Barking, and it is through this book that I would like to speak to each one of them, and it is to these Johns and Marys that I have dedicated this Report. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Medical Officer of Health The Health of Barking SOCIAL CONDITIONS, STATISTICS AND GENERAL PROVISION OF HEALTH SERVICES. Housing. John and Mary were much in love with one another and as in the case of many other young couples, much could be written of their hopes and dreams and how bravely they faced the world together. For the purposes of this narrative, however, all that I will say is that they were married and when they came back from their honeymoon they went to live with Mary's mother. It was not long before Mary came to the window of the Rehousing Office. She told a tale which is none the less tragic because it is so very common; that she did not get on with her mother as she used to do. Mary felt she had achieved something when she was advised her name was down on the rehousing list and when she was told how many points had been awarded her application; but in the course of the year—and these figures are real for the year 1948—no less than 961 other Johns and Marys came to the Rehousing Office so that the list of families awaiting rehousing had grown by the end of the year to the figure of 3,488 However, Mary soon found out that getting her name on the rehousing list was one thing and having enough points to get a house was quite another. Further, from he information given at the window, she realised there were many families who were not nearly so well placed as she and John were. The next thing we find is that John takes a half day from work to come to the Rehousing Office—he says exactly the same things that Mary has said but in a defin ely more emphatic manner because unless things can be changed his married life is going to start out on the wrong foot. He realises his in-laws are quite nice peop! but it is nevertheless true that he does not get on with them—he has married Mar; not the family. hen Mary comes back and this time she is in great trouble—she is going to have baby. Her mother has said not only is it impossible for her to have the baby >orn at home, but that she cannot see how John and Mary can go on living in thk house after the baby is born. Then comes John once more, and this time, quite frankly, he is in a temper. It is ;uite possible he does not want to be in a bad temper, but the situation at home is going from bad to worse and he has promised his wife that he will make the rehousing people " do something about it." HOUSING APPLICATIONS. Number of names on the waiting list at the beginning of the year 3,370 Number of names added to the list 962 Number of names removed from the list 844 Number of names remaining on the list at the end of the year 3,488 Page 3 The Health of Barking The tragedy of this story is not only that it is so common, but that it is incomplete and space will not suffice for me to tell of all that Mary did and all that John did. They interviewed Councillors, they went here, there and everywhere ; they even wrote to the Member of Parliament, and after they had done all this it was only to find that they can't have a house if the house isn't there. Of course, there are hundreds of people who have had houses and who are very well pleased with the points scheme, and there are hundreds of people who, if they haven't got all they wanted, have got something by moving into the accommodation which has been allocated to them. John put his views on housing before me very strongly indeed, and, although I sympathised with him, I did not envy him his job of going home and talking to Mary about it; in fact to be quite truthful I don't think he told Mary all he had been willing to explain in his conversation with me ! Population. Some people reading this report might almost come to the conclusion that the only people in the town in 1948 were John, Mary and myself, but this, of course, is not so because there were nigh on 80,000 other people as well. This is far too many to permit all these people to believe that they belong to one neighbourhood. As a matter of fact, I was talking over with John and Mary what would be the ideal population of a neighbourhood unit, having regard to the fact that each such unit would certainly want its own Health Centre—incidentally each would want its own infants' school, pub, etc., and, of course, its own youth centre. We were, however, discussing this question primarily from the standpoint of Health Centres. It is quite obvious that the possibility of dividing the town into small neighbourhood units of, say, 5,000 to 10,000 is impracticable not only because the numerous Health Centres required would cost so much money, but because there will never be the man-power available to operate such centres. On the other hand, when you get units of population of 20,000 to 25,000 they constitute sizeable towns, and tend to lose the spirit of neighbourliness. It seemed to us that the ideal compromsie would be to divide such a town as Barking into units of some 15,000 each, that is, there would be five such neighbourhood units in Barking with five Health Centres, one of which would be a super centre and would cater for certain specialist services, which it would not be economic, so far as man-power is concerned, to provide at the other centres. Our talk about population naturally brought up the question of flats and whether if you build flats you can get more people into a town than you can if you give each family a house. The answer is, of course, that if you build your flats high enough you can do what you like with regard to housing a large number of people on a small space, but it is not economical to build this way, I am very happy to say, because such big buildings are expensive, particularly as they Page 4 NEIGHBOURHOOD UNITS FLATS The Health of Barking may have to be fitted with lifts. Again, too, it is important that, in order to get the necessary light and air and general ventilation, blocks of flats should be surrounded by relatively large areas of garden space, because even though children live in flats they still require space in which to play. Travelling Facilities. How small the world is—one day I found myself on Charing Cross Station, and it certainly seemed as though John is doomed this year to haunt me, because I found him standing right by me, and when the train came in we somehow or other wedged ourselves in. Talking was all but impossible and by the time the train got to Barking my poor feet felt like two lumps of lead. I had a headache and felt I was about to vomit at any time, and John, who is usually quite a decent sort of fellow, was in a state of nerves that some people call " narky," and what he said of the travelling facilities to Barking was nobody's business ! Elsewhere, and on numerous occasions I have set forth what I think about these travelling facilities and that the condition under which people travel to and from Barking is a serious factor in preventing them enjoying a proper measure of health and happiness. Whether we like it or not the main reason is that Barking is a dormitory town, and such a dormitory town should at least have a railway service which does not add to the difficulties of people who are constrained by force of circumstance to travel a long distance to their daily toil. Years and years ago I did write that the underground railway to Barking was the sewer that ran on four wheels and I was taken to task by a legal friend of mine, in whose judgment and ability I have every confidence. He warned me that such a statement might be actionable—all I can say is that no action was taken upon it, but if such a statement was actionable when the line was administered by a private company, it might be treasonable now ! But if I am to be locked up in the Tower, I must protest that the Railway facilities to and from Barking are not only scandalous from any ordinary standpoint but they are a serious menace to the health of people and possibly contribute more to the ill-health of the people who have to use them than any other factor. Hospital Facilities. It was during the year 1948 that it all changed over—the 5th July, 1948, was history so far as hospitalisation in this country is concerned. It had been obvious for a long time that there was a problem to be faced and that the problem was nation-wide. Some people thought July 5th was going to see the solution of all these problems. As a matter of fact, what occurred was a new orientation towards the problem and a new chapter of hospital administration, and it is hoped that there will, in time to come, grow something which is better than we have had in the past and that the future will find a solution which perplexed so many of us before the Appointed Day. Page 5 The Health of Barking One difficulty which affects us and which, no doubt, affects other parts of the country also, is that within the Boroughs of Barking and Ilford, which together make a sub-division to the Region to which we belong, that is the London North East Metropolitan Region, there never has been, nor can there be for several years, sufficient hospital accommodation to meet the requirements of the population. This is particularly so with regard to the chronic sick and the surgical treatment of tonsils and adenoids. As Mary was to have her baby in the Barking Hospital before the Appointed Day she was particularly interested to know what was going to happen under the new Act, and I was able to tell her that so far as could be seen at present, maternity work would be extended at this Hospital and that wards which during the War were used for the retention of casualties, would be adapted to this end. Here it is interesting to note that ten years ago, that is, before the War, these same wards were being used for infectious disease cases. I cannot leave the question of hospital facilities without saying something about the hospitalisation of tuberculosis. I am fully persuaded that we shall never get to real grips with the difficult problem of reducing the incidence of tuberculosis until, amongst other things, we are in a position to extend very considerably the number of beds that are available to Chest Physicians. The possibility of some immunisation being discovered for tuberculosis, comparable to diphtheria immunisation, is not so fanciful as it appeared a generation ago, but I do think it is sufficiently remote for us to say that, at this stage, hospitalisation and consequential isolation is the only way of dealing with the problem. What is more, there are certain diseases, of which tuberculosis is one, which, even in these enlightened days, are looked upon with much the same awe and dread as leprosy was regarded in the Middle Ages. It isn't too much to say that the effect on the minds of the patients of knowing that they are indeed suffering from tuberculosis is, in many instances, devastating, and the peace of mind of the patient is a very important factor in the treatment of the disease, and, therefore, hospital accommodation must be provided for these people. Now I want to be quite frank and open on this matter. Beds should have been provided pre-War whicl were not provided, and which are now going to cost a lot of money to build, and there are beds which are empty to-day because there are so many other opportunities open to women which, compared with nursing, are more acceptable, botl from the standpoint of remuneration and conditions of environment. I have mentioned some of the problems which are being faced and which it may be possible to solve within the framework of recent legislation. Not the least of the problems, the solution upon which the whole future of the hospital ystem depends, is the realisation of the relative parts to be played by the professional people and by the lay officer. It is a curious thing that whilst no one would dream of asking anyone other than a musician to conduct an orchestra, a large number of Page 6 The Health of Barking people think that a hospital service can be conducted by people who have never passed even the simplest examination in the work which is conducted at a hospital. The power of the public is paramount—they alone have the right to say what money they have available and how it shall be spent, but it will always take a man with a deep appreciation and knowledge of music to become a conductor. Parks and Open Spaces. One day John asked me to address a meeting in which he was interested on the question of parks and open spaces in Barking. the question of parks and open spaces in Barking. Now when called upon to make such an address I always ask the most competent person I know to outline remarks for me, and in this case a colleague, who wishes to remain anonymous, wrote the following notes :— Barking Park 76 acres Mayesbrook Park 116 33 Greatfields Park 14 33 Castle Green 42 33 Parsloes Park ... 14 „ in the Borough of Barking Vicarage Field 4.4 33 Abbey Playing Fields 3.75 33 270.15 This table shows that there is a total of 270 acres in use by the public for recreational purposes—in addition, there is within the Borough a further 330 acres for future development as such when circumstances permit. The statutory and temporary allotments total a further 221 acres. In these days of increased leisure it is important that every facility available to provide exercise in the open air should be used to the maximum and it is with satisfaction 1 notice both young and old making such excellent use of the opportunities provided by the Council in the provision of open spaces, sports buildings and equipment. The cultivation of a garden is a joy and an excellent pastime. May I again plead for landscape gardens and seats to form rest sanctuaries for our aged residents. Here, just removed and safe from the fast-moving traffic among pleasant surroundings, our Darbys and Joans can still feel the pulse of life by watching movement all around them. Burial of the Dead. Talking matters over, John was very surprised to learn that amongst the multifarious duties carried out by a Medical Officer of Health is that of arranging for the burial of certain persons. This duty arises from the provisions of Section 50 Page 7 The Health of Barking of the National Assistance Act, 1948, which provides that it shall be the duty of certain authorities, of which Barking is one, to cause to be buried or cremated the body of any person who has died or been found dead in their area, in any case where it appears to the authority that no suitable arrangements for the disposal of the body have been or are being made otherwise than by the authority. It is not ancitipated that there will be a large number of such cases, and, in fact, during the six months that this Act was in operation during 1948, only one such case did arise. The Problem of the Aged. With the improved welfare conditions more of our population is living longer and remaining in occupation of their long-established homes. It is our experience that there is a determination which is supreme in tenacity to refuse to leave the old home, even when chronically ill. Even the best domestic help service is not adequate for some such cases and the use of the power of Section 47 of the National Assistance Act, 1948, although drastic, must be implemented on occasions. This power enables the Council through their officers and with the authority of the Court of Summary Jurisdiction actually to remove people from their homes who are unable to look after themselves or are not receiving proper care or attention from other persons. During the whole of the year 1948, we did not have to exercise this power, which we always find vastly unpleasant. The following statistics show the number of aged " residents." It is at least interesting to note how the female population live longer in each age-group. Page 8 Old Age Pensioners. M. F. 66-70 years 646 813 71-75 years 367 475 76-80 years 168 275 81 years and over 61 122 Totals 1,242 1,685 Grand Total 2,927 The Health of Barking Wastage of Infant Life. This part of my Report has nothing to do with John and Mary, but I do want to record that in 1948, of the 30 deaths which occurred in Barking children under one year of age, 15 occurred within the first month of life, which means that if we could only do something about these babies that die at a very young age, then we should be getting on to one of the problems most likely to reduce infant mortality as a whole. INFANT AND NEO-NATAL MORTALITY By the courtesy of the coroner and of the pathologist who undertakes work for the coroner, I do see most of, if not all, the post-mortem examinations conducted in Barking. I don't think there is any doubt that a high percentage of these children who die at a very early age die because they don't get enough air in their lungs. One has to remember that when a baby is born there is practically no air in the lungs at all and for all practical purposes you say there is none. In these circumstances the lung is normally so solid as a piece of leather. Some children pump up their lungs and some children don't, and if they don't pump up their lungs, it means that they are much more susceptible to infection than if they did. Now why don't some children pump up their lungs—I wish I knew the answer ! I cannot help feeling that the answer is just around the corner. While we are dealing with this morbid subject of the wastage of child life, it is necessary to continue the gloomy picture by pointing out that during the year 1948 there were no less than 29 stillbirths, a large number of which were subjected to post-mortem examination, and again I am courteously invited to attend and indeed I do so attend. Very many of these post-mortems led me to believe that the children were living but a short time before they were born, but any suggestion as to why they died would, I believe, be at this time speculative. Let me end this rather grim, but I believe necessary part of my Report, and let a little sunshine into it. Our infant mortality rate for 1948 was 20.53. which is the lowest we have ever had in Barking. It would have been even less had it not been for an unknown newly-born baby which was found dead in Barking and which, strictly speaking, was not a Barking death. INFANT MORTALITY RATE On pages 57-58 will be found further statistics relating to infant mortality. Hospital v. Home Confinements. Mary was very worried as to whether she ought or ought not to go into hospital for her forthcoming confinement. John, who, as you know, is a practical sort of man, was all for Mary going into hospital. He said, and quite rightly, " there they have all the equipment and the staff that could possibly be wanted if anything unusual Page 9 The Health of Barking should arise, and for which we are not prepared and equipped. I know the difficulty of doing wayside repairs and I know how easy it is to do the same job when you have got all the necessary tackle and equipment." Mary's mother was definitely opposed to it—she had never been to hospital for a confinement, and she couldn't see why Mary should have her baby born in hospital. Mary was in a quandary. Undoubtedly, the questionis a difficult one. John was quite right when he said all about the wonderful equipment and the expert supervision, but it is also true that you cannot get a number of women together in a delicate state of health without running some risk. If one of these women catches a cold it is likely the others will catch it also, and the same is true with regard to infections which are peculiar to childbirth. There can be no doubt whatsoever that when a person is advised, on mcdical grounds, to have the baby born in hospital, it is folly not to accept this advice. Where the social conditions are not in all respects satisfactory, this means that there are risks at home which more than outweigh the risk of women being congregated together at such a time. There is a lot to be said for women having their first baby in hospital, because it is these first babies which provide so many of the incidents which have to be passed in childbirth. Incidentally, for the same reason there is much to be said for the women who are having their fifth or sixth baby going into hospital. But this leaves a gap between the first and the fifth baby, where the question is quite an open one. In practice, however, it isn't a very pressing problem because we look upon medical necessity, first babies, social emergencies and fifth babies as priority classes and by the time these priority classes have been accommodated, there are few beds left for other expectant mothers. Ante-Natal Service. Elsewhere I talked particularly to Mary about the way in which our ante-natal services are designed to do what we may to deal with the special problem of prematurity. Of course, these services are designed to cater for a much wider field than prematurity, although it is a very important aspect of our work. I do not wish to go into what I have discussed in earlier Reports, but I am happy to be able to say that there are advances in ante-natai work quite comparable with those advances which are taking place in other Departments. We now know more fully than we have known before that a properly balanced diet is very essential to every pregnancy—not only a properly balanced diet, such as flesh, fats, and starchy materials are concerned, but also a properly proportioned diet, so far as NATURE OF ATTENDANCE AT CONFINEMENTS; 1948. No. of Cases. DISTRICT :— Doctor and Midwife 19 Midwife 518 BARKING HOSPITAL ... 875 TOTAL 1,412 Page 10 The Health of Barking those things are concerned which are named accessory food substances, and which sometimes are called vitamins. Mary knew that the chocolate-covered tablets which she was taking contained vitamins A and D, and that these are necessary food substances which could be taken by routine. Another advance which has been made in the past few years is what is known as examination for the rhesus factor. I got into a bit of trouble with this with John and Mary, as is set forth in the following part of my Report. . Blood Tests. When the doctor wanted to get a specimen of Mary's blood for a special examination there was quite a how-to-do, to put it mildly. Mary's mother was up in arms about it. Things like that were never done when she was young ! John didn't take any more favourable a view, and although he didn't talk about it he remembered that in the army blood tests were often taken to find out whether men were suffering from a disease from which they ought not to suffer. All this led to a lot of talk and bother, but the plain simple fact is that such blood is taken for a purpose which was quite unknown when Mary's mother was a young woman, and it has nothing whatsoever to do with what John was thinking about. The difficulty is to explain what it is all about. In the personal interview the doctor had with Mary it was possible to explain it in the spoken word easier than it is in a statement in writing, but the gist of what the doctor told Mary is as follows, and at least the first part of the explanation is easy. The first reason is to do with the fact that blood is of different types and you want to know what type of blood a woman has in order to make quite sure that you do not give the wrong type if she needs a transfusion. The second reason is much more difficult to explain. Curiously enough, there are some people who have as part of their blood a substance which is not found in other people's blood, and which is indeed so different that if it were introduced there it would be broken up. This substance was first discovered in the blood of the Rhesus monkeys and is, therefore, called the Rhesus Factor. Persons who have it are called Rhesus Positive and those who have not are called Rhesus Negative. If a woman who has not this substance in her blood has a child by a father who has—i.e., who is Rhesus Positive—and if the child takes after the father, then the substance (Rhesus Factor) in the child's blood inherited from the father may filter into the mother's blood and the mother will immediately set about to break it up. The machinery which she sets up to break up this substance in time diffuses into the child itself, and, of course, is hostile to the child. We in Barking believe that to be forewarned is to be forearmed, and although we arc quite willing to admit that at this stage we are unable to do so much about it as we would wish, it certainly is wise to know beforehand what is likely to arise, and if the amount we can do isn't a great deal it is at least something. Page 11 The Health of Barking Dental Workshop. Dental Service. On one of the first visits of Mary to the ante-natal clinic she was advised by the doctor to see about her teeth, and the Health Visitor, finding that the dentist at the clinic had a spare moment, arranged for Mary to see him there and then. Fortunately Mary had been brought up in Barking and she had attended the dentist regularly whilst at school, so that, although the intervening years had left something to be desired, she found there was not very much after all that needed to be done. As a matter of fact, until she saw the dentist on this occasion she didn't know anything wanted doing at all, which only shows the value there is in having the teeth regularly inspected. Two or three fillings were all that were needed to put her mouth in really good order, but Mary, like other people, was a bit shy about having her fillings done. Somehow there are very great misgivings about having teeth filled, and alas how many people want to have a tooth out instead of having it filled, and anyhow people who are not so foolish as to have the tooth out will use every excuse possible for putting off the day when the filling is to be done. The dentist explained to Mary that having a baby was a very serious thing so far as her own teeth were concerned. The dentist told her that her unborn baby would be taking from her a good deal of calcium in the building of its own body, and an expectant mother should take enough of those special foods which are so necessary for the growth and development of her baby and at the same time sufficient for her own needs. Page 12 The Health of Barking Mary asked the dentist what would have happened if one of her teeth had needed to come out and whether it would have been possible for her to have had gas ? The dentist was able to reassure her that, generally speaking, expectant mothers could be given gas almost at any time during pregnancy, although it is not highly desirable late in pregnancy. Mary, of course, wasn't the only expectant mother that came to the clinic, and in the table on this page is set out the work that was actually done. DENTAL SERVICE—1948. Mothers and Toddlers Adults— Public Scheme School Children TOTAL Number of patients treated 2,163 3,908 6,440 12,511 Attendances for treatment 4,261 11,913 12,753 28,927 Extractions 2,765 7,024 5,966 15,755 Administrations of Gas 730 1,230 2,715 4,675 Fillings 1,134 1,652 6,963 9,749 Other Operations 3,256 10,142 6,271 19,669 Dentures supplied 253 1,476 110 1,839 Sessions (equivalent of) 364 1,095 1,216 2,675 Now everybody in the town wasn't so sound and sensible as Mary, and it is with regret I have to say that for some of the expectant mothers it was necessary to take out teeth, and to provide dentures. In fact, dentures were supplied to nearly 200 expectant mothers. Quite frankly, this figure is far too high, and the women of Barking have got to ask themselves seriously what they can do about it. We cannot hope to do awa y with fillings and scalings and that sort of thing, but we can hope that these young people will not need to have their teeth out and artificial teeth put in. Prematurity. One thing which hung about Mary like a nightmare whilst she was pregnant was the possibility of her child being born prematurely. How she got hold of the fears I don't know, but she had learned that prematurity was one of the conditions which accounted for a large number of infant deaths. It is with some diffidence I write on this subject because there are other Marys who will read what I am writing and who will be worried, and indeed I would not write on this subject at all if I were not able to introduce a note of optimism. If, therefore, my reader gets a little gloomy when I give him or her the facts, I want them to wait until they have read all I have to say. It is no good blinding your eyes to the fact that one-sixth of all the children who died under the age of one year during 1948 were born prematurely, and that of those who died within the first month of life no less than one in three were premature babies. Page 13 The Health of Barking If that were the whole of my story it would be pretty grim, but I beg to assure everybody that we are doing a great deal in this matter, even though the question is not an easy one. What we do in Barking is to undertake an ante-natal supervision which can be spoken of as intense from the very first time the mother comes to us when she is pregnant, and this intensive ante-natal supervision is stepped up towards the end of pregnancy. Not only do we do this, but we also arrange ante-natal clinics in such a way that the resident obstetricians of the Barking Hospital, who will have to deal with any abnormality if it arises, do in fact take the ante-natal clinics during the latter weeks of pregnancy. Vitamins. When once Mary had got the right idea into her head there was no need to taik to her any more about it. She was one of those practical people, who, when once she had commenced with the right thing, kept on doing it. There was nothing about cod liver oil, orange juice and vitamin tablets that she didn't know about, so far as public provision is concerned, and she took on trust the reliable information she had as to their value. I had a chat one day with Mary as to why so very many mothers didn't avail themselves of these special food substances. Quite frankly, Mary didn't understand it, and nor do I. There is what is known as the London Division, a name which is applied by the Ministry of Food, and in this Division there are some 95 towns. It is quite common, when we have a report on the question of the way in which these various towns take up the special vitamins, to find that Barking is pretty well down the list. For orange juice Barking comes about fortieth. For cod liver oil about thirtieth and for vitamin tablets about twentieth, and indeed there are no less than 15 towns who beat Barking all along the line. Some people would be satisfied that they are a bit better than the average, but theold motto, " the best is good enough for Barking,"' still stands, and I would like to see these food substances taken much more than they are at the present time. So far as orange juice and A and D vitamin tablets are concerned only a little more than half the people take them, and with regard to cod liver oil, it is even less than half. What is difficult to explain is that what are commonly known as the '' better off " places do better than we do, e.g. places like Barnet and Beckenham, which come toward the top of the alphabetical list, and Wood Green, which, of course, comes towards the other end of the alphabetical list. I was discussing this matter with an officer from the Ministry one day and this officer said that in his opinion it was because the people in these other areas were better educated. I'm afraid I was rather angry because quite frankly I don't believe people in these other areas are on the whole better educated than the mothers Pace 14 The Health of Barking of Barking. One fact has occurred to me, and that is that in these other areas, although the people may be getting a little more money they, on the whole, have additional expenses and have to budget more closely than some of the people in Barking, and because of this are only too glad to avail themselves of these special foods, not only by reason of their usefulness but by reason of the financial value in doing so. Anyhow, it still remains that Mary couldn't help me solve this problem and I know that she won't mind my saying so. Quite frankly, I don't know the answer. Domestic Helps. You would not think a young married couple would be very likely to call upon the services of a Domestic Help and, therefore, you may be surprised to find that John and Mary were interested in the provision of this very necessary person. It came about in a curious way. In the latter part of the time Mary was expecting her baby, John found that with the best will and intention in the world she could not help her mother, who was an invalid, in the same way as she had before. Personally, I have no doubt that Mary spoke to John and that John was soon finding out what could be done, but there was one thing he was determined upon and that was Mary was not going to do anything which might lead to complications in her expected confinement. At the end of 1948 we had 5 fulltime and 31 part-time Domestic Helps, of whom many were doing almost, if not altogether, whole-time work. I want to take time by the forelock and anticipate that next year we shall have still further Domestic Helps. In the little table which is set forth on this page you will see the amount of work which has been done. In a significant number of chronic sickness cases the services of a Domestic Help were provided, because there are not enough hospital beds for these cases. These cases usually require the services of a Domestic Help for prolonged periods and constitute a majority of the cases coming within the heading " sickness cases." John had something to say about this. He put forward the idea that because so much of this work was necessary because there were not enough hospital beds, the charges for the services of domestic helps in such cases should fall on the Regional Hospital Board and not on the local rates. This, however, is a matter which I am not qualified to discuss. Analgesia in Midwifery. Mary had not been attending the clinic very long before she began asking the other women who attended what they thought about analgesia and what the Page IS CASES ATTENDED BY DOMESTIC HELPS. Type of Cases. Year. 1945 1946 1947 1948 Confinements Sickness cases 69 – 248 13 366 49 196 107 TOTAL 69 261 415 303 The Health of Barking doctors thought about it. She was a little shy at asking the doctor a direct question on the matter—it was unfortunate that she did not ask because a lot of people attending the clinics have an altogether wrong notion about what is done in Barking with regard to analgesia. A large number of people have a vague idea that doctors generally, owing to their intense conservatism and for other reasons, are opposed to analgesia in midwifery. This, of course, is not so. What doctors are vitally interested in is finding out what is the safest way of bringing about analgesia. It is now 35 to 40 years ago that I was called upon to write the notes on the delivery of a baby under what was then spoken of in general terms as " twilight sleep " and even now I remember writing up that the colour of the baby when born was not healthy. What did happen, I suppose, under this form of analgesia, was that the baby was longer being delivered than would otherwise have been the case, and it suffered more than was normal. Then there came in a vogue for chloroform capsules, which the patient could break on her own and inhale. I myself have tried the use of chloroform, but there is a lot to be said against its introduction into general use. A search is still going on for the ideal analgesia which must at one and the same time be efficient and safe. At this stage we in Barking use gas and air, the same sort of gas that is used in dentistry, and of the 518 confinements on the district, gas and air was used in 317 cases. We do not like the midwife using gas and air unless the doctor has examined the patient and said it is quite safe, and we do not like the midwife to use the apparatus if the patient has had bronchitis between the date of the doctor signing the certificate and the date the woman is confined. At the Barking Hospital trilene is used, which is an analgesia that has come into use more recently than gas and air, but at this stage it is not considered safe to be used generally on the district, although perhaps a technique may be developed which will enable it to be so used in the near future. With all this new work going on we must not forget that some of the older work is quite useful and that drugs which have been known for a very long time can be used and still do give a large measure of relief. The ideal analgesia will be one which makes the patients unconscious of pain ; it will be safe, and it will be without detriment to the child about to be born. Paoe 16 The Health of Barking Maternity Hospital. There was one thing which John talked over with me, and it was that Mary, after she left her cubicle where she had been resting for two days or so, for the first half day was alone in a four-bedded ward. The four beds became occupied in about two days, and then Mary left, but she had made friends with the other people in the ward and, talking it over at the clinic afterwards, she learned that when she had left no other persons were admitted to the ward until the other three had left, and there was about two days interval of time between Mary leaving and the last person leaving. John wanted to know whether more use could not be made of beds and if not, why not! I pointed out to John that if you were running a four-bedded ward and each bed were occupied on the average 200 days out of the year, you were doing very well, and that to try to do any more was to run the risk of cross-infection, a risk which normally it was not proper to run. With the best will and intention in the world we couldn't say that nothing would ever go wrong, but if you were constantly changing your population the possibility of cross-infection would thereby be increased. I told John this was the system we had used in Barking for a long time. Some people call it the Boston system, because these people went to America, long after we had been using it in Barking, and had brought it back as a new system. To hear them talk about it you would think they were Christopher Colombus ! John readily appreciated the situation and recognised that it represented the care and attention which could be expected in such a matter. I pointed out to him that women generally at this time are in a particularly delicate state of health and that to run maternity beds as though an empty bed were a crime is futile and indeed it is filling the beds which is criminal and not having some of them occasionally empty Ambulance Service. One of the services in the town which Mary spoke of most appreciatively was the Ambulance Service. When Mary's time came to go to hospital John went round to the nearest 'phone box, which was only five minutes or so away, and he had only just got back—he got back as quickly as he could—when the ambulance appeared as though by magic. Not everything runs so smoothly as that all the time ; what had happened was that John had 'phoned the Ambulance Station at a time when there was not a peak load. From the figures which are given on this page you will see that in the first six months of the year 1948 we did twice as many calls as in the whole of the year 1944. AMBULANCE CALLS. 1944 4,502 1945 5,532 1946 9,045 1947 12,660 1948 (January to June) 9,302 Page 17 The Health of Barking During the first half of the year there were periods when the number of vehicles available was reduced by mechanical breakdowns due to the age of the ambulances. The two new Daimler ambulances with Lomas bodies, the delivery of which was promised for early 1948, had not been delivered on the appointed day. To-day the Ambulance Service has become the responsibility of the Essex County Council, and is administered centrally at Chelmsford. Breast Feeding. Mary was one of our ideal mothers. She breast-fed her baby, and perhaps, feeling a little virtuous because, of course, to breast-feed a baby is a tie, she was rather impatient, in a very nice way, with women who didn't give their children breast feeding, which is their heritage. Repeatedly, I am emphasising that civilisation only happened yesterday, from which it is quite obvious that if women generally had not been naturally capable of feeding their children there would be no human race at all. There can be no doubt that breast-feeding establishes an emotional relationship between the mother and the child, which is missing where the child is artificially fed. What is more, artificial feeding so often leads to abuse. The temptation to buy a teat with a large hole in it, or even to make the hole that is already big artificially large, seems to be one most difficult for women to withstand. Now it is true that children who are breast-fed sometimes find it difficult to get their food, and children who are artificially fed with a teat with a small hole, find it, if not harder, at least hard. But, believe it or not, I am firmly of the opinion that the child's full character can be altered by making it too easy for it to take its food. Children who have learned the hard way in the early months of their lives grow up mentally and morally a lot harder than other children. Post-Natal Clinic. It is a curious thing that, although Mary came to us to enquire about ante natal treatment and John would have taken a pretty poor view if she hadn't come, ind if we hadn't had something to offer, we definitely had to invite Mary to come to the post-natal clinic. I believe it would take a whole regiment of psychologi sts to begin to unravel the workings of a woman's mind to explain why this should be so. It seems perfectly obvious that a woman who has delivered herself of a baby should take every step possible after the baby is born to find out that everything is alright with herself or, alternatively, if everything isn't alright to find out what is wrong, particularly, of course, having regard to the fact that some time in the future she may be pregnant again when, of course, any residual disability from her previous confinement might be quite a serious affair. But sometimes these things which are so obvious don't always turn out as we expect, and, just as people hesitate to go to Page 18 J The Health of Barking the doctor if they think he is going to tell them there is something wrong with them, so for one reason or another, if I may use a very strong word, women funk being examined after a baby is born. We have been plugging away at the need for post-natal examinations in Barking for many years, and having regard to the fact that I was very dispirited some years ago, I do congratulate not only the women of Barking but my staff on the success we have achieved, although the success isn't up to what I can still hope it might be. The table which is set forth on this page shows how many women were confined and how many women attended the post-natal clinic during the years 1946 to 1948, and although 1,043 for 1948 is not a figure which I look upon with a measure of real satisfaction, I am satisfied it is a figure which means that a lot of hard work has gone into the problem of overcoming what must be a natural disinclination for women to undergo post-natal examination. Gynaecology. Mary was in seeing the doctor one day and in the ordinary course of chit-chat conversation she mentioned that she was sure a middle-aged friend of hers, who lived 1 wo doors away, was not, in all respects, so well as she might be from a woman's standpoint, and that in her opinion it was a pity she could not come to see the doctor as Mary could. A ary was surprised when the doctor told her that a Special Clinic is held where women may obtain advice on any matter associated with conditions relating only to women. As a matter of fact John mentioned the same matter to me a little time afterwards, and I explained to him that the same people who are specialists in midwifery are almost always specialists in the diseases of women, and that our services, so far as women are concerned, are not limited to childbirth. D iring the war, when we were an Emergency Hospital of first reception it was possible to give it a fair amount of this sort of work, and if people want to dig out the figures they will have to look under the heading of gynaecology, which is the old word of a byegone language by which is designated even to this day to the art of dealing with those diseases which are peculiar to women. POST-NATAL CLINIC. Year. No. of Births. No. of cases attending. 1946 1,634 835 1947 1,881 963 1948 1,490 1,043 Page 19 The Health of Barking In the little table which is set forth on this page is shown the number of consultations which have been held during the last three years. It is a very small amount because since the Barking Hospital has closed as an Emergency Hospital we haven't had the beds. But it is, I hope, a department of our work which we shall retain, in order that it may grow naturally when we have beds which may be made available for this very necessary part of our work. Children's Specialist. I found that Mary had a little more confidence than she should have had in her doctor at the clinic. Women do get like this, and John, on the other hand, was at times inclined to be sceptical; I think he was all the more sceptical because of Mary's exaggerated confidence. He came to me one day and pointed out that, after all, these doctors are doing ante-natal work one day, school-children the next day and infant welfare clinic the next day, and also had many other things at other times, including hospital work, examining people for superannuation, etc., and that he knew they could not be experts, and he, not unnaturally, wanted to know all about it—what did, in fact, happen when anything happened which was beyond the competency of a doctor who has so many irons in the fire ? I pointed out to him that we had a Children's Specialist who visited Barking every other week and that all the assistant Medical Officers and general practitioners have a right to send difficult cases to this Children's Specialist. John thought this a very sound scheme and so do I, and so, I am confident, do you. Health Visitors. Mary was clinic-minded and, apart from the post-natal clinic, there was no difficulty whatsoever in getting her to attend all the others. John was talking to me one day as to why so many of the nurses to be found at clinics were Health Visitors. I had to point out to him that health visiting was the backbone of the maternity and child welfare service in the past, and that it is still the backbone, although sometimes I feel, having regard to the little time we can now spend on home visiting that we are a filleted kipper ! It is not only that clinics generally are overcrowded, but somehow or another a heart-to-heart talk in a woman's own home, for reasons I don't understand, does mean more than the same voice spoken at a clinic or in a hospital out-patients department. An expectant mother is more confiding and the Health Visitor is more conversant with the domestic circumstances of the case. GYNAECOLOGICAL CLINIC. Year. No. of cases. 1946 329 1947 259 1948 603 Page 20 The Health of Barking I know of a child who showed no inclination to learn to read until one day quite suddenly she took it up, and within three months was reading " The Pied Piper of Hamelin." The child was six or seven years of age. In the same way these expectant mothers, when they want to learn about things, pick up things enormously quickly, particularly, as I have said, in their own homes. It is in the woman's own home that it can be pointed out to her the value of breast feeding and indeed the danger of bottle feeding, with the milk kept here and the bottle kept there, and father sometimes cleaning the teat, which, even though he does use salt, in the end he doesn't do it so well as mother does. It is so much easier to talk about the value there is in moving air for the baby, and, believe it or not, even premature babies want moving air. When you are in a woman's own home you can show her how to open her windows and doors to get fresh air, without the risk of the child getting too cold. What is more, handling the baby is not something which is learned over-night, and handling the mother's own baby in the mother's own home is a much more homely lesson than seeing exactly the same things done in any clinic, particularly, as I have said before, in our crowded clinics. It is in this homely atmosphere that the value of immunisation against diphtheria can be spoken of much more confidentially, and this can be more compelling than the same advice given anywhere else. It is true that we did during 1948 upwards of 6,000 visits of this nature, and, having regard to all other activities this isn't a figure to our discredit, but I should take a lot more credit to the service as a whole if the figure were larger. As I see it the time of a Health Visitor is also taken up with regard to the aged and the infirm, arranging the problems of the chronic sick, and also co-operating with hospitals which is likely to take up very much more time than it has heretofore. In addition, although no longer personally responsible for infant life protection, as such visits come under the Children's Officer, I think it is safe to say that at this stage we are spending quite so much of our time in this matter as we have in the past. Indeed, I don't think that whatever system is set up, the demands of Health Visitors' time in home visits are likely to be diminished. Health Centres. It was John who brought up the matter to me of health centres in Barking, and I told him in a joking way, which was in fact a true history, of a very young junior clerk in our Department, a boy in the teen-age, who had been reading a lot about the Beveridge Plan, and who came to me one day to ask what was it all about. Because," said he, " after all, it is only what we are doing in Barking." We have had in Barking for many years what I have no doubt can be looked upon as the forerunners of the health centres of the future. The health centre of the future will be very much better than we have had in the past, but our clinics to-day are, Page 21 The Health of Barking Minor Ailments Clinic. in fact, recognised as health centres so far as dental work is concerned. It was necessary that this should be so, because, of course, we have from time to time undertaken a public dental service. Incidentally, I may say we have undertaken other public medical services also. The greatest difference between the health centre of the future and our centres of the past will be that general practitioners will have accommodation at these centres. Some people speak of this as ideal. It is amazing to think that the total number of attendances at all -linic services was 183,221, and these services include a large number of those :pecial services which are to be found at our largest hospitals. I would also wish to record that in October, 1948, the Porters Avenue Clinic was opened. This Clinic was constructed by the adaptation of a former Civil Defence First Aid Post. Birth Rate. One day we were talking about the question of the birth-rate, because now that John and Mary had a baby they were very much interested in other people, and they thought that from their personal experience Barking was literally teeming with babies. Page 22 The Health of Barking As a matter of fact it often occurs that directly one gets interested in one thing it is amazing the number of people we find who have similar interests ; whether you are a mere schoolboy playing marbles or if you are an older man playing a special modification of marbles called golf. For the year 1948 the birth-rate in Barking was not particularly high when compared with the birth-rate for the rest of the country. Although the birth-rate in Barking was higher than that for England and Wales as a whole it was certainly less than the average for the 126 County Boroughs and Great Towns, of which Barking is one, and was even less than that for the 148 smaller towns to be found in England—it was decidedly less than the birth-rate for the Administrative County of London. The question arises, and this is of great interest to the people who have to plan for the future of Barking, as to whether the birth-rate is likely to go up or down. The birth-rate dropped by 5 points in 1,000 over what it was in the year 1947, and, of course, if it continues to drop this will mean a considerable fall in the school population in five years time; on the other hand, it may ery well be that 1947 was a peak ear for post-war babies, and that i he present drop was to be expected after what was in 1947 a most unusual year. Immunisation. When Mary Ann was a month old and Mary brought her to the clinic, one of the first tilings Mary said when she went in to see the doctor was " I am not going to have Vary Ann immunised; my husband does not believe in it." 1 octors at clinics are wise to such things, and when a woman says, " My husband does not believe in it,'" it really means that mother does not intend to have it done, and o course any self-respecting husband, for the sake of peace and quietness, believes and disbelieves on such matters as he is told. Mary went on to say John had attended a lecture, where a man had very stoutly declared that all the improvements in the health of the public were entirely due to the improved social conditions which had been brought about in the last century and had nothing to do with the development of the medical services. BIRTH RATES—1948. England and Wales 17.9 126 County Boroughs and Great Towns, including London 20.0 148 Smaller Towns 19.2 London Administrative County 20.1 BIRTH RATES IN BARKING, 1944-1948. 1944 ... 20.08 1945 ... 17.85 1946 ... 20.6 1947 ... 23.8 1948 ... 18.5 Page 23 The Health of Barking The upshot of the whole matter was that, at a time convenient to John, he was invited, much to his not inconsiderable amazement, to see the Medical Officer of Health, who, knowing what John was coming about, actually had on his table one of his reports, in which he himself had stoutly maintained the value of both food and housing and had indeed placed food higher than housing itself. It would ill-behove any Medical Officer in Barking not to proclaim from the house-tops the value of environment in promoting Public Health. There can be no doubt that the abatement of over-crowding has had an enormous effect on the reduction of the incidence of disease. I refer not only to reduction in the overcrowding of houses, but reduction in the concentration of people in any particular area. In this matter, I would like to enter a warning that crowding a large number of people together—men, women and children—into a small area by the erection of tall flats is going to bring the problem of overcrowding back to us. I think that John, at the end of our little talk, was convinced that we were as fully alive to the problem of social environment as may be, and that if we believed also in immunisation and other public health measures, it was only because we believed they were something which could be added to the fundamental problem of improving the home and its diet. As to whether John will be able to convince Mary, remains to be seen, but somehow I think he will and, what is more, Mary will find that the vast majority of mothers are getting their babies immunised and she won't want her baby to be at a disadvantage compared with those of other people. If anybody goes to the Public Library and looks at the Report of the Medical Officer of Health of Barking over the years, it will become abundantly clear that the number of cases of death from diphtheria is becoming very small indeed. Twenty years ago, when the population of Barking was only half what it is to-day, it was not uncommon to have over 100 cases of diphtheria during a year, whereas for 1948 there were only eight cases, with only one death. It is not too much to say that for all practical purposes immunisation can abolish diphtheria. On page 59 will be found diphtheria immunisation statistics in relation to the child population. Head Lice. Although Mary was not immediately faced with the problem of her baby going to school, she was already beginning to worry, as is the fashion of mothers, particularly from the standpoint of her child becoming accidentally verminous. I was able to assure Mary that there is not a lot of infestation from child to child, anyhow not at school, and that, although I have no reliable statistics, my present information is that most children become infested by catching the vermin from an older person—I hesitate to say so, but who almost always is a woman. Page 24 The Health of Barking As a matter of fact, the other day a very knowledgeable person came to me, pleading with me to take up the possibility of vermin inspections to be carried out in factories similar to those carried out in schools, and quite frankly I did not like to entertain recommending such a possibility, but I do find it difficult to find sufficient grounds for refusing to do so. As I have said elsewhere, it is what I term as the "reservoirs" of infestation which are not only found amongst tousle-headed, bedraggled, incompetent housewives, who, often times should be pitied rather than blamed, but amongst smart people who, often having spent more money than they can afford, imprison their hair in a snood, refraining from brushing or washing it so that, like the wigs men used to wear in olden days, their wonderful hair-do becomes, sad to relate, the abode of a major infestation. There are to-day, I believe, a lesser number of people with actual lice in their hair, but there are still many people who are painstaking enough to remove the lice, but are not painstaking enough to remove nits, so that they become what may be looked upon as perpetual "reservoirs." Ophthalmia Neonatorum. Elsewhere I have written about ophthalmia neonatorum, pointing out it is a long word and that I don't like long words where there is plain English to take its place. In this case, however, there is no other word. What ophthalmia neonatorum means is that there is inflammation of the eyes in a newly-born child, and it would be too much to say this every time you wanted to speak of ophthalmia neonatorum, but here I would like to tell of an incident, when John came up to me in most evident distress. He had been reading about child welfare and somehow or another he had got hold of a book which was twenty or thirty years old, and, of course, thought that it was up-to-date. He wanted to know how he could be sure his child wasn't suffering from ophthalmia neonatorum, and I was very happy to tell him to go home and forget all about it. Although there were no less than 1,461 live births last year, there were only three cases of ophthalmia neonatorum. The point is that John's book wasn't at fault years ago, because this used to be a very devastating disease, but improved midwifery and improved child welfare, amongst other things, have almost brought to an nd what was once a frequent cause of congenital blindness. Pemphigus Neonatorum. There is one thing which John never came to me about, and that is pemphigus neonatorum. This is a disease in newly-born children and causes their poor little bodies to become more or less covered with blemishes. We did not have one case during 1948; in fact we have only had 10 cases during the last ten years, and Page 25 The Health of Barking although this was once a disease to be handled with infinite hygiene, other circumstances have changed the disease. District Nursing. Curiously enough there was one question which was never raised either by John or Mary, and that was with regard to District Nursing. There is a reason for this, because the service has been carried out very quietly, but none the less efficiently, and apart from a very few people who are interested in its administration there are few people who know anything about the District Nursing Service or that there is a District Nursing Service, save only those who unfortunately find it nccessary to call upon the services of a district nurse. During the year 1948, the Plaistow Maternity Hospital and District Nurses' Home closed down their branch in Barking and so brought to an end an association which had long been established even before I came to Barking well over twenty years ago. During the time the Plaistow Nurses were in Barking they won an enviable reputation. The former Matron of the Barking Hospital remembers the time when there was one of these nurses who used to go out to confinements and the only charge made was a fee of five shillings ! The East Barking District Nursing Association also was wound up for all practical purposes when the responsibility for home nursing in the eastern part of the town was taken over by the County Council. So far as the public are concerned, however, in this part of the Town things go on as they have hitherto. During the latter half of the year the arrangements for District Nursing in what we call the older part of the town have been subject to fluctuations. I can only hope that in this way or in that we shall be able to maintain the same close association with the nurses of the new order of things which obtained in the days when the nurses of Plaistow carried out this work. Day Nurseries. It was when John had unfortunately met with an accident and was in hospital situated on the other side of London. The weather was fine and Mary was torn between conflicting emotions. She wanted to go over to see John, but she didn't want to take the baby with her, and the home circumstances were such that she didn't like asking her mother's help in minding the baby. Anyhow, she wanted to place the child into a Nursery for the day, so that she could go over to see her husband, and I am bound to confess that whatever good opinion she had of our services up to this stage went absolutely west—I'm afraid women are apt to be a bit unreasonable at times. Just because Mary couldn't get her child into a Nursery at a time when she so badly wanted to do so, everything in the world was wrong. Page 26 The Health of Barking We pointed out to her that Day Nurseries are intended primarily to accommodate the children of women who go out to work, and I think that a woman who is not going to work has very little chance of getting her child into a Day Nursery. What was more, we pointed out that although we had three Day Nurseries with accommodation for 168 children there were no less than 407 on the waiting list. This was towards the end of 1948. It is pertinent to point out, however, that plans are in hand for the conversion of the former Castle School into a Day Nursery, and for the erection of a further prefabricated Nursery which will be situated in the western part of the town. The accommodation to be provided in these two projected Nurseries will do much to reduce the present constant high waiting list, but, contrariwise, it is to be recorded that the National Trust is very anxious to reopen the Eastbury House as a museum. As a war-time measure Eastbury House was leased by the National Trust for the purpose of using it as a Day Nursery, and at the present time 80 of the present total 168 nursery places are provided in these premises. Now it seems to me that although Mary may have been unreasonable in the way in which she put her case, that doesn't do away with the fact that she has a case, and that these nurseries in the future should cater not only for people who want their children looked after as a long-term policy but for parents who properly want their children looked after one day now and one day at some other time. The older I get the more I am convinced that whatever handicap it may be to a woman to carry a child and to bear a child, and I wouldn't for the world minimise this, it is even a much harder job looking after the child after it is born, particularly now that children are dependent upon parents at least until they are 15 or 16 years of age I do feel that if we are to get young women with young families to lead a normal life, they must have time off from their job and that they are even more entitled to take this time off than most of us who are engaged on other work. Birth Control. John and Mary never did talk to me about personal things, and I must say this is a pity and it is a pity also that because they have not mentioned the matter to me, I have never had the courage to mention it to them. There can be no doubt that until the problems of birth control are discussed openly and in a forthright way, we shall never get an enlightened public opinion on this matter, and just as John had gone into a flap when he was reading about infection of the eyes of young children because he had been reading a book without realising that it was twenty years old, so the reading of other books also leads to the most outlandish notions, so much so that I think that the writers of these books do not realise how grossly they are misinterpreted. Page 27 The Health of Barking Orthopaedic Clinic. Now it must be clearly understood that so far as we are concerned officially at this time, we have no authority whatsoever to deal with birth control which leads to so much misunderstanding. The only thing which we, as doctors in the Public Health Service can do to-day is to give birth control to those who require it on medical grounds, and even then the advice cannot be given other than at a special clinic, which is specially set apart for this special purpose. This means that the medical grounds must be determined at one place at one time, and the persons then referred to a special clinic, which is held at another time. Such a clinic is held in Barking. It is held every week but it cannot and does not cater for the much wider issue of birth control from the standpoint of sociology. Orthopaedic Service. Mary, like all other practical people, did object to us calling one service the "Orthopaedic" Service, but I explained to Mary, as I have explained to so many other people, that there is no ordinary name for this service and that I shall be happy when the public find another name for it. This is a service which has to do with bringing children up straight physically, and, of course, deals with their bones, joints and other parts of the body which may have deformity. In a way, I was sorry Mary asked so many pertinent questions about this particular service, because the history of the year under review does not Page 28 The Health of Barking show us in a very enviable light. The possibility of getting people to work in the service has been particularly remote. These people are named physiotherapists and who, in modern language, are in very short supply. The amount of work we did during the year is set forth on this page, but I am going to take time by the forelock and say that we have a much happier picture to paint for the year to come. ORTHOPAEDIC CLINIC. Toddlers and Adults. School Children. Primary examinations by Surgeon 139 80 Re-examination by Surgeon 158 179 Number of Cases treated 865 1,093 Number of Treatments 9,131 8,419 Extract of a letter to John. "I am sorry that when you came to visit me last evening I was so busily engaged that I could not talk over the matters you raised, but I am writing to assure you that there is an Ear, Nose and Throat Service in Barking, and that we did even more work last year than in the year before, as you will see from the figures on this page. The service caters for mothers and babies, toddlers, school-children and the general public; indeed, virtually anybody who cares to avail themselves of it. EAR, NOSE AND THROAT SERVICE. Mothers and Toddlers Adults— Public Scheme School Children TOTAL 1947 1948 1947 1948 1947 1948 1947 1948 Number of attendances at the Ear, Nose and Throat Clinic 309 331 35 29 767 962 1,111 1,312 Number of cases which received operative treatment 41 86 — — 223 356 264 442 Number of cases which received other forms of treatment 151 112 23 14 308 345 482 471 "With regard to chiropody, this is a service where it seems as if demand is always in excess of the facilities we can supply. It is a service which is very much in the public eye, and as you will see from the figures on this page, the year 1948 was a bumper year so far as the amount of work done was concerned. I would like to tell you too that the work is of a very high order of merit and very much appreciated, but I want to say also, that it should not be necessary. It is a crime for chemists and pharmacists to sell injurious drugs at all and it ought to be a crime for footwear people to sell what are in fact injurious boots and shoes. If Page 29 The Health of Barking Foot Clinic. people get the right shoes instead of the wrong ones, we should have much less chiropody to do. I know the footwear people only sell what customers demand, but this would not be an excuse for a pharmacist to sell poison, and believe me a lot of shoes which are sold are poison to the feet. "With regard to the Skin Clinic, I want to make it clear that although we have a skin clinic there are very few cases which are seen which can be stated to be suffering from diseases of the skin, because the skin is an organ of the body, and when it suffers, other organs of the body suffer also. It is very convenient to classify all these things together, but the classification belongs to olden days when things were grouped together not according to their causes, but by their effects. CHIROPODY SERVICE. 1. Treatment sessions 2,759 2. Total individual patients 5,306 3. New patients 2,354 4. Total treatments given 23,229 5. Infra-red treatments (included in 4.) 1,049 SKIN CLINIC. Consultations. Treatments. Sessions 47 132 Attendances:— Children under 5 years 255 475 , Children 5-15 years 456 2,420 Ante Natal and Post Natal Cases 189 353 Other categories (including Public Adult Scheme) 142 207 Page 30 The Health of Barking Squint Training. I have set forth to you some of the total amount of work we did during the year. Personally I would like to see the amount of work we are doing decreased, particularly, of course, with regard to scabies, where I am happy to be able to say that during 1948 the number of cases occurring went down very much from the previous year, and I hope we shall see a still further decline." SCABIES. New Cases Recurring Cases TOTAL Total number of patients 138 2 140 Adults 70 2 72 Children 68 — 68 Referred from:— Clinics 56 — 56 Other sources 82 2 84 Cleansed at Barking Hospital: Adults 44 1 45 Children 47 — 47 Ophthalmic Service. Mary was a rare one for ferreting out what her friends and neighbours could derive from the various services which are provided, and one day she brought her Page 31 The Health of Barking mother up to the clinic, rather much against her mother's wishes, but she did need her glasses changed, and Mary thought it was her bounden duty to bring her up to the clinic. The clinic not only provides for Mary and her child and school-children but also for other adults, and the figures which are set forth on this page tell of the amount of work which was done during the year. Not only do we deal with the ordinary errors of vision but we spend quite a lot of time on squint training, which, by the way, is quite time-consuming because each case requires very many treatments if it is to be of any value. TREATMENT OF DEFECTIVE VISION. Mothers and Toddlers. Adults— Public Scheme. School Children. TOTAL. Errors of Refraction, etc., requiring treatment 211 378 825 1,414 Number of spectacles prescribed 130 316 493 939 SQUINT TRAINING. Number of sessions 145 Number of children attended 138 Number of Attendances 1,309 Number discharged—cured 36 Number discontinued 3 Infantile Paralysis (Acute Anterior Poliomyelitis), etc. John and Mary were sitting quietly by the fire, the baby was in the bedroom and, of course, it wasn't long before they talked about what a wonderful baby it was, and it wasn't very long before Mary thought of all the dreadful diseases, which at the least would be annoying—might be dangerous and could be fatal, and John and Mary began thinking about which disease they would choose to do away with it only they had an opportunity of making one wish. Now, believe it or not, they did not find this question at all easy to answer. Mary immediately plumped for "infantile paralysis" and was a little impatient when John wanted her to think it over. She conjured up a harrowing picture of the baby having to live in an iron lung for a long time and then requiring months and years of treatment afterwards and at the very end being a disabled person. It all sounded very worrying. "I wish I knew how many cases there were in Barking," said John, "because we must try to keep a sense of proportion." "There you go," said Mary, "always worrying the Medical Officer of Health." "Well, he doesn't mind," said John. Page 32 The Health of Barking So John came to see me about it. He was a little surprised, and certainly relieved, to find that during the year 1948 the total number of cases was three and for the past ten years the total number of confirmed cases was ten. It seemed to me just and proper that as John could come to me and ask such a question, I should in turn ask another person a similar question, and this I did. I asked a particularly well-informed person what disease she would wish was just not there, if she had only one such wish, and, being a woman and, as is a woman's prerogative, she did not answer the question I asked but said forthright "cancer and tuberculosis." CANCER Now we could expect young people to mention cancer because it would appear that people suffer from cancer at an earlier age than they used to, and although many of these cases are diagnosed relatively early in life on account of the improved technique, which would not have been so diagnosed many years ago, I still think there is something to be said in support of the opinion that cancer is becoming more common among younger people than it used to be and, of course, it is a killing disease. There were during the year 1948, 135 Barking people who died from cancer and during the past ten years, 1,028 people have so died. TUBERCULOSIS Tuberculosis, of course, also accounts for a significant number of deaths, and during the year 30 Barking people died from this disease. The table below shows the number of cases which were added to our Register during the year. To complete the picture, however, it must be stated that the names of 262 people were removed from the Register during the year and of these, no less than 100 were removed because they had left Barking. NOTIFICATION OF TUBERCULOSIS. New Cases Notified Pulmonary Non-Pulmonary TOTAL M. F. M. F. Under 1 year — — — — — 1 to 5 years 4 8 — 1 13 5 to 15 years 5 9 3 1 18 15 to 25 years 17 30 2 2 51 25 to 35 years 17 9 2 2 30 35 to 45 years 11 4 1 — 16 45 to 55 years 11 2 — — 13 55 to 65 years 5 1 — — 6 65 years and upwards 3 — — — 3 Totals 73 63 8 6 150 Amongst children I should suppose that rheumatism caused an enormous amount of disability. Rheumatism can appear to be quite trivial in children; they Page 33 The Health of Barking RHEUMATISM may complain of "growing pains" and if you are careful enough to take their temperature, it is not very much raised, and yet this seemingly trivial ailment is something from which the child never fully recovers, for it is a drain on their health and vitality and may be the beginning of serious heart disease and other troubles later in life. I could not say that my conversation with John did help to decide this question for himself and Mary, but I did feel convinced that for Mary to choose infantile paralysis, because the occasional case could be so drastic, was not of necessity an answer to the question—which is the disease we most anxiously wish could be prevented ? Extract of a letter to John regarding Infectious Diseases: "When the other evening you asked me at a public meeting what was the present position with regard to measles, I hesitated to answer you so fully as I would like to have done because I did not want to alarm the public generally, but speaking in my plain blunt way there were no less than 1,436 cases notified in 1948. What I am happy to be able to say is that out of this very large number of cases there was only one death, which shows the epidemic, which I believe we must call it, was a relatively mild one. "You have asked me when I think we are going to get on top of the difficult problem of reducing the incidence of measles, and in my usual forthright way I must tell you I do not know. A few years ago we thought the answer was around the corner, but after that we found that the problem was by no means so simple as it appeared to be. This, of course, is in contrast to whooping cough, of which we had 394 notified cases last year. Here, without being over-confident, we do think the answer is around the corner, and although I would not like to say we shall be able to banish whooping cough in the same way as we have been able to banish diphtheria, I think we shall at least be able to keep it in check. "Scarlet fever was not particularly prevalent during the year—there were only 137 cases notified and not one death occurred. The trouble with scarlet fever is that the germs which cause it are very widespread indeed and I suppose that everyone catches it at one time or another, but fortunately most of us only get it so mildly that we do not know that we have had it! "Pneumonia is still one of the problems left for us to solve because, although there were only 60 cases notified to us, there were no less than 25 deaths from all forms of pneumonia, i.e. from notifiable pneumonias and non-notifiable pneumonias. "One bright spot is that fever following childbirth (puerperal pyrexia) was at a very low ebb indeed—only 12 cases were notified. There can be no doubt that the integration of the health services in Barking has led to very happy results. Page 34 The Health of Barking "Other infectious diseases were of a low incidence and I do not think you need worry unduly about them so far as your own wee baby is concerned." There were many other questions put to me by John and Mary to do with what we call environmental health, but their questions were not of the same personal interest and, incidentally, did not cover all that I would wish to write on this subject. I am, therefore, continuing this Report on more orthodox lines. Page 35 The Health of Barking ENVIRONMENTAL HEALTH SERVICES. INTRODUCTION. I do not think in writing about the environmental health services that I can fail to direct special attention to the fact that the year 1948 is the centenary year of the first Public Health Act. This Act provided for the establishment of a general board of health for the whole country. In the same year there was passed a "Nuisance Removal and Diseases Prevention Act," which gave supplementary powers and applied to the whole of Great Britain. These two measures laid the foundations of subsequent legislation and came as a climax to persistent agitation. When the 1848 Act was introduced, it was said that the bill was a "call for a national assault against the abiding host of disease, the permanent overhanging mist of infection, the annual slaughter doubling in its ravages our bloodiest fields of conflict." It is interesting to quote from a description given in the Edinburgh Review of 1850 of the water used by the citizens of London:— "The refuse and dirt from two millions of individuals, the enormous accumulation of waste and dead animal and vegetable matter, the blood and offal of slaughter-houses, the outpourings from gasworks, dyeworks, breweries, distilleries, glueworks, tanneries, chemical and other works— and a thousand nameless pollutions, all find their way into the Thames. The mixture is next washed backwards and forwards by the tide and, having been thoroughly stirred up and finally comminuted by the unceasing splash of two hundred and ninety-eight steamboats, is then pumped up for the use of the wealthiest city of the world." It is right and proper that you should be reminded not only of the conditions of the river, but also of the housing conditions which prevailed at that time, which were equally deplorable. There can be no doubt that the Public Health Act of 1848 was a turning point in the social history of this country because it was at this time that sanitary consciousness was first developed. From this has followed improved sanitary conditions in home, school, factory, farm and office. Your services to-day, nevertheless, still require an observant mind, personal initiative, understanding and sympathy for the less fortunate. Whilst we rejoice that great improvement has been made we cannot be complacent so long as so many families are without a home of their own and so many of the houses which were condemned ten years ago are still in use. It has been calculated that the floor space needed for the use of every single town dweller in these Islands is, in the house 250 square feet, in his place of work, factory or office, 150 square feet and in other forms of public buildings 170 square Page 36 The Health of Barking feet. We not only have to deal with the amount of space required within buildings which, as I have shown above, makes a total of 570 square feet for every single individual, but during the past years we have been taught to think in terms of good planning and it is to this matter we have to pay special attention. The changes which planning can bring are improvements in amenities and social conditions; on the other hand, planning may seriously delay building development. It is very clear, therefore, that housing and planning must work hand in hand. It is especially important during this period when we are endeavouring to catch up with the lag in housing development consequent upon the war. There is no doubt that most of the people in Barking live, work and travel in overcrowded conditions. Our new estates, however, are an attempt to raise the standard of living space in the home, and it is right that these standards should be universally applicable. On these standards our pre-war 1914 houses must be regarded as obsolescent. Whilst in Barking the Council has built so many houses as are permissible, with the large increase now taking place a new stage has been reached and it is proper that as landlords the standards of design and maintenance should be as good as any that can be achieved. I cannot pass from environmental hygiene without making some reference to atmospheric pollution. After one hundred years of Public Health legislation, so far as the smoke problem is concerned, we are still restricted to punitive measures in relation to offences, already committed. Until the man in the street and the industrialist realise the discomfort and the adverse effect of smoke on animal, vegetable and mineral materials we shall, unfortunately, fail to make adequate progress. It is in the home foremost that immediate improvements can be effected by the use of domestic appliances having a greater efficiency. The output of these new and better types of grates is increasing rapidly, and is now sufficient to meet the demands of the market. (A) SANITARY CIRCUMSTANCES OF THE AREA. CLIMATIC CONDITIONS. The rainfall figure for the year was 22.94 inches compared with 15.92 for the previous year. Barking is fortunate in its situation in the driest part of England. All of us must learn how to take advantage of the sunlight by using the bronzing of the skin as an index of dosage; devise suitable clothing; value the clear early morning—in short, fear the heat and love the light, keep our children cool and bright. In addition we must abolish the deadly pall of smoke against which I have inveighed for some years; so that maximum sunlight may be restored to us. It has been stated that "of all flowers the human flower is that which has most need of the sun," and that "baths of water are good, baths of air are better and baths of light are best." Page 37 The Health of Barking WATER SUPPLY. Over the last few years attention has been called to the temporary hardness of the water supplied in the Borough. Investigations are I know being carried out as to the losses in money suffered by residents due to this hardness, but I am more concerned with the public health aspect. From my own experience of using soft water for domestic purposes I know how much easier it is to bathe and also to wash clothing. As an aid to cleanliness I must support every effort to reduce the present temporary hardness. So far our supply has been unrestricted but the continued increase in the quantity used by reason of the improved facilities in the homes causes us to consider at what stage and when limitation must occur. All the samples submitted, monthly for bacteriological examination and quarterly for chemical examination, have been found to be pure and wholesome. RIVERS AND STREAMS. On page 36 I have given a description of the water of the River Thames as it was found in 1848. Notwithstanding we are now writing of 1948, which is one hundred years later, this description is still true except that there are now many more steamers. With the fall in the quantity of water passing over Teddington Weir during the periods of drought and the substantial increase in the quantity of sewage effluents discharged from the L.C.C. Works at Crossness and the Northern Outfall, conditions have deteriorated so far as to give rise to a public nuisance. The saturation of the beaches of the River with decomposing organic matter has reached the stage where the quantity of hydrogen sulphide produced is not only offensive, but is tarnishing metals and discolouring paintwork. Improvement of the river is a matter of urgency, and can only be brought about by the construction of new capital works for sewage disposal by the L.C.C. I am satisfied that the Works as at present existing are operated efficiently. The River Roding, more familiarly known as Barking Creek, joins the River Thames in the vicinity of the Northern Outfall Works and the conditions in this river are consequently similar. Both rivers are within the area of the Port of London Sanitary Authority. There are other streams and water-courses in the area controlled either by the Essex Rivers Catchment Board, or the River Roding Catchment Board, who have not commenced any works of major improvement during the year. Page 38 The Health of Barking Flooding—Victoria Road.—I am happy to record the successful conclusion of an old-standing nuisance at Nos. 76-122, Victoria Road, where rear gardens to these houses have been raised by 6 feet of filling above flood level. Flooding—Clare Gardens.—The attention of the Council has been called, on a number of occasions to the flooding caused in times of storm due to the failure of the Mayesbrook watercourse to remove quickly he storm water it receives. This failure is due to several causes and is receiving the urgent attention of the Council. DRAINAGE AND SEWERAGE. The whole of the drainage of the Borough is discharged to the Northern Outfall Works of the London County Council. There remains a small number of one-man trade premises at Rippleside where sanitary accommodation consists of a pail closet. The planning of this area has not yet been settled. PUBLIC CLEANSING. During the year 8,508 loads of refuse were collected with an average weight of 2.5 tons per load. The domestic refuse is still disposed of by raising the level of low-lying land, so as to provide playing fields. In my Annual Report for 1947 I called attention to the need of brightening our streets in addition to keeping them clean. Unfortunately, I cannot report any progress in this direction, but I am still sufficiently optimistic to expect our street gloom to be dispelled by the painting of street furniture, such as kiosks, litter bins, etc., in bright and pleasing colours. Private Refuse Tip—Essex County Council Act, 1933, Section 146.—It was necessary during the year to institute proceedings in connection with a tip at Rippleside which was in private ownership. The Defendant was fined the sum of £10 with £2 2s. costs. Secondary Streets. It has still not been possible to improve the surface of the many minor access roads and passages. I again repeat that I regard the paving, lighting and drainage of these streets as an urgent sanitary matter, likely to contribute to the general well-being of the town. Page 39 The Health of Barking ERADICATION OF BED BUGS. In another part of my Report I referred to the general housing position in the district. 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. The Housing Manager reports that in connection with Barking Corporation houses the number of premises found infested and treated was 34. The method of treatment provides for the use of insecticide containing D.D.T. In the present acute house shortage there is serious difficulty in using hydrocyanic gas. FLY NUISANCE With the continuance of the difficult food position in the country, there has been further emphasis on the keeping of the backyard fowl and the utility rabbit— this means food scraps and flies. In addition, the dumping of rubbish on bombed sites, the building of heaps of putrescible matter on allotments, etc., has increased the disease-carrying potentialities of the fly. Special inspections were carried out by the Sanitary Inspectors of all places where flies were likely to breed. To deal with the problem it is becoming apparent that the Council will need to undertake more positive action by employing a mobile spraying unit. Whilst there is still no evidence that flies are responsible for the spread of poliomyelities it is a reasonable precaution to have regard to the dangers of fly-borne disease. I cannot pass from this subject without reference to the storage and collection of waste food made by the Council at the request of the Board of Trade. In summer, using present methods, this collection does increase our health hazards. I must emphasise the need for householders to be supplied with covered receptacles. THE SMOKE MENACE. In my Report for the year 1947 I did indicate that when the details of pollution as measured at the three collection stations became available it would be possible for me to make a more authoritative statement. The following tables show the soot fall in tons per square mile at the three stations, and also the pollution due to the emission of sulphur gases. With the factual evidence gathered through the deposit gauges I can now say with regret that Barking is a dirty town. Smoke knows no parish or borough boundaries, but with the huge coal consumption of the two very large utility undertakings—viz. the Generating Station of the British Electricity Board and the Gas Works at Becton, together with the additional 80 industrial and commercial chimneys—it is to be expected that the atmospheric pollution in the Borough will be heavy. Page 40 The Health of Barking ATMOSPHERIC POLLUTION—1948. Monthly Record of Solid Matter in Tons per Square Mile. Apr. May Jun. Jul. Aug. Sept. Oct. Nov. Dec. Barking Park 21.73 22.93 16.45 12.20 25.01 17.14 20.05 31.96 20.64 Greatfields Park 30.52 23.13 28.20 15.19 29.29 22.00 28.37 52.18 43.04 Parsloes Park 23.25 19.87 22.59 11.62 22.94 21.05 26.72 51.24 32.74 Page 41 The Health of Barking ATMOSPHERIC POLLUTION—1948. Sulphur Dioxide by the Lead-Peroxide Method. Milligrams of S03 per 1,000 Square Centimetres. June July Aug. Sept. Oct. Nov. Dec. Barking Park 11.0 9.8 12.8 16.8 27.1 36.2 34.6 Greatfields Park 18.0 15.3 17.7 24.9 35.0 42.5 42.9 Parsloes Park 16.0 12.5 16.8 23.7 34.5 47.1 38.7 Page 42 The Health of Barking The steep rise in the months of November and December is most noticeable. This rise is due to the substantial contribution to the total load of pollution made by the domestic chimney. Compared with the summer months of July and August the increase represented a rise of 83.5 per cent. The experts tell us that in thirty years we shall be in the smokeless era, but if I express my doubts (in the absence of legal control for the domestic user) I must plead that as one of the domestic consumers of the 40 million tons of raw coal burnt in the grates of our homes, the open fire is still very attractive in winter time. We must, however, continue to press for every scientific and mechanical assistance to increase the efficiency in fuel burning so as to lessen the gloom, fog and grime from which we at present suffer. It is a sad reflection that in this period when there is a demand for cleaner this and cleaner that public opinion is still not sufficiently vocal in its call for a cleaner atmosphere. RATS AND MICE DESTRUCTION ACT, 1919, AND INFESTATION ORDER, 1943. Rodent Control in Sewers.—The biannual treatment of sewers was carried out during the months of May and November. Whilst the results on both occasions were satisfactory the evidence of heavy infestation in certain areas, most of which are in the older parts of the district, gives cause for serious thought. The following table shows the degree of infestation found to exist:— May November Number of manholes baited 403 403 Number showing prebait take 222 179 Number showing complete prebait take 120 109 Test baiting of 70 manholes throughout the newer parts of the district took place in April, and no evidence of infestation was found. Surface Infestation.—In connection with the general surface infestation, the Corporation employs a trained rodent operative who has carried out 709 disin- festations as follows:— Factories and commercial premises 86 Private dwellings 316 Tips, open spaces, ditches and watercourses 103 Branch drains 180 Corporation properties 14 Schools 10 This work involved over 3,000 visits by the operative. The charge made by the Corporation for this service to factories and commercial premises is now at the rate of 4s. 3d. per man-hour. Page 43 The Health of Barking The managements of factories and business premises have continued to co-operate in this work and the general public has taken advantage of the facilities offered. SWIMMING BATHS AND POOLS. The inadequate swimming facilities in Barking have caused concern to the Council for many years, and it is unfortunate that the proposed bath in Mayesbrook Park still had to be postponed. The indoor swimming bath at East Street was used by 69,750 bathers in the short season of 21 weeks, notwithstanding the many weeks when the weather was cold and not conducive to bathing. It is pleasing to learn from the report submitted to the Council that more than half the bathers were children, and whilst this is commendable it does increase the problem of dealing with the pollution load using the present purification plant, and it is not surprising that on two occasions it was necessary to comment on the results of the chemical examination of bath water. The statistics submitted to the Council showed a serious reduction in the bathers attending the Open-Air Pool, due to the unsuitable weather. For one week in June, however, there was a record number. Generally, I can say that I look forward to the time when the new swimming bath is established, and provision made either centrally or in some part of the Borough for Turkish and vapour baths. Samples of swimming bath water were taken as below:— Number Open Air Pool 5 East Street Bath 4 South East Essex County Technical College 9 FACTORIES ACT, 1937. On pages 62-63 will be found statistics in relation to the administration of this Act. SANITARY INSPECTION OF THE AREA. Throughout the year there continued a shortage of inspectors but the easing of the licensing restrictions enabled an increase in repair work to be carried out without quite as much difficulty as hitherto. The present office arrangements for your sanitary inspectors is unsatisfactory and administration will be much improved when the staff can be transferred to the office now occupied by the comptometer operators. (This has since been done.) It has been said that to be meanly housed is to be meanly esteemed, and I believe that for an officer to give his best service regard must be paid to these matters. During the year the sanitary inspectors dealt with 1,476 complaints, which resulted in the service of 564 statutory notices. Page 44 The Health of Barking At the end of the year there were 173 notices outstanding. This result was achieved by some 13,000 inspections and re-inspections. It has become evident that whilst it is now easier to get repairs carried out when the defect is remediable at a cost less than £10, there is a gradual hardening of resistance by owners to notices requiring heavy expenditure. In Barking a substantial number of houses are controlled at an inclusive rent of 10s. per week, which inevitably becomes a limiting factor in view of the term "reasonable cost" mentioned in Section 9 of the Housing Act, 1936. The issue of notices requiring repairs of £50 in cost must give rise to the question as to when the owner should be given an opportunity of stating his willingness or otherwise to carry out repair works. (B) HOUSING. STATISTICS. Your Chief Sanitary Inspector, who is Rehousing Officer for the Borough, has supplied the statistics, to be found on pages 63-64, which show the detailed position in the Borough at the end of the year. POST-WAR HOUSING. The housing problem is still with us and remains acute. It would be wrong to use the term chronic because I believe that with the completion of the Council's post-war building scheme substantial reduction in the large number of families awaiting accommodation will be achieved. During the year 205 new houses were erected and a further 39 rebuilds completed by the Corporation. This, together with the building by the London County Council and private owners of a total of 381 dwellings, represents the maximum amount of building possible in the Borough with the present labour force. The fact that the Council's future building programme consists entirely of flatdw llings is an indication of the land scarcity in the Borough. Whilst I have the usual objection to this type of dwelling for families, particularly where there are small children, I recognise the necessity and also applaud the care the Council is taking to secure that the flats now in course of erection are designed and built to overcome, so far as practicable, the difficulties found in living in flats. CLEARANCE AREAS AND REHOUSING. Unfortunately we still have 150 families living in houses condemned so long ago as 938, and, together with a further 508 houses scheduled as unfit, the Council is faced with a serious problem, but as a progressive housing authority with a proud record in municipal building, I am confident this problem will be solved. Rehousing—Medical Aspects. During the year I have been called upon continuously to express an opinion upon medical certificates issued by my colleagues practising in the Borough. The maximum value of such a certificate, if accepted, is five points. Unfortunately, many applicants for accommodation do not realise that the medical aspect Page 45 The Health of Barking Slum Houses of 1927. Congestion and Slum Dwellings 1933. Page 46 The Health of Barking STANDARD COUNCIL ACCOMMODATION IN 1948. Living Room. Kitchenette. (Photographs reproduced by permission of the North Thames Gas Board). Page 47 The Health of Barking is one of a multiplicity of considerations and that the award of five points does not necessarily secure accommodation. The fact that the number of certificates submitted is approximately six each week, indicates the relation between housing and the general health of the families without separate homes. That friction and disruption of family life is a most potent factor of ill-health is beyond question. Rehousing the Aged. Elsewhere in this Report, on page 8, I have commented on the number of aged persons in the Borough. Here I wish to plead for the early completion of the Council's housing proposals, because I look forward to the provision of the special accommodation proposed for those residents, now in the eventide of life and forced to remain imprisoned in one room without free access to sanitary accommodation or cooking facilities. The provision of such accommodation will also make possible the release by the aged of some large accommodation now retained only because of the lack of an alternative. HUTTED CAMPS. During the year there was an increase in the number of families remaining in occupation of temporary dwellings. In order to relieve the acute overcrowding and as an emergency measure, the Council converted parts of a Ministry of Works hutted camp into housing units totalling 45. As a result of our earlier experience with this type of converted dwelling, improvements were incorporated. Huts were divided by brick partition walls, and each family was provided with a bathroom and w.c. built into the unit, separate and under cover. In addition constant hot water supply was available from gasheaters over sink and bath. The families in occupation of the accommodation were satisfied with this temporary rehousing at a rent of 10s. per week for two bedroom units. The number of complaints subsequently received have been few and have related to the ingress of dampness from roofs and windows in times of storm. The following details of hutted camps are given:— Gunsite hutments 122 families Huts for homeless 50 „ Thames Road conversions 54 „ The huts house a population of 791 persons. (C) INSPECTION AND SUPERVISION OF FOOD. HEALTH EDUCATION. This is becoming a prominent feature of our health activities and should tend to make the public realise the Council's interest in the day-to-day lives of its residents in addition to giving them a lead in healthy living. Page 48 The Health of Barking The year has been significant in new health records and in this regard it is proper for the Council to take credit for the health services it has provided, including its health teaching. CLEAN FOOD CAMPAIGN—PUBLIC CONVENIENCES. In order to assist in a practical way, the Council has arranged for free washing facilities in the public conveniences under its control, particularly for the use of persons engaged in handling food, such as bread and milk roundsmen. ICE CREAM. Reference was made in my report for the year 1947 to the absence of any chemical and bacteriological standards. Whilst that position remains unchanged so far as statutory standards are concerned, progress has been made. It is now recognised with regard to the fat content a maximum of 2.5 per cent, can easily be achieved. In Barking the average was 6.02 per cent. with a peak of 9.80 per cent—the minimum was 2.80 per cent. With the coming of the Heat Treatment Regulations, 1947, many improvements were effected, and by using the provisional grading of the Ministry of Health a better bacteriological picture of the quality of the ice-cream sold in the Borough was available. There are 87 premises registered and of these four only are used for manufacture and the remainder for retail generally of pre-packed ice-cream. During the year 72 samples were submitted for examination. It was unnecessary to remove any registered person from the register. MILK SUPPLY. There are no cowkeepers in the district and we have no dairies where milk is handled or treated. There are 28 premises on the register for the retail of pre-packed supplies. In addition, there are six milk purveyors who occupy premises in other districts, but who retail in Barking. In Appendix F a table is given which sets out the results of the bacteriological examination of various samples. The whole of the milk distributed in the Borough is heat-treated except for about 40 gallons per day of raw designated milk. There were, during the year, 71 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 ile of graded milks under the Milk (Special Designations) Orders, 1936 and 1938 :— Tuberculin Tested 6 Pasteurised 6 Page 49 The Health of Barking TYPICAL FOOD PREMISES IN BARKING. Beer Cellar of a Small Inn. Page 50 The Health of Barking Kitchen of a Large Modern Public House. Page 51 The Health of Barking FOOD HYGIENE. The preparation, storage and distribution of food is continuing to attract more attention, and the public is demanding a higher standard of hygiene. The rapid expansion of what can be described as the meals service, embracing factory canteens, schools canteens, municipal and private restaurants, has led to new problems. In general your officers have acted upon a standard of sanitary considerations in the kitchens as follows :— (a) Adequate lighting for the job; (b) Impervious floor for cleansing; (c) Impervious and durable wall surfaces; (d) Adequate ventilation; (e) Fitments placed so as to prevent vermin infestation; (f) Amples sinks for washing purposes; (g) Ample food storage accommodation, suitably housed; (h) Adequate closet accommodation, and at least one wash-basin with hot and cold water supply. It is a pleasure to report an easing of the difficulty experienced in previous years of securing provision of satisfactory domestic utensils and towels. There is also a more enlightened view among food trade operatives and management, which we must continue to foster and encourage. In no field of a sanitary inspector's work is it made clearer that the job is primarily educative rather than penal, and it is in this way that sanitary inspectors are doing their most effective work. Unsound Food. On page 66, a table is given showing the total quantity of food condemned. FOOD AND DRUGS ACT, 1938—SAMPLING. Details of the 296 samples submitted for examination are to be found on page 67. Of this total 15 were unsatisfactory. In respect of Sample No. 2070, Custard Powder, there was a prosecution resulting in a fine of £5 plus £2 2s. costs. One of the unsatisfactory samples was the result of a complaint that a number of residents who had consumed fish and chips at a local shop had suffered trom diarrhoea. The edible oil which had been used for frying was found to consist of pure castor oil. Lemonade Powder.—The attention of the Ministry of Food was called to the preparation and sale of what were described as lemonade or sherbet powders, which, upon chemical examination, were found to bear more resemblance to effervescing health salts, and were being sold to children. Some of these confections were put up as sweetmeats described as lemonade powder suckers. The Borough Analyst, commenting on his examination, states:— " In conclusion it must be pointed out that none of the samples examined was found to have the composition of Sherbet as it is generally Page 52 The Health of Barking understood, namely that of a flavoured effervescing preparation containing a large proportion of sugar. "While no serious objection can be taken to the non-effervescing lemonade powder preparations, provided they are well supplied with sugar, nevertheless in my opinion the sale of preparations having the general composition of effervescing health salts and containing no sugar is definitely undesirable." An appreciable amount of alarm was caused to mothers of young children because of the distinct staining of lips and tongue by the yellow dye used in the manufacture. Sausages. The detection of horse-flesh in sausages has always been a difficult problem, but during the year the Borough Analyst reported that by using a new serum technique he is now able to establish when horse-flesh has been used. General. The year was unusual in that there were a number of instances where we were called upon to carry out chemical examination of foods under suspicion only to find serious adulteration as the result of some mischievous admixture, e.g. 14 per cent, of salt added to moist sugar ; and milk with 59 per cent, of added water. There was no evidence of wilful adulteration and since the operation of the legislation requiring detailed labelling of containers there has been a marked reduction in misrepresentation. Prosecutions. Two prosecutions were instituted in relation to bread which was unsound, owing the presence of cockroaches. In one case there was a fine of £20 with £2 2s. costs and in the second case a fine of £5. FOOD POISONING. Only eight 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 cases 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, Page 53 The Health of Barking 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.I, whilst the examination of samples of milk for the presence of tubercle is carried out by Dr. A. L. Sheather, of Chorleywood, Herts. The Borough Analyst is Dr. J. H. Hamence, Peak House, Eastcheap, London, E.C. GENERAL STATISTICS—1948. Area (in acres) 4,174 (including 300 acres of Tidal Water H.W.M.) Population (1931 Census) 51,277 Population (June, 1948) (Registrar-General's Estimate) 78,890 Number of Inhabitated Houses, March, 1948, according to Rate Books:— Houses 19,778 Shops 1,370 Total 21,148 Rateable Value—General £570,125 Sum represented by Id. rate, 1948/49 £2,000 General Rate, 1948/49 21/4d. Education Rates, 1948/49 6/6¾d.in the £ EXTRACT FROM VITAL STATISTICS—1948. BIRTHS. Live Births :— Total Males Females Legitimate 1,409 717 692 Illegitimate 52 27 25 Totals 1,461 744 717 Still-Births :— Legitimate 27 14 13 Illegitimate 2 1 1 Totals 29 15 14 Live and Still-Births 1,490 759 731 Live Birth Rate per 1,000 of Estimated Population 18.5. Still-Birth Rate per 1,000 (Live and Still) Births 19.46. Page 54 The Health of Barking DEATHS. Total Males Females Deaths in 1948 593 316 277 Death Rate per 1,000 Estimated Population 7.51. Analysis of Deaths:— Cancer 135 Tuberculosis 30 Measles 1 Whooping Cough 1 Diphtheria 1 Diarrhoea (under 2 years) 2 Maternal Mortality:— Deaths from Puerperal Sepsis — Deaths from other Maternal Causes 1 Rate per 1,000 total (Live and Still) Birth 0.60 Infant Mortality:— Death Rates of Infants under one year of age:— All Infants, per 1,000 Live Births 20.53 Legitimate Infants per 1,000 Legitimate Live Births 19.99 Illegitimate Infants per 1,000 Illegitimate Live Births 0.38 Neonatal Mortality:— Death Rate of Infants under one month of age per 1,000 Live Births 10.26 Page 55 The Health of Barking DEATHS (NET). Causes and Totals. Causes of Death. Total. Enteric Fever — Cerebro-spinal Fever — Scarlet Fever — Whooping Cough 1 Diphtheria 1 Pulmonary Tuberculosis 28 Non-Pulmonary Tuberculosis 2 Syphilitic Diseases 4 Influenza 2 Measles 1 Acute Poliomyelitis and Polio-encephalitis 1 Acute Inf. Encephalitis — Cancer (all forms) 135 Diabetes 5 Intra-cranial Vascular Lesions 56 Heart Diseases 129 Other Diseases of Circulatory System 33 Bronchitis 37 Pneumonia 25 Other Respiratory Diseases 7 Ulcer of Stomach or Duodenum 12 Diarrhoea (under 2 years) 2 Appendicitis 2 Other Digestive Diseases 10 Nephritis 8 Maternal Causes 1 Premature Birth 3 Congenital Malformation, Birth Injury, Infantile Diseases 15 Suicide 8 Road Traffic Accidents 5 Other Violent Causes 16 All Other Causes 44 Total 593 Page 56 The Health of Barking 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 1948 20.53 39 34 Page 57 The Health of Barking INFANT MORTALITY—1948. Age in Months at Death. 0-1 1-2 2-3 3-4 4-5 5-6 6-7 7-8 8-9 9-10 10-11 11-12 Total Prematurity 5 — — — — — — — — — — - 5 Congenital Malformation 4 — — — — — — — — — — — 4 Birth Trauma 1 — — — — — — — — — — — 1 Caesarean Sectn. 1 — — — — — — — — — — — 1 Erythroblastosis Foetalis 1 — — — — — — — — — — — 1 Acute Hepatitis 1 — — — — — — — — — — — 1 Abandoned 1 — — — — — — — — — — — 1 Pneumonia 1 2 — 1 — — 1 — 1 — — — 6 Bronchitis, Acute — 1 — — — — — — — — — — 1 Gastro Enteritis — 2 — — — — — — — — — — 2 Acute Primary General Peritonitis — 1 — — — — — — — — — — 1 Congenital Pyloric Stenosis — — 1 — — — — — — — — — 1 Asphyxia (Accidental) — — 1 — — — — — — — — — 1 Whooping Cough — — 1 — — — — — — — — — 1 Intussesception — — — — — 1 — — — — — — 1 Encephalitis — — — — — — 1 — — — — — 1 Convulsions — — — — — — — — — 1 — — 1 Totals 15 6 3 1 - 1 2 - 1 1 — — 30 Page 58 The Health of Barking DIPHTHERIA IMMUNISATION IN RELATION TO CHILD POPULATION. Number of children at 31st December, 1948, who had completed a course of Immunisation at any time before that date (i.e., at any time since 1st January, 1934). Age at 31.12.48 Under 1 year 1 year 2 years 3 years 4 years 5-9 years 10-14 years Total i.e., Born in Year 1948 1947 1946 1945 1944 1939/43 1934/38 Under 15 Number immunised 48 1,104 1,026 807 975 4,346 4,961 13,267 Estimated mid-year child population 1948 Children under 5 7.041 Children 5-14 11,369 Page 59 The Health of Barking ENVIRONMENTAL HEALTH SERVICES. (A) SANITARY INSPECTION. (i) Inspection of Dwelling-Houses. Total Houses inspected under Public Health or Housing Acts 3,226 Total Number of Inspections made 8,595 After Infectious Disease and Scabies 610 Overcrowded Premises 437 Defects Found 2,706 Notices Served (Preliminary) 1,507 Re-Inspections re Notices Served 4,713 Inspection of Work in Progress 231 (ii) Premises Controlled by Bye-laws and Regulations. Inspections. Contraventions. Notices served. Offensive Trades 57 9 7 Tents, Vans, Sheds and Fairgrounds 15 6 6 Dairies, Cowsheds and Milkshops 39 6 4 Hairdressers' and Barbers' Premises 129 26 17 Smoke Observations 270 5 5 (iii) Miscellaneous. Inspections. Defects. Notices. Bakehouses 23 14 8 Butchers' Premises 272 71 41 Drainage Inspections 191 118 78 Fishmongers 79 31 22 Food and Drugs Act, 1938 933 276 153 Food Sampling 303 — — Ice Cream Vendors 165 52 36 Page 60 The Health of Barking Inspections. Defects. Notices. Milk Sampling 144 — — Other Miscellaneous 350 4 2 Piggeries 14 — — Public Lavatories 20 3 3 Rats and Mice (Destruction) Act, 1919 238 48 46 Restaurants, Dining Rooms and Canteens 333 105 59 Schools 33 — — Shops Act, 1934, and Markets 683 155 85 Stables and Stable Yards 50 5 3 Street Traders 110 10 7 Vacant Land and Refuse Tips 86 4 4 Watercourses 5 — — Water Sampling 57 - - (iv) Notices Served. Informal Notices 1,507 Statutory Notices :— Public Health Act, 1936 : Section 39 103 Section 45 56 Section 83 — Section 93 364 Housing Act, 1936 : Sections 9 and 10 41 Section 24 — Section 32 — Factories Act, 1937: Section 7 2 Dustbins : Public Health Act, 1936 : Section 75 (3) 425 Total 991 Page 61 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 73 38 6 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 171 272 46 - (iiii Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 244 310 52 - 2.—Cases in zvhich 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.l) 4 4 - - - Overcrowding (S.2) — — — — - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) 3 3 — — Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 12 9 - — (b) Unsuitable or defective 42 34 - 1 - (c) Not separate for sexes Other offences against the 2 2 - - - Act (not including offences relating to Outwork) 7 1 - - - Total 70 59 - 1 — Page 62 The Health of Barking OUTWORK. Section 110: Number of out-workers in August List required by Section 110 (1) (c) 135 Nature of work carried out by out-workers:— Making of wearing apparel 112 Cleaning and washing of wearing apparel — Umbrellas, etc. 2 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 16 Brush making 1 Cosaques, Christmas Crackers, Christmas Stockings, etc. 2! Number of cases of default in sending in lists to the Council Nil Section 111 : Number of instances of woik 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 1948:— By the Barking Corporation: New houses 205 Rebuilt houses 39 Prefabricated bungalows — Total 244 By the London County Council: Rebuilt houses 5 Prefabricated bungalows 40 Total 45 By Private Enterprise: New houses 6 Rebuilt houses 86 Total dwellings provided 381 (ii) Number of applications for rehousing outstanding at 31st December, 1948 3,618 Page 63 The Health of Barking (iii) Number of dwellings provided in Barking since the war:— By the Barking Corporation: New permanent houses 260 Prefabricated bungalows 285 Rebuilt houses 57 St. Paul's Flats (Conversion of Civil Defence Depot) 11 Thames Road Hutments 54 Hutments for homeless 50 Hutted Camps 113 Requisitioned properties 455 Rebuilt requisitioned properties 5 Total 1,290 By the London County Council: Rebuilt houses 173 Prefabricated bungalows 337 Total 510 By Private Enterprise: New houses 23 Rebuilt houses 90 113 (iv) Post-war housing programme of the Barking Corporation:— Prefabricated bungalows 285(all erected and let) New permanent dwellings 777(260 erected and let) Rebuilding of properties 63(57 erected and let) Rebuilding of requisitioned properties 5(all completed and let) Total 1,130 (b) Unfit Dwelling-Houses. 1. Inspection of dwelling-houses during the year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 3,226 (b) Number of inspections made for the purpose 8,595 Page 64 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 1,932 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 813 3. Action under Statutory Pozvers 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 41 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 18 (b) By local authority in default of owners 9 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 523 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 275 (b) By local authority in default of owners 2 (c) By local authority on behalf of owners 15 C.—Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made - (2) Number of dwelling-houses demolished in pursuance of Demolition Orders - D.—Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which closing orders were made - (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit E.—Number of dustbins supplied by local authority under Dustbin Maintenance Scheme:— Initial Issues 425 Renewals 275 Total 700 Page 65 The Health of Barking (D) INSPECTION AND SUPERVISION OF FOOD. MILK SAMPLES—BACTERIOLOGICAL EXAMINATION—1948. Type of Sample Satisfactory Unsatisfactory Totals "Pasteurised" Milk 37 - 37 Tuberculin Tested Milk 10 2 12 Tuberculin Tested (Pasteurised) Milk 21 2 23 Totals 68 4 72 UNSOUND FOOD CONDEMNED—1948. Bacon 36 lbs. Bread, Flour, Biscuits, etc. 22 lbs. Butter ½ lb. Cakes 56 lbs. Cereals, Various 219 lbs. Cheese 405 lbs. Confectionery 31 lbs. Cooking Fat 10 lbs. Dried Fruit 67 lbs. Dried Milk 2 tins Fish 220 tins Fish 2,816 lbs. Fish Cakes 60 lbs. Fruit 218 tins Jam 404 lbs. Meat 1,105 lbs. Milk 1,008 tins Peas 236 tins Pepper 112 lbs. Pickles, Sauces 51 pints Rabbits 10 lbs. Sausages 41 tins Soups 91 tins Sugar 10 lbs. Syrup 6 lbs. Tongue (Tinned) 29 lbs. Various Fillings 326 tins, jars, etc. Page 66 The Health of Barking FOOD AND DRUGS ACT, 1938—SAMPLES SUBMITTED FOR EXAMINATION—1948. Baking Powder 3 Beer 15 Beverages (Tea, Coffee, Cocoa) 5 Bun Flour, Cake Mixtures 8 Butter 15 Cooking Fat 14 Custard Powder 8 Date Puddings (Tinned) 2 Edible Oil 1 Flour (Self-Raising) 2 Fish Paste 3 Gravy Powder 1 Ice Cream 8 Lemonade Powder/Crystals 9 Malted Milk 1 Margarine 15 Medicinal Products 32 Milk 13 Mineral Waters and Cordials 12 Other Cereals 2 Other Provisions 38 Porridge, Oats 2 Potato Crisps 1 Pre erves 9 Pre sed Meat 1 Pui ding Mixtures and Powders 4 Salad Oil 2 Sauce, Pickles, etc. 15 Sausages and Sausage Meat 14 She bet-Type Confections 6 Soups (Tinned) 3 Spices 4 Various Fillings 13 Vinegar 6 Wine, Spirits 9 Total 296 Page 67 The Health of Barking TABLE OF CONTENTS SOCIAL CONDITIONS, STATISTICS AND GENERAL PROVISION OF HEALTH SERVICES. Acute Anterior Poliomyelitis 32-33 Maternity Hospital 17 Aged, Problem of 8 Measles 34 Ambulance Service 17-18 National Assistance Act, 1948, Analgesia in Midwifery 15-16 Section 50 Ante-Natal Services 10-11 Neighbourhood Units 4 Birth Control 27-28 Neo-Natal Mortality 9 Birth Rate 22-23 Ophthalmia Neonatorum 25 Blood Tests 11 Ophthalmic Service 31-32 Breast Feeding 18 Orthopaedic Service 28-29 Cancer 33 Parks and Open Spaces 7 Children's Specialist 20 Pemphigus Neonatorum 25-26 Chiropody Service 29-30 Pneumonia 34 Chronic Sick 8 Population 4 Day Nurseries 26-27 Post-Natal Clinic 18-19 Dental Service 12-13 Prematurity 13-14 District Nursing 26 Puerperal Pyrexia 34 Domestic Helps 15 Rheumatism 33-34 Ear, Nose and Throat Service 29 Scabies 31 Flats 4-5 Scarlet Fever 34 Gynaecology 19-20 Skin Clinic 30-31 Head Lice 24-25 Squint Training 32 Health Centres 21-22 Still Births 9 Health Visitors 20-21 Tonsils and Adenoids 29 Hospital and Home Confinements 9-10 Travelling Facilities 5 Hospital Facilities 5-7 Tuberculosis 6, 33 Housing 3-4 Vitamins 14-15 Immunisation 23-24 Whooping Cough 34 Infantile Mortality 9 ENVIRONMENTAL HEALTH SERVICES. Atmospheric Pollution 40-43 Ice Cream 49 Bacteriological Examination of Inspection and Supervision of Milk 49 Food 48-54 Bed Bugs 40 Milk Supply 49 Biological Examination of Milk 49 Post-War Housing 45 Chemical and Bacteriological Public Cleansing 39 Examination of Food 54 Rats and Mice Destruction Act, Clean Food Campaign 49 1919, and Infestation Order, Clearance Areas 45 1943 43-44 Climatic Conditions 37 Refuse Disposal 39 Drainage and Sewerage 39 Rehousing Programme 45 Factories Act, 1937 44 Rivers and Streams 38-39 Flooding 39 Sanitary Circumstances of the Fly Nuisance 40 Area 37-45 Food Markets 53-54 Secondary Streets 39 Food and Drugs Act, 1938 52-54 Street Trading 53 Food Poisoning 53 Swimming Baths and Pools 44 Graded Milk Licences Granted 49 Unsound Food 52 Health Education 48-49 Water Supply 38 Housing 45-48 Wells 38 Hutted Camps 48 Page 68 The Health of Barking TABLES. GENERAL AND VITAL STATISTICS:— Area 54 Population 54 Inhabited Houses 54 Shops 54 Rateable Value 54 Vital Statistics:— Births 54 Deaths 55 DEATHS (NET) 1948 (Causes and Totals) 56 COMPARATIVE INFANT MORTALITY RATES 57 INFANTILE MORTALITY—1948 58 DIPHTHERIA IMMUNISATION 59 ENVIRONMENTAL HEALTH SERVICES:— (.A) SANITARY INSPECTION 60-61 (£) FACTORIES ACT, 1947 62-63 (C) HOUSING 63-65 (D) INSPECTION AND SUPERVISION OF FOOD 66-67 Page 69