c4411(1) PRO Region 5 BARKING BARK 47 BARKING'S HEALTH in 1953 BARK47 CONTENTS Pages 1. Membership of Committees 2-3 2. Staff 4-5 3. Preface 6-8 4. General Public Health 9-29 5. Personal Health Services 31 58 6. Report of the Chief Sanitary Inspector 59-80 7. School Health Service 81-96 PUBLIC HEALTH COMMITTEE as at 31st December, 1953. Chairman—Alderman Mrs. JULIA H. ENGWELL Vice-Chairman—Councillor Mrs. E. G. LAW The Mayor—Mr. Councillor G. H. COLLINS, J.P. Mr. Alderman A. C. COLE Mr. Councillor L. C. JONES Alderman Mrs. A. M. MARTIN Councillor Mrs. M. PRESTON Mr. Councillor S. W. BOSWELL Councillor Mrs. J. E. ROYCRAFT Councillor Mrs. M. BREDO, C.C. Mr. Councillor W. H. ROYCRAFT Councillor Mrs. D. M. GLENNY Mr. Councillor J. R. SWEETLAND Mr. Councillor H. J. HILLS Mr. Councillor LEONARD WRIGHT BARKING HEALTH AREA SUB-COMMITTEE Chairman—Alderman Mrs. JULIA H. ENGWELL Vice-Chairman—Councillor Mrs. E. G. LAW Barking Council Representatives:— Members of the Public Health Committee as listed above and Mr. Councillor S. C. SIVELL Essex County Council Representatives:— County Alderman Mrs. M. BALL Mr. County Alderman F. CULLEN County Councillor Dr. C. SKINNER County Councillor Mrs. A. J. MORRIS County Councillor Mrs. M. H. PAIGE The Executive Council for Essex Representative:— Mr. County Alderman K. E. B. GLENNY The Local Medical Committee Representative: Dr. W. J. C. FENTON, J.P. The Hospital Management Committee Representation:— Mrs. D. L. BELCHAMBER Voluntary Organisations' Representatives:Mr. J. W. HOLMES Mrs. E. POTTER Mrs. I. M. LUCK Miss M. M VERS Page 2 BARKING COMMITTEE FOR EDUCATION as at 31st December, 1953. Chairman:—Mr. Councillor TREVOR WILLIAMS Vice-Chairman:—Councillor Mrs. J. E. ROYCRAFT Representative Members:— The Mayor—Mr. Councillor G. H. COLLINS, J.P. Mr. Alderman A. E. BALL, J.P. Councillor Mrs. E. G. LAW Alderman Mrs !UL1A H. ENGWELL Mr. Councillor H. R. O'NEILL Mr. Alderman ( C. MALLCOTT, J.P. Mr. Councillor A. V. RAY Alderman Mrs. M. MARTIN Mr. Councillor S. R. ROWE Mr. Alderman \ G. WERMERLING Mr. Councillor W. H. ROYCRAFT Councillor Mrs 1 BALL, C.A. Mr. Councillor J. R. SWEETLAND Mr. Councillor J. G. BEANE Mr. Councillor C. C. TWEED Mr. Councillor GOWER Mr. Councillor LEONARD WRIGH Mr. Councillor HILLS Co-opted Members:— Rev. W P. CHADWICK Mr. B. A. CLEMENTS The Very Rev. Canon J. A. DACEY Mrs. L. F. M. DAVIS Rev. B. R. HARVEY Mrs. V. KEAY Mr. J. ANDREWS Mr. H. A. SMITH, J.P. Nominated Members:— Mr. County Alderman K. E. B. GLENNY Mr. County Councillor G. H. SHALDERS Page 3 STAFF, 1953 Medical Officer of Health, Area Medical Officer, and Divisional School Medical Officer: D. E. CULLINGTON, M.A., M B., B.Ch., D.C.H., D.P.H. Assistant Medical Officers: MARGARET I. ADAMSON, M.B., B.Ch., D.P.H. EILEEN E. V. MARTIN, M.B., B.Ch. EUGENIA POPPER, M.D. ARTHUR E. SELIGMANN, M.D., D.T.M. & H. VIOLET SPILLER, M.D., M.R.C.S., L.R.C.P., D.P.H. MARY H. WESTLAKE, M.B., B.Ch., D.P.H. Dental Officers: H. H. COOKE, L.D.S.R.C.S R. GILCHRIST, B.Ch.D, L.D.S. (Terminated 30.5.53) A. R. LEVY, L.D.S.R.C.S. J. PRESSER, M.D., D. J. ROBINSON, L.D.S.R.C.S. Cert. D.S. (Vienna) (Commenced 7.9.53) Chief Sanitary Inspector: N. BASTABLE, F.R.S.I., F.S.I.A. Senior Sanitary Inspector: Mr. C. S. COOK Sanitary Inspectors: Mr. R. S. COLEMAN Mr. E. A. ELLIS (Terminated 10.10.53) Mr. B. HARRAWAY Mr. J. I. MILES Mr. E. G. TWEEDY (Terminated 2.3.53) Superintendent Health Visitor: Miss P. M. FAWCETT Health Visitors, School Nurses, etc. Miss M. BAERLOCHER Mrs. G. HOOD Miss A. CATTLE (Terminated 21.9.53) (Commenced 1.4.53) Miss G. K. JEFFREYS Mrs. M. I. COOPER Miss J. McGILVRAY (Tuberculosis Health Visitor Miss E. PARRY from 12.10.53) Miss E. M. SCHROPFER. Mrs. F. E. FENNA Miss E. P. SCHROPFER Miss N. A. FLUCK (Terminated 30.8.53) Miss J. FRANCE Miss B. SCUDAMORE (Commenced 21.12.53) (Terminated 7.6. 53) Miss L. GOODACRE Miss E. J. WHITING (Commenced 30.1.53) Page 4 STAFF, 1953—cont. Dental Nurses etc.: Miss H. BUSH (Dental Attendant) Mrs. V. HARDING (Dental Nurse) Miss G. GEDEN (Dental Nurse) Mrs. R. MOULE (Dental Nurse) In addition 18 part-time Nurses are employed for the staffing of the various clinic services. Chief Clerk (Administrative): Mr. F. READ Senior Administrative Assistant: Mr. G. RUFF Administrative Assistants: Mrs. E. M. BARTHOLOMEW Mr. H. GARROD Mr. B. S. WEAVER Non-Medical Supervisor of Midwives: Miss D. A. RISELEY District Midwives: Miss E. V. ASHTON Mrs. I. M. BRONNICK Miss A. CUNNINGHAM Matrons of Day Nurseries: Eastbury House Mrs. J. M. HOWELL Rippleside Miss I. K. STOKES Gale Street Miss F. B. NASON Lodge Farm Mrs. K. TAYLOR (Terminated 28.12.53) Domestic Help Organiser: Mrs. L. EVERITT Chief Chiropodist: Senior Dental Technician: Mr. H. LEAVESLEY Mr. J. CONSTABLE Speech Therapist: Mrs. A. LING Oral Hygienist: Occupational Therapist: Miss M„ STANLEY Miss Z. MERCER Superintendent Physiotherapist: Mr. T. HYND Remedial Gymnast: Orthoptist Mr. H. OGLE Miss M. LEWIS Page 5 TOWN HALL, BARKING, ESSEX. March, 1955. To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my first annual report as your Medical Officer of Health. Dr. C. L. Williams officially retired on the 15th January, 1953, although he remained until I took up my duties on the 7th April. You have, I believe, already expressed to him your appreciation for the services carried out during his twenty-five year ten re of office, during which time such outstanding clinic services were developed in the town. An Annual Report should appear as soon as possible after the end of the year to which it relates, and in this respect my first report falls far short of the desirable. In mitigation I can only plead that since 1953 was the centenary of public health in Barking, he occasion demanded a brief historical review of the development of our services I also thought it prudent to pause for a "stocktaking" on assuming my new duties. In the first fifty years of the public health service, efforts were concentrated on man's environment. As a result, we now have pure water supplies, good (though sometimes overloaded) sewage disposal systems, reasonably clean food, and increasing standards of housing. though little has yet been done to achieve clean air. In the second half century of Public Health attention was directed at high maternal and infant mortality rates and personal health. The clinic services were steadily developed, with the gratifying results which are well known to you. Page 6 What are the main problems left for us to tackle at the beginning of our second century? Between one-third and one-half of all the hospital beds in this country are devoted to the care of the mentally ill and the mentally deficient, and it is probable that a similar proportion of patients attending their own doctors for advice do so on account of emotional and mental troubles rather than physical illness. The prevention of this vast amount of illness must surely be one of our major tasks, although in our present state of knowledge the road is not yet clearly defined. You will notice that this report contains a section devoted to the work of the Sanitary Department. I had not intended to make any special reference to this since I personally think it desirable for a Chief Sanitary Inspector to write his own section in the same way that a Principal School Dental Officer contributes to the report of a Principal School Medical Officer. I find, however, that a certain decision taken by you before my appointment has been widely discussed outside Barking, and that a certain amount of misunderstanding exists on the matter. The Sanitary Officers (Outside London) Regulations, 1935, clearly lay down that the Sanitary Inspector "shall perform under the general direction of the Medical Officer of Health all the duties imposed on Sanitary Inspector by statute and by any orders, regulations or directions from time to time made or given by the Minister, and by any bye-laws or instructions of the Local Authority applicable to his office." In Bark: the post of Chief Sanitary Inspector is now combined with that of Re-Housing Officer, in which latter capacity he has control of certain administrative and clerical staff. It thus seems to me a sensible arrangement to combine the clerical work of the Sanitary and Re-Housing Departments in the same way that one set of staff undertakes both t remaining work of the Borough Council's Health Department and the County Council's Health Area Office. Special attention should be drawn to the laundry service for incontinent chronic sick persons which commenced towards the end of the year. Although this deals with a numerically small group, it is of inestimable benefit to families caring for these patients at home under most difficult conditions when accommodation is not available in hospital. Although his report appears under my name, it records the efforts of all the members of the department during the past year. You are, I think fortunate in that you still have in Barking a team Page 7 as good as will be found anywhere, and to all members of that team I should like to give my thanks for their loyal co-operation. A special word is due to Mr. Ruff for his help throughout the year and with the compilation of this report. To my fellow Chief Officers I owe much for their courtesy and ever-ready help. Lastly, but by no means least, I must thank Members of the Committee, and in particular Alderman Mrs. Engwell for her assistance and forbearance during the early days of my office and for the work she has put in during 1953 (as I have no doubt in many years past) towards the public health in Barking. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Medical Officer o f Health. Page 8 GENERAL PUBLIC HEALTH A CENTURY OF PUBLIC HEALTH IN BARKING. The year 1953 saw the completion of 100 years of public health in Barking. Some attention was paid to matters of health prior to 1853 of course, there being record, for example, of the attention of the Vestry being called to "an irregular practice of occupiers of houses opening to the Back Lane throwing out offal and slops from iheir doors on to the pathway." Two years later the Vicar, Parish Officers and certain other gentlemen were constituted a Committee "for inspecting the state of the town as regards the drains, accumulations of offal, etc., and that they take proper steps for the removal of the same." Infectious diseases too had received attention, for in 1832 a special Board of Health was set up to deal with an outbreak of cholera, whilst is far back as the middle of the twelfth century there is record of an hospital for lepers maintained by Barking Abbey. The Abbess of that time knew a thing or two as the hospital was apparently sited in the parish of Ilford ! The first Public Health Act—the so called Health of Towns Act— had been passed in 1848, and the Central Board of Health energetically let about the creation of local boards of health in districts with death rates above the average. It would appear from Minutes of vestry meetings that your predecessors were not as progressive as yourselves in matters affecting public health, for on the 29th September, 1853, they solved "that is, in the opinion of the vestry, inexpedient that the Health of Towns Act should be introduced into this town." On 17th November, 1853, it was decided to set up a committee to meet an inspector appointed by the general board of health to conduct an enquiry, and "to oppose as far as may be deemed expedient the introduction of the Health of Towns Act into the Town of Barking." Despite this opposition a Local Board of Health was set up and its first meeting on 28th November, 1853, under the Chairmanship of a Dr. John Manley is commemorated by a plaque in the present Council chamber. This Local Board of Health was shortlived, for two years later the Nuisan Removals Act transferred the duties to the vestry. The first Medical Officer of Health does not appear to have been appointed until after the Town Ward had been constituted a local government district in 1882, this event also being recorded by a plaque in the Council Chamber which reads as follows:— Past 9 BARKING TOWN LOCAL BOARD Created by Order of Local Government Board October 5th, 1882. Robert Hewett, Esq., Chairman (December, 1882—April, 1890) Messrs. W. Bewers, F. E. Fitt, S. Glenny, The Rev. H. Lindsell, H. H. Mason, H. Martin, J. Smith and G. S. Trewby. Clerk: C. E. Wilson Surveyor: C. J. Dawson, F.R.I.B.A. Medical Officer of Health: H. H. Mason, M.R.C.S., L.S.A. Inspector of Nuisances: F. Martin Amongst other activities the local board carried out a £21,000 sewerage scheme and built the first infectious disease hospital on Upney Meadows. Its powers were taken over by the newly created Urban District Council in 1895. The Urban District Council carried out extensions to the sewerage system and, in conjunction with Ilford, obtained powers to discharge sewage into the Northern Outfall Works of the L.C.C Plans were also laid to rebuild the Infectious Diseases Hospital and to build a Maternity Hospital, whilst roots of the present clinic services began to form. Rapid expansion followed the incorporation of Barking as a Municipal Borough in 1931, and the development of the L.C.C's Becontree Estate. Later in this report I shall deal in gre; er detail with these personal health services which, by 1948, must ha\ been second to none in the country. HOUSING. Amongst the most important of the duties of a Medical Officer of Health is that requiring him to "inform himself as fa; as practicable respecting all matters affecting or likely to affect the public health of the district and be prepared to advise the authority on any such matter" (Sanitary Officers (Outside London) Regulations 1935). I have not found it possible to make a comprehensive survey of housing conditions within the Borough during my first nine months of office, although I hope to devote more time to this next year. The Page 10 importance of good housing in relation to good health cannot be overstressed, and I would go so far as to say that if I had the magical power of producing houses out of a hat I could do more for the health of the people of Barking than through any of the existing health services. Your points scheme for the allocation of houses does, however, give me power to recommend priority for families where one of the members suffers from pulmonary tuberculosis. A lesser degree of priority can be given in respect of patients with other disabilities, but I have used the latter power extremely cautiously because if widely used affords relatively less priority to those most needing it. I have also been conscious that the maximum number of points I can recommend (five) is small in comparison with the total of about 60 points (which can be amassed by a family on such grounds as length of residence in the Borough, service in H.M. Forces and length of time on the waiting list, quite apart from points given by virtue of need for rehousing. The year was notable in that you commenced work on the New Thames View Housing Estate which will ultimately provide accommodation for some 7,000 to 8,000 people. Whilst I was not serving the Council at the time the scheme was conceived I believe that this was not don. without considerable criticism from without and some misgiving fro within. I feel the Council is to be congratulated on its courage in embarking on this project, for despite the additional expense and higher rents resulting from the erection of houses on this difficult site the tenants will be relieved of the strain and expense of additional tra which would have been imposed upon them had they been rehoused outside the Borough. It is also comforting to feel that you have not contributed to the apparently relentless engulfment of the countryside by the town. Towards t the end of the year the Public Health Committee invited the Housing Committee to consider a proposal for making this new estate a smokeless one. The relative proximity of the Barking Power Station suggested the possibility of establishing a district heating scheme similar to that operating in Pimlico, but although the matter was still under consideration at the end of the year your technical officers had warned you that the particular plant at the Barking Power station might not lend itself to the operation of such a scheme. You accordingly made preliminary enquiries as to the possibility of insisting on the use of smokeless fuels by tenants on the new estate. Page 11 MATTERS OF LIFE AND DEATH. Population The population of Barking at mid-1953, according to the Registrar General's estimate, was 76,800. This shows a further decrease the figure of 78,170 at the 1951 Census. Births 1,090 live births and 33 still births were registered during 1953. distributed as follows:— Live Births:— Males Females total. Legitimate 533 528 1,061 Illegitimate 15 14 29 Totals 548 542 1,090 Still-Births:— Legitimate 17 16 33 Illegitimate - - - Totals 17 16 33 Total Live and Still-Births 565 658 1,123 Birth Rate per 1,000 of Estimated Population 14.62. Birth Rate adjusted by Comparability Factor of 0.93=13.60 Still-Birth rate per 1,000 (Live and Still) Births 29 39. Loss of Infant Life The further slight rise in the still-birth rate is disturbing since a still-birth represents the same wastage as a death occurring shortly after birth, and causes just as much disappointment and distress to the mother. During the year 29 children died during the first year of life As will be seen from Figure I the majority of these deaths took place within the first few days of life whilst the babies were still in hospital. By tradition, our statistics for the loss of infant life are divided into those deaths occurring before birth (the so-called still-births) and those occurring between birth and the first birthday (infant deaths). The infant deaths are sub-divided into those occurring in the first Page 12 month of life (neonatal deaths) and those occurring between 1-12 months of age. DISTRIBUTING OF INFANT DEATHS Figure 1. Trends in these rates over the past quarter of a century are shown in Figure 2, Which well illustrates that the greatest reduction has been made in the death rate for infants aged between 1 and 12 months. Neonatal deaths and still-births have responded to our efforts less dramatically. There is growing realisation that the causes of most neonatal deaths are vastly different from those which result in the deaths of older infants, and that they are more closely related to the causes of death just prior to birth. This has led to the conception of a "peri-natal mortality," a rate based on the total of deaths occurring before, during, or shortly after birth. Figure 3 demonstrates the trends in loss of infant life over the same period, dividing deaths into the "peri-natal" (pre-natal+ neonatal) and 12 month periods. It shows most vividly that our attack must b concentrated on the peri-natal deaths, particularly since these have tended to rise in recent years. These peri-natal losses cannot be prevented by our infant welfare services but car, only be attacked by more intensive research into their causation, and the application of knowledge so gained in our ante-natal clinics and maternity hospitals. Page 13 Page 14 DEATHS. Causes of Death in 1953 Total Tuberculosis and other Infectious Diseases.. 19 Cancer and other Malignant Diseases 141 Diseases of the Brain and Nervous System 67 Diseases of the Heart and Circulatory System 216 Pneumonia, Bronchitis and other respiratory diseases (excluding T.B.) 92 Diseases of the Stomach and Digestive System 10 Accidents, Poisonings and Violence 23 Infant Deaths and Congenital Malformations 32 Other causes 45 Total 645 Crude Death Rate per 1,000 Estimated Population 8.40. Adjusted Death Rate (Comparability Factor 134)= 11.17. It will be seen from the above table and from Figure 4 that diseases of the heart accounted for about one-third of all deaths in Barking during 1953. Cancer and diseases of the brain between them were responsible for another third, whilst to the remainder only certain chest diseases made a substantial contribution. These bare figures and percentages hide much of interest, however. Deaths caused through heart failure, for example, mainly occur in more elderly persons who have enjoyed their full pan of life Numerically smaller deaths from such conditions as tuberculosis and by accident represent a proportionately greater wastage of life, since those who succomb to them are often cut off in the prime of life when they have family responsibilities and are making their maximum contribution to society. I have, therefore, thought it of interest to examine the loss of expected life due to the main causes of death, and for this purpose I have taken the biblical three score years and ten as an arbitrary expectation of life for both men and women. For example, a man aged 68 dies from heart failure, so two years are marked up against "heart disease." If a young woman of 30 dies from tuberculosis then years are put against "T.B. and other infectious diseases,'' whilst an infant death contributes 70 to "infant deaths and congenital malformations." Page 16 Figure 5, prepared in this manner, shows that loss of life due to diseases of the heart is equalled by that due to infant deaths. When it is remembered that pre-natal deaths (still-births) are excluded from consideration, the importance of infant life wastage is again emphasized. Cancer, diseases of the brain, and chest diseases all diminish slightly in importance, whilst tuberculosis becomes twice as important and the significance of accidents, suicides, etc. more than doubles. MORTUARY FACILITIES. The Borough Mortuary has been out of use since the end of 1952 owing to the illness and the eventual retirement of your former mortuary keeper. Partly in view of your difficulties in appointing a suitable successor but mainly owing to your realisation that the existing wilding lacked modern amenities, you agreed to continue the temporary arrangements Tor the use of the Ilford mortuary pending the provision of proper facilities in Barking. It was apparent from the outset that it would be uneconomical to build, equip and run a mortuary solely for our own use, and you accordingly considered proposals for the joint use of the mortuary at the Barking Hospital. Plans were prepared for the enlargement and modernisation of this mortuary, including the provision of a refrigerating plant and the addition of a viewing chapel and waiting room for relatives. ese works, together with the provision of the necessary equipment, which would have cost between £3,000 and £4,000 were to be borne entirely by the Borough Council, whilst running costs were to be shared by the Council and the Ilford and Barking Group Hospital Management Committee. Unfortunately your proposals were not favourably received by the Hospital Management Committee and this tractive plan had to be abandoned. it was known that our neighbours in East Ham were in a similar position and that they were also hoping to rebuild. A proposal for the erection of a joint mortuary was turned down by the East Ham Council, although they offered us facilities when their new mortuary as available. You eventually decided to make permanent arrangements for the continued use of the llford Mortuary and you were fortunate in obtaining the co-operation of the Ilford Borough Council. Page 17 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT. Bye-laws made by the Borough Council under the provisions of the Essex County Council Act, 1933, enable the Council to register and supervise establishments within the Borough for the giving of massage and special treatment. Four establishments exist in Barking, mainly for the purposes of chiropody, and the licences were renewed during the year. INFECTIOUS DISEASES. The following notifications of infectious diseases were received during the year:— Measles 460 Whooping Cough 449 Scarlet Fever 140 Tuberculosis 92 Pneumonia 65 Dysentery 59 Food Poisoning 21 Puerperal Pyrexia 20 Erysipelas 14 Scabies 12 Acute Anterior Poliomyelitis 8 Meningococcal Infection 2 Ophthalmia Neonatorum — Pemphigus Neonatorum — Typhoid and Paratyphoid Fever — Diphtheria - Measles The 460 cases of measles were all notified early in jthe year and represent the tail end of the 1952 epidemic. Whooping Cough There was a small outbreak of whooping cough during the earl) summer months accounting for most of the 449 cases rotified. It is to be hoped that with the gathering momentum of whoops cough immunisation the severity of this disease will continue diminish and that there will be fewer complications leading to permanepI damage of the lung. Page 18 Tuberculosis With the exception of 1939 when figures were no doubt artificially low, this is the first year in the Borough's history in which the total number of notifications of tuberculosis has been below 100. Of the 92 cases notified 78 were respiratory and 14 were non-respiratory. Again with the exception of 1939, the number of cases of respiratory tuberculosis notified is also the lowest on record. Optimism must be tempered, however, by my impression that there is a somewhat widespread reluctance amongst chest physicians to notify a patient as a case unless active treatment is required. This attitude seems to me most unfortunate since, irrespective of whether treatment is or is not needed, the patient must have caught the germ from someone else and notification should be made as the first step in epidemiological investigation. There were 580 cases on the Chest Clinic Register at the end of the year after the removal of those who had been discharged as "case arrested." Again I think this figure gives a somewhat optimistic picture of the situation, since it does not include those patients who refuse to accept treatment and more particularly since it excludes those patients who are under observation for tuberculous infection but whose disease does not call for active treatment and thus have not been notified. One of the more modern weapons against tuberculosis is mass radiography, and in common with many of my colleagues I feel it to have been unfortunate that this service was placed under the control of the Regional Hospital Board rather than in the hands of those whose primary interest is prevention. The National Health Service Act has divided responsibility for the tuberculosis services between the Regional Hospital Board (Chest clinic buildings, chest physicians, clerical staff and mass X-ray units), the Local Health Authority (T.B. Health Visitors, Occupational Therapists, Prevention, Care and After-Care) and the Local Sanitary Authorities (notifications and rehousing). In many areas this has led to lack of co-ordination and has had the result that treatment of the disease is now regarded as more important than prevention. In Barking we must regard ourselves as fortunate in that close liaison has been maintained with the Chest Clinic. This is, in no small measure, due to the attitude of the Consultant Chest Physician and I should like to record my appreciation of the courtesy and the very ready help and co-operation which I have always received from Dr. Paterson. Page 19 Dysentery and Food Poisoning Figures for dysentery and food poisoning show a four-fold increase over those for last year. This is largely accounted for by an outbreak in the Woodward Road area towards the end of the year. Since most of the cases notified were amongst school children I have dealt with the details of this outbreak later in this report. The Public Health (Infectious Diseases) Regulations 1953, which came into force during the year, gave us further useful powers for the control of food-borne infection, and for the first time specifically mentioned salmonella infections (other than typhoid and paratyphoid) and staphylococcal infections as causes of food poisoning. Whilst we have had certain powers in respect of patients actually suffering from certain of these diseases, we have hitherto had no means of dealing with the very much more dangerous carriers of these infections. The Regulations gave powers, which you have delegated to me, by which carriers of these diseases working in cafes or food shops can be excluded from work until they are free from infection. They also give you power to require the examination of any employee suspected of being a carrier. Puerperal Pyrexia Of the 20 cases notified 3 related to a small outbreak of streptococcal infection in one of the wards at the Barking Hospital. Four patients were involved, in each case haemolytic streptococci being isolated from vaginal swabs. Haemolytic streptococi were also isolated from the throats of two members of the nursing staff and one maid, and one of the former had a small septic lesion on the thumb from which haemolytic streptococci were also isolated. The ward was closed for 10 days and the members of the staff concerned were excluded from duty until three consecutive negative throat swabs had been obtained. Unfortunately neither of the two notifications received by the time this action was taken indicated the cause of the pyrexia and no typing of these organisms was carried out. It was thus impossible to be certain of the exact source of infection. Poliomyelitis Of the eight cases notified, five were paralytic and three were non paralytic. There were, fortunately, no deaths. Of the five paralytic cases two recovered completely, one has a slight weakness of a shoulder Page 20 muscle, one has an almost imperceptible speech defect due to weakness of the soft palate, whilst only one is likely to have any serious permanent disability. THE PHYSICALLY HANDICAPPED. For many years you have had certain responsibilities for young handicapped persons in Barking through your child welfare and school health services. Prior to 1948, however, the care of the adult handicapped lay mainly in the hands of voluntary associations. The National Assistance Act placed on County Councils and County Borough Councils the duty of preparing schemes for the welfare of the blind, but unfortunately only made optional the development of similar schemes for the deaf and for the physically handicapped. It seems to me a great pity that Essex, like many other County Councils, decided to delegate to a separate welfare committee the duties and powers given it under the 1948 Act. In most cases handicapped persons have been under our care during childhood, and they are well known to the Health Visitors and School Medical Officers. Since their problems invariably involve medical factors it would surely have been preferable for the Health Committee to undertake these new duties which would, presumably, have been decentralised to health area subcommittees. This would have given local members the opportunity of providing those services most needed, and would have obviated the need for the appointment of yet another special social worker. It would also have rendered easier the task of liaison with other local officers. In Barking the gap has been filled to some extent by the formation of the Barking Association for the Physically Handicapped, which is fortunate in having the Chairman of the Public Health Committee as its Chairman and your Senior Administrative Assistant as its Honorary Secretary. Whilst this association has strong local knowledge and initiative, it is severely handicapped by lack of funds. Other voluntary bodies helping the physically handicapped include the Invalid Children's Aid Association, the Shaftesbury Society and the local branch of the National Spastics Society. Others such as the National Association for the Paralysed, the Infantile Paralysis Fellowship (for patients paralysed by poliomyelitis) and the Tuberculosis After Care Committee (for those with tuberculosis of bones or joints) could wall come into the picture. It will thus be clear that it is not only the statutory services which require co-ordination and unification. There seems much to be said Page 21 for the formation of a Council of Social Services to co-ordinate the functions of all appropriate voluntary associations working in the area, and to liaise with statutory authorities. PROBLEM FAMILIES. It is not easy to define what one means by a "problem family"one can only describe the imaginary but typical case of the Browns. Mrs. Brown is now 27 and has been known to us since her family moved into Barking some 20 years ago. She was always backward and attended the Faircross Special School. After leaving she never settled into any regular job and received little supervision from her own parents. She became pregnant at the age of 17, but concealed her condition and had a premature delivery, the baby dying after 24 hours. She eventually married Mr. Brown and they now have four children. It has always been difficult to persuade her to attend ante-natal clinics regularly and to follow the advice given her by the Medical Officer She is a poor manager and her children are dirty, poorly clothed, and badly fed—much to the despair of the health visitor who has done her best to guide her. She blames lack of money as the cause—despite the fact that she herself goes out to work and can afford to be a chain smoker. Her general health is not good and she was advised to attend the Family Planning Clinic, but we were unable to persuade her to do so and she is due for a further confinement next month. Mr. Brown is 30. He spent much of his childhood in a children's home, his father having deserted the family. He believes himself to be in poor health, despite the fact that repeated hospital investigations have shown him to be free from physical disease. He seldom remains in one job for long, usually giving it up on the pretext of his "illness and refusing offers of other employment made by the Labour Exchange on the grounds that the work is unsuited to his state of health. During these intervals the family live largely on National Assistance until Mr. Brown is threatened with proceedings for "failure to maintain the family," miraculously improves in health and accepts another job. If Mr. Brown happens to be working when his wife has her baby we confidently expect that he will once again give up his job and live on his wife's maternity grant. He has little understanding of his children's emotional needs, and takes little interest in them except occasional!) to cane the elder boy to enforce "discipline." Page 22 John, aged 8, has been a member of a small gang engaged in pilfering from chain stores and is now under the supervision of the Probation Officer. Mary, aged 6, has recently been referred to the Child Guidance Clinic on account of her extremely difficult behaviour at school. Both these children have been poor school attenders in the past and the parents have been before the Education Welfare SubCommittee on this account. A third child died at the age of 18 months from whooping cough—the parents, up to that time, having refused to allow any of the children to be immunised. The two youngest children aged three years and eighteen months are at present left in the day nursery whilst their mother is out at work. The N.S.P.C.C. Inspector has been concerned over this family in view of the fact that the parents used to go out at night leaving no one to look after the children. Six months ago the family were evicted for non-payment of rent despite the fact that at that particular time Mr. Brown had a reasonable job and was well able to pay. Mrs. Brown and the two youngest children are now living in one small room in her parents' house, which was already overcrowded. Mr. Brown is living in lodgings and the two older children had to be taken into the case of the Children's Department. This is a sad story so far as it goes, but there is likely to be an even unhappier ending. Least serious of all is the fact that the cost of maintaining the two children in the care of the Children's Departmet will be something like £10 per week for an indefinite period—and remember here that Mr. Brown's arrears were only £8. The real tragedy lies in the fact that the family is split, and is likely to remain since no Council is keen to rehouse a family evicted for arrears of rent when there are so many applicants on their waiting lists. The children will grow up lacking the background and security which is as essential for their emotional development and mental health as vitamins and proteins are for their physical growth. They in their turn, will be liable to "nervous" illness, they are likely to make unsatisfactory marriages and will probably make poor parents for their own children. This is a vicious circle which must be broken, but which in the past has only too often continued its turn unchecked, despite the utmost efforts of the numerous skilled social workers who have had dealings with the family. The break-up of the family must be prevented. Following the receipt of the joint circular from the Ministries of Health and Education and the Home Office in 1950, many Counties Page 23 and County Boroughs appointed Co-ordinating Officers in order to co-ordinate the activities of the many statutory authorities and voluntary bodies interested in the welfare of children from such families, So far as I am aware no co-ordinating officer was appointed for Essex, and indeed the area is too vast and diverse to make the appointment of only one officer of much value. Soon after I took up my duties in Barking, Inspector Holmes, who represents the N.S.P.C.C. on the Health Area Sub-Commitlet, submitted a report on the activities of his Society. Arising out of this and of conversations with Mr. Holmes, I decided to call together) meeting of those interested in the welfare of Barking Children. There was a gratifying response and our first meeting, on 1st July, 1953, was attended by the following:— Superintendent Health Visitor, Barking Health Area Senior Education Welfare Officer, Barking Committee for Education Rehousing Officer, Barking Borough Council Inspector Holmes, Barking with Dagenham Branch N.S.P.C.C Manager, Barking Office, National Assistance Board Children's Visitor, County Children's Department Probation Officer, Becontree Division Psychiatric Social Worker, Ilford Child Guidanr Clinice It was decided to hold regular monthly meetings and Iso to invite a duly authorised Officer from the County Mental Health Department It is not possible to assess the value of our meetings solely on the first six months experience, but I know that all concerne have found the personal contact with their colleagues in other depai ments of the utmost value. I think we can also claim that in some cases where two, three or more workers had been visiting we ha e prevented wasteful and irritating overlapping of services. It was agreed in each. instance that only one worker would continue supervision, reporting back to the Committee when there appeared to be need for further action. The creation of such a committee does not, of course, enable us to provide help which is beyond the power or scope of its individual members and their respective departments or organisations, but the free discussion on possible lines of action has been most valuable in determining policy with regard to some families. Since "co-ordination" is the catchword of today, it might be of interest to remark upon certain inherent difficulties where bounds and catchment areas of the departments concerned differ widely. Page 24 Owing to the policy of the County Health Committee in decentralizing personal health services to correspond with borough boundaries, at least two of our members—the Superintendent Health Visitor and the Senior Education Welfare Officer—cover the same area, that of the Borough of Barking. Strangely enough, the Rehousing Officer is only responsible for a portion of the Borough owing to the fact that the Becontree Housing Estate is managed by the London County Council. During 1953 the N.S.P.C.C. Inspector was responsible for Barking, most (but not all) of Dagenham, a part of West Ham and a part of East Ham. The local office of the National Assistance Board covers Barking and the southern portion of Ilford. The Children's Visitor works from an office which covers that part of the County lying in the Boroughs of Barking, Ilford and Dagenham, she herself being responsible for Barking together with a portion of Ilford. The Psychiatric Social Worker from the Child Guidance Clinic is likewise responsible for Barking and a part of Ilford. The Duly Authorised Officers work from an office in Romford which covers Ilford, Barking, Dagenham and Romford. Three of these officers cover the boroughs of Ilford and Barking, and any one of these three might consequently deal with Barking cases. To complete the picture the Probation Officers are attached to the Becontree Division, their territory co iprising Walthamstow, Leyton, Ilford, Barking and Dagenham. THE AGED. It is well known that our population is "ageing," the result largely of a falling birth rate, a smaller proportion of children, and hence an ncreased prortion of older folk. The act ties of our public health service, however, have also played their: part since more people now live into "old age." Sanitary enginee. with provision of pure water supplies and sewage disposal schemes, has eliminated such scourges as typhoid fever and cholera. Our infant welfare services have reduced infant mortality to less than; fth of what it was some 50 years ago, whilst deaths Prom infectiou diseases other than tuberculosis are now rare. As a suit expectatn of life has increased markedly. A baby boy born in 1900 could expect to live on the average 44 years—whilst today his expectation of life is 66 years. For the "weaker" sex, the average life span has risen from 48 years to 71 years during the past half Century. Whilst many more people are living into old age, however, the old people liemselves are not living substantially longer. For Page 25 example, in 1900 a man of 65 could expect to live a further 11 years, whilst today his expectation of life is only another 12 years. Some of the results of the increasing proportion of old folks in our midst are all too familiar. We know of the great difficulty in finding hospital beds for the aged sick and of the great increase in demands on the home help service in recent years. Not only are there more old people needing care but they are more willing to accept it now that the stigma of the Poor Law has been removed. Smaller families and the tendency of children to seek employment away from their home town has left fewer close relatives in the vicinity of their ageing parents. Fortunately only a small proportion of our old folk are infirm or sick; however, and the majority maintain their health for than hitherto. This, together with other factors, has led to consideration of the desirability—both for the individual and the community—of continuing employment beyond the previously accepted retiring age, and there is a growing body of evidence to suggest that this actually helps to postpone the ageing process. Post-war legislation tacitly assumes that the aged can be meekly divided into three groups, the able-bodied, the infirm, and the chronic sick. Unfortunately the old folk have the temerity not to allow themselves to be thus neatly pigeon-holed, and some even have he audacity to change from one category to another! For the able-bodied the Borough Council can provide houses, and I am pleased to record that you are making special provision on your new Thames View Housing Estate for these old people. If you wished, this accommodation could be grouped to form an hostel and you could also provide laundry facilities and a restaurant service which, I am sure you will agree, would be a boon to the less active. The Council also makes financial grants to the Old People's Welfare Committee, which is thereby enabled to make available recreational facilities for the aged (such as Old People's Clubs)and to provide schemes such as that of subsidized mid-day meals. The bodied also have the opportunity of using such facilities as those provided by the Health Area Sub-Committee in the foot clinics. The aged infirm who can be cared for in their own homes are assisted by the home help service, and they receive supervision from the health visiting staff (both administered by the Health Area subCommittee). The "Meals-on-Wheels "service is provided by the old People's Welfare Committee, whilst if residential accommodation required this is the responsibility of the County Welfare Committee Page 26 who themselves have a separate staff' of visiting officers. If an old person refuses to accept an offer of residential accommodation despite the fact that he is living in insanitary circumstances and is not receiving due care and attention then it is the Borough Council, on my recommendation, which secures a court order for compulsory removal. One such case had to be dealt with under Section 47 of the National Assistance Act during the year—an old lady living by herself in an upstairs flat under grossly insanitary conditions and quite incapable of looking after herself. Although unwilling to leave home she settled down happily in St. George's Hospital and has remained there voluntarily. I should like to record my appreciation of the assistance received from Mr. Fisher, Area Welfare Officer, in this case. The aged sick being nursed in their own homes, either through choice or lack of hospital beds, have available the services of the district nurses (administered from the Lady Rayleigh Training Home, Leytonstone by the Training Homes Sub-Committee of the County Health Committee), and Home Helps (Health Area Sub-Committee). The latter Committee also has power to provide a service of night attendants to relieve relatives in cases where the patient is restless at night, although it was not possible to inaugurate such a service during 1953. The Committee has also made an endeavour to provide a domiciliary chiropody service for patients confined to their beds or homes, although the Ministry of Health has unfortunately refused to sanction such extension to the service—allegedly on financial grounds. Such patients are thus still brought to the clinics by ambulance (one presumes that this costs nothing, and that the ambulances have nothing better to do!) In a further effort to help relatives nursing incontinent patients at home, the Borough Council has inaugurated a laundry service using powers under Section 84 of the Public Health Act. This service, free to the patient, provides for the laundering of soiled articles such as sheets and night clothes at the Barking Hospital Laundry by arrangement with the Hospital Management Committee. Collections and deliveries are made three times per week. Since this service commenced, an average of five hundred articles per month have been dealt with and seven cases were being assisted at the end of the year. The help given to these families is invaluable. There has been the greatest difficulty in obtaining hospital beds for the elderly sick—even in cases of urgency. Within the Ilford and Barking group of hospitals there are only 22 chronic sick beds—all for women—at the Barking Hospital, and admissions are controlled by the Page 27 Surgical Registrar at the King George Hospital, Ilford! Most Barking patients have to be admitted to the St. George's Hospital, Hornchurch, which is administered by the Romford Group Hospital Management Committee, and admissions to which are controlled by the Medical Superintendent of the Oldchurch Hospital, Romford! In neither case does the physician in charge of the beds see the patients before admission in order to assess medical needs, and routine reports on social conditions are not requested, although we send health visitors' reports where home conditions are exceptionally bad. It is thus not surprising that on occasion we feel those with the greatest need of a bed are not necessarily admitted first. The position is aggravated by the fact that many hospital beds are blocked by patients who no longer require skilled nursing or medical attention but who cannot look after themselves. There are seldom vacancies in the County Welfare Department's hostels to which they can be transferred, and difficulties also arise where a patient considered too fit for hospital is classed as too infirm for a hostel! I have the feeling that many old people at present in hostels could have been kept at home had suitable facilities been available, and this aspect is one to which we must devote more attention in coming years. It involves the provision of special housing accommodation—ground floor, compact and easily managed—and routine visiting so that appropriate supporting services such as home helps and meals-onwheels can be brought in to assist before deterioration sets in. The elderly prefer to remain in the familiar surroundings of their own homes—let us do our best to keep them there whenever possible. LOCAL GOVERNMENT RE-ORGANISATION. The last major re-organisation of local government in this country was effected by the 1888 Act which created County Councils and County Borough Councils. This, you will recollect, was only a few years after your first Medical Officer of Health was appointed. Since then the services provided by local authorities have increased in nature and in scope out of all recognition, but the framework of local government has hardly altered. The 1929 Local Government Act concentrated certain powers into the hands of County Boroughs and County Councils, a process which has been taken a step further by post-war legislation. During 1953 the various local authority organisations have been giving detailed consideration to the problems involved, but their reports were not available by the end of the year and in any case it is not for me to comment on the problems of local government in general. Page 28 Scattered throughout this report, however, you will find reference to difficulties experienced in co-ordinating services provided by various statutory authorities and voluntary bodies with widely different boundaries and catchment areas and with functions which often overlap or fail to link up with each other. So far as the health services are concerned, I think there is much to be said for the functions of the existing local health and local sanitary authorities, local education authorities, the hospital management committees and local executive councils, all being administered by one elected body in one given area. In order that the services may be controlled locally, the district should contain a population not exceeding 250,000 and should, if possible, cover both urban and rural areas. (Unfortunately an impossibility in the conurbations.) Perhaps I should also make it quite clear that I am not suggesting that the Medical Officer of Health should necessarily be the senior administrative officer of such a comprehensive health authority, indeed, I think there is much to be said for freeing him for his most important functions—those of epidemiologist and health educator. Certain highly specialised hospital services would still have to be provided on a wider basis and elsewhere I have suggested that likewise ambulance services should be organised regionally. These and other lunctions such as Town and Country Planning, Fire and Police services at present administered by County Councils could well be passed to a limited number of new Regional authorities—in some cases formed by a combination of smaller counties. I realise that proposals of such a nature will not find ready acceptance involving, as they do, the merger of some smaller authorities and the transfer back of certain functions from many "major" authorities. Nothing less than the radical will suffice to strengthen cur local government system however. Unless it is strengthened and rejuvenated still more services will inevitably be turned over to specially seated bodies of centrally appointed, rather than locally elected, members. Local Government will then cease to attract members and officers of the same high standards and abilities as hitherto and will wither away. Page 29 PERSONAL HEALTH SERVICES The National Health Service celebrated its fifth birthday during 953. It is generally agreed that much has been achieved in these first five years, although there is an almost equally widespread feeling that improvements could be made in its administration and available monies spent to better advantage. This was recognised during the year by the setting up of the Guillebaud Committee, whose report will be eagerly awaited by those whose faith is that "prevention is not only better, but also cheaper, than cure." It may be of interest to consider certain of the services which you have built up in Barking mainly during the past quarter of a century and as we find them five years after the "appointed day." HOSPITAL SERVICES When my predecessor came to Barking in 1927 the infectious diseases hospital was housed in what I have had described to me as a "tin hut." his contained 40 beds for infectious cases and, in a separate portion of the building, 12 beds were available for maternity cases. In 1931 the first portion of the new permanent infectious diseases hospital, known as Barking Hospital, was opened and in 1935 the second porton was completed. Before' the war this Hospital, with its complemen- of 108 beds, was substantially filled with patients suffering from such seases as diphtheria, scarlet fever and erysipelas. At the comme ement of hostilities all Barking people suffering from infectious diseases were sent to hospitals in other districts. So great has been th fall in the incidence of diphtheria and the severity of scarlet fever hat since the war there has been no need for special accommodatn to be provided in Barking for such diseases. It is impossible to Compute the enormous sums of money which must have been spent nationally years ago upon the hospital treatment of patients suffering from diphtheria, but I note from my predecessor's annual report for 1927 that a four months' stay in hospital for a diphtheria case was not at all uncommon. As an aid to the work of the Barking Hospitals, a small but well equipped laboratory was built and the high esteem this unit gained many years ago is still maintained. I note that in 1935 no less than 2.792 swabs were examined for diphtheria bacilli but such swabs are rarely taken now. This fact alone must mean that a significant proPortion of laboratory facilities are now available for other investigations. Page 31 A new permanent maternity pavilion—the Upney Pavilionproviding 24 beds was opened in 1936, and it was planned that this building should be duplicated to double the bed complement, but the outbreak of war prevented this development. At the end of the war the decision that the Barking Hospital should not revert to the reception of infectious disease cases led to accommodation becoming available for other purposes. Amongst other things it gave a happy solution to the problem of finding a new home, complete with X-ray facilities, for the Chest Clinic which for many years had been accommodated in very cramped quarters in a house in Linton Road. In addition Harvey and Sydenham Wards were taken into use for maternity and gynaecological cases. A small unit for chronically sick female patients has been opened in the Jenner Ward and Paget acts as an "overflow" for certain clinic services which cannot be fitted into the overloaded Upney Clinic. The Barking Hospital, together with the Upney Maternity Pavilion, came under the administrative control of the Ilford and Barking Group Hospital Management Committee of the North East Metropolitan Regional Hospital Board on the "appointed day," but my predecessor continued to hold the post of Medical Sup rintendent until his official retirement on 15th January, 1953. Whil t I do not pretend that it is necessary or even desirable for a speci ist in preventive medicine to spend too much of his time acting ac a hospital administrator, this appointment must have provided a .trong link between the hospital and the preventive services in the B rough. A measure of liaison with the Hospital Management Committee is secured by the fact that three members of the Council are also members of the Hospital Management Committee, whilst at officer level I have endeavoured to bridge the gap by working closely be h with the Secretary of the Hospital Management Committee and with the Senior Medical Officer at the Barking Hospital. It is a pleasure to record my appreciation for their help and co-operation, which has een steadily building up during 1953. I am hopeful that the link will be strengthened during the forthcoming year by my membership of the Group Hospital Medical Advisory Committee. The need for co-operation between the various branches of the service is of particular importance in the case of the maternity and tuberculosis services and in the provisions for the welfare of the elderly, matters which are discussed in greater detail elsewhere in this report. Page 32 LOCAL HEALTH AUTHORITY SERVICES On the "appointed day "services which you had provided as a welfare authority under the Public Health Act were transferred to the Essex County Council, although the administration of certain of these services was decentralised to the Barking Health Area Sub-Committee for the purposes of day to day control. Of the 29 members of the Health Area Sub-Committee, 15 are members of the Borough Council, 7 (including the Chairman and ViceChairman of the County Health Committee ex officio) are appointed by the County Council, and of the remainder one is nominated by each of four voluntary associations and one by each of the Ilford and Barking Group Hospital Management Committee, the Local Executive Council and the Local Medical Committee. The meetings of this sub-committee are arranged to take place immediately preceding meetings of your Public Health Committee, thus helping to ensure the comprehensive consideration of all matters affecting tl health of the people of Barking on the same evening. The effort keep the environmental and personal health services in one functional unit is also reflected in my joint appointment as Medical Officer of I alth and Area Medical Officer, and by the fact that the Public Health Department and Health Area Office are administered as one—ne ssary financial adjustments being made between the authorities ncerned in respect of joint use of administrative staff. Despite this I think it true to say that you remain far from satisfied with these arrangements. I believe I should be right in assuming that your attitude was particularly well summarised in the following extract fron a recent leading article in The Times, dealing with local government and the need for re-organisation:— "This legalistic nonsense has forced the transfer of many essentially local and personal services to county councils, which are often too big and remote to conduct them in the right spirit and have frequently delegated them back for daily management to 'minor' authorities perfectly capable of assuming full responsibility." health centres On more nan one occasion my predecessor pointed out that certain Barking clinics are already designated as health centres under the National Health Service Act. Such designation was made largely to enable the public dental scheme to be continued by arrangement Page 33 page 34 with the newly formed Local Executive Council, and in the case of the Manor and Bifrons clinics these are health centres in name only. A true health centre provides under one roof facilities for the patient to consult family doctor, health visitors, other members of the local authority team and, where necessary, hospital specialists. A consideration of the development of the services in Barking will show how near you came to this ideal prior to the introduction of the National Health Service. A quarter of a century ago there were three clinics at liarking— Alexandra, Greatfields and East Street, whilst a classroom at Faircross Special School was used for ultra-violet ray treatment. The Alexandra clinic, housed in a temporary building, had limited facilities and was used for infant welfare and ante-natal sessions until its demolition in 1939. Greatfields Clinic, in a more permane building, is still being used although likewise for maternity and cl id welfare services only. East Street was the major clinic of the town and provide services for mothers, infants, and school children, including dental treatment and specialist eye services. It is interesting to read that at that time "by instruction of the Board of Education, the following scale of charges has been made:— (a) Spectacles 2s. 9d. per pair (b) Tonsils and Adenoids operations 5s. per operation (c) X-ray treatment No charge (d) Minor Ailments Is. per 3 months, after 14 days free treatment (e) Dentistry 6d. per extraction, and ls fillings or w ing (f) Orthopaedic treatment No charge Free medical treatment will continue to be given where parents cannot afford to pay." Although most of these services were transferred frc a East Stree to the newly erected Central Clinic in 1934, the buildii gs have been used for one purpose and another ever since. Part was used for health visitors offices, and dental services continued in the remaining portion of the building until the onset of war. It was then used to house the first public foot clinic until more spacious accommodation could be provided, since when it has been re-equipped as a dentai surgery. Following closely on the erection of Central Clinic, new buildswere opened in Woodward Road in 1935 to serve the rapidly expanding Becontree Estate, but your plans for a permanent clinic in the Porters Avenue area were thwarted by the onset of war. At the end of hostilities Central Clinic remain unscathed, but Woodward Clinic had been severely damaged by enemy action and a civil defence building had been grafted on to the remaining fabric of the original building. Of the other first aid civil defence posts built in the town, the one at Upney Hospital and the one in Porters Avenue were earmarked for incorporation in the post-war clinic service of the town, but only as a short term policy. The Porters Avenue premises were eventually adapted for clinic premises according to the plans of the Borough Architect and despite the limitations imposed by the substantial fabric a well planned clinic building has been created, which will serve the area for some years to come. The orthopaedic and physiotherapy service had become very cramped in its home at Faircross School, and was re-housed in classrooms at lie Manor School. It is now hoped that this clinic, which provides all the facilities to be found in the out-patient department of a first lass hospital, will soon be transferred to more suitable accommodation in the Barking Hospital. The enormous growth of the dental service made it necessary to multiply the number of surgeries available and centres were opened up at the Bifrons and Manor Schools, whilst a dental laboratory was set up to lanufacture dentures and the appliances necessary for orthodontic treatment. The Commencement of the war had seen the virile growth of new services. For a number of years clinic services in the town had been accepted as an essential part of the provision for patients coming within the school health and the maternity and child welfare schemes, but their facilities were still denied to patients outside these two categories. A foot clinic had been started in 1938, and dental services were next made available to adults. In the policy of bringing services to the people's doorstep, the consultant specialist schemes were next expanded to include all Barking residents who became entitled to attend Consultant skin, Orthopaedic, Ophthalmic and Ear, Nose and Throat clinics. Moreover, every effort was made to ensure that where obligatory the smallest possible charge was made to the public using such services. Neither must it be forgotten that for 11 years prior to the introduction of the new Health Service you had been operating a scheme whereby mothers and children attending your clinics could be given Prescriptions for medicines which were dispensed free to the patient by arrangement with local chemists—a power which has now been lost. Page 35 It will thus be seen that prior to the "appointed day" it only remained to make family doctor services available to adult males and the elderly for the clinics to have become health centres in the fullest sense. It now appears unlikely that new health centres will ever be built on the scale envisaged when the National Health Service Bill was under consideration, and preparation of the County Development Plan during the year has caused further consideration of long term policy. It was originally planned to have five health centres, each conveniently situated in the neighbourhood unit to be served, but owing to the decision that such neighbourhood units should cater for a population of 20,000 instead of the 15,000 previously envisaged Barking was "rationed " to four health centres. The area comprising the Becontree Estate north of the District Railway and a similar area to the south still form obvious units. For the Becontree north area it had been hoped to reserve a site in Cannington Road but unfortunately this was earmarked exclusively for educational purposes in the County Development Plan, and you have somewhat reluctantly decided to accept an alternative site in the Mayesbrook Park adjacent to the proposed community centre. This is situated at the very periphery of the unit and across busy Lodge Avenue, and when the time comes you may wish to consider the possibility of a multi-story building on the site of the existing Porters Aven e clinic. The originally suggested site on Castle Green remains to serve Becontree South, and here it may later be possible to incorporate a day nursery to replace the existing Gale Street Nursery. The older end of the Town was to have been served by a centre on the St. Paul's Church site but since this was allocate for other purposes you decided to earmark a site in the vicinity of proposed New Town Hall and the area of Central redevelopment. this centre is not likely to be needed for many years to come, and in view of the excellent condition of the existing Central Clinic you may later decide simply to extend the present building and build a new wi to accommodate the dental surgeries still at East Street, the Centra Foot Cliniv and the Dental Workshop. For the fourth centre the Rosslyn Road site provisionally marked on the draft Development Plan has been abandoned and the Health Area Sub-Committee has adopted my suggestion of a site within the Page 36 CLINIC SERVICES IN BARKING Area Served Clinic Services Provided Western end of Town ("Old" Barking) + Central Ante-Natal Infant Welfare Immunisation Dental Minor Ailments øEar, Nose and Throat øOpthalmic (including squint Chiropody training) Chiropody East Street Dental Greatfields Ante-Natal Infant Welfare Manor a nd Eastbury Estates Upney Ante-Natal øObstretic øGynaecological Post-Natal Infant Welfare øPaediatric Immunisation Minor Ailments Paget Ward (Barking Hospital) Birth Control øSkin Speech Therapy + Manor Dental øOrthopaedic (including Physiotherapy) Becontre North + Porters Avenue Ante-Natal Infant Welfare Immunisation Dental Minor Ailments øOphthalmic Chiropody + Bifrons Dental Becontree South + Woodward Ante-Natal Infant Welfare Immunisation Dental Minor Ailments øOphthalmic Chiropody + Designated as Health Centres for Dental Purposes. ø Consultant Specialist Servirp. Page 37 grounds of the Barking Hospital, where there will be an ideal opportunity to develop even closer contacts with the hospital and specialist services. I believe this idea closely resembles a pre-war concept of a "polyclinic" which would form your main health centre and accommodate all those specialist services which could not be provided in each of the other centres. I hope that it will soon be possible to make a modest start on this project by rebuilding the existing Upney Clinic on the health centre site, instead of spending the money on alterations and additions to the existing clinic which had originally been approved for the 1950/51 Capital Building Programme. The draft County Development Plan provided for a health centre on your new Thames View Housing Estate, but since the ultimate population of this Estate was not expected to exceed 7,000 it would clearly have been inappropriate to allocate one of your four major health centres to this area. Provision is being made for clinic premises to be situated in the centre of the Estate close to the shoppin area and adjacent to the schools. The Local Executive Council has been offered accommodation in this clinic for general practitioner services, and we shall all eagerly await the outcome of this approach. Much has been talked for the need for co-operation between the general practitioner and the local health services. In my view this is a golden opportunity to develop the health centre concept with local authority health visiting nursing and secretarial staff to assist the family doctor in his practice, and the general practitioner carrying out for his own patients ir mach of the work traditionally performed by local authority medical officers I sincerely hope that the opportunity will not be missed for it will not present itself again. CARE OF MOTHERS AND YOUNG CHILDRE> MATERNITY SERVICE The National Health Service Act has created a split in idministrative responsibility for the maternity services, control of the Upne) Maternity Pavilion having passed to the Ilford and Ba; ing Group Hospital Management Committee whilst it is now the fui > tion of the County Council to provide ante-natal and post-natal ci tics, and a domiciliary midwifery service. The local Executive Council also conies into the picture in cases where the mother-to-be chooses to receive care from her own doctor or from a general practitioner obstetrician The position is further complicated by the fact that a family doc|pr called in to the home to deal with an emergency receives a fee from Page 38 Local Health Authority if a midwife has sent for him, but is paid by the Local Executive Council if relatives call him in! Ante-Natal Care. Reference has already been made to the good use made of your powers under the 1918 Maternity and Child Welfare Act in the building of the Upney Maternity Hospital, and it will have been apparent that from the earliest days you had a highly developed system of ante-natal clinics for mothers booked for confinement at Upney or in their own homes. The typical Barking approach is shown in the following extract from the report of the Medical Officer of Health for 1927:— "A new development towards the end of the year at the ante-natal clinic was the attendance of one of the health visitors at one session weekly for the purpose of giving advice and instruction in ante-natal hygiene and other appropriate subjects." As long ago as a quarter of a century it was realised that the education of the expectant mother in matters relating to her own health during pregnancy and in the care of the coming baby was even more important than the ection of any obstretic abnormalities, vital though this may be n recent years the health visitors have further developed the educative side to their ante work by the introduction of classes in the art of relaxation. Mothers who have mastered the technique invariably have a shorter and easier delivery, and this is already being reflected in the increasing proportion of those who decline the help of gas and air analgesia. I hope that ultimately it will also have its effect in reducing still-birth and neonatal death rates. In 1927 less than half the Barking mothers received ante-natal care in your clinics. Some may have been seen by private doctors but it is probable that many were without this important supervision. By patient work the position has been steadily improved until the present day when some 90% of expectant mothers receive ante-natal care in 'he clinics, the remainder being under the care of hospitals or their own family doctors. Out of a total of 1,110 mothers confined in 1953 onlyone failed to receive any ante-natal care, this patient being Page 39 ANTE-NATAL CLINICS Number attending for first time 1,402 Total number of attendances 12,600 married and not notifying her condition until the day before labour took place. Arrangements have been maintained whereby mothers booked for Upney Hospital attend their local clinics to receive ante-natal care, thus ensuring continued supervision by the health visitors and other local authority staff to whom she will look for advice after she has been discharged from hospital. The hospital medical officers, who will have the responsibility for caring for the mothers during labour, attend the clinics in order to see the expectant mothers later in pregnancy thus saving the mother unnecessary visits to hospital. The system whereby all ante-natal records are kept in the Upney Hospital overnight ensures that these records will be available if a mother goes into labour during the night, and is of especial benefit if she has to be admitted in an emergency. Confinements. In 1927 less than a quarter of the deliveries took place in hospital. Figure 6 illustrates how during the early years of the developing Becontree Estate the total number of births steadily rose without much alteration in the proportion of hospital and domiciliary confinements. From 1933 onwards, however, there has been a steady upward trend in the proportion of babies born in hospital —curbed only temporarily in 1946 and 1947 by the high birth rates in those years. This trend was made possible by the provision of the Upney Pavilion, later by the wartime evacuation arrangements and finally by the opening of two further wards for maternity cases. It has probably been re-enforced by the introduction of the National Health Service which made it much cheaper for the mother to have a baby in hospital, where domestic help, food and laundry are provided free of charge. The introduction during the year of the new home confinement grant of £3 goes some way to meet this difficulty, but financially the scales are still weighted far too heavily in favour of the mother who goes into hospital. Either the mother who remains at home should have all ancillary services free of charge, or the mother going into hospital should pay towards her keep. There is no doubt that at one time there were insufficient beds lor maternity cases, but today with 80% of Barking mothers being confined in hospital, one wonders whether the pendulum has swung too farIt is essential to provide hospital beds for those cases where any difficulty may be expected. It is equally necessary to provide for those mothers who do not have adequate accommodation for a home confinement. It is questionable, however, whether beds should be provided for those who do not fall into either of these categories whilst Page 40 Page 41 DISTRIBUTION OF CONFINEMENTS 1928-1953 the national economic position renders it impossible to make adequate provision for certain other classes of patients such as the chronic sick and the mentally ill. A higher proportion of home confinements would help to stress the fact that childbirth is a physiological process, and also that it is a family affair. I feel that we tend to overlook the important part the father should play both during the confinement and the puerperium, Surely at this supreme moment a woman needs her husband more than at any other, and with his support would have an easier delivery and would more readily establish breast feeding. Maternal Mortality. No maternal deaths occurred during the year, although a death late in December, 1952, was not registered until early January and thus appears in the Registrar General's figures for 1953. Post-Natal Care. In 1927 only 26 mothers were examined following their confinements and this figure remained low for many years, despite the repeated plea of my predecessor. POST NATAL CLINIC Number attending for first time 1,016 Total number of attendances 1,244 Whilst there has been a steady improvement so that in 1953 approximately 70% of Barking mothers received a post- natal examination, the position is still far from satisfactory. It cannlot be too strongly stressed that a post-natal examination is every bit as important to the mother as ante-natal care. We must not be satisfied until every Barking mother receives this examination about 6 weeks following her confinement. Gynaecological Clinic. The Specialist Gynaecolo; teal Clime, started by the Borough Council in 1933, is still held weekly at the Upney Clinic, and is now attended by Mr. B. G. Spiers, F.R.C.S. GYNÆCOLOGICAL CLINIC Number attending for first time 328 Total number of attendances 1,522 of the conditions treated there could have been prevented had adequate post-natal attention been obtained at the proper time Page 42 Dental Care. The services of the Dental Officers are available to the "priority groups" of expectant and nursing mothers and young children. During the year the Oral Hygienist commenced a series of talks to mothers attending ante-natal classes, an innovation to be encouraged since it is only by education of mothers in the care of their own and their children's teeth that we can prevent needless decay and unnecessary extractions. Too many mothers still refuse to let us fill their children's milk teeth and say "they might just as well come out," not realising that this early loss may cause the second teeth to come through crooked, and lead to months or years of orthodontic treatment to get them straight again. infant welfare Infant welfare clinics have also been provided in Barking from the earliest days of the service, the first having been set up in 1908. The results are reflected in the infant mortality rate, at that time 117 per 1,000 live births, which steadily fell to a figure of 66 a quarter of a century ago, and which stands at 26 for 1953. Despite the assertion in the report of the Medical Officer of Health for 1931 that "many people are igreed that it will be impossible to reduce the infant mortality rate to less than 30 per thousand births," the rate has in fact been below 30 for the past 6 years, as will be seen by reference to Figure 7. In some countries (South Australia for instance) the infant mortality rate 1 is already been reduced to 20 per 1,000 live births and there would appear to be no insuperable obstacle to achieving similar or even better esults in this country also. The task is steadily becoming more diffii It as the mortality falls since most infant deaths now occur in th first weeks of life, the majority whilst mother and babe are still in ospital. We must, therefore, attack the problem more through ou ante-natal and maternity services, and for this we need more know.edge of the true causes of these deaths occurring soon after birth. Paradoxically, the success of the infant welfare movement has led to much criticism and even to the suggestion that infant welfare clinicsare no longer needed. Whilst I should strongly refute any such suggestion I do think it opportune to pause to reflect on the effects 0f earlier successes. The problems today are not those of 25 years ago, yet it may be fairly said that some of our methods have not changed nuch during that time. We must not become complacent, but adjust our ideas to the new problems before us. "Summer diarrhoea" and rickts are now virtually non-existent, and clinics whose main functions are the distribution of dried milk and vitamins have no place in our Page 43 Page 44 COMPARATIVE INFANT MORTALITY RATES 1929 - 1953 service today. Too frequent routine weighing of an obviously healthy baby can do much harm to an over-anxious mother. Much attention is now being directed to the mental health of the nation. Many mental disorders can be traced back to mishandling in early childhood—and here too much "kindness" can be as harmful as too little. I am sure that a very important part of the work of the infant welfare service of the future will be the promotion of sound emotional development by means of the instruction of parents and parents-to-be in the art of handling their children. INFANT WELFARE CLINICS Number of children—First Attendances in Year :— Under 1 year 1,047 Over 1 year 2,385 Total number of attendances of children:— Under 1 year 17,703 Over 1 year 11,016 whilst you have developed excellent services for expectant mothers and for babies, there has been a tendency to neglect the routine supervision of thoddlers in the vital years before they come under the wings of the School Health Service. If it is desirable to examine school children every two or three years then it is essential to arrange and annual routinie medical inspection of every toddler, and I hope to devote some attention to this problem in the ensuing year. A most v iluable service was introduced in 1945 by the appointment of a Children's Specialist who, although now employed by the Regional Hospital Board, continues to attend the Upney Clinic once per fortnight. The Consultant Paediatrician is Dr. S. B. Dimson, M.D. Page 45 PÆDIATRIC CLINIC Attendances :— School Children 258 Toddlers 141 DAY NURSERIES Your day nursery service was originated during the war years to look after children whose mothers were contributing to the war effort, but was developed and maintained to care for those whose mothers were unmarried, widowed or otherwise forced by financial circumstances to go out to work. The premises of Eastbury House and Lodge Farm were taken over in 1942, and a prefabricated building was erected at Gale Street in 1943. On the "appointed day" plans were well in hand for taking over the old Castle School as a fourth day nursery, and Rippleside was opened in 1950. At the beginning of 1953 the four day nurseries were full and there were 134 children on the waiting lists for admission. By the end of the year, however, attendances and the demand for places had fallen so precipitately that we were forced to recommend DAY NURSERIES - DEMAND FOR PLACES JULY 1952-DECEMBER 1955 Figure 8 the closure of Lodge Farm and you were not unaware that it might be necessary to close a second nursery. As will be seen from Figure the falling off in demand for this service coincided with the imposition by the County Council in January of a greatly increased scale o charges, with a maximum of 7s. 6d. against your old standard charge of 2s. per day. You have held the opinion that this increase in charges has been directly responsible for this position, although it is to remembered that a similar position has arisen over most of the country Page 46 and that in general the numbers of children in attendance at nurseries had begun to fall quite steeply well before increased charges came into effect. Nursery and Child Minders Regulation Act. No doubt largely owing to the excellent day nursery service which you built up there has never been a large demand for registration under this Act. In 1953 two women were registered as Child Minders. Only one took advantage of this registration and had two children in her carc for part of the year. MIDWIFERY For many years domiciliary services in Barking were provided by midwives from the Plaistow Maternity Hospital and by midwives practising privately. As the Becontree Estate developed arrangements were made with the Salvation Army for their midwives to cover part of the Porter Avenue district, and you took midwives into your direct employment to serve the remaining areas. The Salvation Army terminated their agreement in 1947, and the Plaistow midwives withdrew on the apppointed day." Those municipal midwives who had been engaged to serve the Upney and Becontree areas were transferred to the control of the Barking Health Area Sub-Committee, whilst the area of "old" Barking was taken over by midwives from the County Training I me at Leytonstone working from the Longbridge Road Home. It ems a pity that at a time of radical change the opportunity was missei. f unifying the domiciliary midwifery services in Barking. I havt already made reference to the fact that a percentage of domiciliary jnfinements has been steadily falling over the last 20 years, and that t! trend will not easily be reversed. The National Health Service Ac as given the family doctors an inducement to undertake more midv ery work, thus tending further to reduce the midwife's responsibi! s. We may be approaching the point where our midwives will not be aling with sufficient cases to maintain the high degree of competence lied for, a problem which will be accentuated in Barking by the divid control of the domiciliary service. I am attracted by the idea of a combined hospital and home midwifery se ice. This suggestion should not be entirely novel to you since a number of your domiciliary midwives spent an aggregate of about 4 year: . the "evacuation" hospital at Radlett during the war, and a Barking Hospital midwife later undertook domiciliary work to help over the difficult position created by the withdrawal of the Salvation ArmY midwives. Such a solution, whilst easy in the days when you Page 47 were a "Welfare Authority," could not so readily be achieved now that responsibility for maternity services is split between the Regional Hospital Board and the County Council. HEALTH VISITING The first "Lady Health Inspector" in Barking was appointed in 1907, and by the time my predecessor took office 25 years ago your staff consisted of three health visitors, two school nurses and one dental nurse. With the rapid expansion of the Borough and of the standard of service provided the establishment was further increased. Today it includes 12 health visitors (who combine their duties with those of school nurse), 4 dental nurses and attendants, and 18 part-time clinic nurses who relieve the health visitors of routine duties in the clinics. The introduction of the National Health Service Act has led to great changes in the duties and responsibilities of health visitors. Previously their duties lay primarily with mothers, young babies and school children, whilst they were also responsible for the supervision of children under the Child Life Protection Enactments. The latter duties were transferred to newly created Children's Officers by the children Act, 1948, a change which health visitors regard for the worse. The National Health Service Act, however, broadened the responsibilities of the health visitor to include all members of the family. This has focussed attention on the need for close co-operation with general practitjners who themselves, for the first time, became able to deal with the damily as a whole. Slow but steady progress has been made in this rirection to which reference is made elsewhere. It is also pleasant to record that co-operation with hospitals has improved likewise. Many more references and enquiries are now received from hospit. almoners, and we receive much more information concerning the discharge from hospital of patients requiring after-care, so that the health visitors now devote more time to hospital follow-up work. on the whole attendances at clinics have tended to fall following the ntroduction of the National Health Service, but since those most in need of advice are often those who never attended clinics in the past, or those who through age or infirmity cannot do so, it can only be to the good if health visitors have available more time in which to carry out home visits. After five years the position of the Health Visitor in he National Health Service is still far from settled. There has been an unfortunate tendency to multiply the number of visitors going into the home (e.g. newly created children's visitors, welfare visitors) and it is my belief that the Health Visitor should become the " general practitioner" Page 48 of the medico-social services, calling in specialist social workers as and when required. Her main job, like that of all members of the Public Health services, is to prevent illness and to promote health. In all her activities she must aim to educate, first in the need for action, and then in the methods of achieving the objective. HOME NURSING In the area of "old" Barking services of home nurses were also provided by arrangement with the Plaistow Maternity Hospital and District Nurses' Home, who received financial aid from the Council. In 1934 the East Barking District Nursing Association was formed on a voluntary basis to provide a district nursing service for the new Becontree Estate and this association also ultimately received your financial support. My predecessor was a member of the Committee of the Plaistow Maternity Hospital and District Nursing Association and was also Honorary Medical Officer to the East Barking District Nursing Association, so that he had a measure of control over the work of the district nurses throughout the area. Since the "appointed day," however, when these services were taken over by the County Council, they have been administered from the County's training home at Leytonstone and your Medical Officer lost contact with this service. It seems to me that the health visiting, domiciliary midwifery, home nursing and home help services are all integral parts of the domiciliary health services, and that proper co-ordination cannot be achieved unless they all come within the day to day control of the Health Area Sub-Committee. In fact the County's arrangements for decentralisation expressly provide that this service shall be administered by health area sub-committees, and it seems to me unfortunate that this principle was not implemented. VACCINATION AND IMMUNISATION Smallpox Vaccination. Prior to the "appointed day" vaccinations in Banking were carried out by public vaccinators and returns were forwarded to the County Health Department, so that figures are not readily available for vaccinations carried out before 1948. The County Council's proposals under Section 26 of the National Health Service Act envisaged that vaccinations would be undertaken mainly by general medical practitioners and supplemented by special sessions in the clinics only if circumstances called for such an extension. Page 49 Page 50 The figures for vaccinations performed under these arrangements show that in the first years of the National Health Service only one out of every 5 or 6 babies was vaccinated during the first year of life (see Figure 9). Assuming that we receive notification of all vaccinations carried out (and this seems reasonable since the doctor receives 5s. for each completed record card) there would appear to be good reason to provide facilities for vaccination at each of the infant welfare clinics so that this simple procedure can be performed as a routine in the early weeks of life. Diphtheria Immunisation. Immunisation against diphtheria was commenced in Barking in 1933, when eight children completed a course of injections. Apart from a slight setback during the first year of the war, the number of children immunised each year rose rapidly to a peak of over 2,000 in 1943. The numbers of cases of diphtheria notified have fallen steadily since the peak number of cases reached in 1933, the last case having been notified in 1950. The fall in incidence had commenced by the time immunisation was started and whilst there have undoubtedly been other factors at work, reference to Figure 10 clearly shows how the incidence of diphtheria progressively diminished as the immunisation programme got under way. Our relative freedom from diphtheria means that young parents now have little first hand knowledge of the horrors of this disease, and there i danger that in consequence they will neglect to have their children protected. Protection given by immunisation in infancy must be maintained by a minimum of one " booster " dose when the child commences school. Whoop Cough Immunisation. Your scheme for whooping cough immunisation was introduced during 1941, and in 1946 a combined vaccine was made available so that babies could be immunised against both whooping cough and diphtheria with one series of injections. The scheme for combined immunisation was continued after the "appointed day" but during 1953 the County Council decided that this should longer be made available and that children should receive separate courses of injections against whooping cough and diphtheria. It was agreed, however, that we could continue to use "combined" vaccines for the purpose of investigating the relative merits of the two methods of immunisation, and I hope to report on this research next year. The work is largely being undertaken by Dr. Spiller. Page 51 AMBULANCE SERVICE Reading through the first Annual Report of my predecessor I was interested to read that " a motor ambulance is now provided for the removal of infectious cases to the Isolation Hospital, Upney Lane." (Italics are mine.) This led me to turn up the report of the Medical Officer of Health for 1926 in which it is recorded that a horse ambulance was provided for the removal of such cases to the Isolation Hospital ! At that time accident and non-infectious cases were dealt with by ambulances coming under the control of the Chief Fire Officer. A fleet of modern motor ambulances was gradually built up, and in 1943 the service was made available to the public without charge. In 1948 the ambulance service was transferred to the County Council and the control of this service was not decentralised to Health Area Sub-Committees. This is a matter which personally causes me no regrets since I feel that to achieve maximum efficiency and economy the service must be based on as wide an area as possible. Ambulances are used almost exclusively for the transport of patients to and from hospital, and local health authorities have virtually no control over the demands for this service. Bearing in mind that it absorbs 28% of the authorities' expenditure, and that the service can in no way be called preventive, it is my feeling that it would more properly have been made the responsibility of Regional Hospital Boards. PREVENTION OF ILLNESS, CARE AND AFTER-CARE Prevention. The National Health Service was set up "to secure improvement in the physical and mental health of the people," and for "the prevention, diagnosis and treatment of illness." Prevention is, or should be, the main function of the local health authorities, and although the word " prevention " does not appear again until Section 28 of the Act, it will be obvious that many of the services such as provision for the care of mothers and young children, health visiting and vaccination and immunisation have a strong preventive bias. It is interesting to compare the money spent on the hospital general practitioner, and local health authority services and as will be seen from Figure 11 the lion's share goes to the Regional Hospital Boards leaving only 8 per cent. to the local health authorities. The breakdown of local health authority expenditure (Figure 12) shows that no less than 28 per cent. goes on the provision of ambulances— a service which I have already referred to as being one which would more properly fall to the Regional Hospital Boards. Provision of midwives, home nurses and domestic helps together account for a further 28 per cent. which amount might be more properly grouped Page 52 Page 53 with the domiciliary treatment facilities provided by the Local Executive Council. What may be termed the preventive services proper account for as little as 31 per cent. of local health authority expenditure. To prevent illness it is necessary to know much about its causation, but this is only a first step. The discoveries of doctors and scientists working in laboratories, hospitals, and in the community at large must be translated into action by the individual. Before people will act they must be convinced of the necessity for action. This conviction can only arise from the efforts of our staff in the field of health education, and I hope to devote more attention to this topic next year. In the meantime it will suffice to say that I believe much of the so called health education consisting of distribution of pamphlets, the displaying of posters, and the giving of formal lectures, to be wholly inadequate for the tremendous tasks before us. Care and After-Care. Convalescent holidays, provided by the Borough Council for mothers and young children, were made available to all in need of them following the introduction of the National Health Service Act. During 1953, 39 cases were sent away for periods averaging two weeks. The loan of sick-room equipment, previously undertaken by the nursing associations receiving financial support from the Council and by voluntary bodies, is now dealt with directly from the Health Area Office. The following articles are available on loan :— Air-rings Back-rests Bed-blocks Bed-pans Bed-cradles Commode-chairs Cushions—latex foam Rubber-sheeting Tables (bedside) Urinals Wheel-chairs Walking sticks Demands for wheel chairs are heavy in the summer months and there was always a waiting list despite the addition of ten chairs to our stock. Mention has already been made of the chiropody service started by you in 1938. The foot clinics have been maintained since the CHIROPODY SERVICE Attendances : School Children 1,007 Adults 22,797 "appointed day," but it has not been possible to extend the scheme to provide treatment in the homes of those confined to bed, owing to Page 54 the refusal of the Minister of Health to sanction any expansion what soever. To many, this appears a short-sighted policy since a small expenditure on foot care for elderly people may well reduce the numbers of those who eventually need the scarce and expensive places in hostels or hospitals for the chronic sick. The lack of beds for even seriously ill aged sick persons means that many have to be cared for at home with inadequate resources and at the cost of almost intolerable strain on relatives. During the year the County Council gave authority for a scheme to provide "night attendants" to sit up with such patients and thus give relatives some respite, but it was not found possible to find suitable volunteers for these arduous duties at the standard rate of 7s 6d.. per night. I expect to report more favourably next year, however. Mention has been made earlier of the Borough Council's laundry scheme for incontinent chronic sick, another service which has proved a boon to relatives caring for such patients. Since he "appointed day" the County's tuberculosis services have been decentralised to Health Area Sub-Committees, and today include the provision of extra nourishment (1 pint of milk per day), loan of garden shelters, boarding out of child contacts, and rehabilitation at such Village Settlements as Enham-Alamein (Andover) and Papworth (Nr. Cambridge) and the British Legion Village at Maidstone. You also share with Dagenham the services of an occupational therapist who goes into the homes of cases confined to bed to provide valuable remedial and diversional handicrafts. The therapist works in close liaison with the Chest Physician and only undertakes cases with his approval. Valuable help is also given to tubercular patients by the Barking Tuberculosis After Care Committee. This Committee is a voluntary organisation which, in addition to raising funds by its own efforts, receives a grant from the Essex County Council. domestic help service The Domestic Help Service in Barking was originated by the Borough Council in 1943 when three part-time helps were appointed to attend home confinement cases. The following year the scheme was extended to cover illnesses of expectant and nursing mothers and children under 5 years of age, and demands on this service were such that for a period of about 2 years you paid private helps to attend cases where the Council's home help was not available. During 1946 the first full-time home helps were appointed and in the following Page 55 year the panel was large enough for you to dispense with the services of private helps. By 1948 the service had expanded far enough to justify the appointment of a domestic help organiser—these duties having previously been undertaken by the Matron of the Barking Hospital. Year Number of Helps Employed Number of Cases Helped Total Hours Worked 1943 3 8 1944 3 32 1945 6 69 1946 12 261 1947 31 415 1948 36 303 1949 65 344 1950 55 387 80,699 1951 49 327 70,611 1952 84 318 85,743 1953 89 384 105,121 Whilst the number of cases helped has not materially increased since the introduction of the National Health Service Act there has been a great increase in the hours of help given, a total of 100,000 hours having been reached for the first time this year. The number of helps employed has been more than doubled since the "appointed day." This increase is due largely to the steadily rising numbers of aged persons to be cared for. Whilst in a few cases hospitalisation is really required in the best interests of the patient, in many other cases the assistance given renders it unnecessary for the old folk to be admitted to hostels or similar institutions and enables them to remain, as they would wish, in their own homes. GENERAL PRACTITIONER SERVICES. Prior to the "appointed day," the National Health Insurance Scheme provided free general practitioner services only for the bread winner of the family, whilst local authorities provided much of the Page 56 medical care for mothers and young children. In 1948 these services were extended in both directions. The general practitioner was, for the first time, enabled to provide free medical attention for all members of the family, whilst the duties of the local health authority, through its Health Visitors, expanded to embrace not only mothers and children but working adolescents, adults and the aged. There was, therefore, a danger of some overlapping of functions which accentuated the necessity for close co-operation between the general practitioner and the local authority services. In an "all purpose" authority, the area served by the Local Executive Council corresponds to the Borough boundaries and the Medical Officer of Health is usually a member both of the Executive Council nd of its Local Medical Committee. In a two-tiered system where the Local Executive Council covers the whole County this is not practicable and many opportunities of co-ordination are thereby lost. In Barking the activities of the British Medical Association do not provide a suitable substitute—once again boundaries providing a stumbling block. The Stratford Division of the Association covers the County Boroughs of East and West Ham and the Borough of Ilford together with most, but not all, of Barking, certain practitioners working at the Becontree end of the Borough belonging to the South East Ess Division. I am hopeful that the Barking Medical Society will soon resume its activities and, inter alia, provide valuable contact between general practitioners and myself. I am certain that we are moving steadily away from the suspicions of the pre-1948 era when it was felt that your extensive services were in competition with the private doctors, and it is with the greatest pleasure that I acknowledge the help afforded me personally by many individual doctors in 1953. True co-operation, however, can only result from personal contact between general practitioner and health visitor and a close understanding of their respective functions. To further this, arrangements were in hand at the end of the year for meetings at each of the clinics to which family doctors working in the area will be invited to give them the opportunity of meeting the health visitors and other members of the local authority team. Page 57 REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR 1953. STAFF. Once again the department has been hit by changes in personnel and staff shortage. At the end of the year we were three inspectors below establishment strength. It is hoped that the new year will bring with it the required personnel to enable the work to proceed on a routine basis. SANITARY CIRCUMSTANCES OF THE AREA. Statistical tables showing the work of the sanitary inspectors are set oat in the appendix. The year produced fewer complaints than in the previous year, the number being 1,474 as compared with 1,615 in 1952. There has been difficulty in coping with the many duties owing to staff shortage. This is reflected in the statistical tables. Complaints were investigated without delay and where necessary, action taken. The statistical tables set out in the appendix show the number and type of inspections made, the number of notices served, and compliances therewith. At the commencement of the year there were two properties referred for default action under the nuisance section of the Public Health Act 1936. An additional 30 were added during the year, making a total of 32 properties which were dealt with as follows :— 30 repaired by owners 2 remaining outstanding In addition to the above work, in one instance work was carried out by the Borough Engineer in default of the owner in accordance with the provisions of Section 45 of the Public Health Act. Rainfall. During the year rain fell on 213 days with a rainfall for the year of 19.68 inches compared with 20.13 inches for the previous year. water supply. The whole of the water supplied to domestic dwellings is drawn from the main supply of the South Essex Waterworks Company. Page 59 Samples were submitted monthly for bacteriological examination and twice during the year for chemical examination, all of which were found to be pure and wholesome. In addition samples of water drawn from the wells at three factory premises using the supply for drinking purposes have also been examined, and found satisfactory. RIVERS AND STREAMS. The major improvements at Loxford Water and the Mayesbrook are now in progress and it is hoped will be completed by the middle of 1955. These works were referred to in the last Annual Report. The following improvements have been carried out :— At the Mayesbrook the stream has been widened and fitted with sluice gates with a complete diversion of the watercourse to Mayesbrook Park Lake. A diversion of the Loxford Water to the north side of the railway has been carried out and the water will now discharge into the River Roding near the cul-de-sac at end of Victoria Road. A culvert 1,000 feet in length has been built. The pollution of the Thames and Roding is still a major nuisance. We wish all speed to the constructional activities of the London County Council at the Northern Outfall Works. SUPPLY OF DUSTBINS. The number of premises where dustbins are supplied and maintained by the Corporation in accordance with Section 75(3) of the Public Health Act, 1936, at the end of the year was 5,119. Action taken under sub-section (1) of that section early in year resulted in appeals against notices in four instances nd in each case judgment was given against the Council. Further consideration is therefore being given to the question but at the end of the year no conclusion had been reached. The number of dustbins supplied by the Corporation during the year under maintenance arrangement was 404 and in addition 546 dustbins were supplied by the London County Council to their tenants after service of preliminary notices. PUBLIC CLEANSING AND REFUSE DISPOSAL. The quantity of refuse collected and disposed of during the year was 60,130 cubic yards. The average weight 6-cwts. per yard. Page 60 total weight 17,343 tons. There was in addition 50,630 tons of refuse received from other Boroughs at the Corporation tip. The tip at Jenkins Lane was closed in May and a new tip was opened at Renwick Road. This new tip will provide accommodation for about 20 years tipping. Permanent buildings for personnel and equipment are to be erected. Disposal was carried out at both tips in accordance with the provisions of the Essex County Council Act, 1933 (Third Schedule). CONTROL OF PESTS. (a) ERADICATION OF BED BUGS. It is with much pleasure that I am able to report a continuing decrease in the number of bug infested premises. Seventeen such premises with minor infestations required action. Fourteen of these properties, which were treated with insecticide, are owned by the Corporation. (b) FLY NUISANCE. The seasonal treatment of vacant lands, refuse tips, piggeries, stables, fishmongers and butchers premises was continued during the warm weather with satisfactory results. The Borough experienced a minor seaweed fly (Coelopa frigida) infestation it three factory premises using tri-chlor-ethylene. Remedial measures were taken by your officers and the infestation was brought to an end with the application of gammexane by the mobile spraying unit of the Corporation. The annual cost of this fly prevention service remains at £150. (c) PREVENTION OF DAMAGE BY PESTS ACT, 1949. RODENT CONTROL IN SEWERS. The half-yearly treatments of sewers were carried out during the months of May and November, the results being as follows :— May November Number of manholes baited 400 397 Number showing bait take 170 193 Number showing complete bait take 66 81 Prior to the May treatment test baiting was carried out throughout the more recently developed areas of the Borough where only minor evidence of infestation has hitherto been found, with the following result Page 61 Number of manholes tested 73 Number showing bait take 6 SURFACE INFESTATION. The following information taken from the Annual Report furnished to the Ministry of Agriculture and Fisheries for the year 1953 shows the degree of infestation dealt with by the department. The charge for this service remains at 5s. per hour for business premises. Private dwellings are serviced free of charge. 1. PREVALENCE OF RATS AND MICE. Type of Property No. of properties in Area in which infestation was found Analysis of Col. 4. Number infested by (1) (2) (3) (4) RATS MICE Only Total Notified by Occupier Otherwise discovered Total Major Minor Local Authority's property 29 10 — 10 — 7 3 Dwelling houses 20,555 105 241 346 — 301 45 Business premises 1,599 29 61 90 — 71 19 Totals 22,183 144 302 446 — 379 67 2. MEASURES OF CONTROL BY CORPORATION. Type of Property No. of properties inspected No. of inspections made No. of notices served under Section 4 No. of treatments carried out by arrangement with Occupier Under Section 5 Treatment Works Rats Mice only Rats Mice only Local Authority's Property 10 25 — — 12 5 — — Dwelling Houses 346 614 — — 301 45 — — Business Premises 290 530 — — 256 33 — — Totals 646 1,169 — — 569 83 — — Page 62 OTHER PESTS. There is a developing demand by residents to deal with other seasonal pests, ants, earwigs, wasps and may-fly bugs. Advice and assistance is given in the practical application of remedies Our complaints arise mainly from residents living near allotments or other stretches of open spaces. ATMOSPHERIC POLLUTION. Since the smog conditions which occurred during the 5th-9th December, 1952, attention is being increasingly directed to the pollutants of town air which it is thought caused the serious increase in the deaths during that period. This smog was the most disastrous that has occurred for 80 years, the possibility of it arising from a freak weather condition or changes in the character of air pollutants is being investigated. In connection with the possible "unusual" constituents of the atmosphere consideration is being given to the problem of sulphur emission from modern high-temperature coal-fired furnaces such as electricity generating stations. Because of this possibility and because the Barking generating station is the largest in the country the Council called the attention of the Ministry of Fuel and Power and Dr. Somerville Hastings, M.P. to what may be an insiduous risk to health from the burning of huge quantities of coal with the emission of thousands of tons of sulphur compounds. The subsequent sulphuric acid mist which is formed from such emissions by the absorption of water from the atmosphere is increased as the result of the modern improved rate of combustion with the possible harmful results. The Council is alive to these possibilities and is one of the local authorities taking part in the investigation of atmospheric pollution conducted by the Department of Scientific and Industrial Research. Measurements of the pollution in Barking are taken at three Points in the Borough and are co-ordinated monthly, with similar observations made throughout the whole of the country. It is realised today that any real step forward must have relation to domestic fires. To this end a recommendation was made to the Council that the tenants of the Thames View estate now being developed should burn none but smokeless fuel. Control it was suggested should be obtained by including a clause in the conditions of tenancy. Page 63 Page 64 ATMOSPHERIC POLLUTION—MONTHLY SOLID DEPOSITS IN TONS PER SQUARE MILE MONTH 1948 1949 1950 1951 1952 1953 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 D.58 JANUARY — — — 20.94 35.55 29.65 20.57 28.27 21.18 21.80 35.56 32.87 17.38 24.30 22.29 30.48 28.61 22.32 FEBRUARY — — — 19.44 28.68 28.23 24.26 43.80 36.14 30.87 45.10 36.42 12.52 17.11 11.07 30.52 23.24 24.97 MARCH — — — 15.22 24.44 21.01 18.17 26.38 24.55 17.32 22.99 32.70 25.46 29.36 26.58 20.48 22.38 14.30 APRIL 21.73 30.52 23.25 24.16 27.37 28.99 23.89 29.29 20.98 18.17 22.85 23.39 19.16 21.79 26.72 22.41 19.88 21.94 MAY 22.93 23.13 19.87 25.08 26.93 26.89 16.02 11.83 10.20 17.62 23.65 21.49 26.11 22.28 21.08 — 21.52 17.47 JUNE 16.45 28.20 22.59 17.25 21.56 19.88 23.37 18.33 14.50 23.48 30.15 23.93 29.33 19.67 17.78 25.58 26.52 12.28 JULY 12.20 15.19 11.62 27.89 26.11 22.66 21.83 26.07 25.55 17.25 19.95 23.49 17.18 — 12.10 26.94 24.64 24.79 AUGUST 25.01 29.29 22.94 23.78 32.34 24.97 29.87 21.25 26.62 16.15 23.51 24.97 30.66 35.90 16.16 25.74 22.89 21.49 SEPTEMBER 17.14 22.00 21.05 20.94 25.46 26.65 19.23 33.10 20.91 17.11 28.85 27.93 23.24 19.92 19.09 30.71 27.75 21.18 OCTOBER 20.05 28.37 26.72 44.35 51.81 47.90 18.89 23.41 19.88 12.11 25.66 26.76 25.35 26.08 22.59 45.89 28.92 21.56 NOVEMBER 31.96 52.18 51.24 21.42 33.98 32.98 37.44 43.02 34.63 23.72 50.13 36.80 — 21.66 20.81 33.55 31.79 21.94 DECEMBER 20.64 43.04 32.74 19.44 29.23 24.83 25.60 29.64 30.69 23.68 22.57 41.99 45.46 35.86 29.57 41.59 44.04 31.74 Averages 20.90 30.21 25.78 23.30 30.29 27.84 23.26 28.70 23.82 19.94 30.08 29.48 28.19 24.90 20.49 30.25 25.18 21.33 + . STATIONS. D.56 =Barking Park —Alfreds Way from May, 1952. D.57 =Greatfields Park. D.58 =Parsloes Park. Page 65 ATMOSPHERIC POLLUTION SULPHUR DIOXIDE READINGS MEASURED AS MILLIGRAMS OF SO3 PER DAY COLLECTED BY 100 sq. C.M. LEAD PEROXIDE MONTH 1948 1949 1950 1951 1952 1953 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 D.58 D.56 D.57 1 D.58 D.56 D.57 D.58 D.56 D.57 D.58 JANUARY — — — 3.95 4.69 4.64 2.28 2.85 3.01 2.29 2.60 1.97 2.04 2.84 2.14 3.50 4.06 3.09 FEBRUARY — — — 3.19 4.17 3.92 2.70 3.99 3.44 2.14 2.24 1.81 2.16 2.82 2.38 2.68 2.98 2.01 MARCH — — — 2.75 2.31 2.64 2.07 2.78 2.77 1.48 2.05 2.09 1.57 1.28 1.68 2.89 2.57 2.77 APRIL — — — 1.76 2.29 2.41 1.77 2.31 2.39 1.31 1.48 1.29 0.95 0.98 1.08 2.16 2.48 2.03 MAY — — — 1.22 1.69 1.56 0.42 1.00 1.41 0.43 1.06 1.05 0.72 1.04 0.77 1.53 1.17 1.50 JUNE 1.00 1.6 1.4 0.94 1.50 1.27 1.00 1.72 1.58 0.55 0.85 0.55 0.04 0.65 0.58 1.27 1.35 0.97 JULY 1.98 1.53 1.25 0.66 0.96 0.73 0.62 1.68 1.43 0.72 1.11 0.97 0.50 1.19 0.78 2.19 2.23 1.82 AUGUST 1.28 1.77 1.68 0.89 1.12 0.96 1.07 1.98 1.53 0.87 1.37 1.01 0.75 1.41 0.77 2.43 2.05 1.57 SEPTEMBER 1.68 2.49 2.37 0.67 0.90 0.83 1.56 2.36 2.58 0.94 1.53 1.21 1.02 1.10 0.65 2.18 1.75 1.75 OCTOBER 2.42 3.13 3.08 1.84 2.38 2.45 1.20 1.48 1.06 1.21 1.63 1.50 1.63 1.54 1.93 2.53 1.84 1.78 NOVEMBER 3.62 4.25 4.71 1.31 2.51 2.74 2.14 2.31 1.85 1.82 1.99 1.68 1.96 2.23 2.15 4.15 3.91 3.51 DECEMBER 3.09 3.83 3.45 2.63 3.95 3.47 1.91 2.25 1.91 1.35 1.88 1.83 3.77 3.24 3.96 3.38 3.08 3.15 Averages 2.01 2.66 2.56 1.82 2.62 2.30 1.56 2.23 2.08 1.26 1.64 1.41 1.43 1.70 1.57 2.57 2.46 2.16 56= Barking Park up to December, 1952, and thereafter Alfreds Way. D.57 = Greatfields Park. D.58=Parsloes Park. The estate which will have 2,000 families upon completion would have provided an example of what could be achieved. The Council did not at this first attempt accept the proposal. The tables on pages 64-65 give comparable results of pollution for the years 1948-1953. As a result of the enquiries addressed to Dr. Somerville Hastings, M.P. and the Minister of Fuel and Power, information was obtained regarding the removal of sulphur gas from the flue gases of Power Stations, and the proposed future disposition of Power Stations. The Ministry of Fuel and Power has stated that flue gas washing is only possible in certain sites with an ample supply of water. It appears that in the case of the Barking Generating Station it is not possible to use the River water for this purpose because it has already been used at Battersea and Bankside and is therefore not suitable. Experiments are being undertaken with another system of removing sulphur gas which may provide a saleable product and may therefore be operated at less than cost to the community. No further information has been elicited on this system. In reply to an enquiry by Dr. Somerville Hastings, M.P. the Chairman of the British Electricity Authority stated that the height of the chimneys of the Generating Stations had been carefully planned after consultations with an eminent meteorologist so that all gases are rapidly dispersed into the upper atmosphere. It may be however, that under certain atmospheric conditions dispersal would not take place, resulting in a higher concentration of sulphur gases in the neighbourhood of the Generating Station. In a later letter the Ministry of Fuel and Power stated that with the completion of more Generating Stations and the feeding of the grid system from Stations situated far from centres of dense population, the use of the older plant at Barking will be discontinued except for intermittent running at peak periods. Dr. Somerville Hastings, M.P. put down questions on the subject in the House of Commons. In answer, the Minister of Fuel and Power said the problem of removing Sulphur Oxides from flue gases is the subject of continuous research. He reiterated the statements made above and added that a steady decrease in fuel consumption at the Barking Generating Station is expected because of the retirement of the older plant. This will reduce the emission of sulphur gases. He stated that the method of sending out the smoke through tall chimneys at high temperature and, by fans, at a high velocity is the best practical Page 66 method known to engineers apart from the method of gas washing, which some experts consider not to be very satisfactory. In reply to a further question the Minister agreed that in dense fogs of several days duration the gases would descend in the neighbourhood, but he said that with fogs of short duration and limited height, this would not be so. FLOOD DAMAGE. The disastrous flood which caused serious damage and loss of life in the Eastern Counties affected two small areas in Barking, at Creekmouth and West Bank. The water entered into 65 houses and whilst none of these were rendered uninhabitable there was considerable damage to furniture and household effects. In many of the houses the floor covering was ruined or extensively damaged. The removal of this covering revealed defects in the floors of a large number of premises, some of which were the result of normal decay. These were renewed after service of sanitary notices. In order to dry out the houses a free issue of 5-cwts. of coal was made to each householder. One of the worst features of the flood was the deposition of silt in the areas covered by water. To assist in cleansing the ground a supply of lime was issued for use in the gardens and sub-floor areas. Financial grants from the Lord Mayor of London's Fund were made to those whose household effects had been damaged, and in order to restore decoration. SWIMMING BATHS AND POOL. East Street Bath.—The season opened on 25th April and closed on 27th September, 1953, a period of 22 weeks. During this period the bath was used by 63,441 bathers, including 37,738 children. The slipper-baths were once more well patronised. During the year they were used by residents on 42,614 occasions. Swimming Pool—Barking Park.—Owing to the inclemency of the weather the season in the early part showed poor results in numbers of bathers. There was an improvement during August and September. The total number of bathers was 78,828. Of this number 54,722 were children. Page 67 Samples of baths water were taken during the year as follows East Street Bath 7 Swimming Pool 5 Bath at South East Essex Technical College 11 The Analyst reported that the samples were on each occasion of a high standard of bacterial purity. BURIAL OR CREMATION OF THE DEAD. The unclaimed body of a child which was found dead was disposed of by burial in accordance with sub-section (1) of Section 50 of the National Assistance Act, 1948. PET ANIMALS ACT, 1951. In accordance with Section 1 of this Act, Licences for the keeping of pet shops have been issued to eight persons within the Borough. Sixteen inspections of their premises were made during the year to ensure that the accommodation and general welfare of the animals is satisfactory. FACTORIES ACT, 1937. The Act places upon the local authority the duty o enforcing the provisions of Part I (Health, General Provisions) which deals with cleanliness, overcrowding, temperature, ventilation, drainage of floors and sanitary accommodation. Statistics showing the activities of the sanitary inspectors in the administration of the Act are set out in page 73. FOOD. NEW LEGISLATION. There became operative during the year :— The Offals in Meat Products Order, 1953 The Public Health (Infectious Diseases) Regulations, 1953 The Labelling of Food Order, 1953 The Public Health (Preservatives, etc. in Food) Regulations, 1953 The Food Standards (Ice Cream) Order, 1953 Page 68 The Cream and use of Milk (Revocation) Order, 1953 The Food Standards (Preserves) Order, 1953 The Merchandise Marks Act, 1953 The Food Standards (Saccharin Tablets) Order, 1953 The Public Health (Condensed Milk) (Amendment) Regulations, 1953 The Milk (Special Designation) (Pasteurised and Sterilised Milk) Amendment Regulations, 1953 Memo 3 Meat The Milk and Dairies (Amendment) Regulations, 1953 Disposal of Condemned Meat and Offal SAMPLING. On pages 76-78 will be found details of the samples submitted to the Public Analyst during 1953. ICE CREAM. (a) CHEMICAL EXAMINATION. Sixteen samples were submitted for chemical examination. A summary of the analysis is given below :— Samples submitted FAT ANALYSIS Under 2.5% 2.5%-5% 5%-8.5% 8.5%-10% Under 10% 16 — 6 2 8 (b) BACTERIOLOGICAL EXAMINATION. Fifty-three samples of ice cream were bacteriologically examined. These were submitted to the Ministry of Health Provisional Methylene Blue Reduction Test. The results of these examinations are set out below :— Bacteriological Examination Satisfactory Unsatisfactory 53 51 2 Methylene Blue Test 53 Grades I & 11 49 Grades III & IV 4 Page 69 ICED LOLLIES. Eight samples of assorted types of iced lollies were submitted to bacteriological examination all of which were found to be satisfactory, Following a report in the public press that iced lollies which were harmful owing to metallic contamination were being sold to the public, eleven samples were submitted to chemical examination. All the samples were found to be free from harmful metallic contamination. In accordance with the provisions of the Barking Corporation Act there were registered in the Borough at the end of the year Ice Cream Manufacturers 2 Retailers within the Borough 174 SUPPLIES OF MILK. The whole of the milk distributed in the Borough is produced and pre-packed in other areas. None but designated tuberculin fested milk is sold in its raw state. The following table shows the position in the Borough :— Number of Registered Retailers 56 Of this number there are 11 operating from premises in other districts. (a) METHYLENE BLUE REDUCTION AND PHOSPHATES TEST. Seventy-nine samples were submitted to this keeping-quality test. One sample taken during the summer months was unsatisfactory. (b) TUBERCULIN TESTED FARM BOTTLED MILK. The eighteen samples submitted to biological examination were found to be free from tubercle. UNSOUND FOOD. On pages 79-80 will be found a summary of the unsound food condemned and destroyed during 1953. ACTION TAKEN IN RESPECT OF SAMPLES REPORTED BY THE PUBLIC ANALYST AS " NOT GENUINE " DURING 1953 1. Sausages Pork and Beef Sausages supplied by a manufacturer with premises outside the Borough were found below a standard of meat content. Page 70 in the case of Pork 65 per cent., and Beef 50 per cent. Notwithstanding the difficulty of establishing a standard the Council decided to prosecute. The Stratford bench considered evidence and arguments at length. The suppliers were convicted and fined £2 on each of four summonses. Costs of £5 5s. 0d. were imposed. The prosecution was resisted strenuously by the trade. Following the prosecution the Council requested the Minister of Food to re-impose standards of meat-content. 2. Eldermint Life Drops Upon examination of the label it was found that contradictory formulae were given. The sample was reported to contain 1.1% Chloroform, contrary to both statements on the label. The manufacturers withdrew the stocks of this preparation from sale and labelled the bottles to conform with requirements. MERCHANDISE MARKS ACT. All the provisions of the various marking orders are now fully operative and the following foodstuffs are required to be marked with an indication of the country of origin on exposure for sale :— Meat, bacon and ham, fresh apples, raw tomatoes, shell-eggs, dried eggs, currants, sultanas, raisins, oat-products, honey, frozen or chilled salmon or sea trout, butter, dead poultry. There has been some difficulty in securing the co-operation of local traders, particularly with relation to meat, apples and tomatoes. Verbal notices have been given and written circular letters sent to all affected traders. HOUSING. The acute shortage of accommodation continues as one of the major problems affecting adversely the health of the families concerned. There is close co-operation between the department and the Re-housing Officer who is also the Chief Sanitary Inspector. During the year the Council were at long last able to make a start Page 71 on the Thames View Estate development. The building contractor entered upon the site in September-October. It is hoped that the estate will provide for 2,000 families and that there will be a delivery of 300 dwellings annually as a minimum in the early years of the development. The worst of the slums in Barking were dealt with between the two wars, but there remained at the end of the year a residue of families in the Abbey Road Clearance Scheme and in the Bennington Avenue and London Road area. Active steps are continuing to decant these families and rehouse them in modern dwellings. As an indication of the future the Council has approved a five-year programme of building and fixed certain ratios for the allocation of accommodation, viz :— From Waiting Applicants 45% From sub-standard accommodation and Requisitioned Properties 35% From Clearance Areas 20% Thus it will be seen that the Council has made the important policy decision which will enable its officers to proceed with further slum clearance and removal of unfit properties on a planned basis. This should avoid the well known forms of nuisance which arise from cleared sites awaiting further development, or the dilapidations which ensue when areas are confirmed for clearance and there is long delay before rehousing is carried out. RENT AND MORTGAGE INTEREST RESTRICTIONS 1920-39. Two applications were made by occupiers and two certificates issued. One certificate was issued to an owner on completion of the works required. HOUSING ACT, 1949—IMPROVEMENT GRANTS. During the year one application for grant under Section 20 of the Act was investigated. This was referred to the Ministry of Housing and Local Government for approval. Page 72 SANITATION, HOUSING, SHOPS ACTS, ETC. 1952 1953 Visits ReVisits Total Visits ReVisits Total — — 1,615 — Complaints received — 1,474 Visits 1. Inspection of Dwelling-houses Visits 4,490 3,566 8,056 — Under Public Health or Housing Acts 3,457 2,957 6,414 315 — 315 — After I.D. and Scabies 395 — 395 — 558 — 558 — Housing Investigations 262 — 262 — Contraventions 2. Premises controlled by Bye Law & Regulations — Contraventions 25 — 25 10 Offensive Trades 13 — 13 — 26 — 26 — Tents, Vans and Sheds 6 — 6 — 88 — 88 12 Milkshops 54 — 54 — 67 — 67 6 Hairdressers' premises 14 — 14 4 283 — 283 20 Atmospheric Pollution Investigations 198 — 198 19 4 — 4 — Massage Establishments 3 — 3 — 775 — 775 193 3. Food and Drugs Act and Shops Acts General Inspections Food & Drugs Act, 1938 752 — 752 198 408 — 408 79 „ „ Shops Acts 1934 & 1950 234 — 234 54 182 — 182 — Food Sampling 175 — 175 — 134 — 134 — Milk Sampling 97 — 97 — 82 — 82 — Ice-cream sampling 86 — 86 — 16 — 16 15 Bakehouses 23 — 23 40 195 — 195 71 Butchers' premises 183 — 183 71 64 — 64 49 Fishmongers 49 — 49 28 179 — 179 65 Ice-cream Vendors 171 — 171 74 85 — 85 44 Licensed premises 22 — 22 16 320 — 320 186 Restaurants, Dining Rooms and Canteens 364 — 364 71 13 — 13 — 4. Miscellaneous Aged and Infirm persons 23 — 23 — 236 — 236 — Drainage Inspections 131 — 131 118 21 — 21 1 Piggeries 18 — 18 — 32 — 32 — Public Lavatories 37 — 37 — 1,317 — 1,317 — Prevention of Damage by Pests Act, 1949 1,169 — 1,169 — 90 — 90 12 Schools 46 — 46 — 75 — 75 6 Stables 51 — 51 — 240 — 240 14 Vacant Lands and Refuse Tips 95 — 95 4 71 — 71 7 Watercourses 4 — 4 — 40 — 40 — Water sampling 58 — 58 — 16 — 16 — Pet Animals Act, 1951 16 — 16 — 306 — 306 — Other Miscellaneous 756 — 756 — Total 14,403 Total 11,919 REMEDIAL ACTION. 1952 1953 Drainage Works 25 Drains relaid or repaired 26 145 Choked drains cleared 118 2 Inspection chambers constructed - 12 New covers fitted 5 46 Tests made 21 Sanitary Conveniences 2 Additional water closets fitted - 3 Separate w.c. accommodation for sex provided - 20 New w.c. pans fitted 17 89 Flushing apparatus repaired or renewed 83 - Intervening vent space provided - - Artificial lighting provided - 14 Other works 26 Other Sanitary fittings 17 New sinks fitted.. 12 - Wash basins provided - 51 Sink and bath waste pipes fitted 28 Other Works 182 Proofs repaired or renewed 247 246 Gutters or rain-water pipes repaired or renewed 206 50 Yards paved and drained 61 72 Chimney pots replaced and stacks repaired 46 149 Dampness remedied 92 25 Houses disinfested 17 33 External walls repointed 61 801 Window frames repaired or renewed 254 7 Stairtreads repaired 5 109 Doors and doorframes renewed or repaired 73 161 Floors renewed or repaired 147 52 Stoves renewed or repaired 69 2 Washing coppers repaired 3 244 Celling and wall plaster repaired 208 938 Dustbins supplied 950 11 Accumulations of rubbish cleared 4 363 Miscellaneous 441 Page 73 NOTICES SERVED AND COMPLIANCES THEREWITH. 1952 1953 Prelimin ary Statutory Compliance Notices Prelimin ary Statutory Compliance Prelimin ary Statutory Prelimin ary Statutory 23,64 742 2,283 631 Dwelling houses 1,709 303 1,522 316 7 - 7 - Offensive Trades - - - - - - - - Tents, vans and sheds - - - - 8 - 8 - Milkshops 4 - 4 - 4 - 4 - Hairdressers' premises 7 - 2 - 20 - 20 - Atmospheric Pollution 19 - 19 - 7 - 7 - Bakehouses 13 - 13 - 46 - 46 - Butchers' premises 47 - 47 - 148 - 148 - Drainage inspection 204 - 204 - 28 - 28 - Fishmongers 13 - 13 - 115 - 115 - Food and Drugs Act, 1938 111 - 111 - 38 - 38 - Ice-cream vendors 39 - 39 - 26 - 26 - Licensed premises 8 - 8 - 1 - 1 - Piggeries - - - - - - - - Public lavatories - - - - 58 - 58 - Shops Acts, 1934 & 1950 39 - 39 - 4 - 4 - Stables 2 - 2 - 14 - 14 - Vacant lands and refuse tips 4 - 4 - Outstanding, 77 (Completed during 1953) Outstanding, 64. FACTORIES ACT, 1937. The following statistics show the results of the activities of the Sanitary Inspectors in the administrations of this Act. Page 74 1.—Inspections for purposes of provisions as to health. 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 25 24 - Nil (ii) Factories not inincluded in (i) in which Section 7 is enforced by the Local Authority 216 227 10 Nil (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 6 10 - Nil Total 247 261 10 Nil 2.—Cases in which Defects were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S. 1) - - - - - Overcrowding (S.2) - - - - - Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4) - 1 - - - Ineffective drainage of floors (S-6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient 1 1 - 1 - (b) Unsuitable or defective 9 14 - 1 - (c) Not separate for sexes 3 - - 2 - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 13 16 - 4 - Page 75 OUTWORK. Section 110 : Number of outworkers in August List required by Section 110 (1) (c) 204 Nature of work carried out by outworkers— Making of wearing apparel 160 Stuffed Toys 1 Umbrellas, etc. 2 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 11 Brush making 1 Cosaques, Christmas Crackers, Christmas Stockings, etc. 21 Artificial flowers 3 Curtains and Furniture Hangings 2 Tents 1 Carding, etc., of Buttons, etc. 2 Number of Cases of default in sending in lists to the Council Nil Prosecutions for default in sending in lists to the Council Nil Section 111: Number of visits to outworkers 326 Number of instances of work in unwholesome premises Nil Number of notices served Nil Number of prosecutions in respect of outworkers' premises Nil SAMPLES SUBMITTED TO THE PUBLIC ANALYST JANUARY 1st-DECEMBER 31st, 1953. Number Analysed Apple Rings 1 Batter Flour 1 Blanc Mange Powder 1 Blood Tonic 1 Brawn 1 Bread 1 Butter 1 Butter Beans 1 Cake Mixture 1 Cake Flour, with Egg 1 Page 76 Carraway Seeds 1 Chicken and Ham Paste 1 Clear Mints 2 Cocoanut, Dessicated 2 Cooking Fat 4 Coffee Creams 1 Cough Linctus 1 Composition Essence 1 Cream of Tartar 1 Curry Powder 2 Custard Powder 1 Dandelion Coffee 1 Dates 1 Dessert, Vanilla Flavoured 1 Eldermint Life Drops 1 Eyebright Composition 1 Flavourings 3 Flour 1 Fruit Drops 3 Fruit Lollipops 1 Gees Linctus 1 Gin 3 Glycerine, Honey and Lemon Balsam 1 Grape Fruit Squash 1 Honey 2 Ice Cream 16 Indian Brandee 1 Jam 8 Kidney Cleansers 1 Krusty Krums 1 Lard 3 Lemon Juice 1 Lemon Squash 3 Lollies, Ice 11 Luncheon Sausage 3 Macaroni 1 Margarine 7 Marmalade 2 Marzipan 1 Meat Pie 1 Mentholated Balsam 1 Milk Chocolate 1 Page 77 Mint in Vinegar 1 Nerve Tonic 1 Olive Oil 2 Orange Squash 1 Orange Wine, Non-alcoholic 1 Pastilles 1 Pepper 5 Popcorn 1 Raspberry Leaf Compound Tablets 1 Raspberries in Syrup 1 Rheumatic Tablets 1 Rice 7 Rosehip Syrup 1 Saccharin Tablets 1 Sage, Dried 1 Sausages, Beef 25 Sausages, Pork 20 Savoury Patty 1 Sherbo Fizz 1 Soda Bicarbonate 1 Soups 5 Steak Pie 1 Strawberries in Syrup 1 S.R. Flour 3 Tapioca Flakes 1 Wafer, Cream Filled Chocolate 1 Whisky 3 203 UNSOUND FOOD CONDEMNED AND DESTROYED—1953. Baby Food 24 tins Bacon 84 lbs. Barley 50 lbs. Beans, Tinned 243 tins Biscuits 48 lbs. Black Puddings 1½ lbs. Butter 2½ Cake 103½ lbs. Page 78 Cake Mixture 79 pkts. Cheese 209 lbs. Coffee Beans 28 lbs. Coffee 1 bottle Confectionery 3 tons 3cwt 261bs. Com Flakes 1 packet Cream 43 tins Dates 8½ lbs. Dried Fruit 30 lbs. Drinking Chocolate 1 tin Figs 19 pkts. Fish 29½ stone Fish Cakes 61 Fish, Tinned 71 tins Flour 34 lbs. Fruit, Tinned 1,634 tins Ham 582½ lbs. Jam and Marmalade 54 lbs. Liver Sausage 1¾ lbs. Margarine 95 lbs. Meat 19,779 lbs. Meat, Tinned 809 tins Milk, Condensed 44 tins Milk, Evaporated 209 tins Mincemeat 11 lbs. Mixed Minerals 10 doz. bottles Nescafe 1 tin Onions 72 cwt. Paste, Me and Fish 101 jars Peas, Tinned 279 tins Peas, Dried 28 lbs. Peas, Split 7 lbs. Pearl Barley 5 lbs. Pickles 33 lbs. Pork Pies 9 Potatoes 3 cwts. Prunes 53 lbs. Rabbit 186 lbs. Rice 1 lb. Salad Cream 1 jar Sausages, Beef 309½ lbs. Sausages, Pork 274½ lbs. Page 79 Semolina 1 lb. Shredded Wheat 1 pkt. Soup, Tinned 98 tins Steak Pies 10 only Sugar 11 lbs. Tomatoes, Tinned 72 tins Veal Brawn 16 lbs. Vegetables, Tinned 3 tins Page 80 SCHOOL HEALTH SERVICE We have seen that Public Health in Barking is now a centenarian and that the National Health Service is a thriving though yet immature toddler of five. The School Health Service will soon celebrate its half century and has, if I may suggest so, reached a respectable but rather complacent middle-age. The School Health Service in this country was conceived some fifty years ago when a committee was appointed to investigate the rather alarming fact that of the young men being medically examined for the South African war nearly one-third had to be rejected on medical grounds. This committee reported that many of the defects from which these young men were suffering had existed during their school life, and that they could have been detected and treated at a much earlier stage had facilities been available. As a result of this report (published in 1904) a system of compulsory school medical examinations was set up. In order to treat the numerous defects which were found on examination facilities for treatment had to be made available, and a system of school meals was instituted for those necessitous children whose condition was one of general debility due to under- nourishment. Does the service, as we know it today, differ in any important aspect from that instituted fifty years ago? True, in addition to routine medical inspections, we have routine dental inspections, School Nurses carry out canliness inspections and we even have people called Audiometricians who go round the schools testing children's hearing. We still have our minor ailment clinics although these are now supported by various specialist services, and to these must be added such facilities as speech therapy, squint training, dental hygiene and child guidance clinics. Arrangements for convalescent holidays are made where necessary, and special schools are available for the more seriously or permanently handicapped child. You will agree that, although increased in scope, there seems little new in Principle in our present-day scheme. I think too that you will be as surprised as I was to discover that, despite the activities of the School Medical Service throughout the country during the best part of a half century, about 18% of young men examined for National Service are still turned down on medical grounds. Page 81 School Medical Inspections Ministry Regulations lay down that three routine medical inspections shall be carried out during a child's school life, but in common with many other progressive authorities it has been your custom to provide more frequent examinations. At present Medical Officers go into each school once in every eighteen months to two years. I have the feeling, however, that the number of children they examine each session in order to fulfill this programme is on the high side and I hope to make some adjustments during 1954. The examination should be the occasion for a conference between child, parent, doctor, health visitor and teacher, and the opportunity taken of imparting Health Education. PERIODIC MEDICAL INSPECTIONS Number of Inspections in the prescribed Groups — Entrants 1,059 Second Age Group 1,189 Third Age Group 1,453 Total 3,701 Number of other Periodic Inspections 3,376 Total 7,077 Cleaminess Inspections The small number of children found to be harbouring nits or lice at cleanliness inspections raises the question as to whether these are a waste of a trained health visitor's time, and indeed whether there is a continuing need to carry out these inspections at all. On the other hand it can be argued that a trained health visitor may well observe some other defect which would not have been noted by an assistant, and that the inspections still serve a useful purpose since parents are more careful in the care of their children's hair when they know regular examinations take place. (i) Total number of examinations in the schools 20,559 (ii) Number of pupils found to be infested 136 Page 82 Minor Ailment Clinics Attendances at minor ailment clinics have fallen off somewhat since the introduction of the National Health Service Act. Now that the services of the family doctors are available to school children free of charge it is not surprising that these are used to a far greater extent. Minor ailment clinics still serve a purpose in that nurses are available to carry out routine treatments, and there is the added advantage that there is less time to wait and the child loses less schooling. The medical officers still feel keenly the loss of their power to issue prescriptions for medicaments. Whilst it could be argued that their function is to prevent and not to treat, one has to face the fact that parents are inclined to think that a doctor who is not allowed to issue a prescription for some trifling malady is necessarily inferior to the family and hospital doctors, and they are the less likely to accept his advice on preventive measures. Cases treated for minor ailments (e.g. minor injuries, bruises, sores, chilblains, etc.) 3,860 Total attendances 25,593 Denial Services Barking has been very much more fortunate than many districts in retaining a staff of Dental Officers during a time of great disparity between earnings in the National Health Service and the School Health Service. Although we lost the services of Mr. Gilchrist during the year we we fortunate in that Mr. R. A. Robinson, L.D.S., joined us and commenced duties on the 27th July, 1953. You will remember that your last Senior Dental Officer resigned in December, 1951. Unfortunately we have not been able to replace him since it not the County Council's policy to make such appointments in Areas. I personally feel that there is as much need for a Senior Dental Officer as for a Superintendent Health Visitor or a Domestic Help Organiser, and I hope that the matter will be reconsidered. The Barking Committee for Education has taken a close interest in orthodontic treatment this year, particularly with regard to measures designed to ensure that children do not abandon the somewhat lengthy treatment before its completion. Page 83 Orthodontic treatment is not only tedious and time consuming but it is expensive, and in most cases the need for it could have been avoided. Unfortunately there are still far too many parents who will not take the Dentist's advice to have their children's first teeth filled.. These teeth are lost early, neighbouring teeth close in to fill the gap, and there is then not enough room for the second teeth which come through crooked. The reconverted East Street Clinic opened during the year thus giving the Oral Hygienist more adequate accommodation. There is, I am convinced, scope for the further extension of her work when the Dental Officers come to realise her full value. In addition to chairside duties she has developed the preventive and educative side of her work by giving talks to groups of expectant mothers attending the ante-natal classes. I am also encouraging head teachers to give her every facility DENTAL INSPECTION AND TREATMENT (1) Number of pupils inspected :— (a) In school 6,322 (b) In clinics 2,499 Total 8,821 (2) Number found to require treatment 6,428 (3) Attendances for treatment 20,180 (4) Fillings : Permanent Teeth 7,214 Temporary Teeth 2,996 Total 10,210 (5) Extractions : Permanent Teeth 838 Temporary Teeth 4,954 Total 5,792 (6) Treatments undertaken by Oral Hygienist 2,936 Page 84 to enter their schools to talk to groups of children on the care of their teeth. Today's schoolchildren are tomorrow's parents, and if convinced of its importance they will take good care not only of their own teeth but their children's also. Dental Workshop The amount of work being undertaken has increased steadily and the establishment was increased by a further technician during the year, which also enabled us to take on a second Apprentice. This workshop, which was built by the Council for the needs of Barking, now undertakes the manufacture of dentures, orthodontic appliances etc. for a large part of the County. The following figures relate to the output of the workshop :— No. of Dentures 362 Repairs to Dentures 53 No. of Orthodontic Appliances 650 Repairs to Orthodontic Appliances 48 No. of Inlays, etc. 39 Speech Therapy Towards the end of the year you authorised the appointment of a part-time Speech Therapist for two sessions per week. This has enabled us to reduce the lengthening waiting list, and has also made it possible for Mrs. A. Ling full-time Speech Therapist, to devote an extra session to the children at Faircross Special School. Figures or this service are as follows :— No. of cases treated 100 Total attendances 2,104 specialist services Eye Clinics Dr. r. F. Jamieson, m.b. Ch.b., d.o.m.s., continues to attend Central, Porters Avenue and Woodward Clinics. Page 85 Cases dealt with were as follows :— External and other diseases excluding errors of refraction and squint 585 Errors of refraction (including squint) 1,111 Total 1,696 Number of pupils for whom spectacles were prescribed 830 The Orthoptic Clinic, now the responsibility of the Hospital Management Committee, is held in somewhat unsatisfactory accommodation at Central Clinic. The Orthoptist, Miss Lewis, who works under the general direction of Dr. Jamieson, treated 150 school children during the year. Ear, Nose and Throat Clinic It is with regret that I report that Mr. F. Courtenay-Mason, B.A., M.B., L.R.C.P., F.R.C.S., Consultant Ear, Nose and Throat Specialist since 1940, died during the year. Figures for treatment are :— Operative treatment (cases):— (a) For diseases of the ear 2 (b) For adenoids and chronic tonsillitis 205 (c) For other nose and throat conditions. 11 Other forms of treatment (cases) 1,367 The Barking Committee for Education has been much concerned at the long waiting list for tonsil and adenoid operations and made representations to the Regional Hospital Board during the year. In reply you were informed that it was hoped that certain beds would be made available at the Ilford Isolation Hospital for tonsil cases. In view of the known association between bulbar poliomyelitis and recent tonsillectomy you viewed this suggestion with some concern, and Page 86 expressed the view that Barking children should not be admitted to the Ilford Isolation Hospital for this operation. The question of tonsillectomy is a most difficult one. It is my personal view that many children have their tonsils removed unnecessarily, and this opinion is confirmed by the fact that when children placed on the waiting list come up for review it is often found that their names can be removed since the operation is no longer required. In so far as a long waiting list stops a child having an unnecessary operation, I am in favour of it and would not like to see more beds made available. Obviously where a case is urgent, priority is needed and is in fact given, although some delay does occur especially with older children admitted to "adult" beds. The question of poliomyelitis and tonsillectomy is even more difficult. In theory, the arrangement whereby children undergoing tonsillectomy are admitted to a block of an infectious diseases hospital is undesirable. It can be argued, however, that in a properly designed and run hospital the risks of cross infection are negligible, whilst in a general hospital where special precautions are not taken cross infection is fr quent. It is of interest to note that a Barking child who had his tonsils moved in a general hospital during 1953 developed poliomyelitis sc e fourteen days later, resulting in a dangerous bulbar paralysis from which, fortunately, he recovered. Orthopaedic Clinic Mr. L. Gillis, M.B.E., F.R.C.S., continues as the Consultant Orthopaedic Surgeon and attends the Manor Clinic once per fortnight: Cases treated were:— (a) In hospital 4 (b) In clinics or out-patient departments 581 The Education Committee has been pressing for the transfer of this clinic from the Manor School in view of the fact that it occupies classroom accommodation badly needed for educational purposes. The Hospital Management Committee has been unable to promise early action owing to lack of money for the proposed adaption of an empty ward at Barking Hospital. Page 87 Your Remedial Gymnast, Mr. Ogle, continues to attend the Faircross Special School to treat the physically handicapped children, and now spends an additional four sessions per week on this work. I hope during the coming year to give him opportunity to take a greater interest in the normal P.T. instruction in ordinary schools in co-operation with the Advisors on Physical Education. Skin Clinic Dr. P. M. Deville, M.R.C.P., M.R.C.S., Consultant Dermatologist, attends the Skin Clinic, Paget Ward, Barking Hospital, weekly. Number of cases treated or under treatment during the year were:— Ringworm:— (i) Scalp 2 (ii) Body 7 Scabies 12 Impetigo 75 Other skin diseases 1,559 In addition Dr. Adamson conducts a special clinic for the treatment of plantar warts. Figures for 1953 are as follows :— New cases treated 141 Total attendances 1 644 Child Guidance The number of cases referred to Child Guidance Clinics this year has risen to eleven as compared with five last year. I must reassure you that these figures do not represent any increase in the numbers of Barking children requiring this form of treatment and should warn you to expect a further increase next year. The reason lies in the fact that I have encouraged Medical Officers to refer such children at the earliest stage possible so as to give the Child Guidance team the best possible chance of righting the position. Page 88 In order to improve liaison and to further our own knowledge of psychological disorders, I arranged with Dr. Davidson, Consultant Psychiatrist, Ilford Child Guidance Clinic, for the Medical Officers and Health Visitors interested in a particular child to attend the relevant case conference. We have found these meetings of immense value in furthering our understanding of the problems involved, and I think too that the intimate knowledge of the whole family possessed by the Health Visitor has often been of great value to the members of the Child Guidance team. I should like to place on record my appreciation of the wholehearted co-operation and help we have received from Dr. Davidson and the other members of the clinic staff. INFECTIOUS DISEASES. Exclusion Our attitude towards the exclusion from school of children who have been in contact with infectious disease is gradually becoming less stringent. We are coming to realise that those infectious diseases which can be prevented (e.g. diphtheria and smallpox) are controlled mainly by our methods is of immunisation and vaccination, quarantine measures playing very little part in the prevention of spread. Disease such as measles, chicken pox and mumps are, in our present state of knowledge, not preventable and nearly every child catches them at one time or another. These diseases can be very serious in infancy and it is wise not to expose babies to infection, but they cause little trouble in childhood. They tend to give rise to complications if caught in later life—for example Mumps can cause sterility and we now now that such virus diseases as German measles in an expectant mother can cause the birth of a baby congenitally blind or deaf. Quarantine does not prevent—it merely postpones an attack until an age when the loss of schooling is more serious, or even until adolescence or early adult life when complications may occur. Contacts of scarlet fever, chicken pox, etc. are no longer excluded and there would seem lit; purpose in continuing our present practice of excluding contacts of measles and whooping cough. Dysentery Of the fifty-nine cases of dysentery in the Borough during the year forty-two related to an outbreak affecting the Monteagle Infants and Junior Girls' schools. Page 89 In November the Head Teacher of the Monteagle Infants' School informed me that several children were away with "gastro-enteritis" and that three had been admitted to hospital. It was immediately apparent that school dinners were not to blame since many of the children affected went home to lunch. Investigations revealed that one of the pupils had had similar symptoms about three weeks previously, but that these had quickly cleared and he was not taken to his doctor Bacteriological investigations on this boy and on one of the cases admitted to hospital revealed the germ of Sonne dysentery and general practitioners were immediately notified. The remaining children in the two classes affected were all swabbed, and seven further cases were found. These were excluded from school until after treatment and two negative laboratory reports, and no further cases occurred in the Infants' Department. Bacteriological investigations of the family contacts of known cases revealed that both parents and an elder sister of one of the infant school children were also affected. The elder sister, who attended the Junior Girls' School, was excluded but unfortunately had spread the infection by this time and an outbreak developed in the Junior School involving a total of twenty-one children. The remaining members of the affected classes were investigated and positives excluded from school, and the outbreak appeared to be under control before the end of the term. Four cases were also discovered amongst brothers and sisters attending other schools, five cases in brother or sisters of pre-school age and two further cases amongst parents. The necessary advice concerning hand hygiene was given and an emergency supply of paper towels was made available. I am most grateful to the Head Teachers concerned for their willing co-operation, despite the extra burden imposed upon them by the outbreak. Reference is made later to your decision to ask Managing and Governing bodies to consider the hand washing facilities in their schools and to submit recommendations. Tuberculosis The follow-up of those who were helping in the rial of B.C.G vaccine was continued during the year, facilities been made available to the M.R.C. team at the Woodward Clinic. Although the final results of this investigation will not be known for some years, the Ministry of Health decided to approve an extension of present arrangements so that this protection might be offered to all children between the ages of 13 and 14. The vaccinations are to be carried out by the Page 90 Local Health Authority under their arrangements for the prevention of tuberculosis, rather than as a part of the School Health Service. It is anticipated that the County Health Committee will give approval to the scheme and that B.C.G. vaccinations may be commenced in Barking next year. During the year a 14-year-old girl attending one of the secondary modern schools developed tuberculous broncho-pneumonia and was admitted to hospital. She herself was in contact with an uncle who is presumed to be the source of her infection. Shortly afterwards a second girl, who sat next to her in class, was admitted to hospital with a pleural effusion. Arrangements were therefore made for the remaining girls in the class and members of the teaching staff to have X-ray examinations. As a result of these a third girl was brought under close surveillance at the Chest Clinic and later in the year she also was notified as case of tuberculosis and admitted to hospital. It was decided to carry out preliminary skin tests on the remaining girls in the school and only to X-ray those who showed a positive test. The "flour paper " jelly test was chosen but the results indicated that, at any rate in our hands, this particular test was not reliable and advantage was taken of the visit of a mass X-ray unit later in the year to X-ray all the remaining girls. One case of primary tuberculosis in a 13-year-old girl was discovered, but this girl was not in contact with the other cases and the source of infection was believed to be outside school. Athlete's Foot and Plantar Warts You have taken a great interest in the problem of athlete's foot and plantar arts, and you decided not to allow plimsolls to be transferred from one child to another since I was unable to assure you that there was any effective method of sterilising these shoes without damaging them. I did seek your authority to carry out certain trials in an endeavour to find a harmless but effective method, although I warned you that results may take some time to obtain. Dr. M. Adamson has for some time been very interested in these foot infections and has been carrying out foot inspections in the schools. When she has had the opportunity of completing her survey we should have information relating to the incidence of these conditions in Barking school children, which will serve as a basis for our further investigations. Page 91 Dr. Adamson also conducts a special clinic for the treatment of plantar warts discovered on routine examination or referred from other school medical officers. This is held in the Skin Clinic, Paget Ward, Barking Hospital. HYGIENE. Toilets In the older schools toilet accommodation is invariably sited at the periphery of the playground, presumably because our predecessors felt it would be unhygienic to have them elsewhere. Even in the more modern schools on the Becontree Estate, where the toilets are attached to the school buildings, access is usually only to be obtained from the playground since most Heads lock the internal communicating door. Although individual toilet compartments are usually roofed, the toilet block as a whole is open to the air in both older and newer schools.. It is invariably cold and wet in the winter months and the flushing system freezes during some part of the winter. Whilst most Heads are aware of the importance of good hygiene and whilst by and large your caretakers are most conscientious, there is always the danger "out of sight, out of mind." From all points of view seems to me that toilet accommodation should always be provided internally. It is a matter of concern that in the majority of the schools no toilet paper is available except by issue from classroom and I fail to see how any teacher or any child can anticipate requirements. If the child takes too much some is wasted, whilst if he takes too little results cannot be but unhygienic. Head Teachers invariably tell me that it is impossible to provide toilet paper in the individual compartments since it is invariably stolen or scattered. In some instances leads arrange this as a matter of routine so I find it hard to believe that there are any insuperable difficulties. Washing Facilities I have already mentioned that the outbreak of c. dysentery at the Monteagle Schools focussed your attention on the need for adequate hand washing facilities. I think it most unlikely that adequate hand hygiene will be practised when a child has to collect soap and towel from she classroom, and when only cold water is available in the handbasins. In the older schools an added difficulty in training children to wash their hands is that washing facilities are not available in the toilet blocks. This should be easier in the Becontree schools for if Heads ere to lock the Page 92 doors leading to the playground rather than the internal doors, the children would pass the washbasins on their way out. Or rather I should say they might pause at the basins in order to wash their hands. I am happy to say that as a result of your interest many schools ire now installing a supply of hot water to the basins and providing suitable towelling. And, what is more important, the children are being trained to use these facilities. SCHOOL MEALS. We have seen that school meals were first introduced for those very under-nourished children who were unable to take advantage of the instruct: provided for them by the earlier Education Acts. Meals are now available to all as part of the educational system however, and I fee it every effort should be made to serve these in as attractive surroundings as possible. It is unfortunate that often school halls have to be used as dining rooms—maybe ore the dust raised by the last P.T. period has settled. Formica type table tops are both pleasant and hygienic, but where the old line-covered tables have to be used tablecloths would add much. A lot can be said both for and against the cafeteria system of serving meals. Whilst this may be administratively easier where large numbers are concerned, I think there is much to be said for the family table system which can be used to develop good table manners. It also help in that the food is not eaten so quickly. I know that you are anxious to provide a kitchen to each school so that cooked food does not have to be carried to various dining centres losing much in the process. I realise that here again lack of money is a determining factor. During the period of meat rationing there was perhaps some excuse for the fact that meat was invariably cooked the previous day, carved whilst cold and then reheated. I do hope that with ending of rationing Cooks will be encouraged to cook meat on the day of consumption, since it is far more appetising this way. The hygiene of the kitchens is a matter which interests me closely. Members of the kitchen staff receive careful medical examination, including appropriate blood tests, before appointment and the importance of reporting sick in the event of any gastro-enteritis is constantly emphasised. The absence of any trouble from food infection during the year is a matter for congratulation, but depends upon the ceaseless vigilance of the Supervisors and the necessary observance of hygiene by other members of the kitchen staff. Page 93 THE HANDICAPPED CHILD. The Educationally Sub-Normal At the end of the year there were 119 children in the E.S.n. section of Faircross Special School. Of the total, 41 came from Barking whilst 78 were from adjacent Boroughs. It is understood that the County Borough of East Ham will be opening their own Special E.S.N, school during 1954, and the removal of East Ham children from this section of Faircross should enable us to admit the children at present on the waiting list. All 17 children who left this section during the year on ceasing to be of compulsory school age (6 Barking children, and 11 out-ofdistrict children) were recommended under Section 57 (5) of the Education Act 1944 for supervision by the Local Health Authority. One Barking and one Romford child were found to be ineducable and were reported accordingly under Section 57 (3) of the Act. Although these children might possibly have been certified as ineducable at an earlier stage, one always feels that it is fairer to give them the benefit of the doubt owing to the difficulties of assessment of individual cases, particularly in the younger child. The same caution is observed before children are admitted to the Educationally Sub-Normal Section, and children who re thought to be backward but capable of higher attainment are dealt with, as far as possible, in ordinary schools. I am pleased to record that during the year a special class was started in the Roding Junior Mixed School to deal specifically with these children who are of average or even above average in intelligence. This class takes children from other schools in the Borough, and it is the aim to return children to their normal class or school as soon as possible. I do hope that similar classes will be set up in other parts of the town, for I am sure the need exists. When the staffing ratio permits, ordinary schools deal with children of low intelligence working up to their full ability (the borderline E.S.N.) by means of small classes in the "D" stream—an arrangement which has much to commend it. The Physically Handicapped and Delicate At the end of 1953 there were 71 children in the Physically Handicapped and Open Air section of Faircross School, divid .d as follows:- Page 94 [ Barking Other districts Cerebral Palsy (Spastics) 8 1 Other diseases of nervous system 6 1 Diseases of Bones and Joints 5 2 Heart disease 4 5 Asthma 5 9 Bronchiectasis and other lung conditions 4 8 Debility 5 1 Others 3 4 40 31 Special facilities exist on the school premises for the treatment of physically handicapped children. During the year arrangements were made for the Remedial Gymnast to attend the school for four whole days per week instead of four half-days as hitherto, and as a result of the appointment of a second Speech Therapist on a part-time basis, the number of Speech Therapy sessions held at the school has been increased from two to three per week. Views on Open-Air schools have altered considerably in recent years and in view of the design of modern school buildings there would appear to be little gained by sending certain children to an "OpenAir" School, particularly when this involves a journey in a crowded school coach. An exception must be made in the case of children who have become backward through the loss of much school time, and with their special skill and experience the Head Teacher and her staff are able to render much valuable assistance to such pupils. If the cases have been properly selected in the first place there is little likelihood that educationally sub-normal and physically-handicapped children will resume attendance at ordinary schools. The position with regard to children in the Open-Air Section is very different, and it is my constant endeavour to ensure that such children are returned to ordinary schools as soon as their physical condition permits. Whenever possible such transfers are timed to take place at the end of an academic year. Close co-operation between Head Teacher and School Medical Officer is desirable in all schools. In a Special School it is essential, and it is a pleasure to record my appreciation of the help afforded me by Miss Storm. Page 95 Other Special Schools Twenty-eight Barking children attend other special schools as follows :— Category Day Residential Blind - 2 Partially Sighted - 1 Deaf 4 2 Partially Deaf 6 2 Physically Handicapped - 2 Delicate - 1 Diabetic - 1 Epileptic - 2 E.S.N - 2 Maladjusted - 3 Convalescence Children requiring a short stay at the seaside or in the country following an illness or general debility, are sent for recuperative holidays. 114 schoolchildren were sent away during 1953 for periods averaging just over one month. Where a stay of more than two months is anticipated children are admitted to residential open-air schools so that their education does not suffer. Page 96