411(1) BARK 51 1 5B 2 Library ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR BARKING FOR THE YEAR 1957 B BARK 51 CONTENTS Pages 1. Membership of Committees 3-4 2. Staff 5-6 3. Preface 7 4. General Public Health 8-21 5. Personal Health Services 22-31 6. School Health Service 32-51 7. Report of the Chief Public Health Inspector 54-90 PUBLIC HEALTH COMMITTEE as at December, 1957 Chairman—Alderman Mrs. JULIA H. ENGWELL Vice-Chairman—Mr. Councillor LESLIE C. JONES The Mayor—Mr. Councillor W. H. ROYCRAFT Mr. Alderman G. H. COLLINS Mr. Councillor A. T. FRENCH Alderman Mrs. A. M. MARTIN Councillor Mrs. D. M. GLENNY Mr. Alderman J. R. SWEETLAND Councillor Mrs. D. M. JONES Councillor Mrs. M. BREDO, C.C. Councillor Mrs. E. G. LAW Councillor Mrs. J. CALLAN Councillor Mrs. M. PRESTON Mr. Councillor S. C. SIVELL Mr. Councillor LEONARD WRIGHT BRKING COMMITTEE FOR EDUCATION as at December, 1957 Chairman—Councillor Mrs. E. G. LAW Vice Chairman—Mr. Alderman G. H. COLLINS Representative Members:— Mr. Alderman A 3ALL, J.P. Mr. Councillor L. F. HENSTOCK Alderman Mrs. M 3ALL, C.A. Mr. Councillor H. J. HILLS, C.C. Alderman Mrs. J H. ENGWELL Mr. Councillor LESLIE C. JONES Alderman Mrs. A.M. MARTIN Mr. Cllr. R. W. G. KALBRAIER Mr. Alderman J.R.WEETLAND Councillor Mrs. M. PRESTON Mr Aid. W. G. WERMERLING Mr. Councillor S. R. ROWE Mr. Councillor G. G. BEANE Mr. Councillor W. H. ROYCRAFT Councillor Mrs. M.BREDO, C.C. Mr. Councillor S. C. SIVELL Councillor Mrs. D.M. GLENNY Mr. Councillor LEONARD WRIGHT Co-opted Members:— The Rev. Conon W. F. P. CHADWICK Mrs. L. F. M. DAVIS The Very Rey Canon J. A. DACEY Mr. A. E. GREEN The Rev. N. POVEY Mr. A. STONE Mr. J. ANDREWS Mr. J. WARD Nominated Members :— Mr. County Alderman K. E. B. GLENNY, J.P. Mr. County Councillor G. H. SHALDERS Page 3 BARKING HEALTH AREA SUB COMMITTEE of the Essex County Health Committee as at December, 1957 Chairman—Alderman Mrs. JULIA H. ENGWFI.L Vice-Chairman—Mr. Councillor LESLIE C. JONES Barking Borough Council Representatives Mr. Alderman G. H. COLLINS Councillor Mrs. D. M. JONES Alderman Mrs. A. M. MARTIN Councillor Mrs. E. ci. LAW Mr. Alderman J. R. SWEETLAND Councillor Mrs. M. PRESTON Councillor Mrs. M. BREDO, C.C. Mr. Councillor W. H. ROYCRAFT Councillor Mrs. J. CALLAN Mr. Councillor S. C. SIVELL Mr. Councillor A. T. FRENCH Mr. Councillor LEONARD WRIGHT Councillor Mrs. D. M. GLENNY Essex County Council Representatives :— Mr. County Alderman F. CULLEN Mr. County Alderman K. E. B. GLENNY, j.P. Mr. County Councillor A. C. BERRY County Councillor Mrs. S. M. BOVILL County Councillor Mrs. L. FALLAIZE Mr. County Councillor H. J. HILLS County Councillor Mrs. M. SMITH The Executive Council for Essex Representative:— Councillor Mrs. A. E. PRENDERGAST The Local Medical Committee Representative:— Dr. W. J. C. FENTON, J.P. The Hospital Management Committee Representative Mrs. D. L. BELCHAMBER Voluntary Organisations' Representatives:— Miss W. DAWSON Miss N. L. ODELL Mrs. G. M. GRAFFY Page 4 STAFF, 1957 Medical Officer of Health, Area Medical Officer, and Divisional School Medical Officer :— F. GROARKE, M B., L.M., D.C.H., D.P.H. Deputy Medical Officer of Health, School Medical Officer, Assistant County Medical Officer, and Medical Supervisor of Midwives :— MARGARET I. ADAMSON, M B., B.Ch., D.P.H. School Medical Officers and Assistant County Medical Officers'.— 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:— A. R LEVY, L.D.S. R.C.S. (Terminated 30.4.57) J. BUNTIN, L.D.S. R.F.P.S.G. Chief Public Health Inspector :— N. BASTABLE, F.R.S.H., F.A.P.H.I. Senior Public Health Inspector :— Mr. C. S. COOK (Retired 24.2.57) Mr. E. G. TWEEDY (As from 25.2.57) Public Health Inspectors:— Mr. E. A. E LIS Mr. R. ROPER Mr. T. W. CLEW (Commenced 1.11.57) Mr. A. G. MERRIMAN Mr. M. R. WILLIAMS (As from 25.7.57) student Public Health Inspector :— Mr. B R. SAUNDERS Superintendent Health Visitor:— Miss P. M. FAWCETT Health Visitors/School Nurses, etc. Miss M. BAERLOCHER Mrs. M. J. P. WEBSTER (Termina i 1.12.57) Miss G. K. JEFFREYS Miss C. M. BROWNING Miss J. McGILVRAY Miss A. CATTLE Miss E. PARRY Miss N. A. FLUCK Mrs. R. ROBERTSON Miss L.COODACRE Miss E. M. SCHROPFER Miss A. M. SMALL—Part-time (Tuberculosis Visitor) Page 5 STAFF, 1957 —cont. Dental Nurses, etc. Miss H. BUSH (Dental Attendant)Mrs. V. HARDING (Dental Nurse) (Terminated 11.5.57) Mrs. MOULE (Dental Nurse) In addition 18 part-time Nurses are employed for the staffing of the various Clinic services. Chief Clerk :— Mr. F. READ (Retired 3.4.57) Mr. G. H. RUFF (As from 4.4.57) Senior Administrative Assistant:— Mr. B. S. WEAVER (As from 4.4.57) Administrative and Senior Clerical Assistants:— Mrs. E. M. BARTHOLOMEW (School Health Service) Miss H. BEARTON (Handicapped Pupils and Special Children) Mr. S. DEEKS (Supplies and Maintenance) Mr. A. HOWLETT (Prevention of Illness; Care and After-Care) Mr. A. G. LONGMUIR (Staffing) Non-Medical Supervisor of Midwives :— Miss D. A. RISELEY District Midwives:— Miss E. V. ASHTON Mrs. I. M. BRONNICK Miss A. CUNNINGHAM Matron of Day Nursery :— Miss F. B. NASON Domestic Help Organiser :— Mrs. L. EVERITT Chief Chiropodist:— Senior Dental Technician:- Mr. H. LEAVESLEY Mr. J. CONSTABLE Speech Therapists :— Mrs. A. LING Mrs. M. WARD (Part-time) (Part-time) Oral Hygienist:— Occupational Therapist:- Miss J. THURSTON (Part-time) Miss D. M. COLDWELL REGIONAL HOSPITAL BOARD STAT17 Superintendent Physiotherapist:— Mr. T. HYND Remedial Gymnast:— Orthopist:- Mr. H. OGLE Miss M LEWIS Page 6 TOWN HALL, BARKING ESSEX December, 1958. Io the Mayor, Alderman and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, In presenting this report, I should like to thank my colleagues and members of he Council for the help they gave me during the year under review. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, Medical Officer of Health. Page 7 GENERAL PUBLIC HEALTH SHORTAGE OF HOSPITAL ACCOMMODATION During the year the Regional Hospital Board honoured their promise made to representatives of the Boroughs of Ilford, Dagenham and Barking in the summer of 1956 that they "would continue to give earnest consideration to the problem of the lack of hospital accommodation in the Ilford, Barking and Dagenham areas," and below is given a summary of the proposals made for the development of hospital facilities in Barking viz. at the Barking Hospital: Short term development 1. Improvements to existing theatre suite. 2. Improved X-ray facilities. 3. Adaptation of West Wing of Ross Ward to provide 16 acute beds (at present used for recreation). 4. Change function of Jenner Ward from 'chronic sick to ' general medicine.' 5. Bring Paget Ward into use for acute work (at present houses clinics). 6. Provide new physiotherapy department (to release East Wing of Ross Ward). 7. Adapt East Wing of Ross Ward to provide 12 acute beds (see 6). 8. Improve Upney Clinic building to provide temporary consultative out-patient facilities. 9. Extend pathological laboratory—in particular to provide waiting facilities for patients. Long term development 1. Extend to provide 300 bedded general hospital (including any additional maternity beds required). 2. Provide major out-patient department, casualty and ancillary departments and services." HEALTH EDUCATION During the year every effort was made to give publicity to such matters as prevention of lung cancer and the need for safety in the home. It is unfortunately true, however, that at the present time Page 8 health education can only command a small part of our resources because of more pressing and more tangible commitments. We have a long way to catch up with the publicity campaigns of commercial firms but there is a growing awareness that the preventive health services must advertise much more and 1 hope that the next few years will show a marked advance in this respect. MASS RADIOGRAPHY After a period of three years, the Mass Radiography Unit 6a, based on the C'onnaught Hospital, Walthamstow, E.17, again paid a welcome visit to the Town in January, 1957. Below is given a summary of the survey conducted by the unit: — Male Female Total Number X -ayed 4,233 5,148 9,381 Number ecalled for further examination 103 90 193 Number v o did not attend for furthe examination 2 3 5 Tuberculosis: (a) Requi lg medical treatment 3 3 6 (b) Requi g supervision 9 12 21 Other abnormalities (i) Cancer of lung 7 3 10 (ii) Heart Disease 5 10 15 (iii) Other including pneumonia, emphy na, sarcoidosis, etc.) 28 12 40 It was significant that in a letter addressed to all family doctors in the area, the Director of the Unit made the following statement:— Our experiance in a neighbouring borough earlier this year shows that the expected yield of tuberculous cases requiring immediate treatment is increased nearly four-fold if we concentrate on Doctor's cases. By this we mean persons attending surgeries, not necessarily with overt respiratory symptoms but with vague symptoms of any kind. It is also our experience that a large number is found among young women under 30, men over 40 and those who have never been X-rayed before. are also finding increasing numbers of middle-aged men with carcinoma of the lung." Page 9 NATIONAL ASSISTANCE ACT, 1948 Section 47—During the year we unfortunately had to invoke the provision of this Act and remove an old man aged 83 years He was found in a weak and debilitated condition and living on his own. He refused to enter hospital despite the appeals of his doctor and relatives. He died three days after admission to hospital. County Welfare Services:—The County Welfare Officer has kmdly supplied the following information: — "The statistics set out below show the extent to which the main services provided by the County Welfare Committee under the National Assistance Act, 1948, have Seen afforded to persons residing within the Borough of Barking during the year 1957:— (1) Residential and Temporary Accommodation (a) Admitted to hostels and other residential establishments: Men, 7; Women, 5. The number of persons emanating from the Borough in residential accommodation provided by or on behalf of the County Council as at 1st December, 1957, was as follows: Men, 18; Women, 29. (b) Admitted to temporary accommodation for homeless families: Men, —; Women, 2; Children, 5. (2) Blind Persons The number of registered blind, partially sighted and defective sighted persons resident in the Borough on the 31st December, 1957, was as follows:— (i) Registered as blind 89 (ii) Partially sighted 24 (iii) Defective sighted all of whom came under the supervision of the County Council's Home Teachers. There was one blind resident in the Home Workers Scheme operated through agency of the Royal Society for the Blind and two were employed in special workshops for the blind. Additionally, eight blind and four partially sighted persons were employed in open industry and one blind resident from the Borough was admitted to a Home for the Blind. Occupational and recreationa ,facilities are also Page 10 available to the blind and many are taught braille and handicraft. (3) Deaf or Dumb and other Handicapped Classes The Welfare Committee have continued to develop their activities in respect of welfare services for permanently and substantially handicapped persons (other than blind, as mentioned above) as provided for under Section 29 of the National Assistance Act, 1948, and in addition to direct provision such as special equipment on loan, grants towards the cost of structural adaptations to meet special needs, etc., the fullest co-operation has been maintained with specialised organisations in this field of welfare services, many of these bodies acting as the Council's agents in this connection." WELFARF. OF THE PHYSICALLY HANDICAPPED For record purposes 1 reprint the annual report for the year 1956-7 upon th work of the Barking Association for the Welfare of the Physically Handicapped. It will be remembered the formation of this association was sponsored by you in 1951. ANNUAL REPORT UPON THE WORK OF THE BARKING ASSOCIATION FOR THE WELFARE OF THE PHYSICALLY HANDICAPPED FOR THE YEAR 1956/57 The year has been a very successful one and for future reference and consideration brief summaries of some of the activities of the Association are given in alphabetical order. Clubs These continue to flourish and are held as under:— "Happy Wanderers" at Greig Hall, Stamford Road, Dagenham (near Woodward Library, Woodward Road—No. 62 bus stop) on Tuesday evenings from 7 p.m. "Golden Sliper" at Greatfields Hall, King Edward Road, Barking each alternate Tuesday evening. Employment Generally speaking handicapped people in this area who require employment and are mobile do find work, either through their own efforts or with the help of the Employment Exchange. There remain, however, number of homebound people who badly need something to occupy their time during the daytime and only an Occupational Centre can meet this need. Page 11 A number of cases continue to be employed at Remploy factories but there does appear to be a long waiting time before suitable applicants are finally given the chance to work in these establishments. Finance It is still not possible to budget properly because the grant receivable from the Essex County Council is not paid promptly at the beginning of the financial year, and continues to be paid in instalments one of which is near the end of the financial year. Footway Crossings The Barking Borough Council is very helpful when such crossings are required and when need be the Welfare Department of the Essex County Council meets the cost for the necessary works to be carried out. To anyone who has to push a handicapped per on in a wheel chair on a pavement, the lowering of kerbs at street intersections would be a boon. It is very tiring even for a strong person to negotiate a number of kerbs with a physically handicapped person (however light in weight) in a wheel chair. Handicraft Classes These are a very popular feature and are held as under:— Central Clinic, Vicarage Drive, Ripple Road, Barking (Blakes Corner), on Wednesday evenings from 6 p.m. Porters Avenue Clinic, Porters Avenue, Dagenham, on Monday evenings from 6 p.m. Health Visitors It is very fortunate that in Barking health visi;ors are allowed to have physically handicapped people on their visaing lists. This does give added advantages to handicapped peopi who may require a domestic help, a district nurse, sick room equipment, chiropody, dental, ophthalmic, etc., treatment, laundry service, etc. Hoists The heavy helpless handicapped patient is a great problem when he or she has to be shifted about the home, it is hoped that soon the provision of hoists will be started by the County Counil in suitable cases. The initial cost of providing these hoists is however, comparatively high and can therefore only be recommended for carefully selected cases. Page 12 Holidays There still remains much to be done to ensure that the more physically handicapped people can get holidays. Apart from the difficulty of raising sufficient money to pay for accommodation there is the main difficulty of finding the accommodation itself which will meet the special needs of the very handicapped. Only when accommodation is freely available will we be able to assure hard pressed relatives that we can relieve them of looking after a handicapped member of the family whilst they have a well earned holiday themselves. Although the Association is only concerned with the arrangements for a small number of holidays each year, the work involved is complicated and protracted. Hospital Treatment Over the past five years many of the Almoners of the larger London Hospitas have become accustomed to rely upon the Association for dealing with social problems relating to physically handicapped attending for hospital treatment. The Association has helped wherever possible and relationships with hospitals remain extremely cordial. Housing Both the London County Council and the Barking Borough Council are very generous in arranging suitable transfers (particularly where ground floor accommodation is necessary) for tenants who are physically handicapped or who have a handicapped person in their household. A number of extremely happy transfers took place during the. year but unfortunately there still remain in private property a number of cases who have to put up with very limited facilities, some of which are now listed:— (1) Absence of bath (2) Absence of garden, hence no chair (3) Lavatory inconveniently placed (4) Lack of ramps, handrails, etc. (5) Gas and electric meters inaccessible. Occupational Centre It is several years since the Association first pressed for the setting up of such a centre in Barking for handicapped people and Page 13 at the present time the County Council is actively considering taking over part of Eastbury House for this purpose. Occupational Therapy Despite the handicraft classes run by the Association and even with a day time occupation centre there will remain a need for a domiciliary occupational therapy service for the truly home-bound or bedfast patient. The numbers to be catered for should not be too great provided transport is made available to the cases to and from the Occupation Centre. Register During the year several cases died and several moved out of the area but despite this the number of cases has increased from 120 to 160. Publicity Mention must be made of the generous help given by the local Press who have regularly reported upon the activities of the Association in their columns. Residential A ccommodation As reported before, there is still a great need for suitab'c accommodation where young adults can be sent when their parents can no longer cope with them, i.e., for both short and long term stays. Social Events Clubs and handicraft classes are social events in themselves but in addition they are the starting point for fur er outings, e.g. to theatres, into the country, to London, etc. In addition, it has become the kind and thoughtful practice for a number of organisations in the area to invite groups of handicapped people to their social functions. These invitations are very much appreciated. Storage Sheds The provision of a storage shed can be a very frustrating business because often it comes after the whee chair has been delivered from the Ministry of Health. So very often too the handicapped person gets bogged down in the formalities of planning consent which have to be met before the shed can be erected and here the Association does everything it can to smooth out difficulties in this matter. Page 14 The London County Council through its local Welfare Officer is extremely helpful to any of its tenants who require storage sheds. Transport The Bedford "Dormobile" has now been in service for nearly ! two years and plays an indispensable part in the activities of the Association. Besides undertaking routine journeys to clubs and handicraft dasses, many other commitments are undertaken, e.g., journeys to railway termini, holiday addresses if reasonably near, theatre and picnic trips, etc. Wheel Chairs To many handicapped people a wheel chair is the pivot of the whole of their existence. It can represent the chance to hold a job and earn money, the opportunity to enjoy human society and in many other ways to case the burdens placed on handicapped people. It is not surprising therefore that a great deal of administrative work accrues from the provision and maintenance of wheel chairs. Liaison is maintained constantly with the Ministry of Health, who even though they operate by "remote control" do their very best to meet th differing needs of individual cases. One problem which cannot be solved at the present is that pre- sented by the mother or wife who may be both frail and ageing but has to push her adult son/daughter or husband about because they are too helpless to manage a chair on their own. Some sort c power-assisted chair would be a boon to many families known the Association, e.g., like the hand guided electric milk floats. Page 15 MATTERS OF LIFE AND DEATH Population The population of Barking at mid-1957, according to the Registrar General's estimate was 75,070. This shows a further decrease from the figure of 78,170 at the 1951 Census. Births 916 live births and 18 still-births were registered during 1957, as under: — Live Births: — Males Females Total Legitimate 504 375 879 Illegitimate 17 Totals 521 395 916 Still-Births: — Legitimate 11 7 18 Illegitimate Totals 11 7 Total Live and Still-Births 532 Birth Rate per 1,000 of Estimated Population 12.2 Birth Rate adjusted by Comparability Factor of 0.5 —11.47. Still-Birth Rate per 1,000 (Live and Still) Births 19 1. Maternal Mortality Regrettably, one maternal death occurred during the year despite every medical attention. This means that for 1957 a maternal mortality rate of 1.07 per 1,000 births must be recorded. Page 16 Loss of Infant Life The infant death rate in 1957 was 18.55 as compared with 19.59 for 1956. The following tables show the causes of infant deaths:— INFANTILE MORTALITY—1957 Cause of Death Age at Death 0-1 mth. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under 1 year Atelectasis 4 — — - - 4 Broncho-Pneumonia — 1 1 - - 2 Congenital Heart Disease — 1 - - - 1 Dural Tear 1 - - - - 1 Prematurity 8 - - - - 8 Toxaemia of Pregnancy 1 — — — — 1 Totals 14 2 1 — 17 NEO-NATAL MORTALITY—1957 Cause of Death Age at Death Under 1 wk. 1-2 wks. 2-3 wks. 3-4 wks. Total Atelectasis 4 - - - 4 Dural Tear 1 — — — 1 Prematurity 8 — - - 8 Toxaemia of Pregnancy 1 — - — 1 Totals 14 — - — 14 of the total of 17 deaths no less than 14 occurred within the first week of life. Page 17 DEATHS Causes of Death in 1957 Total Tuberculosis and other Infectious Diseases 6 Cancer and other Malignant Diseases 189 Diseases of the Brain and Nervous System 57 Diseases of the Heart and Circulatory System 197 Pneumonia, Bronchitis and other Respiratory Diseases (excluding T.B.) 77 Diseases of the Stomach and Digestive System 19 Accidents, Poisonings and Violence 29 Infant Deaths and Congenital Malformations 20 Pregnancy, Childbirth and Abortion 1 Other causes 29 Total 624 Crude Death Rate per 1,000 Estimated Population 8.31. Adjusted Death Rate (Comparability Factor 1.41) 11.72. INFECTIOUS DISEASES The following notifications were received during the year:— Notifications Pneumonia 146 Tuberculosis: Respiratory 28 Non-Respiratory 7 35 Scarlet Fever 50 Dysentery 9 Puerperal Pyrexia 10 Measles 1,113 Whooping Cough 217 Food Poisoning 14 Erysipelas 4 Scabies 12 Meningococcal Infection 3 Poliomyelitis 5 Diphtheria Ophthalmia Neonatorum 2 Page 18 INFLUENZA In early June family doctors were alerted regarding the possible spread to Europe of the influenza epidemic, prevalent in Asia, and below is a copy of the information sent to them:— "Extensive outbreaks of influenza have occurred recently in several countries of the Far East. Brief reports of these have been published in the medical press. Cases were first observed, in mid April, at Hong Kong and at Singapore where large numbers of persons have been affected. Towards the end of April an outbreak, began in Taiwan (Formosa) and it has been estimated that more than 100,000 cases occurred there in the course of two or three weeks. During the first half of May another large outbreak developed in Manila, in the Philippine Islands, and subsequent outbreaks have been reported from Japan, India, Sarawak, North Borneo, Vietnam, Cambodia and Indonesia. Outbreaks e been also reported among persons travelling by sea or air from the affected regions. Most of he cases have been described as clinically mild. A report from Singapore refers to severe headache, generalised pains and fever (101°—103° F.), lasting two or three days and followed by about four days disability. There have been a number of deaths but the fatality rate has been low. The outbreaks have been explosive in character, but the epidemic wave has passed quickly. Virus strains from the Singapore outbreak have been received at the World Influenza Centre, London, where they are being intensively studied. Preliminary investigations have shown that they belong to the Influenza A group, but are markedly different from, trains isolated during past influenza outbreaks. The present strains are not neutralised by any antiserum prepared from previous strains and it is considered that the antigenic variation is the largest that has taken place since the appearance of the A-prime variant in 1946. It is unlikely that the vaccines, which have been prepared again past influenza strains, will protect against infection by the new variant and the possibilities of preparing a vaccine against the recently isolated strains are being actively explored. However favourably this work might proceed there would be an inevitable delay before such a vaccine could be produced in I quantity. Page 19 In the meanwhile it is of importance that any outbreaks of influenza which may occur in Great Britain should be speedily investigated, with particular reference to the identification of the causative agent, but having regard to the fact that the capacity of the Public Health Laboratory Service for this purpose is not unlimited, selection and control of the material sent for investigation may be necessary. You are asked to keep a close watch for the possible introduction of epidemic influenza amongst your patients, and to notify me at once of any unusual trend. When it is apparent that an outbreak of influenza-like disease is developing a decision will be made as to the investigations necessary in the light of the situation as a whole in this and surrounding areas. The early ascertainment, including laboratory investigation of such outbreaks, depends on the co-operation of all general medical practitioners in the matter of early notification." Plans were laid for the emergency measures which could be brought into effect if the outbreak reached this count and spread to this area. In the early Autumn the Ministry of Health nnounced that although no mass vaccination scheme was contemplated, vaccine would be available for " certain groups who are specially exposed to infection and on whom an epidemic places an exceptionally heavy burden, e.g., hospital staff, general practitioners, and local health authority staff who care for the sick in their own hones, for example nurses, midwives, home helps, ambulance staff, and any other staff who may be called upon to visit the sick at home." In mid-October a supply of vaccine was received so that family doctors, district nurses, midwives, domestic helps and other priority groups wishing to be protected could be vaccinated There was a significant rise in sickness, particularly amongst school children, from the middle of October onwarc but towards the end of November there was a distinct fall in the inc ence of influenzas such which, at no time, had been widespread enough to cause serious dislocation of life. Children seemed to be the most affected and at one time one in four of the school population of 12,000 were absent on account of illness. It was a relief to know, however, that what could have been a serious epidemic did not materialise. Page 20 POLIOMYELITIS Of the five diagnosed cases of poliomyelitis, one only developed paralytic symptoms and was still under treatment at the end of the year. CARE OF THE AGED Throughout the year Health Visitors continued to visit the aged in their homes, and resulting therefrom action was taken in many instances to procure necessary treatment and help where needed. One of the most appreciated services which is given on the recommendation of the health visitor's visit is domiciliary chiropody. This is provided by he Barking Old People's Welfare Committee and at the end of the year 134 old people were receiving this service, an increase of nearly 50 over the previous year. It is interesting to note that the average age of the people receiving this service was 79 years. During the year there has been constant and cordial contact with hospitals receiving the chronic sick and with the County Welfare Department. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT Licences we renewed during the year in respect of three establishments which are governed by the Borough's bye-laws. LAUNDRY SERVICE Once again the Borough Council's laundry service proved an invaluable adjun to the services provided in the home to care for the chronic sick During the year 32 cases were assisted. Page 21 PERSONAL HEALTH SERVICE This section deals with those services which come under the control of the Barking Health Area Sub-Committee of the Health Committee of the Essex County Council. CLINIC PREMISES Health Services Clinic—Thames View Estate. Restrictions on capital expenditure were not lifted during the year which meant that approval continued to be withheld for the erection of a Health Services Clinic. It was decided, therefore, to consider the opening of temporary clinic services in the surgery premises erected by the Barking Borough Council on behalf of family doctors serving the Estate. At the end of the year negotiations were in progress with the Thames View Group Practice for the use of their surgery on two afternoons per week, one for an Infant Welfare Clinic and the other for a Mid wives' Clinic. Central Clinic. During the year it became necessary to renew the central heating boiler which had been in continuous use since the clinic was opened in 1933, and the opportunity was taken to instal an oil fired system at a cost of just over £1,000. The utomatic firing of the new installation reduces the need for a boilerman to a minimum and moreover ensures a steadier and more ever heat which in turn means that less supplementary heating, viz. electric heaters, is required. These savings will more than offset the slightly increased expenditure on the purchase of fuel. Upney Clinic. These premises were built originally as a Civil Defence First Aid Post and since the end of the War with very little refinement have been used for out-patients service of the Regional Hospital Board and the Essex County Council. By virtue of its near ness to the Barking Maternity Hospital, the clinic has been used increasingly during the past few years for ante natal and allied vices for patients booked for confinement in the hospital. The first-aid post lay-out of the clinic did not lend itself to the greatly increased number of clinical sessions and it was decided undertake alterations which would enable ante natal and/ or post natal sessions to be run concurrently with minor ailments, infant welfare or paediatric sessions, etc. These alterations were completed in the early autumn and are described as under:— "Additional partition walls have turned one large room Page 22 into two fair sized consulting rooms, with waiting space, and the removal of two partition walls has transformed a very small and inconvenient room into a consulting room and given an enlarged treatment room. Where necessary, additional handbasins, strip lighting and electric points have also been installed." The cost of the necessary work was borne jointly by the County Council and the Hospital Management Committee. RE-ORGANISATION OF CLINIC SERVICES During the year a review was undertaken of the clinic services to ascertain:— (a) what economies in running expenses could be effected without detriment to the service and (b) what could be done to make better use of existing accommodation. A summar of the changes effected is given below. Paget War. Barking Hospital. The Regional Hospital Board estimated that running costs of this ward were something over £1,600 per annum and of this the County Council were liable to pay one half because of the following services installed there:— Birth Control Clinic, Speech Therapy Clinic, Workroom and Office for Occupational Therapist. It was decided to move the birth control clinic to Upney Clinic, to divide speech therapy sessions between Central and Woodward Clinics and to give the occupational therapist office facilities in the Fast Street office premises. In view of thefact that Paget Ward was scheduled to be used for in-patients once more in the redevelopment plan for the Barking Hospital, the Hospital Management Committee decided to move their out-Patient services held in this ward elsewhere also. The first step taken was to move the specialist skin clinic to Upney Clinic, leaving only the orthoptic clinic to be housed elsewhere. Chiropody St ice. At the time of the review there were four chiropodists open ng at Central Clinic and one each at Woodward and Porters Avenue Clinics. It was decided to transfer a chiropodist from Central Clinic to operate a chair at Greatfields Clinic and to transfer the three remaining chairs at Central Clinic from the tem- Page 23 porary building in the grounds of the main building. With the move of the chiropody service to the main building at Central Clinic, it was possible to transfer the receptionist duties to the existing clerical staff and thus dispense with the post of receptionist for the chiropody service. Dental Laboratory. This was held in a mainly wooden building at the rear of Central Clinic and it was decided to transfer the service to the more commodious and more permanent building vacated by the chiropody service. It was decided to use the former dental laboratory as a store for sick room equipment, etc. Medical Staff. It was decided that with the retirement of Dr. A. E. Seligmann in the early summer a replacement for his post would not be sought, thus reducing the number of A istant County Medical Officers from six to five. Infant Welfare Sessions. A survey was taken of infant welfare attendances, and it was found that the demand only justified two sessions per week instead of three at each clinic with the exception of Woodward Clinic. This reduction was introduced at Central, Porters Avenue, Upney and Greatfields Clinics. Sale of Welfare Foods, etc. Prior to the "appointed day" nutrients, etc., were sold at Infant Welfare sessonis by part-time assistants on the staff of the Borough Treasurer, and these arrangements were continuing on an agency basis with the County Council when the Ministry of Food passed over to local health 1 authorities the responsibility of selling National Dried Milk, etc. At the time of the review, part-time assistants 1 the staff of the Borough Council were selling nutrients, welfare foods, etc., at each infant welfare session plus Saturday mornings an each afternoon session at Central Clinic. It was decided to terminate the agency arrangements with the Borough Council and to arrange for existing clerical staff to sell foods throughout the day at Central, Woodward and Porters Avenue Clinics and at infant welfare sessions at Greatfields and Upney Clinics. East Street Clinic. With the resignation of Mr. A. R. Levy, Dental Officer, the only remaining full-time dental officer was Mr. J. Page 24 Buntin who ran his surgery in the wooden wing of the East Street premises. Mr. Buntin agreed to transfer to Central Clinic and East Street was closed for clinic purposes. CARE OF MOTHERS AND YOUNG CHILDREN MATERNITY SERVICE Ante-Natal Care. This was given as follows: — Clinics 666 Hospitals (excluding Barking Hospital) 160 General Practitioners 95 921 Confinements. During the year 922 mothers were confined, giving birth to 931 infants (including 12 pairs of twins). These were horn as follows:— Barking Hospital 501 Other Hospitals 162 At home 271 934 One confinement which occurred in the district related to a woman who had failed to seek ante-natal care and who only called her doctor after the onset of labour. The baby died before medical aid arrived. Post-Natal Care. 339 Barking mothers attended the Post-Natal Clinic making a total of 363 attendances. In addition 226 mothers were under the care of their family doctors and 160 were under the care of hospitals outside the district. INFANT WELFARE ATTENDANCES AT INFANT WELEFARE CLINICS-1956&1957 1956 1957 Number of children born in year who attended 756 771 Total number of children who attended 2,533 2,413 Total attendances 25,157 23,409 Page 25 Distribution of Welfare Foods The following table shows the welfare foods distributed during 1956 and 1957:— 1956 1957 National Dried Milk 33,880 25,124 tins Cod Liver Oil 7,435 6,061 bottles Vitamin Tablets (A & D) 3,692 3,445 packets Orange Juice 63,258 62,398 bottles During the year the cost of a tin of National Dried Milk went up from 10½d. to 2/4d. DAY NURSERIES The table below shows the attendances at Gale Street Day Nursery during 1957:— No. on Register Average daily attendances January 47 34.1 February 45 37.6 March 45 37.6 April 44 37.2 May 47 32.3 June 48 38.5 July 52 38.8 August 54 35.0 September 51 39.9 October 49 34.9 November 48 39.0 December 49 37.7 Nursery and Child Minders' Regulation Act There are no registered child minders in the Borough. MIDWIFERY During 1957, we had five midwives practising in the district. including two under the auspices of the Queen's Nurses; 267 patients were delivered in their own homes, only some 29% of all patient confined. Supervision of Midwives Dr. M. I. Adamson continued as Medical Supervisor of Midwives and Miss D. Riseley, Matron of the Barking Hospital, continued to act as Non-medical Supervisor of Midwives. Page 26 HEALTH VISITING The following statistics relate to the work of health visitors:— HEALTH VISITING 1956 1957 No. of visits to Expectant Mothers 1,388 1,345 No. of visits to Children under five 11,258 10,184 No. of other visits 4,273 4,418 No. of Non-Access visits 2,129 2,487 HOME NURSING This service, together with approximately half of the domiciliary midwifery service, is still administered from the County Training Home at Leytonstone. VSCCINATION AND IMMUNISATION Smallpox Vaccination The number of primary vaccinations carried out in 1957 was 21 in infants under one year, 72 in those over one year. This means that just under 25% of infants are being vaccinated during the first year of life. Pliomyelitis Vaccination During 1956 when vaccination was offered to children born in 1947 to 1954, inclusive, some 2,296 consents were received but at the beginning of 1957 over 2,000 children still remained to be vaccinated. The first delivery very of vaccine in 1957 was not received until March but it wa he largest consignment received since the scheme first began. It was, however, still only sufficient to vaccinate 173 children. Early in the summer, the Ministry of Health extended the scheme to include children born in 1955/56 and asked for a second oppor- tunity to be giver to those born in the original age groups. Arising from this, consents for a further 1,500 children were received. By the end of June a total of some 1,200 had been vaccinated with British type vaccine. The Government, in order to speed up its vaccination programme and in view of the continued shortage of vaccine manu- factured in Britain, entered into negotiations with Canada and the United States for the purchase of vaccine manufactured in North America. In November, the Minister of Health announced that the scheme was to widened still further and would include all children aged from 6 months to 15 years and all expectant mothers. Page 27 It was estimated that the potential number of cases eligible for vaccination in Barking was 17,500. The scheme for poliomyelitis vaccination formulated by the Essex County Council provides for people to choose either their family doctor or a clinic doctor to undertake vaccination, and at the end of the year enquiries were still in progress with family doctors it the area as to whether or not they wished to participate in the scheme. Diphtheria and Whooping Cough Immunisation The number of children receiving primary courses of immunisation during the year was as follows: — DIPHTHERIA Family doctors Clinics Total Separate 70 440 510 Combined with whooping cough 201 - 201 Total diphtheria 271 440 711 WHOOPING COUGH Family doctors Clinics Total Separate 52 229 281 Combined with diphtheria 201 - 201 Total whooping cough 253 229 482 In the 1954 Annual Report, Dr. D. E. cu'lington gave an account of certain investigations on which the department was engaged in conjunction with the Wright Fleming Insitute, St. Mary' Hospital, Paddington, on the matter of immunization against diphtheria and whooping cough by use of a combined method. In September, 1955, our article summarising early results of this work was published in the " British Medical Journal." and it seemed to arouse much interest since requests or reprints were Page 28 received from many parts of the world. The conclusion reached was that the combined method adopted by Barking gave better protection against diphtheria than the separate injections of A.P.T. then in common use, but was slightly less effective than separate injections of P.T.A.P., the diphtheria prophylactic used in our work, and for years previously used in our clinics. As our results were encouraging we continued to use P.T.A.P., and extended the scope of the research by the addition of Tetanus Toxoid to the diphtheria and whooping cough vaccine, this we called Triple Vaccine. As in the previous scheme the parents of babies aged between two and five months were offered the alternative of combined or triple vaccine, and the project was explained to them. About 400 babies were included in the scheme, and at fifteen months a small amount of blood was withdrawn from each, but by an improved niethod to that mentioned in the 1954 report. Parents were most co-operative, and results proved that the children in both groups were equally well imunised against diphtheria. An account of this aspect of the work compared with similar research on guinea pigs has been sent to the World Health Organisation, and will be published shortly. The childrer included in the first and subsequent schemes have been carefully followed up over the years, and blood tests are being repeated as they rach the age of 4½ years to ascertain the level of protection that remains from the injections received in infancy. The second aspect of the follow-up has consisted of a very careful check of those children who in spite of immunization have developed whooping cough. It seemed an almost endless task even finding many of them for almost a half of the original 714 in the scheme had moved, and left no forwarding address. However, in the end only one has remained entirely undetected, and after careful questioning of the others the final result was that 33 of these may have developed whooping cough. mostly of such a mild nature that the diagnosis was not at all certain (11 of these cases in fact are very doubtful). There were only 4 serious cases 2 of them in children who were long overdue for their whooping cough booster injections at 2½ years; the other 2 children had not been brought up at the correct dates for their injections and may have been inadequately immunised. In fact it, was clear that the rate of irregular attendance for injections was much higher among the group who contracted whooping cough than Page 29 among the group as a whole. No proof was found that children immunised by the "combined" method were more likely or less likely to develop whooping cough. An article on the above follow-up is now with the Editor of the "British Medical Journal" and, we hope, may be accepted. The Medical Research Council during 1956 reported that inoculation with certain of the prophylactics used against diphtheria or whooping cough involves some risk of provoking paralysis due to poliomyelitis and as a result official policy now propounds that only certain vaccines should be used against diphtheria and in order to minimise the risk of paralysis that vaccines should be used separately, despite the disadvantages and dangers of submitting children to an increased number of injections and the likely falling of in numbers seeking immunization. Because of the extreme rarity of the complications referred to in this report of the Medical Research Council, there remains amongst doctors and the public much support for the policy of using combined vaccines when inoculating children. It is felt by many that the need of fewer pricks and fewer trips to clinic or surgery would encourage a higher proportion of persons to be protected against more diseases thereby outweighing the hypothetical risk involved in the use of combined vaccines. For protection at present a baby must be give three injections at monthly intervals for whooping cough, two injections for diphtheria and three for Tetanus, totalling eight injections in all. The same degree of protection can be conferred from an early age, as Barking has confirmed, by three injections only, using a triple vaccine. Dr. Spiller was the instigator of this piece of research in 1953 and continues to be its mainstay. PREVENTION OF ILLESS, CARE AND AFTER-CARE Chiropody Service This remains a popular service and during the year attendances were made. Sick Room Equipment. This continues to be much in demand and helps greatly to assist the nursing of patients at home. At the end of the year just over 500 articles were out on loan. Page 30 DOMESTIC HELP SERVICE The following table shows the number of hours of service given during the past eight years, together with a detailed analysis of how the hours of service were deployed in 1957:— Year Number of Helps Employed Number of Cases Helped Total Hours Worked 1950 55 387 80,699 1951 49 327 70,611 1952 84 318 85,743 1953 89 384 105,121 1954 89 503 101,960 1955 90 556 105,104 1956 93 596 104,863 1957 93 581 97,536 DEPLOYMENT OF DOMESTIC HELPS IN 1957 Hours of Service Category Cases Helped Maternity 47 3,524 Acute Sick 25 1,833 Tuberculosis 22 4,009 Chronic Sick 106 20,769 Aged chronic sick 225 37,851 Aged 153 29,139 Others 3 411 Total 581 97,536 During the year a minimum charge of 5/- per wek was duced for each case receiving help. On application by the recipient of the service and in appropriate cases, the National Assistance Board met this charge. Page 31 SCHOOL HEALTH SERVICE JUBILEE OF THE SCHOOL HEALTH SERVICE, 1907—1957 The Chief Medical Officer of the Ministry of Health in his Annual Report for the years 1954/55 concluded as follows: — "EPILOGUE" "It was the Education (Administrative Provisions) Act of 1907 which first provided the statutory basis for our school health service. Before the next report in this series is issued, half a century will therefore have elapsed since the laying of the foundations of that service. It is right and proper that from time to time we should look back at what has been accomplished; so may we gain encouragement from past successes, so may we humbly remind ourselves of the problems to which we have not yet found the answer. The forthcoming Jubilee is one of those times when it is specially appropriate that we should look back and consider the conditions with which our predecessors had to deal. The reports which they submitted contain much which would be of interest to this generation and I hope that principal school medical officers will use this material for a picture in their annual reports of the conditions existing in those pioneering days. An understanding of the difficulties which then had to br overcome should serve as a stimulus to us in our task of building on the foundations which were then so well and truly laid." As an appendix to this report are given extracts of annual reports, in chronological order, written by Medical Officers at the turn of the last century. Since the time of these pioneers great strides have been made to improve the happiness and well-being of our people, particularly the young, but it could well be that Barking people of 2,000 A.D will find our times as equally backward as we find the early years of this twentieth century. Following the Appendix containing the extracts of annual reports will be found a table illustrating briefly the changing pattern of the standards of health of the people of Barking from 1900 to date. Page 32 MEDICAL INSPECTION AND TREATMENT The Statistical Return at the end of this report shows the classification of defects found and the treatment thereof. Minor Ailment Clinics Attendances at these clinics were well maintained during the year. CASES TREATED AT MINOR AILMENT CENTRES Eyes: (External and other—excluding errors of refraction and squint) 430 Ears, Nose and Throat Defects (other than operative) 626 Skin: Ringworm (body) 7 Scabies 2 Impetigo 81 Other 1,888 Other minor ailments (e.g. minor injuries, bruises, sores, chilblains, etc.) 2,929 Total attendances 23,593 Speech Therap During the year 158 cases made 2,240 attendances to the Speech Clinic. Two part-time Speech Therapists were employed throughout the year giving a total of 13 treatment sessions per week. During term time 4 of the 13 sessions held are undertaken at Faircross School. DENTAL SERVICES Statistics relating to the dental inspection and treatment of school children will be found in the statistical return at the end of this report. Unfortunately, the number of full-time dentists was reduced from two to one through the resignation of Mr. A. R. Levy who obtained a post in a Health Centre of the London County Council. Although it was found impossible to recruit full-time staff, a number of parttime dentists were engaged but their services were not sufficient to give true continuity in treatment and inspection. This was particularly Page 33 felt in the case of orthodontics because over the years Mr. A. R. Levy had made a speciality of this branch of dentistry and he had built up a high standard of treatment and supervision. During the year the oral hygienist employed in the Walthamstow area was seconded to us for two sessions per week. The Dental Laboratory continues to construct dentures and appliances not only for Barking but for many dental centres elsewhere in the County and during the year the following appliances and dentures were processed for school children:— DENTURES AND APPLIANCES CONSTRUCTED FOR SCHOOL CHILDREN AT THE DENTAL LABORATORY IN 1957 Description of Denture or Appliance Barking Other County Districts Full upper or lower dentures — 1 Partial Denture (5-9 teeth) 6 9 „ „ (1-4 teeth) 31 87 Repairs to Dentures 26 50 Fixed Splints — 18 Acrylic Crowns 8 4 Oral Shields — 32 Space Retainers — 6 Bars Stainless Steel — 2 Plates Stainless Steel — 1 Simple Orthodontic Appliances — 33 Complex Orthodontic Appliances 62 376 Andresson — 1 Study Models (Sets) 66 478 Special Trays (Acrylic) 2 2 Box Plate Trays — 15 Bands 13 2 Bridges — 1 Gold Plate — 1 Silver Splint — 2 Basket Crown — 1 Sued Plate — 1 Page 34 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. Cases dealt with were as follows:— External and other diseases excluding errors of refraction and squint 76 Errors of refraction (including squint) 1,326 Total 1,402 The number of pupils for whom spectacles were prescribed was 1,040. Miss Lewis, Orthoptist, treated 140 school children during 1957. Ear, Nose and Throat Clinics Miss M. Mason, F.R.C.S., continues as the Consultant Ear, Nose and Throat Specialist. Figures for treatment are:— Operative treatment (cases):— (a) For diseases of the ear 3 (b) For adenoids and chronic tonsillitis 177 (c) For other nose and throat conditions 11 Other forms of treatment (cases) 250 Orthopaedic Clinic Mr. L. Gil M.B.E., F.R.C.S., continues as the Consultant Orthopaedic Surg it and attends fortnightly. Cases treater were: — In hospital 8 In clinics, or out-patients departments 252 Skin Clinic Dr. P. M. Deville, M.R.C.P., M.R.C.S., Consultant Dermatologist, mow attends he Skin Clinic, Paget Ward, Barking Hospital, twice a month, and during the year 727 attendances were made to his clinic. Page 35 Child Guidance Figures for school children are as follows: — No. of cases referred 34 No. who received treatment (plus 9 referred in 1956) 21 (Of this number, one was subsequently recommended for residential placement as a Maladjusted Child.) No. of cases closed—left district or appointments not kept _ No. of cases referred but still awaiting investigation at end of year 13 Participation in case conferences has continued to be of invaluable help and interest, and we are grateful to Dr. Davidson and her team at the llford Child Guidance Clinic for their ir enthusiastic support. Paediatric Clinic The Consultant Paediatrician of the Regional Hospital Board holds a session each fortnight at the Upney Clinic and during 1957 school children were seen as follows:— New cases 70 Re-examination Total attendances 342 Dr. S. B. Dimson who had been the Consultant Paediatrician for some time terminated his service in Barking on the 18th June and. pending the appointment of his successor. Dr. T. Savage undertook locum duties. B.C.G. VACCINATION B.C.G. Vaccination is offered to all 13-year-oid children, and is normally carried out in the term preceding their fourteenth birthday. A Mantoux—as well as a Heaf Puncture—Test is undertaken in every case, and where there is a positive reaction the child is referred to the Barking Chest Clinic for X-ray. Page 36 Below arc given some statistics relating to this service: — Number to whom offered 1,275 Number tuberculin tested after parents' consent had been received 928 Heaf Mantoux Positive result 72 73 Negative result 856 855 Number who received B.C.G. 855 HANDICAPPED PUPILS A summary is given below of the ascertainment and placement of handicapped pupils during the year:— Category No. of pupils ascertained during 1957 No. of pupils admitted to Special School during year Total No. of pupils in Special Schools as at 31.12.57 Day Residential Day Residential Deaf 1 - 1 3 3 Partially deaf - - - 5 - Blind 1 - - - 3 Partially sighted - - - 2 2 Epileptic - - - - - Delicate 5 3 1 12 6 Physically Handicapped 4 4 - 19 2 Educationally Sub-Normal 13 7 1 42 - Maladjusted 6 - - - 7 Speech — — — — — Totals 30 14 3 83 23 Faircross School. At the end of the year there were 189 pupils at Faircross Special School distributed as follows:— Barking Other Districts E.S.N. Section 42 78 Open Air Section 29 40 ES.N. Section. During the year 10 children left the E.S.N. Action on ceasing to be of compulsory school age (3 Barking and 7 out-of-district)—all were recommended for supervision by the Local Health Authority under Section 57(5) of the Education Act, 1944. Eight children (2 Barking and 6 out-of-district) were found to ineducable and recommended for action under Section 57(3) of the Education Act, 1944. Page 37 One child was no longer considered to require special educational treatment and returned to an ordinary school. Open Air Section. The children in this section at the end of the year were suffering from the following conditions:— Barking Other Districts Cerebral Palsy (Spastics) 7 — Other diseases of nervous system 8 2 Diseases of Bones and Joints 2 5 Heart disease — 1 Asthma 3 13 Bronchiectasis and other lung conditions 4 10 Debility 4 6 Others 1 3 Total 29 40 During the year four children left Faircross School on reaching school-leaving age, 11 children (5 Barking and 6 out-of-district) were no longer considered to require special educational reatment—6 returned to ordinary schools and 5, aged 15, were allowed to leave school. In addition, two children transferred to the Educationally Sub-Normal Section. Other Special Schools During the year forty-five Barking children attended other special schools or received home tuition as follows:— Category Day Residential Home Tuition Blind — 3 — Partially Sighted 2 2 — Deaf 4 3 - Partially Deaf 6 1 - Physically Handicapped — 2 - Delicate — 7 2 Diabetic — 3 - Epileptic — - 1 Educationally Sub-Normal — — - Maladjusted — 8 - Convalescence One hundred and thirteen children were sent away for periopds of convalescence of up to 8 weeks. Page 38 SCHOOL HEALTH STATISTICS FOR THE YEAR 1957 Total (All Schools) 1. MEDICAL INSPECTION OF PUPILS (a) PERIODIC Number of children examined at school:— (i) Entrants 968 (ii) Second age group 1,299 (iii) Third age group 1,016 (iv) Others 3,243 Total 6,526 Number of defects found requiring treatment 844 Number of defects found requiring observation 460 Number of individual pupils found to require treatment 802 Nutritional classification of pupils examined:— Entrants 2nd Age Group 3re Age Group Other Satisfactory 965 1,299 1,014 3,242 6,520 Unsatisfactory 3 — 2 1 6 (b) SPECIAL Number children specially examined (including medical examinations for School Camps, Boxing and Part-time Employment) 10,415 Number of defects found requiring treatment 7,059 Number of defects found requiring observation 258 (c) RE-INSPECTION Number of children re-inspected 9,358 2 treatment of children (a) Total attendances at Specialists' Clinics:— (i) Ear, Nose and Throat 656 (ii) Ophthalmic 2,700 (iii) Orthopaedic 77 (iv) Paediatric 342 (v) Skin 727 (b) Total attendances at Treatment Clinics:— (i) Minor Ailment 23,593 (ii) Chiropody 802 (iii) Orthopaedic 4,241 (iv) Orthoptic 1,578 (v) Speech Therapy 2,240 (vi) Skin 3,901 (c) Number of children who received operative treatment for tonsils and adenoids 177 3. HOME VISITING Total number of visits made by School Nurses 2,426 Page 39 SCHOOL HEALTH STATISTICS FOR THE YEAR 1957-cont. Total (All Schools) 4. HYGIENE INSPECTIONS (i) Number of examinations of pupils in school 11,165 (ii) Number of pupils found unclean 119 5. DENTAL INSPECTION AND TREATMENT (i) Number of pupils inspected in school 476 (ii) Number of pupils inspected at Clinics 2,625 Total 3,101 (iii) Number found to require treatment 2,889 (iv) Attendances for treatment 8,999 (v) Number of fillings: Permanent teeth 3,570 Temporary teeth 914 (vi) Number of teeth filled: Permanent teeth 2,970 Temporary teeth 799 (vii) Number of teeth extracted: Permanent teeth 1,081 Temporary teeth 3,342 (viii) Number of general anaesthetics administered for extractions 1,999 (ix) Other operations: Permanent teeth 2,851 Temporary teeth 1,458 (x) Number of treatments (included in (ix) above) carried out by Oral Hygienist 179 Page 40 APPENDIX JUBILEE OF THE SCHOOL HEALTH SERVICE EXTRACTS FROM MEDICAL OFFICERS' REPORTS 1900 " Further Sanitary Requirements of District Much still remains to be done in the relaying and ventilation of drains and sewers in many parts of the town, in rendering many houses more habitable by paving round them. I regret exceedingly that the draining of the old Workhouse property in North Street has not yet been dealt with." " Pauperism. During 1900 there were 461 persons chargeable to the Parish, or 20.4 per 1,000 of the estimated population. The amount expended in relief was £2,410 or about £5 per head of the population." 1902 Diphtheria ar, Membranous Croup Though the number of cases during the year was somewhat less than the year before, the death rate was nearly double Many of the cases were very severe and I fear that the increased death rate is largely due to the fact that hospital accommodation was not always available. The extraordinary efficacy of the anti-diphtheria serum was over and over again demonstrated and I have no doubt that if patients could be brought under treatment in the early stage diphtheria could be banished from our death returns.... The present system of allowing children who have been absent on account of contracting the disease to return to school without their throats being demonstrated clear by bacteriological methods should be abolished and only those allowed to return who can show a clear bacteriological certificate . . ." "Employment of Children The number of male children engaged in occupation, aged 10 and under 14, is 6 i or 5.6 per cent. engaged in occupation to total. The number of children of school age is nearly one-third of entire population, though the number at school age occupied in earning their living is not by any means high . . . ." Page 41 1903 " On the Prevalence of Diphtheria in Barking during 1903 31 out of the 44 school children attended North Street School .... With regard to prophylaxis by means of the Diphtheria Serum I have not used it for that purpose—patients have always objected before the advent of symptoms. Its efficiency as a prophylactic is exceedingly difficult to prove. (19 deaths occurred, i.e., 10.2 per cent. of notified cases.)" " Isolation Hospital .... In June a new building was erected in the Hospital Grounds; consists of two wards containing 4 beds each; with dis-1 charging blocks at either end of the building .... The Diphtheria Wards have been well filled all through the year .... All cases of infectious disease were reported to the School Attendance Officer and Pawnbrokers." 1905 " Council Schools I have inspected these at intervals and always investigated any outbreak of infectious disease " Pauperism There has been an abnormal amount of destitution ion during the year .... I have no doubt that the poverty and destitution which has taken place have added considerably to the Mortality and Sickness returns of the district." " Hospital accommodation 32 Adult beds (Scarlet Fever, 12; Diphtherial 12; Enteric Fever, 8). During the best part of the year the Enteric Wards have been utilised for Diphtheria . . . ." 1906 " Inspections at Schools In addition to inspections at the Council Schools with regard to Diphtheria and Scarlet Fever I have given considerable attention to the question of dirty and verminous children. Ringworm, Measles. Whooping Cough, Chicken Pox, Sores, etc., and I am exceedingly grateful for the very hearty assistance I have received from the teaching staff." Page 42 "Sanitary conditions in Schools The sanitary condition of the public elementary schools of tne district is briefly as follows: — As regards the sanitary conveniences at the schools I am of the opinion they are as satisfactory as can be expected where the trough system has been adopted. In the newer schools the latest form of the system has been adopted but I see nothing in it to recommend its use in the future. Separate pans and flushing cisterns should be used everywhere. The water supply in most of the schools is satisfactory though 1 am strongly of opinion that in some of them there should be more convenience for drinking purposes." 1907 Total population = 29,500 Lady Health Visitor appointed: April, 1907. School population = 6,338 Also Probationer Health Visitor: October, 1907. Seven schools: North Street. Gascoigne Road. Westbury. Church of England. Roman Catholic. Creeksmouth. Castle. Infectious Diseases Percentage of school population Scarlet Fever 1.2% Diphtheria .4% This seems to me to be a most excellent record." Cleanliness of School Children ....A large number of dirty and verminous children have been visited and cleansed and rendered fit to attend school. I regret very much that in my opinion there is a great lack of cleanliness in our midst which is sadly apparent in the condition of the children and the home . In the work of examining and cleansing of the children the services of the Lady Health Visitor have been invaluable. 'Notification of Births Act, 1907, came into force in the district Page 43 on 1st January, 1908.) (Horse drawn ambulance provided for cases of accident and acute disease. The payment for its use was assessed according to means with a maximum charge of £1.)" 1909 " Staff Dr. Fenton, owing to increased work due to recent legislative changes, gave up his appointment on 1st August, 1909. and was succeeded by Dr. Bygott, ' who does not engage in private practice.' The appointment of School Nurse was vacant during the yearduties of this office were discharged by Miss Webster (a certified Sanitary Inspector and Midwife) from the Isolation Hospital as a volunteer from 14th August to 1st December, when she received the usual salary." " School Medical Inspection 1,258 (entrants and leavers only) were examined. 1,197 defects required treatment: Nutrition accounted for 15.7%, Rickets 3% In addition—Defective clothing = 7% Verminous heads — 13% Dirty bodies = 5% 42% were found to have sound teeth. .... In many instances more than one defect was present in the same child. Weights, as a rule, seemed rather below the averages for the rest of the country." " Infectious Diseases The greater number of Scarlet Fever cases is unfortunate-it is probably accounted for by the mildness of the disease as in 6 cases the children were found in school who had evidently been mixing freely with others for two or three weeks whilst suffering from this disease.... Several of the diphtheria cases had no treatment in the early stages of the disease and were sent to the hospital in a dying condition .... Tracheotomy was performed in eight cases with a mortality of 4 ... . It is to be regretted that such serious diseases as Measles and Whooping Cough should be, in most cases, treated entirely without Page 44 medical supervision .... A great many cases alleged to be suffering from Mumps are simply cases of enlarged glands and other minor ailments, but as most of these cases receive no medical assistance they are excluded from school for some weeks quite unnecessarily. Other possible methods of assisting persons suffering from tuberculosis: It does not appear that the cost would be prohibitive for those persons who attend as Hospital out-patients to receive their medicines from a small dispensary connected with the Department and affiliated to one of the larger charities, such as Brompton. In many cases these poor people have spent all they possess and the railway journey and long waits at the institutions is a drain on their purse and strength which seem to be unnecessary. Such cases do not seem to be a source of profit to the family practitioner." 1910 "Staff Miss Maud Webster was appointed permanently in April as an Assistant Sanitary Inspector and School Nurse at a salary of £80 a year ..." " Schools The schools are 7 in number. Drinking water supplied from fountains or taps, iron drinking cups as a rule are provided. I have to draw attention to the existence of a fountain made by Messrs. Shanks and Co. in which a stream of water is directed into the child's mouth, thus obviating the use of what may be a source of infection. The school; were clean throughout .... The window lighting appears to be sufficient .... One towel i as a rule, supplied each week for use in the lavatories and soap is usually kept in the classrooms, and may be applied for by the children. Ambulance and First Aid Arrangements depend entirely on the teacher—I strongly recommend that for each block of schools appliances for first aid should be provided by the Authority, and that similar arrangements be made to those of the London C.C. who pay a fee for one attendance only, to local practitioners, whose services are requisitioned by the teachers to treat accidents occurring on school premises . . . ." "School Medical Inspection Number of children seen at S.M.I. = 1,240. Page 45 All the ordinary inspections took place on the school premises and notice was sent to the parents as to when the inspection would take place, inviting them to be present. In most instances before commencing the inspection an address was delivered by the Medical Officer. The heights and weights were taken by the teachers, and a rough test for vision was also applied by them . . . ." Cases of defective sight: 6/18 and over = 110 6/12 = 88 Total - 198 Glasses obtained in 46 cases. These figures cannot be considered satisfactory. It is importanl to note that in many districts the certifying factory surgeons are preventing children who need them from engaging in factory work until they obtain spectacles. This should be an answe," to the plea that the wearing of spectacles diminishes a child's chance of employment. As an auxiliary to the regular Medical Inspection, children are relerred by teachers or attendance officers, or are brought by their friends to the Medical Officer at the Public Offices for examination by him, and during 1910, 771 cases were so dealt with, including:— Ringworm (suspected) 96 Diphtheria (suspected) 60 Spinal curvature 2 (actual) 6 Club foot 2 Sores 87 MEDICAL CARE " Treatment of Defects .... Is undertaken by Public Health Department in cases of ringworm, contagious skin disease, sores, etc., conditions which are likely to communicate disease to others .... we constantly find that sores that have been treated by friends for weeks and months can be cured in a fortnight or less by simple treatment applied by the nurse. The advice given in the reports of the Medical Officer.... has been followed, that authorities before taking upon themselves the treatment of ordinary defects should endeavour to use the existing arrangements available for this purpose, as there is a theory that adequate medical advice is available for everyone, either by payment from charities, or the Poor Law. With the existence of all these Page 46 arrangements it is remarkable that some of the highly infectious diseases should not have received medical treatment, and should remain to be discovered in my office. And a very pitiable feature of the work is the difficulty which average parents (earning under £1 10s. Od. a week) have to get constant and proper medical help for their children. Some of the parents have brought me budgets showing how their weekly money is spent, which arc worthy of the highest commendation and which leave no margin for the payment for medical assistance. Although there are cheap trains to London for 3d. return fare the unfortunate persons have to start before 7.30 a.m. for the hospitals; many of which do not open until 1.30 p.m. Frequently young children have to be taken as well as the patient because the mother cannot afford to pay any one to take care of them at home, and the whole party wander about the streets for about four hours, until they are admitted. I have suggested to many of them the advisability of using the Br sh Museum or similar institutions as a waiting room. This method of obtaining medical assistance is quite commonly resorted to in cases of whooping cough and other infectious diseases. I have visited various out-patient departments in London and have noticed the want of continuity of treatment which takes place there. I certainly think that some method of dealing with such cases should be provided in the district. We are rightly proud of our great voluntary hospitals but we have long outgrown them as a means for the universal provision of medical assistance. A very persistent attempt has been made to utilise the Poor Law Medical Service to the utmost, and I cannot speak too highly of the care and attention which has been displayed by the District Medical Officer in dealing with those cases which he has attended to. He very properly does not consider himself called upon to undertake operations or the provision of spectacles in connection with this work, at the same time there are an increasing number of cases which need the assistance of the Medical Specialist. In some cases parents cannot provide the few pence to enable them to take children to hospitals, especially for repeated attendances. The Clerk to the Guardians states his authority cannot legally pay their fares to and from hospitals—to meet two of these cases the Guardians admitted the children into the Workhouse for about a month, and sent them by train backwards and forwards to Moorfields Eye Hospital, and then provided the glasses—this was a very expensive arrangement, and interfered with the child's education. Page 47 Parents in such cases are expected to meet the Guardians at Romford, a distance of six miles; this has naturally a very deterring effect on applicants for relief, especially as it is extremely difficult to persuade them that such assistance should be obtained as the children may not be obviously ill—the picture of one public authority urging treatment whilst another provides serious obstacles to their getting it, is a strange paradox. As the result of a considerable amount of pressure, and the expenditure of considerable trouble, and after, in some cases, paying the railway fares of parents to meet the Guardians, six pairs of spectacles were provided, and medical appliances and boots in two cases were obtained during the year. There is a very strong objection on the part of the more respectable parents to obtain such assistance from this source. I am therefore of opinion, after a very exhaustive trial, that this method of providing medical assistance for school children should be abandoned. The loss in grants through absence from school from ringworm probably amounted to about £70 a year at the beginning of the year, besides the serious injury inflicted on the children's education. Arrangements could be made for the treatment of these cases with X-rays at a cost of about 5s. each, some of which money could probably be recovered from the parents. Undoubtedly in the future such cases will have to be dealt with by means of local arrangements, and experiments in this direction in other districts are being carefully watched." " School Feeding This is undertaken by a voluntary society twice a week during certain months of the year; breakfasts are supplied at a centre in the basement at the North Street School. During the year 19,7" breakfasts were given at a cost of l 1/16d. each inclusive, the total cost being £90 8s. 8d. The breakfast consists of ½ lb. bread with jam, and £ pint of cocoa made with a dried milk and sugar." 1911 " School Medical Inspections. Number of school medical inspections = 1,732 (Three age groups—5 years, 8 years, 13 years.) Nutrition 2 = 21% Nutrition 3 = 1.3% (Nutrition 1 is not mentioned—presumably normal and not requiring treatment.) 22% were found to have nasal obstruction. Page 48 16% were found to have neck glands. 12% were found to have defective vision. Six weeks after an inspection a form is sent to the head teacher asking for a report as to whether treatment has been obtained for the children found defective; in the cases in which no treatment has been obtained the school nurse visits the home to induce the parent to obtain it. Owing to the prevalence of various epidemic diseases it was not possible during the year to devote so much attention to the searching out of special cases. No prosecutions took place as the result of medical inspections." " Boots it is not uncommon to find a hole as big as a two shilling piece right through the centre of the sole, and the child walking on the bare foot The cry able remarks respecting malnutrition found in the Report of the Medical Officer to the Board of Education, 1910, apply with great force to Barking . . . Adenoids and enlarged glands account for some of these cases and a short lecture before commencing inspection, and showing parents specimens of Adenoids 1 spirit is doing a great deal to break down the prejudice against operation in these cases." "Defective Teeth I am formed there is no qualified dentist resident in either Barking c Hast Ham some of the temporary teeth are in a shocking condition because they have not been extracted when they ought they have caused serious ulceration of the cheeks and gums; their removal at the out-patients' hospital has been a great boon in several instances. The early decay of the permanent teeth is a very serious matter This serious improvidence with reference to teeth cannot continue if we are to remain healthy nation." "Physical Culture More provision for boys' and girls' games is desirable." Provision of Meals Is undertaken by a voluntary society ; provision of breakfasts in crypt at North Street Schools has been discontinued some children were provided with meals at eating houses in the town 14,466 free meals were provided in 1911." Page 49 Treatment of Defects Last year's report dealt with attempts to treat diseased conditions found on medical inspection by the Poor Law Medical Service—the result, after giving the system a thorough trial, was that this service is not suited for the purpose and likely to cause needless irritation to parents and to the Guardians and their Officers. During the past year except for simple cases requiring either 1000d, drug or home treatment, no persons have been referred to the Relieving Officer The lines upon which treatment has been provided has been a combination of service rendered by the Local Authority and by means of Voluntary Charity. The provision of medical treatment is totally inadequate for the needs of the district. The London, and the Accident Hospital at Poplar cater for most of this work in Barking . the return railway fare is 10d. by ordinary train, and 3d. before 7.30 a.m. To meet some of these needs the Plaistow District Nursing Society allowed two of their nurses to attend at the Old Town Hall to dress wounds and sores ; they did a very valuable workunfortunately the absence of medical direction necessitated ven narrow limits to the cases they could deal with. When the Education Authority commenced to undertake medical supervision of school children and given powers to provide medical treatment it was apparent that needs of the district would not be met by simply providing for school children and neglecting to provide for other persons as well—e.g. in a family of five children, two under school age, if one of these two and a school child suffered from a contagious skin or eye disease the public would not be protected by curing the school child and neglecting the other who would probably promptly re-infect it; moreover many of the eye, ear, nose and throat conditions prevailing in children under five, if not treated at once, results in an incurable deformity by the time they go to school It was therefore decided to provide an Out-Patients' Hospital under Section 130 of the Public Health Act, 1875 the scope of this work being limited as a rule to cases not requiring the internal administration of drugs, home visits by a medical man, or in-patient treatment. These limitations were introduced to keep the work within reasonable limits and not Page 50 interfere more than could be avoided with the interests of medical men practising in the area ; as an additional safeguard the local doctors kindly examine, as confidential scrutineers, the lists of patients treated by the Council. In addition a very complete working relationship has been established with the East London Hospital for Children; the London Hospital; the Throat Department at Middlesex Hospital, and various other Institutions to which the Medical Officer refers suitable cases for consultation or treatment. For several months during 1911 the Medical Officer saw surgical out-patients and eye cases at the East London Hospital for Children, and undertook or supervised treatment of a large number of Barking patients in addition to getting the cases treated it has afforded valuable experience as to value of this method of treatment Now. in suitable cases, the Medical Officer tests the vision, instils the drug, takes the child up to hospital as one of a partv and glassc are provided by a local optician, very often through the Hospital Sunday Fund ; (thus reducing cost and travelling time for parents and children) Scheme only a temporary one until vision is made for treating eye defects in Barking itself Bad cases of eye inflammation are taken up to hospital for consultation whilst the skilled daily treatment is carried out by the doctor or nurses in Barking. A simillar arrangement prevailed in 1911 with throat cases, but a re-arrangement of the work at this hospital and further calls on the Medical Officer's time prevents his taking these patients to the hospital himself; those not requiring anaesthesia are dealt with in Barking—others are sent to the Middlesen Hospital Travelling with parents on these journeys has afforded very valuable experience and some very distressing things have been seen in which mothers have considerable difficulty with children suffering from shock, etc., after anaesthesia, or a big, heavy child has needed carrying, and on more than one occasion he has helped to carry the child to the station himself " Page 51 VITAL STATISTICS, ETC., FOR BARKING DURING THE PERIOD 1907 TO 1957 PRIOR TO 1907 1907 1917 1927 1937 1947 1957 TOTAL POPULATION 1900 — 21,500 29,500 36,000 39,900 76,470 77,660 75,070 INFANT 1900 — 203 MORTALITY 1901 — 198 RATE (per 1,000 births) 1902 — 134 1903 — 113 112 117 66.1 53.8 31.35 18.56 1904 — 143 1905 — 142 1906 — 162 NUMBER OF MEDICAL OFFICERS One M.O.H. (also in private practice) Full-time M.O.H. appointed 1909 M.O.H. only One M.O.H. & S.M.O. One Assistant Medical Officer One M.O.H. & S.M.O. One Deputy M.O.H. & S.M.O. Three Assistant Medical Officers One M.O.H. & S.M.O. One Deputy M.O.H. & S.M.O. Six Assistant Medical Officers One M.O.H. (also Area Med. Offr. & Div. S.M.O.) Five Assistant Medical Officers INFECTIOUS Known Cases Deaths DISEASES 1900 = 75 5 (6.6%) (All ages) 1901 = 80 3 (3.7%) (i) Diphtheria 1902 = 75 6 (8%) Cases Deaths Cases Deaths Cases Deaths Cares Deaths Cases Deaths Cases Deaths 1903 = 194 19 (10%) 37 6 (16%) 93 11 (12%) 77 2 (2.6%) 155 5 (3.2%) 7 Nil Nil Nil 1904 = 145 9 (6%) 1905 = 116 14 (12%) 1906 = 69 9 (13%) Known Cases Deaths 1928 : 5 1933 : 2 (ii) Smallpox 1900 = 1 1929 : 11 1934 : — (cases) 1901 =4 — 1930 : 45 1935 : — 1902 = 103 13 1907 to 1916 1917 to 1927 1931 : 5 1936 : — Nil Nil 1903 =27 2 Nil Nil 1932 : 5 1937 : — 1904 = — — No deaths No deaths 1905 = 1 — occurred occurred 1906 = — — Death Rate per 1,000 Notified Notified Notified Notified Notified Notified (iii) Tuberculosis 1901 = 2.3 Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths (not notifiable 1902 = 1.4 45 39 Pulm. 173 74 Pulm. 87 37 Pulm. 95 37 Pulm. 156 51 Pulm. 28 8 until 1907 1903 = 1.28 Non 61 14 Non. .. 21 9 Non. ., 26 6 Non.,, 15 5 Non.,,7 — and then only 1904 = 1.24 (Death Rate— (Death Rate— (Death Rate— (Death Rate— (Death Rate— voluntary) 1905 = 1.1 2.44 per 1,000) 1.15 per 1,000) 0.56 per 1,000) 0.72 per 1,000) 0.106 per 1,000) 1906 = 1.3 SPECIALIST SERVICES IN BARKING Nil Nil Nil Orthopaedic (at Faircross School) —commenced 1924. Orthopaedic Obst. & Gynae. (commenced 1933) Ophthalmic— ( cnmmcnced 1935 ) Orthopaedic Obst. Gynae. Ophthalmic Bar, Nose & Throat—(commenced 1938) Skin-(com— menced 1943 Orthopaedic Obst. & Gynae. Ear. Nose & Throat Skin Pacdiatric Ophthalie '( REg. Hosp. Page 52 VITAL STATISTICS, ETC., FOR BARKING DURING THE PERIOD 1907 TO 1957 continued PRIOR TO 1907 1907 1917 1927 1937 1947 1957 SCHOOLS Gascoigne Northbury Castle Nonhbury Gascoigne Westbury Church of Eng. Roman Catholic Castle Creeksmouth Not available 8 schools C24 Depts.) 1 Day Special 17 schools (41 Depts.) 1 Day Special 1/ schools (39 Depts.) 1 Day Special (Plus 1 Grammar and 1 Technical for which we undertake medical super— vision) Depts.) 1 Day Special SCHOOL POPULATION 1904 = 6,080 6,338 7,000 13,700 (approx.) 12,120 13,158 ROUTINE SCHOOL MEDICAL INSPECTIONS No records 1909 = 1,258 (Entrants and leavers only) 2.052 2,249 4,812 8,970 6,526 Percentage of pupils found requiring treatment — No. of individual pupils not available, but total of 1,197 defects required treatment. 25.4% 16.7% 16.6% 13.6% 12.2% Nutrition — 15.71% defective (Rickets 3%) .38% malnutrition (Rickets Nil) .5% malnutrition (Rickets nil) Nutrition— A : 36.6% B : 59.1% C : 4.2% D : .1% Nutrition— A : 33.15% B : 66.57% C : .28% Satisfactory: 99.91% Unsatisfactory: .09% UNCLEANLINESS INSPECTIONS: Pupils found unclean — M.O.H. writes:— " A large number of dirty and verminous children have been visited and cleansed and rendered fit to attend school." 41% 11% 3% 3% 1.6% MINOR AILMENT CLINICS Nil Extract from 1910 Report reads: " Infants' Clinic. Mothers are encouraged to bring their babies to the Sanitary Inspector (female) to be weighed on Tuesday afternoons at the Public Offices—now a large and comfortable room at the Old Town Hall is used . . . . " In 1912-13: provision made for establishment of a School Clinic on land belonging to the Council in the Town Yard. Nil East Street East Street Central (opened 1934) Woodward (opened 1935)— (replacing temp, clinic in Church Hall since 1930) Central Woodward Porters (which first started in Church Hall in 1938) Central Woodward Porters Upney (opened 1947) Total attendances during the year — Not available Not available 9,629 41,211 27,156 23.592 Page 53 STATISTICS ANNUAL REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR FOR THE YEAR 1957 Section A—GENERAL ADMINISTRATION Section B—HOUSING Section C—FOOD SUPPLIES Section D— FACTORIES AND WORKPLACES Section E—GENERAL SANITATION AND ATMOSPHERIC POLLUTION Section F—PEST INFESTATION CONTROL Section G—MISCELLANEOUS Section A—GENERAL ADMINISTRATION Table No. 1 Summary Total Inspections 10,821 Complaints received and investigated 1,042 Preliminary notices served 1,172 Statutory notices served 138 Table No. 2 Analysis of Inspection Work performed by the District Public HediInspectors Housing 4,972 After infectious disease 112 Premises at which food is prepared, stored and sold 1,672 Factories and Workplaces 663 Outworkers premises 465 Shops 592 General Sanitation 1,076 Smoke observations 207 Rent Act 864 Pest Infestation Control 216 Page 54 Table No. 3 Premises at which improvements were effected. Dwelling houses (rendered habitable) 489 Premises used for preparation and sale of food 44 Shops 3 Drainage (reconstruction, repair, etc.) 187 Factories and Workplaces 19 Portable dustbins provided 603 Table No. 4 Dejects found and dealt with under the Public Health Act, 1936, and The Housing Acts, 1936/1957. No. of defects 1,655 Roofs and Flashings 121 Gutters 117 Rainwater pipes 34 Sinks 4 Bath and sink waste pipes 16 Choked drains 160 Defective drains 15 Inspection covers 8 Ventilation and soil pipes 8 Gully dishing 12 Flushing arrangements 48 W.C. structures 2 W.C. seats 8 W.C. pans 12 Yard paving 9 Chimney pots and stacks 24 Damp walls 26 External walls 17 Underfloor ventilation 2 Window silk 73 Window and door reveals 17 Window frames 53 Sachcords 40 Stair treads 3 Doors and door frames 23 Door sills 6 Floors 30 Page 55 Stoves 13 Walls and ceilings 71 Water supplies 17 Dustbins and dust chutes 603 Verminous rooms 12 Accumulation of rubbish 45 Animals and birds 3 Draining boards 1 Washing coppers 1 Weatherboards 1 NEW LEGISLATION The Housing Act, 1957. The Rent Act, 1957. The Public Health Officers (Deputies) Act, 1957. STATUTORY INSTRUMENTS No. 628 The Diseases of Animals (Waste Foods) Order, 1951 No. 304 The Local Authorities (Charges for Dustbins) Order. 1957. No. 541 The Smoke Control Areas (Exempted Fireplaces) Order, 1957. No. 191 The Petroleum (Conveyance by road) Regulations, 1957. No. 391 The Milk (Special Designation) (Specified Areas) Order, 1957. No. 1066 The Colouring Matter in Food Regulations, 1957. No. 2157 The Food Hygiene (Amendment) Regulations, 1957. No. 981 The Rent Restrictions Regulations, 1957. Building Byelaws (Smoke Prevention), 1957. Section B—HOUSING Provision of Housing Accommodation, Year 1957 New Accommodation Dwelling Provided Thames View Estate 493 Westbury Road Flats (Mayflower House) 24 London Road Flats/Maisonettes 14 Bradfield Drive (Houses and Flats) 52 Total for year 583 Page 56 Sew Dwellings completed since end of 1939-1945 War Barking Council 2,326 Private Owners 79 London County Council 85 2,490 War destroyed—(Rebuilt) Barking Council 63 Private Owners (including London County Council) 331 394 Temporary Bungalows Barking Council 207 London County Council 297 504 Registered Applicants January, 1957—Waiting List 3,140 December, 1957—Waiting List 3,121 PROVISION OF ACCOMMODATION FOR AGED PERSONS This housing problem has so far been left with Barking Council as a housing authority. The Essex County Council has not provided any form of accommodation under Part III of the National Assistance Act, 1948. Page 57 The Council has found that elderly people are most anxious to obtain small units of modern construction sited near the shops, buss and railway stations. This enables them more easily to cope with daily problems and facilitates visits by relatives. The Council erected 24 units known as Mayflower House in the Town Centre. 3x2 Bedroom Flats 16 x 1 Bedroom Flats 5 x Bed-Sitters 24 This new accommodation proved an attraction. Over 100 applications were received from residents in other dwellings. The lettings were mostly to elderly people who gave up underoccupied dwellings. The released dwellings were:— Barking Council 14 x 3 Bedroom Houses 2x2 Bedroom Houses 1 x 2 Bedroom Bungalow 2 x 1 Bedroom Flats London County Council 1 x 3 Bedroom House Requisitioned Property (released) 2 Clearance Area Transfers 2 Total 24 Unfit Properties During the year under review the Council declared as unfit the following dwellings:— Section 154, Housing Act, 1936 Dwellings Families Highbridge Road, 30-36 and 40 5 5 Axe Street, 67/69 and 73 3 3 Coverdale Road, No. 1 6 6 Linton Road Area, No. 1 152 170 Church Road Area 84 97 Abbey Road, No. 6 5 5 Broadway, No. 1 3 2 Hart Street Area, 38/56 10 14 Westbury Road, No. 1 10 10 Totals 278 312 Section 15 Housing Act, 1957 Dwellings Families North Street, No. 8 3 3 Linsdell Road, No. 1 4 5 North Street, 104/106 2 2 North Street Area, No. 7 15 30 St. Paul's, No. 3 11 11 Thames Road Hutments 84 84 Totals 119 135 Orders were also made in respect of individual unfit dwellings as follows:— Section 154, Housing Act, 1936 66, St. Margaret's Road. 3, Church Road (Demolished) 77, Axe Street (Demolished). Cambridge, Road, 15 and 17, basement rooms closed. Housing Repairs and Rent Act, 1954 In February a report described as "Slum Clearance a Further Review" was submitted to the Council in respect of 2,199 properties situated in the Gascoigne Ward and Abbey Ward of the Borough. Page 59 It was proposed that the dwellings should be dealt with in twelve clearance areas and the operation to be carried out over the period from 1961 until 1972. The Council, by Minute No. 3112 dated 26th February, 1957, adopted the report. Information re Local Land Charges, etc. Information as to statutory orders made in respect of dwelling houses and as to notices not complied with requiring works of repair was supplied in respect of 490 properties upon request for official search of the Land Charges Register. In addition 233 particulars as to properties were supplied in all cases in which mortgages were being arranged under the Housing Act, 1949 in respect of the purchase of small dwellings. Improvement Grants—Housing Acts, 1949/1957 Enquiries as to improvement grants were received principally from owner-occupiers of dwelling houses. Grants for the improvement of housing accommodation were approved in respect of 13 applications, the cost of the work amounting in the aggregate to £3,478 2s. 9d. Improvement grants amounting to £1,906 3s. 9d. vere granted. Default Action In 28 instances it was necessary to report to the Council where owners of properties had not carried out the requirements of notices served within the time specified. The works were carried out by the owners, in each case later, before legal proceedings were instituted. Repairs were carried out by the Corporation 9 premises in accordance with the provisions of Sections 39 and 45 of the Public Health Act, 1936, and the cost charged to the owners of the properties. Housing Subsidies Act, 1956 Following the passing of this Act, subsidies can only be claimed for dwellings provided by the local authority to accommodate families displaced by slum clearance. Corporation dwellings which have been certified as until also rank for subsidy. Page 60 Health Education For the public health officer this means getting among the people and giving them a broad background knowledge of the public health services. It means also teaching them the whys and wherefores of the rules and regulations local authorities must operate to keep health offenders from harming the public. The man-in-the-street is for ever being lectured in his home by television speakers. He is also being encouraged to seek better health by spending his money on all sorts of concoctions by the " commercials." It is relaxing and comforting after such mental bombardment to learn from the sober public health officer the simple rules for a good healthy life, including his duty to his neighbours. Your officers have continued to offer their expert advice to groups, societies and schools whenever an opportunity to do so is given Most of the old pestilences have disappeared. We have entered a new epoch with immunization, insecticides and new sanitary measures. It is necessary for public opinion to be kept in step. We must arouse interest enthusiastic interest if possible—in what the Town Hall is doing in the health field. SUPERVISION OF FOOD SUPPLIES The changes in the methods of distribution, retailing and packaging of the nations food supplies are so many and frequent that any comment must refer to conditions today and tomorrow, so to speak. Our aim is to achieve the ideal of delivering a satisfactory product from producer to consumer without contact with the hands. It is our duty to consider carefully the use of new methods and materials with this target in mind and encourage retailers in their efforts. In the interests of the public we serve we can do no less. With bulk purchasing, bulk packaging and rationalised distribution we are approaching the point of uniform standards in all phases of food supplies to meet the demands of public opinion upon whom " commercials" are such persistent salesmen. The catering service continues to call for close supervision and Page 61 will so remain until the equipment industry finds the answer to the menial tasks which need manual effort for their completion. As the following details show, we have maintained an overall control by inspection and sampling. FOOD PROSECUTIONS AND COMPLAINTS Complaints were received regarding the sale of food alleged to be unsound or not of the nature, substance or quality demanded by the purchaser. The complaints were investigated and action taken as set out in the table below:— Nature of Complaint Action Taken 1. Fruit and Nut Chocolate infested with larva of the Ephestia elutella (cocoa moth) Legal proceedings taken against the retailer. Fined £2 2. Metal in loaf of bread Warning letter sent to manufacturer of the bread 3. Sliced wrapped loaf of bread containing small amount of grease or similar substance Warning letter sent to manufacturer of the bread 4. Larva of Ephestia elutella (moth) in a tin of Vitacup Warning letter sent to manufacturers of the commodity 5. Bristle embedded in the substance of a biscuit Warning letter sent to manufacturers 6. Treacle Toffee containing small strands of sacking or string Producers given a warning 7. Soup Powder containing weevil (manufactured and purchased outside the Borough) Referred to Local Authority where the purchase was made 8. Bottle of pasteurised milk containing small area of mould growth Warning given to the milk sup pliers 9. Bottle of pasteurised milk containing two metal foil caps Warning given to the milk sup plier 10. Mouldy Sausage Roll Legal proceedings taken against the retailer. Fined £2 11. Bottle of pasteurised milk containing 5 metal foil caps and specks of lacquer Reported below 12. Fairy Queen Cakes Reported below Page 62 Page 63 Contravention of Section 2 of the Food and Drugs Act 1955. The Council issued a summons against a multiple Dairy Company with regard to the presence of five milk bottle caps and specks of lacquer in a half pint of milk. At the hearing before Stratford Justices the summons was dismissed. The Justices did not award any costs, the reason for the dismissal was on the judgment given in the case of Reginald Thomas Edwards v Llaethdy Meirion Limited, where the Court found that the milk had not been in contact with the metal containers which remained untouched, and therefore the nature and substance and quality of the milk had not been altered. Fairy Queen Cake The attention of the Council was called to a sample of Fairy Queens which tad been labelled " made with 100% pure butter." A careful study of the process was made at a conference held between the Council's 'icers, including the Public Analyst and the Cake and Biscuit Alliar Ltd., when it was felt that the circumstances were such that an reement to issue a new form of label would achieve the most satis tory result. Food Hygiene Regulations, 1955 It was necessary to complain of a cafe attached to a licensed public house. Upon consideration of the structural alterations which were necessary and the cost of providing further equipment the brewers decided to cease operations. Food Hygiene Regulations, 1955 Action was taken by the Council against the Manager of a butchers shop in the Borough for smoking whilst cutting up meat. \ line of £5 wasposed. Merchandise Marks Act (Imported Goods) No. 7 Order, 1934 Action was taken by the Council against a butchers shop in the Borough under this Act. The defendants were fined £2 for improperly marking imported meat. fouling of Public Footway by Dogs The Council in February, 1957, received a number of complaints about the fouling of footways and were anxious to give it notice by the fixing of bye-law notices. It was later deferred because the difficulty in succeeding with prosecutions is so difficult in practice. Food Hygiene (Amendment) (No. 2) Regulation The Council were concerned at the delay in implementing the coming into operation of Regulation 7 of the Food Hygiene Regulations, 1956, and pressed the Ministry of Agriculture, Fisheries and Food to implement the regulation prohibiting the peeling of onions at the homes of outworkers. Barking is an area where onion peeling is carried out in 60 premises. FOOD SAMPLES REPORTED NOT TO BE GENUINE Sample No. Food Adulteration or Labelling Offence Action Taken 4160 Cheese, Ham and Onion Spread Contained a slight excess of moisture and 16% deficient in fat. Warning letter sent to manufacturers 4162 4178 Meat Pie Contained a small mould growth Warning given to manufacturer and retailer 4214 Bread Whitish patches due to the presence of calcium acid phosphate No led the manufacturer to improve method of mixing 4227 Chocolate Flavour Unsatisfactory labeling of the product Manufacturers issued new labels to distributors 4228 Milk in opened bottle Contained coloured specks - substantially of greenish mould or algar growth Warning to milk betting com- pany 4229 Bread Microscopic examination of this blackish foreign matter revealed that it consisted essentially of dough mixed with dirty oil or fat. The oil or fat was found to consist of edible oil or fat free from mineral oil Warning letter sent to the ufacturers 4331 Cream Soda Contained small areas of mould growth Warning to manufacturers 4330 Cream Soda Chemical examination of the cream soda for sulphurated hydrogen showed that traces present were less than 0.05 part per million Discussed with manufacturers the possible use of plastic stoppers. 4345 Jelly Babies Microscopic examination showed the whitish encrustation consisted of a mould growth. Legal proceedings instituted against wholesaler Fined £10. 4346 Page 64 MANUFACTURE OF SAUSAGES At the present time there are 32 premises registered for the manufacture of sausages. One of these establishments is a central factory for several butchers shops under the same control. Another factory produces sausages and other cooked meat foods for the wholesale trade and distributes over a wide area of London and the County of Essex. The remaining 30 premises are butchers shops where the sausages are made and sold in conjunction with their trade. Routine regular sampling for chemical analysis has been maintained and it is noteworthy to record that although there still remains an absence of official standard for meat content in sausages, on no occasion has there been a sample reported below 50% for Beef Sausages and 65% for Pork Sausages. BEEF SAUSAGES MEAT CONTENT No. of Samples 50%—54% 55%—59% 60% plus 9 2 4 3 PORK SAUSAGES MEAT CONTENT No. of Samples 65%—69% 70%—74% 75% plus 11 6 3 2 OTHER SAUSAGES (Hamburgers, Saveloys, Frankfurter, Liver Sausage, Breakfast Sausage, Luncheon Meat) No. of Samples 40%—49% 50%—59% 60%—69% 70% plus 18 1 7 5 5 Page 65 FOOD PREMISES The following is a list of the various premises in the Borough used for the sale of food:— Bakehouses 6 Bread and Cake Shops 21 Butchers Shops 46 Confectionery Shops 83 Factory Canteens 54 Fishmongers and Fish Fryers 21 Fruiterers and Greengrocers 46 Grocery Shops 81 Ice Cream Manufacturers 2 Ice Cream Vendors 136 Milk Shops 49 Onion Peelers 46 Public Houses and Off-Licensed Premises 38 Public House Restaurants 9 Restaurants 56 Shops in Markets 26 School Meal Centres and Kitchens 45 Street Traders 30 INSPECTION OF FOOD PREMISES During the year the following inspections were made and notices served:— Number of visits made to these premises 1,674 Number of defective or dirty walls, ceilings and floors 9 Number of notices to repair or provide hot water fittings 25 Number of notices to repair counters and tables and cupboards 7 Number of notices to repair drains and yard paving 3 Number of notices to provide sinks and wash-hand basins 19 Number of notices to repair or renew defective sanitary fitments 4 Number of notices to prevent contamination of food 9 Number of notices to provide soap, nail brushes and towels 7 Number of notices to provide suitable and sufficient lighting 1 Number of notices to stop and prevent smoking 1 Number of notices to provide first aid equipment 1 Page 66 On occasions the inspecting officers gave verbal notices to remedy minor defects where it was not considered necessary to serve written notices. Table 5 SAMPLES SUBMITTED TO THE PUBLIC ANALYST JANUARY 1st to DECEMBER 31st, 1957 Apricots (Dried) 1 Beef Broth 1 Brawn 1 Bread 2 Butter 3 Chandy 1 Cheese 4 Cheese & Tomato Spread 1 Christmas Pudding 1 Chocolate Flavour 1 Chutney 1 Cinnamon 1 Coffee 1 Cream 7 Cream Soda 2 Crumpets 1 Curry Powder 1 Currants 4 Custard Powder 1 Dripping 7 Fish 1 Flour 3 Fruit (Dried) 1 Gin 2 Hamburger 4 Ice Cream 5 Instant Icing 1 Irish Stew 1 Jam 4 Jelly 2 Jelly Babies 2 Lard 2 Lemon Cheese 4 Page 67 Lemon Juice 1 Lime Juice 1 Lollies Margarine Marmalade 1 Matzos 1 Meat Pie 1 Meat Pudding 1 Milk 5 Mincemeat 1 Mint 1 Mint Sauce 1 Nesquik 1 Orange Squash 2 Peel 1 Prunes 1 Rice 1 Rum 2 Sauce 1 Sausages 19 Sausage—Breakfast 6 Sausage—Liver 1 Saveloy 2 Soda Crystals 1 Steak and Kidney Pudding 1 Sugar 1 Sultanas 1 Tomatoes 1 Tomato Ketchup 1 Walnuts—Pickled 1 Whisky 2 Total 139 Page 68 MILK SUPPLIES It is gratifying to record that the milk supplies are of a satisfacory bacteriological standard. There have been 77 samples obtained from retailers during delivery and all have been found satisfactory. The whole of the milk supply retailed in the Borough, including hat delivered to schools, is Heat Treated and made safe for public consumption. BACTERIOLOGICAL EXAMINATION OF MILK Designation of Milk Total Samples Submitted Methylene Blue Test Phosphatase Test Turbidity Test Passed Failed Passed Failed Passed Failed Pasteurised 46 46 — 46 — — — Tuberculin Tested (Pasteurised) 27 27 — 27 — — — Sterilised 4 — — — — 4 — LICENCES Milk (Special Designation) (Specified Areas) Order, 1951. Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulat ns, 1949/1953. Dealers Licences 49 Supplementary Licences12 Milk (Special Designation) (Raw Milk) Regulations, 1949/1954. Dealers Licences 1 Supplementary Licences Nil ICE CREAM AND LOLLIES There are two manufacturers and 185 retailers of Ice Cream in the Borough, including 49 itinerant vendors. During the year 14 samples of ice cream have been submitted to the Methylene Blue examination. The results, in accordance with the Provisional gradings, are set out below. Two of these unsatisfactory examples were manufactured outside the Borough and appropriate action was taken in each case. Page 69 The product of one local manufacturer which did not satisfy the methylene blue test was investigated. The cause of the trouble was found to be a new modern type of cooler used in the process presenting difficulty in the sterilisation of the unit. Five samples of ice cream were obtained for chemical analysis and all have been reported satisfactory. Examination of the ice cream samples showed a fat content much in excess of the present standards for fat content. Six samples of lollies were analysed and found to be satisfactory, free from lead and other metals. It is encouraging to note that the producers have succeeded in eliminating the presence of lead or compounds of lead from the moulds necessary for the production of lollies in order to comply with the required standard. ICE CREAM METHYLENE BLUE PROVISIONAL GRADINGS Total No. of Samples Grade 1 Grade 2 Grade 3 Grade 4 14 4 4 5 1 CHEMICAL ANALYSIS FAT CONTENT Total No. of Samples 0%—5% 5%—10% 10 -15% 5 — 3 2 ICE LOLLIES LEAD CONTENT Total No. of Samples Satisfactory Unsatisfactory 6 6 — , Page 70 Table 6 UNSOUND FOOD CONDEMNED AND DESTROYED — 1957 Bacon 58 lbs. Baked Beans 31 tins Cheese 8 lbs. Chicken, Tinned 12 tins Cream, Tinned 9 tins Fish 20 stone Fish, Tinned 28 tins Fruit, Tinned 416 tins Ham 910 lbs. Jam 19 jars Marmalade 11 jars Meat 504 lbs. Meat, Tinned 200 tins Milk, Tinned 162 tins Peach Pulp 9 kilos Peas 416 tins Pease Pudding 6 tins Rice Pudding 7 tins Shrimps 10 gals. Soup 20 tins Suet ½ lb. Syrup 7 tins Tomatoes, Tinned 144 tins Vegetables, Tinned 13 tins Virol 32 ozs. REGISTRATION OF PREMISES USED FOR THE MANUFACTURE OF SAUSAGES. PRESERVATION OF FOOD MANUFACTURE AND SALE OF ICE CREAM AND DEALERS IN MARGARINE Trade Number of applications received during 1957 Number of applications refused during 1957 Total number of premises on register 1957 Manufacturers of Ice Cream — — 2 Retailers of Ice Cream 4 — 136 Manufacturers of Sausages — — 32 Fish Frying and Preserv— ing — — 21 Ham Boilers — — 11 Margarine Dealers — — 1 Page 71 Butchers Shops—Meat Supplies There are 46 butchers shops in the Borough. Each is provided with modern refrigerators, adequate sinks and wash-hand basins with constant hot and cold water supplies. Of these shops eleven are also fitted with modern refrigerated window stalls for displaying meat. Each of these butchers shops has a properly constructed glazed front thus preventing contamination of the meat deposited for sale to the public from dust and dirt from the streets and surroundings. There are no slaughterhouses in the Borough. Meat supplies generally are obtained from Smithfield Market, and arc of high standard. Two meat retailers in the district have animals slaughtered at their own slaughterhouses outside the area. SWIMMING BATHS AND SWIMMING POOL I am indebted to the Borough Engineer who is supplied me with the following figures:— East Street Baths: Total bathers — 77,566. Park Swimming Pool: Total bathers — 99,117. Slipper Baths'. Total users — 39,713. Page 72 Sampling: Samples of swimming bath water were taken during the year, as follows:— East Street Bath 3 Park Swimming Pool 3 South-East Essex Technical College 10 All the samples submitted to the Borough Analyst were reported to be of a high standard of bacterial purity. WATER SUPPLY (a) Domestic Water Each month samples from the main supplies were obtained for bacteriological examination and twice during the year for chemical analysis. (b) Industrial Water There have been 10 samples of water obtained from the wells operated at factories, submitted to bacteriological examination. Samples of water from both mains and deep wells were found to be of a high standard of bacteriological purity. Sectin D—FACTORIES AND WORKPLACES Routine inspections of factories within the Borough was regularly carried out. The visits made and the results are set out in Tables 7 and 8, which have been prepared in accordance with the Factories Act, 1937, and the Public Health Act, 1936. TABLE 7 —Inspections for purposes of provisions as to health Premises. Sections enforced by Local Authority Number on Register Number of Occupiers prosecuted Inspections Notices 1.Factories: Secs 1-6 Factories Act 1937 23 40 6 — 2. Factories (not included in 1) Section 7 Factories Act 262 442 8 — 3. Other premises. Section 7 Factories Act 12 23 2 — 4. Offices and Workplaces Public Health Act, 1936 61 158 3 — Total 358 663 19 — Page 73 TABLE 8 Improvements effected at Factories 2.—Cases in which defects were found Particulars Number of cases in which defects were found 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) - — — — Drainage of floors (S.6) - — — — Sanitary conveniences (S.7) - — — — (a) Insufficient 1 — — — (b) Unsuitable & defective 25 8 — — (c) Not for separate sexes 1 — — — Other offences against the Act (not outwork) 2 2 - - Total 29 10 - - OUTWORK Table 9 sets out the type of outwork being carried out in the Borough and the inspections made in respect thereof TABLE 9—OUTWORK Factories Act, 1937 Section 110: Number of outworkers in list required by Section 110(c) 183 Nature of work carried out:— Making of wearing apparel 142 Household linen 1 Umbrellas 1 Artificial flowers 1 Boxes, etc 11 Brushes 1 Carding of buttons, etc 2 Toys 2 Cosaques, Christmas crackers and stockings, etc. 2 Section 111: Number of visits to outworkers 465 Number of unwholesome premises - Number of notices served - Number of prosecutions - Page 74 CLEAN AIR ACT, 1956 The provisions of the Clean Air Act, 1956, relating to smoke from domestic chimneys came into operation in December, 1956, and were detailed in the Annual Report for that year. Two other important provisions came into force at that time. One, Section 3, provided that no new furnace may be installed which is not capable of being operated continuously without emitting smoke and that notice must be given to the Local Authority of intention to Install a new furnace. The other. Section 10, provided that when considering plans deposited in accordance with the building byelaws which show that it is proposed to construct a chimney, the Local Authority must satisfy themselves that the chimney will be high enough to prevent a nuisance or danger to health. This is an important provision which will contribute not only to the control of smoke nuisance but also to the control of ground level concentration of sulphur gases which are invisible. The main function of a chimney used to be to induce sufficient draught for the combustion of the fuel on the grate. Now, this can be provided more easily and cheaply by fans and the chimney is used for the dispersal of the products of combustion. As a general rule the higher the chimney the better the dispersal of the gases and it is therefore important to ensure that new chimneys are high enough for the purpose. In anticipation of the coming into force of the provisions relating to industrial smoke, your officers brought them to the notice of industrialists. Were necessary it was pointed out that improved methods of combustion or additional plant would be required to ensure compliance with the new legislation. As a result of these activities a number of firms have made changes in their fuel burning installations with the object of reducing smoke emission. These changes have included converting a number of furnaces fuel oil burning and in other cases installing chain Indusiria1 Smoke Thirty-four thousand of coal are consumed annually in Barking by industrial user. One and a half million tons are consumed at the Electricity Generating Station and one and three-quarter million tons at the Gas Works. Page 75 Beckton Gas Works Your officers have been assured that every effort is made to reduce to a minimum the smoke emission from Beckton Gas Works having regard to the present standard of scientific knowledge. Nevertheless, undoubtedly a great deal of pollution of the town's atmosphere arises from this source. A programme of modernisation of some retorts and buildings has been carried out but there is still much to be done. Steam locomotives are in constant use on the light railway system in the Works and add a great deal to the general pollution. Coal fired steam cranes are also in use. It is felt that if a determined effort were made to deal with the pollution problems that are capable of solution a con: ierable reduction could be achieved. In addition it is hoped that improved methods of charging and emptying retorts and quenching coke ill be evolved which will eventually enable the North Thames Gas Board to make a contribution to the cause of clean air. Electricity Generating Station Much of the four thousand tons of coal consumed daily at the Power Station is burnt as pulverized fuel and unless special precautions are taken a problem from dust emission is bound to arise. In "C" station, the latest section to come into c ration, electrostatic precipitators have been installed to deal with the dust in the flue gases. These precipitators achieve a high standard c efficiency. The two chimneys serving the station are 375 feet high so that the flue gases are dispersed into the upper atmosphere. The boilers in "A" and "B" stations are equipped with cyclone dust arresters which are not so efficient as those in "C" station. The chimneys of "A" station are comparatively short so at dispersal of the flue gases and any effluent dust is not so great. It has been stated that as "C" station becomes. fully operative and other electricity generating plants are built e load will be reduced on the older plant at Barking, resulting a reduction of air pollution from this source. Factories Seventy-one furnaces are in operation in he Borough majority of which are operated comparatively smokelessly. Those Page 76 found by experience to be likely to give trouble from smoke emission are the furnaces used for special purposes. The most important of these special furnaces are those consuming wood waste of which there are nine. Unless great care is taken to charge the furnaces properly and to arrange furnace conditions to suit the varying types of wood, either black smoke or wood ash will be emmitted from the chimney mouth. Reclaiming metal from scrap cable is also a process which can give rise to black smoke. All too often it is carried on with no apparatus, the cable being placed in a heap and fired. There is provision for dealing with nuisances arising in this way in Section 16 of the Clean Air Act, 1956, which is not yet in operation. To succeed in any action under the Section it will be necessary to prove that a nuisance has been caused. This necessity may militate against the use of the power as frequently as one would like. It was necessary in respect of factory premises of the Co- operative Wholesale Society Ltd. to issue a statutory notice with regard to emission of smoke from an incinerator used for burning wood waste. Subsequently substantial changes were made in the equipment provided and the methods of operation, including employ- lent of additional personnel. domestic Smoke Whilst the pollution of the atmosphere from the more obvious industrial chimneys is the subject of much public comment, an equal amount of pollution from domestic chimneys does not always arouse the same interest There has been a change since the days when the factory chimney belching black smoke was the symbol of industrial prosperity. Most industrialists now recognise that smokeless combustion means efficient combustion and are susceptible to an appeal to their pocket if not to their public spirit. Householders, however, are more conservative and require a great deal of persuasion before they will change their habits. Many have prejudices which are hard to break down and most feel that to use a which costs more per ton means that heating their homes will necessarily be more expensive. No doubt, a number of years hence, home heating by burning coal in a basket grate will be looked back upon as being as archaic as the log fire in the centre of the baronial hall with the smoke finding its way out through the roof. Page 77 L A significant number of householders are burning smokeless fuel on grates designed for the purpose, and there is evidence to show that once they become accustomed to the technique require householders become enthusiastic about its use and would not revert to the use of coal. They find that owing to improved efficiency the annual cost of heating is no greater than with coal and may indeed be less. This consideration coupled with cleanliness in handling and the fact that it is not necessary to have a bi-annual visit from the Sweep makes the burning of smokeless fuel an attractive proposition Although the Local Authority has power to declare certain areas to be Smoke Control Areas, it is obviously better that the public generally should be persuaded of the wisdom of such a measure rather than that they should be forced to use smokeless fuel against their will. To this end your officers have continued to give lectures and take every opportunity to encourage the voluntary use of smokeless fuel. Industry generally has done a great deal to meet this problem by adopting new methods and changing plant, and should not be too much to expect householders to play their part by taking similar action. Thames View Estate—Smoke Control Area With 1,200 tenancies on the Estate there have been comparatively few difficulties concerning the use of unauthorised fuels. Sudden cold spells create a sharp increase in demand for fuel which present problems of distribution. This is because the economical method of carrying on any trade is to have a constant level demand rather than peak periods. The answer to the problem would be be for each tenant to store sufficient fuel during warmer periods is to last then over cold spells. The limited fuel storage accommodation in the flat and some tenants own economic circumstances however, present difficulties. One feature which contributes to the problem is that tenants are usually reliant upon one merchant because of th r method of payment for fuel. Many of them pay weekly on a club system and in the event of their supplier not having suitable fuel available the have no ready money with which to pay for fuel from a merchant operating a trolley service. It is apparent that something will have to be done to improve Page 78 the distributive machinery and the fuel merchants are being invited to co-operate in this matter. Measurement of Atmospheric Pollution The Corporation continued to maintain four stations for the measurement of solid deposit and the sulphur gas content of the air. The tables on pages 82 and 83 set out the readings for he year under review and the previous year's reading. On page 80 will he found a graph showing the average monthly deposit in the Borough with a similar graph for the year 1951. On the same page is a chart showing the comparison between he four stations in the Borough. Page 79 SOLID DEPOSIT Record of Chimney Observations carried out during 1957 Observations. The number of observations on Factory Chimneys in the Borough during 1957 total 207. Contraventions number 29. Black Smoke minutes Moderate Smoke minutes Little or No Smoke minutes Amount of smoke recorded during the year 262.25 1531.75 4293 Average amount of smoke recorded per observation 1.2186 6.3997 20.7390 7 9 14 3½ 2½ 24 4½ 5 20½ 3 7 20 12 9 9 2½ 5½ 22 5 12½ 12½ 3 11 16 3½ 4½ 22 4 9 17 30 — — 27 - 3 Particulars of contraventions of the Byelaws (over 2 minutes Black Smoke in ½ hour) 15 15 - 12 - 18 4½ 1½ 24 8 9 15 3 1 26 4½ 4½ 21 7 4½ 18½ 14 7 9 4 19 17 30 — — 4¼ 9¾ 16 3 5 22 7 23 — 5 5½ 19½ 3 4 23 3½ 6½ 20 4 2½ 23½ Page 81 Page 82 ATMOSPHERIC POLLUTION MONTHLY DEPOSITS IN TONS PER SQUARE MILE Number of observations 207 Number of contraventions 29 MONTH 1952 1953 1954 1955 1956 1957 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.1571 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.1571 JANUARY 17.38 24.30 22.29 30.48 28.61 22.32 21.40 32.20 18.16 42.09 42.33 - 22.74 35.78 42.74 34.90 24.38 30.98 30.87 24.90 14.34 FEBRUARY 12.52 17.11 11.07 30.52 23.24 24.97 46.03 39.35 27.54 31.85 29.05 14.89 17.28 14.94 21.66 12.52 11.81 34 82 32.41 21.46 15.44 MARCH 25.46 29.36 26.58 20.48 22.38 14.30 30.98 30.35 26.75 24.27 32.75 15.41 14.44 26.08 30.93 19.26 19.35 38.32 37.51 24.00 13.61 APRIL 19.16 21.79 26.72 22.41 19.88 21.94 13.34 16.32 12.31 31.08 30.11 21.43 24.51 20.04 24.40 17.13 15.01 19.94 15.64 13.17 14.40 MAY 26.11 22.28 21.08 — 21.52 17.47 30.48 38.60 18.02 27.48 37.85 27.30 - 22.91 31.35 16.85 18.31 28.88 39.18 21.08 15.68 JUNE 29.33 19.67 17.78 25.58 26.52 12.28 34.28 35.93 22.08 23.04 27.07 20.94 27.51 29.11 37.58 13.44 17.57 22.14 17.92 16.57 10.43 JULY 17.18 — 12.10 26.94 24.04 24.79 26.42 32.61 21.43 17.61 24.23 12.69 32.22 27.11 - 23.11 20.21 39.28 27.38 — 15.37 AUGUST 30.66 35.90 16.16 25.74 22.89 21.49 27.01 32.92 20.15 21.88 28.95 30.30 17.07 26.18 45.51 27.17 16.68 31.08 24.19 17.68 19.24 SEPTEMBER 23.24 19.92 19.09 30.71 27.75 21.18 28.15 38.46 25.31 31.15 31.55 26.14 20.44 37.55 33.74 23.25 14.51 32.08 23.88 18.98 16.81 OCTOBER 25.35 26.08 22.59 45.89 28.92 21.56 34.52 36.82 20.85 22.80 28.91 19.87 16.75 26.71 31.07 16.68 17.07 28.41 26.48 23.08 12.77 NOVEMBER - 21.66 20 81 33.55 31.79 21.94 40.19 38.77 30.67 25.18 30.08 22.59 22.21 21.38 24.44 16.51 11.61 22.07 14.51 23.38 10.70 DECEMBER 45.46 35.86 29.57 41.59 44.04 31.74 29.25 35.83 26.65 25.55 40.66 27.75 17.01 36.45 39.35 29.61 21.11 32.48 41.34 17.64 21.31 Averages 28.19 24.90 20.49 30.25 25.18 21.33 30.17 34.01 22.50 28.32 31.96 21.75 21.10 25.35 32.98 20.87 17.3 30.04 27.61 19.27 15.01 STATIONS D.56 Barking Park; Alfreds Way from May. 1952; Barking Cemetery from May 1955; Roycraft Avenue from August 1956 D.57 Greatfields Park. D.58-farsloes Park. D.1571-Harking Park from January. 1955. ATMOSPHERIC POLLUTION—SULPHUR DIOXIDE READINGS MEASURED AS MILLIGRAMS OF S03 PER DAY COLLECTED BY 100 sq. C M. LEAD PEROXIDE MONTH 1952 1953 1954 1955 1956 1957 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.1571 D.56 D.57 D.58 D.1571 D.56 D.57 D.58 D.157 JANUARY 2.04 2.84 2.14 3.50 4.06 3.09 4.43 3.81 3.71 4.19 3.47 3.20 2.23 3.83 4.09 3.59 2.72 3.73 3.97 3.86 2.51 FEBRUARY 2.16 2.82 2.38 2.68 2.98 2.01 4.24 3.35 3.69 4.39 3.68 3.27 2.39 2.71 3.57 3.45 2.28 3.74 4.57 3.84 3.06 MARCH 1.57 1.28 1.68 2.89 2.57 2.77 3.17 3.64 3.14 3.46 2.24 0.59 1.29 1.91 2.74 2.12 2.41 2.08 2.50 2.35 1.65 APRIL 0.95 0.98 1.08 2.16 2.48 2.03 2.23 1.74 2.38 2.88 2.31 1.92 1.31 2.00 2.49 2.32 1.52 1.17 1.48 1.84 0.88 MAY 0.72 1.04 0.77 1.53 1.17 1.50 2.20 1.80 1.95 1.50 2.11 1.55 1.03 1.32 2.25 1.52 1.17 0.97 1.49 1.24 092 JUNE 0,04 0.65 0.58 1.27 1.35 0.97 2 00 1.94 1.22 1.14 1.71 1.13 0.82 0.82 1.55 1.07 0.89 1.06 1.51 0.98 0 90 JULY 0.50 1.19 0.78 2.19 2.23 1.82 2.63 2.42 1.64 0.34 0.66 0.42 0.32 1.00 2.00 1.49 0.91 1.07 1.67 1.41 0.91 AUGUST 0.75 1.41 0.77 2.43 2.05 1.57 1.93 1.80 1.19 0.70 1.27 0.91 0.64 1.04 2.21 1.67 0.97 1.20 1.84 1.11 1.14 SEPTEMBER 1.02 1.10 0.65 2.18 1.75 1.75 3.32 3.03 2.29 1.40 2.87 1.70 1.11 1.01 1.75 1.59 1.01 1.52 2.34 1.82 1.40 OCTOBER 1.63 1.54 1.93 2.53 1.84 1.78 4.16 3.63 2.89 2.18 3.24 2.38 1.85 1.86 3.06 2.35 1.80 2.47 3.00 2.81 1.91 NOVEMBER 1.96 2.23 2.15 4.15 3.91 3.51 4.36 4.05 3.22 2.66 3.53 2.69 1.91 2.96 3.97 3.20 2.67 2.63 3.08 2.94 2.08 DECEMBER 3.77 3.24 3.96 3.38 3.08 3.15 5.00 4.80 3.48 2.60 3.53 2.56 1.83 3.79 4.45 4.45 2.73 5.27 4.69 4.27 2.98 Averages 1.43 1.70 1.57 2.57 2.46 2.16 3.33 2.95 2.57 2.29 2.55 1.86 1.39 2.2 2.9 2.40 1.75 2.22 2.68 2.37 1.69 STATIONS D.56—Barking Park; Alfreds Way from May, 1952; Barking Cemetery from May, 1955. D.57—Greatfields Park. D.58—Parsloes Park. D.1571—Barking Park from January, 1955. Page 83 Section F—PEST INFESTATION CONTROL The systematic treatment of the sewers in accordance with the recommendations of the Ministry of Agriculture. Fisheries and Food (Infestation Control Division) was carried out twice during the year The results of the treatment are set out as follows:— May November Number of manholes baited 423 421 Number showing pre-bait take 139 83 Number showing complete pre-bait take 131 151 Surface Infestation The following extract from the Annual Report submitted to the Ministry of Agriculture, Fisheries and Food for the year 1957 indicates the incidence of Rodent Infestation in the Be ugh, dealt will by your officers. A charge of 5/6d. per hour is made for treatment of business premises of all description, whilst dwelling houses serviced with out charge. PREVALENCE OF RATS AND MIC Type of Property (1) Properties in Area No. of properties in area in which infestation was found Analysis of Col. 4. Number infested by RATS MICE (2) Notified by Occupier (3) Survey under the Act (4) Total Major Minor Local Authority's property 28 17 8 25 - 4 9 Dwelling houses 21,564 179 294 473 — 77 83 Business premises 2,016 53 74 127 - 95 47 Totals 23,608 249 376 625 — 176 139 Page 84 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 Rats Mice Local Authority's Property 25 25 - - 4 9 - - Dwelling Houses 160 160 - - 77 83 — — Business Premises 142 142 - - 95 47 — — Totals 327 327 — — 176 139 — — Disinfestation of Verminous Premises The Council continues to provide a free disinfestation service. Throughout he year there were only three minor infestations dealt with including two in Council dwellings. This decrease in the number of infested premises results from residents taking early precautionary measures to deal with the lem. Insecticides are available free of charge to residents where it is considered desire. Section G—MISCELLANEOUS Supply of Dustbins The number premises where dustbins are supplied and mainlined by the Corporation in accordance with Section 75(3) of the Pubic Health Act. 1936, was, at the end of the year, 4,726. The number of dustbins supplied by the Corporation under this arrangement during the year was 456. In accordance with a hire scheme complementary to the above mentioned, 135 properties were supplied with dustbins. In each of these the dustbin will be paid for by eight annual payments of five shillings each. The total number of properties in the instalment scheme for provision of dustbins is 590. Therefore, the total number of Page 85 privately owned premises in the Borough now supplied with standan type of dustbin has reached 5,316. Public Cleansing and Refuse Disposal The Borough Engineer and Surveyor has supplied me with the following information:— The quantity of refuse collected and disposed of throughout the year was 70,753 cubic yards, the average weight 5,044 cwts per cubic yard, and the total weight 18,976 tons. In addition 51,002 tons of refuse were received from other Boroughs. Pet Animals Act, 1951 During the year 16 inspections were made of the eight licensa premises in the Borough. All the premises are satisfactorily complying with the above Act which requires provision for fire prevention; proper sanitary conditions throughout the premises and suitable housing and feeding facilities for the pet animals kept for sale. Offensive Trades Throughout the year there have been 27 visits to the eights offensive trade premises in the Borough. Type of Trade Number Oil Boiler 5 Fat Melter 1 Soap Manufacturer 1 Gut Scraper 1 In March a complaint was received of nuisance and distress caused amongst workers in a factory in River Road arising from the emission of fumes from an adjoining factory. An investigation showed that the fumes arose from a Iinseed oil boiling process and were being discharged to the atmosphere untreated. As a result of representations to the Company concern a fume extraction and condensing plant was installed. No further complaints have been received. Sterilisation of Waste Food Boiling Plant On 1st June, 1957, the licensing of waste food boiling Plant became a function of the Council in accordance with the Disease of Page 86 Animals (Waste Foods) Order, 1957. Chemical Supply Co. Ltd., Abbey Road, Barking A copy of the findings of an appeal under the Town and Country Planning Act is appended because of the public health aspect of the objection by the Council. Town and Country Planning Act, 1947: Section 16. Appeals by The Chemical Supply Company Limited, Abbey Road, Burking 1. I am directed by the Minister of Housing and Local Government to say that he has considered the report of his Inspector, Mr. F. J. K. Brindley, M.A., A.M.I.C.E., who held a local Inquiry into your client's appeals against:— (1) the refusal of Essex County Council to grant planning permission for the erection of industrial buildings at the chemical works in Abbey Road, Barking; and (2) the failure of the local planning authority to give not; of their decision on an application to increase by 20 feet the height of an existing chimney at the Hardwicke Street end of the works. Permission for the erection of the industrial buildings was refused on the ground that the proposal involved expansion and consolidation of an unsatisfactorily sited special industrial use Which would adversely affect the amenities of the surrounding area. 2. Your client's chemical works occupy sites on each side of Abbey Road he smaller site, on the west side of the road, is adjoined on the north and south by industrial development and on west by the River Roding ; the eastern and larger site bounded on he east and south by old terrace houses and on the north by two large gasholders, a North Thames Gas Board building and a few more houses. 3. On behalf of your clients, it was explained that they had Manufactured chemicals at the premises under appeal for 44 years they from time to time adapted and extended the existing buildings, some of which were over 50 years old, to accommodate new plant, but the point had now been reached when large scale rebuilding was necessary. The national impor- Page 87 tance of their work was stressed ; 11,500 tons of chemicals were produced annually, and direct and indirect exports amounted some £620,000. Competition was very keen and it was essentia for the company to be able to manufacture products of a quality which could only be obtained from use of the latest plant wort ing in well-designed buildings. The company had given consideration to moving to another site, but it was difficult to find a suitable location and there were many factors militatig against removal. A large quantity of water was used and must be free from chlorides which would cause corrosion and scaling in the formaldehyde plant; and the present site had the advantage of being served by two private wells of exceptional purity The labour force of between 200 and 250 was local and include skilled workers and scientific staff who were unlikely to be willing to leave Barking. The factory was in an area allocated for industry in the Development Plan and was close to the largest power station in England and to Beckton Gas Works, which was one of the main sources of raw materials. There were no fumes or vapours arising from the manufacturing processes a the works which could possibly have any chemical reaction on paint, woodwork, curtain materials or metals, and although there was some smell in the vicinity of the factor this was new strong and the most noticeable was terpineal, a pleasant clean odour. The most objectionable smell outside, derived from production of hexamine, had now been completely eliminate by a new system of manufacture recently introduced. Under it modernisation and rebuilding scheme now proposed, the nil existing chimneys at the works would be replaced by two. Automatic stokers were being installed to reduce coal consumption and the emission of smoke, and the raising of the chimney appeal was necessary in order to provide additional draught for one of these units. The proposed new buildings were intended solely for providing better working conditions and improving efficiency and would reduce the risk of smell outside the works The unsightly collection of buildings fronting on to Abbey Road would be replaced by pleasing buildings and the sheds and wall facing Hardwicke Street would be replaced by a taller building which would conceal the works from the upper windows of the houses there. In the circumstances, it was submitted that very heavy cost of acquiring a new site, building a new fadtory and removing all the plant and equipment could not possible Page 88 be justified and that the firm should be allowed to continue to operate at their present premises without further hindrance. 4. For the local planning authority, it was stated that the chemical works was an industrial undertaking occupying a salient projecting into an extensive residential area. For many years your clients' factory had been a cause of continuing complaint by local residents. Smell always surrounded the works and particularly objectionable odours arose during the manufacture of certain chemicals. The houses near the works were to be demolished and the area redeveloped : it would be fundamentally unsound to build an estate of modern expensive houses beside a factory which was a constant source of nuisance, and it would be ndesirable to reduce the amount of land available for huusing by creating a light industrial or open space zone between the new houses and the chemical works. Moreover, an area to the rth of the works had recently been purchased at considerable xpense as a public open space providing a fine setting for the new Town Hall and the ruins of St. Mary's Abbey, and the implement made by this redevelopment could be seriously marred by the continued presence of the chemical works. The Council were satisfied, therefore, that the only solution to the problem was to remove the works from their present position. The stage had now been reached when your clients must rebuild their factory and it was submitted that this was the proper tir to move to another site. It was appreciated that the relocation of a factory was always difficult and costly, but on this case there were no insuperable difficulties and re-siting would have the advantages of avoiding piecemeal rebuilding during production and of making it possible to build a compact factory on a single undivided site. It was understood that land was available River Road, near the mouth of Barking Creek, Once the works had been vacated they could be given over to light industry now in the central area of Barking, which would from a useful buffer between the residential district to the east and the factories on the west side of Abbey Road. 5. Representations were made by a number of local residents, who complained about intolerable smells, damage to paintwork materials, sparks from the chimneys and noises late at night. 6. The Minister has carefully considered the facts of the case and the representations made. He agrees with the Council that Page 89 it is undesirable for a special industry, such as a chemical works to be sited close to houses, but in this case the present site of the chemical works is allocated for industry in the Development Plan and adjoins an industrial area extending alongside the Rive Roding and Barking Creek. It is dominated by two large gas holders which are within a few feet of the houses in Hardwicke Street and Linsdell Road. Your clients have been established fa many years on the site, which has the advantages of a supply of pure well water and other existing facilities and buildings. Some smell inevitably arises from the chemical works, but your client have hitherto co-operated with the public health authority to reduce this nuisance as far as possible and the modernisation of the works will effect further improvement. The Minister has come to the conclusion that he would not be justified in uphold ing a decision which would be likely to hamper your clients business so seriously as to force them to move their factor to another site. Some improvement on existing conditions will be effected by the new buildings and steam raising equipment proposed, and the Minister hopes that on the redevelopment of the adjoining areas the opportunity will be taken to provide a suitable buffer between the works and the new houses. 7. The Minister has accordingly decided to allow the appeals RAINFALL Rain fell during the year on 231 days and me red 18.80 inches compared with 20.31 inches for the previous year. Daily records show that 0.01 inches or more rain fell on days and 0.04 inches or more rain was recorded or. 97 days. Page 90