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591f3263-9643-46ad-a666-d4c8e3e55130 | Numbers removed from the Dispensary Register. Number on Dispensary Register 31-12-30. Died. Left District. Discharged (Non Tb.) Discharged " Cured " Transferred to another Dispensary. etc. Amended Diagnosis Total 423 22 11 108 16 9 105 271 355 At the end of the year, 341 cases on the Dispensary Register were definitely diagnosed as suffering from tuberculosis, whilst in 14 cases the diagnosis still remained in abeyance. 80 Thirty-seven deaths occurred from tuberculosis (all forms), 34 of these being pulmonary cases. The number of deaths in institutions was 18. The death rate for tuberculosis (all forms) during 1930 was 0.82 per 1,000 population, compared with 0.9 for the previous year. Of the 37 deaths from tuberculosis 3 had not been notified to us before death—i.e., 8.1 per cent. |
0b504d8d-f55b-4dfd-a8a2-507775117401 | of the total deaths from tuberculosis. No action has been taken for wilful neglect or refusal to notify, because none of the 3 cases comes within such category. The figures in Barking in any one year are not sufficiently large for us to express any opinion as to if and whether there is evidence of any excessive incidence of, or mortality from, tuberculosis in any particular occupation in the area, but the association of tuberculosis with asbestosis is well known, and I understand that the figures for the nation as a whole show that there is an increased incidence of tuberculosis amongst these workers in asbestos. During the year 1930 your Medical Officer of Health has continued to be Tuberculosis Officer, and this fact has mitigated to a large extent the disability of divorcing work associated with the detection of tuberculosis from the general duties of the Medical Officer of Health. |
d9d17692-6db9-4210-980d-40bc564d6bf2 | With the development of Barking some variation in our present plan of operation is necessary, and a review of the situation would not be out of the way here, particularly so in view of the fact that the situation in Barking has been interesting as an experiment. It must be remembered that a Tuberculosis Service consists essentially of three more or less distinct factors. These of course overlap to a certain extent. First of all we have prevention, then we have detection and then we have treatment. It is obvious that of these three factors 81 prevention is by far the most important, and everything else should be subordinated to secure the efficiency of the Tuberculosis Service as a preventive service. In London this is done by linking up prevention and detection, giving to the Medical Officers of Health full comprehensive knowledge of the whole of the problem so far as it affects their area. Outside London, unfortunately, except in the case of County Boroughs, this happy state does not obtain. Detection is linked up with treatment. |
0f31a414-69f7-4a61-b0bc-0b592fea08a7 | In the past there has been something to be said for this. The prevention of tuberculosis has never been so seriously entertained generally throughout the country as it should have been. Nor has there been in the past evidence that any activity by a Local Authority which had for its object the prevention of tuberculosis would obtain such a measure of public support as to make it efficient. On this account it has been in a measure wise to link up detection with treatment, so as to increase the efficiency of treatment, in the hope of indirectly helping prevention ; but the people of England are becoming more interested than ever in the prevention of tuberculosis, and particularly have I noticed this in Barking. Where Local Authorities have such an intelligent and enlightened public opinion behind them it is obvious that everything should be done, as I have said, to increase the efficiency of direct prevention, and the benefit of combining prevention and detection outweighs any minor advantage of combining detection and treatment. |
20b836a7-e4f4-44a0-b5b4-1d93c5058e30 | It is only when a Medical Officer has—as the Medical Officers of the Metropolitan Areas have—a comprehensive knowledge of the whole of the problem that this prevention can be really efficient. It is to be hoped that in the future, where Athorities responsible for prevention are able to undertake the responsibility of detection, this responsibility shall be conferred upon them. 82 I am persuaded that to such a measure as this, rather than to any special curative measure, we must look if we want to eradicate tuberculosis. These remarks particularly apply to Barking, because Barking, in its position as an extra metropolitan area, is very well served, so far as treatment is concerned, by the large London hospitals, and treatment does not loom so largely in the work of the Tuberculosis Dispensary in Barking as it does in a Tuberculosis Dispensary in a remote part of the country. The Tuberculosis Dispensary in Barking is essentially a clearing house. |
fe56c1c0-020f-4a3b-9f71-bf52abc44de7 | A certain amount of treatment is of course carried on, but this is a very minor function of the Dispensary. Even the association of prevention and detection will not be sufficient unless there is still closer co-operation between the various sanatoria of the country and Local Authorities. Sanatorium authorities must go out of their way to achieve co-ordination if a truly efficient system is to be built up. No man nor woman should be discharged from sanatorium unless or until there have been conversations between the superintendent of the sanatorium and the Medical Officer of Health. The mere formal chit as required by law is by no means sufficient. Incidentally it is unfortunate that, whilst superintendents of public sanatoria are bound to notify the Medical Officer of Health of the admission and discharge of patients, no such obligation rests upon voluntary hospitals, and I do hope that voluntary hospitals will themselves make arrangements for this very necessary transfer of information. |
727be57e-b783-4acf-ade6-a27131bacc05 | There remains one more thing for me to say under this heading and that is the need there is for persons to be admitted to sanatorium much more quickly than they are at present. To those of us who are mixed up with suffering and disease the plain straightforward thing that must be done appears quite obvious, and it appears to us that it ought to be quite easy for the patient to make up his or her mind. We know, however, by experience that this is not so. 83 Shakespeare wrote:— "Between the acting of a dreadful thing And the first motion, all the interim is Like a phantasma, or a hideous dream." Shakespeare was quite right, and we find in cases of tuberculosis that, however much we sympathise, we cannot enter into the awful confusion and mental rebellion that agitate a patient. |
47b32ec9-4209-4410-a84d-92a61b361c74 | I want to emphasize the point that, often unconsciously, many people when once they realise they are suffering from tuberculosis are in open rebellion, and this is one of the worst things which could possibly happen to them. There is only one thing which we can do to deal with these people, and that is to cut the period of waiting for admission to sanatorium as short as possible. It should never be more than a matter of a few days, because this period of mental disturbance is a very trying one and mental disturbance has but a line that divides it from mental instability. When once a fiat has gone forth that a patient must enter sanatorium, the patient should be admitted forthwith. From time to time I have stressed the importance of after care in respect of patients returning from sanatorium and have pointed out how frequently the beneficial effect of the stay is nullified by the home conditions to which they return. |
5bd9cf20-006f-426e-a807-968fc5a772d8 | The "after care" of tuberculosis patients is linked up inevitably with prevention and sanatorium treatment, and it would therefore appear that the provision of suitable housing accommodation for the patients would be a logical development of any Tuberculosis Service. Several Local Authorities have recognised the importance of this and have in their housing developments allocated a small quota of dwellings for this purpose. 84 Such houses are usually of the non-parlour type, erected in pairs. The large bedroom is divided by a glazed sliding screen, that a portion of the room can be utilised as an open sleeping cubicle, with casement windows opening the full width of the room. The houses are so placed that the sleeping cubicle overlooks a large open space providing for a free current of air and the free admission of sunlight—conditions similar to those existing in sanatorium. The extra cost of these houses, 26 of which have been erected at Wakefield, is £20 per house. |
8509b8b6-8d09-44f1-8901-1c7220742710 | It is unnecessary for me to stress the many advantages this offers to the ex-sanatorium patient and the definite gain to public health arising from less risk of infection to the family. From this arrangement would result also the improved health of any members of the family who may be in a pre-tubeicular condition. In previous years I have called attention to the fact that the Tuberculosis Register in Barking is misleading—that a large number of names appear on its columns which need not be there. The following table shows the present position of the Tuberculosis Register compared with that in 1929. On Reg. 31-12-29. New cases during year. Died. Cured. Lett district. Amend, diagnosis. Other. Total rem. from reg. On Reg. |
727259ae-8f2b-41da-925c-9a231104f028 | 31-12-30 Pulmonary— 504 71 34 10 23 101 2 170 405 Non-Pul.— 233 24 2 16 12 39 1 70 187 Totals 737 95 36 26 35 140 3 240 592 It will be seen that, whereas we started the year with 737 on the Register, we ended the year with only 592, in spite of the fact that there has been a very considerable increase in population. 85 This figure of 592 is, I am persuaded, higher than it should be, and I hope that the introduction of an evening clinic will enable us to deal with many cases who cannot attend during the day and enable us still further to reduce this figure. For comparative purposes it is interesting to note that when I came to Barking in 1927 there were 946 cases on this Register. |
cb9c7419-3e65-4929-9359-7c5d71567ef6 | (g) Enteric Fever.—Five cases of enteric fever were noticed during the year, four of which were removed to hospital. (h) Puerperal Fever.—Three cases were notified during the year; two were admitted to hospital and recovered. (i) Puerperal Pyrexia.—Ten cases were notified during the year. All of the cases recovered. (j) Erysipelas.—40 cases were notified during the year computed with 36 during 1929. Six patients were removed to hospital. (k) Chicken-Pox.—In view of the prevalence of smallpox in surrounding districts, chicken-pox was made a notifiable disease in the district in April, 1928, and continued to be notifiable throughout 1930. A total of 288 cases were notified during the year, compared with 414 during 1929. Sex.—132 were male and 156 female. 45. |
875e245f-6a7b-454f-a077-30463c37a743 | NON-NOTIFIABLE ACUTE INFECTIOUS DISEASES, (a) Measles, etc.—The most important of these are mesles, whooping cough and summer diarrhoea. There were no serious epidemics of these diseases, and the deaths registered were as follows:— Measles 19 Whooping Cough 2 Summer Diarrhoea 7 86 The teachers in the schools keep the Public Health Department well advised of any little outbreaks of non-notifiable infectious diseases which take place amongst the school children, but we have no similar organised help with reference to the adult population. Intimate touch, however, is maintained with the private practitioners working in the area and we confidently believe that almost all such outbreaks are in one way or another brought to the notice of the Public Health Department. A comprehensive system obtains whereby intimations of disease received from the schools or through the investigation officers are utilised so far as practicable. |
a512d1b1-845e-4e82-859f-af630ac9e23d | Cross references are made for the use of the health visitors and school nurses, who follow up cases of whooping cough, mumps, measles and other similar nonnotifiable infectious diseases. (b) Rheumatic Fever.—It is very difficult in Barking to deal with rheumatic fever. The condition is very prevalent, and unfortunately, so far as symptoms are concerned, rather mild, although the number of cases of disorderly action of the heart found, particularly amongst young people, clearly indicates that the condition is by no means so trivial as the symptoms would lead one to believe. Rheumatic fever, as a public health problem, differs from scarlet fever, with which it is closely allied, because it has no rash. This is the most unfortunate thing about the condition. If there were only some such significant sign much more notice would be taken of it. |
30396cde-16dd-4ea4-b0cc-81f6f90f6bb6 | In this connection it is happy to recall the painstaking endeavours of the Boots Minor Sub-Committee of the Education Committee of the Council to provide boots for the bairns, and although certain members have, I believe, incurred the possibility of disciplinary action in a court of law, they have, I am confident, done a very considerable amount of work in decreasing the incidence of rheumatism, because unquestionably children who are dry shod are less likely to contract the disease and are certainly likely to be less seriously affected by it. 87 (c) Psittacosis.—I have dealt elsewhere with psittacosis as a public health problem (see page 18) and have shown how easily it is dealt with. It remains for me here to say a few words on the general characteristics of the disease as we met with it in Barking. Taking one case as representative of the whole, I may say that on January 10th, 1930, the parrot was bought at Spitalfields Market. |
b5f58ab4-e722-44e9-bfb7-552009e56cc3 | The parrot appeared to be ailing and was looked after with commendable humanity until it died on January 21st. The patient, aged 30 years, first felt ill on January 23rd, and first consulted medical opinion on January 25th, on which date another member of the same family first felt ill. Both the first and the second patients were removed to the London Hospital on January 28th. On January 25th, it was obvious that the girl was ill. There was a temperature of 101.6 and a pulse of 108; there was an intractable headache of the forehead, which did not radiate elsewhere; there was an intense fear of light; there was vomiting; the respirations were about 24; the heart showed no signs of disease other than those associated with the high temperature; the lung gave an ordinary note all over on being percussed, but with the stethoscope very fine signs of moisture could be heard over the lower parts of the lungs and the hila. |
62d4b1e5-7f76-400d-addb-f66352ff4093 | The patient was on this day lying in bed in a semi-unconscious condition, from which it was difficult to arouse her. During the time the patient was in Barking the condition was progressive, the temperature became higher, the vomiting continued and the catarrh of the chest became more serious, so that on January 27th, the temperature was 103.8 and the pulse 120. The patient was clammy, hot and perspiring and the general conditions of the lung were those of a diffuse pneumonia. On January 28th, this patient was removed to the London Hospital, where I understand the condition remained unfortunately very much as when she left Barking, and the patient died on February 2nd. 88 There are certain interesting features in this small outbreak. |
551276ae-3917-4f76-9076-8838429e3676 | Firstly, it would appear from the evidence we have gathered that some of the patients contracted the disease from the parrot, and some of them contracted it from the patients who had contracted it from the parrot—in other words, the disease is communicable not only from parrots to man but from man to man. A second line of thought this epidemic brings forward is the possibility that many cases labelled, quite rightly, under that more general heading "influenza" may really be, like psittacosis, derived from the animal world. Thus psittacosis, as we have seen it, may be likened very closely to a case of influenzal pneumonia with cerebral complications, and it may be that we shall find that many cases of pneumonia of the influenzal variety are similarly due to predisposing causes, which, as in the case of psittacosis, should be looked upon as the primary condition. This opens up a vast field for research, both from the purely medical standpoint and from the public health standpoint. |
130f89ce-29bb-4f3a-bd94-802fb1d20612 | (d) Cancer.—There have been 48 deaths from cancer, 25 below the age of 65 years and 23 over the age of 65. It will be seen, therefore, that over half the cases of cancer which have proved fatal this year have affected people who may be looked upon as still members of the working community and therefore still of economic value to the country—that is, they are people with duties and responsibilities, which, if and when they are removed, will probably, in a town such as Barking, have to be shouldered by the State. On October 8th, 1930, I presented you with a report on Circular 1136 issued by the Ministry of Health, and I still hope that something will be done to meet the various suggestions I have laid before you. 89 The following table shows the occupations of the 48 persons who died from cancer during the year 1930. Male. Female. |
98b0ad50-d81c-482c-9946-6200d6acf039 | Gas workers 4 Spinsters 2 General labourers 3 Wives 15 Painters 2 Widows 9 Master Hairdresser 1 Master Builder 1 Master Mariner 1 Fisherman 1 Cooper 1 Warehouse Carman 1 Lead Burner 1 Farm Foreman 1 Schoolmaster 1 Hawker 1 Coal Porter 1 Night Watchman 1 Clerk 1 22 26 The above table shows that cancer is distributed throughout the whole of the population. The largest number appears amongst gas workers, but then of course Beckton is a very big works and we are dealing with one year only. It would, however, be interesting from a national standpoint to see whether cancer is more prevalent amongst gas workers than persons of other occupations. (e) Influenza.—Your Medical Officer has been in constant touch throughout the year with the medical practitioners in the town, and at the end of the year sent out a questionnaire as to nonnotifiable acute infectious diseases, notably influenza. |
d1428d1c-f99d-40e8-a934-ed1a72ac2f74 | From the information available it appears that influenza was the only such non-notifiable disease of any considerable incidence, that this influenza was prevalent at various seasons throughout 90 the year, and that a large percentage of cases were really ill, but that there were relatively few deaths and these deaths occurred for the most part amongst elderly people. 46. ASBESTOSIS. Following up my remarks for the past two years on this disease, which is prevalent amongst asbestos workers, I would like to say how indebted I have been to Dr. Burton Wood and to Dr. Gloyne, both of the Victoria Park Hospital, for their unfailing help in our work on this question. A good word too must be said for the patients who have voluntarily submitted themselves to examination and re-examination, without which we could not have compiled the evidence that has been so helpful in preparing our reports on this disease. |
664af80d-9f92-4c35-a254-bae5a99b0c44 | The helpfulness of the patients in this matter has been most disinterested and therefore all the more deserving of praise, because unfortunately there is so little that can be done for them individually when once their lungs are damaged by the inhalation of asbestos dust. We still continue to keep the dossiers of these patients up to date, in order intensively to study the progress of the disease, with the object of finding out everything possible. It will readily be recognised that it can only be by finding out everything possible that we can hope to build securely a scheme for preventing the future incidence of asbestosis. 91 47. ISOLATION HOSPITAL. (a) Admissions. The following is the table of admissions, etc., in respect of infectious diseases during 1930:— Disease. In Hospital January, 1st, 1930. Admitted during the year. Died. Discharged In Hospital Dec. 31st. 1930. |
9600741a-d16b-4d9d-b11f-26cd0c0c40a9 | Scarlet Fever 22 141 3* 149 11 Diphtheria 31 337 14* 312 42 Pneumonia — 2 1 1 Puerperal Fever — — — — — Puerperal Pyrexia — 3 — 3 — Enteric Fever | - 1 — 1 — Erysipelas - — — — — Chicken-pox - 2 — 2 — •Not the primary cause of death in two cases. (b) Hospital Accommodation.—In February, 1930, a temporary building was erected within the precincts of the hospital to increase the number of beds available, and this ward has proved invaluable. The building is 120 feet by 20 feet, and for the most part has been devoted to dealing with cases of diphtheria. |
badd8baf-2a67-420a-b5a4-0abdaca91617 | During November, 1930, in order to avoid overcrowding the hospital beyond a safety point, cases were sent by the Town to the London Fever Hospital, at an approximate cost of £350. I am asked by the Ministry of Health to refer to any action which has been taken or advised with the object of securing that the hospital accommodation available for cases of infectious disease is utilized to the best advantage, and I am to refer to any action "to replace hospital treatment in suitable instances by nursing and supervision at home. The people of Barking have long been used to expect the amenities which have been provided in your infectious fever hospital, and, as I have expressed myself elsewhere from time to time, I am of opinion that the nursing these cases require is far better carried out in a suitable institution than at home. |
a1900fa1-e146-42c9-b2ee-73749ddbede1 | 92 I am conscious of the fact that in many towns where the social circumstances of the people are happily more fortunate than the circumstances of the majority of the people of Barking, it may be possible to treat mild cases of scarlet fever and diphtheria at home, but with such a highly industrial population as you have in your area, the possibility of a large number of cases being suitably treated at home is very remote indeed. It has been for a long time now the custom to take in cases of measles, when such cases are complicated by broncho-pneumonia or any other serious complication, and when beds are available, and it is hoped that when the new hospital is opened we shall have more beds available for the admission of these very serious cases. 48. VACCINATION. No primary vaccinations or re-vaccinations have been carried out by your Medical Officer of Health, but your Medical Officer works in the closest co-operation with the Public Vaccinator. Dr. |
2d3ede91-aa65-4e18-bcdd-d207b5c020fd | McDonald, who is early notified of any persons who, in tinopinion of the Public Health Department, should be vaccinated. 49. EXAMINATION OF PATHOLOGICAL SPECIMENS, Etc. In a previous table I have shown the use that has been made of the facilities provided for the examination of pathological and bacteriological specimens, but I am to report that no use has been made of the Schick and Dick tests in diphtheria and scarlet fever respectively, or of the artificial methods of immunization against these diseases. My own feeling is that any parent who wishes his child to be immunized against diphtheria or scarlet fever ehould be afforded facilities for this to be carried out, but at the same time I think it is to be remembered that by immunizing only a small percentage of the population we may be increasing the number of potential carriers of the disease—i.e., persons who may have become infected and show none of the ordinary signs of the malady. |
bc15cdd4-b6f0-4a71-b980-84260331f60e | I have already advised you along these lines, and hope that the time will soon come when you will be prepared for Schick and Dick testing to be carried out at the request of parents and for any necessary immunization to be effected. 93 50. CLEANSING AND DISINFECTION OF VERMINOUS PERSONS. In Barking there is no particular station which is known as the Cleansing and Disinfecting Station, but at the Central Clinic there is a small steam disinfector, in which the clothing of children is disinfested, and, to make security double sure, blankets, etc., which are returned to us from the summer camps, are disinfected in the large steam disinfector at Upney Hospital. With these facilities available we could undertake the disinfestation and/or disinfection of any person. The Council are willing to do so on request and a public notice to this effect has been posted. The disinfection of premises is carried out by routine. |
c3612785-3732-44ac-8e84-0580f182bc8b | Where any serious verminous condition of premises is found as a result of inspection or complaint, the Authority arrange for the most effective disinfestation to be carried out, and for this purpose any fitments in the room which might provide habitat for the vermin are removed and the room sprayed with a suitable vermicide. In many of the old houses which have become seriously infested it is entirely impossible to disinfest the premises so as to remove all vermin. 51. RATS. Owing to an unfortunate smallpox epidemic which was prevalent during Rat Week we were unable to undertake any special activities in this regard. However, the general public, as a result of propaganda over a number of years, are now very much alive to the fact that the presence of rats should forthwith be reported to this department, so that we are now throughout the whole of the year dealing, when occasion arises, with this pest. |
dcb66e76-ece3-4209-a6b0-8e8ef08c4211 | 94 There were 161 inspections made in respect of rat infested premises and a large amount of the drainage reconstruction resulted. It is a practice of the Engineer and Surveyor to provide poison baits in the manholes of the Council's sewers and upon land within his jurisdiction. Posters are exhibited in various parts of the town, drawing attention to the purposes of the Rats and Mice (Destruction) Act and advising affected householders what steps to take. 52. MOSQUITOES. The prevalence of mosquitoes in the area is still at certain periods of the year particularly evident, although of course not nearly so much as it must have been when the marshes were not drained so well as they are to-day. It is a wise old saying that "the marsh bailiff (i.e., ague) died in a ditch." |
ad3c9d42-e3b0-44c7-9af5-dcf240ab3778 | It is to proper drainage that we must look for this suppression of the mosquito pest, and from this standpoint we could wish that the Essex Sewers Commissioners had much more money available and more power in order to bring about a happier state of affairs than exists on the marshes of Barking. The Natural History Society have taken up this matter and indeed have spent field days studying mosquito life in Barking. The industrial development of the riverside lands in Barking will do much to do away with the mosquito problem, but we find that many people who complain of mosquitoes have really themselves to blame—as is so often the case—and that if they were themselves to see that there were no pools of stagnant water in the precinctof their own houses they would not be so troubled with mosquitoesas they are to-day. It is not likely that the mosquitoes which actually breed between the Thames and Ripple Road affect any other than the houses in the immediate vicinity of their breeding places. 95 SECTION 7. MATERNITY AND CHILD WELFARE. 53. |
16eee1a7-cf58-426e-83e3-0329ff26f0b7 | GENERAL. The Council's Scheme under the Maternity and Child Welfare Act, 1918, has been extended during the year. On December 3rd, 1930, an Infant Welfare Clinic was held in the St. Alban's Hall in the Gale Street Area, and on the same day an Ante-Natal Clinic was held in those premises. Since this date one ante-natal session and one infant welfare session have been held weekly in the St. Alban's Hall. This is only a temporary arrangement and it is hoped that a permanent Clinic will soon be provided in this area. We have now two systems of medical practice, which are not directly in competition one with another, but which nevertheless are essentially different and which one cannot help comparing, economically and otherwise. |
a55cb0a7-9cd0-43fa-8e59-d2b370c24739 | On the one hand we have a system of general practice, where medical men are available for practically the whole of the twentyfour hours and are called in as and when they are required and oftentimes at the whim of those who are responsible for the patient concerned. . On the other hand we have a system of clinics, where medical practitioners attend for definite periods. It is obvious that the clinic system is capable of a degree of organisation which we can hardly expect to find in general practice, and it is this possibility of organisation which gives it certain peculiar advantages. On the other hand, general practice has certain advantages. 96 My point is that unless attendances at these clinics are so organised they lose in efficiency, to their disadvantage when compared with general practice. It is obvious that if a clinic is planned for half a dozen, a dozen or a score of appointments, those appointments must be kept, because it is impossible to arrange for the practitioner to be available for the whole of the twenty-four hours as in general practice. |
9389b2a1-0f6f-4aa8-84b4-12199d0c5bd4 | Every time, therefore, that a member of the public is given an appointment and does not keep it, he or she is decreasing the efficiency of the service retained by them, and it behoves everybody who is interested in the development of a sound economic clinic system to see that once appointments are made they are kept. 54. REGISTRATION AND NOTIFICATION OF BIRTHS. By the Registration Act, 1836, all live births must be registered within a period of six weeks. The actual number of live births within the district during the year was 786, the net total of 799 being obtained by adjustment of inward and outward transfers, etc. The births registered included 414 males and 385 females. There were 22 illegitimate births, or 2.7 per cent of the total. In comparison with 1929, 12 more births were registered during the year, an increase equivalent to 1.5 per cent. |
c1417365-c2ad-47bc-9d55-fd0778dc1d7f | By the Notification of Births Act, 1907, all live births and still-births of seven months and over are required to be notified to the Medical Officer of Health within 36 hours. Of the total live births all except 11 or 1.4 per cent. were notified. In addition 10 still births were not notified. The following table gives details of the notifications received:— By whom notified. Live Births. Still Births Medical Practitioners 110 4 Certified Midwives 593 19 Parents and Others 72 The percentage of still-births was 2.9 97 Of the total live births within the district during the year, 519, or 66.03 per cent were attended by midwives, the remainder being attended by medical practitioners. 55. BIRTH RATE. The birth rate for the year was 17.8, compared with 16.3 for England and Wales. 56. ANTE-NATAL CLINICS. |
b073d57b-49df-49ed-9508-ec735ad6cf51 | The work of the Clinics was carried on as in previous years, and one extra session was commenced at the St. Albans Clinic on the 3rd December, 1930. The attendances during the year were well maintained. The number of primary attendances was 432 compared with 386 for 1929. Reattendances numbered 1,536 in 1930, and 1,180 during 1929. One hundred and sixty sessions were held during the year, making an average attendance of 12.3 mothers per session. The total number of births including transfers was 832, and the number of first attendances at the Ante-Natal Clinics was 432. It would therefore appear that 51.9 per cent. of these cases availed themselves of our Ante-Natal Service. Expectant mothers attending the Ante-natal Clinics are drawn from the following classes : (a) Patients intending to enter the Upney Maternity Ward for confinement. |
467c2b1a-095d-4ed4-ae80-5eed2740f7b6 | (b) Those engaging with the midwives of the Plaistow .Maternity Charity. (c) Patients engaging with private midwives. Thirty-three cases attended by midwives were referred by them or by the health visitors for examination at the Ante-natal Clinics owing to the presence of defects following childbirth. 98 57. MATERNITY WARD. The admissions to the Maternity Ward of the Municipal Hospital numbered 202, compared with 180 in 1929. Of these 27 cases were admitted for ante-natal treatment, and 175 for confinement. Corresponding figures for 1929 were 36 cases for antenatal treatment, and 144 for confinement. (a) Number of cases admitted 202 (27 of which were Ante-natal) (b) Average duration of stay - 14.6 days (c) Number of cases delivered by:— Midwives 171 Doctors 3 (d) Number of cases in which medical assistance was sought by the midwife, |
23b6a75a-3220-4fe4-97f8-81218332b082 | with reason for requiring assistance:— Torn Perineum 14 Delayed second stage 1 Uterine Inertia 1 High Temperature 1 Complicated Breach 1 Unsatisfactory condition Heart Disease 1 of patient 1 Albuminuria 3 — Miscarriage 1 26 Collapse after Labour 1 — Delayed first stage 1 (e) Number of cases notified as puerperal sepsis, with result of treatment in each case Nil (/) Number of cases notified as puerperal pyrexia, with result of treatment in each case (recovered) 2 (g) Number of cases of pemphigus neonatorum Nil (h) Number of cases notified as ophthalmia neonatorum, with result of treatment in each case Nil (i) Number of cases of " inflammation of the eyes," however slight Nil (j) Number of infants not entirely breast fed while in the Institution, |
b3a44c54-70b3-416a-a10c-8f0aa09044b3 | with reasons why they were not breast fed 5 Weakness or illness of mother 4 Deformed nipples 1 (k) Number of maternal deaths Nil 99 (I) Number of foetal deaths (i) stillborn, and (ii) within 10 days of birth, and their supposed causes— and the results of the post-mortem examination:— (i) Still-born 6 Twin presentation 2 Worry 1 Accident 1 Not known 2 (ii) Within 10 days of birth 1 Feeble—3 days old. 58. PUERPERAL FEVER AND PUERPERAL PYREXIA. Three cases of puerperal fever were notified as compared with one in 1929. Two cases were admitted to Hospital. In addition to the cases of puerperal sepsis, 10 cases of puerperal pyrexia were notified, the confinement in 5 cases being attended by a midwife. All the patients recovered. 59. |
9c31fde2-f59e-4660-a580-08b8f6a585db | MATERNAL MORTALITY. Three maternal deaths occurred during 3930, the deaths being certified as follows:— (a) Eclampsia of pregnancy 1 (b) Rupture of Uterus 1 (c) Toxic jaundice of pregnancy 1 The following table shows the number of maternal deaths occurring in Barking during the past five years. Year. No. of Maternal Deaths. 1926 1 1927 3 1928 2 1929 2 1930 3 100 The number of these deaths is still too high. The figures compare favourably with those for the rest of England, but then the figures for the whole country are too high. It is to be noted that two of the three maternal deaths occurring in 1930 were of young, unmarried, pregnant women of the age of 17 years, and one cannot help feeling that if Society were readier . |
1b9e9dde-50da-4747-872b-2a5ac63ec821 | to help rather than to ostracise these unmarried pregnant women, they would not be so likely to conceal their pregnancies. It is obvious that a concealed pregnancy is a more risky one both for the mother and for the child, so that this concealment, which takes place often for the want of a helping hand, becomcs a crime on the part of the mother, not only against herself but against her unborn child. GO. NEO-NATAL MORTALITY. Of the 49 children who died under the age of one year, no less than 24 of these died under the age of one month—i.e., 48.9 per cent. Of these 24 children, 16 were female and 8 male. Of the 24 deaths 10 were due to premature birth and debility and 8 were due to congenital malformations, the remaining G being due to various causes. |
2b174df3-290c-4cb0-b292-bd9192e22341 | Your activities in maternity and child welfare have not had the profound influence on the number of deaths of infants under the age of four weeks that they have had on the number of deaths of infants between one month and twelve months of age. It is now generally believed that these neo-natal deaths can only be materially influenced by more intensive and efficient antenatal work, and these 24 deaths show you that you have realms to conquer in this direction. 101 61. STILL-BIRTHS. Of the total notifications received under the Notification of Births Act, 23 related to stillborn children, giving a percentage of 2.9 compared with 2.8 in 1929. In addition, 10 still-births were not notified. |
730dded2-ba93-43c0-80c5-3277a3f449c6 | Investigation of the health visitors elicited the following informs tion:— (a) Duration of pregnancy :— Less than seven months 1 More than seven months 22 Not elicited 10 (b) Presentation :— Vertex 12 Breech 5 Not elicited 15 Footling 1 (c) Supposed cause of stillbirth:— Overwork 1 Accident, etc. 4 Not known 17 111 health 6 Shock 2 Worry 1 Twin presentation 2 (d) Occupation of mother:— Household duties at home 31 Shorthand Typist 1 Rag Sorter 1 62. OPHTHALMIA NEONATORUM. There was a decrease in the number of cases of ophthalmia neonatorum, notifications being 12, compared with 14 in 1929. 102 Seven of the cases occurred in the practice of midwives, the remainder being attended by medical practitioners. Age Group. Cases. Vision unimpaired. Vision impaired. |
794016bb-f347-46e2-bc7d-137fb813431f | Total Blindness. Deaths. Treated. Notified At Home. At Hosptl. Under 3 weeks 12 11 1 12 — — The growing appreciation among midwives of the seriousness of the condition and of the value of early treatment makes for a greater readiness on their part to call in medical help to the slighter cases of discharge which previously may have escaped notification altogether. 63. WORK OF THE HEALTH VISITORS AND THE INFANT CLINICS. An analysis of the attendance at the Infant Welfare Centres is given in the following table :— Infant Welfare Centres. Clinic Premises Alex. Centre Movers Lane St. Albans Totals No. of sessions 101 100 100 5 306 No. of attendances of children under one year :— (a) New cases 213 144 163 30 550 (b) Old cases 2496 2064 1967 45 6572 No. |
e9338604-3b2d-442c-9849-6263fd232aab | of attendances of children I to 5 years of age :— (a) New cases 46 60 59 41 206 (b) Old cases 1132 1322 905 30 3389 Average number of attendances per session 38 36 31 29 3 6 No. of sessions attended by medical officers 101 100 100 5 308 No. of children seen by medical officers :— (a) Under one year 1519 1064 1123 46 3752 (b) Over one year 754 763 654 49 2220 Average number of children seen by medical officer per session 23 18 18 19 19 The total attendances during the year were 10,717 as compared with 10,164 in 1929. 103 Particulars of the home visits paid by the health visitors are given in the following table :— No. |
f1c12031-81cd-42c2-a1a7-6f01a33f1e31 | of ante-natal visits :— First visits 99 Subsequent visits 77 No. of first visits to children under one year 1,076 No. of subsequent visits to children under one ye?r:— (a) Attending a Centre 221 (b) Not attending a Centre 3,079 N o. of visits to children 1 to 5 years of age :— (a) Attending a Centre 211 (b) Not attending a Centre 5,139 No. of special visits in connection with Ophthalmia Neonatorum 11 Ditto Deaths of children up to 3 years of age 52 Ditto Still-births 27 Ditto Puerperal sepsis and Puerperal Pyrexia 2 Ditto Foster Children 46 Other visits (re infectious diseases) 387 Total home visits of all kinds 10,427 (54. FACILITIES FOR TREATMENT. |
da912011-6bbc-4bae-87cd-80019b2bee03 | (a) Minor Ailments.—Treatment is given at the Central Clinic and the St. Albans Clinic. (b) Dental Treatment.—Treatment is given at the Central Clinic. (See later section of this Report.) (c) Orthopaedic Treatment.—Treatment is given at the Orthopaedic Clinic at Faircross School. (See later section of this Report.) (d) Tonsils and Adenoids.—Operative treatment is undertaken at the O'Jeen Mary's Hospital, Stratford, and the St. Mary's Hospital, Plaistow, under the Council's scheme. During the year 54 such operations were carried out in respect of children under the age of five years. (e) Convalescent Treatments—This is provided under theCouncil's scheme, and during the year five toddlers and seven mothers and babies received treatment in various convalescent homes. |
abcc74fb-1ad1-4548-97d9-f210e4dd36e3 | 104 (/) Eye Defects.—The Refraction Clinic for toddlers, which was established in 1929, has continued to do useful work. During the year spectacles were provided for two children under this scheme. 65. FOSTER CHILDREN. Prior to the 1st April, 1930, all cases of foster children resident in the district were reported by the Guardians to the Medical Officer of Health under Part I of the Children Act, 1908. On 1st April, 1930, the powers under this Act were transferred to you by the Local Government Act, 1929, and notifications are now received by your Medical Officer direct from the foster parents. During the year 46 notifications were received through the Guardians and from the foster parents, and these children have been kept under special observation by the Health Visitors, who are also Infant Life Protection Visitors. |
c3b8928d-9270-4892-8523-3a6ee1b75f07 | Fortunately, for many years accurate records have been kept in the Public Health Department of all foster children in the district, so that the work which devolved on us in 1930 under the Local Government Act, 1929, was not new to the department. 66. INFANTILE MORTALITY. The total number of deaths of infants under the age of one year during the year was 49, giving an infant mortality rate of 61.32 per thousand registered births, compared with 53.4 per thousand for 1929. The average infant mortality rate for the whole of the country for 1930 was 60, for London 59 and for the 107 County Boroughs and Great Towns including London, of over 50,000 inhabitants, the infant mortality rate was 64. It will therefore be seen that our infant mortality figure for this year was very average. |
031c297e-dd3a-4820-be0d-a30fec04dae0 | 105 It must, however, be remembered that for last year it was only 53.4, so that for the last two years, taking everything into consideration, I think we may say it is rather better than average. The following table shows the infant mortality figure for Barking from 1891 to 1930. Year 1 Number of . : deaths under one year. Infantile Mortality Rate per 1000 live births. Year. Number of deaths under one year. Infantile Mortality Rate per 1000 live births. 1891 96 150.0 1911 158 157.0 1892 99 151.8 1912 90 95.1 1893 98 156.6 1913 116 113.3 1894 85 122.4 1914 104 106.4 1895 112 162.6 1915 108 115. |
0c93f0b5-2a03-45f7-9574-1c50a19bb640 | 0 1896 104 148.9 1916 70 75.0 1897 138 178.0 1917 89 117.4 1898 129 178.0 1918 60 82.4 1899 137 172.0 1919 54 65.0 1900 159 203.0 1920 92 83.0 1901 155 172.0 1921 74 74.1 1902 112 134.0 1922 49 55.5 1903 97 113.0 1923 43* 49.8* 1904 129 143.0 1924 72 85.1 1905 128 142.0 1925 66 80.0 1900 143 163.0 1926 49 59.9 1907 98 112. |
1608656c-cd4d-423f-9131-5a282d75b926 | 0 1927 47 66.1 1908 110 117.0 1928 51 63.3 1909 93 107.0 1929 42 53.4 1910 88 97.7 1930 49 61.3 * Kegistrar-Ueneral s figures. In comparing the figures from this table it should be remembered that many people are agreed that it will be impossible to reduce the infant mortality rate to less than 30 per 1,000 births, so that we should really use these figures comparatively by taking away 30 from each one. The result in each case then more clearly indicates the value of the work which has been done. |
f5c23d2b-d936-4879-bf62-a3e3201b1899 | Thus in 1920 the infant mortality figure was 83, which, less 30, is 53, and in 1930 the figure was 61.3, which, less 30, is 31.3, which means to say that we have brought down the possible reduction of infant mortality by 21.7. 106 It will be clearly understood that it is the final reduction of the last remaining death it is possible to prevent, which is going to be the most difficult. Of the 49 deaths of infants under the age of one year, five were due to broncho-pneumonia following measles, of which we had an epidemic in the earlier part of the year. Of particular interest to me were the four deaths from gastro enteritis following eczema of the scalp. In view of the fact that eczema of the scalp in a mild form is fairly common amongst children, parents should lose no time in seeking medical advice for this condition. 67. ILLEGITIMACY. |
6c8af1ec-6208-4aa4-9ae0-bb459d4b7578 | Twenty-two illegitimate children were born during the year, and in the same period three deaths of illegitimate infants occurred; the infantile mortality rate among these children was therefore 136.4, while that for legitimate infants was 59.2. This difference between 59.2 and 136.4 shows how hopelessly illegitimate children are handicapped from birth, and although I have said elsewhere that " The problem of illegitimate infants ... is not a serious one in Barking, and the fact that we do not find it a serious problem, indicates that the various agencies which are operating in the area meet the demands of the area," and although Barking must be considered to be fairly well off in so far as these facilities are concerned, it is obvious that a lot yet remains to be done. 68. DENTAL CLINIC. |
218437b1-9d70-4bff-9351-8b8c71d21d6b | A general increase in this branch of the work has been taking place, and during 1930 the attendances of expectant and nursing mothers and of children referred from the Maternity and Child Welfare Clinics were as follows:— (a) Number of treatments of children 519 107 (b) Number of mothers treated:— New cases 128 Old cases 386 (c) Number of dentures supplied 77 (d) Sessions held 76 Here it must be observed that the aim of the Maternity and Child Welfare Service is the prevention of the onset of dental caries in the child, and, for this purpose, the improvement of the health of the mother and of her diet during pregnancy, the encouragement of breast feeding and the use of suitable dietaries for the young child, together with the practice of mouth hygiene, are all factors which must be dealt with by the Maternity and Child Welfare staff, in order to bring about an improvement in the structure of the teeth, and delay in the onset of caries. 69. |
eedd1b5b-59ca-44a8-9f8d-ac721d7d7ba3 | ORTHOPAEDIC CLINIC. Forty-three children under school age were referred from the Infant Welfare Clinics or by the local medical practitioners for examination by the Orthopaedic Surgeon during the course of the year, and, in addition, 83 cases attended for re-examination. Eight of the children received in-patient treatment at Orthopaedic Hospitals. The cases dealt with for the first time during 1930 were referred for the following conditions, some children having more than one defect:— (a) Deformities—Bones and. |
cdd990bf-246a-4589-8828-efa7dfc67742 | Joints— (1) Congenital: Webbed Digits of Feet 1 (2) Acquired: Genu Varum 1 Genu Valgum 15 Bow Legs 9 26 108 (b) Muscular Deformities— (1) Congenital: Talipes 1 Torticollis 2 Haematoma-Sterno-Mastoid 5 (2) Acquired: Pes Planus 13 21 (c) Paralysis— (1) Congenital: Spastic Hemiplegia 1 Cerebellar Ataxia 1 (2) Acquired: Paresis of Thigh Muscles 1 Anterior Poliomyelitis 3 6 (d) Congenital Deformities—Nil. Total defects found 53 70.—ARTIFICIAL SUNLIGHT CLINIC. The treatment of infants and children under five years of age at the Artificial Sunlight Clinic was continued during 1930. |
77b23182-b2fa-453b-ac2a-f430c9af2da1 | Cases are referred by the medical officers in charge of the Infant Welfare Clinics, and the children attending are kept under constant medical supervision during their course of treatment. The majority of the children referred for treatment were suffering from early rickets and malnutrition. In addition, cases were referred for the following conditions—chilblains, prematurity, general debility, and anaemia. In all, 114 children received treatment during 1030. One session per week was devoted to these cases, and 1066 treatments were given. 109 This work continues to be attended with good results. The accommodation and apparatus at this Clinic, however, are not sufficient to cope with the work, and I have prepared and submitted to you a report indicating the lines along which I would suggest development. 71. BATHS FOR EXPECTANT MOTHERS. |
b9c14652-43e7-4bd2-aa32-cdf8557bf0c6 | During the year free baths at the Public Baths have been inaugurated for expectant mothers who have no facilities for bathing at home, and who cannot afford to pay the usual charge for the use of the Public Baths. There were 52 baths granted free of charge during 1930. 72. MEALS TO EXPECTANT AND NURSING MOTHERS. Advantage has been taken during 1930 of this provision under the Act. The total number of dinners supplied was 430. The nutrition of the mother during pregnancy and in the lying-in period has a very important bearing on the well being of the infant, and it is at these times that necessitous mothers are particularly encouraged to avail themselves of the Council's scheme. 73. PROVISION OF FRESH MILK. Particulars of the amounts of wet milk supplied free and at reduced rates to necessitous mothers and children are given in the following table:— No. of pints supplied at reduced price. No. |
e31b5551-6e58-469e-bdcc-423ee693d5f2 | of pints supplied free. Total. Total cost of milk supplied. Council's liability in respect of fresh milk supplied. £ s. d. £ s. d. 3,407 10,055 13,462 197, 1 8½ 172 2 3¼ 110 74. PROVISION OF DRIED MILK, Etc. Particulars of the amount of Dried Milk, etc., supplied free and at reduced rates, are as follows :— Cost Price. (lbs.) Reduced Price. (lbs.) Free. (lbs.) Totals. (lbs.) |
22c6c25a-5b49-4b26-818c-22e2f5c82663 | Glaxo (Humanised) 683 148 164 995 Ambrosia 365 93 249 707 Cow and Gate (Full Cream) 1,807 906 802 3,515 Cow and Gate (Half Cream) 106 5 68 179 Emulsion 1,430 14 42 1,486 Ostelin 2 Nil Nil 2 Lactogol 353 Nil 17 370 Virol 646 10 44 700 Parrish's 84 Nil 4 88 Paraffin 103 Nil 4 107 Malt and Oil 279 6 115 400 Vitoleum Cream 460 Nil 5 465 Pure Oil 141 Nil 6 147 Trufood 103 3 12 118 Totals 6,562 1,185 1,532 9,279 111 June, 1931. To The Medical Officer of Health, Barking. From the Public Dental Officer. |
f11af2cf-196f-4afe-a44f-d218d2226011 | Sir, I have the honour to submit the Report on the Dental Service of the Maternity and Child Welfare Scheme for the year ended December 31st, 1930. During the period under review there has been an increase in the number of treatments compared with the corresponding period last year, by 100, and of this increase 50 per cent represents additional conservative work. This may be interpreted as a more enlightened aspect among patients and that the age of the patients attending is younger than in the past. The younger the mother attending for treatment the more manifest is the desire for prompt attention of a conservative nature during pregnancy, while the older mother, with an existing family, is too willing to accept with fatalism that " for every child a tcoth is lost," so much so that after her third or fourth child, her desire is that the trouble she has experienced with teeth, dependent or independent of child bearing, be finished and artificial substitutes supplied. |
d130dc76-d3cc-4c26-ad8e-0974817e274f | ♦ No cases of unique professional interest have been presented for treatment, broken appointments are few and usually due to some domestic cause. 112 Regarding " under age " children, this is rapidly becoming one of the most successful of the Dental Services in Barking, 51!) attendances being made during the year, an increase of 281 over last year. Recognition is due to the invaluable assistance given by the Medical Officers, the Health Visitors and the nursing staff, and to their efforts to make known to mothers the advantages the Dental Service of Barking has to offer mothers and children under school age. I have the honour to be, Sir, Your obedient servant, W. H. FOY, L.D.S., R.C.S. (Eng.). 113 DENTAL CLINIC. Maternity and Under Age Cases. |
329b1ae9-a661-4c2b-8bdd-a6c51b8ed734 | Extractions 752 Scalings 17 Dressings 2 Inspections 49 Fillings 49 Dentures supplied 77 Anaesthetics— General 151 Local 60 Patients— Old 386 New 128 "Under age" children— Treatments 519 Number of Sessions held 76 |
7665f8b1-0266-4862-9fd7-80c6fd5a567f | BARK 72 Borongh of Barking THE ANNUAL REPORT OF THE School Medical Officer For the Year 1930. C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L R.C.P., D.P.H. 116 TABLE OF CONTENTS Pages BLIND CHILDREN 148, 149 CHICKEN-POX 133 CLINIC ATTENDANCES 134,135,139, 140 CONTINUATION SCHOOLS 152 CO-ORDINATION AND CO-OPERATION 121, 147 CRIPPLING DEFECTS AND ORTHOPEDICS 132,139,140,141 DEAF CHILDREN 148, 149 DEFECTIVE FOOTGEAR 129 DENTAL DEFECTS 132, 138, 141 DIPHTHERIA 133 DRYING FACILITIES 122-123 EAR DISEASE 130, |
c7626a1e-5a39-4803-b89e-d378cb440827 | 138 EMPLOYMENT OF CHILDREN AND YOUNG PERSONS 152 EPILEPTIC CHILDREN 148, 149 EYE DISEASE 129, 137, 138 FAIRCROSS SCHOOL 145 FOLLOWING-UP WORK 134 HEIGHTS AND WEIGHTS 129 INFECTIOUS DISEASE 132, 133 INTRODUCTION 119 MALNUTRITION 126 MEASLES 133 MEDICAL INSPECTION AND FINDINGS 124, 125, 126, 127 MEDICAL AND SURGICAL TREATMENT 135, 136 MENTAL DEFECTIVE CLASS 149, 150, 151 MENTALLY DEFECTIVE CHILDREN 148. |
5f451fe4-9fce-424e-ac0b-ca002df388d9 | 149 MINOR AILMENTS 129, 134, 135 NATIONAL ASSOCIATION FOR PREVENTION OF CRUELTY TO CHILDREN 148 NURSERY SCHOOLS 151 OPEN-AIR EDUCATION 142, 144 OPEN-AIR SCHOOLS 144 PHYSICAL TRAINING 145, 146 117 Table of Contents.—Contd. Pages PLAISTOW CHARITY NURSES 135, 136 PLAYGROUND CLASSES 142 PNEUMOCONIOSIS 152 PROVISION OF MEALS 122,146 REPORT OF THE DENTAL SURGEON 157, 158 REPORT OF THE ORTHOPEDIC CLINIC 154, 155, 156 SCARLET FEVER 133 SCHOOL BATHS 143, 147 SCHOOL CAMPS 143 SCHOOL HYGIENE 121, 132 SCHOOL JOURNEYS 142, 143 SCHOOL VENTILATION 133 SECONDARY SCHOOLS 151 SKIN DISEASES 129, |
d905e342-68a0-48b5-83cf-27f275228f12 | 137 SPECIAL ENQUIRIES 152, 153 STAFF 118,121 STATISTICAL TABLES 159-169 STUDENT TEACHERS AND BURSARS 153 TONSILS AND ADENOIDS 130,136 TUBERCULOSIS 131, 136 ULTRA-VIOLET LIGHT TREATMENT 137, 144 UNCLEANLINESS 127 VISION AND SQUINT 129, 130, 138 WHOOPING COUGH 133 118 SCHOOL MEDICAL STAFF, 1930 School Medical Officer : C. LEONARD WILLIAMS, B.Sc. M.R.C.S. L.R.C.P. D.P.H. Assistant School Medical Officers : J. GWEN BEVAN, B.Sc., M.R.C.S., L.R.C.P. HILDA C. DEAN, M.B.B.S., M.R.C.S., L.R.C.P., D.P.H. |
ca0286fe-2084-44e6-a1d2-3b7d30da97c9 | Orthopaedic Surgeon: B. WHITCHURCH HOWELL, M.B., B.S., F.R.C.S. Radiologist: ANGUS E. KENNEDY, M.R.C.S., L.R.C.P., L.S.A. Dental Surgeon: W. H. FOY, L.D.S., R.C.S. (Eng.) Masseuse: Miss A. E. FINDLAY, C.S.M.M.G. Nurses: Miss L. F. SWAIN (h) and (i). Miss S. E. W. GIBSON (j). Miss G. GEDEN (Dental Nurse). Clerical Staff: E. W. HILL, (Resigned Feb, 1930). Chief Clerk F. READ (Commenced June, 1930). D. G. TONKIN. Miss V. SHEAD. Miss H. NUNN. Miss H. KING. |
0638da18-0900-4923-baec-0054fba7d339 | A. J. STORER. (h) Certificate of Central Midwives' Board (i) General Hospital Training. (j) General Fever Training. 119 Barking Town Urban District Council. PUBLIC HEALTH OFFICES, BARKING, ESSEX. May, 1931. To the Chairman and Members of the Local Education Authority. Mr. Chairman, Ladies and Gentlemen, It is one of the most important duties of your Medical Officer to submit to you an annual report on the public medical services you maintain, and this is the fourth such report I have had the honour to submit to you. These annual reports are apt to be very dry reading, but they contain a lot of useful information and are .drawn up to comply with the requirements of the Board of Education. |
b11b32ed-1d12-4b0e-81d2-e69b3d4b55d5 | The year 1930 has been a very important one in the history of Barking, and, in addition to the importance of this report from 120 the standpoint of its being a review of the work we are presently undertaking, it is also very important in that it shows the beginning of those developments in your public .medical services which are taking place owing to the growth and development of the town— particularly the growth and development of the London County Council Becontree Estate. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, C. LEONARD WILLIAMS, School Medical Officer. 121 ANNUAL REPORT OF THE SCHOOL MEDICAL OFFICER For the Year 1930. (1) STAFF. The staff responsible for the school medical services carried out by the Council is shown on a separate page at the beginning of this report. The increase in staff is due to the increased duties which have fallen upon the department. (2) CO-ORDINATION. |
ff72bd26-c010-46ab-8e44-6c470989f91b | You have achieved a very real measure of co-ordination between the various public medical services administered by the Council, but there must of necessity be some difficulty in maintaining these services at maximum efficiency so long as the responsibility for running them is shared by two important Committees of the Council. (3) SCHOOL HYGIENE. The fact that you have a building programme of approximately £400,000 gives you a glorious opportunity in these new schools of giving sanitary circumstances the attention to which they are entitled, and which they certainly did not receive when the old schools were being built. The background of a child's school life is the permanent screen on which he or she will focus the later environment in the factory, in the workshop and in the home, and the silent lesson of hygienic circumstances at school is the most precious thing a child will ever receive from school life. I trust that no one will be prepared to carry out over-crowding in these schools. |
5d05d619-e11a-498c-b658-e684d2776fc4 | This may minimise cost; it will be prodigal extravagance., 122 I trust also that adequate arrangements will be made for the children's boots and clothes to be thoroughly dried whenever necessary, and that further provision will be made for habits of cleanliness, such as bathing, etc., to be enforced. It is not suggested that provision should be made for every child to bathe and clean his teeth, etc., at school, but there should be ample provision at school for this to be carried out where otherwise the children will not be educated in these very essential habits of cleanliness. The time, too, has come when the provision of adequate means of drying the children's clothes and boots in the older schools should not be longer delayed. Rheumatism is one of the prevailing diseases in Barking, and damp clothes must contribute to the incidence of this disease. |
94f88a02-e38d-4ab5-b38d-ca89ae172873 | It is difficult to over-estimate the economic loss to the country from the prevalence of rheumatism, and providing proper drying accommodation at school would not only do something of itself towards preventing the incidence of rheumatism, but it would also be a silent teacher witnessing to the need of similar provision on all occasions. Provision of Meals.—May I call your attention to the fact that last year I suggested to you that the time had come when the temporary buildings in which the children were given these meals should be replaced by a better and bigger building? This is a matter I know you have very much at heart, and I do appreciate the difficulties which you will have to face in dealing with the problem, but it is a problem which does not brook delay and I would seriously recommend to you that the present arrangements have outlived their usefulness and that a better, brighter building, with increased amenities, should be provided forthwith. |
ad0146fe-bc72-4f9e-8312-a68507b90e05 | It is my duty to iterate and to reiterate that perhaps there is no department of education of more social, hygienic and economic advantage than that which deals with table manners, and that whether children congregate at the food centre or whether they partake of their meals at their own schools, these mealtimes should be the occasion of intensive educational training. 123 There is, perhaps, no factor to-day which tends to make persons more conscious of any deficient education than the recognised want of table manners. The inability to speak as an educated person may be mitigated by discreet silences, but coarse table manners cannot be hidden and are a definite hindrance to social life, and— what is even worse—they are very bad from a medical standpoint. The following table shows the number of children who do not return home for the mid-day meal, and if and whether facilities are provided for them. It also shows what facilities, if any, exist for the drying of children's clothes and boots. School. No. |
541bfac1-25f0-4674-8281-48bbd8e222de | of children who do not return home for mid-day meal. Whether facilities exist for heating of children's meals. Whether facilities exist for the drying of children's clothes and boots. Park Modern— 40 Yes Yes C. of E. Boys — No School fires in winter only. Girls — „ „ Infants - „ „ Ripple— Boys - „ „ Girls — ,, „ Infants — „ „ SS. Mary & Ethelburga Mixed 29 „ „ St. Joseph's Infants 30 Yes „ Gascoigae Boys - No „ Girls — ,, „ Infants — „ „ Westbury Boys — „ „ Girls — „ Yes—at Laundry School fires in winter only. Infants — „ North Street— Boys — „ „ Girls — „ „ Infants — „ „ Castle— 18—20 Small stove in teachers' private room. School fires in winter only. |
54296d78-4375-4e56-a4ca-aa8835b483be | Faircross— All children stay at school for mid-day meal, the food being supplied from Municipal Kitchen Yes Yes Cambell— Senior Infants — No. No. — „ „ 124 This table, showing as it does how inadequate are the facilities you have provided for the drying of children's clothes and boots, makes very sorry reading. It is idle to talk of building extra classrooms to afford children special educational facilities and of building extra schools and departments without at the same time making provision for looking after the children while they are at school, and the drying of boots and clothes is a very important matter—so important that no school can be looked upon as efficient where this provision is not adequate. I recommend you earnestly to give this matter your immediate attention. (4) MEDICAL INSPECTION. |
5e6dc664-9f6e-47c4-8cf5-d166235f9adf | Sir George Newman, in his Annual Report for the year 1929, begins by saying "The foundation of the school medical service is the systematic and routine medical inspection of all the children in attendance at public elementary schools, whether sick or well." It is only from the results of such inspection that you can know how far you are catering for the needs of the school population and what special services are required to deal with the disabilities which are found in the course of these inspections. During the year the number of children inspected in the specified age groups was 2,467, together with 234 other routine inspections, making a total of 2,701, or 40.2 per cent. of those in average attendance. In addition 225 children were examined at special inspections. These were referred to your doctors by their parents, by the school teachers or by the nurses. Thus 2,926 children have passed under medical review during the year. This is 43.6 per cent. of the average attendance. |
dcce6233-c1d9-4c05-8591-a9a195357c79 | 125 In Barking we visit most of the schools three times a year for the purpose of these school medical inspections, but I have stressed elsewhere the need there is for medical officers to visit schools on their own initiative and at the request of Head Teachers, apart from these routine visits, and I do hope that Head Teachers will from time to time consult my department on those matters of hygiene and sanitation which come within the purview of your medical officers. The table herewith included, which is a modification of Table IIB to be found in the appendix to this report, shows the number of children who have been examired and the number of defective children referred either for treatment or for observation during the years 1929 and 1930. Entrants Intermediates Leavers Specials Other Routine Examinations Total 1929 1930 1929 1930 1929 1930 1929 1930 1929 1930 1929 1930 No. |
68433b04-df7c-49d3-98aa-6f2ad1825148 | of children examined 914 949 958 975 572 543 162 225 339 234 2945 2926 No. referred for treatment 129 155 156 176 76 90 51 69 14 23 426 513 No. referred for observation 251 281 198 255 104 140 67 122 1 3 621 801 Percentage of defective children 41.6 45.9 37.0 44.2 31.5 42.4 72.8 84.9 4.4 11.1 35.6 44.9 The following table shows the percentage of the children examined who were accompanied by their parents or guardians. Year. Percentage of Children Examined who were Accompanied by Parents. Year. Percentage of Children Examined who were Accompanied by Parents. |
16544add-d33c-4c55-80cd-d4111a3b1731 | 1925 65.5 1928 64.8 1926 60.7 1929 65.7 1927 62.7 1930 66.3 126 The number of children on the school register on 31st December, 1930, was 7,906, compared with 7,284 on 31st December, 1929. During the year, the Medical Officers paid 198 visits to 22 departments for inspection purposes, examinations being conducted throughout the year on the various school premises. Certain cases of defect were, as in previous years, referred to the School Clinic for further examination and treatment. The following table shows the number of children examined at routine and special inspections during 1930, classified according to the schools attended, the number of inspections held in each school and the number of parents or guardians present:— School. No. of inspections. Numbers inspected. No. of Parents present. Boys. Girls. |
42a3ad48-d400-4d31-9ede-29fe0186a63e | Park Modern 6 54 34 34 Gascoigne 35 259 253 328 North St. 28 242 197 284 Castle 4 25 37 40 Westbury 35 259 235 351 Ripple 26 206 204 311 Faircross 21 101 133 174 St, Joseph's and SS. Mary's and Ethelburga's 14 111 85 101 Church of England 17 113 98 111 Cambell 12 140 140 206 (5) FINDINGS OF MEDICAL INSPECTIONS. Table II on page 160, gives in detail a return of defects found during the course of routine inspection. The figures in brackets are the comparable figures for last year. (a) Malnutrition.—It is my happy position to be able to continue to report to you that malnutrition is not a serious problem in Barking. |
d3c8a20b-0987-49ec-a20b-96519d4a2cec | The number of cases referred for treatment has gone down nearly 50 per cent., and I attribute the increased number 127 referred for observation to the fact that our standard has been raised. It is a happy thought that you are doing all that you are doing to feed school children wherever necessary. (b) Uncleanliness. — With reference to uncleanliness, the significant figures are to be found in Table IV, Group V, on page 169. In October, 1930, my report on uncleanliness for the year 1929 was very seriously considered by the Council, who decided that the suggestions contained in pages 13 and 14 of that report be carried into effect. This is a decided step forward on which, if I may, I would like to tender my heartiest congratulations. There is no hardship whatsoever in proceeding with every coercive measure you have to enforce absolute- cleanliness so far as infestation amongst boys is concerned. |
9f1c897a-7e07-4904-a26b-d6cc4c98e9a5 | Last year I said " I do not see why every boy with an infested head should not be excluded forthwith, and the parents proceeded against," and you in your wisdom have decided to accept this recommendation. Similarly I take it you have decided, in conformity with my recommendation of last year, that in any circumstances—including therefore the case of girls—where cleansing is undertaken by the Local Authority in default, a prosecution shall follow. Although the situation with regard to uncleanliness in Barking is one on which I have written strongly from year to year and one which still requires strong language adequately to represent the situation, I want to make it perfectly clear that the teachers and the nurses in Barking are doing very real work and that the problem in Barking is only the same as it is in all other similar towns. |
bfa77ec8-da50-49e8-8d0f-78dd5f65a79e | 128 The whole situation is overshadowed by the fact that a large number of people are living under circumstances which are such that only a continual warfare against infestation can possibly maintain cleanliness in this direction, and these very self-same distressing circumstances are such as to make it unlikely that the parents of these children will maintain the persistent effort without which cleanliness cannot be attained or retained. A relatively small proportion of such cases in any town is likely to infest quite a large number of children because they provide a constant source of infestation, which renders other children unclean whose parents are doing quite sufficient to keep their children clean if it were not for this constant infestation. School. Dept. No. of Examinations Nits only. Nits and Vermin (head) Gascoigne Infants 1170 96 4 Boys 1434 30 1 Girls 1322 188 11 North St. |
6bbcb81e-286a-4988-9307-37defb78acde | Infants 982 57 1 Boys 1088 17 2 Girls 1062 84 6 Castle Infants 452 49 — Boys Girls Westbury Infants 1216 78 7 Boys 769 13 — Girls 1242 120 7 Ripple Infants 1127 61 3 Boys 793 18 1 Girls 1174 116 3 C.of E. Infants 550 81 2 Boys 420 17 1 Girls 420 112 2 St. Joseph's Infants 705 98 7 SS. |
d991c5c5-5061-4bef-9cf7-efddcccfeb23 | Mary's & Boys 668 50 1 Ethelburga's Girls Cambell Infants 939 73 21 Senior Faircross — 454 44 — Park Modern Mixed 460 5 3 129 Defective Footgear.—Cases of children with defective footgear were, as heretofore, referred to the Boots Minor Sub-Committee, who considered applications for the provision of boots in 196 cases, compared with 193 in 1929. In all, 217 children were supplied with boots during the year. (c) Heights and Weights.—The following table gives the average heights and weights of children examined at the three undermentioned age periods in all of the schools, compared with the results at similar age periods in 1926, 1927, 1928 and 1929. Year. Average Height in Inches. Average Weight in Pounds. 5 yrs. 8 yrs. 12 yrs. 5 yrs. 8 yrs. 12 yrs. |
6763b063-04f1-425c-934c-fac92aec5d53 | 1926 42.4 49.9 57.5 40.3 54.6 82.4 1927 42.2 49.3 57.1 40.6 52.5 80.1 1928 42.1 49.5 57.2 40.2 56.4 81.2 1929 41.9 50.5 5G.3 40.9 56.3 83.5 1930 43.5 49.9 57.2 42.6 57.5 82.9 Average for 5 years 42.4 49.8 57.1 40.9 55.5 82.0 (d) Minor Ailments.—The number of minor ailments found at routine medical inspection is not large. |
cef0d5f4-42f7-450d-a3bd-eef9f21f2830 | This does not mean to say that there is not a fairly large number of cases in Barking, but that they are picked up promptly by your teachers and by your nurses and that they are dealt with at your Minor Ailment Clinics, so that when it comes to the children being examined at routine medical inspection the numbers actually found at such inspections are favourable. (e) & (f) Skin Disease and Eye Disease.—Similarly, with skin disease and eye disease, the number of cases actually found at routine inspections is small. (g) Vision and Squint.—The number of cases of defective vision showed an increase last year on the then previous year and 130 shows a further increase this year. The number of cases found must, of course, go up with the increased school population, but I think there is an actual increase as well as a relative increase. This is an increase which has to be watched, because it might mean that the circumstances under which children are being educated are likely to produce eye strain. |
598d0af6-6c59-4642-8a85-097ebcab5fcd | I do not think, however, that the evidence is sufficient to warrant such an opinion being held. (h) Ear Disease.—The number of cases of ear disease, too, shows an increase on last year. This is also being watched. (i) Tonsils and Adenoids.—Last year you were advised that the number of cases of tonsils and adenoids showed then an increase. It is my duty to report this year a further actual and relative increase in the number of these cases. The time is fast approaching when children having their tonsils out will become almost a routine. For my part, I want to make it perfectly clear that these cases are seen by at least two doctors before the operation is performed, in which circumstances it must be admitted that the operations are not lightly undertaken. Thus your School Medical Officers find out that a child has enlarged tonsils and they decide as to if and whether they think it will be right for the child to be operated on. |
e1688e48-c951-4375-87a9-48564db7cb2e | Our routine practice is then to send the child up for interview at the Queen Mary's Hospital, Stratford, where the child is examined by a specialist before an appointment is made for the operation to be carried out. In addition to this, the children are often seen by a third doctor, because a large number of children have been observation cases before they become cases which are put down for treatment. It seems therefore that you are taking every possible precaution against this operation being carried out unnecessarily. My own opinion, as I have told you, is that these enlarged tonsils are due largely to errors of diet. There is too much sameness about children's food; they want more brown bread and fresh 131 fruit and vegetables than they are getting at present. Fortunately, a large number of children are getting milk, because you have established a scheme for milk being provided through the schools. (i) Tuberculosis.—There were 14 cases of tuberculosis amongst children of school age notified to the Medical Officer of Health during the year. |
1e1842c9-d801-4f7c-838e-68973eff58c3 | Of these two were pulmonary and twelve w-ere non-pulmonary. The following table shows the position with regard to notification of tuberculosis amongst children of school age during 1930: Notified during 1930 Pulmonary 2 Non-Pulmonary 12 Total 14 De-notified (of the above) Pulmonary — Non-pulmonary — Total — As reported elsewhere, the revision of the Tuberculosis Register has now been going on for some time, and during the year under review the following numbers of school children have been removed from the Notification Register. Removed from Register. Pulmonary. Non-Pulmonary. Cured 1 6 Amended Diagnosis 36 26 Left District — 2 Died — — Total 37 34 132 (k) Dental Defects.—The general findings of routine medical inspection demonstrate the value of the dental services you have inaugurated. |
324a3e13-16e2-4eb0-8b54-3281500d2e9a | What has to be said this year is said in the Report of the Dental Officer and a more complete statistical review will be submitted next year when owing to the increased services we shall have a fuller opportunity for inspection. (1) Crippling Defects.—Crippling defects are happily only infrequently found during routine medical inspections, and a number of these are of a relatively minor character. Your orthopaedic service, allied to the orthopaedic service carried on by the Public Health Committee has done really useful work. (6) INFECTIOUS DISEASE. The problem as to if and whether infection tends to be spread more by ordinary school life than by closing schools and allowing the children to run wild is a perennial one, and the general consensus of opinion at the present time is that the closing of schools is on the whole to be deprecated. |
bf9fe273-0357-4cbf-91e3-beafb92fc4eb | It is pointed out that unfortunately the sanitary circumstances of school life, even where these are not what we would wish them to be, are better than those of home life, and that, even although a certain amount of infection may be spread at school, this is negligible compared with what would be spread in the homes, particularly where the infectious disease is one which is commonly treated at home and where home isolation is impracticable or otherwise is not likely to be efficiently carried out. It is also suggested that by keeping the children at school they can be kept under more careful observation and cases of infectious disease detected earlier than they would otherwise be, to the advantage of the community and of the individual. |
ae7cb319-5936-4699-9a11-4b50315874a2 | This advantage depends entirely on the relative merits of the sanitary circumstances of school life compared with home life, and if therefore the present tentative opinion in favour of keeping schools open is to be consolidated, it behoves everybody to see that school life represents a higher level of sanitation than home life, even when home life has the advantages of the more modern housing circumstances found on your own and on the London County Council estates. 133 The chief thing to aim at in your schools is adequate ventilation, and the school curriculum, at least during periods of epidemic when any infectious diseases are likely to be prevalent, should be so arranged that children are never in one classroom for more than fifty minutes or so, and that for the remainder of the hour the classroom is literally flushed with sufficient air and the windows and doors opened to the maximum extent. One very great difficulty in combating the incidence of infectious disease is that the public do not know the normal appearance of the various parts of the body that are likely to be affected. |
c0d402dd-031c-40e1-ab10-d4f06d1faf49 | I have had the temerity to suggest that the senior scholars might with advantage learn to draw one another's throats and other similar organs which are likely to be the seat of disease. It is not suggested that they should learn the long, complicated Latin names of all the various parts they would draw, nor that they should in the least be told what these anatomical parts look like when they are diseased, but that they should know what they look like when they are healthy. A good housewife when she rejects a potato because it is diseased does not know the name and the nature of the particular disease from which the potato is suffering. She knows it is a bad potato, and in the same way children should be. taught the normal healthy appearance of various parts of the body so that they may know when there is any deviation from the normal. Where the attendance of a school falls below 60 per cent. |
775cf7c5-3fd8-45ba-9146-77a52de833c2 | and in the opinion of the Medical Officer this bad attendance is directly due to the prevalence of infectious disease, the school sessions so affected are not counted in estimating the average attendance for the purpose of grant. During 1930 one certificate was granted for this purpose. The following table shows briefly the number of children notified and reported suffering from some of the commoner infectious discases:- 1927 1928 1929 1930 Scarlet Fever 117 132 164 91 Diphtheria 39 67 44 202 Measles and German Measles. 1 342 191 283 Chicken-pox 166 Whooping Cough 99 262 378 89 134 (7) FOLLOWING UP. |
ff77de58-1fa9-4f55-9890-72b49aace2e3 | A summary of the "following up" work undertaken by your school nurses is given herewith:— Number of visits to schools for medical inspection 177 Total number of visits to schools 373 Number of home visits in connection with:— 1928 1929 1930 (a) Routine medical inspections 3345 3549 4759 (b) Infectious disease 571 520 660 (c) Uncleanliness inspections 212 80 119 (d) Non-attendance for treatment (Minor Ailments, etc.) 542 124 406 (e) Dental Inspections — 460 406 (f) House to house visits, Gale Street area - - 145 It will be noted that visits in connection with dental inspection and treatment are included in the above table for the second year. Following up dental cases is now done by the health visitors and school nurses as well as by the dental nurse, who only does visiting during certain holiday times. |
9f87ed31-9f75-44b9-8fe1-66f2ecbf9bed | Clinics.—The numbers of school children attending in 1929 and 1930 were as follows:— Clinic. No. of 1st attendances of children. Total No. of attendances. 1929 1930 1929 1930 Minor Ailments (a) Central Clinic 2139 2456 10757 12068 (b) St. Alban's — 128 - 1230 Ophthalmic 139 182 482 738 Dental 951 818 2997 3138 Ringworm 15 4 30 8 Orthopaedic FOR EXAMINATION 28 37 2997 2693 FOR TREATMENT 32 78 135 Minor Ailments Clinic. Central Clinic St. Albans 1920 1930 1930 No. of days clinic was open 331 349 49 Total No. |
eb2faad9-7700-4e96-a723-0242a93932d1 | of attendances 10757 12068 1230 Daily average attendance 32.5 34.6 25.1 No. of cases treated 2139 2456 128 (8) MEDICAL AND SURGICAL TREATMENT. Minor Ailment Clinic.—The arrangements for the treatment of minor ailments have remained substantially the same as for last year, except that the St. Alban's Clinic was opened on November 5th, 1930. This is a temporary clinic held in the St. Alban's Church Hall. We are very happy in being able to make some arrangements for the people in this area, but the circumstances under which the clinic is held are rather primitive and, so soon as practicable, it is hoped that the clinic will be housed in a suitable building. |
7025e370-83ea-49d6-b370-1359ee60574b | Every attempt is made to conduct this work without any encroachment on private practice, and I think the evidence of our work here goes to show that the work we are carrying out promotes the financial and professional interests of private medical practitioners. This clinic in Barking meets a very real need. The number of attendances have gone up again this year very considerably, and altogether you are to be congratulated on this essential work you are so carefully carrying out. I have discussed ways in which even this clinic could be improved upon by continuous medical supervision, and in some measure this has been achieved during the year on which I am reporting, but there still remains for us to arrange for continuous nursing supervision. The present system of staffing these clinics altogether from the Plaistow Charity means that the nursing staff is continually 136 changing, and this is not in the best interests of the clinic. |
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