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ce7011e1-d3f3-46ed-b8ff-0939ef37a1ce | This, however, is not a hardship really as, after all, early in life you are taught to clean your teeth, but you have to go on cleaning your teeth all your life and, in the same way, a person who is a stammerer must go on and on and on practising relaxation and carrying out the every advice which he has learnt from the specialist who has helped him to help himself. Insofar as conversation is the very basis of social relationship, I look upon speech training as one of our most important functions. Difficulty in speech is likely to alter a person's whole outlook on life and all life means. Speech training, of course, whilst it has a lot to do with stammering, takes in other defects also, and during the year 1947 a total of 658 treatments were received by children at the Speech Therapy Clinic. 17 CHIROPODY. Question:—Why does my child develop corns and why do some children have plantar warts ? |
4bc31fd3-f848-41a6-aac0-f301abb9c869 | Answer:—Plantar warts definitely are an infection. Fortunately we do not get a large number of these; fortunately, also, they can be dealt with quite simply. What is definitely indicated is that your child has walked somewhere in bare feet where someone who has plantar warts has already walked; alternatively, he or she has worn a pair of socks worn by a child with plantar warts. What we can do to prevent the spread of plantar warts is to detect them immediately and to treat them immediately, also—of course—to obviate the necessity of children wearing one another's shoes, etc. With regard to corns they are an equally simple matter. A corn develops in response to intermittent pressure. A corn becomes painful when it begins to press upon something, and children's feet are so soft in structure that pain by pressure usually only occurs after the corn has developed to a relatively considerable size. From this standpoint it is wrong of necessity to blame the pair of shoes the child is presently wearing. |
a1b3e1a1-d5a0-4a8d-993e-614aca8fcd14 | Of course the present shoes the child is wearing may be the cause of the corn, particularly if they were bought a little bit too small with the idea they would be comfortable after they were broken in. Equally, it may be true that the corn was started entirely by a previous pair of shoes and, indeed, the child may be wearing sandals at the time the corn becomes an active nuisance. Although I am writing this report for the year 1947, and the remarks I wish to make have particular regard to 1948, I would like to take time by the forelock and say how disappointed I am that all children's shoes have now become free from coupons. I do wish it could have been possible for approved shoes only to have been made coupon free. PAEDIATRIC SERVICE. Question:—What is a paediatrician ? Answer:—A paediatrician is a man who, from a medical standpoint, tries to help people in bringing their children up healthy. |
aa9987e9-1066-47d1-a797-eead7a2f894d | He may be said to be a children's specialist but we do not want this to be true if it means that the paediatrician of the future is going to be linked to the children's specialist of the past, because the children's specialist of the past was far more interested in st udying the diseases of children and curing them than in helping to train parents to bring their children up healthy. Chiropody (a) Number of Patients 404 (b) Number of Treatments 1.525 18 There is a definite field for this specialisation; firstly—because children cannot help the doctor to make a diagnosis in the way that adults can, and therefore require an altogether different technique of examination from that of adults, and secondly— many diseases which are common both to children and adults run a different course in children than in adults. |
79a10506-6ce4-4ef6-84cb-c8534c7d1b9b | To give one simple little illustration of this I mention that where it would be quite usual for an adult to have a shivering attack at the commencement of a chill a child does not commonly so shiver but alternatively suffers from what is known as a fit. Thirdly, of course, there are certain diseases which although not uncommon among the adult population may be said to be children's diseases. What happens in Barking is that the Assistant Medical Officers send cases to the particular clinic where there attends a Consultant Paediatrician. We very carefully see that this Clinic is held at the Barking Hospital so that the services of this specialist may be available for the very young babies in the hospital so well as those who are older. At this Clinic, whenever possible, an Assistant Medical Officer attends, not only to facilitate the work at the Clinic but to be a link between the Specialist Services and the general work which is carried out at your clinics and your schools. |
2efbec18-377f-4ee0-af5d-8945a2cc7202 | This Assistant Medical Officer is changed from time to time but we find it advantageous to have one particular Medical Officer in attendance for several weeks. Your Consultant Paediatrician saw 115 children during the year 1947. INFECTIOUS DISEASE. Question:—To what extent, if any, is infectious disease spread by children being at school ? Answer:—In the sense that being born may facetiously be spoken of as the first stage in contracting infectious disease, so also does school life, no doubt, add in some ways to the danger of catching an infectious disease, but this is not merely because the child goes to school but because the child is getting to an age when—quite normally—he or she would be running about more with other children. Some years ago a very learned man wrote a paper and from the figures he produced proved, to his own satisfaction, that a child in an Infectious Disease Hospital was less likely to catch an infectious disease than a child outside. |
a567f610-3508-45f6-a34c-5683f1a7783a | I was Infectious Diseases Scarlet Fever 71 Whooping Cough 85 Measles 264 Diphtheria 4 Pneumonia 12 Poliomyelitis (both nonparalytic) 2 19 not quite convinced about his figures but recognised there was a lot to be said for his submission and, in the same way, in our modern schools if—on the one hand— a child has an added chance of infection by reason of meeting other children—so, also, can it be said to have a less chance by reason of the fact that the children are meeting together under very good hygienic conditions, adequate ventilation and so forth. As a matter of fact I would not like to answer this question categorically one way or the other—it is like a ledger in which there are both credits and debits. |
a1ff0748-c7b7-46b6-bfb2-5d3a87f5407d | Classes at school or whole schools can be closed if the Medical Officer so advises, but by long experience it has been found that this is only advisable occasionally because whether we like it or not children will mix with one another, particularly in towns, and as a matter of fact keeping the children at school (where they can remain under expert observation if necessary) has much to commend it. Infectious disease among school children showed a decline during the war and we are still in this fortunate condition. Scarlet Fever showed a decrease during the year, 71 cases being notified as against 101 in 1946. Whooping Cough is one of the diseases which must, of necessity, be spread in school because, of course, it is spread everywhere, in buses, cinemas, churches, at parties—where children may be together. It is unfortunate that with regard to Whooping Cough we have not yet any reliable lead as to how to prevent it. |
e8a3f2a7-ec68-4f69-a716-afd6003ef7a6 | Work is being done at the present time but there are some special difficulties in any research which depends upon the diagnosis of this disease. The fact is there are children who cough and who "whoop" but who are not suffering from Whooping Cough, and there are children who cough and who do not "whoop" who are suffering from Whooping Cough. Scientific investigation entails hours and hours of work on each individual case. Incidentally it is my personal view that many mothers keep their children home from school when they know Whooping Cough is prevalent—and small blame to them—and that these parents, when they have to give a reason for Tommy or Mary not being at school so often say that he or she is suffering from Whooping Cough, a very understandable but sometimes inaccurate statement. With all these difficulties it is well nigh impossible to assess the prevalence of Whooping Cough, a disease which is so very often intensely distressing and can, of course, be fatal. |
38d3f2ca-815f-468d-a27b-9f907ab926ed | Measles is another disease which can be spread in school although, as with other diseases, it can be spread elsewhere and—indeed—is often spread elsewhere. Fortunately the type of measles which has prevailed has not been particularly severe, 20 but we do not seem to be able to control this disease in a way in which some other diseases have been controlled. It is very important that Measles should be prevented, of course, under all circumstances, but it is particularly important that Measles should be prevented among young children, not altogether so far as Measles, as such, is concerned, but by reason of the complications which are likely to arise—such as bronchitis. One factor which has made the control of Measles particularly difficult is that the case can be and—indeed—is infectious before the rash develops whilst yet it looks as though the child is suffering from a cold. |
3921586b-92f3-4907-8b3e-cfdfe38574f3 | Even twenty-four hours or so before the rash can be seen with the naked eye it can be detected by taking a photograph of the child; whether this will ever prove of any practical worth in the early detection of Measles I do not know, but we may try it when, having more beds for such cases, early detection can be of real value by leading to early isolation. Another factor which militates against us reducing the incidence of Measles is that it is so often a mild disease and the parents of children who are only mildly affected think lightly of it and allow their children to play with other children before they should. The small incidence of Diphtheria is, of course, one of the remarkable achievements of the age. We diminished the dangers of Diphtheria before the introduction of inoculation, but the introduction of inoculation has chained the disease and, indeed, so far as we can see, could stamp it out if only people were one hundred per cent. |
a928ee9a-d204-418c-8a4d-3ee4f255afd2 | determined to get one hundred per cent, of their children inoculated. Inoculation as carried out today is simple; in the vast majority of cases it is all but painless ; it should be undertaken long before the child attends school but when the child does attend school or otherwise begins to come in contact with large numbers of other children, it should have a boosting dose which will see it through the greater part of its school life, after which Diphtheria is not a major problem. One of the greatest tributes we have had recently to the work of inoculation in Diphtheria is that what, years ago, would have been a very minor outbreak— something to be looked upon as quite normal to the time of year—people of Barking now speak of as an epidemic. I hope the public will remain so alive to the value of inoculation and that the knowledge of its value will spread throughout the whole of the public. INFANTILE PARALYSIS. |
174aa068-ab66-4173-8da1-df924e4b5330 | Question:—What was done in Barking to stop the recent outbreak of Infantile Paralysis ? Answer:—This again is a question not of my asking, but one which was put to me and one which I will try to answer faithfully although it does not represent medicine in a very favourable light. 21 The difficulty about Infantile Paralysis is that no one has yet discovered quite all the facts about how it is spread, and it is only when we understand how the disease is spread that we begin to learn how we may control the spread of this disease. I do not think there is any reasonable doubt but that a person suffering from an acute attack of Infantile Paralysis is infectious, and at this stage the infection is carried by invisible droplets which are inevitably spread from our mouths every time we speak. |
928678b7-e0a3-4edd-9571-84ae7167d9c7 | In other words it comes within the same category as the coughs and colds, concerning which it has been said " coughs and sneezes spread diseases", but it seems quite certain also that this is not the whole of the picture, and particularly in times when there are not a large number of cases the spread takes place in quite another way. What way this may be is not very well known although it is suspected that the infective agent remains in the bowels long after the acute stage of the attack of Infantile Paralysis has passed off. Of course, if this be so, personal hygiene must be a very important point in stopping the spread of Infantile Paralysis. |
67aa237c-63a6-4936-9d08-849d2169040e | What we can do in the present time is to isolate so soon as possible people who may be suffering from Infantile Paralysis, and here I want to say how thankful I am that the people of Barking have whole-heartedly co-operated with us and have allowed their children to go into an Isolation Hospital, even where we have not been able definitely to say this is a case of Infantile Paralysis. This early isolation is the best protection for the children as a whole in curbing an outbreak of Infantile Paralysis. The liaison with our colleagues in general practice was good. We were privileged to be able to co-operate with them almost instantly—cases were brought to our notice even before a diagnosis could be definitely made, and the intelligent co-operation of the public most certainly tended to diminish considerably the outbreak of Infantile Paralysis. IMMUNISATION. Question:—Is immunisation proof against infectious disease ? |
b82fe087-8efb-498c-9299-d3cd879914fb | Answer:—This is an actual question which has been put to me—indeed it is a question which is always cropping up, and sometimes people take a very poor view when in answer I say " it all depends". Generally speaking the public can rest assured that if you are dealing with a disease which people rarely have more than once in a lifetime, it can be hoped either that there is immunisation which will give protection against that disease or that such an immunisation may be discovered at a reasonably early date, but where you find you are dealing with a disease which occurs time and time again during the course of a lifetime, then the problem of creating protection by some method of immunisation is almost sure to be remote. 22 Thus for instance, with regard to Smallpox, the number of people who get this disease twice in a lifetime is infinitesimally small. This was true in England in pre-vaccination days when England was riddled with Smallpox. |
74850fb2-86d2-43ed-bf4b-ba17bfeed8d3 | It is, I believe, true in those countries today where it is prevalent. It is, therefore, quite in accordance with the principles I have set out above that something has been found which does give immunity against Smallpox, which is of course an infectious disease. As I have shown elsewhere immunisation against Diphtheria is simply wonderful; at the other end of the scale immunisation against the common cold is by no means successful, and between these two extremes there are diseases in an intermediate class so far as immunisation is concerned. SKIN DISEASES. Question:—I am always afraid of my children catching some skin disease. Is this likely to happen in Barking? Answer:—As a matter of fact the answer is " No Compared with a generation ago Ringworm is uncommon. There were only 9 cases of Ringworm of the head and 13 cases of Ringworm of the body which came to our notice during the year and I think we see most of these cases. |
fef08e6f-8c56-49a1-a22e-8e5754d00b71 | As I have said elsewhere Scabies is getting less frequent. For the three previous years we were seeing about 250 cases a year; in 1947 we saw but 110 cases. Regarding the masses of scabs and sores which doctors call Impetigo, the figures fell from 401 in 1945 to 257 in 1946 and down to as low as 138 in 1947. Question:—Should we have special Hospitals set aside for diseases of the skin, for out-patients as well as in-patients? Answer:—There are, of course, special Hospitals for skin diseases, but this is not entirely satisfactory because the skin is one of the organs of the body, and it is rarely the skin is diseased unless the whole body suffers also. What is done in Barking is that once a week a Consultant visits the Barking Hospital and there sees cases of skin disease. |
11e000a0-f977-4f75-a5a0-4fda7c0059c1 | In between the visits treatment is maintained at the Barking Hospital, and in this way, and because at the Central Clinic there is a special room for " Skins a number of cases are kept from attending at your ordinary Clinics, save only that there must, of necessity, be cases which come up for the first time to an ordinary Clinic before they are sent to the Special Department. Scabies Year 1945 261 1946 231 1947 110 23 Modern dressing makes it much easier to deal with the skin diseases than it was twenty years ago. Twenty years ago I have seen children with skin diseases of the face tied up in bandages which were very possibly disarranged before the children had left the Clinic very long. Now with special adhesive dressings, it is possible to cover these sore places in a satisfactory way, which means that the children are much less likely to spread the contagion (if it be a contagion) and be a source of trouble to other children as they were many years ago. |
3685102b-450c-44a7-9f81-7f75208b0477 | You will remember that during the war Scabies became quite prominent, and that last year I was able to say the incidence of Scabies was definitely on the decline. In my last report I said it was too early to " Halloa " until we were out of the wood, but having regard to the fact that only no cases were known in 1947 I think we can look upon the situation with some minor satisfaction. Scabies, by the way, is caused by a mite which wanders on the surface of the body very much like mites crawl over cheese. When I was a young man this mite was called an acarus, but the people who deal with the classification of these little mites have changed the name to sarcoptes scabiei. The wedding takes place on the surface, the father wanders off, and the mother burrows away into the skin. |
d5142a48-833a-4fc5-ad07-b3e20c29921c | This does not cause much trouble, but she lays her eggs just under the surface of the skin and when all the little sarcoptes scabiei begin to wiggle about, that is when the skin begins to itch, and Scabies as you know itches quite a lot, so much so it has been properly known as the " itch NUTRITION. Question:—Do you think as a result of the war and our post-war difficulties, the nutrition of the children is being maintained? Answer:—The answer to this is "Yes", but that does not mean to say we can rest content. |
1e817bf2-fd26-48e5-a395-781b6454560f | A friend of mine who for many years lived in Canada in days which can almost be looked upon as the pioneering days, and who was a very observant fellow, noted how the people who came out from mid-Europe—themselves of stunted growth—had fine, strapping, upstanding children, but if they had brought children out with them to Canada those children did not profit much, except the very young ones, whereas those born in the wide open spaces were upstanding, strong and healthy. I am afraid we must accept the fact that there are differences in standards of growth and development in different parts of Europe and, indeed, in different parts of England, and I am convinced that as a matter of fact the children of Barking are taller and heavier than children in less fortunate districts. Personally I am of the opinion that further advances in the science of feeding can make children yet unborn even taller and heavier than children of today. There are, therefore, no grounds whatsoever for " resting on our laurels". |
43ec52e8-290d-47d9-a1e9-9caeadc68379 | 24 Question:—How is my child standing up to the present food shortage? Answer:—I am very much afraid I must incur the possible animosity of many mothers and fathers when I ask " Is there a food shortage "? Certainly the physical condition of the boys and girls of Barking does not lead me to believe there is such a shortage. It may take, and I am sure it does take, much more time now to do shopping than it did years ago. I am equally quite sure that mothers cannot always get just the food they want at the time they want it, but this does not mean to say there is a shortage from the standpoint of a Medical Officer. Now I think you will understand what I mean if I ask you to bear with me when I put before you a few facts and figures. During the year 1947 there were no less than 8,970 medical examinations to enquire into the nutrition of the children, and only in 25 cases was it found that the nutrition was sub-normal. |
1438a1de-0047-4ef8-9c92-4bcc0293ef9e | It is this simple information which makes me say I am very doubtful whether we can speak of a food shortage as such. Herein I have set forth detailed figures and the student will no doubt analyse these figures critically. Age Groups Number of Pupils Inspected A. X (Good) B.+ (Fair) C.— (Poor) No. % of col. 2 No. % of col. 2 No. % of col. |
58d5737d-cc32-4ae6-b122-e20ed311b531 | 2 Entrants 1,786 562 31.47 1,218 68.20 6 .33 Second Age Group 2,047 672 32.83 1,371 66.98 4 .19 Third Age Group 1,700 602 35.41 1,091 64.18 7 .41 Other Periodic Inspections 3,437 1,138 33.11 2,291 66.66 8 .23 Total 8,970 2,974 33.15 5,971 66.57 25 .28 X A. = Excellent Nutrition. + B. = Normal Nutrition. —C. = Slightly sub-normal Nutrition. Children with " bad " Nutrition (classification D year 1946)—NIL, 25 To obtain these figures it is just as necessary to examine the healthy children as children who are not so healthy. |
48fa63be-50d0-430e-b05a-8cce333c161b | Standards of nutrition, however, depend upon the personal idiosyncrasy of the doctor making the assessment. You may take it that doctors generally have a very good knowledge of pre-war conditions and have due regard to this in making their present day assessment. Moreover, although during the past years our medical staff has been constantly changing, the relatively favourable opinion expressed for the year 1947 is consistent with what we have constantly found during the last few years. Incidentally I may mention that having regard to the heights and weights which have been recorded over many years, we believe positively that children today generally are inches taller and pounds heavier than they were a generation ago. SCHOOL MEALS. Question:—What is done and what is going to be done, about School Meals? Answer:—There is no doubt that the first approach to a healthy meal is to have a healthy appetite and, of course, we know only too well that where appetite approaches hunger, it can be the dominating issue to any meal. |
755d3f7e-beeb-4972-9f40-886089314629 | Neither cooking, table appointments nor congenial company can be factors of real importance if once a person is desperately hungry. In the ordinary way when people take meals the way in which the food is cooked and otherwise prepared, the way in which it is served and the company in which it is eaten, are very important factors indeed. I do believe our schools have enormous difficulties in front of them with all this school feeding, but at the same time they have glorious opportunities, of which I have no doubt our teachers will take the fullest advantage, so soon as the necessary equipment and staff can be put at their disposal. I look forward to the time when school meals can be served at small tables seating not more than eight children. I hope that the meals will not only be balanced dietetically, but served in such a way that a meal time becomes a period of enjoyment. |
12fd23a2-9aa9-4525-b4d5-d7293aa02415 | It is a curious thing—two people eat similar meals, the same proteins, fats and carbo-hydrates and alike in every other way by which the scientist can judge— including calorific value—but if the one person eats it quietly in good company Average Number of School Meals served each week during 1947 30,000 26 and good fellowship, and the other eats it standing up from the dirty corner of an overloaded table, the one person has a meal and the other person has something less than a meal. All the Centres where food is provided for children are visited by members of my staff from time to time and every necessary help is given those in charge of this great work. UNCLEANLINESS. Question:—The other day when I was brushing my daughter's hair, I saw what I believe to be a louse, and was horrified. |
5618aa95-762f-4acc-bda4-94b1eaa617f1 | I was ashamed to tell my husband, but I did so, and we began talking matters over and ended up by asking how much time I had spent keeping my child's head clean and what the Public Health Department were doing about this, because quite frankly we felt it was wrong for the louse to be there at all, and if there were not such a possibility of a louse being there I should be spared a lot of time and, incidentally, my daughter would be spared much inconvenience. Answer:—The answer is that a lot of work is done, but as you will see from this answer it is a very difficult problem; thus in the table on this page which sets forth the amount of work we did last year you will note that only 460 children were found to be unclean, and when you realise that a child with just a few nits in the head is classified unclean you will see that the situation is not altogether bad. |
669439d9-d37b-4cf2-aee8-b2c4c6cc0f19 | The trouble is that the number of uncleanliness findings is much higher than the number of individual children who have been cleansed during the year, which means that the real offenders are the repeated offenders. The difficulty, of course, is a family one. Rarely is a child repeatedly verminous unless the mother or an elder sister is also verminous, so that if a child were cleansed as frequently as twice a week, there is no reason for supposing the child will be clean on the whole of the remaining five days. If you will ask your hairdresser about it you will be surprised, (that is, if you can get your hairdresser to talk confidentially) that quite a number of people who are smartly dressed, with a chic " hair do " have not got clean heads. |
b523161b-d87c-4216-a1b6-7a133c3278a4 | I see that some of the papers which advertise permanent waving point out that the permanent UNCLEANLINESS Total Number of examinations in the schools by the School Nurses or other authorised persons 14,280 Total Number of individual pupils found to be infested . . 460 Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 39 27 waving is all the more permanent for being carefully brushed. I hope this is true, and I hope the public will believe it, but the majority of people who spend a lot of money on a so-called permanent wave do not believe it at this time. If there is a reservoir of infestation in a house I certainly think it would do no harm to deal drastically with such a social circumstance, providing always it is the parents of the children who have to bear the stigma and not the children themselves. |
43a60a43-4934-477c-82c7-e494c8b658f3 | A larger number of these cases, however, are where mother has given up the fight and, quite frankly, I cannot help believing that the words of Dr. Ben Johnson were fall of significance when he said—" There, but for the grace of God, go I Not all these people who have given up the fight have given it up without a struggle. Some of them started their married lives with quite high ideals but the babies have come rather quickly; the housing circumstances are poor; nor always are the financial arrangements within the home so good as they might be, and although something must really be done about it whatever is done in such cases must be done with sympathy and understanding. Where, of course, it is found that boys have either nits or lice (or both), I would recommend the sternest measures be undertaken forthwith because, of course, there is no excuse for a boy's head becoming verminous. |
2921c785-0e9b-4f62-9829-95ac3284d174 | It is easy to keep the hair short enough—that really is no problem—or, contrariwise, the problem is such a simple one that it can be overcome in a few minutes. Personally I would suggest teaching the elder girls in every school hairdressing. They could practise upon one another and on the younger girls, and should be encouraged to practise on their mothers and their elder sisters. To make this attractive a classroom devoted to this could be called a "Beauty Parlour". I feel sure this would be of enormous help, particularly if in the course of lessons on hairdressing, girls were specially taught how to deal with customers whose heads were not in all respects satisfactory. NURSERY CLASSES. Question:—I do not believe in Nursery classes. I think that up to the age of five years a child is better in his mother's care than in a Nursery. What are the supposed benefits of Nursery classes? |
999f8eb8-b059-4107-b6ab-271983422195 | Answer:—In the first place I want to say I have a great deal of sympathy with the person who has propounded this question, and there can be no doubt that if mother has a large family and she has enough help in the home, there should be no need for Nursery classes. A child, however, requires company—children of about his own age whom he knows personally, and insofar as families are small, the child brought up at home definitely suffers from lack of this companionship. These little people who have 28 been kept at home suffer mentally when they begin to ask questions. If these questions are not answered to their satisfaction they suffer acutely by feeling a sense of repression. It is not to be expected in these days that the mother will be prepared at all times, or indeed that she can possibly at all times answer all the questions of an enquiring mind. |
c846b79a-e816-4d79-9fbd-7b34e6a3ea61 | I want to make it quite clear that whilst this is to be said on the credit side, there is a debit side which has to be faced, and that is the children come into contact with mass infection at an age younger than the sixth year which is the normal time for a child to go to school. I do believe there are more running noses and catarrhal conditions among children who go to school at a very early age than amongst the stay-at-homes, but generally speaking their mental and physical vigour compares more than favourably with that of the children who are kept at home. There is something to be said for the mother also. It is only, comparatively speaking, yesterday that man became civilised. In his natural state the care of the child was not the all absorbent twenty-four hour job it is for a mother in the 20th century. |
60e797b6-183b-4f29-abae-ed5f9ea5c6f7 | She had in her primitive state, as need she must, periods of relaxation, and today it is just as necessary for the mother's mental health as for the child's mental health that arrangements be made for The child to be cared for under such circumstances. A colleague of mine, learned in literature, sums up the situation by saying "Hamlet never went to a Nursery Class". Had he done so, I have no hesitation in saying Shakespeare would have been robbed of his "Prince of Denmark". Quite frankly children are essentially imitative, they develop most naturally by imitating other children, usually a little older than themselves; children kept at home imitate people much older than themselves—they become quaint—but are not normal. Number of Nursery classes in Barking 20 Number of children attending 620 SPECIAL SCHOOLS AND SPECIAL CHILDREN. Question:—How do Special Schools meet the needs of " Special " Children? |
d577e5bc-77de-4184-8717-6b5a72853297 | Answer:—Faircross School was opened in the year 1922 since when a great deal of very useful information has been acquired. There is in my opinion no doubt that where a child can be taught in an ordinary school that child should be taught in such a school because, as I have said 29 elsewhere, it is at school that a child learns its niche in life, and that very possibly this is the most important thing that any child does learn at school. Where you have schools with a sufficient number of children in each age group to have "A", "B" and "C" classes it is amazing the wide variation of intelligence that can be taught in one and the same school and, of course, in some of your schools in Barking special arrangements have been made for children who are even lower than the " C " streams, and this—with certain reservations—I believe to be good. |
b604e96d-d55d-4f3f-b535-178634d9700f | There are, however, some backward children who cannot keep step with even the lowest grade children to be found in ordinary schools, and these must unquestionably be taken away from the ordinary schools, or otherwise the whole of their mental outlook on life is going to be warped. Many of them too must, of course, be taken away because they require individual tuition and there literally is not the staff in an ordinary school to educate these children who do require special individual attention. I am strongly of opinion that the intelligence of the child, as such, is only one factor in determining whether he can remain at an ordinary school or must go to a Special School. I think the child's adaptability must be taken into account; so, also, his reaction to school life, particularly as to whether he is conscious or not of his deficiency when compared with the other children. |
6aef641c-7086-4fea-a839-2233e6aee9ea | Faircross School does also meet the special needs of delicate and physicallyhandicapped children who, because of their physical disability are unable to fit into the life of the ordinary school, but there have been many happy instances where, after a time at Faircross under open-air conditions and constant medical supervision a child has made such progress physically that it has been possible to allow him (or her) to transfer back to an ordinary school. Question:—What provision is made for the blind children of Barking? Answer:—It makes me very happy to be called upon to answer this question because although tragically it is still a problem which has to be faced, the problem has been so reduced that, compared with when I was a young man, it seems as though we have no problem at all. |
50cfd30f-35ce-4f2f-a3b3-e21db1bacc30 | As a matter of fact, out of all the thousands of school children in Barking, there are only 3 partially blind requiring special educational treatment, and one only who is totally blind—this last case is particularly tragic because it was as the result of war injury. FAIRCROSS SPECIAL SCHOOL Number admitted 43 Number discharged 30 30 The story of the prevention of blindness belongs to my report on the health of the people of Barking. I can, however, briefly say that the prevention of blindness depends on meticulous attention to the eyes of the child at birth, and to very special treatment whenever such special treatment is required. I am happy to be able to say that after over a quarter-of-a-century in Public Health I personally have never known one child whose acuity of vision was impaired by reason of what was once a terrible disease—to wit—Ophthalmia Neonatorum— that is, eye disease of the newly born. Question:—What provision is made for deaf children among the school children of Barking? |
0d476964-f078-4beb-940c-e4f408ccc747 | Answer:—I am happy to say that we have not a sufficient number of deaf children to justify a special school or class for them in Barking, and arrangements are therefore made either for their admission to a Boarding Special School, or to the Tunmarsh Lane Deaf Centre (Day) at West Ham, where with hearing aids and special tuition in lip reading suitable education is given to our deaf and partially deaf children. DEAF CHILDREN Attending Tunmarsh Lane Deaf Centre 5 At Boarding Special Schools 1 DIFFICULT CHILDREN. Question:—What should we do with difficult children? Answer:—A great law-giver once said they should be put to death. The procedure was for their fathers and mothers to indict them before a Court of Summary Jurisdiction and the penalty (the charge being proved) was death. |
f4364175-2488-4750-9aef-62dcc1639839 | This was all a very long time ago; the law-giver was a very wise man; there is no recorded history of the penalty being enforced, because the wise man knew that so-called difficult children are the product of difficult parents and that the last thing the parents would ever do would be to join together and bring an indictment. To talk of children of ten, eleven and twelve being out of hand is banally stupid; it is the parents—very possibly because they have been squabbling between themselves or for some other reason—who have never laid the foundations of confidence, admiration and love which alone are the grounds which any child can have for respecting its parents. |
ff23e1db-3614-48b5-8b11-50ac3ca829f6 | The time is coming when, if the janitor of the Town Hall runs off with the Mace, it will be said to be due to the fact that when he was a lad he was not allowed to have a spoon to stir the sugar in his tea, or if an important officer is known to get frightfully annoyed when he loses his spectacles it will be ascribed to the fact that 31 his mother would not let him sit up one night to see something he wanted to see. As a matter of fact children with normal upbringing overcome these disabilities with very little difficulty and it is among children whose upbringing has been at fault that these disabilities rise like clouds in their adult lives. I have recently been looking at a picture of Croydon as it was 120 million years ago when the Dinosaur commonly lived there and the Pterodactyl had learned to fly; compared with these long ages civilisation only began—as it were—yesterday. |
fbbbce30-8edd-4964-a596-2fa95cb3d705 | Man, however, is much older than civilisation and for aeons of time the youngsters were, like destructive little monkeys, able to go to the fore-shore and elsewhere and enjoy themselves to their hearts' content, smashing pebbles against boulders, and father and mother never worried at all. What we have done in civilisation is to rob the child of the sea-shore as it were, so that instead of on stones children practise their native destructiveness on things that cost time and labour to create. We must remember that destructiveness is a necessary phase in natural development, not only the destruction of physical things but the destruction of ideas also; and we must share any blame when children get into mischief. Nothing in what I have written means I suggest a great Charter allowing children to do wanton destruction, because all children expect, when annoying their elders, to face condign punishment, unless of course, they are nimble enough to escape. OPEN-AIR EDUCATION. |
589e141c-dede-4517-9138-6a1ee06da49d | Question:—Why is it that the playing-fields attached to some schools and the playgrounds of others, are not used more when the schools are not in session? Answer:—So far as the playing-fields are concerned there is not much difficulty in answering this question, because grass is a very difficult thing to grow, so that quite apart from the question of expense the main difficulty is that it can be so easily destroyed by over-use. With regard to the ordinary playgrounds the difficulty is, I believe, one of supervision, both to avoid injury among players and, incidentally, injury to premises, but I do hope these difficulties will be overcome. The Iron Duke said that "the Battle of Waterloo was Won on the playing-fields of Eton Very possibly he thought he was making one of his usual ordinary commonsense statements, but his words became the common parlance of snobs, and although oft-quoted when I was a boy had fallen very much into disrepute. |
3c58ab27-06b2-4f3b-a0f9-0d6f690a6ec2 | 32 As a matter of fact the truth of these words is as true today as it was in the days of the Iron Duke. The battles of the world are fought not only on the playing-fields of Eton but also in the playgrounds of our ordinary schools. What a boy does at an examination will, of course, be very largely determined by his work in the classroom, but what manner of man he is to be is worked out largely, if not entirely, in the playground. It is in the playground that the qualities of leadership are fostered; that the habit of self control is engendered, and the team spirit built up; in other words it is here—in the playground—we find opportunity for natural growth. You will, I think, agree that the proper use of these playgrounds after school will require supervision, but the supervisor need not be a man who by reason of his wonderful games record inspires the boy with hero worship. He or she need not be a psychologist. |
2a58ddc7-5ef2-488b-bcb9-09ceb708ab5a | What is wanted is people who have a genuine love of children and who are loved by children and who understand children, not by reason of their learning in the abstruse sciences, but by reason of the fact that they are sympathetic towards children and can sense their point of view. I am not representing these people in any way of necessity as less intelligent than the people who have to do with more formal education, but I do submit that as in the case of all teachers they must have common sense and I use this word in its proper meaning, that is, a sense which is common to all senses and which binds them together into a united whole. Question:—I have seen photographs in the Press showing children at their lessons in the heart of the country-side. My children aged seven and ten years respectively have never had such an opportunity. Why is this? Answer:—Children in the Senior Schools may be sent to Hydon Heath Camp for a period of four weeks during term time or for periods of two weeks during the school holidays. |
3fcd22ba-8096-4d3e-ac79-1f4e5fbd2b75 | Approximately 500 children were so accommodated from Barking during the year 1947. Hydon Heath Camp which is a National Camp for children, was used for school purposes during the war. It was staffed from Barking and mainly, although not altogether, the children at the Camp school were Barking children. To this school children were sent on what was more or less a long term policy but, since the war, so that a larger number of children would benefit, the period for each individual child has been cut down. The Camp is situated on the upland near Godalming in the heart of Surrey. I do trust there will be a sufficient number of Camps in the country to accommodate a larger number of children for long periods instead of short periods of time. 33 SEX EDUCATION. Question:—Should Senior Schools be taught the elementary facts of sex life? Answer:—Personally I would deprecate any special course or courses devoted to the biology of sex. |
8669018c-0bbc-4fdc-a338-a2c4162a4242 | Any teaching about sex should be purely incidental. In nature study classes it is possible to include teaching on sexual reproduction in plants and some members of the animal kingdom. With such basic training adolescents readily appreciate any further teaching about the physiology of human reproduction—indeed this follows so naturally that there will scarce be need for further training. The art of teaching is a life-long study and while I feel it proper for me to advise generally, final decisions as to how to draw up such a curriculum and how to teach must be left entirely to those professional people who have made this their special study. RADIOGRAPHY. Question:—Is it possible for all children to be X-rayed? (The man who asked this question added " I think it is the finest thing out "). Answer:—It is possible for all school children to be X-rayed, and it is intended that this shall be done as opportunity permits. |
0bf298e2-c1dd-46a4-861f-ee332a83830b | During the latter part of the year the Mobile X-ray Unit attended at the Barking Hospital where 1,387 school children were X-rayed. Because it was not possible to do all the children on this occasion it was decided to concentrate on the older children who would be leaving school at an early date. 34 SCHOOL HEALTH SERVICE. MEDICAL INSPECTION RETURNS Year ended 31st December, 1947. TABLE I. Medical Inspection of Pupils attending Maintained Primary and Secondary Schools. A.—PERIODIC MEDICAL INSPECTIONS. Number of Inspections in the prescribed Groups: Entrants 1,786 Second Age Group 2,047 Third Age Group 1,700 Total 5,533 Number of other Periodic Inspections 3,437 Grand Total 8,970 B.—OTHER INSPECTIONS. |
cdbf5b40-cbd4-41cd-97d5-d15501417bc4 | Number of Special Inspections 10,531 Number of Re-Inspections 11,768 Total 22,299 C.—PUPILS FOUND TO REQUIRE TREATMENT. Number of Individual Pupils found at Periodic Medical Inspection to Require Treatment (excluding Dental Diseases and Infestation with Vermin). Group (1) For defective vision (excluding squint) (2) For any of the other conditions recorded in Table IIA. (3) Total individual pupils (4) Entrants 29 234 246 Second Age Group 68 158 209 Third Age Group 89 165 242 Total (prescribed groups) 186 557 697 Other Periodic Inspections 116 441 529 Grand Total 302 998 1,226 35 TABLE II. A.—RETURN OF DEFECTS FOUND BY MEDICAL INSPECTION. Defect Code No. Defect or Disease (1) Periodic Inspections Special Inspections No. of defects No. |
4cd3680c-c386-4572-91e1-7ba4728dd69e | of defects Requiring treatment (2) Requiring to be kept under observation, but not requiring treatment (3) Requiring treatment (4) Requiring to be kept under observation, but not requiring treatment (5) 4 Skin 113 12 936 8 5 Eyes a. Vision 302 15 161 11 b. Squint 34 4 61 3 c. Other 26 6 500 25 6 Ears a. Hearing 11 2 15 5 b. Otitis Media 5 — 32 - c. Other 38 3 335 33 7 Nose or Throat 307 128 231 34 8 Speech 21 11 18 3 9 Cervical Glands 11 9 62 24 10 Heart and Circulation 17 22 26 15 11 Lungs 55 34 46 31 12 Developmental— a. Hernia 3 3 5 — b. |
3dfa138c-8f7e-46b4-8240-e499b94242b2 | Other 9 13 6 — 13 Orthopaedic— a. Posture 26 29 11 — b. Flat foot 62 13 16 1 c. Other 115 38 61 2 14 Nervous system— a. Epilepsy 2 9 4 — b. Other 14 6 12 4 15 Psychological— a. Development 25 9 30 1 b. Stability - - 19 18 16 Other 761 104 3,913 362 36 TABLE II. B.—CLASSIFICATION OF THE GENERAL CONDITION OF PUPILS INSPECTED DURING THE YEAR IN THE AGE GROUPS. Age Groups Number of Pupils Inspected A.x (Good) B.+ (Fair) C.— (Poor) No. % of col. 2 No. % of col. 2 No. % of col. |
f190d569-2505-4fe6-a430-e9341f9e9e9b | 2 (1) (2) (3) (4) (5) (6) (7) (8) Entrants 1,786 562 31.47 1,218 68.20 6 .33 Second Age Group 2,047 672 32.83 1,371 66.98 4 .19 Third Age Group 1,700 602 35.41 1,091 64.18 7 .41 Other Periodic Inspections 3,437 1,138 33.11 2,291 66.66 8 .23 Total 8,970 2,974 33.15 5,971 66.57 25 .28 X A.=Excellent Nutrition. + B. = Normal Nutrition. —C. - Slightly sub-normal Nutrition. Children with " bad" Nutrition (classification D year 1946) = NIL. TABLE III. Treatment Tables. |
d9ced879-0ea6-4ef4-8f67-bf3908611892 | GROUP I.—MINOR AILMENT S (excluding Uncleanliness, for which see Table V). (a) Number of Defects treated, or under treatment during the year. Skin— Ringworm—Scalp— (i) X-Ray treatment 6 (ii) Other treatment 3 Ringworm—Body 13 Scabies 110 Impetigo 138 Other skin diseases 752 Eye Disease (External and other, but excluding errors of refraction, squint and cases admitted to hospital). 497 Ear Defects 394 Miscellaneous (e.g. minor injuries, bruises, sores, chilblains, etc.) 3,845 Total 5,758 (b) Total number of attendances at Authority's minor ailments clinics 27,156 37 GROUP II.—DEFECTIVE VISION AND SQUINT (excluding Eye Disease treated as Minor Ailments—Group I.) No. of defects dealt with. |
d4096a00-96de-49cc-98ff-1822b76477e2 | ERRORS OF REFRACTION (including squint) 749 Other defect or disease of the eyes (excluding those recorded in Group I) — Total 749 No. of Pupils for whom spectacles were (a) Prescribed 414 (b) Obtained 503 GROUP III.—TREATMENT OF DEFECTS OF NOSE AND THROAT. Received operative treatment:— Total number treated. (a) for adenoids and chronic tonsilitis 223 (b) for other nose and throat conditions — Received other forms of treatment 308 Total 531 GROUP IV.—ORTHOPAEDIC AND POSTURAL DEFECTS. (a) No. treated as in-patients in hospitals or hospital schools 7 (b) No. treated otherwise e.g. in clinics or out-patient departments 908 GROUP V.—CHILD GUIDANCE TREATMENT AND SPEECH THERAPY. No. |
e5c4b99c-e75b-4295-9c54-ed7c45e6f224 | of pupils treated (a) under Child Guidance arrangements — (b) under Speech Therapy arrangements 37 38 TABLE IV. Dental Inspection and Treatment. (1) Number of pupils inspected by the Authority's Dental Officers— (a) Periodic age groups 5,438 (b) Specials 746 (c) TOTAL (Periodic and Specials) 6,184 (2) Number found to require treatment 3,366 (3) Number actually treated 2,548 (4) Attendances made by pupils for treatment 10,511 (5) Half-days devoted to: (a) Inspection 33 (b) Treatment 966 Total (a) and (b) 999 (6) Fillings: Permanent Teeth 3,715 Temporary Teeth 1,282 Total 4,997 (7) Extractions: Permanent T eeth 1,669 Temporary Teeth 5,100 Total 6,769 (8) Administration of general anaesthetics for extraction 3, |
4444c72c-0d38-4f2a-b0b4-295a6c2ad5c9 | 089 (9) Other Operations: (a) Permanent Teeth 2,851 (b) Temporary Teeth 22 Total (a) and (b) 2,873 TABLE V. Infestation with Vermin. (i) Total number of examinations in the schools by the school nurses or other authorised persons 14,280 (ii) Total number of individual pupils found to be infested 460 (iii) Number of individual pupils in respect of whom cleansing notices were issued (Section 54 (2), Education Act, 1944) 39 (iv) Number of individual pupils in respect of whom cleansing orders were issued (Section 54 (3), Education Act, 1944) - |
0c611e92-71e5-4637-916c-10ceda77c93f | Bark 42 AC4411 JOHN and MARY THE ANNUAL REPORT FOR THE YEAR 1948 OF THE MEDICAL OFFICER OF HEALTH, BOROUGH OF BARKING: C. LEONARD WILLIAMS, B.Sc., M.R.C.S., L.R.C.P., D.P.H. TOWN HALL, BARKING, ESSEX November, 1949 To the Mayor, Aldermen and Councillors of the Borough of Barking. Mr. Mayor, Ladies and Gentlemen, We are now nearly half way through a century, a century which so far as health is concerned has been distinguished for the improvements which have been made. This the present century is very different from the latter half of the previous century, when the accent was upon environment, that is, the conditions under which people are living, rather than upon the personal lives of these same people. |
a382a0ec-e635-438e-becb-7147a98d71b0 | It is to emphasise the spirit of the present age that I have made this a personal report in which I want to tell you something of the lives of John and Mary, of the problems which they brought to me, and, what is more, of their difficulties and something of their conversations with me. There are thousands and thousands of Johns and Marys in Barking, and it is through this book that I would like to speak to each one of them, and it is to these Johns and Marys that I have dedicated this Report. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Medical Officer of Health The Health of Barking SOCIAL CONDITIONS, STATISTICS AND GENERAL PROVISION OF HEALTH SERVICES. Housing. John and Mary were much in love with one another and as in the case of many other young couples, much could be written of their hopes and dreams and how bravely they faced the world together. |
1cd812dc-a856-40ac-9b26-dc33c4997e49 | For the purposes of this narrative, however, all that I will say is that they were married and when they came back from their honeymoon they went to live with Mary's mother. It was not long before Mary came to the window of the Rehousing Office. She told a tale which is none the less tragic because it is so very common; that she did not get on with her mother as she used to do. Mary felt she had achieved something when she was advised her name was down on the rehousing list and when she was told how many points had been awarded her application; but in the course of the year—and these figures are real for the year 1948—no less than 961 other Johns and Marys came to the Rehousing Office so that the list of families awaiting rehousing had grown by the end of the year to the figure of 3,488 However, Mary soon found out that getting her name on the rehousing list was one thing and having enough points to get a house was quite another. |
fff4432c-a0a2-4411-a322-f0bcf2dfa4bc | Further, from he information given at the window, she realised there were many families who were not nearly so well placed as she and John were. The next thing we find is that John takes a half day from work to come to the Rehousing Office—he says exactly the same things that Mary has said but in a defin ely more emphatic manner because unless things can be changed his married life is going to start out on the wrong foot. He realises his in-laws are quite nice peop! but it is nevertheless true that he does not get on with them—he has married Mar; not the family. hen Mary comes back and this time she is in great trouble—she is going to have baby. Her mother has said not only is it impossible for her to have the baby >orn at home, but that she cannot see how John and Mary can go on living in thk house after the baby is born. Then comes John once more, and this time, quite frankly, he is in a temper. |
8fcaee39-8757-47a7-900c-18550b81ef57 | It is ;uite possible he does not want to be in a bad temper, but the situation at home is going from bad to worse and he has promised his wife that he will make the rehousing people " do something about it." HOUSING APPLICATIONS. Number of names on the waiting list at the beginning of the year 3,370 Number of names added to the list 962 Number of names removed from the list 844 Number of names remaining on the list at the end of the year 3,488 Page 3 The Health of Barking The tragedy of this story is not only that it is so common, but that it is incomplete and space will not suffice for me to tell of all that Mary did and all that John did. They interviewed Councillors, they went here, there and everywhere ; they even wrote to the Member of Parliament, and after they had done all this it was only to find that they can't have a house if the house isn't there. |
235ff073-7288-42a0-8d59-e8934e690705 | Of course, there are hundreds of people who have had houses and who are very well pleased with the points scheme, and there are hundreds of people who, if they haven't got all they wanted, have got something by moving into the accommodation which has been allocated to them. John put his views on housing before me very strongly indeed, and, although I sympathised with him, I did not envy him his job of going home and talking to Mary about it; in fact to be quite truthful I don't think he told Mary all he had been willing to explain in his conversation with me ! Population. Some people reading this report might almost come to the conclusion that the only people in the town in 1948 were John, Mary and myself, but this, of course, is not so because there were nigh on 80,000 other people as well. This is far too many to permit all these people to believe that they belong to one neighbourhood. |
014ccd54-b38b-4f50-ab2e-c3ddf74a33ff | As a matter of fact, I was talking over with John and Mary what would be the ideal population of a neighbourhood unit, having regard to the fact that each such unit would certainly want its own Health Centre—incidentally each would want its own infants' school, pub, etc., and, of course, its own youth centre. We were, however, discussing this question primarily from the standpoint of Health Centres. It is quite obvious that the possibility of dividing the town into small neighbourhood units of, say, 5,000 to 10,000 is impracticable not only because the numerous Health Centres required would cost so much money, but because there will never be the man-power available to operate such centres. On the other hand, when you get units of population of 20,000 to 25,000 they constitute sizeable towns, and tend to lose the spirit of neighbourliness. |
2591d39e-8678-4d83-8397-eb2f47b211fc | It seemed to us that the ideal compromsie would be to divide such a town as Barking into units of some 15,000 each, that is, there would be five such neighbourhood units in Barking with five Health Centres, one of which would be a super centre and would cater for certain specialist services, which it would not be economic, so far as man-power is concerned, to provide at the other centres. Our talk about population naturally brought up the question of flats and whether if you build flats you can get more people into a town than you can if you give each family a house. The answer is, of course, that if you build your flats high enough you can do what you like with regard to housing a large number of people on a small space, but it is not economical to build this way, I am very happy to say, because such big buildings are expensive, particularly as they Page 4 NEIGHBOURHOOD UNITS FLATS The Health of Barking may have to be fitted with lifts. |
30831bbc-686b-4be5-b68c-6aa4dea3b8a9 | Again, too, it is important that, in order to get the necessary light and air and general ventilation, blocks of flats should be surrounded by relatively large areas of garden space, because even though children live in flats they still require space in which to play. Travelling Facilities. How small the world is—one day I found myself on Charing Cross Station, and it certainly seemed as though John is doomed this year to haunt me, because I found him standing right by me, and when the train came in we somehow or other wedged ourselves in. Talking was all but impossible and by the time the train got to Barking my poor feet felt like two lumps of lead. I had a headache and felt I was about to vomit at any time, and John, who is usually quite a decent sort of fellow, was in a state of nerves that some people call " narky," and what he said of the travelling facilities to Barking was nobody's business ! |
b86a9cc7-a503-47aa-bb4a-4a198ec8ce9b | Elsewhere, and on numerous occasions I have set forth what I think about these travelling facilities and that the condition under which people travel to and from Barking is a serious factor in preventing them enjoying a proper measure of health and happiness. Whether we like it or not the main reason is that Barking is a dormitory town, and such a dormitory town should at least have a railway service which does not add to the difficulties of people who are constrained by force of circumstance to travel a long distance to their daily toil. Years and years ago I did write that the underground railway to Barking was the sewer that ran on four wheels and I was taken to task by a legal friend of mine, in whose judgment and ability I have every confidence. He warned me that such a statement might be actionable—all I can say is that no action was taken upon it, but if such a statement was actionable when the line was administered by a private company, it might be treasonable now ! |
6e13e20c-4a7d-4855-ae67-0251ca2236e2 | But if I am to be locked up in the Tower, I must protest that the Railway facilities to and from Barking are not only scandalous from any ordinary standpoint but they are a serious menace to the health of people and possibly contribute more to the ill-health of the people who have to use them than any other factor. Hospital Facilities. It was during the year 1948 that it all changed over—the 5th July, 1948, was history so far as hospitalisation in this country is concerned. It had been obvious for a long time that there was a problem to be faced and that the problem was nation-wide. Some people thought July 5th was going to see the solution of all these problems. |
19ef0e77-ae44-4511-a229-2e7eee0e1449 | As a matter of fact, what occurred was a new orientation towards the problem and a new chapter of hospital administration, and it is hoped that there will, in time to come, grow something which is better than we have had in the past and that the future will find a solution which perplexed so many of us before the Appointed Day. Page 5 The Health of Barking One difficulty which affects us and which, no doubt, affects other parts of the country also, is that within the Boroughs of Barking and Ilford, which together make a sub-division to the Region to which we belong, that is the London North East Metropolitan Region, there never has been, nor can there be for several years, sufficient hospital accommodation to meet the requirements of the population. This is particularly so with regard to the chronic sick and the surgical treatment of tonsils and adenoids. |
034fe4d8-fd2e-4b62-93b0-d855f0ad8ddf | As Mary was to have her baby in the Barking Hospital before the Appointed Day she was particularly interested to know what was going to happen under the new Act, and I was able to tell her that so far as could be seen at present, maternity work would be extended at this Hospital and that wards which during the War were used for the retention of casualties, would be adapted to this end. Here it is interesting to note that ten years ago, that is, before the War, these same wards were being used for infectious disease cases. I cannot leave the question of hospital facilities without saying something about the hospitalisation of tuberculosis. I am fully persuaded that we shall never get to real grips with the difficult problem of reducing the incidence of tuberculosis until, amongst other things, we are in a position to extend very considerably the number of beds that are available to Chest Physicians. |
54f94ed6-de4a-4e31-8ece-d56b17b40c27 | The possibility of some immunisation being discovered for tuberculosis, comparable to diphtheria immunisation, is not so fanciful as it appeared a generation ago, but I do think it is sufficiently remote for us to say that, at this stage, hospitalisation and consequential isolation is the only way of dealing with the problem. What is more, there are certain diseases, of which tuberculosis is one, which, even in these enlightened days, are looked upon with much the same awe and dread as leprosy was regarded in the Middle Ages. It isn't too much to say that the effect on the minds of the patients of knowing that they are indeed suffering from tuberculosis is, in many instances, devastating, and the peace of mind of the patient is a very important factor in the treatment of the disease, and, therefore, hospital accommodation must be provided for these people. Now I want to be quite frank and open on this matter. |
f1fa83e6-d03f-4436-a49b-c266957e62ab | Beds should have been provided pre-War whicl were not provided, and which are now going to cost a lot of money to build, and there are beds which are empty to-day because there are so many other opportunities open to women which, compared with nursing, are more acceptable, botl from the standpoint of remuneration and conditions of environment. I have mentioned some of the problems which are being faced and which it may be possible to solve within the framework of recent legislation. Not the least of the problems, the solution upon which the whole future of the hospital ystem depends, is the realisation of the relative parts to be played by the professional people and by the lay officer. It is a curious thing that whilst no one would dream of asking anyone other than a musician to conduct an orchestra, a large number of Page 6 The Health of Barking people think that a hospital service can be conducted by people who have never passed even the simplest examination in the work which is conducted at a hospital. |
bf33f586-c082-42d7-a2e0-9f5dfbb1a3a7 | The power of the public is paramount—they alone have the right to say what money they have available and how it shall be spent, but it will always take a man with a deep appreciation and knowledge of music to become a conductor. Parks and Open Spaces. One day John asked me to address a meeting in which he was interested on the question of parks and open spaces in Barking. the question of parks and open spaces in Barking. |
8e08d0d4-f909-4acb-8e5c-0f7800b2993f | Now when called upon to make such an address I always ask the most competent person I know to outline remarks for me, and in this case a colleague, who wishes to remain anonymous, wrote the following notes :— Barking Park 76 acres Mayesbrook Park 116 33 Greatfields Park 14 33 Castle Green 42 33 Parsloes Park ... 14 „ in the Borough of Barking Vicarage Field 4.4 33 Abbey Playing Fields 3.75 33 270.15 This table shows that there is a total of 270 acres in use by the public for recreational purposes—in addition, there is within the Borough a further 330 acres for future development as such when circumstances permit. The statutory and temporary allotments total a further 221 acres. |
f384971a-2531-4096-8c94-d1e559d81a50 | In these days of increased leisure it is important that every facility available to provide exercise in the open air should be used to the maximum and it is with satisfaction 1 notice both young and old making such excellent use of the opportunities provided by the Council in the provision of open spaces, sports buildings and equipment. The cultivation of a garden is a joy and an excellent pastime. May I again plead for landscape gardens and seats to form rest sanctuaries for our aged residents. Here, just removed and safe from the fast-moving traffic among pleasant surroundings, our Darbys and Joans can still feel the pulse of life by watching movement all around them. Burial of the Dead. Talking matters over, John was very surprised to learn that amongst the multifarious duties carried out by a Medical Officer of Health is that of arranging for the burial of certain persons. |
fd855553-6d83-4589-a564-e160570b8173 | This duty arises from the provisions of Section 50 Page 7 The Health of Barking of the National Assistance Act, 1948, which provides that it shall be the duty of certain authorities, of which Barking is one, to cause to be buried or cremated the body of any person who has died or been found dead in their area, in any case where it appears to the authority that no suitable arrangements for the disposal of the body have been or are being made otherwise than by the authority. It is not ancitipated that there will be a large number of such cases, and, in fact, during the six months that this Act was in operation during 1948, only one such case did arise. The Problem of the Aged. With the improved welfare conditions more of our population is living longer and remaining in occupation of their long-established homes. It is our experience that there is a determination which is supreme in tenacity to refuse to leave the old home, even when chronically ill. |
bafe62ae-07aa-4a9e-a61a-f61a96ebe800 | Even the best domestic help service is not adequate for some such cases and the use of the power of Section 47 of the National Assistance Act, 1948, although drastic, must be implemented on occasions. This power enables the Council through their officers and with the authority of the Court of Summary Jurisdiction actually to remove people from their homes who are unable to look after themselves or are not receiving proper care or attention from other persons. During the whole of the year 1948, we did not have to exercise this power, which we always find vastly unpleasant. The following statistics show the number of aged " residents." It is at least interesting to note how the female population live longer in each age-group. Page 8 Old Age Pensioners. M. F. |
1bc47522-d430-4686-b9a9-43d94de984ba | 66-70 years 646 813 71-75 years 367 475 76-80 years 168 275 81 years and over 61 122 Totals 1,242 1,685 Grand Total 2,927 The Health of Barking Wastage of Infant Life. This part of my Report has nothing to do with John and Mary, but I do want to record that in 1948, of the 30 deaths which occurred in Barking children under one year of age, 15 occurred within the first month of life, which means that if we could only do something about these babies that die at a very young age, then we should be getting on to one of the problems most likely to reduce infant mortality as a whole. INFANT AND NEO-NATAL MORTALITY By the courtesy of the coroner and of the pathologist who undertakes work for the coroner, I do see most of, if not all, the post-mortem examinations conducted in Barking. |
1e86e013-f15d-426d-a1a3-2d287f234ef3 | I don't think there is any doubt that a high percentage of these children who die at a very early age die because they don't get enough air in their lungs. One has to remember that when a baby is born there is practically no air in the lungs at all and for all practical purposes you say there is none. In these circumstances the lung is normally so solid as a piece of leather. Some children pump up their lungs and some children don't, and if they don't pump up their lungs, it means that they are much more susceptible to infection than if they did. Now why don't some children pump up their lungs—I wish I knew the answer ! I cannot help feeling that the answer is just around the corner. |
e1638b8b-f569-48e0-b8a2-4951f3005c1b | While we are dealing with this morbid subject of the wastage of child life, it is necessary to continue the gloomy picture by pointing out that during the year 1948 there were no less than 29 stillbirths, a large number of which were subjected to post-mortem examination, and again I am courteously invited to attend and indeed I do so attend. Very many of these post-mortems led me to believe that the children were living but a short time before they were born, but any suggestion as to why they died would, I believe, be at this time speculative. Let me end this rather grim, but I believe necessary part of my Report, and let a little sunshine into it. Our infant mortality rate for 1948 was 20.53. which is the lowest we have ever had in Barking. It would have been even less had it not been for an unknown newly-born baby which was found dead in Barking and which, strictly speaking, was not a Barking death. |
f71465a0-4905-45d0-81f8-7e48a12864d2 | INFANT MORTALITY RATE On pages 57-58 will be found further statistics relating to infant mortality. Hospital v. Home Confinements. Mary was very worried as to whether she ought or ought not to go into hospital for her forthcoming confinement. John, who, as you know, is a practical sort of man, was all for Mary going into hospital. He said, and quite rightly, " there they have all the equipment and the staff that could possibly be wanted if anything unusual Page 9 The Health of Barking should arise, and for which we are not prepared and equipped. I know the difficulty of doing wayside repairs and I know how easy it is to do the same job when you have got all the necessary tackle and equipment." Mary's mother was definitely opposed to it—she had never been to hospital for a confinement, and she couldn't see why Mary should have her baby born in hospital. Mary was in a quandary. Undoubtedly, the questionis a difficult one. |
04af4f5f-1e1c-49ba-a160-1da239d1d355 | John was quite right when he said all about the wonderful equipment and the expert supervision, but it is also true that you cannot get a number of women together in a delicate state of health without running some risk. If one of these women catches a cold it is likely the others will catch it also, and the same is true with regard to infections which are peculiar to childbirth. There can be no doubt whatsoever that when a person is advised, on mcdical grounds, to have the baby born in hospital, it is folly not to accept this advice. Where the social conditions are not in all respects satisfactory, this means that there are risks at home which more than outweigh the risk of women being congregated together at such a time. There is a lot to be said for women having their first baby in hospital, because it is these first babies which provide so many of the incidents which have to be passed in childbirth. |
8fcc75a1-7ef1-409e-ae49-f26c72db7f4c | Incidentally, for the same reason there is much to be said for the women who are having their fifth or sixth baby going into hospital. But this leaves a gap between the first and the fifth baby, where the question is quite an open one. In practice, however, it isn't a very pressing problem because we look upon medical necessity, first babies, social emergencies and fifth babies as priority classes and by the time these priority classes have been accommodated, there are few beds left for other expectant mothers. Ante-Natal Service. Elsewhere I talked particularly to Mary about the way in which our ante-natal services are designed to do what we may to deal with the special problem of prematurity. Of course, these services are designed to cater for a much wider field than prematurity, although it is a very important aspect of our work. |
e60521d9-f6c5-4809-a528-1ddc4fcbf1da | I do not wish to go into what I have discussed in earlier Reports, but I am happy to be able to say that there are advances in ante-natai work quite comparable with those advances which are taking place in other Departments. We now know more fully than we have known before that a properly balanced diet is very essential to every pregnancy—not only a properly balanced diet, such as flesh, fats, and starchy materials are concerned, but also a properly proportioned diet, so far as NATURE OF ATTENDANCE AT CONFINEMENTS; 1948. No. of Cases. DISTRICT :— Doctor and Midwife 19 Midwife 518 BARKING HOSPITAL ... 875 TOTAL 1,412 Page 10 The Health of Barking those things are concerned which are named accessory food substances, and which sometimes are called vitamins. Mary knew that the chocolate-covered tablets which she was taking contained vitamins A and D, and that these are necessary food substances which could be taken by routine. |
771aaedd-1683-45c2-bf09-be1f2c426641 | Another advance which has been made in the past few years is what is known as examination for the rhesus factor. I got into a bit of trouble with this with John and Mary, as is set forth in the following part of my Report. . Blood Tests. When the doctor wanted to get a specimen of Mary's blood for a special examination there was quite a how-to-do, to put it mildly. Mary's mother was up in arms about it. Things like that were never done when she was young ! John didn't take any more favourable a view, and although he didn't talk about it he remembered that in the army blood tests were often taken to find out whether men were suffering from a disease from which they ought not to suffer. All this led to a lot of talk and bother, but the plain simple fact is that such blood is taken for a purpose which was quite unknown when Mary's mother was a young woman, and it has nothing whatsoever to do with what John was thinking about. |
41b257ef-2d32-41e0-8a6b-c6698013fe55 | The difficulty is to explain what it is all about. In the personal interview the doctor had with Mary it was possible to explain it in the spoken word easier than it is in a statement in writing, but the gist of what the doctor told Mary is as follows, and at least the first part of the explanation is easy. The first reason is to do with the fact that blood is of different types and you want to know what type of blood a woman has in order to make quite sure that you do not give the wrong type if she needs a transfusion. The second reason is much more difficult to explain. Curiously enough, there are some people who have as part of their blood a substance which is not found in other people's blood, and which is indeed so different that if it were introduced there it would be broken up. This substance was first discovered in the blood of the Rhesus monkeys and is, therefore, called the Rhesus Factor. |
428ef8bb-6c95-4e1f-9686-8a8a7129b5ac | Persons who have it are called Rhesus Positive and those who have not are called Rhesus Negative. If a woman who has not this substance in her blood has a child by a father who has—i.e., who is Rhesus Positive—and if the child takes after the father, then the substance (Rhesus Factor) in the child's blood inherited from the father may filter into the mother's blood and the mother will immediately set about to break it up. The machinery which she sets up to break up this substance in time diffuses into the child itself, and, of course, is hostile to the child. We in Barking believe that to be forewarned is to be forearmed, and although we arc quite willing to admit that at this stage we are unable to do so much about it as we would wish, it certainly is wise to know beforehand what is likely to arise, and if the amount we can do isn't a great deal it is at least something. |
87ffe718-1224-401d-9762-ed58823f9e30 | Page 11 The Health of Barking Dental Workshop. Dental Service. On one of the first visits of Mary to the ante-natal clinic she was advised by the doctor to see about her teeth, and the Health Visitor, finding that the dentist at the clinic had a spare moment, arranged for Mary to see him there and then. Fortunately Mary had been brought up in Barking and she had attended the dentist regularly whilst at school, so that, although the intervening years had left something to be desired, she found there was not very much after all that needed to be done. As a matter of fact, until she saw the dentist on this occasion she didn't know anything wanted doing at all, which only shows the value there is in having the teeth regularly inspected. Two or three fillings were all that were needed to put her mouth in really good order, but Mary, like other people, was a bit shy about having her fillings done. |
d3f87163-5f6f-4f0f-908f-2eed81c0a9f4 | Somehow there are very great misgivings about having teeth filled, and alas how many people want to have a tooth out instead of having it filled, and anyhow people who are not so foolish as to have the tooth out will use every excuse possible for putting off the day when the filling is to be done. The dentist explained to Mary that having a baby was a very serious thing so far as her own teeth were concerned. The dentist told her that her unborn baby would be taking from her a good deal of calcium in the building of its own body, and an expectant mother should take enough of those special foods which are so necessary for the growth and development of her baby and at the same time sufficient for her own needs. Page 12 The Health of Barking Mary asked the dentist what would have happened if one of her teeth had needed to come out and whether it would have been possible for her to have had gas ? |
aa2271eb-1cbf-4a94-8960-17490521c579 | The dentist was able to reassure her that, generally speaking, expectant mothers could be given gas almost at any time during pregnancy, although it is not highly desirable late in pregnancy. Mary, of course, wasn't the only expectant mother that came to the clinic, and in the table on this page is set out the work that was actually done. DENTAL SERVICE—1948. |
faa99f34-c5cd-4e45-8ad2-90f12ceb1143 | Mothers and Toddlers Adults— Public Scheme School Children TOTAL Number of patients treated 2,163 3,908 6,440 12,511 Attendances for treatment 4,261 11,913 12,753 28,927 Extractions 2,765 7,024 5,966 15,755 Administrations of Gas 730 1,230 2,715 4,675 Fillings 1,134 1,652 6,963 9,749 Other Operations 3,256 10,142 6,271 19,669 Dentures supplied 253 1,476 110 1,839 Sessions (equivalent of) 364 1,095 1,216 2,675 Now everybody in the town wasn't so sound and sensible as Mary, and it is with regret I have to say that for some of the expectant mothers it was necessary to take out teeth, and to provide dentures. |
1ccba02b-0628-4e4b-bcfc-773fbe16151b | In fact, dentures were supplied to nearly 200 expectant mothers. Quite frankly, this figure is far too high, and the women of Barking have got to ask themselves seriously what they can do about it. We cannot hope to do awa y with fillings and scalings and that sort of thing, but we can hope that these young people will not need to have their teeth out and artificial teeth put in. Prematurity. One thing which hung about Mary like a nightmare whilst she was pregnant was the possibility of her child being born prematurely. How she got hold of the fears I don't know, but she had learned that prematurity was one of the conditions which accounted for a large number of infant deaths. It is with some diffidence I write on this subject because there are other Marys who will read what I am writing and who will be worried, and indeed I would not write on this subject at all if I were not able to introduce a note of optimism. |
a6c99cb6-ae7c-4225-95ea-e65ac94fb871 | If, therefore, my reader gets a little gloomy when I give him or her the facts, I want them to wait until they have read all I have to say. It is no good blinding your eyes to the fact that one-sixth of all the children who died under the age of one year during 1948 were born prematurely, and that of those who died within the first month of life no less than one in three were premature babies. Page 13 The Health of Barking If that were the whole of my story it would be pretty grim, but I beg to assure everybody that we are doing a great deal in this matter, even though the question is not an easy one. What we do in Barking is to undertake an ante-natal supervision which can be spoken of as intense from the very first time the mother comes to us when she is pregnant, and this intensive ante-natal supervision is stepped up towards the end of pregnancy. |
02cdfb3f-953d-4bfe-b57b-c10b6cc5fef3 | Not only do we do this, but we also arrange ante-natal clinics in such a way that the resident obstetricians of the Barking Hospital, who will have to deal with any abnormality if it arises, do in fact take the ante-natal clinics during the latter weeks of pregnancy. Vitamins. When once Mary had got the right idea into her head there was no need to taik to her any more about it. She was one of those practical people, who, when once she had commenced with the right thing, kept on doing it. There was nothing about cod liver oil, orange juice and vitamin tablets that she didn't know about, so far as public provision is concerned, and she took on trust the reliable information she had as to their value. I had a chat one day with Mary as to why so very many mothers didn't avail themselves of these special food substances. |
1a12bfb8-7b37-412b-8bc3-92eb46630b4a | Quite frankly, Mary didn't understand it, and nor do I. There is what is known as the London Division, a name which is applied by the Ministry of Food, and in this Division there are some 95 towns. It is quite common, when we have a report on the question of the way in which these various towns take up the special vitamins, to find that Barking is pretty well down the list. For orange juice Barking comes about fortieth. For cod liver oil about thirtieth and for vitamin tablets about twentieth, and indeed there are no less than 15 towns who beat Barking all along the line. Some people would be satisfied that they are a bit better than the average, but theold motto, " the best is good enough for Barking,"' still stands, and I would like to see these food substances taken much more than they are at the present time. |
e262c8ba-875b-4137-a4b8-82c0deac3e1a | So far as orange juice and A and D vitamin tablets are concerned only a little more than half the people take them, and with regard to cod liver oil, it is even less than half. What is difficult to explain is that what are commonly known as the '' better off " places do better than we do, e.g. places like Barnet and Beckenham, which come toward the top of the alphabetical list, and Wood Green, which, of course, comes towards the other end of the alphabetical list. I was discussing this matter with an officer from the Ministry one day and this officer said that in his opinion it was because the people in these other areas were better educated. I'm afraid I was rather angry because quite frankly I don't believe people in these other areas are on the whole better educated than the mothers Pace 14 The Health of Barking of Barking. |
4de3c60b-db4e-41c8-9f14-7d93f99d68da | One fact has occurred to me, and that is that in these other areas, although the people may be getting a little more money they, on the whole, have additional expenses and have to budget more closely than some of the people in Barking, and because of this are only too glad to avail themselves of these special foods, not only by reason of their usefulness but by reason of the financial value in doing so. Anyhow, it still remains that Mary couldn't help me solve this problem and I know that she won't mind my saying so. Quite frankly, I don't know the answer. Domestic Helps. You would not think a young married couple would be very likely to call upon the services of a Domestic Help and, therefore, you may be surprised to find that John and Mary were interested in the provision of this very necessary person. It came about in a curious way. |
0c2e5465-6cb9-4a96-8810-8fa07144e268 | In the latter part of the time Mary was expecting her baby, John found that with the best will and intention in the world she could not help her mother, who was an invalid, in the same way as she had before. Personally, I have no doubt that Mary spoke to John and that John was soon finding out what could be done, but there was one thing he was determined upon and that was Mary was not going to do anything which might lead to complications in her expected confinement. At the end of 1948 we had 5 fulltime and 31 part-time Domestic Helps, of whom many were doing almost, if not altogether, whole-time work. I want to take time by the forelock and anticipate that next year we shall have still further Domestic Helps. In the little table which is set forth on this page you will see the amount of work which has been done. In a significant number of chronic sickness cases the services of a Domestic Help were provided, because there are not enough hospital beds for these cases. |
e65cb6f3-6391-4571-876e-734cb3c580a8 | These cases usually require the services of a Domestic Help for prolonged periods and constitute a majority of the cases coming within the heading " sickness cases." John had something to say about this. He put forward the idea that because so much of this work was necessary because there were not enough hospital beds, the charges for the services of domestic helps in such cases should fall on the Regional Hospital Board and not on the local rates. This, however, is a matter which I am not qualified to discuss. Analgesia in Midwifery. Mary had not been attending the clinic very long before she began asking the other women who attended what they thought about analgesia and what the Page IS CASES ATTENDED BY DOMESTIC HELPS. Type of Cases. Year. |
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