The Urban District Council of Dagenham Annual Report OF THE medical officer of health FOR THE YEAR 1937 CECIL HERINGTON, M.B., B.S. (Lond.), D.P.H. The Urban District Council of Dagenham Annual Report OF THE medical officer of health FOR THE YEAR 1937 CECIL HERINGTON, M.B., B.S. (Lond.), D.P.H. 3 TABLE OF CONTENTS. page. Members of the Council and Committee 7 Officers of the Public Health Services 8 General Statistics 10 General Provision of Health Services for the Area 15 Hospital Provision 15 Ambulance 18 Clinics 20 Nursing in the Home 23 Laboratory Facilities 25 Legislation in Force 26 Sanitary Circumstances of the Area 28 Disinfection 33 Sanitary Inspection 37 Housing Statistics 39 Statistics of Inspections 39 Inspection and Supervision of Food 45 Infectious and Other Diseases 52 Diphtheria 53 Scarlet Fever 61 Tuberculosis 66 Cancer 70 Maternity and Child Welfare 71 Infant Mortality 71 Maternal Mortality 74 Infant Welfare Centres 76 Ante-Natal Services 81 5 To the Chairman and Members of the Council. Mr. Chairman, Ladies and Gentlemen, I have pleasure in submitting my Annual Report. on the health services of the district for the year 1937. Perusal of the pages that follow will show that a satisfactory standard of health is being maintained and that the vital statistics compare very favourably with those of similar areas and the country as a whole. Full reference is made to the scheme instituted for the care by day foster mothers of children under school age. This arrangement is being observed with keen interest and there is evidence to show that it is succeeding in its object. The domiciliary midwifery service is now in full operation. The Council has appointed nine midwives and arrangements have been made with the Essex County Nursing Association for the services of seven and the Salvation Army for two midwives. Once again I offer my thanks to the members of the Council and co-opted members of the Committee for their interest and help in the work of the Public Health Department, 6 Finally, I record with pleasure ray thanks to the members of the staff for their valued help. I have the honour to be, Ladies and Gentlemen, Your obedient servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. June, 1938. 7 MEMBERS OF THE COUNCIL. (31st December, 1937). Councillor A. ROGERS, J.P, Chairman. Councillor A. F. J. CHORLEY, J.P., Vice-Chairman. Coun. J. R. ANDREWS. Coun. W. H. LANGLOIS. C.C. „ A. E. BALE, J.P. „ W. F. LEGON. „ (Mrs.) A. L. BANKS. „ H. L. LYONS. „ V. C. BARNEY. „ W. C. MARKHAM. „ W. E. BELLAMY. „ (Mrs.) M. E. MARLEY, J.P. „ F. BROWN. „ (Mrs.) E. McALISTER, C.C. „ J. W. BURRIDGE. „ R. J. MINCHIN. „ A. A. BUTTERS. „ J. A. PRESTON, J.P. „ W. T. CAIN. „ (Mrs.) F. L. M. ROGERS. „ R. J. D. CLACK. „ B. H. SAUNDERS, C.C. „ C. BELLOW, J.P. „ (Mrs.) F. E. STOCKBRIDGE. „ H. C. DYER. „ (Mrs.) A. R. THOMAS. „ (Mrs.) L. F. EVANS, C.C. „ ,, F. G. THOMAS. „ E. E. HENNEM. „ C. A. THORNEYCROFT. „ C. L. HERMITAGE. „ C. M. WILSON. „ E. HOWARD. PUBLIC HEALTH COMMITTEE. Councillor (Mrs.) M. E. MARLEY, J.P., Chairman. Councillor (Mrs.) F. E. STOCKBRIDGE, Vice-Chairman. Coun. J. R. ANDREWS. Coun. A. ROGERS, J.P. ,, A. E. BALE, J.P. „ (Mrs.) F. L. M. ROGERS. ,, (Mrs.) A. L. BANKS. „ B. H. SAUNDERS, C.C. „ A. F. J. CHORLEY, J.P. „ (Mrs.) A. B. THOMAS. » (Mrs.) E. McALISTER, C.C. „ C. A. THORNEYCROFT. MATERNITY AND CHILD WELFARE COMMITTEE. Same members as Public Health Committee with the addition of the following co-opted members :— Mrs. H. R. CHORLEY. Mrs. A. M. LYONS. Mrs. L. COOMBS. Mrs. L. MORGAN. Mrs. E. M. LEGON. Mrs. A. L. WRIGHT. 8 OFFICERS of the PUBLIC HEALTH SERVICES. Full-Time Staff. Medical Officer of Health : CECIL HERINGTON, M.R.C.S., L.R.C.P. M.B., B.S. (Lond.), D.P.H. Assistant Medical Officer : ELEANOR HENDERSON, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health : CYRIL G. EASTWOOD, M.R.C.S., L.R.C.P., M.B., Ch.B., B.Sc., D.P.H. (Appointed May, 1938.) CHARLES B. HUSS, M.R.C.S., L.R.C.P., M.B., B.S. (Lond.), D.P.H. (Resigned December, 1937.) Senior Sanitary Inspector : G. T. CARTER, Certificate of Royal Sanitary Institute; Meat Inspector's Certificate. Sanitary Inspectors : J. W. ALLAM, Certificate of Royal Sanitary Institute. F. W. S. FOX, Certificate of Royal Sanitary Institute; Meat Inspector's Certificate ; Sanitary Science as applied to Buildings and Public Works Certificate; Smoke Inspector's Certificate. A. J. JAMES, Certificate of Royal Sanitary Institute. L. E. PRIOR, Certificate of Royal Sanitary Institute; Meat Inspector's Certificate. Senior Health Visitor: M. SMITH (1, 2, 3). Health Visitor: V. A. EVERITT (1, 2, 3). I F. RICHARDSON (1, 2, 7). A. K. GIBSON (1, 2, 3). H. A. SHUTT (1, 2, 3). (Appointed March, 1937.) (Resigned November, 1937.) E. M. HURLEY (1, 2, 3). M. B. THOMAS (1, 2, 3). (Appointed March, 1937.) (Appointed June, 1938.) (Resigned May, 1938.) F. N. UDELL (1, 2, 3, 4, 5). J. W. B. MACFIE (1, 2, 3). (Resigned February, 1937.) (Appointed January, 1938.) D. E. WALLER (1, 2, 3). I. PLUMMER (1, 2, 3): L. WEALE (1, 2, 3, 5, 6). General Trained 1 State Certified Midwife 2 New Health Visitor's Certificate 3 Fever Trained 4 Sanitary Inspector's Certificate 5 M. & C. W. Certificate 6 Health Visitor's Certificate 7 9 Midwives : D. H. ANKER. O. M. LISSAMORE. E. M. BEDFORD. H. MITSON. E. CASHMAN. M. ROTHWELL. C. HURRY. M. J. STOREY. G. JIMMACK. Clerical Staff : Senior Clerk : B. E. E. DENNY. Clerk to Sanitary Inspectors : F. W. KNIGHT, Certificate of Royal Sanitary Institute. Clerks : I. M. BISHOP. P. NUTTALL. E. L. CURTIS. (Appointed May, 1937.) (Appointed October, 1937.) (Resigned September, 1937.) P. R. DRISCOLL. B. L. PARRY. (Appointed October, 1937.) (Resigned September, 1937.) H. FIELD. G. A. POWER. D. I. FLETCHER. M. A. WATTS. Part-Time Staff. Consulting Gynaecologist : W. S. O'LOUGHLIN, M.D., M.C.O.G. Consulting Obstetrician : W. S. O'LOUGHLIN, M.D., M.C.O.G. Consulting Orthopaedic Surgeon : B. WHITCHURCH HOWELL, F.R.C.S. Dentist: F. C. RITCHIE, L.D.S., R.C.S. (Edinburgh). Medical Officer, Infant Welfare Centres : M. TURNER, M.R.C.S., L.R.C.P. 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 6,556 Registrar-General's estimate of resident population 1937 105,500 Number of inhabited houses (end of 1937) according to Rate Books 25,920 Rateable value (Dec. 31st, 1937) £556,280 Sum represented by a penny rate (approximate 1937-38) £2,273 Social Conditions of Inhabitants. The population of Dagenham is largely industrial. There are many and varied processes carried out in the area, the chief of which is engineering. The existing factories are being extended and new works introduced. Building has also been an active industry and several new estates arc being built by private enterprise. Extracts from Vital Statistics for the Year. Live Births :— Total. Male. Female. Legitimate 1,939 994 945 Birth rate per 1,000 of the estimated resident population, 18.70. Illegitimate 34 15 19 Stillbirths :— Legitimate 59 38 21 Rate per 1,000 total (live and still) births, 29.99. Illegitimate 2 1 1 11 Deaths 658 361 297 rate per 1,000 of the estimated resident population, 6.236. Deaths from puerperal causes :— Deaths. per 1,000 total (live and still) births. Puerperal sepsis — - Other puerperal causes 6 2.95 Total 6 2.95 Death rate of Infants under one year of age :— All infants per 1,000 live births 52.71 Legitimate infants per 1,000 legitimate live births 52.60 Illegitimate infants per 1,000 illegitimate live births 58.82 Deaths from Measles (all ages) 2 „ „ Whooping Cough (all ages) 4 „ „ Diarrhoea (under 2 years of age) 12 Population. The Registrar-General's mid-year estimate was 105,500 ; this is an increase of 3,500 compared with the previous year. The excess of live births over deaths for the year was 1,315 and 1,026 more houses were occupied than in the previous year. 12 The following figures give the estimated or census population, the number of houses as ascertained from the rate books and the number of persons per house:— Population. No. of houses. No. of persons per house. 1931 Census 89,362 19,457 4.59 1931 Estimated 90,870 19,457 4.67 1932 94,952 19,952 4.71 1933 95,550 20,754 4.60 1934 98,710 21,918 4.50 1935 100,300 22,800 4.40 1936 102,000 23,994 4.25 1937 105,500 25,920 4.07 It will be seen that the number of occupiers per house continues to fall, and has steadily done so since the year 1932. This is an indication that the standard of housing as regards overcrowding is improving; formerly it was common to find married sons and daughters living with their parents. The tendency now is for each married couple to live in a separate house which is a practice to be encouraged. Births. 1,973 live births were registered during the year, there being 1,009 males and 964 females. This is in a ratio of 1,047 males to 1,000 females, approximating very closely to the ratio for the country, which is usually in the neighbourhood of 1,050 males to 1,000 females. The birth rate per 1,000 population was thus 18.7 compared with 14.9 for England and Wales and the same figure for the 125 large towns including London. The rate compares with that of 24.2, 26.5, 30.6, 23.8, 23.6, 20.4, 18.6, 19.6, 18.59 and 18.47 for the years 1927 to 1936 inclusive. It appears that the birth rate is now maintaining a figure of between 18 and 19 per thousand, It is not 13 expected that this high rate will he continued for long, as there is a natural ageing of the population which means that a higher proportion are passing the age of fertility. The illegitimate birth rate continues to be very low, being only 1.72 per cent, of total births. Comparable figures for other districts for the year under review are not to hand, but it would surprise me to learn that there is another large town in the country with a rate as low as that of Dagenham. The rate of illegitimate stillbirths is 3.23 per cent, of total stillbirths. Death Rate. Total deaths in district 332 Outward transfers 76 Inward transfers 415 Deaths of residents 671 Of the 76 deaths of non-residents occurring in the district, 57 took place at the West Ham Sanatorium and 10 at the Joint Isolation Hospital. Of the 415 deaths of local residents taking place outside this area, most occurred in institutions. Of these 240 occurred at Oldchurch Hospital, 21 at King George Hospital, Ilford, 10 at Epping Infirmary, six at Charing Cross Hospital, eight at the London Hospital, six at The Retreat, Billericay, five at Queen Mary's Hospital, Stratford, four at East Ham Memorial Hospital, 35 at Orsett Lodge and two at Mental Hospitals. 658 deaths in a population of 105,500 represent a death rate of 6.24 compared with 12.4 for England and Wales. For the years from 1927 to 1936 inclusive, the local rates were 7.0, 7.3, 8.3, 6.6, 7.2, 6.5, 6.5, 6.6, 5.63 and 6.43. A table giving the causes of death, and the age periods at which they occurred, is given at the end of the report. 14 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1937. Provisional Figures. —The mortality rates for England and Wales refer to the whole population, but for London and the towns to civilians only. Rate per 1,000 total Population. Annual Death-rate per 1,000 Population. Rate per 1,000 Live Births. Live Births. Still Births. All Causes. Typhoid and Paratyphoid Fevers. Small-pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Violence. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths (under one year). England and Wales 14.9 0.60 12.4 0.00 0.00 0.02 0.01 0.04 0.07 0.54 0.45 5.8 58 125 County Boroughs and Great Towns, including London 14.9 0.67 12.5 0.01 0.00 0.03 0.01 0.04 0.08 0.45 0.39 7.9 62 148 smaller towns (1931) resident populations 25,000-50,000 15.3 0.64 11.9 0.00 0.00 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 0.54 12.3 0.00 0.00 0.01 0.01 0.06 0.05 0.51 0.38 12.0 60 Dagenham (estimated population 105,500) 18.70 0.58 6.24 0.00 0.00 0.02 0.01 0.04 0.11 0.45 0.09 0.11 52.71 15 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Hospitals provided or subsidised by the Local Authority or by the County Council. a. (1) Fever. Rush Green Isolation Hospital is maintained by the Romford Joint Hospital Board, which consists of representatives of the Borough of Romford and the Urban District Councils of Dagenham and Hornchurch. This Hospital has recently been extended and now contains 235 beds including 71 cubicles. The new nurses' home has also been completed. The hospital may be regarded as satisfactory in every respect and is now sufficiently large to meet the normal needs of the area it serves. Cases of Puerperal Pyrexia, Ophthalmia Neonatorum and Measles are now admitted to the hospital. Reference to Diphtheria, Scarlet Fever and other infectious diseases is made later in the report. (2) Smallpox. In 1936 the County Council assumed responsibility for the hospital treatment of this condition and it has been arranged that for the greater part of the county, hospital accommodation will be available at Colchester. Arrangements have not yet been completed for the treatment of cases from the County districts within the Metropolitan area ; it is anticipated that some agreement will be reached on this matter in the near future. No case of Smallpox was reported in 1937. 16 b. Tuberculosis. The following table shows the hospitals and institutions to which cases of Tuberculosis are admitted through the County Council scheme :— Institution. Type of case treated. Black Notley Sanatorium Women and children—pulmonary. Men, women and childdren—non-pulmonary. Harold Court Sanatorium Men—pulmonary. High Beech Sanatorium Children—non-pulmonary. Chingford Sanatorium Women—pulmonary. Colchester Sanatorium Women—pulmonary. Ilford Sanatorium Men—non-pulmonary. Lord Mayor Treloar Cripples Hospital. Children—non-pulmonary. King George Sanatorium, Bramshott. Men—pulmonary and non-pulmonary. Borrow Hill Colony, Frimley Boys—pulmonary. Church Army Sanatorium, Farnham. Boys—pulmonary and glands. Hawthorndene Sanatorium, Isle of Wight. Women—pulmonary. Liverpool Road Hospital Men—pulmonary (advanced). Oldchurch Hospital, Romford Men and women—pulmonary and non-pulmonary. Papworth Hall Colony Men—pulmonary. Preston Hall Colony Men—pulmonary. Royal National Sanatorium, Ventnor. Men and women—pulmonary. St. Anthony's Hospital, Cheam Men and women—mixed cases. St. Joseph's Hospice, Hackney Men and women—pulmonary (advanced). Victoria Park Hospital, London Men, women and children— pulmonary. King Edward VII Sanatorium, Midhurst. Men—pulmonary. The following are the numbers of persons admitted from this district during the year :— Pulmonary. Non-Pulmonary. Male. Female. Male. Female. Total. Adults 76 55 5 8 144 Children 7 7 11 6 31 Hospitals for General Cases. (1) Hospitals for Medical and Surgical Cases. Oldchurch Hospital, Romford.—This Hospital, formerly a Poor Law Hospital of the Romford Union, 17 has been taken over by the County Council, and now receives patients suffering from all conditions other than infectious and venereal diseases. Considerable alterations have been made as have also improvements in staffing and equipment. The Hospital now possesses modern X-ray and other electrical installations for diagnostic and therapeutic uses. It serves a wide area in which Dagenham is included. Recently the staffing, both resident and consulting, has been reconsidered, and there is now a specialist staff, many of the members of which hold appointments at the teaching hospitals in London. King George Hospital, II ford. This Hospital received its Charter early in the year 1930 ; it is a modern, well-equipped building and serves a thickly populated district. The Out-Patient Department at Five Elms, Dagenham, is administered from the main hospital and deals with casualties and minor ailments chiefly. The main hospital has special departments for dealing with gynaecological, ophthalmic, ear, nose and throat eases ; there is also a massage and X-ray department. Patients who are found to be in need of treatment at these Special departments may be referred from the Out-Patient Department to the central hospital. During 1937, 1,168 patients were admitted from Dagenham against 1,211 for the previous year, whilst at the main hospital 7,038 out-patients residing in •Dagenham received treatment, and at the Five 'Elms Out-Patient Department there were 7,031 attendances. (2) Hospitals for Maternity Cases. The majority of normal cases are admitted to the Fast End Maternity Hospital ; this arrangement continues to work satisfactorily. Cases discovered by the Consultant Gynaecologist to requite special 18 ment are admitted to Oldchurch Hospital on the recommendation of the Consultant who is a member of the Consultant Staff of Oldchurch Hospital. (3) Hospitals for Children. As I mentioned in my report for 1934, Dagenham is conveniently situated as far as hospitals for children are concerned. Many of the children requiring hospital treatment attend Children's Hospitals in London, Stratford and I1ford. (4) Orthopaedic Hospitals. Orthopaedic cases are admitted to the Royal National Orthopaedic Hospital, Queen's Hospital, Hackney, Cheyne Hospital or Brookfield Orthopaedic Hospital. Institutional provision for unmarried mothers, illegitimate infants and homeless children. This Council does not provide for cases of this nature, but when such arise needing admission to an institution, arrangements are in many cases made by Officers of the Council. Ambulance Facilities. (a) For Infectious Cases. Two motor ambulances, provided by the Joint Hospital Board, are stationed at the Isolation Hospital at Rush Green. (b) Non-Infectious Cases and Accidents. The Council maintains two Well-equipped ambulances and the members of the staff of the fire brigade act as drivers and attendants. These men have 19 all been trained in first-aid and have given evidence of their efficiency over a number of years. A statement of the rules and charges for the use of the Council's ambulances was made in my report for the year 1934. The following are the details of the work done by the ambulances during the year, showing 193G figures for purposes of comparison :— 1937. 1936. No. of accident cases conveyed 651 567 No. of other cases conveyed 2,524 1,679 No. of journeys made 2,917 2,062 No. of miles run 29,765.4 23,844.2 The Council has an agreement with the Borough Councils of Barking and Ilford for the reciprocal use of ambulances and for the conveyance of street cases. In the event of the ambulance of one Authority being called to a case just inside the boundary of one of the other districts, the patient is removed by the ambulance summoned. Both ambulances were out together 459 times, whilst on occasions when both vehicles were in commission, the ambulances of Barking and Ilford were requisitioned. Dagenham was called upon by Barking 25 times and by Ilford twice. (c) Maternity Cases. These cases, if requiring the use of an ambulance, are removed either by the Council's ambulance, or in the case of patients being admitted to Oldchurch Hospital, sometimes by the ambulance attached to that institution. In the latter case, a nurse is always in attendance, When the Council's ambulance is requested 20 for a maternity case, a doctor's certificate is required before removal, to the effect that the patient is fit for conveyance. By arrangement with the District Nursing Association, it is now possible for a certified midwife to accompany all maternity cases. Clinics and Treatment Centres. The following tables show the times at which the various Infant Welfare Centres and Ante-Natal Clinics are held in the different buildings throughout the district and also the average attendances per session:— Infant Welfare Centres. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. Methodist Church, High Road, Chadwell Heath. Weekly Monday, p.m. 87 4 Becontree Clinic, Weekly Monday, p.m. 83 5 Becontree Avenue, Dagenham. Weekly Thursday, p.m. 79 6 Ford Road Clinic, Weekly Tuesday, p.m. 81 6 Ford Road, Dagenham. Weekly Wednesday a.m. 54 3 Weekly Wednesday p.m. 63 3 Pettit Farm, Weekly Thursday, a.m. 50 2 Heathway, Dagenham. Weekly Thursday, p.m. 64 3 Out-Patient Dept., Weekly Tuesday, p.m. 73 5 King George Hospital, Five Elms, Dagenham. Weekly Wednesday p.m. 63 4 Rush Green Clinic, Weekly Friday, a.m. 15 1 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 37 2 21 Ante-Natal Clinics. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. Methodist Church, High Road, Chadwell Heath. Bi-monthly (1st & 3rd in month) (Comm. 1/4/37) Friday, p.m. 16 3 Becontree Clinic, Weekly Monday, a.m. 16 2 Becontree Avenue, Dagenham. Weekly (Comm. 16/9/37) Thursday, a.m. 7 1 Weekly Friday, a.m. 16 3 Ford Road Clinic, Weekly Tuesday, 18 3 Ford Road, Dagenharm.. Weekly a.m. Thursday, a.m. 17 4 Weekly (Comm. 24/9/37) Friday, a.m. 9 1 Out-Patient Dept., Weekly Tuesday, a.m. 15 3 King George Hospital, Five Elms, Dagenham. Weekly Wednesday a.m. 15 1 Rush Green Clinic, 179, Dagenham Road, Rush Green. Monthly (1st in month) Friday, a.m. 8 2 York House, Frizlands Lane, Dagenham. Weekly (Comm. 15/9/37) Wednesday a.m. 10 3 1937 has shown that there is a rapidly increasing demand for the Centres and Ante-Natal Clinics. The Council has now under consideration the provision of additional sessions to meet this demand. School Clinics. A Minor Ailment Clinic is held each morning from 9 to 10 a.m. at the Dagenham and the Becontree Clinics 22 and at King George Out -Patient Department. In addition, an Inspection Clinic is held on Monday mornings and Thursday afternoons at the Dagenham Clinic, on Wednesday mornings and Tuesday and Friday afternoons at the Becontree Clinic and at the Out- Patient Department on Monday afternoons and Friday mornings. Refraction Clinics and Dental Sessions are held as required at the Dagenham and the Becontree Clinics. Tuberculosis Clinic. A Tuberculosis Clinic is held every Monday morning and Thursday afternoon at the King George Hospital Out-Patient Department. A Tuberculosis Officer of the Essex County Council is in attendance. Venereal Diseases. There is no local treatment provided for persons suffering from Venereal Diseases. Provision is made under the London and Home Counties Scheme, the nearest treatment centre being the London . Orthopaedic Clinics. By arrangement with the Essex County Council, children who fall under the provisions of our Maternity and Child Welfare Scheme are referred to the Orthopaedic Surgeon ; an allocation of costs is made which is based on the proportion of attendances of school children and those under five years of age. 23 Remedial Exercises and Massage Clinic. Two sessions are held weekly at the Ford Road Clinic, namely, on Monday afternoons and Friday mornings; and two weekly on Tuesday and Thursday mornings at the Becontree Clinic. The provision of massage and remedial exercises is an essential part of orthopaedic treatment, and in many cases prolonged treatment of this nature obviates the necessity for surgical interference. Light Clinic. Ultra Violet Ray Therapy is administered twice weekly at both the Dagenham and Becontree Clinics. Professional Nursing in the Home. (a) General. The Dagenham District Nursing Association is the only organisation operating in this district. The figures in the next paragraph will show that its activities continue to extend. The nurses undertake midwifery and maternity nursing, and in addition medical and surgical cases are attended. A total of 1,045 general nursing cases was treated during the year, involving 9,788 visits to the homes. 355 midwifery cases and 143 maternity cases were nursed. In addition, these patients paid a total of 3,916 visits to the ante-natal clinic held at York House. Altogether then, the number of persons attending during the year was 1,543 to whom 19,870 visits were paid. During illness or other unforeseen contingencies in the Health Visiting Staff, the services of nurses from the Association are obtainable at our clinics, a fee being payable by this Council. 24 The following is an extract from the Annual Report of the Dagenham District Nursing Association for the year ended 31st March. 1938 :— " Owing to the New Midwives Act the past year has brought many changes to the Midwifery world, but in Dagenham, owing to the close co-operation existing between the Dagenham Urban District Council and the Essex County Nursing Association no drastic changes have been found necessary. Dagenham Council, being its own supervising authority, has appointed its own Midwives, and has entered into an agreement with the Essex County Nursing Association allocating to it a district which will fully occupy what is estimated to be the time of seven Midwives. The Scheme came into force in February and so far appears to be working quite smoothly. During the past year the York House Nurses attended for the Dagenham Council 17 cases of Measles, 30 Pneumonia and three Influenza cases. The Nurses also attended at 38 Ante-Natal Clinics, 36 Post-Natal Clinics, and answered 337 Ambulance Calls." (b) Nursing of Cases of Infectious Diseases. Cases of notifiable infectious disease are normally removed to the Isolation Hospital; certain cases, however, of non-notifiable infections are nursed by special nurses employed by the Nursing Association. An arrangement has been made whereby nurses on the staff of the Dagenham District Nursing Association are available for attending cases of Pneumonia in their own homes. This has already proved its worth and the records show that such cases as a whole do well, In many cases the removal of an Acute Pneumonia case it followed by untoward happenings. 26 Midwives. Owing to the Council being made a Local Supervising Authority under the Midwives Acts in April, 1937, proposals had to be submitted to the Minister of Health for the employment of midwives directly by the Council and the use of the services of midwives employed by Associations. The negotiations resulted in the Council employing nine midwives and arranging with the District Nursing Association for the services of seven and the Salvation Army for the services of two. The employment of these midwives did not actually commence until the early part of 1938. Fuller reference will therefore be made in the report for that year. Laboratory Facilities. Examination of clinical material is undertaken at the Counties Public Health Laboratories. Queen Victoria Street, London. During the year, 432 swabs were examined for the diphtheria bacillus, 408 samples of sputum for the bacillus of tuberculosis, 20 samples of hair for the fungus of ringworm, examination for agglutination of blood against typhoid and allied organisms on 32 occasions, and in addition, 46 specimens were submitted for examinations of a miscellaneous character and two biological examinations for virulence test. The same laboratory also undertakes the bacteriological examination of milk and ice-cream, of which 68 samples of the former and 29 of the latter were submitted during the year. 671 swabs were examined for the diphtheria bacillus at the Public Health Offices. 26 Legislation in Force. The following byelaws were made by the Romford Rural District Council and have been taken over by the Dagenham Urban District Council:— Date of Confirmation. Cleansing of Footpaths January, 1885 Removal of House Refuse January, 1885 Cleansing of Earth Closets, etc. January, 1885 Common Lodging Houses December, 1901 Nuisances May, 1902 Houses Let in Lodgings June, 1902 Tents, Vans, Sheds, etc. March, 1908 Regulation of Certain Offensive Trades. Animal Charcoal Manufacturer; Blood Boiler; Blood Drier; Bone Boiler; Cat Gut Manufacturer; Fat Melter or Fat Extractor; Fish Skin Dresser; Glue Maker; Size Maker; Gut Scraper; Leather Dresser; Manufacture of Manure from fish offal or other putrescible animal matter; Soap Boiler; Tallow Melter; Tanner and Tripe Boiler. Confirming Order July, 1911. Byelaws confirmed August, 1912. Rag and Bone Dealer; Fish Fryer. Confirming Order 25th March, 1927. Byelaws confirmed 26th September, 1928. Slaughter House (Revised). 26th September. 1928. New Streets and Buildings. July, 1925. Regulations with respect to Dairies, Cowsheds, etc. February, 1908. Houses Let in Lodgings. 27th April, 1932. Smoke Abatement. 21st April, 1933. Removal of House Refuse. 23rd August, 1934. 27 Nuisances in connection with the Removal of Offensive and Noxious Matters. 27th November, 1934. Transport and Exposure for Sale of Food. 12th December, 1934. Nuisances from snow, filth, dust, ashes and rubbish and for the prevention of the keeping of animals on any premises so as to be injurious to health. 17th January, 1935. Camping Grounds and Moveable Dwellings. 21st August, 1935. Hairdressers' and Barbers' Premises. 12th September, 1935. Tents, Vans, Sheds and Similar Structures. 19th November, 1935. Local Acts. Dagenham Urban District Council Act, 1928. Dagenham Urban (Water) Order, 1929. Dagenham Urban District Council Act, 1931. Essex County Council Act, 1933. 28 SANITARY CIRCUMSTANCES OF THE AREA. Water. The South Essex Waterworks Company supplies almost the whole of the district. During the year there were 25,492 services afforded by this Company and in addition 63 services were connected with the Metropolitan Water Board's undertaking. The water supplied by the Companies concerned is of a high standard and is subject to periodical analyses by the undertakers. It may be stated for all practical purposes that the district is served by a piped supply. Drainage and Sewerage and Sewage Works Extensions and Closet Accommodation. In 1930, 64 cesspools were emptied by the Council. Since that date, 17 cesspools have been connected to the sewers. 47 earth closets from 41 premises in the district are also emptied by the Council. Of the 47 cesspools, 30 are in the northern area of the district which is not yet sewered, but proposals for this are under consideration. There are also 14 in the eastern area where proposals are in hand for further sewers in connection with the improvement of Dagenham Road, and the remaining three are on agricultural land. The Manor Farm Estate, which was drained almost entirely by cesspools emptied by the owners, has recently been sewered. 45 of the properties on this estate have already been connected, whilst facilities are now available for the remaining properties. 29 The Council do not favour cesspool drainage, and every effort has and is being made to connect up to the main drainage whenever new sewers are laid within a reasonable distance. Ten earth closets are in the eastern area, and it will also be possible to dispense with these when the sewers in the Dagenham Road scheme are constructed. The remaining 37 closets are in the northern area of the district and will be dealt with in the same manner as the cesspools when the proposals for sewering reach maturity. The work of emptying cesspools is carried out with a freighter cesspool emptying machine, which is also equipped with a special apparatus for emptying earth elosets. The capacity of the vehicle is 750 gallons, and the contents are discharged into a manhole constructed for the purpose and connected to the Council's sewers at the Salvage Plant. As a general rule, cesspools are cleansed once per month, but in the northern area of the district, collections are made at more frequent intervals if necessary. The earth closet cleansing is carried out once weekly and usually takes about five hours on one day only. The sewage purification works are situated at Rainham, Essex, and discharge into Rainham Creek, opposite Erith on the River Thames. The original works were constructed in 1924 for the Romford Rural District Council (the precursors of the Dagenham Urban District Council), and were designed only for the partial treatment of a maximum flow of 1 m.g.d. Simultaneously with the demand for increased flow capacity of the works, the Port of London Authority demanded increased purity of the effluent and also 30 provision had to be made for considerable flows of trade waste from Messrs. Ford's and other factories. About 1931, therefore, designs were prepared for a new works to give a high degree of purification to a minimum D.W.F. of 3 m.g.d. domestic sewage, by means of sedimentation and activated sludge treatment; provision also being made for partial treatment of a flow of 2 m.g.d. trade waste from the Ford factory. The required standard of the Port of London Authority is being met by the mixture of the highly purified domest ic effluent with the partially purified trade waste—a system which has proved quite satisfactory in operation. A new pumping station was provided to deal with the domestic sewage flow, whilst the old station was converted to deal with the trade waste arriving from Ford's by a separate sewer. The original settling tanks have since been adapted to work in parallel with the new sedimentation tank and provide further settlement capacity in the domestic section of the plant. The present works thus consist of two pumping stations, separately lifting domestic sewage and trade waste, and for the treatment of the domestic sewage, a radial flow mechanical sedimentation tank with six plain rectangular sedimentation tanks in parallel for balancing flows, followed by activated sludge treatment with simplex aeration tanks and diffused air reaeration tanks. For the treatment of trade waste, there are two transverse flow mechanical sedimentation tanks. An automatic effluent pumping station lifts mixed final effluent to the river when tides are too high for gravity flow. Raw domestic sludge and activated sludge are treated in heated digestors before disposal on ploughed land, whilst trade effluent sludge, being inoffensive, is sent direct to the land. 31 The works arc under the direction of the Council's Engineer and Surveyor with a Chemist in charge at the works. In addition to the Chemist, who is responsible for the operation of the plant, a resident Works Manager attends to works maintenance and two laboratory assistants carry out tests in the well-equipped laboratory maintained. The two Pumping Stations and the contiguous Compressor House for the diffused air Reaeration plant, are staffed by a continuous shift of driver and assistant driver, 9 men in all being employed for this purpose. These men also provide attention for the works generally during the nights and week ends. The Activated Sludge and Sludge Digestion plants are operated by a plant operator with two labourer assistants. The sludge areas require the services of ploughman, ploughboy and two labourers, whilst sludging of tanks, attent ion to screens, and general works maintenance are carried out by five labourers. A wholetime fitter is employed, the total wholetime staff being four officers and 22 men. Rivers and Streams. The upper portion of the district is drained by a number of channels which run in a westerly direction, ultimately finding their way out of the area into the River Roding, which discharges into the Thames. The portion so drained includes the area north of Hog Hill, Marks Gate, Chadwell Heath Ward and part of the Becontree Ward. The eastern side of the district is drained by the Wantz Stream running due south. This ditch became choked with weeds and deposited rubbish and at times of heavy rainfall caused flooding. The ditch was cleaned and now flows without obstruction. Another channel runs into it from the Old Dagenham Park. 32 The Wantz Stream then takes an easterly course to connect to the Ream River, by which it empties into the Thames. The third main surface drainage is the Gores Brook. This runs due south in the western portion of the Dagenham Ward and discharges into Dagenham Breach. Scavenging. Collections are made weekly, seven 10-cubic yard side-loading end-tipping freighter dust vehicles being used for the purpose. The work is carried out by four gangs of approximately six men, each in charge of a ganger. The transport is operated on the relay system so that the work of collection is continuous. At the commencement of 1938, the number of houses from which refuse was collected was 25,554, and the weekly average tonnage was 356 tons. Some periodical revision of the districts in which the gangs operate is necessary in view of the continued development, instanced by the fact that since May, 1937, an additional 1,120 houses have been absorbed into the collection (as at January, 1938). Trade collection is carried out concurrently with the house refuse collection. Three free bins are permitted and a small charge (4d.) per additional bin is made. Sacks arc provided free by the Council to shopkeepers and traders in which waste paper and cardboard are placed. This material provides a source of income to the Council as it is sold with similar material salved from house refuse. Trade refuse is accepted without charge at the Salvage Plant. This service is appreciated by greengrocers and fruiterers whose only means of disposal of waste would be by dumping on waste ground, thereby creating a nuisance and a menace to public health. 33 The following figures relate to the cost of this service for the financial year ended 31st March, 1938:— Collection. Disposal. Total. Net cost £10,488 £2,551 £13,039 Net cost per ton 12s. 11.2d. 3s. 1.8d. 16s. 1d. Net cost per 1,000 population £99.4 £24.2 £123.6 Net cost per 1,000 premises £407.1 £99.1 £506.2 Total refuse collected 16,201 tons Weight per 1,000 population per day 8.41 cwts. No. of houses and premises 25,759 (I am indebted to F. C. Lloyd, Esq., A.M.Inst.C.E., Engineer and Surveyor to the Council, for many of the details given above.) Disinfection. The practice of dispensing with routine terminal disinfection has been continued which the results have justified. Terminal disinfection is a disappearing function of Public Health Departments throughout the country. In certain cases, however, and when particularly requested, a form of disinfection is carried out, the co-operation of the householder being acknowledged to be the most valuable part of this process. During the year 1037, this Council accepted responsibility for the cost of disinfecting bedding and clothing of persons suffering from Scabies in 15 cases, the cost being approximately £8. Disinfection of Library Books. The procedure is for the Libraries to be informed of all cases of infection, whereupon they send a notice, together with a label addressed to this office, to the occupiers of the premises. The notice requests the 34 householder to bring the books either to this office or to the nearest branch library. So far as private libraries are concerned, they are notified of houses where cases of infection exist, and are requested to arrange for the books to brought to this office for disinfection. In all cases, whether public or private libraries, instructions are given to the borrower that no more books are to be borrowed until those have been given up. This routine practice has been in operation since 1934 and gives satisfactory results. Smoke Abatement. There have been no serious or consistent cases of excessive emission of smoke. On one occasion a warning letter was sent to the occupiers of a factory and it was not necessary to report any firm for prosecution. A total of 15 observations was made, each of 30 minutes duration and the emission was as follows:— black smoke 9¼ minutes, moderate 282 3/8 minutes and no smoke 158 minutes. The Senior Sanitary Inspector has been appointed as a delegate to the National Smoke Abatement Society and he reports their proceedings to the Council from time to time. Premises and Occupations which can be controlled by Byelaws. Offensive Trades— Fried Fish Shops. There were 26 fried fish shops in the district at the end of 1937, to which a total of 207 visits was paid during the year. Two new businesses were established. 35 Rag and Bone Dealers. Eight persons were seen to be exchanging toys for rags in contravention of section 73 of the Public Health Act, 1925 or section 154 of the Public Health Act. 1936. Warning letters were sent in each case. Tents, Vans and Sheds. Taking the district throughout, little difficulty is experienced with regard to the control of these structures. It was, however, necessary on one occasion to institute proceedings. A person having charge of some land in the district was summoned for contravention of the Council's byelaws with respect to Tents, Vans, Sheds and Similar Structures. The defendant was found guilty and fined 20s. 0d. on each of three charges. Cases are continually occurring when gypsies occupy sites in the area which are not provided with the amenities required. It has on several occasions been necessary to take steps to get them removed. Camping Grounds and Moveable Dwellings. By an Order of the Minister of Health dated 24th May, 1938, Section 269 of the Public Health Act, 1936, has been applied to this district and Section 93 of the Dagenham Urban District Council Act, 1931. has been repealed. This section of the Public Health Act permits Local Authorities to license camping grounds and further to attach certain conditions to such licences. Byelaws governing Camping Grounds and Moveable Dwellings made under Section 111 of the Essex County Council Act, 1933, came into force on 1st October, 1935. These byelaws govern the sites of camps and disposal of refuse by the occupiers, among other things. They are intended for the better control of camping grounds 36 and holiday camps, four of which are established in the northern part of the district during the summer months. In fairness to those who frequent these camping sites it should be stated that on no occasion has it been necessary to take any action or even to make any complaint. Hairdressers' and Barbers' Premises. 41 premises are registered in the district and receive regular visits by the Sanitary Inspectors. The register has been compiled under byelaws made under Section 87 of the Essex County Council Act, 1933. No difficulty has been experienced with regard to the administration of these byelaws. Shops. The Shops Act, 1934, came into operation on 30th December of that year and Section 10 of the Act provides for the provision and maintenance of suitable and sufficient ventilation, sanitary conveniences, lighting, washing facilities, facilities for taking meals and the maintenance of a reasonable temperature. During the year, 106 inspections were made and a total of 213 visits was paid. The following table shows the number of notices served and complied with in respect of the requirements of Section 10 which are administered by my Department:— Notices Notices served. complied with. Temperature 5 11 W.C. accommodation (repairs, etc.) 6 6 Ventilation 1 — 12 17 37 Swimming Baths. The swimming bath in Valence Park still caters for a large demand, so much so that the Council have decided to construct another bath in the southern portion of the area. The water is analysed at regular intervals and is found to be of a high standard. Schools. There is nothing of outstanding importance to mention with regard to school premises which are nearly all of a modern type and well equipped. Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits:— Houses 3,962 Overcrowding provisions of Housing Act 1,546 Nuisances under Public Health Acts 1,018 Bakehouses 37 Slaughterhouses 772 Milkshops, dairies and vehicles 61 Foodshops and stalls 1,011 Infectious disease enquiries 2,347 Food poisoning enquiries 10 Visits to foster mothers' premises 34 Smoke observations 15 No. of complaints investigated 623 Outworkers' premises 65 Houses let in lodgings 75 Ice-cream premises and vehicles 296 Factories, workshops, etc. 106 Tents, vans and sheds 98 Stables 76 38 Dagenham U.D.C. Act, 1931 169 Rats and Mice (Destruction) Act 261 Hairdressers' and Barbers' premises 36 Shops Act, 1934 213 Rooms fumigated 343 Other visits 44 (b) Notices served. Complied with Statutory 115 114 Informal 840 672 On the Administration of the Factory and Workshop Act, 1901. In this district there are 68 factories, 93 workshops, and 111 workplaces, to which visits were paid during the year as follows:— Factories 49, workshops 49, workplaces 8. There were 148 premises in which outwork was carried oil. At 104 of these the work done was the making of wearing apparel. There was no outwork in unwholesome premises. Rats and Mice (Destruction) Act, 1919. The same procedure operated during the year as in the past in connection with rats and mice. Poisons were supplied upon request and during Rat Week posters were exhibited. A number of rat burrows was treated with smoke and gas with fair results. In addition, 28 informal notices were served during the year and 21 were complied with. 39 HOUSING. HOUSING STATISTICS FOR THE YEAR 1937. Number of New Houses erected during the year:— Total 1,316 (1) By the Local Authority 210 (2) By other Local Authorities Nil (3) By other bodies and persons 1,106 1. Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,786 (b) Number of inspections made for the purpose 3,962 (2) (a) Number of dwelling-houses cluded under sub-head (1) above), which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,309 (b) Number of inspections made for the purpose 2,569 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 40 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 381 2. Remedy of Defects during the Year without Service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 362 3. Action under Statutory Powers during the Year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 1 (b) By Local Authority in default of owners Nil B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 17 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 18 (b) By Local Authority in default of owners Nil 41 C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in pect of which Demolition Orders were made 10 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 9 D. Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 2 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4. Housing Act, 1936— Part IV— Overcrowding:— (a) (1) Number of dwellings overcrowded at the end of the year 509 (2) Number of families dwelling therein 509 (3) Number of persons dwelling therein 3,434 (b) Number of new cases of overcrowding reported during the year 194 (c) (1) Number of cases of overcrowding relieved during the year 493 (2) Number of persons concerned in such cases 3,359 42 (d) There were no cases in which dwellinghouses again became overcrowded after steps had been taken for the abatement of overcrowding. It will be noticed from the foregoing table that the work of relieving overcrowding is being proceeded with. Certain large families have presented difficulties as there are no houses in the area of sufficient size to relieve them. Suggestions, however, have been made that in extreme cases two adjoining houses might be allocated to those families which will meet their needs during the short period that is likely to elapse before the adult children marry. No trouble has been experienced with regard to the acceptance of houses offered as alternative accommodation to overcrowded families. The Department continues to keep under observation families which are known to be border-line cases, and re-visits are paid to premises which have been vacated by overcrowded families in order to ensure that this condition does not recur. In certain privately owned estates it is not possible to assess the occupation of houses as there is a constant change amongst the inhabitants, and as conditions vary so frequently inspections made at very frequent intervals would not give a true picture of the conditions obtaining. The number of occupants permitted in each house is in all cases brought to the notice of the persons responsible for letting, and no Habitation Certificate is issued which does not bear the number of persons permitted in the houses concerned. 43 Legal Proceedings. The owner of a terrace of eight houses in this district was summoned at a Court of Summary Jurisdiction for failing to comply with Statutory Notices under Section 94 of the Public Health Act, 1875, in respect of the houses. The case was adjourned sine die on an undertaking by the defendant to complete the necessary work within 14 days. A Closing Order was made in respect of part of a house, the remainder of which was used for business purposes. The tenant appealed on the grounds (a) that he was not notified of the time and place when the condition of the premises would be considered, (b) that part of the building was fit for human habitation and alternatively (c) that it could be made fit for human habitation at a reasonable cost. The grounds of appeal as specified in (a) above were based on the claim that the occupier was a protected tenant under the Rent Restrictions Act. After hearing legal arguments for both parties the Judge dismissed the Appeal with costs. Houses Let in Lodgings. At the end of the year there were 20 premises registered as houses let in lodgings to which 75 visits were paid. Verminous Premises. 16 Dagenham Council houses and 106 other premises were found to be infested with bugs. 14 Council houses and 98 other premises, making a total of 112, were disinfested by this Department. 44 All the furniture and effects of prospective Council house tenants are examined by the Sanitary Inspectors when application for transfer is being considered. The policy of the Council is usually not to accept tenants whose present houses are verminous. On occasions when it has been necessary that applicants whose furniture is verminous should be allocated a Council house, the contents of their houses have been treated with a preparation before removal. All disinfestation is carried out by employees of the Local Authority. On all occasions when visits are paid by Sanitary Inspectors to houses, the importance of the eradication of the bed bug is impressed upon the occupiers. 45 INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply. There are 70 retailers of milk in the district. The following figures relate to the retailers of the various grades of milk in the district:— Pasteurised 7 Tuberculin Tested 7 Ungraded 34 Sterilised 19 Carton 11 The number of company distributing centres is ten. The number of shops retailing milk in sealed containers is 47. At the end of the year the number of wholesalers registered in this district for the sale of milk was four. The number of cowkeepers in the district at the end of 1937 was one, two having discontinued during the year. During the year 1937, the following licences were issued in respect of graded milks:— Pasteurised 18 Tuberculin Tested 14 The present trend indicates that the smaller retailers are being gradually absorbed by the companies, also that a considerable trade of milk in sealed containers is carried on by grocers shops. It is noticeable that dirty samples are becoming exceptional. 46 Supply of Milk to Schools. The practice of obtaining the views of the Local Authority before milk is supplied to schools has been continued. In all cases approval is only given when the supply is efficiently pasteurised. Milk Sampling. During the year 74 samples of milk were analysed; the following table shows the results, divided into those produced on a small scale and those distributed by large companies:— No. of Bacteria in thousands SMALL DEALERS. LARGE SCALE Local. Not Local. Satisfactory. Not Satisfactory. Satisfactory. Not Satisfactory. Satisfactory. Not Satisfactory. Under 30 13 1 27 3 22 — 30—100 — 1 1 3 — — 100—200 — 1 - - — — 200—500 — - - - — — Over 500 — 1 — — — 1 13 4 28 6 22 1 In the year 1929, one sample in 3 1/3 was unsatisfactory, whereas ill the year 1937, the proportion of unsatisfactory samples was one in 6½. (b) Meat and Other Foods. Meat Inspection. There arc four slaughter-houses in the district, one licensed and three registered. To these a total of 772 visits was paid during the year. The carcases inspected numbered 3,472. 47 The following table shows the extent of unsoundness existing in these animals, the affected meat being surrendered in each case:— Cattle, including Cows. Calves. Sheep and Lambs. Pigs. Number inspected 940 20 1,686 811 All diseases except Tuberculosis. Whole carcases condemned 2 — 3 — Carcases of which some part or organ was condemned 39 — 12 29 Percentage of the number inspected affected with disease other than Tuberculosis 4.36 - .89 3.58 Tuberculosis only. Whole carcases condemned 1 — — 1 Carcases of which some part or organ was condemned 103 — — 40 Percentage of the number inspected affected with tuberculosis 11.06 - — 5.06 In addition to the above, the following casualties were inspected:— 14 Beasts— 250 lbs. (injury) surrendered. 1 Sheep— 22 lbs. (injury) surrendered. Legal Proceedings. Whilst examining meat in a butcher's shop, a District Sanitary Inspector noticed a pair of beast's lungs which were badly affected with Tuberculosis. The lungs were seized and the butcher prosecuted under the provisions of the Public Health Act, 1875. The defendant was fined £l. 48 Following information received, a District Sanitary Inspector visited a butcher's shop and examined a sheep's carcase. This was found to be in a fevered condition, the pelvic cavity being inflamed and in a septic condition. The carcase was seized and condemned. A trader from outside this district was summoned for depositing the carcase at the shop in contravention of the Dagenham Urban District Council Act, 1931. During the hearing of the case the defendant admitted that the animal had been slaughtered because it could not lamb. The Bench said that they took a serious view of the matter and imposed a fine of £20 or 2 months' imprisonment. Slaughter of Animals Act, 1933. Ten slaughtermen were licensed during the year in this area. Bakehouses. There are nine bakehouses in the district; to these, 37 visits were paid during the year. Food Shops. 403 visits were paid to butchers' shops, 306 to fish shops, 83 to provision shops, 56 to dairies and milkshops, 51 to greengrocers' shops, 86 to cafes and 14 to other food shops. During the year the following unsound foodstuffs came to the notice of the Sanitary Inspectors:— Seized:— 109 tins of condensed milk. Surrendered:— 79 lbs. herrings, 4 st. fillets. 13 bags whelks (6 cwt. 3 qrs. 21 lbs.), 9 st. 6 lbs. cod fillets, 8 lbs. haddocks, 8½ st. skate, 1 bag winkles, 9 tins 49 condensed milk, 1 tin tongue, 4 tins oranges, 1 tin peas, 1 tin gooseberries, 2 tins (unlabelled), 2 tins fruit salad, 28 jars jam, 5 lbs. lemonade powder, 2 tins brawn (6 lbs. each), 120 table jellies, 1 tin beans, 5 tins pineapple, 2 tins plums, 2 tins herrings, 3 tins salmon, 3 dozen sample pots jam, 1 tin peaches and 1 tin corned beef. Ice-Cream. During the year, 27 samples were taken for analysis, 24 being satisfactory and 3 unsatisfactory. Careful watch is kept on all purveyors and manufacturers of ice-cream. As a result of action under the Essex County Council Act, the standard of purity of ice-cream has definitely been raised. There is a large public demand for this commodity and provided it is a pure product it may be regarded as a valuable article of food. Food Poisoning. Under section 105 (1) of the Dagenham Urban District Council Act, 1931, ten notifications of food poisoning were received, details of which are added. None of the cases displayed the clinical symptoms of true food poisoning. The value of notification of food poisoning may not immediately be apparent, but on closer examination of the subject it will be recognised that the Health Department is able to glean valuable information with regard to the wholesomeness of the food supply of the area, as the fact that certain foods are suspected initiates an inspection of the methods of production, storage and retail of the commodity under consideration. 50 The following is a summary of the cases:— No. Date. Sex. Age. Alleged Cause. Symptoms. Recovered. Others in family ill. 1. 5/3/37 F. 18 Fish Rash Yes. No. 2. 3/8/37 F. 49 Fish Fever, diarrhoea and sickness. Yes. All family had diarrhoea. 8. 6/9/37 F. 50 Fish or sausages Rash Yes. No. 4. 10/9/37 M. 40 Ham sandwich Diarrhoea and sickness. Yes. No. 5. 17/9/37 M. 49 Bloater roe Diarrhoea and sickness. Yes. No. 6. 20/10/37 F. 35 Sausages Diarrhoea and sickness. Yes. No. 7. 10/11/37 M. 28 Whelks Diarrhoea and sickness. Yes. No. 8. 13/11/37 M. 47 Sausages Diarrhoea and pains. Yes. Wife. 9. 13/11/37 F. 43 Sausages Diarrhoea, pains and sickness. Yes. Husband. 10. 16/12/37 M. 49 ? Diarrhoea and sickness. Yes. Wife. Strictly speaking none of the above cases should be regarded as true instances of this condition as they do not present the three clinical symptoms, and from the nature of the attacks apparently they were not invaded with the usual organisms associated with food poisoning. (c) Adulteration, etc. Sale of Food and Drugs. These Acts are administered by the Essex County Council. During the year, 311 samples were analysed, and proceedings were taken in three instances. In two cases costs of 10s. 0d. were imposed and in the other case the defendant was fined £2 and 6s. 0d. costs. 51 (d) Chemical and Bacteriological Examination of Food. Bacteriological examination of milk, etc., is carried out at the Counties Public Health Laboratories, 91, Queen Victoria Street, London, E.C.4. Chemical analyses are performed by Dr. Bernard Dyer, at 17, Great Tower Street, E.C.3. (e) Nutrition. The Health Visitors at their consultations make a practice of discussing the question of nutrition and impress upon the mothers the necessity for balanced diets. This method of teaching the public has been found to be effective in spreading knowledge of this subject. Auxiliary foods such as malt and cod liver oil and similar products are obtainable at the Clinics. 52 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (other than Tuberculosis). Under 1 year 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and Over | Total. Cerebro-Spinal Fever - - 1 - - - - - - - - 1 Diphtheria — 26 87 37 6 1 2 1 — — — 160 Encephalitis Lethargica - - - - - - - - - - — — Enteric Fever — 1 3 6 2 1 2 — — — — 15 Erysipelas 2 — — 1 — 2 7 8 2 — 2 24 Ophthalmia Neonatorum 4 - - - - - - - - - - 4 Pneumonia Acute Primary 7 18 13 7 4 2 9 7 4 2 1 74 Influenzal 1 1 1 2 1 5 8 10 9 2 7 47 Poliomyelitis Acute — — 1 2 - - - - - - — 3 Puerperal Sepsis - - - - - 1 3 1 — — — 5 Pyrexia - - - - - 3 10 6 — — — 19 Scarlet Fever — 107 184 60 18 6 3 5 1 — — 384 Food Poisoning — — — — 1 — 1 2 3 — — 7 Pemphigus 6 - - - - - - - - - -— 6 Smallpox — — — — — — — — — — — — Dysentery - - - - - - - - - - — 1 Polioencephalitis Acute - - - - - - - - - - - - Notified Admitted to Isolation Hospital, Rush Green. Admittec to other Isolation Hospitals ... Admitted to other Hospitals Deaths Registered. Diphtheria 160 159 - - 12 Scarlet Fever 384 312 1 - 1 5 1 - 3 — Puerperal Pyrexia 19 6 1 3 6 Pneumonia (Primary) 74 1 3 33 69 (Influenzal) 47 9 - Erysipelas 24 8 1 5 — Smallpox — — - — - Food Poisoning 7 — - — — Encephalitis Lethargica - - - — — Poliomyelitis Acute 3 2 - 1 Pemphigus 6 3 - - — Ophthalmia Neonatorum 4 3 - - — Cerebro-Spinal Fever 1 1 - - — Polioencephalitis Acute - - - - - Enteric Fever 15 12 - 2 — Dysentery 1 1 - — 1 53 Diphtheria. The incidence of this disease has again diminished, the number of notifications received being 160 compared with 261 for the previous year. As in former years the bulk of cases occurred between the ages of one and 15 years. Of the total cases notified, 159 were admitted to the Joint Hospital and one remained at home. This case was of a mild type, the parents being willing to pay for the necessary mcdical attention and were able to provide adequate nursing. Also the home of the patient received regular visits by the Sanitary Inspector throughout the course of the illness. Home treatment of Diphtheria is not encouraged as it is a disease characterised by surprises, therefore if a patient presents severe or even moderate symptoms, he should be, and is, removed to hospital. The case referred to was kept at home by special request, and as stated, was of a very mild nature. Death Rate. The second table on the previous page shows that 12 deaths were registered as due to Diphtheria, giving a case mortality rate of 7.5 per cent. This is a marked decrease on the figure for the previous year which was 9.19 per cent. Secondary Cases. There were 16 secondary cases in all, which is a small number compared with the number that might be expected. Only one return case occurred, that being a child who was discharged from hospital on the 30th January, the onset of the second attack being on 9th February. 54 Schools and Diphtheria. A table has been prepared showing the age groups of the children affected and the schools attended by them. It will be noticed that the departments chiefly affected were Finnymore Road Infants and the Village Infants. Immunisation campaigns have been carried out at both these departments with a good response regarding the number of acceptances. The total number of school children affected was 115 against 193 for the year 1936. School. Dept. AGE GROUP. Total 5 G 7 8 9 10 11 12 13 + Alibon Road I. 2 1 - - - - - - - 3 ,, B. - - - - - - - — — — ,, G. — — — — — — — — — — Arnold Road I. 3 1 - - - - - - - 4 ,, B. - - - - - 1 1 — — 2 ,, G. — — 1 3 1 2 — — — 7 Beacontree Heath I. 1 — 1 - - - - - — 2 ,, M. - - - - - - - — — — Beam Bridge I. 1 — — — — — — — — 1 ,, M. — — — — — — — — — — Chadwell Heath I. — — — — — — — — — — Charlecote Road I. 2 4 1 - - - - - — 7 ,, B. — — — — — — — — — — ,, G. - - - - - - - — — — Eastbrook B. - - - - - - - — — - ,, G. - - - - - - - 1 — 1 Fanshawe Crescent I. 1 - - - - - - - — 1 ,, B. - - - - - - —- —- - - M. - - - - - - - — — — Finnymore Road I. 3 8 2 - - - - - - 13 ,, B. — — — 2 — 1 1 — — 4 ,, G. — — 2 1 — 1 — — — 4 Five Elms I. 1 - - - - - - - - 1 ,, M. — — — — — 2 — — — 2 Ford's Endowed M. - - - - - - - - - - Goresbrook Road B. - - - - - - - 3 1 4 ,, G. - - - - - - 1 1 2 4 Grafton Road I. — 2 - - - - - - — 2 ,, G. — — — — 1 — — — — 1 ,, B. - - - - - 1 — — - 1 Carried forward 14 16 7 6 2 8 3 5 8 64 55 School. Dept. AGE GROUP. Total. 5 6 7 8 9 10 11 12 13 + Brought forward 14 16 7 6 2 8 3 5 3 64 Green Lane I. — — — — — — — — — — ,, M. - - - - 1 - - - - 1 Hainault College M. - - - - - - - - - - Hainault Forest I. - - - - - - - - - - ,, M. - - - - - - - - — — Halbutt Street B. - - - - - - 1 1 — 2 ,, G. - - - - - 1 — 1 — 2 Heathway Special M. - - - - - - - - - - Hunters Hall I. — 1 - - - - - - - 1 ,, B. - - - - - — — — — - , G. - - - - - - - - - - Kingsley Hall M. — - — — — — — — — — Lymington Road B. - - - - - - - - - - ,, G. - - - - — — 1 — — 1 Marley B. - - - - - - - - - — . ,, G. - - - - - - - - 1 1 Marsh Green M. — 1 — 1 — — — — — 2 ,, 1. 1 1 1 - - - - - - 3 Park M. - - - - - - 1 2 3 Parsloes I. 1 1 — — - - - — — 2 ,, M. — — — — — — — — — — ,, G. - - - - - - - - 1 1 Rush Green I. - - - - - - - - - — ,, M. - - - - - — 1 - — 1 St. Joseph's R.C. I. 1 1 - - - - - - - 2 ,, M - - - - - - - - - - St. Peter's R.C. I - - - - - - - - - - „ M. — — — — — — — — — — South Wood Lane I. 3 2 - - - - - - - 5 „ B. - — - - - - - - - - ,, G. - - - - - - - - - - Triptons B. - — — - - - - 1 - 1 ,, G. - - - - - - 1 1 2 4 Valence Avenue I. 3 - 2 - - - - - - 5 B. — — — — — — — — — — G. - - - - - - - - - - Village I. 3 7 - 1 - - - - - 11 Warren M. - - - - - - - - - - Whalebone M. — — - — 1 — — — — 1 ,, I. 1 — — — — — — — — 1 Schools not in District — — — 1 — — — — — — 1 27 30 11 8 4 9 8 9 9 115 Schick Testing and Immunisation. As in former years this treatment was encouraged for all children between the ages of one year and fourteen. 56 The scheme is brought to the notice of parents chiefly by two methods, namely, consent forms are posted so as to arrive on the child's first birthday and schools are visited by the Medical Ollicer of Health and the Head Teachers are asked to co-operate by explaining the methods to parents anxious for their children to be protected. I11 addition, the Medical Officer of Health has on many occasions during the year addressed meetings of Co-operative Guilds, Women's Labour Sections and Mothers' Unions and during the course of his remarks has brought to the notice of the audience the facilities offered. The scheme for enlisting the help of General Practitioners has continued in operation but advantage is only taken of it to a small extent. By this scheme parents wishing to have the treatment administered by their Doctors can do so by paying the fee of the Doctor, the material being supplied free by the Health Department. The final test and, if the child is over six years of age, the preliminary test are carried out at the immunization clinics. The reagent used for promoting immunity was Toxoid Antitoxin Floccules. This material has proved highly effective for attaining immunity and at the same time gives rise to practically on local or general reaction. The following is a summary of the work carried out during the year:— No. immunized without preliminary testing 371 No. Schick Tested 531 Of these 182 were Negative. No. of Schick Positives who received 3 doses 268 No. of Re-Schiek tests after 1 dose 7 Of these 4 were Negative. No. of Re-Schick tests after 2 doses Of these 2 were Negative. 57 No. of Re-Schick tests after .3 doses 531 Of these 522 were Negative. No. of Re-Schick-Positives who received 3 further doses 11 No. of Re-Schick-Positives subjected to a further Schick test after 1 more dose 1 This was Negative. No. of Re-Schick-Positives subjected to a further Schick test after 2 more doses 1 This was Negative. No. of Re-Schick-Positives subjected to a further Schick test after 3 more doses 5 These were Negative. No. of Re-Re-Schick-Positives subjected to a further Schick test after 3 more doses 1 This was Negative. Immunization by General Practitioners. No. immunised without preliminary testing 39 No. Schick tested 3 These were Positive. No. of Re-Schick tests 7 These were Negative. No. of Re-Schick-Positives subjected to a further Schick test after 3 more doses 2 These were Negative. Total number of children found to be immune during the year 727 The following figures are those of children dealt with from the time immunization was first started in September, 1930, to December 31st, 1937:— No. subjected to Schick test Positive 3,020 (Primary) Negative 1.635 No. subjected to Re-Schick test Positive 241 (after having undergone one course of injections) ( Negative 2,910 58 No. subjected to Re-Schick test Positive 9 (after having undergone two courses of injections) Negative 117 No. subjected to Re-Schick test Positive 1 (after having undergone three courses of injections) Negative 4 No. of children immunized without having been Schick-tested (under 6 years) 2,664 Total number of children found to be immune (including immunization by General Practitioners) 4,695 Immunization by General Practitioners. No. subjected to Schick test j Positive 18 (Primary) Negative 7 No. subjected to Re-Schick test Positive 4 (after having undergone one course of injections) Negative 20 No. subjected to Re-Schick test Positive Nil (after having undergone two courses of injections) (Negative 2 No. of children immunized without having been Schick-tested (under 6 years) 75 The following table shows details of children who attended for immunization and were subsequently notified as suffering from Diphtheria, together with observations as to the type and the ultimate result. It will be seen that cases number 1 and 7 died from Diphtheria. In case number 1 the child had received a Schick test which proved Negative, but unfortunately contracted what is known as the Gravis type which has a high fatality. In case number 7 we were not satisfied that the test was Negative and arrangements had been made to repeat the test, but the child was taken ill before this could be carried out:— 50 No. Age. Particulars of treatment. Notified as Diphtheria. Confirmed ? Severity. Result. 1 7½ Primary Schick-Negative, March, 1936 16/2/37 Yes. Severe. Died. 2 8½ Primary Schick-Positive and 3 doses T.A.F. June-July, 1936. Not re-tested. 2/3/37 No. — Recovered. 3 5 3 doses T.A.M. January-March, 1935. Re-SchickNegative, October, 1935. 10/4/37 Yes. Moderate. Recovered. 4 7 3 doses T.A.M. January-March, 1935. Re-SchickNegative, October, 1935. 26/4/37 Yes. Mild. Recovered. 5 6 Primary Positive test on 21/4/37. Removed to hospital with Diphtheria the following week. 29/4/37 Yes. Moderate. Recovered. 6 3 3 doses T.A.M. January-March, 1935. Re-SchickNegative, October, 1935. 21/5/37 No. — Recovered. 7 11 ? Primary Schick-Negative, April, 1937 14/6/37 Yes. Severe. Died. 8 6 3 doses T.A.M. March-April, 1933. Re-SchickNegative, April, 1934. 15/6/37 No. — Recovered. 9 4½ 2 doses T.A.F. April-June, 1937 31/7/37 No. — Recovered. 10 11 Primary Schick test on same day as removed to hospital. 1/12/37 Yes. Mild. Recovered. 11 6 Primary Schick-Positive and 1 dose T.A.F. November-December, 1937. 13/12/37 No. - Recovered. 60 The following table shows the proportion of children of various ages who rcacted Schick positively :— Age. Total. No. of Positives. Percentage Positive. Under 6 33 24 72.7 ,, 7 975 743 76.2 8 860 614 71.4 9 675 429 63.6 ,, 10 664 382 57.5 ,, 11 514 300 58.4 ,, 12 397 219 55.2 ,, 13 284 155 54.6 ,, 14 170 73 42.9 „ 15 31 15 48.4 Over 15 81 34 42.0 The following table shows the relation of the number of immunes in the household to the Schick-reactions of the children of various ages:— No. of immunes in family. Under 7. 7 and 8. 9 and 10. 11 and over. 7 and over 50.0 (4) — (3) 25.0 (8) 6 70.6 (17) 56.0 (25) 34.4 (32) 30.3 (33) 5 64.0 (25) 50.0 (38) 26.8 (41) 37.5 (40) 4 50.7 (69) 44.4 (117) 33.1 (121) 28.7 (108) 3 57.3 (150) 50.0 (276) 38.3 (243) 44.6 (204) 2 81.7 (623) 76.6 (917) 71.8 (617) 62.2 (381) (The numbers in brackets are the total number of children dealt with in the group.) The figures given in this table indicate the percentages of children found to be positive in the various age groups in relation to the numbers who are considered to be immune. The immunes consist ot members of the family who either have given a primary Schick negative reaction or for other reasons may be regarded as insusceptible. Although the number of 61 children dealt with is comparatively small, it will be seen that the tendency is to show that the greater the number of immunes per family, the greater will be the number who give a negative primary Schick reaction. Scarlet Fever. There was a marked decrease in the incidence, there being 384 cases notified compared with 482 for the previous year. Of these, 312 were admitted to Rush Green Isolation Hospital, 11 to other Isolation Hospitals and 61 remained at home. The age incidence resembles closely that exhibited by Diphtheria. It will be recalled that terminal disinfection has not been carried out for a number of years ; the figures above referred to bear out the wisdom of this policy. Reference has been made to disinfection generally in this and previous reports. Deaths. Only one death occurred from this cause, which gives the remarkably low figure of .26 per cent. Secondary Cases. There were 16 secondary cases compared with 34 for the year 1936, and in addition six cases are regarded as being return cases. Dick Test. No children were Dick-tested during the year. Schools. The incidence at the various schools with the ages of the children concerned is set out in tabular form. The disease was fairly evenly spread throughout the Various schools and it will be noticed that the depart- 62 ments mostly concerned have been the infants. The incidence of the disease tends to be reduced as the children get older. The total number of school children affected, it will be seen, was 267 compared with 208 for the previous year. School. Dept. AGE GROUP. Total. 5 6 7 8 9 10 11 12 13 + Alibon Road I. 7 2 2 - - - - - — 11 ,, B. - - - - - - - - - 1 ,, G. - - - - 2 - - - - 2 Arnold Road I. 3 - - - - - - - - 3 ,, B. — — — 1 1 1 — — — 3 ,, G. - - - - - - - - - — Beacon tree Heath I. 1 1 1 - - - - - — 3 ,, M. - - - 1 - - - - - 1 Beam Bridge I. — 1 - - - - - - -— 1 ,, M. - - - 1 - - - - - 1 Chadwell Heath I. 2 - - - - - - - — 2 Charlecote Road I. 5 1 2 - - - - - - 8 ,, B. — — — 1 — — — — — 1 ,, G. — — — 1 — 1 — — — 2 Eastbrook B. - - — — — — 2 — — 2 ,, G. - — — — — — 1 — 1 2 Fanshawe Crescent I. 3 — 3 - - - - - — 6 ,, B. — — — 1 — — — — 1 2 ,, M. - - - - - - 1 — — 1 Finnymore Road I. 5 2 4 - - - - - - 11 ,, B. — — — 1 — 2 — — — 3 ,, G. — — — — 1 1 — — — 2 Five Elms I. 1 2 1 — — — — — — 4 M. — — — 1 — 1 — — — 2 Ford's Endowed M. — 1 1 2 3 2 — — — 9 Goresbrook Road B. - - - - - - 1 — — 1 G. - - - - - - - - - - Grafton Road I. 7 3 - - - - - - - 10 ,, G. — — — 2 — — — — — 2 ,, B. - - - - - - - — — - Green Lane I. 3 15 5 — — — — — — 23 ,, M. — — — 2 4 2 3 — - 11 Hainault College M. 1 — 1 — — — — — - 2 Hainault Forest I. - - - - - - - — - - ,, M. - - - - - - - - - - Halbutt Street B. - - - - - - - — 1 1 ,, - - - - - - - - 1 1 Heathway Special M. — 1 — — — — — - 2 3 Hunters Hall I. 1 3 1 — — — — - - 5 ,, B. - - - - - 1 — — - ,, G. - - - - - - - - - - Carried forward 39 32 21 15 11 11 8 - 6 143 63 School. Dept. AGE GROUP. Total. 5 6 7 8 9 10 11 12 13 + Brought forward 39 32 21 15 11 11 8 - 6 143 Kingsley Hall M. — — — — — — — — — — Lymington Road B. — — — — — — — 1 1 2 ,, G. — — — — — — 2 2 2 6 Marley B. G. - - - - - - - - - - - - - 1 1 1 — - 1 2 Marsh Green M. — — — — — — — — — - ,, I. 1 3 4 8 Park M. 2 2 2 6 Parsloes I. 6 10 2 - - - - - - 18 ,, M. — — 1 — 1 1 — — — 3 ,, G. - - - - - - 1 — 1 2 Rush Green I. 1 2 - - - - - - - 3 ,, M. — — — — 1 — — — — 1 St. Joseph's R.C. I. 1 — 2 — — — — — — 3 ,, M. — — — — — 1 — — — 1 St. Peter's R.C. I. — — 1 — — — — — — 1 ,, M. — — — — 2 1 — — 1 4 South Wood Lane I. 1 2 1 - - - - - - 4 ,, B. - - - 1 - - - - - 1 ,, G. - - - 1 - - - - - 1 Triptons B. - - - - - - 2 1 - 3 ,, G. — — — — — — — 1 — 1 Valence Avenue I. 8 8 1 — — — — — — 17 " B. — — — 1 — — — — — 1 G. — — 1 2 - 3 — — — 6 Village I. 7 5 4 - - - - - - 16 Warren M. - - - - - - - - - - Whalebone M. - - - 1 2 1 - - - 4 ,, I. 5 1 - - - - - - - 6 Schools not in district - - - - - - - - 1 2 3 69 63 38 21 17 18 16 10 15 267 Enteric Fever. fifteen cases of fever of the Enteric type were notified, six of which were stated to be Para Typhoid. AH made complete recoveries. Each case was investigated and no common source of infection discovered. It will be remembered that dring the year there was a widespread incidence of diseases of this type, but in the areas surrounding Dagenham they were mostly of a mild form. The 64 onset of nine of the cases was stated to be during February and in nearly all instances the milk was either boiled or pasteurised, and the water supply was derived from the South Essex Waterworks Company. There was no evidence to support a view that the water supply was in any way attributable. One patient drank water from a stream in an outlying district. At the request of the Medical Officer of Health the local Medical Officer concerned immediately investigated this stream and it was found that there was no sewage effluent or suspected water passing into this stream at or above the point from which the water was taken. The ages of the patients varied between 3½ and 29 years, there being ten females and five males. Five of the cases only were above school age. In no instance was there a case of more than one patient at one address. As in former years, a careful watch was kept on all the contacts and instructions given with regard to precautions to be taken by the remaining members of the families. Sonne Dysentery. One case was notified, a male aged 21 years, who unfortunately died about four weeks after the date of onset. This patient took all his meals at cafes and restaurants ; it was not possible therefore, to trace the disease to any particular commodity of food. During the year there was an extensive outbreak of Sonne Dysentery in the County of Essex and elsewhere : it was, with few exceptions, of an exceedingly mild nature and fatalities were rare. Dagenham appeared to have escaped the epidemic with the one exception cited above. 65 Erysipelas. There were 24 eases notified, a slight reduction on the number in 19.36. Cerebro-Spinal Meningitis. One case of this disease was notified in October in a child aged six. She was removed to the Isolation Hospital and recovered. A second case, a sister of the above, contracted this disease in January, 19.38, some months after her sister was removed to hospital. Acute Anterior Poliomyelitis. There were three cases of Acute Anterior Poliomyelitis notified, one in August and two in September. Two were admitted to the Isolation Hospital at Rush Green and one was an in-patient at the time of notification at Princess Elizabeth of York Hospital. It is with regret that 1 have to report that one of these eases proved fatal. There were no cases of Polioencephalitis or Encephalitis Lethargica. Pneumonia. The number of notifications of Pneumonia received was 121, this being slightly less than those for the previous year. The number of deaths attributed to Pneumonia was 54, the same figure as for the previous year. The mortality was 44 per ccnt. of notified cases. Smallpox. Smallpox did not occur in Dagenham during 19.37. On several occasions, however, the Medical Ollieer of Health was called by General Practitioners to see cases suspected of this disease, but in no instance was the diagnosis confirmed. 66 The following table shows the position of vaccination for the last year:— 1. Successfully vaccinated 478 2. Insusceptible 2 3. Conscientious objectors 794 4. Died before vaccination 43 5. Postponed by medical certificate 54 6. Removed 36 7. Unaccounted for at present 282 There is no striking deviation from the normal in the above enumeration. No vaccinations were performed during the year by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. Tuberculosis. New Cases. Deaths. Primary Notification. Brought to notice other than by Form A Pulmonary NonPulmonary Pulmonary NonPulmonarv Pulmonary NonPulmonary M F M F M F M F M F M F Under 1 - - - 1 - - - - - - - 1 1- — — 4 1 — — 1 2 — 1 2 - 5- — 3 6 5 — — 3 3 1 1 — - 10- — 1 6 3 — 2 3 3 — — — - 15- 10 10 1 1 — 3 1 1 3 8 5 2 20- 5 11 1 2 2 7 — — — — — - 25- 20 12 1 2 4 6 — 2 6 6 — - 35- 15 8 4 — 6 4 — — 8 7 — - 45- 11 1 — — 2 3 — — 4 2 — - 55- 3 - - 1 - - - - 3 1 — - 65 & - - - - - - - - 1 — — - upwards 64 46 23 16 14 25 8 11 26 26 7 3 67 Register. Pulmonary. Non-Pulmonary., Male. Female. Male. Female. No. on register 1st Jan., 1937 30G 248 121 115 During the year:— New notifications 64 46 23 16 Deaths 24 25 6 1 Transfers into area 14 25 8 11 Transfers out of area 39 27 19 18 No. on register 31st Dec., 1937 321 267 127 123 The total number of new cases of tuberculosis notified during the year was 149 ; of these, 64 males and 46 females suffered from the pulmonary and 23 males and 16 females from the non-pulmonary type. In addition, there were brought to notice other than by primary notification, 39 pulmonary and 19 nonpulmonary cases; these were transferred into the district. Also 66 pulmonary cases and 37 nonpulmonary cases were transferred out of the area. The second table shows that at the end of the year there were 838 cases on the register compared with 790 on the 1st January, 1937. Deaths. 52 persons died from pulmonary tuberculosis, of whom 26 were males and 26 females. This compares with 33 males and 22 females for the previous year, ten deaths from non-pulmonary tuberculosis were registered, there being seven male and three female; in 1936 there were nine deaths registered as being due to this cause. With regard to notification of this disease, when it comes to our knowledge that a patient has died from 68 this cause and no notification has been received, the medical practitioner who last attended is approached, and an explanation of the omission requested. In most cases the reason given is that the doctor was of the opinion- that the case had already been notified. In five instances, deaths attributed to tuberculosis were registered in cases in respect of which no notification under the regulations had been received; three of these were pulmonary and two non-pulmonary. This gives a ratio of 8.06 per cent, of un-notified to total deaths due to tuberculosis, compared with 24.46 for the year 1936, thereby showing a very marked improvement in the notification of Tuberculosis. Sputum Analysis. 408 samples of sputum were submitted for analysis during the year at the Counties' Public Health Laboratories. Public Health (Prevention of Tuberculosis) Regulations, 1925 and Public Health Act, 1925, Section 62 (now Public Health Act, 1936, Section 172). No case arose during the year requiring action under the above Regulations and Acts. Tuberculosis After-Care Association. This Association has continued its activities throughout the year. Members of the Association are allotted certain patients, on whom they report periodically, when the results of their visits are communicated to the Committee, and in many cases milk and other supplements to their diet are granted. This 69 Association does a great deal of most valuable work in the area, and the members deserve the thanks of the community. Its activities, however, are unfortunately curtailed by scarcity of funds ; this is to be deplored as the assistance afforded to patients is not only of great material value, but it also must contribute to a large extent to the chances of the patients making a recovery. Pemphigus, Puerperal Sepsis and Puerperal Pyrexia. Remarks concerning the above notifiable diseases are contained in the section of the report dealing with Maternity and Child Welfare. Blindness. Circular 1621, issued in August 1937, advised County Councils and Local Supervising Authorities as to methods calculated to prevent blindness. Following this circular, arrangements were made with the County Council for the treatment of children under school age suffering from ocular defects to be treated by the County Ophthalmic Specialist. A further recommendation that 1 per cent, silver nitrate should be used as a prophylactic for the eyes of newly born infants was also put into operation. Further, arrangements have been made whereby the services of the County Venereal Diseases Officer are made available at the ante-natal clinics when necessary. The Members and Officers of the Local Authority continue to work in close relationship with the Association for the Welfare of the Blind which operates in this district. 70 Cancer. The following table gives the age incidence of fatal cases of cancer affecting certain specified sites:— MALES. FEMALES. UNDER 35 35-44 45-54 55-64 OVER 65 UNDER 35 35-44 45-54 55-64 OVER 65 Total Oesophagus - - - - 1 - - - - - 1 Stomach — — 2 2 1 — — 1 1 1 8 Large Intestine incl. Rectum — 2 — 2 1 1 — 1 1 1 9 Larynx — — — — 2 — — — — 1 3 Lungs — 1 2 — 1 — — 1 — — 5 Liver — — 1 1 2 — — 1 — — 5 Breast - - - - - - 1 3 — 3 7 Ovary — — — — - - - - - — — Uterus - - - - - - - - - 1 1 Other sites 3 3 4 3 8 — 3 5 1 8 38 3 6 9 8 16 1 4 12 3 15 77 It will be noticed that only four cases occurred in persons under the age of 35 years. The total number 77 was arrived at by scrutinizing the death returns as they were received. The Registrar-General assigns 80 deaths from Cancer to this district, 43 being males and 37 females. It was mentioned in my last report that owing to the ageing of the population an increase in the cancer death rate might be expected ; experience has justified this view. Alleged Cause. G«station. Presentation. Duration of Labour. Previous. Ante-Natal Supervision. Further Remarks. Stillbirths. Live Births. Miscarriages. Prolapse of cord Term Breech ? 1 1 - Ante-Natal Clinic and Hospital Birth in Hospital Debilitated condition of mother Term Vertex 12 hours — 2 — Midwife and private doctor — Toxaemia of pregnancy 30 weeks Breech 4 hours 5 4 — Midwife B.B.A. A.P.H. (placenta praevia) Term ? 3 days 1 — — Ante-Natal clinic and hospital Birth in hospital Toxaemia of pregnancy 32 weeks ? ? 1 2 — Ante-Natal clinic Macerated foetus A.P.H. Term Vertex 4 hours — 11 — Doctor (private) — Toxaemia of pregnancy Term Vertex 9 hours — — — Ante-Natal clinic — ? Prolonged labour Term Vertex Prolonged 1 — — Doctor (private) — Hydraminos Term Vertex Prolonged — 3 — Midwife — Toxaemia of pregnancy Term ? 12 hours 1 — — Ante-Natal clinic and hospital Birth in hospital A.P.H. (Placenta praevia) 32 weeks V ? 1 2 — Midwife Removed to hospital ? Term ? 6 hours 3 — Ante-Natal clinic and hospital Birth in hospital ? 32 weeks Vertex 12 hours 4 2 — Doctor (private) — ? ? 28 weeks Breech 9 — — — Doctor (private) One of triplets Malpresentation 39 weeks Footling 2 hours 1 2 '— Ante-Natal clinic and hospital Birth in hospital Complicated breech Term Breech 4 days — — — Hospital Birth in hospital A.P.H. (Placenta praevia) Term ? ? — 4 — Ante-Natal clinic and hospital Birth in hospital Debilitated condition of mother Term Breech ? — 2 — Midwife — Malformed foetus Term ? Prolonged 1 — 1 Ante-Natal clinic Birth in hospital Delayed second stage Term Breech 14 hours — — Midwife — ? Prolonged labour Term Vertex Prolonged 1 — — Doctor (private) — ? Term Breech 4 days — — — Midwife — ? 28 weeks Vertex 3 days 9 — Doctor (private) — Eclampsia 32 weeks ? 1 hour 1 1 — Ante-Natal clinic Removed to hospital ? Diabetes Term Vertex 14 hours — 8 3 Ante-Natal clinic — ? Term ? 48 hours — 5 — Ante-Natal clinic Twin A.P.H. Term Vertex ? — 2 — None Removed to hospital A.P.H. (Placenta praevia) 34 weeks ? ? — — — Doctor (private) Removed to hospital Complicated breech Term Breech 14 hours — 6 — Ante-Natal Clinic ? Shock (fire at home) Term Vertex 7 hours — 4 1 Midwife _ Toxaemia of pregnancy 34 weeks Vertex 14 hours — — — Doctor (private) — ? Term ? 48 hours — 3 2 Doctor (private) — Poor general health during pregnancy 28 weeks Vertex 6 hours — 2 — Private nursing home Twin ? Term Vertex 5 hours — — — Midwife — Poor general health during pregnancy Term ? 9 — 2 1 Doctor (private) Removed to hospital Malpresentation Term Vertex 24 hours - 5 — None Malpresentation (anencephalic) Term Breech 14 hours — 1 — Ante-Natal clinic and hospital Birth in hospital 9 Term Breech 12 hours — — — Doctor (private) — y 32 weeks Breech 4 hours 1 5 — Ante-Natal clinic — A.P.H, poor general health 32 weeks ? 9 — 10 — Ante-Natal clinic Birth in hospital ? 32 weeks ? 9 1 9 — Doctor (private) Birth in hospital A l .11. (Placenta praevia) Term ? 9 — 2 — Ante-Natal clinic and hospital Birth in hospital ? Term Vertex 24 hours — — — Doctor (private) Macerated foetus ? Shock following breaking down of old Caesarean scar 38 weeks — — — 1 — Ante-Natal clinic and hospital Caesarean section (Placenta praevia) Term ? 24 hours — 3 1 Ante-Natal clinic Removed to hospital ? Term Vertex ? 15 minutes - 8 - Midwife B.B.A. Complicated breech Term Breech 5 hours 1 — None Removed to hospital Diabetes Term ? 6 hours 4 — Hospital Macerated foetus ? 32 weeks Vertex 6 hours — — Ante-Natal clinic — or general health during pregnancy Term ? ? 2 6 — None Removed to hospital ?Prolonged labour Term Vertex Prolonged - 3 - Doctor (private) 71 MATERNITY AND CHILD WELFARE. Notification of Births. 1,852 notifications of live births were received during the year. 192 notifications (including stillbirths) were received from medical practitioners and parents and 1,246 from mid wives. Information was received of 462 births outside this area. The following list shows where most of these took place:— East End Maternity Hospital 251, Oldchurch Hospital 93, Charing Cross Hospital 22, Plaistow Maternity Hospital 22, Queen Mary's Hospital, Stratford 11 and The London Hospital 9. The Notification of Births Acts have now been repealed by Section 203 of the Public Health Act, 1936. Illegitimate births accounted for 1.72 per cent, of the total births. Stillbirths. 33 male and 15 female stillbirths were notified, the corresponding figures for registration being 39 and 22. I he rate per 1,000 of total population registered was 0.58, the rate for England and Wales being 0.60. The percentage of illegitimate stillbirths to the total was 3.28 compared with a percentage of illegitimate to total births of 1.72. The stillbirths which occurred in the district, the alleged causes and other associated details are shown in the table. Infant Mortality. 104 infants under one year of age died during the vear, giving an infant mortality rate of 52.71 per 1,000 live births, compared with that of 58 for England and 72 Wales and 60 for London. The rate amongst legitimate children was 52.60 while for illegitimate children it was 58.82. In order to give a clear picture of the causes of infant deaths and the ages at which they occurred, the following table has been prepared :— Infant Deaths Under One Year. of death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total under Four weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total deaths under 1 year. Bronchial Pneumonia ... 1 2 3 2 8 5 5 2 2 22 Gastro Enteritis — — — 1 1 3 4 2 1 11 Marasmus — — — — — 1 2 — — 3 Spina Bifida 2 — — 1 3 — — — — 3 Pyloric Stenosis - - - - - - 1 - - 1 Atelectasis 4 — — — 4 — — — — 4 Congenital Heart Disease 1 - - 1 2 - 1 1 2 6 Prematurity 29 1 1 — 31 — — — — 31 Intussusception — — — — — — — 2 — L Inanation at Birth 1 — — — 1 — — — — 1 Haemorrhagic disease of the new born 1 - - - 1 - - - — 1 Hydrocephalus — — — — — — — — 1 1 Icterus Neonatorum 3 — — — 3 — — — — 3 Miliary Tuberculosis — — — — — — 1 —- — 1 Acute Ileo Colitis, Chronic Otitis Media — — — — — 1 — — — 1 Cerebral Injury—Obstructed labour 4 - 1 - 5 - - - — 5 Complete obstruction of small intestine (Congenital) 1 - - - 1 - - - - 1 Pulmonary Oedema 1 — — — 1 — — — — 1 Intoxication from scalds Congenital heart (Coroner's inquest) 1 - - - 1 - - — — 1 Meningitis — — — — — — — 1 - 1 Acute Mastoiditis - - - - - - - — 1 - Pulmonary Tuberculosis - - - - - - - 1 — 1 Cerebral Haemorrhage 1 — — — 1 — — — - 1 Asphyxia Neonatorum 1 — — — 1 — — - - - 51 3 5 5 64 10 14 9 7 104 73 Deaths of Older Children. 34 children died between the ages of one and five years ; of these, 22 were males and 12 females. The largest individual cause of death was Pneumonia which was assigned as the reason for 14 deaths in children under the age of five, Whooping Cough two, Scarlet Fever one and Pneumonia five between the ages of one and two and nine between the ages of two and five. There has been a very marked decrease in the number of children who died between the ages of one and five, 34 compared with 81 for the previous year. This is partly accounted for by the fact that 1937 was not a Measles year. Owing to the almost constant cycle of Measles, we may expect an increase in the deaths from this cause for the year 1938. Ophthalmia Neonatorum. Notified. Treated at home. Treated in hospital. Vision Unimpaired. Vision impaired. Total Blindness. Deaths. 4 — 4 — — - — There were 51 cases in which a medical aid notice was sent by a midwife to a medical practitioner on account of some eye condition occurring in a newly born infant. All these cases were visited by the Medical Officer of Health and a Health Visitor. Of the total cases investigated, only four were notified as suffering from true Ophthalmia Neonatorum. Under the ruling of the Central Midwives Board discharge from the eye of a newly born infant, however slight, must be notified to the Medical Officer of the Local Supervising Authority, who in the case of Dagenham is the Medical Officer of Health. 74 Pemphigus. During the year, there were six notifications of children suffering from Pemphigus, three of whom were removed to hospital and the remainder treated at home. Maternal Mortality. Six deaths were registered as being due to pregnancy or associated with that condition which is equivalent to a maternal mortality rate of 2.95 per thousand total births, compared with 3.11 for England and Wales. The actual causes of death as stated on the certificates were:— Case 1. a. Suppurative Pyelonephritis. b. Hypostatic Pneumonia. c. Pregnancy (Full term). Case 2. Shock following Parturition. Case 3. a. Heart failure. b. Eclampsia. c. Pregnancy. Case 4. Post Partum Haemorrhage. Adherent Placenta. Childbirth. Case 5. 1. a. Myocardial Degeneration. b. Caesarean section and Hysterectomy done for Ante-Partum Haemorrhage due to Macerated foetus. 2. Toxaemia of Pregnancy. 75 Case 6. Shock due to uterine inertia. Difficult Labour. Of the above, numbers 1, 2 and 4 did not receive ante-natal supervision, case number 5 attended an antenatal clinic on one occasion and it was not possible to obtain information with regard to ante-natal attendances in cases 3 and 6. Puerperal Fever and Pyrexia. 24 notifications were received during the year; of these, 19 were those of puerperal pyrexia and five puerperal fever. Per 1,000 total births (i.e. live and stillbirths) the rate for these conditions was 11.79, the corresponding figure for the country as a whole being 13.93. Of the total number of patients notified, 13 were removed to hospital for treatment. Every case of this condition is investigated by a Health Visitor and in addition many of them are visited by the Medical Officer of Health. Work of Health Visitors. The scheme introduced for planning and recording visits by Health Visitors has been in operation sufficiently long to show that it has enhanced the efficiency of this branch of the service. This scheme ensures that no children shall be overlooked and allows a continuous record of their history to be filed, which is subsequently passed on to the County Council for the information of the School Medical Officers. In addition to the routine visits, special visits are paid to cases of Ophthalmia Neonatorum, Puerperal Fever and Pyrexia, stillbirths, infant deaths, etc., and subsequent to operative treatment of tonsils and 76 adenoids. The Health Visitors also attend the various clinics. In the case of infant welfare centres and ante-natal clinics, the Health Visitor is, as far as possible, in charge of the session at which the mothers from her district attend, thus preserving the personal association of the Health Visitor with the mother and children who live in her area. The following table shows the number of visits paid by Health Visitors during the year:— (a) To expectant mothers First visits 623 Total visits 1,117 (b) To children under one year of age First visits 2,091 Total visits 4,578 (c) To children between the ages of one and five years Total visits 12,880 Grand Total 18,575 Infant Welfare Centres. There are two weekly infant welfare centres at the Becontree Clinic, three at Ford Road, two at Five Elms, two at Pettit Farm, one at Chadwell Heath and two at Rush Green. At the time of writing this report, the Committee has under consideration the question of increasing the number of clinic sessions to meet the constantly growing attendances. Each of these centres is attended by two Health Visitors and one clinic clerk, with the exception of Rush Green, at which there is only one Health Visitor in attendance owing to the limited accommodation. 77 At most of the centres ladies acting in an entirely voluntary capacity attend the clinics for the purpose of supplying teas. These services are very much valued and add considerably to the harmony of the clinics. Profits derived from the teas are paid in to the Treasurer's Department and are applied in helping necessitous cases whose needs are not catered for otherwise. A considerable sum of money was paid in by these ladies during the year. The thanks of those concerned is once more extended to them. The following table shows the work done at the infant welfare centres:— Total attendances at all centres during the year:— (1) By children under one year of age 21,009 (2) By children between the ages of one and five 16,356 Average attendances of children per session at all centres during the year ... 69 Total number of children who attended at the centres for the first time during the year:— (1) Children under one year of age 1,542 (2) Children between the ages of one and five 635 Percentage of total notified births represented by the number of children under one year who attended for the first time 83.26% Treatment. Adenoids and Enlarged Tonsils. The same arrangements continue in operation for the treatment of these conditions, namely, agreements with the following hospitals:—King George Hospital, Ilford; Queen Mary's Hospital, Stratford; St. Mary's 78 Hospital, Plaistow; and Oldchurch Hospital. Most cases, however, are treated at King George Hospital, the majority being detained overnight. During the year a total of 26 cases was treated at a cost of £27 6s. 0d. Orthopaedic Treatment. (a) Ascertainment Clinic.—The Consultant Orthopaedic Surgeon paid six visits to the district during the year, when 102 children made 149 attendances. 74 children attended once only, 19 attended twice, 11 three times and one four times. The commonest conditions for which children were referred were genu valgum, pes planus, bowed tibiae, talipes and poliomyelitis. The cost allocated to this Council was £16 10s. 0d. (b) Massage Clinic.—The massage and remedial exercises clinic was held twice weekly at the Ford Road and Becontree Clinics. During the year 294 children under school age received treatment at a cost of £82 9s. 0d. making a total of 824 attendances. Most cases were referred on account of flat foot, knock knee or bowed legs. (c) Provision of Appliances.—A member of the staff of a firm of instrument makers usually attends on the Monday following the visit of the Orthopaedic Surgeon, to take measurements of those children requiring surgical appliances. The Local Authority assists in payment for these according to the financial circumstances of the family. Four appliances were supplied at a total cost of £3 15s. 0d. (d) Hospital Treatment.—Three children were sent to hospital for operative treatment at a total cost of £70 18s, 0d. 79 Ultra-Violet Ray Therapy. Light treatment is carried out at the Becontree and Dagenham Clinics, two sessions being held weekly at each of the premises. The cases treated are referred from the Infant Welfare Centres and all children are seen by a Medical Officer every fortnight. A few children of school age are referred by the School Medical Officer, payment for which is made by the County Education Committee to the Dagenham Council. A course of treatment commences with a two minutes exposure back and front, working up to a six minutes double exposure, being 12 exposures in all. The clinics close down from May to September. 231 children commenced treatment of whom 139 completed one course, seven completed two courses and two four courses. Dental Treatment. 23 extraction sessions were held, at which 206 children were treated and 179 mothers, making a total of 547 attendances. A charge is made for each case (not per attendance), the amount depending upon the financial circumstances of the family. The amount received was £21 15s. 6d. and the nett cost of this service was £43 17s. 4d. Dentures are provided, usually only to those persons referred from the ante-natal clinic. The amount received as patients' contributions was £28 2s. 7d., leaving a sum of £99 2s. 5d. as the cost to the Council. Treatment of Minor Ailments. By arrangement with the Education Committee, children under school age in certain cases receive treatment at the minor ailment clinics, this Council being responsible for a per capita charge. 80 Ophthalmic Treatment. As mentioned under the heading of blindness, arrangements are in force for treating children under school age at the School Ophthalmic Clinics. The cost of this treatment is borne by the Council. Convalescent Home. 15 mothers and children were admitted to convalescent homes at a cost of £165 8s. 4d. As in former years, the local branch of the Invalid Children's Aid Association and the Personal Service Council have been most helpful in arranging convalescent treatment for mothers and children. The Secretaries of these organisations have rendered valuable assistance on many occasions. The same number of mothers and children were dealt with as in the previous year. Jubilee Boot Fund. As part of the celebration of the Silver Jubilee of His late Majesty King George V, the Council decided to invest a sum of £1,000, the interest on which was to be devoted to the provision of boots and similar necessities which could not otherwise be obtained through public funds. During the year a total sum of £8 8s. 6d. has been expended in the purchase of boots. Other Provisions. One child was supplied with a pair of glasses at a cost of 9s. 10d. and another child was treated for ringworm at the Queen's Hospital for Children, the cost to the Council being one guinea. 81 Consultant Obstetrician. The Consultant Obstetrician has been called into consultation on 21 occasions. This service is very much valued and there is no doubt that the efficiency of the maternity and child welfare organisation has been much enhanced by this addition. Originally patients were requested to refund to the Council a portion or the whole of the assessed cost of each consultation, but having in mind that patients in certain instances might hesitate to call in the survices of the Consultant for fear of incurring a debt, the Council decided that these emergency consultations should be free to all except those who would, in the ordinary course of events, call in a Consultant in a private capacity. Emergency Obstetric Unit. A unit of this nature has been inaugurated whereby the services of the Council's Obstetric Consultant and a trained nurse can be obtained in the patient's own house when an emergency arises which would prevent her from being safely removed to hospital. Apparatus, blankets and hot water bottles in readiness for this purpose are kept at York House. Ante-Natal Services. Ante-Natal Clinics.—During the latter part of the year, three weekly ante-natal sessions were held at the Becontree Clinic, three at the Dagenham Clinic, two at the Five Elms Out-Patient Department and a new weekly clinic was commenced at York House. In addition, the Chadwell Heath Clinic was held twice monthly and at Rush Green once monthly. At, the Five Elms Out-Patient Department the Consultant Gynaecologist paid fortnightly visits throughout the year, seeing a total of 200 women who made 315 attendances. 82 185 cases were referred to hospital for confinement under the Council's scheme, of whom 152 were admitted to the East End Maternity Hospital, eight to Charing Cross Hospital and 25 to Oldchurch Hospital. The cost to the Council for these patients, after the receipt of the patients' fees, amounted to £858 12s. 9d. The total number of attendances made by the 1,043 women was 5,556. As will be mentioned later, arrangements are now in force for the attendance at the ante-natal clinic of the midwife who has been engaged for the confinement. Hospital Cases. Of the 362 cases referred to hospital, 252 were admitted on other than medical grounds. 185 were assisted under the Maternity and Child Welfare Scheme. Abnormal cases are referred to their own medical attendants, or where the patient desires, and her condition demands, arrangements are made for her confinement to take place in an institution. When patients are referred for admission to Oldchurch Hospital they continue to attend the Consultant at our Ante-Natal Clinic, unless some special investigation such as an X-ray examination is required, when they attend at Oldehureh Hospital for that purpose. Furthermore, the Consultant sees on behalf of any local medical practitioner, any patients referred to him by them. Post Natal. There is a tendency for mothers to take advantage increasingly of the Post-Natal examinations; 138 mothers took advantage of this service during the year. The importance of a Post-Natal examination cannot be 83 stressed too much as there is ample evidence to prove that many untoward conditions can be averted by proper attention in this direction. Gynaecological Clinic. This clinic continues to be held at Becontree Avenue on the first Saturday morning of each month, the total number of attendances being 137, giving an average of five per session. In my previous report a full statement was given of cases for the period ended May, 1037. Foster Children. The following tables show the number of foster children and foster mothers in the district:— Foster children— No. on register, December 31st, 1036 34 No. added to register 32 No. deducted owing to refusal, removal, deaths or reaching age of nine 32 No. on register, 31st December, 1937 34 Foster Mothers— No. on register, 31st December, 1936 32 No. of additions during year 18 No. taken off during year 19 No. on register, 31st December, 1937 31 Those who intend to receive foster children, on making application to the Authority (The Dagenham Urban District Council), receive a visit by a Health Visitor and Sanitary Inspector. A full examination is made of the conditions obtaining in the home and a report on the prospective foster mother is made by the Health Visitor; further, if the foster mother should have recently moved into the district and previously acted 84 in this capacity, a report is obtained from the Medical Officer of Health of the district in which she formerly lived. It will be seen that every effort is made to maintain a high standard of foster parent. According to the existing law, when notification is received that a woman intends to accept a foster child, the Local Authority has no power to refuse except under certain specified conditions. If, however, it is subsequently considered that the environment of the foster mother may be prejudicial to the child, the procedure is to obtain an order from the Court of Petty Sessions to prohibit the foster mother from continuing to act as such. The Welfare Authority may fix the number of children under the age of nine years who may be kept in any premises in which a foster child is kept. For the purpose of the Children and Young Persons Act, 1932, now re-enacted by Section 209 of the Public Health Act, 1936, all the Health Visitors are Infant Life Protection Visitors and visit foster children in their district at regular intervals, and in addition, all foster children below the age of five are required to attend the Infant Welfare Centres. Day Foster Mothers. During 1937, the Council decided to adopt a scheme for supervising the well-being of children under school age. The question of the establishment of one or more day nurseries was considered but owing to the nature of the distribution of the population in relation to the industries, it was decided that one day nursery would only serve such a limited number of inhabitants that some alternative scheme might be adopted. 85 A scheme was, therefore, introduced for establishing a system of Day Foster Mothers. Briefly, this scheme is as follows:— (1) In order to compile a Panel of Foster Mothers, notices are displayed in the Clinics, also names of suitable people are obtained by the Health Visitors. (2) A supply of application forms for the use of Foster Mothers is kept at the Clinics. (3) Prospective Foster Mothers arc informed that only in exceptional circumstances will more than one child be allowed to be taken by one Foster Mother. (4) The charge is 1s. 6d. per day with a maximum of 7s. 6d. per week. Foster Mothers are informed of this verbally by Health Visitors. (5) The Health Visitor visits the homes of applicants before they are included in the Panel, and reports to the Medical Officer of Health. (6) Sanitary Inspectors report regarding accommodation and cleanliness of premises. (7) Mothers wishing to obtain the services of Day Foster Mothers apply to the Health Visitor at the Infant Welfare Centre for names of available Day Foster Mothers on her district. She is told what the charge is and if able to pay, does so direct to the Foster Mother. If unable to do so, she is given an income form and is assisted according to scale. (8) Day Foster Mothers notify the office before taking over the care of the child. Leaflets are then sent on feeding and general care of the child and it is definitely stated that the diet must include at least the equivalent of one pint of milk per day. Rules regarding attendance at the Infant Welfare Centre are also forwarded. It is made clear that the child must be returned to its own home for the night. 86 (9) The child attends the Infant Welfare Centre and is seen by the Doctor at the Clinic monthly. (10) The home is visited by the Health Visitor monthly, irrespective of attendance at the Infant Welfare Centre. Surprise visits are also paid to the home. (11) Day Foster Mothers notify the Public Health Department as soon as possible after the child is removed from her care. (12) Mothers are discouraged from going out to work except in cases of financial difficulties. (13) The services of Day Foster Mothers can be utilised in special circumstances on single days, for instance, if a mother has to attend hospital or on other similar occasions. As far as is known, this Council is the first of any in the country to operate a scheme on these lines. Being an innovation, it was submitted in detail to the Minister of Health, who intimated his approval. Considering the short period of its operation, the use being made of the scheme is distinctly encouraging, and it appears that it is justified. Maternity Homes. There are no Maternity Homes in the district, but one Nursing Home which is licensed to receive eight medical or chronic cases has been established in Whalebone Lane. The Minister of Health, has, by Circular 1433, issued in October, 1934 and by Circular 1622 dated May, 1937, suggested that new maternity homes should not be established unless they are in association with general hospitals. 87 Assisted Milk Scheme. The expenditure incurred by the Council under the assisted milk scheme for the year was:— £ s. d. (a) For ordinary milk 899 17 3 (b) For dried milk 362 8 1 Total quantity of milk supplied to expectant and nursing mothers and young children:— Liquid Gallons. Dried Pounds. 9,625 4,415 Education. This Council participated in the "National Campaign to Encourage the Wider Use of Health Services" which was organised by the Central Council for Health Education. A number of posters were displayed and leaflets issued. Many meetings and local organisations were addressed by the Medical Officer of Health and the Senior Health Visitor during the year. The interest of the general public on health matters appears to be well maintained. The practice of sending out birthday cards accompanied by appropriate pamphlets to reach infants on the first anniversary of their birth has been continued. There is no evidence to show that the restriction of sending cards only on the first birthday has in any way curtailed the efficiency of this method of propaganda. Birth Control Clinic. A Birth Control Clinic under the auspices of a voluntary committee is held once a fortnight. The Local Authority makes a per capita grant to this body 88 for persons who attend in whom pregnancy would be detrimental on medical grounds. During the year payments amounting to £9 15s. 0d. were made for this purpose. Supervision of Midwives. The Council became the Local Supervising Authority under the Midwives Acts as from 1st April, 1937. The number of Midwives who notified their intention to practise at the end of 1937 was 32. The routine inspection and special investigations are undertaken by the Medical Officer of Health. Notifications received from 1st April to 31st December, 1937:— Notices summoning medical aid 339 For (a) Mothers 223 For (b) Infants 110 The following is a summary of the reasons for sending for medical help by midwives:— Prolonged Labour 55 Discharging Eyes 51 Perineal Tear 50 Rise of Temperature 33 Ante-Partum Haemorrhage 14 Malpresentation 14 Feebleness of Infant 13 Deaths 12 Stillbirths 11 Deformity 4 Post-Partum Haemorrhage 4 Miscarriage 4 Jaundice 4 Placenta Praevia 1 Other Causes 69 339 89 Notification was received intimating that artificial feeding had been resorted to in 13 cases. In two instances midwives gave notice that they had laid out dead bodies, and on 25 occasions midwives notified that they were liable to be sources of infection. Domiciliary Midwifery Service. The scheme under the Midwives Act, 1936 for the provision of a domiciliary midwifery service is now in full operation. The Council has appointed nine midwives and arrangements have been entered into with the Essex County Nursing Association and Salvation Army Nurses, whereby the former body provides seven midwives and the latter two. The district has been divided into three areas. To the northern area, that is the part of the district north of Wood Lane, four Council and two Salvation Army midwives have been allocated. The central area, which is bounded on the north by Wood Lane and the South by the L.M.S. Railway line, is served by the Essex County Nursing Association, and five Council midwives practise in the southern section. The fees charged and general conditions of practice are the same for both Council and Association midwives; holidays, off duty times and booking arrangements being the same for all midwives. The aim is to restrict the number of cases to approximately 80 per midwife. Each patient is visited until the 14th day and seven evening visits are paid. W ith regard to the Council midwives, these work in pairs in order that they may relieve one another for off-duty times, or on other occasions when, for any reason, they are not available to answer calls. Midwives also attend the Ante-Natal Clinics at which they 90 assist; this enables them to become acquainted with their patients, to be informed of all conditions associated with the pregnancy and to work in close collaboration with the Health Visitors, who will, at a later date, visit the children. All patients to be attended by Council and Association midwives are provided free of charge with a sterile maternity outfit, and in certain cases miscarriages are attended by the midwives included in the scheme. Up to the time of writing the scheme has worked harmoniously and should ultimately have the effect of reducing maternal mortality and morbidity. Up to the time of writing the scheme has worked harmoniously and should ultimately have the effect of reducing maternal mortality and morbidity. CAUSES OF DEATH Under 1 year Over 1 and under 2 Over 2 and under 5 Over 5 and under 15 Over 15 and under 25 Over 25 and under 35 Over 35 and under 45 Over 45 and under 55 Over 55 and under 65 Over 65 and under 75 75 and over TOTAL RegistrarGeneral's Allocations. M F M F M F M F M F M F M F M F M F M F M F M F M F 1. Typhoid and paratyphoid fevers - - - - - - - - - - - - - - - - - - - - - - - - - - 2. Measles - — — — 2 — — — — — — — — — — — — — — — — — 2 — 2 — 3. Scarlet Fever — — — — 1 — — — — — — — — — — — — — — — — — 1 — 1 — 4. Whooping Cough 1 1 - — 1 1 - - - - - - - - - - - - - - - - 2 2 2 2 5. Diphtheria — — 1 — 1 2 2 6 — — — — — — — — — — — - — — 4 8 4 8 6. Influenza — — — — — — — — — — 1 — — — 2 — 2 — — 1 — 1 5 2 5 4 7. Encephalitis lethargica - - - - - - - - - - - - - - - - - - - - - - - - - - 8. Cerebro-spinal fever — — — — —- — — — — — — — — — — — — — — — — — — — — — 9. Tuberculosis of respiratory system — 1 — — — — 1 1 3 8 6 6 8 7 4 2 3 1 1 — — — 26 26 26 25 10. Other tuberculous diseases — 1 1 — 1 — — — 5 2 — — — — — — - - — — — — 7 3 6 4 11. Syphilis - — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 — 12. General paralysis of the insane, tabes donahs - - - - - - - - - - - - - - - - - - - - - - - - - - 13. Cancer, malignant disease — — — — — — 1 — 1 — 1 1 6 4 9 12 8 3 15 11 1 4 42 35 43 37 14. Diabetes — — — — — — — — — — — — — — — 2 1 — — 1 — — 1 3 1 4 15. Cerebral haemorrhage, etc. - - - - - - - - 1 - 1 - - - 2 — 3 4 1 3 2 3 10 10 3 11 16. Heart Disease — — — 1 — — — 1 1 2 4 2 11 2 14 4 14 9 10 12 16 18 70 51 75 55 17. Aneurysm — — — — — — — — — — — — 1 — — — 1 — — — — — 2 — 3 — 18. Other circulatory diseases — — — — 1 — — — 3 — 1 — 1 — - — 2 — — 3 — — 8 3 8 9 19. Bronchitis 1 1 — — 1 — — — — — 1 — 1 — 1 — 2 1 3 4 3 4 13 10 12 11 20. Pneumonia (all forms) 15 6 3 2 6 3 1 — — 1 1 — 2 2 6 3 2 3 3 3 1 6 40 29 32 22 21. Other respiratory diseases - - - - - - - - - - - - - - 1 — 1 1 1 1 — 2 5 4 3 1 22. Peptic Ulcer 1 — - — — — — — — — 1 — 1 — 2 — — — — — — — 5 — 3 — 23. Diarrhoea, etc. (under 2 years) 6 3 1 - - - - - - - - - - - - - - - - - - - 7 3 8 4 24. Appendicitis - - - - - - - - 1 - 1 - 1 — — — 2 — — — — — 5 — 5 — 25. Cirrhosis of liver - - - - - - - - - - — — — — - — — — 1 — — — 1 — 1 — 26. other diseases of liver, etc. - - - - - - - - - - - - - - - - - - - - - - - 1 1 1 27. digestive diseases - 1 - — - — - —. - — — - — — 2 1 2 1 — — — 2 4 5 10 6 28. Other chronic nephritis — — — — — — — — — — 3 4 1 2 1 2 4 2 1 1 1 3 11 14 5 9 29. Puerperal sepsis — — — — — — — — — — — — — — — — — — — — — — — — — — 30. Other puerperal diseases - - - - - - - - - 1 - 3 - 1 - 1 — — — - - - - 6 — 6 31. Congenital debility, premayure birth, malformation, etc. 36 23 - - - - - - - - - - - - - - - - - - - - 36 23 36 26 32. Senility - - - - - - - - - - - - - - - - - - 1 1 7 11 8 12 8 12 33. Suicide - - - - - - - - - - - - 2 2 - 4 1 - - 1 - - 3 7 2 7 34. Other violence 1 1 - - - - 1 1 9 2 6 - 5 4 2 1 1 2 - - 2 1 27 12 27 11 35. Other defined diseases 4 3 1 2 1 1 5 3 2 2 1 — 6 2 2 4 4 3 2 3 1 4 29 27 28 21 36. Causes ill-defined or unknown - - - - - - - - - - - - - - - - - - - - - - - - - 1 65 41 7 5 15 7 11 12 27 18 29 16 46 27 48 36 54 30 39 45 34 59 375 296 361 297 INDEX. A Page Acute Anterior Poliomyelitis 65 Acute Polio Encephalitis 65 Adenoids and Tonsils 77-78 Ambulance Facilities 18-20 Ante-Natal Clinics 21, 81-82 Artificial Sunlight 23,79 B Bacteriological Examination 51 Bakehouses 48 Baths 37 Birth-rate 10,14 Births 11, 12-13,71 Birth Control 87-88 Births, Illegitimate 10,71 Births, Still 10,71 Blind, Association for the Welfare of 69 Blindness—Prevention of 69 Boot Fund 80 Byelaws—Premises and Occupations controlled by 34-36 C Camping Grounds 35 Cancer 70 Cerebro-Spinal Fever 65 Cesspools 28-29 Chemical and Bacteriological Examination 51 Children's Invalid Aid Association 80 Clinics and Treatment Centres 20-23 Closet Accommodation 28-29 Committees 7 Contents—Principal 3 Convalescent Home 80 Council—Members of 7 D Day Foster Mothers 84-86 Deaths 11,13-14,71-78,74,91 Death-rate, General 13-14 Death-rate, Infantile 11,14 Deaths, Causes of 91 Deaths, Infants 11,14,71-72 Dental Treatment 22,79 Diarrhoea (Deaths from—under two years of age) 11 Diphtheria 53-61 Disinfection 33-34 District Nursing Association 20,23—24,25 Drainage and Sewerage 28-31 Dried Milk 87 Dust Collection 32—33 INDEX.—Continued. E Page Education in Health 56,87 Encephalitis Lethargica 65 Enteric Fever 63-64 Erysipelas 65 Extracts from Vital Statistics 11 F Factories and Workshops 38 Food and Drugs 50 Food Inspection 45-50 Food Poisoning 49-50 Food Shops 48-49 Foster Children and Mothers 83-86 Free Supplies of Milk 87 Fried Fish Shops 34 G General Provision—Health Services 15 Gynaecological Cases 83 H Hairdressers' and Barbers' Premises 36 Health Committee 7 Health Services—General Provision of 15 Health Visitors—Work of 75-76 Hospitals—Children 18 Hospitals—General and Special 16-18 Hospitals—Infectious Diseases 15 Hospitals—Maternity 17 Hospitals—Orthopaedic 18 Hospital—Smallpox 15 Houses Let in Lodgings 43 Housing Statistics 39-42 I Ice-Cream 49 Illegitimate Births 10 Immunization Clinics 55-61 Infant Deaths 11, 14,71-72 Infant Welfare Centres 20, 76-77 Infantile Mortality 11, 14, 71-72 Infectious Diseases Hospital 15 Infectious Diseases 52-69 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 18 Invalid Children's Aid Association 80 INDEX. Continued. L Page Laboratory Facilities 25 Legal Proceedings 43,47-48,50 Legislation in Force 26-27 Library Books 33-34 Light Treatment 23,79 M Massage Clinic 23 Maternal Mortality 74-75 Maternity and Child Welfare 71—90 Maternity and Child Welfare Committee 7 Maternity Homes and Hospitals 17-18, 86 Measles 11,73 Meat Inspection 46—48 Meningitis, Cerebro-Spinal 65 Midwives 25, 88-90 Milk—Free Supplies 87 Milk in Schools 46 Milk (Special Designation Order) 45 Milk Supply 45-46 Minor Ailments 79 Mortality, Analysis of 91 Mortality, Infantile 11,14,71-72 Mortality, Maternal 74- 75 Mortality, Neo-Natal 11,14,71-72 N Neo-Natal Mortality 11, 14, 71-72 Notices Served and Complied with 36-41 Notifications of Births 71 Nursing Arrangements 23-24 Nutrition 51 O Obstetrician-Consultant 81 Offensive Trades 34 Ophthalmia Neonatorum 73 Ophthalmic Treatment 80 Orthopaedic 18, 22, 78 Overcrowding 41-42 P Pail Closets 28 Pemphigus 69,74 Personal Service Council 80 Physical Features of Area 31-32 Pneumonia 65,73 Population 11 INDEX.—Continued. P Pago Post-Natal Examination 82-83 Preface 5-6 Premises and Occupations Controlled by Byelaws 34-36 Prevention of Blindness 69 Principal Contents 3 Prosecutions—Unsound Food 47-48 Prosecutions, Sale of Food and Drugs Act 50 Public Health Committee 7 Puerperal Fever and Pyrexia 69,75 R Rag and Bone Dealers 35 Rateable Value 10 Rats and Mice (Destruction) 38 Refraction Clinic 22 Refuse Removal and Disposal 32-33 Remedial Exercises and Massage Clinic 23 Rivers and Streams 31-32 S Sanatoria 16 Sanitary Circumstances of the Area 28 Sanitary Inspection of Area 37-38 Scarlet Fever 61-63,73 Scavenging 32-33 Schick Immunization Clinics 55-61 School Clinics 21-22 Schools 37 Sewerage 28-31 Shops Act, 1934 36 Slaughterhouses 46-47 Slaughter of Animals Act, 1933 48 Smallpox 15, 65-66 Smoke Abatement 34 Social Conditions of Area 10 Sonne Dysentery 64 Staff 8-9 Statistics 10-11 Stillbirths 10, 71 Streams 31-32 Swimming Baths 37 T 14 Table, Birth-rate, etc. „ Cancer 70 „ Death-rate, etc. 14 „ Deaths, Causes of 91 ,, Diphtheria Immunization 56-60 „ Foster Children 83 INDEX.—Continued. T Pago Table, Housing 39-41 „ Infant Mortality 72 ,, Infectious Diseases, Notifiable 52 Infectious Diseases, Removed to Hospital 52 „ Infectious Diseases in School Children 54-55, (12—63 ,, Inspections for Year 37—38 „ Meat Inspection 47 „ Milk Samples 46 Ophthalmia Neonatorum 73 „ Record of Inspections 37-38 „ Stillbirths facing 71 „ Tuberculosis Deaths 66-67 „ Tuberculosis Notifications 66-67 „ Vaccination 66 Tents, Vans and Sheds 35 Tonsils and Adenoids 77-78 Treatment 20-23,77-80 Tuberculosis 16, 22, 66-69 Tuberculosis After Care Committee 68-69 Typhoid Fever 63-64 U Ultra Violet Ray Therapy 23,79 Unmarried Mothers Is V Vaccination 66 Vermin 43-44 Venereal Diseases 22 Vital Statistics, Extracts from 10-11 Visits, Health Visitors' 75-76 Visits, Sanitary Inspectors' 37-38 W Water Supply 28 Welfare of the Blind—Association for 69 Whooping Cough 11,73 Workshops 38 Z Zymotic Diseases 52—69