AC 44 11 (1) DA GENHAM DAG 12 BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1938 CECIL HERINGTON, M.B., B.S. (Lond.), D.P.H. BOROUGH OF DAGENHAM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1938 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 25 Sanitary Circumstances of the Area 27 Disinfection 33 Sanitary Inspection 36 Housing Statistics 40 Statistics of Inspections 40 Inspection and Supervision of Food 45 Infectious and Other Diseases 50 Diphtheria 51 Scarlet Fever 57 Tuberculosis 61 Cancer 64 Maternity and Child Welfare 66 Infant Mortality 66 Maternal Mortality 69 Infant Welfare Centres 71 Ante-Natal Services 76 Supervision of Midwives 83 5 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I beg to submit my report upon the Health Services of the Borough for the year 1938. Perusal of the report will show that the health of the people compares favourably with that of similar districts, and the statistics with those of the country as a whole. The birth-rate at 18 per thousand remains high, but is slightly lower than that for 1937. The infant mortality rate of 50.51 is remarkably low, especially when one has in mind the very large child population. This figure reflects credit not only on your services, but also on the care bestowed by the mothers on their infants. Ninety-one per cent, of children under one year of age attended the infant welfare centres. The incidence of Diphtheria and Scarlet Fever is also worthy of note ; in both diseases there is a marked drop, in the latter the total number of notifications tailing by over one hundred. The domiciliary midwifery scheme, the newest of our services, has worked well, and has been in operation sufficiently long to enable an assessment of its value as 6 a public health measure to be made. In my view, the hope expressed that the Midwives Act, 1930 would eventually raise the standard of midwifery will be realised. It will be noticed that this report appears somewhat later than is customary. The reason for this, it is submitted, is obvious and therefore calls for no excuses. My sincere thanks are offered to my colleagues and the whole of the staff of the Public Health Department for their efficient service and loyal co-operation. In conclusion, I have pleasure in recording once more my appreciation of the support received from the members of the Corporation at all times, with special reference to the Chairmen and members of the committees concerned with the activities of the Public Health Department. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 7 members of the council. (31st December, 1938). Mayor : Alderman A. F. J. CHORLEY, J.P. Deputy Mayor : Alderman B. H. SAUNDERS, E.C.C. Aldermen : A. L. BANKS (Mrs.) R. J. D. CLACK. L. F. EVANS (Mrs.), E.C.C. E. E. HENNEM. M. E. MARLEY (Mrs.), J.P. R. J. MINCHIN. Councillors : J. R. ANDREWS. V. C. BARNEY. A. BARR. W. E. BELLAMY. D. E. BROWN. F. BROWN. J. W. BURRIDGE. W. T. CAIN. A. E. <;115BS. F. T. GRINDROD. C. L. HERMITAGE. W. F. LEGON. W. C. MARKHAM. J. E. MUNN. R. G. MURRELL. J. NEISH (Mrs.) E. OSBORNE. M. REDDY. E. S. REDDY (Mrs.) F. L. M. ROGERS (Mrs.) A. ROGERS. A. R. THOMAS (Mrs.) F. G. THOMAS. C. A. THORNEYCROFT. public health committee. Councillor C. A. THORNEYCROFT, Chairman. Councillor (Mrs.) F. L. M. ROGERS. Vice-Chairman. His Worship the Mayor (Aid. A. F. J. CHORLEY, J.P.) Deputy Mayor (Aid. B. II. SAUNDERS, E.C.C.) Coun. J. R. ANDREWS. Coun. J. W. BURRIDGE. Coun. W. F. LEGON. Coun. J. E. MUNN. Coun. (Mrs.) J. NEISH. Coun. (Mrs.) E. S. REDDY. maternity and child welfare committee. Councillor (Mrs.) A. R. THOMAS, Chairman. Alderman (Mrs.) A. I,. BANKS. Vice-Chairman. His Worship the Mayor (Aid. A. F. J. CHORLEY, J.P.) Deputy Mayor (Aid. B. H. SAUNDERS, E.C.C.) Coun. D. E. BROWN. Co-opted members :— Mrs. F. M. BUNTING. Mrs. E. E. KINGDON. Mrs. L. MORGAN. Coun. A. E. GIBBS. Coun. W. F. LEGON. Coun. (Mrs.) J. NEISH. Coun. E. OSBORNE. Coun. (Mrs.) F. REDDY. Mrs. B. R. ROBERTS. 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.K.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. Senior Sanitary Inspector : G. T. CARTER, Certificate of Royal Sanitary Institute ; Meat Inspector's Certificate. (Retired November, 1938.) L. E. PRIOR, Certificate of Royal Sanitary Institute ; Meat Inspector's Certificate. (Appointed November, 1938.) Sanitary Inspectors : J. W. ALLAM, Certificate of Royal Sanitary Institute ; Meat Inspector's Certificate. 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. F. W. KNIGHT, Certificate of Royal Sanitary Institute; .Meat Inspector's Certificate. (Appointed November, 1938.) Senior Health Visitor: M. SMITH (1, 2, 3). Health Visitors : V. A. EVERITT (1, 2, 3). A. K. GIBSON (1, 2, 3). J. W. B. MACFIE (1. 2, 3). I. PLUMMER (1, 2, 3). I. F. RICHARDSON (1, 2, 7) (Resigned April. 1939.) M. B. THOMAS (1. 2, 8). D. E. WALLER (1, 2, 3) L. WEALE (1, 2, 3, 5, 6) Midwives : D. K. ANKER (2) E. M. BEDFORD (1. 2). E. CASHMAN (2). C. HURRY (2). G. JIMACK (1, 2). O. M. LISSAMORE (2). H. MITSON (1, 2). M. ROTHWELL (2). M. J. STOREY (2). 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 Clerical Staff : Senior Clerk : B. E. E. DENNY. Clerk to Sanitary Inspectors : H. FIELD, Certificate of Royal Sanitary Institute. Clerks : I. M. BISHOP E. L. CURTIS. P. R. DRISCOLL. D. I. FLETCHER. (Resigned August, 1938.) P. H. M. MURPHY. (Appointed August, 1938.) G. A. M. POWER. K. W. SKEATES. (Appointed November, 1938.) M. A. WATTS. Part-Time Staff : Consulting Gynecologist : W. S. O'LOUGHLIN, M.D., M.C.O.G. (Resigned June, 1938.) R. L. DODDS, M.Ch., F.R.C.S. (Eng.). (Appointed June, 1938.) Consulting Obstetrician: W. S. O'LOUGHLIN, M.D., M.C.O.G. (Resigned June, 1938.) 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 1938 107,400 Number of inhabited houses (end of 1938) according to Rate Books 25,904 Rateable value (Dec. 31st, 1938) £587,702 Sum represented by a penny rate (approximate 1938-39) £2,354 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 are being built by private enterprise. Extracts from Vital Statistics for the Year. Live Births:— Total. Male. Female. Legitimate 1,890 992 898 Birth rate per 1,000 of the estimated resident population, 18.06. Illegitimate 50 26 24 Stillbirths:— Rate per 1,000 total (live and still) births, 30.00. Legitimate 59 27 32 Illegitimate 1 1 — 11 Total. Male. Female Deaths 665 889 326 Death rate per 1,000 of the estimated resident population, 6.19. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.5 Other puerperal causes 6 3.0 Total 7 3.5 Death rate of Infants under one year of age:— All infants per 1,000 live births 50.51 Legitimate infants per 1,000 legitimate live births 48.68 Illegitimate infants per 1,000 illegitimate live births 120.00 Deaths from Measles (all ages) 9 ,, „ Whooping Cough (all ages) 5 „ ,, Diarrhœa (under 2 years of age) 17 Population. The Registrar-General's mid-year estimate was 107,400; this is an increase of 1,900 compared with the previous year. The excess of live births over deaths for the year was 1,275. 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:— 12 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 25,170 4.19 1938 107,400 25,904 4.15 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. 1,940 live births were registered during the year, there being 1,018 males and 922 females. This is in a ratio of 1,104 males to 1,000 females, which is considerably higher than the average, as usually male births exceed females by about 50 per 1,000. There is a drop of total births from 1,973 in 1937 to 1,940. The birth rate per thousand population was 18.06 compared with 15.1 for England and Wales and 15.0 for the 126 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, 18.47 and 18.7 for the years 1927 to 1937 inclusive. This is the lowest birth rate recorded for the district, but despite this, it still exceeds that for England and Wales by nearly 3 per 1,000. 13 The illegitimate birth rate continues to be very low, being only 2.58 per cent, of total births. The rate of illegitimate stillbirths is 1.67 per cent, of total stillbirths. Death Rate. Total deaths in district 383 Outward transfers 118 Inward transfers 403 Deaths of residents 668 Of the 118 deaths of non-residents occurring in the district, 50 took place at the West Ham Sanatorium, 23 at the Joint Isolation Hospital, 28 at Hainault Lodge and four at Storrington Nursing Home. Of the 403 deaths of local residents taking place outside this area, most occurred in institutions. Of these, 225 occurred at Oldchurch Hospital, 28 at Orsett Institution, 14 at the London Hospital. 13 at King George Hospital, seven at St. Peter's Hospital, seven at Epping Institution, six at St. Andrew's Hospital, six at Severalls Mental Hospital, six at Brentwood Mental Hospital, five at the London Fever Hospital, four at St. Joseph's Hospice, and four at Queen Mary's Hospital, Stratford. 665 deaths in a population of 107,400 represent a death rate of 6.19 compared with 11.6 for England and Wales. For the years from 1927 to 1937 inclusive, the local rates were 7.0, 7.3, 8.3, 6.6, 7.2, 6.5, 6.5, 6.6, 5.63, 6.43 and 6.24. 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 1938. 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. Influenza. Diarrhoea and Enteritis (under two years). Total Deaths (under one year). England and Wales 15.1 0.60 11.6 0.00 0.00 0.04 0.01 0.03 0.07 0.11 5.5 53 126 County Boroughs and Great Towns, including London 15.0 0.65 11.7 0.00 0.00 0.05 0.01 0.03 0.07 0.10 7.8 57 148 smaller towns (1931) resident populations 25,000-50,(KM) 15.4 0.60 11.0 0.00 0.00 0.03 0.01 0.02 0.06 0.11 3.6 51 London 13.4 0.48 11.4 0.00 0.00 0.06 0.01 0.03 0.05 0.06 13.1 57 Dagenham (estimated population 107,400) 18.06 0.56 6.19 0.00 0.00 0.08 0.00 0.05 0.12 0.07 8.77 50.51 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 Boroughs of Dagenham and Romford and the Urban District Council of 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 it was arranged that cases could be admitted to the hospital at Colchester ; negotiations were undertaken for the treatment of cases in the western portion "I the County at another hospital, but finality on this point has not yet been reached. No case of Smallpox was reported in 1938. 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 71 61 11 8 151 Children 7 5 11 11 34 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, Ilford.—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 cases; 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 1938, 1,143 patients were admitted from Dagenham against 1,168 for the previous year, whilst at the main hospital 6,246 out-patients residing in Dagenham received treatment, and at the Five Elms Out-Patient Department there were 7,101 attendances. (2) Hospitals for Maternity Cases. The majority of normal cases were admitted to the East End Maternity Hospital; this arrangement continues to work satisfactorily. Cases discovered by the Consultant Gynaecologist to require special 18 ment are admitted to Oldehurcb Hospital and the City of London Maternity Hospital on the recommendation of the Consultant. (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 Ilford. (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 three well-equipped ambulances and the members of the staff of the fire brigade act as drivers and attendants. These men have all been trained in first-aid and have given evidence of their efficiency over a number of years. 19 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 1937 figures for purposes of comparison:— 1938. 1937. No. of accident cases conveyed 611 651 No. of other cases conveyed 2,581 2,524 No. of journeys made 3,195 2,917 No. of miles run 33,190.4 29,765.4 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. All ambulances were out together 643 times, whilst on occasions when the vehicles were in commission, the ambulances of Barking and Ilford were requisitioned. Dagenham was called upon by Barking 77 and by Ilford three times. Dagenham called upon Ilford 63 and on Barking 12 times. (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 that the patient is fit for conveyance is required before removal. 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 (Comm. 9/7/38) Weekly Monday, a.m. 31 1 Monday, p.m. Monday, p.m. Thursday, p.m. 85 4 Becontree Clinic, Becontree Avenue, Dagenham. Weekly 94 6 Weekly 95 7 Ford Road Clinic, Ford Road, Dagenham. Weekly Tuesday, p.m. Wednesday, a.m. Wednesday, p.m. 91 8 Weekly 57 3 Weekly 63 4 Pettit Farm, Heathway, Dagenham. Weekly Thursday, a.m. Thursday, p.m. 50 3 Weekly 67 4 Out-Patient Dept., King George Hospital, Five Elms, Dagenham. Weekly Tuesday, p.m. Wednesday, p.m. 84 3 Weekly 85 5 Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Friday, a.m. Friday, p.m. 14 1 Weekly 32 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) Friday, p.m. 20 5 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Monday, a.m. Thursday, a.m. 16 3 Weekly 13 3 Weekly Friday, a.m. 15 3 Ford Road Clinic, Ford Road, Dagenham. Weekly Tuesday, a.m. Thursday, a.m. Friday, a.m. 17 4 Weekly 17 4 Weekly 11 2 Out-Patient Dept., King George Hospital, Five Elms, Dagenham. Weekly Tuesday, a.m. Wednesday, a.m. 17 4 Weekly 12 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. Monthly (1st in month) Friday, a.m. 11 3 York House, Frizlands Lane, Dagenham. Weekly Wednesday, a.m. 18 3 The attendances at both Infant Welfare Centres and Ante-Natal Clinics remained high during the early part of 1939. A scheme for increasing the numbers of these clinics and consequently the medical, nursing and clerical staff was approved, but owing to special circumstances, the putting into operation of this scheme was delayed. 22 School Clinics. Clinic. Inspection. Minor Ailments. The Clinic, Becontree Avenue. Tuesday afternoon, Wednesday morning, and Friday afternoon. Mondays, Wednesdays and Thursdays, 9-10 a.m. The Clinic, Ford Road. Monday morning and Thursday afternoon. Tuesdays, Wednesdays and Fridays, 9-10 a.m. Out-Patient Dept., King George Hospital, Five Elms. Monday afternoon and Friday morning. Tuesdays and Thursdays, 9-10 a.m. 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. In addition to facilities at the London Hospital under arrangement with the London and Home Counties Scheme, a treatment centre has been established at Oldchurch Hospital and the clinic is open daily for treatment 9 a.m. until 8 p.m. and Sundays 10 to 12 noon. Medical sessions are held on Tuesdays 9 a.m. to 12.30 p.m. and Thursdays 5 to 7 p.m. 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 23 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. 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 nurses undertake midwifery and maternity nursing, and in addition medical and surgical cases are attended. A total of 1,234 general nursing cases was treated during the year, involving 8,692 visits to the homes. 386 midwifery cases and 64 maternity cases were nursed. In addition, these patients paid a total of 3,937 visits to the ante-natal clinic held at York House. Altogether then, the number of persons attended during the year was 1,684 to whom 23,192 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 year, the York House Nurses attended at 177 ante-natal clinics, three post-natal clinics and answered 466 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. It was only necessary for one case of Pneumonia to be treated at home by these nurses for the year under review. Experience shows that, normally, severe cases of Pneumonia stand removal badly. 25 Midwives. Nine Council Midwives are employed, and by agreement, seven nurses employed by the District Nursing Association and two employed by the Salvation Army are at the disposal of the Council. The arrangements for domiciliary midwifery have in practice worked out satisfactorily. Fuller reference to midwives will be made under the appropriate heading later in this report. Laboratory Facilities. Examination of clinical material is undertaken at the Counties Public Health Laboratories, Queen Victoria Street, London. During the year, 450 swabs were examined for the diphtheria bacillus, 307 samples of sputum for the bacillus of tuberculosis, 37 samples of hair for the fungus of ringworm, examination for agglutination of blood against typhoid and allied organisms on 14 occasions, and in addition, 41 specimens were submitted for examinations of a miscellaneous character. The same laboratory also undertakes bacteriological examination of milk and ice-cream, of which 56 samples of the former and 28 of the latter were submitted during the year. 413 swabs were examined for the diphtheria bacillus at the Public Health Offices. Legislation in Force. Byelaws. Date of Confirmation. Common Lodging Houses 24/12/1901 Slaughter Houses 26/9/1928 New Streets and Buildings 10/7/1925 Sanitary Conveniences 8/1/1932 Houses let in Lodgings 27/1/1932 26 Date of Confirmation Smoke Abatement 21/4/1933 Collection of Refuse 23/8/1934 Sale of Food from Stalls 12/12/1934 Removal of Offensive and Noxious Matters 27/11/1934 Prevention of Nuisances and Keeping of Animals 17/1/1935 Moveable Dwellings and Camping Grounds 21/8/1935 Hairdressers' and Barbers' Premises 12/9/1935 Tents, Vans, Sheds and similar Structures 19/11/1935 Rules and Regulations. Dairies, Cowsheds, etc. 25/2/1908 Domiciliary Midwifery Scheme 1/2/1938 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. Local Acts. Dagenham Urban District Council Act, 1928. Dagenham Urban District Council Act, 1931. Essex County Council Act, 1933. Dagenham Urban (Water) Order, 1929. 27 SANITARY CIRCUMSTANCES OF THE AREA. Water. At the instigation of the Medical Officer of Health, the County Medical Officer called a meeting of Medical Officers of Health of eight districts in the South Essex Waterworks Company's area of supply. As a result of the deliberations of the Conference and subsequent consultations with the Company, there has been arranged:— (a) A co-ordinated system of sampling by the local authorities to avoid adjoining districts taking, for example, simultaneous samples of the same water supply. Each local authority will take a sample once a month, in accordance with a rota. The Company will be given the opportunity of being present and taking a check sample. (b) That the Company shall, in relation to their own tests, supply to each Medical Officer of Health:— (1) a copy of any particular analysis on request ; (2) an annual statement of examinations carried out by the Company during the year upon request; and (3) full details whenever the Company's bacteriologist agrees that any particular source of supply is unsatisfactory. (c) That each Medical Officer of Health shall supply to the Company prompt notification of "cases of enteric fever or other diseases likely to be waterborne." It does not appear to be necessary to 28 notify every case, but the necessity for notifying any case will be left to the discretion of the Medical Officer of Health. The scheme was submitted to the Ministry of Health, who expressed general approval thereto. This scheme came into operation on the first Monday in November, 1938. The samples for November and December both proved to be satisfactory. I am indebted to B. W. Bryan, Esq., Engineer of the South Essex Waterworks Company, for the following “ Mains Laid : 3 ” 178 yards 4 ” 2,784 ,, 6 ” 1,004 ,, Total 3,966 ,, New supplies connected 818 The analytical reports on all analyses made of the water supplied in your Borough showed that the water was pure and wholesome and suitable for the purposes of a public supply. It is anticipated that the Stour Supply Scheme (1935) will come into supply during the late Spring or early Summer of 1940. Early in the present year (1939) a laboratory was built and equipped at the Company's Langham Works and a whole-time chemist and bacteriologist, together with an assistant chemist and bacteriologist were engaged and 1,500 to 2,000 samples per year are now being analysed." Samples have been taken from three wells serving Thornton's Farm Cottages and the reports show that in each case the water is polluted. The users of the water 29 have been warned that the water should not be consumed without previously having been boiled for 20 minutes. As it is anticipated that this land will soon be developed and main water made available, it would not appear to be necessary to take further action at the present time. Seven other samples of water were taken; four proved satisfactory and three unsatisfactory. Drainage and Sewerage and Sewage Works Extensions and Closet Accommodation. Under this heading I am indebted to the Borough Surveyor for the following information:— "At the commencement of year there were 46 cesspools in the district: during the year five of these were connected to the sewer. The cesspools were emptied by the Shelvoke & Drewry mechanical emptier, which removes 750 gallons per load. The total number of loads emptied was 1,103. 30 cesspools are situated in the northern part of the district and 11 in the south and east. At the commencement of the year there were 38 premises having earth closets. During the year this number was decreased to 33, due to demolition and connection to the sewer. The number of closets to empty was 39, and the number of visits made was 1,897. The total number of clearances during the year was 2,133. The cleansing of earth closets is a weekly service, carried out by the Shelvoke & Drewry cesspool emptying machine. 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 30 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 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 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 discharge of the highly purified domestic effluent mixed 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, pending construction of further extensions to meet increasing flows, now in the region of 4 m.g.d. D.W.F. 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 31 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. The works are under the direction of the Borough 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. It may be added that these tests include Atmospheric Pollution Examinations for the Borough. 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, attention 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 32 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 occasionally becomes choked with weeds and rubbish and it is necessary, from time to time, for the obstruction to be cleared, this, on occasions, being done by the Borough Engineer's Department. 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. Refuse Collection. The work of refuse collection is a weekly service, carried out by means of seven freighters. Five of these are of the side-loading type, and two are of the endloading revolving floor type. The personnel required for this work is four gangs of approximately eight men each in charge of a ganger. The transport is operated on the relay system, so that the work of collection is continuous, and that as new areas become built-up, they can be added to the existing "rounds" without causing undue inconvenience. At the commencement of the year there were 25,759 premises from which refuse was collected. This number was increased by 543 during the year, making a total of 26,302. The total number of visits made was 1,354,197, and the total number of loads removed was 10,219. Collection of waste paper and trade refuse are made concurrently with the house refuse collection. Sacks are provided free to tradesmen for the collection of paper and three bins of trade refuse are collected free of charge from tradesmen; any additional bins are charged for at the 33 rate of 4d. per bin. A concession granted and appreciated by tradesmen is that trade refuse is accepted at the Salvage Plant for disposal free of charge. This has made the careless dumping of trade refuse on waste land a thing of the past. The following figures relate to the cost of this service for the financial year ended 31st March, 1939:— Collection. Disposal. Total. Net cost £10,592 £3,428 £14,020 Net cost per ton 13s. 8.1d. 4s. 5.1d. 18s. 1.2d. Net cost per 1,000 popu- lation £98.6 £31.9 £130.5 Net cost per 1,000 premises £402.7 £130.3 £533 Total Refuse collected 15,492 tons Weight per 1,000 population per day 7.9 cwts. No. of houses and premises 26,302 Disinfection. There has been no change in the position with regard to disinfection, and as mentioned under Diphtheria and Scarlet Fever elsewhere in the report, the omission to provide terminal disinfection definitely does not cause a spread of infection. During the year 1938, this Council accepted responsibility for the cost of disinfecting bedding and clothing of persons suffering from Scabies in 12 cases, the cost being approximately £6. 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 householder to bring the books either to this office or to 34 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 be 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. During the year a total of 15 observations was made. In three cases chimneys were found to be emitting smoke for a period in excess of that laid down by the byelaws. In each case the fact was immediately brought to the notice of the firms concerned and no furt her trouble was experienced. During 1938 the Council became a member of the Greater London Advisory Regional Smoke Abatement Committee. Premises and Occupations which can be controlled by Byelaws. Offensive Trades—Fried Fish Shops. There were 23 fried fish shops in the district at the end of 1938, to which a total of 215 visits was paid during the year. No new businesses were established. Rag and Bone Dealers. 19 persons were seen to be exchanging toys for rags in contravention of section 154 of the Public Health Act, 1936. Warning letters were sent in each case. 35 Tents, Vans and Sheds. Taking the district throughout, little difficulty is experienced with regard to the control of these structures. Cases are continually occurring where 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. The co-operation of the Police has been of great assistance in this matter. Camping Grounds and Moveable Dwellings. There are four camping grounds in the district. Systematic inspections are carried out during the period of occupation and conditions were found to be satisfactory. Licences have been granted in respect of two sites under Section 269 of the Public Health Act, 1936. The estimated maximum number of campers resident in the area at any one time during the summer season of 1938 was 250. 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 36 year 98 inspections were made and a total of 270 visits was paid. One certificate of exemption under Section 10, Sub-Section 6 of the Shops Act, 1934, was granted in respect of premises in the district. 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 served. Notices complied with. Temperature 10 8 W.C. accommodation (repairs, etc.) 2 3 Ventilation ... – 12 11 Swimming Baths. The swimming bath at Valence Park still attracts a large number of persons, and the demand for swimming facilities has been so great that the Council decided to build a swimming bath in the southern part of the district; this was completed and opened during 1939. 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 4,171 Overcrowding provisions of Housing Act 451 Nuisances under Public Health Acts 1,476 37 Bakehouses 67 Slaughterhouses 778 Milkshops, dairies and vehicles 144 Food shops and stalls 1,549 Cafes 165 Infectious disease enquiries 2,078 Food poisoning enquiries 3 Visits to foster mothers' premises 62 Smoke observations 15 No. of complaints investigated 889 Outworkers' premises 111 Houses let in lodgings 94 Ice-cream premises and vehicles 242 Factories, workshops, etc. 130 Tents, vans and sheds 162 Stables 65 Dagenham U.D.C. Act, 1931 11 Rats and Mice (Destruction) Act 439 Hairdressers' and Barbers' premises 19 Shops Act, 1934 270 Rooms fumigated 184 Other visits 55 (b) Notices served. Complied with. Statutory 17 15 Informal 1,094 881 Factories. Administration of the Factory and Workshop Act, 1901 and the Factories Act, 1937 (which superseded the Act of 1901 on 1st July, 1938). 38 1. Inspections for the purposes of provisions as to health including inspections made by Sanitary Inspectors:— Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power 88 2 Factories without mechanical power 42 — — Other premises under the Act (including works of building and engineering construction but not including outworkers premises) 1 — — Total 131 2 — 2. Defects Found. Particulars. No. of Defects No. of defects in respect of which prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness 4 1 — Overcrowding — 1 — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors 1 1 — — Sanitary Conveniences: Insufficient 1 1 — — Unsuitable or defective 13 7 — — Not separate for sexes — — — — Other offences 4 4 Totals 23 15 — — 39 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, 21 informal notices were served during the year and 27 were complied with. 40 HOUSING. HOUSING STATISTICS FOR THE YEAR 1938. Number of New Houses erected during the year:— Total 742 (1) By the Local Authority Nil (2) By other Local Authorities Nil (3) By other bodies and persons 742 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) 1,933 (b) Number of inspections made for the purpose 4,171 (2) (a) Number of dwelling-houses cluded under sub-head (1) above), which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 1,334 (b) Number of inspections made for the purpose 2,620 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 605 41 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 460 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 5 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 5 (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 3 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 2 (b) By Local Authority in default of owners Nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil 42 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 5 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 Nil (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 347 (2) Number of families dwelling therein 347 (3) Number of persons dwelling therein 2,372 (b) Number of new cases of overcrowding reported during the year 39 (c) (1) Number of cases of overcrowding relieved during the year 201 (2) Number of persons concerned in such cases 1,233 (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 43 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. New Housing Estate. During the year 1938 the Council completed the Frizlands Housing Estate ; incidentally, the 1,000th house to be built by this Council was included in this group. Amongst these houses are 30 bungalows for the use of aged couples; these are equipped with such labour saving devices as hot and cold water and bathrooms which are combined with the sculleries. They have proved of immense benefit, and are so much sought after that the Council has decided that when another 44 housing estate is contemplated, a proportion of the dwellings shall be of the bungalow type. Legal Proceedings. Proceedings were taken against the owner of a house which was the subject of a Demolition Order under Section 11 of the Housing Act, 1936, because of his refusal to vacate the premises. An order for possession within a month was granted. Proceedings were taken under the byelaws in respect of Tents, Vans, Sheds and similar structures, against the occupant of a shed. A fine of 20s. Od. was imposed. Houses Let in Lodgings. At the end of the year there were 17 premises registered as houses let in lodgings to which 94 visits were paid. Verminous Premises. Three Dagenham Council houses and 78 other premises were found to be infested with bugs. All disinfestation was carried out by this Department and material used was Zaldecide Spray, or in certain cases "Cescones" were employed. 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 78 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 6 Ungraded 65 The number of company distributing centres is ten. The number of shops retailing milk in sealed containers is 74. At the end of the year the number of wholesalers registered in this district for the sale of milk was lour. The number of cowkeepers in the district at the end of 1938 was one; during the year this cowkeeper made application to the County Council for a licence to use the designation "Accredited" in relation to milk produced at the farm. During the year 1938, the following licences were issued in respect of graded milks:— Pasteurised Tuberculin Tested 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 47 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 6 – 17 1 17 -– 30—100 3 – – 2 1 – 100—200 – – – – – – 200—500 – – – – – – Over 500 – – – – – – 9 — 17 3 18 – (b) Meat and Other Foods. Meat Inspection. There are four slaughter-houses in the district, one licensed and three registered. To these a total of 773 visits was paid during the year. The carcases inspected numbered 3,403. The following table shows the extent of unsoundness existing in these animals, the affected meat being surrendered in each case:— 47  Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 794 30 21 2,267 865 Number inspected 720 30 20 1,844 838 All diseases except Tuberculosis. Whole carcases condemned 1 — — — — Carcases of which some part or organ was condemned 23 — — 10 10 Percentage of the number affected with disease other than tuberculosis 3.4 — — 0.54 1.1 Tuberculosis only. Whole carcases condemned 3 — — — 1 Carcases of which some part or organ was condemned 55 — — — 42 Percentage of the number inspected affected with tuberculosis ... 7.7 — — — 5.1 Legal Proceedings. No legal proceedings were taken during the year 1938. 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, 67 visits were paid during the year. Food Shops. 658 visits were paid to butchers' shops, 444 to fish shops, 221 to provision shops, 144 to dairies and milkshops, 115 to greengrocers' shops, 165 to cafes, 38 to confectioners and 73 to other food shops. 48 The following unsound foodstuffs came to the notice of the Sanitary Inspectors and were surrendered:— ] crate lettuce; 4 stone mixed fish; 16 stone skate; 10 tinned hams—120 lbs.; 8 tins jellied veal—38 lbs.; 2 tins lambs livers; 6½ boxes kippers; 7 sausage rolls; 3 Cornish pasties; 1 box prunes and 3 boxes fillets. Ice-Cream. During the year, 27 samples were taken for analysis. 25 were satisfactory and two 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 icecream 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, four notifications of food poisoning were received, details of which are added. None of the cases displayed the clinical symptoms of true food poisoning. It will be of interest to note that under the Food and Drugs Act, 1938, food poisoning is made notifiable and thus becomes general law. 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 ot 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. The following is a summary of the cases:— 49 No. Date. Sex. Age. Alleged Cause. Symptoms. Recovered. Others in family ill. 1. 15/1/38 M. 4 Sardines or kippers. Blisters and pimples. Yes. No. 2. 5/2/38 F. 14 Sardines Rash Yes. No. 3. 28/2/38 F. 32 Meat pie Diarrhoea, rash and sickness. Yes. No. 4. 8/12/38 F. 35 ? Diarrhoea, rash and sickness. Yes. No. (c) Adulteration, etc. Sale of Food and Drugs. Until the appointed day for the operation of the Food and Drugs Act, 1938, the Acts governing this subject will be administered by the County Council. The appointed day is 1/10/39. During the year, 241 samples were analysed, only one sample was adversely reported upon, and the trader was cautioned regarding a small deficiency of acetic acid in vinegar. (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 lound 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. 50 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 05 and Over Total. Cerebro-Spinal Fever 2 1 — 1 1 — — — — — — 5 Diphtheria — 30 68 19 1 — 4 1 1 — — 124 Encephalitis Lethargica — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — Erysipelas 1 4 4 1 3 8 6 6 9 3 2 47 Ophthalmia Neonatorum 8 — — — — — — — — — — 8 Pneumonia Acute Primary 6 19 13 8 2 2 5 15 6 2 1 79 Influenzal 1 1 1 2 1 — 4 3 2 — 1 16 Poliomyelitis Acute — — 1 — — — — — — — — 1 Puerperal Pyrexia — — — — 3 13 7 4 — — — 27 Scarlet Fever 5 80 124 36 11 3 11 5 — — — 275 Food Poisoning — 1 — 1 — — 1 1 — — — 4 Pemphigus 10 — — — — — — — — — — 10 Smallpox — — — — — — — — — — — — Dysentery (Sonne) — 1 — — — — — — — — — 1 Polioencephalitis Acute — — — — — — — — — — — — Notified. Admitted to Isolation Hospital, Rush Green. Admitted to other Isolation Hospitals. Admitted to other Hospitals Deaths Registered. Diphtheria 124 123 — 1 12 Scarlet Fever 275 244 — 1 Puerperal Pyrexia 27 13 — 5 Pneumonia (Primary) 79 30 — 15 83 (Influenzal) 16 5 — 1 Erysipelas 47 32 — 4 1 Smallpox — — — — — Food Poisoning 4 — — — — Encephalitis Lethargica — — — — 1 Poliomyelitis Acute 1 1 — — — Pemphigus 10 4 — — — Ophthalmia Neonatorum 8 4 — — — Cerebro-Spinal Fever 5 5 — — 1 Polioencephalitis Acute — — — — — Enteric Fever — — — — — Dysentery (Sonne) 1 — — 1 — 51 Diphtheria. The incidence of this disease has decreased, the number of notifications received being 124 compared with 160 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, all except one were admitted to the Joint Hospital; this remaining one was sent to another hospital. Fuller information regarding the course of the disease in a few cases who had received immunisation treatment is given under the heading Diphtheria Immunisation later in the report. Death Rate. The second table on the previous page shows that 12 deaths were registered as due to Diphtheria, this being the same number as recorded in 1937. The case mortality rate is 9.7 per cent., which exceeds that for the previous year. Secondary Cases. There were only two secondary cases during the year which is truly remarkable, and is further testimony that dispensing with disinfection as formerly practised, is not a contributory factor in spreading infection from this disease. No return cases occurred during the year. Schools and Diphtheria. A table has been prepared showing the age groups of the children affected and the schools attended by them. The disease was spread fairly evenly throughout the schools, no particular one showing an abnormal number of cases. The total number of school children affected was 93 against 115 for the year 1937. 52 School. Dept. AGE GROUP. Total. 4 5 6 7 8 9 10 11 12 13 + Alibon Road I. — 1 2 — — — — — — — 3 „ B. — — — — 4 1 — — — — 5 „ G. — — — — — 1 1 — — — 2 Arnold Road I. — 3 4 1 — — — — — — 8 „ B. — — — — 1 — 1 — — — 2 „ G. — — — — — 2 — — — — 2 Beacontree Heath I. — — — — — — — — — — — „ M. — — — — — — 1 — — — 1 Beam Bridge I. — — — — — — — — — — — „ M. — — — — — — — — — — — Chadwell Heath I. — — — — — — — — — — — Charlecote Road I. — 2 — — — — — — — — 2 „ B. — — — — — — — — — — — „ G. — — — — — — — — — — 1 Eastbrook B. — — — — — — — — — — — „ G. — — — — — — — — — 2 2 Fanshawe Crescent I. — 2 1 — — — — — — — 3 „ „ B. — — — — — — 1 — — — 1 „ „ M. — — — — 2 — 1 — — — 3 Finnymore Road I. — — 2 1 — — — — — — 3 „ „ B. — — — — 1 2 1 — — — 4 „ „ G. — — — — — — — — — — — Five Elms I. 1 1 — — — — — — — — 2 „ M. — — — — — — — — — — — Ford's Endowed M. — — 1 — 2 2 — — — — 5 Goresbrook Road B. — — — — — — — — 1 — 1 „ „ G. — — — — — — — 2 — 1 3 Grafton Road I. — — 1 — — — — — — — 1 „ „ B. — — — — 1 — 1 — — — 2 „ „ G. — — — — — — — — — — — Green Lane I. — 1 — — — — — — — — 1 „ M. — — — — — — — — — — — Hainault College M. — — — — — — — — — — — Hainault Forest I. — — — — — — — — — — — „ „ M. — — — — — — — — — —- — Halbutt Street B. — — — — — — — — — 1 1 „ G. — — — — — — — — — — — Heathwav Special M. — — — — — — 1 — 1 — 2 Hunters Hall I — 1 2 2 — — — — — — 5 „ B. — — — — — 1 1 — — — 2 „ G. — — — — — — — — — — — Kingsley Hall M. — — — — — — — — — — — Lymington Road B. — — — — — — — — 1 — 1 „ „ G. — — — — — — — — — — — Marley B. — — — — — — — — — 1 1 „ G. — — — — — — — — — — — Marsh Green I. — — 2 — — — — — — — 2 „ M. — — — — — 1 2 — — — 3 Carried forward 1 11 15 4 12 10 11 2 3 5 74 53 School Dept. AGE GROUP. Total. 4 5 6 7 8 9 10 11 12 13 + Brought forward 1 11 15 4 12 10 11 2 3 5 74 Park M. — — — — — — — — — — — Parsloes I. — — — — — — — — — — — „ M. — — — — — — — — — — — „ G. — — — — — — 1 — — — 1 Rush Green I. — — — — — — — — — — — „ M. — — — — — — — — — — — St. Joseph's R.C. I. — — — — — — — — — — — „ „ M. — — — — — — — — — — — St. Peter's R.C. I. — — — — — — — — — — — „ „ M. — — — — — — — — — — — South Wood Lane I. — — — — 1 — — — — — 1 „ „ B. — — — — — — — — — — — „ „ G. — — — — 1 — — — — — 1 Triptons B. — — — — — — — — — — — „ G. — — — — — — — — — — — Valence Avenue I. — 1 2 1 — — — — — — 4 „ „ B. — — — 1 — 1 — — — — 2 „ „ G. — — — — — — 1 — — — 1 Village I. 5 3 — 1 — — — — — — 9 Warren M. — — — — — — — — — — — Whalebone I. — — — — — — — — — — — „ M. — — — — — — — — — — — —Schools not in District — — — — — — — — — — — — 6 15 17 7 14 11 13 2 3 5 93 Schick Testing and Immunisation. As in former years this treatment was encouraged for all children between the ages of one year and fourteen. 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 Officer of Health and the Head Teachers are asked to co-operate by explaining the methods to parents anxious for their children to be protected. In 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 54 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 immunisation 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 no local or general reaction. The following is a summary of the work carried out during the year:— No. of school children immunised without preliminary testing 34 No. of pre-school children immunised without preliminary testing 195 No. Schick Tested 118 Of these 36 were Negative. No. of Schick Positives who received 3 doses 126 No. of Re-Schick tests after 1 dose 1 This was Negative. No. of Re-Schick tests after 3 doses 335 Of these 330 were Negative. No. of Re-Schick-Positives who received 3 doses 2 No. of Re-Schick-Positives subjected to a further Schick test after 3 more doses 5 These were Negative. No. of Re-Schick-Positives subjected to a further Schick test after 3 more doses 1 This was Negative. 55 Immunisation by General Practitioners. No. of school children immunised without preliminary testing 4 No. of pre-school children immunised without preliminary testing 4 No. Schick tested 2 These were Positive. No. of Re-Schick tests 17 These were Negative. Total number of children found to be immune during the year 390 The following figures are those of children dealt with from the time immunisation was first started in September, 1930, to December 31st, 1938:— No. subjected to Schick test (Primary) Positive 3,092 Negative 1,671 No. subjected to Re-Schick test (after having undergone one course of injections) Positive 246 Negative 3,240 No. subjected to Re-Schick test (after having undergone two courses of injections) Positive — Negative 122 No. subjected to Re-Schick test (after having undergone three courses of injections) Positive 1 Negative 5 No. of children immunised without having been Scbick-tested (under 6 years) 2,893 Total number of children found to be immune (including immunisation by General Practitioners) 5,086 56 Immunisation by General Practitioners. No. subjected to Schick test (Primary) Positive 20 Negative 7 No. subjected to Re-Schick test (after having undergone one course of injections) Positive 4 [Negative 37 No. subjected to Re-Schick test (after having undergone two courses of injections) Positive Nil Negative 2 No. of children immunised without having been Schick-tested (under 6 years) 83 The following table shows details of children who attended for immunisation and were subsequently notified as suffering from Diphtheria, together with observations as to the type and the ultimate result:— No. Age. Particulars of Treatment. Notified as Diphtheria. Confirmed? Severity. Result. 1 9 3 doses T.A.F. Jan.-Feb. 1932 2/4/38 Yes Moderate Recovered 2 5 Re-Schick Negative—15/11/35 20/10/38 Yes Moderate Recovered 3 9 Re-Schick Negative—30/10/30 22/10/38 Yes Moderate Recovered 4 4½ Re-Schick Negative—22/1/37 25/11/38 Yes Mild Recovered 5 6 1 dose T.A.F.— 4/11/38. 3/12/38 Yes Moderate Recovered The following table shows the proportion of children of various ages who reacted Schick positively:— 57 Age. Total. No. of Positives. Percentage Positive. Under 6 34 24 70.5 „ 7 978 770 78.7 „ 8 866 627 72.4 „ 9 685 447 65.2 „ 10 670 891 58.3 „ 11 515 308 59.8 „ 12 401 229 57.1 „ 13 286 158 55.2 „ 14 173 75 43.4 „ 15 31 16 51.6 Over 15 81 34 42.0 Scarlet Fever. There was a marked decrease in the incidence, there being 275 cases notified compared with 384 for the previous year. Of these, 244 were admitted to Rush Green Isolation Hospital, one to another hospital and 30 remained at home. The age incidence resembles that shown by Diphtheria, but the upper limit is somewhat higher in the case of Scarlet Fever. The continued decrease in Scarlet Fever emphasises once more the futility of routine disinfection of premises and fomites. Deaths. It is gratifying to be able to record that no deaths assignable to Scarlet Fever have been recorded ; considering the large child population this is worthy of special note. Secondary Cases. There were 10 secondary cases compared with 16 for the year 1937, and in addition four cases are regarded as being return cases. 58 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 departments 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 172 compared with 267 for the previous year. School. Dept. AGE GROUP. Total. 4 5 6 7 8 9 10 11 12 13 14 AlibonRd. I. 1 5 1 1 — — — — — — — 8 „ B. — — — — 1 — — — — — — 1 „ G. — — — — — 1 — — — — — 1 Arnold Rd. I. — 4 2 2 — — — — — — — 8 „ B. — — — — — 2 1 — — — — 3 „ G. — — — — 1 1 — — — — — 2 Beacontree Hth. I. 1 — — — — — — — — — — 1 „ „ M. — — — — — — — — — — — — Beam Bridge I. 1 — 2 — — — — — — — — 3 „ M. — — — — — — — — — — — — Bungalow Sch. M. — — — 1 — — — — — — — 1 Chadwell Hth. I. — — 1 2 — — — — — — — 3 Charlecote Rd. I. 1 4 3 — — — — — — — — 8 „ „ B. — — — — — — — — — — — — „ „ G. — — — — — — — 1 — — — 1 Eastbrook B. — — — — — — — — — — — — „ G. — — — — — 1 — — 1 — — 2 Fanshawe Cres. I. — 2 3 3 — — — — — — — 8 „ „ B. — — — — 1 — — 1 — 1 — 3 „ „ M. — — — — 2 — — — 1 — — 3 Finnymore Rd. I. — 1 4 1 — — — — — — — 6 „ „ B. — — — — — — — — — — — — „ „ G. — — — — — 1 1 — — — — 2 Five Elms I. — 2 2 1 — — — — — — — 5 „ M. — — — — — — — — — — — — Ford's Endowed M. — — — — 2 1 1 1 — — — 5 Goresbrook Rd. B. — — — — — — — — — — — — „ „ G. — — — — — — — 1 1 1 — 3 Carried fwd. 4 18 18 11 7 7 3 4 3 2 — 77 59 School. Dept. AGE GROUP. Total. 4 5 6 7 8 0 10 11 12 13 14 Brought fwd. 4 18 18 11 7 7 3 4 3 2 77 Grafton Rd. ... I. 1 3 4 2 10 » ,, B. — — — 1 1 Green Lane ... I. — 2 2 1 — — 5 • I M. — — — — — — — 1 — — — 1 Hainault Coll.... M. Hainault Forest I. >» »» Halbutt Street B. „ G. — — — — — — — — 1 — 1 Heath way Spec. M. Hunters Ilall ... I. — 1 1 3 5 ,, B. 1 1 >> G. 1 1 Kingsley Hall... M. — — — — — — —. — Lymington Rd. B. 1 2 — 3 ,, G. Marley B. — — — — — — — — 1 — — 1 » G. — — — — — — — 1 — — — 1 Marsh Green ... M. — — — 1 2 3 G M I. — 2 2 Park M. Parsloes I. — 1 2 3 1. M. — 1 1 II G. I 1 1 1 2 0 Rush Green ... I. 2 2 M M. 1 1 2 St.Joseph'sR.C. I. — »» it M. St. Peter's R.C. o »» M M. 1 1 2 Sth. Wood Lane I. »> » B. 1 »» ii G. Triptons B. 1 .. G. — — — — — — 2 — 2 ^ alcnce Avenue I. — 8 2 1 11 B. 2 ... " •» G. — — — — 2 — 1 — — — — 3 V illage... I. — 3 o 1 — 6 Warren M. — 1 1 W halebone M. — — — 2 1 3 I. — 2 — — — — — — — — — 2 District — 1 — - 1 — — — 2 — 1 5 5 45 31 20 20 1C 5 10 10 8 2 172 60 Enteric Fever. No case of the Enteric type was notified during the year. Erysipelas. There were 47 cases notified; this is considerably more than the previous year. It is however, gratifying to note that only one death occurred from this cause. 32 of the cases were admitted to hospital. Cerebro-Spinal Meningitis. Five cases were notified, all of whom were treated at Rush Green Isolation Hospital; unfortunately, one fatality, a female aged 19, occurred. Acute Anterior Poliomyelitis. There was one case of Anterior Poliomyelitis notified in July, the patient being a boy aged six. I am pleased to record that he recovered after treatment at Rush Green Isolation Hospital. Pneumonia. The number of notifications of Pneumonia received was 95, this being slightly less than those for the previous year. The number of deaths attributed to Pneumonia was 51 ; the case mortality therefore was 53.7 per cent., which is a very high figure, and the conclusion to be drawn from this is that the disease was incompletely notified. Smallpox. No eases were notified in Dagenham during 1938. The following table shows the position of vaccination for the last year:— 61 1. Successfully vaccinated 576 2. Insusceptible Nil 3. Conscientious objectors 762 4. Died before vaccination 35 5. Postponed by medical certificate 39 6. Removed 48 7. Unaccounted for at present 229 The above table shows an increase in the numbers successfully vaccinated and a decrease in the number of conscientious objectors. 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 NonPulmonary Pulmonary NonPulmonary M F M F M F M F M F M F Under 1 — — — 1 — — — — — — — — 1- 1 — 2 — — — — — — — 1 1 5- — 1 6 5 — — 1 2 — — — 1 10- 5 1 3 2 1 1 — 3 1 — — 1 15- 11 8 0 1 0 — 1 — 2 3 2 1 20- 4 8 — — 2 7 1 — 1 6 — — 25- 19 13 2 — 4 8 — 1 9 2 — — 35- 14 8 1 — 3 2 — — 6 3 — — 45- 10 1 1 — 1 2 — — 10 2 — — 55- 3 — — — — — — — 2 — — — 65 & upwards — 2 — — — — — — — 1 — — 67 42 21 9 17 20 3 6 31 17 3 4 62 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register 1st Jan., 1938 321 267 127 123 During the year:— New notifications 67 43 21 10 Deaths 26 16 1 1 Transfers into area 17 20 3 6 Transfers out of area 52 62 22 23 No. on register 31st Dec., 1938 327 252 128 115 The total number of new cases of tuberculosis notified during the year was 139; of these, 67 males and 42 females suffered from the pulmonary and 21 males and 9 females from the non-pulmonary type. In addition, there were brought to notice other than by primary notification, 37 pulmonary and 9 non-pulmonary cases; these were transferred into the district. Also 114 pulmonary cases and 45 non-pulmonary cases were transferred out of the area. The second table shows that at the end of the year there were 822 cases on the register compared with 838 on the 1st January, 1938. Deaths. 48 persons died from pulmonary tuberculosis, of whom 31 were males and 17 females. This compares with 26 males and 26 females for the previous year. Seven deaths from non-pulmonary tuberculosis were registered, there being three male and four female; in 1937 there were 10 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 this cause and no notification has been received, the 63 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 ten instances, deaths attributed to tuberculosis were registered in cases in respect of which no notification under the regulations had been received; seven of these were pulmonary and three non-pulmonary. This gives a ratio of 18 per cent. compared with 8.06 per cent. for the year 1937; this figure compares unfavourably with that for the previous year. As mentioned previously all cases of un-notified tuberculosis are investigated. Sputum Analysis. 307 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, 1936, Section 172. No case arose during the year requiring action under the above Regulations and Act. 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 Association does a great deal of most valuable work in the area, and the members deserve the thanks of the community. 64 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. The number of children under the age of five years who were referred to the County Ophthalmic Surgeon during the year for treatment was 32. Cancer. The following table gives the age incidence of fatal cases of cancer affecting certain specified sites:— 65 MALES. FEMALES. UNDER 35 35-44 45-54 55-64 OVER 65 UNDER 35 35-44 45-54 55-64 OVER 65 Total Oesophagus — 2 1 — 1 — — — 1 — 5 Stomach — 1 4 1 1 — — — 3 — 10 Large Intestine incl. Rectum — — — 1 5 l — — — 2 9 Larynx — 1 1 — — — — — — — 2 Lungs — — 1 1 1 l — — — — 4 Liver — — — — — l 1 1 — 2 5 Breast — — — — — — — 4 2 1 7 Ovary — — — — — — — — — — — Uterus — — — — — — 1 1 1 1 4 Other sites — 2 1 2 6 3 3 5 6 5 33 — 6 8 5 14 6 5 11 13 11 79 It will be noticed that only six cases occurred in persons under the age of 35 years. The total number of 79 was arrived at by scrutinizing the death returns as they were received. The Registrar-General assigns 85 deaths from Cancer to this district, 36 being males and 49 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. 66 MATERNITY AND CHILD WELFARE. Notification of Births. 1,898 notifications of live births were received during the year. 145 notifications (including stillbirths) were received from medical practitioners and parents and 1,255 from midwives. Information was received of 556 births outside this area. The following list shows where most of these took place:—East End Maternity Hospital 271, Oldchurch Hospital 131, City of London Maternity Hospital 26, Plaistow Maternity Hospital 21, The London Hospital 18 and Queen Mary's Hospital, Stratford 10. The Notification of Births Acts have been repealed by Section 203 of the Public Health Act, 1936. Illegitimate births accounted for 2.58 per cent. of the total births. Stillbirths. 29 male and 28 female stillbirths were notified, the corresponding figures for registration being 28 and 32. The rate per 1,000 of total population registered was 0.56, the rate for England and Wales being 0.60. The percentage of illegitimate stillbirths to the total was 1.67 compared with a percentage of illegitimate to total births of 2.58. The stillbirths which occurred in the district, the alleged causes and other associated details are shown in the table. Infant Mortality. 98 infants under one year of age died during the year, giving an infant mortality rate of 50.51 per 1.000 live births, compared with that of 53 for England and DETAILS OF STILLBIRTHS WHICH OCCURRED DURING 1938. Alleged Cause. Gestation. Presentation. Duration of Labour. Previous. Ante-Natal Supervision. Further Remarks. Stillbirths. Live Births. Miscarriages. Ante-Partum Haemorrhage Term Vertex 6 hours — 2 — Ante-Natal Clinic Birth in hospital Ante-Partum Haemorrhage Term Breech 16 hours — 8 — Ante-Natal Clinic Birth in hospital Ante-Partum Haemorrhage (Concealed) 30 weeks ? 18 hours — — — Ante-Natal Clinic and hospital Birth in hospital. Macerated foetus. (Maternal death.) Ante-Partum Haemorrhage (Concealed) 28 weeks ? 3 hours — 6 — Midwife Birth in hospital. (Maternal death.) Ante-Partum Haemorrhage 29 weeks Vertex 2 hours — 1 — Ante-Natal Clinic Birth in hospital Ante-Partum Haemorrhage 28 weeks Vertex 12 hours — — — Midwife Birth in hospital Ante-Partum Haemorrhage Term Vertex 3 hours — 3 — Ante-Natal Clinic Birth in hospital. Ante-Partum Haemorrhage (Poor general health during pregnancy) Term Vertex ? — — — Hospital Macerated foetus. Birth in hospital Ante-Partum Haemorrhage (Placenta praevia) Term Vertex 6 hours 1 4 — Ante-Natal Clinic Birth in hospital Asphyxia (Cord round neck of foetus) Term Vertex 28 hours — — — Ante-Natal Clinic and hospital Birth in hospital Asphyxia (Cord round neck of foetus) Term Vertex 14 hours — — — Ante-Natal Clinic and hospital — Asphyxia (Cord round neck of foetus) Term Vertex 4 hours — 3 — Ante-Natal Clinic and hospital Birth in hospital Asphyxia (Cord round neck of foetus) Term Vertex ? — — 1 Ante-Natal Clinic and hospital Birth in hospital Asphyxia (Cord round neck of foetus) Term Vertex 6 hours — — — Own Doctor — Asphyxia (Cord round neck of foetus) Term Vertex 2 hours — 3 — Ante-Natal Clinic — Asphyxia (Cord round neck of foetus) Term. Vertex 12 hours — — — Hospital Birth in hospital Complicated Breech Term Breech 3 hours — 1 — Ante-Natal Clinic early in nancy. One of twins Complicated Breech Term Breech 36 hours — — — None — Complicated Breech Term Breech 16 hours — 1 — Own Doctor — Complicated Breech Term Breech 8 hours 1 1 — Ante-Natal Clinic and hospital Birth in hospital Delayed Labour Term R.O.P. 72 hours — — — Ante-Natal Clinic and hospital Birth in hospital Delayed Labour (Early rupture of membranes) 28 weeks Vertex ? 7 days — 2 1 Own Doctor — Delayed Labour Term Vertex 54 hours — — — Midwife — Delay of aftercoming head Term Breech 4 hours — 4 — Ante-Natal Clinic — Eclampsia-Prolapse of cord Term Vertex 8 hours — — — Midwife Birth in hospital. Excessive sickness during pregnancy 37 weeks Vertex 3 hours — 6 — Ante-Natal Clinic One of twins. Macerated foetus. Injury due to fall at 39th week of pregnancy Term Vertex 12 hours — — — Ante-Natal Clinic Macerated foetus Malformation of foetus (Hydrocephalic) Term ? 6 hours — 6 — Midwife B.B.A. Macerated foetus Malformation of foetus Term Vertex ? — 3 — Midwife Birth in hospital. Macerated foetus. DETAILS OF STILLBIRTHS WHICH OCCURRED DURING 1938—continued. Alleged Cause. Gestation. Presentation. Duration of Labour. Previous. Ante-Natal Supervision. Further Remarks. Stillbirths. Live Births. Miscarriages. Poor general health during pregnancy 26 weeks Vertex ? 1 2 — Own Doctor Birth in hospital Poor general health during pregnancy Term Vertex 8 hours — 1 — Ante-Natal Clinic Birth in hospital Poor general health during pregnancy Term ? 4 hours 2 1 — Hospital Birth in hospital. Mother spinal curvature. Poor general health during pregnancy (Mitral Stenosis) 32 weeks Vertex ? — 2 — None Birth in hospital. Maternal death. Poor general health during pregnancy Term Face 12 hours — 2 — Midwife Macerated foetus Poor general health during pregnancy (Anaemia) 32 weeks Vertex 8 hours — 5 — Ante-Natal Clinic — Poor general health during pregnancy Term ? 48 hours — 1 — Ante-Natal Clinic Birth in hospital Prolapse of cord (Malpresentation) 28 weeks Footling 6 hours — 1 — Ante-Natal Clinic — Prolapse of cord (Malpresentation) Term ? 26 hours — 1 — Ante-Natal Clinic — Prolapse of cord (Malpresentation) Term Transverse 12 hours — 6 — Ante-Natal Clinic Birth in hospital Prolapse of cord (10 lbs. baby) Term Breech 3 hours — 1 — Midwife — Prolapse of cord Term Breech 6 hours — 1 — Midwife — Toxaemia of pregnancy Term Vertex 2 hours 1 1 — Ante-Natal Clinic — Toxaemia of pregnancy Term Vertex ? — — — Ante-Natal Clinic Birth in hospital. Macerated foetus. Toxaemia of pregnancy ? Post mature Vertex 3 hours — 1 — Own Doctor Maternal death Toxaemia of pregnancy 28 weeks Vertex 16 hours — — — Midwife Birth in hospital Toxaemia of pregnancy 28 weeks Vertex ? — — — Ante-Natal Clinic Birth in hospital Toxaemia of pregnancy 38 weeks Vertex 2 hours — 5 — Ante-Natal Clinic Macerated foetus Toxaemia of pregnancy 38 weeks Vertex 14 hours — — — Ante-Natal Clinic and hospital Birth in hospital Toxaemia of pregnancy Term Breech 3 hours 1 3 — Ante-Natal Clinic — ? Term Vertex 12 hours — — — Midwife — ? Term Vertex 6 hours 1 1 — Own Doctor — ? Term Vertex 6 hours — — — Own Doctor Macerated foetus ? 28 weeks Vertex 12 hours 1 1 — Hospital Birth in hospital. (One of twins.) ? 30 weeks Vertex 6 hours — 1 — Ante-Natal Clinic and hospital Birth in hospital ? Term Vertex 12 hours 1 — — Own Doctor — ? 36 weeks Vertex 12 hours — — — Ante-Natal Clinic Birth in hospital. ? Term Breech 3 hours — 2 — Ante-Natal Clinic Macerated foetus, One of twins ? 28 weeks Vertex ½ hour — 1 — None — 67 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. Cause 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. Atelectasis 2 — — — 2 — — — — 2 Bronchial Pneumonia 2 1 — — 3 3 11 3 1 21 Cachexia — — 1 — 1 — — — — 1 Cerebral Compression (Prolonged Labour) 2 — — — 2 — — — — 2 Cerebral Tumour — — — — — — — — 1 1 Congenital Heart Disease) 2 1 — — 3 1 — — — 4 Castro-Enteritis — — — 2 2 4 4 1 1 12 Hemorrhagic Disease of the New Born 1 — — — 1 — — — — 1 Icterus Neona torum 1 — — — 1 — — — — 1 Inanition at Birth 2 — — — 2 — — — — 2 Intussusception — — — — — 1 — 3 — 4 Marasmus — — — 1 1 — — — — 1 Mediastinal Lymphadenoma — — — — — — — — 1 1 Measles — — — — — — 1 — — 1 Meningitis — — 1 — 1 — — 1 — 2 Otitis Media — — — — — — 1 1 — 2 Overlaid (Coroner's Inquest) 1 — — — 1 — — — — 1 Pallida Asphyxia 1 — — — 1 — — — — 1 Prematurity 20 3 — — 23 3 — — — 26 Pyloric Stenosis — — — 1 1 — 1 — — 2 Septicaemia — — — 1 2 — — — — 2 Spina Bifida 1 — — — 1 — — — — 1 Toxaemia 1 — — 1 1 — — — — 1 Whooping Cough — — — 2 2 — 2 1 1 6 35 6 2 8 51 12 20 10 5 98 Wales and 57 for London. The rate amongst legitimate children was 48.68 while for illegitimate children it was 120.00. 68 Deaths of Older Children. 29 children died between the ages of one and five years; of these, 17 were males and 12 females. The largest individual cause of death was Pneumonia which was assigned as the reason for 10 deaths in children under the age of five, Measles six, Diphtheria two and Pneumonia six between the ages of one and two and four between the ages of two and five. There has been a diminution in the number of children who died between the ages of one and five, 29 compared with 34 for the previous year. Ophthalmia Neonatorum. Notified. Treated at home. Treated in hospital. Vision Unimpaired. Vision impaired. Total Blindness. Deaths. 8 4 4 – – – – There were 61 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 eight were notified as suffering from true Ophthalmia Neonatorum. Under the rules 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. Pemphigus. During the year, there were 10 notifications ot children suffering from Pemphigus, four of whom were removed to hospital and the remainder treated at home , all recovered. 69 Maternal Mortality. 11 cases in which pregnancy and/or childbirth were mentioned as causes of death were brought to the notice of this department, particulars of these cases are set out below :— Case 1. Pyaemia from retained products of abortion. Natural Causes. Case 2. Pulmonary Embolism during Caesarian Section operation for full term pregnancy. Live birth. 2 previous pregnancies—mitral stenosis, anaesthetic Gas and Oxygen. Case 3. Acute Eclampsia with Hepatic Necrosis. Case 4. la. Cardiac Failure. b. Mitral Stenosis (Rheumatic). 2. Spontaneous delivery of 7 months foetus one week previous. Case 5. Obstetric Shock. Toxaemia, Ante-partum haemorrhage. Case 6. Concealed Accidental Haemorrhage. Toxaemia of Pregnancy—8th pregnancy. Case 7. a. Hepatic failure. b. Acute Yellow Atrophy. c. Toxaemia of Pregnancy. Case 8. Hyperemesis Gravidarum. Case 9. la. Post Partum Haemorrhage. b. Excessive size of foetus. 2. Adherent Placenta. 70 Case 10. Toxaemia of Pregnancy. (Stillbirth 2nd Pregnancy). Case 11. a. Obstetric Shock. b. Concealed Accidental Haemorrhage 7th pregnancy S.B.—-Solitary. The Registrar-General, however, in his assignment of these causes has only allocated seven cases to Dagenham, one to sepsis and six to other puerperal causes. This gives a maternal mortality rate of 3.5, compared with 2.97 for England and Wales. Of the eleven cases tabulated, four apparently did not receive ante-natal attention. Puerperal Pyrexia. 27 notifications were received during the year; per 1,000 total births (i.e., live and stillbirths) the rate for this condition was 13.5, the corresponding figure for the country as a whole being 14.42. Of the total number of patients notified, 18 were removed to hospital for treatment and nine were treated at home. 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 71 Officers. In addition to the routine visits, special visits are paid to eases of Ophthalmia Neonatorum, Puerperal Pyrexia, Stillbirths, Infant Deaths, etc., and subsequent to operative treatment of tonsils and adenoids. The Health Visitors also attend the various clinics. In the case of infant welfare centres and antenatal 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 34.9 Total visits 386 (b) To children under one year of age First visits 2,003 Total visits 5,131 (c) To children between the ages of one and five years Total visits 12,107 Grand Total 17,624 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, two at Chadwell Heath and two at Rush Green. During 1939 the Council decided to augment the numbers of clinic sessions both ante-natal and infant welfare ; for this purpose it was decided to increase the whole-time medical staff by one, and also appoint an additional Health Visitor and clinic assistant. Wach 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. 72 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 23,039 (2) By children between the ages of one and five 18,909 Average attendances of children per session at all centres during the year 68 Total number of children who attended at the centres for the first time during the year:— (1) Children under one year of age 1,729 (2) Children between the ages of one and five 816 Percentage of total notified births represented by the number of children under one year who attended for the first time 91.82% 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 Hospital, Plaistow; and Oldchurch Hospital. Most 73 cases, however, are treated at King George Hospital, the majority being detained overnight. During the year a total of 24 cases was treated at a cost of £25. 4s. Od. Orthopaedic Treatment. (a) Ascertainment Clinic.—The Consultant Orthopaedic Surgeon paid six visits to the district during the year, when 120 children made 166 attendances. 81 children attended once only, 34 attended twice, 3 three times and 2 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. 4s. 5d. (b) Massage Clinic.—The massage and remedial exercises clinic was held twice weekly at the Ford Road and Becontree Clinics. During the year 269 children under school age received treatment at a cost of £80. 4s. Od. making a total of 802 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. Nine appliances were supplied at a total cost of £7. 19s. 6d. (d) Hospital Treatment.—Three children were sent to hospital for operative treatment at a total cost of £132. 17s. Od. 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 74 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 Corporation. 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. 227 children commenced treatment of whom 119 completed one course, 13 completed two courses and one three courses. Dental Treatment. 24 extraction sessions were held, at which 232 children were treated and 181 mothers, making a total of 531 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 £27. 15s. Od. and the nett cost of this service was £38. Os. 2d. Dentures are provided, usually only to those persons referred from the ante-natal clinic. The amount received as patients' contributions was £23. 16s. 0d. leaving a sum of £75. 5s. 10d. 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. 75 Cases. Attendances. Treated at Ford Road Clinic 42 114 „ Becontree Clinic 9 68 „ Out-Patient Dept., King George Hospital 3 6 54 188 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. 14 mothers and children were admitted to convalescent homes at a cost of £128. 11s. 2d. 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. 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 £19. 18s. Od. has been expended in the purchase of boots. Other Provisions. One child was supplied with a pair of glasses at a cost of 2s. 6d. and another child was sent to the Royal Deaf and Dumb School, Margate, at a charge of £75 Per annum. 76 Consultant Obstetrician and Emergency Obstetric Unit. The Consultant Obstetrician, Mr. W. O'Loughlin, resigned and left the district in June, 1938. It was not found possible to secure the services of an obstetrician of consultant status who lived sufficiently near to the district to fill the vacancy and arrangements were therefore made with the County Council to secure the services of the Emergency Obstetric Unit at Oldchurch Hospital, the fee charged being three guineas per attendance. This unit would only be called into service where a patient, in her own home, was the subject of some obstetric emergency which would render her removal to hospital hazardous. Up to date it has not been necessary to apply for this unit. The unit provided by this Council and located at York House, has now, of course, ceased to function. Ante-Natal Services. Ante-Natal Clinics.—Three weekly ante-natal sessions are held at the Becontree Clinic, three at the Dagenham Clinic, two at the Five Elms Out-Patient Department and a weekly clinic at York House. In addition, the Chadwell Heath Clinic was held twice monthly and Rush Green once monthly. At the Five Elms Out-Patient Department the Consultant Gynaecologist paid fortnightly visits throughout the year, seeing a total of 139 women who made 313 attendances. 244 cases were referred to hospital for confinement under the Council's scheme, of whom 208 were admitted to the East End Maternity Hospital, 13 to City of London Maternity Hospital and 23 to Oldchurch Hospital. The cost to the Council for these patients, after the receipt of the patients' fees, amounted to £1,465. 10s. Od. 77 The total number of attendances made by the 1,544 women was 7,263. 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 314 cases referred to hospital, 249 were admitted on other than medical grounds. 244 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. During the latter half of the year, arrangements were completed for the treatment of abnormal cases at the City of London Maternity Hospital, this being in conformity with the practice of the Council, viz., that the Consultant Gynaecologist should, where possible, be on the staff of the hospital to which abnormal cases would be sent. Mr. R. L. Dodds commenced his duties in Dagenham in June, on the termination of Mr. O'Loughlin's appointment. Post-Natal. It would appear that the facilities for Post-Natal examinations, which are constantly advised by Health Visitors and Midwives, are not being utilised in spite of the advantages to be derived by the mothers. The year 1938 showed a falling off in the attendances, there being only 43 mothers concerned. Gynaecological Clinic. This clinic continues to be held at Becontree Avenue on the first Saturday morning of each month, the total 78 number of attendances being 96, giving an average of eight per session. Here again, for no apparent reason, is found a diminution in the numbers attending. Foster Children. The following tables show the number of foster children and foster mothers in the district :— Foster children :— No. on register, December 31st, 1937 34 No. added to register 44 No. deducted owing to refusal, removal, deaths or reaching age of nine 47 No. on register, 31st December, 1938 31 Foster mothers:— No. on register, 31st December, 1937 30 No. of additions during year 30 No. taken off during year 33 No. on register, 31st December, 1938 27 Those who intend to receive foster children, on making application to the Authority (The Dagenham Corporation), 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 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, but it is competent for the Local Authority to fix the number of children permitted 79 in the household under the age of nine years. Unless special reasons exist it is the practice in Dagenham to limit the number of foster children taken by one person to one. The practice of herding numbers of foster children together is to be deprecated, and with very few exceptions, is disallowed. The exceptions are in the cases of certain foster mothers who, for many years, have been permitted to take several children; as no complaints have been received and further, the children have been well cared for, it is not considered necessary in these cases to break the practice which has obtained for a long period. If 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. For the purpose of 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. A scheme was, therefore, introduced for establishing a system of Day Foster Mothers. Briefly, this scheme is as follows:— 80 (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 are 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. (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. 81 (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 eases 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. It is not known that any similar scheme is in existence in any other district. Reference is made to this scheme in the Annual Report of the Ministry of Health for the year 1938-39. Day Foster Mothers :— No. of Day Foster Mothers on register at 31st December, 1938 19 In addition to above:— No. of prospective Day Foster Mothers unsuitable during year 3 No. withdrawn application 5 27 This involved :— 28 visits by Health Visitors. 21 visits by Sanitary Inspectors. Day Foster Children :— No. on register at 31st December, 1938 4 In addition to above:— No. removed during year 7 11 This involved 24 visits by Health Visitors. Maternity Homes. There are no Maternity Homes in the district, but one Nursing Home which is licensed to receive eight 82 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. Assisted Milk Scheme. The expenditure incurred by the Council under the assisted milk scheme for the year was £ s. d. (a) For ordinary milk 2,227 16 2 (b) For dried milk 639 4 2 Total quantity of milk supplied to expectant and nursing mothers and young children :— Liquid Gallons. 21, 466 Dried Pounds. 27,299 Education. No specific effort in this district of health education was undertaken, as it is felt that individual talks to mothers at the clinics and at the homes of the people by Health Visitors, result in more lasting benefit than spasmodic efforts. Some years ago this Council decided in principle to hold a health week and exhibition when the proposed town hall was in being. The medical and nursing staff on occasions give lectures to organised bodies on health matters. 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. 83 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 for persons who attend in whom pregnancy would be detrimental on medical grounds. During the year payments amounting to £10. 2s. 6d. were made for this purpose. Supervision of Midwives. The number of Midwives who notified their intention to practise during the year 1938 was 47, and the number practising at the end of the year was 26. The routine inspection and special investigations are undertaken by the Medical Officer of Health. Notifications received from 1st January to 31st December, 1938 :— Notices summoning medical aid 461 For (a) Mothers 330 For (b) Infants 131 The following is a summary of the reasons for sending for medical help by midwives :— Perineal Tear 87 Prolonged Labour 69 Discharging Eyes 61 Rise of Temperature 46 Malpresentation 22 Ante-Partum Haemorrhage 19 Miscarriage 18 Post-Partum Haemorrhage 12 Albuminuria 9 Watery Blisters 8 Feebleness of Infant 7 Varicose Veins 6 Circumcision 5 Deformity 4 Other Causes 88 461 84 Notification was received intimating that artificial feeding had been resorted to in 19 eases. In one instance a midwife gave notice that she had laid out a dead body, and on 59 occasions midwives notified that they were liable to be sources of infection. Midwives Act, 1936, Section 6. An order of the Minister of Health putting the above Section into force was made and became effective on the 1st November, 1938. This Section prohibits the attendance of persons at confinements for gain, who have not certain qualifications as prescribed by the Act. The Minister only deems it expedient to put this Section into force in an area where he is satisfied that an adequate domiciliary midwifery service is in being. Domiciliary Midwifery Service. The provision of a domiciliary midwifery service became operative early in the year ; 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. 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. 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 — 1 3 — 2 1 — 1 — 1 — — — — — — — — — — — — 5 4 5 4 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough 3 3 — 1 — — — 1 — — — — — — — — — — — — — — 3 5 2 3 5. Diphtheria — — — — — 2 8 2 — — — — — — — — — — — — — — 8 4 9 4 6. Influenza — — — — — — — — 1 — — 1 — — — — 2 1 — — 1 1 4 3 4 4 7. Encephalitis lethargica — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 — 8. Cerebro-spinal fever — — — — — — — 1 — — — — — — — — — — — — — — — 1 — 2 9. Tuberculosis of respiratory system ... — — — — — — 1 — 3 9 9 2 6 3 10 2 2 — — 1 — — 31 17 30 16 10. Other tuberculous diseases — — 1 1 — — — 3 2 — — — — 1 — — — — — — — — 3 5 5 5 11. Syphilis — — — — — — — — — — — — — — — — — — — — — — — — 4 — 12. General paralysis of the insane, tabes dorsalis — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 — 13. Cancer, malignant disease — — — — — — 1 — — 3 — 2 6 6 8 10 7 11 7 8 4 6 33 46 36 49 14. Diabetes — — — — — — — — — — — — — — 2 — — 1 1 4 — — 3 5 3 5 15. Cerebral haemorrhage, etc. — — — — — — — — — — 1 — — 1 1 1 — 6 3 6 2 5 7 19 2 10 16. Heart Disease — — 2 1 — 1 3 3 2 1 2 — 8 4 13 5 15 14 14 16 19 29 78 74 72 66 17. Aneurysm — — — — — — — — — — — — — — — — — — — — — — — — 1 — 18. Other circulatory diseases — — — — — — — — — — — — — — — — 1 — — — — — 1 — 5 14 19. Bronchitis 1 1 1 — — — — — 1 — — — — 1 — 1 — — 1 1 5 4 9 9 11 20. Pneumonia (all forms) 10 11 4 2 3 1 1 3 4 2 1 1 8 3 7 6 3 4 3 4 2 44 39 27 24 21. Other respiratory diseases — — — — — 1 — — — — — — — — — 2 — — — 1 — 1 — 5 1 7 22. Peptic Ulcer — — — — — — — — — — — — — — 3 — — — — 1 1 — 4 1 4 1 23. Diarrhoea, etc. (under 2 years) 0 6 1 — — — — — — — — — — — — — — — — — — — 10 6 10 7 24. Appendicitis — — — — — — 1 — — — — — — — — — 1 — 2 2 25. Cirrhosis of liver — — — — 1 1 2 — 2 26, Other diseases of liver, etc — — 1 1 — 1 1 1 3 27. Other digestive diseases — — 1 — 1 7 10 28. Acute and chronic nephritis — 1 1 2 2 1 2 3 2 2 1 2 6 13 4 11 29. Puerperal sepsis — — — — — — — 1 30. Other puerperal diseases — — — — — — — — — 1 — 7 — 3 — — — — — — — — — 11 6 31. Congenital debility premature birth, malformations, etc. 29 15 — — — — — — — — — — — — — — — — — — — — 29 15 33 14 32. Senility — — — — 1 10 19 10 20 8 11 33. Suicide —_— —_ — _ — —_ 1 — — — 2 — 2 — 1 — — — — — 6 — 6 _ 34. Other violence — — — — — 8 — — — 7 1 5 1 1 1 1 1 18 8 21 5 35. other defined disease 7 2 — — — 1 3 2 1 1 1 4 — 3 8 5 3 4 — 1 4 3 22 27 26 27 36. Causes ill-defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — — 2 59 39 12 5 5 7 21 16 16 20 21 20 36 29 52 86 37 44 81 46 43 73 333 336 339 326 85 With 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 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. Below is a table setting forth in statistical form, the work of the Corporation Midwives, Dagenham Nursing Association and Salvation Army Midwives :— Municipal Midwives. Dagenham Nursing Association. Salvation Army Nurses. From 1/2/38-31/12/38 From 1/2/38-31/12/38 From 3/3/38-31/12/38 Binhs Attended : As Midwife 367 344 146 As Maternity Nurse 132 53 11 Miscarriages Attended 12 9 1 Visits Paid: As Midwife 6,992 (9,351 ) 3,242 As Maternity Nurse 3,117 243 Ante-Natal 3,122 2,916 221 Ante-Natal Clinics Attended 384 177 74 The arrangements whereby midwives attend antenatal clinics is giving satisfaction, as the findings of the Doctors in charge are thereby explained in detail to the midwife who will take the confinement. Further, the fact that the patient becomes acquainted with the midwife is helpful, inasmuch as it allays any fear the former may have with regard to calling in a person who otherwise would be a stranger. INDEX. A Page Acute Anterior Poliomyelitis 60 Adenoids and Tonsils 72-78 Adulteration of Foodstuffs 49 Ambulance Facilities 18-19 Analysis Ante-Natal Clinics 21,76-77 Artificial Sunlight 23,73-74 Atmospheric Pollution 34 B Bacteriological Examination 49 Bakehouses 47 Baths 36 Birth-rate 10, 12 Births 10,12,13,66 Birth Control 83 Births, Illegitimate 10,66 Births, Still 10.66 Blind, Association for the Welfare of 64 Blindness—Prevention of 64 Boot Fund 75 Byelaws—Premises and Occupations controlled by 25,34 C Camping Grounds 35 Cancer 64-65 Caravans 35 Cerebro-Spinal Meningitis 60 Cesspools 27 Chemical and Bacteriological Examination 49 Child Life Protection 78-73 Children's Invalid Aid Association 75 Cleansing, Public 29-33 Clinics and Treatment Centres 20-23 Closet Accommodation 29-31 Committees 7 Consultant Obstetrician and Emergency Unit 76 Contents—Principal 3 Convalescent Home 75 Council—Members of 7 D Day Foster Mothers 79-81 Deaths 11,13,14.66-68,86 Death-rate, General 11, 136 14 Death-rate, Infantile 11,14 Deaths, Causes of 86 Deaths, Infants 11, 14, 66-67 Dental Treatment 22, 74 Diarrhora (Deaths from—under two years of age) 11 Diphtheria 51-57 INDEX.—Continued. Page Disinfection 33-34 District Nursing Association 20, 23-24, 25 Domiciliary Midwifery Service 84 Drainage and Sewerage 29-31 Dried Milk 82 Dust Collection 32-33 E Education in Health 82 Enteric Fever 60 Erysipelas 60 Extracts from Vital Statistics 10 F Factories and Workshops 37-38 Food and Drugs 49 Food Inspection 45-49 Food Poisoning 48-49 Food Shops 47-48 Foodstuffs, Adulteration of 49 Foster Children and Mothers 78-79 Free Supplies of Milk 82 Fried Fish Shops 34 G General Provision—Health Services 15 Graded Milk 45 Gynaecological Cases 77-78 H Hairdressers' and Barbers' Premises 35 Health Committee 7 Health Services—General Provision of 15 Health Visitors—Work of 70-71 Hospitals—Children 18 Hospitals—General and Special 16-18 Hospitals—Infectious Diseases 15 Hospitals—Maternity 17-18,77 Hospitals—Orthopaedic 18 Hospital—Smallpox 15 Houses Let in Lodgings 44 Housing Statistics 40-44 I Ice-Cream 48 Illegitimate Births 10,66 Immunisation Clinics 53-57 Infant Deaths 11,14,66-67 Infant Welfare Centres 20,71—72 Infantile Mortality 11,14,66—67 INDEX.—Continued. Page Infectious Diseases Hospital 15 Infectious Diseases 50-64 Inspection of and Supervision of Food 45 Institutional Provision for Unmarried Mothers, Illegitimate Infants, etc. 18 Invalid Children's Aid Association. 75 L Laboratory Facilities 25 Legal Proceedings 44,47 Legislation in Force 25-20 Library Books 33-34 Light Treatment 23,73-74 M Massage Clinic 23 Maternal Mortality 69-70 Maternity and Child Welfare 66-85 Maternity and Child Welfare Committee 7 Maternity Homes and Hospitals 17-18, 81 Maternity Outfits 85 Measles 11,68 Meat Inspection 40-47 Meningitis, Cerebro-Spinal 60 Midwives, Municipal 25,83-85 Milk—Free Supplies 82 Milk in Schools 46 Milk (Special Designation Order) 45 Milk Supply 45-46 Minor Ailments 74-75 Mortality, Analysis of 86 Mortalitv, Infantile 11,14, 66-67 Mortality, Maternal 69-70 Mortality, Neo-Natal 11,14,66-67 N Neo-Natal Mortality 11, 14, 66, 67 Notices Served and Complied with 36-42 Notifications of Births 66 Nursing Arrangements 23-24 Nutrition 49 O Obstetrician-Consultant 76 Offensive Trades 26,34 Ophthalmia Neonatorum 68 Ophthalmic Treatment 75 Orthopaedic 18, 22-23, 73 Overcrowding 42-43 INDEX.—Continued. P Page Pail Closets 29 Pemphigus 64,68 Personal Service Council 75 Physical Features of Area 31-32 Pneumonia 60,68 Population 11 Post-Natal Examination 77 Preface 5-6 Premises and Occupations Controlled by Byelaws 34-36 Prevention of Blindness 64 Principal Contents 3 Prosecutions—Unsound Food 47 Prosecutions, Sale of Food and Drugs Act 49 Public Health Committee 7 Puerperal Pyrexia 64,70 R Rag and Bone Dealers 34 Rateable Value 10 Rats and Mice (Destruction) 39 Refraction Clinic 22 Refuse Collection 32-33 Remedial Exercises and Massage Clinic 23 Rivers and Streams 31-32 S Sanatoria 16 Sanitary Circumstances of the Area 27 Sanitarv Inspection of Area 36-67 Scarlet Fever 57-59 Scavenging 32-33 Schick Tests 53-57 School Clinics 22 Schools 36 Sewerage 29-31 Shops Act, 1934 35 Slaughterhouses 46 Slaughter of Animals Act, 1933 47 Smallpox 15,60-61 Smoke Abatement 34 Social Conditions of Area 10 Staff 8-9 Statistics 10-11 Stillbirths 10,66 Streams 31-32 Supervision of Midwives 83-85 Swimming Baths 36 T Table, Birth-rate, etc. 14 „. Cancer 65 INDEX.—Continued. Page Table, Death-rate, etc. 14 „ Deaths, Causes of 86 ,, Diphtheria Immunisation 56-59 „ Foster Children 78 ,, Housing 40-42 ,, Infant Mortality 67 „ Infectious Diseases, Notifiable 50 ,, Infectious Diseases, Removed to Hospital 50 ,, Infectious Diseases in School Children 52-53, 58-59 ,, Inspections for Year 36-37 „ Meat Inspection 47 „ Milk Samples 46 ,, Ophthalmia Neonatorum 68 „ Record of Inspections 36-37 ,, Stillbirths facing 66 „ Tuberculosis Deaths 61-63 „ Tuberculosis Notifications 61-62 „ Vaccination 60-61 Tents, Vans and Sheds 35 Tonsils and Adenoids 72-73 Treatment 20-23,72-75 Tuberculosis 16,22,61-63 Tuberculosis After Care Committee 63 Typhoid Fever 60 U Ultra Violet Ray Therapy 23,73-74 Unmarried Mothers 18 V Vaccination 61 Vermin 44 Venereal Diseases 22 Vital Statistics, Extracts from 10-11 Visits, Health Visitors' 70-71 Visits, Sanitary Inspectors' 36-37 W Water Supply 27-29 Welfare of the Blind—Association for 64 Whooping Cough 11 Workshops 38 Z Zymotic Diseases 50-64