DAG 14 BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1940 CECIL HERINGTON, M.B., B.S. (Lond.). D.P.H. CR68539B 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report on the health of the Borough for the year 1940. The Ministry of Health Circular, No. 2814, of 26th March, 1941, directs that the report shall be an interim one but that all records and statistics, including those to be supplied by the Registrar General, be carefully preserved with a view to a more detailed report after the war. One notable feature is the low incidence of the more common infectious diseases; this is particularly significant in the case of Diphtheria. When one considers the conditions under which the majority of people passed their nights in the latter part of the year, it is remarkable that there was not an increase rather than a diminution in this group of diseases. The reason for this has not up till now been fully explained scientifically, although of course, in the case of Diphtheria, immunisation has been an important factor. I would like to make special mention of the loyal co-operation of my colleagues and the staff of the Public Health Department during a very trying period. No case arose when individual members, on being asked to undertake duties which were outside their normal scope, hesitated to carry them out with alacrity. 4 The Members of the Council and the Health Services Committee have shown their continued interest in the work of this Department, and I offer them my thanks for their co-operation. I am, f Mr. Mayor, Ladies and Gentlemen, Your obedient servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 5 MEMBERS OF THE COUNCIL. (31st December, 1941.) Mayor ; Alderman R. J. D. CLACK, J.P. Deputy Mayor : Alderman (Mrs.) L. F. EVANS, E.C.C. Aldermen : A. F. J. CHORLEY, J.P., E.C.C. W. C. MARKHAM. E. E. HENNEM. M. E. MARLEY (Mrs.), J.P. W. F. LEGON. B. H. SAUNDERS,- E.C.C. Councillors : J. R. ANDREWS. R. G. MURRELL. W. E. BELLAMY. J. NEISH (Mrs.) D. E. BROWN. F. J. PERFECT. F. BROWN. A. E. PRENDERGAST (Mrs.) J. W. BURRIDGE. E. S. REDDY (Mrs.). A. A. BUTTERS. M. REDDY. S. W. DEEIvS. F. L. M. ROGERS (Mrs.). E. EDWARDS. E. R. SAYWOOD. A. E. GIBBS. A. R. THOMAS (Mrs.). F. T. GRINDROD. F. G. THOMAS. H. L. LYONS. C. A. THORNKYCKOFT. J. E. MUNN. M. A. E. WARREN (Mrs.). HEALTH SERVICES COMMITTEE. Alderman (Mrs.) M.lE. MARLEY, J.P., Chairman. Councillor (Mrs.) A. R. THOMAS, Vicc-Chairman. His Worship the Mayor Coun. F. J. PERFECT. (Ald. R. J. D. CLACK, J.P.) Coun. E. S. REDDY (Mrs.). Deputy Mayor Coun. A. E. PRENDERGAST (Mrs.). (Ald. (Mrs.) L. F. EVANS, Coun. M. A. E. WARREN (Mrs.): E.C.C.) 6 OFFICERS of the PUBLIC HEALTH SERVICES. Full-Time Staff: Medical Officer of Health : CECIL IIERINGTON, M.R.C.S., L.R.C.P., M.B., B.S. (Lond.), D.P.H. Deputy Medical Officer of Health : JAMES A. C. FRANKLIN, M.R.C.S., L.R.C.P., M.B., B.S. (Lond.) D.P.H. Assistant Medical Officer : HARRY B. CARTER-LOCKE, M.R.C.S., L.R.C.P., M.B., B.S. (Lond.), D.P.H. Senior Sanitary Inspector : L. E. PRIOR (1. 2). Sanitary Inspectors : J. W. ALLAM (1, 2). A. J. JAMES (1). F. W. S. FOX (1, 2, 3. 4). F. W. KNIGHT (1, 2). Senior Health Visitor : M. SMITH (5, 0, 7). Health Visitors : V. A. EVERITT (5, 6. 7). D. B. STEWART (5, 6, 7). A. K. GIBSON (6. 6, 7). M. B. THOMAS (5, 6, 7). J. W. B. .VIACFIE (5, 6, 7). D. E. WALLER (5, 6, 7). J. M. MARTIN (5, 6, 7). L. WEALE (1. 5. 6, 7, 8). B. L. MARYON (5, 6, 7). Senior Midwife : M. A. E. TAYLOR (5,'6, 9, 10, 11). Midwives : D. K. ANKER (6). C. M. KIPLING (5, 6). E. II. BEDFORD (5. 6). O. M. LISSAMORE (6). M. HALL (6). H. MITSON (5, 6). C. HURRY (6). M. J. STOREY (6). Certificate of Royal Sanitary Institute 1 Meat Inspector's Certificate 2 Sanitary Science as applied to Building and Public Works Certificate 3 Smoke Inspector's Certificate 4 General Trained Nurse 5 State Certified Midwife 6 New Health Visitor's Certificate 7 M. & C. W. Certificate 8 Midwifery Teachers' Diploma 9 Analgesia Certificate 10 Hospital Administration and Housekeeping Certificate 11 7 Clerical Staff: Senior Clerk : B. E. E. DENNY. Clerk to Sanitary Inspectors : H. FIELD (1). Clerks : I. M. BISHOP. P. H. M. MURPHY. E. L. CURTIS. K. W. SKEATES. P. R. DRISCOLL. E. J. SMEE. M. A. WATTS. Part-Time Staff: Consulting Gynecologist : R. L. DODDS, M.Ch.. F.R.C.S. (Eng.). Consulting Orthopædic Surgeon : B. WHITCHURCH HOWELL, F.R.C.S. (Eng.). Dentist : F. C. RITCHIE, L.D.S., R.C.S. (Edinburgh). Public Analysts : BERNARD DYER, D.Sc., F.I.C. J. HUBERT HAMENCE, Ph.D., M.Sc., F.I.C. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 6,556 Registrar-General's estimate of resident population, 1940 91,740 Number of inhabited houses (end of 1940) according to Rate Books *26,309 Rateable value (December 31st, 1940) £612,419 Sum represented by a penny rate (approximate 1940-41) £2,390 * No demolished premises had been taken out of Rating at this date. Social Conditions of Inhabitants. There has been a considerable increase in industrial activity, as the factories, particularly those engaged in engineering, have been extended. The building industry, which formerly was an important one, has for obvious reasons almost entirely ceased. Extracts from Vital Statistics for the Year. Live Births ((B.K.) for calculating Birth Rates) :— Total. Male. Female Legitimate 1,679 832 847 Birth rate per 1,000 of the estimated resident population, 18.77. Illegitimate 43 25 18 Live Births ((I.M.) for calculating Infant and Maternal Mortalities) :— Total. .Male. Female. Legitimate 1,611 796 815 Illegitimate 43 25 18 9 Stillbirths :— Legitimate 54 30 24 Rate per 1,000 total (live and still) births, 32.04. Illegitimate 3 1 2J Deaths 817 456 361 Death rate per 1,000 of the estimated resident population, 8.91. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis — 0.00 Other puerperal causes 7 4.09 Total 7 4.09 Death rate of Infants under one year of age :— All infants per 1,000 live births 51.39 Legitimate infants per 1,000 legitimate live births 51.52 Illegitimate infants per 1,000 illegitimate live births 46.51 Deaths from Cancer (all ages) 93 „ „ Measles (all ages) 1 ,, ,, Whooping Cough (all ages) — „ Diarrhea (under 2 years of age) 7 Population. The Registrar-General's mid-year estimate of 91,740 is much less than that for recent years; this is accounted for largely by evacuation. Births. 1,722 live births were registered during the year, there being 857 males and 8G5 females. There is a drop of total births from 1,885 in 1939 to 1,722. The birth rate per thousand population was 18.77 compared with 14.6 for England and Wales and 16.0 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, 10 18.47, 18.7, 18.06 and 17.61 for the years 1927 to 1939 inclusive. The illegitimate birth rate continues to be very low, being only 2.50 per cent. of total births. The rate of illegitimate stillbirths is 5.20 per cent. of total stillbirths. Death Rate. Total deaths in district 575 Outward transfers 164 Inward transfers 404 Deaths of residents 815 Of the 164 deaths of non-residents occurring in the district, 73 took place at the West Ham Sanatorium, 37 at the Joint Isolation Hospital and 14 at Hainault Lodge. Of the 404 deaths of local residents taking place outside this area, most occurred in institutions. Of these 168 occurred at Oldchurch Hospital, 33 at Suttons Institution, 13 at King George Hospital, Ilford", 10 at Warley Hospital, 10 at 42, The Plain, Epping, 10 at Essex County Hospital, Wanstead, 10 at 142, Rayne Road, Braintree, 8 at 48, Wood Street, Chelmsford, 8 at Severalls Mental Hospital, 7 at 32a, Spital Road, Maldon, 7 at Ilford Isolation Hospital, 5 at Little Heath House, 4 at New Hall, Boreham, 4 at The Retreat, Billericay, 4 at Essex County Hospital, Broomfield, and 4 at St. Mary's Hospital, West Ham. 817 deaths in a population of 91,740 represent a death-rate of 8.90 compared with 14.3 for England and Wales. For the years from 1927 to 1939 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, 6.24, 6.19, and 5.96. A table giving the causes of death, and the age Periods at which they occurred, is given at the end of the report. 11 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1940. 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. Diarrhœa and Enteritis (under two years) Total Deaths (under one year). England and Wales 14.6 0.55 14.3 0.00 — 0.02 0.00 0.02 0.06 0.32 4.6 65 126 County Boroughs and Great Towns, including London 16.0 0.64 15. 8 0.00 — 0.02 0.00 0.02 0.07 0.20 5.9 61 148 smaller towns (1031) resident populations 25,000—50,000 15.7 0.55 12.8 0.00 — 0.02 0.00 0.02 0.05 0.30 4.4 54 London 13.7 0.44 17.8 0.00 — 0.01 0.00 0.00 0.01 0.18 5.8 50 Dagenham— Estimated resident population mid-1940. 91.740 1 18.77 0.62 8.91 0.00 — 0.01 0.00 0.00 0.08 0.05 4.23 51.39 12 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Hospitals for General Cases. Rush Green Isolation Hospital has been allocated to some extent for the reception of general, medical and surgical cases. A number of beds has also been earmarked for the reception of air-raid casualties. Oldchurch Hospital still takes the majority of general cases from this Borough. The activities of the Out-Patient Department of King George Hospital have been severely restricted owing to the fact that the greater part of the building is used as a First Aid Post. Hospitals for Maternity Cases. The East End Maternity Hospital which formerly accepted a large number of patients from Dagenham, has been transferred to a safer area; a few patients still take advantage of this Hospital, but the majority of uncomplicated maternity patients are treated in their own homes. Complicated maternity cases are admitted to Oldchurch Hospital under an arrangement which has been in operation since the City of London Maternity Hospital was evacuated. 13 Ambulance Facilities. There has been no material change in the arrangements. " 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. Avearge New Cases. Co-operative Hall, Whalebone Lane North Chadwell Heath. Weekly Wednesday, p.m. 26 5 Valence Club. Corner of Becontree Weekly Monday, a.m. 47 4 Avenue and Bennetts Castle Lane, Dagenham. Weekly Monday, p.m. 60 6 Arnold Road (Temp.) School, Weekly Thursday, a.m. 62 4 Arnold Road, Dagenham. Weekly Thursday, p.m. 71 7 Osborne Hall, Osborne Square, Weekly Wednesday, a.m. 43 5 Dagenham. Weekly Wednesday, p.m. 67 7 Rush Green Clinic. 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 34 2 11 Ante-Natal Clinics. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. Co-operative Hall, Whalebone Lane North, Chadwell Heath. Weekly Monday, a.m. 9 2 Becontrec Clinic, Becontree Avenue, Weekly Tuesday, a.m. 14 4 Dagenham. Weekly Friday, a.m. 15 4 Arnold Road (Temp.) School, Weekly Monday, p.m. 12 4 Arnold Road, Dagenham. Tuesday, a.m. 13 4 Rush Green Clinic, 179, Dagenham Road, Rush Green. Monthly (1st in month) Friday a.m. 7 2 York House, Frizlands Lane, Weekly Thursday, a.m. 15 5 Dagenham. Weekly Thursday, p.m. 14 4 Owing to the increased attendance at the Ante-Natal and Infant Welfare Clinics, it has been necessary during 1941 to open three additional weekly sessions. School Clinics. Clinic. Inspection. Minor Ailment. Co-operative Hall, Whalebone Lane North, Chadwell Heath. Friday morning. Tuesday morning. Green Lane School, Dagenham. Tuesday and Thursday afternoons. Monday, Wednesday and Friday mornings. Five Elms School, Wood Lane, Dagenham. Monday and Friday mornings. Tuesday, Wednesday and Thursday mornings Arnold Road School, Arnold Road, Dagenham. Every second Tuesday afternoon and every Friday afternoon. Wednesday morning. 15 Tuberculosis Clinic. A Tuberculosis Clinic is held every Monday and Thursday morning at the King George Hospital OutPatient 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 5 p.m., and Sundays 10 to 12 noon. Orthopaedic Clinics. By arrangement with the Essex County Council, children who fall under the provisions of our Maternity and Child Welfare Scheme arc referred to the Orthopaedic Surgeon; an allocation of costs is made which is based on the proportion of attendances of school children and those under five years of age. Remedial Exercises and Massage Clinic. Two sessions are held weekly at the Heathway Special School, namely, on Monday and Thursday mornings. Professional Nursing in the Home. General. The Dagenham District Nursing Association is the only organisation operating in this district. The nurses undertake midwifery and maternity nursing, and addition medical and surgical cases are attended. A total of 445 general nursing cases was treated during the year, involving 5,386 visits to the homes. 415 midwifery cases and 68 maternity cases were nursed. 16 Midwives. Nine Council Midwives, including one Senior Midwife with special experience, are employed, and by agreement seven nurses employed by the District Nursing Association and two by the Salvation Army are in practice. In addition to these there are three independent midwives residing in the area. Laboratory Facilities. With the exception of Diphtheria swabs and occasionally other investigations which are examined at the Public Health Offices, the bulk of the clinical investigations are undertaken by the Counties Public Health Laboratories now situate at Gidea Park College, Romford. Legislation in Force. There has been no change in local legislation since the date of the last report. 17 SANITARY CIRCUMSTANCES OF THE AREA. Water. I am indebted to B. W. Bryan Esq., Engineer of the South Essex Waterworks Company for the following " The total length of new mains laid in the Borough during the year 1940 was 122 yards of 6-inch main. " The whole of the analytical reports for that year showed the water to be pure and wholesome and suitable for the purpose of a public supply. " I may add that our new Stour Scheme came into permanent use early in 1941, and it may be of interest to know that the total number of samples analysed for chemical, bacteriological and biological purposes is something like 2,500 for the year." Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits: — Houses 905 Nuisances under Public Health Acts 1,663 Bakehouses 30 Slaughterhouses 125 Milkshops, dairies and vehicles 43 Foodshops and stalls 766 Cafes 80 Infectious disease enquiries 852 18 Food poisoning enquiries 2 Visits to foster mothers' premises 21 Smoke observations 7 Number of complaints investigated 618 Outworkers' premises 32 Ice-cream premises and vehicles 94 Factories 51 Tents, vans and sheds 37 Stables 10 Rats and Mice (Destruction) Act 170 Hairdressers' and Barbers' premises 79 Shops Act, 1934 160 Rooms fumigated 42 Inspections of Billets for Refugees 331 Inspections of Air-Raid Shelters 145 Inspections of Food Shops following War Damage 278 Other Visits 22 (b) Notices served. Complied with. Statutory 1 2 Informal 226 170 Rats and Mice (Destruction) Act, 1919. The same procedure operated during the year as in the past in connection with rats and mice. Poisons are supplied upon request. A number of rat burrows was treated with smoke and gas with fair results. In addition, eight informal notices were served during the year and five were complied with. 19 HOUSING. The prevailing circumstances rendered it necessary in some respects, to relax certain standards of housing, but the work of inspection was continued, and, where possible, conditions remedied. The Sanitary Inspectors have been given additional duties connected with Civil Defence which to some extent have interfered with their normal duties. At the time of writing this report, however, with some exceptions they have resumed their normal functions. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. As in former years, careful attention has been paid to. this important subject and, taken on the whole, the milk sold in this area has been found to be of good quality. During the year 1940, 18 licences were issued in respect of pasteurised and 11 for tuberculin tested milk. Food Poisoning. Two cases of Food Poisoning were notified, neither of which, after investigation, was confirmed as being true examples of this condition. Food and Drugs Act, 1938. The following table summarises samples of various foods taken under this Act, together with those found to be adulterated or otherwise not complying with the provisions of the Act. As in the previous year, Doctors Bernard Dyer and Hammence have continued in their appointment as Public Analysts to the Borough. 20 Article. Number Examined. Number Adulterated, etc. Formal. Informal Total. Formal. Informal Total. Rum Essence _ 1 1 – – – Essence of Rennet 1 1 – Lemonade Crystals 1 ' — 1 – – Custard and Cake Powders 7 3 10 – – – Cream 1 1 – Milk 54 54 4 4 Milk—Condensed 5 5 _ – Butter 13 1 14 – _ Margarine 9 1 10 – – _ Whisky 1 — 1 – – – Suet—Shredded 3 1 4 1 – 1 Bile Ovals 1 1 – – Bread and Butter 10 10 3 3 Cod Liver Oil 1 1 – – – Loaf—Vienna 1 – 1 Compound Glycerine and Thymol – 1 1 – – – Meat and Fish Pastes 1 11 12 – – – Epsom Salts 1 3 4 2 – Meatox Cubes – 1 1 – – Glauber Salts – 1 1 1 – 1 Tinned Fish – 9 9 – – – Health Saline – 1 1 – – – Sausages 22 – 22 3 3 Saccharine Tablets 1 1 – – – Sauces and Pickles 5 5 – – Seidlitz Powder 1 1 – – – Peas—Tinned 2 2 – – – fincture of Quinine 1 ] – – – Tapioca – 2 2 – – – Swiss Roll 1 1 – – – Baking Powder – 2 2 – – – Oatmeal 1 – 1 1 – – – Flour 1 2 3 – – – Jam – 2 2 – – – Dried Fruit 7 7 – – – Spices 4 o 6 – – – Vinegar – 2 2 – – – Aspirin — 2 2 – Basilicum Ointment — 1 1 – Bicarbonate of Soda — 1 1 – — Camphorated Oil — 1 1 – Cascara Sagrada _ 3 3 – Castor Oil — 2 2 – Olive Oil — 3 3 — — — Petroleum Jelly — 2 2 — Syrup of Figs — 1 1 — — — Yeast Tablets — 1 1 — _ — Carried forward 137 82 219 12 – 12 21 Article. Number Examined. Number Adulterated, etc. Formal. Informal Total Formal. Informal. Total.   Brought forward 137 82 219 12 — 12 Cheese 3 — 3 — — — Lard 1 1 2 — — — Cooking Fat 3 i 4 — — — Cooked Meats 7 i 8 — — — Jelly 1 2 3 — — — Rice 1 — 1 — — — Egg Substitute — 5 5 — — — Pepper — 1 1 — — — Herbs 3 4 7 1 2 3 Aromatic Spirit of Sal Volatile — 1 1 — 1 1 Extract of Witch Hazel — 1 1 — — — Glycerine — 2 2 — — — Medicinal Paraffin — 1 1 — — — Parrish's Chemical Food — 1 1 — — — Cocoa 2 — 2 — — — Coffee — 1 1 — — — Soup — 2 2 — — — Gelatine 1 1 2 1 — 1 Sweets, including chocolate 4 3 7 — — — Cornflour 1 — 1 — — — 164 110 274 14 3 17 22 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (other than Tuberculosis). Under 1 year 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and over Total Cerebro-Spinal Fever 3 6 7 1 1 4 3 1 1 27 Diphtheria — 23 26 12 1 2 2 1 67 Encephalitis Lethargica — — — Entcrie Fever — 1 3 3 5 2 1 15 Erysipelas __ 4 8 9 4 1 26 Food Poisoning 2 – – – 2 Measles 4 26 21 3 8 2 2 66 Ophthalmia Neonatorum 2 – – – – – – – – – – 2 Pemphigus 6 – – – – – – – – – – 6 Pneumonia— Acute Primary 13 25 9 4 6 3 3 9 8 5 6 91 Influenzal — — 1 — 2 1 11 1 2 1 19 Poliomyelitis Acute – – – – – – – – – – – – Polioencephalitis Acute – – – – – – – – – – – – Puerperal Pyrexia 1 7 . 9 3 – 20 Scarlet Fever 39 50 22 21 4 2 4 142 Smallpox – – – – – Whooping Cough – 10 2 – — — — — — — _ 12 Notified. Admitted to Isolation Hospital, Rush Green. Admitted to other Isolation Hospitals. Admitted to other Hospitals. Deaths Registered. Cerebro-Spinal Fever 27 25 – – 9 Diphtheria 67 67 – 5 .Encephalitis Lethargica – – – – – Enteric Fever 15 15 – – – Erysipelas 26 9 – 1 – Food Poisoning 2 – – – – Measles 66 1 – – – Ophthalmia Neonatorum 2 2 – – – Pemphigus 6 5 – – – Pneumonia— – – – Acute Primary 91 37 – 6 77 Influenzal 19 6 – 4 Poliomyelitis Acute – – – – – Polioencephalitis Acute – – – – – Puerperal Pyrexia 20 8 – 2 – Scarlet Fever 142 78 – – – Smallpox – – – – – Whooping Cough 12 2 – – – 23 Diphtheria. There has been a further considerable drop in the incidence of Diphtheria, the total number of cases being 67, compared with 117 for the preceding year. This is the more remarkable when one remembers that for a portion of the year many persons were spending their nights in air-raid shelters. Evacuation, however, must claim a part in the diminution as a number of the population at risk were living in reception areas. Schick Testing and Immunisation. Towards the latter part of the year and more so during 1941, a much larger number of children has been presented for treatment at the Immunisation Clinic. The requests now average over 100 per week. The reagent used is Alum Precipitated Toxoid, and is supplied by the Government through the Sector Pathologist. Normally no preliminary Schick test is given, but parents are encouraged to submit their children to a test three months or more after the completion of treatment. It has been found that the rate of protection is high and the comparatively small numbers dealt with show an immunity of over 99 per cent. Undoubtedly the publicity given to this subject by Sir Wilson Jameson, Principal Medical Officer of the Ministry of Health, did a great deal towards persuading parents to accept this treatment. I feel that my opinion is shared by the majority of Medical Officers of Health that the broadcasts given by Sir Wilson did more than all the previous publicity put together. 21 Scarlet Fever. This disease also shows a very marked fall, and despite the fact that it was only possible to admit 78 out of the 142 cases to hospital, no deaths occurred from this disease, thus Scarlet Fever continues to become less virulent. 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- 2 — 1 1 — — — — — — 1 — 5- 2 1 1 2. — 1 2 1 — — — 10- — 1 2 1 — 1 — 2 — 1 — — 15- 7 12 1 4 — 2 — — 2 8 — — 20- 4 5 — 1 3 4 — — 4 4 1 — 25- 10 6 — — 13 6 1 1 7 4 — — 35- 17 8 — — 2 3 — — 8 10 — — 45- 15 4 — — 1 — — 9 3 1 55- 4 — — — — 1 — — 4 1 — — 65 and upwards 1 — — — — — — — — — — — 62 37 5 9 20 18 3 4 34 31 3 1 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register 1st Jan., 1940 349 267 132 117 During the year :— New Notifications 62 37 5 9 Deaths 34 31 3 1 Transfers into area 20 18 3 4 Transfers out of area 22 25 6 5 No. on register 31st Dec., 1940 375 266 131 124 25 MATERNITY AND CHILD WELFARE. Notification of Births. 1,552 notifications of live births were received during the year. 153 notifications (including stillbirths) were received from medical practitioners and parents and 1,218 from midwives. Stillbirths. 28 male and 19 female stillbirths were notified, the corresponding figures for registration being 31 and 26. The rate per 1,000 of total population registered was 0.62, the rate for England and Wales being 0.55. The percentage of illegitimate stillbirths to the total was 5.26, compared with a percentage of illegitimate to total births of 2.50. Infant Mortality. 85 infants under one year of age died during the year, giving an infant mortality rate of 51.39 per 1,000 live births, compared with that of 55 for England and Wales and 50 for London. The rate amongst legitimate children was 51.52 while for illegitimate children it was 46.51. Ophthalmia Neonatorum. Two cases of this disease were notified, both of which were treated in hospital and made complete recoveries. 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 26 and a Health Visitor. Of the total cases investigated, only two were notified as suffering from true Ophthalmia Neonatorum. Pemphigus. During the year, there were six notifications of children suffering from Pemphigus, five of whom were removed to hospital and the remainder treated at home; all recovered. Maternal Mortality. Seven cases of maternal mortality were assigned to this district, giving a maternal mortality rate of 4.09 compared with 2.16 for England and Wales and 2.57 for this district for the preceding year. Work of Health Visitors. The following table shows the number of visits paid by the Health Visitors during the year:— (a) To expectant mothers First visits 365 Total visits 543 (b) To children under one year of age First visits 1,637 Total visits 6,213 (c) T o children between the ages of one and five years Total visits 17,259 Grand Total 24,015 Although the number of births is somewhat less than in previous years, the work done by the Health Visitors has increased. This is partly due to additional duties which they now have to undertake and are directly connected with the war. 1 here is a general tendency throughout the Borough value the work of Health Visitors more as time goes on. It is a rare event now-a-days for a Health Visitor to be 27 refused admission to a home, thereby showing that the valuable advice which Health Visitors are in a position to give is being appreciated more and more. Supervision of Midwives. The number of Midwives who notified their intention to practise during the year 1940 was 45, and the number practising at the end of the year was 27. The routine inspection and special investigations are undertaken by the Medical Officer of Health. Notifications received from 1st January to 31st December, 1940: — Notices summoning medical aid 424 For (a) Mothers 308 For (b) Infants 116 The following is a summary of the reasons for sending for medical help by midwives:— Perineal Tear 100 Discharging Eyes 61 Prolonged Labour 44 Ante-Partum Haemorrhage 34 Rise of Temperature 26 Miscarriage 22 Malpresentation 20 Feebleness of Infant 19 Post-Partum Haemorrhage 16 Albuminuria 13 Deformity 5 Watery Blisters 3 Varicose Veins 1 Other Causes 60 424 28 Notification was received intimating that artificial feeding had been resorted to in 22 cases and on 48 occasions midwives notified that they were liable to be sources of infection. Domiciliary Midwifery Service. Below is a table setting forth in statistical form the work of the Corporation Midwives, Dagenham Nursing Association and Salvation Army Midwives for the year 1940:— Municipal Midwives. Dagenham Nursing Association. Salvation Army Nurses. Births Attended : As Midwife 546 415 148 As Maternity Nurse 91 68 37 Miscarriages Attended 8 9 8 Visits Paid : As Midwife 10,602 8,280 3,405 As Maternity Nurse 1,378 1,273 731 Ante-Natal 4,176 2,797 226 Ante-Natal Clinics Attended... 331 174 47 Over 55 and under 65 Over o5 and under 75 75 and over TOTAL Regis trarGeneral's Allocations. M F M F M F M F M F — — — — — — — — — — 1 — — — — — 7 2 7 2 — — — — — — — — — — — — — — — — — — — — — — — — — — 3 2 5 2 5 2 — — — — 40 31 41 31 — — — — — — 5 7 5 8 1 — — — — — 3 2 4 1 — — — — — — — — 3 2 — — — — — — — — 1 — — — — — — — — — — 1 — — — — — — — — — — 1 — — — 1 — 2 — 4 7 — — — 1 — 1 — 3 1 1 1 4 1 1 7 7 8 8 — 4 — — — 3 — 10 — 17 11 7 9 8 2 3 32 31 32 17 — 1 2 5 — — 2 8 1 6 4 8 7 6 5 11 25 32 19 22 15 13 20 13 25 21 86 71 74 58 — — 1 1 1 — 4 2 4 10 6 — 3 1 3 12 19 14 43 16 7 4 8 4 3 6 48 29 31 16 — 1 1 3 1 1 6 9 5 8 — — 1 — — — 1 1 6 2 — — — — — — 3 1 5 1 — — — — — — 4 — 5 4 2 1 1 3 — 1 8 9 7 9 1 — 4 1 4 2 18 7 13 7 — — — — — — — — — — — — — — — — — 8 — 7 — — — — — — 10 11 8 10 — — — — — — 7 5 14 11 1 — 3 — — 6 2 5 3 1 — — — — 1 8 4 11 4 3 3 3 1 1 — 65 43 59 44 1 1 1 2 8 6 27 18 35 27 61 47 65 53 55 69 446 369 455 361 CAUSES OF DEATH Under 1 vear 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 RegistrjrGencral'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. Cerebro-spinal Fever 1 1 1 — 1 1 2 — — — — — 1 — — — 1 — — — — — 7 2 7 2 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Diphtheria. — — — — 1 — 2 2 — — — — — — — — — — — — — — 3 2 5 2 6. Tuberculosis of Respiratory System — — — — — — — 1 4 9 12 4 9 9 10 6 5 2 — — — — 40 31 41 31 7. Other forms of Tuberculosis _ 1 — — 1 — — 1 1 3 1 — 1 1 1 1 — — — — — — 5 7 5 8 8. Syphilitic Disease — — — — — — — — — — — — 1 — 1 2 1 — — — — — 3 2 4 1 9. Inlluenza — — — — — — — — — — — — — — — — — — — — — — — — 3 2 10. Measles — — — — — — — — — — — — — — — — — — — — — — — — 1 — 11. Acute Poliomyelitis and Polio-encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — 1 12. Acute Infectious Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 13.m. Cancer of Buccal Cavity of Oesophagus — — — — — — — — — — — — — — — — — — — — — — — — 4 7 13.f. Cancer of Uterus — — — — — — — — — — — — — — — — — — — 1 — 1 — 3 — — 14. Cancer of Stomach and Duodenum — — — — — — — — — — — — 2 — 2 1 1 1 1 4 1 1 7 7 8 8 15. Cancer of Breast — — — — — — — — — — — — — — — — — — — — — — — — — 17 16. Cancer of all other sites — — — — — — — — — 1 — — 3 4 7 8 11 7 9 8 2 3 32 31 32 17 17. Diabetes — — — — — — — 1 — — — — — — — — — 1 2 5 — — 2 8 1 6 18. Inter-cranial Vascular Lesions 2 2 — — — — — — 1 1 — 2 2 2 4 — 4 7 6 5 11 25 32 19 22 19. Heart Disease 2 1 — — — 2 3 — 2 2 4 8 7 12 7 15 13 . 20 13 25 21 86 71 74 58 20. Other diseases of the Circulatory System 1 — — — — — — — — — — — — — — — — 1 1 1 1 — 4 2 4 10 21. Bronchitis 3 1 — — — — 1 — — — — — 1 — 2 — 6 — 3 1 3 12 19 14 43 16 22. Pneumonia 17 6 1 — 2 1 — — — 1 — 1 5 3 5 3 7 4 8 4 3 6 48 29 31 16 23. Other Respiratory diseases — — — — — — — — — 1 — — 1 3 2 — — 1 1 3 1 1 6 9 5 8 24. Ulceration of the Stomach or Duodenum — — — — — — — — — — — — — — — — — — — — — — 1 1 6 2 25. Diarrhcea (under 2 years) 3 1 — — — — — — — — — — — — — — — — — — — — 3 1 5 1 26. Appendicitis — — — — — — — — — — — — — — — — — — — — — — 4 — 5 4 27. Other Digestive Diseases 1 1 — — — — — — — — 1 1 2 1 1 1 2 1 1 3 — 1 8 9 7 9 2d. Nephritis ... 1 — — — — — — — _ 1 — 2 3 4 1 1 — 4 1 4 2 18 7 13 7 29. Pueiperal and post Abortive Sepsis — — — — — — — — — — — — — — — — — — — — — — — — — — 30. Other maternal causes — — — — — — — — — 2 — 4 — 2 — — — — — — — — — 8 — 7 31. Premature Birth 10 11 — — — — — — — — — — — — — — — — — — — — 10 11 8 10 32. Congenital malformation, birth injury, infantile disease 7 5 — — — — — — — — — — — — — — — — — — — — 7 5 14 11 33. Suicide — — — — — — — — — — — — — 2 2 1 — 3 — — _ 6 2 5 3 34. Road Traffic Accidents — — — — — — 1 — 1 1 4 — 1 2 — — 1 — — — — 1 8 4 11 4 35. Other Violent Causes 1 2 2 2 2 3 11 2 8 12 11 7 15 6 8 5 3 3 3 1 1 — 65 43 59 44 30. All Other Causes 5 — 1 1 1 — 4 1 2 1 — 1 3 4 1 1 1 1 1 2 8 6 27 18 35 27 54 32 5 4 8 5 24 11 20 34 33 25 57 49 64 40 61 47 65 53 55 69 446 369 455 361