914.2691 DAG 15 BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1941 CECIL HERINGTON, M.B., B.S. (Lond.), D.P.H. 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Report on the health of the Borough for the year 1941. By direction of the Ministry of Health, this Report is again curtailed and should be regarded as an interim one; records and statistics are, however, being preserved in order to enable a comprehensive report to be prepared at a later date. A noteworthy feature is the occurrence of one maternal death only; whilst not claiming the whole of the credit for this, it may fairly be assumed that the high efficiency of the maternity services, coupled with the co-operation of the mothers, are contributory factors of some importance. The problem of caring for children of mothers who have entered or re-entered industry was tackled by the Council in the latter part of the year. At the time of writing, two War-Time Nurseries are in full operation and others contemplated. The Education Committee is also actively engaged in establishing Nursery Classes in the schools. The Daily Guardian Scheme is of limited application in this Borough, as most of the would-be guardians are themselves employed. Once, more I am pleased to record my appreciation of the loyal services of my colleagues and the staff of 4 the Public Health Department, who have not only discharged their obligations to the Town with credit, but have evinced a spirit of willingness which does so much to help the smooth working of any organisation. To the Members of the Council, with special reference to those of the Health Services Committee, I offer my thanks for their continued interest shown in the health of the people of the Borough. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, CECIL HERINGTON;l 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. MURKELL. 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. DEEKS. 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. THORNE YCROFT. J. E. MUNN. M. A. E. WARREN (Mrs.). HEALTH SERVICES COMMITTEE. Alderman (Mrs.) M.lE. MARLEY, J.P., Chairman. Councillor (Mrs.) A. It. THOMAS, Vicc-Chairman. His Worship the Mayor Coun. F. J. PERFECT. (Aid. R. J. D. CLACK, J.P.) Coun. E. S. REDDY (Mrs.). Deputy Mayor Coun. A. E. PRENDERGAST (Mrs.). (Aid. (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 cf Health : CECIL HERINGTON, 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. ALL AM (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, 6, 7). Health Visitors : V. A. EVERITT (5, 0, 7). D. B. STEWART (5, 6, 7). A. K. GIBSON (5, 0, 7). E. THOMAS (5. 0. 7). J. W. B. MACFIE (5, (5, 7). D. E. WALLER (5, 6, 7). B. L. .MAKVON (5, 6, 7). L. WEALE a, 5, 6, 7, 8). (One Vacancy) Senior Midwife : M. A. E. TAYLOR (5, 6, 0, 10, 11). Midwives : D. K. ANKER (6). C. M. KIPLING (5, 6). E. M. BEDFORD (5, 6). O. M. LISSAMORE (6). M. HALL (0). H. MITSON (5, 6). C. HURRY (6). M. J. STOREY (6). 7 Clerical Staff: Senior Clerk : B. E. E. DENNY. Clerk to Sanitary Inspectors : H. FIELD (1). Clerks : I. M. BISHOP. K. W. SKEATES. K. BRIMBLECOMBE (12). M. A. WATTS. G. K. HARRIS. E. HIGHAM (12). B. JONES (12). 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 M. & C. W. Certificate 8 Midwifery Teachers' Diploma 9 Analgesia Certificate 10 Hospital Administration and Housekeeping Certificate 11 Temporary War-Time Appointment 12 Part-Time Staff : Consulting Gynecologist : R. L. DODDS. M.Ch., E.R.C.S. (Eng.). Consulting Orthopcedic Surgeon : B. WHITCHURCH HOWELL, E.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 Number of inhabited houses (end of 1941) according to Rate Books 25,797 Rateable value (December 31st, 1941) £595,355 Sum represented by a penny rate (approximate 1941-42) £2,290 Social Conditions of Inhabitants. The progress of the war has necessitated the employment of large numbers of women in both light and heavy industries. Reference is made in a later part of the Report to the facilities offered for care of children of women now employed. Extracts from Vital Statistics for the Year. Live Births:— Total. Male. Female. Legitimate -17640 843 797 Birth rate per 1,000 of the estimated Illegitimate 52 34 18 resident popula- tion, 19.08. Stillbirths:— Legitimate 45 23 22 Rate per 1,000 total (live and still) Illegitimate 2 1 1 births, 27.03. Death rate per Deaths 755 412 343 1,000 of the esti- mated resident population, 8.51. 9 Deaths from puerperal causes :— Deaths, Rate per 1,000 total (live and still) births. Puerperal sepsis 0.00 Other puerperal causes 1 0.63 Total 1 0.63 Death rate of Infants under one year of age :— All infants per 1,000 live births 46.34 Legitimate infants per 1,000 legitimate live births 43.89 Illegitimate infants per 1,000 illegitimate live births 117.65 Deaths from Cancer (all ages) 108 „ Measles (all ages) 3 „ „ Whooping Cough (all ages) 6 „ ,, Diarrhœa (under 2 years of age) 2 Births. 1,692 live births were registered during the year, there being 877 males and 815 females. There is a drop of total births from 1,722 in 1940 to 1,692. The birth rate per thousand population was 19.08 compared with 14.2 for England and Wales and 14.7 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, 18.7, 18.06, 17.61 and 18.77 for the years 1927 to 1940 inclusive. The illegitimate birth rate continues to be very low, being only 3.07 per cent. of total births. The rate of illegitimate stillbirths is 4.26 per cent. of total stillbirths. 10 Death Rate. Total deaths in district 485 Outward transfers 117 Inward transfers 390 Deaths of residents 758 Of the 117 deaths of non-residents occurring in the district, 57 took place at the West Ham Sanatorium, 46 at the Joint Isolation Hospital and 15 at Hainault Lodge. Of the 390 deaths of local residents taking place outside this area, most occurred in institutions. Of these 167 occurred at Oldchurch Hospital, 23 at 48, Wood Street, Chelmsford, 15 at Orsett Lodge, 10 at Warley Hospital, 10 at the London Hospital, nine at King George Hospital, eight at Severalls Mental Hospital, eight at 32a, Spital Road, Maldon, six at New Hall, Boreham, six at Harold Court Sanatorium, six at The Retreat, Billericay, five at Brookside, Barley Lane, Goodmayes, four at IIford Isolation Hospital, four at Black Notley Sanatorium and four at the Essex County Hospital, Broomficld. 755 deaths are equivalent to a death rate of 8.51 compared with 12.9 for England and Wales. For the years from 1927 to 1940 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, 5.96 and 8.90. 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 1941. 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 14.2 0.51 12.9 0.00 — 0.03 0.00 0.06 0.07 0.19 5.1 59 126 County Boroughs and Great Towns, including London 14.7 0. 58 14.9 0.00 — 0.03 0.00 0.07 0.08 0.17 7.5 71 14S smaller towns (1931) resident populations 25,000-50,000 16.4 0.60 13.0 0.00 — 0.03 0.01 0.06 0.06 0.20 4.6 56 London 8.9 0.33 16.3 0.01 — 0.02 0.00 0.04 0.03 0.15 6.8 68 Dagenham 19.08 0.53 8.51 0.01 — 0.03 0.00 0.07 0.08 0.20 1.30 40.34 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 cases 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 vari6us 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. Co-operative Hall, Whalebone Lane North Chadwell Heath. Weekly Wednesday, p.m. 40 3 Valence Club. Corner of Becontree Weekly Monday, a.m. 45 3 Avenue and Bennetts Castle Lane, Dagenham Weekly Monday, p.m. 64 6 Arnold Road (Temp.) School, Weekly Thursday, a.m. 43 5 Arnold Road, Dagenham. Weekly Thursday, p.m. 07 7 Osborne Hall, Weekly Tuesday, 42 4 Osborne Square, Dagenham. Weekly a.m. Tuesday, p.m. 55 6 Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 27 2 14 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. 10 3 Becontree Clinic, Becontree Avenue, Weekly Tuesday, p.m. 17 4 Dagenham. Weekly Wednesday a.m. 11 3 Weekly Friday, 18 4 Arnold Road (Temp.) School, Weekly a.m. Monday, p.m. 17 5 Arnold Road, Dagenham. Weekly Tuesday, a.m. 18 4 Weekly Wednesday a.m. 12 2 Rush Green Clinic, 170, Dagenham Road, Rush Green. Monthly (1st in month) Friday a.m. 11 3 York House, Frizlands Lane, Weekly Thursday, a.m. 15 4 Dagenham. Weekly Thursday, p.m. 19 5 Owing to the increased attendance at the Ante-Natal Clinics, it has been necessary during 1942 to open two additional weekly sessions. School Clinics. Clinic. Inspection. Minor Ailment. Co-operative Hall, Whalebone Lane North, Chadwell Heath. Tuesday morning. Friday 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 EssexCounty 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 are referred to the Orthopaedic Surgeon; an allocation of costs is made which is based on the proportion of attendances of school children and those under five years of age. Remedial Exercises and Massage Clinic. Two sessions are held weekly at the Five Elms 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 in addition medical and surgical cases are attended. A total of 443 general nursing cases was treated during the year, involving 10,815 visits to the homes. 335 midwifery cases and 41 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 occa- sionally 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. During the year 1942 arrangements were made for pathological investigations to take place at the laboratory at Oldchurch County Hospital. I take this opportunity of acknowledging with thanks the service which has been carried out for many years by the Counties Public Health Laboratories. 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:— " There were no extensions of mains in the Borough of Dagenham for the year 1941. " Between 2,500 and 3,000 chemical, bacteriological and biological analyses were made of the various waters supplied during the year 1941 and all were reported on as pure and wholesome and suitable for the purpose of a public supply." Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits: — Houses 851 Nuisances under Public Health Acts 2,708 Bakehouses 81 Slaughterhouses 10 Milkshops, dairies and vehicles 93 Foodshops and stalls 1,324 Cafes 257 Infectious disease enquiries 1,404 Food poisoning enquiries 4 18 Visits to foster mothers' premises 32 Number of complaints investigated 942 Outworkers' premises 171 Ice-cream premises and vehicles 17 Factories 153 Workplaces 53 Tents, vans and sheds 34 Stables 18 Rats and Mice (Destruction) Act 363 Hairdressers' and Barbers' premises 37 Shops Act, 1934 95 Rooms fumigated 42 Inspections of Air-Raid Shelters 990 Inspections of Food Shops following War Damage 72 Other Visits 53 (b) Notices served. Complied with. Statutory 48 29 Informal 609 410 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, 21 informal notices were served during the year, and 18 were complied with. Mosquito Nuisance. A conference was arranged at the request of the Barking Borough Council, and attended by the local authorities and River Catchment Boards concerned, to consider the mosquito nuisance said to exist on the marshes adjoining the Thames. Investigations are proceeding. 19 HOUSING. In common with nearly every other municipal authority, there is a shortage of accommodation due to various causes, the chief of which being the complete cessation of new building. It is therefore necessary to relax somewhat the standards of overcrowding, but every endeavour is made to remedy the more serious cases; assistance has been freely given by the London County Council, the Housing Committee of this Council and the . Rehousing Officer. 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 1941, 20 licences were issued in respect of pasteurised and 10 for tuberculin tested milk. One retailer, whose premises are in an adjoining district, was interviewed in respect of unsatisfactory samples as a result of bacteriological examination. Food Poisoning. One case of Food Poisoning was notified, but on investigation it did not appear that this was a true case of this condition. 20 Legal Proceedings. (a) Two boneless carcases of beef were found by the local Food Enforcement Officer on hotel premises. The Sanitary Inspectors were called in, but before their inspection was completed, the meat was requisitioned by the Area Meat Agent, and taken into an adjacent district. The meat was subsequently condemned as unfit for human consumption. Proceedings under the Food and Drugs Act were instituted but failed, as the meat had not been condemned by a Justice of the Peace. It was pointed out during the proceedings that when the meat was requisitioned, it became the property of the Crown, and therefore could not be seized. (b) Two sides of beef were found by the Sanitary Inspectors on premises licensed for the sale of horseflesh only. The facts were reported to the local Food Executive Officer, who instituted proceedings, and obtained a conviction (total fines £100). (c) A quantity of beef and horseflesh (12 cwts.) was found on a butcher's premises, and was seized and condemned as unfit for food. A portion of the beef (3 boned hindquarters and 3 boned forequarters) had been coloured green, but not in the prescribed manner. Proceedings were taken (costs and fines £150). 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. 21 Article. Number Examined. Number Adulterated, etc. Formal. 111formal Formal. Informal Milk 55 - 1 — Fish Pastes 1 2 — — Sausages and Sausage Meat 16 — — — Soup Powders 9 — — — Sauces and Pickles 6 2 — — Dried Fruit 1 •- — — Confectionery 3 — — — Jam and Marmalade — 7 — — Coffee 5 1 — — Cordials, Minerals, etc. 3 — — — Cereals 21 1 — 1 Egg Substitutes 3 1 2 — Milk Substitutes 1 — 1 — Sugar Substitutes 1 3 1 1 Flour 7 2 — — Pudding Mixtures 9 3 - — Herbs 2 — — — Vinegar 10 1 2 1 Beer and Spirits 7 — — — Drugs 16 5 — — Medicines 3 — — — Camphorated Oil 2 — — — Castor Oil 1 — — — Cod Liver Oil 7 — — — Cooked Meats 4 1 — — Beans, Baked 2 — — — Baking Powder - — — — Cocoa 2 2 — — Lemonade Crystals 2 — — — Mustard 3 1 — — Spices 7 — — — Flavourings 2 4 — — Salad Oil 5 1 1 1 Beef (Minced) 1 — 1 — Custard Powder 9 4 — — Pepper Stuffings 4 — — — 4 — 2 — Lemon Essence — 2 — — Lemon Substitute 1 2 — 1 Lemon Juice Substitutes 2 — — — Orange Substitutes 1 ] — — Colourings — 1 — — Onion Substitutes 1 2 — — Saccharine 2 — - — Tea Improver — 1 - — Buttered Rolls 1 — - — Cake Mixtures 2 — - — Egg Custard — 1 - 1 Egg Flour 1 — - — Wine Essence — 1 — — Glycerine Substitute 1 — — — Total 248 62 11 6 22 Adulterated Samples No. of Sample Article Examined formal or Informal Nature of Adulteration Observations 33l Milk Formal 8% deficient in fat Vendor cautioned. 123A Flaked Rice Informal Contained 2% Quartz sand Formal sample satisfactory. 289 390 Vinegar Formal Contained only 3.3% of Acetic Acid Vendor fined 20/and costs 10/6. Beef, Minced Formal Contained 250 parts per million of Sulphur Dioxide Vendor cautioned. 415 Parsley Thyme & Lemon Stuffing Formal Contained no , lemon flavouring Manufacturers cautioned. 143 426 Salad Oil Informal Contained 73% of mineral oil Formal sample taken No. 426. Salad Oil - Formal Contained 74% of mineral oil Vendor fined £20 & costs £2/12/6 (paid by manufacturers). 431 Liquid Egg Substitute Formal A viscous liquid bearing no resemblance to liquid egg in respect of chemical composition Summonses against vendor & supplier adjourned since die, endeavouring to trace manufacturer. 431 135a Milk Substitute Formal Chemical composition bears no resemblance to dried milk powder Manufacturers fined £20 and £10/10/0 costs. Sugar Substitute Informal Exaggerated claim as to sweetening power Formal sample taken No. 421. 421 Sugar Substitute Formal do. Retailer fined 40/-. Manufacturers fined £10 & costs 10/6. 140a Vinegar Informal 22% deficient in strength Formal sample taken No. 419. 419 Vinegar Formal 18% deficient in strength Summons against retailer dismissed. 152a 510 Egg Custard Informal Contained' no appreciable quantity of egg Unable to obtain formal sample. Parsley Thyme & Lemon Stuffing Formal Contained no appreciable quantity of lemon or lemon flavouring Manufacturers cautioned. 155a Lemon Substitute Informal Contained no appreciable quantity of Vitamin C Unable to obtain formal sample. 432 Egg Powder Substitute Formal Exaggerated stareCase dismissed on merit as to equilegal grounds. 23 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (other than Tuberculosis). Under 1 year 1-5 5-10 10-15 15-20 20-25 25-35 35-45 45-55 55-65 65 and over Total Cerebro-Spinal Fever 1 2 3 1 3 2 3 4 — 1 — 20 Diphtheria — 12 15 5 4 2 1 1 — — — 43 Encephalitis Lethargica 1 1 Enteric Fever — — — 1 3 — — — 1 — — 5 Erysipelas — 2 1 — — 3 2 4 4 3 4 23 Food Poisoning — — 1 — — — — — — - — 1 Measles 5G 952 1037 31 8 4 3 — 1 - — 2092 Ophthalmia Neonatorum 5 - - - - - - - - - - 5 Pemphigus 11 - - - - - - - - - - 11 Pneumonia— Acute Primary 14 27 4 1 6 4 10 7 7 8 2 90 Influenzal — 2 — — 1 — — 6 2 2 2 15 Poliomyelitis Acute - - 1 - - - - - - - - 1 Polioencephalitis Acute - - - - - - - - -. - - - Puerperal Pyrexia — — — — 1 5 10 2 — — — 18 Scarlet Fever — 46 95 10 6 1 2 1 — — — 161 Smallpox — — - - — — — — — — - — Whooping Cough 36 266 150 11 3 3. 2 1 1 1 — 474 Notified. Admitted to Isolation Hospital, Rush Green. Admitted to other Isolation Hospitals. Admitted to other Hospitals. Deaths Registered. Cerebro-Spinal Fever 20 20 - - 5 Diphtheria 43 39 2 2 7 Encephalitis Lethargica 1 1 - - 2 Enteric Fever 5 5 — — 1 Erysipelas 23 14 - - - Food Poisoning 1 — — — — Measles 2092 13 — 2 3 Ophthalmia Neonatorum 5 — — 1 — Pemphigus 11 5 — — — Pneumonia— Acute Primary 90 24 — 9 74 Influenzal 15 2 — 1 Poliomyelitis Acute 1 1 — 1 Polioencephalitis Acute — — — — — Puerperal Pyrexia 18 15 — — —- Scarlet Fever . 161 101 — — — Smallpox - - - - - Whooping Cough 474 16 - 1 6 24 Diphtheria. The incidence of Diphtheria continues to fall, the number of cases being 43 compared with 67 for the preceding year. When the public realise, what is now a proven fact, that immunisation is an almost certain preventive, this disease will disappear. Schick Testing and Immunisation. Immunisation against Diphtheria is taken advantage of more and more as time goes on. In 1942 there has been an intensification of the propaganda which has been helped very largely by the personal broadcasts of the Chief Medical Officer of the Ministry of Health. The results will no doubt convince the unbelieving that this method of prevention is the only reliable procedure for eliminating Diphtheria. The few who have been immunised and who develop the disease, all present minor manifestations and invariably recover without leaving permanent "damage. In the early days of Immunisation it was considered necessary to Schick test children over the age of six and, if found positive, they underwent a course of Immunisation and were subsequently retested in order to ascertain whether they had attained immunity. Owing to the improved methods in the technique in the preparation of the antigen, it is found that the percentage of those treated who become immune is so high that it is unnecessary to perform a Schick test subsequently. There are, however, occasionally circumstances which indicate that a test should be performed, but this rarely occurs. Children who have been immunised in very early life should, to give them adequate protection, receive a "boosting" dose on admission to school. The number of children who completed a course of Immunisation during 1941 was 1,561. 25 Scarlet Fever. 161 cases were notified, and of these 101 were admitted to hospital. The disease still shows a very low level of virulence, complications are rare and no deaths occurred. The tendency to treat Scarlet Fever at home is becoming widespread, and there is evidence to support the contention that domiciliary treatment of this disease contributes to the lowering of the virulence, the explanation be.ing that a large section of the population receives "subclinical" infections which stimulate the production of anti-bodies. Tuberculosis. New Cases. Primary Notification. Brought to notice other than by Form A Deaths. 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 5 — 1 1 3 3 — 2 10 1 2 1 — 2 — 4 1 - — — — 15 8 13 4 2 2 1 2 1 1 4 — 1 20 7 7 1 — 6 6 2 2 4 2 1 — 25 21 20 1 1 8 8 — - 13 6 — — 35 l 9 8 — 2 3 2 — - 8 7 1 — 45 14 2 — — 4 4 — - 13 3 — — 55 - 2 - — 2 — — — 2 1 — — 65 and upwards - — - - 1 1 - - 2 1 — - 75 55 8 10 31 22 10 5 43 24 1 2 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register 1st Jan., 1941 376 265 131 124 During the year :— New Notifications 75 55 8 10 Deaths 43 2 ^ 2 2 Transfers into area 31 22 10 5 Transfers out of area 16 25 7 6 393 293 140 131 26 MATERNITY AND CHILD WELFARE. Notification of Births. 1,345 notifications of live births were received during the year. 64 notifications (including stillbirths) were received from medical practitioners and parents and 1,069 from midwives. Stillbirths. 24 male and 16 female stillbirths were notified, the corresponding figures for registration being 24 and 23. The rate per 1,000 of total population registered was 0.53, the rate for England and Wales being 0.51. The percentage of illegitimate stillbirths to the total was 4.26, compared with a percentage of illegitimate to total births of 3.07. Infant Mortality. 71 infants under one year of age died during the year, giving an infant mortality rate of 46.34 per 1,000 live births, compared with that of 59 for England and Wales and 6S for London. The rate amongst legitimate children was 43.89 while for illegitimate children it was 117.65. Ophthalmia Neonatorum. Five cases of this disease were notified, one of which was treated in hospital; all made complete recoveries. There were 34 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 five were notified as suffering from true Ophthalmia Neonatorum. 27 Pemphigus. During the year, there were eleven notifications of children suffering from Pemphigus, five of whom were removed to hospital and the remainder treated at home; all recovered. For some years Pemphigus Neonatorum has not given rise to severe clinical symptoms. It is highly infectious and causes considerable disorganisation in the midwifery service owing to the fact that when a midwife has been in contact with a case, it is necessary to prohibit her from visiting other cases, and to remain off duty for a period after she has been in contact. It may be almost regarded as "a nuisance disease," but it cannot be staled definitely that it will not revert to a more malignant type. At one time it was regarded very seriously and a high mortality was experienced. Maternal Mortality. One maternal death was assigned to this district, which gives a maternal mortality rate of .63 per thousand births. This is a remarkably low figure, that for England and Wales for the corresponding period was 2.53, which also is low. It is not so many years since a figure of 5 per thousand was regarded as an average. Work of Health Visitors. The following table shows the number of visits paid by the Health Visitors during the year:-— (a) To expectant mothersFirst visits 3(30 Total visits 552 (b) To children under one year of age First visits 1,597 Total visits 6,005 (c) To children between the ages Total visits 16,288 of one and five years (d) Ineffective visits Total visits 2,788 Grand Total 25,633 28 There is a general tendency throughout the Borough to 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 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. War-time Nurseries. At the time of writing the report two War-Time Nurseries have been established, and preparations for two others are being made. Women who are now in industry find these nurseries of great help, and no doubt as time goes on the scheme will be extended. Other methods by which young children can be cared for are under the Government Daily Guardian Scheme. The Dagenham Day Foster Mother Scheme has been in operation for several years and is similar in nearly every respect to the government arrangements for daily minding. The Education Committee has recently commenced nursery classes, and details are now being prepared for the establishment of such classes at a large proportion of the infant schools in the Borough. Supervision of Miciwives. The number of Midwives who notified their intention to practise during the year 1941 was 33, and the number practising at the end of the year was 23. The routine inspection and special investigations are undertaken by the Medical Officer of Health. In the table below it will be noted that although the number of births was only very slightly less than that for the preceding year the medical aid notices issued fell from 424 to 351. This may be explained by the fact that a Senior Midwife was appointed and took up duty in 29 the middle of October, 1940. The Committee decided that such an appointment would probably have the effect shown by the figures. Notifications received from 1st January to 31st December, 1941:— Notices summoning medical aid 351 For (a) Mothers 265 For (b) Infants 86 The following is a summary of the reasons for sending for medical help by midwives: — Perineal Tear 80 Discharging Eyes 34 Prolonged Labour 33 Rise of Temperature 26 Ante-Partum Haemorrhage 24 Miscarriage 22. Feebleness of Infant 20 Malpresentation 15 Post-Partum Haemorrhage 11 Albuminuria 11 Watery Blisters 10 Circumcision 8 Retained Placenta 4 Other Causes 53 351 Notification that they had been associated with the undermentioned conditions were received from midwives as under:— Liable to be sources of infection 35 Stillbirths 13 Substitution of artificial feeding 9 Infant Deaths 8 Laying out dead bodies 3' 30 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 1941:— Municipal Midwives. Dagenham Nursing Association. Salvation Army Nurses. Births Attended: As Midwife 486 335 135 As Maternity Nurse 64 41 10 Miscarriages Attended 13 11 3 Visits Paid: As Midwife 9,955 7,070 2,57S As Maternity Nurse 910 915 167 Ante-Natal 3,893 3,001 207 Ante-Natal Clinics Attended 424 180 68 In addition to her duties as Senior Midwife, the Senior Midwife paid 374 visits in a supervisory capacity. foed seeven t Aeef CAUSES OF Over 65 and under 75 75 and over TOTAL RegistrarGeneral's Allocations. M F M F M F M F 1. Typhoid and Paratyphoid - - - - - 1 — 1 2. Cercbro-spinal Fever — — — — 2 3 2 3 3. Scarlct Fever - - - - - - - - 4. Whooping Cough — — — 2 4 2 4 5. Diphtheria — — — - 2 5 2 5 6. Tuberculosis of Respiratory 2 1 — — 37 20 37 20 7. Other forms of Tuberculosis — — - — 6 8 6 8 8. Syphilitic Disease 2 — - — 3 2 5 2 9. Influenza 1 1 — 1 3 2 9 9 10. Measles - - - - - 3 — 3 11. Acute Poliomyelitis and Po - — — - 1 — 1 — 12. Acute Infectious Encephali - - - - - 2 — 2 13.m. Cancer of Buccal Cavity — — — — 1 — 3 — 13.f. Cancer of Uterus - - - - - 1 — 6 14. Cancer of Stomach and Duc 1 1 1 — 8 5 13 6 15. Cancer of Breast — 2 — — — 8 — 12 16. Cancer of all other sites 9 9 6 5 47 31 45 23 17. Diabetes 1 1 — 2 2 5 1 4 18. Inter-cranial Vascular Lesic 8 11 7 5 24 25 21 26 19. Heart Disease 17 25 26 33 95 83 57 66 20. Other diseases of the Circul 1 — 1 — 3 1 8 7 21. Bronchitis — 2 5 2 13 6 29 20 22. Pneumonia 4 2 2 8 45 29 39 17 23. Other Respiratory diseases 2 1 2 6 9 13 6 6 24. Ulceration of the Stomach — — — — 1 — 4 — 25. Diarrnœ a (under 2 years) — — — — 1 — 2 — 26. Appendicitis — 1 — — - 2 2 2 27. Other Digestive Diseases 1 1 — 1 9 9 7 13 28. Nephritis 3 3 1 1 12 13 9 10 29. Puerperal and post Abortiv — — — - - — - — 30. Other maternal causes — — — — - 1 — 1 31. Premature Birth — — — — - 8 14 6 32. Congenital malformation, disease — — — - 9 6 13 9 33. Suicide - — - - — 2 — 2 34. Road Traffic Accidents — — — — 4 - 9 I 35. Other Violent Causes 1 — 1 4 40 23 36 24 30. All Other Causes 2 3 3 9 21 24 | 30 25 i 55 64 55 77 413 315 412 j 343 31—32 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 — — - — — — - — - 1 - - - - - - - - - - - - 1 - 1 2. Cerebro-spinal Fever 1 — — — — 2 — — 1 — _ — — — — — — 1 - — — - 2 3 2 3 3. Scarlet Fever — — — — — — - — - — - — — — — — — — — — — - - — — — 4 Whooping Cough — 3 — — 2 1 — — — — - — — — — — - — - — — - 2 4 2 4 5. Diphtheria — — — 1 — 1 2 3 - - - - - - - - - - - - 2 5 2 5 6. Tuberculosis of Respiratory System — — — — — — — — 4 6 7 6 5 5 15 1 4 1 2 1 — - 37 20 37 20 7. Other forms of Tuberculosis — — — 2 1 1 1 1 2 1 1 1 — 2 1 — — — - — — - 6 8 6 8 8. Syphilitic Disease — — — — —- — — — — — — — — — — 2 1 — 2 — — — 3 2 5 2 9. Influenza — — — — — — — — — — — — — — 1 — 1 - 1 1 — 1 3 2 9 9 10. Measles — 1 — — — 2 — — — — — — — — — — — - - — — — — 3 — 3 11. Acute Poliomyelitis and Polio-encephalitis — — — — 1 — — — - — — — — — — — — — — — — - 1 — 1 — 12. Acute Infectious Encephalitis — — — — — — — — — 2 — — — — — — — — — — — - - 2 — 2 13.m. Cancer of Buccal Cavity & sophagus (Malos only) - - - - - - - - - - - - - - 1 - - - - - - - 1 - 3 13.f. Cancer of Uterus — — — — — — — — — — — — 1 — — — — — — — — — 1 — 6 14. Cancer of Stomach and Duodenum — — — — — - - — — — — — 2 — 2 — 2 4 1 1 1 — 8 5 13 6 15. Cancer of Breast — — — — — - - — — — — — — 1 — 4 — 1 — 2 — - - 8 — 12 16. Cancer of all other sites — — — — — — 2 — - - 3 — 3 4 11 7 13 6 9 9 6 5 47 31 45 23 17. Diabetes — — — — — — — — — 1 1 — — — — — — 1 1 1 — 2 2 5 1 4 18. Inter-cranial Vascular Lesions — — — — — — — — — — 1 3 — 3 2 3 6 8 11 7 5 24 25 21 26 19. Heart Disease 1 1 2 1 — — 5 2 3 3 1 — 4 5 20 6 16 7 17 25 26 33 95 83 57 66 20. Other diseases of the Circulatory System - — — — — — — — — — — — — - - 1 1 — 1 — 1 — 3 '1 8 7 21. Bronchitis — — — - — — — — — — 2 — 1 - 1 1 4 1 — 2 5 2 13 6 29 20 22. Pneumonia 16 5 — 1 2 3 1 — 2 1 — 1 3 1 10 1 5 6 4 2 2 8 45 29 39 17 23. Other Respiratory diseases — — — — — - — — — 1 1 — — 1 3 2 1 2 2 1 2 6 9 13 6 6 24. Ulceration of the Stomach or Duodenum - - - - - - - - - - - - - - - - - - - - - - 1 - 4 - 25. Diarrhoea (under 2 years) 1 — — — — - — — — - — — — — — — — - — — — — 1 — 2 — 20. Appendicitis — - — — — — — — — - — — — — 1 — _ — 1 — — — 2 2 2 27. Other Digestive Diseases 1 1 - - - - - - - - - 1 — 1 4 2 3 2 1 1 — 1 9 9 7 13 28. Nephritis 1 — — — — — — — 1 1 1 2 1 3 3 3 1 — 3 3 1 1 12 13 9 10 29. Puerperal and post Abortive Sepsis — — — — — — — — — — — — — — — — — - - - — — — - - — 30. Other maternal causes — - — — — — — — — — — 1 — — — — - - — — — — — 1 — 1 31. Premature Birth 13 8 - - - - - - - - - - - - - - - - - - - - 13 8 14 6 32. Congenital malformation, birth injury, infantile disease 8 6 - - 1 - — — — - — — — — — — — — — — 9 6 13 9 33. Suicide - - - - - - - - - - - - - - - - - - - - - - 2 - 2 34. Road Traffic Accidents — - — — - — 1 - 1 — 1 _ 1 - - — — — — - 4 - - 1 35. Other Violent Causes — - — — 2 2 4 6 5 3 8 1 9 3 7 - 3 2 1 - 1 4 40 23 36 24 36. All Other Causes 3 2 - — 3 - - - 2 - — 2 3 — 1 5 4 3 2 3 3 9 21 24 30 25 45 27 2 5 12 12 15 12 21 21 26 16 35 27 84 41 63 43 55 64 55 77 413 345 412 343 1 1 JRZ/68 1