AC 4411(1)DAGENHAM DAG 17 BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1943 CECIL HERINGTON, M.D. (Lond.), D.P.H. BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1943 CECIL HERINGTON, M.D. (Lond.), D.P.H. 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Your Worship, Ladies and Gentlemen, The lines adopted in compiling my report for the year 1943 closely follow those employed in the previous year, and it will be found that the report consists largely of statistical matter, the main comments being included in the earlier pages. As in previous war years, the report is abbreviated in accordance with Circular 2773 issued by the Ministry of Health, many statistics are omitted but are preserved for presentation at a date to be determined by the Minister. SONNE DYSENTRY. This condition has been prevalent over a large part of the country and outbreaks occurred in two of the War-Time Nurseries, one at the end of 1943 and a further one in the spring of 1944. The original cause in the first wave was ascertained and appropriate measures, consisting of bacteriological examinations of rectal swabs from both staff and patients, were taken and the results tabulated. The services of the Bacteriologist at Oldchurch County Hospital were sought and readily given. A scheme was then put into operation of systematic treatment of all those infected, the drug employed was supplied by Messrs. May and Baker, and the results were eminently satisfactory. The second outbreak was entirely cleared up within a matter of a few weeks. Among other precautions taken, it was found necessary to close the two nurseries concerned for brief periods. A full account of these outbreaks has been sent for publication in the medical press. SCARLET FEVER. The control of Scarlet Fever has been the subject of controversy for many years, the practice amongst different local authorities often varied widely, causing confusion in the minds of the public. It was considered advisable to obtain some uniformity and the Essex Epidemiological Committee gave it their close attention. In due course a memorandum was prepared and circulated to all Medical Officers of Health, Medical Officers in charge of hospitals and General Practitioners in the administrative county of Essex. It was also published in the principal medical periodicals. The following is the text of the memorandum :— "It is generally agreed that 'scarlet fever' has become so benign as to make largely unnecessary its administrative control as previously exercised. It is recognised also that this condition is only one of the many manifestations of infection with Group A haemolytic streptococci and that there is no justification for 4 isolating in hospital individuals suffering from streptococcal sore throat associated with a rash, whilst ignoring those with a similar sore throat and no rash. To do so does not protect the community, but it is impracticable to remove to hospital all those suffering from streptococcal sore throat and it follows that the needs of the particular patient should decide whether or no he should be given hospital accommodation. Cross infection, which is largely responsible for the complications of ' scarlet fever,' does not occur if the patient is nursed at home and this is one of the main reasons for advocating home treatment of this disease wherever possible. Although the welfare of the patient is the first consideration, other aspects of the problem cannot be ignored, and one of these is the possibility of the spread of infection by milk or foods which are consumed uncooked, whilst another is the risk of infecting a woman in the later stages of pregnancy. Where, therefore, a case of ' scarlet fever ' occurs in a household, a member of which is a food handler, or where there is a woman approaching confinement, it would be inadvisable to have the patient nursed at home. It is, therefore, recommended that admission (of cases of ' scarlet fever') to hospital should be determined by:— (1) the severity of the disease; (2) the home nursing facilities; (3) the employment of another member of the household in the preparation or distribution of food for public consumption; (4) the approaching confinement, say within one month, of any female in the patient's home. It is highly desirable that the public should be informed of the altered view now taken by the medical profession of ' scarlet fever,' and it is felt that this can best be done by the family doctor." Members of the Council will recall that occasions have arisen in the past when the methods of the control of Scarlet Fever have been challenged. It is hoped that now the position has been clarified, the confidence of the public will be won. DIPHTHERIA IMMUNISATION. A steady flow of children to the Diphtheria Immunisation Clinics has been maintained during the year, and an increasing number of children under five years of age has attended the Infant Welfare Centres for this purpose. Owing to removals from and into the Borough, it is not possible to give with any accuracy, the percentage of children in the Borough who may be regarded as successfully immunised, but the low incidence of Diphtheria may be taken as an index of the immunity of the population. 5 Close co-ordination with the School Medical Service exists and it has been arranged that entrants to infants' departments should be notified to this department in order that they may receive a " boosting dose " if they have already been immunised in infancy, or the two standard doses of antigen. It is hoped that the comparative freedom of the population as a whole from Diphtheria will not lull parents into a state of false security. In order to maintain the interest of parents in the importance of immunisation, the head teachers and factory executives all received a personal letter from the Medical Officer of Health inviting earnest consideration of this important subject. VERMINOUS CONDITIONS. The Health Visitors have given special attention to the control of head lice, and in accordance with Circular 2831 of the Ministry •of Health dated July, 1943, they have, when occasion so demanded, visited the homes of children outside their normal working hours in order to instruct the mothers with regard to the elimination of vermin. In times like these it is often difficult otherwise to make contact with mothers who, in many cases, are employed during the greater part of the day. There are no statistical records of the prevalence of head lice, but one gathers from medical inspections prior to evacuation and other indications, that parents are becoming more conscious of their duties in this respect. New reagents are now available for the eradication of nits and five vermin, these mark a long step forward and simplify the technique. Assistance has been received on many occasions from the School Medical Department of the County Council, which employs a lady in this district specifically for cleansing the heads of school children. In many instances her services have been utilised for pre-school children, as it will be agreed that it is useless to cleanse some members of a family and leave others who will readily cause re-infestation of their brothers and sisters, and even parents. SCABIES CLINIC. In the autumn the Council, being concerned with the apparent increase in Scabies, resolved to provide treatment for this condition, and after receiving permission from the Scheme-making Authority, commenced treatment sessions at Five Elms First Aid Post. The reagent used is a preparation of Benzyl-Benzoate, it is applied after the patient has had a hot bath and been thoroughly dried. Normally one application suffices to clear up the condition, but occasionally obstinate cases occur requiring further treatment. One important factor is that the whole family infected should be treated if possible at one session, otherwise those cured soon become re-infected. From the time that the clinic was opened in the middle of September to the end of the year 274 treatments were given. 6 POLIOMYELITIS. This disease has not been prevalent recently, but its reappearance must at all times, be guarded against. My report for the previous year indicated the dangers of transmission of diseases, particularly of the typhoid group, by hands unwashed after the use of the toilet. I would add that it is now the opinion of many Epidemiologists that Poliomyelitis can also be transmitted in this manner. This calls for increased attention to this very important subject and when designs of future houses are prepared, the necessity for the provision of wash-hand basins with hot and cold water convenient to the W.C. should be borne in mind. RODENT CONTROL. Infestations are dealt with in accordance with the technique suggested by the Ministry of Food, the work is supervised by the Sanitary Inspectors and the personnel of the mortuary squad carry out the work. A publicity campaign was begun in the autumn and the general public invited to notify the presence of rats and mice. The local press published advertisements and posters were exhibited; the wardens' posts were used as receiving centres for complaints. FOOT CLINIC. During the early part of the year the Council decided to open a foot clinic. To commence with, one part-time Chiropodist was appointed but owing to the demand for his services, it was soon found necessary to employ him on a whole-time basis. The demand continued, and in September an additional Chiropodist was appointed, who also in the early months of 1944, was retained in a full-time capacity. The services of this clinic are meeting a much felt want, as in addition to the relief of pain, the efficiency of many of those who formerly suffered is greatly enhanced. As an experiment, a branch clinic has been opened in Chadwell Heath and this has been fully justified by results. PROVISION OF INSULIN. Certain persons suffering from Diabetes who are unable to procure Insulin, are able to purchase it from the Public Health Department at or below cost price. The circular empowers Local Authorities to distribute this product to those persons who are entitled to benefit under this scheme. Recently this facility has been taken advantage of to an increasing extent, to those requiring large doses the advantage is considerable. HOME HELPS. It has been possible to satisfy the demand for Home Helps, although occasionally it has been difficult owing to the demand for workers in the factories. At the moment two Home Helps are paid a retaining fee and an additional wage whilst they are working. Normally their 7 services are limited to confinement cases, but exceptionally the Committee has sanctioned their employment when domestic difficulties have not been able to be met otherwise. Once more I wish to record my appreciation of the services of the members of the staff, all of whom have continued to show their willingness to contribute to the efficiency of the department. I would like also to thank the Chairman and Members of the Health Services Committee for their support and interest in the activities directed towards prevention of illness and maintenance of health in this Borough. I am, Your Worship, Ladies and Gentlemen, Your obedient servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 8 MEMBERS OF THE COUNCIL (31st December, 1943.) Mayor: Alderman (Mrs.) L. F. EVANS, J.P., E.C.C. Deputy Mayor : Councillor F. BROWN. Aldermen: A.F.J. CHORLEY, J.P., E.C.C. R.J.D. CLACK. E.E.HENNEM. W.F.LEGON. W.C.MARKHAM. M.E.MARLEY (Mrs.), J.P. B.H.SAUNDERS, E.C.C. Councillors: J.R.ANDREWS. W.E.BELLAMY. D.E.BROWN. J.W.BURRIDGE. A.A.BUTTERS. S.W.DEEKS. E.EDWARDS. A.E.GIBBS. F.T.GRINDROD. H.L.LYONS. J.E.MUNN. R.G.MURRELL. J.NEISH (Mrs.). F.J.PERFECT. A.E.PRENDERGAST (Mrs.). E.S. REDDY (Mrs.). M.REDDY. F.L.M. ROGERS (Mrs.). E.R.SAYWOOD. A.R.THOMAS (Mrs.). F.G.THOMAS. C.A.THORNEYCROFT. M.A.E. WARREN (Mrs.). HEALTH SERVICES COMMITTEE Councillor (Mrs.) A. E. PRENDERGAST, Chairman. Councillor (Mrs.) E. S. REDDY, Vice-Chairman. The Worshipful the Mayor Coun. A. E. GIBBS. (Ald. (Mrs.) L.F.EVANS, Alderman W.F.LEGON. J.P., E.C.C.) Coun. A. R. THOMAS (Mrs.). Deputy Mayor Coun. M. A. E. WARREN (Mrs.). (Coun. F. BROWN). 9 OFFICERS of the PUBLIC HEALTH SERVICES Full-Time Staff: Medical Officer of Health: CECIL HERINGTON, M.D., B.S. (Lond.), D.P.H., M.R.C.S., L.R.C.P. Deputy Medical Officer of Health: JAMES A. C. FRANKLIN, M.B., B.S. (Lond.), D.P.H., M.R.C.S., L.R.C.P. Assistant Medical Officer: (Serving with R.A.F.) HARRY B. CARTER-LOCKE, M.B., B.S. (Lond.), D.P.H. M.R.C.S., L.R.C.P. Temporary Assistant Medical Officer: M. WEIZMANN, M.R.C.S., L.R.C.P. 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, 6, 7). Health Visitors : V. A. EVERITT (5, 6, 7). D. B. STEWART (5, 6, 7). A. K. GIBSON (5, 6, 7). E. THOMAS (5, 6, 7). P. SILBY (5, 6, 7). D. E. WALLER (5, 6, 7). C. KIPLING (5, 6, 7). L. WEALE (1, 5, 6, 7, 8). L. SALTER (5, 6, 7). Senior Midwife : E. M. BEDFORD (5, 6). Midwives: D.K. ANKER (6). O.M. LISSAMORE (6). M. HALL (6). H. MITSON (5, 6). C.HURRY (6). M.ROBSON (6). M.GOODBUN (5, 6). M.J.STOREY (6). 10 Clerical Staff: Senior Clerk: B. E. E. DENNY. Clerk to Sanitary Inspectors: H. FIELD (1). Clerks: G. BALLARD (9). E. HIGHAM (9). I. M. BISHOP. K. W. SKEATES. K. BRIMBLECOMBE (9). M. A. WATTS. G. K. HARRIS. 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 Temporary War-Time Appointment 9 Part-Time Staff: Consulting Gynaecologist: R. L. DODDS, M.Ch., F.R.C.S. (Eng.). Consulting Orthopaedic Surgeon: B. WHITCHURCH HOWELL, F.R.C.S. (Eng.). Dentist: F. C. RITCHIE, L.D.S., R.C.S. (Edin.) Public Analysts: BERNARD DYER, D.Sc., F.I.C. J. HUBERT HAMENCE, Ph.D., M.Sc., F.I.C. 11 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 6,556 Number of inhabited houses (end of 1943) according to Rate Books 25,854 Rateable value (December 31st, 1943) £594,849 Sum represented by a penny rate (approximate 1943-44) £2,290 Extracts from Vital Statistics for the Year. Live Births:— Total Male Female Legitimate 1,762 861 901 Birth rate per 1,000 of the estimated resident population, 19.83. Illegitimate 83 43 40 Stillbirths :— Legitimate 49 26 23 Rate per 1,000 total (live and still) births, 26.38. Illegitimate 1 — 1 Deaths 742 419 323 Death rate per 1,000 of the estimated resident population, 7.98. Deaths from puerperal causes— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 2 1.06 Other puerperal causes 2 1.06 Total 4 2.11 Death rate of Infants under one year of age:— All infants per 1,000 live births 46.07 Legitimate infants per 1,000 legitimate live births 47.11 Illegitimate infants per 1,000 illegitimate live births 24.10 Deaths from Cancer (all ages) 123 „ „ Measles (all ages) 3 ,, „ Whooping Cough (all ages) 6 ,, „ Diarrhoea (under 2 years of age) 6 12 Births. 1,845 live births were registered during the year, there being 904 males and 941 females. There is a decrease of total births from 1,898 in 1942 to 1,845. The birth rate per thousand population was 19.83 compared with 16.5 for England and Wales and 18.6 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, 18.77, 19.08 and 20.37 for the years 1927 to 1942 inclusive. The illegitimate birth rate continues to be very low, being only 4.50 per cent. of total births. The rate of illegitimate stillbirths is 2.0 per cent. of total stillbirths. Death Rate. Total deaths in district 460 Outward transfers 120 Inward transfers 405 Deaths of residents 745 Of the 120 deaths of non-residents occurring in the district, 48 took place at the West Ham Sanatorium and 52 at the Joint Isolation Hospital. Of the 405 deaths of local residents taking place outside this area, most occurred in institutions. Of these 186 occurred at Oldchurch Hospital, 31 at Orsett Lodge, 27 at The Retreat, Gt. Burstead, 17 at the London Hospital, 15 at 48, Wood Street, Chelmsford, 13 at King George Hospital, Ilford, seven at the Ilford Isolation Hospital, seven at 32a, Spital Road, Maldon, six at East End Maternity Hospital, five at Severalls Mental Hospital, five at Warley Wood Emergency Hospital, four at New Hall, Boreham, and four at Warley Hospital. 742 deaths are equivalent to a death rate of 7.98 compared with 12.1 for England and Wales. For the years from 1927 to 1942 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, 8.90, 8.51 and 6.85. A table giving the causes of death, and the age periods at which they occurred, is given at the end of the report. 13 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1943. 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 16.5 0.51 12.1 0.00 — 0.02 0.00 0.03 0.03 0.37 5.3 49 126 County Boroughs and Great Towns, including London 18.6 0.63 14.2 0.00 — 0.02 0.00 0.03 0.04 0.36 7.9 58 148 smaller towns (1931) resident populations 25,000-50,000 19.4 0.61 12.7 0.00 — 0.02 0.00 0.03 0.04 0.37 4.4 46 London 15.8 0.45 15.0 0.00 — 0.02 0.00 0.03 0.02 0.27 10.4 58 Dagenham 19.83 26.38 7.98 0.00 — 0.03 0.00 0.06 0.01 0.13 3.25 46.07 14 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Infant Welfare Centres. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. First Aid Post, Ashton Gardens, Chadwell Heath. Weekly Wednesday, p.m. 61 4 Valence Club, Corner of Becontree Weekly Monday, a.m. 49 3 Avenue and Bennetts Castle Lane, Dagenham. Weekly Monday, p.m. 68 6 Finnymore Road School, Dagenham. Weekly Thursday, a.m. 57 3 Weekly Thursday, p.m. 73 6 Osborne Hall, Osborne Square, Weekly Tuesday, am. 42 2 Dagenham. Weekly Tuesday, p.m. 70 7 Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 61 2 15 Ante-Natal Clinics. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. First Aid Post, Ashton Gardens, Chadwell Heath. Weekly Monday, a.m. 13 3 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 18 5 Weekly Wednesday, a.m. 16 3 Weekly Friday, a.m. 19 4 Finnymore Road School, Dagenham. Weekly Monday, p.m. 14 4 Weekly Tuesday, a.m. 15 4 Weekly Wednesday, a.m. 14 4 Rush Green Clinic, 179, Dagenham Road, Rush Green. Monthly (1st in month) Friday, a.m. 13 5 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 16 4 Weekly Thursday, a.m. 17 4 Weekly Thursday, p.m. 21 5 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. Finnymore Road School, Dagenham. Every second, Tuesday afternoon and every Friday afternoon. Wednesday morning. 16 Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits:— Houses 850 Nuisances under Public Health Acts 2,565 Bakehouses 57 Slaughterhouses 26 Milkshops, dairies and vehicles 69 Foodshops and stalls 1,441 Cafes 468 Infectious disease enquiries 2,506 Visits to foster mothers' premises 35 Number of complaints investigated 745 Outworkers' premises 54 Factories 159 Workplaces 38 Tents, vans and sheds 51 Stables 27 Hairdressers' and Barbers' premises 84 Shops Act, 1934 17 Houses fumigated 97 Inspections re billeting of war workers 90 Rodent Control 619 Other visits 9 (b) Notices served Complied with. Statutory 36 55 Informal 388 309 17 INSPECTION AND SUPERVISION OF FOOD. Legal Proceedings. Proceedings were instituted under the provisions of the Milk and Dairies Order, 1926, against a local milk retail purveyor observed filling dirty milk bottles in the street, which had apparendy just been collected from his customers. Defendant fined £3. Slaughterhouses. Arrangements were made early in the year for a District Sanitary Inspector to be loaned to a neighbouring Borough one day per fortnight to carry out meat inspection at the Regional Slaughterhouse. This procedure was found necessary because of the shortage of Inspectors in this Borough and the failure to obtain additional whole-time staff. 18 FOOD AND DRUGS ACT, 1938. Analyses. Article. Number Examined. Number Adulterated, etc. Formal. Informal Total Formal. Informal Total Baking Powder 7 — 7 1 — 1 Beer 7 — 7 1 — 1 Bread and Butter 1 — 1 1 — 1 Cake Flour 5 — 5 — — — Cake and Pudding Mixtures 8 1 9 — — — Cocoa 4 — 4 — — — Coffee 6 — 6 — — — Cordials 3 — 3 — — — Crystals—Lemon, etc. 2 — 2 — — — Custard Powder 1 — 1 — — — Egg—Dried 1 — 1 — — — Egg—Powder Substitute 3 — 3 , 1 — 1 Essences—Various 2 1 3 — — — Extracts—Various 4 2 6 1 — 1 Flour—Self Raising — 1 1 — 1 1 Pea Flour 3 — 3 1 — 1 Gelatine Powder 2 — 2 — — — Golden Raising Powder 2 — 2 — — — Gravy 3 — 3 — — — Meat 1 — 1 — — — Medicinal Samples 15 6 21 — — — Milk 43 — 43 1 — 1 Mustard 3 — 3 1 — 1 Oatmeal 3 — 3 — — — Paste—Fish — 1 1 — — — Pepper 4 — 4 — — — Rum 3 — 3 1 — 1 Salt 4 — 4 — — — Sauces—Ketchup 3 — 3 — — — Sausages 17 — 17 1 — 1 Semolina 4 — 4 — — — Soups 3 — 3 — — — Spaghetti—Macaroni 4 — 4 1 — 1 Spices 15 — 15 — — — Spreads 2 — 2 — — — Stuffing 2 — 2 — — — Suet—Chopped 1 — 1 1 — 1 Table Creams, etc. 3 1 4 — 1 1 Tonic—Vigor 1 — 1 — — — Vinegar 15 — 15 1 — 1 Whisky 1 — 1 — — — Total 211 13 224 13 2 15 19 Adulterated Samples, etc. Serial Number. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. 148 Spaghetti Formal Contained 1.6% fine dust including dead mites, a few living mites, fibres and miscellaneous debris. Vendor warned. Withdrawn from sale. 151 Beer (Burton) Formal A little low in original gravity. Vendor warned. 50 Rum Formal 3% added water. Vendor warned. 68 Bread and Butter Formal The fat in this sample consisted of margarine. Referred to Food Executive Officer at whose request sample was taken. 82 Pork Sausages Formal Contained 140 pans per million of sulphur dioxide (undeclared). Vendor warned. 183 Chopped Suet Formal Contained excess of cereal filler, viz., 28 per cent. 11 per cent, beyond the recognised limit of 17. Vendor warned. 308 Egg Substitute Powder Formal 43% deficient in available Carbon Dioxide. Vendor warned. Withdrawn from sale. 239a Ice Blanc Mange Informal Consisted of a coloured and flavoured wheaten flour preparation, sweetened with sugars and saccharin and was therefore a food as defined in the Manufactured Pre-packed Foods Control Order thus requiring a licence for its sale. Referred to Food Executive Officer at whose request sample was taken. 307 Mustard Mixture Formal Out of condition having a poor flavour and containing dead mites. Vendor warned. Withdrawn from sale. 20 Adulterated Samples, etc.—continued. Serial Number. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. 97 Onion Extract Formal A dilute solution of onion juice with only a slight smell and taste of onions. Vendor warned. Withdrawn from sale. 230 Pea Flour Formal Out of condition being lumpy and containing living maggots. Vendor warned. Withdrawn from sale. 314 Milk Formal 16% added water. Vendor warned. 324 Baking Powder Formal 55% deficient in available carbon dioxide. Vendor warned. Withdrawn from sale. Self-raising Flour Informal Contaminated with a red dye. Vendor warned. 235 Vinegar Formal Deficient in acetic acid to the extent of 1/7th of the quantity proper to vinegar. Legal proceedings taken. Case against Manufacturers dismissed on payment of £10.10.0 costs 21 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (other than Tuberculosis). Under 1 year 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Total Cerebro-Spinal Fever — 1 — — — — 1 — — — 1 — 3 Diphtheria — 2 1 2 5 7 4 5 2 — — — 28 Dysentery — 1 — — — — — — — — — — 1 Encephalitis Lethargica — — — — — — — — — — — — — Enteric Fever — — — — — — — 1 — — — — 1 Erysipelas 1 — — 1 — — 2 3 7 11 10 4 39 Food Poisoning — — — — — — — — — — — — — Measles 44 127 135 132 155 533 34 7 7 — — — 1174 Ophthalmia Neonatorum 3 — — — — — — — — — — — 3 Pemphigus 3 — — — — — — — — — — — 3 Pneumonia— Acute Primary 11 15 8 9 11 22 5 10 14 19 24 3 151 Influenzal 1 — 1 1 2 1 1 1 5 11 8 1 33 Poliomyelitis Acute — — — — 1 — — — — — — — 1 Polioencephalitis Acute — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — — 18 1 1 — 20 Scarlet Fever — 12 29 32 38 191 62 6 1 1 4 — 376 Smallpox — — — — — — — — — — — — — Whooping Cough 42 43 42 46 55 96 6 — — 2 1 — 333 Notified. Admitted to Isolation Hospital, Rush Green. Admitted to other Isolation Hospitals. Admitted to other Hospitals. Deaths Registered. Cerebro-Spinal Fever 3 3 — — 1 Diphtheria 28 26 2 — 1 Dysentery 1 — — — — Encephalitis Lethargica — — — — — Enteric Fever 1 1 — — — Erysipelas 39 12 — — — Food Poisoning — — — — — Measles 1174 13 1 — 3 Ophthalmia Neonatorum 3 1 — — — Pemphigus 3 3 — — — Pneumonia— Acute Primary 151 37 — 10 }97 Influenzal 33 10 — 2 Poliomyelitis Acute 1 1 — — — Polioencephalitis Acute — — — — — Puerperal Pyrexia 20 13 — — — Scarlet Fever 376 161 2 — — Smallpox Whooping Cough 333 20 — — 6 22 DIPHTHERIA IMMUNISATION. The following is a summary of the work carried out during the year:— Number of SCHOOL children immunised without preliminary testing 2,269 Number of PRE-SCHOOL children immunised without preliminary testing 1,588 Number of SCHOOL children re-Schick tested 53 Of these one was positive. Number of PRE-SCHOOL children re-Schick tested 37 Of these three were positive. Number of SCHOOL children who received one dose after Re-Schick test positive 1 Number of PRE-SCHOOL children who received one dose after Re-Schick test positive 3 Total number of children found to be immune during the year—86. The following table shows details of children who attended for immunisation and were subsequently notified as suffering from Diphtheria, together with observations as to type and the ultimate result:— Age Particulars of Treatment. Notified as Diphtheria. Confirmed. Severity. Result. 3 0.1 c.c. A.P.T. 23/9/42 14.1.43 Yes Moderate Recovered 4½ 0.1 c.c. A.P.T. 10/12/42 20.2.43 Yes Moderate Recovered 11 13½ Immunised at Cheltenham. Cannot trace. Ditto 10.3.43 3.3.43 Yes Yes Moderate Moderate Recovered Recovered 6 1 c.c. T.A.F.-25.4.38 1. c.c. T.A.F.-20.6.38 1 c.c. T.A.F.-19.9.38 12.6.43 Yes Very severe Recovered 4 0.1 c.c. A.P.T. 3/12/42 9.10.43 Yes Severe Recovered Scarlet Fever. 376 cases were notified, and of these 163 were admitted to hospital. The disease still shows a very low level of virulence, complications are rare and no deaths occurred. This subject is also dealt with in an earlier part of the report. 23 Tuberculosis. New Cases Deaths. Primary Notification. Brought to notice other than by Form A. Pulmonary. NonPul monary. Pulmonary. NonPul monary. Pulmonary. NonPul monary. M F M F M F M F M F M F Under 1 — — — — — — — — — — — — 1- — 1 — I — — — — — — — — 5- 1 — 4 3 — — 2 3 — — — — 10- 2 — 1 1 — — 2 — 1 2 — — 15- 14 13 4 1 — 1 1 — 1 2 1 — 20- 13 18 5 — 2 4 1 1 4 5 2 — 25- 12 9 2 — 3 3 1 — 6 4 — 1 35- 9 5 1 1 2 — — 1 8 6 — — 45- 11 4 — — — — 1 — 7 4 — — 55- 5 2 — — 1 — — — 3 — — — 65 and upwards — 1 — — — — — — — — — — 67 53 17 7 8 8 8 5 30 23 3 1 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register 1st Jan., 1943 434 312 150 142 During the year:— New Notifications 67 53 17 7 Deaths 30 23 3 1 Transfers into area 8 8 8 5 Transfers out of area 17 12 2 2 No. on Register 31st December, 1943 462 338 170 151 24 MATERNITY AND CHILD WELFARE. Notification of Births. 1,781 notifications of live births were received during the year; the majority of these were notified by midwives. Stillbirths. 26 male and 24 female stillbirths were notified and registered. The rate per 1,000 of total population registered was 0.45, the rate for England and Wales being 0.51. The percentage of illegitimate stillbirths to the total was 2.0, compared with a percentage of illegitimate to total births of 4.50. Infant Mortality. 85 infants under one year of age died during the year, giving an infant mortality rate of 46.07 per 1,000 live births, compared with that of 49 for England and Wales and 58 for London. The rate amongst legitimate children was 47.11 while for illegitimate children it was 24.10. Ophthalmia Neonatorum. Three cases of this disease were notified, one of which was treated in hospital; all made complete recoveries. There were 27 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 three were notified as suffering from true Ophthalmia Neonatorum. Maternal Mortality. Four maternal deaths were assigned to this district, which give a maternal mortality rate of 2.11 per thousand births. This is a remarkably low figure; that for England and Wales for the corresponding period was 2.29 which also is low. 25 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 538 Total visits 829 (b) To children under one year of age First visits 2,107 Total visits 7,409 (c) To children between the ages of one and five years Total visits 15,190 (d) Ineffective visits Total visits 3,336 Grand Total 26,764 Supervision of Midwives. The following is a summary of the reasons for sending for medical help by midwives:— Perineal Tear 116 Prolonged Labour 41 Rise of Temperature 44 Discharging Eyes 27 Miscarriage 23 Ante-Partum Haemorrhage 18 Premature Baby 13 Malpresentation 7 Post-Partum Haemorrhage 7 Albuminuria 7 Retained Placenta 6 Feebleness of Infant 4 Other Causes 70 383 Notices summoning medical aid 383 For (a) Mothers 307 For (b) Infants 76 Notification that they had been associated with the undermentioned conditions were received from midwives as under:— Liable to be sources of infection 37 Infant Deaths 13 Stillbirths 12 Substitution of artificial feeding 8 Laying out dead bodies 2 26 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 1943:— Municipal Midwives. Dagenham Nursing Association. Salvation Army Nurses. Births Attended: As Midwife 508 392 154 As Maternity Nurse 85 56 7 Miscarriages Attended 15 10 4 Visits Paid: As Midwife 10,168 7,254 4,551 As Maternity Nurse 942 1,032 199 Ante-Natal 3,560 1,610 1,193 Ante-Natal Clinics Attended 461 222 99 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 RegistarGeneral'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. Cerebrospinal Fever — — — — — — — — — — — — — — 1 — — — — — — — 1 — 1 — 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough 3 — — 1 1 — — 1 — — — — — — — — — — — — — — 4 2 4 2 5. Diphtheria — — — — — — — 1 — — — — — — — — — — — — — — — 1 — 1 6. Tuberculosis of Respiratory System — — — — — — 1 1 4 9 7 5 9 5 11 4 3 — 1 1 — — 36 25 35 24 7. Tuberculosis (other forms) — — 1 — — — 1 — 5 — — 1 — 1 — — — — — — — — 7 2 7 4 8. Syphilitic Disease — — — — — — — — — — — — — — — 2 — — 2 — — — 2 2 2 2 9. Influenza — — — — — — — — — — — — 1 — — — 1 — — 1 — 1 2 2 7 5 10. Measles — 2 — 1 — — — — — — — — — — — — — — — — — — — 3 — 3 11. Acute Poliomyelitis and Polio-encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Acute Infectious Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cancer of Buccal Cavity & Oesophagus (Males only) — — — — — — — — — — — — — — — — — — — — — — — — 3 — 13.f. Cancer of Uterus — — — — — — — — — — — — — 1 — — — 3 — 1 — — — 5 4 14. Cancer of Stomach and Duodenum — — — — — — — — — — — — — — 4 4 2 2 2 2 — — 8 8 18 10 15. Cancer of Breast — — — — — — — — — 1 — — — 2 — 1 — 1 — 1 — — — 6 — 7 16. Cancer of all other sites — — — — 1 — — 1 — — — 3 5 6 8 5 16 9 14 1 8 8 52 33 50 31 17. Diabetes — — — — — — — — — — — 1 — — — 1 — 2 1 3 1 — 2 7 2 4 18. Inter-cranial Vascular Lesions 1 1 — — — — — — — — — 1 3 3 3 6 1 7 6 6 10 6 24 30 23 32 19. Heart Disease 1 1 — — 1 — 1 3 2 1 1 4 5 5 18 12 29 10 21 18 18 18 97 72 51 58 20. Other diseases of the Circulatory System — — — — — — — — — — — — — 1 — — — — — — 1 1 1 2 16 9 21. Bronchitis 1 — — — — — — — — — — — 2 — 2 — 4 — 5 2 1 3 15 5 40 10 22. Pneumonia 15 10 — — 1 1 2 — 1 1 1 1 6 2 8 4 10 2 10 5 8 9 62 35 37 28 23. Other Respiratory diseases — — — — — — — — — — — — — — 1 — 3 2 4 1 2 2 12 5 12 2 24. Ulceration of the Stomach or Duodenum — — — — — — — — 1 — — — 1 — 2 — 3 — — 1 1 — 8 1 14 1 25. Diarrhoea (under 2 years) 3 2 — — — — — — — — — — — — — — — — — — — — 3 2 4 2 26. Appendicitis — — — — — — — — — — — — — — — 1 1 — — — — — 1 1 2 2 27. Other Digestive Diseases — — — — — — — — — — 1 — — 1 1 — 2 1 — 4 2 1 6 7 6 9 28. Nephritis — — — 1 — — — — — — — 1 4 1 1 3 2 1 1 4 5 1 13 12 12 12 29. Puerperal and post Abortive Sepsis — — — — — — — — — — — 1 — — — — — — — — — — — 1 — 2 30. Other Maternal Causes — — — — — — — — — — — 2 — 1 — — — — — — — — — 3 — 2 31. Premature Birth 13 8 — — — — — — — — — — — — — — — — — — — — 13 8 13 9 32. Congenital malformation, birth injury, infantile disease 8 12 — — — — — — — — — — — — — — — — — — — — 8 12 9 16 33. Suicide — — — — — — — — — — — — — — — — — — 1 — — — 1 — 1 — 34. Road Traflic Accident — — — — — — 3 — — — — 1 2 1 2 — — — — — — 2 7 4 7 2 35. Other Violent Causes — — — — — — 2 1 1 — — — 2 1 3 — — — — — — 1 8 3 9 5 36. All Other Causes 1 2 — — 1 — 2 2 — 3 — 1 4 2 6 2 7 1 3 4 7 5 31 22 34 25 46 38 1 3 5 1 12 10 14 15 12 22 44 33 71 45 84 4. 71 55 64 58 424 321 419 323