AC 4411 (1) DAEENTTAM DAG 18 BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1944 CECIL HERINGTON, M.D. (Lond.), D.P.H. BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1944 CECIL HERINGTON, M.D. (Lond.), D.P.H. 8 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, The report on the health of the district for the year 1944 follows closely on the lines of those for the preceding war years, the main difference being that certain figures, such as the estimated population, are now included. It will be noted that the population as estimated by the Registrar General is 91,770, there are good reasons to believe that since that estimate was made there has been a very substantial increase, largely due to returns from evacuation. The vital statistics are very encouraging, the birth rate of 22.26 is the highest since the year 1931, the death rate remains low, but the infant mortality rate of 39.16 per 1,000 live births is worthy of special mention; this establishes a new low record and is all the more significant when one recalls that it is about half that experienced less than a generation ago. It can fairly be stated that the infant mortality rate inversely represents the health of a community. maternal mortality. Later in the report reference will be found to the low rate of maternal mortality, the actual number of maternal deaths was two, the figure for the previous year was four. The rate per thousand total births is almost exactly half that for England and Wales. From some quarters criticism has been directed against the Council for not providing a maternity home in the Borough, surely the consistently low death rate is sufficient to vindicate the Council's policy of making satisfactory arrangements with Oldchurch County Hospital and the East End Maternity Hospital for institutional confinements. The following quotation from the recent Hospital Survey for the Ministry of Health is pertinent to the argument "We share the views advanced by the Department's Committee on Maternal Mortality and Morbidity and elsewhere that maternity accommodation should whenever practicable be provided in a unit associated with a general hospital, and that small units are unable to maintain the skilled medical and nursing staff required, the optimum size of unit being in the neighbourhood of 70 beds (including ante-natal beds)." gas/air analgesia. The use of this service is being extended to meet the increasing demand which is no doubt prompted by good reports of its efficacy. Formerly the Central Midwives Board required that the "second person," i.e., additional to the midwife, should possess certain specified qualifications, this restriction somewhat hampered the scheme as these people were not always available after the Civil Defence Service was 4 disbanded. It has now been decided that any person approved by the midwife and acceptable to the patient may act in this capacity. The apparatus is now conveyed by the sitting case car of the ambulance service. We extend our cordial thanks to those ladies who in the past kindly acted as "second persons." domestic helps. Authority was given at the end of the year 1944 for Welfare Authorities to arrange for the provision of helps for households in need owing to illness, old age and other specified conditions. The beneficiaries contribute to the cost in accordance with their means. This service is distinct from the Home Help scheme which caters only for maternity patients and has been in operation in Dagenham for many years. clinics. War-time conditions of necessity disturbed our arrangements, the two buildings owned by the Corporation were turned over to the Civil Defence Service and for this purpose radical alterations were carried out. Those using the clinics were subjected to inconvenience and discomfort which they bore with very little protest. There is reason to believe that both Becontree Avenue and Ford Road Clinics will soon be restored to their former use. A war-time nursery situate in Ballards Road is very suitable for a clinic and this has now been purchased by the Corporation. With a few comparatively minor alterations it will serve a much needed demand and it is hoped to put it into service early in December of this year. The sunlight clinics which were suspended for a time during the war are now again in operation. diphtheria. A small but explosive outbreak occurred at one of the schools. On information being received the school was visited immediately, a large number of contacts were examined and swabs taken. Altogether 11 cases were confirmed and unfortunately two children aged six and ten years died. Only two of the children affected had previously been immunised and both of these suffered only a mild attack. Whilst the bereaved parents are deserving of every sympathy, it must be borne in mind that these tragedies need not have happened. Preventive treatment is free to all, children under the age of five can receive it at any of the Infant Welfare Centres without appointment; appointments for the treatment of school children can be made on applying to the Head Teacher or the Medical Officer of Health at the Civic Centre. Immunisation should be commenced at the age of one year, and a further injection is strongly recommended on entering school. 5 immunisation against whooping cough. On a number of occasions approaches have been made urging the Council to institute this service. I have advised against it chiefly on the grounds that the reagents at our disposal are not sufficienriy trustworthy to prevent the disease to warrant its introduction. Further, the failures to prevent, which would undoubtedly ensue, would undermine the confidence we have built up after many years of patient labour in the efficacy of Diphtheria Immunisation. To strengthen my argument, a report has recently been made to the Medical Research Council by three eminent workers which states : "The evidence obtained from this investigation lends no support to the view that pertussis vaccine is of value in the prophylaxis of whooping cough." And again " We should not discard the present vaccine prophylaxis of whooping cough because it is disappointing, but because it sometimes produces quite a severe reaction which has no immunising result." Many workers are now engaged on the production of a suitable vaccine; when the time is opportune the sanction of the Council will be sought to make it available to the public. I have no misgivings as to the attitude the Council will adopt! food poisoning. A factory canteen experienced what threatened to be an outbreak of alarming proportions. The management sought the advice of this department, which of course was readily forthcoming. The Medical Officer of Health and the Senior Sanitary Inspector visited the factory and inspected the appliances used for the preparation of the meals. A defective joint in a potato peeling machine was discovered; this joint was packed with red lead, some of which might have passed into the potatoes. The canteen manager had, previous to our visit, ordered the use of this machine to be suspended until a proper repair had been carried out. Our later enquiries showed that potatoes were not a common factor amongst those affected. In all 117 persons were questioned, all of these had symptoms of food poisoning to a greater or less degree, the predominant one being diarrhoea associated with abdominal pain, and/or vomiting. Careful enquiry elicited the fact that the only article of diet common to all was beef. The origin of this beef was quickly traced and enquiries made as to whether there had been any trouble experienced by other consumers, with negative results. Rectal swabs taken from a number of those affected failed to establish the identity of any specific organism as the cause. It seemed quite clear, however, that one particular joint out of the consignment of meat delivered on the material day was the cause of the outbreak. 6 Fortunately there were no fatal cases, and the symptoms though acute, did not persist for long. From an epidemiological point of view the outbreak presented many aspects of great interest and the investigation was greatly facilitated by the willing co-operation afforded by the staff of the factory. the future. There are indications that the exercise of the provisions of the Education Act, 1944, relating to the School Medical Service will be largely delegated to the Corporation by the County Council and that when the draft of the promised Bill to establish a national health service is published, it will have regard to integrating the maternity and child welfare service with the school medical service. If events justify this surmise, distinct advantages will emerge; it will be possible to arrange for the medical and nursing staff to supervise the welfare of families as units, the same individual doctors and nurses will be able to watch the progress of the families from the stage of ante-natal care to schoolleaving age. This in addition to providing mutual confidence will widen the scope of the staff and thus maintain their professional interest. I gladly seize upon this opportunity of recording my thanks to the staff of this department, including those engaged on civil defence, for their loyal co-operation during a very difficult year. To the latter I bid farewell, sharing with them the gratitude we all feel that circumstances have rendered their services no longer necessary. Finally, I would offer my sincere thanks to the Chairman and Members of the Health Services Committee for their continued help and interest in the work of the Public Health Department. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 7 MEMBERS OF THE COUNCIL (31st December, 1944.) Mayor : Councillor F. BROWN, J.P. Deputy Mayor : Councillor F. G. THOMAS. Aldermen : A. F. J. CHORLEY, J.P., E.C.C. W. C. MARKHAM. R. J. D. CLACK. L. F. EVANS (Mrs.), J.P., E.C.C. E. E. HENNEM. M. E. MARLEY (Mrs.), J.P. B. H. SAUNDERS, E.C.C. C. A. THORNEYCROFT. 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. J. P. HOLLIDGE. H. L. LYONS. Councillors : J. E. MUNN. R. G. MURRELL. J. NEISH (Mrs.) E. OSBORNE. A. E. PRENDERGAST (Mrs.) E. S. REDDY (Mrs.). M. REDDY. F. L. M. ROGERS (Mrs.) E. R. SAYWOOD. A. R. THOMAS (Mrs.). 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. (Coun. F. BROWN). Alderman M. E. MARLEY (Mrs.), J.P. Deputy Mayor Coun. M. REDDY. (Coun. F. G. THOMAS). Coun. A. R. THOMAS (Mrs.). 8 OFFICERS of the PUBLIC HEALTH SERVICES Full-Time Slaff: 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 : (Serving with R.A.M.C.). 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 Officers : M. WEIZMANN, M.R.C.S., L.R.C.P. G. H. MILES, L.M.S.S.A. Senior Sanitary Inspector : L. E. PRIOR (I, 2). Sanitary Inspectors : J. W. ALLAM (i, 2). A. J. JAMES (i). F. W. S. FOX (i, 2, 3, 4). F. W. KNIGHT (i, 2). Senior Health Visitor : M. SMITH (5, 6, 7). Health Visitors : V. A. EVERITT (5, 6, 7). E. FISKE (5, 6, 7). H. H. L. FREYTAG (5, 6, 7, 8). A. K. GIBSON (5, 6, 7). D. GORDON (5, 6, 7, 8, 9). L. SALTER (5, 6, 7). P. SILBY (5, 6, 7). D. B. STEWART (5, 6, 7). D. E. WALLER (5, 6, 7). Senior Midwife : E. M. BEDFORD (5, 6). D. K. ANKER (6). M. HALL (6). C. HURRY (6). M. GOODBUN (5, 6). O. M. LISSAMORE (6). Midwives : H. MITSON (5, 6). M. E. RISBY (5, 6, 10). M. ROBSON (6). M. J, STOREY (6). 9 Clerical Staff: Senior Clerk : B. E. E. DENNY. Clerk to Sanitary Inspectors : H. FIELD (i). (Serving with R.E.M.E.) Clerks : G. BALLARD (8). E. HIGHAM (8). I. M. BISHOP. K. W. SKEATES (Serving with R.A.F.) K. BRIMBLECOMBE (8). M. A. WATTS. G. K. HARRIS. Certificate of Royal Sanitary Institute I 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 Temporary War-Time Appointment .. .. .. .. .. 8 State Certified Mental Certificate .. .. 9 State Registered Fever Nurse.. .. .. .. .. .. .. 10 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. (Eng.). Public Analysts : BERNARD DYER, D.Sc., F.R.I.C. J. HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. 10 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 6,556 Registrar-General's estimate of resident population, 1944 91,770 Number of inhabited houses (end of 1944) according to Rate Books 25,629 Rateable value (December 31st, 1944) £599,024 Sum represented by a penny rate (approximate, 1944-45) £2,330 Extracts from Vital Statistics for the Year. Live Births:— Total Male Female Legitimate 1,948 1,043 905 Birth rate per 1,000 of the estimated Illegitimate 95 51 44 resident population, 22.26. Stillbirths:— Legitimate 44 28 16 Rate per 1,000 total (live and still) Illegitimate 2 2 — J births, 22.02. Death rate per 1,000 of the estimated Deaths 717 412 305 president population, Deaths from puerperal causes— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 1 0.48 Other puerperal causes .. .. 1 0.48 Total 2 0.96 Death rate of Infants under one year of age :— All infants per 1,000 live births 39-16 Legitimate infants per 1,000 legitimate live births.. .. 39.53 Illegitimate infants per 1,000 illegitimate live births .. 31.58 Deaths from Cancer (all ages) 112 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) 4 „ „ Diarrhoea (under 2 years of age) .. .. 10 11 Births. 2,043 live births were registered during the year, there being 1,094 males and 949 females. There is an increase of total births from 1,845 in 1943 to 2,043. The birth rate per thousand population was 22.26 compared with 17.6 for England and Wales and 20.3 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, 20.37 and 19.83 for the years 1927 to 1943 inclusive. The illegitimate birth rate continues to be very low, being only 4.65 per cent, of total births. The rate of illegitimate stillbirths is 4.35 per cent, of total stillbirths. Death Rate. Total deaths in district 472 Outward transfers 101 Inward transfers 346 Deaths of residents 717 Of the 101 deaths of non-residents occurring in the district, 49 took place at the West Ham Sanatorium, 40 at the Joint Isolation Hospital and four at Storrington Nursing Home. Of the 346 deaths of local residents taking place outside this area, most occurred in institutions. Of these 118 occurred at Oldchurch Hospital, 23 at The Retreat, Great Burstead, 20 at 32a, Spital Road, Mai don, 14 at King George Hospital, Ilford, 12 at 42, The Plain, Epping, 10 at the London Hospital, seven at Warley Hospital, seven at 14, Pope's Lane, Colchester, six at 48, Wood Street, Chelmsford, six at 142, Rayne Road, Braintree, five at Ilford Isolation Hospital, four at East End Maternity Hospital and four at Orsett Lodge. 717 deaths are equivalent to a death rate of 7.81 compared with 11.6 for England and Wales. For the years from 1927 to 1943 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, 6.85 and 7.98. A table giving the causes of death, and the age periods at which they occurred, is given at the end of the report. 12 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1944. 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 17.6 0.50 11.6 0.00 — 0.01 0.00 0.03 0.02 0.12 4.8 46 126 County Boroughs and Great Towns, including London 20.3 0.64 13-7 0.00 — 0.01 0.00 0.03 0.03 0.10 7.3 52 148 smaller towns (1931) resident populations 25,000-50,000 20.9 0.61 12.4 0.00 — 0.01 0.00 0.02 0.03 O.11 4-4 44 London 15.0 0.42 15-7 0.00 — 0.00 0.00 0.04 0.01 0.08 10.1 61 Dagenham 22.26 0.50 7.81 0.00 — 0.00 0.00 0.04 0.02 0.02 4.89 39.16 13 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 Tuesday, p.m. 56 5 Valence Club, Corner of Becontree Avenue and Bennetts Castle Lane, Dagenham. Weekly Monday, a.m. 47 3 Weekly Monday, p.m. 71 6 The Leys Nursery, Ballards Road, Dagenham. Weekly Thursday, a.m. 41 3 Weekly Thursday, p.m. 54 6 Out-Patient Dept., King George Hospital, Five Elms, Dagenham. Weekly Wednesday, p.m. 26 2 Weekly Friday, a.m. 65 S Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 25 2 14 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. 15 3 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 20 5 Weekly Wednesday, a.m. 15 3 Weekly Friday, a.m. 18 4 The Leys Nursery, Ballards Road, Dagenham. Weekly Monday, p.m. 14 4 Weekly Tuesday, a.m. 17 4 Weekly Wednesday, a.m. 14 3 Rush Green Clinic, 179, Dagenham Road, Rush Green. Monthly (1st in month) Friday, a.m. 13 3 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 18 4 Weekly Thursday, a.m. 16 3 Weekly Thursday, p.m. 16 4 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. 15 Water. The water supply is satisfactory in quality and quantity. Since November, 1938, eight local authorities in the South Essex Waterworks Company's area of supply have carried out a co-ordinated system of sampling. Each authority takes one sample a month for bacteriological examination and one sample every six months for chemical examination in accordance with a rota. The 12 bacteriological and two chemical samples taken from the company's mains in this Borough were all satisfactory. The water is not liable to have plumbo-solvent properties and no action was called for in respect of any form of contamination. Approximately .14 per cent, of the inhabited houses and .13 per cent, of the population of the Borough take their water from standpipes. Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits :— Houses 594 Nuisances under Public Health Acts 1,970 Bakehouses 61 Slaughterhouses 26 Milkshops, dairies and vehicles 82 Foodshops and stalls 1,304 Cafes 584 Infectious disease enquiries 1,655 Visits to foster mothers' premises 22 Number of complaints investigated 562 Outworkers' premises 42 Factories 144 Workplaces 26 Tents, vans and sheds 64 Stables 43 Hairdressers' and Barbers' premises 54 Shops Act, 1934 34 16 Houses fumigated 61 Inspections re billeting of war workers 849 „ of food shops following war damage 273 Rodent control 1,024 Other visits 73 (b) Notices served Complied with. Statutory 56 56 Informal 313 312 INSPECTION AND SUPERVISION OF FOOD. Slaughterhouses. The arrangements made in 1942 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 has continued. This procedure was found necessary because of the shortage of Inspectors in that Borough and the failure to obtain additional wholetime staff. 17 FOOD AND DRUGS ACT, 1938. Analyses. Article. Number Examined. Number Adulterated, etc. Formal. Informal Private. Total Formal. Informal Private. Total Apple Rings 1 — — 1 — — Arrowroot 1 1 — 2 — — — — Baking Powder 6 — — 6 2 — — 2 Bicarbonate of Soda 2 — — 2 — — — — Bread and Butter 1 — — 1 — — — — Cake Flour 5 — — 5 — — — — Cake and Pudding Mixtures 6 — — 6 — — — — Cocoa 5 — — 5 — — — Coffee 6 1 — 7 — — — Cordials 3 — — 3 — — — — Crystals, Lemon, etc. 2 — — 2 — — — Curry Powder 2 2 — 4 — — — — Custard Powder and Flavour 1 — — 1 — — — — Egg Powder Substitute 2 — — 2 — — — — Essences, Various 5 2 — 7 — — — — Flavourings, Various 8 — — 8 — — — — Flour, Self Raising 11 — — 11 — — — — Pea 2 — — 2 — — — — Gelatine Powder 6 — — 6 — — — — Ginger, Ground 4 — — 4 — — — — Golden Raising Powder 2 — — 2 — — — — Gravy 3 — — 3 — — — — Jam 4 — — 4 — — — — Meat 2 — — 2 — — — — Medicinal Samples 22 1 — 23 — — — — Milk 7i — — 71 11 — — 11 Mustard 3 1 — 4 2 — — 2 Paste, Fish 1 — 3 — — — — Rapper 6 — — 6 — — — — Rennet 1 — — 1 — — — — Saffor 1 — — 1 — — — — Sausages and Sausage Meat 21 — 22 — — — — Semolina 3 — — 3 — — — — Soups 1 — — 1 — — — Spices and Herbs 15 1 — 16 — — — — Spreads 2 — — 2 — — — — Stuffing 2 — — 2 — — — — Sugar, Icing 1 — — 1 — — — — Table Creams 7 1 — 8 — — — — Tea 1 — — 1 — — — — Turpentine 1 — — 1 — — — Vinegar 17 1 — 18 1 — — 1 Whisky and Gin 4 — — 4 — — — — Total 270 14 - 284 16 - — 16 18 Adulterated Samples, etc. Serial Number. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. 270 Milk Formal Contained a little added water. Vendor warned. 337 Vinegar Formal Deficient in acetic acid to the extent approximately 1/9th of the quantity proper to vinegar. Manufacturers fined £5 and 4s. costs. 275 Milk Formal 1% added water. Vendor warned. 276 Milk Formal 1% added water. Vendor warned. 361 Milk Formal 28% deficient in fat. Vendor warned. 285 Milk Formal 23% deficient in fat. Samples taken as " Appeal to cows " were deficient in fat. j Attention paid by Inspectors to times of milking 1 and " stripping," but only slight improvement. Jersey cow added to this small herd and further samples satisfactory. 292 Milk Formal 26% deficient in fat. 402 Milk Formal 30% deficient in fat. 414 Milk Formal 3% deficient in fat. 401 Milk Formal 13% deficient in fat. 428 Milk Formal 9% deficient in fat. 429 Milk Formal 28% deficient in fat. 430 Milk Formal 27% deficient in fat. 434 Milk Formal 12% deficient in fat. 435 Milk Formal 14% deficient in fat. 502 Milk Formal 13% deficient in fat. Vendor warned. 458 Baking Powder Formal 23% deficient in available carbondioxide. Old stock withdrawn from sale. 528 Baking Powder Formal 25% deficient in available carbondioxide. Old stock withdrawn from sale. 437 Mustard Formal Contained only o.o6°„ of allylisothiocyanate and therefore consisted of white mustard instead of a mixture of brown and white mustard yielding at least 0.35% of allylisothiocyanate. Old stock; to be sold as " Pickling Mustard." 490 Mustard Formal Yielded not more than 0.05% allylisothiocyanate. Withdrawn from sale. 19 prevalence of, and control over, infectious and other diseases. NOTIFIABLE DISEASES (other than Tuberculosis). Under i year 1-2 » 34 45 | 5-io 10-15 15-20 20-35 | 35-45 45-65 65 and over | No age Non-Civilian Total Cerebro-Spinal Fever — — — — — 1 — — 1 — — — — — 2 Diphtheria — — I — 8 1 2 — — — 12 Dysentery — 2 4 I I 9 2 6 — 1 — 26 Encephalitis Lcthargica — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — Erysipelas 1 — — — — 1 — — 5 5 14 1 — — 27 Food Poisoning — — — — — — — 1 2 — 3 — — — 6 Measles 8 14 12 16 17 87 11 9 2 — — — — — 176 Ophthalmia Neonatorum 2 — — — — — — — — — — — — — 2 Pemphigus 3 — — — — — — — — — — — — — 3 Pneumonia— Acute Primary 16 11 5 5 5 14 I 5 3 10 13 8 — — 96 Influenzal — — — — — — — 1 2 5 — — — — 9 Poliomyelitis Acute — — — — 1 — — — — — — — — — 1 Polioencephalitis Acutc — — — — — — — — — — — — — — — Puerperal Pyrexia — — — — — — — 2 13 2 — — 1 — 18 Scarlet Fever 2 9 n 10 15 101 41 9 3 — I — — 1 205 Smallpox — — — — — — — — — — — — — — — Whooping Cough 63 54 59 43 50 124 8 2 5 — 2 — 2 — 412 — — — — — — — — — — — — — 1 1 Notified. Admitted to Isolation Hospital, Rush Green. Admitted to other Isolation Hospitals. Admitted to other Hospitals. Deaths Registered. Cerebro-Spinal Fever 2 2 1 Diphtheria 12 12 — — 2 Dysentery 26 7 — — — Encephalitis Lethargica .. — — — — — enteric Fever — — — Erysipelas 27 6 — 1 — Food Poisoning 6 — — — — Measles 176 8 1 — — Ophthalmia Neonatorum .. 2 2 — — — 1 emphigus Pneumonia :— 3 1 — — — Acute Primary 96 30 — 2 } 46 Influenzal 9 4 — — 'oliomyelitis Acute 1 1 polioencephalitis Acute — — — — 1 uerperal Pyrexia . . Jcarlet Fever ^nallpox 18 205 11 75 — — — — — * hooping Cough 412 21 — — 3 Malaria 1 1 — — — 20 DIPHTHERIA IMMUNISATION. The following is a summary of the work carried out during the year Number of SCHOOL children immunised without preliminary testing 243 Number of PRE-SCHOOL children immunised without preliminary testing 706 Number of SCHOOL children re-Schick tested 1 (This was negative). Number of PRE-SCHOOL children re-Schick tested 1 (This was negative.) Number of SCHOOL children who received a boosting dose 5 Total number of children found to be immune during the year 2 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 ultimate result Age Particulars of Treatment. Notified as Diphtheria. Confirmed. Severity. Results 2¼ 15.6.43.—0.1 c.c. A.P.T. 20.7.43.—0.3 c.c. A.P.T. 8.5.44 Yes Mild Recovered 9 Immunised at Deptford privately. Unable to trace. 3-7-44 Yes Moderate Recovered Deaths. During the year two children, aged 6 and 9 years, died from Diphtheria, and in each case they had not received preventive treatment against this disease. Scarlet Fever. The incidence of this disease fell from 376 to 205 with no fatal cases. This should allay any fears that the somewhat revolutionary control of scarlet fever, as referred to fully in my report for 1943, might reverse the trend of this infection. 21 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- 5 — — — — — — — 1 — — — 5- 1 — 2 2 — — 1 2 — — — 1 10- 3 2 3 8 — — — 1 — — 2 1 15- 14 15 — 2 1 1 — — 2 7 — — 20- 8 12 3 3 3 5 — — 2 4 1 — 25- 9 14 2 1 3 2 — — 6 4 — — 35- 12 1 1 2 1 1 — 1 6 1 — — 45- 5 2 — — 1 — — — 7 2 — — 55- 11 1 — 1 3 — — — 9 — — — 65 and upwards — 1 1 — — — — — 1 1 — — 68 49 12 19 12 9 1 4 34 19 3 2 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register 1st Jan., 1944 462 338 170 151 During the year :— New Notifications 68 49 12 19 Deaths.. 34 19 3 2 Transfers into area 12 9 1 4 Transfers out of area 86 80 54 48 No. on Register 31st Dec., 1944 422 297 126 124 22 MATERNITY AND CHILD WELFARE. Notification of Births. 1,998 notifications of five births were received during the year; the majority of these were notified by midwives. Stillbirths. 34 male and 18 female stillbirths were notified, the corresponding figures for registration being 30 and 16. The rate per 1,000 of totd population registered was 0.50, the rate for England and Wales also being 0.50. The percentage of illegitimate stillbirths to the total was 4.35 compared with a percentage of illegitimate to total births of 4.65. Infant Mortality. 80 infants under one year of age died during the year, giving an infant mortality rate of 39.16 per 1,000 live births, compared with that of 46 for England and Wales and 61 for London. The rate amongst legitimate children was 39.53 while for illegitimate children it was 31.58. Ophthalmia Neonatorum. Two cases of this disease were notified, both of which were treated in hospital; both made complete recoveries. There were 18 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 two were notified as suffering from true Ophthalmia Neonatorum. Maternal Mortality. Two maternal deaths were assigned to this district, which give a maternal mortality rate of 0.96 per thousand births. This is a remarkably low figure; that for England and Wales for the corresponding period was 1.93 which also is low. 23 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 394 Total visits 559 (b) To children under one year of age First visits 2,096 Total visits 6,827 (c) To children between the ages of one and five years Total visits 14,403 (d) Ineffective visits Total visits 3,466 Grand Total 25,255 Supervision of Midwives. The following is a summary of the reasons for sending for medical help by midwives :— Perineal Tear 105 Prolonged Labour 36 Rise of Temperature 35 Miscarriage 24 Ante-Partum Haemorrhage 24 Discharging Eyes 18 Unsatisfactory Condition of Infant 14 Malpresentation 14 Premature Baby 8 Post-Partum Haemorrhage 8 Watery Blisters 6 Albuminuria 4 Retained Placenta 4 Malformation 3 Jaundice 3 Other Causes 25 331 Notices summoning medical aid 331 For (a) Mothers 272 For (b) Infants 59 24 Notification that they had been associated with the undermentioned conditions were received from midwives as under :— Liable to be sources of infection 23 Stillbirths 13 Substitution of artificial feeding 12 Infant Deaths 10 Laying out dead bodies 1 Domiciliary Midwifery Servicc. 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 1944 :— Municipal Midwives. Dagenham Nursing Association. Salvation Army Nurses. Births Attended: As Midwife 505 361 145 As Maternity Nurse 121 74 9 Miscarriages Attended 25 18 13 Visits Paid : As Midwife 9.833 6,556 5.459 As Maternity Nurse 1,756 1,438 287 Ante-Natal 3.551 1,837 1.085 Ante-Natal Clinics Attended 473 257 95 Gas and Air Administered .. 81 108 7 CAUSES OF DEATH. Under 1 year 1 and under 2 years. 2 and under 5 vears. 5 and under IS vears. 15 and under 25 years. 25 and under 35 vears. 35 and under 45 vears. 45 and under 55 vears. 55 and under 65 vears. 65 and under 75 years. 75 and over. TOTAL RegistrarGeneral's 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 — 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough 3 — — — — — — — — — — — — — — — — — — — — — 3 — 4 — 5. Diphtheria .... — — — — — — 1 1 — — — — — — — — — — — — — — — 1 1 1 6. Tuberculosis of Respiratory System — — — — — — 1 2 5 7 6 4 7 1 6 1 9 — 1 1 — — 35 16 35 18 7. Tuberculosis (other forms) — — 1 — — — 2 4 1 2 — — — — — — — — — — — — 4 6 4 6 8. Syphilitic Disease — — — — — — — — — — — — — — 2 — 1 — — — — — 3 — 4 — 9. Influenza — — — — — — — — — — — — — — — — — — — — — — — 2 — 10. Measles — — — — — — — — — — — — — — — — — — — — — — — — — — 11. Acute Poliomyelitis and Polio-encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Acute Infectious Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cancer of Buccal Cavity & Oesophagus (Males only) — — — — — — — — — — — — — — — — — — — — 2 — 2 — 4 — 13-f.Cancer of Uterus — — — — — — — — — — — — — — — 1 — — — — — 2 — 3 — 7 14. Cancer of Stomach and Duodenum — — — — — — — — — — — 1 1 1 1 — 5 2 6 1 2 4 15 9 19 13 15. Cancer of Breast — — — — — — — — — — — — — — — 5 — 1 — 2 — — — 9 — 11 16. Cancer of all other sites — — — — — — — — — — — 1 4 5 17 5 10 7 5 7 2 6 38 31 37 21 17. Diabetes — — — — — — 1 — — 1 2 — 2 — — — — 1 1 1 1 2 7 5 4 4 18. Inter-cranial Vascular Lesions — 1 — — — — — — — 1 — — 2 1 2 7 3 8 3 6 7 7 17 31 10 27 19. Heart Disease 1 3 1 — — 1 2 2 1 1 9 5 3 8 10 9 32 8 27 17 34 19 120 73 93 53 20. Other diseases of Circulatory System . . — — — — — — — — — — — — — — — — 1 — 3 — — 2 4 2 16 10 21. Bronchitis 1 — — — — — — — 1 — — — 1 — 3 1 — 1 1 1 6 2 13 5 26 12 22. Pneumonia 10 8 — — 2 1 — 2 — — 1 1 4 1 5 — 2 1 4 2 6 2 34 18 29 17 23. Other Respiratory Diseases 1 — — — — — — — — — 1 — — 1 — 2 1 1 3 — 3 3 9 7 4 4 24. Ulceration of the Stomach or Duodenum — — — — — — — — — — — — — — 2 — 3 — 2 — — — 7 — 8 1 25. Diarrhoea (under 2 years) 3 3 1 — — — — — — — — — — — — — — — — — — — 4 3 4 6 26. Appendicitis — — — — 2 — — — — — 1 — — — — — — 1 — — — — 3 1 4 1 27. Other Digestive Diseases 2 1 — — — — 1 — — 1 — — I — — 2 1 — 2 1 — — 7 5 5 4 28. Nephritis — — — — — — — — — — — — 1 3 3 2 3 1 2 — 2 1 11 7 8 6 29. Puerperal and post Abortive Sepsis — — — — — — — — — — — — — — — — — — — — — — — — — I 30. Other Maternal Causes — — — — — * — — — — — — I — 1 — — — — — — — — — 2 — I 31- Premature Birth 8 11 — — — — — — — — — — — — — — — — — — — — 8 11 6 II 32. Congenital malformations, birth injury, infantile disease . . 9 13 — — — — — — — — — — — — — — — — — — — — 9 13 16 16 33* Suicide — — — — — — — — — — — — — 1 — — 1 — — — 1 — 2 1 3 I 34' Road Traffic Accidents — — — — — 1 2 2 1 1 — — 2 — 2 — — 1 — — — 8 4 8 4 35- Other Violent Causes 1 — 1 1 2 1 3 2 3 4 — — 6 2 7 3 5 6 1 2 1 3 30 24 29 24 36. All Other Causes — — 1 — 1 — 3 1 — — 3 3 1 3 1 — 1 1 1 — 5 10 17 18 28 25 40 40 5 1 7 4 16 l6 12 18 23 16 35 29 61 38 78 39 63 4i 72 63 412 305 412 305