C 4411 (1) DAGENHAM BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1945 CECIL HERINGTON, M.D. (Lond.), D.P.H BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1945 CECIL HERINGTON, M.D. (Lond.), D.P.H. 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I submit herewith my report for the year 1945 ; this is in line with the reports prepared during the war years as directed by the Ministry of Health. The estimated population for mid-1945 has been given by the Registrar-General as 94,530; since this estimate, however, the quarterly returns issued by the Registrar-General have shown a continued increase, the latest showing a figure of over 108,000. The increased provision of houses and the re-building of those demolished materially help to maintain the upward trend. The birth rate of 19.54, although in excess of that for England and Wales, viz., 16.1, is less than for 1944. Only two maternal deaths were assigned to this district, this being the same number as for the previous year; the rate per thousand births is, however, slightly increased owing to the diminished number of total births. The death rate from all causes continues to be very low; this is partly accounted for by the fact that Dagenham possesses a high proportion of young people. There was a high incidence of Measles, the age group mostly affected being that between five and ten years, the total number of notifications received being 1,330. In spite of this high incidence, however, it is gratifying to note that no deaths have been attributed to this disease. The incidence of Whooping Cough declined from 412 in 1944 to 177; here again I am pleased to record that no fatal case occurred. STAFF. It is with much regret that I have to record the death of Miss M. Smith, Senior Health Visitor. Miss Smith had been on the Health Visiting staff for a great many years. For the latter part of her period of service she was in charge of the other Health Visitors and undertook important duties with regard to Council and Association midwives. Her loss to the department was severely felt. We were, however, fortunate in securing the services of Miss V. Everitt, who was promoted to succeed Miss Smith. Dr. J. A. C. Franklin is still serving as a Staff Major with the Royal Army Medical Corps and it is not anticipated that his release will be obtained until the early part of 1947. It is understood that being classified as a Specialist his demobilisation will be delayed. Dr. Carter-Locke was demobilised in May, 1946; on his return to the staff he was appointed as Acting Deputy Medical Officer of Health pending Dr. Franklin's return. Messrs. Field and Skeates returned from the Forces during 1946 and resumed duty with the department; Mr. Field, however, has since 4 secured an appointment as a Sanitary Inspector with another authority. CLINICS. The adaptation of The Leys Nursery for clinic purposes has been fully justified by the large attendances both at the Infant Welfare and Ante-natal clinics. Arrangements are being made for orthopaedic clinics to be held also at these premises. The Becontree Avenue and Ford Road clinics have been restored to their former use, consequently the premises temporarily utilised at Valence Club and Finnymore Road have been vacated. HOME AND DOMESTIC HELPS. The scheme previously in force has been amended and extended. The rates of payment have been increased and a new scale for recovery of fees is under consideration as is the appointment of a full-time organiser. MOBILE OBSTETRIC UNIT. On the 1st March this unit was called to a patient in Chadwell Heath who was gravely ill. The personnel of the unit remained with the patient for many hours until midnight and then returned at 1.30 a.m. on the following morning. The patient was given a blood transfusion and after a stay in Rush Green Emergency Hospital made a complete recovery. The child also was discharged fit and well and suffered no after-effects from the ordeal undergone by the mother. The highest praise is due to all concerned with this episode including, of course, the midwife in charge of the patient. It is undoubtedly true to state that but for the prompt turning out of this unit and the devoted services of all those associated, the patient would have lost her life. SCHOOL MEDICAL SERVICE. At the time of writing this report no final arrangements had been made fully to implement the scheme of divisional administration. ment has been reached on major points and it is hoped that the final details will be settled early in 1947 to enable the Maternity and Child Welfare and School Medical Services to be completely integrated. PREMATURE INFANTS. Having in mind the ease of access to Oldchurch County Hospital where all facilities exist for dealing with premature infants, it was felt that the needs would be fully met by the provision of hot water bottles and other facilities for the use of premature infants. During the year 62 infants whose birth weight was 5½ lbs. and under were notified to the department. With very few exceptions, all of these 62 infants survived beyond the first four weeks of life. 5 The scheme prepared by the Council has now received the approval of the Ministry of Health and it is considered that the full details will be of use to those reading this report. I therefore set them out at length :— 1. Ascertainment: Information is obtained through the tion's Ante-Natal clinics and the following voluntary organisations:— The Dagenham Personal Service Council, Romford Branch of the Chelmsford Diocesan Moral Welfare Association. 2. Advice : The assistance of the voluntary organisations will be enlisted to advise and guide on the lines suggested in Ministry of Health Circular No. 2866 of the 1st October, 1943- 3. Institutional Accommodation : Facilities are available for the maintenance and rehabilitation of mothers and children at (a) the Romford Hostel of the Chelmsford Diocesan Moral Welfare Association and (b) at the Essex County Council Hostel at Ardmore, Buckhurst Hill. 4. After Care : (a) Foster Mothers : Where necessary, ments will be made for children to be placed with suitable foster mothers to whom a payment will be made by the Corporation of 12s. 6d. per week for maintenance and £3 per quarter clothing allowance up to the age of five years. (b) Residential Accommodation: The Corporation will participate in the proposal of the Essex County Council to establish a residential nursery for children who cannot be boarded out. 5. Contributions : Mothers will be required to contribute towards the cost of maintenance of children on the following basis:— (i) Amount of affiliation order (if any) or specific allowance received by the mother in respect of the child, Plus— (ii) Gross earnings, Less— (a) Reasonable cost of board and lodgings not exceeding (i) 20s. od. if mother resident with parents, and (ii) 30s. od. if resident elsewhere, (b) Reasonable cost of additional meals, (c) Fares to work and to visit child, (d) Statutory insurance contributions, (e) Hospital contributory schemes, (f) Personal allowance—10s. od. per week. (g) Any other exceptional expenses as approved by the Chairman of the Health Services Committee, not exceeding the cost of maintenance to the Council. 6 6. Payments to Voluntary Bodies: In recognition of the work performed by them, and to assist in the continuance and extension of their work the Corporation will make annual grants to the voluntary organisations viz. :—The Dagenham Personal Service Council and Chelmsford Diocesan Moral Welfare Association. The scheme is now being carried out by the department and it is hoped that when it becomes more widely known suitable and sufficient foster homes will be available for those needing them. SCABIES This Clinic has been of great service as is shown CLINIC. by the fact that in 1945, 967 attendances were made. The premises have been altered and improved since the end of hostilities and present facilities under which treatment is carried out enable the patients to be attended to under very good conditions. No alteration has been made in the staffing of this clinic. FOOT CLINICS 8,691 attendances were made during the year; of these 7,314 were at the Parsloes Avenue Clinic and 1,377 at The Clinic, Ashton Gardens, Chadwell Heath. Recently the Clinic has been transferred from Parsloes Avenue to what was formerly the orthopaedic room at Ford Road Clinic. At the present time two whole-time Chiropodists are employed. The services provided by this scheme are much appreciated and the Chiropodists are fully booked for all the available sessions. Reference to the portion of the report dealing with this subject will show that the number of children immunised has almost doubled. Great stress is laid upon the importance of immunising children on or about their first birthday. The practice of sending birthday cards accompanied by explanatory literature is still in operation and may be credited with stimulating the interest of parents in this very important process. I am pleased once more to take the opportunity of extending my grateful thanks to all the members of the staff of my department for their services and help during the year, and finally I ask the Chairman and members of the Health Services Committee to accept my thanks for their 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, 1945.) Mayor : Alderman F. G. THOMAS, J.P. Deputy Mayor : Alderman A. F. J. CHORLEY, J.P., E.C.C. W. E. BELLAMY. F. BROWN, J.P. J. W. BURRIDGE. S. F. BANKS. D. E. BROWN. S. W. DEEKS. F. GRINDROD. A. HADDOCK. G. T. HARRIS. J. HOLLIDGE. W. C. IRELAND. A. KEMPSON. H. L. LYONS. E. M. MILLARD (Mrs.). R. G. MURRELL. Aldermen : R. J. D. CLACK. L. F. EVANS (Mrs.), M.B.E., J.P., E.C.C. E. E. HENNEM. Councillors : C. J. MUSTOO. J. NEISH (Mrs.). E. OSBORNE. A. E. PRENDERGAST (Mrs.). C. PRENDERGAST. E. S. REDDY (Mrs.). M. REDDY. F. L. M. ROGERS (Mrs.). E. R. SAYWOOD. A. R. THOMAS (Mrs.). A. F. WARR (Mrs.). J. WRIGHT. HEALTH SERVICES COMMITTEE Councillor (Mrs.) A. E. PRENDERGAST, Chairman. Councillor (Mrs.) A. F. WARR, Vice-Chair man. His Worship the Mayor (Alderman F. G. THOMAS). Deputy Mayor (Alderman A. F. J. CHORLEY) Councillor E. M. MILLARD (Mrs.) Councillor E. OSBORNE. Councillor E. S. REDDY (Mrs.) Councillor M. REDDY. 8 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 : (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. Chief Sanitary Inspector : L. E. PRIOR (i, 2). Sanitary Inspectors : J. W. ALLAM (1, 2). F. W. S. FOX (1, 2, 3, 4). A. J. JAMES (1). F. W. KNIGHT (1, 2). Senior Health Visitor : V. A. EVERITT (5, 6, 7). Health Visitors : 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). M. B. NELSON (5, 6, 7). 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). Midwives : D. K. ANKER (6). M. HALL (6). C. HURRY (6). M. GOODBUN (5, 6). O. M. LISSAMORE (6). 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 (1). (Serving with R.E.M.E.) Clerks : G. BALLARD (8). I. M. BISHOP. K. BRIMBLECOMBE (8). G. K. HARRIS. E. HIGHAM (8). K. W. SKEATS (Serving with R.A.F.) M. A. WATTS. 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 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, 1945 94,530 Number of inhabited houses (end of 1945) according to Rate Books 25,672 Rateable value (December 31st, 1945) £605,962 Sum represented by a penny rate (approximate, 1945-46) £2,340 Extracts from Vital Statistics for the Year. Live Births :— Total Male Female Legitimate 1,743 875 868 Birth rate per 1,000 of the estimated resident population, 19.54. Illegitimate 104 61 43 Stillbirths:— Legitimate 47 22 25 Rate per 1,000 total live and still) births, 25.84. Illegitimate 2 1 1 Deaths 659 360 299 Death rate per 1,000 of the estimated resident population, 6.97- Deaths from puerperal causes— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis - — Other puerperal causes 2 1.05 Total 2 1.05 Death rate of Infants under one year of age :— All infants per 1,000 live births 42.23 Legitimate infants per 1,000 legitimate live births 41.31 Illegitimate infants per 1,000 illegitimate live births .. 57.69 Deaths from Cancer (all ages) 109 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) — „ „ Diarrhoea (under 2 years of age) 11 11 Births. 1,847 birth births were registered during the year, there being 936 males and 911 females. There is a decrease of total births from 2,043 in 1944 to I5847. The birth rate per thousand population was 19.54 compared with 16.1 for England and Wales and 19.1 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, 20.37,19.83 and 22.26 for the years 1927 to 1944 inclusive. The illegitimate birth rate continues to be very low, being only 5.59 per cent. of total births. The rate of illegitimate stillbirths is 4.08 per cent. of total stillbirths. Death Rate. Total deaths in district 453 Outward transfers 119 Inward transfers 326 Deaths of residents 660 Of the 119 deaths of non-residents occurring in the district, 43 took place at the West Ham Sanatorium and 62 at the Joint Isolation Hospital. Of the 326 deaths of local residents taking place outside this area, most occurred in institutions. Of these 147 occurred at Oldchurch Hospital, 26 at The Retreat, Great Burstead, 13 at Ilford Isolation Hospital, 11 at 48, Wood Street, Chelmsford, 10 at London Hospital, eight at 32a, Spital Road, Maldon, seven at King George Hospital, six at 42, The Plain, Epping, five at Severalls Hospital, five at Orsett Lodge, five at Warley Hospital and four at the E.M. Hospital, Black Notley. 659 deaths are equivalent to a death rate of 6.97 compared with 11 .4 for England and Wales. For the years from 1927 to 1944 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, 7.98 and 7.81. 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 1945 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 16.1 0.46 11.4 0.00 — 0.02 0.00 0.02 0.02 0.08 5.6 46 126 County Boroughs and Great Towns, including London 19.1 0.58 13.5 0.00 — 0.02 0.00 0.02 0.02 0.07 7.8 54 148 smaller towns (1931) resident populations 25,000-50,000 19.2 0.53 12.3 0.00 — 0.02 0.00 0.01 0.02 0.07 4.5 43 London 15.7 0.40 13.8 0.00 — 0.01 0.00 0.02 0.01 0.07 7.6 53 Dagenham 19.54 0.52 6.97 0.00 — 0.00 0.00 0.00 0.02 0.01 5.96 42.23 13 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Infant Welfare Centres. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. The Clinic, Ashton Gardens, Chadwell Heath. Weekly Tuesday, p.m. 63 4 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Monday, a.m. 57 2 Weekly Monday, p.m. 71 5 The Leys Clinic, Ballards Road, Dagenham. Weekly Thursday, a.m. 47 3 Weekly Thursday, p.m. 48 4 Out-Patient Dept., King George Hospital, Five Elms, Dagenham. Weekly Wednesday, p.m. 52 4 Weekly Friday, a.m. 54 5 Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 28 2 14 Ante-Natal Clinics. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. The Clinic, Ashton Gardens, Chadwell Heath. Weekly Monday, a.m. 17 3 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 22 4 Weekly Wednesday, a.m. 19 4 Weekly Friday, a.m. 21 4 The Leys Clinic, Ballards Road, Dagenham. Weekly Monday, p.m. 17 4 Weekly Tuesday, a.m. 21 4 Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Wednesday, a.m. 19 4 Monthly (1st in month) Friday, a.m. 14 4 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 22 5 Weekly Thursday, a.m. 20 3 Weekly Thursday, p.m. 18 4 School Clinics. Clinic. Inspection. Minor Ailment. Co-operative Hall, Whalebone Lane North, Chadwell Heath. — Tuesday and Friday mornings. Green Lane School, Dagenham. Monday morning and Wednesday afternoon. Tuesday afternoon and Thursday and Friday mornings. Five Elms School, Wood Lane, Dagenham. Monday and Friday mornings. Tuesday, Wednesday and Thursday mornings. Finnymore Road School, Dagenham. Monday afternoon. T uesday, Wednesday, Thursday and Friday mornings. 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-ordinatcd 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. Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits :— Houses 23 Nuisances under Public Health Acts 4,029 Bakehouses 88 Slaughterhouses 36 Milkshops, dairies and vehicles 49 Foodshops and stalls 1,586 Cafes and canteens 506 Infectious disease enquiries 1,755 Visits to foster mothers' premises 14 Number of complaints investigated 987 Outworkers' premises 75 Factories 168 Workplaces and offices 98 Tents, vans and sheds 56 Stables 44 Hairdressers' and barbers' premises 51 Shops Act, 1934 29 Ice cream premises and vehicles 140 16 Houses fumigated 34 Rodent control 507 Other visits 207 (b) Notices served :— Complied with:— Statutory 121 116 Informal 577 525 INSPECTION AND SUPERVISION OF FOOD. Slaughterhouses. The arrangement 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 whole-time staff. This was terminated in October, 1946, on the appointment of an additional Sanitary Inspector. FOOD AND DRUGS ACT, 1938. Analyses. Article. Number Examined. Number Adulterated, etc. Arrowroot 1 — Baking Powder 15 1 Barley Pudding 1 — Batter Flour 1 — Beef Cubes 1 — Beef Fluid 1 — Biscuit Mixture 1 — Black Pudding 1 — Chocolate Cup 2 — Cocoa 3 — Coffee 3 — Coffee and Chicory 2 — Culinary Essence 1 — Curry Powder 4 — Custard Powder 1 — Egg Substitute 2 1 Flour—Self Raising 1 — Pea 2 — Soya 2 — Gelatine 6 — Golden Raising Powder 3 — 17 Article. Number Examined. Number Adulterated, etc. Golden Rusks 1 — Gravy Browning and Gravy Salt 6 — Ice Cream 8 — Jam 13 — Jelly Dessert 1 — Junket 2 — Lemonade Crystals 2 — Lime Flavour Compound 1 — Meat and Vegetable Powder 1 — Medicinal Samples 67 1 Milk 51 2 Milk Tablets—Malted 1 — Mince 1 — Mineral Water 1 — Mustard 2 1 Mustard Cream 1 — Mustard Mixture 1 — Orange Essence Emulsified 1 — Pastes—Various 10 — Pepper 2 — Pimento 1 — Pudding and Cake Mixtures 18 1 Salad Dressing and Sauce 2 — Sausages and Sausage Meat 33 2 Semolina 9 1 Soup 2 — Spaghetti 1 — Spices and Herbs 28 1 Stuffing 5 — Table Cream 1 — Tea 2 — Vinegar 14 1 Wheat Food—Malted 1 — Total 344 12 Adulterated Samples, etc. Serial No. Article. Formal or Informal Nature of Adulteration or Irregularity. Observations. 635 Milk Formal 1½% added water. Vendor warned. 638 Glycerine Formal Contained glycerine substitute. Original bottle marked" Artificial Glycerine." The word " Artificial " was in very small type and could easily be overlooked. Manufacturers warned. l8 Adulterated Samples, etc.—contd. Serial No. Article. Formal or Informal Nature of Adulteration or Irregularity. Observations. 650 Milk Formal 3% added water. Vendor warned. 671 Pork Sausages Formal Contained a small percentage of soya bean product. Vendor warned. 693 Ginger Formal Contained excess of mineral matter, viz. 14.4%. 8.4% beyond the recognised limit of 6%. Vendors warned. 733 Mustard Formal Capable of yielding only 0.14% of allyl isothiocyanate and therefore consisted very largely of white mustard instead of a mixture of brown and white mustard yielding at least 0.35% of allyl isothiocyanate. Vendors warned. (Remainder of stock voluntarily surrendered.) 736 Malt Vinegar Formal Consisted of bacterial slime. It was full acid strength. Vendors warned. 776 Pork Sausages Formal Deficient in meat content to extent of 18% of the requirements, viz. 50%. Vendor warned. 832 Baking Powder Formal 26% deficient in available carbon dioxide. Vendor warned. 855 Chocolate Semolina Pudding Formal In accord with the description of Pudding, but no statement of weight and ingredients appeared on wrapper as required by Labelling of Food Order (No. 2) 1944. Vendor warned. 279A Yorkshire Pudding Mixture Informal 0.21% deficient in available carbon dioxide. Vendor warned. 295A Egg Substitute Informal 5.7% deficient in available carbon dioxide. Vendor warned. (Remainder of old stock voluntarily surrendered). 19 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 No age Non-Civilian Total Cerebro-Spinal Fever 1 1 1 — — — 2 — — — — — — — 7 Diphtheria — 1 1 — 1 11 s — — — — — — — 19 Dysentery — 4 3 2 3 6 4 1 1 1 1 — — — 26 Encephalitis Lethargica — — — — — — — — — — — — — — — Enteric Fever — — — — — — — — — — — — — — — Erysipelas 1 1 2 — — — — 1 2 3 18 2 — — 31 Food Poisoning — — — — — — — — — — — — — — — Measles 72 161 220 186 163 493 31 3 1 — — — — — 1330 Ophthalmia Neonatorum 15 — — — — — — — — — — — — — 15 Pemphigus 2 — — — — — — — — — — — — — 2 Pneumonia— Acute Primary 10 9 8 2 3 14 6 7 13 11 17 6 — — 106 Influenzal — — — — — 1 1 — 1 — — — — — 4 Poliomyelitis Acute — — — 1 1 — 1 — — — — — — — 4 Polioencephalitis Acute — — — — — 1 — — — — — — — — 1 Puerperal Pyrexia — — — — — — — 2 7 4 — — — — 13 Scarlet Fever 2 5 12 22 15 133 36 — — — — — 1 1 233 Smallpox — — — — — — — — — — — — — — — Whooping Cough 25 23 32 22 16 53 1 — — — — — 5 — 177 Malaria — — — — — — — — 1 — — — — — 6 Typhoid Fever — — — — — — — — — — — — — — 1 Notified. Admitted | to Isolation Hospital) ! Rush Green. Admitted to other Isolation Hospitals. Admitted to other Hospitals. Deaths Registered. Cerebro-Spinal Fever 7 6 — 1 1 Diphtheria 19 19 — — 2 Dysentery 26 1 — — — Encephalitis Lethargica — — — — 1 Enteric Fever — — — — — Erysipelas 31 10 — 1 — Food Poisoning — — — — — Measles 1330 25 — — — Ophthalmia Neonatorum 15 7 — — — Pemphigus 2 2 — — — Pneumonia:— Acute Primary 106 31 — — 43 Inhuenzal 4 2 — 1 Poliomyelitis Acute 4 1 — 3 — Policencephalitis Acute 1 — 1 — — Puerperal Pyrexia 13 9 3 1 — Scaret Fever 233 64 — — — Smallpox — — — — — Whooping Cough 177 6 — 1 — Malaria 6 4 — — — Typhoid Fever 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 523 Number of PRE-SCHOOL children immunised without preliminary testing 1,364 Number of SCHOOL children re-Schick tested (This was negative.) 1 Number of PRE-SCHOOL children re-Schick tested .. (These were negative.) 3 Number of SCHOOL children who received a boosting dose 20 Total number of children found to be immune during the year 4 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. 6 16.12.40—0.2 c.c. A.P.T. 17. 2.41—0.5 c.c. A.P.T. 9.2.45 Yes Moderate Faucial Diphtheria Recovered 5 9. 8.44—0.2 c.c. A.P.T. 6. 9.44—0.3 c.c. A.P.T. 7.5.45 Yes Mild Faucial Diphtheria Recovered 7 Immunised at West Ham. Unable to trace. 16.3.45 Yes Mild Faucial Diphtheria Recovered Deaths. During the year two children, aged 6 and 10 years, died from Diphtheria, and in each case they had not received preventive treatment against this disease. 21 Scarlet Fever. The number of cases notified was 233 which is very slightly in excess of that for the previous year and once more there were no fatal cases. The practice of hospitalising only those cases selected on clinical and/or domestic grounds has been continued with gratifying results. It appears that the tendency throughout the country to nurse uncomplicated cases of Scarlet Fever in their own homes has gained impetus. 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- — 2 3 — — 1 — — — — 2 — 5- 2 2 4 4 — — — — 1 10- 1 4 2 2 — — 1 2 — — — — 15- 11 10 — 1 — — 1 — 2 5 — 1 20- 14 14 — 4 3 7 1 — 4 4 — 1 25- 14 11 — 3 5 5 — 1 4 6 — 1 35- 15 11 — 3 2 3 — — 2 2 — — 45- 13 3 1 2 3 — — — 3 4 — — 55- 11 2 1 — — — — — 8 — — — 65 and upwards 1 — — — — — — — — — — — 82 59 11 19 13 16 3 3 26 21 2 4 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register 1st January, 1945 During the year :— 422 297 126 124 New notifications 82 59 11 19 Deaths 26 21 2 4 Transfers into area 13 16 3 3 Transfers out of area 23 18 5 4 No. on Register 31st December, 1945 468 333 133 138 22 MATERNITY AND CHILD WELFARE. Notification of Births. 1,832 notifications of live births were received during the year; the majority of these were notified by mid wives. Stillbirths. 26 male and 27 female stillbirths were notified, the corresponding figures for registration being 23 and 26. The rate per 1,000 of total population registered was 0.52, the rate for England and Wales being 0.46. The percentage of illegitimate stillbirths to the total was 4.08 compared with a percentage of illegitimate to total births of 5.59. Infant Mortality. 78 infants under one year of age died during the year, giving an infant mortality rate of 42.23 per 1,000 live births, compared with that of 46 for England and Wales and 53 for London. The rate amongst legitimate children was 41.31, while for illegitimate children it was 57.69. Ophthalmia Neonatorum. 15 cases of this disease were notified, seven of which were treated in hospital; all made complete recoveries. There were 29 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 investigated by the Medical Officer of Health and all were visited by a Health Visitor. Maternal Mortality. Two maternal deaths were assigned to this district, which give a maternal mortality rate of 1.05 per thousand births. This is a remarkably low figure; that for England and Wales for the corresponding period was 1.79, which also is low. 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 348 Total visits 443 (6) To children under one year of age First visits 1,934 Total visits 5,643 (c) To children between the ages of one and five years Total visits 13,547 (d) Ineffective visits Total visits 3,749 Grand Total 23,382 23 Supervision of Midwives. The following is a summary of the reasons for sending for medical help by midwives:— Perineal Tear 124 Rise of Temperature 29 Discharging Eyes 29 Prolonged Labour 25 Malpresentation 21 Miscarriage 16 Ante-Partum Haemorrhage 16 Post-Partum Haemorrhage 13 Threatened Miscarriage 13 Feebleness of Infant 8 Premature Baby 7 Albuminuria 5 Watery Blisters 4 Retained Placenta 4 Jaundice 4 Toxaemia of Pregnancy 4 Premature Labour 4 Unsatisfactory Condition of Patient 3 Other Causes 55 384 Notices summoning medical aid 384 For (a) Mothers 309 For (b) Infants 75 Notification that they had been associated with the undermentioned conditions were received from midwives :— Stillbirths 17 Liable to be sources of infection 14 Substitution of artificial feeding 10 Infant deaths 7 Laying out dead bodies 1 24 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 1945 :— Municipal Midwives. Dagenham Nursing Association Midwives. Salvation Army Midwives. Births Attended : As Midwife 498 369 129 As Maternity Nurse 91 55 12 Miscarriages Attended 22 14 21 Visits Paid : As Midwife 9,654 6,463 4,883 As Maternity Nurse 1,247 1,029 224 Ante-Natal 3,410 2,409 1,105 Ante-Natal Clinics attended 479 210 93 Gas and Air Administered 96 109 32 CAUSES OF DEATH. Under 1 year 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 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 All Causes :— I. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — — — — 2. Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — — — 1 — 1 — 3. Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — — — 5. Diphtheria — — — — — — 1 1 — — — — — — — — — — — — — — 1 1 1 1 6. Tuberculosis of Respiratory System — — — — — — — — 5 9 6 8 3 3 6 2 10 — 2 — — — 32 22 30 24 7. Tuberculosis (other forms) — 1 1 — 1 — — 1 — 2 — 1 — 1 1 — — — — — — — 3 6 2 5 8. Syphilitic Disease — — — — — — — — — — — — — — 3 — — — — — — — 3 — 6 — 9. In uenza — — — — — — — — — — — — — — — — — 1 1 — — — 1 1 — 1 10. Measles — — — — — — — — — — — — — — — — — — — — — — — — — — 11. Acute Poliomyelitis and Polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Acute Infectious Encephalitis — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 — 13. Cancer of Buccal Cavity and Oesophagus (Males only) — — — — — — — — — — — — — — — — — — — — — — — — 3 — 13. Cancer of Uterus — — — — — — — — — — — — — — — 1 — 2 — 1 — — — 4 — 6 14. Cancer of Stomach and Duodenum — — — — — — — — — — — — 1 2 — 2 3 — 3 2 4 — 11 6 12 7 15. Cancer of Breast — — — — — — — — — — — — — 2 — 4 — — — 2 — 1 — 9 — 11 16. Cancer of all other sites — — — — — — — 2 — — — 1 2 4 4 5 13 2 13 12 5 2 37 28 41 29 17. Diabetes — — — — — 1 — — — 1 — — — — 1 2 — — 4 — 2 4 7 3 3 18. Inter-craninal Vascular Lesions 1 — — — — — — — — — — — — — 3 4 9 6 4 8 9 7 26 25 26 21 19. Heart Disease 4 2 — — 1 — 1 1 2 1 1 3 7 5 20 12 21 12 23 9 21 20 101 65 76 62 20. Other Diseases of Circulatory System — — — — — — — — — — — — — 1 1 — 1 — — — — — 2 1 7 9 21. Bronchitis — 1 — — — — — — — — — — 1 — 3 1 2 1 1 2 6 3 13 8 28 13 22. Pneumonia 13 11 1 1 — — — — — — 1 1 3 — 1 — 4 1 5 4 3 3 32 21 25 18 23. Other Respiratory Diseases 1 — — — — — — — — — 1 — 1 — 1 — 2 ~~ 1 2 2 9 9 11 4 5 24. Ulceration of the Stomach or Duodenum — — — — — — — — — — — — — — — — — — — — 1 — 3 — 6 1 25. Diarrhoea (under 2 years) 6 2 — — — — — — — — — — — — — — — — — — — — 6 2 8 3 26. Appendicitis 2 — — — — — — 1 — — — 1 — — — — — — — 1 — — 2 3 1 2 27. Other Digestive Diseases — 1 — — — — — — — — — — 2 1 1 1 4 1 1 2 — 1 8 7 3 7 28. Nephritis — — — — — — — — 1 — — — 2 1 1 3 3 1 4 2 3 — 14 7 8 5 29. Puerperal and Post-Abortive Sepsia — — — — — — — — — — — — — — — — — — — — — — — — — — 30. Other Maternal Causes — — — — — — — — — — — 1 — — — — — — — — — — — 1 — 2 31. Premature Birth — — — — — — — — — — — — — — — — — — — — — — 10 7 11 4 32. Congenital malformations, birth injury, and infantile disease 8 6 — — — — — — — — — — — — — — — — — — — — 8 6 13 11 33. Suicide — — — — — — — — — — 1 1 2 — — — 1 — — — — — 4 1 4 1 34. Road Traffic Accidents — — — — 1 — — 2 — 1 — — — 1 — — 2 — — 1 — 1 3 6 3 5 35. Other Violent Causes — 1 — — 1 1 2 5 — — 2 3 3 — 2 2 3 1 — — 1 — 14 13 13 16 36. All Other Causes — — — — — — 1 4 — — 1 — 2 3 1 2 3 3 1 1 10 11 19 24 24 27 368 292 360 299