C 4411(1) DAGENHAM DAG 20 * | ft * BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1946 CECIL HERINGTON, M.D. (Lond.),D.P.H. BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1946 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 have the honour to submit herewith my report for the year 1946, which has been drawn-up in accordance with the requirements of Articles 6(3) and 17(5) of the Sanitary Officers (Outside London) Regulations, 1935, as modified by Circular 13/47 of the Ministry of Health dated 13th March, 1947. This circular again states that the report should be an interim one. The estimated population for mid-1946 is given as 106,530. The Registrar-General, however, in his latest quarterly return estimates the civilian population at 110,300. To these should be added the unascertainable number of those serving in the Forces. The upward trend of the population since the cessation of hostilities is thus being maintained. It will be recalled that before the war each official estimate of population year by year was in excess of that previously shown. One other gratifying fact is the low record infant mortality rate which is 31.09 per thousand live births. This figure compares with 43 for England and Wales as a whole and 46 for the 126 County Boroughs and Great Towns including London. In 1928 the corresponding figure for Dagenham was 73.1 and with minor fluctuations it has tended to decrease. The previous low record of 39.16 occurred in 1944. The infant mortality rate is usually accepted as the index of the health of the population as a whole. The other vital statistics shown in the body of the report are satisfactory including the maternal mortality rate which is .82 per thousand total births. It is not so many years ago that a maternal mortality rate of four per thousand was regarded with complacency. BIRTH RATE. The total births numbered 2,380 compared with 1,847 for the previous year. The birth rate per thousand of the resident population is 22.34 compared with 19.54 for 1945. This further substantial rise has strained to the utmost the facilities offered by this department. Medical Officers, Health Visitors, Midwives and Clerical Staff have all been working at high pressure to cope with the rapid increase. The Committee has already given consideration to supplementing the health services in order to cope with the demand. It is scarcely necessary to point out that beyond a certain point it is not possible to deal satisfactorily with large numbers at Ante-Natal and Infant Welfare Clinics. Adverting to Midwives, it is recommended by the Rushcliffe Committee that the number of cases to be attended by a domiciliary midwife without a pupil should not exceed 66 per year. Reference to the table on "Domiciliary Midwifery Services" later in the report will show that our ten Municipal Midwives undertook 818 cases, including miscarriages. This number at the rate of 66 per year 4 represents the work of 12.4 midwives. There is no evidence at the time of writing this report that there is likely to be a reduction in the number of births. The Council has agreed to the appointment of an additional midwife for holiday relief duty and every endeavour is being made to fill this post. INSTITUTIONAL MIDWIFERY. Owing to lack of hospital accommodation the majority of confinements take place in the patients' homes. In cases, however, where medical reasons and housing conditions so indicate, patients are admitted either to Oldchurch County Hospital or the East End Maternity Hospital. The latter, however, owing to shortage of nursing staff has been compelled to restrict the numbers they will admit from Dagenham. Oldchurch County Hospital is in a similar position, but I am pleased to take this opportunity of expressing appreciation for the most ready assistance and co-operation which have at all times been received from the Medical Superintendent and his staff, who always use their best endeavours to overcome their difficulties, which they invariably succeed in doing to the benefit of the Dagenham mothers. GAS AND AIR ANALGESIA. The provision of gas and air analgesia for domiciliary confinements continues to be popular. On 305 occasions during the year this appliance was used, compared with 237 in the previous year. There is still a certain amount of prejudice against this form of analgesia, particularly on the part of the older mothers. This prejudice appears to be diminishing and the palliative effect is highly appreciated by those who elect to take advantage of it. Unless there are medical reasons for its contra-indication, all prospective mothers are offered, and encouraged to have, this form of treatment. HOME HELP SERVICE. A full-time Home Help Organiser has been appointed and took up her duties early in the present year. Amongst her duties are the selection of home and domestic helps, the allocation of these helps and the supervision of their work. A further duty is to publicise the service and to address representative meetings of women in order that knowledge of the advantages of the service may be disseminated. At the present time there are 24 helps available for service, four of whom are receiving a retaining fee in return for which they hold themselves ready to undertake duty in any part of the Borough. Up to date, it has been possible to supply a home or domestic help on every occasion where one has been needed. DAY NURSERIES. The three Day Nurseries, viz., Chadwell Heath, Kingsley Hall and Goresbrook, have continued in operation. Demands for places therein have increased to such an extent that the Committee recommended that in order to avoid disappointment it should be made known that priority 5 of admission is given to those mothers who are dependent on their own earnings. There are many such cases, as would be expected after a war which caused the widowhood of many young mothers who are forced to provide for their children. The number of attendances at all the nurseries during 1946 was 30,526. There was no undue prevalence of sickness amongst these children. Special care is directed towards the prevention of intestinal and respiratory infections. DIPHTHERIA IMMUNISATION. 13 cases of diphtheria occurred in 1946, of these only three had received preventative inoculation. Two of these cases were mild, one was moderate and all recovered. Diphtheria Immunisation is offered at all the Infant Welfare Sessions and at special periodic immunisation clinics. The low incidence of diphtheria in so large a child population indicates that the rate of protection is very high. The acceptance by all mothers of this facility would reduce the problem of diphtheria in this country to negligible proportions. WHOOPING COUGH IMMUNISATION. The Health Services Committee has given very careful consideration to preventive inoculation against Whooping Cough. The Committee is fully aware that this form of prevention is still in its experimental stage and that no guarantee can be given either to prevent the disease or to mitigate its evil effects should it be contracted. A large volume of research work is now being undertaken by a committee of the Medical Research Council. This research involves widespread and varied experiments; it is not expected, however, that the findings of this committee will be fully collated in the immediate future, but having in mind the ravages caused by Whooping Cough it is earnestly hoped that an effective antigen will soon be made available. In certain cases where the parents are anxious to have this treatment for their children, it is provided, the limitations being fully explained to them. SANITARY INSPECTION. The figures later in the report will show the many and varied duties undertaken by the Sanitary Inspectors. It is very notable that compared with previous years the work undertaken has increased to a remarkable extent. Additional duties have been assumed in connection with the Shops Acts. It will be noted that 986 visits connected with these Acts were paid. Rodent Control has also given rise to a great deal of work, this aspect of the Sanitary Inspector's duties having increased nearly fourfold. It is pleasing to be able to record that maintaining a high standard of sanitation in this district has been possible without having to resort to court action. It was necessary, however, to institute legal proceedings under the Food and Drugs Act on one occasion, the result being that the vendors were fined £8 and 10s. 6d. costs. The food involved was beef sausage which was deficient in meat content. 6 The many cases of overcrowding are, of course, well known to the department and endeavours to assist those most affected are constantly being made. It is scarcely necessary to point out, however, that the remedy is not entirely in our hands. SCHOOL MEDICAL SERVICE. This Council, being an "Excepted District" under the Education Act, 1944, has now assumed, with some limitations, administrative responsibility for the School Medical Service. The limiting factors are firstly that certain functions are retained by the Essex Education Committee and secondly that staff is not yet fully adequate to deal with the number of children within the Borough. The Medical Officer of Health has been designated "Borough School Medical Officer" and in addition there are three Assistant School Medical Officers who give the greater part of their time to work in Dagenham. It is hoped that in the future it will be possible to integrate more closely the work of the medical and nursing personnel with a view to the same individuals having supervision of children from the ante-natal stage to the school leaving age. At the present time this is not possible owing to the fact that some members of the nursing staff do not possess the qualifications required by the Ministry of Health to enable them to undertake health visiting duties. One of the serious gaps in the organisation is the lack of Dental Officers. The school population which is upwards of 18,000 requires the services of approximately nine wholetime Dental Surgeons. At the moment there is only one, the consequence being that he is only able to touch the fringe of the problem. Dagenham is not, however, peculiar in this respect, as most other authorities are suffering from a shortage of dental personnel. STAFF. I am pleased to say that all members of the Public Health Department have now been released from the Services. I would, however, mention that Mrs. B. E. E. Denny, who has acted as senior clerk in this department since its inception, has now retired. Mrs. Denny saw the department grow from its infancy to its present dimensions. I fell sure the Committee will share with me in wishing Mrs. Denny a long and happy retirement. In conclusion I offer my best thanks to the Chairman and members of the Health Services Committee and to other members of the Council for their help and interest, and also to the members of the staff of this department for their valued assistance and loyal support during the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CECIL HERINGTON, Public Health Department, Medical Officer of Health. Civic Centre, Dagenham. 7 MEMBERS OF THE COUNCIL (31st December, 1946.) Mayor: Alderman W. E. BELLAMY, J.P. Deputy Mayor: Alderman F. G. THOMAS, J.P. Aldermen: F. BROWN, J.P. R. J. D. CLACK. J. W. BURRIDGE. L. F. EVANS (Mrs.), M.B.E., J.P., E.C.C. A. F. J. CHORLEY, J.P., E.C.C. E. E. HENNEM. Councillors: S. F. BANKS. E. M. MILLARD (Mrs.) I. M. BROCKELBANK (Mrs.). C. J. MUSTOO. F. COOMBS. E. OSBORNE. G. H. A. CROUCH. A. E. PRENDERGAST (Mrs.). S. W. DEEKS. C. PRENDERGAST. F. GRINDROD. M. REDDY. A. HADDOCK. B. M. ROADKNIGHT (Mrs.). G. T. HARRIS. F. L. M. ROGERS (Mrs.). J. HOLLIDGE, E.C.C. E. R. SAYWOOD. W. C. IRELAND. A. R. THOMAS (Mrs.). A. KEMPSON. A. F. WARR (Mrs.), E.C.C. H. L. LYONS. J. WRIGHT. HEALTH SERVICES COMMITTEE Councillor (Mrs.) A. E. PRENDERGAST, Chairman. Councillor (Mrs.) A. F. WARR, E.C.C., Vice-Chairman. His Worship the Mayor Councillor E. M. MILLARD (Mrs.). (Alderman W. E. BELLAMY, J.P.). Councillor E. OSBORNE. Deputy Mayor Councillor B. M. ROADKNIGHT (Mrs.). (Alderman F. G. THOMAS, J.P.). Councillor F. L. M. ROGERS (Mrs.). 8 OFFICERS of the PUBLIC HEALTH SERVICES (1947.) 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: 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. Chief Sanitary Inspector: L. E. PRIOR (1, 2). Sanitary Inspectors: J. W. ALLAM (1, 2). A. HUTCHINGS (1, 2). F. W. S. FOX (1, 2, 3, 4). A. J. JAMES (1). Superintendent Health Visitor: V. A. EVERITT (5, 6, 7). Health Visitors: E. FISK (5, 6, 7). M. T. ROCHE (5, 6, 7). A. K. GIBSON (5, 6, 7). L. SALTER (5, 6, 7). D. GORDON (5, 6, 7, 9). P. SILBY (5, 6, 7). M. B. NELSON (5, 6, 7). D. B. STEWART (5, 6, 7). Senior Midwife: E. M. BEDFORD (5, 6). Midwives: D. K. ANKER (6). H. MITSON (5, 6). D. J. FISHER (5, 6). M. M. RICHARDS (6). M. GOODBUN (5, 6). M. ROBSON (6). M. HALL (6). M. J. STOREY (6). C. HURRY (6). 9 Clerical Staff: Chief Clerk: F. W. KNIGHT (1, 2). Clerk to Sanitary Inspectors: K. W. SKEATES. Clerks: I. M. BISHOP. M. J. ELLERTON. N. CLOKE. G. K. HARRIS. S. COCKS. P. ROBINS. V. CONINGHAM. M. A. WATTS. Day Nurseries: Goresbrook Nursery, Matron: Mrs. E. MADDISON (10). Dagenham Avenue, Dagenham. Deputy: (Vacant). Chadwell Heath Nursery, Matron: Mrs. P. NESS (8). Ashton Gardens, Chadwell Heath. Deputy: Miss A. BUTLER (5). Kingsley Hall Nursery, Warden: Miss D. HOWES. Parsloes Avenue, Dagenham. Clerk: Mrs. E. M. HOLLEY (8). 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 State Enrolled Assistant Nurse 8 State Certified Mental Certificate 9 State Registered Fever Nurse 10 Part-Time Staff: 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, 1946 106,530 Number of inhabited houses (end of 1946) according to Rate Books 26,028 Rateable value (December 31st, 1946) £614,902 Sum represented by a penny rate (approximate, 1946-47) £2,410 Extracts from Vital Statistics for the Year. Live Births:— Total Male Female Legitimate 2,259 1,144 1,115 Birth rate per 1,000 of the estimated resident population, 22.34. Illegitimate 121 56 65 Stillbirths:— Legitimate 59 34 25 Rate per 1,000 total live and still) births, 25.79. Illegitimate 4 2 2 Deaths 692 374 318 Death rate per 1,000 of the estimated resident population, 6.50. Deaths from puerperal causes:— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 1 0.41 Other puerperal causes 1 0.41 Total 2 0.82 Death rate of infants under one year of age:— All infants per 1,000 live births 31.09 Legitimate infants per 1,000 legitimate live births 30.10 Illegitimate infants per 1,000 illegitimate live births 49.59 Deaths from Cancer (all ages) 133 „ „ Measles (all ages) - „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years of age) 4 11 Births. 2,380 live births were registered during the year, there being 1,200 males and 1,180 females. There is an increase of total births from 1,847 in 1945 to 2,380. The birth rate per thousand population was 22.34 compared with 19.1 for England and Wales and 22.2 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, 22.26 and 19.54 for the years 1927 to 1945 inclusive. The illegitimate birth rate continues to be very low, being only 5.08 per cent. of total births. The rate of illegitimate stillbirths is 6.35 per cent. of total stillbirths. Death Rate. Total deaths in district 514 Outward transfers 121 Inward transfers 296 Deaths of residents 689 Of the 121 deaths of non-residents occurring in the district, 49 took place at the West Ham Sanatorium and 57 at the Joint Isolation Hospital. Of the 296 deaths of local residents taking place outside this area, most occurred in institutions. Of these, 133 occurred at Oldchurch Hospital, 14 at King George Hospital, 13 at The Retreat, Great Burstead, 13 at London Hospital, 10 at Ilford Isolation Hospital, seven at East End Maternity Hospital, seven at St. Bartholomew's Hospital, six at 14, Pope's Lane, Colchester, five at Severall's Hospital, five at The Hall, Stisted, Braintree, five at 32a, Spital Road, Maldon, four at Emergency Hospital, Black Notley, and four at Poplar Hospital. 692 deaths are equivalent to a death rate of 6.50 compared with 11.5 for England and Wales. For the years from 1927 to 1945 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, 7.81 and 6.97. 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 1946. 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 19.1 0.53 11.5 0.00 0.00 0.00 0.00 0.02 0.01 0.15 4.4 43 126 County Boroughs and Great Towns, including London 22.2 0.67 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.13 6.1 46 148 smaller towns (1931) resident population 25,000-50,000 21.3 0.59 11.7 0.00 0.00 0.00 0.00 0.02 0.01 0.14 2.8 37 London 21.5 0.54 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.12 4.2 41 Dagenham 22.34 0.59 6.50 0.00 0.00 0.00 0.00 0.01 0.01 0.05 1.68 31.09 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. 70 5 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Monday, a.m. 59 3 Weekly Monday, p.m. 62 5 The Leys Clinic, Ballards Road, Dagenham. Weekly Thursday, a.m. 57 5 Weekly Thursday, p.m. 82 8 Out-Patient Department, King George Hospital, Five Elms, Dagenham. Weekly Wednesday, p.m. 74 7 Weekly Friday, a.m. 60 5 Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 28 2 The Clinic, Ford Road, Dagenham. Weekly Thursday, a.m. (Com. Nov., 1946) 70 7 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. 27 5 Weekly Monday, p.m. (Com. Sept., 1946) 10 2 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 27 6 Weekly Wednesday, a.m. 21 4 Weekly Friday, a.m. 20 4 Weekly Friday, p.m. (Com. June, 1946) 15 1 The Leys Clinic, Ballards Road, Dagenham. Weekly Monday, p.m. 27 6 Weekly Tuesday, a.m. 25 4 Weekly Wednesday, a.m. 18 3 Rush Green Clinic, 179, Dagenham Road, Rush Green. Monthly (1st in month) Friday, a.m. 19 4 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 25 6 Weekly Wednesday, p.m. (Com. June, 1946) 19 3 Weekly Thursday, a.m. 23 4 Weekly Thursday, p.m. 19 4 The Clinic, Ford Road, Dagenham. Weekly Thursday, p.m. (Com. Nov., 1946) 12 3 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. Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits:— Houses 78 Nuisances under Public Health Acts 5,104 Bakehouses 123 Slaughterhouses 14 Milkshops, dairies and vehicles 51 Foodshops and stalls 1,751 Cafes and canteens 554 Infectious disease enquiries 2,270 Visits to foster mothers' premises 30 Number of complaints investigated 1,353 Outworkers' premises 59 Factories 135 Workplaces and offices 56 Tents, vans and sheds 134 Stables 20 Hairdressers' and barbers' premises 46 Shops Acts. 986 Ice cream premises and vehicles 184 Houses fumigated 48 Rodent control 1,916 Other visits 156 (b) Notices served :— Complied with:— Statutory 141 151 Informal 690 506 16 FOOD AND DRUGS ACT, 1938. Analyses. Article. Number Examined. Number Adulterated, etc. Almond Flavouring 1 — Alum 1 — Aspirin 1 — Baking Powder 9 1 Barley Flakes 1 — Beef Extract 1 — Beef—Minced 1 — Beef and Vegetable Extract Cubes 1 — Betalax 1 — Bicarbonate of Soda 13 — Boracic Ointment 1 — Boracic Powder 1 — Borax 1 — Bun and Cake Flours and Mixtures 9 — Cake Mixtures 2 — Camphorated Oil 2 — Cascara Segrada 1 — Castor Oil 3 — Celery Salt 2 — Chemical Food 1 — Children's Tonic 1 — Chu-Lax 1 1 Cinnamon 1 — Cinnamon—Ground 3 — Cloves 1 — Cochineal Colour 1 — Cocoa 5 — Coffee 3 — Coffee and Chicory 4 — Coffee Extract 2 — Curry Powder 6 — Custard Powder 3 — Epsom Salts 3 — Eucalyptus Oil 1 — Fish Paste 5 — Food Flavouring Powder 1 — Forcemeat 1 — Friars Balsam 1 — Frizets 1 — Gelatine 4 — Gin 2 — Ginger—Ground 3 — Ginger Wine Essence 1 — Glycerine and Borax 2 — Glycerine, Lemon and Aniseed Cough Mixture 1 — Glycerine, Lemon and Ipecac Mixture 1 — Glauber Salts 1 — Golden Raising Powder 1 — Gravy Improver 1 — Gravy Salt 5 — 17 Article. Number Examined. Number Adulterated, etc. Health Salts 1 — Herbs—Dried 1 — Herbs—Mixed 5 2 Jam 8 — Jelly 1 — Jelly Crystals 1 — Junkets 2 — Lanolin Ointment 1 — Lemon Cough Balsam 1 — Lemon Essence 1 — Lemon Curd 1 — Lemon Juice Flavouring 1 — Lemonade Crystals 3 — Lime Jelly 1 — Lung Mixture 1 — Malt Cup 1 — Malted Milk Tablets 2 — Malto Bar 1 — Marmalade 1 — McLean Tablets 1 — Meat—Minced 2 — Meat Paste 1 — Meat and Vegetable Extract 1 — Milks 48 3 Mushroom Ketchup 1 — Mustard 1 — Mustard Cream 1 — Nerve Tonic Syrup 1 — Nursery Powder 1 — Nutmeg—Ground 1 — Oatmeal 1 — Paprika 1 — Pea Flour 3 2 Pepper 3 — Pepper Compound 1 — Peppermint Medicine Tablets 1 — Pineapple Conserve 1 — " Propax " Brand Tablets 1 — Pudding Mixture 4 1 Rum 1 — Saccharine and Sweetening Tablets 2 — Sage 1 — Sage and Onion Stuffing 6 — Salad Dressing 1 — Sandwich Paste 1 — Sausages 30 4 Sausage Meat 5 — Sausage Meat Preserved 1 — Sausages—Preserved 5 — Seasoning 1 — Semolina 8 — Soup 5 — Soup Desiccated 1 — Spice Mixed 5 — Spice Pickling 3 — 18 Analyses—continued. Article. Number Examined. Number Adulterated, etc. Sponge Mixture 3 — Suet—Shredded 3 — Super Tonic Tablets 1 — Syrup 1 — Syrup of Figs 1 — Tea 10 — Thyme 1 — Thyme and Parsley Stuffing 3 — Vegetable Savouries 1 — Vinegar 6 — Vitamin Tablets 1 — Vitamin B Yeast Tablets 1 — Whisky 2 — Yeast Vite 1 — Zinc and Castor Oil Ointment 1 — Adulterated Samples, etc. Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. 893 Pea Flour Formal Genuine pea flour, but no statement of weight as required by Labelling of Food Order (No. 2) 1944. Vendor warned. Stock sold out. 943 Pork Sausages Formal Preserved sausage containing 250 parts per million of sulphur dioxide. Vendor warned. 980 Baking Powder Formal 32% deficient in available carbon dioxide. Vendor warned. Withdrawn from sale. 983 Mixed Herbs Formal Contained 15.9% sand, which is 12.9% above that ordinarily found. These samples exhausted the retailer's stock. Vendor warned. 991 Mixed Herbs Formal Contained 15.9% sand, which is 12.9% above that ordinarily found. J 19 Adulterated Samples, etc.—contd. Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. 1014 Pork Sausages Formal Preserved sausage containing 170 parts per million of sulphur dioxide. Vendor warned. 1032 Beef Sausages Formal Contained 39% meat. Deficient in meat content to extent of 22% of requirements, viz. 50%. Further sample taken. (No. 1043.) 1043 Beef Sausages Formal Contained 40% meat. Deficient in meat content to extent of 20% of requirements, viz. 50%. Legal proceedings taken. Vendors fined £8, and 10/6 costs. 1055 Milk Formal Freezing point indicated the presence of at least 1% added water. Vendor warned. 1118 Milk Formal Freezing point indicated the presence of at least 1% added water. Vendor warned. 358A Pudding Mixture Informal No statement of weight as required by Labelling of Food Order (No. 2) 1944. Vendor warned. Stock relabelled. 387A Milk Informal 50% deficient in fat. At least 44% added water. Bottle of milk left on doorstep. No evidence as to who had tampered with the bottle. 415A Pea Flour Informal Contained a number of small living maggots. Vendors warned. Remainder of stock withdrawn from sale. 420A Chu-Lax Informal Satisfactory laxative containing phenolphthalein. No declaration on label showing active ingredient as required by Pharmacy Medicines Act. Vendor warned. Withdrawn from sale. 20 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (other than Tuberculosis.) Under I 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 — 1 1 — — 2 1 — — 1 9 Diphtheria — — 1 — 2 6 — 3 1 — — — — — 13 Dysentery — 1 3 — — 3 3 1 1 — 1 — — — 13 Enteric Fever — — — — — — — — — — — — — — — Erysipelas — — — — 1 1 — 2 1 6 20 1 1 — 33 Food Poisoning — — — — — — — — — 2 1 — — — 3 Malaria — — — — — — — — — — — — — — — Measles 37 75 106 90 105 275 20 2 4 — 1 — 8 — 723 Ophthalmia Neonatorum 11 — — — — — — — — — — — — — 11 Pemphigus 4 — — — — — — — — — — — — — 4 Pneumonia— Acute Influenzal — — — 1 — — 1 3 2 2 4 3 — — 16 Acute Primary 23 20 12 11 4 18 11 7 18 17 24 11 1 — 177 Polioencephalitis Acute — — — — — — — — — — — — — — — Poliomyelitis Acute — — 1 1 — — — — — — — — — — 2 Puerperal Pyrexia — — — — — — — 1 16 2 — — — — 19 Scarlet Fever — 2 14 26 22 90 35 7 3 1 — 1 — — 201 Smallpox — — — — — — — — — — — — — — — Whooping Cough 45 42 44 53 50 84 4 — — — 1 — 4 — 327 Notified Admitted to Isolation Hospital, Rush Green. Admitted to other Isolation Hospitals Admitted to other Hospitals. Deaths Registered. Cerebro-Spinal Fever 9 8 — 1 2 Diphtheria 13 13 — — 1 Dysentery 13 — 1 1 — Enteric Fever — — — — — Erysipelas 33 10 — 1 — Food Poisoning 13 — — — — Malaria — — — — — Measles 723 9 — 1 — Ophthalmia Neonatorum 11 2 — — — Pemphigus 4 3 — — — Pneumonia— Acute Influenzal 16 3 — — 45 Acute Primary 177 41 — — Polioencephalitis Acute — — — — — Poliomyelitis Acute 2 2 — — — Puerperal Pyrexia 19 5 — 3 2 Scarlet Fever 201 73 — — — Smallpox — — — — — Whooping Cough 327 15 — — 1 21 DIPHTHERIA IMMUNISATION, 1946. The following is a summary of the work carried out during the year:— Number of SCHOOL children immunised without preliminary testing 269 Number of PRE-SCHOOL children immunised without preliminary testing 1,297 Number of SCHOOL children re-Schick tested 1 (This was negative.) Number of SCHOOL children who received a boosting dose 85 Total number of children found to be immune during the year 1 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. 7 27.10.42—0.1 c.c. A.P.T. 22.7.46 Yes Moderate Recovered 24.11.42—0.3 c.c. A.P.T. 4 1.1.43—0.1 c.c. A.P.T. 24.7.46 Yes Mild Recovered 2.3.43—0.3 c.c. A.P.T. 7 8.12.42—0.1 c.c. A.P.T. 28.10.46 Yes Mild Recovered 12.2.43—0.3 c.c. A.P.T. Deaths. During the year one child, aged 9 years, died from Diphtheria; he had received only part of the preventative treatment against this disease. Scarlet Fever. The number of cases notified was 201, which is a slight decrease 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. 22 Tuberculosis. New Cases. Primary Notification. Brought to notice other than by Form A. Deaths. Pulmonary. NonPul monary. Pulmonary. NonPul monary. Pulmonary. NonPul monary, M F M F M F M F M F M F Under I – 1 – – – – – – – – – – 1- 2 — 3 3 – – – – – – – – 5- 2 4 1 2 — 2 — 1 – 1 1 1 10– 3 3 — 3 — 2 1 – – 1 – 1 15- 6 14 4 — 1 2 — – 2 – 1 – 20- 20 21 – 2 1 5 — 1 2 8 – – 25- 17 13 – 3 6 4 3 – 4 5 – – 35- 12 2 — — 2 — — 1 4 11 – – 45- 15 4 — 1 1 — – 5 – 1 – 55- 6 – – – – – – – 3 – – – 65- and upwards 1 – – – – – – – – – – – 84 62 8 13 12 17 4 3 20 26 3 2 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register, 1st January, 1946 468 333 133 138 During the year :— New notifications 84 62 8 13 Deaths 20 26 3 2 Transfers into area 12 17 4 3 Transfers out of area 20 20 5 4 No. on register 31st December, 1946 524 366 137 148 23 MATERNITY AND CHILD WELFARE. Notification of Births. 2,338 notifications of live births were received during the year; the majority of these were notified by midwives. Stillbirths. 35 male and 26 female stillbirths were notified, the corresponding figures for registration being 36 and 27. The rate per 1,000 of total population registered was 0.59, the rate for England and Wales being 0.53. The percentage of illegitimate stillbirths to the total was 6.35 compared with a percentage of illegitimate to total births of 5.08. Infant Mortality. 74 infants under one year of age died during the year, giving an infant mortality rate of 31.09 per 1,000 live births, compared with that of 43 for England and Wales and 41 for London. The rate amongst legitimate children was 30.10 while for illegitimate children it was 49.59. Ophthalmia Neonatorum. 11 cases of this disease were notified, two of which were treated in hospital; all made complete recoveries. There were 38 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 0.82 per thousand births. This is a remarkably low figure ; that for England and Wales for the corresponding period was 1.43 which also is low. Work of Health Visitors. The following table shows the number of visits paid by the Health Visitors during the vear:— (a) To expectant mothers First visits 367 Total visits 587 (b) To children under one year of age First visits 2,248 Total visits 5,048 (c) To children between the ages of one and five years Total visits 11,425 (d) Ineffective visits Total visits 2,811 Grand Total 19,871 24 Supervision of Midwives. The following is a summary of the reasons for sending for medical help by midwives:— Perineal Tear 135 Prolonged Labour 56 Discharging Eyes 43 Rise of Temperature 38 Malpresentation 22 Miscarriage 19 Threatened Miscarriage 17 Ante-Partum Haemorrhage 17 Premature Baby 14 Post-Partum Haemorrhage 13 Watery Blisters 9 Infant Unsatisfactory 5 Albuminuria 4 Feebleness of Infant 4 Jaundice 3 Adherent Placenta 3 Poor Condition of Patient 3 Other Causes 52 457 Notices summoning medical aid 457 For (a) Mothers 368 (b) Infants 89 Notifications that they had been associated with the undermentioned conditions were received from midwives:— Liable to be sources of infection 26 Stillbirths 15 Infant deaths 10 Substitution of artificial feeding 8 Laying out dead bodies 2 25 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 1946:— Municipal Midwives. Dagenham Nursing Association Midwives. Salvation Army Midwives. Births Attended : As Midwife 653 427 128 As Maternity Nurse 141 83 34 Miscarriages Attended 24 15 12 Visits Paid : As Midwife 13,127 7,750 3,924 As Maternity Nurse 1,586 1,630 507 Ante-Natal 4,007 1,868 933 Ante-Natal Clinics Attended 493 242 101 Gas and Air Administered 154 127 24 Day Nurseries. There are three Nurseries in the Borough accommodating 164 children in all. Staff: Matrons 2 Deputy Matron 1 Warden 1 Nursery Trained Nurses 6 Nursery Assistants 8 Part Time Nursery Assistants 3 Nursery Students 12 Nursery Helpers 2 Total 35 Total Attendances at Nurseries for 1946:— Goresbrook Nursery Under 2 years of age 4,480 Over 2 „ „ 9,135 Chadwell Heath Nursery Under 2 years of age 2,483 Over 2 „ „ 7,304 Kingsley Hall Nursery Over 2 years of age 7,124 TOTAL 30,526 Under I and 2 and 5 and 15 and 25 and 35 and 45 and 55 and 65 and 75 and CAUSES OF DEATH. 1 year under under under under under under under under under over. TOTAL. General's 2 years. 5 years. 15 years. 25 years. 35 years. 45 years. 55 years. 65 years. 75 years. Allocations. MFMF MF MFMFMFMFMFMFMFMFMFMF 1. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — — — — 2. Cerebro-Spinal Fever — — — — — — — — — — — — — — — — 1 — — — — — 1 — 2 — 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough— — — — — — — — — — — — — — — — — — — — — — — 1 — 1 6. Tuberculosis of Respiratory System — — — — — — — — 3 8 4 5 5 8 5 — 6 — — — — — 23 21 23 21 7. Tuberculosis (other forms) — — — — — — 1 3 2 1 — — — 1 — — — — — — — — 3 5 4 6 8. Syphilitic Disease — — — — — — — — — — — — — — 1 — 2 — — 1 — 1 3 2 4 — 9. Influenza — — — — — — — — — — — — — — — 1 — — 1 1 — — 1 2 — 5 10. Measles — — — — — — — — — — — — — — — — — — — — — — — — — — 11. Acute Poliomyelitis and Polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 12. Acute Infectious Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — 13- Cancer of Buccal Cavity and Oesophagus (Males only) — — — — — — — — — — — — — — — — — — — — — — — — 3 — 13-f. Cancer of Uterus — — — — — — — — — — — — — — — 1 — 1 — — — 1 — 3 — 6 14- Cancer of Stomach and Duodenum — — — — — — — — — — — — — 3 3 3 5 — — 4 1 2 9 12 14 12 15- Cancer of Breast — — — — — — — — — — — — — 1 — 5 — 1 — — — — — 7 — 12 16. Cancer of all other sites — — — — — — — — 1 — 1 2 2 4 23 4 12 14 4 7 2 5 45 36 53 33 17. Diabetes—— — — — — 1 — — — — — 1 — — 1 — 3 1 2 — — 3 6 2 2 18. Inter-cranial Vascular Lesions — 1 — — — — — — 1 — — 1 — 2 1 — 5 6 8 8 4 6 19 24 17 22 19- Heart Disease — 1 — — — — 1 — 1 — 2 6 9 6 20 12 18 10 23 19 25 27 99 81 79 76 20. Other Diseases of Circulatory System 1 — — — — — 1 — — — — — — — — — 1 — 2 1 1 — 6 1 5 14 21. Bronchitis —— — — — — 2 — 1 — — — — — 4 — 6 1 4 3 2 5 19 9 43 17 22. Pneumonia 6 6 — 2 — — 2 1 — 1 — — 2 2 3 2 11 1 7 8 3 8 34 31 x9 26 23. Other Respiratory Diseases — — — — — — — — — — — — 1 — 1 1 1 — 1 3 3 8 7 12 7 2 ' s 24. Ulceration of the Stomach or Duodenum — — — — — — — — — — — — — — I 1 — 1 -— 1 — — — 3 6 25. Diarrhoea (under 2 years) 3 2 — — — — — — — — — — — — — — — — — — — — 3 2 3 1 26. Appendicitis — — — — — — — — — — — — — — — 1 — — — — 1 — 1 1 2 1 27. Other Digestive Diseases 211 — — — — — 1 — — 1 — 1 1 2 4 — 2 1 — 41110 6 8 28. Nephritis — — — — — 2 — — — ; — — 1 1 1 4 3 1 — 3 1 5 — 14 8 10 5 29. Puerperal and Post-Abortive Sepsis — — — — — — — — — — — — — 1 — — — — — — — — — 1 — 1 30. Other Maternal Causes— — — — — — — — — — — — — — — — — — — — — — — — 1 31. Premature Birth 17 13 — — — — — — — — — — — — — — — — — — x7 13 J4 12 32. Congenital malformations, birth injury, and infantile disease 13 7— 1 1 — — — — — — — — — — — — — — — — — — *4 8 18 11 33. Suicide — — — — — — — — — — — — — — — — 1 — — — — — 1 — 1 — 34. Road Traffic Accidents — — — — — — 1 1 2 ! — — — 2 — — — 1 — — 1 2 — 8 2 10 2 35. Other Violent Causes — — — — 1 — 3 — 1 — 3 1 — 1 1 — 1 1 1 — 3 — 4 3 8 2 36. All Other Causes — 1 — | — — — 1 — — 2 1 — 4 1 I 2 4 1 — 122 2 6 13 16 20 19 372 317 374 318