DAE 2 ??? BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1947 CECIL HERINGTON,M.D.(Lond.),D.P.H BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1947 CECIL HERINGTON, M.D. (Lond.),D.P.H 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Madam Mayor, Ladies and Gentlemen, In presenting my annual report for the year 1947, I would mention that this report is again a summary as has been the practice for several years past by direction of the Ministry of Health. The population has risen from 106,530 to 110,040 and the principal vital statistics are on the whole favourable, the birth rate having risen from 22.34 to 23.71, the death rate, however, showed a slight rise from 6.50 to 6.63, the still-birth rate fell from 25.79 to 19.17 and the infant mortality rate from 31.09 to 30.66. It is interesting to note that the infant mortality rate for illegitimate children has fallen from 49.59 to 27.27, this latter figure being lower than the general infant mortality rate. It is the usual experience for the illegitimate infant mortality rate to exceed, sometimes to a very great extent, the rate for legitimate infants, the inference being that such infants are deprived of much of the care which is experienced by legitimate children. INFECTIOUS DISEASES. A feature of the year has been the large incidence of Measles, of which disease 936 cases were notified compared with 723 in 1946. There were also two deaths from Measles which, considering the prevalence of the disease, may be regarded as not unduly high. The epidemic of Poliomyelitis which was widespread throughout the Country during the year accounted for nine cases in Dagenham, of whom one died. There were two cases with no deaths in 1946. When one considers the large child and adolescent population of the Borough, it might be expected that the incidence of this disease would have been considerably higher. Cases who were suspected of suffering from Poliomyelitis were promptly removed to hospital, in many instances before the diagnosis was confirmed. Thanks to the facilities offered at the hospital, this was made possible, and it would appear that the practice contributed to the limitation of infections by the prompt isolation which was thereby effected. IMMUNISATION. There has been a considerable increase in the number of children, both of school and preschool age, who have been immunised. The total number who underwent this treatment in 1947 was 2,485, and in addition 204 received "boosting" doses ; in 1946 1,566 children were immunised and 85 were given "boosting" doses. The practice of issuing birthday cards with which is enclosed the relevant literature, has been continued, and other methods of publicity such as showing 4 slides in the local cinemas have been carried out as in former years. All children attending Infant Welfare Centres are offered this service, and those who have previously been immunised are encouraged on their entrance to school, to receive a further dose known as a " boosting " dose which augments the protection afforded by the initial course of immunisation. It will be noted in the body of the report that only three children who had received protective treatment were subsequently notified as suffering from Diphtheria ; in all these cases recovery ensued. Unfortunately, one child aged four years died from Diphtheria, and he had not received any prophylactic treatment. Reports on the research work on immunisation against Whooping Cough are becoming more encouraging, and there is reason to hope that an effective antigen will be at our disposal in the fairly near future. As has been mentioned previously, however, it would be unwise to embark upon a scheme for general immunisation against this disease until an efficient vaccine is in production. ICE CREAM. Much controversy has been going on over a long period regarding the control of the manufacture and distribution of ice cream. It has been argued that standards of fat and total solids should be laid down in order to ensure that ice cream attains a certain level of food value. When one considers ice cream, it is doubtful whether the consumers really pay much attention as to the amount of nutriment they are ingesting ; the real reason for taking this commodity is that it is refreshing and palatable, particularly so where children are concerned. With the limitation imposed upon the ice cream trade at the present time, I suggest that the question of minimum standards for fat and solids should be disregarded ; it is all a matter of quantity or quality. With regard to purity of ice cream, this is an entirely different matter, and premises for the production and or reconstitution of ice cream are inspected at regular intervals and samples are taken for analysis. A comment I should like to make on this is that as soon as conditions and supplies so warrant, I would press for ice cream to be sold wrapped and prohibit its sale in the form of wafers and cornets. COMMUNAL FEEDING. Much attention has been directed recently towards the possible dangers arising from communal feeding, and incidents have arisen where outbreaks of Food Poisoning have been widespread amongst persons using canteens and restaurants. It is all the more necessary to pay particular regard to the inspection, preparation and handling of food and the hygiene of kitchens and eating and drinking utensils. The safety factor is largely influenced by the intelligent co-operation 5 between management and staff of catering establishments. On previous occasions I have pointed out the necessity of paying the strictest attention to the personal hygiene of all those associated with food production and handling. One might mention here with advantage the cleansing of utensils in public houses where, during busy periods, the necessary and desirable washing of glasses and tankards is sometimes carried out in a too perfunctory manner. I am informed that adequate washing facilities are provided in most of the licensed houses, but the human factor sometimes predominates and the washing facilities are not properly and adequately used. It would be difficult to adduce positive evidence of the spread of diseases from this cause, but the aesthetic side deserves consideration, and I have no doubt that individual representations made by the consumers would, to a large extent, convince the staffs of the desirability of proper cleansing processes. NURSING IN THE HOME. Dagenham is not alone in experiencing difficulty in obtaining sufficient nurses for duty in the homes. One of the limiting factors is the difficulty in providing accommodation for the nurses. Building extensions are now taking place at the Nurses' Home, York House, but when these are completed, it is doubtful whether there will be sufficient accommodation for the nurses required for the population. I am further informed that Housing Authorities are contemplating putting at their disposal premises which will give further accommodation. GAS AND AIR. Gas and air analgesia was administered to 571 mothers during the year ; this is an increase of 266 over the previous year. All three sections of the midwifery service, viz., Municipal Midwives, Dagenham District Nursing Association and Salvation Army Midwives are participating in proportion to their numbers. A great deal of suffering is alleviated by the use of this apparatus, and its rate of expansion testifies to its popularity. At one time there was considerable prejudice against such analgesia, particularly among the older mothers who had previously had several confinements, but the manifest advantages are quickly overcoming the reluctance on the part of all to accept gas and air. DOMESTIC HELP. Considerable expansion has taken place in this service during the year. At the time of reporting, recommendations have been made for the employment of a number of full-time salaried helps, their services to be supplemented by those who have given such 6 service in the past but who are unable to devote the whole of their time to this work. A long-felt need has been filled by the institution of this scheme, and the work has been highly appreciated. There are many instances in which elderly persons without near relatives would, had hospital accommodation been available, have been transferred to an institution for the remainder of their lives. Not only does the availability of domestic help relieve the hospital bed situation, which is still acute, but it also allows aged persons to spend their declining years in their own home surrounded by their own possessions. Recently the domestic help service has been supplemented by the inauguration of a scheme for providing " Meals on Wheels." The Dagenham branch of the Women's Voluntary Services has undertaken to distribute meals which are obtained from one of the British Restaurants ; such meals are limited to persons who have no friends or relatives who are able to do their shopping or carry their meals to their homes. As this service is becoming more widely known, it is at the same time more sought after, and the date is not far distant when the provision of a more comprehensive service will need to be considered. SCHOOL HEALTH SERVICE. Gradually Dagenham as an excepted district is being able to assume full local responsibility for this service. In the early stages, owing to lack of staff, the greater part of the statistical side of this service remained with the County Authority. Staff locally has been augmented, and it is probable that in the very near future the whole of the clerical work entailed will be carried out at the Civic Centre and the relative clinics. One defect is the lack of dental surgeons, the establishment for our school population having been fixed at nine dental surgeons together with nine dental attendants. During a part of the year we were able to obtain the full-time services of three dental officers and three attendants; unfortunately one of these officers has resigned, and owing to the grave shortage of dental surgeons, there does not at the moment seem any prospect of being able to approach the number required for this area. Ideally every child should be dentally inspected on entry to school, the treatment recommended carried out and the child should be re-inspected annually during his school life. Were it possible to carry out this scheme there would be lasting benefit, as not only would the mouths of all be dentally sound, but the educational value of periodic inspections would encourage those who had left school to seek dental treatment throughout their lives. I would say that Dagenham is not alone in this respect as the deficiency prevails throughout the country. As the course of 7 training for a dental surgeon extends to approximately five years, and the number of dental schools in the country is limited, it is unlikely that the gap will be filled for many years to come. AMBULANCE SERVICE. This service, which has been run by the Borough Council for a great many years, passed to the County Council on 5th July, 1948. I would take this last opportunity of referring to the efficient manner in which the service has been carried out in the past, despite the fact that until very recently the vehicles, with one exception, were becoming obsolete. It will be agreed, I feel sure, that the drivers and attendants have rendered excellent service, not only to Dagenham, but to many of the surrounding districts with whom we had reciprocal arrangements. STAFF. I take this opportunity once again of recording my deep appreciation of the loyal and devoted service of all the members of the staff of the Public Health Department, and at the same time to ask the Chairman and Members of the Health Services Committee to accept my best thanks for their help and deep interest taken in the activities of the Public Health Department. I am, Madam Mayor, Ladies and Gentlemen, Your obedient Servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 8 MEMBERS OF THE COUNCIL. (31st December, 1947.) Mayor : Councillor (Mrs.) A. R. THOMAS, J.P. Deputy Mayor : Alderman W. E. BELLAMY, J.P. Aldermen : F. BROWN, J.P. J. W. BURRIDGE. A. F. J. CHORLEY, M.B.E., J.P. E.C.C. R. J. D. CLACK. L. F. EVANS (Mrs.), M.B.E., J.P., E.C.C. E. E. HENNEM. F. G. THOMAS. Councillors : S. F. BANKS. I. M. BROCKELBANK (Mrs.). G. A. BROOKER. F. COOMBS. G. H. A. CROUCH. F. GRINDROD. A. HADDOCK. G. T. HARRIS. J. P. HOLLIDGE, E.C.C. Wm. C. IRELAND. A. KEMPSON. H. L. LYONS. E. M. MILLARD (Mrs.). R. J. MINCHIN. C. J. MUSTOO. E. OSBORNE. D. O'DWYER. A. E. PRENDERGAST (Mrs.). C. PRENDERGAST. B. M. ROADKNIGHT (Mrs.). E. R. SAYWOOD. A. F. WARR (Mrs.), E.C.C. J. WRIGHT. HEALTH SERVICES COMMITTEE. Councillor (Mrs.) A. E. PRENDERGAST, Chairman. Councillor (Mrs.) A. F. WARR, E.C.C., Vice-Chairman. Her Worship the Mayor (Councillor Mrs. A. R. THOMAS, JP.) Deputy Mayor (Alderman W. E. BELLAMY, J.P.) Councillor G. A. BROOKEK. Councillor D. O'DWYER. Councillor E. OSBORNE Councillor B. M. ROADKNIGHT, (Mrs.) 9 OFFICERS OF THE PUBLIC HEALTH SERVICES. Full-Time Staff : Medical Officer of Health : CECIL HERINGTON, M.D., B.S.(Lond.), D.P.H., M.R.C.S., L.R.C.P. Deputy Medical Officer of Health : JAMES A. C. FRANKLIN, M.B., B.S.(Lond-), D.P.H. M.R.C.S., L.R.C.P. Assistant Medical Officer : 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 (i, 2). Sanitary Inspectors : J. W. ALLAM (1, 2). F. W. S. FOX (1, 2, 3, 4). A. HUTCHINGS (1, 2). A. J. JAMES (1). Superintendent Health Visitor : V. A. EVERITT (5, 6, 7). Health Visitors : E. FISK (5, 6, 7). A. K. GIBSON (5, 6, 7). D. GORDON (5, 6, 7, 9). M. B. NELSON (5, 6, 7)- M. T. ROCHE (5, 6, 7). L. SALTER (5, 6, 7). P. SILBY (5, 6, 7). D. B. STEWART (5, 6, 7). (Two vacancies). Senior Midwife : E. M. BEDFORD (5, 6). Municipal Midwives : D. K. ANKER (6). D. J. FISHER (5, 6). M. GOODBUN (5, 6). M. HALL (6). C. HURRY (6) O. LISSAMORE (6). H. MITSON (5, 6). M. M. RICHARDS (6). M. ROBSON (6, 10). E. T. SIMPSON (6). M. J. STOREY (6). 10 Clerical Staff: Chief Clerk : F. W. KNIGHT (1, 2). Clerk to Sanitary Inspectors : K. W. SKEATES (1). Clerks : I. M. BISHOP. S. COCKS. V. CON INGHAM. G. K. HARRIS. L. A. MOORE. P. ROBINS. M. A. WATTS. Day-Nurseries : Goresbrook Nursery, Dagenham Avenue, Dagenham. MATRON : E. MADDISON (10). DEPUTY: K. GRAHAM. Chadwell Heath Nursery, Ashton Gardens, Chadwell Heath. MATRON : P. NESS (8). DEPUTY : M. J. SHAW (10). Kingsley Hall Nursery, Parsloes Avenue, Dagenham. WARDEN : D. HOWES. Clerk : E. M. HOLLEY (8). Home Help Organiser : J. M. PI LONE. Chiropodists : A. S. BRAMSTON (11). N. FREEMAN. Foot Clinic Receptionist : K. RICHARDS. SCHOOL HEALTH SERVICE. Borough School Medical Officer : CECIL HERINGTON, M.D., B.S.(Lond.), D.P.H., M.R.C.S., L.R.C.P. School Medical Inspectors : JEANNE LISTER, M.B., B.S.(Lond.). THELMA PHELPS, M.B., B.S.(Lond.), M.R.C.S., L.R.C.P. MARY SUTCLIFFE, M.A., M.B., B.Ch.(Camb.), M.R.C.S., L.R.C.P., D.P.H. 11 School Nurses : M. BAYS (5, 6). A. C. BRIMBLECOMBE (5, 6). G. F. DOWNARD (5). L. DUNBAR (5, 6, 7). E. HOGG (5). E. McCHEYNE (5). E. MURPHY (5, 6). C. A. NICHOLSON (5, 6). H. YARNELL (5). (Three vacancies). School Dental Officer : C. SUMSAWASTE, L.D.S. Speech Therapists : D. M. FLEMING, F.C.S.T. K. M. WHALLEY, L.C.S.T. Clerks : N. CLOKE. M. D. WALSH. Adult General Helpers : M. BRIDESON. A. D. CULVER. 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 Certificate of Royal Medico-Psychological Association 10 Member of National Institute of Chiropodists 11 Part-Time Staff: Dentist : F. C. RITCHIE, L.D.S., R.C.S.(Eng.). Public Analysts : BERNARD DYER, D.S., F.R.I.C. J. HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. Scabies Clinic Attendants : F. FARROW. J. PHARAOH. 12 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 6,556 Registrar-General's estimate of resident population, 1947 110,040 Number of inhabited houses (end of 1947) according to Rate Books 26,392 Rateable value (December 31st, 1947) £623,307 Sum represented by a penny rate (approximate, 1947-48) £2,465 Extracts from Vital Statistics for the Year. Live Births:— Total Male Female Legitimate 2,499 1,292 1,207 Birth rate per 1,000 of the estimated resident population, 23.71. Illegitimate 110 63 47 Stillbirths:— Legitimate 49 22 27 Rate per 1,000 total (live and still) births, 19.17. Illegitimate 2 2 - Deaths 730 398 332 Death rate per 1,000 of the estimated resident population, 6.63. Deaths from puerperal causes:- Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.38 Other puerperal causes 2 0.75 Total 3 1.13 Death rate of infants under one year of age:— All infants per 1,000 live births 30.66 Legitimate infants per 1,000 legitimate live births 30.81 Illegitimate infants per 1,000 illegitimate live births 27.27 Deaths from Cancer (all ages) 128 „ „ Measles (all ages) 2 „ „ Whooping Cough (all ages) 5 „ „ Diarrhœ (under 2 years of age) 3 13 Births. 2,609 live births were registered during the year, there being 1,355 males and 1,254 females. There is an increase of total births from 2,380 in 1946 to 2,609. The birth rate per thousand population was 23.71 compared with 20.5 for England and Wales and 23.2 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, 19.54, and 22.34, for the years 1927 to 1946 inclusive. The illegitimate birth rate continues to be very low, being only 4.22 per cent, of total births. The rate of illegitimate stillbirths is 3.92 per cent, of total stillbirths. Death Rate. Total deaths in district 588 Outward transfers 134 Inward transfers 274 Deaths of residents 728 Of the 134 deaths of non-residents occurring in the district, 40 took place at the West Ham Sanatorium and 74 at the Rush Green Emergency Hospital. Of the 274 deaths of local residents taking place outside this area, most occurred in institutions. Of these 135 occurred at Oldchurch Hospital, 13 at King George Hospital, n at Ilford Isolation Hospital, 10 at London Hospital, nine at The Retreat, Great Burstead, five at 32a, Spital Road, Maldon, four at the East End Maternity Hospital, four at St. Bartholomew's Hospital, four at the Royal Eastern Counties Institution, Colchester, four at Black Notley Sanatorium and four at Warley Hospital. The death rate of 6.63 compares with 12.0 for England and Wales. For the years from 1927 to 1946 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, 6.97, and 6.63. A table giving the causes of death, and the age periods at which they occurred, is given at the end of the report. 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 14 no action was called for in respect of any form of contamination. Approximately .11 per cent, of the inhabited houses and .086 per cent. of the population of the Borough take their water from standpipes. During the year the mains laid in the Borough were as follows:— Size Location Yards Laid Total Yards 12" Chequers Lane 23 23 6" Freshwater Road 37 6" Dagenham Road Housing Estate 195 6" Rookery Farm Estate 90 6" Whalebone Estate (North) 15 6" Rose Lane 12 6" Road off Chequers Lane 250 599 4" Dagenham Road Housing Estate 848 4" Rookery Farm Estate 1,495 4" Valentines Way 18 4" Ingleby Close 56 4" Ingleby Road 162 4" Blackborne Road 100 4" Charlotte Road 16 4" Station Road 14 4" Dagenham Road (Rush Green) 15 4" Legon Avenue 94 2,818 3" Dagenham Road Housing Estate 270 3" Ingleby Close 47 3" Rookery Farm Estate 33 350 Total for year 3,790 15 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1947. 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 20.5 0.50 12.0 0.00 0.00 0.01 0.00 0.02 0.01 0.09 5.8 41 126 County Boroughs and Great Towns, including London 23-3 0.62 13.0 0.00 0.00 0.02 0.00 0.03 0.01 0.09 8.0 47 148 smaller towns (1931) resident population 25,000-50,000 22.2 0.54 11.9 0.00 0.00 0.02 0.00 0.02 0.01 0.08 3.7 36 London 22.7 0.49 12.8 0.00 — 0.01 0.00 0.02 0.01 0.08 4.8 37 Dagenham 23.71 0.46 6.63 0.00 0.00 0.02 0.00 0.05 0.01 0.06 1.15 30.66 16 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. 82 6 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Weekly Monday, a.m. Monday, p.m. 59 77 4 6 The Leys Clinic, Ballards Road, Dagenham. Weekly Weekly Thursday, a.m. Thursday, p.m. 36 70 2 5 Out-Patient Department, King George Hospital, Five Elms, Dagenham. Weekly Weekly Wednesday, p.m. Friday, a.m. 91 64 8 4 Rush Green Clinic, 179, Dagenham Road, Rush Green. Weekly Friday, p.m. 38 2 The Clinic, Ford Road, Dagenham. Weekly Thursday, a.m. 92 8 17 Ante-Natal Clinics. CENTRE. Sessions held. Times Sessions held. Average Attendances. Average New Cases. The Clinic, Ashton Gardens, Chadwell Heath. Weekly Monday, a.m. 16 3 Weekly Monday, p.m. 13 2 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 23 5 Weekly Wednesday, a.m. 15 3 Weekly Friday, a.m. 19 4 Weekly Friday, p.m. 13 1 The Leys Clinic, Ballards Road, Dagenham. Weekly T uesday, a.m. 13 3 Weekly Wednesday, a.m. 14 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. Monthly (1st in month) Friday, a.m. 22 5 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 27 5 Weekly Wednesday, p.m. 14 1 Weekly Thursday, a.m. 21 5 Weekly Thursday, p.m. 16 3 The Clinic, Ford Road, Dagenham. Weekly Monday, p.m. (Com. Feb., 1947) 27 5 Weekly Thursday, p.m. 20 5 18 Sanitary Inspection of the District. Report of the Sanitary Inspectors. (a) Nature and number of visits :— Nuisances under Public Health Acts— Dwelling Houses 5,939 Other Premises 561 Bakehouses 133 Milkshops, dairies and vehicles 129 Foodshops and stalls 1,521 Cafes and canteens 373 Infectious disease enquiries 1,282 Visits to foster mothers' premises 39 Number of complaints investigated 1,882 Outworkers' premises 62 Factories 144 Workplaces and offices 12 Tents, vans and sheds 260 Stables 9 Hairdressers' and barbers' premises 63 Shops Acts 1,004 Ice cream premises and vehicles 216 Houses fumigated 53 Rodent control 669 Other visits 30 (1b) Notices served :— Complied with Statutory 123 118 Informal 836 688 Bacteriological Sampling of Milk. During the year 78 samples of milk were submitted for examination and seven were found to be unsatisfactory. Bacteriological Sampling of Ice Cream. During the year 87 samples of ice cream were submitted for analysis and 14 were found to be unsatisfactory. Ice Cream. An application for the sale and storage of ice cream was refused after the applicant had appeared before the Committee, The applicant desired to set up an ice cream business on the forecourt of a Butcher's shop; this was not considered a suitable site. 19 FOOD AND DRUGS ACT, 1938. Analyses. Article. Number Examined. Number Adulterated, etc. Anchovies 1 — Armstrong Tonic 1 — Aspirin Tablets — Baking Powder 10 1 Barley 1 — Barley Flakes and Flour 2 — Batter Mixture 3 — Beef Extract . 1 — Bicarbonate of Soda 6 — Black Pudding I — Boracic Crystals I — Bread 2 2 Brisling Paste I — Bronchial Lozenges I — Bun Flour I — Cake Flour I — Cake Mixture 2 — Camphorated Oil 2 — Caraway Seeds 3 — Castor Oil 2 — C(Laxative) 1 1 Celery Salt 1 — Cinnamon 3 — Cinnamon and Quinine 1 — Cloves 1 — Cocktail 1 1 Cocoa 4 — Cod Roe Spread 1 — Coffee Extract 4 — Cough Linctus 2 — Cream of Tartar 1 — Curry Powder 8 — Custard Powder 1 — Dessert Mould 1 — Dessert Sauce Powder 1 — Dutch Drops I — Egg Substitute Powder 2 — Epsom Salts 1 — Fish Paste 2 — Flavouring Essence I — Formalin and Mint Tablets I — Frizets I — Gelatine 5 — Ginger—Ground 12 — Ginger Wine Essence 1 — Glycerine 2 — Golden Raising Powder 3 — Good Health Salts 1 — Gravy Powder 10 — Herbs—Dried Mixed 17 2 Horlick's Tablets 1 — Ice Cream 1 — 20 Analyses—cont. Article. Number Examined. Number Adulterated, etc. Iodine Paint 1 Iodised Throat Lozenges — — Jardex 1 — Jelly Crystals 1 — Junket Powder 1 1 Laxobac (Laxative) 1 — Lemonade Crystals — — Lung Syrup — — Malt Cup 1 — Malt Extract Tablets 1 — Malted Milk Tablets 1 — Malto Bar 1 — Master Mix 1 — Matte 1 — Meat Extract — — Milk 61 8 Mineral Oil 1 — Mustard Compound — 1 Noodles 1 — Nutmeg—Ground — — Pancake Mixture 1 — Parrish's Chemical Food 1 — Parsley 1 1 Pepper — — Petate Powder 1 — Piccalilli 1 — Pork Pressed 1 — Pudding Mixture 5 — Sage .. .. 3 1 Sage and Onion Stuffing 3 — Salad Dressing 2 1 Salad Oil 1 — Salmon and Tomato 1 — Sauces and Sauce Powder 4 — Sausages 14 1 Sausage Meat 2 — Savora 1 — Seidlitz Powders 4 — Semolina 4 — Soda Mint Tablets 1 — Soup 4 — Soup Desiccated 1 — Soya Flour 1 — Spice Mixed 12 — Spice—Pickling 6 — Sponge Mixture 4 — Sulphur Tablets 1 — Synofin B 1 — Syrup of Figs 1 — Thyme 4 1 Tumeric 1 — Veal and Poultry Stuffing 2 — Vinegar 11 1 Vita-cup 1 — Whaleburger 1 — Yeast Tablets 1 — r 21 Adulterated Samples, etc. Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. 1128 Milk Formal Contained 1 % added water. Vendor warned. 1132 Beef Sausages Formal Contained 41% meat. Deficiency 9%. Vendor warned after further sample found to be satisfactory. 381A Thyme Informal Contained 8% sand. Vendor warned. 385A Rum Orange Cordial Informal The proportion of proof spirit was 1.6% less than minimum quantity stated on label. Unable to obtain formal sample. 391A Baking Powder Informal 25% deficiency in available carbon dioxide. Vendor warned. Remainder of stock surrendered. 398A Dried Sage Informal Contained 4.9% sand. Vendor warned. Remainder of stock surrendered. 1084 Milk Formal 15% deficiency in milk fat. Appeal to cow samples also showed deficiency of milk fat— producer advised and referred to milk Production Officer for help. 1095 Milk Formal 13% deficiency in milk fat. 1096 Milk Formal 18% deficiency in milk fat. 1092 Milk Formal Contained 1 % added water. Producer warned. 1137 Thyme Formal Contained 9.1% sand. Vendor warned. 432A Parsley Informal Contained 5.8% sand. Vendor warned. 457A C (Laxative) Informal No declaration on label of active ingredients. Vendor warned. Remainder of stock surrendered. 459A Mustard Compound Informal Contained 0.06% Allyl Isothiocyanate. Standard laid down is 0.28% Vender warned. Remainder of stock surrendered. 22 Adulterated Samples, etc.— cont. Serial No. Article. Formal or Informal. Nature of Adulteration or Irregularity. Observations. 472A Mixed Herbs Informal Three packets containing 7.5%, 6.2%, 8.7% sand Vendor warned. Remainder of stock withdrawn for further sifting. 1230 Milk Formal Contained 2% added water. Producer warned. 1239 Milk Formal Contained 2½% added water. 1240 Milk Formal Contained 1½% added water. 493A Salad Dressing Informal Label did not show Carob Gum as principal constituent. Manufacturer warned. 454A Bread Informal Contained black mass which consisted of dirty grease. Vendor fined £10 45 5A Bread Informal Dark patches due to mould growths. Vendor warned. 494A Herbs Informal Three packets containing 4-5%> 3-9%. 4-7% sand. Vendor warned. Stock withdrawr for further sift ing. 529A Junket Informal Sample failed to make a satisfactory junket. No declaration of ingredients on label. Stock exhausted. Vendor warned. 23 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. NOTIFIABLE DISEASES (Other than Tuberculosis). Under i year 1-3 3-5 5-IO 10-15 15-25 25 and over No age Non-Civilian Total Scarlet Fever 1 9 32 78 25 11 5 1 162 Whooping Cough 64 102 95 100 3 1 1 4 — 370 Acute Poliomyelitis — 2 2 1 2 1 1 — — 9 Acute Polioencephalitis — — — — — — — — — — Measles 65 215 266 353 19 10 5 3 — 936 Diphtheria — — 1 7 1 — — — — 9 0-5 5-15 15-45 45-65 . 65 and over No age Non-Civilian Total Pneumonia:— Acute Primary 52 18 38 26 8 — 1 143 Influenzal — — 4 2 4 — — 10 Dysentery 1 — I — — — — 2 Smallpox — — — — — — — Enteric Fever — — — 1 — — — 1 Para-typhoid — — — — — — — Erysipelas 2 — 8 10 — — — 20 Cerebro-Spinal Fever 2 — 3 1 — — — 6 Puerperal Pyrexia — — 16 — — — 16 Ophthalmia Neonatorum 10 — — — — — 10 Pemphigus 3 — — — — — 3 Food Poisoning 1 — 2 — 1 — — 4 Notified. Admitted to Isolation Hospital, Rush Green. Admitted to other Isolation Hospitals. Admitted to other Hospitals. Deaths Registered. Cerebo-Spinal Meningitis 6 6 — 1 Diphtheria 9 9 — — 1 Dysentery 2 — — — Enteric 1 1 — — — Erysipelas 20 7 — — — Food Poisoning 4 — — — — Malaria — — — — — Measles 936 7 — — 2 Ophthalmia Neonatorum 10 2 — — — Pemphigus 3 2 — — — Puerperal Pyrexia 16 7 — 1 1 Pneumonia:— Acute Influenzal 10 3 42 Acute Primary 143 49 — — Polioencephalitis Acute — — — — — Poliomyelitis Acute 9 9 — — 1 Scarlet Fever 162 29 — — — Smallpox.. — — — — Whooping Cough 370 19 — 3 5 24 DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year :— Number of SCHOOL children immunised without preliminary testing 1,003 Number of PRE-SCHOOL children immunised without preliminary testing 1,482 Number of SCHOOL children who received a boosting dose 204 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. Result 10 27.10.42—0.1 c.c. A.P.T. 19. 1.43—0.3 c.c. A.P.T. 1. 1.47 Yes Severe Recovered 5 28. 3.44—0.1 c.c. A.P.T. 24. 5.44—0.3 c.c. A.P.T. 6. 1.47 Yes Severe Good Recovery 9 9.10.42—0.1 c.c. A.P.T. 5.11.42—0.3 c.c. A.P.T. 8.10.47 Yes Moderate Recovered Deaths. During the year one child, aged 4 years, died from Diphtheria ; he had not received treatment against this disease. 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 I- 4 — 3 2 — 1 — — — — — 2 5- 6 3 1 3 1 3 — 1 1 — — 1 10- 2 2 — — 1 2 — — — 1 — — 15- 15 16 1 2 2 1 — 1 — 2 — 1 20- 23 11 — 2 7 5 — 2 5 4 — — 25- 18 23 — 4 6 5 — — 5 7 — — 35- 13 8 — — 2 5 1 — 4 8 2 — 55- 10 — 1 8 1 — 65- and upwards 2 3 — 108 64 6 13 23 23 1 4 34 17 — 4 25 Register. Pulmonary. Non-Pulmonary. Male. Female. Male. Female. No. on register 1 st J anuary, 1947 524 366 137 148 During the year :— New notifications 108 64 6 13 Deaths 34 17 0 4 Transfers into area 23 23 I 4 Transfers out of area 28 18 3 3 No. on register 31st December, 1947 593 418 141 158 Mass Miniature Radiography Unit. The unit set up by the County Council came to Dagenham during the year and visited several of the large industrial factoiies and organisations. In certain cases factories were dealt with in groups by arrangement with the occupiers. The unit also visited Five Elms Out-patients Department and conducted a series of public sessions. Wide publicity was given and a large number of members of the public submitted themselves to investigation. The Mayor and many members of the Council, together with Chief and Deputy Chief Officers and members of the staff of the Corporation were also examined. MATERNITY AND CHILD WELFARE. Notification of Births. 2,585 notifications of live births were received during the year; the majority of these were notified by midwives. Stillbirths. 23 male and 26 female stillbirths were notified, the corresponding figures for registration being 24 and 27. The rate per 1,000 of total population registered was 0.49, the rate of England and Wales being 0.50. The percentage of illegitimate stillbirths to the total was 3.92 compared with a percentage of illegitimate to total births of 4.22. Infant Mortality. 80 infants under one year of age died during the year, giving an infant mortality rate of 30.66 per 1,000 live births, compared with that of 41 for England and Wales and 37 for London. The rate amongst legitimate children was 30.81, while for illegitimate children it was 27.27. 16 Ophthalmia Neonatorum. io cases of this disease were notified, two of which were treated in hospital; all made complete recoveries. There were 47 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. Three maternal deaths were assigned to this district, which give a maternal mortality rate of 1.13 per thousand births. That for England and Wales for the corresponding period was 1.17. 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 484 Total visits 711 (1b) To children under one year of age First visits 2,752 Total visits 4,969 (c) To children between the ages of one and five years Total visits 9,190 (d) Ineffective visits Total visits 2,801 Grand Total 175671 Supervision of Midwives. The following is a summary of the reasons for sending for medical aid by midwives :— Perineal Tear 235 Prolonged Labour 85 Discharging Eyes 47 Rise of Temperature 33 Miscarriage 28 Post-Partum Haemorrhage 20 Malpresentation 18 Toxaemia of Pregnancy 12 Adherent Plancenta 11 Premature Baby 10 Ante-Partum Haemorrhage 9 Phlebitis 6 Feebleness of Infant 6 Jaundice 4 Circumcision 3 Other Causes 83 610 27 Notices summoning medical aid 610 For (a) Mothers 516 For (b) Infants 94 Notifications that they had been associated with the undermentioned conditions were received from midwives :— Liable to be sources of infection 15 Stillbirths 15 Substitution of artificia feeding 12 Laying out dead bodies 8 Infant Deaths 7 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 1947 :— Municipal Midwives. Dagenham Nursing Association Midwives. Salvation Army Midwives. Births Attended : As Midwife 772 610 179 As Maternity Nurse 144 107 23 Miscarriages Attended 13 9 9 Visits Paid : As Midwife I5,307 11,035 4,677 As Maternity Nurse 1,649 1,914 460 Ante-Natal 3,919 2,160 1,128 Ante-Natal Clinics Attended 551 197 91 Gas and Air Administered 168 301 102 Day Nurseries. There are three Nurseries in the Borough accommodating 164 children in all. Staff: Matrons 2 Deputy Matrons 2 Warden 1 Nursery Trained Nurses 5 Nursery Assistants 12 Part-Time Nursery Assistant 1 Nursery Students 8 Nursery Helpers 7 Total 38 Total Attendances at Nurseries for 1947 :— Goresbrook Nursery Under 2 years of age 6,811 Over 2 „ ,, ,, 7,336| Chadwell Heath Nursery Under 2 „ „ „ 3,130 Over 2 „ „ „ 8,018 Kingsley Hall Nursery Over 2 „ „ „ 7,844 Total 32,939 Premature Infants. Total number of premature babies notified during 1947 Home 98 Hospital 2 Of those born at Home :— 85 were nursed entirely at home. 9 died during the first 24 hours. 82 survived at the end of one month. Of those born in Hospital:— None died during first 24 hours. Two survived at end of one month. CAUSES OF DEATH. Under 1 year M F 1 and under 2 years. M F 2 and under 5 years. M F 5 and under 15 years. M F 15 and under 25 years. M F 25 and under 35 years. M F 35 and under 45 years. M F 45 and under 55 years. M F 55 and under 65 years. M F 65 and under 75 years. M F 75 and over. M F TOTAL. M F RegistrarGeneral's Allocations. M F 1. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — — — — 2. Cerebro-Spinal Fever — — — — — — — — — — — — — — — — — — — — 1 — 1 — 1 — 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough 1 1 — — — 1 — — — — — — — — — — — — — — — — 1 2 2 3 5. Diphtheria — — — — 1 — — — — — — — — — — — — — — — — — 1 — 1 — 6. Tuberculosis of Respiratory System 1 2 8 3 8 5 3 7 2 8 2 3 — — — 28 24 29 25 7. Tuberculosis (other forms) — — — — 1 2 1 3 3 1 6 6 5 4 8. Syphilitic Disease — — — — — — — — — — — — — — — — — — — — 1 — 1 — 2 — 9. Influenza I — 1 1 — 1 2 4 3 10. Measles 1 — — — — — — — — — — — — — — — — — — — — — 1 — 2 — II. Acute Poliomyelitis and Polioencephalitis — — — — — — — — — — — — — — — — — — — — — — — 1 — 1 12. Acute Infectious Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 13- Cancer of Buccal Cavity and Oesophagus (Males only) — — — — — — — — — — — — — — — — 2 — — — 1 — 3 — 8 — I3.f. Cancer of Uterus — — — — — — — — — — — — — 1 — 2 — 1 — — — 2 — 6 — 6 14. Cancer of Stomach and Duodenum — — — — — — — — — 1 1 — — 1 2 2 6 3 3 4 — 3 12 14 18 12 15. Cancer of Breast — — — — — — — — — — — — — 3 — — — 2 — 1 — 2 — 8 — 15 16. Cancer of all other sites — — — — — — — — — — — 1 4 2 12 7 9 9 11 10 9 2 45 31 42 27 17. Diabetes — — — — — — — — — — — — — — — — — 2 — — — — — 2 1 I 18. Inter-cranial Vascular Lesions — — — — — — — — — — — 1 — — 4 4 3 3 6 8 8 9 21 25 19 22 19- Heart Disease — — — — — — — — 1 1 1 2 1 5 19 9 30 9 30 15 22 37 104 78 96 80 20. Other Diseases of Circulatory System — — — — — — — — — — — — — — — — 1 2 5 2 5 5 13 9 7 8 21. Bronchitis 1 — — — — — 1 — — — — — — — 4 1 7 — 6 2 5 8 24 11 43 14 22. Pneumonia 13 7 1 — 1 — 1 — 1 — — — 4 1 3 1 12 3 5 3 6 11 47 26 26 16 23. Other Respiratory Diseases — — — — — — 1 — — — — — — 2 3 1 2 2 — 1 — 1 6 7 3 4 24- Ulceration of the Stomach or Duodenum — — — — — — — — — — — — — — 2 I I — 2 — 1 2 6 3 10 3 25. Diarrhoea (under 2 years) 2 2 — — — — — — — — — — — — — — — — — — — — 2 2 1 2 26. Appendicitis — — — — — — — — — — — — — — — — — — — — — — — — — — 27. Other Digestive Diseases I 1 — — I 2 1 — 2 — 1 4 6 5 6 28. Nephritis — — — — — — — — 1 1 — 1 3 2 2 — 2 — I I 3 — 12 5 11 10 29. Puerperal and Post-Abortive Sepsis — — — — — — — — — — — — — — — — — — — — — — — 1 — I 30. Other Maternal Causes — — — — — — — — — — — — — — — — — — — — — — — 2 — 2 31. Premature Birth 11 13 — — — — — — — — — — — — — — — — — — — — 11 13 11 12 32. Congenital malformation, birth injury, and infantile disease 11 14 — — — — — — — — — — — — — — — — — — — — 11 14 13 13 33. Suicide — — — — — — — — . — — — — — 1 — — I — — 1 2 — 3 2 3 2 34. Road Traffic Accidents — — — — 1 — 2 1 1 — 2 — — — — — — — — — 1 1 8 2 8 2 35. Other Violent Causes — 1 — — — — — — 1 — 1 1 — — 2 — 1 — I I 1 3 7 6 6 3 36 All Other Causes — I — — — — 2 1 1 4 — 3 — — 2 I I 1 4 2 7 11 17 24 21 35 396 332 398 332