LIBRARY BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1948 CECIL HERINGTON, M.D. (Lond.), D.P.H. BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1948 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, I present herewith my report on the health of Dagenham for the year 1948. This must be regarded as a historical year in the annals of Public Health, July 5 th being the date on which certain of the services hitherto provided by the Corporation passed to the control of the County Council. It is difficult to differentiate accurately between the County and Corporation activities, therefore no attempt has been made to draw a hard and fast line to divide the functions of the Authorities concerned. Indeed, I would go further and suggest that our endeavour should be to knit all the agencies into one homogeneous whole, the target being to raise the level of health. I would here invite attention to some of the vital statistics. The Infant mortality rate has touched a new low level, 29.04 per thousand live births compared with 34 for England and Wales and 31 for London. The general death rate was 6.15 (England and Wales 10.8). The fall in births is shown by the fact that the birth rate was 19.15 in 1948 as against 23.71 in 1947. Now that the full complement of medical staff has been attained, it has become possible to re-distribute the duties entailed by the maternity and child welfare and the school health services. Each member of the medical staff is now engaged in both these services. Where possible the same medical officer who is in charge of infant welfare centres is attached to the schools which serve the same areas, thus preserving continuity of supervision. health Consideration has been given to the centres provision of health centres and certain sites in the Borough have been earmarked for this purpose. The guiding principle in selecting sites has been that each centre should give facilities for approximately 10,000 of the population and that it should not be necessary to travel more than half a mile to the centre. The sites earmarked are at the moment ten in number, but with the development of building estates some modification will be necessary. Building restrictions at the present time have prevented any actual construction from taking place. It will be appreciated that there should be no confusion between existing combined treatment centres and proposed health centres. CARE of mothers Fourteen weekly and two fortnightly AND YOUNG ante-natal sessions are held at six clinic CHILDREN. buildings, these latter are at Ashton Gardens, Chadwell Heath, Becontree Avenue, Ballards Road, Rush Green, Frizlands Lane and Ford 4 Road. The days and times of these sessions are set out in tabular form later in the report, together with average attendances. All these sessions are staffed by Medical Officers, Midwives and Health Visitors. Infant Welfare Centres are held at the same premises as the Ante-Natal Clinics with the exception of Frizlands Lane and the addition of King George Hospital Out-Patient Department. Thirteen weekly sessions are held and two fortnightly sessions. Here again the average attendances are given in another part of this report; all the sessions are staffed by Medical Officers and Health Visitors. Patients seen at the Ante-Natal Clinics are referred, when the clinical condition so indicates, to the Consultant Obstetrician at Oldchurch Hospital who conducts a session for Dagenham cases only once a fortnight. A Gynæcological Clinic is held once a month at Becontree Avenue Combined Treatment Centre, one of the medical staff being in charge of this session. Three day nurseries are provided and are situate at Chadwell Heath, Kingsley Hall and Goresbrook Park. Priority is given to children of mothers who have of necessity to go out to work. The capacity of these nurseries is far from sufficient to meet the demand and the waiting list for non-priority cases is very long. The problem is tackled to some extent by the Daily Guardian Scheme whereby the local health authority contributes the sum of 4/per week and the balance is payable by the mother concerned. When Daily Minders desire to take under their care more than two children, it is necessary for them to register with the Local Authority before this is permitted; in these circumstances the houses of the Daily Minders are visited and on the report obtained the advice of the Area Medical Officer is tendered to the SubCommittee. "Deprived" children are now dealt with by officers of the Children's Department of the County Council. The services of the Health Visitors are, however, utilised and local investigations are carried out by officers of this Borough. Facilities for the convalescence of pre-school children are arranged and the services of the local branch of the Invalid Children's Aid Association are made use of when placing these children. MIDWIFERY. The total number of whole-time midwives serving the area is 21, there being one senior Council Midwife, 11 District Midwives, two employed by the Salvation Army and seven employed by arrangement with the Dagenham District Nursing Association, now controlled by the 5 County Council. Only one independent midwife was in practice at the end of the year. Until the appointed day Dagenham Corporation was the Local Supervising Authority under the Midwives' Acts and the Medical Officer of Health carried out the duties of inspection. Since that day supervision of midwives has passed to the County Council and by arrangement the detailed supervision is still carried out by the Medical Officer of Health. Institutional midwifery is afforded at Oldchurch Hospital and the East End Maternity Hospital. Occasionally beds in other hospitals are put at our disposal. The housing shortage has caused an increased demand for maternity beds, and it is now only possible to arrange for institution midwifery when the clinical condition or the domestic circumstances so indicate. HEALTH The duties of Health Visitors have been VISITING. extended by the National Health Service Act, 1946. Health Visitors are now required to visit persons suffering from illness and to advise as to measures necessary to prevent the spread of infection. Before the provisions of this Act came into force the activities of Health Visitors were chiefly confined to visiting expectant mothers and children under school age in addition to attendances at Ante-Natal and Infant Welfare Centres. There are at present nine Health Visitors on the staff, of whom one is the Superintendent. The total number of visits paid during the year was 16,716. A table is included later in the report giving more details as to these visits. HOME Home Nursing is carried out by nurses NURSING. attached to the training home, York House, Frizlands Lane. This was formerly controlled by the Essex County Nursing Association, there being a local sub-committee styled the Dagenham District Nursing Association Sub-Committee. Since the appointed day this home is managed by the Training Home Management Sub-Committee which also controls the home at Leytonstone. There is a shortage of district nurses which it is hoped will be remedied to some extent when facilities for housing these nurses are available at York House which is in process of being extended. VACCINATION Vaccination is now carried out by general AND practitioners who have agreed to perform IMMUNISATION. this service. At the present time the fee for this service is under consideration. the only information with regard to the number of persons who have been vaccinated is that provided by the general practitioners 6 who have completed record cards and sent them to this office. Since the appointed day records of 85 persons have come to hand and those of 11 persons who have been re-vaccinated. Provision is made for medical officers of the Local Health Authority to carry out vaccination under certain conditions, such as the occurrence of an outbreak of smallpox. This has not been necessary during the period under review. General practitioners also participate in immunisation against Diphtheria. The total number of children protected by general practitioners was 56; this figure includes four boosting doses. A table is given in the report showing the number of children immunised by medical officers of the Local Health Authority which indicates that 2,224 children were protected and 118 children were given boosting doses. Only one case of Diphtheria was notified who had been given protective doses; this was a child aged nine years who had an attack of moderate severity six years approximately after the final dose. There were no deaths from Diphtheria during 1948. Immunisation against Whooping Cough must still be regarded as in the experimental stage. It has been carried out to a limited extent in this district for some time, but the effectivity has not been evaluated and parents of children receiving this treatment have been informed in every case that no guarantee of protection could be given. 439 children were given the full course of vaccine during the year. There are indications that a vaccine of higher efficacy will shortly be available for general use. AMBULANCE Until 5th July the ambulance service was SERVICES. provided by the Dagenham Corporation, there being three ambulances and one sitting case car. The service was sited at the Fire Station, the maintenance of the vehicles and control of personnel being the responsibility of the Borough Engineer; the Medical Officer of Health was the officer in charge of the operational control of the service. On 5th July the County Council was vested with all duties connected with the provision of ambulances. PREVENTION OF This heading covers a large number of ILLNESS, CARE activities which will no doubt, in due AND AFTER-CARE. course, be extended. At the present time sick room appliances are stored at York House and loaned to persons who require them. Convalescence is provided for adults who are not in need of medical and/or nursing attention. It is understood that arrangements are being made to extend facilities under this head. 7 The existing Tuberculosis Care Committee has been in operation for very many years, but it is contemplated that this Committee shall be re-grouped and that there will be some changes in its personnel and secretariat. Garden shelters for persons suffering from certain forms of Tuberculosis are at present stored by the County Council but arrangements are being made for a quota of shelters to be stored in the area and for these to be erected, dismantled and maintained locally. DOMESTIC A Home Help Organiser was appointed HELP. and took up duty in April, 1947. vision has been made for six whole-time domestic helps, at the time of writing four are employed. In addition there are 65 part-time helps who each undertake an average of 25 hours of duty per week. The average number of householders helped per week is 49. Up to date it has been possible to meet every demand for this service, but in a minority of cases there has, of necessity, been a slight delay in supplying the help required. Arrangements are in hand for the National Institute of Houseworkers to examine certain selected Home Helps with a view to conferring upon them a diploma of proficiency. The successful candidates will be rewarded by a slight increase in the normal hourly rate of wage. GASTRO-ENTERITIS. There were two explosive outbreaks of Enteritis during November within a period of nine days; the food was supplied from the same canteen in both instances. The first outbreak occurred at schools situate in a neighbouring area. Meals were supplied from a canteen in this Borough. 532 dinners were served and 324 diners complained of diarrhœa; all had completely recovered within 48 hours. The second outbreak occurred at the canteen itself. 320 dinners were served and 55 diners complained of diarrhoea. Minced meat was the suspected food in both outbreaks. In the second outbreak scraps from five dinners, together with some minced meat, were submitted for examination but no pathogenic organisms were isolated. I visited the canteen with the Chief Sanitary Inspector and carried out an investigation, including the processes adopted in the cooking of the various items of food. Advice was given in respect of minced meat to ensure that during cooking a temperature sufficient to kill pathogenic organisms would be maintained. These nstructions have been followed and there has been no further trouble. I am pleased once more to record my appreciation of the services of all members of the Public Health Department who have 8 continued to give of their best. There have been a few changes, one of which was the resignation of the Deputy Medical Officer of Health, Dr. H. B. Carter'Locke. I would also mention how much the interest and help of the members of the Committee concerned, with particular reference to the Chairman, are valued, and state that the burden of administration of my department has thus been lightened. I am, Madam Mayor, Ladies and Gentlemen, Your obedient Servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 9 MEMBERS OF THE COUNCIL (31st December, 1948) Mayor : Councillor (Mrs.) A. R. THOMAS, J.P. Deputy Mayor : Alderman W. E. BELLAMY, J.P. Aldermen : F. BROWN, J.P. R. J. D. CLACK J. W. BURRIDGE L. F. EVANS (Mrs.), M.B.E., J.P., A. F. J. CHORLEY, M.B.E., J.P. E.C.C. E.C.C. E. E. HENNEM F. G. THOMAS Councillors : S. F. BANKS H. L. LYONS I. M. BROCKELBANK (Mrs.) E. M. MILLARD (Mrs.) G. A. BROOKER R. J. MINCHIN F. COOMBS C. J. MUSTOO G. H. A. CROUCH E. OSBORNE F. GRINDROD D. O'DWYER A. HADDOCK A. E. PREDERGAST (Mrs.) G. T. HARRIS C. PRENDERGAST J. P. HOLLIDGE, E.C.C. B. M. ROADKNIGHT (Mrs.) Wm. C. IRELAND E. R. SAYWOOD A. KEMPSON 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 G. A. BROOKER (Councillor Mrs. A. R. THOMAS, Councillor D. O'DWYER J.P.) Councillor E. OSBORNE Deputy Mayor Councillor B. M. ROADKNIGHT (Alderman W. E. BELLAMY, J.P.) (Mrs.) 10 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 : HARRY B. CARTER-LOCKE, M.B., B.S.(Lond.), D.P.H., M.R.C.S., L.R.C.P. Assistant Medical Officers : THOMAS HARRISON, M.R.C.S., L.R.C.P., D.P.H., D.T.M. 6? Hy. JEANNE LISTER, M.B., B.S.(Lond.) ELIZABETH MITCHELL, M.B., Ch.B. H. D. H. ROBINSON, M.R.C.S., L.R.C.P., D.P.H. G. C. SHERRIFF, M.B., Ch.B., D.P.H. Chief Sanitary Inspector : L. E. PRIOR (1, 2) Sanitary Inspectors : J. W. ALLAM (1, 2) A. HUTCHINGS (1, 2) E. 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, 10) D. B. STEWART (5, 6, 7) M. E. HARVEY (5, 7) (Two vacancies) M. B. NELSON (5, 6, 7) Senior Midwife : E. M. BEDFORD (5, 6) Municipal Midwives : D. K. ANKER (6) K. MOYNIHAN (5, 6) M. GOODBUN (5, 6) M. M. RICHARDS (6) M. HALL (6) M. M. ROBSON (6, 10) O. LISSAMORE (6) E. T. SIMPSON (6) H. MITSON (5, 6) M. J. STOREY (6) (One vacancy) 11 Clerical Staff : Chief Clerk: F. W. KNIGHT (1, 2) Clerk to Sanitary Inspectors : K. W. SKEATES (1) Clerks : I. M. BISHOP D. TYLER S. COCKS M. A. WATTS G. K. HARRIS J. WHATLING L. A. MOORE S. WILLIAMS Day Nurseries : Goresbrook Nursery, MATRON: E. MADDISON (10) Dagenham Avenue, DEPUTY K. GRAHAM Dagenham. Chadwell Heath Nursery, MATRON : P. Ness (8) Ashton Gardens, DEPUTY : M. J. SHAW (10) Chadwell Heath. Kingsley Hall Nursery, WARDEN : D. HOWES Parsloes Avenue, Dagenham. Clerk : E. M. HOLLEY (8) Home Help Organiser : J. M. PILONE Chiropodists : N. FREEMAN M. KELLY (11). Foot Clinic Receptionist : K. RICHARDS Certificate of Royal Sanitary Institute 1 Meat Inspector's Certificate 2 Sanitary Science as applied to Building and Public Works Certificate Smoke Inspector's Certificate 4 General Trained Nurse 5 State Certified Midwife 6 Health Visitor's Certificate 7 State Enrolled Assistant Nurse 8 State Certified Mental Certificate 9 Registered Mental Nurse 10 Member of Society of Chiropodists 11 12 Part-Time Staff : Dentist : F. C. RITCHIE, L.D.S., R.C.S. (Eng.) Public Analysts : J. HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. Scabies Clinic Attendants : F. FARROW J. PHARAOH 13 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar General's estimate of resident population, 1948 111,500 Number of inhabited houses (end of 1948) according to Rate Books 27,282 Rateable value (December 31st, 1948) £625,018 Sum represented by a penny rate (approximate, 1948-49) £2,470 Extracts from Vital Statistics for the Year. Live Births:— Total Male Female Legitimate 2,072 1,061 1,011 Birth rate per 1,000 of the estimated resident population, 19.15. Illegitimate 63 38 25 Stillbirths:— Legitimate 32 22 10 Rate per 1,000 total (live and still) births, 14.77. Illegitimate – — — Deaths 686 385 301 Death rate per 1,000 of the estimated resident population, 6.15. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 2 0.92 Other puerperal causes 2 0.92 Total 4 1.85 Death rate of infants under one year of age:— All infants per 1,000 live births 29.04 Legitimate infants per 1,000 legitimate live births 28.47 Illegitimate infants per 1,000 illegitimate live births 47.62 14 Deaths from Cancer (all ages) 136 „ „ Measles (all ages) 1 „ „ Whooping Cough (all ages) 3 „ „ Diarrhcea (under 2 years of age) 5 Births. 2,136 live births were registered during the year, there being 1,099 males and 1,036 females. There is a decrease of total births from 2,609 in 1947 to 2,135. The birth rate per thousand population was 19.15 compared with 17.9 for England and Wales and 20.0 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, 22.34 and 23.71 for the year 1927 to 1947 inclusive. The illegitimate birth rate continues to be very low, being only 2.95 per cent. of total births. There were no illegitimate stillbirths. Death Rate. Total deaths in district 542 Outward transfers 146 Inward transfers 292 Deaths of residents 688 Of the 146 deaths of non-residents occurring in the district, 34 took place at the West Ham Sanatorium and 99 at the Rush Green Emergency Hospital. Of the 292 deaths of local residents taking place outside this area, most occurred in institutions. Of these, 125 occurred at Oldchurch Hospital, 19 at the London Hospital, 10 at King George Hospital, eight at 117 Sutton Lane, Hornchurch, eight at Severalls Hospital, six at The Retreat, Gt. Burstead, five at 48 Wood Street, Chelmsford, five at 14, Pope's Lane, Colchester, four at the London Chest Hospital and four at Heath House, Tendring. The death rate of 6.15 compares with 10.8 for England and Wales. For the years from 1927 to 1947 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, 6.63 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. 13 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1948. 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 Smallpox Measles Scarlet Fever Whooping Cough Diphtheria Influenza Diarrhoea and Enteritis (under two years) Total Deaths (under one year) England and Wales 17.9 0.42 10.8 0.00 — — — 0.02 0.00 0.03 3.3 34 126 County Boroughs and Great Towns, including London 20.0 0.52 11.6 0.00 — — — 0.02 0.00 0.03 4.5 39 148 smaller towns (1931) resident population 25,000-50,000 19.2 0.43 10.7 0.00 — — — 0.02 0.00 0.04 2.1 32 London 20.I 0.39 11.6 0.00 — — — 0.01 0.01 0.02 2.4 31 Dagenham 19.15 0.28 6.15 0.00 0.00 0.00 0.00 0.03 0.00 0.00 2.34 29.04 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 Thursday, a.m. 45 3 Weekly Thursday, p.m. 47 3 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Monday, a.m. 43 2 Weekly Monday, p.m. 60 5 Weekly Tuesday, p.m. (Com. Jan., 1948) 42 3 The Leys Clinic, Ballards Road, Dagenham. Weekly Thursday, a.m. 44 2 Weekly Thursday, p.m. 67 4 Out-Patient Department, King George Hospital, Five Elms, Dagenham. Weekly Wednesday, a.m. (Com. Jan., 1948) 52 3 Weekly Wednesday, p.m. 80 6 Weekly Friday, a.m. 59 3 Rush Green Clinic, 179, Dagenham Road, Rush Green. (2nd 4th in Month) Friday, a.m. 16 1 Weekly Friday, p.m. 33 2 The Clinic, Ford Road, Dagenham. Weekly Tuesday, a.m. 63 4 Weekly Tuesday, p.m. (Com. Jan., 1948) 61 5 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. 13 2 Weekly Monday, p.m. 13 2 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 22 5 Weekly Wednesday, a.m. 11 2 Weekly Friday, a.m. 17 3 Weekly Friday, p.m. 13 2 The Leys Clinic, Ballards Road, Dagenham. Weekly Tuesday, a.m. 15 2 Weekly Wednesday, a.m. 16 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (1st & 3rd in month) Friday, a.m. 18 4 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 30 5 Weekly Wednesday, p.m. 15 2 Weekly Thursday, a.m. 23 4 Weekly Thursday, p.m. 18 3 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 18 3 Weekly Monday, p.m. 26 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 6,435 Other Premises 660 Bakehouses 116 Milkshops, dairies and vehicles 127 Foodshops and stalls 1,913 Cafes and canteens 578 Infectious disease enquiries 862 Visits to foster mothers' premises 68 Number of complaints investigated 1.830 Outworkers' premises 215 Factories 269 Workplaces and offices 16 Tents, vans and sheds 244 Stables 81 Hairdressers' and barbers' premises 57 Shops Acts 179 Ice cream premises and vehicles 308 Houses fumigated Rodent control 1,307 Other visits 67 (b) Notices served:— Complied with:- Statutory 160 168 Informal 858 659 19 Water The water supply is satisfactory in quality and quantity. Since November, 1938, eight local authorities in the South Essex Waterworks Company's area of supply have carried out a co-ordinated system of sampling. Each authority takes one sample a month for bacteriological examination and one sample every six months for chemical examination in accordance with a rota. The 12 bacteriological and two chemical samples taken from the Company's mains in this Borough were all satisfactory. The water is not liable to have plumbo-solvent properties, and no action was called for in respect of any form of contamination. Approximately .10 per cent, of the inhabited houses and .084 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 Yards Laid 6" diameter 677 4" „ 1,169 y „ 93 Total 1,939 784 Supplies were afforded to houses during the year. The Chief Engineer of the South Essex Waterworks Company has furnished me with the following report:— "Bacteriological and chemical examinations are made of the raw river water, of the water in its various stages of treatment and of the water going into supply and of both raw and chlorinated water from the Company's wells. "Analyses are also made of samples obtained from consumers' taps in the various parts of the Company's district and all proved to be satisfactory. "Over 3,300 chemical, bacteriological and biological examinations have been made during the year. "All water going into supply was wholesome." 20 FACTORIES ACTS, 1937 & 1948 Inspections. Premises Number on Register Number of Inspections W ritten Notices Occupiers Prosecuted Factories without mechanical power 33 39 1 - Factories with mechanical power 108 176 2 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 37 54 4 - TOTAL 178 269 7 — Defects Found. No. of defects No. of prosecutions instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 1 1 - 1 - Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation 1 — — — — Ineffective drainage of floors — — — — — Sanitary Conveniences:— Insufficient 3 3 — - — Unsuitable or defective 6 7 — — — Not separate for sexes — — — — — Other offences 1 1 — — — TOTAL 12 12 — 1 — Outwork No. of out-workers in August list 32 Nature of work Making, etc., wearing apparel. 21 Smoke Abatement One large industrial firm in the Borough was the source of a definite smoke nuisance. The installation of additional boilers is in progress and it is anticipated that considerable improvement will result. Bacteriological Sampling of Milk During the year 107 samples of milk were submitted for examination and five were found to be unsatisfactory. Bacteriological Sampling of Ice Cream During the year 90 samples of ice cream were submitted for analysis and 10 were found to be unsatisfactory. 22 FOOD AND DRUGS ACT, 1938 Analyses Article Number Examined Number Adulterated, etc. Baking Powder 2 — Barley, Ground 2 — Barley Crystals 1 — Batter Flour 2 — Beef Extract 1 — Beef, Tomato Paste 1 — Black Currant Beverage 1 — Black Pudding 1 — Brawn 2 — Bread 2 1 Bun, Cake, Scone, Sponge Flours and Mixtures 18 - Cake 1 — Caraway Seeds 4 — Chicken Broth 2 — Cinnamon 2 — Cloves 1 — Cocoa 1 — Cod Roe Spread 1 — Coffee 6 — Coffee Extract 1 — Coffee and Chicory Extracts 2 — Confectionery Dip 1 — Crab Paste 1 - Cream Bun 1 - Curry Powder 1 — Custard Powder 6 — Doughnut 1 1 Essence of Rennet 1 — Essence of Lemon 1 - Fat 1 - Fish Paste 3 - Fruit Drink Powder 1 — Fruit Sauce 1 - Gelatine 4 - Gin 3 - Ginger 2 - Golden Raising Powder 2 - Gravy Powder 2 - Gravy Powder and Salt 4 - Herbs, Dried Mixed 6 - Horseradish 1 - Isinglass 1 - Jam 5 - Tunket Powder 1 - Ketchup, Tomato Flavour 1 1 Lemon Powder 1 - Lemonade Crystals and Powder 3 - Luncheon Roll 1 - Malted Milk and Egg, Chocolate Flavour 1 - Meat Extract 1 - Milk 45 4 23 Analyses—cont. Article Number Examined Number Adulterated, etc. Mint, Dried 2 — Mock Rice 1 — Mustard Compound 1 - Nutmeg, Ground 2 — Olive Oil 3 — Onion Powder 1 — Pea Flour 1 — Pepper 11 — Pickles 1 — Pudding Flour Mixture 1 — Rum 3 — Sage 1 — Salad Dressing 2 — Sauces 7 — Sausages and Sausage Meat 39 — Sausages, Savory Whale Meat 2 — Semolina 2 Sherbet Dip 1 - Soup 4 — Sparkle Fizz 1 — Spice, Mixed 6 - Spice, Pickling 1 — Stuffings 8 — Tea 4 - Tea Tablets 1 - Tomato Ketchup 1 — Vegetable Rissole Mixture 1 - Vinegar 10 2 Whisky 5 - Medicinal Samples:— Aspirin Tablets 1 - Backache Pills 1 - Basilicon Ointment 1 - Bicarbonate of Soda 2 - Bile Beans 2 - Bronchial Mixture 1 - Catarrh Pa'stiles 2 - Catarrh Syrup 1 - Cough Linctus 4 1 Digestive Mints 1 - Eucalyptus 1 - Glycerine and Borax 1 - Health and Liver Salts 1 - Iodised Throat Tablets 2 - Liquid Paraffin 2 - Marshmallow Ointment 1 - Mentholated Balsam 1 - Quinine Cinnamon 1 - Seidlitz Powder 1 - Senna Pods 1 - Soda Mint Tablets 1 - Throat Tablets 1 - Wintergreen Ointment 1 - Witch Hazel 1 - Zinc Ointment 1 - 24 Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 562A Milk Informal Presence of extremely minute specks of metallic aluminium powder. Vendor warned. 563A Milk Bottle Informal Bottle contained dirt and a little milk. Vendor warned. 564A Malt Vinegar Informal Contained gelatinous mass, also dead insects. Proceedings instituted. Case dismissed. 574A Cough Mixture Informal Contained weevils and maize starch. Vendor warned. 617A Spirit Vinegar Informal Had peculiar smell and taste. Contained traces of pine disinfectant. Vendor warned. 634A Tomato Ketchup Informal Contained small particles of foreign matter of the nature of coke fragments. Manufacturers warned. 644A Doughnut Informal Contained discoloured patches. Vendor warned. 645A Bread Informal Contained greyishbrown mass and fragments. Vendor warned. 1281 Milk Formal 5% deficiency in milk fat Producer advised and referred to Milk Production Officer for help 1265 Milk Formal 5% deficiency in milk fat Unsound Food There has been an increase in the number of articles of food brought to the department. These included wire in a sweet, glass in bread, a snail in jam, a screw in sausages, a bandage in bread. There were six successful prosecutions; in two cases, however, the summonses were dismissed. In all other instances warning letters were sent to the vendors. 25 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES NOTIFIABLE DISEASES (Other than Tuberculosis) Under 1 year 1-3 3-5 5-10 10-15 15-25 25 and over No age Non-Civilian Total Scarlet Fever 1 18 38 106 27 13 2 - - 205 Whooping Cough 70 136 138 121 5 - 1 - - 471 Acute Poliomyelitis - - - 1 2 2 1 - - 6 Acute Polioencephalitis - - - - - - - - - - Measles 77 382 394 563 19 6 2 1 - 1444 Diphtheria - - - 1 - - - - - 1 0-5 5-15 15-45 45-65 65 and over No age Non-Civilian Total Pheumonia: Acute Primary 37 15 16 14 4 - - 86 Influenzal - - 3 - 1 — — 4 Dysentery - 2 1 - - 1 - 4 Smallpox - - - - - - - - Enteric Fever - - - - - - - - Paratyphoid - - 1 - - - - 1 Erysipelas - - 7 9 5 1 - 22 Cerebro Spinal Fever 1 - 2 - - - - 3 Puerperal Pyrexia - - 8 - - - - 8 Ophthalmia Neonatorum 7 - - - - - - 7 Pemphigus 1 - - - - - - 1 Pood Poisoning - - 2 3 - - - 5 26  Notified Admitted to Isolation Hospital, Rush Green Admitted to other Isolation Hospitals Admitted to other Hospitals Deaths Registered CerebrcSpinal Meningitis 3 3 - - 1 Diphtheria 1 1 — — — Dysentery 4 1 — — — Enteric - - — — — Erysipelas 22 8 — — — Food Poisoning 5 1 — — — Malaria - — — — — Measles 1,444 29 — — 1 Ophthalmia Neonatorum 7 1 — — — Pemphigus 1 1 — - — Puerperal Pyrexia 8 6 — 1 — Pneumonia:— Acute Influenzal 4 1 — — 32 Acute Primary 86 38 1 1 Polioencephalitis Acute — — — — — Poliomyelitis Acute 6 6 — — 1 Scarlet Fever 205 38 1 — - Smallpox — — — — - Whooping Cough 471 21 - - 3 DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year:— Number of SCHOOL children immunised without preliminary testing 426 Number of PRE-SCHOOL children immunised with' out preliminary testing 1,798 Number of SCHOOL children who received a boosting dose 118 Immunisation by General Practitioners. Number of SCHOOL children immunised without preliminary testing 5 Number of PRE-SCHOOL children immunised without preliminary testing 47 Number of SCHOOL children who received a boosting dose 4 The following table shows details of a child who attended for immunisation and was 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 9 18.9.42—0.1 c.c. A.P.T. 31.3.48 Yes Moderate Recovered 17.11.42—0.3 c.c. A.P.T. Deaths There were no deaths from Diphtheria during the year. 27 VACCINATION CARRIED OUT BY GENERAL PRACTITIONERS (Since the Appointed Day) Vaccinated. 1948 (Under 1) 62 1944-7 (1—4) 7 1934-43 (5—14) 3 Before 1934 (15 or over) 13 TOTAL 85 Re-Vaccinated. 1948 (Under 1) — 1944-7 (1—4) — 1934-43 (5—14) 2 Before 1934 (15 or over) 9 TOTAL 11 TUBERCULOSIS New Cases Deaths Primary Notification Brought to notice other than by Form A Pulmonary NonPul monary Pulmonary NonPul monary Pulmonary NonPul monary M F M F M F M F M F M F Under 1 1 - - - - - - - - - - - 1— 6 3 1 1 - 1 - - - - - - 5— 5 5 1 - 2 - 2 2 - - - - 1O— 3 1 2 1 - - 1 - - - - - 15— 13 10 - 1 2 2 - - 3 1 1 1 20- 17 17 - 4 1 5 - - 2 4 - - 25— 10 13 — 2 5 6 — 1 8 9 — — 35— 15 8 - - 6 4 - - 3 3 - - 45— 9 1 - - 2 - - - 3 1 - - 55— 8 2 — — — — — — 5 — — — 65—and upwards - - - - - - - - - - - - 87 60 4 9 18 18 3 3 24 18 1 1 28 Register. Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1948 593 418 141 158 During the year:— New notifications 87 60 4 9 Deaths 24 18 1 1 Transfers into area 18 18 3 3 Transfers out of area 12 12 1 3 No. on register 31st December, 1948 662 466 146 166 MATERNITY AND CHILD WELFARE Notification of Births 2,118 notifications of live births were received during the year ; the majority of these were notified by midwives. Stillbirths 22 male and 15 female stillbirths were notified, the corresponding figures for registration being 22 and 10. The rate per 1,000 of total population registered was 0.28, the rate for England and Wales being 0.42. Infant Mortality 62 infants under one year of age died during the year, giving an infant mortality rate of 29.04 per 1,000 live births, compared with that of 34 for England and Wales and 31 for London. The rate amongst legitimate children was 28.47, while for illegitimate children it was 47.62. Ophthalmia Neonatorum Seven cases of this disease were notified, one of which was treated in hospital ; all made complete recoveries. There were 39 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. 29 Maternal Mortality Four maternal deaths were assigned to this district, which give a maternal mortality rate of 1.85 per 1,000 births. That for England and Wales for the corresponding period was 1.02. It should be mentioned that two of these maternal deaths were attributed to Septicaemia following abortion and in both cases " in circumstances not fully disclosed by the evidence." 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 286 Total visits 332 (b) To children under one year of age First visits 2,268 Total visits 4,633 (c) To children between the ages of one and five years Total visits 9,163 (d) Ineffective visits Total visits 2,588 Grand Total 16,716 Supervision of Midwives The following is a summary of the reasons for sending for medical aid by midwives:— Perineal Tear 169 Prolonged Labour 61 Discharging Eyes 39 Rise of Temperature 28 Miscarriage 23 Adherent Placenta 20 Threatened Miscarriage 17 Post-Partum Hæmorrhage 16 Premature Baby 13 Malpresentation 12 Ante-Partum Hæmorrhage 11 Phlebitis 6 Jaundice 5 Albuminuria 5 Cyanosed Infant 4 Instrumental Delivery 4 Septic Spots 3 Placenta Prævia 2 Asphyxiated Infant 2 Feebleness of Infant 2 Other Causes 78 520 30 Notices summoning medical aid 520 For (a) Mothers 422 For (b) Infants 98 Notifications that they had been associated with the undermentioned conditions were received from midwives:— Substitution of artificial feeding 29 Liable to be sources of infection 15 Stillbirths 6 Deaths of Mother or Child 5 Laying out dead bodies 1 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 1948:— Municipal Midwives Dagenham Nursing Association Midwives Salvation Army Midwives Births Attended: As Midwife 599 480 158 As Maternity Nurse 72 61 11 Miscarriages Attended 17 5 4 Visits Paid: As Midwife 12,099 8,939 4,861 As Maternity Nurse 691 1,168 199 Ante-Natal 4,270 3,289 596 Ante-Natal Clinics Attended 650 224 98 Gas and Air Administered 232 191 115 31 Day Nurseries There are three Nurseries in the Borough, accommodating 164 children in all. Staff: Matrons 2 Deputy Matrons 2 Wardens 3 Nursery Trained Nurses 4 Nursery Assistants 11 Part-Time Nursery Assistant 1 Nursery Students 14 Nursery Helpers 1 Total 38 Total Attendances at Nurseries for 1948:— Goresbrook Nursery Under 2 years of age 5,566 Over 2 „ „ „ 9,365 Chadwell Heath Nursery Under 2 „ „ „ 2,504 Over 2 „ „ „ 9,008 Kingsley Hall Nursery Over 2 „ „ „ 9,033 Total 35,476 Premature Infants Total number of premature babies notified during 1948:— Home 97 Hospital 1 Of those born at Home:— 84 were nursed entirely at home. 10 died during the first 24 hours. 84 survived at the end of one month. Of those born in Hospital:— None died during first 24 hours. One survived at end of one month. CAUSES OF DEATH Under 1 year1 and under 2 years 5 and under 15 year 15 and 25 year 25 and under 35 year 35 and under 45 year 45 and under 55 55 and under 65 year 65 and 75 year 75 and over Registrar-General's Allocations MFMFMFMFMFMFMFMFMFMFMFMFMF 1. Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough 1 — — — 1 — — — — — — — — — — — — — — — — 1 2 1 2 6. Tuberculosis of Respiratory System — — — 1 — — — — 3 4 10 9 3 2 4 — 7 — 2 — 1 — 30 16 31 16 7. Tuberculosis (other forms) — — — — — — — — — 1 1 — — — — — — — — — — — 1 1 1 1 11. Acute Poliomyelitis and Polioencephalitis — — — — — — — — — j — — — — — — — — — — — — — 1 — 1 12. Acute Infectious Encephalitis — — — — — — — — — — — — — — — — — — — — — — — — — — 13. Cancer of Buccal Cavity and Oesophagus 13.f. Cancer of Uterus — — — — — — — — — — — — — 1 — 2 — 1 — 1 — 2 — 7 — 12 14. Cancer of Stomach and Duodenum — — — — — — — — — — — — 2 2 3 2 7 27 1 1 2 20 9 21 II 15. Cancer of Breast — — — — — — — — — — — — — 1 — 3 — 1 — 1 — 2 — 8 — IO 16. Cancer of all other sites — — — — — — — — 1 — 1 1 5 2 9 14 20 49 6 7 7 52 34 52 27 18. Inter-cranial Vascular Lesions 1 — — — — — — — — 2 — 1 — — 4 4 4 7 8 14 5 4 22 32 23 26 19. Heart Disease 1 — — — — — — — — 2 2 2 1 1 16 7 35 IO 23 16 22 35 IOO 73 89 75 20. Other Diseases of Circulatory System — — — — — — — — — — — — — 1 1 — — 3 4 — 2 ^ 7 10 11 11 21. Bronchitis 3 1 — — — — — — — — — — 2 1 2 2 8 1 6 2 5 5 26 12 36 IO 22. Pneumonia 4 8 1 1 2 — 2 1 — — 1 1 1 2 1 1 5 1 3 2 8 628231517 23. Other Respiratory Diseases — — — — — — — — — — — — 1 1 2 1 1 1 2 — — 1 6 4 5 7 24. Ulceration of the Stomach or Duodenum — — — — — — — — — — — — — — 4 — 1 — 2 — — — 7 — 7 — 25. Diarrhoea (under 2 years) — — — — — — — — — — — — — — — — — — — — — 5 — 5 — 27. Other Digestive Diseases — — — — — — — — — — — — 2 1 — 1 — 1 — 2 — — 2 5 2 7 28. Nephritis — — — — — — — 1 — — 1 1 2 — 3 3 1 1 3 1 2 1 . 12 8 8 8 29. Puerperal and Post-Abortive Sepsis — — — — — — — — — 1 — 1 — — — — — — — — — — — 2 — 2 30. Other Maternal Causes — — — — — — — — — — — 2 — — — — — — — — — — — 2 — 2 31. Premature Birth II 6 — — — — — — — — — — — — — — — — — — — — 11 6 9 4 32. Congenital malformation, birth injury, and infantile disease 9 7 — — 1 — — — — — — — — — — — — — — — — — IO 7 12 9 33. Suicide — — — — — — — — — — 1 — — 1 1 — — 1 1 — — — 3 2 3 2 34. Road Traffic Accidents — — — — 1 — 1 — 3 1 — — 3 — 1 1 3 — 1 — — — 13 2 14 2 35. Other Violent Causes 1 — — — 1 — — 2 1 — 1 — 2 — — 1 — 1 — — — 26654 36. All Other Causes 2 — 1 — — — — — 2 2 4 2 — 2 3 1 4 1 2 3 21520262830 387 301 385 301