AC 4411 (1)DAGEN HAM DAG 23 BOROUGH OF DAGENHAM INTERIM ANNUAL REPORT of the Medical Officer of Health for the year 1949 » CECIL HERINGTON, M.D. (Lond.), D.P.H. i — i jalth J.PH. 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I submit herewith my report on the health of Dagenham for the year 1949. One fact deserving of special note is that there were no maternal deaths, which is truly remarkable bearing in mind the fact that there were slightly less than 2,000 confinements which took p'.ace. This is the only occasion that it has been possible to record such a success in Dagenham with the one exception of the year 1926 when the population was less than 38,000. A point of special interest is that for the first time on record no cases of Diphtheria occurred. It is appropriate here to express an appreciation of the co-operation of the parents with the immunisation scheme which, it may be remembered, was instituted in Dagenham as far back as 1930, Dagenham being one of the first Local Authorities to put into operation a systematic service of immunisation. The birth rate was 17.14 which is less than that for the 126 large towns, the figure for which was 18.7. It will be seen under the section of the report dealing with Health Visitors, that there is an item 427 "other visits"; these visits were occasioned by additional duties entrusted to Health Visitors under the provisions of the National Health Service Act. Much of the report deals with services which are now administered by the Local Health Authority through the Area Health Sub-Committee and the officers now under the local contro! of that Sub-Committee. With the object of making the report informative, the services affecting the health of the Borough are touched upon without discriminating between the Authorities ultimately responsible for them. CLEAN FOOD CAMPAIGN. Efforts have been, and are made wherever opportunity occurs, to instil the principles of food hygiene into the minds of everyone, especially those whose occupation is the preparation and distribution of food. One frequently hears of the horror evinced by customers in public houses and restaurants when they detect lipstick on glasses °r teacups. Their indignation is directed towards the users of the lipstick, quite unjustly in my opinion. These ladies, unwittmgly, confer a benefit on their fellow customers inasmuch as the proprietors, forced by public opinion (and indignation !) are compelled to cleanse their utensils properly. HEALTH CENTRES. Authority centres. taken in were and acc CARE c AND Y children receive mo no means the nu. from. C held found deter in 195 was opened and Forest houses building is Hospital patients are r on medical maternity church, Barking . Convalescence cence for circumstances, indicate that are made according with under Dental clinic for age of five Avenue 5 MIDWIFERY. The establishment for domiciliary mid- wives is 12; these midwives are allotted specific areas and they cover roughly two-thirds of the Borough. Midwifery for the remaining third is provided by the midwives residing at York House. In addition, the arrangement with the Solvation Army Midwives continues to function. This organisation usually supplies two midwives but owing to the reduction in the number of cases, one midwife only is based at the Salvation Army Home at the present time. All the midwives working in the Borough have received training in the administration of gas and air analgesia. HEALTH VISITING. The establishment of Health Visitors for Dagenham is 12 plus one Superintendent. During the year 1949 it was not possible to fill the establishment and consequently the work had to be spread over. Additional duties have been entrusted to Health Visitors under the Nationa! Health Service Act which have considerably extended their scope. VACCINATION AND IMMUNISATION. Immunisation against both Diphtheria and Whooping Cough is carried out in the district, although that against Whooping Cough is on a limited scale. Mothers ire discouraged from having their children "protected" against this disease owing to the low immunity, if any, achieved by the reagents at present available. In addition to that carried out by the staff of the area, immunisation is also carried out by general practitioners who receive a fee of 5/- for each report submitted. Vaccination is paid for under the same scheme. prevention of illness, care and after-care. A number of activities are carried out under Section 28 of the Act and it is likely that these activities will be extended. the tuberculosis Care association This Association has been in operation for a number of years and it plays an active part in its particular field. To complete the liaison, the Chairman of the Health Area Sub-Committee has been appointed Chairman of the Local Association. The Association receives a grant from the County Council and undertakes the mvestigation of cases and recommends provision of articles and nutrients which would not otherwise be obtainable by the patients. 6 On the recommendation of the Chest Physician extra nourishment is given under the provisions of the Act to tuberculous patients awaiting admission to sanatoria. There are arrangements for boarding out contacts which have been carried into effect in certain cases. The provision of sick room equipment is under review by the County Council. At the present time equipment is held at the Nurses Training Home, York House, and some is supplied by the Dagenham Branch of the British Red Cross Society. A limited amount has been issued from the Area Office. rehabilitation of tuberculous cases. One patient was sent to Papworth during 1949. For reasons of her own, she elected to discharge herself after a stay of only a few days. convalescent homes. Recuperative Holiday Homes are available for those in need, and in suitable cases abatement of fees is made by the application of an income scale of assessment. Arrangements were made for 28 cases of adults in 1949 and in three instances mothers with their children were placed. chiropody service. Chiropody Clinics have been in operation in Dagenham for a number of years and are being continued. The demand is such that an extension of the service would serve a much felt need. At the present time two full-time and one part-time Chiropodists are employed together with a full-time receptionist. The premises used are Ford Road Combined Treatment Centre and Chadwell Heath Clinic. Treatment in 1949 is shown below:— No. of patients treated:— Men 387 (including 96 Old Age Pensioners) Women 1,196 (including 241 Old Age Pensioners) School Children 186 Total 1,769 Total number of attendances 9,164. No. of patients attending regularly for treatment:— Men 210 Women 667 Total 877 7 HEALTH EDUCATION. Health Education is given with particular regard to food handlers. The managers of local cinemas have helped on a number of occasions by showing films. A clean food campaign was commenced in October, 1949. Lectures were given by the Medical Officer of Health and Chief Sanitary Inspector to:— (a) Members of Local Chamber of Trade; (b) 287 Food Handlers (these lectures were given at the Civic Centre on Wednesday afternoons in the employers' time). DOMESTIC HELP. There is a full-time organiser who receives some clerical assistance. At the end of the year 1949 there were 11 full-time and 58 part-time domestic helps. The tendency is for an increase in the demand for this service; it has been possible hitherto to satisfy this demand. Patients suffering from Tuberculosis who have been discharged from sanatoria or who are awaiting admission, form a considerable section of those people receiving domestic help. There is in addition, a number of persons suffering from Chronic illness who require this help and this is likely to become a permanent feature of the service. I tender my grateful thanks to the Chairman and members of the Council for their continued interest in the work of the Public Health Department and have pleasure in putting on record my high esteem for the manner in which my colleagues and the staff of the department have assisted me during the year. I am, Mr. 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, 1949) Mayor : Alderman J. W. BURRIDGE, J.P. Deputy Mayor: Councillor (Mrs.) A. R. THOMAS, J.P. Aldermen: W. E. BELLAMY F. GRINDROD F. BROWN, J.P. A. E. PRENDERGAST (Mrs.) R. J. D. CLACK F. G. THOMAS L. F. EVANS (Mrs.), M.B.E., J.P., E.C.C. Councillors: S. F. BANKS A. KEMPSON A. BASS E. M. MILLARD (Mrs.) R. BLACKBURN R. J. MINCHIN I. M, BROCKELBANK (Mrs.) C. J. MUSTOO G. A. BROOKER D. O'DWYER F. COOMBS C. PRENDERGAST G. H. A. CROUCH B. M. ROADKNIGHT (Mrs.) E. W. DEEKS L. A. SAYER A. S. HADDOCK L. S. SNELLING (Mrs.) G. T. HARRIS A. F. WARR (Mrs.), E.C.C. J. HOLLIDGE, J.P., E.C.C. J. WRIGHT Wm. C. IRELAND public health committee Alderman (Mrs.) A. E. PRENDERGAST, Chairman Councillor D. O'DWYER, Vice-Chairman His Worship the Mayor Councillor A. BASS (Alderman J. W. BURRIDGE, J.P.) Councillor G. A. BROOKER Deputy Mayor Councillor B. M. ROADKNIGHT (Councillor (Mrs.) A. R. THOMAS, (Mrs.) J.P.) Councillor A. F. WARR (Mrs.) 9 officers of the public health services Officers employed by the Essex County Council are indicated thus "(C)" 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: THOMAS HARRISON, M.R.C.S., L.R.C.P., D.P.H., D.T.M. & Hy. (C) Assistant Medical Officers : MARION G. FISH, M.B., B.Ch., B.A.O. (C) JEANNE LISTER, M.B., B.S.(Lond.) (C) ELIZABETH MITCHELL, M.B., Ch.B. (C) H. D. H. ROBINSON, M.R.C.S., L.R.C.P., D.P.H. (C) MADELINE WEIZMANN, M.R.C.S., L.R.C.P. (C) 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: (C) V. A. EVERITT (5, 6, 7) Health Visitors: (C) I. A. BARROW (5, 6, 13) M. B. NELSON (5, 6, 7) J. J. CLACHERTY (5, 6, 7) E. RICHARDS (5, 6, 7) 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) 10 Senior Midwife: (C) E. M. BEDFORD (5, 6) Midwives: (C) D. K. ANKER (6) M. M. ROBSON (6, 10) M. GOODBUN (5, 6) M. ROCK (6) M. HALL (6) D. W. STIMSON (5, 6) H. MITSON (5, 6) M. J. STOREY (6) K. MOYNIHAN (5, 6) M. TEATHER (5, 6) M. M. RICHARDS (6) Clerical Staff : Chief Clerk: F. W. KNIGHT (1, 2) Cler\ to Sanitary Inspectors: S. COCKS Clerks: E. ADAMS (C) D. TYLER (C) W. J. BATCHELER M. A. WATTS (C) I. M. BISHOP (C) J. WHATLING (C) G. K. HARRIS S. WILLIAMS (C) L. A. MOORE (C) Day Nurseries: (C) Goresbrook Nursery, MATRON: E. MADDISON (12) Dagenham Avenue, DEPUTY: K. GRAHAM (8) Dagenham. Chadwell Heath Nursery, MATRON: P. NESS (8) Ashton Gardens, DEPUTY: M. J. SHAW (12) Chadwell Heath. Kingsley Hall Nursery, WARDEN: D. HOWES Parsloes Avenue, Dagenham. Clerk: E. M. HOLLEY (8) (C) Home Help Organiser: J. M. PILONE (C) Chiropodists: (C) N. FREEMAN M. KELLY (11) Foot Clinic Receptionist: K. RICHARDS (C) 11 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 Registered Mental Nurse 10 Member of Society of Chiropodists 11 State Registered Fever Nurse 12 Tuberculosis Certificate 13 Part-Time Staff: Dentist: F. C. RITCHIE, L.D.S., R.C.S.(Eng.) (C) Public Analyst: 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, 1949 113,800 Number of inhabited houses (end of 1949) according to Rate Books 28,278 Rateable value (December 31st, 1949) £642,073 Sum represented by a penny rate (approximate 1949-50) £2,555 Extracts from Vital Statistics for the Year. Live Births:— Total Male Female Legitimate 1,879 979 900 Birth rate per 1,000 of the estimated Illegitimate 71 35 36 resident population, 17.14. Stillbirths:— Legitimate 27 9 18 Rate per 1,000 total (live and still) Illegitimate 2 1 1 births, 14.65. Death rate per 1,000 Deaths 756 449 307 of the estimated resident population, 6.64. Deaths from puerperal causes:— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis Nil — Other puerperal causes Nil — Total Nil — Death rate of infants under one year of age:— All infants per 1,000 live births 28.21 Legitimate infants per 1,000 legitimate live births 26.61 Illegitimate infants per 1,000 illegitimate live births 70.42 13 Deaths from Cancer (all ages) 153 „ „ Measles (all ages) 1 „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years of age) Nil Births. 1,950 live births were registered during the year, there being 1,014 males and 936 females. There is a decrease of total births from 2,136 in 1948 to 1,950. The birth rate per thousand population was 17.14 compared with 16.7 for England and Wales and 18.7 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, 23.71 and 19.15 for the years 1927 to 1948 inclusive. The illegitimate birth rate continues to be very low, being only 3.64 per cent, of total births. The rate of illegitimate stillbirths is 6.90 per cent, of total stillbirths. Death Rate. Total deaths in district 597 Outward transfers 153 Inward transfers 314 Deaths of residents 758 Of the 153 deaths of non-residents occurring in the district, 21 took place at the West Ham Sanatorium and 126 at the Rush Green Emergency Hospital. Of the 314 deaths of local residents taking place outside this area, most occurred in institutions. Of these, 153 occurred at Old' church Hospital; 38 at 117, Sutton Lane, Hornchurch; 12 at the London Hospital; 10 at Harold Wood Hospital; eight at King George Hospital; five at The Retreat, Gt. Burstead; four at Severalls Hospital; four at Ilford Isolation Hospital; and four at St. Joseph's Hospice. The death rate of 6.64 compares with 11.7 for England and Wales. For the years from 1927 to 1948 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, 890, 8.51, 6.85, 7.98, 7.81, 6.97, 6.63, 6.63 and 6.15. A table giving the causes of death, and the age periods at which they occurred, is given at the end of the report. 14 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1949. 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 16.7 0.39 11.7 0.00 0.00 8.95 1.63 0.01 0.00 0.15 3.0 32 126 County Boroughs and Great Towns, including London 18.7 0.47 12 5 0.00 0.00 8.91 1.72 0.02 0.00 0.15 3.8 37 148 smaller towns (1931) resident population 25,000-50,000 18.0 0.40 11.6 0.00 — 9.18 1.83 0.01 0.00 0.14 2.4 30 London 18.5 0.37 12.2 0.00 — 8.54 1.46 0.01 0.00 0.11 1.7 29 Dagenham 17.14 0.25 6.64 0.00 0.01 0.00 0.01 0.00 0.04 0.00 28.21 15 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. 43 2 Weekly Thursday, p.m. 51 4 Becontree Clinic, Becontree Avenue, Dagenham. / / Weekly Monday, a.m. 40 2 Weekly Monday, p.m. 49 3 The Leys Clinic, Ballards Road, Dagenham. Weekly Tuesday, p.m. 56 3 Weekly Thursday, a.m. 33 2 Weekly Thursday, p.m. 61 4 Out-Patient Department. King George Hospital, Five Elms, Dagenham. Weekly Wednesday, a.m. 51 3 Weekly Wednesday, p.m. 72 5 Weekly Friday, a.m. 44 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (2nd & 4th in Month) Friday, a.m. 15 1 Weekly Friday, p.m. 32 2 The Clinic, Ford Road, Dagenham. Weekly Tuesday, 'a.m. 59 4 Weekly Tuesday, p.m. 73 5 16 Ante-Natal Clinics CENTRE Sessions Held Times Sessions Held Average Attend' ances Average New Cases The Clinic, Ashton Gardens, Chadwell Heath. Weekly Monday, a.m. 13 2 Weekly Monday, p.m. 12 2 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 18 4 Weekly Wednesday, a.m. 12 2 Weekly Friday, a.m. 14 2 Weekly Friday, p.m. 14 1 The Leys Clinic, Ballards Road, Dagenham. Weekly Tuesday, a.m. 21 3 Weekly Wednesday, a.m. 14 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (1 st & 3 rd in month) Friday, a.m. 10 2 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 25 4 Weekly Wednesday, p.m. 17 2 Weekly Thursday, a.m. 19 3 Weekly Thursday, p.m. 17 3 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 21 3 Weekly Monday, p.m. 27 5 17 Sanitary Inspection of the District Report of the Sanitary Inspectors. (a) Nature and number of visits:— Overcrowding and Housing Conditions 936 Nuisances under Public Health Acts— Dwelling Houses 6,025 Other Premises 680 Bakehouses 112 Milkshops, dairies and vehicles 150 Foodshops and stalls 2,491 Mobile fish and meat vans 15 Cafes and canteens 698 Infectious disease enquiries 1,706 Visits to foster-mothers premises 94 Number of complaints investigated 1,482 Outworkers' premises 212 Factories 148 Workplaces and offices 23 Tents, vans and sheds 330 Stables 55 Hairdressers' and barbers' premises 76 Shops Acts 41 Ice-cream premises and vehicles 476 Houses fumigated 76 Rodent control 937 Other visits 45 (b) Notices served:— Complied with: — Statutory 99 97 Informal 792 701 18 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. During the year two chemical and two bacteriological samples were taken from the Company's mains in this Borough and all were 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 :— Location. Yards Laid 9in. 6in. 4in. 3in. Heath Park Estate 4 1,082 1,578 20 Marston Avenue — — 263 Rose Lane Estate 69 59 — - Rosslyn Avenue — — 150 Totals 73 1,141 1,991 20 Total for year 3,225 yards. 351 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 3,800 chemical, bacteriological and biological examinations have been made during the year. " All water going into supply was wholesome." 19 FACTORIES ACTS, 1937 8C 1948 Inspections. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 31 33 - - Factories with mechanical power 119 115 - - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 24 38 2 - TOTAL 174 186 2 — Defects Found. No. of defects No. of prosecutions instituted Found Reme' died Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 1 1 - - - Overcrowding — — - — — unreasonable temperature Inadequate ventilation — - - - - Ineffective drainage of floors — — - — — Sanitary Conveniences :— Insufficient 2 2 - 1 — Unsuitable or defective — — - — — Not separate for sexes — — - — — Other offences — — — — — TOTAL 3 3 — 1 — Outwork No. of out-workers in August list 29 Nature of work Making, etc., wearing apparel. 20 Smoke Abatement Additional boilers have been installed at a large industrial firm in the Borough which in past years has been the source of a smoke nuisance. This has resulted in considerable improvement. Bacteriological Sampling of Milk During the year 104 samples of milk were submitted for examination and eleven were found to be unsatisfactory. Ice Cream Bacteriological Sampling. During the year 91 samples of ice cream were submitted for analysis and nine were found to be unsatisfactory. Registration of Premises. During the year 49 applications for the storage and sale of ice cream were granted. In all cases the provision on the premises of running hot water is required. 21 FOOD AND DRUGS ACT, 1938 Analyses Article Number Examined Number Adulterated, etc. Baking Powder 3 - Black Pudding 1 — Blanc Mange Powder 3 — Bread 7 7 Bun, Buttered 1 1 Cake Flour 1 - Cake Mixture 1 - Capers 1 — Caraway Seeds 1 — Chocolate Drink 1 - Chocolate Spread 1 - Cinnamon, Ground 2 - Coffee 2 - Coffee and Chicory Cubes 2 - Coffee and Chicory Essence 2 - Cooking Fat 1 - Cordial 1 - Curry Powder 2 - Custard 8 - Custard Powder and Mixture 3 - Dessert Powder 2 - Dough Nuts 5 - Dough Nut Rings 1 - Fish Cakes 1 - Fish Paste 1 - Flavouring Powder (Custard) 1 - Flour 1 1 Fruit Rock 1 - Frying Oil 5 - Gelatine 5 - Gin 8 - Ginger Wine, Non-alcoholic 1 - Ginger Wine Essence 1 - Glace Pineapple 1 - Golden Pudding Mixture 1 - Gravy Browning, Salt and Thick 5 - Herbs 9 - Herring Roes, Soft 1 - Ice Cream 8 - Jam Tarts 3 - Jelly 6 - Jelly Cream 1 - Junket Powder 1 - Lemon Flavour 1 - Lemonade Powder 1 - Lime Flavour Compound 1 - Macaroni 1 - Malt Cup 1 - Meat Extract Cubes 1 - Milk 44 7 "Appeal to Cow" Samples 7 - Mint Sauce 1 - 22 Analyses—cont. Article Number Examined Number Adulterated, etc. Mock Rice 1 - Nutmegs, Ground 1 - Oatmeal 1 - Olive Oil 4 - Onions, Dried 1 - Parsley 1 - Pastry Mix 3 - Peach Puree 1 - Pepper 3 - Pickles 1 - Potato Crisps 1 - Pudding Mixture 1 - Sago 1 - Salad Cream 1 - Salad Oil 1 - Sandwich Spread 3 - Sauces 14 - Sausage Meat 5 - Sausages 24 - Savoury Rissole Mixture 1 — Scone Flour Mixture 2 - Semolina 1 - Shortbread 1 - Soup 2 - Spice 3 - Sponge Mixture 1 - Stuffings 4 - Suet 2 - Sultana Chutney 1 - Sweetened Fat Compound 1 - Sweetmeats 2 - Tea 1 - Tomato Ketchup 2 - Tomato Spread 1 - Vinegar 6 - Whisky 17 - Medicinal Samples :— - Asprin Tablets 1 - Bicarbonate of Soda 2 - Borax 1 - Bronchial Catarrh & Chest Mixture 1 - Cough Mixture 1 - Cream of Tartar 1 - Epsom Salts 1 - Glycerine 1 - Heart Tonic 1 - Linctus 1 - Paraffin, Liquid 1 - Peppermints 1 - Saccharin Tablets 3 - Seidlitz Powder 1 - Syrup of Figs 1 - Tincture of Iodine 1 - 23 Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 709A Bread Informal Contained foreign matter. Vendor warned. 725A Milk Informal Contained blood. Vendor warned. 769A Flour Informal Slight taint suggestive of a chlorphenolin disinfectant. Vendor warned. 791A Milk Informal Sour taste due to acidity. No action necessary. 792A Bread Informal Contained fragments of dirty dough containing traces of mineral oil. Vendor warned. 794A Bread Informal Contained a dead maggot, a larval case and web. Vendor warned 801A Milk Informal Contained 30 per cent, added water. No action possible. 821A Bread Informal Contained a brownish black mass of dirty dough. Vendor warned. 822A Bread Informal Contained discoloured patches due to stale dough. Vendor warned. 823A Buttered Bun Informal Contained a thumbnail—not baked in bun. Complainant informed. 824A Bread Informal Contained brownish black mass of dirty dough. Vendor warned. 851A Bread Informal Tainted with mineral oil. Vendor warned. 24 Adulterated Samples, etc.—cont. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1521 Milk Formal Contained 2% added water. Proceedings instituted. Vendor discharged on payment of £l costs. 1523 Milk Formal Deficient in milk fat to the extent of 6%. 1524 Milk Formal Deficient in milk fat to the extent of 6%. "Appeal to Cow' samples taken. 1525 Milk Formal Deficient in milk fat to the extent of 13%. Unsound Food A considerable number of articles of food continued to be brought to the department. These included a variety of foreign substances in bread, a bird's wing in cake and a bolt in butter. There were two successful prosecutions. Warning letters were sent in other cases. Clean Food Campaign Lectures were given by the Medical Officer of Health and Chief Sanitary Inspector to food handlers working in the Borough. Arrangements were made for the assistants to attend in the employers' time ; there was a good response. It is hoped to arrange a further series of lectures to include the members of various local organisations, especially those attended by women. Food Poisoning Outbreaks During the year 12 cases of food poisoning were notified; these covered three small outbreaks. In no case was the causative organism identified. 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 23 60 152 27 10 2 - - 275 Whooping Cough 31 53 60 56 - 1 - - - 201 Acute Poliomyelitis - 6 6 4 4 4 2 - - 26 Acute Polioencephalitis. . - - 1 — - - - - - 1 Measles .. 24 221 183 160 6 8 1 - - 603 Diphtheria - - - - - - - - - - 0—5 5-15 15-45 45-65 65 and over No age Non-Civilian Total Pheumonia : Acute Primary .. 11 2 9 7 6 - - 35 Influenzal .. - 1 1 - - - - 2 Dysentery .. - - - - - - - - Smallpox .. - - - - - - - - Enteric Fever .. - - - - - - - - Paratyphoid .. - - - - - - - - Erysipelas .. - 2 6 10 1 - - 19 Cerebro Spinal Fever .. 4 - - - - - - 4 Puerperal Pyrexia .. - - 6 - - - - 6 Ophthalmia Neonatorum .. 12 - - - - - - 12 Pemphigus .. 1 - - - - - - 1 Food Poisoning .. 3 3 2 3 1 — - 12 26  Notified Admitted to Isolation Hospital, Rush Green Admitted to other isolation Hospitals Admitted to other Hospitals Deaths Registered Cerebro Spinal Meningitis 4 4 - - 1 Diphtheria - - - - — Dysentery - - - - — Enteric - - - - — Erysipelas 19 3 1 - — Food Poisoning 12 - - - — Malaria 1 1 - - — Measles 603 14 2 - 1 Ophthalmia Neonatorum 12 3 - 1 — Pemphigus 1 1 — — — Puerperal Pyrexia 6 5 — — — Pneumonia:— Acute Influenzal 2 - 1 — 44 Acute Primary 35 4 1 1 Polioencephalitis Acute 1 1 — — 1 Poliomyelitis Acute 26 25 — 1 2 Scarlet Fever 275 25 13 2 Smallpox — — — — - Whooping Cough 201 7 2 2 1 DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year:— Number of SCHOOL children immunised without preliminary testing 711 Number of PRE SCHOOL children immunised with' out preliminary testing 1,475 Number of SCHOOL children who received a boosting dose 346 Immunisation by General Practitioners. Number of SCHOOL children immunised without preliminary testing 10 Number of PRE SCHOOL children immunised with' out preliminary testing 119 Number of SCHOOL children who received a boosting dose 5 27 VACCINATION CARRIED OUT BY GENERAL PRACTITIONERS Vaccinated. 1949 (Under 1) 51 1945-8 (1—4) 54 1935-44 (5—14) 10 Before 1935 (15 or over) 27 Total 142 Re-Vaccinated. 1949 (Under 1) — 1945-8 (1—4) — 1935-44 (5—14) — Before 1935 (15 or over) 34 Total 34 TUBERCULOSIS New Cases Deaths Primary Notification Brought to notice other than by Form A Pulmonary NonPul monary Pulmonary NonPul monary Pulmonary NonPul monary M F M F M F M F M F M F Under 1 - - - - - - - - - - - - 1— 1 5 1 2 1 1 1 1 - - 2 - 5— 1 3 1 3 - 1 — 1 - — — 10- 1 1 2 3 1 1 1 - - - - - 15— 9 21 1 1 - 2 - - - - - - 20- 21 13 2 1 6 7 - 1 2 2 — 1 25- 13 23 2 1 5 9 - - 5 4 1 - 35- 13 3 - - 3 2 - - 4 2 - - 45— 15 1 - 1 - - 1 - 12 - 1 - 55— 8 4 1 - - - - - 9 4 - - 65—and upwards - - 1 - - 1 - - 5 - - - 82 74 11 12 16 24 3 3 37 12 4 1 28 Register. Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1949 662 466 146 166 During the year:— New notifications 89 81 11 11 Deaths 37 12 4 1 Transfers into area 17 28 3 1 Transfers out of area 151 106 15 20 Removed from register as " Recovered " 81 106 69 69 No. on register 31st December, 1949 499 351 72 88 MATERNITY AND CHILD WELFARE Notification of Births 2,028 notifications of live births were received during the year; the majority of these were notified by midwives. This number includes 76 children who were born in Rush Green Hospital but whose normal residence is not within the Borough. Stillbirths 9 male and 22 female stillbirths were notified, the corresponding figures for registration being 10 and 19. The rate per 1,000 of total population registered was 0.25, the rate for England and Wales being 0.39. Infant Mortality 55 infants under one year of age died during the year, giving an infant mortality rate of 28.21 per 1,000 live births, compared with that of 32 for England and Wales and 29 for London. The rate amongst legitimate children was 26.61 while for illegitimate children it was 70.42. Ophthalmia Neonatorum 12 cases of this disease were notified, 4 of which were treated in hospital ; all made complete recoveries. There were 52 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 It is very pleasing to be able to report that there were no instances of maternal mortality in 1949. 30 Notices summoning medical aid 568 For (a) Mothers 479 For (b) Infants 89 Notifications that they had been associated with the undermentioned conditions were received from midwives:— Substitution of artificial feeding 19 Liable to be sources of infection 8 Stillbirths 3 Deaths of Mother or Child 1 Laying out dead bodies - Domiciliary Midwifery Service Below is a table setting forth in statistical form the work of the County Midwives, Midwives residing at York House Training Home and Salvation Army Midwives for the year 1949:— County Midwives Midwives Residing at York House Training Home Salvation Army Midwives Births Attended: As Midwife 535 389 80 As Maternity Nurse 59 36 6 Miscarriages Attended (included in above) 14 11 12 Visits Paid: As Midwife 10,429 7,388 2,888 As Maternity Nurse 1,229 684 147 Ante-Natal 4,210 3,118 531 Ante-Natal Clinics Attended 767 238 100 Gas and Air Administered 310 162 65 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 5 Nursery Assistants 11 Nursery Assistant (Part-Time) 1 Nursery Students 14 Nursery Helper 1 Total 39 Total Attendances at Nurseries for 1949: - Goresbrook Nursery Under 2 years of age 4,585 Over 2 „ „ 9,786 Chadwell Heath Nursery Under 2 years of age 2,932 Over 2 „ „ „ 8,765 Kingsley Hall Nursery Over 2 ,, ,, ,, 8,853 Total 34,921 Premature Infants Number of premature infants notified during the year (including transferred notifications) whose mothers normally reside in the Authority's area:— (i) Born at Home 60 (ii) Born in Hospital or Nursing Home 17 Premature babies born in the area (whether their mothers normally reside in the area or not) but excluding babies born in maternity homes and hospitals in the National Health Service:— Transferred to hospital Nursed entirely at home Grand Total Died in first 24 hrs. Died on 2nd to 7th day Died on 8th to 28th day Suvived 28 days Total Under 3 lbs. 1 1 1 - 2 3 3-4 lbs. 10 - - - 1 1 11 4-5½ lbs. 4 — — — 42 42 46 Total 15 1 1 — 43 45 60 CAUSES OF DEATH Under I year 1 and under 2 years 2 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 35 years 35 and under 45 years 45 and under 55 years 55 and under 65 years 65 and under 75 years 75 and over TOTAL RegistrarGeneral's Allocations M F M F M F M F M F M F M F M F M F M F M F M F M F 1. Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - - - - - - - - - - - - 2. Cerebro-Spinal Fever — — 1 — — — — — — — — — — — — — — — — — — — 1 — 1 — 3. Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — — 4. Whooping Cough — 1 — — — — — — — — — — — — — — — — — — — — — 1 — 1 5. Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — — 6. Tuberculosis of Respiratory System - — — — — — — — 2 2 6 3 4 2 12 — 8 5 5 — — — 37 12 36 12 7. Tuberculosis (other forms) - — — — 1 — 1 — — 1 1 - - - 1 - - - - - - - 4 1 5 2 8. Syphilitic Disease — — — — — — — — — — — — — — 1 — — — — — — 1 1 1 2 — 9. Influenza - 1 - - - - - - - - - - 1 - - - - - - - - 1 1 2 2 3 10. Measles — — — — — — — 1 — — - — — - - - - - - - - - - 1 - 1 11. Acute Poliomyelitis and Polioencephalitis - - - - - 2 1 - - 1 - - - - - - - - - - - - 1 2 1 2 12. Acute Infectious Encephalitis - - - - - - - - - - - - - - - - - - - - - - - - - - 13. Cancer of Buccal Cavity and Oesophagus (Males only) - - - - - - - - - - - - - - 1 - - - - - 1 - 2 - 4 - 13.f. Cancer of Uterus — — — — — — — — — — — — — — — 1 — 2 — 1 - 1 - 5 - 7 14. Cancel of Stomach and Duodenum — — — — — — — — — — — — 1 — 4 — 4 4 1 2 3 2 13 8 15 8 15. Cancer of Breast — — — — — — — — — — — — — 2 — 1 — 2 — — — 1 — 6 — 9 16. Cancer of all other sites — — — — — — — 1 — — 1 1 3 — 14 7 25 12 29 9 7 6 79 36 77 33 17. Diabetes — — — — — — — — — — — — — — — 1 — 2 — — — 1 — 4 1 5 18. Inter-cranial Vascular Lesions 1 — - — — — — — 1 — — — 1 — — 3 4 6 11 10 5 9 23 28 15 25 19. Heart Disease — — - — — - 1 — — 1 1 — 2 3 20 6 31 11 34 13 29 36 118 70 110 77 20. Other Diseases of Circulatory System - - - - - - - - - - - 1 - - 3 2 6 2 5 4 3 7 17 16 12 15 21. Bronchitis — — — - - — — — — — — — — 1 6 — 6 1 6 4 7 2 25 8 43 16 22. Pneumonia 7 4 - - - - - 1 — — 1 — 1 2 3 1 7 2 10 6 8 15 37 31 29 15 23. Other Respiratory Diseases - - — — — — — — — — 1 — 1 - 1 2 2 2 1 1 — 1 6 6 8 6 24. Ulceration of the Stomach or Duodenum - - - - - - - - - - - - - - - - 1 1 — — — — 1 1 3 2 25. Diarrhoea (under 2 years) — 1 - - - - - - - - - - - - - - - - - - - - - 1 - - 26. Appendicitis — — — — — — 1 — 1 — — — — — — — — — — — — — 2 — 4 — 27. Other Digestive Diseases — 1 — — 1 — — 1 — — — — — 4 3 — 2 2 1 3 2 2 9 13 3 11 28. Nephritis — — - — — — - — 1 — 1 — 1 — 1 2 1 4 3 1 3 — 11 7 8 7 29. Puerperal and Post-Abortive Sepsis - - - - - - - - - - - - - - - - - - - - - - - - - - 30. Other Maternal Causes — — — — — — — — — — — — — — — — — — — — — — — — — — 31. Premature Birth 14 7 - - - - - - - - - - - - - - - - - - - - 14 7 11 7 32. Congenital malformation, birth injury, and infantile disease 11 5 - - - - - 1 - - - 1 - - - - - - - - - - 11 7 17 10 33. Suicide — — — — — — — — — — — — 1 — 1 1 — 1 - - - - 2 2 2 2 34. Road Traffic Accidents — — — — 1 1 1 - 2 - - - 1 - - - 1 - - - - - 6 1 6 1 35. Other Violent Causes — — — — — — — — — — — — 1 — 2 — 1 — 1 — — — 5 — 5 3 36. All Other Causes 1 2 — — 1 — — 1 3 — 2 3 4 1 — 4 3 4 5 5 6 10 25 30 29 27 451 307 449 307