DAGENHAM AC 4411 (1) DAEENHAM DAE 24 BOROUGH OF DAGENHAM ANNUAL REPORT of the Medical Officer of Health for the year 1950 CECIL HERINGTON, M.D. (Lond.), D.P.H. BOROUGH OF DAGENHAM ANNUAL REPORT of the Medical Officer of Health for the year 1950 CECIL HERINGTON, M.D. (Lond.), D.P.H. 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting my report on the health of the Borough of Dagenham for the year 1950. For the first time since Dagenham became a municipal entity (in 1926) the birth rate has fallen below that for England and Wales as a whole, 15.36 compared with 15.8. 15.36 is the crude birth rate, when the comparability factor of 0.95 is applied the adjusted rate is 14.59. This reduction is an indication of the stabilization of the population and of the fact that the population is ageing, or in other words that the number of persons of the reproductive age compared with the total population is diminishing. The crude death rate was 6.92, the adjusted rate being 11.35, which compares favourably with that for the country as a whole which was 11.6. The comparability factor given for Dagenham for purposes of computing the death rate is 1.64. It is very gratifying to be able to record that for the second year in succession there were no maternal deaths. INFECTIOUS DISEASES. There has been a marked increase in the notifications of both Measles and Whooping Cough, but probably the severity of attack has been light; there were no deaths attributed to Whooping Cough, but one death was assigned to Measles. With regard to active prevention of Whooping Cough, the Whooping Cough Immunisation Committee of the Medical Research Council has now released some very informative findings gleaned as results of extensive research over a number of years. These may be considered as encouraging but it must be borne in mind that the effectivity of the best antigens so far prepared falls far short of the Diphtheria prophylactics in common use. One case of Diphtheria was notified in the person of a man aged 22. He had not been immunised. It might be of interest here to quote from the Annual Report of my predecessor 20 years ago "The light incidence of Diphtheria in the country as a whole during 1931 was reflected in the small number of local notifications received, these being only 207 as against 383 in 1930." Compare this with 1950 when, as mentioned above, one case only was reported and that was not fatal. In the year 1931, 12 deaths occurred from Diphtheria. 4 Poliomyelitis was confirmed in seven cases ; two of these were of the nonparalytic type. There was one death. This is a large reduction from the previous year when 26 cases were confirmed. The differentiation between paralytic and nonparalytic forms of this disease was not made prior to 1950. The number of persons on the Tuberculosis register shows an increase from 1,010 to 1,113, but the number of deaths from Tuberculosis (all forms) shows a reduction from 54 to 49. This apparent increase in incidence should not be regarded with alarm. It is attributable to immigration of persons suffering from this disease, who receive priority in housing by sending Authorities. MORTUARY. The Council's mortuary which was built many years ago and proved to be obsolete by reason of its size, design and equipment, has been closed down. Accommodation has temporarily been afforded by the East Ham Corporation. Negotiations are now proceeding with a neighbouring Borough with a view to the extension and modernization of an existing mortuary, which, when completed, should meet the needs of the participating Authorities. CARAVANS. Three applications for land in the Northern part of the Borough to be used as sites for caravans were received. In view of the inability of providing satisfactory sanitary facilities the applications were refused. The only appeal against the Council's decisions was dismissed by the Magistrate's Court. FOOD POISONING. Information was received that several children in an Infants' School were suffering from diarrhoea and abdominal pains. On visiting it was found that of the 138 children on the register 16 were absent, the cause of each case being given as diarrhoea and abdominal symptoms. Of these, eight had taken school dinners. All four classes were involved. I visited the school and discussed the position with the Head Mistress. Suggestions were made to her with regard to the control of the outbreak, and the names of the private Doctors of the children concerned were ascertained. Following this I telephoned these Doctors and informed them of the possibility of Sonne Dysentery. During my interview with the Head Mistress I requested her to supply me with any information of sickness amongst members of the teaching and canteen staff. Three days later a telephone message was received that a member of the canteen staff was away ill. This lady was visited at her home and in co-operation with her Doctor a bacteriological 5 investigation was carried out. Infection with the Sonne Dysentery bacillus was confirmed. After suitable treatment and a series of further investigations, she became free from infection and was permitted to resume duty. Although it is impossible to pinpoint the cause of this out' break, there is substantial evidence that the canteen worker was the source of infection. The fact that eight of the children infected did not take school meals does not disprove this ; the probability is that the infected children disseminated the organisms by close contact. SCABIES. It is somewhat unsual to have to invite atten' tion, with pleasure, to the discontinuance of a service provided for the benefit of the public. Such, however, is the case with the Scabies Clinic. Scabies has now, fortunately, ceased to exist as a public health problem in Dagenham. I take this opportunity of expressing appreciation of the value of the services of Mr. Farrow and Mrs. Pharaoh, Clinic attendants. It is with pleasure that I again record my thanks to the Chair' man and members of the Committees associated with the adminis' tration of the health services of the Borough. I would also once more offer my sincere thanks to my colleagues and members of the staff for their help so readily given at all times. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, CECIL HERINGTON, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 6 MEMBERS OF THE COUNCIL ( 31st December, 1950) Mayor : Alderman (Mrs.) A. E. PRENDERGAST, J.P. Deputy Mayor : Alderman J. W. BURRIDGE. Aldermen : W. E. BELLAMY L. F. EVANS (Mrs.), M.B.E., F. BROWN, J.P. J.P., E.C.C. R. J. D. CLACK F. GRINDROD, J.P. F. G. THOMAS Councillors : S. F. BANKS A. BASS R. BLACKBURN J. BOWLES I. M. BROCKELBANK (Mrs.) G. A. BROOKER E. A. BROWNE F. COOMBS G. H. A. CROUCH E. W. DEEKS A. S. HADDOCK G. T. HARRIS J. HOLLIDGE, J.P., E.C.C. Wm. C. IRELAND A. KEMPSON E. M. MILLARD (Mrs.) D. O'DWYER C. PRENDERGAST B. M. ROADKNIGHT (Mrs.) L. A. SAYER L. S. SNELLING (Mrs.) A. F. WARR (Mrs.), E.C.C. S. J. C. WARR J. WRIGHT PUBLIC HEALTH COMMITTEE Councillor G. A. BROOKER, Chairman Councillor (Mrs.) A. F. WARR, Vice-Chairman Her Worship the Mayor (Alderman Councillor A. BASS (Mrs.)A.E. PRENDERGAST, J.P.) Councillor E. A. BROWNE Deputy Mayor Councillor D. O'DWYER (Alderman J. W. BURRIDGE) Councillor B.M ROADKNIGHT 7 DAGENHAM HEALTH AREA SUB-COMMITTEE Alderman (Mrs.) A. E. PRENDERGAST, J.P., Chairman Alderman (Mrs.) L.F. EVANS, M.B.E., J.P., E.C.C., Vice-Chairman Members: — Borough Council Deputy Mayor : Alderman J. W. BURRIDGE Councillor A. BASS Councillor A. BLACKBURN Councillor G. A. BROOKER Councillor E. A. BROWNE Councillor F. COOMBS Councillor E. W. DEEKS Councillor A. KEMPSON Councillor D. O'DWYER Councillor C. PRENDERGAST Councillor (Mrs.) B. M. ROADKNIGHT Councillor L. A. SAYER Councillor (Mrs.) A. F. WARR Councillor S. J. C. WARR County Council Councillor (Mrs.) M. BREDO Councillor K. GLENNY Councillor W. HERRIDGE Councillor P. PORTER Councillor (Mrs.) E. SAYWOOD Councillor K. STONEBANK Councillor (Mrs.) E. STROM-OLSEN Hospital Management Committee Alderman (Mrs.) L. F. EVANS, M.B.E., J.P., E.C.C. Executive Council for Essex Mr. E. E. FARRANT Local Medical Committee for Essex Dr. P. GROARKE Voluntary Miss N. L. ODELL, Miss F. WAINWRIGHT and Organisations Miss I. WHEELER 8 OFFICERS OF THE PUBLIC HEALTH SERVICES (at time of going to press) 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 : H. D. H. ROBINSON, M.R.C.S., L.R.C.P., D.P.H. (C) Assistant Medical Officers : CATHERINE FITZPATRICK, M.B., B.Ch. (C) FANNIE HIRST, M.B., Ch.B., D.P.H. (C) W. B. KNAPMAN, M.R.C.S., L.R.C.P., L.D.S., R.C.S. (Eng.) (C) ELIZABETH MITCHELL, M.B., Ch.B. (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) M. E. ALLAM (S, 7) E. RICHARDS (5, 6, 7) I. A. BARROW (5, 6, 13) L. SALTER (5, 6, 7) G. M. CLUGSTON (5, 6, 7) D. B. STEWART (5, 6, 7) A. K. GIBSON (5, 6, 7) J. E. THOMAS (5, 6, 7, 10, 14) D. GORDON (5, 6, 7, 9, 10) R. E. WALKER (5, 6, 7, 12, 13) D. HICKEY (5, 6, 7) L. WARR (5, 13) 9 Senior Midwife : (C) E. M. BEDFORD (5, 6) Midwives: (C) D. K. ANKER (6) M. M. RICHARDS (6) M. GOODBUN (5, 6) M. M. ROBSON (6, 10) M. HALL (6) M. ROCK (6) H. MITSON (5, 6) M. J. STOREY (6) K. MOYNIHAN (5, 6) M. TEATHER (5, 6) Clerical Staff : Chief Clerk: (C) F. W. KNIGHT (1, 2) Clerk to Sanitary Inspectors: W. J. BATCHELER (1) Clerks : E. ADAMS (C) I. M. BISHOP (C) N. BRIAND (C) N. E. CLOKE (C) G. DOVEY S. DOWDING (C) M. GOODCHILD (C) H. GOODCHILD (C) G. K. HARRIS E. M. HOLLEY (8) (C) S. B. LEADER (C) L. A. MOORE (C) D. TYLER (C) M. A. WATTS (C) J. WHATLING (C) Goresbrook Nursery, Dagenham Avenue, Dagenham. Chadwell Heath Nursery, Ashton Gardens, Chadwell Heath. Kingsley Hall Nursery, Parsloes Avenue, Dagenham. Day Nurseries: (C) MATRON: E. MADDISON (12) DEPUTY : K. GRAHAM (8) MATRON : Vacant DEPUTY : Vacant WARDEN : D. HOWES Domestic Help Organiser : G. HICKINBOTHAM Chiropodists : (C) N. FREEMAN M. KELLY (11). Foot Clinic Receptionist : K. RICHARDS (C) Dental Attendant: M. E. SEALEY 10 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 Certificate of Royal Medico Psychological Association 14 Part-Time Staff : Dentist : F. C. RITCHIE, L.D.S., R.C.S. (Eng.) Public Analyst: J. HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. 11 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar General's estimate of resident population, 1950 115,400 Number of inhabited houses (end of 1950) according to Rate Books 28,431 Rateable value (December 31st, 1950) £654,615 Sum represented by a penny rate (approximate 1950-51) £2,662 Extracts from Vital Statistics for the Year. Live Births :— Total Male Female Legitimate 1,699 918 781 Illegitimate 74 32 42 Birth rate per 1,000 of the estimated resident population, 15.36. Stillbirths Legitimate 44 25 19 Illegitimate 1 1 — Rate per 1,000 total (live and still) births, 24.75. Deaths 799 453 346 Death rate per 1,000 of the estimated resident population, 6.92. Deaths from pregnancy, childbirth, abortion :— Rate per 1,000 total Deaths. (live and still) births. Nil Nil Death rate of infants under one year of age :— All infants per 1,000 live births 29.33 Legitimate infants per 1,000 legitimate live births 24.72 Illegitimate infants per 1,000 illegitimate live births 135.14 12 Deaths from Cancer (all ages) 179 „ „ Measles (all ages) 1 „ Whooping Cough (all ages) Nil „ „ Gastritis, Enteritis and Diarrhoea 3 Births. 1,773 live births were registered during the year, there being 950 males and 823 females. There is a decrease of total births from 1,950 in 1949 to 1,773. The birth rate per thousand population was 15.36 compared with 15.8 for England and Wales and 17.6 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, 19.15 and 17.14 for the years 1927 to 1949 inclusive. The illegitimate birth rate continues to be very low, being only 4.17 per cent, of total births. The rate of illegitimate stillbirths is 2.22 per cent, of total stillbirths. Death Rate. Total deaths in district 599 Outward transfers 160 Inward transfers 360 Deaths of residents 799 Of the 160 deaths of non-residents occurring in the district, five took place at the Dagenham Hospital and 144 at the Rush Green Hospital. Of the 360 deaths of local residents taking place outside this area, most occurred in institutions. Of these, 159 occurred at Old' church Hospital; 39 at 117, Suttons Lane, Hornchurch; 16 at King George Hospital; 13 at Severalls Hospital; 10 at the London Hospital; 10 at Whipps Cross Hospital; nine at St. Joseph's Hospice; eight at East End Maternity Hospital; seven at Harold Wood Hospital; five at The Retreat, Great Burstead, and four at Wanstead Hospital. The death rate of 6.92 compares with 11.6 for England and Wales. For the years from 1927 to 1949 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, 6.63, 6.15 and 6.64. 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 195O. 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 15.8 0.37 11.6 0.00 - - - - - 0.10 1.9 29.8 126 County Boroughs and Great Towns, including London 17.6 0.45 12.3 0.00 — — — — — 0.09 2.2 33.8 148 smaller towns (1931) resident population 25,000-50,000 16.7 0.38 11.6 0.00 - — — — — 0.10 1.6 29.4 London 17.8 0.36 11.8 0.00 — — — — — 0.07 1.0 26.3 Dagenham 15.36 0.39 6.92 0.00 — 0.01 0.00 0.00 0.00 0.04 1.69 29.33 14 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. 39 1 Weekly Thursday, p.m. 45 2 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Monday, p.m. 56 3 Weekly Tuesday, a.m. 28 1 Weekly Tuesday, p.m. 46 2 The Leys Clinic, Ballards Road, Dagenham. Weekly Thursday, a.m. 31 1 Weekly Thursday, p.m. 47 3 Out-Patient Department, King George Hospital, Five Elms, Dagenham. Weekly Wednesday, a.m. 47 2 Weekly Wednesday, p.m. 62 3 Weekly Friday, a.m. 40 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (2nd, 4th & 5th in month) Friday, a.m. 12 1 Friday, p.m. 30 2 The Clinic, Ford Road, Dagenham. Weekly Tuesday, a.m. 61 3 Weekly Tuesday, p.m. 67 4 The Clinic, 30/32, Elmbridge Road, Hainault. (now held at Manford Way) Weekly (commenced 6.3.50) Monday, p.m. 30 4 15 Ante-Natal Clinics CENTRE Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Ashton Gardens, Chadwell Heath. (1st, 3rd 6 & 5 th in month) Monday, a.m. 9 1 Weekly Monday, p.m. 12 2 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 16 3 Weekly Wednesday, a.m. 12 2 Weekly Friday, a.m. 13 2 Weekly Friday, p.m. 13 2 The Leys Clinic, Ballards Road, Dagenham. Weekly Tuesday, a.m. 15 2 Weekly Wednesday, a.m. 13 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (1 st & 3 rd in month) Friday, a.m. 12 1 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 22 3 Weekly Wednesday, p.m. 18 2 Weekly Thursday, a.m. 11 2 Weekly Thursday, p.m. 13 2 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 19 3 Weekly Monday, p.m. 29 4 The Clinic, 30/32, Elmbridge Road, Hainault. (now held at Manford Way) (2nd & 4th in month) Monday, a.m. 13 3 16 Sanitary Inspection of the District Report of the Sanitary Inspectors. (a) Nature and number of visits: — Overcrowding and Housing Conditions 857 Nuisances under Public Health Acts— Dwelling-houses 5,278 Other Premises 550 Bakehouses Milkshops, dairies and vehicles 127 Foodshops and stalls 2,045 Meat Vans 15 Cafes and canteens 724 Infectious disease enquiries 1,145 Visits to foster-mothers' premises 239 Number of complaints investigated 1,129 Outworkers' premises 215 Factories 226 Workplaces and offices 44 Tents, vans and sheds 182 Stables 22 Hairdressers' and barbers' premises 81 Shops Acts 126 Ice Cream premises and vehicles 395 Houses fumigated 63 Rodent Control 1,393 Other Visits 124 (b) Notices served: Complied with: — Statutory 173 153 Informal 779 637 17 Water The water supply is satisfactory in quality and quantity. Since November, 1938, eight local authorities in the South Essex Water' works 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 :— Diameter length 3" 52 yards 4" 1,270 „ 6" 356 „ Total 1,678 „ 307 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 treat' ment 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. Between 3,000 and 4,000 chemical, bacteriological and biological examinations have been made during the year. All water going into supply was wholesome." 18 FACTORIES ACTS, 1937 & 1948 Inspections. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 31 48 5 - Factories with mechanical power 133 178 8 - Other premises under the Act (including works of building and engineering construction but not including outworkers' premises) 15 19 - - TOTAL 179 245 13 - Defects Found. No. of defects No. of prosecutions instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness 5 5 - 5 - Overcrowding - - - - - Unreasonable temperature - - - - - Inadequate ventilation - - - - - Ineffective drainage of floors - - - - - Sanitary Conveniences :— Insufficient 7 7 - 4 - Unsuitable or defective 9 8 - 1 - Not separate for sexes - - - - - Other offences 1 1 - - - TOTAL 22 21 - 10 - Outwork No. of out-workers in August list 15 Nature of work Making, etc., wearing apparel. 19 Smoke Abatement Observations were taken throughout the year; no serious cases of pollution were recorded. Bacteriological Sampling of Milk During the year 73 samples of milk were submitted for examination and two were found to be unsatisfactory. Ice Cream Bacteriological Sampling. During the year 38 samples of ice cream were submitted for analysis and eight were found to be unsatisfactory. Registration of Premises. During the year 20 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. One application was refused because of the lack of cleansing facilities available on the premises. 20 FOOD AND DRUGS ACT, 1938 Analyses Article Number Examined Number Adulterated, etc. Baking Powder 4 - Beef Beverage 1 - Beef Cubes 1 - Beef, (Minced 2 - Beverage 1 - Bicarbonate of Soda 4 - Blanc Mange Powder 2 - Bread 5 3 Breadcrumbs 1 - Brown Ale (Ingredients for making 1 - Bun and Cake Flour Batter 3 - Cake Mixture 1 - Capers, French 1 - Caraway Seeds 1 - Celery Salt 1 - Chocolate Biscuits 1 - Chocolate Cup Cake 1 1 Chocolate, Drinking 1 - Chocolate Spread 1 - Cinnamon 1 - Cloves, Ground 1 - Cocktails 3 1 Coconut, Sweetened 1 - Coffee and Chicory Extract 1 - Cornflour 2 - Curry Powder 1 - Custard Powder 8 - Dessert Powder 5 - Filets de Chinchards a l'huile 1 - Fish Cakes 3 - Gelatine 1 - Ginger Beer 1 1 Ginger Wine 1 - Ginger, Ground 3 - Golden Raising Powder 1 - Gripe Water 1 - Herbs 12 - Horseradish 1 - Ice Cream 7 - 21 Analyses—cont. Article Number Examined Number Adulterated, etc. Icing 1 1 Jam 2 - Jellies 4 - Junket 1 - Lemonade Cyrstals 2 - Lollipop 2 - Meat Extract 1 - Milk 48 2 Mint in Vinegar 1 - Mustard Compound 1 - Nutmeg, Ground 4 - Olive Oil 2 - Pastry Mix 5 1 Pea Flour 1 - Pepper 4 - Pepper Flavoured Compound 2 - Potato Crisps 1 - Sage and Onion 1 - Sandwich Spread 1 - Sauces 3 - Sausages 37 - Sausage Meat 2 - Self Raising Flour 2 - Sherry 2 - Short Bread Mixture 1 - Soup 2 - Spice, Mixed 2 - Sponge Mixture 4 - Stuffings 3 - Suet 4 - Sugar Wheat Puffies 1 - Tart 1 1 Tunny Fish 1 - Vegetable Extract 1 - Vinegar 5 - Vitamin Tonic 1 - Whisky 2 - Wines 3 - Yorkshire Pudding & Pancake Mixture 1 - 22 Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 852A Tart Informal Contained cockroach which had been baked in tart. Manufacturer prosecuted. Defendant discharged on payment of £5 costs. 868A Ginger Beer Informal Contained mould growth in suspension. Vendor warned. 882A Bread Informal Contained patches of dirty fatty dough. Vendor warned. 887A Soft Icing Informal Had separated into two parts, one containing sugar, the other oil. Manufacturers warned. 927A Bread Informal Contained a piece of cotton wool. Vendor warned. 928A Bread Informal Contained fragments of charred bread. Vendor warned 929A Chocolate Cup Cake Informal Contained a cigarette end. Manufacturer prosecuted. Fined£ 2. 93 4A Pastry Mix Informal Fat in rancid condition. Vendor warned. 1567 Milk Formal Contained 2% added water. Vendor prosecuted. Fined £10. 1570 Milk Formal Contained 2% added water. 1719 Cocktail Formal 0.6% deficient in proof spirit. Vendor warned. 23 Unsound Food The department continues to receive articles of food containing a variety of foreign substances. There were eight 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. Lectures have also been given to the members of various local organisations, especially those attended by women. On two occasions all the local cinemas exhibited films ("Another Case of Poisoning" and "Fly About the House") and the department arranged suitable publicity throughout the Borough. Food Poisoning Outbreaks During the year 11 cases of food poisoning were notified; these covered four small outbreaks and one single case. In one case the causative organism was identified. 24 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES NOTIFIABLE DISEASES (Other than Tuberculosis) Under1 year 1-2 3-4 5-9 10-14 15-24 25 and over Age unknown Total Scarlet Fever 2 12 43 105 37 8 5 - 212 Whooping Cough 42 130 174 204 6 2 3 - 561 Acute Poliomyelitis :— Paralytic - 1 1 1 1 1 - - 5 Non-paralytic - 1 1 - - - - - 2 Measles 35 250 298 405 7 4 2 - 1001 Diphtheria - - - - - 1 - - 1  Under 5 years 5-14 15-44 45-64 65 and over Age unknown Total Pneumonia :— Acute Primary 11 8 15 8 6 - 48 Acute Influenzal - 1 1 1 - - 3 Dysentery 1 - - - - - 1 Smallpox - - - - - - - Encephalitis, Acute :— Infective - - 1 - - 1 - - - - - - - Enteric Fever - - - - - - - Paratyphoid Fever - - - - - - - Erysipelas 1 - 4 6 1 - 12 Meningococcal Infection - 2 - - - - 2 Food Poisoning 2 4 2 3 - - 11 Puerperal Pyrexia - - 4 - - - 4 Ophthalmia Neonatorum 5 - - - - - 5 Pemphigus - - - - - - Malaria (Foreign Origin) - - 2 2 25 Notified Admitted to Isolation Hospital, Rush Green Admitted to other isolation Hospitals Admitted to other Hospitals Deaths Registered Diphtheria 1 - 1 - - Dysentery 1 - 1 - - Encephalitis, Acute 1 1 - - 1 Enteric Fever - - - - - Erysipelas 12 1 - - - Food Poisoning 11 1 2 - - Malaria 2 1 - - - Measles 1001 10 8 - 1 Meningococcal Infection 2 2 - - 4 Opththalmia Neonatorum 5 - - - - Pemphigus - - - - - Puerperal Pyrexia 4 1 1 2 - Pneumonia .— - Acute Influenzal 3 1 - 41 Acute Primary 48 6 - - Poliomyelitis, Acute Paralytic 5 4 - 1 1 Nonparalytic 2 2 - - - Scarlet Fever 212 23 9 - - Smallpox - - - - - Whooping Cough 561 15 9 - - DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year :— Number of SCHOOL children immunised without preliminary testing 131 Number of PRE-SCHOOL children immunised with- out preliminary testing 1,088 Number of SCHOOL children who received a boosting dose 242 Immunisation by General Practitioners. Number of SCHOOL children immunised without preliminary testing 27 Number of PRE-SCHOOL children immunised without preliminary testing 174 Number of SCHOOL children who received a boosting dose 38 26 VACCINATION CARRIED OUT BY GENERAL PRACTITIONERS Vaccinated. 1950 (Under 1) 180 1946-9 (1-4) 50 1936-45 (5-14) 32 Before 1936 (15 or over) 34 Total 296 Re-Vaccinated. 1950 (Under 1) - 1946-9 (1-4) - 1936-45 (5-14) - Before 1936 (15 or over) 55 Total 55 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 I - - - - - - - - - - - - 1- 4 4 2 1 1 - - - - - 1 - 5- 5 5 - 4 1 2 1 - - - - 10- 5 2 - - - - - - - - - - 15- 6 16 3 4 - 2 - - - 1 - - 20- 16 34 2 3 2 4 - 1 1 1 - - 25- 28 27 6 4 5 8 - - 7 9 1 - 35- 20 1 2 1 1 1 - - 6 2 - - 45- 10 5 - - 1 - - - 6 1 - - 55 65-and 7 - - - - - - - 7 3 - - upwards 1 - - - - - - - 3 - - - 102 94 15 17 11 17 1 1 30 17 2 - 27 Register. Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1950 499 351 72 88 During the year :- New notifications 102 94 15 17 Deaths 30 17 2 - Transfers into area 11 17 1 1 Transfers out of area 28 25 2 10 Removed from register as "Recovered" 16 14 5 6 No. on register 31st December, 1950 538 406 79 90 MATERNITY AND CHILD WELFARE Notification of Births 1,935 notifications of live births were received during the year; the majority of these Were notified by midwives. This number includes 120 children who were born in Rush Green Hospital but whose normal residence is not within the Borough. Stillbirths 27 male and 18 female stillbirths were notified, the corresponding figures for registration being 26 and 19. The rate per 1,000 of total population registered was 0.39, the rate for England and Wales being 0.37. Infant Mortality 52 infants under one year of age died during the year, giving an infant mortality rate of 29.33 per 1,000 live births, compared with that of 29.8 for England and Wales and 26.3 for London. The rate amongst legitimate children was 24.72 while for illegitimate children it was 135.14. Ophthalmia Neonatorum Five cases of this disease were notified ; all made complete recoveries. There were 35 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 1950. 28 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 . 262 Total visits . 434 (b) To children under 1 year of age First visits . 1,888 Total visits 3,894 (c) To children between the ages of 1 and 5 years Total visits 10,444 (d) Ineffective visits Total visits 2,940 (e) Other visits Total visits 1,499 Grand Total 19,211 Domiciliary Midwifery Service The following is a summary of the reasons for sending for medical aid by midwives:- Perineal Tear 107 Discharging Eyes 35 Prolonged Labour 31 Doctor Engaged for Delivery 30 Threatened Miscarriage 21 Malpresentation 20 Ante-Partum Haemorrhage 20 Miscarriage 17 Bleeding per Vagina 16 Rise of Temperature 15 Threatened Abortion 14 Postpartum Haemorrhage 12 Inflamed and Swollen Varicose Veins 10 0Unsatisfactory condition of patient 7 Adherent Placenta 7 High Blood Pressure 7 Albuminuria 6 Jaundice 6 Early Rupture of Membranes 6 Abortion 6 Infant Unsatisfactory 5 Foetal Distress 5 Premature Labour 4 Premature Baby 4 Inertia 3 Cyanosed Infant 3 Malformation of Infant 2 Other Causes 51 470 29 Notices summoning medical aid 470 For (a) Mothers 395 For (b) Infants 75 Notifications that they had been associated with the undermentioned conditions were received from domiciliary midwives:- Substitution of artificial feeding 21 Liable to be sources of infection 7 Stillbirths 7 Deaths of Mother or Child Nil Laying out dead bodies Nil 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 1950:- County Midwives Midwives Residing at York House Training Home Salvation Army Midwives Births Attended : As Midwife 433 277 71 As Maternity Nurse 60 21 13 Miscarriages Attended (included in above) 11 15 9 Visits Paid : As Midwife 8,753 6,198 2,181 As Maternity Nurse 810 378 282 Ante-Natal 4,248 2,193 415 Ante-Natal Clinics Attended 799 277 93 Gas and Air Administered : As Midwife 250 197 53 As Maternity Nurse 34 6 6 30 Dental Treatment The following particulars relate to dental treatment provided for mothers and young children:- Expectant Nursing Mothers or Children Under Five Years of Age Number of patients examined 224 228 Number of patients needing treatment 207 220 Number of patients treated 207 220 Number of patients made dentally fit 200 220 Number of Extractions 1,261 626 Number of fillings 5 10 Number of Anaesthetics administered : (a) local - - (b) general 263 291 Number of Scalings or scaling and gum treatment 38 - Number of Silver Nitrate treatment - 37 Number of Dressings 16 - Number of X-ray examinations 7 3 Number of Dentures provided : (a) full 95 - (b) partial 68 - 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 7 Nursery Assistants 12 Nursery Assistant (Part-Time) 1 Nursery Students 15 Nursery Helper 1 Total 43 31 Total Attendances at Nurseries for 1950 :— Goresbrook Nursery Under 2 years of age .— 3,343 Over 2 „ „ „ — 9,497 Chadwell Heath Nursery Under 2 years of age — 2,573 Over 2 „ „ 9,303 Kingsley Hall Nursery. Over 2 „ „ 8,130 Total 32,846 Premature Infants Live premature births occurring in the Area :— Weight at birth Under 3 lbs. 3-4 lbs. 4-5 i lbs. Bom at home and nursed entirely at home — 3 23 Born at home and transferred to hospital 1 4 7 Born in a private nursing home and nursed entirely there — — — Born in a private nursing home and transferred to hospital — — — Of those born at home two died in hospital, at one hour and three days respectively. CAUSES OF DEATH Under 1 year I 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. Tuberculosis, respiratory - - - - - - - - - 2 7 8 7 1 4 1 6 3 3 - - - 27 15 27 15 2. Tuberculosis, other - - - - 1 - - - - - 1 - 1 - - - - - - - - 3 - 3 - 3. Syphilitic disease - - - - - - - - - - -_ - - - - - 1 1 2 - - - 3 1 3 1 4. Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - - - 5. Whooping Cough - - - - - - - - - - - - - - - - - - - - - - - - - - 6. Meningococcal infections - 1 1 - 1 1 - - - - - - - - - - - - - - - - 2 2 2 2 7. Acute Poliomyelitis - - - - - - - - 1 - - - - - - - - - - - - - 1 - 1 - 8. Measles - - - - - - - - - - - - - - - - - - - - - - 1 - 1 - 9. Other infective and parasitic diseases - - - - - - - - - - - - - 1 - - - - - - - - - 1 - 1 10. Malignant neoplasm, stomach - - - - - - - - 1 - - - 1 2 - 1 6 6 2 - 1 5 14 14 16 13 11. Malignant neoplasm, lung, bronchus - - - - - - - - - - - - 1 - 5 3 16 - 13 3 2 - 37 6 36 8 12. Malignant neoplasm, breast - - - - - - - - - - - - - 2 - 8 - 5 - 2 - 1 - 18 - 18 13. Malignant neoplasm, uterus - - - - - - - - - - - - - - - 2 - - - 4 - - - 6 - 7 14. Other malignant and lymphatic neoplasms - - - - - - 1 - - - - 1 1 - 4 5 16 7 20 5 10 6 52 27 52 29 15. Leukæmia, aleukæmia - - - - 1 - - - - - - - - - 1 1 1 - 1 - - - 4 1 4 1 16. Diabetes - - - - - - - - - - - - - - - - - 2 5 4 - 2 5 8 4 8 17. Vascular lesions of nervous system 1 - - - - - - - - - - - - 4 1 6 5 10 11 10 7 15 25 45 28 43 18. Coronary disease, angina - - - - - - - - - - - - - - 11 - 23 3 18 5 5 1 57 9 64 12 19. Hypertension with heart disease - - - - - - - - - - 1 - - 1 1 - 5 8 3 7 2 7 12 23 1 3 23 20. Other heart disease - - - - - - 1 - - - - - 1 4 5 4 15 - 8 6 22 19 43 33 48 54 21.Other circulatory disease - - - - 1 - - - - - - - 2 - 1 3 1 3 4 8 5 6 - 20 - - 22. Influenza - - - - - - 1 - - - - - - - - - - 1 1 1 1 - 3 2 3 2 23. Pneumonia 6 1 1 - - - - - - 1 - - I 1 - - 5 3 7 2 3 10 23 18 16 14 24. Bronchitis 3 3 - - - - - - - - - - 1 - 3 - 19 2 10 5 11 9 23 19 40 16 25. Other diseases of respiratory system - - - - - - - - - - - - - - - - - - - - - - 2 2 5 2 26. Ulcer of stomach and duodenum - - - - - - - - 1 1 - - 1 - 3 - 2 2 1 1 - - 8 4 8 2 27. Gastritis enteritis and diarrhœa 1 - - - - - - - - - - - - 1 - - - - - 1 - - 1 2 1 2 28. Nephritis and nephrosis - - - - - - - _ - - - 1 1 - 1 2 - 2 - 1 1 2 3 8 1 4 29. Hyperplasia of prostate - - - - - - - - - - - - - - - - 2 - 4 - 1 - 7 - 4 - 30 Pregnancy, childbirth, abortion - - - - - - - - - - - - - - - - - - - - - - - - - - 31. Congenital malformations 7 2 - - - - - - - - - - - - - - - - - - - - 7 2 7 2 32. Other defined and ill-defined diseases 13 13 - 1 - - 1 1 1 - 1 3 3 5 3 1 - 7 4 8 6 13 32 52 38 49 33. Motor vehicle accidents - - - - - - 3 - 1 1 - - - - - - 1 - - - - 1 5 2 5 2 34. All other accidents - 1 - - - - 1 - 3 - - - 2 - 3 - - - - - 2 1 11 2 11 2 35. Suicide - - - - - - - - - - - 1 - - 3 - - - 2 - - - 5 1 5 1 36. Homicide and operations of war - - 1 - - - - - - - - - - - - - - - - - - - 1 - 1 - 31 21 3 1 4 1 9 1 8 8 10 15 23 22 53 38 117 65 119 73 79 98 456 343 453 346