AC 4411(1) DAOOMTAM 1 Mr. Dmara Dvi 5B 2 library DAG 28 BOROUGH OF DAGENHAM ANNUAL REPORT of the Acting Medical Officer of Health for the year 1954 H. D. H. ROBINSON, m.r.c.s., l.r.c.p., d.p.h. BOROUGH OF DAGENHAM ANNUAL REPORT of the Acting Medical Officer of Health for the year 1954 H. D. H. ROBINSON, m.r.c.s., l.r.c.p., d.p.h. 3 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you the annual report on the state of health and the working of the health services in the Borough of Dagenham in 1954. i must here pay tribute to Dr. Herington and his clinical, sanitary and administrative staffs who have laid the foundations on which you can build a major structure despite the lack of those key items, the health centres, from the National Health Service. Dr. Herington has, as he said, kept this a happy ship and much has been done silently and well in the past as in all happy ships. We need not waste time patting ourselves on the backs about what is going well, let us glance at what needs to be done. CARE OF This presents a major problem of the health THE ELDERLY. and welfare services. Those elderly people who have lost contact with their relatives and are in need of care and attention are often brought to our notice by their doctors or by kindly neighbours. Sometimes they do not realize their need of treatment or of the welfare services. In this connection, however, it must be said that people at times have false impressions of the needs of the aged. Often all that is needed is a period of temporary recuperative treatment to recover, to a considerable degree, their physical and mental powers. It is no act of unadulterated kindness to take the elderly man or woman out of the community unnecessarily and place him or her for a prolonged period into the new disciplines amongst strangers, a situation inseparable from institutional life. However, where it is unavoidable or where some urgent treatment or care is needed it is always difficult to obtain accommodation for the elderly. The responsibility for the solution of this problem is ours and we must meet it. Measures taken since the end of the year will, let us hope, improve a dreadful situation. Tuberculosis. This is the biggest of the endemic plagues which affect man for which we think we know some of the answers. Application of methods of control with determination is the need, speaking of the country as a whole. If the same determination is shown as was shown in the case of diphtheria we shall eliminate tuberculosis. Our aims, briefly, are to discover as many existing cases as possible, as early as possible; make them non-contagious and keep them so; and to trace and examine contacts of the cases. This, with an intensive campaign of 4 immunisation with B.C.G. for the age groups on the threshold of the years of greatest susceptibility, should result in a considerable elimination in the disease as the years go by. The work of control of Tuberculosis is a joint job of the Regional Hospital Board and the Local Authority. The closer the liaison between them the better will be the results. Most of the liaison so far achieved is the result of efforts of individual doctors and nurses in the service, and is maintained despite the existing organisation rather than with its help. It could be better. In February, 1954, the Borough Education Officer informed the Medical Officer of Health that a Headmistress had reported that two children from different families had been admitted to hospital suffering from Tuberculosis, and that the children concerned were from the same class in her school. Dr. Herington visited the school and arrangements were made for examination of all the children in the class, subject to parental consent. The full co-operation of the parents was obtained and all except four of the children attended for examination, two being absent on account of sickness and two already being under observation for chest conditions. Of the two who were absent ill, one was found to have pulmonary Tuberculosis and the other was found to be free from tubercular disease on her return to school. Four teachers associated with the class were also examined and found to be satisfactory. Dr. Herington subsequently visited the school and ascertained that all the teaching staff had been investigated recently for Tuberculosis with satisfactory results. The history of these five children including the two who had been under observation for years is instructive. Taking these two first—one was a contact of a parent suffering from Tuberculosis and was first referred as such seven years previously. She was quite healthy. The second had recovered from Tuberculosis of the spine and is now well. Of the other three, one child had been notified by the Chest Physician as having pulmonary Tuberculosis two years previously and had undergone treatment which necessitated absence from school for 80 days. She became ill again in January, 1954, and was admitted to hospital for treatment three weeks later. The second child was admitted to hospital, after investigation by the Chest Physician, in August, 1953. The third, after an illness lasting twelve days was sent home on her return to school as she was thought to be ill; one month later she was notified as suffering from pulmonary Tuberculosis. On the face of it, there would appear to have been a connection between all these cases, but in all except one case investigation by the Sanitary Inspectors brought to light the fact that these children had been for years close contacts of other cases in their families. 5 vaccination and There has been an improvement during immunisation. the year but we are still a long way from being safe from a smallpox epidemic. Steps have been taken to increase further the number of vaccinated children and there should be a gradual improvement in the situation. The position regarding diphtheria immunisation could also be improved. In conclusion I would like to express my thanks to the Chairman and members of the Committees concerned with administration of the services covered by this report. I would also offer my sincere thanks to all members of the staff for their assistance during the time i had the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. D. H. ROBINSON, Acting Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. 6 members of the council (31st December, 1954) Mayor: Councillor A. S. HADDOCK, J.P. Deputy Mayor: Councillor A. W. KEMPSON AIdermen: W. E. BELLAMY D. O'DWYER F. BROWN, E.C.C. A. E. PRENDERGAST (Mrs.) F. GRINDROD, J.P. C. PRENDERGAST E. M. MILLARD (Mrs.) F. G. THOMAS Councillors: S. F. BANKS J. P. HOLL1DGE, J.P., E.C.C. R. BLACKBURN B. L. HOLLINGSWORTH. J. EOWLES B Sc., Ph.D., A.R.I.C. 1. M. BROCKELBANK (Mrs.) H. P. LARKING G. A. BROOKER J. F. MOULTRIE, F.A.I. E. A. BROWNE W. A. PARISH R. F. BURSILL B. M. ROADKNIGHT (Mrs.) F. G. BYRNE J. SCOTT G. H. A. CROUCH L. S. SNELLING (Mrs.), E.C.C. D. A. L. G. DODD A. R. THOMAS (Mrs.) M. EALES L. W. TODD M. WARREN (Mrs.) public health committee Alderman (Mrs.) A. E. PRENDERGAST, Chairman Councillor M. EALES, Vice-Chairman His Worship the Mayor Alderman D. O'DWYER (Councillor A. HADDOCK) The Deputy Mayor Councillor (Councillor A. W. KEMPSON) (Mrs.) B. M. ROADKNIGHT Alderman (Mrs.) E. M. MILLARD Councillor (Mrs.) M. WARREN 7 dagenham health area sub-committee Alderman (Mrs.) A. E. PRENDERGAST, Chairman Councillor (Mrs.) A. R. THOMAS, Vice-Chairman Members: — Borough Counc'l The Mayor: Councillor A. S. HADDOCK, J.P. The Deputy Mayor: Councillor A. W. KEMPSON Alderman (Mrs.) E. M. MILLARD Alderman D. O'DWYER Alderman F. G. THOMAS Councillor (Mrs.) I. M. BROCKELBANK Councillor R. F. BURSILL Councillor D. A. L. G. DODD Councillor M. EALES Councillor J. P. HOLL1DGE, J.P.. E.C.C. Councillor W. A. PARISH Councillor (Mrs.) B. M. ROADKNIGHT Councillor (Mrs.) L. S. SNELLING, E.C.C. Councillor (Mrs.) M. WARREN County Council Alderman (Mrs.) M. BALL Alderman (Mrs.) E. SAYWOOD Councillor (Mrs.) M. BREDO Councillor C. F. H. GREEN Councillor W. HERRIDGE Councillor E. R. D. DeROUGEMONT Councillor L. F. SAUNDERS Hospital Management Committee Councillor (Mrs.) A. R. THOMAS (Vice-Chairman) Executive Council for Essex Mr. E. E. FARRANT, M.P.S. Local Medical Committee for Essex Dr. P. GROARKE Voluntary Organisations Miss N. L. ODELL. Miss A. TOLD and Miss I. WHEELER 8 OFFICERS OF THE PUBLIC HEALTH SERVICES (as at 31.8.55) Officers employed by the Essex County Council are indicated thus "(C)" Full-Time Staff: Medical Officer of Health: (Post Vacant) 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) JEANNE LISTER, M.B., B.S.(Lond.) (C) WILHELMINA C. MAGU1RE, L.R.C.P., L.R C.S.I (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) F. COLLINS (5, 6, 7, 10) Health Visitors: (C) M. E. ALLAM (5, 7, 8) P. LANE (5, 6, 7, 14) P. G. COLLYER (5, 7, 8, 12) L. SALTER (5, 6, 7) L. DUNBAR (5, 6, 7) D. E. SMITH (5, 7, 8, 16) J. R. FRANCE (5, 6, 7) D. B. STEWART (5, 6, 7) A. K. GIBSON (5, 6, 7) J. E. THOMAS (5, 6, 7, 13, 18) D. HICKEY (5, 6, 7) E. VALENTINE (5, 6, 7, 16) R. E. WALKER (5, 6, 7, 16, 17) 9 Senior Midwife: (C) E. M. BEDFORD (5, 6) Midwives: (C) M. GOODBUN (5, 6) M. M. ROBSON (6, 13) M. HALL (6) M. ROCK (6) H. MITSON (5, 6) M. TEATHER (5, 6) M. M. RICHARDS (6) Clerical Staff: Chief Clerk: (C) F. W. KNIGHT (1, 2) Trainee Sanitary Inspector-. G. DOVEY Clerks: E. ADAMS (C) L. A. MANNING (C) I. M. BISHOP (C) F. H. MARTIN (20) (C) M. A. BRIDESON (C) L. A. MOORE (C) N. E. CLOKE (C) E. NEPORT (C) D. B. ELLMORE (C) I. PAGE (C) L. M. FREESTONE (C) J. POWELL M. GOODCHILD (C) K. RICHARDS (C) G. K. HARRIS G. SHANNON (C) B. ISBELL (C) D. TYLER (C) S. B. LEADER (C) M. A. WATTS (C) Day Nurseries: (C) Goresbrook Nursery, MATRON: E. MADDISON (16) Dagenham Avenue, Dagenham. DEPUTY: K. GRAHAM (9) Chadwell Heath Nursery, MATRON: I. MUSGRAVE (9) Ashton Gardens, Chadwell Heath. DEPUTY: P. HEINSON (19) Kingsley Hall Nursery, Parsloes Avenue, WARDEN : D. HOWES Dagenham. Domestic Help Organiser: (C) G. HICKINBOTHAM Chiropodists: (C) N. FREEMAN M. KELLY (15) 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 ••• ® New Health Visitor's Certificate • 7 Midwifery, Part 1 8 State Enrolled Assistant Nurse . " Ex. Queen's Nurse . . • • State Certified Mental Certificate H Neurological Certificate 12 Registered Mental Nurse 13 Industrial Nurse's Certificate 14 Member of Society of Chiropodists • " State Registered Fever Nurse Tuberculosis Certificate 17 Certificate of Royal Medico-Psychological Association 18 Certificate of National Nursery Examination Board 1® Diploma in Public Administration 20 10 Part-Time Staff Dentist: A. S. ROBERTS, L.D.S., R.C.S.(Edin.) Public A nalyst: J. HUBERT HAMMENCE, PhD.. M.Sc., F.R.l.C. Occupational Therapist: ZELDA E. MERCER (New Zealand Diploma of Occupational Therapy) Chiropodist: C. K. BOWER (15) 11 STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar-General's estimate of resident population, 1954 115,300 Number of inhabited houses (end of 1954) according to Rate Books 29,810 Rateable value (December 31st, 1954) £701,456 Sum represented by a penny rate (approximate 1954-55) £2,828 Extracts from Vital Statistics for the Year. Live Births:— Total Male Female Legitimate 1,612 835 777 , Birth rate per 1,000 of the estimated resident population, 14.50. Illegitimate 60 33 27 ) Stillbirths:— Legitimate 49 25 24 Rate per 1,000 total (live and still) births, 29.59. Illegitimate 2 1 1 Deaths 717 397 320 Death rate per 1,000 of the estimated resident population, 6.22. Deaths from pregnancy, childbirth, abortion:— Deaths Rate per 1,000 total (live and still) births. 2 1.16 Death rate of infants under one year of age:— All infants per 1,000 live births 23.92 Legitimate infants per 1,000 legitimate live births 22.95 Illegitimate infants per 1,000 illegitimate live births 50.00 Deaths from Cancer (all ages) 146 ,, Measles (all ages) Nil ,, Whooping Cough (all ages) 1 ,, Gastritis, Enteritis and Diarrhoea (all ages) 5 12 Births. 1,672 live births were registered during the year, there being 868 males and 804 females. There is a decrease of total births from 1,796 in 1953 to 1,672. The corrected birth rate per thousand population was 13.20 compared with 15.2 for England and Wales and 16.8 for the 160 large towns, including London. The illegitimate birth rate continues to be very low, being only 3.59 per cent. of total births. The rate of illegitimate stillbirths is 3.92 per cent. of total stillbirths. Death Rate. Total deaths in district 583 Outward transfers 172 Inward transfers 306 Deaths of residents 717 Of the 172 deaths of non-residents occuring in the district, six took place at the Dagenham Hospital and 153 at Rush Green Hospital. Of the 306 deaths of local residents taking place outside this area, most occurred in institutions. Of these 166 occurred at Oldchurch Hospital; 19 at the London Hospital; 16 at King George Hospital; nine at the Ilford Isolation Hospital; six at Harold Wood Hospital; five at St. Joseph's Hospice; five at the East End Maternity Hospital; four at St. Andrew's Hospital and four at the Victoria Hospital. The crude death rate of 6.22, when corrected becomes 10.20 and compares with 11.3 for England and Wales. A table giving the causes of death, and the age periods at which they occurred, is given at the end of the report. Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1954 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 Whooping Couch Diphtheria Influenza Diarrhoea and Enteritis (under two years) Total Deaths (under one year) England and Wales 15.2 0.36 11.3 0.00 0.00 0.00 0.00 0.05 0.8 25.5 160 County Boroughs and Great Towns, including London 16.8 0.44 12.1 0.00 0.00 0.00 0.00 0.04 0.9 29.2 160 smaller towns (1951 Census) resident population 25,000-50,000 15.4 0.36 11.3 0.00 0.00 0.00 0.00 0.05 0.5 23.8 London 17.7 0.35 11.7 0.00 0.00 0.00 0.00 0.02 0.4 22.1 Dagenham (Corrected) 13.2 0.40 10.2 0.00 0.00 0.00 0.00 0.00 1.8 23.92 13 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. 41 2 Weekly Thursday, p.m. 42 2 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Monday, p.m. 35 2 Weekly Tuesday, 23 1 Weekly a.m. Tuesday. 58 4 Weekly (Discontinued after 27.11.54) p.m. Wednesday, p.m. 29 1 The Leys Clinic, Ballards Road, Dagenham. Weekly Thursday, a.m. 23 1 Weekly Thursday, p.m. 30 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (2nd, 4th & 5th in month) Friday, a.m. 19 1 Weekly Friday, p.m. 29 1 The Clinic, Ford Road, Dagenham. Weekly Tuesday, a.m. 54 3 Weekly Tuesday, p.m. 44 3 Weekly (Discontinued at end of year) Friday, a.m. 21 1 The Clinic, Manford Way, Hainault. Weekly Monday, p.m. 22 1 London City Mission Hall, Dagenham Road, Weekly Wednesday, p.m. 37 2 Dagenham. Weekly Thursday, a.m. 25 1 Weekly Thursday, p.m. 44 2 15/17, Thompson Road, Dagenham. Weekly (Commenced 4.12.54) Wednesday, p.m. 24 2 15 Ante-Natal Clinics CENTRE Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Ashton Gardens, Chadwell Heath. Weekly Wednesday, p.m. 7 1 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 13 2 Weekly Wednesday, a.m. 10 1 Weekly Friday, p.m. 8 1 The Leys Clinic, Ballards Road, Dagenham. Weekly (Discontinued after 4.12.54) Tuesday, a.m. 5 1 Weekly Wednesday, a.m. 10 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (1st & 3rd in month) Friday, a.m. 10 2 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 18 3 Weekly Wednesday, p.m. 23 3 Weekly Thursday, a.m. 14 2 Weekly Thursday, p.m. 11 2 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 17 2 Weekly Monday, p.m. 19 2 The Clinic, Manford Way, Hainault. Weekly Monday, a.m. 5 1 16 Sanitary Inspection of the District Report of the Sanitary Inspectors. (a) Nature and number of visits:— Overcrowding and Housing Conditions 999 Nuisances under Public Health Acts— Dwelling-houses 2,886 Other Premises 693 Bakehouses 51 Milkshops and dairies 82 Foodshops, stalls and itinerant vendors 2,830 Cafes and canteens 687 Infectious disease enquiries 892 Visits to foster-mothers' premises 31 Number of complaints investigated 970 Outworkers' premises 153 Workplaces and offices 53 Rag Flock, etc. 55 Tents, vans and sheds 261 Stables 20 Pet Shops 44 Hairdressers' and barbers' premises 84 Shops Act 89 Ice Cream premises and vehicles 390 Houses disinfested 14 Other Visits 78 (b) Notices served:— Complied with:— Statutory 150 121 Informal 496 364 Legal proceedings were instituted in respect of nine properties to enforce compliance with statutory notices. 17 PREVENTION OF DAMAGE BY PESTS ACT, 1949 Local Authority Dwelling Houses All other (including Business Premises) Total Agricultural No. of properties 25 29,813 1,691 31,529 6 No. of properties inspected as a result of: (a) Notification 4 136 77 217 - (b) Survey under the Act 3 318 89 410 — (c) Otherwise 8 2,112 686 2,806 4 Total inspections carried out 121 4,303 4,654 9,078 16 No. of properties inspected and found to be infested by:— Major - - - - - (a) Rats Minor 4 69 25 98 — Major _ _ (b) Mice Minor 3 98 67 168 — No. of infested properties treated by Local Authority 7 167 92 266 - Total treatments carried out—including retreatments 10 177 114 301 - No. of notices served under Section 4 of the Act:— (a) Treatment - - - - - (b) Structural Work — — — — — No. of cases in which default action was taken following issue of notice under Section 4 - - - - - Legal Proceedings — — — — — No. of "Block" control schemes carried out — — — — — 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 coordinated 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 .033 per cent. of the inhabited houses and .021 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:— Length of Mains Yards 12" 36 6" 906 4" 796 3" 663 241 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 HOUSING Statistics. Number of New Houses erected during the year:— Total '289 (1) By the Local Authority 195 (2) By other Local Authorities 4 (3) By other bodies and persons 90 1. Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 912 (b) Number of inspections made for the purpose 2,762 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceeding sub-head) found not to be in all respects reasonably fit for human habitation 369 2. Remedy of Defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 301 3. Action under Statutory Powers during the year:— A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil 20 B. Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 127 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 113 (b) By Local Authority in default of owners Nil C. Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil D. Proceedings under Section 12 of the Housing Act, 1936, and Section 10 of the Local Government (Miscellaneous Provisions) Act, 1953 Nil Overcrowding No exact information is available as to the degree of overcrowding in the Borough although there appears to be an improvement. Housing Repairs and Rents Act, 1954 This Act, which came into operation on 30th August, 1954, requires local authorities to submit for the Minister's approval within a period of 12 months proposals for dealing with the houses in their area which appear to be unfit for human habitation and liable for demolition. Approval has been given to the Council's proposal to deal with 58 properties during the next five years. Subject to conditions the Act allows the Landlord a limited increase in the rent of certain houses if the house is in good repair and is reasonably suitable for occupation. The tenant can apply to the local authority for a certificate that the house is not in good repair and/or not reasonably suitable for occupation. During the first four months of the operation of the Act eight applications were received from tenants for certificates that the conditions justifying an increase in rent were not fulfilled. Certificates were issued in all but one of the cases. Only two of these certificates have so far been revoked. It would appear that in the majority of cases the Landlord has not attempted to increase the rent because of the cost of satisfying the conditions attached to such increase. 21 Improvement Grants The Housing Act, 1919, as amended by the 1954 Act, provides for grants to be made by the local authority up to 50% (with a maximum of £400) of the cost of converting larger houses into flats or improving older houses which lack modern amenities, e.g., running hot water, bathroom, internal or otherwise readily accessible W.C., etc. The cost of repairs, except those necessary to eliminate inherent structural defects, is not eligible for grant. During the year 11 enquiries were made in respect of improvement grants. Five definite applications were considered by the Council. Two applications were approved; three were refused, two because the work proposed was not considered to come within the scope of "improvement" and one because the property was not considered likely to provide satisfactory housing accommodation for the requisite period. The majority of enquiries is in respect of premises occupied by the owner. Tents, Vans and Sheds A site in respect of which a licence was refused, because of inadequate accommodation and drainage facilities, continued to be used for one caravan. Legal proceedings .were instituted against the person controlling the land and a fine of £2 imposed. The occupants of the van pleaded their inability to find alternative accommodation. The removal of the van from the site was not accomplished until further proceedings had been taken. National Assistance Act, 1948 Section 47. Several cases of elderly people who were unable to look after themselves and were without proper care and attention were brought to the notice of the Department. In all cases the voluntary agreement of the person was eventually obtained and removal arranged through the County Welfare Department. Section 50. The only corpse to be buried under the provisions of this Section was that of an unknown female child (5 hours old) murdered and found on a footpath in the Borough. Laundry Service for the Incontinent Aged This service, inaugurated in December, 1953, and operated under the provisions of the Public Health Act, 1936, Section 84, continues to meet a real need in the home at a time when help is 22 urgently required. Soiled articles are collected, and laundered articles returned each Monday, Wednesday and Friday. The frequency of the collection and delivery is of the utmost importance as the resources of the home in respect of bedding, clothes, etc., are inevitably stretched to capacity. The service has worked well and the co-operation of the laundry staff at the Barking Hospital, especially at holiday periods, has been excellent. At the time of writing this report 58 cases have receivea assistance; 33 have died, 17 have been removed to hospital or no longer require the service and eight are still participating. The number of articles laundered is 10,189. Dustbins The Public Health, Public Cleansing and Finance Committees met jointly to consider the question of the provision of dustbins to properties in the Borough. The alternatives of providing dustbins at an annual charge not exceeding 5/-, or of meeting the cost out of the General Rate Fund, were investigated. It was finally decided that the matter should be deferred for the time being. Atmospheric Pollution Systematic observations continue to be made of the chimneys of industrial premises in the Borough. In one case it was necessary to serve a statutory notice; considerable improvement followed this action. For many years the Council have maintained an observation station in the vicinity of Valence House for the purpose of measuring atmospheric pollution. Recently equipment was installed at the Civic Centre for making regular observations of the daily average concentration of smoke, suspended impurity and sulphur dioxide in the atmosphere. An article dealing with atmospheric pollution and how the individual citizen can help to reduce the pollution from domestic chimneys was included in a recent issue of the "Dagenham Digest " (published quarterly by the Council). Rag Flock and Other Filling Materials Act, 1951 There are two premises in occupation which have been registered under Section 2 of the Act. One licence for the manufacture and one licence for the storage of Rag Flock have been issued. 23 Samples are regularly taken at the three factories in the Borough where filling materials are manufactured. The manufacture of Rag Flock has continued to be satisfactory. One sample of Cotton Felt had a trash content of 9% (the permitted maximum is 7.5%); all other samples taken from this factory during the year were satisfactory. Forty-three samples (37 informal and 6 formal) were taken during the year. The details are as follows:— Material Satisfactory Not Satisfactory Rag Flock 14 — Cotton Felt 9 1 Kapok 4 — Kapok mixed with cotton 2 — Woollen Mixture Felt 6 — Coir Fibre 2 — Grey Fibre 1 — Sisal 4 — Pet Animals Act, 1951 Six licences authorising the keeping of pet shops have been renewed. The conditions attached to the licences are those approved by the Association of Municipal Corporations. Premises are regularly inspected and no serious breach of the conditions has arisen. 24 FACTORIES ACTS, 1937 & 1948 Inspections. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 17 28 - - Factories with mechanical power 143 245 5 — Other premises under the Act (including works of building and engineering construction but not including out-workers' premises) 29 60 8 - TOTAL 189 333 13 — 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 - - - Overcrowding — — — — — Unreasonable temperature — — — — — Inadequate ventilation — — — — — Ineffective drainage of floors — — • — — Sanitary Conveniences:— Insufficient 2 2 - — — Unsuitable or defective 9 6 - 2 — Not separate for sexes I 1 - — — Other Offences 1 1 2 — — TOTAL 14 11 2 2 — Outwork No. of out-workers in August list 17 Nature of work Making, etc., wearing apparel. 25 FOOD AND DRUGS ACT, 1938 Analyses Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Almonds, Ground 1 1 - - Baking Powder - 1 - - Beef, Corned - 1 - 1 Beef Roll - 1 - 1 Blackcurrant Juice 1 - - — Bread — 3 - 3 Bun - 1 - 1 Butter 1 - - — Cake — 2 - 2 Cauliflower — 1 - — Cheese - 2 - 2 Cinnamon - 1 - — Coconut 3 1 - — Coffee 2 - - — Coffee and Chicory Essence 2 — - — Cordial --- 1 - — Curry Powder — 1 - — Cream - 1 - — Doughnuts — 1 - — Fruit, Mixed — 1 - — Ginger, Crystallised — 1 — Ginger, Ground — 2 - — Gravy Salt — 1 - •— Herbs 2 3 - 1 Ice Cream — 8 - — Ice Lollies 8 - — Icing Sugar 1 — - — Jams, etc. 3 4 - — Jelly I 1 - — Ketchup — 1 - — Lard 1 — - — Lemonade Powder and Crystals 2 1 1 1 Margarine — 7 - — Margarine with 10% Butter 2 — - — Marmalade, Diabetic — 1 - — Milk 45 2 - 2 Milk, Powder — 1 - — Milk, Skimmed — 1 - — Milk-Chocolate Drink 1 - - — Mint in Vinegar — 1 - — Nut Oil - 1 - — Nutmeg, Ground - 1 - — Olive Oil - 1 - — Oranges 9 — 4 — Paste - 6 — — Pepper 1 2 — — Pepper Flavouring Compound — 1 — — Pie Filling — 1 — — Salad Cream 2 — — — Sausages 29 — — — 26 Article Number Examined Number Adulterated) etc. Formal Informa 1 Formal Informal Soup 1 — — — Spices — 2 — — Suet 5 2 - — Sweets 1 5 - — Table Creams — 1 - — Tea 1 1 - — Vinegar 1 1 - - Medicinal Samples 1 13 — 1 INSPECTION AND SUPERVISION OF FOOD Clean Food Campaign The numbers and types of food premises in the Borough are as follows;— 6 Bakehouses 23 Bakers and Confectioners 59 Butchers 129 Cafes and Canteens 29 Fishmongers 52 Fruiterers and Greengrocers 116 Grocers 19 Licensed Premises 10 Off-licensed Premises 88 Sweets, etc. All food premises are regularly inspected and during the year 3,848 visits were paid. In addition to numerous requests and suggestions during these routine visits, 49 informal notices were served upon owners or occupiers. In addition 200 inspections of itinerant vendors were carried out; much of this work is done at the weekends. The number of premises registered under Section 14, apart from those in respect of ice cream, is as follows:— Out of a total of 59 butchers' premises 40 are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these, 825 visits were paid. Out of a total of 29 fish shops 21 are registered for fish frying. To these 396 visits were paid. Lectures have been given to members of local organisations. With the co-operation of the County Council a stand was erected at the Dagenham Town Show. There was a record attendance during the two days of the show. 27 Milk Under the provisions of The Milk and Dairies Regulations, 1949, eight premises are registered as dairies and 67 persons with premises in the Borough are registered as distributors. 82 visits were paid to these premises. The only pasteurising plant in the Borough ceased to operate on the 30th September, 1954; the dairy was not equipped to tit caps overlapping the lip of the milk bottles. During the year 70 samples of milk were submitted for bacteriological examination. Three samples of pasteurised milk failed (during the summer months) to pass the Methylene Blue Test. Ice Cream The total number of premises in the Borough registered under the provisions of Section 14 of the Food and Drugs Act, 1938, is 156; of this number two are registered for the manufacture of ice cream. 350 visits were paid to such premises. During the year 12 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, in respect of Licensed premises, was refused. The majority of itinerant vendors of ice cream (mostly operating box tricycles) are selling only wrapped products. The few selling loose ice cream are required to have enclosed vehicles and carry suitable washing facilities. Even under these conditions this is an undesirable method of selling ice cream. 40 inspections in connection with itinerant vendors were carried out. Bacteriological Sampling. During the year 42 samples of ice cream were submitted for examination. They were graded as follows:— Grade I Grade II Grade III Grade IV Total 30 11 — 1 42 In addition 32 samples of ice lollies were submitted for examination; two were unsatisfactory. In both cases the lollies were manufactured outside the Borough and the local authority concerned were notified. Unsound Food Complaints continue to be received in respect of food containing foreign substances or otherwise alleged to be unfit for human consumption. 28 Following the receipt of a number of complaints concerning pieces of glass in bottles of milk delivered (all by one firm) to a local school, members of the Public Health Committee visited the dairy. Certain adaptations of machinery were made and the complaints have ceased. In two instances, mouldy apple puffs, legal proceedings were taken and a fine of £5 imposed in each case. In one case the complainant refused to take part in legal proceedings. The normal method of disposing of unsound food is to use the incinerator at the Council's Refuse Disposal Works. Occasionally when there is a quantity of meat, it is disposed of, under supervision, through the Council's waste food service; the meat is previously cut up and dyed. Slaughterhouses As indicated in last year's report the Council refused the two applications received for premises to be licenced. In one case an appeal was lodged against the Council's decision but was later withdrawn. There is, therefore, no slaughterhouse in the Borough, but the needs of local butchers appear to be adequately met by the facilities available in London. The Council have been represented at the meetings of local authorities held to consider the provision of a joint Municipal Abbattoir for the South West area of Essex. In this connection the report of the Inter-departmental Committee on Slaughterhouses is still awaited. Registration of Food Hawkers Essex County Council Act, 1952 — Section 103 48 persons were registered as food hawkers together with 12 premises within the Borough. 16 of the applicants had premises in adjoining districts and 20 were without storage premises. Food Poisoning Outbreaks During the year 11 cases of food poisoning were notified. The causative organism was identified in the only outbreak which consisted of two cases (two sisters aged 4 and 6 years). In the nine single cases the cause was unknown. Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1272A Cake Informal Contained a blackish foreign body which was found to consist of a mass of caramelised or burnt crumbs. Vendor informed. 1275A Dried Herbs Informal Contained 3.34% sand. Formal sample unable to be taken—stock at retail shops exhausted. 1296A Processed Cheese Informal Had a strong smell due to growth of microorganisms. Out of condition. Vendor warned. 1297A Bread Informal Contained black striations due to presence of fragments of burnt bread. Vendor informed. 1305A Corned Beef Informal Contained the head portion of a beetle. Vendor warned. 1324A Cake Informal The filling of this cake was in a mouldy condition. No longer suitable for human consumption. Vendor warned. 1325A Bun Informal Contained a drawing pin. Vendor warned. 1323 A Cheese Roll Informal Contained a small black foreign body consisting of a mass of charred or burnt dough. Vendor informed. 1328 A Milk Informal Contained foreign matter in the form of a "milk skin" containing masses of mould growth. Vendor warned. 1329A Glucose, Lemon and Barley Powder Informal Ingredients stated in wrong order. Glucose Monohydrate given as principal constituent whereas cane sugar was present in by far the greater proportion. Formal sample taken—see N o. 2154. 1344A Loaf of Bread Informal Contained greyish black foreign bodies consisting of compact masses of mould growth and flour. Vendor warned. 30 Adulterated Samples, etc.—continued Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 1345A Bread Informal Showed the presence of a blackish streak and smallish black masses of foreign material found to consist of dirty dough containing traces of oil and gritty material. Vendor warned. 1360A Glycerine, Lemon and Honey Pastilles Informal Poor in respect of Glycerine content. Manufacturers warned. Agreed to alter label. 1362A Beef Roll Informal Consisted of a satisfactory meat roll containing a small portion of added cereal but no declaration of the ingredients appeared on the label as is required by the Labelling of Food Order. Importers warned. New labels to be issued. 1372A Milk Informal Inner surface of the bottle partly covered with masses of green algal growth. Suppliers warned. 2123 Oranges Formal Contained Thiourea Preservative parts per million Juice 14 Peel 20 2127 Oranges Formal Juice 4 Peel 15 Vendors warned. 2128 Oranges Formal Juice <20 Peel 20 2129 Oranges Formal Juice 6 Peel 15 2154 Glucose, Lemon and Barley Powder Formal Ingredients stated in wrong order. Glucose Monohydrate given as principal constituent, whereas cane sugar was present in by far the greater proportion. Manufacturers warned. Labels to be altered. 31 PREVALENCE OF, AND CONTROL OVER INFECTIOUS AND OTHER DISEASES NOTIFIABLE DISEASES (Other than Tuberculosis) Under 1 year 1—2 3-4 5—9 10—14 15—24 25 and over Total Scarlet Fever 1 20 52 147 15 4 3 242 Whooping Cough 34 61 64 109 5 — — 273 Acute Poliomyelitis:— Paralytic — - - - - - 1 1 Non-paralytic — — — 1 — 1 — 2 Measles 7 23 26 52 1 — — 109 Diphtheria — — 1 — — — — 1 Under 5 years 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary 2 3 5 13 7 30 Acute Influenzal - 3 2 2 - 7 Dysentery 3 11 3 1 - 18 Encephalitis, Acute: — Infective - - - - - - Post-Infectious - - - - - - Enteric Fever - - - - - Paratyphoid Fever - - 1 - - 1 Erysipelas - - 6 4 4 14 Meningococcal Infection 4 1 1 — — 6 Food Poisoning 3 4 2 1 1 11 Puerperal Pyrexia — — 8 — 8 Ophthalmia Neonatorum 9 — - - - 9 Pemphigus — — — — — — Malaria (Foreign Origin) — — 4 — — 4 Smallpox — — — — — — 32 Notified Admitted to Isolation Hospital, Rush Green Admitted to other Isolation Hospitals Admitted to other Hospitals Registered Deaths Diphtheria 1 1 — — — Dysentery 18 1 — 1 — Encephalitis, Acute — — — — — Enteric Fever — — — — — Erysipelas 14 5 2 — — food Poisoning 11 4 2 1 — Malarii 4 4 — — — Measles 109 4 1 — — Meningococcal Infection 6 5 1 — 2 Ophthalmia Neonatorum 9 — — 1 — Paratyphoid Fever 1 — I — — Pemphigus — — — — — Puerperal Pyrexia 8 1 — ;—. — Pneumonia:— Acute Influenzal 7 2 — 1 — Acute Primary 30 2 1 — — Poliomyelitis, Acute:— Paralytic 1 1 — — — Non-Paralytic 2 2 — — — Scarlet Fever 242 12 7 1 — Smallpox — — — — — Whooping Cough 273 7 2 1 I DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year:— Age (in years) at final injection Children immunised Without preliminary testing Children who received a boosting dose Under 1 480 — 1—4 401 13 5 — 9 69 548 10 — 14 11 235 Total 961 796 Immunisation by General Practitioners. Age (in yean) at final injection Children immunised Without preliminary testing Children who received a boosting dose Under 1 214 — 1 — 4 221 35 5 — 9 27 217 10 — 14 6 54 Total 468 306 WHOOPING COUGH IMMUNISATION The number of children who received protective doses against Whooping Cough was 889, the majority of these being under the age of four years. 33 VACCINATION CARRIED OUT BY GENERAL PRACTITIONERS Vaccinated. Age at date of vaccination Under 1 254 1 — 4 78 5 — 14 46 15 or over 83 Total 461 Re-Vaccinated. Age at date of re-vaccination Under 1 ... ... ... ... ... ... — 1 — 4 3 5—14 23 15 or over 113 Total 139 VACCINATION CARRIED OUT BY LOCAL HEALTH AUTHORITY STAFF Vaccinated. Age at date of vaccination Under 1 133 1—4 140 5—14 58 15 or over — Total 331 Re-Vaccinated. Age at date of re-vaccination Under 1 — 1—4 2 5-14 7 15 or over Total 26 TUBERCULOSIS New Cases Deaths Primary Notifications 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 1 1 1 1 - - - - - - - 5— — 1 — — 1 1 — 1 — - — - 10— 1 4 - - - 1 - - - - - — 15— 5 1 — 2 — — - — — 20— 9 12 1 1 4 10 — 1 — - — — 25— 8 6 — 1 13 16 — 1 2 6 — 1 35— 3 2 — 1 6 2 — — 3 — — — 45— 4 — 1 — 3 2 — — 4 3 — — 55— 4 — — — 9 1 — — 4 1 — — 65—and upwards 1 - - - - - - - 4 - - - 34 31 4 4 37 35 — 3 17 10 — 1 Register. Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1954 535 415 75 82 During the year:— New notifications 34 31 4 4 New cases brought to notice by Registrars' Deaths Returns 3 1 - - Deaths 17 10 - 1 Transfers into area 34 34 — 3 Transfers out of area 28 30 2 3 Removed from register as "Recovered" 34 17 4 10 No. on register 31st December, 1954 527 424 73 75 MATERNITY AND CHILD WELFARE Ophthalmia Neonatorum Nine cases of this disease were notified, all made complete recoveries. There were 38 cases in which a medical aid notice was sent by a midwife to a medical practitioner on account of some eye condition occurring in a newly-born infant. All these cases were investigated by the Medical Officer of Health and all were visited by a Health Visitor. 35 Maternal Mortality There were two maternal deaths assigned to this district during the year under review, giving a mortality rate of 1.16 compared with 0.69 for England and Wales. 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 309 Total visits 654 (b) To children under 1 year of age First visits 1,837 Total visits 4,432 (c) To children between the ages of 1 and 5 years Total visits 12,531 (d) Ineffective visits Total visits 4,328 (e) Other visits Total visits 1,671 Grand Total 23,616 Domiciliary Midwifery Service The following is a summary of the reasons for sending for medical aid by mid wives:— Perineal Tear 74 Discharging Eyes 38 Rise of Temperature 22 Prolonged Labour 20 Malpresentation 18 Ante-Partum Haemorrhage 13 Miscarriage 11 Post-Partum Haemorrhage 10 Inflammation over Veins in Leg 10 Adherent Placenta 9 Premature Baby 6 Flushed Area on Breast 5 High Blood Pressure 5 Threatened Miscarriage 5 Septic Spots 4 Premature Labour 4 Unsatisfactory Condition of Infant 3 Jaundice 3 Threatened Abortion 3 Unsatisfactory Condition of Patient 3 Abortion 3 Cyanosed Infant 3 Early Rupture of Membranes 2 Other Causes 38 312 36 Notices summoning medical aid 312 For (a) Mothers 244 For (b) Infants 68 Notifications that they had been associated with the undermentioned conditions were received from domiciliary midwives:— Substitution of artificial feeding 25 Liable to be sources of infection 11 Stillbirths 4 Laying out dead body 4 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 1954:— County Midwives Midwives Residing at York House Training Home Salvation Army Midwives Births Attended: As Midwife 186 262 40 As Maternity Nurse 129 10 19 Miscarriages Attended (included in above) 5 10 11 Visits Paid: As Midwife 5,426 7,587 972 As Maternity Nurse 1,336 180 396 Ante-Natal 2,838 1,936 380 Ante-Natal Clinics Attended 612 235 46 Gas and Air Administered: As Midwife 116 189 34 As Maternity Nurse 84 6 14 37 Dental Treatment The following particulars relate to dental treatment provided for mothers and young children:— Expectant or nursing mothers Children under five years of age Number of patients examined 164 175 Number of patients needing treatment 140 136 Attendances for treatment 370 310 Number of patients who have completed treatment 50 107 Number of Extractions 429 120 Number of Fillings 67 256 Number of Anaesthetics administered: (a) local 176 82 (b) general 2 1 Number of Scalings or scaling and gum treatment 12 1 Number of Silver Nitrate treatment — — Number of Dressings 29 26 Number of X-ray examinations 1 — Number of Dentures provided: (a) full 17 — (b) partial 19 — 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 10 Nursery Students 8 Total 30 38 Total Attendances at Nurseries for 1954: Go.esbrook Nursery Under 2 years of age 2,545 Over 2 ,, ,, ,, ... 5,805 Chadwell Heath Nursery. Under 2 ,, ,, ,, ... 2,739 Over 2 ,, ,, ,, ... 6,460 Kingsley Hall Nursery Over 2 ,, ,, ,, ... 4,839 Total 22,388 Premature Infants Live premature births occurring in the area:— 31b. 4oz. or less 31b. 5oz. —41b. 6oz. 41b. 7oz. —41b.l5oz. 51b.— 51b. 8oz Born alive at home and nursed entirely at home — 1 5 18 Born alive at home and transferred to hospital — 1 2 1 Born alive in a private nursing home and nursed entirely there — - — 1 Born alive in a private nursing home and transferred to hospital — - - — Born in hospital 10 10 22 38 CAUSES OF DEATH (As classified in Public Health Department) under 1 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 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 5 1 - 2 3 3 1 3 - - - 11 9 2 Tuberculosis, other — — — — — — — — — — 1 — 1 1 - - - - - - - - 2 1 3 Syphilitic disease - — — — — — — — — — — — — — — — 2 — — — — — 2 — 4 Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - 5 Whooping Cough 1 — — — — — — — — — - - — — — — — — — — — — 1 — 6 Meningococcal infect ions - 1 - - 1 - - - - - - - - - - - - - - - - - 1 1 7 Acute Poliomyelitis - — — — — — — — — — — — — — — — — — — — — — - - 8 Measles - — — — — — — — — — — — — — — — — — — — — — — - 9 Other infective and parasitic diseases - - - - - - - - - - - - - - - - - - - - - - — — 10 Malignant neoplasm, stomach - - - - - - - - - - - 1 1 1 2 — 6 1 5 3 1 2 15 8 11 Malignant neoplasm, lung, bronchus - - - - - - - - - - - - 1 2 8 1 19 — 5 3 2 1 35 7 12 Malignant neoplasm, breast - - - - - - - - - - - - - 1 - 1 - 1 — 4 — 2 — 9 13 Malignant neoplasm, uterus - - - - - - - - - - - - - 1 - 3 - 2 - - - 3 — 9 14 Other Malignant and lymphatic neoplasms - — - — - — — — 1 1 1 — — 2 10 3 7 10 15 7 4 6 38 29 15 Leukaemia, aleukaemia - — - — 1 — 1 1 — — — — 1 — 1 — — — — — — — 4 1 16 Diabetes - - - - - - - - - - - - - - - 1 - - - - 1 — 2 1 17 Vascular lesions of nervous system - — — — 1 — — — — — — 1 — 1 6 4 6 9 11 12 10 17 34 44 18 Coronary disease, angina - - - - - - - - - - - — 2 — 18 1 26 5 21 11 12 10 79 27 19 Hypertension with heart disease — — — — — — — — — 1 — — 1 1 — — 2 3 2 3 2 5 7 13 20 Other heart disease - - - - - - - - 1 — 1 1 4 1 3 4 3 7 5 8 10 19 27 40 21 Other circulatory disease - - - - - - - - - 1 - - — 2 — 4 4 4 3 7 5 6 12 24 22 Influenza — — — — — — — — — — — — — — — — — — — — — 1 — 1 23 Pneumonia 1 1 — 1 - - - - - - - - - - - - 3 1 7 5 5 6 16 14 24 Bronchitis — — — — — — — — — — — — — 1 6 — 12 1 7 5 5 5 30 12 25 Other diseases of respiratory system - - - - - - — — — — — 1 — — 1 — 1 — 2 4 1 26 Ulcer of stomach and duodenum — — — — — — — — — — 1 — 1 — — — 3 — 2 — — 2 7 2 27 Gastritis, enteritis and diarrhoea 2 1 - - - - - - - - - - - - - - - 1 - - - - 2 2 28 Nephritis and nephrosis — — - - - - - - - — - - - - - - 1 1 1 2 - 2 2 5 29 Hyperplasia of prostate — — - - - — - - - — - - - - — - - - 2 - 2 - 4 - 30 Pregnancy, childbirth and abortion - - - - - - - - - - - 1 - 1 - - - - - - - - - 2 31 Congenital Malformations 7 3 - - - - - 1 - - - - - - - - 1 - - - - - 8 4 32 Other defined and ill-defined diseases 10 11 - - 1 - 1 - - 1 2 1 - 1 1 4 3 4 11 8 9 15 38 45 33 Motor vehicle accidents — — - - - - 1 1 2 _ 1 - - - 1 - 1 - - - - 1 6 ? 34 All other accidents — 1 - - - - 1 - - 1 2 - - - - - - - 1 - - 1 4 3 35 Suicide - - - - - - - - 1 - - - 1 - - - 2 2 - 1 1 - 5 3 36 Homicide and operations of war — 1 — — - - - - - - - 1 - - - - - - - - - - - 2 21 19 — 1 4 - 4 3 5 5 12 12 14 16 59 29 105 53 101 79 71 104 396 321