BOROUGH OF DAGENHAM ANNUAL REPORT Medical Officer of Health for the year 1956 J. ADRIAN GILLET, M.B., Ch.B., D.P.H. DAG 30 BOROUGH OF DAGENHAM ANNUAL REPORT of the Medical Officer of Health for the year 1956 J. ADRIAN GILLET, M.B., Ch.B., D.P.H. 3 TABLE OF CONTENTS Dagenham Borough Council — Members — Municipal Year 1956-57 Page 4 Public Health Committee — Members — Municipal Year 1956-57 4 Dagenham Health Area Sub-Committee — Municipal Year 1956-57 5 Officers of the Public Health Services 6 Introduction 9 Statistics of the Area 10 Report of the Chief Public Health Inspector 15 Tuberculosis : Mass Radiography Survey 33 Care of Mothers and Young Children : Clinics 38 Maternity Services 40 Health Visiting 44 Vaccination and Immunisation 46 Day Nurseries 48 Health Education 50 Domestic Help 52 Recuperative Holidays 53 Co-operation and Liaison 54 MEMBERS OF THE COUNCIL (as at 31.12.56) Mayor: Alderman G. H. A. CROUCH, J.P. Deputy Mayor: Alderman C. PRENDERGAST Aldermen : W. E. BELLAMY A. W. KEMPSON F. BROWN, E.C.C. D. O'DWYER F. GRINDROD, J.P. Councillors: R. BLACKBURN A. E. PRENDERGAST (Mrs.) E. H. BOWDLER B. M. ROADKN1GHT (Mrs.) D. A. L. G. DODD B. SEENEY (Mrs.) M. EALES L. A. SNELLING (Mrs.) A. S. HADDOCK J. SWIFT B. L. HOLLINGSWORTH, A. R. THOMAS (Mrs.), E.C.C. B.Sc., Ph.D., A.R.I.C. H. P. LARKING F. G. THOMAS J. F. MOULTRIE, F.A.I. J. S. THOMAS W. G. NOYCE L. W. TODD W. A. PARISH S. J. C. WARR PUBLIC HEALTH COMMITTEE Councillor (Mrs.) A. E. PRENDERGAST, Chairman Councillor M. EALES, Vice-Chairman His Worship the Mayor Councillor W. G. NOYCE (Alderman G. H. A. CROUCH) The Deputy Mayor Councillor J. SWIFT (Alderman C. PRENDERGAST) Alderman D. O'DWYER Councillor S. J. C. WARR 4 DAGENHAM HEALTH AREA SUB - COMMITTEE Councillor (Mrs.) A. E. PRENDERGAST, Chairman Councillor (Mrs.) A. R. THOMAS, Vice-chairman Members: — BOROUGH COUNCIL The Mayor: Alderman G. H. A. CROUCH The Deputy Mayor: Alderman C. PRENDERGAST Alderman D. O'DWYER Councillor R. BLACKBURN Councillor E. H. BOWDLER Councillor M. EALES Councillor H. P. LARKING Councillor W. A. PARISH Councillor (Mrs.) B. M. ROADKNIGHT Councillor F. G. THOMAS Councillor J. THOMAS Councillor L. W. TODD Councillor S. J. C. WARR COUNTY COUNCIL . Alderman K. E. B. GLENNY, O.B.E., J.P. Councillor A. C. BERRY Councillor (Mrs.) S. M. BOVILL Councillor S. W. DEEKS Councillor L. F. SAUNDERS Councillor W. A. SIBLEY Hospital Management Committee Councillor (Mrs.) A. R.THOMAS (Vice-Chairman) Executive Council for Essex Mr. F. A. WORTLEY Local Medical Committee for Essex Dr. W. J. SMITHER, D.P.H., D.I.H. Voluntary Organisations. Mrs. S. M. HOXLEY, Miss N. L. ODELL, Miss A TOLD and Mr. J. WALSH 5 OFFICERS OF THE PUBLIC HEALTH SERVICES (as at 31.12.56) Full-Time Staff: Medical Officer of Health-. J. ADRIAN GILLET, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health: HELEN MAIR, M.B., Ch.B., D.P.H. Assistant Medical Officers: CATHERINE FITZPATRICK, M.B., B.Ch. (C) FANNIE HIRST, M.B„ Ch.B., D.P.H. (C) EDMUND PERCIVAL JAMES M.R.C.S., L.R.C.P., D.RC.O.G. (C) WILHELMINA C. MAGUIRE, L.R.C.P., L.R.C.S.I. (C) MADELINE WEIZMANN, M.R.C.S., L.R.C.P. (C) Chief Public Health Inspector: L. E. PRIOR (1, 2) Public Health Inspectors: J. W. ALLAM (I, 2, 4) F. W. S. FOX (1, 2. 3, 4) G. DOVEY (1, 2) A. J. JAMES (1) Superintendent Health Visitor: (C) F. COLLINS (5, 6, 7, 10) Health Visitors: (C) H. M. BEVERIDGE (5, 6, 7) D. B. RUDD (5. 6, 7) P. G. COLLYER (5, 7, 8, 12) L. SALTER (5. 6. 7) L. DUNBAR (5, 6, 7) D. E. SMITH (5, 7. 8. 15) J. R. FRANCE (5, 6, 7) D. B. STEWART (5. 6, 7) I. A. GARRARD (5, 16) E. VALENTINE (5, 6, 7, 15) D. HICKEY (5, 6, 7) R. E. WALKER (5. 6, 7. 15. 16) 6 Senior Mi wife: (C) E. M. BEDFORD (5, 6) Mid wives: (C) M. GOODBUN (5, 6) M. M. ROBSON (6, 13) H. MITSON (5, 6) M. ROCK (6) M. M. RICHARDS (6) M. TEATHER (5, 6) Clerical Staff: Chief Clerk: (C) F. W. KNIGHT (1,2) Trainee Public Health Inspector: J. POWELL Clerks : E. ADAMS (C) F. H. MARTIN (18) (C) I. M. BISHOP (C) L. A. MOORE (C) M. A. BRIDESON (C) E. NEPORT (C) A. M. BROWN (C) I. PAGE (C) N. E. CLOKE (C) K. RICHARDS (C) D. B. ELLMORE (C) G. SHANNON (C) L. M. FREESTONE (C) F. W. SILVERTHORNE G. K. HARRIS D. TYLER (C) S. B. LEADER (C) M. A. WATTS (C) L. A. MANNING (C) Day Nurseries: (C) Goresbrook Nursery, MATRON: E. MADDISON (15) Dagenham Avenue, DEPUTY: K. GRAHAM (9) Dagenham. Chadwell Heath Nursery, MATRON: I. MUSGRAVE (9) Ashton Gardens, DEPUTY: P. COFFEE (17) Chadwell Heath. Kingsley Hall Nursery, WARDEN : D. HOWES Parsloes Avenue, Dagenham. Domestic Help Organiser: (C) G. HICKINBOTHAM Chiropodists-. (C) N. FREEMAN M. KELLY (14) Officers employed by the Essex County Council are indicated thus (C) 7 Part-Time Staff: Dentist: A. S. ROBERTS, L.D.R., R.C.S.(Edin.) Public Analyst: HUBERT HAMMENCE, Ph.D., M.Sc., F.R.I.C. Occupational Therapist: D. M. COLDWELL Chiropodist: C. K. BOWER (14) Physiotherapist: F. C. COCKER, M.C.S.P. CONSULTING STAFF: Orthopaedic Surgeon: A. M. A. MOORE, F.R.C.S. Ophthalmologists: L. H. MACFARLANE T. J. REGAL QUALIFICATIONS 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 Midwifery, Part I 8 State Enrolled Assistant Nurse 9 Ex Queen's Nurse 10 State Certified Mental Certificate 11 Neurological Certificate 12 Registered Mental Nurse 13 Member of Society of Chiropodists 14 State Registered Fever Nurse 15 Tuberculosis Certificate 16 Certificate of National Nursery Examination Board 17 Diploma in Public Administration 18 8 To the Mayor, Aldermen and Councillors of the Borough of Dagenham. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting this report on the health of the people of Dagenham in 1956. The population of the area has remained fairly constant for the last few years. The estimated mid-year population for 1956 is 115,100. The birth rate showed a slight increase from 12.98 in 1955 to 13.77 per 1,000 in 1956 and the death rate also increased from 6.83 to 7.25 during the same period. The infant mortality rate of 20.87 compared very favourably with the provisional figure for England and Wales of 23.7. The number of deaths under 1 year was 33 and from a study of Table III in the body of the report it will be seen that almost one-third were attributed to prematurity. Further investigation into the cause of deaths from prematurity and still birth may well be of assistance in still further lowering the infant death rate. During the year an outbreak of Paratyphoid Fever resulting in over 40 cases was investigated and steps were taken to tighten up the food hygiene in a food establishment to guard against the risk of a recurrence. There were no deaths from Diphtheria and out of a total of 13 cases of Poliomyelitis reported, only 4 were paralytic. Vaccination against Poliomyelitis was introduced and talks were given and discussions were held to give the public the opportunity to ask any questions they wished. The national upward trend for hospital confinement has been reflected in the domiciliary midwifery services of the area and it will be interesting to see whether this trend continues as a result of the report of the Cranbrook Committee which is now sitting to consider the maternity services in England and Wales. I mentioned in the report for 1955 that I hoped to be able to report further progress in Health Education at the end of 1956. A special section of this report is devoted to some of the activities in this field and I anticipate that further developments will take place. The illustrations appearing this year show some aspects of the work and there is included a photograph of a discussion between the Dagenham Public Health Inspectors and a student from Singapore who attended weekly as part of her training course with The Central Council for Health Education for discussions and demonstrations on health topics. 9 At the beginning of the year Dr. Helen Mair was appointed Deputy Medical Officer of Health and Assistant County Medical Officer, and Dr. E. P. James as Assistant County Medical Officer. My thanks are due to the Chairman and Members of the Committees concerned with the administration of the services covered by this report, and to all the staff and particularly to the heads of sections for their co-operation and help in this my first full year of work in Dagenham. This report should be read in conjunction with that of the work of the School Health Service as no report on the health of the area can be complete unless all age groups are considered together, so that in future years it is hoped to submit a complete report covering the work of the department as a whole. J. ADRIAN GILLET, Medical Officer of Health. Public Health Department, Civic Centre, Dagenham. STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 6,556 Registrar-General's estimate of resident population, 1956 115,100 Number of inhabited houses (end of 1956) according to Rate Books 30,390 Rateable value (December 31st, 1956) £1,372,259 Sum represented by a penny rate (approximate 1956-7) £5,620 Extracts from Vital Statistics for the Year. Live Births :— Total Male Female Legitimate 1,530 754 776 Birth rate per 1,000 of the estimated resident population, 13.74. Illegitimate 51 22 29 Stillbirths :— Legitimate 33 16 17 Rate per 1,000 total (live and still) births, 21.66. Illegitimate 2 1 1 Deaths 835 477 358 Death rate per 1,000 of the estimated resident population, 7.25. 10 Death rate of infants under one year of age :— All infants per 1,000 live births 20.87 Legitimate infants per 1,000 legitimate live births 19.61 Illegitimate infants per 1,000 illegitimate live births 58.2 Deaths from Cancer (all ages) 181 ,, Measles (all ages) Nil ,, Whooping Cough (all ages) Nil ,, ,, Gastritis, Enteritis and Diarrhoea (all ages) 6 Deaths from pregnancy, childbirth, abortion :— Rate per 1,000 total Deaths (live and still) births. Nil Nil Births. 1,581 live births were notified during the year, there being 776 males and 805 females. There is an increase of total births from 1,501 in 1955 to 1,581. The corrected birth rate per thousand population was 12.78 compared with 15.7 for England and Wales. The illegitimate birth rate continues to be very low, being only 3.23 per cent of total live births. The rate of illegitimate stillbirths is 5.71 per cent, of total stillbirths. Death Rate. Total deaths in district 662 Outward transfers 214 Inward transfers 387 Deaths of residents 835 Of the deaths of non-residents occurring in the district, 189 took place at Rush Green Hospital, and 15 at Dagenham Hospital. Of the deaths of local residents taking place outside this area, most occurred in institutions. Of these 225 occurred at Oldchurch Hospital ; 18 at King George Hospital ; 20 at the London Hospital ; 8 at the Ilford Isolation Hospital ; 6 at Harold Wood Hospital ; 5 at Guy's Hospital ; 4 at Whipps Cross Hospital and 9 at the Victoria Hospital, Romford. The crude death rate of 7.25 when corrected becomes 12.54 and compares with 11.7 for England and Wales. On the next page is a table giving causes of death and the age periods in which they occurred. 11 CAUSES OF DEATH under 1 year 1 and under 5 years 5 and under 15 years 15 and under 25 years 25 and under 45 years 45 and under 65 years 65 and under 75 years 75 and over Total M F M F M F M F M h M h M F M F M F 1 Tuberculosis, respiratory — — — — — — — — 3 3 4 2 — — — — 7 5 2 Tuberculosis, other — — — — — — — — 1 — — — — — — — — — 1 — 3 Syphilitic disease — — — — — — — — — 1 — — — 1 1 ! — 1 2 4 Diphtheria — — — — — — — — — — — — — — — — — — 5 Whooping Cough — — — — — — — — — — — — — — — — — — 6 Meningococcal infections — — — — — 1 — — — — — — — — — — — 1 7 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — 8 Measles — — — — — — — — — — — — — — — — — — 9 Other infective and parasitic diseases — — — — — — — — — — 1 — — — — — 1 — 10 Malignant neoplasm, stomach — — — — — — — — 2 — 8 5 7 4 2 2 19 11 1 1 Malignant neoplasm, lung, bronchus — — — — — — — — 2 1 32 6 11 1 4 — 49 8 12 Malignant neoplasm, breast — — — — — — — — — 1 — 4 — 4 — 3 — 12 13 Malignant neoplasm, uterus — — — — — — — — — — — 1 — 1 — — — 7 14 Other Malignant and lymphatic neoplasms 1 — 1 — — — — 1 3 4 13 19 9 5 10 9 37 38 15 Leukaemia, aleukaemia — — — 1 1 — 1 — — — 2 — 2 2 1 — 7 3 16 Diabetes — — — — — — — — — — — 3 1 3 — 2 1 8 17 Vascular lesions of nervous system — — — — — — 1 — — 2 13 10 10 13 17 15 41 40 18 Coronary disease, angina — — — — — — — — 8 1 45 6 32 13 9 13 94 33 19 Hypertension with heart disease — — — — — — — — — — 1 3 3 4 3 2 7 9 20 Other heart disease — — — — — — 1 — 1 3 7 8 6 8 21 38 36 57 21 Other circulatory disease — — — — — — — — — 2 6 5 3 3 2 6 11 16 22 Influenza — — — — — — — — — — — 1 — — — 1 — 2 23 Pneumonia 5 2 1 — — — — — 1 1 4 2 4 3 4 8 19 16 24 Bronchitis — — — — — — — — 1 — 23 3 13 6 15 10 52 19 25 Other diseases of respiratory system — — — — — — — — — 1 4 — 3 I — 2 7 4 26 Ulcer of stomach and duodenum — — — — — — — — 1 — 2 2 1 — 2 1 6 3 27 Gastritis, enteritis and diarrhoea 1 — — — — — — — — 1 1 — — 1 — 2 2 4 28 Nephritis and nephrosis — — — — 1 — 2 — 2 — 4 1 — — — 2 9 3 29 Hyperplasia of prostate — — — — — — — — — 1 — 1 — 4 — 6 — 30 Pregnancy, childbirth and abortion — — — — — — — — — — — — — — — — — — 31 Congenital Malformations 1 6 1 2 1 1 1 1 — 2 — 2 — — — — 4 14 32 Other defined and ill-defined diseases 12 5 1 1 1 1 2 4 8 8 4 6 3 10 31 35 33 Motor vehicle accidents — 1 — — — 1 — 1 2 1 1 1 1 1 7 3 34 All other accidents — — | — 1 — 1 — — — 3 — — — — 2 6 2 35 Suicide — — — — — — 1 1 3 1 7 1 4 1 16 3 36 Homicide and operations of war — — — — — — — — — — — — — — — — — — 20 13 6 4 5 2 9 4 31 28 191 93 115 80 100 134 477 358 !2 13 Table showing Birth-rate, Death-rate and Analysis of Mortality during the year 1956 Provisional Figures 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 Tuberculosis Whooping Cough Influenza Total Deaths (under one year) EnglanJ and Wales 15.7 0.38 11.7 0.12 0.00 0.06 23.8 Dagenham (Corrected) 12.78 0.28 12.54 0.19 0.00 0.35 20.87 INFANT MORTALITY Details of deaths registered during 1956 which were under one year of age. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total deaths under 1 year Congenital Abnormality (uncomplicated) 5 — 1 1 7 2 — — — 9 Congenital Abnormality with Bronchopneumonia ... — 1 — — 1 1 1 1 — 4 Congenital Abnormality with Meningitis — 1 — — 1 1 — — — 2 Prematurity 9 1 — — 10 — — — — 10 Bronchopneumonia 1 — — — 1 1 — — 1 3 Birth Trauma—Intracranial Haemorrhage 1 — — — 1 — — — — 1 Birth Trauma—Inhalation of infected liquor amnii 1 1 — — 1 Acute Meningitis — 1 — — 1 — — — — 1 Reticulo-endotheliosis — — — — — — — — 1 1 Volvulus — — — — — 1 — — — 1 Totals 17 4 1 1 23 6 1 1 2 33 SANITARY INSPECTION OF THE DISTRICT Report of the Chief Public Health Inspector. (a) Nature and number of visits :— Overcrowding and Housing Conditions 904 Nuisances under Public Health Acts— Dwelling-houses 3,714 Other Premises 977 Bakehouses 53 Milkshops and dairies 67 Foodshops, stalls and itinerant vendors 2,534 Cafes and canteens 545 Infectious disease enquiries 1,363 Visits to foster-mothers' premises 113 Number of complaints investigated 818 Outworkers' premises 272 Workplaces and offices 50 Rag Flock, etc. 34 Tents, vans and sheds 331 Stables 16 Pet Shops 24 Hairdressers' and barbers' premises 72 Shops Act 88 Ice Cream Premises and vehicles 278 Houses disinfested 24 Other visits 92 (b) Notices served :— Complied with :— Statutory 141 83 Informal 665 587 Legal proceedings were instituted in respect of eight properties to enforce compliance with statutory notices. 15 PREVENTION OF DAMAGE BY PESTS ACT,1949 Local Authority Dwelling Houses All other (including Business Premises) Total Agricultural No. of properties 24 30,447 1,921 32,392 6 No. of properties inspected as a result of: (a) Notification 8 187 85 280 — (b) Survey under the Act — 332 26 358 — (c) Otherwise 10 1,357 977 2,344 2 Total inspections carried out 156 6,575 4,289 11,020 10 No. of properties inspected and found to be infested by:— (a) Rats Major — — — — — Minor 5 120 34 159 — (b) Mice Major — — — — — Minor 3 81 56 140 — No. of infested properties treated by Local Authority 8 201 90 299 — Total treatments carried out—including retreatments 8 212 107 327 — 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 — — — — — 16 Water The water supply is satisfactory in quality and quantity. During the year two chemical and two bacteriological samples were taken from the Company's mains in this Borough ; 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 -029 per cent, of the inhabited houses and -016 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 :— Lengths of Mains Yards Diameter 22 6" 116 4" 420 3" 429 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 3,880 chemical, bacteriological and biological examinations have been made during the year. " All water going into supply was wholesome." 17 HOUSING ACTS Slum Clearance In their five-year programme the Council propose to deal with 58 properties. Up to the end of this year four areas have been represented containing 16 houses. In addition six houses included in the programme and owned by the Council have been demolished ; a further four houses are being voluntarily demolished by the owner. Certificates of Disrepair The Housing Act, 1954, allowed the landlord a limited increase in the rent of certain houses, if the house was in good repair and was reasonably suitable for occupation. The tenant could apply to the local authority for a certificate that the house was not in good repair and/or not reasonably suitable for occupation. During the period these provisions operated (they were repealed and superseded by the Rent Act, 1957) 15 applications were received from tenants, 13 certificates were issued ; two applications were refused. Of the 13 certificates granted only six were revoked on the application of the landlord. Overcrowding In one case, in which nine adult males were accommodated in a flat over a shop with a permitted number of " 5 informal action secured an immediate reduction to five occupants. Improvement Grants During the year, preliminary enquiries were made in respect of 22 houses. Four preliminary enquiries were referred to the Council and refused, in two cases because the alterations were not eligible and in the other two because the Council hoped to redevelop the area within the next 15 years. Grants were made in respect of four houses, three of which were occupied by the owner ; the tenant in the other house was an employee of the owner. 18 Tents, Vans and Sheds This year there have not been any applications under the provisions of the Public Health Act, 1936, Section 269. Gypsies, who pull their vans on to any open land, have been a continual source of annoyance to residents in the neighbourhood. The Council's building sites have been a favourite camping ground. A determined effort, including the impounding of horses, has been made to mitigate this nuisance. National Assistance Act, 1948 Section 47. The surveillance of elderly persons who are unable properly to look after themselves continues to receive the attention of the department. Where removal was necessary the voluntary agreement of the person was obtained in each case and the removal arranged through the County Welfare Department. Section 50. Two persons (male 81 years and female 64 years) were buried under the provisions of this section. Laundry Service for the Incontinent Aged This service, operated under the provisions of the Public Health Act, 1936, Section 84, commenced in December, 1953. It continues to meet a real need in the home when help is usually urgently required. Soiled articles are collected, and laundered articles returned each Monday, Wednesday and Friday. A small metal bin is provided in the home for the reception of soiled articles after they have been rinsed in cold water. The service continues to work well and there has been no known abuse of the facilities provided. The co-operation of the laundry staff at Barking Hospital continues to be excellent. From the commencement of the service to the end of the year 103 cases received assistance. During this year, 19 cases died, 14 were removed to hospital or no longer required the service and nine were still participating at the end of the year. The number of articles laundered during the year was 8,551. Atmospheric Pollution There was no need for statutory action during the year, but systematic observations were made of the chimneys of industrial premises. Certain provisions of the Clean Air Act, 1956, were brought into operation on the 31st December, 1956. The Council continue to operate at the Civic Centre and in the vicinity of Valence House instruments for the measurement of air pollution. 19 Rag Flock and Other Filling Materials Act, 1951 Two premises which have been registered under Section 2 of the Act have operated during the year. One licence for the manufacture and one licence for the storage of rag flock have been issued during the year. Samples are regularly taken at the three factories in the Borough where filling materials are manufactured. One sample of rag flock (described at the factory as jute flock) was unsatisfactory, inasmuch as the oil and soap content was 6.28% ; the statutory maximum is 5%. Further samples were satisfactory. A local resident complained of the filling material of a pillow purchased for a baby's cot. The filling material was rag flock and on analysis complied with the statutory standard. The pillow was not sold under the British Standards Institution Kite Mark and, therefore, although the contents of the pillow (consisting of pieces of rag) appeared nauseating, no offence was committed. Forty informal samples were taken during the year. The details are as follows Material Satisfactory Not Satisfactory Rag Flock 13 1 Cotton Felt 8 — Kapok 3 — Kapok mixed with cotton 5 — Coir Fibre 5 — Sisal 5 — Pet Animals Act, 1951 Five licences authorising the keeping of pet shops have been renewed ; in one case the trade had ceased and the licence was not renewed. The conditions attached to the licences are those approved by the Association of Municipal Corporations ; no serious breach of the conditions arose during the year. 20 FACTORIES ACTS, 1937 & 1948 Inspections. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted Factories without mechanical power 19 33 – – Factories with mechanical power 165 324 6 – Other premises under the Act (including works of building and engineering construction but not including out - workers' premises) 29 88 6 – TOTAL 213 445 12 – 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 5 4 – 3 – Unsuitable or defective 14 15 – 3 – Not separate for sexes – – – – – Other Offences 1 – – – – TOTAL 21 20 – 6 – OUTWORK No. of outworkers in August list 63 Nature of work - Making etc., wearing apparel 21 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 61 Butchers 166 Cafes and Canteens 26 Fishmongers 51 Fruiterers and Greengrocers 124 Grocers 21 Licensed Premises 11 Off-licensed Premises 96 Sweets, etc. All food premises are regularly inspected and during the year 3,291 visits were paid. In addition to numerous requests and suggestions during these routine visits, 62 informal notices were served upon owners or occupiers. 159 inspections in connection with itinerant vendors were carried out; much of this work is done at the week-ends. The number of premises registered under the Food and Drugs Act, apart from those in respect of ice cream, is as follows :— Out of a total of 61 butchers' premises 38 are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food. To these 698 visits were paid. In addition three other food premises are registered for this purpose. Out of a total of 26 fish shops 21 are registered for fish frying. To these 302 visits were paid. Lectures have been given to members of local organisations. At the Dagenham Town Show an exhibition was arranged dealing with Clean Food. 22 Public Her.lt b Inspectors dircuss Health Education methods with foreign student. Food Hygiene talk in progress at local food factory. 23 Food Hygiene Regulations, 1955 The following letter, together with a statement on the main provisions of the regulations, was sent to each food trader in the Borough:— "The increase in cases of food poisoning throughout the country during the past few years have given cause for concern and attempts have been made to reduce the numbers by introducing new legislation. "As you are no doubt aware, new food hygiene regulations have been introduced, some of which came into effect on January 1st of this year and others are to come into effect on July 1st. "It is only by close co-operation that these regulations can be made to work smoothly and to the best advantage. "Attached is a general statement about the main provisions of the new regulations which we trust you will find helpful. It is emphasised that this statement is only a summary and you will be well advised to purchase a copy of the regulations (they may be obtained from H.M. Stationery Office or any stationers, price 6d.). "The District Sanitary Inspectors during their routine visits will consider the points with you, but if you wish to raise any matters with us direct we will be prepared to discuss them with you." At a meeting arranged by the Chamber of Trade the Chief Inspector discussed the regulations with the local traders. The traders have generally co-operated well and the inspectors have spent considerable time in explaining to individual occupiers their responsibilities under the regulations. Two certificates of exemption have been granted during the year. Milk Under the provisions of the Milk and Dairies Regulations, 1949, eight premises are registered as dairies and 74 persons with premises in the Borough are registered as distributors. 77 visits were paid to these premises. During the year 61 samples of milk were submitted for bacteriological examination ; all were satisfactory. The Chairman of the Public Health Committee (Alderman Mrs. A. E. Prendergast) is a local authority representative on the Milk Sub-Committee of the Essex County Agricultural Executive Committee. 24 Ice Cream The total number of registered premises is 152; of this number two are registered for the manufacture of ice cream. 252 visits were paid to these premises. During the year four applications for the storage and sale of ice cream were granted. 26 inspections in connection with itinerant vendors were carried out. During the year 36 samples of ice cream were submitted for bacteriological examination ; they were graded as follows:— Grade I Grade II Grade III Grade IV Total 26 7 2 1 36 In addition 30 samples of ice lollies were submitted for examination ; two were unsatisfactory. In both cases the lollies were manufactured outside the Borough and the local authorities concerned were notified. Fourteen samples were taken of the ice cream manufactured in the Borough (at the two registered premises) with the following results:– Grade I Grade II Grade III Grade IV Total 10 3 1 – 14 Unsound Food Complaints continue to be received in respect of food containing foreign substances or otherwise alleged to be unfit for human consumption. Discussions took place with the management of a local factory in an endeavour to prevent the contamination of empty milk bottles with metallic dust. In three instances (cigarette end, hair clips and rodent excreta in bread) legal proceedings were taken and a fine of £5 was imposed in each case. 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. Registration of Food Hawkers Essex County Council Act, 1952 — Section 103 During the year six persons were registered as food hawkers. 25 FOOD AND DRUGS ACT, 1955 Analyses Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Angelica – 1 – – Biscuits – 5 – – Blackcurrant Juice – 1 – – Bread 2 16 – 6 Bread and Butter 7 – – – Butter – 1 – – Buttered Roll – 1 – 1 Cake – 1 – – Cake Mix – 1 – – Caraway Seeds – 1 – – Cheese – 3 – – Chicken, Chopped – 1 – – Chicken Patties – 1 – – Coffee – 1 – – Confectionery – 4 – – Cordials – 5 – – Condiment, Non-brewed – 1 – – Cream – 1 – – Custard Powder – 1 – – Dessert Sweet – 1 – – Egg Loaf 1 – – – Fruit – 1 – – Gelatine – 2 – – Gherkins in Vinegar – 1 – – Herbs, Dried – 3 – – Ice Cream – 16 – – Ice Lollies – 11 – – Jams, etc – 2 – 1 Jellies – 2 – – Lemon Juice – 2 – – Margarine – 1 – – Marzipan – 2 – – Medicinal Samples – 16 – – Meat Pie – 5 – – Meat Pudding – 3 – – Milk 36 4 1 2 Milk in Dirty Bottle – 1 – 1 Milk Bottle—Dirty – 2 – 2 26 Analyses Article Number Examined Number Adulterated, etc. Formal Informal Formal Informal Milk—Evaporated – 1 – – Milk—Dried – 1 – – Mussels – 1 – – Mustard – 1 – – Pastes – 5 – – Pea Flour – 1 – – Peel – 1 – – Pepper – 3 – – Pudding Mix – 1 – – Sago – 1 – – Sauces – 4 – – Sausages 16 1 – 1 Savoury Straws – 1 – – Soups – 2 – – Spices – 6 – – Spreads, various – 4 – – Stuffing – 1 – – Suet – 2 – – Sugar – 1 – – Tea – 3 – – Tomato Juice – 1 – – Vinegar – 1 – – Wines and Spirits 12 1 – – 27 ADULTERATED SAMPLES, Etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 106 A Foreign matter found in beef sausage. Informal Consisted of a piece of fur with attached connective tissue from a beef carcase. Manufacturers warned. 107A Bread Informal Contained a foreign body consisting of charred or burnt dough, bread and cotton fibres. Manufacturers warned. 109 A Milk in dirty bottle. Informal Contained small blackish spots of foreign matter adhering to bottom and sides of bottle. Foreign matter found to consist of round fragments of metallic iron. Factory Management agreed to alter system of distribution to employees. 110A Dirty Milk bottle. Informal Heavy yellowish brown deposit adhering to bottom of bottle. Deposit consisted of round fragments of metallic iron and rust cemented together by dried milk solids. 111A Dirty Milk bottle. Informal Heavy yellowish brown deposit adhering to bottom of bottle and extending for part of the way up the side. Deposit consisted of round fragments of metallic iron and rust cemented together by dried milk solids. 133A Lemon Cheese Contained foreign matter on lid of jar found to consist of some form of jam and small fibres from a sack. Manufacturers warned. 28 Adulterated Samples, etc. Serial No. Article Formal or Informal Nature of Adulteration or Irregularity Observations 176 A Rolls (Proprietary). Informal 8% deficient in protein. Formal sample obtained. 187A1. Milk Informal Contained three very small foreign bodies (black) consisted of fat containing traces of mould growth. Suppliers warned. 187A2. Bread Informal Contained bluish coloured foreign bodies found to consist of small pieces of paper taken from a flour bag. Manufacturers warned. 188A Egg Milk Loaf Informal Contained insufficient egg and milk to justify the description egg and milk loaf. Formal sample satisfactory. 223A Milk Informal Contained five blackish film-like fragments of foreign matter. Found to consist of a milk film covered with mould growth. Suppliers warned. 244A Buttered Roll Informal Showed patches of dirt on the outside and contained a small black foreign body embedded in the roll. Foreign body found to consist of dirty dough. Manufacturers warned. 2331 Rolls (Proprietary) Formal 11 % deficient in protein. Manufacturers agreed to alter label. 2343 Milk Formal 1% added water. Vendor warned. 29 Food Poisoning Forty-six cases of food poisoning were notified during the year. The following is a copy of the annual return submitted to the Ministry of Health 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Total 4 27 2 13 46 Outbreaks due to Identified Agents. Total Outbreaks 1 Total Cases 2 (Salmonella Typhi-murium) Outbreaks of Undiscovered Cause. Total Outbreaks 9 Total Cases 24 Single Cases. Agent identified 4 Unknown Cause 16 Total 20 (Salmonella Typhi-murium 2) (Salmonella Heidelberg 1) (Salmonella Enteritidis 1) All the outbreaks were confined to individual families. In five outbreaks two members of the family were notified, in four outbreaks three members and in one outbreak four members of the family. A suspected outbreak of food poisoning occurred at a local factory with between three and four thousand employees. About 200 persons were affected. Exhaustive enquiries by this department and the medical department at the factory failed to ieveal the cause. At least 33 different foods were available for employees at the material time; investigations ruled out lunch as being the source of infection. Tea-breaks occurred in the morning and afternoon and food was obtained from a trolley service and the canteens. Twenty-six swabs were submitted for bacteriological examination; all were negative. The times of onset of symptoms varied; the following were the times of onset in 140 cases :— 1-6 hours 7-11 hours 12-20 hours 19 16 105 The main symptoms were abdominal pain, diarrhoea and vomiting. In most cases the persons recovered within 24 hours. Undoubtedly in more or less every case the affected person was treated at the factory's medical department. Not a single notification of food poisoning was received by me nor, as far as I am aware, by medical officers of health in the neighbouring districts in which many of the employees live. Dysentery Sixty-seven cases of dysentery were notified during the year; of these 41 were due to Shigella Sonnei. 35 of the cases were children attending school ; these were distributed as follows :— At each of 2 schools 6 cases ,, „ „ 3 3 „ „ ,, „ 2 2 „ ,, 10 schools 1 ,, 30 Paratyphoid B. Fever Circumstantial evidence indicated that imitation cream contaminated by imported frozen egg products in a local bakery gave rise to an outbreak of paratyphoid B. fever in which at least 42 cases were notified. Two employees at the bakery were found during the investigations to have contracted the disease, but were without doubt victims and not the cause of the outbreak. Elaborate precautions had been taken at the bakery to prevent contamination of imitation cream, but failure to comply with the precautionary measures laid down by the management resulted in this outbreak. There were no known secondary cases. Following this outbreak the management agreed to arrange for a local doctor regularly to attend the bakery to advise on medical matters and examine employees where necessary. 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 8 11 51 10 4 1 86 Whooping Cough 31 77 88 210 6 – – 412 Acute Poliomyelitis:— Paralytic – 2 – – 1 – 1 4 Non-paralytic – – 2 2 2 2 1 9 Measles 8 18 21 41 2 1 – 91 Diphtheria – – – – – – – – Under 5 years 5—14 15—44 45—64 65 and over Total Pneumonia:— Acute Primary 1 5 3 15 10 34 Acute Influenzal 2 2 – 7 3 14 Dysentery 16 39 7 5 – 67 Encephalitis, Acute: — Infective – 1 – – – 1 Post-Infectious – – – – – – Erysipelas – – 4 9 2 15 Meningococcal Infection 2 1 – – – 3 Food Poisoning 14 9 18 5 – 46 Puerperal Pyrexia – – 3 – – 3 Ophthalmia Neonatorum 8 – – – – 8 Paratyphoid "B" – 3 2 1 – 6 31  Notified Admitted to Isolation Hospital, Rush Green Admitted to other Isolation Hospitals Admitted to other Hospitals Registered Deaths Diphtheria – – – – – Dysentery 67 13 2 1 – Encephalitis, Acute 1 – 1 – – Enteric Fever – – – – – Erysipelas 15 5 1 – – Food Poisoning 46 1 1 1 – Malaria – – – – – Measles 91 1 – – – Meningococcal Infection 3 1 2 – 1 Ophthalmia Neonatorum 8 – 1 – Paratyphoid Fever 6 5 1 – – Pemphigus – – – – – Puerperal Pyrexia 3 – – – – Pneumonia:— Acute Influenzal 14 – 1 1 Acute Primary 34 2 1 I Poliomyelitis, Paralytic 4 4 – – – Non-Paralytic 9 9 – – – Scarlet Fever 86 3 1 – – Smallpox – – – – Whooping Cough 412 3 7 – – 32 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 2 – – – – – – – – – – 5— – 4 – – – – – – – – – – 10— – 3 – – 1 – – – – – – – 15— 2 8 – – – – – – – – – – 20— 3 5 – – – 1 – – – – – – 25— 11 5 – – 5 5 – – 3 3 – – 35— 11 5 – – 1 3 – – 3 – – – 45— 6 – – 1 1 2 – – 4 2 – – 55— 8 2 – – – – – – 5 – – – 65—and upwards 3 1 – – – – – – 2 – – – 45 35 – 1 8 11 – – 17 5 – – Register. Pulmonary Non-Pulmonary Male Female Male Female No. on register 1st January, 1956 543 424 73 78 During the year:— New notifications 45 35 – 1 New cases brought to notice by Registrars' Deaths Returns – – – – Deaths 17 5 – – Transfers into area 8 11 – – Transfers out of area 31 30 3 1 Removed from register as " Recovered" 6 11 4 6 No. on register 31st December, 1956 544 424 67 71 33 Dagenham may feel justly proud of the work of the Chest Clinic during the past year. The small team of three tuberculosis Health Visitors maintain the links between the hospital services, the health department and the social agencies involved in the care of the tuberculosis patient. Their duties involve visiting the homes of all notified cases to give reassurance and help to the family, to advise on the care of the patient and arrange for the medical examination of all contacts. They ensure by frequent visits and discussions that the patient and family understand the physician's instructions, as it is only by adequate education of patients and contacts that tuberculosis can be eradicated. In necessitous cases arrangements for grants and assistance are made by the Health Visitor in contact with statutory and voluntary agencies in the Borough. The Tuberculosis Care Committee plays an active part in the rehabilitation of these patients and our thanks are due to the members of the public and the staff who so willingly give their time to this work. The success of the work of the Occupational Therapist for tuberculosis patients in the teaching of handicrafts can be judged from the high quality of work exhibited each year at the Dagenham Town Show. Mass Radiography Survey The Mass Radiography Unit came to Dagenham in November, 1956, and this year special emphasis was placed on the radiological examination of old people in the area. Talks were given and films shown at Old People's Clubs by members of the Health Department to encourage them to attend. The following analysis of the survey indicates the attendances and results : 34 MASS RADIOGRAPHY : ANALYSIS OF SURVEY Group Number Examined Recalled for Large Film Recalled for Clinical Interview Did not attend for Large Film or Interview Carcinoma of Bronchus PULMONARY TUBERCULOSIS Cardiovascular lesions Other Abnormalities Presumed Healed Suspect T.B. Not yet Confirmed Occasional Clinic Supervision Close Clinic Supervision Requiring Immediate Treatment Organised Groups: Male 440 21 10 – 1 3 – 4 – – – 5 Femlae 361 12 4 – – 2 – 1 – – – – Public Sessions: Male 835 26 14 – – 2 – 4 – 3 3 5 Female 1,367 32 19 – – 7 – 4 – 1 5 2 Refferrals by General Practitioners: Male 219 19 11 – – – – 1 – 1 1 12 Female 237 12 5 – – 1 – – – 1 1 7 School Children: Male 217 4 2 – – – – – – – – 2 Female 146 2 1 1 – – – – – – – – Industrial: Male 8,685 239 132 8 4 51 – 16 4 12 6 63 Female 2,063 48 22 – – 11 – 1 1 – 4 7 Totals: Male 10,414 309 169 8 5 56 – 25 4 16 10 87 Female 4,174 106 51 1 – 21 – 6 1 2 10 16 Grand Totals 14,588 415 220 9 5 77 – 31 5 18 20 103 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. 44 2 Weekly Thursday, p.m. 37 2 Becontree Clinic, Becontree Avenue, Dagenham. Weekly Monday, p.m. 30 2 Weekly Tuesday, p.m. 36 2 Weekly Wednesday, a.m. 26 1 The Leys Clinic, Ballards Road, Dagenham. Weekly Thursday, a.m. 19 1 Weekly Thursday, p.m. 26 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (2nd, 4th & 5th in month) Weekly Friday, a.m. 15 1 Friday, p.m. 25 1 The Clinic, Ford Road, Dagenham. Weekly Tuesday, a.m. 39 2 Weekly Tuesday, p.m. 46 3 The Clinic, Manford Way, Hainault. Weekly Monday, p.m. 14 1 London City Mission Hall, Dagenham Road, Dagenham. Weekly Wednesday, p.m. 24 2 Weekly Thursday, a.m. 11 1 Weekly Thursday, p.m. 48 3 15/17, Thompson Road, Dagenham. Weekly Wednesday, p.m. 35 2 Weekly Friday a.m. 12 1 36 Toddlers Clinics Clinic Sessions Held Average Attendance Chadwell Heath Weekly: Tuesday—p.m. 9 Leys First Thursday in the month—a.m. 8 Ford Road Alternate Fridays—a.m. 10 Ante-Natal Clinics CENTRE Sessions Held Times Sessions Held Average Attendances Average New Cases The Clinic, Ashton Gardens, Chadwell Heath. Weekly Wednesday, p.m. 10 2 The Clinic, Becontree Avenue, Dagenham. Weekly Tuesday, p.m. 12 2 Weekly Wednesday, a.m. 8 1 The Leys Clinic, Ballards Road, Dagenham. Weekly Wednesday, p.m. 12 2 Rush Green Clinic, 179, Dagenham Road, Rush Green. (1st & 3rd in month) Friday, a.m. 6 1 York House, Frizlands Lane, Dagenham. Weekly Tuesday, a.m. 17 3 Weekly Wednesday, p.m. 18 3 Weekly Thursday, a.m. 13 2 Weekly (Discontinued after 28.2.56) Thursday, p.m. 11 2 The Clinic, Ford Road, Dagenham. Weekly Monday, a.m. 15 3 Weekly Discontinued after 25.2.56. Monday, p.m. 16 3 The Clinic, Manford Way, Hainault. Weekly Monday, a.m. 6 1 37 CARE OF MOTHERS AND YOUNG CHILDREN The changing picture of the health of mothers and young children in the country in the last twenty years has brought changes in the maternity and child welfare services. The early problems of infectious disease, especially gastroenteritis, and malnutrition in infancy and the more serious disorders of pregnancy are no longer met. A generation of mothers has grown up, healthy in themselves, willing and ready to take all the known aids to a healthy pregnancy and with a vastly increased knowledge of the problems of child care. So that in the clinics of today we are seeing healthier mothers-to-be and the emphasis is on the teaching of the facts about normal pregnancy and confinement rather than on the need to cure abnormal conditions. In the Infant Welfare Clinic the marked improvement seen in the physical health of babies and toddlers can but give us the opportunity and incentive to turn our attention increasingly to the problems of the child's social adjustment and development. These problems which in the past were overshadowed by the more urgent necessity of keeping the children physically healthy, are none the less important to ensure a happy, stable, and unharrassed background of family life in which the children may grow and learn. Thus it is that Infant Welfare Clinics are now fulfilling a new but very important function of providing a consultative service for mothers faced with problems of child behaviour and development. In an attempt to bridge the gap between the two-year-old attending the Infant Welfare Clinic and the five-year-old's first school examination, Toddler Clinics were started in three clinics in the area during the year. These have met with only partial success, but it is felt that they can be of value if the mothers are educated to continue their attendance until the children reach school age. 38 Dental Treatment The treatment given to expectant mothers and nursing mothers and to children under 5 is detailed below: Expectant or nursing mothers Children under five years of age Number of patients examined 108 132 Number of patients needing treatment 92 105 Attendances for treatment 302 218 Number of patients who have completed treatment 51 74 Number of Extractions 354 75 Number of Fillings 54 194 Number of Anaesthetics administered: (a) local 149 52 (b) general – 4 Number of Scalings or scaling and gum treatment 2 – Number of Silver Nitrate treatment – – Number of Dressings – 4 Number of X-ray examinations – – Number of Dentures provided: (a) full 29 – (b) partial 5 – As in previous years this is nothing like an adequate service for the Borough, and at times the almost total lack of dental staff has meant long waiting periods or referral to private dentists. 39 MATERNITY SERVICES Maternal Mortality There were no maternal deaths in this area during 1956. Ophthalmia Neonalorium Eight cases of ophthalmia neonatorium were notified—all made a complete recovery. There were 33 cases of other eye conditions occurring in newlyborn infants requiring medical treatment. Domiciliary Midwifery Service Below is a table showing the work of the County Midwives, Midwives residing at York House Training Home and Salvation Army Midwives for the year 1956: County Midwives Midwives Residing at York House Training Home Salvation Army Midwives Births Attended: As Midwife 139 201 76 As Maternity Nurse 156 8 3 Miscarriages Attended (included in above) 3 11 3 Visits Paid: As Midwife 4,279 5,200 1,960 As Maternity Nurse 2,574 297 70 Ante-Natal 1,952 1,527 421 Ante-Natal Clinics Attended 327 164 51 Gas and Air Administered: As Midwife 81 112 71 As Maternity Nurse 116 3 2 York House—Midwifery, 1956 The domiciliary midwifery undertaken by the staff of York House has steadily fallen due to the increasing facilities for hospital delivery. A number of patients prefer hospital confinement because of the convenience and others were admitted because of inadequate home conditions. 40 Mothercraft demonstration by Health Visitor. Ante-natal relaxation exercises. 41 Domiciliary Cases 1954. Cases attended—no doctor present 263 ,, —doctor present 10 273 1955. Cases attended—no doctor present 223 —doctor present 18 241 1956. Cases attended—no doctor present 196 ,, —doctor present 13 209 Visits to patients, both ante-natal and nursing, totalled 7,604 in 1956. In the first half of 1956, 130 cases were attended and in the second six months 79 cases. Of the total 209, 179 received an analgesic, most of the others preferring to be without. Both gas and air and Trilene analagesia were used and records of advantages and disadvantages of the methods were made for a survey now being undertaken by the Essex County Council. Ante-natal clinics at York House continued to be well attended. Five clinics are held each week, three staffed by the Medical Officer, nurses and midwives, and two by midwives. One relaxation class conducted by the Health Visitor continues to be popular. Relaxation Classes The following were the attendances at the relaxation classes during the year:— The Becontree Clinic 325 Chadwell Heath Clinic 313 Leys Clinic 345 York House Clinic 488 Total 1,471 42 Maternity Services continued The Domiciliary Midwifery Service provided by midwives other than those based on York House continues as in previous years, but as the number of hospital deliveries increases, the work of the midwives for the care of the mother and neo-natal infant from discharge up to the fourteenth day has increased. Premature Infants All infants weighing 51/2-lbs. or less at birth are regarded as premature infants, whatever the length of the pregnancy. Premature Infants Live premature births occurring in the area:— 3 4 lb. oz. or less 3 5 lb. oz. —4 6 lb. oz 4 7 lb. oz. —4 15 ls.oz. 5 0 lb. oz. —5 8 lb.oz. Total No. Surviv ing One Week Born alive at home and nursed entirely at home 2 1 3 19 25 22 Born alive at home and transferred to hospital 1 — — 1 2 2 Born alive in a private nursing home and nursed entirely there — — — — — — Born alive in a private nursing home and transferred to hospital — — — — — — Born in hospital 7 17 19 31 74 68 43 HEALTH VISITING The duties of the health visitor continue to expand. Her present function of health teacher and family advisor, together with her knowledge of the social conditions affecting the welfare of the family, tend to make her the most suitable person to interpret to the public scientific and legal publications affecting the health and welfare of the family. She is always willing to act as liaison between statutory and voluntary social agencies and the family. In her role as home visitor the health visitor advises parents, foster parents and expectant mothers on the best means of promoting their own health and welfare and that of their families. By frequent follow-up visits to children suffering from illness, defect or handicap, to those living in unsatisfactory homes, to the illegitimate and children day-minded in homes other than their own, the health visitor can get a complete picture of the trouble spots in her area and thus keep informed all the agencies whose help may at any time be needed. This is of special value in dealing with the problem families who are economically and socially inadequate and need the constant bolstering hand of all branches of the Health and Welfare Services. As well as visits made at the request of the public, the health visitors continue to make special surveys for the department on many and varied topics—hospital admissions and discharges, the investigation of notifiable diseases and special follow-up visits for national surveys in certain diseases of infancy. Problems associated with housing conditions are ever present and health visitors referred all defects and overcrowding to the sanitary section of the department. They co-operated also in many cases where medical certificates had been submitted to the Housing Department in support of applications for rehousing. Increasingly the care of the aged has been added to the work of the health visitor. As the problem of the welfare of old people 44 comes into the forefront of preventive medicine, so we must see that the many and varied voluntary and statutory agencies already set up are brought to the notice of the aged and that their health is maintained by early diagnosis, adequate nutrition and health education. There is much still to be done in the field of mental defect and it is hoped that the visiting of defectives in their homes will become part of the work of the health visitors who already do much in the under-5 age group in referring cases for ascertainment, in encouraging the parents to co-operate in any suggested training of the defective, and in helping them to understand their children's problems. The work of the clinics goes on and by her attendance at the clinic and the advice and discussions there, the health visitor can encourage early medical consultation, vaccination and immunization. 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 148 Total visits 513 (b) To children under 1 year of age First visits 1,689 Total visits 5,758 (c) To children between the ages of 1 and 5 years Total visits 11,030 (d) Ineffective visits Total visits 3,736 (e) Other visits Total visits 1,061 Grand Total 22,098 45 VACCINATION AND IMMUNISATION Vaccination During the year 922 persons were vaccinated or re-vaccinated VACCINATION CARRIED OUT BY GENERAL PRACTITIONERS Vaccinated. Age at date of vaccination Under 1 201 1—4 37 5—14 50 15 or over 81 Total 369 Re-Vaccinated. Age at date of re-vaccination Under 1 — 1—4 3 5—14 9 15 or over 130 Total 142 VACCINATION CARRIED OUT BY LOCAL HEALTH AUTHORITY STAFF Vaccinated. Age at date of vaccination Under 1 348 1 — 4 48 5 — 14 7 15 or over 1 Total 404 Re-Vaccinated. Age at date of re-vaccination Under 1 — 1 — 4 — 5 — 14 — 15 or over 7 Total 7 IMMUNISATION I—Diphtheria The following is a summary of the work carried out during the year. A total of 1,269 children received primary immunisation injections and a total of 785 received boosting doses. 46 DIPHTHERIA IMMUNISATION The following is a summary of the work carried out during the year:— Age (in years) at final injection Primary Immunisation Children who received a boosting dose Under 1 374 — 1—4 320 43 5—9 58 306 10—14 17 80 Total 769 429 Immunisation by General Practitioners. Age (in years) at final injection Primary Immunisation Children who received a boosting doie Under 1 231 — 1 — 4 227 33 5— 9 34 268 10 — 14 8 55 Total 500 356 II—Whooping Cough 1,091 children received immunising doses against Whooping Cough including boosting doses. Of these, 227 children received combined Pertussis-Diphtheria injections. Poliomyelitis Following notification by the Ministry that supplies of Poliomyelitis vaccine would be available to local health authorities during the year, a letter offering vaccination was sent to the parents of all children between 2-9 years, and a form of registration to be returned was attached. Later in the year a small supply was sent to all areas and a selected group of children were offered vaccination. Number of Acceptors registered in 1956 6,116 Number of completed courses of injections in 1956 . 665 47 Year of Birth Children born in: 1947 1948 1949 1950 1951 1952 1953 1954 Total March — — — — 46 50 24 35 155 August — — 11 45 28 21 26 21 152 November 78 64 54 44 20 28 38 32 358 Totals 78 64 65 89 94 99 88 88 665 The response and attendances were encouraging and the scheme will expand during the coming years as more vaccine becomes available. To encourage parents to agree to vaccination against Poliomyelitis, an intensive health education programme was organised with poster displays and public meetings held in the libraries and public halls, at which members of the Medical Staff gave talks on Poliomyelitis and the present stage of knowledge of the vaccine. Talks and a Brains Trust were arranged with Parent Teacher Associations in the town. The large attendance at the meetings was in all cases most encouraging and welcome. DAY NURSERIES Throughout the year the Day Nurseries maintained their high standard of care for those children who for one reason or another cannot be looked after at home. There are many reasons why a child must enter a nursery and the nursery has much to offer these children. Widowhood, divorce, illegitimacy—all play their part in making necessary admission of an infant or toddler to the day nursery. Other factors such as overcrowding in the home with its almost inevitable tension and frustration must also be weighed in the balance when considering admission to a day nursery. The nurseries must play their part in promoting and maintaining the physical, emotional and mental well-being of the children and in providing child companionship and playing-space when it is not available to the child in its own home. They can also assist during emergencies in the family such as the illness of the parent and can be of inestimable value in helping to demonstrate to the parent the correct handling of the young child, particularly the handicapped and those with early behaviour disorders. 48 Attendances, 1956 Day Nursery Number of approved Places Average Daily Attendance Average Number on Register Total Attendances Goresbrook 70 29 40 7,384 Chad well Heath 54 39 49 9,806 Kingsley Hall 40 21 26 5,323 Totals 164 89 115 22,513 Nursery Widows Parents Separated Desertion Illness of Father Unmarried Mothers Socioeconomic Mothers working to supplement income Total Goresbrook 5 4 6 13 19 47 Chadwell Heath 1 14 — — 4 17 19 55 Kingsley Hall 1 5 1 — — 8 14 29 Number of Children in all nurseries 1956 2 24 1 4 10 38 52 131 HEALTH EDUCATION Health Education should not be a separate section of the work of the Health Department, but must permeate into every member of the staff's daily work. By the health visitors it is carried out during the course of home visits by help and advice and by group teaching in clinics, clubs and women's guilds, and by the public health inspectors in their daily round of food premises and of house inspection. Relaxation classes for expectant mothers are held regularly every week, an average of four sessions per week, and great benefit is derived from these not only in the teaching of relaxation during childbirth, but in the lessons on mothercraft given during these classes. Diet, feeding, clothing, hygiene and general care are taught and discussed. During the year talks have been given on a variety of subjects by the medical and health visiting staff and public health inspectors. "Accidents in the Home," "The Work of the Health Visitor," "Problem Families," "The Work of the Tuberculosis After-Care Committee," "The Problems of Cancer "and" Food Hygiene" are among some of the subjects dealt with. Series of lectures were given to Civil Defence and Red Cross recruits, and to Domestic Helps attending the courses on child care, food values and food hygiene, first aid in the home, and the care of the tuberculosis patient. A useful link with the hospital services are the visits of student nurses to the department to observe the work of the health visitors, and one health visitor attends the local hospitals to give lectures on public health work. DIARY OF TALKS —1956 Date Organization Subject January: Members of Dagenham Round Table No. 421, Eastbrook Hotel, Dagen- The Work of the Public ham Road, Dagenham Health Inspector. February: Student Nurses, Oldchurch Hospital Public Health. February: Student Nurses, Oldchurch Hospital Public Health. March: Libraries: Valence House, Poliomyelitis Chadwell Heath, Immunisation. Queenswood Hall, Rectory Road, Wantz. 50 Date Organization Subject March: Rookery Farm School Brains Trust: Poliomyelitis Immunisation. March: Parent Teacher Association Poliomyelitis Immunisation. March: May & Baker Ltd Poliomyelitis Immunisation. July: Dagenham Chamber of Food Food Hygiene July: Church Guild, Free Church, Crown Street, Dagenham Tuberculosis After-Care. September: Members of Dagenham's Old People's Welfare Council Our Advancing Years. September: Five Elms Co-operative Guild The Work of the Medical Officer of Health (with supporting film). October: Rush Green Over 60 Club, Avenues Social Club, Dagenham Tuberculosis & the Aged. October: Wantz Old Folk's Club, Wantz Restaurant, Dagenham Tuberculosis & the Aged. October: Darby & Joan Club, Cecil Hall, Chadwell Heath Tuberculosis & the Aged. October: Dockland Old Folk's Club, Dockland Settlement, Dagenham Tuberculosis & the Aged. November: Old Folk's Club, Co-op Hall, Broad Street, Dagenham Tuberculosis & the Aged. November: Members of Dagenham Round Table No. 421, Eastbrook Hotel, Dagenham Road, Dagenham ... Epidemics. The importance of informal discussion and question-time after talks were shown on each occasion by the number of subjects discussed or questions asked. 51 DOMESTIC HELP The table below sets out the various categories of cases in which this service was used and the number of visits paid by the Organiser during the year. Type of Case Number of Cases Hours Help Provided Maternity 77 4,944 Tuberculosis 16 3,951 Acute Sick 60 5,435 Chronic Sick (Others) 85 17,544 Chronic Sick (Aged) 329 39,598 Aged Not Sick 7 721 Others 6 1,041 Totals 580 73,234 Number of visits paid by Organiser 1,234 Average number of Domestic Helps employed each week 66 Maternity The number of maternity cases served showed a slight increase as compared with 1955, from 74 to 77. Tuberculosis Sixteen homes were provided with help necessitated by the presence of a tuberculous patient. Though the numbers served were small, the service provided was of immense value. Care of the Aged The increased services of the domestic helps given to the aged is shown in the table. The figures show an increase in the number of cases of chronic sick of 44. This increase is doubtless due to a variety of factors—not least the increasing number of aged in the population. This combined with the shortage of accommodation for the old both in hospital and accommodation provided under Part III of the National Assistance Act, 1948, increases the strain put upon the service. The domestic helps in many cases do far more for the aged than duty demands, and are looked upon by them as friends who help to lessen the burden of loneliness in their advancing years. Care of Children In cases where the mother of a family has been admitted to hospital the service has been called upon to help to run the home and keep the family together. Not only has this been achieved, but in a number of cases the helps have visited the mother in hospital to assure her that her family is being cared for during her absence. This has no doubt contributed to the mother's peace of mind and ultimately helped towards her recovery. 52 Recruitment Great care is taken in the selection of the right type of personnel for this service and courses of instruction are organised twice yearly by the County Health Department at which a small number of helps each year are given further instruction in their duties. Social activities were arranged twice during the year—on one occasion a party of domestic helps visited the London Palladium, and the Christmas Party held at the Civic Centre was a great success. RECUPERATIVE HOLIDAYS In conjunction with the General Practitioners recommending recuperative holidays, the following indicates the number for whom these were arranged and the holiday homes to which they were sent. National Health Service Act Section 28: 15 Bell Memorial Home, Lancing. 24 Essex Convalescent Home, Clacton. 9 T.B. cases placed by Spero. 2 All Saints Convalescent Hospital, Eastbourne. 5 St. Joseph's Convalescent Home, Bournemouth. 2 Victorian Convalescent Home, Bognor. 3 Surrey Convalescent Home, Seaford. 1 Mr. & Mrs. Beech Home, Chingford. 1 Mrs. Armfield's Home, St. Leonards. 1 Charford St. Peter Colony. 2 Shoreditch Holiday Home, Copthorne. Section 22: 3 Mothers with children—Shoreditch Holiday Home. 6 Children placed by I.C.A.A. 53 CO-OPERATION AND LIAISON No report on the work of this department would be complete without a warm tribute being paid to the help that we are so rapidly given by all the Social Agencies in the area. Much of the work on problem families could not be successful without the close co-operation and understanding of Inspector Riley and his staff of the N.S.P.C.C.—so close is this co-operation that we might well consider him to be a member of the Health Department staff ! No request for help goes unanswered from the Personal Service Council, the W.V.S. and the Children's Department. Their willing assistance at all times greatly facilitates the overcoming of the socio-economic problems that go hand in hand with those of the health of the family. During the year there have been two meetings of the General Practitioners and medical and nursing staff of the department. We discussed the problems of the aged and the possibilities of a future clinic for old people run by the department. At the second meeting the proposals for Poliomyelitis vaccination and the present state of knowledge on Poliomyelitis were reviewed. These informal meetings encourage the closer co-operation between the two branches of the health service, and serve to increase the personal contact between the staff and the Practitioners. I would like to thank the Practitioners in the area for the help they have given to me and my staff, and particularly for their readiness to call in the help of the health visitors where they feel they can be of service. I should like to see closer hospital liaison in the area particularly between doctors and health visitors and hospital departments. Following a circular addressed to all hospitals admitting child patients from Dagenham there has been an increase in letters recording hospital admissions and discharges as far as children are concerned, but there are still gaps which could be filled either by visits to the hospital by one of my staff to bring back reports from the specialists and take to the hospital knowledge of the home conditions, or by routine admission and discharge notes sent to me from the hospital. 54 GREENUATE PRESS LTD. (T.U.), 594/6 BARKING ROAD, E.13