HORNC 11 Hornchurch Urban District Council INTERIM REPORT OF THE MEDICAL OFFICER OF HEALTH 1943 ALFRED BALL, M.D., D.P.H., Medical Officer of Health. W. & W. Ltd., Romford. 2 MEMBERS OF THE COUNCIL. Councillor A. S. Hulkes, J.P., Chairman. Councillor W. H. F. Maunder, Vice-Chairman. Councillor Mrs. E. M. Field. (1) ,, Mrs. A. J. E. King. ,, Mrs. E. J. Reynolds. ,, Mrs. F. Sherring. (2) ,, Mrs. C. M. Stevens. (2) ,, Mrs. H. S. E. Williams. (1) ,, O. P. W. Ashdoavn. ,, O. S. Biggs. (1) ,, W. G. Bunch. (3) and (2) E. W. J. W. Bush. (1) and (2) ,, F. J. R. Hecker. ,, A. C. Holmes. (1) ,, H. Holock . ,, A. W. Pettit. ,, A. C. Salinger. (1) ., A. J. Twigger. H. H. Wake, J.P. (1) W. H. F. Webb. (1) (1) Member of the Public Health and Ambulance Committee. (2) Member of the Romford Joint. Hospital Board. (3) Chairman of the Public Health and Ambulance Committee. OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: Alfred Ball, M.D., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (R.C.P.S.) Lond. Deputy Medical Officer of Health: P. X. O'Dwyer, M.B., B.Ch., B.A.O., D.P.H. Sanitary Inspectors: L. Ager, San. Insp. Cert. R.S.I. Cert. Insp. of Meat and Other Foods. A. V. J. Hutchings, San. Insp. Cert. R.S.I, and S.I. Joint Board. Cert. Insp. of Meat and Other Foods. E. Ellerington, San. Insp. Cert. R.S.I, and S. I. Joint Board. Cert. Inspector of Meat and Other Foods. Clerk: *J. Blay. E. Tomsett (Temp.). * On War Service. 3 COUNCIL OFFICES, HORNCHURCH, 1st June, 1944. To the Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, The report for the year 1943 now presented for your consideration is abbreviated in conformity with the suggestions contained in circular letters 2773 and 10/44 from the Ministry of Health. Full records for each of the last four years, including the figures supplied by the Registrar General, will be preserved, so that at the termination of hostilities a report may be prepared dealing more fully with the vital statistics of the war period. During the year under review, the general health of the inhabitants of the District was maintained at a high level. The birth rate remains higher than that for England and Wales, the reason being that the District contains a larger number of young people than the average for the whole Country. A wave of Influenza appeared in the last quarter of the year, but on the whole the cases were not of the severe type which has occurred in some previous epidemics, and deaths were not numerous. My thanks are due to the members of the Council for the support which I have received from them in the execution of my work. I also wish to put on record the assistance which I have received from the Public Health staff and from my fellow officers in all Departments. ALFRED BALL, M.D., D.P.H., Medical Officer of Health. 4 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres (land and inland water) 19,768 Number of inhabited houses (Sept., 1943), according to Rate Books 26,356 Rateable Value (September, 1943) £671,153 Sum represented by a Penny Rate (Sept., 1943) .£2,715 There are no conditions of occupation or environment which have had a prejudicial effect on health. Vital Statistics. Extracts from the Vital Statistics of the year. Male. Female. Total Rate. Live Births:— Legitimate 773 761 1,587 Illegitimate 26 27 Still Births:— Legitimate 25 27 54 Illegitimate 0 2 Rate per thousand total (live and still) births 32.9 Deaths 359 392 751 Deaths from Puerperal Causes :— Total. Rate. (a) from Puerperal and Post-abortion Sepsis 0 (b) from other maternal causes 4 (c) rate per thousand total (live and still) births 2.4 Death rate of infants under one year of age:— All infants per thousand live births 30 Legitimate infants per thousand legitimate births 29 Illegitimate infants per thousand illegitimate live births 56 Deaths from Measles (all ages) 0 ,, ,, Whooping Cough (all ages) 2 ,, ,, Diarrhoea (under 2 years of age) .. 3 ,, ,, Cancer (all ages) 117 ,, ,, Diabetes (all ages) 11 ,, ,, Influenza (all ages) 11 ,, ,, Pneumonia (all ages) 33 5 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (1) Bacteriological Laboratory Service. A County Laboratory has been established at Oldclmreh County Laboratory to which specimens requiring bacteriological examination are sent by Doctors practising in the District. The Emergency Laboratory at St. Margaret's Hospital, Epping, has continued to supply, on request, the material used in immunisation against Diphtheria. (2) Ambulance Facilities. The Council maintain an ambulance at Harrow Lodge Depot which is provided especially for street accidents and persons seized with sudden illness needing removal, but it is also available to convey maternity and other cases to hospitals and institutions. The scheme of mutual assistance for the use of ambulances belonging to the neighbouring districts of Romford and Brentwood and also the Essex Council has continued to operate, and the use of the Dagenham Ambulances has also been obtained on several occasions. (3) Nursing in the Home. There are three Nursing Associations affiliated to the Essex County Nursing Association working in the District. The Hornchurch Nursing Association serves the central part of the area including the North-West Ward and also Harold Wood pending the formation of a local Association in that area. The two other Associations are the Upminster and Cranham Association, and the Rainham Association, which have continued to carry on with great success. (4) Treatment Centres and Clinics. Maternity and Child Welfare Clinics are carried on by the County Council which is the Welfare Authority at the following centres:— (i) 21, Berther Road, Hornchurch. (ii) Malvern Road, Romford. (iii) 61, Athelstan Road, Harold Wood. (iv) 5, Waldegrave Gardens, Upminster. (v) Council School and First-Aid Post, Rainham. (vi) 3, Hazel Close, Elm Park. 6 Insulin for persons suffering from Diabetes. Ministry of Health Circular 2734. Arrangements under which Insulin may be supplied either free or at reduced cost to persons suffering from Diabetes are available under the National Health Insurance Acts, the Poor Law Acts, and the Education Acts. In Circular '2734, the Minister of Health pointed out that there are certain other classes of persons for whom no public provision is made apart from Poor Belief, and who find that the increase which has occurred in the cost of insulin since the beginning of the war is a serious burden. The Minister advises that these classes, which include the dependents of insured persons and women engaged on household duties, can be dealt with under the provisions of the Public Health Act, 1936, Section 177, under which, with the Minister's approval or consent, a Local Authority may provide a temporary supply of medicine for the poorer inhabitants of their District. The Minister has now given the necessary approval or consent to Local Authorities to provide supplies of insulin for persons suffering from Diabetes among the poorer inhabitants of their District until the termination of the present war. The Council, having considered the Circular, decided to use the powers thus obtained and adopted scales of income below or within which applicants would be supplied with insulin free or at reduced cost. They also gave public notice by advertisement in the local press of the new powers and invited applications from persons of the classes referred to. At the end of the year, nine applications for insulin had been received from persons suffering from Diabetes and, of these, seven were supplied free or at reduced cost. Water. A piped supply of water from the mains of the South Essex Waterworks Company is laid on to almost the whole of the houses in this District, but, in some of the outlying part, private wells still form the only source of supply. Many of these have been in use for a great many years, and in general the supply is unfailing. The water supplied by the Waterworks Company is maintained at a high level of purity, and the supply has been adequate in quantity. Consumers, however, have been asked to exercise due care in not wasting the water. 7 Rodent Infestation. The administration of the Rats and Mice (Destruction) Act, 1919, having been transferred from the Minister of Agriculture to the Minister of Pood, the latter made an Order known as the Infestation Order, 1943, dated May 6th, 1943, which deals amongst other things with the destruction of rats and mice. Article 5 of the Order requires every Local Authority under the Act, to whom Directions have been issued by the Minister, to make a report on the extent to which the land in the District is infested, and to take the necessary action to remedy such infestation. On Llth June, 1943, Directions were issued to the Council by the Minister to submit a report on the extent to which land in the area of (he Council was infested by rats and mice. A survey of the District which was carried out revealed no major infestation, but in some parts infestations of a minor character were found. On 9th November, 1943, the Ministry gave Directions to the Council to take the necessary action to destroy rats and mice where found. By advertisement in the press, the general public were asked to report the presence of any rats in their vicinity. Each of these reports, when received, was investigated by a Sanitary Inspector, and appropriate advice given to the occupier on the best means of dealing with the pests. The Sanitary Inspectors have devoted a good deal of time to this work with satisfactory results. SECTION C. Sanitary Officers Regulations. The Sanitary Inspectors are mainly engaged in carrying on their normal duties as far as possible, and in addition undertake work of a similar character for which they are specially qualified by reason of their training. This work includes visiting public air-raid shelters: private shelters when necessary: civil defence shelters: inspecting damaged foodstuffs, etc. One Sanitary Inspector also regularly carries out inspections of the carcases of animals slaughtered for food at the Regional Slaughterhouse in Romford. 8 SECTION D. HOUSING. During the year 19 houses were completed by private builders and housing certificates were issued. No houses were built by the Council. SECTION E. CONTROLLED TRADES. Milk Production. There are 17 dairy farms in the District, which include ten farms licensed by the County Council for the production of Accredited Milk and one farm for the production of Tuberculin Tested Milk. Inspections of these farms are carried out by the Sanitary Inspectors, and suitable advice given on the production of clean milk and the general hygiene of the premises. Meat. There are 4 slaughterhouses in the district licensed under Section 57 of the Food and Drugs Act, but none is in regular use for slaughtering animals, this being prohibited during the war by the Livestock (Restriction on Slaughtering) Order, 1940. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. During the year 1943, no case of Smallpox or Typhoid Fever occurred, but three cases of Paratyphoid Fever were notified. The progressive decline in the incidence of Diphtheria over the last two years has continued and would seem to be correlated with the immunisation campaign which has so successfully been carried on. There were 8 cases of Diphtheria during the year as compared with 25 in the year 194'2, and these included 1 fatal case, a child of 3 years, who had not been immunised. This high fatality rate emphasises the fact that Diphtheria is a very dangerous disease, especially to young children, unless medical treatment is obtained very promptly. Scarlet Fever continues to be very prevalent, though the cases were, on the whole, very mild, and there was no death from this disease. The notifiable diseases of the central nervous system were few in number, but they included three deaths from Cerebro-spinal Fever. 9 In the following table are shown the number of notifications received, the number of cases removed to hospital, etc. :— Disease. Total Number of Cases Died. Notified. Admitted to Hospital. Smallpox 0 0 0 Scarlet Fever 373 148 0 Diphtheria 8' 8 1 Paratyphoid Fever 3 3 0 Cerebro-spinal Fever 3 3 3 Poliomyelitis 1 1 0 Puerperal Pyrexia 7 4 0 Erysipelas 19 6 0 Pneumonia 111 43 33 Measles 600 9 0 Whooping Cough 130 5 2 Ophthalmia 2 0 0 Dysentery 7 6 0 Diphtheria Prevention. The Ministry of Health carried on active propaganda during the year by public advertisements, notices in the National and local press, the distribution of literature through the schools, child welfare centres, etc., and by cinema notices. Mothers were also advised by the Health Visitors and Sanitary Inspectors of the facilities provided by the Council for the immunisation of their children. As a result of all these influences, there was a steady flow of acceptances by the parents, many of whom took advantage of the opportunity offered by the Council to have their children immunised. Special sessions for this purpose were held at convenient centres throughout the District, and to each parent, an individual appointment was sent, stating the time at which to attend. The treatment consists of two injections in the arm at an interval of four weeks between the first and second injection. Alum precipitated toxoid, which is the material used, was supplied by the Ministry of Health through the emergency laboratory at Epping. During the year, 1,180 children under five years of age, and 1,188 between five and fourteen years of age, completed the course of immunisation. It is estimated that of the children in Hornchurch, 62% of those under five and 49% of those between five and fourteen have been immunised. 10 Tuberculosis. During the year, 127 new eases of Tuberculosis were added to the register. These included 100 cases in which the respiratory organs were affected, and 27 cases in which the infection was in some other part of the body. There were 55 deaths from this disease. Infective Jaundice: Compulsory Notification. The Minister of Health, on account of the increasing prevalence of cases of Jaundice which are of an infectious character, has arranged for special investigations to be carried out by a group of expert workers at Cambridge in collaboration with the Medical Research Council. A study is being made of the epidemiology and pathology of these types of Jaundice in order to bring them under control, and to establish effective methods of treatment. In order to ascertain the incidence of the diseases for a length of time over a large area, the Minister decided to require compulsory notification in the Eastern Region, this being the area in which the research centre is stiuated. To this end the Jaundice Regulations, 1943, dated November 17th, 1943, were made. They had not been applied to this District by the end of the year, but will come into operation in Hornchurch on 22nd January, 1944. Non-notifiable Diseases of Childhood. During the year, the cases of non-notifiable infectious disease occurring among school children have been reported by head teachers as follows:—Chicken Pox, 117; Mumps, 151; Influenza, 84; Scabies, 58; Jaundice, 10; Rubella. 9.