HORNC14 Hornchurch Urban District Council OF THE INTERIM REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1946 Hornchurch Urban District Council INTERIM REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1946 2w& w. Ltd 2 MEMBERS OF THE COUNCIL. Councillor A. J. Twigger, J.P., Chairman. Councillor A. C. Holmes, Vice-Chairman. Councillor Mrs. E. M. Field. ,, Mrs. A. J. E. King. ,, Mrs. E. G. Richardson. (2) ,, Mrs. F. Sherring. Mrs. C. M. Stevens. (2) Mrs. H. S. E. Williams. (1) (2) & (3) H. C. Breeze. W. G. Bunch. (1) E. W. J. W. Bush. F. Cullen ,, B. T. Dodge. H. Holock. R. S. Howe. A. S. Hulkes. (1) W. H. F. Maunder. (1) & (4) A. J. H. Okey. (1) ,, A. W. Pettit. ,, A. C. Salinger. W. H. F. Webb. (1) & (2) (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. (4) Vice-Chairman of the Public Health and Ambulance Committee. 3 OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: +James Gorman, M.B., Ch.B., D.F.H. 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. M. F. G. Randall, San. Insp. Cert. R.S.I, and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. L. W. Cole, San. Insp. Cert. R.S.I, and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. Clerks: J. E. Blay (Returned from War Service 27-5-46). S. N. Dance (Temporary). Miss E. M. Trinnaman (Commenced duties 9-12-46). Miss D. K. Manning (Temporary Part-time). Commenced duties 1-10-46. Acting M.O.H. for period 1-1-46 to 30-9-46. 4 Public Health Department, Council Offices, Billet Lane, HORNCHURCH. 24th September, 1947. To the Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I beg to present the Annual Report for the year 1946. In conformity with the suggestions of the Minister of Health a considerable amount of detail has been omitted. The general health of the population has remained good. The birth rate at 21.3 is the highest recorded since the constitution of the Urban District, and is also higher than that for the country as a whole (19.1). The death rate at 9.0 is materially lower than the country as a whole (11.5) and the same applies to the infant mortality rate of 41.0. Among the causes of death, heart disease plays the general part (with a total of 204) followed by cancer with 147. Premature births and other causes associated with foetal development and the mechanism of childbirth accounted for 54 deaths, a calamitous waste of life to which research and ante-natal care are doing their best to provide an answer. Infectious diseases during the year were in general of a mild type and without any unduly high incidence. Comment is made in the body of the report on certain other features of importance. I must express my indebtedness to Dr. P. X. O'Dwyer for his unfailing assistance. It is a source of considerable satisfaction that he remains available. I must also sincerely acknowledge the help which I have obtained invariably from the Chief Officers and staffs in other Council Departments as well as from my own staff. I must also express my appreciation to the County Medical Officer of Health, Dr. W. A. Bullough, with whose Department close liaison must naturally exist, and to Dr. E. James, Medical Superintendent of the Rush Green Isolation Hospital for his readiness in dealing with the hospitalisation of infectious cases at any time. James Gorman, M.B., Ch.B., D.P.H., Medical Officer of Health. 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres (land and inland water) 19,768 Registrar-General's estimate of the civilian population population (mid-year) 1946 95,460 Registrar-General's quarterly estimates of civilian population for year 1946 :— at 31st March, 1946 93,720 at 30th June, 1946 95,670 at 30th September, 1946 97,750 at 31st December, 1946 99,090 Number of inhabitated houses (September 1946) according to Rate Books 26,728 Rateable Value (September 1946) 6678,861 Sum represented by a Penny Rate (September 1946) £2,780 Social Conditions. The District is, to a considerable degree, residential in character and building development, which has re-started within a limited scope, has attracted a number of new residents to the area. There are, however, still large areas in the district in which agriculture remains a predominant occupation. There are no conditions of occupation or environment which have had a prejudicial effect on health. Vital Statistics. Extracts from Vital Statistics of the Year. Number of births registered in the District as supplied by the Registrar-General and corrected for inward and outward transfers (1,005 males, 1,024 females) .... 2,029 Birth rate per 1,000 civilian population .... .... 21.3 Number of deaths registered in the District:— Residents 511 Non-residents 77 Number of deaths of residents occurring outside the District 363 Total number of deaths of Hornchurch residents adjusted for inward and outward transfers 874 Death rate per 1,000 civilian population 9.0 Puerperal Deaths:— (a) from Sepsis 1 (b) from other causes 4 6 Deaths of infants under one year of age 86 Infant Mortality Kate (per 1,000 births) 41.0 Deaths from :— Male. Female. Cancer 66 81 Diabetes 4 0 Diarrhoea (under 2 years) 9 2 Influenza 5 3 Pneumonia 77 22 Measles 0 0 Whooping Cough 0 0 The Vital Statistics show a satisfactory trend in that the birth rate is higher and the death rate lower than the previous year. It is, however, to be regretted that the Puerperal deaths showed an increase from 3 to 5. The infant mortality remains constant at a figure, which although not what might be termed high, could still bear a material reduction. SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Bacteriological Laboratory. The County Laboratory, established by the Essex County Council at Oldchurch Hospital, has continued to serve the needs of the District and is available for any medical practitioners who desire to have a bacteriological report on the specimens which they send. Ambulance Service. There is no change in the ambulance service for the civilian population described in last year's report which includes the mutual assistance scheme with neighbouring authorities. The ambulance, which is stationed at Harrow Lodge Depot, is under the supervision of the Surveyor. Nursing in the Home. The three nursing associations, viz. : the Hornchurch Nursing Association, the Upminster and Cranham District Nursing Association, and the Rainham, Wennington and South Hornchurch Nursing Association, have continued their beneficent work. 7 1 note below certain details of the work of these local Nursing Associations. Bodies of this kind serve a most useful purpose and it is gratifying to observe that due notice is taken of this fact in the National Health Service Act. It is, in a way, to be regretted that more people do not avail themselves of the opportunities presented by membership of these Associations. The Hornchurch Nursing Association maintained three private nurses during the year, and the total number of visits paid was 4,018. The Upminster and Cranham District Nursing Association maintained two private nurses, who carried out the following visits during the year :— Midwifery and Maternity 1,396 General 1,153 Ante-Natal 157 Old Age Pensioners 353 Casual 91 Clinics 12 Total 3,162 The liainham, Wennington and South Hornchurch Nursing Association maintained three private nurses during the year and the following shows the numbers of visits made :— Midwifery and Maternity 3,101 General 206 Ante-Natal . 1,131 Old Age Pensioners 159 Casual 342 Clinics 157 Medical 1,966 Surgical 465 Total 7,527 Maternity and Child Welfare. The Essex County Council is the Welfare Authority in this District under the Public Health Act, 1936, and maintained Clinics at the following centres :— (i) Westland Avenue, Hornchurch. (ii) Abbs Cross Lane, Hornchurch (serving the Elm Park Estate). 8 (iii) Malvern Road, Hornchurch. (iv) Athelstan Road, Harold Wood. (v) Upminster Road, Rainham. (vi) Station Road, Upminster. The County Council has arrangements for the accommodation of maternity patients at Oldchurch County Hospital, Romford, for the following types of patient:— (i) Complicated or difficult cases of confinement where hospital treatment is essential. (ii) Cases of confinement where, in the opinion of the medical attendant, the patient cannot safely be confined in her own home. (iii) Patients who, after confinement, are found to be suffering from Puerperal Pyrexia. (iv) Pregnant women for whom hospital treatment is necessary. Patients contribute towards the cost in accordance with their financial circumstances. We have a considerable mutual problem in cases where the home surroundings are so unsatisfactory, very often through overcrowding, as to render domiciliary confinement practically impossible. Our resources as the housing authority are naturally strained to the utmost while the County as the maternity and child welfare authority are in a like position with regard to their hospital resources. Nevertheless, every effort is made to dispose of the difficulties which do arise in this regard. Hospital Services—Infectious Disease. During the year 1:26 persons notified to be suffering from infectious diseases and 50 observation cases needing hospital treatment were admitted to the Joint Isolation Hospital at Rush Gren. The average weekly number of patients from this District in the Isolation Hospital was 10. The large number of observation cases will be specially noted. This illustrates practically the fact that the diagnosis of infectious disease is not always a simple matter. It should be realised that the admission of these cases necessarily throws a great strain on the hospital resources since individual isolation is required for such cases at the hospital until the case is fully investigated and classified, but nevertheless since the admission of these cases removes a probable source of infection from the community at a very early stage so can the value of their admission be properly assessed. Our 9 thanks are especially due to the Rush Green authorities for their assistance in admitting doubtful cases often under circumstances of considerable difficulty. Supply of Insulin for Diabetics. The policy outlined in last year's report has been pursued. The number of persons supplied during the year was '20 free issue (5 new applications) and 6 persons supplied at half-price (one new application). During the year 3 patients were removed from the register (all free issue). All patients were females. Foot Clinics. The Essex County Council was approached during the year on the question of providing Fool Clinics, possibly at the Combined Treatment Centres, which in general terms might be said to cover the District. Medical Services—Elm Park Estate. The Council considered the medical services on the Elm Park Estate in relation, among other things, to the development of the estate generally and that part south of the railway in particular. The County were requested to consider re-inforcing the existing medical services in the area. Superannuation Examinations—Staff. The services of private practitioners are secured for these examinations save in instances where an existing employee's suitability for continued service is in question, which examinations are done by the Medical Officer of Health. SECTION C. Water. During the year the views of the Council were requested for the information of the Committee appointed by the Minister of Health to consider the question of water supplies for Greater London. The South Essex Waterworks Company were good enough to supply us with the following details :— " The water supply of the whole of your area has been satisfactory in quality and quantity. Bacteriological and chemical examinations are made of the raw water, of the water in its various stages of treatment, and of the water going into supply. 10 A total of about 3,300 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. In addition, analyses have also been made of samples obtained from consumers' taps in the various parts of the Company's district, including that of your Council, and all proved to be satisfactory. The water supplied is not plumbo-solvent. No action has been necessary in respect to any form of contamination. The number of dwelling houses supplied as at 31st December, 1946, was '27,450, and the population in December 1946 as obtained from the Registrar-General was 99,090." In accordance with Ministry of Health Circular 1684/38, systematic sampling is carried out by the Department in conjunction with other local authorities obtaining their supplies from the South Essex Waterworks Company. These samples were taken on the second Monday in each month throughout the year and were submitted to the Counties Public Health Laboratories for bacteriological and chemical examination. A typical report is as follows :— " This sample is clear and bright in appearance, neutral in reaction and free from metals apart from a negligible trace of iron. The water is hard in character, but not to an excessive degree, and is free from any excess of mineral or saline constituents in solution. It is of a satisfactory standard of organic quality and bacterial purity. These results are indicative of a pure and wholesome water suitable for drinking and domestic purposes." Standpipes. Approximately 0.7 per cent. of the inhabitated houses, and 0.7 per cent. of the population of the Urban District obtain their water from standpipes. Certain areas of the district have not got a main water supply and in view of the predominantly rural nature of these areas it is in no way expressing support of a non-progressive policy to say that a considerable time is likely to elapse before main water will in fact be provided for these areas. During the year the Acting Medical Officer of Health, at your request, obtained for analysis samples of water from certain wells. This policy of sampling was continued subsequently and the results considered. It must, unfortunately, be recorded that the water 11 supply from certain of these wells—mainly supplying each one or two cottages—leaves something to be desired as a safe product. It is, however, advantageous to know just what the position is so that steps may be taken without delay to deal with it. In the cases reviewed, when water was found to be unsatisfactory, a notice that the water should be boiled was immediately served upon the consumers and the person responsible for the well. Coincidently remedial measures relative to the well itself and the surrounding ground were taken and so far as possible the source of supply was rendered satisfactory. It is, however, the case that recurrences of pollution in instances such as this must always be borne in mind as a possibility. Every household is entitled to a sufficient and pure water supply, but the difficulties of ensuring that this theoretical observation is translated into practical reality must be realised, as must the fact that time also will elapse before it is an established fact. In regard to certain unsatisfactory wells the question of extending the water main to the households affected is being pursued with the South Essex Waterworks Company. As an example of progress a certain group of cottages was found to have a water supply open to pollution by reason of exposure to contamination through disposal of excreta on nearby ground, and in this instance arrangements were made with the owner of the cottages for main water to be supplied and at the same time for an extension of the scheme to include provision for dealing with the waste water after domestic use, and for privy conversions. This illustrates the complexity of the many problems of this nature in that the matter begins rather than ends with the provision of main water, since this latter in turn also necessitates the provision of some adequate form of drainage on obvious sanitary grounds, since apart from anything else, the increased use for domestic purposes, such as washing, must entail corresponding disposal difficulties. Rodent Control. During the year a special scheme sponsored by the Ministry of Food came into being for private dwellings. You agreed to participate and ultimately 3 Rodent Operatives were appointed for the purpose of completing by 31st March, 1947, that part of the scheme relating to this department. A charge was fixed for dealing with business premises although private dwellings under this particular scheme were treated free. 12 The number of infestations found from the commencement of the scheme in September, 1946, until the end of the year, was 131, and the number treated during the year was 127. The number of houses visited was 9,244. The Operatives were specially trained and there can be no question but that a service of this kind fills a definite want especially at a time such as this. Smoke Abatement. Although perhaps in this District generally it cannot be said that the pollution problem is an obvious one, yet as a public health measure, the adequate control of smoke is more and more being regarded as being in the forefront. Delegate.s attended a Conference at Brighton in October, after which a report was presented for your consideration. It might reasonably be regarded as essential for every Local Authority to keep in touch with the latest developments in this connection. Public Cleansing. The collection and disposal of house refuse are carried out under the direction of the Surveyor. The Council have a fleet of S.D. freighters, which are closed vehicles with a low loading line. Refuse is disposed of by controlled tipping on land which is under the control of the Council. The Courts adjacent to certain flat and shop property were found continually to be in an unsatisfactory state, and as one would naturally conjecture, no responsibility was accepted by one party more than another. Action to cleanse the area involved was accordingly under consideration through Section 78 of the Public Health Act, 1936. Steps were eventually taken early in 1947 under the said section and a solution, which proved at least temporarily satisfactory, was secured. SECTION D. Number of new houses erected during the year. 379 houses were completed during the year 1946 by private enterprise. The Council erected 162 temporary houses during the year and 3 houses were re-built as a result of destruction by enemy action. 13 Housing. You are aware from a report presented to you of the general consideration pertaining to this mo.st important question. Broadly speaking the amount of so-called slum property in the area is at the moment relatively small and the methods available at present for dealing with that which does exist are unfortunately unavoidably limited. Clarification will undoubtedly be given in the future when the general housing position doe.s itself become satisfactory. Repairs provide a considerable amount of work and worry for this department and have increased considerably in amount due to the impracticability of carrying out routine maintenance during the war years. Complete and effective action in this regard is also quite clearly impeded by the shortages of various kinds which occur from time to time and doubtless by the natural emphasis placed upon the construction of new dwellings or the repair of war-damaged buildings. Overcrowding represents the most clamant problem to be tackled and here again time, allied to housing progress, will provide the solution. It cannot be anything but a source of anxiety to see the conditions under which many of our inhabitants are today living. Gratifyinglv the building position appears now to be making considerable progress and in time will, of course, reduce the incidence of overcrowding to a minimum. As a question to be tackled it should be borne in mind that overcrowding was in fact appreciable on the facts ascertained from the Housing Survey under the 1936 Act, and the advent of war with its inevitable social upheaval could not but aggravate even beyond anticipation the pre-war state of affairs. Eventually when a relatively stable population is assured a further survey will require to be made and a further report reviewing the position and the measures to be taken for dealing with it will be presented to you. although this is likely to be a considerable way off yet. It is, I think. apt not to receive due emphasis that the housing problems of an area are not completely met by providing new dwellings for the needy inhabitants thereof. It is equally essential to provide full encouragement for the best possible use of these dwellings by their new occupants and to ensure that a ready ear is available for the reception of their difficulties and the giving of the necessary advice to cope with them. Every family is entitled not only to view the latest labour saving developments at an Ideal Home Inhibition and to read of them in the Press, but what is far more important, to see them translated into their own daily life and 14 routine. Especially is this the case at the present time, when, for example, the cost of laundry is high and the amount of soap available for domestic purposes low. The kitchen unit of , for example, the new temporary dwellings, forms what in the relatively near past must have been only a vision to most householders. It is to be hoped that in the future they will become a prominent feature of all new houses and with them should be included such aids as a washing machine, which enables the mother of a family to obtain at any rate some relaxation from the never ending round of her household duties. Work in the home commences earlier and finishes later than most other employment and there is the more need to make it congenial. To aid the improvement of maternal health in this way should surely be interpreted not as providing a luxury for the individual, but as a substantial contribution to improving the general health of this vital section of our population. Housing, as it relates to rural districts, should receive equal consideration with that of the urban areas, although it is regrettable and to some extent at least an inevitable fact that in the very nature of things rural houses may not always approach the standard of good dwellings in an urban area. In this District there is a considerable rural area, which, I hope, will form the subject of a housing enquiry by us with a view to determining the actual number of houses involved, the condition of these houses, the number of their inhabitants, and the extent to which, in fact, they are made use of by rural workers. It would not be profitable at this stage to anticipate the results of this enquiry, and shortage of staff, apart from other considerations, is likely to delay its completion. The Housing Committee have paid considerable attention to the advisability of housing, for example, midwives, who provide an essential service under the County Council. This Committee is being kept fully in touch with the position. Temporary Dwellings. Force of circumstances has somewhat accentuated this problem. It is not merely a matter of caravans arriving in a rural area, stopping for a very short period and then moving on—and even this position has its evident drawbacks—but of the very practical danger that people will tend to establish what are practically permanent dwellings in unsatisfactory surroundings, if not always to the nuisance of, at least very often to, the inconvience of their neighbours. Admittedly the present housing position has contributed to this state of affairs, but from the point of view of the public 25 15 health and amenities of the District, no time should be lost in dealing with such instances as have arisen and preventing the occurrence of other similar ones. The "weekend dwelling" was not. surely designed for more than weekend habitation, if in fact it was ever satisfactory even for this, and even present conditions cannot enable one to view with complacency its promotion from temporary to permanent status without concomitant structural alteration. Housing Applicants. Any evidence of a medical character submitted in furtherance of a housing application is submitted foe opinion to the Medical Officer of Health. The diversity of these certificates makes an equitable assessment extremely difficult in many cases, but in every case a recommendation is made to the appropriate Committee. It must also be stated that the Committee are always prepared to consider an exceptionally bad case, for example, infectious tuberculosis, in the most sympathetic manner, and this policy will undoubtedly reap its own reward in due course. SECTION E. CONTROLLED TRADES. Milk Production. There are 18 dairy farms in the District, which include 7 farms licensed by the County Council for the production of Accredited Milk, 3 farms licensed for the production of Tuberculin Tested Milk, and 1 farm licensed for the production and bottling of Tuberculin Tested Milk. A regular and reasonably frequent visit of inspection is paid to each farm in the area coming within our jurisdiction. It is perhaps slightly misleading to refer to this visit as one of inspection only, as our object is not merely to inspect from a practical viewpoint but also to keep in touch with the farmers concerned and afford them what advice and help we, as a Sanitary Authority, are able to offer. Our farms naturally, in an area of this size, comprise several different types, but it should be said that during the period under review, the general standard maintained was, from the Public Health angle, very satisfactory. 16 It is a matter for at any rate personal regret that under the Food & Drugs (Milk & Dairies) Act, 1944, we will lose a considerable amount of our present power of farm control. If, however, and only time will provide the answer, such part of our present functions as we are to lose'can be more effectively carried out by the Authority to which they are transferred, then the changes will be a matter"for satisfaction. A loss of local control is never necessarily prejudicial, a loss of local interest can never fail to be. Ice Cream. Ice cream manufacturers find vendors are required to be registered by the local Council under Section 158 of the Essex County Council Act, 1933, which was adopted by the Council by resolution on 20th February, 1934, and came into force three months later. During the year 1946, 32 applications for registration were granted (7 manufacturers and 25 vendors). At the end of the year, 27 persons were registered as manufacturers and 103 as vendors in the District. This commodity—in certain instances it has unfortunately very limited claims to being regarded as food—has been very clearly brought into the limelight as a potential danger. It might be reasonably argued that so long as a product has the degree of demand from the public associated with ice cream, and is apparently from its very appearance, pure, then so long will it be difficult to bring home to the public the necessity for insisting upon its being raised to and maintained at the highest possible degree of purity. Psychologically white is associated with cleanliness, and ice cream is no exception to this rule. The absence of a definite standard of satisfaction necessarily precludes the possibility of dealing with sub-standard samples on a properly effective basis. It must in common justice be said that where unsatisfactory samples have been ascertained locally the producers, when in our area, have proved fully co-operative in the taking of what suggested themselves as necessary measures of improvement, and doubtless the same can be said of the vast mapority of producers anywhere. It is, one is sure, regretted by most manufacturers as by everyone else, that present conditions do not permit the production of ice cream which does have a very satisfactory food value, and again only time can provide the solution. Cleanliness, if not calories, can be our immediate objective, 17 Meat. There are 4 slaughterhouses in the District licensed under Section 57 of the Food and Drugs Act, 1938, but none is in regular use for slaughtering animals, this being prohibited by the Livestock (Restriction of Slaughtering) Order, 1940. A successful prosecution for failing to notify slaughter was taken early in the year. Offensive Trades and Business of Fish Frying. The question of an order being submitted to the Minister of Health for confirmation pursuant to sub-paragraph B, paragraph 2 of sub-section 1, section ]07 of the Public Health Act, 1936, declaring the trade or business of Fish Frying to be an Offensive Trade within the Urban District was considered. The Order had not been confirmed by the Ministry of Health at the end of the year. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. As compared with last year the figures show an increased incidence of Scarlet Fever ('214 as against 121) and Whooping Cough (150 as against 38), and a decrease of Measles cases (478 vice 1,196). There were no cases of Smallpox, Typhoid Fever or Encephalitis Lethargica. In the following table are shown the number of notifications received, and the number of cases removed to hospital. Disease. Notified Total Number of Cases Admitted to Hospital. Smallpox 0 0 Scarlet Fever 214 76 Diphtheria 4 4 Cerebro-spinal Fever 5 5 Poliomyelitis 2 2 Polio-encephalitis 1 1 Puerperal Pyrexia 2 2 Krysipelag 15 3 Pneumonia 87 19 Measles 478 7 Whooping Cough 150 5 Ophthalmia Neonatorum 2 2 Dysentery 4 3 Paratyphoid Fever 1 1 Malaria (contracted abroad) 6 5 18 Scarlet Fever. One limited outbreak of Scarlet Fever occurred at a school in the area. As often happens it did continue to drag on for a period of some weeks and no exact source was ascertained. Measures to prevent the spread of the infection were put in hand at the outset and the cases were mostly of a mild clinical type. It should be emphasised that where anything like reasonable home isolation can be secured, sufferers from this disease should, in the light of present-day knowledge, be treated at home rather than removed to hospital. In the presence of very unsatisfactory home conditions or clinical complications in the case, hospital treatment may evidently be selected, but the chief difference between Scarlet Fever and epidemic sore throat is simply that in the one instance a rash develops and in the other it does not. This of itself is not sufficiently material to demand the selective treatment of the case with a rash which at present is apt to be given. This association of identity betwen sore throat (without a rash) and Scarlet Fever (with a rash) is one which should do much to allay the diversity of outlook which is exhibited towards them by the public. Diphtheria. Diphtheria incidence was, during the year, very low. It would be satisfactory to argue that the increased immunisation figures are wholly responsible for this satisfactory state of affairs, and it may well be that the public consciousness of the value of immunisation is playing a very important part in preventing the disease. The present low incidence of Diphtheria may, however, also be influenced by other factors and the need for a considerably greater parental appreciation of the value of immunisation is still present. Immunisation is still regarded by some people with a certain amount of apprehnesion. It is normally carried out at an age when children are in a state of transition through feeding, teething, and the like, and also at a time when they are essentially susceptible to infectious conditions. Understandably, parents are inclined in some instances to associate any departure from the normal, occuring within weeks or months of immunisation, to that immunisation. Unless, therefore, I am satisfied that a child is perfectly fit I do not either commence or continue Diphtheria protective measures until the child is fit. Admission of Cases to Hospital, save for Smallpox (which are admitted to Colchester Smallpox Hospital). All other cases are dealt with at our Joint Hospital at Rush Green ; subject naturally to the limitation of accommodation which 19 might conceivably occur in unusual circumstances, admission for any case can be obtained either through the Public Health Department or at other times, as for example, after office hours and on public holidays, by direct arrangement between the attending practitioner and the medical authorities at the Rush Green Isolation Hospital. Diphtheria Immunisation. It will be known that the County Council as the Welfare Authority are responsible for dealing with the children under 5 years of age, while the local Council are responsible for those children over that age. In practice we, as Agents of the County Council, deal with the under fives also to a very large extent, maintaining, of course, a close liaison with the County in this matter. During the year 1,245 children (1,153 under 5, and 9'2 over 5) completed the course, which consists of two injections of A-P.T. with an interval of four weeks, and '248 children were given a secondary or re-inforcing injection subsequent to the complete full course. The following shows the immunisation state in relation to the child population regarding the number of children who had completed a full course of immunisation at any time up to 31st December, 1946 :— Age at 31.12.46 Number immunised Estimated mid-year population 1946. Under 1 29 7,980 1 839 2 1,067 3 904 4 812 5 to 9 4,427 14,620 10 to 14 4,494 Total under 15 12,572 22,600 Disinfection. A proposed local scheme was submitted to the Council. Opinion has changed significantly in recent years on the question of terminal disinfection, and whilst in diseases such as smallpox, typhoid and the like, its importance must not be minimised, yet in the minor diseases, such as measles, scarlet fever and whooping cough, opinion has swung heavily to the side of efficiency of control being vested largely in concurrent disinfection. In other words, the application of common sense and practical hygiene to the 20 circumstances of the particular case, represents the best way of tackling this problem. Occasions do arise when apart from purely medical consideration, bedding which may have been in contact with a patient but after suitable treatment is non-infectious, is nevertheless discarded largely for psychological reasons; a happening which one understands without, of course, agreeing with it.' It is to be regretted that steam disinfection has to be carried out through the good services of our local Isolation Hospital since the amount of material with which they can cope is naturally limited and, this apart, they have evidently no obligation at all to deal with articles not concerned with infectious disease. From time to time bedding and other articles do require disinfection irrespective of there being infection in the household, the example coming readily to mind being that of a bug-infested house, and appropriate treatment is not easy to secure. Transport of infected material has also presented something of a problem regarding alike the actual vehicle and the personnel employed. The situation lias, however, after due consideration, been dealt with by arranging for the provision of a light motor van to be operated by our own staff for the purpose of dealing with infected material. This vehicle, after suitable disinfection, will also serve for general departmental use, and only its arrival will lessen our anxieties. Infective Hepatitis. The total number of cases of Infective Hepatitis notified during the year was 90, referring to 87 civilians and 3 persons in the Armed Forces. The figure for the previous year was 52 (43 civilians and 9 persons in the Armed Forces). The following are the age groups of the 87 civilians :— Years. Males. Females. 1- 2 1 0 3 - 4 4 1 5 - 9 6 8 10 - 14 5 3 15.- 24 12 15 25 - 34 9 9 35 - 44 4 8 45 - 54 0 1 55 - 64 1 0 42 45 21 Tuberculosis. During the year, 116 new cases of Tuberculosis were added to the register. These included 105 cases in which the respiratory organs were affected, and 11 cases in which the infection was in some other part of the body. This is 32 less than last year. There were 51 deaths from this disease, being 1 less than last year. At the end of the year the Tuberculosis Dispensary serving this area was transferred from 70, Eastern Road, Romford, to 89 Western Road, Romford, to enable the provision of greater facilities. The new address is a modern Clinic with a first-class X-ray Department, and eventually it is hoped to commence artificial-pneumothorax treatment. The Tuberculosis register at the end of the year shows as follows :— Pulmonary. Males 358 Females 238 Non-Pulmonary. Males 105 Females 94 Pulmonary and Non-Puhnonarv Total 795 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 followsChickenpox, 331; Mumps, 126; Scabies, 12; Rubella, 4; Impetigo, 11; Ringworm, 3; Influenza, 254. This is a considerable increase on the numbers reported during the previous year. These numbers must necessarily be accepted with due reserve since they represent our only available, but not necessarily wholly, accurate information. 22 TABLE 1. BIRTHRATES, CIVILIAN DEATH RATES AND ANALYSIS OF MORTALITY. Local Figures compared with England and Wales and certain towns. England and Wales 1'26 C.B.s and Great Towns including London. 148 Smaller Towns Resident Pop. '25,000-50,000 1931 Census. London Adm. County Hornehureh. * Rates per 1,000 Civilian Population :— Live Births 19.1‡ 22.2 21.3 21.5 21.3 Still Births 0.53 0.67 0.59 0.54 0.57 Deaths: All causes 11.51 12.7 11.7 12.7 9.0 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 – Scarlet Fever 0.00 0.00 0.00 0.00 – Whooping Cough 0.02 0.02 0.02 0.02 – Diphtheria 0.01 0.01 0.01 0.01 – Influenza 0.15 0.13 0.14 0.12 0.08 Smallpox 0.00 0.00 0.00 – – Measles 0.00 0.01 0.00 0.01 – Rates per 1,000 Live Births :— Deaths under 1 year of age . 43† 46 37 41 41 Deaths from diarrhoea and E under 2 year of age 4.4 6.1 2.8 4.2 5.4 * A dash (—) signifies that there were no deaths, † Per 1,000 related births. ‡ Rates per 1,000 total population. 23 TABLE 2. REGISTRAR-GENERAL'S ABRIDGED LIST OF CAUSES OF DEATH. These figures are corrected for outward and inward transfers. Causes of Death. Male. Female. All causes 461 405 1. Typhoid and paratyphoid fevers 0 0 2. Cerebro-spinal fever 2 1 3. Scarlet fever 0 0 4. Whooping cough 0 0 5. Diphtheria 0 0 6. Tuberculosis of respiratory system 29 17 7. Other forms of tuberculosis 4 1 8. Syphilitic diseases 4 0 9. Influenza 5 3 10. Measles 0 0 11. Acute polio-myelitis and polio-encephalitis 2 1 12. Acute inf. encephalitis 2 0 13. Cancer of buc., cav., and oesoph, (M) uterus (F) 4 3 14. Cancer of stomach and duodenum 13 11 15. Cancer of breast 0 23 16. Cancer of all other sites 49 44 17. Diabetes 4 0 18. Intra-cranial vascular lesions 31 48 19. Heart disease 112 92 20. Other diseases of circulatory system 16 17 21. Bronchitis 31 16 22. Pneumonia 17 22 23. Other respiratory diseases 7 4 24. Ulcer of stomach or duodenum 6 1 25. Diarrhoea under 2 years 9 2 26. Appendicitis 4 2 27. Other digestive diseases 7 10 28. Nephritis 14 4 29. Puerperal, and post-abortion, sepsig 0 1 30.' Other maternal causes 0 4 31. Premature birth 10 4 32. Congenital malformation, birth injury, etc. 25 15 33. Suicide 4 8 34. Road traffic accidents 3 6 35. Other violent causes 7 4 36. All other causes 40 41 24 TABLE 3. DEATHS IN CERTAIN AGE GROUPS DURING WHOLE YEAR, Age. No. of deaths. Under 1 year 86 1 and under 2 8 2 ,, ,, 5 6 5 ,, ,, 15 8 15 ,, „ 25 18 25 ,, ,, 35 33 35 ,, ,, 45 41 45 ,, ,, 55 94 55 ,, ,, 65 150 65 ,, ,, 75 167 75 and upwards 263 Total 874 TABLE 4. DEATH RATE—COMPARISON WITH PREVIOUS YEARS 1929 9.9 1938 8.1 1930 8.2 1939 7.8 1931 8.4 1940 9.4 1932 7.9 1941 9.6 1933 7.8 1942 7.9 1934 8.4 1943 8.9 1935 8.4 1944 9.2 1936 7.9 1945 9.9 1937 8.6 1946 9.0 TABLE 5. BIRTH RATE—COMPARISON WITH PREVIOUS YEARS 1929 17.0 1938 19.7 1930 16.1 1939 18.9 1931 20.1 1940 16.4 1932 18.1 1941 15.5 1933 18.4 1942 17.5 1934 17.6 1943 19.0 1935 17.0 1944 11.9 1936 20.2 1945 18.4 1937 19.6 1946 21.3 25 TABLE 6. CASE RATES FO R CERTAIN INFECTIOUS DISEASES. (Rates per 1,000 Civilian Population.) Local figures compared with England and Wales and certain towns. England and Wales 126 C.B.s and Great Towns including London. 148 Smaller Towns Resident l'op. 25,000-50,000 1931 Census. LondoD Adm. Hornchureh. County Notifications:— Typhoid Fever 0.01 0.01 0.01 0.01 – Paratyphoid Fevei 0.02 0.02 0.01 0.01 0.01 Cerebro-spinal Fever 0.05 0.05 0.04 0.06 0.05 Scarlet Fever 1.38 1.51 1.33 1.42 2.24 Whooping Cough 2.28 2.48 2.05 2.22 1.57 Diphtheria 0.28 0.32 0.31 0.24 0.04 Erysipelas 0.22 0.25 0.22 0.27 0.16 Smallpox 0.00 0.00 0.00 0.00 – Measles 3.92 4.73 3.70 7.35 5.01 Pneumonia 0.89 1.02 0.74 0.75 0.91 A dash (—) signifies that there were no notifications. 26 TABLE 7. RAINFALL DURING THE YEAR. 1 am indebted to Mr. Y. W. Williams, the Surveyor, for the subjoined information on rainfall as recorded at the two recording stations used during the vear. Amount of rainfall in inches. Nos. of days in which rain fell. At Eastern Outfall Works :— January- 0.98 11 February 1.66 16 March 1.11 7 April 1.34 10 May 2.52 13 June 2.59 19 July 1.08 10 August 3.20 15 September 1.76 19 October 1.03 10 November 1.96 17 December 1.73 14 20.96 161 At Langtons J anuary 1.25 12 February 2.13 20 March 0.99 9 April 1.37 11 May 2.75 15 June 2.12 17 July 1.36 11 August 3.61 18 September 2.15 18 October 1.13 13 November 2.15 19 December 1.99 18 23.00 181