1 LF 52. ILFORD URBAN DISTRICT COUNCIL. Interim Report for 1918 of the Medical Officer of Health. To the Chairman, and Members of the Ilford Urban District Council. Gentlemen, In accordance with the suggestion of the local Government Board, this interim report is brief. I hope to compile, together with my report for the year 1919, a detailed report on the health of the district during the War period, together with the needs of the district in the future. The Registrar-General's estimate of the civil population in Ilford in the middle of 1918 was 72,825. This may he taken as the actual resident civil population, and this figure is used in calculating the death-rate. For the purpose of calculating the birth-rate, the number of persons in the forces coming from Ilford must he added to this estimate, and this gross estimate of the Registrar-General is 81,598. During 1918, 947 deaths of Ilford civilians occurred, giving a death-rate of 13.00 per 1,000. This compares with 10.5, 8.91 and 10.5 in 1915, 1916 and 1917 respectively. The increased death-rate is almost entirely due to the influenza epidemic. During 1918 there were 1,053 births, 1,008 legitimate and 45 illegitimate. The figures for 1917 are 1,176 births, 1,123 legitimate and 53 illegitimate. In 1918 there were 1,490 births, 1,447 being legitimate and 43 illegitimate. The birth-rates are 1918 12.9 1917 14.4 1916 17.2 1915 19.1 1914 18.3 An examination of the above figures will show that while the number of births in wedlock has diminished nearly a third, the number of births out of wedlock remains about the same. One can obtain some consolation for the diminished birthrate from the fact that the average baby is now a finer creature than babies of past times, owing to the increased attention and scientific study given to its welfare and—health. There is every reason to suppose that the number of births will increase now that demobilisation is in course. The number of illegitimate births continues at a high level (that is for this town). This is much to be regretted by reason of its effects on the children born out of wedlock. During 1918, 73 infants died in the first year of life, this gives an infantile mortality of 69 per 1,000 births. When ???e compare legitimate and illegitimate children, a striking difference is seen, Legitimate-Infantile Mortality 60 per 1,000 births. Illegitimate-Infantile Mortality 289 per 1,000 births. In other words a legitimate infant has nearly five times as much chance of surviving as an illegitimate child. This remains a great blot on our social life which local authorities can now remove. The old-fashioned idea of reforming the errant mother by penalising the innocent child must be abandoned. At present, unmarried mothers are to a large extent harassed and over-worked before the child is born and separated from the child after its birth. As a result an infant which might have been a vigorous specimen is born ill-prepared for life and often succumbs to the perils of life with a foster-mother. Notifiable Diseases. The type of Diphtheria and Scarlet Fever prevalent continued to be mild and there was no unusual incidence of these diseases. Only a small number of Measles cases occurred. 32 cases of Typhoid Fever were notified, but 25 of these were from Claybury Mental Hospital. Influenza. The outstanding feature of the year was the epidemic of influenza. As the epidemic had not spent its force until the spring of 1919, it would not be profitable to draw any elaborate deductions from the figures for 1918 only. One or two observations may, however, be made. The disease principally attacked adults in the prime of life, i.e., from 20 to 50 years of age. The young and the old did not contract the disease so readily. The disease was frequently followed by a pneumonia of a dangerous and infectious type. It was a common occurrence to find a whole family ill at the same time. No less than 249 persons died of influenza or its complications It is a surprising thing that the large institutions, Claybury and West Ham Mental Hospitals, escaped the full force of the disease and very few deaths were reported. As regards the means of dealing with the epidemic, the main difficulty was the shortage of doctors and nurses. Owing to the prevalence of influenza in the army, it was not found possible to release many doctors and nurses for civil work, although I myself was granted a fortnight's leave of absence from the army to help with the civil work. The epidemic showed up in a glaring manner our national lack of organisation in combating disease. Nurses were impossible to obtain and those available betook themselves to the houses of the well-to-do, attracted by the high wages current. The poorer parts of the community were left without nurses, with disastrous results. As regards Ilford as much was done as was possible. Posters and handbills were Issued containing advice as to the prevention of the disease. The schools were closed from 23rd October to 9th November. As much paid and voluntary help as could be obtained was utilised in home-nursing. The accommodation at the Isolation Hospital only permitted of a few cases being admitted. Much credit is due to the local doctors for their untiring efforts to combat the disease. Maternity & Child Welfare. Great progress was made in this important subject, and following the passing of the Maternity and Child Welfare Act, a Statutory Committee of the Council has been formed. The Council Maternity Home was opened on the 20th July, 1918, and during the year 21 cases were admitted for confinement. As might be expected the Home did not fill up at once and required a little time to become known. At the time of writing any doubt as to the need of the Home has been removed and it has proved a great success. The Home includes two adjoining houses at Nos. 130 and 132, Cranbrook Road. There are 9 rooms, each with a single bed and 3 or 4 more beds can be put up in case of need. It will not be possible to give at present a detailed account of the Home and its scope and possibilities will be more apparent after a years experience of its working. Work of the Health Visitors:- Number of first visits paid 1,042 Number of subsequent visits paid to infants under 12 months 6,239 Number of visits paid to children between the ages of one and five years 5,383 Two Health-Visitors were engaged in the work during the year. The Welfare Centres continued to be well attended:- Number of first attendances of children 430 Number of subsequent attendances 3,469 Dental treatment was provided for those expectant and nursing mothers who would accept it. The dentist attended on two or three half days a month. I am, Gentlemen, Your obedient Servant, Medical Officer of Health. 7th June, 1919. CAUSES OP DEATH IN ILFORD URBAN DISTRICT, 1918. Causes of Death (Civilians only). Males. Females. All causes 438 509 1. Enteric Fever 1 2 2. Small-pox - - 3. Measles 1 2 4. Scarlet Fever - — 5. Whooping Cough 6 6 6. Diphtheria and Croup 4 3 7. Influenza 115 134 8. Erysipelas - - 9. Pulmonary Tuberculosis 38 44 10 . Tuberculous Meningitis 4 3 11. Other tuberculous diseases 2 8 12. Cancer, malignant disease 36 53 13. Rheumatic Fever 1 2 14. Meningitis — 3 15. Organic heart disease 30 37 16. Bronchitis 21 25 17. Pneumonia (all forms) 26 29 18. Other respira ory diseases 5 6 19. Diarrhoea, etc. (voider 2 years) 3 3 20. Appendicitis and Typhlitis - - 21. Cirrhosis of Liver 1 1 21a. Alcoholism - - 22. Nephritis and Bright's Disease 11 9 23. Puerperal Fever - 2 24. Parturition, apart from puerperal fever - 1 25. Congenital debility, etc. 20 14 26. Violence, apart from suicide 10 9 27 Suicide 3 1 28. Other defined diseases 97 111 29. Causes ill-defined or unknown 3 1 Special Causes (included above) Cerebro-spinal Fever - 1 Poliomyelitis - - Deaths of infants under 1 year of age-total 39 34 Illegitimate infants 8 5 TOTAL BIRTHS 534 529 Legitimate 498 510 Illegitimate 26 19 Population for Death-rate 72,825 „ „ Birth-rate 81,598 INFANTILE MORTALITY DURING THE YEAR ENDING 3lst December, 1918. Nett deaths from stated causes at various ages under one year of age. CAUSE OF DEATH. Under 1 week. 1-2 weeks. 2-3 weeks. 5-4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 3 months and under 9 months. 9 months and under 12 months. Total deaths under one year. All Causes Certifled 14 10 15 3 32 15 15 8 2 72 Uncertified - - - - - 1 - - - 1 Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Diphtheria and Croup - - - - - - - - - - Whooping Cough - - - - - 2 - 2 - 4 Diarrhoea (104 B. E & F) - - - - - 1 1 - - 2 Enteritis (104 A.C.D&G) - - - - - 2 2 - - 4 Tuberculous Meningitis (30) - - - - - - 1 — — 1 Abdominal Tuberculosis (31) - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Congenital Malformations (150) - - - - - - 1 - - 1 Premature Birth (151a) 9 2 4 1 16 2 - - - 18 Atrophy Debility and Marasmus (151B) 3 4 - - 7 4 1 - - 12 Atelectasis (152B) - - - - - - - - - - Injury at Birth (152C) - - - - - - - - - - Erysipelas - - - - - - - - - - Syphilis - - - - - - 2 - - 2 Rickets (36a) - - - - - - - - - - Meningitis (not Tuberculous) (61) - - - - - - - - - - Convulsions (71) - 2 - 1 3 1 2 1 - 7 Gastritis (103a) - - - - - - - 1 - 1 Laryngitis (87B) - - - - - - - - - - Bronchitis - 1 - 1 2 1 1 - 1 5 Pneumonia (all forms) (91 & 92) - - - - - 2 1 3 1 7 Suffocation, overlying - - - - - - - - - - Other Causes 3 1 1 - 4 1 3 1 - 9 Totals 14 10 5 3 32 16 15 8 2 73 Nett Births registered during the calendar year: legitimate 1,008, illegitimate 46,—total 1,053. Nett Deaths registered during the calendar year of legitimate infants 60, illegitimate infants 13—total 73. Note:-The numbers given in brackets after certain causes of death indicate the numbers of the corresponding headings in the detailed international list of causes of death, 1909. Cases of Infectious Disease notified during the year 1918. Notifiable Disease. Number of cases notified. Total notified in each Locality Total cases removed to Hospital. At all ages At ages-years. Cranbrooke Ward Park; Ward. Seven Kings. North Hainault. Loxford Ward. Clement swood. South Hainault Under 1 yr. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and over. Small Pox - - - - - - - - - - - - - - - - Cholera, Plague - - - - - - - - - - - - - - - - Diphtheria (including Membranous Croup) 216 1 43 136 25 11 - - 9 33 21 46 36 49 22 166 Erysipelas 27 2 2 - 5 8 8 2 3 5 - 2 6 4 7 6 Scarlet Fever 167 - 14 118 29 6 - - 6 26 8 79 15 26 7 74 Typhus Fever - - - - - - - - - - - - - - - - Enteric Fever 32 - 3 12 10 7 - - - 2 1 25 - 4 - 6 Relapsing Fever - - - - - - - - - - - - - - - - Continued Fever - - - - - - - - - - - - - - - - Puerperal Fever 1 - - - - 1 - - - - - - - - 1 - Cerebro Spinal Meringitis 3 - 1 - 1 1 - - - - 1 1 1 - - 2 Acute Poliomyelitis 2 - 1 1 - - - - - - - - - 2 - 2 Pulmonary Tuberculosis 129 - - 8 35 60 20 6 14 23 6 20 26 20 20 - Other forms of Tuberculosis 39 - 7 14 12 5 1 - 3 6 5 7 7 7 4 - Measles 204 - 126 78 - - - - 9 27 38 12 31 65 22 - German Measles 72 - 16 41 7 7 1 - 5 5 19 1 11 5 26 - Ophthalmia Neonatorum 8 8 - - - - - - 2 1 1 3 1 - - 3 TOTALS 900 11 213 408 124 106 30 8 51 128 100 196 134 182 109 259