BOROUGH OF ROMIFORD ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1937 JAMES B. SAMSON, M.D., D.P.H. Medical officer of Health. W. & W. Ltd. Ro m 12 BOROUGH OF ROMFORD HEALTH DEPARTMENT. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1937. JAMES B. SAMSON, m.d., d.p.ii., Medical Officer of Health. 3 BOROUGH OF ROMFORD. MEMBERS OF THE COUNCIL (As at 31st December, 1937) His Worship The Mayor: Alderman C. H. Allen, J.P. Deputy Mayor: Alderman E. A. Forge. Aldermen: Alderman C. H. Barney. Alderman H. W. Hole. ,, F. L. J. Cole. ,, C. E. Smart. ,, W. M. Goldsmith. Councillors: Councillor A. E. Blane. Councillor A. E. Fruitnight. ,, B. G. L. Bowyer. ,, W. D. Hill. ,, A. J. Brian. ,, L. A. Lucas. ,, G. W. Butcher. ,, A. Needham. ,, J. Butterfield. ,, C. A. Osborn. ,, G. F. Chaplin. ,, G. E. C. Quartermaine ,, Mrs. I. J. Coates. ,, W. J. Russell. ,, H. F. Davenport. ., E. W. Smith. ,, W. F. Davies. ,, G. A. Stafford. A. J. Dyer, O.B.E. L.S.Webb. ,, N. Eyre. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December, 1937) His Worship The Mayor: Alderman C. H. Allen, J.P. (Ex-officio member). Deputy Mayor: Alderman E. A. Forge (Ex-officio member). Chairman: Alderman C. E. Smart. Vice-Chairman: Councillor L. S. Webb. Alderman C. H. Barney. Councillor H. F. Davenport. ,, F. L. J. Cole. ,, W. F. Davies. ,, H. W. Hole. ,, L. A. Lucas. Councillor A. E. Blane. ,, G. E. C. Quartermaine ., A. J. Brian. ,, W. J. Russell. ,, Mrs. I. J. Coates. Maternity and Child Welfare Committee. As above with the addition of— Mrs. A. Damant. Mrs. L. Fox. Mrs. B. Hollingsworth. Mrs. H. C. Woodcock. 5 HEALTH DEPARTMENT. Public Health Staff. Medical Officer of Health. J. B. Samson, m.d., cii.b., d.p.h. Assistant Medical Officer of Health for M. & C.W. Purposes. Hilary S. M. Hadaway, m.b., b.s. Sanitary Inspectors. (a) W. S. Gent, Chief Sanitary Inspector, Certificate of the Royal Sanitary Institute; Certificate of the Liverpool University School of Hygiene for Meat and Foods. (b) C. H. Bossley, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute (Meat and Foods). (c) C. H. Sargent, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute (Meat and Foods). Health Visitors. (a) Mrs. E.J. Bingham, State Registered Nurse; State Certified Midwife. (b) Miss M. J. Thomas, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate; State Certified Fever Nurse; Certificate for Tuberculosis. (c) Miss F. K. Wells, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. Council Midwives. (a) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing (Commenced duties 1st September, 1937). (b) Mrs. D. Shaddick, State Registered Sick Children's Nurse; State Certified Midwife (Commenced duties 1st September, 1937). (c) Mrs. A. P. Shuttleworth, State Registered Nurse; State Certified Midwife. (d) Mrs. J. Thompson, State Registered Nurse; State Certified Midwife (Commenced duties 1st September, 1937). Clerks. (a) E. W. Gowers, Senior Clerk to the Medical Officer of Health. (b) C. G. Humberston, Clerk to the Sanitary Inspectors. (c) S. Adams, Junior Clerk to the Medical Officer of Health. 6 BOROUGH OF ROMFORD. To His Worship the Mayor, Aldermen, and Councillors of the Romford Borough Council. Mr. Mayor, Madam, and Gentlemen, I have the honour, herewith, to present to you, this, my Annual Report on the Health of the District for the year 1937. This is the Fourth Report in the series since 1 was appointed your Medical Officer of Health, and it is drawn up in accordance with the requirements of Article 17 (5) of the Sanitary Officer's (Outside London) Regulations, 1935, and Circular 1650 of the Ministry of Health, dated 4th October, 1937. The outstanding events of the year have been the granting of a Charter of Incorporation to the District, and the transfer of the Department to the new Town Hall. This latter event has ensured more commodious premises for the staff, and a closer co-operation with the other Departments of the Council. In the Offices which we now occupy we feel that we can exemplify the teaching of our health posters without fear of criticism. With regard to the Staff, 3 additional midwives were appointed during the year by the Council, so as to enable us to comply with the requirements of the Midwives Act, 1936. Further reference is made to this in the body of the Report. Apart from these 3 additions, there have been no alterations in the personnel of the Department. In general, I think I can confidently state that in Romford we are keeping pace with modern conceptions of what is required for the hygienic development of the Town. In conclusion, my best thanks go to all who have sought the advancement of Public Health, and to the members of my staff who, each in his or her own sphere, have contributed to the compilation of this Report. I am, Mr. Mayor, Madam, and Gentlemen, Your obedient servant, JAMES B. SAMSON, Public Health Department, Medical Officer of Health. Town Hall, Romford, May, 1938. 7 LOCAL ACTS, ADOPTIVE ACTS, BYELAWS, ETC., IN FORCE WITHIN THE DISTRICT. Local Act. Eomford Urban District Council Act, 1931. Adoptive Acts. Infections Disease (Prevention) Act, 1890 as amended. Private Street Works Act, 1892. Public Health Acts (Amendment) Act, 1890— Parts 2, 3, 4 and 5, as amended. Public Health Acts (Amendment) Act, 1907— Part 2, Sections 15, 16, 17, 18, 20, 21, 22 and 28/33 (inclusive). Parts 4 and 6. Part 7, Section 81. Parts 8 and 9. Part 10, Section 95. Public Health Act, 1925—Part 2, as amended. Small Dwellings Acquisition Acts, 1899 to 1923. The Slaughter of Animals Act, 1933, has also been made applicable to "sheep, ewes, wethers, rams and lambs." Byelaws. Hackney Carriages. New Streets and Buildings. Raphael Park, etc. Eomford Market. Slaughterhouses. Orders. Eomford Urban (Offensive Trades) Confirmation Order, 1929, declaring each of the following trades to be an offensive trade, viz.: Trades of Blood-Drier, Leather Dresser, Tanner, Fat Melter or FatExtractor, Glue-Maker, Size-Maker, Gut-Scraper, Eag and Bone Dealer, and Fish Frier. Eomford, Hornchurch, and Upminster Weekly Half-Holiday (Hairdressers) Order, 1923. Rules and Regulations. Eomford Cemetery. 8 The population of Romford consists of persons who are occupied in business or professional duties either in the town itself or in London. A certain number is engaged in agricultural pursuits. Regarding particulars of the extent of unemployment in the district, I have again to thank the Manager of the Local Employment Exchange for supplying me with the necessary information. As before these figures relate not only to Romford, but also to adjacent areas supervised by the Romford Branch of the Exchange. Table 1. Men Women Boys Girls Total Totally Unemployed, 1936 686 269 42 57 1,054 Short Time Workers, 1936 42 20 — — 62 Totals 728 289 42 57 1,116 Men Women Boys Girls Total Totally Unemployed, 1937 1,601 330 72 49 2,052 Short Time Workers, 1937 103 36 — 1 140 Totals 1,704 366 72 50 2,192 These are the Live Register figures as on December 31st. It is unfortunate that this year I have to report an increase of unemployment amongst Men, Women, and Boys. With Girls, however, there is a slight decrease. It is to be hoped that the cause is of a seasonal character only, although hardships are more difficult to bear at the time of the year to which these figures relate. With a rise in unemployment, a greater strain is thrown on the social services of the Council, but, thanks to the services that do exist, I have no evidence, statistical or otherwise, that there has been any significant influence on the health or physique of children or adults. 9 ANNUAL REPORT of Medical Officer of Health for the Year 1937. Statistics and Social Conditions of the Area. Area (in acres) 9,342 Population: Census (1931), 35,918. Mid. 1937 (Estd.) 51,830 Number of Inhabited Houses (end of 1937) 14,680 Rateable Value (end of 1937) £450,203 Product of Penny Rate (end of 1937) £1,730 Extracts from Vital Statistics for the Year. Total M. F. Live Births: Legitimate 808 421 387 Illegitimate 39 22 17 Birth Rate: 16.3 per 1,000 of estimated resident population. Still Births: Legitimate 33 21 12 Illegitimate 3 2 1 Rate per 1,000 total (live and still) births: 40.8. Deaths 496 257 239 Death Rate: 10.4 per 1,000 estimated resident population. Rate per 1,000 total (live and Deaths still) births Deaths from Puerperal Causes:— From Puerperal Sepsis 0 0 Other Puerperal Causes 1 1.1 Total 1 1.1 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 51.9 Legitimate Infants per 1,000 legitimate live births 53.2 Illegitimate Infants per 1,000 illegitimate live births 51.3 Deaths from Cancer (all ages) 74 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 3 Deaths from Diarrhœa (under 2 years of age) 5 10 TABLE 2. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL DEATH-RATES and CASE-RATES for certain Infectious Diseases in the year 1937. England and Wales, London, 125 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns). Rate per 1,000 Population. DEATH-RATE PER 1,000 POPULATION. Rate per 1,000 Live Births All Causes Typhoid and Paratyphoid fevers Small-pox Measles Scarlet fever Whooping cough Diphtheria Influenza Violence Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year Live Births Stillbirths England and Wales 14.9 0.60 12.4 0.00 - 0.02 0.01 0.04 0.07 0.45 0.54 5.8 58 125 County Boroughs and Great Towns, including London. 14.9 0.67 12.5 0.01 - 0.03 0.01 0.04 0.08 0.39 0.45 7.9 62 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census). 15.3 0.64 11.9 0.00 — 0.02 0.01 0.03 0.05 0.42 0.42 3.2 55 London 13.3 0.54 12.3 0.00 - 0.01 0.01 0.06 0.05 0.38 0.51 12.0 60 ROMFORD 16.3 0.69 10.4 0.00 - 0.02 0.00 0.06 0.06 0.17 0.48 5.9 53 The maternal mortality rates for England and Wales are as follow „ „ „ Romford are as follow: Puerperal Sepsis Others Total per 1,000 Live Births 0.97 2.26 3.23 „ ,, Total Births 0.94 2.17 3.11 ,, ,, Live Births — 1.18 1.18 ,, ,, Total Births — 1.13 1.13 11 TABLE 3. Causes of Death All ages Deaths at the subjoined ages of Residents, after correction for Inward and Outward Transfers. M. F. Total Under 1 1 2-4 5-14 1524 2534 3544 4554 5564 6574 75 & upwards 1 Typhoid and paratyphoid fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 Measles ... 1 1 1 ... ... ... ... ... ... ... ... ... ... 3 Scarlet fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Whooping cough ... 3 3 3 ... ... ... ... ... ... ... ... ... ... 5 Diphtheria 2 1 3 ... ... ... 3 ... ... ... ... ... ... ... 6 Influenza 1 8 9 ... ... ... ... ... 3 ... 2 1 ... 3 7 Encephalitis legarthica ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... 8 Cerebro-spinal fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 Tuberculosis of respiratory system 13 12 25 ... ... ... ... 4 4 5 5 6 1 ... 10 Other tuberculous diseases 1 4 5 ... ... ... ... 1 3 ... ... ... 1 ... 11 Syphilis 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 12 General paralysis of the insane, tabes dorsalis 1 ... 1 ... ... ... ... ... ... 1 ... ... ... ... 13 Cancer, malignant disease 37 37 74 ... ... ... ... ... ... 3 14 21 18 18 14 Diabetes ... 1 1 ... ... ... ... ... ... 1 ... ... .. ... 15 Cerebral hæmorrhage, &c. 7 12 19 ... ... ... 1 ... ... 1 3 8 2 4 16 Heart Disease 62 41 103 1 ... ... ... 1 2 6 9 22 30 32 17 Aneurysm ... ... ... ... ... ... ... ... ... ... ... ... ... ... 18 Other circulatory diseases 20 21 41 ... ... ... ... ... ... ... 3 5 17 16 19 Bronchitis 4 4 8 ... ... ... ... ... ... ... ... ... 3 5 20 Pneumonia (all forms) 23 15 38 ... 1 l 4 ... 2 ... 2 7 7 8 21 Other respiratory diseases 4 8 12 ... ... ... 1 1 2 1 3 1 1 2 22 Peptic ulcer 7 4 11 ... ... ... ... ... ... ... 2 5 3 1 23 Diarrhœa, &c. (under 2 years) 4 1 5 5 ... ... ... ... ... ... ... ... ... ... 24 Appendicitis 2 1 3 ... ... ... ... ... 2 ... 1 ... ... ... 25 Cirrhosis of liver 1 0 1 ... ... ... ... ... ... ... ... ... ... 1 26 Other diseases of liver etc. ... 2 2 ... ... ... ... ... ... ... ... 1 ... 1 27 Other digestive diseases 7 3 10 ... 1 ... ... 1 1 ... 4 2 ... 1 28 Acute and chronic nephritis 8 4 12 1 ... ... 1 ... ... 3 1 3 ... 3 29 Puerperal sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30 Other puerperal causes ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... 31 Congenital debility, premature birth, malformations, etc. 16 12 28 26 ... ... 1 ... 1 ... ... ... ... ... 32 Senility 9 9 18 ... ... ... ... ... ... ... ... ... 4 14 33 Suicide 1 4 5 ... ... ... ... ... 1 1 2 ... 1 ... 34 Other violence 16 9 25 ... 1 ... 4 2 1 2 1 5 3 6 35 Other defined diseases 10 20 30 1 ... ... 4 3 2 4 4 2 7 3 36 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 257 239 496 44 3 1 20 13 25 28 56 90 98 118 12 TABLE 4. Collier Row and Havering Ward Gidea Park and Noak Hill Ward South Ward Town Ward West Ward Death Rate per 1,000 Estimated Resident Population 8.23 7.17 11.13 9.87 9.61 Infant Mortality Rate 48.39 24.69 64.08 63.49 41.67 This year the Registrar General has given his estimate of the mid-year population of Romford as 51,830, which compares, with 49,250 last year, an increase of 2,580, and incidentally, it will be noted that officially we have now passed the 50,000 mark. In the various returns of the Registrar General, however, it would appear that the designation of "Great Town" is based on a population of 50,000, or over, at the last Census, so Romford, statistically speaking, will have to bask in potential glory for a few years yet. Populations vary in size according to two factors, viz.: 1. The Ratio of Births to Deaths, and 2. Migration. So far as Romford is concerned, during 1937, the total number of live births registered was 847, and the total number of deaths registered was 496. The difference of 351 gives the natural increase in the population. As this number falls far short of the Registrar General's estimated increase of 2,580, it follows that the remainder, 2,229 is made up of excess of Immigration over Emigration. In a district such as this, with considerable building activity still going on, it is difficult to estimate the future trend of population, so far as size is concerned, and, yet, this trend has an important bearing on social and economic factors. Then, again, in dealing with trend of population, consideration must also be given to age distribution, for it naturally follows that different types of social service have to be provided for varying age groups. Sex distribution is also of great importance, for, as McCleary has pointed out, "most members of the population are not capable of bearing children. It is a service reserved by Nature for women at certain ages," and these ages are generally stated to be between 15 and 45 years. I think it will be conceded that a fall in the birth rate means in time that there will be a fewer number of individuals in the younger age groups, although, temporarily, this may be checked by a fall in the Infant Mortality Rate. In Romford, however, for a number of years, the Infant Mortality Rate has fluctuated between 35 and 60, and it is unlikely that a spectacular reduction will occur, so this factor can, with us, be ignored. 13 The fall, then, in the younger age groups will have the effect of proportionately increasing the numbers in the adolescent and middle age groups, but only for a time, for eventually, by reason of fewer recruits to this group, the numbers here will begin to fall, and the proportion of persons in the older age groups will increase. Now, as deaths do not take place at a uniform rate for all ages, we will find that as the population passes from a group of expected low mortality to one of expected high mortality, the death rate will go up, and this is beginning to show in the National statistics. In Eomford, however, the building activities will continue to attract the 20 to 30 year olds to the district, and help to swell the population at this favourable time of life. And, as the fertility rate is naturally higher at this period, it is to be expected that the town will have its fair share of births for some time to come, but how long this will be maintained will depend on the birth rate, which does show the tendency even now to a fall. I think I can safely say that statistically we are favourably placed in the matter of population, and what has happened to the Country as a whole has yet to take place in Eomford. For 1937, we estimate the Birth Rate to be 16.3 per 1,000 of the estimated resident population, a figure equal to that of 1936. The Bate for England and Wales for 1937 is given as 14.9, and for the 148 smaller towns with populations ranging from 25,000 to 50,000, the Eate is 15.3. The Death Eate for the town is estimated at 10.4 per 1,000 of the estimated resident population. This figure is obtained by multiplying the Crude Death Eate of 9.6 by the Areal Comparability Factor for Eomford, which is 1.08. The Death. Eate last year for the District was 10.5. The Eates for England and Wales, and for the 148 smaller towns referred to above are 12.4, and 11.9 respectively. The chief causes of death in order of frequency are:— 1. Diseases of the Heart and Circulation; 2. Cancer; 3. Bronchitis, Pneumonia, and other Eespiratory Diseases; 4. All Forms of Tuberculosis. This is the same order as last year. The Maternal Mortality Eate is 1.1 per 1,000 total registered (live and still) births, a decrease of 2.5, and, incidentally, our lowest rate on record. The corresponding rate for England and Wales is 3.1. 14 The Infant Mortality Rate, or the Death Rate of Infants under 1 year of age per 1,000 registered live births, is 53, a decrease of 7. The corresponding figures for England and Wales, and the 148 smaller towns are 58 and 55 respectively. In general it will be noted that, compared with England and Wales as a whole and Towns of a population equivalent to that of Romford, we have a higher birth rate, a lower death rate, and a lower Infant Mortality Rate. The Maternal Mortality Rate for the other towns is not yet available, but, compared with England and Wales in general, we have, also, a lower rate. Furthermore, it will been seen from Table 2 that the Death Rates in Romford for certain specified conditions bear favourable comparison with other parts of the Country. This, in my opinion, is a gratifying conclusion of a year's work. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. A. Infectious Diseases. 1. Fevers. The Infectious Diseases' Hospital at Rush Green, under the jurisdiction of the Romford Joint Hospital Board, continues to serve this District, Dagenham Urban District, and Hornchurch Urban District, and draws from a population of approximately 215,000. Although the Hospital is not actually within the geographical area of Romford, yet its situation at about two to three hundred yards from the South-West boundary is sufficiently near to make it accessible for the immediate admission of urgent cases. During the month of November, the extensions contemplated in my previous reports, were completed, and officially opened. These comprise a new Nurses' Home, and 5 Ward Blocks, made up of 2 Pavilion Wards each with 26 Beds, and 3 Cubicle Blocks, two of which are Y shaped having 15 Cubicles each, and a third consisting of a straight row of 12 Cubicles with an Operating Theatre. In addition, the Boiler House and Laundry have been practically doubled in size. A Porter's Lodge has also been erected near the main gate with Visitors' Room and Waiting Room attached. Roads have been built around the Wards, and all Wards are connected by Covered Ways. The Hospital now provides 235 beds on an estimate of 144 square feet per bed, which compares with 141 beds on a similar estimate prior to enlargement. This will undoubtedly relieve the pressure on beds which has been so noticeable during previous years, and will allow for a greater variety of infectious diseases to be admitted. Hitherto, many cases have had to be sent to the London Fever Hospital, or to Isolation Hospitals under the control of the London County Council when the Rush Green Hospital has been full, 15 There is adequate provision for Surgical Treatment, and during the year under review, the Hospital Board appointed Mr. M. R. Ernst, F.R.C.S. as Visiting Surgeon to the Hospital. There is also adequate provision for the carrying out of Laboratory work at the Hospital. 2. Smallpox. It was stated in my report for last year that the Essex County Council was an authority for the provision of accommodation in the Administrative County for the treatment of cases of Smallpox, and that for this purpose an agreement had been made between the Essex County Council and the Borough of Colchester for the use of a Smallpox Hospital of 24 beds adjacent to the Colchester Isolation Hospital. This agreement continues in operation. It was also stated that in addition, the Essex County Council had an informal arrangement with the London County Council whereby the latter would receive Essex patients into their Smallpox Hospital in so far as they had accommodation available. Notice to terminate this arrangement, however, has been received, and the position at the end of the year was that the London County Council had been approached by the Essex County Council with a view to securing a permanent arrangement. 3. Tuberculosis. The arrangements of the Essex County Council for the supervision of patients suffering from Tuberculosis and contacts remain as before, but a Clinic is now held three times a week at the Combined Treatment Centre, Oldchurch Hospital, Romford, instead of twice. Once again I am indebted to Dr. J. E. Stokes, the District Tuberculosis Officer for this area, for his willing co-operation throughout the year. The Tuberculosis Care Association has again carried out good work, and by the provision of Extra Nourishment, Convalescent Holiday Treatment, the provision of Fares, Clothing, and Boarding cut of Children has brought welcome comfort to many of our patients and contacts. As before, the members of this Association have acted as Visitors to the homes, and by their sympathetic advice have given encouragement, not only to the patients, but to the dependants as well. Meetings are held on the fourth Thursday of each month, and your Medical Officer of Health has again attended, and has acted as a link between the Public Health Department of the Council, and the work of the Association. The Romford Council has now placed the Committee Room at the Town Hall at the disposal of the Association for their monthly meetings, free of charge, and has continued the annual donation to the funds, 16 B. Maternity. Our arrangement here is an agreement with the Essex County Council whereby Maternity cases can be admitted to Oldchurch Hospital. This Council is financially responsible for such cases, but recovers the charge if possible from the patient. During the year, the Essex County Council was endeavouring to get unanimity amongst the various Welfare Councils for the acceptance of financial responsibility by those Councils for nondestitute cases admitted in emergency to Oldchurch Hospital; that is to say for cases who requested admission during labour, and who had not previously booked a doctor or midwife. At the end of the year the matter was still under consideration. In the meantime, however, if patients present themselves at the Hospital at an early stage of pregnancy for the purpose of booking accommodation for confinement, they are referred by the Medical Superintendent to this Department if the patient resides in this area, so that the necessary arrangements for ante-natal supervision can be made at one of the clinics of the Department. Cases of Puerperal Pyrexia, and Ophthalmia Neonatorum can, if necessary, be sent under a scheme of treatment to the Romford Isolation Hospital. C. Children. The facilities in this category remain the same. D. Other. Accident cases and non-infectious cases can be catered for either at the Victoria Hospital, a voluntary hospital with 31 beds or at Oldchurch Hospital, which is under the jurisdiction of the Public Health Committee of the Essex County Council, and which has 860 beds. Both these hospitals are situated within the boundary of Romford. In addition, many large London Hospitals are within easy mileage of Romford. Venereal Diseases' Schemes are administered by the County Council. AMBULANCE SERVICES. The Ambulances available for use in the District are:— (a) Eor Infectious Diseases—Two, which are stationed at the Isolation Hospital. (b) For General and Accident Cases—Two. One of these is stationed at the Car Park in Church Lane. The other is stationed at the Town Yard, Market Place, and is used for reserve purposes only. 17 (c) For Old church Hospital—Two, which are stationed at the Hospital. Regarding the matter of co-ordination of services, the agreement entered into with the Essex County Council and the District Councils in the County relative to the reciprocal user of the ambulances owned by the various Authorities is still in operation. The effect of this agreement is that each Authority is responsible for the maintenance of its own ambulance service, but in addition, is able to call on other ambulances in cases of emergency, and can also assist other Authorities where the need arises in other areas. The Ambulance Serivce is therefore adequate and satisfactory. LABORATORY FACILITIES. Clinical material in all forms for Bacteriological and Chemical Analyses is sent to the Counties Public Health Laboratories, Queen Victoria Street, London under an arrangement entered into with the Essex County Council. When a report is sent to a practitioner, the Health Department here receives a duplicate, and, in this manner, is kept informed of the results of various specimens submitted from patients in the district. In addition to the above, we still have the scheme whereby swabs for Klebs Loeffler Bacillus can be taken by hand to the Isolation Hospital, and examined at the laboratory there. NURSING FACILITIES. 1. General Nursing. There are now in the District, 4 District Nurses who devote their time to domiciliary nursing. Two of these are provided by the Romford District Nursing Association, and two by the Collier Row District Nursing Association. In each case, the nurse also undertakes midwifery duties, but in the case of the Collier Row District Nursing Assocition it is the intention, so far as practicable, to allow one of the nurses to carry out all the general duties, and one all the midwifery duties. 2. Midwives. As from September 1st, a scheme for the supply of a domiciliary service of salaried midwives came into operation in the District. By an arrangement with the Local Supervising Authority viz. the Essex County Council, the Romford Council were enabled to appoint the midwives who would reside and carry out duties in the Romford area. In this manner 3 midwives were appointed, and an adjustment was made in the terms of service of Midwife Shuttleworth, who had been in the employ of the Romford Council for a number of years, so as to enable her conditions to be made comparable to those of the new service. 18 The names and qualifications of the 4 midwives are given in the front of this Report under the heading of "Public Health Staff." It has taken some time to get over the many practical problems that have arisen, and indeed continue to arise, but shortly after the inauguration of the scheme, the major matters quickly adjusted themselves, and the service is now fitting in smoothly with the general work of the Department. At its initiation a circular letter was sent to all the medical practitioners in the area explaining the the service, and your Medical Officer of Health outlined the main provisions of the Midwives Act, 1936 at a meeting of the Romford and District Medical Society. There are in addition to the above, 5 midwives in independent practice in the District, and the 4 Distinct Nurse Midwives to whom reference has already been made. Seven midwives, resident outside the area, also undertook cases within the area. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare. 1. Ante-Natal Clinics. The services of the Council available for Expectant Mothers remain the same, and 1 am pleased to be able to record that increasing advantage is being taken of such services. There is no doubt but that the scheme of Municipal Midwives offers a partial explanation for the larger attendances, but, on the other hand, it is gratifying to know that a number attended on the recommendation of friends who had already passed through the Clinics, and who felt that the benefits obtained should be more widely known. I can also say that when an expectant mother has once been to our centres we find her there again on her own initiative for a subsequent pregnancy. This speaks highly of the work done, and of the sympathetic and individual attention that is given. On the receipt of Circular 1621 of the Ministry of Health, dated 6th August, 1937, dealing with "Prevention of Blindness," I had occasion to recommend to the Public Health Committee the need for expert examination of the fundus of the eye in cases of failure of reading sight during pregnancy, and where the presence of albuminuria gives rise to the suspicion of retinal changes. As a result of this we now have an arrangement with the Essex County Council whereby such cases can be referred to an Ophthalmologist for expert advice and treatment. The Ophthalmoligist concerned is Mr. G. A. Jamieson, M.B., B.S., D.O.M.S., who attends periodically at the Combined Treatment Centre at Oldchurch Hospital. 19 During the year 1937, 531 individual expectant mothers attended the Clinics, representing 58.7 per cent. of the total notified births (live and still). In addition 99 mothers attended for post-natal advice, representing 10.9 per cent. of total notified births. In all 147 sessions were held during the year. The total number of attendances of the 630 mothers mentioned above was 2,204, giving an average of 3.5 attendances per patient. The average number attending at each session was 15.0. 2. Infant Welfare Clinics. This service continues on the same lines as last year. On reviewing the work of the year, I find that there is still a tendency in the matter of infant and toddler feeding for the mother to overlook the simple diets, and to seek various substitutes. Perhaps in this respect the mother is hardly to blame, for several times in the course of a day our attention is focussed on advertisements of the languid infant, who, apparently as the result of a stimulating conversation between two mothers and the subsequent trial of a concentrated food, is finally portrayed as a fully developed, and very often, overdeveloped child. It is difficult in the face of this to suggest that such humble nutrients as Milk, Vegetables, Wholemeal Bread, Eggs, Butter, Fruit, and Fish are all that is required, provided these are given in the right quantity and at the right time. Then, again, the faith in the bottle of medicine is still predominant in this part, and until this is broken we cannot hope to get far in preventive medicine. I agree that not infrequently pure Cod Liver Oil, or some preparation of Iron, or some specific medicine may be called for, but indiscriminate dosing by the mouth should be avoided at all costs. Another matter to which I wish to refer is the question of "baby talk." A mother should endeavour to get her infant out of the habit of using "baby words" as soon as possible. Not infrequently when the child enters school he or she is still using phrases that had better be forgotten. This acts as a deterrent to the natural development of speech, and makes the child sound ridiculous. Before closing my remarks I must mention the subject of sleep. All the children with whom we deal at Child Welfare Clinics should be in bed by 6 o'clock at the latest, and, yet, how very often we find that this is not the case. Frequently, we are told they cannot sleep at this hour, but a child in bed cannot run about the house, and the mere fact of being in bed gives lest to the body, and mind, though sleep may not come at once. Many of the present day ills require nothing more for prevention than adequate rest. 20 During 1937, the suggestions in Circular 1519 of the Ministry of Health, dated 1st April, 1937, dealing with Nutrition, were brought to the notice of the Public Health Committee with a recommendation to consider supplying more than one pint of milk per day to each individual, and other foods such as Butter Eggs, and Fruit, if necessary. The result of this was that your Medical Officer of Health was authorised to make any of the additional grants to urgent and necessitous cases, and to bring the matter forward again for further consideration when the estimates for the financial year 1938/1939 were being discussed. Regarding the provision of Milk, there were 1388 applications for receiving cow's milk free, or at less than cost price—177 had to pay a proportion of the cost, and the remaining 1271 received it free. In a similar manner 951 applications were received regarding dried milk and other foods, 111 had to pay a proportion, and 840 received free grants. When recommended, dried milk and accessories can also be purchased at the Clinics at cost price. During 1937, 354 Child Welfare sessions were held, and the following table gives a summary of the attendances. TABLE 5. Individual Children attending 2,163 Children attending for the first time 918 Medical Consultations 7,653 Attendances of Children under 1 year 11,186 Attendances of Children between the ages of 1 and 5 years 7,585 Average attendance per session 53.0 The percentage of notified live births represented by the total number of children who attended for the first time during the year, and who on the date of their first appearance were under J year of age, was 76.5. Ultra-Violet Ray Therapy has continued as before. Altogether during the year 97 individual patients were treated. Of these 18 had had less than 6 doses by the end of the year. Dr. Hadaway has kindly tabulated statistics relative to this form of treatment, and has excluded those patients who have received less than 6 doses. Group 1. Debilitated and Nervous Children. ,, 2. Anaemic Children. ,, 3. Children under weight. ,, 4. Rickety Children. ,, 5. Those suffering from Respiratory Defects. 21 Table 6. I. II. III. IV. V. No. of Individual Patients treated 20 12 7 23 15 Total No. of Exposures 348 169 78 401 274 Total No. of Minutes 3028 1478 580 3284 2212 Average period of treatment in weeks 8.7 7 5.6 8.7 9 Minimum period of treatment in weeks 3 3.5 3 3 3.5 Maximum period of treatment in weeks 20 12 12 12 18 Average No. of doses 17.4 14 11.2 17.4 18 Minimum No. of doses 6 7 6 6 7 Maximum No. of doses 40 24 24 24 36 Average strength of dose in minutes 8.7 8.7 7.4 8 8 Minimum strength of dose in minutes 4 4 4 4 4 Maximum strength of dose in minutes 10 10 10 10 10 Average increase of weight in lbs. .59 .93 .3 .76 .88 Average increase in hegiht in inches .87 .81 .46 1.88 .99 Table 7 relates to the Home Visits paid by the Health Visitors. TABLE 7. (a) To Expectant Mothers. First Visits 68 Total Visits 104 (b) To Children under One Year of age. First Visits 815 Total Visits 2,399 (c) To Children between the Ages of 1 and 5 years. Total Visits 4,749 3. Child Life Protection. In Bomford, each Health Visitor also holds the appointment of Child Protection Visitor under Sections 206 to 220 of the Public Health Act, 1936. TABLE 8. (a) Number of Persons who were receiving Children for reward at the end of the year 42 (b) Number of Children: (1) At the end of the year 50 (2) Who died during the year 0 (3) On whom inquest were held during the year 0 (c) Number of Child Protection Visitors at the end of the year who were: (1) Health Visitors 3 (2) Female, other than Health Visitors 0 (3) Male 0 22 (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or Societies authorised to visit under the proviso to Section 209 (2) of the Public Health Act, 1936 0 (e) Proceeding taken during the year: (1) Number of Cases 0 (2) Act and Section under which proceedings were taken 0 (f) Number of cases in which the Local Authority has given a sanction during the year under Section 210 of the Public Health Act, 1936 0 (g) Number of Orders obtained during the year under Section 212 of the Public Health Act, 1936 0 4. Gynæcological and Birth Control Clinic. It was stated in my last report that arrangements were being made for the establishment of a Gynæcological Clinic. The first session was held at the end of March at Oldchurch Hospital, and has subsequently been held on the second and fourth Thursdays of each month. At this Clinic: 1. Medical advice and treatment are available to women who suffer from gynaecological defects; 2. Contraceptive advice is available to married women in whose cases pregnancy would be detrimental to health. If cases submit themselves for gynæcological treatment, birth control advice is given, if necessary, and if cases submit themselves for birth control advice, gynæcological treatment is given, if necessary. The charge made by the Essex County Council for this service is 2/- per visit, inclusive of appliances, for which the Eomford Council is financially responsible. 5. Midwives Act, 1936. The following shows the number of cases attended by the Council Midwives, as Midwives, and as Maternity Nurses during the last 4 months of the year: As Midwives 36 As Maternity Nurses 7 6. Inspection of Nursing Homes, Etc. Quarterly inspections have again been carried out during the year on behalf of the Essex County Council, which is the Local Supervising Authority, and investigations have been made in respect 23 of cases of Puerperal Pyrexia, Puerperal Fever, Eye Discharges of an Infant, and Liability of the Midwives to be a Source of Infection, etc. 7. Additional Service. At the end of the year our existing scheme for the treatment of minor ailments was extended to include advice and treatment for Skin Diseases. For this purpose an arrangement was made with the Essex County Council for such cases to be seen by Mr. Arthur Burrows, M.D., M.ll.C.P., D.M.R.E., Skin and Radium Specialist at Oldchureh Hospital. The charge for this is 1/6 per patient per week. SANITARY CIRCUMSTANCES OF THE AREA. 1. Water. During the year there was sufficient rainfall to enable us to have an adequate supply of water to meet all requirements. As recorded at Raphael Park, the total rainfall for 1937 was 27.33in. Mr. Bernard W. Bryan, Engineer to the South Essex Waterworks Company has once again kindly supplied me with information, relative to the Company's water supply, which is as follows:— "The construction of the further Stour Supply Scheme, for which Parliamentary powers were obtained in 1937, is proceeding satisfactorily and it is anticipated that the scheme will be in supply by the Spring of 1940. Mains were extended in your Borough as follows:— 3in. 223 yards 4in. 8,121 yards 6in. 2,591 yards 9in. 150 yards The analytical reports on all analyses made on water supplied were that the water was pure and wholesome and suitable for the purpose of a public supply." In addition to the above analyses, on March 9th a sample of tap water taken from premises in the District by the Sanitary Inspector was submitted for Chemical and Bacteriological examination with the following result "This is a bright water containing a few particles of mineral matter in suspension. It is of faint yellow colour, neutral reaction, hard in character and free from excess of saline or metallic matter. 24 The water is of satisfactory organic quality and a high degree of bacterial purity. It is a pure and wholesome water suitable for drinking and domestic purposes." Again, on October 12th a sample was taken for similar purposes with the following result:— "This sample is clear and bright, of normal colour, and neutral in reaction. The water is hard in character, though not to an excessive degree, contains no excess of saline or mineral matter, in solution, or metals, and is of a high standard of organic and bacterial purity. We are of opinion therefore that it is a pure and wholesome water, suitable for drinking and domestic purposes." During the year, as a result of inspections by the Sanitary Inspectors, water supplies were provided inside 2 dwelling-houses. In these cases the water supplies had previously been outside. 2. Drainage and Sewerage. Mr. F. G. Beaumont, Borough Engineer and Surveyor has kindly supplied me with the following information relative to the above:— (1) Lengths of sewers laid during 1937 (a) Surface water sewers—3.961 yards. (b) Foul sewers—1,038 yards. (2) Number of premises re-drained and connected to sewers— 102. Improvements carried out in regard to drainage included ditches piped in front of houses, extension of foul sewer for flushing manholes, and manholes put on surface water sewers. 3. Sanitary Inspection of the Area. The Chief Sanitary Inspector has given me the following report as required by Article 27 (18) of the Sanitary Officers (Outside London) Begulations, 1935. 25 Table 9. (a) Nature and Number of Inspections during the year:— Number Bakehouses 34 Butchers' Shops and Stalls 190 Common Lodging Houses 7 Cowsheds, Dairies, and Milkshops 166 Drainage 489 Factories and Workshops 65 Food Preparing Premises 46 Fried Fish Shops 22 Ice Cream Premises 141 Markets 151 Piggeries 11 Public Baths and Swimming Pools 18 Public Conveniences 20 Rag and Bone Dealers 7 Rats and Mice (Destruction) Act, 1919 1,912 Shops Acts 284 Slaughter-houses 1,477 Smoke Observations 40 Stables 10 Tents, Vans, Sheds 38 (b) Informal Notices (Number served) 585 Statutory Notices (Number served) 11 (c) As a result of service of notices the necessary works were completed by the owner or occupier in all cases except 71, the works for which were still in hand at the end of the year. PREMISES AND OCCUPATIONS CONTROLLED BY LOCAL ACT, BYE LAWS, REGULATIONS, ETC. A. Fried Fish Shops. Fish Frying is an offensive trade in Romford under the provisions of the Romford Urban (Offensive Trades) Confirmation Order, 1929. Business of this nature is now being carried on in 12 shops in the District. B. Ice Cream. Traders and manufacturers of ice-cream have to be registered under the provisions of the Romford Urban District Council Act, 1931. There are now 48 manufacturers, and 142 vendors on the register. 26 27 samples of ice-cream were taken for analysis during the year. Of these, 26, or 96% proved to be satisfactory from a bacteriological point of view. Investigations were made in respect of the unsatisfactory sample, and after the necessary precautions had been taken a further sample proved satisfactory. C. Rag and Bone Dealers. Such business is an offensive trade in Romford, under the provisions of the Eomford Urban (Offensive Trades) Confirmation . Order, 1929. There are 4 dealers in the District. Disinfection after Infectiou Diseases. After cases of infectious diseases have been removed to Hospital, or after the termination of illness, if they have been treated at home, the sick room and contents are fumigated with Formalin vapour. The bedding is exposed to the vapour at the time the room is disinfected, routine steam disinfection not being employed. Eradication of Bed Bugs. When a house is found to be bug infested the occupants are advised by the staff of the Sanitary Department what steps to take to secure eradication of the bugs. This advice depends largely on the degree of infestation, and was described in detail in my report for last year. When the house has been rendered free from bugs the tenant is advised to communicate with us if any more are seen. Opportunity was taken during Health Week, at the stand of the Eomford Council, of educating the public on this matter, and a film entitled the "Red Army" was shown. During the year, 2 Council houses, and 19 other houses were found to be infested. These were all disinfested, although in 1 case the disinfestation took place at the beginning of 1938. Regarding the method employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses from condemned properties, this, also, was mentioned in the last report. Briefly, I can recapitulate by stating that the work is contracted out to a firm which specialises in the use of Hydrogen Cyanide Gas, a 2.5% concentration of this gas being used. After . ventilation a series of tests is carried out, and when found to be satisfactory the house is pronounced as ready for occupation, and a certificate is issued to this Department by the firm stating that the tests have been found to be satisfactory. 27 Rats and Mice (Destruction) Act, 1919. During the year the Sanitary Inspectors have continued their endeavours to get occupiers of premises that are rat infested to take the necessary steps to get rid of these vermin. At the same time we have been fortunate in getting the co-operation of the occupiers of adjacent premises. Most of these latter realise that it is also to their advantage to do what they can. The rat-catcher, who works under the direction of the Sanitary Inspectors, paid 1,912 visits and revisits to private houses, slaughterhouses, bakehouses, timber yards, stables, poultry farms, hedgerows, etc., and has employed ferrets, dogs, traps, and baits. He has been successful on several occasions in prevailing upon occupiers to remove accumulations from their yards or buildings. During the Romford Health Week and Exhibition, the Eat Exhibit of the Ministry of Agriculture and Fisheries was displayed on the Council stand, and leaflets were distributed giving advice on the destruction of Eats and Mice. This exhibit proved both interesting and informative. Factories, Workshops and Work Places. Table 10. 1. Inspection. Inspections Written Notices Prosecutions Factories 33 2 — Workshops 19 3 — Workplaces 33 — — Total 85 5 — 2. Defects. Nuisances under the Public Health Acts. Number of Defects Found. Number of Defects Remedied. Want of Cleanliness 3 3 Want of Ventilation — — Overcrowding — —' Want of Drainage of Floors — — Other Nuisances — — Sanitary Accommodation— Insufficient — — Unsuitable or Defective 3 3 Not separate for sexes — — Total 6 6 28 3. Outwork in Unwholesome Premises— One instance occurred in connection with the making of wearing apparel, but the unsatisfactory conditions were remedied on service of a notice. Closet Accommodation. During the year 18 pail closets were converted to water closets. In 18 instances drains were relaid. Also, during the year, water waste preventers were fitted, and water provided to closets in 5 instances, where previously the closets, though connected to the sewer, had to be flushed by hand. The following indicates the numbers of the various types of sanitary conveniences, other than Water Closets connected to Sewers, existing in the Borough at the end of the year:— Water Closets not connected to the Sewer 235 Pail Closets 169 Common Lodging Houses. There is only one Common Lodging House in the District. This has accommodation for 45 persons, and is being administered in a satisfactory manner. Public Cleansing. This work is undertaken by the Surveyor's Department. Twenty-seven street orderly barrows were put into use during the year. Shops Act, 1934. 188 routine inspections were carried out during the year for the requirements of the above Act, the result being that 9 informal notices were served. Three of these were complied with, the remaining 6 being outstanding at the end of the year. It was not found necessary to serve any statutory notices. Smoke Abatement. During the year 40 observations were carried out, and warning notices were served when necessary. Swimming Baths and Pools. Particulars of the Public Baths, and the Privately owned Swimming Pool which is open to the Public, were given in my Annual Report for 1935. There are no alterations to record this year. As before, several visits have been paid to both premises, and samples of water have been taken for Chemical and Bacteriological Analyses. 29 Regarding the Public Baths, these samples have shown the water to be "safe and suitable for swimming bath purposes." This has also, on each occasion, been the report for the Privately owned Pool, except once when the absence of Chlorine resulted in an unsatisfactory sample. This absence of Chlorine was due to delay in delivery of the Chemical by the manufacturers. To obviate this recurring several cylinders have since then been obtained and kept at hand and a new cylinder has been ordered whenever the one in use has emptied. A subsequent sample when the Chlorine plant was put into operation proved satisfactory. Tents, Vans, Sheds. There are only 10 such in the District. Constant supervision is maintained so as to prevent those that may come into the District from remaining in the District for any length of time. Last year, however, we were not troubled in this respect. Housing Statistics for the Year 1937. Table 11. No. of houses erected duing the year:— (1) By Local Authority Nil. (2) By Private enterprise 1,481 1. Inspection of Dwelling-houses during the year:— (1) (a) Total Number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 833 (b) Number of inspections made for the purpose 2,550 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations , 1925 112 (b) Number of inspections made for the purpose 280 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of dWelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 552 2. Remedy of defects during the year without Service of Formal Notices:— Number of dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 495 30 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 9, 10 and 10 of the Housing Act, 1936: (1) Number dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By Owners 0 (b) By Local Authority in default of Owners 0 (b) Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 11 (2) Number of dwelling-houses in which defects were remedied after service of formal notices. (a) By Owners 10 (b) By Local Authority in default of Owners 0 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936: (1) Number of dwelling-houses in respect of which Demolition Orders were made 10 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 7 (d) Proceedings under Section 12 of the Housing Act, 1936: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 0 4. Housing Act, 1936, Part IV—Overcrowding. (a) 1. No. of dwellings Overcrowded at end of year 34 2. No. of Families dwelling therein 34 3. No. of persons dwelling therein 255 31 (b) No. of new cases of Overcrowding reported during year 5 (c) 1. No. of cases of Overcrowding relieved during year 19 2. No. of persons concerned in such cases 110 (d) Particulars of any Cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil. Official Representations were made during the year under Section 11 of the Housing Act, 1936 in respect of 4 dwelling-houses, and, later in the year, Demolition Orders were made on all 4. Demolition Orders were also made on the 6 houses represented under Section 19 of the Housing Act, 1930, and mentioned in last year's report as being under consideration at the end of the year. Altogether, 7 houses were demolished during the year. These demolitions were in pursuance of orders made prior to 1937. Ten now remain to be demolished under existing orders. In addition to the above, 1 Closing Order was made in respect of property represented during 1936, and mentioned in my report for that year. This property was represented under Section 20 of the Housing Act, 1930. It has not yet been found possible to close this house, as the tenants have not been re-housed. During 1937, 4 families consisting of 14 individuals were rehoused by the Council on the housing estate at Rush Green. As before, the household effects of these tenants were disinfested with Hydrogen Cyanide Gas prior to deposit in the new houses, and for this purpose the work of removal was contracted out to a firm, which specialises in the use of this gas. (See under heading "Eradication of Bed Bugs"). For the purpose of ascertaining likely overcrowding in the district, 974 visits were paid to houses during the year. INSPECTION AND SUPERVISION OF FOOD. A. Milk Supply. On examination of the register which is kept at this office of all producers of milk, and retail purveyors of milk in the district, we find that at the end of 1937 there were 26 persons registered as producers, and 56 as retail purveyors. Of these 56 retail purveyors, 14 are also registered as producers in this area. The various farms and dairies have again been closely inspected, and where necessary improvements have been advised and carried out to ensure that the requirements of the Milk and Dairies Order, 1926 are being complied with. 32 Periodically, samples of milk have been taken, and subjected to bacteriological analysis. During 1937, 41 samples were analysed, 16 of these being for Designated Milks. Of the 25 samples of Ordinary Milk, 23 proved satisfactory, giving a percentage of 92. Of the 16 samples of Designated Milk, only 1 an "Accredited" sample proved unsatisfactory. This gives a percentage of 94 as satisfactory. When unsatisfactory samples are obtained the Sanitary Inspector goes into the details of production and distribution, and points out any defects which may exist. When rectified further samples are taken, and these have proved satisfactory. The Essex County Council scheme for routine Veterinary inspection has continued with satisfactory results. In this manner the health of the herds has received careful scrutiny. To facilitate the operation of the scheme there is a close co-operation between this Department and the Veterinary Department of the County, and a free interchange of information. Milk (Special Designations) Order, 1936. Under this Order the main designations are 1. Tuberculin Tested Milk; 2. Accredited Milk; and 3. Pasteurised Milk. When the Essex County Council receive an application for a producer's licence it is now the custom to communicate with the Local Authority in whose area the farm is situate in order to ascertain if the producer is complying with the requirements of the Milk and Dairies Order, 1926. Not until a satisfactory reply has been received can the licence be granted. There are now 39 licences in force within the District under the Milk (Special Designations) Order, 1936. Of these, 15 firms or individuals retail Tuberculin Tested Milk, 1 retails Accredited Milk, and 17 retail Pasteurised Milk. One of the firms also held a licence to Pasteurise Milk, but gave up the process during the year. Three milk producers hold licences to produce Accredited Milk. B. Meat and Other Foods. A considerable amount of the Sanitary Inspectors time has again been taken up with the important duty of inspecting meat in slaughter-houses, and butchers' shops and stalls. For this purpose 1,477 visits were paid to slaughter-houses and 190 visits to other premises. Suitable precautions are taken for the destruction of meat found to be diseased. The following tables set out the post-mortem findings in respect of Cattle, Calves, Sheep and Lambs, and Pigs, also the quantities of foodstuffs surrendered from slaughter-houses and other premises. 33 TABLE 12. CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Total. Number killed (if known) 535 688 247 4,204 1,422 7,096 Number inspected 535 688 247 4,204 1,422 7,096 All diseases except Tuberculosis:— Whole carcases condemned — — — — 1 1 Carcases of which some part or organ was condemned 27 57 1 253 22 360 Percentage of the number inspected affected with disease other than Tuberculosis 5.04 8.28 0.4 6.018 1.61 - Tuberculosis only:— Whole carcases condemned 1 3 1 — 9 14 Carcases of which some part or organ was condemned 76 237 — — 63 376 Percentage of the number inspected affected with Tuberculosis 14.39 34.9 0.4 — 5.06 — 34 TABLE 13. QUANTITY OF FOOD SURRENDERED FROM SLAUGHTERHOUSES DURING 1937. Beasts. Calves. Sheep and Lambs. Pigs. Total. Tons Cwts. Qrs. Lbs. Tuberculosis 9,529 lbs. 45 lbs. Nil 1,691 lbs. 5 0 3 1 Distomatosis 923 lbs. Nil 475 lbs. Nil - 12 1 26 Cirrhosis and Necrosis Nil Nil 63 lbs. 53 lbs. - 1 0 4 Swine Erysipelas - - - 130 lbs. - 1 0 18 Other Conditions 710 lbs. 14 lbs. 159 lbs. 25 lbs. - 8 0 12 Total Tons. Cwts. Qrs. Lbs. Tons. Cwts. Qrs. Lbs. Tons. Cwts. Qrs. Lbs. Tons. Cwts Qrs. Lbs. Tons Cwts. Qrs. Lbs. 4 19 3 10 - - 2 3 - 6 0 25 - 16 3 23 6 3 2 5 35 TABLE 14. QUANTITY OF FOOD SURRENDERED FROM PREMISES OTHER THAN SLAUGHTERHOUSES DURING 1937. Beasts. Calves. Sheep and Lambs. Pigs. Potatoes. Rabbits. Fish. Corned Beef. Total. Tuberculosis Nil Nil Nil 6 lbs. Nil Nil Nil Nil 6 lbs. Distomatosis Nil Nil Nil Nil Nil Nil Nil Nil Nil Cirrhosis and Necrosis Nil Nil Nil Nil Nil Nil Nil Nil Nil Swine Erysipelas Nil Nil Nil Nil Nil Nil Nil Nil Nil Other Conditions 1,136 lbs. 59 lbs. 940 lbs. 14 lbs. 300 lbs. 16 lbs. 98 lbs. 46 lbs. Tons. Cwts. Qrs. Lbs. 1 3 0 23 Total Cwts. Qrs. Lbs. Cwts. Qrs. Lbs. Cwts. Qrs. Lbs. Cwts. Qrs. Lbs. Cwts. Qrs. Lbs. Cwts. Qrs. Lbs. Cwts. Qrs. Lbs. Cwts. Qrs. Lbs. Tons. Cwts. Qrs. Lbs. 10 0 16 - 2 3 8 1 16 - - 20 2 2 20 - - 16 - 3 14 - 1 18 1 3 1 1 36 C. Nutrition. During the year at our Ante-natal and Child Welfare Clinics we have continued to lay emphasis on the importance of adequate nutrition, and, as pointed out under the heading of "Infant Welfare Clinics" in the earlier part of this report, we have endeavoured to impress on the mothers the great value to be obtained from such articles of food as Milk, Fruit, Vegetables, etc. Then, again, during our Health Week, special talks were given on this subject in the lecture hall, and at some of the stands in the Exhibition, and the well-known films on Nutrition were shown. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. As before for purposes of description it is convenient to divide the Infectious Diseases into two groups when dealing with this section, viz.: the Notifiable, and the Non-Notifiable. 1. Notifiable Diseases. (a) Diphtheria. This infectious disease remained endemic throughout the year, and at no time showed in epidemic form, although there was the suspicion of such in one of the elementary schools. At the beginning of October, 3 cases occurred in one classroom, all of a very severe type, two rapidly proving fatal, and the third subsequently manifesting paralytic signs. A daily inspection of those in the classroom with the exclusion of children showing nasal discharge, or excoriations, or sore throat brought the condition temporarily to an end. About 4 weeks later another two cases of Diphtheria were notified. Both these had previously been immunised, and had proved negative to a post Schick test, and it was interesteing to note that both had very mild attacks. Daily inspections were again carried out on lines similar to the previous month, and the outbreak terminated. It would appear that a carrier, or more probably carriers of a virulent type of organism was responsible for the cases, and the fact that the attack in the two immunised was mild, whereas in the 3 non-immunised it was severe proves the value of immunisation when the individual finds himself in an environment of virulent infection. During 1937, throughout the District, 87 cases were notified, but 25 of these were reported from Oldchurch Hospital. It would appear from enquiries made that these latter acquired the infection outside the District, but were not diagnosed prior to admission, and had therefore to be included in the returns for this area. Last year the notifications numbered 64. There has been no alteration in the method of dealing with the removal of cases, or in the method of providing antitoxin to practitioners, if they desire a supply. 37 Diphtheria Immunisation. The details of this scheme were given in my report for 1935. There has been 110 alteration in the procedure. Below is a table setting out the work, and the results that have been achieved during 1937. Table 15. Percentage of Acceptances 39 Number of Immunising Injections given at the Clinics 1,803 Persons under School age who have received:— 1 injection 2 injections 3 injections 4 injections 3 4 184 0 Persons of School age, and over, who have received:— 1 injection 2 injections 3 injections 4 injections 10 18 386 10 Totals 13 22 570 10 = 615 persons. In addition to the above, during the same period, approximately 124 persons received injections from private practitioners, making a grand total of 739 persons who have received injections under the scheme. Post Schick Test. Number of Schick Test Injections given at the Clinics, including Control Injections =1,053 Number who have received such injections at the Clinics - 540 Percentage found to be immune after receiving 3 immunising injections =97.9 Those found to be Schick Positive after 3 immunising injections have been given a 4th immunising injection, which has been found to render them Schick Negative. Some of the adolescents received 4 immunising injections in the first instance instead of 3 in order to minimise sensitivity. In those cases the first injection consisted of 0.5 c.c. of material instead of lc.c. In connection with this work, my best thanks are again due to the teachers of the various schools for their willing co-operation, and for the enthusiasm which they have shown. 38 (b) Scarlet Fever. During the year, 233 cases of Scarlet Fever were notified, 11 of these being reported from Oldchurcli Hospital under circumstances similar to those described under the heading "Diphtheria." Last year 148 cases were notified. The type on the whole has again been mild. (c) Enteric Fever. During 1937, 10 cases were notified, 4 of these being from Oldchurch Hospital. The number for 1936 was 9. Of the 10 cases, 9 proved on blood examination to be Paratyphoid B, and the remaining one proved to be Typhoid. During the month of July, we received a communication from the Medical Officer of Health of the London County Council that a family consisting of British Befugees from Spain had left the Metropolitan area for this District. This family was kept under surveillance in case they should have contracted Enteric Fever or other infectious diseases before arrival in this Country, but they were found to be free from infection. (d) Small Pox. There has again been an absence of cases from the District. Although we have been fortunate in not having had this disease for a number of years, constant vigilance is necessary, and the practitioners are aware of this, for 1 have frequently been called out on consultation by doctors when Smallpox has been suspected. This naturally happens more often when Cliickenpox is epidemic in the District. (e) Puerperal Fever and Puerperal Pyrexia. On October 1st, "Puerperal Fever" ceased to be a notifiable disease under this term, and since then has been included under the designation "Puerperal Pyrexia." This should have the effect of bringing potential cases of Puerperal Fever to the notice of the Health Department at the earliest possible moment, so that the facilities for prevention and treatment can be put into operation without delay. During the year, 1 case of Puerperal Fever, and 9 cases of Puerperal Pyrexia were reported. From Oldchurch Hospital the numbers were 1 and 5 respectively. Ophthalmia Neonatorum. Two cases of Ophthalmia Neonatorum were notified, particulars of which are given in Table 22. 39 Pneumonia. Ninety-five cases of Pneumonia were reported. The greater number of these, however, 63, were notified from Oldchurch Hospital, and had, as explained above, to be enumerated as cases belonging to this area. Of the 95 cases 7 were stated to have been of Influenzal origin. Acute Poliomyelitis. There were only 5 cases of this disease notified during the year. Encephalitis Lethargica. Only 1 case was notified during the year. Malaria. This year I have not received a notification of Malaria, so it would appear that the District is now free from this condition. Tuberculosis. Table 21 sets out the number of notified cases of Tuberculosis and the number of deaths during the year at certain age periods, distinguishing separately the pulmonary and non-pulmonary forms, male and female. Of the 30 deaths from Tuberculosis, 8 were unnotified during life, but were discovered from the returns of the Registrar of Deaths. This gives a percentage of 26.7 which compares with 48.3 last year. It was not found necessary to take any action under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 62 of the Public Health Act, 1925, or Section 172 of the Public Health Act, 1936. 2. Non-Notifiable Diseases. The stastistics given here are obtained from the returns of the head-teachers of the schools, and give a fair indication of the relative prevalence of these diseases. They are as follow:— Table 16. Influenza 191 cases Measles 138 „ Chickenpox 108 „ Whooping Cough 99 „ Mumps 31 „ Rubella 1 case Influenza was in epidemic form during the first quarter of the year, and was carried over from December, 1936. Fortunately, the disease was not of the severe type. 40 During November and December there was a rising incidence of Measles, and several of the schools were affected. Noak Hill Elementary School had its first epidemic of this disease after an absence of many years with the result that the attack rate was high. Towards the end of October, at the request of the Medical Superintendent of the Romford Isolation Hospital, the general practitioners of Romford had a circular letter from this Department asking for the early intimation of Adult Cases of Measles, so that Convalescent Serum might be obtained at the appropriate time. It was hoped that a stock might be procured primarily for use at the Hospital, but also for use outside the Hospital if a sufficient supply was forthcoming. SUPPLEMENTARY. "Better Health." 2,000 copies of the publication "Better Health," the Official Journal of the Central Council for Health Education were again supplied to this Department each month, and distributed to the Members of the Council, to various schools in the District, to the Maternity and Child Welfare Centres, to the Public Library, and to the Enquiry Offices of the various departments of the Council. This booklet is proving very popular, and is much in demand. Poster Frames. During the year we made use of the Poster Frames, previously the property of the Empire Marketing Board and mentioned in my last report, for the display of Health Posters, these latter being obtained monthly from the Central Council for Health Education. National Health Campaign. Since the inauguration of this campaign at the beginning of November the Romford Borough Council has endeavoured to give as much publicity as possible to Health matters by the distribution of leaflets, bookmarks, mounted display cards, posters, etc., and I am indebted to the Boy Scouts for the ready and willing manner in which they have helped by taking cards and leaflets round the various shops in the town. By the end of the year we had given publicity to Health services in general, and to Maternity and Child Welfare work. Health Week. From November 24th to 30th a Health Week was held in Romford, and, in conjunction with this, a Health Exhibition. The organisation was placed in the hands of the Central Council for Health Education to which my best thanks are due for the efficient manner in which the work was carried out. 41 The Health Exhibition was declared open by the Countess Baldwin of Bewdley, G.B.E., and during the ensuing week lectures were held twice daily, dealing with the different aspects of Public Health work. Other activities were talks given to various organisations in the town, and during the mornings school children were conducted in parties round the stands of the Exhibition, and taken to two cinemas where Health films were shown. Advantage was taken of the week for the distribution of leaflets, posters, etc., in connection with the National Health Campaign. Visit of Minister of Health. On February 1st we were honoured by the visit of Sir Kingsley Wood, Minister of Health, who came to Romford in connection with Milk Week. During his visit, the Minister took the opportunity of inspecting the Clinic at Marks Road, and afterwards expressed his appreciation of the services which the Romford Council had available for the supervision of the Health of Nursing and Expectant Mothers, and Children under school age. 42 TABLE 17. MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASES. Month. Scarlet Fever. Diphtheria. Enteric Fever. Puerperal Fever. Puerperal Pyrexia. Erysipelas. Pneumonia. Ophthalmia Neonatorum. Poliomyelitis. Encephalitis Lethargica. Dysentery. CerebroSpinal Fever. Tuberculosis Total. Respiratory. Non-respiratory. January 18 2 — — 2 — 7 — — — — — 5 — 34 February 8 8 8 1 — 3 8 — — — — 1 3 1 41 March 13 10 1 — — 2 19 — — — — — 8 — 53 April 17 22 — — — — 15 — — - — — 3 — 57 May 20 8 — — 1 1 7 — — - — — 10 1 48 June 37 5 — — 1 — 10 1 1 — — — 5 2 62 July 39 3 1 - — 1 3 — — — — — 3 2 52 August 22 2 — — 2 2 2 1 2 - — — 2 1 36 September 12 6 — — — 1 — — — 1 — — 3 — 23 October 17 8 — — 1 — 4 — 2 — — - 6 1 39 November 8 6 — — 1 1 11 — — — 1 - 12 1 41 December 22 7 — — 1 1 9 — — — — - 3 — 43 Total 233 87 10 1 9 12 95 2 5 1 1 1 63 9 529 43 TABLE 18. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO AGE GROUPS. Disease. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 and over Total Scarlet Fever — 8 7 12 8 132 20 12 15 8 2 — 233 Diphtheria 2 2 2 5 4 36 15 5 15 1 — — 87 Enteric Fever — — — — — 2 4 1 2 — 1 — 10 Puerperal Fever — — — — — — — — 1 — — — 1 Puerperal Pyrexia — — — — — — — 1 7 1 — — 9 Erysipelas — — — — — 2 - 2 4 2 1 1 12 Pneumonia 8 3 4 — 1 15 3 8 16 15 17 5 95 Ophthalmia Neonatorum 2 — — — — — — — — — — - 2 Poliomyelitis — 2 — — 1 1 1 — — — — — 5 Encephalitis Lethargica — — - — — — 1 — — — — — 1 Dysentery — — — — — — 1 — — — — — 1 Cerebro-Spinal Fever — — — — — 1 — — — — — — 1 Total 12 15 13 17 14 189 54 29 60 27 21 6 457 44 TABLE 19. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO WARDS. Disease. Collier Row and Havering Ward. Gidea Park and Noak Hill Ward. South Ward. Town Ward. West Ward. Scarlet Fever 103 29 44 28 29 Diphtheria 21 3 48 11 4 Enteric Fever 1 1 7 1 — Puerperal Fever — — 1 — - Puerperal Pyrexia 2 — 7 — — Erysipelas 4 1 6 — 1 Pneumonia 13 3 70 3 6 Ophthalmia Neonatorum 1 - — — 1 Encephalitis Lethargica - - - 1 — Poliomyelitis 3 — 1 1 — Dysentery — — 1 — — Cerebro-Spinal Fever — — 1 — — Tuberculosis: Respiratory 27 14 5 10 7 Non-Respiratory 4 — 2 1 '2 Total 179 51 193 56 50 45 TABLE 20. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1937, AND HOSPITAL ADMISSIONS. Disease. Cases Notified. Cases Admitted to Hospital. Total Deaths. Scarlet Fever 233 191 — Diphtheria 87 87 3 Enteric Fever 10 10 — Puerperal Fever 1 1 — Puerperal Pyrexia 9 9 — Erysipelas 12 8 — Pneumonia 95 75 38 Ophthalmia Neonatorum 2 — — Poliomyelitis 5 4 — Encephalitis Lethargica 1 1 1 Dysentery 1 1 — Cerebro-Spinal Fever 1 1 — Total 457 388 43 46 TABLE 21. TUBERCULOSIS—NEW CASES AND MORTALITY DURING 1937. Age Periods NEW CASES DEATHS Respiratory Non-Respiratory Respiratory Non-Respiratory M. F. M. F. M. F. M. F. 0 — — — — — - — - 1 1 — 2 2 — — — - 5 2 — 2 2 — — — — 15 6 9 - - 1 3 1 - 25 9 7 — - 2 2 — 3 35 7 6 1 — 3 2 — — 45 7 3 — — 4 1 — — 55 4 1 — — 3 3 — — 65 and upwards — 1 - — — 1 — 1 Total 36 27 5 4 13 12 1 4 47 TABLE 22. OPHTHALMIA NEONATORUM. CASES Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital 2 2 — 2 — — - _ ........ - .. .: , ' • •v. . " ...\