Rom 14 BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1939. JAMES B. SAMSON, M.D., D.P.H., Medical Officer of Health. W. & W. Ltd. BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH for the Year 1939. JAMES B. SAMSON, M.D., D.P.H., Medical Officer of Health. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December, 1939). His Worship The. Mayor : Alderman R. A. Forge, J.P. Deputy Mayor: Alderman W. M. Goldsmith. Aldermen: Alderman C. H. Barney. Alderman W. J. Russell. ,, F. L. J. Cole, C.C. ,, C. E. Smart. H. W. Hole, J.P. Councillors: Councillor A. E. Blane. Councillor D. P. Hartnett. ,, R. G. L. Bowyer. ,, W. D. Hill. ,, A. J. Brian. ,, Mrs. L. A. Irons. ,, G. W. Butcher. ,, L. A. Lucas. ,, J. Butterfield. ,, A. Needham. ,, G. F. Chaplin. ,, C. A. Osborn. ,, Mrs. I. J. Coates. ,, G. E. C. Quartermaine. ,, H. F. Davenport. ,, E. W. Smith. A. J. Dyer, O.B.E. ,, G. A. Stafford. N. Eyre. ,, L. S. Webb. ,, A. E. Fruitnight, C.C. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December, 1939). His Worship The Mayor: Alderman R. A. Forge, J.P. (Ex-officio member). Deputy Mayor: Alderman W. M. Goldsmith (Ex-officio member). Chairman: Alderman F. L. J. Cole, C.C. Vice-Chairman: Councillor G. W. Butcher. Alderman C. H. Barney. ,, W. J. Russell. ,, C. E. Smart. Councillor A. E. Blane. ,, A. J. Brian. ,, Mrs. I. J. Coates. Councillor H. F. Davenport. ,, D. P. Hartnett. ,, Mrs. L. A. Irons. ,, G. E. C. Quartermaine. L. S. Webb. Maternity and Child Welfare Committee. As above with the addition of— Mrs. G. Bignold. Mrs. A. Damant. Mrs. L. Fox. Mrs. B. Hollingsworth. 6 Medical Officer of Health. J. B. Samson, m.d., Ch.b., d.p.h. Assistant Medical Officer of Health. Hilary S. M. Hadaway, m.b., b.s. (Resigned 28th February, 1939). Elizabeth N. Christie, m.b., Ch.b., d.p.h. (Commenced Duties 1st March, 1939). Sanitary Inspectors. (a) W. S. Gent, Chief Sanitary Inspector; Certificate of the Royal Sanitary Institute; Certificate of the University of Liverpool 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). (Resigned 11th February, 1939). (c) R. Martin, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute (Meat and Foods). (Commenced Duties 1st April, 1939). (d) 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. Roberts, State Registered Nurse; State Certified Midwife; Health Visitor's Certificate. (Commenced Duties 22nd May, 1939). (c) Miss M. J. Thomas, State Registered Nurse; State Certified Midwife; Health Visitor's Certificate; State Certified Fever Nurse; Certificate for Tuberculosis. (Resigned 29th April, 1939). (d) Miss F. K. Wells, Slate Registered Nurse; State Certified Midwife ; Health Visitor's Certificate. HEALTH DEPARTMENT. Public Health Staff. 6 Council Midwives. (a) Mrs. D. Axton, State Registered Nurse; State Certified Midwife; Certificate for Tuberculosis. (Commenced Duties 24th July, 1939). (b) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (c) Mrs. D. Shaddick, State Registered Sick Children's Nurse; State Certified Midwife. (d) Mrs. A. P. Shuttleworth, State Registered Nurse; State Certified Midwife. (e) Mrs. J. Thompson, State Registered Nurse: State Certified Midwife. Clerks. (a) E. W. Growers, Senior Clerk to the Medical Officer of Health. (b) S. Adams, Clerk to the Medical Officer of Health. (c) C. G. Humberston, Clerk to the Sanitary Inspectors. (d) Miss M. E. Pollitt, Clerk to the Medical Officer of Health. (Commenced Duties 10th October, 1939). 7 BOROUGH OF ROMFORD. To His Worship the Mayor, Aldermen, and Councillors of the Romford Borough Council. Mr. Mayor, Ladies, and Gentlemen, I have the honour, herewith, to present to you an Interim Annual Report on the Health of the District for the year 1939. This Report is drawn up in accordance with the requirements of Circular 2067 of the Ministry of Health, dated 19th July, 1940, which states that, in view of the increasing pressure of work in the Public Health Department of Local Authorities, and the need for strict economy in the use of paper, the Minister considers that Interim Reports only should be made for the year, and that the subject matter should be curtailed to certain specified items. The Minister points out, however, that suitable arrangements should be made for useful preservation of all records, including the statistics to be supplied by the Registrar General, in order that after the termination of the war a report could be made dealing more fully with the period from the beginning of 1939 to the end of the last complete year, giving separate statistics for each year in order that the annual records may, as far as practicable, be continuous and complete. During the year 1939, the work of the Health Department has been accomplished under difficult and trying conditions, for no sooner did we attempt to settle down to our routine duties than we were interrupted by a series of crises, which culminated in the outbreak of war at the beginning of September. This necessitated a variation of the duties of most members of the Staff, and I think it speaks well for the industry of all individuals that this Report, could it have been completed, would have shown a very successful year's work. Every endeavour has been made to maintain normality in Preventive Medicine, in spite of varying and adverse conditions, and, at the same time, to put into operation a scheme for a Casualty Service, which would prove effective in the event of Air Raid damage in this area. As usual, my best thanks go to all members of my staff who, each in his or her own sphere, have assisted in the compilation of this Report, to my fellow officials for their kind assistance throughout the year, and to all the members of the Council who have shown continued interest in the health of the inhabitants of the town. I am, Mr. Mayor, Ladies, and Gentlemen, Your obedient servant, JAMES B. SAMSON, Public Health Department, Medical Officer of Health. Town Hall, Romford. July, 1940. 8 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. For particulars of these, see the list at the beginning of this Report. (ii) Laboratory Facilities. At the beginning of the War the Ministry of Health intimated that an Emergency Laboratory Service had been organised by the Medical Research Council, in order to augment the existing facilities for bacteriological diagnostic work required for the Public Health Services. For this purpose laboratories had been established at different points throughout England and Wales, and the nearest to this area was at Brentwood School. As, however, it was not intended that the scheme should interfere in any way with the operation of normal services where these could be maintained it was not found necessary during 1939 to avail ourselves of this laboratory. (iii) Nursing in the Home. (a) Midwives. The scheme for a domiciliary service of salaried midwives continued throughout the year, and proved to be popular with the General Practitioners in the District, and the Public alike. Owing to an increased demand for the services of the Midwives, it was apparent that a fifth Midwife would have to be appointed, in order to prevent the others from being burdened with too many cases, which would, in time, result in less attention being given to each case. Accordingly, Mrs. D. Axton was appointed, and commenced duties on '24th July. In addition to the 5 Council Midwives, there are 5 Midwives in independent practice in the Area, and also 4 District Nurse Midwives. Seven Midwives, resident outside the Borough, also undertook cases in the District during the year. It is not believed that there are now many "handywomen" undertaking maternity work in Romford, but to control the activities of those who remain, we await the sanction of the Ministry of Health to invoke Section 6 of the Midwives Act, 1936, for which application has been made to the Ministry of Health by the Essex County Council. (iv) Hospitals: Public and Voluntary. (a) Infectious Diseases. The Infectious Diseases' Hospital at Rush Green, under the jurisdiction of the Romford Joint Hospital Board, continues to serve this District, the District of the Dagenham Borough Council, and Hornchurch Urban District. 9 This Hospital was scheduled dining the year by the Ministry of Health as a la Hospital, and to enable as many Casualties as possible to be admitted in the event of the outbreak of hostilities 65 additional beds were provided, also equipment. At the commencement of the War, the pre-arranged scheme was put into operation. As many Infectious Diseases' cases as possible were sent home, and 210 beds were reserved for the admission of casualties. Happily, we found it unnecessary to admit many Infectious Diseases from Romford during the latter part of the year. Apart from the necessary works of adaptation and protection occasioned by the War, no alterations of any extent were carried out at the Hospital. Immediately prior to the outbreak of War, however, arrangements had been made for the reception and treatment of 36 cases of Tuberculosis, which were transferred from Oldchurch County Hospital. These were discharged from the Isolation Hospital at the beginning of September. (b) Maternity. Patients in whom complications have arisen during pregnancy or confinement can be admitted to Oldchurch County Hospital for treatment, and if the home environment is unsatisfactory arrangements can also be made for admission to this Hospital. Cases of Puerperal Pyrexia, and Ophthalmia Neonatorum are, if necessary, admitted to the Romford Isolation Hospital, under a scheme of treatment. Cases of Puerperal Pyrexia arising in Oldchurch Hospital, and suspected of being septic in origin, are also transferred to the Romford Isolation Hospital. (c) Children. The facilities in this category remain as before. (d) Other Cases. Accident cases, and non-infectious cases can be catered for either at the Victoria Hospital, a voluntary Hospital with 31 beds, or at Oldchurch County 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. Under the Emergency Medical Services Scheme of the Ministry of Health, the Oldchurch County Hospital from the commencement of the War was classified as a la Hospital and had to reserve 700 beds for the admission of casualties. The Victoria Hospital, on the other hand, was earmarked for the admission of cases of ordinary sickness. During 1939, the Romford Council again granted a donation of 10 guineas to the Victoria Hospital, and 20 guineas to the King George Hospital, Ilford. 10 2.—MATERNITY AND CHILD WELFARE. (i) Ante-natal Clinics. These have continued on the same lines as before, and the Consultative Ante-natal Clinic held at Oldchurch County Hospital, under the supervision of Mr. S. Henderson, M.C.O.G., F.R.C.S., is still available for patients sent direct by General Practitioners, or referred from the Council's Ante-natal Clinics. During the year 1939, 784 individual expectant mothers attended the Clinics, representing 82 5 per cent. of the total notified births (live and still). In addition 87 mothers attended for post-natal advice, representing 91 per cent. of total notified births. In all 147 sessions were held during the year. The total number of attendances of the 871 mothers mentioned above was 3,077, giving an average of 3'5 attendances per patient. The average number attending at each session was 20.9. (ii) Infant Welfare Clinics. Clinic services in this respect remained very much as before, and even the onset of war caused but a minimum of interference with our routine. At the beginning of September, it was ncessary to transfer the sessions being held at St. Michael's Hall, Gidea Park, and Wembley Hall, Princes Road, to the Marks Road Centre, as these halls were earmarked for other purposes. In December, however, we were able to re-open the Gidea Park Clinic at another hall, St. George's Hall, Straight Road; and, at the end of December, arrangements were being made to re-open the other session at its previous premises, as early as possible in 1940. Another minor adjustment, after the cessation of Summer-time, was the holding of the afternoon sessions from 1.30 p.m. to 3.30 p.m., to enable mothers to return home before the hours of darkness. During 1939, the building of a new Clinic was commenced to serve the Collier Row Area, and at the end of the year the work of building was still in progress. Owing to the outbreak of war, many families evacuated from this area, although Romford was officially scheduled as a Neutral Area. The reason for this, in many cases, was the fact that businesses had been evacuated from London, and the families of those employed in these businesses had naturally to leave this area where so many had previously resided. Others, again, went with their children to safer areas. To counteract this exodus, however, many families from the Evacuation Areas of London, not wishing to go too far afield, found their way into Romford, and it was not long before their attendances at the Clinics of the Council counterbalanced those who had left. 11 The Dental arrangements were carried out by rota as before, and on April 1st, Mr. S. R. Johns, L.D.S., took over duties from Mr. N. S. Fames. In order, however, to maintain continuity of service those patients who required completion of treatment after April 1st were permitted to have this done by Mr. Fames. Regarding the provision of Milk, there were 2,308 applications for receiving cows' milk free, or at less than cost price—204 had to pay a proportion of the cost, and the remaining 2,104 received it free. In a similar manner 1,901 applications were received regarding dried milk, and other foods, 189 had to pay a proportion, and 1,712 received free grants. When recommended, dried milk and accessories can also be purchased at the Clinics at cost price. During 1939, 410 Child Welfare Sessions were held, and the following table gives a summary of the attendances. Table 1. Individual Children attending 2,525 Children attending for the first time 897 Medical Consultations 9,587 Attendances of Children under 1 year 13,672 Attendances of Children between the ages of 1 and 5 years 8,525 Average attendance per session 54.1 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 attendance were under 1 year of age was 66.5. Ultra-violet Ray Therapy was temporarily suspended during the last four months of the year, so as to avoid too large aggregations of children, but it was felt that circumstances might justify re-commencement at the beginning of 1940. Dr. Christie has kindly tabulated statistics relative to the treatment given during 1939. Altogether 65 individual patients were treated. Of these 9 had had less than 6 doses by the end of the year. These are excluded from the table. Table 2. Group 1. Debilated and Nervous Children. „ 2. Anaemic Children. ,, 3. Children under weight. „ 4. Rickety Children. ,, 5. Children suffering from Respiratory Defects 12 I. II. III. IV. V. No. of Individual Patients treated 14 4 18 14 6 Total No. of Exposures 225 94 373 253 77 Total No. of Minutes 1762 610 3206 2078 620 Average period of treatment in weeks 8.5 9.5 11.4 10.3 9.7 Minimum period of treatment in weeks 4 6 6 5 5 Maximum period of treatment in weeks 16 12 18 18 12 Average No. of doses 16 23.5 20.7 18 12.8 Minimum No. of doses 6 12 8 9 8 Maximum No. of doses 34 24 36 36 24 Average strength of dose in minutes 7 6.4 8.6 8.2 8.0 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. 1.2 1.2 1.4 1.2 1.1 Average increase of height in inches 1.4 1.4 1.2 2.5 1.0 Table 3 relates to the Home Visits paid by the Health Visitors. TABLE 3 (a) To Expectant Mothers. First Visits 34 Total Visits 40 (b) To Children under One Year of age. First Visits 853 Total Visits 2,228 (c) To Children btween the Ages of 1 and 5 years. Total Visits 4,607 (iii) Child Life Protection. In Romford, each Health Visitor also holds the appointment of Child Protection Visitor under Sections 206 to 220 of the Public Health Act. 1936. Table 4. (a) Number of persons who were receiving children for reward at the end of the year 40 (b) Number of children:— (1) At the end of the year 56 (2) Who died during the year 2 (3) On whom inquests 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 (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 13 (e) Proceedings taken during the year:— (1) Number of Cases 0 (2) Act and Section under which proceedings were taken — (iv) Legal Adoption. The Adoption of Children (Regulation) Act, 1939 embodies a section giving power for certain adopted children to be supervised by Welfare Authorities, and a Welfare Authority is defined in the Act as meaning a Welfare Authority for the purposes of Part VII of the Public Health Act, 1936. The Romford Borough Council is such an Authority. This Act would normally have come into operation on 1st January, 1940, but at the end of December, 1939, the Home Office intimated that Welfare Authorities would be relieved until further notice of this duty in accordance with the Postponement of Enactments (Miscellaneous Provisions) Act, 1939. (v) Midwives Act, 1936. The following gives a summary of the cases attended by the Council Midwives, as Midwives, and as Maternity Nurses during 1939. As Midwives 279 As Maternity Nurses 60 As mentioned previously a fifth Midwife commenced duties on 24th July, 1939. Under the requirements of Section 7 of the Act, which relates to the necessity for Post-Certificate Training, the Essex County Council, which is the Local Supervising Authority for the purposes of the Act, made arrangements for one of the Midwives to attend a course of one month's duration at Plaistow Maternity Hospital, Plaistow, E.13. Three of our Midwives have now attended a Post-Certificate Course. The other two will have an opportunity later. It is hoped that arrangement will be made for each Midwife to undergo this training, at least every 7 years. (vi) Inspection of Nursing Homes, Etc. Three Nursing Homes in the District are Registered by the Essex County Council under Section 187 of the Public Health Act, 1936. One of these is Registered for the reception of 5 Maternity or Medical Patients, and an annex is Registered for 5 MaternityPatients. Another is Registered for 2 Maternity Patients, and the third is Registered for 5 Medical, Surgical, or Chronic Patients, and 1 Maternity Patient. 14 Quarterly inspections of these Nursing Homes have again been carried out during the year on behalf of the Essex County Council, and, generally throughout the District, investigations have been made in respect of Maternal Deaths, Cases of Puerperal Pyrexia, Eye Discharges of Infants, and Liability of the Midwives to be a Source of Infection, etc. Regarding Puerperal Sepsis, Memo. 226/ Med. was received during the year, and copies were sent to the General Practitioners in the District. 3.—INSPECTION AND SUPERVISION OF FOOD. Meat and Other Foods. A large proportion of the Sanitary Inspectors' time was again devoted to the important duty of inspecting meat and other foods at slaughter-houses, butcher's shops, stalls, etc. During the latter part of the year a section of the big London wholesale markets of Smithfield and Billingsgate was decentralised, and Romford was one of the Regional Centres which was established. This necessitated increased duties being placed on the Sanitary Inspectors in the way of food inspection. Later in the year, the Billingsgate section was discontinued, but the Smithfield section remained. 4.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. There was no increased prevalence of these diseases during the year. The Measles and Whooping Cough Regulations, 1939. On the 23rd October the Measles and Whooping Cough Regulations, 1939, came into operation as a provisional measure, with the result that, as from that date, both these diseases have been notifiable. The object is to enable the Department to ascertain readily and rapidly the incidence of Measles and Whooping Cough, as it may be affected by the displacement of child population caused by emergency measures, and the Changes that may have occurred in the geographical distribution of the infectious diseases. The intention is that the Regulations will remain in operation only as long as the special conditions created by the present emergency continue, and that they shall then be revoked. A copy of the Regulations was sent to each of the Local Practitioners, and a public announcement was inserted in the local press, drawing the attention of the Public to the Regulations. 15 (ii) Non-Notifiable Diseases. The relative prevalence of these is set out below:— Table 5. Mumps 498 cases Chickenpox 110 „ Influenza 76 ,, Rubella ... 4 „ 5.—SUPPLEMENTARY. Air Raid Precautions. Although not specifically asked for by the Ministry of Health for the Annual Report, except in so far as the general health services are affected, it will not be out of place to comment very briefly on the A.R.P. Casualty Services for the Borough, as the organisation of these services has taken up a considerable part of the time of the staff of the Health Department. Ever since the crisis of September, 1938, and even before that, we have been perfecting a scheme, enrolling volunteers, and training these volunteers in First Aid, and Anti-Gas masures. At the beginning of September, 1939, we mobilised our personnel, and adapted premises in the District for the reception of casualties. Since then, further training, both individual, and collective, has been carried out by the Post Personnel, the Stretcher Parties, Ambulance Drivers, Ambulance Attendants, etc. and although, at the end of 1939, the services of the Personnel had not been required, the training they have had has not been wasted, as it is based on the peace-time training, which for many years has been taught by the various Ambulance Organisations, and which is applicable to peacetime measures, as well as warfare. In conclusion, I find it opportune, by this brief comment on Air Raid Precautions, to refer to the untiring efforts of my staff, who have given up a considerable portion of their leisure time to this work both in the evenings and during week-ends. For this, I am indeed grateful.