ROM 15 BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1940. 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 1940. JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December, 1940). His Worship The Mayor : Alderman W. M. Goldsmith, J.P. Deputy Mayor : Alderman R. A. Forge, J.P. Aldermen: Alderman C. H. Barney. F. L.J. Cole, C.C. H. W. Hole, J.P. Alderman W. J. Russell. ,, C. E. Smart. Councillors : Councillor A. E. Blane. ,, R. G. L. Bowyer. ,, A. J. Brian. „ G. W. Butcher. ,, J. Butterfield. ,, G. F. Chaplin. ,, Mrs. I. J. Coates. ,, H. F. Davenport. ,, A. J. Dyer, O.B.E. ,, N. Evre. ,, A. E. Frnitnight, C.C Councillor D. P. Hartnett. „ W. D. Hill. ,, Mrs. L. A. Irons. ,, L. A. Lucas. ,, A. Needham. ,, C. A. Osborn. ,, G. E. C. Quartermaine. „ E. W. Smith. ,, G. A. Stafford. „ L. S. Webb. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December, 1940). His Worship The Mayor : Alderman W. M. Goldsmith, J.P. (Ex-officio member). Deputy Mayor : Alderman R. A. Forge, J.P. (Ex-officio member). Chairman : Alderman F. L. J. Cole, C.C. Vice-chairman : Vacant. Alderman C. H. Barney. W. J. Russell. ,, C. E. Smart. Councillor A. E. Blane. ,, A. J. Brian. G. W. Butcher. Councillor Mrs. I. J. Coates. ,, H. F. Davenport. ,, D. P. Hartnett. Mrs. L. A. Irons. ,, G. E. C. Quarternaine. 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. 5 HEALTH DEPARTMENT. Public Health StaS. Medical Officer of Health. J. B. Samson, m.d., ch.b., d.p.h. Assistant Medical Officer of Health. Elizabeth N. Christie, m.b., Ch.b., d.p.h. 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) H. C. Boswell, Certificate of the Royal Sanitary Institute ; Certificate of the Royal Sanitary Institute for Meat and Foods. (Commenced Duties 2nd September, 1940). (c) R. Martin, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Foods. (Reported for Military Service 13th May, 1940). (d) C. H. Sargent, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Foods. (Resigned 13th July, 1940). 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. (c) Miss F. K. Wells, State Registered Nurse; State Certified Midwife ; Health Visitor's Certificate. 6 Council Midwives. (a) Mrs. D. Axton, State Registered Nurse; State Certified Midwife ; Certificate for Tuberculosis. (Resigned 11th October, 1940). (b) Miss C. M. Kerr. State Registered Nurse; State Certified Midwife. (Commenced Duties 14th October, 1940). (c) Mrs. G. E. Sexton, State Registered,Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (d) Mrs. D. Sliaddick, State Registered Sick Children's Nurse; State Certified Midwife. (e) Mrs. A. P. Shuttleworth, State Registered Nurse; State Certified Midwife. (f) Mrs. J. Thompson, State Registered Nurse; State Certified Midwife. Clerks. (1) Permanent. (a) E. W. Gowers, Senior Clerk to the Medical Officer of Health. (b) S. Adams, Clerk to the Medical Officer of Health. (Reported for Military Service 25th August, 1940). (c) C. G. Hufnberston, Clerk to the Sanitary Inspectors. (Reported for Military Service 20th November, 1940). (d) Miss M. E. Pollitt, Clerk to the Medical Officer of Health. (2) Temporary. (a) L. Goold, Clerk to the Medical Officer of Health. (Commenced Duties 16th December, 1940). (b) M. J. Cole, Clerk to the Sanitary Inspectors. (Commenced Duties 15th July, 1940). (c) Miss D. E. Powell, Clerk to the Medical Officer of Health, (Commenced Duties 14th May, 1940), 7 BOROUGH OF ROMFORD. To His Worship the Mayor, Aldermen, and Councillors of the Borough of Romford. Mr. Mayor. Ladies, and Gentlemen. I have the honour, herewith, to present to you this, my Annual Report on the Health of the District for the year 1940. This is the Seventh Report in the series, since I was appointed your Medical Officer of Health, and it is drawn up in accordance with the requirements of Article 17 (5) of the Sanitary Officers (Outside London) Regulations, 1935, as modified by Circular '2314 of the Ministry of Health, dated 26th March, 1941. This Circular states that the Report should again be an Interim one. At the same time careful preservation is being made of all records, which, in normal times, would have appeared in this publication, so that, at some future date, these can be reported upon. During the year 1940, we have again carried out the dual role of attack against conditions likely to affect the health and well-being of the public of Romford, and also against the onslaught from our more spectacular foes. It will be appreciated that should we relax or fail in our first endeavour, the second would become almost insurmountable, and so in this Department we have pursued our welltried policies of the past, but, at the same time, have adapted ourselves to the changed conditions. In the course of the year our permanent staff was depleted, as members enrolled for Military Service, and their respective positions were filled by temporary personnel. As before, my best thanks go to all the 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. April, 1941, 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. The Emergency Laboratory Service, organised at the commencement of the War by the Medical Research Council, and mentioned in my Report of last year, continued in operation throughout the year, but transferred from the Brentwood School, where it had established itself, to St. Andrew's Hospital at Billericay. As the intention of this laboratory was to augment existing facilities and not to interfere with the operation of normal peacetime services, it was not found necessary during 1940 to avail ourselves of it to any large extent. Mention, however, is made later in this Report, under the Section dealing with Infectious Diseases, of the services which we did obtain. (iii) Nursing in the Home. (a) Midwives. Our scheme for a domiciliary service of salaried midwives continued as before, and maintained its popularity. During the year, Midwife D. Axton resigned her duties, and the vacancy was filled by the appointment of Midwife C. M. Kerr. It was felt that, with the recent growth of the District in the Collier Row Area it would be better if a Midwife were actually in residence in this comparatively new area, so advantage was taken at the time of the new appointment to establish Midwife Kerr in this part of the town. In addition to the 5 Council Midwives, there are 4 Midwives in independent practice in the District, and, also, 4 District Nurse Midwives. Eight Midwives, resident outside the Borough, also undertook cases in the District during the year. (iv) Hospitals : Public and Voluntary. (a) Infectious Diseases. The Infectious Diseases' Hospital at Rush Green, under the jurisdiction of the Romford Joint Hospital Board, has continued to serve this District as before, and, at the same time, has functioned as an la Hospital under the Emergency Medical Services Scheme of the Ministry of Health, 9 For this latter purpose, 210 beds are allotted for the admission of war casualties. No alterations of any extent were carried out at the Hospital during the year. (b) Maternity. Patients in whom complications have arisen during pregnancy or confinement, have been admitted to Oldchurch County Hospital for treatment and, likewise, patients where the home environment has proved unsatisfactory for the safe delivery of the mother. Cases of Puerperal Pyrexia, and Ophthalmia Neonatorum have, if necessary, been admitted to the Romford Isolation Hospital, under our scheme of treatment. (c) Children. The facilities in this category remain as before. (d) Other Cases. Accident cases, and non-infectious cases, have been 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 Hospital, and which has 860 beds. Both these hospitals are situate within the boundaries of Romford. In addition, many large London Hospitals are within easy distance of Romford. Oldchurch County Hospital is also a la Hospital under the Emergency Medical Services Scheme, and has reserved 700 beds for the admission of casualties. The Victoria Hospital remains as a hospital for the admission of cases of ordinary sickness. During 1940, the Romford Council again granted a donation of 10 guineas to the Victoria Hospital. 2.—MATERNITY AND CHILD WELFARE. (i) Ante-natal Clinics. Our arrangements here were as before—3 sessions being held weekly, but on the opening of the new Clinic building at Collier Row (vide infra), 1 of the Ante-natal sessions was transferred to this building from the Maternity and Child Welfare Centre at Marks Road, 10 A Consultative Ante-natal Clinic continues to be held at Oldchurch County Hospital, under the supervision of Mr. S. Henderson, M.C.O.G., F.R.C.S., and this Clinic has proved of considerable value to us, insofar as a second opinion is available for those patients for whom further and more elaborate investigation is required. During the year 1940, 668 individual expectant mothers attended the Clinics, representing 710 per cent, of total notified births (live and still). In addition, 27 mothers attended for post-natal advice, representing 2.9 per cent, of total notified births. In all, 153 sessions were held during the year. The total number of attendances of the 695 mothers mentioned above was 3 ,356, giving an average of 4'8 attendances per patient . The average number attending at each session was 219. (ii) Infant Welfare Clinics. Our 8 Child-Welfare Sessions continued in operation throughout the year. As anticipated in last year's Report, we were able to recommence the session at Wembley Hall, Princes Road, at the beginning of 1940, but, after a short period, found it more convenient and suitable to hold this session at the Jubilee Hall, Victoria Road, which is in the same district as that served by Wembley Hall. Owing to the fact that "Summer Time" continued throughout the darker months of the year, it was unnecessary to alter the hours of the afternoon sessions during the last quarter of the year. On September 9th, the new Clinic situate in Hulse Avenue, Collier Row, was opened for Maternity and Child Welfare purposes, and the 2 Child Welfare Sessions, previously held at the Hall of the Church of the Ascension, Collier Row Road, were then transferred to this new building. As mentioned above, 1 Ante-natal Session was also tranferred from the Marks Road Clinic. The new building comprises a Central Hall, Weighing Room, Undressing Room with separate cubicles, Medical Officer's Consulting Room, Toddlers' Room (also used for the administration of Ultra-violet Ray Therapy), a Dental Room with Recovery Room attached, Kitchen, Food Cupboard, Staff Room, and suitable Sanitary accommodation. At the end of the year the Local Education Authority was furnishing and equipping the Dental Room, and also preparing to utilise part of the building for a Minor Ailments' Clinic. Dental arrangements under our Maternity and Child Welfare Scheme were carried out according to the annual rota, and on April 1st, Mr. F. C. Ritchie, L.D.S., took over duties from Mr. S. R. Johns. 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. Johns. 11 At the end of December, 1939, the sanction of the Ministry of Health was obtained to the operation in this Area of a scheme, prepared by the Milk Marketing Board, for the supply of liquid milk to Expectant and Nursing Mothers, and Children under 5 years of age, at a reduced rate, as outlined in Circular 1840 of the Ministry of Health, dated '2nd August, 1939. This scheme was accordingly given effect as from the 1st January, 1940, and this was one of the first half dozen Authorities to operate the scheme. In brief, the purpose was to supply in the home 1 pint of liquid milk per head to those in the categories mentioned above, free, or at such price, not exceeding 2d. a pint, as the Welfare Authority should determine. A greater quantity, not exceeding 2 pints per head per day, could, however, be supplied by the Welfare Authority on the recommendation of the Medical Officer of Health. In order to bring the scheme to the notice of the public, advertisements were inserted in the local press, and notices were placed in each of the Maternity and Child Welfare Clinics. The General Practitioners, and Midwives, were also circulated. A considerable amount of clerical work devolved on the Department, and some idea of the magnitude of the scheme can be obtained when I state that during the period from January 1st till July 31st, when the scheme terminated, 114,986 pints of milk had been supplied. On August 1st this scheme was superseded by that of the Ministry of Food for the supply of liquid milk under the National Milk Scheme, and this is undertaken locally by the Local Food Office. As, however, it is permissible, on the recommendation of a Medical Officer, to issue National Dried Milk to children under the age of 1 year, in lieu of the liquid milk, it has been found necessary to establish a very close co-operation between the Local Food Office and this Department. This co-operation is complete and working smoothly. Regarding the provision of Milk in general during the year, there were 2,533 applications for receiving cow's milk free, or at less than cost price—840 had to pay a proportion of the cost, and the remaining 1,693 received it free. In a similar manner 1,153 applications were received regarding dried milk, and other foods, 154 had to pay a proportion, and 999 received free grants, 12 When recommended, dried milk and accessories can also be purchased at the Clinics at cost price. During 1940, 414 Child Welfare Sessions were held, and the following table gives a summary of the attendances Table 1. Individual Children attending 2,633 Children attending for the first time 1,111 Medical Consultations 8,512 Attendances of Children under 1 year 12,440 Attendances of Children between the ages of 1 and 5 years 7,529 Average attendance per session 48.2 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 96.8. Ultra-violet Ray Therapy was again carried out during the year. Dr. Christie has kindly tabulated .the statistics, as under. Altogether. 45 individual patients were treated. Of these 12 had had less than 6 doses by the end of the year. These are excluded from the table, as also 2 cases, who were the only patients in two separate groups. Table 2. Group 1. Debilated and Nervous Children. ,, 2. Children under weight. ,, 3. Rickety Children. I. II. III. No. of Individual Patients treated 10 9 12 Total No. of Exposures 141 163 260 Total No. of Minutes 860 1272 2140 Average period of treatment in weeks 7 9 11.2 Minimum period of treatment in weeks 2.5 6 4 Maximum period of treatment in weeks 16 18 18 Average No. of Doses ... 14.1 18.1 21.7 Minimum No. of Doses 5 12 8 Maximum No. of Doses 32 36 37 Average strength of dose in minutes 6.2 9.0 8.2 Minimum strength of dose in minutes 4.0 4.0 4.0 Maximum strength of dose in minutes 10.0 10.0 10.0 Average increase of weight in lbs. 0.58 0.43 1.3 Average increase of height in inches 1.1 1.5 2.2 Table 3 relates to the Home Visits paid by the Health Visitors. 13 Table 3. (a) To Expectant Mothers. First Visits 42 Total Visits 81 • (b) To Children under One Year of age. First Visits 978 Total Visits 2,707 (c) To Children between the Ages of 1 and 5 years. Total Visits 4,156 (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 37 (b) Number of children:— (1) At the end of the year 58 (2) Who died during the year 0 (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 (e) Proceedings taken during the year:— (1) Number of Cases 0 (2) Act and Section under which proceeding's were taken (iv) Midwives Act, 1936. The following gives a summary of the causes attended by the Council Midwives, as Midwives, and as Maternity Nurses during 1940. As Midwives 324 As Maternity Nurses 74 14 (v) 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 Maternity Patients. Another is Registered for 2 Maternity Patients, and the third is Registered for 5 Medical, Surgical, or Chronic Patients, and 1 Maternity Patient. Quarterly inspections of these Nursing Homes have been carried out on behalf of the Essex County Council as hitherto, 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 Source of Infection, etc. (vi) Consultant. During the year, the Council appointed Mr. H. G. Everard Williams, M.D., F.R.C.O.G., of 79 Harley Street, London, as part time Consultant Obstetrician and Gynaecologist under the Puerperal Pyrexia Regulations, 1939, and also to be available in cases where a practitioner should require additional assistance for difficulties or complications arising during pregnancy, or at, or after confinement. 3.—INSPECTION AND SUPERVISION OF FOOD. Meat and Other Foods. The Sanitary Inspectors have again had to devote a considerable amount of time to the inspection of meat and other foods at the Regional Slaughterhouse, the Meat Depot, Butchers' Shops, Stalls, etc. Altogether 656 visits were paid. At the Slaughterhouse alone 31,909 carcases were inspected. 4.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. There was no increased prevalence of these diseases during the year, but special mention is made below of a slight increase in the incidence of Cerebro-Spinal Fever and Enteric Fever. (a) Cerebro-Spinal Fever. This disease was prevalent throughout the Country at the beginning of the year, and, although 7 cases occurred in Romford at this time, the condition did not gain a foothold and assume epidemic proportions. Nevertheless, 3 cases contracted the disease in fulminant form, with fatal results within 24 or 48 hours of onset. 16 On receiving notice that cases had been admitted to the Isolation Hospital from neighbouring authorities, the local practitioners were told of its presence, and given a short summary of initial symptoms, together with the recommendation that suspicious cases should be brought to my notice, so that the patients could be admitted to the Isolation Hospital at the earliest possible moment, and undergo treatment with M. & B. 693, which has proved to be very effective, if given early enough. As is not uncommon when Cerebro-Spinal Fever is prevalent, we also had, during this period, notification of 2 cases of Acute Anterior Poliomyelitis, and 2 cases of Encephalitis Lethargica. Many Practitioners availed themselves of my services for diagnosis of suspicious cases. In several instances I could say quite definitely that the patient was not suffering from Cerebro-Spinal Fever, but, in other cases, I arranged for admission to the Isolation Hospital, where further observations were carried out. At this time, opportunity was taken of contacting the Emergency Public Health Laboratory established at Brentwood Grammar School, and assistance from a bacteriological point of view was promptly given by Dr. A. B. Kosher. (b) Enteric Fever. As a special precaution during the present state of emergency, local practitioners were asked to bring to my notice any suspicious cases of alimentary infection. As a result, between the middle of June and the middle of July, I had notification of 21 cases of Enteric Fever. Ten of these, however, were reported from Oldehurch County Hospital, and were diagnosed shortly after admission to be suffering from this condition. These cases did not reside in this District, and the Medical Officers of the appropriate Districts were accordingly informed. The remaining eleven cases resided in the Borough, and were all diagnosed as Paratyphoid B. One of these was a child removed from a farm in the District. This farm, however, supplied milk to a few neighbours only. Nevertheless, full investigations were carried out, all consumers were visited, and arrangements were made for the milk to be pasteurised. No further cases occurred in this part of the area. Three patients were members of one family, but investigation did not reveal the source of infection. All cases were mild, exhibiting very few symptons, apart from General Malaise and some Diarrhoea. At this period, Enteric Fever was prevalent in many other parts of the Conntry. Various samples of water, milk, and icecream gave negative results. 16 Several cases of illness, suggestive of Enteric Fever, were seen by me at this time, but were diagnosed as not suffering from this infection. (ii) Non-Notifiable Diseases. The relative prevalence of these is set out below:— Table 5. Rubella 144 cases Chickenpox 24 „ Measles and Whooping Cough were taken out of this category on the '23rd October, 1939, as a result of the Measles and Whooping Cough Regulations, 1939. It was anticipated that Measles would appear in epidemic form during the first quarter of 1940, but this was not so. As I write, however, it is now prevalent, in the first quarter of 1941. During the month of December, 1940, an offer was received from the Emergency Public Health Laboratory of the free issue to medical practitioners of Adult Serum for the prevention of Measles in contact cases, and advantage was taken of this in several instances. 5.—SUPPLEMENTARY. Air Raid Precautions. I again comment on the A.R.P. Casualty Services for the Borough, but very briefly, as this is not specifically asked for by the Ministry of Health for the Annual Report. T do not think that I will give away any secret, likely to be of information to the enemy, when I state that the S.E. has been visited on more than one occasion by planes of foreign origin, As a result, the Casualty Services have been brought into action, and have fulfilled their obligations to the public in a manner worthy of the highest praise. Throughout the year, and especially during the latter half, members of the staff of the Public Health Department have, in conjunction with those in other departments, played their part, and have in a voluntary capacity, and unstintedly given a large proportion of their own time to duties in the Report Centre, and elsewhere. I take this opportunity, therefore, of expressing my thanks to them for their assistance in this additional work, which has devolved on the Department.