Rom 17 BOROUGH OF ROMFORD HEALTH DEPARTMENT INTERIM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1942 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 1942 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health, 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December. 1942). His Worship The Mayor : Alderman C. H. Barney, J.P. Deputy Mayor : Councillor J. Butterfield, J.P. Aldermen : Alderman P. L. J. Cole, Alderman H. W. Hole, J.P. J.P.,C.C. ,, W. J. Russell. ,, R. A. Forge, J.P. ,, C. E. Smart. ,, W, M. Goldsmith. Councillors : Councillor A. E. Blane. Councillor W. D. Hill. ,, R. G. L. Bowyer. ,, Mrs. L. A. Irons. ,, A. J. Brian. ,, L. A. Lucas. ,, G. W. Butcher. ,, 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. ,, A. E. Fruitnight, C.C. ,, L. S. Webb. ,, J. Gow. ,, Mrs. E. A. White 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December, ]94'2). His Worship The Mayor : Alderman C. H. Barney, J.P. (Ex-officio member). Deputy Mayor : Councillor J. Butterfield, J.P. (Ex-officio member). Chairman : Alderman F. L. J. Cole, J.P., C.C. Vice-Chairman : Councillor Mrs. E. A. White. Alderman R. A. Forge, J.P. ,, W. M. Goldsmith. ,, W. J. Russell. ,, C. E. Smart. Councillor A. E. Blane. ,, A. J. Brian. Councillor W. G. Butcher. ,, Mrs. I. J. Coates. ,, II. F. Davenport. ,, 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. s Maternity, Etc., Cases Sub-Committee. Chairman : Councillor Mrs. L. A. Irons. Councillor Mrs. I. J. Coates. Mrs. A. Damant. ,, Mrs. E. A. White. Mrs. L. Fox. Mrs. G. Bignold. Mrs. B. Hollingsworth. DAY NURSERY COMMITTEE. His Worship The Mayor : Alderman C. H. Barney, J.P. (Ex-officio member). Chairman : Councillor Mrs. I. J. Coates. Vice-Chairman : Councillor Mrs. E. A. White: Alderman F. L. J. Cole, J.P., C.C. Councillor A. J. Brian. ,, A. E. Fruitnight, C.C. Councillor Mrs. L. A. Irons. Mrs. A. Damant. Mrs. L. Fox HEALTH DEPARTMENT. Public Health Staff. 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. (Resigned, 13th June, 1942). Elizabeth M. James, m.b., b.s., l.r.c.p., d.p.H. (Commenced Duties, 15th June, 1942). 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. (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). 6 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 (Resigned, 31st December, 1942). (c) Miss F. K. Wells, State Registered Nurse; State Certified Midwife ; Health Visitor's Certificate. Council Midwives. (a) Miss C. M. Kerr, State Registered Nurse; State Certified Midwife. (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. (1) Permanent. (a) E. W. Gowers, Senior Clerk to the Medical Officer of Health. (Reported for Military Service 20th February, 1941). (b) S. Adams. (Reported for Military Service 25th August, 1940). (c) C. G. Humberston. (Reported for Military Service 20th November, 1940). (d) Miss M. E. Pollitt. (2) Temporary. (a) L. Gold, Senior Clerk to the Medical Officer of Health. (b) Miss P. Brabban. (Commenced Duties 20th April, 1942). (c) Mrs. L. Canham. (Commenced Duties 19th October, 1942). (d) M.j. Cole. (Reported for Military Service 28th September, 1942). (e) Miss B. Parker. (Commenced Duties 19th October, 1942). (f) Miss S. J. Rose. (Resigned 25th Septembr, 1942). (g) Miss V. Stock. (Commenced Duties 12th August, 1942, Resigned 19th October, 1942). Day Nursery—"St. Moritz", Matron. Mrs. E. E. Holland, State Registered Nurse, State Certified Midwife. (Commenced Duties 16th February, 1942). 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 1942. This is the Ninth Report in the series, since I was appointed your Medical Officer of Health, and it is drawn up in accordance with the requirements of Articles 6(3) and 17(5) of the Sanitary Officers (Outside London) Regulations, 1935, as modified by Circular 2773 of the Ministry of Health, dated 10th March, 1943. This Circular, like those for the past two years again states that the Report for 1942 should be an Interim one, and that careful preservation should be made of all records, not published, so that, at some future date, these can be reported upon. As I write this Report, the War, unfortunately has been in progress for more than 3 years, and it is, therefore, with a not inconsiderable feeling of pride that I can still report a satisfactory year of progress. I must admit that in the far off, and depressing days of 1939, few of us hoped to be able to maintain the services that had previously existed, at any rate in their entirety, but, since then, not only have we done so, but we have also consolidated, and extended those services. This extension has involved an increase of staff, from 14, pre-war to 32, to-day (not including the Civil Defence Personnel), and, with the opening of a third War-time Nursery, the staff will be increased by another 8 personnel. It is inevitable, dealing as we are mainly with a temporary staff, that there should be frequent changes, which have thrown an extra responsibility and burden on those who remain, but, nevertheless, records have been maintained, and when these are duly published the statistics will I feel show favourable comparison with pre-war years. As before, my best thanks go to all the members of my staff, who have assisted in the work of the Department, to my fellow officials, for their kind assistance during the year, and to all the members of the Council, who have shown sympathetic consideration of our difficulties, and a continued interest in the well-being, and 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, 1943. 8 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. It will be noted from the list given at the beginning of this report that there has been a considerable movement amongst the temporary personnel. This, we must expect as one of the inevitable outcomes of war, but is unfortunate from an administrative point of view, for each new-comer has to be trained to specific duties, and such movement is not conducive to good clerking and record keeping. This was especially noticed in connection with the work of Diphtheria Immunisation, for which there was intensive propaganda during the year, and, as a result, a considerable amount of recording had to be undertaken. I am glad, however, to be able to report that, with very few exceptions, the standard of record keeping has been maintained. (ii) Laboratory Facilities. As from 1st April, 1942, the Essex County Couuncil, under an agreement with the Ministry of Health, made new arrangements for their laboratory services. Prior to that date bacteriological examinations were carried out at the Counties Public Health Laboratories, established at Gidea Park College, Romford . Since April, this work has been performed at six hospitals throughout Essex; Oldchurch County Hospital being the Hospital for this area. The arrangements at Oldchurch Hospital, however, were delayed because of staffing difficulties, etc., but, by 1st October, were in full operation. Samples of Milk and Water continue to be examined at the Counties Public Health Laboratories. In addition to the above, the Emergency Laboratory Service at St. Margaret's Emergency Hospital, Epping, again supplied material throughout the year for Diphtheria Immunisation. (iii) Nursing in the Home. (a) Midwives. The domiciliary service of salaried midwives continued as before, but, for domestic reasons, two of the midwives were not available for several months of the year. During this period, however, we had the services of a relief midwife from the Essex County Council. 9 Towards the end of the year, arrangements had been made for the appointment of a 6th midwife for the district. This was the number which, on the introduction of the Midwives Act, 1936, was visualised as being required for the area. The 6th midwife will commence duties early in 1943. In addition to the Council Midwives, there are 3 Midwives in independent practice in the District, and also 5 District Nurse Midwives. Five Midwives, resident outside the Borough, also undertook cases in the District during the year. (iv) Hospitals: Public and Voluntary. (a) Infectious Diseases. (b) Maternity. (c) Children. (d) Other Cases. There is nothing new to report in either of these sections. 2.—MATERNITY AND CHILD WELFARE. (i) Ante-natal Clinics. Sessions for this purpose continued as before, as also the Consultative Ante-natal Clinic at Oldchurch Hospital. During the year 1942, 1,021 individual expectant mothers attended the Clinics. In addition 21 mothers attended for postnatal advice. In all 199 sessions were held during the year. The total number of attendances of the 1,042 mothers mentioned above was 4,354 giving an average of 4.2 attendances per patient. The average number attending at each session was 21.9. (ii) Infant Welfare Clinics. Sessions for Infant Welfare purposes also continuued on the lines indicated in my Interim Eeport for 1941. Full advantage was again taken of the National Milk Scheme of the Ministry of Food, and, for this purpose, close co-operation was maintained with the Local Food Office. Vitamin preparations, in the form of fruit juices and cod liver oil, continued to be distributed at each of the Child Welfare Centres, in addition to distribution at the Town Hall and the Food Office, and towards the end of the year arrangements were made for distribution at each of the Ante-natal Clinics when the scheme was extended to expectant mothers. 10 During 1942, two new services were introduced, viz., cooperation in the facilities of a clinic for speech therapy, and in a clinic for child guidance. Both these clinics are organised by the Essex County Council, but, by arrangement with the Romford Borough Council, they are held at the Borough's Maternity and Child Welfare Centres at Hulse Avenue and Marks Boad respectively. Each child referred from our clinics for speech therapy is charged at the rate of 2/6 for'each attendance, and each child referred for child guidance is charged at the rate of 7/6 per case. Regarding the provision of Dried Milk and other preparations, there were 176 applications received during the year, 48 had to pay a proportion of the cost, and the remaining 128 received free grants. During 1942, 361 Child Welfare Sessions were held, and the following table gives a summary of the attendances :— Table 1. Individual Children attending 2,059 Children attending for the first time 1,339 Medical Consultations 7,063 Attendances of Children under 1 year 12,728 Attendances of Children between the ages of 1 and 5 years 4,899 Average attendance per session 48.8 (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. lable 2 relates to the Home Visits paid by the Health Visitor Table 2. (a) Expectant Mothers. First Visits 36 Total Visits 62 (b) To Children under One Year of age. First Visits .... 1,004 Total Visits .... 2,893 (c) To Children between the Ages of 1 and 5 years. Total Visits .... 6,175 11 Table 3. (a) Number of persons who were receiving children for reward at the end of the year 54 (b) Number of Children:— (1) At the end of the year 77 (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 (e) Proceedings taken during the year :— (1) Number of Cases 0 (2) Act and Section under which proceedings were taken — (iv) Midwives Act, 1936. The following gives a summary of the cases attended by the Council Midwives, as Midwives, and as Maternity Nurses during 1942 :— As Midwives .... .... .... .... 303 As Maternity Nurses .... .... .... 51 (v) Inspection of Nursing Homes, etc. Quarterly inspections of the two Nursing Homes, registered by the Essex County Council under Section 187 of the Public Health Act, 1936, were again carried out, and investigations on the same lines as before were made in respect of certain cases which occurred throughout the district. (vi) Day Nurseries. In last year's report mention was made of the preparations, which, by the end of the year were under way for the establishment of a Day Nursery in the area. This Nursery was opened at the beginning of March, and since then has provided for children from 0 to 5 years of age, whose mothers are engaged in war work. To supplement the full-time staff, voluntary workers are in regular attendance, and everything possible is being done to care for the physical and mental welfare of the children, for whom the Nursery caters. 12 During the year, arrangements were being made for the establishment of two other Nurseries in the district, one to serve the Collier Row area, and the other the Bush Green area. By the end of the year both these Nurseries were being built, and the staff was being selected by interview. 3.—INSPECTION AND SUPERVISION OF FOOD. Meat and Other Foods. The Sanitary Inspectors have again carried out numerous duties in connection with the inspection of meat and other foods at the Regional Slaughterhouse, the Meat Depots, Butchers' Shops, Stalls, etc., and, in this connection, we are grateful for the assistance rendered by the Sanitary Inspectors of the Dagenham and Hornchurch Districts, who, for the purpose of carrying out inspections, have attended at the Regional Slaughterhouse on one day of each week. Altogether, 76'2 visits were paid. At the Slaughterhouse alone 14,303 carcases were inspected. 4.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. (a) During the year there was an increased prevalence of Scarlet Fever, especially during August, September, and October. Whooping Cough was prevalent from January till about June, and Measles from April till August. (b) Diphtheria Immunisation. Propaganda was again well maintained throughout the year, in order to bring to the notice of the Public the great advantages to be obtained from the scheme of Immunisation against Diphtheria, and, as a support to the National publicity given on this subject, we, in Romford, advertised the service by means of posters and handbills. A special article written by myself was also given prominence in the local press. In addition, lantern slides were shown at all the cinemas, and a letter was sent to all the doctors and nurses in the district. At the same time forms of acceptance were distributed to all the schools, and, at a later date, the Essex Education Committee re-circularised the schools. Towards the end of the year, the Health Visitors, acting on the recommendation of Ministry of Health Circular 2713 carried out a wide investigation, in order to 13 The following statistics apply, since the inauguration of the scheme in Romford in 1935, till the end of 1942 :— Table 4. Number of Immunisation injections given at the Clinics 16,491 Number of Children who have completed the Course of In jections, either at the Clinics or Privately 6,448 Number Schick Test Injections given at the Clinics, including control injections 9,391 Number who have been Schick Tested 4,715 Percentage found to be Immune after Course of Treatment .... 88.7 (ii) Non-Notifiable Diseases. (a) The relative prevalence of these is set out below:— (b) Scabies. In accordance with the various Circulars issued by the Ministry of Health in connection with Scabies, I have to report that, in this area, an arrangement was made before the war for institutional treatment to be carried out at the Oldchurch County Hospital. This arrangement is still in force, and, on admission, the Medical Superintendent informs this department of cases belonging to this district, so that the necessary follow-up can be done. A scheme also exists whereby the School Medical Inspectors send a notification of cases found in the schools, at the same time indicating whether treatment is being carried out at the home, at one of the school clinics, or in hospital. Younger children found to be suffering from Scabies are brought to my notice through the Child ascertain the immunisation acceptance rate amongst children under school age. This investigation was under way by the end of the year, and it was not uncommon to get a report that certain streets showed almost a 100% acceptance in this group. Material for the purpose was again provided by the Emergency Laboratory Service in the form of Alum Precipitated Toxoid, and, on the advice of the Ministry of Health, the primary dose was increased from 0.1 c.c. to 0.2 c.c., and the second dose from 0.3 c.c. to 0.5 c.c. Sessions have been held at each Child Welfare Clinic, and also at all the schools. Furthermore, Alum Precipitated Toxoid is given free of charge to any practitioner who wishes to avail him- 14 Welfare Clinics, or by the home visits of the Health Visitors. If necessary, such cases are referred to the Skin Specialist at Oldchurch County Hospital. Home treatment is adopted, where possible, and, if necessary Public Cleansing can be carried out by arrangement at the Cleansing Centres of the First Aid Posts. Steam Disinfestation of bedding, clothes, etc., is arranged for but, in the main, the recommendation as set out in Memo. 229/M'ed. (Amended February/43) viz., that ironing with an ordinary hot iron is quite effective for clothing or blankets, has been the method generally adopted. Public notice has been drawn to the question of Scabies by handbills, posters, etc. 5.—SUPPLEMENTARY. Air Raid Precautions. Throughout the year, in order to maintain efficiency, the Casualty Service Personnel had revision in theoretical and practical aspects of their work, and, in conjunction with the Military Authorities, the Home Guard, and other Services, took part in invasion exercises. In accordance with the Government policy to reduce the number of whole-time personnel in the Civil Defence Service, arrangements were made with the Ministry of Labour and National Service to put into effect such reduction as applied in this area. At the same time the local branch of the Employment Exchange directed personnel to undertake part-time duties, in order to make good any deficiencies in the total strength of the services, This reduction and direction had not been completed by the end of the year.