Rom 18 medl LIBRARY BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1943 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 1943 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 3 BOROUGH OF ROMFORD ♦ MEMBERS OF THE COUNCIL (As at 31st December, 1943). His Worship The Mayor : Alderman C. 15. Smart, J.P. Deputy Mayor : Alderman W. J. Russell. Aldermen : Alderman C. H. Barney, J.P. Alderman R. A. Forge, J.P. „ F. L. J. Cole, „ W. M. Goldsmith. J.P.,C.C. „ H. W. Hole, J.P. Councillors : Councillor Mrs. P. Besant. Councillor W. D. Hill. „ A. E. Blane. „ Mrs. L. A. Irons. „ R. G. L. Bowyer. „ L. A. Lucas. „ A. J. Brian. „ A. Needham. „ G. W. Butcher. „ C. A. Osborn. „ G. F. Chaplin. „ E. W. Smith. „ H. F. Davenport. „ Mrs. E. S. South. „ A. J. Dyer, O.B.E. „ G. A. Stafford. „ A. E. Fruitnight, C.C. „ L. S. Webb. „ J. Gow. „ Mrs. E. A. White. „ Mrs. O. Haseltine. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December. 1943). His Worship The Mayor : Alderman C. E. Smart, J.P. (Ex-officio member). Deputy Mayor : Alderman W. J. Russell (Ex-officio member). Chairman : Councillor Mrs. L. A. Irons. Vice-Chairman : Councillor Mrs. E. S. South. Alderman C. H. Barney, J.P. Councillor A. J. Brian. „ F. L. J. Cole, „ H. F. Davenport. J.P., C.C. Mrs. O. Haseltine. „ R. A. Forge, J.P. „ L.S. Webb. W. M. Goldsmith. Mrs. E. A. White. Councillor A. E. Blane. Maternity and Child Welfare Committee. As above with the addition of— Mrs. G. Bignold. Mrs. A. Damant. Mrs. L. Fox. Mrs. B. Hollingsworth. Maternity, Etc., Cases Sub-Ccmmittee. Chairman : Councillor Mrs. L. A. Irons. Councillor Mrs. O. Haseltine. Mrs. A. Damant. „ Mrs. E. S. South. Mrs. L. Fox. „ Mrs. E. A. White. Mrs. B. Hollingsworth, Mrs. G. Bignold. 5 WAR-TIME NURSERIES COMMIITTEE. His Worship The Mayor: Alderman C. E. Smart, J.P. (Ex-officio member). Chairman : Councillor Mrs. E. A. White. Vice-Chairman : Councillor Mrs. L. A. Irons. Alderman F. L. J. Cole, Councillor Mrs. O. Haseltine. J.P., C.C. „ Mrs. E. S. South. Councillor Mrs. P. Besant. Mrs. A. Damant. „ A. E. Blane. 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 M. James, M.D., b.s., L.R.C.P., 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. (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). Health Visitors. (a) Mrs. E. J. Bingham, State Registered Nurse; State Certified Midwife. (b) Miss O. Clements, State Registered Nurse; State Certified Midwife; Health Visitor's Certificate. (Commenced duties 6th December, 1943). (c) Mrs. B. Croft, State Registered Nurse; State Certified Midwife; Health Visitor's Certificate. (Commenced duties 12th July, 1943; resigned 2nd October, 1943). (d) Miss F. K. Wells, State Registered Nurse; State Certified Midwife; Health Visitor's Certificate. 6 Council Midwives. (a) Miss C. M. Kerr, State Registered Nurse; State Certified Midwife. (b) Mrs. M. Mylward, State Certified Midwife. (Commenced duties 11th January, 1943). (c) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (d) Mrs. D. Shaddick, 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. (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. (Reported for Military Service 16th July,1943). (2) Temporary. (a) L. Goold, Senior Clerk. (b) Miss P. Brabban. (c) Mrs. L. Can ham. (d) Miss Y. G. Coningham. (Commenced duties 20th September, 1943). (e) Miss B. Parker. War-time Nurseries—Matrons. "St. Moritz." Mrs. E. E. Holland, State Registered Nurse; State Certified Midwife. (Resigned 30th April, 1943). Mrs. O. Haga, State Registered Nurse. (Commenced duties 26th July, 1943). Collier Row. Miss A. H. Charity, State Registered Nurse. (Commenced duties 4th January, 1943). Rush Green. Mrs. E. M. Ellerington, State Registered Nurse; State Registered Fever Nurse; State Certified Midwife; Tuberculosis Certificate. (Commenced duties 24th June, 1943). 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 1943. This is the Tenth 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 10/44 of the Ministry of Health, dated 15th February, 1944. This Circular, like those of previous war years, states that the Report for 1943 should be an Interim one, owing to the necessity of economising in paper. Furthermore, on grounds of national security, restrictions are placed on the publication of population figures, and of any statistics based on those figures. Similarly, no reference can be made to activities in connection with war-time industrial, military, or other important developments, such as extensions of water supply, or sewerage works, or other public utility undertakings. It is, however, no breach of security when 1 state that the health of the district has again been satisfactorily maintained, and that no epidemic of serious magnitude has been encountered. This, in no small measure, can be attributed to the wise foresight of the Ministry of Food which, from the commencement of the war, has provided the public, and more especially the children and expectant mothers, with a well-balanced diet. As before, my best thanks go to all members of my staff, who have assisted in the work of the Department and in the compilation of this report; 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 of the inhabitants of this town. I am, Mr. Mayor. Ladies, and Gentlemen, Your obedient servant, JAMES B. SAMSON, Public Health Department, Medical Officer of Health, Town Hall, Romford. March, 1944. 8 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. On referring to the list at the beginning of this report, it will be seen that there have again been substantial changes amongst the personnel, thus creating the inevitable difficulties which are incidental thereto. The four permanent members of the Clerical staff are now serving with His Majesty's Forces, and this work is being carried on with temporary staff, who, however, are also liable to be enlisted for Military Service or Factory work. During the year, an additional Midwife was appointed, and, owing to the opening of two additional War-time Nurseries, further staff was appointed. At the commencement of hostilities, the staff of the department numbered 15. At the present day it numbers 40, excluding Civil Defence personnel, Domestic Staff, etc. I am pleased, however, to report that, on the whole, the work has progressed smoothly, and that the essential records have been kept satisfactorily. (ii) Laboratory Facilities. These continue to be available, in accordance with the scheme as detailed in last year's report, and give every satisfaction. The Emergency Laboratory Service has again supplied a considerable amount of material, free of charge, throughout the year, for the purpose of immunisation against Diphtheria. We are also grateful for the kind assistance of Dr. E. V. Suckling, of the Counties Public Health Laboratories, for the advice which he has readily given, and for the examination of samples of milk, and water, which are periodically submitted to this Laboratory for analysis. (iii) Nursing in the Home. (a) Midwives. Full advantage was taken of the domiciliary service of salaried midwives and, at the beginning of the year, the sixth midwife, whose appointment has previously been referred to, commenced duties. This gives Romford the quota originally agreed upon, at the time of the introduction of the Midwives' Act, 1936, and visualised then as likely to be required for the area, and has the advantage of giving the Midwives more time to devote to each of their cases, and also the necessary relaxation, which they have hitherto not managed to enjoy. 9 As is already known, in July, the Report of the Midwives Salaries Committee—one of the Committees appointed, under the (hairmanship of Lord Rushcliffe—was published (Cmd. 6460), and is popularly referred to as the "Midwives' Charter". This gives to Midwives a salary more in keeping with their status, and sets out various other conditions of service, concerned with hours of duty, holiday periods, etc., which will go a long way towards improving the lot of Midwives, and encouraging a greater number of nurses with the midwifery certificate to remain in the midwifery service, in addition to influencing young women to enter this profession. Consideration was still being given to this Report by the Essex County Council, which is the Local Supervising Authority, at the end of the year. At the beginning of November one of the Midwives, for domestic reasons, was granted extended leave of absence, but we were fortunate to obtain the services of a relief Midwife to act in her place. In addition to the Council Midwives, there are 2 Midwives in independent practice in the District, and also 5 District Nurse Midwives. Two Midwives, resident outside the Borough, undertook cases in the District during the year. (iv) Midwives Act, 1936. The following gives a summary of the cases attended by the Council Midwives, as Midwives, and as Maternity Nurses during 1943:— As Midwives 276 As Maternity Nurses 88 (v) 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 County Hospital. 10 During the year .1943, 1,162 individual expectant mothers attended the Clinics. In addition 29 mothers attended for post-natal advice. In all 197 sessions were held during the year. The total number of attendances of the 1,191 mothers mentioned above was 4,514, giving an average of 3.8 attendances per patient. The average number attending at each session was 22.9. (ii) Infant Welfare Clinics. Sessions for Infant Welfare also continued on the lines indicated in my Interim Report for 1941, but the Rush Green and Victoria Road Clinics transferred to the Rush Green and Victoria Road Borough Restaurants respectively. 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 from each of the Child Welfare Centres, as also from the Food Office, and Food Advice Centre in South Street. Furthermore, expectant mothers can now receive Orange Juice, and Cod Liver Oil; the latter in liquid form, or in the form of tablets of Concentrated Fish Liver Oil, as desired. These are obtainable from the same sources as above. Regarding the provision of Dried Milk, and other preparations, not within the scheme of the Ministry of Food, there were 146 applications received during the year, 93 had to pay a proportion of the cost, and the remaining 53 received free grants. During 1943, 364 Child Welfare. Sessions were held, and the following table gives a summary of the attendances:— Table 1. Individual Children attending 2,094 Children attending for the first time 937 Medical Consultations 7,240 Attendances of Children under 1 year 14,288 Attendances of Children between the ages of 1 and 5 years 4,742 Average attendances per session 52.3 Table 2 relates to the Home Visits paid by the Health Visitors. 11 Table 2. (a) Expectant Mothers. First Visits 31 Total Visits 42 (b) To Children under One Year of age. First Visits 1,053 Total Visits 1,354 (c) To Children between the Ages of 1 and 5 year Total Visits 2,677 (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 3. (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 69 (2) Who died during the year 2 (3) On whom inquests were held during the year 1 (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 – The number of visits paid by the Health Visitors this year has been small compared to previous years, and this is explained by the fact that, since the resignation of one of the Visitors on 31st December, 1942, it has been very difficult to obtain the services of another Visitor, although advertisements have been inserted in the Press, and applications have been made to the appropriate Appointments Office. One Visitor was, in fact, appointed on 12th July, but, for 12 domestic reasons, she had to resign on 2nd October. For practically the whole of the year, therefore, we had the services of 2 Health Visitors only. On the 6th December, we were successful in obtaining a Visitor to fill the vacancy, and, by the end of the year, were endeavouring to obtain a 4th Health Visitor. In the month of December the Second Report of the Nurses Salaries Committee—one of the Committees appointed under the Chairmanship of Lord Rushcliffe—was published (Cmd. 6487). This particular report deals with the Salaries and Conditions of Service of Health Visitors, in a manner analogous to that of the Midwives already mentioned. Consideration was being given to this Report at the end of the year. (iv) 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. (v) Consultant. In my Interim Report for the year 1940, I indicated that the Council had appointed Mr. H. G. Everard Williams, 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 assistance for difficulties or complications arising during pregnancy, or at, or after confinement. During the present year, it was ascertained that Mr. Everard Williams had enlisted for military service, so arrangements were made for Mr. Alan Brews, F.R.C.S., of 36, Wimpole Street, London, and "Coombe Hill," Priests Lane, Shenfield, to be appointed in his place for the duration of the war. The terms of service are similar, and this does not exclude practitioners from availing themselves of the Emergency Unit, which is stationed at Oldchurch County Hospital, Romford, and which is ready to turn out for urgent cases. (vi) Adoption of Children (Regulation) Act, 1939. Circular 2790 of the Ministry of Health drew attention to the fact that an Order in Council appointed 1st June, 1943, as the date on which the Adoption of Children (Regulation) Act, 1939, should come into operation, 13 Section 7 of the Act is the section with which Welfare Authorities are concerned. It makes it the duty of any person (other than a registered adoption society or a local authority, and not being the parent or guardian or a near relative of the child or the person in whose care or possession he is to be placed) who participates in making arrangements for the adoption of a child under the age of nine years to give notice in writing of the arrangements to the Welfare Authority for the area in which the adopter resides, not less than seven days before the possession is taken of the child by the adopter. This does not apply when an adoption order is made. Furthermore, an adopter must notify a Welfare Authority if he changes his address, or if the child dies. In the latter event he must also notify the Coroner. Certain duties are placed upon the Child Protection Visitors in regard to visiting and examining the children concerned. The following statistics have also to be supplied:— (a) No. of persons who gave notice under Section 7 (3) during the year 0 (b) Total No. of children "adopted" under the section during the year 0 (c) No. of such children:— 0 (i) Under supervision at the end of the year 0 (ii) Who died during the year 0 (iii) On whom inquests were held during the year 0 (d) Particulars of any proceedings taken during the year — (vii) The Care of Illegitimate Children. Circular 2866 of the Ministry of Health draws attention to the fact that the Minister of Health had had under special consideration the problems arising under war conditions in regard to illegitimate children, and various suggestions were submitted for tackling the problems, inter alia, that Welfare Authorities should co-operate with and reinforce the work of existing voluntary moral welfare associations. It was pointed out that the range of work would be a wide one, and the appointment of a trained worker experienced in the special problems which would arise would probably be considered desirable. The Circular also stated that County Districts might find it convenient to arrange for a combination of areas, and, for this purpose, the County Council might call a Conference of the separate Welfare Authorities within the County, in order that a joint scheme might be prepared. Such a Conference was held in December when the matter was referred back to the individual Authorities for further consideration. 14 (viii) War-time Nurseries. Since the opening in March, 1942, of the "St. Moritz" Nursery, incidentally one of the first to be opened in this Region, (wo other Nurseries have been established—the Collier Row Nursery opened on February 8th, and the Rush Green Nursery opened on August 30th. The Collier Row Nursery is for 40 children, and the Rush Green Nursery for 50. At "St. Moritz," and Collier Row the demand for admissions has been continuous, and, in view of the fact that there has been a waiting list at both Nurseries, the Council, at the end of the year, had under consideration the question of more Nurseries for the area At Rush Green, there has not been the same demand, but this Nursery, by the end of the year, had not been established very long. It has taken some time to provide Staff for the three Nurseries, and we have had the added difficulty of replacing Staff, who have resigned. To supplement the Full-time Staff, & small number of voluntary workers have attended regularly, and, in addition, assistance is given by the personnel of the First-aid Posts. Infectious diseases create a problem amongst the children in attendance, especially during periods of epidemics, and the procedure adopted here, apart from excluding the cases, is to inform the parents of children who remain that such and such an infection has been found in the Nursery, and that they can, if they so wish, send, or exclude their children. No new admissions are permitted during a specified period, if the infection is epidemic in the district. 3—INSPECTION AND SUPERVISION OF FOOD. 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 again 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, 1,084 visits were paid. At the Slaughterhouse alone 15,027 carcases were inspected. 15 4.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. (a) Scarlet Fever. During the year there was an increased prevalence of Scarlet Fever, especially during the last quarter, when the height was reached about the end of October. Although it was of epidemic proportions, there was not an unduly large number of cases, and the great majority were mild in type. In accordance with the repeated recommendations of the Ministry of Health such cases as could be nursed at home, having regard to the domestic environment, were not removed to the Isolation Hospital. (b) Diphtheria Immunisation. Propaganda was again maintained throughout the year by Press advertisement, and a special article to the Press by myself, posters, film "trailers," lantern slides, details in the local page of "Better Health," letters to doctors and nurses, etc. The schools were also periodically circularised with particulars, and attached acceptance forms, and the Health Visitors constantly carried out propaganda in the homes, and at the Maternity and Child Welfare Clinics. As mentioned under the section of this report dealing with "Laboratory Facilities," the Emergency Laboratory Service has again provided Alum Precipitated Toxoid free of charge, and this is given out from the Department to any practitioner, who wishes to avail himself of it. Sessions for Diphtheria Immunisation are held at each Child Welfare Session, and also at all the Schools. An endeavour has been made to perform a Post Schick Test in every case where two immunising injections have been given, but precedence has been given to the immunisations. When the reading after the Post Schick Test proves negative, the parent is given a certificate, indicating that the child is believed to be immune, so that, should the child subsequently be examined during illness by a doctor, the parent can produce the certificate to guide the doctor in his diagnosis. Before entering School, many pre-immunised children are again Schick Tested, and, if found to be positive, are given a "boosting" injection of A.P.T. 16 The Probationers at the War-time Nurseries are encouraged to be Schick Tested, and, if positive, are immunised with ToxoidAntitoxin Floccules. This preparation is also issued free of charge by the Emergency Laboratory Service for this purpose. The following statistics relate to the state of Immunisation as at 31st December, 1943:— Table 4. Under 5 yrs. 5-15 yrs. Total. No. of children who completed the full course of Immunisation between 1st Jan. and 31st Dec. 1,051 1,101 2,152 (a) Approx. estimated No. of children 4,900 9,800 (b) Percentage Immunised at 31st Dec. 66 51 Table 5 gives the statistics since the inauguration of the scheme in Romford in 1935, till the end of 1943. Table 5. Number of Immunisation injections given at the Clinics 20,001 Number of children who have completed the Course of Injections, either at the Clinics or Privately 8,601 Number of Schick Test Injections given at the Clinics, including control injections 12,071 Number who have been Schick Tested 6,055 Percentage found to be Immune after Course of Treatment 90.7 (c) Sonne Dysentery. At various periods throughout the year we had notifications of cases of Sonne Dysentery, characterised by sickness and diarrhoea of comparatively short duration. Although, in itself, not disabling, and more of a nuisance value than anything else, it is, however, an indication of contamination of bowel content of food or drink, and, whilst there is the possibility of this mode of infection, there is also the possibility of more severe infections being spread in a similar manner. It is, therefore, of the very greatest importance that all persons handling foodstuffs should take the greatest care in the cleanliness of their hands at all times, and also in the cleanliness of cups, mugs, plates, milk bottles, and other containers of articles taken by the mouth. 17 During the month of July there was a small epidemic at one of the schools in the district. Daily investigations were made by myself, and the Chief Sanitary Inspector, as to the likely cause of infection and, although this was not discovered the precautionary measures recommended brought the epidemic to a close. During this period the Ministry of Health, and the County Medical Officer were kept informed of the progress of the investigations. (d) Measles and Whooping Cough. Both these diseases were epidemic during the months of January, February, March, April and May. (e) Acute Infective Hepatitis. This condition, previously alluded to as "Catarrhal Jaundice" has for some time now given Public Health Authorities some concern, owing to its wide spread distribution, not only in this Country, but also abroad. For the most part it affects children and adults, although it is perhaps not so common amongst children under 5 years of age, and the mode of spread is probably by infective droplets by way of the upper respiratory tract, that is to say it can be disseminated by coughing and sneezing. The Incubation Period is believed to be about 1 month, and the onset of symptoms is gradual. Symptoms of a "cold" and sore throat may be present in the early stages, prior to abdominal symptoms. The abdominal symptoms are sickness and vomiting, which are fairly constant features. The evidence of Jaundice occurs shortly after the onset of the abdominal symptoms, and may be transient. The bowel motions are pale, and the urine is bile stained. It is not, however, known for how long the patient is infectious, but it is believed that he might be for a period of a fortnight. With some the condition clears up fairly rapidly, but, with others, it is of long duration—several months. The Medical Besearch Council has, with a view to ascertaining the unknown factors in the disease, formed a team of investigators, and these are stationed at Cambridge. This team consists of both laboratory and field workers. To enable these workers to get as complete a picture as possible of the incidence of the disease "The Jaundice Begulations" came into operation in November. These Begulations provide for the compulsory notification of cases of Jaundice in the Eastern Begion. 18 (ii) Non-Notifiable Diseases. (a) Mumps—Chickenpox—Ruisella. The relative prevalence of these is set out below:— Table 6. Mumps 309 Chickenpox 189 Rubella 43 (b) Influenza. Influenza of a mild type was prevalent during the last month of the year. This caused a fairly high morbidity, but a low mortality rate, most of the deaths occurring over 55 years of age. Arising out of Ministry of Health Circular 2897, all the Doctors and Nurses in the District were reminded of the Cash and Carry System, which is in operation for the provision of meals from the Borough Restaurants. They were also informed that where no member of the household was available to collect the meals these could be delivered to the homes by the members of the Women's Voluntary Services. The W.V.S. also notified all Group Housewives, asking them to give domestic assistance, whenever possible. The British Red Cross Society, at the same time, indicated that their members would give what assistance they could, and the Boy Scouts, and Girl Guides' Associations were prepared to do any family shopping. Furthermore, the Military Authorities agreed to give Medical assistance, if possible, to the General Practitioners. (c) Lice. Circular 2831 of the Ministry of Health dated 2nd July, 1943, drew attention to reports of a Sub-Committee of the Advisory Committee on the Welfare of Mothers and Children. The reports pointed out the primary responsibility for the cleanliness of children rests with the mother, and that the problem is, in fact, a house and family one. As regards children under 5 years of age, the Sub-Committee states that Health Visitors should include the examination of the children's heads (though not the cleansing) as part of their work in the homes, and in the clinics. The Circular points out that the first and best line of defence must always be cleanliness, and that nothing can take the place of regular weekly washing, and daily brushing and combing of the hair, and that mothers should be advised that the hair of young children, up to the age of 5 at least, should be kept short. 19 Details are set out as to the best insecticide to use for cases of severe infestation. The preparation is known as Lethane Hair Oil (384—"Special"). In order that this preparation may have as much publicity as possible, I give below the instructions for use, as required to be included by makers on bottles containing the preparation:— (i) Amount to be applied to each head varies from about half a drachm, in the case of a child with short hair, to about two drachms tor a woman with long thick hair (one half to two teaspoonsful) ; (ii) Method of application—Part the hair with one hand and apply the liquid to the scalp itself with a dropper held in the other hand. This should be done in about eight places, four on each side. Then spread the oil evenly over the scalp by gently massaging with the fingers. Do not distribute by combing, as this tends to draw the insecticide away from the scalp; (iii) Do not apply oftener than once a week; (iv) The head should not be washed for a week after treatment, unless the scalp becomes much reddened. If this occurs the hair oil should be washed off at once; (v) Lethane hair oil does not remove nits from the hair, though it kills those that are wetted by it. To remove nits, whether alive or dead, the hair must be combed, preferably whilst it is wet, with a fine metal comb; (vi) The preparation must be carefully labelled "For External Use Only". Instructions, in accordance with the Circular, have been given to the Health Visitors. The problem is not a major one in Romford, and those who are infested are generally old offenders. These are known to the Health Visitors, and are dealt with in the appropriate manner. (d) Scabies. As mentioned in my Report of last year, an arrangement is in force whereby cases of Scabies requiring institutional care can be removed to Oldchurch County Hospital for treatment. The Medical Superintendent of this Hospital has continued to notify this department of cases belonging to this area, who have been admitted, 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 '20 is being carried out at the home, at one of the school clinics, or in hospital. Children under school age suffering from Scabies are brought to my notice by the Health Visitors. If necessary, cases can be referred for confirmation to the Dermatologist at Oldchurch County Hospital. Where, for any reason, home treatment or hospital treatment or school medical treatment cannot be arranged, patients can be treated at the Cleansing Centres of the First-aid Posts. Steam disinfestation of bedding, clothes, etc., is arranged for in some instances, but, generally, ironing with an ordinary hot iron is all that is required for blankets or clothing. The general consensus of opinion is that Scabies is transferred by close bodily contact with a sufferer, and not through clothing or bedding The Incubation Period is a long one, about 6 weeks, so that it may be necessary to trace back during that period to ascertain the source of contact. Scabies is not necessarily associated with a dirty environment, so that persons who normally are clean in their habits, or surroundings, if they suffer from itching would do well to bear the possibility of infestation by the Scabies mite in mind, and seek early expert advice. In the month of June, the Ministry of Information Film "Scabies: Diagnosis and Treatment" was shown at Stratford, by arrangement of the Stratford Division of the British Medical Association, to Practitioners, Sanitary Inspectors, Nurses, etc., and, for those who could not attend on this occasion, the film was again shown in Romford in July, by arrangement of the Essex County Council. 5.—SUPPLEMENTAKY. (i) Water. Mr. Bernard W. Bryan, Engineer to the South Essex Waterwork Comspany, has informed me that the water supplied throughout the Company's District was sufficient for all purposes. The water is under constant analytical observation, and all analyses have been reported on as pure and wholesome, and suitable for the purposes of a public supply. In addition to the above analyses, samples of water are taken, monthly, from different premises in the District by the Sanitary Inspectors. These are submitted for Chemical and Bacteriological examination, and the results have confirmed the findings of the Waterworks Company. 21 Mr. Bryan also states that the supply is constant throughout, that no water is supplied through standpipes, and that the water in the District is not plumbo-solvent. (ii) The Infestation Order, 1943. . In the month of June a "Direction" order was served upon Local Authorities by the Ministry of Food to ascertain the prevalence of rats and mice in the district, and, accompanying the "Direction," were notes designed for the assistance of Authorities to enable them to locate and determine major infestations. Special demonstrations were also given for the same purpose. On completing the survey, we found only 1 major infestation, and, as this was on agricultural premises, the eradication was left to the Ministry of Agriculture. Following the "Direction." the Ministry of Food undertook propaganda by Press advertisement, and posters placed on Air-raid Wardens' Posts, drawing attention to the menace of rats and mice, and inviting the public to report the presence of rats. On receipt of these reports, the Eat Catcher and the Sanitary Inspectors carried out inspections, and, in addition to setting traps and bait, etc., advised occupiers how best to get rid of these vermin. In the month of November, a second "Direction" was received, asking Local Authorities to proceed with the necessary action for the remedying of all infestation by rats and mice on land, as defined by Acticles 1 and 5 (l)a of the Order, within the area- of the Council, and this was dealt with in the appropriate manner. (iii) Air-raid Precautions. The work throughout the year has consisted for the most part in the training of "directed" personnel in First-aid and Anti-gas measures, and also the Ambulance personnel in driving and procedure. Revision, has also been given to those who have previously been trained. Outdoor exercises and tactical table exercises have been held periodically, and the training has been designed to make the personnel as much as possible interchangeable in their duties. During the year, the First-aid Parties were absorbed into the Rescue Service, as the work of the two services is complementary. Towards the end of the year, arrangements were being made to train the Food Treatment Squads in Decontamination in general, and the Decontamination Squads in Food Treatment. .