ROM 20 BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1945. 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 1945. JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. Borough of Romford. J. TWINN, SOLICITOR, TOWN HALL, TOWN CLERK. ROMFORD. Telephone ROMFORD 2121. With the Town Clerk's Compliments. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December, 1945). His Worship The Mayor: Councillor G. A. Stafford, J.P. Deputy Mayor: Councillor Mrs. L. A. Irons. Aldermen: Alderman C. H. Barney. Alderman R. A. Forge, J. P. „ R. G. L. Bowyer. „ W. M. Goldsmith. „ A. J. Dyer, O.B.E. „ C. E. Smart. Councillors: Councillor Mrs. P. Besant. Councillor G. Issitt. ,, A. E. Blane. „ L. A. Lucas. „ A. J. Brian. „ A. Needham. „ G. F. Chaplin, C.C. „ J. B. Poel. „ H. F. Davenport. „ G. Roberts. „ N. Eyre. „ E. W. Smith. „ A. E. Fruitnight, C.C. „ Mrs. E. S. South. „ J. A. B. Goode. „ L. S. Webb. „ Mrs. O. Haseltine. „ B. Yeal. „ W. D. Hill. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December, 1945). His Worship The Mayor: Councillor G. A. Stafford, J.P. (Ex-officio member). Deputy Mayor: Councillor Mrs. L. A. Irons (Ex-officio member). Chairman: Councillor L. S. Webb. Vice-Chairman: Councillor G. Issitt. Alderman R. A. Forge, J.P. Councillor J. A. R. Goode. „ W. M. Goldsmith. „ Mrs. O. Haseltine. Councillor Mrs. P. Besant. „ G. Roberts. „ A. E. Blane. „ Mrs. E. S. South. „ G. F. Chaplin, C.C. „ R. Yeal. Maternity and Child Welfare Committee. As above with the addition of— Mrs. A. Damant.. Mrs. A. E. Evans. Mrs. L. Fox. Mrs. E. A. White. Mrs. E. G. Yeal. Maternity, Etc., Cases Sub-Committee. Chairman: Councillor Mrs. P. Besant. Councillor Mrs. O. Haseltine. Mrs. A. Damant. „ Mrs. L. A. Irons. Mrs. A. E. Evans. „ Mrs. E. S. South. Mrs. L. Fox. Mrs. E. G. Yeal. 5 War-Time Nurseries Committee. His Worship The Mayor. Councillor G. A. Stafford, J.P. (Ex-officio member). Chairman: Councillor Mrs. E. S. South. Vice-Chairman: Councillor Mrs. P. Besant. Councillor A. E. Blane. Mrs. A. Damant. „ Mrs. O. Haseltine. Mrs. L. Pox. „ Mrs. L. A. Irons. Mrs. E. A. White. 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.B., 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 Liverpool University 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; Resumed duties, 3rd November, 1945.) Health Visitors. (a) Mrs. E. J. Bingham, State Registered Nurse; State Certified Midwife. (b) Miss O. Clements, State Registered Nurse; Registered Fever Nurse; State Certified Midwife; Health Visitors' Certificate. (c) Miss F. K. Wells, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. 6 Council Midwives. (a) Miss I. A. Bassett, State Certified Midwife. (Commenced duties, 1st August, 1945.) (b) Miss C. M. Kerr, State Registered Nurse; State Certified Midwife. (c) Mrs. M. Mylward, State Certified Midwife. (d) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (e) Mrs. D. Shaddick, Registered Sick Children's Nurse; State Certified Midwife. (f) Mrs. J. Thompson, State Registered Nurse; State Certified Midwife. (g) Miss M. R. Waddell, State Registered Nurse; State Certified Midwife. (Commenced duties, 1st October, 1945.) (h) Mrs. E. A. Whaley, State Certified Midwife. (Commenced duties, 14th May, 1945.) 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) Mrs. L. Canham. (c) Miss V. G. Coningham. (d) Miss B. A. Cubitt. (e) Miss B. Parker. War-time Nurseries—Matrons. "St. Moritz." Mrs. O. Haga, State Registered Nurse. Collier Row. Miss A. H. Charity, State Registered Nurse. Rush Green. Mrs. M. Earl, State Registered Nurse; Registered Sick Children's Nurse. 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 1945. This is the Twelfth 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 28/46 of the Ministry of Health, dated 11th February, 1946. This Circular again states that the Report should be an Interim one. In his Report for the year 1932, the Chief Medical Officer of the Ministry of Health stated that "The surest of all tests of grave results are the Mortality Returns. Any long sustained physical pressure or stress of serious degree represents itself ultimately in a rise in Mortality, particular or general." In view, therefore, of the physical pressure and strain of serious degree that we have experienced since 1939, I think that this Council can congratulate itself on the Health Services, which it has maintained and extended throughout the years of war; the benefits of which are reflected in the low mortality returns for this area. Furthermore, it should also be borne in mind that the returns would have been even lower, had we not had to include deaths directly attributable to war injuries. Once again, I have pleasure in reporting that there was no death in the district of a mother, arising out of confinement, although one maternal death occurred outside the district, and has to be recorded in this area, under the arrangements for the recording of transferable deaths. In conclusion, 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. May. 1946. 8 ANNUAL REPORT of Medical Officer of Health for the Year 1945 Statistics and Social Conditions of the Area. Area (in acres) 9,342 Population: Census (1931), 35,918. Mid. 1945 (Estd.) 57,960 Number of Inhabited Houses (end of 1945) 18,143 Rateable Value (end of 1945) £511,904 Product of Penny Rate (end of 1945) £2,028 Extracts from Vital Statistics for the Year. Total M. F. Live Births: Legitimate 1,053 560 493 Illegitimate 85 52 33 Birth Rate: 19.6 per 1,000 of estimated resident population. Still Births: Legitimate 29 15 14 Illegitimate 2 - 2 Rate per 1,000 total (live and still) births: 26.5. Deaths 624 307 317 Death Rate: 10.8 per 1,000 estimated resident population. Deaths Rate per 1,000 total (live and still) births Deaths from Puerperal causes:— From Puerperal Sepsis — — Other Puerperal Causes 1 0.9 Total 1 0.9 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 40.4 Legitimate Infants per 1.000 legitimate live births 37.0 Illegitimate Infants per 1,000 illegitimate live births 82.4 Deaths from Cancer (all ages) 104 Deaths from Measles (all ages) - Deaths from Whooping Cough (all ages) - Deaths from Diarrhoea (under 2 years of age) 6 9 TABLE I. BIRTH-RATES,DEATH-RATES,ANALYSIS OF MORTALITY, England and Wales,London, 126 Great Town and MATERNAL MORTALITY and CASE-RATES for certain 148 Smaller Towns. Infectious Diseases in the year 1945. (Provisional Figures based on Weekly and Quarterly Returns). Rate per 1,000 Population. DEATH-RATE PER 1,000 POPULATION. Rate per 1,000 Live Births All Causes Typhoid and Paratyphoid fevers Small-Pox Measles Scarlet fever Whooping cough Diphtheria Influenza Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year Live Births Stillbirths England and Wales 16.1 0.46 11.4 0.00 0.00 0.02 0.00 0.02 0.02 0.08 5.6 46 126 County Boroughs and Great Towns, including London 19.1 0.58 13.5 0.00 0.00 0.02 0.00 0.02 0.02 0.07 7.8 54 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) 19.2 0.53 12.3 0.00 0.00 0.02 0.00 0.01 0.02 0.07 4.5 43 London 15.7 0.40 13.8 0.00 0.00 0.01 0.00 0.02 0.01 0.07 7.6 53 ROMFORD 19.6 0.53 10.8 0.00 0.00 0.00 0.00 0.00 0.03 0.14 5.3 40 Puerperal Sepsis Others Total The Maternal Mortality Bates for England and Wales are as follow: Per 1,000 Total Live Births 0.49 1.30 1.79 „ „ „ Bomford are as follow: Per 1,000 Total Live Births 0.00 0.86 0.86 10 TABLE 2. Causes of Death All ages Deaths at the subjoined ages of Residents, after correction for Inward and Outward Transfers. M. F. Total Under 1 1 2-4 5-14 1524 2534 3544 4554 5564 6574 75 & upwards 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2. Cerebro-spinal lever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria ... 2 2 ... ... 1 ... ... ... ... ... l ... ... 6. Tuberculosis of Respiratory System 13 14 27 ... ... ... ... 4 9 7 3 2 9 ... 7. Other forms of Tuberculosis 5 1 6 ... 1 ... 1 1 ... 1 1 ... 1 ... 8. Syphilitic disease 9 1 3 ... ... ... ... ... ... ... ... 3 ... ... 9. Influenza 4 4 8 ... ... ... ... 1 ... 1 ... ... 2 4 10. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute Poliomyelitis and Polioencephalitis ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... 12. Acute infectious Encephalitis 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 13. Cancer of Buccal Cavity, etc. 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 14. Cancer of Uterus ... 6 6 ... ... ... ... ... ... 1 1 4 ... ... 15. Cancer of Stomach and Duodenum 14 8 22 ... ... ... ... ... ... 2 3 8 5 4 16. Cancer of Breast ... 12 12 ... ... ... ... ... ... 1 2 2 5 2 17. Cancer of all other sites 31 32 63 ... ... ... ... ... ... 4 16 16 18 9 18. Diabetes 1 2 3 ... ... ... ... ... ... ... ... 1 2 ... 19. Inter-cranial Vascular Lesions 26 46 72 ... ... ... ... ... ... 3 7 12 21 29 20. Heart Diseases 95 71 166 ... ... ... ... 2 2 5 12 21 49 75 21. Other Diseases of the Circulatory System 3 2 5 ... ... ... ... ... ... ... ... 1 1 3 22. Bronchitis 10 12 21 1 ... ... ... ... ... ... 1 4 5 11 23. Pneumonia 20 25 45 14 1 ... ... ... ... 2 2 5 7 14 24. Other Respiratory Diseases 7 5 12 1 ... ... ... ... ... 1 1 2 4 3 25. Ulceration of the Stomach or Duodenum 3 1 4 ... ... ... ... ... ... 1 ... 2 1 ... 26. Diarrhoea 4 2 6 6 ... ... ... ... ... ... ... ... ... ... 27. Appendicitis 2 1 3 ... ... ... 1 ... ... 1 ... 1 ... ... 28. Other digestive diseases 5 11 16 2 1 ... 1 ... 2 3 ... 2 2 3 29. Nephritis 5 7 12 ... ... ... ... ... ... 2 3 4 1 2 30. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31. Other Maternal causes ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... 32. Premature Birth 4 3 7 7 ... ... ... ... ... ... ... ... ... ... 33. Congenital Malformations and Birth injuries 8 6 14 13 ... ... ... ... ... ... ... 1 ... ... 34. Suicide 2 3 5 ... ... ... ... ... 2 1 1 1 ... ... 35. Road Traffic Accidents 4 1 5 ... ... 2 1 ... ... ... 2 ... ... ... 36. Other violent causes 16 7 23 2 ... 1 3 2 1 4 3 2 4 1 37. All other causes 21 30 51 1 ... ... 1 5 1 5 4 4 10 20 Total 307 317 624 47 3 5 8 15 18 45 63 99 141 180 11 The following tables set out the various Rates for Births, Deaths, Maternal Mortality, and Infant Mortality since 1938, as these have not previously been published. These tables also show a comparison with the rates for England and Wales as a whole —for 126 County Boroughs and Great Towns, including London —for 148 Smaller Towns with resident populations of 25,000 to 50,000 at the 1931 Census, and for London. For the information of the Council the Birth Rate is the number of live births per 1,000 of the estimated resident populationthe Death Rate is the number of deaths per 1,000 of the estimated resident population—the Maternal Mortality Rate is the number of maternal deaths, due to conditions associated with pregnancy or confinement, per 1,000 total (live and still) births, and the Infant Mortality Rate is the number of deaths of infants under one year of age per 1,000 live births. All Rates are adjusted for outward and inward transfers. TABLE 3. BIRTH RATES. 1939. 1940. 1941. 1942. 1943. 1944. 1945. England and Wales 15.0 14.6 14.2 15.8 16.5 17.6 16.1 126 County Boroughs, etc. 14.8 16.0 14.7 17.3 18.6 20.3 19.1 148 Smaller Towns 15.6 15.7 16.4 18.4 19.4 20.9 19.2 London 12.3 13.7 8.9 14.0 15.8 15.0 15.7 Romford 17.9 18.2 17.2 17.9 19.2 19.8 19.6 TABLE 4. DEATH RATES. 1939. 1940. 1941. 1942. 1943. 1944. 1945. England and Wales 12.1 14.3 12.9 11.6 12.1 11.6 11.4 126 County Boroughs, etc. 12.0 15.8 14.9 13.3 14.2 13.7 13.5 148 Smaller Towns 11.2 12.8 13.0 12.1 12.7 12.4 12.3 London 11.9 17.8 16.3 13.9 15.0 15.7 13.8 Romford 10.0 12.9 10.4 9.3 10.1 11.1 10.8 TABLE 5. MATERNAL MORTALITY RATES. 1939. 1940. 1941. 1942. 1943. 1944. 1945. England and Wales ... 2.8 2.2 2.2 2.0 2.3 1.9 1.8 126 County Boroughs, etc. 148 Smaller Towns London Not available Romford 5.6 1.9 2.9 1.8 1.6 0.9 0.9 TABLE 6. INFANT MORTALITY RATES. 1939. 1940. 1941. 1942. 1943. 1944. 1945. England and Wales 50 55 59 49 49 46 46 126 County Boroughs, etc. 53 61 71 59 58 52 54 148 Smaller Towns 40 54 56 46 46 44 43 London 48 50 68 60 58 61 53 Romford 44 40 41 32 40 46 40 12 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. During the year there were several changes amongst the members of the staff of the department. but not to any very great extent. One member, viz., an Additional Sanitary Inspector resumed duties after an absence of 5½ years on Military Service. The particulars of the staff are given at the beginning of this report. At the time of writing the staff numbers 39, which includes those employed at the Day Nurseries, but excludes Domestic Staff, etc. (ii) Laboratory Facilities. The scheme for Laboratory services remains the same as during last year, viz., all routine examinations, with the exception of those for Milk and Water, are carried out at the Oldchurch County Hospital Laboratory, and examinations of Milk and Water are carried out at the Counties Public Health Laboratories, which are situated in Romford. These arrangements are adequate and satisfactory—and no complaints were received, regarding the services rendered. • During the year, the Essex County Council extended their facilities to include examinations for Male Fertility. When required the necessary outfits are sent to the General Practitioners in the area. Advantage was again taken of the free issue of Alum Precipitated Toxoid from the Emergency Laboratory at St. Margaret's Hospital, Epping, for the purpose of Diphtheria Immunisation. (iii) Nursing in the Home. (a) Midwives. By acquiring the services of two Relief Midwives, and making an establishment of eight, we were able, during the year, to bring into operation the complete recommendations of the Rushcliffe Committee in regard to the "off" duty periods of the Midwives, so that in three weeks out of every four, each Midwife is given two consecutive nights and the intervening day "off" duty a week, and in the fourth week, is given a long week-end of 60 hours' consecutive free time. The other recommendations of the above Committee were implemented in 1944. In addition to the Council Midwives, there is one Midwife in independent practice in the district, and also five District Nurse Midwives. Two Midwives, resident outside the Borough, undertook cases in the district during the year. 13 (iv) Midwives' Act, 1936. The following gives a summary of the cases attended by the Council Midwives, as Midwives, and as Maternity Nurses during 1945:— TABLE 7. As Midwives 329 As Maternity Nurses 92 (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. Arrangements were made during the year with the Medical Superintendent of the Hospital whereby every mother, and not only those where an abnormality is anticipated, who will subsequently enter the hospital for confinement, is referred as a routine at least once during pregnancy to the Ante-natal Clinic at the hospital. During the year 1945, 1,196 individual expectant mothers attended the clinics. In addition 16 mothers attended for post-natal advice. In all 199 sessions were held during the year. The total number of attendances of the 1,212 mothers mentioned above was 4,713, giving an average of 3.9 attendances per patient. The average number attending at each session was 23.7. (ii) Infant Welfare Clinics. These sessions, also, were held as before. Close co-operation was again maintained with the Local Food Office, so as to enable full and satisfactory advantage to be taken of the schemes of the Ministry of Food for the distribution of National Dried Milk, Fruit Juices and Cod Liver Oil. These preparations continued to be distributed from each of the Child Welfare Centres, from the Food Office, and from the Food Advice Centre in South Street. Suitable posters and leaflets advertising the scheme received wide distribution from the clinics. 14 The Principal Regional Medical Officer of the Ministry of Health at Cambridge has very kindly supplied me, periodically, with statistics, relative to the take-up of the various preparations, and the average for Romford bears very favourable comparison with that for England as a whole. Regarding the provision of Dried Milk and other preparations, not within the scheme of the Ministry of Food, there were 46 applications received during the year, and all these received free grants, in accordance with the scale of the Council. During 1945, 349 Child Welfare Sessions were held, and the following table gives a summary of the attendances. TABLE 8. Individual children attending 2,284 Children attending for the first time 968 Medical consultations 6,443 Attendances of children under one year 12,258 Attendances of children between the ages of one and five years 4,631 Average attendance per session 48.4 Table 9 relates to the Home Visits paid by the Health Visitors TABLE 9. (a) Expectant Mothers. First Visits 156 Total Visits 206 (b) Children under One Year of age. First Visits 1,017 Total Visits 2,724 (c) Children between the Ages of 1 and 5 years. Total Visits 4,945 (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 10. (a) Number of persons who were receiving children for reward at the end of the year 25 (b) Number of Children:— (1) At the end of the year 31 (2) Who died during the year 0 (3) On whom inquests were held during the year 0 15 (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 Particular attention was again given to the supervision of foster mothers in the area. Our routine procedure is now as follows:— On receipt of a Notice of Reception, sent by a mother, who is taking a child for the first time, the Assistant Medical Officer visits the house for the purpose of ascertaining the suitability of the environment, and deciding upon the maximum number of children whom the foster mother can take. This number is then officially given in writing. This is followed by a visit from the Child Protection Visitor, who gives the mother particulars of her obligations under the Public Health Act, 1936, and, later, by routine quarterly inspections, and additional inspections, when necessary. In all cases the foster mothers are persuaded to bring the children under five years of age to one of the Child Welfare Centres. The reports of the Visitors help the department to keep a check on the Register of Foster Parents and Children. In addition to the above, the Sanitary Inspectors carry out routine inspections and report upon their findings. All transfers out of the district are notified to the appropriate Medical Officer of Health of the district concerned. Occasionally, but I am glad to say infrequently, cases occur of failure on the part of some of the mothers to notify the department on reception or removal of a child. These are referred to the Town Clerk for suitable action. (iv) Inspection of Nursing Homes, Etc. The two Registered Nursing Homes in the area received the usual quarterly visits, when conditions were found to be satisfactory. At the end of the third quarter, one of these homes discontinued the reception of patients. 16 Routine investigations were also made by the Assistant Medical Officer, when notices were given by the midwives in Romford that they were liable to be a source of infection, by reason of attendance on patients who had developed a rise in temperature, indicating puerperal pyrexia, or where babies showed a rash, or discharges from the eyes. Reports on the results of these investigations have been forwarded to the County Medical Officer. (v) Adoption of Children (Regulation) Act, 1939. Again, at the request of the various Adoption Societies, many enquiries were made by the staff of the department as to the suitability of persons desiring to adopt children, and, on being informed by the societies that such children had been received, further inspections were carried out, and the Adoption Societies notified accordingly. I feel, however, that it would be an advantage if the Court, on granting an Adoption Order would, at the same time, inform the Health Department, so that a more complete check could be kept on adoptions. There has been a considerable rise in the numbers of adoptions during the war period, and, so far, there has been little evidence of abatement. The following statistics are given, as requested by Circular 2790 of the Ministry of Health. TABLE 11. (a) Number of persons who gave notice under Section 7 (3) during the year 0 (b) Total number of children "adopted" under the Section during the year 0 (c) Number of such children:— (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 — (vi) The Care of Illegitimate Children. The draft scheme of the Essex County Council, referred to in my last Report, was duly received, and presented to the Public Health Committee, which forwarded their observations, mainly of a financial character to the County. Further consideration was being given to this matter by the County Council at the end of the year. 17 (vii) The Care of Premature Children. Referring again to Ministry of Health Circular 20/44 the new "Notification of Birth" cards have now been forwarded to all Medical Practitioners and Midwives in the district. On these cards a space is provided for the weight at birth, when this is 5½ lbs. or less, this weight being taken arbitrarily as an indication of prematurity. Furthermore, two draught proof cots of the "Sorrento" type are available, with detachable linings, bedding, hot water bottles, special feeding bottles, etc., and can be delivered to the homes, upon request of Practitioners or Midwives. Experience will show if more than two cots are required. When it is necessary for a premature infant to be removed to hospital, an ambulance will be available with a supply of oxygen, and a heated carrier; part of the "Sorrento" cot can be used for conveyance. It has not been possible to obtain the services of a paediatrician for domiciliary attention, but it is hoped that, in time, we shall be able to utilise the services of the consultant paediatrician, who, at the end of the year, was appointed by the Essex County Council to Oldchurch Hospital. In this connection, we are in negotiation with the County. (viii) War-Time Nurseries. For the greater part of the year waiting lists had to be maintained for each of the three day nurseries, and the demand was most marked, on the return of families from evacuation. Later in the year, many mothers gave up their employment, and withdrew their children from the nurseries, or sought part-time employment, and left their children for a proportion of the day, or week, only. The requests from Romford mothers, for the admission of their children to the Rush Green Nursery, has again been insufficient to fill the nursery, and, in consequence, it has been possible to admit a number of children whose residence is in neighbouring districts. At any one time, at this nursery, approximately 50 per cent. of the admissions are from districts other than Romford. The average attendance for the year at each nursery is as follows:— TABLE 12. "St. Moritz" Nursery 33 Collier Row Nursery 29 Rush Green Nursery 26 18 The "St. Moritz" and Collier Row Nurseries are capable of taking 40 children each, and the Rush Green Nursery, 50 children. For most of the year it was possible to maintain a sufficiency of staff, but, towards the end of the year, there was a number of resignations, in part due to the return from Military Service of husbands of members of the staff, who no longer wished to continue in employment, or who moved out of the district. By the end of the year, however, practically full establishment had been reached, although several untrained helpers had to be employed to achieve this. Some of the probationers were successful in obtaining the Diploma, granted by the National Society of Children's Nurseries. Others failed on the first attempt, but were successful in a subsequent examination. Others could not be persuaded to re-sit, and left the nurseries. To supplement the full-time staff, assistance was given in the first part of the year by the personnel of the Civil Defence First Aid Posts, but this terminated on the cessation of the Posts. 3.—INSPECTION AND SUPERVISION OF FOOD. The Sanitary Inspectors, once again, under considerable difficulties owing to lack of staff, carried out their numerous duties in connection with the inspection of meat and other foods, at the Regional Slaughterhouse, the Meat Depots, Butchers' Shops, Stalls, Stores of the Ministry of Food, Civil Defence Canteens, etc., and, once more, we were grateful for the assistance rendered by the Sanitary Inspectors of the Dagenham Borough, and Hornchurch Urban District Councils, and especially to the Sanitary Inspectors of the former district, who readily gave us additional assistance when Hornchurch could no longer help us by reason of their own shortage of personnel. Since the return, however, of one of our Inspectors from Military Service at the beginning of November, we have been able to cope with the inspections ourselves. Altogether, 918 visits have been paid. At the Slaughterhouse alone, 14,507 carcases were examined. 4.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. As particulars, relative to the notifications of infectious diseases have not been published since 1938, I give below a suitable table, setting out the appropriate information. 19 TABLE 13. 1939. 1940. 1941. 1942. 1943. 1944. 1945. Cerebrospinal Fever 3(1) 7(2) 4 2 3 5(3) 10(4) Diphtheria 43(1) 58(9) 29(1) 24(2) 10(1) 3 9 Dysentery 3(2) - 3(1) 8(1) - 20(8) 15(10) Encephalitis Lethargica - 2 1 - - - 1 Enteric Fever 1(1) 21(11) 5(2) - - - 2 Erysipelas 20(2) 13(4) 16 13 13 18(2) 21(2) Infectious Jaundice - - - - - 46 14 Malaria 2 1(1) - 2 5 51(49) 15(6) Measles 1 30(2) 1014(16) 253 408 47 876(7) Ophthalmia Neonatorum 1 1 4(1) 2(1) 2(1) - - Polio-Encephalitis - - - - — — - Poliomyelitis 1(1) 2 3 1 - - 3(2) Pneumonia 30(1) 16(1) 53(14) 30 47 21 44(1) Puerperal Pyrexia 41(21) 23(14) 14(3) 9 6(2) 17(9) 27(12) Scarlet Fever 80(5) 96(4) 87(5) 212 198 137(1) 95(1) T.B. Respiratory 82 71 91 74 89 76 68 T.B. Non-Respiratory 23 11 18 16 19 6 9 Whooping Cough 4 7(1) 307 114 40 190(3) 74(1) The figures in brackets represent the notifications of cases reported from Oldchurch County Hospital. These are non-residents in the Borough. Measles and Whooping Cough were not notifiable until the latter part of 1939. Infective Jaundice, or, as it is sometimes called, Acute Infective Hepatitis was not notifiable until the end of 1943. (a) Scarlet Fever. This year, 94 cases of Scarlet Fever were notified with residence in the area. Most of these occurred during the last quarter, and, on the whole, were mild in character. (b) Diphtheria. Propaganda in connection with Diphtheria Immunisation was again maintained throughout the whole of the year, and all the Nursing Personnel of the Department, and the Sanitary Inspectors took every opportunity of proving its value to parents. Sessions for Immunisation and Schick Testing were again held at each Child Welfare Clinic, at the Schools and at the Day Nurseries. Once again the number of cases of Diphtheria was extremely small, reflecting the success of the scheme. The following statistics relate to the state of Immunisation as at 31st December, 1945. 20 TABLE 14. Under 5 yrs. yrs. No. of children who had completed a full course of Immunisation at any time up to 31st December, 1945, and who were born between 31st December, 1931, and 31st December, 1945 3,230 6,685 Approx. estimated No. of children 5,110 9,720 Percentage Immunised at 31st December, 1945 63 69 This, however, does not give a complete record as children, as a general rule, are not inoculated before reaching their first birthday. By allowing for this, the percentage of children immunised between one and five years of age is raised to 79. Table 15 gives the statistics since the inauguration of the scheme in Romford in 1935, till the end of 1945. TABLE 15. Number of Immunising injections given at the Clinics 23,125 Number of children who have completed the Course of Injections, either at the Clinics or Privately 10,676 Number of Schick Test Injections given at the Clinics, including Control Injections 15,293 Number who have been Schick Tested 7,666 Percentage found to be Immune after Course of Treatment 92.5 (c) Measles and Whooping Cough. Measles was epidemic from the months of January to June. There was no epidemic of Whooping Cough, although there was a slight rise in the number of cases during July. (d) Acute Infective Hepatitis. Fourteen cases of this disease were notified during the year, and, in accordance with Ministry of Health Circular 2883, the actual notification forms were forwarded each week to the Regional Medical Officer at Cambridge, or "Nil" returns were given, where appropriate. 21 (e) Smallpox. During the months of March and April information was received about certain passengers and crew proceeding to this area from ships reaching this Country from the East, and on which one or two cases of Smallpox had occurred. These contacts were visited, and kept under supervision, but no cases developed. On several occasions, I was called upon for consultation by the practitioners in the district to decide on the diagnosis of rashes suggestive of Smallpox, but none of the cases proved to be Small pox. (f) Typhus Fever. As in the case of Smallpox, information was received on one occasion about certain members of the crew proceeding to this area from a ship reaching this Country from the East, and on which a case of Typhus had occurred. The contacts were visited, and kept under supervision, but no cases developed. In addition to the above, information was given about passengers who had arrived by air from infected areas. These, also, were kept under observation, without further development. (ii) Non-Notifiable Diseases. (a) The relative prevalence of these is set out below, information being compiled from the school returns. TABLE 16. Chickenpox 133 Mumps 40 5.—SUPPLEMENTARY. (i) Water. Mr. Bernard W. Bryan, Engineer to the South Essex Waterworks Company, informs me that Bacteriological and Chemical Examinations are made of the raw water, of the water in its various stages of treatment, and of the water going into supply. Analyses are also made of samples obtained from consumers' taps in the various parts of the Company's district. A total of about 3,300 examinations were made. All proved to be satisfactory. Mr. Bryan also states that during the year the supply was sufficient, and that the water in the district is not plumbo-solvent. Approximately 0.2 per cent. of the inhabited houses, and 0.02 per cent. of the population of the Borough take their water from standpipes. 22 Further details as to the source of supply, and the process of treatment are given in my Report for the Year, 1944. In addition to the above analyses, samples of water have again been taken monthly from different premises in the district by the Sanitary Inspectors. These were submitted for Chemical" and Bacteriological Analyses, and the results have confirmed the findings of the Waterworks Company. (ii) The Rats and Mice (Destruction) Act, 1919. During this year, we were somewhat handicapped in our investigations in connection with the destruction of these vermin, by reason of the fact that the Rat Catcher resigned his duties, and thus threw an extra burden on the already depleted Sanitary Inspector's staff. However, the two remaining Sanitary Inspectors did their best, under the circumstances, to deal with as many , complaints as they could. At the latter part of the year we did obtain the services of another Rat Catcher, and it is now hoped that this work will proceed as satisfactorily as in the past. The new Rat Catcher is being trained in the methods of pre-baiting, and poison baiting, as recommended by the Infestation Branch of the Ministry of Food. Also, at the latter part of the year, the Borough Surveyor commenced the works in connection with disinfestation of the sewers. This was in consequence of an earlier test baiting, which revealed varying densities of rat infestation in different parts of the Borough. Unpoisoned bait is now placed in each foul sewer manhole in a particular section of the Borough on each of four consecutive days, and, on the fifth day, poison is added to the bait. By the end of the year, the number of rats affected by the poisoning were not known, but observations indicated some cases of neither the bait nor poison being taken, whilst in other instances there was slight evidence of amounts being removed, and, in other cases of large quantities having been taken. (iii) Infestation. This work continues as before. There are still very few cases of Lice infestation. When found, suitable cleansing of the person, and disinfestation, or destruction of clothing and bedding has been arranged. There has been a decided reduction in the number of cases of Scabies brought to our notice. (iv) Evacuation. During the first half of the year arrangements were still being made for the evacuation of expectant mothers, who wished to be evacuated during the last month of pregnancy. After this period, those arrangements terminated. 23 Whilst in operation, we again had the kind assistance of the Women's Voluntary Services, and the members of the Volunteer Car Pool, in the matte rof transport. (v) Air Raid Precautions. During this year, owing to the successful conclusion of hostilities, work in connection with Air Raid Precautions ceased, pending further instructions from the Government, and all equipment, not permitted to be retained by the personnel, was returned to store. Suitable letters of appreciation for the services rendered were sent to the personnel. TABLE 17. MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASES. Month. Scarlet Fever Diphtheria Puerperal Pyrexia Erybipelas Pneumonia Infective Hepatitis Poliomyelitis Dysentery Cerebro Spinal Fever Measles Whooping Cough Malaria Enteric Fever Encephalitis Lethargica Tuberculosis Total Resp. NonResp. January 7 1 1 1 10 1 - 2 — 18 2 3 — - 8 — 54 February 6 2 - 1 15 1 - — 4 71 2 - — — 5 — 107 March 1 1 5 2 5 — - — 1 313 3 - — — 4 2 337 April 6 1 3 3 1 3 — - 2 321 8 1 — — 4 — 353 May 7 - 3 3 2 2 — - 2 115 6 2 — — 7 2 151 June 4 3 — 1 - 2 — - — 24 10 2 — — 5 — 51 July 16 — 7 1 1 — — 12 — 10 7 1 1 — 4 — 60 August 1 1 3 1 1 - 1 - — 3 6 — — — 2 2 21 September 14 - - 3 — 2 1 1 — — 15 - — — 12 2 50 October 18 - 1 1 3 2 1 - — — 3 3 — 1 6 1 40 November 10 — 2 1 2 - — — 1 1 3 — — — 8 — 28 December 5 — 2 3 4 1 — — - — 9 3 1 — 3 — 31 Total 95 9 27 21 44 14 3 15 10 876 74 15 2 1 68 9 1,283 25 TABLE 18. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO AGE GROUPS. Disease. Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15 20 20-35 35-45 45-65 Over 65 Total Scarlet Fever 1 9 2 10 6 40 13 6 4 3 1 - 95 Diphtheria - - 1 1 1 1 1 - 4 - - - 9 Puerperal Pyrexia - - - - - - - 1 24 2 - - 27 Erysipelas - - - - - - - 1 5 3 6 6 21 Pneumonia 12 4 2 2 2 4 1 2 2 7 4 2 44 Infective Hepatitis - - - 1 - - 3 5 1 2 1 1 14 Poliomyelitis - - - - - 1 2 - - - - - 3 Dysentery - - 1 - - 5 3 2 2 1 1 - 15 Cerebro-Spinal Fever 1 1 - 2 - - 1 2 1 - 2 - 10 Measles 31 85 105 106 124 395 24 3 3 - - - 876 Whooping Cough 7 12 13 11 6 24 - - 1 - - - 74 Malaria - - - - - - - - 10 5 - - 15 Enteric Fever - 1 - - - 1 - - - - - - 2 Encephalitis Lethargica - - - - - - - - 1 - - - 1 Total 52 112 124 133 139 471 48 22 58 23 15 9 1,206 26 TABLE 19. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO WARDS Disease. Collier Row and Havering Ward. Gidea Park and Noak Hill Ward. South Ward. Town Ward. West Ward Total Scarlet Fever 38 15 17 17 8 95 Diphtheria 4 1 — 2 2 9 Puerperal Pyrexia 6 6 13 1 1 27 Erysipelas 8 3 3 6 1 21 Pneumonia 13 11 6 10 4 44 Infective Hepattiis 10 2 — 2 — 14 Poliomyelitis 1 — 2 - — 3 Dysentery 1 - 14 - — 15 Cerebro-Spinal Fever 3 2 4 1 — 10 Measles 324 153 146 171 82 876 Whooping Cough 31 24 8 7 4 74 Malaria 1 - 13 — 1 15 Enteric Fever — 2 — — - 2 Encephalitis Lethargica 1 — — — - 1 Tuberculosis: Respiratory 26 11 12 10 9 68 Non-Respiratory 3 1 3 1 1 9 Total 470 231 241 228 113 1,283 27 TABLE 20. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1945, AND HOSPITAL ADMISSIONS. Disease. Cases Notified. Cases Admitted to Hospital. Total Deaths. Scarlet Fever 95 34 - Diphtheria 9 9 2 Puerperal Pyrexia 27 7 - Erysipelas 21 2 - Pneumonia 44 16 45 Infective Hepatitis 14 2 - Poliomyelitis 3 1 - Dysentery 15 - - Cerebro-Spinal Fever 10 6 - Measles 876 6 - Whooping Cough 74 2 - Malaria 15 2 - Enteric Fever 2 2 - Encephalitis Lethargica 1 1 1 Total 1,206 90 48 28 TABLE 21. TUBERCULOSIS—NEW CASES AND MORTALITY DURING 1945. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 1 1 - - - - 1 - 5 2 2 2 1 - - 1 - 15 10 9 - 4 2 2 1 - 25 8 8 1 1 4 5 - - 35 8 3 - - 2 5 1 - 45 11 1 - - 2 1 1 - 55 - 2 - - 1 1 - - 65 and upwards 2 - - - 2 - - 1 Total 42 26 3 6 13 14 5 1 29 TABLE 22. OPHTHALMIA NEONATORUM. CASES Vision Unimpaired Vision Impaired Total Blindness Deaths Notified Treated At Home In Hospital Nil Nil Nil Nil Nil Nil Nil