LIBRARY ROM 21 BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1946. JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 1 BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1946. VV. & W. Ltd., Romford. JAMES B. SAMSON, M.D., D.P.H., Medical Officer of Health. 1 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December, 1946). His Worship The Mayor: Alderman G. F. Chaplin, J.P., C.C. Deputy Mayor: Alderman A. J. Dyer, O.B.E. Aldermen: Alderman C. H. Barney. Alderman W. M. Goldsmith. ,, R. G. L. Bowyer. ,, C. E. Smart. ,, R. A. Forge, J.P. Councillors: Councillor Mrs. W. Baskerville. Councillor A. McGonagle. H. A. Beck. ,, A. Needham. ,, Mrs. P. Besant. ,, J. R. Poel. ,, H. F. Davenport. ,, W. A. Reeder. ,, N. Eyre. ,, P. E. Reynolds. ,, W. S. Gardner. ,, G. Roberts. ,, J. A. R. Goode. ,, Mrs. E. S. South. ,, Mrs. 0. Haseltine. ,, G. A. Stafford, J.P. W. D. Hill. „ L. S. Webb. ,, Mrs. L. A. Irons. ,, R. Yeal. „ G. H. Issitt. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December, 1946). His Worship The Mayor: Alderman G. F. Chaplin, J.P., C.C. (Ex-officio member). Chairman: Councillor G. H. Issitt. Vice-Chairman: Councillor Mrs. B. S. South. Alderman R. A. Forge, J.P. Councillor Mrs. L. A. Irons. Councillor Mrs. W. Baskerville. ,, P. E. Reynolds. ,, Mrs. P. Besant. ,, L. S. Webb. ,, W. S. Gardner. Maternity and Child Welfare and Nurseries Committee. As above with the addition of— Mrs. V. M. Burt. Mrs. A. E. Evans. Mrs. L. H. Gomer. Mrs. E. A. White. Mrs. E. G. Yeal. 5 Education Committee. His Worship The Mayor Alderman G. F. Chaplin, J.P., C.C. (Ex-officio member). Deputy Mayor Alderman A. J. Dyer, O.B.E. (Ex-officio member). Chairman Alderman C. E. Smart. Vice-Chairman Alderman C. H. Barney. Representative Members Alderman R. G. L. Bowyer. Councillor J. R. Poel. Councillor H. P. Davenport. ,, G. Roberts. . ,, Mrs. O. Haseltine. ,, Mrs. E. S. South. ,, A. McGonagle. ,, G. A. Stafford, J.P. ,, A. Needham. ,, L. S. Webb. Nominated Members Mrs. D. Peake. County Alderman W. H. F. Webb. Co-Opted Members Mr. E. R. Bird. The Rev. C. V. Porter. Mr. F. W. Jackson Mr. F. W. Small. Mr. L. G. Peake, 6 Primary and Secondary Education Sub-Committee. His Worship The Mayor Alderman G. F. Chaplin, J.P., C.C. Chairman Alderman C. H. Barney. Vice-Chairman Councillor G. Roberts. Alderman A. J. Dyer, O.B.E. Councillor L. S. Webb. ,, C. E. Smart. Mr. E. R. Bird. Councillor Mrs. o. Haseltine. Mr. F. W. Jackson. ,, A- McGonagle. Mr. F. W. Small. ,, A. Needham. HEALTH DEPARTMENT. Public Health Staff. Medical Officer of Health. J. B. Samson, M.D., Ch.B., D.P.H. Assistant Medical Officers. (a) Elizabeth M. James, M.B., B.S., L.R.C.P., D.P.H. (b) A. P. Draper, M.C., M.A., M.D. Dental Officers. (a) P. A. Chandler, L.D.S., R.C.S. (Eng.). (b) Mrs. D. Shirlaw, L.D.S. (Edin.). Sanitary Inspectors. (a) W. S. Gent, Senior Sanitary Inspector, Certificate of the Royal Sanitary Institute; Certificate of the Liverpool University School of Hygiene for Meat and Other Foods. (b) H. C. Boswell, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Other Foods. (c) R. Martin, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Other Foods. (Resigned, 28th February, 1946). (d) J. F. Stables, Certificate of the Royal Sanitary Association, Scotland; Certificate of the Royal Sanitary Association, Scotland for Meat and Other Foods. (Commenced duties, 7th October, 1946). 7 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. Council Midwives. (a) Miss I. A. Bassett, State Certified Midwife. (b) Mrs. B. Drew, State Registered Nurse; State Certified Midwife. (Commenced duties, 2nd December, 1946). (c) Miss C. M. Kerr, State Registered Nurse; State Certified Midwife. (d) Mrs. M. Mylward, State Certified Midwife. (e) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (f) Mrs. D. Shaddick, Registered Sick Children's Nurse; State Certified Midwife. (Resigned, 22nd September, 1946). (g) Mrs. J. Thompson, State Registered Nurse; State Certified Midwife. (h) Miss M. R. Waddell, State Registered Nurse; State Certified Midwife. (i) Mrs. E. A. Whaley, State Certified Midwife. School Nurses. (a) Miss N. Harwood, State Registered Nurse. (b) Miss J. Jones, State Registered Nurse; State Certified Midwife. (c) Miss E. J. Morgan, State Registered Nurse; State Certified Midwife. Dental Attendants. (a) Mrs. E. M. Croom. (b) Mrs. M. Warder. 8 Clerks. (1) Permanent. (a) E. W. Cowers, Chief Clerk. (Reported for Military Service, 20th February, 1941. Resumed duties, 1st January, 1946). (b) C. G. Humberston, Chief Assistant. (Reported for Military Service, 20th November, 1940. Resumed duties, 3rd June. 1946). (c) S. Adams. (Reported for Military Service, 25th August, 1940. Resumed duties, 3rd June, 1946). (d) Miss B. Parker. (e) Miss M. E. Pollitt. (Reported for Military Service, 16th July, 1943). (2) Temporary. (a) L. Goold. (Resigned, 15th February, 1946). (b) Mrs. L. Canham. (c) Miss V. G. Coninghnm. (Resigned, 14th September, 1946). (d) Miss B. A. Cubitt. (Resigned, 19th July, 1946). Day Nurseries—Matrons. "St. Moritz." Mrs. o. Haga, State Registered Nurse. Collier Row. Miss A. H. Charity, State Registered Nurse. (Resigned, 31st August, 1946). Mrs. M. L. Kendall, State Registered Nurse. (Commenced duties, 6th May, 1946). Rush Green. Mrs. I. C. Bowyer, State Registered Nurse. (Commenced duties, 1st April, 1946). Mrs. M. Earl, State Registered Nurse; Registered Sick Children's Nurse. (Resigned, 4th April, 1946). 9 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 1946. This is the Thirteenth 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 13/47 of the Ministry of Health, dated 13th March, 1947. This Circular again states that the Report should be an Interim one. 1 feel that it would be appropriate to give a word of explanation for the apparent delay each year in the publication of the Annual Report of the Department. As a matter of fact, the greater part of the Report is drafted during the month of January following the termination of the calendar year to which it refers, but it is impossible to give particulars of the vital statistics until the Registrar-General has submitted his inward and outward transfers of deaths for the last quarter of the year, and these are not available, as a rule, until the month of March. Furthermore, the RegistrarGeneral's estimate of the mid-year population, and tabulation of statistics for local and National rates are not obtained until May or June. The delay, therefore, is outside the control of the Department. An interesting feature of the year under review was the approval of the Minister of Education on the 28th January of the Romford Education (Divisional Administration) Scheme, 1945, and the Borough then became an "Excepted" District for the purpose of the Education Act, 1944. Arising out of this, on the 1st October, 1946, your Medical Officer of Health was appointed Acting Borough School Medical Officer, and took over the administration of the School Health Services in the Borough as from that day. In this way it will be possible to achieve a still closer co-ordination of all health services in the district. As regards the question of Staff for the Department, we have again had to contend with a shortage of Sanitary Inspectors, and Health Visitors, and have, of necessity, had to adjust our work accordingly. It is to be hoped, however, that the future will offer brighter prospects in this direction. 10 In conclusion, as in the past, 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 O/ficer of Health. Town Hall, Eomford. May, 1947. 11 ANNUAL REPORT of Medical Officer of Health for the Year 1946 Statistics and Social Conditions of the Area. Area (in acres) 9,342 Population: Census (1931), 35,918. Mid. 1946 (Estd.) 65,9'20 Number of Inhabited Houses (end of 1946) 18,007 Rateable Value (end of 1946) £524,780 Product of Penny Rate (end of 1946) £2,042 Extracts from Vital Statistics for the Year. Total M. F. Live Birth: Legitimate 1,383 744 639 Illegitimate 79 42 37 Birth Rate: 22.2 per 1,000 of estimated resident population. Still Births: Legitimate 27 15 12 Illegitimate 4 3 1 Rate per 1,000 total (live and still) births: 20.8. Deaths 641 335 306 Death Rate: 9.7 per 1,000 estimated resident population. Deaths from Puerperal causes:— Deaths Rate per 1,000 total (live and still) births Prom Puerperal Sepsis - - Other Puerperal Causes 1 0.7 Total 1 0.7 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 41.7 Legitimate Infants per 1,000 legitimate live births 41.2 Illegitimate Infants per 1,000 illegitimate live births 63.3 Deaths from Cancer (all ages) 101 Deaths from Measles (all ages) Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 3 TABLE 1. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY and CASE-RATES for certain Infectious Diseases in the year 1946. ) England and Wales, London, 126 Great Towns and 148 Smaller Towns. (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 19.1 0.53 11.5 0.00 0.00 0.00 0.00 0.02 0.01 0.15 4.4 43 126 County Boroughs and Great Towns, including London 22.2 0.67 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.13 6.1 45 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) 21.3 0.59 11.7 0.00 0.00 0.00 0.00 0.02 0.01 0.14 2.8 37 London 21.5 0.54 12.7 0.00 0.00 0.01 0.00 0.02 0.01 0.12 4.2 41 ROMFORD 22.2 0.47 9.7 0.02 0.00 0.00 o.oo 0.02 0.02 0.06 2.1 42 Puerperal Sepsis Others Total The Maternal Mortality Rates for England and Wales are as follow: Per 1,000 Total Live Births 0.31 1.12, 1.43 ,, ,, ,, Romford are as follow: Per 1,000 Total Live Births 0.00 0.7 0.7 12 13 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 45- 54 5564 6574 75 & upwards 1. Typhoid and Paratyphoid Fevers ... 1 1 ... ... ... ... ... ... ... ... ... 1 ... 2. Cerebrospinal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough 1 ... 1 1 ... ... ... ... ... ... ... ... ... 6. Diphtheria l ... 1 ... ... 1 ... ... ... ... ... ... ... ... 6. Tuberculosis of Respiratory System 25 9 34 ... ... ... ... 4 5 7 5 9 3 1 7. Other forms of Tuberculosis 2 2 4 ... 1 2 ... ... ... ... ... 1 ... ... 8. Syphilitic disease 3 1 4 ... ... ... ... ... ... ... 1 ... 1 2 9. Influenza 1 3 4 ... ... ... ... ... ... 1 2 1 ... 10. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute Poliomyelitis and Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious Encephalitis 1 ... 1 ... ... ... ... ... ... ... ... l ... ... 13.M Cancer of Buccal Cavity, etc. 2 ... 2 ... ... ... ... ... 1 ... ... ... ... 1 13.F Cancer of Uterus ... 6 6 ... ... ... ... ... ... ... ... 4 1 1 14. Cancer of Stomach and Duodenum 13 4 17 ... ... ... ... ... ... ... 5 1 8 3 15. Cancer of Breast ... 14 14 ... ... ... ... ... 1 3 4 1 4 1 16. Cancer of all other sites 39 23 62 ... ... 1 1 ... 1 3 8 13 25 10 17. Diabetes 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 18. Intra cranial Vascular Lesions 15 36 51 1 ... ... ... ... ... 2 7 9 13 19 19. Heart Disease 89 88 177 ... ... ... ... ... 1 7 14 26 53 76 20. Other Diseases of the Circulatory System 11 13 24 ... ... ... ... ... ... 1 2 8 7 6 21. Bronchitis 16 9 25 2 1 ... ... ... ... 1 5 5 8 3 22. Pneumonia 17 17 31 7 1 ... ... ... 2 2 1 5 7 9 23. Other Respiratory Diseases 2 4 24 6 ... ... ... 1 ... ... 1 ... 1 2 1 24. Ulceration of the Stomach or Duodenum 6 1 7 ... ... ... ... ... 1 1 1 3 ... 1 25. Diarrhoea 1 2 3 3 ... ... ... ... ... ... ... ... ... ... 26. Appendicitis ... 2 2 ... ... ... 1 ... ... ... ... 1 ... 27. Other digestive eases 5 6 11 1 ... ... ... ... ... 2 1 3 3 1 28. Nephritis 9 7 16 ... ... ... ... 2 ... ... 1 4 6 3 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other Maternal causes ... 1 1 ... ... ... ... 1 ... ... ... ... ... 31. Premature Birth 13 6 19 19 ... ... ... ... ... ... ... ... ... ... 32. Congenital Malformations and Birth injuries ... 16 13 29 25 ... 2 l ... 1 ... ... ... ... ... 33. Suicide 7 2 9 ... ... ... ... ... ... 3 1 2 1 2 34. Road Traffic Accidents 4 ... 4 ... ... ... ... 2 1 ... 2 ... 1 1 35. Other violent causes 3 1 4 ... ... 1 ... ... ... 1 1 36. All other causes 32 35 67 2 l 2 1 3 4 8 9 8 29 Total 335 306 641 61 3 8 6 7 18 37 67 109 155 170 14 This year the Registrar-General has given his estimate of the mid-year population of Romford as 65,920 which compares with 57,960 last year, an increase of 7,960. It will noted that this is a substantial increase on the mid-year population for 1939, which was given as 57,460. As there has been practically no development since 1939, and, as several houses had to be written-off as a total loss, owing to enemy action, the increase in the population has of necessity led to undesirable overcrowding. For comparative purposes the Registrar-General includes Romford amongst the 148 smaller towns with populations ranging from 25,00 to 50,000 at the 1931 Census, and in this list Romford takes 7th place. As a matter of fact, there are a number of great towns, that is to say towns with a population greater than 50,000 at the 1931 Census, with a population now less than Romford. During 1946, the total number of live births registered was 1,462, and the total number of deaths registered was 641. The difference of 821 gives the natural increase in the population. As this number falls short of the Registrar-General's estimated increase of 7,960, it follows that the balance of 7,139 is made up of excess of Immigration over Emigration. For 1946, we estimate the Birth Rate to be 22.2 per 1,000 of the estimated resident population, an increase of 2.6 compared to 1945. This is the highest rate since 1920, which was 22.8. The Rate for England and Wales for 1946 is given as 19.1, and for the 148 smaller towns with populations ranging from 25,000 to 50,000 at the 1931 Census, the Rate is 21.3. The Death Rate for Romford is estimated at 9.7 per 1,000 of the estimated resident population. For last year the rate was 10.8. The comparable rates for England and Wales, and for the 148 smaller towns, as referred to above, are 11.5 and 11.7 respectively. The chief causes of death in order of frequency were:—1. Diseases of Heart and Circulation; 2. Cancer; 3. Bronchitis, Pneumonia, and Other Respiratory Diseases; 4. All Forms of Tuberculosis. The order remains the same as pre-war. The Maternal Mortality Rate, which is the number of Maternal Deaths, due to conditions associated with pregnancy or confinement, per 1,000 total (live and still) births is 0.7. The corresponding rate for England and Wales is 1.43. The Infant Mortality Rate, or the Death Rate of Infants under 1 year of age per 1,000 live births is 41.7 a rise of 1.3. The corresponding figures for England and Wales, and the 148 smaller towns are 43.0 and 37.0 respectively. 15 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. During the year there were again several changes amongst the members of the staff of the department, for the most part due to the return of serving members—these, in turn, replacing the temporary staff, who had carried on in their absence. Particulars are given at the beginning of this report. (ii) Laboratory Facilities. (a) Under our arrangement with the Essex County Council, the greater portion of the clinical material from the District is sent to the Oldchurch County Hospital Laboratory. (b) Under a similar arrangement, samples of Milk and Water are analysed at the Counties Public Health Laboratories, which, during the year, returned to London from their temporary premises in Romford. (c) Alum Precipitated Toxoid, used for the Immunisation of children against Diphtheria, was again issued free by the Sector Pathologist of the London Hospital Medical College. All these arrangements have proved satisfactory, and have not given rise to complaint. (iii) Nursing in the Home. (a) General Nursing. There are, in the district, 6 District Nurses, who devote their time to domiciliary nursing. Three of these are provided by the Romford District Nursing Association, two by the Collier Row District Nursing Association, and one by the Havering District Nursing Association. One of those provided by the Romford District Nursing Association undertakes general nursing duties only, whilst all the others combine their general nursing with midwifery. (b) Midwives. Our establishment of municipal midwives remains at 8, and, during the year, they were all fully employed. One resigned to take up similar employment with another Authority, but this vacancy was filled at the end of the year. Each of the Midwives took a special course in the administration of Gas and Air Analgesia, and, having been issued with the requisite equipment, are now prepared to make use of this in the course of their duties. 16 Further recommendations were forthcoming from the Rushcliffe Committee as to salaries, and these were put into operation. In addition to the Council Midwives, there were 2 Midwives in independent practice in the district, and also 5 District Nurse Midwives. Three 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 1946:— TABLE 3. As Midwives 489 As Maternity Nurses 163 (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. These sessions continued as before, as, also, the Consultative Ante-natal Clinic at Oldchurch County Hospital. Owing to the increased numbers attending, one additional session was held per month, this being restricted to new cases only. During 1946, 1,469 individual expectant mothers attended the clinics. In addition 20 mothers attended for post-natal advice. In all 208 sessions were held during the year. The total number of attendances of the 1,489 mothers mentioned above was 5,575, giving an average of 3.7 attendances per patient. The average number attending at each session was 26.8. (ii) Infant Welfare Clinics. This service continued on the same lines as last year, as, also, the close co-operation with the Local Food Office, which enabled satisfactory advantage to be taken of the schemes of the Ministry of Food for the distribution of National Dried Milk, and Food Supplements, 17 Regarding the provision of Dried Milk, and other preparations, not within the scope of the Ministry of Food, there were 56 applications received, and of these, 49 received free grants in accordance with the scale of the Council. During 1946, 353 Child Welfare Sessions were held, and the following table gives a summary of the attendances. TABLE 4. Individual children attending 2,612 Children attending for the first time 1,299 Medic.il consultations 7,286 Attendances of children under one year 15,430 Attendances of children between the ages of one and five years 5,276 Average attendance per session 58.7 Towards the latter part of the year, we were obliged to discontinue temporarily our scheme for the dental treatment of Nursing and Expectant Mothers, and Children under five years of age, owing to disagreement as between the private dental practitioners and the Minister of National Insurance on financial matters. On the recommendation of the Assistant Medical Officer, cases requiring Ultra-violet Ray Therapy have received this at special sessions held at the clinics. Other requisite forms of treatment, e.g., Ear, Nose, and Throat Treatment, Circumcisions, Treatment for Eye defects, etc., have been given in accordance with the Council's schemes. (iii) Home Visits. Table 5 relates to the Home Visits paid by the Health Visitors. TABLE 5. (a) To Expectant Mothers— First Visits 122 Total Visits 172 (b) To Children under one year of age— First Visits 1,456 Total Visits 2,484 (c) To Children between the ages of one and five years— Total Visits 4,833 As in the case of the Midwives, further recommendations from the Rushcliffe Committee were approved by the Council, and given effect as from the 1st January. 18 (iv) Child Life Protection. 1]] Romford, each Health Visitor also holds the appointment of Child Protection Visitor under Sections '206 to 220 of the Public Health Act, 1936. TABLE 6. (a) Number of persons who were receiving children for reward at the end of the year 30 (b) Number of Children:— (1) Received during the year 73 (2) At the end of the year 33 (3) Who died during the year 2 (4) 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 - Once again particular attention was given to the supervision of foster mothers in the area, on the lines set out in my report of 1945. (v) Adoption of Children (Regulation) Act, 1939. Again, at the request of the various Adoption Societies, many enquiries were made by the Assistant Medical Officer, and the Health Visitors 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 Societies notified accordingly. When any doubts arose as to the status of an organisation, desiring to place children for adoption, the appropriate Medical Officer of Health of the district in which the organisation was situated was given full particulars, in order to enable him to deal with the matter. 19 The following statistics are given, as requested by the Ministry of Health:— TABLE 7. (a) Number of persons who gave notice under Section 7(3) during the year 3 (b) Total number of children in respect of whom notice was given under Section 7(3) during the year 3 (c) Number of such children:— (i) Under supervision at the end of the year 1 (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. So far as the County Districts are concerned, this matter is still under the County's consideration, but during the year, the Health Visitors in this area carried out the necessary enquiries, on behalf of the County Council, at the homes of prospective foster parents, under the County's scheme. Furthermore, this Council sent two mothers with their children to a Hostel for Mothers and Children at "Ardmare", Buckhurst Hill. (vii) The Care of Premature Children. The arrangements we have for the care of premature children was described in my report for last year, and use was made of these facilities during the present year. (viii) Inspection of Nursing Homes, Etc. The one Registered Nursing Home in this area again received quarterly inspections, when conditions were found to be satisfactory. Routine investigations were also made by the Assistant Medical Officer, when notices were given by the midwives in Romford as to their liability 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 of the results of these investigations were forwarded to the County Medical Officer. (ix) Day Nurseries. Arising out of the combined Ministry of Health Circular No. 221/45, and the Ministry of Education Circular No. 75, this Authority decided to continue the services rendered by the 3 War-Time Nurseries already existent in the district. 20 The requests from Romford mothers, for the admission of their children to the Rush Green Nursery, lias again been insufficient to fill the Nursery, and in consequence, it has been possible to admit a number of children whose residence is in the neighbouring districts of Dagenham, and Hornchurch. Periodically, we had difficulty in maintaining sufficient staff at the nurseries, but, fortunately, this had no reaction on the care of the children. The amended recommendations of the Rushcliffe Committee were approved by the Council. The average attendance for the year at each nursery is as follows :— TABLE 8. "St. Moritz" Nursery 31 Collier Row Nursery 23 Rush Gre.en Nursery 28 The "St. Moritz" and Collier Row Nurseries are capable of taking 40 children each, and the Rush Green Nursery, 50 children. 3.—SANTARY CIRCUMSTANCES OF THE AREA. (i) Water. Mr. Bernard W. Bryan, General Manager of the South Essex Waterworks Company, has again confirmed that Bacteriological and Chemical Examinations have been made of the raw water, of the water in its various stages of treatment, of the water supplied from the Company's wells, and of the water going into supply. Analyses have also been 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 wholesome, and constant throughout, and with no plumbo-solvent action. Approximately 0.2 per cent, of the inhabited houses, and 0.2 per cent, of the population of the Borough take their water from standpipeg. 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 liav.e invariably confirmed the findings of the Waterworks Company. (ii) The Rats and Mice (Destruction) Act, 1919. As stated in last year's report, the Rodent Operative received the necessary training in the methods of pre-baiting, and poison baiting, as recommended by the Infestation Branch of the Ministry of Food, and dealt appropriately with all complaints, in addition to routine inspections and re-inspections. 21 In connection with the disinfestation of sewers, the Borough Surveyor informs me that poison baiting was completed during the first quarter of the year, and, as a result, the Ministry of Food estimate that approximately 1,787 rats were destroyed. (iii) Infestation. There is no fresh development to report in this section. Cases of Lice infestation are relatively few in number, and the reduction in cases of Scabies, previously mentioned, has been maintained. When infestation is found, cleansing, disinfestation, and destruction of clothing and bedding, when necessary, have been arranged. (iv) Sanitary Inspection of the Area. The Senior Sanitary Inspector has given me the following report as required by Article 27(18) of the Sanitary Officers (Outside London) Regulations, 1935. TABLE 9. (a) Nature and Number of Inspections during the year:— Bakehouses 24 Butchers' Shops and Stalls, etc. 88 Common Lodging Houses 9 Cowsheds, Dailies and Milk Shops 24 Drainage 521 Establishments for Massage and Special Treatment 8 Factories (Mechanical Power) 13 Factories (Non-Mechanical Power) 9 Food Preparing Premises 52 Food Shops 341 Foster Mothers 29 Infectious Disease 300 Keeping of Animals 12 Markets 90 Meat Depots 149 Public Baths 20 Public Conveniences 23 Rats and Mice (Destruction) Act 4,436 Scabies 21 Shops Acts 11 Slaughterhouses 346 Stables 7 Streams and Ponds 4 Tents, Vans and Sheds 51 Verminous Premises 39 Water Supplies 25 (b) Informal Notices (Number served) 604 Statutory Notices (Number served) 25 22 (c) As the result of the service of notices, the necessary works were completed, by the owners or occupiers in all cases except '281, the works for which were still in hand at the end of the year. (v) Factories Act, 1937. It 13 noted from Ministry of Health Circular 13/47 that, in respect of the year 1947, amended statistics will be required in connection with the above Act. The following table is, therefore, given for the year under review in the form which was required, immediately prior to the outbreak of the war. TABLE 10. 1. Inspections. Premises. Inspections. Written Notices. Occupiers Prosecuted. Fiictories with mechanical power 13 3 — Factories without mechanical power 9 2 — Other premises under the Act — — — Totals 22 5 — 2. Defects Found. Particulars. Number of Defects Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness — — — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — — Sanitary Conveniences:— Insufficient 5 3 — — Unsuitable or defective 3 2 — — Not separate for sexes — — — — Other, offences 2 2 — — Totals 10 7 — — 3. Outwork in Unwholesome Premises—Nil. The defects, which were not remedied were outstanding at the end of the year. 23 4.—INSPECTION AND SUPERVISION OF FOOD. The Sanitary Inspectors have as usual had to give a considerable amount of time to the inspection of meat and other foods at the Regional Slaughterhouse, the Meat Depots, Butchers' Shops, Stalls, etc., and once more we were grateful for the additional assistance rendered by the Sanitary Inspectors of the Dagenham Borough, and Hornchurch Urban District Councils, who, for the purpose of carrying out inspections, have attended at the Regional Slaughterhouse on one day of each week. Since the appointment, however, of a Second Additional Inspector in (his area, we have been able to cope with all the inspections ourselves. Altogether, 1,000 visits have been paid. At the Slaughterhouse alone, 16,136 carcases were examined. 5.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. (a) Acute Infective Hepatitis. 31 cases of this disease were notified during the year, and, as investigations are still being made into the cause, and mode of distribution of this condition, the actual notifications were forwarded each week to the Regional Medical Officer at Cambridge, or "Nil" returns, where applicable. (b) Diphtheria. During 19-16, 7 cases were notified with residence in the area. The number of cases of this disease continues to be very few, and, in part at any rate, this can be accounted for by the large number of children, who have been artificially immunised. It may also, however, be due to a periodic diminuation in the virulence of the infecting organism. It is impossible to say which has the greater influence, but there is no doubt that the former plays a very considerable role in the present freedom of the district from Diphtheria. Propaganda in connection with Diphtheria Immunisation was again maintained throughout the whole of the year, and I feel sure that, of all forms of propaganda, the most fruitful is that given by personal persuasion of the staff to the individual mothers. This is achieved not only by individual contact at the various clinics, but also in the homes by routine and follow-up visits. Sessions for Immunisation were again held at each Child Welfare Clinic, at the Schools, and at the Day Nurseries, and, in addition, a free issue of material was given to any practitioner, who asked for it. 24 The following statistics relate to the state of Immunisation as at 31st December, 1946. TABLE 11. Under 5 yrs. 5-15 yrs. No. of children who had completed a full course of Immunisation at any time up to 31st December, 1946, and who were born between 31st December, 193'2 and 31st December, 1946 3,590 7,118 Approx. estimated No. of children 5,580 10,210 Percentage Immunised at 31st December, 1946 64 70 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 78. Table 12 gives the statistics since the inauguration of the scheme in Romford in 1935, till the end of 1946l TABLE 12. Number of Immunising injections given at the Clinics 25,248 Number of children who have completed the course of Injections, either at the Clinics or Privately 12,070 Number of Schick Test Injections given at the Clinics, including Control Injections 16,229 Number who have been Schick Tested 8,134 Percentage found to be Immune after Course of Treatment 92.9 (c) Measles. 550 cases were notified with residence in the area, and for the most part they occurred during the months of June and July. (d) Scarlet Fever. This year 73 cases were notified with residence in the area. For many years now this disease has been of very mild manifestation, and, in fact, would again seem to come within the description given to it by Sydenham, in 1676, when he said of it that it hardly rose above a name. Other forms of illness, of course, caused bv the Haemolytic Streptococcus, and which is the organism responsible for Scarlet Fever, e.g., Sore Throats are of relatively frequent occurence, but are not notifiable. 25 (e) Smallpox. There were no cases reported in the district, but 2 or 3 cases were reported in the County. Supervision of contacts of these cases, resident in Romford was maintained for the requisite period, and, also, of contact passengers and crew proceeding to this area from ships, and aircraft reaching this Country from abroad. Again my services were freely given to practitioners in a consultative capacity, where any doubt existed. (f) Typhus Fevf.r. Here, also, information was received on several occasions of passengers who had arrived by air from infected areas. These were kept under surveillance, without further development. (g) Whooping Cough. 199 cases were notified with residence in the area, and the majority of these occurred during the first four months of the year. (ii) Non-Notifiable. There are now relatively few diseases which are non-notifiable. The prevalence of these, during the year, is set out below, but they are of necessity a low estimate, as the figures are compiled from the school returns only. TABLE 13. Mumps 382 Chickenpox 221 Rubella 4 •26 TABLE 14. MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASES Month. Scarlet Fever Diphtheria Enteric Fever Puerperal Pyrexia Pneumonia Cerebro Spinal Fever Dysentery Erysipelas Malaria Measles Ophthalmia Neonatorum Whooping Cough Infective Hepatitis Tuberculosis Total Resp. NonResp. January 8 — — 2 4 2 2 — — 1 — 7 — 3 4 33 February 8 — 1 3 10 1 — 4 — — — 30 3 6 — 66 March 10 — — 3 8 1 1 3 — 8 .— 34 2 8 — 78 April 11 — — 5 9 — — 6 — 18 — 41 5 13 4 112 May 3 — — — 7 — — 1 — 73 — 25 5 8 1 123 June 6 — — — 5 1 — 6 2 104 — 18 2 6 1 151 July 8 — — — 6 1 3 — 218 — 17 4 5 1 263 August 6 — 1 1 2 — — 1 — 62 — 11 4 4 3 95 September 2 — — 1 2 — — 2 — 9 — 4 2 6 2 30 October 3 1 — 4 5 — — 3 — 28 1 5 1 9 1 61 November 4 2 — 5 9 — — — 1 23 — 5 2 14 1 65 December 7 4 — 9 19 — — 2 — 8 — 3 1 7 2 62 Total 76 7 2 33 86 6 3 31 2 552 1 200 31 89 20 1,139 27 TABLE 15. 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 — 2 5 5 6 42 9 6 1 1 — — 76 Diphtheria — — 1 1 — 2 — — 3 — — — 7 Enteric Fever — — — — — — — — 1 1 — — 2 Puerperal Pyrexia — — — — — — — 2 28 3 — — 33 Pneumonia 8 8 4 8 5 15 2 3 4 10 15 4 86 Cercbro-Spinal Fever — — — — — 1 1 1 1 1 1 — 6 Dysentery — — — 1 — 1 — 1 — — — — 3 Erysipelas — — 1 1 — — — 1 12 6 9 1 31 Malaria — — — — — — — — 2 — — — 2 Measles 18 45 57 88 83 244 12 1 3 1 — — 552 Ophthalmia Neonatorum 1 — — — — — — — — — — — 1 Whooping Cough 21 25 29 30 19 72 1 — 2 1 — — 200 Infective Hepatitis — — — 1 — 4 4 7 8 3 3 1 31 Total 48 80 97 135 112 381 29 22 65 27 28 6 1,030 28 TABLE 16. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO WARDS Disease. Collier Row and Havering Ward. Gidea Park and Noak Hill Ward. Mawney Ward. West Ward. South Ward. Town Ward. Hare Park Ward. Total Scarlet Fever 20 14 12 8 14 3 5 76 Diphtheria — — — 2 — 5 — 7 Enteric Fever — — — 1 1 — — 2 Puerperal Pyrexia 2 1 2 — 25 2 1 33 Pneumonia 7 12 14 15 13 20 5 86 Cerebro-Spinal Fever 1 1 1 — 2 — 1 6 Dysentery 1 — — — 2 — — 3 Erysipelas 4 3 5 8 1 9 1 31 Malaria — — 1 — 1 — — 2 Measles 209 33 91 59 50 82 28 552 Ophthalmia Neonatorum — — — — 1 — — 1 Whooping Cough 77 15 22 20 16 35 15 200 Infective Hepatitis 6 4 7 1 2 5 6 31 Tuberculosis: Respiratory 22 2 15 7 14 13 16 89 Non-Respiratory 4 3 3 1 2 3 4 20 Total 353 88 173 122 144 177 82 1,139 29 TABLE 17. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1946, AND HOSPITAL ADMISSIONS. Disease. Cases Notified. Cases Admitted to Hospital. Total Deaths. Scarlet Fever 76 23 — Diphtheria 7 7 1 Enteric Fever 2 2 1 Puerperal Pyrexia 33 28 — Pneumonia 86 19 34 Cerebro-Spinal Fever 6 6 — Dysentery 3 2 — Erysipelas 31 5 — Malaria 2 2 — Measles 552 10 — Ophthalmia Neonatorum 1 1 — Whooping Cough 200 9 1 Infective Hepatitis 31 2 — Total 1,030 116 37 30 TABLE 18. TUBERCULOSIS—NEW CASES AND MORTALITY DURING 1946. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 — — — — — — — —- 1 1 — 2 — — — 1 2 5 2 4 1 6 — — 1 — 15 8 10 1 2 3 1 — — 25 21 12 2 1 3 3 — — 35 12 3 2 2 4 3 — — 45 7 — — 1 3 1 — — 55 6 — — — 9 — — — 65 and upwards 1 2 — 1 2 1 — — Total 58 31 8 12 25 9 2 2 31 TABLE 19. OPHTHALMIA NEONATORUM. Notified CASES Vision Unimpaired Vision Impaired Total Blindness Deaths Treated At Home In Hospital 1 Nil 1 1 Nil Nil Nil