ROM 22 BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1947 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1947 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December, 1947). His Worship The Mayor: Councillor L. S. Webb, J.P. Deputy Mayor: Alderman A. J. Dyer, O.B.E. Aldermen: Alderman C. H. Barney. Alderman R. A. Forge, J.P. ,, R. G. L. Bowyer. ,, W. M. Goldsmith. ,, G. F. Chaplin, ,, C. E. Smart. J.P., C.C. Councillors: Councillor P. J. Bartaby. Councillor A. Keeble. ,, Mrs. W. Baskerville. ,, A. McGonagle. ,, H. A. Beck. ,, Mrs. M. L. ,, H. F. Davenport. McWeeney. ,, S. Y. Ellmore. ,, A. Needham. W. S. Gardner. „ J. R. Poel. W. D. Hill. ,, W. A. Reeder. ,, Mrs. L. A. Irons. ,, G. Roberts, J.P. ,, G. H. Issitt. ,, Mrs. E. S. South. ,, C. L. Jones. ,, R. Yeal. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE. His Worship The Mayor: Councillor L. S. Webb, J.P. (Ex-officio member). Chairman: Councillor G. H. Issitt. Vice-Chairman: Councillor Mrs. W. Baskerville. Alderman W. M. Goldsmith. Councillor Mrs. M. L. McWeeney. Councillor W. S. Gardner. ,, G. Roberts, J.P. ,, Mrs. L. A. Irons. ,, Mrs. E. S. South. Maternity and Child Welfare and Nurseries Committee. As above with the addition of:— Mrs. V. M. Burt. Mrs. A. E. Evans. Mrs. L. N. Gomer. Mra. E. A. White. Mrs. E. G. Yeal. 6 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. Haga, M.B., B.S., L.R.C.P., D.P.H. (b) A. P. Draper, M.C., M.A., M.D. Sanitary Inspectors. (a) W. S. Gent, Senior Sanitary Inspector, Certificate of the Eoyal 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) J. F. Stables, Certificate of the Royal Sanitary Association, Scotland; Certificate of the Royal Sanitary Association, Scotland for Meat and Other Foods. Health Visitors. (a) Mrs. E. J. Bingham, State Registered Nurse; State Certified Midwife. (Part-Time Service from 3rd January, 1947). (b) Miss 0. 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. (Resigned 12th September, 1947). (c) Miss C. M. Kerr, State Registered Nurse; State Certified Midwife. (d) Miss M. Kitson, State Registered Nurse; State Certified Midwife. (Commenced duties, 10th September, 1947). (e) Mrs. M. Mylward, State Certified Midwife. Council Midwives—continued. (f) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (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. Clerks. (a) E. W. Gowers, Chief Clerk. (b) C. G. Humberston, Chief Assistant. (c) S. Adams. (d) Mrs. J. Flavell. (Commenced duties, '29th September, 1947). (e) Miss B. Parker. (f) Miss M. E. Pollitt. (Resigned, 29th August, 1947). Home Help Organiser. Mrs. L. Canharn. Day Nurseries—Matrons. "St. Moritz." (a) Mrs. 0. Haga, State Registered Nurse. (Resigned, 19th April, 1947). (b) Mrs. I. C. Bowyer, State Registered Nurse. (Commenced duties, 20th April, 1947). Collier Row. Mrs. M. L. Kendall, State Registered Nurse. Rush Green. (a) Miss W. D. Bowtle, State Registered Nurse. (Commenced duties, 20th April, 1947. Resigned, 11th September, 1947). (b) Mrs. G. Pease, Registered Children's Nurse. (Commenced duties, 12th September, 1947). 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 1947. This is the Fourteenth 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 170/47 of the Ministry of Health, dated 31st December, 1947. This Circular again states that the Report should be an Interim one. The year 1947 has been one of the most active and strenuous in the field of Public Health, and the various services have been strained to the utmost. The reason for this strain has been partly due to a lack of staff, and partly to the changing conditions, which prevail at the present day. With regard to staff, there has been a shortage of Health Visitors, a shortage of Sanitary Inspectors, and a shortage of Day Nursery personnel, whilst, on the other hand, there has been a rise in the birth rate, with an increased demand on the Child Welfare services, a rise in population, partially accounted for by the rise in the birth rate, and partly by the influx of families to the developing L.C.C. estate at Harold Hill, an increased number of applications from overcrowded families, who desire alternative accommodation, and an increased request for the admission of children to the Day Nurseries. Nevertheless, thanks to the active co-operation of all the staff of the department, these demands have been met to the best of our ability, and, as the following pages will show, I trust to the general satisfaction of the public. In July next, with the coming into operation of the National Health Service Act, a new era will commence in the Public Health Service, but this will mainly be evolutionary in character, and a natural progression from the schemes which the Romford Council has been developing over a number of years. 8 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. May, 1948. 9 ANNUAL REPORT of Medical Officer of Health for the Year 1947 Statistics and Social Conditions of the Area. Area (in acres) 9,342 Population: Census (1931), 35, 918. Mid. 1947 (Estd.) 68,860 Number of Inhabited Houses (end of 1947) 19,203 Rateable Value (end of 1947) £550,625 Product of Penny Rate (end of 1947) £2,204 Extracts from Vital Statistics for the Year. Total M. F. Live Births: Legitimate 1,557 808 749 Illegitimate 67 33 34 Birth Bate: 23.6 per 1,000 of estimated resident population. Still Births: Legitimate 25 10 15 Illegitimate 2 — 2 Bate per 1,000 total (live and still births: 16.4. Deaths 667 328 339 Death Bate: 9.7 per 1,000 estimated resident popuation. Deaths Rate per 1,000 total (live and still) births Deaths from Puerperal causes:— From Puerperal Sepsis — — Other Puerperal Causes 1 0.6 Total 1 0.6 Death Bate of Infants under one year of age:— All Infants per 1,000 live births 24.0 Legitimate Infants per 1,000 legitimate live births 21.2 Illegitimate Infants per 1,000 illegitimate live births 89.6 Deaths from Cancer (all ages) 113 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 4 10 TABLE 1. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY and CASE-RATES for certain England and Wales London, 126 Great Towns and Infectious Diseases in the year 1947. 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-p<>x Measles Scarlet fever Whooping cough Diphtheria Influenza Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year Live Births Stillbirths England and Wales 20.5 0.50 12.0 0.00 0.00 0.01 0.00 0.02 0.01 0.09 5.8 41 126 County Boroughs and Great Towns, including London 23.3 0.62 13.0 0.00 0.00 0.02 0.00 0.03 0.01 0.09 8.0 47 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) 22.2 0.54 11.9 0.00 0.00 0.02 0.00 0.02 0.01 0.08 3.7 36 London 22.7 0.49 12.8 0.00 0.00 0.01 0.00 0.02 0.01 0.08 4.8 37 ROMFORD 23.6 0.39 9.7 0.00 0.00 0.00 0.00 0.03 0.00 0.03 2.4 24 Puerperal Sepsis Others Total The Maternal Mortality Rates for England and Wales are as follow: Per 1,000 Total Live Births 0.26 0.91 1.17 ,, ,, ,, Romford are as follow: Per 1,000 Total Live Births 0.00 0.6 0.6 11 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 Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough 1 1 2 2 ... ... ... ... ... ... ... ... ... ... 6. Diphtheria ... ... ... .. ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of Respiratory System 20 9 29 ... ... ... ... 4 5 11 6 2 ... 1 7. Other forms of Tuberculosis 1 1 2 ... ... ... 1 1 ... ... ... ... ... ... 8. Syphilitic disease ... 1 4 ... ... ... ... ... ... ... 1 1 1 1 9. Influenza 1 1 2 ... ... ... ... ... ... ... ... 1 1 ... 10. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute Poliomyelitis and Polioencephalitis 2 ... 2 ... ... ... 1 ... 1 ... ... ... ... ... 12. Acute infectious Encephalitis ... 1 1 ... ... ... ... ... ... ... ... 1 ... ... 13.M Cancer of Buccal Cavity, etc. 3 ... 3 ... ... ... ... ... ... ... ... ... 1 2 13.F Cancer of Uterus ... 5 5 ... ... ... ... ... ... ... 1 3 1 ... 14. Canccr of Stomach and Duodenum 9 9 18 ... ... ... ... ... ... ... 5 5 6 9 15. Cancer of Breast ... 14 14 ... ... ... ... ... ... ] 2 ... 7 1 16. Cancer of all other sites 39 34 73 ... ... ... ... ... 1 2 11 23 20 16 17. Diabetes 2 6 8 ... ... 1 ... ... 2 ... ... ... 4 1 18. Intra cranial Vascular Lesions 31 46 77 ... ... ... ... ... 1 ... 2 11 29 34 19. Heart Disease 96 99 195 ... ... ... ... 2 2 3 13 23 58 94 20. Other Diseases of the Circulatory System 13 10 23 ... ... ... ... ... ... ... 2 2 9 10 21. Bronchitis 23 22 45 1 1 ... ... ... 2 2 3 7 8 21 22. Pneumonia 13 15 28 7 ... 2 ... 1 1 1 2 1 6 7 23. Other Respiratory 24 Diseases 5 4 9 ... ... ... ... ... 1 1 1 1 2 3 21. Ulceration of the Stomach or Duodenum 5 ... 5 ... ... ... ... ... ... 1 1 ... 1 2 25. Diarrhoea 2 2 4 3 1 ... ... ... ... ... ... ... ... ... 26. Appendicitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27. Other digestive dis eases 5 8 13 2 ... ... ... ... ... ... 2 ... 3 6 28. Nephritis 5 6 11 ... ... ... ... ... ... ... 1 1 2 7 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other Maternal causes ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... 31. Premature Birth 4 5 9 9 ... ... ... ... ... ... ... ... ... ... 32. Congenital Malformations and Birth injuries 9 7 16 13 1 ... ... 1 ... 1 ... ... ... ... 33. Suicide 2 3 5 ... ... ... ... 1 1 ... ... 1 2 ... 34. Road Traffic Accidents 3 1 4 ... ... ... 1 1 ... 1 ... ... 1 ... 35. Other violent causes 7 6 13 1 ... ... 1 2 1 4 ... 1 1 2 36. All other causes 24 22 46 1 ... 1 2 2 3 1 3 8 4 21 Total 328 339 667 39 3 4 6 15 21 30 56 92 167 234 12 This year the Registrar-General has given his estimate of the mid-year population of Romford as 68,860 which compares with 65,920 last year, an increase of 2,940. For comparative purposes the Registrar-General includes Romford amongst the 148 smaller towns with populations ranging from 25,000 to 50,000 at the 1931 Census, and in this list Romford takes 6th place. During 1947, the total number of live births registered was 1,624, and the total number of deaths registered was 667. The difference of 957 gives the natural increase in the population. As this number falls short of the Registrar-General's estimated increase of 2,940, it follows that the balance of 1,983 is made up of excess of Immigration over Emigration, and this is largely accounted for by the development of the Harold Hill Estate. For 1947, we estimate the Birth Rate to be 23.6 per 1,000 of the estimated resident population, an increase of 1.4 compared with 1946. The Rate for England and Wales for 1947 is given as 20.5, and for the 148 smaller towns with populations ranging from 25,000 to 50,000 at the 1931 Census, the Rate is 22.2. The Death Rate for Romford is estimated at 9.7 per 1,000 of the estimated resident population. For last year the rate was 9.7. The comparable rates for England and Wales, and for the 148 smaller towns, as referred to above, are 12.0 and 11.9 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 last year. 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 0.6. The corresponding rate for England and Wales is 1.17. The Infant Mortality Rate, or the Death Rate of Infants under 1 year of age per 1,000 live births is 24.0 a decrease of 17.7. The corresponding figures for England and Wales, and the 148 smallertowns are 41.0 and 36.0 respectively. 13 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. During this year, there were again several staff changes, which is to be expected with an Establishment of the present size. For the most part, they occurred amongst the members of the Day Nursery Staff. In several instances it has been difficult to fill the vacancies, and, in some cases, impossible e.g. with the Health Visitors, which has placed an undue strain upon those remaining, and a great deal of credit must be given to those who do remain for the satisfactory condition of the work. At the beginning of the year, Mrs. E. J. Bingham relinquished her full-time duties as a Health Visitor, after 23 years of meritorious service with the Council, but we were fortunate in being able to retain her in a part-time capacity. Particulars of the staff are given at the beginning of this report. (ii) Laboratory Facilities. The facilities are as indicated in my report for last year, without any amendment. (iii) Nursing in the Home. (a) General Nursing. There are in the area, 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. During the year, the Collier Row District Nursing Association suffered a grievous loss by the sudden death of Nurse Whitton, whilst she was on duty. Nurse Whitton had given excellent service for many years in the Collier Row area, and she will be sadly missed by all her patients, who were also her friends. Most of the District Nurses combine Midwifery with their General Nursing. (b) Midwives. Our Establishment of Municipal Midwives remains at 8. One resigned for domestic reasons, but we were fortunate in being able to fill the vacancy. All the Midwives are now trained in the administration of Gas and Air Analgesia, and this is offered in every case. In this connection, and to enable the Midwives to carry about the apparatus, which is rather cumbersome, arrangements have been made with the Essex County Council to provide each Midwife with a car, and, pending the delivery of cars, the Midwives have been permitted to use taxi-cabs for this purpose. 14 la accordance with the recommendations of the Rushcliffe Committee, 2 of the Midwives attended a post certificate course of training, of approximately 1 week's duration, at Bristol and London respectively. In addition to the Council Midwives, there are 4 Midwives in independent practice in the district, and also 4 District Nurse Midwives. Five 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 1947:— TABLE 3. As Midwives 465 As Maternity Nurses 194 (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, except that the charge for Institutional treatment at Oldchurcli County Hospital for Maternity Cases has now been raised from 14/- per day to 15/8 per day. This is the first increase which has been made in the charge for many years. 2.—MATERNITY AND CHILD WELFARE. (i) Ante-Natal Clinics. Both the Ante-natal sessions at the Council Clinics, and the Consultative session at Oldchurcli County Hospital have been continued as during 1946, with the addition of 2 sessions per month at the Marks Road Clinic. During the year, 1,545 individual expectant mothers attended the clinics. In addition 31 mothers attended for post-natal advice. In all 213 sessions were held. The total number of attendances of the 1,576 mothers mentioned above was 6,037, giving an average of 3.8 attendances per patient. The average number attending at each session was 28.3. (ii) Infant Welfare Clinics. This service was augmented during the year by the establishment. of an additional weekly session at Collier Row Clinic, necessitated by the increased numbers attending this Clinic. 15 There was the usual close co-operation with the Local Food Office, which enabled satisfactory advantage to be taken of the scheme of the Ministry of Food for the distribution of National Dried Milk, and Food Supplements. As from 1st August, every mother became entitled to Vitamin A and D Tablets, free of charge, for 30 weeks after the birth of her child, and arrangements were made to bring this into effect. Regarding the provision of Dried Milk, and other preparations, not within the scope of the Ministry of Food, there were 23 applications received, and of these, 21 received free grants in accordance with the scale of the Council. During 1947, 406 Child Welfare Sessions were held, and the following table gives a summary of the attendances:— TABLE 4. Individual Children attending 2,233 Children attending for the first time 1,341 Medical Consultations 7,479 Attendances of children under one year 18,075 Attendances of children between the ages of one and five years .... 4,669 Average attendance per session 56.0 Auxiliary 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. During the latter part of the year, the Council made a recommendation to the Essex County Council for the utilisation of the School Dental Officers on one session each per week, for the purpose of attending to Expectant and Nursing Mothers, and Children under the age of 5 years. This was put forward as a temporary measure, pending the proposal that, when the total number of Dental Officers reached the approved Establishment of 5, each would give 20% of his or her time to this work. The matter was still under the consideration of the Essex County Council at the end of the year. (iii) Home Visits. Table 5 relates to Home Visits paid by the Health Visitors, and these, of necessity, have had to be curtailed, owing to the acute shortage of staff. 16 TABLE 6. (a) To Expectant Mothers— First Visits 69 Total Visits 71 (b) To children under one year of age— First Visits 1,405 Total Visits 2,126 (c) To Children between the ages of one and five years— Total Visits 2,154 (iv) 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 6. (a) Number of persons who were receiving children, under nine, for reward at the end of the year 29 (b) Number of Children under nine:— (1) Received during the year 35 (2) At the end of the year 32 (3) Who died during the year Nil (4) On whom inquests were held during the year Nil (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 a 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, and, as an additional safeguard, it is now a requirement that a prospective foster mother must give 2 satisfactory references before she can be approved. It has further been arranged that the lady members of the Maternity and Child Welfare Committee be supplied with the names of foster mothers, so that they can supplement the work of the Health Visitors. 17 (v) Adoption of Children (Regulation) Act, 1939. Many enquiries have again been made by the Assistant Medical Officer, and the Health Visitors as to the suitability, or otherwise, of persons desiring to adopt children. Most of these have been made at the request of the various Adoption Societies, but a few have been made 011 the receipt of notice from an "intermediary." When the children have been placed, further visits have been carried out, until the adoption has been legalised. 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 5 (b) Total number of children in respect of whom notice was given under Section 7(3) during the year 5 (c) Number of such children:— (i) Under supervision at the end of the year Nil (ii) Who died during the year Nil (iii) On whom inquests were held during the year Nil (d) Particulars of any proceedings taken during the year — (vi) The Care of Illegitimate Children. Under the County Council's scheme, the Health Visitors have again carried out the necessary enquiries at the homes of prospective foster parents. The Romford Council also gave a donation of £21 to the Romford, Hornchurch, and Upminster Moral Welfare Committee towards the maintenance of their hostel in Romford. All mothers, whether normally resident in this area or not, admitted to this hostel can, if they so wish, take advantage of the services given at the Ante-natal Clinics in the Borough. (vii) The Care of Premature Infants. When required, use has again been made of the two draught proof cots, which are kept at one of the clinics for distribution for the nursing in the home of premature infants. These cots have proved to be of valuable service both to the midwives, and to the children. (viii) Inspection of Nursing Homes, Etc. During 1947, there was a transfer of interest in the "Vinton" Nursing Home in Heath Park Road, and an additional Nursing Home was established at 71 Western Road. This latter is registered for the receipt of 4 Maternity patients, and 2 other patients. Both these received the usual quarterly visits, when conditions were found to be satisfactory. 18 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 of 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) Home and Domestic Helps. These services, hitherto administered as two separate schemes, have now been amalgamated, and are supervised by an Organiser, working under the control of the Public Health Department. This has enabled a better service to be provided, and a better recruitment of Helpers. The Organiser, on taking up duties, was introduced to a representative gathering of Women's Organisations in the town, and an important part of her work is to give personal interviews at the homes of the helpers, and also at the homes of the recipients of the service. This is very much appreciated by both parties, as difficulties on both sides have been smoothed out, although, on the whole, these difficulties have been of a minor character. This combined scheme was the outcome of Ministry of Health Circular 110/46. and the full details, as applicable to Romford, received the approval of the Minister of Health during the month of March. (x) Day Nurseries. The 3 Day Nurseries were retained during the year, and continued to be of service to those Mothers who, of necessity, had to go out to work, or who, by reason of illness, could not properly give attention to their young children. This year there has been a great demand for admissions, and it has been necessary to maintain a waiting list for each Nursery. There has again been the usual difficulty of maintaining a sufficient staff, and, at no time has the staff reached full establishment, but co-operation and goodwill have overcome many of those difficulties. Unfortunately, one of the Nurseries was broken into on several occasions, and, apart from the loss of equipment, it was very disheartening for the staff to find such an upheaval in the early hours of the morning. In accordance with Ministry of Health Circular 119/47, arrangements were made to supply drinking milk, free of charge, as from 1st July, to each of the Nurseries, and the amount available for this purpose is § of a pint per child per day. Cod Liver Oil Compound has also been made available, free of charge, at the rate of 1 × 6 ounce bottle per child per 12 weeks. 19 The .average attendance for the year at each Nursery is as follows :— TABLE 8. "St. Moritz" Nursery 32 Collier Row Nursery 30 Rush Green Nursery 29 The "St. Moritz" Nursery and Collier Row Nursery are capable of taking 40 Children each, and the Rush Green Nursery 50 Children. 3.—SANITARY CIRCUMSTANCES OF THE AREA, (i) Water. Mr. H. G. Ramsey, Chief Engineer of the South Essex Waterworks Company reports as follows with regard to the water supply of the district:— "(a) There have been no extensions of public water supply during the year 1947, other than those necessitated by the supply to the temporary and permanent housing sites, as under :— 3in. diameter mains 20 yards 4in. ,, ,, 3,777 yards 6in. ,, ,, 1,009 yards 9in. ,, ,, 2,053 yards Total 6,859 yards (b) Bacteriological and Chemical examinations are 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 are also made of samples obtained from consumers' taps in the various parts of the Company's district; all proved to be satisfactory. A total of about 3,300 Chemical, Bacteriological and Biological examinations have been made. (c) The water supplied was sufficient and wholesome, and the supply .was constant throughout, with no plumbo-solvent action." In addition to the above analyses, independent samples have again been taken monthly by the Sanitary Inspectors from different premises in the district. These were submitted for Bacteriological analysis once per month, and Chemical analysis once per 6 months, and the results have invariably confirmed the findings of the Waterworks Company. 20 Approximately 0.2 per cent, of the inhabited houses, and 0.2 per cent, of the population of the Borough take their water from standpipes. (ii) The Rats and Mice (Destruction) Act, 1919. The Rodent Operative has again dealt promptly with all complaints, and, in addition, has made routine inspections, and reinspections. In connection with the disinfestation of sewers, the Borough Surveyor informs me that test baiting of manholes was effected in the early part of the year, which proved continued traces of infestation, so that maintenance treatment was carried out. (iii) Infestation. There is no fresh development to report in this section. Where necessary, arrangements exist for the treatment of cases of Scabies in Oldchurch County Hospital. Arrangements are also in operation for the disinfestation, or destruction of clothing and bedding. This applies not only to cases of Scabies, but also to Lice infestation, and infestation with Bugs. (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 33 Butchers' Shops and Stalls, etc 82 Common Lodging Houses 6 Cowsheds, Dairies and Milkshops 31 Drainage 489 Establishments for Massage and Special Treatment 16 Factories (Mechanical Power) 24 Factories (Non-Mechanical Power) 11 Food Preparing Premises 52 Foodshops 510 Foster Mothers 30 Infectious Diseases 374 Keeping of Animals 7 Markets 42 Meat Depots 44 Public Baths 16 Public Conveniences 1 Rats and Mice (Destruction) Act 3,145 Scabies 1 21 Shops Acts 98 Slaughterhouses 363 Stables 4 Streams and Ponds 24 Tents, Vans and Sheds 29 Verminous Premises 45 Water Supplies 27 (b) Informal Notices (Number served) 1,291 Statutory Notices (Number served) 39 (c) As the result of the service of notices, the necessary works were completed by the owners or occupiers in all cases except 191, the works for which were still in hand at the end of the year. To enable the work to be carried out more satisfactorily, the Council sanctioned the appointment of another Sanitary Inspector, but, by the end of the year, we were unable to obtain one to fill this appointment. (v) Factories Act, 1937. As mentioned in the Report of last year, Ministry of Health Circular 13/47 requires that the statistics, relative to this section of the work should be submitted in an amended form. A summary of this amended form is given below :— TABLE 10. 1. Inspections. Premises. Number on Register. Inspections. Written Notices. Occupiers Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are enforced by Local Auths. 29 11 2 - (ii) Factories not included in (i) to which Section 7 applies:— (a)Subject to the Local Auths. (Transfer of Enforcement) Order, 1938 - - - - (b) Others 194 24 — — (iii) Other Premises under the Act (excluding Out-Workers) 13 - - - Total 236 35 2 - 2. Cases in which Defects were Found. Particulars. No. of Cases in which defects were found No. of . Cases in which . prosecu- cutions instituted. Found. Remedied Referred to H.M. Inspector. by H.M. Inspector. Want of Cleanliness 1 1 — — Overcrowding — — - - Unreasonable Temperature - — - — - Inadequate Ventilation — - — — - Ineffect. drain, of floors - - _ - Sanitary Conveniences :— (a) Insufficient 2 1 — — - (b) Unsuitable or Defective ! 1 1 - - - (c)Not Separaet for Sexes - - - - - Other Offences - - — — - Total 4 3 - - - 3. Outwork. Nature of Work. List of No. of Outworkers in August. No. of Cases of default in sending List. • No. of Prosecutions for failure to supply Lists. No. of Instances of Work in Unwhole some Premises. Notices Served. Prose cutions. Wearing Apparel— Making, etc 14 - - - - - 4.—INSPECTION AND SUPERVISION OF FOOD. The Sanitary Inspectors have again given a considerable amount of time to the inspection of meat and other foods at the Regional Slaughterhouse, which is situate in this area, at the Meat Depots, Butchers' Shops, Stalls, etc. Altogether, 1,018 visits have been paid, and at the Slaughterhouse alone, 14,954 carcases were examined. 23 5.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. In order to give a more accurate picture of the number of cases of infectious diseases in the district, those notifications, where the diagnosis is altered after observation are not recorded in the following tables, unless the amended diagnosis proves the condition to be one of another type of infection which is notifiable, when the case is then recorded under its appropriate nomenclature. (a) Acute Anterior Poliomyelitis. This condition is popularly called "Infantile Paralysis," but, as I have already pointed out to the Council, the term is a misleading one, because the illness can affect adults, as well as children, and all cases do not advance to the stage of paralysis. This diagnosis of these latter cases rests on preliminary symptoms, and 011 the examination of the cerebro-spinal fluid. In common with the rest of the Country, there was an increased prevalence of this'disease from the early part of July, until the beginning of October, although it did not seriously affect this area. In all 8 cases were notified, and, unfortunately, 2 died. Of the remainder, 5 of the patients had the condition in such a mild form that the disease did not progress to the paralytic stage. In addition to the above, 13 patients were removed to the Isolation Hospital as suspect cases, but they were proved not to be suffering from the disease. In order to allay anxiety on the part of the public, an early opportunity was taken to issue a statement to the local press, setting out briefly the nature of the infection, the means of transference of the organism, the symptoms and signs, and the simple precautionary measures to be adopted to prevent spread. Weekly reports as to the number of the cases were also issued. The General Practitioners in the district were circularised as to the present day knowledge of the disease, and arrangements were made by the local branch of the British Medical Association for them to see the Ministry of Health film upon the subject. Advice was also given to the Borough Surveyor to avoid overcrowding at the Public Baths, by limiting the sale of tickets, but it soon became evident that the public was already taking action in this respect, and were not attending the Baths in large numbers. Furthermore, advice was given regarding the cleaning of towels, and the keeping of the floors, etc., clean. This, however, is a normal procedure at the Baths. With regard to the Chlorine content, it was advised that there should be a residual amount of 0.5 parts per million. Similar advice was given in respect of the openair swimming bath at the Royal Liberty Grammar School. Dental extractions at the School Clinics were limited to emergencies only, and these, as far as possible, were carried out by using local anaesthetics. The Hospitals were recommended to discontinue the removal of Tonsils and Adenoids. Proved and suspected cases were all removed to the Isolation Hospital, which has all facilities for special treatment. All contacts were traced and advised. This, in one particular case, meant tracing about 60 contacts, who had been at a camp with the patient a week previously. None of the contacts developed the disease. At the request of the Ministry of Health, arrangements were also made to complete a comprehensive survey questionnaire, in respect of the cases and contacts, so that a close study could be given to the condition, about which comparatively little is known at present. (b) Acute Infective Hepatitis. 33 cases were notified during the year, and, as before, the notifications were forwarded each week to the Regional Medical Officer at Cambridge for research purposes. (c) Diphtheria. During 1947, 4 cases were notified with residence in the area. Propaganda in connection with Diphtheria Immunisation was again maintained throughout the whole of the year, and particular attention was drawn to the advisability of children receiving "booster" doses at 5 and 10 years of age. These "booster" doses consist of one injection only, at each of those ages, and are applicable only to children who have previously had a course of injections in early infancy. It is also considered desirable to have the preliminary 2 injections given before the child completes his first birthday, so every endeavour is now made to secure acceptances at about the 10th month. 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 by the department to any practitioner, who asked for it. The following statistics relate to the state of Immunisation as at 31st December, 1947. 25 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, 1947, and who were born between 31st December, 1933 and 31st December, 1947 3,558 7,402 Approx.- estimated No. of children 6,160 10,200 Percentage Immunised at 31st December, 1947 58 73 This, however, does not give a complete record as children, as a general rule, do not complete inoculation earlier than their first birthday. By allowing for this, the percentage of children immunised between one and five years of age is raised to 69. Table 12 gives the statistics since the inauguration of the scheme in Romford in 1935, till the end of 1947. TABLE 12. Number of Immunising injections given at the Clinics 27,614 Number of children who have completed the course of Injections, either at the Clinics or Privately 13,223 Number of Schick Test Injections given at the Clinics, including Control Injections 18,647 Number who have been Schick Tested 9,343 Percentage found to be Immune after Course of Treatment 93.7 (d) Measles. 575 cases were notified with residence in the area; and they occurred mostly during the first quarter of the year. (e) Scarlet Fever. This year 118 cases were notified with residence in the distrk-t, and, on the whole, were again very mild in type. An unusual and interesting outbreak occurred during the month.of September when 5 children (4 in the Romford area, and 1 in an adjoining area) developed Scarlet Fever within a few days of discharge from one of the local Hospitals, where they had been operated upon for the removal of tonsils and adenoids. Two other patients were operated upon the same day, but did not contract the infection. This outbreak was immediately reported to the County Medical Officer, and the Ministry of Health, and the County Medical Officer made arrangements with the Emergency Public Health Laboratory Service for Dr. E. A. Atkinson, Pathologist at Oldchurch Conn'.y Hospital to assist in the investigation of the circumstances, and 1 am indebted to Or. Atkinson for the enthusiasm with whijh lie made his enquiries. 26 It was ascertained that 7 patients were admitted to the Hospiral, and operated upon on Friday, 5th September. These children were kept by themselves in one ward, and discharged on Sunday, 7th September. All were reported as being fit before admission. Tonsillectomies performed at the Hospital before and after that date were uneventful. Throat and Nose swabs of the staff proved negative. Swabs of the notified cases were also taken, and proved negative, except in one case (B.L.) who gave a growth of Haemolytic Streptococci, which proved on typing to be Tll/27. Hemolytic Streptococci were also found in the throat of one child (J.H.) who did not develop Scarlet Fever, and this also was Type Tll/27. No cases subsequently developed in the home of this child. As regards the other child (M.W.) who was not reported as having Scarlet Fever, the swabs proved negative, but, subsequently, her Mother developed a sore throat , which gave a growth of Haemolytic Streptococci, Type Tll/27, and her Sister developed Scarlet Fever, with a similar growth of organisms. This child (M.W.), however, did show some evidence of Desquamation, which suggests that she may have had a mild attack. It is impossible to be dogmatic as to the sequence of events, but suspiscion does rest upon either J.H. or M. W. having initiated the outbreak, and the removal of the Tonsils no doubt caused local lowering of resistance, which was favourable to the implantation, and development of the Streptococci. (f) Smallpox. No cases occurred in the district,, but supervision was again given to contacts who had travelled from abroad. (g) Whooping Cough. 191 cases were notified with residence in the area, and they occurred at fairly even intervals throughout the whole of the year. (ii) Non-Notifiable. There are relatively few diseases, which are non-notifiable. The prevalence of these, during the year, is set out below, but they are a low estimate, as the figures are compiled from the school returns only. TABLE 13. Chickenpox 48 Mumps 46 Rubella 14 27 6.—SUPPLEMENTARY. (i) The National Health Service Act, 1946. A considerable amount of time and thought was given to the preparation of statistics and information required by the County Medical Officer to enable him to formulate a scheme to submit to the County Council for bringing into operation on the appointed day the requirements of the relative sections of the National Health Service Act, 1946. These sections deal with Vaccination and Immunisation, Ambulances, the Care of Mothers and Young Children, Midwives, Home Nursing, the Prevention of Ilhjess, Care and After-Care, Domestic Helps, and Mental Health. 28 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 Poliomyelitis Whooping Cough Infective Hepatitis Tuberculosis Total Keep. Non- Resp. January 3 2 3 3 17 — 2 — 40 — — 4 3 7 — 84 F ebruary 7 1 — 1 15 1 — 4 1 116 — — 7 1 3 1 158 March 14 1 — 4 17 1 - 1 — 131 - - 11 4 8 2 194 April 10 — — 10 4 2 - 3 — 97 — — 5 2 6 — 139 May 12 — — 4 7 - - 3 — 61 1 — 12 3 16 — 119 June 6 — — 3 2 — - 1 — 49 — - 19 4 4 — 88 July 11 — — 6 4 1 — 2 1 60 — 1 27 2 5 1 12] August 2 — — 2 1 — — 1 1 9 — 3 41 1 11 1 73 September 10 — — 1 - — - 1 — 6 — 3 20 2 5 - 48 October 8 — — 7 13 - - 1 — 4 - 1 11 5 12 — 62 November 18 — — 1 3 — - 3 — — — — 18 4 5 2 54 December 17 — — 1 18 1 3 4 — 2 — — 19 2 10 - 77 Total 118 4 3- 43 101 6 3 26 3 575 1 8 194 33 92 7 1,217 29 TABLE 15. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO AGE GROUPS. Disease. Under 1 1-2 2 3 3-4 4-5 5-]0 10-15 15 20 20-35 35-45 45-65 Over 65 Total Scarlet Fever - 2 4 10 12 6 5 27 6 2 — — — 118 Diphtheria - — — — 2 2 — — — — — — 4 Enteric Fever — — — — - — — — 3 — — — 3 Puerperal Pyrexia — _ ~~ — - — - 4 32 7 — — 43 Pneumonia 11 13 3 2 4 16 1 4 12 9 15 11 101 Cerebro-Spinal Fever 1 2 — — 1 2 — - - — — — 6 Dysentery — 1 1 1 — - — — - — — — 3 Erysipelas — — — — - 1 1 1 5 13 5 26 Malaria — — — — — — — — 1 2 — — 3 Measles 16 58 65 71 79 257 17 6 2 4 — — 575 Ophthalmia Neonatorum 1 — - - - — — — - — — 1 Poliomyelitis I 1 — - - - 2 2 2 1 — — — 8 Whooping Cough | 31 25 22 21 19 67 3 1 4 — 1 — 194 Infective Hepatitis 1 — — 1 - 5 3 5 16 1 1 - 33 Total 62 101 95 106 117 407 54 29 73 26 30 16 1,118 30 TABLE 16. DISEASES NOTIFIED DDEING THE YEAR, DIVIDED INTO WARDS. Disease. Collier Row. Gidea Park. Hare Park. Mavvney. South. Town West. Total. Scarlct Fever - 15 19 14 21 11 14 118 Diphtheria - — - — 1 2 1 4 Enteric Fever — — - 1 2 — — 3 Puerperal Pyrexia 3 1 1 1 35 — 2 43 Pneumoma 15 9 1 18 20 21 17 101 Cerebro-Spinal Fever 1 1 2 - 2 — — 6 Dysentery — — — - 3 — — 3 Erysipelas 4 1 5 3 3 3 7 26 Malaria — 2 — — 1 - — 3 Measles 148 71 64 103 98 40 51 575 Ophthalmia Neonatorum — - — 1 — — — 1 Poliomyelitis 2 1 1 2 — 1 1 8 Whooping Cough 49 13 22 44 24 29 13 194 Infective Hepatitis 9 1 2 8 1 3 10 — 33 Tuberculous: Respiratory 14 17 15 12 10 13 1 92 Non-Rc spiratory 1 2 3 — — 1 — 7 Total 270 135 141 200 223 131 117 1,217 81 TABLE 17. NOTIFIABLE DISEASES (.OTHER THAN TUBERCULOSIS) DURING THE YEAR 1947, AND HOSPITAL ADMISSIONS. Disease. Cases Notified. Cases Admitted to Hospital. Total Deaths. Scarlet Fever 118 35 — Diphtheria 4 4 — Enteric Fever 3 3 — Puerperal Pyrexia 43' 43 — Pneumonia 101 26 28 Cerebro-Spinal Fever 6 6 — Dysentery 3 3 — Erysipelas 26 9 — Malaria 3 1 — Measles 575 13 Ophthalmia Neonatorum 1 - — Poliomyelitis 8 8 2 Whooping Cough 194 9 2 Infective Hepatitis 33 4 1 Total 1,118 164 33 32 t TABLE 18. TUBERCULOSIS—NEW CASES AND MORTALITY DURING 1947. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. 0 M. 1 F. M. F. M. F. M. F. 1 5 2 1 1 1 1 3 - - 1 - 15 8 20 — 1 - 4 — 1 25 11 16 — 1 3 2 — 35 9 4 — 1 8 3 — — 45 11 1 — — 6 — — — 55 3 2 — — 2 — — — 65 and upwards 1 — — — 1 — — — Total 47 45 1 6 20 9 1 1 33 TABLE 19. OPHTHALMIA NEONATORUM. CASES Vision Unimpaired Vision Impaired Total Blindness Deaths Notified. Treated At Home In Hospital 1 1 — 1 — — — Wilson & Whitworth Ltd., Romford.