LIBRARY ROM 23 BOROUGH OF ROMFORD HEALTH DEPARTMENT. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1948 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. BOROUGH OF ROMFORD HEALTH DEPARTMENT. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1948 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December, 1948). His Worship The Mayor : Alderman 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. „ C. E. Smart. ,, G. F. Chaplin, J.P., C.C. Councillors : Councillor P. J. Bartaby. Councillor A. Keeble. ,, Mrs. W. Baskerville. ,, A. McGonagle. ,, H. A. Beck. ,, Mrs. M. L. ,, S. C. Brown. McWeeney. ,, H. F. Davenport. ,, A. Needham. ,, S. V. Ellmore. ,, J. R. Poel. ,, W. S. Gardner. ,, W. A. Reeder. W. D. Hill. „ G. Roberts, J.P. ,, Mrs. L. A. Irons, J.P. ,, Mrs. E. S. South. G. H. Issitt. „ L. A. T. Welch. ,, C. L. Jones. „ R. Yeal, 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE. His Worship The Mayor : Alderman L. S. Webb, J.P. (Ex-officio member). Chairman : Councillor G. H. Issitt. Vice-Chairman : Councillor Mrs. W. Baskerville. Councillor S. C. Brown. Councillor Mrs. M. L. McWeeney. ,, W. S. Gardner. ,, G. Roberts, J.P. ,, Mrs. L. A. Irons, J.P. ,, Mrs. E. S. South. L. A. T. Welch. 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. Mrs. E. A. White. Mrs. E. G. Yeal. 5 HEALTH DEPARTMENT. Public Health Staff. Medical Officer of Health. J. B. Samson, M.D., Ch.B., D.P.H. Assistant Medical Officers. (a) A. P. Draper, M.C., M.A., M.D., B.Ch., B.A.O. (b) Mrs. E. M. Haga, M.B., B.S., L.R.C.P., D.P.H. (c) Mrs. H. Symonds, M.D., M.R.C.S., L.R.C.P. (Commenced duties, 1st April, 1948). 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 ; Certilcate of the Royal Sanitary Institute for Meat and Other Foods. (c) R. J. Nichols, Certificate of the Royal Sanitary Institute. (Commenced duties, 15th March, 1948. Resigned, 28th November, 1948). (d) 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) Miss O. Clements, State Registered Nurse; Registered Fever Nurse; State Certified Midwife; Health Visitors' Certificate. (b) Miss M. A. Cowles, State Registered Nurse; State Certified Midwife; Queens Certificate of Nursing; Health Visitors' Certificate. (Commenced duties, 3rd May, 1948). (c) Miss J. Jones, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (Commenced duties, 25th October, 1948). (d) Miss F. K. Wells, State Registered Nurse ; State Certified Midwife; Health Visitors' Certificate. Council Midwives. (a) Miss I. A. Bassett, State Certified Midwife. (b) Miss C. M. Kerr, State Registered Nurse; State Certified Midwife. (c) Miss M. Kitson, State Registered Nurse; State Certified Midwife. (d) Mrs. M. Mylward, State Certified Midwife. (e) Mrs. E. A. Rooks, State Certified Midwife. 6 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. M. B. Woodhouse, State Registered Nurse ;• State Certified Midwife; Registered Fever Nurse. Clerks. (a) E. W. Gowers, Chief Clerk. (b) C. G. Humberston, Chief Assistant. (c) S. Adams. (d) Miss M. E. Firmin. (Commenced duties, 14th June, 1948). (e) Mrs. J. Flavell. (Resigned 3ist January, 1948). (f) Miss E. M. Kerr. (Commenced duties, 23rd February, 1948). (g) Mrs. E. Meloy. (Commenced duties, 7th December, 1948). (h) Miss B. Parker. Home Help Organiser. Mrs. L. Canham. Day Nurseries—Matrons. "St. Moritz." Mrs. I. C. Bowyer, State Registered Nurse. Collier Row. (a) Mrs. M. L. Kendall, State Registered Nurse. (Resigned 31st October, 1948). (b) Mrs. D. Eveling, State Registered Nurse. (Commenced duties, 1st November, 1948). Rush Green. Mrs. G. Pease, Registered 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 1948. This is the Fifteenth 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 3/49 of the Ministry of Health, dated 17th January, 1949. This Circular states that the Report should be prepared on the lines of that for 1947. As is well known to all the Members, the outstanding feature of the year has been the introduction of a new system of administration. occasioned by the inception of the National Health Service Act on the 5th July, which was nominated by the Minister of Health as the "Appointed Day." The main feature is that the Essex County Council is now the Local Authority for the administration of functions, relating to Maternity and Child Welfare, Domiciliary Midwifery, Home Nursing, Prevention of Illness, Care and After Care, etc., and. for the purpose of the administration, the County has been divided into 11 Areas, and each has a Health Area Sub-Committee. Romford, in this respect, is one of these areas. For convenience, and, in order to give a proper picture of conditions as they apply to the Public Health of the District, and, after all the services mentioned above have a very close bearing on public health in general, I have throughout this report given statistics as they relate to the whole of the year, and have not endeavoured to divide them into two parts, as between those relating to conditions as they existed before and after the 5th July. It only remains for me to say that the statistics reveal a steady improvement, and auger well for the future. 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, at all times show a keen interest in the well-being of the inhabitants of the town. I am, Mr. Mayor, Ladies, and Gentlemen, Your obedient servant, JAMES B. SAMSON, Public Health Department, Medical Officer of Health Town Hall, Romford. May, 1949. 8 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1948. Statistics and Social Conditions of the Area. Area (in acres) 9,342 Population : Census (1931), 35, 918. Mid. 1948 (Estd.) 72,610 Number of Inhabited Houses (end of 1948) 19,979 Rateable Value (end of 1948) £561,954 Product of Penny Rate (end of 1948) £2,212 Extracts from Vital Statistics for the Year. Total M. F. Live Births: Legitimate 1,283 683 600 Illegitimate 54 31 23 Birth Rate : 18.4 per 1,000 of estimated resident population. Still Births: Legitimate 25 13 12 Illegitimate 1 — 1 Rate per 1,000 total (live and still births) : 19.1. Deaths 597 339 258 Death Rate: 8.2 per 1,000 estimated resident population. Rate per 1,000 Deaths total (live and Deaths from Puerperal causes still) births From 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 22.4 Legitimate Infants per 1,000 legitimate live births 24.2 Illegitimate Infants per 1,000 illegitimate live births 18.5 Deaths from Cancer (all ages) 117 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 1 9 TABLE 1. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, England and Wales,London,126 Great Towns and 148 Smaller Towns. MATERNAL MORTALITY and CASE-RATES for certain Infectious Diseases in the year 1948. (Provisional Figures based on Weekly and Quarterly Returns). Rate pbr 1,000 tion DEATH-RATE PER 1,000 POPULATION. Rate per 1,000 Live Births Live Births Stillbirths All Causes Typhoid and Paratyphoid fevers Whooping cough Diphtheria Tuberculosis Influenza Small-pox Acute Poliomyelitis and Polioencephalitis Pneumonia Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year England and Wales 17.9 0.42 10.8 0.00 0.02 0.00 0.51 0.03 - 0.01 0.41 3.3 34 126 County Boroughs and Great Towns, including London 20.0 0.52 11.6 0.00 0.02 0.00 0.59 0.03 - 0.01 0.38 4.5 39 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) 19.2 0.43 10.7 0.00 0.02 0.00 0.46 0.04 - 0.01 0.36 2.1 32 London 20.1 0.39 11.6 0.00 0.01 0.01 0.63 0.02 - 0.00 0.54 2.4 31 ROMFORD 18.4 0.36 8.2 0.00 0.00 0.00 0.41 0.01 - 0.00 0.22 0.75 22 The Maternal Mortality Rates for England and Wales are as follow: Per 1,000 Total Live Births ,, „ Romford are as follow: Per 1,000 Total Live Births Puerperal Sepsis Others Total 0.24 0.78 1.02 0.00 0.73 0.73 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 Fever 1 ... 1 ... ... 1 ... ... ... ... ... ... ... ... 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of Respiratory System 13 12 25 ... ... ... ... 3 8 ... 8 4 2 ... 7. Other forms of Tuberculosis 5 ... 5 ... ... . 1 3 ... ... 1 ... ... 8. Syphilitic disease 2 ... 2 ... ... ... ... ... ... 1 ... 1 ... ... 9. Influenza 1 ... 1 ... ... ... ... ... ... ... ... 1 ... ... 10. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute Poliomyelitis and Polioencephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. Acute infectious Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 13.M Cancer of Buccal Cavity, etc. 5 ... 5 ... ... ... ... ... ... ... ... ... 3 2 13.F Cancer of Uterus ... 5 5 ... ... ... ... ... ... ... 1 ... 1 3 14. Cancer of Stomach and Duodenum 17 7 24 ... ... ... ... ... ... 1 8 5 8 2 15. Cancer of Breast ... 8 8 ... ... ... ... ... ... 2 1 1 3 1 16. Cancer of all other sites 45 30 75 ... ... 2 ... ... 1 3 12 23 22 12 17. Diabetes ... 2 2 ... ... ... ... ... ... ... ... 1 ... 1 18. Intra cranial Vascular Lesions 25 38 63 ... ... ... ... ... ... ... 6 4 20 33 19. Heart Disease 92 73 165 ... ... ... ... 2 ... 4 16 27 42 74 20. Other Diseases of the Circulatory System 22 13 35 ... ... ... ... ... ... ... 3 7 14 11 21 Bronchitis 19 7 26 ... ... ... ... ... 1 ... 2 6 9 8 22. Pneumonia 8 8 16 3 2 ... ... ... 2 ... 2 1 1 5 23. Other Respiratory Diseases 5 4 9 ... ... ... 1 1 ... ... ... 1 3 3 24. Ulceration of the Stomach or Duodenum 4 ... 4 ... ... ... ... ... ... ... 1 2 1 ... 25. Diarrhæa 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 26. Appendicitis 2 ... 2 ... ... ... ... 1 ... ... ... ... 1 ... 27. Other digestive diseases 6 5 11 ... ... ... ... 1 ... 3 ... 3 9 2 28. Nephritis 9 5 14 1 ... ... ... ... 1 ... 1 3 4 4 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other Maternal causes ... 1 1 ... ... ... ... 1 ... ... ... ... ... ... 31. Premature Birth 8 5 13 13 ... ... ... ... ... ... ... ... ... ... 32. Congenital Malformations and Birth injuries 4 6 10 10 ... ... ... ... ... ... ... ... ... ... 33. Suicide 6 1 7 ... ... ... ... 1 ... 2 3 ... 1 ... 34. Road Traffic Accidents 2 2 4 ... ... ... 1 1 ... ... 1 1 ... ... 35. Other violent causes 6 7 13 1 ... 1 ... 2 2 1 1 1 2 2 36. All other causes 31 19 50 1 ... 1 1 2 1 1 6 5 8 24 Total 339 258 597 30 2 5 4 18 16 18 73 97 147 187 11 This year the Registrar-General has given his estimate of the mid-year population of Romford as 72,610 which compares with 68,860 last year, an increase of 3,750. 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 1948, the total number of live births registered was 1,337, and the total number of deaths registered was 597. The difference of 740 gives the natural increase in the population. As this number falls short of the Registrar-General's estimated increase of 3,750, it follows that the balance of 3,010 is made up of excess of Immigration over Emigration, and this again is largely accounted for by the development of the Harold Hill Estate. For 1948, we estimate the Birth Rate to be 18.4 per 1,000 of the estimated resident population, a decrease of 5.2 compared with 1947. The Rate for England and Wales for 1948 is given as 17.9, and for the 148 smaller towns with populations ranging from 25,000 to 50,000 at the 1931 Census, the Rate is 19.2. The Death Rate for Romford is estimated at 8.2 per 1,000 of the estimated resident population; the lowest yet recorded. 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 10.8 and 10.7 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 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 0.7. The corresponding rate for England and Wales is 1.0. The Infant Mortality Rate, or the Death Rate of Infants under 1 year of age per 1,000 live births is 22.4 a decrease of 1.6 and the lowest yet recorded. The corresponding figures for England and Wales, and the 148 smaller towns are 34.0 and 32.0 respectively. 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. Particulars of the staff, as at the 4th July, 1948, are given at the beginning of this report. Since then, the Assistant Medical Officers, Health Visitors, Midwives, Home Help Organiser, and Staff of the Day Nurseries, although still working in the Romford Area, have been transferred to the Staff of the Local Health Authority, viz., the Essex County Council. At the end of the year, negotiations were still proceeding with the County, as to the proportion of time to be given by the Medical Officer of Health in his capacity of Area Medical Officer, and by the Clerical Staff. 12 (ii) Laboratory Facilities. The facilities are as before and fulfil the requirements of the district. (iii) Nursing in the Home. (a) General Nursing. The Establishment for this area is 7 Home Nurses. Since the 5th July, the District Nursing Associations have ceased to function, and the service was taken over by the Essex County Council, under the terms of Section 25 of the National Health Service Act, 1946. One Representative of the 3 District Nursing Associations has been appointed as a Co-opted Member to serve on the Health Area SubCommittee for the area of Romford. Table 3 sets out the work of the Home Nurses during the year. Table 3. No. of Cases Attended. No. of Visits. General 771 11,797 Midwifery 78 1,912 Tubercular 19 355 (b) As mentioned in (i) above, the 9 Council Midwives in Romford, although in the employ of the Essex County Council, still serve in this area. All have had the necessary tuition in the administration of Gas and Air Analgesia. The following gives a summary of the cases attended by the Midwives, as Midwives, and as Maternity Nurses :— Table 4. As Midwives 465 As Maternity Nurses 128 2.—MATERNITY AND CHILD WELFARE. (i) Ante-natal and Post-natal Clinics. During the year, 1,209 individual expectant mothers attended the Ante-natal Clinics. In addition 31 mothers attended for Postnatal advice. In all 245 sessions were held. The total number of attendances of the 1,240 mothers mentioned above was 5,749, giving an average of 4.6 attendances per patient. The average number attending at each session was 23.5. During the same period 478 Child Welfare Sessions were held, and the following table gives a summary of the attendances:— Table 5. Individual Children attending 3,251 Children attending for the first time 1,192 Medical Consultations 7,708 Attendances of Children under one year 19,340 Attendances of Children between the ages of one and five years 6,404 Average attendance per session 58.9 (ii) Home Visits. Table 6 relates to Home Visits paid by the Health Visitors during the year:— 18 Table 6. (a) To Expectant Mothers— First Visits 69 Total Visits 61 (b) To children under one year of age— First Visits 1,240 Total Visits 2,031 (c) To children between the ages of one and five years— Total Visits 3,164 (iii) The Care of Premature Infants. Use was again made of the two draught proof cots, which are kept at one of the clinics for loan, if required, in connection with the nursing in the home of premature infants. (iv) Inspection of Nursing Homes, etc. The 3 Nursing Homes in this area were again inspected, as a routine, once per quarter, and, when necessary, further visits were paid for the purpose of giving advice. On all occasions conditions were found to be satisfactory. Routine investigations were also made by an Assistant Medical Officer, when notices were given by the Midwives 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 discharge from the eyes. (v) Domestic Helps. This service not only embraces assistance in the home, during the period of confinement of the mother, but also in the home where help is required, owing to the presence of any person, who is ill, aged, etc. The allotment of Domestic Helps is supervised by an Organiser, working under the control of the Medical Officer's Department. The scheme in Romford has proved very popular and successful, and at the end of the year approximately 60 Part-Time Helps were employed. Assistance was given in 191 individual cases. (vi) Day Nurseries. The 3 Day Nurseries were retained during the year, and working to full capacity, with a fairly large waiting list for each Nursery. At the end of the year consideration was being given to the provision of an additional Nursery, and to an extension of the "St. Moritz" Nursery. The average attendance for the year at each Nursery was as follows:— Table 7. "St. Moritz" Nursery 32 Collier Row Nursery 30 Rush Green Nursery 29 The "St. Moritz" Nursery, and the Collier Row Nursery are capable of taking 40 Children each, and the Rush Green Nursery 50 Children, 14 (vii) Dental Service. This service is, unfortunately, one which has not developed to the extent we desired. Our original intention was to employ 5 Dentists, and for each to devote 20% of his or her time to dental work as required by Expectant and Nursing Mothers, and Children under school age, but, as we had only 2 School Dentists available on July 5th, it was felt that the best that we could do would be to allow each to give 1 Session per week to this particular branch of the work. By the end of the year, however, one of the School Dentists resigned, and the whole of the school work had, therefore, to be undertaken by the 1 remaining Dentist. Nevertheless, a token service has been maintained for the Maternity and Child Welfare patients, and this is being operated on 2 sessions per fortnight. The following gives particulars of the service given to Expectant and Nursing Mothers, and Children under 5 years of age, not attending school:— Table 8. Mothers. Children Number treated 14 19 Number of attendances 52 23 Number of fillings 42 — Number of extractions 124 34 Number of general anaesthetics 18 19 Number of local anaesthetics 20 — Number of scalings 4 — Number of impressions 1 — Number of other operations 7 — 3.—SANITARY CIRCUMSTANCES OF THE AREA. (i) Water. Mr. H. G. Ramsey, Chief Engineer of the South Essex Waterworks Company has kindly given me the following report, with regard to the water supply of the district:— "(a) There have been no new extensions of public water supply during the year 1948, other than those necessitated by the supply to the temporary and permanent housing and industrial sites, as under:— 9" 6" 4" 3" Gobions Estate — 154 yds. 1,093 yds. - Havering Park Estate — 604 yds. 1,177 yds. 50 yds. Industrial Site, Eastern Avenue — 102 yds. — — L.C.C. Estate Harold Hill 16 yds. 2,133 yds. 3,642 yds. 1,186 yds. Totals 16 yds. 2,993 yds. 5,912 yds. 1,236 yds. Total length of all diameters=10,157 yds., of which 6,977 yds. laid for L.C.C. Estate, Harold Hill. 15 (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 consumer's taps in the various parts of the Company's district, all of which proved to be satisfactory. A total of over 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, byt the Sanitary Inspectors from different premises in the district. These were submitted for bateriological analyses once per month, and Chemical analyses once per 6 months, and the results have invariably confirmed the findings of the Waterworks Company. Approximately 0.2 per cent. of the inhabitated 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 continued to deal promptly with all complaints, and in addition to routine inspections has carried out a large number of re-inspections. In connection with the disinfestation of sewers, the Borough Engineer and Surveyor informs me that further maintenance treatment was undertaken during the year. (iii) Infestation. Where necessary, arrangements exist for the in-patient treatment of cases of Scabies at Oldchurch Hospital. Arrangements also exist for the disinfestation, or destruction of clothing and bedding. This applies to Lice infestation, and infestation with Bugs, as well as cases of Scabies. (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 15 Butchers' Shops and Stalls, etc. 88 Common Lodging Houses 22 Cowsheds, Dairies and Milkshops 51 Drainage 563 Establishments for Massage and Special Treatment 18 Factories (Mechanical Power) 52 Factories (Non-Mechanical) 12 16 Food Preparing Premises 44 Foodshops 463 Fostermothers 32 Infectious Disease 343 Keeping of Animals 17 Markets 39 Meat Depots 34 Public Baths 26 Public Conveniences 2 Rats and Mice (Destruction) Act 2,300 Shops Acts 103 Slaughterhouses 550 Stables 2 Streams and Ponds 17 Tents, Vans and Sheds 72 Verminous Premises 96 Water Supplies 41 (b) Informal Notices (Number served) 1,058 Statutory Notices (Number served) 138 (c) As a result of the service of Notices, the necessary works were completed by the owners or occupiers in all cases except 205, the works for which were still in hand at the end of the year. (v) Factories Act, 1937. A summary of the statistics, as required by the Ministry of Health, 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 to be enforced by Local Authorities 22 52 5 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 167 12 - - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding OutWorkers premises) 22 - - - Total 211 64 5 - 17 2. Oases 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 2 2 — — — Overcrowding — — — — — Unreasonable Temperature 1 1 — 1 — Inadequate Ventilation 2 2 — — — Ineffect. drain, of floors — — — — — Sanitary Conveniences :— (a) Insufficient 1 1 — — — (b) Unsuitable or Defective 1 1 — — — (c)Not Separate for Sexes — — — — — Other Offences 3 3 1 3 — Total 10 10 1 4 — 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. 22 — — — — — 4.—INSPECTION AND SUPERVISION OF FOOD. (i) Milk Supply. At the end of 1948 there were 11 persons registered as producers, and 21 as retail purveyors. All the farms and dairies have again been regularly inspected, and, where necessary, improvements have been advised and carried out. Under the terms of the Milk (Special Designations) Regulations, 1936-1946, 11 firms or individuals retail Tuberculin Tested Milk, none retail Accredited Milk, and 8 retail Pateurised Milk. Six milk producers hold licences to produce Accredited Milk, and 1 milk producer holds a licence to produce Tuberculin Tested Milk, 18 (ii) Ice Cream. All Traders and Manufacturers of ice cream have to be registered under the provisions of the Romford Urban District Council Act, 1931. There were at the end of the year 45 manufacturers, and 144 vendors on the register. As regards the question of the sale of food products in general, including Ice Cream, this Council, like so many other Councils, has given consideration to the suggestion that registrations should be made governing the conditions under which unwrapped products could be sold. It has, however, been decided to leave the matter in abeyance, until a copy of the Model Byelaws proposed to be made under Section 15 of the Food and Drugs Act, 1938, has been received. (iii) Meat. The Sanitary Inspectors, for this purpose, have again regularly attended at the Regional Slaughterhouse, which is situate in this area, and, in addition, have paid the usual visits to Meat Depots, Butchers' Shops, Stalls, etc. Altogether, 1,126 visits have been paid, and at the Slaughterhouse, 15,249 carcases were examined. No Ante-Mortem inspections are carried out, but all animals slaughtered are examined PostMortem. Table 11 sets out the particulars of the carcases inspected and condemned. 19 TABLE 11. CARCASES INSPECTED AND CONDEMNED. Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed (if any) 3,137 1,201 3,569 4,787 468 Number inspected 3,137 1,201 3,569 4,787 468 All diseases except Tuberculosis. Whole Carcases condemned 3 14 3 10 4 Carcases of which some part or organ was condemned 1,203 460 10 142 22 Percentage of the number inspected affected with disease other than tuberculosis 38.4 39.5 0.3 3.1 5.6 Tuberculosis only. Whole carcases condemned 34 73 2 — — Carcases of which some part or organ was condemned 465 339 1 — 11 Percentage of the number inspected affected with tuberculosis 15.9 34.3 0.1 — 2.4 20 Table 11. 5—HOUSING STATISTICS FOR THE YEAR, 1948. Table 12. No. of Houses erected during the Year:— (1) By Local Authority 316 (2) By Private Enterprise 97 1. Inspection of Dwelling-Houses during the Year:— (l) (a) Total number of Dwelling-Houses inspected for Housing Defects (under the Public Health or Housing Acts) 1,263 (b) Number of inspections made for the purpose . 4,171 (2) (a) Number of Dwelling-Houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil. (b) Number of inspections made for the purpose Nil. (3) Number of Dwelling-Houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-Houses (exclusive of those referred to under the preceeding subhead) found not to be in all respects fit for human habitation 1,058 2. Remedy of Defects during the Year without service of Formal Notices:— Number of Dwelling-Houses rendered fit in consequence of Informal action by the Local Authority or their Officers 855 3. Action under Statutory Powers during the Year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936— (1) Number of Dwelling-houses in respect of which notices were served requiring repairs 105 (2) Number of Dwelling-Houses which were rendered fit after service of Formal Notices:— (a) By Owners 60 (b) By Local Authority in default of owners 1 (b) Proceedings under the Public Health Acts— (1) Number of Dwelling-Houses in respect of which notices were served requiring defects to be remedied 33 (2) Number of Dwelling-Houses in which defects were remedied after service of Formal Notices:— (a) By Owners 25 (b) By Local Authority in default of Owners 5 21 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of Dwelling-Houses in respect of which Demolition Orders were made 4 (2)Nurnber of Dwelling-Houses demolished in pursuance of Demolition Orders Nil. (d) Proceedings under Section 12 of the Housing Act, 1936:— (1)Number of separate tenements or underground rooms in respect of which Closing Orders were made 2 (2)Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit Nil. 4. Housing Act, 1936, Part IV—Overcrowding:— (a) 1. Number of Dwellings overcrowded at end of year 127 2. Number of Families dwelling therein 221 3. Number of Persons dwelling therein 924 (b) Number of New Cases of Overcrowding reported during the Year 52 (c) 1. Number of New Cases of Overcrowding relieved during the Year 4 2. Number of Persons concerned in such cases 30 (d) Particulars of any cases in which Dwelling-Houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil. 6.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. Most of the Infectious Diseases now fall within this category, and, as I mentioned in last year's report 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. In this way it is possible to give a more accurate picture of the number of cases of infectious diseases in the district. (a) Acute Anterior Poliomyelitis. It will be remembered that this condition goes by the popular name of "Infantile Paralysis," but, as this is now a misnomer, it is better to use the technical term, although it is a more cumbersome one. During 1948, there were only 2 cases. 22 (b) Acute Infective Hepatitis. 11 cases were notified during the year, and these notifications were, as usual, forwarded to the Regional Medical Officer at Cambridge for statistical and research purposes. (c) Diphtheria. During 1948, only 2 cases were notified with residence in the area. Propaganda in connection with Diphtheria Immunisation was carried out on similar lines to previous years, and particular attention was again drawn to the desirability of children receiving "booster" doses at 5 and 10 years of age. The "booster" consists of one injection only, at each of these ages, and is applicable only to children who have previously had a course of injections in early infancy. 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 available to any practitioner who asked for it. The following statistics relate to the state of Immunisation as at the 31st December, 1948. Table 13. Under 5 yrs. 5-15 yrs. No. of children who had completed a full course of Immunisation at any time up to 31st December 1948, and who were born between 31st December, 1934 and 31st December, 1948 3,712 8,102 Approx. estimated No. of children 7,054 10,305 Percentage Immunised at 31st December, 1948 53 79 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 14 gives the statistics since the inauguration of the scheme in Romford in 1935, till the end of 1948. Table 14. Number of Immunising injections given at the Clinics 30,744 Number of children who have completed the course of Injections, either at the Clinics or Privately 14,880 Number of Schick Test Injections given at the Clinics, including Control Injections 20,545 Number who have been Schick Tested 10,292 Percentage found to be Immune after Course of Treatment 96.8 23 (d) Food Poisoning. No cases were notified during the year, but there is no doubt that many cases of a minor degree have occurred, which have not been brought to our notice, either because they have been attributed to some other condition, or because the symptoms have been so mild that the sufferers have not troubled to seek medical advice. There is no doubt but that a major outbreak would come to our notice immediately. (e) Measles. 488 cases were notified, and they occurred mostly during the months of May and June. (f) Scarlet Fever. This year 99 cases were notified with residence in the district, and the type continued to be mild. (g) Smallpox. No cases occurred in the district, but supervision was again given to contacts who had travelled from abroad. (h) Whooping Cough. 327 cases were notified with residence in the area, and these were distributed fairly evenly throughout the year, with perhaps rather larger numbers during January, April, and May. (ii) Non-Notifiable. There are relatively few infectious diseases, which are nonnotifiable. The prevalence of these, during the year, is set out below, but they are probably a low estimate, as the figures are compiled from the school returns only. Table 15. Mumps 218 Chickenpox 53 Rubella 2 7.—SUPPLEMENTARY. (i) Section 47, National Assistance Act, 1948. It was not found necessary to take action under this Section of the National Assistance Act, 1948. (i) Mass Radiography. During the months of November and December, arrangements were made by one of the Mass Radiography Units of the NorthEast Metropolitan Regional Hospital Board for the examination of volunteers in this area, and I am indebted to Dr. H. Ramsey, the Medical Director for the following information:— A total of 5,189 miniature photographs were taken, and subsequently 199 large films. Of these 199; 48 were classified as normal; 31 showed abnormalities, which did not require further action; 110 were investigated by the Medical Director; 1 was already attending a dispensary; and 9 did not attend for investigation. Dr. Ramsey expressed himself as being very satisfied not only with the response, but also with the results. 24 TABLE 16. 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 Resp. NonResp. January 20 — — — 29 1 1 3 — 7 — — 59 3 9 2 134 February 8 — — 1 7 — — 1 1 14 — — 33 1 6 2 74 March 12 1 — — 6 — — 2 — 17 — — 19 — 6 1 64 April 7 — — 1 2 — — — 40 1 — 56 — 4 — 111 May 6 — — 2 2 2 — 1 — 116 — 1 50 1 2 2 185 June 5 1 — 2 5 — — — — 156 — — 21 1 9 — 200 July 12 — — — 1 1 i — — 87 1 — 13 1 5 4 126 August 2 — — — — — — 3 — 5 — — 21 1 3 — 35 September 5 — — 1 1 — — — — 10 1 — 26 1 6 — 51 October 6 — — — 2 — 1 — 2 — — 12 — 8 — 31 November 13 — — 1 6 — — 1 — 6 1 1 3 1 12 — 45 December 3 — 1 1 8 — — — — 28 — — 14 1 8 2 66 Total 99 2 1 9 69 4 2 12 1 488 4 2 327 11 78 13 1,122 25 TABLE 17. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO AGE GROUPS. Disease. Under 1 12 2-3 3-4 4-5 5-10 10-15 15 20 20-35 35-45 45-65 Over 65 Total Scarlet Fever 2 7 7 3 7 51 9 5 5 3 — — 99 Diphtheria 1 — — — — — — — — — 1 — 2 Enteric Fever — — — — — — — — 1 — — — 1 Puerperal Pyrexia — — — — — — — — 6 3 — — 9 Pneumonia 13 8 5 4 5 7 2 — 6 1 16 2 69 Cerebro-Spinal Fever — 1 1 I — 1 — — — — — — 4 Dysentery — — — — — 1 — — 1 — — — 2 Erysipelas — — — — — 1 1 2 1 4 3 12 Malaria — — — — — — — — 1 — — — 1 Measles ... 15 50 53 60 69 224 10 2 5 — — — 488 Ophthalmia Neonatorum 4 — — — — — — — — — — — 4 Poliomyelitis — 2 — — — — — — — — — — 2 Whooping Cough 39 35 41 41 47 119 3 — 1 1 — — 327 Infective Hepatitis — — 1 — — — 1 1 5 1 1 1 11 Total 74 103 108 109 128 403 26 9 33 10 22 6 1,031 126 TABLE 18. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO WARDS Disease. Collier Row & Havering Ward. Gidea Park & Noak Hill Ward. Mawney Ward. Ward. West South Ward. Town Ward. Hare Park Ward. Total. Scarlet Fever 30 13 11 3 22 9 11 99 Diphtheria 1 1 — — — — — 2 Enteric Fever — — 1 — — — — 1 Puerperal Pyrexia 2 — — — 5 1 1 9 Pneumonia 22 6 6 15 6 10 4 69 Cerebro-Spinal Fever — — 1 — .3 — — 4 Dysentery — — 1 — 1 — — 2 Erysipelas 1 1 2 2 1 4 1 12 Malaria — — 1 — — — — 1 Measles 89 69 121 30 76 67 36 488 Ophthalmia Neonatorum — — — 1 — 2 1 4 Poliomyelitis 1 — — — — — 1 2 Whooping Cough 107 34 73 31 28 27 27 327 Infective Hepatitis 3 — 2 1 — 3 2 11 Tuberculosis: Respiratory 14 23 8 9 7 6 11 78 Non-Respiratory 1 — 3 2 3 — 4 13 Total 271 147 230 94 152 129 99 1,122 37 TABLE 19. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1948 AND HOSPITAL ADMISSIONS. Disease. Cases Notified. Cases Admitted to Hospital. Total Deaths. Scarlet Fever 99 21 — Diphtheria 2 2 — Enteric Fever 1 1 — Puerperal Pyrexia 9 9 — Pneumonia 69 15 16 Cerebro-Spinal Fever 4 4 1 Dysentery 2 1 — Erysipelas 12 2 — Malaria 1 — — Measles 488 26 — Ophthalmia Neonatorum 4 3 — Poliomyelitis 2 2 2 Whooping Cough 327 15 2 Infective Hepatitis 11 — — Total 1,031 111 17 28 TABLE 20. TUBERCULOSIS—NEW CASES AND MORTALITY DURING 1948. AGE PERIODS. NEW CASES. DEATHS. Eespiratory. Non-Kespiratory. Eespiratory. Non-Kespiratory. M. F. M. F. M. F. M. F. 0 — — — — — — — — 1 — 3 — — — — — — 5 1 4 2 5 — — 1 — 15 7 18 2 1 — 3 3 — 25 11 14 1 1 2 6 — — 35 5 4 — — — — — — 45 2 3 — 1 8 — 1 — 55 5 1 — — 3 1 — — 65 and upwards — — — — — 2 — — Total 31 47 5 8 13 12 5 — 29 TABLE 21. OPHTHALMIA NEONATORUM. GASES Vision Unimpaired Vision Impaired Total Blindness Deaths Notified. Treated At Home In Hospital 4 1 3 4 Nil Nil Nil Wilson & Whit worth Ltd.. Romford.