Rom 24 LIBRARY BOROUGH OF ROMFORD HEALTH DEPARTMENT. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1949 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 1949 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (as at 31st December, 1949). His Worship The Mayor: Councillor A. Needham, J.P. Deputy Mayor: Alderman G. F. Chaplin, C.C. Aldermen: Alderman C. H. Barney. Alderman W. D. Hill. „ A. J. Dyer, O.B.E. „ C. E. Smart. R. A. Forge, J.P. „ L. S. Webb, J.P. Councillors: Councillor P.J. Bartaby. Councillor A. Keeble. Mrs. W. Baskerville. „ A. McGonagle. H. A. Beck. „ Mrs. M. L. A. E. Blane. McWeeney. S. C. Brown. „ J. R. Poel. C. Charlton. „ W. A. Reeder. Mrs. M. Clark-Lewis. „ G. Roberts, J.P. S. V. Ellmore. ,, L. A. T. Welch. W. S. Gardner. ,, A. G. Western. Mrs. L. A. Irons, J.P. „ R. Yeal. C. L. Jones. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE. His Worship The Mayor: Councillor A. Needham, J.P. (Ex-officio member). Chairman: Councillor P. J. Bartaby. Vice-Chairman : Councillor S. C. Brown. Alderman E. A. Forge, J.P. Councillor Mrs. L. A. Irons, J.P. „ L. S. Webb, J.P. „ A. Iveeble. Councillor Mrs. W. Baskerville. „ A. McGonagle. ,, H. A. Beck. „ L. A. T. Welch. ,, Mrs. M. Clark-Lewis. „ A. G. Western. „ W. S. Gardner. 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. 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) H. H. Seddon, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Other Foods. (Commenced duties 24th January, 1949). (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. Superintendent Health Visitor: Miss F. K. Wells, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (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; Queen's Certificate of District Nursing; Health Visitors' Certificate. (Also holds the appointment of School Nurse). (c) Miss H. E. S. Holmes, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (Commenced duties 30th December, 1949). (Also holds the appointment of School Nurse). (d) Miss J. Jones, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (Also holds the appointment of School Nurse). (e) Miss M. A. Mander, State Registered Nurse; Part 1 S.C.M.; Health Visitors' Certificate. (Commenced duties 19th December, 1949). (Also holds the appointment of School Nurse). 6 Tuberculosis Visitors. (a) Mrs. B. Alder, State Registered Nurse; State Certified Midwife. (b) Mrs. I. M. Baldwin, State Registered Nurse; Certificate for Tuberculosis. (c) Miss K. F. Roots, State Registered Nurse; Registered Fever Nurse; Certificate for Tuberculosis. Domiciliary Mid wives. Non-Medical Supervisor o[ Midwives and Home Nurses: Miss M. B. Worby, State Registered Nurse; State Certified Midwife ; Midwifery Diploma. (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. (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. Home Nurses. (a) Miss E. M. Hern, State Registered Nurse. Commenced duties 18th July, 1949). (b) Miss J. M. Holliday, State Registered Nurse; State Certified Midwife. (Commenced duties '20th June, 1949). (c) Miss J. Macaulay, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (d) Miss R. E. May, State Registered Nurse; Registered Mental Nurse. (e) Mrs. K. A. Rushworth, State Registered Nurse; State Certified Midwife; Queen's Certificate for District Nursing. (Commenced duties 12th December, 1949). (f) Mrs. A. C. Silcock, State Registered Nurse; State Certified Midwife. (g) Miss J. D. Silcock, State Registered Nurse; State Certified Midwife. 7 Clerks. (a) E. W. Gowers, Chief Clerk. (b) C. G. Humberston, Chief Assistant. (c) S. Adams. (d) Miss M. E. Firmin. (e) Mrs. P. Flynn. (f) Miss F. Makings. (g) Mrs. E. Meloy. (h) Miss B. Parker. Home Help Organiser. Mrs. L. Canham. Day Nurseries—Matrons. "St. Moritz." Mrs. I. C. Bowyer, State Registered Nurse. Collier Row. Mrs. D. Eveling, State Registered Nurse. Rush Green. (a) Mrs. G. Pease, Registered Children's Nurse. (Resigned 24th September, 1949). (b) Mrs. R. M. O' Halloran, State Registered Nurse; Registered Fever Nurse. (Commenced duties 26th September, 1949). 8 BOROUGH OF ROMFORD To His Worship the Mayor, Aldermen and Councillors of the Borough of Romford: Me. 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 1949. This is the Sixteenth 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 2/50 of the Ministry of Health, dated 25th January, 1950. This Circular states that the Report should be prepared on the lines of that for 1948, with a few additions. As the chief function of the Medical Officer of Health is to safeguard the health of the area for which he acts by such means as are at his disposal, and as he should endeavour to acquire an accurate knowledge of the influences which may operate prejudicially to health in the area, and combat those influences insofar as he is able to do so, it is clear that his activities, and consequently this report, cannot be limited to any one aspect, but must also embrace those functions of the National Health Service Act, 1946, for which the Essex County Council is the Local Authority. The following pages therefore deal, in part, with such services. The new estate at Harold Hill has grown considerably during the year, and whilst it is not expected that many complaints of sanitary defects will arise, nevertheless there are other problems to he met, such as a rise in the rate of Infectious Diseases during epidemic periods, and an additional number of cases suffering from Tuberculosis. This latter is not due to an unsuitable environment, but rather the reverse, as patients suffering from Tuberculosis have priority for re-housing by the L.C.C., and it is thereby hoped that the better conditions on the Estate will in large measure prove beneficial, not only to the sufferers, but also to their families. I think that it will be agreed that the statistics, in general, throughout this report are satisfactory and encouraging. As before, my best thanks go to all members of my staff, who have assisted in the work in their own individual spheres, and, in the compilation of this report; to my fellow officials for their kind aid during the year, and to all the Members of the Council, who, at all times, have shown a keen interest in matters pertaining to the health and 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, 1950, 9 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1949. Statistics and. Social Conditions of the Area. Area (in acres) 9,342 Population: Census (1931), 35,918. Mid. 1949 (Estd.) 73,640 Number of Inhabited Houses (end of 1949) 21,083 Rateable Value (end of 1949) £588,543 Product of Penny Rate (end of 1949) £2,300 Extracts from Vital Statistics for the Year. Total M. F. Live Births: Legitimate 1,329 705 624 Illegitimate 49 23 26 Birth Rate: 18.0 per 1,000 of estimated resident population Still Births: Legitimate 29 17 12 Illegitimate 1 — — Rate per 1,000 total (live and still births): 21.4. Deaths 659 345 314 Death Rate : 10.8 per 1,000 estimated resident population. Deaths Rate per 1,000 total (live and still) births I )eaths from Puerperal causes :— 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 16.6 Legitimate Infants, per 1,000 legitimate live births 15.6 Illegitimate Infants per 1,000 illegitimate live births 40.8 Deaths from Cancer (all ages) 104 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 1 TABLE 1. BIRTH-RATES, DEATHS-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY and CASE -RATES for certain Infectious Diseases in the year 1949. England and Wales, London, 126 Great Towns and 148 Smaller Towns. (Provisional Figure based on Weekly and Quarterly Returns). Rate per 1,000 Population DEATH-RATE PER 1,000 POPULATION. Rate per 1,000 Live Births Live Births still-births 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 16.7 0.39 11.7 0.00 0.01 0.00 0.45 0.15 0.00 0.01 0.51 3.0 32 126 County Boroughs and Great Towns, including London 18.7 0.47 12.5 0.00 0.02 0.00 0.52 0.15 0.00 0.02 0.56 3.8 37 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) 18.0 0.40 11.6 0.00 0.01 0.00 0.42 0.14 0.00 0.02 0.49 2.4 30 London 18.5 0.37 12.2 0.00 0.01 0.01 0.52 0.11 0.00 0.01 0.59 1.7 29 ROMFORD 18.0 0.39 10.8 0.00 0.00 0.00 0.42 0.12 0.00 0.04 0.42 0.75 17 Puerperal Sepsis Others Total The Maternal Mortality Rates for England and Wales are as follow: Per 1,000 Total Live Births 0.22 0.76 0.98 „ .. „ Romford are as follow: Per 1,000 Total Live Births 0.00 0.74 0.74 10 11 TABLE 2. Causes of Death All ages Deaths at the subjoined age 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Tuberculosis of Respiratory System 19 9 28 ... ... ... ... 4 6 6 2 9 1 ... 7. Other forms of Tuberculosis 2 1 3 ... ... 2 ... ... 1 ... ... ... ... ... 8. Syphilitic disease 2 ... 2 ... ... ... ... ... 1 ... 1 ... ... ... 9. Influenza 6 3 9 ... ... ... ... ... ... 1 ... 3 4 1 10. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 11. Acute Poliomyelitis and Polioencephalitis 3 ... 3 ... ... ... 3 ... ... ... ... ... ... ... 12. Acute infectious Encephalitis ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... 13.M Cancer of Buccal Cavity, etc. 2 ... 2 ... ... ... ... ... ... ... ... 1 1 ... 13.F Cancer of Uterus ... 4 4 ... ... ... ... ... ... 1 2 ... 1 ... 14. Cancer of Stomach and Duodenum 12 8 20 ... ... ... ... ... ... ... ... 8 6 6 15. Cancer of Breast ... 11 11 ... ... ... ... ... ... 1 1 3 2 4 16. Cancer of all other sites 38 29 67 ... ... ... 1 ... ... 3 5 20 25 13 17. Diabetes 1 3 4 ... ... ... ... 1 ... ... ... 1 1 13 18. Intra-cranial Vascular Lesions 24 46 70 ... ... ... ... ... ... 3 5 7 22 1 19. Heart Disease 97 97 194 ... ... ... ... ... 1 5 11 29 52 33 20. Other Diseases of the Circulatory System 12 16 28 ... ... ... ... ... ... ... 4 1 11 96 21. Bronchitis 30 16 46 ... ... ... 1 ... ... 1 3 4 17 20 22. Pneumonia 16 15 31 2 ... ... 1 l ... 1 3 2 6 20 23. Other Respiratory Diseases 1 3 4 ... ... 1 ... ... ... ... ... 1 1 15 24. Ulceration of the Stomach or Duodenum 7 1 8 ... ... ... ... ... ... ... 2 4 1 1 25. Diarrhœa 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... 26. Appendicitis 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 27. Other digestive diseases 4 5 9 ... ... 1 ... ... 1 1 1 2 2 1 28. Nephritis 6 7 13 ... ... ... ... 1 9 ... ... 1 4 1 29. Puerperal Sepsis ... ... ... ... ... ... ... 1 ... ... ... 1 4 5 30. Other Maternal causes ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 31. Premature Birth 4 3 7 7 ... ... ... ... ... 1 ... ... ... ... 32. Congenital Malformations and Birth injuries 6 3 9 8 ... ... 1 ... ... ... ... ... ... ... 33. Suicide 3 4 7 ... ... ... ... 1 ... 2 3 ... ... 1 34. Road Traffic Accidents 8 1 9 ... ... ... 3 1 2 ... 1 ... ... 2 35. Other violent causes 3 5 8 2 ... ... 1 ... ... 1 1 ... 1 2 36. All other causes 37 22 59 2 2 1 2 1 2 1 7 6 9 26 Total 345 314 659 22 2 5 13 10 16 29 52 102 167 241 12 This year the Registrar-General has given his estimate of the mid-year population of Romford as 73,640 which compares with 72,610 last year, and increase of 1,030. 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 4th place. During 1949, the total number of live births registered was 1,329, and the total number of deaths registered was 659. The difference of 670 gives the natural increase in the population. As this number falls short of the Registrar-General's estimated increase of 1,030, it follows that the balance of 360 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 1949 we estimate the Birth Rate to be 18.0 per 1,000 of the estimated resident population, a decrease of 0.4 compared with 1948. The Rate for England and Wales for 1949 is given as 16.7, and for the 148 smaller towns with populations ranging from 25,000 to 50,000 at the 193] Census, the Rate is 18.0. The Death Rate for Romford is estimated at 10.8 per 1,000 of the estimated resident population. For last year the rate was 8.2. The Crude Death Rate, however, for Romford this year is 8.9, but, in order to compare this with the Rate for England and Wales, this figure has to be multiplied by a Comparability Factor of 1.21, which gives the figure of 10.8. The comparable rates for England and Wales, and for the 148 smaller towns, as referred to above, are 11.7 and 11.6 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 16.6 a decrease of 5.8 and the lowest yet recorded. The corresponding figures for England and Wales, and the 148 smaller towns are 32.0 and 30.0 respectively. 13 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Staff. Particulars of the staff are set out at the beginning of this report. The Assistant Medical Officers, Nursing Staffs and Home Help Organiser, as also some of the Clerical Staff, now come under the jurisdiction of the Essex County Council, in their capacity as Local Health Authority, and your Medical Officer of Health is also Acting Area Medical Officer for the Part III duties of the National Health Service Act, 1946. 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. (ii) Laboratory Facilities. There is no change in the facilities as previously recorded, and these meet the requirements of the district. (iii) Nursing in the Home. (a) General Nursing. There, are at present 7 Home Nurses serving the area. These give the whole of their time to general domiciliary nursing, with the exception of one, who has also Midwifery duties to perform. Arrangements are being made to provide nurses for the new estate at Harold Hill, in order to keep pace with the development there, and, at the end of the year, 1 of the Home Nurses had taken up residence on this estate. Table 3 sets out the work of the Home Nurses during the year. TABLE 3. (1) Number of Visits paid 12,492 (2) Number of Cases attended 1,169 (b) Domiciliary Midwives. At the end of the year 9 Domiciliary Midwives were employed, and, here also, the requirements of the Harold Hill Estate are receiving attention. All the Midwives have had the necessary tuition in the administration of Gas and Air Analgesia, and all have been provided with the necessary apparatus. Eight of these Midwives now have cars, either provided by themselves, or by the County Council. The following gives a summary of the cases attended by the Domiciliary Midwives, as Midwives, and as Maternity Nurses:— TABLE 4. As Midwives 354 As Maternitv Nurses 132 As from 1st February, Miss M. B. Worby has acted as NonMedical Supervisor of Midwives and Home Nurses in this area. The appointment is a part-time one, as Miss Worby is also Queen's Superintendent of the York House Training School at Dagenham. 14 The arrangement is quite a satisfactory one, and, by frequent visits to the district, Miss Worby not only keeps in touch with all the Midwives and Home Nurses, but also enquires into notices given by the Midwives as to their liability to be a source of infection, by reason of attendance on patients, who develop a rise of temperature, and also into notices which have been sent by the Midwives for Medical Aid. All "Medical Aid" notices are now sent to me in my capacity as Acting Area Medical Officer, and Doctors' accounts in this connection are received, checked, and certified for payment in the department. Table 5 gives a summary of the notices received. TABLE 6. Individual Children attending 2,996 Children attending for the first time 1,106 Medical Consultations 5,747 Attendances of Children under one year 18,155 Attendances of Children between the ages of one and five years 7,538 Average attendance per session 56.3 TABLE 5. (1) Where the medical practitioner had arranged to provide the patient with maternity services under the National Health Service 5 (2) Others 143 (iv) Ante-Natal and Post-Natal Clinics. At the beginning of December, an Ante-natal Clinic was established at No. 66 Briar Road, at the lock-up surgery of Dr. Fife, one of the General Practitioners in the area, and, for the time being, this serves the needs of the expectant mothers on the Harold Hill Estate. During the year, 1,319 individual expectant mothers attended the Ante-natal Clinics. In addition, 83 mothers attended for Postnatal advice. In all 256 sessions were held. The total number of attendances of the 1,402 mothers mentioned above was 6,232, giving an average of 4.4 attendances per patient. The average number attending at each session was 24.3. (v) Child Welfare Clinics. During the same period 456 Child Welfare Sessions were held, and the following table gives a summary of the attendances:— 15 (vi) Health Visitors. As from 1st April, Miss F. K. Wells has acted as Superintendent Health Visitor, and her duties include not only the supervision of the Health Visitors, but also that of the School Nurses, the Matrons of the Day Nurseries, and the Tuberculosis Visitors. Table 7 relates to House visits paid by the Health Visitors during the year. Table 7. (a) To Expectant Mothers— First Visits 46 Total Visits 48 (b) To Children uder one vear of age— First Visits 1,364 Total Visits 2,124 (c) To Children between the ages of one and five years— Total Visits 2,527 (vii) The Care of Premature Infants. The arrangements, as hitherto, were again continued throughout the year, and use was made of the two draught-proof cots, etc., which are kept at one of the clinics for issue on loan, if required. (viii) Inspection of Nursing Homes. The number of Nursing Homes in this area remains at 3, and these were inspected, as a routine, once per quarter. On each of these occasions, conditions were found to be satisfactory. (ix) Domestic Helps. This service continues to be very popular, and hitherto the supply has met the demand. At the end of the year approximately 100 Part-time Helps were employed, and during the year these Helps gave assistance in 387 individual cases. (x) Day Nurseries. The 3 Day Nurseries have again been working to full capacity, and a fairly large waiting list has been maintained at each. During the year, the Health Area Sub-Committee gave consideration to the provision of two additional Nurseries, and the extension of the "St. Moritz" Nursery to take another 20 children. This latter, however, was not sanctioned by the Ministry of Health. The average attendance for the year at each Nursery was as follows:— TABLE 8. "St. Moritz" Nursery 35 Collier Row Nursery 37 Rush Green Nursery 42 The "'St. Moritz" Nursery and the Collier Row Nursery are scheduled to take 40 children each, and the Rush Green Nursery 50 children. 16 (xi) Dental Service. At the September meeting of the Health Area Sub-Committee, I had to report that our sole remaining Dental Officer would be absent from work for about six months due to illness, and that, during this time, no Dentist would be available for the priority classes. Even prior to September, it was, of course, impossible for one Dental Officer to attend to the needs of approximately 10,(XX) school children, and the priority classes as well. This position regarding Dental Staff is not peculiar, however, to this area, or even' to Essex, but is of national importance. The following gives particulars of the service given to Expectant and Nursing Mothers, and Children under 5 years of age, not attending school:— 2.—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 to the district:— " (a) There have been no new extensions of public water supply during the year 1949, other than those necessitated by the supply to the temporary and permanent housing sites, TABLE 9. (a) Numbers provided with Dental care:— Examined. Needing Treatment. Treated. Made Dentally Fit. Expectant and Nursing Mothers 28 28 25 19 Children under five 12 12 - - (b) Forms of Dental Treatment provided:— Anaesthetics. Scalings or Scaling and Gum Treatment. Silver Nitrate Treatment. Dressings. Radiographs. Dentures provided. Extractions. Local. Fillings. General. Complete. Partial Expectant and Mothers 41 — 27 29 11 — - - 2 3 Nursing Children under five 23 — 12 - — — — — — — 17 (b) Lengths of mains laid in yards:— 12" 9" 6" 4" 3" Coleridge Road 292 Keats Avenue 117 Eyre Close 30 The Ridgeway 103 Eastern Avenue 224 16 Main Road 284 Gobions Estate 319 78 Heaton Avenue 227* Straight Road 345* L.C.C. Harold Hill Estate 8* 1,740* 720 9,024 1,349 Totals 580 1,964 1,339 3,644 1,349 The 12" and 9" mains marked * are the trunk feeder mains to L.C.C. Harold Hill Estate. (c) 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 over 3,300 Chemical, Bacteriological and Biological examinations have been made. (d) 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, by the Sanitary Inspector for Bacteriological analyses once per month, and Chemical analyses once per 6 months, and the results have invariably confirmed the findings of the Waterworks Company. Approximately 0.1 per cent. of the inhabited houses, and 0.1 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 with all complaints, and has also carried out routine inspections, and re-inspections. On the 31st March, 1950, this Act will be repealed by the "Prevention of Damage by Pests Act, 1949," which comes into force on that date, and which gives added powers to Local Authorities to deal with Rats and Mice, and Infestation of Food, 18 (iii) Infestation. The same arrangements exist for the treatment of cases of infestation, and the same facilities for the disinfestation, or destruction of clothing and bedding. This applies to cases of Scabies, and infestation with Lice and 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 10. (a) Nature and number of Inspections during the year:— Bakehouses 24 Butchers' Shops and Stalls, etc. 55 Common Lodging Houses 10 Cowsheds, Dairies and Milkshops 89 Drainage 536 Establishments for Massage and Special Treatment 7 Factories (Mechanical Power) 41 Factories (Non-Mechanical) 13 Food Preparing Premises 80 Foodshops 319 Infectious Disease 548 Keeping of Animals 54 Markets 36 Meat Depots 29 Public Baths 23 Public Conveniences 2 Rats and Mice (Destruction) Act 2,059 Sale of Horseflesh 37 Shops Acts 89 Slaughterhouses 520 Stables 2 Streams and Ponds 8 Tents, Vans and Sheds .... 144 Verminous Premises .... 54 Water Supplies 30 (b) Informal Notices (Number served) 1,005 Statutory Notices (Number served) 251 (c) As a result of the service of Notices, the necessary works were completed by the owners or occupiers in all cases except 203, 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:— 19 TABLE 11. 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 21 45 1 - (ii) Factories not included in (i) which Section 7 is enforced by the Local Authority 178 15 - - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding Out Workers premise) 12 - - - Total 211 60 1 - 2. Cases in which Defects were Found. Particulars. No. of Cases in which prosecucutions instituted. No. of Cases in which defects were found. Found. Remedied Referred to H.M. Inspector. by H.M. Inspector. Want of Cleanliness 1 - - - - Overcrowding — - — — — Unreasonable Temperature - - - - - Inadequate Ventilation - - - - - Ineffect. drain. of floors 2 2 - - - Sanitary Conveniences:— (a)Insufficient 1 1 - - - (b)Unsuitable or Defective 1 1 - - - (c)Not Separate for Sexes - - - - - Other Offences - — — — — Total 5 4 — — — 20 3.—INSPECTION AND SUPERVISION OF FOOD. (i) Milk Supply. With the coming into force on the 1st October, 1949, of the Pood and Drugs (Milk and Dairies) Act, 1944, the Milk (Special Designations) Act, 1949, the Milk and Dairies Regulations, 1949, the Milk (Special Designation) (Raw Milk) Regulations, 1949, and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, alterations were made in the procedure for Registrations and Licensing, and these, where appropriate, were put into operation forthwith. At the end of the year, 32 persons were licensed to retail designated milks. Of the latter, 5 were licensed to retail Tuberculin Tested Milk, 14 were licensed to retail Pasteurised Milk, and 13 were licensed to retail Sterilised Milk. (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 44 manufacturers, and 180 vendors on the register. Particular attention was given to the manufacture and sale of Ice Cream, in view of the Ice Cream (Heat Treatment, etc.) Regulations, 1947 and 1948, and the public feeling which now exists in general for more cleanly conditions in the manufacture and sale of this commodity. The great majority of manufacturers and vendors are themselves aware of public opinion, and are eager to co-operate with the Department, but even the best, at times, require a stimulation of their faith, especially at the height of the season, and the Sanitary Inspectors do their best to meet this requirement. The adoption by the Council of the Model Byelaws of the Ministry of Food, referred to in Sub-Section (iv) of this Report, will strengthen considerably the powers of the Inspectors. (iii) Meat. The Sanitary Inspectors have again regularly attended at the Regional Slaughterhouse, and, in addition, have paid the usual visits to Meat Depots, Butchers' Shops, Stalls, etc. Altogether, 959 visits have been paid, and at the Slaughterhouse alone, 15,427 carcases were examined. No Ante-Mortem inspections are carried out, but all animals slaughtered are examined Post-Mortem. Table 12 sets out the particulars of the carcases inspected and condemned. 3. Outwork. Nature of Work. List of No. of Outworkers in August. No.of Cases of default in ing List No. of tion for failure to supply Lists. No. of Instances of Work in Unwhole some Premises. Notices Served. Prose cutions. Wearing Apparel— Making, etc. 88 - - - - - TABLE 12. CARCASES INSPECTED AND CONDEMNED. Cattle except Cows. Cows. Calves. Sheep and Lambs. Pigs. Horses. Total. Number killed (if known) 3,023 1,985 3,085 6,577 757 1,485 16,912 Number inspected 3,023 1,985 3,085 6,577 757 1,485 16,912 All diseases except Tuberculosis. Whole Carcases condemned 4 16 6 4 11 6 47 Carcases of which some part or organ was condemned 1,281 939 9 176 329 72 2,806 Percentage of the number inspected affected with disease other than tuberculosis 42.7 48.1 0.5 2.7 44.9 5.2 16.5 Tuberculosis only. Whole carcases condemned 20 76 1 — 7 — 104 Carcases of which some part or organ was condemned 486 592 — — 13 — 1,091 Percentage of the number inspected affected with tuberculosis 16.7 33.6 0.03 — 2.6 — 7.6 21 22 (iv) Food Products in General. During the year consideration was given to the establishment in this area of a Romford Hygienic Food Trading Guild to be administered on lines similar to others throughout the Country, and by the end of the year an Exploratory Committee, consisting of representatives of interested parties, had the matter under review. Also, during the latter part of the year, the Council gave consideration to the Model Byelaws, issued by the Ministry of Food for securing the observance of sanitary and cleanly conditions and practices in connection with the Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air, and resolved to adopt the Model Byelaws. The necessary steps are now being taken to secure the approval of the Minister of Food thereto. Whilst several inspections were carried out of restaurants, etc., and improvements made in consequence, the Sanitary Staff has been insufficient in number to cope with all inspections that are desirable, and when the Model Byelaws are finally approved, it will be necessary to increase the staff accordingly. 4.—HOUSING STATISTICS FOR THE YEAR, 1949. TABLE 13. No.of Houses erected during the Year:— (1) By Local Authority 258 (2) By Private Enterprise 85 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) 1,340 (b) Number of inspections made for the purpose .... 4,247 (•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 preceding subhead) found not to be in all respects fit for human habitation 982 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 800 23 3. Action under Statutory Powers during the Year:— (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936— (l)Number of Dwelling-Houses in respect of which notices were served requiring repairs 221 (2)Number of Dwelling-Houses which were rendered fit after service of Formal Notices :— (a) By Owners 145 (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 30 (2) Number of Dwelling-Houses in which defects were remedied after service of Formal Notices:— (a) By Owners 19 (b) By Local Authority in default of Owners — (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (l)Number of Dwelling-Houses in respect of which Demolition Orders were made 2 (2)Number of Dwelling-Houses demolished in pursuance of Demolition Orders Nil. (d) Proceedings under Section 12 of the Housing Act, 1936:— (l)Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (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 137 2. Number of Families dwelling therein 139 3. Number of Persons dwelling therein 974 (b) Number of New Cases of Overcrowding reported during the Year 35 (c) 1. Number of New Cases of Overcrowding relieved during the Year 3 2. Number of Persons concerned in such cases 29 (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. 24 5.—PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. As I mentioned last year, most of the Infectious Diseases now fall within this category, and, as in the past, I have not recorded those notifications, where the diagnosis has been altered after a period of observation, unless the amended diagnosis proved the condition to be one of another type of infection which is notifiable, when the case has then been appropriately recorded. (a) Acute Anterior Poliomyelitis. Popularly known as Infantile Paralysis, this, condition was dormant in this area during 1948, when only 2 cases were notified. During 1949, however, in keeping with the rest of the Country, the disease again became prevalent. Altogether in Romford during the epidemic period there were 7 proved cases, 6 being cases of Acute Anterior Poliomyelitis, and 1 being a case of Polio-Encephalitis, in the latter, affection of the cerebral nervous system being also manifest. Three patients, unfortunately, died. Of the remainder, 2 showed evidence of paralysis in varying degree, and 2 showed no evidence of paralysis, being abortive in type. All the cases were removed to Rush Green Hospital. There is no doubt, however, that a number of cases escaped detection, their symptoms being so slight and evanescent as not to warrant their seeking medical advice. The carrier rate was also probably high and widespread. The same precautionary measures were adopted, as set out in my report for 1947. There is still a considerable amount unknown about this condition, and to assist in the research side of the work full particulars of the cases were forwarded to the Ministry of Health. Why Poliomyelitis should in two years since 1947 have assumed such outstanding proportions is not yet known, but it is comforting to know that research not only of statistics in this Country, but of other Countries which have suffered more considerably, will, without doubt, eventually pave the way to mastery of the disease. (b) Acute Infective Hepatitis. Twenty-eight cases were notified during the year, and these notifications were again forwarded to the Regional Medical Officer at Cambridge, who is still pursuing research into the condition. (c) Diphtheria. During 1949, no cases of this disease were notified. This is the first year on record when a "Nil" return has been recorded. This is a disease which has been practically eliminated from the district, thanks to Diphtheria Immunisation, which has now been practised in a large measure in Romford since 1935. To maintain this satisfactory position, however, it is essential that the Immunisation rate is maintained at a high level, and this can only be 25 done by the will of the parents themselves. All injections are now given free of charge by family practitioners as well as at the Clinics, and at the Schools. It is immaterial to us by which doctor it is done, so long as it is done, and cost no longer enters into it. General Practitioners have again continued to send in their records to the Department. Propaganda was carried out as before, and particular attention was drawn to the desirability of "booster" doses at 5 and 10 years of age, in order to maintain a high standard of immunisation amongst those children who have previously had a course of injections in early infancy. The following statistics relate to the state of Immunisation at the 31st December, 1949. TABLE 14. Under 5 yrs. 5-15 yrs. No. of children who had completed a full course of Immunisation at any time up to 31st December, 1949, and who were born between 31st December, 1935 and 31st December, 1949 3,578 8,891 Approx. estimated No. of children 7,180 10,500 Percentage Immunised at 31st December, 1949 50 85 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 65. Table 15 gives the statistics since the inauguration of the scheme in Romford in 1935, till the end of 1949. TABLE 15. Number of Immunising injections given at the Clinics 32,582 Number of children who have completed the course of Injections, either at the Clinics or by own Doctors 16,258 Number of Schick Test Injections given at the Clinics, including Control Injections 21,619 Number who have been Schick Tested 10,829 (d) Food Poisoning. Nine cases were notified during the year, but there is no doubt there were many more. A very large number, however, suffer only to a relatively slight degree, and do not call in the assistance of a doctor, even although food poisoning is suspected. During the month of September 4 were notified, with cockles as the suspected food factor. These were stated to have been purchased from a district on the Thames estuary. On investigation 15 other cases were brought to light. Some of the cockles had been •26 consumed on purchase, others were taken home to Romford and shared amongst friends, with uncomfortable results. Samples of stools were reported upon as showing no organisms present, and, likewise, the samples of cockles. What the cause of the poisoning was we do not know, but the unusual dryness of that time of year was probably a contributing factor. There were no deaths arising from this outbreak. (e) Measles. Measles was in epidemic form, mainly during the months of January to April, and altogether during the year there were 1,116 cases. No deaths were recorded. (f) Scarlet Fever. This disease was in epidemic form during the latter part of the year, and the year ended with 198 notifications. On the whole the condition was very slight in this area, with relatively few complications, although this was not so in many parts of the Country, or, indeed, in some parts of Essex. Whether or not Scarlet Fever, after many years, is assuming a more serious form remains to be seen in future epidemics. (g) Smallpox. No cases occurred in the district, but with the arrival of the S.S. "Mooltan" at the Port of London on 2nd April, with a case of Smallpox on board, 2 members of the crew with residence in this area were kept under surveillance for the recognised period. Daily workers on board were also kept under supervision. One of these showed suspicious symptoms, and was removed to Clandon Isolation Hospital, Surrey, for observation, where eventually it was proved not to be Smallpox. If Vaccination against Smallpox were as popular as Immunisation against Diphtheria, we should not feel so anxious when Smallpox is introduced into this Country from abroad. Table 16 gives the statistics relative to Vaccination, as recorded by the General Practitioners of the district:— TABLE 16. Vaccinated: Under 1 year of age 105 Between the ages of 1 and 5 years 163 Between the ages of 5 and 15 years 29 Over 15 years 45 Re-Vaccinated: Under 1 year of age — Between the ages of 1 and 5 years 4 Between the ages of 5 and 15 years 7 Over 15 years 73 27 (h) Whooping Cough. Altogether, 248 cases were notified, the largest proportion of these occurring between January and August. As with Measles, no deaths were recorded. (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 17. Mumps 310 Chickenpox 172 Rubella 10 6.—SUPPLEMENTARY. (i) Section 47, National Assistance Act, 1949. It was not found necessary to take any action during the year under this Section of the National Assistance Act, 1948. 28 TABLE 18. MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASES. Month. Scarlet Fever Diphtheria Enteric Fever Puerperal Pyrexia Pneumonia Cerebro Spinal Fever Dysentery Erysipelas Measles Ophthalmia Neonatorum Polio- litis Poliomyelitis Whooping Cough Infective Hepatitis Food Poisoning Tuberculosis Total Resp. NonResp. January 4 - - 1 10 - — 1 155 — — — 35 — — 18 2 226 February 11 — — 1 12 1 - - 501 — — — 33 2 - 7 — 568 March 3 — — 5 10 1 - - 299 — — 1 35 — - 7 2 364 April 5 - — 2 7 - — 1 100 — — — 23 2 - 4 — 144 May 12 — — — 2 _ — 2 35 — — — 24 5 — 8 2 90 June 15 — - 1 2 — - 2 5 — - — 20 5 — 13 1 64 July 7 - - 2 — - - 1 8 1 - 1 26 1 - 10 1 58 August 5 - — 3 — - - 2 2 — — 3 25 4 1 11 — 56 September 14 — — 2 — - — 1 9 — 1 2 15 1 8 12 1 66 October 27 - — — — — — — 1 — — 3 5 6 — 11 — 53 November 53 - - 2 5 — — 3 1 — — 1 4 — — 9 1 79 December 42 — — — 2 - — 2 — — — — 3 2 - 20 2 73 Total 198 - — 19 50 2 — 16 1,116 1 1 11 248 28 9 130 12 1,841 29 TABLS 19. 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 4 16 20 28 116 6 3 3 — — — 198 Diphtheria - - - - - - - - - - - - - Enteric Fever — - - - - - - - - - - - - Puerperal Pyrexia — — — — — — — 4 13 2 — — 19 Pneumonia 4 3 5 3 2 7 2 2 8 3 5 6 50 Cerebro-Spinal Fever — 1 — — — - 1 — — — — — 2 Dysentery — — — — — - - — — — — — — Erysipelas — — — — — - - — 3 2 7 4 16 Measles 43 133 199 177 155 379 25 2 4 — — — 1,116 Ophthalmia Neonatorum 1 — — — — — — — — — — — 1 Polioencephalitis — - — — — — — — 1 — — — 1 Poliomyelitis — 1 — 1 2 6 — - - 1 — — 11 Whooping Cough 21 26 48 46 34 63 5 — 1 3 1 — 248 Infective Hepatitis — — — - 1 8 7 1 5 1 3 2 28 Food Poisoning — — — - — 1 2 2 - 2 2 — 9 Total 70 168 268 247 222 580 48 14 38 14 18 12 1,699 30 TABLE 20. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO WARDS. Disease. Collier Row & Havering Ward. Gidea Park & Noak Hill Ward. Hare Park Ward. Mawney Ward. South Ward. Town Ward. Ward. West Total. Scarlet Fever 81 20 12 39 15 24 7 198 Diphtheria — — — — — — — — Enteric Fever — - — — — — — — Puerperal Pyrexia 3 - 2 1 9 2 2 19 Pneumonia 23 3 4 7 2 8 3 50 Cerebro-Spinal Fever — 1 — 1 — — — 2 Dysentery — — — — — — — — Erysipelas 5 2 1 2 2 3 1 16 Measles 429 203 132 180 93 65 14 1,116 Ophthalmia Neonatorum 1 — — — — - — 1 Polioencephalitis — — 1 — — — — 1 Poliomyelitis — 2 1 3 3 2 — 11 Whooping Cough 88 42 14 65 14 19 6 248 Infective Hepatitis 4 5 6 7 2 4 — 28 Food Poisoning 7 2 — — — — — 9 Tuberculosis: Respiratory 17 59 7 6 16 18 7 130 Non-Respiratory 2 4 4 2 — — — 12 Total 660 343 184 313 156 145 40 1,841 31 TABLE 21. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1949, AND HOSPITAL ADMISSIONS. Disease. Cases Notified. Cases Admitted to Hospital. Total Deaths. Scarlet Fever 198 43 — Diphtheria — — — Enteric Fever — — - Puerperal Pyrexia 19 4 — Pneumonia 50 18 31 Cerebro-Spinal Fever 2 2 — Dysentery — - — Erysipelas 16 16 — Measles 1,116 — — Ophthalmia Neonatorum 1 — — Polioencephalitis 1 1 — Poliomyelitis 11 8 3 Whooping Cough 248 8 — Infective Hepatitis 28 1 — Food Poisoning 9 1 — Total 1,699 104 34 32 TABLE 22. TUBERCULOSIS—NEW CASES AND MORTALITY DURING 1949. AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 — — — — — — — — 1 3 - — 1 — — 2 — 5 5 7 2 2 — — — — 15 12 16 1 1 2 2 — — 25 24 23 — 1 3 3 — 1 35 16 3 1 2 6 — — — 45 9 2 1 — 1 1 — — 55 6 2 — — 6 3 — — 65 and upwards 1 1 — — 1 — — — Total 76 54 5 7 19 9 2 1 33 TABLE 23. OPHTHALMIA NEONATORUM. CASES Vision Unimpaired Vision Impaired Total Blindness Deaths Notified. Treated At Home In Hospital 1 1 Nil 1 Nil Nil Nil Wilson & Whitworth Ltd., Romford. V ! ■