C.I. Ac. 4411 (3) HORNCHURCH HORNCHURCH URBAN DISTRICT COUNCIL ANNUAL REPORT of the Medical Officer of Health FOR THE YEAR 1932 Langtons, Billet Lane, Hornchurch, 29th May, 1933. To the Chairman and Members of the Hornchurch Urban District Council Mr. Chairman, Ladies and Gentlemen, I have the honour to present herewith my Annual Report for the year 1932, being the seventh report since the constitution of the District. The two outstanding features of the year have been the enquiry by the Ministry of Health into the County proposals for the extension of this District by the inclusion of neighbouring areas, and the scheme adopted by the Council and submitted to the Ministry of Health for a new Outfall Works in the Southern part of the District. Both of these questions are still under consideration. The continued rapid development has brought a considerable number of new inhabitants into the District. Examination of the figures in the following report will show that the District is a healthy one for residential purposes and that the Public Health remains satisfactory. ALFRED BALL, m.d., d.p.h., Medical Officer of Health. 2 Members of the Hornchurch Urban District Council. Chairman: Councillor F. H. R. Davis, J.P. Vice-Chairman: Councillor C. L. Parker. Councillors:—Mesdames E. M. Field, F. Sherring. Messrs. E. G. Bratchell, J.P., F. L. J. Cole. J. S. Everson, A. Ferguson, C. J. Fielder, M.B.E., J. Matthews, E. T. Potter, F. E. Standen, B. L. Tarr. Representatives on the Romford Joint Hospital Board. Councillor F. H. R. Davis, ex-officio. ,, E. G. Bratchell, J.P. ,, F. L. J. Cole. Representatives on the Guardians Committee. On the Southern Area Guardians Committee are three members of the Council: Councillor E. G. Bratchell, J. P., Chairman of the Committee, appointed by the County Council, and Councillors F. L. J. Cole and C J. Fielder, M.B.E. In addition Councillor Bratchell, J.P., is a member of the Public Assistance Committee. Section A.—Statistics and Social Conditions of the Area. Area (in acres) 6,783 Registrar-General's estimate of the resident population (mid-year) 1932 33,720 Number of inhabited houses (end of 1932) according to Rate Books 9,914 Rateable value (September, 1932) £244,027 Sum represented by a Penny Kate, (September) £915 Social Conditions. The development of new estates still continues and the District has become mainly residential in character. As most of the houses which are being built are occupied by new comers to the District the population is increasing very rapidly. In the south ward, agriculture, market gardening and other outdoor work are the principal occupations. In the north-west ward many persons are employed in transport undertakings (railway, omnibus, &c.) There are no occupations which have any marked influence on the Public Health. 3 Vital Statistics. Extracts from Vital Statistics of the year. M. F. Live births: Legitimate 327 264 Illegitimate 9 12 Birth rate per thousand population 18.1 Still Births 7 14 Rate per thousand total (live and still) births 33.2 Deaths 134 135 Death rate per thousand population 7.9 Percentage of total deaths occurring in public institutions 46%. Deaths from puerperal causes: (a)—from Puerperal Sepsis 0 (b)—from other puerperal causes 3 (c)— rate per thousand total births 4.7 Death rate of infants under one year of age: All infants per thousand live births 53.9 Legitimate Infants per thousand legitimate live births 49.1 Illegitimate Infants per thousand illegitimate live births 190.5 Deaths from Measles (all ages) 5 „ „ Whooping cough (all ages) 2 „ „ Diarrhcea (under 2 years of age) 1 There has been no excessive or unusual mortality during the year. Comparison of certain rates with those of England and Wales, London, and smaller towns. Birth rate. Death rate. Infant Death rate. England and Wales 15.3 12.0 65 London 14.2 12.3 66 Smaller towns (population 25,000—50,000 15.4 10.8 58 Hornchurch 18.1 7.9 53.9 Section B. General Provision of Health Services for the Area. 1. Public Health Officers of the Authority. (a) Medical. The Medical Officer of Health holds a combined appointment under three Local Authorities, being the Medical Officer of Health for the Hornchurch Urban District Council, the Romford Urban District Council, and the Romford Rural District Council. 4 (b) Sanitary Inspector. There is one whole time Sanitary Inspector, Mr. H. Bousfield, who holds the Sanitary Inspector's Certificate of the Royal Sanitary Institute. 2. Nursing in the Home. A. There is one district nurse-midwife maintained by the Local Nursing Association in the Village. The nurse is supplied by the Essex County Nursing Association to the funds of which the County Council contribute. B. No home nursing of Infectious cases is provided by the Council. 3. Laboratory Facilities. Under arrangements made by the Essex County Council sputum, swabs and other pathological material are examined by Dr. Beale, the County Pathologist, at the Laboratories, 96 Queen Victoria Street, London, E.C.4. Reports are sent to the Doctors submitting the sample, and a copy is forwarded to the Medical Officer of Health. Water, milk, and other foodstuffs may also be examined in the Laboratories on the instructions of the Local Council. 4. Legislation in Force. For details of the Special Orders, adoptive Acts, and Byelaws in force in the District, see page 5 of the Annual Report for the year 1930. 5. Hospitals. Infectious Diseases. The Romford Joint Hospital Board of which this Council is a constituent authority, has provided an Isolation Hospital at Rush Green, containing 150 beds. During the year under consideration the cases admitted to hospital from this District were 44 cases of Scarlet Fever, 29 of Diphtheria, 2 of Puerperal Pyrexia, 2 of Erysipelas, 3 of Enteric Fever, one of Acute Poliomyelitis, and one of Ophthalmia Neonatorum. Smallpox. The Romford Joint Hospital Board has has an agreement since the 1st April, 1932, by which cases of Smallpox may be admitted to the Orsett Smallpox Hospital. During the year no case of Smallpox has occurred in this District. 5 6. Ambulance Facilities. (a) The Romford Joint Hospital Board remove cases of notifiable infectious diseases in their motor ambulance which is stationed at the Hospital, Rush Green. (b) Public Assistance cases are removed to Oldchurch Hospital in a motor ambulance provided for the purpose and kept at the Institution. The Romford Urban District Council maintain a motor ambulance for the removal of non-infectious and accident cases in Romford which may be available for Hornchurch on payment of scale charges. Section C.—Sanitary Circumstances of the Area. Water. The South Essex Waterworks Company maintain a constant supply of water in the populous parts of the District which is satisfactory in quality and has not failed in quantity. The additional supply of water from the river Stour is now in use. A sample of water was taken in a consumer's house and examined at the Counties Laboratory. The report showed that the water was wholesome, pure and suitable for drinking and domestic purposes. Drainage, Sewerage, &c. The Council has two sewage disposal works in the District, one on Rainham Road and the other in the valley of the Ingrebourne river. In addition the Council has placed before the Ministry of Health a proposed plan for the provision of an outfall works in the South Ward adjacent to Rainham. This matter is still under consideration. Extensions of Sewerage. The Surveyor has kindly supplied the following information: New sewers or extensions of existing sewers completed during the year:— SEWERS LAID 12" S. Water feet 9" Soil feet 9'' S. Water feet Abbs Cross Gardens 190 440 Benets Road 1,380 1,370 Candover Road 601 623 6 SEWERS LAID—Contd. 12" S. Water feet. 9" Soil feet. 0" S. Water feet. Cecil Avenue 300 790 Chiltern Road 406 317 Church Road 430 330 Dorian Road 819 851 Frimley Gardens 480 830 Geoffrey Road 900 900 Harwood Avenue 769 697 Hornchurch Road 153 Kenilworth Gardens 480 Manser Road 680 875 Maywyn Drive 260 210 Pegelm Gardens 430 430 Ravenscourt Drive 300 300 St. Margarets Drive 470 460 Slewins Lane 1,324 Vicarage Road 190 1,143 932 Totals 12„ Surface water sewers 190 feet 9" Surface water sewers 12,159 feet 9" Soil sewers 9,711 feet Extensions and Improvements to Outfall Works. No extensions have been made. Underdrains have been taken up and relaid to several of the land beds at the Rainham Road Works and Harold Wood Works. New Streets. Streets made up and taken over. feet Balmoral Road 500 Keswick Avenue 900 Boscombe Avenue (from Osborne Road to Cromer Road) 519 Great Gardens Road (from junction with Brentwood Rd.) 424 Emerson Drive 458 Grey Towers Avenue 743 Gordon Avenue 1,000 Edison Avenue 750 Burn Way 1,028 Keith Way 260 Warriner Avenue 620 Total 7,202 feet. 7 New Estates which are being developed. Hardley Green Estate Hall Estate, Harold Wood Lee Gardens Estate Redden Court Estate Closet Accommodation. Most of the houses in the District are provided with closets connected with sewers including 269 which drain to the Riverside Outfall Works. There are 638 houses which drain to cesspools. Scavenging. The collection and disposal of house refuse is carried out under the directions of the Surveyor. The house refuse is removed weekly in horse drawn closed-in vehicles to a tip which is under the control of the Council and where it is covered with earth. The emptying of cesspools is only undertaken by the Council in one area which is remote from any sewer. Sanitary Inspection of the District. Report of the Sanitary Inspector under Article 19 of the Sanitary Officers' Order, 1926. The following information supplied by the Sanitary Inspector is a classified statement of the number of premises visited, the defects or nuisances discovered, and the action and result of action in regard to these. (a) Nature and Number of Inspections:— Bakehouses 61 Slaughterhouses 91 Cowsheds, Dairies, etc. 101 Butchers' Shops 111 Fish Shops 91 Infectious disease enquiries 205 Disinfections 106 Workshops (including Factories and Workplaces) 61 (b) Number of Notices served:— Informal 118 Statutory 15 8 (c) Result of Notices served:— Informal Notices complied with 97 Statutory Notices complied with 8 (d) Outstanding on 31st December, 1932:— Informal Notices 8 Statutory Notices 7 Works completed:— Blocked drains cleared 41 Fireplaces, stoves and coppers repaired or replaced by new ones 29 Cement dishing round gully traps repaired 4 Dampness abated 27 Pail closets provided 2 Window frames repaired 19 Floors repaired 5 Window sash cords renewed 12 Walls and ceilings repaired 17 Walls and ceilings cleansed 47 Animals discontinued being kept so as to cause a nuisance 4 Dustbins provided 12 Overcrowding abated 2 Flushing cisterns to W.C.'s repaired or replaced by new ones 6 Rain water guttering cleared and cleansed 1 Roofs and gutters repaired 16 Fasteners provided to windows 4 New locks provided and fixed to doors 1 Waste pipes of scullery sinks repaired 5 Water service pipes repaired 1 Windows reglazed 2 New covers and frames provided to inspection and intercepting chambers 1 Sinks and waste pipes repaired or new ones fixed 4 New W.C. pans fixed and seats repaired 1 Rain water down pipes fixed or repaired 3 Chimney pots provided and fixed 1 Accumulations removed 4 Yard paving repaired 1 Door posts repaired 1 Stairtreads repaired 1 Drains relaid 1 Hand basins provided and fixed 1 Doors repaired or new ones fixed 1 Window sills repaired 1 9 Slaughter Houses. There are 2 registered slaughter houses in the District which are regularly inspected and the animals and carcases examined. 91 visits were paid by the Sanitary Inspector during the year. Offensive Trades. The Hornchurch Urban Confirmation Order, 1930, which came into operation on the 24th March, 1930, gave powers to the Council to regulate the trades of a fish frier and of a rag and bone dealer. During the year the Council gave their consent to the establishment of 2 new businesses for the trade of a fish frier. There are now 9 persons carrying on this trade in the District. Tents, Vans and Sheds. Appropriate action has been taken by the Council to control sheds and hutments. The powers contained in the Byelaws dealing with tents, vans and sheds, are of limited application. There are no underground sleeping rooms, cellar dwellings, or common lodging houses in the District. Cemetery. The new cemetery adjoining the churchyard, containing acres which has been acquired by the Council, was opened on the 22nd April, 1932. This extension will make adequate provision for future requirements for a number of years. A Public Mortuary will be provided in the near future. Rag Flock Act. There are no premises in the District on which Rag Flock is manufactured or used. Schools. The Sanitary condition of the schools is satisfactory also the water supply which is from the South Essex Waterworks Company. Cases of notifiable infectious diseases occurring amongst school children and any contacts which there may be in the same house are dealt with by exclusion from school, in accordance with the Memorandum on Exclusion from School. 1927. An intimation is sent in every case to the Head Teacher of the school concerned. 10 Furthermore, the names of the children absent from school stated to be suffering from Infectious Disease are reported on Form M. 1. 13, by Head Teachers to the Medical Officer of Health. Housing. 1. Inspection of dwelling houses during the year:— (1) (a) Total No. of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 413 (b) Number of inspections made for the purpose 1,276 (2) (a) Number of dwelling houses (included under subhead (l) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 78 (b) Number of inspections made for the purpose 271 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 112 2. Remedy of defects during the year without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 96 3. Action under Statutory Powers during the year: A. Proceedings under sections 17, 18, and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 0 (b) By Local Authority in default of owners 0 B. Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 13 11 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 6 (b) By local authority in default of owners 0 C. Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 5 (2) Number of dwelling-houses demolished in suance of Demolition Orders 1 D. Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 0 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 0 E. Proceedings under section 3 of the Housing Act, 1925:— (1) Number of dwelling houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling houses which were rendered fit after service of formal notices:— (a) By owners 0 (b) By Local Authority in default of owners 0 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 F. Proceedings under sections 11, 14, and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which Closing Orders became operative 0 (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwellinghouses having been rendered fit 0 (3) Number of dwelling-houses in respect of which Demolition Orders became operative 0 (4) Number of dwelling-houses demolished in pursuance of Demolition Orders 0 12 4. Number of new bouses erected during the year:— a. Total (including numbers given separately under (b) 1,153 (i) By the Local Authority 22 (ii) By other bodies and persons 1,131 b. With State assistance under the Housing Acts:— (i) By the Local Authority 22 (ii) By other bodies or persons 0 Section E.—Inspection and Supervision of Food. (a) Milk Supply. There are 7 producers of milk in the District. Dairy farms and dairies are inspected frequently in connection with the Milk and Dairies Order, 1926. 27 samples of milk were obtained and submitted to the Counties Laboratory for examination and report on bacterical content and cleanliness. 4 of these were not satisfactory and had to be examined again to obtain a better result. Altogether 22 reports were satisfactory and 5 were not satisfactory. In each case the matter was taken up with the producer. Milk. (Special Designations) Order, 1923. Six firms have been granted licences by the Council to sell graded milks in the district, of which one retails Certified Milk, 6 retail Grade A (TT) Milk, one Grade A Pasteurised Milk, one Grade A Milk, and two Pasteurised Milk. (b) Meat. There are two slaughter houses in the district which are visited regularly by the Sanitary Inspector for the purpose of inspection of carcasses. Section F.—Prevalence of, and control over, Infectious and other Diseases. The incidence of Scarlet Fever and Diphtheria cases was about the same as last year. Most of the cases were removed to hospital for treatment including 30 cases which were removed to London County Council Hospitals from the Hornchurch Residential Schools. 13 Most of these cases were of a mild type and those which were uncomplicated and were treated at the Isolation Hospital at Rush Green, were detained lor a period of about 33 days. No case of Smallpox has occurred in the District. Accommodation is now provided for the treatment of cases of Measles and Whooping Cough complicated with Pneumonia. The Schick test and Dick test have have not been employed nor have any artificial methods of immunization against Diphtheria and Scarlet Fever. The Pathological specimens examined by the County Bacterologist during the year included the following:—97 throat swabs, 88 specimens of sputum for Tuberculosis, 3 samples of Blood for Widal reaction, and also 5 miscellaneous specimens. Intimations of non-notifiable infectious diseases occurring amongst children attending the elementary schools are received from the Head Teachers. Notices of the exclusion of contacts of notifi able infectious diseases are sent to the Head Teachers. The dust shoots in the district are periodically gassed in order to destroy rats. Incidence of Notiable Infectious Diseases during the year. Cases Notified. Admitted to Hospital. Total Deaths. Smallpox 0 0 0 Scarlet Fever 57 49 0 Diphtheria 57 56 1 Enteric Fever (includining Paratyphoid) 3 3 0 Puerperal Fever 1 1 0 Puerperal Pyrexia 5 5 0 Pneumonia 16 2 1 Erysipelas 7 4 0 Acute Poliomyelitis 2 2 1 Malaria 1 0 0 Ophthalmia Neonatorum 2 2 2 Included in the above are 25 cases of Diphtheria and 5 of Scarlet Fever which occurred among the children in the L.C.C. Residential Schools and were moved to a London County Council Hospital. 14 Ophthalmia Neonatorum. There were two cases of Ophthalmia Neonatorum during the year. Both were removed to hospital where one died of Erysipelas and Congenital Disease of the heart; the other died of Toxaemia. Analysis of Cases in stated Age Groups. Years Scarlet Fever Diphtheria Under 1 0 0 1 1 0 2 6 3 3 5 4 4 3 6 5—9 24 19 10—14 9 10 15—19 2 0 20—34 7 7 35—44 0 4 45—64 0 4 65 and upwards 0 0 57 57 Cancer. There were 31 deaths from various forms of Cancer. The age groups were.— Years. M. F. 15—34 1 1 35—44 0 1 45—64 5 6 65—74 7 7 75—84 1 2 The sites of the disease were:— Liver 2 Stomach 7 Colon 2 Rectum 2 Prostate 2 Breast 6 Cervix 1 Pancreas 2 Leg 1 Anus 1 Mandible 1 Glands of neck 1 Ovary 1 Testis (Sarcoma) 1 Spinal cord (Sarcoma) 1 15 Tuberculosis. New Cases. Deaths. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary. Age periods. M F M F M F M F Under 1 1 2 3 2 5 1 6 1 10 1 15 4 2 1 1 20 15 1 25 11 7 2 35 4 4 2 1 4 45 2 1 1 55 1 1 2 65 and over 1 1 Totals 23 22 10 7 6 6 0 2 Public Health (Prevention of Tuberculosis) Regulations, 1925. No action taken. Public Health Act, 1925, Section 62. No action taken. Registrar-General's Short Table of Causes of Death. Corrected for inward and outward transfers. The following figures are supplied by the Registrar General. Causes. Number. Male. Female. 2 Measles 3 2 4 Whooping Cough 2 0 5 Diphtheria 1 0 6 Influenza 3 3 9 Tuberculosis of respiratory system 7 6 10 Other tuberculous diseases 0 2 16 Causes. Male. Female. 12 General paralysis of the insane, tabes dorsalis 1 0 13 Cancer, malignant disease 14 17 14 Diabetes 1 2 15 Cerebral Hæmorrhage, &c. 8 10 16 Heart Disease 18 30 18 Other circulatory diseases 2 4 19 Bronchitis 1 7 20 Pneumonia (all forms) 12 9 21 Other respiratory diseases 1 3 22 Peptic ulcer 6 0 23 Diarrhoea, &c. (under 2 years) 0 1 24 Appendicitis 1 3 27 Other digestive diseases 5 1 28 Acute and chronic nephritis 5 4 30 Other puerperal causes 0 3 31 Congenital debility, premature birth, malformations, &c. 12 4 32 Senility 2 5 33 Suicide 3 1 34 Other violence 6 6 35 Other defined diseases 17 10 36 Causes ill-defined or unknown 3 1 Poliomyelitis 0 1 Total 134 135 Deaths in certain Age-groups during the whole year. In the following table the deaths are given in stated age- groups. Age. No. of Deaths. Under 1 year 33 1 and under 2 8 2 „ „ 5 8 5 „ „ 15 4 15 „ „ 25 8 25 „ „ 35 17 35 „ „ 45 20 45 „ „ 55 30 55 „ „ 65 29 65 „ „ 75 51 75 ,, upwards 60* * Including 8 males and 19 females between 80 and 89 years of age, and 4 females of 90 years and over. 17 Infantile Mortality. The following table shows the causes of death and the distribution in age groups of the infants who died under one year of age. Ages Under 1 week Purpura Hæmorrhagica 1; Prematurity 5; Injury or lack of attention 4; Congenital Malformation 2. Over 1 week and under 1 month Prematurity 2; Congenital Malformation 1; Debility 1; Bronchitis 1. Over 1 month and under 3 months Congenital Malformation 2; Pneumonia 3; Marasmus 2; Toxæmia 1; Asphyxia 1. Over 3 months and under 6 months Pneumonia 1; Congenital Malformation 1. Over 6 months and under 12 months Gastro-enteritis 1; Pneumonia 3; Measles 1. Rainfall during the year. I am indebted to Mr. F. Alderson, the Surveyor, for the subjoined information on rainfall as recorded at the Sewage Disposal works on the Rainham Road. Amount of rainfall in inches No. of days in which rain fell January 1.24 12 February 0.18 8 March 1.34 14 April 1.63 22 May 2.71 19 June 0.81 5 July 1.95 10 August 170 9 September 1.79 18 October 4.70 23 November 0.69 12 December 0.41 10 Total 19.15 162 18 During the year 1931 rain fell on 151 days the total rainfall being 22.04 inches, and in the year 1930 the corresponding figures were 165 days and 22.26 inches. On the Administration of the Factory and Workshop Act, 1901. 1 Inspection. Premises. Inspections. Number of Written Notices Prosecutions. Factories 12 0 0 Workshops 45 0 0 Workplaces 4 0 0 Totals 61 0 0 2 Defects. Nuisances under the Public Health Act.—None. 3 Outwork in unwholesome premises, Section 108. None.