HORNCHURCH URBAN DISTRICT COUNCIL. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1933 romford j. e. castle, printer, market place. HORNC 3 Ac 4411(3) HORNCHURH Langtons, Billet Lane, Hornchurch. 11th May, 1934. To the Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present for your consideration my Annual Report for the year ended 31st December, 1933, which is submitted in accordance with the requirements of Article 14 (3) of the Sanitary Officers' Order, 1926, which provides that a Medical Officer of Health, in respect of the District for which he is appointed, shall make an Annual Report to the Local Authority up to end of the December, on the sanitary circumstances, sanitary administration, and the vital statistics of the District. Building development still continues at a rapid pace and attracts a large number of new inhabitants into the District. A much greater increase both in population and acreage of the District is foreshadowed by the decision of the Essex County Council in its Review Order, which had not received the final assent of the Ministry of Health at the end of the year. ALFRED BALL, m.d., d.p.ii., Medical Officer of Health. 2 Members of the Hornchurch Urban District Council. Chairman: - - Councillor C. L. Parker, J.P. Vice-Chairman : - Councillor Mrs. E. M. Field. Councillors-.—Mrs. F. Sherring, Messrs. E. G. Bratcliell, J.P., F. L. J. Cole, F. H. R. Davis, J. S. Everson, A. Ferguson, C. J. Fielder, M.B.E., J. Matthews, E. T. Potter, F. E. Standen and B. L. Tarr. Representatives on the Romford Joint Hospital Board. Councillor C. L. Parker, cx-officio. „ F. L. J. Cole. ,, J. Matthews. Representatives on the Guardians Committee. On the southern area Guardians Committee are three members of the Council. Councillor E. G. Bratcliell, 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 E. G. Bratcliell, 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) 1933 38,650 Number of inhabited houses fend of 1933) according to Ratebooks £11,548 Rateable value (September, 1933) £273,389 Sum represented by a Penny Rate (September) £1,040 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 on occupations which have any marked influence on the Public Health. 3 Comparison of certain rates with those of England and Wales, London, and smaller towns. Birth rate Death rate. Infant Death rate England and Wales 14.4 123 64 London 13.2 12.2 59 Smaller towns (population 25,000—50,000) 14.5 11.0 56 Hornchurch 184 7.8 51.8 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, also Deputy Medical Superintendent of the Romford Isolation Hospital. Vital Statistics- Extracts from Vital Statistics of the year. M. F. Live births: Legitimate 338 359 Illegitimate 7 10 Birth rate per thousand population . 18'4 Still Births 14 10 Rate per thousand total (live and still) births 32'5 Deaths 151 154 Death rate per thousand population7'8 Percentage of total deaths occurring in public institutions 46'5% Deaths from puerperal causes: (a) from Puerperal Sepsis 0 (b) from other puerperal causes 1 (c) rate per thousand total births 1.3 Death rate of infants under one year of age: All infants per thousand live births 51.8 Legitimate infants per thousand legitimate live births 47 3 Illegitimate infants per thousand illegitimate live births 235'3 Deaths from Measles (all ages)0 „ „Whooping Cough (all ages) 1 „ „Diarrhoea (under 2 years of age) 4 There has been no excessive or unusual mortality during the year. 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. 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. 3. 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. (c) The Hornchurch Council have entered into a financial arrangement with the St. John Ambulance Brigade who are responsible for the maintenance of an ambulance which is stationed in Upminster. This is a provisional arrangement and will be reviewed when the proposed enlargement of the District has taken effect. 4. 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. 5. Clinics and Treatment Centres. The Essex County Council's Combined Treatment Centre at Westland Avenue, Hornchurch, was opened on the 31st May, 1933 This building accommodates Infant Welfare, Antenatal, Orthopaedic and Dental clinics. 5 6. 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 bed. During the year under consideration the cases admitted to hospital from this District were 128 cases of Scarlet Fever, 31 of Diphtheria, 1 of Puerperal Septicaemia, 2 of Erysipelas, 2 of Enteric Fever, 1 of Pneumonia, 1 of Tonsilitis, 1 of Mumps and 1 of Rheumatism. Smallpox. The Romford Joint Hospital Board has entered into an agreement whereby cases of Smallpox may be admitted to the Orsett Smallpox Hospital. During the year no case of Smallpox has occurred in this District. 7. 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. 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. Drainage and Sewerage. The Council have two sewage disposal works in the District, one on Rainham Road and the other in the valley of the Ingrebourne river. Extensions of Sewerage. The Surveyor has kindly supplied the following information : 6 New sewers or extensions of existing sewers completed during the year:— SEWERS LAID. 15" S.W. feet. 12" . Soil feet. 12" S. Water feet. 9" Soil feet. 9" S. Water feet. 6" S. Water feet. Hornford Way 510 510 Rom Crescent 300 550 900 Rainham Road 1,554 1,160 Banyards Farm 1,125 180 Birch Avenue 150 1,310 1,312 550 Oak Glen 90 Laburnum Avenue 881 745 1,460 Squirrels Heath Road 936 Chestnut Glen 755 835 Chestnut Avenue 1,125 1,395 The Crescent 618 Cecil Avenue 490 Harwood Avenue 300 120 Macdonald Avenue 625 600 Dorset House Estate 647 440 Acacia Avenue 938 1,160 Primrose Glen 912 927 Grove Road 670 670 Minister Way 420 Dawes Avenue 830 850 Crystal Avenue 790 975 Winifred Avenue 490 Ravenscourt Drive 1,051 1,055 Church Road 885 Court Avenue 480 David Drive 780 785 Oliver Road 295 290 Great Gardens Road 670 700 Maybrick Road 470 Somerset Road 990 985 Holme Road 150 145 Queens Park Road Harold Wood 264 Rainham Road from the Cherry Tree 693 Billet Lane 1,679 Butts Green Road 1,814 Westland Avenue 490 480 Glanville Drive 890 900 Bellevue Drive 260 255 Elm Park Avenue 1,305 1,395 Haynes Road 300 Miles 264 5,783 2,481 18,136 24,957 640 05 1.1 .47 35 4.73 .12 Total 9.97 miles 7 Extensions and Improvements to Outfall Works. Underdraining has been carried out but no new work has been put in hand at the existing outfall works. A complete scheme involving new works has been submitted to the Ministry of Health. New Streets. Streets made up and taken over. feet Lambourne Gardens 732 Connaught Road 661 Northdown Road 1,208 Southdown Road 1,062 Purbeck Road 926 Cromer Road (part of) 800 Fairkytes Avenue 909 Candover Road 707 Dorian Road (part of) 878 Vicarage Road 1,118 Norman Road (part of) 1,312 Cheviot Road 836 Globe Road (part of) 280 Stafford Avenue 1,110 Ashlyn Grove (part of) 475 Cecil Avenue (part of) 870 Harwood Avenue (part of) 1,740 Recreation Avenue (part of) 415 Maybrick Road 905 Great Gardens Road (part of) 1,030 Total 17,974 3.4 miles. New Estates which are being developed. Extension of Hardley Green Estate. Maylands Estate. Dorset House Estate. Hornford Estate. Grove Farm Estate. Closet Accommodation. Most of the houses in the District are provided with closets connected with sewers including 349 which drain to the Riverside Outfall Works, There are 691 houses which drain to cesspools. 8 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 39 Slaughterhouses 83 Cowsheds, Dairies, &c 90 Butchers'Shops 73 Fish Shops 73 Infectious disease enquiries 328 Disinfections 228 Workshops (including Factories and Workplaces) 81 (b) Number of Notices served:— Informal 126 Statutory 31 {c) Result of Notices served:— Informal Notices complied with 81 Statutory Notices complied with 25 (d) Outstanding on 31st December, 1933:— Informal Notices 41 Statutory Notices 6 9 Works completed:— Blocked drains cleared 42 Walls and ceilings cleansed 26 Walls and ceilings repaired 12 Flushing cisterns to W.C.'s repaired or replaced by new ones 24 Vans moved 1 Food discontinued being prepared in bathroom 1 Dampness abated 12 Defective joints made good between flush pipes and W.C. basins 3 Cesspools emptied 2 Fireplaces, stoves and coppers repaired or replaced by new ones 9 Overcrowding abated 2 Drains relaid 1 Window frames repaired 11 Roofs and gutters repaired 12 Floors repaired 8 Stairtreads repaired 2 Doors repaired or new ones fixed 6 Window sash cords renewed 9 New cast iron ventilating pipes provided and fixed 2 Accumulations removed 2 Walls repapered 5 Dustbins provided 7 Yard paving repaired 3 Sufficient damp proof course inserted 1 New W.C. pans fixed and seats repaired 4 New covers and frames provided to inspection and intercepting chambers 2 Fresh air inlets to drains repaired 2 Sinks and waste pipes repaired or new ones fixed 2 Water service pipes repaired 1 Cement dishing round gully traps repaired 2 New locks provided and fixed 1 Slaughter Houses. There are two registered slaughterhouses in the District which are regularly inspected and the animals and carcases examined. Eighty-three visits were paid by the Sanitary Inspector during the year. 10 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 3 new businesses for the trade of a fish frier. There are now 13 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 85acres which has been acquired by the Council, was opened on 22nd April, 1932 This extension will make adequate provision for future requirements for a number of years. A Public Mortuary has been provided at the Old Council Offices, Billet Lane, Hornchurch. 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 theie 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. Furthermore, the names of the children absent from school stated to be suffering from Infectious Disease are reported on Form M-I. 13, by Head Teachers to the Medical Officer of Plealth. 11 Section D.-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) 494 (b) Number of inspections made for the purpose 826 (2) (a) Number of dwelling houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations 40 (b) Number of inspections made for the purpose 120 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 128 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 81 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 authoritv 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 30 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 24 (b) By local authority in default of owners 0 12 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 4 (2) Number of dwelling-houses demolished in suance of Demolition Orders 4 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 4. Number of new houses erected during the year:— a. Total (including numbers given separately under B)1,580 (1) By the Local Authority 14 (2) By other bodies and persons 1,566 B. With State assistance under the Housing Acts:— (1) By the Local Authority 14 (2) 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. 18 samples of milk were obtained and submitted to the Counties Laboratory for examination and report on bacterial content and cleanliness. Two of these were not satisfactory and had to be examined again to obtain a better result. Altogether 15 reports were satisfactory and 3 were not satisfactory. In the latter cases the matter was taken up with the producer. 13 Milk (Special Designations) Order, 1923. Eight firms have been granted licences by the Council to sell graded milk in the District, of which one retails Certified Milk, 7 retail Grade A (TT) Milk, one Grade A Pasteurised Milk, one Grade A Milk, and 4 Pasteurised Milk. (b) Meat. There are two slaughterhouses in the District which are visited regularly by the Sanitary Inspector for the purposes of inspection of carcases. Section F.—Prevalence of. and Control over. Infectious and other Diseases. The incidence of Diphtheria was less than last year, there being 35 cases as against 57 in the year 1932. The Scarlet Fever cases showed an increase in numbers this being due to a wave of the disease which was experienced in Hornchurch in common with most parts of the Kingdom. Two hundred and nine cases were notified of which 67 were removed for treatment to the Isolation Hospital. The majority of the cases were of a mild type. Twelve cases of infectious disease occurred in the Hornchurch Children's Homes and were removed for treatment to London County Council Hospitals. No case of Smallpox has occurred in the District. The Schick test and Dick test 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:—105 throat swabs, 74 specimens of sputum for Tuberculosis, 4 samples of Blood for Widal reaction, and also 14 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 notifiable infectious diseases are sent to the Head Teachers. No cases of Anthrax, Jaundice, Psittacosis, Glandular or Undulant Fever, have been notified in the District. 14 Incidence of Notifiable Infectious Diseases during the year Cases Notified. Admitted to Hospital. Total Deaths Smallpox 0 0 0 Scarlet Fever 209 142 2 Diphtheria 35 31 0 Enteric Fever (including Paratyphoid) 2 2 0 Puerperal Fever 5 5 0 Puerperal Pyrexia 2 1 0 Pneumonia 18 10 - Erysipelas 7 2 0 Cerebrospinal Fever 1 1 1 Ophthalmia Neonatorum. There was 110 case of Ophthalmia Neonatorum during the year. Analysis of cases in stated Age Groups. Years. Scarlet Fever. Diphtheria. Under 1 0 1 1 5 1 2 1 1 3 11 2 4 12 2 5—9 119 13 10 — 14 34 8 15—19 7 1 20—34 11 4 35—44 8 1 45—64 1 1 65 and upwards 0 0 209 35 Cancer. There were 41 deaths from various forms of Cancer. The age groups were :— Years. M. F. 1 — 14 1 0 15—34 3 0 35—44 1 4 45—64 10 11 65—74 3 3 75—84 2 3 15 The sites of the disease were:— Duodenum 1 Stomach 7 Pancreas 2 Gall Bladder 1 Rectum 3 Uterus 2 Colon 5 Lung 3 Breast 8 Jaw 1 Larynx 1 Tongue 1 Orbit 1 Caecum 1 Spine 1 Liver 1 Kidney (Sarcoma) 1 Lymphosarcoma 1 Tuberculosis. The Notifications of cases of Tuberculosis included 34 males and 31 females suffering from Pulmonary and 9 males and 4 females suffering from non-pulmonary forms of the disease. Age periods New Cases. Pulmonary. Non-Pulmonary. Pulmonary. Deaths. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 1 2 5— 1 5 3 1 1 15— 6 8 1 1 3 1 25— 10 7 1 2, 2 1 35— 10 8 2 1 45— 4 6 2 1 55— 1 1 1 65 — 3 1 1 Public Health (Prevention of Tuberculosis) Regulations. 1925. No action taken. 16 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. 3 Scarlet Fever 2 4 Whooping Cough 1 6 Influenza 6 9 7 Encephalitis lethargica 1 8 Cerebro-spinal fever 1 9 Tuberculosis of respiratory system 12 5 10 Other tuberculous diseases 1 2 11 Syphilis 1 12 General paralysis of the insane, tabes dorsal is 1 1 13 Cancer, malignant disease 21 22 14 Diabetes 1 3 15 Cerebral hæmorrhage, &c. 8 8 16 Heart disease 27 41 17 Aneurysm 2 1 18 Other circulatory diseases 4 2 19 Bronchitis 5 10 20 Pneumonia (all forms) 7 9 22 Peptic ulcer 1 23 Diarrhoea, etc. (under 2 years) 2 2 24 Appendicitis 4 3 27 Other digestive diseases 4 4 28 Acute and chronic nephritis 5 2 30 Other puerperal causes 1 31 Congenital debility, premature birth, malformations, &c. 13 10 32 Senility 2 4 33 Suicide 1 34 Other violence 9 4 35 Causes ill-defined or unknown 13 7 151 154 17 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 37 1 and under 2 2 2 „ „ 5 8 5 „ „ 15 7 15 „ „ 25 12 25 „ „ 35 26 35 „ „ 45 21 45 „ ,, 55 25 55„„65 46 65 „ „ 75 53 75 „ upwards 70* * Including 8 males and 22 females between 80 and 89 years of age, and 1 male and 2 females of 90 years and over. 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 Congenital Malformation 1; Prematurity 7; Asphyxia 1; Debility 2; Atelectasis 2; Enteritis 1. Over 1 week and under 1 month Pyloric Stenosis 1; Prematurity 3; Icterus Neonatorum 1; Pneumonia 1; Enteritis 1. Over 1 month and under 3 months Pneumonia 2; Congenital Malformation 1; Marasmus 2; Prematurity 1. Over 3 months and under 6 months Congenital Malformation 1; Pneumonia 4; ( Gastro-enteritis 2. Over 6 months and under 12 months Whooping Cough 1; Septic Dermatitis 1; Pneumonia 1. 18 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 0.93 12 February 0.95 15 March 1.46 15 April 0.54 6 May 1.81 16 June 3.17 12 July 2.61 12 August 0.48 6 September 2.04 11 October 1.36 14 November 1.03 16 December 0.41 6 Total ... 16.79 141 On the Administration of the Factory and Workshop Act. 1901. 1. Inspection Premises Inspections. Number of Written Notices. Prosecutions. Factories 17 0 0 Workshops 48 0 0 Workplaces 16 0 0 Total 81 0 0 2. Defects Nuisances under the Public Health Act.—None. 3. Outwork in unwholesome premises, Section 108 - -None. During the year 1932 rain fell on 162 days the total rainfall being 19.15 inches, and in the year 1931 the corresponding figures were 151 days and 22.04 inches.