HORNC 6 Hornchurch Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1936. ALFRED BALL, M.D., D.P.H. Medical Officer of Health. Hornchurch Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1936. ALFRED BALL, M.D., D.P.H. Medical Officer of Health. 3 Council Offices, HORNCHURCH, Essex. 14th June, 1937. To The Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour herewith to present my eleventh Annual Report on the Vital Statistics and Sanitary Circumstances of the District. The most important event of the year under review has been the promotion of the Hornchurch private Act which received the Royal Assent on the 31st July, 1936. This Act is divided into 11 parts containing 172 sections and further reference will be made in the body of the report to those parts of the Act which contain provisions dealing with Public Health. On the 1st April, 1936, a further accession to the district administered by the Council occurred when a large part of the parish of North Ockendon was included in Cranham Ward. The year has been a healthy one and the District continues to attract many new inhabitants. I wish to thank the members of the Council for their continued support in my work and to acknowledge the assistance which I have received from my fellow officers. ALFRED BALL, M.D., D.P.H., Medical Officer of Health. 4 MEMBERS OF THE COUNCIL Councillor J. W. Mathews, J.P., Chairman. Councillor R. W. Beard, J.P., Vice-Chairman. Councillor Mrs. E. M. Field. „ Mrs. A. J. E. King. „ Mrs. F. Sherring. „ O. P. W. Ashdown. „ G. C. Cardnell. „ F. H. R. Davis. „ F. D. K. Farnan. „ A. Ferguson. „ A. C. Holmes. „ T. Martin. Councillor W. H. F. Maunder. „ C. L. Parker. „ E. T. Potter. „ D. A. Ramsay. „ B. L. Tarr. „ A.J. Twigger. H. H. Wake. „ T. F. Willoughby. „ J. R. Wren. Representatives of the Council on the Romford Joint Hospital Board: Councillor J. W. Mathews (ex-officio) „ Mrs. F. Sherring. „ G. C. Cardnell. Councillor F. D. K. Farnan. „ T. F. Willoughby. Representatives of the Council on the Romford and Hornchurch Joint Sewerage Committee: Councillor Mrs. E. M. Field. „ F. H. R. Davis. „ J. W. Mathews. Councillor W. H. F. Maunder. „ J. R. Wren. Representatives of the Council on the Southern Area Guardians Committee: Councillor Mrs. A. J. E. King. Councillor Mrs. F. Sherring. 5 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres 19,768 Registrar-General's estimate of the resident population (mid-year) 1936 64,447 Number of inhabited houses (end of 1936) according to Rate books 20,923 Rateable Value (September, 1936) £501,442 Sum represented by a Penny Rate (September) £1,990 Social Conditions. The district is, to a great extent, residential in character and building estates which continue to be developed rapidly, attract new residents to the district and increase the population very considerably. There are still large areas in the district in which agriculture remains a predominant occupation. There are no conditions of occupation or environment which have had a prejudicial effect on health. There is little unemployment in the district and the public works which have been carried out attract workers from other districts. Vital Statistics. Extracts from the Vital Statistics of the year. The net births and deaths after correction for inward and outward transfers as supplied by the Registrar-General. Male. Female. Total. Rate. Live Births:— Legitimate 634 626 1,301 Illegitimate 17 24 Birth rate per 1,000 calculated on composite population of 64,385 20.2 Still Births:— Legitimate 22 19 45 Illegitimate 1 3 Rate per thousand total (live and still) births 33 Deaths 270 240 510 Death rate per 1,000 calculated on composite population of 64,385 7.9 6 Deaths from Puerperal Causes:— Total. Rate. (a) from Puerperal Sepsis 1 (b) from other puerperal causes 3 (c) rate per thousand total (live and still) births 2.9 Death rate of infants under one year of age:— All infants per thousand live births 47.6 Legitimate infants per thousand legitimate live births 48.4 Illegitimate infants per thousand illegitimate live births 24.3 Deaths from Measles (all ages) 3 ,, ,, Whooping Cough (all ages) 0 ,, ,, Diarrhoea (under 2 years of age) 7 Area and Population. On the 1st April, 1936, part of the parish of North Ockendon formerly in the Orsett Rural District was added to the Hornchurch Urban District. In the following table the district as constituted at the 30th June, 1936, is shown divided into wards with their acreage and with the population which was enumerated at the census in 1931. Wards, as constituted at 30th June, 1936. Acreage land and inland water. Population census 1931. Cranham 5,110 1,703 Emerson Park 1,246 5,380 Harold Wood 2,160 3,661 North West 1,061 10,185 Rainham 4,546 4,256 Thameside 2,329 2,540 Town 1,177 6,420 Upminster 2,139 5,244 Total 19,768 39,389 Of the total population of 39,389 at the census of 1931, 19,376 were males and 20,013 were females. The number of persons per acre of the whole district was 2. In the administrative County there were 1.2 persons per acre; in the Municipal Boroughs and Urban Districts there were 3.9; and in the County Boroughs 31.0 persons per acre. In Hornchurch at the Census of the year 1931 there were 10,223 private families occupying dwellings and rooms as shown in the following table:— 7 Private Families and Dwellings 1931. Private Families. Population in Private Families. Structurally separate dwellings. Occupied. Unoccupied. Rooms occupied. Persons per room. 10,223 37,988 9,695 383 50,125 0.76 Ages and Marital Conditions. In the table given below are shown ages in groups also the marital conditions of the population as ascertained at the Census 1931 in the Urban District of Hornchurch as constituted at the 30th June, 1936. Marital conditions. Total Population. Married only. Males. Females. Males. Females. 19,376 20,013 9,527 9,583 Single 9,323 9,221 — — Married 9,527 9,583 9,527 9,583 Widowed 510 1,191 — — Divorced 16 18 — — Ages. 0—4 1,767 1,676 — — 5—9 1,950 1,814 — — 10—14 1,573 1,479 — — 15—19 1,417 1,438 4 35 20—24 1,466 1,559 259 530 25—29 1,868 1,906 1,183 1,363 30—34 1,820 2,002 1,547 1,661 35—39 1,661 1,811 1,526 1,584 40—44 1,344 1,464 1,232 1,207 45—49 1,136 1,144 1,043 935 50—54 920 985 825 775 55—59 776 793 690 585 60—64 648 654 555 436 65—69 457 529 357 289 70—74 307 359 193 149 75—79 167 233 74 49 80—84 74 117 30 17 85—89 19 43 7 2 90—94 4 7 — 2 95 and over 2 — 2 — On examination of this table it is found that the number of children up to 14 years of age in Hornchurch is 260 per 1,000 of the total population: the corresponding figure for the Administrative County of Essex is 228 per 1,000 of the total population of 1,189,004. 8 In Hornchurch the total persons aged 15 to 44 years represent 501 per thousand of the population and in the Administrative County the corresponding figure is 471. These figures show that the population of the District contains an unusually large number of young people and also tend to explain the high birth rate. A high birth rate is frequently accompanied by a high death rate but the favourable death rate experienced in Hornchurch shows that this District is healthy and satisfactory for residential purposes. Births. The number of births registered in the district during the year was 1,046. The number of births corrected for inward and outward transfers is as follows:— Males. Females. Legitimate 634 626 Illegitimate 17 24 The percentage of illegitimate births to the total registered was 3.1 The birth rate calculated on a population of 64,385 is 20.2 per thousand estimated population. A comparison with previous years follows:— 1935 17.0 1930 16.1 1934 17.6 1929 17.0 1933 18.4 1928 14.9 1932 18.1 1927 16.3 1931 20.1 1926 17.3 Deaths. There were 306 deaths registered in the district during the year, this number including 57 belonging to other districts which have, therefore been subtracted. 146 males and 116 females whose residence was in Hornchurch died elsewhere and these deaths are added as inward transfers. The deaths of Hornchurch residents occurring in hospitals were as follows:— Oldchurch Hospital, Romford 142 Orsett Institution 26 Brentwood and Severalls Mental Hospitals 8 9 Victoria Hospital, Romford 4 Romford Isolation Hospital 7 King George Hospital, Ilford 9 Queen Mary's Hospital, Stratford 2 Other Hospitals in Essex 15 Hospitals in London 37 Other 1 49 per cent. of the total Hornchurch deaths occurred in hospitals, or other institutions. The crude death rate calculated on a population of 64,385 was 7.9 per thousand. A comparison with previous years follows:— 1935 8.4 1930 8.2 1934 8.4 1929 9.9 1933 7.8 1928 8.4 1932 7.9 1927 9.4 1931 8.4 1926 10.6 Comparative Mortality after allowing for differences in the Population Constitution. The Registrar-General has supplied an areal comparability factor by which the crude death rate is to be multiplied in order to give a mortality figure which is strictly comparable with those of other districts to which the same treatment has been applied. The adjusted mortality rate for Hornchurch in the year 1936 thus obtained is 8,769. Coroner's Inquisitions. During the year the deaths of 27 males and 17 females were investigated by the Coroner. Of these 33 were residents and 11 were persons belonging to other districts. In 15 cases an Inquest was held. In 24 cases the Coroner certified the cause of death after autopsy and in 5 cases after inquiry only. The ages at death are shown in the following age-groups:— Age-group. No. Age-group. No. Under 1 year 4 35—44 years 5 1—4 years 2 45—54 „ 9 5—14 „ 2 55—64 „ 4 15—24 „ 4 65—74 „ 8 25—34 „ 3 75—84 „ 3 10 The fifteen deaths which were the subject of an Inquest are classified thus:— Deaths from Violence:— Suicide by coal gas poisoning 3 Suicide by prussic acid 1 Suicide by drowning 1 Suicide by decapitation by train 1 Accidental injuries by motor vehicles 4 Septicaemia following accidental injuries 1 Accidental injury to brain by heavy weight 1 Accidental drowning 2 Accidental immersion and heart failure 1 Causes of death certified after autopsy:— Heart Disease 12 Cerebral Hæmorrhage 2 Atelectasis 1 Pneumonia 1 Bronchitis and Emphysema 1 Carcinoma of oesophagus 1 Rupture of Aorta 1 Tuberculosis 2 Acute Septicæmia 1 Arterio-sclerosis 1 Jaundice 1 Causes of death certified by Coroner after inquiry:— Heart disease 4 Hydrocephalus 1 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 62 1 and under 2 5 2 „ „ 5 8 5 „ „ 15 13 15 „ „ 25 18 25„ „ 35 29 35 „ „ 45 46 45 „ „ 55 46 55 „ „ 65 70 65 years and upwards 214 Total 511 11 SENILE DEATHS. The deaths amongst persons aged 65 years and upwards have been further sub-divided into five-year periods as follows:— Male. Female. 65 25 24 70 34 17 75 26 27 80 9 22 85 8 17 90 2 2 95 — 1 104 110 Maternal Mortality. One death occurred during the year from Puerperal Sepsis and three from other Puerperal causes. The maternal mortality rate, i.e. the deaths from all puerperal causes, per 1,000 (live and still) births is 2.9. The corresponding rate in the year 1935 was 4.67, in 1934 it was 6.3, and in 1933 it was 1.3. The maternal mortality rate for England and Wales was 3.81 for the year 1936. The following table shows the causes of death:— Age. Cause. 22 years Post partum eclampsia. 27 „ Puerperal fever. 30 „ Puerperal eclampsia. 31 „ Cerebral haemorrhage : pre eclampsia. These 4 deaths occurred in hospitals. Infantile Deaths. During the year 1936 there were 39 male and 23 female deaths of children under one year of age. The infant mortality rate per 1,000 births was 47; for England and Wales it was 59. The figures for the last 6 years are subjoined. 12 Year. No. of deaths under one year. Rate. 1935 50 48.0 1934 53 57.4 1933 37 51.8 1932 33 53.9 1931 37 62.5 1930 33 72.7 Neonatal Mortality. This term is applied to the deaths of children under one month. There were 30 of such deaths yielding a rate of 23.0 per 1,000 births for the year. Prematurity was the cause of death in 15 cases and Congenital Malformation in 6 cases. Pneumonia was the cause of death in 9 of the 32 children who were more than one month old. The following table shows the deaths from stated causes at various ages under one year of age:— Table—INFANT MORTALITY, 1936. Deaths from stated causes at various ages under one year of age. Under 1 week 1-2 weeks 2-3 weeks 3-4 weeks Total under 4 weeks 4 weeks and under 3 months 3 months and under 6 months 6 months and under 9 months 9 months and under 12 months Total Deaths under 1 year Measles Whooping Cough Diphtheria Influenza Tuberculosis Meningitis 1 1 Convulsions Bronchitis Pneumonia 3 2 2 2 9 Diarrhoea and Enteritis 1 1 4 3 8 Congenital Malformation 4 1 1 6 2 8 Congenital Debility 1 1 3 4 Premature Birth 9 3 2 1 15 4 19 Injury at Birth 2 1 3 3 Atelectasis 1 1 2 2 Icterus Suffocation Inattention at Birth Other causes 1 1 2 2 3 1 8 13 In the following table the infantile deaths are distributed amongst the various wards; when the death occurred outside the district it has been allocated to the ward in which the parents resided. Ward. No. of deaths. In District. Outside District. Male. Female. Male. Female. Cranham 0 1 2 0 Emerson Park 2 1 1 2 Harold Wood 0 2 1 2 North West 3 4 5 2 Rainham 1 1 1 2 Thameside 5 1 1 2 Town Ward 4 0 10 1 Upminster 1 0 2 2 Deaths from Malignant Disease. There were 75 deaths from carcinoma and other forms of malignant disease: the death rate being 1.1 per thousand population. The corresponding rate for England and Wales was 1.6. The ages at death in certain age-groups and the site of the disease are set out below. Years. Male. Female. Under 1 1 0 1—14 0 0 15—34 2 1 35—44 1 6 45—54 6 3 55—64 12 6 65—74 12 10 75—84 3 11 85 and upwards 1 0 Part affected. Number. Male. Female. Alimentary tract, etc.: Tongue 2 0 Oesophagus 2 0 Stomach 5 7 Ileum 0 1 Colon 4 5 Rectum 2 4 Gall bladder 0 1 Liver 0 2 Pancreas 1 0 14 Part affected. Number: Male. Female. Alimentary tract, etc.: Kidney 1 0 Prostate 5 0 Bladder 2 0 Reproductive system, etc.: Ovary 3 Uterus 5 Breast 2 Miscellaneous: Jaw 4 0 Throat 1 0 Hand 2 0 Cheek 2 0 Abdominal wall 1 0 Mediastinum 1 2 Bronchus 1 0 Tonsil 1 0 Sarcoma of femur 0 1 Cerebral tumour 1 2 Mediastinal glands 0 1 15 VITAL STATISTICS OF WHOLE DISTRICT DURING 1936. Year. Population estimated to middle of each year. Births. Total Deaths registered in District. Transferable Deaths. Nett Deaths belonging to the District. Uncorrected Number. Nett. of Non-residents registered in district. of Residents not registered in district. Under 1 year of age. At all ages. No. Rate. No. Rate. No. Rate per 1,000 Nett Births. No. Rate. 1934 55,798 728 922 17.6 254 4.5 41 231 53 57.4 444 8.4 1935 59,910 780 1,023 17.0 301 5.0 44 250 50 48.8 507 8.4 1936 64,447 1,046 1,301 20.2 306 4.7 57 262 62 47.6 510 7.9 16 BIRTH RATES, DEATH RATES AND ANALYSIS OF MORTALITY Local figures compared with England and Wales and certain towns. England and Wales. London Administrative County. 122 County Boroughs and Great Towns, including London. 143 Smaller Towns (resident populations 25,000-50,000 at 1931 Census). Hornchurch. Rates per 1,000 Population. Births:— Live 14.8 13.6 14.9 15.0 20.2 Still 0.61 0.53 0.67 0.64 0.60 Deaths:— All causes 12.1 12.5 12.3 11.5 7.9 Typhoid and Paratyphoid Fevers 0.01 0.01 0.01 0.00 0.00 Smallpox — — — — — Measles 0.07 0.14 0.09 0.04 0.04 Scarlet Fever 0.01 0.01 0.01 0.01 0.01 Whooping Cough 0.05 0.06 0.06 0.04 0.00 Diphtheria 0.07 0.05 0.08 0.05 0.09 Influenza 0.14 0.14 0.14 0.15 0.13 Violence 0.52 0.52 0.45 0.39 0.43 Notifications:— Smallpox — — — — — Scarlet Fever 2.53 2.57 2.18 2.48 3.64 Diphtheria 1.39 1.69 1.31 1.26 1.47 Enteric Fever 0.06 0.06 0.05 0.06 0.03 Erysipelas 0.40 0.44 0.38 0.35 0.31 Pneumonia 1.11 0.99 1.10 0.96 0.74 17 REGISTRAR-GENERAL'S ABRIDGED LIST OF CAUSES OF DEATH. These figures are corrected for outward and inward transfers. Causes of death. Male. Female. All causes 270 240 1. Typhoid and paratyphoid fevers 0 0 2. Measles 1 2 3. Scarlet fever 0 1 4. Whooping cough 0 0 5. Diphtheria 4 2 6. Influenza 2 7 7. Encephalitis lethargica 0 0 8. Cerebro-spinal fever 0 0 9. Tuberculosis of respiratory system 17 14 10. Other tuberculous diseases 2 3 11. Syphilis 0 0 12. General paralysis of the insane, tabes dorsalis 0 0 13. Cancer, malignant disease 36 35 14. Diabetes 1 1 15. Cerebral haemorrhage, etc. 6 10 16. Heart Disease 62 53 17. Aneurysm 1 0 18. Other circulatory diseases 12 3 19. Bronchitis 4 9 20. Pneumonia (all forms) 11 18 21. Other respiratory diseases 0 1 22. Peptic ulcer 3 0 23. Diarrhoea, etc. (under 2 years) 6 1 24. Appendicitis 2 1 25. Cirrhosis of liver 0 2 26. Other diseases of liver, etc. 1 2 27. Other digestive diseases 7 5 28. Acute and chronic nephritis 10 10 29. Puerperal sepsis 1 30. Other puerperal causes 3 31. Congenital debility, premature birth, malformations, etc. 21 18 32. Senility 8 14 33. Suicide 4 2 34. Other violence 15 7 35. Other defined diseases 34 13 36. Causes ill-defined or unknown 0 2 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. 1. Officers of the Public Health Department. Medical Officer of Health. Alfred Ball, M.D., B.S. (Lond.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (R.C.P.S.) Lond. Sanitary Inspectors. H. Bousfield, San. Insp. Certif. R. San. Institute. L. Acer, Assoc. Royal San. Institute. * E. H. Lloyd, San. Insp. Certif. R.S.I. and S.I. Joint Board. C. S. Smith, San. Insp. Certif. R.S.I. and S.I. Joint Board. † S. Appleyard, San. Insp. Certif. R.S.I. and S.I. Joint Board. * (Resigned 30.6.36). † (Commenced duties 7.9.36). Clerk. J. Blay. 2. Laboratory Facilities. Under arrangements made by the Essex County Council, sputum, swabs and other pathological material are examined by Dr. J. F. Beale, the County Pathologist, at the Laboratories, 91, 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. The pathological specimens examined by the County Bacteriologist during the year included:— 341 throat swabs (42 positive, 299 negative). 9 nasal swabs (1 positive, 8 negative). 245 sputum for tubercle bacilli (57 positive, 188 negative). 27 urine. 9 samples of blood for Widal test (2 positive, 7 negative). 12 swabs for hæmolytic streptococci (3 positive, 9 negative). 5 hair for ringworm. 5 blood films. 2 feces (both negative). 2 miscellaneous. 18 19 3. Ambulance Facilities. The Council maintain a Talbot motor ambulance at the Central Fire Station. Agreements have "been entered into with the Essex County Council and the Romford Council for the reciprocal use of their motor ambulances. The whole of the District is thus adequately served by these ambulance services. During the year 478 calls were received and a total of 6,084 miles was run. The nature of the cases was:— Illness 235 Accident 43 Road accident 120 Maternity 12 Removals 44 Not required or refused 24 Origin of Calls. The calls were made by:— Doctors in 130 instances. Police in 168 instances. Hospitals in 28 instances. Others in 152 instances. Destination. The hospitals to which most of the cases were removed are shown in the following table:— Oldchurch Hospital, Romford 215 King George Hospital, Ilford 43 Victoria Hospital, Romford 29 Queen Mary's Hospital, Stratford 6 Other destinations 185 Times at which calls were received:— From 6 a.m. to 6 p.m. 348 From 6 p.m. to 6 a.m. 130 4. Nursing in the Home. There are three District Nursing Associations:— (1.) The Hornchurch Nursing Association maintains three private nurses, two in the Town Ward and one in the North West Ward. 20 (2.) The Upminster and Cranham Nursing Association maintains two private nurses. (3.) The Rainham Nursing Association maintains two private nurses in Rainham. All of the local associations are affiliated to the Essex County Nursing Association. 5. Treatment Centres and Clinics. The County Council is the Local Authority for Maternity and Child Welfare and for the medical services amongst school children. Ante-natal clinics are held twice a week and a Women's Welfare clinic, at which instruction in birth control is given to married women, once a week at the Combined Treatment Centre in Westland Avenue. Infant Welfare clinics are held at the Combined Treatment Centre in Westland Avenue: Memorial Hall, Harold Wood: Holy Cross Hall, Park Lane : Social Hall, Rainham : and St. Laurence Hall, Upminster. Refraction, dental and orthopaedic clinics are also held at the Centre in Westland Avenue. 6. Nursing and Maternity Homes. There are 10 registered Nursing and Maternity Homes in the District. 7. Midwives. The number of midwives practising in the district and registered by the County Council is 35. 8. Hospitals. INFECTIOUS DISEASES. The Romford Joint Hospital District, constituted in the year 1899, is comprised of the Urban Districts of Hornchurch, Dagenham and Romford, containing about 35,600 acres and with a combined population of approximately 230,000. The Hospital Board consists of 4 elected members from Hornchurch, 5 from Dagenham and 3 from Romford, together with the Chairman of each Council ex officio. 21 The Hospital which is situated at Rush Green contains about 150 beds and is administered by a Resident Medical Superintendent with one Assistant Medical Officer. An important extension to the hospital is now in course of construction and it is anticipated that 5 new ward pavilions, a new Nurses' Home, additions to the Laundry and Boilerhouse, etc., will be completed by the Autumn of 1937. During the year 295 patients from Hornchurch were treated in the hospital, 114 being admitted as Diphtheria, 149 as Scarlet Fever, 1 Paratyphoid, 11 Measles, 3 Whooping cough, and 17 miscellaneous. In addition 3 cases of Diphtheria, and 22 cases of Scarlet Fever, were sent to London Hospitals under agreement, owing to lack of accommodation in the Romford Isolation Hospital. SMALLPOX. The Essex County Council is now the Authority for the provision of hospital accommodation for cases of Smallpox. By agreement between the County and the Borough of Colchester the latter have constructed a Smallpox Hospital which will be available for the central and northern part of the County. Cases occurring in the County Districts near the Metropolis will be admitted to London County Council hospitals by agreement between the two County Councils. No case of Smallpox occurred in Hornchurch during the year. Legislation. Hornchurch Urban District Council Act, 1936. This Act, which is described as "An Act to make further and better provision for the improvement, health, local government, and finance of the urban district of Hornchurch and for other purposes," received the Royal Assent on the 31st July, 1936. It is divided into eleven parts of which the most important powers of a Public Health nature are contained in Part IV, which deals with Infectious Disease and Sanitary Provisions, Part V, Human Food, and Part VI Camping Grounds. Part IV. Section 66 defines and extends for certain purposes the meaning of the words "infectious disease," 22 Section 67 requires parents to notify to head teachers the occurrence of infectious disease. Section 68 enables the Council to close Sunday Schools for the purpose of preventing the spread of infectious disease or to exclude children from public entertainment for a specified time. Section 70 enables the Council to supply antidotes against infectious disease. Section 74 gives power to require precautions to be taken by the person who is responsible for the removal of the body of anyone who has died of infectious disease. Sections 77, 78 and 79 deal with the cleansing of premises in certain cases. Section 81 enables the Council to effect the discontinuance of an offensive trade in the interests of public health. Section 82 requires the provision of a proper and sufficient water supply inside dwelling houses. Sections 84 and 85 give power to make byelaws, etc. in connection with stables. Sections 86, 87 and 88 deal with house refuse and dustbins. Part V. Sections 90 to 98 give additional powers to the Council to control the sanitary conditions under which certain food products are manufactured stored and sold; for the prohibition of the handling of food by infected persons ; and for the notification of cases of food poisoning. Part VI. Sections 103 and 104 strengthen the powers of the Council for the regulation of camping grounds. In other parts of the Act the Council have obtained powers to order alterations in the height of chimneys: to deal with dilapidated, neglected or dangerous buildings: to require the provision of sanitary conveniences for workmen engaged on buildings: to proceed under certain conditions against noise nuisance. 23 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. The South Essex Waterworks Company provide a constant supply of water which is satisfactory in quality. It is understood that previously the main source of supply was from deep wells but the water is now mainly derived from the River Stour. The Company has been able to meet all demands as to quantity. Sewerage and Sewage Disposal. During the year the main trunk sewers in the Ingrebourne and Ravensbourne valleys were constructed. The extensions to the Outfall Works at Bretons Farm were completed and were put into use in the early part of May. The Harold Wood, Upminster, and Rainham Road works thereupon ceased to be used and the ground occupied by them will be retained as open spaces after the apparatus has been removed and the ground levelled and made suitable. There are now two sewage disposal works namely Bretons Farm and Berry Farm which serve the greater part of the district. In addition some houses in Rainham and South Hornchurch are drained to the Riverside Works by agreement with the Dagenham Urban District Council. DRAINAGE OF THE WHYBRIDGE ESTATE. Foul sewers were laid in all the roads on the Whybridge Estate and the occupants of the houses were requested to connect up their premises thereto. This is a great improvement which has resulted in the abolition of 238 cesspools. BRANCH SEWERS. The Surveyor informs me that 23,887 feet of 9 inch and 2,950 feet of 12 inch soil sewers; also 8,227 feet of 9 inch and 3,700 feet of 12 inch surface water sewers and 280 feet of concrete culvert 3 feet in diameter were laid during the year. New Streets—Made up and Taken Over. The Highway Surveyor has supplied the following list of streets made up and taken over from the 1st January to the 31st December, 1936, 24 Street. Length. Feet. Brian Close 418 Belmont Avenue 450 Bruce Avenue 1,895 Claremont Gardens (part) 526 Clarence Avenue 670 Church Road (Ockendon) 924 Elm Park Avenue 4,119 Fairfield Avenue 911 Fen Lane 9,780 Hyland Close 940 Ingrebourne Gardens (part) 636 Norfolk Road 1,230 Pea Lane 3,600 Dennis Lane 2,740 Pike Lane 1,263 The Shrubbery 689 The Drive 716 31,507 = 5.967 miles He also states that 5.86 miles of first class roads, 13.94 miles of second class roads and 2.54 miles of non-classified roads have been maintained on behalf of the Essex County Council since 1st April, 1936. Closet Accommodation. Most of the houses are provided with water-closets connected with the sewers. Public Cleansing. The collection and disposal of house refuse are carried out under the direction of the Surveyor. Refuse is disposed of by controlled tipping on a site in the southern part of the district. Eradication of Bed Bugs. Houses found to be infested with bed bugs have been treated by fumigation with the gases created by the burning of sulphur candles particular attention being given to the woodwork. Picture rails and skirting boards have been removed and other woodwork treated with the blowlamp. 25 Wallpapers have been stripped and walls and ceilings thoroughly cleansed and tenants have been instructed as to careful cleansing. Disinfestation is carried out by the Housing Outdoor staff in houses owned by the Council and in private houses by the occupier or in empty houses by the landlord the work being supervised by the Sanitary Inspector. Sanitary Inspection of the District. Report of the Sanitary Inspectors under Article 27 of the Sanitary Officers (outside London) Regulations 1935. The following information supplied by the Sanitary Inspectors 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 44 Slaughterhouses 639 Cowsheds, Dairies, etc. 333 Butchers' Shops 153 Fish shops 97 Infectious Disease enquiries 703 Disinfections 313 Workshops (including Factories and Workplaces). 105 Public House Urinals 22 Refuse Tips 32 Ice Cream dealers' premises 91 Watercourses 41 Tents, Vans, and Sheds 127 House drainage 227 Other 517 (b) Number of Notices Served :— Informal 406 Statutory 18 (c) Result of Notices Served :— Informal Notices complied with 275 Statutory Notices complied with 14 (d) Outstanding on 31st December, 1936 :— Informal Notices 125 Statutory Notices 4 26 Works completed. Water-closets :— W.C. flushing cisterns repaired or replaced by new ones 19 W.C.s renewed 11 W.C.s repaired 14 Light and ventilation provided to W.C. apartments. 1 Drainage :— Blocked drains cleared 49 New drains laid and drains relaid and repaired 5 Gullies repaired 13 Sinks and waste pipes repaired or new ones fixed 35 New covers and frames to inspection chambers provided 6 Cesspools emptied 11 New vent shafts or cages provided and fixed 9 General repairs, etc. :— Food stores provided and light and ventilation provided to existing food stores 5 Water supply provided and service pipes, etc., repaired 27 Roofs, gutters and downspouts repaired or renewed 77 Walls and ceilings repaired 87 Windows and doors repaired or renewed 100 Yards paved and paving repaired 18 Fireplaces, stoves and coppers repaired or renewed 31 Walls and ceilings cleansed and distempered or papered 57 Airbricks cleared or new ones provided 22 Sash cords renewed 41 Dustbins provided 43 Staircases and stairtreads repaired and handrails provided and fixed 29 Dampness abated 28 Chimney pots refixed, renewed or repaired 2 Floors repaired or relaid 9 Miscellaneous works carried out 27 Shops Act, 1912-1934. Since September 1st each of the 4 Sanitary Inspectors has had included in his duties inspections under the Shops Acts both with regard to the sanitary provisions of the Act of 1934 and the shops hours regulated by these Acts. All the shops were inspected during the year and where there was any minor infringement the attention of the proprietor was called to it. 27 No legal proceedings were taken during the year. At the end of the year there were 730 shops on the register. Mortuary. The Council have provided a Mortuary in Billet Lane in premises adjoining the Fire Station. During the year 10 bodies were deposited in the mortuary and 25 post mortem examinations were carried out in the post mortem room at Oldchurch Hospital under the terms of an agreement with the Essex County Council. Swimming Baths and Pools. There are no public swimming baths or pools in the district which are open to the public. Schools. The sanitary accommodation and the water supply of the 25 schools in the district were satisfactory. Cases of notifiable infectious diseases occurring amongst school children and any contacts 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. Head Teachers supply on Form M.I. 13 to the Medical Officer of Health the names of children who are absent from school stated to be suffering from the common infectious diseases. 28 SECTION D. HOUSING. 1. Number of New Houses Erected During the Year:— (i) By the Local Authority 10 (ii) By Other Local Authorities 0 (iii) By other bodies or persons 1,387 1,397 2. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 528 (b) Number of inspections made for the purpose 1,477 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under Housing Consolidated Regulations, 1925 173 (b) Number of inspections made for the purpose 543 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 24 (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 297 3. 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 184 4. 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 defects to be remedied 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 16 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a)By owners 12 (b) By Local Authority in default of owners 0 29 (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 13 (2) Number" of dwelling-houses demolished in pursuance of Demolition Orders 5 (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 5. Demolished voluntarily in lieu of formal action under Housing Acts 4 6. Housing Act, 1935. Overcrowding (a) (i) Number of dwellings overcrowded at the end of the year 71 (ii) Number of families dwelling therein 72 (iii) Number of persons dwelling therein 555 (b) Number of new cases of overcrowding reported during the year 2 (c) (i) Number of cases of overcrowding relieved during the year 48 (ii) Number of persons concerned in such cases 291 (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 0 (e) Other particulars with respect to overcrowding :— Overcrowding in 5 Council Houses was relieved by transferring the occupants to larger existing Council Houses. HOUSING ACT, 1935. Section 1 of this Act placed on every Local Authority the duty of causing an inspection of the District to be made to ascertain what dwelling houses were overcrowded. Section 2 enacted that a house shall be deemed to be overcrowded when two persons of opposite sexes above the age of ten years and not being husband and wife MUST sleep in the same room or when the number of persons sleeping in the house is in excess of the permitted number as defined in the first schedule of the Act. This schedule defines the number of persons who are permitted to occupy a house containing from one to five rooms or more and also defines for small 30 rooms the permitted number in relation to the floor space in square feet. When the extent of overcrowding had been ascertained the Council were required to submit to the Minister a report showing the result of the inspection and the number of new houses which would be required to abate the overcrowding. The Housing Act, 1935, (Operation and Overcrowding Provisions) Order, 1936, dated 26th June, 1936, provided that in Hornchurch the standard referred to above would come into force on the 1st January, 1937, and that overcrowding which existed on that date would have to be dealt with by the Council on the lines laid down in the Act. As from the 1st January, 1937, rent books must contain a summary of the sections of the Act which define overcrowding and also a statement of the permitted number of persons in relation to the house. Programme. The Council were required to complete the inspection of the working class houses in the District by the 1st April, 1936. They were also required to submit before the 1st August, 1936, their proposals for the provision of the number of houses required together with the types and accommodation which were found to be necessary for the overcrowded families. Method of Inquiry. The Council gave instructions for a temporary staff to be engaged to carry out the enumeration of dwellings and persons by calling at the house and enquiring the number of rooms and occupiers. The particulars thus obtained were entered directly on special forms and these when handed in at the office were filed in streets and wards. Staff. Four enumerators were employed on this work temporarily from January to April, for a total of 46 weeks. Temporary clerical assistance was also provided in the office for tabulating the figures obtained. The forms were scrutinised and all houses in which apparent overcrowding was observed were at a later date measured by the Sanitary Inspectors. It was necessary for the Sanitary Inspectors to give a considerable amount of time to this work which included 493 houses. 31 Result of Survey. The survey of the District confirmed an opinion previously held that the extent of overcrowding was small. The following table shows its distribution in wards :— Cranham 3 Emerson Park 13 Harold Wood 5 North West 16 Rainham 28 Thameside 31 Town 19 Upminster 3 Total 118 These figures include 20 Council Houses which had been alloted in former years to persons with large families who were in need of accommodation. It was found that most of the overcrowded houses were occupied by one family only and that the cause of the overcrowding was too few bedrooms in relation to the size of the family. In some cases sub-letting to a second family was the cause but here again as a rule only one family of the two had insufficient accommodation and a more judicious selection of the subtenant would have avoided any overcrowding. The fact is that in a new residential district such as Hornchurch there appears to be no need for overcrowding to occur. The only difficulty arises in those few large families who have been unable to obtain a large enough house. Provision of New Houses. It was found that most of the cases of overcrowding could be dealt with by the provision of new houses in two centres, namely, one in Rainham and one in the Village of Hornchurch. In the former the Council were already in possession of suitable building land and for the latter it was decided to transfer for building, land already owned by the Council which was being used for another purpose. The Council also decided to provide small dwellings for young couples or for old people in addition to the bigger houses for large families. 32 Information supplied to Landlords. Under the Housing Act it is the duty of the Council to supply to landlords on request the permitted number of persons in relation to each of their houses. During the year 1936 this information was supplied for 1,584 houses. 33 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply. During the year there were 22 cowkeepers in the district with farms registered under the Milk and Dairies Order, 1926. These farms are all inspected from time to time and samples of milk taken by the Sanitary Inspectors for examination as to cleanliness and the number of bacteria. In Cranham Ward there are 8 dairy farms, 4 of which produce Accredited milk. In Harold Wood Ward there are 8 dairy farms. Two of these farms are licensed to produce Accredited milk. The other dairy farms are situated in Emerson Park Ward (1), Town Ward (1), and Rainham Ward (4), and of these two are licensed to produce Accredited milk. All dairy farms in the District with one exception have water laid on from the South Essex Waterworks Company's mains. Milk (Special Designations) Order, 1936. This Order which came into operation on the 1st June, 1936, revokes previous Milk (Special Designations) Orders and substitutes the following terms in place of the designations formerly used :— (i) "Tuberculin Tested" This is milk from cows which have passed a veterinary examination and a tuberculin test and it must reach a certain bacterial standard. If bottled on the farm the word " Certified " may be added to its description. If pasteurised it must be described as " Tuberculin Tested milk (pasteurised)." (ii) "Accredited" This is milk from cows which have passed a veterinary examination and it must satisfy the same bacteriological tests as are required for raw Tuberculin Tested milk. (iii) "Pasteurised" The conditions under which the milk may be sold under this designation are laid down in the Order. Licences issued by the Council year ended 31st December, 1936. 12 licences have been issued to retail Grade A (Tuberculin Tested) now known as Tuberculin Tested milk ; 16 licences to retail Pasteurised 34 milk ; also 2 licences to sell Certified milk, 2 licences to sell Grade A pasteurised milk, and 2 licences to sell Grade A milk. In addition 16 supplementary licenses, 9 for Grade A (Tuberculin Tested) milk, 6 for Pasteurised milk, and 1 for Grade A milk, were issued, these being licences required by retailers who hold principal licences in another district and wish to sell the milk in this district from premises elsewhere. Milk Retailers. There are 26 milk retailers with registered premises in the District, including 11 producers who are registered both as producers and retailers. In addition there are 19 persons registered as milk retailers in Hornchurch, but whose premises are registered in neighbouring districts. MILK SAMPLING. During the year 54 samples of milk were examined for cleanliness and bacterial content by the County Bacteriologist. They included 10 samples of graded milk all of which were satisfactory, and 44 samples of raw milk, of which 37 were satisfactory. An excerpt from the report on each sample is given below. Grade of Milk. Number of Bacteria. Presence of B. Coli. Remarks. 1. Pasteurised 9,300 Absent in 0.1 c.c. Satisfactory. 2. ,, 2,400 Absent in 0.1 c.c. ,, 3. ,, 2,400 — ,, 4. ,, 3,200 — ,, 5. ,, 32,000 — ,, 6. ,, 3,200 — ,, 7. Grade A 17,000 Absent in 0.01 c.c. ,, 8. Accredited 14,000 Absent in 0.01 c.c. ,, 9. ,, 34,000 Absent in 0.01 c.c. ,, 10. Grade A (T.T.) 21,000 Absent in 0.01 c.c. ,, 11. Ungraded 8,800 Present in 1 c.c. ,, 12. ,, 13,000 Present in 1 c.c. ,, 13. ,, 11,000 Absent in 1 c.c. ,, 14. ,, 6,100 Absent in 1 c.c. ,, 15. ,, — Absent in 0.01 c.c. ,, 16. ,, — Absent in 0.01 c.c. ,, 17. ,, — Absent in 0.01 c.c. ,, 18. ,, — Present in 0.001 c.c. ,, 19. ,, 32,000 Present in 0.01 c.c. ,, 20. ,, 26,000 Present in 1 c.c. ,, 21. ,, 31,000 Present in 0.1 c.c. ,, 35 Grade of Milk. Number of Bacteria. Presence of B. Coli. Remarks. 22. Ungraded 7,600 Absent in 0.01 c.c. Satisfactory. 23. ,, 8,900 Absent in 0.01 c.c. ,, 24. ,, 14,000 Present in 0.01 c.c. ,, 25. ,, 38,000 Present in 0.01 c.c. ,, 26. ,, 4,600 Absent in 0.01 c.c. ,, 27. ,, 42,000 Present in 0.001 c.c. Unsatisfactory. 28. ,, 3,800 Absent in 0.01 c.c. Satisfactory. 29. ,, 16,000 Present in 0.01 c.c. ,, 30. ,, 6,500 Absent in 0.01 c.c. ,, 31. ,, 120,000 Present in 0.001 c.c. Unsatisfactory. 32. ,, 78,000 Present in 0.001 c.c. ,, 33. ,, 24,000 Present in 0.01 c.c. Satisfactory. 34. ,, 130,000 Present in 0.001 c.c. Unsatisfactory. 35. ,, 42,000 Present in 0.001 c.c. ,, 36. ,, 120,000 Present in 0.001 c.c. ,, 37. ,, 2,600 Absent in 0.01 c.c. Satisfactory. 38. ,, 30,000 Present in 0.001 c.c. Unsatisfactory. 39. ,, 3,800 Absent in 0.01 c.c. Satisfactory. 40. ,, 38,000 Present in 0.01 c.c. ,, 41. ,, 29,000 Absent in 0.01 c.c. ,, 42. ,, 8,900 Absent in 0.01 c.c. ,, 43. ,, 36,000 Present in 0.01 c.c. ,, 44. ,, 21,000 Present in 0.01 c.c. ,, 45. ,, 47,000 Present in 0.01 c.c. ,, 46. ,, 11,000 Absent in 0.01 c.c. ,, 47. ,, 6,800 Absent in 0.01 c.c. ,, 48. ,, 42,000 Present in 0.01 c.c. ,, 49. ,, 9.800 Absent in 0.01 c.c. ,, 50. ,, 16,000 Present in 0.01 c.c. ,, 51. ,, 7,000 Absent in 0.01 c.c. ,, 52. ,, 6,000 Absent in 0.01 c.c. ,, 53. ,, 15,000 Absent in 0.01 c.c. ,, 54. ,, 6,100 Absent in 0.01 c.c. ,, Graded Milk 10 10 satisfactory. Ungraded Milk 44 37 satisfactory, 7 unsatisfactory. When an unsatisfactory report is received the retailer is cautioned and investigations are made with a view to obtaining better results. Milk and Dairies (Consolidation) Act, 1915. The County Medical Officer states that two samples of milk produced on farms, and thirteen other samples of milk taken in schools to which it had been supplied under the Milk-in-schools Scheme were submitted to the biological test during the year. In thirteen instances the report was negative, i.e. satisfactory. 36 2. Ice Cream. Essex County Council Act, 1933. Part XI. Ice cream vendors or manufacturers are required to be registered by the local Council under section 158 of the Act which was adopted by the Council by resolution on 20th February, 1934, and came into force three months later. During the year 27 applications for registration were granted. At the end of the year 92 persons were registered as vendors in the District and 1 as a wholesale manufacturer only. 3. Meat. There are 5 slaughterhouses, 3 registered and 2 licensed, which are visited regularly by the Sanitary Inspectors and the carcases inspected. The total number of carcases inspected during the year was :— Cattle 1,054 Pigs 1,492 Sheep and lambs 5,261 The following table shows the number of condemnations as a result of inspection :— Entire Carcases :— (a) for Tuberculosis (i) Cattle 7 (ii) Pigs 5 (iii) Sheep and lambs 0 (b) for other conditions :— (i) Cattle 4 (ii) Pigs 1 (iii) Sheep and lambs 16 Parts of Carcases or Organs :— (a) for Tuberculosis :— (i) Cattle 134 (ii) Pigs 26 (iii) Sheep and lambs 0 (b) for other conditions :— (i) Cattle 34 (ii) Pigs 14 (iii) Sheep and lambs 8 37 Slaughter of Animals Act, 1933. In September, 1934, the Council resolved that section 1 of this Act shall apply to sheep and lambs. This Act requires animals to be stunned or slaughtered by a mechanically operated instrument so that they shall be rendered insensible to pain until death occurs. It is also necessary for all slaughtermen to be registered under section 3 of the Act. 18 applications for licences under the Act were received during the year and all were granted. Meat Traders. There are 51 Butchers' shops in the District which are inspected by the Sanitary Inspectors. Beef amounting to 88 lbs. weight was surrendered voluntarily as being unfit. Shell Fish (Molluscan). There are no shell fish beds or layings in this District. On enquiry it is stated that the sale of shell fish is not very large in amount the trade being principally at the week ends and the shell fish being obtained by the fishmongers from the London market. 38 SECTION F. PREVALENCE AND CONTROL OVER INFECTIOUS DISEASE. Scarlet Fever. During the year 235 cases of Scarlet Fever, yielding a case rate of 3.6 per 1,000 of the population, were notified. The corresponding rate in England and Wales being 2.53. The rates in this District in the years 1935, 1934 and 1933 were 3.5, 4.3 and 5.4. Of the total number of cases 147 were admitted to the Romford Isolation Hospital and 23 were sent to hospitals in London when accommodation was not available locally. Most of the cases were mild in character. Antiscarlet serum is administered in the Romford Isolation Hospital to cases admitted early in the disease and to all severe cases. It is considered that the use of serum cuts short the course of the disease and it is now the practice for uncomplicated cases to be detained in hospital for a period of about 4 weeks. One death occurred from Acute Septicaemia in a child of 8 years. Diphtheria. The number of cases of Diphtheria notified was 95 yielding a rate of 1.4 per 1,000 of the population, the case rate for England and Wales being 1.39. In the years 1935, 1934 and 1933 the case rates in this District were 1.9, 3.02 and 0.9. During the year there were 6 deaths from Diphtheria as follows :— Sex. Ages in years. Male 3, 3, 8, 17. Female 2, 5. The cases notified in each ward during each month of the year are shown in the following table :— 39 TABLE SHOWING SCARLET FEVER AND DIPHTHERIA CASES OCCURRING IN EACH MONTH. Total. Cranham. Emerson Pk. Harold Wd. North-West. Rainham. Thameside. Town. Upminster. S.F. Diph. S.F. Diph. S.F. Diph. S.F. Diph. S.F. Diph. S.F. Diph. S.F. Diph. S.F. Diph. S.F. Diph. January 29 8 1 5 1 1 5 3 4 1 8 2 5 1 February 20 13 2 3 10 3 3 1 7 2 2 March 28 4 4 2 10 4 7 5 April 36 4 1 5 1 2 13 1 11 2 4 May 27 6 2 3 12 3 1 1 1 7 1 2 June 18 3 3 2 7 3 1 3 2 July 11 5 1 2 4 2 3 1 1 2 August 10 14 3 1 2 7 4 1 1 2 1 2 September 7 12 2 2 1 9 2 1 1 1 October 16 15 4 3 6 3 5 2 5 2 1 November 19 4 1 4 1 5 1 2 2 1 3 2 1 December 14 7 1 1 1 3 3 1 1 1 1 6 1 1 235 95 5 1 32 5 11 1 69 45 23 18 10 10 59 14 26 1 40 Immunisation against Diphtheria. Active immunisation against Diphtheria was continued during the year amongst the children attending the Public Elementary schools in the District and the Essex County Council which is the Education Authority in Hornchurch allowed the use of Treatment centres and other premises for this purpose. I am much indebted to the County Medical Officer who assisted very considerably by arranging that I should have the services of the School Nurses and Health Visitors during the time that the treatment was being carried out and to the Head Teachers who granted facilities and helped very materially by assembling the children and in many other ways. A circular letter explaining the purpose of and offering this treatment was sent to the parents of children newly entered on the registers of the schools and at a later date appointments were sent to all who accepted. The importance of securing immunising treatment especially for the infants and for young children under school age was emphasized and mothers were encouraged to bring their young children. 15 schools or departments of schools were visited during the year. The total number of children who have received a course of treatment since the scheme began in 1934 is 2,542. Of the persons who have completed their treatment 1,782 have been tested at a date usually about 4 months after the last injection and of these 97 per cent. were found to be immune. The total number of children on the registers of the Elementary schools in Hornchurch during 1936 was approximately 9,000. In the following tables are shown the numbers of persons tested before treatment, the number treated and the number tested after treatment. The adults who were treated were almost all teachers in the Infants' Departments. YEAR 1936. Immunisation against Diphtheria. 1. Primary Schick Test :— No. tested. Result. Negative. Positive. Adults 6 5 1 School Children 311 109 202 Children under 5 years of age 2 1 1 Total 319 115 204 41 2 . Number Treated :— Completed. Incomplete. Adults 1 0 School children 717 72 Pre-school children 144 18 862 90 3. Schick tested after treatment :— No. tested. Result. Negative. Positive Adults 8 6 2 School children.. 1,222 1,188 34 Pre-school children 253 251 2 1,483 1,445 38 Measles. Measles was rather prevalent in the District during the first 4 months of the year and in some parts continued to affect the school attendance until the summer. There were 3 deaths from this disease. 11 persons were admitted to the Isolation Hospital for treatment and the average duration of stay was 26 days. Of the ages 3 were one year of age ; 5 were children between the ages of 4 and 9 ; and 3 were adults. Several of these cases had Pneumonia. Whooping cough. A small outbreak of Whooping cough occurred in the late Spring and 3 cases were treated in the Romford Isolation Hospital. There were no deaths from this disease during the year. Ophthalmia Neonatorum. 9 cases of Ophthalmia Neonatorum were notified of which 6 were treated in hospital. All recovered with no scarring of the cornea. Poliomyelitis. One notification of Poliomyelitis was received this being a child who was already suffering from the disease when the family came to live in Hornchurch. 42 Cerebrospinal Fever. One case of Cerebrospinal Fever was notified and was treated in a London Hospital. Public Health Act, 1925. No action was taken during the year under section 66 of this Act. Typhoid Fever. 2 cases of Paratyphoid B were notified during the year and both made a good recovery. 43 TABLE SHOWING THE CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1936. Notifiable Disease. Total. Number of cases notified in age-groups. Total cases notified in each Ward. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Cranham. Emerson Park. Harold Wood. North West. Rainham. Thameside. Town. Upminster. No. removed to hospital. Smallpox 0 0 Scarlet Fever 235 0 47 152 16 16 4 0 5 32 11 69 23 10 59 26 170 Diphtheria 95 0 20 59 7 7 1 1 1 5 1 45 18 10 14 1 95 Enteric Fever (with Paratyphoid) 2 1 1 1 1 1 Puerperal Pyrexia 4 1 3 1 2 1 2 Polio-encephalitis 1 1 1 1 Pneumonia 48 3 11 10 4 10 9 1 1 1 22 8 7 8 1 24 Erysipelas 20 1 1 2 7 9 1 5 5 2 2 3 2 8 Ophthalmia Neonatorum 9 9 1 3 4 1 6 Cerebrospinal fever 1 1 1 1 44 Tuberculosis. The notifications of cases of Tuberculosis included 49 males and 30 females suffering from Pulmonary, and 9 males and 15 females suffering from Non-Pulmonary forms of the disease. The 36 deaths included those of 7 pulmonary and 2 non-pulmonary cases which were not notified. The death rate was .559 per 1,000 and the rate for England and Wales was .692 per 1,000. Age Periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 1 1 3 2 5 7 6 15 10 14 1 1 1 3 1 25 13 8 4 4 6 35 9 7 1 5 5 1 45 13 1 5 55 2 1 1 65 2 1 49 30 9 15 17 14 2 3 No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under section 62 of the Public Health Act, 1925, (relating to the compulsory removal to hospital of persons suffering from Tuberculosis). 45 SECTION G. FACTORY AND WORKSHOP ACT. HOME OFFICE TABLES. 1. Inspection of Factories, Workshops and Workplaces :— Premises. Inspections. Written notices. Prosecuted. Factories 27 4 0 Workshops 45 0 0 Workplaces 33 1 0 105 5 0 2. Defects found in Factories, Workshops and Workplaces Particulars. Number of defects. Found. Remedied Nuisances under Public Health Acts :— Want of cleanliness 3 3 Want of drainage of floors 1 1 Sanitary accommodation insufficient 2 2 Offences under the Factory and Workshop Acts :— Illegal occupation of underground bakehouses (s. 101) 1 1 7 7 3. Homework :— Nature of work. Outworkers lists, section 107. Lists received from employers. Wearing apparel 39 Making or repairing umbrellas 2 Making stuffed toys 2 Making sugar cake ornaments 2 Making of brushes 2 No notices were served under section 108. 46 SECTION H. RAINFALL DURING THE YEAR. I am indebted to Mr. D. E. Hart, the Surveyor, for the subjoined information on rainfall as recorded at the three recording stations which were used during the year. Amount of rainfall in inches. No. of days in which rain fell. Rainham Road Works :— January 3.18 22 February 1.27 15 March 1.10 12 April 1.22 9 May .45 7 June Not recorded. July Not recorded. At Langtons :— August .51 7 September 2.57 17 October 1.07 14 November 3.57 19 December 1.65 18 Eastern Outfall Works :— January 3.16 18 February 1.33 13 March .94 12 April 1.24 8 May .34 3 June 3.22 19 July 4.10 20 August .38 5 September 2.32 16 October 1.40 17 November 2.94 17 December 1.31 12 Total 22.68 160 During the years 1935 and 1934 the total amount of rainfall at the Eastern Outfall Works was 21.64 inches and 16.58 inches and rain fell on 159 days and 133 days respectively. ILFORD RECORDER, HIGH ROAD, ILFORD.