??? 7 Hornchurch Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1937. ALFRED BALL, M.D., D.P.H. Medical Officer of Health. Hornchurch Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1937. ALFRED BALL, M.D., D.P.H. Medical Officer of Health. W. & W. Ltd., Romford. 3 COUNCIL OFFICES, BILLET LANE, HORN CHURCH, Essex. 7th June, 1938. To the Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report on the Vital Statistics and Sanitary Circumstances of the District for the year 1937. Housing development is still very active in the District, layout plans for new estates have been submitted to the Council and more than 2,000 new houses have been completed. The year under review has been a healthy one and that the District is a desirable one for residential purposes is shown by the large number of new inhabitants which it attracts. 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 R. W. Beard, J.P., Chairman. Councillor H. H. Wake, Vice-Chairman. Councillor Mrs. E. M. Field ,, Mrs. A. J. E. King ,, Mrs. R. J. Reynolds ,, Mrs. F. Sherring ,, W. G. Bunch ,, F. H. R. Davis, J.P. ,, A. Ferguson ,, A. C. Holmes ,, C. J. Josephs Councillor T. Martin ,, J. W. Mathews ,, W. H. F. Maunder ,, C. L. Parker ,, H. Perry ,, D. A. Ramsay ,, B. L. Tarr ,, A. J. Twigger ,, T. F. Willoughby Representatives of the Council on the Romford Joint Hospital Board: Councillor R. W. Beard, J.P. (ex-officio) ,, Mrs. A. J. E. King Councillor Mrs. F. Sherring ,, Mrs. H. S. E.Williams ,, D. A. Ramsay Representatives of the Council on the Romford and Hornchurch Joint Sewerage Committee: Councillor Mrs. E. M. Field ,, F. H. R. Davis, J.P. ,, A. Ferguson Councillor J. W. Mathews ,, W. H. F. Maunder Representatives of the Council on the Southern Area Guardians Committee: Councillor Mrs. A. J. E. King ,, Mrs. R. J. Reynolds Councillor H. Perry 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) 1937 72,010 Number of inhabited houses (end of 1937) according to Rate books 23,406 Rateable Value (September, 1937) £562,346 Sum represented by a Penny Rate (September) £2,235 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. The unemployed persons in the northern part of the district register at the Romford Employment Exchange and those in the southern part at the Dagenham Exchange. Vital Statistics. Extracts from Vital Statistics of the year. The net births and deaths are, after correction for inward and outward transfers, as supplied by the Registrar-General. Live Births:— Male. Female. Total Rate. Legitimate 676 664 1,373 Illegitimate 16 17 Birth rate per 1,000 resident population 19.6 Still Births:— Legitimate 24 19 46 Illegitimate 3 0 Rate per thousand total (live and still) births 32 Deaths 333 290 623 Death rate per 1,000 estimated resident population 8.6 6 Deaths from Puerperal Causes:— Deaths. Rate per 1,000 total births. No. 29. Puerperal Sepsis 2 1.4 No. 30. Other puerperal causes 4 2.8 Total 6 4.2 Death rate of Infants under one year of age:— All infants per thousand live births 51.7 Legitimate infants per thousand legitimate live births 49.2 Illegitimate infants per thousand illegitimate live births 90.9 Deaths from Cancer (all ages) 85 Deaths from Measles (all ages) 0 Deaths from Whooping Cough (all ages) 2 Deaths from Diarrhoea (under 2 years of age) 4 Area and Population. 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 in 1931, 19,376 were males and 20,013 were females. The number of persons per acre of the whole district was 2. In Hornchurch at the 1931 census there were 10,223 private families occupying 9,695 dwellings containing 50,125 rooms. The average number of persons per room was 0.76. 7 In the Annual Report for the year 1936 a table was printed showing the ages in groups and the marital condition of the population of the District as ascertained at the 1931 Census. The number of children in the District under 14 years of age was found to be 260 per 1,000 total population and the corresponding figure for the whole of the Administrative County was 228 per ] ,000. The number of persons aged 15 to 44 years in Hornchurch represented 501 per 1,000 total population as compared with 471 per 1,000 in the Administrative County. These figures show that the population of Hornchurch contains a large number of young people and also tend to explain the high birth rate. Births. The number of births registered in the District during the year was 1,077. The number of births corrected for inward and outward transfers is as follows :— Males. Females. Legitimate 676 664 Illegitimate 16 17 The percentage of illegitimate births to the total registered was 2.4. The birth rate calculated on a population of 72,010 is 19.6 per thousand estimated population. A comparison with previous years follows:— 1936 20.2 1931 20.1 1935 17.0 1930 16.1 1934 17.6 1929 17.0 1933 18.4 1928 14.9 1932 18.1 1927 16.3 Deaths. There were 393 deaths registered in the District during the year, this number including 69 belonging to other Districts which have, therefore, been subtracted. 165 males and 131 females whose residence was in Hornchurch died elsewhere and these deaths are added as inward transfers making a nett total of 620. 8 The crude death rate calculated on a population of 72,010 was 8.6 per thousand. A comparision with previous years follows:— 1936 7.9 1931 8.4 1935 8.4 1930 8.2 1934 8.4 1929 9.9 1933 7.8 1928 8.4 1932 7.9 1927 9.4 Comparative Mortality after allowing for differences in the Population Constitution. The Registrar-General has supplied a 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 1937 thus obtained is 9,546. The deaths of Hornchurch residents occurring in hospitals were as follows:— Oldchurch County Hospital 141 Orsett Institution 42 Victoria Hospital, Romford 6 Isolation Hospital, Rush Green 5 King George Hospital, Ilford 11 Queen Mary's Hospital, Stratford 3 Brentwood and Severalls Mental Hospitals 5 The Retreat, Great Burstead 10 Epping Infirmary 6 Hospitals in London 39 Other hospitals 4 44 per cent of the total Hornchurch deaths occurred in hospitals or other institutions. Coroner's Inquisitions. During the year the deaths of 38 males and 19 females were investigated by the Coroner. Of these 46 were residents and 11 were persons belonging to other districts. An inquest was held in 24 cases including 20 in which a post-mortem examination was made. In 30 cases the Coroner certified the cause of death after autopsy and in 3 cases after inquiry only. 9 The ages at death are shown in the following age groups:— Age-group No. Age-group No. Under 1 year 3 35-44 years 6 1-4 years 1 45-54 „ 6 5-14 ,, 1 55- 64 ,, 11 15-24 „ 4 65-74 ,, 12 25-34 ,, 6 75-84 „ 7 The twenty-four deaths which were the subject of an Inquest are classified thus:— Deaths from Violence:— Suicide by coal gas poisoning 5 Suicide by lysol poisoning 1 Suicide by firearms 1 Suicide by drowning 1 Accidental injuries by motor vehicles 7 Accidental injury by crushing 1 Accidental injuries by aeroplane 2 Accidental injury from fall 1 Accidental injury by fall from train (open verdict) 1 Accidental drowning 1 Shock after attempted abortion 1 Asphyxia—suffocation 1 Other causes:— Asbestosis 1 Causes of death certified after autopsy:— Heart Disease 18 Cerebral Haemorrhage 4 Influenza 2 Pneumonia 3 Bronchitis 1 Pulmonary Embolism 1 Puerperal Eclampsia 1 Causes of death certified by Coroner after inquiry:— Diseases of the heart and blood vessels 3 Street Accidents from 1st April, 1937, to 31st March, 1938. I am indebted to the Highway Surveyor for the following information on street accidents in the District which is taken from his report to the Council. It must be observed that the number of persons reported killed refers only to those who received fatal injuries at the time of the accident but does not include any deaths 10 which may have occurred subsequently among those who met with serious accidents. Period under review—one year. Number of persons killed in the street 19 Number of serious accidents 129 Number of slight accidents 307 The fatal accidents occurred in the following roads:—Dagenham Road, 2; Hornchurch Road, 5; Hillcrest Road, 1; New Road, Rainham and Wennington, 5; Park Lane, 1; Rainham Road, 1; Rush Green Road, 1; South End Road, 2; Squirrels Heath Road, 1. The roads on which most accidents occurred were:— New Road, Rainham 117 Hornchurch Road 46 High Street 23 South End Road 22 Rainham Road 19 In addition to the above, the following is a statement of the accidents which have been reported to have occurred during the same period on that portion of the Arterial Road (A.127) which is in this District:— Number of persons killed on the road 5 Number of serious accidents 53 Number of slight accidents 100 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 71 1 and under 2 8 2 „ „ 5 11 5 „ „ 15 14 15 „ „ 25 23 25 „ ,, 35 38 35 ,, ,, 45 46 45 „ „ 55 58 55 „ „ 65 91 65 years and upwards 260 620 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 32 35 70 30 35 75 28 30 80 23 22 85 7 12 90 0 6 120 140 Maternal Mortality. Two deaths occurred during the year from Puerperal Sepsis and four from other Puerperal causes. The maternal mortality rate, i.e. the deaths from all puerperal causes per 1,000 (live and still) births is 4.22. The corresponding rate in the year 1936 was 2.9, in 1935 it 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 3.23 for the year 1937. The following table shows the causes of death:— 40 years Peritonitis following septic uterine infection after delivery of stillborn infant. Coroner's Inquiry. 24 „ 1. (a) Paralytic Ileus. (b) Caesarian section. 30 „ 1. (a) Myocardial failure. (b) Puerperal Sepsis. 2. Caesarian section. 32 ,, 1. (a) Myocardial degeneration. (b) Eclampsia. (c) 5 months pregnancy terminated. 35 „ 1. (a) Acute Dilatation. (b) Caesarian section. 2. Extended breech. 37 „ Eclampsia. Stillbirth. Coroner's Inquiry. 12 Infantile Deaths. During the year 1937, there were 42 male and 29 female deaths of children under one year of age. The infant mortality rate per 1,000 births was 51; for England and Wales it was 58. The figures for the last 7 years are subjoined. Year. Number of deaths under one year. Rate. 1936 62 47.0 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 37 of such deaths yielding a rate of 26.9 per 1,000 births for the year. Prematurity was the cause of death in 18 cases and Congenital Malformation in 10 cases. Pneumonia was the cause of death in 8 of the 34 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:— 13 TABLE—INFANT MORTALITY, 1937. 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 1 1 Diphtheria Influenza 1 1 Tuberculosis Meningitis Convulsions 1 1 Bronchitis Pneumonia 1 1 2 4 3 1 10 Diarrhoea and Enteritis 2 2 1 1 6 Congenital Malformation 8 1 1 10 7 3 20 Congenital Debility 1 1 1 Premature Birth 13 4 1 18 1 19 Injury at Birth 1 1 1 Atelectasis 1 1 Icterus 1 1 1 Suffocation 1 1 Inattention at Birth Other Causes 2 1 1 4 2 1 1 8 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, 14 Ward. No. of deaths. In District. Outside District. Male. Female. Male. Female. Cranham 0 0 0 0 Emerson Park 3 0 8 0 Harold Wood 0 0 3 1 North West 2 4 1 2 Rainham 3 1 3 1 Thameside 2 6 2 2 Town Ward 7 3 4 6 Upminster 3 1 1 2 Deaths from Malignant Disease. There were 85 deaths from carcinoma and other forms of malignant disease : the death rate being 1.18 per thousand population. The corresponding rate for England and Wales was 1.63. The ages at death in certain age-groups and the site of the disease are set out below. Years. Male. Female. Under 1 0 0 1-14 0 0 15-34 0 0 35-44 3 2 45-54 5 8 55-64 10 14 65-74 12 16 75-84 5 7 85 and upwards 1 0 Not stated 0 2 Part affected. Number. Male. Female. Alimentary tract and abdominal organs:— Oesophagus 1 0 Stomach 6 6 Duodenum 1 1 Caecum 0 1 Colon 7 5 Rectum 7 4 Intestine 0 1 Peritoneum 0 1 Liver 1 0 Pancreas 1 2 15 Part affected. Number. Male. Female Genito-urinary organs:— Prostate 3 0 Bladder 0 1 Ovary 2 Uterus 8 Breast 14 Miscellaneous:— Face, etc. 1 2 Throat 1 0 Glands of neck 1 0 Lung 4 0 Tonsil 1 0 Sarcoma of thigh 0 1 Hip joint 1 0 VITAL STATISTICS OF WHOLE DISTRICT DURING 1937. 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 1937 72,010 1,077 1,373 19.6 393 5.4 69 296 71 51.7 623 8.6 BIRTH RATES, DEATH RATES AND ANALYSIS OF MORTALITY. Local figures compared with England and Wales and certain towns. England and Wales London Administrative County. 125 County Boroughs and Great Towns, including London. 148 Smaller Towns (resident populations 25,000-50,000 at 1931 Census). Hornchurch Rates per 1,000 Population. Births:— Live 14.9 13.3 14.9 15.3 19.6 Still 0.60 0.54 0.67 0.64 0.63 Deaths:— All causes 12.4 12.3 12.5 11.9 8.6 Typhoid and Paratyphoid Fevers 0.00 0.00 0.01 0.00 0.00 Smallpox — — — — — Measles 0.02 0.01 0.03 0.02 0.00 Scarlet Fever 0.01 0.01 0.01 0.01 0.01 Whooping Cough 0.04 0.06 0.04 0.03 0.02 Diphtheria 0.07 0.05 0.08 0.05 0.04 Influenza 0.45 0.38 0.39 0.42 0.30 Violence 0.54 0.51 0.45 0.42 0.62 Notifications:— Smallpox 0.00 — — 0.00 — Scarlet Fever 2.33 2.09 2.56 2.42 3.87 Diphtheria 1.49 1.93 1.81 1.38 0.72 Enteric Fever 0.05 0.05 0.06 0.04 0.09 Erysipelas 0.37 0.44 0.43 0.34 0.34 Pneumonia 1.36 1.18 1.58 1.20 1.13 18 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 333 290 1. Typhoid and paratyphoid fevers 0 0 2. Measles 0 0 3. Scarlet fever 1 0 4. Whooping cough 2 0 5. Diphtheria 1 2 6. Influenza 11 11 7. Encephalitis lethargica 0 0 8. Cerebro-spinal fever 0 0 9. Tuberculosis of respiratory system 21 15 10. Other tuberculous diseases 4 3 11. Syphilis 1 1 12. General paralysis of the insane, tabes dorsalis 1 1 13. Cancer, malignant disease 36 49 14. Diabetes 3 2 15. Cerebral haemorrhage, etc. 19 17 16. Heart Disease 67 68 17. Aneurysm 2 0 18. Other circulatory diseases 7 7 19. Bronchitis 11 7 20. Pneumonia (all forms) 25 7 21. Other respiratory diseases 6 5 22. Peptic ulcer 2 2 23. Diarrhoea, etc. (under 2 years) 2 2 24. Appendicitis 4 2 25. Cirrhosis of liver 0 0 26. Other diseases of liver, etc. 0 2 27. Other digestive diseases 4 7 28. Acute and chronic nephritis 6 7 29. Puerperal sepsis 2 30. Other puerperal causes 4 31. Congenital debility, premature birth, malformations, etc. 26 20 32. Senility 9 11 33. Suicide 7 1 34. Other violence 28 9 35. Other defined diseases 27 28 36. Causes ill-defined or unknown 0 0 19 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. Ager, Assoc. Royal San. Institute. 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. * L. C. Corlett, San. Insp. Certif. R.S.I. and S.I. Joint Board. † (Resigned 30.9.37). * (Commenced duties 29.11.37). Clerk. J. Blay. 2. Laboratory Facilities. Under arrangements made by the Essex County Council, Dr. J. F. Beale, 91 Queen Victoria Street, London, E.C.4., appointed Bacteriologist for Essex, undertakes the examination of specimens as enumerated below. Blood:— (a) Agglutination reaction for Typhoid Bacillus, etc. (b) Cultural examination of Blood for organisms. Cerebro-spinal Fluid:—Chemical and bacterioligical examination. Fasces:—Bacteriological and other microscopical examinations. Gastric Contents. Pleural, Peritoneal and Ascitic Fluids. Pus:—Microscopical examination, etc. Sputum. Urine:—Chemical and bacteriological examinations. Swabs:—Examination for Diphtheria Bacilli, Streptococci, etc. Water:— (a) Chemical and bacteriological examination of drinking water. (b) Swimming bath water for chemical and bacteriological examination. 20 Food:—Bacterial examination in cases of suspected Food Poisoning. Foodstuffs:—Examination of milk, ice cream and shell-fish. The pathological specimens examined by the County Bacteriologist during the year were reported as follows:— 307 throat swabs for diphtheria bacilli (22 positive, 285 negative). 16 nasal swabs (1 positive, 15 negative). 337 sputum for tubercle bacilli (62 positive, 275 negative). 31 urine. 4 samples of blood for Widal test (3 positive, 1 negative). 13 swabs for hæmolytic streptococci (4 positive, 9 negative). 5 hair for ringworm. 19 miscellaneous. 3. Ambulance Facilities. The Council maintain a Talbot motor ambulance at the Central Fire Station in Billet Lane and agreements are also in operation with the Essex County Council and the Romford Council for the reciprocal use of their motor ambulances. The whole of the District is adequately served by these ambulance services and in addition an ambulance maintained by the Upminster and Hornchurch Division of the Essex Branch of the St. John Ambulance Brigade has continued its voluntary work in the northern part of the District. Public assistance cases are removed to Oldchurch County Hospital by motor ambulances provided for that purpose and stationed there. Cases of Infectious Disease are removed to the Isolation Hospital 'by ambulances provided by the Joint Hospital Board which are maintained at the hospital. During the year 1,027 calls were received by the Hornchurch ambulance and a total of 10,279 miles was run. The nature of the cases were:— Illness 578 Accident 114 Road accident 180 Maternity 73 Removals 44 Not required or refused 38 21 Origin of calls. The calls were made by:— Doctors in 571 instances. Police in 169 instances. Hospitals m 65 instances. Others in 222 instances. Destination. The hospitals to which most of the cases were removed are shown in the following table:— Oldchurch Hospital, Romford 672 King George Hospital, Ilford 59 Victoria Hospital, Romford 28 London Hospital 27 Other destinations 241 Times at which calls were received:— From 6 a.m. to 6 p.m. 729 From 6 p.m. to 6 a.m. 298 4. Nursing in the Home. There are three District Nursing Associations:— (1.) The Hornchurch Nursing Association maintain two private nurses, one in the Town Ward and one in the North West Ward. (2.) The Upminster and Cranham Nursing Association maintains two private nurses. (3). The Rainham Nursing Association maintains one private nurse 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 the Women's Welfare Clinic once a week at the Combined Treatment Centre in Westland Avenue, also an ante-natal clinic once a week at the Rainham Clinic. Infant Welfare Clinics are held at the Combined Treatment Centre in Westland Avenue; Memorial Hall, Harold Wood; Holy Cross Hall, Park Lane; Combined Treatment Centre Rainham, and St. Laurence Hall, Upminster. 22 Refraction and dental clinics are held at the Centres in Westland Avenue and Rainham, school clinics for minor ailments at Westland Avenue and Rainsford Way School and Orthopaedic clinics at Westland Avenue. 6. Nursing and Maternity Homes. There are 11 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 47. 8. Hospitals. GENERAL HOSPITALS. The District is served by Oldchurch County Hospital, Romford; Victoria Hospital, Romford; King George Hospital, Ilford; also general hospitals at Plaistow, Poplar and Stratford. INFECTIOUS DISEASES. The Romford Joint Hospital District constituted in the year 1899 is formed by the Borough of Romford and the Urban Districts of Hornchurch and Dagenham, with a population of over 240,000. The Hospital which is situated at Rush Green contains 235 beds and is administered by a Resident Medical Superintendent with one Resident Assistant Medical Officer. During the year, 300 patients from this District were treated in the hospital, including 70 admitted as Diphtheria, 198 as Scarlet Fever, 5 as Enteric Fever, 3 Measles, and 24 miscellaneous. 6 cases of Scarlet Fever were sent to the London Fever Hospital owing to lack of accommodation in the Romford Isolation Hospital. SMALLPOX. The Essex County Council is the authority for the provision of hospital accommodation for cases of Smallpox in the administrative County. By agreement the Smallpox Hospital provided and maintained by the Borough of Colchester is available for cases occurring in the County, but it is anticipated that cases occurring in the southern part of the County will be sent to London County Council hospitals. No case of small pox occurred in Hornchurch during the year 1937. 23 SECTION C. Water. The South Essex Waterworks Company provide throughout the greater part of the District a constant supply of water which is satisfactory in quality and adequate in quantity. The water is derived from the River Stour at Langham, and also from wells in the chalk, but almost the whole of the water supplied to this District is obtained from the River Stour. The river water is treated by sedimentation, filtration and chlorination, and also storage. Weekly analyses, both chemical and bacteriological, are made of the Stour water at the following stages: (a) as river water, (b) river water after sedimentation, (c) water pumped to the District after filtration and chlorination. In addition, further chemical and bacteriological examinations are made of the water after primary filtration through the rapid filters and also after secondary filtration through the sand filters prior to chlorination. Drainage and Sewerage. BRANCH SEWERS. The Surveyor informs me that 40,063 feet of 9 inch and 1,974 feet of 12 inch soil sewers; also 2,672 feet of 15 inch, 2,950 feet of 12 inch and 27,074 feet of 9 inch surface water sewers were laid during the year. Rivers and Streams. The River Rom has been cleaned out near the Haveringwell Bridge and attention given to the banks. No action has been taken with regard to the pollution of rivers or streams. 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, 1937. 24 Street. Length. Feet. Church Road (section 2) 1,700 Suttons Lane (section 2) 850 Hillview Avenue 2,450 Babington Road 940 Westmoreland Avenue 1,800 Northumberland Avenue 2,530 Manor Avenue 575 Keith Way (part) 165 Fairfield Avenue (part) 932 11,942 = 2.261 miles Closet Accommodation. Throughout the District most of the houses are provided with water-closets connected to the sewer. At the beginning of the year there were approximately 360 cesspools which were emptied by the Council. Some of these have since been abolished in roads where sewers have been laid. The greatest number of cesspools, approximately 200, are in roads of estates adjoining Upminster Road, Rainham, where the existing sewer is somewhat shallow. The sewering of this part of the District is an engineering problem which is now receiving the attention of the Council. With the exception of this area, most of the other cesspools still being used are in isolated parts of the Districts. Public Cleansing. The collection and disposal of house refuse are carried out under the direction of the Surveyor. The Council have a fleet of S.D. freighters which are closed vehicles with a low loading line. Refuse is now disposed of by controlled tipping on land which is under the control of the Council. One area is in the North West Ward, where low lying land is being covered and levelled with the ultimate intention of making a public open space. In another part of the area, low lying ground is being filled up and when completed will be used as a school playing ground. Cesspool emptying is carried out by mechanical emptiers and the contents disposed of on land under the control of the Council. Sanitary Inspection of the District. Report of the Sanitary Inspectors under Article 27 of the Sanitary Officers (Outside London) Regulations, 1935, 25 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 53 Slaughterhouses422 Cowsheds, Dairies, etc. 290 Butchers' Shops 143 Fish Shops 117 Other Food Shops 25 Infectious Disease Enquiries 681 Disinfections 112 Workshops (including Factories and Workplaces) 101 Public House Urinals 35 Refuse Tips 12 Ice Cream Dealers' Premises 62 Watercourses 48 Tents, Vans, Sheds and Camping Grounds 55 House Drainage 393 Rat and Vermin Infestation 153 Petrol Installations 18 Outworkers 66 Accumulations 87 Schools 8 Water Supply 45 Other 168 (B) NUMBER OF NOTICES SERVED Informal 437 Statutory 52 (C) RESULT OF NOTICES SERVED Informal Notices Complied With 369 Statutory Notices Complied With 36 (D) OUTSTANDING ON 31st DECEMBER, 1937 Informal Notices 26 Statutory Notices 16 26 Works Completed. WATER CLOSETS W.C. flushing cisterns repaired or replaced by new ones 33 W.C.'s renewed 4 W.C.'s repaired 13 Light and ventilation provided to W.C. apartments 9 DRAINAGE Blocked drains cleared 66 New drains laid and drains relaid or repaired 12 Gullies repaired 17 Sinks and waste pipes repaired or new ones fixed ... 38 New covers and frames to inspection chambers provided 11 Cesspools emptied 53 New vent shafts or cages provided and fixed 15 GENERAL REPAIRS, ETC. Dampness abated 125 Roofs, gutters and downspouts repaired or renewed 115 Walls and ceilings cleansed and distempered or papered 159 Walls and ceilings repaired 253 Staircases and stairtreads repaired and handrails provided and fixed 71 Water supply provided and service pipes, etc. repaired 20 Dustbins provided 63 Sash cords renewed 84 Fireplaces, stoves and coppers repaired or renewed 121 Windows and doors repaired or renewed 294 Floors repaired or relaid 48 Yards paved and paying repaired 30 Food stores provided and light and ventilation provided to existing food stores 2 Miscellaneous works carried out 94 Shops. Each of the 4 Sanitary Inspectors has 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. 668 shops were inspected during the year and where there was any minor infringement the attention of the proprietor was called to it. No legal proceedings were taken during the year. At the end of the year there were 855 shops on the register. 27 Smoke Abatement No action with regard to smoke abatement was taken during the year. Swimming Baths and Pools. There are no public or privately owned swimming baths or pools in the District which are open to the public. Eradication of Bed Bugs. Houses found to be infested with bed bugs are treated by fumigation with sulphur fumes. Picture rails and skirting boards are generally removed for cleansing and other woodwork treated with a blowlamp. Wallpapers are stripped and walls and ceilings thoroughly cleansed. 1. No. of houses infested :— (a) Council houses 4 (b) Other houses 8 2. Infested houses are treated by fumigation with sulphur dioxide vapour and general cleansing with soap and water. 3. The belongings of tenants are inspected prior to removal to Council Houses and if necessary subjected to fumigation. 4. In Council Houses disinfestation is carried out by the Housing Staff. Other houses are disinfested by the tenant under supervision. 5. Tenants are instructed by the Housing Staff on steps to be taken to prevent re-infestation. Schools. The sanitary condition and water supply of the schools in the District are 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 2 (ii) By Other Local Authorities 4 (iii) By other bodies or persons 2,164 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) 777 (b) Number of inspections made for the purpose 2,172 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under Housing Consolidated Regulations, 1925 201 (b) Number of inspections made for the purpose 689 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 25 (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 479 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 342 4. Action under Statutory Powers during the Year:— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 0 29 (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 49 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 35 (b) By Local Authority in default of owners 0 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made 15 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 11 (d) Proceedings under section 12 of the Housing Act, 1936 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 1 (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 13 6. Housing Act, 1936, part IV. Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 49 (ii) Number of families dwelling therein 50 (iii) Number of persons dwelling therein 415 30 (b) Number of new cases of overcrowding reported during the year 7 (c) (i) Number of cases of overcrowding relieved during the year 29 (ii) Number of persons concerned in such cases 204 (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 2 Council Houses was relieved by transferring the occupants to larger existing Council Houses. It was enacted by the Housing Act, 1935 (Operation and Overcrowding Provisions) Order, 1936, dated 26th June, 1936, that in this District the appointed day for the purpose of the section which provides for the entering in rent books of a summary in the prescribed form of certain provisions of the Act relating to overcrowding should be the 1st July, 1936, and that the appointed day for the purposes of the sections dealing with affences in relation to overcrowding should be the 1st January, 1937. Provision of New Houses. The Council have decided to build new houses to relieve overcrowding and to re-house persons who have vacated houses which are to be demolished. In Rainham Ward the Council have suitable building land which can be used for this purpose and in the Town Ward it is proposed to build houses on land already in the possession of the Council which has been hitherto used for another purpose. In their scheme the Council have decided to provide some houses with 4 or 5 bedrooms for large families and also small dwellings for aged persons. Building was commenced on the Rainham site in March, 1938. 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. 31 During the year 1937 this information was supplied for 2,599 houses which is additional to the 1,584 houses in respect of which the information was supplied during the year 1936. Housing Act, 1936, Section 62. Proceedings were taken under Section 62 of the Housing Act, 1936, against a landlord who after repeated warnings had failed to enter in several tenants' rent books a summary of the provisions of Sections 58, 59 and 61 of the Housing Act. The landlord was convicted in the Court of Summary Jurisdiction and was fined £5. 32 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply. During the year there were 19 cowkeepers in the District with farms registered under the Milk and Dairies Order, 1926, but two of these producers gave up their business at Michaelmas reducing the total to 17. These farms are all inspected from time to time and samples of milk taken by the Sanitary Inspectors for examination by the County Bacteriologist. Production of Accredited Milk. There are 8 dairy farms licensed by the County Council for the production of Accredited Milk of which 4 are in Cranham Ward, 2 in Harold Wood Ward, 1 in Emerson Park Ward, and 1 in Rainham Ward. At the end of the year one other producer had applied to the County Council for an Accredited Milk licence and his application was under consideration. Milk (Special Designations) Order, 1936. Licences issued by the Council for the year ended 31st December, 1937. 15 licences have been issued to retail Tuberculin Tested Milk; 18 licences to retail Pasteurised Milk; and 2 licences to sell Accredited Milk. In addition 15 supplementary licences, namely 9 for Tuberculin Tested Milk; 5 for Pasteurised Milk; and 1 for Accredited Milk, were isued, these being licences required by retailers who hold principal licences in another district and wish to sell milk in this district from premises elsewhere. Milk Retailers. There are 23 milk retailers with registered premises in the District, including 7 producers who are registered both as producers and retailers. In addition there are 15 persons registered as milk retailers in Hornchurch, but whose premises are registered in neighbouring districts. 33 Milk Sampling. During the year 56 samples of milk were examined for cleanliness and bacterial content by the County Bacteriologist. They included 21 samples of graded milk all of which were satisfactory, and 35 samples of raw milk, of which 30 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 6,600 — Satisfactory 2. „ 7,000 — „ 3. „ 93,000 — „ 4. „ 2,800 — „ 5. „ 16,000 — „ 6. „ 1,400 — „ 7. „ 3,600 — „ 8. Accredited — — „ 9. „ — — „ 10. „ — — „ 11. „ — — „ 12. „ 7,000 Absent in 0.01 c.c. „ 13. „ 13,000 Absent in 0.01 c.c. „ 14. „ 16,000 Absent in 0.01 c.c. „ 15. „ 3,200 Absent in 0.01 c.c. „ 16. „ 7,600 Absent in 0.01 c.c. „ 17. „ 9,300 Absent in 0.01 c.c. „ 18. „ 9,600 Absent in 0.01 c.c. „ 19. „ — — „ 20. „ — — „ 21. „ — — „ 22. Ungraded 16,000 Present in 0.01 c.m. „ 23. „ 11,000 Absent in 0.01 c.m. „ 24. „ 8,600 Absent in 0.01 c.m. „ 25. „ 9,000 Absent in 0.01 c.m. „ 26. „ 16,000 Absent in 0.01 c.m. „ 27. „ 8,800 Absent in d.01 c.m. „ 28. „ 6,600 Absent in 0.01 c.m. „ 29. „ 5,600 Absent in 0.01 c.m. „ 30. „ 4,800 Absent in 0.01 c.m. „ 31. „ 11,000 Present in 0.01 c.m. „ 32. „ 11,000 Present in 0.01 c.m. „ 33. „ 13,000 Absent in 0.01 c.c. „ 34. „ 42,000 Present in 0.01 c.c. „ 35. „ 64,000 Present in 0.01 c.c. „ 36. „ 78,000 Present in 0.01 c.c. „ 34 Grade of Milk. Number of Bacteria. Presence of B. Coli. Remarks. 37. Ungraded 30,000 Absent in 0.01 c.c. Satisfactory 38. „ 9,000 Absent in 0.01 c.c. „ 39. „ 1,600 Absent in 0.01 c.c. „ 40. „ 28,000 Absent in 0.01 c.c. „ 41. „ 21,000 Absent in 0.01 c.c. „ 42. „ 72,000 Present in 0.01 c.c. „ 43. „ 13,000 Absent in 0.01 c.c. „ 44. „ 6,000 Absent in 0.01 c.c. „ 45. „ 32,000 Present in 0.01 c.c. Unsatisfactory 46. „ 22,000 Present in 0.01 c.c. „ 47. „ 16,000 Absent in 0.01 c.c. Satisfactory 48. „ 7,000 Absent in 0.01 c.c. „ 49. „ 13,000 Absent in 0.01 c.c. „ 50. „ 11,000 Absent in 0.01 c.c. „ 51. „ 79,000 Present in 0.001 c.c. Unsatisfactory 52. „ 18,000 Present in 0.01 c.c. „ 53. „ 66,000 Present in 0.001 c.c. „ 54. „ 4,800 Absent in 0.01 c.c. Satisfactory 55. „ 7,000 Absent in 0.01 c.c. „ 56. „ 12,000 Absent in 0.01 c.c. „ 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 has supplied the following information about samples of milk which he has had taken for examination during the year :— Milk in Schools Scheme. 12 samples were submitted to the Methylene Blue Test of which 9 were satisfactory and 3 unsatisfactory. In addition three samples were examined by the biological test of which two were satisfactory. Milk samples taken at Accredited Farms or in connection with applications for "Accredited Milk" licences. 31 samples were submitted to the Methylene Blue Test of which 26 were satisfactory and 5 unsatisfactory. In addition 12 biological tests were carried out of which 12 were satisfactory. 35 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 15 applications for registration were granted. At the end of the year, 36 persons were registered as manufacturers and 66 as vendors in the District. 3. Meat. There are 5 slaughterhouses, 3 registered and 2 licensed, which are visited regularly by the Sanitary Inspectors and the carcases inspected. In the following table appear the number of carcases inspected and the number found to be diseased or unwholesome. Cattle Cows. Calves. Sheep and Lambs. Pigs. Number inspected 927 438 109 3,383 1,051 All diseases except Tuberculosis:- Whole caracases condemned 1 0 0 46 0 Carcases of which some part or organ was condemned 21 26 0 6 5 Percentage of the number inspected affected with disease other than Tuberculosis 2.37 5.9 0 1.55 .47 Tuberculosis only:— Whole carcases condemned 5 7 ] 0 2 Carcases of which some part or organ was condemned 99 145 0 0 32 Percentage of the number inspected affected with Tuberculosis 1 11.2 34.7 .91 0 3.23 Slaughter of Animals Act, 1933. Under Section 3 of the above Act, it is necessary for all slaughtermen to be registered. 36 15 applications for renewal and 16 applications for new licences were received during the year and all were granted. Meat Traders. There are 48 Butchers' shops in the District which are inspected by the Sanitary Inspectors. Meat amounting 3401bs. weight was surrendered voluntarily as being unfit. 4. Shell Fish (Molluscan). There are no shell fish beds or layings in this District. 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 markets. 5. Nutrition. A combined Milk Week for Bomford and Hornchurch was held in February, during which by means of lectures, film displays, and public meetings, which were well attended, the importance of a pure milk supply and the necessity of increasing the amount consumed were brought to the notice of the public. 37 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE Scarlet Fever. During the year 279 cases of Scarlet Fever, yielding a case rate of 3.8 per 1,000 of the population, were notified. The corresponding rate in England and Wales being 2.33. The rates in this District in the years 1936, 1935, 1934 and 1933 were 3.6, 3.5, 4.3 and 5.4. Of the total number of cases 189 were admitted to the Romford Isolation Hospital and 6 were sent to the London Fever Hospital when accommodation was not available locally. Most of the cases were mild in character. Anti-scarlet 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 hopsital for a period of 4 weeks. There was one fatal case, a male aged 6 years, who died of Streptococcal meningitis. Diphtheria. The number of cases of Diphtheria notified was 52 yielding a rate of 0.70 per 1,000 of the population, the case rate for England and Wales being 0.07. In the years 1936, 1935, 1934 and 1933, the case rates in this District were 1.4, 1.9, 3.02 and 0.9. During the year there were 3 deaths from Diphtheria as follows : Sex. Site Age in years. Male Nasal 6 Female Laryngcal 4 Female Faucial 62 Terminal Disinfection. The practice of routine fumigation by formalin or sulphur dioxide vapour of the sick room after the removal to hospital of the patient or at the termination of the illness if treated at home, was discontinued after a resolution of the Council meeting on the 18th May, 1397. In place of the fumigation formerly carried out, the occupier of the house is now instructed in the thorough cleansing of the room and disinfection of infected articles. 38 Careful observation has been made as to the occurrence of secondary cases of Scarlet Fever or Diphtheria, and it was found that after the cessation of routine fumigation there was no increase in the number of secondary cases. The following table shows the number of secondary cases which occurred after the removal of the primary case to hospital:— Scarlet Fever Diphtheria. No. removed No. of No. removed No.of to hospital secondary to hospital secondary cases cases Fumigation carried out 51 9 21 1 Fumigation discontinued 144 7 30 2 The cases of Scarlet Fever and Diphtheria notified in each ward during each month of the year are shown in the following table:— TABLE SHOWING SCARLET FEVER AND DIPHTHERIA CASES OCCURRING IN EACH MONTH. Total Cranham. Emerson Park Harold Wood North-West Rainham Thameside Town Upminster 8.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 18 5 1 1 1 4 1 2 1 10 2 February 22 6 2 4 1 2 1 5 4 4 5 March 15 2 1 1 3 2 1 5 1 3 April 20 4 1 4 1 2 6 2 1 1 2 4 May 15 5 5 2 2 2 2 5 1 1 June 14 4 2 1 1 4 2 3 1 3 1 July 20 4 1 1 2 2 2 3 4 6 2 1 August 15 1 2 4 1 4 2 3 September 22 7 2 1 2 1 4 1 2 1 12 3 October 52 2 3 4 4 2 8 12 21 November 32 7 1 6 1 5 2 2 9 2 11 December 34 5 1 1 15 7 1 1 2 6 2 3 279 52 4 0 23 4 35 4 49 16 28 7 14 7 78 10 48 4 40 Immunisation against Diphtheria. Artificial immunisation against Diphthria was continued during the year. To the parents of all children attending the Infant Departments of the Public Elementary Schools throughout the District a leaflet describing the object of this treatment was distributed and those wishing to have their children both of school age and under school age immunised were asked to sign a form of consent. Subsequently written apointments were made for each child, and the mother was asked to attend at the time when the treatments was carried out. Children under school age were also treated, the invitations being extended through the Child Welfare Clinics. By permission of the Education Committee this work was carried out in the Treatment Centres or on school premises. 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. During the year T.A.T. was the immunising agent which was used, the dose being 1 c.c. injected intra-muscularly at intervals of approximately three weeks, and followed by a Schick test after a period of between three and four months. The total number of persons who have received a full course of treatment since the scheme was begun in the year 1934 is 3,272. In the following tables are shown the numbers of persons tested before treatment, the number treated and the number tested after treatment. The adults treated were teachers in the Infants' Departments. YEAR 1937. Immunisation against Diphtheria. 1. Primary Schick Test:— Result. No. tested. Negative. Positive Adults 6 2 4 School Children 167 62 105 Children under 5 years of age 1 1 0 174 65 109 41 2. Number Treated :— Completed. Incomplete. Adults 3 0 School Children 589 66 Pre-school Children 138 25 730 91 3. Schick Tested after Treatment:— Result. No. tested. Negative Positive Adults 3 3 0 School Children 671 650 21 Pre-school Children 123 121 2 797 774 23 No person can he considered to have been immunised until he has received three injections and has been found to have a negative reaction to the subsequent Schick test. In every case of illness in which Diphtheria or suspected Diphtheria is notified enquiry is made as to whether immunisation has been carried out previously and the Schick test performed. The following table shows particulars of all such cases which have occurred since 1934. Year. Case No. Sex. Age Treatment received. Final Diagnosis. Result. 1935. 41 F 5 T.A.M. 2 c.c. Mild Faucial Diph. Recovered 1935. 70 F 6 T.A.M. 2 c.c. „ „ „ „ 1935. 408 M 8 T.A.M. 1 c.c. Severe Faucial Diph. Died 1936. 15 F 6 T.A.M. 2 c.c. Mild Faucial Diph. Recovered 1936. 103 M 7 T.A.F. 2 c.c. Moderately severe „ 1936. 159 F 3 T.A.F. 2 c.c. Moderately severe Faucial Diphtheria. „ 1936. 164 F 7 T.A.F. 2 c.c. Moderately severe. „ 1936. 170 F 4 T.A.M. 1 c.c. Tonsilitis. „ 1936. 221 M 9 T.A.F. 3 c.c. Diphtheria carrier. „ 1936. 359 M 5 T.A.F. 1 c.c. Faucial Diphtheria. „ 1936. 376 M 5 T.A.F. 1 c.c. „ „ „ 1936. 410 M 5 T.A.M. 3 c.c. Tonsilitis. „ 1937. 188 F 5 T.A.M. 3 c.c. „ „ 1937. 231 F 5 T.A.F. 2 c.c. Diphtheria mild. „ It will be seen that in each of the above in which the diagnosis of Diphtheria was confirmed, the Immunisation treatment had not been completed. 42 Measles. Measles was prevalent at North Street and Harold Wood Schools in June. 4 persons were admitted to the Isolation Hospital for treatment. Whooping Cough. Whooping cough was very prevalent in Upminster Infants School in the Spring. Two cases were treated in. the Romford Isolation Hospital. Ophthalmia Neonatorum. Since the 1st April, 1937, Ophthalmia has ceased to be notifiable to the Sanitary Authority and since that date has been notifiable to the Maternity and Child Welfare Authority, which in this District is the County Council. A copy of each notification is sent to me by the County Medical Officer. During the year 6 cases of Ophthalmia were notified of which 3 were treated in hospital. Poliomyelitis. 2 cases were notified, one aged 14 years and one aged 28 years. Both were admitted to hospital and the latter a female died. Pneumonia. 82 notifications, including 50 males and 32 females were received. 20 were stated to be suffering from Influenzal Pneumonia. 30 were removed to hopsital. The deaths occurred of 6 males and 3 females of those which were notified, the ages being, males—3 months: 34 ; 42 ; 44 ; 59 and 63 years, females: 76 ; 77 and 90 years. In addition, 16 males and 6 females died from Pneumonia outside the District. Catarrhal Jaundice. 20 cases of Catarrhal Jaundice were reported in the southern part of the District amongst school children. In only one instance did more than one case occur in a family. All the cases were mild and recovered in 2 or 3 weeks. Dysentery. 2 cases of Dysentery of the Sonne type were notified, both being treated in hospital to which they had been admitted for other conditions. One was aged 7 and the other 18 years. Both recovered. 43 In addition, a male aged 51 years, who had lived in India, was notified to be suffering from a relapse of Amæbic Dysentery for which he was admitted to a special hopsital. Erysipelas. 25 cases were notified, 9 males of which 4 were removed to hospital and 16 females of which 6 were removed to hospital. Enteric Fevers. 6 cases of Paratyphoid were notified, all being removed to hospital and all recovered. The ages were:—males, 11: 8 and 4 years, and females, 16 : 13 and 8 years. 3 cases occurred in Harold Wood Ward, being two sisters and a brother in one family. The cause of the illness was not ascertained. 2 cases occurred in Rainham Ward in February, but there was no connection between them and the cause of the illness was not evident. One other case occurred in Cranham Ward in February which cannot appear to have any connection with other cases. One case of Typhoid Fever, a male aged 33 years, was notified in the Town Ward in December and he was removed to hospital for treatment. This man was engaged in loading barges on the riverside. Public Health Act, 1925. No action was taken during the year under Section 66 of this Act or under Section 176 of the Public Health Act, 1936. TABLE SHOWING THE CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1937. NOTIFIABLE DISEASE Total Number of cases notified in age-groups. Total cases notified in each Ward. No. removed to Hospital j 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 Smallpox 0 0 Scarlet Fever 279 1 57 184 20 15 2 0 4 23 35 49 28 14 78 48 199 Diphtheria 52 0 15 24 4 6 3 0 0 4 4 16 7 7 10 4 51 Enteric Fever (with Paratyphoid) 7 1 4 1 1 1 3 1 1 1 7 Puerperal Pyrexia.. 10 5 4 1 2 2 4 1 1 4 Polio-myelitis 2 1 1 1 1 2 Pneumonia 82 6 16 17 8 14 14 7 1 5 1 46 7 5 16 1 30 Erysipelas 25 1 1 I 13 8 1 4 1 6 3 9 3 10 Ophthalmia Neonatorum 6 5 1 2 2 3 Dysentery 3 1 1 1 1 1 1 3 45 Tuberculosis. The notifications of cases of Tuberculosis included 51 males and 41 females suffering from Pulmonary, and 15 males and 17 females suffering from Non-Pulmonary forms of the disease. The 43 deaths included those-of 6 pulmonary and 2 non-pulmonary cases which were not notified. The death rate was 0.59 per 1,000, and the rate for England and Wales was 0.695 per 1,000. New Cases. Deaths. Age periods. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary Under 1 0 0 0 0 0 0 0 0 1 1 1 3 3 0 0 1 1 5 4 0 3 8 0 0 0 1 15 10 9 4 3 2 5 2 0 25 7 20 3 1 4 4 0 0 35 13 8 1 0 7 3 1 0 45 7 2 0 2 5 1 0 0 55 8 1 1 0 3 0 0 0 65 1 0 0 0 0 2 0 1 51 41 15 17 21 15 4 3 No action was taken under the Public Health (Prevention of Tuberculosis) Regulations, 1925, or under Section 62 of the Public Health Act, 1925, or Section 172 of the Public Health Act, 1936 (relating to the compulsory removal to hospital of persons suffering from Tuberculosis). 46 SECTION G. FACTORY AND WORKSHOP ACT. HOME OFFICE TABLES. l. Inspection of factories, Workshops and Workplaces:- Premises. Inspections. Written notices. Prosecuted Factories 72 4 0 Workshops 10 0 0 Workplaces 19 2 0 101 6 0 2. Defects found in Factories, Workshops and Workplaces:— Particulars. Number of defects Pound. Remedied Nuisances under Public Health Acts :— Want of ventilation 1 1 Want of drainage of floors 1 1 Other nuisances 1 0 Sanitary accommodation :— Insufficient 2 2 Unsuitable or defective 7 7 Not separate for sexes 1 1 Offences under the Factory and Workshop Acts :— Other offences 8 8 21 20 3. Homework:— Nature of work. Outworkers lists, Section 107. Lists received from employers. Wearing apparel 44 Making or repairing umbrellas 1 Making handbags 2 Making sugar cake ornaments 2 Making cushions 1 Making artificial flowers 3 General merchants 2 Making brushes 2 Making or repairing shoes 2 Making flags 1 No notices were served under Section 108. 47 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 two recording stations which were used during the year. Amount of rainfall in inches. No. of days in which rain fell. At Langtons :— January 3.06 20 February 3.96 23 March 2.74 18 April 2.42 16 May 2.84 14 June 2.09 10 July 1 .97 10 August .80 7 September 1.16 14 October 1.61 10 November 1.52 11 December 3.70 19 27.87 172 Eastern Outfall Works January 2.81 19 February 3.46 21 March 2.33 15 April 2.19 13 May 2.37 12 June 2.06 11 July 2.70 9 August .60 6 September 1.22 13 October 1.23 9 November 1.45 7 December 3.76 15 26.18 150 During the years 1936 and 1935, the total amount of rainfall at the Eastern Outfall Works was 22.68 inches and 21.64 inches, and rain fell on 160 days and 159 days respectively.