MED. INTEL Hornchurch Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH ALFRED BALL. M.D . D.P.H Medical Officer of Health, Hornchurch Urban District Council. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH 1938. ALFRED BALL, M.D., D.P.H. Medical Officer of Health. W. & W. Ltd., 28.6.AW. 3 COUNCIL OFFICES, BILLET LANE, HORNCHURCH, Essex. 7th June, 1939. 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 1938. Perusal of the statistics set out in the report will show that the year has been a healthy one. Many new houses have been constructed and building development still continues, although towards the end of the year there was a little slackening. 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 H. H. Wake, J.P., Chairman. Councillor Mrs. E. M. Field, Vice-Chairman. Councillor Mrs. A. J. E. King ,, Mrs. R. J. Reynolds ,, Mrs. P. Sherring ,, Mrs. H. S. E.Williams ,, W. G. Bunch ,, A. Perguson ,, A. C. Holmes ,, C. J. Josephs ,, T. Martin ,, J. W. Mathews, J.P. Councillor w. H. F. Maunder ,, C. L. Parker ,, H. Perry ,, D. A. Ramsay ,, A. C. Salinger ,, B. L. Tarr ,, A. J. Twigger ,, T. P. Webb ,, T. F. Willoughby Representatives of the Council on the Romford. Joint Hospital Board: Councillor H. H. Wake, J.P. (ex-officio) ,, Mrs. A. J. E. King Councillor Mrs. H. S. E.Williams W. H. F. Webb ,, T. F. Willoughby Representatives of the Council on the Romford and Hornchurch Joint Sewerage Committee: Councillor Mrs. E. M. Field ,, Mrs. R. J. Reynolds ,, A. C. Holmes Councillor J. W. Mathews, J.P. ,, W. H. F. Maunder Representatives of the Council on the Southern Area Guardians Committee: Councillor Mrs. A. J. E. King ,, Mrs. H. S. E.Williams 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) 1939 76,000 Number of inhabited houses (end of 1938) according to Rate books 24,100 Rateable Value (December, 1939) £630,902 Sum represented by a Penny Rate (March, 1939) £2,460 Social Conditions. The district is, to a considerable degree, residential in character and building development which still continues rapidly, attracts new residents to the district and increases the population very considerably. There are, however, 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 has been an increase in unemployment in the district especially in the last quarter of the year. 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 have been corrected for inward and outward transfers, as supplied by the Registrar-General. Live Births:— Male. Female. Total Rate. Legitimate 728 732 1,500 Illegitimate 24 16 Birth Rate per 1,000 resident population 19.7 Still Births:— Legitimate 28 24 53 Illegitimate 1 0 Rate per thousand total (live and still) births 34 Deaths 308 308 616 Death rate per 1,000 estimated resident population 8.1 6  Rate per 1,000 Deaths from Puerperal causes:— Deaths. total births. No. 29. Puerperal Sepsis 0 0 No. 30. Other puerperal causes 5 3.2 Total 5 3.2 Death rate of infants under one year of age:— All infants per thousand live births 47.3 Legitimate infants per thousand legitimate live births 44.5 Illegitimate infants per thousand illegitimate live births 150.0 Deaths from Cancer (all ages) 97 Deaths from Measles (all ages) 6 Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 14 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 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 1,000. 7 The population of Hornchurch contains a large number of young people and this fact tends to explain the high birth rate. Births. The number of births registered in the District during the year was 1,113. The number of births corrected for inward and outward transfers is as follows:— Males. Females. Legitimate 728 732 Illegitimate 24 16 The percentage of illegitimate births to the total registered was 2.7. Deaths. There were 381 deaths registered in the District during the year, this number including 92 belonging to other Districts which have, therefore, been subtracted. 182 males and 141 females whose residence was in Hornchurch died elsewhere and these deaths are added as inward transfers making a nett total of 612. The birth rate calculated on a population of 76,000 is 19.7 per thousand estimated population. A comparison with previous years follows:— 1937 19.6 1932 18.1 1936 20.2 1931 20.1 1935 17.0 1930 16.1 1934 17.6 1929 17.0 1933 18.4 1928 14.9 The crude death rate calculated on a population of 76,000 was 8.1 per thousand. A comparison with previous years follows:— 1937 8.6 1932 7.9 1936 7.9 1931 8.4 1935 8.4 1930 8.2 1934 8.4 1929 9.9 1933 7.8 1928 8.4 8 Comparative Mortality after allowing for differences in the Population Constitution. The Registrar-Genreal 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 1938 thus obtained is 8.991. The deaths of Hornchurch residents occurring in hospitals were as follows:— Oldchurch County Hospital 155 Orsett Institution 34 Victoria Hospital, Romford 1 Isolation Hospital, Rush Green 10 King George Hospital, Ilford 12 Queen Mary's Hospital, Stratford 4 Brentwood and Severalls Mental Hospitals 9 St. Andrew's P.A.I., Billericay 9 Epping P.A.I. 1 St. Joseph's Hospice 6 Hospitals in London 35 Other hospitals 19 48 per cent. of the total Hornchurch deaths occurred in hospitals or other institutions. Deaths referred to the Coroner. During the year the deaths of 18 males and 17 females were investigated by the Coroner. Of these 29 were residents and 6 were persons belonging to other districts. An inquest was held in 20 cases in all of which a post-mortem examination was made. In 14 cases the Coroner certified the cause of death after autopsy and in 1 case after inquiry only. The ages at death are shown in the following age groups:— Age-group No. Age-group No. Under 1 year 7 45 - 54 ,, 2 1-4 years 0 55 - 64 ,, 6 5-14 „ 1 65 - 74 ,, 4 15-24 „ 3 75 - 84 ,, 1 25 - 34 „ 5 85 and upwards 1 35 - 44 years 5 9 The twenty deaths which were the subject of an Inquest are classified thus:— Deaths from Violence :— By liquid poison 1 By coal gas poisoning 3 By hanging 1 By drowning 2 By decapitation 1 By immersion and shock 1 Accidental injuries by motor vehicles 3 Accidental suffocation 3 Accidental drowning 1 Inattention at birth 1 Other causes:— Cerebral Hæmorrhage 2 Meningitis 1 Causes of death certified after autopsy:— Diseases of Heart and blood vessels 11 Meningitis 1 Accident of childbirth 1 Natural causes 1 Cause of death certified by Coroner after inquiry:— Accidental asphyxia 1 Street Accidents from 1st April, 1938, to 31st March, 1939. I am indebted to the Surveyor, Mr. T. E. Spencer, for information relating to street accidents during the period 1st April, 1938, to 31st March, 1939. 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 which may have occurred subsequently among those who met with serious accidents. Period under review—one year. Number of persons killed in the street 11 Number of serious accidents 145 Number of slight accidents 285 The fatal accidents occurred on the following roads:— Corbets Tey Road (1), New Road, South Hornchurch (1), New Road, Rainham (5), St. Mary's Lane, Upminster (1), Hornchurch Road (1), St. Mary's Lane, Cranham (1), Ockendon Road (1). 10 The roads on which most accidents occurred were:— Road. No. of accidents. No. of persons involved in personal injury. High Street 15 17 Hornchurch Road 45 52 New Road, South Hornchurch 16 25 New Road, Rainham 55 83 Southend Road 18 22 St. Mary's Lane, Upminster 16 17 Arterial Road, A.127. There were 84 accidents on the Arterial Road between Gallows Corner and Bird Lane. Between Bird Lane and Little Warley Hall there were 15 accidents including 2 immediately fatal. 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 27 70 35 30 75 23 36 80 17 28 85 7 12 90 1 10 108 143 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 11 2 „ „ 5 7 5 „ „ 15 11 15 „ „ 25 24 25 „ „ 35 36 35 ,, ,, 45 52 45 „ ,, 55 66 55 „ „ 65 83 65 years and upwards 251 612 11 Maternal Mortality. No deaths occurred during the year from Puerperal Sepsis but there were 5 deaths from other Puerperal causes. . The maternal mortality rate, i.e. the deaths from all puerperal causes per 1,000 (live and still) births is 3.2. The corresponding rate in the year 1937 was 4.2, in 1936 it was 2.9, in 1935 it was 4.6, in 1934 it was 6.3, and in 1933 it was 1.3. The maternal mortality rate for England and Wales was 2.97 for the year 1938. The following table shows the causes of death:— Age. 39 years Uraemia. Eclampsia. Adherent 31 „ Toxaemia of Pregnancy. 23 „ Shock. Inverted uterus. placenta. 27 „ Air Embolism. 37 „ Pre-eclamptic Toxaemia. Infantile Deaths. During the year 1938, there were 38 male and 33 female deaths of children under one year of age. The infant mortality rate per 1,000 births was 47.3; for England and Wales it was 53. The figures for the last 8 years are subjoined. Year. Number of deaths under one year. Rate 1937 71 51.0 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 12 Neonatal Mortality. This term is applied to the deaths of children under one month. There were 41 of such deaths yielding a rate of '27.3 per 1,000 births for the year. Prematurity was the cause of death in 18 cases and Congenital Malformation in 6 cases. Pneumonia was the cause of death in 3 of the 30 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, 1938. 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 1 1 Whooping Cough 1 1 Diphtheria Influenza Tuberculosis Meningitis Convulsions 1 1 1 Bronchitis 1 1 2 Pneumonia 1 1 1 3 Diarrhœa and 4 7 2 1 14 Enteritis Congenital 3 1 1 1 6 1 7 Malformation Congenital Debility 1 1 1 2 Premature Birth 17 1 18 1 1 20 Injury at Birth 5 1 6 6 Atelectasis 4 1 5 5 Icterus Suffocation 1 1 1 2 4 Inattention at Birth 1 1 1 Other Causes 1 1 2 2 4 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  No. of deaths. Ward. In District. Outside District Male. Female. Male. Female Cranham 1 0 0 0 Emerson Park 1 1 3 2 Harold Wood 0 0 4 2 North West 1 7 7 5 Rainham 5 1 4 0 Thameside 2 3 1 3 Town Ward 0 0 7 3 Upminster 2 2 0 4 Deaths from Diarrhoea (under 2 years of age). Among children under two years of age there were 14 deaths registered as due to Diarrhœa; this is equivalent to a rate of 0.9 per thousand births the corresponding rate for England and Wales being 5.5. Deaths from Malignant Disease. There were 97 deaths from carcinoma and other forms of malignant disease; the death rate being 1.27 per thousand population. The corresponding rate for England and Wales was 1.66 The ages at death in certain age-groups and the site of the disease are set out below:— Years. Male. Female. 25-34 2 2 35-44 2 9 45-54 7 12 55-64 11 12 65-74 15 7 75-84 5 8 85 and upwards 0 2 Alimentary tract and abdominal organs:— Part affected. Number. Male. Female. Oesophagus 1 3 Stomach 13 7 Duodenum 0 1 Colon 5 1 Rectum 1 1 Intestine 1 1 Peritoneum 1 1 Liver 0 2 Pancreas 2 2 Gall bladder 0 1 Tongue 2 0 15 Breast and Genito-urinary organs:— Number. Part affected. Male. Female. Breast 12 Uterus 5 Ovary 3 Bladder 2 2 Prostate 4 Miscellaneous:— Lung 5 1 Pleura 1 0 Thorax 1 0 Nasopharynx 1 0 Thyroid 0 1 Middle Ear 0 1 Postcricoid 0 1 Carcinomatosis 0 2 Sarcoma 2 3 (abdomen, ilium, leg, pelvis, glands) Malignant Teratoma 0 1 VITAL STATISTICS OF WHOLE DISTRICT DURING 1938. 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 1938 76,000 1,113 1,500 19.7 381 5.0 92 323 71 47.3 616 8.1 BIRTH RATES, DEATH RATES AND ANALYSIS OF MORTALITY. Local figures compared with England and Wales and certain towns. England and Wales London Administrative County. 126 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 15.1 13.4 15.0 15.4 19.7 Still 0.60 0.48 0.65 0.60 0.69 Deaths:— All causes 11.6 11.4 11.7 11.0 8.1 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.01 Smallpox 0.00 — — 0.00 0.00 Measles 0.04 0.06 0.05 0.03 0.08 Scarlet Fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.03 0.03 0.03 0.02 0.01 Diphtheria 0.07 0.05 0.07 0.06 0.03 Influenza 0.11 0.06 0.10 0.11 0.05 Notifications:— Smallpox 0.00 0.00 0.00 0.00 Scarlet Fever 2.41 2.05 2.60 2.58 2.9 Diphtheria 1.58 1.90 1.85 1.53 0.59 Enteric Fever 0.03 0.05 0.03 0.04 0.04 Erysipelas 0.40 0.46 ' 0.46 0.39 0.40 Pneumonia 1.10 0.98 1.28 0.98 0.96 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 308 308 1. Typhoid and paratyphoid fevers 1 0 2. Measles 5 1 3. Scarlet fever 0 0 4. Whooping cough 0 1 5. Diphtheria 1 1 6. Influenza 2 2 7. Encephalitis lethargica 0 0 8. Cerbro-spinal fever 0 0 9. Tuberculosis of respiratory system 23 13 10. Other tuberculous diseases 5 5 11. Syphilis 1 1 12. General paralysis of the insane, tabes dorsalis 2 0 13. Cancer, malignant disease 44 53 14. Diabetes 3 4 15. Cerebral hæmorrhage, etc. 14 17 16. Heart Disease 63 75 17. Aneurysm 4 0 18. Other circulatory diseases 12 8 19. Bronchitis 6 7 20. Pneumonia (all forms) 6 13 21. Other respiratory diseases 1 2 22. Peptic ulcer 4 0 23. Diarrhœa, etc. (under 2 years) 9 5 24. Appendicitis 1 7 25. Cirrhosis of liver 3 1 26. Other diseases of liver, etc. 0 3 27. Other digestive diseases 5 6 28. Acute and chronic nephritis 6 8 29. Puerperal sepsis 0 30. Other puerperal causes 5 31. Congenital debility, premature birth, malformations, etc 23 18 32. Senility 9 13 33. Suicide 7 3 34. Other violence 19 8 35. Other defined diseases 27 27 36. Causes ill-defined or unknown 2 1 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. L. Ager, San. Insp. Cert. R.S.I. Cert. Inspect, of Meat and Other Foods. C. S. Smith, San. Insp. Cert. R.S.I, and S.I. Joint Board. Cert. Insp. of Meat and Other Foods. S. H. Beyer, San. Insp. Cert. R.S.I. and S.I. Joint Board. Cert. Insp. of Meat and Other Foods. A. V. J. Hutchings, San. Insp. Cert. R.S.I. and S.I. Joint Board. Cert. Insp. of Meat and Other Foods. Clerk. J. Blay. 2. Laboratory Facilities. Under arrangements made by the Essex County Council, sputum, swabs, and pathological specimens are examined by Dr. E. Suckling, the County Pathologist at the Laboratories, 91 Queen Victoria Street, London, E.C.4. Reports on each specimen examined are sent to the practitioner submitting the sample and to the Medical Officer of Health. Water, milk, and other foodstuffs are also examined in the Laboratories. The specimens examined by the County Bacteriologist during the year are enumerated in the following table:— 279 throat swabs for diphtheria bacilli (11 positive, 268 negative). 26 nasal swabs (all negative). 278 sputum for tubercle bacilli (50 postive, 228 negative). 28 urine. 9 samples of blood for Widal test (all negative). 7 swabs for hæmolytic streptococci (all negative). 20 hair for ringworm (11 positive, 9 negative) 16 miscellaneous. 20 3. Ambulance Facilities. The Council maintain a Talbot motor ambulance at the Fire Station in Billet Lane. 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 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. It would be an advantage if reciprocal agreements were entered into with the Borough of Dagenham and the Urban District Council of Brentwood. 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, 1,288 calls were received by the Hornchurch ambulance and a total of 11,721 miles was run. The nature and numbers of the cases were:— Illness 787 Accident 154 Road accident 176 Maternity 133 Removals 29 Not required or refused 9 Origin of calls. The calls were made by:— Doctors in 792 instances. Police in 148 instances. Hospitals in 50 instances. Others in 298 instances. 21 Destination. The hospitals to which most of the cases were removed are shown in the following table:— Oldchurch Hospital, Romford 993 King George Hospital, Ilford 58 Victoria Hospital, Romford 24 London Hospital 31 Other destinations 182 Times at which calls were received:— From 6 a.m. to 6 p.m. 881 From 6 p.m. to 6 a.m. 407 4. Nursing in the Home. There are three District Nursing Associations:— (1) The Hornchurch Nursing Association maintains 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, which is the Welfare Authority, opened during the year a new building planned and designed for Maternity and Child Welfare and for school medical work. There are now three of these Health Centres in the Urban District, viz., at Westland Avenue, Hornchurch; Abbs Cross Lane, Hornchurch, and Upminster Road, Rainham, and at each, clinics are held for expectant and nursing mothers, infants, minor ailments of school children, dental treatment, refraction, and orthopaedics. Ante-natal and baby clinics are also held at Malvern Hall, St. Lawrence Hall, and the Memorial Institute, and clinics for school children at Rainsford Way School and the Memorial Institute, 22 6. Nursing and Maternity Homes. There are 7 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 27, of whom 7 are employed by the County Council, 6 are District Nurse Midwives, and 14 work independently. 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 Board constituted in the year 1899 is formed by the Boroughs of Dagenham and Romford, and the Urban District of Hornchurch. The hospital is situated at Rush Green, contains 235 beds, and is administered by a Resident Medical Superintendent with two Resident Assistant Medical Officers. During the year, 342 patients from this District were treated in the hospital, including 59 admitted as Diphtheria, 173 as Scarlet Fever, 32 as Measles, 15 as Erysipelas, 8 as Mumps, 6 as Puerperal Pyrexia, 6 as Chickenpox, 5 as Whooping Cough, 3 as Enteric Fever, and 35 miscellaneous. SMALLPOX. The Essex County Council is the Authority for the provision of hospital accommodation for cases of Small pox in the administrative County. By agreement the Small pox Hospital provided and maintained by the Borough of Colchester is available for cases occurring in the County. Under a former arrangement cases occurring in the southern part of the County could be sent to London County Council hospitals but this has now lapsed. No case of Small pox occurred in Hornchurch during the year 1938, 28 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. The following is a report on a sample of drinking water supplied by the South Essex Waterworks Company and taken from a standpipe : "This sample is reasonably clear and bright and of normal colour. The water is neutral in reaction not unduly hard in character, contains no excess of saline or mineral matter in solution and is of a high degree of bacterial purity. It is, therefore, considered wholesome in character and suitable for drinking and domestic purposes." Drainage and Sewerage. BRANCH SEWERS. The Surveyor informs me that 32,169 feet of 9 inch and 8,211 feet of 12 inch soil sewers; also 44,443 feet of 9 inch, 5,840 feet of 12 inch, 879 feet of 15inch, 1,101 feet of 18 inch, 2,364 feet of 30 inch, 84 feet of 36 inch, and 2,790 feet of 48 inch surface water sewers were laid during the year. There were no extensions or improvements to the Outfall Works, 21 Rivers and Streams. No action has been required with regard to the pollution of rivers or streams in the District. New Streets—Made up and taken over, The Surveyor, Mr. T. E. Spencer, has supplied the following list of new streets made up and taken over from 1st January, 1938. Street. Length. Feet. Ashwood Avenue 435 Austral Drive 265 Bowden Drive 450 Benets Boad 1,335 Bridge Avenue 1,590 Babington Boad 940 Cranston Park Avenue (part) 789 Coniston Avenue (part) 790 Coronation Drive 1.330 Cherry Tree Close 620 Cecil Avenue (part) 615 Crescent Avenue 645 Court Avenue 900 Devonshire Boad 2,050 Douglas Avenue 420 Eyhurst Avenue (West) 1,477 Eyhurst Avenue (East) 938 Ellis Avenue 659 Findon Gardens 455 Frimley Avenue 490 Fireman's Quarters 150 Granton Avenue (part) 920 Glenwood Avenue 300 Grey Towers Avenue 620 Glebe Way 1,550 Hawthorne Avenue 625 Hill Crescent 635 Howard Road 200 Hillview Avenne 2,450 Keith Way (part) 166 Link Way 1,110 Milton Avenue 880 Michael Gardens 145 Manor Avenue 575 Martin Drive 526 25 Street. Length. Feet. Northumberland Avenue 2,530 Orchard Avenue 1,125 Pinewood Avenue 210 Philip Road 1,620 Recreation Avenue 635 Southview Drive (part) 302 Sycamore Avenue 1,317 Stanley Road 1,910 Spring Gardens 900 Sandown Avenue 680 Spencer Crescent 570 Springfield Gardens 770 Tennyson Way 460 Vaughan Avenue (part) 540 Woodcote Avenue 1,135 Wilfred Avenue 320 Wentworth Way 978 Warren Drive 2,900 Waverley Road 565 Woodfield Way 220 Westmoreland Avenue 1,800 Westland Avenue 1,310 50,842 feet. = 9.63 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 425 cesspools which were emptied by the Council. The largest number of cesspools is in a part of Rainham where the existing sewer is somewhat shallow. With the exception of this area most of the other cesspools still being used are in isolated parts of the district. 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 26 Refuse is 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 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. NATURE AND NUMBER OF INSPECTIONS. Accumulation of refuse 98 Factories, etc. 173 Outworkers 56 House drainage 1,153 Infectious disease visits 1,138 Disinfections 17 Places of entertainment 13 Rats & Mice (Destruction) Act inspections 286 Refuse tips 84 Sanitary conveniences and public house urinals 29 Schools 18 Stables 61 Tents, Vans, Sheds: Camping grounds 112 Watercourses 59 Other 612 NUMBER OF NOTICES SERVED. Informal 351 Statutory 32 RESULT OF NOTICES SERVED. Informal Notices complied with 305 Statutory Notices complied with 30 27 OUTSTANDING ON 31st DECEMBER, 1938. Informal Notices 26 Statutory Notices 2 WORKS COMPLETED. Drainage:— Cesspools emptied 46 Choked drains cleared 121 Guttering and downspouts repaired 24 New drains laid: drains relaid or repaired 25 New covers to inspection chambers 15 Sinks and sink wastes repaired or provided 39 Water Closets:— W.C. cisterns repaired or renewed 26 W.C. pan and traps renewed 15 W.C. compartments repaired 13 Lighting and ventilation provided 7 General Repairs:— Dampness abated 33 Dustbins provided 34 Floors repaired 12 Fireplaces, stoves and coppers repaired or renewed 27 Plaster repaired 82 Roofs repaired 24 Rooms redecorated 180 Sashcords renewed 18 Yards paved 10 Miscellaneous 92 NUMBER OF VISITS PAID TO FOOD SHOPS, ETC. Bakehouses 68 Butchers' shops 205 Cafes or dining rooms 71 Dairy farms and milk shops 323 Fishmongers and fish friers 146 Greengrocers 25 Ice cream dealers 124 Slaughterhouses 716 28 COMPLAINTS INVESTIGATED. Accumulation of manure and refuse 34 Animals improperly kept 13 Dampness of premises 25 Defects 29 Defective drains, W.C., etc. 68 Defective roof 4 Defective guttering and downspouts 2 Dirty and verminous houses 25 Offensive smells 33 Smoke nuisance 13 Overcrowding 11 Rats and mice 29 Caravans 6 Noise 4 Cesspools full and overflowing 8 Miscellaneous 81 Shops. Bach 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. 1,195 visits of inspection were paid to shops 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 887 shops on the register. 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. 1. No. of houses infested:— (a) Council houses 7 (b) Other houses 30 29 2. Infested Council houses are treated by fumigation with sulphur fumes. Picture rails and skirting boards are generally removed for cleansing and other woodwork treated with a blow-lamp. Wallpapers are stripped off and walls and ceilings thoroughly cleansed. 3. The belongings of tenants are inspected prior to removal to Council houses and if necessary subjected to fumigation. 4. The Council houses disinfestation is carried out by the Works Dept. In those houses in which proprietory substances were used for disinfestation the work was carried out by firms specialising in this work and was paid for by the owners. Other houses are disinfested by the tenant under supervision. 5. Council house tenants are instructed by the Works Department 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. Camping. The legislation dealing with camping and camping sites in this District is contained in the Public Health Act, 1936, section 268; the Essex County Council Act, 1933, sections 105 to 114; and the Hornchurch Urban District Council Act, 1936, sections 102 and 103. In addition Byelaws are in operation dealing with:— (i) Camping grounds and moveable dwellings (dated 11.6.1935). (ii) Tents, Vans, Sheds and similar structures used for human habitation (dated 24.1.1939, and made under section 268 (4) of the Public Health Act, 1936). 30 Public Health Act, 1936, gives power to deal with nuisances arising from the occupation as human habitations of tents, etc. and also to make Byelaws. Section 109 of the Essex County Council Act, 1933, prohibits the use of moveable dwellings without the consent of the Council provided they are intended to be used for an unbroken period of three months and are to be the sole means of habitation. Section 110 gives a Local Authority power to provide camping grounds. In this District section 269 of the Public Health Act, 1936, is not in force owing to the provisions of the Essex County Council Act. No sites for camping have been licensed by the Council nor have licences been issued to individuals. There were two small privately owned camping grounds in the District which were used for the erection of tents during the summer months. The estimated number of campers resident in the area at one time during the summer season was 150 persons. The camps were visited periodically and the powers of the Byelaws were used to ensure sanitary conditions. 31 SECTION D, HOUSING. 1. Number of New Houses Erected during the Year :— (i) By the Local Authority 56 (ii) By Other Local Authorities 0 (iii) By other bodies or persons 2,111 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) 752 (b) Number of inspections made for the purpose 1,323 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under Housing Consolidated Regulations, 1925 and 1932 102 (b) Number of inspections made for the purpose 248 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 (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 472 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 307 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 (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 32 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 18 (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 6 (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 9 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 22 (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 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 1 6. Housing Act, 1936, part IV. Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 24 (ii) Number of families dwelling therein 24 (iii) Number of persons dwelling therein 228 (b) Number of new cases of overcrowding reported during the year 4 (c) (i) Number of cases of overcrowding relieved during the year 29 (ii) Number of persons concerned in such cases 203 (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 Nil. 33 Provision of New Houses. To relieve overcrowding and to rehouse families living in houses on which Demolition Orders had been made the Council built 40 houses during the year on land already in their possession at Rainham. As it was found that unusually large and also quite small families had to be rehoused the Council decided to build some houses with only one or two bedrooms and others with four or five bedrooms in addition to the normal three bedroom non-parlour type. The numbers of each sort are shown in the following table:— Number of Rent exclusive of rates. Bedrooms. Houses. 1 6 4/- per week. 2 8 6/6 „ „ 3 12 8/6 „ „ 4 8 9/6 „ „ 5 6 10/6 „ „ The houses were planned in blocks of four, each one bedroom house having a five bedroom house next to it, the additional bedrooms of the larger house being on the first floor above the one bedroom house. By this arrangement it will be possible at a future date if there is no need for a five bedroom house to convert each pair of five and one bedroom habitations into two three bedroom houses. Housing for Members of the Fire Brigade. During the year the Council built 16 houses near the Fire Station in Billet Lane to house members of the Fire Brigade. 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 1938 this information was supplied for 607 houses which is additional to the 2,599 houses and 1,584 houses in respect of which the information was supplied during the years 1937 and 1936 respectively. 34 SECTION E. INSPECTION AND SUPERVISION OF FOOD. 1. Milk Supply. During the year there were 16 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 14. 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 10 dairy farms licensed by the County Council for the production of Accredited Milk of which 5 are in Cranham Ward, 3 in Harold Wood Ward, 1 in Emerson Park Ward, and 1 in Rainham Ward. Milk (Special Designations) Order, 1936. Licences issued by the Council for the vear ended 31st December, 1938. 16 licences have been issued to retail Tuberculin Tested Milk; 18 licences to retail Pasteurised Milk; and 1 licence to sell Accredited Milk. In addition 7 supplementary licences, namely 4 for Tuberculin Tested Milk; 2 for Pasteurised Milk; and 1 for Accredited Milk, were issued, 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 21 milk retailers with registered premises in the District, including 7 producers who are registered both as producers and retailers. In addition there are 11 persons registered as milk retailers in Hornchurch, but whose premises are registered in neighbouring districts. 35 Milk Sampling. During the year 28 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 18 samples of raw milk, of which 9 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. Pasteurisec 12,000 — Satisfactory 2. Accredited — — „ 3. „ — — „ 4. „ — — „ 5. „ — — „ 6. „ — — „ 7. „ — — „ 8. „ — — „ 9. „ — — „ 10. „ — — „ 11. Ungraded 230,000 Present in 0.001 c.c. Unsatisfactory 12. „ 85,000 Present in 0.01 c.c. „ 13. „ 84,000 Present in 0.01 c.c. „ 14. „ 120,000 Present in 0.001 c.c. „ 15. „ 8,500 Absent in 0.01 c.c. Satisfactory 16. „ 11,000 Absent in 0.01 c.c. „ 17. „ 18,000 Present in 0.01 c.c. Unsatisfactory 18. „ 500,000 Present in 0.001 c.c. „ 19. „ 150,000 Absent in 0.01 c.c. Satisfactory 20. „ 260,000 Present in 0.001 c.c. Unsatisfactory 21. „ 24,000 Absent in 0.01 c.c. Satisfactory 22. „ 84,000 Present in 0.01 c.c. Unsatisfactory 23. „ 120,000 Present in 0.01 c.c. „ 24. „ 62,000 Absent in 0.01 c.c. Satisfactory 25. „ 7,000 Absent in 0.01 c.c. „ 26. „ 3,700 Absent in 0.01 c.c. „ 27. „ 4,600 Absent in 0.01 c.c. „ 28. „ 21,000 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 taken for examination during the year:— 36 Milk in Schools Scheme. 16 samples were submitted to the Methylene Blue Test all of which were satisfactory. In addition 5 samples were examined by the Biological Test of which 4 were satisfactory. Milk samples taken at Accredited Farms or in connection with applications for "Accredited Milk" licences. 20 samples were submitted to the Methylene Blue Test of which 18 were satisfactory and 2 unsatisfactory. In addition 3 Biological Tests were carried out all of which were satisfactory. 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 39 applications for registration were granted. At the end of the year, 23 persons were registered as manufacturers and 89 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 killed 524 819 115 4,882 1,158 Number inspected 512 749 115 4,587 1,118 All diseases except Tuberculosis:— Whole carcases condemned 0 1 4 33 1 Carcases of which some part or organ was condemned 35 34 0 44 11 Percentage of the number inspected affected with disease other than Tuberculosis 6.83 4,67 3.48 1.68 1.07 37 Tuberculosis only:— Whole carcases condemned 4 17 1 0 0 Carcases of which some part or organ was condemned 27 280 1 0 23 Percentage of the number inspected affected with Tuberculosis 6.05 39.65 1.74 0 2.06 Slaughter of Animals Act, 1933. Under Section 3 of the above Act, it is necessary for all slaughtermen to be registered. '26 applications for renewal and 4 applications for new licences were received during the year and all were granted. Meat Traders. There are 52 Butchers' shops in the District which are inspected by the Sanitary Inspectors. Meat amounting to 112lbs. 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. 38 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Scarlet Fever. During the year, 226 cases of Scarlet Fever, yielding a case rate of 2.9 per 1,000 of the population, were notified. The corresponding rate in England and Wales being 2.41. The rates in this District in the years 1937, 1936, 1935, 1934 and 1933 were 3.8, 3.6, 3.5, 4.3 and 5.4. Of the total number of cases, 164 were admitted to the Romford Isolation Hospital. Most of the cases were mild in character. Antiscarlet serum is administered in the Romford Isolation Hospital to oases 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 a.nd it is now the practice for uncomplicated cases to be detained in hospital for a period of 4 weeks. There were no fatal cases. Diphtheria. The number of cases of Diphtheria notified was 45 yielding a rate of 0.59 per 1,000 of the population, the case rate for England and Wales being 1.58. In the years 1937, 1936, 1935, 1934 and 1933, the case rates in this District were 0.70, 1.4, 1.9, 3.02 and 0.9. During the year there were two deaths from Diphtheria as follows:— Sex. Site. Age in years. Male Fauces 5 Female Fauces 8 Terminal Disinfection. The practice of routine fumigation of the sick room by formalin or sulphur dioxide vapour after the removal to hospital of the patient or at the termination of the illness if treated at home, was discontinued by resolution of the Council on the 18th May, 1937. 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. 39 Careful observation has been made of the number of secondary cases of Scarlet Fever occurring in any house after the removal to hospital of the first case, and it was found that there has been no increase in the number of secondary cases since the discontinuance of routine fumigation. During the year, following the removal of 150 primary cases to hospital, 8 secondary cases were notified but in 7 of these the onset occurred within 5 days of the removal of the first case and therefore they may be presumed to have been incubating the disease at the time of removal of the primary case. In only one instance did a secondary case develop after a period of 7 days. The period was 15 days after removal of the first case and as it was known that there had been contact in the interval with a case in another house, it is probable that the infection was thus contracted. There were 3 secondary Diphtheria cases in one family which occurred 2, 6 and 10 days respectively after the removal to hospital of the first case notified. There was, however, reason to suspect that one or more of these cases was infected by a carrier. No other secondary Diphtheria cases occurred during the year. 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 Tharaeside 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 32 10 4 14 3 1 1 10 7 2 February 16 5 1 4 4 4 5 1 2 March 23 1 3 6 6 2 1 3 2 1 April 15 2 1 3 4 2 4 3 May 19 6 3 2 4 5 1 1 4 5 June 15 3 1 4 2 3 1 1 1 2 3 July 16 1 1 2 3 1 1 8 1 August 18 3 1 2 1 4 1 4 2 5 1 September 12 8 2 2 3 3 2 2 2 2 2 October 20 2 2 5 1 1 2 1 5 1 4 November 20 3 3 1 1 2 10 2 3 1 December 20 4 1 1 3 2 8 2 226 45 11 5 27 5 29 0 43 15 9 1 24 6 54 11 29 2 41 Immunisation against Diphtheria. Artificial immunisation against Diphtheria 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 appointments were made for each child, and the mother was asked to attend at the time when the treatment 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.F. 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 3,913. 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 1938. Immunisation against Diphtheria 1. Primary Schick Test:— Result. No. tested. Negative. Positive Adults 11 5 6 School Children 102 33 69 Children under 5 years of age 0 0 0 113 38 75 42 2. Number Treated:— Completed. Incomplete. Adults 6 0 School Children 462 96 Pre-school Children 173 36 641 132 3. Schick Tested after Treatment:— Result. No. tested. Negative. Positive. Adults 5 5 0 School Children 541 503 38 Pre-school Children 174 170 4 720 678 42 No person can be 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 been reported during the year. Sex. Age. Treatment received. Final diagnosis. Result. F. 10 T.A.F. 3 c.c. Diphtheria Recovered. F. 13 T.A.M. 3 c.c. Tonsillitis „ M. 4 T.A.F. 3 c.c. Laryngitis „ F. 9 T.A.M. 3 c.c. Rhinorrhoea „ F. 7 T.A.F. 3 c.c. Diphtheria „ M. 12 T.A.F. 3 c.c. Tonsillitis „ It will be seen that two cases of Diphtheria which were confirmed bacteriologically occurred after the injection of three 1 c.c. doses of Toxoid antitoxin floccules which had been followed by a negative Schick test. The first was a mild case and was a child who had been subjected to a very severe infection with the Gravis type of K.L.B. The second case was that of a girl who also received three 1 c.c. injections of Toxoid antitoxin floccules followed by a negative Schick test. The type of organism with which she was infected was the Intermediate type. She had a moderately severe attack but made a good recovery. 43 There is good reason to believe that both of these children would have suffered from a very dangerous if not fatal attack if they had not acquired a degree of immunity from the injections. Measles. Measles was very prevalent in the first quarter of the year in Harold Court, Park Lane, Upminster Junior Mixed and Infants, and Rainsford Way schools, and to a lesser degree in St. Mary's, North Street, Harold Wood and Elm Park schools. 32 persons were admitted to the Isolation Hospital for treatment. Whooping Cough. Whooping Cough was reported in the Autumn in Park Lane and Harold Court schools and there was a slight recrudescence in the Spring in Upminster. 5 cases were treated in the Romford Isolation Hospital. Chickenpox. Chickenpox was prevalent in the Autumn in Ardleigh Green school. 6 cases were treated in the Romford Isolation Hospital. Mumps. Mumps occurred in Cranham, Upminster and North Street schools. 8 cases were treated in the Isolation Hospital. Poliomyelitis. One case was notified; a boy aged 9 years who was admitted to hospital. Catarrhal Jaundice. 5 cases of Catarrhal Jaundice were reported. Pneumonia. Notifications were received of 73 cases of Pneumonia of which 6 were attributed to Influenza and 57 were Primarv cases. The sex and age-groups are given in the following table:— 44 Age in years. Male. Female Under one 3 4 1 3 3 2-4 5 6 5-9 8 5 10-14 0 2 15-24 4 2 25-44 10 4 45-64 5 3 65 and upwards 4 2 42 31 30 cases were treated in hospital including 20 in Oldchurch Hospital and 4 in the Romford Isolation Hospital. The deaths of 6 males and 13 females were attributed to Pneumonia (all forms). 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 6 years and the other one year. Both recovered. Erysipelas. 31 cases were notified, 13 males of whom 6 were removed to hospital and 18 females of whom 9 were removed to hospital. Enteric Fevers. During the year three cases, two being Typhoid and one Paratyphoid, were notified, and were treated in hospital. The notification rate per 1,000 population was the same as that for England and Wales, viz., 0.03. The first case was infected in a hospital outside the District; the second was in contact with cases of Typhoid Fever in a neighbouring district and probably developed the disease there; the third case was also probably infected outside this District. There was no possible connection between the three cases. The ages and sex were:—male, 21 years; females, 8 years and 15 years. One case, a male aged 21 years, proved fatal. Public Health Act, 1925. No action was required to be taken during the year under Section 66 of this Act or under Section 176 of the Public Health Act, 1936. TABLE SHOWING THE CASES OP INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1938. NOTIFIABLE DISEASE Total Number o£ cases notified in age-groups. Total cases notified in each Ward. No. removed to Hospital 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 226 47 150 14 14 1 11 27 29 43 9 24 54 29 166 Diphtheria 45 1 14 23 3 4 5 5 15 1 6 11 2 44 Enteric Fever (with Paratyphoid) 3 1 2 1 2 3 Puerperal Pyrexia 11 3 8 1 1 3 2 3 1 7 Polio-myelitis 1 1 1 1 Pneumonia 73 7 18 14 6 14 8 6 1 4 1 43 5 8 8 3 30 Erysipelas 31 1 3 16 9 2 3 2 12 1 3 8 2 15 Ophthalmia Neonatorum 6 6 1 2 2 1 2 Dysentery 2 1 1 1 1 2 Cerebrospinal Fever 1 1 1 1 46 Tuberculosis. The notifications of cases of Tuberculosis included 47 males and 44 females suffering from Pulmonary, and 26 males and 28 females suffering from Non-Pulmonary forms of the disease. The 46 deaths included those of 10 Pulmonary and 4 Non-Pulmonary cases which were not notified. The death rate was 0.605 per 1,000, and the rate for England and Wales was 0.635 per 1,000. Age periods. New Cases. Deaths. Pulmonary. NonPulmonary. Pulmonary. NonPulmonary. M. F. M. F. M. F. M. F. Under 1 0 0 0 0 0 0 0 0 1 1 0 3 1 0 0 2 3 5 0 2 17 15 0 0 2 0 15 12 10 2 3 3 2 0 0 25 15 19 2 4 7 7 0 1 35 7 7 2 3 4 ] 1 1 45 9 5 0 2 7 1 0 0 55 3 1 0 0 2 0 0 0 65 0 0 0 0 0 2 0 0 47 44 26 28 23 13 5 5 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). 47 SECTION C. FACTORIES ACT, 1937. HOME OFFICE TABLES. 1 Inspections. Premises. Inspections. Written notices. Prosecuted. Factories with mechanical power 121 8 0 Factories without mechanical power 52 2 0 Other premises under the Act 0 0 0 173 10 0 2. Defects Found. Particulars. Number of defects. Found. Remedied. Nuisances under Public Health Act:— Want of cleanliness 6 6 Ineffective drainage of floors 1 1 Sanitary accommodation:— Unsuitable or defective 4 4 11 11 3. Outwork in Unwholesome Premises. Nil. 48 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 2.15 22 February 0.58 11 March 0.49 5 April 0.20 6 May 1.52 12 June 0.52 5 July 1.29 14 August 2.41 13 September 2.27 16 October 2.50 19 November 2.43 20 December 1.87 15 18.23 158 Eastern Outfall Works:— January 1.93 19 February 0.45 8 March 0.36 4 April 0.17 4 May 1.31 13 June 0.48 4 July 1.44 8 August 1.73 9 September 2.27 13 October 2.18 13 November 2.23 13 December 2.19 19 16.74 127 During the years 1937 and 1936, the total amount of rainfall at the Eastern Outfall Works was 26.18 inches and 22.68 inches, and rain fell on 150 days and 160 days respectively.