library HORNC 15 Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1947 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of HealtH. Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1947 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. 3 MEMBERS OF THE COUNCIL. Councillor A. J. Twigger J.P., Chairman. Councillor A. C. Holmes, Vice-Chairman. Councillor Mrs. E. M. Field. „ Mrs. A. J. E. King. (1) „ Mrs. R. J. Reynolds (Elected 27.11.47 to fill vacancy caused by resignation of Councillor R.E.Fisher). „ Mrs. E. G. Richardson. (2) „ Mrs. H. S. E. Williams. (1) (2) & (3) „ H. C. Breeze. „ E. W. J. W. Bush. „ H. E. Chapman. „ F. Cullen. „ B. T. Dodge. „ S. W. Emms. (1) „ R. E. Fisher (Resigned 15.10.47). „ F. J. R. Hecker. (1) (2) & (4) „ H. Holock. „ R. S. Howe. „ A. g. Hulkes. „ A. J. H. Okey. (1) „ A. W. Pettit. (1) „ A. C. Salinger. „ A. Wheeler. (2) (1) Member of the Public Health and Ambulance Committee. (2) Member of the Romford Joint Hospital Board. (3) Chairman of the Public Health and Ambulance Committee. (4) Vice-Chairman of the Public Health and Ambulance Committee. 4 OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: James Gorman, M.B., Ch.B., D.F.H. Deputy Medical Officer of Health: (Part time) P. X. O'Dwyer, M.B., B.Ch., B.A.O., D.P.H. Senior Sanitary Inspector: M. F. G. Randall, San. Insp. Cert. R.S.I. and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. (Appointed 22.4.47.) Sanitary Inspectors: L. Ager, San. Insp. Cert. R.S.I., Cert. Inspector of Meat and Other Foods. §A. V. J. Hutchings, San. Insp. Cert. R.S.I, and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. *M. F. G. Randall, San. Insp. Cert. R.S.I. and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. ‡L. W. Cole, San. Insp. Cert. R.S.I. and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. †N. J. Howard, San. Insp. Cert. R.iS.I. and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. †J. M. Williams, San. Insp. Cert. R.S.I. and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. Clerks: J. E. Blay. S. N. Dance (Appointed to permanent staff 1.2.47). Miss E. M. Trinnaman. Miss D. K. Manning (Appointed to permanent staff 16.12.47) * Ceased duties as District Sanitary Inspector 21.4.47 on appointment as Senior Sanitary Inspector. † Commenced duties 1.12.47. ‡ Resigned 12.6.47. § Resigned 31.7.47. 5 Public Health Department, Council Offices, Billet Lane, HORNCHURCH 8th September, 1948. To the Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I beg to present the Annual Report for 1947. Opportunity has been taken in this report to enlarge the scope of previous recent annual reports with a view to providing a somewhat greater insight into the affairs of the public health in what has been and is a rapidly expanding district. The vital statistics for the year showed a satisfactory trend. The birth rate remained high, the death rate low and the infant mortality rate also touched a low figure. The incidence of infectious disease was in general low although a periodic epidemic of Measles, with however no fatal cases, falls to be noted. Special mention is made later in the report of how our area fared in the general epidemic of the diseases of the Poliomyelitis Group (the term Infantile Paralysis is rapidly falling into desuetude). Special mention should also be made of the fact that throughout the year there was not a single case of Diphtheria. Tuberculosis showed a slight increase in the number of notifications with a decrease in the number of deaths. This disease, however, retains a disappointingly high and continuous incidence. Very considerable progress was made in the provision of new houses during the year and our area remains fortunate in that the average age of its houses must be considerably lower than that of a vast majority of districts comparable in size. No greater contribution can be made to the cause of preventive medicine than the provision of a satisfactory standard of housing for everyone. I beg to acknowledge with gratitude the support accorded to me by the Public Health and other Committees of the Council and would also express my appreciation of the help afforded me by my colleagues in other Council departments and by my own staff. James Gorman, M.B., Ch.B., D.P.H., Medical Officer of Health 6 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres (land and inland water) 19,768 Registrar-General's estimate of the civilian population population (mid-year) 1947 99,660 Registrar-General's quarterly estimates of civilian population for year 1947:— at 31st March, 1947 99,900 at 30th June, 1947 100,170 at 30th September, 1947 100,930 at 31st December, 1947 101,060 Number of inhabited houses (September 1947) according to Rate Books 27,866 Rateable Value (September 1947) £698,652 Sum represented by a Penny Rate (September 1947) £2,850 Vital Statistics. Extracts from Vital Statistics of the Year. Births. Number of live births registered in the District as supplied by the Registrar-General and corrected for inward and outward transfers 2,064 (1,067 males, 997 females) Birth rate per 1,000 civilian population 20.7 Number of still births registered in the District as supplied by the Registrar-General and adjusted1 for inward and outward transfers 40 (24 males, 16 females) Still birth rate per 1,000 civilian population 0.40 Still birth rate per 1,000 total (live and still) births 19.0 Deaths. Number of deaths occurring in the District:— Residents 531 Non-residents 93 7 Number of deaths of residents occurring outside the District 288 Total number of deaths of Hornchurch residents adjusted for inward and outward transfers as compiled locally 819 Number of deaths registered in the District as supplied by the Registrar-General (423 males, 406 females) 829 NOTE.—The number of deaths supplied by the Registrar-General are those REGISTERED during the year adjusted for inward and outward transfers and, therefore, differ from adjusted figures compiled locally. Death rate per 1,000 civilian population 8.3 Puerperal Deaths:— (a) from Sepsis 0 (b) from other maternal causes 1 Deaths of infants under one year of age (31 male, 25 female) 56 Infant Mortality Rate (per 1,000 births) 27.1 Deaths from:— Male. Female Cancer 70 72 Diabetes 2 2 Diarrhoea (under 2 years) 5 1 Influenza 0 3 Pneumonia 21 27 Measles 0 0 Whooping Cough 0 0 REGISTRAR GENERAL'S ESTIMATE OF THE MID-YEAR POPULATION SINCE EXTENSION OF THE URBAN DISTRICT. Year. Year. 1934 55,798 1941 79,750 1935 59,910 1942 83,870 1936 64,447 1943 83,520 1937 72,010 1944 81,840 1938 76,000 1945 84,430 1939 81,620 1946 95,460 1940 81,050 1947 99,660 8 REGISTRAR GENERAL'S ABRIDGED LIST OF CAUSES OF DEATH. These figures are corrected for inward and outward transfers. Causes of Death. Male. Female. All causes 423 406 1. Typhoid and paratyphoid fevers 0 0 2. Cerebro-spinal fever 0 0 3. Scarlet fever 0 0 4. Whooping cough 0 0 5. Diphtheria 0 0 6. Tuberculosis of respiratory system 16 17 7. Other forms of tuberculosis 2 3 8. Syphilitic diseases 3 1 9. Influenza 0 3 10. Measles 0 0 11. Acute polio-myelitis and polio-encephalitis 1 0 12. Acute inf. encephalitis 1 0 13. Cancer of buccal cavity and oesoph (M); uterus (F) 6 6 14. Cancer of stomach and duodenum 8 14 15. Cancer of breast 0 13 16. Cancer of all other sites 56 39 17. Diabetes 2 2 18. Intra-cranial vascular lesions 44 47 19. Heart diseases 106 123 20. Other diseases of circ. system 14 10 21. Bronchitis 43 23 22. Pneumonia 21 27 23. Other respiratory diseases 7 5 24. Ulcer of stomach or duodenum 10 2 25. Diarrhoea under 2 years 5 I 26. Appendicitis 0 0 27. Other digestive diseases 5 11 28. Nephritis 13 15 29. Puerperal, and post-abortion, sepsis 0 0 30. Other maternal causes 0 1 31. Premature birth 11 8 32. Congenital malformation, birth injury, etc 7 6 33. Suicide 5 5 34. Road traffic accidents 5 1 35. Other violent causes 4 3 36. All other causes 28 20 NOTE.—The deaths are those REGISTERED during the calendar year. They will differ, therefore, from adjusted figures compiled locally. 9 DEATHS IN CERTAIN AGE GROUPS DURING WHOLE YEAR (Local Figures). Age No. of deaths. Under 1 year 55 1 and under 2 8 2 „ „ 5 6 5 „ „ 15 8 15 „ „ 25 16 25 „ „ 35 23 35 „ „ 45 41 45 „ „ 55 74 55 „ „ 65 120 65 „ „ 75 181 75 „ „ 85 218 85 „ „ 95 68 95 and upwards 1 Total 819 10 Comparative View of The Principal Causes of Death During The Year 1947 11 DEATH RATE—COMPARISON WITH PREVIOUS YEARS. 1930 8.2 1931 8.4 1932 7.9 1933 7.8 1934 8.4 1935 8.4 1936 7.9 1937 8.6 1988 8.1 1939 7.8 1940 9.4 1941 9.6 1942 7.9 1943 8.9 1944 9.2 1945 9.9 1946 9.0 1947 8.3 BIRTH RATE—COMPARISON WITH PREVIOUS YEARS. 1930 16.1 1931 20.1 1932 18.1 1933 18.4 1934 17.6 1935 17.0 1936 20.2 1937 19.6 1938 19.7 1939 18.9 1940 16.4 1941 15.5 1942 17.5 1943 19.0 1944 11.9 1945 18.4 1946 21.3 1947 20.7 12 13 BIRTH RATES, CIVILIAN DEATH RATES, ANALYSIS OF MORTALITY AND MATERNAL MORTALITY, 1947. Local figures compared with England and Wales and certain towns. England and Wales 126 C.B.s and Great Towns including London. 148 Smaller Towns (Resident Pop. ; '25,000-50,000 at 1981 Census London Admin. County. Hornchurch. Rates per 1,000 Civilian Population. Births— Live Births 20.5† 23.3 22.2 22.7 20.7 Still Births 0.50† 0.6.2 0.54 0.49 0.40 Deaths— All Causes 12.00† 13.00 11.9 12.8 8.3 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 - Scarlet Fever 0.00 0.00 0.00 0.00 - Whooping Cough 0.02 0.03 0.02 0.02 - Diphtheria 0.01 0.01 0.01 0.01 - Influenza 0.09 0.09 0.08 0.08 0.03 Smallpox 0.00 0.00 0.00 — — Measles 0.01 0.02 0.02 0.01 — Deaths— Rates per 1.000 Live Births. All causes under 1 year of age 41‡ 47 36 37 27.1 Enteritis and Diarrhoea under 2 years of age 5.8 8.0 3.7 4.8 2.9 Maternal Mortality: Rates per 1,000 Total (Live and Still) Births. Abortion with Sepsis 0.10 — Abortion without Sepsis 0.06 - Puerperal infections 0.16 — Other maternal causes 0.85 0.47 A dash (—) signifies that there were no deaths. † Rates per 1,000 total population. ‡ Per 1,000 related births. 14 15 VITAL STATISTICS FOE YEARS 1937-1947. Year. Population Estimated to the Middle of the Year. Net Births. Deaths belonging to the District. No. Rate per 1,000 Population. Under 1 year of age. At all ages. No. Rate per 1,000 Population. No. Rate per 1,000 Population. 1937 72,010 1,373 19.6 71 51.7 620 8.6 1938 76,000 1,500 19.7 71 47.3 612 8.1 1939 81,620 1,539 18.9 67 43.7 641 7.8 1940 81,050 1,331 16.4 64 42.1 768 9.4 1941 79,750 1,240 15.5 49 42.6 767 9.6 1942 83,870 1,474 17.5 37 25.1 666 7.9 1943 83,520 1,587 19.0 49 30.8 751 8.9 1944 84,130 1,004 11.9 59 58.7 776 9.2 1945 84,430 1,553 18.4 64 41.2 841 9.9 1946 95,460 2,029 21.3 86 41.0 874 9.0 1947 99,660 2,064 20.7 56 27.1 819 8.3 16 CASE RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1947. (Rates per 1,000 Civilian Population.) Local figures compared with England and Wales and certain towns. England and Wales 126 C.B.s and Great Towns including London. 148 Smaller Towns (Resident Pop. 25,000-50,000 at 1931 Census) London Admin. County. Hornchurch. Notifications:— Typhoid Fever 0.01 0.01 0.00 0.01 0.01 Paratyphoid Fever 0.01 0.01 0.01 0.01 0.01 Cerebro-spinal Fever 0.05 0.06 0.05 0.05 0.06 Scarlet Fever 1.37 1.54 1.37 1.31 1.22 Whooping Cough 2.22 2.41 2.02 2.80 1.79 Diphtheria 0.13 0.15 0.14 0.14 — Erysipelas 0.19 0.21 0.18 0.22 0.29 Smallpox 0.00 0.00 0.01 0.00 — Measles 9.41 9.13 9.58 5.29 6.29 Pneumonia 0.79 0.89 0.68 0.64 0.60 Poliomyelitis 0.13 A dash (—) signifies that there were no notifications. 17 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staff. Pending the filling of vacancies, we were understaffed (this to a very serious extent) for a considerable proportion of the period of this report. Fortunately the commencement of 1948 saw a full establishment again, but in a complex area such as ours and in which the Sanitary Inspector: population ratio is not high, any staff depletion necessarily produces a leeway of work requiring a considerable time to overtake even though further staff changes did not from time to time occur. Laboratory Facilities. The County Laboratory, established by the Essex County Council at Oldchurch County Hospital, Romford, has continued to serve the needs of the District and is available for any medical practitioners who desire to have bacteriological report on the specimens which they send. Ambulance Service. There is no change in the ambulance service for the civilian population described in last year's report, which includes the mutual assistance scheme with neighbouring authorities. The ambulance which is stationed at Harrow Lodge Depot, is under the supervision of the Surveyor. Nursing in the Home. The three nursing associations, viz.: the Hornchurch Nursing Association; the Rainham, Wennington and South Hornchurch Nursing Association; and the Upminster and Cranham District Nursing Association, have continued their beneficent work. I note below certain details of the work of these local Nursing Associations. The Hornchurch Nursing Association maintained two private nurses during the year, and the total number of visits paid was 6,343. The Rainham, Wennington and South Hornchurch Nursing Association maintained three private nurses during the year, the total number of visits paid being 5,613 (220 cases). 18 The Upminster and Cranham District Nursing Association maintained two private nurses during the year who carried out the following visits:— Midwifery 513 Maternity 983 Ante-natal 346 Surgical 710 Medical 1,529 Casual 62 Old Age Pensioners 424 Total 4,567 Maternity and Child Welfare. The Essex County Council is the Welfare Authority in this District under the Public Health Act, 1936, and maintained Clinics at the following centres:— (i) Westland Avenue, Hornchurch. (ii) Abbs Cross Dane, Hornchurch (serving the Elm Park Estate). (iii) Malvern Road, Hornchurch. (iv) Athelstan Road, Harold Wood. (v) Upminster Road, Eainham. (vi) Station Road, Upminster. The County Council's arrangements for the hospitalisation of maternity patients are the same as those outlined in last year's report. Nursing and Maternity Homes. There are 6 registered Nursing and Maternity Homes in the District. Midwives. There are 10 midwives practising in the District who were appointed by the Essex County Council, and are available to act in the capacity of midwife, and of maternity nurse under the supervision of a registered medical practitioner. In addition there are the District Nurse-Midwives engaged by the local Nursing . Associations, and independent midwives who practise in the District. During the year the Council were again approached by the Essex County Council on the question of providing housing accommodation for Midwives, District Nurses and Health Visitors employed in the area. After full consideration the Council re-housed three County Council Midwives, one Relief Midwife, and two District Nurse-Midwives. This preferential housing is indicative of the Council's desire to co-operate to the full with the County in the furtherance of essential local services. 19 Hospitals. General Hospitals. The District is served by Oldchurch County Hospital, Romford; Victoria Hospital, Romford; King George Hospital, Ilford; also general hospitals in London. In addition there are E.M.S. blocks at the Harold Wood Hospital, Hornchurch; and the Isolation Hospital, Rush Green, Romford. Infectious Diseases. The Romford Joint Hospital Beard, constituted in the year 1899, is formed by the Dagenham Borough Council with 6 representatives, the Hornchurch Urban District Council with 5 representatives, and the Romford Borough Council with 4 representatives. The hospital is situated at Rush Green and is now functioning as a combined Fever and E.M.S. Hospital, having 120 beds for fever cases and 120 beds for E.M.S. purposes. There is a modern wellequipped theatre and also a bacteriological laboratory. Two ambulances are stationed at the hospital for the removal of patients. The hospital is recognised by the General Nursing Council for England and Wales as a complete training school for fever nurses. Probationer nurses are accepted at the age of 17 years. The medical staff consists of a Resident Medical Superintendent, a Senior Assistant Medical Officer, and three E.M.S. Surgeons. The total area of land owned by the Joint Hospital Board is approximately 35.5 acres, of which 12 acres are still unenclosed. During the year 113 persons notified to be suffering from infectious diseases and 84 observation cases needing hospital treatment were admitted to the Isolation Hospital from this District. The average weekly number of patients from this District in the hospital was 13. Smallpox. The Essex County Council is the Authority for the provision of hosptial 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. No case of smallpox occurred in Hornchurch during the year 1947. Tuberculosis. Cases of tuberculosis from this District requiring institutional treatment are normally admitted to the following County Council Sanatoria:— Essex County Council Hospital, Broomfield. Essex County Council Hospital, Black Notley. Harold Court Sanatorium (within this Urban District). 20 Accommodation is also provided at the Isolation Hospitals at Thurrock, Ilford, Chingford and Colchester, and at St. Margaret's, Epping (Social Welfare Institution), for patients suffering from the intermediate and later stages of the disease not requiring any active treatment. Supply of Insulin for Diabetics. The policy outlined in previous reports has been pursued. The number of persons supplied during the year was 27 free issue (9 new applications) and 7 persons at half-price (one new application). During the year 3 patients were removed from the register. Foot Clinics. This matter engaged the earnest attention of the Council for a considerable period and it was felt that a demonstrable public need for facilities of this kind existed. Upon approach being made to the County (which would in any event become the responsible Authority under the National Health Service Act, 1946), one weekly clinic was finally commenced in the District. Unfortunately, however, staffing difficulties both delayed its commencement and inhibited its subsequent progress. The single clinic noted, when re-started, will at any rate be an acceptance of the fact that the need for a service of this kind exists, but in an area such as ours it is very far from representing a satisfactory scheme. The various main centres of population in the District should each be afforded the opportunity of showing whether or not local arrangements are justifiable. I have little doubt that clinics of this kind would be appreciated. It is earnestly to be hoped, therefore, that quite apart from the local council being divested of responsibility, the near future will see a reasonably comprehensive scheme both planned and practised. National Health Service Act, 1946. As you are aware, every effort has been made to secure independent recognition of Hornchurch as a Health Service area; but unfortunately without success. A lengthy examination of the circumstances and our claims is not here opportune and would not in any event result in a feeling of much satisfaction. I firmly believe that the divorcement of what might be regarded as purely sanitary functions from those associated with a more personal health service—as for example under the Act—is not in the best interests of the community, since it represents a segmentation of what might otherwise be a comprehensive and efficient whole. Nevertheless recent legislation has permitted the continued separation of strictly sanitary from other services, and although one may disagree with the principle of so doing, yet if it is still held 21 to be a good one I regret that at least, Hornchurch was not permitted to retain that degree of independence which might have been accorded to it as an area privileged to have its own SubCommittee for the administration locally of the Act. The Act will in the long run be judged in the light both of its performance and its promise, and it must therefore be our endeavour that so far as lies within our power the two should be made to coincide. Health Propaganda. There exists considerable unity of interest with the County Council in this sphere of activity and the closest identity of effort is necessary if our mutual endeavours are to produce the maximum effect. This point is borne in mind and an endeavour has been made to unify cur efforts in this regard. SECTION C. SANITARY CIRCUMSTANCES OP THE AREA. Water. The general pipe supply to the area is excellent if hard, and meetings were held during the year to consider softening proposals. Although the medical considerations directly bearing upon hard water nun not be weighty, indirectly it is a grave inconvenience— especially at the present time when soap is limited— for a housewife to endure, if at the same time she has to maintain a high standard of household and personal cleanliness. Water should be supplied ready for easy use and the advantages conferred locally by the ownership of a water softener demonstrate that the question of undue hardness is of the utmost practical importance. We have a certain number of wells sited rurally and with very limited supply areas, and these inevitably present their difficulties, depending as they do mainly upon surface supplies. The provision of a pipe supply in lieu of well water has been pursued vigorously with interested parties (decision finally may not rest with the local council) but to date it has not been possible to achieve finality. The boiling of all water for drinking or domestic purposes represents a pastime of which one would speedily pall. This is recognised to the full and will serve to maintain our interest until the most effective practical action has been taken to prevent its necessity. The South Essex Waterworks Company were good enough to supply us with the following details :— "The water supply to the whole of your area has been satisfactory in quality and quantity. Bacteriological and chemical examinations are made of the raw water, of the water in its various stages of treatment and of the water going into supply. A total of over 3,300 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. 22 In addition, analyses have also been made of samples obtained from consumers' taps in the various parts of the Company's district, including that of your Council, and all proved to be satisfactory. The water supply is not plumbo-solvent. No action has been necessary in respect to any form of contamination. The number of dwelling houses supplied as at 31st December, 1947, was 28,363, and the population as at 30th September, 1947, as obtained from the Registrar-General was 100,930." Approximately 0.7 per cent, of the inhabited houses, and 0.7 per cent. of the population of the Urban District obtain their water from standpipes. Systematic sampling was carried out by the Department during the year in conjunction with other local authorities obtaining their supplies from the South Essex Waterworks Company. In all cases satisfactory reports were received. A typical report is as follows:— "This sample is clear and bright in appearance, free from metals apart from a negligible trace of iron and its reaction is on the alkaline side of neutrality. It is hard in character but not unduly so, while its salinity and content of mineral constituents in solution are not excessive. The water is of satisfactory organic quality and of a satisfactory standard of bacterial purity. These results are consistent with a pure and wholesome water suitable for public supply purposes." Closet Accommodation. At the end of the year a scheme had almost achieved completion whereby the pail closets in a group of some 6 houses had been replaced by water carriage system, with coincident alteration to deal with the households' waste water. The Council contributed to the first part of this scheme under Section 47 of the Public Health Act, 1936. The result has been to obliterate at least one example of the pail closet/garden/well triangle which is so dangerous. It is indeed surprising that persons living under relatively primitive sanitary circumstances do not suffer more from conditions associated with such elementary amenities. Perhaps they develop immunity; perhaps we just do not hear of their illnesses. Smoke Abatement. As you know, proposals were formulated for making a series of atmospheric observations in this District. The lack of suitable fuel and the lack of suitable appliances for utilising it are alike inopportune factors in the planning of an immediate radical attack on smoky atmosphere. The appearance of the buildings in our cities is, however, ample memorial to the failure of our efforts over a long period. The prevention of a smoke and grit laden atmosphere is much more important that its suitable dispersal, and domestic smoke also must shoulder a material responsibility for the present unsatisfactory conditions, 23 Air aw it is scientifically understood forms an almost unrecognizable relation to the vitiated atmosphere which many of our city dwellers are forced to breathe. In matters sanitary the standard of the town is often regarded as a thing of perfection for the country and it may well be our endeavour in the matter of atmosphere somewhat to reverse the usual trend. Domestic appliances must be pleasing in appearance and economical in practice. The housewife can judge the former for herself, she should be safeguarded in the latter by an authenticated fuel efficiency standard in respect of the product she purchases. Factories are also vitally concerned in efficiency if sometimes less in the appearance of the atmosphere and—apart from utilising the results of the continuous research in smoke and grit prevention methods—ensuring a fully trained stoker service would be no small contribution. Householders and factory managements alike should be interested in the question. Open Spaces. There are necessarily at the moment in our area many vacant - plots of land either on cleared bomb sites or on land left over from housing or other development. Naturally, if regrettably, these plots tend to become a dumping ground for the discarded material of householders and others to the annoyance, if not to the actual prejudice, of neighbouring residents. The unsightly result is not what we desire or condone and if a sense of amenity was weighted as carefully as the likelihood of escaping detection appears to be by the persons responsible, then the present situation would not arise. Since civic pride is not enforceable by legislation a solution must depend upon an awakened civic conscience. Campers and Caravans. Occasional instances have come to light of campers or caravans arriving in the District and settling down under conditions which, if congenial to the people concerned, were not equally so to their neighbours. With certain limited exceptions land cannot be used for the housing of movable dwellings without the permission of the Local Authority. This at the least enables action to be taken in the event of flagrant contravention and ensures a reasonable standard of hygiene on any site communally used. One prosecution was successfully brought during the year by the police authority in respect of a case in our area. Fairs have caused considerable discussion in the past. One 'must recognise that reputable fairs are protected to a considerable extent but they do provide reasonable amenities for themselves and on sanitary grounds do not constitute a nuisance. In the nature of things, however, they are noisy, attract considerable crowds and gravitate as near as possible to centres of population 24 with inevitable disturbance to householders. The area would seem large and varied enough to permit of a suitable compromise being found. Waste Food. Bins. Complaints as to alleged nuisance caused by waste food receptacles come to us in steady supply. In normal circumstances "pig bins" represent a type of street decoration which would not be encouraged, but the present circumstances are not normal and if these bins are utilised sufficiently to cause the degree of complaint alleged, they must be of sufficient service to save a considerable amount of food. It is also found that objection is frequently raised not on the grounds that such bins are not required but that a site other than the proximity of the complainant's house is regarded by the complainant as preferable for a variety of reasons of varying merit. The fixation of the bins, periodical emptying and thorough cleansing, must be the points guiding our approach and the Surveyor (in control of the Food Salvage service) is fully alive to the problem and to the necessity adequately of dealing with it. Disinfestation. Infested effects are, where possible, cyanide treated. Gammexane is used where cyanide is impracticable. Considering the overcrowding which exists, known infestations are not of high proportions. A close liaison is maintained with the Housing Department so far as concerns Council property. Ditches. The district is liberally intersected by ditches which from time to time tend to become occluded through natural vegetation, the dumping of a variety of material, or both. It would be unwise to generalise as to the degree of nuisance or danger to health which subsequently arises as this depends so largely upon the individual site of the trouble. It- is in any event very often exceedingly difficult to allot the responsibility for the occurrence and hence to take the necessary remedial measures. Children are very often blamed, probably rightly, for dumping tins and so forth into a stream nearby their homes, but the extent of the practice leaves little doubt but that their elders are not free from blame in this regard. The maintenance of ditches in a satisfactory condition is undoubtedly a contribution to amenity to put it at the least, and any adequate scheme for dealing with the problem would, therefore, constitute in my opinion a marked advance in sanitation. 25 Cesspools. There are certain areas of the District not at present sewered and certain others in which the provision of sewers in the future appears most unlikely. This position is inseparable from any district with a rural part. Whilst the legislative position for dealing with overflowing cesspools is straightforward it should be recognised that every cesspool is a potential nuisance and although it may on occasions be unavoidable, the provision of cesspools to serve any house in an urban part of the area is initially to be deprecated and should subsequently be remedied at the earliest available opportunity. Rodent Control. The special scheme outlined in last year's report for the systematic inspection of the District for rodent infestation in accordance with Ministry of Food L.A. Circular No. 12 was completed on the 30th April, 1947, by the 3 Rodent Operatives. During the period 1st January, 1947, to 30th April, 1947, 14,361 visits were made in this connection and 85 rat and 6 mice infestations were cleared. Following completion of the special scheme a Rodent Operative was oppointed to deal with any further rodent infestations. He made 1,242 visits and cleared 99 infestations up to the end of the year, the charges being 2s. 6d. for dealing with infestations on private premises and 5s. Od. for minor infestations on business premises. This service has been much appreciated and has filled a definite want in these times when food particularly must be saved from destruction by rodents. Sanitary Inspection of the District. SUMMARY OF SANITARY INSPECTORS' WORK DURING 1947. Inspection of Food— Bakehouses: visits paid 46 Butchers' shops: visits paid 170 Cafes: visits paid 146 Cowsheds: visits paid 127 Dairies: visits paid 162 Fish shops: visits paid 79 Grocers' shops: visits paid 198 Ice Cream Dealers' premises : visits paid 148 Slaughterhouses: visits paid 3 Miscellaneous visits 67 26 Housing— Drainage of houses: visits paid 336 Permitted number: visits paid 189 Overcrowding enquiries 224 Structural defects: visits paid 1,227 Waterpipes: visits paid 70 Inspection of premises and effects of prospective Council House tenants 190 Re-inspections 1,129 Miscellaneous visits . 29 General Sanitary Circumstances— Accumulations: visits paid 172 Camping grounds, Vans, etc. : visits paid 81 Drainage and sewerage: visits paid 395 Dustbins: visits paid 104 Keeping of animals and birds: visits paid 77 Public house urinals: visits paid 30 Refuse tips: visits paid 133 Rodent and vermin infestation : visits paid 201 Schools: visits paid 3 Watercourses: visits paid 40 Sanitary fittings : visits paid 93 Re-inspections 337 Miscellaneous visits 94 Factories and Outworkers— No. of visits paid 88 Shop Acts— No. of inspections 45 Infectious Diseases— Visits paid (including contacts) 710 No. of disinfections carried out 76 Number of Notices Served— Informal 967 Statutory 71 SECTION D. Number of new Houses erected during the year. 252 houses were completed during the year 1947 by private builders. The Council erected 378 houses during the year and 212 houses were re-built as a result of destruction by enemy action. Hornchurch was in fact the leading Urban District in England and Wales for housing completion during the year. 27 Slum Clearance. This problem is not locally of the magnitude so apparent in many other areas. The worst houses remaining have been closed or demolished during the period reviewed, the outstanding substandard dwellings will receive radical attention as soon as we are permitted effectively to do so. Overcrowding. This remains our main concern although the re-housing progress being made, notably by Hornchurch, naturally tends to improve the position. From a general viewpoint it is obvious that a steady improvement is being made although individual cases of extreme degree are ascertained, brought forward from time to time and dealt with sympathetically. Rural Housing (with which may be included Housing of Agricultural Workers). The staff shortage precluded the commencement of a survey which will reveal the local circumstances in detail. It is now hoped to commence it during the coming year and steps are being taken in the interim to provide a certain number of dwellings for farm workers. I feel sure that an unsuspected number of rural cottages are not in fact occupied predominantly by farm workers. The war years and subsequent extreme housing shortage have tended to encourage a movement of population from the towns which may very well have altered the pre-war position. The town and the country dweller must be regarded as equally deserving of satisfactory amenities and the accommodation for the country dweller of the future will undoubtedly so aim. Unfortunately it seems certain that many of our present rural dwellings can never be brought up to modern standards—apart from structural defects, the absence of main services such as water, sewers and ready facilities for refuse disposal are apparent obstacles —but much can be done to raise their present standard to a much higher level. Re-housing: Medical Aspects. During the year some 530 certificates containing medical evidence in support of council house applicants were submitted to me for opinion as to the degree of priority applicable. Cases of infectious tuberculosis for example, are accorded very high priority and are assessed—always with the patient's consentafter consultation with the Tuberculosis Officer for the area, to whom I must accord my sincere thanks. 28 In every case where the circumstances appear uncertain, visits of clarification are paid by my staff and upon these, and in some cases after personal visitation, my recommendations to the Housing Committee are based. My suggestions are founded necessarily on a relative and not an absolute basis, but at least they represent an impartial assessment of each case and I believe that, without such a procedure, the position would be chaotic insofar as each case might to the layman appear of equal and outstanding merit. I must note the social aspect of certain applications submitted for priority and do so as a matter of comment rather than an opportunity for opinion. It is evident that many couples living with their parents tend to be unsettled and this position is normally aggravated by the arrival of a family. If there is a room in the house, so small as to be uncountable in our points system, it often appears to be the inevitable accommodation for a young married couple and one is told from time to time that the arrival of a child would in fact result in their being forced completely to relinquish even the limited accommodation provided. Persons in lodgings are in fact often apparently better off than those living with relatives. I know that young children by their noise and natural exuberance are not ideal companions for elderly people, especially when the grandparents may feel that time has earned them relaxation from the burdens of too intimate family life, but it should be emphasised that the disadvantages do not lie only with the older ones since the child who is forced to lead a repressed life for the sake of family peace is surely in no enviable plight. It is all too easy to survey a housing position so dispassionately as to smack of inhumanity and medically also it is obvious that nervous upsets are encouraged by present circumstances. Nevertheless in the ultimate the practice of mutual toleration and forbearance will go far to palliate a state of affairs which the Council is making every endeavour, by the provision of houses, to correct. Week-end Houses. Our proximity to London doubtless contributes to parts of our area having been chosen as a form of rural retreat by persons interested in securing a week-end domicile. The buildings selected or erected vary greatly in type, some being very poor and dubiously suitable even for occupation under so-called holiday conditions. In due course the war has made many of these dwellings sought as permanent houses with a consequent aggravation of the position. A review of these places will be made so that in fairness to the occupier of the dwellings and the amenities of the District the full facts may be ascertained and considered. Meanwhile one has repeated complaints from certain occupiers as to the unsuitability of their premises and even owner/occupiers are included in the number of complainants. 29 In many instances it is quite evident that occupation was commenced in the full light of all the circumstances, unsatisfactory though they may have been, and until housing assumes a different appearance it may well be as impossible as it might be unfair to deal with cases of this type before those in which occupiers, through no fault of their own, have been forced for long to live under bad conditions with a minimum of amenities. Sub-let Houses. Instances are evident in which houses of very ordinary average type have been divided for separate family use. However well intentioned that may have been, the result is not always happy ; when one observes the landing as the site of election for cooking facilities the wisdom of this improvised planning is at once open to question. Houses intended for eventual splitting should ideally be so planned at the outset but should in any event ensure that each family would receive such amenities in regard to their part of the house as they would enjoy if they occupied the whole house. Since a bath, electric light, or gas do not appear at present to be legally enforceable in a dwelling, it is evident that even this standard is not unduly imaginative. The degree of friction amongst families sharing a house often seems directly proportionate to the number of services they are forced to share. Squatting. Mention might be made of this practice, not because of its present importance but because to disregard it might omit eloquent comment on our times. It might be described as the unauthorised occupation of suitable—or more often unsuitable—premises by persons determined to emphasize their urgent need for re-housing by methods not legally provided for so doing. The Public Health aspect of this matter obtrudes itself very clearly. Potential and very often actual nuisance can be caused to neighbouring residents by the occupation of premises not designed for habitation and consequently deplorably lacking the amenities associated therewith. It is necessary, therefore, that when these cases do arise steps should be taken, both in the communal and personal interest, to ensure the termination of the tenancies without delay. It is not in the interest of the families concerned that they should be allowd to remain under such deplorable conditions. A difficult problem has confronted the Council in this connection but fortunately it is now near complete solution. 30 Front and back view of a condemned dwelling. A picture of this nature is fortunately very difficult to secure in our Urban District but is nevertheless incorporated since although it represents the exception it still reminds us that there is a certain minor degree of slum property which requires our attention. 31 Aluminium type temporary bungalow (South Hornchurch site). 32 B.I.S.F. two-storey permanent prefabricated steel house (Harold Wood, Maylands Green and Hacton Farm sites). 33 Three-bedroom traditional brick house (Hacton Farm Estate). 34 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. During the year there were 21 cowkeepers in the District with farms registered under the Milk and Dairies Order, 1926. These farms are regularly inspected by the Sanitary Inspectors. It was found necessary to serve informal notices in 4 cases for infringements of the Milk and Dairies Order, 1926. It is interesting to note that only 5.8 per cent, of the milk sold in the District is raw, ungraded in type. All the schools have, of course, Heat Treated milk. Production of Designated Milk. There are 6 dairy farms licensed by the County Council for the production of Accredited milk and 4 licensed for the production of Tuberculin Tested milk, one of the latter also being licensed to bottle. Milk (Special Designations) Regulations, 1936 to 1946. Licences issued by the Council for the year ended 31st December, 1947, to retail graded milk were as follows:— 13 Tuberculin Tested; 18 Pasteurised; 1 Accredited. In addition, 7 supplementary licences, namely 4 for Tuberculin Tested and 3 for Pasteurised 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 to which the principal licence applies. Milk Retailers. There are 16 milk retailers with registered premises in the District, including 3 producers who are registered both as producers and retailers. There are also 7 persons registered as milk retailers in Hornchurch whose premises are registered in neighbouring districts. Milk Bottles. Owing to the shortage of transport during the war years a number of milk retailers at various times during the year continued to dump crates of full bottles of milk on the pavements in the District for the roundsman to deliver later in the day. Letters were sent to the retailers concerned and this undesirable practice was stopped. Complaints as to dirty bottles inevitably occur, but if the same individual care were to be given to the bottles by the consumers as is given by the central supplier the general position would be considerably improved. 35 Heat-Treated Milk (Prescribed Tests) Order, 1944. Reports were received from the County Medical Officer on 23 samples taken during the year from a retailer's premises in this District where the milk is heat-treated. 4 of these reports were unsatisfactory. Milk Sampling. The 31 routine samples of milk taken from the dairies and in the streets during the course of delivery to customers throughout the year were submitted to the laboratory for bacteriological examination and the results on the whole were very satisfactory. NOTE— The column heading No. of Colonies is an abreviation for Number or colonies per millititre of milk growing on Agar at 37°C. in 48 hours." In certain cases where milk sold as ungraded is thought to have been either heat-treated or pasteurised it is submitted to the Methylene Blue and Phosphatase tests. Note on Phosphatase Test. Group I—Sufficiently heat-treated. ” II—Insufficiently heat-treated. ,, III—Grossly under-treated or contains an apreciable quantity of raw milk. An excerpt from the report on each sample is given below. Designation. No. of Colonies. Coliform Test. Methylene Blue Test. Phosphatase Test. Remarks. I. Pasteurised — — Satisfactory Group I Satisfactory 2. Tuberculin Tested (Certified) — Satisfactory Satsifactory — Satisfactory 3. Pasteurised — — Satisfactory Group I Satisfactory 4. Ungraded 2,000 Satisfactory — — Satisfactory 5. Tuberculin Tested (Pasteurised) — — Satisfactory Group I Satisfactory 6. Heat-treated — — Unsatisfactory Group I Unsatisfactory 7. Ungraded ( ?Heat treated) 15,000 Satisfactory Unsatisfactory Group I Satisfactory 8. Ungraded (?Heat treated) 1,500 Satisfactory Unsatisfactory Group I Satisfactory 9. Sterilised — — Satisfactory Group I Satisfactory 10. Tuberculin Tested (Pasteurised) — — Satisfactory Group I Satisfactory 11. Heat-treated 1,500 Satisfactory Satisfactory Group I Satisfactory 12. Ungraded 48,000 Satisfactory — — Satisfactory 13. Pasteurised — — Satisfactory Group I Satisfactory 14. Ungraded 7,000 Satisfactory — — Satisfactory 15. Pasteurised — — Unsatisfactory Group I Unsatisfactory 16. Tuberculin Tested (Pasteurised) — — Satisfactory Group I Satisfactory 17. Pasteurised — — Satisfactory Group I Satisfactory 18. Ungraded 90,000 Unsatisfactory — — Passable 19. Ungraded 48,000 Satisfactory — — Satisfactory 20. Pasteurised — — Satisfactory Group I Satisfactory 21. Ungraded 20,000 Satisfactory — — Satisfactory 22. Tuberculin Tested (Pasteurised) — — Satisfactory Group I Satisfactory 23. Tuberculin Tested (Pasteurised) — — Satisfactory Group I Satisfactory 24. Pasteurised — — Satisfactory Group I Satisfactory 25. Pasteurised — — Satisfactory Group I Satisfactory 26. Pasteurised — — Satisfactory Group I Satisfactory 27. Pasteurised — — Satisfactory Group I Satisfactory 28. Ungraded 13.000 Satisfactory Satisfactory Group I Satisfactory 29. Ungraded 3,300 Satisfactory Satisfactory Group I Satisfactory 30. Ungraded 36,000 Unsatisfactory Satisfactory Group I Satisfactory 31. Pasteurised — — Satisfactory Group I Satisfactory 36 Ice Cream. Prominence has been given to the new Heat-Treatment Regulations which represent a forward step in administration. Viewed in proper perspective they do not in any degree justify relaxation of the high standards which are necessary both in production and distribution. Producers should exercise that care in preparation which would be essential if no heat treatment of the product was subsequently practised and only the firm inculcation of this idea can ultimately succeed. The Heat-Treatment Regulations will not abolish the carton handled inside and out by the careless assistant who is quite unappreciative of the necessity for careful handling by clean hands, nor will it effect for example the container into which the oft handled measure is carelessly tossed after sales. The employer must be convinced that the highest standards are necessary and he in turn must convince his employees that such standards are not only necessary but reasonable. It is our responsibility to initiate this line of action. Legislation may be a good servant but our difficulties are going to be most effectively dealt with, not by indicating the fear of consequences but by demonstrating the value of prevention. Our aim must be to secure as soon as possible such standards as will enable the public to be given an article not only safe bacteriologically but with substantial claims as a food, to which latter regard many samples of ice cream can at the moment exercise but a very flimsy right. The words "ice" and "cream" are certainly at the moment in their proper sequence, but it might be our endeavour as soon as possible to secure a reversal of this position. In general, the present situation must be accepted rather than welcomed and the future viewed with anticipation rather than complacency. It must, however, be added that sampling results of the product as it is sold locally to customers satisfies us that a clear improvement has resulted as against previous years and that the upward trend is being maintained. During the year under review 37 samples of ice cream were examined at the laboratory, and 11 applications for registration were granted (1 manufacturer and 10 vendors). At the end of the year 25 persons were registered as manufacturers and 106 as vendors. Meat. The question of the transportation of imported meat to butchers' shops under unsatisfactory conditions was taken up with the Ministry of Food. I was assured that the reason for complaint was the shortage of stockingette for covering carcases and that active steps were being taken to see that meat is delivered to butchers in a clean and wholesome state. 37 Food Premises. Food hygiene is increasingly exercising the conscience of administrators, if not always of the public. Morbidity caused by food or inadequate precautions in its preparation or serving, is a problem of considerable magnitude which will respond materially to consistent routine supervision, educative measures for employers and employees alike, and last but not least, a higher standard of acceptance by the consumers. Food hygiene represents a subject for study by both management and employees, since the former will not secure any response from their employees if they themselves are not sufficiently interested, and the latter will only react to supervision if they are individually convinced of their own indispensible part in any scheme for producing and serving safe food. Apart from what can be done by us to protect the public, a great deal can be done by the public to protect themselves. They can be insistent upon adequate standards of cleanliness in places, which they frequent, bringing an influence to bear upon the position which is perhaps all the greater because it is unofficial and, therefore, more unexpected. If the public require a high standard of service in that section of the cafe, restaurant or shop which they can see, then there is the more likely to be an attempt to reach a satisfactory standard in the less obvious parts of the establishment. If it can be represented truthfully regarding food premises that the section not accessible to the public maintains as high a standard as that which is so accessible, then we might not have achieved perfection but would have achieved a considerable advance. Two successful prosecutions were brought during the year, one in respect of a nail and the other of a cigarette end, both in loaves. We mention this not in any spirit of satisfaction since the value of our work lies in its advisory aspect whereby, as far as possible, the conditions giving rise to serious complaint are avoided rather than punished. There is far too much indiscrimate handling of food and it is fortunate that germs are so temperamental in their environmental likes and dislikes as it is that so much of the food commonly requires cooking before consumption. It is perhaps a pity that milk, for example, is so often regarded as a separate problem rather than that the principles applicable to its production and distribution should be equally applicable to all kinds of food. Bakeries. Many of our bakeries occupy old buildings, ill adaptable or adapted for satisfactory service. The increased public demand has aggravated the position although a compensatory feature is that the resulting prosperity has maintained at a high level the desire of the bakers to extend and improve their premises. The existing restrictions do not, however, encourage such alterations as alone would satisfy both the bakers and ourselves. 38 A genuine desire, therefore, to maintain the premises at the highest level is, to some extent, frustrated by the building situation which compels the present circumstances to be endured rather than welcomed. Food and Drugs Act, 1938—Section 13. 19 informal notices were served during the year on owners of premises coming within the scope of this Section of the Food and Drugs Act, 1938. No statutory action was required. Food and Drugs Act, 1938. The Essex County Council as the Food and Drugs Authority for this District administer the provisions of the Act which relate mainly to the composition of food and drugs. 1 am indebted to Mr. F. W. Horsnell, the Chief Inspector, Weights and Measures, etc., Department of the Essex County Council, who has kindly furnished the, following particulars of samples taken by his department within the Urban District during 1947. Article. No. of Samples. Acidulated Fruit Drops 1 Baking Powder 2 Baking Bi-carb. of Soda 1 Baked Farfals 1 Barley Flour 1 Barley Mints 1 Beef Sausages 1 Bi-carb. of Soda 1 Black Pepper 1 Black Pudding 2 Borax 1 Breakfast Sausages 1 Bread 1 Butter 13 Caramel Taps (Sweetmeat) 1 Cake Mixture 1 Cake Flour 1 Cayenne Pepper 2 Cake Dressing 1 Cheese 1 Chocolate Allsorts 1 Condensed Skimmed Milk 1 Cocoa 1 Cooking Fat 7 Curry Powder 4 Coffee and Chicory 1 Coffee 1 Cream of Barley 1 Edible Cake Decoration 1 Epsom Salts 1 Faggot Meat 1 39 Article. ' No. of Samples. Fish Cakes 1 Fish and Chips 2 Flavouring Powder 1 Flavoured Dessert 1 Gale Pie 1 Gelatine Crystals 2 Gelatine Powder 1 Ginger Cake and Pudding Mixture 1 Glauber Salts 1 Golden Raising Powder 2' Gravy Powder 3 Gravy Improver 1 Gravy Salt 1 Granulated Gelatine 1 Ground Cinnamon 2 Ground Barley 1 Ground Coffee 1 Ground Nutmeg 1 Hare Soup Powder 1 Herring and Tomato Paste 1 Ice-cream 3 Jelly Crystals 4 Junket Powder 1 Lard 1 Lemonade Powder 2 Liver Sausage 1 Malt Vinegar 7 Malted Wheaten Food 1 Malt Choco Spread 1 Malt, Milk and Eggs 1 Madeira Cake Mixture 1 Margarine 1 Mattee 1 Milk 9 Mixed Spice 1 Mixed Pickling Spice 1 Mustard 1 Non-Brewed Vinegar 9 Paste of Dates 1 Persian Fruits 1 Powdered Gelatine 1 Pork Sausages 2 Potted Meat 1 Pressed Ham and Beef 1 Pressed Pork 1 Pudding Mixture 1 Reomel 1 Sausages 1 Sauce Powder 1 Semolina . 1 40 Article. No. of Samples. Self-Raising Powder 1 Sherbert Lemons 1 Smoked Salmon Paste 1 Soft Roe 1 Soup 1 Sponge Mixture 1 Steamed Pudding 2 Sweet Herbs 1 Table Dessert 1 Table Jelly 2 Tea 2 Thyme and Parsley Forcing 1 Turmeric 1 Veal Stuffing 1 Vego Cereal Sausages 1 Vinegar 1 Whisky 2 White Pepper 2 166 Of the above samples, the following were certified by the Public Analyst to be unsatisfactory:— Bread.—This sample was found to contain the foetus of a rat cr mouse and was therefore unfit for human consumption. This particular sample was submitted by an Officer of your Authority. Non-Brewed Vinegar.—Two samples were found to be deficient in acetic acid to the extent respectively of 30% and 12% of the minimum quantity of 4 per cent, proper to vinegar. Proceedings were instituted against the wholesale supplier who was fined £2 0s. 0d. and ordered to pay £1 6s. 0d. costs. Soft Roe.—This sample was submitted as "Soft Roe," but in the opinion of the Analyst it was considered to consist of a foodstuff commonly known as "Chitterlings." On investigation it was found that some confusion existed in the trade as to what article the description "Chitterlings" refers. Condemned Food. During the year the following foods were condemned by the Sanitary Inspectors as being unfit for human consumption:— Tinned Milk 1,831 tins. Tinned Fruit 167 tins. Tinned Vegetables 457 tins. Tinned Fish 341 tins. Tinned Meat 522 tins. Jam and Marmalade 296 tins/jars. Miscellaneous Groceries 254 tins. Miscellaneous Groceries 296 packets, 41 Prunes 25 lbs. Oatmeal 329 lbs. Sauce 383 bottles. Macaroni 10 lbs. Biscuits 59½ lbs. Bread 4 loaves. Sausage Rusks 112 lbs. Sweets 79¾ lbs. Apples 6¼ lbs. Bananas 1 lb. Dried Peaches 16 lbs. Dates 70 lbs. Potatoes 3,136 lbs. Tomatoes 56 lbs. Bacon 33¾ lbs. Cheese 66 lbs. Corned Mutton 24 lbs. Corned Beef 1,277 lbs. Meat 4,2171 lbs. Fish 1,376 lbs. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIONS DISEASE. Food Poisoning. A small outbreak occurred during the year in which, although not surprisingly the particular organism responsible was not isolated, circumstances gave a very clear indication as to the probable origin. We were fortunate insofar as the chain of events was unusually clear, and by the co-operation of the various parties involved, it was possible to form a clear picture almost at the outset and to take the necessary steps in regard thereto. The persons involved speedily recovered. Facility of investigation is not helped by the fact that a food product may well be produced in one area, distributed to a wholesaler in another, and finally goes into retail channels in yet a third, and it is clear that the closest co-operation between authorities is essential if outbreaks of this kind are to be prevented and controlled. Disinfection. No change has been made in the arrangements previously obtaining. It is hoped in the near future to obtain a. van for the transport of infected material. Co-operation with the School Medical Service. Head Teachers return a Form M.l. 13 showing children excluded as suspected contacts or suffering from suspected infectious 42 disease. This return has proved of considerable value in ascertaining certain cases which although notifiable had through inadvertance not come to our notice by more conventional methods. From the point of view of a head teacher a form of this kind may represent an additional statistical nuisance but its value to us is not that of a mere addition to our filing cabinet and its main importance is worth recording. Poliomyelitis. In common with most of the country we had an increased incidence of this disease which ran—if the word could ever be applicable in this connection—a normal course. The first case notified was fatal; others varied greatly from mild non-paralytic to fairly severe paralytic in type. Details of certain aspects of the outbreak are noted below:— The number of suspects notified during the year was 25, of which subsequently some 13 were confirmed. Type. 9 of the cases did not show any paralysis, whilst 4 evinced paralysis in varying degree, one of the latter being at first considered non-paralytic hut subsequently developing a widespread paralysis. Age and Sex. 7 of the cases were male and 6 female : the ages being 2 years in two cases, 3 years (one case), 5 years (one case), 7 years (two cases), 8 years (one case), 11 years (one case), 13 years (one case) , 14 years (one case), 17 years (one case), 33 years (one case), and 35 years. Ward Distribution. Upminster 4, North-West 3, Thameside 3, Cranham 1, Rainham 1, Emerson Park 1. Hospitalisation. All save one of the cases were isolated in hospital. The average stay of the non-paralytic cases was something under three weeks, whilst the paralytic cases completing treatment (save one which died on the day of admission—the only fatal case in the series) averaged 15 weeks. Results. One case of a bulbar type died very shortly after hospital admission, and of the others, two are still attending for remedial treatment, one is still in hospital and the remaining nine have made complete recovery. Various facts even if only of negative interest emerged from the survey we conducted for Ministerial information and certain of them may be here noted:— 43 Accommodation. No legal overcrowding existed in any household where there was a case, and with the exception of one four-roomed house all the other cases occurred in a house comprising 6 rooms or more. Number in eamily. Including the patient, the households comprised 3 persons in four instances; 4 persons in six instances; 6, 7 and 9 persons in one instance each. Children in Household. Including the patients, there were in seven instances 2 children, in one instance 4 children, in one instance 5 children, in one instance 7 children, whilst in three instances the household did not include any children. Multiple Cases. In no instances did more than one case arise in the family. Drainage of Houses. Save in one instance where there was an earth closet, the affected households were all provided with main drainage facilities. History. In only one instance did it appear that there might have been exposure to infection, and even in this one instance, a near relative of the case had only been exposed to risk from other cases in the course of his employment without the area. Swimming Pools. In no instance was a history given of regular visits to Swimming Pools. Paddling Pools. In only one instance was attendance at a Paddling Pool noted. Cinema Clubs. No instance arose in which the case attended the cinema clubs, although some patients had been intermittent attenders at the cinema. Oganisations. One case was connected both with a Sunday School and Scouts, but in none of the other cases was an association with either of these bodies suggested. Pig Bins. In one instance there was a pig bin within 7 yards of the house (the case in this house was a very mild non-paretic one). In two instances there was a pig bin within 75 yards; in three instances within 100 yards; in one within 150 yards; whilst all the others were over 200 yards. 44 Railways. In one instance there was a railway about 120 yards distant from the house, but in none of the others was a railway proximate even to that extent. Occupation of Cases. 7 were school children, 3 were under school age, one was a teacher, one a children's nurse and one a butcher's assistant. The attack rate was approximately 13 per 100,000 of the population, which compares very favourably with that suffered by many other areas. The fatality rate of just under 8% was also not alarming. The months in which the cases occurred were:— July 2 August 5 September 2 October 3 November 1 General. This disease affords a fertile field for speculation but rather arid soil for conviction. Considerable evidence has been submitted for analysis under the survey conducted by Dr. A. Mc Farlane (with the approval of the Ministry of Health) and the results reflected from such a wide range of cases as will come within his purview should be better calculated to elicit significant facts than is the appreciation of purely local figures. His report is awaited with interest. Our local practitioners were given an early opportunity of seeing the Ministry film on the disease. A close liaison was maintained throughout with the County whilst Rush Green Hospital relieved us of all isolation worries; after care receiving due provision. A major pre-occupation in such an outbreak is how best to ensure that the public realise that all reasonable steps have been taken to maintain control. Just as the spectacular course of action will be applauded so does the conservative tend to be under-valued. Closing this, restricting that, prohibiting the other, looks better than it is save under exceptional circumstances which did not here arise. Idealistic advice such as isolating every case of pyrexia of unknown origin and the like is so impracticable as to be largely futile, and in the event of a really large outbreak it would be a pity if immediate hospitalisation of every suspected case came to be regarded as the only satisfactory course of action. We were fortunate in that Press and public alike approached the situation rationally and did not embarass us. In the ultimate while we were far from escaping unscathed we fared by no means badly relative to many other areas attacked. 45 Diphtheria. For the first time since records have been kept no case of this disease occurred in the course of the year. There appears little doubt but that public awareness of the value of immunisation has aided materially in producing this result but it would have been foolish to ascribe our long standing immunity to this factor alone as the state of immunity of our population, and especially our susceptible population, is not sufficiently high to warrant any such assumption. Apart from the susceptibility of the individual it would seem that the virulence of the attacking organism may in the past few years have undergone something of a change, which equally of course may be transient in character. DIPHTHERIA. Notifications 1937-1947. Year. Total Notifications. 1937 52 1938 45 1939 27 1940 42 1941 36 1942 25 1943 9 1944 7 1945 8 1946 4 1947 0 Diphtheria Immunisation. It will be known that the County Council as the Welfare Authority are responsible for dealing with the children under 5 years of age, while the local Council are responsible for those children over that age. In practice we, as agents of the County Council, deal with the under fives also to a ven large extent maintaining, of course, a close liaison with the County in this matter. During the year 1,408 children (1,292 under 5, and 116 over 5) completed the course, which consists of two injections of A.P.T. with an interval of four weeks, and 671 children were given a secondary or re-inforcing injection subsequent to the complete full course. The following shows the immunisation state in relation to the child population regarding 46 the number of children who had completed a full course of immunisation at any time up to 31st December, 1947 Age at 31.12.47 Number Immunised Estimated mid-year child population Percentage. Under 1 26 1 988 8,830 46% 2 920 3 112 4 977 5 to 9 5.053 14,190 68% 10 to 14 4,611 Total under 15 13,687 23,020 59% 47 Scarlet Fever. At 122 cases the annual incidence is low as compared with an average of 203 for the past 11 years. The type of disease remained mild. Clarification is urgently required on the question of the necessary period of isolation for uncomplicated home nursed cases. The tendency to shorten the period of isolation, be it at home or hospital, has gained considerable ground with the development in chemotherapy of recent years, but to what extent this should go affords an opportunity for collaboration between the general practitioners, epidemiologists and the bacteriologists. The table and graph following show the relationship of this disease to housing. 48 SCARLET FEVER CASES NOTIFIED YEAR 1947. Persons in family. Number of rooms. Total Cases. 1 2 3 4 5 6 7 8 1 — — — — 1 — — — 1 2 — — — — — — — — — 3 — 1 — 1 5 13 2 — 22 4 — 2 4 4 7 29 1 2 49 5 — — 1 2 5 17 — 1 26 6 — — — 4 2 12 1 — 19 7 — — — — — 2 — — 2 8 — — — — 1 — — 1 2 9 — — — — — 1 — — 1 No. of Cases — 3 5 11 21 74 4 4 122 49 SCARLET FEVER, Notifications 1937-1947. Total Year. Notifications. 1937 279 1938 226 1939 214 1940 97 1941 119 1942 274 1943 373 1944 194 1945 121 1946 214 1947 122 50 Measles and Whooping Cough. Although 627 cases were notified no deaths from this disease occurred and in 179 cases of Whooping Cough again there was no mortality. Seasonal Incidence. Scarlet Fever was most prevalent in March, as was Pneumonia. Measles showed a high incidence in January, February and March, when it subsided, to recrudesce in July. Whooping Cough was most in evidence in March to July, followed by an exacerbation in December. Age Incidence. Measles, Scarlet Fever and Whooping Cough showed a maximum incidence during the age period 5 to 10 years; although it was interesting to note that 36 cases of Measles out of 627 occurred over 10 years, whereas only 3 cases of Pertussis out of 179 occurred in persons over 10. Hospitalisation. 25 cases of Scarlet Fever, 21 cases of Measles and 9 of Pertussis were the major reasons for hospital treatment. 51 MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASES—1917. MONTH Scarlet Fever Diphtheria Enteric with Paratyphoid Poliomyelitis Pneumonia Erysipelas Cerebrospinal fever Dysentery Ophthalmia Neonatorum Infective Hepatitis Measles Whooping Cough Malaria Puerperal Pyrexia January 12 — — — 8 1 — — — 6 90 10 1 .—. February 12 — 1 — 6 2 1 1 — 12 135 6 — — March 18 — — — 18 3 1 — — 2 139 18 — 1 April 10 — — — 9 4 — — — 8 41 37 — — May 9 — — — 1 — 1 1 1 5 34 22 — — June 8 — — — 3 3 — — — 3 18 11 — — July 5 — — 1 1 — — — — 3 109 23 1 — August 6 — — 3 1 1 1 — — — 37 9 — — September 3 — 1 5 — 4 1 — — 4 2 5 — 1 October 9 — — 3 4 1 — — — 1 4 5 — — November 11 — — 1 2 1 1 — — 1 4 6 — — December 19 — — — 7 9 — — — 2 14 27 — 1 Totals 122 — 2 13 60 29 6 2 1 47 627 179 2 3 52 AGE GROUPS OF INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS) NOTIFIED IN 1947. DISEASE. At all Ages At the Ages Specified — Years. 0 — 1 1 — 3 3 — 5 5 — 10 10 — 15 15 — 25 25 — 45 ' 45 — 65 65 & Over M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Scarlet Fever 57 65 1 2 2j 3 9 7 24 36 16 10 4 4 1 3 — — — Diphtheria - - - - - - - - - - - - - - - - - - - - Poliomyelitis 7 6 — — — 2 — 1 2 2 3 — — 1 2 — - — — — Pneumonia Enteric or 24 36 3 2 2 1 2 2 3 1 3 3 1 12 2 7 5 4 3 4 Typhoid Fever 1 1 — — — — — — — — — 1 1 - - - - - - spinal Fever 3 3 — — - - 1 — — 1 1 1 — 1 1 - - - - - Dysentery 1 1 - - - - - - - - - - - - - - - - - - Measles 299 328 9 8 54 60 86 94 137 143 8 7 2 15 3 1 — — — — Whooping Cough 86 93 9 12 26 21 21 28 30 29 — — — 1 - 2 — - - — Erysipelas 18 11 1 - — — — - 1 — — — 9 4 - - 4 3 3 4 Totals 496 544 23 24 84 87 119 132 197 212 31 21 18 39 9 13 9 8 6 8 53 TABLE SHOWING THE TOTAL NUMBER OF INFECTIOUS DISEASE CASES NOTIFIED IN EACH WARD DURING THE YEAR 1947. DISEASE Total Cases Notified WARDS f Cases Hospitalised/ Town Cranham Emerson Park Harold Wood Northwest Rainham Thameside Upminster Scarlet Fever 122 37 5 14 9 15 9 7 26 25 Poliomyelitis 13 — 1 1 — 3 1 3 4 12 Pneumonia 60 4 2 2 1 25 10 5 11 27 Enteric of Typhoid Fever 2 1 — — — — — — 1 2 Cerebro-Spinal Fever 6 1 — — — 3 2 — — 6 Dysentery 2 — — —. — — 1 — 1 1 Measles 627 102 10 29 108 135 122 73 48 21 Whooping Cough 179 37 10 8 12 27 23 9 53 9 Erysipelas 29 7 1 2 2 5 2 2 8 6 TOTALS 1,040 189 29 56 132 213 170 99 152 109 54 Tuberculosis. During the year, 127 new cases (63 male and 64 female) of Tuberculosis were added to the register. These included 109 cases (56 male and 53 female) in which the respiratory organs were affected, and 18 cases (7 male and 11 female) in which the infection was in some other part of the body. There were 38 deaths from this disease. The number of notifications for the year showed an increase of 11 as against the figure of the previous year, but the incidence for 1947 approximated to the average for the past 11 years, and 13 fewer deaths from the disease occurred during 1947. The Tuberculosis register at the end of the year showed as follows — Pulmonary— Males 387 Females 267 Non-Pulmonary— Males 106 Females 103 Pulmonary and Non-Pulmonary Total 863 The problem of Tuberculosis is quite inseparable from that of housing, and it is a considerable satisfaction to record alike the very close collaboration which 1 have with the local Tuberculosis Officer and the complete sympathy which the Council affords to deserving cases which I am responsible for bringing to their notice. 55 NEW CASES AND DEATHS FROM TUBERCULOSIS, 1947. AGE GROUPS NEW CASES TOTAL NEW CASES DEATHS TOTAL DEATHS PULMONARY NONPULMONARY PULMONARY NONPULMONARY M. F. M. F. M. F. M. F. M. F. M. F. 0- 1 years — — — — — — — — — — — — 1- 5 ,, 1 — 2 — 3 — — — — — — — 5-10 „ 3 4 1 2 4 6 1 — — — 1 — 10-15 „ — 2 1 — 1 2 — — — 1 — 1 15-20 „ 4 9 1 2 5 11 1 3 — — 1 3 20-25 „ 7 12 — 3 7 15 3 2 — 1 3 3 25-35 ,, 10 15 — 3 10 18 3 3 1 — 4 3 35-45 „ 11 6 2 1 13 7 5 5 — — 5 5 45-65 „ 18 4 — — 18 4 5 4 — — 5 4 65 and over 2 1 — — 2 1 — — — — — — Totals 56 53 7 11 63 64 18 17 1 2 19 19 56 YEAR 1947—INTERVAL BETWEEN NOTIFICATION AND DEATH OF FATAL CASES OF TUBERCULOSIS. YEAR Within one month From 1-3 months From 3-6 months From 6-12 months From 1-2 years From 2-3 years From 3-4 years From 4 years and upwards Notified after death TOTAL 1947 1 5 1 1 7 5 3 10 5 38 TUBERCULOSIS NOTIFICATIONS—1937-1947. YEAR PULMONARY NON-PULMONARY TOTAL 1937 92 32 124 1938 91 54 145 1939 74 20 94 1940 78 13 91 1941 93 39 132 1942 110 31 141 1943 100 27 127 1944 94 23 117 1945 126 22 148 1946 105 11 116 1947 109 18 127 57 Infective Hepatitis—Year 1947. The total number of cases of Infective Hepatitis notified during the year was 47 (44 civilians and 3 persons in the Armed Forces). The figure for the previous year was 90 (87 civilians and 3 service personnel). The following are the age groups of the 44 civilians :— Years. Males. Females. 1-2 0 1 3-4 1 2 5 - 9 1 1 10 - 14 5 6 15 - 24 9 4 25 - 34 5 2 35 - 44 2 3 45 - 54 1 1 55 - 64 0 0 24 20 Non-Notifiable Diseases of Childhood. These numbers must necessarily be accepted with due reserve since they represent our only available, but not necessarily wholly accurate information. During the year the cases of non-notifiable infectious disease occurring among school children have been reported by Head Teachers as follows:— Chickenpox 118 Mumps 76 Scabies 6 Rubella 39 Impetigo 16 Ringworm 2 Influenza 145 Gastro-enteritis 3 Conjunctivitis 1 58 SECTION G. FACTORIES ACT,1937 Ministry of Labour and National Service Form 572. PART 1 OF THE ACT. 1. Inspections. Premises. No. on Register. No. of Inspections. No. of written notices. No. of occupiers prosecuted Factories in which Sees. 1, 2, 3, 4 & 6 are to be enforced by l.a. s 25 16 0 0 Factories not included above in which Sec. 7 is enforced by l.A. 131 21 8 0 Other premises in which Sec. 7 is enforced by the L.A. 7 6 0 0 Total 163 43 8 0 2. Cases in which Defects were Found. Particulars. Fonnd. Remedied. Referred Proseen tions. To H.M. Inspector. By H.M. Inspector. San. Conveniences (Sec. 7) (a) Insufficient 4 4 1 0 (b) Unsuitable or defective 4 4 1 0 Other offences against the Act 2 2 2 0 Total 10 10 2 2 0 OUTWORK — Sections 110 and 111. Nil. Inspection of Factories. Far less supervision than is desirable was maintained because of staff shortages but this section of our responsibilities will be restored to its proper level at the earliest opportunity. Apart from our own visits, H.M. Inspector of Factories keeps in touch with us concerning defects of mutual interest. Opportunity was taken personally to visit certain of the larger factories in the District with most instructive results. It is always interesting to see the actual work and working conditions occupying 59 the time of so many of our inhabitants. It is, I think, really inseparable from a full personal health service that the medical practitioners providing that service should be afforded—and should even at some inconvenience take advantage of—opportunities of seeing just what their patients' work really mean in practice. Managements, in my experience, are in accord with this idea and it should be as acceptable to the employees. SECTION H. RAINFALL DURING THE YEAR. I am indebted to Mr. V. W. Williams, the Surveyor, for the subjoined information on rainfall as recorded at the two recorded stations used during the year. Amount of rainfall No. of days in in inches. which rain fell. At Eastern Sewage Works:— January 1.22 14 February 62 8 March 3.95 22 April 1.03 7 May 60 10 June 1.79 11 July 2.81 8 August 21 3 September 1.36 7 October .09 3 November .70 7 December 2.11 15 16.49 115 At Langtons :— January 1.60 19 February 1.15 10 March 4.79 22 April 1.22 10 May 67 10 June 2.19 11 July 2.7 10 August .06 2 September 1.36 10 October .18 5 November .85 10 December 2.03 20 18.80 1.39 Wilson & Whitworth Ltd. Romford.