Journal Rebind Co. Ltd. Unit 4, Pier Wharf, Grays, Essex. A C4411 (3) Horn church HORN C 16 Horn church Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1948 JAMES GORMAN, M.B.,Ch.B.,D.P.H., Medical Officer of Health. 67990 Horn church Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1948 JAMES GORMAN, M.B.,Ch.B.,D.P.H., Medical Officer of Health. 3 TABLE OF CONTENTS. page. Members of the Council 4 SECTION A -Statistics and Social Conditions of the Area 8 SECTION B -General Provision of Health Services for the Area 16 SECTION C -Sanitary Circumstances of the Area 20 SECTION D -Housing 28 SECTION E -Inspection and Supervision of Food 30 SECTION F -Prevalence of, and control over, Infectious Disease 37 SECTION G-Factories Act, 1937. Ministry of Labour and National Service Form 572 48 SECTION H- Rainfall during the Year 49 4 MEMBERS OF THE COUNCIL. Councillor E. W. J. W. Bush, J.P., Chairman. Councillor A. Wheeler, Vice -Chairman. Councillor Mrs. E. M. Field. ,, Mrs. R. J. Reynolds. ,, Mrs. E. G. Richardson ,, Dr. E. Anthony. C. T. Soulter. ,, H. E. Chapman. S. W. Collischon. ,, B. T. Dodge. W. M. Edwards. S. W. Emms. P. C. Ford. F. J. R. Hecker. ,, A. C. Holmes. ,, H. Holock. R. S. Howe. ,, A. S. Hulkes. ,, E. Humphrey. G. W. Lagden. A. G. Newman. A. J. H. Okey. S. C. Parrish. ,, L. R. Plaskett. A. C. Salinger, J.P. ,, S. M. Tucker. ,, A. J. Twigger. 5 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Councillor S. W. Emms, Chairman. Councillor S. W. Collischon, Vice -Chairman. Councillor Mrs. R. J. Reynolds. ,, Dr. E. Anthony. C. T. Boulter. ,, E. W. J. W. Bush, J.P. ,, S. M. Tucker. ,, A. J. Twigger. ,, A. Wheeler. MEMBERS OF THE HOUSING COMMITTEE. Councillor S. W. Collischon, Chairman. Councillor P. C. Ford, Vice-Chairman. Councillor Mrs. R. J. Reynolds. E. W. J. W. Bush, J.P. ,, H. E. Chapman. ,, H. Holock. ,, R. S. Howe. ,, L. R. Plaskett. A. Wheeler. REPRESENTATIVES OF THE COUNCIL ON THE SOUTH ESSEX AREA HEALTH SUB-COMMITTEE. Councillor Mrs. R. J. Reynolds. ,, Mrs. E. G. Richardson. ,, S. W. Collischon. H. Holock. ,, S. M. Tucker. ,, A. J. Twigger. ,, A. Wheeler. REPRESENTATIVES OF THE COUNCIL ON THE ROMFORD & HORN CHURCH JOINT SEWERAGE COMMITTEE. Councillor H. E. Chapman. S. W. Collischon. ,, H. Holock. ,, R. S. Howe. ,, A. S. Hulkes. 6 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. Sanitary Inspectors: L. Ager, San. Insp. Cert. R.S.I., Cert. Inspector of Meat and Other Foods. *T. W. Glew, 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.S.I, and S.I. Joint Board, Cert. Inspector of Meat and Other Foods. IS. Whitfield, San. Insp. Cert. R.S.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 (Senior Clerk). S. N. Dance. Miss E. M. Trinnaman (Shorthand-typist). Miss D. K. Manning (Diphtheria Immunisation Assistant). *Commenced duties 1.1.48. †Resigned on 17.7.48. ‡Commenced duties 20.9.48. 7 Public Health Department, Council Offices, Billet Lane, HORN CHURCH. 25th August, 1949. To the Chairman and Members of the Horn church Urban District Council. Mr. Chairman, Ladies and Gentlemen, Public health is not one of the local government activities which lends itself to the spectacular, but its Annual Balance Sheet is none the less important because it is translatable into terms of human well being rather than of finance. The details presented in this report are therefore of real significance as presenting a general picture of the health, hygiene services and environment of our people. The general health picture is satisfactory. The vital statistics show that the birth rate is lower than. of recent years, the death rate is also slightly lower and the infant mortality figure, although higher than last year, is almost identical with the country as a whole. The maternal mortality rate is higher this year than for the country in general. There has been an increase both in notification and deaths from Tuberculosis, although the death rate from this disease is slightly lower locally than for England and Wales in general. The principal causes of death remain as in recent years. Infectious disease notifications show that Scarlet Fever and Measles were both below last year's figure and the national average, whilst Whooping Cough, although higher locally than in 1947, was also below the national average. Infantile Paralysis cases were somewhat higher than the average. An outbreak of Dysentery specially reported to you at the time accounted for a large increase in the 1948 figures for this disease. Housing continues to make good progress, although we are not yet permitted easily to deal radically with all our sub-standard properties, whilst the time for the over-crowding survey has not yet arrived An interesting development has been the initiation of a series of observations in Atmospheric Pollution problems. Further details will be noted later in this report. Current problems such as food hygiene have occupied the attention of your staff and use is made locally of suitable propaganda material to emphasize the importance of the subject. The coming into force of the National Health Service Act, 1946-which occurred during the year under review-whilst not the cause of any major change in the services coming within the realm of this report, nevertheless basically affects the general medical 8 services of the district and will in due course be the subject of review as to its local effects. I beg to acknowledge 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. 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) 1948 101,000 Registrar-General's quarterly estimates of civilian population for year 1948:- at 31st March, 1948 101,080 at 30th June, 1948 101,540 at 30th September, 1948 101,790 at 31st December, 1948 101,300 Number of inhabited houses (September, 1948) according to Rate Books 27,678 Rateable Value (September, 1948) £711,352 Sum represented by a Penny Rate (September, 1948) £2,840 Vital Statistics. Extracts from Vital Statistics for the Year. Births. Number of live births registered in the District as supplied by the Registrar-General and adjusted for inward and outward transfers 1,745 (919 males, 826 females) Birth Rate per 1,000 civilian population 17.2 Number of still births registered in the District as supplied by the Registrar-General and adjusted for inward and outward transfers 35 (13 males, 22 females) Still Birth Rate per 1,000 civilian population 0,34 Still Birth Rate per 1,000 total (live and still) births 19.6 9 Deaths. Number of deaths occurring in the District:- Residents 519 Non-residents 159 Number of deaths of residents occurring outside the District 300 Total number of deaths of Horn church residents adjusted for inward and outward transfers as compiled locally 819 Number of deaths registered in the District as supplied by the Registrar-General, adjusted for inward and outward transfers 820 NOTE. -The number of deaths supplied by the Registrar-General are those REGISTERED during the year and, therefore, differ from adjusted figures compiled locally. Death Rate per 1,000 civilian population 8.2 Puerperal Deaths:- (a) from Sepsis 1 (b) from other maternal causes 2 Deaths of infants under one year of age 60 Infant Mortality Rate (per 1,000 live births) 34.3 Deaths from:- Male. Female Cancer 73 66 Diabetes 1 5 Diarrhoea (under 2 years) 5 2 Influenza 1 0 Pneumonia 18 12 Measles 1 0 Whooping Cough 1 1 Diphtheria 0 1 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 1948 101,000 10 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 406 414 1. Typhoid and paratyphoid fevers 0 0 2. Cerebro-spinal fever 0 0 3. Scarlet fever 0 0 4. Whooping Cough 1 1 5. Diphtheria 0 1 6. Tuberculosis of respiratory system 26 11 7. Other forms of tuberculosis 2 5 8. Syphilitic diseases 1 0 9. Influenza 1 0 10. Measles 1 0 11. Acute polio-myelitis and polio-encephalitis 0 1 12. Acute inf. encephalitis 0 0 13. Cancer of buccal cavity and oesoph (M); uterus (F) 7 3 14. Cancer of stomach and duodenum 14 6 15. Cancer of breast 0 18 16. Cancer of all other sites 52 39 17. Diabetes 1 5 18. Intra -cranial vascular lesions 39 55 19. Heart diseases 123 127 20. Other diseases of circ. system 10 17 21. Bronchitis 17 19 22. Pneumonia 18 12 23. Other respiratory diseases 6 3 24. Ulcer of stomach or duodenum 6 1 25. Diarrhoea under 2 years 5 2 26. Appendicitis 2 2 27. Other digestive diseases 4 10 28. Nephritis 6 7 29. Puerperal, and post-abortion, sepsis 0 1 30. Other maternal causes 0 2 31. Premature birth 6 6 32. Congenital malformation, birth injury, etc. 9 16 33. Suicide 6 2 34. Road traffic accidents 6 1 35. Other violent causes 8 6 36. All other causes 29 35 NOTE. -The deaths are those REGISTERED during the calendar year. They will differ, therefore, from adjusted figures compiled locally. 11 DEATHS IN CERTAIN AGE GROUPS DURING WHOLE YEAR (Local Figures). Age No. of deaths. Under 1 year 60 1 and under 2 — 2 „ „ 5 9 5 „ ,, 15 5 15 „ „ 25 14 25 ,, ,, 35 23 35 ,, ,, 45 37 45 „ ,, 55 86 55 ,, ,, 65 118 65 „ ,, 75 188 75 „ ,, 85 219 85 „ „ 95 55 95 and upwards 5 Total 819 12 COMPARATIVE VIEW OF THE PRINCIPAL CAUSES OF DEATH DURING THE YEAR 1948 13 DEATH RATE—COMPARISON WITH PREVIOUS YEARS. 1931 8.4 1940 9.4 1932 7.9 1941 9.6 1933 7.8 1942 7.9 1934 8.4 1943 8.9 1935 8.4 1944 9.2 1936 7.9 1945 9.9 1937 8.6 1946 9.0 1938 8.1 1947 8.3 1939 7.8 1948 8.2 BIRTH RATE—COMPARISON WITH PREVIOUS YEARS. 1931 20.1 1940 16.4 1932 18.1 1941 15.5 1933 18.4 1942 17.5 1934 17.6 1943 19.0 1935 17.0 1944 11.9 1936 20.2 1945 18.4 1937 19.6 1946 21.3 1938 19.7 1947 20.7 1939 18.9 1948 17.2 14 BIRTH RATES, CIVILIAN DEATH RATES, ANALYSIS OF MORTALITY AND MATERNAL MORTALITY, 1948. 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, Horn church. Rates per 1,000 Civilian Population. Births- Live Births 17.9(a) 20.0 19.2 20.1 17.27 Still Births 0.42(a) 0.52 0.43 0.39 0.34 Deaths- All Causes 10.8(a) 11.6 10.7 11.6 8.2 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 - Whooping Cough 0.02 0.02 0.02 0.01 0.02 Diphtheria 0.00 0.00 0.00 0.01 0.01 Tuberculosis 0.51 0.59 0.46 0.63 0.43 Influenza 0.03 0.03 0.04 0.02 0.01 Smallpox - - - - - Acute poliomyelitis & Polioencephalitis 0.01 0.01 0.01 0.00 0.01 Pneumonia 0.41 0.38 0.36 0.54 0.29 Deaths- Rates per 1,000 Live Births. All causes under 1 year of age 34(b) 39 32 31 34.3 Enteritis and Diarrhoea under 2 years of age 3.3 4.5 2.1 2.4 4.1 Maternal Mortality : Rates per 1,000 Total (Live and Still) Births. Abortion with Sepsis 0.11 0.56 Abortion without Sepsis 0.05 - Puerperal infections 0.13 - Other maternal causes 0.73 1.12 A dash (-) signifies that there were no deaths. (a) Rates per 1,000 total population. (b) Per 1,000 related births. 15 VITAL STATISTICS FOR YEARS 1938-1948. 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. 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 1,587 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 1948 101,000 1,745 17.2 60 34.3 819 8.2 16 CASE RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1948. (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. Horn church. Notifications:- Typhoid Fever 0.01 0.00 0.01 0.00 0.01 Paratyphoid Fever 0.01 0.01 0.01 0.01 - Cerebro-spinal Fever 0.03 0.03 0.02 0.03 0.02 Scarlet Fever 1.73 1.90 1.82 1.37 1.08 Whooping Cough 3.42 3.51 3.31 3.13 2.52 Diphtheria 0.08 0.10 0.09 0.10 0.01 Erysipelas 0.21 0.23 0.21 0.22 0.24 Smallpox - - - - - Measles 9.34 9.75 8.84 9.17 8.49 Pneumonia 0.73 0.84 0.60 0.57 0.56 Acute Poliomyelitis 0.04 0.05 0.04 0.04 0.08 Acute Polioencephalitis 0.00 0.00 0.00 0.00 Rates per 1,000 Total (Live and Still) Births. Puerperal Fever and Pyrexia 6.89 8.90 4.71 7.34 1.12 A dash (-) signifies absence of notifications. SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. National Health Service Act, 1946. This Act duly came into operation on the 5th July, 1948, and prior to that date meetings were held and considerable discussion took place with the Local Health Authority on the question of our position relative to the de-centralisation of administration. It should be pointed out that so far as the Act affected our powers, we as a Sanitary District were affected to a minimum degree and in fact, save for the responsibility for dealing with Diphtheria protection in those over 5 years of age and for issuing Insulin on sympathetic terms to certain diabetics our work was in fact practically unaffected by the coming into force of the Act. A resume of the negotiations concerning area administration would serve no useful purpose-suffice to say that this district now 17 forms part of South Essex Health Area which includes also Thurrock and Brentwood. A review of the position is likely to be made in 1950. It would be misleading to regard all County Districts as being in the same category, since clearly those districts which have been permitted to function as separate areas have been delegated some greater degree of responsibility than others which have been coalesced to perform the same functions. There must, I think, be close consultation on major matters between all the authorities responsible in whatever measure for implementing the Act if the very considerable difficulties patent in a measure of the kind, are to be surmounted with a minimum of upset. Even though it has been argued at some length that the opportunities of a Medical Officer of Health on the strictly environmental side of hygiene have never been greater, and that he may in fact now be coming into his own, I think that it would be a great pity both from the point of view of the implementation of the Act, the local authority served by the M.O.H., and last but by no means least, the public for whom the Act was designed, if in fact every Medical Officer of Health, be he concerned with a rural district or any other form of authority, is not so absorbed as to form part of the general mosaic. The two years' verdict on both the general and local effects of the Act should make interesting reading and should prove profitable in the designing of future plans, always of course presuming that the two years noted has in fact been sufficiently long to permit of any accurate conclusions being drawn. Office Accommodation. During the year the Department was moved from its former site to other accommodation in close proximity to the main Council Offices. Staff. Details of the Public Health Officers of the Authority are outlined at the beginning of this report. It was agreed during the year that a further Additional Sanitary Sanitary Inspector should be appointed. Miss D. K. Manning, Diphtheria Immunisation Assistant, was automatically transferred to the Local Health Authority (Essex County Council) with effect from 5th July, 1948, although at the end of the year this service was still being conducted from these premises pending the acquisition of property for use as an Area Health Office. Chiropodists' Services. The local Council has been interested in the chiropodist facilities available to the public and but for this service coming within the scope of the Local Health Authority after the 5th July, would undoubtedly have provided such a service, at any rate, a short time 18 before. Although the responsibility now rests with the County Council there is little doubt but that our interest will not cease on that account. Our members will certainly advocate the provision and extension of this service to all parts of our area. Laboratory Facilities. The Council Laboratory, established by the Essex County Council at Oldchurch Hospital, Romford, has continued to serve the needs of the District and is available for any medical practitioners who desire to have bacteriological reports on the specimens which they send. On exceptional matters recourse is had to the Public Health Laboratory at Colindale. Ambulance Service. The ambulance station was transferred from Harrow Lodge to Billet Lane, Hornchurch, at the beginning of the year and subsequently as from the appointed day under the National Health Act. 1946, came under the complete control of the Local Health Authority. Nursing in the Home. The local nursing organisations, viz. the Hornchurch Nursing Association; the Eainham, Wennington and South Hornchurch Nursing Association; and the Upminster and Cranham District Nursing Association, whilst functioning independently until the appointed day under the National Health Service Act, 1946, subsequently became merged into the County's general scheme. Maternity and Child Welfare. The Essex County Council maintained clinics at the following centres throughout the year:— (i) Westland Avenue, Hornchurch. (ii) Abbs Cross Lane, Hornchurch (serving the Elm Park Estate). (iii) Malvern Eoad, Hornchurch. (iv) Athelstan Eoad, Harold Wood. (v) Upminster Eoad, Eainham. (vi) Station Eoad, Upminster. Nursing and Maternity Homes. There are 5 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. 19 In addition, for the first part of the year, there were the District Nurse-Midwives engaged by the local nursing associations, and independent midwives practising in the District, who have now been absorbed into the National Health Scheme. Hospitals. Prior to the appointed day the hospital arrangements for the District were the same as those obtaining last year, subsequently the general control being transferred to the North East Metropolitan Regional Hospital Board. In the case of the infectious disease hospitals our cases possibly tended to be hospitalised over a wider area but there is as yet insufficient experience of the new system to justify any definite observations. Our co-operation with Rush Green Hospital remained unaffected by the transfer. Supply of Insulin for Diabetics. The policy outlined in previous reports was pursued up to the 4th July, 1948, after which this service became the responsibility of the Essex Executive Council. The number of persons supplied during the former period was 26 free issue (2 new applications) and 8 persons at half-price (2 new applications). During this period 2 patients were removed from the register. Health Propaganda. The Council subscribe to the Central Council for Health Education. It is clear that re-orientation of services renders more imperative than ever an integration of Local Health Authority and District Authority plans and to this end we are continuing the efforts noted last year. National Assistance Act, 1948, Section 47. No action was taken during the year under this head. Periodically cases are brought to our notice in which action under this section is deemed worth considering. There is no doubt but that a substantial number of old people do develop personal characteristics and habits of a type which do not always commend themselves to their neighbours. There is also an impression, doubtless fostered by the present wealth of legislation, that even a District Council has only to be informed of any departure from the normal to be able automatically to regularise it. Such fortunately is not the case and unless in a very extreme case indeed I would be most reluctant to interfere with the liberty of the individual. 20 Superannuation Examinations—Staff. The services of private practitioners are secured for these examinations save in instances where an existing employee's suitability for continued service is in question, which examinations are carried out by the Medical Officer of Health. During the year arrangements were made for the examination of 213 employees or prospective employees (57 permanent and 156 temporary). SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. Efforts have continued throughout the year to bring to finality the question of providing a piped main supply to certain properties served by wells of doubtful quality. Our efforts were being continued at the end of the period under review and had made some progress. It should be mentioned that in one area of the district main water supply was, through the concerted action of the Council and the persons more immediately concerned, made available to the premises involved (which included two cafes). Circumstances in this case were, however, more favourable for mains extension than they happen to be in other parts of the area with which we would be very happy to deal in like manner. The South Essex Waterworks Company were good enough to supply us with the following particulars:— The water supply of 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 3,500 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. In addition, anaylses have also been made of samples obtained from consumers' taps in various parts of the Company's district, including that of your Council, and all proved to be satisfactory. The water supplied 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, 1948, was 28,922, and the population as at 30th June, 1948, as obtained from the Registrar-General was 101,000." Approximately 0.7 per cent. of the inhabited houses, and 0.7 per cent. of the population of the Urban District t obtain their water from standpipes. 21 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 13 samples were taken. A typical report is as follows:— "This sample is practically clear and bright in appearance, neutral in reaction and free from metals apart from a negligible trace of iron. The water is hard in character but the hardness and its content of mineral and saline constituents in solution are not excessive and its organic quality is satisfactory. These results are indicative of a water which, from the aspect of chemical analysis, is pure and wholesome in character and suitable for drinking and domestic purposes." 11 samples of well water were taken during the year and submitted to the Counties Public Health Laboratories for bacteriological and chemical examination. Insect Pests. From time to time complaints are received of insect pests causing a nuisance in the district and during the year the following specimens were sent to the Department of Entomology, British Museum (Natural History), for identification. In all cases advice was given to the complainants on eradication of the pests. (1) Pachydrilus lineatus: Harmless red worms found in water. (2) Thaumatomyia notata Mg: Small flies which live on vegetable matter and during Autumn seek shelter in premises in which to hibernate. (3) Anthrenus Verbasci: Small "ladybird" type of beetle, better known as "woolly bears", which attack articles made of hair, bristle, wool, silk, etc., and can be quite as serious as clothes moths when once established. (4) Stegobuim paniceum: Small beetles belonging to the family known as "furniture beetles". This beetle attacks stored food. (5) Ocypus Olens. L: These large black beetles approximately one inch long are commonly known as the "Devil's Coach Horse Beetle". It is thought to be harmless and does not normally infest occupied premises. In addition complaints regarding crickets, wasps and bees were dealt with and advice given in respect of 19 premises infested with bugs. 22 Smoke Abatement. We are represented on the Standing Conference of Co-operating Bodies in the Investigation of Atmospheric Pollution and on the London and Home Counties' Smoke Abatement Advisory Council. Under plans approved by our Council we also make recordings at representative parts of the area. We have lead peroxide gauges at Redden Court, Rainham, North Ockendon, and Suttons Schools. There is also at Rainham a deposit gauge (which gives information of a much more comprehensive character than the lead peroxide gauge) and at the Public Health Offices we maintain our Volumetric SO 2 apparatus. Our results are submitted to the Atmospheric Pollution Section of the Department for Scientific and Industrial Research and are incorporated in the monthly bulletin issued to co-operating bodies throughout the country. It should be emphasised that investigations of this kind must, to be of value, be of a long-term nature and apart from local considerations are also of significance in helping to present a national picture when interpreted co-incidentally with lines of enquiry carried out by other authorities in varying parts of the country. It would be a mistake to presume that because any particular area might be developed industrially to only a very slight extent, there therefore exists no atmospheric pollution problem. In our case we are on the fringe of a highly industrialised belt and whatever we do to prevent it, we cannot avoid pollution from outside areas (this to say nothing of the pollution caused by our own domestic smoke). What we can do, however, is to obtain some idea of how far our district is affected through its position and how far the improvement of conditions in other areas will influence our atmosphere. Present indications suggest that results are as expected, but review over a considerable period is necessary before any hard and fast deductions could be drawn. The accompanying graphs illustrate the relative positions occupied by the various parts of the area. Rainham, as might be anticipated, shows the least satisfactory results, almost inevitably because of its position and of the nearby industrial development. It is clearly most important that at the planning stage all possible steps should be taken to ensure that industrial extension does not coincide with a corresponding increase in gross pollution of the atmosphere. 23 MEASUREMENT OF SULPHUR DIOXIDE THE LEAk PERQX1DE METHOD AT FQUR SITES IN THE UR5AN DISTRICT QF HORNCHURCH AUGUST— DECEMBER 1948 RAINHAM HAROLDWOOD SUTTONS LANE NTH.OCKENDON AMOUNT OF SOLUBLE AND INSOLUBLE MATTER RECORD BY DEPOSIT GAUGE SlTED AT RAINHAM SECONDARY SCHQOL AUGUST- NQVEMBER. 1948 SOLUBLE INSOLUBLE 25 MEASUREMENT OF ATMOSPHERIC POLLUTION THE VOLUMETRIC METHQD AT THE PUBLIC HEALTH OFFICES HORNCHURCH JULY - DECEMBER 1948 HEAVY FOG 26 Drainage. A further block of property was agreed upon during the year as being suitable for conversion to a water carriage system. There is no doubt but that compared with pails, or even a cesspool system, the tenant of a house connected to main drains occupies an enviable position and the observations of a person who has for many years had to cope with the difficulties of. for example, a pail system, fully compensates one for any trouble occasioned by arranging for the change-over to a water carriage system. It is, however evident that in relatively inaccessible areas with no future development, it is quite impractible economically to do other than permit the more primitive forms of sanitary accommodation. Waste Food Bins. The position remains the same as outlined last year. 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. Rodent Control. The Rodent Operative made 2,630 visits and cleared 87 infestations up to the end of the year. A charge of 2s. 6d. is made for dealing with infestations on private premises and 5s. Od. for minor infestations on business premises. It would be unfortunate if the fact that our Rodent Operative was available lessened the sense of personal responsibility for dealing with infestations. We are only too glad to provide assistance of this kind but every effort should continue to be made, and without doubt is normally being made, by the householder to deal with trivial infestations. Sanitary Inspection of the District. SUMMARY OF SANITARY INSPECTORS' WORK DURING 1948. Inspection of Food— Bakehouses—visits paid 63 Butchers' shops—visits paid 210 Cafes, Canteens, etc.—visits paid 166 Cowsheds—visits paid 83 Dairies—visits paid 117 Fish shops—visits paid 82 Food complaints—visits paid 26 Food vehicles—Number inspected 31 27 Greengrocers' shops—visits paid 7 Grocers' shops—visits paid 201 Ice Cream Dealers' premises—visits paid 100 Sausage factory—visits paid 6 Sweet shops—visits paid 5 Miscellaneous visits 6 Housing— Clearance area survey—visits paid 9 Dirty premises—visits paid 18 Drainage of houses—visits paid 408 Environmental reports (housing applicants) 89 Inspection of premises and/or effects of prospective Council House tenants 105 Overcrowding enquiries 146 Permitted Number—visits paid 222 Sanitary fittings—visits paid 26 'Squatters'—visits paid 32 Structural defects—visits paid 1,166 Waterpipes and water supply—visits paid 48 He-inspections 2,058 Miscellaneous visits 9 General Sanitary Circumstances— Accumulations—visits paid 146 Camping grounds, Vans, etc.—visits paid 28 Drainage and sewerage—visits paid 248 Dustbins—visits paid 124 Establishments for massage or special treatment—visits paid 9 Hairdressers'—visits paid 9 Insect pests, etc.—visits paids 16 Keeping of Animals and Birds—visits paid 77 Lectures given 2 Public Conveniences and public house urinals—visits paid 55 Refuse tips—visits paid 73 Rodent and vermin infestation—visits paid 293 Schools—visits paid 22 Smoke nuisances—visits paid 32 Watercourses—visits paid 32 Re-inspections 216 Miscellaneous visits 22 Factories and Outworkers— Number.of visits paid 206 Shop Acts— Number of inspections 152 28 Infectious Diseases— Visits paid (including contacts) 1,157 Number of disinfections carried out 18 Number of Notices Served— Informal 787 Statutory * 49 SECTION D. Number of new houses erected during the year. 78 houses were completed during the year 1948 by private builders. The Council erected 460 houses during the year and 106 houses were rebuilt as a result of destruction by enemy action. Hornchurch retained its place as the leading Urban District in England and Wales for housing completion during the year. Slum Clearance. Comment has previously been made on the relatively high average standard of housing accommodation in this area, largely because of its recent and rapid development. The way is not yet clear for other than isolated instances of slum property to be dealt with radically and until area procedure under the Housing Act is once more available to us, our powers will remain limited. We can, however, ensure that the necessary information is available to enable us to tackle the problem when once again we are permitted to do so. Rural Housing (including Housing of Agricultural Workers). Owing to staff conditions it has not yet been found possible to proceed with a survey of the housing conditions of rural workers. The Council is, of course, in association with the War Agricultural Executive Committee for the County, taking steps on a limited scale to provide new accommodation for selected agricultural workers, but the problem naturally extends considerably beyond this into the realm of those workers who have perhaps been living for many years under conditions which would not commend themselves particularly to the average inhabitant in the urban part of the area. Overcrowding. This problem will have to be tackled in time, but it is difficult to determine whether the population movement has yet become sufficiently normal to render any survey results of lasting value. My own view is that although such a time is approaching fairly rapidly, it has perhaps not yet arrived and as a matter of policy caution should be exercised in not initiating steps through the carrying out of a survey which will not result in smooth and speedy 29 action to deal with the housing conditions which may be brought to light thereby. If, for example, you carry out an overcrowding survey and from the results, formulate proposals, you must be reasonably assured that the problem with which you are finally going to deal, substantially resembles the problem which has been presented as an outcome of that survey—hence the need for ensuring that population movements are normal before attempting to embark on plans largely governed by this factor. Temporary Dwellings. We have naturally on occasion had to deal with various visitations from persons of the gipsy class passing through the district. Whilst they generally choose a rural spot in which to camp, aside altogether from such considerations as sanitary arrangements, it is often found that the site of their camp is left in a most unsatisfactory condition and we shall therefore continue our policy of ensuring that their stay within our boundaries is of minimum duration. In the course of our routine inspection of the area and on any particular information, every effort is made to discourage settling of this type and I think the circumstances reflect a considerable success in this direction. The present housing shortage seems undoubtedly to have emphasised the relative attractions of living in a caravan until fortune favours the housing application which has often been submitted. Frequent permission may be sought for caravan dwellings of this type to be sited in, for example, the garden of a house, the amenities of which would be made available to the caravan dwellers. Very exceptionally, a case may be made out for permitting accommodation of this type, but in general it does not add to the amenity of the neighbourhood and depends for suitability on factors over which we have very little control, and which may well alter as time goes on. Although at the outset it may be designed for occupation by relatives our review of housing applications proves all too clearly that few factors can be more potent in their disruptive effect on family good fellowship than housing, and whilst superficially there may appear a certain amount of justification for applications of this type the potentialities of difficulty are always very considerable. Apart from purely holiday provision which comes within a somewhat different category, as houses become more freely available, so the temptation to seek authority for accommodation of this kind will lessen. Re-housing: Medical Aspects. During the year some 425 applications for Council houses were referred to me for opinion on the degree of medical priority which should be accorded. A vast majority of the applicants of this type do not seem to realise that the provision of alternative accommodation necessarily depends upon a multiplicity of considerations of which the medical aspect in general merely forms part and consequently my recommendation is not always synonymous with complete satisfaction for the applicant. 30 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Milk Supply. During the year there were 19 cowkeepers in the District with farms registered under the Milk and Dairies Order, 1926. These farms are subject to routine inspection by the Sanitary Inspectors. It was found necessary to serve informal notices in 2 cases for infringements of the Milk and Dairies Order, 1926. Production of Designated Milk. There are 7 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, 1948, to retail designated milk were as follows:— 14 Tuberculin Tested. 18 Pasteurised. 1 Accredited. In addition, 7 supplementary licences, namely 4 for Tuberculin Tested milk 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 15 milk retailers with registered premises in the District, including 4 producers who are registered both as producers and retailers. There are also 6 persons registered as milk retailers in Hornchurch whose premises are registered in neighbouring districts. Heat-Treated Milk (Prescribed Tests) Order, 1944. Reports were received from the County Medical Officer on 28 samples taken during the year from a retailer's premises in this District where the milk is heat-treated. 3 of these reports were unsatisfactory. Tuberculous Milk: Veterinary Investigation. An intimation was received during the year from the County Medical Officer that a sample of milk taken from an Accredited farm in this District contained tubercle bacilli and that the Animal Health Division of the Ministry of Agriculture and Fisheries had been informed so that the matter could be further investigated. Veterinary investigation and action by the Ministry of Agriculture and Fisheries subsequently reached a satisfactory conclusion. Milk Sampling. The 47 routine samples of milk taken from the dairies and in the streets during the course of delivery to customers throughout 31 An excerpt from the report on each sample is given below:— Designation. No, of Colonies. Coliform Test. Methylene Blue Test. Phosphatase Test. Remarks. l. Pasteurised 28,000 — Satisfactory Group I Satisfactory 2. Pasteurised — — Satisfactory Group I Satisfactory 3. Tuberculin Tested (Certified) — Satisfactory Satisfactory — Satisfactory 4. Pasteurised — — Satisfactory Group I Satisfactory 5. Tuberculin Teste (Certified) — Satisfactory Satisfactory — Satisfactory 6. Pasteurised — — Satisfactory Group I Satisfactory 7. Undesignated 20,000 Satisfactory — — Satisfactory 8. Undesignated 10,000 Satisfactory — — Satisfactory 9. Pasteurised — — Satisfactory Group I Satisfactory 10. Pasteurised 23,000 Satisfactory Satisfactory Group I Satisfactory 11. Undesignated 12,000 Satisfactory — — Satisfactory 12. Heat-treated — — Satisfactory Group I Satisfactory 13. Heat-treated — — Satisfactory Group I Satisfactory 14. Undesignated 2,400 Satisfactory — — Satisfactory 15. Pasteurised — — Satisfactory Group I Satisfactory 16. Pasteurised — — Satisfactory Group I Satisfactory 17. Pasteurised — — Satisfactory Group I Satisfactory 18. Pasteurised — — Satisfactory Group I Satisfactory 19. Pasteurised — — Satisfactory Group I Satisfactory 20. Undesignated 720,000 Unsatisfactory — — 21. Tuberculin Tested (Certified) — Satisfactory Satisfactory — factory Satisfactory 22. Tuberculin Tested (Certified) — Satisfactory Satisfactory — Satisfactory 23. Pasteurised — — Satisfactory Group I Satisfactory 24. Undesignated 350,000 Unsatisfactory — — Unsatisfactory 25. Undesignated 95,000 Satisfactory — — Satisfactory 26. Undesignated 80,000 Satisfactory — — Satisfactory 27. Undesignated 19,000 Satisfactory — — Satisfactory 28. Undesignated 100,000 Satisfactory — — Satisfactory 29. Undesignated 18,000 Satisfactory — — Satisfactory 30. Undesignated 22,000 Satisfactory — — Satisfactory 31. Pasteurised — — Satisfactory Group I Satisfactory 32. Heat-treated — — Satisfactory Group I Satisfactory 33. Sterilised — — Satisfactory Group I Satisfactory 34. Undesignated 12,000 Satisfactory — — Satisfactory 35. Pasteurised — — Satisfactory Group I Satisfactory- 36. Pasteurised — — Satisfactory Group I Satisfactory 37. Pasteurised — — Satisfactory Group I Satisfactory 38. Pasteurised — — Satisfactory Group I Satisfactory 39. Tuberculin Teste (Certified) — Satisfactory Satisfactory — Satisfactory 40. Undesignated 20,000 Satisfactory — — Satisfactory 41. Pasteurised — — Satisfactory Group I Satisfactory 42. Pasteurised — — Satisfactory Group I Satisfactory 43. Pasteurised — — Satisfactory Group I Satisfactory 44. Pasteurised — — Satisfactory Group I Satisfactory 45. Heat-treated — — Satisfactory Group I Satisfactory 46. Pasteurised — — Satisfactory Group I Satisfactory 47. Heat-treated — — Satisfactory Group I Satisfactory NOTE.—The column heading "No. of Colonics" is an abbreviation for "Number of colonies per millilitre 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 appreciable quantity of raw milk. the year were submitted to the laboratory for bacteriological examination and the results on the whole were very satisfactory. 32 Ice Cream. The selling of this commodity wrapped is very strongly advocated at the moment. It is of course very necessary that apart from its being wrapped, it should be handled to the minimum degree, and preferably not at all, before it is wrapped. The co-operation of the public should also be sought in ensuring that the roads around the vendors' premises do not resemble a "paper chase." Admittedly children are very often the culprits in this respect and their care in disposing of wrappers cannot always be guaranteed. It is, however, surprising how well children will co-operate even at an early age if any point is explained to them in language which they can understand and the best way to ensure that they won't pay attention to details of this kind is to believe that they are incapable of thought. It might incidentally be pointed out that, in more favourable times possibly, the number of cigarette cartons tossed here and there doesn't suggest that adults are any more careful than children- Registration of Manufacturers and Vendors of Ice Cream. Ice cream manufacturers and vendors are required to be registered by the local Council under Section 158 of the Essex County Council Act, 1933, which was adopted by the Council by resolution on 20th February, 1934. During the year 15 applications for registration (all vendors) were granted. At the end of the year, 23 persons were registered as manufacturers and 137 as vendors. Ice Cream Sampling. During the year under review 34 samples of ice cream were examined at The Counties Public Health Laboratories. An excerpt from the report on each sample is given below:— Designation. No. Of Colonies. Coliform Test. Bact. Coli. Methylene Blue Reaction. Remarks. 1. Heat Treated 300 Negative Negative Grade I Satisfactory 2. Heat Treated 8,500 Positive Negative Grade I Satisfactory 3. Heat Treated 800 Negative Negative Grade I Satisfactory 4. — 15,000 Positive Negative Grade IV Satisfactory 5. — 3,900 Positive Negative Grade I Satisfactory 6. — 42,000 Positive Negative Grade II Satisfactory 7. — 300,000 Positive Negative Grade IV Unsatisfactory 8. — 7,000 Negative Negative Grade I Satisfactory 9. Heat Treated 38,000 Negative Negative Grade III Satisfactory 10. — 300 Negative Negative Grade I Satisfactory 11. Heat Treated 6,000 Negative Negative Grade II Satisfactory 12. — 20,000 Negative Negative Grade I Satisfactory 13. — 2,000 Negative Negative Grade I Satisfactory 33 Designation. No. of Colonies. Coliform Test. Bact. Coli. Methylene Blue Reaction. Remarks. 14. — 1,500 Negative Negative Grade I Satisfactory 15. Cold mix. 20,000 Positive Negative Grade I Satisfactory 16. — 6,200 Positive Negative Grade II Satisfactory 17. — 500,000 Positive Positive Grade IV Unsatisfactory 18. — 42,000 Negative Negative Grade II Satisfactory 19. Heat Treated 80,000 Negative Negative Grade III Satisfactory 20. Heat Treated 1,000 Negative Negative Grade II Satisfactory 21. Heat Treated 25,000 Positive Negative Grade III Satisfactory 22. Heat Treated 600 Negative Negative Grade I Satisfactory 23. Heat Treated 250,000 Positive Positive Grade IV Unsatisfactory 24. Heat Treated 300 Negative Negative Grade I Satisfactory 25. Heat Treated 20,000 Positive Negative Grade III Satisfactory 26. Heat Treated 300 Positive in 1 tube Negative Grade I Satisfactory 27. Cold Mix. 2,000 Negative Negative Grade II Satisfactory 28. Heat Treated 20,000 Positive Negative Grade III Satisfactory 29. Heat Treated 1,000 Negative Negative Grade II Satisfactory 30. Heat Treated 15,000 Positive in 1 tube Negative Grade I Satisfactory 31. Heat Treated 90,000 Positive Negative Grade III Satisfactory 32. Heat Treated 80,000 Positive Negative Grade III Satisfactory 33. Heat Treated 18,000 Positive Negative Grade I Satisfactory 34. Heat Treated 35,000 Positive Negative Grade IV Satisfactory NOTE.—No. of Colonies means "Number of colonies per millilitre of ice-cream growing on Agar at 37°C. in 48 hours." Coliform Test : The quantity submitted to the coliform test is 3 tubes each containing l/10th ml. Bact. coli : The: quantity examined for Bact. coli is the same as for the coliform test. Methylene Blue Reaction: This test consists of the addition of 1 ml. of methylene blue solution and 7 ml. of sterile ¼ strength Ringer solution to 2 ml. of ice cream. The tubes are incubated in a water-bath for 17 hours at 20°C. (this period is referred to as pre-incubation), and then transferred to a water-bath at 37°C. and observed at half-hourly intervals until decolourised. On this basis the Ministry of Health suggest that the methylene blue reduction test should be given a trial for assessing the bacteria] cleanliness of ice cream and that four grades should be tentatively defined as follows:— Grade 1—Time taken to reduce methylene blue 4½ hours or more. Grade 2—Time taken to reduce methylene blue 2½ to 4 hours. Grade 3—Time taken to reduce methylene blue ½ to 2 hours. Grade 4—Time taken to reduce methylene blue 0 hours (i.e. reduction at the end of the pre-incubation period). Food and Drugs Act, 1938—Section 13. 8 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. 34 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 relates mainly to the composition of food and drugs. I 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 1948 :— Article. No. of Samples. Bacon 2 Baking Powder 1 Barley Crystals 1 Barley Flour 2 Barley Pearl 1 Batter Mixture 1 Beef 1 Bicarbonate of Soda 5 Biscuits 1 Brawn 2 Bread 1 Butter 17 Cake Decoration, Edible 1 Cake Flour 5 Cake Mixture 2 Celery Salt 1 Cheese 1 Chocolate Cup 1 Cocoa 3 Cocoa artd Malt 1 Coffee 2 Confectionery, Rhum and Butter 1 Cooking Fat 1 Cupkaff 1 Curry Powder 1 Custard Powder 2 Delicaf 1 Figs, Dried 1 Fish Spread 3 Fish Paste 6 Flaked Faronoco 1 Gelatine 2 Ginger, Ground 1 Gravy Powder 2 Gravy Salt 1 Haslet 1 Honey 1 Jam 1 Jelly Crystals 2 35 Article. No. of Samples. Keiller-Vita 1 Lemonade 1 Lemonade Powder 1 Macaroni 1 Malted Milk 1 Marmalade 1 Melbex Melba Toast 1 Milk 62 Mustard Pickling 1 Nutmeg, Ground 1 Oatmeal 1 Olive Oil 2 Paste of Dates 1 Pate de Foie 1 Pepper 5 Plums (Victoria) 1 Pudding Mixture 2 Quince, Drained 1 Roe Spread 1 Sago 1 Sausagemeat 5 Sausage Whalemeat 1 Sausage Liver 1 Sausage Luncheon 1 Scone Mixture 1 Semolina 2 Soup 2 Soup Tablets 1 Soya Flour 1 Spice 2 Sponge Cake 1 Sponge Mixture 2 Sponge Roll 2 Sponge Sandwich 1 Suet Shredded Beef 1 Sugar (pieces) 1 Sweet, Chunk Chewing 1 Tartar, Cream of 2 Tapioca 1 Tea 3 Tomato Juice 1 Verox Cubes 9 Vinegar 1 Weetabix 1 212 36 All the 212 samples were reported to be genuine by the Public Analyst with the exception of the following:— Bacon—(Informal)—The fishy taste and smell which this sample possessed was so strong and objectionable as to make the bacon unfit for consumption. Bread—(Informal)—One sample was contaminated with dirty lubricating oil and was unfit for consumption. Milk—One sample was found to contain 17% of added water. Pepper—A sample submitted as 'White Pepper' although consisting of genuine pepper, was found to contain too high a proportion of pepper-husk to be properly described as 'white' pepper. Prosecutions. Proceedings were instituted in respect of the unsatisfactory milk sample quoted above. The producer-retailer concerned was also prosecuted for obstruction of the sampling officer. The Bench convicted on both summonses and imposed fines totalling £7. Os. Od. and costs of £2. Os. Od. Condemned Food. During the year the following foods were condemned by the Sanitary Inspectors as being unfit for human consumption:— Apple Puree 224 lbs. Bacon 20 lbs. 2 ozs. Barley Flakes 30 lbs. Bread 4 loaves. Cheese 35 lbs. 4 ozs. Chestnuts 59 lbs. Coffee 11 bottles. Confectionery 152 lbs. 10 ozs. Currants 50 lbs. Dates 149 lbs. Eggs 97. Fish 2,297 lbs. Jam, Marmalade, Syrup, Jelly, etc. 214 tins/jars. Meat 1,939 lbs. Miscellaneous Groceries 170 tins/jars. ,, ,, 86 packets. Oranges 3 cases. Paste 405 tins. Pearl Barley 20 lbs. Pickles 65 jars. Babbits 62(140 lbs.). Boiled Oats 32 lbs. Sauce 9 bottles. 37 Wrapped Bread. The compulsory wrapping of bread continues to engage public support, but it appears on adequate grounds to be at the moment impracticable. Few instances seem to be authenticated in which bread has actually been incriminated as a vehicle of infection and although its delivery as a wrapped product, naturally appeals strongly to one ; nevertheless this may incline forgetfulness of the fact that it is likely to be handled very considerably subsequent to its delivery and prior to its consumption. We should, therefore, co-incidentally emphasise the necessity for careful protection and delivery by the vendor and careful handling by the consumer. School Canteens. It tell to our lot during the year as a result largely of the outbreaks of Dysentery and Enteritis in schools noted elsewhere, to inspect with the School Medical Authorities, the school canteens affected. No doubt can exist as to the sense of responsibility felt by those in charge of such canteens and unfortunately, but quite unavoidably, the risk of some mishap must exist whether the canteen be attached to the school, a factory, or anywhere else, dealing with large numbers of diners. No standard can be too high for the hygiene routine as it relates to any establishment of this kind and repeated inspection, followed by a speedy remedying of any faults found, will, I think, go far to achieve and maintain the desired standard. It is in my view essential that the ncmber of meals supplied should be governed by the facilities which exist for supplying them, and not by the demand for them. Even in present circumstances it is, 1 think, essential that canteens should await the completion of extensions rather than that they should under unfavourable circumstances endeavour, in advance, to cope with the increased demand for meals which made their extension necessary. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Diphtheria. Last year it was noted that not a single case of this disease had occurred. The current year unfortunately opened with a fatal case within the first week. This case was of interest in showing how quite sporadically from no known cause a severe instance of the disease can occur, Tinned fish 333 tins Tinned fruit 236 tins Tinned meat (including Corned Beef) 889 tins Tinned milk 1,205 tins Tinned vegetables 488 tins 38 It is also of interest in that although it occurred in a house and in circumstances where any infectious disease might readily have been thought likely to spread, and in which the other children had not been immunised, nevertheless no further case of Diphtheria occurred. The arrangements for protection against this disease have now passed completely under the control of the Local Health Authority. Diphtheria Immunisation. During the period ending 4th July, 1948, 871 children (805 under 5, and 66 over 5) completed the course of two injections of A.P.T. with an interval of four weeks between each injection, and 507 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 up to the 31st December, 1948:— Age at 31.12.48 Number Immunised Estimated mid-year child population Percentage of children Immunised Under 1 58 9,094 51% 1 1,152 2 1,316 3 983 4 1,159 5 to 9 5,180 14,041 71% 10 to 14 4,840 Total under 15 14,688 23,135 63% Infantile Paralysis. 9 cases were notified as against 13 last year, the months of August and September again showing the greatest number of cases and one death resulting in each year. In the absence of a simple conclusive test the diagnosis of the abortive case and the control of spread is complicated and the premonitory symptoms of Poliomyelitis are common to so many illnesses as to render missed cases inevitable. Public awareness of the disease following upon last year's epidemic has undoubtedly resulted in medical advice being more readily sought, and whilst this has possibly increased the number of cases ascertained, it will correspondingly have reduced the chance of unwitting spread. Scarlet Fever. 116 cases occurred during the year, representing a decreased incidence of 6, as compared with 1947. In considering 92 of these cases in which circumstances render environmental analysis worth recording in this report, it appears that 44 of the cases occurred in households of four people (including the patient) ; 17 in households of 5 persons ; 15 in households of 3 39 persons; 12 in households of 6 persons; 1 in a household of 2 persons; and 3 in households of over 6 persons. So far as concerns the number of children—apart from the patient—in the affected households, it appears that in 42 instances there was not any child under 14 in the house; in 34 cases there was only one child under 14; in 13 cases there were only 2 children under 14; and only in 3 cases were there three or more children of this age. Even bearing in mind the relatively small families of the present age, 1 find it somewhat surprising that in 76 instances there should be only one other child or no other child under 14, apart from the patient, in the households involved. Duration of Isolation.—The hospital stay of the average case was 19.8 days, whilst the average home case was a stay of 30.5 days. In general the disease was of a mild type. When, for example, an opinion is asked for in regard to some person probably working and possibly the main support of a household, who has had a transient rash with trivial constitutional upset some time before, and in the absence of visible sequelae such as desquamation, it is very difficult to reconcile public health caution with, at the same time, due regard for the circumstances of the patient, and so mild is this disease in many present-day cases, that problems of this kind must very frequently present themselves. The necessary length of isolation for a home case must also present considerable difficulty and the variation in practice which is apparent on analysing any large number of cases is evident proof of the lack of precision on this point. It is perhaps worth recording that 3 cases of Scarlet Fever of a mild type developed after 12 children had attended a party.. It must be pointed out that no question of negligence on anyone's part by any means necessarily arises if, for example, children contract a disease of this nature after their attendance at some gathering. It is of course essential that should there be a case of infectious disease in a household, any social event in the house, especially for the younger members of the family should be deferred until a more auspicious occasion, but it may well be that there is in fact no indication that anything untoward is present and hence quite unwittingly infection may be contracted or carried. Irrespective, however, of social events, cinemas and the like, it must be recognised that it is quite impossible for anyone living a normal life to avoid daily exposure to disease of various types, and the object must therefore must be to eliminate quite unnecessary exposures. Dysentery. Work during the year on an extensive outbreak of Dysentery— of a Sonne type—at a local school. A full report has already been presented to the various Authorities interested, and it is not intended here to repeat the facts in detail. 40 I might, however, properly mention the difficulty of effectively controlling an outbreak of this kind, involving as it does, influencing the habits of a large number of persons who may have suffered only the slightest inconvenience through illness, but may nevertheless, remain for a variable and even lengthy period, a source of danger to others. The question may be asked as to whether, in an outbreak of this type, in which the danger to life in general is practically nil and even the feeling of personal illness is both transient and mild, the vast amount of routine work necessary even to keep in touch with the position accurately, is worth while. The answer is that the same mechanisms responsible for the outbreak of Sonne Dysentery might well be responsible for a similar outbreak caused by a. more dangerous germ. It is also imperative that whatever degree of public alarm has been caused should be allayed as quickly as possible, and this can well be assisted by a very obvious interest being manifested in the position by those responsible for dealing with it, i.e. by the Health Authorities. In addition, advantage can be taken of the occasion to emphasize to the public the necessity of adopting high standards of personal hygiene. Apart altogether also from the many contacts of cases which might of themselves have very little potential danger, it is inevitably found that a certain number of contacts are in fact employed in duties concerned with communal feeding—often in other widespread districts—and must therefore be dealt with appropriately to prevent the spread of infection far beyond the confines of the original outbreak. I feel that the negligible number of secondary cases which are thought to have occurred in our outbreak is largely due to the assiduous visiting and advice given to households affected and acted upon by them. On outbreak of Enteritis of an explosive and very transient type also occurred at another school in the district during the year, and was fully investigated and duly reported upon. In this instance no causative organism was discovered, but it was clearly established that no connection existed with the outbreak of Dysentery noted above. Infective Hepatitis. This disease is notifiable in this region and the case incidences in the three years ended 1948 show that 90 cases were notified in 1946, 47 in 1947, and 9 in 1948. This is, of course, a dramatic drop in the attack rate and even though, as in other diseases, the actual number of notifications may differ materially from the actual number of cases, it would appear to have some significance. Only two of the cases concerned involved adults and no two cases occurred in the same house. No spread occurred in one instance where a party was held within the period when the disease was in all probability capable of being transmitted from a person attending the party. 41 MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASE—1948. MONTH Scarlet Fever Diphtheria Poliomyelitis Pneumonia Erysipelas Dysentery Ophthalmia Neonatorum Infective Hepatitis Measles Whooping Cough Malaria Puerperal Pyrexia January 17 – – 4 3 1 – 1 37 41 – – February 16 1 1 1 5 – – 1 39 28 – – March 14 – – 5 1 – – – 15 17 – – April 12 – – 3 1 – – – 40 16 – – May 2 – – 2 2 – 1 1 82 25 – – June 4 – – 2 3 – – 1 37 16 – – July 9 1 – 1 1 – – – 75 41 – – August 12 – 4 1 3 1 – – 68 38 1 – September 8 – 3 – 2 – – – 18 12 – – October 6 – 1 2 1 58 – – 31 11 – – November 5 – – 5 2 61 – 4 7 29 – – December 11 – – 10 4 – – 1 136 33 – 1 Totals 116 2 9 36 28 121 1 9 585 307 1 1 42 AGE GROUPS OF INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS) NOTIFIED IN 1948. 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 58 58 – – 4 2 13 6 25 31 9 14 4 3 2 1 1 1 — — Dysentery 50 71 – 1 2 4 3 1 43 59 2 2 – – – 2 – 2 — — Diphtheria 2 – – – – – – – 2 – – – – – – – – – – – Poliomyelitis 7 2 – – – – 1 – 3 1 – – 1 – 2 1 – – – – Pneumonia 23 13 – 1 4 – – 3 4 2 – 1 – 2 7 – 5 2 3 2 Cerebrospinal Fever – – – – – – – – – – – – – – – – – – – – Erysipelas 15 13 – – – – 1 – – 2 – 1 2 1 3 3 6 5 2 2 Measles 292 293 12 12 61 43 57 69 152 155 7 6 – 6 3 2 – – – – Whooping Cough 158 149 16 9 48 39 45 45 44 51 3 – – 1 2 4 – – – – Enteric or Typhoid Fever – – – – – – – – – – – – – – – – – – – – Totals 605 599 28 23 119 88 120 124 273 301 21 24 7 13 19 13 12 10 5 4 43 TABLE SHOWING THE TOTAL NUMBER OF INFECTIOUS DISEASE CASES NOTIFIED IN EACH WARD DURING THE YEAR 1948. DISEASE Total Cases Notified WARDS No. of Cases Hospitalised Town Cranham Emerson Park Harold Wood Northwest Rainham Thameside Upminster Scarlet Fever 116 36 9 10 13 7 6 12 23 20 Dysentery 121 86 – 24 – 9 1 – 1 1 Diphtheria 2 – – – – – 1 1 – 2 Poliomyelitis 9 4 1 – – 2 1 1 – 9 Pneumonia 36 5 1 5 1 13 1 2 8 10 Erysipelas 28 5 – 1 – 4 10 2 6 5 Measles 585 109 2 15 16 134 125 86 98 10 Whooping Cough 307 57 5 28 14 75 55 17 56 8 Infective Hepatitis 9 1 – – 3 1 2 – 2 1 TOTALS 1,213 303 18 83 47 245 202 121 194 66 44 Tuberculosis. During the year 152 new cases (92 male and 60 female) of Tuberculosis were added to the register. These included 138 cases (84 male and 54 female) in which the respiratory organs were affected and 14 cases (8 male and 6 female) in which the infection was in some other part of the body. There were 44 deaths from this disease. The number of notifications for the year showed an increase of 25 as against the figure of the previous year. Males of the 15 to 20 year old group and of the 25 to 35 year old group showed respective rises of 5 and 16 and were largely responsible for this increase. Six more deaths from the disease occurred during the year in comparison with the 1947 figure. 13 of the deaths occurred within one year of notification and 9 cases were notified after death. This suggests that either the disease has run a very rapid course in many instances or that diagnosis has been made very late, probably a measure of both factors. Chemotherapeutic advances offer an interesting line of treatment, but early diagnosis of the condition—which may largely be secured by the seeking of early medical attention—remains of paramount importance. The Tuberculosis Register at the end of the year showed as follows :— Pulmonary— Males 324 Females 215 Non-Pulmonary— Male 52 Females 45 Pulmonary and Non-Pulmonary Total 636 It will be noted that the number of persons remaining on the register at the end of the year show a very considerable reduction on the corresponding figures for the previous year. A reminder should be given that whilst the register has a considerable value it does not in tact provide that precise information which its numerical content might suggest. The reduction noted is the result of very careful enquiry into the existing cases. Arrangements have also been made with the Chest Physician for the area which should ensure our being informed of any alterations in the register which might be initiated through him of, for example, persons leaving the district, being cured, and the like. 45 It is for a variety of reasons impracticable at any one time to be in possession of complete information on all cases on such a register, but a regular follow-up by the departmental staff will go far to maintain the general picture at its most informative level. It is interesting to note that during the year certain housing applicants were re-housed on the grounds of their suffering from an infective type of tuberculosis. Mass Radiography.—It is interesting to note from a review of some 89 of the pulmonary cases notified during the year (excluding transfers) that 8 of them came to light through mass radiography. Contact Infection.—In 18 there was apparently a definite association, at any rate in the minds of the family, between the case and some other sufferer from the disease. A relation had been notified in 15 of the 18 cases and rarely more than one relative had been affected. In the remaining 3 of the 18 cases non-relatives were mentioned, including, for example, a neighbour on terms of close friendship with the affected household. Housing.—It was observed that in 24 instances the inmates of the houses concerned included persons not apparently belonging to the. household immediately affected. Grandparents were not regarded as forming a normal part of the immediate family. As might be expected in a district of this character, the environmental circumstances of the cases were not significant, in that, in 69 instances the sufferer lived in a house comprising 2 living and 3 bedrooms, in 6 instances one living room and 2 bedrooms, whilst the accommodation for the remainder varied from one living room and one bedroom (3) to 3 living rooms and 4 bedrooms (1). Number in family.—The number of persons (including the patient) comprising the affected families varied from 3 in 27 instances, 4 in 18 instances, 5 in 17, 6 in 11, 7 in 7 down to 9 in 2, 8 in 1, etc. It appears to me interesting and unexpected to see that such a relatively high proportion of the affected households comprised only three persons, as this undoubtedly means that the housing conditions of a substantial number of the new patients are of a very satisfactory nature. These points are merely submitted as of passing interest but they do give a very general picture of the type of household affected, the effect of family history and the prevailing environment. I consider that in general the environment of tuberculosis sufferers in this district is likely to be and to remain of a satisfactory standard and with our present arrangement for according medical priority to housing applicants the position is one which makes it reasonably certain that all deserving cases receive sympathetic treatment. 46 NEW CASES AND DEATHS FROM TUBERCULOSIS, 1948. 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 ,, 4 2 – – 4 2 – 1 – – – 1 5-10 „ 1 2 1 1 2 3 – – – – – – 10-15 „ 2 – 3 2 5 2 – – – – – – 15-20 „ 9 12 1 3 10 15 1 2 – 1 1 3 20-25 „ 8 13 1 – 9 13 3 2 – – 3 2 25-35 „ 26 13 – 1 26 14 3 4 – 1 3 5 35-45 „ 13 5 – – 13 5 7 2 – – 7 2 45-65 „ 19 4 1 – 20 4 10 1 1 2 11 3 65 and over 4 1 – 4 1 2 – 1 – 3 – Totals 86 52 7 7 93 59 26 12 2 4 28 16 47 YEAR 1948—INTERVAL BETWEEN NOTIFICATION AND DEATH OF FATAL CASES OF TUBERCULOSIS. YEAR Within one month Prom 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 1948 4 4 2 3 4 4 2 12 9 44 TUBERCULOSIS NOTIFICATIONS—1938-1948. YEAR PULMONARY NON-PULMONARY TOTAL 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 1948 138 14 152 48 Non-Notifiable Diseases of Childhood. Head Teachers return a Form M.I. 13 showing children excluded as suspected contacts or suffering from suspected infectious 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. In addition, this form shows the cases of non-notifiable infectious disease occuring among school children during the year the number reported being as follows:— Chickenpox 348 Conjunctivitis 12 Gastro-enteritis 5 Impetigo 6 Mumps 358 Ringworm 7 Rubella 5 Scabies 6 These numbers must necessarily be accepted with reserve since they represent our only available, but not necessarily wholly accurate information. 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 23 45 0 0 Factories not included above in which Sec. 7 is enforced by L.A. 143 96 8 0 Other premises in which Sec. 7 is enforced by the L.A. 9 19 0 0 Total 175 160 8 0 49 2. Cases in which Defects were Found. Particulars. Found. Bemedicd. Beferred Prosecutions. To H.M. Inspector. By H.M. . Inspector. San. Conveniences (Sec. 7) (a) Insufficient 1 1 – – – (b) Unsuitable or defective 6 6 – 2 – (c) Not separate for sexes 1 1 – – Other offences against the Act 4 – 4 – – Total 12 8 4 2 – OUTWORK — Sections 110 and 111. Nature of Work. No. of out-workers in August list. Wearing Apparel— Making, etc. 38 No cases of default SECTION H. RAINFALL DURING THE YEAR. 1 am indebted to Mr. V. W. Williams, the Surveyor, for the subjoined information on rainfall as recorded at the two recording stations used during the year. Amount of rainfall in inches. No. of days in which rain fell. At Eastern Sewage Works :— January 2.53 19 February 1.02 11 March 56 3 April 1.30 11 May 1.28 9 June 2.01 15 July 78 6 August 3.53 11 September 76 6 October 1.58 10 November 1.62 12 December 1.62 11 18.59 127 50  Amount of rainfall in inches. No. of days in which rain fell At "Langtons":— January 3.01 22 February 1.37 13 March 40 7 April 1.60 12 May 1.93 12 June 2.32 15 July 89 8 August 4.13 16 September 1.08 10 October 1.79 12 November 1.74 13 December 1.74 20 22.00 160 51 INDEX. PAGE Acreage 8 Ambulance Service 18 Analysis of Mortality 14 Atmospheric Pollution—Graphs 23, 24, 25 Births 8 Birth Rate 8 —Comparative 13, 14 Bread, Wrapped 37 Canteens, School 37 Chiropody 17 Condemned Food 36, 37 Deaths 9 —Age Distributions 11 —Causes of 10, 12 —Infantile 9 —Maternal 14 —Puerperal 9, 14 Death Rate 9 —Civilian 14 —Comparative 12, 13, 14 —Infant 9, 14 Diphtheria 37, 38 —Immunisation 38 Disinfestation 26 Dysentery 39, 40 Enteritis 40 Factories Act, 1937— Forms 572 48, 49 Inspections 48 Defects 49 Outworkers 49 Food and Drugs Act, 1938— Section 13 33 Sampling 34, 35, 36 Hepatitis, Infective 40 Houses—Number erected 28 Number inhabited 8 52 INDEX (cont.). PAGE Housing— Applications 29 Overcrowding 28, 29 Rural 28 Slum Clearance 28 Temporary Dwellings 29 Ice Cream 32 —Registration 32 —Sampling 32,33 Infectious Disease— Age Incidence 42 Comparative 16 Non-Notifiable 48 Seasonal Incidence 41 Ward Distribution 43 Insect Pests 21 Insulin 19 Laboratory Facilities 18 Maternity and Child Welfare 18 Midwives 18, 19 Milk- Heat Treated 30 Production of Designated 30 Retailers 30 Sampling 30, 31 Special Designations 30 Supply 30 Tuberculosis: Veterinary Investigation 30 National Assistance Act, 1948, Section 19 National Health Service Act, 1946 16, 17 Nursing and Maternity Homes 18 Nursing in the Home 18 Office Accommodation 17 1'ennv Rate Product 8 Population— Comparative 9 Mid-year 8 Quarterly 8 Preface 7 Propaganda, Health 19 Rainfall 49, 50 53 INDEX (cont.). PAGE Rateable Value 8 Rodent Control 26 Sanitary Inspectors' Work—Summary 26, 27, 28 Scarlet Fever 38, 39 Smoke Abatement 22 Staffing 17 Staff 6 Staff—Superannuation Examinations 20 Statistics—Comparative 15 Still Births 8 Still Birth Rate 8 Tuberculosis— Comparative 47 Contact Infection 45 Housing 45 Incidence and Mortality 44, 45, 46 Mass Radiography 45 Notification Mortality Inte 47 Number in family 45 Waste Food Bins 26 Water 20 —Sampling 21