HORNC 17 Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1949 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 1949 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. •1 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 14 SECTION C—Sanitary Circumstances of the Area 15 SECTION D—Housing 20 SECTION E—Inspection and Supervision of Food 21 SECTION F—Prevalence of, and control over, Infectious Disease 28 SECTION G—Factories Acts, 1937 and H948. Ministry of Labour and National Service Form 572 37 3 MEMBERS OF THE COUNCIL. Councillor E. W. J. W. Busii, J.P., Chairman. Councillor A. Wheeler, Vice-Chairman. Councillor Mrs. R. J. Reynolds. ,, Mrs. E. G. Richardson. ,, Mrs. B. Vango. ,, E. E. Baxter. C. T. Boulter. B. E. E. Cannon. H. E. Chapman. ,, S. W. Collischon, C.C. W. E. Daubeney. W. M. Edwards. P. C. Ford. E. W. Fryd. ,, A. C. Holmes. ,, H. Holock. J. W. G. Hughes. ,, A. S. Hulkes. ,, E. Humphrey. C. E. Kingham. G. W. Lagden, C.C. A. G. Newman. P. I. Page. S. C. Parrish. A. C. Salinger, J.P. ,, S. M. Tucker. A. J. Twigger, 4 MEMBERS OF THE PUBLIC HEALTH COMMITTEE. Councillor S. C. Parrish, Chairman. Councillor Mrs. R. J. Reynolds, Vice-Chairman. Councillor C- T. Boulter. B. W. J. W. Bush, J.P. ,, S. W. collischon, C.C. ,, E. W. Fryo. ,, A. ft. Newman. ,, P. i. Page. ,, A. J. Twigger. ,, A. Wheeler. 5 OFFICERS OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: James Gorman, M.B., C'h.B., D.P.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, M.S.I.A. (2) & (3). Sanitary Inspectors: L. Acer, M.S.I.A. (1) & (3). T. W. Glew, M.iS.I.A. (2) & (3). S. Whitfield, M.S.I.A. (2) & (3). J. M. Williams, M.S.I.A. (2) & (3). Additional Sanitary Inspector: J. P. Barton, M.S.I.A. (2), (3) & (4). (Commenced duties 19.9.49). Clerical Staff: J. E. Blay (Chief Clerk). S. N. Dance. Miss E. M. Trinnaman (Shorthand-typist). (Resigned 24.4.49). Miss W. A. Hepburn (Shorthand-typist). (Commenced duties 3.5.49). Rodent Operative and General Assistant: C. A. Crookbain. (1) Sanitary Inspectors' Certificate of the Royal Sanitary Institute. (2) Sanitary Inspectors' Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Joint Board. (3) Certificate of the Royal Sanitary Institute as Inspector of Meat and Other Foods. (4) Certificate of the Royal Sanitary Institute as Smoke Inspector, 6 Public Health Department, Council Offices, Billet Lane, HORNCHURCH. 10th August, 1950. To tlie Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I beg to present to you the Annual Report of my Department for the year 1949, the main considerations being noted below and a more detailed report on certain aspects of the public health being embodied later. Vital Statistics. The civilian population of the district is 102,300 at mid-year 1949. The birth rate at 16.0 is the lowest post-war figure recorded and continues the post-war fall. It is also slightly below the average for the country generally. The death rate at 10.6 is the highest post-war rate but this year the Area .Comparability Factor (which has the effect of standardising the national figures but of raising the Hornchurch local figure) has again been introduced. There is nevertheless a slight rise in this rate. The infant mortality rate of 17.6 is the lowest figure yet recorded in this district in this connection. Whilst the causes of infant deaths are so varied and are in the present state of our knowledge far from wholly preventable, some annual fluctuations in this rate are to be expected, but this year's figure is outstandingly satisfactory, compared for example witli the figure of 32 which applies to the country as a whole. Infectious Diseases. The Tuberculosis death rate has dropped, as has the number of notifications. Scarlet Fever notifications have risen ; Measles rose steeply and Whooping Cough showed reduction—all during the year. The Infantile Paralysis incidence dropped very slightly as compared to 1948. Food and Drugs. Following an application under Section 64 of the Food and Drugs Act, 1938, the Minister of Health, as from 1st November, 1949, approved this Authority as a Food and Drugs Authority. This represents a recognition of real significance which comes at a time when it is becoming increasingly difficult for any but the 7 largest Authorities to retain the powers they have, far less to add to them, and it marks a milestone in this Council's progress as a Sanitary Authority. The question of food hygiene received our especial attention and noteworthy in this connection is the agreement we reached with the Local Education Authority whereby the arrangements obtaining in local school canteens fell to be inspected by us and considered subsequently by both ourselves and the said Authority. Housing. Such slum property as exists in the district cannot yet receive adequate attention and the housing problem still largely relates to overcrowding and the subsequent complications which arise therefrom. This Authority is making rapid progress with its re-housing plans and any medical considerations relating to housing applications receive a full measure of consideration when the relative priorities are assessed. General. The general sanitary circumstances of the district, including, for example, water supply, sewerage conversions and the like, receive our constant supervision. The district is favoured by having a number of well maintained and developed open spaces which are being developed as rapidly as the present difficult circumstances will permit. Such amenities must go far to maintain the well being of our population. The addition of further amenities, e.g. swimming baths, are far from escaping the attention of the Council, but again must of necessity await the advent of more favourable times. Administration. It is worthy of particular note that late in the year I undertook as a temporary measure, duties which entailed my being Deputy to the Area Medical Officer. This secured a very desirable integration of our local sanitary services with those provided by the Local Health Authority. It could not of course be achieved without having its effect upon our existing administrative arrangements and apart from any personal repercussions it clearly entails the bearing of considerable added responsibility by the Senior Sanitary Inspector. Acknowledgements. My best thanks are due especially to the Chairman of the Public Health Committee as well as to the members of the Council generally and to my colleagues in my own and other departments for the plenitude of their co-operation during the year. I am, your obedient servant, James Gorman, M.B., Ch.B., D.P.H., Medical Officer of Health. 8 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres (including half of tidal basin) 20,308 Registrar-General's estimate of the civilian population (mid-year) 1949 102,300 Registrar-General's estimate of total population (including non-civilians stationed in the area) (midyear) 1949 103,000 Registrar-General's estimate of civilian population at 31st December, 1949 102,750 Number of inhabited houses (September, 1949) according to Rate Books 27,911 Rateable Value (September, 1949) £735,158 Sum represented by a Penny Rate (September, 1949) £2,950 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 1,640 (871 males, 769 females) Birth rate per 1,000 civilian population 16.0 Number of still births registered in the District as supplied by the Registrar-General and adjusted for inward and outward transfers 40 (20 males, 20 females) Still Birth Rate per 1,000 civilian population 0.39 Still Birth Rate per 1,000 total (live and still) births 23.8 Deaths. Number of deaths occurring in the District:— Residents 596 Non-residents 438 Number of deaths of residents occurring outside the District 319 Total number of deaths of Hornchurch residents adjusted for inward and outward transfers as compiled locally 915 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 using area comparability factor calculated for the purpose of securing comparability between local death rates 10.6 9 Puerperal Deaths :— (a) from Sepsis 0 (b) from other maternal causes 1 Deaths of Infants under one year of age 29 Infant Mortality Rate (per 1,000 live births) 17.6 Deaths from :— Male. Female. Cancer 97 83 Diabetes 2 2 Diarrhoea (under 2 years) 0 0 Influenza 4 5 Pneumonia 16 15 Measles 1 0 Whooping Cough 0 0 Diphtheria 0 0 REGISTRAR-GENERAL'S ESTIMATE OF THE MID-YEAR POPULATION SINCE EXTENSION OF THE URBAN DISTRICT. Year. 1934 55,798 1935 59,910 1936 64,447 1937 72,010 1938 76,000 1939 81,620 1940 81,050 1941 79,750 Year. 1942 83,870 1943 83,520 1944 81,840 1945 84,430 1946 95,460 1947 99,660 1948 101,000 1949 102,300 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 494 420 1. Typhoid and paratyphoid fevers 0 0 2. Cerebro-spinal fever 2 4 3. Scarlet fever 0 0. 4. Whooping Cough 0 0 5. Diphtheria 0 0 6. Tuberculosis of respiratory system 20 13 7. Other forms of tuberculosis 2 0 8. Syphilitic diseases 1 1 9. Influenza 4 5 10. Measles 1 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) 8 13 14. Cancer of stomach and duodenum 8 13 15. Cancer of breast 0 14 16. Cancer of all other sites 74 52 17. Diabetes 2 2 18. Intra-cranial vascular lesions 44 72 19. Heart diseases 136 117 20. Other diseases of circ. system 16 19 21. Bronchitis 39 26 22. Pneumonia 16 15 23. Other respiratory diseases 4 2 24. Ulcer of stomach or duodenum 13 0 25. Diarrhoea under 2 years 0 0 26. Appendicitis 4 2 27. Other digestive diseases 6 4 28. Nephritis 11 7 29. Puerperal and post-abortion sepsis 0 0 30. Other maternal causes 0 1 31. Premature birth 8 1 32. Congenital malformation, birth injury, etc. 13 8 33. Suicide 3 0 34. Road traffic accidents 9 2 35. Other violent causes 5 3 36. All other causes 36 33 11 DEATHS IN CERTAIN AGE GROUPS DURING WHOLE YEAR (Local Figures). Age No. of deaths. Under 1 year 29 1 and under 2 3 2 „ „ 5 8 5 „ „ 15 10 15 „ „ 25 14 25 „ „ 35 21 35 „ „ 45 49 45 „ „ 55 85 55 „ „ 65 153 65 ,, „ 75 223 75 ,, „ 85 240 85 „ „ 95 74 95 ,, ,, 100 5 100 and upwards 1 Total 915 DEATH RATE—COMPARISON WITH PREVIOUS YEARS. 1938 8.9 1944 9.2 1939 7.8 1945 9.9 1940 9.4 1946 9.0 1941 9.6 1947 8.3 1942 7.9 1948 8.2 1943 8.9 1949 10.6 BIRTH RATE—COMPARISON WITH PREVIOUS YEARS. 1938 19.7 1944 11.9 1939 18.9 1945 18.4 1940 16.4 1946 21.3 1941 15.5 1947 20.7 1942 17.5 1948 17.2 1943 19.0 1949 16.0 12 BIRTH RATES, CIVILIAN DEATH RATES, ANALYSIS OF MORTALITY AND MATERNAL MORTALITY, 1949. Local figures compared with England and Wales and certain towns. 126 C.B.s 148 Smaller England and Great Towns London and Towns (Resident Pop. Admin. Hornchurch. Wales including 25,000-50,000 County. London. at 1931 Census). Rates per 1,000 Civilian Population. Births— Live Births 16.7(a) 18.7 18.0 18.5 16.0 Still Births 0.39(a) 0.47 0.40 0.37 0.39 Deaths— All Causes 11.7(a) 12.5 11.6 12.2 10.6 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 — Whooping Cough 0.01 0.02 0.01 0.01 — Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.45 0.52 0.42 0.52 0.34 Influenza 0.15 0.15 0.14 0.11 0.08 Smallpox 0.00 0.00 — — — Acute poliomyelitis & Polioencephalitis 0.01 0.02 0.02 0.01 0.00 Pneumonia 0.51 0.56 0.49 0.59 0.30 Rates per 1,000 Live Births. All causes under 1 year of age 32(b) 37 30 29 17.6 Enteritis and Diarrhoea 3.0 3.8 2.4 1.7 — Maternal Mortality : Rates per 1,000 Total (Live and Still) Births. Abortion with Sepsis 0.11 — Abortion without Sepsis 0.05 — Puerperal infections 0.11 — Other maternal causes 0.71 0.59 A dash (—) signifies that there were no deaths, (a) Rates per 1,000 total population. i(b) Per 1,000 related live births. 13 NOTIFICATION RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1949. (Eates 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. Typhoid Fever 0.01 0.01 0.01 0.01 Paratyphoid Fever 0.01 0.02 0.01 0.01 0.01 Cerebro-spinal Fever 0.02 0.03 0.02 0.02 0.06 Scarlet Fever 1.63 1.72 1.83 1.46 2.06 Whooping Cough 2.39 2.44 2.39 1.70 2.84 Diphtheria 0.04 0.05 0.04 0.07 0.02 Erysipelas 0.19 0.20 0.19 0.17 0.16 Smallpox 0.00 0.00 0.00 0.00 — Measles 8.95 8.91 9.18 8.54 16.80 Pneumonia 0.80 0.91 0.65 0.55 0.47 Acute Poliomyelitis 0.13 0.13 0.12 0.18 0.08 Acute Polioencephalitis 0.01 0.01 0.02 0.01 0.01 Food Poisoning 0.14 0.16 0.14 0.19 0.04 Eates per 1,000 Total (Live and Still) Births. Puerperal Fever and and Pyrexia6.31 8.14 -5.30 6.82 2.3 A dash (—) signifies absence of notifications. 14 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staff. As authorised an Additional Sanitary Inspector has been appointed and has assisted greatly in expediting action in regard to certain aspects of our work, notably inspection of factories and food premises. My participation in Area administration has been noted earlier. It is, of course, of a temporary nature, represents a departure from precedent so far as concerns this Authority and also entails duties of a responsible nature quite additional to those of a Medical Officer of Health for this Council. 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. Samples of water, sewage and trade effluents, milk, ice cream, other foods and shellfish, are examined at The Counties Public Health Laboratories, 66 Victoria Street, London, S.W.I, in accordance with arrangements made by the Essex County Council. Ambulance Service. The County Ambulance Service maintains a day and night service at their ambulance station in Billet Lane, Hornchurch. 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. (iii) Upminster Road, Rainham. (iv) Athelstan Road, Harold Wood. (v) St. Laurence Hall, Upminster. (vi) Rainsford Way School, Hornchurch. Nursing and Maternity Homes. There are 5 registered Nursing and Maternity Homes in the district. 15 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 4 District Nurse-Midwives, 2 Independent Midwives and 1 Independent Maternity Nurse practising in the area. Nursing in the Home. In addition to the District Nurse-Midwives there are 4 District Nurses working in the district. National Assistance Act, 1948, Section 47. No action was taken during the year under this head. Superannuation Examinations—Staff. The services of private practitioners are secured for these examinations save in instances where an existing employee's suitability for continued employment is in question, which examinations are carried out by the Medical Officer of Health. During the year arrangements were made for the examination of 230 employees or prospective employees (59 permanent and 171 temporary). SECTION C. SANITARY CIRCUMSTANCES OF THE AREAWater. A main supply was provided during the year to premises (including cafes) on the Southend Arterial Road, A.127. Efforts were continued to secure a similar provision for certain parts of the rural portion of Upminster. 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 3,800 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. 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. 16 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 last, was 29,112 and the population as at 30th June, 1949, as obtained from the Registrar-General, was 103,000." Approximately 0.6 per cent, of the inhabitated houses, and 0.6 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 11 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. The water is very hard in character though not to an excessive degree, contains no excessive saline or mineral constituents in solution, and is of satisfactory organic quality. These results are consistent with a water which, from the aspect of a chemical analysis, is wholesome in character and suitable for drinking and domestic purposes." 5 samples of well water were taken during the year and submitted to the Counties Public Health Laboratories for bacteriological and chemical examination. The results as were to be expected, were variable. Fortunately, although this is important, only a very small percentage of our population is supplied other than from the mains, but it is recognised that shallow wells are not likely to be a suitable source of any domestic water supply and it will be our endeavour as soon as opportunity permits to deal with such sources in a manner other than by merely advocating boiling. Insect Pests. A full note on this matter was made last year. Complaints have arisen during the unusually good weather we had in the summer of 1949 that the house fly was unusually prevalent. It may be assumed that we will take immediate steps to deal with any reservoir of infection which may exist in the area but it should be emphasised that every householder can provide a valuable contribution to the house fly problem byensuring that the said flies are not encouraged to frequent houses through careless habits in relation to food and the like. Smoke Abatement. Arrangements continue as last year. 60 visits were paid to the various sites throughout the district in addition to which 596 analyses were made in connection with the Volumetric SO 2 17 apparatus maintained at the Public Health Offices. A comprehensive report was presented to you during the year. The main cost of atmospheric pollution research for us is that of Analysts' fees and if this important public health problem is to receive widespread investigation and sympathy some more economical method of having samples analysed should be sought. This might well engage the attention of the appropriate Government department and might be pursued to the point of keeping under constant review the possibility of arranging such analyses under the auspices of the Department of Scientific and Industrial Research who are after all assisted by the work of the local authorities in this connection. River Thames. Complaints arose during the year which appear to have their origin in an unsatisfactory condition of the River Thames. They were thought to have a certain basis in the unusual conditions of drought and high temperature which obtained during the summer and the question of prevention is being actively pursued by the various Authorities concerned. Drainage. Some 17 properties were converted from pail to water closet and sewer at the joint expense of owner and Council and similar action is proceeding in respect of others similarly placed. Only an insignificant number of houses in the urban part of our area is not provided with W.C.s, although cesspools are unavoidably present in a minority of instances. Practically every cesspool seems to be a potential nuisance and their avoidance where it is at all possible is a course of obvious choice. Whatever be the legal position, from a practical viewpoint a cesspool is not an effective substitute for a sewer. 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 2,053 visits and cleared 82 infestations up to the end of the year. In addition routine baiting of the Council's refuse tips was carried out during the year. A charge of 2s. fid. is made for dealing with infestations on private premises and 5s. Od. for minor infestations on business premises. 18 The Eats and Mice (Destruction) Act, 1919, is the main statute under which in the past these duties have been performed. This Act will be repealed by the Prevention of Damage by Pests Act, 1949, which comes into force on the 31st March, 1950, and gives additional powers to Local Authorities, including the Hornchurch Urban District Council, to deal with infestations of rats and mice. It will then be the duty of occupiers of premises to give written notice to the Council when they have knowledge that rats or mice are present in substantial numbers. Sanitary Inspection of the District. Increased visits to food premises of all kinds and to factories are noteworthy features and the work in general has fully maintained the standard of last year. SUMMAEY OF SANITABY INSPECTOES' WOEK DUEING 1949. Inspection of Food— Bakehouses—visits paid 73 Butchers' shops—visits paid 236 Cafes—visits paid 269 Cowsheds—visits paid 87 Dairies—visits paid 140 Fish shops—visits paid 171 Food vehicles—number inspected 54 Greengrocers' shops—visits paid 10 Grocers' shops—visits paid 335 Ice Cream Dealers' premised—visits paid 304 Samples taken 159 Sausage factory—visits paid 8 School canteens—visits paid 19 Staff canteens—visits paid 25 Sweet Manufacturers' premises—visits paid 6 Miscellaneous visits 67 Housing— Drainage of houses—visits paid 407 Environmental reports (housing applicants) 112 Overcrowding enquiries 130 Permitted Number—visits paid 61 Sanitary fittings—visits paid 56 Structural defects—visits paid 918 19 Waterpipes and water supplies—visits paid 22 Re-inspections 2,161 Miscellaneous visits 10 General Sanitary Circumstances— Accumulations—visits paid 146 Camping grounds, vans, etc.—visits paid 147 Drainage and sewerage—visits paid 277 Dustbins—visits paid 180 Fair grounds—visits paid 6 Insect pests, etc-—visits paid 16 Keeping of animals and birds, etc.—visits paid 133 Massage and special treatment establishments—visits paid 9 Public conveniences and public house urinals—visits paid 35 Refuse tips—visits paid 108 Rodent and vermin infestation—visits paid 247 Schools;—visits paid 28 Smoke nuisances—visits paid 27 Unclean premises—visits paid 22 Watercourses1—visits paid 44 Water samples taken 16 Wells—visits paid 36 Re-inspections 165 Miscellaneous visits 66 Factories and Outworkers— Number of visits paid 452 Shops Acts— Number of inspections 71 Infectious Diseases— Visits paid (including contacts) 956 Disinfections 28 Number of Notices served— Informal Statutory 586 73 20 SECTION D. HOUSING. Number of new houses erected during the year. 25 houses were completed during the year 1949 by private builders. The Council erected 365 houses during the year and 31 houses were rebuilt as a result of destruction by enemy action. 14 houses were erected by other local authorities during the year. Hornchurch retained its place as the leading Urban District in England and Wales for housing completion during the year, a lead which has been maintained since the end of the war. Overcrowding. This problem is bound to be decreasing in degree as a result of our very active building programme which reduces the number of bad cases slowly but surely. In .common fairness, however, it must be established that good reasons exist before such cases are given high pointage as otherwise self-created and quite unjustifiable overcrowding would form a passport to priority at the expense of more deserving if less astute applicants. 130 visits were made by the staff to deal with overcrowding enquiries. Slum Clearance. Individual cases have been cleared up and houses demolished but no present opportunity exists for a radical attack on this problem which, however, is of no great local dimensions. Week-end bungalows constitute a special class which will require careful review varying as they do so widely in standards of construction. Medical Priorities. My advice was sought in 444 instances in which the medical aspect of a housing or building licence application was emphasized. 112 visits were made by the staff to investigate points of doubt in this regard. It should be ensured that when a licence is granted for a new house to be built due regard is paid to the future—or lack of it— of the less satisfactory structure often on the same site as a new building and temporarily occupied by the applicant during the construction of the new building. Clearly if the temporary structure was satisfactory little justification could under present circumstances exist for supplanting it and hence its cessation as a human habitation requires very careful preliminarv attention. 21 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Act, 1938. The fact that as from 1st November, 1949, we became a Food and Drugs Authority has been noted earlier. This greatly increases our responsibilities as they relate to the supervision of the quality of our local food supplies and co-ordinates the general scheme of food supervision in our area. Mr. Gr. Taylor and Dr. J. H. Hamence of Dr. Bernard Dyer and Partners were appointed Public Analysts. We are indebted to the County Council as the previous Food and Drugs Authority for making the take-over a Smooth one and for the assistance they willingly afford in cases involving both our Authorities. The number and variety of samples taken, which are noted below, suggest that we have made a satisfactory start with our new responsibility. The following samples were taken by officers of the Public Health Department during the period 1st November to 31st December, 1949:– Article. No. of Samples. Satisfactory– Cloves 1 Coffee and Chicory Essence 1 Doughnuts 1 Elixir of Quinine, Hydrochloride and Oil Cinnamon 1 Extract of Malt and Cod Liver Oil 1 Gee's Linctus 1 Ice Cream 4 Lemon Flavouring 1 Malt Vinegar 1 Medicinal Liquid Paraffin 1 Milk 31 Mint 1 Parrish's Food 1 Pectoral Balsam 1 Pepper 1 Sauce, Thick 1 Sausage, Beef 3 Sausage Meat, Beef 3 Syrup of Figs 1 Tomato Ketchup 1 57 22 Article. No. of Samples. Unsatisfactory– Milk 1 Salad Cream 1 The unsatisfactory sample of milk was found to contain added water to the extent of 4%. The Council sent a warning letter to the retailer concerned. The Food Standards (Salad Cream and Mayonnaise) Order, 1945, requires that salad cream shall contain not less than 25% by weight of oil. The sample in question was found to contain only 22% by weight of oil and was, therefore, deficient in oil to the extent of 3%–this deficiency being equivalent to 12% of the minimum quantity of 25% of oil required by the above mentioned Order. I am indebted to Mr. F. W. Horsnell, the Chief Inspector, Weights and Measures, etc., Department, of the Essex County Council, who has kindly supplied the following particulars of samples taken by his department within the Urban District during the period 1st January to 31st October, 1949:– The following samples were taken and found to be genuine:– Article. No. of samples. Arrowroot 1 Aspirin Tablets 1 Beef Cubes 1 Bread 1 Brompton Tablets 1 Bubble Gum 1 Butter 14 Cereal Beverage 1 Chocolate Cup Tablets 1 Chocolate Cream-filled Biscuits 1 Chocolate, drinking 1 Choco-Sandwich Biscuits 1 Chocolate Wafer 1 Coffee and Chicory Cubes 1 Coffee and Chicory Extract 1 Coffee, Pure 1 Confectionery,– Almond Creams 1 Almonds, Sugared 1 Lime Fruits 1 Liquorice Allsorts 1 Liquorice Comfits 1 Milk Chocolate 1 Nutty Crunch 1 Park Lane Assortment 1 Sweets 1 23 Article. No. of samples. Currants 1 Custard Powder 5 Dessert Sauce Powder 1 Drink Powder 1 Eggs, Dried 2 Fat, Cooking 1 Fat, Sweetened 1 Fizz Powder 1 Fizz Sherbet 1 Flour, Bun 1 Flour, Cake 1 Fruit 1 Ginger, Crystallised 2 Gravy Powder 1 Jellies, Table 3 Lemonade Crystals 1 Lemonade Powder 2 Mayonnaise 1 Meat, Whale 1 Melba Toast 1 Milk 38 Mix, Golden Pudding 1 Mixture, Pastry 3 Mixture, Sponge Pudding 1 Peel, Cut 1 Peel, Cut Mixed 1 Pepper 1 Pepper, White 7 Popcorn 1 Potato Crisps 2 Quoffy 1 Saccharin Tablets 2 Salts, Health 1 Sausage, Beef 2 Sausage, Liver 2 Sausage, Luncheon 1 Sausage, Pork 1 Sausage, Pork and Beef 1 Sausage Meat, Beef 1 Stuffing, Sage and Onion 2 Suet, Beef 2 Suet, Shredded Beef 1 Sugar 1 Tea 3 Tea-time Tablets 1 Vinegar, Malt 1 Whisky, Liqueur 1 Yeast Extract 1 148 24 The undermentioned samples were taken and found to be unsatisfactory and resulted in the following prosecutions :– Milk. Two samples contained 7% added water. The vendor of these samples was summoned under the Food and Drugs Act, 1938. The defendant in turn summoned the driver under Section 83 (3) of the Act. The charge against the original defendant was dismissed but the driver was fined £5. 0s. Od. Two further samples contained 9% and 13% of added water respectively. The vendor was the same in each case and he was summoned under the Food and Drugs Act. A conviction was obtained and he was fined £15 and ordered to pay £3. 3s. 0d. costs. Steak. Two samples which had been sold as steak were found on analysis to be horseflesh. The vendor was summoned for contravention of the Food and Drugs Act, 1938, and was fined a total of £6. 0s. 0d. Doughnuts. These were found on analysis to contain mineral oil which is prohibited as an ingredient in food-stuff under the Mineral Oil in Food Order, 1949. The vendor was summoned and fined £5. 0s. 0d. and ordered to pay £9. 9s. 0d. costs. Pastry Mix. A sample was found to contain only 20% of fat instead of 45% as stated in an accompanying notice. The defendant was summoned under the Defence (Sale of Food) Regulations, 1943, and fined £4. 0s. 0d. He was also ordered to pay £1. 1s. Od. costs. Food and Drugs Act, 1938–Section 13. 17 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. Condemned Food. During the year the following foods were voluntarily surrendered to the Sanitary Inspectors as being unfit for human consumption:– Bacon 20 lbs. 5½ ozs. Barley 50 lbs. Butter 9 lbs. 12 ozs. Cheese 63 lbs. 6½ ozs. Confectionery 7 lbs. 8 ozs. Cooking Fat 20 lbs. Currants 30 lbs. Dates 26 lbs. Dried Peas 131 lbs. 8 ozs. Eggs 77. Fish 1,308 lbs. 8 ozs. Ice Cream Powder 20 lbs. Jam/Marmalade 35 jars. 25 Margarine 53 lbs. Meat 466 lbs. Meat Pies 541. Miscellaneous Groceries 58 lbs. 6 ozs. Oats 55 lbs. Oranges 375 lbs. Paste 8 lbs. 1 oz. Pickles 51 jars. Raisins 210 lbs. Sauce 43 bottles. Spaghetti 30 lbs. Suet 12 lbs. 8 ozs. Sugar 791 lbs. Syrup 69 lbs. Tea 6 lbs. Tinned Fish 370 tins. Tinned Fruit 166 tins. Tinned Jam 26 tins. Tinned Marmalade 23 tins. Tined Mead (including Corned Beef) 346 tins. Tinned Milk 1,129 tins. Tinned Pudding 22 tins. Tinned Soup 89 tins. Tinned Vegetables 590 tins. Turkey 7 lbs. 8 ozs. Milk Supply. The Milk and Dairies Regulations, 1949, came into force on 1st October, 1949, and as from that date the responsibility for supervising our 21 farms passed to the Ministry of Agriculture and Fisheries. This 1 greatly regret, since I feel that an Authority as interested in the work as we were could exercise a ready and valuable influence in achieving and maintaining high local standards of milk production. To regret the diminution of direct local control is not always to evince parochialism, and the relative remoteness and impersonality of a central authority dealing directly with the smaller units of a scheme makes unusually onerous their task of exercising effective and sympathetic local control. It was found necessary to serve informal notices in two cases for infringements of the Milk and Dairies Regulations, 1926-1943. There are 14 milk retailers with registered premises in the District, including 4 producers who are registered both as producers and retailers. There are also 4 persons registered as milk retailers in Hornchurch whose premises are registered in neighbouring districts. 26 At the beginning of the year there were 6 dairy farms licensed by the County Council for the production of Accredited milk and 6 licensed for the production of Tuberculin Tested milk, one of the latter also being licensed to bottle. The control of these farms also passed to the Ministry of Agriculture and Fisheries on the 1st October, 1949. The Milk (Special Designation) (Raw Milk) Regulations, 1949, and the Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949, came into force on 1st October, 1949, and reenacted with amendments the provisions of the Milk (Special Designations) Regulations, 1936 to 1948. The number of licences issued by the Council was as follows:– Dealer's (Pasteuriser's) 2 Dealer's Pasteurised 19 Supplementary's Pasteurised 4 Dealer's Sterilised 37 Supplementary Sterilised 5 Dealer's Tuberculin Tested 16 Supplementary Tuberculin Tested 4 Dealer's Accredited 1 The 2 pasteurising establishments were regularly inspected and the pasteuring plants thoroughly tested prior to the issue of the necessary licences. Routine samples of the milk from these plants are taken approximately each week and during 1949 the results obtained were very satisfactory. Milk Sampling. The 68 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 Counties Public Health Laboratories for bacteriological examination. 10 samples failed to satisfy the prescribed tests and the necessary follow-up action was taken. 16 reports were received from the County Medical Officer on samples taken during the year from a retailer's premises in this district under the Heat-Treated Milk (Prescribed Tests) Order, 1944. Registration of Manufacturers and Vendors of Ice Cream. Ice cream manufacturers, vendors and premises 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 62 applications for registration (1 manufacturer, 61 vendors) were granted. At the end of the year, 17 persons were registered as manufacturers and 182 as vendors. 27 Since the coming into operation of the Ice Cream (Heat Treatment, etc.) Regulations, 1947 and 1948, there has been a gradual improvement in the purity of ice cream sold in Hornchurch. More than 3 times as many samples were taken in 1949 as compared with the previous year, 86% being classed as Grade I or II as compared with 65% for 1948. All sources of manufacture were sampled and particular care was taken in obtaining samples from itinerant vendors throughout the district. Ice Cream Sampling. During the year under review 105 samples of ice cream were examined at the Counties Public Health Laboratories, of which 10 were unsatisfactory. Appropriate action was taken in the case of the unsatisfactory samples. Preserved Food Manufacturers. Section 90 of the Hornchurch Urban District Council Act, 1936, requires registration of preserved food manufacturers and premises. 3 applications for registration as preserved meat manufacturers were granted during the year. At the end of the year, 47 persons and premises were registered for the manufacture of preserved meat (sausages). Clean Food. A considerable amount of time–principally by the Additional Sanitary Inspector and far in excess of last year–has been devoted by your staff to this section of our work. A visit was paid to Guildford to investigate the formation of Guilds. A meeting was held with the local Chamber of Commerce and Co-operative Societies to discuss local conditions and plans. A special exhibit was shown at our "Three Towns' Show" and attracted a large public interest. The Ministry of Food Circular 18/49 outlining Model Byelaws on Handling, Wrapping and Delivery of Food and Sale of Food in the Open Air was discussed by the Public Health Committee and was adopted by you. In addition to all this and to the various forms of propaganda which we employ, no opportunity is neglected by the Sanitary Inspectors in the course of their daily work of encouraging and insisting upon the highest standards of food production. Individual variations of performance are inevitable in a district of our size, but it is our intention rigorously to pursue a policy of supervising carefully and advising readily. School Canteens. By agreement with the local Education Authority we now operate a scheme whereby visits to all the local school canteens forms part of our routine work. Detailed reports are submitted to the local Education Authority . 28 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. In general the picture is that Scarlet Fever cases rose from 116 to 211 as against the previous year; Measles rose from 585 to 1,719; Whooping Cough dropped from 307 to 291. Sporadic outbreaks of limited extent and transient duration characterised by Enteritis and vomiting occurred at one or two schools, but after a lightning onset and diminution left with a cause unascertained and no lasting ill-effects evident. Infantile Paralysis showed a very slight decreased relative incidence as compared to last year – 9 cases occurred – 6 of these did not show any paralysis. 3 had paralysis of varying degree which persisted until the end of the year at which time treatment was still being continued. It should be emphasized that improvement can continue for many months if not even for years after the onset of the disease. Whilst this number of cases does not represent an epidemic, all precautions of known value were taken and contacts were followed up carefully. I believe that the normal habits of the community should only be disrupted if there is strong evidence that the preventive benefits likely to accrue are commensurate with the interference caused. Our knowledge of Poliomyelitis is admittedly limited but this by no means outmodes the application of ordinary hygienic practice. Personal hygiene, hand-washing, e.g. before meals, avoidance of crowds during an epidemic, generous house ventilation–these and many other simple precautions are of value. The public health authority can and do advise, but only the individual can practise. Scarlet Fever. The type of disease remains very mild with few complications. Missed cases must in these circumstances be numerous. Isolation of the individual probably assists in preventing spread but I consider it doubtful whether really strict home isolation can be practised for long in any large household irrespective of the excellent intentions of many of the occupants. In addition the period of isolation from this disease has lessened of late years and cannot be defined with conviction since routine swabbings is impracticable–and in any event of limited value. The date of release often depends upon the views of the attending practitioner and with certain reservations this policy may gain in practical merit what it lacks in theoretical justification. 29 Cases connected with communal services of any kind, or contacts with similar associations especially where the catering trade is involved, present of course a problem which should be and is tackled immediately and vigorously. Measles. This was an epidemic year and we had 1,719 cases, with one death. A few (15) required hospitalisation. No generally acceptable preventive inoculations are yet available. Whooping Cough. This disease again assumed a mild form and no fatalities resulted from the 296 cases which occurred. It appears likely that some authoritive guidance on the efficacy of preventive vaccine will shortly be to hand. Diphtheria. It is curious to note that 3 cases occurred in the same month and almost at the same time. These involved sisters of 2 and 11 years who developed the disease coincidentally and a female of 20 quite unconnected with the other cases. None of the cases had been immunised; all remained in hospital about 6 weeks and recovery was complete. Contact Supervision. Contacts not only of local cases but of others occurring elsewhere but with local associations are supervised by us, and one feels that this is a service of value even although few contacts appear actually to develop the disease. It should be emphasized–one wonders if it is generally appreciated–that infectious disease supervision, if it is to be effective, must be immediate and continued whether the period involved is within or without office hours or during holidays. This throws a very considerable and continued responsibility upon your staff and I would acknowledge the ungrudging service given by all my Sanitary Inspectors and especially the Senior Sanitary Inspector, Mr. Randall, in this connection. The responsible senior public health officer who is enabled to work "office hours only" is as yet unknown to me. 30 MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASE–1949. MONTH Scarlet Fever Diphtheria Poliomyelitis Pneumonia Erysipelas Dysentery Food Poisoning Infective Hepatitis Measles Whooping Cough Cerebrospinal Fever Puerperal Pyrexia Polio- Encephalitis Paratyphoid January 15 – – 4 2 – – – 362 18 – 1 – –– February 13 – – 12 1 – – 3 537 6 3 1 1 –– March 11 – – 8 1 – – 2 390 9 – – – – April 8 – 1 6 – – – 4 226 14 1 1 – – May 14 – – 3 4 – – 5 93 37 1 – – – June 24 – – 4 2 – 1 2 73 25 – 1 – – July 16 – – 4 1 – – – 22 50 1 – – – August 10 – 3 1 1 – – – 8 40 – – – – September 11 3 2 2 1 – 4 2 2 36 – – – 1 October 17 – 2 1 1 – – 3 – 16 1 – – 1 November 32 – 1 – 1 1 – 3 6 19 – – 1 – December 40 – – 4 2 – – 3 – 21 – – – – Totals 211 3 9 49 17 1 5 27 1,719 291 7 4 2 2 31 AGE GROUPS OF INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS) NOTIFIED IN 1949. 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 110 101 – – 4 5 13 14 74 46 14 24 2 4 3 8 – – – – Diphtheria – 3 – – – 1 – – – – – 1 – 1 – – – – – – Poliomyelitis 5 4 1 – 1 – 1 1 – 1 1 2 1 – – – – – – – Pneumonia 31 18 – 1 2 1 1 1 1 2 – – – 1 6 3 14 3 7 6 Erysipelas 5 12 – – – – – – – – – – – – – 2 4 5 – 5 Dysentery – 1 – – – – – – – – – – – – – 1 – – – – Food Poisoning 2 3 – – – 1 – – – – 1 – – – 1 1 – 1 – – Infective Hepatitis 15 12 – – – – – 1 4 1 2 2 4 2 4 5 1 – – 1 Measles 862. 857 27 20 206 219 243 220 368 382 10 10 4 3 4 3 – – – – Whooping Cough.. 142 149 13 9 37 44 34 43 55 51 3 1 – 1 – – – – – – Cerebrospinal Fever 3 4 – 1 – – 1 – 1 3 1 – – – – – – – – – Puerperal Pyrexia – 4 – – – – – – – – – – – – – 4 – – – – Polio-Encephalitis 2 – 1 – – – – – – – – – 1 – – – – – – – Para-Typhoid 2 – – – – – – – 1 – – – 1 – – – – – – – Totals 1,179 1,1(58 42 31 250 271 293 280 504 486 32 40 14 12 18 27 19 9 7 19 32 TABLE SHOWING THE TOTAL NUMBER OF INFECTIOUS DISEASE CASES NOTIFIED IN EACH WARD DURING THE YEAR 1949. DISEASE Total Cases Notified WARDS No. of Cases Hospitalised Town Cranham Emerson Park Harold Wood Northwest Rainham Thameside Upminster Scarlet Fever 211 60 9 23 10 31 26 15 37 41 Diphtheria 3 1 – – – – 2 – – 3 Poliomyelitis 9 2 – – 1 2 4 – – 9 Pneumonia 49 5 ' – 4 1 25 1 2 11 7 Polio-Encephalitis 2 – 1 – – 1 – – – 1 Erysipelas 17 3 _ 2 1 4 1 1 5 6 Dysentery 1 1 – – – – – – – 1 Infective Hepatitis 27 6 – – – 10 4 2 5 1 Measles 1,719 381 31 191 261 234 193 279 149 15 Whooping Cough 291 65 2 35 30 47 44 57 11 6 Paratyphoid 2 – – – – – – – 2 2 Cerebro-Spinal Fever 7 – – – – 4 2 – 1 7 Food Poisoning 5 – – – – 4 – 1 – – Puerperal Pyrexia 4 – – – – 1 2 – 1 2 TOTALS 2,347 524 43 255 304 363 279 357 222 101 33 Tuberculosis. The drop in new notifications from 152 to 120 will be noted with relative satisfaction. This disease, however, caused 35 deaths which although it represents a reduction as compared with the previous year, is still a terrible thing. Hospitalisation is not a complete preventive answer. Good housing, good hygiene–personal and communal–early diagnosis and treatment, isolation of the chronic positive case, preventive vaccination wherever practicable, perhaps above all the education of everyone to an understanding of the disease, its problems and the method of attack upon it–these represent factors of vital significance. Households containing a tuberculous victim are, and are likely to remain for long, an inevitable happening in our midst. Tuberculosis must be appreciated as a social problem without being distorted into a social stigma. It is not only a personal disease–it is one which has vital repercussions extending in ever widening circles from the sufferer, through his family and dependants to the community as a whole. The attack upon it, therefore, must take cognizance not only of the patient but also of all the other factors which go to complicate the problem of treatment in its widest and most real sense. Our priority re-housing scheme is continuing to function satisfactorily but it need hardly be said that a family without previous local claims cannot expect to be immediately re-housed solely on medical grounds. The Tuberculosis Register at the end of the year showed as follows:– Pulmonary— Males 327 Females 221 Non-Pulmonary– Males 40 Females 33 Pulmonary and Non-Pulmonary Total 621 34 NEW CASES AND DEATHS FROM TUBERCULOSIS, 1949. AGE GROUPS NEW CASES TOTAL NEW CASES DEATHS TOTAL DEATHS PULMONARY NON| PULMONARY PULMONARY NONPULMONARY M. F. M. F. M. F. M. F. M. F. M. F. 0- 1 years – – – – – – – – – – – – 1- 5 ,, 4 2 2 2 6 4 – – 1 – 1 – 6-10 ,, 1 1 – – 1 1 – – – – – – 10-15 ,, 1 2 1 – 2 2 – – – – – – 15-20 ,, 3 11 1 1 4 12 – 1 – – – 1 20-25 ,, 9 6 – 1 9 7 1 – – – 1 – 25-35 ,, 14 15 1 2 15 17 – 5 – – – 5 35-45 ,, 12 8 – 3 12 11 5 2 – – 5 2 45-65 ,, 11 4 – – 11 4 8 3 1 – 9 3 65 and over – 1 – 1 — 2 6 2 – – 6 2 Totals 55 50 5 10 60 60 20 13 2! – 22 13 35 YEAR 1949–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 1949 1 1 1 3 9 2 2 10 6 35 TUBERCULOSIS NOTIFICATIONS–1938-1949. 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 1949 105 15 120 36 Non-Notifiable Diseases of Childhood. Head Teachers return a Form M.I. 13 showing children excluded from school 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 occurring among school children during the year, the number reported being as follows:— Chickenpox 272 Conjunctivitis 43 Gastro-enteritis 1 Glandular Fever 2 Impetigo 4 Influenza 4 Mumps 327 Ringworm 1 Rubella 7 Scabies 1 These numbers must necessarily be accepted with reserve since they represent our only available, but not necessarily wholly accurate, information. 37 SECTION G. FACTORIES ACTS, 1937 and 1948. Ministry of Labour and National Service Form 572. PART I OF THE ACT. 1. Inspections. Premises. No. on Register. No. of Inspections. No. of written notices. No. of occupiers prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by L.A's 25 52 – – (ii) Factories not included in (i) in which Section 7 is enforced by the L.A. 150 304 29 – (iii) Other premises in which Section 7 is enforced by the Local Authority 8 16 2 – Total 183 372 31 – 2. Cases in which Defects were Found. Particulars. Found. Remedied, Referred To H.M. Inspector. By H.M. Inspector, Prosecutions. Overcrowding (S. 2) 2 – 2 – – Sanitary Conveniences (Section 7) (a) Insufficient 7 1 – – – (b) Unsuitable or Defective 24 10 – 2 – (c) Not separate for sexes 1 1 – – – Other offences against the Act 37 – 37 – – Total 71 12 39 2 – PART VIII OF THE ACT. OUTWORK — Sections 110 and 111. Nature of Work. No. of out-workers in August list. Wearing Apparel- Making, etc. 76 No cases of default, etc. 38 INDEX. PAGE Acreage 8 Ambulance Service 14 Analysis of Mortality 12 Atmospheric Pollution 16, 17 Births 8 Birth Rate 8 –Comparative 1l, 12 Canteens, School 27 Condemned Food 24, 25 Deaths 8 –Age Distribution 11 –Causes of 10 –Infantile 9 –Maternal 12 –Puerperal 9 Death Rate 8 –Civilian 12 –Comparative 11, 12 –Infant 9; 12 Diphtheria 29 Disinfestation 7 Enteritis 28 Factories Acts, 1937 and 1948– Form 572 37 Inspections 37 Defects 37 Outworkers 37 Food– Byelaws 27 Clean 27 Condemned 24, 25 Preserved 27 Food and Drugs Act, 1938 21 –Public Analysts 21 –Section 13 24 –Sampling 21, 22, 23, 24 39 INDEX (cont.). PAGE House–Number erected 20 Number inhabited 8 Housing– Applications 20 Drainage 17 Overcrowding 20 Slum Clearance 20 Ice Cream– Heat Treatment 27 Registration 26 Sampling 27 Infantile Paralysis (Poliomyelitis) 28 Infectious Disease– Age Incidence 1 Comparative 13 Contact Supervision 29 Hospitalisation 32 Non-Notifiable 36 Seasonal Incidence 30 Ward Distribution 32 Insect Pests 16 Laboratory Facilities 14 Maternity and Child Welfare 14 Measles 29 Midwives 15 Milk- Heat Treated 26 Pasteurising Plants 26 Production of Designated 26 Retailers 25 Sampling 26 Special Designations 26 Supply 25 National Assistance Act, 1948, Sec. 47 15 Nursing and Maternity Homes 14 Nursing in the Home 15 40 INDEX (cont.). PAGE Penny Kate Product 8 Poliomyelitis (Infantile Paralysis) 28 Population– Comparative 9 Mid-year 8 At 31st December, 1949 8 Preface 6 Rateable Value 8 River Thames 17 Rodent Control 17 Sanitary Inspectors' Work–Summary 18 Scarlet Fever 28 Smoke Abatement 16 Staff 5, 14 –Superannuation Examinations 15 Staffing 14 Still Births 8 Still Birth Rate 8 Tuberculosis 33 –Comparative 35 –Incidence and Mortality 34 – Notification/Mortality Interval 35 Water– Sampling 16 Supply 15,16 Whooping Cough 29