library Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1950 LIBRARY 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 1950 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. TABLE OF CONTENTS page. Members of the Council 3 SECTION A -Statistics and Social Conditions of the Area 7 SECTION B—General Provision of Health Services for the Area 10 SECTION C—Sanitary Circumstances of the Area 13 SECTION D—Housing 16 SECTION E—Inspection and Supervision of Food 18 SECTION F—Prevalence of, and control over, Infectious Disease 26 SECTION G—Factories Acts, 1937 and 1948. Ministry of Labour and National Service Form 572 34 3 MEMBERS OF THE COUNCIL. (as at 31.12.50) Councillor A. Wiieeler, J.P., Chairman. (1) Councillor P. C. Ford, Vice-Chairman. (1) Councillor Mrs. It. J. Reynolds. (1) and (3) ,, Mrs. E. G. Richardson. ,, Mrs. B. Vango. ,, E. E. Baxter. ,, C. T. Boulter. ,, E. W. J. W. Bush. ,, B. E. E. Cannon. ,, S. W. collischon, c.C. (1) W. E. Daureney. ,, E. W. Fryd. (1) A. C. Holmes. ,, H. Holock. ,, J. W. G. Hughes. ,, A. S. Hulkes. ,, E. Humphrey. (1) ,, C. E. Kingham. ,, G. W. Lagden, C.C. ,, A. G. Newman. (1) ,, P. I. Page. ,, S. C. Parrish. (1) and (2) ,, W. E. Philo. ,, A. C. Salinger, J.P. ,, S. M. Tucker. ,, A. J. Twigger. (1) ,, C. A. Welch. (1) (1) Member of Public Health Committee. (2) Chairman of Public Health Committee. (3) Vice-Chairman of Public Health Committee. 4 OFFICERS OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: James Gorman, M.B., Ch.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. Ager, M.S.I.A. (1) & (3). T. W. Glew, M.S.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). Clerical Staff: J. E. Blay (Chief Clerk). S. N. Dance. Miss W. A. Heprurn 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. 5 Public Health Department, Council Offices, Billet Lane, HORNCHURCH 10th August, 1951 To the Chairman and Members of the Hornchurch Urban District Council. Mu. Chairman, Ladies and Gentlemen, 1 beg to present to you the Annual Report of my Department for the year 1950, the main considerations being noted below and a more detailed report on certain aspects of the public health being embodied later. Vital Statistics. The home population of the district is 103,700 at mid-year 1950. The birth rate shows a clear fall at 13.68 as against 16.00 last year. The date rate—adjusted—shows a slight reduction and the infant mortality rate at 27.74 a rise as against 1949. Relative to the country as a whole these figures may be deemed generally satisfactory. Infectious Diseases. With the exception of Whooping Cough which showed an increased incidence, the more prevalent infectious diseases showed a drop notably in the case of Measles and, to a lesser extent, Scarlet Fever. Poliomyelitis showed a slightly increased incidence, there being 15 cases against 9 in the previous year. A further note will be made of individual diseases later. Food and Drugs. The first full year's working of the Food and Drugs Act, 1938, proved satisfactory and our responsibilities in this direction are without doubt an administrative and practical asset to the district. Food Hygiene. This matter received our particular attention and our plans in this regard are being developed. 6 Housing. This Authority continues to make rapid progress in this connection and the small slum problem will be dealt with as opportunity permits. The time is not thought ripe yet for overcrowding to be the subject of a detailed survey. Atmospheric Pollution. This matter continues to receive the sympathetic attention of the department and our observation points noted previously continue to operate. General. The sanitary circumstances of the district remain favourable. Administration. The temporary arrangement with the local Health Authority outlined last year persists. Acknowledgments. 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 wealth 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. 7 SECTION A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area in acres (including half of tidal basin) 20,308 Registrar-General's estimate of Home Population (midyear) 1950 103,700 Number of inhabited houses according to rate books (September, 1950) 29,268 Rateable value (September, 1950) £759,493 Sum represented by a penny rate £3,110 Extracts from Vital Statistics for the Year. Births. Number of live births allocated to the District as adjusted for inward and outward transfers 1,478 (737 males, 741 females) Birth rate per 1,000 Home Population using area comparability factor 13.68 Number of stillbirths allocated to the District 27 (14 males, 13 females) Stillbirth rate per 1,000 Home Population 0.26 Stillbirth rate per 1,000 total (live and still) births 17.94 Deaths. Number of deaths of Hornchurch residents as supplied by the Registrar-General (adjusted for inward and outward transfers) 900 Death rate per 1,000 Home Population using area comparability factor 10.43 Deaths of infants under one year of age 41 (23 males, 18 females) Infant mortality rate (per 1,000 live births) 27.74 REGISTRAR-GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH. (Corrected for inward and outward transfers.) Causes of Death Male Female ALL CAUSES 480 420 1. Tuberculosis, respiratory 17 5 2. Tuberculosis, other 3 4 3. Syphilitic disease 2 0 4. Diphtheria 0 0 8 Causes of Death Male Female 5. Whooping cough 0 1 6. Meningococcal infections 1 0 7. Acute poliomyelitis 1 0 8. Measles 0 0 9. Other infective and parasitic diseases 0 0 10. Malignant neoplasm, stomach 14 13 11. ,, ,, lung, bronchus 24 3 12. ,, ,, breast 0 18 13. ,, ,, uterus 0 5 14. Other malignant and lymphatic neoplasms 41 37 15. Leukaemia, aleukremis 4 3 16. Diabetes 0 9 17. Vascular lesions of nervous system 60 60 18. Coronary disease, angina 76 33 19. Hypertension with heart disease 15 19 20. Other heart disease 66 89 21. Other circulatory disease 11 12 22. Influenza 2 1 23. Pneumonia 12 8 24. Bronchitis 42 21 25. Other diseases of respiratory system 3 0 26. Ulcer of stomach and duodenum 11 1 27. Gastritis, enteritis and diarrhoea 3 .5 28. Nephritis and nephrosis 3 5 29. Hyperplasia of prostate 7 0 30. Pregnancy, childbirth, abortion 0 1 31. Congenital malformations 3 5 32. Other defined and ill-defined diseases 41 49 33. Motor vehicle accidents 6 3 34. All other accidents 6 6 35. Suicide 6 4 36. Homicide and operations of war 0 0 DEATH RATE—COMPARISON WITH PREVIOUS YEARS 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 1944 9.2 1950 10.4 9 BIRTH RATE—COMPARISON WITH PREVIOUS YEARS 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 1944 11.9 1950 13.6 BIRTH RATES, DEATH RATES AND ANALYSIS OF MORTALITY AND MATERNAL MORTALITY, 1950. 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. Hornchurch. County. Rates per 1,000 Home Population. Births— Live births 15.8 17.6 16.7 17.8 13.6 Still births 0.37 0.45 0.38 0.36 0.26 Deaths— All causes 11.6 12.3 11.6 11.8 10.4 Typhoid and para typhoid 0.00 0.00 0.00 0.00 Whooping cough 0.01 0.01 0.01 0.01 0.00 Diphtheria 0.00 0.00 0.00 0.00 Tuberculosis . 0.36 0.42 0.33 0.39 0.27 Influenza 0.10 0.09 0.10 0.07 0.03 Smallpox — — — — — Acute poliomyelitis (including polio encephalitis) . 0.02 0.02 0.02 0.01 0.00 Pneumonia . 0.46 0.49 0.45 0.48 0.19 Rates per 1,000 live births. All causes under year of age 29.8 (a) 33.8 29.4 26.3 27.7 (a) Per 1,000 related live births. 10 CASE RATES FOR CERTAIN INFECTIOUS DISEASES IN THE YEAR 1950. 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. Hornchurch. County. (Rates per 1,000 Home Population.) Typhoid fever 0.00 0.00 0.00 0.01 0.00 Paratyphoid fever 0.01 0.01 0.01 0.01 — Meningococcal Infec tion 0.03 0.03 0.02 0.03 0.00 Scarlet fever 1.50 1.56 1.61 1.23 1.76 Whooping cough 3.60 3.97 3.15 3.21 4.93 Diphtheria . 0.02 0.03 0.02 0.03 Erysipelas 0.17 0.19 0.16 0.17 0.19 Smallpox 0.00 0.00 Measles 8.39 8.76 8.36 6.57 5.52 Pneumonia 0.70 0.77 0.61 0.50 0.48 Acute poliomyeliti (including polioencephalitis) Paralytic 0.13 0.12 0.11 0.08 0.11 Non-paralytic 0.05 0.05 0.06 0.05 0.02 Food poisoning 0.17 0.16 0.14 0.25 0.01 Rates per 1,000 total (live and still) births. Puerperal fever and pyrexia 5.81 7.43 4.33 6.03 1.32 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Local Health Authority. As a result of my temporarily acting as assistant to the Area Medical Officer it has been possible to effect a much closer integration of service between the local Sanitary Authority and the work of the South Essex Health Area Sub-Committee. Although Hornchurch as an authority is not directly concerned with the discharge of local Health Authority functions it is nevertheless in my view of inestimable value that at officer as well as member level it should be kept in constant touch with the planning, execution and development of such functions as are exercised on behalf of the local Health Authority by their Area Sub-Committee, and to this end 11 the close association of your Medical Officer of Health with the Area administration is a very material contribution. Care of the Aged. During the year an Advisory Committee for the Care of the Aged was formed in the South Essex Health Area and you appointed a representative upon it. The establishment of this Committee was evidence of the increasing attention which at present is being given to this problem. Cases come to notice from time to time in which an aged person is unable to receive satisfactory care and in which hospital attention can only be made available after a very considerable period of waiting. The problem is no simple one, nor is the solution simple, nor can any one class of person or agency be held culpable. It is true that there may be a lessening of family ties which results in the care of an aged parent or relative being regarded as less of a duty than formerly. It is true that as time goes on small families will ensure that there are fewer persons who would have such a duty. Housing circumstances have for some years been of a most difficult character, placing a considerable strain upon especially young married people and last but not least it must be said that in some cases an aged person—viewed in terms of outlook and habit possibly more than in terms of actual years—is not the easiest of companions especially in a household comprising, in particular, young children. It is also apt to be forgotten that the aged viewed in terms of years have in the course of their lives naturally developed habits, likes and dislikes and I am not convinced that the provision of new housing accommodation—which would in many instances radically uproot them from their old environment—is the general desire of the aged. Companionship they doubtless need and it would appear that many of them do enjoy hostel life. If home conditions are radically unsatisfactory and a move is really sought, then the provision of houses, hostels and the like, so long as they are properly sited and provided with amenities, is obviously an advantage. It is, however, all too easy to look at the problem of the aged with the eyes of the not so aged and in so doing a certain amount of care must be exercised in order that the image be true. Laboratory Facilities. There is no change in the facilities which continue to serve the needs of the district. On exceptional matters recourse is had to the Public Health Laboratory at Colindale. Ambulance Service. The County Ambulance Service maintains a day and night service at their Ambulance Station in Billet Lane, Hornchurch. 12 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) Kims Hall, Hornchurch Road, Hornchurch. Nursing and Maternity Homes. There are 5 registered Nursing and Maternity Homes in the district. Mid wives. There are 9 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 5 Home Nurse-Midwives, 3 Independent Midwives and one Independent Maternity Nurse practising in the area. Nursing in the Home. In addition to the Home Nurse-Midwives there are 4 Home 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 203 employees or prospective employees (48 permanent and 155 temporary). 13 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. The main supply remains adequate and wholesome. 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 14 samples were taken. An example of analysis is given below :— "This sample is clear and bright in appearance and is of a high standard of bacterial purity. The results are indicative of a water which is wholesome in character and suitable for drinking and domestic purposes." The question of extending the supply in the Hacton Lane— "White Hart" and Rainham Lodge area—was pursued to a point when it seemed the work was likely shortly to be put in hand. 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. 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, 1950, was 29,905 and the population as at 30th June, 1950, as obtained from the Registrar-General was 103,700." Approximately 0.6 per cent, of the inhabited houses, and 0.6 per cent! of the population of the Urban District obtain their water from standpipes. We have a limited number of properties in which there is not and is never likely to be a main water supply. The buildings concerned are often of an old type and in some instances the problem of an unsatisfactory supply has been solved by the building itself 14 becoming unfit for habitation and subsequently being demolished. In other cases, however, in which the water supplies come from a shallow well and are demonstrably unfit, all practical steps are taken to improve the supply and so to deal with the water as an interim measure as to make it safe. Four 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. Atmospheric Pollution. The number of recording instruments remain as last year and an aggregation of evidence is being painstakingly accumulated and will in due course be critically analysed. The results in general so far correspond with our expectations. Apart from any local significance which may emerge from our findings the importance of the contribution made by an authority such as ours in forming part of a national chain of such investigations is manifest. It is, however, to be regretted that an encouragement is not given to a wide extension of such exploratory work by the making available of considerably cheaper methods of analysis than are at presfent open to us. Sixty visits were paid to the various sites throughout the district during the year in addition to which 467 analyses were made in connection with the Volumetric SO 2 apparatus maintained at the Public Health Offices. Pollution of the Thames. This matter was investigated and kept under review throughout the year. It may be taken that all possible steps to improve the condition of the river are being considered or planned and will be taken to improve a position which is by general consent regarded as unsatisfactory, not least to those districts through which the river passes in its lower reaches. Local action can expedite but not provide a solution. Swimming Baths. Due to circumstances over which there is no local control, Hornchurch has not been enabled to enjoy the facilities of a local swimming baths. Irrespective of the modern standard of local housing it is still most desirable that the numerous potential users of such a swimming baths should be catered for at the earliest possible moment. Paddling Pools. The water from the various paddling pools in the parks is regularly analysed and the results are satisfactory. 15 Drainage. Some four properties were converted from pail to water closet and sewer at the joint expense of owner and Council. 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 Prevention of Damage by Pests Act, 1949, came into force on 31st March, 1950, and repealed the Eats and Mice (Destruction) x\ct, 1919. This new Act granted additional powers to local authorities in dealing with the prevention and eradication of rodent infestations. During the year the Sanitary Inspectors and Eodent Operative made a total of 1,954 visits and re-visits and the Eodent Operative cleared 110 infestations of rats and mice and as a routine measure baited the Council's refuse tips on a number of occasions. In one instance it was found necessary to serve a notice under the Prevention of Damage by Pests Acts, 1949, in order that certain premises be made rat proof. A nominal charge is made for dealing with infestations as follows :— Infestation on private premises 2s. 6d. Infestation on business premises 5s. Od. Sanitary Inspection of the District. Increased visits to food premises of all kinds and Shops Act inspections are noteworthy features of the year's work. SUMMAEY OF SANITAEY INSPECTOES' WOEK DUEING 1950. Inspection of Food and Food Premises (visits paid) :— Bakehouses 97 Butchers' shops 263 Cafes 288 Dairies (including Pasteurisyig Plants) 89 Fish shops 126 Greengrocers' shops 93 Ice Cream Dealers' premises 231 Grocers' shops 438 Samples taken 632 School canteens 51 Staff canteens 12 Miscellaneous visits 155 16 Housing (visits paid) :— Drainage of houses 541 Environmental reports 177 Overcrowding enquiries 88 Sanitary fittings 62 Structural defects 709 Re-inspections 1,693 Miscellaneous visits 44 General Sanitary Circumstances (visits paid) :— Accumulations 77 Camping grounds, vans, etc 183 Drainage and sewerage 262 Dustbins 267 Insect pests, etc 20 Keeping of animals and birds, etc 128 Massage and special treatment establishments 8 Public conveniences 28 Refuse tips 97 Rodent and vermin infestation 331 Schools 15 Unclean premises 37 Watercourses 81 Re-inspections 251 Miscellaneous visits 99 Factories and Outworkers :— Number of visits paid 184 Shops Acts:— Number of inspections 764 Infectious Diseases :— Number of visits paid (including contacts) 543 Number of Notices served :— Informal 577 Statutory 127 SECTION D. HOUSING. Number of new houses erected during the year. 125 houses were completed during the year 1950 by private builders. The Council erected 332 houses during the year and four 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—a lead which has been maintained since the end of the war—and had in fact at the end of the year increased the lead. 17 Overcrowding. Cases of overcrowding continue sporadically to come to our notice and are given further attention. It must, however, be said that in certain of these cases the overcrowding has quite apparently been entered into in the full knowledge of the facts by everyone. It is quite appreciated that with present housing difficulties and due to various circumstances, relatives will naturally tend towards communal living and married children towards living with their parents even if in so doing they worsen what has previously been strained accommodation. Whilst this is understandable and whilst little action has so far been taken to insist upon an abatement of overcrowding so brought about, it is nevertheless difficult in equity to afford a high priority to cases of overcrowding brought about in this way. Each case is investigated, its merits are so far as may be assessed and appropriate recommendations are made to the Health and/or Housing Committee for their attention. No general survey of overcrowding is at present deemed profitable. Eighty-eight visits were made by the staff regarding cases of alleged overcrowding. Slum Clearance. As previously remarked the local problem is of very small proportions. It is being tackled in individual cases as opportunity permits and whenever a very extensive attack upon what problem we have becomes possible then it will without delay be made. Medical Aspect—Re-housing. During the year some 437 applications were referred to me for opinion as to the degree of medical priority warranted by the circumstances and 265 visits were made by the staff to investigate points of doubt in this regard. It is exceedingly difficult actually to ensure that the minute details of each case are considered but a comprehensive picture is obtained of every case and further enquiries where necessary are made into the exact housing circumstances on the spot or through the medium of the certifying practitioner. Full weight- is given to any aspects of communal importance such as infectious disease, pulmonary tuberculosis of an infective type and where special circumstances such as the presence of young children under poor housing conditions exist. There is also the significant advantage that a parity of attention is given to each case and it may reasonably be advanced that in this district the medical claims of each case receive such attention that subsequently in any case a reasoned argument may be advanced in justification of any course of action which we may have adopted. I think that unless some system of scrupulous assessment of the various claims was in operation the conflicting claims of various applicants would be such as inevitably 18 to produce little short of chaos and to result in such a degree of priority being given to all as would in effect benefit none. Temporary Accommodation. A considerable amount of time has been spent and appears likely to continue to be spent in generally keeping in touch with the conditions obtaining in respect of the accommodation provided by the Essex County Council under Part III arrangements at St. George's Hospital. There is a large mobile population, the arrangements are necessarily communal to some extent and the control, for example, of infectious disease in these circumstances is a matter of some difficulty. A liaison has, however, been established with the Department of the County Medical Officer so that our action concerning this problem should so far as possible be joint. In addition we have found the authorities on the spot most helpful. One must, of course, earnestly hope for the day to arrive when such accommodation will no longer be necessary, as so long as it exists it must remain a focus of anxiety. Land Charges Enquiries. During the year '2,777 land charges enquiries were referred to the department regarding the question of outstanding sanitary notices. SECTION E. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Act Administration. The period under review marks the first complete year for which we were responsible for Food and Drugs administration within our district. As noted previously the change over from the County took place on 1st November, 1949, and 1950 saw the gradual development of our administrative machinery. The results of our work are noted below and illustrate not only the results of the actual sampling but the number and diversity of the food and drugs which come within our field of supervision. I consider that the assumption of food and drugs authority has in practice proved advantageous to the district since it enables a real local supervision to be maintained over an important branch of public health work at a time when such supervision is, to say the least, showing signs of decline. We must also acknowledge the assistance which the County Council officials were always ready to give when approached. In this as in other fields co-ordination of effort with the County Council is clearly to be desired. Mr. G. Taylor and Dr. J. H. Hamence of Dr. Bernard Dyer and Partners are the Council's Public Analysts. 19 The following samples were taken by officers of the Public Health Department during the year:— Article No. of Samples Acetic Acid Solution 1 Almonds, Ground 4 Apple crush 1 Apple Juice 1 Arrowroot 2 Bacon 1 Baking Powder 1 Batter Flour 1 Beef Pressed 1 Beef Weasand 1 Brandy 1 Bread 1 Butter 2 Cake Flour Mixture 1 Caraway Seeds 1 Cherries, Cocktail 1 Chocolate Sponge Cake 1 Chocolate Spread 2 Chutney 1 Cider 1 Cinnamon 2 Cloves 1 Cochineal Colouring 1 Coconut 3 Coffee 1 Coffee and Chicory Essence 4 Coffee and Chicory Extract 2 Coffee Extract 1 Cooking Fat 1 Corn Flakes 1 Cream Cake 1 Cream of Tartar 1 Crystal Sweetener 1 Curry Powder 5 Custard Powder 1 Dandelion Coffee 1 Date Chutney 1 Doughnuts 2 Dripping 1 Egg Noodles 1 Essence of Rennet 1 Farinoca 1 Fish Paste 2 Flour 1 Fondant 1 20 Article No. of Samples Fruit Pectin 1 Fruit Shapes 1 Fruit Wine 1 Frying Oil 1 Gelatine 2 Ginger, Ground 1 Ginger in Syrup 1 Ginger Wine 2 Glace Cherries 3 Golden Raising Powder 1 Gravy Powder 2 Ice Cream 26 Jam 6 Jelly and Jelly Cream 2 Jelly Crystals 4 Jelly, Dessert 1 Lard 1 Lemonade Powder 1 Lemon Cheese 1 Lemon Curd 1 Lemon Squash 1 Loaf, Portion of 1 Malted Milk with Cocoa 1 Margarine 2 Marmalade 3 Marzipan 1 Meat Pie 1 Meringues 1 Milk 43 Milk, Condensed 6 Milk Whipping Compound 1 Mincemeat 3 Olive Oil 1 Orange Squash 3 Pastry Mixture 1 Peas, Processed 1 Peel, Candied 1 Peel, Mixed 1 Pepper 5 Pepper Flavoured Compound 3 Polony 1 Port 1 Potato Crisps 2 Pudding, Christmas 1 Quoffy 1 Sage and Onion Stuffing 1 Salad Cream 5 Salmon Spread 1 Sauce 2 21 Article No. of Samples Sausages, Beef 16 Sausages, Liver 1 Sausages, Luncheon 1 Sausages, Pork 8 Sausage Meat Beef 2 Self Raising Flour 3 Semolina 1 Sherry 2 Soup, Chicken Noodle 1 Spice, Mixed 2 Stuffing 1 Suet 4 Sugar 1 Sweets 10 Tapioca 3 Tea 2 Teaseed Oil 1 Toffee Apples 1 Vermicelli 1 Vinegar 5 Vinegar, Artificial 1 Vinegar, Non-brewed 1 Whisky 3 Ammoniated Tincture of Quinine 1 Aspirin 2 Balsam 1 Bicarbonate of Soda 1 Blackcurrant and Liquorice Pellets 1 Borax 1 Boric Acid Ointment 1 Calamine Lotion 1 Camphorated Oil 2 Cascara Sagrada 1 Castor Oil 1 Compound Bismuth Lozenges 1 Compound Linseed, Liquorice and Aniseed Tablets 1 Compound Syrup of Figs 1 Cough Lozenges 3 Epsom Salts 2 Famal Syrup 1 Flu Nips 1 Friars Balsam 1 Fruit Saline 1 Gees Linctus 1 Glauber's Salts 1 Glycerine 1 Glycerine and Thymol 1 Glucose Tablets 1 22 Article f Samples Iodised Throat Tablets 1 Magnesia Tablets 1 Magnesium Carbonate 1 Milk of Magnesia 1 Paraffin, Liquid 1 Parrish's Chemical Food 1 Peroxide of Hydrogen 1 Quinine Tonic Water 1 Rose Hip Syrup 1 Saccharin Tablets 1 Seidlitz Powder 1 Sodamint Tablets 1 Spirit of Sal Volatile 1 Sulphur Ointment 1 Sulphur Tablets 1 Vitamin Chocolate 1 Worm Tablets 1 Zinc Ointment 1 Total 337 The undermentioned samples were found to be unsatisfactory and resulted in the following action being taken:— Suet. 3% deficient in fat. Warning letter sent to manufacturer. Toffee Apples. Consisted entirely of a sugar preparation and therefore misdescribed as "Toffee Apples". Vendor and manufacturer informed of misdescription. Chocolate Sponge Cake. Rodent excreta embedded in chocolate covering on top surface. Not possible to prove whether contamination occurred at the bakery or in the home of the complainant—no legal proceedings taken. Curry Powder. Contained 40 parts per million of lead (standard lays down that no curry powder shall contain lead in excess of 10 parts per million). Retailer instructed to remove this powder from stock and the wholesale spice merchant and grinder who manufactured this curry powder was informed of Analysts' report. Beef Sausages. Contained 650 parts per million of sulphur dioxide (standard should not exceed 450 parts per million). Warning letter sent to butcher who discontinued the use of preservative in sausages. 23 Bread. One sample contained two small black oval foreign bodies. The Analysts reported that they consisted of dirty dough containing mould growth. Warning letter sent to baker. Examination of another sample of bread showed that fragments of some closely woven patterned fabric were embedded therein. Warning letter sent to the baker concerned. Milk. Three samples were found to be deficient in fat to the extent of 21%, 16% and 5%. Two of these samples were taken from the same source of supply. The matter was reported to the farmer concerned and the Medical Officer of Health for the area in which the farm is situated. An assurance was given that advice had been obtained and appropriate steps taken to improve the quality of the milk supply. Further samples were taken and found to be satisfactory. In the third case (5% deficient) the retailer and farmer were informed of the result of the examination and action was taken to improve the quality of the milk. Further samples were found to be satisfactory. An unopened one pint bottle of milk contained a mould growth attached to the side of the bottle. A warning letter was sent to the firm concerned. Food and Drugs Act, 1938—Section 13. 122 notices were served during the year on owners or occupiers of premises coming within the scope of this section of the Food and Drugs Act, 1938. No statutory action was required. Unsound Food. During the year the following foods were voluntarily surrendered to the Sanitary Inspectors as being unfit for human consumption:— Tons Cwts. lbs. ] Bacon — 1 15 2 Butter — — 20 8 Cheese — — 103 8 Corned beef — 3 35 12 Dried figs — — 28 — Fish — 12 106 8 Meat — 12 78 — Miscellaneous groceries — 1 108 31/4 Poultry — — 14 8 Sausages — — 51 — Tea — — 3 8 Tinned food — 16 3 1½ Tinned milk — 10 30 9 Total 3 — 38 33/4 24 Milk Supply. It is interesting to note that 98% of our local milk supply is either pasteurised or tuberculin tested. The amount of raw milk distributed locally is therefore exceedingly small although even then the view might be advanced that on grounds of pure hygiene it is not small enough. We have within the district two pasteurising plants, the efficiency of which is frequently tested. Considerable publicity has been given in the past by many quarters to the necessity for maintaining a strict watch upon the performance of pasteurising plants and there is no doubt but that in fact maintaining at its full working potential and efficiency such a plant is a matter of considerable complexity and concern both to the operator of the plant and the local Public Health Department. It should be said that locally we do have the full co-operation of the plant owners in the difficulties which in the very nature of things do occasionally arise. The results which we obtain from our testing are satisfactory. There are 13 milk distributors with registered premises in the district. There are also 13 firms registered as milk distributors in Hornchurch whose premises are registered in other districts. In addition 19 shopkeepers are registered for the sale of bottled milk only. The Milk (Special Designation) (Raw Milk) Regulations, 1949, and The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949. The number of licences issued by the Council during the year was as follows:— Dealer's (Pasteuriser's) 2 Dealer's Pasteurised 20 Supplementary Pasteurised 5 Dealer's Sterilised 38 Supplementary Sterilised 5 Dealer's Tuberculin Tested 16 Supplementary Tuberculin Tested 4 Dealer's Accredited 1 Milk Sampling. The 134 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 testing. Nine samples failed to satisfy the prescribed tests and the necessary follow-up action was taken. Ice Cream. Ice cream manufacturers, vendors and premises are required to be registered by the Council under Section 158 of the Essex County Council Act, 1933, which was adopted by the Council by resolution on 20th February, 1934. 25 During the year 39 applications for registration (5 manufacturers and 34 vendors) were granted. At the end of the year 18 persons and premises were registered for manufacture and 210 for the storage and/or sale of ice cream. It will be. seen that a generous standard of sampling was practised during the year and a note on the results is to be seen below. Number of samples taken 92 Number satisfactory 79 Number unsatisfactory 13 It will be seen that some 79 samples out of 92 proved satisfactory. 1 am convinced that ice cream is a good example of one food product in which the methods of production, distribution and handling generally have been very substantially improved, largely as a result of public concern and interest. It is our experience that manufacturers almost without exception are keenly alive to the necessity for maintaining the highest standards and any even minor variation from a satisfactory standard is taken by them most seriously. The small trader who distributes the products of a larger firm is also encouraged thereby to give the fullest care to the product once it has arrived in his shop and pending its distribution to the public. The composition of ice cream engaged our serious attention this year and representations were made to the Minister of Food with a view to securing whenever possible satisfactory standards of food value for this product. Until times are much more normal the ordination of a desirably high standard may not be possible but the interest of all the authorities responsible is clearly not wanting and the desirable standards will be insisted upon as soon as practicable. The pre-packed article has the advantage that—presuming satisfactory production—the consumer has the cleanliness factor literally in his own hands. Preserved Food Manufacturers. Section 90 of the Hornchurch Urban District Council Act, 1936, requires registration of preserved food manufacturers and premises. Eleven applications for registration as manufacturers of preserved meat were granted during the year. At the end of the year, 52 persons and premises were registered for the manufacture of preserved meat (sausages). Food Hygiene. The year was signalised by the confirmation of byelaws by the Minister made under Section 15 of the Food and Drugs Act, 1938, and which came into operation on the 3rd July, 1950. This gives us considerably more discretion in dealing with especially the hygienic conditions governing the delivery and sale of food. As I believe that traders may more easily and lastingly be persuaded into commendable practices rather than legislated into them, a plan was drawn up of meetings with the various classes of 26 food traders at which a short talk was given on the hygienic aspects of food production and distribution. The Chairman of the Public Health Committee normally opened the meeting, the Medical Officer of Health and Chief Sanitary Inspector spoke briefly on their work and notably on the byelaws. Full opportunity was given for questions on any aspect of the subject and finally a short film "Another Case of Food Poisoning" was shown to the meeting. It was found that the attendances in general were disappointing, although the persons attending showed a considerable interest in the subject. Public opinion is undoubtedly taking more interest in matters of food hygiene and is increasingly coming to expect higher standards of practice. This is a most desirable happening since in the ultimate the dictators of food hygiene practice are the consumers themselves and without their support our efforts can never achieve complete fulfilment. Our Sanitary Inspectors are devoting a steady attention towards food establishments and it is our intention to see that reasonable observance is paid to the latest byelaws. It requires but a cursory awareness of the practices existing in many shops to be convinced that far too much unnecessary handling of food is carried out. Similarly too much food is left exposed and liable to contamination by flies and the like. The reason for this lies largely in tradition and a disinclination natural to all of us to change. It is perhaps too much to expect that the habits of years can be changed in days but it is equally too little to expect that they should not be changed at all. Soap and water provide the best barrier between the convenience and the consumer—a clear recognition of this fact being the best safeguard for the customer. School Canteens. Our Sanitary Inspectors continue to provide detailed reports upon the conditions obtaining at all the local school canteens and where any improvements are considered desirable they are brought to the notice of the local Education Authority. I have no doubt but that this information service readily secured by the local Sanitary Authority staff in the course of their normal district work, is of paramount importance and provides a very adequate alternative to the carrying out of the same work by other staff. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE Scarlet Fever. The number of cases dropped from 211 to 183 and of these 29 were admitted to hospital. It must again be emphasized that unless in the presence of complications, hospitalisation is not the course 27 of choice for this disease. The optimum period of isolation appears as yet, to say the least, undetermined, and in addition there must be many mild cases, not to mention cases of streptococcal sore throat which do not come to professional notice and hence are probably never isolated at all. The general control over Scarlet Fever must therefore be regarded as unsatisfactory but so long as the control over especial risks, e.g. cases in contacts working in connection with raw milk, is maintained and this is so at the moment, then no great prejudice is likely to result. Diphtheria. It is again a pleasure to record that no cases of this disease were notified during the year. The dramatic decrease in incidence which has noted diphtheria over the past decade is an outstanding event in epidemiology. It seems reasonable to suppose that the drive to promote active immunisation which gained momentum during the war years has played a significant part in this happy state of affairs although there may well have been other factors of which we know little which have also been of significance. It is to be hoped that no false sense of complacency will diminish the enthusiasm of parents in continuing to have their children granted that degree of protection which we know is afforded by modern protective methods. Measles. At 573 the cases represented exactly one-third of the cases in the previous year. The disease was of a mild type and did not cause any deaths. Whooping Cough. Whooping Cough notifications at 512 compare unfavourably with the 291 of the previous year and one death from this cause occurred. The control both of Measles and Whooping Cough is rendered especially difficult because the maximum period of liability to spread may be before the rash comes out in the one case and before the characteristic cough develops—if it ever does develop—in the other. Whooping Cough, especially in a young baby, is a serious disease requiring, if there are any complications, the most careful nursing. It is therefore only fair that the most stringent possible precautions should be taken by every parent whose child is suspected of being a sufferer. It is impossible to isolate every case of infectious disease such as Measles or Whooping Cough. It is, however, never impossible to view the situation-as clearly as possible and to take with regard to the safety of your neighbours' children, all the precautions you would expect them to take with regard to yours. TABLE SHOWING THE TOTAL NUMBER OF INFECTIOUS DISEASE CASES NOTIFIED IN EACH WARD DURING THE YEAR 1950. DISEASE Total Cases Notified WARDS No. of Cases Hospitalised Town Cranham Emerson Park Harold Wood Northwest Rainham Thameside Upminster Scarlet Fever 183 53 8 30 15 26 23 16 12 29 Poliomyelitis 15 2 1 2 — 3 1 4 2 13 Pneumonia 49 8 2 6 2 24 1 4 2 22 Meningococcal Infection 1 — — — — — 1 — — 1 Dysentery 4 2 — 1 — 1 — — — 2 Infective Hepatitis 53 11 — 5 — 11 20 2 4 10 Measles 573 104 46 81 36 96 111 42 57 7 Whooping Cough 512 116 20 62 30 104 54 62 64 6 Typhoid Fever 1 — — — 1 — — — — 1 Food Poisoning 2 — — — 2 — — — — 2 Puerperal Pyrexia 2 — — 1 — 1 — — — 2 Ophathalmia Neonatorum 3 — — — — 2 1 — — — Malaria (Contracted abroad) 1 — — — — — — 1 — 1 TOTALS 1,399 296 77 188 86 268 212 131 141 96 28 29 Poliomyelitis. We had during the year 15 cases of Poliomyelitis of whom 12 developed paralysis and 3 did not. There was one death from the disease and this suggests correctly that the type of disease was not especially severe. One of the cases is of especial interest in that it occurred in a twin aged 9 who developed paralysis of the upper and lower limbs followed by respiratory paralysis requiring treatment in an iron lung. So far as our information serves the other twin had no illness of a suspicious nature. The case made an excellent recovery. In two cases there was respiratory paralysis. In nine cases there was paralysis of the upper and/or lower limbs. In one case there was bulbar paralysis and in three an abortive poliomyelitis. The bulbar paralysis case died but all the others including the two cases of respiratory paralysis requiring iron lung treatment were at the end of the year making good progress, which the latest information suggests is being maintained where treatment is still being continued. There comes of course a time when the results of treatment cannot be improved upon and a varying degree of defect may persist. In the case noted during the year, however, it is clear that the results of treatment have been excellent and the degree of disability persisting even at this time is in the average case either very small or practically completely absent. Gastro-enteritis. During the year an outbreak of diarrhoea and vomiting occurred at a local primary and infants' school and involved some 60 children. The onset was dramatic in its suddenness, the symptoms were of moderate severity and transient, passing off in a matter of a few hours; the complications in general were nil and the day following the onset the average case appeared practically normal. Specimens of everything which could reasonably be expected to afford assistance in determining the cause of the outbreak were speedily available and as speedily sent for examination without, however, any bacterial cause being found. There was no recurrence. Disinfection. Sunlight and soap and water still retain their importance of place as bactericidal agents despite the absence of advertisement. It is being ever more widely recognised that in, for example, diseases such as Scarlet Fever concurrent disinfection is of much greater importance than terminal disinfection. The local practice in this respect follows accepted principles and is unchanged as compared with last year. 30 Tuberculosis. During the year 107 new cases were notified and there were 29 deaths from the disease. This compares with 120 notifications and 35 deaths in 1949. This figure of 107 represents the lowest figure recorded since 1940 and represents an advance which everyone hopes will be continued. The mortality rate for tuberculosis in Hornchurch of 0.27 per 1,000 of the population is lower than the national figure and the figures for the great and smaller towns. It must not, however, be forgotten that the 29 deaths caused by this disease still places it among the most important of our killers and apart from the fact that it strikes the young and working age groups of our population it must also be appreciated that apart from the actual deaths it causes an incapacity of varying degree lasting for years. Advances in treatment appear undoubtedly to be very promising indeed although no specific has yet clearly emerged. Preventive measures by B.C.G. vaccination are also assuming increasing prominence although in this regard it is a fact that the number of persons who are suitable for this form of protection is necessarily limited. Housing continues to play an important part in preventing the spread of disease and the local picture in this matter is, I consider, reasonably satisfactory. The menace of the chronic positive case is still real but modern advances in treatment may well lessen the incidence of such cases and hence minimise their influence as a communal prejudice. Tuberculosis is a vivid example of the multiplicity of control which still exists even since the National Health Service Act has become a working reality. The Local Health Authority, the Regional Hospital Board and the Local Sanitary Authority all have their part to play, but one feels that the problem would be none the less effectively tackled if some reduction in the number of agencies dealing with it could be effected. The local Council is naturally concerned from the environmental angle and especially from the housing viewpoint. Any case of tuberculosis in which the housing circumstances are bad may be assured of the fullest sympathetic consideration on our becoming aware of them and there is no reason to believe that in fact the housing aspect of tuberculosis is not being dealt with quite adequately at the present time. I think that due acknowledgment should be made of the assistance which is afforded to us in this connection by Dr. S. Thompson, the Local Chest Physician, and too great an emphasis could not be placed upon the necessity for the closest association with the local Chest Physician if the problem of housing the tuberculous is to receive due attention. 31 The Tuberculosis Register at the end of the year showed as follows:— Pulmonary— Males 326 Females 250 N on-Pulmonary— Males 40 Females 37 Pulmonary and Non-Pulmonary total 653 32 NEW CASES AND DEATHS FROM TUBERCULOSIS, 1950. 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 – 1 – – – – – – 1-5 „ 1 2 2 – 3 2 – – 1 1 1 1 5-10 „ 1 – 3 – 4 – – – – – – – 10-16 „ 2 – – 1 2 1 – – – – – – 15-20 ,, 1 9 1 – 2 9 – – – – – – 20-25 ,, 8 12 – 4 8 16 1 1 – – 1 1 25-35 „ 11 15 – 3 11 18 2 3 – 1 2 4 35-45 „ 9 5 – – 9 5 1 – – 1 1 1 45-65 „ 10 4 – 1 10 5 12 1 1 – 13 1 65 and over – 1 – – – 1 1 – 1 1 2 1 Totals 43 48 6 10 40 58 17 5 3 4 20 9 YEAR 1950—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 1950 — 1 3 2 — 4 2 10 7 29 TUBERCULOSIS NOTIFICATIONS—1939—1950. YEAR PULMONARY NON-PULMONARY TOTAL 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 1950 91 16 107 33 34 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 525 Conjunctivitis 8 Gastro-enteritis 4 Impetigo 11 Influenza 1 Mumps 161 Ringworm 2 Rubella 21 Scabies 1 These numbers must necessarily be accepted with reserve since they represent our only available, but not necessarily wholly accurate, information. 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 occupicrs prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by L.A's. 14 26 — — (ii) Factories not included in (i) in which Section 7 is enforced by the L.A. 171 191 6 — (iii) Other premises in which Section 7 is enforced by the Local Authority 10 12 — — Total 195 229 6 — 35 2. Gases in which Defects were Found. Particulars. Referred Found. Remedied. To H.M. Inspector. By H.M. Inspector. Prosecutions. Sanitary Conveniences (Section 7) (a) Insufficient 1 2 - 1 - (b) Unsuitable or Defective 4 4 - 3 - (c) Not separate for sexes - - - - - Other offences against the Act 1 1 1 - - Total 6 7 1 4 - PART VIII OF THE ACT. OUTWORK — Sections 110 and 111. No. of Nature of Work. out-workers in August list. Wearing Apparel- Making, etc. 146 3 cases of default in sending lists to the Council. No prosecutions. Informal action taken. No instances of work in unwholesome premises.