AC 4411 (3) HORNCHURCH Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER HEALTH For the Year 1951 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 1951 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. 2 TABLE OF CONTENTS PAGE Members of the Council 8 SECTION A—Statistics and Social Conditions of the Area 7 SECTION B—General Provision of Health Services for the Area 11 SECTION C—Sanitary Circumstances of the Area 12 SECTION D —Housing 16 SECTION E—Inspection and Supervision of Food 17 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 31.12.51). Councillor P. C. Ford, J.P., Chairman. (1) Councillor S. M. Tucker, Vice-Chairman. (1) Councillor Miss C. F. M. Cannon. (1) „ Mrs. R. J. Reynolds. (1) and (3) „ Mrs. E. G. Richardson. „ Mrs. B. Vango. „ E. E. Baxter. E. W. J. W. Bush. ,, B. E. E. Cannon. ,, S. W. Collischon, C.C. (1) and (2) ,, W. E. Daubeney. E. W. Fryd. (1) „ H. Holock. „ J. W. G. Hughes. „ E. Humphrey. „ G. W. Lagden, C.C. „ A. G. Newman. (1) P. I. Page. (1) ,, S. C. Parrish. W. E. Philo. ,, A. C. Salinger, J.P. „ W. A. Sibley. „ A. J. Twigger. (1) „ C. A. Welch. (1) „ G. Welham. B. C. Wells. „ A. Wheeler. (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) and (3) Sanitary Inspectors : L. Acer, M.S.I.A. (1) and (3) J. P. Barton, M.S.I.A. (2), (3) and (4) T. W. Glew, M.S.I.A. (2) and (3) S. Whitfield, M.S.I.A. (2) and (3) J. M. Williams, M.S.I.A. (2) and (3) Clerical Staff: .T. E. Blay (Chief Clerk). S. N. Dance. Miss W. A. Hepburn. 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, HORNCHURCII. 16th July, 1952. To the Chairman and Members of the Hornchureh Urban District Council. Mr. Chairman, Ladies and Gentlemen, I beg to present to you the Annual Report on the health of the district during 1951. The Vital Statistics are satisfactory generally. The Birth Rate shows a slight rise as against last year, the Death Rate shows a slight fall, whilst the infant mortality rate at 16.84 is the lowest figure yet recorded. All these rates are below the national average. Infectious Diseases. A major measles epidemic occurred during the year when our total cases notified was 2,023. No deaths from the disease occurred in spite of the great incidence. Scarlet Fever, Whooping Cough and Poliomyelitis were all less prevalent than in 1950. Housing. The demand for Council Houses continued apparently unabated and the submission of medical evidence for priority claims showed a marked increase. The general position is not yet sufficiently stable for an overcrowding survey to be made. Accommodation provided by the Council catered for a variety of needs. Food and Drugs. A full and satisfactory year's work was carried out in a manner which reflects considerable credit especially upon Mr. M. F. G. Randall, my Senior Sanitary Inspector and his Assistants. Details are given later. Food Hygiene. Our efforts to assist in maintaining the local standards at a high level were continued. Model Bye-Laws are now in force and routine inspections are emphasized as a necessity for their implementation. Atmospheric Pollution. Our investigations in this connection are co-ordinated with the aims of the Department of Scientific and Industrial Research. 6 The policy is—as you are aware—of long term value—but useful information is being assembled through our monthly analyses. General Supervision. Not the least important feature of our work is the district inspections carried out by the Sanitary Inspectors. This might be described as preventive hygiene and certainly it both permits timely action to avoid trouble and knowledgeable action to deal with any trouble which has arisen. My thanks are due to you for your support throughout the year, to my colleagues in other Council Departments for their co-opcration and to my own staff for their wholehearted assistance. I am, your obedient servant, James Goeman, 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 (mid-year) 1951 103,800 Number of inhabited houses according to rate books (September, 1951) 29,923 Rateable value (September, 1951) £773,022 Sum represented by a penny rate £3,135 Extracts from Vital Statistics for the Year. Births. Number of live births allocated to the District as adjusted for inward and outward transfers 1,544 (754 males, 790 females) Birth rate per 1,000 Home Population using area comparability factor 14.11 Number of stillbirths allocated to the District 32 (22 males, 10 females) Stillbirth rate per 1,000 Home Population 0.30 Stillbirth rate per 1,000 total (live and still) births 20.30 Deaths. Number of deaths of Hornchurch residents as supplied by the Registrar-General (adjusted for inward and outward transfers) 926 Death rate per 1,000 Home Population using area comparability factor 10.39 Deaths of infants under one year of age 26 (14 males, 12 females) Infant mortality rate (per 1,000 live births) 16.84 REGISTRAR-GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH. (Corrected for inward and outward transfers). Causes of Death Male. Female. ALL CAUSES 496 430 1. Tuberculosis, respiratory 13 8 2. Tuberculosis, other 0 4 3. Syphilitic disease 1 0 4. Diphtheria 0 0 5. Whooping cough 0 1 8 Causes of Death. Male. Female. 6. Meningococcal infections 2 1 7. Acute poliomyelitis 0 0 8. Measles 0 0 9. Other infective and parasitic diseases 1 2 10. Malignant neoplasm, stomach 22 12 11. „ ,, lung, bronchus 37 3 12. ,, ,, breast 1 19 13. ,, ,, uterus 0 6 14. Other malignant and lymphatic neoplasms 46 37 15. Leukaemia, aleukaemia 3 1 16. Diabetes 2 3 17. Vascular lesions of nervous system 43 63 18. Coronary disease, angina 64 39 19. Hypertension with heart disease 12 13 20. Other heart disease 77 87 21. Other circulatory disease 8 12 22. Influenza 10 9 23. Pneumonia 15 15 24. Bronchitis 44 25 25. Other diseases of respiratory system 5 2 26. Ulcer of stomach and duodenum 7 2 27. Gastritis, enteritis and diarrhoea 4 3 28. Nephritis and nephrosis 4 7 29. Hyperplasia of prostate 7 0 30. Pregnancy, childbirth, abortion 0 0 31. Congenital malformations 4 7 32. Other defined and ill-defined diseases 41 35 S3. Motor vehicle accidents 11 3 34. All other accidents 7 5 35. Suicide 5 6 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* 1951 10.3* * Area Comparability Factor returned. 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 1951 14.1 9 BIRTH RATES, DEATH RATES AND ANALYSIS OF MORTALITY, 1951. Local figures compared with England and Wales and certain towns. England and Wales 120 C.B .s and Great Towns including London. 148 Smaller Towns (Resident Pop. 25,000/50,000 at 1931 Census). London Admin. County. Hornchurch Rates per 1,000 Home Population. Births— Live births 15.5 17.3 16.7 17.8 14.11 Still births 0.36 0.45 0.38 0.37 0.30 Deaths— All causes 12.5 13.4 12.5 13.1 10.39 Typhoid and paratyphoid 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 0.31 0.37 0.31 0.38 0.24 Influenza 0.38 0.36 0.38 0.23 0.18 Smallpox 0.00 0.00 0.00 — — Acute poliomyelitis (including polioencephalitis) 0.00 0.01 0.01 0.00 Pneumonia 0.61 0.65 0.63 0.61 0.28 Rates per 1,000 live births. All causes under 1 year of age 29.6(a) 33.9 27.6 26.4 16.84 (a) Per 1,000 related live births. 10 CASE RATES FOR CERTAIN INFECTIOUS DISEASES, 1951. Local figures compared with England and Wales and certain towns. England and Wales 120 C.B.s and Great Towns including London. 148 Smaller Towns (Resident Pop. 25,000/50,000 at 1931 Census] London Admin. County. Hornchurch. Rates per 1,000 Home Population. Typhoid fever 0.00 0.00 0.00 0.01 — Paratyphoid fever 0.02 0.03 0.02 0.01 0.00 Meningococcal infection 0.03 0.04 0.03 0.03 0.01 Scarlet FeVer 1.11 1.20 1.20 1.10 1.22 Whooping Cough 3.87 3.62 4.00 3.11 4.76 Diphtheria 0.02 0.02 0.03 0.01 — Erysipelas 0.14 0.15 0.12 0.15 0.15 Smallpox 0.00 0.00 0.00 — — Measles 14.07 13.93 14.82 14.64 19.49 Pneumonia 0.99 1.04 0.96 0.72 0.64 Acute polio-myelitis (in eluding polioencephalitis) Paralytic 0.03 0.03 0.03 0.02 0.01 Non-paralytic 0.02 0.02 0.03 0.02 0.05 Food poisoning 0.13 0.15 0.08 0.23 0.07 Rates per 1.000 total (live and still) births. Puerperal Fever arc Pyrexia 10.66 13.77 8.08 14.90 2.53 11 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Local Health Authority. My temporary assistance to the Area Medical Officer was continued and the Local Health Services benefited, I believe, by this co-ordinated effort. Care of the Aged. Local Committees continued enthusiastically to pursue the work. Cases do arise from time to time where aged persons somewhat infirm physically and certainly with very strong opinions on hospital treatment gradually drift into conditions which are an anxiety to all. Very often friends or relatives give a great deal of time to looking after the aged but the danger of, for example, an accident through say an overturned oil lamp or a gas flame is evident. I believe that encouraging useful activity in the aged is a vital approach, as the capacity other people regard them as having will so often be regarded by them as a true reflection of their own value. Public Health Propaganda. Apart from utilising the recognised journals which deal with this subject every opportunity is taken of introducing it into talks to local organisations. A regular and topical poster display service is carried on throughout the area. Items of interest are noted for issue by our Public Relations Committee who maintain a constant press liaison. 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. 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. 12 Nursing and Maternity Homes. There are 4 registered Nursing and Maternity Homes in the district. Midwives. 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 4 Home Nurse-Midwives, 3 Independent Midwives and I Independent Maternity Nurse practising in the area. Nursing in the Home. In addition to the Home Nurse-Midwives there are 5 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 188 employees or prospective employees (40 permanent and 148 temporary). SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. The general supply is from the South Essex Waterworks Company and is of excellent quality. 13 samples were taken by the Public Health Department during the year and a typical sample analysis is provided below:— " This sample is clear and bright in appearance and is of a high standard of bacterial purity. These results are indicative of a water which is wholesome in character and suitable for drinking and domestic purposes." 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. 13 A total of over 3,500 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 last, was 30,436 and the population as at 30th June, 1951, as obtained from the Registrar General was 103,800." 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. The hardness of the water is a source of much inconvenience to housewives especially but so far as I am aware it has not been found prejudicial at all to health. Under existing circumstances any scheme of general water softening is not likely to achieve fruition for some considerable time to come. Certain isolated dwellings in the rural portion of the area must still depend upon well water for their supply. Shallow wells are, by and large, a source of potential trouble and provide a hygienic affront lo the district. The trouble they actually cause (as compared to the trouble the results of analysis suggest they might cause) is relatively small and even when new residents come to occupy the houses concerned complaints are seldom heard. This may well be because the incoming tenants have enjoyed—or borne with—comparable conditions elsewhere and have therefore secured immunity elsewhere. It is interesting and important to note that where there are very young babies even boiling does not—in a few instances—make the water fit for drinking and in these cases the provision of an alternative supply is the more urgent. During the year arrangements for connecting up certain cafe premises were completed on the Council offering to pay a substantial sum towards the cost. I know that similarly it is the wish of the Council to secure a main supply for all dwellings and if this is likely to be difficult of attainment it is certainly regarded as a target. Atmospheric Pollution. Our routine observations at the various sites throughout the district have been continued and the results are in general accord with the sites involved and with previous years. We have in addition for a limited period of a year obtained facilities for siting in the district two pieces of apparatus supplied through the Department of Scientific and Industrial Research for the investigation of metal corrosion. 14 Public Conveniences. It would seem sensible in this age to provide facilities for personal washing at these points but the amount of wanton damage done— probably by a few irresponsibles—is such as to render unreasonable any recommendation by me to this end. Pollution of the Thames. The condition of the river in so far as it might have a bearing on our local circumstances continues to receive our attention. The problem is, however, of such a nature that a solution is really possible only on a long term basis. There is, however, reason to believe that the authorities principally responsible are fully aware of the position and quite sympathetic towards our attitude. Swimming Baths. General circumstances have not yet made possible the provision of swimming baths in this area. It may not be essential to the public health but from a general viewpoint of encouraging physical recreation especially amongst our younger population and of providing what is generally regarded as a necessary facility for a town a further plea should be made for considering seriously the provision of a local swimming baths just as soon as it can possibly be done. It seems a pity that in an area of this size your swimmers, potential swimmers and bathers should have to find a medium for their recreation at such distances from their homes. Paddling Pools. The water from the various paddling pools in the parks is regularly analysed and the results are satisfactory. 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. During the year the Sanitary Inspectors and Rodent Operative made a total of 1,99.5 visits and re-vi.sits and the Rodent Operative cleared 97 infestations of rats and mice and as a routine measure baited the Council's refuse tips on a number of occasions. A nominal charge is made for dealing with infestations as follows:— Infestation on private premises 2. 6d. Infestation on business premises 5s. Od. 15 Sanitary Inspection of the District. SUMMARY OF SANITARY INSPECTORS' WORK DURING 1951 Inspection of Food and Food Premises (visits paid):— Bakehouses 70 Butchers' shops 244 Cafes 240 Dairies (including Pasteurising Plants) ... ... ... 78 Fish shops 105 Food complaints 48 Greengrocers' shops 55 Grocers' shops 397 Ice Cream Dealers' premises 247 Public Houses 64 Samples— (a) Chemical 398 (b) Bacteriological 370 School canteens 55 Staff canteens 50 Miscellaneous visits 51 Housing (visits paid):— Drainage of houses 328 Environmental reports 189 Sanitary fittings 88 Structural dcfects 608 Re-inspections 1,549 Miscellaneous visits 38 General Sanitary Circumstances (visits paid):— Accumulations 118 Camping grounds, vans, etc. 57 Drainage and sewerage 204 Dustbins 324 Fair Grounds 12 Insect pests, etc 25 Keeping of animals and birds, etc. 99 Massage and special treatment establishments' 11 Public Conveniences 7 Refuse tips 161 Rodent and vermin infestation 329 Schools Smoke Complaints 34 Unclean premises 35 Watercourses and ponds 19 Re-inspections 210 Miscellaneous visits 68 Factories and Outworkers:— Number of visits paid 183 Shops Act:— Number of inspections 503 Infectious Diseases:— Number of visits paid (including contacts) 518 Number of Notices served:— Informal 461 Statutory 174 16 SECTION D. HOUSING Number of new houses erected during the year. The number of new houses built during the year was as follows:— By Local Authority 332 By Private Enterprise 182 Re-built following destruction by enemy action 15 It is interesting to compare this with the figures for 1934 when in this district the Local Authority built 6 houses and other bodies or persons built 1,304. The very different times in which we now live renders any further comparison quite irrelevant. Overcrowding. The general housing position is not yet sufficiently stable to justify an overcrowding survey. Unfit Houses. Some five old and dilapidated houses were demolished during the year. Medical Aspect Re-housing. Some 549 medical certificates in support of re-housing claims were submitted to me. It is clearly necessary that any medical condition justifying re-housing priority must have bad housing (in the broad sense) as a cause or aggravating factor. A most prolific source of appeal is the apparent inability of many related families to live together without producing a near nervous breakdown on the part of someone. There can be no doubt as to the fact that these cases actually exist in large numbers and the cause is clearly to be seen. It does on the other hand seem to be inequitable to upgrade many such applications at the expense of the equally numerous uncomplaining applicants who are prepared to accept their normal points assessment. The responsibility for maintaining a dangerous degree of nervous strain especially in related families living together cannot in my view rest solely with the Council simply because in spite of all efforts a house is not available for every applicant. A plea for the maximum tolerance on the part of the families themselves may justly be made however difficult the circumstances may be. St. George's Hospital. During the year a visit was paid with the County Medical Officer of Health to the premises here under t he control of the County Council. I believe that this particular accommodation does represent an important problem and that from a hygienic point of view it can only successfully be tackled through the concerted efforts of both the County Council and ourselves since our interests are so substantially mutual. Land Charges Enquiries. During the year 3,090 land chargcs enquiries were referred to the department regarding the question of outstanding sanitary notices. 17 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Act Administration. For our annual programme we aim at obtaining approximately 300 samples of food and drugs—this figure being based on the commonly adopted figure of three samples per 1,000 population of the district. The samples are obtained in the highways in course of delivery, in shops, canteens and from other food premises. Firstly, priority is given to the sampling of products likely to be under-standard or adultcrated and secondly to a very wide range of food and drugs in order to assure ourselves that the commodities on sale are genuine. To minimise duplication an index is kept of all samples obtained and care is taken to limit the amount of sampling of well known proprietary branded articles where adulteration is improbable but where analysis is occasionally required. Regularly advice is sought from the Public Analysts on the nature, type and advisability of the sampling of certain food and drugs and their unstinted assistance is acknowledged in this regard. There is a noticeable world-wide tendency for an increasing amount and variety of chemical substances to be used in the food trade and I am glad to report that the Public Analysts are fully aware of this trend and are vigilant in the protection of the purity of our supplies from these sources. It is regretted that, a Food and Drugs Authority is still not normally empowered to enforce chemical standards prescribed by the Minister of Food in Statutory Instruments which are mainly concerned with maximum prices. The standards have to be quoted to the Court when proceedings have been instigated and we then have the uncertainty of acceptance or rejection. The standard for the sausage is a typical example. However in reviewing the results of the samples taken this year I feel we have reason to have confidence in the quality of the food and drugs sold in this district. During the year the Sanitary Inspectors obtained 306 samples of food and drugs, all of which were examined by our Public Analysts who ascertained that 289 of these samples were genuine and 17 samples adulterated or under-standard etc. ARTICLES Number of Samples examined. No. found to be genuine. No. found to be adulterated or under-standard etc Almonds, Ground 1 1 — Baking Powder 2 2 — Beef Steak and Carrots (Minced) 1 1 — Beef Steak, Canned 1 1 — Beef and Vegetables 1 1 — Blanc Mange Powder 1 1 — Biscuits, Chocolate Sandwich 1 1 — Bread 1 — 1 18 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Bread Roll containing beef filling 1 — 1 Cake Flour 1 1 — Cherries, Glace 1 1 — Chocolate, Drinking 1 1 — Coconut, Desiccated 1 1 — Coffee 1 1 — Coffee and Chicory Essence 1 1 — Condiment, Non-brewed 5 3 2 Corn Flour 1 1 — Crab, Dressed 1 1 — Cream 8 8 — Cream, Clotted 1 1 — Cream, Synthetic 1 1 — Cream Powder, Synthetic 1 1 — Curry Powder 3 3 — Custard Powder 1 I — Drink Powder 1 1 — Fish Paste 2 2 — Gelatine 2 2 — Golden Raising Powder 1 1 — Honey 1 1 — Horseradish Relish 1 1 — Ice Cream 21 21 — Jaffa Juice 1 1 — Jam 5 5 — Jelly Crystals 1 1 — Lemon Curd 1 1 — Lemon Juice 1 1 — Lemon Squash 2 2 — Luncheon Meat, Canned 2 2 — Malted Milk 1 1 — Mayonnaise 2 2 — Marmalade 1 1 — Marshmallow Creme l 1 — Meat Paste l 1 — Meat, Potted l 1 — Milk 52 47 5 Milk, Condensed 2 2 — Milk, Dried 1 1 — Mincemeat 2 2 — Mustard 2 2 — Nut Clusters 1 1 — Orange Squash 4 4 — Pea Nut Butter 1 1 — Peel, mixed 1 — Pepper 17 17 — Pepper Compound 1 1 — Pepper Flavoured Compound 7 7 — Pickle 1 1 — Pork Pie 1 1 — 19 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Potato Powder 1 1 — Pudding, Christmas 1 1 — Pudding and Pancake Mixture 1 1 — Rennet 1 1 — Salad Cream 10 10 — Sausages, Beef 8 8 — Sausages, Luncheon 1 1 — Sausages, Pork 9 8 1 Sausage Meat, Beef 4 4 — Sausage Meat, Pork 3 1 2 Sausage Meat, Unclassified 1 1 — Self-raising Flour 1 1 — Sponge Flour Mixture 2 2 — Sundae Creme 1 1 — Sunny Spread 1 1 — Tomato Ketchup 3 3 — Veal and Ham Pie 1 1 — Vinegar 10 7 3 Vinegar, Malt 5 5 — Vinegar, Non-brewed 1 — 1 Vinegar, Tarragon 1 1 — Vinegar, Wood 1 — 1 Brandy 2 2 — Cherry Brandy 1 1 — Gin 1 1 — Port 2 2 — Rum 8 3 — Sherry 3 3 — Whisky 5 5 — Acetic Acid 1 1 — Adexolin (Vitamin Preparation) 1 1 — Almond Oil 1 1 — Ammoniated Tincture of Quinine 1 1 — Aspirin 2 2 — Boric Acid Crystals 1 1 — Camphorated Oil 1 1 — Caseara Sagrada 1 1 — Castor Oil 3 3 — Chemical Food, Parrish's 2 2 — Cinnamon and Quinine 2 2 — Codeine Tablets 1 1 — Cod Liver Oil 1 1 — Compound Glycerine. Lemon and Honey Mixture 1 1 — Compound Glycerine, Lemon and Ipecac Mixture 2 2 — Compound Syrup of Figs 1 1 — Epsom Salts 1 1 — Eucalyptus Oil 2 2 — Eumydrin 1 1 — 20 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Frooty Assorted Flavours (Sweets Vitamins) 1 1 — Gee's Linctus 1 1 — Genaspirin 1 1 — Glucose 1 1 — Glycerine 2 2 — Haliborange (Vitamised Orange Juice) 1 1 — Health Salts 1 1 — Iron Tonic 1 1 — Lung Syrup 1 1 — Malt and Cod Liver Oil 1 1 — Rose Hip Syrup 1 1 — Senna Pods 1 1 — Sulphur Ointment 1 1 — Tincture of Iodine 1 1 — Wintergreen Ointment 1 1 — TOTAL 306 289 17 The undermentioned samples were found to he adulterated or under standard etc.:— Sample No. ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity. Action taken. F.269 Pork Sausage Meat. Formally. Contained 100 pts. per million of sulphur dioxide. Vendor fined £l on each of two offences committed. F.271 Pork Sausages. Formally. Deficient in meat 7%. Shop Manager fined £2. F.272 Pork Sausage Meat. Formally. Deficient in meat 14%. Shop Manager fined £2. F.325 Non- brewed Condiment. Formally. Deficient in acetic acid 15%. Vendor fined £2. F.329 ,, Formally. Deficient in acetic acid 22%. Vendor fined £1 F.343 Milk. Formally. 6% deficient in fat. These 3 samples were taken in F.347 Milk. Formally. 3% deficient in fat, course of delivery to a local 21 Sample No. ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity. Action taken. F.348 Milk. Formally. 15% deficient in fat. dairy when actually a total of 6 samples from a consignment of 6 churns was taken An average of all the results for the 6 samples showed that the complete consignment was up to the required standard. lnf.171 Bread. Complainant. Contained discoloured light brown areas due to presence of iron oxide (rust). Manufacturer warned. Inf.] 80 Vinegar. Informally. Consisted of dilute solution of acetic acid and colouring matter and therefore should not have been described as " vinegar." Following the taking of this sample the vendor re-named the product "Nonbrewed condiment " in accordance with a recent Court decision. Inf. 181 Wood Vinegar. Informally. ,, A follow-up formal sample was taken (F.329) and finally the vendor was prosecuted. Inf.182 Vinegar. Informally. Consisted of dilute solution of acetic acid and colouring matter and therefore should not have been described as " vinegar." Following the taking of this Sample the vendor re-named the product "Non-brewed Condiment" in accordance with a recent Court decision. Inf.183 Non- brewed vinegar. Informally. ,, A follow-up formal sample was taken(F.325) and finally the vendor was prosecuted. 22 Sample No. ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity, Action taken. Inf.209 Milk. Complainant. Contained mould growth, dirt and sand. Vendor (bottling firm) fined £3. Inf.230 Vinegar. Informal. Consisted of dilute solution of acetic acid and colouring matter and therefore should not have been described as " vinegar." Following the taking of this sample the product was sold as "Non-brewed Condiment" in accordance with a recent Court decision. Inf.257 Milk. Informally. 11% deficient in fat. Follow-up formal samples were found to be satisfactory. Inf.259 (a). Bread roll containing Beef filling. Complainant. Bread contained small portion of discoloured dough. Baker informed. No further action considered necessary. Food and Drugs Act, 1938—Section 13. 60 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. Food Complaints. A substantial amount of work accrues from the investigation of sporadic food complaints brought to our notice by members of the public and I note below general details of the cases which were selected for prosecution and the action taken in connection therewith :— Complaint. Action. Bread containing rubber material. Prosecution ; fined £2 with £1 2s. 6d. costs. Bun containing rusty nail. Prosecution ; fined £2. Doughnut containing wire. Prosecution ; fined £3. Certain other complaints after a full investigation were not deemed suitable for prosecution either because the evidence was not wholly satisfactory or the offence—if in fact there was any at all—seemed trivial. Examples under this heading included:— Strawberry jam containing glass. Bread containing portion of flour sack label. Bread containing a small insect, and various meats which had come under suspicion as the cause of alleged illness. Numerous instances of dirty milk bottles were also brought to our notice. 23 The list I have given whilst bringing into relief the fact that food complaints naturally occur and are often justified, does not mean that in fact we are more unfortunate in this regard than any other district of our size. Very often the chain of evidence is such that the possibility of fault not being laid at the door of the person from whom the article was brought or of the manufacturer is considerable and naturally it is only where the evidence appears unequivocal that legal proceedings are taken. Every effort is made in the course of routine inspections by the staff to avoid the conditions which give rise to complaints and our local traders it must be said prove most co-operative. Dirty milk bottles represent an annual cause for complaint and one with which if the milk is produced outside our area it may not easily be possible to deal. Although the bottling firms are naturally deemed responsible for the condition of the bottles when they leave their premises, it is natural and clear that on occasions despite precautions a " dirty " bottle does escape into distribution. If, however, each milk consumer was at as great pains to ensure that the used milk bottle was returned in reasonable condition to the dairy as the dairy is to see that the bottle arrives at the consumer in reasonable condition, then many of the complaints as to dirty milk bottles would never arise. It should surely be quite easy thoroughly to rinse a bottle after use and prior to collection by the milkman. It is unfair that having on occasions been used for a variety of purposes, such bottle should eventually be returned to the dairy. This is no argument in favour of slackness on the part of the dairies; it is merely a recognition of the fact that the human element does creep into the issue of clean milk bottles as to everything else and whilst individual cases may be dealt with legally and prove a certain deterrent, the most profitable course of action is to have it clearly realised that responsibility in the matter rests alike hygienically upon the vendor and the consumer. Unsound Food. During the year the following foods were voluntarily surrendered to the Sanitary Inspectors as being unfit for human consumption : Tons Cwts. lbs. ozs. Bacon Rind — 5 80 0 Corned Beef — 2 0 0 Fish — 15 33 0 Ham 1 2 15 15 Meat — 12 4 1½ Meat Pies — — 30 0 Miscellaneous Groceries — 5 26 5½ Pigs' Trotters — 2 30 0 Sausages — 1 23 8 Tinned Food 1 3 30 12 Tinned Milk — 5 77 8 4 15 15 2 Food Hygiene. During the year an exhibit was staged in concert with Romford and Dagenham at "The Three Towns' Show" and considerable public interest was manifested in the display. 24 During the period also meetings were held with the varied groups of food traders throughout the district, at which after our views had been given, questions were invited and a film, " Another Case of Food Poisoning " was shown. The attendance at these meetings was disappointing although the interest displayed by those who did attend was gratifying. The work of consolidating the intention of the Model Bye-Laws was furthered by repeated visits of the Sanitary Inspectors and a Notice dealing with the question of animals in food shops was drafted and will be offered free to shopkeepers prepared prominently to exhibit it. I feel that in this connection whilst dogs may—perhaps in some instances because of their size and in others because of their habits—be regarded as not being worthy of free circulation or even entry to shops, I think that to single out only dogs is unreasonable. Cats are, I consider, by no means free from possible suspicion and they are undoubtedly far too often allowed far too intimate a run of food premises. The problem of course is weighted not only by the animals concerned but by their habits and possibly most important by the degree of commonsense exercised by their owners. There is nothing much new to be said upon the subject of food hygiene. The three main influences upon the matter are—in order of importance—(1) the outlook of the consumer—since the vendor is far more likely to be convinced by the reaction to his practices of a buyer with consequent reflection upon his trade than by other means; (2) as a matter of detail the degree of personal care devoted by each individual concerned to the hygiene of the matter, and (3) the influence which we ,in the Public Health Department, are permitted to exercise by ensuring observance with the various laws and Bve-Laws. This is mainly done through our system of repeated inspections. In brief, the consumer can set the standard. We have ,during the year, attained an appreciable measure of success in securing the supply of running hot water in food shops. This is clearly of the highest importance in securing the requisite standards of personal hygiene. Our visits to local schools have been continued and a constant liaison maintained with the Divisional Executive Education Officer. Our mutual efforts have, I think, improved the standard of practice to our mutual advantage. Milk. The Council favoured our inclusion as an area under Section 23 Food and Drugs (Milk Dairies and Artificial Cream) Act, 1950, within which the use of a special designation shall be obligatory for the purpose of all sales of milk by retail for human consumption. We did not, however, form part of the area finally planned but it was hoped to include us in an early subsequent such area. Our local pasteurisation or Heat Treatment plants are kept under review and frequent tests are made. The results are, in general, satisfactory. Intricate processes are subject to unavoidable failure through both mechanical and human error. Every step must be taken to ensure that both are recognised. The views of the Ministry of Agriculture and Fisheries were sought on the visiting of local dairy farms under the Food and Drugs (Milk 25 and Dairies) Act, 1944, and a meeting with one of their officials was held. Although one cannot be dogmatic, the new scheme (which has had some time now to bed down) appears to be finding that its resources are—to say the least—being well taxed. There are 13 milk distributors with registered premises in the district. There are also 13 firms registered as milk distributors in Horn church whose premises are registered in other districts. In addition, 28 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 24 Supplementary Pasteurised 5 Dealer's Sterilised 41 Supplementary Sterilised 0 Dealer's Tuberculin Tested 15 Supplementary Tuberculin Tested 4 Milk Sampling. The 199 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. 4 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. During the year 37 applications for registration as vendors and 21 applications for registration of premises for the storage and sale of ice cream were granted. At the end of the year, 17 persons and premises were registered for manufacture and 238 for the storage and/or sale of ice cream. Our sampling was increased from 92 last year to 153 this year. 130 proved satisfactory. The product is retailed—and even produced doubtless under such a diversity of circumstances that its close supervision remains an important matter. Fortunately it is very often prepacked and this lessens the risk of faulty handling. We have the cooperation of our local traders and the results of sampling are deemed satisfactory. Preserved Food Manufacturers. Section 90 of the Hornchurch Urban District Council Act, 1930, requires registration of preserved food manufacturers and premises One application for registration as a manufacturer of preserved meat was granted during the year. At the end of the year, 53 persons and premises were registered for the manufacture of preserved meat (sausages). 26 SECTION F PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Scarlet Fever. The incidence showed a reduction to 127 (from 183 in 1950) and of these 17 were removed to hospital. This disease has become markedly milder and it must be a matter of great difficulty for a practitioner to decide in certain cases whether to notify a doubtful case or not. When called in late it must be virtually impossible to do so with confidence. Control over contacts having a higher danger potential, e.g. dairy employees, remains important. Removal to hospital remains a policy only to be adopted under unusual circumstances. Diphtheria. No case occurred during the year. Seldom has a disease so radically altered in occurrence as has this one in the past ten years especially. I think that a picture in graph form might be provided by noting (a) the population and (b) the cases of Diphtheria. Immunisation is commonly accepted as the major factor in bringing about the present satisfactory situation and the necessity for maintaining a high degree of protection is great if the disease is not again to be given a golden opportunity to inflict itself upon an unprotected population. Factors other than immunisation clearly exist, but their nature and relative importance are largely unknown. Measles. Measles occurred on a very large scale during 1951 and over 2,000 cases were notified. Despite this figure no death was ascribed to the disease. Apart from any alteration in the virulence of the germ or the immunity of the present-day child, this relatively satisfactory position must surely have been aided by the high standard of general hygiene now obtaining and by the advances of chemotherapy which have done so much to minimise the danger from the concurrent—and often killing —companions of infectious disease—ior example the pneumonias. A long protection is normally afforded by a childhood attack. Whooping Cough. Incidence at 195 cases remained high. In babies this persists as a serious disease although only one case from our total died. Dangerous sequelae may, however, be left with the young child and complete recovery takes a considerable time to effect. Encouraging progress is being made towards producing an effective vaccine against the disease. 27 28 TABLE SHOWING THE TOTAL NUMBER OF INFECTIOUS DISEASE CASES NOTIFIED IN EACH WARD DURING THE YEAR 1951. DISEASE Total Cases Notified WARDS No. of Cases Hospitalised Town Cranham Emerson Park Harold Wood Northwest Rainham Thameside Upminster Scarlet Fever 127 21 3 14 5 18 22 26 18 17 Poliomyelitis 8* 2 — — — — 3 1 2 8 Pneumonia 67 7 2 7 3 23 7 10 8 18 Meningococcal Infection 2 — — — — 1 1 — — 2 Dysentery 13 9 — — — 1 1 1 1 11 Infective Hepatitis 37 16 — 1 2 3 5 6 4 2 Measles 2,023 563 21 202 208 385 186 321 137 11 Whooping Cough 495 60 15 58 78 92 109 44 39 15 Food Poisoning 8 1 — — — — — — 7 1 Puerperal Pyrexia 4 1 — — 1 — — 2 — 2 Ophathalmia Neonatorum 3 — — 3 Paratyphoid Fever 1 1 1 — — — — — — 1 TOTALS 2,788 681 41 282 297 526 334 411 216 88 * 2 Paralytic. 29 Poliomyelitis. During the year two paralytic and six abortive cases occurred. This compares with twelve paralytic and three abortive cases in the previous year. Apart from the fact that the last year's total is practically halved it is interesting to note that the paralytic: non-paralytic ratio has swung from 12:3 last year to 2:6 this year. This so far as it goes, is highly satisfactory. Medical and public awareness of this disease must be held to account in some measure for the increased incidence. In the nonparalytic cases especially the general signs are such that frequently in the past the illness has probably been dubbed "influenzal chill"; ."pyrexia of unknown origin," and the like. So far as we know no second case arose in any of the homes concerned and this must be somewhat reassuring as indicating that virulent though this disease is in individual instances it does not affect other than a very small minority of even intimate contacts. In non-epidemic times it is both useful and possibly desirable that non-paralytic and ' abortive ' suspects should be diagnosed with some certainty in hospital. In epidemic times, however—if they should arise—it seems to place an unnecessary strain upon the hospitals to admit such cases, the more so if reasonable home isolation can be secured. If the public can be enlightened in this regard (and it is our job to do so as doctors) then hospitalisation of cases will be viewed in its true perspective to the benefit of the beds they have available and without prejudice to the ease nursed at home. Food Poisoning. A localised outbreak involving some six persons, occurred during the year. Various articles of food were sampled and analysed baetcriologically and although suspicion fell upon liquid in which the meal was cookcd the positive evidence was not conclusive. Apart from hand-washing and general personal hygiene it is most important that all food handlers (and of course everyone) should observe extreme care that any cuts or septic spots should be adequately covered until they have cleared up or no longer endanger food. Although I do not relate it to the outbreak noted, history suggests a septic finger and re-heated food to be perfect partners for the foundations of a food poisoning outbreak. Disinfection. No change in our methods has occurred. Fresh air, sunlight, strict personal and general cleanliness have gone far to obviate the necessity for the more dramatic procedures of the past. Tuberculosis : Pulmonary—The notifications for the year are seen to total 128 vice 91 in 1950 and this increase clearly calls for some analysis. In fact this figure includes three main categories (a) new cases in every respect and domiciled in our district; (b) cases originally on the register of another Authority and being transferred to us on change of domicile to our district; (c) cases with a definite previous history of the disease 30 AGE GROUPS NEW CASES TOTAL NEW CASES DEATHS TOTAL DEATHS PULMONARY NONPULMONARY PULMONARY NONPULMONARY M. F. M. F. M. F. M. F. M. F. M. F. 0- 1 years — — — — — — — — — — — — 1- 5 „ 3 2 3 1 6 3 — — — — — — 5-10 „ — 2 2 — 2 2 — — — — — — 10-15,, 2 2 — — 2 2 — — — — — — 15-20,, 8 8 2 — 10 8 1 — — — 1 — 20-25,, 7 13 1 — 8 13 — 1 — — — 1 25-35 ,, 18 23 — 2 18 25 — 4 — 1 — 5 35-45,, 18 4 — 1 18 5 1 — — — 1 — 45-65 ,, 11 5 — 1 11 6 9 1 — 3 9 4 65 and over 2 — — — 2 — 3 1 — — 3 1 Totals 69 59 8 5 77 64 14 7 — 4 14 11 31 YEAR 1951—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 1951 3 — — 1 2 2 5 12 25 TUBERCULOSIS NOTIFICATIONS—1939-1951. 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 1951 128 13 141 32 elsewhere but which have become quiescent and, possibly after a period of many years, active again in our area. The number of inward transfers included in our 128 pulmonary cases was 38. These factors necessarily colour the picture of the number of new cases in its relation peculiarly to our area. Non-Pulmonary—The notifications decreased from 10 to 13. The death rate of 0.24/1000 population is a reduction on last year and is below the average for the country as a whole. The deaths numbered 25, a decrease of 4 on 1950. The presence of Tuberculosis was in twelve of the eases only made known in fact after death had occurred and in three other instances death occurred within one month of notification. Whatever progress is being made with chemotherapy and antibiotics it is clearly vital that early diagnosis should be made possible. The factors causing this delay in seeking advice must evidently be sought and countered by the appropriate Authorities. If a case is not elicited until after death then that person has had considerable scope for spreading the disease for a problematical period before death and the same general argument applies in varying degree to all cases diagnosed at an advanced stage. Money spent in halting tuberculosis is invested not wasted and one of the major reassuring factors to a patient will be the feeling that this disease both can be cured and will not produce penury in the process. The tuberculosis register at the end of the year showed as follows Pulmonary— Males 339 Females 267 Non-Pulmonary— Males 36 Females 34 Pulmonary and Non-Pulmonary Total 676 Mass Radiography. A visit to Hornchurch was paid by a Unit in September/October, 1951. The success of its appeal may be gauged by the fact that in all 6,644 individuals attended. The full results of the visit are not yet available but the appeal which it made is indicative of the vastly different popular outlook towards a subject of this kind. It shows I think that the public do in certain instances appreciate the value of prevention rather than cure and although it could be argued that in this example it is much easier to put across the value of preventionsince Tuberculosis as a scourge is so well known—we in the Public Health service must strive to secure the same outlook in directions and regarding problems which may not have the popular appreciation of Tuberculosis. 33 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 :— Chiekenpox 270 Conjunctivitis 8 Gastro - enteritis 1 Impetigo 7 Mumps 361 Ringworm 5 Rubella 85 These numbers must necessarily be accepted with reserve since they represent our only available, but not necessarily wholly accurate, information. 34 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. 22 12 — — (ii) Factories not included in (i) in which Section 7 is enforced by the L. A 187 119 5 — (iii) Other premises in which Section 7 is enforced by the Local Authority 28 3 — — Total 237 134 5 — 2. Cases in which Defects were Found. Particulars. Referred Prosecutions To H.M. By H.M. Found. Remedied Inspector. Inspector. Sanitary Conveniences (Section 7) (a) Insufficient 1 1 — 1 — (b) Unsuitable or Defective 4 3 — — — (c) Not separate for sexes — — — — — Other offences against the Act 3 3 3 — — Total 8 7 3 1 PART VIII OF THE ACT. OUTWORK—Sections 110 and 111. Nature of No. of Outworkers Work in August last Wearing Apparel— No instances of work in Making, etc. 145 some premises. 35 Factories. A list of trades carried on in local factories is appended :— Animal and poultry feeding stuffs manufacture 1 Aquarium manufacture 1 Bakehouses 19 Blacksmith 4 Boot repairs 25 Breeze Blocks manufacture 3 Builders Workshops (joinery etc.) 21 Chemical manufacture 3 Clothing repairs and cleaning 9 Creosote manufacture 1 Caravan builder 2 Dental mechanic 1 Dressmaking 10 Duplicating Machine manufacture 1 Electrical Engineering 1 Firewood manufacture 2 Fireplace manufacturer Fishing tackle manufacturer 1 Furniture repairer 1 Garages 36 Glaziers 1 lee Cream manufacturers 2 Mechanical Engineering 31 Metal refiners 1 Meat products 1 Paint Spraying 2 Printers Plastics 1 Radio Repairs Refrigerating Engineers 1 Saw Mills Sausage manufacturers 1 Shirt manufacturers 2 Sweet manufacturer 1 Upholsterers 3 Vinegar bottlers 2 Other premises (building sites etc.) 28 237