NM0 LIBRARY AC4411(3)HORNCHURCH HORNC 20 Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1952 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 1952 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. 2 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 11 SECTION C—Sanitary Circumstances of the Area 13 SECTION D—Housing 19 SECTION E—Inspection and Supervision of Food 21 SECTION F—Prevalence of, and control over, Infectious Disease 31 SECTION G—Factories Acts, 1937 and 1948. Ministry of Labour and National Service Form 572 (Revised) 40 3 MEMBERS OF THE COUNCIL (as at 31.12.52). Councillor S. M. Tucker, J.P., Chairman. (1) Councillor S. C. Parrish, Vice-Chairman. (1) Councillor Mrs. M. Anfilogoff. (1) ,, Miss C. F. M. Cannon. Mrs. E. H. Dean. (1) „ Mrs. R. J. Reynolds. (1) and (2) „ Mrs. E. G. Richardson. „ E. E. Baxter. „ E. W. J. W. Bush. „ L. W. Carroll ,, W. E. Daubeney. „ P. C. Ford. „ E. W. Fryd. (1) and (3) „ R. S. Howe. J. W. G. Hughes. „ G. W. Lagden, C.C. ,, W. E. Large. H. G. W. Levy. (1) „ A. G. Newman. (1) ,, G. W. Phillips. „ W. E. Philo. „ P. M. Rowe. „ A. C. Salinger, J.P. ,, G. M. D. Shaw. (1) „ W. A. Sibley. „ A. J. Twigger. (1) „ C. A. Welch. „ G. Welham. „ A. Wheeler. A. W. Wren. (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) and (3) Sanitary Inspectors: L. Ager, M.S.I.A. (1) and (3) *J. P. Barton, M.S.I.A. (2), and (3) T. W. Glew, M.S.I.A. (2) and (3) †. Goodwin, 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) *Resigned 7.9.52. †Commenced duties 10.11.52. Clerical Staff: J. E. Blay (Chief Clerk). S. N. Dance (Resigned 26.10.52.) R. M. Jamieson (Commenced duties 8.12.52). 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, 5 Public Health Department, Council Offices, Billet Lane, HORNCHURCH. 12th June, 1953. To the Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I beg to present to you the Annual Report on the health of the district during 1952. Vital Statistics. The Birth Rate—13.8—is down compared with last year (14.1). The Infant Mortality Rate has risen from 16.84 to 32.2, whilst the Death Rate showed little change at 10.4 vice 10.3 in 1951 and is still below the general average. The national figures for this year compare somewhat favourably with those for 1951 and locally—especially as regards our infant mortality figure—our trend has not followed the national example. It should however, be noted that our infant mortality figure for 1951 was very low and our present figure even although it shows a considerable increase is only now very slightly higher than the national average figure for comparable areas. Infectious Disease. The most evident comparative features as against 1951 are the increase in Scarlet Fever cases and the diminution in Measles and Poliomyelitis notifications. Tuberculosis. The number of notifications and the death rate alike dropped markedly and provided a substantial encouragement that the attack on this disease is succceding. Everyday experience amply proves that the time has not yet arrived for the disease to be regarded as other than a major national and personal anxiety. Housing. Steady progress in Council building was maintained and our postwar record in this respect is one for satisfaction. Atmospheric Pollution. Our investigations—pursued as part of a national framework of research into this problem—were continued and provided much valuable information of a specialised nature. This is a subject which is rightly assuming increased public importance and the burden of enquiry has in the past been left too exclusively to progressive Authorities. This position has probably largely eventuated through an absence of sufficiently widespread local interest and central stimulus. No urban and few rural authorities can justifiably regard the state of the atmosphere as being the sole privilege of someone else to investigate. 6 Food and Drugs. A very satisfactory year's programme was carried out. The benefits both of local control and County co-operation have been evident. General. The hygienic circumstances of the district remain satisfactory and the work done in the past year gives solid ground for confidence but not complacency. Even in a district of largely modern development problems both diverse and complex continue to arise and can only be tackled by present and future endeavour aligned with modern scientific development and by utilising our past experience only insofar as it provides an aid to future progress. Acknowledgments. My best thanks are due to you for your support throughout the year and in this expression I would include the chief officers and staffs of other Council departments. I would also acknowledge the services rendered by my own department notably through Dr. O'Dwyer and Mr. Blay my Chief Clerk. I must finally pay tribute to the assistance rendered by my Senior Sanitary Inspector, Mr. Randall. His able, unostentatious and ready advice has gone far to secure a successful year's working. 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 (mid-year) 1952 104,100 Number of inhabited houses according to rate books (September, 1952) 30,229 Rateable value (September, 1952) £786,825 Sum represented by a penny rate (September, 1952) £3,160 Extracts from Vital Statistics for the Year. Births. Number of live births allocated to the District as adjusted for inward and outward transfers 1,517 (770 males, 747 females) Birth rate per 1,000 Home Population using area comparability factor 13.84 Number of stillbirths allocated to the District 35 (22 males, 13 females) Stillbirth rate per 1,000 Home Population 0.33 Stillbirth rate per 1,000 total (live and still) births 22.54 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 10.49 Deaths of infants under one year of age 49 (29 males, 20 females) Infant mortality rate (per 1,000 live births) 32.30 REGISTRAR-GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH. (Corrected for inward and outward transfers). Causes of Death Male. Female ALL CAUSES 481 445 1. Tuberculosis, respiratory 12 4 2. Tuberculosis, other 0 1 3. Syphilitic disease 4 2 4. Diphtheria 0 0 5. Whooping cough 0 1 8  Causes of Death. Male. Female 6. Meningococcal infections 0 0 7. Acute poliomyelitis 0 0 8. Measles 0 0 9. Other infective and parasitic diseases 0 0 10. Malignant neoplasm, stomach 14 13 11. ,, „ lung, bronchus 27 4 12. ,, ,, breast 2 21 13. uterus 0 5 14. Other malignant and lymphatic neoplasms 43 55 15. Leukaemia, aleukaemia 2 3 16. Diabetes 2 2 17. Vascular lesions of nervous system 54 65 18. Coronary disease, angina 80 36 19. Hypertension with heart disease 6 3 20. Other heart disease 61 87 21. Other circulatory disease 15 18 22. Influenza 1 1 23. Pneumonia 28 21 24. Bronchitis 34 18 25. Other diseases of respiratory system 5 4 26. Ulcer of stomach and duodenum 5 2 27. Gastritis, enteritis and diarrhoea 2 3 28. Nephritis and nephrosis 4 6 29. Hyperplasia of prostate 9 0 30. Pregnancy, childbirth, abortion 0 2 31. Congenital malformations 7 5 32. Other defined and ill-defined diseases 47 57 33. Motor vehicle accidents 7 2 34. All other accidents 2 2 35. Suicide 8 2 36. Homicide and operations of war 0 0 Malignant Disease. Lung and bronchus. In 1950, deaths from this cause were 24 males and 3 females, in the following year, 37 males and 3 females and in 1952, 27 males and 4 females. The figures for previous years are not available but the striking reduction in male mortality front this cause during 1952 vice 1951 is noteworthy. Other malignant and lymphatic neoplasms. In 1950, 41 males and 37 females died from this cause. The following year the figures were respectively 46 and 37, whilst in 1952, the male mortality had fallen to 43 and the female had risen to 55. This latter appears to be a significant rise but as in all matters statistical it is wise to observe trends over a considerable period of time before making deductions. 9 DEATH RATE—COMPARISON WITH PREVIOUS YEARS. 1939 7.8 1946 9.0 1940 9.4 1947 8.3 1941 9.6 1948 8.2 1942 7.9 1949 10.6* 1943 8.9 1950 10.4* 1944 9.2 1951 10.3* 1945 9.9 1952 10.4* * Area Comparability Factor returned. BIRTH RATE-COMPARISON WITH PREVIOUS YEARS 1939 18.9 1946 21.3 1940 16.4 1947 20.7 1941 15.5 1948 17.2 1942 17.5 1949 16.0 1943 19.0 1950 13.6* 1944 11.9 1951 14.1* 1945 18.4 1952 13.8 * Area Comparability Factor used. The A.C.F. might very generally be translated as one which being applied to certain local figures makes them suitable for general comparisons. BIRTH RATES, DEATH RATES AND ANALYSIS OF MORTALITY, 1952. Local figures compared with England and Wales and certain towns. England and Wales 160C.B.s and Great Towns (including London.) 160 Smaller Towns (Resident Pop. 25,000/50,000 at 1951 Census). London Admin. County. Hornchurch Rates per 1,000 Home Population. Births— Live births 15.3 16.9 15.5 17.6 13.84 Still births 0.35 0.43 0.36 0.34 0.33 22.6 (a) 24.6 (a) 23.0 (a) 19.2(a) 22.54(a) Deaths— All causes 11.3 12.1 11.2 12.6 10.49 Typhoid and paratyphoid 0.00 0.00 0.00 — — Whooping cough 0.00 0.00 0.00 0.00 0.00 Diphtheria 0.00 0.00 0.00 0.00 — Tuberculosis 0.24 0.28 0.22 0.31 0.16 Influenza 0.04 0.04 0.04 0.05 0.01 Smallpox 0.00 — — — — Acute poliomyelitis (including polioencephalitis) 0.01 0.01 0.00 0.01 — Pneumonia 0.47 0.52 0.43 0.58 0.47 Rates per 1,000 live births. All causes under 1 year of age 27.6(b) 31.2 25.8 23.8 32.30 (a) Per 1,000 Total (Live and Still) Births. (b) Per 1,000 related live births. 10 CASE RATES FOR CERTAIN INFECTIOUS DISEASES, 1952. Local figures compared with England and Wales and certain towns. England and Wales 160 C.B.s and Great Towns (including London.) 160 Smaller Towns (Resident Pop. 25,000/50,000 at 1951 Census). London Admin. County. church. Rates per 1,000 Home Population. Typhoid fever 0.00 0.00 0.00 0.00 — Paratyphoid fever 0.02 0.02 0.03 0.01 — Meningococcal infection ... 0.03 0.03 0.03 0.02 0.00 Scarlet Fever 1.53 1.75 1.58 1.56 2.35 Whooping Cough 2.61 2.74 2.57 1.66 4.89 Diphtheria ... 0.01 0.01 0.03 0.01 — Erysipelas ... 0.14 0.15 0.12 0.14 0.14 Smallpox 0.00 0.00 0.00 — — Measles 8.86 10.11 8.49 9.23 11.39 Pneumonia 0.72 0.80 0.62 0.57 0.33 Acute poliomyelitis (including polioencephalitis) Paralytic 0.06 0.06 0.06 0.06 0.01 Non-paralytic 0.03 0.03 0.02 0.03 0.02 Food poisoning 0.13 0.16 0.11 0.18 0.01 Rates per 1,000 total (live and still) births. Puerperal Pyrexia 17.87 23.94 10.22 30.77 3.22 11 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staffing. We had during the year two staff changes ; one relating to a District Sanitary Inspector who resigned in order to secure a more favourable appointment in the North, and the second relating to a clerical post in the office in which again a better opportunity presented itself. Local Health Authority. In pursuance of your resolution of 13th May, 1952, to the effect that the proposed basis for my continued participation in the administration of the County Council's Health and School Medical Services in the South Essex Health Area was not acceptable, I ceased duty as from the date noted. My views should be recorded as coinciding with yours in this connection. Care of the Aged. From time to time during each year we have brought to our notice instances of aged people in which there appears to be some prejudice to the health either of the individual concerned or possibly even other residents in the same house by reason of these aged persons either not having the will or the means to look after themselves properly. Age, of course, is not only a matter of years and appears as the result of the impact of time upon the established habits and custom of the individual so that a situation may well be arrived at in which one person of 80 may well differ little or be even in better shape than another many years junior. There is no doubt that increasing attention through Geriatric Committees, Old Age People's Welfare Associations, visiting of the aged by Health Visitors and others, Home Help Services and the like substantially provide for the needs of many aged individuals so long as these individuals know the facilities open to them and are willing to avail themselves of them. Such, however, is the innate and acquired independence of many of these people that it would appear they literally have to be at death's door before they will accept assistance. The plight of the more unfortunate of the aged is being appreciated to a very large extent by those who can help and it remains to do all that is possible to ensure that if full use is not made of the opportunities provided it is not through ignorance of these opportunities on the part of the aged. Scope still remains for propaganda in this connection. 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. 12 The Department was also represented at a vocational exhibition held under the auspices of the local Rotary Club. We were able to provide visible evidence on certain feature of our work and including notably our Food and Drugs duties and considerable public interest was evidenced in our exhibit. 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) Southend Road, South Hornchurch. (vi) Upminster. (vii) Hornchurch Road, Hornchurch. Nursing and Maternity Homes. There are 3 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, 2 Independent Midwives and 1 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. It is difficult to establish a dividing line between cases properly coming within this section and cases which can be dealt with at least temporarily through Home Help and Allied Services. Our chief troubles probably arise from the few individuals aged and otherwise who vacillate between the unobtrusively unsatisfactory and the more 13 obvious stage of mental irresponsibility which just falls short of the certifiable. Tact is often more effective than the law in coping with the impatience of neighbours and the resentment of the person complained about. No action was taken under this section during the year—a satisfactory situation only made possible by much painstaking informal work. 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 201 employees or prospective employees (52 permanent and 149 temporary). SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water. The general supply is from the South Essex Waterworks Company and is of excellent quality. 12 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. 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. 14 The number of dwelling houses supplied as at 31st December last, was 30,655 and the population as at 30th June, 1952, as obtained from the Registrar General was 104,100." 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. It will be noted that we are fortunate to have an adequate and satisfactory main water supply to practically all our district. This position is now regarded as commonplace and it is only when one comes to reflect upon the very different supplies which were utilised many years ago that one appreciates something of the advance made by sanitation. We have of course certain small and relatively isolated units which still depend upon spring or well supplies. Hunts Hill Cottages and Dennises Corner represent probably the most obvious examples and in present circumstances it seems likely that further delay in dealing with this matter will be inevitable. No opportunity will, however, be lost in providing a solution to the present difficulties of these areas. Atmospheric Pollution. Our plans during the year remained substantially on their preexisting basis. This it will be recalled consists of the provision of lead peroxide apparatus at St. George's Hospital, Rainham Secondary School, North Ockendon Vicarage and Redden Court School, a deposit gauge at Rainham Secondary School and a volumetric sulphur dioxide apparatus at these offices. There remains another year before our 5-year programme is complete and any comprehensive review of the results would therefore be at this stage somewhat premature. Interim consideration of the position, however, suggests that the provision of one or two additional deposit gauges in parts of the district other than Rainham would prove informative and this will be considered in our next year's programme. It is difficult to assess the value of atmospheric pollution investigations in precise terms as there is still so much that is unknown in this field of research. It is also very difficult and equally unwise probably to endeavour to arrive at any far-reaching conclusions purely on the basis of local findings. Especially in areas such as ours the effect of drift from neighbouring areas must be considerable and must account for a significant degree of our local air pollution. The overall picture should in due course enable some idea of how far we are affected by the neighbouring urban and industrial aggregations. Although it might be unwise to be dogmatic on the results of our local findings it nevertheless remains, I believe, of vital importance that the established interest which we have shown in the investigation of atmospheric pollution should be not only maintained but increased. The contribution of a Local Authority by presenting their own findings to a co-ordinating body such as the Department of Scientific and Industrial Research is undoubtedly very useful in that only by the increasing participation of Local Authorities in atmospheric pollution work will it be possible for a really comprehensive picture to be built up. 15 Although recently a somewhat shorter form of analysis for deposit gauge material has reduced the cost, it might well be possible to effect further economies in this general field of analysis. The vital nature of atmospheric pollution research is also in my view not brought sufficiently forcibly to the attention of Local Authorities and whilst they may at heart be receptive to suggestions that something should be done, there is lacking that final spark which would in fact ensure that their general sympathy with work of this kind, was translated into positive action. If atmospheric pollution is really the problem that it is frequently said to be and is, then it can undoubtedly be brought much more directly to the notice of people who can do something about it. In this latter regard once more a passing reference must be made to the fact that domestic smoke is a substantial contributor to the dirtiness of our air. Whilst this is due in some measure to the impossibility of securing the most desirable grades of fuel, it is also contributed to in part by the fact that the housewives are by and large not yet sufficiently convinced of the fact that atmospheric pollution is really a problem or if it is that it is one which concerns them. If industry and if the homes in this country are not really convinced of the seriousness of the problem then national and local authorities must undoubtedly shoulder a substantial part of the responsibility. If on the other hand we do know of proved and reasonably economic methods of preventing even in small part the menace presented by polluted air. then it is up to everyone responsible to see that practical means are devised of making remedial measures known and practised. Sewerage. With the very rapid advance of housing development allied to the difficulties of the war and post-war era, the adequacy of the main sewage system of the district as reflected especially by the Ingrebourne and St. Mary's Lane sewers, has naturally been under repeated review. The situation is I think known to be unsatisfactory and it may be presumed that measures to deal with it will be adopted with all possible speed. Whilst sewage overflow say in times of storm cannot be said so far to be related to any actual prejudice to health, it is nevertheless obvious that such overflows in the urban parts of an area (where there are shops especially) represent potential danger of an order not to be despised and where houses are involved represent a situation that no individual likes to have facing him. Surface Water Sewer. Attempts have been made to secure the provision of adequate drainage for surface water in South Hornchurch and it is to be regretted that so far these have been without avail. Again it must be admitted that if one is asked frankly to detail the actual damage to health which is caused by the filled ditches and other surface accumulations in this area, it is in fact impossible to establish any serious case. It is, however, perfectly clear that in these times one does not expect to find such accumulations of water and although I think some grounds can clearly be advanced for attempting to minimise the 16 treme urgency of this work, it is earnestly to be hoped that as soon as conditions permit South Hornchurch amenities will benefit by the reduction of their capacity as a form of secondary storage reservoir. Not only will this be advantageous from a public health point of view but it will also encourage the inhabitants of the district to develop or augment a real pride in their surroundings. Pollution of the Thames. Although the position is not yet ideal at any rate fewer complaints on this score were received than during 1951 and the position is still being kept under review. Swimming Baths. My annual plea for provision of this kind must be renewed. Circumstances beyond our control—at any rate in the post-war years— have so far precluded our being permitted to proceed with this project. We must, however, ensure that every effort is made to secure the provision of suitable baths as soon as possible. Our persistent efforts should make this more than a distant dream. Paddling Pools. A routine cheek is maintained upon the local paddling pools and the general standard maintained is satisfactory. It is clear that pools of this nature used not only for paddling but to some extent for attempted swimming by the younger members of the community and subject to all sorts of contamination—generally of a minor character—cannot be expected to achieve the bacteriological standards of pure main water or at any rate not to maintain them for long, but from our results there is little to support any apprehension about the possibility of disease spread even when the waters concerned appear far from crystal clear. Our samples it should be emphasized were taken often after the pool had been in use for some time and the results show, I think, the value of the preventive measures taken by the Engineer and Surveyor. Six samples were taken during the year and were satisfactory. Disinfestation. The prevailing practice in this regard was continued. Rodent Control. During the year the Sanitary Inspectors and Rodent Operative made a total of 2,084 visits and re-visits and the Rodent Operative cleared 140 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. Intestation on business premises 5s.0d. 17 Pet Animals Act, 1951. A result of this coming into force was the provision locally of rules governing the keeping of animals within the terms of this Act. Various aspects of the question such as accommodation, ventilation, lighting, temperature, cleanliness, food and drink, delivery of animals, prevention of spread of infectious disease, fire precautions, the display of animals and the storage of feeding stuffs, were covered comprehensively and were brought to the notice of persons applying for a licence. Due to our detailed inspection and the co-operation of the persons responsible, we have brought about a considerable improvement in premises and have no reason to doubt that this satisfactory outcome will continue to be reflected in a satisfactory everyday practice. 12 licences to keep a Pet Shop were issued during the year. Rag Flock and Other Filling Materials Act, 1951. One address in the Urban District was registered during the year pursuant to the provisions of Section 2 of this Act. Five samples were taken during the year and in one instance an unsatisfactory report was received. This sample (cotton felt) was manufactured in a neighbouring district and the matter was pursued with the Authority concerned. Sanitary Inspection of the District. SUMMARY OF SANITARY INSPECTORS' WORK DURING 1952 Inspection of Food and Food Premises (visits paid):— Bakehouses 89 Butchers' shops 261 Cafes 302 Dairies (including Pasteurising Plant) 96 Fish shops 106 Greengrocers' shops 65 Grocers' shops 422 Ice Cream Dealers' premises 165 Samples (Chemical and Bacteriological) 673 School canteens 35 Staff canteens 21 Miscellaneous visits 239 Housing (visits paid):— Drainage of houses 328 Environmental reports 194 Sanitary fittings 88 Structural defects 680 Water supplies, pipes, etc. 42 Re-inspections 1,438 General Sanitary Circumstances (visits paid):— Accumulations 102 Camping grounds, vans, etc. 82 Drainage and sewerage 251 Dustbins 237 Keeping of animals and birds (including Pet Animals Act) 175 Public Conveniences 52 18 SUMMARY OF SANITARY INSPECTORS' WORK—Continued. Refuse tips 90 Rodent and vermin infestation 364 Smoke Abatement 47 Watercourses and wells 205 Re-inspections 200 Miscellaneous visits 213 Factories and Outworkers:— Number of visits paid 153 Shops Act:— Number of inspections 473 Infectious Diseases:— Number of visits paid (including contacts) 622 Number of Notices served:— Informal 415 Statutory 119 The standard of the previous years has been well maintained and comment on certain details of the work will be found separately. The main headings under which work was done may be noted as follows:— Housing 2,760 visits Inspection of food and food premises 2,474 „ General sanitation 1,918 ,, Infectious diseases 622 „ Shops Act inspections 473 ,, Factories and Outworkers 153 ,, Undue emphasis on purely numerical aspects of the work may be misleading although naturally a reasonable number of visits is inseparable from an efficient service. The Sanitary Inspector should however, have time to do both himself and his Authority justice. His function of maintaining a sound hygienic environment is none the less important because scientific progress has provided the basis for such environment and ensured a public demand for it. The Inspector still occupies an indispensable place in our schcme of preventive medicine. 19 SECTION D. HOUSING Number of new houses erected during the year. 385 houses were completed during the year by private builders. The Council's own housing scheme produced a total of 193 dwellings during the year comprising 108 two-bedroomed maisonettes, 8 aged persons' bungalows and 77 houses. These latter included a doctor's residence and surgery for each of the Dovers and Elm Park Estates. Overcrowding. Opportunity is taken when enquiring into the circumstances of housing applicants for medical priority to investigate the presence of possible overcrowding and as some 194 visits for this purpose were made during the year the overcrowding position was kept reasonably under review. Six cases of overcrowding were reported to the Council during the year. Unfit Houses. Some four old and dilapidated houses were represented for demolition during the year. We propose shortly to review the position of such sub-standard houses as previous surveys have shown to us to exist. In the meantime we have pursued our policy of individual demolitions of the worst and often isolated properties. Many of the relatively few sub-standard dwellings which exist in this district are occupied by aged individuals or couples—in many cases because they have been there a lifetime and in others doubtless because of the low rentals. It is a heavy responsibility to initiate action which will uproot aged persons from a lifelong environment to which they may have become attached even although such action is taken on the grounds of hygiene. It is certain that anything approaching a normal Council house rent could only ensure hardship for these people and it has therefore been and will continue to be our policy to go very carefully into the circumstances of each case before we recommend action which will result in the vacation of the property. This of course does not mean that such sub-standard properties are going to remain up permanently because experience has shown and will continue to show that the problem can be resolved equally radically, if less speedily, by more protracted methods. ' Week-End ' Dwellings. In certain parts of our district notably Rainham and perhaps to a somewhat lesser extent, Cranham, there exist so called "weekend bungalows" to which in the past were attracted seekers after such rural amenities as those parts of the district then possessed and who probably occupied the structures for the most part during weekends under favourable conditions. Time and circumstance have however decreed that far from merely being used at weekends by their owners they have subsequently tended to be used as full-time habitations not only by the owners but in some instances have been let to tenants. This is a state of affairs which is just not good enough 20 and whilst—so long as no detriment to others is caused—some reason might be advanced for occupancy by the owners themselves, there can be none—even on the grounds of alleged generosity—for letting these places at a substantial figure to people unfortunate enough to be so needy as to see in such letting a temporary solution to their worries. Again the individual circumstances of the case must and will influence our attitude towards it but I intend to see that any structure used for habitation will be fit for habitation. It is to be expected therefore that from time to time action will continue to be recommended to you in respect of sub-standard dwellings which although relatively insignificant in number do so prejudice the housing amenities of our district Caravans. Caravans and their siting still occasion us concern from time to time. Whilst it is easy theoretically to establish that a caravan sited almost anywhere and provided with a dustbin and pail closet and a bucket for clean water, does not in fact constitute anything against which on public health grounds we can take action, it is nevertheless clear that such a situation is highly undesirable. One has every sympathy with caravan dwellers who genuinely cannot find somewhere better to live and are therefore forced to live with their families in confined and often, one imagines, uncongenial surroundings. Permanent life on a caravan site can assuredly not be the life of choice for many people in really urban surroundings and it certainly is not the choice we as a Public Health Authority would wish them to have to make. If for any reason the perpetuation of caravans as a means of permanent or semi-permanent dwelling for inhabitants of an urban district is necessary, then such caravans should be placed only in a site which from every point of view can reasonably be regarded as satisfactory. It is also unsatisfactory that no reasonably clear-cut overcrowding standard seems to exist for caravans. The result is that it is practically impossible to quote any legal standard when suggesting overoccupancy of any individual structure. This is a matter which might receive careful official consideration at a national level. Medical Aspects of Re-housing. Some 466 certificates were considered during the year. To secure significant priority the circumstances must be unusual as otherwise any priority given must be given so often as to negative any real value. It appears to me that such conditions as ' nervous debility ' (a general term impossible of real definition) must in some degree represent the lot of perhaps a majority of our applicants whether or not they seek medical confirmation of it and one's judgment must therefore be influenced by this assumption. The number of housing applications influenced generally by medical factors must be legion, the number which should in equity be determined by such factors is of a much lower order. Land Charges Enquiries. During the year 3,043 land charges enquiries were referred to the department regarding the question of outstanding sanitary notices. 21 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Act Administration. The sampling of food and drugs has been continued on the basis of our programme as detailed in my 1951 annual report. During the past year the Sanitary Inspectors obtained a total of 269 samples of food and drugs (231 food and 38 drugs) of which 20 samples (16 food and 4 drugs) were found to be unsatisfactory. The particulars of this work as noted below 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. Sampling of food would appear superficially to have received more attention than has been given to the sampling of drugs, but I would emphasize that the National Health Service Executive Committee for Essex also takes samples of drugs (prescriptions etc.) in this district under the general medical and pharmaceutical services provided in accordance with the provisions of the National Health Service Act, 1946. In the course of actual sampling the Sanitary Inspectors have also checked the labelling of food and drugs and other items such as possible substitution of foods, e.g. sale of smoked cod as smoked ' haddock '. In no instance was any contravention found. In reviewing the results of the samples taken by us I feel we can have confidence in the quality of food and drugs sold in Hornehurch. Once again I express my thanks to the Public Analysts, Mr. George Taylor, F.R.I.C., and Dr. J. W. Hamence, F.R.I.C. ARTICLES Number of Samples examined. No. found to be genuine. No. found to be adulterated or under-standard etc Aberdeen Pearl 1 — 1 Apricot Preserve 1 1 — Bacon 1 1 — Baking Powder 1 1 — Barley Crystals 1 1 — Barley Flour 1 1 — Beans in Tomato Sauce 1 1 — Blackcurrant juice 1 1 — Blanc Mange Powder 2 2 — Bread (portion of loaf) 1 — 1 Bread 4 — 4 Butter 3 3 — Cake Decorations 1 1 — Celery Cheese Spread 1 1 — Cheese, processed 1 1 — Cheese Spread 3 3 — Cherries 1 1 — Chocolate Spread 1 1 — Cochineal Colouring 1 1 — 22 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under–standard etc Coconut Shredded in Syrup 1 1 – Coconut Spread 1 1 – Coconut, sugared 1 1 – Coffee 2 2 – Coffee and Chicory Extract 2 2 – Cooking Fat 1 1 – Crab, Dressed 1 1 – Crab Paste 1 1 – Cream Powder, Synthetic 1 1 – Curry Powder 1 1 – Custard Powder 3 3 – Essence of Anchovies 1 1 – Essence of Rennet 1 1 – FishCakes ... 1 1 – Fish Paste ... 1 1 – Flour, self–raising 1 1 – Frying Oil ... 1 1 – Gelatine 1 1 – Ginger, Ground 1 1 – Glucose 1 1 – Gruyere Cheese, Processed 1 1 – Honey 2 2 – Horseradish Cream 1 1 – Ice Cream 11 11 – Ice Cream Powder 1 1 – Jam 4 4 – Jelly Creams 1 1 – Jelly Crystals 4 4 – Lard 1 1 – Lemonade Crystals 1 1 – Lime Juice Cordial 2 2 – Luncheon Meat 1 — 1 Macaroni 1 1 – Margarine 2 2 – Marjoram 1 1 – Marmalade ... 2 2 – Meat Paste ... 1 1 – Meringue Mixture 1 1 – Meringue Powder 1 1 – Milk 44 37 7 Milk, Condensed 3 3 — Milk, Dried 1 1 — Mussels in Spirit Vinegar 1 1 — Mussel Paste 1 1 — Mustard 1 1 — Mustard, French 1 1 — Mustard Sauce 1 1 — Olive Oil 2 2 — Orange Squash 5 5 — Parsley and Thyme Stuffing 1 1 — 23 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Pea Nut Butter 2 2 – Peas, Processed 1 1 – Peel, Lemon and Orange 1 1 – Pepper 5 5 – Pineapple Slices, dried 1 1 – Pork Liver in Gravy 1 1 – Pork, pressed 1 1 – Pork Savouries 1 1 – Porker Savouries 1 — 1 Rice, Ground 1 1 – Salad Cream 2 2 – Salad Oil 1 1 – Sandwich Spread 1 1 – Sauces 4 4 – Sausage Meat, Beef 2 – Sausage Meat, Pork 1 1 – Sausages, Beef 7 7 – Sausages, Frankfurter 1 1 – Sausages, Liver 1 1 – Sausages, Pork 10 10 – Shortbread Mixture 1 1 – Soups 2 2 – Soya Flour 1 1 – Sugar 1 1 – Tea 1 1 – Tomato Ketchup 3 3 – Vegetables, Mixed 1 1 – Vinegar 1 1 – Vitacream 1 — 1 Yeast Extract 1 1 – Yoghourt 1 1 – Advocaat 1 1 – Apricot Liqueur 1 1 – Beer 2 2 – Cherry Liqueur 1 1 – Gin 4 4 – Rum 5 5 – Vermouth 2 2 – Whisky 4 4 – Wine Cocktail 1 1 – Boracic Ointment 1 1 – Boracic Powder 1 1 – Borax 2 2 – Calomine Lotion 1 1 – Camphorated Oil 1 1 – Castor Oil 1 1 – Chlor-o-Filt (Chlorophyll Pastilles) 1 1 – Compound of Glycerine of Thymol 1 1 – Confection of Senna 1 1 – Cream of Tartar 1 1 – 24 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Epsom Salts 3 3 – Glauber Salts 2 2 – Glycerine 2 2 – Halibut Liver Oil Capsules 1 1 – Kilkof Kones (cough pastilles) 1 1 – Liqufruta 1 1 – Liquid Extract of Cascara Sagrada 1 1 – Liquid Paraffin 1 1 – Magnesium Carbonate 1 1 – Malt and Cod Liver Oil 1 1 – Peroxide of Hydrogen 2 2 – Sodium Bicarbonate 1 1 – Sulphur Powder 1 1 – Surgical Spirit 1 1 – Sweet Spirit of Nitre 4 — 4 Tincture of Iodine 1 1 — Vitamin Tablets 1 1 — Wintergreen Liniment 1 1 — Zinc Ointment 1 1 — TOTAL 269 249 20 The undermentioned samples were found to be adulterated or under standard ete.:— Sample No. ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity. Action taken. F.463 Sweet Spirit of Nitre. Formally. Contained only 1/10 of the minimum quantity of ethyl nitrite. Prosecution. Vendor fined £1. F.470. „ „ Contained only fths of the minimum quantity of ethyl nitrite. Prosecution. Vendor fined £1. F.474. Porker Savouries. „ Sold in a skin and had general appearance of a sausage but contained only 40% of meat. Recommended that description be altered to comply with Ministry of Food requirements. 25 Sample No. ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity. Action taken. F.527. Milk. Formally 10% deficient in fat County Milk Regulations Officer and Milk F.531. Milk. „ 3% „ F.535. Milk. „ 25% „ Marketing Board F.536. Milk. „ 3% „ informed. F.537. Milk. „ 10% „ Above five samples were obtained from same source. Also deficient in non-fatty solids. In 'no case were these deficiencies due to adulteration. Steps taken to improve these supplies. Inf. 301 Sweet Spirit of Nitre. Informally. Contained only 1/6th of the minimum quantity of ethy 1 nitrite. A formal followup sample was taken (F.463) and finally the vendor was prosecuted. Inf.310 Luncheon Meat (Tinned). „ End portions of meat badly blackened and contained excessive quantities of tin and iron. Recommended that discoloured end portions be trimmed. Inf.311 Sweet Spirit of Nitre. „ Contained only fths of the minimum quantity of ethyl nitrite. A formal followup sample was taken (F.470) and finally the vendor was prosecuted. Inf.315 Bread, Sliced. Complainant. One slice contained mass of discoloured dougl: with traces of coal dust and quartz sand. Manufacturer warned. Inf.327 Bread „ Abnormal taste —slightly rancid and soapy. This may have come from grease used in baking tin. New supply of grease obtained by baker. 26 Sample No. ARTICLE Sample obtained formally, informally, or from complainant Nature of adulteration or irregularity, Action taken. Inf.337 Bread. Complainant. Contained what appeared to be discoloured dough Dough found to contain seeds used in cake decoration. Analysts' report conveyed to Baker. Inf.350 Bread. „ Small piece of glass in crust. Baker warned. Inf.365 Vitacream Informal. Labelled as "Thick Rich Cream". No butter fat present, therefore statement misleading. Apparently old cartons were being used. Firm advised to use suitable cartons in future. Inf.377 Milk. Complainant. White residual film adhering to bottom and sides of bottle, consisting of dried milk. Bottling firm warned regarding future cleansing of bottles prior to filling. Inf.384 Milk. „ 70% added water Investigation at bottling establishment by Local Authority and firm concerned provided no satisfactory explanation for adulteration. Bottling firm warned in view of case evidence. Inf.404 Aberdeen Pearl. Informal. Preserved ginger labelled as “Aberdeen Pearl” — ingredients Semolina. (Old cellophane packets used, printing on which had no bearing on contents). Firm warned. Inf.407 Portion of loaf of bread. Complainant. Contained mass of discoloured dough, consisting of 40% of fat. Baker warned. 27 Food and Drugs Act, 1938 Section 13 and Bye-Laws made under Section 15 of the Food and Drugs Act. 44 notices were served during the year on owners or occupiers of premises coming within the scope of these sections of the Food and Drugs Act, 1038. No statutory action was subsequently required. Food Complaints. As in previous years a considerable amount of time has been spent by my staff in dealing with food complaints brought to our notice by members of the public. The following list gives details of the cases deemed worthy of comment:— Complaint. Cockroach in bread. Doughnut containing piece of wire. Sausage rolls for sale in a mouldy condition. Loaf contained needle. Spider in bottle of non-brewed condiment. Tuft of bovine hair in meat pie (due to careless trimming of carcase meat). Prunes thought to be contaminated by tar. Case investigated and eonclusion formed that unusual taste of prunes was characteristic taste of prunes from the country of origin. Action. Warning letter sent. Baker prosecuted—fined £3. Butcher's Manager prosecuted— fined £1. Baker prosecuted—fined £5. Vendor prosecuted. Case dismissed. Makers warned and particulars of case forwarded to Local Authority responsible for inspection of factory concerned. No further action taken. 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. Dates — — 28 — Dundee Cake — — 64 — Fish — 10 15 — Ham — 8 47 18 Meat (including tinned meat) 1 6 59 14 Miscellaneous groceries — 4 22 4 Prunes — — 79 8 Tinned Foods 1 3 37 4 Tinned Milk — 3 5 15 3 17 23 10 28 Food Hygiene. Our efforts to promote high local standards have been continued and our various food handling agencies do in general make sincere and successful efforts to meet our wishes. The average small establishment, has however, a serious lack of space which dictates that their work must be carried on under great difficulties. This factor, however, does not explain the fact that far too much food is still handled and left exposed to contamination by flies, customers breathing over it and the like and it should not be necessary for the law to be invoked in order to remedy this situation. Milk. Our only local pasteurising plant proved somewhat temperamental during the year and the results were therefore not up to the very high standard of efficiency which we desired. It should be noted that we secure a considerable number of samples from the plant for phosphatase and methylene blue testing and any departure from the normal should be relatively quickly ascertained. It is nevertheless desirable to have plants which do not make such demands upon our time and analytical resources and the plant in question undoubtedly was of an old type in which necessarily a somewhat greater strain than is desirable is placed upon the human element concerned in its operation. The position was very comprehensively discussed with the owners of the plant and there is every reason to suppose that the matter is within sight of a satisfactory remedy. Instances of this kind throw into relief the very high practical value provided for us by such as the phosphatase test as when a defect is indicated detailed step by step investigation into the working of the plant seems normally and often speedily to bring to light the defects ascertained by the failure of the milk to the test. 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, 32 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) 1 Dealer's Pasteurised 27 Supplementary Pasteurised 7 Dealer's Sterilised 47 Supplementary Sterilised 8 Dealer's Tuberculin Tested 15 Supplementary Tuberculin Tested 6 Milk Sampling. The 165 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. 16 samples failed to satisfy the prescribed tests and ihe necessary follow-up action was taken. 29 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 23 applications for registration as vendors and 18 applications for registration of premises for the storage and sale of ice cream were granted. At the end of the year, 16 persons and premises were registered for manufacture and 248 for the storage and/or sale of ice cream. Our sampling was decreased from 153 last year to 135 this year. 131 proved satisfactory. As you are aware you took an unfavourable view of the lowering of lee Cream standards which The Food Standards (Ice Cream) (Amendment) Order, 1952, made possible. lee Cream may or may not be deemed generally to be a food but if its food value is regarded as important then it could be argued that the standard ought to be maintained even at the expense of the possible drop in the amount made available. Nowadays it seems a great pity that any standard which provides for the better nutrition of the public should be lowered even although it is in an article which by common consent could be regarded as being popular for reasons other than its food value. Bacteriologically it will be noted from the samples taken that our results were in general satisfactory and our locally produced ice cream in this regard was fully up to standard. Where you get a pre-packed article there is no doubt but that the bacteriological quality maintains a more satisfactory level with far less difficulty and there is no doubt that in this connection our nationally distributing firms maintain a high standard for which a considerable amount of credit is due. When one is dealing with a loose article then no matter how carefully attention is paid to cleanliness of servers and the like, there is clearly a greater danger of contamination and this can arise of course not only from the servers and from contamination of the ice cream in the container, but also from handling of the container in which the ice cream is sold to the consumer. The amount of handling or contamination introduced by a retail purchaser of the article he has purchased is largely a matter for his own judgment or lack of it. The vendor is under an obligation, which in our experience he usually implements very reasonably, to ensure that such ice cream as leaves his care is fit for consumption. Preserved Food Manufacturers. Section 90 of the Hornchurch Urban District Council Act, 1936, requires registration of preserved food manufacturers and premises. At the end of the year, 53 persons and premises were registered for the manufacture of preserved meat (sausages). 30 Licensed Premises. There are in our area some 31 premises of this type and we have taken the opportunity to review their circumstances. They vary greatly in design—according to their age- and to a somewhat lesser degree in the service provided. Where full-scale meals are supplied the kitchen and dining room standard will bear comparison with any similar catering establishment and usually not lose by the comparison. The use of detergents in glass cleaning is not yet popularly accepted partly because the subsequent appearance of the glass is said not necessarily to be altogether attractive. The disposal of everspill and dregs is a matter of some complexity and unless considerable care is exercised could lead to unsatisfactory practices. The sanitary accommodation provided inside the premises is well maintained generally. The outside accommodation is much less well kept largely attributed to the poor regard paid to hygiene by the public who utilise it. School Canteens. Some two years ago we commenced a close association with the Divisional Executive Education Committee in the supervision of school canteens and since then some 134 visits have been made by our Inspectors. These have brought to light certain defects which in due course have, for the most part, been remedied by the Education Authority. Looking back even after this short period of time and comparing the present position with that which obtained initially, it is clear that our mutual co-operation has been of real value and that as a policy it is clearly most desirable to continue it. We have found the staff generally co-operative and anxious to be at one with us in securing the best possible service for the children. We have fortunately during the year escaped any significant outbreak of food poisoning and (insofar as care will provide) this state of affairs will I trust continue. The human element is, however, inseparable from any eventuality and is always sufficiently evident even in the realm of school canteens to make prevention of trouble a matter for relentless vigilance. It is understood that there has been some slight relaxation in the attitude towards improving old canteens and it is hoped, therefore, to recommend for action one or two local examples of this type. 31 SECTION F PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Scarlet Fever. The figures for 1952 show a decided increase on last year. Under the existing circumstances this cannot really create undue surprise because although the disease is notifiable it has of late been of a mild type and consequently there appears to have been a lessening in the regard previously held for it by the public and thus in the measures adopted by the public to prevent spread. It may be said rightly that the Public Health Authority are under an obligation to insist upon requisite measures of prevention but in the ultimate the degree to which any advice is carried out depends entirely upon the outlook of the individual concerned. Since Scarlet Fever has frequently been referred to as largely of the same family as epidemic sore throats and since in one household a ease or cases of sore throatwhich is not notifiable—precede or even follow the case of Scarlet Fever, it is naturally difficult for people to realise that Scarlet Fever retains any of its pristine importance. It is appreciated that absolute rigid isolation for any lengthy period is under ordinary circumstances practically impossible save in hospital but it would probably be premature to say that scant regard should now be paid to the disease. Our visiting of notified cases of the disease has two main advantages in that firstly some degree of isolation for a minimum period is secured and any very close contacts who may be in occupations of public health importance, e.g. catering or milk trades, are ascertained and can be kept under observation until (at any rate immediate) danger is passed. This role of acting as a gleaner and supervisor of important contacts remains one of our most important functions in preventing the spread of infection and however relatively mild the disease would appear, there is 110 doubt as to the preventive value of practice of this nature. I have noted below certain features of importance concerning some of our local cases during the year, viz:— Duration of Isolation. The figures are based on the interval elapsing between the appearance of the rash and the date upon which the case was certified by the private practioner as free from infection or discharged from hospital. 1-6 days 7-14 days 15-21 days 22-28 days Over 28 days Home 6 21 36 50 58 Hospital 2 10 5 1 Number of house occupants No. in house No. of Cases 3 29 4 78 5 40 6 17 6+ 10 Of the cases hospitalised, 3 occurred in households of 3 persons, 6 in 4, 5 in 5, 4 in 6. 32 Circumstances of cases sent to Hospital. The cases arose generally in households of 4 or 5 persons and in houses containing normally 2 living rooms and 3 bedrooms. The reasons for hospital reference were generally noted as unsatisfactory progress, young children in the house, complications in the disease and inadequate isolation. In some seven of the eighteen cases analysed no reason was ascertained. General. It is clear from the extreme limits during which isolation was achieved in various cases that in fact anything like a recognised minimum period of isolation is sadly lacking. The result is that the period appears naturally and almost inevitably to be determined in some cases by the individual inclinations of the persons concerned. It is clearly impossible to define with any precision the interval which must elapse in every case before the danger of infection spread may be regarded as over. There was nevertheless in the past an approximate guide as to the advisable duration of isolation and if Scarlet Fever is to retain any importance as an infectious disease, the question of isolation should be reviewed in the light of the changes brought about by antibiotics. Until some indication in this respect is afforded to Medical Officers of Health the adequate control of individual cases—if control is in fact any longer regarded as necessary—will continue to be as it is now—a near impossibility. Diphtheria. No case occurred during the year. Measles. The diminution in this disease as compared with 1951 is noted statistically. Its type appeared to remain mild. Whooping Cough. The incidence remained at approximately the same level as last year. The public introduction of an effective vaccine is still awaited. Poliomyelitis. Five eases occurred in 1952 and these comprised three non-paralytic and two paralytic. In the latter cases the initial paralysis was moderate to severe and satisfactory progress was maintained. Both have now regained fair power in the affected limbs although attendance for physiotherapy is still being continued. The incidence of the disease will be seen to have dropped as against 1951 and the non-paralytic cases continue to exceed those paralysed. This disease again is one in which the surveillance of contacts probably enables us both to effect some measure of infection control and to increase our knowledge of the possible paths of disease spread. 33 Food Poisoning. Only two cases were noted during 1052. It is strange how hard dies the belief that tinned foods are prone to cause this disease. Canning not only abroad but in this country has within the past few years made very considerable strides and I do not think that any evidence could be adduced of canned foods being more dangerous than any other, although the contrary, i.e. that canned goods may be safer than those susceptible to more frequent handling could possibly with some justification be advanced. The emphasis apt to be laid on the alleged short comings of canning might more appropriately be transferred to the short comings of some food handlers. If scrupulous care in the handling —or rather in avoiding the handling—of food were exercised and insisted upon then an immeasurable service would be done the community. Constant communal danger exists where there is the possibility of an unwitting union between the susceptible food and the carefree, not to say careless handler. Food poisoning outbreaks can happen when care is exercised—they will happen unless it is exercised. 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. Dysentery. The notification of two cases only is probably far from representative of the true incidence of this disease. Unless there is a substantial outbreak few cases with mild dysenteric symptoms are fully investigated and as they generally resolve speedily and satisfactorily so far as clinical appearances go, proof of actual causation of the illness is seldom sought or obtained. Dysentery is above all a disease preventable by the inception and practice of rigorous standards of personal hygiene. Even so it is, in a family with young children, exceedingly difficult to check its spread and it is perhaps fortunate that the complications of, for example, Sonne infection are normally few. Psittacosis. During the course of the year we made detailed investigations into two instances where this disease was suspected and in which there might have been a possibility of a certain local association. The checking up of suspect birds is clearly a matter of some difficulty but in our experience local vendors have been able even after a considerable lapse of time to detail with remarkable accuracy the movements of birds which they have purchased often from foreign sources. This makes the potential danger line reasonably well known to all concerned and thus minimises in the ultimate the amount of unwitting danger which may result. It is I think very satisfactory to note that the importation of parrots has once again been generally stopped. Apart from other considerations the Pet Animals Act has assisted in controlling avian establishments and the average dealer is only too well aware that considerations of public and avian health are very closely allied. He would not and in our experience has not risked the possibility of a high mortality among his birds for want of proper care and attention in the running of an establishment. Nevertheless there may exist avian carriers of this disease and it may not always be associated with a high avian mortality so that the reimposition of the prohibition of importation provides that extra safeguard which should deal effectively with what is after all a disease of considerable severity. 34 Infective Hepatitis. The number of cases notified—18—was a reduction of almost half on last year's total of 37. Analysis of the cases shows as under:— AGE 0-5 6-10 11-15 Over 15 M F M F M F M F 4 0 3 2 0 1 3 5 Six cases occurred in December, five in November and the remainder were dispersed throughout the year. Twelve cases occurred in the Rainham area and in fact only one of the cases under 15 did not reside in this area. Only one instance of more than one case occurring in a house was noted and in this instance the second case developed the disease probably 8-15 days after the first ease had become infectious. Remarks : The relatively high incidence in Rainham may be partially explained by casual contact, as, for example, at school or elsewhere (no direct evidence of this was found), and by the fact that parents and doctors are naturally sensitive to the occurrence of such cases in a somewhat self-contained community. The proportion of over fifteens —8 out of 18 appears rather high. The eases appeared clinically to clear up as rapidly as might be expected. This disease is not seemingly regarded by parents as of serious moment and is not generally notifiable. Tuberculosis. The Public Health (Tuberculosis) Regulations 1952 came into force on 1st May, 1952 replacing the 1930 Regulations. The register of cases—although no longer legally necessary—continues to be kept by us and is useful notably perhaps in maintaining some sort of check on the cases which have refused public medical treatment and hence have ceased to receive attention from the local Chest Clinic. Regard continues to be paid to tuberculosis in relation to re-housing and no infective case brought to our notice fails to be recommended for higher priority so long as other circumstances are of reasonable appeal. If, however, infective cases select our district for residence and hence come to live under an unsatisfactory environment, then with all the goodwill possible it is difficult to substantiate their claim for a degree of priority which would necessarily result in their taking precedence over perhaps hundreds of deserving local applicants. Regard must therefore be paid to factors other than medical if a balanced 35 scheme of house allocation is to be effected, but there can be no valid criticism that the local Council does anything but evidence their sympathy with deserving sufferers. The tuberculosis register at the end of the year showed as follows:— Pulmonary— Males 344 Females 297 Non-Pulmonary— Males 34 Females 35 Pulmonary and Non-Pulmonary Total 710 Pulmonary— The 85 notifications represent the lowes^ annual total since 1940 and a reduction of one third on last year. This is a remarkable and welcome drop. Included in the figure is a total of some '26 inward transfers, i.e. persons suffering from pulmonary tuberculosis who within the year have come to reside in our district. Since our Council's rc-housing is done within our own borders the preferential consideration of tuberculous cases docs not have the effect of increasing the tuberculosis problem locally. Building by private licence may of coursc influence the position slightly. Non-Pulmonary— For the first time since prior to 1939 notifications dropped to single figure dimensions—the incidence this year of 6 being one-half of that for 1951 (13). There seems little doubt but that the present national campaign to secure safe milk supplies is showing increasing fruit. The percentage of raw milk sold in this area is now probably only of the order of 2%. Mass Radiography. The results of the autumn visit of the Unit in the previous year came to hand and show that 6.644 miniature photographs -including 2,948 at public sessions-were taken. Public sessions are by no means easy to arrange because of the difficulty of providing suitable accommodation but they were in fact held at Harold Wood, Billet Lane and the Rainham Combined Treatment Centre. In the securing of the suitable premises wc were assisted by the County Council. As a result of the investigation some 45 inactive primary lesions were found and some 90 inactive post-primary lesions, together with 1 active post-primary lesion and a variety of non-tuberculous conditions The results are considered very satisfactory both from the angle of public response and low incidence of active disease which the survey brought to light. 36 Non-Notifiable Diseases of Childhood. Head teachers return a Form M.I. 13/Form 2033 showing children excluded from school as suspected contacts or suffering from suspected infectious disease. This return has proved of considerable value in ascertaining ccrtain cases which although notifiable had through inadvertance not comc 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 845 Conjunctivitis 14 Eczema 1 Gastro-enteritis 2 Glandular Fever 6 Impetigo 8 Mumps 195 Ringworm 2 Rubella 805 Scabies 5 These numbers must necessarily be acceptcd with reserve since they represent our only available, but not necessarily wholly accurate, information. 37 NEW CASES AND DEATHS FROM TUBERCULOSIS, 1952. 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- 4 „ — — — — — — — — — — — — 5- 9 ,, 6 3 — 2 6 5 — — — — — — 10-14 „ — 4 1 1 1 5 — — — — — — 15-19 „ 3 4 — — 3 4 — — — — — — 20-24 „ 3 10 — 1 3 11 — — — — — — 25-34 „ 12 15 — — 12 15 2 — — — 2 — 35-44 „ 3 8 — — 3 8 2 1 — — 2 1 45-64 „ 11 2 — — 11 2 6 2 — 1 6 3 65 and over 1 — 1 — 2 — 2 1 — — 2 1 Totals 39 46 2 4 41 50 12 4 — 1 12 5 38 YEAR 1952—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 TOTAI, 1952 — 1 — — 2 — 2 7 5 17 TUBERCULOSIS NOTIFICATIONS—1939-1952. YEAR PULMONARY NON-PULMONARY TOTAL 1939 74 20 94 1940 78 13 91 1941 93 39 132 1942 no 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 1952 85 6 91 89 TABLE SHOWING THE TOTAL NUMBER OF INFECTIOUS DISEASE CASES NOTIFIED IN EACH WARD DURING THE YEAR 1952. DISEASE Total Cases Notified WARDS No. of Cases Hospitalised Town Craaham Elm Park Emerson Park Harold Wood Northwest Rainham Thameside Upminster Scarlet Fever 245 53 1 57 42 21 25 5 22 19 28 Poliomyelitis Paralytic 2 — 1 1 — — — — — — 2 Non-Paralytic 3 — — — — 1 1 — — 1 3 Pneumonia 35 7 — 10 3 2 7 — 5 1 8 Meningococcal Infection 1 — — — — — 1 — — — 1 Dysentery 2 — — 2 — — — — — — 2 Infective Hepatitis 18 1 1 — — 2 1 10 3 — 2 Measles 1,186 200 17 262 96 164 65 28 248 106 8 Whooping Cough 510 114 — 110 59 49 67 18 56 37 10 Food Poisoning 2 — — — — — 2 — — — — Puerperal Pyrexia 5 — — 2 — — 2 1 — — 4 Malaria (contracted abroad) 1 — — — — — 1 — — — — Erysipelas 15 4 — — 5 1 3 2 — — 2 TOTALS 2,025 379 20 444 205 240 175 64 334 164 70 40 SECTION G. FACTORIES ACTS, 1937 and 1948. Ministry of Labour and National Servicc Form 572. PART I OF THE ACT. 1. Inspections. No. on Register. No. of Inspections. No. of written notices. No. of occupiers prosecuted. Premises. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by L.A's. 17 22 – – (") Factories not included in (i) in which Section 7 is enforced by the L.A. 192 197 3 – (iiij Other premises in which Section 7 is enforced by the Local Authority. 25 28 – – Total 234 247 3 — 2. Cases in which Defects were Found. Referred Particulars. Sanitary Conveniences (Section 7) Found. Remedied To H.M. Inspector. By H.M. Inspector. Prosecutions (a) Insufficient — — — — — (b) Unsuitable or Defective 4 2 — 1 — (c) Not separate for sexes. — — — — — Other offences against the Act. 1 — — — — Total 5 2 — 1 — PART VIII OF THE ACT. OUTWORK—Sections 110 and 111. Nature of Work No. of Outworkers in August list Wearing Apparel— Making, etc. 140 No instances of work in unwholesome premises.