AC 4411(3) HORN CHURCH 2 MISS KNOWBO BHES THE 3 LIBRORY HORNC 21 Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER of \; « r HEALTH For the Year 1953 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 1953 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. 2 TABLE OF CONTENTS PAGE Members of the Council (as at 31.12.53) 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 14 SECTION D- Housing 22 SECTION E- Inspection and Supervision of Food 23 SECTION F- Prevalence of, and control over, Infectious Disease 34 SECTION G- Factories Acts, 1937 and 1948. Ministry of Labour and National Service Form 572 (Revised) 43 Index 44 3 MEMBERS OF THE COUNCIL (as at 31.12.53). Councillor S. C. Parrish, J.P., Chairman. (1) Councillor J. W. G. H, 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. Raxter. E. W. J. W. Rush. „ L. W. Carroll. (1) „ W. E. Daubeney. „ P. C. Ford, J.P. „ E. W. Fryd. (1) and (3) ,, R. S. Howe. „ G. W. Lagden, C.C. ,, W. E. Large. H. G. W. Levy. (1) ,, G. W. Philips. „ W. E. Philo. ,, H. D. M. Rivers. „ P. M. Rowe. „ A. C. Salinger, J.P. „ G. M. D. Shaw. (1) „ W. A. Sibley. „ S. M. Tucker. „ 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) T. W. Glew, M.S.I.A. (2) and (3) J. 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) Clerical Staff: J. E. Blay (Chief Clerk). R. M. Jamieson Miss W. A. Hepburn. Rodent Operative and General Assistant: C. A. Crookbain (Resigned 26.9.53). F. J. Gilbey (Commenced 19.10.53). Public Analysts: George Taylor, O.B.E., F.R.I.C. J. Hubert Hamence, M.Sc., Ph.D., F.R.I.C. (]) 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. 20th May, 1954. 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 1953. Vital Statistics. The Birth Rate at 14.83 shows a rise as against recent years, but the Death Rate 13.18 also indicates a distinct rise. The Infant Mortality figure of 30.17 is fractionally better than in 1952. As compared with the national average our Birth Rate is slightly lower; our Death and Infant Mortality Rates are higher. Compared with the average for the 160 Great Towns (of which Hornchurch is one) the Birth Rate is lower, the Death Rate higher, but our Infant Mortality Rate is slightly lower. The Birth Rate thus shows a satisfactory trend, the Death Rate an unsatisfactory one and judgment on the Infant Mortality Rate might well be reserved. It seems that the inclusion of a special type of institutional death in our local figures (a feature now included for the first time) has gone far to produce the increased mortality rate. Our area comparability factor does not, it is understood, take cognizance of these deaths which are now deemed as occurring in Hornchurch residents although the actual residence in the district may be slight and a permanent tie with an outside area clear. This point might well receive further review in official circles if the area comparability factor is to continue to produce the desired comparative effect. Infectious Disease. Our Poliomyelitis figures as against 1952 increased to 9 and became predominantly paralytic in composition. One hopes that the trend will again revert to a non-paralytic or abortive type. The results of treatment were, however, generally good. Scarlet Fever remains much as in 1952. Its effective control is practically impossible since the condition is so commonly regarded as trivial. We do nevertheless pay considerable attention to dealing with particular types of contacts and I think that this undoubtedly limits, if it cannot control, the spread. I do not consider it in the public interest that the notification of any infectious disease should be treated purely academically and when the position is reached such as now obtains with Scarlet Fever the question of any longer retaining it as notifiable clearly calls for consideration. I would like to express my appreciation to Dr. E. James of Rush Green Hospital, for his help and ready co-operation throughout the year. 6 Tuberculosis. Our Tuberculosis Register showed an increase of 22 pulmonary and 6 non-pulmonary cases as against 1952, but included in these figures are some 14 additional inward transfers in the first category and 4 in the second. Our death rate at 0.2 per 1,000 is identical with the national average and is below the average for the Great Towns. I would like to express my appreciation of Dr. S. Thompson's ready help and co-operation throughout the year. Housing. The number of houses privately built showed a sharp rise and the Council house-building programme showed a fall in the number made available for occupation. The overall picture is that of marked housing development and our population at 105,100 continues to increase. Atmospheric Pollution. We have further increased our number of instruments and now have available a fairly representative picture of our district. This problem permits neither of ready solution nor of defeatism. It will not be adequately tackled let alone vanquished until every Authority and individual regards the problem as personal. It is, however, becoming almost fashionable to show an increased interest in the subject and the press have done much to keep alive the public feeling generated in recent years by the " Smog of 1952." Food and Drugs. A satisfactory year's working has been carried out on comprehensive lines as will be evidenced by the facts noted elsewhere in this report. Home Safety. It seems shortly that a local committee will be formed to which the Council may subscribe. The freedom of action permitted an Authority such as ours is not, I consider, reconcilable with the avowed necessity for tackling it by all possible means. General Hygiene. I must particularly emphasize that the success of our work is largely patterned by the painstaking, conscientious day-by-day routine contribution of the individual Sanitary Inspectors. Our district is new and rapidly developing but presents nevertheless a very wide variety of sanitary problems. The ostentatious side of any departmental work is apt to achieve publicity quite incommensurate with its value ; the unostentatious sets the standard. Acknowledgments. In appreciation of your understanding of the work of my own and other Council Departments I cannot do better than reaffirm my best thanks for your support throughout the year. I am especially conscious of the debt which I owe to Dr. O'Dwyer, my deputy, Mr. Randall my chief Sanitary Inspector and Mr. Blay my chief Clerk. 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) 1953 105,100 Number of inhabited houses according to rate books (September, 1953) 31,304 Rateable value (September, 1953) . £801,352 Sum represented by a penny rate (September, 1953) £3,205 Extracts from Vital Statistics for the Year. Births. Number of live births allocated to the District as adjusted for inward and outward transfers 1,591 (791 males, 800 females) Birth rate per 1,000 Home Population using area comparability factor 14.83 Number of stillbirths allocated to the District 28 (17 males, 11 females) Stillbirth rate per 1,000 Home Population 0.27 Stillbirth rate per 1,000 total (live and still) births 17.29 Deaths. Number of deaths of Hornchurch residents as supplied by the Registrar-General (adjusted for inward and outward transfers) 1,205 Death rate per 1,000 Home Population using area comparability factor 13.18 Deaths of infants under one year of age 48 (27 males, 21 females) Infant mortality rate (per 1,000 births) 30.17 REGISTRAR-GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH. (Corrected for inward and outward transfers). Causes of Death Male. Female ALL CAUSES 648 557 1. Tuberculosis, respiratory 13 6 2. Tuberculosis, other 1 1 3. Syphilitic disease 5 1 4. Diphtheria 0 0 5, Whooping cough 0 0 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 2 3 10. Malignant neoplasm, stomach 22 11 11. „ „ lung, bronchus 36 9 12. „ „ breast 0 24 13. ,, ,, uterus 0 6 14. Other malignant and lymphatic neoplasms 63 40 15. Leukaemia, aleukaemia 5 4 16. Diabetes 4 7 17. Vascular lesions of nervous system 72 79 18. Coronary disease, angina 76 39 19. Hypertension with heart disease 14 7 20. Other heart disease 108 174 21. Other circulatory disease 17 16 22. Influenza 7 7 23. Pneumonia 29 23 24. Bronchitis 60 25 25. Other diseases of respiratory system 7 3 26. Ulcer of stomach and duodenum 11 5 27. Gastritis, enteritis and diarrhoea 7 5 28. Nephritis and nephrosis 8 9 29. Hyperplasia of prostate 10 0 30. Pregnancy, childbirth, abortion 0 2 31. Congenital malformations 8 3 32. Other defined and ill-defined diseases 45 35 33. Motor vehicle accidents 7 4 34. All other accidents 5 5 35. Suicide 4 3 36. Homicide and operations of war 0 0 The Registrar-General's ruling that Part III accommodation and hospitals for the chronic sick should be classed as " normal residence " has a repercussion in this district since we have accommodation of this kind, notably in St. George's Hospital. The position is not completely clear as it may relate to an exact definition of the hospitals concerned. An analysis of the causes of death show that as compared with last year other heart disease deaths have increased by 134; Bronchitis by 43; Vascular lesions of the nervous system by 32 and certain other conditions in lesser degree. The main increases might well be attributable to the type of institutional death noted elsewhere. Malignant neoplasm of the lungs caused 45 deaths—36 males, 9 females—as against 31 last year. The marked increase in female deaths from this cause will be noted. It is also of interest that Diabetes which last year caused 4 deaths was in the present period responsible for 11. 9 DEATH RATE—COMPARISON WITH PREVIOUS YEARS. 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* 1946 9.0 1953 13.1* * Area Comparability Factor returned. BIRTH RATE COMPARISON WITH PREVIOUS YEARS. 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* 1946 21.3 1953 14.8* * 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, 1953. 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 15.5 17.0 15.7 17.5 14.83 Still births 0.35 0.43 0.34 0.38 0.27 22.4 (a) 24.8 ( a) 21.4 (a) 21.0(a) 17.29(a) Deaths— All causes Typhoid and 11.4 12.2 11.3 12.5 13.18 paratyphoid 0.00 0.00 - - - Whooping cough 0.01 0.01 0.00 0.00 - Diphtheria 0.00 0.00 0.00 - - Tuberculosis 0.20 0.24 0.19 0.24 0.20 Influenza 0.16 0.15 0.17 0.15 0.13 Smallpox ... 0.00 0.00 0.00 - - Acute poliomyelitis (including polioencephalitis) 0.01 0.01 0.01 0.01 - Pneumonia 0.55 0.59 0.52 0.64 0.49 Rates per 1,000 live births. All causes under 1 year of age 26.8(b) 30.8 24.3 24.8 30.17 (a) Per 1,000 Total (Live and Still) Births. (b) Per 1,000 related live births. 10 CASE RATES FOR CERTAIN INFECTIOUS DISEASES, 1953. Local figures compared with England and Wales and certain towns. England and Wales 160 C.B.s and Great Towns (including London.) 100 Smaller Towns (Kesident Pop 25,000/50,00( at 1951 Census London Admin. County. )■ Hornchurch . Rates per 1,000 Home Population. Typhoid fever 0.00 0.00 0.00 0.01 — Paratyphoid fever 0.01 0.01 0.01 0.01 — Meningococcal infection 0.03 0.04 0.03 0.03 0.03 Scarlet Fever 1.39 1.50 1.44 1.02 1.94 Whooping Cough 3.58 3.72 3.38 3.30 4.70 Diphtheria 0.01 0.01 0.01 0.00 — Erysipelas 0.14 0.14 0.13 0.12 0.15 Smallpox 0.00 0.00 0.00 — — Measles 12.36 11.27 12.32 8.09 11.76 Pneumonia 0.84 0.92 0.76 0.73 0.25 Acute poliomyelitis (ii eluding polioencephalitis) Paralytic - 0.07 O.Ofi 0.06 0.07 0.07 Non-paralvtic 0.04 0.03 0.04 0.03 0.00 Food poisoning 0.24 0.25 0.24 0.38 0.06 Rates per 1,000 total (live and still) births. Puerperal Pyrexia 18.23 24.33 12.46 28.61 3.09 11 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staffing. Only one staff change occurred during the year, i.e. that of the Rodent Operator and general assistant. Public Health Propaganda. The comprehensive arrangements noted last year have been continued and are modified as opportunity dictates. 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. Dr. Atkinson of the Oldchurch Hospital laboratory is always ready to assist us in any investigations concerning bacteriological work and I appreciate the value of this fact as in many circumstances which do arise a close and immediate liaison between my department and the bacteriologist can be the means of dealing with the situation rapidly and aborting or at any rate minimising the possibility of further trouble. B. Tuberculosis. Under arrangements made by the Essex County Council the new Public Health Laboratory, County Hall, S.E.I, undertake the biological testing of milk for this organism. 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 supervised by the County Council. 12 Midwives. There are 9 midwives 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. No cases were dealt with during the year under this Section although certain circumstances were investigated with a view to determining whether such action was appropriate. In any large district it is obvious that the type of circumstance implied under Section 47 is bound to arise from time to time. If, however, by a combination of voluntary and official agencies and the support of relatives it is possible to avoid practical action in terms of Section 47, then I think it is probably all to the good. People of the kind we have in mind are often suspicious, unco-operative and essentially averse to going into institutions (partially or largely because they have no first hand knowledge of them) and are very apprehensive of entering them. It is, however, surprising how regular visits by a sympathetic visitor can almost imperceptibly break down reserve, engender confidence and in the end secure if not a complete solution of the problem, at least a palliation which enables an institutional bed or place to be allotted to a very urgent case without at the same time permitting an aggravation or continuance of local inconvenience. The work of the Sanitary Inspector in dealing with complaints from neighbours concerning aged, infirm or eccentric persons is unobtrusive but invaluable. It should also be said that a complaint is seldom the beginning of the story. Rather is it usually found that some neighbour has been helping for a long time but eventually finds that the task is becoming insuperable and—out of consideration for the plight of the person concerned rather than for their own benefit— only then is the matter brought to official notice. There must be a great deal of selfless service devoted by neighbours and friends in instances of this kind and this without the assistance of any organised movement. The Home Help and District Nursing Services under the charge of the Area Medical Officer merit high praise also in the same connection and it can safely be said that these services render tolerable and keep tolerable for lengthy periods conditions which otherwise would undoubtedly require radical action by the Sanitary Authority. Medical 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. 18 During the year arrangements were made for the examination of 165 employees or prospective employees (39 permanent and 126 temporary). Home Safety. The Heating Appliances (Fireguards Act) 1952 came into force on 1st October 1953 and will be capable of full implementation as from 1st October, 1954. We were during the year privileged to have a talk from Dr. C. A. Boucher of the Ministry of Health on this subject. Representatives of many local voluntary bodies attended and showed a keen appreciation of the information given whilst they also seemed particularly interested as to how further steps to follow up the talk were going to be taken. It is perhaps unfortunate that full consideration of this important subject should inevitably establish the inadequacies of a local authority to deal with it comprehensively. Local Health Authorities have wider powers in this regard and although in general public health propaganda we can and do exercise our own rights directly, in home safety affairs an authority such as ours is permitted only to contribute (and this subject to due permission) to an independent Committee. It may well be that our Council would in any event have decided that the setting up of such a Committee represented the best means of ensuring widespread public support and would have adopted this course as the one of election. At least, however, it should have had freedom to make up its own mind as to what was the best method of approach and to deal with the subject within discretionary limits wide enough to be appropriate to the importance and complexity of the issue at stake. Needless to remark the possibility of encouraging the formation of an independent Committee is being pursued and one hopes that a successful outcome will in the near future result. Canvey Island Floods. Although not coming strictly within the terms of this section of the report mention must be made of the very severe flooding which arose along the East coast in February 1953 when Canvey Island was badly hit. As a result problems of hygiene arose which necessitated help being drafted to that area from outside. Under arrangements co-ordinated by the County Council we lent the services of a Sanitary Inspector for some 5½, weeks. This represented only that part of the assistance given by Hornchurch with which I am competent to deal and the whole story of the floods has been and doubtless will again be authoritatively told elsewhere. It is reassuring to see how a happening such as this brings out an immediate, spontaneous and generous response and to feel that this would happen whenever and wherever the occasion arose. 14 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water Supplies— General. A comprehensive report on the well waters used in the district was submitted to you, together with notes on the nitrate position reflected therein. The report emphasized not only what remains to be done to provide a main service for the whole area but also what has been done to make the position as satisfactory as it now is. As a consequence the Council have agreed to contribute some £260 for 12 years towards the cost of a mains extension from the Gerpins Lane area to Hunts Hill Cottages available en route to serve properties along Aveley Road and part of Bramble Lane. The actual work approved by the Ministry of Housing and Local Government comprised 1,300 yards of 6 inch main and 400 yards of 4 inch main. This represents a major step in tackling what relatively small well water problem persists locally and removes a real source of potential trouble to the district and disquiet to my Department. The largest problem now remaining in this connection is that of the Dennises Corner area which is still supplied by well water but is smaller in extent than the Hunts Hill area and more difficult to solve. This problem also you will doubtless review in due course. On a minor note it may be mentioned that we secured the provision of a standpipe to certain mainly old property in the Corbets Tey area. The water supply position has therefore received radical and enlightened treatment during the year. The main supply is from the South Essex Waterworks Company and is of excellent quality. 11 samples were taken by the Public Health Department during the year and a typical sample analysis is provided below :— "This sample is practically clear and bright in appearance, has a reaction on the alkaline side of neutrality and is free from metals apart from a negligible trace of iron. The water is hard in character but its hardness and its content of mineral and saline constituents in solution are not excessive. Its organic quality and bacterial purity are very satisfactory. These results are indicative of a water which is pure and 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 3,800 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. 15 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 31,306 and the population as at 30th June, 1953, as obtained from the Registrar General was 105,100." 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. Atmospheric Pollution. It was agreed that our future programme should include two additional deposit gauges to be sited at the Council Offices and Oglethorpe School (this latter through the kind co-operation of the Divisional Education Committee and Mr. Dance, the Headmaster). This will enable a broader view to be taken of the types of pollution occurring in the atmosphere in varying parts of our area. Our 5-year programme ended in August of this year and will be continued in the meantime on the same general lines. It is a great pity that some practical financial incentive is not given to Authorities—or for that matter individuals—exhibiting a progressive outlook towards this problem. Familiarity breeds if not contempt at least indifference and divests any problem after a time of any real glamour, popular appeal or sense of urgency. It is, however, to the credit of the press that since the ' London Smog' of December 1952 periodic and very pertinent reminders have been given us that the time for complacency is not yet. As you are aware a Sub-Committee has been set up to consider this question and the local position will doubtless be kept under surveillance. The use of smokeless fuel on a wide scale is allied to quality, price, availability and convincing the public of its benefits, not to mention the practical necessity for having an appliance suitable for its combustion. Both the domestic consumer and the industrial user have contributions which they can make and it must be the responsibility of central and local government to persuade them that the interests of all will be served by their acting as quickly as possible. It is true that getting rid of smoke will not clear the atmosphere of contamination in whole but surely if smoke either by itself or more possibly in combination with other contaminants can cause trouble then if we can lessen or obviate the smoke whilst at the same time tackling the other contaminants, e.g. sulphur dioxide, then it is a worthwhile step. The Heaver Committee are pursuing their enquiries following the issue of their interim report. This document was very readable and presented the problem succinctly and in small compass. The ultimate 16 17 18 success of the Committee, however, will be reflected in the skies and in the deposit gauge and lead peroxide candle findings more than in print. You were represented at the National Conference of the Smoke Abatement Society, at the meetings of the Council and Co-operating Bodies and the London and Home Counties Smoke Abatement Advisory Committee. You were also represented at meetings held in connection with the proposal to form a South East Division of the National Smoke Abatement Society. Sewerage. The year saw the relaying of the St. Mary's Lane sewer make satisfactory progress and when completed it will greatly facilitate the sewage disposal arrangements for our Cranham housing development. The question of the Ingrebourne sewer is being resolved. It will be seen therefore that a steady planned advance is being made in the sewerage affairs of the area. The size of the problem is a timely reminder that rapid development brings in its trail' commensurate obligations and that the resources which might have sufficed many years ago demand constant review and if necessary alteration to permit of the modern services now regarded as essential being in fact made available. Pollution of the River Thames. Intimation has now been received that the London County Council have secured Government approval to a vast programme over several years which will it is anticipated eventually alleviate the unsatisfactory position now existing. The present position did not arise in a day and cannot be solved in one, particularly within the necessary limitations of expenditure still obtaining. The matter is however being given due weight. Swimming Baths. Very considerable strides were made during the year towards achieving, at any rate, first steps towards a swimming baths in Hornchurch. If events follow the lines which appear probable, our district will at not too distant a date, be provided with baths which will be a credit to us apart from providing a much needed amenity for our area. Crematorium. The provision of a Crematorium in Hornchurch to serve other Authorities also was discussed in detail during the year and appears likely to become a reality within the next few years. By modern standards such provision would be accepted as a practical necessity and would undoubtedly be an addition to the public health services of our area. Paddling Pools. Our routine checks numbering 6 again provided satisfactory results. The supervision over the water in the pools is adequate and even when the actual appearance of the pool may be disturbed by the 19 very considerable and enthusiastic use to which it is put, one can be sanguine that no danger to health is likely to arise even when—as frequently happens—the pools are used by the children of the community as a training ground for the swimming baths which will in the future be provided. Disinfestation. The prevailing practice in this regard was continued. Rodent Control. The year's work approximated very closely to that for 1952 in that 2,062 visits were made and 146 infestations cleared as compared with 2,084 and 140 respectively for the previous year. The staff' dealing with this matter is kept fully apprised of all the modern methods of rodent control and the service provided is undoubtedly valuable and appreciated. The charges have been increased in accordance with the ruling of the Ministry of Agriculture and Fisheries and although infestations on private premises continue to be dealt with at a charge of 2/6d., factory premises, etc. are treated at a charge assessed on the work involved. This is to ensure that so far as possible the service is selfsupporting. Establishments for Massage or Special Treatment. The Essex County Council granted licences to 9 persons during the year authorising them to carry on establishments for massage or special treatment. 13 visits were paid to these premises throughout the year. Pet Animals Act, 1951. 11 licences to keep a Pet Shop were issued during the year and a total of 41 visits were paid to these premises. Rag Flock and Other Filling Materials Act, 1951. One address in the Urban District is registered pursuant to the provisions of Section 2 of this Act. One sample was taken during the year and an unsatisfactory report was received. This sample (cotton felt) was manufactured in a neighbouring district and the matter was pursued with the Authority concerned. Stubbers Camp. During the Coronation Camp of the St. John's Ambulance Cadet Division attended by some 2,300 people from all over the world a young South African girl developed Meningitis a few days prior to the projected visit of Her Royal Highness Princess Margaret. Fortunately the case developed very early in the Camp, the isolation facilities utilised during the short preliminary period of observation prior to the removal of the case to hospital, were very good and the number of close contacts relatively negligible. The visit of H.R.H. was 20 doned. No other cases occurred and the case noted made a full and speedy recovery. In view of the large numbers of people of a susceptible age attending camps such as this it seems to me that the infectious diseases so far noted and including the Cadet Camp were of a minimal order. When, however, open visiting days are contemplated and when people from perhaps all over the world come to these Camps, a considerable responsibility rests upon those responsible for the hygiene arrangements. This Camp lends itself to a high standard of hygiene and the authorities have so far seen to it that no opportunity was lost of maintaining such a standard. It is, however, essential that the closest co-ordination should be maintained between the authorities responsible for each Camp and my Department as only then can we achieve successfully that day to day co-ordination and contact which will enable us most effectively to deal with any outbreaks of disease which may arise. Sanitary Inspection of the District. SUMMARY OF SANITARY INSPECTORS' WORK DURING 1953 Inspection of Food and Food Premises (visits paid):— Bakehouses 82 Butchers' shops 250 Cafes 340 Confectioners 74 Dairies (including Pasteurising Plants) 117 Fish shops 122 Food Complaints 39 Food and Drugs Samples (Chemical and Bacteriological) 552 Greengrocers' shops 59 Grocers' shops 424 Ice Cream Dealers' and Manufacturers' Premises 151 School canteens 97 Staff canteens 42 Miscellaneous visits 120 Mobile Shops (Hawkers) 27 Housing (visits paid) :— Drainage of houses 402 Environmental Enquiries (including overcrowding Enquiries) 209 Sanitary fittings 64 Structural defects 546 Water supply and pipes 16 Miscellaneous Housing Visits 298 Re-inspections 1,645 General Sanitary Circumstances (visits paid) : - Accumulations 51 Atmospheric Pollution Survey 53 Camping grounds, vans, etc. 111 Drainage and sewerage 54 Dustbins 127 Fair Grounds 8 Keeping of Animals and Birds 28 Insect Pests 38 Public Conveniences (including Public House Urinals) 20 Refuse Tips 73 21 SUMMARY OF SANITARY INSPECTORS' WORK—Continued. Rodent and Vermin Infestation 278 Schools 7 Smoke Complaints and Observations 50 Stables and Piggeries 46 Unclean Premises 37 Water Supplies (Main) 12 Well Water Supplies 28 Watercourses 57 Miscellaneous Sanitary Visits 163 Re-inspections 370 Factories and Outwork:- Number of visits paid 387 Shops Act:— Number of inspections 445 Infectious Disease :— Number of visits paid (including contacts) 599 Number of Notices served :— Informal 363 Statutory 149 The visits paid represent a sound year's work. From year to year the general pattern of visiting remains much the same but particular emphasis is from time to time placed upon individual aspects of the work. It will be noted that Cafes received considerable attention and that our work under the Food and Drugs Act necessitated a large number of visits. The total housing visits paid was generally on a par with that of previous years and the 209 environmental enquiries made enables us at once to assess the degree of housing need from the public health point of view where Council house applications were in question and at the same time throws a considerable light on the question of overcrowding and general conditions of occupancy. It will be noted that our work under the Pet Animals Act was continued although the numbers as compared with the previous year are naturally much reduced since a multiplicity of enquiry had to be made in 1952 when the question of registration fell to be dealt with for the first time. On the other hand the number of visits paid to factories and outworkers rose substantially this year as the work of completing the details in our factories register was completed. It is interesting to note that the number of Notices—formally and informally served—was very comparable with the same number for 1952, the figures being 512 as against 534. 22 SECTION D. HOUSING Number of new houses erected during the year. 631 houses were completed during the year by private builders. The Council's own housing scheme produced a total of 64 dwellings during the year. 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 209 visits for this purpose were made during the year the overcrowding position was kept reasonably under review. Nine cases of overcrowding were reported to the Council during the year. Sub-standard Property. Demolition orders were made in respect of:— " St. Teresa," Berwick Road, Rainham. 1, Finches Cottages, North Street, 118, North Street, 120, North Street, " The Brook," Frederick Road, Rainham, Elms Farm, Briscoe Road, " Rosedene," Briscoe Road, " Zanda," Stanley Road North, Premises at rear of " Bretby," Stanley Road North, 117, Butts Green Road. Our policy of dealing with individual unfit houses was therefore continued with effect. The dwellings concerncd were mainly either old in the central part of the area or temporary type dwellings in the Rainham area. We are gradually producing a different picture in the week-end dwelling position and with perseverance may well secure that health and amenity will alike benefit from our efforts. Itinerant Population. The problem arising here is frequently related to that of the sub-standard dwelling since it is found that the occupants of these dwellings, especially those of the week-end type, have often arrived there by the arduous paths of lodgings or caravans. It is obviously just that families arriving in our district should not secure rapid Council re-housing at the expense of our old and normal inhabitants and because they have placed themselves in conditions demanding urgent hygienic attention. On the other hand these are family units—often with one or more children—which surely must eventually have a right to be re-housed by some Authority somewhere and it does seem that an outstanding difficulty still is for, as I have termed them, the itinerant family to secure a place on the Housing list of any Authority. It certainly is not to the financial gain of families of this type to remain 23 in their unsatisfactory environment at any rate as far as concerns rent. However kindly disposed the owners of property of this type may be they seldom appear to allow their sympathies to obliterate the desirability of securing some financial recompense for their good feeling and to charge sums which are sometimes charged for the environment in which some of these families reside makes the offer of accommodation of this type a doubtful blessing. Medical Aspects of Re-housing. Some 209 enquiries were made during the year and advice as to medical priority was tendered in some 332 cases. Our present scheme permits of considerable discretion being exercised in dealing with the medical aspects of re-housing and this is at once appreciated by me and is at the same time advantageous to the equitable working of the 'Points ' scheme generally. Much of the medical evidence adduced is necessarily of so general a character as to minimise it as a vital factor in substantially advancing the re-housing of the patient. Where, however, unusual weight of evidence is produced presenting a picture which is not commonplace in the applications of most housing claimants, then re-housing can be and is secured on a preferential basis. It should perhaps be noted that although the majority of medical certificates may not secure materially additional pointage, each certificate requires to be and is thoroughly assessed and it is not necessarily a simple matter to decide that medical priority should not be accorded any particular application. It will be a signal day which sees it possible for young married people to obtain a house of their own without serving a preliminary period often with their in-laws and without having to produce health evidence in support of their wishes. Land Charges Enquiries. During the year 3,515 land charges enquiries were referred to the department regarding the question of outstanding sanitary notices. SECTION E. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Administration. The sampling of food and drugs continued broadly on the basis of our programme detailed in my 1951 Annual Report. During the past year the Sanitary Inspector obtained 312 samples of food and drugs (249 food and 63 drugs) of which 14 samples (8 food and 6 drugs) proved to be unsatisfactory in one way or another. The particulars of this work as noted below illustrate not only the results of the actual sampling but the number and diversity of the commodities which come within our field of supervision. When one considers the large number of samples examined and the various reasons for the 14 unsatisfactory samples which in fact 24 relate only to 9 different types of food or drugs, I think we can continue to have confidence in the relatively high standard of products sold in this area. In the course of sampling the Sanitary Inspectors have checked the labelling of food and drugs and other items relating to substitution of food by-products of inferior quality and preservatives in food etc. Advertisements of local and national interest have not escaped our attention. It is with a sense of some satisfaction I record that a number of officers from other Local Authorities have sought and taken our advice on sampling methods, equipment, records and programmes prior to their Council's assuming Food and Drugs Authority status. It also gives me pleasure to express my thanks to the Public Analysts, Mr. George Taylor, O.B.E., F.R.I.C., and Dr. J. Hubert Hamence, M.Sc., Ph.D., F.R.I.C., for their helpful advice in this specialised sphere of public health endeavour. The number and variety of complaints illustrates that the public is conscious of the necessity for maintaining food standards although it is reasonable to assume that the complaints actually brought to our notice in this way represent probably a minority of the numbers which could be brought to our notice since many people naturally deal with complaints informally. Although the number of prosecutions may not be high, the mere fact that we take the complaints up with the manufacturers or vendors serves to act as a valuable piece of public health propaganda. ARTICLES Number of Samples examined. No. found to be genuine. No. found to be adulterated or under-standard etc Almonds, ground 2 2 - Banana Curd 1 1 — Bananas, dried 1 1 - Beans and Grilled Sausages in Tomato Sauce 1 1 - Beans in Tomato Sauce 3 2 1 Butter 2 2 - Cake and Pudding Mixture 1 1 — Calves Feet Jelly 1 1 — Celery Salt 1 1 — Cheese and Tomato Spread 1 1 — "Cherryade" (Soft drink) 1 1 — Chocolate Assortment 1 1 - Chocolate, Drinking 1 1 — Cocktail Cherries 1 1 - "Coco-Cola" (Soft drink) 1 1 — Coconut, dessicated 1 1 — Coffee 2 2 - Coffee and Chicory Essence 2 2 — Coffee Extract 1 1 - Condiment, non-brewed 3 3 - Cream 1 1 - Cream, synthetic 1 1 — 25 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Curry Powder 2 2 — Custard Powder 1 1 — Doughnuts 1 1 — Dripping 1 1 — Essence of Rennet 1 1 — Fish Cakes 1 1 — Fish and Cutlet Dressing 1 1 — Fish Paste 3 3 — Flour 5 5 — Fruit Pectin 2 2 — "Fruit Sandwich" 1 1 — Frying Oil 1 1 — Gelatine 2 2 — Ginger 1 1 — Ginger Beer 2 2 — Ginger Cordial 1 1 — Ginger Wine, non-alcoholic 1 1 — Grapefruit Squash 1 1 — Gravy Powder 1 1 — Ham and Meat Paste 1 1 — Honey 1 1 — Horseradish Sauce 1 1 — Ice Cream 25 25 — Ice Lollies 6 6 — Jam 8 3 — Jelly 2 2 — Lard 1 1 — Lemonade Powder 1 1 — Lemon Cheese 1 1 — Loaf, part of cut 1 — 1 Luncheon Meat 1 1 — Margarine 1 1 — Marmalade 1 1 — Marshmallow Cream 1 1 — Mayonnaise 1 1 — Meat Paste 2 2 — Milk 48 48 — Milk Bottle 1 — 1 Milk, Channel Island 4 4 — Milk, Condensed 1 1 — Mincemeat 3 3 — Mustard 2 2 — Oatmeal 1 1 — Orange Squash 2 2 — Pepper 3 3 — "Pineade" (Soft drink) 2 — 2 Potato Crisps 2 2 — Pudding Christmas 2 2 — Sage 1 1 — Salad Cream 3 3 — Sarsparilla 1 1 — 26 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Sauce 3 3 - Sausage Meat, beef 1 1 - Sausages, beef 5 5 - Sausages, Chipolata 1 1 - Sausages, pork 7 6 1 Sherbert 1 1 - Soup 2 2 - "Sparkling Orange" (Soft drink) 2 2 - "Sparkling Special" (Soft drink) 1 - 1 Sponge Mixture 1 1 - Steak Pudding 1 1 - Suet, shredded beef 3 3 - "Sugar Kist" (rice) 1 1 - Tapioca Dessert 1 1 - Tea 2 2 - "Tizer" (Soft drink) 1 1 - Tomato Juice 1 1 - Tomato Ketchup 3 3 - Treacle 1 1 - Vinegar, Malt 2 2 - Vitacup 1 — 1 Yeast, dessicated 1 1 - Yoghourt 1 1 - Yorkshire Pudding and Pancake Mixture 1 1 - Advocaat 2 2 - Brandy 2 2 - Gin 2 2 - Ginger Wine 1 1 - Port 2 2 - Rum 2 2 - Sherry 2 2 - Vermouth 1 1 - Whisky 5 5 - Wine—British White 1 1 - Abidec Capsules 1 1 - Adexolin Capsules 1 1 - Ammonia 1 1 - Ammoniated Tincture of Quinine 1 1 - Aspirin 2 2 - Baby Powder 1 1 - Bio-Chemic Salt 1 — 1 Boracic Powder 2 2 - Camphorated Oil 1 1 - Cascara Sagrada 1 1 - Castor Oil 2 2 - Chemical Food 2 2 - Cod Liver Oil 1 1 - Compound Vitamin Tablets 1 1 - Cream of Calomine 1 1 - 27 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc "Easton's Syrup" 1 1 - Epsom Salts 1 1 - Eucalyptus Oil 2 2 - Extract of Malt with Cod Liver Oil 1 1 - "Family" Ointment 1 — 1 Flowers of Sulphur 1 1 - Friars Balsam 1 1 - Fruit Salt 1 1 - Gee's Linctus 1 1 - Glaubers Salt 1 1 - Glycerine 1 1 - Glycerine and Rose Water 1 1 - Glycerine, Honey and Lemon 1 1 - "Hacks" for throat and chest 1 1 - Halibut Liver Oil Capsules 2 — 2 Halibut Oil 2 1 2 Health Salts 1 1 - Influenza Mixture 1 1 — Iodized Throat Lozenges 1 1 — Linseed, Liquorice and Chlorodyne 1 1 - Liquid Paraffin 1 1 — Magnesium Carbonate 1 1 — Milk of Magnesia Tablets 1 1 — Nasal Drops 1 1 — Oil of Spike Lavender 1 1 — Olive Oil 1 1 — "Plurivite" Pellets 1 1 — Saccharin Tablets — "Saspre" 1 1 — Seidlitz Powder 1 1 — Soda Bicarbonate 1 1 — Soda Mint Tablets 1 1 — Sulphur Ointment 1 1 — Tincture of Iodine 2 2 — Toothache Drops 1 1 — "Vick" Vapour Rub 1 1 — "Vigor" Tonic 1 1 — Zinc and Castor Oil Ointment 1 1 — TOTAL 312 298 14 28 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.551 Beans in Tomato Sauce. Formally. The tomato sauce had a slightly fishy taste. No cause for odd taste found on analysis. Further tins from same consignment satisfactory. No further action. Inf.448 Part of loaf. Complainant. Contained two small fragments of cement mortar. Manufacturer warned. F.557 Pork Sausages. Formally. 18% deficient in meat. Prosecution. Manufacturer fined £3 plus £1.1.0 costs. Inf.494 Pineade (soft drink) Informally. Deficient in sugar containing only 0.40%. A formal followup sample was taken — (No. F.620). F.619 Sparkling Special (soft drink) Formally. Deficient in sugar containing only 0.55%. Ministry of Food informed for possibility of action under Soft Drinks F.620 Pineade (soft drink). Deficient in sugar containing only 0.32%. Order. Seller subsequently deemed to be a " Caterer " and therefore no further action possible in these cases. Inf.506 Halibut Liver Oil Capsules. Informally. 32% deficient in Vitamin A. A formal followup sample was taken (F.634) and vendor subsequently prosecuted. F.634 Halibut Liver Oil Capsules. Formally. 28% deficient in Vitamin A. Prosecution. Vendor fined £2. Inf.537 Vitacup. Informally. Contents caked Vendor informed hard and no and remainder of longer fit for use, stock withdrawn. 29 Sample No. ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity. Action taken. F.643 Bio-Chemic Salt. Formally. Label false and misleading in respect of dietary and nutritional claims. Proportion of minerals not stated on label. Prosecution. Manufacturer fined £10. Inf.555 Halibut Oil.-Informally. 16% deficient in Vitamin A. A formal followup sample was taken (F.668). F.668 ,, Formally. 8% deficient in Vitamin A. Warning letter sent to vendor. Inf.564 Family Ointment. Informally. No description of ingredients as required by Pharmacy and Medicines Act. Vendor and manufacturer warned. Manufacturer agreed to consult an analyst regarding new labels. Inf.582 Empty Sterilized Milk Bottle. Informally. Contained fragments of glass. Warning letter sent to vendor and Sterilizer/ bottler. Food and Drugs Act, 1938 Section 13 and Bye-Laws made under Section 15 of the Food and Drugs Act. 33 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, 1938. 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. Action. Can of peaches alleged to have caused food poisoning. Tin from same consignment bacteriologically examined and found to be sterile. 30 Complaint. Action. Piece of metal embedded in portion of butter. Metal gained access to butter accidentally. Vendor warned. Tin foil cap in bottle of milk. Bottler advised. No further action. Part steak pie mouldy. Manufacturer advised. Vendor warned. Weevil and dark brown substance in loaf of bread. Baker warned. Jar of Pickle alleged to have caused food poisoning. Jar and contents bacteriologically examined. No pathogenic organisms isolated. Australian forequarter crop (beef) in dirty condition. Complaint from butcher. Meat Supply Depot informed. 8 lb. trimmings condemned. Insects in part of loaf of bread. Baker and Medical Officer of Health of neighbouring Local Authority (in whose area bakehouse situated) informed. Weevil in Wheat Flakes. Vendor informed. Old stock. Remainder destroyed. Replacement given to complainant. No further action. Maggot in packet of groats. No maggots visible on inspection. Evidence of presence of maggots seen on paper container. Vendor advised. No more packets of commodity in stock. Offal sack in filthy condition. Ministry of Food Distributing Agents advised and warned. Foreign body in loaf of bread. Identified as dark cake crumbs. Odd taste of two loaves of bread. Unusual taste thought to be due to salt deficiency. Piece of muslin cloth in tin of corned beef; Packers agents informed (overseas product). Pie mouldy. Vendor warned. Foreign body on a small coconut covered cake. Vendor warned. Improved storage and display accommodation obtained. Small quantity of ham slightly putrefactive. Vendor advised. 31 Complaint. Action. Foreign bodies (wood and stones) in sweets. Sample of sweets from same consignment purchased and analysed. Satisfactory. No further action. Can of plums alleged to contain paper. Canners informed who stated substance was crust formed by fermentation. Remainder of stock withdrawn. Cough medicine linctus containing flies. Referred to Executive Council and still under consideration. Sausages—tasteless and of poor quality. Submitted to Public Analysts who found that sausages contained an unusually high proportion of meat. It is felt that if not because of its importance at least for the unusual outcome the last complaint on the list relating to sausages must be especially remarked. 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. No. Chocolate Tea Cakes — — — — 512 Fish — 2 32 12 — Flour — 7 70 — — Meat 1 12 31 9 — Miscellaneous Groceries — 2 102 14 — Oranges — — — — 92 Sausages — 2 32 14 — Tinned Food 1 11 32 14 — Tinned Ham — 1 61 15 — Tinned Meat — 5 18 10 — Tinned Milk — 4 34 6 — 4 9 71 8 604 This food, if suitable, is used for animal feeding purposes and the remainder buried on the Council's refuse tips. Food Premises. The number of food premises in the district may be classified as follows (where more than one trade is carried on at any premises, then an entry is made in respect of each trade):— Bakehouses 18 Butchers 57 Cafes 72 Confectioners (bread, cakes, etc.) 42 Confectioners (sweets, etc.) 82 Fish Shops 30 32 Grocers 157 Greengrocers 78 Ice Cream Dealers 227 Ice Cream Manufacturers 16 Clean Food Propaganda. Our policy of utilising the public notice boards included within its scope propaganda in this field as well as in other branches of hygiene. Every opportunity is taken by the staff when giving talks to local organisations to emphasize the importance of clean food and the vital role that can be played in achieving this end not only by our staff but by the consumer. It remains for me to repeat that the buyer of food is in a position of privilege in demanding the highest standards by manufacturers and vendors. So far as our staff is concerned the day to day visit of the Inspector to the actual premises of the manufacturer or vendor in which the circumstances can be seen and discussed on the spot represents what I regard as the most useful path towards our goal. Milk. Our only local pasteurising plant which was noted in last year's report as having behaved 'temperamentally' has now been replaced by a plant which is giving more satisfactory achievement and in fact no unsatisfactory samples from the plant now being used have been reported in spite of close supervision. 55 methylene blue and phosphatase test samples were examined. There are 13 milk distributors with registered premises in the district. There are also 13 firms registered as milk distributors in Hornehurch whose premises are registered in other districts. In addition 36 shopkeepers are registered for the sale of bottled milk only. Milk—Special Designations. The Milk (Special Designation) (Specified Areas) Order 1953 came into operation on 2nd December 1953 and designated this area as one within which the use of special designations in relation to milk sold by retail became obligatory. This means in effect that the sale of raw undesignated milk in this district is no longer permissible. The practical effect of this will not be great because we have for long had only a very small per centage of raw milk sold in the district. 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 45 Supplementary Sterilised 8 Dealer's Tuberculin Tested 16 Supplementary Tuberculin Tested 6 33 Milk Sampling. The 154 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. 6 samples failed to satisfy ihe prescribed tests and the necessary followup action was taken. L.C.C. Children's Home, Hornchurch Road. We have arranged to keep the Medical Officer of Health of the L.C.C. informed of the results of testing of milk supplied to these premises. Ice Cream. During the year 28 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 227 for the storage and/or sale of ice cream. Our sampling was decreased from 135 last year to 82 this year. 77 proved satisfactory. The Food Standards (Ice Cream) (Amendment) Order 1952, came into force during the year and restored the ice cream standard to that of pre-July 1952. In view of the interest which you have maintained in this question the step afforded very considerable satisfaction. 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 41 persons and 57 premises were registered for the manufacture of preserved meat. Essex County Council Act, 1952, Section 103. This section which deals with the registration of hawkers of food and their premises came into force on 1st April, 1953, and at the end of the year 11 persons and 3 premises had been registered. Food and Drugs Act, 1938, Section 34. Two premises are registered for carrying on the business of wholesale dealer in margarine. Licensed Premises (Public Houses). Within the limits of our responsibility we continued to keep under observation the hygienic arrangements obtaining in our local premises. School Canteens. Again this year we conducted in association with the Divisional Executive Education Committee routine inspections of all the School Canteens. This work involved in all 97 visits. 34 It was noted in last year's report that one or two of the Canteens fell below the general standard—largely because of their age, planning and amenities and not because of any staff weakness- and this particular matter is at present being pursued with the Committee. I feel that when in all modern schools the standard of canteen provided is of a very high order, the time has now arrived when any relatively unsatisfactory old canteens should be brought up to a good average standard. I think it is a matter for congratulation especially for the staffs concerned that our school canteens have during the year provided us with not a single outbreak of food poisoning and it is the more imperative to secure that even the oldest canteens are brought up to a high standard. I trust that the latter point may next be commented upon as a matter of achievement rather than of hope. SECTION F PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASE. Scarlet Fever. The total number of cases during the year declined from 245 to 204 and the number hospitalised declined from 26 to 11. This is satisfactory but from the point of view of control and hence prevention, the same could not be said. The number of notifications also is probably far from being a true reflection of the incidence of this disease since I am sure many cases never come to medical light. In addition sore throats with or without an accompanying rash occur over the year to a very considerable extent and fall within the Scarlet Fever type of illness. As the disease has assumed a mild form with—so far as we are aware—few complications, so the question of isolation for any appreciable length of time has receded more and more into the background. Even where home isolation can be achieved with no real practical inconvenience at all, the reason for such isolation is often not appreciated and there is a tendency for the patient to have a relative freedom of the house and household. The question of the period during which isolation should be insisted upon is very much an open one and to this fact may well be attributed a substantial amount of the relative disrespect which this disease has now achieved. Allowing for the mildness of the disease and the effects of Sulphonamides and other drugs, we should still face the fact that cases of Scarlet Fever can be a source of considerable inconvenience if not worse. Our problems are not going to be solved until we have some really firm ground to rest upon as to a reasonably fixed period of isolation. Until then the control of this disease must from the public health point of view represent what has become an unsatisfactory feature of our work. Dysentery. Five cases were notified during the year. This figure is at any rate of significance in establishing that no epidemic occurred during 1953. 35 Anterior Poliomyelitis. We had during the year some 9 cases as against 5 in the previous year. Case Details. Site of Paralysis. Of the 9, 8 showed some degree of paralysis, the sites involved being lower limbs 4, upper limbs 2, lower and upper limbs 1, other sites 1. Ages. The youngest ease was 18 months; 5 were between 5 and 10 years; 2 were between 10 and 15 years and 1 adult was affected. Hospital stay. Of the completed hospital cases the shortest stay was 22 days and the longest was 229 days—the average stay therefore being 79 days. Month of attack. July showed 3 cases. The first occurred in June and the last in October. Household contacts at risk. 23 adults were in the affected households as against 14 children under the age of 15 years. Supervision of contacts. Periodic visits were made for the usual supervisory period and no illness was ascertained. Progress. The most recent information suggests that of the paralysed cases 4 have recovered without any material disability remaining and 4 are still attending hospital for physiotherapy but are making good progress. Remarks. It is disconcerting to note that the last year's ratio in which the non-paralytic exceeded the paralytic has now been completely reversed and although no death occurred and the paralysis was not of a central character, it is to be hoped that if this disease continues to trouble us—as there seems every indication it will—the paralytic forms will again tend to be in the minority and to be of minor degree. It is a truism of course to say that Poliomyelitis is a very complex subject with which to attempt to deal and certainly to control. It is interesting to note that one of the cases followed at a short interval after an undiagnosed febrile illness in another member of the household and it may well be that if a completely detailed and accurate record could be ascertained of the movements of cases and contacts over a material period it would be possible often to establish evidence of a case to case link. It is, however, clearly very difficult to do this and in fact is practically in many cases impossible. In general public health work in any district there is not in practice such a thing as a 'closed community' and hence even in a relatively small outbreak such as ours in 1953 there is evidence of persons coming into the district on holiday with relatives and others leaving the district. Whilst a contact line must be drawn somewhere it is also a fact that playmates or persons visiting a house may be as close or even closer contacts of the case than other persons resident in the house. It is thus possible and—although it does not come within scope of this report—I think there is some basis for a supposition that a case in this district may 36 readily have had its origin not as household contact but as a visitor to a household. It is clear that difficult though the control of ordinary cases may be insofar as contacts cannot be immobilised on the relative off-chance of their becoming ill, even if this could be done, the problem is far from solved because the movements of carriers, convalescent or otherwise and 'missed' cases, will remain a source of potential and inevitable danger. It may be a source of very modified consolation to reflect that if this were not the case the resistance of many might be at a lower ebb and hence the disease might be even more widespread and dangerous than is at present the case. Food Poisoning. Seven cases were notified during the year as against two for the previous year and one of these cases only was hospitalised and that for a short period. A small outbreak, involving three persons was brought to our notice and fully investigated. The material thought to be infected was boiled ham, contaminated unwittingly possibly by a human handler under conditions of a good average working type. Concerted action succeeded in clearing up the possible human source. The amount of infected material was small and the sufferers recovered well and reasonably quickly. The outbreak was interesting also in that a portion of the suspected material was made available for investigation when the outbreak was made known to us. The incidence of food poisoning bears some relation to the subject of food hygiene. We are of course armed legally to deal with defections in the preparation, distribution, etc. of food. Whilst undoubtedly the unremitting diligence of our staff and the food trade staffs allied to the increasing public interest in the question of clean food is raising the general standard, it would be unwarranted to suggest that any dramatic change has come over the situation as a whole. Public watchfulness and individual action on the part of members of the public constitute the least expensive and most efficacious safeguards for ensuring high standards of food preparation and distribution. Unfortunately few of us really have the courage of our convictions for if we acted as much as we talked about clean food standards there would be a lot less work for the staff of a Public Health Department to do. Far too much food is handled far too often and far too unnecessarily. Foods in shops appear often to be picked up, cut, weighed and then placed in wrappers by hand. Other susceptible foods are placed where any customer can breathe over them. A lick of the finger to separate the top of an obstinate wrapper is accepted as a commonplace. These are things which happen in public and every day and yet I am sure that all too seldom is comment made about them. You have spent a considerable amount of money issuing clean food notices to food traders in respect of dogs entering the premises but whilst this is of undoubted value it tends to place rather out of perspective by far the major danger which arises not from canines but from humans. 37 I am not suggesting that Hornchurch traders are more lacking in their appreciation of the subject of food hygiene than are their counterparts in other towns; I do not believe they are. That, however, is purely relative- the important point is that a tremendous lot remains to be done nationally and locally before the subject of food hygiene can be viewed by any of us with a really clear conscience. No opportunity is lost when members of the Department address local organisations to stress the importance of showing practically that food hygiene is a vital subject. Erysipelas. 16 cases have been notified as against 15 in the previous year. A good case doubtless existed once upon a time for notifying this disease, but I am not convinccd that its continuation as a notifiable disease any longer remains necessary. Measles. The number of cases occurring during the year approximated generally to the previous year, being 1,236 as against 1,186. The disease was of a mild type with so far as I am aware a minimum of complications. 11 of these cases were hospitalised because in six of the eases there were complications with other diseases; 3 cases were members of H.M. Forces; in one ease there was loss of weight and apathy and 1 case could not be adequately isolated at home. Whooping Cough. Again the number of cases approximated to that for 1952, the figures being 495 for the year under review and 519 for the previous year. The disease was mild and again also the minimum of complications came to light. Nine of the eases were hospitalised because in six of the eases there were complications with other diseases; one child had an unidentified rash; one did not respond to home treatment and the mother of one patient was already treating four other children in the house. Infective Hepatitis. 17 cases were notified during the year, the age incidence being:— Males Females Under 5 None None 5-10 5 5 10-15 3 1 Over 15 1 2 It will be noted that the sex incidence in the major group attacked is equal. As against last year the 6-10 age group shows more cases whilst the under 5 group shows fewer (in 1952 4 males in this group were affected). This year in the adult group there were 3 cases as against 8 last year. The disease was most marked at Rainham at the beginning of the year and at Hacton at the end of the year and there is therefore some evidence that outbreaks tend to be localised and not explosive. In 3 instances it was known that more than 1 case 88 occurred in a house. It is pointless to quote recovery periods since one case was never off work at all (doubtless being diagnosed retrospectively), whilst the longest period of isolation was 34 days. In view of what we know or don't know about this disease, the figures would in any event be of questionable significance. Tuberculosis. Primary respiratory notifications. 66 eases were analysed in some detail and the under-noted facts were elicited:— Age Incidence Under 5 5-15 15-20 20-30 30-40 40-50 50-60 Over 60 M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1 6 6 4 5 3 8 7 5 3 3 3 8 2 2 — It is of some interest to note that the number of persons notified between the ages of 50/60 was greater than that between 15/20 and the 30/40 groups. Number in family (including patient) 1 2 3 4 5 6 7 8 9 Number of cases 1 10 11 17 11 8 4 2 2 Since it may be taken that the average accommodation included three bedrooms, it is evident from the numbers noted that the question of overcrowding in either the legal or any other reasonable sense could not be regarded as being prejudicial. It will be noted that in fact 39 of the families had. including the patient, 4 persons or fewer in the house. Number of children at risk. In the households considered some 16 under 5 and 40 between 5 and 15 were ascertained. Wards. The primary notifications related to the following Wards:— Cranham Elm Park Emerson Park Harold Wood North- West Rainham Thame-side Town Up-minster 2 7 3 6 12 11 2 16 8 Family Association. In 22 of the primary notified cases there appeared some family association of interest. A relative appeared to be involved either as being a present case in the household or having suffered from the disease as follows:— 89 Parents 7 Children 4 Uncle 1 Aunt 5 Others (sisters-in-law, grandmother, brother-in-law) 3 Sisters 2 Multiple Cases. There were certain instances in which more than 1 case actually co-existed in a house at the same time. In one family five cases were actually in being at the same time out of a family of 8. Housing. I have noted that the average accommodation was of a reasonable nature. It is, however, very difficult to accord high priority to a young married couple, one of whom suffers from tubercle if. for example, on marriage they immediately take up residence in a house which is already either near to overcrowded or overcrowded. I am in no way minimising the difficulties of securing accommodation but these difficulties must surely be more manifest when children also are involved. It does happen on occasion that no sooner has one family been rehoused from an overcrowded house than their place is taken by a new family unit from within the same parent family and the obligation of the Council to keep re-housing family after family on this basis must surely in fairness to other applicants be limited. Residence within the district. A note might reasonably be made of certain examples of notifications which have really no very direct link in practice with this district although they fall to be registered by us. One such notification resided in temporary accommodation within the district; one had been in a mental home (not in Hornchurch) since 1934; one appeared to have used an accommodation address in the district; two were hospital employees within the district; one was in a children's home within the district and one had been in the Services for many years. The tuberculosis register at the end of the year showed as follows:— Pulmonary— Males 372 Females 317 Non-Pulmonary— Males 37 Females 31 757 40 CASES OF AND DEATHS FROM TUBERCULOSIS, 1953. AGE GROUPS NEW CASES INWARD TRANSFERS TOTAL NO. OF CASES ADDED TO REGISTER DEATHS TOTAL DEATHS PULMONARY NONPULMONARY PULMONARY NONPULMONARY PULMONARY NONPULMONARY M. F. M. F. M F. M. F. M. F. M. F. M. F. M. F. 0-1 years - 1 - - - - - - - 1 - - - - - - 1-4 „ 1 3 2 - — 1 — — 3 4 - - 1 — 1 - 5-9 ,, 1 3 2 — 2 1 — — 5 4 - - - - - - 10-14 4 1 - - 1 1 — - 5 2 - — — - - - 15-19 ,, 7 3 - — 1 — — — 8 3 — — — - - - 20-24 ,, 6 4 — 1 2 5 — — 8 10 — 2 — - — 2 25-34 „ 3 8 - 2 8 7 1 2 12 19 — 1 — - — 1 35-44 ,, 4 3 — — 3 2 1 - 8 5 — 1 — — — 1 45-64 ,, 10 8 — 1 1 3 — — 11 7 11 2 — 1 11 3 65 and over 2 — — — 2 — — — 4 — 2 — — — 2 0 Totals 38 29 4 4 20 20 2 2 64 55 13 6 1 1 14 7 41 YEAR 1953—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 1953 2 — 1 1 1 2 2 8 4 21 TUBERCULOSIS NOTIFICATIONS—1940-1953. (including Inward Transfers) YEAR PULMONARY NON-PULMONARY TOTAL 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 1952 85 6 91 1953 107 12 119 42 TABLE SHOWING THE TOTAL NUMBER OF INFECTIOUS DISEASE CASES NOTIFIED IN EACH WARD DURING THE YEAR 1953. DISEASE Total Cases Notified WARDS No. of Cases Hospitalised Cranham Elm Park Emerson Park Harold Wood Northwest Rainham Thameside Town Upminster Scarlet Fever 204 3 32 20 23 27 3 5 79 12 11 Poliomyelitis Paralytic 8 - 2 - 1 1 - 2 2 - 7 Non-Paralytic 1 — — — — 1 — — — — 1 Pneumonia 26 — 3 3 5 8 — 3 3 1 9 Meningococcal Infection 4 1 — — - 1 — 1 — 1 4 Dysentery 5 — 1 1 1 1 — — 1 — 4 Infective Hepatitis 17 1 2 1 1 0 7 1 4 0 0 Measles 1,236 6 108 163 89 274 190 111 254 41 11 Whooping Cough 495 7 104 38 43 56 33 133 58 23 9 Food Poisoning 7 — — 1 1 1 — 2 — 2 1 Puerperal Pyrexia 5 — — 1 — 1 1 — 2 — 3 Malaria (contracted abroad) 1 — — — — — 1 — — — 1 Erysipelas 16 — — 4 2 3 — 1 6 — 2 Encephalitis Infective 1 - — — — — — 1 — — 1 Ophthalmia Neonatorum 4 — — — — 1 — 1 2 — — TOTALS 2,030 18 252 232 166 375 235 261 411 80 64 43 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. 18 25 - - (») Factories not included in (i) in which Section 7 is enforced by the L.A. 207 275 10 - (iii) Other premises in which Section 7 is enforced by the Local Authority 24 20 1 - Total 249 320 11 — 2. Cases in which Defects were Found. Particulars. Found. Remedied Referred Prosecutions To H.M Inspector. . By H.M. Inspector. Want of cleanliness (S.l) — — — 1 — Sanitary Conveniences (Section 7) (a) Insufficient 5 2 — 2 — (b) Unsuitable or Defective 7 4 — 3 — Other offences against the Act — — 2 — — Total 12 6 2 6 — PART VIII OF THE ACT. OUTWORK—Sections 110 and 111. Nature of Work No. of Outworkers in August list Wearing ApparelMaking, etc. 120 No instances of work in unwholesome premises. 44 INDEX Page Acknowledgments 6 Acreage 7 Ambulance Service 11 Analysis of Mortality 9 Atmospheric Pollution 6, 15, 18 —Graphs 16, 17 Births 7 Birth Rate 7, 9 —Comparative 9 Camping Grounds 19, 20 Canteens, School 33,34 Clean Food Propaganda 32 Crematorium 18 Deaths 7 —Causes of 7, 8 —Infantile 7 Death Rate 7, 9 —Comparative 9 —Infant 7 Disinfestation 19 Dysentery 34 Erysipelas 37 Establishments for Massage or Special Treatment 19 Factories Acts, 1937 and 1948— Defects 43 Form 572 (Revised) 43 Inspections 43 Outwork 43 Visits paid 21 Flooding, Canvey Island 13 Food Poisoning 36,37 Food— Clean 32 Complaints 29, 30, 31 Hawkers of 33 Inspection of 20 Premises 20, 31,32 Preserved 33 Unsound 31 Food and Drugs Act, 1938 6, 23, 24 —Administration 23, 24 —Public Analysts 4,24 —Sampling 24 to 29 —Section 13 and Byelaws 29 —Section 34 33 Health Propaganda 11 Heating Appliances (Fireguards) Act, 1952 13 Home Safety 6, 13 Houses— Number erected 22 Number inhabited 7 45 Page Housing— Applications (medical aspect) 23 Itinerant Population 22, 23 Overcrowding 22 Sub-standard Property 22 Visits paid 20 Hygiene, General 6 Ice Cream— Registration 33 Sampling 33 Standard 33 Infectious Diseases— Case Rates (Comparative) 10 Hospitalisation 42 Notifications 5, 42 Visits paid 21 Ward Distribution 42 Infective Hepatitis 37 Informal Notices Served 21 Laboratory Facilities 11 Land Charges Enquiries 23 Licensed Premises (Public Houses) 33 Maternity and Child Welfare 11 Measles 37 Members of the Council 3 Midwives 12 Milk- Distributors 32 Pasteurising Plant 32 Sampling 33 Special Designations 32 Specified Areas 32 National Assistance Act, 1948, Section 47 12 Nursing and Maternity Homes 11 Nursing in the Home 12 Officers of the Public Health Department 4 Paddling Pools 18, 19 Penny Rate Product 7 Pet Animals Act, 1951 19 Poliomyelitis 35, 36 Population 7 Preface 5 Propaganda— Clean Food 32 Health 11 Public Houses 33 Rag Flock and Other Filling Materials Act, 1951 19 Rateable Value 7 River Thames 18 Rodent Control 19 Sanitary Circumstances, Visits paid 20,21 Sanitary Inspectors' Work, Summary 20, 21 Scarlet Fever 34 School Canteens 33, 34 46 Page Sewerage 18 Shops Act, 1950, visits paid 21 Staff 4 —Medical Examinations 12, 13 Staffing 11 Statutory Notices Served 21 Still Births 7 —Rate 7 Swimming Baths 18 Stubbers Camp 19,20 Tuberculosis 6, 38, 39 —Comparative 41 —Incidence and Mortality 40 —Notification/Mortality Interval 41 Vital Statistics 5, 7 Water 14, 15 —Sampling 14, 15 —Supply 14, 15 Whooping Cough 37