Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For The year 1954 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 1954 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. TABLE OF CONTENTS PAGE Members of the Council (as at 31.12.54) 3 SECTION A—Statistics and Social Conditions of the Area 7 SECTION B—General Provision of Health Services for the Area 12 SECTION C—Sanitary Circumstances of the Area 15 SECTION D—Housing 23 SECTION E—Inspection and Supervision of Food 31 SECTION F—Prevalence of, and control over, Infectious and other notifiable Diseases 47 SECTION G—Factories Acts, 1937 and 1948. Ministry of Labour and National Service Form 572 (Revised) 59 Index 60 3 MEMBERS OF THE COUNCIL (as at 31.12.54). Councillor R. S. Howe, J.P., Chairman. (1) Councillor H. Holock, Vice-Chairman. (1) Councillor Mrs. M. Anfilogoff. ,, Miss C. F. M. Cannon. „ Mrs. E. H. Dean. (1) „ Mrs. W. M. Jiggins. (1) „ Mrs. R. J. Reynolds. (1) „ Mrs. E. G. Richardson. ,, R. Atkinson. „ E. E. Raxter. E. W. J. W. Rush. „ R. E. E. Cannon. ,, L. W. Carroll. (1) and (3) ,, W. E. Daubeney. (1) „ N. G. Dix. (1) „ E. W. Fryd. „ J. W. G. Hughes. „ W. E. Large. „ H. F. Moss. „ S. C. Parrish. ,, G. W. Phillips. „ W. E. Philo. „ H. D. M. Rivers. „ P. M. Rowe. „ A. C. Salinger, J.P. G. M. D. Shaw. (1) „ S. M. Tucker. „ A. J. Twigger. (1) ,, C. A. Welch. A. W. Wren. (1) and (2) (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) W. J. Batcheler M.S.I.A. (2) 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) (3) and (4) * Resigned 14.3.54. ** Commenced duties 20.4.54. Clerical Staff: J. E. Blay (Chief Clerk). R. M. Jamieson Miss W. A. Hepburn. Miss E. Thompson (Commenced duties 20.12.54). Rodent Operative and General Assistant: F. J. Gilbey. 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. (4) Certificate of the Royal Sanitary Institute as Smoke Inspector. 5 Public Health Department, Council Offices, Billet Lane, HORNCHURCH. 14th June, 1955. To the Chairman and Members of the Hornehurch Urban District Council. Mr. Chairman, Ladies and Gentlemen, I beg to present to you the Annual Report on the health of the district during 1954. Vital Statistics. The figures are satisfactory in that the birth rate remains much as last year; the death rate is lower at 12.1 as against 13.1; and the infant mortality rate shows a substantial reduction at 17.38 as against 30.17. Infectious Diseases. The number of Poliomyelitis cases at 4 showed a distinct reduction as against 9 in 1953 and happily 3 of the 4 were in fact of the nonparalytic type. Scarlet Fever retained much the same incidence and type. Measles—it being a non-epidemic year—showed a relatively insignificant total of 81 as against 1,236; and Whooping Cough also showed a reduction from 495 to 108. All these are clearly very satisfactory features. Housing. Our review of sub-standard properties within the district was made comprehensively during the year and is noted in detail elsewhere in this report. Hornehurch has in reality no "slum" problem of any real magnitude and is in this respect in a very favoured position as compared to older and industrialised towns even of a much smaller size. The local house building development is still proceeding apace. Tuberculosis. I have dealt in some detail later with this disease and its local picture and suffice here to say that the diminution both in new cases and of deaths, together with certain other features, reveals a position which gives real cause for modified optimism. Atmospheric Pollution. We have now completed a full year's working with certain additional recording instruments and we have readily available a most useful picture to assist not only in letting us know what is happening locally but also in utilising the local findings to more general advantage. 6 Food and Drugs. Once again this most interesting feature of our work has been carried out on a wide and satisfactory basis as noted in the detailed report later. Home Safety. A local Committee upon which you are represented is now functioning and has made a satisfactory start mainly through the issue of propaganda material. This is an activity which will require long painstaking effort to produce results which may not in any event be easily demonstrable statistically. Acknowledgments. My best thanks are due to my fellow Council officials in other Departments, and especially to Dr. O'Dwyer, Mr. Randall and Mr. Blay in my own Department. 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) 1954 107,100 Number of inhabited houses according to rate books (September, 1954) 32,492 Rateable value (September, 1954) £828,141 Sum represented by a penny rate (September, 1954) £3,290 Extracts from Vital Statistics for the Year. Births. Number of live births allocated to the District as adjusted for inward and outward transfers 1,611 (807 males, 804 females) Birth rate per 1,000 Home Population using area comparability factor... 14.73 Number of stillbirths allocated to the District 32 (16 males, 16 females) Stillbirth rate per 1,000 Home Population 0.29 Stillbirth rate per 1,000 total (live and still) births 19.05 Deaths. Number of deaths of Hornchurch residents as supplied by the Registrar-General (adjusted for inward and outward transfers) 1,126 (581 males, 545 females) Death rate per 1,000 Home Population using area comparability factor 12.08 Deaths of infants under one year of age 28 (16 males, 12 females) Infant mortality rate (per 1,000 births) 17.38 Deaths of infants under 4 weeks of age 22 (12 males, 10 females) Neonatal mortality rate (per 1,000 births) 13.65 3 DEATH RATE—COMPARISON WITH PREVIOUS YEARS. 1939 7.8 1947 8.3 1940 9.4 1948 8.2 1941 9.6 1949 10.6* 1942 7.9 1950 10.4* 1943 8.9 1951 10.3* 1944 9.2 1952 10.4* 1945 9.9 1953 13.1* 1946 9.0 1954 12.1* * Area Comparability Factor returned. BIRTH RATE- COMPARISON WITH PREVIOUS YEARS. 1939 18.9 1947 20.7 1940 16.4 1948 17.2 1941 15.5 1949 16.0 1942 17.5 1950 13.6* 1943 19.0 1951 14.1* 1944 11.9 1952 13.8* 1945 18.4 1953 14.8* 1946 21.3 1954 14.7* * 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. 9 10 REGISTRAR-GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH. (Corrected for inward and outward transfers). Causes of Death Male. Female ALL CAUSES 581 545 1. Tuberculosis, respiratory 5 5 2. Tuberculosis, other 1 0 3. Syphilitic disease 1 1 4. Diphtheria 0 0 5. Whooping cough 0 0 6. Meningococcal infections 1 0 7. Acute poliomyelitis 0 0 8. Measles 0 0 9. Other infective and parasitic diseases 0 2 10. Malignant neoplasm, stomach 15 14 11. „ „ lung, bronchus 46 2 12. „ „ breast 0 25 13. ,, ,, uterus 0 10 14. Other malignant and lymphatic neoplasms 53 69 15. Leukaemia, aleukaemia 5 4 16. Diabetes 2 2 17. Vascular lesions of nervous system 69 108 18. Coronary disease, angina 93 51 19. Hypertension with heart disease 16 17 20. Other heart disease 81 123 21. Other circulatory disease 21 11 22. Influenza 0 1 23. Pneumonia 23 18 24. Bronchitis 37 17 25. Other diseases of respiratory system 7 1 26. Ulcer of stomach and duodenum 5 2 27. Gastritis, enteritis and diarrhoea 3 3 28. Nephritis and nephrosis 10 4 29. Hyperplasia of prostate 5 0 30. Pregnancy, childbirth, abortion 0 1 31. Congenital malformations 6 2 32. Other defined and ill-defined diseases 49 40 33. Motor vehicle accidents 7 3 34. All other accidents 14 4 35. Suicide 6 5 36. Homicide and operations of war 0 0 11 GENERAL MORTALITY : MAIN CAUSES 1946-1954 Causes of Death 1946 1947 1948 1949 1950 1951 1952 1953 1954 Tuberculosis (all forms) 51 38 44 35 29 25 17 21 11 Cancer 147 142 139 180 155 183 184 211 234 Infectious diseases 8 2 5 9 3 4 1 3 1 Cardio-vascular disease 316 344 371 404 441 418 425 602 590 Influenza 8 3 1 9 3 19 2 14 1 Pneumonia 39 48 30 31 20 30 49 52 41 Bronchitis 47 66 36 65 63 69 52 85 54 Other respiratory diseases 11 12 9 6 3 7 9 10 8 Gastro intestinal diseases 18 18 14 13 20 16 12 28 13 Motor vehicle accidents 9 6 7 11 9 14 9 11 10 All other accidents 11 7 14 8 12 12 4 10 18 Suicide 12 10 8 3 10 11 10 7 11 The features of the above statistics are : The reduction in the Tuberculosis mortality from an average figure of 39 for the first 5 years of the period to an average of 18 in the last 4; the increase of Cancer from an average of 152 for the first 5 years to 203 in the last 4, and Cardio-vascular Disease from 375 to 508 in the like periods. 12 SECTION B GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staffing. The year saw the resignation of Mr. T. W. Glew, a District Sanitary Inspector, who was succeeded by Mr. W. J. Batcheler. The clerical staff was augmented by Miss E. Thompson who commenced on 20th December, 1954. The resignation and replacement of staff inevitably involves an interval of staff shortage which reflects upon the annual work carried out by the department. Medical Examinations—Staff. The services of private practitioners arc generally utilised. In particular cases, e.g. an existing employee's suitability for continued employment, any necessary examinations are carried out by the Medical Officer of Health, specialist opinion being sought where required. During the year arrangements were made for the examination of 232 (165) employees or prospective employees—58 (39) permanent and 174 (126) temporary. It will be noted that the numbers examined during the current year show a very considerable increase over those for the previous year. The 1953 figures are given in parenthesis. Public Health Propaganda. Use is niade generally of the material issued by the Central Council for Health Education and the Council's notice boards are partially available to us for this purpose. Talks were also given by various members of the staff during the year to various organisations, and this is probably one of the most useful means of publicity. The Public Health Committee gladly acccptcd an invitation to visit a dairy supplying certain parts of our district. I think the members who found it possible to visit the establishment found the details both interesting and informative. Laboratory Facilities. Oldehurch Hospital laboratory with the kind assistance of Dr. Atkinson is always ready to help us and on exceptional matters recourse may be had to the Public Health Laboratory at Colindale. Ambulance Service. This is carried on under arrangements made by the County Council. 18 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) St. Mary's Lane, Upminster. (vii) Hornchurch Road, Hornchurch. (viii) Front Lane, Cranham. Nursing and Maternity Homes. There are 4 registered Nursing and Maternity Homes in the district supervised by the County Council. Midwives and Home Nurses. There are 9 midwives and 5 home nurse/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 to the home nurse/midwives there are 6 home nurses working in the district. Care of the Aged. No official action under Section 47 of the National Assistance Act was required during the year. There was one case of an elderly female living alone which was on the verge of necessitating action under the Section but fortunately secured hospital accommodation by other means. The problem of mental health undoubtedly comes very pertinently into the picture in a number of cases with which we are concerned. At the one end of the scale you have a person living alone, with no relatives, with a social conscience gradually becoming more numbed, with the services provided by neighbours gradually falling off, with a mental capacity gradually deteriorating and in brief drifting into a position when action under Section 47 would become imperative. Fortunately one is often able to secure hospital or other provision which does keep the position on a basis that avoids public health offence. At the other end is a person usually living alone but of perfectly sound habits and chiefly annoying because of a mental state which clearly demonstrates a balance delicately but firmly poised between the normal and the certifiable. There is very naturally and rightly a keen appreciation of the necessity for ensuring that no one be certified for admission into a mental institution unless grounds are reasonably beyond all doubt. There is on the other hand no doubt that in the everyday affairs of a department like this one sees instances where there is a degree of mental abnormality sufficient from time to time to make a person quite incompatible in the ordinary scheme of things—and especially as a neighbour—but about which next to nothing effective can really be done. I do not think there is any answer to this problem, but it does exist. 14 The foregoing remarks are perhaps not directly related to the care of the aged because age may not be by any means the causative factor. So far as concerns the actually aged, the Council is continuing by its housing provision to contribute materially towards assisting them, and this department also does all it can, quietly, to help anyone brought to our notice. Home Safety. As was visualised in my last report a Home Safety Committee was duly formed at a meeting held on 25th February, 1954. The District Council subsequently made a grant of some £50 towards the first year's workings and you are represented upon a Committee comprising many local interests. The Committee has commenced work in an inauspicious but practical fashion and have endeavoured by film shows, posters and the like to arouse public interest. Additionally it has had produced a most informative Home Safety brochure which it is intended should be distributed through the media of the Area Health Sub-Committee, our own Housing Department, local general practitioners and other interested organisations. Although the past year has seen a certain amount of publicity given to the subject of Home Safety it would, I think, strike the casual observer—and this means the average person—as unbelievable that deaths through home accidents outnumber those resulting from road accidents. The home accident represents a relatively private happening about which everyone naturally tends to keep as quiet as possible ; the road accident represents news and it seems usually possible to infer the motorist, cyclist or pedestrian as responsible depending upon the merits of the situation, one's choice or prejudice. No such analysis so spontaneously crops up in the case of the home accident which at the best usually results in a review if not of all the safety factors in the home at least of such of them as could cause a recurrence of the particular accident. Whether a local Council such as ours wishes to form a Home Safety Committee of its own or not is clearly a matter entirely within their own discretion, but if the subject of Home Safety is to be taken as seriously as reality demands, and as some day it will have to be taken, then a local authority should be enabled to deal with it in whatever fashion they deem appropriate. It would be idle to pretend that Home Safety achieves anything like a real interest in the average home. If, however, all the local organisations which have initially displayed an interest in the work of the newly formed Home Safety Committee proceed practically to do all they can to further the cause then one may be assured of a sound nucleus of effort in Hornchureh. Like most worthwhile things, however, success cannot be achieved merely by support in principle, and it is up to all of us to ensure that the formation of the Hornchurch Home Safety Committee represents the beginning of an attack and not its culmination. 15 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water Supplies—General. The South Essex Waterworks Company have kindly supplied the following particulars concerning the main supply for the district: "The water supply of the whole of your area has been satisfactory in quality and quantity. Bacteriological and chcmical examinations are made of the raw water, of the water in its various stages of treatment and of the water going into supply. A total of over 3,800 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. In addition, anaylses 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 plumbosolvent. No action has been necessary in respect to any form of contamination. The number of dwelling houses supplied as at 31st December last was 32,724 and the population as at 30th June, 1954, as obtained from the Registrar General was 107,100. We are unable to state the number of houses supplied by standpipes, but the total is quite insignificant." The largest individual well supply serving a group of houses is that in the Dennises Corner area. The position in this area was included in the comprehensive report on water supplies submitted to you last year and the circumstances are being kept under observation. Atmospheric Pollution. Present programme. Close co-operation is maintained with the National Smoke Abatement Society, the London and Home Counties Smoke Abatement Advisory Council, the Department of Scientific and Industrial Research and the Council of Co-operating Bodies. Our present programme has been gradually built up over a period of some six years and at present comprises monthly analysis for four lead peroxide candles (giving the SO3 content) and three deposit gauges providing information as to the total solids (assessed in tons per square mile). One volumetric SO2 apparatus is maintained for daily analysis at the Council's offices. This is the first year in which I have been able to report the findings of three deposit gauges, since the original gauge at Rainham has been augmented as from the beginning of 1954 by one additional gauge each at "Langtons," Billet Lane, and Oglethorpe School. I have noted below some statistical information (in graph form) concerning the findings from the deposit gauges and the lead peroxide candles. The Total Deposit graph and the Sulphur Dioxide graph reflect the position which the siting of the apparatus would lead one to expect. Quite apart, therefore, from the undefined implications of drift the maximum local amount of deposit and the maximum local SO2 emission occur at the Rainham site. 16 In the case of the deposit gauges (total deposited solids) the deposit at Oglethorpe School, Cranham, and the Council Offices, Billet Lane, Hornchurch, often approximate quite closely. The same remark is justified in the case of the SO2 readings at St. George's Hospital, Hornchurch, and the Redden Court site in Harold Wood. The apparatus at The Vicarage, North Oekendon, naturally enough gives the best reading unaffected as it must be by any material pollution in the immediate vicinity. Local position. Complaints were received during the year from householders in respect of various industrial, institutional and other sources of pollution, and in general whatever the legal justification may have been, considerable practical justification did exist for the most part. Our local pollution is, in view of the nature of the area, principally caused by domestic smoke and drift from outside areas. The inward drift can only radically be affected by anti-pollution measures taken in other areas, especially in the line of the prevailing wind. The domestic smoke represents a domestic problem, influenced it is true by a variety of considerations, such as whether smokeless fuel is available in adequate quantity and of a suitable type, whether the domestic consumers consider that the price is within their means, and whether the type of grate in the particular house is in fact capable of dealing with smokeless fuel. The position is largely controlled by the national fuel policy and the degree to which the public can be persuaded to accept atmospheric pollution as a menace. So far as our reports show, and I am speaking broadly, there has been no sensational improvement for the better over the past few years, although it might be argued that with the increasing domestic development of the district, even our lack of increased pollution might reflect a relative decrease. I think, however, that smoke abatement is still generally regarded almost as someone else's problem. Future programme. This so far as we are concerned locally will proceed without any great variation. You have agreed to co-operate with the Department of Scientific and Industrial Research, in making a special pollution analysis at times of unusual fog prevalence, and this, allied to the figures available from our present programme, will continue to be utilised in helping to build up the National Atmospheric Pollution picture on the lines advocated by the Department of Scientific and Industrial Research. It is clear that the degree to which the Government consider practical implementation of the "Beaver" report possible will from a longterm point of view determine how soon our atmosphere is going to become appreciably and permanently clear. However desirable it might be, it does not seem to me that any speedy solution to a problem of this kind is possible, but if a definite long-term solution is made available, it will represent a big step forward and one with which in the intervening period we shall have to be content. Atmospheric pollution is a national problem, capable only of a national remedy, but susceptible in some measure to local influence. 17 A joint Sub-Committee of Housing and Public Health met during the year and considered the subject on the following lines: (1) Propaganda. (2) Availability of smokeless fuel. (3) The question of how far we might request that science teaching in schools should include atmospheric pollution. (4) The desirability of making bye-laws. (5) The intermittent pollution created by domestic chimney fires. (6) The issue of a questionnaire regarding the use of smokeless fuel by domestic consumers. It will be seen that in fact the Sub-Committee really dealt with the question of the pollution caused by domestic smoke and not by industry. Action was taken to emphasize the need for making available sufficient smokeless fuel. The question of making bye-laws was deferred because the whole subject is at present engaging official attention and the matter of the questionnaire was left over until a later date. Sewerage. Large-scale plans have been approved for re-laying the St. Mary's Lane sewer to Bury Farm Works and the Ingrebourne sewer to the Riverside Works in Dagenham. Subsequently of course the re-laying of the St. Mary's Lane sewer will have repercussions on the capacity of the Bury Farm Works itself to deal adequately with the increased flow and hence some extension to the Works themselves will doubtless be necessary. The situation which necessitated the large-scale works did not arise in a day and has in fact been the subject of consideration for some time. The very rapid housing development in the district has possibly accentuated the urgency of remedial measures if the said development was to proceed smoothly, but even apart from that it may well be that some work at any rate would have been required. It should be noted that the re-laying of the Ingrebourne sewer will be effected on lines designed to form part of the proposed regional sewerage scheme and the capacity provided is therefore in excess of that likely to be necessary by the development of the Hornchurch district alone. It is difficult to comment upon the future sewage arrangements of the area since if the regional scheme is to achieve fruition—and this would certainly seem to be the scheme of choice—authorities other than Hornchurch will naturally be involved. Conversion. During the year one house—"Busy Bee," Bryant Avenue—was joined to the sewer, half the cost of converting the pail closet involved being borne by the local authority. 16 19 Pig Food Collection. The year saw the discontinuance of the Council's scheme of collecting food salvage for pig food. 1 must admit to regarding this as highly satisfactory, since however well conditions of collection may be organised the very nature of the scheme makes it inevitable that it will have as accompaniment conditions arising here and there which are hygienically unsatisfactory. It will also effect a certain saving of time in that the seasonal correspondence on the subject (which often ran on the relatively constant theme that if a pig bin was necessary, it was more necessary at somebody else's door) will now be obviated. River Pollution. A close watch continues to be kept upon the condition of our local streams and the co-operation of the Essex River Board has ensured a mutual exchange of information which enables the scene to be viewed comprehensively instead of as could so easily happen parochially. The condition of the River Thames is being dealt with on a longterm basis by the authorities concerned although meetings of riverside authorities have taken place with a view possibly to doing what they can to expedite and ensure the adequacy of the remedial measures planned. The river Ingrcbourne changes little as the years go by. It is still unsatisfactory and it will always be unsatisfactory to reflect upon how far its flow depends on the effluent of a neighbouring authority's sewage works. The course of the river has been improved by straightening it somewhat in parts and cleaning it out, but whatever may be the ultimate effect of a regional sewage scheme coming into being, some disquiet is bound to arise from time to time until a satisfactory scheme conies to fruition. In the absence of actual disquiet only a sense of acceptance born of experience enables the situation to be suffered. Ponds. During the year the water course adjacent to Parkland Avenue was inspected in connection with the possibility that the water level might be varied. On a general inspection no mosquito menace appeared to exist. The pond on the Ingrcbourne side of Haydock Close and adjacent to the Council housing estate, was reported upon and as a result it was agreed that it should be filled in and that the water be taken into the Ingrebourne. I think this is a very wise step as ponds proximate to housing development must be a source of considerable anxiety to the parents of young children. Swimming Bath. Good progress was made during the year towards the provision of a Swimming Bath suitable to the needs of the area, and although the matter is as yet in its early stages, 110 time is being lost in pressing on with it. Crematorium. Progress was made towards the establishment of a crematorium to serve other authorities also and proposed to be sited near Upminster. 20 Paddling Pools. Our usual investigations were made into the paddling pools at Harrow Lodge, Harold Wood, Spring Farm, and Rainham Recreation Ground, controlled by the Council and the results were generally satisfactory. Fifteen samples were taken in process of our supervision. Disinfestation. The prevailing practice in this regard was continued. Rodent Control. Increasing use has been made of the services of our Rodent Operative. During the year his advice was requested in respect of 216 infestations and 2,379 routine and re-visits were made. During that period he remedied 202 and 14 were under continued treatment or observation. It might be opportune here to utter a note of caution in respect of the bait used in anti-rodent work. Even under controlled conditions and when operating with the greatest care—as a local authority will always do—it should be borne in mind that a bait which will kill rodents, no matter how non-toxic it might appear to be, will form, to say the least, a very poor diet for anything else, and in this connection domestic animals-pets—come immediately to mind. I cannot emphasize too strongly that if any bait is laid down with a view to exterminating rodents, then the strictest precautions should be taken by the owner of any pet to ensure that it does not interfere with or eat, the bait. This is essential on two counts above all others, the one being that if the pet eats the bait then the rat can't and hence the rat cannot be destroyed. The second point is that the pet should not be subjected to gratuitous risk. 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. Fifteen visits were paid to these premises throughout the year. Heating Appliances (Fireguards) Act 1952 and Regulations 1953. A commencement was made with the testing of certain electrical appliances on the standards laid down by the Regulations. The result showed that of 29 appliances tested, 10 were unsatisfactory. The details are noted below : Type of Test Satisfactory Unsatisfactory Probe 20 9 Strength 29 0 Flannelette 3 1 It should be explained that fireguards of an approved type were in fact available for all but one of the appliances which failed the probe test and the inspecting officer was informed and was quite prepared to accept, that before any of the appliances had been sold the safeguard would have been attached (the fires tested were in fact obtained from a window display). 21 The flannelette test is almost impracticable to carry out in bulk, but may well be taken gradually to cover the various types of appliance. The various vendors of heating appliances to which the Act and Regulations apply have been directly approached with a view to emphasizing that the Council regard the carrying out of the legal obligations in respect of these appliances seriously. When assessing the value of this legislation, one must bear in mind that it applies only to new heating appliances and that necessarily at the moment the vast majority of such appliances in current use would not fall within the scope of the Regulations. In time, however, the new standards will gradually come to cover all such appliances and as time goes on the Accident Prevention factor would become increasingly apparent. From the point of view of Home Safety, legislation of this kind is greatly to be commended, although in the long run the vital factor is not only the standards which must be attained but the commonsense approach to dealing with heating appliances of any kind. It would seem that in some instances the name of the manufacturer, the date of manufacture, or a distinguishing mark, is not to be found; and it is suggested that every appliance should in fact be traceable by its bearing sufficient evidence of identification. Pet Animals Act, 1951. Twelve licences to keep a Pet Shop were issued during the year, and a total of 45 visits were paid to these premises. The results were satisfactory in that the conditions of the Act were being observed. 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 a satisfactory report was received. It may be of interest to refer to certain of the provisions of Section 9 of this Act which include that " the occupier of any premises registered under this Act shall keep records of all filling materials to which this Act applies consigned to the premises " . . . " and records shall be kept under this section in the prescribed form and in the prescribed manner and shall include the prescribed information as to the nature and quantity of materials or articles consigned, the persons from or to whom they were consigned, the places from or to which they were consigned, and the dates of receipt at or despatch from the premises." Dogs and Footpaths. Our footpaths in many instances are still a reflection upon some of our dog owners and it surely should not need an official reminder that the footpath is not a place to be fouled by dogs to the apparent indifference of their owners. Enough nuisance will certainly be caused by dogs normally to be found wandering around the district. Taking the dog for a walk is not inseparable from providing offence to other people. 22 Sanitary Inspection of the District. SUMMARY OF SANITARY INSPECTORS' WORK DURING 1954. Inspection of Food and Food Premises (visits paid) : Bakehouses 60 Butchers' Shops 190 Cafes 188 Confectioners 86 Dairies (including Pasteurising Plants) 65 Fish Shops 113 Food Complaints 49 Food and Drugs (Chemical and Bacteriological) 681 Grocers' Shops 340 Greengrocers' Shops 89 Ice Cream Dealers' and Manufacturers' Premises 140 Meat Inspection 202 Mobile Shops (Hawkers) 57 School Canteens 60 Slaughterhouse 176 Staff Canteens 10 Miscellaneous Visits 74 Housing (visits paid) : Drainage of Houses 491 Environmental Enquiries (including overcrowding Enquiries) 115 Sanitary Fittings 56 Structural Defects 679 Water Supply and Pipes 40 Miscellaneous Housing Visits 282 Re-Inspections 1,550 General Sanitary Circumstances (visits paid): Accumulations 88 Atmospheric Pollution Survey 89 Camping Grounds, Vans, etc. 86 Drainage and Sewerage 52 Dustbins 95 Fair Grounds 5 Keeping of Animals and Birds 19 Stables and Piggeries 37 Insect Pests 18 Public Conveniences (including Public House Urinals) 20 Refuse Tips 42 Rodent and Vermin Infestation 189 Schools 14 Smoke Complaints and Observations 65 Unclean Premises 21 Water Samples (Main) 31 Well Water Supplies 47 Watercourses 50 Miscellaneous Sanitary Visits 158 Re-Inspections 402 Factories and Outworkers : Number of visits paid 274 23 SUMMARY OF SANITARY INSPECTORS' WORK—continued. Shops Act: Number of inspections 503 Miscellaneous (visits paid) : Heating Appliances (Fireguards) Act 25 Massage Establishments 15 Pet Animals Act inspections 45 Rag Flock and Other Filling Materials Act 5 Infectious Disease : Number of visits paid (including contacts) 626 Number of Notices served : Informal 387 Statutory 110 The year's work has been of the customary painstaking conscientious variety fully comparable in standard and volume with that of previous years. The routine work of the district Inspector provides the basis for the success or failure of the work of a Public Health Department. He eschews the spectacular but commands the respect of those of us in a position to see and evaluate the results of his efforts. The main headings under which work was done may be noted as follows : Housing 3,213 visits Inspection of Food and Food Premises 2,580 General Sanitation 1,528 „ Infectious Diseases 626 „ Shops Act Inspections 503 „ Factories and Outworkers 274 „ SECTION D. HOUSING During the year 6 houses were officially represented as being unfit, 7 demolition orders were made, 2 closing orders (under the Local Government (Miscellaneous Provisions) Act 1953, Section 10, subSection 1) and 1 undertaking not to use a structure for human habitation was accepted and informal agreement to close was obtained in respect of a further property. It will thus be seen that apart from our major programme shortly to commence in respect of unfit dwellings, steady progress has been made with the routine work of ensuring that unfit habitations receive adequate attention. 24 Number of New Houses erected during the Year. (i) By the Local Authority 78 (ii) By other Local Authorities — (iii) By other bodies or persons 1,371 Inspection of Dwelling Houses during the Year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 888 (b) Number of inspections made for the purpose 1,704 (2) (a) Number of dwelling houses (included under sub-head (1) above) which were inspected and recorded under Housing Consolidated Regulations, 1925 and 1932 113 (b) Number of inspections made for the purpose 154 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 81 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 331 Remedy of Defects during the Year without Service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 176 Action under Statutory Powers during the Year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 : (1) Number of dwelling houses in respect of which notices were served requiring repairs 0 (2) Number of dwelling houses which were rendered fit after service of formal notices : (a) By owners 0 (b) By Local Authority in default of owners 0 (b) Proceedings under Public Health Acts : (1) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 100 (2) Number of dwelling houses in which defects were remedied after service of formal notices : (a) By owners 111 (b) By Local Authority in default of owners 5 25 (e) Proceedings under Sections 11 and 13 of the Housing Act, 1936 : (1) Number of dwelling houses in respect of which demolition orders were made : 7 82, North Street. " Coate Lodge," Fairview Avenue. 117, Butts Green Road. " Glenshee," Thorn Lane. 1 and 2, Church Hill Cottages, Warley Street. " Boa Vista," Berwick Road. (2) Number of dwelling houses demolished in pursuance of demolition orders : 6 117, Butts Green Road. 118, North Street. 120, North Street. 1, Finches Cottages, North Street. Premises rear " Bretby," Stanley Road North. " Glenshee," Thorn Lane. (d) Proceedings under Section 10(1) of the Local Government (Miscellaneous Provisions) Act, 1953 : (1) Number of dwelling houses in respect of which closing orders were made : 2 78, High Street. 80, High Street. (2) Number of dwelling houses in respect of which closing orders were determined, the dwelling house having been rendered fit 0 Number of dwelling houses demolished voluntarily in lieu of formal action under Housing Acts 0 Number of dwelling houses closed voluntarily in lieu of formal action under Local Government (Miscellaneous Provisions) Act, 1953 2 Structure at side of " Rosery,' Briscoe Road. Old Romford Lodge, Aveley Road, Upminster. Certificates of Disrepair. Under the Housing Repairs and Rents Act, 1954, a further duty has fallen to this department of reporting upon applications for Certificates of Disrepair in cases thought by the tenant of a house to justify disallowing increase of rent sought by the landlord. Experience of this particular matter is naturally lacking to a considerable extent and apart from any other factors the Courts will undoubtedly in due course throw light upon many points which may at the moment appear indefinite. Even at this early stage, however, it is clear that difficulties of interpretation will arise in some cases and in many the degree of disrepair is of a minimum order. Up to the end of the year we had submitted to us some 11 applications and of these the certificates sought were issued in 6 and refused in 5. The period covered represents only some 4 months during which the Act was in operation and the coming year will doubtless see the numbers noted greatly augmented. 26 Re-Housing Medical Aspects. During the year advice was sought on the degree of priority which should be accorded some 175 housing applications respecting which medical recommendations for priority had been submitted by the private practitioner. In general the basis for seeking priority remained much as it has done over the years and many of the conditions represented in the certificates were of a type which, whilst well-founded medically were nevertheless not of an order to justify a substantial degree of priority. Each applicant naturally enough considers his own case to be almost without peer but when one has to take a broad view it must perforce tone down the general effect produced by medical certification. No case of real outstanding appeal in which the public health is seriously prejudiced and which is brought to my notice goes without being fully considered by the Committee in the full light of the circumstances and no such case has yet in my view been rejected. Overcrowding. Although during the year some insight into the extent of this problem was necessarily given through the environmental report visits carried out by my District Inspectors, the time does not yet appear opportune to conduct the large scale survey which alone would provide a concise picture. In these days of rapid housing development, the position must necessarily be changing almost from day to day, and the overall housing position should be much more stable before one can embark upon a special survey with any degree of confidence. Instances are apparent where in spite of the fact that the legal standards may be complied with, practical standards are giving more cause for concern. You have, for example, the couple who on marriage have a self-contained flat of say two rooms with a kitchen, and in due course on the arrival of a family may find themselves having to bring up two or three children in precisely the same accommodation and without having any optimistic prospect of early betterment. In the case of the large families, which are relatively few in number, in spite of the fact that there is a " permitted number," it seems to me that an exceptionally large family is better re-housed in any reasonable accommodation which is larger than their existing house even although such accommodation may not be of an optimum character. General District Development. The year has seen a period of intense activity in building as the figures clearly reveal. During the year the Council built 78 houses and 1,371 houses were built by private enterprise. Notably was the private development taking place in the Hall Lane, Front Lane area of Upminster and Cranham, and private development in the South Hornchurch area adjoining the aerodrome. When one considers the increased calls made upon the sewers and the inevitable implications such development has upon the general services for the area, it will be seen that a vast problem confronts us. It would seem that without " green belt " restrictions the problem would have been a much greater one and one can only hope that in the 27 interests of public health the " green belt " is regarded as an area in which housing development need not be anticipated. It seems to me that once a slight encroachment has taken place in a matter of this kind, the end can never really be anticipated and it is surely better in these circumstances for such encroachment never to have been started. Caravans. It cannot be said that the year has seen a solution to this problem in Hornchurch. We still have with us occupied sites at Rainham; near Gallows Corner ; at Ingrebourne Farm and near Hacton House. These sites, to some extent, present a very varied picture in many ways, but they all have in common the feature that they provide accommodation for caravans without permission and that it appears to be impossible to regularise the position with real rapidity. As I mentioned in a previous report, it is no easy matter on public health grounds to take action in respect of caravan sites even although such sites are not licensed. Only minimum provision is required to satisfy, theoretically, any public health demands that might be made, and such provision may fall far short of what one would wish to see in a district of this kind, or for that matter, in any district. The solution to the caravan problem must be the increasing provision of other forms of accommodation, since surely only a small minority of people would freely select caravan accommodation as their first choice. Especially where there are children, a caravan is not the place for a permanent home to be set up. In the case of childless couples, under controlled conditions and, for example, temporarily on holidays, the position might be different; but at any rate in Hornchurch, caravaning as it is practised is not in general going to provide much of a counter attraction to permanent housing provision. Land Charges Enquiries. During the year 4,628 land charges enquiries were referred to the department regarding the question of outstanding sanitary notices. Housing Repairs and Rents Act, 1954. In terms of Section 1 of this Act I submitted to you a comprehensive report on the local position and I have noted below certain extracts from this report. A local survey was undertaken with the specific objective of ascertaining the number of permanent dwellings in respect of which demolition action, either by Individual House or Area Procedure, appeared indicated within the next five years (five years was adopted as a period, because it is specifically noted by the Ministry of Housing and Local Government in their request for information). In view of the objects sought our attention was directed in the main to those houses which in the light of our existing knowledge of them by their age, by their external appearance or by any other factor, suggested themselves as demanding detailed inspection and classification. With this end in view some 250 houses were inspected—in some cases repeatedly—by my Senior Sanitary Inspector and myself, and only after most careful assessment was a decision made as to the most suitable course of action. 28 Temporary Dwellings. Week-end bungalows came within our coincidental review but they have been excluded from our findings because, although week-end bungalows represent a feature notably of the Rainham part of our area, as a problem they tend towards self-solution by their disappearance when a modern dwelling is built on the site and the temporary building ceases—so far as human habitation is concerned—to remain a source of anxiety. It is difficult to determine accurately how many of these premises are occupied at any one time, although it is probably a fair statement that most of them are owner-occupied. The Unfit House. The houses deemed to be unfit were analysed in the light of Section 9, sub-Section 1 of the above Act which states the exact classification of the houses inspected was broadly defined as follows : Class 1. Houses so seriously unfit as to demand action to secure their demolition within 5 years. Class 2. Houses lacking modern amenities and with defects but not requiring the urgent radical treatment of Class 1. (It is suggested that Class 2 properties be kept under continuous review which may well result in some instances in their being found suitable for transfer to Class 1 within a few years.) Class 3. Houses lacking modern amentiies and probably not suitable for Improvement Grant but otherwise thought to be reasonably sound. These should be specifically reviewed at no later period than the end of 5 years. Class 4. Houses of a type lacking modern amenities but probably suitable for consideration as improvement prospects. Class 5. Sound houses with modern amenities. The average Class 1 house consisted of a living room, two small bedrooms, badly planned with outdoor sanitation, no bathroom, no constant hot water supply and showing unfitness as noted in the earlier definition. Some tenants had considerably improved their position by installing cooking facilities. It will be noted that I have limited my subsequent detailed numerical analysis to houses falling within the first two classes. This does not imply that no action need be taken on certain houses outwith these classes but that in, for example, the question of Improvement Grants, the initiative would appear to rest with the owner, although of course the existence of these Grants is a matter which merits publicity and our advice is always available to assist in arriving at any decision as to whether such a Grant should be initiated or should be agreed. Section 30 of the Town and Country Planning Act 1947 has laid down the. procedure to be adopted in regard to certain properties of architectural merit, and naturally enough this has its repercussions on certain of the properties included in my first two classes. Since, however, I am concerned basically with the fitness of houses for human habitation, the question as to whether antiquity or archaeological claims justify continued existence is not a matter with which I would be primarily concerned so long as continued use as human habitation would not inevitably follow retention. 29 Although general guidance on unfitness is given in Section 9 Housing Repairs and Rents Act, 1954, precise standards still remain a matter for individual discretion, doubtless aided as time goes on by case law. It is clear that many older houses lack such amenities as bathrooms, baths, indoor sanitation and constant hot water supply, and whilst ideally these failings should not be permitted, realistically there is no legal power to insist on their being remedied. Our national housing standards have some way to go before the gap between the modern and the old is bridged, and even in a district of predominantly modern development such as exists in Hornchurch the contrast is readily apparent. Survey Findings. Class 1 Analysis Occupancy— Occupants 1 2 3 4 Over 4 Number of Houses so occupied 21 14 9 8 2 = 54 Unoccupied = 15 Total 69 Children (under 15) were present in ten instances. Length of Tenancy— Under 5 years 5-10 years 11-15 years 16-20 years Over 21 years 4 13 12 5 20 Rents per week (including rates)— 5-10 shillings 11-15 shillings Over 15 shillings 32 15 5 (1 owner/occupier and 1 " tied " cottage excluded.) Class 2 Number of Houses involved 52 Comments on result of survey. Under 150 dwellings seem to require either demolition or serious consideration for demolition within five years. The average number of occupants of Class 1 houses was very small. The average occupier of a Class 1 house had no expressed desire to move but even expressed a desire not to move (this was probably governed by long residence, low rent and a fear of being uprooted to a strange environment at an advanced age). The number of children and young couples in the Class 1 houses was relatively and absolutely small. The variation in housing standards in even one road was very marked and certain houses externally poor might internally be found good with the converse applying elsewhere. Back-to-back houses are confined to one block in the central area of the district. 30 General comment. The general needs will be evident from the survey results. It should be borne in mind that certain of the occupants may make their own arrangements for alternative accommodation and representing the houses does not necessarily ensure their demolition, although in the vast majority of cases 1 believe that demolition will result. Although this survey has been conducted with a view to the immediate start of a major attack on our sub-standard property it should in fairness be pointed out that in the post-war years we have to date dealt individually with some 49 houses, viz. : Premises demolished 31 Premises awaiting demolition 11 Undertakings accepted— Premises reconstructed 2 Premises not to be used for human habitation 5 49 In view of the fact that the problem in this district is not in my view relatively a large one and in view of the fact that slum clearance has been officially discouraged until now, it can fairly be advanced that our policy towards the sub-standard dwelling has been far from one of inactivity. The present survey does, however, provide a picture which is adequate to found a programme upon. It has further been clearly stated in Appendix II, Housing Repairs and Rents Act, 1954, that proposals may be adjusted in the light of further surveys. Although 5 years has been noted as the time within which action is planned, in a district such as ours it may well be found that the size of the problem enables it to be dealt with within the period noted. Deferred Demolition. It might be thought that the type of occupancy and relative satisfaction noted in the worst houses would justify consideration of a policy permitting a continuation of their present occupancy so long as it could be ensured that as they become vacant or as any new development made appropriate these houses could be precluded from further use as human habitations. On the other hand from a strictly practical point of view these houses are considered unfit for habitation and should not therefore continue to be used for this purpose. It would seem, however, that local circumstances—analysed in the light of Ministry of Housing and Local Government Circular 55/54 precludes Deferred Demolition being invoked to assist in the local solution to the problem of unfit houses. Summary. (1) Estimated number of houses unfit for human habitation within the meaning of Section 9 of the Housing Repairs and Rents Act, 1954, and suitable for action under Section 11 or Section 25 of the Housing Act, 1936 ... 69 (2) Number of houses which are to be included in clearance areas still to be declared (13 areas) 64 (3) Number of houses (including those already comprised in operative Demolition Orders) to be demolished in the five years as a result of action under Section 11 of the Housing Act, 1936 16 31 SECTION E. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Administration. It will be noted that during the year 351 samples were taken by your staff and of these 22 were in one way or another unsatisfactory. On analysis the reasons for regarding the 22 samples as unsatisfactory one finds a wide variation of cause but nevertheless there is sound evidence—taking our results as a whole—for having confidence in the standard of products sold in this area. Our programme generally followed the lines noted in previous years and embraced supervision over a full scale of food and drugs. 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. It is apparent that the public is aware of the assistance which this Department can render to them in investigating and dealing with food complaints. It may be taken that every complaint, no matter how seemingly trivial, is the subject of a full enquiry, although the actual mode of dealing finally with any complaint depends upon the merits of that particular complaint and relatively seldom deserves prosecution. I must express my indebtedness 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 and ready advice in the many difficulties which necessarily crop up in this highly specialised branch of our work. ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Almonds, ground 1 1 — Arrowroot 1 1 — Baked Beans with Pork Sausages 1 1 — Beef Chipolatas 1 1 — Blanc Mange Powder 1 1 — Bun Mixture 1 1 — Butter 1 1 — Butter Drops 1 1 — Buttered Brazils 1 1 — Butter Mints 1 1 — Cake Flour 1 1 — Cake Flour Mixture 1 1 — Cake Mixture 2 2 — Cheese Spread 3 3 — Chocolate Sponge Cake 1 1 — Chocolate Spread 1 1 — Christmas Pudding 2 2 — Cinnamon Chips 1 1 — Cockles 1 1 — Coconut, dessicated 1 1 — Coconut, sugared 1 1 — Coffee 1 1 — 32 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Coffee and Chicory 1 1 — Coffee and Chicory Essence 2 2 — Coffee Product, soluble 1 1 — Colouring 2 2 — Condiment, non-brewed 2 2 — Confectionery 4 3 1 Cornflour 1 1 — Cottage Pie 1 1 — Cream 4 4 — Currants 1 1 — Custard Powder 2 2 — Doughnuts 2 2 — Egg Noodles 1 1 — Essences, flavouring 2 2 — Faggots 1 1 — Farinoca 2 2 — Fish Paste 5 5 — Frizets 1 1 — Frying Oil 1 1 — Gelatine 2 2 — Ginger Ground 1 1 — Gravy Powder 1 1 — Honey Bake 1 1 — Horseradish Relish 1 1 — Ice Cream 37 37 — Jam 2 2 — Jelly 3 3 — Jelly Creams 1 1 — Koola Cream (Ice Lolly) 1 1 — Lard 1 1 — Lemonade 1 — 1 Lemonade Powder 1 1 — Lemon Juice 1 1 — Liquid Apple 1 1 — Loaves, portions of 2 — 2 Lollies 8 7 1 Macaroni 1 1 — Margarine (with 10% Butter) 2 2 — Marmalade 1 1 — Marzipan 1 1 — Mayonnaise 1 1 — Meat Paste 3 3 — Milk 46 45 1 Milk, Channel Island 3 3 — Milk, Condensed 3 3 — Milk Food 1 1 — Milk Powder, dried skim 1 1 — Mimosa, crystallized 1 1 — Mincemeat 2 2 — Mint Sauce 2 2 — 83 ARTICLES Number of Samples examined No. found to be genuine, No. found to be adulterated or under-standard etc Mustard 2 2 — Oatmeal 1 — 1 Olive Oil 1 1 — Oranges 8 4 4 Ovaltine 1 1 — Pancake and Yorkshire Pudding Mixture 1 1 — Pea Flour 1 1 — Peanut Butter 1 1 — Peas, garden 2 — 2 Peel, mixed 1 1 — Pepper 4 4 — Pepper flavoured compound 1 1 — Piccalilli 1 1 — Popcorn 1 1 — Pork Luncheon Meat 1 1 — Potato Crisps 1 1 — Potato Puffs 1 1 — Pudding Mixture 1 1 — Raisins, stoned 1 1 — Red Currant Jelly 1 1 — Rennet, essence of 1 1 — " Ribena " Blackcurrant 1 1 — Rice 1 1 — Rice, cooked 1 1 — Rose Petals, crystallized 1 1 — Sage and Onion Stuffing 1 1 — Salad Cream 2 2 — Salt 1 1 — Sausage Meat, Pork 1 1 — Sausages, Beef 4 4 — Sausages, Pork 9 9 — Self Raising Flour 2 2 — Semolina 1 1 — Shrimps 1 1 — Sild in Oil 1 1 — Soup, Cream of Mushroom 2 — 2 Soup, dessicated 1 1 — Soup Mixture 2 2 — Spaghetti in Tomato Sauce with Cheese 1 1 — Spice, mixed 1 1 — Steak and Kidney, stewed 1 1 — Steak Stewed 2 2 — Suet, Beef 1 1 — Suet, Beef, shredded 1 1 — Suet, chopped 1 1 — Sugar Strands 1 1 — Sultanas 1 1 — Tea 1 1 — Tea Cake Mixture 1 1 — 34 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Tea Seed Oil 1 1 — Toffee Malts 1 1 — Tomato Ketchup 1 1 — Vinegar, Malt 2 2 — Walnut Fudge 1 1 — Winkles 1 1 — Yeast Extract 1 1 — Brandy 2 2 — Cherry Brandy 1 1 — Drambuie 1 1 — Gin 3 3 — Green Ginger Wine 1 1 — Port 2 2 — Rum 2 2 — Sherry 2 2 — Whisky 3 3 — Wine Cocktail 2 2 — Ammoniated Tincture of Quinine 2 2 — Aspirin Tablets 1 1 — Balm of Gilead Pastilles 1 1 — Bicarbonate of Soda 2 2 — Bismuthated Magnesia Ovals 1 1 — Borax and Honey 1 1 — Brewers' Yeast Tablets 1 1 — Brompton Lozenges 1 1 — Camphorated Oil 1 1 — Castor Oil 1 1 — Chlorophyll Tablets 1 1 — Cojene 1 1 — Cough Pastilles 1 1 — Embrocation 1 — 1 Extract of Malt with Cod Liver Oil 1 1 — Flowers of Sulphur 1 1 — Foot Ointment 1 1 — Friars Balsam 1 1 — Fruit Salt 1 1 — Glaubers Salts 2 2 — Glycerine 1 1 — Glycerine and Rose Water 2 2 — Glycerine, Lemon and Honey Pastilles 2 1 1 Glycerine, Lemon and Honey Toffee 2 — 2 Glycerine, Lemon and Honey with Ipecechuana 1 1 — Halliborange 1 1 — Hydrogen Peroxide Solution 2 2 — Junipah Tablets 1 1 — Linseed, Liquorice and Chlorodyne Lozenges 2 2 — 35 ARTICLES Number of Samples examined No. found to be genuine. No. found to be adulterated or under-standard etc Oil of Wintergreen 1 1 — Petroleum Jelly 1 1 — Raspberry Leaf Tablets 1 1 — Saccharine Tablets 1 1 — Sal Volatile 1 — 1 Surgical Spirit 1 1 — Tartaric Acid 1 1 — Tincture of Iodine 1 1 — Tonic Wine 1 1 — Travel Tablets 1 1 — Vita Glucose Tablets 1 1 — Vitamin Pellets 2 — 2 Zinc and Castor Oil Cream 1 1 — Zinc and Castor Oil Ointment 1 1 — TOTAL v 351 329 22 36 The undermentioned samples were found to be adulterated or under standard, etc. Sample No. ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity. Action taken ] F.712 Oranges. Formally. Juice contained Thiourea preservative 3 parts per million. Peel 10 p.p.m. Reports referred to Spanish Commercial Attache— and wholesalers. F.713 Oranges. Formally. Juice 3 p.p.m. Peel 10 p.p.m. Further samples to be taken particularly when new crop of oranges received. F.714 Oranges. Formally. Juice 4 p.p.m. Peel 15 p.p.m. F.746 Channel Island Milk. Formally. Deficient in fat by 10% of special standard of 4%. Considered by Council ; referred to Ministry of Food, Milk Division for their attention. Inf. 645 Lemonade. Complainant. Contained a deposit of greyish flocculent matter identified as a mould growth. Bottling firm warned by Council. Inf. 765 Portion of Complainant. Loaf. Contained piece of oil - stained fabric. Identified as greasing rag. Baker warned by Council. F.760 Glycerine, Lemon and Honey Toffee. Formally. Contained insufficient glycerine and lemon to justify description. Observations of manufacturer considered by Public Analyst and Council. Firm warned. Inf.644 Embrocation. Informally. Oil base 1/3 rape oil ; 2/3 mineral oil. Not all rape oil as formula. Referred to Ministry of Health. Pharmaceutical Section. Manufacturer advised. Inf.742 " Creem Cups." Informally. Contained insufficient fat to justify description " Creem." Manufacturer warned and is seeking Public Analysts' advice re alteration of description or ingredients, 37 Sample ARTICLE Sample obtained formally, informally, or from complainant. Nature of adulteration or irregularity. Action taken, Inf.739 Fruit Lolly. Informally. Lead content 1.6 p.p.m. Standard 1 p.p.m. Further sample taken which proved to be satisfactory. Manufacturer advised. F.775 Oranges. Formally. Contained Thiourea preservative. Juice 30 p.p.m. Peel 50 p.p.m. Retailer prosecuted. Fine of 10/- imposed. (Retailer unable to trace his source of supply.) Inf.716 Garden Peas. Complainant. Contained number of weed seeds. Formal follow-up sample taken— F.780. F.780 Garden Peas. Formally. Contained number of weed seeds. Manufacturer warned. F.781 Glycerine, Lemon and Honey Toffee. Formally. Devoid of lemon flavour and contained insufficient glycerine and honey to justify description. Manufacturer warned. Inf.729 Vitamin Pellets. Informally. Deficient in Vitamin B. Formal follow-up sample taken— F.805a. F.805a Vitamin Pellets. Formally. Slightly deficient in Vitamin B. Analysts' advice taken by retailer ; remainder of stock withdrawn. Inf.776 Loaf, part of. Complainant. Contained small pieces of black oily impregnated starchy substance. Manufacturer warned. Inf.747 Oatmeal. Complainant. Contained rodent excreta. Vendor prosecuted. Fined £5 at Romford Police Court. Inf.763 Cream of Mushroom Soup. Informally. Contained insufficient fat to justify description " Cream of Mushroom Soup." Formal follow-up sample taken— F.840. F.840 Cream of Mushroom Soup. Formally. Ditto Council decided to institute proceedings against manufacturers (subject to Ministry of Food consent). 38 Sample No. ARTICLE Sample obtained formally, informally, ox from complainant. Nature of adulteration or irregularity. Action taken. Inf.774 Glycerine, Lemon and Honey Pastilles. Informally. Contained insufficient glycerine honey to justify description. Reported to Council. Analysts' observations noted. Inf.790 Sal Volatile. Informally. Deficient in free ammonia and ammonium carbonate by 59% and 21% respectively. Follow-up formal sample No. F.845 taken. Result of sample genuine. Chemist concerned has now ceased bottling Sal Volatile as result of first unsatisfactory sample and he now sells this product prepacked. The above samples require little additional comment but it will be noted that 5 unsatisfactory results originated directly and one indirectly from complaints. Oranges have been noted separately under Thiourea. Thiourea in Oranges. Thiourea is a chemical used in certain cases to prevent mould growth 011 oranges and was the subject of a special representation to us by the Ministry of Food earlier in the year. On checking samples, we found in fact that Thiourea was present both in the peel and pulp of Spanish oranges sampled by us and being sold in this district. In view, however, of the fact that the matter was only then receiving national publicity and might not have been fully appreciated even in the trade, it was decided that representation should be made to the appropriate Ministry and to the Spanish Trade Authorities with a view to preventing trouble. It should be mentioned that although Thiourea has not, in humans, had any proved toxic effects in the concentrates likely to be found in oranges, it had in America been suspected and it was presumably thought that the situation was sufficiently serious as to justify the issue of advice 011 the subject by the Ministry of Food. Later in the year, further samples of Spanish oranges were taken and a concentration of Thiourea was found greater than that found in the earlier samples. In these circumstances and in the circumstances of the particular case, it was decided that a prosecution should be taken and accordingly at Romford Police Court 011 the 16th September 1954 the offending firm was fined 10/-. It may seem relatively trivial that 39 a prosecution is decided upon in respect of a few parts per million being present of a substance such as this in a common commodity like oranges, sold perhaps by traders who have no precise knowledge of the effects of chemicals 011 their wares. It should, however, be pointed out quite clearly that the presence of any Thiourea in fruit is a contravention of the Public Health Preservatives in Food etc. Regulations, and that regulations of this kind are designed solely to protect the public from the possible adverse effects of anything they buy. It is not my view that prosecution is often the course of election, but in certain circumstances— and I consider the Thiourea practice one of them—it is necessary publicly to establish the responsibility of vendors to the purchasers, for products which are sold. In the case of Thiourea which attained widespread national publicity earlier in the year, there can be little reason for anyone engaged in the trade not knowing that in fact this practice was illegal and had potential dangers. It is not and should not be the basis of our policy that action should be taken after trouble has resulted, rather than that potential dangers to health should be avoided. Vitamin Preparations. I am not sure that the actual keeping qualities of vitamins are determinable with certainty at the present time and analysis may further show some minor deviation from an accepted standard. There is, however, 110 evidence from our sampling that serious vitamin deficiency had occurred in any particular case. 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 011 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. It will be noted that of the 25 complaints deemed worthy of comment and listed below, a warning resulted in 12 cases, no further action was necessary in 10, advice was given in 2, and one prosecution —successful—resulted. Bakers' products, usually bread, formed the basis of 9 complaints, meat and milk of 5 each, vegetables 3, and 2 miscellaneous. Very detailed investigation is given to every complaint and action is determined accordingly. If complaint is made concerning an articlc which has passed through several hands after being sold or has been in the possession of the purchaser for some time and has been exposed to interference by others it is extremely difficult precisely to allocate blame to the vendor or manufacturer. 40 Complaint Brussels tops said to be contaminated. Screw in loaf of bread. Dirty appearance of Banbury cake. " Fishy" taste of pork when cooked. Caterpillar in tin of peas. Tin of stewed steak containing about one-third gristle. Bitter taste of cooked joint of meat. Bath chaps slightly mouldy. Unopened milk bottle containing extraneous dirt on side. Empty milk bottle containing mortar substance. Part contents of tin of stewed steak discoloured. Fragment of glass in empty milk bottle. Fragment of glass in half full milk bottle. Half loaf of bread containing dark substance. Part wrapped and sliced loaf with dark stain on outside. Wrapped and sliced loaf containing black substance. Wrapped and sliced loaf mouldy. Piece of cloth in loaf of bread. Foreign body in tin of peas. Action Shopkeeper advised to improve storage arrangements. New storage shed provided in consequence. Manufacturer warned. Manufacturer stated " dirty appearance due to burnt cake residue picked up from baking trays." Not unfit for consumption. Animal had probably been fed on fish meal. Manufacturer warned. Further tin from same consignment submitted to Analysts. Not unfit for consumption. Condemned. Butcher advised re storage. No further action. Bottling firm warned. Submitted to Analysts. Bottling firm advised and warned. Bottling firm's observations sought and warned. No further action. Stain due to contamination by oil used in bread-making machinery. Firm warned. Manufacturer stated " due to inclusion of some finely particulate black matter similar to that which accumulates in air lines of plant." Firm concerned warned. Enquiries made of manufacturer and retailer. Retailer warned regarding storage. Submitted to Analysts (sample No. Inf. 765). Result noted above. Submitted to Analysts (sample No. Inf.716). Result noted above. 41 Complaint. Opened bottle of lemonade containing foreign matter. Sponge cakes tasting of disinfectant. Tin of dried milk powder containing brown particles. Part of loaf containing black mass. Oatmeal containing small particles of foreign matter. Tinned cream. Cough Medicine linctus containing flies. Action. Submitted to Analysts (sample No. Inf.645). Result noted above. Submitted to Analysts. Submitted to Analysts. Submitted to Analysts (sample No. Inf.776). Submitted to Analysts (sample No. Inf.747). Result noted above. 2 tins submitted to Pathologist for examination. No organisms of the Salmonella or Shigella groups isolated. As was stated in my last Annual Report this matter was referred to the Essex Executive Committee. I have since been informed that the Committee considered the case fully and the chemist was warned to ensure that in future more care is to be taken in dispensing in conformity with the National Health Service. 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 — — — — 60 Fish — 3 21 — — Meat — 12 21 14 — Miscellaneous Groceries — 1 89 10 — Buns — — — — 43 Sausages — 1 62 — — Offal (imported) — — 8 — — Tinned Skimmed Milk Powder — 1 35 — — Tinned Food — 12 45 11 — Tinned Ham — —- 71 15 — Tinned Meat — 4 68 9 — Tinned Milk — 1 106 — — Rabbits — — 60 — — " Iced Bars " — — 9 — — 2 — 38 11 103 This food, if suitable, is used for animal feeding purposes and the remainder buried on the Council's refuse tips. 42 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 Grocers 157 Greengrocers 78 Ice Cream Dealers 251 Ice Cream Manufacturers 15 Shellfish. Opportunity was taken during the year to sample various types of shellfish (cockles, winkles, shrimps etc.) sold, often at weekends, in our district. The nature of the analyses comprised bacteriological and metallic examinations and produced informative results. Eight samples of cooked shellfish of various kinds showed evidence of significant bacteriological contamination in two instances. The source of the contamination could not be determined with certainty, but steps were taken to ensure that a recurrence of the contamination through any local agency, such as handling by the vendor, was reduced to a minimum. Some degree of metallic contamination was found in certain of the shellfish examined, but it should be borne in mind that such metallic content is normally to be found in shellfish and no ground was found for legal action in the matter since the origin was natural. I consider that in the circumstances the possibility of trouble arising from the local sale of shellfish is not of a serious order so long as it is appreciated that the utmost care must be exercised from the time of production to the time of consumption. Meat Inspection. The decontrol of meat rationing saw the opening of a private slaughterhouse in the district. This had been preceded by considerable activity culminating in the approval of the local court being given to the re-opening of the slaughterhouse. The situation in Hornchurch is perhaps unusual in that pre-1939 only a very small number of private slaughterhouses were in existence and this fact lessened the embarrassment which might have been caused when the resumption of private slaughtering again became possible in 1954. There is no doubt that from an aesthetic point of view—if such a term could ever be deemed appropriate in such a connection—the siting of private slaughterhouses in the developed parts of an urban district as, for example, where there are houses in close proximity or near a shopping centre would certainly not seem really desirable, and in this connection one tends to regard the subject broadly and without especial reference to the merits of any particular case. Having said 43 that, however, if by law there is no means of preventing the resumption of slaughtering under the circumstances noted, then clearly one must accept the situation and make the best possible bargain. Apart from persisting in my general disagreement in principle with the resumption of slaughtering in the middle of one of the busiest parts of our area, I must say that so far the situation has resolved itself on far more favourable lines than might have happened. The establishment is conducted in a spirit of close co-operation with us and with due regard to the susceptibilities of others. Considerable trouble has been taken in bringing the buildings up to a modern standard, one of the results being that your Inspectors can now carry out their meat inspection under circumstances which enable them to do full justice to the job. Since we only have one private slaughterhouse the matter of meat inspection has been considerably simplified. Perhaps the situation could be summed up by saying that in the event it has measured up rather to our expectations than to our fears. Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) 249 24 131 815 633 Number inspected 249 24 131 815 633 All diseases except Tuberculosis Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 20 2 - 15 1 Percentage of the number inspected affected with disease other than tuberculosis 8% 8.3% - 1.9% 16% Tuberculosis (mly— Whole carcases condemned 1 - - - - Carcases of which some part or organ was condemned 17 2 - - 19 Percentage of the number inspected affected with tuberculosis 7.2% 8.3% - - 3% Centralised Slaughtering. The question of a central local authority owned abattior has of course engaged your attention and will doubtless continue so to do until clarification of future national plans is available. It does not at the moment seem possible to go further into this point since so far as I am aware plans, if in fact any exist, covering this district are in such an early stage of development as to render speculation quite profitless. 44 Illicit Slaughtering. " Cornsland Farm," Hall Lane, Upminster. On 16th March 1954, at the request of the Ministry of Food, your Senior Sanitary Inspector and District Sanitary Inspector visited the above premises and in a fairly recently constructed concrete shed, approximately 20 ft. X 23 ft. the following carcase meat and offal was inspected : 6 hind quarters of beef total 3 carcases. 6 forequarters of beef 3 Ox livers. 2 Ox hearts. 3 Ox tongues. 3 Ox tails. Quantity of fat. 1 Sheep carcase. The sheep carcase and two of the ox livers were found to be unfit for human consumption and the remainder was quite satisfactory. The Ministry of Food officially seized the meat which had been passed as fit for human consumption and the remainder was surrendered to the Sanitary Inspectors by the owner, Mr. E. V. Smith of 72, Norwood Avenue, Romford, and subsequently destroyed. From information received it transpired that the slaughtering of the animals had been carried out at these premises which arc not licensed as a slaughterhouse in accordance with Section 57 of the Food and Drugs Act 1938. In addition no notification was received from the owner that the slaughtering was taking placc. This case was heard at Romford Court on 24th June when the defendant pleaded guilty. Proceedings were also taken at the same time by the Ministry of Food and the defendant pleaded guilty in that case also. Fines totalling £20 were imposed in respect of your prosecutions and £30 in respect of the Ministry of Food's cases. Ice Cream. During the year 14 applications for registration as vendors and 10 applications for registration of premises for the storage and sale of ice cream were granted. At the end of the year 15 persons and premises were registered for manufacture and 251 for the storage and/or sale of ice cream. Our sampling was decreased from 82 last year to 80 this year. 77 proved satisfactory. The spelling complexities of our English language would reasonably be conceded -and not only by foreigners—as formidable. The list noted below of a particular type of product sampled under the Food and Drugs Act does not suggest that the path of the present day child is going to be any easier in this respect than was that of bis parents : " Archie Andrews " Choc. Lolly Kreem. " Choc-Frol " Lolly. Frostie Frute Lolly. 45 Frosty Kreme Lolly. Fru-t-Creme Lolly. " Fruitie " Ice Lolly. " Koolafruta." "Kool Delite." Kooljoy Lolly. Lollie Kreme. Lolly Creme. Orange and Creme Lik Lap Lolly. Orange Fruit Pop Lolly. Orange Glojoy. Pineapple Fru-T-Ice Lolly. Pineapple Lucky Koola Lolly. Pola Maid Ice Cream. Raspberry Topsy Lolly. Preserved Food Manufacturers. Section 90 of the Hornchurch Urban District Council Act, 1936, requires registrat.on of preserved food manufacturers and premises. At the end of the year 40 persons and 56 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 26 persons and 8 premises had been registered. Food and Drugs Act, 1938, Section 34. Three premises are registered for carrying on the business of wholesale dealer in margarine. Clean Food Propaganda. The provision of clean food for the public depends in varying degree upon the manufacturer, the vendor, the purchaser and the Public Health Department. Whilst it would be unwise to assume that the agencies noted are given in direct order of priority, it must again be stated that education rather than legislation is going to be the ultimate dictator of our food hygiene standards. By the time food comes into our local shops it has often got without the immediate sphere of the manufacturer and where it is pre-packed the chances of subsequent complaint are necessarily of a minimal order. Where, however, the food is not prepacked or is prepared locally, an increasingly heavy responsibility is thrust upon everyone concerned. One of the most important contributions towards a high standard of food hygiene is the routine day-today visit carried out by my Sanitary Inspectors ; but however interested and efficient they may be there is still an essential gap which can only be filled by the food trade operatives and the public. Public education will not be complete until individuals are not only aware of what the whole question of food hygiene is about but also have become sufficiently convinced of their case to cast aside the diffidence in making complaints to the shopkeeper or cafe proprietor which unfortunately reflects the present-day position so much. No one has greater influence than a legitimately dissatisfied purchaser. 46 Our notices concerning the admission of dogs to food shops have continued to be prominently displayed but I personally feel that this tends to put the matter scientifically if not apparently somewhat out of perspective. If all the humans concerned in the multifarious processes of food manufacture, distribution and preparation become sufficiently informed of their own responsibilities, then I do not think that tne role played by the unfortunate canine is likely to be a matter ror national concern. Milk Pasteurising Plant. The plant noted last year has given uniformly satisfactory results and has thereby relieved my staff of a certain amount of labour and anxiety. 52 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 Hornchurch whose premises are registered in other districts. In addition 38 shopkeepers are registered for the sale of bottled milk only. The Milk (Special Designation) (Raw Milk) Regulations 1949-54, and The Milk (Special Designation) (Pasteurised and Sterilised Milk) Regulations, 1949-53. : The number of licences issued by the Council during the year was as follows:— Dealer's (Pasteuriser's) 1 Dealer's (Pasteurised) 29 Supplementary Pasteurised 7 Dealer's Sterilised 50 Supplementary Sterilised 8 Dealer's Tuberculin Tested 19 Supplementary Tuberculin Tested 6 Milk Sampling. The 184 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. In each case a satisfactory report was received. 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. School Canteens. During the year we paid some 60 visits to the local school canteens and placed our observations thereon at the disposal of the Education Committee. Some improvement in the position of the old canteens should be recorded, and plans for the radical improvement of one of them are likely one hopes to bear fruit in the near future. 47 The number of new canteers over the past lew years has necessarily risen coincident with the expansion of the new school programme, and whilst naturally the standard of these canteens is generally of a high order, one or two instances come readily to mind and have been reported upon where minor blemishes are thought to exist. The fact that a canteen is new should not be held to imply that it is necessarily perfect, and perfection even in matters of school canteens —if it is ever attainable—is only attainable through the hard path of learning from mistakes. A further minor point I would make on school canteens is that in my view if the sanitary accommodation for the staff of these canteens is to be satisfactory it is better to be exclusively used by that staff and must be adequate and readily accessible. The sharing of sanitary amenities between teachers and canteen staff, however economical it might appear occasionally at first sight, is not in my view a satisfactory arrangement. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER NOTIFIABLE DISEASES. It is always interesting to compare the number of the common infections with the passing years and on reference to the Council report covering, it is true, districts other than (although including) Hornchurch and comprising the old Romford Rural District with a population of 20,415, it is found that in the year 1904 the incidence of three diseases was as follows : Diphtheria : 179 cases, 95 of which were hospitalised and 9 of which died ; Scarlet Fever : 144 cases, 140 being hospitalised and 4 died ; and Enteric Fever : 12 cases, 4 of which went to hospital. As we now see, Diphtheria has for the present at least, almost ceased to be a Public Health problem. This is doubtless contributed to substantially by immunisation, but—although I have not got the exact figures —it seems doubtful whether the number of young children immunised maintains a sufficiently high level to attribute the absence of the disease entirely to this factor. It is in any event within the last 20 years that Diphtheria has ceased to be a menace. Scarlet Fever, as will be seen from this year's figures, still pursues its steady course, although it is becoming milder in type and it is many years since four deaths from this cause occurred. Enteric also, which in 1904 provided 12 cases, is a relative rarity and seems now to occur occasionally in explosive outbreaks of a relatively isolated character and in odd individual cases without ascertainable cause. So long as " carriers," discovered or undiscovered, remain with us, so long will there be a trouble potential from this disease. Among the common infectious diseases the most noteworthy feature has been the exceedingly low number (81) of Measles cases notified in 1954 as against the figures for the preceding three years 48 (1,236, 1,186 and 2,023). The incidence of Scarlet Fever at 225 showed an increase of 21 over the previous year, but Whooping Cough cases were reduced to 108. Scarlet Fever. Nothing noteworthy came to light in this connection. The number of eases removed to hospital was 16. The reasons for the removal were : illness or incapacity in family, 5 ; complications, 5 ; lack of isolation at home, 6. The type of disease apparently remains mild and so far as one can judge the complications remained few. Any real attempt at controlling the ordinary mild case remains a difficult if not insuperable problem, and our efforts continue to be focused upon achieving some degree of isolation and mainly upon advising contacts who may be in a position of unusual potential as spreaders of infection, e.g. those employed in food trades. Measles. I have noted the annual incidence of this disease. As with Scarlet Fever the type appears to be mild and the complications few. It is noteworthy that in the first three months of the year, which might be expected to provide the months of heaviest attack, only one case was in fact notified in each month : in other words, January to March 1954 revealed 3 cases of Measles in Hornchurch as against 1,109 cases in 1953 and 1,616 cases in 1951. Whooping Cough. The incidence figures for 1951, 1952 and 1953 remain remarkably constant at 495, 510 and 495 ; but again in 1954 the incidence dropped very sharply indeed to 108 cases. The disease was mild and few complications appeared to arise. Typhoid Fever. A case of Typhoid in a female was notified during the year, and after a prolonged stay in hospital cleared up completely as evidenced by negative results before and at some interval after her discharge. The only previous illness of note in the ease appeared to be a fever of unknown origin which kept the patient in a hospital for some weeks some 24 years ago, but which apparently proved negative on investiga tion. In the course of investigating the possible source of infection it was ascertained that the mother of the patient had contracted Typhoid Fever some 28 years before while in the Middle East, and had since provided a history suggestive of gall bladder infection. On investigation the mother proved to be a Typhoid " carrier." (The only other occupant of the house in question—an elderly lady—apparently proved negative on investigation.) The subsequent history of the " carrier " is that she was admitted to a local Infectious Diseases Hospital and after a course of treatment with Chloromycetin and subsequently Streptomycin she gave continuous negative results. Unfortunately on re-investigation after some three months she again gave positive results. She has been provided with notes as to the inherent danger of the situation. 49 It should be realised that the praetical danger of a Typhoid " carrier " generally arises in instances where they don't regard themselves as being dangerous at all and fail to adapt themselves to the situation in which, through no fault of their own, they are placed. If—as I am sure obtains in the case I have noted above- the realities of the position are understood, then the observance of unremitting care and attention to detail should go far to avoid any unfortunate consequences. This case is clearly interesting because of the length of time which elapsed between the original infection of the mother and the development of the disease by the daughter. Lengthy intervals have of course been known, but even so the time which elapsed is noteworthy. Infectious and Other Notifiable Diseases, 1954. Disease Total Cases notified. Number of Cases hospitalised. Dysentery 3 2 Erysipelas 12 1 Food Poisoning 7 2 Infective Hepatitis 57 2 Malaria (contracted abroad) 1 1 Measles 81 0 Ophthalmia Neonatorum 3 0 Paratyphoid B. Fever 1 1 Pneumonia 12 3 Poliomyelitis— Paralytic 1 0 Non-paralytic 3 3 Puerperal Pyrexia 1 1 Scarlet Fever 225 16 Typhoid Fever 1 1 Whooping Cough 108 4 Food Poisoning-. No outbreak of importance occurred during the year. Necessarily from time to time isolated instances are reported of illness attributed to food but it is commonly extremely difficult to secure any proof as, for example, by the recovery of a food poisoning organism from the patient or from the suspected food, or both. It cannot be over-emphasized that our chances of securing the fullest information from any investigation are in direct ratio to the speed with which the case is brought to our notice. If, for example, we don't hear of cases until a matter of days has elapsed, then our chances of securing any of the suspected food are negligible, and without something concrete to go upon our final views on any outbreak can never become more than suspicions. Speedy notification of suspected food poisoning is therefore of the utmost importance. The following is a copy of the Annual Return of Food Poisoning notifications for the year 1954 which is sent to the Ministry of Health in accordance with statutory requirements : 188 Appendix D (i) to Ministry of Health Memo Med. (Revised 1949)—FOOD POISONING (Corrected). 50 Annual Return of Food Poisoning Notifications (Corrected). 1. Local Authority: HORNCHURCH U.D.C. Year: 1954. 2. Food Poisoning Notifications (Corrected) Returned to R.G. lst Quarter. '2nd Quarter. Srd Quarter. 4th Quarter. TOTAL 3 Nil. 1 3 7 3. Outbreaks Due to Identified Agents : Total Outbreaks : Nil. Total Cases : Nil. 4. Outbreaks of Undiscovered Cause : Total Outbreaks : Nil. Total Cases : Nil. 5. Single Cases : Agent Identified : 2. Unknown Cause : 5 7 (Salmonella typhimurium in both cases.) Erysipelas. 12 cases were notified during the year. My lack of conviction noted in last year's report as to the benefits accruing from notifying this disease persist. Dysentery. 3 cases were notified during the year. This again represents a minor incidence and although is probably by no means representative of the actual occurrence of the disease in the district—since many mild cases will never be investigated—it remains tangible evidence that no major outbreak has occurred. Poliomyelitis. The year saw a reduction in the number of eases from 9 last year to 4 this, and satisfactorily of the 4, 3 were non-paralytic, and 1 showed some paralysis. All the cases were males, their ages being 15, 12, 7 years, and 14 months. The paralytic case is of some interest in that although it can clearly not be established with certainty, substantial evidence could be adduced to suggest that this case—a boy of 14 months—might well have had contact with a child closely associated with a definite ease of Poliomyelitis who had suffered from a febrile illness (which could have been an abortive Poliomyelitis) and which would, within the terms of its incubation period, have fitted into the general picture of the present case. The paralysis in this case affected the left foot and it appeared to be making reasonable progress. It was not hospitalised because it came to light through the medium of an orthopaedic department at a late stage. The usual routine measures of supervising contacts were put in force. The paralytic case illustrates in some measure the complexity of securing a really full history of the circumstances of a case and especially of endeavouring to ascertain the contacts involved. One must draw a definite line somewhere, but it almost seems that in some eases the more serious type of contact may relate to a friend, playmate, or visitor to a house, rather than to an actual inmate of a house. Not only in Poliomyelitis but in infectious disease enquiries generally, it is 51 a source of constant surprise and education to find that having made what was thought to be full enquiry, some vital point emerges purely casually in the course of conversation. The most fruitful method of attack on Poliomyelitis—apart from contact supervision—does not yet appear to have been finalised, although it may well be that in due course a suitable vaccine will emerge. It certainly does not seem that at the moment Gamma Globulin produces a satisfactory answer. Infective Hepatitis. As you know I made a special report on an outbreak of this disease which related primarily to Oglethorpe Primary and Junior Schools and which largely covered the period January to July, 1954. I have included below substantial portions of this report so that a permanent record of the outbreak may be available. Nature of Disease. Infective Hepatitis is notifiable in the Eastern Region under the Jaundice Regulations 1943. The illness is usually, but not always, characterised by a general upset followed by Jaundice lasting from one to ten weeks, and its control is complicated considerably by the illness frequently being typical. It is thought to be caused by a virus which may spread through infected hands, food or articles. The question of " carriers " is still undecided. 52 The general picture was as follows (cases notified to me from schools, doctors or other sources are included) : School Cases— Oglethorpe Junior Boys 15 Girls 27 — 42 Comprising: Hornchurch Residents 32 Outside Hornchurch— Aveley 6 Warley 2 Hornden 2 Oglethorpe Infants Boys 19 Girls 22 — 41 Comprising : Hornchurch Residents 28 Outside Hornchurch— Aveley 10 Warley 3 Other cases associated with Oglethorpe— Teachers 2 School Meals Assistant 1 Mothers 2 5 Other Schools—January/July 1954 12 12 Other Adults—January/July 1954 8 8 (Six of the adults resided in Upminster) Pre-school Children : Rainham 1 Upminster 1 — 2 TOTAL 110 53 Progress of Outbreak. Apart from an isolated case at Hacton Primary School in midJanuary no trouble arose until the last week of that month when a batch of cases was suddenly reported at Oglethorpe Junior Mixed School. Early in February a single case was reported from Oglethorpe Infants, but until late March Oglethorpe Junior School provided the main focus of trouble. Then, however, a batch of some 7 cases arose at Oglethorpe Infants, followed almost immediately by another 5 cases in the same school. April and May saw the same source of trouble with the Junior School providing a few sporadic cases also. June and early July figures were contributed to from both Junior and Infants Schools at Oglethorpe, but the epidemic appeared to lose impetus after the end of May as evidenced by the monthly totals, viz. : General (including Oglethorpe) Oglethorpe January 11 10 February 17 13 March 17 15 April 20 16 May 27 22 June 9 5 July 9 7 110 88 Distribution. The picture is that arising from a school outbreak. The majority of cases had the common factor that they attended Oglethorpe School although living in different parts of this district and outside the district. Naturally most of them resided close to the school, but this is clearly to be expected. The figures I have already noted show, however, that Aveley Estate itself provided a relatively substantial number of cases. Multiple Cases. Two cases arose in one family in four instances. Three cases arose in one family in two instances. Where the two cases arose in one family the interval between the first and second cases appeared to be in the region of 23 days, 25 days, and 32 days. The fourth example provided a gap of 63 days between the first and second case. It is to be noted that in two of the above examples the second case had a minor upset shortly after the first case developed Jaundice although the second case did not itself develop Jaundice until some time after the minor upset. In the two instances where three cases occurred in one house the gap between the first case and the third was never longer than 17 days. Control Measures. I have already noted that control was difficult because of the subclinical case and possibly because of " carriers." It should be realised also that there is no ready bacteriological or other test (as there is for example in certain infectious diseases and food poisoning) which enables us to substantiate the presence of the disease in certain cases or the freedom from infection in any individual. 54 From the outset close liaison was maintained with the Area Medical School Officer, and the wholehearted co-operation of both the headmaster of the Junior School and headmistress of the Infants School was freely available. The canteen and general sanitary arrangements in the school were discussed very frequently between the school staff and my District Sanitary Inspector. I myself repeatedly visited the school with my Inspector and discussed the position with the school staff. There was no evidence found to incriminate school meals. It was arranged from the outset that cases of slight illness should be excluded from school until the cause of the illness became apparent. The necessity for the highest standard of individual hygiene even in infants was emphasized. Numerous home enquiries were made into the circumstances of cases and suspected cases. Where necessary local practitioners were approached. In a disease of this kind it is not thought practicable to insist upon the exclusion of contacts. In outbreaks of infectious disease generally (and this includes Infective Hepatitis) it is necessary to draw a mean by adopting those measures of restriction which can prove of value without at the same time being of a nature so completely to paralyze the life of the school or community concerned as to prove on that very account impossible of fulfilment. Discussion. The best method of attacking an outbreak of this nature is by devoting attention to restricting spread along the channels thought to be capable of causing spread and hence emphasis should be laid on personal hygiene, undiagnosed illness and the like. The age incidence of those affected is evident from the details I have given of the outbreak. It will be known that the school mainly involved is of very modern construction with equivalent high standards of canteen and general sanitation, and to these advantages must be added the real interest of the headmaster and headmistress in securing that personal hygiene was always maintained at the highest possible level. There is not, I think, any method of radically stopping an outbreak of this kind, although one can hope with reason that stringent measures can prevent the extent of spread. In this instance the school holidays came at a time when the epidemic showed a substantial lessening in extent, and it was in fact found that the school holidays saw a cessation of the outbreak. Visit of Mass Radiography Unit. A visit by Unit 6 B. was paid to this district from 14th June to 22nd July 1954. An improved coverage of the district as compared with the previous Unit visit was obtained and I note below details of the centres at which the Unit operated and the attendances at each centre. Although the total attendances was reduced as compared with the visit in 1951 the figures are not wholly comparable since on the previous occasion the operating Unit coincidently carried out certain large factory visits, the attendances at which were included—justifiably—in our totals. 55 No such industrial work was carried out during the present visit. Males Females TOTAL South Hornchurch Clinic 180 464 644 Rainham Combined Treatment Centre 288 401 689 Harold Wood Hospital 247 498 745 Methodist Church, Upminster 329 682 1,011 Billet Lane Hall, Hornchurch 650 994 1,644 Elm Park Day Nursery 328 626 954 Grand Total 2,022 3,665 5,687 As a result of the investigation some 23 inactive primary lesions were found and some 57 inactive post-primary lesions, together with 5 active post-primary lesions and a variety of non-tuberculous conditions. The overall number of attendances during the visit of Unit No. 6A in 1951 was 6,644. Tuberculosis. The tuberculosis register at the end of the year showed as follows : Pulmonary— Males 374 Females 341 N on-Pulmonary— Males 35 Females 25 775 The picture shows a great improvement as against 1953. The number of new pulmonary cases notified has dropped from 67 to 53 and of non-pulmonary cases from 8 to 5. The number of deaths from pulmonary disease has dropped from 19 to 6 and of non-pulmonary from 2 to 1. None of the notified cases died within six months of notification— the first time that this has happened since the war. There were three cases brought to notice after death—the lowest figure of this kind since the war. It is noteworthy that the number of inward transfers, i.e. cases originally notified elsewhere but coming to live permanently in our district, has risen from 40 to 52 (pulmonary type), due doubtless to the rapidity of building development in Hornchurch. These facts indeed provide a stimulus to the many workers attacking the disease and give great ground for future confidence in the outcome of the struggle. CASES OF AND DEATHS FROM TUBERCULOSIS, 1954. AGE GROUPS NEW CASES INWARD TRANSFERS TOTAL NO. OF CASES ADDED TO REGISTER DEATHS PULMONARY NONPULMONARY PULMONARY NONPULMONARY PULMONARY NONPULMONARY TOTAL DEATHS M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 0- 1 years 1 1 — — — — - — 1 1 - - - - - - 1- 4 „ — — — — — 2 — — — 2 — — — — — — 5- 9 " 1 2 1 — — 1 - — 2 3 - - - - - - 10-14 " — 1 — 1 — — - — — 2 — — — — — — 15-19 „ 4 6 — 1 1 1 — — 5 8 - - - - - - 20-24 " 6 5 — - 2 11 — — 8 16 — 1 — — — 1 25-34 " 6 3 — 1 11 14 2 — 19 18 — 2 — — — 2 35-44 " 2 5 — — 2 4 — — 4 9 1 1 — — 1 1 45-64 ,, 6 2 1 — 1 1 — 1 8 4 3 — — 3 — 65 and over 2 — — — 1 — — — 3 — 1 1 1 — 2 1 Totals 28 25 2 3 18 34 2 1 50 63 5 5 1 0 6 5 56 57 INTERVAL BETWEEN NOTIFICATION AND DEATH OF FATAL CASES OF TUBERCULOSIS; 1947=1954 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, 1947 1 5 1 1 7 5 3 10 5 38 1948 4 4 2 8 4 4 2 12 9 44 1949 1 1 1 3 9 2 2 10 6 35 1950 — 1 3 2 — 4 2 10 7 29 1951 3 — — 1 2 — 2 5 12 25 1952 — 1 — — 2 — 2 7 5 17 1953 2 — 1 1 1 2 2 8 4 21 1954 — - - 1 2 — — 5 3 11 58 59 SECTION G. FACTORIES ACTS, 1937 and 1948. Ministry of Labour and National Service Form 572. PART I OF THE ACT. 1. Inspections. G 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. 20 13 - - (ii) Factories not included in (i) in which Section 7 is enforced by the L.A 212 232 5 - (iii) Other premises in which Section 7 is enforced by the Local Authority 21 19 - - Total 253 264 5 — 2. Cases in which Defects were Found. Particulars. Found. Remedied Referred Prosecutions To H.M. Inspector. By H.M. Inspector. Sanitary Conveniences (Section 7) (a) Insufficient 1 1 — 5 — (b) Unsuitable or Defective 4 5 — 1 — Other offences against the Act — — 6 — — Total 5 6 6 6 — PART VIII OF THE ACT. OUTWORK—Sections 110 and 111. Nature of No. of Outworkers Work in August list Wearing Apparel— No instances of work in unwhole- Making, etc. 130 some premises. 60 INDEX Page Acknowledgments 6 Acreage 7 Ambulance Service 12 Atmospheric Pollution 5, 15 —Future Programme 16 —Graphs 18 —Local Position 16 —Present Programme 15 Births 7 Birth Rates 7 —Comparative 8 —Graph 9 Canteens, School 46 Caravans 27 Care of the Aged 13 Centralised Slaughtering 43 Certificates of Disrepair 25 Clean Food Propaganda 45 Contents, Table of 2 Crematorium . 19 Deaths 7 —Causes of 10 —Graph of Main Causes 11 —Infantile 7 —Main Causes 11 Death Rates 7 —Comparative 8 —Graph 9 —Infant 7 —Neonatal 7 Disinfestation 20 Drainage and Sewerage 17 Dysentery 50 Essex County Council Act, 1952, Section 103 45 Erysipelas 50 Establishments for Massage or Special Treatment 20, 23 Factories Acts, 1937 and 1948—Defects 59 Form 572 (Revised) 59 Inspections 22, 59 Outwork 59 Visits paid 22, 59 Fireguards 20, 23 Food Poisoning 49 Food- Clean 45 Complaints 39-41 Hawkers of 45 Inspection of 22 Meat Inspection 42 Premises 42 Preserved 45 Shellfish 42 Unsound 41 61 Page Food and Drugs Act, 1938 6,31 —Administration 6,31 —Public Analysts 31 —Sampling 31-38 —Section 13 and Byelaws 39 —Section 34 45 —Thiourea in Oranges 38 —Vitamin Preparations 39 Fouling of Footpaths by Dogs 21 Graphs— Atmospheric Pollution 18 Birth and Death Rates 9 Main Causes of Death 11 Tuberculosis Cases and Deaths 58 Health Propaganda 12 Heating Appliances (Fireguards) Act, 1952, and Regulations, 1953 20, 23 Home Nurses and Midwives 13 Home Safety 6, 14 Hornchurch Urban District Council Act, 1936, Section 90 45 Houses— Inspection of 24 Number erected 24 Number inhabited 7 Housing— Action under Statutory Powers 23, 24 Applications (Medical Aspect) 26 Closing and Demolition Orders 25 General District Development 26 Overcrowding 26 Remedy of Defects Informally 24 Sub-standard Property 5,27 Temporary Dwellings 28 Visits Paid . 22 Housing Repairs and Rents Act, 1954 27 —Certificates of Disrepair 25 -—Deferred Demolition 30 —Summary 30 —Survey Findings 29 —Temporary Dwellings 28 —The Unfit House 28 Ice Cream—- Nomenclature 44, 45 Registration 44 Sampling 44 Illicit Slaughtering 44 Infectious Diseases 5, 47 —Hospitalisation 49 —Notifications 49 —Visits paid 23 Infective Hepatitis 51-54 Informal Notices Served 23 Laboratory Facilities . 12 Land Charges Enquiries 27 Mass Radiography 54 62 Page Maternity and Child Welfare 13 Measles 5,48 Meat Inspection 42 —Carcases Inspected and Condemned 43 —Centralised Slaughtering 43 —Illicit Slaughtering 44 Members of the Council 3 Midwives and Home Nurses 13 Milk- Distributors 46 L.C.C. Children's Home 46 Pasteurising Plant 46 Sampling 46 Special Designations 46 National Assistance Act, 1948, Section 47 13 Notices Served 23 Nursing and Maternity Homes 13 Officers of the Public Health Department 4 Paddling Pools 20 Penny Rate Product 7 Pet Animals Act, 1951 21, 23 Pig Food Collection 19 Poliomyelitis 5, 50 Ponds and Watercourses 19 Population 7 Preface 5 Propaganda— Clean Food 45 Health 12 Rag Flock and Other Filling Materials Act, 1951 21, 23 Rateable Value 7 River Ingrebourne 19 River Pollution 19 River Thames 19 Rodent Control 20 Safety in the Home 6, 14 Sanitary Circumstances, visits paid 22 Sanitary Inspector's Work, Summary 22 Scarlet Fever 5, 48 School Canteens 46 Sewerage 17 Shellfish 42 Shops Act, 1950, visits paid 23 Staff 4, 12 —Medical Examinations 12 Staffing 4, 12 Statutory Notices Served 23 Still Births 7 —Rates 7 Swimming Bath . 19 Table of Contents 2 Temporary Dwellings 28 63 Page Tuberculosis 5, 54 —Comparative Graph 58 —Incidence and Mortality 56 —Mass Radiography 54 —Notification/Mortality Interval 57 Typhoid Fever 48 Vital Statistics 5, 7 Water 15 —Sampling 15 —Supplies 15 Watercourses and Ponds 19 Whooping Cough 48