Ac. 4411 (3)2 HORNCHURCH HORNC 23 Hornchurch Urban District Council ANNUAL REPORT of the MEDICAL OFFICER of HEALTH For the Year 1955 JAMES GOEMAN, 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 1955 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. 2 TABLE OF CONTENTS page Members of the Council (as at 31.12.55) 3 SECTION A—Statistics and Social Conditions of the Area 7 SECTION B—General Provision of Health Services for the Area 11 SECTION C—Sanitary Circumstances of the Area 13 SECTION D—Housing 21 SECTION E—Inspection and Supervision of Food 25 SECTION F—Prevalence of, and control over, Infectious and other notifiable Diseases 40 SECTION G—Factories Acts, 1937 and 1948, Ministry of Labour and National Service Form 572 (Revised) 47 Index 48 3 MEMBERS OF THE COUNCIL (as at 31.12.55) Councillor E. W. Fryd, J.P., Chairman. (1) Councillor J. W. G. Hughes, Vice-Chairman. (1) Councillor Mrs. M. Anfilogoff. (1) ,, Miss C. F. M. Cannon. ,, Mrs. E. H. Dean. (1) ,, Mrs. W. M. Jiggins. (1) ,, Mrs. R. J. Reynolds. (1) and (2) ,, Mrs. E. G. Richardson. ,, M. A. Andrews. (1) and (3) ,, R. Atkinson. ,, E. E. Baxter. ,, E. W. J. W. Bush. (1) ,, B. E. E. Cannon. L.W.Carroll, (1). N. G. Dix. ,, H. Holock. ,, R. S. Howe. ,, R. M. Hunt. (1) H. F. Moss. S. C. Parrish. W. E. Philo. H. D. M. Rivers. ,, A. C. Salinger, J.P. ,, S. B. Sanders. ,, G. M. D. Shaw. ,, S. M. Tucker, J.P. ,, A. J. Twigger. (1) ,, C. A. Welch. ,, G. Welham. ,, A. W. Wren. (1) (1) Member of Public Health Committee. (2) Chairman of Public Health Committee. (3) Vice-Chairman of Public Health Committee. 4 OFFICERS OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: James Gorman, M.B., Ch.B., D.P.H. Deputy Medical Officer of Health: (Part-time) P. X. O'Dwyer, M.B., B.Ch., B.A.O., D.P.H. Senior Sanitary Inspector: M. F. G. Randall, M.S.I.A. (2) and (3) Sanitary Inspectors: L. Ager, M.S.I.A. (1) and (3) W. J. Batcheler, M.S.I.A. (2) and (3) * J. Goodwin, M.S.I.A. (2) and (3) W. C. Scales, 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 30.11.55. ** Commenced duties 1.4.55: Clerical Staff: J. E. Blay (Chief Clerk) R. M. Jamieson (Resigned 4.11.55) Miss W. A. Hepburn Miss E. Thompson 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. (1) Sanitary Inspectors' Certificate of the Royal Sanitary Institute. (2) Sanitary Inspectors' Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Joint Board. (3) Certificate of the Royal Sanitary Institute as Inspector of Meat and Other Foods. (4) Certificate of the Royal Sanitary Institute as Smoke Inspector. 5 Public Health Department, Council Offices, Billet Lane, HORNCHUCH. 30th May, 1956. To the Chairman and Members of the Hornchurch Urban District Council. Madam Chairman, Ladies and Gentlemen, I beg to present to you the Annual Report on the health of the district during 1955. This in general follows the usual lines. An annual reflection on the contents of these reports does suggest that they are at least unusual in that they succeed in publicising the prosaic, something which at the present time is difficult to achieve but is by no means a bad thing in certain instances. Vital Statistics: Population: The main rates are satisfactory in that there is a slight increase in the birth rate from 14.73 to 15.45 and a corresponding decrease in the death rate from 12.08 to 11.60. The infant mortality rate is fractionally up from 17.38 to 18.29, the neonatal rate being slightly down. The population estimated mid-1955 was 110,900 as against a corresponding figure of 107,100 in the previous year. Infectious Diseases: Poliomyelitis accounted for some 25 cases during the year— the highest number yet recorded and an increase of some 21 over the previous year. A more detailed examination of this position will be noted later in the report. Measles showed a very steep increase in the period reviewed as for this disease it was an epidemic year. Pertussis also showed a much less marked increase from 108 to 163. Infective Hepatitis (Catarrhal Jaundice) at 24 cases was less than half the figure for the previous year. The Dysentery and Food Poisoning group of diseases showed no increase worthy of note and reflected a negligible incidence. It is significant as an index of medical progress that one death only occurred from Whooping Cough and no deaths from Scarlet Fever or Measles. Although Poliomyelitis was of a paralytic type in 12 cases, only one death was noted. Housing: The local picture in this regard is one of continued progress since the number of houses built both privately and by the Local Authority showed a substantial increase as compared with 1954 and our programme for dealing with sub-standard dwellings—a comprehensive report upon which was submitted last year—has now got well under way. 6 Tuberculosis: Although a slight rise in the number of new non-pulmonary cases is noted there has been a substantial drop in the number of new pulmonary cases of from 53 to 37. The number of deaths also has decreased from 10 to 4 in the case of respiratory tuberculosis and no death has occurred from any other form of tuberculosis. This is fully in accord with the remarkable change for the better which has taken place in our efforts to tackle this disease. Atmospheric Pollution: It seems likely that comprehensive legislative measures will soon come to our assistance in coping with this tremendous problem. A further note will be made on this subject later in the report but it is obvious that a great effort will have to be made not only by industry who could probably be persuaded that it would in the long run be economic not to waste fuel and its by-products, but also to convince the householder that clean air is not only a possible but an essential aim towards securing which only a concerted effort can produce, any success. There are, however, many problems of supply, cost, etc., yet to be solved before the outlook can be either clear or helpful and this is a matter which must of necessity be governed more by national possibly than by local considerations. Food and Drugs: Again the year has seen a variety of interesting features resulting from the steady routine work of sampling and complaint investigations which has been carried on by my staff. Home Safety: The Committee noted last year continues to function satisfactorily and in close liaison with my Department. The frequency of home accidents makes it very evident that this problem has lost none of its urgency. It is it is true being accorded a much greater degree of publicity than previously obtained but even in this connection much still remains to be done before the public thinks of 'Home Safety' as being of anything like the same order of importance as 'Road Safety.' 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 (midyear) 1955 110,900 Number of inhabited houses according to rate books (December, 1955) 34,255 Rateable value (December, 1955) £893,079 Sum represented by a penny rate (December, 1955) £3,440 Extracts from Vital Statistics for the Year. Births. Number of live births allocated to the district as adjusted for inward and outward transfers 1,749 (942 males, 807 females) Birth rate per 1,000 Home Population using area comparability factor 15.45 Number of stillbirths allocated to the district 39 (14 males, 25 females) Stillbirth rate per 1,000 Home Population 0.35 Stillbirth rate per 1,000 total (live and still) births 21.81 Deaths. Number of deaths of Hornchurch residents as supplied by the Registrar-General (adjusted for inward and outward transfers) 1,119 (600 males, 519 females) Death rate per 1,000 Home Population using area comparability factor 11.60 Deaths of infants under one year of age 32 (21 males, 11 females) Infant mortality rate (per 1,000 births) 18.29 Deaths of infants under 4 weeks of age 22 (15 males, 7 females) Neonatal mortality rate (per 1,000 births) 12.57 8 DEATH RATE—COMPARISON WITH PREVIOUS YEARS 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 1947 8.3 1955 11.6 *Area Comparability Factor returned. BIRTH RATE—COMPARISON WITH PREVIOUS YEARS 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 1947 20.7 1955 15.4 *Area Comparability Factor returned. 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 REGISTRAR-GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH. (Corrected for inward and outward transfers). Causes of Death Male Female ALL CAUSES 600 519 1. Tuberculosis, respiratory 3 1 2. Tuberculosis, other 0 0 3. Syphilitic disease 0 2 4. Diphtheria 0 0 5. Whooping cough 0 1 6. Meningococcal infections 0 0 7. Acute poliomyelitis 1 0 8. Measles 0 0 9. Other infective and parasitic diseases 1 2 10. Malignant neoplasm, stomach 21 12 11. ,, ,, lung, bronchus 32 8 12. ,, ,, breast 0 19 13. ,, ,, uterus 0 8 14. Other malignant and lymphatic neoplasms 57 53 15. Leukaemia, aleukaemia 2 6 16. Diabetes 2 5 17. Vascular lesions of nervous system 70 87 18. Coronary disease, angina 93 46 19. Hypertension with heart disease 23 29 20. Other heart disease 92 117 21. Other circulatory disease 18 16 22. Influenza 1 1 23. Pneumonia 26 23 24. Bronchitis 48 17 25. Other diseases of respiratory system 9 1 26. Ulcer of stomach and duodenum 5 3 27. Gastritis, Enteritis, and Diarrhoea 0 2 28. Nephritis and nephrosis 6 2 29. Hyperplasia of prostate 7 0 30. Pregnancy, childbirth, abortion 0 1 31. Congenital malformations 8 1 32. Other defined and ill-defined diseases 47 43 33. Motor vehicle accidents 9 3 34. All other accidents 11 7 35. Suicide 8 3 36. Homicide and operations of war 0 0 10 GENERAL MORTALITY: MAIN CAUSES 1946-1955 Causes of Death 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 Tuberculosis (all forms) 51 38 44 35 29 25 17 21 11 4 Cancer 147 142 139 180 155 183 184 211 234 210 Infectious diseases 8 2 5 9 3 4 1 3 1 2 Cardio-vascular disease 316 314 371 404 441 418 425 602 590 591 Influenza 8 3 1 9 3 19 2 14 1 2 Pneumonia 39 48 30 31 20 30 49 52 41 49 Bronchitis 47 66 36 65 63 69 52 85 54 65 Other respiratory diseases 11 12 9 6 3 7 9 10 8 10 Gastro intestinal diseases 18 18 14 13 20 16 12 28 13 10 Motor vehicle accidents 9 6 7 11 9 14 9 11 10 12 All other accidents 11 7 14 8 12 12 4 10 18 18 Suicide 12 10 8 3 10 11 10 7 11 11 The features of the above statistics are:— Tuberculosis—4 deaths from respiratory tuberculosis occurred during the year as against 10 last year. The decreasing mortality is well indicated in the table on Page 46. Malignant diseases—there has been a general reduction of 234 to 210 in the deaths ascribed to this cause. Specifically there was an increase in actual deaths from cancer of the stomach from 29 to 33 and reduction in the mortality from breast and uterus neoplasms; cancer of the lung and bronchus caused the death of 32 males as against 46 in the previous year, whilst the female deaths from this cause rose from 2 to 8. Deaths from coronary disease and angina total 139 as against 144 in the previous year. Deaths from bronchitis and pneumonia showed a rise. 11 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staffing. Mr. W. J. Batcheler resigned at the end of November and the vacancy had not been filled at the end of the year. The Sanitary Inspectorate was augmented by Mr. W. C. Scales who commenced duty on 1st April, 1955. Mr. R. M. Jamieson, Clerical Assistant, resigned on 4th November, 1955, and at the end of the year the filling of this vacancy was in abeyance. Medical Examinations—Staff. The services of private practitioners are 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 168 (232) employees or prospective employees—52 (58) permanent and 116 (174) temporary. The 1954 figures are given in parenthesis. Public Health Propaganda. The services of the Central Council for Health Education are still utilised substantially in this matter. No opportunity is lost by the staff in giving advice either individually in the course of their duties or by talks to various local organisations. During the year also the Public Health Committee decided to purchase a number of booklets designed initially by the Hornchurch Home Safety Committee but which contained a substantial amount of information of primarily a public health nature. These booklets were given a wide distribution. Laboratory facilities. Oldchurch 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. Maternity and Child Welfare. The Essex County Council maintained clinics at the following centres throughout the year:— 12 (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 3 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. Although the welfare of the aged is substantially the concern of voluntary bodies such as the Hornchurch Urban District Old People's Welfare Committee, the Public Health Department has nevertheless instances regularly cropping up which fall particularly within their province. The old person perhaps unwilling to have a direct association with any of the existing organisations, depending upon neighbours or even upon their own increasingly inadequate efforts, eventually tends to fall into a state when complaints are received as to alleged nuisance or when friends or neighbours simply feel that somebody should do something radically to alter an increasingly unsatisfactory state of affairs. This is a case with which the Sanitary Inspector not only deals but deals well. Section 47 of the National Assistance Act may in the last resort be of considerable assistance in dealing with instances of this kind but it is really the last resort and not a remedy to be selected without the most careful examination of all the other alternatives. In fact with continued patience, the exercise of sympathy with a certain amount of firmness and the encouragement of friends and neighbours where possible, it is usually found that even acute situations can be tided over without prejudice to anyone. The old person very often has an inherent dislike of institutions under whatever guise they may be offered. Often this may spring from a purely imaginery picture which they have devised of a life both restrictive and essentially communal in character; in other words a picture designed to repel the independent. In fact this I believe is far from the truth and in instances within my knowledge admission to Part III accommodation has transformed useless into useful members of society with considerable personal enjoyment accruing to them as a result. So 13 long, however, as the community is not being prejudiced I favour leaving the aged alone when they want to be left alone. It is a pity that some arrangements of a flexible nature could not be secured whereby old people, possibly largely feeble but not ill, could be given an annual 'holiday' in some convalescent home to enable those looking after them to enjoy a rest from their labours. The danger of such an arrangement is its patent liability to abuse. Home Safety. The past year, despite the continued activities of the Home Safety Committee, does reveal little greater awareness among the general public of the problem of accidents in the home. Statistics collated during the year show that the number of accidents—including fatalities—has not diminished and it would seem that without national guidance or action at Ministerial level the problem cannot be realistically tackled locally. The interest of the public is usually aroused only when some tragedy 'hits the headlines' and the dangers that we live with are made apparent. As stated earlier, propaganda in the form of posters, lectures and a wide distribution of the Home Safety brochure has continued and it is probably true to say that the phrase 'Safety in the Home' means more to certain of the residents of Hornchurch than it did twelve months ago. The Committee is generously subsidised by a grant of £100 made by the Urban District Council. 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 chemical examinations are made of the raw water, of the water in its various stages of treatment and of the water going into supply. A total of over 3,900 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. In addition, analyses have also been made of samples obtained from consumers' taps in the various parts of the Company's district, including that of your Council, and all proved to be satisfactory. The water supplied is not plumbo-solvent. No 14 action has been necessary in respect to any form of contamination. The number of dwelling houses supplied as at 31st December last was 34,939 and the population as at 30th June, 1955, as obtained from the Registrar-General was 110,900. We are unable to state the number of houses supplied by standpipes, but the total is quite insignificant." The only part of our district to which the main water supply is not yet available is a very small area on our boundary at Dennises Corner. Certain of the cottages there have in fact been provided with access to a main supply but three of them have not so far been similarly favoured. This is a matter which will be kept under review. Atmospheric Pollution. This matter is attracting an ever increasing amount of attention and one hopes that our powers will shortly be radically strengthened in our fight to combat unclean air. In a district such as Hornchurch, very largely residential, any pollution from a factory in the area tends to be more evident because of its infrequency (because there are so few factories) whilst at the same time the substantial pollution caused by domestic smoke tends to be overlooked. The problem of achieving clean air depends on no one authority and no one individual but it is equally a problem which cannot begin to be solved unless each authority and each individual makes a positive contribution to its solution. This can readily be achieved if the will to do so exists. So far as concerns smokeless fuel, however, it seems to me that the national fuel policy is involved and the householder must eventually be convinced that he is getting at least equal value for money if he buys this type of fuel as against bituminous coal. He must also of course have an adequate supply of smokeless fuel, of adequate quality made available to him for purchase as well as a suitable grate in which to burn it. I think few people would claim that these criteria have yet been satisfied. We have in Hornchurch certain definite causes of complaint, notably St. George's Hospital and railway engines at Upminster. Although some improvement has resulted from our efforts I am still not really satisfied with the degree of success which co-operation with the authorities concerned has achieved. I think that complainants on matters of this nature whilst they undoubtedly have some cause for complaint, in many instances are far from fully appreciating the difficulty of securing smokeless air. How far imminent legislation is likely to clear the air only practice will show. Legislation must be directly related to reality and in the case of atmospheric pollution this very fact may well tend to make progress more leisurely than the average member of the public may hope or expect. 15 Local investigation of atmospheric pollution. We have had—in association with the Department of Scientific and Industrial Research—a scheme whereby recording instruments of various kinds were sited throughout the district. This scheme is now some eight years old and as a result we have obtained a considerable amount of information. It has, however, now been decided that certain of the recording instruments might be re-sited and we have accordingly taken in the lead peroxide candle from the Vicarage at North Ockendon to Oglethorpe School and moved out the deposit gauge from the school in Upminster Road, Rainham, to the new school at Lambs Lane. Although these re-sitings are not of major moment they will nevertheless furnish us with information from a slightly different angle; they will enable a greater degree of centralisation to be practised and they should in time prove advantageous. In this connection it might be recorded that the County Council have very recently sponsored a scheme which would seem likely to provide a somewhat cheaper figure for analyses. As Hornchurch, however, has had a scheme working smoothly for some 8½ years the Council decided that, whilst they would not of course close the door to any alterations, they were not at present prepared to interfere with our existing arrangements. Sewerage. Little progress falls to be recorded in connection with the Regional Scheme save that our Ingrebourne sewer re-laying which is progressing satisfactorily has been of a size adequately eventually to fit in with the Regional Scheme. So far as concerns the river Ingrebourne it is of course the recipient of the effluent from the Nags Head Sewage Works situated in a neighbouring area. It is I think both impossible and unnecessary to indicate in detail the degree to which health might be prejudiced by a sewage effluent traversing one's district even though on occasion it may provide a major constituent of the 'River Ingrebourne'. It is sufficient to say that sewage effluent is not designed to be anything other than a desirable product of a sewage works and even thus may be quite an undesirable element as the main constituent of a so-called river. Save at times of heavy rainfall it seems to me impossible for the Nags Head effluent to secure really substantial dilution and it would be well if everyone viewed this question in the light not of whether it was a good effluent (and even on this point I would not be prepared to be dogmatic) but whether it is in these modern times really good enough as part of a river flowing through our district from one end to the other. I think the time is not only ripe but overdue for some other means to be found of dealing with the effluent from this sewage works. 16 The first and second stages of the St. Mary's Lane soil sewer have been completed, the former consisted of laying a total length of 11,020ft. made up as follows:—27in.—4,525ft., 24in.—1,945ft., 21in.—4,550ft., from the Bury Farm Works to a point near the "Thatched House", St. Mary's Lane, Cranham, the tender price being £63,500. The second stage consisted of a total length of 5,197ft. of 15in. sewer from a point near the "Thatched House", St. Mary's Lane, Cranham, to the junction of Kings Gardens/Front Lane, Cranham, at a total cost of £24,400. The Bury Farm Works themselves will of course also require considerable extension and this work is in fact in hand. Conversion. The Council agreed that subject to certain conditions one half the cost of the expenses reasonably incurred in replacing pail closets by water closets connected to the sewer at 1 and 2, Druces Cottages, Hacton Lane, and 1, 2 and 3, Knights Cottages, Hacton Lane, be borne by them. Cesspools. There still remain some parts of the district in which the provision of main drainage is unlikely to be achieved for a considerable time to come—the sanctioning of cesspool accommodation on a limited scale is therefore an unfortunate necessity. Cesspools are it is to be regretted all too often inseparable from potential or actual nuisance. However adequate their capacity may appear in theory it tends to be forgotten—if it is ever recognised— that whilst persons living in a house served by a cesspool may and probably will have amenities equal to those enjoyed by householders with main drainage, it is in practice impossible for them to make an equal use of such facilities without seriously jeopardising the capacity of their cesspool. The result is that a common source of complaint is the overflowing of either an individual cesspool or of a common cesspool serving a group of houses. The only solution to a problem of this kind is of course an extension of main drainage sufficient to serve all the houses at least in the urban part of the area and this should in fact be our aim although force of circumstances is likely to render it impossible of achievement for a considerable time to come. Where a part of the area is involved for which main drainage seems impracticable in the foreseeable future then the only solution appears to be either sufficient frequency of emptying to cope with their problems or the provision of a small treatment plant to serve the properties involved. Such plants of course are by no means cheap to instal and subsequently need continued supervision if they are to be regarded as a solution to the problem with which they are intended to cope and not merely an aggravation of it. Whichever of the alternatives is chosen it must in any event be allied to a realistic use of the facilities, e.g. baths, etc., by the householders concerned. 17 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 long-term 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 Ingrebourne 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 comes to fruition. In the absence of actual disquiet only a sense of acceptance borne of experience enables the situation to be suffered. Ponds. Complaints are received from time to time concerning the various collections of water in the district occurring either on left over pieces of old building sites or as permanent features of the district. The question with which we are interested is of course largely one of whether or not any individual instances provide a demonstrable danger to health and it is to this end our enquiries and subsequent actions are directed. 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, no 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. Sandpits. It has become almost traditional in some areas that sandpits should be provided for the benefit of the younger members of the community. Whilst this may have its advantages in that it provides a source of distraction for them, whilst at the same time relieving their parents of undue anxiety as to their Welfare, it can be argued 18 with some cogency that on public health grounds the absence of sandpits is preferable to their presence. As with so many things it is an impossible task to estimate the degree to which they might be undesirable in a hygienic connection and it may well be that any risk attendant upon their presence is of a relatively minimal character. The fact remains, however, that it is virtually impossible to keep them free from contamination of various kinds and this of itself would suggest to me that unless their provision was imperative they would be well omitted from our scheme of things. I do not think that the problem can be solved either by periodic sandchanging with any frequency likely to be effective or really by any of the other methods open to us. It will be gathered therefore that I do not favour sandpits as part of the desirable equipment of children's playgrounds. 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. Sixteen samples were taken in process of our supervision. Disinfestation and Disinfection. The practice of encouraging concurrent disinfection was continued. I often think that taking the disinfection of library books as seriously as legally we are bound to has more theoretical than practical value and I do not really believe that either public health or the incidence of infectious disease would be affected greatly if our action in this regard was limited to one or two of the really serious diseases and not adopted in such instances as Scarlet Fever. I think probably a substantial amount of what time is devoted to dealing with library books is largely wasted. Rodent Control. Increasing use has been made of the services of our Rodent Operative. During the year his advice was requested in respect of 210 infestations and 1,907 routine and re-visits were made. During that period he remedied 203 infestations and 7 were under continued treatment or observation. Establishments for Massage or Special Treatment. The Essex County Council granted licences to 8 persons during the year authorising them to carry on establishments for massage or special treatment. Twelve visits were paid to these premises throughout the year. Heating Appliances (Fireguards) Act 1952 and Regulations 1953. During the year 11 appliances were tested (involving 21 tests) and of these 9 appliances were satisfactory. The two unsatisfactory appliances were withdrawn from sale. Pet Animals Act, 1951. Ten licences to keep a Pet Shop were issued during the year and a total of 26 visits were paid to these premises. The results showed that the conditions of the Act were being observed. Rag Flock and Other Tilling 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. Riding Establishments Act, 1939. During the year the three premises coming under the above heading were inspected on a quarterly basis by the Veterinary Officer appointed by the Council for this purpose. The results were satisfactory. These inspections will in future be made six-monthly. Sanitary Inspection of the District. SUMMARY OF SANITARY INSPECTORS' WORK DURING 1955. Inspection of Pood and Food Premises (visits paid) : Bakehouses 78 Butchers' Shops 203 Cafes 209 Confectioners 99 Dairies (including Pasteurising Plants) 102 Fish Shops 96 Food Complaints 63 Food and Drugs (Chemical and Bacteriological) Sampling 681 Grocers' Shops 317 Greengrocers' Shops 87 Ice Cream Dealers' and Manufacturers' Premises 154 Meat Inspection 304 Mobile Shops (Hawkers) 70 School Canteens 17 Slaughterhouse 293 Staff Canteens 11 Miscellaneous Visits 56 Housing (visits paid): Drainage of Houses 377 Environmental Enquiries (including overcrowding Enquiries) 151 Improvement Grants 65 Sanitary Fittings 68 Structural Defects 443 Water Supply and Pipes 26 Miscellaneous Housing Visits 213 Re-Inspections 1,957 19 20 Sanitary Inspectors' Work. The figures for the current year are satisfactory in spite of our being short-staffed for a period. The number of visits paid under the main headings of Housing, Food, General Sanitation and Factories, all showed a significant increase. The number of informal notices served showed a slight increase whilst the number of statutory notices showed a decrease. I regard all these factors as showing a desirable trend. The Sanitary Inspectors' work of routine investigation and visiting may safely be asserted as being unostentatious but invaluable. In general terms the sanitary circumstances of a district are a direct reflection of the success achieved by the day-to-day work of its Sanitary Inspectors. SUMMARY OF SANITARY INSPECTORS' WORK—cont. General Sanitary Circumstances (visits paid) : Accumulations 85 Atmospheric Pollution Survey 82 Camping Grounds, Vans, etc. 131 Drainage and Sewerage 79 Dustbins 95 Fair Grounds 6 Keeping of Animals and Birds 20 Stables and Piggeries 48 Insect Pests 29 Public Conveniences (including Public House Urinals) 54 Refuse Tips 34 Rodent and Vermin Infestation 199 Schools 10 Smoke Complaints and Observations 92 Unclean Premises 33 Water Samples (Main) 58 Well Water Supplies 19 Watercourses 86 Miscellaneous Sanitary Visits 238 Re-Inspections 481 Factories and Outworkers: Number of Visits paid 373 Shops Act: Number of inspections 586 Miscellaneous (visits paid) : Heating Appliances (Fireguards) Act 12 Massage Establishments 12 Pet Animals Act Inspections 26 Rag Flock and Other Filling Materials Act 2 Infectious Disease: Number of visits paid (including contacts) 475 Number of Notices served: Informal 416 Statutory 133 21 The main headings under which work was done may be noted as follows:— Housing 3,300 visits Inspection of Food and Food Premises 2,843 „ General Sanitation 1,878 „ Infectious Diseases 475 „ Shops Act Inspections 586 „ Factories and Outworkers 373 „ SECTION D. HOUSING The form of comment this year is varied as against last because the Ministry no longer require the reports to be made as previously. Number of New Houses erected during the Year. (i) By the Local Authority 171 (ii) By other Local Authorities 92 (iii) By other bodies or persons 1,857 Houses Voluntarily Demolished—2. 139, Billet Lane, Shack rear of "Croft," Cranham Gardens. Houses Voluntarily Closed—4. "St. Margarets," Glebe Road, 82, Billet Lane, 34, Front Lane, 1, Moor Lane. Demolition Orders Made—7. 7, 9, 11, 13, 15 and 17, North Street, "The Cottage," Betterton Road. Houses Demolished following Demolition Orders—5. 1 and 2, Church Hill Cottages, Warley Street, Great Warley. "Coate Lodge," Fairview Avenue, "Rosedene," Briscoe Road, "The Cottage," Betterton Road. Areas Represented to Special Sub-Committee. 6 Areas representing 28 houses. 108, 110 and 112, Ardleigh Green Road, 68, 70, 72, 74 and 76, Ardleigh Green Road, 2, 3, 4, 5 and 6, Old Gun Site, Brentwood Road, 82, 84, 86, 88, 90 and 92, Billet Lane, 121, 123, 125, 127, 129, 131 and 133, North Street, 1 and 2, The Potteries, Bird Lane. 22 Certificates of Disrepair. 31 applications for Certificates of Disrepair under the Housing Repairs and Rents Act, 1954, were received by the Council during the year and after investigations 4 were withdrawn. 20 Certificates were issued and 7 were refused. It does not really seem that extensive use has been made by owners of the power to increase rents. The variety of reasons coming to light on application forms for Certificates of Disrepair is quite instructive and presents from time to time quite interesting and difficult points for decision. Improvement Grants. A close liaison is maintained with the Engineer and Surveyor in assessing the desirability of approving applications under this heading. This collaboration has signficant practical advantages not least of which is that it discounts the possibility of an Improvement Grant being seriously considered for property which we regard as likely to come within our five-year plan., Re-Housing—Medical Aspects. My advice was sought during the year on some 186 housing applications respecting which medical recommendations for priority have been submitted by hospitals or private practitioners. This figure remains substantially the same as for last year. The reasons determining medical priority have remained on much the same basis for many years being interpreted of course in the light of the individual case. In view of the large number of requests for medical priority which have been made over the years I think it will be conceded that the Council's arrangements for according medical priority have over a long period worked with to say the least reasonable satisfaction. Whilst it has been impossible to please everyone—in fact the allocation of the Council's building programme in its entirety to medical priorities would hardly have enabled this to be done—yet the number of dissatisfied or at any rate openly dissatisfied has certainly been negligible. I do not think that unless the Medical Officer of Health is given a free hand as I have been and unless the general practitioners view the position with understanding—which in Hornchurch has been done—any system of medical priorities can end other than disastrously. I do not think that any case of real outstanding medical appeal has gone unassisted. Overcrowding. Coincident with the increased number of houses being made available in the district and even allowing for an incursion of population from other areas it is reasonable to presume that the actual amount of overcrowding in the district should have been reduced. The overcrowding position is of course influenced not only by the standard insisted upon by law but also upon the standard considered appropriate by the individual householders. There must be a substantial number of instances in which although no legal 23 overcrowding exists the housing circumstances are nevertheless far from generally satisfactory. In some cases this is well nigh inevitable but this is not the case in other instances; it has been by no means exceptional for the Council to re-house an applicant only to find that the space vacated by them is filled by another in like circumstances. This situation could react unfairly to the prejudice of other applicants if the situation was not investigated in detail. General District Development. 1 have noted that 1,857 houses were built privately—171 by Hornchurch Council and 92 by other local authorities. The major development took place in the Upminster and Cranham area and in South Hornchurch, in each of which areas private building and Council development took place side by side. This situation has of course had its repercussions and the questions of sewage provision and refuse collection and disposal were clearly of paramount importance. It is to be hoped that the "Green belt" will not be interpreted too flexibly as even in this district what country remains to us in the proximity of our urban development might well be allowed permanently to remain as country. Caravans. There is in the district still one large and one small unauthorised site—the former of long duration, the latter of recent origin. Although it is far from easy always to produce positive evidence of conditions prejudicial to health, it is certainly clear that conditions at unauthorised sites can seldom do other than prejudice the amenity of the district. The fact that they are unauthorised naturally acts as a deterrent to the provision of those amenities which the owner might be encouraged to provide and the Local Authority might be encouraged to demand were the site to be of a permanent character. The result is that the persons living on these sites may very often be the victims of circumstances with little apparent prospect of doing other than paying dearly for accommodation which they would not under normal circumstances choose. Their position therefore, is not one which I would envy. It would be as unwise to generalise as to the position of unauthorised sites as it is to generalise on anything and obviously conditions do vary from site to site. Unless, however, a caravan site is officially authorised with its concomitant relatively high standard of amenity then the district is well without it. Whether a built-up area is in any event the site of election for a permanently occupied caravan site is a matter for conjecture. Generally I do not think that it is. Certain itinerant caravaners, gipsies and the like, do in small numbers spend a day or so at various spots throughout the district. Sited as we are and with the somewhat rural character of certain parts of our area, it is almost inevitable that this should happen. It is to be regretted in that the caravaners on departing practically always leave visible evidence of their stay but by and large our worries in this connection are small and the stay of these people is practically never protracted. 24 During the year one case was heard at the Romford Court appealing against the use of a caravan on a refuse tip and the Court upheld the decision of the Local Authority. Land Charges Enquiries. During the year 4,594 land charges enquiries were referred to the department regarding the question of outstanding sanitary notices. Housing Repairs and Rents Act, 1954. It will be seen from the tables given earlier that in fact we have made substantial progress in dealing with our sub-standard dwellings, either through individual or area procedure. We have also been fortunate enough in securing when in certain instances houses which in due course would have been represented for demolition have become empty and have by arrangement with the owners been allowed to remain empty. It is of course true that our path towards the goal of slum erasure has been made simpler by reason of the potential development of the areas occupied by sub-standard dwellings and this doubtless accounts in large measure for the lack of opposition evinced on occasion by owners on our plans being made known to them. The main point, however, is that the substandard dwelling should be got rid of as speedily as possible and the greater facility with which this can be achieved the better. Temporary Accommodation. The 'week-end bungalow' dwelling is still with us in the Rainham and Cranham areas although increasing development in both these areas is tending to reduce the size of the problem. In spite of that, however, so long as these "dwellings" exist and can be let to anyone so long will they tend to offer a temptation as a cheap form of permanent habitation—a role for which they were never intended and for which in the main they are quite unfit. I cannot really say therefore that the situation is no longer a source of concern to me but I can say that it is becoming less so as time goes on. The annual review of the position made for purposes of this report does also show the substantial progress which in quite difficult times has been made over the nost-war period. Sub-Standard Accommodation. Following upon our survey of the district we have now proceeded officially to represent certain areas and to deal with the possibility of providing alternative accommodation for the occupants. Up to the end of the year we had in 1955 represented '28 houses in areas and 8 individually. Our progress in this regard is likely to be steady and our programme for ridding the district substantially of sub-standad accommodation is likely to be completed within the five years period originally specified. 25 As I have noted before the problem involves largely elderly people living in units of one or two persons and although it may be desirable that better surroundings be found for these people should this proceeding take a certain amount of time I don't think that the persons concerned would be either worried or prejudiced so that the so-called problem in Hornchurch is, considering its size, of a minimal order. It is also found to a certain extent that the sub-standard properties form part of development areas and are dealt with as part of the normal development of the area. INSPECTION AND SUPERVISION OF FOOD. Food and Drugs Administration. During the year some 300 samples were taken and of these some 28 were unsatisfactory in one way or another. These results include a special investigation we did into certain articles such as Bread and Butter and Hot Milk, a note of which will be made later. Our programme generally followed the lines noted in previous years and embraced supervision over a full scale of food and drugs. The public remains aware of the fact that this department is available to deal witli complaints and this is well evidenced by the number received during the year. It must be emphasised that the individual circumstances of each case must determine the action to be taken and prosecution therefore is by no means the rule. Action is taken, however, in every case to ensure both that the complainant is informed of what we did and that the person allegedly responsible for providing cause for complaint is similarly acquainted with the position. I must express my indebtedness to the Public Analysts, Mr. (reoro'e Tavlor. O.B.E.. F.R.I.C.. and Dr. .T SECTION E I must express my indebtedness to tbe Public Analysts, Mr. George Taylor, O.B.E., F.R.I.C., and Dr. J. Hubert Hamence, M.Sc., Pb.D., F.R.T.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 3 3 - Almond Oil 2 1 l Angelica 1 1 - Arrowroot 1 1 - Beef and Ham Paste 1 1 - 26 ARTICLES Number of Samples examined No. found to be genuine No. found to be adulterated or under-standard, etc. Bread 12 3 9 Bread and Butter 2 1 1 Butter 2 2 - Butterdrops 1 1 - Butter Toffee 2 2 - Cake Decorations 1 1 - Caramelle 1 1 - Caraway Seed Loaf 1 1 - Cheese, grated 1 1 - Cheese and Tomato Spread 1 1 - Cherries, Glace 1 1 — "Chicken Bones" (sweets) 1 — 1 Chicken, minced 1 1 — Cloves, ground 1 1 — Coconut, desiccated 2 2 — Coffee 1 1 — Coffee and Chicory Essence 1 1 - Cokernut Ice 1 1 — Confectionery 1 1 — Confectionery (white drops) 1 1 — Cream 4 4 — Currants 1 1 — Currant Bun 1 — 1 Currant Loaf 1 — 1 Custard Tarts 1 1 — Dandelion Coffee 1 1 — Dates 1 1 — Dates, stoned 1 1 — Doughnuts 2 2 — Dried Egg 1 — 1 Dripping 2 2 — Energen Rolls 1 1 — Essence of Rennet 2 2 - Faggots 1 1 — Fish Cakes 2 2 — Food Colour 1 1 — Fruitarian Luncheon 1 1 — Gelatine 2 2 — Ginger Cordial 1 1 — Ginger Crystallised 1 1 — Ham and Chicken 1 1 — Horseradish and Beetroot Sauce 1 1 — Ice Cream 29 29 — Jam 2 2 — Jelly 1 1 — Lard 3 3 - 27 ARTICLES Number of Samples examined No. found to be genuine No. found to be adulterated or under-standard, etc. Lemon Squash 1 l — Lentils 1 I — Lollies 10 10 — Malt & Honey Fruit Loaf 1 1 — Margarine 4 3 1 Margarine (containing butter) 1 1 — Marshmallows 1 1 — Marzipan 3 3 — Mayonnaise 1 1 — Milk 47 41 6 Milk, Channel Island 8 7 1 Milk, Condensed 1 1 — Milk, Dried Skimmed 1 - 1 Milk Powder, Dried Skimmed 1 - 1 Mincemeat 1 1 — Mint Jelly 1 1 — Nut Oil 1 1 — Oatmeal 1 1 — Peel, Mixed 1 1 — Pepper 1 1 — Pickles 1 1 — Pickling Spice 1 1 — Pineapple Juice 1 1 — Pork Chipolatas 2 2 — Rolls and Butter 2 2 — Rum & Butter Toffee 1 — 1 Sage & Onion Stuffing 1 1 — Salad Cream 2 2 — Salmon, Pink 1 1 — Salmon Spread 1 1 — Sardine & Tomato Paste 1 1 — Sausages, Beef 3 3 — Sausages, Liver 1 1 — Sausages, Pork 4 4 — Sausage Meat, Beef 2 2 — Saveloys 1 1 — Self-Raising Flour 1 1 — Semolina 1 1 — Soup 1 1 — Soup, Chicken 1 1 — Soup, Cream of Tartar 1 1 — Soup Powder 1 1 — Splendo (Yeast & Malt Extract) 1 1 — Steak (Minced) 1 1 — Suet, shredded beef 2 2 — Sugar 1 1 - 28 ARTICLES Number of Samples examined No. found to be genuine No. found to be adulterated or under-standard etc. Sultanas 1 1 — Sunny Spread 1 1 — Tea 1 1 — Tomato Ketchup l 1 - Turkey, minced 1 1 - Vinegar, Malt 2 2 - Wholemeal Loaf l —. 1 Brandy 2 2 - Gin 2 2 - Gin, Lemon 1 1 - Rum 3 3 - Vodka «... l 1 - Whisky 3 3 - Adescolin 1 1 - Ammoniated Tincture of Quinine 1 1 - Aspirin Tablets 1 1 - Boric Acid Eye Lotion l 1 - Brewers Yeast Tablets 1 1 - Calamine Lotion 1 1 - Calcium Lactate Tablets l 1 - Cascara Sagrada l 1 - Castor Oil .... 2 2 - Charcoal Tablets l 1 - Cod Liver Oil Capsules 2 2 - Cod Liver Oil Emulsion l 1 - Cold and Cough Cure l 1 - Compound C-itronella Oil 1 1 - Compound Tablets of Codeine l 1 - Digestoids 1 1 - Euthvmol Tablets 1 1 - Friars Balsam 1 1 - Fruit Preserving Tablets 1 — 1 Gees Linctus 1 1 - Glycerine and Borax 1 1 - Glycerine, Honey & Ipecac Mixture 1 1 - Glycerine, Honey & Lemon Zubes 1 1 - Glycerine & Honey (with lemon flavour) 1 1 - Halibut Liver Oil capsules 1 1 - Halibut Oil capsules 2 2 - Iodised Throat Lozenges 1 1 - Malt Extract with Cod Liver Oil 1 1 - Neoklenz Tablets 1 1 - Oil of Spike Lavender 1 1 - Olive Oil 1 1 - Paraffin Liquid 1 1 - 29 ARTICLES Number of Samples examined No. found to be genuine No. found to be adulterated or under-standard, etc. Parish's Syrup, Chemical Food 1 1 — Persomnia Tablets 1 1 — Senna Pods 1 1 — Slimming Herbs 1 1 — Slimming Tablets 1 1 — Sodium Bicarbonate 1 1 — Spirit of Sal Volatile 1 1 — Surgical Spirit 1 1 — Tincture of Iodine 1 1 — Tonic Yeast 1 1 - Vitaminized Iron Jelloids 1 1 — Winter Candy 1 1 — Wintergreen 1 1 — Zinc, Starch and Boric Powder 1 1 — TOTALS .... 300 272 28 The undementioned samples were found to be adulterated or under standard, etc. Sample No. ARTICLE Sample obtained formally, in formally or from complainant. Nature of adulteration or irregularity Action Taken F.846 Hot Milk Formally 24% added water Legal proceedings instituted. Cafe proprietor fined £2 and 1 guinea costs at Romford Police Court. F.857 Hot Milk- Formally Milk — already deficient in fat —73%. Added water 27% Legal proceedings instituted. Cafe proprietor fined £5 at Romford Police Court. F.859 Hot Milk Formally 21% of added water and 3% sugar Legal proceedings instituted. Cafe proprietor fined £5 at Romford Police Court. F.863 Hot Milk- Formally 14% added water Legal proceedings instituted. Cafe proprietor fined £3 and 1 guinea costs at Romford Police Court. 30 Sample No. ARTICLE Sample obtained formally, in formally or from complainant. Nature of adulteration or irregularity Action Taken F.854 Channel Island Milk Formally 7.5% deficient in fat of the special standard of 4% Referred to the Ministry of Agriculture, Fisheries and Food (Milk Division) for their attention. F.860 Bread and Buttei Formally Fat consisted not of butter but of Margarine Legal proceedings instituted. Cafe proprietor fined £5 at Romford Police Court. F.852 Margarine Formally Stated to contain 25% dairy cream but no statement of the butter content given on the label Council considered labelling unsatisfactory and referred the matter to Ministry of Agriculture Fisheries and Food (Food Standards and Hygiene Div.) for formal action. Inf.805 Rum & 1 Butter Toffees Informally Contained insufficient butterfat to justify the description Butter Toffees Matter considered by Council and warning given to Vendor — toffees were correctly labelled but the show card omitted the word "Flavoured." Vendor withdrew unsatisfactory show card. Cpt.808 Whole- 1 meal Loaf. [nformally Contained two dozen small foreign bodies consisting of hard baked dough Matter considered by Council—Baker/ Vendor warned. Tnf.814 Almond ] Oil [nformally (Contained an excessive quantity of free fatty acids Remaining stock destroyed. Warning sent by Council to Chemist concerned. Cpt.832 Bread [nformally Contained a cockroach and mass of mouldy dough Warning sent by Council to baker concerned. 31 Sample No. ARTICLE Sample obtained formally, in formally or from complainant. Nature of adulteration or irregularity Action Taken Cpt.837 Bread Informally Contained a cigarette end In view of history of complaint Council sent warning letter to producer. Cpt.964 Bread Informally Contained blackish foreign bodies — weed seeds and charred dough. No rodent excreta found Bread baked outside our area. Local Authority concerned reported that bake-house was reasonably satisfactory. Cpt.850 Currant Bun Informally Contained a fragment of glass In view of history of complaint warning sent by Council to baker concerned. Cpt.838 Dried Skimmed Milk Powder Informally Reconstituted milk containing heavy deposits of iron oxide or rust. The foreign matter did not originate from the dried milk powder This milk powder was the property of the Local Education Authority for use in School Canteens. The remaining milk powder was destroyed. Inf.831 Fruit Preserving Tablets Informally 68% deficient in sulphur dioxide The small stock remaining had been disposed of before formal sample could be taken. Cpt.879 i Milk Informally Contained 12 i nsect pupae being the pupae of a specimen of fruit fly Council considered Analyst's report, also Entomologist's report and bottling firm was warned. Cpt.901 Milk Informally Contained minute masses of mould growtli in suspension Warning letter sent to bottling firm. 32 Sample No. ARTICLE Sample obtained formally, informally or from complainant. Nature of adulteration or irregularity Action Taken Cpt.877 Dried Skimmec Milk Powder Informally I Contained a substantial quantity of foreign matter consisting of masses of mould growth. Unfit for human consumption This milk powder wjaaof New Zealand origin and had been issued to a school canteen. The carton of milk powder was condemned as unfit for human consumption. Cpt.900 Bread Informally Cbntained a foreign body consisting of a mass of dirty dough together with mineral oil Warning given to bakery firm. F.903 Bread (Procea loaf) Formally Contained insufficient protein to justify the description "Procea" All these samples were obtained from the same source. Legal proceedings instituted under Section 2(2) Merchandise Marks Act, 1953. Baker concerned fined £20 plus £5 5s. Od. costs on each of three counts — total £75 15s. 0d. Cpt.878 Bread (Procea loaf) Informally do. Inf.902 Bread (Procea loaf) Informally do. Inf. 903 Bread (Procea loaf) Informally do. Inf. 904 Bread (Procea loaf) Informally do. Inf.970 'Chicken Bones' (Sweets) Butterscotch Informally Contained two splinters of wood ½in. and ¼in. respectively in length protruding from the sweets Contained only 3% butter fat Formal follow-up sample obtained to check butter fat content. Warning letter sent to manufacturers regarding splinters. 33 'Bread and Butter,' 'Hot Milk' Samples: Although local publicity was given to the results of these samples at the time and to the Court proceedings which followed, I cannot but remark further on the findings in this annual review. It was frankly astonishing to find that so many of the samples purchased did not come up to the legal standard which governed them. It may seem relatively trivial that 'hot milk' is supplied just a bit below the standard and that 'bread and butter' is taken by some to mean 'bread and margarine' but in cases such as these the public are not really in a position to protect themselves and it is our duty to do this for them. I say with all sincerity that I do hope that the publicity given to this affair has been seen and digested by everyone because it is our intention from time to time to take further like steps with a view, one hopes, to establishing that the deplorable results achieved on our initial incursion into this particular field were exceptional. Food and Drugs Act, 1938—Section 13 and Bye-Laws made under Section 15 of the Food and Drugs Act. 44 notices were served during the year on owners or occupiers of premises coming within the scope of these sections of the Pood and Drugs Act, 1938. No statutory action was subsequently required. Sample No. ARTICLE Sample obtained formally, informally or from complainant. Nature of adulteration or irregularity Action Taken Cpt.932 Currant Loaf Informally Contained a rodent excretion. Unfit for human consumption Baker prosecuted. Fined £5 and 35/costs at Romford Police Court. F.936 Dried Egg Formally Had a poor solubility in water, contained a small live grub and three dead similar grubs. Out of condition and unsuitable for human consumption Consignment surrendered and destroyed. This product had been received at shop concerned from store outside our area. The Local Authority concerned was informed of this report. 34 Pood Complaints. A note of the food complaints received and the action taken with regard thereto is noted hereunder :— Complaint Action Loaf with flour moth adhering Manufacturer warned. to base. Ticket from bagged meat in Firm took matter up with beef sausage. Department concerned. Peculiar taste of two loaves of Passed to Woodford as bake- bread. house is in their district. Small piece of glass in sliced Referred from Basildon. loaf of bread. 5 windows in bakery maliciously broken. Information passed to Basildon. False trade description of Submitted to Analysts. "Procea" applied to bread. Unopened one pint bottle of Submitted to Analysts. milk containing mould growth. Discolouration on inside of un- Passed to Local Authority in opened bottle of Channel whose district milk was bot- Island Pasteurised milk. tled. Discolouration of dried milk Submitted to Analysts. powder on reconstitution. Unsatisfactory taste of pickled Old stock. Complaint uncon- onions. firmed. No action taken. Foreign body in loaf of bread. Submitted to Analysts. Part of nail in content of tin of Imported product. Matter luncheon meat. taken up with firm concerned Unopened bottle of orange juice Matter taken up with firm con- containing broken cap. cerned. Mouldy Swiss Roll. Prosecution. Fined £3. Stale Swiss Rolls. Manufacturer and shopkeeper warned. One pint bottle of Pasteurised Reported to firm concerned milk alleged to taste of disin- whose laboratory could find fectant. no trace of phenol. Two small flour weevils em- Baker warned. bedded in crust of loaf of bread. Insect in loaf of bread. Baker warned. Sediment adhering to base of Referred to vendor. Deposition two milk bottles. of milk solids due to homogenising process. Mouldy sausage roll. Old stock. Vendors warned. Insect in 'Bloomer' loaf. Baker warned. Mouldy meat pasties. Manufacturer and Vendor warned. Fuse wire in loaf of bread. Baker warned. Piece of metal in bar of chew- "Chewing gum" not a food; no ing gum. action possible. 35 This food, if suitable, is used for animal feeding purposes and the remainder is buried on the Council's refuse tips. Clean Food. It is not my intention in this report to deal in any detailed fashion with the local position in this regard since the Food and Drugs Act 1955 with the concomitant Food Hygiene Regulations will entail a detailed survey of this area and will in due course be presented to you for your consideration. There is no reason to suppose that the premises involved in Hornchurch are not of at least an average standard compared with other districts but it is idle to suppose that the importance of maintaining the highest standards Complaint Action Foreign bodies in loaf of bread. Submitted to Analysts. Insect in loaf of bread. Insect identified as a flour moth. Baker warned. Foreign body in loaf of bread. Submitted to Analysts. Bread containing foreign body. Submitted to Analysts. Black deposit in dried skim Submitted to Analysts. milk powder. Currant bun containing foreign Submitted to Analysts. body. Part of wholemeal loaf contain- Submitted to Analysts. ing foreign bodies. Milk containing foreign bodies. Submitted to Analysts. Currant loaf containing foreign Submitted to Analysts. body. Chinese Egg Albumen. Local bakers advised. Fish delivered to retail shop in Matter taken up with suppliers, an unhygienic manner. 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. Meat — 12 57 8 Fish — 4 89 10 Shellfish — 1 8 — Sausages — — 13 8 Bacon — — 8 8 Tinned Meat — 11 69 7 Tinned Ham — 6 76 — Tinned Food - 14 74 4 Tinned Milk — 7 59 4 Dried Skim Milk Powder — 1 56 — Miscellaneous Groceries — 1 84 14 3 2 36 15 36 of food hygiene are generally understood. The biggest fallacy is perhaps to confuse the relative importance of knowledge of the subject and equipment. Premises with a minimum of equipment but conducted and managed with understanding of the hygiene problems involved are far less of a worry than for more lavishly equipped premises conducted on the basis that if you pay enough the situation will keep itself satisfactory. I hope that full advantage will be taken of the advice of my Department when the Food Hygiene Regulations are being considered by traders and that any advice which we offer to them will be accepted. There can be few able genuinely to claim that they have nothing to learn in this matter. 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 64 Cafes 65 Confectioners (bread, cakes, etc,) 33 Confectioners (sweets, etc.) 104 Fish Shops 29 Grocers 164 Greengrocers 87 Ice Cream Dealers 250 Ice Cream Manufacturers 14 Shellfish. During the year some 33 samples of various types of this product were sent for examination. The vendors included both shopkeepers and those selling from carts. The products included cooked and shelled cockles, cooked shrimps, potted shrimps, cooked prawns, peeled prawns, fresh mussels, Dutch bottled mussels, bottled whelks, frozen peeled scampi, periwinkles and cooked periwinkles. Approximately two-thirds of the samples taken were satisfactory, the remainder being unsatisfactory in some—possibly minor— degree. On the whole as might be expected the shopkeepers appeared to provide a somewhat higher standard of article than the itinerant vendor. It is very difficult to be precise on the implications of the results and far too easy to generalise to the prejudice either of the articles as a whole or to any particular type of vendor and I do not therefore propose to deal precisely with the results relating to either a particular type of shellfish or a particular type of vendor since I do not think this would be warranted. It should, however, be pointed out that shellfish are susceptible to contamination both at source and possibly in transit and in process of sale. That is a fact which is known to everyone dealing 37 with them and should be known to everyone eating them. So long as these facts are borne in mind then there is no particular reason why shellfish more than any other food should prove prejudicial to the consumer. It is, however, essential that at every stage the utmost care should be exercised in dealing with them so that the eventual purchaser may consume an article in which be can have complete confidence. Meat Inspection. The Council was during the year represented on the Joint Conference of South West Essex Authorities concerning the provision of a Municipal Abattoir. Since, however, the national policy in this regard appears not yet to be finalised little really falls to be reported so far as concerns Hornchurch and although our single privately owned slaughterhouse is far from ideally situated it has not been the subject of complaint so far. Meat inspection is carried out by the Sanitary Inspectors on a rota basis and even at times of staff shortage it has been possible to provide a full service in this regard. In these days when Refresher Courses for almost everything seem to be the rule, Sanitary Inspectors deserve I think that someone should periodically permit them similarly to attend, e.g. a Refresher Course in Meat Inspection. 1 think that official recognition of this fact could only serve to stimulate the interest of the Inspectors in the matter of meat inspection whilst at the same time enhancing their knowledge. Slaughter of Animals Acts, 1933 to 1954. 8 slaughtermen's licences were issued during the year. Carcases Inspected and Condemned. Details of the work done are noted below. The only slaughterhouse in the district, a private one, has not given any real cause for complaint and the owners have proved most co-operative in arranging that any necessary alterations to the buildings and the general administration of the premises is carried out to our mutual satisfaction. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Number killed 403 2 173 1,206 1,416 Number inspected 403 2 173 1,206 1,416 All diseases except Tuberculosis— Whole carcases condemned Carcases of which some part or organ was condemned Percentage of the number inspected affected with disease other than Tuberculosis - - - - - 53 - - 13 21 12.16% - - 1.08% 1.5% 38 Ice Cream. During the year 23 applications for registration as vendors and 9 applications for registration of premises for the storage and sale of ice cream were granted. At the end of the year 14 persons and premises were registered for manufacture and 250 for the storage and/or sale of ice cream. Our bacteriological sampling increased from 80 last year to 86 this year. 73 proved satisfactory. In addition 29 samples were taken under the Food and Drugs Act for examination by the Public Analysts. The quality of the ice cream sold locally remains in general of a highly satisfactory order. Preserved Food Manufacturers. Section 90 of the Hornchurch Urban District Council Act, 1936, requires registration of preserved food manufacturers and premises. At the end of the year 43 persons and 60 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 36 persons and 10 premises had been registered. Food and Drugs Act, 1938, Section 34. Three premises remained registered for carrying on the business of wholesale dealer in margarine. Clean Food Propaganda. Comment has been made elsewhere on this point and it is not proposed to pursue the matter here. Milk Pasteurising Plant. The only plant operated in the district continues to give satisfactory results. 53 methylene blue and phosphatase test samples were examined.  Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Tuberculosis only— Whole carcases condemned Carcases of which some part or organ was condemned Percentage of the number inspected affected with Tuberculosis - — — — — 19 — — — 18 4.7% — — — 1.28% 39 Milk Distributors. 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 41 shopkeepers are registered for the sale of bottled milk only. Milk Bottles. The need for milk bottles being washed out before return to the distributor remains as desirable as ever. Too many members of the public are still too prone to blame the dairy companies—who do in fact take a tremendous amount of care to avoid giving cause for complaint—and are too prone to forget their own responsibilities. It might also be advanced that although they may not be exposed to mis-use or contamination it would provide an excellent propaganda lesson for the pupils if the local schools made arrangements for their milk bottles also to be cleansed before return. Whilst the cost of ensuring this is naturally not known to me it is a matter which in my view should receive the serious attention of the Education Authority. 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) 39 Supplementary Pasteurised 7 Dealer's Sterilised 63 Supplementary Sterilised 8 Dealer's Tuberculin Tested 20 Supplementary Tuberculin Tested 6 Milk Sampling. The 159 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 154 cases a satisfactory report was received. In addition 55 samples were submitted to the Public Analysts. 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 17 visits to school canteens. This is a considerable diminution on last year. This does not reflect any intention on our part to minimise the supervision which we exercise over them but various factors outwith our control have made it impracticable to carry out the number of inspections which I would have wished. My remarks on school canteens on page 47 of last year's report still represent my view and need not further be recapitulated. 40 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER NOTIFIABLE DISEASES. Certain diseases such as Scarlet Fever are so mild that a firm notification may only be possible at a relatively late stage when the full implications of the condition become apparent. Other conditions such as Erysipelas whilst notifiable do not in my view at the present time require to be treated with this sense of importance. I think that the policy of notification should be rendered more flexible than it at present is so that diseases once made notifiable could be taken from the list in the light of experience and if necessary after a period of time and further experience restored. This might lead to some slight confusion but I do not think it could make the position appreciably worse than it is. It would at any rate have the benefit of realism. The role of the Public Health Department in Infectious Disease at the present time is concerned substantially with the prevention of spread and the control of contacts. This in turn is clearly indebted directly so far as concerns any preventive success to the phase of the disease at which notification is made—hence a notification coming to light weeks or even days after the onset of the disease tends largely to be valueless. I think that our function in this connection is one which ought to receive publicity particularly in the education of the undergraduate and in the many post-graduate courses open to general practitioners and to hospital officers. Improved enviromental hygiene may have lessened somewhat the burden borne by a Medical Officer of Health and his Department with regard to the control of infectious disease but the importance of the work of his Department is in danger of becoming more overlooked than the circumstances of the case can reasonably be held to warrant. Scarlet Fever. 93 cases occurred during the year (as compared with 225 in 1954) and six of the cases were admitted to hospital for various reasons which rendered home isolation inadvisable or impossible. The type of disease appears to be mild and its complications appear to be few. This whilst eminently satisfactory clinically brings in its trail more difficulty in achieving control both of the individual and of the spread of infection since the milder the clinical type of disease the less seriously is it taken by everyone and the less importance is devoted to regarding it as being infectious at all. Our attention has been directed largely to supervising contacts in which their position relates to the community at large, e.g. employees in food trades were of real importance. At the present time I think it is debatable whether Scarlet Fever is of sufficient importance as to be continued as a notifiable disease. 41 Measles. This being an epidemic year some '2,272 notifications were received as against 81 in 1954. 21 of the cases were admitted to hospital and no deaths occurred. It is a remarkable illustration of the advance of medicine and probably mainly of the anti-biotics in treatment that this disease has relinquished its place as a killer. Apart from the initial measles infection the secondary infection is primarily pneumonia, but also such complications as eye and ear troubles have been successfully conquered. Whooping Cough. A rise from 108 in 1954 to 163 in 1955 is to be recorded. 2 cases were admitted to hospital and there was one death. This again is relatively satisfactory in that what was once a serious disease has now been substantially tackled. It may well be that the immunisation campaign is also bearing fruit. Infectious and other Notifiable Diseases, 1955. Disease Total Cases notified Number of Cases hospitalised Dysentery 3 2 Encephalitis (post-infectious) 1 0 Erysipelas 21 3 Food Poisoning 15 6 Infective Hepatitis 24 2 Measles 2,272 21 Meningococcal infection 1 1 Ophthalmia Neonatorum 4 0 Pneumonia 43 9 Poliomyelitis— Paralytic 12 12 Non-paralytic 13 13 Puerperal Pyrexia 1 1 Scarlet Fever 93 6 Whooping Cough 163 5 Dysentery and Food Poisoning Group. 15 cases of Food Poisoning were notified during the year as against 7 for the previous year, whilst the number of Dysentery notifications remained the same at 3. Considering the size of the population of the area these figures in fact reveal a negligible incidence. I would again emphasize that it is of vital importance that whenever Food Poisoning is suspected it should be immediately notified to me. The longer the interval which elapses between suspicion and notification the more unlikely is it that any of the suspected food can be secured for analysis either bacteriological or chemical and hence the less likelihood is there of any causative organisms being isolated. It is in any event extremely difficult to pin-point the exact cause of any outbreak even though grave suspicion may be aroused in certain specific directions. 42 I do not think that the low incidence of Food Poisoning can be ascribed entirely to a meticulous regard for the desirable standards of food handling. A great deal remains to be done before one can go into a shop or cafe in the district with the confidence that nothing will be found to give cause for a certain disquiet. I think that due to the advice of our Sanitary Inspectors, propaganda being conducted on a national basis and the increased awareness of the general public in this matter, not to mention the enhanced interest shown by the shopkeepers themselves, a higher standard of food hygiene generally is becoming a rule, but it can still be improved without any unreasonable degree of effort. It is in this connection that one has hopes of the Food Hygiene Regulations made under the Food and Drugs Act, 1955, and which will come into full effect in the middle of 1956. The following is a copy of the Annual Return of Food Poisoning notifications for the year 1955 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). 1. Local Authority : HORNCHURCH U.D.C. Year: 1955. 2. Food Poisoning Notifications (Corrected) Returned to R.G. 1st Quarter. 2nd Quarter. 3rd Quarter. 4th Quarter. TOTAL 2 4 3 6 15 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 : 5. Unknown Cause : 10. 15 (Salmonella Typhimurium : 4) ( ,, Enteritidis: 1) Poliomyelitis. As noted earlier 25 cases occurred this year as against only 4 last year. I have set out below the number and type of cases which have occurred since 1947. Year Paralytic Non-Paralytic Total 1947 4 9 13 1948 2 7 9 1949 3 6 9 1950 12 3 15 1951 2 6 8 1952 2 3 5 1953 8 1 9 1954 1 3 4 1955 12 13 25 13 of the cases were non-paralytic (6 males, 7 females), whilst 12 of the cases were paralytic. A brief analysis of the paralytic 43 cases shows that there were 7 in which the limbs were affected, 3 of a respiratory and 2 of a bulbar type. 6 males were involved aged from 3 to 12 years. All the paralytic male cases occurred in children, the female paralytic cases showed a much wider range of from 14 months to 35 years, 3 of the 6 cases were under 5 but the two most severe cases were adult females of 26 and 35 years. A complete recovery has been made by 4 of the paralytic- cases, 6 are still receiving out-patient treatment and 2 (the adult females previously noted) are still in hospital. The average stay in hospital of the male paralytic cases was 63 days, individually ranging from 37 to 114; the average stay of the female paralytic cases was 32 days but that is an unreal figure in that 2 females are still in hospital after a stay of several months. It is regrettable that after a significant drop this disease should once again have manifested itself in relatively large numbers and equally interesting is the fact that cases tended to trickle on throughout the winter so that after 2 cases in July, 12 in August, 3 in September, 3 in October, 3 occurred in November and 2 in December. There has previously been a complete cessation of the disease in mid-winter but although it may be exceptional this has clearly not been the case during the past winter. Although it does not come within the strict scope of this report mention must be made of the new vaccine which, within the limits of its efficiency and of the number of children limitation of supply make it possible to protect, should mark a very significant step in our fight to minimise what is in effect a scourge. The development of this vaccine and the results of the programme now being initiated will be awaited with very great interest. Infective Hepatitis. 24 cases were notified during the year (this disease is notifiable under Regulations made in 1943 and applicable to the Eastern region); the cases were largely scattered in the district and did not represent any significant individual outbreak. Tuberculosis. The tuberculosis register at the end of the year showed as follows:— Pulmonary— Males 398 Females 354 Non-Pulmonary— Males 41 Females 25 818 44 The picture presented by this disease continues to assume a most encouraging form. The number of new pulmonary cases has again dropped from 53 to 37 and the number of deaths from 10 to 4. The non-pulmonary cases increased from 5 to 7 with no deaths. The total of 4 deaths from this disease included 1 brought to notice after death. The number of inward transfers which rose from 40 to 52 (pulmonary type) last year have again increased to 58 this year, doubtless again because of the building development in this district. The figures show that one death occurred within 1 month of notification and none of the other deaths occurred earlier than from 3 to 4 years of their original notification. It is clear that a very great improvement in the general outlook has occurred in connection with tuberculosis not only in this country but probably generally. I had the pleasure of attending the Fourth Commonwealth Health and Tuberculosis Conference in London during the year when the picture throughout the Commonwealth was comprehensively discussed and the statistics then made available showed a general improvement both in the facilities becoming available to deal with the disease and the results accruing from the increased efforts being devoted to the attack upon it. 45 CASES OF AND DEATHS FROM TUBERCULOSIS, 1955. AGE GROUPS NEW CASES INWARD TRANSFERS Total No. of Cases added to Register DEATHS Total Deaths Pulmonary NonPulmonary Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Under 5 years 1 0 0 1 0 0 0 1 l 2 — — — — — — 5-14 years 1 0 2 0 2 0 1 1 6 1 — — — — — — 15-24 „ 5 5 1 0 3 1 0 0 9 9 — — — — — — 25-44 ,, 11 4 1 0 25 20 1 1 38 25 — 1 — — — 1 45-64 ,, 9 1 0 1 3 1 0 0 12 3 2 — — — 2 — 65 and over 0 0 0 1 0 0 0 0 0 1 1 — — — 1 — Totals 27 10 4 3 33 25 2 3 66 41 3 1 — — 3 1 46 INTERVAL BETWEEN NOTIFICATION AND DEATH OF FATAL CASES OF TUBERCULOSIS; 1947 - 1955. YEAR Within one month From 1-3 months From 3-6 months From 6-12 months From 1-2 years From 2-3 years From 3-4 years From 4 years and upwards Notified after death TOTAL 1947 1 5 1 1 7 5 3 10 5 38 1948 4 4 2 3 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 1955 1 — — — — — 1 1 1 4 47 SECTION G. FACTORIES ACTS, 1937 and 1948. Ministry of Labour and National Service Form 572. PART I OF THE ACT. 1. Inspections. Premises No. on Register No. of Inspections No. of written notices No. of occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by L.A's. 31 34 l — (ii) Factories not included in (i) in which Sec. 7 is enforced by the L.A. 202 234 8 — (iii) Other premises in which Sec. 7 is enforced by the Local Authority. 78 40 5 — Total 311 308 14 — 2. Cases in which Defects were Found. Particulars Found Remedied Referred Prosetions To H.M. Inspector By H.M. Inspector Sanitary Conveniences (Section 7). (a) Insufficient 6 6 — 1 — (b) Unsuitable or Defective 8 6 — 4 Other offences against the Act — — 2 — — Total 14 12 2 5 — PART VIII of the Act. OUTWORK—Sections 110 and 111. Nature of Work No. of Outworkers in August list. Wearing Apparel— Making, etc. 135 No instances of work in wholesome premises. 48 INDEX PAGE Acknowledgments 6 Acreage 7 Aged, Care of 12, 13 Ambulance Service 11 Atmospheric Pollution 6, 14, 15 Births 7 Birth Rates 7 —Comparative 8 Canteens, School 39 Caravans 23, 24 Care of the Aged 12, 13 Centralised Slaughtering 37 Certificates of Disrepair 22 Cesspools 16 Clean Food Propaganda 38 Clinics, Child Welfare 11, 12 Contents, Table of 2 Crematorium 17 Deaths 9, 10 —Causes of 9 —Infantile 7 —Main Causes (1946 - 1955) 10 Death Rates 7 —Comparative 8 —Infant 7 —Neonatal 7 Disinfection 18 Disinfestation 18 Drainage and Sewerage 15, 16 Dysentery and Food Poisoning 41, 42 Erysipelas 40 Essex County Council Act, 1952, Section 103 38 Essex River Board 17 Establishments for Massage or Special Treatment 18 Factories Acts, 1937 and 1948—Defects 47 Form 572 (Revised) 47 Inspections 20, 47 Outwork 47 Visits paid 20, 47 Fireguards 18 Food Poisoning and Dysentery 41, 42 Food— Clean 35, 36, 38 Complaints 34, 35 Hawkers of 38 Inspection of 19 Meat Inspection 37, 38 Premises 36 49 PAGE Food—continued Preserved 38 Shellfish 36, 37 Unsound 35 Food and Drugs Act, 1938 6 —Administration 25 —Adulterated Samples 29, 30, 31, 32, 33 —Public Analysts 4, 25 —Sampling 25, 26, 27, 28, 29 —Section 13 & Byelaws 33 —Section 34 38 Health Propaganda 11 Heating Appliances (Fireguards) Act, 1952, and Regulations, 1953 18 Home Nurses and Midwives 12 Home Safety 6, 13 Hornchurch Urban District Council Act, 1936, Section 90 38 Houses— Inspection of 19 Number erected 21 Number inhabited 7 Housing 5, 21 Action under Statutory Powers 21 Applications (Medical Aspect) 22 Closing and Demolition Orders 21 General District Development 23 Improvement Grants 22 Overcrowding 22, 23 Slum Clearance Areas 21 Sub-standard Property 21, 24, 25 Temporary Dwellings 23, 24 Visits Paid 19 Housing Repairs and Rents Act, 1954 24 —Certificates of Disrepair 22 —Slum Clearance Areas 21 Ice Cream— Registration 38 Sampling 38 Infectious Diseases 5, 40, 41 —Hospitalisation 41 —Notifications 41 —Visits paid 20 Infective Hepatitis 43 Informal Notices Served 20 Laboratory Facilities 11 Land Charges Enquiries 24 Maternity and Child Welfare 11, 12 Measles 41 50 PAGE Meat Inspection 37 —Carcases Inspected and Condemned 37, 38 —Centralised Slaughtering 37 —Slaughtermen's Licences 37 Members of the Council 3 Midwives and Home Nurses 12 Milk- Bottles 39 Distributors 39 L.C.C. Children's Home 39 Pasteurising Plant 38 Sampling 39 Special Designations 38, 39 National Assistance Act, 1948, Section 47 12, 13 Notices Served 20 Nursing and Maternity Homes 12 Officers of the Public Health Department 4 Outworkers 20, 47 Paddling Pools 18 Penny Bate Product 7 Pet Animals Act, 1951 19 Poliomyelitis 42, 43 Ponds and Watercourses 17 Population 5, 7 Preface 5 Propaganda— Clean Food 38 Health 11 Public Analysts 4 Rag Flock and Other Filling Materials Act, 1951 19 Rateable Value 7 Riding Establishments Act, 1939 19 River Ingrebourne 15, 17 River Pollution 17 River Thames 17 Rodent Control 18 Sandpits 17,18 Safety in the Home 6, 13 Sanitary Circumstances, visits paid 20 Sanitary Inspectors' Work 20 —Summary of 19, 20, 21 Scarlet Fever 40 School Canteens 39 Sewerage 15, 16 Shellfish 36, 37 Shops Act, 1950, visits paid 20 Slaughter of Animals Acts, 1933 to 1954 37 Staff 4 —Medical Examinations 11 Staffing 11 51 PAGE Statutory Notices Served 20 Still Births 7 —Rates 7 Swimming Bath 17 Table of Contents 2 Temporary Dwellings 23, 24 Tuberculosis 6, 10, 43 —Incidence and Mortality 10, 43, 44, 45 —Notification/Mortality Interval 46 Vital Statistics 5 Water Supplies 13, 14 Watercourses and Ponds 17 Whooping Cough 41