Ac 4411(3) 1 dh Cmafa Dw 5 B 2 Seloary HORNC 24 Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER HEALTH For the Year 1956 JAMES GORMAN, M.B., Ch.B.. D.P.H., Medical Officer of Health Hornchurch Hrban District Council JAMES GORMAN, M.B., D.P.H. COUNCIL OFFICES, Medical Officer of Health BILLET LANE, Tel.: Hornchurch HORNCHURCH. (10 lines) Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1956 JAMES GORMAN, M.B., Ch.B., D.P.H., Medical Officer of Health. 2 TABLE OF CONTENTS PAGE Members of the Council (as at 31.12.56) 3 SECTION A—Statistics and Social Conditions of the Area 7 SECTION B—General Provision of Health Services for the Area 11 SECTION C—Sanitary Circumstances of the Area ... 14 SECTION D—Housing 20 SECTION E—Inspection and Supervision of Food ... 22 SECTION F—Prevalence of, and control over, Infectious and Other Notifiable Diseases 35 SECTION G—Factories Acts, 1937 and 1948 45 Index 46 3 MEMBERS OF THE COUNCIL (as at 31.12.56). Councillor Mrs. E. G. Richardson, J.P., Chairman. (1) Councillor H. Holock, Vice-Chairman. (1). Councillor Mrs. M. Anfilogoff. (1) Miss C. F. M. Cannon. Mrs. E. H. Dean. (1) Mrs. W. M. Jiggins. (1) M. A. Andrews. (1) R. Atkinson. E. W. J. W. Bush. B. E. E. Cannon. J. D. Cantwell. (1) L. W. Carroll. (1) and (3) N. G. Dix. E. W. Fryd. S. G. Heath-Coleman. R. S. Howe. (1) and (2). J. W. G. Hughes. R. M. Hunt. (1) W. E. Large. H. F. Moss. (1) G. W. Phillips. 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. (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. Chief Public Health Inspector : M. F. G. Randall, M.A.P.H.I. (2) and (3). Public Health Inspectors : L. Acer, M.A.P.H.I. (1) and (3) T. H. Cutler, M.A.P.H.I. (2) (3) and (4) * J. Goodwin, M.A.P.H.I. (2) and (3). A. V. J. Hutchings, M.A.P.H.I. (2) and (3) ** W. C. Scales, M.A.P.H.I. (2) and (3) *** S. Whitfield, M.A.P.H.I. (2) and (3). J. M. Williams, M.A.P.H.I. (2) (3) and (4). * Commenced duties 23.7.56. ** Commenced duties 1.6.56. *** Resigned 8.4.56. Clerical Staff : J. E. Blay (Chief Clerk). Miss E. Thompson. Miss W. A. Hepburn. Rodent Operative and General Assistant : F. J. GlLBEY. Public Analysts : George Taylor, O.B.E., F.R.I.C. J. Hubert Hamence, M.Sc., Ph.D., F.R.I.C. (1) Public Health Inspectors' Certificate of the Royal Society of Health. (2) Public Health Inspectors' Certificate of the Royal Society of Health and Public Health Inspectors' Joint Board. (3) Certificate of the Royal Society of Health as Inspector of Meat and Other Foods. (4) Certificate of the Royal Society of Health as Smoke Inspector. 5 Public Health Department, Council Offices, Billet Lane, HORNCHURCH, 15th May, 1957. To the Chairman and Members of the Hornchurch Urban District Council. Madam Chairman, Ladies and Gentlemen. I beg to present my Annual Report for 1956. General District Development. The district quite manifestly continued to develop throughout the year especially in the South Hornchurch neighbourhood. Such expansion necessarily brings with it problems of roads, sewers, refuse collection and the like. No expansion is one-sided in its implications and when a new house is erected its occupants not only pay rates but demand services. The difficulties, however, of the local authority in providing these services are often not wholly understood by those desirous of receiving them. In the provision of particular amenities mention must be made of the new swimming bath at Harrow Lodge Park (described elsewhere in my report) which was opened in December. Vital Statistics. An increase in the birth rate from 15.45 to 16.79 and a diminished death rate of 10.59 as against 11.60 are satisfactory features. The infant mortality rate shows a slight rise from 18.29 to 21.86. Infectious Diseases. These have ceased to be a continuous major problem although even individual cases apart from sporadic outbreaks of certain diseases make it necessary always to be on the alert to deal with the avoidance of spread. Atmospheric Pollution. The emergence of the Clean Air Act 1955 with its repercussions upon industrialists and householder alike was a noteworthy feature of the year and it is safe to say that no future Annual Report for some time to come will be complete without some note of the effects of this piece of legislation which must essentially be so cumulative in its results. Our routine investigations into the question of Clean Air in Hornchurch were pursued at a number of places throughout the district. 6 Food and Drugs. The impact of the Food Hygiene Regulations 1955 was during the year felt in many quarters. A great deal of work was done throughout the various food premises in the district and school canteens came in for their full measure of attention. It is regrettable that there should be some dubiety as to whether or not hospitals come within the scope of these Regulations. The question of whether it is advantageous to the hospitals or to the local authorities or most imporant of all to the community that they should in fact be brought within the scope of the Regulations could be argued at leisure and probably without profit so long as the basic position of hospitals in this connection was determined. Housing. The year saw a steady continuation of house building principally by private enterprise but also by the local authority. The removal of sub-standard property in the district proceeded apace in conjunction with the Housing Department who pay considerable attention to integrating their re-housing measures with our sub-standard property clearance. Organisation and Methods. Last but not least and although strictly not solely medical in its field of enquiry a note should be made of the visit during the year by a firm of organisation and methods consultants. 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) 1956 113,600 Number of inhabited houses according to rate books (December, 1956) 35,000 Rateable value (December, 1956) £1,483,526 Sum represented by a penny rate (December, 1956) £5,800 Extracts from Vital Statistics for the Year. Births. Number of live births allocated to the district as adjusted for inward and outward transfers 1,967 (1,041 males, 926 females) Birth rate per 1,000 Home Population using area comparability factor 16.79 Number of stillbirths allocated to the district 33 (15 males, 18 females) Stillbirth rate per 1,000 Home Population 0.29 Stillbirth rate per 1,000 total (live and still) births 16.5 Deaths. Number of deaths of Hornchurch residents as supplied by the Registrar-General (adjusted for inward and outward transfers) 1,294 (667 males, 627 females) Death rate per 1,000 Home Population using area comparability factor 10.59 Deaths of infants under one year of age„ 43 (22 males, 21 females) Infant mortality rate (per 1,000 births) 21.86 Deaths of infants under 4 weeks of age 31 (14 males, 17 females) Neonatal mortality rate (per 1,000 births) 10.67 DEATH RATE—COMPARISON WITH PREVIOUS YEARS. 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 1948 8.2 1956 10.5 *Area Comparability Factor returned. 8 The Area Comparability Factor for deaths this year was reduced from 1.15 to 0.93 which has been instrumental in securing a marked diminution in the rate. Mention was made by me in a previous report of the possible effects consequent on the procedure governing transfers of deaths outlined by the Registrar-General in October 1952 and which in this district had particular reference to St. George's Hospital Which is an Institution including provision for the aged and chronic sick. It could reasonably be said that three-quarters of the deaths occurring in this Institution relate to non-Hornchurch residents. Taking this as a figure from 1953 onwards if this percentage was subtracted from the deaths occurring in this Institution, then—using the A.C.F. supplied annually—the Hornchurch rates would be as under:— Year Hornchurdi Hornchurch excluding 75% of St. George's Hospital deaths 1953 13.1 10.6 1954 12.1 9.7 1955 11.6 9.3 1956 10.5 7.9 It is true that the A.C.F. during these years varied as under:— 1949 1.19 1950 1.19 1951 1.18 1952 1.18 1953 1.15 1954 1.15 1955 1.15 1956 0.93 but even though the reduction in the A.C.F. was designed from 1953 specifically to deal with the St. George's Hospital figures it even then clearly failed to cushion the effect of this Institution on the local rates. This of course is not a problem exclusively concerning Hornchurch but is one which must give localities placed as ours is or even worse placed considerable food for thought. BIRTH RATE—COMPARISON WITH PREVIOUS YEARS 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 1948 17.2 1956 16.7 * 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 IN CERTAIN AGE GROUPS (Corrected for Inward and Outward Transfers) CAUSES OF DEATH ALL AGES AGE GROUPS Under 1 1—4 5—14 15—24 25—44 45—64 65—74 75 and upwards TOTAL MALE FEMALE M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1. Tuberculosis, respiratory 5 4 1 - - - - - - - - - - 3 1 1 — — — 2. Tuberculosis, other 0 0 0 - - - - - - - - - - - - - - - - 3. Syphilitic disease 1 0 1 - - - - - - - - - - - - - - — 1 4. Diphtheria 0 0 0 - - - - - - - - - - - - - - - - 5. Whooping cough 0 0 0 - - - - - - - - - - - - - - - - 6. Meningococcal infections 0 0 0 - - - - - - - - - - - - - - - - 7. Acute poliomyelitis 0 0 0 - - - - - - - - - - - - - - - - 8. Measles 0 0 0 - - - - - - - - - - - - - - - - 9. Other infective and parasitic diseases 2 1 1 1 — - - - - - - - - - - - - - - 10. Malignant neoplasm, stomach 34 18 16 — — - - - - - - 1 1 8 2 7 6 2 7 11. Malignant neoplasm, lung, bronchus 59 51 8 - - - - - - — 1 1 — 28 4 15 7 1 12. Malignant neoplasm, breast 23 0 23 — — — — — — — — — 1 — 13 — 5 — 4 13. Malignant neoplasm, uterus 14 0 14 — — — — — — — — — — — 4 — 5 — 5 14. Other malignant and lymphatic neoplasms 123 58 65 — — — — 2 1 1 — 1 5 17 22 16 13 21 24 15. Leukaemia, aleukaemia 4 1 3 - - - - - - - - - - — 1 - — — 16. Diabetes 13 5 8 — — — — — — — — 2 — — 2 1 3 2 3 17. Vascular lesions of nervous system 197 93 104 - - - - - - - - 2 3 7 17 31 29 53 55 18. Coronary disease, angina 159 106 53 - - - - - - - - — 1 45 9 38 18 23 25 19. Hypertension with heart disease 45 18 27 - - - - - - - - - - 4 2 8 5 6 20 20. Other heart disease 241 99 142 - - - - - - - - 4 3 11 14 12 17 72 108 21. Other circulatory disease 40 22 18 - - - - - - - - 1 — 3 4 9 5 9 9 22. Influenza 7 5 2 - - - - - - - - - - 3 1 1 — 1 1 23. Pneumonia 53 22 31 2 4 - - - - - - — 1 6 1 4 2 10 23 24. Bronchitis 95 69 26 - - - - - - - - - - 16 — 22 3 31 23 25. Other diseases of respiratory system 7 4 3 - - - - - - - - - - 3 2 1 — — 1 26. Ulcer of stomach and duodenum 10 9 1 - - - - - - - - - - 2 — 3 1 4 — 27. Gastritis, enteritis and diarrhoea 4 3 1 — — — — — — — — 1 — 1 — 1 — — 1 28. Nephritis and nephrosis 13 6 7 - - - - - - - - 1 1 3 2 — 2 2 2 29. Hyperplasia of prostate 5 5 0 — — — — — — — — — — 1 — 2 — 2 — 30. Pregnancy, childbirth, abortion 1 0 1 - - - - - - - - - - - - - - — 1 31. Congenital malformations 14 3 11 3 8 — — — 1 — 1 — — — — — 1 — — 32. Other defined and ill-defined diseases 87 41 46 15 9 — 1 2 1 1 — 3 1 4 12 9 6 7 16 33. Motor vehicle accidents 8 6 2 — — 2 — — — — — 1 1 3 — — — — 1 34. All other accidents 20 11 9 1 — — 3 1 — 2 — 1 — 2 2 1 — 3 4 35. Suicide 9 7 2 — — — — — — 1 — 3 — 3 1 — 1 — — 36. Homicide and operations of war 1 0 1 — — — — — — — — — — — — — — — 1 TOTAL 1,294 667 627 22 21 2 4 5 3 5 2 22 18 173 117 183 126 255 336 10 GENERAL MORTALITY: MAIN CAUSES 1947-1956. Causes of Death 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 Tuberculosis (all forms) 38 44 35 29 25 17 21 11 4 5 Cancer 142 139 180 155 183 184 211 234 210 253 Infectious diseases 2 5 9 3 4 1 3 1 2 0 Cardio - vascular disease 344 371 404 441 418 425 602 590 591 682 Influenza 3 1 9 3 19 2 14 1 2 7 Pneumonia 48 30 31 20 30 49 52 41 49 53 Bronchitis 66 36 65 63 69 52 85 54 65 95 Other respiratory diseases 12 9 6 3 7 9 10 8 10 7 Gastro intestinal diseases 18 14 13 20 16 12 28 13 10 14 Motor vehicle accidents 6 7 11 9 14 9 11 10 12 8 All other accidents 7 14 8 12 12 4 10 18 18 20 Suicide 10 8 3 10 11 10 7 11 11 9 Cardiovascular disease, Cancer and Bronchitis all showed increases and noteworthy is Cancer of the Lung and Bronchus which while remaining static in females at 8 deaths increased among males from 32 to 51—a very substantial rise. So far as concerns Bronchitis it might seem—and this would be more evident to the hospital medical officer or to the general practitioner—that a time comes when antibiotics fail to exert a significant effect in clearing up this condion in the aged. 11 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staffing. Mr. W. C. Scales, Public Health Inspector, resigned in April. This created a second vacancy in our establishment for Public Health Inspectors and the two posts were eventually filled by the appointment of Mr. A. V. J. Hutchings who commenced duty on the 1st June and Mr. T. H. Cutler who started on 23rd July. The Sanitary Inspectors (Change of Designation) Act, 1956, enacted that Sanitary Inspectors appointed under the Local Government Act, 1933, shall henceforth be designated "Public Health Inspectors" and the new designation of "Chief Public Health Inspector" and "Public Health Inspectors" were applied to the positions of " Senior Sanitary Inspector" and "Sanitary Inspectors" respectively as from 25th September, 1956. Medical Examinations—Staff. Stalf arrangements remain as before save that an amended examination fee has been agreed. During the year arrangements were made for the examination of 216 (168) employees or prospective employees—68 (52) permanent and 148 (116) temporary. The 1955 figures are given in parenthesis. Public Health Propaganda. The Department was represented at a Rotary Careers Exhibition when the exhibit consisted of a model Pasteurising Plant (kindly lent by United Dairies) and a Volumetric Sulphur Dioxide apparatus (kindly lent by the Department of Scientific and Industrial Research) in addition to a variety of material illustrating public health in its many aspects as a career. Considerable public interest was evinced in our exhibit. A most instructive visit was paid during the year to a margarine factory of Messrs. Van den Berghs & Jurgens Ltd., situated in a neighbouring district. A close liaison is maintained with the Area Medical Officer on using the various clinics as avenues for propaganda. Various talks have as usual been given by members of my staff to local organisations, the most popular topic being the Food Hygiene Regulations. The Council's Notice Boards covering the entire district are also available for the periodic display of any particular aspect of the public health and in addition the facilities of the County Library service are very generously offered to us. 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. 12 Ambulance Service. This district is served by a normal complement of four ambulances and two sitting case vehicles, which are stationed at Hornchurch. Two ambulances and two sitting case vehicles are fitted with radio-telephony sets. A day and night service is maintained. Under the re-organisation of the County Ambulance Service a new Divisional Control Centre and twenty-vehicle Ambulance Station has been established at Aldborough Road, llford, together with a twentyvehicle Ambulance Station at Goresbrook Road, Dagenham. A similar Station is planned to serve the Romford/Hornchurch area. During the year radio telephony was introduced to the Service operating in the Metropolitan part of Essex, the main transmitter/ receiver in this area being situated at Lambourne End and remotely controlled from Uford. Forty ambulance vehicles have been equipped with radio-telephony sets. All emergency telephone calls originating in the area are connected direct to the Divisional Control at llford and the nearest available ambulance is directed to the scene of the incident by private telephone which is connected to each Ambulance Station or by radio telephone. Maternity and Child Welfare. The Essex County maintained clinics at the following centres throughout the ye<ar:— (i) Abbs Cross Lane, Hornchurch. (ii) Athelstan Road, Harold Wood. (iii) Front Lane, Cranham. (iv) Hornchurch Road, Hornchurch. (v) St. Mary's Lane, Upminster. (vi) South End Road, South Hornchurch. (vii) Upminster Road, Rainham. (viii) Westland Avenue, Hornchurch. Nursing and Maternity Homes. The three registered Nursing and Maternity Homes in the district are supervised by the County Council. Midwives and Home Nurses. There are 11 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 7 home nurses working in the district. Care of the Aged. There is little new to be said on this topic since the essence of the subject remains the same. It is basically a matter for team work and in this team the District Public Health Inspector plays no inconsiderable part. It must be a matter of common knowledge to those really informed 13 ol how often it is found possible for a District Public Health Inspector purely by advice and persuasion to transform someone who is in fact practically a social outcast (perhaps because of habits and outlook) into a useful and appreciated member of society. Scarcely a year goes by without an annual review bringing into the forefront specific and striking examples of this kind. So far as concerns the re-housing of aged persons dispossessed possibly from sub-standard houses, it is essential so far as possible that they be transferred to their new surroundings with a minimum of upset. The aged naturally are less resilient to change and to alter the surroundings of a lifetime possibly is not a task lightly to be undertaken. It may safely be said I think that in Hornchurch re-housing of these persons is done after a full enquiry into their circumstances and with a view to minimising any upset from the change. Home Safety. I remain closely associated with the work of the Home Safety Committee and increasing experience confirms me in the belief that apart from what might almost be termed ' scratching the surface ' at local level I believe it to be imperative that a greater sense of urgency be shown centrally not only by the safety organisations but by any Ministry concerned in taking steps to ensure that the local field is encouraged to be more receptive to the efforts of local volunteers. Especially so is this perhaps the case in the sphere of education. It remains to me a source of wonderment why a local Sanitary Authority should not have the same flexibility of action in dealing with the problem of Home Safety as does a local Health Authority. It only remains to be said that the local District Council is exceedingly generous in its attitude to Home Safety and their liberal subsidy goes far to maintain the work of the local Committee at a useful level. It would be interesting and perhaps salutary to think what might happen to the prevention of Home Accidents campaign locally if the Council decided to take a less enlightened view. The strength of a Home Safety Committee even at district level must surely repose not only and perhaps not primarily in its financial position but in the interest and support accorded to it both in theory and practice by the individual members of its constituent organisations. National Assistance Act, 1948. No formal action was taken under Section 47 of this Act during the year. 14 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water Supplies. As I mentioned in a previous report this district is exceedingly well favoured even in its rural part so far as the availability of a main water supply is concerned. One or two isolated instances still remain of houses in which the provision of a main supply, whilst in very general terms possible, has not yet been effected, but these are exceptional. The conclusion of satisfactory arrangements with the owner of the "White House," Aveley Road, for a main water supply to be made available to his house has reduced the number still further. Eleven samples were taken by the Public Health Department during the year from the main supply. 5 were submitted for chemical and bacteriological examination and 6 for bacteriological examination only. In each case a satisfactory report was received. 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 3,880 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. In addition, analyses have also been made of samples obtained from consumers' taps in the various parts of the Company's district, including that of your Council, and all proved to be satisfactory. The water supplied is not plumbo-solvent. No action has been necessary in respect to any form of contamination. The number of dwelling houses supplied as at 31st December, 1956, was 36,663 and the population as at 30th June, 1956, as obtained from the Registrar General was 113,600. We are unable to state the number of houses supplied by standpipes, but the total is quite insignificant." Atmospheric Pollution. Our programme of investigation continued on the same general lines as previously with the relatively minor modification that two lead peroxide candles were re-sited at Oglethorpe School and " Langtons," as against their former positions at North Ockendon Vicarage and St. George's Hospital. The implications of the Clean Air Act were reported in some detail to you by the Clerk and these were being pursued further at the end of the period covered by this report. 15 In the field of general propaganda a leaflet was distributed through the kind assistance of the Treasurer and the Housing Manager to general ratepayers and Council house tenants. Widening the field of direct propaganda by this means is exceedingly valuable in providing a background of information against which the inevitable effects of the Clean Air Act will in due course tend to be more easily understood. Clean Air Act: The Clean Air Act represents a signal step towards the ultimate goal of clean air but it must in truth be said that the signal is at present still at distant. Not only is the Act still to become operative in many of its requirements but the public has still to be educated to the point when they will themselves demand action rather than be content to remain passive participants in a scheme which they do not fully understand and concerning which they are not really interested. The initial smoke control area is an enlightened gesture but only when such an area or its subsequent counterparts deal with industrial and domestic pollution on the major scale can the harvest of the Act really begin to be gathered. The supply of smokeless fuel and its cost cannot fail to continue to influence the demand and the public outlook. Sewerage. The first stage of the Tngrebourne Valley Sewer was completed during the year at a cost of approximately £150,000 between Harold Wood and Suttons Pumping Station. This forms part of the Regional Drainage Scheme and is designed ultimately to take part of the flow from Harold Hill and the Nags Head drainage area of Brentwood, in addition to that part of Hornchuich which it now drains. These additional flows cannot of course be taken until the second stage of the Ingreboume Sewer from Suttons Pumping Station to the Riverside Works is completed and the Riverside Works itself further extended. The length of sewer recently laid is approximately 4| miles long and comprises 990 yards of 36" diameter; 5,330 yards of 33"; 760 yards of 30" and 160 yards of 21" diameter; part of the works being in tunnel. The contract for the first part of the extension of the Bury Farm Sewage Works was completed at an approximate cost of £80,000. It included the construction of a main pumping station, grit channels, settling tanks, humus tanks, sludge beds and a large diameter percolating filter. This is the first stage of a large scale extension to the Works which will result in the eventual employment of sludge digestion. Conversion. During the period under review 1 and 2, Druces Cottages, and 1, 2 and 3, Knights Cottages, Hacton Lane, were converted to main drainage, the Council paying 50% of the cost under Section 47 of the Public Health Act, 1936. Cesspools. The Surveyor was authorised to deal with the emptying of certain cesspools at periods of under 6 but not under 4 weeks. 16 Unfortunately certain parts of the district even where development is still taking place are not served by a main sewer. The disadvantage of cesspools is clearly that their use must be related to their capacity and that even when this is done they require regular and relatively frequent emptying at no mean cost and with a certain inevitable smell during the process of emptying. The situation when overflowing takes place, i.e. through over-usage need not of course be pursued here in detail. It is additionally a most difficult matter to site the cesspools in any one area in such a way as to avoid offence to houses appearing subsequent to the cesspools. The trouble really is that cesspools can usually only be planned on a very local basis instead of on a general basis as might be possible if a large area was being developed at one time by one developer. Clearly the district generally would benefit by the provision of roads and sewers in the Parsonage Estate area of Rainham and it must be conceded that a substantial amount of the area lying off the Upminster Road, Rainham, is not particularly attractive. This, however, should not be viewed mistakenly as meaning that the Council, for example, has failed to take any ready means of providing amenities such as roads and sewers. It simply means that under the existing circumstances viewed as part of the district administration as a whole and in the light of any necessary government restrictions, it has not been found possible to provide that measure of amenity which not only the residents but also the Council would wish to see achieved. 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. Quite an amount of time and space has been devoted to the River Ingrebourne in past reports—both Committee and Annual—and it is not proposed to dwell upon the matter in any great detail on this occasion. Suffice it to say that periodic sampling of this watercourse at various points in its passage, suggests that the necessity for a comprehensive regional drainage scheme has lost none of its urgency. Swimming Bath. The Hornchurch Swimming Pool, sited in Harrow Lodge Park, off the main Hornchurch Road, was officially opened by the Chairman of the Council, Councillor Mrs. E. G. Richardson, J.P., on 8th December, 1956. The Pool is 110ft. long and 42ft. wide, has a depth of 3ft. at the shallow end and a maximum depth of 12ft. 6ins. under the diving stage. It is equipped with 3 and 5 metres fixed diving stages and 1 and 3 metres spring boards. The filtration plant is capable of working on break-point chlorination and comprises six vertical air-scoured filters, chemical tanks and pump and vacuum chlorinator. The Pool surround and dressing rooms are finished with non-slip tiles. 17 The Pool is sited on one side of the Pool Hall allowing for a large public gallery with 474 fixed seats of tip-up pattern and the seating can be implemented for Gala purposes. A Buffet Bar is available for patrons and provision is made for a restaurant. The " Hy-gard-all" system of clothes storage has been adopted and all bathers must enter the Pool through pre-cleansing tunnels with a footbath and continuous shower sprays of filtered and chlorinated water. Heating and ventilating is by the Plenum system and radiators. All air circulated is filtered on intake and prior to re-circulation. Full use is being made of the Pool by Hornchurch schools, the attendance being 68 classes per week. That the Pool was a long-felt need is amply proved by the attendance figures of the general public which increase each month. 111,788 patrons including 9,165 spectators had attended up to the end of April 1957, i.e. in less than 5 winter months. Crematorium. Work on the new Crematorium at Corbets Tey was proceeding at the end of the year. Paddling Pools. AH the Paddling Pools under the Council's supervision are examined bacteriologically from time to time and the results have in general been satisfactory. Fifteen samples were taken during the current year. Disinfestation and Disinfection. No change has taken place in our policy in this connection. Rodent Control. The advice of the Rodent Operative continues to be appreciated and during the year 155 new infestations and 1,355 routine and re-visits were made. Establishments for Massage or Special Treatment. The Essex County Council granted licences to 7 persons during the year authorising them to carry on establishments for massage or special treatment. 7 visits were paid to these premises throughout the year. Heating Appliances (Fireguards) Act 1952 and Regulations 1953. During the year 12 appliances were tested (involving 24 tests) and of these 8 appliances were satisfactory. (The 4 unsatisfactory appliances were withdrawn from sale). 18 Old Metal Dealers (Hornchurch) Order, 1956. By an Order dated 28th June, 1956, the Secretary of State, Home Office, declared Section 86 of the Public Health Acts Amendment Act, 1907, to be in force in the Urban District. My Department was delegated the responsibility for administering this Section. At the end of the year 13 persons had registered as Dealers in old metal. Pet Animals Act, 1951. Thirty-eight visits were paid to the 9 licencees of the Pet Shops in the district. 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. Riding Establishments Act, 1939. The two premises were inspected on a half-yearly basis. The third establishment closed down during the early part of the year. Public Health Inspection of the District. SUMMARY OF PUBLIC HEALTH INSPECTORS' WORK DURING 1956: Inspection of Food and Food Premises (visits paid): Bakehouses 75 Butchers' shops 247 Cafes 190 Confectioners 187 Dairies (including Pasteurising Plant) 129 Fish Shops 92 Food complaints 103 Grocers' shops 601 Greengrocers' shops 128 Ice Cream Vendors and Manufacturers' premises 135 Meat Inspection 299 Mobile shops (hawkers) 66 Public houses 11 Sampling 634 School Canteens 76 Slaughterhouse 294 Staff Canteens 31 Miscellaneous visits 46 19 Housing (visits paid)-. Drainage of houses 622 Overcrowding, etc. enquiries 110 Improvement Grants 49 Sanitation 88 Structural defects 482 Water supply and pipes 133 Miscellaneous housing visits 133 Re-inspections 1,792 General Sanitary Circumstances (visits paid) Accumulations 97 Atmospheric Pollution 67 Camping grounds, vans, etc 93 Conveniences 30 Drainage and sewerage 142 Dustbins 139 Fair grounds 19 Stables, piggeries, animals, birds, etc. 53 Insect pests 54 Paddling pool samples 24 Refuse tips.. 54 Rodent and vermin infestation 233 Schools 5 Smoke complaints and observations 85 Unclean premises 41 Water samples (main supply) 17 Well water supplies 7 Watercourses 76 Miscellaneous visits 98 Re-inspections 332 Factories and Outworkers : Number of visits paid 310 Shops Act : Number of inspections 553 Miscellaneous (visits paid) : Heating Appliances (Fireguards) Act 13 Massage establishments 7 Old Metal Dealers 18 Pet Animals Act 38 Rag Flock and Other Filling Materials Act 4 Infectious Disease: Number of visits paid (including contacts) 1,083 Number of notices served: Informal 748 Statutory 130 20 The main headings under which work was done may be noted as follows: Housing 3,409 visits Inspection of Food and Food Premises 3,344 General Sanitation 1,666 Infectious Diseases 1,083 Shops Act Inspections 553 Factories and Outworkers 310 Public Health Inspectors' Work. The work of the Inspectors covered an increased volume as compared to the previous year. I would regard it as misleading to assess the value of an Inspector's work purely on the number of visits which he is able to arrange on this or that branch since thorough inspections and detailed investigation into points arising, for example, under the Food and Drugs Act and The Clean Air Act are time-consuming in their effects but practically if not statistically on that account probably rewarding in their results. I have endeavoured at all times during this year and previously to secure a co-ordination between the work of the Public Health Inspector and that of the Local Health visitors who come under the direction of the Area Medical Officer. In this endeavour—notably perhaps in the field of the Care of the Aged—I have worked in close harmony with Dr. Boul, The Area Medical Officer, Miss Knox, his Superintendent Health Visitor and Miss Thompson his Superintendent of Midwives and Home Nurses. SECTION D. HOUSING Number of New Houses erected during the year: (i) By the Local Authority 263 (ii) By other Local Authorities 160 (iii) By other bodies or persons 1,619 Number of Houses made fit following representations: 1. 72, Front Lane, Cranham. Number of Houses voluntarily demolished: 3. 34, Front Lane, Cranham. 273 and 275, St. Mary's Lane, Upminster. Number of Houses voluntarily closed: 6. 84, Billet Lane, 141, „ 145, „ 125, North Street, 127, „ 129, „ 21 Number of Demolition Orders made: 6. 116, 118 and 120, Ardleigh Green Road. " Old Romford Lodge, "Aveley Road, Upminster. 6, Church Lane, Wennington. " Glen Rosa," Glebe Road, Rainham. Number of Houses demolished following representations: 27. 68, 70, 72, 74 and 76, Ardleigh Green Road. 108, 110 and 112, Ardleigh Green Road. " Old Romford Lodge," Aveley Rad, Upminster. 2, 3, 4, 5 and 6, Old Gun Site, Brentwood Road. 6, Church Lane, Wennington. " Glen Rosa," Glebe Road, Rainham. 7, 9, 11, 13, 15 and 17, North Street. 82, North Street. " Zanda," 42, Stanley Road North, Rainham (by Council in default). " Rose Villa," Briscoe Road, Rainham. Structure at " Ellens Farm," Briscoe Road, Rainham. " St. Theresa's," Berwick Road, Rainham. Certificates of Disrepair. 6 applications for Certificates of Disrepair under the Housing Repairs and Rents Act, 1954, were received by the Council during the year and after investigation 1 was withdrawn. 4 Certificates were issued and 1 was refused. It is interesting to note that since the Act came into operation a total of 48 applications have been received. 30 Certificates were issued, 17 of these were subsequently revoked, 12 refused and 6 withdrawn. Improvement Grants. In connection with applications under this heading our advice has been sought in 27 instances during the year. Our opinion has then been submitted to the Surveyor for consideration by the Committee when the application for grant came up for determination. Re-Housing—Medical Aspects. A slight diminution took place in the number of certificates submitted to me during the year. Medical priority cannot be dissociated from considerations of other basic re-housing qualifications although in unusual circumstances some relaxation of these qualifications may be permitted by the Council on medical grounds. The majority of medical certificates submitted do not demand any high priority of re-housing. Overcrowding. The general position is doubtless improved with the increased provision of houses in the district. Individual instances—notably in Rainham—suggest that certain houses may be let off in apartments to a variety of friends, relatives and lodger:) (or all three) to a number exceeding that permitted under the Housing Acts. This state of affairs appears likely to arise largely— 22 if not exclusively—amongst non-natives of this country and is explained often by a householder allowing his sympathy for his fellow-countryman (or often fellows of some other country) to outrun his discretion. Housing standards can be lowered very easily in this fashion and no matter how well intentioned such a householder or owner may be the habit is apt to spread and is not in my view to be tolerated. The 'permitted number' for any house is obtainable from my office and it is designed to be a practical guide to the number of persons who can occupy a house and not merely to become a statistical ornament. General District Development. It can be said truly and in a complimentary sense that within the last few years parts of this district have through development become unrecognisable. The South Hornchurch area at the present time is an excellent example of this fact. Caravans. One large unauthorised site still remains occupied in the district and has been the object of protracted legal action which is doubtless on the way to producing the desired effects. Land Charges Enquiries. During the year 3,875 land charges enquiries were referred to the department regarding the question of outstanding sanitary notices. Temporary Accommodation. Whilst some week-end bungalows are still with us the fact that ground for development has become so valuable has indirectly assisted greatly in getting rid of the sub-standard buildings occupying sites since the demolition of the buildings and the comprehensive and modern re-development of the site appears to be a more favourable proposition than leaving the sub-standard building in situ. Sub-Standard Accommodation. During the year we represented 6 houses individually. SECTION E. INSPECTION AND SUPERVISION OF FOOD Food and Drugs Administration. During the year some 316 samples were taken and of these 9 were unsatisfactory in some particular. In addition 22 food complaints were submitted to the Public Analyst with the results noted. The general pattern of our sampling programme has been divided between Food and Drugs. 23 The Food section has been more satisfactory in that it poses problems and difficulties which—if not always completely soluble—at least in a spirit of informality and compromise achieved relative solution. The formal and informal samples covered a wide range and established the high standing of our food supplies. The number and nature of the complaints received from the general public shows that the part played by this department is recognised. The Drug sampling side of the work is at once satisfactory and less satisfactory. The many popularly advertised preparations sampled have been established by the Analyst to contain what they purported to contain and hence to be genuine. In some instances their claims might be described with moderation as being optimistic especially when they enter—or claim to enter—the field of prevention against common diseases with ill-defined or unknown causes. The onus of proof that any claims are in the legal sense misleading is however, heavy and not to be lightly embarked upon. A review of our work during the year has in this connection therefore, proved interesting and informative but to some extent unrewarding. A new scale of fees for Public Analysts was approved, viz: from 21/- to 28/- for milk samples and from 35/- to 50/- for other samples. 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. The under-noted tables are self-explanatory. SAMPLES SUBMITTED TO PUBLIC ANALYSTS AND FOUND TO BE GENUINE Article No. Article No. Almonds, ground 1 Cheese, processed 1 Apple Sauce 1 Cheese Spread 2 Baking Powder 1 Cheese and Tomato 1 Batter Flour Mixture 1 Cherry Ginger Concentrate 1 Beans baked in Tomato sauce with pork sausages 1 Chickettes 1 Chop Sauce 1 Beef, corned 1 Coconut 1 Biscuits 1 Coconut Ice 1 Blackcurrant Cordial 1 Coconut Macaroons 1 Blackcurrant Juice Syrup 1 Cod Roe, smoked 1 Bread 6 Coffee 1 Bread loaves and rolls 1 Coffee and Chicory product 1 Browning for gravies 1 Confectionery and sweets 9 Butter 6 Cornish Pasty 1 Butter Coconut Macaroons 1 Cream 2 Cake Mixture 1 Currants 1 Caraway Seeds 1 Curry Powder 1 Celery Salt 1 Custard Powder 2 Cheese 1 Dates 1 24 Article No. Article No. Dripping 2 Ruti Concentrate 1 Egg Custard Tarts 1 Salad Cream 1 Faggots 1 Salt 2 Figs 1 Sauce 1 Fish Fingers 1 Sausages, Beef 5 Fruit Pudding 1 Sausages, pork 3 Gelatine 1 Sausage Meat, pork 1 Ginger Beer 3 Saveloys 1 Glucose Drink 1 Scones 1 Glucose Lozenges 1 Self-raising flour 2 Golden Raising Powder 1 Soup, Cream of Tomato 2 Honey 1 Steak and Kidney Pie 2 Horseradish, grated 1 Suet, shredded beef 2 Ice Cream 31 Sugar 1 Ice Cream Mix 1 Tapioca Flakes 1 Jam 2 Tea 1 Jelly , 1 Tomato Juice 1 Jelly Cream 1 Tomato Ketchup 1 Jelly Crystals 2 Tomato Puree 1 Kidneys, braised 1 Tomato Sauce 1 Kreemy Fruits 1 Vegetable Soup 1 Lemon Juice 1 Vinegar 1 Lemon Squash 1 Venegar, malt 1 Lemonade Powder 1 Wheat Embryo 1 Lollies 15 Apricot Liqueur 1 Margarine 2 Beer 1 Marmalade 1 Chocolate Liqueur bottles 1 Meat Patties 1 Cointreau 1 Meat Pudding 1 Gin 1 Meat Soup 1 Rum 1 Meringues 1 Vermouth 1 Milk 44 Whisky 1 Milk bottle 1 Wine Cocktail 1 Milk, condensed 2 Acriflavine Balm 1 Milk, evaporated 1 Adrexalin Liquid 1 Milk Chocolate Cake Coating 1 Ammoniated Tincture of Quinine 2 Mincemeat 1 Baby Cough Syrup 1 Mint in Vinegar 1 Bisurated Magnesia 1 Orange Curd 1 Bronchial Balsam 1 Orange Squash 2 Calamin Cream 1 Peas, Garden 1 Calamine Lotion 1 Pastry Mix 1 Calsimil Tablets 1 Puff Pastry 1 Camphorated Oil 1 Puff Pastry Mix 1 Cherry Bark Linctus 1 Pudding Mixture 1 Chest and Throat Antiseptic 1 Ravioli with Tomato Sauce 1 Rice, flaked 1 Chloro-Yeast Tablets 1 Rice, granulated 1 Citrate of Magnesia 1 Rice, ground 1 Cold Capsules 2 Roe Liver Paste., 1 Cold sore ointment 1 25 Article No. Article No. Cream of Magnesia 1 Oils of Amber, Clove Cream of Tartar 1 camphorated 1 Enerjoid Tonic Tablets 1 Olive Oil 1 Eucalyptus Menthol Pastilles 1 Phospherine 1 Pro-plus Tablets 1 Eye Drops 1 Radio Malt 1 Fibrosine Balm 1 Regasprin 1 Fish Oil Capsules 1 Saccharin Tablets 1 Flower of Sulphur and Treacle 1 Saccharin Sodium Tablets 1 Skin Ointment 1 Fruit Preserving Tablets 1 Slimming Treatment 1 Geeps 1 Soda Mint Tablets 1 Gripe Water 1 Spirit of Camphor 1 Halibut Liver Oil Capsules 1 Spring Family Medicine 1 Honey and Horehound Compound 1 Sulphur Ointment 1 " Sure-Rest" Tablets 1 Lactochoc 1 Syrup of Figs 1 Liquid Paraffin 1 Teething Jelly 1 Lion Ointment, blue 1 Toothache Drops 1 Lotil Ointment 1 Valderma Antiseptic Balm 1 Lystone Salt 1 Vitamin Mineral Capsules 1 Nasal Compound 1 Nerve Tonic 1 Total 307 Noctynol Tablets 1 Oastrax Tonic Tablets 1 In the case of the samples of Condensed Milk the Analyst certified them as genuine but in view of a labelling offence proceedings were taken against the Vendors under the Public Health (Condensed Milk) Regulations, 1923/53. The prosecution was on the grounds that the tin was not labelled so as to give the name and address of the manufacturer or of the dealer or merchant in the United Kingdom for whom it was manufactured. The case was dismissed on the grounds that a warranty was pleaded by the retailing company and accepted by the Magistrates. 26 SAMPLES SUBMITTED TO PUBLIC ANALYSTS AND FOUND TO BE ADULTERATED OR UNDER STANDARD, etc. Sample No. ARTICLE Nature of Adulteration or Irregularity Action taken Inf.991 Cream Buns. Filling consisted not of cream but of imitation cream. Matter considered by Council — firm warned. Inf. 1014 Liqueur Bottles (assorted chocolates). Contained insufficient alcohol to justify description " Liqueur chocolates." Matter considered by Council. No offence committed under Food and Drugs Act 1955 or Labelling of Food Order. F.977 Macaroni and grated cheese Dinner. Wrapper stated to contain the complete ingredients for macaroni and cheese grated but directions stated margarine and milk to be added. Therefore the statement "complete ingredients" is incorrect. After consideration by the Council, matter brought to manufacturer's notice Assurance given that label has been reworded and instructions given for calling in old type packets. Inf. 1034 Pop Corn Contained insufficient calcium to justify the claim " provides more calcium than many other foods." Formal follow-up sample taken. F.972 Pop Corn Contained insufficient calcium to justify the claim " provides more calcium than many other foods." After detailed consideration by Council it was decided that legal proceedings should not be instituted, the manufacturer having already ceased to produce these goods and the retailer withdrawing remainder of stock from sale. Inf. 1076 Nerve Tonic. 8% deficient in protein. Formal follow-up sample taken. F.996 Nerve Tonic. 8% deficient in protein. Brought to manufacturer's notice and suggested to them that label should be amended so as to either give true protein content or to give the actual casein content withour reference to protein. 27 Sample No. ARTICLE Nature of Adulteration or Irregularity Action taken Inf.1198 Starch Reduced Bread. 10% deficient in protein. Formal follow-up sample taken. F.1049 Starch Reduced Bread 13% deficient in protein. Brought to manufacturer's notice who undertook to keep a close watch on the factors which tend to decrease the protein content of a food such as this, and if necessary to have new labels printed carrying a lower protein figure in the disclosed analysis. FOOD COMPLAINTS REFERRED TO PUBLIC ANALYSTS. Sample No. ARTICLE Nature of Adulteration or Irregularity Action taken Cpt.992 Slice of Bread. Contained a greyish foreign body found to consist of a mixture of dough—mineral matter (mortar). Matter considered by Council Bakery firm warned. Cpt.1045 Bread Contained fragments and streaks of blackish foreign material. Consisted of dirty or discoloured dough. Matter considered by Council—Bakery firm warned. Cpt.1046 Bread Contained fragments and streaks of blackish foreign material. Consisted of dirty or discoloured dough. Matter considered by Council Bakery firm warned. Cpt.1072 Bread Contained a foreign body found to consist of an orange coloured label. Matter considered by Council—Bakery firm warned. Cpt.1073 Milk — containing extraneous matter. Contained foreign matter in suspension. Found to consist of a milk film covered Matter considered by Council — Dairymen warned. Cpt.1093 Bread roll. with mould growth. Contained a greyish foreign body found to consist of a mass of discoloured fatty dough. Matter considered by Council—Bakery firm warned. 28 Sample No. ARTICLE Nature of Adulteration or Irregularity Action taken Cpt.1115 Milk—alleged to contain piece of glass. Examination of milk showed it to be free from fragments of glass and bottle free from fractures except for rim. Matter considered by Council—no further action. Cpt.1116 Bread. Contained blackish foreign matter consisting of blackened dough. Matter considered by Council—Baker warned. Cpt.1119 Bread —• loaf of. Had a sickly odour and contained damp sticky masses. Objectionable condition of the bread due to the development of 'rope.' Matter considered by Council— Baker warned. Cause for complaint partially due to loaf being cut and wrapped before being cooled down sufficiently. Cpt.1120 Doughnut— portion of. Contained foreign matters in the form of small masses of sacking fibre. Matter considered by Council — Baker warned. Cpt.1121 Orange Drink. Contained a blackish deposit found to consist of mould growth. Matter considered by Council —- Bottling firm warned. Cpt.1122 Milk. Contained foreign matter in the form of mortar or cement. Matter considered by Council — vendor warned. Cpt.1143 Milk. Had an objectionable butyric smell and taste. In co-operation with Milk Regulations Officer arrangements Cpt.1143a Milk. Had an objectionable butyric smell and taste. for washing bottles and supply of clean bottles investigated. Cpt.1144 Milk. Had an objectionable butyric smell and taste. In view of unsatisfactory position farmer decided to discontinue bottling of milk. Cpt.1145 Milk. Contained foreign matter in the form of fragments of leaf tissue. Matter considered by Council — Bottling firm warmed. Cpt.1146 Milk — in alleged dirty bottle. Analyst reported that milk free from extraneous mineral matter but inner surface of bottle showed patches of white film which was magnified when bottle full of milk. No action necessary. 29 Sample No. ARTICLE Nature of Adulteration or Irregularity Action taken Cpt.1147 Bread - loaf of. Contained fragments of foreign matter found to consist of charred or burnt bread. Matter considered by Council — Baker warned. Cpt.ll 48 Wafer Biscuits alleged to have caused sickness. Analyst reported that the biscuits were examined and found to be free from any harmful substances. No action necessary. Cpt.1185 Milk. Contained fragments of leaf tissue. Matter considered by Council Bottling firm warned. Cpt.1192 Aniseed Balls alleged to have caused sickness. Analyst reported that examination showed the aniseed balls to be free from harmful metallic contamination No action necessary. Cpt.1215 Essence of Rennet — alleged to have caused sickness. Analyst reported that examination of the rennet showed it to be free from any harmful substances. No action necessary. FOOD COMPLAINTS WHERE ANALYSIS WAS NOT REQUIRED. Complaint Action Bread containing piece of lead. Bottle of milk containing bottle cap. Manager of Bakery firm warned. Dairy firm warned. Cake containing insect. Piece of glass in 1/3 pint bottle of milk. Manufacturer warned. Matter taken up with firm concerned. Stale and mouldy meat pies. Piece of glass in bottle of milk. Vendor warned. Matter taken up with vendor and manufacturer. Alleged glass in tin of salmon. Found to be chemical deposit usual in salmon and not glass. Slice of bread containing dark brown particles. Only one slice of the loaf available—no action possible. Unpleasant taste of meat pies. Matter taken up with manufacturer. 1/3 pint bottle of milk alleged to contain a fly. Matter taken up with firm concerned. Piece of glass in 1/3 pint bottle of milk. Matter taken up with firm concerned. Mouldy meat pies. Matter taken up with vendor and Manufacturer. Mouldy cream filled slab cake. Vendor warned. 80 Complaint Action Maggots in currants. Matter taken up with firm concerned and all stock checked. Maggots in currants. Warning given to firm concerned who took matter up with their suppliers. Maggot in chocolate caramel. Matter taken up with vendor; remaining stock withdrawn from sale. Sponge cake with wasp embedded in under surface. Manufacturer warned. Glass in 1/3 pint bottle of milk. Matter taken up with firm concerned. Maggots in currants. Firm concerned prosecuted at Romford Police Court. Pleaded guilty and fined £20. Sausage containing piece of vein from meat. Matter taken up with manufacturer. Milk bottle in dirty condition internally. Matter referred to local authority in whose district milk was bottled. Grit in tin of plums. Matter taken up with firm concerned and sediment found to consist of portions of disintegrated plum stone. Packet of currants stated to be dirty. Matter taken up with vendor. Poor texture of sliced loaf. Baker stated poor texture due to slicing before being properly cooled. 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 68 Cafes 55 Confectioners (bread, cakes etc.) 33 (sweets, etc.) 107 Fish shops 29 Grocers 172 Greengrocers 92 Ice Cream Dealers 280 Ice Cream Manufacturers 14 Food and Drugs Act, 1955—Food Hygiene Regulations 1955. 280 notices were served during the year on owners or occupiers of premises coming within the scope of these Regulations. 81 Unsound Food. During the year the following foods were voluntarily surrendered to the Public Health Inspectors as being unfit for human consumption:— Tons Cwts. Lbs. Ozs. Meat — 8 63 14 Fish — 3 21 — Poultry — 2 13 8 Tinned Meat — 9 48 4 Tinned Fish — — 106 10 Tinned Milk — 9 5 15 Tinned Food 1 — 109 6 Miscellaneous Groceries — 6 99 13 Skim Milk Powder — — 80 — 3 1 100 6 Clean Food. The application of the Food Hygiene Regulations to individual premises within the area was made the subject of both general propaganda and personal approach by the District Public Health Inspectors. It is inevitable that the application of any legislation of this nature should on occasion be difficult to relate practically to every premise coming within its scope. It can be said that in this district the Inspectors have secured a very wide measure of co-operation in carrying out the various works which were deemed necessary to make these premises comply with the Regulations and so maintain a standard of food hygiene in keeping with modern demands. Four Certificates of Exemption were issued during the year. When it is stated that only 9 applications for Certificates of Exemption under Section 16 were made, the full measure of the co-ordination that has been received is evident. The applications were considered by the Committee in considerable detail and were only granted where it could be established that the difficulties of complying with the Regula tions were in fact insuperable. Meat Inspection. It was agreed that model bye-laws concerning slaughterhouses should be adopted. The question of providing a municipal abbatoir was investigated in concert with other Authorities and at the end of the year the matter stood adjourned sine die. Slaughter of Animals Acts, 1933 to 1954. Seven slaughterman's licences were issued during the year. 82 Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Horses Number killed 477 179 1,437 1,311 — Number inspected 477 — 179 1,437 1,311 -- All diseases except Tuberculosis— Whole carcases condemened - - - - - - Carcases of which some part or organ was condemned 44 - - 6 15 - Percentage of number inspected affected with disease other than tuberculosis. 9.2% - - 4% 1.1% - Tuberculosis only— Whole carcases condemned 1 - - - - - Carcases of which some part or organ was condemned 23 - - - 22 - Percentage of number inspected affected with tuberculosis 5.03% - - - 1.7% - Cysticercosis— Carcases of which some part or organ was condemned - - - - - - Carcases submitted to treatment by refrigeration - - - - - - Generalised and totally condemned - - - - - - Ice Cream. During the year 21 applications for registration as vendors and 13 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 280 for the storage and/or sale of ice cream. Our bacteriological sampling increased from 86 last year to 98 this year. 78 proved satisfactory. In addition 44 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 53 yersons and 72 premises were registered for the manufacture of preserved meat, an increase of 10 persons and 12 premises. The increase appeared mainly due to grocers cooking their own hams. This practice requires constant vigilance in hygiene if it is not to be a source of potential difficulty. I think that this point has been duly impressed upon the applicants and upon everyone cooking ham in this fashion but a formal word on the matter here may not be amiss. 38 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 42 persons and 12 premises had been registered. Clean Food Propaganda. One thousand copies of the Central Council for Health Education "Guide to the Food Hygiene Regulations 1955 " were purchased and distributed on a wide scale to the various traders and persons concerned in the execution of the Regulations. Milk Pasteurising Plant. The only plant operated in the district continues to give satisfactory results. 53 methylene blue and phosphatase test samples were examined and in one instance failed the phosphatase test. 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 42 shopkeepers are registered for the sale of bottled milk only. Cleanliness of Milk Bottles. The bottles in which milk was supplied by a local vendor were examined empty and immediately before filling for distribution. Initially the results were not wholly satisfactory but on further investigation and on advice being given to the supplier, a completely satisfactory result was obtained. The crates in which the bottles are distributed were also investigated and proved satisfactory. May I once again exhort the public to wash empty milk bottles before they are returned to the vendor. The Milk (Special Designation) (Raw Milk) Regulations 1949-54, and The Milk (Spccial 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) I Dealer's (Pasteurised) 51 Supplementary Pasteurised 7 Dealer's Sterilised 72 Supplementary Sterilised 8 Dealer's Tuberculin Tested 38 Supplementary Tuberculin Tested 6 84 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 158 cases a satisfactory report was received. In addition 51 samples were submitted to the Public Analysts and 12 for biological examination. Biological Samples. A positive result was obtained from the milk from a local farm examined biologically for B. Tuberculosis. Whilst no danger to the public health oh this account existed (because of the heat treatment to which the milk would in any event have been subjected before human consumption) it nevertheless indicates that even with the rapid advance in the quality of our herds occasions still arise when serious unsatisfactory results are obtained. Liaison With Other Authorities. Apart from our existing arrangement with the London County Council through which the results of our testing of milk supplied to their Children's Homes in this district were transmitted to them, agreement has now been reached by which I supply the Brentwood Hospital Management Committee with the results of our milk testing of the supplies to their Harold Wood and Harold Court Hospitals. School Canteens. A very detailed report was presented to you during the year on the condition of each school canteen and the extent to which it fell short of the Food Hygiene Regulations 1955. The principal directions in which individual canteens failed mainly related to certain points concerning ventilation, hand-washing facilities, storage of clothng and the like. It is the intention of the Council that the standard adopted for canteens should be of the highest and on the attention of the Divisional Education Committee being drawn to works which are considered necessary to achieve this object, a considerable amount of relatively minor work was proceeded with. The result was to effect a substantial improvement in the conditions of the canteens (which were it should be emphasised by no means bad initially) and a continuation of the necessary works to ensure complete compliance with our requirements was in process at the end of 1956. Game Dealer's Licence. One Game Dealer's licence was issued during the year pursuant to Section 27(1) of the Local Government Act, 1894. 35 SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER NOTIFIABLE DISEASES A substantial increase is noted in Scarlet Fever and Whooping Cough notifications, a much lesser increase in Dysentery and Food Poisoning. This not being a year of high Measles incidence there was a very substantial decrease in the number of cases of this disease and a gratifying fall in Poliomyelitis notifications is also recorded. The rise in Scarlet Fever cases is not really remarkable if one reflects that it is a mild highly infectious condition whether with or without a rash, has no specified period of isolation and on occasions it may be questioned whether any prolonged isolation is practised at all. It represents our most unsatisfactory disease to deal with administratively and the only saving grace appears to be that it is mild in form with few complications. A special note was made on Infective Hepatitis during the year, viz: This disease is notifiable under the Jaundice Regulations 1943 in the Eastern Region and encouraged to some extent by a query from Dr. Geffen of the Ministry of Health, I have analysed its behaviour in Hornchurch during the past two years. It will be recalled that a detailed report on a somewhat extensive yet localised outbreak in the district was reported by me in 1954. An attempt has been made in this instance to analyse the local incidence of the disease as between the two years on a comparative basis relating to various factors which might be shown to have a particular connection with it, viz: Number of Cases': In 1956 there were thirty three cases and in 1955 twenty four. Age of Cases. 1956 1955 M. F. M. F. 0—4 — -— — 3 5—10 4 11 1 2 11 — 20 5 3 1 — 21—30 — 1 2 3 31 — 40 2 2 — 2 41 — 50 2 1 1 — 51 — 60 — 1 4 3 Over 60 — 1 — 2 It will be observed that in 1956 no pre-school child was attacked although in fact five 6-year old and five 7-year olds were affected. In the later age groups it is evident that nine people over 50 contracted the disease in 1955 as against two the following year. 86 Month of Occurrence: 1956 1955 January 2 4 February 1 0 March . 0 2 April 2 4 May 0 5 June 2 0 July 6 1 August 7 2 September 4 1 October 1 1 November 6 2 December 2 2 Sequence of Notifications by Wards: The numbers below represent the notifications in chronological order as they were received by me. This analysis was done to elicit any particular grouping which happened to be present and to evidence whether the condition was largely limited to any particular part of the area: — WARDS 1955 1956 Elm Park . 22. 26, 28, 29, 30, Emerson Park 3, 13, 20, 21. Nil. Harold Wood Nil. Nil. North West 1, 2, 6, 17. 6, 8, 9, 11, 15, 16, 17,18,21, 23, Rainham 7, 9, 10, 14, 15, 16, 18, 24. 2, 3,'7, 24, 27, 31, 32, 33. Upminster and Cranham 5, 8, 12, 19. 1. Town 4,11,23. 5, 10, 12, 13, 14, 19,20,25. Numbers in the Home: 1956 1955 Under 3 persons — 3 3 persons 4 5 4 persons 12 7 5 persons 8 2 6 persons 3 3 7 persons 2 1 The remaining cases were not suitable for inclusion under this heading. Occupation: It is of interest to note that in 1956, 22 school children were affected whereas in 1955 only 4 were attacked. The remaining cases showed a natural variety of occupations which did not appear to have any particular relevance to the disease. Isolation of Cases: Seven cases were removed to hospital in 1956 and two in 1955, the remainder being treated at home with a natural range both of isolation and of the period for which isolation was attempted. 37 Contacts—1956: (1) A boy of 13 contracted the disease on the 10th August whilst residing in a house containing his parents and 4 brothers and sisters. No spread in the actual family came to light but a boy of 10 attending a different school altogether but a friend of the patient became ill on the 27th August. (2) A housewife of 34 contracted the disease on the 19th July, there being in the house also 3 school children aged 15, 13 and 7. The 13-year-old commenced the disease on the 21st August. (3) On the 1st July a girl of 7 years contracted the disease to be followed on the 29th July by the sister aged 10. A friend of the above children a girl of 7—commenced the disease on the 11th August. Of the remaining cases in one instance the brother of a man in the Services (who was a case) had had Jaundice 3 months before. It is certainly of interest to note that although the disease showed itself in one particular instance amongst families living under largely communal conditions there was not in fact any spread. Contacts—1955: In one family a boy of 12 contracted the illness on the 12th November to be followed by a brother of 7 on the 11th December and a brother of 16 on the 21st December. Remarks. It is exceedingly difficult to draw any firm conclusions from the foregoing details or at any rate to draw such conclusions as would suggest that this illness has anything like a fixed pattern of behaviour. Viewed in the light of any or all of the headings under which the two years have been compared, the results do not appear to provide a consistent picture. Whilst Rainham, including both years, provides the largest single Ward number of cases, North West in fact had more cases in 1956 and Town Ward had the same numbers, whilst in 1954 Cranham had of course more than any of them. So far as concerns actual infectivity it would seem that this at any rate for the two years under review is not, speaking generally, of a high order and has an incubation period which may be of several weeks duration. The limited analysis I have made of the position in this district during the two years mentioned does not so far as I can see establish anything save the inconsistency of the disease but nevertheless may be of value in providing comparative data for use with similar investigations made either here or elsewhere. 38 Infectious and Other Notifiable Diseases, 1956. Disease Total eases notified No. of Cases hospitalised Dysentery 34 10 Encephalitis (post-infectious) 1 1 Erysipelas 18 4 Food Poisoning 23 4 Infective Hepatitis 33 7 Measles 630 8 Meningococcal infection 1 1 Ophthalmia Neonatorum 3 0 Paratyphoid Fever 2 2 Pneumonia 18 4 Poliomyelitis— Paralytic 8 8 Non-paralytic 5 4 Scarlet Fever 167 5 Whooping Cough 298 9 It is interesting to note that in 1936 there were 6 deaths from Diphtheria; 4 male and 2 female, and in 1926, with an estimated population of 11,370, 1 death from Diphtheria; in 1946 46 respiratory and 5 other tuberculosis notifications; in 1936 the corresponding figures were 31 and 5 and in 1926 from a smaller population 20 and 5; in 1936 and 1926 each show 3 deaths from Measles. As compared to the present day these are illuminating figures. Poliomyelitis Paralytic:. It is relatively satisfactory to see that during the year only some 13 cases were notified in this district although the ratio of paralytic to non-paralytic has not been of an equally good order. In all 8 paralytic and 5 non-paralytic cases were notified. The paralytic cases comprised 5 males aged 29, 18, 15 and 2 years and 3 females aged 10, 7 and 4. The hospital stay varied from 128 days to 21 days. The lower limb was attacked in 5 instances, the upper limb in one and both upper and lower in 2. The cases occurred as follows:— January 1 February 1 August 2 September 1 November 2 December 1 Follow-up of paralytic cases: Of the 8 paralytic cases, three appear to have recovered completely; 1 is still in hospital; 3 attend hospital once a week and 1 attends hospital three times a week. 39 Non-paralytic: The non-paralytic cases nominally total 5 although one of them— whilst strictly notifiable—must be regarded as having certain points of doubt about the diagnosis. It is interesting to observe that of this type 4 of the cases were males, one being 24 years and 3 ten years, whilst the one female affected was a 10-year old. Thus 4 of the non-paralytic cases were aged 10. The months in which the attacks took place were August (1), September (2), and December (1). It is clear that at any rate here in Hornchurch the disease cannot be regarded as being one of the summer months since last year cases occurred in October (3), November (3) and December (2), whilst this year sporadic cases have cropped up additionally in January and February. Whether the months of major incidence remain the summer months or not the fact remains that to some extent this disease is clearly always with us. Paratyphoid B. Fever. One case occurred in a local hospital having originated almost certainly outside the district. A child of 15, very shortly after arriving in the district developed an illness diagnosed as Paratyphoid B. No spread occurred. Dysentery and Food Poisoning Group. 23 cases of Food Poisoning were notified during the year as against 15 for the previous year, whilst the number of Dysentery notifications increased to 34. The following is a copy of the Annual Return of Food Poisoning notifications for the year 1956 which is sent to the Ministry of Health in accordance with statutory requirements:— 1 st Quarter 2d Quarter 3rd Quarter 4th Quarter TOTAL 2 2 8 11 23 Outbreaks due to Identified Agents: Total Outbreaks: Nil. Total Cases: Nil. Outbreaks of Undiscovered Cause : Total Outbreaks: Nil. Total Cases: Nil. Single Cases : Agent Identified: 1. Unknown Cause: 22. 23 (Salmonella Typhimurium: 1). Food Poisoning: Three oases came to light as suspected food poisoning in which the most likely cause appeared to be a brisket of beef which had been consumed by all the sufferers. Proof is always difficult to obtain without there being some reservations and this case proved no exception so that the exact origin must remain presumptive. 40 Another outbreak reported was of some 8 or 10 people out of 60 who attended a wedding reception becoming ill within a few hours after a main meal, which as might be expected comprised a variety of food which could conceivably have been responsible. Amongst the food suspected was ham (hock) which had pursued a rather less direct path towards its consumption than most of the other food concerned and hence might have been more susceptible to contamination. Be that as it may the outbreak was very suggestive but not proven of having a staphylococcus toxic origin. Various other minor instances involving largely individual cases were brought to notice. Sonne Dysentery: For some unknown reason there appears to be an increase of this particular type of Dysentery in various parts of this district and—as is evident from general reading—in many other parts of the country as a whole. One particular outbreak in this district related to Oglethorpe School at which a large number of cases or suspected cases occurred both in the Junior and Infant Schools. Scrupulous investigation of the canteen and staff was made and no possible reflection can rest upon either of these as a possible source. Each case or suspected case was investigated primarily to deal with any house contacts who might also be suffering or had suffered from the condition and who might be in a positiion which could give rise to a spread, e.g. a suspect engaged in the food industry. In point of fact surprisingly few contacts were found who were in a position to cause any communal trouble and very many of the absentees from school whilst the Sonne Dysentery outbreak was prevalent, were found to be absent from causes quite dissociate from Sonne. It was deemed impracticable to carry out a meticulous bacteriological investigation of every case and suspected case with a view to securing three or more negatives before school return and a more arbitrary decision was taken, in agreement with the Divisional School Medical Officer, that after a certain period of exclusion a child was allowed to return to school. This policy appeared to work reasonably well and by the time the Christmas holidays had arrived (the outbreak came to light 26.11.56) the outbreak was showing signs of diminution and in fact—as a review in early 1957 proved—it had finally died during the holidays. An individual, but interesting instance arose of a food handler in this district being ascertained to be a Sonne 'carrier' as a result of investigations made in her district of residence and in which she was a household contact of a case of Sonne. In agreement with the Medical Officer of Health of her area of residence, this lady—a waitress—was excluded from work under the terms of the Public Health Infectious Disease Regulations 1953, until proved bacteriologically to be freed of the possibility of transmitting infection. I am in fact authorised to deal with cases of this type under the Fourth Schedule of the Public Health Infectious Disease Regulations, 1953, and this enabled the matter to be dealt with immediately and without reference to or delay in awaiting a particular Committee or Council meeting. 41 With the increasing amount of Gastro-intestinal infection it must equally be a source of increasing concern that food handlers may from time to time be ascertained to be suffering from or 'carriers' of Dysentery or Food Poisoning germs and may on this account have to be excluded from work. I consider it doubtful whether the vast progress made in the field of antibiotics can always be reflected in dealing with cases or especially 'carriers' of, for example, Sonne. Certainly duration of the 'carrier' state in some of these instances is problematical and even lengthy. It can readily be understood that one or two instances of this kind could involve a local authority in a substantial and hardly to be anticipated outlay in compensation. Mass X-Ray Unit. This Unit visited Hornchurch from 22nd August to 8th October. Details are noted below. The 1954 totals are given in parenthesis. Centre No. X-rayed on miniature film No. recalled for large film M. F. Total M. F. Total Rainham Combined Treatment Centre 320 396 716 (689) 6 8 14 S. Hornchurch Clinic 296 405 701 (644) 9 12 21 Elm Park Day Nursery 414 668 1,082 (954) 12 16 28 Billet Lane Hall 844 1,326 2,170 (1,644) 30 22 52 Health Service Clinic, Upminster 649 1,253 1,902 (1.011) 9 16 25 Local Works 1,070 1,190 2,260 (745) 37 29 66 Totals 3,593 5,238 8,831 (5,687) 103 103 206 DETAILS OF GROUPS EXAMINED. Group Male Female Total General Public 1,858 3,349 5,207 Factories, offices, etc. 1,301 1,294 2,595 Scholars 387 542 929 General practitioner referrals 47 53 100 Total 3,593 5,238 8,831 Tuberculosis. The register at the end of the year showed an increase of both females and males in the respiratory sections. New cases were mainly noted in the 15 to 24 year-old female group. In spite of the increased numbers the picture generally is encouraging. The table showing the interval between notification and death not only dramatises the decrease in deaths but also the gradual increasing tendency for cases to live longer after notification. 42 Lest there be any false optimism however, it is clear that tuberculosis whilst very much on the run is still capable of running quite strongly. Its treatment has been advanced greatly, almost miraculously, in the past 20 years but its prevention still leaves us plenty of scope for endeavour. The number of cases of tuberculosis on the register at the end of the year was as follows:— Respiratory : Males 432 Females 389 Non-Respiratory : Males 42 Females 24 887 48 CASES OF AND DEATHS FROM TUBERCULOSIS, 1956 AGE GROUPS NEW CASES INWARD TRANSFERS TOTAL NO. OF CASES ADDED TO REGISTER DEATHS TOTAL DEATHS RESPIRATORY NONRESPIRATORY RESPIRATORY NONRESPIRATORY' RESPIRATORY NONRESPIRATORY M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Under 5 years 1 — - — — — — — 1 — — — — — — — 5—14 years 3 — 1 — — 3 — — 4 3 — — — — — — 15—24 „ 8 15 — — 4 11 — - 12 26 — — — — — — 25—44 ,, 14 5 1 3 16 16 2 1 33 25 - - - - - - 45—64 „ 7 2 — — 1 1 — — 8 3 3 1 — — 3 1 65 and over 4 — — — — — — - 4 — 1 — — — 1 — Totals 37 22 2 3 21 31 2 1 62 57 4 1 — — 4 1 44 INTERVAL BETWEEN NOTIFICATION AND DEATH OF FATAL CASES OF TUBERCULOSIS, 1947—1956 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 1956 1 — — — — — — 3 1 5 45 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 26 30 1 - (ii) Factories not included in (i) in which Sec. 7 is enforced by the L.A. 238 235 16 - (iii) Other premises in which Sec. 7 is enforced by the Local Authority 43 22 — — Total 307 287 17 — 2. Cases in which Defects were Found. Particulars Found Remedied Referred Prosecutions To H.M. Inspector By H.M. Inspector Want of cleanliness (Sec. 1) 1 1 — 1 — Inadequate ventilation (Section 4) 1 1 - 1 - Sanitary Conveniences (Section 7) (a) Insufficient 2 1 - 2 - (b) Unsuitable or Defective 26 15 - 8 - (c) Not separate for sexes 1 1 — — - Other offences against the Act 5 1 4 — - Total 36 20 4 12 - 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. 139 some premises. 46 INDEX Page Acknowledgments 6,23 Acreage 7 Aged, Care of 12 Ambulance Service 12 Atmospheric Pollution 5,14 Births 7 Birth Rates 7 —Comparative 8 Bury Farm Sewage Works 15 Canteens, School 34 Caravans 22 Care of the Aged 12 Centralised Slaughtering 31 Certificates of Disrepair 21 Cesspools 15 Clean Air Act 5,14,15 Clean Food Propaganda 31,33 Clinics, Child Welfare 12 Contents, Table of 2 Conversion 15 Crematorium 17 Deaths 7 —Age Groups 9 —Causes of 9 —Infantile 7 —Main causes (1947-1956) 10 —St. George's Hospital 8 Death Rates 7 —Area Comparability Factor 8 —Comparative 7 —Infant 7 —Neonatal 7 Disinfection 17 Disinfestation 17 Drainage and Sewerage 15 Dysentery and Food Poisoning 39 Essex County Council Act, 1952, Section 103 33 Essex River Board 16 Establishments for Massage or Special Treatment 17,19 Factories Acts, 1937 and 1948— Defects 45 Form 572 (Revised) 45 Inspections 19,45 47 Page Outwork 19,45 Visits paid 19,45 Fireguards 17,19 Food Poisoning and Dysentery 39 Food— Clean 31 Complaints 27 Hawkers 33 Inspection of 18 Meat inspection 31,32 Premises 18, 30 Preserved 32 Unsound 31 Food and Drugs Act, 1955 6, 22, 30 —Administration 22 —Food Hygiene Regulations 1955 30,31 —Public Analysts 4,23 —Sampling 23 Game Dealers 34 General Sanitary Circumstances (visits paid) 19 Health Propaganda 11 Heating Appliances (Fireguards) Act, 1952, and Regulations, 1953 17, 19 Home Nurses and Midwives 12 Home Safety 13 Hornchurch Urban District Council Act, 1936, Section 90 32 Houses— Inspection of 19 Number erected 20 Number inhabited 7 Housing 6 —Action under statutory powers 20,21 —Applications for rehousing (medical aspects) 21 —Closing and Demolition Orders 20, 21 —General district development 5,22 —Improvement grants 21 —Overcrowding 21 —Sub-standard property 22 —Temporary dwellings 22 —Visits paid 19 Housing Repairs and Rents Act, 1954 21 —Certificates of Disrepair 21 Ice Cream 32 —Registration 32 —Sampling 32 48 Page Infectious and Other Notifiable Diseases 5, 35, 38 —Hospitalisation 38 —Notifications 38 —Visits paid 19 Infective Hepatitis 35 Informal notices served 19 Ingrebourne Valley Sewer 15 Laboratory facilities 11 Land charges enquiries 22 Mass X-ray 41 Maternity and child welfare 12 Meat Inspection 31,32 —Carcases inspected and condemned 32 —Centralised slaughtering 31 —Slaughtermen's licences 31 Medical examinations 11 Members of the Council 3 Metal Dealers 18, 19 Midwives and Home Nurses 12 Milk- Bottles 33 Distributors 33 Pasteurising plant 33 Sampling 34 Special Designations 33 National Assistance Act, 1948, Section 47 13 Notices served 19 Nursing and Maternity Homes 12 Officers of the Public Health Department 4 Old Metal Dealers 18, 19 Outworkers 19 Paddling Pools 17 Paratyphoid B. Fever 39 Penny Rate Product 7 Pet Animals Act, 1951 18,19 Poliomyelitis 38 Population 7 Preface 5 Propaganda- Clean Food 33 Health 11 Public Analysts 4,23 Public Health Inspectors' work 18,19,20 40 Page Rag Flock and Other Filling Materials Act, 1951 18,19 Rateable Value 7 Regional Drainage Scheme 15 Riding Establishments Act, 1939 18 River Ingrebourne 16 River pollution 16 Rodent control 17 Safety in the Home 13 School canteens 34 Sewerage 15 Shops Act, 1950 (visits paid) 19 Slaughter of Animals Acts, 1933 to 1954 31 Staff 4.11 —Medical examinations 11 Staffing 11 Statutory notices served 19 Still Births 7 —Rates 7 Swimming Bath 16 Table of contents 2 Temporary dwellings 22 Tuberculosis 41 —Incidence and Mortality 43 —Mass X-ray 41 —Notification/Mortality interval 44 Vital Statistics 5,7 Water supplies 14