Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1958 Public Health Department, James Gorman, Council Offices. M.B., Ch.B., D.P.H., Billet Lane, Medical Officer of Health HORNCHURCH. ESSEX. Telephone: Hornchurch 52555. Hornchurch Urban District Council ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1958 Public Health Department, Council Offices, Billet Lane, HORNCHURCH, ESSEX. Telephone: Hornchurch 52555. James Gorman, M.B., Ch.B., D.P.H.. Medical Officer of Health 2 TABLE OF CONTENTS page Members of the Council (as at 31.12.58) 3 SECTION A— Statistics and Social Conditions of the Area 7 SECTION B— General Provision of Health Services for the Area 10 SECTION C— Sanitary Circumstances of the Area 13 SECTION D— Housing 24 SECTION E— Inspection and Supervision of Food and Food Premises 26 SECTION F— Prevalence of, and control over, Infectious and Other Notifiable Diseases 40 SECTION G— Factories Acts, 1937 and 1948 48 Index 49 3 MEMBERS OF THE COUNCIL (as at 31.12.58). Councillor G. W. Phillips, J.P., Chairman. (1) Councillor H. F. Moss, Vice-Chairman. (1) Councillor Miss C. F. M. Cannon. Mrs. E. H. Dean. (1) Mrs. W. M. Jiggins. Mrs. E. G. Richardson. R. A. H. Allen. A. T. Booton. (1) J. D. Cantwell. (1) and (2) L. W. Carroll, J.P. (1) F. W. H. Embleton. A. C. Good. (1) A. J. Hall. K. T. Hay. S. G. Heath-Coleman. W. Hegarty. E. A. Hillman, J.P. H. Holock. (1) W. E. Large. M. P. V. Leigh. (1) A. J. H. Okey. W. E. Philo. (1) and (3) H. D. M. Rivers. A. C. Salinger, J.P. S. B. Sanders. S. M. Tucker, J.P. A. J. Twigger. (1) C. A. Welch. R. E. Whitworth. A. E. Winch. (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. Chief Public Health Inspector: M. F. G. Randall, M.A.P.H.I. (1) and (2) Public Health Inspectors: J. Goodwin, M.A.P.H.I. (1) and (2) A. V. J. Hutchings, M.A.PH.I. (1) and (2) R. J. Morse, M.A.P.H.I. (1) (2) and (3) (Resigned 6.7.58) E. Oliver, M.A.P.H.I. (1) (2) and (3) F. W. Reeve, M.A.P.H.I. (1) and (2) (Commenced 14.4.58) G. H. Smith, M.A.P.H.I. (1) and (2) (Commenced 29.9.58) S. Whitfield, M.A.P.H.I. (1) and (2) Student Public Health Inspector: M. A. Jackson. Clerical Staff: J. E. Blay (Chief Clerk). Miss E. Thompson. Miss W. A. Hepburn. Rodent Operative and General Assistant : W. T. Blanchard. (Commenced 1.1.58). 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 and Public Health Inspectors' Joint Board. (2) Certificate of the Royal Society of Health as Inspector of Meat and Other Foods. (3) Certificate of the Royal Society of Health as Smoke Inspector. 5 Public Health Department, Council Offices, Billet Lane, HORNCHURCH, 28th May, 1959. Telephone: Hornchurch 52555. To the Chairman and Members of the Hornchurch Urban District Council. Mr. Chairman, Ladies and Gentlemen. I beg to present my Annual Report for 1958. The general picture of district, health remained satisfactory. Individual points of importance and interest are noted below and— in certain instances— analysed in some detail later in the report. Vital Statistics. The Birth Rate (corrected) rose from 17.15 to 18.51, the Death Rate (corrected) fell from 10.42 to 10.27 and the Infant Mortality rate from 18.85 to 13.91. These most important figures all show a satisfactory trend. Infectious Diseases. There was a decrease in 1958 of all the common notifiable Infectious Diseases. It was not a Measles epidemic year, Infective Hepatitis fell from 33 to 8, Poliomyelitis from 17 to 10 (and most important six of the reduction was in paralytic cases). Housing. The number of sub-standard dwellings still remaining is small indeed but naturally enough fresh instances periodically come to light. Overcrowding. No survey of overcrowding has yet been deemed desirable and only the general picture is available. The position should have improved gradually in terms of the amount of post-war building which— in this district— has been notable. Food and Drugs. A steady programme has been carried through. The food sampling causes, perhaps, more satisfaction than that of drugs since it is more readily possible to assess the results obtained. What, however, is clearly demonstrated is the skill invested in the various methods of advertising products. 6 In the world of drug products it is relatively easy, one imagines, to obtain some evidence that various drug preparations are said to have produced beneficial results. It is difficult and costly to initiate clinical trials on a strictly impartial basis. It may well be that whilst their individual therapeutic effects may vary within quite wide limits their common factor is at least their safety. The addition— and undoubted present and potential force— of television as an advertising medium makes it even more desirable for a benevolent— but real— interest to be maintained in protecting the public interest. Clean Air. This matter is dealt with at length elsewhere. Our first area— at Cranham— has been confirmed and will come into force on 1st September, 1959. This is a milestone which time will serve to emphasise. A Clean Air programme is no longer a fit subject for specious dismissal or criticism— not always by the informed— but is a logical sequence of present-day thought translated into action which will, one believes, produce cumulative benefit both to the community and its environment. Local Government Re-organisation. This matter is largely one of policy and hence outwith my legitimate field of comment, the more so as a Royal Commission is at present considering the position. Hornchurch is now deemed within Greater London which should occasion no surprise. I do not propose to comment on the Local Health Authority services in this area under the National Health Service Act 1946, but I would record my opinion that the denial of even delegated powers to this district in 1947 was much to be regretted. It will be interesting to see how time and experience will bear upon that decision. 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 1958) 120,300 Number of inhabited houses according to rate books (December 1958) 38,111 Rateable value (December 1958) £1,589,389 Sum represented by a penny rate (December 1958) £6,290 Extracts from Vital Statistics for the Year. Number of live births allocated to the district as adjusted for inward and outward transfers 2,371 (1,221 males, 1,150 females) Birth rate per 1,000 Home Population using area comparability factor 18.51 Number of still-births allocated to the district 28 (20 males, 8 females) Still-birth rate per 1,000 live and still-births 11.67 Total live and still-births 2,399 (1,241 males, 1,158 females) Deaths of infants under one year of age 33 (21 males, 12 females) Infant mortality rate per 1,000 live births— total 13.91 Infant mortality rate per 1,000 live births—legitimate 13.78 Infant mortality rate per 1,000 live births—illegitimate 20.40 Deaths of infants under four weeks of age (Neo-natal) 28 (17 males, 11 females) Neo-natal mortality rate per 1,000 live births 11.80 Illegitimate live births per cent of total live births 2% Maternal deaths including abortion Nil Maternal mortality rate per 1,000 live and still-births Nil Number of deaths of Hornchurch residents as supplied by the Registrar-General (adjusted for inward and outward transfers) 1,166 (611 males, 555 females) Death rate per 1,000 Home Population using area comparability factor 10.27 DEATH RATE -COMPARISON WITH PREVIOUS YEARS. 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 1949 10.6* 1957 10.4 1950 10.4 1958 10.2 *Area Comparability Factor returned. 8 The Area Comparability Factor for deaths this year varied from 0.94 to 1.06 and for births from 0.95 to 0.94. BIRTH RATE— COMPARISON WTTH PREVIOUS YEARS 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 1949 16.0 1957 17.1 1950 13.6* 1958 18.5 * 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. GENERAL MORTALITY: MAIN CAUSES 1948-1958. Causes of Death 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 Tuberculosis (all forms) 44 35 29 25 17 21 11 4 5 3 9 Cancer 139 180 155 183 184 211 234 210 253 248 236 Infectious diseases 5 9 3 4 1 3 1 2 0 2 0 Cardio-vascular disease 371 404 441 418 425 602 590 591 682 679 592 Influenza 1 9 3 19 2 14 1 2 7 8 6 Pneumonia 30 31 20 30 49 52 41 49 53 65 58 Bronchitis 36 65 63 69 52 85 54 65 95 79 76 Other respiratory diseases 9 6 3 7 9 10 8 10 7 9 13 Gastro intestinal diseases 14 13 20 16 12 28 13 10 14 10 15 Motor vehicle accidents 7 11 9 14 9 11 10 12 8 10 15 All other accidents 14 8 12 12 4 10 18 18 20 18 15 Suicide 8 3 10 11 10 7 11 11 9 14 8 Cardio-vascular disease (592), Cancer (236), Bronchitis (76) and Pneumonia (58) represent the main causes of death. Each has caused fewer deaths than last year but a re-allocation of the St. George's Hospital deaths may well be reflected in this picture. Once again infectious disease failed to cause a single death, but Tuberculosis caused nine deaths— the highest figure for the past four years. Cancer of the lung and bronchus was responsible for 49 deaths (47 male, 2 female) as against 54 (48 male and 6 female) last year. REGISTRAR-GENERAL'S ABBREVIATED LIST OF CAUSES OF DEATH IN CERTAIN AGE GROUPS (Corrected for Inward and Outward Transfers) CAUSES OF DEATH TOTAL ALL AGES AGE GROUPS Under 1 1—4 5—14 15—24 25—44 45—64 65—74 75 and upwards MALE FEMALE M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1. Tuberculosis, respiratory 8 5 3 - - - - - - - - - - 2 2 2 1 1 - 2. Tuberculosis, other 1 0 1 — — — — — — — — — - — 1 — — — — 3. Syphilitic disease 1 1 0 - - - - - - - - - - 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 4 0 4 — — — 2 — — — — — — — 1 — — — 1 10. Malignant neoplasm, stomach 35 23 12 — — — — — — — — 1 — 9 — 7 3 6 9 11. Malignant neoplasm, lung, bronchus 49 47 2 - - - - - - - - 2 — 29 2 12 — 4 — 12. Malignant neoplasm, breast 23 0 23 — — — — — — — — — 7 — 11 — 2 — 3 13. Malignant neoplasm, uterus 13 0 13 — — — — — — — — — 1 — 6 — 4 — 2 14. Other malignant and lymphatic neoplasms 116 60 56 — — 3 — 1 — 1 .— 3 4 22 17 15 13 15 22 15. Leukaemia, aleukaemia 6 3 3 — — — — — — — — 2 — — 1 1 1 — 1 16. Diabetes 3 2 1 — — — — — — — — — — 2 — 1 17. Vascular lesions of nervous system 151 56 95 - - - - - - - 1 - 2 8 18 17 18 31 56 18. Coronary disease, angina 173 126 47 — — — — — — — — 4 — 50 8 40 15 32 24 19. Hypertension with heart disease 12 4 8 - - - - - - - - - - 1 — 1 3 2 5 20. Other heart disease 214 76 138 — — — — — — — — 1 2 8 14 20 18 47 104 21. Other circulatory disease 42 17 25 — — — — — — — — — 1 6 2 6 9 5 13 22. Influenza 6 4 2 — — — — — — — — — — 1 2 2 - 1 - 23. Pneumonia 58 32 26 3 1 - 1 — 1 - — 1 - 6 2 12 7 10 14 24. Bronchitis 76 57 19 1 — 1 - — = - — — - 9 2 23 3 23 14 25. Other diseases of respiratory system 13 9 4 — — — — — — — — — 1 4 1 5 2 26. Ulcer of stomach and duodenum 12 9 3 — — — — — — — — 1 1 3 5 2 127. Gastritis, enteritis and diarrhoea 3 0 3 — - 1 - - - - - - - - - 1 1 28. Nephritis and nephrosis 5 3 2 — — — — — — 1 — — - 1 1 - - 1 1 29. Hyperplasia of prostate 1 1 0 — — — — — — — — — - - — - - 1 - 30. Pregnancy, childbirth, abortion 0 0 0 - - - - - - - - - - - - - - - - 31. Congenital malformations 11 8 3 5 3 1 — - - 1 - 1 - - - - - - - 32. Other defined and ill-defined diseases 91 43 48 11 8 1 1 1 - - - 2 3 10 6 5 6 13 24 33. Motor vehicle accidents 15 11 4 - - - - - - 5 - 2 - 2 - 1 1 1 3 34. All other accidents 15 11 4 1 — 2 - - - 3 - 3 1 1 - - - 1 3 35. Suicide 8 2 6 — — — - - - - 1 1 1 1 4 - - - - 36. Homicide and operations of war 1 1 0 — — — — — — — — - - 1 - — — — — TOTAL 1,166 611 555 21 12 8 5 2 1 11 2 23 23 175 102 172 105 199 305 9 10 SECTION B. GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Staffing. Mr. R. J. Morse resigned during the year in order to take up the appointment of Deputy Chief Public Health Inspector at Barrow-inFurness. He was succeeded by Mr. G. H. Smith. The other vacancy on the establishment was filled by the appointment of Mr. F. W. Reeve. Mr. W. T. Blanchard commenced with us as General Assistant and Rodent Operator on 1st January, 1958. With your agreement an Assistant County Medical Officer from the South Essex Area Health Department has been afforded the opportunity of attending this department for a period of 3 months in order to gain experience in the more general duties of a Public Health Department. This is of real value in that it affords an Assistant Medical Officer an opportunity of keeping in touch with the functions which as a future Medical Officer of Health he or she will have to discharge and which are necessarily not covered in their post with a Local Health Authority which may embrace largely clinical and routine duties. Medical Examinations— Staff. Staff arrangements remain as last year. During the year arrangements were made for the examination of 206 (222) employees or prospective employees— 58 (79) permanent and 127 (143) temporary. The 1957 figures are given in parentheses. Public Health Propaganda. Community talks and individual advice comprised our approach as a department. It is difficult to assess the value of community work but some good is done by widening the appreciation of the nature of our duties. Public notice boards, releases by the Public Health to Public Relations Committee, Civics Committee and Press interviews are also utilised. Liaison with the Personal Health Services is maintained. Clean Air and Food Hygiene were the topics most featured, although Infectious Disease prevention also received attention. Laboratory Facilities. Our arrangements follow the existing lines and include primarily the utilisation of Oldchurch Hospital laboratory (by kind assistance of Dr. Atkinson) with reference to essential specialised investigations always available through the Central Public Health Laboratory at Colindale. In the routine examination of milk, water, etc., the Essex County Council's scheme is utilised. 11 Ambulance Service. The arrangements remain the same as last year. Maternity and Child Welfare. The Essex County Council maintained clinics at the following centres throughout the year: — (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) Suttons Hostel, Hornchurch. (viii) Upminster Road, Rainham. (ix) 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 nine midwives and seven 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 eight home nurses working in the district. Day Nursery. A Day Nursery is established within the district at Diban Avenue, Elm Park. It provides accommodation for 50 children up to five years of age. Domestic Help Service. A domestic help scheme is in operation and is administered for the Essex County Health Services by the Area Medical Officer, 34, Cresthill Avenue, Grays. Domestic Helps can be supplied for a period of two weeks in the case of a home confinement, but as there is a great demand for this service, it is essential to apply as early as possible. Where there is illness approval may be given, upon receipt of a medical certificate, for a Help to attend. Domestic Helps are paid by the County Council, but the person assisted is required to contribute towards the cost according to his, or her, means. An assessment form must therefore be completed if it is desired to claim reduction in the charge, otherwise the full standard charge, which is at present 3s. 6d. an hour, will be payable. 12 Care of the Aged. A variety of agencies provide help under this heading. The most valuable help should be the acceptance that the aged— with all their advantages and disadvantages— remain part of a family. Neither the old folk nor the young married couple with a family necessarily benefit by occupying the same house (although this may often be done quite happily). If, however, the old people do have a place of their own contact with them should be maintained especially in times of crisis. All this sounds in all conscience— too reasonable to demand special note but it is a revelation how often this contact is allowed to lapse not apparently by force of circumstance but through lack of will. I am not really persuaded that Registers and the like are essential. It is more important that the free services should be publicised generally so that they may be called upon if required, rather than that the aged be specially regimented into utilising them. The aged have earned a little peace and quiet and the danger is that our solicitude for them may deprive them of their privilege. Home Safety. The Council agreed to afford full participation in the "Guard that Fire" campaign organised by the Home Office. A close liaison still exists between the local Committee and your Public Health Department. National Assistance Act. 1948, Section 47. It was not necessary to take formal action during the year under this Section. Once more I would emphasise that the unostentatious work of the Public Health Inspector is a vital link in the forces dealing with the less fortunate of our citizens. It is easy to forget that the delineation of the environmental and the personal health services may on occasion be more readily achieved in theory than practice- Health Centres. By the kind permission of the Area Medical Officer a visit was paid by the Public Health Committee to Aveley Health Centre. This was of value in eliciting the attempts which are being made by the Local Health Authority and the Executive Council to produce the closest possible liaison between the general practitioner and the Local Health Authority services. Hornchurch has not of course got a Health Centre of the comprehensive type within its boundaries although Romford and Thurrock by reason doubtless of their having large new housing development in Harold Hill and Aveley are so provided. If the practical results measure up to the theoretical possibilities then these Centres mark a distinct advance in at least the partial co-ordination of medical services and there is still plenty of scope for such co-ordination between the various Authorities exercising health functions. 13 SECTION C. SANITARY CIRCUMSTANCES OF THE AREA. Water Supplies. Thirteen samples were taken by my Department during the year from the main supply. Five were submitted for chemical and bacteriological examination and eight 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 4,080 chemical, bacteriological and biological examinations have been made and all water going into supply was wholesome. In addition samples were examined for radioactivity. 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 supply is not plumbo-solvent. No action has been necessary in respect to any form of contamination. The number of dwelling houses supplied as at the 31st December last was 39,043 and the population as at the 30th June, 1958, as obtained from the Registrar-General was 120,300. We are unable to state the number of houses supplied by standpipes, but the total is quite insignificant." Atmospheric Pollution. Legislation: The Clean Air Act 1956 (Appointed Day) Order 1958 brought into force on 1.6.58 further sections of the Act and provided yet another demonstrable step towards our target- Pollution Factors: Apart from the detailed survey of an area in Cranham (subsequently selected as our first Clean Air zone) which was published in the "Medical Officer," a report was presented to you on the steps which might be taken in the near future to mark initial progress in our efforts to eliminate unnecessary smoke in the town. 14 It might be well to point our that far fewer towns are without a smoke problem than the wishful thinking of some of the inhabitants would suggest. Apart altogether from the question of drift from other areas smoke arises both from industry and from the domestic chimney. This latter inclusion makes it clear that although industry (and one would include hospitals and the much maligned railway engine) is a significant factor, in towns— such as Hornchurch— where there is a very limited amount of industry, the air is still grossly polluted by domestic chimneys which have been indicted as responsible for some half the smoke produced. One has in the past been left in no doubt as to local reaction in connection with, for example, St. George's Hospital chimney and the behaviour of the railway engines at Upminster but it would take an unprecedented amount of activity on the part of both these sources to produce even a small portion of the pollution which is occurring daily from the chimneys of our houses and which any morning and evening in Winter demonstrates as being a major factor in air pollution. Admittedly the position of the ordinary house as a smoke producer is contingent on a variety of factors such as whether it has an appliance which will burn smokeless fuel or utilise gas and electricity to the exclusion of smoke; whether the smokeless fuel is in fact available with sufficient facility to permit the householder readily to use it; whether if a suitable appliance is provided the householder is sufficiently informed on how to operate it efficiently and last but not least whether the householder has any desire to have any fire other than the open bituminous coal burning smoke producer. It is our responsibility to see that every assistance is given to the householder in what initially can be quite a tricky position. It should be emphasised that at all events for the present any exclusive reliance upon the proprietary types of smokeless fuel is almost bound to end in the householder being fuelless and coke must—of the solid fuels— be regarded as the keystone of the smokeless air plan. In this connection continual efforts are being made by this Council to ensure that small supplies are readily available at short notice to every householder. To this end they will undoubtedly have the support of the North Thames Gas Board and this body is also perfectly willing to give advice to any householder in difficulty with the burning of their coke. The production of the really satisfactory coke fire is to a very large extent a matter of technique and numerous instances are in fact known to us in which sceptics on the use of coke have been readily converted after appropriate advice. In modern houses the mere provision of a smokeless fuel burning appliance clearly does not affect the atmosphere if the appropriate smokeless fuel is not used for burning in it and an earnest plea is made here for every householder to consider seriously the advantages both to themselves and to others of having an individual smoke elimination plan. It is needless to recapitulate in detail the various factors which persuade one that smokeless air is the best policy but the embarrassment caused to sufferers from bronchitis in terms of atmospheric pollution is— quite apart from the cogent economic factors also present—enough reason for giving clean air full support. 15 Industrial Co-operation: I was enabled to attend the conference of the Combustion Engineering Association which in the event proved very informative. Many representatives both of industry and of Local Authorities were present and the result was that even during the very short period of the conference the respective viewpoints of diverse interest were brought out in a manner which under more formal surroundings might have been well nigh impossible. The future progress of Clean Air proposals as they affect industry must rest substantially upon goodwill and understanding between the Local Authority seeking to enforce the law and industry responsible for carrying it out. It is, however, clearly advantageous if each can be convinced that the other is not acting purely arbitrarily and is seeking in fact to carry out the spirit as apart from the letter of the law. I think that this conference achieved considerable progress in a limited sphere towards this end. It is always tempting to be critical of a smoke control policy which quite clearly presents a path with some thorns but nevertheless with an ultimate target from which there can on grounds of national policy and personal health and economy be no deviation. I might, therefore, apart from appealing to individuals also appeal to any organisations interested to consider not only the problems associated with securing clean air but also the manner in which these problems can be overcome. Constructive suggestion is the most profitable form of criticism. Joint Meeting: Meetings were held with our neighbours Romford and Dagenham to explore the possibility of joint action in. the creation of smoke control areas and in the taking of any other measures which might react to our common advantage. The meetings were helpful in that they elicited the points of view of the varying Authorities regarding future action to deal with the adjacent parts of the three towns. It was not, however, possible at this early stage to decide upon concrete proposals to this end and the immediate results of our meetings were therefore of a strictly limited character. What is possibly more important is that a mutual liaison has been established and is maintained in being which will undoubtedly be called upon in the future to bring about much more important and practical advances towards clean air than have so far been achieved. Smoke Control Area-Cranham: The first Smoke Control Area selected was in Cranham in the area bounded by Front Lane, Brunswick Avenue and Roseberry Gardens. It consisted largely of a modern Council Housing Estate in which each house had in fact a modern smokeless fuel burning appliance. In addition some 11 private houses were also included. The area was selected after careful consideration and in terms of the Government's Memorandum on Smoke Control Areas. Certain points which determined us to select the Cranham area were; — 16 (1) It comprised almost entirely a modern Council Estate and was therefore uniform. (2) It had no permanent smoke source in the vicinity. (3) It suffered from no major drift. (4) It was small but readily extensible and had already been investigated. (5) Public reaction had been sought. (6) No slum clearance possibility arose. (7) Negligible cost of conversion existed. It should also be stressed that the policy of declaring Smoke Control areas has started but by no means finished with Cranham as an additional and much larger area of a more mixed housing character is already being explored as a potential second area and this process may be expected to continue until all Hornchurch is adequately protected from unnecessary smoke. A final word on this subject might be to the effect that smokeless air will only become a reality when the Government, the Local Authority, the fuel producers, the householder and not least the fuel distributor are alike satisfied that it is an essential policy and take all the necessary steps not only theoretically but practically to enforce it. The central government has given an undoubted lead and this Council has been quick to follow it. This example is however still readily possible of extension amongst at least some of the other interests noted. Publicity: A film entitled "Guilty Chimneys" was exhibited to your Public Health Committee and 250 copies of the booklet "Clean Air" issued by the British Medical Association and dealing with diverse aspects of this subject were purchased. The various organisations represented on the Civics Committee were approached concerning their co-operation in our clean air plans and a certain number agreed to afford practical assistance. So far the need to trespass upon their time in this connection has not arisen but it is always helpful to know that such assistance is at our disposal when— as will in all probability be the case—future publicity measures will render their help valuable. Local Observations: The "EEL" Reflectometer was made available to other Authorities for reading the day-to-day results of their volumetric SO2 apparatus. This ensures a uniformity of results classification over an area as against a district. Until a national arrangement is instituted embodying similar methods it is difficult to see how widespread inconsistencies on the evaluation of results from this type of SO2 recording apparatus are to be avoided. Drainage and Sewerage. The unprecedented rainfall in September, following the preceding excessively wet season, gave rise to widespread flooding in parts of the 17 district. The intensity of the) storm was such that rivers, watercourses and surface water drainage systems were overwhelmed and some soil sewers surcharged. Farmlands, houses and roads were invaded by surface water (in some instances contaminated to a relatively minor degree by sewage) the areas chiefly affected being Rainham (Bridge Road), Cranham (East of Front Lane) Upminster (St. Mary's Lane) and Gidea Park (Belgrave Avenue). Although the incident occurred on a Friday night the Council staffs of all departments were readily available to deal with complaints which came to their notice and I think that taken generally the situation—which was on a scale which could not reasonably have been foreseen—was dealt with effectively. It should be borne in mind that apart from the very many problems besetting the Engineer and Surveyor, especial items (such as food affected by the flooding) were dealt with by my department and the Housing Department also paid particular and speedy attention to Council houses involved. Numerous instances arose in which help was not requested and which did not appear to demand assistance and these probably accounted largely for any complaints which subsequently arose. From a public health viewpoint flooded gardens are clearly to be deplored but with sewage contamination of the minimal order present in this type of flooding and the large area involved (added to the fact that germs of the type causing trouble do not find such conditions favourable to growth) it is impracticable to sterilise them through disinfectants or otherwise. Whatever psychological value there might be in pouring disinfectant down the drain it achieves in general the success which the common meaning) of tha saying reflects as its value. One cannot but have every sympathy with people who in the middle of the night suddenly find that flood water has entered their houses and it is patent that the vast majority tackled and overcame their major difficulties with speed and assiduity. The most important sequel to an incident of this kind should be that the pre-existing arrangements of a local authority should be carefully reviewed in the light of their efficacy and how far modification is required. It is in no way critical to say that few authorities could pursue this line of action without being able to devise some degree of improvement. Adoption of Private Streets. The Engineer and Surveyor, Mr. V. Williams, has supplied the following list of private streets adopted during the year ended 31st December, 1958: — 18 ROAD Length feet Hacton Drive (part) 490 Service Road—Upminster Road and Hacto Lane 657 Station Parade, Elm Park 423 Edison Close 80 Roseberry Gardens 620 Anglesey Drive 330 Lynross Close 137 Suttons Lane 1,400 Worcester Avenue 731 Canterbury Avenue 904 Maylands Way 705 Craven Gardens 157 Mount Avenue 172 Brierley Close 316 Colne Valley 275 Forth Road 768 Franmil Road 475 The Ridgeway 1,009 Fames Drive 377 Pine Court 336 New Hall Drive (part) 294 Heron Way (part) 1,530 Swift Close 134 Swan Avenue 735 Tern Gardens 175 Plover Gardens 151 Ford Close 448 Bader Way 1,789 Broadhurst Walk 184 Bouchier Walk 79 Stapleton Crescent 592 Deere Avenue 1,881 Simpson Road 1,128 Gilroy Close 139 Beaumont Crescent 260 Tuck Road 1,284 Locke Close 141 Hugo Gardens 325 Gillam Way 579 Malan Square 728 Tempest Way 496 Finucane Gardens 746 Boulter Gardens 284 Harlow Road (part) 478 Ryder Gardens 602 Wells Gardens 613 Denholme Walk 285 Sowrey Avenue 1,153 Syracuse Avenue 312 Lovell Walk 451 19 ROAD Length feet Gray Gardens 810 Adnams Walk 119 Stephen Avenue 1,119 Cherry Walk 408 Lindsey Way 160 Great Nelmes Chase 995 Wychelm Close 673 Freeborne Gardens 170 Mungo Park Road (part) 1,890 Manor Crescent (part) 200 Chipperfield Close 392 35,294ft. = 6.7 miles Conversions. Plans were agreed for the conversion of 1, 2 and 3, Mashiters Cottages, New Road, Rainham, from pail closets to main sewer. Relatively few instances now remain where anything like ready conversions of this kind remain to be tackled. Cesspools. The only satisfactory entry under this heading would be of a "Nil" order but that, alas, is still a distant dream. It is surprising that more nuisance is not reported to us but probably a spirit of mutual tolerance is engendered in districts where their occurrence is commonplace. No opportunity is being lost in eliminating them when a sewer becomes available. River Ingrebourne. No improved story falls to be told in relation to the content of this somewhat insignificant stream. It need only be asserted once again that a good effluent is not good enough unless it also is adequately diluted. It an effluent fails to be of the highest standard then the position is correspondingly prejudiced. The River Ingrebourne therefore remains a public health embarrassment to which an application of the solution is long overdue. Swimming Pool. The Swimming Pool, in spite of the poor weather experienced, has again proved a popular venue, 264,485 patrons being admitted for swimming and a further 19,530 spectators. The swimmers total includes 61,548 visits by school children attending in classes. This is slightly lower than last year, mainly due to school staffing difficulties, but a much heavier programme has been planned for 1959. During the year 1,678 children gained primary and higher certificates of the Hornchurch 20 Schools Swimming Association, 310 more than the previous year. Hornchurch Swimming Club has shown considerable progress, and due to them the name of Hornchurch is becoming well known in Essex swimming circles. Nineteen Swimming Galas were held in the Pool during the year and the advance bookings for 1959 show an increase on this and include the English Schools National Championships and a Southern Counties A.S.A. Championship Gala. The Swimming Pool water continues to be maintained at a very high standard of purity and clarity, and the building has been kept warm and well ventilated. There appear to have been more regular patrons from outside areas than during 1957, and many compliments have been paid on the bright appearance and cleanliness of the building. ACTUAL FIGURES FOR REFERENCE Adult Bathers 48,515 Junior Bathers 123,401 Adult Spectators 13,038 Junior Spectators 6,492 Adult Transfers 526 Junior Transfers 207 Adult Book Tickets 2,256 Junior Book Tickets 2,868 Swimming Clubs 25,164 We co-operate with the Bath Superintendent and Engineer in maintaining a high standard of quality. Twelve samples were taken by us during the year and submitted for bacteriological and chemical analysis, all of which were satisfactory. Paddling Pools. It is noteworthy that the pool at Harrow Lodge has been forsaken by its long attendant sandpit (removed elsewhere). Maybe some day sandpits will just be quietly discontinued. Four samples were taken from each of the four Paddling Pools, i.e., in May, June, July and August, 1958. One of the samples was unsatisfactory. Disinfestation and Disinfection. No change in our arrangements has taken place within the last year. Rodent Control. The advice of the Rodent Operative continues to be appreciated and during the year 229 new infestations and 1,721 routine and re-visits were made. One notice was served during the year under the Prevention of Damage by Pests Act. 21 Establishments for Massage or Special Treatment. The Essex County Council granted licences to ten persons during the year authorising them to carry on establishments for massage or special treatment. Heating Appliances (Fireguards) Act 1952 and Regulations 1953. Twenty-five visits were paid during the year. Eighty-one appliances were tested (involving 166 tests) and 28 were unsatisfactory. All the unsatisfactory fires were old appliances. Action was also taken to bring the various fires etc. in the Council offices up to a modern legal standard. It would be interesting to know how many Councils in the country have put their own houses in order both as regards the use of smokeless fuel and the safety of their heating appliances. Old Metal Dealers (Hornchurch) Order, 1956. At the end of the year 13 persons had registered as Dealers in old metal. Periodic visits were paid by the Public Health Inspectors. Pet Animals Act, 1951. Forty-nine visits were paid to the 12 licensees of the Pet Shops in the district. Rag Flock and Other Filling Materials Act, 1951. Two addresses in the urban district are registered pursuant to the provisions of Section 2 of this Act. Two samples were taken during the year and satisfactory reports were received. Riding Establishments Act, 1939. The two premises were inspected on a half-yearly basis and were both found to be satisfactory. Diseases of Animals (Waste Food) Order, 1957. This Order—at the request of the County Council—became the responsibility of this Council to enforce and accordingly licences previously dealt with by the County Council in respect of the operation of waste food sterilisation plant fell to the lot of our Council to administer. In addition it is proposed to deal with a certain number of licences authorised by the Ministry of Agriculture, Fisheries and Food on the termination—after due notice—of their present licences. Nine licences had been issued up to the end of the year. Agriculture (Safety, Health and Welfare Provisions) Act, 1956. Certain sections of this Act dealing with the provision, maintenance and cleanliness of sanitary conveniences fell to be dealt with under your 22 jurisdiction and arrangements for discharging the necessary duties are being carried out by my staff. Ten notices were served during the year. Public Health Inspection of the District. SUMMARY OF PUBLIC HEALTH INSPECTORS' WORK DURING 1958: Inspection of Food and Food Premises (visits paid): Bakehouses 109 Butchers' Shops 269 Cafes 225 Confectioners 245 Dairies 13 Fish Shops 104 Food Complaints 115 Greengrocers' Shops 242 Grocers' Shops 647 Ice Cream Vendors and Manufacturers' premises 159 Mobile Shops (hawkers) 66 Public Houses 36 Sampling 566 School Canteens 38 Slaughterhouse 403 Staff Canteens 12 Miscellaneous visits 62 Housing (visits paid): Overcrowding etc., enquiries 158 Improvement Grants 42 Sanitation 40 Structural defects 483 Water supply and pipes 109 Miscellaneous housing visits 273 Re-inspections 1,584 General Sanitary Circumstances (visits paid): Atmospheric Pollution 171 Camping and Fairgrounds, vans etc. 78 Conveniences 25 Drainage and sewerage 587 Dustbins 30 Farms 68 Stables, piggeries, animals, birds etc. 93 Nuisances 242 Paddling pool samples 31 Refuse tips 46 Pest Control 245 Sewage Works (Effluent samples) 16 Swimming Pool Samples 13 23 Water samples (main supply) 18 Rivers, streams, ponds, etc. 158 Miscellaneous visits 116 Re-inspections 802 Factories and Outworkers: Number of visits paid 587 Shops Act: Number of inspections (10 notices were served during the year) 990 Miscellaneous (visits paid): Heating Appliances (Fireguards) Act 25 Massage establishments 14 Pet Animals Act 49 Rag Flock and Other Filling Materials Act 6 Old Metal Dealers 3 Smoke Control Areas 260 Infectious Disease: Number of visits paid (including contacts) 526 Number of notices served: Informal 317 Statutory 151 The main headings under which work was done may be noted as follows: Housing 2,689 visits Inspection of Food and Food Premises 3,311 „ General Sanitation 2,739 „ Infectious Diseases 526 „ Shops Act Inspections 990 „ Factories and Outworkers 587 „ Public Health Inspectors' Work. Both qualitatively and quantitively this was of a very satisfactory order. 24 SECTION D. HOUSING Number of New Houses erected during the year: (i) By the Local Authority 4 (ii) By other Local Authorities 0 (iii) By other bodies or persons 806 Number of Houses voluntarily demolished: 13. 85, 87. 89, 91 and 93, High Street. 34, 36, 38, 40, 42, 44, 46 and 48, North Street. Number of Houses voluntarily closed: 4. 85, 87, 175 and 177, High Street. Number of Demolition Orders made: 10. 70, 72, 74 and 76, High Street. 29, St. Mary's Lane. la, 4, 5 and 6, Harveys Cottages, Upminster Road. 119, Upminster Road. Number of Houses demolished following representations: 1. 205, Rainham Road. Number of Undertakings accepted to make houses fit for human habitation: 1. 15, Staverton Road. As seen Local Authority housebuilding during the year was at a low completion level and private building also declined somewhat. It is also reasonable that the number of houses demolished showed a decline. Certificates of Disrepair. The following is a copy of a Return under the Rent Act, 1957, sent to the Ministry of Housing and Local Government for the period 1st January to 31st December, 1958: Part I—A pplications for Certificates of Disrepair: (1) Number of applications for certificates 94 (1 withdrawn by tenant). (2) Number of decisions not to issue certificates 1 (3) Number of decisions to issue certificates (a) in respect of some but not all defects 74 (b) in respect of all defects 26 (4) Number of undertakings given by landlords under Paragraph 5 of the First Schedule 70 (5) Number of undertakings refused by Local Authority under proviso to Paragraph 5 of the First Schedule 1 (6) Number of Certificates issued 45 25 Part II— Applications for Cancellation of Certificates: (7) Applications by Landlords to Local Authority for cancellation of certificates 30 (8) Objections by tenants to cancellation of certificates 6 (1 eventually withdrawn). (9) Decisions by Local Authority to cancel in spite of tenant's objection - (10) Certificates cancelled by Local Authority 20 Improvement Grants. In connection with applications under this heading our advice has been sought in 30 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. My advice was sought during the year on some 127 housing applications respecting which medical recommendations for priority had been submitted by hospitals or private practitioners. Overcrowding. Instances still arise where gross overcrowding has been brought to your notice and as a result has been remedied. It is essential that if satisfactory living standards are to be maintained overcrowding of a marked and unnecessary kind should be frowned upon. It seems to me that unless a careful watch is kept on the situation serious overcrowding once started can spread rapidly and the necessity for taking the earliest and most effective steps both to remedy overcrowding where it occurs and to discourage it where it seems likely to occur are of paramount public importance. One can understand the position in which a minor degree of temporary overcrowding results from housing difficulty but the instances which have demanded action for the most part were not within this category. Especially perhaps attention should be drawn to the potential result of sub-letting and taking in lodgers without regard to the permitted number (which exists for every house and which is by no means too onerous in its application). Economic necessity cannot always be held even to be a cause of certain overcrowding arising in this way. House owners or occupiers who propose therefore to go to the limit in occupation, by multi-family occupation, should give serious thought to the Permitted Number for the house involved, upon which information is always available at my office. Caravans. The Rainham Site has been dealt with so far as the law permits. It is still not easy to deal with caravans effectively and expeditiously and they are still periodically moving into our district. 26 Land Charges Enquiries. During the year 3,607 land charges enquiries were referred to the department regarding the question of outstanding sanitary notices and Certificates of Disrepair. This is one of the routine unpublicised but time-consuming occupations of the department. Sub-Standard Accommodation. Our initial programme for dealing with this matter has been largely completed and was never of major moment. Central Area Development around High Street has dealt with some aged property which might well have fallen to my Department to represent. Inevitably, however, as time goes on other properties deteriorate and whilst some can usefully be repaired others appear most suitable for demolition. The problem of sub-standard property is, therefore, small but ever recurring. In general individual representation has been utilised and the persons dispossessed have been sympathetically considered' for re-housing. I feel most strongly that persons dispossessed as a result of official representation should—save in very exceptional circumstances—be offered alternative accommodation. If in occasional instances they prove bad tenants remedies exist for the situation thereby created. SECTION E. INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES Food and Drugs Administration. During the year some 294 samples were taken and of these 25 were unsatisfactory in some particular. In addition 7 food complaints were submitted to the Public Analyst with the results noted. The sub-divisions of the work detailed later relate to: — (1) Samples submitted to the Public Analyst and found to be genuine 269 (2) Samples submitted to the Public Analyst and found to be sub-standard, etc. 25 (3) Food complaints referred to Public Analyst 7 (4) Food complaints not warranting reference to Public Analyst 44 The programme of sampling followed normal lines. The number of samples found sub-standard was somewhat higher than last year. The number of food complaints received was approximately the same as in 1957. Inflation may well be regarded as not peculiar to the economic field 27 since modern descriptive methods suggest that a like malady has made a full scale and successful incursion into the verbal field of advertising. It may be that in due course the ordinary product may well achieve a demand because of its seeming scarcity. Until then various permutations and combinations of superlatives must go far to bemuse the ordinary purchaser, who, by this time entering into the spirit of the thing, probably ends up satisfied or at any rate having no adequate legal grounds for being otherwise. It will be noted that few prosecutions were undertaken—only watered milk and tobacco in foodstuffs being dealt with in this way. A variety of circumstances attend each instance of substandard report or complaint, and in many of these the degree of failure is of a minimal order and could not justify prosecution. Informal action has, however, succeeded in having the labels of several products modified in accordance with our desires or the product itself altered to a less contentious standard. The main difficulty in dealing with food complaints from members of the public is the time lag (with its consequent complications) between the time of purchase and the time of notification to this department. There must be a reliable and unequivocal chain of evidence attending the article from the sale until it is received by us and the circumstances after sale must not be of such a nature as to cast doubt upon the validity of the original complaint. To quote only one type of complaint, if a mouldy meat pie is brought to us days after purchase having meantime been kept at room temperature in warm weather it is impossible to determine when the mould was actually present. Even a complaint of this nature can be explored and provides an insight into the length and conditions of shop storage which is valuable and on occasion reveals practices not elicited at routine inspections. It must also be emphasised that food not intended for sale should be kept rigidly away from other normal food in the shop as, if not, it may well cause trouble by inadvertent sale or otherwise and produce a situation prejudicial both to vendor and buyer and yet readily preventable. The success of our work is not to be regarded as reflected in our successful prosecutions. The latter are a last resort. A careful analysis of the informal action taken suggests a substantial measure of progress. 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. 28 SAMPLES SUBMITTED TO PUBLIC ANALYSTS AND FOUND TO BE GENUINE Article No. Article No. Almonds, ground 1 Instant Coffee 1 Apples 1 Irish Stew 1 Apples and blackberries 1 Jaffi-Jelli 1 Aspic Jelly Powder 1 Jam 2 Beans with sultanas, curried 1 Jam, mixed fruit 1 Jam, Morello Cherry 1 Beef, Minced 1 Jelly 1 Beef Steak, stewed 1 Lactachoc 1 Bread 1 Lemon Curd 2 Bread and butter 2 Lemon and Orange peel 1 Brisling, Cocktail 1 Lemonade Powder 1 Butta Fingers 1 Lollies 15 Butter 1 Luncheon Meat 1 Butter Finger Biscuits 1 Margarine 1 Cauliflower 1 Marmalade 1 Cheese, Danish processed Gruyere 1 Meat, paste 1 Meat, pudding 1 Cheese Food 1 Milk 39 Cheese Rarebit 1 Milk Block, Full Cream 1 Cheese Scones 1 Milk, condensed 1 Cheese Spread, buttered 1 Milk, evaporated 1 Cheese Spread with Ham and Onions 1 Milk Shake cordial 1 Mincemeat 1 Cheez Whiz 1 Mozfat 1 Christmas Pudding 1 Mushrooms, dried 1 Coconut Macaroons 1 Mustard 1 Coffee 1 New Potatoes 1 Coffee Spread 1 Nut Paste 1 Colours, various 3 Oat Cakes 1 Cream 2 Onion Sauce (Powder) 1 Cream Bannocks 1 Orange 1 Cream Sponge 1 Orange Juice 1 Custard Powder 2 Orange Squash 1 Enriched Loaf 1 Oranges, Mandarin in Syrup 1 Figs 1 Orangeade Crystals 1 Fill-me-Flan 1 Pancake Mixture 1 Fish Cakes 1 Parsley Sauce (Powder) 1 Fish, Fingers 1 Plum Pudding 1 Fish paste 1 Pork Pies 1 Fruit Salad 1 Pork Roll, stuffed 1 Ginger, ground 1 Potatoes 3 Gingerbread, mix 1 Potato Water, discoloured 1 Glucose Powder 1 Quosh 1 Glucose, Pyramid, orange 1 Rice, ground 1 Horseradish with Beet 1 Rice Pudding 1 Ice Cream 32 Roast Beef with two vegs. 1 Ice Cream Pudding 1 Rolls and butter 1 Icing Sugar 1 Salmon 1 29 Article No. Article No. Salmon, red 1 Catarrh Pastilles 1 Salmon, potted 1 Chlorodyne 1 Saltines (Biscuits) 1 Clo-Ro-Filt Tablets 1 Sardines in Pure Olive Oil 1 Compound Glycerine of Thymol 1 Sausages, beef 2 Sausages, pork 1 Compound Lemon, Glycerine and Honey Mix 1 Sausages, chipolatas, pork 1 Sausage Meat, Beef and Pork 1 Cough Syrup 1 Self-Raising Flour 1 Cream of Tartar 1 Semolina 1 Dentosine 1 Shortbread 1 Euclyptus Oil 1 Slim-Easy Rolls 1 First Aid Cream 1 Spaghetti with Tomato & Cheese Sauce 1 Fullers Earth Cream 1 Gon Tablets (for prevention and relief of chilblains) 1 Sponge Drops 1 Steak Casserole 1 Halibut Oil Capsules 1 Stuffing 1 Ivy Lotion 1 Suet, shredded 1 Kill-all-Pain Liniment 1 Sugar Candy 1 Laxative Chocolate 1 Sultanas 1 Linseed Licorice and Chlorodyne Lozenges 1 Sweets 9 Toast and butter 1 Night Cough Pastilles 1 Tomato Cocktail 2 Parrish's Syrup 1 Tomato Ketchup 2 Pax (for corns) 1 Tomatoes, peeled 1 Peppermint Oil Lozenges 1 Weinkraut, (pickled cabbage) 1 Quinine Compound Tablets 1 Seven Rubbing Oils 1 Brandy 1 Spirit of Sal Volatile 1 Gin 1 Sweetex Pellets 1 Rum 1 Thru 1 Whisky 2 Tincture of Iodine 1 Adult Cough Mixture 1 Tyzanol Hydrochloride 1 Alum 1 Vercolate Tablets 1 Athletes Foot Ointment 1 Wasp Sting Cream 1 Baby Chest Rub 1 White Embrocation 1 Baby Cream 1 Zinc and Castor Oil Cream 1 Boracic Acid 1 Bronchial Balsam 1 Total 269 Calamine Lotion 2 Camphorated Oil 2 30 SAMPLES SUBMITTED TO PUBLIC ANALYSTS AND FOUND TO BE ADULTERATED OR UNDER STANDARD, etc. Sample No. ARTICLE (General description) Nature of Adulteration or Irregularity Action Taken F.1160 Red Delicious Apples. Contained slightly excessive amounts of arsenic and lead spray residues. Apples withdrawn from sale by retailers for cleansing. F.1161 —do— Contained slightly excessive amount of lead spray residue. —do— Inf. 1497 —do— Contained excessive amounts of arsenic and lead spray residues. Apples withdrawn from sale and wholesalers agreed to cleanse. Inf.1498 -do— —do— —do— F.1159 Extra Quality Rice Pudding. Prepared from skimmed milk powder but skimmed milk not stated in ingredients. Manufacturers agreed to amend label. F.1162 Scotch Farls Contained insufficient butter for claim. Incorrect claim made by Shop Manageress. Warning given. Inf.1484 Glycerine Lemon and Ipecac Cough Mixture. Contained insufficient glycerine to justify claim for value as cough remedy. Manufacturer agreed to increase glycerine content in future. Inf. 1475 Linseed, Liquorice & Chlorodyne Lozenges. Contained no morphine therefore misdescribed as Chlorodyne. Formal follow-up sample taken. F.1166 —do— —do— Consigned to Chemist by manufacturer as "L.L.C. Lozenges" and sold in error, as Linseed Liquorice & Chlorodyne, whereas in fact, they were Linseed, Liquorice and Chloroform Lozenges. Stock of Lozenges withdrawn from sale immediately. 31 Sample No. ARTICLE (General description) Nature of Adulteration or Irregularity Action Taken Inf. 1546 Beef Suet. Labelling unsatisfactory in that the word "Shredded" was in smaller type than the words "Beef Suet" in the description "Fresh Beef Suet Shredded." Manufacturer agreed to amend label and show the word "Shredded" in the same type as the words "Beef Suet." F.1186 Biscuits. The claim "Definitely Non-Fattening" was false and misleading. Manufacturer promised to obtain new labels deleting all claims regarding nonfattening properties. Inf.1548 Ammoniated Tincture of Quinine. Slightly deficient in ammonia. Remainder of consignment withdrawn from sale. Firm to improve sealing of bottles. Inf. 1549 Spirit of Camphor. Incorrectly labelled "Spirit of Camphor B.P." New labels being provided by Manufacturing Chemists. F.1202 Fruit Salad in Syrup. Complaint of smell and oily taste, not confirmed, but sample had, however, a slight sulphur smell which was insufficient to be objectionable. No action in view of further can— same consignment— having no objectionable taste or smell. F.1203 Fruit Lollie (orange). Contained fruit juice less than 1%- insufficient to justify description. Manufacturer agreed either to increase the fruit content or to amend label. Inf. 1641 Milk. 16% deficient in fat. Formal follow-up samples taken and found to be genuine. Dairy firm stated deficiency due to failure of mechanical storers in storage vessels. All milk in question thought to have been recovered for processing but some bottles must have slipped through. 32 Sample No. ARTICLE (General description) Nature of Adulteration or Irregularity Action taken F. 1226 Milk. 25% added water. Legal proceedings instituted. Vendor fined £1 plus 28/- costs. Inf. 1679 Apricots (for making apricot preserve). Would not make full fruit standard jam. Matter taken up with manufacturer. Inf. 1620 Cottage cheese Should be labelled "Skim Milk Cheese" on front panel Matter brought to the attention of the Manufacturers. Inf. 1657 Beef Soupmix. Insufficient meat extracts to justify description "Beef Soup" Further enquiries being made and discussions with, Manufacturers (after the 1958 period). Inf. 1658 Oxtail Soup. Poor in respect of oxtail and should be described as oxtail flavour. Inf. 1659 Chicken Noodle Soup. Contained insufficient chicken meat to justify the description "Super Chicken Noodle Soup." Inf. 1661 Steaklets Description "Steaklets" might be misleading. Matter brought to the attention of the Manufacturer. Inf. 1631 Tea Biscuits. Claim in respect of slimming properties false and misleading. Informal approach to Manufacturer regarding television advertisement. No repeat of advertisement observed. Inf. 1667 Bath Salts. Contained only 0.5% of sodium percarbonate and not in accord with claim of 1.4%. Formal follow-up sample taken. FOOD COMPLAINTS REFERRED TO PUBLIC ANALYSTS. Cpt. 1485 Bread. Contained foreign matter which was found to consist of dirty dough. Matter considered by Council— Baker warned. Cpt. 1486 Minced Loaf. Beef Contained cigarette tobacco. Australian produce. Importers and Trade Authority advised. 33 Sample No. ARTICLE (General description) Nature of Adulteration or Irregularity Action taken Cpt. 1528 Golden Plums. Contained a sediment of foreign matter in the form of earth or soil. Matter considered by Council and Canners warned. Cpt. 1538 ⅓ pint bottle of pasteurised milk containing extraneous matter. Contained a foreign body in the form of a piece of ferruginous earthy matter. Matter considered by Council and taken up with Bottling Firm. Cpt. 1616 Milk Bottle. Contained a caterpillar. Insufficient evidence to establish that caterpillar was in bottle of milk before delivery to school. Cpt. 1613 Bread— slice of. Contained foreign bodies consisting of dough and traces of mineral oil. Matter considered by Council— Baker warned. Cpt. 1623 Bread— loaf of. Contained a handmade cigarette end. Legal proceedings instituted Bakery firm fined £5. FOOD COMPLAINTS WHERE ANALYSIS WAS NOT REQUIRED. Complaint Action Tins of baby food (apricots and rice) alleged to have caused sickness. Matter taken up with Vendor, remaining stock examined and found to be satisfactory. Dirty and cracked bottles of milk. Matter referred to Local Authority where Dairy situated. Sour milk delivered to school. Matter referred to Local Authority where Dairy situated. Hair in jar of pickled onions. Matter taken up with Manufacturer. Bottle of milk delivered without cap and milk dirty. After investigation— complaint withdrawn as facts not substantiated. Maggot in tin of tomatoes. No action— remainder of contents of tin had been destroyed. Third pint bottle of milk containing milk bottle top. Matter taken up with Bottling Firm concerned and assurance given that a recurrence would be avoided. Screw in bun. Complainant settled matter privately with Vendor. 34 Complaint Action Brown dough in white loaf. Matter taken up with Bakery concerned. Pint bottle of milk containing pieces of glass. Matter taken up with Dairy concerned. Dirty pint bottle of milk. Matter taken up with Dairy concerned. Unsound potatoes. Vendor agreed to exchange any unusable. Mouldy loaf. No action in view of delay in complaint being notified. Glass in third pint bottle of milk. Matter taken up with Dairy concerned. Hairs on apple tart. Baker warned. Maggots in bread. Investigation shewed 'maggot' to be from mill moth. Not Baker's responsibility referred by them to Miller. Mouldy bread. Vendor warned. Mould on steak pie. Matter taken up with Vendor. Foreign matter in bottle of vinegar. Insufficient evidence to show how foreign matter came to be in bottle. Mouldy bread. Vendor warned. Brown dough in white loaf. Matter taken up with Bakery concerned. Dirty block of ice cream. Ice Cream obtained from mobile van, stock examined and found to be satisfactory. Mouldy French Jam Sandwich. Vendor warned. Small paint marks inside milk bottle. Matter taken up with Dairy concerned. Mouldy sausage rolls. Legal proceedings instituted and Vendor fined £5. Unsound potatoes. Vendor agreed to exchange any unusable. Wire in sausages. Matter taken up with Vendors, but insufficient evidence to determine how wire came to be in sausages. Mouldy Luncheon Meat. No action—only small amount of mound growth, and delay in notifying complaint. 35 Complaint Action Mouldy fruit pies. No action—delay in notifying complaint. Insect in cereals. Matter taken up with Vendor and Manufacturer. Maggot in packet of semolina. No action—delay in notifying complaint. Mouldy bread. Vendor warned. Piece of metal in biscuits. Matter taken up with Manufacturer. Foreign matter in tin of prunes. Matter referred to Local Authority where goods purchased. Maggots in processed cheese. Matter taken up with Vendor, remainder of stock destroyed. Third pint bottle of milk—neck of bottle broken. After due consideration no action taken. Piece of paper in bottle of milk. Matter taken up with Dairy concerned. National Dried Milk alleged to have caused sickness. Matter referred to Essex County Health Services. Vinegar eels in non-brewed condiment. Matter taken up with Manufacturer. Dirty bottle of milk. Matter taken up with Dairy. Mouldy pork sausages. Vendor warned. Fingernail in jar of jam. Evidence insufficient to prove 'fingernail' was in jam. Sale of cooked bacon as ham. All grocers in Urban District advised that Council would take a serious view of any such occurrence. Packets of sweets containing toys, etc. Legal opinion obtained. No action possible. Bacon and Ham. Enquiry was made into the practice at a few shops of selling bacon described as 'ham.' It seemed clear that a reasonably definite line of demarcation between the two existed and the appropriate trade members were duly advised of your views. This clarification— which in no way reflected upon the vast majority of traders—appeared to stop the practice. Imported Apples—metallic contamination. As information suggested that there was a possibility of certain imported apples which had arrived in this district containing lead and arsenic in small but undesirable quantity, steps were taken to sample the products mentioned and our Analyst reported that the lead and/or 36 arsenic contamination was a little high. Cleansing would have made them fit for consumption. As a result the exposure for sale of the apples noted was by agreement avoided and the apples were returned to the wholesaler. There is a suggestion that contamination of this kind is largely concentrated in the eye and stem of the apple and does not significantly permeate the skin but that is of interest largely insofar as it affects the feasibility of cleaning the fruit subsequently. Practical difficulties still exist in ensuring that food posssibly contaminated in this fashion does not reach a stage of general distribution before effective restrictive action can be taken. To secure, for example, that a consignment does not get beyond the Port of entry until it is cleared is difficult, and by the time the products have secured passage through wholesalers, main branches of shops to subsidiary branches and so on, it is evident that the like passage of information stage by stage from one Authority to another will have taken time—the more so as adresses of various shops are not always initially referable with complete accuracy to the proper Authority. Even, however, if the existing system may have its defects it does secure that a national exchange of information enables ultimately an appropriate check to be kept on any product from the time of its arrival in the country to its final exposure for sale possibly in some remote country district. 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 14 Butchers 74 Cafes 53 Confectioners (bread, cakes etc.) 41 „ (sweets, etc.) 118 Fish Shops 29 Grocers 183 Greengrocers 99 Ice Cream Dealers 279 Ice Cream Manufacturers 3 No significant alteration in numbers has taken place save that Ice Cream Manufacturers have been reduced from 14 to 3. Food and Drugs Act, 1955—Food Hygiene Regulations 1955. The major initial work under this head has been completed and new premises (for this purpose) provided most cause for thought. Section 105 of the Essex County Council Act, 1952 provides for prior notification of 14 days in this connection but its provisions are 37 not always appreciated or acted upon although some improvement in this regard is possibly occurring. Outstanding contraventions are notified to the responsible parties who are then given very considerable latitude so long as an earnest endeavour to rectify matters is evident. Only one prosecution under Regulation 16 was actually taken. This action was successful in obtaining the provision of a hot water supply to the wash-hand basin. Some 94 notices were served during the year following upon routine inspections made by the Public Health Inspectors. The degree of co-operation which was received is high, our attitude towards compliance with our requirements or requests takes full cognizance of the individual case circumstances and the future success practically of the Regulations now hinges upon the District Public Health Inspectors. 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 — 12 59 — Fish — 3 40 — Poultry — — 3 — Tinned Meat — 11 47 7 Tinned Fish — 1 1 7 Tinned Milk — 3 36 6 Tinned Food 1 1 108 4 Miscellaneous Groceries — 12 43 11 3 6 3 3 During the localised flooding in September a certain amount of food was ascertained to be unfit and was surrendered and disposed of. It is interesting to note that cans exposed to flood water and badly dented when sent for bacteriological examination—with their labels onprovided a higher bacterial count externally than undamaged cans. 38 Carcases Inspected and Condemned. Cattle excluding Cows Cows Calves Sheep and Lambs Pigs Horses Number killed 450 4 42 1,343 1,474 — Number inspected 450 4 42 1,343 1,474 — All diseases except Tuberculosis and Cysticercosis— Whole carcases condemned — — — — 1 — Carcases of which some part or organ was condemned 23 1 — 10 40 — Percentage of number inspected affected with disease other than tuberculosis, etc. 5.1% 25% - 0.7% 2.8% - Tuberculosis only— Whole carcases condemned — — — — — — Carcases of which some part or organ was condemned 14 - - - 17 — Percentage of number inspected affected with tuberculosis 3.1% - — — 1.1% — Cysticercosis only— Carcases of which some part or organ was condemned 1 — — — — — Carcases submitted to treatment by refrigeration 2 - — — — — Generalised and totally condemned - - - - - - Slaughter of Animals Acts, 1933 to 1954. Six slaughterman's licences were issued during the year. Ice Cream. During the year 30 applications for registration as vendors and 22 applications for registration of premises for the storage and sale of ice cream were granted. At the end of the year 3 persons and premises were registered for manufacture and 279 for the storage and/or sale of ice cream. Eighty-one samples were taken during the year. 79 proved satisfactory. In addition 49 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. 39 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 65 persons and 84 premises were registered for the manufacture of preserved meat, an increase of 2 persons and 2 premises. Regular supervision is maintained over them. 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 54 persons and 13 premises had been registered. 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 46 shopkeepers are registered for the sale of bottled milk only. Cleanliness of Milk Bottles. The year provided its usual quota of complaints. It is difficult to deal as one might wish with certain types of complaint since the Authority in the area of bottling is primarily concerned. When complaints of the type brought to our notice arise as they do it is clear that no fool-proof standard of inspection is reasonably practicable and that equally no lesser standard of inspection should be considered adequate. 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 (Pasteurised) 56 Supplementary Pasteurised 7 Dealer's Sterilised 79 Supplementary Sterilised 8 Dealer's Tuberculin Tested 41 Supplementary Tuberculin Tested 6 Milk Sampling. The 102 samples of milk taken from the dairies and in the streets during the course of delivery to customers throughout the year were submitted to the Counties Public Health Laboratories for testing. In each case a satisfactory report was received. In addition 43 samples were submitted to the Public Analysts. Liaison With Other Authorities. Our excellent liaison with the London County Council in respect of the Hornchurch Children's Homes and the Brentwood Group Hospital 40 Management Committee in respect of Harold Wood and Harold Court Hospitals regarding the testing of their milk supplies noted in last year's report continues. School Canteens. The last few months of the year provided a 'waiting period' for the Education Authorities views on your proposals (concerning outstanding items) to be available. Practically any legislation, is open to diverse interpretation but an agreed standard (possible only after consultation) initially devised and securing subsequent adherence is the only firm basis for progress. Conversely the absence of such a standard retards progress. The seeming division of responsibility for 'old' and 'new' schools also militates against uniformity of approach and action. It is, however, my hope (to put it no higher) that all the schools in the district will have a satisfactorily high standard of hygiene in their canteens and to this end the close cooperation of the local Education Authority is indispensable. Shellfish. A variety of samples was taken and the results in general were satisfactory. This remains a food in respect of which the closest supervision must be maintained in view of the contamination possibilities present. SECTION F. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER NOTIFIABLE DISEASES Infectious and Other Notifiable Diseases, 1958. Disease Total cases notified No. of Cases hospitalised Meningococcal Infection 5 5 Dysentery 4 1 Erysipelas 18 1 Food Poisoning 14 6 Infective Hepatitis 8 0 Measles 245 1 Ophthalmia Neonatorum 3 0 Pneumonia 27 1 Poliomyelitis- Paralytic 2 2 Non-paralytic 8 8 Puerperal Pyrexia 3 2 Scarlet Fever 129 3 Whooping Cough 30 5 Malaria (contracted abroad) 3 2 The year generally has been a very satisfactory one. Our outlook towards notifiable disease has altered greatly with time due to the progress in sanitary engineering, housing, public education and 41 therapeutic and preventive medicine. It is essential that if diseases are to be notifiable and hence to receive attention from the outset they must be viewed primarily in the light of their present-day potentialities and not in that of history. Probably the greatest present-day menace is Influenza of which only its complication—Pneumonia—is notifiable and in truth it would be idle to notify specifically the thousands of cases of all the diverse patterns which arise in every epidemic. Although also the clinical pattern is definable broadly there is still a similarity in mild cases to the common cold and the like which would prejudice the interpretation of notifications. Scarlet Fever is not in my opinion a priority for notification for reasons generally outlined elsewhere. Measles and Whooping Cough notifications are largely a waste of everyone's time since it is impracticable to have each case visited and the complications have largely lost their terror with progress in treatment. Why Erysipelas remains notifiable is not clear. When the rationale for notification in any disease is not patent then the process of notification becomes prone to disregard and subsequent action becomes a source of frustration and practically ineffective. That reflects the present position. We would be better off with a few diseases notifiable on their current record and with readily available means of augmenting or diminishing their numbers than with a relative multiplicity whose contribution is more notable for their clerical than for their hygienic repercussions. In this latter connection the transfer under Schedule 10 of the National Health Service Act of a copy notification to the County Medical Officer within 48 hours may serve some useful purpose but if so—apart from serving as a basis for our recovering the notification fee—it is not known to me. Meningitis. Five cases were notified during year. Here again therapeutic medicine has vastly changed the position for the better. Scarlet Fever. Scarlet Fever continues to be a mild disease often coming to light at a late stage and hence becoming practically impossible of rigid control. Fortunately its danger potential has decreased with the years notably because of its susceptibility to antibiotic therapy and of the lessened likelihood of communal spread through, for example, milk (since almost all milk in Hornchurch is heat treated). It is always possible that the type of this illness may change but until some trend in this connection is evident it is not likely to continue to be regarded very seriously by either medical or lay opinion. 129 cases were notified during the year, of which 87 were in school children. The distribution throughout the district was general . 7 households produced more than one case—3 cases were removed to hospital. 42 Contacts'. School exclusion for 5 days is the practice commended by the Education Authority to their Head Teachers not only in Scarlet Fever but in streptococcal sore throat. Whatever identity may exist bacteriologically between these two conditions, one is notifiable, the other is not, and the bacteriology is in any event seldom pursued. Home isolation is I am sure a more flexible form of control than theoretically might appear and a specific period such as 5 days is in my view largely academic in its significance. Poliomyelitis A clear drop in the number of cases occurred as compared with 1957. Paralytic cases:— In the present year two paralytic cases occurred, one in a woman aged 47, a resident of Upminster, who suffered from a bulbar type of infection, the second a boy of 5 from Rainham who had facial involvement. These two cases compared with a figure of 8 such cases found in the previous year. Non-paralytic cases:— This type was reflected in 8 instances—males of 31, 14 (2), 7, 3 and 1; females aged 30 and 16. Nine such cases were notified in 1957. How far it is profitable in practice to notify non-paralytic cases is possibly problematical. In the nature of things probably a large number of such cases remain undiscovered, the complications are negligible and a substantial amount of public apprehension is caused. On the other hand if notification results in minimising the paralytic type of the disease, then it has valid claims to continuation. In general the disease still behaves unpredictably and immunisation appears to offer the best available chance of protection. It cannot of course be claimed as a complete safeguard and in fact certain of the cases noted above as having occurred this year are thought to have had two injections some months before. So long, however, as there is nothing to be lost and a substantial chance of gain, then clearly immunisation can be reasonably advocated. Food Poisoning. 14 notifications represented single cases. In 8 it proved impossible to isolate the causative organisms. In 5 Salmonella Typhimurium was isolated and in the other Salmonella Enteritidis. The local General Practitioners were reminded of the value of full and prompt notification of food poisoning cases. International Certificates of Vaccination or Inoculation. 439 certificates were stamped during the year. Although cogent reasons may exist as to why the practice is not followed, it would superficially seem distinctly advantageous if a supply of blank forms was kept at this office as is understood to be the case with Travel Agents etc. Immunisation and Vaccination Statistics. I am indebted to Dr. W. T. G. Boul, Area Medical Officer, for the 43 following information concerning immunisation and vaccination statistics applicable to the Urban District for the year 1958:— Diphtheria Immunisation: Completed primary immunisations 1,721 Boost injections 990 Whooping Cough Immunisation: Completed primary immunisations 1,557 Boost injections 156 Combined Diphtherial Pertussis Immunisation: Completed primary immunisations 295 Boost injections 30 Poliomyelitis Vaccination: Completed vaccinations (2 injections) 18,319 Boost injections (November and December only) 1,630 Smallpox Vaccination: Primary vaccinations 1,487 Re-vaccinations 269 Infective Hepatitis: Cases occurred in Wards as under:— Ward Age Sex Upminster 41 M Emerson Park 61 M Rainham 68 M Thameside 20 F Emerson Park 30 F Thameside 30 F Rainham 27 F Rainham 8 F Tuberculosis. Respiratory: Fifty four new cases were notified during the year as compared with forty six last year. Non-Respiratory: These cases were notified as against ten last year. Inward Transfers: These totalled 38 as against 67 last year possibly an index of the decreased housing activity here. Deaths: There were nine this year as compared with one in 1957. I noted last year that this disease had certainly not been eradicated and this year's position is not wholly reassuring. The deaths represent the highest total since 1954 and the number of deaths from the disease not notified before—5—represented the highest figure since 1952. Two deaths occurred within 3 months of notification as against no similar deaths last year. It is unwise to generalise on one year alone and the tuberculosis trend will be watched with interest. 44 Fifth Commonwealth Chest Conference: I was privileged to attend the Fifth Commonwealth Chest Conference of the National Association for the Prevention of Tuberculosis and Diseases of the Chest and Heart which proved really instructive in providing a world instead of a parish picture of the steps which are being taken to eliminate this disease. Tuberculosis is not yet written off in its social importance and the notification of new cases for the year establishes this point. Treatment advances allied to higher housing and other standards have improved the picture beyond all knowledge and in so doing have reduced the degree of spread which formerly existed. The number of cases of tuberculosis on the register at the end of the year was as follows:— Respiratory: Males 514 Females 446 Non-Respiratory: Males 48 Females 30 1,038 Romford Chest Clinic. I am indebted to Dr. S. Thompson, the Consultant Chest Physician, for the following notes:— "During the year 1958 the Romford Chest Clinic has continued its activities, serving the Borough of Romford and the Urban District of Hornchurch. Although the incidence of new cases of tuberculosis in the country as a whole continues to fall, the number of cases on the Romford register continues to increase, but this is in part due to the increasing population of the area and the influx of a certain number of tuberculous cases amongst the new residents. For example, during 1958 there were 70 cases transferred into the area from other districts. The pattern of the disease is changing considerably and there is an increase of the disease in the male population over 45 years of age. During the year it has been found that there is an increasing number of unoccupied beds in chest hospitals and many of the smaller units have been closed down and also Harold Court Hospital is likely to be closed in the near future. The tuberculosis chest unit in Rush Green Hospital has also been under discussion with a view to closure, but as it was felt that a certain number of local beds are always desirable it is possible that this unit may be allowed to continue to serve the needs of some of the local population who are requiring treatment for tuberculosis. The B.C.G. vaccination scheme is being extended and is producing satisfactory results, so that in addition to the reduction in notified cases of tuberculosis amongst children the more severe forms of the disease, 45 such as tuberculous meningitis and miliary tuberculosis, are now comparatively rare. The examination of contacts is also being extended and serves a useful purpose as a follow-up to abnormal cases found at the Mass Radiography Units. The figures of the Mass Radiography Units show that about 20% of the new cases of tuberculosis that are brought under the surveillance of Chest Physicians are discovered by mass radiography. It would therefore seem very desirable that a larger response should be made by the general public of the area when the mobile Mass Radiography Unit visits it." Mass Radiography Unit. This survey was arranged through Dr. Lawless, the Medical Director of Mass Radiography Unit No. 6B—North East Metropolitan Regional Hospital Board. Three factory visits and seven general public sessions were carried out and a note of the attendance at the latter is given below: Male Female Total Rainham Working Men's Club 173 215 388 Cherry Tree Car Park, South Hornchurch 348 378 726 Elm Park Hotel Car Park 461 800 1,261 Odeon Car Park, Hornchurch 571 787 1,358 Spencers Arms Car Park, Ardleigh Green 290 423 713 Plough Inn Car Park, Cranham 163 231 394 Gaumont Car Park, Upminster 299 469 768 A total of 8,508 persons attended comprising 4,169 males and 4,339 females. Although this is a decrease of some 313 on the 1956 visit figures no especial arrangements were made on this occasion for school leavers, a factor which of course might reflect upon the numbers. The clinical evaluation of the visit is not yet to hand. CASES OF AND DEATHS FROM TUBERCULOSIS, 1958 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 1 — — — — — — — 1 — — — — — — — 15—24 ,, 10 4 — 1 2 4 — — 12 9 — — — — — — 25—44 ,, 8 10 — 1 9 12 2 1 19 24 - - - - - - 45—64 ,, 14 1 — — 6 — — — 20 1 2 2 — 1 2 3 65 and over 5 1 — 1 1 — — — 6 2 3 1 — — 3 1 Totals 28 16 — 3 19 16 2 1 59 36 5 3 — 1 5 4 46 INTERVAL BETWEEN NOTIFICATION AND DEATH OF FATAL CASES OF TUBERCULOSIS, 1948—1958 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 Not Notified TOTAL 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 I 1 4 1956 1 — — — — — — 3 1 5 1957 - — — 1 — — — 1 1 3 1958 1 1 — — 1 — — 1 5 9 47 48 SECTION G. FACTORIES ACTS 1937 and 1948. Ministry of Labour and National Service Form 572. (Revised) PART I OF THE ACT. 1. Inspections. No. on Register No. of Inspections No. of written notices No. of occupiers prosecuted Premises (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by L.A's 24 14 5 - (ii) Factories not included in (i) in which Sec. 7 is enforced by the L.A. 282 358 13 - (iii) Other premises in which Sec. 7 is enforced by the Local Authority 39 38 2 — Total 345 400 20 — 2. Cases in which Defects were Found. Particulars Referred Found Remedied To H.M. Inspector By H.M. Inspector Prosecutions Want of cleanliness (Sec. 1) — — — — — Overcrowding (Sec. 2) — — — — — Unreasonable temperature (Section 3) - - - — — Inadequate ventilation (Section 4) - - - - — Ineffective drainage of floors (Section 6) - - - - - Sanitary Conveniences (Section 7) - - - - - (a) Insufficient 4 2 — 3 — (b) Unsuitable or Defective 15 8 - 11 - (c) Not separate for sexes — — — — — Other offences against the Act — — 4 — — Total 19 10 4 14 - PART VIII OF THE ACT. OUTWORK—Sections 110 and 111. Nature of Work No of Outworkers in August list Wearing Apparel— No instances of work in unwhole Some Premises Making, etc 136 49 INDEX Page Acknowledgments 6,27 Acreage 7 Adoption of Private Streets 17 Aged, Care of 12 Agriculture Safety, Health & Welfare Provisions) Act, 1956 21 Ambulance Service 11 Apples (Imported) 35 Atmospheric Pollution 6, 13 Bacon & Ham 35 Births 7 Birth Rates 7 —Area Comparability Factor 8 —Comparative 8 Canteens, School 40 Caravans 25 Care of the Aged 12 Certificates of Disrepair 24 Cesspools 19 Clean Air Act, 1956 6,13 Clinics, Child Welfare 11 Contents, Table of 2 Conversions (Pail Closets) 19 Day Nursery 11 Deaths 7 —Age Groups 9 —Causes of 9 —Infantile 7 —Main Causes 8 —Maternal 7 Death Rates 7 —Area Comparability Factor 8 —Comparative 7 —Infant 7 —Neonatal 7 Diphtheria Immunisation 43 Diseases of Animals (Waste Food) Order, 1957 21 Disinfection 20 Disinfestation 20 Domestic Help Service 11 Drainage and Sewerage 16 Essex County Council Act, 1952, Section 103 39 Establishments for Massage or Special Treatment 21,23 50 Page Factories Acts, 1937 and 1948 23,48 Defects 48 Form 572 (Revised) 48 Inspections 23,48 Outwork 23.48 Fireguards 21,23 Flooding 16 Food Poisoning 42 Food— Apples (Imported) 35 Bacon and Ham 35 Complaints 32,33 Flood Damaged 37 Hawkers 39 Inspection of 22,23,26 Meat Inspection 38 Powdered Soups 32 Premises 22,23,36 Preserved 39 Unsound 37 Food and Drugs Act, 1955 5, 26 —Administration 26 —Food Hygiene Regulations, 1955 36 —Public Analysts 4, 27 —Sampling 28 General Sanitary Circumstances 22, 23 Health Centres 12 Heating Appliances (Fireguards) Act, 1952, Etc. 21,23 Home Nurses and Midwives 11 Home Safety 12 Hornchurch Urban District Council Act, 1936, Section 90 39 Houses— Inspection of 22 Number erected 24 Number inhabited 7 Housing 5,24 —Applications for rehousing (medical aspect) 25 —Caravans 25 —Certificates of Disrepair 24 —Closure and Demolition 24 —Improvement Grants 25 —Overcrowding 5,25 —Sub-standard Accommodation 26 —Visits paid 22,23 51 Page Ice Cream 38 —Registration 38 —Sampling 38 Immunisation and Vaccination Statistics 42, 43 Improvement Grants 25 Infectious and Other Notifiable Diseases 5, 40 —Hospitalisation 40 —Notifications 40 —Visits paid 23 Infective Hepatitis 43 Informal Notices Served 23 International Certificates of Inoculation/Vaccination 42 Laboratory Facilities 10 Land Charges Enquiries 26 Local Government Re-organisation 6 Maternity and Child Welfare 11 Meat Inspection 38 —Carcases Inspected and Condemned 38 Medical Examinations 10 Members of the Council 3 Meningitis 41 Metal Dealers 21,23 Midwives and Home Nurses 11 Milk- Bottles 39 Distributors 39 Sampling 39 Special Designations 39 National Assistance Act, 1948, Section 47 12 New Streets 17 Nursing and Maternity Homes 11 Officers of the Public Health Department 4 Old Metal Dealers 21,23 Outworkers 23,48 Paddling Pools 20 Penny Rate Product 7 Pet Animals Act, 1951 23 Poliomyelitis 42 —Vaccination 43 Population 7 Preface 5 Public Analysts 4,27 52 Page Public Health—Inspection 22,23 —Inspectors 4, 23 —Propaganda 10 Rag Flock and Other Filling Materials Act, 1951 21, 23 Rateable Value 7 Rent Act, 1957— Certificates of Disrepair 24 Riding Establishments Act, 1939 21 River Ingrebourne 19 Rodent Control 20 Scarlet Fever 41 School Canteens 40 Sewerage 16 Shellfish 40 Shops Act, 1950 23 Slaughter of Animals Acts, 1933 to 1954 38 Smoke Control Areas 13,23 Soups (Powdered) 32 Staff 4,10 —Medical Examinations 10 Staffing 10 Statutory Notices Served 23 Stillbirths 7 —Rates 7 Swimming Pool 19 Table of Contents 2 Tuberculosis 43 —Commonwealth Chest Conference 44 —Incidence and Mortality 46 —Mass Radiography 45 —Notification/Mortality Interval 47 —Chest Clinic 44 Vaccination Statistics 43 Vital Statistics 5, 7 Water Supplies 13 Whooping Cough Immunisation 43