ROM 9 ANNUAL REPORT OF THE Medical Officer of Health FOR THE ROMFORD URBAN DISTRICT, For the Year 1909. ROMFORD: Wilson and whitworth ltd., printers, high street. ANNUAL REPORT. To the Romford Urban District Council. Gentlemen, I have the honour to put before you my Annual Report on the Sanitary Condition of the Romford Urban District for the year 1909. In accordance with the plan adopted by Medical Officers of Health, this Report is arranged in the following divisions I.—Summary of Action taken during the year for preventing the spread of Disease. II.—An account of the sanitary condition of the district generally. III.—Statement of enquiries made into the conditions injurious to health and proceedings thereon. IV.—Tables of Sickness and Mortality. V.—Proceedings, &c., under the Factories and Workshops Act. 3 Summary of Action taken to prevent the spread of Disease. No. Date. Locality. Disease. Source of Disease. Action taken. Result. 1 Jan. 1 Hush Green Diphtheria .. One case. Foul drains. Removed No other case 2 „ 9 Union Workhouse Scarlet Fever Two cases. Infection presumed to be from visitors. Removed „ 3 „ 14 Waterloo Road Scarlet Fever One case. Infected by a neighbouring case. Removed „ 4 „ 11 Collier Row Scarlet Fever One case. Infection imported. Not removed See Nos. 5, 8& 13 5 „ 18 Collier Row Scarlet Fever One case. Infected by No. 4 6 „ 22 Albert Road Scarlet Fever One case. Removed No other case 7 „ 22 Wolsley Road Scarlet Fever One case. Removed „ 8 „ 22 Collier Row Scarlet Fever Another case in same family as No. 4 9 „ 15 Salisbury Road . Scarlet Fever Two cases. Removed „ 10 Feb. 3 Collier Row Diphtheria Two cases. Local sanitary defects „ 11 7 Como Street Scarlet Fever One case. Infection imported. Removed „ 12 „ 11 Margaret Road Scarlet Fever One case. Infection imported. Removed „ 13 „ 11 Collier Row Scarlet Fever Another case in same house as No. 4 14 „ 11 North Street Scarlet Fever One case. Removed „ 15 „ 8 Western Road Diphtheria One case 16 „ 14 Stockland Road Scarlet Fever One case. A ''return'' case. Removed See No. 18 17 „ 14 Well Yard Scarlet Fever One case. Removed No other case 4 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 18 Feb. 14 Stockland Road Scarlet Fever One ease in same family as No. 16. Removed No other case 19 „ 23 Squirrels Heath Scarlet Fever One case. Removed „ 20 Mar. 1 Squirrels Heath Scarlet Fever Two cases in School hours. Infection supposed to be taken from No. 19. Removed „ 21 „ 10 George Street Scarlet Fever One case. Removed „ 22 „ 15 Shaftesbury Road Diphtheria One case. Removed „ 23 „ 23 Victoria Road Diphtheria One case. Removed „ 24 „ 24 Union Workhouse Diphtheria One case. (See footnote) 25 „ 5 Squirrels Heath Scarlet Fever One case. Infected at School by No. 19. Removed „ 26 „ 12 Market Place Diphtheria One case. Removed „ 27 „ 5 Squirrels Heath Scarlet Fever One case. Infected by No. 19. Removed „ 28 April 6 Brentwood Road Diphtheria One case. Removed „ 29 „ 13 Boarded-out Home, Heath Park Scarlet Fever Three cases. Supposed to be infected by a visitor. Removed. Home closed for a time „ 30 May 3 Albert Road Diphtheria One case. Mother a nurse at Isolation Hospital. Removed „ 31 „ 6 Rush Green Scarlet Fever One case. Infection imported. Removed „ 32 „ 12 Shaftesbury Road Scarlet Fever One case. Infection imported. Removed „ 33 „ 13 Squirrels Heath Scarlet Fever „ One case, followed by five other cases amongst children in the Infants' Home, these cases occurring at intervals up to May 3rd. On investigating the premises I found there was a foul pond (on the Railway property) adjoining the grounds where the children were in the habit of frequenting, very offensive at some distance away. Special report to Council. The pond was filled in. There was also a piggery close by which was not drained in a sufficiently sanitary sense. This was remedied after some time by the Guardians. No cases occurred after the pond was filled in. All the children were removed to the Isolation Hospital. 5 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 34 May 20 Western Road Enteric Fever One case. Supposed to have been contracted away. Instructions, &c. No other case 35 „ 25 Gladstone Road Scarlet Fever One case. Removed „ 36 „ 26 Willow Street Scarlet Fever One case. Removed „ 37 „ 26 Squirrels Heath Scarlet Fever One case. Boy attending Brentwood School. A good deal of Scarlet Fever in Brentwood at this time. Removed „ 38 June 7 Honiton Road Scarlet Fever One case. Source of infection obscure. Removed See No. 43 39 „ 7 Pretoria Road Scarlet Fever Ditto ditto No other case 40 „ 12 London Road Scarlet Fever Ditto ditto „ 41 „ 13 Gladstone Road Scarlet Fever One case. Infected by No. 38. Removed „ 42 „ 28 Catherine Road Diphtheria One case. Removed „ 43 „ 29 London Road Diphtheria Two cases. Sanitary defects 44 „ 29 St. Andrew's Road Diphtheria One case. Sanitary defects. Removed „ 45 „ 30 Catherine Road Diphtheria Ditto ditto „ 46 July 9 Sherrington Av'nue Scarlet Fever One case. Not removed See Nos. 47, 48 &52 47 „ 10 Kensington Road Scarlet Fever One case. Infected by No. 46 48 „ 12 Kensington Road Scarlet Fever One case. Infected by No. 46 49 „ 18, 20 & 21 Margaret Road Diphtheria Six cases. First case attended School with sore throat. Bacteriological Examination showed Diphtheria Bacilli. Removed See Nob. 50, 51, 52, & 57 50 „ 18, 20 & 21 Albert Road Diphtheria One case. Child attending same School as No. 49. Removed 51 „ 22 Milton Road Diphtheria Ditto ditto 52 „ 23 Sherrington Av'nue Scarlet Fever Another case of infection by No. 46 B 6 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 53 July 23 Milton Road Diphtheria A child attending same School as No. 49. Removed No other case 54 „ 27 Como Street Scarlet Fever One case. Infection imported from beyond district. Removed See No, 61 55 „ 27 Havering Road Scarlet Fever One case. Removed No other case 56 „ 27 Honiton Road Scarlet Fever One case. Removed „ 57 „ 27 Kensington Road. Scarlet Fever One case. Infected by No. 46 „ 58 „ 27 Vine Street Scarlet Fever One case. Removed „ 59 „ 27 Queen Street Scarlet Fever One case. Removed „ 60 „ 30 Victoria Road Diphtheria One case. Origin obscure. Removed „ 61 „ 31 Como Street 62 Aug. 3 London Road 63 „ 6 Hainault Road 64 „ 7 Hainault Road 65 „ 10 Hainault Road Scarlet Fever Five cases. Children attending Mawney Road School. Suspicion of an unrecognised case attending School. Removed No other case 66 „ 8 Honiton Road Scarlet Fever One case. Removed „ 67 „ 10 Marlboro Road Scarlet Fever One case. Mawney Road School. Removed „ 68 „ 11 Hainault Road Scarlet Fever One case. Living next door to a case which had not been removed for a week after the disease had occurred. Removed „ 69 „ 12 Como Street Scarlet Fever Ditto. Ditto „ 70 „ 30 Marks Road Scarlet Fever Three cases. First case ill 3 weeks unrecognised, and attended Mawney Road School before attacked. The other two cases infected by the first case. Removed „ 7 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 71 Sept. 20 Lawrence Road Scarlet Fever One case. Removed No other case 72 „ 20 & 23 Queen Street Scarlet Fever Two cases. Removed „ 73 „ 20 Brentwood Road Diphtheria One case, Origin obscure 74 „ 24 & 25 Shakespeare Road Scarlet Fever Two cases in contiguous houses. One of several days' duration. Removed See No. 76 75 „ 21 Squirrels Heath Scarlet Fever One case. Removed No other case 76 „ 29 Shakespeare Road Scarlet Fever One case. Infected by No. 74. Removed „ 77 Oct. 6 Hainault Road Diphtheria One case. An adult infected by a friend whom he had visited. Removed „ 78 „ 7 Shaftesbury Road Scarlet Fever 79 „ 9 Richmond Road Scarlet Fever 80 „ Richmond Road Scarlet Fever .81 „ 10 Richmond Road Scarlet Fever 82 „ 12 Hamilton Road Scarlet Fever Five case. Presumably infected by an unrecognised case in a neighbouring house. Removed „ 83 „ 13 Como Street Scarlet Fever One case in same house where a child had returned from Isolation Hospital three weeks previously. Query a "return case." Removed „ 84 „ 14 George Street Scarlet Fever 85 „ 16 Milton Road Scarlet Fever 86 „ 19 Shakespeare Road Scarlet Fever Three cases. Presumably infected by same source as No. 79. Removed „ 87 „ 22 Willow Street Enteric Fever One case. A child had been ill a month in the same house, presumably from the same disease. Removed „ 8 No. Date. Locality. Disease. Source of Disease. Action taken. Result. 88 Oct. 27 Honiton Road Scarlet Fever One case. Origin obscure. Removed. No other case 89 „ 27 Mawneys Road Diphtheria Ditto ditto 90 Nov. 1 Kings Road Scarlet Fever Ditto ditto 91 „ 4 London Road Scarlet Fever One ease. Child had visited house where an unrecognised case of Scarlet Fever was found by me to exist. See No. Removed „ 92 „ 5 Catherine Road Scarlet Fever One case. Child had visited a house in the Rural district where Scarlet Fever existed. Removed „ 93 „ 5 Squirrels Heath Scarlet Fever Ditto ditto „ 91 „ 5 Hamilton Road Scarlet Fever One case. Infection caught away from home. Removed „ 95 „ 5 Albert Road Scarlet Fever A case similar to No. 87 „ 96 „ 5 George Street Scarlet Fever One case. Presumably infected by a visitor, Removed „ 97 Dec. 7 Squirrels Heath Scarlet Fever One case. Origin obscure. Removed „ 9S „ 12 Union Workhouse Enteric Fever One case. Admitted to the Union Infirmary from Ilford. Removed „ 99 „ 18 Milton Road Scarlet Fever One case. Origin obscure. Removed „ 100 „ 18 Drummond Road Scarlet Fever One case Infection imported from a distance. Removed „ 101 „ 26 George Street Scarlet Fever One case. Removed „ 9 II.—An account of the sanitary condition of the district generally. The following represents the sanitary condition of the district as far as relates to the prevalence of zymotic disease, &c. Scarlet Fever.—90 cases of this disease were notified daring the year. The disease occurred in more or less an isolated manner, not assuming the character of an epidemic. Attendance at school of unrecognised cases was the means of spreading the disease to a considerable extent. Nearly all cases were removed to the Isolation Hospital, and to this I attribute the fact that the disease was kept fairly within bounds. The disease was mainly of a non-severe type, but few cases giving cause for anxiety by reason of severity, two only being fatal. The steps taken to prevent the spread of Scarlet Fever are as under:—If the case is removed to the Hospital, the Sanitary Inspector at once disinfects the rooms, bedding, &c., and when the wall and ceiling are especially dirty, notice is served on !the owner to re-paper and whitewash. When the case is not removed, the disinfection is done after the patient has ceased to be infectious, and in these instances, the bedding, &c., which has necessarily become more infectious than when the patient is removed in the early stages of the disease, is taken to the Hospital disinfector. That these steps for checking the spread of the disease are successful is shown by the fact that it is very rare for a second case to occur in the same 'family, except where the disease has been simultaneously caused by exposure to the same source of infection as the first case removed. Diphtheria.—42 cases of this disease were notiefid several of which were not confirmed by a bacteriological examination. The disease did not assume an epidemic form, and was, in most instances, connected with local sanitary defects which were remedied on notice being served by the Sanitary Inspector. 10 29 of these cases were removed to the Isolation Hospital. Of these some were of a very severe character, four terminating fatally. Enteric Fever.—Three cases of this disease were notified, one contracted away from the district, one removed from the Union Workhouse, where it had been admitted from another part of the Romford Union, and one contracted from a previous case in the same house, and which had not been recognized, None were fatal. Measles prevailed to a fairly considerable extent, in the early part of the year, but only one death was caused by this disease. Disease of this type (zymotic disease) caused 7 deaths, as shown in the annexed table. The death-rate from this class of disease was 0.4: per 1,000. Scarlet Fever 2 Diphtheria 4 Measles 1 7 The death-rate from this class of disease for the past five years has been 0.2, 0.4, 0.4, 0.7, 0.4. The following table represents the total number of infectious diseases notified during the year, 105 of which were removed to the Isolation Hospital. Scarlet Fever 90 Diphtheria 42 Erysipelas 22 Enteric Fever 3 Purpureal Fever 1 Total 158 11 The number of cases of infectious disease notified during the past three years was respectively, 138, 170, and 158. Infantile Diarrhoea, which, during the summer months is frequently very prevalent, was unusually absent, only one death having been caused by it. Every case of infectious disease notified to me is reported by me to the Sanitary Inspector, who visits and reports to me all cases which I do not personally investigate, supplies disinfectants and disinfects the room, bedding, &c., and in cases of those diseases usually associated with insanitary surroundings (Diphtheria, &c.) he makes an exhaustive examination of the sanitary arrangements and causes any defect found to be remedied. He also, in such cases, when the drinking water is from a private source, brings me a sample of it for analysis. Phthisis.—This disease, which has recently become notifiable, in the case of paupers, has not been very prevalent in the district. The usual practice in the cases which are brought under official notice, is to disinfect the house, &c., when the disease has been fatal, or when the patient has been removed elsewhere. The sanitary condition of the district at the end of the year was satisfactory, and but few cases of infectious disease were notified, a condition which has been continued up to the period of making this report, Feb. 28th, 1910. III.— Statement of enquiries mnde into the conditions injurious to the public health and proceedings thereon. The following are the instances in which my action as Medical Officer of Health was required, by your instructions, or by the request of the Sanitary Inspector. 12 Jan. 2nd. 2 and 3, Archer's Cottages, Rush Green. A sample of the water from the well on these premises was submitted to me for analysis, and found to be bad. A supply of water from the South Essex Water Company's main has been provided and the well closed. Jan. 11th. Hare Hall Cottages, Hare Hall Lane. A sample of the water from the well supplying this cottage was submitted to me for analysis and found to be for for potable purposes. The well has been thoroughly cleansed. Jan. 25th. Tuberculosis Cow. Information was wired to the Inspector that a cow with a Tuberculosis udder had been purchased in Chelmsford Market by a dairyman of Albert Road, Romford. I at once visited the premises, and was shown the cow. A veterinary surgeon was called in, who certified that it was Tuberculous. The beast was at once removed from the premises, and ever dually sold. The name and address of the purchaser, and the destination of the beast was ascertained, and the Authorities into whose district it would be taken, were notified. Notification of its arrival was received by the Inspector. Feb. 19th. Pigstyes, Marlborough Road. Notice to abate a nuisance arising from the defective construction of paving and drainage of these pigstyes had been served on the owner, Mr. Whiffen. The owner failed to comply with the notice, and at the reuqest of the Inspector I visited the premises, confirmed the requirements of the notice, and reported to the Council, who ordered a summons to be issued. Mar. 29th. 1 and 2, Douglas Villas, Rirkbeck Road. A sample of water from the well supplying these premises was submitted to me for analysis. I was unable to certify that it was bad, and requested the Inspector to furnish me with another sample in about a month. April 8th. Disused gravel pit adjoining Playing Field of Infants of Romford Union. A sample of the water in this pit 13 was submitted to me for examination, complaint of the smell from the water having been made by the Union Master. I found the sample to be purely pond water, from which no nuisance emanated. The pit has, however, since been filled in. April 16th. 1 and 2, Douglas Villas, Birkbeck Road. As requested, the Inspector furnished me with another sample of water from the well on these premises for analysis, and I found it to be fit for potable purposes. April 23rd. Children's Hall, Romford Union. A case of Diphtheria having occurred at this Hall, I requested the Inspector to test the drains. The test disclosed one defective joint on the drain; this was made good, the drain again tested, and approved. April 30th. Further cases of Diphtheria having occurred, I made an inspection of the Hall and of the drain. I found, the Hall well appointed and the sanitary arrangements satisfactory. The Inspector, however, suggested that owing to the great length and the quantity of sewage flowing through the main drain of the Union, to which the drain of the Hall was directly connected, at a manhole, and into which manhole all the washings from the Laundry discharged, that it would be advisable to place an interceptor on the drain of the Hall. This suggestion was at once carried out. April 30th. Pigstyes, Romford Union. The Inspector not being satisfied with the drainage of these styes, which are at no great distance from the Infants' Hall, and were drained into an open brick pit about 30ft. by 18ft. by 4ft. deep, the pit also receiving all the dung, garbage, and offal from the Union, and a very offensive odour emanating, the contents always being in a state of putrefaction. At his request I inspected the styes, and recommended in my report to the Council that they should be drained into the main drain, and that the pit be filled in. This recommendation was conveyed to the Guardians, and ultimately carried out. 14 May 4th. Gulley, Mildmay Road. Complaint was made by residents that sewer gas issued from this gulley. The gulley was examined, and found connected to the surface drain in the road. It has since been trapped. A sample of the water from the gulley was submitted to me, and I found it to be stagnant road water. May 21st. Pigstyes, &c., Marlborough Road. Visited these premises and examined the works which had been carried out by Mr. Whiff.en, the owner, who had been summoned for not complying with a notice, and reported to the Council that they had been satisfactorily performed. June 28th. Ditch near Thorpe Villas, Havering Road. Complaint was made by a resident that sewage matter was flowing along this ditch. A sample of the water was submitted to me, and I found it to be natural ditch water. Nov. 12th. No. 76 and Nos. 1 to 6, Victoria Row, Queen Street. A sample of the water from the well supplying these cottages was submitted to me for analysis, and found to be bad. A supply from the South Essex Water Company's mains has been provided. Nov. 15th. 46, George Street. A sample of the water from the well supplying this house was submitted to me for analysis. I was unable to say that it was bad, and requested the Inspector to furnish me with another sample in about a month. Nov. 18th. Two Cottages, Sungate, Collier Row. At the reuqest of the Inspector I visited these premises to ascertain their habitable condition, and in consequence of the defective roof, their damp and dilapidated condition. I reported to the Council that in their present state they were not fit for habitation. Notices have been served on the owner to make them fit for habitation. Both are at present unoccupied. 15 Nov. 18th. Park Farm House, London Road. At the request of the Inspector I visited this house to ascertain its habitable condition, and in consequence of the dilapidated condition of the back portion of the house, 1 reported to the Council that that portion was unfit for habitation. Notice has been served on the owner to make it habitable. At present it is unoccupied. Dec. 11th. 46, George Street. A further sample of water from the well supplying this house was submitted to me for analysis, and found to be bad. A supply from the South Essex Water Company's main has been provided. Dec. 29th. The Sanitary Inspector having been informed that a girl had come from Brentwood into service in this district, whom the Billericay Sanitary Inspector suspected to have had Scarlet Fever, brought the case to my notice. Having examined the girl, I found no reason to confirm such suspicion, and the Billericay Inspector was so informed. SEWERS.—There has been no extension of the sewers in the district during the year. RIVER Rom.—This River north of the town has been cleanse I partly by private enterprise and partly by the Council. Private Street Improvements.—The following streets which were in a very insanitary condition, are now being repaired under the Private Street Works Act, viz.:—Drummond, Marshalls, Brooklands, Medora and King Edward Road. Sanction for the loan has been received for the repair of the following streets under the above Act, viz.:—Oak Street and part of Mildmay Road, but the work has not yet been commenced. The whole of these roads were sewered and surface water drained when laid out. removal of House Refuse.—The house refuse is removed fortnightly by the Council's own men, horses, and vans. Some 16 of the refuse is carted to a brickfield, and some to a large disused gravel pit. During the summer months there are a few complaints, and some desire a more frequent removal. water Supply.—The town is principally supplied with water by the South Essex Water Company, and no complaint has been made as to its quality. It is a constant supply. The Company's mains have been extended in the following roads, viz.:—Brooklands, Medora. Heath Park Road, part of Essex Road, Mawneys Road, and Oak Street. There are, however, a number of wells in use in the district, but these are gradually being disused, and a supply from the main is obtained. In some cases voluntarily, and where the water on analysis is found to be bad. PLACES OVER WHICH THE COUNCIL HAVE SUPERVISION.— There are no offensive trades in the district. There are two common lodging houses, and these have been regularly inspected, and always found to be well kept. The workshops (including Rakehouses) and Workplaces have been regularly inspected, and generally found in a sanitary condition. Six notices only having to be served, three of these were for want of cleanliness and three for structural defects, which were remedied. The sanitary accommodation at the various Factories has also been regularly inspected, and found in good condition. 17 Two notices only have had to be served, one for cleansing and one for insufficient accommodation, which were duly attended to. The slaughter-houses have been regularly inspected, and found to be kept in a (cleanly state. Slight complaint has been made about one, and this is situate in South Street, in almost its narrowest part, and it is almost hemmed in by buildings. Periodical inspection of the various parts of the district have been made, and all sanitary conditions discovered remedied by notices served by the Sanitary Inspector, whose intervention is recorded in the tabular list below, my aid being called upon by him, when required. Nuisances abated 331 Notices served 316 Summonses taken out 9 Convictions 3 Houses disinfected 155 Overcrowding abated 4 Improved water supply 4 Wells closed 2 Cisterns repaired,. &c. 5 Animals improperly kept 7 Samples of water analyzed 5 The various Bake-houses, Slaughter-houses, Dairies and Workshops have been inspected, and any defects found remedied on notice served by the Sanitary Inspector. In nine cases it was necessary to issue summonses to compel compliance with the notices, and of these six were dismissed on the application of the Inspector, on payment of the costs incurred, the necessary works having been carried out. In 18 the remainder the defaulters were fined a nominal fine, and ordered to pay the costs. The Inspector attends at each Market, viz., Wednesday and Saturday, and examines the food and provisions exposed for sale and during the year nothing liable to seizure has been exposed for sale. He is also in attendance during the holding of the Cattle Market, for the purpose of enforcing the Bye-Laws with respect to the overstocking of milch cows, and has on numerous occasions compelled the owner of cattle to cause their cows to. be milked to relieve undue or painful distension of the udder. He also in cases where diseased, poor or emanciated cattle are exposed for sale, obtains the name and address of the purchaser, and the destination of the beast, and acquaints the Local Authorities of the district into which the beasts are taken. Acknowledgments of the arrival, &c., of the beasts have been received from the respective Local Authorities. Van and Tent Dwellers.—Considerable trouble is experienced by the Inspector in dealing with Van and Tent Dwellers, who, at all times during the year, encamp on the various unenclosed lands in the district. Notices under the Bye-Laws made under the Housing of the Working Classes Act, are served upon them; they leave at the expiration of the time specified in the notices, and as soon as they are gone, fresh batches take their place. Further stringent measures should be adopted by the legislature to deal with them, as they are a source of considerable annoyance and nuisance where encamped, on account of their filthy habits, and the insanitary conditions under which they live. 19 Only in three instances has it been possible to summon such offenders, in all of which cases a conviction was obtained. PUBLIC street improvement.—During the year the following public street improvement has been carried out, viz.:— A footpath on the South side of London Road, from Bury House to the New Infants' School, a distance of 4442/3 yards has been formed, paved with Victoria Stone, and Kerbed and Channelled, and all road crossings paved with granite cubes. Tables of Mortality and of Sickness, compiled in accordance with the requirement of the Local Government Board's instructions, are appended to this report. I have the honour to be, Gentlemen, Your obedient Servant, ALFRED WRIGHT, Medical Officer of Health. Romford, February 25th, 1909. ISOLATION HOSPITAL. This Hospital is controlled by the "Joint Hospital Board," a body composed of Members of the Urban and Rural District Councils, to whom I beg to express my warmest thanks for the readiness with which all suggestions from the matron and myself, for the well-being of the hospital and its patients, are responded to. The hospital continues to work satisfactorily, many grave cases having been successfully treated, which could not possibly have resulted favourably in their own homes, thus saving much human life and suffering. The number of cases admitted during the year was 268. Of these 200 were cases of Scarlet Fever, 66 of Diphtheria, and 2 of Enteric Fever (Typhoid). Not all of them came from the Romford Urban 20 and Rural Districts, as 35 were admitted from Brentwood and neighbourhood, the Isolation Hospital for that District being, at that time, full. 16 cases came from the Romford Union Workhouse and its Boarded-out Homes. The cases of Scarlet Fever were, for the most part, of a mild type, but 'many of the Diphtheria cases were extremely severe, necessitating the operation of Tracheotomy in 11 instances. Of the Enteric Fever cases, one was severe and one mild. Eight deaths were caused by Diphtheria and three by Scarlet Fever. I should like here to say a few words about "Return Cases," i.e., instances where, after the return of a child to its home, another inember of the family has been attacked, apparently infected by the case just returned from hospital. This only applies to Scarlet Fever, no instance of a "Return Case" in Diphtheria having occurred. These occurrences have caused some uneasiness in the public mind, and I have, on several occasions, been called upon to give an explanation of what has been unjustly assumed to be the fault of the hospital staff. I have, on these occasions, pointed out to the Hospital Board how impossible it is in all cases of Scarlet Fever, to say when infection is over. The greatest precautions are taken not to discharge a patient from hospital until the risk of infection is past. When cases are convalescent, and apparently no longer infectious, they are removed to the "Discharge Block," and kept there for about a week; a separate Nurse attends to them, and there is no communication between this block and the infectious wards. In some cases, however, infective germs lurk in the intricate channels of the "Naso-Pharynx" (back of nose and throat), which, supposing the child to take cold when leaving hospital, and get nasal discharge, at once renders it infectious to others in close contact with it. This is the rationale of "Return Cases," and no amount of care will prevent such cases occasionally occurring. It happens in all Scarlet Fever Hospitals, and I am happy to say that in our own hospital the percentage of "Return Cases" is less than in most Isolation Hospitals During the past year it was about 3 per cent. TABLE I. Vital Statistics or Whole District during 1909 and Previous Years. ROMFORD URBAN DISTRICT. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Total Deaths in Public Institutions in the District. Deaths of Non-residents registered in Public Institutions in the District. Deaths of Residents registered in Public Institutions beyond the District. Nett Deaths at al ages belonging to the District. Under 1 yr. of age At all Ages. Number. Rate.* Number. Rate per 1,000 Births | registered. Number. Rate.* Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1899. 1900. 11,500 398 28.7 42 105 226 16.5 66 53 0 171 12.6 1901. 13,650 395 28.9 58 113 232 16 9 96 80 10 152 11.1 1902. 14,000 414 29.5 42 101 251 17. 9 85 79 4 172 12.2 1903. 14,400 424 29.4 42 99 241 16.7 99 73 1 168 11.6 1904. 14,700 418 28.4 49 117 203 13.8 104 79 4 148 1006 1905. 15,000 412 261 53 128 296 19.7 114 91 1 187 12.4 1906. 15,500 371 229 53 142 305 20.8 98 82 2 226 13.2 1907. 50,780 467 29.6 42 89 266 16.8 104 90 0 176 11.1 1908. 16,300 418 25.*9 38 10 285 175 140 108 11 188 11.5 Averages for years 1 8991908 1909. 16,600 418 25.1 35 78 291 17.8 139 111 6 186 10.3 * Rates in columns 4, 8, and 13. calculated per 1,000 of estimated population. Area of District in acres (exclusive of area covered by water), 5,629. Total population at all ages, 13,656 Number of inhabited houses, 2805 Average number of persons per house, 4.8 At Census of 1901. I. Institutions within the District receiving Sick and Infirm persons from outside the District. II. Institutions outside the District receiving sick and infirm persons from the District. III. Other Institutions, the deaths in which hnve been distributed among the several localities in the District. Union Infirmary. Romford Hospital. Isolation Hospital. TABLE II. Vital Statistics of Separate Locadities in 1909 and previous years. ROMFORD URBAN DISTRICT Names of Localities. YEAR. Population estimated to middle of each year. Births registered. Deaths at all 1 Ages. Deaths under 1 year. a. b. c. d. 1899 1900 11,500 398 226 42 1901 13,650 395 232 58 1902 14,000 414 251 42 1903 14,400 424 241 42 1904 14,700 418 203 49 1905 15,000 412 296 53 1906 15,600 371 305 53 1907 15,780 476 266 42 1908 16,300 418 258 31 Averages of Years 1899 to 1908. J 1909 16,600 418 186 35 TABLE III. Cases of Infectious Disease notified during the Year 1909, in the Romford Urban District. Notifiable Disease. Cases notified in Whole District. Total Cases Notified in each Locality. No. of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. Total cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 42 ... 12 26 4 ... ... ... ... ... ... ... ... ... 29 ... ... ... ... ... ... ... Erysipelas 22 ... ... 4 3 15 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 90 21 65 3 1 73 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 3 ... ... 2 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Relapsing Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... • ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 158 ... 33 97 11 17 ... ... ... ... ... ... ... ... 103 ... ... ... ... ... ... ... Isolation Hospital—Romford Joint Hospital, Rush Green, Romford. Total available beds—40. Number of Diseases that can be concurrently treated, 3 TABLE IV. Causes of, and Ages at, Death during Year 1909. Romford Urban District. Causes of Death. Deaths at the subjoined ages of "residents" whether occurring in or beyond the district deaths at all ages of "Residents" belonging to Localities, whether occurring in or beyond the district. Total Deaths whether of "Residents" or 'non-residents' in Public Institutions in the District All Ages. Under 1 year. 1 and under 5. 5 and under 15. 5 and under 25. 25 and under65. 65 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Scarlet Fever 2 ... 2 ... ... ... ... 2 ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 4 ... 2 ... ... ... ... 4 ... ... ... ... ... ... ... Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other contin'd ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Epidemic Influenza 3 ... ... ... ... 2 1 3 ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhæa 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Enteritis 1 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... Puerperal Fever 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 10 ... ... 1 ... 8 1 10 ... ... ... ... ... ... 17 Other tubercular Diseases 9 2 2 2 1 1 1 8 ... ... ... ... ... ... 2 Cancer, Malignant Disease 21 ... ... ... ... 12 9 21 ... ... ... ... ... ... 15 Bronchitis 13 2 1 ... ... 2 8 13 ... ... ... ... ... ... ... Pneumonia 14 2 3 ... ... 7 2 14 ... ... ... ... ... ... 6 Pleurisy ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of Respiratory Organs ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism Cirrhosis of Liver ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Venereal Diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Premature Birth 13 13 ... ... ... ... ... 13 ... ... ... ... ... ... 2 Diseases and Accidents of Parturition 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... Heart Diseases 21 2 ... ... ... 13 9 24 ... ... ... ... ... ... 20 Accidents 2 1 ... ... ... 1 ... 2 ... ... ... ... ... ... 7 Suicides ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Senile Decay 21 ... ... ... ... ... 21 21 ... ... ... ... ... ... 19 All other causes 45 10 3 1 ... 7 24 45 ... ... ... ... ... ... 48 All Causes 186 35 13 6 1 55 76 186 ... ... ... ... ... ... 139 TABLE V. INFANTILE MORTALITY DURING THE TEAR, 1909. Deaths from stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 3-4 Weeks. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-11 Months. 11-12 Months. Total Deaths under One Year. All Causes Certified 10 4 4 1 4 2 1 1 1 1 1 2 1 34 Uncertified 1 1 Common Infectious Diseases. Small-pox .... .... .... .... .... .... .... .... .... .... .... .... .... .... Chicken-pox .... .... .... .... .... .... .... .... .... .... .... .... .... .... Measles .... .... .... .... .... .... .... .... .... .... .... .... .... .... Scarlet Fever .... .... .... .... .... .... .... .... 1 .... .... .... .... 1 Diphtheria: Croup .... .... .... .... .... .... .... .... .... .... .... .... .... .... Whooping Cough .... .... .... .... .... .... .... 1 .... .... .... .... .... .... Diarrhœa, all forms .... .... .... .... .... .... .... .... .... .... .... .... .... 1 Diarrhœal Diseases. Enteritis, Muco- enteritis Gastro-enteritis .... 1 .... .... .... .... .... .... .... .... .... .... .... 1 Gastritis, Gastro- intestinal Catarrh .... .... 1 .... .... .... .... .... .... .... .... .... .... 1 Wasting Diseases. Premature Birth 8 .... 2 .... .... .... .... .... .... .... .... .... .... 10 Congenital Defects 1 .... .... .... .... 1 .... .... .... .... .... .... .... 2 Injury at Birth .... .... .... .... .... .... .... .... .... .... .... .... .... .... Want of Breast-milk Starvation .... .... .... .... .... .... .... .... .... .... .... .... .... .... Atrophy, Debility, Marasmus 1 1 .... .... .... .... .... .... .... .... .... .... .... 2 Tuberculous Diseases. Tuberculous ingitis .... .... .... .... .... .... .... .... .... 1 .... .... .... 1 Tuberculous Peritonitis; Tabes enterica .... .... .... .... 1 .... .... .... .... .... .... .... .... 1 Other Tuberculous Diseases .... .... .... .... .... .... .... .... .... .... .... .... .... 3 Other Causes. Erysipelas .... .... .... .... .... .... .... .... .... .... .... .... .... .... Syphilis .... .... .... .... .... .... .... .... .... .... .... .... .... .... Rickets .... .... .... .... .... .... .... .... .... .... .... .... .... .... Meningitis (not Tuberculous) .... .... .... .... .... .... .... .... .... .... .... 1 .... 1 Convulsions .... .... .... .... 3 .... .... .... .... .... .... 2 .... 5 Bronchitis .... .... .... 1 .... .... .... .... .... .... .... .... .... 1 Laryngitis .... .... .... .... .... .... .... .... .... .... .... .... .... .... Pneumonia .... .... 1 .... .... .... .... .... .... .... .... .... 1 2 Suffocation, overlaying 1 .... .... .... .... .... .... .... .... .... .... .... .... .... Other Causes .... 2 .... .... .... .... 1 .... .... 1 .... .... .... 5 11 4 4 1 4 2 1 1 1 2 1 2 1 35 Population estimated to middle of 1909, 16,600. Births in the year, legitimate, 401; illegitimate, 17. Deaths in the year, legitimate. 34; illegitimate, 4. Death from all causes at all ages, 186. ESSEX COUNTY COUNCIL. Summary of Work done through the Sanitary Inspector in the Urban Sanitary District of Romford during the year ending December 31st, 1909. ( To be sent to the Clerk to the County Council with the Medical Officer of Health's Annual Report). Total Number for year. Notes, Results of Inspection, &c. 1 Complaints received 39 2 Nuisances detected without complaint 310 3 Nuisances abated 331 4 Notices served 316 5 Summonses taken out 9 6 Convictions 3 7 Cottages inspected 398 8 Lodging-houses inspected 2 9 Slaughter-houses inspected 8 10 Bakehouses inspected 15 11 Dairies and Milk Shops inspected 26 12 Cowsheds inspected 16 13 Workshops inspected 9 14 Filthy houses cleansed, sec. 46 Public Health Act, 1875 5 5 15 Houses disinfected 131 16 Overcrowding abated 4 17 Houses placed in habitable repair 18 Houses closed 19 Houses erected or re-built for which Water" Certificates" were applied 20 "Certificates" granted . 21 „ deferred. 22 Wells sunk or improved supplies of Water afforded 3 23 Wells cleansed or repaired 1 SANITARY INSPECTOR'S REPORT—Continued. Total Number for year. Notes, Results of Inspection, &c. 24 Wells closed 2 25 Houses connected with sewers 26 Houses connected with water mains 3 27 Earth, pail, or improved Privies constructed or existing Privies altered Nil. 28 Privies and W.C.'s repaired ; W.C.'s supplied with water Nil. 29 Cisterns cleansed, ed, or covered 5 30 Animals improperly kept, removed 7 31 Samples of water taken for Analysis 5 32 Compensation paid for destruction of infected bedding Nil. 33 Seizures of unsound Meat, &c. Nil. (Signed) GEO. R. BAILEY, Inspector of Nuisances. Annual Report of the Medical Officer of Health for the year 1909, for the Urban District of Romford, on the administration of the Factory and Workshop Act, 1901, in connection with Factories, Workshops, Workplaces, and Homework. 1—Inspection of Factories, Workshops, and Workplaces. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections Written Notices. Prosecutions. Factories (Including Factory Laundries) 20 2 Workshops (including Workshop Laundries) 306 4 Workplaces 12 - Total 338 6 2.—DEFECTS FOUND. Particalars. Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts: Want of Cleanliness 4 4 Want of Cowl to Brazing Hearth 1 1 Defective floor to Bakehouse. 1 1 New Roof and Door to Bakehouse 1 1 Insufficient Sanitary Accommodation. 1 1 Total 8 8 3.—HOME WORK. NATURE OF WORK. OUTWORKERS' LISTS. Lists received from Employers twice in the year. Addresses of Outworkers. Inspection of Outworkers' premises Lists. Outworkers. Received from other Councils. Forwarded to other Councils. Contractors. Workmen. Wearing Apparel— Making, &c. 14 4 32 Brush Making 1 2 Total 14 5 34 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at the end of the year. Number. Workshops .and Bakehouses 99 Workshop Bakehouse 15 114 Total number of workshops on Register 114 5.—OTHER MATTERS. Class. Number. Matter notified by H. M. Inspector of Factories:— 2 ALFRED WRIGHT, February 24th, 1910. Medical Officer of Health.