Rom 25 BOROUGH OF ROMFORD HEALTH DEPARTMENT ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1950 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. BOROUGH OF ROMFORD HEALTH DEPARTMENT ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1950 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (as at 31st December, 1950) His Worship The Mayor: Councillor J. E. Poel, J.P. Deputy Mayor: Councillor A. Needham Aldermen: Alderman C. H. Barney Alderman W. D. Hill Alderman G. F. Chaplin, C.C. Alderman C. E. Smart Alderman A. J. Dyer, O.B.B. Alderman L. S. Webb Alderman R. A. Forge, J.P. Councillors: Councillor P. J. Bartaby Councillor Mrs. L. A. Irons, Councillor H. A. Beck J.P. Councillor A. E. Blane Councillor C. L. Jones Councillor T. W. Bradley Councillor A. Keeble Councillor S. C. Brown Councillor A. McGonagle Councillor E. F. Castle Councillor Mrs. M. L. Councillor C. Charlton McWeeney Councillor Mrs. M. Clark-Lewis Councillor W. A. Reeder Councillor S. V. Ellmore Councillor G. Roberts, J.P. Councillor O. J. Hammond Councillor S. E. C. Stevens Councilor R. Yeal 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE His Worship The Mayor: Councillor J. K. Poel, J.P. (ex-offieio member) Chairman: Councillor P. J. Bartaby Vice-Chairman: Councillor S. C. Brown Alderman R. A. Forge, J.P. Councillor Mrs. L. A. Irons, J.P. Alderman L. S. Webb Councillor A. Keeble Councillor H. A. Beck Councillor A. McGonagle Councillor E. F. Castle CouncillorMrs. M. L. Councillor Mrs. M. Clark-Lewis McWeeney Councillor O. J. Hammond Councillor S. E. C. Stevens 5 HEALTH DEPARTMENT Public Health Staff Medical Officer of Health J. B. Samson, M.D., Ch.B., D.P.H. Assistant Medical Officers (a) A. P. Diaper, M.C., M.A., M.D., B.Ch., B.A.O. (b) Mrs. E. M. Haga, M.B., B.S., L.R.C.P., D.P.H. (c) Mrs. H. Symonds, M.D., M.R.C.S., L.R.C.P. Sanitary Inspectors (a) W. S. Gent, Senior Sanitary Inspector, Certificate of the Royal Sanitary Institute; Certificate of the Liverpool University School of Hygiene for Meat and Other Foods. (b) H. C. Boswell, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Other Foods. (c) T. E. R. Jones, Certificate of the Royal Sanitary Institute. (Commenced duties, 1st September, 1950.) (d) H. H. Seddon, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Other Foods. (e) J. F. Stables, Certificate of the Royal Sanitary Association, Scotland; Certificate of the Royal Sanitary Association, Scotland, for Meat and Other Foods. Health Visitors. Superintendent Health Visitor: Miss F. K. Wells, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (a) Miss M. K. Bays, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (Also holds the appointment of School Nurse.) (Commenced duties on 5th September, 1950.) (b) Miss O. Clements, State Registered Nurse; Registered Fever Nurse; State Certified Midwife; Health Visitors' Certificate. (c) Miss M. A. Cowles, State Registered Nurse; State Certified Midwife; Queen's Certificate of District Nursing; Health Visitors' Certificate. (Also holds the appointment of School Nurse). 6 (d) Miss M. Hill, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (Also holds appointment of School Nurse.) (Commenced duties on 1st May, 1950.) (e) Miss H. E. S. Holmes, State Registered Nurse; State Certified Midwife; Health Visitors' Certificate. (Also holds the appointment of School Nurse.) (f) Miss M. A. Mander, State Registered Nurse; Part I iS.C.M.; Health Visitors' Certificate. (Also holds the appointment of School Nurse.) Tuberculosis Visitors. (a) Mrs. B. Alder, State Registered Nurse; State Certified Midwife. (b) Miss I. M. Baldwin, State Registered Nurse; Certificate for Tuberculosis. (c) Miss K. F. Roots, State Registered Nurse; Registered Fever Nurse; Certificate for Tuberculosis. Domiciliary Midwives. Non-Medical Supervisor of Midwives and Home Nurses: Miss M. B. Worby, State Registered Nurse; State Certified Midwife ; Midwifery Teaching Diploma. (a) Miss I. A- Bassett, State Certified Midwife. (b) Miss C- M. Kerr, State Registered Nurse; State Certified Midwife. (c) Miss M. Kitson, State Registered Nurse; State Certified Midwife. (d) Mrs. M. Mylward, State Certified Midwife. (e) Mrs. B. A. Rooks, State Certified Midwife. (f) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife; Queen's Certificate of District Nursing. (g) Mrs. J. Thompson, State Registered Nurse; State Certified Midwife. (h) Miss M. R. Waddell, State Registered Nurse; State Certified Midwife. (i) Mrs. M. B. Woodhouse, State Registered Nurse; State Certified Midwife; Registered Fever Nurse. 7 Home Nurses. (a) Mrs. E. M. Broome, State Registered Nurse. (b) Miss J. M. Holliday, State Registered Nurse ; State Certified Midwife. (Resigned 16th December, 1950.) (c) Miss J. Macaulay, State Registered Nurse; State Certified Midwife; Queen's Certificate of District Nursing. (d) Miss R. E. May, State Certified Midwife; Registered Mental Nurse. (e) Mrs. K. A. Rushworth, State Registered Nurse; State Certified Midwife ; Queen's Certificate of District Nursing. (f) Mrs. A. C- Silcock, State Registered Nurse ; State Certified Midwife. (g) Miss J. D. Silcock, State Registered Nurse ; State Certified Midwife. Clerks. (a) E. W. Gowers, Chief Clerk. (b) C. G. Humberston, Chief Assistant. (c) Miss C. Debrie. (Commenced duties 17th June, 1950.) (d) Mrs. P. Flynn. (Resigned 8th July, 1950.) (e) Miss B. Parker. (f) Mrs. I. Pugh. (Commenced duties 3rd July, 1950.) (g) J. Rivett. (Commenced duties 17th July, 1950.) Home Help Organiser. Mrs. L. Canham. Day Nurseries—Matrons. " St. Moritz." Mrs. I. C. Bowyer, State Registered Nurse. Collier Row. Mrs. D. Eveling, State Registered Nurse. Rush Green. Mrs. R. M. O'Halloran, State Registered Nurse; Registered Fever Nurse, 8 BOROUGH OF ROMFORD To His Worship The Mayor, Aldermen, and Councillors of the Borough of Romford. Mr. Mayor, Ladies, and Gentlemen, 1 have the honour, herewith, to present to you this, my Annual Report on the Health of the District for the year 1950. This is the Seventeenth Report in the series since 1 was appointed your Medical Officer of Health, and it is drawn up in accordance with the requirements of Articles 6(3) and 17(5) of the Sanitary Officers' (Outside London) Regulations, 1935, as modified by Circular No. 112/50 of the Ministry of Health, dated 6th December, 1950. This circular states that the Report should be prepared on the lines of that for 1949. For the reasons mentioned m last year's report, the following pages deal, in part, with the Health Services administered in this Area by the Essex County Council, as the Local Authority for those services, in accordance with the National Health Service Act, 1946. Under the Scheme of the County, Health Area No. 6 is coterminous with the Borough of Romford, and your Medical Officer of Health also holds the appointment of Acting Area Medical Officer. Furthermore, your Medical Officer holds the appointment of Borough School Medical Officer. It will be appreciated that such an arrangement is in the best interests of a unified service. The district continues to grow, if not in area, at any rate in population, and, as is well known, this is largely accounted for by the establishment of the London County Council Estate at Harold Hill. Progress in development will continue there for a few years yet, and will, no doubt, bring its own problems. The general statistics, 1 feel, are again satisfactory and encouraging. As in the past, my thanks go to all the members of my staff who have assisted in the work in their own individual spheres, and in the compilation of this report; to my fellow officials for their kind aid during the year; and to all the members of the Council and Health Area Sub-Committee, who, at all times, have shown a keen interest in matters pertaining to the health and well-being of the inhabitants of the town. I am, Mr. Mayor, Ladies, and Gentlemen, Your obedient servant, JAMES B. SAMSON, Medical Officer of Health. Public Health Department, Town Hall, Romeord. May, 1951, 9 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1950 Statistics and Social Conditions of the Area Area (in acres) 9,342 Population: Census (1931), 35,918; Mid. 1950, (Estd.) 80,240 Number of Inhabited Houses (end of 1950) 22,932 Rateable Value (end of 1950) £631,150 Product of Penny Rate (end of 1950) £2,547 Extracts from Vital Statistics for the Year Total M. F. Live Births: Legitimate 1,365 716 649 Illegitimate 64 33 31 Birth Rate: 16.6 per 1,000 of estimated resident population Still Births: Legitimate 31 21 10 Illegitimate 4 3 1 Rate per 1,000 total (live and still births): 23.9 Deaths 665 355 310 Death Rate: 10.0 per 1,000 estimated resident population. Rate per 1,000 total (live and still) births Deaths from Puerperal causes 0.7 Death Rate of Infants under one year of age:— All Infants per 1,000 live birtths 23.1 Legitimate Infants per 1,000 legitimate live births 22.7 Illegitimate Infants per 1,000 illegitimate live births 31.3 Deaths from Cancer (all ages) 124 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 1 10 TABLE 1. BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY, and CASE-RATES for certain Infectious Diseases in the year 1950. England and Wales, London, 126 Great Towns, and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns) RATE PER 1,000 POPULATION DEATH-RATE PER 1.000 POPULATION RATE PER 1,000 LIVE BIRTHS All Causes Typhoid and Paratyphoid Fevers Whooping Cough Diphtheria Tuberculosis Influenza Small-pox Acute Poliomyelitis and Polioencephalitis Pneumonia Diarrhoea and Enteritis (under 2 years) Total Deaths under 1 year Live Births Still Births England and Wales 15.8 0.37 11.6 0.00 0.01 0.00 0.36 0.10 0.00 0.02 0.46 1.9 29.8 126 County Boroughs and Great Towns, including London 17.6 0.45 12.3 0.00 0.01 0.00 0.42 0.09 0.00 0.02 0.49 2.2 33.8 148 Smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) 16.7 0.38 11.6 0.00 0.01 0.00 0.33 0.10 0.00 0.02 0.45 1.6 29.4 London 17.8 0.36 11.8 0.00 0.01 0.00 0.39 0.07 0.00 0.01 0.48 1.0 26.3 ROMFORD 16.6 0.44 10.0 0.00 0.00 0.00 0.40 0.07 0.00 0.01 0.34 0.7 23.1 The Maternal Mortality Rate for England and Wales is as follows: Per 1,000 Total Live Births — 0.86 The Maternal Mortality Rate for Romford is as follows: Per 1,000 Total Live Births — 0.68 11 TABLE 2. Causes of Death All Ages Deaths at the subjoined ages of Residents, after correction for Inward and Outward transfers M. F Total Under 1 1 2-4 5-14 1524 2534 3544 4554 5564 6574 75 & upwards 1. Tuberculosis, respiratory 19 10 29 ... ... ... ... 5 7 3 4 6 3 1 2. Tuberculosis, other 3 ... 3 ... ... ... 1 1 ... ... ... 1 ... ... 3. Syphilitic disease 1 2 3 ... ... ... ... ... ... ... ... 1 1 1 4. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... 7. Acute poliomyelitis 1 ... 1 ... ... ... • 1 ... ... ... ... ... 8. Measles ... ... ... ... ... ... ... ... ... ... ... ... 9. Other infective and parasitic diseases 1 3 4 ... ... ... 1 ... ... ... ... ... 1 2 10. Malignant neoplasm, stomach 13 9 22 ... ... ... ... ... 1 ... 2 5 4 10 11. Malignant neoplasm, lung, bronchus 24 2 26 ... ... ... ... ... ... 3 5 7 9 2 12. Malignant neoplasm, breast ... 12 12 ... ... ... ... ... ... 6 5 1 ... 13. Malignant neoplasm, uterus ... 4 4 ... ... ... ... ... ... ... 2 1 ... 1 14. Other malignant and lymphatic neoplasms 31 29 60 ... ... ... 1 2 3 5 4 10 19 16 15. Leukaemia, aleukaemia 2 1 3 ... ... ... ... ... 1 ... ... 1 1 ... 16. Diabetes 3 3 6 ... ... ... ... ... ... ... 1 ... 2 3 17. Vascular lesions of nervous system 30 46 76 ... ... ... ... ... 1 2 4 14 25 30 18. Coronary disease, angina 45 38 83 ... ... ... ... ... ... 4 8 24 21 26 11). Hypertension with heart disease 7 14 21 ... ... ... ... ... ... ... 1 5 9 6 20. Other heart disease 34 58 92 ... ... ... ... ... 2 3 2 9 22 54 21. Other circulatory disease 16 14 30 ... ... ... ... ... ... 1 3 3 9 13 22. Influenza 3 3 6 ... ... ... ... ... 1 ... 1 1 3 ... 23. Pneumonia 23 4 27 10 l ... ... ... ... ... ... 1 6 9 24. Bronchitis 23 9 32 ... ... ... ... ... 1 1 3 10 17 25. Other diseases of respiratory system 4 1 5 ... ... ... ... ... 1 ... ... 1 1 2 26. Ulcer of Stomach and duodenum 4 ... 4 ... ... ... . ... ... ... l 1 ... 2 27. Gastritis, enteritis, and diarrhoea 2 2 4 1 ... 1 ... ... ... ... ... 1 1 ... 28. Nephritis and nephrosis 4 3 7 ... ... ... ... 2 ... ... ... 2 2 1 29. Hyperplasia of prostrate 6 ... 6 ... ... ... ... ... ... ... ... ... 1 5 30. Pregnancy,childbirth, abortion ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... 31. Congenital malformations 5 3 8 4 1 1 ... ... 1 1 ... ... ... ... 32. Other defined and illdefined diseases 33 29 62 18 1 ... ... 4 5 4 5 7 8 10 33. Motor vehicle accidents 8 1 9 ... ... ... 1 2 2 1 1 ... 1 1 34. All other accidents 3 5 8 ... ... 1 1 1 ... 2 ... ... 1 2 35. Suicide 7 4 11 ... ... ... ... 1 2 1 2 3 1 1 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 355 310 665 33 3 3 5 20 28 31 53 112 162 215 l2 This year the Registrar-General has given his estimate of the mid-year population of Romford as 80/240, which compares with 73,640 last year, an increase of 6,600. For comparative purposes the Registrar-General includes Romford amongst the 148 smaller towns with populations ranging from '25,000 to 50,000 at the 1931 census, and, in this list, Romford takes fourth place. During 1950, the total number of live births registered was 1,429, and the total number of deaths registered was 667. The difference of 762 gives the natural increase in population. As this number falls short of the Registrar-General's estimated increase of 6,600, it follows that the balance of 5,838 is made up of excess of Immigration over Emigration, and this again is largely accounted for by the development of the Harold Hill Estate. For 1950 we estimate the Birth Rate to be 16.6 per 1,000 of the estimated resident population. This figure is obtained by multiplying the Crude Birth Rate of 17.8 by the Comparability Factor of 0.93. For last year the Rate was 18.0, but no Comparability Factor was given. The Rate for England and Wales for 1950 is given as 15.8, and for the 148 smaller towns with populations ranging from 25,000 to 50,000 at the 1931 census, the Rate is 16.7. The Death Rate for Romford is estimated at 10.0 per 1,000 of the estimated resident population. This figure is obtained by multiplying the Crude Death Rate of 8.3 by the Comparability Factor of 1.21. For last year the Rate was 10.8. The comparable Rates for England and Wales, and for the 148 smaller towns, as referred to above, are 11.6 and 11.6 respectively. The chief causes of death, in order of frequency, were :— (1) Diseases of Heart and Circulation. (2) Cancer. (3) Bronchitis, Pneumonia and other Respiratory Diseases. (4) All Forms of Tuberculosis. The order remains the same as last year. The Maternal Mortality Rate, which is the number of Maternal Deaths due to conditions associated with pregnancy or confinement, per 1,000 total (live and still) births is 0.7. The corresponding rate for England and Wales is 0.9. The Infant Mortality Rate, or the Death-Rate of Infants under 1 year of age per 1,000 live births, is 23.1, an increase of 6.5. It was not to be expected that the extremely low rate of last year would be maintained without subsequent fluctuation. The corresponding figures for England and Wales and the 148 smaller towns are 29.8 and 29.4 respectively. 13 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA (i) Staff. Particulars of the staff are set out at the beginning of this report. The Assistant Medical Officers, Nursing Staff, and Home Help Organiser, as also some of the Clerical Staff come under the jurisdiction of the Essex County Council in their capacity as Local Health Authority, and, as 1 have already mentioned, your Medical Officer of Health is also Acting Area Medical Officer for the Part III duties of the National Health Service Act, 1946. (ii) Laboratory Facilities. There is no change in the facilities, and they meet the requirements of the district. Full advantage is taken of the service by the Department and by the General Practitioners. (iii) Nursing in the Home. (a) General Nursing. There are, at present, seven Home Nurses in the area. These are employed whole-time in general domiciliary nursing, but one also performs midwifery duties. More Home Nurses will be appointed, as and when the needs of the Harold Hill Estate justify such appointments being made. A scheme is in operation, under the provisions of Section 28 of the National Health Service Act, for the loan of sick-room equipment, and a small charge is made for this service. Table 3 sets out the work of the Home Nurses during the year. TABLE 3 (1) Number of Visits paid 14,385 (2) Number of Cases attended 1,328 (b) Domiciliary Midwives. At the end of the year nine Domiciliary Midwives were employed, and here also, the needs of Harold Hill Estate are borne in mind. All the midwives have had the necessary tuition in the administration of Gas and Air Analgesia, and all have been provided with the necessary apparatus, which is regularly serviced by the British Oxygen Company. AH th.e midwives have cars, either provided by themselves or by the County Council, and these are helpful for the conveyance of the equipment, as well as allowing the midwives to get quickly to their cases. Furthermore, all the midwives are capable of administering Pethedine, another of the analgesics, and this is given as required. 14 The following gives a summary of the cases attended by the Domiciliary Midwives, as midwives, and as maternity nurses:— TABLE 4 As Midwives 398 As Maternity Nurses 146 The number of confinements attended by the Domiciliary midwives has decreased, owing to the decrease in the birth rate, and to the fact that many of the confinements are now taking place in hospitals. In order to balance out the cases more evenly between the midwives, the boundaries of their districts have been re-arranged, and, at the end of the year, arrangements were being made to transfer one of the staff to the Harold Hill Estate, instead of making a newappointment in this particular area. Table 5 gives a summary of the "Medical Aid" notices received during the year. TABLE 5 (1) Where the medical practitioner had arranged to provide the patient with maternity services under the National Health Service 26 (2) Others 170 (iv) Ante-natal and Post-natal Clinics. There are now five ante-natal sessions held each week, and two post-natal sessions per month. When necessary, mothers are also referred to the Consultative Clinic at Oldchurch Hospital. During tlie year,1,356 individual expectant mothers attended the ante-natal clinics. In addition, 323 mothers attended for postnatal advice. In all, 252 ante-natal sessions were held. The total number of attendances of the 1,356 ante-natal mothers, mentioned above, was 5,193, giving an average of 3.8 attendances per patient. The average number attending at each session was 20.6. Twenty-two post-natal sessions were held, and 332 attendances were recorded. The average number attending at each session was 15.1. (v) Child Welfare Clinics. There are now ten child welfare sessions held each week, an additional session having been commenced during the year to meet the needs of the residents on the Harold Hill Estate. 15 Altogether 489 sessions were held, and the following table gives a summary of the attendances:— TABLE 6 Individual children attending 3,621 Children attending for the first time 1,272 Medical consultations 7,027 Attendances of children under one year 18,022 Attendances of children between the ages of one and five years 8,339 Average attendances per session 53.9 (vi) Health Visitors. There is still a shortage of Health Visitors in the district, but it is hoped that in the future, more will be obtained from the scheme for the training of Health Visitors, now in operation throughout the County. Table 7 relates to Home Visits paid by the Health Visitors during the year. TABLE 7 (a) To expectant mothers— First visits 134 Total visits 171 (b) To children under one year of age— First visits 1,462 Total visits 3,408 (c) To children between the ages of one and five years— Total visits 7,142 (vii) The Care of Premature Infants. These arrangements remain the same, the two draught-proof cots being available as required. (viii) Inspection of Nursing Homes. Two additional Nursing Homes were established during the year, one at 72 Heath Park Road, for the reception of eight chronic or aged patients, and one at '21 Gilbert Road, for the reception of eight medical or chronic patients. Two Nursing Homes, however, one at 20 Parkland Avenue, and one at 71 Western Road, discontinued, so that the total number remains at three. All were inspected, once per quarter, on behalf of the County Council. 16 (ix) Domestic Helps. This service has continued to spread, especially with the demands of the Harold Hill Estate, where so many residents, because of a physical hardship, have had a priority for re-housing. This is one of the problems inseparable from an Estate of this nature. These demands have been met to the best of our ability, and, at the end of the year, approximately 97 part-time helps were employed throughout the whole district, and, during the year, the helps gave assistance in 507 individual cases. A limited number have continued to carry out duties in households where there is a case of tuberculosis. As a precautionary measure, these helps are first referred to the Chest Physician. Whilst working, they are provided with protective clothing, and are given a list of instructions on precautionary measures to be adopted in the home. (x) Day Nurseries. The three day nurseries have again been working to full capacity, and a fairly large waiting list has been maintained at each. Because of this waiting list, the Health Area Sub-Committee drew up a system of priorities for admissions, and this is now in operation. The question of the provision of two additional nurseries, and the extension of the "St. Moritz" nursery is still under consideration. The average attendance for the year at each nursery was as follows :— TABLE 8 "St. Moritz" Nursery 35 Collier Row Nursery 37 Rush Green Nursery 43 The "St. Moritz" Nursery and the Collier Row Nursery are scheduled to take forty children each, and the Rush Green Nursery, fifty children. (xi) Dental Service. There is nothing to add to what I have already said as to the total inadequacy of this service, and the position remains the same as before. The following gives particulars of the service :— TABLE 9 (a) Numbers provided with dental care:— Examined. Needing Treatment. Treated. Made Dentally Fit. Expectant and Nursing Mothers Children under five 17 15 12 12 17 (b) Forms of dental treatment provided:— Anaesthetics. Scalings Extracor Silver Radio- Dentures tions Fillings. Scaling Nitrate Dressings. provided. and Gum Treatment. grapns. Local. General. Treatment. Complete. Partial Expectant and Nursing Mothers. Children under five 21 12 1 2.—SANITARY CIRCUMSTANCES OF THE AREA (i) Water. Mr. H. CI. Ramsay, Chief Engineer of the South Essex Waterworks Company, has kindly given me the following report with regard to the water supply to the district:— "(a) There have been no new extensions of public water supply during the year 1950 other than those necessitated by the supply to the permanent housing sites. (b) Lengths of mains laid, in yards:— 3" 4" 6" 9" L.C.C. Harold Hill Estate 177 9,043 633 1,939 Romford Area — 1,294 278 392 Totals 177 10,337 911 2,331 (c) Bacteriological and chemical examinations are made of the raw water, of the water in its various stages of treatment, of the water supplied from the Company's wells, and of the water going into supply. Analyses are also made of samples obtained from consumers' taps in various parts of the Companys' district; all proved to be satisfactory. A total of over 3,300 chemical, bacteriological, and biological examinations have been made. (d) The water supplied was sufficient and wholesome, and the supply was constant throughout, with no plumbo-solvent action." Approximately 0.1 per cent of the inhabited houses, and 0.1 per cent of the population of the Borough take their water from standpipes. In addition to the above analyses, independent samples have again been taken by the sanitary inspeatoiis for bacteriological analyses once per month, and chemical analyses once per six months and the results have confirmed the findings of the Waterworks Company. On one occasion, however, an abnormality was found, 18 although consistent with a water wholesome in character, and suitable for drinking and domestic purposes. This was due to the main at this particular point being a "dead end," caused by the closure of a valve where the high pressure system from the Heaton Grange Reservoir meets the low pressure system from the Romford supply. After flushing the "dead end." a subsequent sample of the water proved entirely satisfactory. Nevertheless, the Company made arrangements to provide a small bv-pass from the two services at this point. (ii) Prevention of Damage by Pests Act, 1949. This Act, which came into force on the 31st March, 1950, repealed the Rats and Mice (Destruction) Act, 1919, as from that date. Added powers are now given to local authorities to deal with rats and mice, and infestation of food. During the year the Sanitary Inspectors and Rodent Operative paid 2,397 visits and re-visits to premises. Further maintenance treatment, in respect of rat disinfestation to sewers, was undertaken during the year. (iii) Infestation. The same arrangements exist for the treatment of cases of infestation, and the same facilities for the disinfestation, or destruction of clothing and bedding. This applies to cases of scabies, and infestation with lice and bugs. (iv) Sanitary Inspection of the Area. The Senior Sanitary Inspector has given me the following report, as required by Article 27(18) of the Sanitary Officers' (Outside London) Regulations, 1935. TABLE 10 (a) Nature and number of Inspections during the year:— Bakehouses 37 Butchers' Shops and Stalls, etc 54 Common Lodging Houses 34 Cowsheds, Dairies, and Milkshops 52 Drainage 575 Establishments for Massage and Special Treatment 13 19 Factories (Mechanical Power) 29 Factories (Non-Mechanical) 3 Food Preparing Premises 276 Foodshops 296 Infectious Disease 572 Keeping of Animals 36 Markets 45 Meat Depots 47 Prevention of Damage by Pests Act, 1949 2,397 Public Baths 28 Public Conveniences 49 Sale of Horseflesh 41 Shops Acts 39 Slaughterhouses 500 Smoke Observations 46 Stables 10 Streams and Ponds 31 Tents, Vans, and Sheds 126 Verminous Premises 52 Water Supplies 33 (b) Informal Notices (Number served) 1,034 Statutory Notices (Number served) 224 (c) As a result of the service of Notices, the necessary works were completed by the owners or occupiers in all cases except 166, the works for which were still in hand at the end of the year. (v) Factories Act, 1937. A summary of the statistics, as required by the Ministry of Labour and National Service, is given below:— TABLE 11 1. Inspections. Premises. Number on Register. Inspections. Written Notices. Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 24 29 1 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 188 3 1 - 20 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding OutWorkers premises) 20 - - - Total 232 32 2 - 2. Oases in which Defects were Found. No. of Cases in which prosecucutions instituted Particulars. No. of Cases in which defects were found. Found. Remedied. Referred to H.M. Inspector. by H.M. Inspector. Want of Cleanliness 1 1 - - - Overcrowding - - - - - Unreasonable Temperature - - - - - Inadequate Ventilation - - - - - Ineffect. drain. of floors - - - - - Sanitary Conveniences :— (a) Insufficient 6 6 - - - (b) Unsuitable or Defective - - - - - (c)Not Separate for Sexes - - - - - Other Offences 4 4 - - - Total 11 11 - - - 3. Outwork. Nature of Work. List of No. of Outworkers in August. No. of Cases of default in sending List. No. of Prosecutions for failure to supply Lists. No. of Instances of Work in Unwhole some Premises. Notices Served. cutions. Wearing Apparel— Making, etc. 82 - - - - - Artificial Flowers 4 - - - - - Making of Boxes 4 - - - - - Feather Sorting 1 - - - - - Stuffed Toys 1 - - - - - Christmas Goods 4 - - - - - Total 96 - - - - - 21 (vi) Camping Sites. Camping sites, or perhaps I should rather say, caravan sites, are creating a problem of growing concern in this area, as two of these are fairly firmly established, and one is in embryo. In two of these cases planning consent, as well as consent from the Public Health Committee, has been sought by the owners of the land, but in the third case, individual consents have been requested from the occupiers of the caravans. At the end of the year, the Council. from the Public Health aspect, prescribed certain conditions, but planning consent was still awaited. Under present-day conditions of housing, the problem is bound to increase, but I am afraid that, even in the ideal lay-out, these sites may become unsightly, and foster neighbourly quarrels. 3.—INSPECTION AND SUPERVISION OF FOOD (i) Milk Supply. Samples of milk have again been taken periodically throughout the district, and, in particular, one sample is taken per supplier per school term, for bacteriological examination, and one sample is taken of pasteurised milk, per supplier per school year for biological examination. At the end of the year, sixteen persons were licensed to retail designated milks. Of these, five were licensed to retail Tuberculin Tested milk, fourteen were licensed to retail pasteurised milk, and ten were licensed to retail sterilised milk. (ii) Ice Cream. All traders and manufacturers have to be registered. There were, at the end of the year, 32 manufacturers and 182 vendors on the register. Here, also, regular sampling has been carried out. (iii) Meat. The Sanitary Inspectors have again regularly attended at the Regional Slaughterhouse, and, in addition, have paid the usual visits to Meat Depots, butchers' shops, stalls, etc. Altogether, 983 visits have been paid, and at the slaughterhouse alone 13,162 carcases were examined. No Ante-Mortem inspections are carried out, but all animals slaughtered are examined. Table 12 sets out the particulars of the carcases inspected and condemned. 22 TABLE 12. CARCASES INSPECTED AND CONDEMNED. Cattle except Cows. Cows. Calves. Sheep and Lambs. Pigs. Total. Number killed (if known) 4,025 1,950 3,187 7,639 761 17,562 Number inspected 4,025 1,950 3,187 7,639 761 17,562 All diseases except Tuberculosis. Whole Carcases condemned 1 21 10 12 14 58 Carcases of which some part or organ was condemned 1,353 805 18 365 80 2,621 Percentage of the number inspected affected with diseases other than tuberculosis 33.6 42.3 0.87 4.93 12.3 15.25 Tuberculosis only. Whole carcases condemned 17 67 - - 7 91 Carcases of which some part or organ was condemned 292 455 - - 12 759 Percentage of the number inspected affected with tuberculosis 7.6 26.7 - - 2.49 — 23 (iv) Food Products in General. Byelaws relating to the handling, wrapping, and delivery of food and sale of food in the open air, based on the Model Byelaws of the Ministry of Food, received the confirmation of the Minister of Food on the '26th June, 1950, and came into operation on the 31st July, 1950. This should go a long way towards helping the cleanliness of food in general, and action is being taken accordingly. At the end of August, the Health Departments of this area, the Borough of Dagenham, and the Urban District of Hornchurch took advantage of a Three Town's Show to demonstrate propaganda relating to the cleanliness of food, and this appeared to be well received by the public during the two days of the exhibition. 4.—HOUSING STATISTICS FOR THE YEAR 1950 TABLE 13 Number of Houses erected during the year:— (1) By Local Authority 316 (2) By Private Enterprise 77 1. Inspection of Dwelling-Houses during the Year :— (l)(a) Total number of Dwelling-Houses inspected for Housing Defects (under the Public Health or Housing Acts) 1,406 (b) Number of inspections made for the purpose 4,219 (2) (a) Number of Dwelling-Houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil (3) Number of Dwelling-Houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (4) Number of Dwelling-Houses (exclusive of those referred to under the preceding subhead) found not to be in all respects fit for human habitation 1,006 2. Remedy of Defects during the year without service of Formal Notices :— Number of Dwelling-Houses rendered fit in consequence of Informal action by the Local Authority or their Officers 868 3. Action under Statutory Powers during the year:— (a) Proceedings under Sections 9, 10, and 16 of the Housing Act, 1936— (l)Number of Dwelling-Houses in respect of which notices were served requiring repairs 1 24 (2) Number of Dwelling-Houses which were rendered fit after service of Formal Notices :— (a) By Owners 1 (b) By Local Authority in default of owners Nil (b) Proceedings under the Public Health Acts— (1) Number of Dwelling-Houses in respect of which notices were served requiring defects to be remedied 223 (2) Number of Dwelling-Houses in which defects were remedied after service of Formal Notices :— (a) By Owners 195 (b) By Local Authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936 :— (1) Number of Dwelling-Houses in respect of which Demolition Orders were made 6 (2) Number of Dwelling-Houses demolished in pursuance of Demolition Orders 3 (d) Proceedings under Section 12 of the Housing Act, 1936 :— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit 1 4. Housing Act, 1936, Part IV— Overcrowding :— (a) 1. Number of Dwellings overcrowded at end of year 154 2. Number of Families dwelling therein 266 3. Number of Persons dwelling therein 1,075 (b) Number of New Cases of Overcrowding reported during the year 47 (c) 1. Number of New Cases of Overcrowding relieved during the year 5 2. Number of Persons concerned in such cases 18 (d) Particulars of any cases in which Dwelling-Houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 25 5.— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES (i) Notifiable Diseases. As before, I have not recorded those notifications where the diagnosis has been altered after a period of observation, unless the amended diagnosis proved the condition to be one of another type of infection which is notifiable, when the case has been appropriately recorded. (a) Acute Anterior Poliomyelitis. Owing to the press publicity which has, for two or three years, been given to this condition, it is now unnecessary for me to remind you that this is the technical term for infantile paralysis. 1950 was again an epidemic year throughout the country, and, as far as residents in Romford were concerned, there were altogether seventeen cases. Two of these, however, occurred in the month of January, when the condition was quiescent in the district. The other cases occurred when the disease was prevalent in the country. Of the total cases, nine showed evidence of paralysis, four showed no evidence of paralysis, and four were stated to be abortive. One patient, unfortunately, died. All were removed to hospital, as also a number of other patients thought to be suffering from poliomyelitis but which eventually proved not to be the case. The same generally accepted precautionary measures were adopted. When paralysis is manifest it is more easy to be relatively sure of the diagnosis, especially during an epidemic period, but when there is no paralysis, diagnosis, to a large extent, rests on the examination of the cerebro spinal fluid. In these latter, if there is no clinical evidence of meningeal irritation, it is customary to diagnose the condition as "abortive," but where there is evidence of meningeal irritation, the case is diagnosed as "non-paralytic." Full particulars of each case were again forwarded to the Ministry of Health for statistical purposes. (b) Acute Infective Hepatitis. This continues to be notifiable throughout the Eastern Region, and there were twenty-four notifications. These were again forwarded to the Regional Medical Officer at Cambridge for research purposes. (c) Diphtheria. During 1950, there was only one case of diphtheria, but, as this patient came from abroad, and was ill on arrival, and admitted to the isolation hospital almost immediately, it would appear that the infection was not contracted in this country. 26 This means that for the second consecutive year, no cases occurred in Romford. Prominence has again been given to diphtheria immunisation and to the desirability of "booster" doses at 5 and 10 years of age in order to maintain a high standard of immunisation amongst those children who have previously had a course of injections in early infancy. The following statistics relate to the state of immunisation at the 31st December, 1950. TABLE 14 Under 5 yrs. 5-15 yrs. Number of children who had completed a full course of Immunisation at any time up to 31st December, 1950, and who were born between 31st December, 1936, and 31st December, 1950 3,859 10,208 Approximate estimated number of children 7,950 11,580 Percentage Immunised at 31st December, 1950 49 88 This, however, does not give a complete record, as children, as a general rule, do not complete inoculation earlier than their first birthday. By allowing for this, the percentage of children immunised between one and five years of age is raised to 64. Table 15 gives the statistics since the inauguration of the scheme in Romford in 1935, till the end of 1950. TABLE 15 Number of Immunising injections given at the Clinics 33,787 Number of children who have completed the course of Injections, either at the Clinics or by own doctors 17,510 Number of Schick Test Injections given at the Clinics, including Control Injections 22,107 Number who have been Schick Tested 11,073 (d) Dysentery. During the last quarter of the year there was an outbreak of dysentery in the area, due to Shigella Sonnei. My attention was first drawn to this by reason of about thirty cases amongst school children in one particular school. Immediate investigation was made, when it was found that a number of the sufferers had returned to school, as the illness was mild and had cleared up in about 24-28 hours. It was found, however, that three members of the canteen staff had suffered, and had returned to duty. 27 Further cases continued to be reported, with no relationship to this school, and altogether 100 cases were ascertained. No doubt, however, many others suffered and did not seek medical advice, with the result that they were never ascertained. Samples of various foodstuffs were sent for analysis, but gave negative results. It would appear that there was some general infection throughout the district, and it is possible that one or other of the patients amongst the canteen staff, on return to duty, may have been a temporary carrier and may have infected the school meals. (e) Food Poisoning. Eight cases were officially notified during the year, but there is no doubt that there were many more, as a large number of patients suffer only to a relatively slight degree, and, in consequence, do not call in the asistance of a doctor, even though they may themselves suspect food poisoning. It should be constantly borne in mind by all concerned in the handling, preparation, and storage of food, and particularly by those who work in canteens, or who serve food to large numbers, that the utmost care must be taken to obviate the risk of food poisoning. This may occur, even in the best equipped of canteens, and prevention is largely dependent on personal hygiene. The food itself need not necessarily be bad, but it can act as a vehicle for the transference of infection. This was exemplified in two outbreaks at a school in the district during the year. At the first occasion, staphylococcus pyogenes, an organism commonly associated with food poisoning, was found in some of the foodstuffs, and likewise, in the nasal swabs from some of the canteen staff. Whilst it is appreciated that about forty per cent of adults carry such an organism in the nose, nevertheless the carrier rate in this case was about eighty per cent. On the second occasion, at the same school, the foodstuffs proved negative to organisms of the food poisoning group, and the carrier rate, this time, amongst the canteen staff, was about thirtythree per cent. On both occasions it was not possible to state, with any degree of accuracy, the true cause of the outbreak, but the danger of transmission of infection was carefully pointed out to the staff, and precautionary measures adopted. (f) Measles. Measles was in epidemic form, mainly during the months of June and July. Altogether, during the year, there were 720 cases. No deaths were recorded. 28 (g) Scarlet Fever. This disease was in epidemic form during the latter part of 1949, and continued during 1950. During this latter year there were 174 notifications. On the whole, the condition was very slight in this area. (h) Smallpox. No cases occurred in the district, but a few possible contacts of cases were kept under surveillance for the recognised period. Table 16 gives the statistics relative to vaccination, as recorded by the general practitioners of the district. TABLE 10 Vaccinated: Under one year of age 343 Between the ages of one and five years 71 Between the ages of five and fifteen years 52 Over fifteen years 58 Re-Vaccinated: Under one year of age - Between the ages of one and five years 1 Between the ages of five and fifteen years 21 Over fifteen years 128 (i) Tuberculosis. (i) An interesting innovation, towards the latter part of the year, was a research measure, carried out by the Medical Research Council into the value of the anti-Tuberculosis vaccine, B.C.G. In brief, the scheme is as follows :— Secondary Modern School-leavers are selected, and it is done entirely on a voluntary basis. All children taking part are given the benefit of regular supervision, over three to five years, by x-ray, skin tests, and other examinations. The skin test is used to show whether the child has, at any time, had contact with the germ of tuberculosis. The chest x-ray indicates if there is any disease of the lungs. All the children are followed up with the greatest care. At regular intervals, the chest x-ray and other examinations are repeated. In addition, any children known to be in contact with tuberculosis, or found to have the disease, has the full care provided by the Chest Clinic Service. 29 The vaccine known as B.C.G. is a possible measure of strengthening resistance to tuberculosis, although we do not know if this vaccine is so useful that it is necessary to offer it to all children who have never harboured the germ of tuberculosis. Therefore, a part of the scheme is an enquiry into the value of the vaccine. The children who show by the skin test that they have already, at some time, had their first contact with the germ of tuberculosis, are not vaccinated. Some of the others are vaccinated, and an equal number are not. It is only by such a scheme that the real value of B.C.G. can be tested, and, needless to say, the Committee for Education and Heads of the Secondary Modern Schools concerned have given their full co-operation. (ii) Mass Radiography. During the month of December, arrangements were made by one of the Mass Radiography Units of the North East Metropolitan Regional Hospital Board, under the direction of Dr. H. Ramsay, to visit the area. As these examinations will also be continued dining January, 1951, it is not possible, at this stage, to give the results of Dr. Ramsay's findings. (j) Whooping Cough. Altogether, 357 cases were notified, and these were fairly evenly distributed throughout the year. As with measles, no deaths were recorded. (ii) Non-Notifiable. There are relatively few infectious diseases which are nonnotifiable. The prevalence of these, during the year, is set out below, but they are probably an under-estimate as the figures are compiled from the school returns only. TABLE 17 Chickenpox 227 Mumps 98 Rubella 3 6.—SUPPLEMENTARY (i) Section 47, National Assistance Act, 1948. It was not found necessary to take any action during the year under this section of the National Assistance Act, 1948. 30 TABLE 18. MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASES Month Scarlet Fever Diphtheria Enteric Fever Puerperal Pyrexia Pneumonia Dysentery Erysipelas Malaria contracted abroad Measles Meningococcal Infection Ophthalmia Neonatorum Poliomyelitis Paralytic Poliomyelitis Non- Paralytic Whooping Cough Infective Hepatitis Food Poisoning | Tuberculosis Total Resp. Non.Resp. January 38 - - - 13 - 1 - 2 2 - 1 - 8 3 - 12 6 96 February 16 - - - 11 - - - 5 - 1 1 - 18 3 - 11 - 66 March 15 - - - 8 - - - 19 - - - 1 30 3 - 8 5 89 April 16 1 - 2 6 - 1 - 36 1 - - - 45 3 - 15 3 129 May 21 - - - 2 - - - 69 1 - - - 41 - - 16 - 150 June 15 - - 2 1 - - - 187 - 1 1 1 26 1 5 13 - 253 July 13 - - 2 1 - 1 - 276 - - 1 1 31 4 - 16 1 347 August 9 - - 1 3 - 1 - 85 - - 1 6 44 4 - 26 3 183 September 2 - - 1 2 - 2 1 16 - - - 1 32 1 3 26 2 89 October 10 - - - 6 19 2 - 1 - - 2 1 24 1 - 21 2 89 November 14 - 1 1 4 37 1 - 6 3 - 3 - 33 1 - 29 3 136 December 5 - - 1 4 39 - - 18 - - - - 25 - - 11 1 104 Total 174 1 1 10 61 95 9 1 720 7 2 10 11 357 24 8 214 26 1,731 31 TABLE 19. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO AGE GROUPS. Disease Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15 20 20-35 35-45 45-65 Over 65 Total Scarlet Fever - 3 9 21 24 96 14 4 2 1 - - 174 Diphtheria - - - - - 1 - - - - - - 1 Enteric Fever - - - - - - - 1 - - - - 1 Puerperal Pyrexia - - - - - - - - 10 - - - 10 Pneumonia 12 3 6 1 3 4 3 4 7 7 9 2 61 Dysentery 8 7 9 7 7 32 6 1 7 6 5 - 95 Erysipelas - - - - - - - - 2 1 6 - 9 Malaria contracted abroad - - - - - - - - 1 - - - 1 Measles 22 73 87 97 96 337 4 1 2 1 - - 720 Meningococcal Infection 3 2 - 1 - - 1 - - - - - 7 Ophthalmia Neonatorum 2 - - - - - - - - - - - 2 Poliomyelitis Paralytic 1 1 1 1 1 3 1 - 1 - - - 10 Poliomyelitis Non-Paralytic - 1 - - 2 4 4 - - - - - 11 Whooping Cough 32 36 60 58 51 115 - 1 3 1 - - 357 Infective Hepatitis - - - - 1 4 3 2 7 2 2 3 24 Food Poisoning - 1 - 1 - 1 - - 2 3 - - 8 Total 80 127 172 187 185 597 36 14 44 22 22 5 1,491 32 TABLE 20. DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO WARDS Disease Collier Row & Havering Ward. Gidea Park & Noak Hill Ward. Hare Park Ward. Mawney Ward. South Ward. Town Ward. West Ward. Total. Scarlet Fever 52 37 22 21 17 18 7 174 Diphtheria - 1 - - - - - 1 Enteric Fever - 1 - - - - - 1 Puerperal Pyrexia - 1 - 1 5 3 - 10 Pneumonia 31 12 5 4 5 1 3 61 Dysentery 83 1 - 2 7 1 1 95 Erysipelas 2 - 2 3 1 - 1 9 Malaria contracted abroad 1 - - - - - - 1 Measles 252 65 36 117 67 101 82 720 Meningococcal Infection 2 - - 1 3 - 1 7 Ophthalmia Neonatorum - 2 - - - - - 2 Poliomyelitis Paralytic 1 3 3 - 1 - 2 10 Poliomyelitis Non-Paralytic 3 1 - 2 3 1 1 11 Whooping Cough 155 54 38 48 40 15 7 357 Infective Hepatitis 5 2 5 3 5 3 1 24 Food Poisoning 6 - - - 2 - - 8 Tuberculosis—Respiratory 21 143 5 15 13 8 9 214 Tuberculosis—Non-Respiratory 4 12 2 2 3 2 1 26 Total 618 335 118 219 172 153 116 1,731 33 TABLE 21 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING YEAR 1950, and HOSPITAL ADMISSIONS Disease Cases Notified. Cases Admitted to Hospital Total Deaths Scarlet Fever 174 23 - Diphtheria 1 1 - Enteric Fever 1 1 - Puerperal Pyrexia 10 5 - Pneumonia 61 27 27 Dysentery 95 5 - Erysipelas 9 - - Malaria contracted abroad 1 1 - Measles 720 12 - Meningococcal Infection 7 6 - Ophthalmia Neonatorum 2 - - Poliomyelitis Paralytic 10 10 1 Poliomyelitis Non-Paralytic 15 10 - Whooping Cough 357 14 - Infective Hepatitis 24 2 1 Pood Poisoning 8 - - Total 1,491 117 29 34 TABLE 22 TUBERCULOSIS: NEW CASES AND MORTALITY DURING 1950 AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 2 2 2 - - - - - 5 7 9 2 3 - - 1 - 15 30 26 1 5 3 2 1 - 25 36 42 3 4 4 3 - - 35 19 11 2 2 1 2 - - 45 13 6 1 - 3 1 - - 55 4 2 - - 6 - 1 - 65 and upwards 4 1 1 - 2 2 - - Total 115 99 12 14 19 10 3 - 35 TABLE 23. OPHTHALMIA NEONATORUM. CASES Vision Unimpaired Vision Impaired Total Blindness Deaths Notified. Treated At Home In Hospital 2 2 Nil 2 Nil Nil Nil WILSON & WHITWORTH LTD., ROMFORD.