BOROUGH OF ROMFORD Rom 28 HEALTH DEPARTMENT Annual Report of the MEDICAL OFFICER OF HEALTH for the year 1953 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 1953 JAMES B. SAMSON, m.d., d.p.h. Medical Officer of Health 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (as at 31st December, 1953) His Worship The Mayor: Alderman Mrs. L. A. Irons, J.P. Deputy Mayor: Alderman G. Roberts, J.P. Aldermen: Alderman C. H. Barney, Alderman S. V. Ellmore A.S.A.A. Alderman A. McGonagle Alderman H. A. Beck Alderman L. S. Webb Alderman T. W. Bradley Alderman E. Yeal, M.B.E. Councillors: Councillor P. J. Bartaby Councillor F. C. Bell Councillor P. F. Broadhead, D.S.C. Councillor S. C. Brown Councillor A. M. Cannon Councillor F. G. Carrick Councillor C. Charlton Councillor Mrs. M. Clark-Lewis Councillor G. Coulson Councillor E. W. Driscoll Councillor L. F. P. Eley Councillor W. S. Gardner Councillor W. J. Hawkins, B.A. (Com.) Councillor T. P. Hunt Councillor E. H. Jarvis Councillor A. C. Latham Councillor W. F. Long Councillor W. J. Martin Councillor W. R. Pike Councillor P. D. Ridley, M.A. (Cantab.) Councillor M. J. Riordan Councillor Mrs. O. M. J. Roberts Councillor M. Sharp Councillor H. W. Talbot Councillor A. G. Western Councillor W. A. White 4 BOROUGH OF ROMFORD PUBLIC BUILDINGS AND HEALTH COMMITTEE His Worship The Mayor: Alderman Mrs. L. A. Irons, J.P. (ex-officio member) Chairman: Councillor W. S. Gardner Vice-Chairman: Councillor W. R. Pike Alderman L. S. Webb Councillor T. P. Hunt Councillor Mrs. O. M. J. Councillor C. Charlton Roberts Councillor Mrs. M. Clark-Lewis Councillor M. Sharp 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. Draper, M.C., M.A., M.D., B.Ch., B.A.O. (Resigned 30th June, 1953.) (b) J. J. Duffy, M.B., B.Ch., B.A.O., D.P.H. (Commenced duties 7th July, 1953.) (c) R. C. Greenberg, M.B., B.S., C.P.H. (Commenced duties 19th January, 1953.) (d) Mrs. E. M. Haga, M.B., B.S., L.R.C.P., D.P.H. (e) Mrs. G. A. Kolibabka, M.A., M.B., Ch.B. Sanitary Inspectors (a) H. C. Boswell (A.B.) (Senior Sanitary Inspector). (b) M. J. Dove (A.B.). (c) T. E. R. Jones (A.B.). (d) G. F. Hobson (A.B.). (Commenced duties 16th February, 1953.) (e) W. Hodson (A.B.). (f) H. H. Seddon (A.B.). A. Sanitary Inspector's Certificate of the Royal Sanitary Institute, and Sanitary Inspectors' Joint Examination Board. B. Certificate of the Royal Sanitary Institute for Inspectors of Meat and Other Foods. Health Visitors. Superintendent: Miss F. K. Wells (A.B.D.). (a) Miss B. C. Blackley (A.B.D.E.G.). (b) Miss O. Clements (A.B.D.F.). (c) Mrs. G. E. Engall (A.B.D.F.G.). (d) Mrs. E. M. H. Geary (A.C.D.G.). (Commenced duties 11th August, 1953) (e) Miss D. I. A. Hall (A.B.D.G.). (f) Miss M. Harrison (A.C.D.F.G.). (Resigned 29th December, 1953) (g) Miss M. Hill (A.B.D.G.). (h) Miss H. E. S. Holmes (A.B.D.G.). (i) Miss F. Lambert (A.C.D.G.). (Commenced duties 20th July, 1953) (j) Mrs. Y. Stone (A.C.D.G.). (Resigned 31st December, 1953) (k) Miss A. M. Tidd (A.C.D.F.G.). (Commenced duties 1st October, 1953) (l) Mrs. G, Wallach (A.C.D.E.G.). 6 Tuberculosis Visitor. Mrs. B. Alder (A.B.). Domiciliary Midwives. Non-Medical Supervisor of Midwives and Home Nurses: Miss R. A. B. Baker (A.B.), Midwifery Teaching Diploma. (Commenced duties 11th August, 1953) (a) Miss I. A. Bassett (B.). (b) Miss E. E. Jeenes (A.B.). (Commenced duties 7th April, 1953) (c) Miss C. M. Kerr (A.B.). (d) Miss M. Kitson (A.B.). (e) Miss F. L. Law (A.B.). (f) Mrs. M. Mylward (B.). (g) Mrs. E. A. Rooks (B.). (h) Mrs. G. E. Sexton (A.B.). (i) Mrs. J. Thompson (A.B.). (j) Miss M. R. Waddell (A.B.). (Resigned 16th February, 1953) (k) Mrs. M. B. Woodhouse (A.B.). Home Nurse/Midwives. (a) Miss D. D. K. Martin (A.B.). (b) Miss R. E. May (B.). (c) Mrs. A. H. Menzies (A.B.). (Commenced duties 1st December, 1953) (d) Mrs. I. Mobbs (A.B.). (Commenced duties 9th February, 1953) Home Nurses. (a) Mrs. E. M. Broome (A.). (b) Mrs. B. Casey (A.C.). (c) Mrs. C. Cook (A.). (Commenced duties 17th August, 1953) (d) Miss J. Macaulay (A.B.). Queen's Certificate of District Nursing. (e) Mrs. A. C. Silcock (A.B.). (f) Miss J. D. Silcock (A.B.). (g) Mrs. M. Slavin (A.). (Resigned 28th February, 1953) (h) Mrs. D. I. Towell (A.). (Commenced duties 27th April, 1953) (i) Mrs. S. A. Wotherspoon (A). A. State Registered Nurse. B. State Certified Midwife. C. Part 1 S.C.M. D. Health Visitor's Certificate. E. Certificate of Tuberculosis Nursing. F. Registered Fever Nurse. G. Also holds the appointment of School Nurse. 7 Domestic Help Organiser. Mrs. L. Canham. Day Nurseries—Matrons. "St. Moritz" Mrs. I. C. Bowyer. Collier Row— Mrs. D. Eveling. Rush Green— Mrs. R. M. O'Halloran. Clerical Assistants. (a) E. W. Gowers, Chief Administrative Assistant. (b) C. G. Humberston, Senior Administrative Assistant. (c) S. J. Adams, Administrative Assistant. (d) W. Norris, Administrative Assistant. (e) Miss M. E. Firmin. (f) Miss B. Parker. (g) Mrs. M. Barnard. (h) Mrs. S. Corner. (i) Mrs. I. M. Gray. (j) Miss R. Harvey. (k) Mrs. M. E. Riley. (l) Miss J. V. Saggers. (m) Miss V. C. Warren. (Commenced duties 28th December, 1953) (n) Miss K. E. Wilkins. (Commenced duties 16th November, 1953) 8 BOROUGH OF ROMFORD To His Worship The Mayor, Aldermen, and Councillors of the Borough of Romford. Mr. Mayor, Ladies and Gentlemen, I have the honour, herewith, to present to you, this, my Annual Report on the Health of the District for the year 1953. This is the Twentieth Report in the series, since I was appointed your Medical Officer of Health, and it is drawn up in accordance with the requirements of Article 17(5) of the Sanitary Officers (Outside London) Regulations, 1935, and with Circular No. 1/54 of the Ministry of Health, dated 12th January, 1954. After negotiations between the Borough Council and the Essex County Council, it was agreed that, as from 1st April, your present Medical Officer would act in the capacity of Medical Officer of Health for the Borough of Romford, as to fifty per cent. of his time, and, for the remaining fifty per cent. would be Area Medical Officer and Divisional School Medical Officer for the Romford Area of the Essex County Council. This makes no difference in practice, and has the merit of co-ordinating the various functions and duties. This Report deals with my work as Medical Officer in all capacities, with prevention as its prime aim. Although there is still growth in the population, this is not likely to increase to the same extent in the future, so that we shall be better able to take stock of our position. My thanks are again gratefully tendered to all members of the Borough Council, and the Health Area Sub-Committee; to the members of my staff; and to my fellow officials. Each, and every one, has given willing assistance in the compilation of this report and has the interest of the health of the district at heart. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, JAMES B. SAMSON, Medical Officer of Health. Public Health Department, Town Hall, Romford. May, 1953. 9 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1953 Statistics and Social Conditions of the Area Area (in acres) 9,342 Population: Census (1951), 88,002; Mid. 1953 (Estd.) 104,100 Number of Inhabited Houses (end of 1953) 28,480 Rateable Value (end of 1953) £751,317 Product of Penny Rate (end of 1953) £2,924 Death Rate: 10.5 per 1,000 estimated resident population. Rate per 1,000 total (live and still) births Deaths from Puerperal causes 1.5 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 31.6 Legitimate Infants per 1,000 legitimate live births 32.8 Illegitimate Infants per 1,000 illegitimate live births 0. Deaths from Cancer (all ages) 139 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 5 Extracts from Vital Statistics for the Year Total M. F. Live Births: Legitimate 1,889 983 906 Illegitimate 73 33 40 Birth Rate: 15.8 per 1,000 of estimated resident population Still Births : Legitimate 37 19 18 Illegitimate 3 1 2 Rate per 1,000 total (live and still births): 20.0 Deaths 768 420 348 TABLE 1 BI.RTH-RATES, DEATH-HATES, ANALYSIS OF MORTALITY, England and Wales, London, 160 County Boroughs and MATEBNAL MOBTALITY, and CASE-BATES for certain Infectious Great Towns, and 160 Smaller Towns. Diseases in the year 1953. (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 Live Births Still 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 England and Wales 15.5 0.35 11.4 0.00 0.01 0.00 0.20 0.16 0.00 0.01 0.55 1.1 26.8 160 County Boroughs and Great Towns, including London 17.0 0.43 12.2 0.00 0.01 0.00 0.24 0.15 0.00 0.01 0.59 1.3 30.8 160 Smaller Towns (Resident Populations 25,000 to 50,000 at 1951 Census) 15.7 0.34 11.3 0.00 0.00 0.00 0.19 0.17 0.00 0.01 0.52 0.9 24.3 London 17.5 0.38 12.5 0.00 0.00 0.00 0.15 0.15 0.00 0.01 0.64 1.1 24.8 BOMFORD 15.8 0.38 10.5 0.00 0.00 0.00 0.19 0.11 0.00 0.01 0.43 2.5 31.6 The Maternal Mortality Bate for England and Wales is as follows: Per 1,00(1 Total Live Births — 0.76 The Maternal Mortality Bate for Romford is as follows: Per 1,000 Total Live Births — 1.50 10 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 upwards 1. Tuberculosis, respira- 13 4 17 ... ... ... ... 1 4 3 4 4 1 ... •2. Tuberculosis,other 1 2 3 ... 1 ... ... ... ... ... 1 1 ... ... 3. Syphilitic disease 2 ... 2 ... ... ... ... ... ... ... ... 2 ... ... 4. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Meningococcal infections ... ... ... ... ... ... ... ... ... ... ... ... ... ... 7. Acute poliomyelitis 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... 8. Measles ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9. Other infective and parasitic diseases ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10. Malignant neoplasm, stomach 13 5 18 ... ... ... ... ... ... ... 4 5 6 3 11. Malignant neoplasm, lung, bronchus 28 3 31 ... ... ... ... ... ... 1 9 11 6 4 12. Malignant neoplasm, breast ... 10 16 ... ... ... ... ... ... 2 5 2 3 4 13. Malignant neoplasm, uterus ... 9 9 ... ... ... ... ... ... ... 3 4 1 1 14. Other malignant and lymphatic neoplasms 37 28 65 ... ... ... 1 ... 2 3 6 10 25 18 15. Leukaemia, aleukaemia 4 1 5 1 ... 1 1 ... ... ... ... ... 2 ... 16. Diabetes 3 2 5 ... ... 1 1 ... ... ... 1 ... 2 ... 17. Vascular lesions of nervous system 35 45 81 ... ... ... ... ... ... 2 7 14 23 35 18. Coronary disease, angina 73 36 109 ... ... ... ... ... 1 3 5 26 36 38 19. Hypertension with heart disease 4 3 7 ... ... ... ... ... ... ... ... 1 5 1 20. Other heart disease 43 66 109 ... ... ... ... ... 2 2 8 7 18 72 21. Other circulatory disease 22 15 37 ... ... ... ... ... ... 2 3 1 13 14 22. Influenza 7 5 12 ... ... 1 ... ... 2 ... 2 1 4 2 23. Pneumonia 31 14 45 10 ... 1 1 ... ... 1 1 6 8 16 24. Bronchitis 25 20 45 ... ... ... l ... ... 1 2 15 12 14 25. Other diseases of respiratory system 3 3 6 ... ... ... ... ... ... 1 2 2 ... 1 26. Ulcer of Stomach and duodenum ... 1 1 ... ... ... ... ... ... ... ... ... ... 1 27. Gastritis, enteritis, and diarrhoea 6 1 7 5 ... ... ... ... ... ... ... 2 ... ... 28. Nephritis and nephrosis 2 7 9 ... ... ... ... ... 1 ... 1 2 1 4 29. Hyperplasia of prostrate 4 ... 4 ... ... ... ... ... ... ... ... ... ... 4 30. Pregnancy, childbirth, abortion ... 3 3 ... ... ... ... ... 2 1 ... ... ... ... 31. Congenital malformations 12 12 24 13 3 1 ... 2 1 1 3 ... ... ... 32. Other defined and illdefined diseases 38 34 72 33 ... 1 ... ... 3 1 9 6 13 11 33. Motor vehicle accidents 4 4 8 ... ... 1 ... 1 ... ... 1 1 2 1 34. All other accidents. 4 4 8 ... 1 ... ... ... 1 ... ... 1 ... 5 35. Suicide 5 4 9 ... ... ... ... ... 3 ... 2 1 ... 1 36. Homicide and operations of war ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 420 348 768 62 5 7 9 5 23 24 72 128 183 250 12 This year the Registrar-General has given his estimate of the mid-year population of Romford as 104,100, which compares with 99,360 for last year, an increase of 4,740. During 1953, the total number of live births registered was 1,962, and the total number of deaths registered was 769. The difference of 1,193 gives the natural increase in the population. As t his number falls far short of the Registrar-General's estimated increase of 4,740, it follows that the balance of 3,547 is made of excess of Immigration over Emigration. For 1953, we estimate the Birth Rate to be 15.8 per 1,000 of The estimated resident population. This figure is obtained by multiplying the Crude Birth Rate of 18.8 by the Comparability Factor of 0.84. For last year the Rate was 17.9. The Rate for England and Wales for 1953 is given at 15.5, and for the 160 County Boroughs and Great Towns with populations exceeding 50,000 at the 1951 Census, the Rate is 17.0. The Death Rate for Romford is estimated at 10.5 per 1,000 of the estimated resident population. This figure is obtained by multiplying the Crude Death Rate of 7.4 by the Comparability Factor of 1.42. For last year the Rate was 9.1. The comparable Rates for England and Wales, and for the 160 Great Towns referred to above are 11.4 and 12.'2 respectively. The chief causes of death in order of frequency were:— (1) Diseases of the Heart and Circulation. (2) Cancer. (3) Bronchitis, Pneumonia, and Other Respiratory Diseases. Other conditions now take a very minor place as a cause of death. 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 1.5. This is somewhat higher than in the past. In all there were three deaths. One, however, although admitted to hospital from an address in this area, had permanent residence elsewhere—another was complicated by an associated Bilateral Pulmonary Tuberculosis. The corresponding Rate for England and Wales is 0.76. The Infant Mortality Rate, or the Death Rate of Infants under one year of age per 1,000 live births, is 31.6, an increase of 6.3 The corresponding figures for England and Wales, and the 160 Great Towns are 26.8 and 30.8 respectively. This figure also is higher than we have hitherto been accustomed to, and, on subdividing the total number, viz : sixty-two, it is found that forty-six occurred during the first month, and sixteen thereafter. Eight of the babies were born at home and fifty-four in hospital. Twentynine of the deaths were attributed to Congenital causes, fifteen to Prematurity, and eighteen to other conditions. 13 1.—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA (i) Staff The particulars of staff are set out at the beginning of this report. The Assistant Medical Officers, Nursing Staff, the Domestic Help Organiser, and also the majority of the Clerical Staff come under the jurisdiction of the Essex County Council, in their capacity as Local Health Authority. For my own part, I hold the position of Medical Officer of Health for the Borough of Romford, and Area Medical Officer for the Part III duties of the National Health Service Act, 1946, as administered by the Essex County Council. (iii) Laboratory Facilities These facilities remain as hitherto, and meet requirements. Good use of the services has been made by the Department, and by the General Practitioners. (iii) Nursing in the Home (a) General Nursing. At the end of the year eight Home Nurses and four Home Nurse/Midwives were serving the area. These were all employed in general domiciliary nursing, but, in addition, the Home Nurse/ Midwives also combined this work with midwifery duties. Instructions have been issued to the Home Nurses to the effect that all patients must be visited when requested by a doctor, and that no treatment must be undertaken without a note or telephone message from a doctor, except in the case of an emergency. Under the provision of Section 28 of the National Health Service Act, arrangements continued for the loan of sick-room equipment, for which no charge is made. Table 3 sets out the work of the Home Nursing section, during the year. TABLE 3 (1) Number of Visits paid 25,082 (2) Number of Cases attended 1,429 (b) Domiciliary Midwives. At the end of the year ten Domiciliary Midwives were employed and also the four Home Nurse/Midwives referred to above. The following gives a summary of the cases attended by the Domiciliary Midwives, as Midwives and as Maternity Nurses. TABLE 4 As Midwives 803 As Maternitv Nurses 125 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 16 (2) Others 96 14 (iv) Ante-natal and Post-natal Clinics. Six Ante-natal sessions are held each week, and two Post-natal sessions are held per month. Mothers have again been referred, if necessary, to the Consultative Clinic at Oldchurch Hospital. During the year 753 individual expectant mothers attended the Ante-natal Clinics. In addition ten mothers attended for Postnatal advice. In all, 283 Ante-natal sessions were held. The total number of attendances of the 753 Ante-Natal mothers mentioned above was 3,219, giving an average of 4.3 attendances per patient. The average number attending at each session was 11.4. Twenty-three Postnatal sessions were held, and 288 attendances were recorded. The average number attending at each session was 11.2. (v) Child Welfare Clinics Twelve Child Welfare sessions are now held each week. Altogether there were 592 sessions, and the following table gives a summarv of the attendances :- TABLE 6 Individual children attending 4,157 Children under one year attending for the first time 1,543 Medical consultations 5,662 Attendances of children under one year 19,215 Attendances of children between the ages of one and five years 7.699 Average attendance per session 45.5 (vi) Health Visitors At the end of the year there were ten Health Visitors. The majority of these also carried out duties as School Nurses, and several of them also acted as Tuberculosis Nurses. Table 7 relates to Home Visits paid by the Health Visitors under their duties in connection with Maternal and Child Welfare. TABLE 7 (a) To Expectant Mothers— First Visits 212 Total Visits 257 (b) To Children under one year of age— First Visits 2,464 Total Visits 6,182 (c) To Children between the ages of one and five years— Total Visits 9,417 During the course of the year 1 communicated with all General Practitioners and told them that the Health Visitors were prepared 15 to give them all assistance within their power, and asked them to communicate with the Superintendent whenever such assistance was required. Increasing use is also being made of the Health Visitors' services by many of the local and London Hospitals when information is required regarding the patients who are, or have been, attending those Hospitals. (vii) Care of Premature Infants To a certain extent the special draught-proof cots were again in use, but all parts of the area are within easy access of Oldchurch Hospital, where a special unit for treatment is in operation. (viii) Inspection of Nursing Homes The same four Nursing Homes are on the register. These were inspected on four occasions throughout the year, on behalf of the County Council, when conditions were found to be satisfactory at each. (ix) Domestic Helps The demand on this service was maintained, and all requests for assistance were dealt with promptly. During the year 167 Parttime Helps were employed, and during the course of the year, those Helps attended 692 individual cases. As before, several volunteered for duties in households where there were cases of Tuberculosis. These Helps are specially selected, and have to undergo a medical examination before acceptance. They are provided with protective clothing and given special instructions on the precautionary measures which they must adopt. Many of the requests for assistance are received from family practitioners who appreciate what we can offer, and who are at all times willing to give us information regarding the subsequent progress of their patients. (x) Day Nurseries After the introduction of the increased charges, which took effect in January, there was a considerable diminution in the attendances, and whereas before this date we were maintaining a waiting list for the three nurseries of between 200-300, after this date the waiting list quickly dropped to "nil". The average attendances for the year at each Nursery were as follows:— TABLE 8 "St. Moritz" Nursery 24 Collier Row Nursery 19 Rush Green Nursery 19 The "St. Moritz" Nursery and the Collier Row Nursery are each scheduled to take forty children and the Rush Green Nursery fifty children, 16 (xi) Dental Service I am glad to he able to report that, in November, we managed to obtain the services of an additional Dental Officer on a sessional basis, for five sessions per week. Although this is only a small contribution to the dental section, nevertheless it is appreciated. The following gives particulars of the work done during the year:— TABLE 9 (a) Numbers provided with Dental care:— Examined. Needing Treatment. Treated. Made Dentally Fit Expectant and Nursing Mothers 25 25 27 13 Children under Five 55 55 51 51 (b) Forms of Dental Treatment provided:— Extractions. Anaesthetics. Scalings or Scalings and Gum Treatment. Silver Nitrate Treatment. Dressings. Radio graphs. Dentures provided Local. General Fillings. Complete. Partial Expectant and Nursing Mothers - - - 106 23 - - - - - Children under five 31 — 29 12 — 15 — — — — 2.—SANITARY CIRCUMSTANCES OF THE AREA Mr. H. G. 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 1953, other than those to permanent housing sites. (b) Lengths of mains laid, in yards:— 3" 4" 6" 9" L.C.C. Harold Hill Estate 6 22 1,823 — Romford Area 1,428 2,463 560 3 1,434 2,485 2,383 3 (c) The water supply of the area and of its several parts has been satisfactory both as to quality and quantity. (d) 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 the various parts of the Company's district; all proved to be satisfactory. A total of over 3,800 chemical, bacteriological, and biological examinations have been made. 17 (e) The waters are not liable to plumbo-solvent action. (f) No contamination has arisen, therefore no action has been necessary. In addition to the anaylses given above, independent samples have again been taken by the Sanitary Inspectors, for Bacteriological analyses, once per month, and for Chemical analyses, once per six months. The results have confirmed the findings of the Waterworks Company. (ii) Sanitary Inspection of the Area The Senior Sanitary Inspector has given me the undermentioned report, as required by Article 27(18) of the Sanitary Officers' (Outside London) Regulations, 1935, and also the particulars which follow. During the year 1,563 complaints were received and investigated. TABLE 10 Nature and Number of Inspections during the year— Accumulations and Refuse Deposits 35 Bakehouses 20 Butchers' Shops and Stalls, etc. 152 Cesspools 92 Common Lodging Houses 22 Cowsheds, Dairies and Milkshops 77 Drains, relaid or altered 127 Drainage—obstructed or defective 898 Drains Tested 80 Diseases of Animals Act 3 Disinfections and Disinfestations 13 Dustbins 60 Establishments for Massage and Special treatment 14 Factories Act (Mechanical Power) 157 Factories Act (Non-mechanical) 75 Factories Act (Outworkers Premises) 562 Food Preparing Premises 306 Food Hawkers 64 Food Inspection 466 Food Shops 209 Housing Acts 882 Ice Cream 416 Heating Appliances (Fireguards) Acts, 1952 15 Infectious Disease (including Food Poisoning) 1,055 Insects and Pests 16 Keeping of Animals 6 Markets 112 Miscellaneous 46 Nuisances, Public Health Act 2,620 Pet Animals Act, 1951 27 Piggeries 103 18 Prevention of Damage by Pests Act, 1949 2,913 Public Baths 9 Public Conveniences 56 Rag Flock Act 7 Sale of Horseflesh 12 Schools 14 Shops Act 127 Slaughterhouses 575 Smoke Observations 75 Stables 5 Streams and Ponds 71 Tents, vans and sheds 170 Verminous premises 120 Water closets 20 Water Supplies 36 Informal Notices (number served) 863 Statutory Notices (number served) 154 As a result of the service of Notices, the necessary works were completed by the owners or occupiers in all cases except 94, the works for which were still in hand at the end of the year. (iii) Factories Acts, 1937 and 1948 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 13 29 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 229 157 4 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding OutWorkers premises) 37 46 4 - Total 279 232 11 — 19 2. Cases in which Defects were Found. Particulars. No. of Cases in which prosecucutions instituted No. of Cases in which defects were found. Found. Remedied. Referred to H.M. inspector. by H.M. Inspector. Want of Cleanliness 3 3 Overcrowding — — — — - Unreasonable Temperature - - - - - Inadequate Ventilation - - - - - Ineffect. drain, of floors - - - - - Sanitary Conveniences— - - - - - (a insufficient 3 3 — — — (b) Unsuitable, or defective 5 5 - - - (c)Not separate for Sexes - - - - - Other Offences — — — — — Total 11 11 — — — 3. Outwork. Nature of Work No. of OutWorkers in August List 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 Prosecutions Wearing Apparel— Making, etc. 38 - - - - - Brush Making 14 - - - - - Total 52 - - - - - During the year 562 inspections were made of Outworkers' premises. (iv) Caravan Sites. There are 4 licensed caravan sites, one of which is controlled by the Council. Altogether, there are 240 caravans on these sites. The sites are maintained in a satisfactory condition. (v) Prevention of Damage by Pests Act, 1949. During the year the Sanitary Inspectors and Rodent Operative carrried out 2,913 inspections of re-inspections to premises infested by rats and mice. 20 Further maintenance treatment, in respect of rat disinfestation, to sewers, was undertaken during the year on two occasions, when a total of 266 manholes were test baited, and 440 manholes were poison baited. (vi) Infestation. The facilities for disinfestation, and the destruction of clothing and bedding, are the same. (vii) Pet Animals Act, 1951. Thirteen persons are licensed to keep Pet Shops. Frequent inspections are carried out. 3.—INSPECTION AND SUPERVISION OF FOOD (i) Milk Supply. Samples of milk have again been taken by the Sanitary Inspectors as part of their routine duties. At the end of the year, 41 persons were registered as Retailers or Distributors. Of these 11 were licensed to retail TuberculinTested Milk, 1 was licensed to retail Accredited Milk, 15 were licensed to retail Pasteurised Milk, and 29 were licensed to retail Sterilised Milk. As from 2nd December, the Milk (Special Designations) (Specified Areas) No. 2) Order, 1953, came into operation. This specifies certain areas, including the Borough of Romford, where all milk sold for retail must be special designated milk, i.e. Sterilised Milk, Pasteurised Milk, Tuberculin Tested Milk, or Accredited Milk from a single herd. Taking into account the areas that have been specified in a previous Order, the milk supplies of 41% of the population of England and Wales now consist wholly of specially designated milk. (ii) Ice Cream. All Traders and Manufacturers have to be registered. There were at the end of the year 4 manufacturers, and 186 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, 739 visits have been paid, and, at the Ministry of Food Slaughterhouse alone 25,088 carcases were examined. No Ante-Mortem inspections are made, but all animals are examined after slaughter. The carcases of 675 horses were also examined at a private slaughterhouse, which is used solely for the slaughter of horses. During the course of the year, the Council made application to the Minister of Food for authority to employ a system of meat marking at the regional slaughterhouse, in accordance with Article 15 of the Public Health (Meat) Regulations, 1924, and this was duly approved. Table 12 sets out the particulars of the carcases inspected and condemned, 21 TABLE 12. CARCASES INSPECTED AND CONDEMNED. Cattle except Cows. Cows. Calves. Sheep and Lambs. Pigs. Horses. Total. Number killed (if known) 3,960 1,291 1,946 10,099 7,592 675 25,563 Number inspected 3,960 1,291 1,946 10,099 7,592 675 25,563 All diseases except Tuberculosis. Whole Carcases condemned 13 18 10 12 110 1 162 Carcases of which some part or organ was condemned 1,225 628 4 1,074 2,677 1 5,609 Percentage of the number inspected affected with diseases other than tuberculosis 31,2 50.0 0.7 10.7 36.5 0.3 22.5 Tuberculosis only. Whole carcases condemned 21 24 1 - 13 - 59 Carcases of which some part or organ was condemned 222 278 - — 142 — 642 Percentage of the number inspected affected with tuberculosis 6.1 24.7 0.05 — 2.08 — 2.7 21 (iv) Food Products in General. In addition to the premises used for Milk, Ice Cream and Meat referred to above, the following food premises are registered under the Romford Urban District Council Act, 1931, and are subject to the Clean Food Byelaws made under Section 16 of the Food and Drugs Act, 1938. Bakers 31 Cafes 61 Confectioners 61 Fishmongers 29 Greengrocers 44 Grocers 115 Miscellaneous 12 Hawkers 25 There are also 45 food stalls situated in the Market Place on three days of the week. All these premises are subject to regular inspections to ensure that the requirements of the Byelaws and Section 13 of the Act are complied with. During the past year 711 such inspections were made and where necessary informal notices were served, but it is generally found that improvements can be obtained by personal approach rather than the service of notices. (v) Unsound Food. During the year 466 visits were made to food premises mainly on request, for the purpose of dealing with unsound food, and a total quantity of 5 tons 8 cwts. 96 lbs. of food was surrendered as unfit for human consumption. At present all unsound food if suitable is disposed of for animal feeding. (vi) Legal Proceedings, Food and Drugs Act, 1938. Three cases were taken before the Magistrates under Section 9 of the Act, two under Section 13, and one under the Clean Food Byelaws and the following convictions were recorded:— Offence Section Fine (1) Unsound food exposed for sale 9 £2 (2) Sale of diseased chicken 9 £2 (3) Unsound meat deposited for sale 9 £25 (4) Dirty condition of cafe kitchen 13 £9 (5) Continuing offence of dirty kitchen (4) 13 £15 (6) Failure to exhibit name on stall Byelaws £1 In the case of Nos. 4 and 5, following the second conviction for non-compliance with Section 13 the cafe proprietor closed down and sold the premises. (vii) Food Hygiene. The Senior Sanitary Inspector has given talks to various organisations on Food Hygiene and has assisted in the instruction of the Emergency Feeding Section of the Civil Defence Service. Wherever possible these talks are illustrated by the aid of film strips. 23 4.—HOUSING STATISTICS FOR THE YEAR, 1953 TABLE 13 Number of houses erected during the year— (1) By Local Authority 303 (2) By Private Enterprise 264 (3) By L.C.C. at Harold Hill Estate 297 1. Inspection of Dwelling Houses during the Year. (l) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,143 ( b) Number of inspections made for the purpose 4,790 (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 14 (4) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects fit for human habitation 863 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 789 3. Action under Statutory Powers during the Year. (a) Proceedings under Sections 9, 10 and 10 of the Housing Act, 193&— (1) Number of dwelling houses in respect of which Notices were served requiring repairs Nil ('2) Number of dwelling houses which were rendered fit after service of Formal Notices— (a) By owners Nil (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 154 (2) Number of dwelling houses in which defects were remedied after service of Formal Notices— (a) By owners 107 (b) Bv local authority in default of owners 15 21 (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 10 (2) Number of dwelling houses demolished in pursuance of Demolition Orders 9 (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 1 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit Nil 4. Housing Act, 1936, Part IV: Overcrowding. (a) Number of dwellings overcrowded at end of year 66 (2) Number of families dwelling therein 122 (3) Number of persons dwelling therein 485 (b) Number of new cases of overcrowding reported during the year 31 (c)(1) Number of new cases of overcrowding relieved during the year 4 (2) Number of persons concerned in such cases 22 (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 5. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES (i) Notifiable Diseases. According to custom, I have not recorded those notifications, where the diagnosis has been altered after a period of observation, or after investigation. Where, however, the amended diagnosis has proved to be another type of infection which is notifiable, then the case has been appropriately recorded. All amendments are sent to the Registrar-General at the end of each quarter. (a) Acute Anterior Poliomyelitis. Altogether, there were 24 cases in the district. These occurred from the middle of May until the beginning of October. Of the 24 cases, 11 had paralysis of varying degree, and 13 were diagnosed as non-paralytic. There were, fortunately, no deaths. On investigation, it was found that 3 of the cases, and possibly 4, contracted 25 the infection elsewhere. The usual routine precautions were put into operation. Although the total number of cases which occurred in this district was relatively few, and, therefore, practically useless from which to draw statistical conclusions, nevertheless, it is noticeable that the proportion of non-paralytic to paralytic cases has risen. This might be explained by the fact that more cases of indeterminate illness, during an epidemic, are now being refered for investigation, as possible cases of Poliomyelitis, and are subsequently being proved as non-paralytic Poliomyelitis, and/or, it may be that the virus is altering in type, and manifesting itself in a different manner. After all, it is well known, epidemiologically, in another field that the Haemolytic Streptococcus may manifest its attack on the human body in several ways. To mention but two, in some instances it may show with a rash, when the illness gets the name of Scarlet Fever, or it may show as an inflammation of the tonsils, without a rash, when it gets the label of Tonsilitis. It might probably be as simple for us to talk of an Erythrogenic, and a Non-Erythrogenic Scarlet Fever, as it is to talk of a Paralytic and a Non-Paralytic Poliomyelitis. (b) Acute Infective Hepatitis. This condition continues to be notifiable throughout the Eastern Region for purposes of research. Altogether, there were 41 notifications, and these were again forwarded to the Regional Medical Officer at Cambridge. (c) Diphtheria. Once again there were no cases of Diphtheria during the year. The following statistics relate to the state of Immunisation at the 31st December, 1953. In addition to the initial series of injections, "booster" doses have also been administered. TABLE 14 Under 5 yrs. 5-15 yrs. Number of children who had completed a full cause of Immunisation at any time up to 31st December, 1953, and who were born between 31st December, 1938, and 31st December, 1953 5,325 12,629 (d) Dysentery. Thirty-eight cases of Dysentery were notified as belonging to Romford. Twenty-nine were due to Shigella Sonnei, and nine were unclassified. (e) Food Poisoning. During the year 10 cases were notified, which proved to be suffering from food poisoning. In addition another 31 proved indefinite. The following table sets out the details, as required by the Ministry of Health. 20 TABLE 15 (a) Total Number of Outbreaks 2 (b) Total Number of Cases involved in (a) 7 (c) Number of Single Cases 34 (d) Number of Deaths Nil (e) (i) Organisms responsible Salmonella Typhi-Murium Paracolon Proteus Vulgaris Unknown (ii) Outbreaks attributable to (i) 1 - 1 - (iii) Single cases attributable to (i) 2 1 - 31 (f) (i) Foods involved Ducks Eggs Cold Mutton Unknown (ii) Outbreaks attributable to (i) 2 (iii) Single cases attributable to (i) 2 1 31 (f) Measles. Measles acquired high epidemic proportions this year. This was not peculiar, however, to Romford, as the cases notified throughout England and Wales were about the largest on record. The epidemic in this district accounted for a large number of absences from school, and was the main factor contributing to the low percentage of school attendance amongst infant departments during the first quarter of the year. Altogether, 2,153 cases were notified, but there were no deaths. (g) Scarlet Fever. The notifications numbered 227. The type was mild, and no deaths were recorded. (h) Smallpox. No cases occurred in the district, and there was no contact, so that there was no call for surveillance this year. Table 16 gives the statistics relative to Vaccination, as recorded by the General Practitioners of the district. TABLE 16 Vaccinated: Under 1 year of age 466 Between the ages of 1 and 2 years 55 Between the ages of 2 and 5 years 55 Between the ages of 5 and 15 years 50 Over 15 years 71 Re-Vaccinated: Under 1 year of age — Between the ages of 1 and 2 years 1 Between the ages of 2 and 5 years 12 Between the ages of 5 and 15 years 41 Over 15 years 164 27 (i) Tuberculosis. The work being undertaken by the Medical Research Council into the question of the value of the Anti-Tuberculosis Vaccine B.C.G. was continued, and the unit revisited the area in order to carry out Skin Tests and X-ray examinations of those children, now adolescents, who partook of the scheme whilst at school, but who subsequently had left school. A large percentage returned for the examinations, and we are grateful to them for this co-operation and for their continuing interest, also to the Health Visitors for stimulating their attendance. In the early part of the year two cases of Pulmonary Tuberculosis were reported to me in one classroom of an infants' school. The particular classroom was in hutted premises away from the main building and accommodated some 115-120 children. A full investigation was carried out with the co-operation of the Chest Physician, the Headmistress, the Staff, and the parents. With the consent of the parents, ninety-one children were Mantoux tested and only two were found to be positive, indicating that they had received primary infection. As I pointed out to the Committee this primary infection is contracted by nine out of ten of the population before reaching the age of 20 years, and in the majority of instances is not accompanied by signs and symptoms of Tuberculosis. In fact it creates an "acquired resistance" which enhances any "native resistance" and increases the powers of the tissues to overcome the harmful effects of subsequent infection. It is only when "native resistance" is low, or the initial dose of bacilli is large, that noticeable constitutional changes occur. The two positive cases mentioned above were further examined at the Chest Clinic, when it was shown that they had no evidence of Tuberculosis. Furthermore, the adult staff of the portion of the school in question were examined and found to he free from infection. Likewise, the home contacts of the two children who suffered from Tuberculosis, and who initiated the investigation, were examined and found to be free. To sum up, there was no evidence that the disease was contracted at the school or at home. (j) Whooping Cough. Altogether, 924 cases were notified. For the most part these occurred in June, July and August. No deaths occurred from this. As from the beginning of April, immunisation against this condition was offered to the parents of infants. The preparation used is Plain Suspension Vaccine, and three injections, subcutaneously, of 1 c.c. are given at four-weekly intervals. A Whooping Cough is most likely to attack the young infant, the treatment should for preference commence at about the age of two months. As the Medical Research Council have not yet completed their investigations as to the best antigen to be used for combined DiphtheriaWhooping Cough Immunisation, for the time being a separate series 28 of injections are given. The treatment is free of charge and the injections are given by the family practitioner or by the medical officers of the department, according to the wishes of the parents. It is hoped that the scheme will prove successful and that, in due course, Whooping Cough will become as rare a condition as Diphtheria is today. This latter result has been in no small measure achieved by our scheme of immunisation, which was introduced into Romford in 1935. Since the beginning of April 749 children have been immunised. (ii) Non-Notifiable. Relatively few of the infectious diseases come under this category. The prevalence of these is set out below, and the figures are compiled from the school returns. It will be appreciated, however, that being non-notifiable the number of cases occurring amongst those who are either below or above school age is unknown, and we can only judge from those of school age whether or not an epidemic exists. TABLE 17 Chickenpox 317 Mumps 112 Rubella 42 6.—SUPPLEMENTARY. (i) Section 47, National Assistance Act, 1948. It was not found necessary to take any action daring the year under this Section of the National Assistance Act. Some investigations were, however, made but it was possible, by other means, to get a satisfactory solution. 29 TABLE 18 MONTHLY NOTIFICATIONS OF INFECTIOUS DISEASES Month Scarlet Fever Diphtheria Enteric Fever Puerperal Pyrexia Pneumonia Dysentery Encephalitis Acute Infective Erysipelas Malaria contracted abroad Measles Meningococcal Infection Ophthalmia Neonatorum Poliomyelitis Paralytic Poliomyelitis Non- Paralytic Whooping Cough Infective Hepatitis Food Poisoning Tuberculosis Total Resp. NonResp. January 40 — - 2 5 — 2 — 865 i — — 29 9 2 7 — 962 February 39 — - 10 i — 2 — 476 i — — 26 7 — 5 3 570 March 40 — - 2 8 i — — — 546 — — — 43 4 1 6 — 651 April 19 — - 13 3 i — — 188 i — — - 44 — — 6 — 275 May 11 — — — 6 13 - 1 — 58 — — 3 2 59 1 3 8 — 165 June; 4 — - 1 3 3 . — 4 i 10 — — 2 i 128 2 3 7 1 170 July 11 — — 1 1 1 I — 6 — — 1 4 258 2 5 9 2 302 August 9 - 4 190 1 3 3 1 215 September 11 — — — — 1 — 1 — 1 i — — 2 71 — 4 7 — 91> October 9 — — — 5 Q 3 — 1 — — 1 — 58 3 8 12 — 102 November 16 — - 1 3 5 1 i 2 — — — — 11 5 1 5 1 52 December 18 — - 8 2 10 — — — — i — — — 7 7 11 6 — 70 Total 227 — - 28 46 38 1 14 2 2,153 5 — 11 13 924 41 41 81 8 3,633 30 TABLE 19 DISEASES NOTIFIED DURING THE YEAR, DIVIDED INTO AGE GRODPS. Disease Under 1 12 2 3 3-4 4.5 5-10 10-16 15-20 20-35 35-45 45-65 Over 65 Total Scarlet Fever — 6 18 21 27 122 25 3 2 2 1 — 227 Diphtheria - — — — — — — — — — — — — Enteric Fever - — — — — — — - — — — — — Puerperal Pyrexia - — — — — — — 3 21 4 — — 28 Pneumonia 3 3 3 2 5 8 — - — 8 10 4 46 Dysentery 1 1 4 3 4 10 4 — 5 3 2 1 38 Encephalitis—Acute Infective - - - 1 — — — — — — — — 1 Erysipelas — - — — — — - — — 3 9 2 14 Malaria contracted abroad — - — — — — - — 2 — — — 2 Measles 82 255 305 343 300 828 19 10 8 2 1 - 2,153 Meningococcal Infection - 1 1 — — 2 - — — — 1 — 5 Ophthalmia Neonatorum — - — — — — - — — — — - - Poliomyelitis Paralytic 1 1 1 — 1 4 2 1 — — — — 11 Poliomyelitis Non-Paralytic - — — 1 1 8 1 — 1 — 1 — 13 Whooping Cough 83 86 128 112 135 356 11 2 6 3 2 — 924 Infective Hepatitis — — — 2 3 18 7 1 5 2 2 1 41 Food Poisoning — 4 5 1 2 9 4 3 6 — 6 1 41 Total 170 357 465 486 478 1,365 73 23 56 27 35 9 3,544 31 TABLE -20 NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING YEAR 1953, and HOSPITAL ADMISSIONS Disease Cases Notified. Cases Admitted to Hospital Total Deaths Scarlet Fever 227 15 — Diphtheria — — — Enteric Fever — — — Puerperal Pyrexia 28 2 — Pneumonia 46 24 45 Dysentery 38 12 — Encephalitis—Acute Infective 1 1 — Erysipelas 14 3 — Malaria contracted abroad 2 2 — Measles 2,153 31 — Meningococcal Infection 5 3 — Ophthalmia Neonatorum — — — Poliomyelitis Paralytic 11 10 1 Poliomyelitis Non-Paralytic 13 11 — Whooping Cough 924 29 — Infective Hepatitis 41 2 — Food Poisoning 41 3 — Total 3,544 148 46 32 TABLE 21 TUBERCULOSIS: NEW CASES AND MORTALITY DURING 1953 AGE PERIODS. NEW CASES. DEATHS. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M. F. M. F. M. F. M. F. 0 — - - — — — - — 1 1 2 — — — — — 1 5 4 2 — 1 — — - — 15 6 10 1 — — 1 — — 25 14 10 1 2 3 3 — — 35 10 4 2 — 2 3 - — 45 10 1 1 — 7 — — — 55 3 — — — 3 1 — 1 65 and upwards 3 1 — — 1 — - — Total 51 30 5 3 16 8 — 2 Wilson & Whitworth Ltd., Romford—G518.54