2 Lbry BOROUGH OF ROMFORD Rom 31 HEALTH DEPARTMENT ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the year 1956 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 1956 JAMES B. SAMSON, M.D., D.P.H., Medical Officer of Health 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (as at 31st December, 1956) His Worship the Mayor: Alderman S. V. Ellmore, J.P. Deputy Mayor: Alderman F. C. Bell Aldermen: Alderman T. W. Bradley Alderman P. D. Ridley, M.A., (Cantab.) Alderman Mrs. L. A. Iron9, J.P., C.C. Alderman G. Roberts, J.P. Alderman A. McGonagle Alderman H. W. Talbot Alderman W. R. Pike Councillors : Councillor R. P. Barton Councillor W. J. Hawkins, B.A. ( Com.) Councilor H. A. Beck Councillor Mrs. O. N. Boultwood Councillor E. H. Jarvis Councillor P. F. Broadhead, D.S.C. Councillor A. C. Latham Councillor F. G. Carrick Councillor J. Raebum Councillor E. F. Castle, Councillor D. Raper B.Com.A.S.A.A., C.C. Councillor G. A. Roberts Councillor Mrs. M. Clark-Lewis Councillor Mrs. O. M. J. Roberts, J.P. Councillor E. T. Clough Councillor G. W. Dockrill Councillor V. Rowlands A.M.I.E.E. Councillor L. F. P. Eley Councillor J. C. Searle Councillor W. H. England Councillor P. J. Smyth Councillor F. A. Fisher Councillor G. E. Waller Councillor W. S. Gardner Councillor W. A. White Councillor A. Hawkesworth, B.E.M. Councillor F.W. Wright 4 BOROUGH OF ROMFORD PUBLIC BUILDINGS AND HEALTH COMMITTEE His Worship the Mayor: Alderman S. V. Ellmore, J.P. (ex-officio member) Chairman : Alderman P. D. Ridley, M.A. (Cantab.) Vice-Chairman : Alderman W. R. Pike Councillor P. F. Broadhead, D.S.C. Councillor W. J. Hawkins, B.A. (Cantab.) Councillor E. F. Castle, Councillor V. Rowlands. B.Com.A.S.A.A., C.C. A.M.I.E.E. Councillor W. S. Gardner Councillor W. F. Wright 5 HEALTH DEPARTMENT Public Health Staff (As at 31st December, 1956) Medical Officer of Health J. B. Samson, M.D., Ch.B., D.P.H. Assistant Medical Officers (a) N. P. Bhandari, M.B., B.S., M.R.C.S., L.R.C.P., C.P.H. (Commenced duties 15th October). (b) J. J. Duffy, M.B., B.Ch., B.A.O., D.P.H. (c) Mrs. E. M. Haga, M.B., B.S., L.R.C.P., D.P.H. (d) Miss S. R. Ingold, M.B., B.S., M.R.C.S., L.R.C.P., D.(Obst.) (Commenced duties 16th January). R.C.O.G. Dental Officers (a) R. T. Broadway, M.D.S., (Lond.) F.D.S., R.C.S. (Eng.) (Commenced duties on a sessional basis on 30th May). (b) Mrs. F. Ell, Registered Dentist. (Commenced duties on a sessional basis on 24th February). (c) Miss M. L. Ell, L.D.S., R.C.S. (Eng.). (d) Mrs. F. Morris, L.D.S., R.F.P. & S. (Glas.). (Commenced duties on a sessional basis on 23rd February). (e) Mrs. D. Shirlaw, L.D.S., R.C.S. (Edin.). Public Health Inspectors (a) H. C. Boswell (A.B.) (Chief Public Health Inspector). (b) M. J. Dove (A.B.). (c) G. D. John (A.B). (d) T. E. R. Jones (A.B.). (e) G. F. Hobson (A.B.). (f) W. Hodson (A.B.). A. Sanitary Inspector's Certificate of the Royal Sanitary Institute, and Sanitary Inspectors' loint Examination Board. B. Certificate of the Royal Sanitary Institute for Inspectors of Meat and Other Foods. Shops Inspector S. F. Titterton, Dip. Shops' Acts Admin. Health Visitors Superintendent: Miss F. K. Wells (A.B.D.). (a) Miss J. A. Bainbridge (A.B.D.G.). 6 (b) Miss A. D. Bate (A.B.D.G.). (c) Miss B. C. Blackley (A.B.D.E.G.). (d) Miss O. Clements (A.B.D.F.G.). (e) Miss P. F. Cullis (A.B.D.G.). (f) Miss D. I. A. Hall (A.B.D.G.). (g) Mrs. B. Kersey (A.C.D.G.). (Commenced duties 1st August). (h) Miss F. Lambert (A.C.D.G.). (i) Mrs. M. K. Pressey (A.B.D.G.). (j) Mrs. L. Thompson (A.B.D.G.). (k) Miss A. M. Tidd (A.C.D.F.G.). (l) Mrs. G. Wallach (A.C.D.E.G.). Tuberculosis Visitors (a) Miss D. N. Chilton (A.C.E.). (b) Miss E. G. Govan (A.B.E.). (Commenced duties 16th January). (c) Mrs. F. C. Marshall (A.E.F.). (Commenced duties l2th March). Domiciliary Midwives Non-Medical Supervisor of Midwives and Home Nurses (Part-time): Miss H. E. Basterfield (A.B.D.) Queen's Certificate of District Nursing. Midwife Teacher's Diploma. (a) Miss I. A. Bassett (B). (b) Mrs. J. Dennis (A.B.). (c) Miss E. E. Jeenes (A.B.). (d) Miss C. M. Kerr (A.B.). (e) Miss F. L. Law (A.B.). (f) Miss D. D. Martin (A.B.). (g) Mrs. A. H. Menzies (A.B.). (h) Mrs. M. Mylward (B). (i) Miss B. Richards (A.B.). (Commenced duties 1st September). (j) Mrs. E. A. Rooks (B). (k) Mrs. G. E. Sexton, (A.B.) Queen's Certificate of District Nursing. (1) Mrs. M. B. Woodhouse (A.B.F.). Home Nurse/Midwife Mrs. Z. G. Turner (A.B.) Queen's Certificate of District Nursing. (Commenced duties 27th February). Home Nurses (a) Mrs. E. M. Broome (A.). (b) Mrs. E. D. Carrington (A.B.) Queen's Certificate of District Nursing. (c) Mrs. B. Casey (A.C.). (d) Mrs. C. Cook (A). (e) Miss J. Macaulay, M.B.E. (A.B.) Queen's Certificate of District Nursing. 7 (f) Mrs. A. C. Silcock (A.B.). (g) Miss J. D. Silcock (A.B.). (h) Mrs. D. I. Towell, (A.). (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. Domestic Help Organiser Mrs. I. M. Gray, Diploma in Social Theory and Social Structure. (Commenced duties 1st January). Day Nurseries—Matrons "St. Moritz" Mrs. I. C. Bowyer, S.R.N. Collier Row Mrs. D. Eveling, S.R.N. Rush Green Mrs. R. M. O'Halloran, S.R.N., R.F.N. Domiciliary Occupational Therapist Miss A. J. McB. Allan, Dual Dip. Ass. of Occup. Theraps. (Parttime). (Commenced duties 1st October). Dental Attendants (a) Miss A. E. Bell. (b) Mrs. E. M. Davies. (Commenced duties on a sessional basis on 23rd February). (c) Mrs. H. E. Lightfoot. (Commenced duties 25th April). (d) Mrs. M. Warder. 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) Mrs. B. Mather. (g) Mrs. M. Barnard (Part-time). (h) Mrs. K. E. Blome. (i) Mrs. F. Butt. (j) Mrs. D. E. Cast. 8 (k) Mrs. S. Corner. (1) Mrs. K. M. Druce. (m) Miss R. Harvey. (n) Miss J. V. Saggers. (o) Miss G. Smith. (p) Miss A. Vale. (q) Miss V. C. Warren. Harold Hill Health Centre Nursing Staff Mrs. W. Clegg, S.R.N. (Commenced duties 7th August). Mrs. P. Hodgson, S.R.N. (Commenced duties 5th November). Clerical Assistants Miss M. O. Little. Miss R. Markram. Miss P. Fisher. (Commenced duties 7th August). 9 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 1956. This is the Twenty-third 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. 19/56 of the Ministry of Health, dated 11th December, 1956. As the position I hold is a "mixed" one, being that of Medical Officer of Health for the Borough, and Area Medical Officer for the Romford Area of the Essex County Council, it is convenient to deal with both duties in this one Report. As before, my best thanks go to all the members of the Borough Council, and the Health Area Sub-Committee, to the members of my staff; and to my fellow officials for their kind aid, during the year, and for their keen interest in all matters pertaining to the health, and, wellbeing 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, Romford. May, 1957, 10 ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year 1956 Statistics and Social Conditions of the Area Area (in acres) 9,342 Population: Census (1951), 88,002; Mid. 1956 (Est.) 110,100 Number of Inhabited Houses (end of 1956) 30,784 Rateable Value (end of 1956) £1,478,323 Product of Penny Rate (end of 1956) . £5,770 Extracts from Vital Statistics for the Year Total M. F. Live Births: Legitimate 1,836 951 885 Illegitimate 65 38 27 Birth Rate: 14.5 per 1,000 of estimated resident population. Still Births: Legitimate 43 25 18 Illegitimate 6 4 2 Rate per 1,000 total (live and still births): 25.1. Deaths 722 385 337 Death Rate: 10.3 per 1,000 estimated resident population. Rate per 1,000 total (live and still) births Deaths from Puerperal causes 0.51 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 22.1 Legitimate Infants per 1,000 legitimate live births 20.7 Illegitimate Infants per 1,000 illegitimate live births 61.5 Deaths from Cancer (all ages) 160 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Death from Diarrhoea (under 2 years of age) 3 11 TABLE 1 BIRTH-RATES, DEATH-RATES, ANALYSIS OF MORTALITY, MATERNAL MORTALITY, and CASE-RATES for certain Infectious Diseases in the year 1956. England and Wales, and Romford. (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 15.7 0.38 11.7 0.00 0.00 0.00 0.12 0.06 0.00 ... 0.53 ... 23.8 ROMFORD 14.5 0.45 10.3 0.00 0.00 0.00 0.06 0.02 0.00 0.02 0.34 1.6 22.1 The Maternal Mortality Rate for Romford is as follows : Per 1,000 Total Live and Still Births — 0.51 The Maternal Mortality Rate for England & Wales is as follows : Per 1,000 Total Live and Still Births — 0.56 *** Not available. 12 TABLE 2. Causes of Death All Ages Deaths at the subjoined ages of Residents, after correction for Inward and Outward transfers i M. F. Total Under 1 1 2-4 5-14 1524 2534 3544 4554 5564 6574 75 upward[/##] 1. Tuberculosis, respiratory 2 3 5 .. .. .. .. .. 1 1 1 2 .. .. 2. Tuberculosis, other 2 .. 2 .. .. .. .. .. .. 1 .. 1 .. .. 3 Syphilitic disease 4 1 5 .. .. .. .. .. .. .. 2 2 1 .. 4 Diphtheria .. .. .. .. .. .. .. .. .. .. .. .. .. .. 5. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. 6 Meningococcal infections 1 1 2 2 .. .. .. .. .. .. .. .. .. .. 7. Acute poliomyelitis 2 .. 2 .. .. .. 2 .. .. .. .. .. .. .. 8. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. 9. Other infective and parasitic diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. 10. Malignant neoplasm, stomach 13 13 26 .. .. .. .. 1 .. 2 4 8 11 11. Malignant neoplasm, lung, bronchus 31 7 38 .. .. .. .. .. .. 3 8 13 12 2 12. Malignantneoplasm, breast .. 12 12 .. .. .. .. .. 1 1 2 3 1 4 13. Malignantneoplasm, uterus .. 6 6 .. .. .. .. .. .. 4 .. 1 1 .. 14. Other malignant and lymphaticneoplasms 45 33 78 .. .. .. 2 2 6 4 11 14 17 22 15. Leukaemia, aleukaemia 4 5 9 .. .. 1 .. .. .. 1 2 4 .. 1 16. Diabetes 1 1 2 .. .. .. .. .. .. .. .. 2 .. .. 17. Vascular lesions of nervous system 26 41 67 .. .. .. .. .. .. 1 3 10 ,:3 30 18. Coronary disease, angina 67 41 108 .. .. .. .. .. .. 2 14 30 31 31 19. Hypertension with heart disease 1 4 5 .. .. .. .. .. .. .. .. .. 4 1 20. Other heart disease 41 57 98 .. .. .. .. .. 2 4 3 9 24 56 21. Other circulatory disease 11 12 23 .. .. .. .. .. .. .. 2 8 7 6 22. Influenza .. 2 2 .. 1 .. .. .. .. .. .. .. .. 1 23. Pneumonia 15 22 37 4 2 .. .. .. 1 .. 2 2 8 18 24. Bronchitis 32 10 42 .. .. .. .. .. .. .. 1 11 15 15 25. Other diseases of respiratory system .. 1 1 .. .. .. .. .. .. .. .. .. 1 .. 26. Ulcer of stomach and duodenum. 4 .. 4 .. .. .. .. .. .. 1 .. .. 1 1 27. Gastritis, enteritis, and diarrhoea 3 3 6 3 .. .. .. .. 1 1 .. .. 1 .. 28. Nephritis and nephrosis 6 5 11 .. .. .. .. .. 1 1 2 1 2 4 29. Hyperplasia of prostrate 3 .. 3 .. .. .. .. .. .. .. .. .. 1 2 30. Pregnancy, childbirth, abortion .. 1 1 .. .. .. .. .. 1 .. .. .. .. .. 31. Congenital malformations 4 5 9 5 .. .. .. 1 .. 2 .. ' ' 1 .. 32. Other defined and ill-defined diseases 47 38 85 28 1 3 2 .. .. 4 4 13 15 15 33. Motor vehicle accidents 4 2 6 .. 1 .. .. 1 .. 1 1 1 .. 1 34. All other accidents 10 5 15 .. 1 1 1 1 1 .. 2 3 l 4 35. Suicide 6 6 12 .. .. .. .. .. l 3 3 2 1 2 36. Homicide and operations of war .. .. .. .. .. .. .. .. .. .. .. .. .. .. Total 385 337 722 42 6 5 7 5 17 35 65 137 176 227 13 This year the Registrar-General has given his estimate of the midyear population of Romford as 110,100, which compares with 107,800 for last year, an increase of 2,300. During 1956, the total number of live births registered was 1901, and the total number of deaths registered was 722. The difference of 1,179 gives the natural increase in the population. As this number falls short of the Registrar-General's estimated increase of 2,300, it again follows that the balance of 1,121 is made up of Immigration over Emigration. For 1956, we estimate the Birth Rate to be 14.5 per 1,000 of the estimated resident population. This figure is obtained by multiplying the Crude Birth Rate of 17.3 by the Comparability Factor of 0.84. For last year the Rate was 14.9. The Rate for England and Wales for 1956 is given as 15.7. The Death Rate for Romford is estimated at 10.3 per 1,000 of the estimated resident population. This figure is obtained by multiplying the Crude Death Rate of 6.6 by the Comparability Factor of 1.56. For last year the Rate was 9.2. The comparable Rate for England and Wales is 11.7. 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. 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 0.51 The Infant Mortality Rate, or the Death Rate of Infants under one year of age per 1,000 live births, is 22.1, a decrease of 0.9 compared with the previous year. The corresponding figure for England and Wales is 23.8. 14 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, Dental Staff, Nursing Staff, Domestic Help Organiser, and also the majority of the Clerical Staff come under the jurisdiction of the Essex County Council who are the Local Health Authority for the Part iii duties of the National Health Service Act, 1946. It will be noted that, in accordance with the Sanitary Inspectors (Change of Designation) Act, 1956, the term "Public Health Inspector" is now used throughout the Report. (ii) Laboratory Facilities These facilities are the same as before, and meet our requirements, and those of the General Practitioners. (iii) Nursing in the Home (a) General. At the end of the year 9 Home Nurses, and 1 Home Nurse/Midwife were serving in the area. These were employed in general domiciliary nursing, but, in addition, the Home Nurse/Midwives combined this work with midwifery duties. Sick-room equipment has again been made available on loan, free of charge, in accordance with Section 28 of the National Health Service Act. Table 3 sets out the work of the Home Nursing service during the year. TABLE 3 (1) Number of Visits paid 22,880 (2) Number of Cases attended 1,267 (b) Domiciliary Midwives. At the end of the year 12 Domiciliary Midwives were employed, also the one Home Nurse/Midwife 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 878 As Maternity Nurses 58 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 7 (2) Others 72 15 (iv) Ante-natal, and Post-natal Clinics Three Ante-natal sessions are held each week, and three Post-natal sessions are held per month. When necessary, use has again been made of the Consultative Clinic at Oldchurch Hospital. During the year 408 individual expectant mothers attended the Ante-natal Clinics, of which 152 sessions were held. The total number of attendances of the Ante-natal mothers was 1,883, giving an average of 4.6 attendances per patient. The average number attending at each session was 12.4. Thirty-one Post-natal sessions were held, and 184 attendances were recorded. The average number attending at each session was 5.9. (v) Child Welfare Clinics Twelve Child Welfare sessions are held each week. Altogether, there were 610 sessions, and the following table gives a summary of the attendances. TABLE 6 Individual children attending 3,577 Children under one year attending for the first time 1,485 Medical consultations 6,314 Attendances of children under one year of age 19,816 Attendances of children between the ages of one and five years 5,727 Average attendance per session 41.9 (vi) Health Visitors At the end of the year, there were 16 Health Visitors. All of them also acted as School Nurses. Table 7 relates to Home Visits paid by the Health Visitors in connection with their duties under Maternal and Child Welfare. TABLE 7 (a) To Expectant Mothers:— First visits 181 Total visits 229 (b) To Children under one year of age:— First visits 2,177 Total visits 7,188 (c) To Children between the ages of one and five years:— Total visits 9,815 (vii) Inspection of Nursing Homes The Nursing Home at No. 68, Heath Park Road discontinued on 3rd june. The other three Homes were inspected, as a routine, on four occasions throughout the year, when conditions were found to be satisfactory. 16 (viii) Domestic Helps The demand for this service has again been fairly constant. During the year 119 part-time and casual helps were employed, and they attended 662 individual cases. Tuberculous patients were again given domestic assistance, and, for this purpose, special volunteers were recruited. (ix) Day Nurseries The three Day Nurseries continued on the same basis, as hitherto. The average daily attendances for the year at each Nursery is shown below: TABLE 8 " St. Moritz " Nursery 33 Collier Row Nursery 27 Rush Green Nursery 26 The "St. Moritz" Nursery and the Collier Row Nursery are scheduled to take 40 children each, and the Rush Green Nursery 50 children. (x) Dental Service There has been a very slight improvement in the number of Dental Officers during the year. In addition to the two full-time Officers mentioned in my last report, we now have the services of a part-time Dentist for four sessions per week, and another for 2 sessions per week. Furthermore, two Dentists are available, each for one evening a week for the purpose of treating expectant and nursing mothers. Another innovation, during the year, was the appointment of a Consultant Anaesthetist, who attends on one session per week, for the purpose of administering general anaesthetics to the more difficult cases. The following gives particulars of the work done during the year for expectant and nursing mothers, and children under school age. TABLE 9 (a) Numbers provided with Dental care:— Examined Needing Treatment Treated Made Dentally Fit Expectant and Nursing Mothers 131 119 103 90 Children under Five 332 26/ 245 242 (b) Forms of Dental Treatment provided: — Anaesthetics Scalings or Scalings and Gum Silver Nitrate Dressings Treatment Radiographs Dentures provided Extractions Fillings. Local General Treatment Complete Partial Expectant and Nursing Mothers 305 134 21 322 82 5 53 17 20 11 Children under five 250 8 157 501 2 97 53 2 - — 17 (xi) Harold Hill Health Centre The Harold Hill Health Centre has now got over the period of initial difficulties. It was anticipated that a new venture of this nature would have some difficulties, but, I am glad to say that they have all been minor in character. The Local Authority section has, for another year, continued to provide services for Maternal and Child care, and for the care of the health of the school child. A Dental Officer is in daily attendance for looking after the dental requirements of school children, and those of the other priority classes viz., nursing and expectant mothers, and children under 5 years of age. The Dental Officer, appointed by the Executive Council for General Dental Services, is also in daily attendance. So far as the General Medical Practitioners) section is concerned, the four suites are allocated on the same basis as before. The nursing staff, and clerical assistance for this wing are provided by the Local Health Authority, and meet the requirements of the practitioners. 2.—SANITARY CIRCUMSTANCES OF THE AREA (i) Water 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 1956, other than those for the supply to permanent housing sites. (b) Lengths of mains laid, in yards:— 3" 4" 6" Romford Area 1,322 669 693 (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 he 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 Company's district, all proved to be satisfactory. A total of over 3,880 Chemical, Bacteriological, and Biological examinations have been made. (e) The waters are not liable to plumbo-solvent action. (f) No contamination has arisen, therefore no action has been necessary," 18 In addition to the analyses carried out by the Waterworks Company, samples have also been taken from consumers' taps by the Public Health Inspectors and sent for Bacteriological analyses once per month, and Chemical analyses once per six months, and the results have confirmed the findings of the Company. (ii) Sanitary Inspection of the Area The Senior Public Health 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, 1,309 complaints were received, and investigated, and 3,577 visits were made for this purpose. TABLE 10 Nature and Number of Inspections During the Year Accumulations and Refuse Deposits 98 Bakehouses 34 Butchers' Shops and Stalls, etc. 153 Cesspools 196 Common Lodging Houses 3 Cowsheds, Dairies and Milkshops 139 Drains, relaid or altered 171 Drainage—obstructed or defective 510 Drains Tested 86 Disinfections and Disinfestations 9 Dustbins 93 Establishments for Massage and Special treatment 23 Factories Act (Mechanical Power) 147 Factories Act (Non-mechanical) 52 Factories Act (Outworkers Premises) 101 Food Preparing Premises 297 Food Hawkers 54 Food Inspections 395 Food Sampling;—Formal 16 Food Sampling—Informal 202 Food Shops 344 Housing Acts 507 Heating Appliances (Fireguards) Act 1952 118 Ice Cream 125 Infectious Disease including Food Poisoning 2577 Insects and pests 73 Keeping of Animals 50 Milk Sampling 111 Miscellaneous 445 Markets 62 Nuisances, Public Health Act 2178 Old Metal Dealers 26 Pet Animals Act, 1951 32 Prevention of Damage by Pests Act, 1949 2702 Public Baths 39 Public Conveniences 20 19 Rag Flock Act 11 Sale of Horseflesh 7 Schools and School Canteens 49 Shops Act—All Sections 2780 Slaughterhouses 1045 Smoke Observations 75 Streams and Ponds 118 Tents, Vans and Sheds 254 Verminous premises 39 Water Closets 28 Water Supplies 72 Informal Notices (number served) 483 Statutory Notices (number served) 119 As a result of the service of Notices the necessary works were completed by the owners or occupiers in all cases except 126, the works for which were still in hand at the end of the year. Notices served under the Shops Act 97 Notices served under the Food & Drags Act 41 (iii) Factories Acts 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 17 52 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 285 147 3 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding OutWorkers premises) 48 2 - - Total 350 201 3 — 20 2. Cases in which Defects were Found Particulars No. of Cases in which defects were found No. of Cases in which prosecutions instituted Found Referred Remedied to H.M. Inspector by H.M. Inspector Want of Cleanliliness 1 1 - 1 - Overcrowding — — — — — Unreasonable Temperature - - - - Inadequate Ventilation 4 4 4 Ineffect. drain, of floors - - - - - Sanitary Conveniences— (a) Insufficient . 1 1 — 1 — (b) Unsuitable or defective 4 4 4 (c) Not separate for Sexes - - - - - Other Offences — — — — — Total 10 10 — 10 — 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. 45 - - - - - Box Making 18 - - - - - Total 63 — — - — — During the year 101 inspections were made of Outworkers' premises. (iv) Caravan Sites. There are 7 licensed caravan sites, one of which is still controlled by the Council. Altogether, there are 291 caravans on these sites. The sites, in general, are maintained in a satisfactory condition. (v) Prevention of Damage by Pests Act, 1949. During the year the Public Health Inspectors and Rodent Operative carried out 2,702 inspections, or re-inspections, to premises suspected of being infested by rats or mice. Further maintenance treatment, in respect of rat disinfestation to sewers, was undertaken during the year. 21 (vi) Pet Animals Act, 1951. Fifteen persons are licensed to keep Pet Shops. Frequent inspections are carried out. 3.—INSPECTION AND SUPERVISION OF FOOD (i) Milk Supply. At the end of the year 44 persons were registered as Retailers or Distributors. Of these 15 were licensed to retail Tuberculin Tested Milk, 22 were licensed to retail Pasteurised Milk, and 44 were licensed to retail Sterilised Milk. The two Pasteurising plants are kept under surveillance by the department. During the year, 101 samples of milk wefe taken, and all passed the prescribed tests. (ii) Ice Cream. There were at the end of the year four manufacturers, and 208 vendors on the register. During the year, 45 samples were taken for Bacteriological examination, and of these 41 were satisfactory, and four unsatisfactory. Fourteen samples of ice-lollies were taken, and only one proved unsatisfactory. Twelve samples of ice-cream, and eleven ice-lollies were taken for Chemical examination, and only two of the samples of ice-cream, and one ice-lolly proved unsatisfactory. (iii) Meat. There are three licensed slaughterhouses in the Borough, two of these being licensed for the slaughter of horses, as well as livestock. One slaughterhouse is operated by a firm of Wholesale Butchers, who supply meat to retail butchers in the Borough and adjoining, Districts, and provide meat for the London Markets. Slaughtering takes place on seven days of the week, and the Public Health Inspectors attend the slaughterhouses regularly, including Saturday afternoons and Sundays, to ensure that 100% inspection of all meat produced in the Borough is maintained. During the year under review, 1,045, such visits were made. During this period a total of 27,128 animals were slaughtered, and a total of 19 tons, 12 cwts. 80 lbs of meat was found to be unfit for human consumption, this wasi disposed of for animal feeding through the recognised channels. Table 12 sets out the particulars of the animals slaughtered and inspected, and the details of condemnation. There are also three Wholesale Meat Depots, and 64 butchers shops in the Borough, and, during the year, 153 inspections were made of these premises. 22 TABLE 12 CARCASES INSPECTED AND CONDEMNED 1956 Cattle except Cows Cows Calves Sheep and Lambs Pigs Horses TOTAL Number killed (if known) 1,543 1,125 1,828 9,957 12,388 287 27,128 Number inspected 1,543 1,125 1,828 9,957 12,388 287 27,128 All diseases except Tuberculosis. Whole carcases condemned 2 7 3 29 25 2 65 Carcases of which some part or organ was condemned 405 412 5 573 459 17 1,878 Percentage of the number inspected affected with diseases other than tuberculosis 26.2% 37.3% 0.4% 3.6% 3.9% 6.6% 71% Tuberculosis only. Whole carases condenmed 3 14 2 — 3 — 22 Carcases of which some part or organ was condemned 70 155 — — 268 — 493 Percentage of the number inspected affected with tuberculosis 4-7% 15.1% 0.1% — 2-1% — 1.9% 23 (iv) Food Products in General. In addition to the premises used for Milk, Ice Cream, and Meat, referred to above, the following are registered under the Romford Urban District Council Act, 1931. Bakers 32 Cafes 52 Confectioners 62 Fishmongers 30 Greengrocers 49 Grocers 123 Miscellaneous 12 Hawkers 44 There are also 45 food stalls situated in the Market Place on three days of the week. All the above are regularly inspected. During the year, 666 such inspections were made. The majority of the food shops now have constant hot water provided for washing purposes. (v) Clean Food Campaign. At the beginning of the year the Council decided to embark on a Clean Food Campaign. The prime object of the campaign is to encourage the occupiers of food premises to attain a higher standard for their premises, than tha required by the Food Hygiene Regulations, and to adopt improved me'hods for the storage, handling and preparation of food, also to encourage staff, engaged in food handling, to attend lectures on food hygiene. To encourage food handlers to participate in the scheme, the Condi decided to issue a Certificate to the occupiers of all food premises which reached the required standard, and where at least 70% of the staff had attended a lecture on Food Hygiene. The occupiers of all food premises were written to, asking them to co-operate in the Council's scheme. During the year several illustrated lectures have been given by the Public Health Inspectors to persons engaged in food premises, and a special lecture was given to the staff employed in the School Canteens. By the end of the year 65, Certificates had been issued to premises which complied with the Councils requirements. In conjunction with the above scheme, the Council had a Clean Food Handbook published for circulation amonest the traders and public. (vi) Unsound Food. During the year, 395 visits were made to food premises, mainly on request, for the purpose of dealing with unsound food, and a total of 6 tons, 2 cwts., 55 lbs of food was surrendered as unfit for human consumption. Where possible, all unsound food is disposed of for animal feeding, the remainder being dealt with sby the Cleansing Department. 24 (vii) The Food and Drugs Act, 1955. During 1956, 217 samples were submitted for analysis, comprising 9 Formal, and 208 Informal. Of the 9 formal samples taken, 2 proved to be not genuine. Table 13 sets out the types of food examined. One of these was a sample of Starch Reduced Bread Rolls, the Public Analyst reported that these rolls contained less protein than the declaration on the label. This matter was reported to the Committee, who resolved to write to the manufacturers, drawing their attention to the discrepancy. The siecond unsatisfactory sample was of Ice Cream, which was 94% deficient in fat. In this case the Committee resolved to prosecute the manufacturer, and a conviction was obtained. Of the 208 informal samples taken the Public Analyst reported adversely on the following 11. Bread This sample was submitted to the Analyst as a result of a complaint that the bread contained dark streaks of foreign matter, this proved to be discoloured dough which was not harmful. The matter was taken up with the manufacturers. Carrots— (tinned) This sample was submitted as a result of a complaint that the carrots had made a child ill. The Analyst reported that the carrots did not contain any foreign matter likely to cause illness, but did contain an excess of iron. The manufacturers attention was drawn to this excess. Chocolate Swiss Roll. This swiss roll was found to be affected with mould. The manufacturers were advised to change the heavy waxed wrappings. This advice was accepted. Flavourings (3) The Analyst reported that 3 samples of milk flavourings contained Benzoic Acid Preservative in contravention of the Soft Drinks Orders 1953/4 as the flavourings did not come within the meaning of cordials. The manufacturers agreed to change the labels on these flavourings so as to comply with the requirements of the Order. Fruit Pie This fruit pie was submitted to the Analyst as a result of a complaint that it was affected with mould and contained foreign matter. The Analyst reported that the pie contained a profuse growth of mould hyphae and spores and was unfit for human consumption. This complaint was reported to the Public Buildings and Health Committee, who resolved to prosecute the vendor and a conviction vas recorded. Ice Cream One informal sample of ice cream was reported as being 94% deficient in fat, this was followed by taking the formal sample as reported on above. 25 Lollies One sample of ice loliy was found to contain an excess amount of lead, viz. 3.0 parts per million. This was referred to the local authority in whose area the lolly was manufactured. Luncheon Meat This tin of luncheon meat was submitted to the Analyst as the result of a complaint. The contents and tin were badly corroded owing to prolonged storage. No action was taken as the complainant had had the tin in stock at home for some time. Milk, Dried Skimmed A sample of dried milk powder was found to contain a considerable amount of black specks, this was found to be charred milk powder. The manufacturers withdrew the consignment, from which the sample was taken, from stock. LEGAL PROCEEDINGS (i) The following cases were taken under the Food and Drugs Acts 1938. Offence Section Result (1) Dirty food preparing premises, contrary to Sec. 13 and the Clean Food Byelaws Fined £6 (2) Plant stalk in bottle of milk 3 Fined £2 (3) Mouldy meat pies 9 Dismissed (ii) The following cases were taken under the Food and Drugs Act 1955. (4) Tobacco in bread roll 2 Fined £5 (5) Piece of cardboard in bottle of milk 2 Fined £2 (6) Razor blade in loaf 2 Fined £3 (7) Piece of cardboard in bottle of milk 2 Fined £2 (8) Mouldy fruit pie 8 Fined £5 (iii) The following cases were taken under the Food Hygiene Regulations. (9) Dirty food containers Dismissed (10) Smoking in food preparation room Fined £1 (11) Smoking in food preparation room Fined £1 (12) Smoking in food preparation room Fined £1 (13) Smoking in food preparation room Fined £1 (iv) The following case was taken under the Food Standards (Ice Cream) Order, 1953. (14) Ice Cream 94% deficient in fat Fined £3 £2.10.0 costs. 26 SUMMARY OF SAMPLES TAKEN FOR ANALYSIS DURING THE YEAR 1956 Article Number examined Result of Analysis Formal Informal Total Genuine Not Genuine Almond Tarts - 1 1 1 — Almonds, Chopped Col'rd — 1 1 1 — Almonds (ground) — 1 1 1 — Apricot Pie — 1 1 1 — Aspirin Tablets 1 1 1 — Beef Essence — 1 1 1 — Beef Stealc Curried — 1 1 1 — Bi-carbonate of Soda — 1 1 1 — Bisto — 1 1 1 — Blackcurrant Cordial — 1 1 1 — Bread — 1 1 1 — Bread Crumbs — 1 1 1 — Bread Sliced — 1 1 — 1 Bread Starch Reduced. 1 1 1 1 Butter — 1 1 1 — Butter Brazils — 1 1 1 — Butter Crunch — 1 1 1 — Buttered Assortment — 1 1 1 — Buttered Toffee — 1 1 1 — Butterscotch — 1 1 1 — Carrots, Tinned — 1 1 — 1 Cashews — 1 1 1 — Cheese — 2 2 2 — Cheese Spread — 2 2 2 — Cheese Spread with Ham — 2 2 2 — Cheese Spread with Tomato 1 1 1 — Chicken Supreme, Sliced — 1 1 1 — Chlorophyl Tonic Tablets — 1 1 1 — Chocolate — 1 1 1 — Chocolate Swiss Roll — 1 1 — 1 Cinnamon, Ground — 2 2 2 — Coffee & Chicory — 1 1 1 — Colorings — 2 2 2 — Cough Pastilles — 1 1 1 - Cream — 6 6 6 — Cream Cereal Strained — 1 1 1 — Cream of Tartar — 1 1 1 — Dripping — 1 1 1 — Dripping (Beef) — 1 1 1 - Fish Cakes — 1 1 1 - Fish Paste — 1 1 1 — Flavourings — 7 7 4 3 Froment — 1 1 1 - Fruit Bon Bons — 1 1 1 - Fruit, Dried — 1 1 1 - Fruit Pie — 1 1 — 1 Gelatine — 1 1 1 - Gluco-Lem — 1 1 1 - Glycerine & Blackcurrant — 1 1 1 - Grape Fruit Squash — 2 2 2 - Herbaline(Veg. Laxative) — 1 1 1 - Herb Tablets — 1 1 1 - Hog Pudding — 1 1 1 - Honey — 1 1 1 - Honey and Borax — 1 i 1 - Ice Cream 1 11 12 10 2 Instant Pudding — 1 1 1 - Iron and Yeast Tablets — 1 1 1 - Jam — 6 6 6 - Jelly — 2 2 2 - Carried Forward 2 93 95 85 10 27 Table 13—continued Article Number examined Result of Analysis Formal Informal Total Genuine Not Genuine Brought forward 2 93 95 85 10 Lard — 1 1 1 - Lemon Juice — 3 3 3 - Lemon Squash — 1 1 1 - Lime Juice Cordial — 1 1 1 - Liquorice, Comfits - 1 1 1 — Liquorice Powder — 1 1 1 — Lobster — 1 1 1 - Lollies 1 10 11 10 1 Luncheon Meat — 3 3 2 1 Lung Syrup — 1 1 1 - Maplemeat — 1 1 1 - Margarine — 5 5 5 - Marsh Mallows - 1 1 1 - Meat Paste - 1 1 1 - Meringue Powder — 1 1 1 - Milk .. 6 7 13 13 - Milk, Condensed — 5 5 5 - Milk, Dried Skimmed — 1 1 - 1 Milk, Evaporated - 1 1 1 - Mint in Vinegar — 1 1 1 - Mints , - 1 1 1 - Nougate Whirls - 1 1 1 - Orange Squash - 1 1 1 - Peas, Dried - 1 1 1 - Pepper — 2 2 2 - Pepper Flavoured Com - 2 2 2 - pound Pickle - 2 2 2 - Pork and Meat Roll, stufEed - 1 1 1 - Pork linced - 1 1 1 - Pork Pie - 1 1 1 - Quenchers - 1 1 1 - Raspberry Cordial - 1 1 1 - Rocks, Sweets - 4 4 4 - Rolls - 1 1 1 - Salmon and Shrimp Paste - 1 1 1 - Sardines - 1 1 1 - Sauce - 1 1 1 - Sausage Meat, Beef - 1 1 1 - Sausages, Beef - 6 6 6 - Sausage, Liver - 1 1 1 - Sausages, Pork - 5 5 5 - Saveloys - 1 1 1 - Scotch Broth - 1 1 1 - Sherbert Limes - 1 1 1 - Soup, Green Pea - 2 2 2 - Spice, Mixed - 1 1 1 - Spice, Pickling . . - 1 1 1 - Steak and Kidney Pud- . dins - 1 1 1 - Steak, Stewed - 1 1 1 - Strength Tablets - 1 1 1 - Stuffing, Sage & Onion - 1 1 1 - Suet, Beef - 1 1 1 - Suet, Beef & Rice Flour - 1 1 1 - Sweets .. - 1 1 ] - Tea - 9 9 9 - Toffee - 1 1 1 - Tomato Ketchup - 1 1 1 - Tomato Sauce — 1 1 1 - Carried forward 9 202 211 198 13 28 Table 13—continued Article Number examined Result of Analysis Formal Informal Total Genuine Not Genuine Brought forward 9 202 211 198 13 Tom Thumb Tablets (Confect.) - 1 1 1 - Tonic Tablets - 1 1 1 - Vinegar, Malt — 1 1 1 - Vitamin B1 Tablets — 1 1 1 - Yeast - 1 1 1 - Yeast Extract — 1 1 1 - Totals 9 208 217 204 13 (viii) Shops Act, 1950. (a) Inspections. 991 shops have been inspected and recorded on the Register. Altogether 2,754 inspections and observations have been made for various purposes under the Act during the year. l"he following contraventions were noted: — Failure to exhibit prescribed Notices 290 Failure to keep records . 41 Conditions of employment 12 Arrangements for Health and Welfare 30 Other matters 31 (b) Legal Proceedings. The Council authorised the following cases to be taken before the Magistrates' Court. Offence Section Result (1) Evening closing hours 2 Fined 10/-. (2) Evening closing hours 2 Fined 10/-. (3) Hours of employment of young persons 27 Fined £1. (4) Failing to keep records of hours worked by young persons 32 Fined £1. (5) Sunday Trading 47 Fined £2. (6) Sunday Trading 47 Fined £1. (7) Sunday Trading 47 Fined 10/-. (8) Obstructing an inspector in the course of his duties 71 Fined £5 and Factories Act 1937, Sec. 123. (9) Obstrucling an inspector in the course of his duties 71 Fined £1. and Factories Act 1937, Sec. 123. (ix) The Heating Appliances (Fireguards) Act, 1952. 116 premises have been visited where heating appliances were exposed for sale and advice has been given to persons responsible. As a result of these visits, 7 appliances were found not to conform with the standards prescribed, and these were immediately withdrawn from sale and scrapped. 29 4.—HOUSING STATISTCS FOR THE YEAR, 1956. TABLE 14 Number of houses erected during the year: — (1) By Local Authority 234 (2) By Private Enterprise 541 (3) By L.C.C. at Harold Hill Estate ... 106 1. Inspection of Dwelling Houses during the Year. (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,754 (b) Number of inspections made for the purpose 3,880 (2) (a) Number of dwelling houses (included under head (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 dangerousi or injurious to health as to be unfit for human habitation 12 (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 595 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 417 3. Action under Statutory Powers during the Year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936: — (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 ownersNil (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 119 (2) Number of dwelling houses in which defects were remedied after sendee of Formal Notices: — (a) By owners 64 (b) By local authority in default of owners 14 30 (c) Proceedings under Section 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 6 (3) Number of Demolition Orders Revoked 2 (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 Nil 4. Housing Act, 1936, Part IV—Overcrowding (a) (1) Number of dwellings overcrowded at end of year 43 (2) Number of families dwelling therein 69 (3) Number of persons dwelling therein 340 (b) Number of new cases of overcrowding reported during the year 7 (c) (1) Number of cases of overcrowding abated during the year . 13 (2) Number of new cases of overcrowding relieved during the year 5 (3) Number of persons concerned in such cases 38 (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. Housing Repairs and Rents Act, 1954. During the year 16 applications were received for Certificates o( Disrepair under the above Act, and 16 Certificates were issued, maidng a total of 102 Certificates issued since October 1954. Eight applications were also received for the Revocation of Certificates, and in 8 cases the Certificates were revoked when the repairs had been completed satisfactorily. 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, the case has been appropriately recorded. These amendments are sent to the RegisterGeneral at the end of each quarter. 31 (a) Acute Anterior Poliomyelitis So tar as we were concerned in Romford, this has not been an epidemic year. Three cases were notified with varying degrees of paralysis, and 7 were of the non-paralytic type. One of the former, unfortunately, died. During the early part of the year, the County decided to implement the Circular from the Ministry of Health which gave particulars of a scheme for vaccination against Poliomyelitis. As a result of this, 173 children received the first injection, but, for one reason or another did not have the second injection, and 836 completed both injections. (b) Acute Infective Hepatitis. This condition remains notifiable in this region. Altogether, there wer 14 notifications. (c) Diphtheria. No cases of Diphtheria were reported. The following statistics relate to the state of Immunisation at the 31st December, 1956. In addition to the initial series of injections, "booster" doses have also been administered. TABLE 15 Under 5 years 5-15 years Nui ber of children who had completed a full cc rse of Immunisation at any time up to 3 t December, 1956, and who were bom b _ween 31st December, 1941, and 31st December, 1956 5,198 15,244 (d) Dysentery. forty-eight cases of Dysentery were notified, as belonging to Romford. Twenty-five of these were due to Shigella Sonnei, and twentythree were unclassified. At the early part of November, a number of cases of diarrhoea and vomiting was reported by the Headmistress of one of the Infants' schools. Home visits were immediately carried out on all absentees, and faecal samples were requested from those suffering from diarrhoea and vomiting. Bacteriological examination showed a number to be affected by Shigella Sonnei, As the majority of the patients had not partaken of school meals, this factor was excluded, but, nevertheless, a sample of the meals was examined, and found to be negative. Suitable advice was given as to the precautionary measures to adopt, and, each morning,, a new list of absentees was submitted, and the homes were visited. Subsequently, cases were also ascertained in two school departments, within the same curtilage. As I made it a condition that three consecutive negative results had to be obtained, before the patients were re-admitted to the schools, this caused a low attendance for some time. 32 Altogether, 51 initial positive results were obtained, and 119 initial negative results. It appears to me, from our findingsi, that two separate conditions may have been operating at one and the same time viz. Sonne Dysentery, and Epidemic (or Winter) Vomiting. The total schools' population at risk in these three schools was about 720. As a matter of interest, after a positive result, it took an average of about 5.3 further samples, before the sequence of 3 negative results, mentioned above, was obtained. Altogether, during our investigations, approximately 1,000 'samples were submitted to the laboratory at Oldchurch Hospital for examination, and I am indebted to the laboratory, to the heads of the schools in question, to the general practitioners, the health inspectors, the health visitors, and my clerical staff for their united efforts to clear up this outbreak, which, if rot spectacular in itself, nevertheless, does show what can be done by co-operation on such occasions. (e) Food Poisoning. During the year, 5 cases were notified, which proved to be suffering from food poisoning. In addition, another 45 proved indefinite. The following table sets out details, as required by the Ministry of Health. TABLE 16 (a) Total Number of Outbreaks Nil (b) Total Number of Cases included in (a) Nil (c) Number of Single Cases 50 (d) Number of Deaths Nil (e) (i) Organisms responsible Sal. Typhi-Murium B.Proteus Slap. Aureus. Unknown (ii) Outbreaks attributed to (i) Nil Nil Nil Nil (iii) Single cases attributable to (i) 3 1 1 45 During one period of the year 7 cases of Paratyphoid B. Fever were notified in the district, and, at the same time, several other cases were reported in neighbouring districts. Investigations throughout each of the areas concerned, suggested that infection was caused by the consumption of confectionery, containing imitation or artificial crtam made in a bakery outside the Borough. The probability was that the cream was contaminated by infected Chinese egg products. No secondary cases were reported in the district. (f) Measles. Measles was again present in epidemic form from March until July, although to a much less extent than last year. Altogether, during the year, 743 cases were notified. (g) Scarlet Fever. The notifications numbered 150, and the type was again mild. (h) Smallpox. No cases occurred in the district, and no contacts required to be kept under surveillance. 33 Table 17 gives the statistics relative to Vaccination, as recorded by the General Practitioners. TABLE 17 Vaccinated: Under 6 months 362 Between the ages oi 6 months and 1 year of age 208 Between the ages of 1 and 2 years 96 Between the ages of 2 and 5 years 67 Between the agesi of 5 and 15 years 100 Over 15 years 108 Re-Vaccinated: Under 1 year of age — Between the ages of 1 and 2 years — Between the ages of % and 5" years 44 Between the ages of 5 and 15 years 195 Over 15 years 154 (i) Tuberculosis. The scheme whereby B.C.G. is offered, with parental consent, to children at the age of 13 years was continued on the same lines as last year, with the following results. TABLE 18 Number of pupilsi tuberculin tested 605 Number found to be positive 59 Number found to be negative 546 Number who received B.C.G. 468 Number post-tested 457 Number found to be positive 443 Number found to be negative 14 (j) Whooping Cough. Altogether, 368 cases were notified. These were fairly evenly distributed throughout the year, with maximum intensity in May. During, 1956, 1,598 children received immunisation injections. (ii) Non-Notifiable The particulars of these are set out below, and the figures are compiled from the school leturnsi. As they are not notifiable, however, the general prevalence is unknown. TABLE 19 Chickenpox 397 Mumps 243 German Measles 216 6.—SUPPLEMENTARY. (i) Section 47, National Assistance Act, 1948. It was not found necessary to take any formal action under this section. Investigations, however, were carried out in two or three instances, and other means were found to achieve a satisfactory solution. 34 TABLE 20 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 NonParalytic Whooping Cough Infective Hepatitis Food Poisoning Tuberculosis Total Resp. NonResp. J anuary 10 — — — 3 1 — — — 1 I — 21 1 1 4 43 February 8 — — — 6 — — 1 — 2 — — — — 18 — 5 7 — 47 March 17 — — — 9 3 — — — 65 — — — — 33 3 4 6 — 140 April 6 — — 1 1 1 — — — 98 1 — — — 42 1 2 7 — 160 May 9 — 6 — 1 — — I — 151 — — — — 50 — 2 7 — 227 June 12 — 1 1 2 1 — — — 144 I — — — 40 — 1 2 1 206 July 4 — — — 1 1 — 2 — 90 — — — — 35 — 3 6 — 142 August 7 — — — 2 1 — — — 28 — — I — 26 1 5 6 — 77 September 15 — — I 2 — — — — 8 — — I I 46 2 2 4 — 82 October 12 — — — 2 1 — 2 — 7 — — I — 19 2 7 3 1 57 November 26 — — — 2 26 — 1 — 8 — — — 5 22 1 7 6 — 104 December 24 — — — 6 13 — 1 — 141 I — — — 16 3 11 4 — 220 Total 150 — 7 3 37 48 - 8 - 743 4 - 3 6 368 14 50 62 2 1505 B5 TABLE 21 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 8 9 17 95 12 5 I — — 150 Diphtheria - - - - - - - - - - - - - Enteric Fever — — 1 — — 3 2 — — 1 — — 7 Puerperal Pyrexia - - - - - - - - 3 - - - 3 Pneumonia 2 3 2 2 3 5 — — 4 6 9 1 37 Dysentery 1 3 2 2 — 25 3 2 8 — 2 — 48 Encephalitis—Acute Infective - - - - - - - - - - - - - Erysipelas - - - - - - - 2 1 1 3 1 8 Malaria contracted abroad - - - - - - - - - - - - - Measles 21 56 78 105 90 381 6 3 1 2 — — 743 Meningococcal Infection 2 — 1 - - 1 - - - - - - 4 Ophthalmia Neonatorum - - - - - - - - - - - - - Poliomyelitis Paralytic — — — 1 — 1 1 — — — — — 3 Poliomyelitis Non-Paralytic — — — — — 3 1 — 2 — — — 6 Whooping Cough 28 33 45 45 34 168 9 1 3 1 1 — 368 Infective Hepatitis - - - - - 4 2 2 4 — 2 — 14 Food Poisoning — 5 2 6 1 6 5 — 12 5 7 1 50 Total 54 103 139 170 145 692 41 15 39 16 24 3 1441 36 TABLE 22. NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING YEAR 1956, and HOSPITAL ADMISSIONS Disease Cases Notified Cases Admitted to Hospital Total Deaths Scarlet Fever 150 8 — Diphtheria — — — Enteric Fever 7 6 — Puerperal Pyrexia 3 2 — Pneumonia 37 19 37 Dysentery 48 1 — Encephalitis—Acute Infective — — — Erysipelas 8 2 — Malaria contracted abroad — — — Measles 743 10 — Meningococcal Infection 4 4 2 Ophthalmia Neonatorum — — — Poliomyelitis Paralytic 3 3 2 Poliomyelitis Non-Paralytic 6 6 — Whooping Cough 368 12 — Infective Hepatitis 14 3 — Food Poisoning 50 — Total 1441 77 41 37 TABLE 23 TUBERCULOSIS : NEW CASES AND MORTALITY DURING 1956 AGE PERIODS NEW CASES DEATHS Respiratory Non-Respiratory Respiratory N on-Respiratory M. F. M. F. M. F. M. F. 0 — 2 — — — — — 1 1 — — — — — — 5 3 2 — 1 — — — — 15 5 7 — — — — — — 25 9 6 — — — 1 — — 35 4 4 1 — 1 — 1 — 45 8 1 - - — 1 — — 55 8 1 — - 1 1 1 — 65 and upwards 1 — — — — — — — Total 39 23 1 1 2 3 2 —