rom 35 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR ROMFORD FOR THE YEAR 1960 CONTENTS Pages Committee Members 3 Health Department Staff 5 General Public Health County Welfare Services 9 Mental Health 10 Housing Roger Reede's Charity 14 Health Education 15 Vital Statistics 15 Romford Chest Clinic 19 Brentwood Chest Clinic 20 Care of the Aged 21 Care of Mothers and Young Children 22 Welfare Foods 25 Day Nurseries 25 Vaccination and Immunisation 27 Prevention of Illness, Care and After Care 28 Problem Families 30 School Health Service 31 Vaccination Against Tuberculosis 32 Specialist Services 33 Handicapped Pupils 35 Romford Child Guidance Clinic 36 Sanitary Circumstances of the Area 40 Inspections 42 Factories Acts 43 Caravans 44 Inspection and Supervision of Food 46 Shops Act 58 Clean Air Act 60 Noise Abatement 62 Housing Administration 63 TOWN HALL, ROMFORD, ESSEX March, 1961. To the Mayor, Aldermen and Councillors of the Borough of Romford. Mr. Mayor, Ladies and Gentlemen, In presenting this report may I record that I commenced duty as your Medical Officer of Health in November, 1960. on the retirement of Dr. J. B. Samson who held the appointment since 1934. I should also like to record my thanks for the ready ssistance I have received from my colleagues and from members of the Council. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Medical Officer of Health- Page 2 PUBLIC BUILDINGS AND HEALTH COMMITTEE as at December, I960. His Worship The Mayor—Alderman W. R. PIKE, J.P. Chairman—Councillor W. S. GARDNER Vice-Chairman—Councillor D. RAPER Alderman Mrs. M. CLARK-LEWIS Councillor E. T. DAVIS, F.I.O.B. Councillor R. C. BAKER Councillor J. RAEBURN Councillor H. L. BARRETT Councillor V. ROWLANDS, A.M.I.E.E. ROMFORD COMMITTEE FOR EDUCATION as at December, 1960 His Worship The Mayor—Alderman W. R. PIKE, J.P. Deputy Mayor—Alderman Mrs. M. CLARK-LEWIS "hairman—Alderman Mrs. O. M. J. ROBERTS, J.P., C.C. Vice-Chairman—Councillor W. S. GARDNER Representative Members:— Alderman A. McGONAGLE Councillor W. G. RUSSELL Alderman Mrs. L. A. IRONS, J.P., C.C. Councillor S. E. SHUTE Councillor Y. G. CARRICK Councillor G. URBEN, F.E.I.A. Councillor V. A. PHILLIPS, Councillor Mrs. D. M. BISHOP D.S: F.R.I.C., M.I., Chem.E. Councillor Mrs. O. N. BOULTWOOD Councillor V. ROWLANDS, A.M.I.E.E. Co-opted Members:— Mr, V. W. CUSDIN Mr. R. S. EMMS Mr. F. FISHER Mrs. R. M. LATHAM Mr. J. G. PITT AW AY Nominated Members:— County Councillor E. F. CASTLE, B.Com., A.C.A. County Councillor H. G. H. EVERITT Page 3 ROMFORD HEALTH AREA SUB-COMMITTEE of the Essex County Health Committee as at December, 1960. Chairman—Alderman Mrs. L. A. IRONS, J.P., C.C. Vice-Chairman—Councillor W. S. GARDNER Romford Borough Council Representatives:— Alderman F. C. BELL Councillor F. G. CARRICK Alderman P. D. RIDLEY, M.A.(Cantab.) Councillor A. C. LATHAM Alderman G. ROBERTS Councillor Dr. M. A. PHILLIPS Alderman Mrs. M. CLARK-LEWIS Councillor D. RAPER Alderman Mrs. O. M. J. ROBERTS, Councillor W. G. RUSSELL J.P.C.C. Councillor W. A. WHITE Councillor R. C. BAKER Councillor Mrs. R. C. COFFIN Essex County Council Representatives:— County Alderman Mrs. M. BALL County Alderman Mrs. E. C. SAY WOOD County Councillor Dr. M. L. ANFILOGOFF County Councillor L. F. SAUNDERS County Councillor W. A. SIBLEY County Councillor Mrs. L. FALLAIZE The Executive Council for Essex Representative:— The Venerable J. E. ELVIN The Local Medical Committee for Essex Representative:— Dr. R. M. S. MATTHEWS The Romford Group Hospital Management Committee Representative:— Mr. C. T. NUNN, J.P. Voluntary Organisations' Representatives:— Mrs. L. N. GOMER Mrs. E. McCORD Mrs. C.E.SIMS Miss N. HOWLEY Page 4 HEALTH DEPARTMENT STAFF 1960 Medical Officer of Health, Area Medical Officer, and Divisional School Medical Officer:— J. B. SAMSON, M.D., Ch.B., D.P.H. (Retired 31.10.60) F. L. GROARKE, M.B., L.M., D.C.H., D.P.H. (Commenced 1.11.60) Assistant Medical Officers of Health and School Medical Officers:— N. P. BHANDARI, M B., B.S., M.R.C.S., L.R.C.P., D.P.H. J. J. DUFFY, M.B., B.C.H., B.A.O., D.P.H. Mrs. E. M. HAGA, M B., B.S., M.R.C.S., L.R.C.P., D.P.H. Miss S. R. 1NGOLD, M B., B.S., M.R.C.S., L.R.C.P., M.R.C.O.G. (Resigned 2.10.60) Dental Officers:— Miss M. L. ELL, L.D.S., R.C.S.(Eng.) Mrs. F. ELL, Registered Dentist (Part-time) L . MORR1SSEY, B.D.S. (Part-time) (Resigned 5.9.60) Chief Public Health Inspector:— H. C. BOSWELL Senior Public Health Inspector:— W. HODSON Public Health Inspectors:— M. J. DOVE T. E. R. JONES P. (V. EDWARDS G. F. HOBSON G. D. JOHN M. J. LEE (Pupil) Shops Inspector:— S. F. TITTERTON Superintendent Health Visitor:— Miss F. K. WELLS Health Visitors, School Nurses, etc.:— Mrs. P. ALGHALI Mrs. S. HOLLAND Miss B. C. BLACKLEY (Tuberculosis Visitor) Miss G. BROCKLEBANK Mrs. F. C. MARSHALL Mrs. W. CLEGG (Clinic Nurse) (Tuberculosis Visitor) Miss 0. CLEMENTS Miss B. MULLIGAN Miss M. E. COOKE (Clinic Nurse) Mrs. M. RIGBY (Commenced 22.8.60) Miss E. ROWSTON Miss P. F. CULUS Miss A. P. M. THOMAS Miss W. DOWDALL (Clinic Nurse) (Commenced 16.8.60) Miss D. I. HALL Mrs. L. THOMPSON Miss N. HARWOOD (Part-time) Miss A. M. TIDD Mrs. M. WILLIAMS Page 5 STAFF—cont. Superintendent of Home Nurses and Area Non-Medical Supervisor of Midwives:— Miss R. LISTER (Commenced 1.3.60) District Midwives:— Miss I. A. BASSETT Miss R. A. MERRY Mrs. M. DOVE (Commenced 7.11.60) MISS E. E. JEENES Mrs. M. MYLWARD Miss C. M. KERR Mrs. E. A. ROOKS Mrs. A. M. KING Mrs. G. E. SEXTON Miss D. D. K. MARTIN Mrs. F. A. SMITH Mrs. G. MERRY District Nurses:— Mrs. E. M. ANDREWS Mrs. J. D. JENNINGS Mrs. E. BROOME Mrs. I. NORRIS Mrs. E. D. CARRINGTON Mrs. A. C. SILCOCK Mrs. B. CASEY Mrs. D. I. TOWELL Mrs. C. COOK Mrs. S. A. WOTHERSPOON Day Nurseries—Matrons:— "ST. MORITZ "—Mrs. I. C. BOWYER COLLIER ROW—Mrs. D. STINSON RUSH GREEN—Mrs. R. M. O'HALLORAN Domestic Help Organiser:— Miss N. KEAY Dental Attendants:— Mrs. K. GOULDING (Part-time) Speech Therapists:— Mrs. J. E. BAYLISS (Part-time) Miss E. BREWITT (Part-time) Mrs. J. M. LEE Chiropodists:— Mr. G. H. EVANS (Part-time) Commenced 23.11.60 Mr. A. H. PARKER (Part-time) Commenced 14.11.60 Mrs. A. GAMMON (Part-time) Commenced 5.4.60 Miss A. M. JONES (Part-time) Commenced 20.10.60 Occupational Therapist:— Mrs. Z. MERCER (Part-time) Page 6 CLERICAL STAFF Chief Clerk (Administrative):— E. W. GOWERS Senior Administrative Assistant:— C. G. HUMBERSTON Administrative and Senior Assistants:— E. LAMB —School Health A. G. MELOY —Supplies and Maintenance S. A. BOWERS —Environmental Health Mrs. M. BARNARD —School Health Miss M. E. FIRMIN —Immunisation and Vaccination Mrs. B. MATHER —Secretarial and Records Clerical Assistants:— Mrs. B. CAREY (Part-time) Miss P. MANN Mrs. A. S. CORBEN Mrs. S. M. MOSS Mrs. L. CRUSE (Part-time) Mrs. J. NICHOLS (Part-time) Mrs. A. J. FASSAM Mrs. P. REYNOLDS (Clinic Clerk) Mrs. W. J. GRIFFIN (Clinic Clerk) Miss J. V. SAGGERS (Clinic Clerk) (Commenced 16.9.60) Miss G. G. SMITH Mrs. P. A. HARRIS Miss A. J. VALE Miss R. HARVEY (Clinic Clerk) Miss V. C. WARREN (Clinic Clerk) Miss M. O. LITTLE (Clinic Clerk) Public Analyst:— HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. REGIONAL HOSPITAL BOARD STAFF Orthopaedic Surgeons:— G. BARCLAY, F.R.C.S. A. M. A. MOORE, F.R.C.S. Child Psychiatrist:— J. E. VINCENZI, M.R.C.S., L.R.C.P., D.P.M. Chest Physicians:— S. THOMPSON, M B., Ch.B. E. WOOLF, M.R.C.S., L.R.C.P. (Harold Hill Area) Opthalmologists:— T. J. REGAL, M.D., D.O.M.S. B. G. DIAS, M B., B.S., D.O. D. E. HONE, M.A., B.M., M.R.C.S., L.R.C.P., D O. Physiotherapists:— Mrs. B. V. WAND Mrs. A. SLIP Page 7 GENERAL PUBLIC HEALTH Oldchurch Hospital The North East Metropolitan Regional Hospital Board are planning extensions, and improvements for this hospital, and work is expected to commence shortly on a new out-patients department. This will fulfil a most urgent need for the district. Further developments under consideration include improvements to the Casualty Department, extensions to the Radiotherapy Unit, certain ward improvements, the provision of a new kitchen, and a central sterilising unit. Land for extensive new building is not available on this Hospital site. Victoria Hospital and Strathmore Annexe It will be recalled that the Cranbrook Report advised the setting up of general practitioner maternity units wherever possible. The Regional Board has now agreed to provide such a unit of approximate!) 20 beds at this hospital. Accommodation for maternity patients is planned for the surround ing hospitals of Harold Wood, St. George's Hospital, Hornchurd and Rush Green Hospital. Such provision should make good the deficiencies in accommodation for this category of patient Total confinements for the district numbered 2,019 of which 932 took place at home. Probably half of the mothers confined at home would have preferred to have their babies in Hospital, but were unable to be admitted for lack of accommodation. Page 8 COUNTY WELFARE SERVICES The County Welfare Officer has kindly supplied the following information:— The statistics set out below show the extent to which the main services provided by the County Welfare Committee under the National Assistance Act, 1948, have been afforded to persons residing within the Borough of Romford during the year 1960:— (1) Residential Accommodation (a) Number of domiciliary visits undertaken 347 (b) Number of applications received 109 (c) Admitted to hostels and other residential ments 39 (2) Temporary Accommodation (Homeless Families, etc.) (a) Domiciliary visits by Family Case Workers, etc 352 (b) Number of applications (including references from Borough Council) 47 (c) Number of cases admitted to temporary modation 3 (3) Blind Persons That lumber of registered blind, partially sighted and defective sighted rsons resident in the Borough on the 31st December, 1960, was as fc'lows:— (a) Registered as blind 151 (b) Partially sighted 45 (c) Defective sighted 8 all of whom came under the supervision of the County Council's Home Teachers. There were two blind persons in the Home Workers' Scheme operated through the agency of the Royal Society for the Blind and three were employed in special workshops for the blind. Additionally, nine blind and ten partially sighted persons were employed in open industry; three blind persons from the Borough were admitted to Homes for the Blind. Occupational and recreational facilities are also available to the blind and many are taught braille and handicraft. Specialist officers are employed for the placement of blind persons in local employment and close co-operation is maintained with voluntary organisations working for the blind. (4) Deaf and Dumb and other Handicapped Classes The Welfare services for physically handicapped persons (other than blind us mentioned above) as provided by the County Council under Section 29 of the National Assistance Act, 1948, are available Page 9 for all registered handicapped persons of whom, at the present time, 166 reside in the Borough; these services have been extended considerably and in addition to direct provision, such as special equipment on loan, grants are made in approved cases towards the cost of structural adaptations to meet special home needs. Voluntary organisations also materially assist the County Council in this work. The County Council have their own Occupational Centre for the Physically Handicapped and others are contemplated in the near future. Visiting of the handicapped is carried out by specialist officers and they are instrumental in the ascertainment of individual needs, giving advice and also instruction in handicraft, especially to the home bound. RESIDENTIAL ACCOMMODATION The Welfare Committee have submitted proposals to the Ministry of Health for a new 60 bedded Hostel for aged persons at Harold Hill, and work is expected to start early in 1961. When completed this project will provide the Borough's first Part III accommodation. It is expected that the children's residential home at ,Harold Wood Hall will also be used for welfare purposes in the near future. There appears to be, as yet little likelihood of the provision by the Welfare Department of an Occupation Centre for the Physically Handicapped. Great benefit and happiness is derived from such centres by handicapped persons. MENTAL HEALTH Proposed Comprehensive Training Centre for Romford Dr. G. G. Stewart, County Medical Officer informs me that plans are well advanced for the provision of a Comprehensive Training Centre catering for 50 senior and 75 junior pupils, on part of the Harold Wood Hall estate. It is hoped that the erection of the Centre will commence early in 1961. This Centre, when completed, will provide facilities within the Borough for the training and care of children unsuitable for education at school because of a disability of mind, and for certain others requiring care from the Local Authority. Page 10 HOUSING The importance of good housing in relation to good health cannot be overstressed and there is no falling off in the numbers of housing applications from the public. Apart from the general housing need there is growing demand and serious shortage of planned homes for the aged, the infirm and handicapped. Elderly persons prefer to retain their independence in their own homes and to enable them to do so they require small units of modern construction sited near shops and buses. Your Council houses are let to applicants on a points code, and the scheme operated allows me to recommend priority to those suffering from illhealth. Persons who suffer from Tuberculosis are granted the maximum priority and lesser degrees of priority can be given in respect of persons with other disabilities. This latter authority is used cautiously because if widely used it affords relatively less priority to those most needing it. Mr. C. Hetherington, Housing Officer, has kindly supplied the following information:— Total number of Council Properties 4,500 Total number of applicants on the housing waiting list 1,864 Applications received during 1960 638 Medical certificates claiming priority submitted to the Housing Department during the year 300 Lettings during 1960:— New houses and flats 225 Properties re-let 172 Page 11 PROPERTIES PROVIDED FOR ACCOMMODATION OF AGED PERSONS Pre-War Bellhouse Estate 1 bedroomed flats in two storeys 16 Poplar Street 1 bedroomed bungalows 38 Post-War 1 -Bedroomed Bungalows Cedar Road and Cedar Close 22 Beech Street 4 Cross Road Estate 11 Fullers Farm Estate 4 Thameshill Avenue 1 Crossways 1 Leatherland Estate (Harrow Crescent) 4 1 -Bedroomed Flats Brooklands Lane 12 Carlisle Road Oldchurch Gardens 36 Barham Close/Cross Road 42 Leatherland Estate Tom Bradley House. Bed-sitting room flats Total 226 UNDER CONSTRUCTION AND PROPOSED Waterloo Road Estate Villa "A" (including Warden's flat). Bed-sitting room flats 14 Villa "B". Bed-sitting room flats 13 Villa "C". Bed-sitting room flats 13 1-Bedroomed flats in two-storey blocks 12 No. 61, Main Road Conversion and extension similar to Tom Bradley House, 22 including Warden's flat. Bed-sitting room flats Total 74 Page 12 Tom Bradley House was a large old Victorian property, purchased by the Council out of requisition and extended and converted for old people's accommodation. The premises now comprise three double bed-sitting room flats, (for couples), and six single bed-sitting room flats, with a two bedroomed flat occupied by the Warden and her family. The whole property is provided with central heating from a coke boiler in the basement, and with domestic hot water from a second boiler. There is a large Lounge available to all residents, furnished by the Council, including a television set and crockery for teas. In an outbuilding is a small laundry, supplied with hot water from the boiler, two sinks and an electric drying heater for use by tenants. Each flat consists of one room, with a curtained bed space and a kitchenette in a small recess. The kitchenette is provided with a larder, sink with hot and cold water, and a small gas cooker. Bathrooms and lavatories are separate, on the basis of one lavatory to two persons, and one bathroom to four persons. The tenants have the use of a pleasant rear garden—mainly lawns and trees. The Warden's duties are the cleaning of corridors, landings and staircases, bathrooms and lavatories, and the cleaning of the Lounge, with a coal fire in the winter to supplement the central heating. The Warden (with some assistance from her husband) maintains the two boilers. The accommodation, therefore, relieves the old folk of all chores in connection with space heating, hot water and the cleaning of bathrooms and lavatories, but leaves them free to live an independent life in their own flats with their own furniture, and doing their own cooking, etc. The Warden also keeps a register of names of tenants, with names of their General Practitioners and nearest relatives, to notify them in case of need. A telephone is provided for the Warden. The Warden is not expected to do any work for tenants, but to ensure their wants are met by Domestic Home Helps, Domiciliary Nurses, Doctors, etc. The Borough Council have leased to the Trustees of British Legion Haig Homes an area of land at the junction of Gobions Avenue and Chase Cross Road for homes for disabled ex-servicemen. There are eight dwellings on this site, which is leased to the Trustees at a nominal rent, the Trustees being treated as a Housing Association under the Housing Acts. Page 13 ROGER REEDE'S CHARITY I am indebted to Mr. Thomas F. Hunt, Solicitor and Clerk to the Trustees for the following information. Roger Reede died in the year 1483 and founded the Charity by a bequest of various lands in Romford, Hornchurch and Dagenham including land in North Street, Romford, on which it is known that there were almshouses previous to 1785. In that year they were re-built as they were again in 1896 as six dwellings. The Charity's remaining property in North Street, Romford, including the six almshouses was sold in 1959 and nineteen new almshouses, a warden's house and ancillary buildings have been erected in Church Lane on land which has been owned by the Charity since its foundation. The running of the Charity is regulated and controlled by a scheme of The Board of Charity Commissioners for England and Wales and the most recent scheme affecting this Charity, dated the 9th April, 1940, sets out in some detail the conditions governing admission to the almshouses and eligibility for the other benefits of the Charity. Briefly, however, the chief conditions of admission are that applicants must be poor men, of good character who from age, ill health, accident or infirmity, are wholly or in part, unable to maintain themselves by their own exertions. Almsmen are elected by, and at the discretion, of the Trustees. The wife of a married almsman may reside with him and if she survives him may be appointed as an almsperson in place of her late husband. Page 14 HEALTH EDUCATION During the year every effort was made to give publicity to such matters as prevention of lung cancer, and the need for safety in the home. Health Education is an important Health Department function aimed at the promotion of health and is carried out by Medical Officers, Health Visitors, Public Health Inspectors and others. There is a growing awareness that the preventive health services must advertise more and present material in an attractive way, and we might endeavour to compete more fully with the ingenuity of the Commercial Advertisers who link their product with desired ideals and images. Rate per 1,000 of Estimated Population 18.2 Birth Rate adjusted by Comparability Factor of 0.84 15.3 Still Birth Rate per 1,000 (Live and Still) Births 14.0 Page 15 MATTERS OF LIFE AND DEATH Population of Romford The Registrar General's estimated mid-year population for 1960 amounts to 115,840 compared to the figures of 114,800 and 113,700 for 1959 and 1958 respectively. The population at the 1951 census was 88,002 and at the 1931 census 35,918. Births 2,106 live births and 30 still births were registered in 1960, as follows:— Live Births:— Males Females Total. Legitimate 1,026 993 2,019 Illegitimate 46 41 87 1,072 1,034 2,106 Still Births:— Legitimate 16 14 30 Illegitimate — — — 16 14 30 Total Live and Still-Births 1,088 1,048 2,136 Loss of Infant Life Statistics for the loss of infant life are divided into those occurring before Birth (Stillbirths) and those occurring between birth and the first Birthday (Infant Deaths). The Infant Deaths are further divided into those occurring in the first month of life (Neo-Natal deaths) and those occurring between 1-12 months of age. During the year 43 children died during the first year of life and there were 30 Stillbirths. Distribution of Infant Deaths Under one day 13 One/Seven days 11 One/Four weeks One/Twelve months 16 Trends over the past 25 years show that the greatest reduction has been made in the death rate for infants aged between 1 and 12 months. Neo-Natal deaths and stillbirths have responded less dramatically to our efforts. The prevailing perinatal mortality rate (Stillbirths and deaths in the first week of life) of 34 per 1,000 live and stillbirths for England and Wales is considered by the Ministry of Health to be too high, and compares unfavourably with some other Countries. It is estimated that in England and Wales alone the numbers of such deaths could be reduced by 5,000 per annum by raising the general standard of care of the premature baby, and by adopting Although there are bound to be fluctuations in local figures from year to year due to the comparatively small numbers dealt with, the overall trend would appear to be downwards. The infant death rate for 1960 was 20.4. This is higher than the figure of 17.2 for 1959, but is still lower than the rate of 21.7 for England and Wales. Page 16 all possible measures to prevent the onset of premature labour. Year Stillbirths Deaths in first week of life Perinatal Death. Rate At Home In Hospital Born at Home Born in Hospital Romford England & Wales 1960 6 24 6 22 27.2 32.9 1959 12 17 1 19 24.7 34.2 1958 10 37 4 25 35.9 35.1 1957 11 24 3 20 30.0 36.2 1956 10 34 7 14 34.8 36.8 The following tables show the causes of infant deaths:— INFANTILE MORTALITY—1960 Cause of Death 0-1 mth. 1-3 mths. 3-6 mths. 6-9 mths. 9-12 mths. Total under 1 year Atelectasis 4 - - - - 4 Birth Injury 3 — — — — 3 Bronchitis - 1 1 1 — 3 Cerebral Thrombosis — — — — 1 1 Congenital Malformations 2 1 — 1 1 5 Fractured Skull (Abandoned Newborn Infant) 1 - - - - 1 Hydrocephalus 1 — — 1 1 3 Inhalation of Vomit 1 1 — - — 2 Neo-Natal Nephritis 1 — — - — 1 Neo-Natal Septicaemia 1 — — - — 1 Pneumonia 1 1 — - — 2 Prematurity 17 - — - - 17 Totals 32 4 1 3 3 43 Page 17 NEO-NATAL MORTALITY—1960 Cause of Death Under 1 wk. 1-2 wks. 2-3 wks. 3-4 wks. Total Atelectasis 4 - - - 4 Birth Injury 3 - - - 3 Congenital Malformations - - 1 1 2 fractured Skull (Abandoned Newborn Infant) 1 - - - 1 Hydrocephalus - 1 - - 1 Inhalation of Vomit 1 __ - 1 Neo-Natal Nephritis - - 1 - 1 Neo-Natat Septicaemia 1 - - - 1 Pneumonia 1 1 Prematurity 17 — — 17 Totals 28 1 2 1 32 DEATHS Causes of Death in 1960 Total Tuberculosis and other Infectious Diseases Cancer and other Malignant Diseases 165 Diseases of the Brain and Nervous System 102 Diseases of the Heart and Circulatory System 272 Pneumonia, Bronchitis and other Respiratory Diseases (excluding T.B.) 87 Diseases of the Stomach and Digestive System 9 Accidents, Poisonings and Violence 39 Infant Deaths and Congenital Malformations 42 Other causes 66 Total 790 Crude Death Rate per 1,000 Estimated Population 5.93. Adjusted Death Rate (Comparability Factor 1.56)=9.2. INFECTIOUS DISEASES The following notifications were received during the year:— Notifications Deaths Pneumonia 18 36 Tuberculosis: Respiratory 50 54 6 7 Non-Respiratory 4 1 Scarlet Fever 145 — Dysentry 729 — Puerperal Pyrexia 3 — Measles 194 — Whooping Cough 386 — Food Poisoning 223 Erysipelas 7 — Scabies — — Meningococcal Infection 1 — Poliomyelitis — 1 Diphtheria — - Ophthalmia Neonatorum 3 - Paratyphoid Fever — — Infectious Diseases Immunisation against Diphtheria was introduced in Romford in 1935, a year in which 169 notified cases of the disease occurred which Page 18 resulted in 7 deaths. In his Annual Report for 1934, the Medical Officer of Health states "Throughout the year Diphtheria has been prevalent. There has, however, been no epidemic of any magnitude. In all, notifications numbered 203, and deaths amounted to 15." The progress made since that time is evident from the fact that not only did Romford have no case of the disease during 1960, but the total number of cases in England and Wales amounted to 49 only, and 5 deaths were ascribed to the disease. The fact that cases and deaths from the disease occurred in the London area recently should be a warning to all parents against complacency. Freedom from this disease can only be maintained by parents insisting on having their children fully immunised against it. ROMFORD CHEST CLINIC Dr. S. Thompson, Chest Physician, reports as follows:— During the year 1960 the trend towards lower incidence and lower death rate from tuberculosis continued, though in the combined districts of Romford and Hornchurch served by the Romford Chest Clinic there was a slight rise in new respiratory cases and also in the death rate. More cases of tuberculosis were transferred into the area than were transferred out, so that the total notified cases remaining on the register at the end of the year showed a rise and there were over 1,500 notified cases at the end of the year. It is gratifying to note that the incidence in children is very small and the more serious forms of miliary tuberculosis of the lungs and tuberculous meningitis are becoming extremely rare. This is no doubt attributable partly to the great reduction in infectious cases in the population due to the widespread use of chemotherapy and antituberculous drugs. In addition, the extension of the use of B.C.G. vaccination is giving the child population increased protection against infection. The Regional Board decided to close the smaller chest units in the Region and unfortunately the chest unit at Rush Green Hospital, which had served a most useful purpose for the local population for the past 10 years, was one of the units to be closed and the beds used for other purposes. The bulk of the local cases of tuberculosis are now treated in Broomfield Hospital and Dagenham Hospital, together with a small chest unit at High Wood Hospital, Brentwood. The seeking out of contacts and the follow-up of cases referred from the Mass Radiography Units continues to increase and the Page 19 miniature x-ray unit is most useful in catering for these cases, of which the total has now reached almost 3,000. In addition to dealing with cases of tuberculosis, large numbers of non-tuberculous chest conditions are referred for diagnosis by the General Practitioners and assistance is given to them in the treatment and management of these cases. BRENTWOOD CHEST CLINIC Dr. E. Woolf, Chest Physician, reports as follows:— The Brentwood Chest Clinic has continued to cater for the needs of that part of the Romford area lying to the east of Straight Road, and to the north of the Colchester Road. From this area the statistical analysis is as follows:— Respiratory Non-Respiratory M W C M W C Cases on register—1.1.60 248 260 66 22 30 11 Transfers in (notified cases) 13 9 2 0 0 0 Transfers out (notified cases) 14 15 2 0 2 0 New notifications 4 8 1 1 0 0 Recovered 16 15 4 2 0 0 Died 5 4 0 0 0 0 Total removed from register 49 48 7 5 5 1 Cases on register—31.12.60 220 227 58 19 25 9 From this it will be seen that the overall number of tuberculous cases on the register is continuing to diminish. However, this Clinic is being used increasingly by the local practitioners for the diagnosis and treatment of non-tuberculous cases of chest illness, and the number of these is correspondingly increasing steadily. It expected that these trends will continue. It is my practice to visit patients at their homes in company with the Tuberculosis Health Visitors whenever convenient, and I have found that this has proved very helpful in many cases. We have maintained the service of checking up the children Mantoux tested at school as part of the Tuberculosis accination Scheme, and found to be positive. It is also our practice, at this Clinic, to check up the home contacts of these children. In this connection it may be noted that the number of contacts seen continues at a gratifyingly high level. In the period under review, 793 contacts were examined and 66 individuals were vaccinated with B.C.G. Page 20 CARE OF THE AGED Throughout the year, Health Visitors continued to devote more time to visiting the aged in their homes, and resulting therefrom action was taken in many instances to procure necessary treatment. Elderly persons frequently need reminding of the welfare and social services that are available for them. The provision of domestic help for the elderly and infirm is one of the services most appreciated, and approximately 500 aged persons residing in the Borough were provided with Domestic Help during the year. Suitable housing accommodation can be all important to the comfort and well being of elderly infirm persons who are unable to negotiate stairs to bedroom, toilet, etc. without great difficulty and hardship The ageing of the population will result in increased demand for aged person's houses and flats. NATIONAL ASSISTANCE ACT, 1948—SECTION 47 It was not necessary during the year to remove any person compulsorily to hospital or residential accommodation because they were not eceiving proper care and attention at home. It is till difficult to find hospital beds for the aged sick, and the majority of such patients either through choice or lack of hospital beds are treated at home. Fiftf n District Nurses are employed in this Health Area to undertake the home nursing of every type of illness. Nurses may visit very ill people two or three times daily to carry out treatment prescribed by the patient's own Doctor. Night attendants may be provided to relieve relatives in cases where the patient requires frequent attention during the night. The Borough council inaugurated a free laundry service to help relatives nurse incontinent patients at home. This service provides for the laundering of soiled articles such as sheets and night clothes, etc. Collections and deliveries are made twice per week. The number of articles dealt with per month averages 206 and the help given is a valuable adjunct to the Domiciliary Services. During the year 5 cases were assisted in this way. Volumary organisations operating in the Borough provide a meals-on-wheels service, summer holidays, a limited Chiropody Service, and Clubs for the aged. Roger Reede Almshouses provide nineteen homes on a convenient site for local veterans. Page 21 One of the biggest problems the aged have to face is that of idleness and loneliness. Kindly neighbours do a great deal of voluntary duties in visiting and assisting aged persons living alone, but often the only caller is the Home Help. Many old people become depressed and apathetic and will not make any effort to join in social activities outside their own homes. Sometimes they vigorously resist the offer of social services they sorely need, and in many cases patient and understanding contact is required to help without offending. PERSONAL HEALTH SERVICE Under the National Health Service Act, the Romford Health Area Sub-Committee of the Health Committee of the County Council controls the day-to-day administration of the Maternity and Child Welfare Service, Domiciliary Nursing, etc. Details of these services and of the work carried out are given below:— CARE OF MOTHERS AND YOUNG CHILDREN Ante-Natal Care. Of the 932 mothers confined at home during the year, 841 received ante-natal care from their General Practitioners. 181 mothers attended the ante-natal Clinics, 90 of whom were confined at home. Ante-Natal Instruction Classes Incomplete understanding of the process of childbearing can give rise to the development of a state of anxiety and apprehension in a mother during her confinement. This in turn creates tension which causes much of the discomfort and pain of childbirth. The overanxious fearful mother will tend to have a more painful labour than her more placid neighbour. An increasing number of expectant mothers are now demanding that they should be instructed, as a part of ante-natal care, in the changes taking place in their bodies so that they can adopt a relaxed state of mind during pregnancy and parturition. Health Visitors now hold classes for expectant mothers at three Centres in the town where instruction in the process of pregnancy and labour is given, and exercises are taught in order to help mothers rest and relax during labour. Such preparation is well worthwhile not only for emotional reasons but also because it helps greatly in conserving a mother's energy for the physical efforts which the process of parturition demands. Page 22 A full course consists of 13 classes held once weekly, and an outline of the subject matter is given below. Husbands are invited to join their wives at some of the sessions. Syllabus Introduction—Purpose of Mothercraft and Relaxation. Anatomy and Physiology of Pregnancy. Birth of the Baby—flannelgraphs. Hygiene of Pregnancy (1) Hygiene of Pregnancy (2) Preparation for confinement at home and hospital—gas and air. Films—Brother for Susan. My First Baby. A Tooth in time. Layette. Bathing the baby. Minor ailments in babyhood. Breast and artificial feeding—recapitulation. Films—Your Children and You. A Flying Start. A Modern Guide to Health. Prophylaxis and general discussion. Confinements. During the year, 2,135 mothers were confined, giving birih to 2,156 infants (including 21 pairs of twins). These were born as follows:— Oldchurch Hospital 804 Other Hospitals 420 At Home 932 2,156 It is pleasing to note that no maternal deaths occurred during the year. While the demand for beds for hospital confinements remain greater than the local hospitals can meet it is necessary to select patients for hospital confinements. Priority is given to cases with medical or obstetric indications, and to those cases in which there are adverse social conditions. As available accommodation does not enable us to include all mothers having their first babies, priority is given to those aged 30 years or more at the time of confinement. Mothers who have Page 23 had four or more children get priority, and cases of multiple pregnancy, women aged 35 years or more, where there is a long interval between the children, or where the parents were attending an Infertility Clinic, or were married for 10 years or more without a family. Hospital confinement is also considered wise for all small women (those under 5 feet in height). Priority is recommended for these categories because they carry greater liability to complications. Assessment of the social conditions of patients is made by Local Authority Nursing Staff. Post Natal Care. As mentioned, 90 of the mothers attending the ante-natal clinics were confined at home. All were urged to return for post-natal examination, but only 51 (or 60%) did so. The importance of post-natal care cannot be over-emphasised, and every mother should ensure that she returns either to the hospital, general practitioner or the ante-natal clinic as the case may be for an examination. Clinic Premises The first purpose built clinic to be erected in Romford was provided by the Borough Council at Marks Road and opened in 1934. A second clinic was built at Hulse Avenue and came into use during 1940. With the L.C.C. development at Harold Hill a Health Centre was provided at Gooshays Drive to cater for the 30,000 population of this Estate. Despite the steady increase in population over the years no further clinics were provided by the Essex County Council who assumed responsibility for such development in 1948. The accommodation at the existing clinics is now inadequate to cope with the various services which local Health Authorities are required to provide, and it is necessary to provide additional accommodation as soon as possible. Infant Welfare sessions are held at hired premises in three instances, and it would be well worth considering transferring these se ions from Church Halls to buildings designed for Health Services purposes. Additional services could then be provided such as Mothercraft and Relaxation, Chiropody, Immunisation, etc. Infant Welfare Attendances at the Child Welfare Clinics during 1960 are given below:— No. of children born in 1960 who attended 1,269 Total number of children who attended 3,144 Total attendances 21,103 Page 24 The 1,269 children born in 1960 who attended the Clinics during the year represents 62% of the total number born, after taking into account the fact that mothers of babies born in the last two weeks of the year could scarcely have had an opportunity of taking their babies along to a clinic in that year. Distribution of Welfare Foods. Welfare foods were distributed from the Clinics, the Health Department, and 16 shops during the year. The following table shows the number of items distributed in 1960:— National Dried Milk 44,038 tins Cod Liver Oil 7,663 bottles Vitamin Tablets (A & D) 7,779 packets Orange Juice 75,968 bottles Day Nurseries. There are two 30-place Nurseries, and one 40-place Nursery in the Area, and the following gives the combined attendances at all three Nurseries during the year:— No. on Register Avge. Daily Attendances January 117 83.3 February 114 86.4 March 123 93.1 April 125 92.5 May 133 103.9 June 131 100.1 July 127 90.5 August 135 82.3 September 126 95.4 October 132 96.4 November 137 100.7 December 132 92.5 Romford's Day Nursery Service originated during the war years to look after children whose mothers were contributing to the war effort, but was developed and maintained afterwards to care for children of mothers obliged to work for a living away from home. Top priority for admission is given to the children of widows, widowers, a parent separated, divorced or deserted, an unmarried mother, or a mother working because of her husband's disablement. Other priorities include admissions due to illness of either parent, including confinement of mother, and children of mothers in employment highly essential to communal needs, such as school teachers, nurses, etc. Priority is given also to children recommended for admission by medical practitioners. Page 25 Three Nurseries continue to serve the area providing accommodation for a total of 130 children. Two of the Nurseries were purpose built during the war at a time when restricted sites only were available, and the war-time materials used have now seriously deteriorated. It is hoped to replace one of these buildings on a new site in the not too distant future. The third Nursery is housed in a large and old Victorian property which has been adapted for the purpose. There is ample play space on this site. Dr. N. Bhandari, Assistant Medical Officer, in his recent "Medico—Social study of The New Housing Estate, Harold Hill," in regard to care of pre-school children of parents who work states "about 5 per cent of wives with pre-school children work outside the home, leaving their children in other's care. Financial need and boredom are the most usual motives. The pre-school children, including babies are usually entrusted to a neighbour or acquaintance who may take one or more such children for gain. The casualness of some such arrangements was shown when a child becoming ill, the 'minder' brought it to the clinic. Hospital treatment was needed and when asked the mother's place of work it was revealed she did not know it, nor did she even know her name and home address, the child's christian name being her only knowledge of it. The unsatisfactory n ture of such arrangements is obvious and a partial solution would be a day nursery on the estate. However, the high cost of such establishments might well lead to 'minders' undercutting the rate, and it seems that even with such facilities, unofficial arrangements would probably continue to be made." Nurseries and Child Mothers' Regulation Act Registrations in force under this Act during the year were as follows:— Registered Children permitted Premises 1 12 Persons 1 8 Midwifery During 1960, fourteen Midwives were employed, and in addition the Salvation Army Midwives from the Mothers' Hospital, Clapton, provided a domiciliary midwifery service in the Rush Greer Area ot the Borough; 932 patients were delivered in their own homes, approximately 46% of all patients confined. Page 26 Health Visiting The following statistics relate to the work of Health Visitors:— No. of visits to Expectant Mothers 331 No. of visits to children under five 7,138 No. of other visits 11,264 No. of non-access visits 3,970 Home Nursing The ten full-time Home Nurses employed in the Area paid 24,439 visits to 1,351 cases during 1960. Vaccination and Immunisation Smallpox Vaccination. The total number of primary vaccinations carried out in 1960 for persons of all ages was 933, of whom 520 were infants under one year of age. This means that approximately 24.7% of infant are being vaccinated during the first year of life. Poliomyelitis Vaccination The publicity given to this scheme over the past four years has borne fruit, in the fact that Poliomyelitis Vaccination appears to have become a "must" in the minds of the majority of parents, and acceptances for the vaccination of infants and young children were received regularly throughout the year. In the older age groups, acceptances are more spasmodic, periodic increases occurring whenever an epidemic occurs, or some intensive propaganda brings a reminder of the danger of being unprotected. The Scheme was further extended early in 1960 to include persons born before 1932 who had not reached their 40th birthday. During the year, 6,309 persons were vaccinated as follows:— Children 2,013 Young persons 840 Persons born before 1932 and under 40 yrs. 3,616 Others 22 In addition 9,678 third (or booster) injections were given. A total of 22,353 primary and booster injections were given, of which 17,786 were performed by general practitioners. Page 27 Diphtheria and Whooping Cough Immunisation The number of children receiving primary courses of immunisation during the year was as follows:— DIPHTHERIA Family Doctors Clinics Total Separate 659 619 1,278 Combined with whooping cough 490 - 490 Total 1,149 619 1,768 WHOOPING COUGH Family Doctors Clinics Total Separate 599 578 1,177 Combined with diphtheria 490 - 490 Total 1,089 578 1,667 Prevention of Illness, Care and After-Care Chiropody Service Approval was given to the establishment of three chiropody clinics in April 1960. Unfortunately it has not been possible to recruit the necessary staff, and the service that has been given has been limited to approximately 10 sessions per week, provided by part-time sessional chiropodists. At present these sessions are held at the Harold Hill Health Centre, and at the Clinics at Marks Road and Coi'ier Row. Adequate accommodation is not available but plans are bein prepared for alterations or extensions to each of these buildings to provide proper facilities. The total number of attendances made for treatment between April and December 1960 was 1,520. Sick Room Equipment Requests for the loan of sickroom equipment continued to increase during the year, and at 31st December, 1960, 685 articles were out on loan. The articles most in demand were wheelchairs, commodes, bedpans, urine bottles, backrests, air rings and rubber sheets, but Page 28 occasional requests were received during the year for many other items. These included a hydraulic hoist, crutches, walking sticks, walking aids, rubber mattresses, bed cradles, etc. This service is very much appreciated by the patients and their families, and helps many patients to be cared for in their own homes in a proper manner, and in a degree of comfort, which would only be available by their admission to hospital. Recuperative Holidays During the year, 53 persons, on the recommendation of their medical practitioner, were sent to convalescent homes for a recuperative holiday. In most instances the period recommended was two weeks. Milk for Tuberculous Patients Free milk was provided throughout the year to tuberculous patients vhen recommended by the Chest Physician. Following the downward trend in the incidence of Tuberculosis, the number of patients receiving milk declined from 84 to 69 during the year. Domestic Help Service There were approximately 100 part-time Domestic Helps engaged in the ho nes of patients throughout the year, 642 patients were helped and the otal number of hours service given amounted to 94,741. Equivalet figures for 1959 were 673 patients, 90,263 hours. More than half the patients assisted in 1960 (376) were in the category of aged chronic sick, 65,181 of the total number of hours service being provided for them. Night Attendance Service This service which was commenced in the latter part of 1959, is administered by the Domestic Help Organiser. The demand for the services of the night attendants has not been as great as had been anticipated, but no doubt more calls will be made on it as it becomes more widely known that such facilities exist. Ten patients were provided with a night attendant during the year, the total number of hours involved being 979. Page 29 PROBLEM FAMILIES The problem of neglectful parents is receiving more attention nowadays, and increasing efforts are being made to rehabilitate such families. The symptoms frequently present themselves as child cruelty and child neglect, and it is often the case that the parents, particularly the mothers, are found to be apathetic, unstable and mentally retarded. Social Workers face a difficult task in attempting to reform the parents because the cause is often ingrained and deep rooted, but every effort is made to spare the children from the worst effects of their distressing home environment. In most cases it is best to keep the family together, but occasionally the children have to be taken into care. The problems of such parents require sympathetic handling and Health Visitors and Home Helps endeavour to improve matters by educating mothers in their own homes in home making, child care, cooking, cleaning laundry sewing and household budgeting. The work is time consuming and frequently there is little enough to show for the efforts made by the many Social Workers that may be involved in any particular case. Page 30 SCHOOL HEALTH SERVICE 1960 MEDICAL INSPECTION AND TREATMENT The Statistical Return at the end of this report shows the classification of defects found and the treatment thereof. Minor Ailment Clinics Conditions treated at these clinics are of a minor nature only; they include skin complaints, minor diseases of the eyes, ears, nose and throat, minor injuries, etc. In addition to this treatment many children are seen by the School Medical Officers for Special Examinations and for re-examination following routine medical inspection in school. Children are also examined prior to taking up part-time employment, e.g. in the delivery of newspapers, milk, etc., and in entertainment. New Cases Treated During The Year:— Ear, Nose and Throat defects 2 Skin defects: Ringworm (scalp) 1 Impetigo 1 Other skin conditions 218 Other minor ailments 49 Medical Consultations:— Spccial inspections 744 Re-inspections 488 Examinations of Children for Employment:— In entertainment 3 Other employment 200 Total attendances at minor ailment clinics 2,905 Speech Therapy During the year 104 new cases were referred to the Speech Clinics and 189 children were under treatment at the end of the year. The total number of attendances during the year was 2,367. DENTAL SERVICES Statistics relating to the dental inspection and treatment of school children will be found in the statistical return at the end of this report. During the year the number of Dental Officers suffered further reductions and at the end of the year only two officers, one full-time and one part-time, were employed. In the circumstances it is impossible to maintain a satisfactory dental service for school children. Page 31 Enuresis Enuresis (bed-wetting) is one of the most socially disabling disorders found in children; additionally it throws a heavy burden upon the mother. Following a pilot scheme there are now six Enuresis Alarms available for loan to patients for use at home in the treatment of this condition. The underlying principle is that by waking the patient each time he or she wets the bed, the alarm brings about a habit whereby the patient wakes shortly before he or she would have otherwise wetted the bed; and rises to pass urine in the normal way; such a habit is of course unremarkable socially and in many cases the improvement is carried a stage further and the patient is able to sleep throughout the night without any need to pass urine. Although early results were encouraging those obtained later showed improvement due probably to a better selection of cases, and perhaps due to better handling of the case in general by the Medical Officer concerned. The early cases were obtained from school contacts, either at School Medical Inspections, or referred by Head Teachers Later as knowledge of the treatment spread, cases have been referred by Family Doctors, and in some cases parents have contacted the Clinic direct, inspired by friends or neighbours whose children have been successfully treated. Treatment, on the average, appears to take between two and three months, so that with the present complement of alarms, about twenty-five cases can be treated annually, which is a small number considering the size of the problem. However it is felt that the personal relationship between the Medical Officer and the child and parents is an important part of treatment, so that even with an unlimited number of Alarms available the number that could be helped would be limited by this factor, bearing in mind other commitments. VACCINATION AGAINST TUBERCULOSIS B.C.G. Vaccination was again offered to all 13 year old school children and the statistics relating to this service are as follows:— Number to whom offered 1,226 Number tuberculin tested after parents' consent had been received 697 Positive result 49 Negative result 632 Number who received B.C.G. Vaccination 6. 2 (16 children were tuberculin tested but failed to attend the clinic for the result to be observed). Page 32 SPECIALIST SERVICES In co-operation with the Regional Hospital Board, Eye Clinic sessions and Orthopaedic Clinic sessions were continued at Marks Road Clinic and the Health Centre, Harold Hill. Cases dealt with were as follows:— Eye Clinics External and other diseases 8 (excluding errors of refraction and squint) Errors of refraction (including squint) 927 Total 935 The number of children for whom spectacles were prescribed was 559. Vision Vision gradually develops to the full during the early years provided the eye; are straight. Should squint be present not only is normal function of using both eyes together (binocular vision) arrested but there is gradual loss of vision of the squinting eye, due to a process of suppres on of the Image. If treatment is neglected blindness in a squinting eye can result. Consequently the ascertainment and treatment of squint in children is a matter of importance. It is unfortunate that some children do not receive treatment early enough to prevent serious consequences. No squint ever rights itself and no child is too young for treatment. There isastrong hereditary element in the aetiology of squint and special attention should be paid to infants of parents with a history of defective vision or squint. Dr. Regal, Dr. Dias and Dr. Hone, Ophthalmic Specialisis,hold between them eight sessions monthly at our clinics,and I am indebted to Dr. T. Regal for the following report:— During 1960 the number of sessions held at this (Marks Road) Clinic were 47 and in these sessions 706 cases were dealt with. The number of patients seen amounted to 435, of which 115 attended the clinic for the first time. Thus, whilst 271 children attended twice during that period the remaining 164 were only seen once during that year. Taking into account that of the 115 new cases at least half the number attended in the second half of the year and were not yet due for the six-monthly check up which I think is the desirable period, taking furthermore into account school leavers and children moving out of Page 33 the district and those who are discharged as satisfactory by us, this ideal half-yearly attendance is almost achieved. Of the 435 children seen during I960:— 17 left school now. 4 transferred to other areas. 34 were discharged satisfactory. This leaves 380 children still under our care plus 21 new cases awaiting treatment, a total, so far of 401 children. Our patients are referred to us mainly by the School Medical Officer or the School Nurse, some from the Infant Welfare Clinics, a few are sent by their family doctor, and in some instances parents approach the clinic on their own initiative or prompted by the school teacher who observed some abnormal behaviour in the child suggestive of eye trouble. During the year, we meet every type of pathological eye condition, but the main work is refraction work and the treatment of squints. Thus, 274 pairs of glasses were prescribed, i.e. 252 for school children and 22 for children of pre-school age. The incidence of squint is a fairly high one. Fortunately these children come usually already in the early stages of this abnormality and are thus much better amenable to treatment. I cannot but praise the very good co-operation we get from the hospitals and the orthoptic departments. Their reports come speedily and the waiting period for appointments is very short now, and also the waiting period for operations. Unfortunately, at each weekly session we get some absentees. Discounting the instances of sickness, there are always some parents who fail to attend without any special reason and without any notification, thus taking up time from which another patient could have benefited. It is through this laxity that we are never able to reduce our waiting list to nil and that at the end of the year there were still 21 new cases awaiting their first appointment. In this respect, I should like to express my special gratitude to the Health Visitors trying to find time to visit these parents in their homes and finding out the reasons for the non-attendance. I should also like to thank the clerocal staff for sending out reminders and keeping check of these cases. Orthopaedic Clinics Number of children receiving treatment 614 Total attendances at Specialists' clinic 280 Total attendances at Physiotherapy sessions 3,572 Page 34 HANDICAPPED PUPILS Special Educational Treatment There are no Day or Residential Special Schools in the Borough for Handicapped Pupils, and all pupils who require special educational treatment because of various handicaps must attend schools outside the Borough. However the 1960/61 Programme provides for a school for Educationally Sub-normal Pupils to be built in Romford. E.S.N, is the largest single handicaps in terms of numbers of pupils concerned, and is approximately equal to that of all other handicaps combined. A summary is given below of the ascertainment and placement of handicapped pupils during the year:— Category No. of pupils Ascertained during 1960 No. of pupils admitted to Special Schools during year Total No. of pupils in Special Schools at end of year Day Residential Day Residential Deaf 1 - - 4 1 Partially Deaf 1 3 - 8 1 Blind - - - - 2 Partially Sighted 1 1 - 5 - Epileptic 1 - 1 - 2 Delicate 10 6 6 16 16 Physically Handicapped 7 2 2 14 9 Educationally Sub- Nomal 19 15 3 71 16 Maladjusted 7 - 4 - 11 Speech - - - - - Dual Defects* - - - 5 2 Totals 47 27 16 123 60 *Children ascertained in respect of more than one defect:— Attending Day Special Schools 1 E-S.N./Physically Handicapped 1 E.S.N./Maladjusted 1 Partially Deaf/Partially Sighted 1 Partially Deaf/E.S.N. 1 Partially Deaf/E.S.N./Physically Handicapped Attending Residential Special Schools 1 Deaf/E.S.N. 1 E.S.N./Maladjusted Page 35 Employment of Handicapped Pupils With the co-operation of the Youth Employment Officer the following information has been obtained regarding the employment of Handicapped Pupils who left school in 1960:— Category Boys Girls Occupation Delicate 1 Shop Assistant 1 Trainee Cutter (Clothing Manufacturer) 1 Radio Assembly Physically Handicapped 1 Trainee—Mica Factory 1 Packer—Wholesale Chemists 1 Artificial flower maker 1 2 Clerk 1 Welfare Dept. Training Centre Educationally Sub-normal 1 Shop work (2nd job) 1 Light engineering assembly 1 Trainee—garage 1 Laundry van boy 1 1 Factory work 1 Trainee—cabinet maker 1 Dress machinist 1 Messenger (2nd job) 1 Artificial flower maker (2nd job) 1 Labourer (4th job) 1 Attending training centre 1 Awaiting place at Mentat Health Hostel 1 Several jobs Blind 1 Attending Blind Occupation -Centre Maladjusted 1 Clerk 1 Apprentice Hairdresser Convalescence During the year 31 children were sent away for short term convalescent holidays. ROMFORD CHILD GUIDANCE CLINIC Cases are initially referred to this clinic by parents, Schoc vledical Officers, General Medical Practitioners, Hospital Consultant Health Visitors, Educational Psychologists, Head Teachers, Children Officer, Probation Officers and Magistrates. Dr. J. Vincenzi, Consultant Psychiatrist to this Clinic reports as follows:— It will be seen from the returns that there has been a sligh increase in referrals to the Child Guidance Clinic for 1960; there were 256 in 1960 and 245 in 1959. There is now approximately six weeks delay Page 36 between the time a case is referred and the initial psychiatric interview. Staffing 383 psychiatric sessions were held during the year and the total number of cases seen during this time was 1,240. This represents about 3.3 cases per session, but it will be realised that the psychiatric treatment of children entails interviews for parents and outside social workers, as well as administration and discussion with Clinic colleagues. There is an establishment in the Clinic for two whole-time Psychiatric Social Workers, but unfortunately we have had but one only during 1960, and this has thrown a greater load of work on the psychiatrists. Psycho-therapy is a time-consuming procedure and it is obvious that every case referred cannot, nor does it need to be, treated in this way. In this respect the establishment permits one whole-time nonmedical psycho-therapist but here we have been under strength for a greater part of the year, thus a great deal of psychiatric time is spent in counselling parents and attempting to resolve unhappy marital relationships, vhich are an important factor in children's problems. Other adjustments to the child's environment such as in school or home do help to reduce those stresses which produce unhappy, anxious or behaviour disordered children. Remedial teaching has been of considerable help and this is on some occasions carried out by the Educational Psychologist, or by one of the two lady remedial teachers, whose services we fortunately have. This procedure is of much greater importance than merely teaching a child, as when done by specialists it will go far to reverse a child's unhappy attitude towards education. Court Cases 28 court cases were seen and reports prepared for the Magistrate. In these boys predominate strongly, and where girls are brought before the Magistrate the problem is usually one in the sexual sphere, whereas those of boys are predominantly offences against property. Court cases are given absolute priority and, quite often, this means extending the waiting period for other cases. There has been a significant increase in the number of school refusal cases. These are suitably divided into school phobia and truanting. Truanting is usually associated with a rebellious and hostile attitude towards parents and is frequently associated with delinquency. School phobia is a condition in which there is extreme dependence on Page 37 the parents and much associated anxiety, and is often a minor presenting symptom of severe anxiety state. As a general rule the great bulk of these cases have been brought to a satisfactory conclusion and unfavourable prognostic signs are lack of co-operation on the part of the parents, and a psychotic history in the family, or signs in the child. It is hoped to complete a follow-up of those cases seen in 1960, after Easter 1961. SCHOOL HEALTH STATISTICS FOR THE YEAR 1960 Total (All Schools) 1. MEDICAL INSPECTION OF PUPILS (a) PERIODIC Number of children examined at school:— (i) Entrants 1,878 (ii) Second age group 2,272 (iii) Third age group 1,588 Total 5,738 Number of defects found requiring treatment 1,018 Number of defects found requiring observation 1,051 Number of individual pupils found to require treatment 949 Nutritional classification of pupils examined:— Entrants 2nd Age Group 3 rd Age Group 5,730 Satisfactory 1,877 2,268 1,585 Unsatisfactory 1 4 3 8 (b) SPECIAL Number of children specially examined 750 Number of defects found requiring treatment 534 Number of defects requiring observation 136 (c) RE-INSPECTION Number of children re-inspected 565 2. TREATMENT OF CHILDREN (a) Total attendances at Specialists' Clinics:— (i) Ophthalmic 1,488 (ii) Orthopaedic 280 (b) Total attendances at Treatment Clinics:— (i) Minor Ailment 2,905 (ii) Orthopaedic 3,572 (iii) Speech Therapy 2,367 (c) Number of children who received operative treatment for tonsils and adenoids 167 Page 38  Total (All Schools) 3. HYGIENE INSPECTIONS (i) Number of examinations of pupils in school 22,105 (ii) Number of pupils found unclean 82 4. DENTAL TREATMENT (i) Number of pupils inspected 1,443 (ii) Number found to require treatment 1,010 (iii) Attendances for treatment 3,472 (iv) Number of fillings: Permanent teeth 1,692 Temporary teeth 1,235 (v) Number of teeth filled: Permanent teeth 1,509 Temporary teeth 1,083 (vi) Number of teeth extracted: Permanent teeth 115 Temporary teeth 402 (vii) Number of general anaesthetics administered for extractions 331 (viii) Other operations: Permanent teeth 650 Temporary teeth 122 Page 39 SANITARY CIRCUMSTANCES OF THE AREA Mr. H. C. Boswell, Chief Public Health Inspector, reports as follows:— (i) Water Supply Mr. P. Gordon Spencer, Chief Engineer to the South Essex Waterworks Company, has kindly provided the following information regarding the water supply to the district. (a) There have been no new extensions of public water supply during the year 1960, other than those for the supply to permanent housing sites. (b) Length of mains laid in yards:— Romford Area 3" 4" 6" 578 279 47 Total—904 yards. (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 4,400 chemical bacteriological and biological examinations have been made. In addition samples were examined for radioactivity. (e) The waters are not liable to plumbo-solvent action. (f) No contamination has arisen therefore no action has been necessary. (g) The following are the average dwelling houses supplied during 1960, viz. 33,643. SAMPLING OF WATER In addition to the control maintained by the Waterworks management, the Public Health Inspectors take frequent samples from consumers premises for Bacteriological and Chemical examination. All the samples taken during the year proved to be satisfactory. The Public Health Laboratories report on these samples generally was, that the water was of a high Bacteriological standard and was pure and wholesome. Page 40 (ii) Sewerage of the District Most of the borough is provided with separate systems of foul and surface water sewers. The foul sewage disposal works situated at Bretons Farm, Rainham Road, are under the control of the Romford and Hornchurch Joint Sewerage Committee. The Borough Engineer has reported that during the year the following extensions have been made to the main sewers:— 1,516 yards of foul sewer. 615 yards of surface water sewer. A new foul sewer has been provided in Orange Tree Hill which will enable 44 properties to be connected to main drainage. Work has also commenced on the new sewer in North Road for drainage of the northern portion of Havering, at the end of the year this work was well in hand. The public health inspectors have carried out a survey of all the properties in Orange Tree Hill and Havering. And at the er.d of the year approximately two thirds of the properties in Orange Tree Hill had been connected to the new sewer. It is hoped that the remainder of the houses in the road and the 123 properties in North Road that are at present served by cesspools and pail closets will be connected to the new sewer by the end of 1961. (iii) R use Collection Refuse collection is carried out under the supervision of the Cleansing Superintendent and forms part of the Borough Engineers Department. A weekly service is in operation and during the year refuse was collected from 35,912 premises, amounting to 37,913 tons of refuse. In addition 1,780 tons of refuse was collected from trade premises. Salvage operations are carried out for waste paper and scrap metal, and the refuse is disposed of by tipping at South Ockendon. (iv) Sanitary Inspection of the Area (a) Complaints During the year 1,629 complaints were received and recorded, 5,702 visits were made to investigate these complaints, and where necessary notices were served to abate nuisances or remedy defects. Page 41 (b) TABLE 10 NATURE & NUMBER OF INSPECTIONS DURING THE YEAR Accumulations and Refuse Deposits 115 Agriculture (Safety, Health and Welfare) 10 Bakehouses 22 Butchers' Shops and Stalls, etc. 252 Cesspools 85 Clean Air Act General 63 Clean Air Act Smoke Observations 93 Clean Air Act Smoke Control Areas 15 Clean Air Act Atmospheric Pollution Common Lodging Houses Dairies and Milkshops 51 Drains, relaid and altered 309 Drainage—obstructed or defective 604 Drains tested and inspected Disinfections and Disinfestations 15 Diseases of Animals Act 8 Dustbins 62 Establishments for Massage and Special treatment 14 Factories Act (Mechanical Power) 65 Factories Act (Non-mechanical) 16 Factories Act (Outworkers Premises) 47 Food Preparing Premises 214 Food Hawkers 38 Food Hygiene Observations 451 Food Inspections 414 Food Sampling—Formal Food Sampling—Informal 245 Food Shops 349 Food Vehicles 18 Housing Acts—General 1,542 Housing—Rent Act 1957 121 Heating Appliances (Fireguards) Act 1952 Ice Cream Vendors Ice Cream Samples Infectious Disease including Food Poisoning 2,973 Insects and Pests 93 Keeping of Animals 23 Milk Sampling 104 Miscellaneous 920 Page 42 Markets 145 Nuisances, Public Health Act 1,418 Pet Animals Act 1951 32 Prevention of Damage by Pests Act 1949 3,915 Public Baths 26 Public Conveniences 23 Rag Flock Act 2 Sale of Horseflesh 24 Schools 31 Shops Act—All Sections 3,583 Slaughterhouses and Meat Inspection 1,390 Streams, Ponds and Watercourses 152 Tents, Vans and Sheds 436 Verminous premises 113 Water Closets 17 Water Supplies and Samples 91 (c) Informal Notices (number served) 608 Statutory Notices (number served) 71 (d) As a result of the service of Notices, the necessary works were completed by the owners or occupiers in all cases except 80, the works for which were still in hand at the end of the year. (e) Notices served under the Shops Act 86 (f) Notices served under the Food & Drugs Act 19 (v) Factories Acts, 1937 and 1948 A summary of the statistics, as required by the Ministry of Labour and National Service, is given below:— TABLE II 1. INSPECTIONS Premises No. 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 18 16 - - (ii) Factories not included in (i) in which Sec. 7 is enforced by the Local Auth- ority 328 65 - - (iii) Other 1'remises in which Sec. 7 is enforced by the Local Authority (excluding out-workers premises) 84 10 4 - Total 420 81 4 - Page 43 2. CASES IN WHICH DEFECTS WERE FOUND. PARTICULARS No. of Cases in which defects were found Found Remedied Referred To MM. Inspector Referred by H.M. Inspector Want of Cleanliness - - - - Overcrowding - - - - Unreasonable Temperature .. - - - - Inadequate Ventilation - - - - Ineffective drainage of floors - - - - Sanitary Conveniences:— (a) Insufficient 4 4 - - (b) Unsuitable or defective .. - - - - (c) Not Separate for sexes - - - - Other Offences - - - - Total 4 4 - — 3. OUTWORK Nature of Work No. of Out- Workers No. of Casesof Default No. of Prosecutions Wearing Apparel-Making etc. 32 - - Box Making 6 - - Total 38 - - During the year 47 inspections were made of Outworkers" premises. (vi) Caravan Act 1960 (a) LICENSED RESIDENTIAL SITES There are eight licensed residential caravan sites within the Borough, one of which is owned and managed by the Council. At the end of the year there were 443 caravans, stationed on the sites, being used for permanent residential accommodation. These sites are provided with the essential amenities in the way of water supply, washing facilities and refuse disposal, hard standings are provided for most of the caravans and electricity supply is available on two of the sites for the occupants of the caravans. All these sites are subject to Planning Approval under the new Act, and conditions will be attached to the new licences in order to bring these sites up to the requirements of the Model Standards. Frequent inspections are made of the sites and they are maintained in a reasonably satisfactory condition. Page 44 (b) INDIVIDUAL CARAVANS At the end of the year there were 45 individual caravans stationed in the Borough, some on isolated plots and others on land adjoining houses, most of these caravans being used for residential purposes. None of these caravans are licensed under the Public Health Act, 1936, and they will all be subject to control under the new Act. It is anticipated that enforcement measures will have to be taken to secure the removal of the majority of these caravans that are on unauthorised sites. (c) GIPSY ENCAMPMENTS A large number of gipsy caravans visit the district throughout the year and encamp on unfenced parcels of land, mainly in the northern end of the Borough. These nomads cause a considerable nuisance to the householders in the neighbourhood of the encampments by their persistent demands for water, their very low standards of hygiene and the refuse they leave behind when breaking camp. The Public Health Inspectors have to spend a considerable amount of time in securing the removal of these people, and in the majority of cases they have to resort to towing the caravans off the land with the assistance of tractors from the Parks Department and the protection of the police. The police have been very helpful in rendering assistance for this purpose. During the year the Public Health Inspectors made no less than 355 visits to gipsy encampments. The owners of a number of these pieces of land have been pe.suaded to fence them in or to form other barriers to keep the gipsies off and the Council have authorised expenditure for the erection of barriers on pieces of land where the owners are not known. It is hoped that by these means the gipsies will eventually be dissuaded from visiting this town. (vii) Prevention of Damage by Pests Act 1949 During the year the Public Health Inspectors and Rodent Operative carried out 3,915 inspections or re-inspections to premises suspected of being infested with rats or mice, and disinfestation measures were carried out where necessary. Further treatment of the sewers for rat disinfestation has been carried out during the year by the Highways Department. Page 45 In addition to rats and mice a number of complaints were received concerning grey squirrels, pigeons and moles. Advice was given in all instances and where special treatment was necessary the matters were referred to the County Pest Officer. (viii) Disinfestation Advice is given on all cases of infestation. Where the infestation is slight the Council has agreed to the work of disinfestation being carried out by the Rodent Operative under the supervision of a Public Health Inspector, the charge made being based on labour and material. When the infestation is found to be severe, the persons concerned are advised to employ the services of specialist firms. The destruction of clothing and bedding is undertaken on receipt of a written request. During the year assistance has been given to householders in ridding premises of wasps, carpet beetles and other troublesome insects. (ix) Pet Animals Act 1951 There are 16 persons licensed under the above Act to keep Pet Shops. Frequent inspections are made to ensure that the conditions of the licence are complied with. 3. INSPECTION AND SUPERVISION OF FOOD (i) Milk Supply Romford is a "Specified" area under the Milk (Special Designations) (Special Area) (No. 2) Order 1952, and all milk sold in the area must be Special Designated milk, i.e., Tuberculin Tested, Pasteurised or Sterilised Milk. At the end of the year 42 firms were registered as Retailers and distributors of milk. Of these 17 were licensed to retail Tuberculin Tested Milk, 32 were licensed to retail Pasteurised Milk and 32 were licensed to retail Sterilised Milk. One of the retailers has his own Pasteurising p ant, the licensing of which is the responsibility of this Council. Frequent inspections are carried out at these premises to ensure that all milk is pasteurised efficiently. During the year 104 samples of milk were taken for bacteriological purposes, all of which passed the prescribed tests satisfactorily. Page 46 (ii) Ice Cream All dealers in ice cream must be registered, and at the end of the year there were 244 vendors on the register. During the year 11 samples of ice cream were taken for bacteriological examination. All were satisfactory, and were further classified as follows:— Ministry of Health (Provisional) Grade I —9 Grade II—2 Ten samples of ice lollies were taken for examination and all were of a satisfactory standard. Thirteen samples of ice cream were submitted to the Public Analyst for chemical examination. All these proved to be genuine and complied with the Food Standards (Ice Cream) Regulations 1959. (iii) Meat Inspection There are now four licensed slaughterhouses in the Borough, one 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 a 100% inspection of all meat produced in the Borough is maintained. Daring the year under review 1,390 such visits were made. Daring this period a total of 31,194 animals were slaughtered. A total of 10 tons 12 cwts. 100 lbs. of meat was found to be unfit for human consumption, and this was 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. During the year under review the number of animals slaughtered was 139% higher than that of the previous year. Naturally this means, that in order to secure 100% inspection, the inspectors had to spend approximately double the amount of time at the slaughterhouses and during the year a total of 670 hours overtime was worked this being mainly on Saturdays and Sundays. It is interesting to note the decrease in the evidence of tuberculosis found in cattle and pigs over the past 10 years. In 1950 the percentage of cows infected with T.B. was 26.7% as compared with 0.33% in 1960, in 1950 the per- Page 47 TABLE 12 CARCASES INSPECTED AND CONDEMNED 1959 Cattle except Cows Cows Calves Sheep and Lambs Pigs Horses TOTAL Number killed 2,147 891 1,565 14,994 11,372 225 31,194 Number inspected 2,147 891 1,565 14,994 11,372 225 31,194 All diseases except Tuberculosis: Whole carcases condemned 7 4 11 29 24 2 77 Carcases of which some part or organ was condemned 350 214 7 476 471 4 1,152 Percentage of the number inspected affected with diseases other than tuberculosis 16.62% 24.46% 1.15% 3.36% 4.39% 2.66% 3.95% Tuberculosis only: Whole carcases condemned 3 3 Carcases of which some part or organ was condemned 4 3 91 98 Percentage of the number inspected affected with tuberculosis 0.18% 0.33% 0.82% 0.32% Page 48 centage of pigs found to be infected was 2.49% as compared with 0.82% in 1960. This decrease in bovine tuberculosis is no doubt due to the excellent work of the Animal Health Division of the Ministry of Agriculture, Fisheries and Food in securing the certification of all dairy herds in the country. The decrease in the number of pigs found to be infected is probably the result of the Waste Food Order, 1957, made under the Diseases of Animals Act, which requires the thorough boiling of all waste food before feeding to pigs. There are 4 Wholesale Meat Depots and 82 butchers shops in the Borough and during the past year 252 inspections were made of these premises. (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 Food Hygiene Regulations, 1960:— Bakers 35 Cafes 64 Confectioners 82 Fishmongers 38 Greengrocers 68 Grocers 165 Miscellaneous 19 Hawkers 52 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 Food Hygiene Regulations are complied with. During the past year 1,947 such inspections were made. Nineteen informal notices were served where contraventions were noted, many improvements were obtained through personal approach and the majority of the food shops in the Borough comply with the requirements of the Food Hygiene Regulations. (v) Unsound Food During the year 414 visits were made to food premises mainly on request, for the purpose of dealing with unsound food, and a total quantity of 8 tons 19 cwt. 77 lbs. of food was surrendered as unfit for human consumption. Where possible all unsound food is disposed of for animal feeding, any which is not suitable for this purpose being disposed of by the Cleansing Department. Page 45 (vi) Food and Drugs Act 1955 (a) FOOD AND DRUGS AUTHORITY The Council are a Food and Drugs Authority as defined by Section 85 of the Food and Drugs Act 1955, and are responsible for the enforcement of the provisions of the Act relating to sampling of foods and drugs, and the Public Health Inspectors are accordingly " Authorised Officers " under the Act. (b) PUBLIC ANALYST It is the duty of every Food and Drugs Authority to appoint a Public Analyst; the Analysts appointed by this Council in accordance with the Act are:— Dr. J. H. Hamence, F.R.I.C. and Mr. P. S. Hall, A.R.I.C., both of 20, Eastcheap, E.C.3. The Analysts have been most helpful in advising on the types and quantities of samples taken and any complicated points relating to samples. (c) SAMPLES SUBMITTED FOR ANALYSIS During the year 272 samples were taken, comprising 27 Formal and 245 Informal samples. Table 13 which follows gives an indication of the variety of foods sampled. Of the 272 samples submitted for analysis, 25 were found to be not genuine. Observations and comments on these unsatisfactory samples are as follows:— Apples (1 unsatisfactory sample) This sample of apples were wrapped in a dark blue paper and were submitted to the Analyst as the result of a complaint that they smelt of paraffin and had probably been contaminated. The Analyst reported that although the apples themselves had a slight paraffin smell they were free from any objectionable taste. As it appeared that the paraffin taint on the wrappers might have been introduced as the result of spraying with an insecticide dissolved in paraffin, the wrappers were examined for the presence of insecticide or fungicide but with negative results. The retailer was advised to remove the wrappings and thoroughly wash the apples before sale. This matter was also taken up with the Superintendent ot the Wholesale Market where the apples were sold. Page 50 Bread (4) Four samples of bread were submitted for examination following complaints that they contained foreign matter. The analyst reported that the foreign matter in two of the samples consisted essentially of discoloured gluten, but examination proved them to be free from dirt or mineral oil. The foreign body in the third sample was reported as being composed of fibres saturated in oil, this presumably being a piece of cleaning material picked up from the machinery. The foreign matter in the fourth sample consisted of crumpled portions of orange coloured stiffish paper, similar in colour and texture to the labels frequently used on flour sacks. These last two complaints were taken up with the manufacturers who, whilst expressing their regrets, gave reasonable explanations for the presence of these foreign matters. Both cases were reported to the Public Health Committee and after considering the complaints fully the Committee resolved to send letters to the manufacturers requesting that more care should be taken to prevent further complaints. Cake (1) This sample was a piece of battenburg cake that was submitted following a complaint that it was mouldy. The analyst reported that the exterior of the cake was free from extensive mould growths, but there was evidence of mould growth in the cream filling between the coloured portions of the cake. He further stated that in his opinion the cake was out of condition and no longer suitable for human consumption. On further investigation at the retailers premises it was found that a label was affixed to cakes of this nature stating that artificial cream was used in the manufacture and that the cakes should be consumed within 24 hours of purchase. As the complainant admitted keeping the cakes over a much longer period than this, no formal action was taken. Flour (1) Complaint was made concerning black specks that appeared when the flour was mixed with water. Examination proved these to be minute poppy seeds of the type used to decorate certain types of loaves. These Page 51 apparently gained access to the flour in the bakehouse at the time of weighing and packing. Tinned Jam (I) An informal sample of imported Blackberry Jam was found to contain only 63.5% of soluble solids as against 65.0% as required by the Food Standards (Preserves) Order 1953. The fruit content of the jam however was found to be satisfactory. The matter was taken up with the importers. Tinned Meats (7) Informal samples of Luncheon Meat, Luncheon Meat Loaf, and Pork Luncheon Meat were submitted at intervals during the year. In seven cases the proportions of meat content varied between 64 and 74 per cent. The Analyst considered this to be a low meat content and therefore unsatisfactory. At the end of 1959 an agreement was reached between the Food Manufacturers Federation and the Association of Public Analysts that meat products described as "Luncheon Meat " should contain at least 80 per cent of meat. As the samples in question were manufactured prior to this agreement being reached it was felt only fair that time should be allowed for existing stocks to be disposed of before taking formal action. Milk (4) Four samples of milk were submitted to the analyst as a result of complaints that they contained foreign matter. (a) The first bottle was a one-third pint similar to those issued to schools. The foreign object was found to consist of a cylindrical mass of wheaten dough coloured with a pink dye. It was suspected that this object was introduced into the bottle after leaving the suppliers premises, therefore no formal action was taken. (b) This was a one pint bottle showing faint brownish stains on the inside. On examination the matter causing the stains was found to consist of traces of dried milk film associated with silicious dust. A letter was sent to the suppliers suggesting that more care should be taken in cleansing bottles. (c) This was a pint bottle of milk which contained foreign matter not only adhering to the sides of the bottle but also in suspension. The matter adhering to the inside of the bottle was found to consist of mould growths, the suspended matter consisted of two small flies and wing fragments together with pieces of vegetable tissue. There was also a white ring of dried milk scum round the inside of the bottle about three inches from the bottom. Legal proceedings were taken against the supplier, but the case was dismissed. (d) This again was a pint bottle of milk and the foreign bodies were found to be adult specimens of the common housefly. In each instance the flies were found to be covered with a thin film of curdled mouldy milk. The suppliers were summoned under Section 8 of the Food and Drugs Act, 1955, and fined £10 0s. 0d. Sweets and Confectionery (5) Out of 49 samples of sweets and confectionery submitted for examination five proved to be unsatisfactory. In each case it was found that all the pink sweets contained a dye stuff known as Rhodamine B. This is a coal tar dye which is not now permitted for use in foods by the Colouring Matter in Foods Regulations, 1957. On investigation it was found that these sweets were manufactured before the prescribed date in the Regulations, but on being approached the wholesalers withdrew all stocks from sale. (vii) Food Hygiene Regulations, 1955 The Public Health Inspectors continue to devote a considerable amount of time to the inspection of food premises of all types to ensure that the requirements of the above Regulations are complied with. Provision is not made in these Regulations for the service of Statutory Notices in the case of contraventions and legally every contravention found by the Inspectors could result in prosecution. However, in practice it is rare that the contraventions observed are sufficiently serious as to warrant immediate legal action. When contraventions are noted they are immediately drawn to the attention of the occupier and the need for improvement explained. Page 53 This verbal intimation is always followed by a letter indicating the nature of the offence and allowing the offender a period of grace in which to comply with the Regulations. This procedure has been adopted with a view to educating food traders rather than to prosecute, and it appears to be paying dividends as the general standard of food shops in the district has greatly improved. In addition to the inspection of food shops and restaurants frequent visits are made to factory and school canteens and other food preparing premises. The two main difficulties experienced with the enforcement of the Regulations are (a) the protection of open foodstuffs exposed for sale on stalls in the open market and (b) smoking by food handlers. It is extremely difficult to impress on stallholders in the Market the real need for protecting foodstuffs from contamination in the open air, but there has been a marked improvement especially with regard to the stalls used for the sale of meat and fish. Some concern is still felt, however, regarding the stalls used for the retail trade of biscuits, cakes and sugar confectionery. It is considered that the only way to ensure that the Food Hygiene Regulations are complied with is to request these stallholders to provide their own mobile stalls constructed on a caravan basis, so that they are properly enclosed and service is only made from behind a screened counter. As regards smoking, the main difficulty is that this habit is so widespread and ingrained and some food handlers, especially the stallholders, do not appreciate that they should be subjected to this prohibition whilst the customer is not. Few people appear to appreciate that the reason for prohibiting the use of tobacco, including snuff, whilst handling open food is that the habit brings the fingers into close contact with the nose and mouth, both possible reservoirs of food poisoning germs. The hands thus become contaminated and the contamination is then transferred to the foodstuffs. During the past year it was necessary to prosecute one person for smoking whilst handling open food. (viii) Educational Activities In addition to the routine duties of inspections and observations, the Public Health Inspectors continue to give talks and lectures to local organisations and wherever possible great stress Page 54 is laid on food hygiene. At least once during the year a lecture is given to the staffs employed in the school canteens. Frequent lectures are also given on the general work of the Health Department. These lectures are enhanced by the use of coloured slides depicting the various aspects of the work. The department now possesses a collection of over 500 coloured slides that have all been taken locally by one of the Public Health Inspectors. (ix) Legal Proceedings (a) The following cases were taken under the Food and Drugs Act, 1955:— Offence Section Result Cashew Nuts containing Rodent Excreta 8 Fined £5 0s. 0d. Costs £2 2s. 0d. Sour and Mouldy Meat Pies 8 Fined £5 0s. 0d. Mouldy Apple Tarts 8 Fined £5 0s. 0d. Apricot Tart containing Rodent Excreta 8 Fined £5 0s. 0d. Foreign Matter in Milk 8 Dismissed Flies in Bottle of Milk 8 Fined £10 0s. 0d. (b) The following cases were taken under the Food Hygiene Regulations, 1960:— Smoking whilst handling open food Reg.9 (e) Fined £5 0s. 0d. Name and address not displayed on food stall Reg.26 (l)a Fined £2 0s. 0d. (c) The following case was taken under the Essex County Council Act, 1952:— Failure to register as a Food Hawker Sec.l03(l)a Fined £1 0s. 0d. Page 55 TABLE 13 SUMMARY OF SAMPLES TAKEN FOR ANALYSIS DURING THE YEAR 1960 Article Number examined Result of Analysis Formal Informal Total Genuine Not Genuine Apples - 3 3 2 1 Beef, Corned - 1 1 1 - Beer 4 3 7 7 Biscuits, Milk Chocolate - 1 1 1 - Blackcurrant Drink - 1 1 1 - Bread - 4 4 - 4 Broth - 1 1 1 - Bubble Gum - 1 1 1 - Butter - 1 1 ] - Buttered Coconut Macaroon.. - 1 1 1 - Cake - 1 1 - 1 Cake Mixture - 2 2 2 - Cheese Spread - 1 1 1 - Cheese Spread with Ham - 1 1 1 - Chicken in Jelly, Chopped - 2 2 2 - Chicken, Chopped - 1 1 1 - Chicken and Pork Rissoles - 1 1 1 - Chicken Fillets - 1 1 1 - Chicken and Rice - 1 1 1 - Coffee - 2 2 2 - Coffee and Chicory Essence - 1 1 1 - Colyard - 1 1 1 - Corned Beef Loaf - 1 1 1 - Crab - 1 1 1 - Cream - 5 5 5 - Cream of Tartar - 1 1 1 - Curry Powder - 1 1 1 - Dates - 1 1 1 - Flour, Partly Mixed - 1 1 - 1 Fruit Cocktail in Syrup - 1 1 1 - Fruit Drink - 1 1 1 - Fruit Pectin - 1 1 1 - Glycerine, Lemon and Honey - 1 1 1 - Gravy Browning - 1 1 1 - Ground Nut Oil - 1 1 1 - Hamburgers - 2 2 1 1 Honey Comb Mould - 1 1 1 - Ice Cream - 13 13 13 - Jam - 5 5 4 1 Jelly - 2 2 2 - Junket Powder - 1 1 1 - Kola Nut Health Drink - 1 1 1 - Lard - 1 1 1 - Lemon Juice - 1 1 1 - Lemon Pie - 1 1 1 - Lemonade Powder - 1 1 1 - Liver and Vegetables - 1 1 1 — Lollies - 12 12 12 — Luncheon Meat - 5 5 4 1 Luncheon Meat Loaf 2 2 - 2 Meat Pudding - 3 3 3 — Milk - 22 22 20 2 Milk Bottles - 2 2 - 2 Milk Shake Powder — 1 1 1 — Carried Forward 4 131 135 119 16 Page 56 Article Number examined Result of Analysis Formal Informal Total Genuine Not Genuine Brought Forward 4 131 135 119 16 Orange Drinks - 3 3 3 - Peanut Butter — 1 1 1 - Peanuts, Salted — 1 1 1 - Peanuts, Sugared — 1 1 1 - Pepper — 1 1 1 - Pork Chipolatas — 1 1 1 - Pork Luncheon Meat — 5 5 2 3 Pork and Meat Roll — 1 1 1 - Pork Roll, Corned — 1 1 1 — Pork Pic — 1 1 1 - Pork with Ham, Chopped — 1 1 1 — Prunes — 1 1 1 — Prunes n Blackberry Jelly — 1 1 — 1 Radoxon Vitamin C Tablets — 1 1 1 — Raisins - 1 1 1 - Rennet Essence of — 1 1 1 — Rice, Creamed — 3 3 3 — Rice, Ground - 1 1 1 - Rice Pudding — 1 1 1 — Royal Chiffon — 1 1 1 — Rum 6 - 6 6 - Salmon - 1 1 1 - Salmon Sandwich - 1 1 1 - Salmon Spread - 2 2 2 - Salmon Spread with Butter — 1 1 1 — Sardine and Tomato Paste - 1 1 1 - Sauce - 1 1 1 - Sausages. Beef - 1 1 1 - Sausage,Cooked — 1 1 1 - Sausags, Skinless - 1 1 1 - Sausages, Pork - 1 1 1 - Sea Legs, Travel Sickness Pills — 1 1 1 — Self Raising Flour - 5 5 5 - Slimming Tablets - 1 1 1 - Soup - 1 1 1 - Soup, Cream of Chicken - 1 1 1 - Steak, Stewed - 3 3 2 1 Steak and Kidney Pie - 2 2 2 - Sweets and Confectionery 2 47 49 44 5 Topioca Flake - 1 1 1 - Tea - 1 1 1 - Tea Cake Mixture - 1 1 1 - Tomatoes - 1 1 1 - Tomato Puree - 1 1 1 - Turkey in Jelly, Minced - 1 1 1 - vegetable Oil - 1 1 1 - Whisky 15 - 15 15 - Vinegar, Malt - 3 3 3 - Vita Cup — 1 1 1 — totai 27 242 269 243 26 Page 57 4. SHOPS ACT, 1950 (a) Inspections 1,155 shops have been inspected and recorded on the register. Altogether 3,608 inspections and observations have been made for various purposes under the Act during the year. The following contraventions were noted:— (i) Early Closing Day Failing to exhibit notice 70 Failing to close shop for the serving of customers 5 (ii) Evening Closing Hours Failing to close shop for the serving of customers 2 (iii) Sunday Trading Failing to close shop for the serving of customers 18 Failing to observe the Regulations .. .. .. .. 33 (iv) Conditions of Employment Failing to exhibit notice as to Assistants' Weekly Half-holiday 97 Failing to allow assistants a weekly half-holiday Failing to allow proper intervals for meals and rest Failing to exhibit abstract of Act and keep records of hours worked by young persons 104 Employing young persons more than the maximum working hours. 3 Failing to keep records of Sunday employment 15 Failing to allow compensatory leave for Sunday employment 4 (v) Health and Welfare Seats not provided for the use of female shop assistants.. Absence of, or unsatisfactory, sanitary accommodation 40 Absence of, or unsatisfactory, washing facilities *Ventilation unsatisfactory 14 Temperature unsatisfactory Lighting unsatisfactory *Ventilation and the free circulation of air is a factor of the greatest importance for a healthy environment, yet, in the design of the modern shop there is a tendency to omit this provision. Many of those responsible for the design and development of shops give little regard to this need. The commercial emphasis is placed on increased artificial shop lighting creating a further difficulty of removing the excessive heat. Page 58 In some rooms of shops the heat created by the lighting arrangements is equal to that of a 3 Kw. electric fire, therefore, it is not surprising that shop workers complain of oppressiveness and headaches. (vi) Legal Proceedings Offence Section Result 1. Failing to allow young persons intervals for meals and rest 19 (29 offences) Fined £14 0s. 0d. 2. Employing a young person more than the normal maximum working hours 24 Fined £5 0s. 0d. 3. Employing young perms more than the normal maximum working hours 27 (2 offences) Fined £10 0s. 0d. 4. Record of hours worked by young persons not properly kept 32 (6 offences) Fined £15 0s. 0d. Costs £5 0s. 0d. 5. Failing to close shop on Sunday 47 Fined £2 0s. 0d. 6. Failing to close shop on Sunday 47 Fined £3 0s. 0d. Costs £1 1s. 0d. 7. Failing to close shop on Sunday 47 Fined £5 Os. Od. Costs £2 2s. 0d. 8. Failing to close shop on Sunday 47 Fined £3 0s. 0d. 9. Failing to close shop on Sunday 47 Fined £5 0s. 0d. 10. Obstructing Inspector 71 (2) and Factories Act, 1937, Section 123 Absolute discharge on payment of £1 1s. 0d. costs Page 59 5. HEATING APPLIANCES (FIREGUARDS) ACT, 1952 Twenty-seven visits were made to premises where heating appliances were exposed for sale and as a result of these visits 2 appliances were found not to conform to the standards prescribed and were withdrawn from sale. 6. THE OIL BURNERS (STANDARDS) ACT, I960 The Act provides for safety standards and instructions for use of oil heaters and comes into force on the 1st day of January, 1961. 7. THE FABRICS (MISDESCRIPTION) ACT, 1913 AND REGULATIONS, 1959 It is regretted that in the Borough there is no demand for childrens non-inflammable fabrics owing to the cost and shopkeepers find it unprofitable to stock these materials for sale. Generally those fabrics which carry a warranty of inflammability are described as "Low Flammability ". 8. CLEAN AIR ACT, 1956 (a) Smoke Control Areas The Council have now agreed to establish Smoke Control Areas. A scheme has now been prepared and it is hoped that the whole Borough will be covered within the next 10 to 12 years. The Council have adopted the Building Byelaw, referred to in Section 24 of the Act, requiring the installation of approved ieating and cooking appliances, capable of burning approved smokeless fuel, in all new buildings. (b) Atmospheric Pollution The Council has continued to co-operate in the schem,onducted by the Fuel Research Station, for recording atmospheric pollution. A Rain Deposit Gauge is situated on the roof of the Town Hall This instrument is used to measure the rainfall in inches per month and to estimate the amount of suspended pollutants in the air in the form of soluble and insoluble matter. A Lead Peroxide instrument is situated at North Road, Havering, this records the amount of Sulphur Dioxide in milligrams deposited per day on 100 sq. cm. These recordings are taken monthly and the recordings for 1960 are set out on Table 14. Page 60 TABLE 14 ATMOSPHERIC POLLUTION, READINGS FOR YEAR 1960 Rain Fall in inches Insoluble Matter in tons per sq. mile Soluble Matter in tons per sq. mile Total Solids in tons per sq. mile Mg. of SO if day per 100 sq. cm. January 1.30 5.67 8.69 14.36 1.6 February 1.38 6.78 9.16 15.94 1.5 March 0.79 5.03 7.92 12.95 0.80 April 0.08 6.11 2.58 8.69 0.96 May 1.34 5.13 8.76 13.89 0.60 June 1.34 5.67 7.28 12.95 0.55 July 2.48 4.80 6.24 11.04 0.45 August 2.52 5.30 7.89 13.19 0.46 September 3.11 5.00 8.46 13.46 0.49 October 5.59 6.18 11.61 17.79 0.71 November 2.91 10.60 10.74 21.34 1.4 December 2.25 9.56 8.66 18.22 1.8 TOTAL 25.09 75.83 97.99 173.82 11.32 MEAN AVERAGE 2.08 6.31 8.16 14.48 0.94 The total rainfall for the year as measured at Raphael Park was 28.56 inches. Page 61 The Council have agreed to participate in a National Survey for Atmospheric Pollution. This survey will be carried out by means of Volumetric Meters which measure the amount of Smoke deposits and Sulphur Dioxide in a known volume of air. Five of these meters will be installed in the Borough as soon as the sites have been agreed with the Department of Scientific and Industrial Research. 9. PUBLIC BATHS There is one Public Bath situated in Romford, which was opened in 1900. The swimming bath is 70 feet long by 30 feet wide. The water for the swimming bath is obtained from a well situated in the curtilage of the baths. This water is filtered and heated, with Break-Point Chlorination, and has a turnover every 2½ hours. The temperature of the water is maintained at 76°F. The maximum load for the swimming bath is 100 persons. The bath is very well patronised and during the high season admission has to be restricted. Both Chemical and Bacteriological samples are taken from the well and bath at frequent intervals and the results of the examination have always been satisfactory. In addition to the swimming bath, hip baths are also available for the use of the public. Although the baths are old they are maintained in a very satisfactory manner. Improved lighting has been installed in several parts of this building, and interior decorating was carried out during the year. An improved method of testing the swimming bath water by tablet has now been developed. The Council have for a long time appreciated that this bath is inadequate and does not meet the demands of the public. Plans have now been approved for the building of a new swimming bath at Central Park, Harold Hill, and at a later date the provision of another swimming bath near to the centre of the town. 10. NOISE ABATEMENT The Noise Abatement Act, 1960, came into operation on the 27th November, 1960. This Act empowers the local authority to deal with noise nuisances, and restricts the use of loudspeakers for certain purposes. It also restricts the use of loudspeakers on ice-cream vehicles except during the hours from noon to seven o'clock in the evening. Page 62 In addition Section 150 of the Romford Urban District Council Act, 1931 prohibits the sounding of noisy instruments for the purpose of advertising trade at all hours on Sundays. During the year eight ice-cream vendors were prosecuted under the local Act for sounding chimes on Sundays and each of the offenders was fined £2. 0s. 0d. 4. HOUSING ADMINISTRATION (a) Housing " Five Year Plan " The period for the first "Five Year Plan" ended on the 31st December, 1960. There were 350 properties detailed in this programme as being considered unfit for habitation, and the Council agreed that the programme should be put into operation to secure the demolition of these houses. Included in the programme were 218 houses which formed the Waterloi Road Redevelopment Scheme, and 11 in Prospect Place, Collier Row. The Council purchased the whole of the properties in these two areas and undertook the redevelopment of the sites. Prospect Place redevelopment was completed in August, 1959. In addition to the 11 unfit properties a further 4 were certified as unfit, and the Council purchased the 9 adjoining cottages and a parcel of back land On the site now there are blocks of 3 and 4 storied flats, giving accommodation for 72 families in place of the former 20. The Waterloo Road redevelopment is progressing very well, all the old propclies with the exception of 8 are now demolished and rebuilding is well in Hand. At present there are 28 four storied maisonettes and 53 flats in an 11 storey building occupied. A second 11 storey block of flats is nearing completion and accommodation for old people is well in hand. Of the 121 other properties included in the plan 28 were improved and reconditioned, 59 have been demolished or closed and 34 still remain to be dealt with. In addition to the above, 26 individual unfit houses, not included in the "Five Year Programme" have been dealt with either by demolition or closing. It is to be regretted that the programme was not completed by the appointed date, but the biggest drawback has been the rehousing of tenants from houses where demolition or closing orders have been made. Page 63 It is considered that if the Housing Management Committee could make a set percentage, say 20% annually, of houses available, for rehousing families from unfit houses, a plan could be devised for dealing with unfit properties on a proper basis. (b) Future Plans Surveys have been carried out in the older parts of the district, consultations have been held with the Area Planning Officer, and schemes are now being prepared for redevelopment plans covering the next twenty years, when it is hoped that some of the older sub-standard properties can be effectively dealt with, to ensure that good housing conditions only exist within the Borough. (c) Council Housing During the past year the Public Health Inspectors have visited the accommodation at present occupied by applicants on the Councils Housing List, in order to assess the property in connection with the " Points " scheme adopted by the Housing Management Cormittee. TABLE 15 HOUSING STATISTICS FOR THE YEAR 1960 Number of houses erected during the year:— 1. By Local Authority 2. By Private Enterprise 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) 2,173 (b) Number of inspections made for the purpose 3,698 2. (a) Number of dwelling houses (included under sub-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 dangerous or injurious to health as to be unfit for human habitation 8 4. Number of dwelling houses (exclusive of those referred to under the preceeding sub-head) found not to be in all respects fit for human habitation 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 528 Page 64 3. Action under Statutory Powers during the Year (a) Proceedings under Sections 9, 10 and 12 of the Housing Act, 1957:— (i) Number of dwelling houses in respect of which Notices were served requiring repairs .. Nil (ii) Number of dwelling houses which were rendered fit after services of Formal Notices:— (a) By Owners Nil (b) By local authority in default of owners .. Nil (b) Proceedings under the Public Health Acts:— (i) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 71 ( ) Number of dwelling houses in which defects were remedied after service of Formal Notices:— (a) By Owners 51 (b) By local authority in default of owners 14 (c) Proceedings under Section 16 and 17 of the Housing Act, 1957:— (i) Number of dwelling houses in respect of which demolition orders were made 14 (ii) Number of dwelling houses demolished in pursuance of Demolition Orders 111 (iii) Number of demolition orders revoked Nil (iv) Number of Closing Orders made 3 (v) Number of Closing Orders revoked Nil (d) Proceedings under Section 18 of the Housing Act, 1957 (i) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (ii) 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, 1957: Part IV—Overcrowding (a) (i) Number of dwellings overcrowded at end of year 14 (ii) Number of families dwelling therein 21 (iii) Number of persons dwelling therein 11l (b) Number of new cases of overcrowding reported during the year 1 Page 65 Page 66 (c) (i) Number of cases of overcrowding abated during the year l (ii) Number of new cases of overcrowding relieved during the year Nil (iii) Number of persons concerned in such cases Nil (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. Rent Act, 1957 This Act came into operation on the 6th July, 1957, and replaced the Housing Repairs and Rents Act, 1954. The object of that part of the Act, that imposes duties on the Health Department, is to permit owners of controlled properties to increase the rents to a sum equal to twice the gross rateable value providing the house is kept in a satisfactory state of repair. During the year the Public Health Inspectors made 121 ispections in connection with the requirements of the Act. These inspections dealt with applications for Certificates of Disrepair, check'rig Undertakings made by owners, and inspecting the works carried out to remedy the defects and disrepair. The following is a summary of the matters dealt with during the year:— Number of applications for Certificates 13 Number of certificates issued 13 Number of Certificates cancelled 7 Number of Undertakings accepted 9 Number of applications for Certificates as to remedying of defects, "Form O" 5 Number of Certificates as to remedying of defects:— Granted " Form P " 3 Refused 2