AC 4411 (1) ROM 38 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR ROMFORD FOR THE YEAR 1963 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR ROMFORD FOR THE YEAR 1963 CONTENTS Pages Committee Members 3 Health Department Staff 5 County Welfare Service 8 Housing 10 Vital Statistics 12 Infectious Diseases 17 Maternity Services 19 Clinics 21 Welfare Foods 22 Day Nurseries 22 Staff Medical Examinations 23 Health Visiting 23 Health Education 24 Vaccination and Immunisation 25 Insirvice Training 27 Prevention of Illness, Care and After Care 28 Care of the Aged 29 Nursing Homes 30 Home Nursing 30 Children at Risk 30 Development cr Local Authority Health and Welfare Services 32 School Health Service 33 Vaccination against Tuberculosis 35 Handicapped Pupils 35 Child Guidance Service 37 School Psychological Service 38 Sanitary Circumstances of the Area 42 Insertions 45 Factories Acts 46 Carawans Act, 1960 48 Prevention of Damage by Pests Act, 1949 49 Insection and Supervision of Food 52 Clean Air 73 Public Baths 75 Noise Abatement 76 Housing 76 Shops and Offices 80 TOWN HALL, ROMFORD ESSEX June 1964 To the Mayor, Aldermen and Councillors of the Borough of Romford Mr. Mayor, Ladies and Gentlemen In presenting this report on the health of the Borough for the year 1963, I should like to thank my colleagues and members of the Council for the help they have given during the year under review. I am Mr. Mayor, Ladies and Gentlemen Your obedient servant Medical Officer of Health Tel.: Romford 46040 page 2 PUBLIC BUILDINGS AND HEALTH COMMITTEE as at December, 1963 His Worship the Mayor—Councillor A. HAWKESWORTH, J.P. Chairman—Councillor F. G. CARRICK Vice-Chairman—Councillor W. C. MILLS Alderman Mrs. M. CLARK-LEWIS Alderman Mrs. L. A. IRONS, Councillor C. B. BARNETT J.P., C.C. Councillor G. R. G. JOHNSON, Councillor F. E. BROOKS LL.M. Councillor J. G. McGLASHAM Councillor G. ROBERTS ROMFORD COMMITTEE FOR EDUCATION as at December, 1963 His Worship the Mayor—Councillor A. HAWKESWORTH, B.E.M., J.P. Deputy Mayor—Alderman Mrs. O. M. J. ROBERTS. J.P.. C.C. Chairman—Alderman P. D. RIDLEY, M.A.(Cantab.) Vice-Chairman—Councillor W. G. RUSSELL Representative Members: — Alderman Mrs. M. CLARK-LEWIS Alderman Mrs. L. A. IRONS, J.P. C.C. Councillor Mrs. I. M. BARBER Councillor F. G. CARRICK Councillor F. E. BROOKS Councillor G. R. G. JOHNSON, Councillor Mrs. L. S. HUTTON LL.M. Councillor R. S. KILBEY Councillor L. C. MILLS Councillor S. E. SHUTE, C.C. Co-opted Members.— Mr. F. FISHER Mrs. R. M. LATHAM Mr. J. G. PITTAWAY Mr. F. W. WAKEFORD Nominated Members: — Councillor W. FALK Councillor M. WARD page 3 ROMFORD HEALTH AREA SUB-COMMITTEE of the Essex County Health Committee as at December, 1963 Chairman—Alderman Mrs. L. A. IRONS, J.P., C.C. Vice-Chairman—Councillor Mrs. M. P. HURLEY, C.C. Romford Borough Council Representatives:— Alderman Mrs. M. CLARK-LEWIS Alderman A. McGONAGLE Alderman P. D. RIDLEY, Councillor C. B. BARNETT M.A.(Cantab.) Councillor F. G. CARRICK Councillor F. E. BROOKS Councillor A. DAY Councillor Mrs. R. C. COFFIN Councillor R. J. G. McGLASHAM Councillor R. S. KILBEY Councillor W. G. RUSSELL Councillor H. PACKHAM Councillor P. J. SMYTH Essex County Council Representatives'.— County Alderman K. E. B. GLENNY County Alderman Mrs. E. C. SAYWOOD County Councillor Mrs. S. M. BOVILL County Councillor S. A. LEGG 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 as at December, 1963 Medical Officer of Health, Area Medical Officer, and Divisional School Medical Officer: — F. L. GROARKE, M B., L.M., D.C.H., D.P.H. Assistant Mcdical Officers of Health and School Medical Officers'.— Mrs. M. M. DENHAM, M B., B.S. 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. Mrs K. THAKRE, M B., B.S. Dental Officers: — Miss M. L. ELL, L.D.S., R.C.S.(Eng.) (Area Dental Officer) C. CHESTER, L.D.S., R.C.S.(Eng.) J. LUKE, L.D.S., R.C.S.(Eng.) (Part-time) N. YELLON, L.D.S., R.C.S.(Eng ) (Part-time) Chief Public Health Inspector: — H. C. BOSWELL Senior Public Health Inspector: — W. HODSON Public Health Inspectors: — E. B. BECKETT G. F. HOBSON M. J. DOVE A. G. MERRIMAN P. W. EDWARDS O. WHITWORTH T. GIBBS (Student) Shops Inspector: — S. F. TITTERTON Rodent Officer: — R. DENT Superintendent Health Visitor: — Miss F. K. WELLS Health Visitors, School Nurses, etc..— Mrs. P. ALGHALI Miss K. ISZATT Mrs. J. BERRY Mrs. A. M. LeCOUNT (Tuberculosis Visitor) Mrs. C. C. LEDDEN Miss B.C. BLACKLEY Mrs. F. C. MARSHALL Mrs. J. A CHILD (Tuberculosis Visitor) Miss O. CLEMENTS Mrs. B. M. MATTHEWS Miss E. COOGAN Miss O. OLNEY Miss P. F. CULLIS Mrs. G. PHILLIPS (Clinic Nurse) Mrs. J. GORDON (Clinic Nurse) Miss M. POOLE Miss D. I. HALL Mrs. M. RIGBY Miss N. HARWOOD (Part-time) Miss A. P. M. THOMAS Mrs. S. HOLLAND Miss A. M. TIDD (Tuberculosis Visitor) Mrs. M. WILLIAMS page 5 STAFF—com. Superintendent of Home Nurses and Area Non-Medical Supervisor of Midwives: — Miss N. MARSH District Midwives:— Mrs. G. V. CHANDLER Miss C. M. KERR Miss C. GOWERS Miss D. D. K. MARTIN Miss E. B. GRAHAM Mrs. G. MERRY Mrs. C. GRAY Miss R. A. MERRY Miss M. C. HAMER Mrs. M. PARSONS Mrs. D. JACKSON Mrs. G. E. SEXTON Miss E. E. JEENES Mrs. F. A. SMITH District N urses: — Mrs. E. M. ANDREWS Mrs. J. CORNISH Mrs. E. BROOME Mrs. J. D. JENNINGS Mrs. E. D. CARRINGTON Mrs. I. NORRIS Mrs. B. CASEY Mrs. A. C. SILCOCK Mrs. C. COOK Mrs. D. I. TO WELL Mrs. S. A. WOTHERSPOON Day Nurseries—Matrons: — " St. Moritz "—Mrs. D. GIBSON. Collier Row— Mrs. D. STINSON Rush Green—Mrs. R. M. O'HALLORAN. Domestic Help Organiser:— Miss T. HARROD Dental Surgery Assistants: — Mrs. V. COOPER Mrs. K. GOULDING Mrs. J. D. SKINGSLEY Mrs. C. THOMAS Speech Therapists : — Mrs. P. DAVIS Miss A. JONES Mrs. K. HILTON (Part-time) Chiropodists: — L. BOLLAND N. A. CUM MING (Sessional) E. DRANSFIELD G. H. EVANS (Part-time) D. D. WATERS Occupational Therapist : — Miss Z. MERCER (Part-time) Organiser, Workshop for the Elderly: — Mrs. L. LYON page 6 ADYIINISTRATIVE AND CLERICAL STAFF Chief Administrative Assistant : — E. W. GOWERS Senior Administrative Assistant: — E. LAMB Administrative and Senior Assistants:— A. G. MELOY —Supplies and Maintenance Mrs. B. MATHER —Secretarial and Records M. J. LEE —Environmental Health G. PALMER —Smoke Control Mrs. M. BARNARD —School Health Miss M. E. FIRMIN —Immunisation and Vaccination Miss P. MANN —Domestic Help Section Clerical A ssistants: — Miss D. M. BARTLEY-BERRY Mrs. D. HOBSON (Clinic Clerk) Mrs. B. CAREY (Clinic Clerk) Miss M. O. LITTLE (Clinic Clerk) Miss E. COOPER Miss J. NEWBERRY Mrs. E. CHAPMAN (Clinic Clerk) Mr. M. PAPWORTH Mrs. J. COMPTON Miss J. SAGGERS (Part-time) Mrs. M. CONN (Clinic Clerk) Mrs. E. SLEAP (Clinic Clerk) Mrs. L. CRUSE (Part-time) Miss G. G. SMITH (Clinic Clerk) Mrs. E. M. FLYNN (Clinic Clerk) Miss V. C. WARREN Miss P. GOODREM Mrs. A. J. WHITE Miss R. HARVEY Public Analyst: — HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. REGIONAL HOSPITAL BOARD STAFF Orthopaedic Surgeons: — G. BARCLAY, F.R.C.S. J. A. McLAUCHLAN. 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) Ophthalmologists: — B. G. DIAS, M B., B.S., D O. P. LANCER, M B.. B.S., M.R.C.S., L.R.C.P., D.C.H. Physiotherapists: — Mrs. B. V. WAND Mrs. A. SLIP page 7 COUNTY WELFARE SERVICES Mr. Walter E. Boyce, 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 1963 (1) Residential Accommodation (a) Number of domiciliary visits undertaken 516 (b) Number of applications received 131 (c) Admitted to hostels and other residential establishments 27 (d) Number of Romford residents in residential accommodation at 31.12.63 130 (2) Temporary Accommodation (Homeless Families, etc.) (a) Domiciliary visits by Family Case Workers, etc. 623 (b) Number of applications (including references from Borough Council) 60 (c) Number of cases admitted to temporary accommodation 12 (3) Special Housing for Old People The County Council make contributions towards the cost of welfare services and amenities provided by the Borough in their special housing accommodation for old people. (4) Blind Persons The number of registered blind, partially sighted and defective sighted persons resident in the Borough on 31st December, 1963, was as follows:— (a) Registered as blind 54 (b) Partially sighted 36 (c) Defective sighted all of whom came under the supervision of the County Council's Home Teachers. page 8 There were 2 blind persons in the Home Workers' Scheme operated through the agency of the Royal Society for the Blind and 2 were employed in special workshops for the blind. Additionally, 11 blind and 6 partially sighted persons were employed in open industry: 6 blind persons from the Borough have been 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. (5) Deaf and Dumb and other Handicapped Classes The welfare services for physically handicapped persons (other than blind as mentioned above) as provided by the County Council under Section 29 of the National Assistance Act, 1948, are available for all registered handicapped persons of whom, at the present time, 249 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 provide Occupational Centres for the physically handicapped; this service is being developed and a centre in Romford is contemplated in the ten-year development plan. 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. page 9 HOUSING The following information, kindly supplied by Mr. C. Hetherington, Borough Housing Officer, gives details of the position relating to Council Houses and the waiting list as at 31st December, 1963. Total number of Council dwellings 4,666 Total number of applicants on Housing List as at 31.12.63 2,099 Applications received during 1963 459 Medical Certificates submitted claiming priority during 1963 356 Lettings during 1963 (a) New houses and flats 104 (b) Properties purchased 55 (c) Properties re-let 151 310 Redevelopment The last of the families occupying prefabricated bungalows on the Highfield Road Estate were rehoused and the dwellings all demolished. The redevelopment of this Estate is now well under way. During the year the first of the families to move from Factory Road in connection with the Upper Brentwood Road Redevelopment were rehoused and at the end of December 1963, 27 of the 41 dwellings had been vacated and await demolition. An early start has been made in 1964 to rehouse the tenants of the 115 prefabricated bungalows on the Heaton Avenue Estate to enable the site redevelopment to proceed. At the time of writing this report, 4 of the 115 prefabs have been vacated. page 10 New Housing The total of 104 houses and flats completed in 1963 continued to reflect that new dwellings were entirely dependent on redevelopment of areas from which families must first be rehoused. The period under review saw the completion of the Waterloo Road Estate and the completion of more houses and flats on the new Highfield Road Estate. Contracts for further dwellings are well advanced. Erection of new houses and flats (including two multi-storey blocks) on the Upper Brentwood Road Redevelopment Site was commenced during the latter part of the year. Housing of Aged Persons Twelve one-bedroomed flats for pensioners were completed and occupied in Queen Street. The elderly tenants have the benefit of the services of the Warden for the Queen Street Villas if and when required. Caravans The removal of all caravans from "Trees" Site, Colchester Road, was completed during 1963 largely by transfer to Broxhill and by rehousing. This site is now cleared. During 1964 it is intended that vacancies at Broxhill should be used for the clearance of Peek's Site. Widdrington Farm, Noak Hill, with the intention of closing the site when the Licence finally expires. At the time of the introduction of the Caravan Sites and Control of Development Act 1960 there were some 500 caravans in the Borough. The number has been considerably reduced by the above methods. page 11 MATTERS OF LIFE AND DEATH Population of Romford The Registrar General's estimate for the mid-year population for 1963 is 115,960 an increase of 360 over the figure for 1962 of 115,600. As the natural increase of births less deaths would be 1,057 it follows that a slightly larger number of persons moved away from the Borough than came to live here. Births 1,956 live births and 45 still births were registered in 1963 as follows:— Live Births :— Males Females Total Legitimate 984 872 1,856 Illegitimate 58 42 100 1,042 914 1,956 Still Births:— Legitimate 25 17 42 Illegitimate 1 2 3 26 19 45 Total Live and Still-Births 1,068 933 2,001 Rate per 1,000 of Estimated Population 16.8 Birth Rate adjusted by Comparability Factor of 0.96 16.1 Still Birth Rate per 1,000 (Live and Still) Births 22.4 Loss of Infant Life During the year 34 children died during the first year of life and there were 45 Still births. page 12 Statistically these are divided as follows :— 1. Perinatal Mortality. (Still births and deaths during the nrst week of life). The following table sets out details for the past five years and comparison with the rate for England and Wales. Year Stillbirths Deaths in first week of life Perinatal Death Rate At Home In Hospital Born at Home Born in Hospital Romford England & Wales 1963 7 38 2 21 34.0 29.3* 1962 6 24 4 20 27.9 30.8 1961 6 34 3 21 31.9 32.2 1960 6 24 6 22 27.2 32.9 1959 12 17 1 19 24.7 34.2 *Provisional. 2. Infant Deaths. (Deaths of infants under one year of age.) The infant death rate per 1,000 live births in 1963 was 17.0. This is lower than the figure of 22.5 for 1962 and the rate of 20.9 for England and Wales. The following table shows the cause of infant deaths:— INFANT MORTALITY—1963 Cause of Death 0-1 Month 1-3 Months 3-6 Months 6-12 Months Total under 1 year Atelectasis 2 - - - 2 Broncho-pneumonia 2 1 - 1 4 Cerebral Haemorrhage 2 — - — 2 Congenital Heart Disease 2 — - — 2 Congenital Malformation 1 — 1 - 2 Erythroblastosis Foetalis 1 — - - 1 Exomphalus 1 — - - 1 Fibrosystic Disease of Pancreas - — - 1 1 Foreign Body in Throat - — 1 - 1 Gliogen Storage Disease - - - 1 1 Haemolytic Disease of Newborn 1 — - - 1 Obstructive Jaundice - 1 - - 1 Prematurity 12 - - 12 Tentorial Tear 1 - - - 1 Tracheo - oesophygeal Distula 2 — — — 2 Totals 27 2 2 3 34 page 13 3. Neo Natal Deaths. (Deaths occurring in the first month of life). NEO-NATAL MORTALITY—1963 Cause of Death Under 1 wk. 1-2 weeks 2-3 weeks 3-4 weeks Total Atelectasis 2 - - - 2 Broncho-pneumonia - - 1 1 2 Cerebral Haemorrhage 2 - — — 2 Congenital Heart Disease 2 - — — 2 Congenital Malformations 1 - — — 1 Erythroblastoris Foetalis 1 - — — 1 Exomphalus 1 - — — 1 Haemolytic Disease of Newborn 1 - — — 1 Prematurity 11 - 1 — 12 Tentorial Tear 1 - — — 1 Tracheo-oesophygeal Fistula 1 1 — — 2 Totals 23 1 2 1 27 EXPECTATION OF LIFE The Expectation of life in this Country of a boy at birth is now just over 68 years, and almost 74 years for a girl. page 14 DEATHS 1963 Sex Total all ages Under 4 weeks 4 weeks & under 1 year 1— 5— 15— 25— 35— 45— 55— 65— 75 & over Tuberculosis, Respiratory M 4 - - - - - - - - 4 - - F 2 - - - - - - 1 - - - 1 Syphilitic Disease M 1 - - - - - - - - 1 - F - - - - - - - - - - - - Meningococcal Infections M 1 - - 1 - - - - - - - - F - - - - - - - - - - - - Other Infective and Parasitic Diseases M - - - - - - - - - - - - F 1 - - - - - - 1 - - - - Malignant Neoplasm, Stomach M 9 - - - - - - 1 1 2 3 2 F 10 - - - - - - 1 — 1 4 4 Malignant Neoplasm, Lung. Bronchus M 51 - - - - - - - 9 15 19 8 F 9 - - - - - - 1 - 3 4 1 Malignant Neoplasm, Breast M - - - - - - - - - - - - F 13 - - - - - - 2 3 — 4 4 Malignant Neoplasm, Uterus F 6 - - - - - - 2 1 1 1 1 Other Malignant and Lymphatic Neoplasms M 39 — — — — 3 1 1 4 12 12 6 F 27 — — — 1 — — 1 5 5 10 5 Leukaemia, Aleukaemia M 4 - - - - - - 1 1 1 — 1 F 2 - - 1 - - - - - 1 - - Diabetes M 1 - - - - - - - - - - 1 F 6 - - - - - - - - 3 2 1 Vascular Lesions of Nervous System M 44 - - - - - - 1 4 2 13 24 F 58 - - - - - - — 4 10 18 26 Coronary Disease, Angina M 111 - - - - - - 4 17 40 24 26 F 91 - - - - - - 2 4 16 27 42 Hypertension with Heart Disease M 6 - - - - - - - - 1 4 1 F 9 - - - - - - - - - 1 8 Other Heart Disease M 26 - - - - - - 1 2 3 7 13 F 49 - - - - - - 2 4 2 9 32 Other Circulatory Disease M 14 - - - - - - 2 1 2 3 6 F 15 - - - - - - 1 1 1 3 9 page 15 page 16  Sex Total all ages Under 4 weeks 4 weeks & under 1 year 1— 5— 15— 25— 35- 45— 55— 65— 75 & over Influenza M 1 - - - - - 1 - - - - F 1 - - - - - - - - - - 1 Pneumonia M 32 1 2 2 1 — — — — 1 9 16 F 29 1 - - - - - 1 — 1 6 20 Bronchitis M 40 - - - - - - - 2 12 12 14 F 28 - - - - - - - - 3 4 21 Other Diseases of Respiratory System M 5 - - - - - - - 2 1 2 — F 3 - - - - - - - - 1 1 1 Ulcer of Stomach and Duodenum M 3 - — — — — — — 1 1 — 1 F 2 - - - - - - - - 1 1 — Gastritis, Enteritis and Diarrhoea M 1 - - - - - - - 1 — - — F 4 - - - - - - - - - 3 1 Nephritis and Nephrosis M 2 - - - - - - - - - — 2 F 2 - - - - - - - - - - 2 Hyperplasia of Prostate M 2 - - - - - - - - 1 - 1 Pregnancy, Childbirth, Abortion F 2 - — — — — 1 1 — — - - Congenital Malformations M 4 3 - - - - - - 1 - - - F 6 3 1 — 2 - - - - - - - Other Defined and Ill-Defined Diseases M 36 10 2 — — — 1 2 2 4 6 9 F 45 9 1 — 1 — — 1 — 11 7 15 Motor Vehicle Accidents M 14 — — — 2 1 3 1 1 3 2 1 F 5 - - - - 1 - - 1 2 - 1 All Other Accidents M 7 — 1 — 1 2 1 1 — — - 1 F 3 - - - - - - - - 1 - 2 Suicide M 8 — — — — 1 1 — 2 2 - 2 F 4 — — — — — — — 2 1 1 — Homicide and Operations of War M 1 - - - - - - - 1 - - - F - - - - - - - - - - - - TOTAL ALL CAUSES M 467 14 5 3 4 7 7 16 52 108 1 16 135 F 432 1 3 2 1 4 1 1 17 25 64 106 198 Crude Death Rate per 1,000 Estimated Population 7.6. Adjusted Death Rate (Comparability Factor 1.56)= 12.0. 60 deaths of residents of Romford were due to Lung Cancer. 51 of these were male and 9 were female. The deaths of 139 persons were ascribed to Bronchitis and other allied respiratory diseases. Accidents accounted for 29 deaths during the year, 21 males and 8 females. This total, includes the deaths of 14 male and 5 females resulting from motor vehicle accidents. Eight male and four females committed suicide, compared with a total of four in 1962. INFECTIOUS DISEASES The following notifications were received during the year:— Notifications Deaths Pneumonia 7 61 Tuberculosis: Respiratory 31 6 Non-Respiratory 1 — Scarlet Fever 37 — Dysentery 224 — Puerpeial Pyrexia 2 — Measles 1,088 — Whooping Cough 109 — Food Poisoning 560 — Erysipelas 2 — Meningococcal Infection 1 1 Poliomyelitis—Non-Paralytic — — Diphtheria — — Ophthaimia Neonatorum 2 — Typhoid and Paratyphoid — — Measles Of the 1,088 cases of measles, half were notified in the first quarter of the year, being a continuation of the rise in notifications which commenced in June of the previous year. Practically all the page 17 notifications were of school children or pre-school children, but one referred to a patient aged 72 years. Tuberculosis Notifications of Tuberculosis in 1963 totalled 32, and there were six deaths from this disease. These figures reflect the continued downward trend in both notifications and deaths, and indicate that the comparatively higher figures of 55 notifications and 13 deaths recorded in 1962, were merely an instance of abnormal fluctuations that can occur when figures relating to a small proportion of the population of the Country are reviewed. B.C.G. Vaccination of Mantoux Negative Contacts has been continued, as has the routone follow-up of all contacts by the Health Visiting Staff. B.C.G. Vaccination of Secondary School children, and students at colleges has continued, details of which are included in the Section of this report dealing with the School Health Service. Food Poisoning Of a total of 560 notifications, thirteen were confirmed cases of Food Poisoning due to organisms of the Salmonella group. Negative bacteriological reports were received in respect of the majority of the remaining 547, but some of the patients were found to be suffering from Shigella Sonnei Dysentery. Dysentery 224 Suspected cases were notified, the final numbers after correction being 217 positive cases. Children in the 3 years—9 years age groups were most affected, the main outbreak being confined to two of the schools in the Borough. Although intensive efforts were made to control the outbreak, by excluding from school all those affected until consecutive negative reports had been obtained, and by the imposition of strict supervision over hygiene, including the mechanical disinfection of flushing cisterns, two months elapsed before the outbreak was cleared up. page 18 MATERNITY SERVICES Attention has frequently been drawn to the difficulties experienced in finding local maternity beds for some expectant mothers who require a hospital confinement. This problem is caused by an acute shortage of maternity beds in the Romford Group Hospital Management Committee area, and adjoining districts. It appears this position cannot be remedied for some 3-5 years unless present plans of the North-East Metropolitan Regional Hospital Board for this area are quickly amended. Place of Confinement of Romford Mothers during 1963 At home 761 = 39.9% Oldchurch Hospital 859 = 45.1% Rush Green Hospital 74 = 3.9% Barking Hospital 64 = 3.3% Other Hospitals 148 = 7.8% Total 1,906 Other Hospitals Listed Forest Gate Hospital 38 East End Maternity Hospital 21 Mile End Hospital 15 Thorpe Coombe Hosp. 10 St. Bartholomew's Hosp. 9 Ilford Maternity Home 8 London Hospital 7 Queen Mary's Hospital E.15 7 Middlesex Hospital 5 St. Margaret's, Epping 4 Wanstead Hospital 4 Mancroft Nursing Home 3 Plaistow Maternity Hospital 2 Buchanan Hospital, Hastings 1 Hackney Hospital 1 Royal Victoria Hospital Fokestone 1 City of London Hosp. 1 Queen Charlotte's Hosp. 1 St. Andrew's Hosp., Bow 1 North Middlesex Hosp. 1 ElizabethGarret Anderson Hospital 1 Brent wood Maternity Hospital 1 Salisbury House Mat. Home, Leigh 1 Bethnal Green Hospital 1 St. George's Hospital, Hyde Park 1 St. Andrew's Hospital, Billericay 1 Guy's Hospital 1 Woolwich Military Hospital 1 page 19 It should be possible for local Medical Practitioners to arrange a hospital confinement for all their expectant mother patients in the priority groups, details of which include the following— (i) patients requiring admission on account of obstetrical complications; (ii) patients requiring admission on account of medical or surgical complications, etc; (iii) patients who are primapara (first babies) or para four and over; (iv) patients requiring admission to hospital for social reasons, e.g. unsuitable living conditions. As 70-75 per cent. of all expectant mothers fall within one or other of the priority groups for hospital confinement it is obvious that many Romford priority cases were confined at home during the year. There were, in fact, approximately 300 such cases. All mothers in the priority groups should be confined in hospital where the risks to which they are usually prone are more easily controlled. In last year's report I mentioned that mortality data are only a very crude measure of the efficiency of a Maternity and Child Welfare Service. For every perinatal death there are probably many more near-deaths from such conditions as Prematurity, Toxaemia, Haemorrhage, Asphyxia, etc., and such morbidity is known to be associated with the occurrence of Mental of Physical defects in some of the survivors. Paediatricians claim that 50 per cent. of the 70,000 spastics in this country might have been avoided by a better obstetric service for the babies when they were born. Other conditions which may be associated with accidents at birth include epilepsy and mental subnormality. Home Confinements. 761 mothers were confined at home during the year. All expectant mothers booking a Midwife were advised to book a doctor, if they had not already done so, and ante-natal care in all cases was undertaken by the doctor and midwifery staff. This had the effect of rendering the Ante-natal clinics held by the Local Authority unnecessary, and these sessions ceased early in 1963. page 20 Ante-Natal Instruction Classes. The classes for expectant mothers in Mothercraft and Relaxation held by the Health Visitors continued in four centres throughout the year, and an additional class was held at the Surgery of one of the Group Medical Practices in the town to which a member of the Health Visiting staff is attached. Ante-Natal Care. As all expectant mothers are now advised to book a General Medical Practitioner for Maternity Medical Services, attendances at the Ante-natal Clinics have gradually declined and these clinics were discontinued during the year. Many general practitioners hold regular Ante-natal Clinic Sessions in their own premises and at a number of these sessions Midwives employed by the Health Department are also in attendance thus ensuring close co-operation between Doctor and Midwife. Midwifery. During 1963 the full establishment of 15 District Midwives was maintained, and the arrangement whereby a Salvation Army Midwife from the Mother's Hospital. Clapton, provides a service in the Rush Green area continued. Analgesia. 83.8 per cent. of the women who are confined at home received inhalation analgesia during labour, and 49.9 per cent. 'eceived injections of pethidine. Some, of course, received both analgesia and injections. Clinic Premises. Work commenced on the extensions to Marks Road Clinic in the Autumn of 1963. This caused considerable difficulties in the functioning of the Clinic, but despite this attendances remained high. The staff employed at the Clinic have had to carry on under very trying conditions, with various portions of the building being demolished and rebuilt section by section. These extensions however, will ultimately result in the Clinic being able to function much more efficiently, and with improved facilities. Infant Welfare Attendances at the Child Welfare Clinics are given below with those of 1962 for purposes of comparison:— 1963 1962 No. of children born in 1963 who attended 1,444 1,392 Total number of children who attended ... 4,200 4,194 Total Attendances 21,874 22,773 page 21 The 1,444 children born in 1963 who attended the Clinics during the year represent 86 per cent, of the total number born, after allowing for 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 to a clinic before the end of the year. Distribution of Welfare Foods Distribution of Welfare Foods was continued from all Child Welfare Clinics and from the 7 shops undertaking distribution on a voluntary basis. The following are details of the number of items distributed during the year with those of 1962 for comparison. 1963 1962 National Dried Milk 32,747 34,501 Cod Liver Oil 3,000 2,802 Vitamin Tablets (A & D) 3,296 3,680 Orange Juice 35,396 31,945 Day Nurseries Attendances at the two 40-place and one 50-place Nursery during the year were as follows:— No. on Register A v. Daily Attendance 1963 1962 1963 1962 January 138 126 92.7 87.3 February 138 137 99.5 93.8 March 146 139 101.4 104.0 April 136 131 86.6 99.0 May 152 124 102.5 106.5 June 153 131 100.8 98.0 July 145 130 91.7 84.6 August 152 128 80.2 90.1 September 149 142 85.4 103.5 October 140 144 98.8 110.3 November 141 152 95.3 109.5 December 139 139 97.0 83.6 page 22 Nurseries and Child Minders" Regulation Act Registrations under this Act at the end of the year were as follows:— Children Registered Permitted Premises 2 62 Persons 7 38 Staff Medical Examinations 748 medical examinations were carried out by Local Authority Medical Staff during 1963. Charges The Health Services for which Local Authorities are responsible are in the main provided free to the user, but Local Health Authorities have power to make charges for the use of some services, for example. Day Nursery care, in respect of Recuperative Holidays and for Domestic Help. A standard scale of charges is fixed which can be varied in accordance with the means of the persons concerned. Health Visiting The duties of the Health Visitor are no longer limited to the routine visiting of children under five years of age, as was the case up to comparatively recent times. As mentioned in previous reports the Health Visitor is being called upon to undertake a wider range of duties—visiting the sick and the aged, problem families and school children, in addition to increasing activity in the field of health education. During 1963, a commencement was made in the training of Health Visitors to undertake routine hearing tests of young children, and additional members of the Health Visiting Staff will receive similar training in the near future. As soon as this training is completed, it is hoped to conduct hearing tests of all children, as deafness is sometimes the cause of maladjustment and backwardness. page 23 During 1963, the Health Visitors paid 21,339 visits as follows:— Visits to Children under 5 years of age 15,790 Tuberculous households 3,199 The aged 1,054 Schoolchildren 568 Other cases 728 As an indication of the trend of increasing care required for the elderly and infirm in their own homes, it is interesting to compare the number of visits to the aged in 1962 (571) with those for 1963. which, as shown above total 1,054. Co-ordination of Domiciliary Services with the General Practitioners The arrangement whereby one of the Midwives was allocated to a group practice, was extended during the year, by the allocation of a Health Visitor to the same group. The Health Visitor concerned reports that this arrangement leads to a much closer contact with the families, and simplifies the work for families with problems as it is much easier to discuss difficulties with a doctor. Co-operation between the General Practitioner and Health Visitor ensures a twoway exchange of information which benefits the patients, and, as the family doctor knows the old people on his list, renders survey work of the needs of the elderly much easier. An ante-natal clinic, a Child Welfare clinic and Mothercraft and Relaxation classes were held at the surgery each week, which means that there is a greater contact with the mothers both before and after the birth of the child, which renders visiting of the children much easier, as the Health Visitor, like the Midwife is recognised as a part of the health team associated with the family doctor. This arrangement has proved extremely successful due to the co-operation between the general practitioners and their staff. and the Health Visitor and Midwife. The surgery is a new spacious building with adequate accommodation for the secondment of Local Authority Nursing Staff. Without these ideal conditions, fulltime secondment would be difficult. Health Education The Health Visitor includes aspects of Health Education in her duties, and therefore early in 1963, Mrs. Ledden, one of the Health Visitors, particularly interested in this part of the Health Service. page 24 was asked to undertake, on a part-time basis, the duties of coordinating the Health Education. A full range of Health Education aids, including a film projector, have been obtained, and a series of talks has been arranged in the schools which have continued throughout the year. Emphasis has been placed on the dangers of smoking in a whole series of these talks, coupled with the showing of films on the subject, in addition to a syllabus of nine talks covering the health servies, personal health, cleanliness, nutrition, etc. Lectures and talks have also been arranged for local organisations on many subjects connected with the Health Service. Health Visitors, Nurses, Public Health Inspectors and other members of the staff have co-operated in giving the various talks. A programme for the display of posters on a particular Health subject each month has also been inaugurated. These have been displayed in Clinics, and on public notice boards throughout the Area. Statistics relating to talks, etc., given by members of the Area Health Staff, are as follows:— Total Attendances 100 talks given in schools to school children 3,142 25 film sessions given in schools to school children 2,256 18 talks given to girls in connection with the Duke of Edinburgh Award Scheme 720 Seven talks were also given to outside organisations, in addition to those given by the Public Health Inspectors as mentioned elsewhere in this Report. Vaccination and Immunisation Smallpox Vaccination. Comparison of figures for the year l962 and 1963 relating to Vaccination against Smallpox produces no real guide as to whether the numbers being vaccinated are being maintained. The inflated figures for 1962 resulting from the incidence of Smallpox in this country, have no doubt reduced the number of vaccinations which would normally have been performed page 25 in 1963. The figures for the two years are as follows, but also given are the statistics for 1961 which provide a better guide as to what would normally be expected:— 1963 1962 1961 Number of Primary Vaccinations at Clinics 92 12,125 320 Number of Primary Vaccinations by General Practitioners 417 16,527 1,038 509 28,652 1,358 Number of Re-vaccinations at Clinics 11 9,771 23 Number of Re-vaccinations by General Practitioners 504 15,400 577 515 25,171 600 Total Vaccinations and Re-vaccinations 1,024 53,823 1,958 Diphtheria Immunisation, etc. The following tables show the number of immunisations against Diptheria, Whooping Cough and Tetanus with separate figures for the single antigens, combined and triple. Family Doctor Clinics Total Diphtheria 18 5 23 Diphtheria & Tetanus 142 57 199 Diphtheria, Whooping Cough & Tetanus 607 541 1,148 Whooping Cough 137 6 143 Tetanus 347 54 401 The use of triple antigen has steadily increased since it was included in the County Council's scheme at the end of 1961, a total of 1,148 children being immunised with this vaccine compared with 705 in 1962. This has had the effect of increasing the numbers immunised against Whooping Cough from 981 in 1962 to 1,291 in 1963. page 26 Poliomyelitis. During the years from 1956, vaccination against Poliomyelitis has been offered to various age groups and the number of children and adults vaccinated since then has resulted in the optimum number of the population included in the priority classes being immunised. For 1963 therefore, the figures relate almost entirely to infants. The following tables set out the numbers treated. Family Doctors Clinics Salk Vaccine 94 813 - 610 Sabin Vaccine (Oral) 928 784 1,036 506 Total 1,022 1,597 1,036 1,116 The total primary courses given were as follows:— 1693 1962 Salk Vaccine 94 1,423 Sabin Vaccine 1,964 1,290 Total 2,058 2,713 It will be seen from the above, that the use of Salk Vaccine given by injection, has now been almost completely discontinued in favour of the Sabin Vaccine given by mouth. In-Service Training To enable members of professional staff to be informed of modern techniques and advances in medical knowledge, refresher courses are held at regular intervals by the various professional organisalions. All members of the health service staff attend such courses, normally every five years, at the expense of the County Council. During 1963, one Assistant Medical Officer, two Health Visitors, two Home Nurses and a Midwife attended refresher courses. In addition arrangements are made from time to time for inservice training on special subjects, and during the year five Health Visitors attended In-service Training Courses in Mental Health. One Health Visitor and an Assistant Medical Officer attended special courses in Audiometry, and two Assistant Medical Officers attended courses on the ascertainment of educationally sub-normal children. page 27 Apart from the above, courses are also arranged centrally by the County Council from time to time for the in-service training of Domestic Helps and during 1963, one of the Home Helps from this Area attended such a course. PREVENTION OF ILLNESS, CARE AND AFTER CARE Chiropody Service The Chiropody Service was further extended in 1963 by the appointment of an additional full-time Chiropodist, which, with the assistance of a part-time sessional Chiropodist, enabled a wholetime service to be available at the three main clinics in the Borough in addition to a domiciliary service. The total number of attendances made for treatment were as follows:— 1963 1962 A t Clinics / Domicilary At Clinics I Domicilary 6,233 462 3,886 209 In addition, 248 treatments were given to residents at Old People's Homes administered by the Welfare Department. Sick Room Equipment The number of articles on loan at the end of the year was 905 compared with 842 at the end of the previous year. During the year 763 articles were loaned for the first time. 7,700 Disposable Hospital Underpads for incontinent persons being nursed at home were issued free of charge during ihe year. This compares with 6,000 in 1962. Recuperative Holidays 46 persons recommended by their medical practitioners were sent to Convalescent Homes for recuperative holidays during the year. Domestic Help Service 882 patients were provided with a Domestic Help during the year. The Domestic Helps worked for 117,008 hours at the homes page 28 of these patients. The following table gives details of the classes of patient assisted:— No. of cases Hours Provided Aged 611 90,558 Maternity 123 4,360 Chronic Sick 94 18,207 Others 54 3,883 The other cases helped included patients suffering from mental disorder, harassed mothers, problem families, acute illness, etc. The total number of hours provided was some 4,500 less than in 1962. but help to the aged continued to increase as follows:— 1961 463 patients 69,722 hours 1962 528 patients 82,610 hours 1963 611 patients 90,558 hours Night Attendance Service 12 patients were provided with a night attendant during 1963, as follows:— Hours Patients Involved 1. PaUents residing alone 1 30 2. Patients seriously ill in their own home where an aged husband or wife could not provide the necessary assistance 1 10 3. The relief of relatives who had to give routine night attendance to sick people 10 510 The service is administered by the Domestic Help Section. Care of the Aged Details relating to the services provided by the Romford Borough Council for the aged were given in my report for 1962. The workshop for the elderly was extended during 1963 to permit the numbers attending to be increased, and additional work page 29 has become available from various firms, both in the Borough and elsewhere. This has increased the variety of work carried out. Whilst only employed for two hours per day, the old people appreciate a change in the type of work performed. The other facilities provided by the Romford Borough Council ^holidays, coach outings, Christmas food parcels, and luncheon centre—have been continued as in previous years, and at the end of the year, endeavours were being made by the W.V.S. to expand the meals-on-wheels service to housebound persons. Residential Accommodation A hostel for old people, Hillside, North Hill Drive, Harold Hill, the first to be provided by the County Welfare Department in the Borough was opened early in 1963. This home accommodates 63 persons. Registered Nursing Homes The three Nursing Homes registered to receive Chronic Sick cases were inspected quarterly by me to ensure that the County Council's bye-laws were being observed. Home Nursing 23,136 visits were paid to the homes of 1,129 sick persons during the year by the eleven full-time Home Nurses employed in the area. 110 of these visits were to patients under 5 years of age, 7,538 to patients over 5 years of age and under 65, and 15,488 to patients over 65 years. Children at Risk An "At Risk" Register was commenced during the year to enable any adverse factors connected with the newly-born infant, whether related to the medical history of the mother, the pregnancy, or the birth, to be recorded, and for the child itself to be followed-up with a view to the detection of any defects at an early age, so that treatment can be started as soon as possible. Early detection of a handicap concerns all doctors responsible for the care of children. page 30 In many cases a defect is readily apparent—in others, it is recognised only by careful observation or special tests, such as hearing tests for deafness and examination of newborn infants for evidence of congenital dislocation of the hip. When development is proved to be normal, the child's name is removed from the register, but where a handicap is found, the name is transferred to the handicapped registed. The "At Risk "Register was commenced in August 1963, and of the 720 babies born between 1st August and 31st December 1963, 210 were entered on the Register as being at risk. Twelve of the 210 children have been found to be suffering from defects as follows:— Mongolism Suspected Congenital Dislocation of Hip Systolic Murmur Pilonidal Sinus Calcareous Varus Lump in Linea Alba Left Sided Hare Hip Hyperthyroidism Left Partial Cleft Palate Defective Vision Myleomeningocele Suspected Deafness Some difficulty is experienced in following-up infants who do not attend the Child Welfare Clinics, but the Health Visitors regularly visit all children on the "At Risk" Register, and should any defect appear apparent, discuss with the mother the advisability of having the child medically examined. Handicapped Register A Register of all handicapped children under school age was commenced in August 1963. Children known to be handicapped at the time the register was commenced and children on the "At Risk Register found to be handicapped have been included. By page 31 the end of the year, the number of children on the register totalled 33 in categories as set out:— Mental Retardation 5 Mongols 5 Partial hearing 3 Motor Aphasia 2 Hyperthyroidism 1 Congenital Abnormalities 7 Hirschsprungs Disease 1 Blind 1 Epilepsy 2 Congenital Heart Disease 4 Nephritis 1 Enucleation of Right Eye 1 DEVELOPMENT OF LOCAL AUTHORITY HEALTH AND WELFARE SERVICES In accordance with Ministry of Health Circular 2/62 the County Council was asked to review its Health and Welfare Services and to draw up a plan for developing them over the next ten years. The following Capital Building Programme was approved by the Romford Health Area Sub-Committee:— Approximate Total Cost (Site, Building and Equipment as Project appropriate £ 1962/63 Extensions to Harold Hill Health Centre 1,000 Extensions to Marks Road Clinic 8,000 1963/64 New Day Nursery, Clockhouse Lane, Romford 26,000 page 32 1964/65 Extensions to existing Clinic, Hulse Avenue, Collier Row, Romford 8,500 New Clinic and Ambulance Station (one vehicle) Havering Road, Romford 25,000 1965/66 Day Nursery, 60 places, Rush Green Road, Romford 30,000 New Clinic, Balgores Lane, Gidea Park 12,500 Day Nursery, 60 places, Harold Hill, Romford 30,000 1966/67 New Clinic, Rush Green 25,000 1967/68—1971/72 (inclusive) New Clinic, Heaton Way, Straight Road, Romford 19,000 New Clinic, Collier Row, Romford 12,500 New Clinic, Romford (Albert/ Victoria Road) 12,500 New Clinic, Rise Park, Romford 12,500 Extensions to an existing clinic to provide for audiology 5,000 The top two items have now been completed and a start is shortly to be made on the new Day Nursery project. SCHOOL HEALTH SERVICE 1963 School Population 21,000 (approx.) Primary Schools 40 Secondary and Grammar Schools 15 Special School for Handicapped Pupils 1 Minor Ailment Clinics These clinics provide for the treatment of miscellaneous minor ailments and for special consultations with the school medical officers. Regular sessions are held at 5 separate clinics. page 33 New Cases Treated during the Year:— Eye Diseases 2 Ear, Nose and Throat defects 6 Skin defects Impetigo 1 Other skin conditions 119 Miscellaneous minor ailments 33 161 Medical Consultations: — Special Inspections 564 Re-examinations 444 Examination of Children for Employment:— In entertainment 6 Other employment 144 Total Attendances at Minor Ailment Clinics 3,764 Speech Therapy During the year 117 new cases were referred for Speech Therapy and 2,661 attendances were made for treatment. At the end of the year 199 children were under treatment at the Speech Clinics. Dental Services The staffing position at Dental Clinics was maintained throughout the year and 11,541 dental inspections were carried out. All children found to be dentally unfit were offered treatment at one of the authority's dental clinics and 7,868 attendances were made for treatment. Statistics relating to the School Dental Service are shown in the table at the end of this report. SPECIALIST SERVICES In co-operation with the Regional Hospital Board the Orthopaedic and Ophthalmic Clinic sessions were continued at the Harold Hill Health Centre and Marks Road Clinic. page 34 Cases dealt with were as follows:— Ophthalmic Clinics Conditions treated:— External and other eye diseases Errors of refraction (including squint) 1,174 Number of children for whom spectacles were prescribed 510. Orthopaedic Clinics Number receiving treatment 891 Total attendances at Specialists Clinics 302 Total attendances at Physiotherapy Sessions 3,114 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 tuberculin tested after parents' consent received 1,672 Positive results 66 Negative results 1,475 Number who received B.C.G. Vaccination 1,455 HANDICAPPED PUPILS The ascertainment of pupils handicapped by reason of physical or menial disability forms an important part of the work of the School Health Service. Each case must be given individual consideration with the object of providing the form of education most suited to the childs needs, and the observations of the head teachers and parents are taken into account before a recommendation is made. During the year 38 children were newly ascertained as handicapped pupils and 36 handicapped pupils were admitted to schools providing special educational facilities suited to their individual handicaps. page 35 Havering Grange School, Romford, which provides for educationally sub-normal pupils, was able to accept more children during the year and there were 72 on the school roll at the end of 1963. Regular visits were paid by the School Medical Officer and weekly speech therapy sessions have been a feature of the special facilities provided for these handicapped pupils. The following is a summary of the ascertainment and placement of handicapped pupils during the year:— No. of pupils ascertained during the year No. of pupils admitted to Special Schools during the year Total No. of pupils in Special School at end of year Day Residential Day Residential Deaf 1 — — 4 — Partially Hearing. 1 — 2 7 2 Blind — — — — — Partially Sighted. — — — 2 — Epileptic — — 1 — 2 Delicate 4 1 4 10 7 Physically Handicapped 1 2 1 13 7 Educationally Sub-normal 18 19 3 78 18 Maladjusted 12 — 1 1 17 Speech — — — — — Dual Defects* 1 1 1 4 5 Totals 38 23 13 119 58 * Children ascertained in respect of more than one defect: — Attending Residential Special Attending Day Special Schools Schools 2 E.S.N./Physically Handicapped 1 Deaf/E.S.N. 1 Partially Hearing/Partially Sighted 1 Deaf/Physically 1 Partially Hearing/E.S.N. Handicapped 1 Maladjusted/Physically Handicapped 1 E.S.N./Physically Handicapped 1 Maladjusted/E.S.N. Convalescence During the year 37 children were sent away for short stay convalescent holidays. page 36 Child Guidance Service Dr. J. Vincenzi, Consultant Psychiatrist, has submitted the following report on the work of the Romford Child Guidance Clinic during the year:— In the past year there was a slight increase of referrals. There were 312 cases in 1963 and 299 cases in 1962. Of this number 144 were from Romford, 91 from Dagenham and 77 from South Division. We estimate that we are having half the cases from South Division, the other half going to Grays, which means that we are catering for a school population of between 55,000 and 60,000. Staff Psychiutric Sessions Since September there have been eight weekly consultant sessions and five Senior Hospital Medical Officer sessions. Dr. Swift, who has taken over Boyles Court, does do some of the Boyles Court referrals. Dr. Berstock started as locum psychiatrist in September. Follow up It is now possible to make an attempt at review of the follow-up which was done in 1962 for children referred in 1959. 124 cases were followed up but in 17 of these the family had moved md it was not possible to trace them. Of the remaining 106 cases, 46 under eleven years of age out of 73 were felt by the parents or the referring body to have benefited by Clinic attendance, of the 33 over eleven, 24 were felt to have benefited by Clinic attendance. This suggests that older children tended to do better than younger children, which is against usual experience. The Psychiatric Social Worker, who followed up the 124 cases felt that in only 9 cases were the parents openly rejecting of the child which suggests that although we had not in every case "improved" the child, we had helped the parent to accept the problem as it was. Nursery for Pre-School Maladjusted Children Purklands Nursery. There are now nine children and I think this experiment has justified this, although every case there has not page 37 been quite the type of child that I envisaged when the nursery was originally discussed. Mead Nursery. There are now eight children in this nursery. Waiting List This is now about two to four weeks from time to time of referral to diagnostic interview. This is satisfactory and will give more time to psychotherapy. One is unduly anxious of a large waiting list when considering treatment time. School Psychological Service Miss I. A. Poulton, Educational Psychologist has submitted the following report:— During 1963 the educational psychologist interviewed a total of 169 children for individual assessment in schools, in most cases seeing one of the parents also and discussing the problem with the school staff. Although a separate record has not been kept of the attendance of fathers this year, there has been a tendancy for the number accompanying mothers for interview to increase. Ninetyfour of the children seen were of below average intelligence. Regular visits to Havering Grange School have continued and about half the children who were tested on the 1937 version of the Terman Merrill Scale before admission have now been re-tested on the 1960 Scale which came into use shortly after the opening of the school. At Ramsden Hall School the Wechsler Scale has been used with the older boys with a view to vocational guidance and also diagnostically with boys whose reading difficulty has proved particularly severe. The Youth Employment Officer again sought advice about several young people who had failed to settle in a number of posts over a short period. Children leaving boarding schools for maladjusted children outside the County are now interviewed about a year before leaving school in order to allow the Youth Employment Officer a long period in which to explore the possibilities of placing them suitably. Parklands Nursery was visited regularly and the progress of the leavers followed up in their ordinary schools. Of the first intake, page 38 all have settled well and progressed normally. One child who was silent at home and outside when admitted to the Nursery at four years old, gradually began to speak a little in the Nursery, and eventually, on joining the ordinary admission class became one of its most confident members. In November and December a considerable amount of time was spent on the preparations for the opening of the second Nursery at Mead School, Harold Hill, and the first children were admitted in January, 1964. During December also, preparations were made for the beginning of the therapeutic group housed in the Manor School. This group would ideally meet on Clinic premises as the treatment given is designed for children who need the company of others to help them towards improvement rather than individual treatment. The therapeutic teacher in charge of the group is an experienced teacher who is following a specialised course at the University of London. A number of children were interviewed in schools between October and December by an assistant educational psychologist who is a post-graduate student at University College, London, and who attends the Child Guidance Clinic on one day each week to gain experience in the School Psychological Service, Clinic Administration and Case Conferences. Remedial teaching followed the same pattern as in previous years with advice being given when necessary to the teachers of the groups in the Junior Schools and continual discussions with the two pari-time teachers in the Clinic. The educational psychologist again saw eight particularly difficult cases who received a total of 167 lessons. One of these children who had specific dyslexia with severe secondary emotional disturbance received very intensive treatment. He was later admitted to a school near the Clinic where the staff had previously assisted with a similar child who was treated by one of the remedial teachers, and where constant observation is possible. Of the children referred to the Child Guidance Clinic, 117 had their preliminary interviews with the educational psychologist for Romford, but a few of these children came from other areas. Fortyfive visits were made to schools to discuss the progress of children attending the Clinic. Very detailed psychological testing, including the Rorschach technique was carried out with nine children attending the Clinic. page 39 As in the previous year several visits were made to the Neurosurgical Ward at Oldchurch Hospital where the work of the teacher is particularly exacting and it was possible to advise about equipment which would make the children more comfortable and better able to use her services. Children receiving home tuition were discussed regularly with their tutors but this year all had been known to the psychologist before home tuition was commenced so that no new assessments were required. The total of 54 interviews with people other than children, their parents or their teachers, is higher than previously and includes students of various types who have visited the Clinic to learn about Child Guidance and the School Psychological Service, talks to groups of interested people, e.g. The Townswomen's Guild, Inner Wheel, etc. and discussions about general matters concerning handicapped and disturbed children with Special Medical Officers, Her Majesty's Inspectors, staff at Oldchurch Hospital and various other people. page 40 School Health Statistics for the year 1963 Total (All Schools) 1. MEDICAL INSPECTION OF PUPILS (a) PERIODIC Number of children examined at school: — (i) Entrants 2,106 (ii) Second age group 1,956 (iii) Third age group 2,093 (iv) Other periodic examinations 16 Total 6,171 Number of defects found requiring treatment 1,198 Number of defects found requiring observation 2,658 Number of individual pupils found to require treatment 1.095 Nutritional classification of pupils examined: — Satisfactory 6,165 Unsatisfactory 6 (b) SPECIAL Number of children specially examined 690 Number of defects found requiring treatment 332 Number of defects found requiring observation 142 (c) RL-INSPECTION Number of children re-inspected 731 2. TREATMENT OF CHILDREN (a) Total attendances at Specialists' Clinics: — (i) Ophthalmic 1,673 (in Orthopaedic 302 (b) Total attendances at Treatment Clinics: — (i) Minor Ailment 3,764 (ii) Physiotherapy 3,114 (iii) Speech Therapy 2,661 3. HYGIENE INSPECTIONS (i) Number of examinations of pupils in schools 11,291 (ii) Number of pupils found unclean 45 4. DE TAL TREATMENT (i) Number of pupils inspected 11,541 (ii) Number found to require treatment 5,427 (iii) Attendances for treatment 7,868 (iv) Number of fillings: Permanent teeth 4,347 Temporary teeth 2,491 (v) Number of teeth filled: Permanent teeth 3,677 Temporary teeth 2,334 (vi) Number of teeth extracted: Permanent teeth 449 Temporary teeth 1,820 (viii) Number of general anaesthetics administered 898 (viii) Other operations: Permanent teeth 1,262 Temporary teeth 540 page 41 SANITARY CIRCUMSTANCES OF THE AREA Mr. H. C. Boswell, Chief Public Health Inspector, reports as follows:— THE PHYSICAL ENVIRONMENT The following report is essentially a review of the work performed by the Public Health Inspectorate during the past year in their endeavours to secure satisfactory hygienic conditions for the well being of the inhabitants of the Borough, and also gives one an opportunity of assessing a programme for further improvements in the environment. As stated in previous reports, the work of the public health inspectors is varied and covers a very wide field in their endeavour* to secure good conditions of living, working and recreation. Although some of the services mentioned in the following report are not the direct responsibility of the public health inspector, he must keep himself acquainted with all the kindred branches of environmental health and sanitation. It is therefore pleasing to state that there is a happy relationship and co-operation with all sections of the Health Services, including the Public Analysts and the Pathological Laboratories. During the past year there has again been an increase in legislation, the implementation of which falls on the public health inspectors, these include numerous Regulations, Orders and Standards relating to the purity and quality of foods. The two most important pieces of legislation recently introduced are The Meat Inspection Regulations, 1963. The Offices, Shops and Railway Premises Act, 1963. Both of these will mean increased work for the department, and are referred to more fully later on in this report. Much of the work carried out is collated under the heading "Nature and Number of Inspections," this unfortunately relies on the number of inspections made for specific purposes, and does not present a true picture of the amount of work involved, for example, one visit may only occupy a few minutes of an inspectors time but there are others which require his attention for many hours. 1' would not be possible to give details of all complaints and inspections made in connection therewith, the following however is a good example. page 42 A complaint was received concerning fumes emanating from a factory, before any reasonable improvement was obtained, this complaint caused over fifty inspections and observations to be made by the inspectors and occupied over a hundred man hours. 1. (1) 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) Length of mains laid in yards:— 3" 4" 6" 9" 12" 15" (Bedford's Park 8 821 256 300 142 1,203 Reservoir) Total 2,730 yards. (b) The water supply of the area and of its several parts has been satisfactory both as to quality and quantity. (c) Bacteriological and chemical examinations are made of the raw water, of the water in its various stages of treatment, of the water supplied from the Company's wells and of the water going into supply. Analyses are also made of samples obtained from consumers' taps in the various parts of the Company's district and all proved to be satisfactory. A total of over 3,967 chemical, bacteriological and biological examinations have been made. In addition samples were examined for radioactivity. (d) The waters are not liable to plumbo-solvent action. (e) No contamination has arisen therefore no action has been necessary. (f) The following are the average dwelling houses supplied during 1963—34,517. 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 43 (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 2,185 Lineal yards of foul sewer. 3,626 Lineal yards of surface water sewer. The village of Noak Hill has now been provided with a foul sewer and work is in progress of connecting premises to the main sewer and abolishing the existing cesspools. Flood relief schemes have been carried out in Taunton Road and Frinton Road. (iii) Refuse Collection Refuse collection is carried out under the supervision of the Cleansing Superintendent and form part of the Borough Engineers Department. A weekly service is in operation and during the year refuse was collected from 37,400 premises, amounting to 37,500 tons of refuse. In addition 2,000 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 1,882 complaints were received and recorded, 6,558 visits were made to investigate these complaints, and where necessary notices were served to abate nuisances or remedy defects. page 44 (b) TABLE 10 NATURE AND NUMBER OF INSPECTIONS DURING THE YEAR Accumulations and Refuse Deposits 184 Bakehouses 21 Butchers' Shops and Stalls, etc. 153 Canteens (School and Factories) 107 Cesspools 45 Clean Air Act General 164 Clean Air Act Smoke Control Areas 2,612 Clean Air Act Smoke Observations 24 Clean Air Act Atmospheric Pollution 1,040 Common Lodging Houses 14 Dairies and Milkshops 17 Drains, relaid and altered 432 Drainage—obstructed or defective 593 Drains, tested and inspected 548 Disinfections and Disinfestations 3 Diseases of Animals Act 12 Dustbins 18 Establishments for Massage and Special treatment 3 Factories Act (Mechanical Power) 66 Factories Act (Non mechanical) 1 Factories Act (Outworkers Premises) 8 Food Preparing Premises 222 Food Hawkers 40 Food Hygiene Observations 257 Food Inspections 476 Food Sampling—Formal 6 Food Sampling—Informal 140 Food Shops 330 Food Vehicles 22 Housing Acts—General 262 Housing—Rent Act 1957 73 Heating Appliances (Fireguards) Act 1952 12 Ice Cream Vendors 111 Ice Cream Samples 116 Infectious Diseases Including Food Poisoning 4,542 Insects and Pests 45 Keeping of Animals 64 page 45 TABLE 10—continued Licensed Caravan Sites 159 Licensed Premises 17 Milk Sampling 135 Miscellaneous 578 Markets 59 Noise Abatement Act 71 Nuisances, Public Health Act 1,495 Pet Animals Act, 1951 8 Prevention of Damage by Pests Act, 1949 3,857 Public Baths 13 Public Conveniences 21 Public Health Act, 1936, Section 59 2 Schools 63 Shops Act—All Sections 2,046 Slaughterhouse and Meat Inspection 1,699 Streams, Ponds and Watercourses 119 Tents, Vans and Sheds 186 Verminous premises 42 Water Closets 47 Water Supplies and Samples (c) Informal Notices (number served) 241 Statutory Notices (number served) 46 (d) As a result of the service of Notices, the necessary works were completed by the owners or occupiers in all cases except 93, the works for which were still in hand at the end of the year. (e) Notices served under the Shops Act 9 (f) Notices served under the Food Hygiene Regulations 26 (v) Factories Acts, 1937 and 1948 A summary of the statistics, as required by the Ministry of Labour and National Service, is given below:— page 46 TABLE 11 1. INSPECTIONS Premises No. on Register Inspections Written Notices iers Prosecuted (i) Factories in which Sections 1, 2, 3, 4, and 6 are to be enforced by Local Authorities 27 1 - - (ii) Factories not included in (i) in which Sec. 7 is enforced by the Local Authority 361 66 4 - (iii) Other Premises in which Sec 7 is enforced by the Local Authority (excluding outworkers premises) 42 2 - - Total 430 69 4 — 2. CASES IN WHICH DEFECTS WERE FOUND PARTICULARS No. of Cases in which defects were found Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Want of Cleanliness 1 1 - - Overcrowding — — — — Unreasonable Temperature — — — Inadequate Ventilation - — — — Ineffect. drain. of floors. — — — Sanitary Conveniences (a) Insufficient 1 1 — — (b) Unsuitable or defective 2 2 - - (c) Not separate for sexes — — — — Other Offences — - - — Total 4 4 — — 3. OUTWORK Nature of Work No. of Out-Workers No. of Cases of Default No. of Prosecutions Wearing Apparel—Making, etc. 23 - - Box Making 6 — — Total 29 - — During the year 8 inspections were made of Outworkers' premises. page 47 (vi) Caravan Act, 1960 (a) LICENSED RESIDENTIAL SITES There are five residential caravan sites within the Borough, one of which is owned and managed by the Council. At the end of the year there were 324 caravans, stationed on the sites, being used for residential accommodation. These sites are provided with the essential amenities in the way of water supply, washing facilities, sanitary accommodation 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 have been 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. (b) INDIVIDUAL CARAVANS At the end of the year there were 26 individual caravans stationed in the Borough, some on isolated plots and others on land adjoining houses, most of these caravans are being used for residential purposes. These caravans are subject to control under the above act, and enforcement action is being taken for the removal of caravans that are on unauthorised sites. (c) LEGAL PROCEEDINGS During the year one prosecution was instituted concerning an offence under the act and contravention of site licence conditions. A fine of five pounds with two guineas costs was imposed by the Magistrates' Court. (d) GIPSY ENCAMPMENTS A large number of gipsy caravans visit the district throughout the year and camp 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. page 48 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 186 visits to gipsy encampments. The owners of a number of these pieces of land have been persuaded 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 It is the duty of every local authority, under the above act, to take such steps as may be necessary to secure as far as practicable that their district is kept free from rats and mice. The local authority also have a specific liability to ensure, as far as practicable, that all land and buildings occupied by them are kept free from rats and mice. This includes Parks, Recreation Grounds, Schools and Public Buildings and all sewers vested in the local authority. It is not widely known; but it is the duty of the occupier or owner of any premises to notify the local authority of the presence or rats or mice on land that they occupy and it is in fact the responsibility of the occupier to take steps to rid their premises of these pests. This Council have however provided a service for this purpose over a number of years, and one Rodent Officer is employed in the Health Department. This Officer is provided with a van and the necessary equipment to trace and deal with all forms of infestation. 1 his service is provided free to all ratepayers in the district. During the past year 463 notifications were received of infestations and the Public Health Inspectors and Rodent Officer carried out 3,857 inspections and reinspections of premises and all necessary measures were taken to eradicate the rats and mice. page 49 Regular routine inspections are made of all Parks, Recreation Grounds and Schools and disinfestation is carried out when necessary. Considerable thought has to be given to the right type of poison to be used, and after much experience it is considered that the most satisfactory and economical poison to use is that commonly known as "Warfarin." This poison has the approval of the Ministry of Agriculture, Fisheries and Food and has the following advantages:— It is reasonably safe as far as humans and domestic animals are concerned, it is not necessary to use pre-baits, therefore the first baits contain poison and much time is saved. There are two specific ways that members of the public encourage rats and mice, to which specific attention should be drawn, The first of these is the frequent practice of the public in throwing large quantities of bread out to feed birds. Instances have been found where large slices of bread have been thrown onto lawns, these are far too large for birds to consume or carry away and supply plenty of food for rats and mice. If people desire to feed birds, the bread should be broken up fine and placed on a bird table. The second point is the placing of sheds and chicken houses too close to the ground, all buildings of this type should be kept at least nine inches above the ground so as to enable a dog or cat to get under. Sheds very close to the ground afford comfortable nesting places for rats and mice. Treatment of Sewers The inspection and baiting of sewers is under the supervision of the Highways Superintendent. This work is usually carried out at regular intervals on a block basis, specified areas of the Borough being treated at one time. Where, however, it is proved that certain house drains are infested, treatment of the sewers in that area are carried out on request from this department. During last year 315 manholes were inspected and treated. page 50 (viii) Disinfestation of Insects and Pests Numerous complaints were dealt with during the year concerning insects and pests that invade homes, shops and stores. Insects can have a variety of effects on the human race or its environment, they can destroy or harm food, ruin furniture, materials and works of art, cause damage to timbers, endanger health or just cause annoyance. The present modes of travel, whereby any destination can be reached in a relatively short time is a great asset to the public, but at the same time it has brought its problems, as during recent years new species of insects have been introduced to this country from abroad, either in cargoes or luggage. The variety of species of insect pests is always increasing, and identification becomes more difficult, however, we are fortunate in being able to send species either to the Natural History Museum or to one of the firms that manufacture " pesticides," for identification. From these sources, in addition to the identification, we can learn the life history, country or origin, whether the insect is harmful or not and the best control measures to use. It is evident that the public are becoming more insect conscious, by the number of requests that are made for assistance to eradicate various insects. Apart from the housefly which is the most common of household pests, those that we are mainly called up to deal with are, timber beetle, furniture beetles, carpet moths, store beetles, gooseberry mite and most frequently wasps and ants. One of the outstanding effects of the better standard of housing and hygiene enjoyed by most people today is the notable decrease in the infestations of bed-bugs and house fleas. Prior to the war these were common to the majority of working class houses, and created full time work for disinfestation teams, but today they are relatively rare. Assi-tance and advice is given in all cases of infestation, some treatments are carried out by the Rodent Operatives, but in severe cases the persons concerned are advised to obtain the services of specialist firms. Where necessary the destruction of clothing and bedding is undertaken by the Council upon the receipt of a written request from the owner. page 51 (ix) Pet Animals Act, 1951 Under this Act, a person who desires to sell pets, of any description, by retail, must be licensed by the local authority. These licences are renewable annually and conditions are attached to the licence, in order to regulate the manner in which the animals are kept and exposed for sale. At present there are 15 persons licensed in the Borough to keep Pet Shops, 5 of these are in respect of stalls in the Market Place. Pets on these stalls are restricted to puppies, goldfish and tortoises. Inspections are made to ensure that the conditions of the licences are complied with. 3. INSPECTION AND SUPERVISION OF FOOD The inspection, sampling and supervision of foods in all its phases, from the producer to the consumer, forms a very important part of the duties of the health inspectorate in the protection of the health of the public. Various infectious diseases can be transmitted by foodstuffs. Food poisoning and other intestinal illnesses can be caused by the ingestion of foods that are either contaminated, are out of condition or badly processed. It is therefore essential that all premises where foods are processed, manufactured, prepared and sold are kept under constant supervision in order to ensure that the food is handled and stored in a proper manner and also that the premises and personnel comply with the requirements of the Food Hygiene Regulations. The various Acts, Regulations and Orders that are in existence for controlling the processing, manufacture, composition, labelling, storage and sale of food are far too numerous to list in detail in this report, suffice it to say that they have been made by the Government with a view to protecting the public in one form or other, it is the inspectorates duty to be conversant with all this legislation and ensure that it is complied with. More detailed information concerning various branches of these duties are set out in the following remarks. page 52 (i) Milk Supply Milk has often been acclaimed as the " most perfect " of foods, inasmuch as it contains all the essential nutriments required by the human body, especialy infants, and is a food that is easily assimilated by most persons. It must be admitted, however, that it is unfortunately a very good media for the transmission of certain diseases. Constant supervision is therefore essential at all stages that milk passes through from the cow to the consumer. Since 1949, the control of milk production at the farm has been the responsibility of the Ministry of Agriculture, Fisheries and Food. Local authorities, who are also food and drugs authorities, are responsible for the licensing of retailers and distributors and the administration of the Milk and Dairies (General) Regulations in respect of processing plants and dairies. All dairy cattle in the country are now certified as tuberculin free, thus reducing the risk of the spread of bovine tuberculosis to the public. All milk sold by retail must be heat treated to comply with the Milk (Special Designation) Regulations. Contrary to some beliefs, this heat treatment does not impair the nutritional value of milk, it does, however, destroy any harmful bacteria that may be present and improved the keeping quality. It is only fair to say that the processing plants and dairies in this country have attained a very high standard and every endeavour is made to ensure that the public obtains a pure safe milk supply. There is, however, one problem that is always with us and that is the occasional dirty milk bottle, this problem causes as much concern to the dairy trade as it does to local authorities, and in spite of all the efforts made by the trade to detect these offending bottles one occasionally gets through to the consumer. The public are really to blame for this problem by their constant misuse of the milk bottle. It is well known that some people allow these bottles to accumulate in the house, a lot of them containing deposits of milk which sours and ferments, children are flowed to play with them in the garden and building operatives are some of the worst offenders as they allow bottles to accumulate on page 53 building sites where they become coated with sand and cement. School authorities even are not free from blame, as it has often been found that scholars are permitted to use milk bottles to hold plants and as containers for washing brushes that have been used for water colour paints. The long term answer to this problem is primarily to educate the public to regard the milk bottle as a valuable returnable food container, for the dairy to make a returnable charge on the bottle, or to go over entirely to wax non-returnable containers which would naturally increase the cost. Registration of Milk Vendors All dairies and distributors of milk must be registered with the local authority under the Milk (General) Regulations, 1959. Premises must comply with the conditions laid down in the regulations, and the local authority have power to revoke or cancel a registration for certain non-compliance of the Regulations. At the end of the year 72 firms were on the Council's register as Retailers or Distributors. Licensing of Milk Vendors As Romford is a specified area, where only designated milk may be sold, all retailers must be licensed under the Milk (Special Designation) Regulations, 1960. The licensing authority under these Regulations is the Food and Drugs Authority, therefore as Romford is a Food and Drugs Authority we still retain these powers. Supplementary licences are no longer necessary and a licence holder is now permitted to sell milk outside the area of the licensing authority without having to obtain a supplementary licence, this provision has reduced the work of cross checking between local authorities. The form of licence, known as the Dealers (Pre-Packed) Licence permits the sale of the three types of designated milk. These are issued to the dealer who received his milk in the bottle or container ready for sale to the consumer. Licences are issued to cover a period of five years instead of one year as previously. page 54 The 72 dairies and distributors who are registered with this Council have all been granted Dealers (Pre-Packed) Licences. Sampling During the year 137 samples of milk were taken for bacteriological examination. Of these, 3 failed the Methylene Blue Test for keeping quality. Two further samples were void when they reached the laboratory and were obviously not included in the tests. Of the unsatisfactory samples two were from automatic vending machines, the fault being traced to the cooling element. The third sample was obtained from a small distributor, it was found that stock rotation was the cause of this poor sample. The matters were taken up with the persons responsible and improvement effected. Eighteen samples of milk were submitted for chemical analysis and all proved to be satisfactory. (ii) Ice Cream The manufacture and sale of ice cream is governed by the Food and Drugs Act and various Orders and Regulations made thereunder. Prevision is also made under the various Acts for the registration of manufacturers and vendors of ice cream. In this borough registration is made under the Romford Urban District Council Act, 1931, as this Act provides for the registration of the person as well as the premises, whereas the Food and Drugs Act, 1955, only provides for the registration of premises. By using the local Act, the local authority have control over the itinerant vendor which is not previded for under the National Act. The ice cream trade has passed through many phases, and during the last few years it had reached the stage where practically 90 per cent. of the ice cream was sold pre-packed and frozen hard. A recent development has been the sale of "soft" ice cream. This is an ice cream that has been made in the factory, put into hermetically sealed containers, and stored in a cold place. When required, this mix is fed into a freezer and served direct as a loose ice crean. The public seem to prefer this softer ice cream to the factory made pre-packed type that has undergone a hardening process. The sales of this new type of ice cream was at first confined to shops, but vans are now equipped with motor driven freezers for page 55 this type of trade, therefore vans adapted for this purpose can no longer be classified as vending vehicles, but are in fact a mobile manufacturing plant. Vans that have been specially built for this purpose, comply in all respects with the Food Hygiene Regulations, as all surfaces are covered with impervious material and in addition to cold storage cabinets and freezers, they are equipped with hand basins and means for providing hot water for washing. Providing the operator obtains his initial mix from a reputable firm and observes the highest standards of hygiene in regard to the equipment and methods of handling this new form of vending should not create any hazards or problems, but great care must be observed in cleaning and sterilising the equipment. At the end of the year, 269 persons were registered with the Council as vendors of ice cream, of these 38 were registered as itinerant vendors, the remainder being shop premises. Regular checks are made on all premises and vehicles. During the year 116 samples of ice cream were taken for bacteriological examination. These samples were classified as follows:— Ministry of Health (Provisional) Grade 1 45 Ministry of Health (Provisional) Grade 2 19 Ministry of Health (Provisional) Grade 3 17 Ministry of Health (Provisional) Grade 4 35 Twenty-one lollies were also submitted for bacteriological examination and five were found to be unsatisfactory. Eleven samples of ice cream and seven ice lollies were also submitted to the Public Analyst for chemical examination and all proved to be genuine and complied with the Food (Standard) Regulations, except for one sample of ice cream. (iii) Meat Inspection There are now three licensed slaughterhouses in the Borough one small private slaughterhouse having closed down during the year owing to the death of the owner. One of the slaughterhouses is licensed for the slaughter of horses as well as cattle. page 56 The two large slaughterhouses are operated by Wholesale Butchers who supply meat to retail butchers over a large area and also provide meat for the London markets. Ritual slaughter is performed at one slaughterhouse in accordance with the Mohammedan religion for the supply of mutton for shipping crews and to meet the demands of the increasing Mohammedan population in the East-end of London. The Meat Inspection Regulations, 1963, came into operation on the 1st October, 1963. These Regulations now make it compulsory for every local authority to ensure that 100 per cent. inspection of the carcases and organs or every animal slaughtered for sale for human consumption within their district is carried out by competent officers. The Regulations permit the local authorities to make a charge for this service, and this Council resolved to make the maximum charges allowed which are as follows:— Cattle and Horses 2s. 6d., Calves and Pigs 9d., Sheep 6d. When these charges were first introduced, it was not surprising that the local meat traders objected to making payment on principle, especially as they had had this service free for a number of years. At the end of the year there was one trader who still refused to pay the charges, and was appealing to the Minister. This is the first time in history that this service has been made compulsory and local authorities have been permitted to make a charge. Prior to these Regulations coming into operation this Council had, for the past twenty years or more, considered that meat inspection was an essential part of public health work, and the Public Health Inspectors had always endeavoured to carry out 100 per cent. inspection in spite of the long hours of duty involved. These Regulations contain certain requirements that the meat trade must comply with in order to facilitate the inspections. They also contain detailed instructions regarding the method of inspections and procedure to be adopted, and require the inspectors to mark all carcases that have been passed as fit for human consumption with an official stamp, this naturally places a great responsibility °n the inspector. page 57 In the Schedule annexed to the Regulations, there are no less than 37 diseases and pathological conditions which can render a carcase unfit and the inspector must be conversant with all these. Ministry regulations do not provide for any restrictions being placed in regard to time of slaughtering and due to the traditions of the trade our Public Health Inspectors are obliged to undertake late evening and week-end duties on a rota system for which the Council makes an allowance of £70 each per annum. Slaughtering takes place in the Borough on seven days a week and the Public Health Inspectors attend the slaughterhouses late in the evenings and on Saturdays and Sundays to ensure that 100 per cent. inspection of all meat produced in the Borough in maintained. During the year under review 1,391 such visits were made. During this period a total of 58,698 carcases were inspected, and a total of 10 tons 11 cwts. 30 lbs. of meat was found to be unfit for human consumption. Table 12 sets out the particulars of animals slaughtered and inspected, together with details of condemnation. Cystieercus Bovis During the year 10 beasts were found to be infectcd with C. Bovis, these are sub-divided as follows:— 3 Cattle (ex Cows) lesions in the heart muscle 3 Cattle (ex Cows) lesions in the cheek muscles 4 Cows lesions in the cheek muscles No generalised cases were found and after condemnation of the affected parts, the carcases were subjected to cold storage treatment for the required period. Export of horse-flesh In addition to meat inspected for home consumption, horse carcases are inspected for export to Belgium, this inspection has to satisfy the requirements of the Belgian Government, and each consignment of horse-flesh has to be accompanied by an official certificate signed by the inspector, who has examined and passed the meat. These certificates as well as official labels are provided by the Ministry of Agriculture, Fisheries and Food and have been approved by the Belgian Government. page 58 Meat Additives During the year it was found that some butchers were using a proprietary chemical compound to add to meat in order to keep it bright and enhance the red colouring. This compound was mainly used in minced beef or on the cut surfaces of joints. Samples of minced beef that had been treated with this compound were submitted for chemical analysis, when it was found that the meat contained excess quantities of nicotinic acid, which could prove harmful when eaten. As a result of this, local butchers were advised not to use this additive and a quantity of it was surrendered to the Council. By coincidence some other authorities discovered this at the same time and as a result of certain publicity and approaches that were made to the Ministry of Agriculture, Fisheries and Food, the Ministry have made Regulations prohibiting the use of compounds of this nature. Pretenderised Beef Whilst on the subject of meat inspection, comment should be made regarding a new practice introduced into this country which has caused a considerable amount of controversial discussion. The practice is that of tenderising beef by the injection of Papain into the jugular vein of the animal about half hour before slaughter. Papain is an enzyme extraction from the Paw Paw fruit. When applied meat it acts on the protein molecules and makes the meat more tender than it would otherwise have been. It has been used for a number of years by Chefs sprinkling it on steaks prior to cooking but this method only acts on or near the surface. The new process consists of injecting a concentrated preparation of Papain into the blood stream of the live animal. The blood distributes the enzyme throughout the body tissue, so that when the animal is slaughtered all the meat contains small quantities of the enzyme which tenderises the meat on cooking. This treatment does not alter the appearance or the flavour of the meat, it only makes it more tender. page 59 It is held that this treatment cannot have any effect on the human being as the enzymes are destroyed by normal cooking. This treatment is not considered to be an additive to food, and has received the approval of the Ministry of Health and the Ministry of Agriculture, Fisheries and Food. It has however been suggested, by the Foods Standards Committee, that all meat so treated should be labelled accordingly when offered for sale for human consumption. In addition to the slaughterhouses, there are four wholesale butchers and 78 butchers shops in the district. These are all inspected frequently throughout the year. (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 9 Fishmongers 31 Confectioners 122 Grocers 145 Greengrocers 73 Hawkers 64 Miscellaneous 6 Licensed Premises 54 Cafes 68 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 such inspections were made, 26 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 476 visits were made to food premises mainly on request, for the purpose of dealing with unsound food, and a total quantity of 9 tons 6 cwts. 97 lbs. of food was surrendered as unfit for human consumption. Where possible all unsound food is disposed of for animal feeding, that which is not suitable for this purpose is disposed of by the Cleansing Department. page 60 TABLE 12 CARCASES INSPECTED AND CONDEMNED 1963 Cattle Calves Sheep and Lambs Pigs G oats Horses Deer TOTAL Number killed 2,270 1,634 34,190 20.446 3 156 1 58,700 Number inspected 2,270 1,634 34,190 20,446 3 156 1 58,700 All diseases except Tuberculosis: Whole carcases condemned 13 10 83 62 - 2 - 170 Carcases of which some part or organ was condemned 269 83 567 535 10 1,634 Percentage of the number inspected affected with diseases other than tuberculosis 12.42% 5.70% 1.90% 2.91% - 7.70% - 3.07% Tuberculosis only whole carcase condemned 4 — — 14 - — - 18 Carcases of which some part or organ was condemned - - - 199 - - - 199 Percentage of the number inspected affected with tuberculosis 0.18% — — 1.04% — — — 0.37% page 61 (vi) Food and Drugs Act, 1955 (a) FOOD AND DRUGS AUTHORITY The Council are a Food and Drug 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 food 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 Public Analysts; Dr. J. H. Hamence, F.R.I.C., and Mr. P. S. Hall, F.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 250 informal samples and 3 formal samples were submitted to the analyst, of these only 26 were found to be not genuine. A few of these samples were submitted as a result of complaint, but in the majority of cases the complaints were not confirmed. Informal samples are purchased by the sampling officers in the same manner that the articles would be purchased by an ordinary customer, no indication being given to the vendor that the article is to be subjected to analysis, should the informal samp!? however prove to be not genuine a formal sample is taken and the vendor is notified to this effect and is given one part of the sample for future reference. The original purpose of sampling under the Food and Drugs Act was in order to trace adulteration of foods and drugs Fortunately, this practice is not so common as it used to be in the early part of the century. Sampling nowadays is carried out to ensure that foods and drugs comply with the various legal standards and codes of practice regarding composition, and do not contain any harmful preservatives or colouring matter contrary to t the Regulations on these matters. Also to ensure that the public are not being deceived by mis-descriptions or exaggerated claims on labels or advertisements. page 62 Duplicity of sampling by local authorities is difficult to control, but fortunately as far as this area is concerned, consultations are held at regular intervals with the adjoining authorities, where information on sampling is exchanged and duplication is therefore reduced to a minimum. As will be seen from Table 13, a wide variety of foods were sampled during the year. The number of samples reported as being unsatisfactory was rather high in comparison with previous years, as already stated thirteen of these arose as the result of complaints, which were made to the department by members of the public and ten other samples were considered to be unsatisfactory as they were incorrectly labelled. The following comments are made regarding the unsatisfactory samples:— Bread Three samples of bread were submitted to the public analysts following complaints that they contained foreign mailer. In all cases the foreign bodies, although objectionable, proved not to be harmful. Each case was taken up with the manufacturers with satisfactory results. Bread Rolls Five bread rolls were submitted for analysis following the discovery of blackish pellets embedded in the bread. It was confirmed that these pellets were in fact rodent excreta. f he matter was reported to the Public Health Committee who authorised legal proceedings against the manufacturers. Unfortunately the manufacturer went out of business before the summons could be served and the case was not proceeded with. Beef Milano The meat content of this sample was only 18 per cent., the analyst was of the opinion that a canned meat product of this description should contain at least 35 per cent. meat. page 63 This matter was taken up with the manufacturers who agreed to modify the labels for this product, they also stated that they were awaiting guidance from the Food Standards Committee on meat products. Cream Horn (Artificial) This sample was submitted as the result of a complaint. The analyst confirmed that there was mould growths in the artificial cream filling and that the fat constituent of the cream was rancid. He expressed an opinion that the cream horn was unfit for human consumption. This complaint was reported to the Public Health Committee who resolved to prosecute the manufacturer. Cream Iced Cake This sample was submitted as the result of a complaint that it contained a small blackish cylindrical body resembling rodent excreta. The analyst reported that the foreign body consisted essentially of a mass of charred dough and there was no evidence of rodent excreta. No further action was taken. Chicken Supreme One can of Chicken Supreme was submitted to the analyst as an informal sample. The analyst reported that this consisted of a mixture of chicken and vegetables in a white sauce, and was found to contain only twenty per cent. meat. He expressed an opinion that the meat content was low for such an article and stated that in his opinion the meat content should be at least 35 per cent. This matter was taken up with the manufacturers, who expressed surprise, and stated that they endeavoured to maintain a good quality article, and requested that further sample be taken as a cross-check. Two further samples were taken, each sample consisting of three cans each from two different batches, and the code numbers on each can were noted. page 64 The three cans constituting one sample were found to have meat contents of 31, 28 and 26 per cent. respectively, all being below the recommended minimum of 35 per cent. The three cans in the other sample had a meat content of 49, 39 and 55 per cent. respectively, all above the minimum requirements. The manufacturers were again contacted and were very concerned at the varying results of the samples. The fault was eventually traced to faulty mixer and filling machines. Fruit Salad (Tinned 2) (a) One sample of fruit salad was found to be unsatisfactory owing to the pulped condition of the fruit, and the analyst stated that in his opinion this article was no longer suitable for sale. This was an imported article, and the main distributors were contacted, on being informed of the analysts report they agreed to withdraw this particular consignment. (b) A further sample of fruit salad was found to have rather a high tin content of 220 parts per million which was just below the permissable amount of 250 parts per million. Two further samples from the same batch were submitted and these were found to have a tin content of 182 and 78 parts per million respectively. The suppliers were advised that the stock should be used up as soon as possible, since the slow dissolving of the tin content of the container by the contents was a continuous process. Hamburgers with Gravy This canned meat product was found to contain only 47 per cent. of meat. The analyst was of the opinion that this percentage of meat was low for an article described as "Hamburgers with Gravy." The low meat content of this article again emphasised the urgent need for official standards of meat content for commodities of this nature. page 65 Ice Cream One informal sample of ice cream was found to have a fat content of 4.3 per cent. The Food Standards (Ice Cream) Regulations, 1959, prescribe that ice cream shall contain a minimum of 5.0 per cent. fat. This sample was therefore deficient in fat to the extent of 14 per cent. of the prescribed minimum. A follow up formal sample proved to be satisfactory. Minced Beef This sample of minced beef had been heated with one of the proprietory preparations, containing Nicotinic Acid and Ascorbis Acid, which have been used by retail butchers to preserve the natural red colouring of meat. This sample was found to contain:— Nicotinic Acid 125 milligrams per 100 grams Ascorbic Acid (Vitamin C) 13 milligrams per 100 grams The analyst reported that in his opinion the proportion of nicotinic acid present in this sample was excessive, being approximately 2½ times the minimum therapeutic dose. Therapeutic doses of nicotinic acid are known to give rise to a sensation of heat and flushing, particularly of the face. In this case, the butchers concerned surrendered all meat that had been treated with this preparation, and also surrendered the remaining stock of the preparation, and undertook not to use this or any similar preparations. As reported earlier in the section regarding Meat Inspection, it is gratifying to report, that following representations made to the Ministry of Agriculture, Fisheries and, ood, by various organisations, the Minister has now made Regulations forbidding the use of preparation of these substances with fresh meat. Pork Sausages One sample of pork sausages was reported as being unsatisfactory as it contained only 59 per cent. meat. The Society of Public Analysts are of the opinion that pork sausages should contain at least 65 per cent. meat. page 66 Unfortunately, since the end of the last war, there has been no legal standard for the percentage of meat content for sausages. It would be of considerable assistance to local authorities if the Food Standards Committee would recommend a prescribed standard of meat content for sausages to the Minister. Labelling of Food A number of samples were taken where it was found that the labels on the containers were not satisfactory, and did not comply with the Labelling of Food Order, inasmuch as the labels did not bear a true statement of the ingredients of the article or that the food was mis-described, thereby being liable to mislead the purchaser as to the true nature of the food in the container. The most outstanding of these were:— Pasteurised Cream Cheese with Strawberry The sample was found to consist of cream cheese and a strawberry preparation containing 10 per cent. added sugar. There was no indication on the label that this preparation contained sugar. French Beans This sample on analysis was found to consist of dehydrated french beans containing sulphur dioxide within the prescribed limits. To comply with the Order, this article should have been described as "Dehydrated French Beans" and not merely "French Beans" as stated on the label. Peas This sample was similar to that of the french beans and should have been described as "Dehydrated Peas" or "Quick Dried Peas "and not merely as "Peas" as stated on the label. page 67 Mushroom Salad Mushrooms Neither of the samples had a correct list of ingredients on the labels. The Mushroom Salad was found to consist essentially of mayonnaise containing small pieces of chopped mushroom, the mushroom content being 25 per cent. which was considered to be low for an article of this nature. German Caviar (Mock) This sample consisted essentially of lump fish roe, coloured with an artificial colouring matter. This was another case of unsatisfactory labelling in that no statement of ingredients were printed on the label. All these matters were taken up with either the manufacturers or distributors. The English manufacturers were very co-operative when approached and in every case agreed to have new labels printed in order to comply with the requirements of the Labelling of Food Order, in most cases copies of the new labels were submitted to this department for approval. Unfortunately some of the articles were produced abroad and proved a little difficult to deal with, but in most instances the shippers undertook not to accept future consignments where the labels were not in compliance with the Labelling of Food Order. (vii) Food Hygiene Regulations, 1955 The Public Health Inspectors continue to devote a con iderable 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 page 68 tion of the occupier and the need for improvement explained, 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 biscuit 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 enclose.! and service is only made from behind a screened counter. It is pleasing to report that during the past year, several of the stalls seiling open food have been modernised to comply with the Regulations. As egards 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 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. page 69 TABLE 13 SUMMARY OF SAMPLES TAKEN FOR ANALYSIS DURING THE YEAR 1963 Article Number examined Result of Analysis Formal Informal Total Genuine Not Genuine Almonds, Ground — 1 1 1 — Apple and Orange Drink — 1 1 1 — Apple Pie — 1 1 1 — Apricot Sponge — 1 1 1 — Aromat Flavouriser — 1 1 1 — Bakewell Tart Mixture — 1 1 1 — Baking Yeast — 1 1 1 — Batter and Pancake Mixture — 1 1 1 — Beef and Kidney Pie — 1 1 1 — Beef and Steak Pudding — 1 1 1 — Beef Suet — 1 1 1 — Beef Milano — 1 1 1 — Beef Savouries in Gravy — 1 1 1 — Better Flour — 1 1 1 — Beetroot with Vinegar — 1 1 1 — Biscuits — 1 1 1 — Bitter Lemon — 1 1 1 — Blackcurrant Drink — 1 1 1 — Blackcurrant Juice — 1 1 1 — Blanc-mange Powder — 1 1 1 — Bolognese Sauce — 1 1 1 — Bramble Jelly — 1 1 1 — Butter — 4 4 4 — Bread — 3 3 - 3 Bread Rolls — 1 1 — 1 Bread Sauce — 1 1 1 — Candy Cup - 1 1 — 1 Chandy — 1 1 1 — Cheese, Cottage — 1 1 1 — Cheese Spread — 1 1 1 — Cherries — 1 1 1 — Chicken Supreme — 3 3 2 1 Chicken Curry, Indian - 1 1 1 — Chili Beef with Beans - 1 1 1 — Chocolates — 1 1 1 — Chocolate Coated Sultanas — 1 1 1 — Christmas Pudding — 1 1 1 — Coating Batter Mixture — 1 1 1 — Cocktail Onions — 1 1 1 — Coffee — 3 3 3 — Coffee and Chicory Essence — 1 1 1 — Coffee, French — 1 1 1 — Coffee Cup — 1 1 1 — Corned Beef ... — 1 1 1 — Cream — 5 5 5 — Cream Horn — 1 1 — 1 Cream Double — 3 3 3 — Creamed Ice Cake with Foreign Body - 1 - - 1 Creamed Smatana - 1 1 1 - page 70 page 71 TABLE 13—continued Article Number examined Result of Analysis Formal Informal Total Genuine Not Genuine Cultured Butter Milk Drink - 1 1 1 - Cuslard Powder — 1 1 1 - Drinking Chocolate — 1 1 1 - Dripping - 1 1 1 - Flour 2 2 2 - French Beans 1 1 1 - Frisch Ei Mayonnaise 1 1 1 - Fruit Salad 6 6 5 1 Fruit Sauce 1 1 1 - Gelatine 1 1 1 - German Caviar 1 1 - 1 Golden Orange Drink 1 1 1 - Gooseberry Fruit Pie 1 1 1 - Grapefruit Juice 1 1 1 - Gravy Browning 1 1 1 - Halva Supreme 1 1 1 - Ham and Beef Roll 1 1 1 - Hamburger with Gravy 2 2 1 1 Home Bread Mix 1 1 1 - Ice C ream 3 8 11 10 1 Ice Pops — 1 1 1 - Ice Lollies — 7 7 7 - Ice Lolly Mix — 1 1 1 - Icing, Easy — 1 1 1 - Instant Milk Set 1 1 1 - Jam - 1 4 1 - Jelly - 1 1 4 - Lamb Shoulder - 1 1 1 - Lard - 4 4 1 - Lazy Garlic - 1 1 4 - Lemonade Chandy — 1 1 1 - Lime — 1 1 1 - Luncheon Meat — 5 5 4 1 Macaroon Biscuit Mix - 1 1 - 1 Margarine - 1 J 1 Mashed Potato, Instant - 1 - - Meat - 1 1 - 1 Meat Pie - 1 1 1 1 Meat 1 enderizer - 2 i 2 - Milk - 15 15 2 15 - Milk, Channel Isles - 3 3 3 - Milk, Top of - 1 1 1 - Milk Shake Syrup - 1 1 1 - Milk Chocolate Mallows - 1 1 1 - Milk, evaporated - 1 1 1 - Minced Beef - 1 1 1 - Mincemeat - 1 1 - 1 Mint in Vinegar - 2 2 2 - Mineral Soda Water - 1 1 1 — Molasses - 1 1 — 1 Morello Cherries - 1 1 1 — Munchy Crunch 1 1 1 — Mushrooms - 1 1 l 1 Mushroom Salad — 1 1 - 1 TABLE 13—continued Article Number examined Result of Analysis Formal Informal Total Genuine enuine Onion Salt - 1 1 1 — Orange Drink — 1 1 1 — Parmesan Grated Cheese — 1 1 1 — Paste — 5 5 5 — Pasteurised Cream Cheese with Strawberry - 1 1 - 1 Pate 1 - — 1 Peas 5 5 3 2 Peas, processed - 1 1 1 — Peanut Butter - 1 1 1 — Pineapple Juice 1 1 1 — Pork Pie 3 3 3 — Prunes in Syrup 1 1 1 — Rice, Boiled 1 1 1 — Rice pudding 2 2 2 — Rice with Liver Soup 1 1 1 — Robert Sauce 1 1 1 — Rolls, Starched Reduced 1 1 1 — Salmon, Fancy Pink 1 1 1 — Savoury Puffs 1 1 1 — Savoury Powder 1 1 1 — Sausages, beef 2 2 2 — Sausages, pork 13 13 12 1 Savor Salt 1 1 1 — Shepherds Pie 2 2 1 1 Shortcake Sweetened Mix 1 1 1 — Slimmers Sugar 1 1 1 — Sliced Roast Beef in Gravy 1 1 1 — Soup Nuts 1 1 1 — Soup 4 4 4 — Spanish Rice 1 1 1 — Spaghetti Sauce Seasoning with imported mushrooms - 1 1 1 — Steak and Kidney Pudding 3 3 2 1 Steak and Kidney Pie 2 2 2 — Steak Pie 1 1 1 — Stewed Steak 1 1 1 — Strawberry Pie Filling 1 1 1 — Stewed Steak with Gravy 1 1 1 — Sucron 1 1 1 —- Sweets 1 1 1 — Toasted Bread 1 1 1 — Toffee Apple Mix 1 1 1 — Tomato and Ham Sauce 1 1 1 — Truffled Sandwich Spread 1 1 1 - Turkey and Ham Pie 1 1 1 - Raspberry and Rose Hip 2 2 2 - Vegetable Shortening 1 1 1 — Vinegar 1 1 1 — Vinegar, Malt 1 1 1 — Walnuts, Pickled - 1 1 1 — Yoghurt — 3 3 3 - 3 250 253 226 27 page 72 (viii) Educational Activities In addition to the routine duties of inspections and observations the Public Health Inspectors continue to give talks and lectures to organisations and wherever possible great stress is laid on food hygiene. At least once during the year a lecture is given to 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 organisations and wherever possible great stress is laid on food 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 The following cases were taken under the Food Hygiene Regulations, 1960. (a) Bakers Premises. 24 offences under Regs. 6, 16, 17, 19, 23 and 24 Fined £72 0s. 0d. (b) Smoking whilst handling open food Reg. 9(e) Fined £2 0s. 0d. 4. CLEAN AIR ACT, 1956 (a) Smoke Control Areas During the year the Council resolved to make the first two "Smoke Control" Orders in the Borough and the Minister of Housing and Local Government confirmed the Orders on 21st May, 1963, to come into operation on the 1st December, 1963. The Orders are known as the Romford (No. 1) Smoke Control Order, 1963, and the Romford (No. 2) Smoke Control Order, 1963. The area covered by the Orders are situated in the Collier Row district in the North West corner of the Borough, the details of each being as follows:— No 1 Area Area covered by Order 622 acres Dwellings—Private 351 „ Council 168 „ Estimated total cost £2,500 Council's contribution £750 page 73 No. 2 Area Area covered by Order 277 acres Dwellings—Private 1,424 „ Council 62 „ Estimated total cost £14,588 Council's contribution £4,276 Prior to these Orders coming into operation, every householder was notified in writing and two copies of the Order were posted in each road within the areas. A public meeting was held in each area at which the householders affected were advised on the requirements of the Order, types of appliances approved for these purposes and also on fuel supplies. The householders were encouraged to ask questions and many problems were discussed. The meetings were very well attended and it is considered that they served a useful purpose. It is gratifying to report that there was extremely good co-operation on the part of the householders affected, and very little opposition was met. Unfortunately one regrets having to report that owing to a shortage of appliances and trained operators to carry out the fixing and adaptations, the whole of the conversions were not completed by the appointed day. However, at the end of the year, the Orders were in operation and no complaints had been received from householders in respect of supplies of smokeless fuel. (b) Atmospheric Pollution Romford is one of 120 towns that have agreed to co-operate with the Department of Scientific and Industrial Research in a National Survey. Five volumetric meter stations have been set up within the Borough and daily recordings are assessed and the results forwarded to the Ministry Department. A monthly bulletin is published showing a comparison between the towns participating. The sites were chosen under direct Ministry guidance and designed to standardise throughout the country the positioning of the meters so that National figures when obtained were from basically similar stations. These stations are set in the following positions:— 1. Residential district with high population density. 2. Residential district with low population density. 3. Industrial District. 4. Business and commercial district. 5. Proposed Smoke control area. page 74 A volumetric meter consists of apparatus capable of extracting from the atmosphere approximately 70 cubic feet of air per day. This air passes through a filter pad to remove the smoke and into a hydrogen peroxide solution to arrest the sulphur dioxide. By reading the stain density on an electrometer concentrations of smoke in microgrammes per cubic meter of air are obtained and by titration the concentration of SO2 is obtained. Daily weather records are required and the Royal Liberty School Meteorological Society are kindly co-operating and supplying these records. These daily recordings by use of the volumetric meter were commenced on the 1st November, 1960. 5. RAINFALL During the year the amount of rainfall recorded at Raphael Park was 21.86 inches. 6. 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. During the year, the boilers at the baths were converted to oil fired in place of solid fuel. An improved method of testing the swimming bath water by tablet has now been developed. page 75 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. It is anticipated that work on this bath will commence in mid 1964. SCHOOL BATHS A number of schools within the Borough are now provided with outdoor swimming baths. These are inspected at regular intervals and samples of the bath water taken for examination. The standard of purity of the water is satisfactorily maintained. 7. 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. 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. 8. HOUSING ADMINISTRATION (a) General Surveys continue to be made in order to deal with sub-standard and unfit houses. During the year 4 unfit houses were demolished, and a further 45 had been represented and were waiting final consideration by the Committee at the end of the year. (b) Council Housing The Public Health Inspectors continue to co-operate with the Housing Department by carrying out inspection of houses, at present occupied by applicants on the Housing List, in order to assess the properties in connection with "points" scheme for sub-standard housing. page 76 TABLE 14 HOUSING STATISTICS FOR THE YEAR 1963 Number of houses erected during the year:— 1. By Local Authority 104 2. By Private Enterprise 157 3. By London County Council (to replace 8 prefabs demolished) 8 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) 3,514 (b) Number of inspections made for the purpose 4,520 2. (a) Number of dwelling houses (including under head 1 above) which were inspected and recorded under the Housing Consolidated Regulations 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 45 4. Number of dwelling houses (exclusive of those reterred to under the preceding sub-head) found not to be in all respects fit for human habitation 826 2. Remedy of Defects during the Year without service of formal notices Number of dwelling houses rendered fit in consequenee of Informal action by the Local Authority or their officers 643 3. Action under Statutory Powers during the Year (a) Proceedings under Section 9, 10 and 12 of the Housing Act, 1957:— (1) Number of dwelling houses in respect of which Notices were served requiring repairs - page 77 (2) Number of dwelling houses which were rendered fit after service of Formal Notices (a) By Owners (b) By Local Authority in default of owners (b) Proceedings under the Public Health Acts:— (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 289 (2) Number of dwelling houses in which defects were remedied after service of Formal Notices (a) By Owners 167 (b) By Local Authority in default of owners 27 (c) Proceedings under Section 16 and 17 of the Housing Act, 1957:— (1) Number of dwelling houses in respect of which demolition orders were made Nil (2) Number of dwelling houses demolished in pursuance of Demolition Orders 4 (3) Number of demolition orders revoked - (4) Number of Closing Orders made - (5) Number of Closing Orders revoked 1 (d) Proceedings under Section 18 of the Housing Act, 1957:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been made fit Nil page 78 4. Housing Act, 1957, Part IV—Overcrowding (a) (1) Number of dwellings overcrowded at the end of year 12 (2) Number of families dwelling therein 17 (3) Number of persons dwelling therein 88 (b) Number of new cases of overcrowding reported during year — (c) (1) Number of cases of overcrowding abated during the year - (2) Number of new cases of overcrowding relieved during the year Nil (3) 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 During the year the Public Health Inspectors made 75 inspections in connection with the requirements of this Act. These inspections dealt with applications for Certificates of Disrepair, checking 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 4 Number of Certificates cancelled 2 Number of Undertakings accepted 7 Number of applications for Certificates as to remedying of defects, "Form O" 3 Number of Certificates as to remedying of defects:— Granted "Form P" 3 Refused Nil page 79 SHOPS AND OFFICES Mr. S. F. Titterton, D.S.A.A., the Council's Shops Inspector, who works under the supervision of the Chief Public Health Inspector has submitted the following report on the various duties for which he is responsible. Shops Act, 1950 This Act consolidated a series of measures from 1912-1938 and made no change in the law. It provides for the statutory closing hour of shops (much in the news now that the Government has decided to end Resale Price Maintenance) early closing days, restrictions on the opening of shops on a Sunday, maximum working hours of young persons and some health and welfare facilities. More than fifty years ago, the principle part of the Act came into force and placed for the first time a definite responsibility on the Local Authority to enforce the law. Conditions of employment for shop workers have improved much since then but the act still affords a valuable protection. A routine inspection to one shop revealed that the only employee worked on every day of the week and was not given a weekly halfholiday or allowed compensatory time for working on a Sunday. Housing accommodation went with the job. Several enquiries were made by employees regarding the midmorning and afternoon tea breaks (assumed to be a statutory obligation) but were advised that the law is the same as it was when enacted in 1912 and that they would only be entitled to a break of twenty minutes during a working spell of six hours or five hours in respect of young persons and half-hour for tea if the employment goes beyond 7 p.m. In most shops, one hour must be allowed for dinner between 11.30 a.m. and 2.30 p.m. The working spell laid down in the Act does seem to be out of line with the accepted practice of most employers. Incidentally, office workers have no statutory right to a meal break, so at any rate, the shop worker is better off in this respect. The employment of young persons received considerable attention throughout the year and none were found to be exceeding the permitted hours, 44 hours for those under 16 years and 48 hours for those between the ages of 16-18 years. However, many do work these hours, in particular at petrol service stations, hairdressing and page 80 catering establishments. Some parents complained that young people were being employed more than 40 hours a week and thought is was wrong they should be so employed when adults often work less. The national working week is 42 hours. The maximum working week laid down in the Act is no longer justified. The Gowers Committee of 1949 recommended an adjustment of these hours to include juveniles employed in offices. "The Inspector" the official journal of the Institute of Shops Acts Administration has reported some disturbing results of prosecutions in which young persons were involved. In one case a boy was employed in a butcher's shop for 62 hours and at a petrol service station boys were employed throughout the night. Official Notices may be informative but appear to have no inspiration to teenagers, at least this was the impression of the Inspector when he called at a ladies' hairdressing establishment. The staff had removed the Shops Acts notices from the wall, hid them where they could not be found and substituted in their place photographs of their favourite pin-ups the "Beatles." The Inspector pointed out the legal requirements and on re-visiting the premises found the notices neatly displayed edged with pin-ups. The Inspector was asked if this was all right and replied "Both the notices and pin-ups can be readily seen, Inspectors are not all that square." The Act, with its limitations, has been enforced as can be seen in the schedule of this report. Offices, Shops and Railway Premises Act, 1963 This Act is a measure which brings the working conditions in shops and offices into line with those enforceable in factories. It replaces certain enactments under the Public Health and Shops Acts which fell short of proper standards and places a duty of Local Authorities to enforce. Owners of Buildings and employers are legally responsible for complying with the requirements of the Act from the dates the various sections come into force. The Minister has made an Order bringing the main provision of the Act into force on the 1st August, 1964, and that employers must register their premises with the appropriate Authority during the period 1st May to 31 st J uly and new occupations after this date. page 81 Owners and employers will be required to observe the following requirements as to safety, health and welfare:— Cleanliness Overcrowding Temperature Ventilation Lighting Sanitary conveniences Washing facilities Supply of drinking water Accommodation for clothing Sitting facilities and seats for sedentary work Eating facilities (shops) Floors, passages and stairs Fencing of exposed parts of machinery Exposure of young persons to danger in cleaning machinery Training and supervision of persons working at dangerous machines Prohibition of heavy work First Aid Fire precautions and means of escape Notification of Accidents. The Minister has power to make Regulations and is now in the process of making them in respect of :— 1. Sanitary conveniences 2. Washing facilities 3. Dangerous machines 4. First Aid 5. Fire 6. Accidents and annual reports. The Minister has also exercised his powers on the appointments of Central Government Inspectors whose duty will be to consult and advise Local Authorities so as to secure unformity of enforcement. It is estimated that there are one million premises affected by the Act covering some eight million workers, a formidable task which page 82 inevitably will require more inspectors and clerical staff, if it is to be carried out in accordance with the enforcement provisions. Consumer Protection Act, 1961 This Act gives the Secretary of State power to make Regulations on safety requirements and instructions on Certain Goods likely to cause death or personal injury. There are two sets of Regulations in force, the Heating Appliances (fire-guards) Regulations 1953 and the Oil Heaters Regulations, 1962. Twelve visits were made to shops where these goods are sold and of those appliances examined none were found not to comply with the Regulations. With the ever increasing number of deaths and injuries caused to children by burning and in particular the use of inflammable children's nightwear, the Government has decided to make a further Regulation under this Act banning their use unless made in conformity with a B.S.I. standard which will come into force before the winter of 1964. In view of the wide publicity given to this problem, many retailers have agreed not to sell any children's nightdresses unless conforming to a standard of safety. It is to be regretted that when the Government had the Oil Heaters Regulations, 1962, they did not fix a time limit for the sale of these appliances manufactured before the 1st June, 1962, as they did when making the Heating Appliances (fire-guards) regulations, . 1953. In a BBC broadcast, the Medical Officer of Health for the Metropolitan Borough of Stepney, highlighted the problem of the second-hand oil heater especially those manufactured before the Regulation came into force which are easily purchased from street markets and second-hand dealers. Many of these sub-standard heaters have been responsible for fires and loss of life. The Romford Home Safety Committee have also considered this problem and are much concerned. page 83 TABLE 15 SHOPS ACT, 1950 (a) Inspections 2,046 inspections and observations were carried out for various purposes under the Act, during the year. The following contraventions were noted:— (i) Early Closing Day Failing to exhibit notice 23 Failing to close shop for serving of customers 3 Failing to observe the Regulations 3 (ii) Evening Closing Hours Failing to close shop for serving of customers 4 (iii) Sunday Trading Failing to close shop for the serving of customers 11 Failing to observe the Regulations 14 (iv) Conditions of Employment Failing to exhibit Notice as to Assistants Weekly Half-holidays 24 Failing to allow Assistant a weekly half-holiday 3 Failing to allow proper intervals for meals and rest 1 Failing to exhibit Abstract of Act, and keep records of hours worked by young persons 42 Employment of young person after 10 p.m. 1 Failing to keep records of Sunday employment 1 page 84 (v) Health and Welfare Seats not provided for use of shop assistant 1 Failing to give notice of intention to use seats provided 3 Absence of, or unsatisfactory sanitary accommodation 4 Unsatisfactory temperature 1 Unsatisfactory facilities for taking of meals 1 Obstruction of fire escape route 2 (b) Legal Proceedings Offence Section Result 1. Failing to close shop on Sunday 47 Fined £10 0s. 0d. second offence 2. Failing to close shop on Sunday 47 Fined £5 0s. 0d. Costs £1 1s. 0d. 3. Aiding and Abetting an offence 47 Magistrates Court Act, 1952 Fined £5 0s. 0d. page 85