15 Chigwell Urban District Council. ANNUAL REPORT of the Medical Officer of Health Including the Report of the Senior Sanitary Inspector, For the Year ending December 31st, 1939. BUCKHURST HILL: Printed by John W. Phelp, Queen's Road. 1 CONTENTS OF THE REPORT FOR 1939. PAGES. Report—Medical Officer of Health's Letter 1—2 Air Raid Precautions 2 Public Health Committee 3 Public Health Staff 3—4 Statistics and Social Conditions of the Area 4—5 Vital Statistics 5 — 6 Analysis of Deaths according to age incidence 6 Number of Deaths by Years 6 Causes of Deaths 6 Comparative Table, Birth and Death Rates 6 Table of Birth Rates, Death Rates and Analysis of Mortality 7 General Provisions of Health Services in the District 8 Ambulance Calls 8 Sanitary Circumstances of the Area 9—10 — 11—12—13 Housing Statistics for the Year 13—14 Housing Act, 1936 15 — 16 Inspection of, and Supervision of, Food 16—17—18—19 Shops 19—20 Inspection of Factories, etc. 21 Prevalence of, and Control over, Infectious Diseases 22—23 — 24 Bacteriological Investigations 24 Summary 25 Meteorological Record—Rainfall 26 CHIGWELL URBAN DISTRICT COUNCIL To the Chairman and Members of the Chigwell Urban District Council. Mr. Chairman, Ladies and Gentlemen, I beg to present the Annual Report for the year 1939 upon the health and sanitary circumstances of the district. It is appropriate here to record that Dr. C. R. Dykes retired in May of the year under review, after 38 years of service, from 1905— 1933 as Medical Officer of Health to the Buckhurst Hill Urban District Council and subsequently from 1933—1939 as Medical Officer of Health of the Chigwell combined district. At the meeting of the Council held in June, the Chairman referred to Dr. Dykes long and loyal service and wished him many years of happiness. CHIGWELL URBAN DISTRICT COUNCIL. With the Compliments of the Medical Officer of Health. Council Offices, Old Station Road, Loughton, Essex. 2 My personal thanks are due to Dr. Dykes for his friendly help and co.operation on taking over my new duties and also to the staff of the Public Health Department for their assistance in compiling this report. A.R.P. Since the outbreak of war, a large amount of the time of the Public Health Staff has necessarily been taken up with A.R.P. duties. A summary of the personnel and organisation of the casualty services in the first months of the war is given below:— Officer in charge of the Casualty Services Medical Officer of Health. Officer in charge of Decontamination Mr. Heath, Senior Sanitary Inspector. Ambulance Officer Mr. Ellis, Temp. Assist. Sanitary Inspector. Officer in charge of Stretcher Bearers Mr. N. F. Brunt. First Aid Posts were established as follows:— Loughton. M.O. in charge. Sister in charge. Roding Road School Dr. Hamill Mrs. Kearney Staples Road School Dr. Bell (Sept.—Nov.) Mrs. Platten Dr. Matland (from Nov.) Chigwell. Great West Hatch Dr. Anderson Mrs. Williams (S.R.N.) Buckhurst Hill. The Clinic, Dr. Voller Miss Bishop Buckhurst Way Mobile First Aid Unit Dr. Roberts. Mrs. Ashwell (S.R.N.) Transport Officer Councillor Perry In March, 1939, Mr. W. H. Digweed, Assistant Sanitary Inspector, was seconded for duty as A.R.P. Officer and Mr. E. A. Ellis appointed Temporary Assistant Sanitary Inspector in his place. I am, Your obedient Servant, L. S. FRY, M.D., D.P.H. 3 CHIGWELL URBAN DISTRICT COUNCIL. PUBLIC HEALTH COMMITTEE Owing to the National emergency, the Public Health Committee has been incorporated with the General Purposes, Finance, Housing and Town Planning and Valuation Committees and constituted as No. 2 Committee. (As at 31st December, 1939). Chairman: Councillor F. S. Foster, J.P., C.C. Vice.Chairman: „ H. Spurr. Members: Councillor J. G. S. Ambrose. „ A. W. Golightly. „ N. H. Hedges. „ E. G. Perry. ,, B. G. Platten. ,, J. Seabrook. „ T. E. Moore. ,, S. G. Weaver, F.C.A. „ E. Sutton.Pryce. Meeting. First Tuesday in each month except April and August. PUBLIC HEALTH STAFF. Medical Officer of Health: C. R. Dykes, M.R.C.S., L.R.C.P. (January 1st—May 31st, 1939). L. S. Fry, M.D., D.P.H. (June 1st—December 31st, 1939). Senior Sanitary and Petroleum Inspector: J. T. Heath, M.R.San.I., M.S.I.A. Royal Sanitary Institutes Certificates for:— (i) Sanitary Inspector. (ii) Inspector of Meat and Other Foods. Sanitary Inspector: W. H. Digweed, A.R.San.I., M.S.I.A. (Seconded to Air Raid Precautions). Royal Sanitary Institute and Sanitary Inspectors Joint Board Certificate. Royal Sanitary Institute Certificate for Inspector of Meat and Other Foods 4 Temporary Assistant Sanitary Inspector: E. A. Ellis, A. R.San.I. Royal Sanitary Institute and Sanitary Inspectors Joint Board Certificate. Royal Sanitary Institute Certificate for Inspector of Meat and Other Foods. Clerk: Miss J. Warriner. Medical Officers of Welfare Centres: Buckhurst Hill: C. R. Dykes, M.R.C.S., L.R.C.P. Chigwell and Loughton: I. M. Bell, M.B., Ch.B. Health Visitors: Buckhurst Hill : Miss R. Bartter, S.C.M., R.S.I. Chigwell: Miss S. J. Myers, S.R.N., S.C.M., R.S.I. Loughton: Miss E. Glover, S.R.N., S.C.M., R.S.I. Midwives practising in the Area:—County Council 3 District Nurse Midwives 2 Independent — Number of Registered Nursing Homes — Midwives: Buckhurst Hill: Miss R. Bartter, S.C.M., R.S.I. Chigwell: Miss F. E. Guise, S.C.M. Loughton: Miss G. H. Quill, S.C.M. Assistant for Buckhurst Hill and Loughton: Miss G. Jones, S.R.N., S.C.M. Section A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 8,970 (14 sq. miles approx.). Population (30th June, 1939) Reg. Gen. Figures—25,500 (estimated). Number of inhabited houses 7,480 Number of separate families or separate occupiers, not available. Rateable Value £240,192 Sum represented by a Penny Rate £920 The population has increased by 1,350 (estimated) during the year. Last year the increase was 1,140. This again, as last, is almost entirely due to the occupation of new property. The rateable value has increased by over £20,000, as against £13,000 in 1938. The sum obtained from a Penny Rate has also increased by £70. The rate in the pound for 1939/40 was 13/7. 5 The information regarding unemployment for 1939 has been supplied by the Ministry of Labour and shows a slight increase as compared with last year. The figures relate to the district for which the Exchange operates, of which, the Chigwell Urban District is only a part. Men. Women. Boys. Girls. total. Total Unemployed, 1938 522 89 7 3 621 Temporarily suspended from work 4 6 1 0 11 526 95 8 3 632 Total Unemployed, 1939 383 258 23 26 690 VITAL STATISTICS. Male. Female. total. Live Births. Legitimate. 210 200 410 Illegitimate. 2 4 6 Total 416 Birth rate per 1,000 of estimated resident population 1939. 1938. 16.57 17.09 Male. Female total. Still Births. Legitimate. 7 6 13 Illegitimate. 1 — 1 Total 14 1939. 1938. Rate per 1,000 total (live and still) births 3255 21.68 Male. Female. TOTAL. Deaths 111 99 210 Death Rate per 1,000 of estimated resident population (corrected) 1938. 1939. 8.97 8.09 Deaths from Puerperal Causes. 1938. 1939. Puerperal Sepsis 0 0 Other Puerperal Causes 2 1 2 1 Deaths of Infants Under 1 Year 1938. 1939. Legitimate. 10 9 Illegitimate. 1 1 6 Death Rate of Infants Under 1 Year of age: 1938. 1939. All Infants per 1,000 live births. 27 24 Legitimate Infants, per 1,000 Legitimate births. 25 22 Illegitimate „ „ „ Illegitimate ,, 8.33 167 1938. 1939. Deaths from Cancer (all ages) 43 38 ,, „ Measles (all ages) 1 0 „ ,, Whooping Cough (all ages) 0 0 „ ,, Diarrhoea (under 2 years) 3 1 Analysis of Deaths according to Age Incidence. No. of Deaths. Age. 1939. 1938. 1937. 1936. 1935. Under 1 year 1 and under 11 11 8 18 2 2 — 3 1 1 2 2 „ „ 5 1 2 3 — 1 5 „ „ 15 9 3 2 5 4 15 „ „ 25 9 3 2 7 4 25 „ „ 35 5 10 10 7 8 35 „ „ 45 16 14 13 9 11 45 „ „ 55 12 28 24 16 13 55 „ „ 65 36 33 30 26 42 65 „ „ 75 48 58 58 36 48 75 and upwards 63 57 51 69 44 Total 210 222 202 194 179 COMPARATIVE TABLE OF BIRTH AND DEATH RATE. Year. Estimated Population. Number of Births. Rate per 1,000. N umber of Deaths. Rate per 1,000 (Corrected) Infant Mortality. Number of Deaths. Rate per 1,000 (Live Births). 1935 19,460 266 13.66 179 7.8 2 7.5 1936 20,780 295 14.19 194 8.95 18 61 1937 22,510 319 14.17 202 8.57 8 25 1938 23,750 406 17.09 222 8.97 11 27 1939 25,100 416 16.57 210 8.09 10 24 TABLE IX.—Birth.rates, Death.rates and Analysis of Mortality in the year, 1939. England and Wales, London, 126 Great Towns, and 148 Smaller Towns. (Provisional Figures, based on Weekly and Quarterly Returns). rate per 1,000 Population. Annual Death-Rate per 1,000 Population. Rate per 1,000 Live Births. Live Births. Still Births. All Causes. Typhoid and Paratyphoid Fevers. Small.pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Influenza. Diarrhoea and Enteritis (under 2 years). Total Deaths under One Year. England and Wales 15.0 0.59 12.1 0.00 0.00 0.01 0.01 0.03 0.05 0.21 4.6 50 126 County Boroughs and Great Towns, including London 148 0.59 12.0 0.00 0.00 0.01 0.00 0.03 0.05 0.19 6.3 53 148 Saller Towns (Esti- mated Resident Popula- tions 25,000 to 50,000 at Census 1931) 15.6 0.57 11.2 0.00 0.00 0.01 0.00 0.02 0.04 0.20 3.0 40 London 12.3 0.44 11.9 0.00 0.00 0.00 0.00 0.03 0.02 0.18 8.2 48 Chigwell U.D.C. 16.57 0.55 8.09 0.00 0.00 0.00 0.00 0.00 0.08 0.24 6.97 24.04 Puerperal Sepsis. Others. Total The maternal mortality rates for England and Wales are as follow per 1,000 Live Births 077 2.16 2.93 „ ,, Total Births 074 2.08 2.82 Chigwell Urban District Council (Live and Still). „ „Live Births 0.00 2.4 2.4 ,, ,, Total Births (Live and Still). 0.00 2.32 232 8 Section B. GENERAL PROVISIONS OF HEALTH SERVICES IN THE DISTRICT. 1. ( i) Public Health Officers of the Authority—See page 2. (ii) (a) Laboratory facilities. Under arrangements made by the Essex County Council. (b) Ambulance facilities—no change. Number of ambulance calls received during the year, 215, as against 195 in 1938. List as follows:— AMBULANCE CALLS. Month. Number of Calls. Accident or other reason. Urgent Medical. January 17 7 10 February 15 8 7 March 14 5 9 April 15 10 5 May 22 15 7 June 22 18 4 July 20 12 8 August 24 14 10 September 24 17 7 October 20 13 7 November 8 6 2 December 14 9 5 215 134 81 (c) Nursing in the home. No change. (d) Clinics and Treatment Centres. No change. (e) Hospitals, Public and Voluntary. No change. 2. (i) Midwifery and Maternity Centres. Administered by the Essex County Council. There is a Child Welfare Centre in each ward in the district: Buckhurst Hill: The County Council Clinic, Buckhurst Way. Chigwell: St. Winfred's Church Hall. Loughton: Union Church Hall, High Road. All these centres have worked satisfactorily during the year. 9 ESSEX COUNTY COUNCIL ACT, 1933. List of Establishments for Massage or Special Treatment. These establishments are licensed to 31st March, 1940. Miss E. Mackern, 45, Church Hill, Loughton. Miss C. Dewar, 100, High Road, Loughton. These premises have been inspected and are being carried on in a satisfactory manner. Section C. SANITARY CIRCUMSTANCES OF THE AREA. 1. (i) Water— The water supply for almost the whole district is derived from the Metropolitan Water Board. This supply is very satisfactory both in quality and quantity. There are a few isolated houses where the supply is from wells. (ii) Drainage and Sewerage— The new outfall works at Luxborough were brought into operation towards the end of the year, and the whole of the new intercepting sewer between Debden Green and Luxborough having been completed, the old works at Loughton, Buckhurst Hill and Debden have been put out of service, except for the treatment of a small flow from part of the Station Estate at the Loughton works. This will cease when the Roding Road Pumping Station alteration and enlargement can be proceeded with and completed. Pumping Stations at Rous Road and Monkhams Estate, Buckhurst Hill, have been dispensed with, the flow previously lifted now gravitating by the new sewer. The building of a Manager's House and Staff Cottages at Luxborough Works, and the erection of proper offices, laboratory, etc., all of which formed part of the complete scheme, have been deferred on accouut of financial restrictions imposed as a result of war conditions. 10 The only other sewage works in the area is now the small plant at Millers Lane, Chigwell Row. A scheme for reconstruction and improvement has been deferred on account of the war, but minor modifications have been made and the works have given a satisfactory effluent. Grange Hill Pumping Station has been completed and put into service during the year and the works at Grange Hill, as also the small L.N.E.R. works adjoining, have been dispensed with by connections to the new sewer laid and delivering to the pumping station. With the discontinuance of the use of Loughton works, the chlorination plant there has been removed. During the period it was in service it had exercised a very beneficial effect on the effluent from the overloaded works. 2. Rivers and Streams— The River Roding is the only one passing through the centre of the district dividing the wards of Chigwell on the south east side and Buckhurst Hill and Loughton on the north west side. There are no buildings at present in the area liable to floods and this is under the jurisdiction of the Roding Catchment Board. 3. (i) Closet Accommodation— A few closets on the conservancy system remain in Chigwell and Loughton Wards. They are situated in remote cottages out of the reach of sewers. (ii) Public Cleansing— House refuse is removed weekly by covered motor vans under contract. The refuse is disposed of at the contractors own tip near the district boundary, the contract requiring that the precautions and methods of controlled tipping shall be adopted. Butchers' offal and refuse from fish shops is disposed of at the tip adjoining Loughton Sewage Works, being delivered there by the tradesmen and dealt with under the Engineer and Surveyor's instructions. A small charge is made for the facilities given. Putrescible refuse from greengrocers' shops is deposited at this tip also but is dealt with without charge. Road gullies (in streets under the Council's control) are emptied by a mechanical suction process. The gullies are cleared three times in each year and are re.sealed with clean water after each emptying. 11 (iii) Sanitary Inspection of the Area. The Work of the Sanitary Inspectors is given below. Further details will be found in the Summary at the end of the report. No. of Inspections made 3,097 „ ,, Summons or Legal Proceedings Nil „ „ Cesspools cleaned 5 „ „ „ dispensed with 2 „ „ Nuisances abated 113 „ „ Formal Notices served 5 „ „ Informal Notices served 73 ,, ,, Informal Notices complied with 76 „ „ Formal Notices complied with 5 „ ,, Complaints received Nil Summary of Nuisances. Animals improperly kept 1 Cellars Flooded 1 Cesspool Overflows 10 Drains Blocked or Defective 80 Manure from Stables, etc. - Polluted Ditches and Streams 5 Refuse Dumps, etc. 1 Rubbish Burning - Sheds used for habitation 1 Smells from dead animals 1 Water closets defective 5 Water Supply—defective or cut off 8 113 12 Verminous Houses.- Five houses were found to be verminous during the year: Council Houses 0 Other Houses 5 All these houses were fumigated by the use of Hydrogen Cyanide gas. In twenty.one cases the furniture of tenants was fumigated by Hydrogen Cyanide gas before it was allowed to be installed in the Council Houses provided for their occupation. Number of inspections and visits, 23. Rats and Mice (Destruction) Act, 1919. The destruction of rats continues to take up a considerable amount of time and it is carried on throughout the year. The rat population must be gradually decreasing as building operations encroach upon farm land and private estates, but with such a large area of forest it is difficult to take other than palliative measures to exterminate these pests. There are a few places in the district where it seems impossible to get rid of all the rats but in farms a very considerable reduction has been made; and as much help as possible is given to keep the rats from unduly increasing. There is one refuse dump in the district and the contractors who dump on this site engage a firm who specialize in rat destruction to deal with the problem. I understand that considerable progress continues to be made. The methods used for rat destruction have not been changed, they are:— 1. Gassing by a Cyano Gas Pump. 2. Baiting with Red Squill. These methods continue to give satisfactory results. Baiting is done where it is dangerous to use the Gas Pump and the results obtained are, on the whole, very good. During Rat Week posters were exhibited in prominent places throughout the district calling the attention of everyone to the importance of destroying rats and intimating that help and advice can be obtained on application to the Public Health Department. The usual slide was also shown at the Loughton Cinema. 13 Several visits have been made to the Council's sewage works and a few rats have been killed. Where evidence of the presence of rats is noticed immediate steps are taken to "gas" the "workings." The sewers are kept under observation and special bait for use in sewers has been obtained. The baits are watched and renewed where necessary. Rat bait is still supplied free on application. Number of visits—no. (iv) Smoke Abatement—No action taken. 4. Schools— The sanitary conditions and water supply are satisfactory. In one school the flush to the boys' urinal has been renewed. Section D. HOUSING STATISTICS FOR THE YEAR 1939. Number of new houses erected during the year 1939. (a) Total (including numbers given separately under (b)) 1. By Local Authority 30 2. By other Authorities Nil 3. By other bodies and persons 209 (b) With State assistance under the Housing Acts. 1. By Local Authority 30 2. By other bodies and persons Nil Inspection of Dwelling Houses during the Year. 1. (a) Total number of Dwelling.houses inspected for housing defects (under Public Health and Housing Acts) 90 (b) Number of Inspections made for the purpose 149 2. (a) Number of Dwelling.houses (included under sub.head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 9 (b) Number of Inspections made for the purpose 44 3. Number of Dwelling.houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 14 (4) Number of dwelling.houses (exclusive of those referred to under the preceding sub.head) found not to be in all respects reasonably fit for human habitation 71 Remedy of Defects During the Year without Service of Formal Notices. Number of defective dwelling.houses rendered fit in consequence of informal action by the Local Authority or their Officers 71 Action under Statutory Powers during the Year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936. (1) Number of dwelling.houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling.houses which were rendered fit after service of formal notices:— (a) by Owners Nil (b) by Local Authority in default of Owners Nil (b) Proceedings under Public Health Acts. (1) Number of dwelling.houses in respect of which notices were served requiring defects to be remedied 4 (2) Number of Dwelling.houses in which defects were remedied after service of formal notices:— (a) by Owners Nil (b) by Local Authority in default of Owners 4 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936. (1) Number of dwelling.houses in respect of which Demolition Orders were made Nil (2) Number of dwelling.houses demolished in pursuance of Demolition Orders 7 (d) Proceedings under Section 12 of the Housing Act, 1936. (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 15 Housing Act, 1936—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year Nil (ii) Number of families dwelling therein Nil (iii) Number of persons dwelling therein Nil (b) Number of cases of overcrowding reported during the year 2 (c) (i) Number of cases of overcrowding relieved during the year 2 (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 (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil Licences for 2 families shown under (c) (I) have been cancelled, the number of occupants being reduced to comply with the provisions of the Housing Acts. Summary of Defects. Defective Roofs 34 ,, Walls and Windows 21 „ Gutters and Rain.Water Pipes 22 „ Floors (Wood) 14 Paving 4 ,, Sash Cords 7 ,, Plaster 23 Blocked or defective Drains 80 Dampness 11 Defective Water Closet 5 „ Water Waste Preventer 7 Sink and Waste Pipes 7 Cleansing of Walls and Ceilings 23 Lack of Ashbins 3 Miscellaneous, including stoves 44 Housing Act, 1936— The number of houses overcrowded at the end of the year, 1939, was:- Nil. 16 The building of the 46 houses to accommodate the occupants of overcrowded houses and houses demolished has been completed. All the houses built are semi.detached. The accommodation provided is as follows:— 14 in family 1 12 „ „ 1 9 „ „ 16 6 „ „ 26 4 „ „ 1 2 „ „ 2 flats— 2 each 1 46 The issue of certificates showing permitted numbers to the end of the year is as follows:— To the end of To the end of 1938. 1939. Buckhurst Hill 327 334 Chigwell 157 162 Loughton 341 371 Number of visits, 450. Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply— There are 15 cowkeepers on the register for the district, 6 produce and retail and 9 produce and sell wholesale; 195 visits have been made during the year. The cowsheds have been maintained in a satisfactory condition. Four samples of milk were taken and submitted to the County Laboratories for examination and the result was satisfactory in three cases. A further sample was taken in respect of the unsatisfactory one and this proved to be satisfactory. The County Council took 60 samples of Tuberculin Tested and Accredited milk which were submitted to the Methylene Blue Test, 59 were satisfactory, 1 unsatisfactory. 17 Further samples were taken in the case of the unsatisfactory one and the appropriate action was taken by the Essex County Council. Licences to produce Tuberculin Tested and Accredited milk have all been renewed during the year. The number of farms producing Graded and Ungraded milk are— Tuberculin Tested (Certified) Accredited Ordinary 1 11 3 There are 18 Dairies and Milkshops on the register. 86 visits were made. There are 36 retail purveyors of milk on the register. The following licences have been issued under the Milk (Special Designations) Orders, 1936 and 1938. Principal Licences— Nil. Licences— Tuberculin Tested 5 Accredited 1 Pasteurised 4 Supplementary Licences— Tuberculin Tested 9 Accredited 1 Pasteurised 8 Milk to Schools— Milk supplied to Schools during the year was Accredited, Pasteurised and ordinary. Biological examinations were made in respect of the samples taken and all were satisfactory. (b) Meat and other Foods— There are 7 Slaughterhouses in the district, 6 registered and 1 licenced. Regular inspections are made and the number of visits was 587. These will all become licenced under the Food and Drugs' Act, 1938. Your Medical Officer of Health is visiting all of these and will make recommendations to the Council early in 1940. 18 The following animals were slaughtered during the year:— CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number Killed 206 24 167 1,475 586 Number Inspected 206 24 167 1,475 586 All Diseases except Tuberculosis. Whole carcases condemned Nil. Nil. Nil. Nil. Nil. Carcases of which some part or organ was condemned 8 2 Nil. 12 1 Percentage of the number inspected affected with disease other than Tuberculosis 3.88 8.33 Nil. .81 .17 Tuberculosis only. Whole carcases condemned Nil. Nil. Nil. Nil. Nil. Carcases of which some part or organ was condemned 8 1 Nil. Nil. 2 Percentage of the number inspected affected with Tuberculosis 3.88 4.17 Nil. Nil. .34 In addition 1, 6 lb. tin of corned beef and 56 lbs. of meat trimmings were condemned as unfit for human consumption. There are 9 Bakehouses in the district and all these are kept in good condition. Number of visits—98. There are four Fish Friers in the urban district and the premises are in good order. Number of visits—35. 7 stone of skate and 2 stone of dogfish were condemned as unfit for human consumption. The food shops are kept under observation. 19 (c) Ice Cream—Essex County Council Act, 1933. (Part XI). Number of Registrations, on 31st December, 1939. Manufacturer. Vendor. Dealer. Buckhurst Hill Ward 2 16 1 Chigwell Ward 3 13 — Loughton Ward 9 9 1 14 58 2 Two samples of Ice Cream were taken, both of which proved satisfactory. No. of Visits—78. (d) SHOPS ACT, 1934. Class of Shop. Lock-up. Otherwise. Total. Buck. Hill. Chigwell. Loughton. Buck. Hill. Chigwell. Loughton. Animal Clinic - - 1 - - - 1 Art Needlework 1 — 3 1 - 1 6 Bakers — — 2 3 1 8 14 Bazaar — - 1 - - - 1 Boots and Shoes 2 1 6 3 - 2 14 Builders' Merchant 1 — 4 1 1 - 7 Butchers 2 1 6 6 1 5 21 Chemists 2 — 3 1 1 3 10 China, Glass and Hardware - - 2 - - 1 3 Coal Merchants 2 1 3 — — — 6 Confectioners - 1 3 — 2 4 10 Cooked Food Stores 1 — - — - 1 2 Costumiers - — 1 — - - 1 Cycle, Radio and Sports 1 — 2 1 - 2 6 Dairy - 1 2 1 - 2 6 Draper - — 3 4 1 2 10 Dressmaker - — — 1 - — 1 Dyers and Cleaners - 1 4 — - 1 6 Electrical Showrooms - — 1 — - — 1 Fishmongers 2 — 1 1 - 1 5 Florist 1 — 1 — - 1 3 Fried Fish 1 — 1 1 - 1 4 Furniture - — 1 2 - 1 4 Gas Show Rooms - — 1 — — — 1 Carried forward 16 6 52 26 7 36 143 20 Class of Shop. Lock-up. Otherwise. Total. Buck. Hill. Chigwell. Loughton. Buck Hill Chigwell Loughton. Brought forward 16 6 52 26 7 36 143 General Merchants 2 — 3 — — — 5 General Stores 1 - 3 6 7 7 24 Golf Club - - - - 1 — 1 Greengrocer 4 1 6 2 — 6 19 Grocer 2 — 1 2 1 1 7 Grocer and Provision Merchant 2 - 4 2 - 6 14 Hairdresser 2 1 8 3 — 1 15 Ironmonger — — 2 4 — 1 7 Library — — 2 I 1 — 4 Licensed Premises — — — 11 8 11 30 Newsagent 1 — 1 2 1 1 6 Newsagent and Tobacconist - - - 2 2 2 6 Off Licence — — — 1 1 3 5 Optician 1 — — - — — 1 Outfitters — — 2 1 — 4 7 Photographer - - - - - 1 1 Provision Merchant — - — - — 1 1 Saddler - — 1 — — — 1 Sewing Machines — — 1 - — — 1 Stationer — — 1 - — 1 2 Tailor — — — 1 — — 1 Teashops — 1 4 4 8 — 17 Tobacconist — — — — — 1 1 Tobacconist and Confectioner 3 1 3 8 3 8 26 Toys and Fancy Goods — — — — — 1 1 Watchmaker and Jeweller - - 2 1 — — 3 Wine and Spirit Merchants — — — 1 — 1 2 Totals 34 10 96 78 40 93 351 Additional Water Closet Accommodation 1 Number of Visits 58. (e) Adulteration—This is dealt with by the County Council. (f) Chemical and Bacteriological Examination of Food— This is dealt with by the County Council (g) Nutrition—No action. 21 TABLE. 1.—INSPECTION OF FACTORIES AND OTHER PREMISES. Including Inspections made by the Sanitary Inspector. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power 18 None None Factories without mechanical power 65 None None Other Premises None None None Totals 83 None None 2.—DEFECTS FOUND. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness None None None None Overcrowding None None None None Unreasonable Temperature None None None None Inadequate Ventilation None None None None Ineffective drainage of floors None None None None Sanitary Conveniences:— Insufficient None None None None Unsuitable or defective None None None None Not separate for sexes None None None None Other offences None None None None Totals None None None None 22 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The incidence of infectious disease in the district, with the exception of diphtheria, was not abnormal. Scarlet fever was of the mild type now prevalent; the home nursing of cases is encouraged whenever circumstances permit. Diphtheria. Of the twenty-four cases of the disease, twenty occurred in the first six months of the year and of these no less than twelve were amongst children and staff at an open air school where the disease had been prevalent in 1938. Immunisation of the children either before or after admission was suggested but hitherto the authorities of the school have not seen their way to adopt the suggestion, although there is abundant evidence that the disease in schools and institutions can be almost entirely eradicated by systematic immunisation. Diphtheria Immunisation. In the later part of the year immunisation clinics were opened at the Child Welfare Centres in Loughton and Buckhurst Hill and the response from parents has been encouraging. Details of the work at these clinics and of cases immunised by private practitioners are given below. Cases Immunised. At Child Welfare Clinics. By Private Practitioners. Total 2 doses of Alum Toxoid 0.2 c.c. and 0.5 c.c. at 1 months interval or 3 doses of T.A.F. 82 11 1 dose of A.P.T. (i.e., treatment not completed by end of 1939). 24 10 106 21 127 Age distribution of Children treated: Pre-School age Total 1—2 2—3 3—4 4—5 98 127 27 33 20 18 School age 5—6 6—7 7-8 8 29 10 5 4 10 23 Owing to the prevalence of diphtheria in the district during 1938-39, it may be assumed that the number of children immune to the disease, either as the result of an actual attack or through having acquired a natural immunity by exposure to cases or carriers, is above the average. It is likely therefore that for several years the incidence of the disease in the district will be below the average and if full advantage were taken by parents of the opportunities offered for the immunisation of their children it should be possible to build up a high level of herd immunity against the next epidemic period. There is now ample evidence to show that if 70—80% of the child population in a community is immunised, the incidence of diphtheria becomes almost negligible. This means the immunisation every year of about 300 children aged 1—2 years in the district. Summary of Cases of Infectious Diseases, showing Number of Cases, Admission to Hospital and Deaths. Infectious Disease. Total Cases (Notified). Admissions to Hospital. Deaths Registrar General's Figures Scarlet Fever 23 17 — Erysipelas 4 1 — Diphtheria 23 23 2 Typhoid 2 2 - Measles 6 - - Anterior Poliomyelitis 1 1 - 59 44 2 Terminal Disinfection. During the latter part of the year a modified system of disinfection after the removal of cases of scarlet fever and diphtheria to hospital was introduced. The routine spraying of rooms and steam disinfection of bedding were abandoned and reliance placed mainly on soap, water, air and sunlight. Householders are issued with detailed instructions as to the procedure to be adopted and this is carried out under the supervision of the Sanitary Inspector. Long experience in many other areas has shown that what may be termed the "spring cleaning" method of disinfection has caused no apparent increase in the incidence of infectious disease and probably ensures greater household cleanliness than the older methods. In cases presenting special difficulties, e.g., where lack of space, overcrowding or weather conditions would throw an undue burden on the house wife, bedding and clothing are removed for steam disinfection, as in the past. The total number of deaths from notifiable infectious diseases, excluding Tuberculosis was 2 (from diphtheria). 24 TUBERCULOSIS. Age. New Cases. Deaths. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M F M F M F M F Under 1 year - - - - - 1 - - i and under 5 - — — i — — 1 — 5 .• '5 1 — 5 1 — — 1 — 15 ., „ 25 3 3 — - - - - - 25 .. .. 35 5 2 1 - 1 1 — — 35 .. » 45 5 2 — - — 2 — — 45 .. .. 55 — 1 — - 1 1 — — 55 .. •• 65 1 — — - — — - — 65 and upwards 1 - - - 1 - - - Totals 16 8 6 2 3 5 2 — M.—Male. F.—Female. Notification is satisfactory. Of the deaths registered from tuberculosis, two had not been previously notified. The return of deaths from the Register General exceed the local figure by three. Laboratory Specimens Examined during the Year. By the County Specimen. Bacteriologist. Diphtheria 79 Sputa 36 Typhoid 3 Ringworm — General 52 Milk Ice Cream 15 Water 1 Sewage - Total 186 25 general sanitation. housing infectious diseases. meat and food INSPECTION. House refuse is collected under the supervision of Mr. G. Holbourn, A.M.Inst., C.E., Engineer and Surveyor. (Signed) j. t. heath, M.R.San.I., m.S.I.a., Senior Sanitary Inspector. (a) Including visits made under Housing Act, 1936. Summary of Sanitary Inspector's Visits during the Year ended 31st December, 1939. Nature of Visit or Inspection. No. of Visits Water Supply 27 Drainage 412 Stables and Piggeries 20 Fried Fish Shops 35 Tents, Vans and Sheds 5 Factories 18 Workshops 52 Outworkers 13 Bakehouses 98 Refuse Collection 7 Refuse Disposal 11 Rats and Mice 110 Schools — Shops 58 Knackers Yard 22 Petroleum 94 Miscellaneous Sanitary Visits 230 Billets 19 1,231 Under Public Health Acts. Number of houses inspected 81 Visits paid to above houses 95 Under Housing Acts. Number of houses inspected 9 Visits paid to above houses 44 Verminous Premises. Number of houses inspected 3 Visits paid to above houses 20 Miscellaneous Housing Visits (a) 450 702 Inquiries in cases of Infectious Disease 43 Visits re Disinfection 73 Miscellaneous Infectious Disease Visits 30 146 Visits to Slaughterhouses 587 „ „ Butchers 31 „ „ Fishmongers and Poulterers 12 „ „ Grocers 6 „ „ Greengrocers and Fruiterers 4 „ „ Cowsheds 195 „ „ Dairies and Milkshops 86 „ „ Ice Cream Premises 78 „ „ Restaurants 4 Visits in Connection with Sampling. Milk—Bacteriological 4 Miscellaneous Food Visits 11 1,018 Total 3,097 26 APPENDIX. RAINFALL IN INCHES BY MONTHS FOR 1939. Buckhurst Hill. High Beech. January 4.88 7.38 February 0.92 0.94 March 1.51 1.70 April 2.46 2.67 May 1.46 1.61 June 1.21 1.43 July 2.79 2.56 August 2.70 3.49 September 1.23 1.50 October 6.09 5.73 November 4.52 4.54 December 1.29 1.18 Totals 31.-06 34.73 The highest point in the District is 372 O.D., and the lowest 44 O.D.