CHIG 5 LIBRARY 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, 1941. BUCKHURST HILL: Printed by John W. Phelp & Co., Queen's Road. 1 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 1941 upon the health and sanitary circumstances of the district. The Minister of Health directs that the Report shall again be an interim one and that arrangements be made for the careful preservation of all records. I take this opportunity of thanking Professor M. Greenwood and the Staff of the Public Health Department for their help and co-operation during the year. L. S. FRY, M D., D.P.H. 2 CHIGWELL URBAN DISTRICT COUNCIL. PUBLIC HEALTH COMMITTEE. Owing to the National emergency, the Public Health Committee remains incorporated with the General Purposes, Finance, Housing and Town Planning and Valuation Committees constituted as No. 2 Committee. (As at 31st December, 1941). Chairman: Councillor F. S. Foster, J.P., C.C. Vice-Chairman: „ E. Sutton-Pryce, B.D. Members: Councillor A. S. Adams. ,, A. G. Gould. „ N. V. Fortescue. „ A. E. Leach. T. F. Moore. ,, E. G. Perry. ,, J. Seabrook. ,, H. Spurr. ,, S. G. Weaver, F.C.A. Meetings. These were held on the following dates :— 4th January, 1st March, 6th May, 1st July, 2nd September and 4th November. PUBLIC HEALTH STAFF. Medical Officer of Health: L. S. Fry, M.D.(Camb-), D.P.H. Hon. Assistant Medical Officer of Health : Professor M. Greenwood, F.R.S., F.R.C.P. 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 Dept. as Controller). Royal Sanitary Institute and Sanitary Inspectors Joint Board Certificate. Royal Sanitary Institute Certificate for Inspector of Meat and Other Foods. 3 Temporary Sanitary Inspector:— P. T. Shelton, M.R.San.I., M.S.I.A., A.A.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. Section A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 8,970 (14 sq. miles approx.). Population 25,070. The rate in the pound for 1941/42 was 13/8. Owing to war conditions the Ministry of Labour is unable to furnish any particulars in respect of persons unemployed during 1941, and these are therefore unavoidably omitted from this Report. VITAL STATISTICS. Male. Female. Total Live Births. Legitimate. 163 155 318 Illegitimate. 7 6 13 Total 331 Birth rate per 1,000 of estimated resident population: 13.2. Male. Female Total. Still Births. Legitimate. 5 3 8 Illegitimate. 0 1 1 Total 9 Rate per 1,000 total (live and still) births: 26.4 Male. Female. Total. Deaths x53 I+I 294 Death rate per 1,000 estimated resident population: 117. Deaths from Puerperal Sepsis 0 ,, „ other Maternal Causes 2 2 Deaths of Infants Under 1 Year Male. Female. total. Legitimate. 11 6 17 Illegitimate. 0 0 0 4 Death rate of Infants Under 1 Year of age: All Infants per 1,000 live births 52 Legitimate Infants, per 1,000 legitimate live births 55 Illegitimate „ ,, „ illegitimate „ „ o Deaths from Cancer (all ages) 48 „ „ Measles (all ages) 1 „ „ Whooping Cough (all ages) o „ „ Diarrhoea (under 2 years) o „ ,, Road Traffic 1 ,, ,, Suicide 2 ,, ,, Other Violent Causes 26 It will be observed that compared with 1940 the birth rate has fallen, as has also the death rate to a slightly less extent. The infantile mortality rate rose from 39 in 1940 to 55 in the year under review. Analysis of Deaths according to Age Incidence. Age. No. of Deaths. 1941. 1940. 1939. 1938. 1937 Under 1 year 17 15 11 11 8 1 and under 2 — 1 — 3 1 2 „ „ 5 — 4 1 2 3 5 „ „ 15 4 2 9 3 2 15 „ „ 25 5 7 9 3 2 25 „ „ 35 12 12 5 10 10 35 „ „ 45 27 20 16 14 13 45 „ „ 55 32 28 12 28 24 55 „ „ 65 46 50 36 33 30 65 „ „ 75 68 57 48 58 58 75 and upwards 79 96 63 57 51 Total 290 292 210 222 202 COMPARATIVE TABLE OF BIRTH AND DEATH RATE. Year. Estimated Population. Number of Births. Hirth Rate per 1.000 of Population. Number of Deaths. Death Rate per 1,000 (Standardised). Infant Mortality. Number of Deaths. Rate per 1,000 (Live Births). 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 1940 24,850 380 153 296 12.7 15 39 1941 25,070 331 13'2 294 11.7* 17 52 * The death rate for 1941 has not been corrected by the use of the area comparability factor so is not strictly comparable with those of previous years. 5 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case-rates for certain Infectious Diseases in the year 1941. (Provisional Figures based on Weekly and Quarterly Returns). England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Kesident Populations 25,000 to 50.000 at 1931 Census). London Administrative County. Chigwell U.D.C. Rates per 1,000 Population. Births:— Live 14.2 14.7 16.4 8.9 13. 2 Still 0.51 0.58 o.6o 0.33 - Deaths:— All Causes 12.9 14.9 13.0 16.3 11. 7 Typhoid & Paratyphoid Fevers 0.00 0.00 0.00 0.01 0.00 Scarlet Fever 0.00 0.00 0.01 0.00 0.00 Whooping Cough 0.06 0.07 0.06 0.04 0.00 Diphtheria 0.07 0.08 0.06 0.03 0.00 Influenza 0.19 0.17 0.20 0.15 1.55 Smallpox — — - - - Measles 0.03 0.03 0.03 0.02 0.03 Notifications:— Typhoid Fever 0.03 0.02 0.03 0.04 0.00 Paratyhoid Fever 0.09 0.12 0.09 0.05 0.07 Cerebro Spinal Fever 0.25 0.31 0.20 0.30 0.00 Scarlet Fever ... 1.47 1.49 1.51 1.01 0.83 Whooping Cough 4.39 4.37 4.50 3.50 7.20 Diphtheria 1.25 1.53 1.19 0.93 0.31 Erysipelas 0.30 0.36 0.27 0.50 0.31 Smallpox — — — — - Measles ... 10.33 8.27 10.47 4.77 22.4 Pneumonia 1.25 1.53 1.04 1.07 0.59 Rates per 1,000 Live Births. Deaths under i year of age 59 71 56 68 52 Deaths from Diarrhoea & Enteritis under 2 years of age Rate per 1,000 Total Birth (i.e Live and Still) Maternal Mortality:— Excluding (abortion) Puerperal Infection 0.48 Not Available. 6.2 Others 1.75 - TOTAL 2.23 6.2 Notifications:— Puerperal Fever 11.91 15.64 9.43 2.29 6.2 Puerperal Pyrexia 19.3 6 Section B. GENERAL PROVISIONS OF HEALTH SERVICES IN THE DISTRICT. (a) Laboratory facilities. No change. (b) Ambulance facilities—no change. A summary of the work done by the Civil Ambulance is given below. AMBULANCE CALLS. Accident or Number of Calls. other reason. Urgent Medical. 208 87 121 (c) Nursing in the home. No change. (d) and (e) Clinics, Treatment Centres and Hospitals. Diphtheria Immunisation: Clinics are held once a month at the following Child Welfare Centres:— Buckhurst Hill.—County Council Clinic, Buckhurst Way— 2nd Thursday in month at 2.30 p.m. Chigwell—St. Winifred's Church Hall—3rd Wednesday in month. Loughton—Union Church Hall, High Road—2nd Friday in month at 2.30 p.m. Goldings Hill Mission Hall—3rd Thursday in month at 2.30 p.m. Roding Road Church Hall— 2nd Tuesday in month at 2.30 p.m. Tuberculosis Dispensary—Essex County Council-For patients in the district:— County Council Clinic, Buckhurst Way, Buckhurst Hill—2nd and 4th Wednesday in month at 2.30 p.m. Combined Treatment Centre, Regent Road, Epping—every Tuesday from 11 a.m. to 1 p.m. Ante-Natal Clinic—Union Church Hall—2nd Thursday in month at 9.30 a.m. and 4th Thursday in month at 1.30 p.m. 7 ESSEX COUNTY COUNCIL ACT, 1933. List of Establishments for Massage ok Special Treatment. The following establishments are licensed to 31st March, 1943:— Mrs. J. M. Burt, Tresco, Knighton Lane, Buckhurst Hill. Miss E. Mackern, 45, Church Hill, Loughton. "Madame Pauline," 100, High Road, Loughton. These premises have been inspected and are being conducted in a satisfactory manner. Section C. SANITARY CIRCUMSTANCES OF THE AREA. 1. Water— The water supply for almost the whole district is derived from the Metropolitan Water Board, and is very satisfactory both in quality and quantity. There are a few isolated houses where the supply is from wells. Despite the extensive work done to the well at "Broadstoode Lodge," Keeper's Cottage, Loughton, the samples of water taken have not yet proved entirely satisfactory and the tenant is continuing to boil the water before using it for drinking purposes. Precautions have been taken to guard against contamination of emergency water supplies should the main supply be cut off as a result of enemy action. Every wardens' post in the district has been issued with a supply of water steriliser and this will be made available to the public should necessity arise. Directions as to the proper use of the fluid have been given to Wardens' Posts. Drainage and Sewerage— The sewage disposal plants continue to work efficiently and yield a satisfactory effluent. 8 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 liable to floods in the area which is under the jurisdiction of the Roding Catchment Board. 3. (i) Closkt 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. Little trouble was experienced during 1941 from fly nuisance in the neighbourhood of the tip and the measures taken by the contractors to alleviate this must be considered satisfactory. The efforts to maintain and even to increase the quantity of salvage have been continued and intensified with satisfactory results. Collection of salvage is carried out as part of the refuse collection operations and by the same contractor. Trailers, primarily for carrying paper are attached to the covered collecting vehicles. The more important materials (paper and bones in particular) are kept separate at the time of collection and further separation takes place at the tip when all 9 useful salvage is carefully taken out of the general refuse, sorted and disposed of. At the end of the year every household was supplied with a sack in which to place paper for salvage, thus ensuring that this important material is kept separate and clean. The co-operation of the W. V.S. in salvage has been very effective and greatly appreciated. Apart from operations of a general nature this organisation has set up a system of street stewards, and every street in the district has at least one W.V.S. representative, who maintains contact with the householders, encouraging and stimulating the salvage effort and providing a means for the speedy investigation and remedying of complaints and difficulties. The quantity of paper received as salvage during the year was approximately 243 tons, which figure takes no account of appreciable amounts disposed of direct by private persons or firms. A quantity of 26J tons per month is aimed at, which it will be seen was not achieved over the 12 months period. This datum was almost reached in April, 1941, and as a result of the sack system and intensified efforts it was actually exceeded in December. Efforts are being made in the future to ascertain what amounts are disposed of direct and privately so that the true recovery from the district may be more accurately known and compared with the standard of 1 ton per 1,000 population, indicated by the Ministry of Supply as a possible and reasonably satisfactory yield. On a similar basis the yield of bones should be 265 cwt. per month, which has never been achieved. Among the efforts to improve this item has been the enlistment of the assistance of school children who are asked to collect and take bones to school and place them in bins supplied and regularly cleared. The figures for the respective schools are circulated to them all in an effort to set up a competitive spirit between them. 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 resealed with clean water after emptying. 10 (iii) Sanitary Inspection of thk 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 3,557 ,, ,, Summons or legal proceedings Nil „ ,, Cesspools cleaned 2 „ „ Defective 2 ,, „ Nuisances abated 153 „ ,, Formal Notices served Nil ,, ,, Informal Notices served 82 ,, ,, Informal Notices complied with 80 „ „ Formal Notices complied with 1 „ „ Complaints received 81 Summary of Nuisances. Animals improperly kept 1 Cellars flooded 2 Cesspool overflows 2 Drains blocked or defective 123 Manure from stables, etc 1 Polluted ditches and streams 1 Sheds used for habitation 2 Water closets defective 11 Water supply—defective or cut off 10 153 11 Verminous Houses— Four houses were found to be verminous during the year. These have all been treated with insecticide under the direction of this department and it is hoped that the measures taken will prove to be of lasting benefit. Rats and Mice (Destruction) Act, 1919. A considerable amount of time was devoted during the year to the work of rat destruction. Efforts were continued to prevent the increase of the rat population in the Council's sewage works and on farms and other likely breeding places in the district. Several farms were visited during threshing operations when some rats were destroyed. Methods of destruction are unchanged and bait is given free on request together with a pamphlet setting out advice on the subject. At the end of the year a campaign against rats was inaugurated by the Council. The following steps were taken:— (1) A reward of 2d. for each tail brought in was offered by the Council. (2) A slide was exhibited at the local cinema advertising the above. (3) Farmers, butchers, bakers, wardens' posts, schools and various other places were notified of the campaign. (4) Ratting was carried out at likely places in the district. The campaign was moderately successful and 62 tails were brought in, although of course this figure did not necessarily represent the number of rats destroyed. It is not generally understood that the responsibility for rat destruction rests with the occupier of land under the Rats and Mice Destruction Act, 1919, but the public generally appear to be taking more interest in the work than formerly, and it is hoped that the interest will continue. Number of visits—206. (iv) Smoke Abatement—No action taken. 4 Schools— The sanitary conditions and water supply are satisfactory. 12 Section D. HOUSING STATISTICS FOR THE YEAR 1941. Number of new houses erected during the year 1941. (a) Total (including numbers given separately under (i)) 1. By Local Authority Nil 2 By other Authorities Nil 3. By other bodies and persons Nil (b) With State assistance under the Housing Acts. 1. By Local Authority Nil 1. 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) 93 (b) Number of Inspections made for the purpose 261 2. (a) Number of Dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3 (b) Number of Inspections made for the purpose 19 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 (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 93 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 93 Action under Statutory Powers during the Year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1916. (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:— (а) by Owners 1 (b) by Local Authority in default of Owners Nil 18 (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied Nil (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 Nil (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 Nil (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 Housing Act, 1936—Part IV—Overcrowding. (a) (i) Number of dwellings overcrowded at the end of the year See (e) (ii) Number of families dwelling therein See (e) (iii) Number of persons dwelling therein See (e) (b) Number of cases of overcrowding reported during the year See (e) (c) (i) Number of cases of overcrowding relieved during the year See (e) (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority has taken steps for the abatement of overcrowding See (e) (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report:— Since September, 1940, a considerable number of evacuees from bombed areas has been received into the district and it would not be possible without complete re-survey of the district to give particulars under the above headings. 14 Summary of Defects. Defective Roofs 13 „ Walls and Windows 11 „ Gutters and Rain-Water Pipes 12 ,, Floors 4 „ Sash Cords 6 ,, Plaster 10 Blocked or defective Drains 123 Dampness 19 Defective Water Closet 9 „ Water Waste Preventer 2 Sink and Waste Pipes 6 Cleansing of Walls and Ceilings 12 Lack of Ashbins 2 Defective stoves 8 Verminous Rooms 4 Miscellaneous 11 Housing Act, 1936— The number of houses overcrowded at the end of the year was:—See remarks under Part IV (e). The issue of certificates showing permitted numbers to the end of the year is as follows:— To the end of 1941. Buckhurst Hill 341 Chigwell 169 Loughton 384 Number of visits, 71. 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; 180 visits have been made during the year. The cowsheds have been maintained in a satisfactory condition. 18 samples of milk were taken and submitted to the County Laboratories for examination and the results were satisfactory in all cases. Licences to produce Tuberculin Tested and Accredited Milk have all been renewed during the year. 15 The number of farms producing Graded and Ungraded milk are— Tuberculin Tested (Certified) Accredited Ordinary 1 11 3 There are 11 Dairies and Milkshops on the register. 88 visits were made. There are 23 retail purveyors of milk on the register. Milk to Schools— Milk supplied to Schools during the year was Accredited, Pasteurised and ordinary. Samples taken by this Department in respect of the milk supplied were satisfactory. (b) Meat and other Foods— There are 7 Slaughterhouses in the district, now all licenced under the Food and Drugs Act, 1938. 11 visits were made. The following animals were slaughtered during the year:— CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows. Cows. Calves. Sheep and I.ambs. Pigs. Number Killed Nil. Nil. Nil. Nil. 7 Number Inspected Nil. Nil. Nil. Nil. 7 All Diseases except Tuberculosis. Whole carcases condemned Nil. Nil. Nil. Nil. Nil. Carcases of which some part or organ was condemned Nil. Nil. Nil. Nil. Nil. 1 Percentage of the number inspected affected with disease other than Tuberculosis Nil. Nil. Nil. 14'3 Tuberculosis only. Whole carcases condemned Nil. Nil. Nil. Nil. Nil. Carcases of which some part or organ was condemned Nil. Nil. Nil. Nil. Nil. Percentage of the number inspected affected with Tuberculosis Nil. Nil. Nil. Nil. Nil. From time to time some assistance was given in the work of meat inspection at the Ministry of Food Slaughterhouse at Waltham Abbey. 16 In addition, the following food was condemned as unfit for human consumption:— 2 kippered mackerel. 19 tins baked beans. 16¾ lbs. bacon. 56 lbs. butter. 18 lbs. cheese. 156 lbs. forequarter of beef. 440 imported eggs. 3 tins of milk. 1 tin of luncheon meat. 1 bullock's head. The following food was condemned as a result of damage caused by enemy action:— 4 loaves. 4 lbs. lard. 5 lbs. bacon. 6 1d. cakes. 1 lb. cheese. 3 lbs. butter. 3 pints milk. 6 pots of jam. 3 packets of blancmange. 10 packets of cornflakes, etc. 5 packets of salt. ½ lb. packet of tea. Where possible the condemned food was disposed of for pig food. There are 9 Bakehouses in the district and all these are kept in good condition. Number of visits—115. There are two Fish Friers in the urban district and the premises are in good order. Number of visits—4. The food shops are kept under observation and particular attention is devoted to the butchers' shops in the district. Number of visits—358. (c) Ice Cream—Food and Drugs Act, 1938. Number of Registrations, on 31st December, 1941 54. No. of Visits—63. (d) SHOPS ACT, 1934. 340 visits were made during the year. No action was found to be necessary under Section 10 of the Act, but a certain amount of work was carried out at various food shops in order to ensure their compliance with the provision of Section 13 of the Food and Drugs Act, which relates to measures necessary to prevent contamination of food. (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. 17 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. The only noteworthy epidemiological features of the year were the outbreaks of measles and whooping cough, the former extending over from the previous year and the latter during the spring and summer. Copies of the notification of these diseases were sent to the County Council Health visitors for the cases to be followed up and unsatisfactory home conditions brought to light. Fortunately both diseases were comparatively mild in type and caused only one death. Seventeen cases of measles and seven of whooping cough were removed to Isolation Hospital. Diphtheria Immunisation. Propaganda.—The campaign of immunisation was widely advertised throughout the district by means of posters and leaflets and by the M. of I. film which was shown in Loughton, Buckhurst Hill and Chigwell. Clinics.—An immunisation clinic was held once a month at each of the Child Welfare Centres in the district, and in addition all the schools were visited at least once during the year. The response to the campaign must be regarded as only moderately successful, but it is difficult to convince the British parent of the advantages of prophylactic inoculation unless the danger of an epidemic is obvious and imminent. It is, however, becoming the exception rather than the rule for mothers attending the Child Welfare Centres not to have the children protected, and the bulk of the unimmunised -children are probably to be found amongst the older school children. With patience and persistence therefore it should be possible to build up a high level of immunity amongst the school entrants. The general practitioners' scheme continued to operate, and the total numbers of children immunised at clinics and by their own doctors are given below. Diphtheria Immunisation, 1941. Number of children who completed the full course of treatment : Age under Aged 5 years. 5—15. At Clinics 372 1,038 By General Practitoners 184 240 556 1,278 Total 1,834. 18 Summary of immunisation work done during last three years:— Number treated. 1939 102 1940 197 I941 1,834 Total 2,133 Shick Testing. Batches of children immunised between 1936 and 1941 were Shick tested and the results are set out in the following table. It will be noted that the number of positive reactions amongst children immunised in 1941 is high, but there is reason to believe that some of the alum toxoid used in the early part of 1941 was of low potency. When Immunised. 1938. 2 Injections. a.p.t. 1939. 2 Injections. a.p.t. 1940. 2 Injections. a.p.t. 1936-38. 1 Injection and 1 in 1941. 1941. 2 Injections. a.p.t. Total. Neg. + Neg. + Neg. + Neg, + Ne*. + Neg. + At Clinics — — 8 6 7 0 — — 176 12 191 18 By General Practitioners 14 2 1 1 21 0 59 0 119 6 214 9 14 2 9 7 28 0 59 0 295 18 405 27 (938 p.c.) (6.2 p.c.) Typhoid and Paratyphoid Fever. The arrangements for the prophylactic inoculation of A.R.P. personnel and of the general public were continued, and particulars of the numbers treated are given below. 1941. M. F. Total. A..R.P. personnel and members of general public 7 48 55 19 SUMMARY OF CASES OF INFECTIOUS DISEASES NOTIFIED, SHOWING NUMBER OF CASES, ADMISSIONS TO HOSPITAL AND DEATHS. Infectious Disease. Total Cases (Notified). Admissions to Hospital. Deaths Registrar General's Figures. Scarlet Fever 21 18 0 Diphtheria 8 8 0 Cerebro Spinal Fever o 0 0 Erysipelas 8 2 0 Measles 562 17 1 Paratyphoid 2 2 0 Pneumonia 15 1 12 Whooping Cough 182 7 0 798 55 13 TUBERCULOSIS. Age. New Cases. Deaths. Respiratory. Non-Respiratory. Respiratory. Non- Respiratory. M F M F M F M F Under 1 year - - - - - - - - 1 and under 5 — — 1 — — — — — 5 „ „ 15 — 1 — 3 1 — — — 15 „ „ 25 2 7 1 2 — — — — 25 „ „ 35 1 5 — 1 — 1 — — 35 „ „ 45 7 4 — — 2 2 1 — 45 „ „ 55 3 2 — 2 2 1 — — 55 „ „ 65 4 — 2 — 2 — — — 65 and upwards - - - - - - 1 - Totals 17 19 4 8 7 4 2 0 M.— Male. F.—Female. Note It will be seen that 48 new cases were notified as compared with 28 in the previous year. Of these 48 cases 7 were transfers from other areas. There were 13 deaths from tuberculosis compared with 11 in 1940. 20 General Sanitation. Housing. Infectious Diseases. Meat and Food Inspection. Summary of Sanitary Inspector's Visits during the Year ended 31st December, 1941. Nature of Visit or Inspection. No. of Visits Water Supply 53 Drainage 501 Outworkers 48 Public Conveniences 2 Factories 13 Workshops and Workplaces 26 Bakehouses 115 Refuse Collection 4 Refuse Disposal 13 Rats and Mice 206 Shops 340 Knackers Yard 30 Petroleum 32 Miscellaneous Sanitary Visits 609 Re Salvage Drive 24 Iron Railings Survey 205 Shelters and Wardens' Posts 42 2,263 Under Public Health Acts. Number of houses inspected . 90 Visits paid to above houses 242 Under Housing Acts. Number of houses inspected 3 Visits paid to above houses 19 Overcrowding. Number of Houses Inspected 64 Visits paid to above houses 7 Verminous Premises. Number of houses inspected 5 Visits paid to above houses 4 Miscellaneous Housing Visits (a) 13 447 Inquiries in cases of Infectious Disease 48 Visits re Disinfection 69 Miscellaneous Infectious Disease Visits 17 134 Visits to Slaughterhouses 11 „ „ Butchers 229 „ „ Fishmongers and Poulterers 8 „ „ Grocers 56 „ „ Greengrocers and Fruiterers 15 „ „ Cowsheds 180 „ „ Dairies and Milkshops 88 „ „ Ice Cream Premises 63 „ „ Restaurants i „ „ Food Preparing Premises 1 Visits in Connection with Sampling. Milk—Bacteriological 13 Miscellaneous Food Visits 48 713 Total 3,557 House refuse is collected under the supervision of Mr. G. h0lb0urnr A.M.Inst., C.E., Engineer and Surveyor. (Signed) J. T. HEATH, M.K.San.I., M.S.I.A., Senior Sanitary Inspector, {a) Including visits made under Housing Act, 1936. 21 APPENDIX. RAINFALL IN INCHES BY MONTHS FOR 1941. Metropolitan Water Board Figures. High Beech. Buckhurst Hill. Luxborough S.D. Works. Figures. January 3.00 2.3 2.45 February 2.69 2.23 1.84 March 3.21 2.95 2.66 April 1.56 1.55 1.52 May 2.20 1.80 1.99 June 0.93 1.22 0.95 July 5.12 4.03 3.75 August 4.36 4.23 4.12 September 0.86 0.75 0.81 October ... 1.00 0.82 074 November 2.39 2.33 2.30 December 1.73 1.88 1.68 Totals 29.05 26.52 24-78 The highest point in the District is 372 O.D., and the lowest 44 O.D. CONTENTS OF THE REPORT FOR 1941. PAGES, Report—Medical Officer of Health's Letter 1 Public Health Committee 2 Public Health Staff 2—3 Statistics and Social Conditions of the Area 3 Analysis of Deaths according to age incidence 4 Number of Deaths by Years ... ... ... ... ... 4 Comparative Table, Birth and Death Rates 4 Table of Birth Rates, Death Rates and Analysis of Mortality 4—5 Vital Statistics 4—5 Causes of Deaths 5 Ambulance Calls 6 General Provisions of Health Services in the District 6—7 Sanitary Circumstances of the Area 7—8—9—10—11 Housing Statistics for the Year 12—13 Housing Act, 1936 14 Inspection of, and Supervision of, Food 14—15—16 Shops 16 Prevalence of, and Control over, Infectious Diseases 17—18—19 Summary of Inspector's Visits 20 Meteorological Record—Rainfall 21