Chig 6 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, 1942. 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 1942 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. 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, 1942). 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. ,, E. G. Perry. ,, J. Seabrook. R. F. J. Smith. ,, H. Spurr. ,, S. G. Weaver, F.C.A. Meetings. These were held on the following dates:— 6th January, 3rd March, 5th May, 30th June, 1st September and 3rd 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 24,860. The rate in the pound for 1942/43 was 13/6. VITAL STATISTICS. Male. Female. TOTAL Live Births. Legitimate. 226 168 394 Illegitimate. 9 14 23 Total 417 Birth rate per 1,000 of estimated resident population: 167. Male. Female total. Still Births. Legitimate. 4 5 9 Illegitimate. — — — Total 9 Rate per 1,000 total (live and still) births: 21.1. Male. Female. TOTA1 . Deaths 139 110 249 Death rate per 1,000 estimated resident population:10.0 Deaths of Infants Under 1 Year Male. Female. total. Legitimate. 11 3 14 Illegitimate. 1 1 2 Total l6 4 Death rath: of Infants Under 1 Year of age: All Infants per 1,ooo live births 38 Legitimate Infants, per 1,000 legitimate live births 35 Illegitimate „ ,, „ illegitimate ,, „ 87 Deaths from Cancer (all ages) 40 „ ,, Measles (all ages) 0 ,, ,, Whooping Cough (all ages) 0 ,, „ Diarrhoea (under 2 years) 0 „ „ Road Traffic 3 ,, ,, Suicide 3 ,, ,, Other Violent Causes 4 It will be observed that as compared with 1941, the birth rate increased and there was a fall in both the death and infantile mortality rates. There was a large increase in the number of illegitimate births. Analysis of Deaths according to Age Incidence. No. of Deaths. Age. 1942. 1941. 1940. 1939. 1938. Under 1 year 16 17 15 11 11 1 and under 2 — — 1 — 3 2 „ „ 5 — — 4 1 2 5 „ „ 15 6 4 2 9 3 15 „ „ 25 4 5 7 9 3 25 „ „ 35 8 12 12 5 10 35 „ „ 45 10 27 20 16 14 45 „ „ 55 18 32 28 12 28 55 „ „ 65 40 46 50 36 33 65 „ „ 75 66 68 57 48 58 75 and upwards 80 79 96 63 57 Total 248 290 292 210 222 COMPARATIVE TABLE OF BIRTH AND DEATH RATE. Year. Estimated Population. Number of Births. Birth Rate per 1.000 of Population. Number of Deaths. Death Rate per 1,000 (Standardised). Infant Mortality. N umber of Deaths. Rate per 1,000 (Live Births). 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 15.3 296 12.7 15 39 1941 25,070 331 13.2 294 11.7* 17 52 1942 24,860 417 16.7 241 10.0 16 38 * 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 other years. 5 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case-rates for certain Infectious Diseases in the year 1942. (Provisional Figures based on Weekly and Quarterly Returns). England and Wales. 126 County Boroughs and Great Towns including London. 148 Smaller Towns (Resident Populations 25,000 to 50.000 at 1931 Census). London Administrative County. Chigwell u.u.c. Rates per 1,000 Population. Births;— Live 15.8 17. 3 18. 4 14. 0 16. 7 Still 0.54 o.66 0.62 0.48 0.36 Deaths:— All Causes 11.6 13.3 12.1 13.9 10.0 Typhoid & Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.03 0.02 0.04 0.00 Diphtheria 0.05 0.06 0.04 0.02 0.00 Influenza 0.09 0.09 0.10 0.07 0.08 Smallpox - — — — — Measles 0.01 0 .02 0.01 0.01 0.00 Notifications:— Typhoid Fever 0.01 0.01 0.01 0.02 0.00 Paratyhoid Fever 0.01 0.01 0.01 0.01 0.00 Cerebro Spinal Fever 0.14 0.17 0.12 0.15 0.00 Scarlet Fever 2.10 2.49 2.34 1.86 1.76 Whooping Cough 1.73 1.97 1.58 2.72 2.17 Diphtheria 1.05 1.35 0.91 0.76 o.o8 Erysipelas 0.30 0.36 0.26 0.43 0.20 Smallpox 0.00 0.00 — 0.00 0.00 Measles 7.46 9.27 7.39 8.62 5.67 Pneumonia 1.07 1.30 0.94 0.94 0.24 Rates PER 1,000 Live Births. Deaths under 1 year of age 49 59 46 60 38 Deaths from Diarrhcea& Enteritis under 2 years of age 5.2 7.5 4.8 8.6 — 6 Section B. GENERAL PROVISIONS OF HEALTH SERVICES IN THE DISTRICT. (a) Laboratory facilities. No change. (b) Ambulance facilities. Towards the end of the year, authority was obtained for the use of Civil Defence ambulances and cars for the conveyance of medical and surgical cases to and from hospitals within the London Civil Defence area, when the ordinary public transport facilities were unsuitable for the patient. This arrangement has benefited many sick persons and also familiarised the ambulance drivers with the hospitals in their area. AMBULANCE CALLS. Number of Calls. 304 Accident or other reason. 94 Urgent Medical. 210 (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. 7 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. ESSEX COUNTY COUNCIL ACT, 1933. List of Establishments for Massage or Special Treatment. The following establishments are licensed to 31st March, 1943 :— Mrs. J. M. Burt, Tresco, Knighton Lane, Buckhurst Hill. Miss E. Mackhrn, 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 this supply is satisfactory. There are a few isolated houses where the supply is still obtained from wells. The report on the last sample of water taken from the well at " Broadstroode Lodge," Keepers Cottage, Loughton, was satisfactory. Precautions taken to guard against contamination of emergency water supplies remain the same. Every wardens' post in the district has a supply of water steriliser which will be made available to the public should necessity arise. Directions as to the proper use of the fluid are at Wardens' Posts. 8 Drainage and Sewerage— The sewage disposal plants continue to work efficiently and yield a satisfactory effluent. 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. Facilities are available to tradesmen by direct arrangement with the contractors for butchers' offal, fish waste and putrescible vegetable refuse to be deposited at the refuse tip on payment of a small charge. Precautionary measures were again taken against fly nuisance at and around the refuse tip and appear to have been effective. Salvage operations continued during the year throughout the district. Nearly 500 tons of salvage materials of all descriptions was collected, sorted and disposed of, including over 300 tons of paper. In addition nearly 130 tons of household kitchen waste was collected. This latter activity has been extended so that collection is now made weekly from practically the whole district. 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. 9 (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 3,153 „ „ Summons or legal proceedings Nil „ ,, Cesspools cleaned 4 „ ,, Defective 2 „ ,, Nuisances abated 147 ,, ,, Formal Notices served 21 „ Informal Notices served 91 ,, ,, Informal Notices complied with 91 „ „ Formal Notices complied with 21 „ ,, Complaints received 98 Summary of Nuisances. Cellars flooded 1 Cesspool overflows 4 Common passageways dirty and unswept 4 Drains blocked 114 Manure from stables, etc. 1 Polluted ditches and streams 1 Water closets defective 12 Water supply—defective or cut off 10 147 Verminous Houses— Seven houses were found to be verminous during the year. In all cases fumigation was carried out by, or under the instructions of, this department and the measures taken appear to have been effective. Rats and Mice (Destruction) Act, 1919. The work of rat destruction continued as opportunity permitted. Likely breeding places in the district were visited and gasing carried out. Farms were again visited during threshing operations when some rats were destroyed. Methods of destruction remain unchanged and bait is given free on request together with advising pamphlets on the subject. 10 No rat week was held in 1942 as the Ministry of Food held the opinion that "every week is rat week." This point of view was pointed out to the public on as many occasions as possible, and generally speaking, they continued to co-operate well in this work. Number of visits—249. (iv) Smoke Abatement—No action taken. 4. Schools— The sanitary conditions and water supply are satisfactory. Number of visits—7. Sec/ion D. HOUSING STATISTICS FOR THE YEAR 1942. Number of new houses erected during the year 1942. (a) Total (including numbers given separately under (b)) 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 2. By other bodies and persons Nil Inspection of Dwelling Houses duking the Year. 1. (a) Total number of Dwelling-houses inspected for housing defects (under Public Health and Housing Acts) 148 (b) Number of Inspections made for the purpose 378 2. (a) Number of Dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 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 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 148 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 91 11 Action under Statutory Powers during the Year. {a) Proceedings under Sections 9, 1O 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 remedied21 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— (a) by Owners 8 (b) by Local Authority in default, of Owners 13 (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 madeNil (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) 12 (e) Any other particulars with respect to overcrowding conditionsupon 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. Summary of Defects. Defective Roofs 25 „ Walls and Windows 5 „ Gutters and Rain-Water Pipes 14 „ Floors 12 ,, Sash Cords 12 ,, Plaster 11 „ Drains 22 Dampness 12 Defective Water Closet 12 „ Water Waste Preventer 7 Sink and Waste Pipes 7 Cleansing of Walls and Ceilings 8 Lack of Ashbins 7 Defective stoves 16 Verminous Rooms 7 Miscellaneous 13 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 1942. Buckhurst Hill 346 Chigwell 169 Loughton 390 Number of visits, 28. Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply — There are 16 cowkeepers on the register for the district, 3 produce and retail and 13 produce and sell wholesale; 218 visits have been made during the year. The cowsheds have been maintained generally in a satisfactory condition. 29 samples of milk were taken. 12 of these were satisfactory and 17 were unsatisfactory. Close contact is being maintained with the Essex County Council Public Health Department in efforts to improve on these results. 13 The number of farms producing Graded and Ungraded milk are— Tuberculin Tested (Certified) Accredited Ordinary I II 4 There are 10 Dairies and Milkshops on the register. 77 visits were made. There are 25 retail purveyors of milk on the register. Milk to Schools— Milk supplied to Schools during the year was Accredited, Pasteurised and ordinary. (b) Meat and other Foods— There are 7 Slaughterhouses in the district, now all licenced under the Food and Drut;s Act, 1938. 22 visits were made. The following animals were slaughtered during the year :— CARCASES INSPECTED AND CONDEMNED. Cattle, excluding Cows. Cows. Calves. Sheep and r.ainbs. Pigs. Number Killed Nil. Nil. Nil. Nil. 21 Number Inspected Nil. Nil. Nil. Nil. 21 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. Percentage of the number inspected affected with disease other than Tuberculosis Nil. Nil. Nil. Nil. Nil. Tuberculosis only. Whole carcases condemned Nil. Nil. Nil. Nil. Nil. Carcases of which some part or organ was condemned Nil. Nil. Nil. Nil. 5 Percentage of the number inspected affected with Tuberculosis Nil. Nil. Nil. Nil. 23'8 From time to time some assistance was given in the work of meat inspection at the Ministry of Food Slaughterhouse at Waltham Abbey. 14 In addition, the following food was condemned as unfit for human consumption:— 33 tins apples. 92 lbs. bacon. 26 tins baked beans. 6 tins runner beans. 9¼ lbs. butter. 5 tins carrots. 47¼ lbs. cheese. 20 tins chopped ham. 2 bottles coffee. 2 tins corned pork. 4 tins crawfish. 60 eggs. 54 lbs. figs. 13 tins fish (various). 26 tins herrings. 37 tins milk. 11 tins meat and meat roll. 43 tins oranges. 49 tins peaches. 37 tins peas 22 jars pickles. 29 tins pilchards. 8 tins pineapple. 21 tins plums. 40 tins pork luncheon meat. 16 tins pork sausage meat. 7 tins rabbit. 10 rabbits (frozen). 4 tins " ready meat." 11 tins salmon. 112 lbs. spaghetti. 7 tins stewing steak. 45 lbs. stewing steak. 8 tins soup. 13 bottles tomato cream. 19 tins tomatoes. 2 tins tongue. 7 tins mixed vegetables. 7¼ lbs. lard. 138 assorted cakes (damaged as a result of war operations). Where possible the condemned food was disposed of for pig food. There are 10 Bakehouses in the district and all these are kept in good condition. Number of visits—112. There are two Fish Friers in the urban district and the premises are in good order. Number of visits—2. The food shops are kept under observation and particular attention is devoted to the butchers' shops in the district. Number of visits—390. (c) Ice Cream—Food and Drugs Act, 1938. Number of Registrations, on 31st December, 1942 54. No. of Visits—64. (d) SHOPS ACT, 1934. 53 visits were made during the year. No action was found to be necessary under Section 10 of the Act. (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. 15 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Scarlet Fever was prevalent throughout the year, but the disease maintained its mild character and caused no deaths. It is now generally accepted that Scarlet Fever is but one manifestation of infection with a particular germ, a streptococcus, which may cause various symptoms. Whether a patient has a sore throat with a rash or tonsillitis without a rash, makes little or 110 difference to his or her infectivity and consequent danger to the community. It is time, therefore, to revise our ideas on the hospitalisation of Scarlet Fever, for to remove a case with a rash to the Isolation Flospital when there are perhaps other equally infectious cases in the house suffering only from tonsillitis is clearly a waste of time and public money. Unless we are prepared to send to hospital all cases of streptococcal infection, a quite impracticable proposition, the removal or not of a patient should rest upon his or her individual needs for nursing or special treatment and the accommodation available at home. There is little doubt that wherever the patient can have a separate bedroom and be looked after adequately, home nursing is the best procedure. If these views are correct, it is plainly irrational to make notifiable, one particular manifestation only of the disease and it has been suggested that the term " streptococcal throat" should be used to cover all cases of sore throat, including those with rash, due to this germ. In this district 30 or 40% of the cases of Scarlet Fever notified during the year were nursed at home and in none did a second case of the disease occur in the same household. Scabies. There was a considerable increase in the number of cases of scabies brought to the notice of the Local Authority. Arrangements were made to give the necessary baths and treatment at the cleansing sections of the First Aid Posts in Buckhurst Hill and Loughton. The most satisfactory routine treatment has been found to be two applications of benzyl benzoate at one week's interval but it was repeatedly shown that unless all the members of an infected family were examined, and treated if necessary, recurrences were frequent. 1C Particulars given below of the number of cases treated Number of persons treated. 0—5 years. 5—15 years. 15 years and over. Total. M. F. M. F. M. F. 14 11 15 35 17 31 123 Total number of treatments given:— Sulphur ointment 126 applications Benzyl benzoate 158 „ Total 284 Diphtheria Immunisation. Clinics were held monthly at all five Child Welfare Centres as in the previous year and visits made to schools when required. The response in the pre-school age group was good and a high proportion of children attending the Welfare Centres have now been immunisedNone of three cases of diphtheria notified during the year had been previously immunised. Number of children who completed the full course of treatment in 1942:— Under 5 Years. 5-15 Years. Total At Clinics 419 218 637 By General Practitioners 120 54 174 539 272 811 Summary of immunisation work done during last three years:— Number treated. 1940 197 I941 1,834 1942 762 Total 2,793 17 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 Scarlet Fever 44 24 — Registrar General's Figures. Diphtheria 3 3 — Cerebro Spinal Fever 1 1 1 Erysipelas 5 2 — Measles 141 1 — Pneumonia 6 - — Puerperal Pyrexia 1 — — Whooping Cough 54 1 — 254 31 1 TUBERCULOSIS. Age. New Cases. Deaths. Respiratory. Non-Respiratory. Respiratory. Non- Respiratory. M F M F M F M F Under 1 year - - - - 1 - - - 1 and under 5 — — — 1 — — — — 5 „ „ 5 2 1 3 1 — — — — 15 „ „ 25 5 2 2 1 — — — — 25 ,, ,, 35 4 2 — - 3 1 — — 35 „ „ 45 3 1 — 2 1 — — — 45 „ „ 55 1 1 — - — 1 — — 55 „ „ 65 — — — — — 1 — — 65 and upwards - - - - - - - - Totals 15 7 5 5 5 3 — — M. — Male. F.—Female. Note It will be seen that 32 new cases were notified as compared with 48 in the previous year. There were 8 deaths from tuberculosis compared with 13 in 1941. 18 Summary of Sanitary Inspector's Visits during the Year ended 31st December, 1942. Nature of Visit or Inspection. No. of Visits. General Sanitation. Water Supply 43 Drainage 365 Outworkers 65 Public Conveniences 4 Factories 47 Workplaces 10 Bakehouses 112 Piggeries 6 Refuse Disposal 2 Rats and Mice 249 Shops 53 Knackers Yard 26 Petroleum 38 Theatres, etc. 2 Schools 7 Miscellaneous Sanitary Visits 484 1,513 Under Public Health Acts. Housing. Number of houses inspected 148 Visits paid to above houses 361 Under Housing Acts. Visits paid 17 Overcrowding. Number of Houses Inspected 10 Visits paid to above houses 18 Verminous Premises. Infectious Diseases. Number of houses inspected 7 Visits paid to above houses 36 Miscellaneous Housing Visits (a) 21 618 Inquiries in cases of Infectious Disease 52 Visits re Disinfection 134 Miscellaneous Infectious Disease Visits 26 212 Visits to Slaughterhouses 22 Meat and Food Inspection. ,, ,, Butchers 262 ,, ,, Fishmongers and Poulterers 8 ,, „ Grocers 102 ,, ,, Greengrocers and Fruiterers 18 ,, ,, Cowsheds 218 ,, ,, Dairies and Milkshops 77 ,, ,, Ice Cream Premises 64 ,, ,, Restaurants 4 ,, ,, Food Preparing Premises 5 Visits in Connection with Sampling. Milk—Bacteriological 7 Miscellaneous Food Visits 22 810 Total 3,153 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. 19 APPENDIX. RAINFALL IN INCHES BY MONTHS FOR 1942. Metropolitan Water Board Figures. Luxborough S.D. Works. C.U.D.C. Loughton High Beech. Buckhurst Hill. Figures. Depot. January 2.36 2.38 1.30 2.52 February 1.41 1.13 1.24 1.00 March 2.19 2.29 2.13 2.04 April 1.30 1.ll 0.94 1.00 May 2.56 2.43 2.37 2.96 June 0.2 1 0.22 0.20 0.13 July 1.73 1.62 1.48 1.59 August 2.15 2.66 2.36 2.74 September 1.46 1.34 1.30 1.11 October 4.47 4.24 4.97 4.32 November 2.40 2.29 2.26 2.27 December 2.78 2.41 1.65 2.03 Totals 25.02 24.12 22.20 2371 The highest point in the District is 372 O.D., and the lowest 44 O.D. CONTENTS OF THE REPORT FOR 1942. 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 Vital Statistics 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 Causes of Deaths 5 General Provisions of Health Services in the District 6 Ambulance Calls 6—7 Sanitary Circumstances of the Area 7—8—9—10 Housing Statistics for the Year 10—11—12 Housing Act, 1936 12 Inspection of, and Supervision of, Food 12—13—14 Shops 14 Prevalence of, and Control over, Infectious Diseases 15 — 16—17 Summary of Inspector's Visits 18 Meteorological Record—Rainfall 19