CHIG 7 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, 1943. 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 1943 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, 1943). Chairman: Councillor F. S. Foster, J.P., C.C. Vice-Chairman: „ E. Sutton-Pryce, B.D. Members: Councillor A. S. Adams. „ A. G. Gould. E. C. Finch. „ N. V. Fortescue. „ A. E. Leach. „ E. G. Perry. „ J. Skabrook. „ R. F. J. Smith. „ S. G. Weaver, F.C.A. Meetings. These were held on the following dates:— 5th January, 2nd March, 4th May, 6th July, 31st August and 2nd 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 Institute's 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:— B. G. Bannington. Royal Sanitary Institute Certificate. Clerk: Miss J. Warriner. Section A. STATISTICS AND SOCIAL CONDITIONS OF THE AREA. Area (in acres) 8,970 (14 sq. miles approx.). Population 24,680. The rate in the pound for 1943/44 was 14/-. VITAL STATISTICS. Male. Female. TOTAL Live Births. Legitimate. 230 212 442 Illegitimate. 19 18 37 Total 479 Birth rate per 1,000 of estimated resident population:19.4. Male. Female. TOTAL. Still Births. Legitimate. 6 3 9 Illegitimate. — 1 1 Total 10 Rate per 1,000 total (live and still) births:19.8. Male. Female. TOTAL Deaths 128 143 271 Death rate per 1,000 estimated resident population:10.81. Deaths of Infants Under 1 Year Male. Female. TOTAL Legitimate. 7 8 15 Illegitimate. 1 — 1 Total 16 4 Death rath of Infants Under 1 Year of age: All Infants per 1,000 live births 33 Legitimate Infants, per 1,000 legitimate live births 33 Illegitimate „ „ „ illegitimate „ 27 Deaths from Cancer (all ages) 51 „ „ Measles (all ages) 1 „ „ Whooping Cough (all ages) 0 ., „ Diarrhoea (under 2 years) 2 „ Road Traffic 3 „ „ Suicide 2 „ Other Violent Causes 4 Analysis of Deaths according to Age Incidence. Age. No. of Deaths. 1943. 1942. 1941. 1940. 1939. Under 1 year 16 16 17 15 11 1 and under 2 1 — — 1 — 2 „ „ 5 — — — 4 1 5 „ „ 15 2 6 4 2 9 15 „ „ 25 7 4 5 7 9 25 „ „ 35 10 8 12 12 5 35 „ „ 45 8 10 27 20 16 45 „ „ 55 24 18 32 28 12 55 „ „ 65 42 40 46 50 36 65 „ „ 75 62 66 68 57 48 75 and upwards 95 80 79 96 63 Total 267 248 290 292 210 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. Number of Deaths. Rate per 1,000 (Live Births). 1939 25,100 416 16.5 210 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 16.7 249 10.0 16 38 1943 24,680 479 19.4 267 10.81 16 33 *The death rates from 1941/43 have not been corrected by the use of the area comparatibility figure so are not strictly comparable with those of 1939/40. 5 Section B. GENERAL PROVISIONS OF HEALTH SERVICES IN THE DISTRICT. (a) Laboratory Service. The facilities at the E.M.S. Laboratory at St. Margaret's Hospital, Epping, continue to provide a much improved service for the district. (b) Ambulance Service. Continued use was made of Civil Defence vehicles and the Volunteer Car Pool to supplement the Council's ambulance. The Volunteer Car Pool in particular has proved invaluable in the conveyance cf patients to and from hospitals, clinics, etc. AMBULANCE CALLS. Number of Calls. Accident or other reason. Urgent Medical 556 86 470 (c) Nursing in the Home. The influenza epidemic at the end of the year placed a great strain on doctors and district nurses and to alleviate this to some extent arrangements were made for nursing auxiliaries from the First Aid Posts to do home nursing when requested to do so by a doctor or district nurse. This arrangement proved helpful especially at Buckhurst Hill. (d) and (e) Clinics, Treatment Centres and Hospitals. Child Welfare Centres:— Buckhurst Hill.—County Council Clinic, Buckhurst Way— Thursdays at 2.30 p.m. Chigwell.—St. Winifred's Church Hall, Chigwell Row—1st and 3rd Wednesdays at 2.30 p.m. Loughton.-Union Church Hall, High Road—Fridays at 2.30 p.m. Roding Road Church Hall—Tuesdays at 2.30 p.m. Goldings Hill Mission Hall—1st, 3rd and 5th Thursdays at 2.30 p.m. 6 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 at 2.30 p.m. 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 Councii.-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 10.30 a.m. to 1 p.m. Ante-Natal Clinic.-Union Church Hall, Loughton—1st and 3rd Friday in month at 9.30 a.m. 2nd and 4th Thursday in month at 2 p.m. ESSEX COUNTY COUNCIL ACT, 1933. List of Establishments for Massage or Special Treatment. The following establishments are licensed to 31st March, 1944:— 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. 7 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. 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. 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 Lough ton 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) 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. Precautionary measures were again taken against fly nuisance at and around the refuse tip and appear to have been effective. 8 Salvage operations continued during the year throughout the district. Nearly 490 tons of salvage materials of all descriptions were collected, sorted and disposed of, including over 274 tons of paper. In addition nearly 172 tons of kitchen waste were collected. 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. (iii) Sanitary Inspection of the Area. An outline of the work of the Sanitary Inspectors is given below:— No. of Complaints received 199 „ „ Inspections made 3,608 „ „ Cesspools cleaned 1 „ „ Nuisances abated 72 „ „ Informal Notices served 102 „ „ Informal Notices complied with 102 „ „ Statutory Notices served 3 „ „ Statutory Notices complied with 3 „ „ Legal Proceedings Nil Summary of Nuisances. Overflowing Cesspool 1 Flooded Cellar 1 Defective Drains 3 Choked Drains 56 Offensive Matter 1 Defective W.C.'s 5 Deficient Water Supply 5 72 Verminous Houses— Six houses were found to be verminous during the year. In all cases fumigation was carried out by, or under the instructions of, this department. Fifty visits were paid to these premises. 9 Rats and Mice (Destruction) Act, 1919. Action under this Act was vigourously and consistently carried out. All complaints were promptly investigated, likely breeding places were visited and threshing operations attended. Where possible, gassing was carried out and bait and advice freely given where it could be usefully employed. During the year the central administration of the Act was transferred to the Ministry of Food and the County War Agricultural Committee was made responsible for measures of extermination in agricultural areas. This department keeps in close touch and co-operates with the Committee in its efforts to eradicate the pest In the latter part of the year a widespread publicity campaign was inaugurated by the Ministry. The department co-operated by arranging displays and fixing boxes for the receipt of complaints at each of the twenty-four wardens' posts in the district. The number of complaints received and the result of widespread investigation give nc reason to think that there is any serious infestation in the district. 555 visits were made during the year. (iv) Smoke Abatement—There are no big industrial premises in the district and, as the few manufacturing concerns use electricity as motive power, no action has been necessary. 4. Schools— I'he sanitary conditions and water supply are satisfactory. Section D. HOUSING STATISTICS FOR THE YEAR 1943. Number of new houses erected during the year 1943 Nil Inspection of Dwelling Houses during this Year. 1. (a) Total number of Dwelling-houses inspected for housing defects (under Public Health and Housing Acts) 179 (b) Number of Inspections made for the purpose 476 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 10 3. Number of Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 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 102 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 102 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 2 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) by Owners 2 (b) by Local Authority in default of Owners Nil (b) Proceedings tinder Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 105 (2) Number of Dwelling-houses in which defects were remedied after service of formal notices:— (a) by Owners 3 (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 1 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 11 Housing Act, 1936—Part IV—Overcrowding. No formal action. In order to obtain data upon which to formulate a post„war housing programme all known cases of bombed„out evacuees residing in the district were visited to ascertain the approximate number wishing to remain in the district and an informal survey of houses which were likely to be scheduled for demolition was carried out. 321 visits were made for these purposes. The issue of certificates showing permitted numbers to the end of the year is as follows:— To the end of 1943. Buckhurst Hill 350 Chigwell 169 Loughton 397 Number of visits, 10. Summary of Defects. Defective Roofs 36 „ Gutters and Rain„Water Pipes 21 „ Walls and Windows 22 „ Floors, Doors, etc. 18 „ Sash Cords 18 „ Plaster 13 ., Drains 6 W.C.'s 3 „ Flush Tanks 17 „ Sinks and Waste Pipes 7 „ Water Fittings 4 „ Stoves 1 Dampness 24 Under Floor Ventilation, Lack of 7 Insufficient Sanitary Conveniences 1 Ashbins, Lack of 3 Verminous Rooms 9 Dirty Walls and Ceilings 38 Miscellaneous 19 Section E. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply— There are 13 cowkeepers on the register for the district, 3 produce and retail and 10 produce and sell wholesale. The number of farms producing Graded and Ungraded milk are:— Tuberculin Tested (Certified), 1; Accredited, 11; Ordinary, 4. The 16 cowsheds have been maintained generally in a satisfactory condition. 180 visits were made during the year. 12 11 samples of milk were taken during the latter part of the year. Of these five were satisfactory, in one case the milk (pasteurised) was satisfactory, but pasteurisation was not, the remainder were unsatisfactory. Three out of four samples of pasteurised milk satisfied the Phosphatase test. The case of the unsatisfactory sample was referred to the Authority within whose area it was produced. In the latter cases steps were at once taken to secure improvement to which end close contact and co-operation with the Essex County Council Public Health Department is maintained. There are 7 Dairies and Milkshops on the register. To these 74 visits were made. There are 12 retail purveyors of milk on the register. (b) Meat and other Foods— There are 7 Slaughterhouses in the district, all licenced under the Food and Drugs Act, 1938. During the year 14 pigs were slaughtered under licence, inspected and found to be sound. 89 visits were made to ensure that premises were kept in order in case of emergency and that they were not used for prohibited purposes. There are 22 Butchers' shops in the district. To these 288 visits were made. Other food shops were kept under observation. 138 visits having been made during the year. It no case was is found necessary to take proceedings against or even warn traders for having unsound food in their possession. On the contrary, they co-operate with the Department by notifying any foodstuff about which there is any doubt; as a result the following foods have been condemned, surrendered, and where suitable, disposed of for pig food:— 14 tins meat roll. 5 tins tongue. 6 tins ham. 5 tins beef. 9 tins mutton. 24 tins pork. 5 tins sausage meat. 2 tins stewed steak. 2 tins rabbit. 21¾ lbs. bacon. 53 tins soups and stews. 26 tins herrings. 28 tins pilchards. 14 tins salmon. 2 tins mackerel. 2 tins crawfish. 10 tins sardines. 109 tins milk. 8 lbs. butter. 47 tins various fruits. 7 tins jam. 7 tins marmalade. 1 tin syrup. *2 packets dates. 14 tins carrots. 31 tins beans. 13 tins peas 1 tin beetroot. 7 tins mixed vegetables. 16 gallon jars pickles. 60 lbs. oatmeal. 25 lbs. spaghetti. *5 packets Ryvita. *5 packets custard powder. 3 packets pudding mixture. 956 eggs. 1 lb. tea. 23 lbs. cheese. 13 All the tinned items were either blown or punctured. Those marked * were damaged and fouled by mice; on our advice a professional rodent destroyer was engaged to periodically visit the premises. The eggs were apparently part of a consignment from Ireland which had been delayed and damaged in transit. The tea contained a number of minute insects which the authorities at the British Museum identified as the saw-toothed grain beetle; as it attacks any dried vegetable products the dealers were notified so that they might take the necessary precautionary measures. It is interesting to know that this was the first case of the presence of the insect in tea that had come to their notice. There are 10 Bakehouses in the district and all these were kept in good condition. Number of visits—131. (c) Factories— 183 visits were paid to these premises, most of which are small. In three cases the provision of new and the extension and improvement of existing sanitary conveniences was secured. (d) Outworkers— The number of these notified during the year showed a considerable reduction. 45 visits were paid, the conditions found generally satisfactory. (e) SHOPS ACT, 1934. 17 visits were made. No infringements of the Act were complained of or found. (f) Adulteration—This is dealt with by the County Council. (g) Chemical and Bacteriological Examination of Food— This is dealt with by the County Council. (h) Nutrition—No action. 14 Summary of Sanitary Inspector's Visits during the Year ended 31st December, 1943. General Sanitation. Nature of Visit or Inspection. No. of Visits. Water Supply 7 Drainage 296 Outworkers 45 Factories 183 Workplaces 1 Bakehouses 131 Piggeries — Refuse Disposal 2 Rats and Mice 555 Shops 17 Knackers Yard 21 Petroleum 27 Miscellaneous Sanitary Visits 267 1,552 Housing. Under Public Health Acts. Number of houses inspected 169 Visits paid to above houses 448 Under Housing Acts. Number of houses inspected 10 Visits paid to above houses 28 Overcrowding. Number of houses inspected 5 Visits paid to above houses 5 Verminous Premises. Number of houses inspected 17 Visits paid to above houses 33 Miscellaneous Housing Visits 321 1,036 Infectious Diseases. Inquiries in cases of Infectious Disease 79 Visits re Disinfection 28 Miscellaneous Infectious Disease Visits 29 136 Meat and Food Inspection. Visits to Slaughterhouses 89 ,, ,, Butchers 288 ,, ., Fishmongers and Poulterers 14 ,, ,, Grocers 69 ,, ,. Greengrocers and Fruiterers 5 ,, ,, Cowsheds 180 ,, ,, Dairies and Milkshops 74 ,, ,, Restaurants 21 ,, ,, Food Preparing Premises 4 Visits in Connection with Sampling. Milk—Bacteriological 12 Miscellaneous Food Visits 126 882 Total 3.606 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. 15 Section F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. There was an increased incidence of Scarlet Fever compared with 1942, but the disease maintained its mild character and 48% of the cases were isolated at home. The Measles epidemic which began in November, 1942, rapidly reached its peak in January with 93 cases, then gradually subsided, coming to an end in May when only 11 cases were notified. Scabies. The arrangements at the First Aid Posts in Loughton and Buckhurst Hill for the treatment of this disease were continued and as will be seen from the following table, a large number of cases received treatment. Two applications of benzyl benzoate at a week's interval effected a cure in the great majority of cases and relapses or recurrences were almost invariably due to failure to get all the members of an infected family treated in the first instance. In September, the disease was made notifiable in the district under the Scabies Order. In June, the Ministry of Information film on the diagnosis and treatment of the disease was shown in Loughton to a large audience of doctors, nurses and other health workers from Chigwell and the surrounding districts. Particulars are 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. 185* 5 47 36 24 59 *This total includes those cases which relapsed and received a second course of treatment. 16 Total number of treatments given:— Sulphur ointment 44 applications Benzyl benzoate 300 „ Total 344 N umber of cases diagnosed by:— Medical Officer of Health 81 General Practitioners 104 185 Diphtheria Immunisation. Particulars of the number of children immunised are given in the following table. Monthly immunisation clinics were held at the five Child Welfare Centres and no difficulty is now being experienced in getting practically all children attending the centres immunised at about the age of 12 months. This statement may seem at variance with the fact that only 62% of the children under 5 were estimated to have been immunised by the end of the year, but the remaining 38% comprise those still under 1 year of age, together with those not attending one of the welfare centres. Of the 5 notified cases of diphtheria, 4 were in children under school age and none of these had been immunised. Number of children who completed the full course of treatment in 1943:— Under 5 years. 5—15 years. Total. 260 148 408 Estimated percentage immunised 62% 56% Summary of immunisation work done during last three years:— Number treated. 1941 1,834 1942 762 1943 408 Total 3,004 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 94 49 — Diphtheria 5 5 — Erysipelas 7 4 — Pneumonia 24 8 — Puerperal Pyrexia 2 1 — Measles 234 1 — Whooping Cough 74 — - Scabies 43 — - Dysentery 4 1 — 487 69 — TUBERCULOSIS. Age. New Cases. Deaths. Respiratory. Non-Respiratory. Respiratory. Non-Respiratory. M F M F M F M F Under 1 year — — — — — — — — I and under 5 — 1 — — — 1 — — 5 „ „ 15 „ — 2 1 — — — — 15 „ „ 25 4 3 — 1 — 2 — — 25 „ „ 35 5 3 — — 1 2 — — 35 „ „ 45 4 1 — — 2 — — — 45 „ „ 55 1 2 — — 2 — — — 55 „ „ 65 2 — — — 1 — — — 65 and upwards — 1 — — 1 — — — Totals 16 11 2 3 7 5 — — M. —Male. F.—Female. Note.-It will be seen that 32 new cases were notified as in the previous year. There were 12 deaths from tuberculosis compared with 8 in 1942. APPENDIX. RAINFALL IN INCHES BY MONTHS FOR 1943. Metropolitan Water Board Figures. Luxborough S.D. Works. Figures. C.U.D.C. Loughton Depot. High Beech. Buckhurst Hill. January 4.85 4.81 3.69 3.62 February 1.33 1.21 1.64 1.59 March 0.44 0.39 0.29 0.56 April 1.21 1.35 0.88 0.87 May 1.81 1.55 1.61 1.65 June 1.69 1.49 1.33 1.48 July 1.78 1.41 1.11 1.08 August 1.52 1.79 2.38 2.28 September 2.23 1.74 1.50 1.24 October 2.45 2.37 1.97 2.35 November 1.78 1.80 1.69 1.20 December 1.48 1.53 1.38 1.21 Totals 22.57 21.44 19.47 19.13 The highest point in the District is 372 O.D., and the lowest 44 O.D. CONTENTS OF THE REPORT FOR 1943. PAGES Report—Medical Officer of Health's Letter 1 Public Health Committee 2 Public Health Staft 2—3 Statistics and Social Conditions of the Area 3 Vital Statistics 3—4 Analysis of Deaths according to age incidence 4 Comparative Table, Birth and Death Rates 4 Table of Birth Rates, Death Rates and Infantile Mortality 4 General Provisions of Health Services in the District 5 Ambulance Calls 5 Clinics, Treatment Centres and Hospitals 5—6 Sanitary Circumstances of the Area 7 Housing Statistics for the Year 9—10—11 Inspection and Supervision of Food 11—12—13 Shops 13 Summary of Inspector's Visits 14 Prevalence of, and Control over, Infectious Diseases 15-16—17 Meteorological Record—Rainfall 18