Journal Rebird Co. Ltd Unit 4, Pie Wharf, Grays, Essex. AC 4411(3)CHI CHIG 9 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, 1945 Printed by A. Willis, The Caxton Press, Waltham Cross 68613 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 1945 upon the health and sanitary circumstances of the district. I take this opportunity of thanking the staff of the Public Health Department for their help and cooperation and the members of the Public Health Committee for their support during the year. After 6 years of an exhausting war the health of the district, as judged by the infantile mortality, death rates and the incidence of infectious disease must be regarded as remarkably good. The outstanding material need for health and happiness is first and foremost houses ; it is unnecessary to enlarge upon this which is universally recognised. A second problem that faces us, perhaps less frequently mentioned, is the changing age structure of the population. In 1900, there were less than 2 million people over 65 years of age in the country, in 1951, there will probably be 5½ million. The housing shortage, the complete lack of domestic help and of hospital accommodation for the chronic sick is resulting in an amount of suffering amongst the aged and infirm which is not perhaps fully realised except by doctors and nurses. There is of course no rapid and easy answer to the problem. The shortage of institutional accommodation is mainly one of nursing and domestic staff, but there is a strong case for the inclusion of a certain number of dwellings suit- 1 able for old people in every housing estate. These should be carefully sited to be within easy reach of shopping facilities and other amenities. Small hostels for the aged have worked well in many areas during the war and small groups of almshouses have been built successfully by some authorities. It is necessary only to visit "Beechlands" and other Homes in this district to realise how greatly old people requiring simple nursing attention and the minimum of medical treatment appreciate the friendly atmosphere of a small unit run on non-institutional lines. To quote from a recent leading article in the Lancet, "The more intelligently and kindly a community looks after it's old people, the less the need for expensive institutional care given domestic help, nursing care and medical attention when needed, many old people who now die after years in hospital could live interesting and possibly useful lives, finally dying triumphantly in their own beds." L. S. FRY, M.D., D.P.H. 2 Chigwell Urban District Council. Public Health Committee: The General Purposes, Public Health and Ambulance Committees remained incorporated as Committee No. 2. Chairman : Councillor S. G. Weaver, f.c.a. Members : Councillor A. S. Adams ,, E. C. Finch „ N. V. Fortescue „ A. E. Leach „ R. F. J. Smith „ W. H. Wilson ,, H. W. A. Woollard The Chairman and the Vice-Chairman of the Council ex-officio Public Health Staff: Medical Officer of Health: L. S. Fry, m.d., (camb.) d.p.h. Senior Sanitary and Petrolenm 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. dlgweed, a.r.san.i., m.s.i.a. (Seconded to Air Raid Precautions Dept. as Controller until 30th September, 1945, Returned to Public Health duties on 1st Octobcr, 1945). Royal Sanitary Institute and Sanitary Inspector's Joint Board Certificate. Inspector of Meat and Other Foods. Temporary Sanitary In&pectot : B. G. Bannington Royal Sanitary Institute Certificate. (Ceased to be employed on 1st October, 1945). Clerk : mlss J. WaRRINER 3 SECTION A. Statistics and Social Conditions of the Area. Area (in acres) 8,970 (14 sq miles approx.) Population 25,170 Number of inhabited houses 7,884 Number of separate families or separate occupiers —not available Rateable value £245,179 Sum represented by a penny rate £980 The rate in the pound for 1945/46 is 15/4 The district comprises roughly 5½ miles of the Roding Valley with much open forest and farm land. The soil is clay with pockets of gravel on the higher ground. There must inevitably in the near future be encroachment on what is at present open space, but the Abercrombie Report suggests an optimum population of 50,000; this figure, however, does not take into account the full extent of the new L.C.C. Estates in Loughton and Chigwell and a total population of about 60,000 must be envisaged at no distant date. There is a large dormitory population in the district, but many persons are employed locally in agriculture, railways and transport and local factories and business premises. The district is a healthy one and there is no employment which is injurious to health. Vital Statistics. Male Female Total Live births [ Legitimate 197 182 379 [illegitimate 35 33 68 Total 447 Birth rate per 1,000 estimated resident population 17.7 4  Male Female Total Still births Legitimate 3 1 4 Illegitimate — 1 1 Total 5 Rate per 1,000 (live and still) births 11.2 Male Female Total Deaths 138 144 *282 •Registrar General's figures Death rate per 1,000 estimated resident population 11.2 Deaths from puerperal sepsis and other maternal causes 1 Deaths of infants under 1 year— Male Female Total Legitimate 11 4 15 Illegitimate 2 0 2 Total 17 Death rate of infants under 1 year— All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 39.5 Illegitimate infants per 1,000 illegitimate live births 29.4 Deaths from Cancer (all ages) 44 Deaths from Measles (all ages) 1 Deaths from Whooping Cough (all ages) 0 Deaths from Diarrhoea (under 2 years) 3 Deaths from road traffic accidents 2 Deaths from suicide 1 Deaths from other violent causes (including deaths due to enemy action 10 5 Comments on Vital Statistics for 1945. The population increased according to the Registrar General's estimate from 24,820 to 25,170. The birth rate fell from 20.9 to 17.7. The death rate increased from 10.9 to 11.2. Infantile mortality decreased from 48 to 38. Analysis of Deaths according to age incidence. No. of Deaths Age. 1945 1944 1943 1942 1941 Under 1 year 16 25 16 16 17 1 and under 2 3 — 1 — — 2 „ „ 5 1 — — — — 5 ,, ,,15 3 7 2 6 4 15 „ „ 25 5 — 7 4 5 25 „ „ 35 7 3 10 8 12 35 „ „ 45 15 13 8 10 27 45 „ „ 55 18 20 24 18 32 55 „ ,, 65 31 47 42 40 46 65 „ „ 75 69 62 62 66 68 75 and upwards 111 89 95 80 79 Total 279 266 257 248 290 The following table shows the vital statistics for district for the six war years 1940-45:— Year. Birth Rate. Per 1,000 of Population Number Infantile of Mortality Illegitimate Rate. Births. Per 1000 (Live Births) Death Rate. Estimated Population. 1940 15.3 8 39 12.7 24,850 1941 13.2 13 52 11.7 25,070 1942 16.7 23 38 10.0 24,860 1943 19.4 37 33 10.8 24,680 1944 20.9 66 48 10.9 24,820 1945 17.7 68 38 1 1.2 25,170 6 Birth-rates, Civilian Death-Rates, Analysis of Mortality, and Case Rates for certain Infectious Diseases in the year 1945. (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 Adm. County Chigwell Rates per 1,000 population:— Live Births 16.1 19.1 19.2 15.7 17.7 Still Births 0.46 0.58 0.53 0.40 0.19 Deaths:— All causes 11.4 13.5 12.3 13.8 11.2 Typhoid & Paratyphoid 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 0.02 0.01 0.02 0.00 Diphtheria 0.02 0.02 0.02 0.01 0.00 Influenza 0.08 0.07 0.07 0.07 0.04 Smallpox — — — — — Measles 0.02 0.02 0.02 0.01 0.04 Rates per 1,000 Live Births:— Deaths under 1 year of age 46 54 43 53 38 Deaths from Diarrhoea and Enteritis under 2 years of age 5.6 7.8 4.5 7.6 6.7 Rates per 1,000 Civilian Population:— Notifications Typhoid Fever 0.01 0.01 0.01 0.01 0.00 Paratyphoid Fever 0.01 0.00 0.01 0.00 0.00 Cerebro Spinal Fever 0.05 0.05 0.05 0.06 0.00 Scarlet Fever 1.89 2.02 2.03 1.57 1.58 Whooping Cough 1.64 1.65 1.47 1.25 2.10 Diphtheria 0.46 0.52 0.56 0.31 0.04 Erysipelas 0.25 0.28 0.24 0.31 0.16 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 11.67 10.89 11.19 9.03 8.34 Pneumonia 0.87 1.03 0.72 0.78 0.19 7 SECTION B. General Provision of Health Services in the District. (a) Public Health Officers of the Local Authority —see page 3. (b) Laboratory Facilities An E.M.S. Laboratory is situated at St. Margaret's Hospital, Epping. Milk samples are examined at the Essex County Council Laboratory at the Agriculture College, Writtle. (c) Ambulance Facilities. Continued use was made of Civil Defence personnel and vehicles until their disband ment in May, 1945. Subsequently, a sitting case car with drivers was provided, in addition to the Council's ambulance. The Volunteer Car Pool continued to render invaluable service until it ceased to function in July, 1945, and was then succeeded by the Hospital Car Service. Reciprocal arrangements for ambulances are now in force with the Boroughs of Wanstead and Woodford, Chingford and Ilford. These arrangements are satisfactory and, in addition, in the event of an emergency, an ambulance can be obtained from Messrs. Flack, of Epping. Ambulance calls during 1945 were : — Accidents. Medical Cases. Maternity Cases. Total number of Calls. 96 245 12 353 Sitting Case Car (including Civil Defence vehicles):— Accidents. Medical Cases. Maternity Cases. Total number of Calls. 17 141 90 248 Total calls 601 8 (d) Nursing in the Home. No change. (e) and (f) Clinics and Treatment Centres. Child Welfare Centres:— Buckhurst Hill: County Council Clinic, Buckhurst Way—Thursdays at 2.30 p.m. Chigwell: St. Winifred's Church Hall, Chigwell— 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 Tuesdays at 2.30 p.m. Diphtheria Immunisation: Clinics are held once a month at the following Child Welfare Centres:— Buckhurst Hill : County Council Clinic, Buckhurst Way—2nd Thursday at 2.30 p.m. Chigwell : St. Winifred's Church Hall—3rd Wednesday at 2.30 p.m. Loughton : Union Church Hall, High Road—2nd Friday at 2.30 p.m. Goldings Hill Mission Hall—3rd Tuesday at 2.30 p.m. Roding Road Church Hall —2nd Tuesday at 2.30 p.m. Tuberculosis Dispensary: Essex County Council: For patients in the district: Buckhurst Hill : County Council Clinic, Buckhurst Way—2nd and 4th Wednesday at 2.30 p.m. Combined Treatment Centre, Regent Road, Epping, —every Tuesday from 9.30 a.m. to 1 p.m. Ante-Natal Clinic : Union Church Hall, Loughton—1st, 2nd, 3rd and 4th (not 5th) Thursdays at 2 p.m. County Council Clinic, Buckhurst Hill—every Friday at 2.30 p.m. 9 ESSEX COUNTY COUNCIL ACT, 1933. List of Establishments for Massage or Special Treatment The following establishments are licensed to 31st March, 1946 : Miss E. Mackern, 45, Church Hill, Loughton "Madame Pauline," 100, High Read, Loughton These premises have been inspected and are being conducted 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, and this supply is satisfactory. There are a few houses where the supply is still obtained from wells. (ii) Drainage and Sewerage. The sewage disposal plants continued 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 river 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 reach of sewers. 10 (ii) Public Cleansing. House refuse was removed weekly by hired covered motor vans. During the year a change was made from the previous arrangements of a contract for the whole service to hiring vehicles and drivers only, and employing the Council's own employees for all other purposes. It is expected that in the next year the transition will be taken further by the introduction of Council-owned vehicles and their own drivers. The refuse was disposed of at the contractor's tip near the district boundary by the method and with the appropriate precautions of controlled tipping Precautionary measures were again taken against fly nuisance during certain months and appear to have been effective. Salvage operations continued during the year throughout the district. The yield showed a continued tendency to decrease, but 411 tons of salvage materials of all descriptions were collected, sorted and disposed of, including 157 tons of paper. In addition, 167 tons of kitchen waste was collected and disposed of to a concentrator plant at Stapleford Abbotts. 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:— Complaints received and dealt with 89 Inspections made 3,611 Nuisances abated 78 Informal Notices served 135 ,, „ complied with 122 Statutory „ served „ ,, complied with 4 4 Legal Proceedings 0 11 Summary of Nuisances: Animals improperly kept 4 Cellars flooded 5 Cesspool overflows, etc. 3 Drains blocked or defective 112 Manure from stables, etc. 1 Polluted ditches and streams 6 Smells from dead animals 2 Water closets defective 7 Water supply defective or cut off 12 152 Verminous Houses: Nine houses were found to be verminous during the year. These houses were fumigated with " Thermatox" with satisfactory results. Number of inspections and visits—27. Rats and Mice (Destruction) Act, 1919: There was a slight rise in the number of complaints. Four hundred and twenty-eight visits were made and considerable success has been achieved by gassing with " Cymag" gas or baiting. There is no serious infestation, but the presence of rats has been reported from all over the district. SECTION D. Housing Statistics for the year 1945 Number of new houses erected and occupied during the year 1945 ... ... ... ... 1 Inspection of Dwelling Houses during the Year. 1. («) Total number of dwelling-houses inspected for housing defects (under Public Health and Housing Acts) ... ... ... 227 12 (6) Number of inspections made for the purpose 386 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 subhead) found not to be in all respects reasonably fit for human habitation 23 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 Section 9, 10 and 16 of the Housing Act, 1936. (1) Number of dwelling-houses in respect of which notices were served requiring repairs 3 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (а) by Owners 2 (б) by Local Authority in default of Owners 1 (b) Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied Nil 13 (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 Section 11 and 13 of lhe 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 Housing Act, 1936—Part IV—Overcrowding. No formal action. Seventeen inspections and visits have been made and action taken where possible, but there is great difficulty in dealing with overcrowding due to the acute shortage of houses. The issue of certificates showing permitted numbers to the end of the year is as follows:— Buckhurst Hill 350 Chigwell 169 Loughton 397 Total to end of 1945 916 Summary of Defects. Defective roofs 40 ,, gutters and rain water pipes 37 ,, external walls 23 ,, yard paving 12 ,, drains and vent pipes 17 „ W.C.'s 11 „ flush tanks 6 ,, sinks and waste pipes 10 14 Defective water fittings 9 ,, internal walls (plaster) 25 ,, floors, doors, etc 49 ,, sash cords 23 ,, stoves 15 Dampness 19 Under floor ventilation, lack of 2 Dustbins, inefficient, etc. 10 Verminous rooms 9 Dirty wall and ceilings 60 Miscellaneous 10 SECTION E. Inspection and Supervision of Food (a) Milk Supply. There are 12 cowkeepers on the register for the district; 2 produce and retail and 10 produce and sell wholesale. The number of farms producing graded and ungraded milk is :—Tuberculin Tested (Certified) 1 ; Accredited 10; Ordinary 4. Total 15. The cowsheds have been kept in a satisfactory condition and 195 visits were made during the year. Borders Farm, Loughton, closed down and ceased to produce Accredited milk from the end of September, 1945. 11 samples of milk were taken during the year, 8 proving satisfactory and 3 unsatisfactory. In the latter case other samples were taken and the second test was satisfactory. There are seven dairies and milkshops on the register. 99 visits to these premises have been made during the year. There are 14 retail purveyors of milk registered. 15 (b) Meat and other Foods. There are 7 slaughter-houses in the district, all licensed under the Food and Drugs Act, 1938. During the year, 13 pigs were slaughtered under licence. 57 visits were made to ensure that premises were properly maintained. There are 22 butchers' shops in the district to which 283 visits were made. 108 visits have been made to restaurants and cafes which are kept in good condition. Other food shops, to which 148 visits have been made, have been well conducted. The following foodstuffs have been submitted for inspection, found unsound, surrendered and where possible disposed of for animal feeding:— FRUIT. Oranges: 6 cases ; l,087½ Lemons: 16 lbs. lbs.; 712 Grape Fruit: 14 lbs.; 60 Plums: Tins 2 Dates: 2 cwts.; 72 lbs. MEAT. Sausages: Tins 2 Kam : Tins 5 Luncheon Meat: Tins 12 Ham: Tins 8 Steak: Tins 21 Sausage Meat: Tins 2 Tongue: Tins 5 Treet: Tins 1 Spam: Tins 2 Beef: Tins 2 Prem : Tins 1 Pork : Tins 7 Pigeons: No. 15 Meat & Vegetables: Tins 4 FISH. Pilchards : Tins 63 Mackerel: Tins 9 Herrings: Tins 7 Sardines: Tins 16 Salmon: Tins 11 Fish Paste: Jars 10 Lobsters: lbs. 70 Turbot: Stone 2 Plaice : Stone 9i Crayfish : Tins 1 Crawfish : Tins 1 16 VEGETABLES. Peas: Tins 18 Beans : Tins 44 Vegetables: Tins8 Tomatoes: lbs. 36 Vegetable Stew : Tin 1 Carrots : Tin 1 OTHER ITEMS. Tea : ½lb. Milk : 364 tins Sugar: 21 lbs. Marmalade: 7 tins Soup: Tins 13 Jam Rolls: 31 Oatmeal : 7 lbs. Oak Flakes : Packets 1 All Bran : Packets 2 Dried Egg : Packets 4 Syrup: Tins 2 Jam: Tin 1 Flour: 15 lbs. Rolled Oats: 75 lbs. Soya Flour : 8 lbs. All the tinned goods were either blown or punctured. The citrus fruits were parts of consignments which had been unduly delayed in transit. Some items were rendered unfit by fouling by vermin. In addition the following foodstuffs were damaged by enemy action :— Meat: 60 lbs. Jam: Jars 12 Sauce: 10 bottles Pickles: 4 bottles Rennet: 1 bottle Eggs: 6 In dealing with the above we co-operated with the Ministry of Food (Salvage Department) and the local Food Office. In the district there are 10 bakehouses ; 140 visits to these premises have been made. (c) Factories. 172 visits have been made. (d) Outworkers These again show a decrease, only 12 visits having been made during the year. (e) Shops Acts. 34 visits have been made. 17 (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. A few samples of milk have, however, been submittted for examination. (h) Nutrition. No action. Summary of Sanitary Inspector's visits during the Year ended 31st December, 1945. General Sanitation. Nature of Visit or Inspection No. of visits Water Supply 15 Drainage 415 Factories 172 Workshops 2 Outworkers 12 Bakehouses 140 Refuse Collection 1 Refuse Disposal 18 Rats and Mice 428 Shops 34 Schools 1 Knackers Yard 16 Petrol 38 Miscellaneous Sanitary Visits 303 1,595 Housing. Under Public Health Acts. Number of houses inspected 227 Visits paid to above houses 386 Under Housing Acts. Number of houses inspected 23 Visits paid to above houses 16 18 Overcrowding. Number of houses inspected 12 Visits paid to above houses 5 Verminous Premises. Number of houses inspected 9 Visits paid to above houses 18 Miscellaneous Housing Visits 242 938 Infectious Diseases. Inquiries in cases of Infectious Disease 41 Visits re disinfection 7 Miscellaneous Infectious Disease Visits 31 79 Meat and Food Inspection. Visits to Slaughter-houses 57 ,, ,, Butchers 283 ,, ,, Fishmongers and Poulterers 10 „ ,, Grocers 78 ,, ,, Greengrocers & Fruiterers 7 ,, ,, Cowsheds 195 „ ,, Dairies and Milkshops 99 ,, ,, Ice Cream Premises 53 ,, ,, Restaurants 108 Miscellaneous Food Visits 99 Visits in connection with Sampling. Milk—Bacteriological 10 999 Total 3.61 1 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. 19 SECTION F. Prevalence of, and Control over, Infectious and other Diseases. Diphtheria Immunisation. As will be seen from the Table below, 445 children were immunised compared with 401 in 1944. The main effort has been directed towards getting the pre-school age protected and 85% of these treated were under 5 years of age. At the lowest estimate 62% of this age group have now been immunised and as few children are treated before the age of one, the percentage immunised between 1 and 5 years is now about 80, which may be regarded as satisfactory. The parents of the children still unprotected are mainly those who "don't believe in it" or the indifferent, apathetic and lazy and it is doubtful whether propaganda by means of posters, leaflets, wireless talks, etc., has much effect on these who are probably most influenced by personal contact. There has been no change in the days and times of immunisation clinics which are set out at the beginning of this report. Number of children immunised during the last 5 years:— 1941 1942 1943 1944 1945 Number treated 1834 762 408 401 445 Under 5 years 5—15 years Estimated percentage of child population immuni- on 31st December, 1945: 62% 65% 20 Three cases of diphtheria were notified during the year, but in two the diagnosis was not confirmed, the third was in an adult aged 19. This represents the lowest incidence of the disease in the district during the last 10 years. It would be unwise, however, to attribute this with any confidence to immunisation, for the disease is notoriously erratic in delivering its attacks and a period of at least 20 years must elapse before we can form a sound and final judgment of the results of our efforts. Measles. The expected biennial epidemic reached its peak in March and petered out in August. One death was recorded. Scarlet Fever. There was a slight increase in the incidence of the disease, which continued to be mild in type and twothirdfe of the cases were nursed at-home. Scabies. The disease continued to be more common in the district than before the war and 116 cases were notified compared with 88 in 1944. This prevalence is probablydue to a number of causes, amongst which may be mentioned overcrowding with the consequent inadequacy of bedroom and washing accommodation. The disease is almost invariably spread by direct bodily contact and the sharing of a bed with an infected person must almost inevitably lead to infection. Too often sufferers have neglected to seek medical advice until several members of the family have become infected and been deprived of rest and sleep fur weeks. In some cases the origin of infection has been traced to the return home of men from the forces on leave or demobilization. Treatment. Arrangements were made for treatment to be carried out by ex-First Aid Post workers 21 trained during the war years. In Loughton a part of an old A.R.P. building in the Council's yard has been adapted for the purpose and in Buckhurst Hill continued use made of the County Council Clinic in Buckhurst Way. The routine attendance of all contacts in infected families for examination and prophylactic treatment has been insisted upon and led to the detection of numerous cases which would not otherwise have came to light. To facilitate the treatment of contacts and those at work, clinics have been arranged after working hours. The routine treatment adopted has been 2 applications of benzyl benzoate at an interval of one week for definite cases and one application for contacts. Summary of treatment at clinics:— Male Female Under 15 Over 15 Under 15 Over 15 Total Notified cases 23 13 23 44 103 Contacts 24 27 25 38 114 217 Summary of Cases of Infectious Diseases notified, showing number of Cases, Admissions to Hospital and Deaths. Total Cases notified (Civilian Cases only Admissions to Hospital Deaths Scarlet Fever 39 12 — Erysipelas 4 2 — Scabies 103 — — Acute Primary Pneumonia 5 — — Diphtheria 1 1 — Dysentery 10 2 — Measles 274 4 1 Whooping Cough 54 — — 490 21 1 22 Tuberculosis. NEW CASES DEATHS Age Period Respiratory Nonrespiratory Respiratory Nonrespiratory M. F. M. F. M. F. M. F. Under 1 year — — — — — — — — 1 and under 5 — 1 — — — — — — 5 „ ,, 15 — — — 2 — — — 1 15 „ „ 25 1 5 1 — 1 — — — 25 „ „ 35 5 6 — — 2 1 — — 35 „ „ 45 3 2 1 — 1 — — — 45 ,, „ 55 2 2 — — — — — — 55 „ „ 65 2 — — 1 — — — — 65 and upwards 2 — — — 1 — — — Totals 15 16 2 3 5 1 — 1 Note.—31 new cases of pulmonary tuberculosis and 5 of non-pulmonary were notified as compared with 30 and 4 in 1944. There were 7 deaths compared with 6 in 1944. APPENDIX. Rainfall in Inches by Months for 1945. Metropolitan High Beech Water Board Buckhurst Hill Luxborough S.D. Work. C.U.D.C. Loughton Depot January 1.64 2,10 1.19 1.46 February 1.55 1.69 1.59 1.54 March 0.85 0.85 0.39 0.71 April 1.21 1.03 0.83 0.98 May 2.46 3.60 2.53 2.78 June 1.90 1.18 1.64 1.47 July 3.01 3.44 2.89 3.07 August 1.42 1.32 1.28 1.23 September 1.72 1.45 1.27 1.31 October 2.59 2.21 1 82 2.00 November .29 .39 0.24 0.23 December 3.12 2.77 2.65 2.77 Totals 21.76 22.66 18.32 19.55 The highest point in the District is 372 O.D., and the lowest 44 O.D. 24 CONTENTS OF THE REPORT FOR 1945 Report—Medical Officer of Health's Letter 1 Public Health Committee 3 Public Health Staff 3 Statistics and Social Conditions of the Area 4 Vital Statistics 4 Analysis of Deaths according to age incidence 6 Comparative Table, Birth and Death Rates 6 Table of Birth Rates, Death Rates and Infantile Mortality 7 General Provision of Health Services in the District 8 Ambulance Calls 8 Clinics, Treatment Centres and Hospitals 9 Sanitary Circumstances of the Area 10 Housing Statistics for the Year 12 Inspection and Supervision of Food 15 Shops 17 Summary of Inspector's Visits 18 Prevalence of, and Control over, Infectious Diseases 20 Meteorological Record—Rainfall 24