E ND Urban District of Chingford ANNUAL REPORT OF THE Medical Officer of Health INCLUDING THE REPORT OF Sanitary Inspector FOR THE YEAR 1925. ANNUAL REPORT FOR THE YEAR 1925. To the Chairman and Members of the Clungford Urban District Council. Ladies and Gentleman, I have much pleasure in submitting my Annual Report for the year 1925, which in accordance with instructions of the Minister of Health (vide Circular 648) is a Survey Report embracing ail measures for the improvement of the Public Health of the District during the period 1920-25. The Report also indicates any action of importance contemplated or considered desirable in the organization or development of public health services. Natural and Social Conditions of the District. Area 2,807 acres Population—Census 1911 8,186 „ 1921 9,481 „ 1925 (estimated) 10,310 The Urban District of Chingford may be divided into Northern and Southern areas. The Northern area, situated on a plateau is 60—300 feet above sea level, and is thus one of the highest parts of the County of Essex. The Southern area, lying on lower ground forms part of the Lea Valley and is separated from the Northern portion by a somewhat abrupt decline. To the West of Chingford the ground falls to a district, scarcely populated and partly occupied by two large reservoirs of the Metropolitan Water Board. Owing to its elevation—its bordering to the North on a wide open plain, that disafforested portion of Epping Forest now forming the public golf links—its abrupt escarpment to the West, with open spaces to the East and South, interspersed with woods, the Urban District of Chingford is thoroughly exposed to every purifying air current, whilst the sea is distant just 40 miles. 2 The open surroundings on all sides and its proximity to that large tract of forest and plain, its accessability to the City, together with the other amenities of the district render this suburb one of the most desirable of Greater London in this direction. The soil is firm clay, but owing to a considerable slope to the West and South the water continuously drains away. The inhabitants consist of Professional and Business men and a large Artisan population. The district is well served by train, tram and 'bus, the routes in each case being direct to the City and North-east London. Number of Inhabited Houses, 1921 1,974 „ Families or Separate Occupiers, 1921 2,221 Rateable Value £76,679 Sum represented by a Penny Rate £300 VITAL STATISTICS. Births. Total. Male Female. Birth-rate per 1000, 15.6 Legitimate 157 82 75 Illegitimate 4 3 1 Birth-rate for England and Wales, 1925 18.3 Deaths. Total. Male. Female. Deaths 86 46 40 Death-rate per 1,000 8.3 Death-rate for England and Wales, 1925 12.2 No. of Women dying in or in consequence of child-birth 0 Infantile Mortality. Deaths of Infants under one year of age—Legitimate 6 „ „ „ „ „ —Illegitimate 1 Total 7 Infantile Mortality (per 1,000 births) 43 „ „ „ for England and Wales 75 Deaths from Measles (all ages) 0 „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years) 0 „ due to Congenital Debility 3 Notifiable Diseases. Diseases. Total cases Notified. Cases admitted to Hospital Total Deaths, Diphtheria 4 3 0 Scarlet Fever 19 11 0 Enteric Fever 0 0 0 Small Pox 0 0 0 Erysipelas 6 0 0 Pneumonia 6 0 6 Malaria 1 0 0 Analysis of Notifiable Diseases and Deaths therefrom Tabulated according to age. Y E A R S. Under 1 year 1 2 3 4 5-9 10-14 15-19 20-34 35-44 45.64 65 &. over. Diphtheria 0 0 0 0 0 1 0 1 1 1 0 0 Scarlet Fever 0 1 2 0 1 9 4 0 2 0 0 0 Enteric Fever 0 0 0 0 0 0 0 0 O O 0 0 Small Pox 0 0 0 0 0 0 0 0 O O 0 0 Erysipelas 0 0 0 0 0 1 0 0 1 3 1 0 Pneumonia 0 0 0 0 0 0 0 0 O 1 5 0 Malaria 0 0 0 0 0 0 0 0 1 0 0 0 Six deaths occurred among notifiable diseases, they were confined to Pneumonia and occurred under the following age groups:— 45-64, 4; 65 and over, 2. Tuberculosis. Age Periods. NEW CASES DEATHS. Pulmonary. NonPulmonary, Pulmonary. NonPulmonarv. M. F. M. F. M. F. M. F. 0 0 0 0 0 0 0 0 0 1 to 4 0 0 0 0 0 0 0 0 5 to 9 0 0 0 1 0 0 0 0 10 to 14 0 0 0 0 0 0 0 0 15 to 19 0 0 0 0 0 0 0 0 20 to 24 2 0 0 1 0 0 0 0 25 to 34 2 0 0 0 i 0 0 0 35 to 44 1 0 0 0 1 0 0 0 45 to 54 0 2 0 0 1 0 0 0 55 to 64 0 0 0 0 0 0 0 0 65 and upwards 0 1 0 0 0 0 0 0 Totals 5 3 0 2 3 0 0 0 All cases of Tuberculosis resulting in death had been previously notified. 4 Poor Law Relief. The number of persons receiving relief varies during the year. Approximately 12 cases are on permanent out-relief. Five of these are disabled through bad health, the remaining seven are elderlv people not yet. in receipt of the Old Age Pension, but unable to support themselves. There are seven cases (3 women, 4 men) at present in the Infirmary not all totally incapacitated. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Hospitals.—There is no Hospital in the district provided or subsidized by the Council. The Infectious Diseases Hospital for the Walthamstow Urban District is situated within the Urban District of Chin,gford and has a sanatorium block maintained by the County Council of Essex, to which orthopaedic and mixed cases of surgical and pulmonary tuberculosis are admitted for treatment. Infectious Disease.—Accommodation for cases of infectious disease is provided by the Waltham Joint Hospital Board at Waltham Abbey. Patients are also admitted to this hospital from the adjoining districts of Woodford, Waltham Abbey and Buckhurst Hill, The hospital consists of an Administrative Block and the following Wards : Observation or Isolation Block with four beds. Diphtheria Block with eight beds. Two Scarlet Fever Blocks, one with twelve beds and convalescent room, and one with 16 beds and convalescent room. Laundry and Mortuary Block. Steam Disinfector, etc. Ambulance Shed. The Patients' expenses (which include provisions and medical sundries, Medical Attendance and Salaries of Nurses) are charged to the Constituent Authorities sending them at the actual cost per Patient Day. Paying patients are accepted provided there is accommodation. The remaining expenses are charged to the Constituent Authorities, proportionately to the number of Assessable Houses within their districts. 5 Number of cases admitted during 1925, 14. An arrangement has been made by the Waltham Joint Hospital Board with the West Ham County Borough Council for the reception of Small-pox patients from the Constituent districts at the Orsett Joint Hospital. General.—Two beds in the Forest Hospital, Buckhurst Hill, are reserved for the residents of Chingford. Cases are also sent to the Walthamstow and Leyton General Hospitals and to the London Hospitals. Ambulance Facilities.—For non-infectious and accident cases an ambulance, maintained by the St. John's Ambulance Association at Walthamstow, is available for use in Chingford. For infectious cases an ambulance is provided by the Waltham Joint Hospital Board. CLINIC AND TREATMENT CENTRES. Maternity and Child Welfare Centre.—The Welfare Centre is situated at the Congregational Church Room, South Chingford. Mothers and Children are seen every Tuesday at 2.30 p.m. The Health Visitor also attends at the Council Office, North Chingford, every Thursday at 2 p.m. Day Nurseries.—There is no need for a day nursery in this district at present. School Clinics.—A School Clinic is held weekly (Wednesday afternoon) at the New Road Council Schools. The School Medical Inspector attends every alternate session. Tuberculosis Dispensary.—Persons suffering from Tuberculosis or under observation attend the Tuberculosis Dispensary at 334, Hoe Street, Walthamstow. A special day or time is not set apart for cases from this district, although some arrangement is likely to be made in the future. Treatment Centre for Venereal Disease.—Patients attend the London Hospitals under the scheme of the Essex County Council. 6 Public Health Officers of the Local Authority. Medical Officer of Health : MALCOLM BARKER, M.R.C.S. (Eng.), L.R.C.P., D.P.H. (Lond.), (Part-time, Exchequer Grant). Sanitary Inspector: W. E. LEATHER, A.R.San.I. (Whole-time, Exchequer Grant). Health Visitor and School Nurse : Miss M. WATERHOUSE. NURSING ARRANGEMENTS. General.—I am pleased to state that during the year an arrangement has been entered into whereby the services of a District Nurse (Miss Day) are now available for general illness. This innovation has been much appreciated. Where the necessity arises the Health Visitor, who is also School Nurse, assists generally with advice in cases of minor infectious diseases nursed at home. Midwifes.—There are five Midwives practising in the district— no subsidy is at present granted by the County Council. LABORATORY WORK. Pathological and Bacteriological Examinations. Examinations are made at the Essex County Public Health Laboratories free of charge. During the year the following examinations have been made. Swabs examined for Diphtheria Organisms 23 Exam, of Sputum for Tubercle Bacilli 32 Specimens of Urine Exam. of Blood 1 Miscellaneous 27 Diphtheria Antitoxin is supplied free to Medical Practitioners for use in necessitous cases. A supply is available at the Council Offices. Chemical Work.—Dr. Bernard Dyer, County Public Analyst for Essex, carries out investigations of food-stuffs and other substances, including water samples, when required. 7 LEGISLATION IN FORCE. SANITARY ADMINISTRATION. Adoptive Acts. The following Adoptive Acts are in force within the District: — Year adopted. Infectious Diseases (Prevention) Act) 1890 1896 Public Health Acts (Amendment) Act, 1890, part 2 1901 „ „ „ „ „ „ „ 3 1904 Private Street Works Act, 1892 1895 Public Health Acts (Amendment) Act, 1907 1908 Whole Act, except part 6, and sections 61, 94, and section 81, after the words " Towns Improvement Clauses Act, 1847." Rats and Mice (Destruction) Act, 1919. Power to administer this Act was delegated to this Authority by the Essex County Council in 1922. The Council in May, 1925, obtained adoption of new Nuisance Bye-Laws in which special provisions became operative with regard to the keeping of Pigs. The Public Health Act, 1925, dated August 7th, 1925, in so far as it related to this district, came into force on September 8th, 1925. The adoptive sections were under the consideration of the Council on December 31st, 1925. SANITARY CIRCUMSTANCES OF THE AREA. Water.—A hard pure constant water supply is provided by the Metropolitan Water Board. The average supply per head per day is 35 gallons. The water supply of Chingford is obtained from two deep wells; one is situated at Chingford Mill and the other at Waltham Abbey. The average hardness of the water is 22 parts per 100,000, with permanent hardness about 8.3. • The Chingford water is well below the average hardness for the district in which it is situated—-namely, the Northern District of the Metropolitan Water Board Supply. Rivers and Streams.—The River Ching passes through the district. During the year the Council have not found it necessary to take any action in regard to the pollution of this brook. 8 Drainage and Sewerage.-—Practically the whole of the District is provided with well-constructed modern pipe-sewers, which are properly ventilated and the sewage discharged by gravitation at the Council's Sewage Disposal Farm on the Southern boundary of the District, where it is received into subsidence tanks, from whence it is pumped and distributed over Bacteria filters by means of revolving sprinklers; it is then treated by irrigation on cultivated land, and finally discharged into the Ching Brook. Owing to the rapid growth of the district in recent years necessitating increased measures for dealing with a large volume of sewage, the Council have temporarily rented several acres of land adjacent to the farm for treatment of the effluent by irrigation before finally discharging same into the Ching. The drainage of a comparatively small number of houses has to be raised by means of pumping to the higher level of the general sewage system, and a few dwellings in the outlying and isolated parts of the District are provided with pail-closets or Cesspools. As far as practicable, all surface water is excluded from the sewers, and is carried away by separate channels. Automatic flushing and other means are adopted for cleansing the sewers as required. A new scheme for the efficient treatment and disposal of sewage by modern methods, coupled with the relief of various overtaxed sewers, has been prepared by the Council, and considered by the Ministry of Health. This will give greater facilities for the satisfactory drainage of the district, provide means for the further development of a considerable area of building land, and at the same time permit of a much higher degree of purity of the sewage farm effluent. Owing to the favourable situation of the district, which is thereby likely to become more populated, an undertaking such as this should ensure a higher standard of health and be a definite factor in the well-being of present and future residents. Closet Accommodation.—There are in the district 33 dwellings not connected with the public sewer. Of these 22 drain into cesspools. Two have sink waste and surface drainage discharging into streams. Nine isolated cottages are without drains. There are 4 water closets without flushing cisterns, 39 pail closets, and no privies. All other houses in the district are provided with at least one properly constructed W.C. Scavenging.—The weekly collection of dust and house refuse is carried out efficiently. 9 I am glad to report that during the period 1920-25, the disposal of refuse has been more effectively dealt with, and for this purpose the site known as the Old Church brick-field and a seventy-foot shaft standing thereon has been purchased. At the base of the shaft two furnaces have been constructed, between which is an elevated platform provided with a screening chamber. The refuse is tipped at the front of the screen and dragged across so that the tine ash and small materials jall into a chamber beneath. During this process all articles of a saleable nature are removed, and the remainder of the refuse is destroyed in the furnaces. The Destructor is centrally situated in the district for the purpose, yet is well isolated from the more populous areas. Owing to the rapid growth of Chingford within the last few years the present facilities for dealing with refuse are likely to prove inadequate, and increased means will have to be provided in order to dispose of same in a satisfactory manner. The present site and accommodation permit of extension in this respect. It does, however, need to be more generally known that the Council remove only house refuse—trade and garden rubbish is not collected by the Council free of charge. It is desirable also to stress the importance to house-holders of keeping the contents of their dustbins dry and covered—as free as possible from organic material, which forms a nidus for the breeding of flies and is open to other objections. With the exception of one or two premises in outlying districts, all houses are provided with dust-bin accommodation. SANITARY INSPECTION OF THE AREA. I beg to herewith append the Annual Report of the Sanitary Inspector for the year 1925. A comparison with previous years will show an increased number of inspections with very satisfactory results. Many inspections have been undertaken by us jointly. All the Dairies and Cowsheds in the District have been personally visited by me. 10 Report of the Sanitary Inspector for 1925. To the Medical Officer of Health, Urban District of Chingford. Sir, In accordance with the General Order of the Ministry of Health, I herewith submit my Annual Report for the year 1925. The report deals with practically the whole of the duties entrusted to me, and is therefore not confined strictly to the items set out in the above-mentioned Order. Inspection of District. Periodical Inspections of the district have been made in accordance with the General Order of the Ministry of Health, in order to administer the various Public Health Acts, Housing Acts, Bye-laws and Regulations in force within the district, and to secure the early abatement of nuisances found. The nature of the nuisances dealt with, and the works earrieti out, are classified as far as possible under the various Acts and Headings to which they relate. Public Health Acts. Under the Public Health Acts, a total of 1.207 Inspections have been made during the past year. 385 nuisances have been found. 20 notices were outstanding at the close of 1924, and 16 notices were outstanding at the close of 1925, giving a total of 395 nuisances having been abated during 1925. The following table shows the nature of the work carried out under the sections of the Public Health Acts dealing with nuisances. — TABLE I. — Nature of Nuisances dealt with. Burst water pipes 2 Dirty urinals or W.C. 's 2 Premises redrained to Sewer 1 Defective yard gullies 3 Defective water tanks 1 Deposits of refuse on land 8 Defective drains repaired 5 Fresh-air inlet valves, repaired or provided 6 Choked drains 17 Broken manhole covers 1 Defective sink waste pipes 1 Ventilation shafts repaired or erected 4 Defective bath waste pipes 1 Broken W.C. pans 4 Windows made to open 2 Defective flushing cisterns 10 Animals improperlv kept 16 Cesspools overflowing 6 Ditches requiring cleaning 20 Broken dust bins 43 Dirty or untidy yards 7 Overcrowding 2 Yards repaired 4 Fallen ceilings 6 II Dampness 6 Broken plaster 5 Defective eaves, gutters and down spouts 3 Broken sash cords 4 Rooms of dwellings cleansed 46 Defective roofs 14 Defective fire places 7 Accumulation of House Refuse 38 Houses without water supply 5 Accumulation of Trade Refuse 9 Defective floor boards 2 Defective dung pits 2 Verminous dwellings 1 Accumulations of dung 16 Stables redrained and repaired 3 Insufficient lavatory accommodation 1 Dilapidated structures 1 Pig sties redrained and repaired 5 Insufficient ventilation 1 Defective W.C. supply or Insanitary Hut 1 charge pipes 4 Offensive materials removed 15 Defective cesspools 3 Miscellaneous 47 Statutory Notices Served. Section 36. Public Health Act, 1875 4 „ 91 „ „ „ „ 42 46 Nuisance Bye-Laws 1 Total 47 No prosecutions have been necessary under the above Acts. Complaints. Sixty-one Complaints have been received during the year, and each one was investigated with as little delay as possible. Summary of Complaints. Of Nuisances 4 Of Dilapidated dwellings 6 Of non-removal of house refuse 13 Of notice to remove house refuse from newly occupied houses 25 COMPLAINTS WITHOUT FOUNDATION 13 Total 61 Housing and Town Planning, etc., Acts. Housing (Inspection of District) Regulations, 1910. Or Housing Consolidated Regulations, 1925. Under the Housing Acts, a systematic inspection of the dwellings in several Streets has been made. T 2 The following table show the result of these inspections:— — TABLE 2. — Housing Inspections. Number of dwellings inspected 152 „ „ in which defects were found 75 „ „ in which defects have been remedied 63 „ „ remaining under notice 12 Procedure to enforce the execution of works found necessary under the Housing', Town Planning' Acts has been taken under the similar powers contained in the Public Health Acts. Food Inspection. One hundred and twenty-seven visits have been made to premise upon which meat and other articles of food are prepared, stored or exposed for sale, and the following' amount has been voluntarily surrendered as unfit for the food of man:— 58 lbs. of Beef. Traders hawking articles of food within the district have not escaped supervision. Under the Public Health (Meat) Regulations, 1924, in force April 1st, 1925, increased inspection facilities were given and carried out in regard to the slaughtering, storing and handling of meat intended for sale, for human consumption. Fifty-two visits for the inspection of carcases at the time of slaughter have been made, and in two instances portions were found to be diseased which were voluntarily surrended and destroyed. Slaughter Houses. There are four private slaughter houses within the district. Two are registered, aand two are Licensed Slaughter Houses. These are inspected frequently to secure the good sanitary condition of same. Limewashing has been carried out in accordance with the provisions of the Slaughter-house Bye-laws. Dairies, Cowsheds and Milksliops. The register for the district contains the names of 16 Cowkeepers, 11 Dairymen, 10 Wholesale Purveyers of Milk, and 26 Retail Purveyors of Milk. Seven of the latter number reside outside the district. During the year application for registration has 13 been made by 2 Cowkeepers, 2 Dairymen, and 10 Purveyors of Milk. Three names have been taken off the register owing to removal. Ninety-three visits have been made to the Dairies, Cowsheds and Milkshops within the district in order to ascertain the conditions under which Milk and other articles of food are produced, stored and exposed for sale, and to ensure that all persons carrying on the business of a Cowkeeper, Dairyman or Purveyor of Milk are registered in accordance with the Dairies, Cowsheds and Milkshops Order, 1885. The following Table shows the action taken in respect of above premises during the year :— — TABLE 3. — Dairies, Cowsheds and Milkshops. Floors or walls cleansed 8 Cesspools overflowing 2 Accumulations of manure 6 Defective cooling chamber 1 Blocked or defective drains 3 Yard and approach repaved 2 Dirty utensils 1 Dirty cooling chambers 2 Roofs repaired 1 Apart from 3 Cowsheds recently rebuilt, the remaining sheds are old structures in a more or less dilapidated condition, and with the exception of paying attention to their cleanliness, little can be done in the way of modern sanitation. However, my requests are generally complied with, and the provisions of the Bye-laws as to lime washing, etc., have been carried out. Sale of Food and Drugs Act. Sixteen samples of milk have been procured under the Sale of Food and Drugs Acts and submitted to the Public Analyst for the County of Essex. Fifteen samples were certified' to be genuine, one sample was reported on as follows:—" That it was deficient in milk fat to the extent of at least 10 per cent. of the normal quantity present in natural milk." This resulted in the retailer being prosecuted and a fine of £2 with part costs wis imposed. 14 Factory and Workshops Acts. Periodical inspection of all premises coming within the definition of these Acts is made in order to ascertain the conditions under which the work is carried on and the sanitary condition of the premises occupied. There are within the district 17 Factories, 28 Workshops and 18 Workplaces. The following table is a summary of the defects remedied at premises used as Factories, Workshops or Workplaces. — TABLE 4. — Factories, Workshops and Workplaces. Dirty rooms cleansed 2 Improper drainage 3 Insufficient Sanitary accommodation 2 Defective Sanitary accommodation 9 Outworkers. There are 16 names on the list of Outworkers in the district. Inspection of these premises has been made to ascertain the condition under which the work is carried out. No cases of infectious disease have occurred at outworkers' premises during the year. Bakehouses. There are 5 Bakehouses within the district. These are inspected frequently and such alterations and requirements as are found necessary, as well as periodical lime-washing have been carried out. Infectious Disease and Disinfection. Thirty-one cases of infectious disease have been investigated during the year and in each case the necessary precautions have been taken to prevent the spread of infection. Fourteen patients have been removed for treatment at the Waltham Joint Isolation Hospital. Thirty-five rooms have been fumigated, and ]8 lots of bedding have been removed for disinfection by the Walthamstow Urban District Council, after cases of infectious disease. Offensive Trades. Fat extracting and fish frying constitute the offensive trades carried on within the district. There are two fat extractors and two fish fryers. 15 These premises have been inspected frequently, and such steps as have been necessary to minimise the offensive character of these trades, including frequent cleansing, have been taken. One application has been made for sanction to establish an offensive trade, but the Council's consent was not given. House Refuse (Collection and Disposal). The weekly collection of Domestic House Refuse is carried out by annual contract. During the past year this has been done satisfactorily, and only 38 complaints (of which 25 relate to new houses becoming occupied) have been received. At the Refuse Disposal Works over 2,000 tons of refuse are dealt with annually. The screened material is composed chiefly of fine ash. It has no objectionable feature, and is a marketable commodity without further treatment. Clinker and a fine vegetable ash are the products of combustion, and can be disposed of readily. Other materials obtained from the refuse, such as rags, bones, bottles, rubber, broken glass, iron, mixed metals, etc., are sold from time to time. Salvage materials during the past year realised the sum of £130 7s. l1d. Rats and Mice Destruction Act. The powers contained in the above Act were transferred to this Authority by the County Council in January, 1922. Under the Act 15 rat-infested premises have been dealt with. During " Rat Week" (Nov. 2nd) by posters and other means special efforts were made to induce residents to partake in an active campaign against rats and mice, and as far as can be ascertained, god results were obtained. I have the honour to remain, Sir, Your obedient Servant, W. E. LEATHER, Sanitary Inspector. 16 Smoke Abatement.—It has not been found necessary on any occasion to complain of smoke nuisance. Premises and Occupations Which Can be Controlled by Bye-laws and Regulations:-—There are no Premises or Occupations where special Bye-laws or Regulations are necessary for the control thereof. Other Sanitary Conditions Requiring Notice.—There are within this district numerous open ditches draining portions of undeveloped land and other vacant areas which in the event of building taking place in the immediate vicinity would tend to cause a serious nuisance, and prove a menace to public health. These should be piped, or culverted in, prior to building operations. Schools. Numerous private schools are situated in the district. There are two public elementary schools—one in North, the other in South Chingford. The North Chingford school was partially destroyed by fire last year, necessitating alternative temporary accommodation for the older scholars. This is suitable, but not ideal. That portion of the infant school saved from fire is still being used. The South Chingford School is a modern building and is well situated in a rapidly-growing district. The Schools are periodically visited and any sanitary defects found immediately remedied. Minor outbreaks of infectious illness have occurred and have been satisfactorily controlled by examination of contacts and a judicious exclusion of scholars in accordance with the Ministry of Health and Board of Education Memo, on " Closure of and Exclusion from School, 1925." It has not been found necessary to close the school on account of any epidemic. The School Medical Inspector (Dr. Vaudrey) has attended the public elementary schools at frequent intervals and visits have also been paid by the school nurse weekly, or more often, if found necessary. Housing. The General Housing conditions of the district are good. There is a shortage of houses available for letting purposes on rental, which is essential for a certain section of the population. 17 Numerous houses are being built by private enterprise, but this is unlikely to ameliorate the conditions mentioned above. The population Census, June 30th, 1921, was 9,471, and the estimated population as given by the Register-General for June, 1925, is 10,310. During this period approximately 590 houses have been built and occupied. Of these 75% (75 per cent.) as far as can be ascertained are inhabitated by families migrating into this district. The estimated figure of 10,310 for 1925, apart from the natural increase of births over deaths, does not faithfully indicate the influx of new residents and is obviously much below the actual population. The estimation, however, is reached by consideration of data applicable to the whole country and the electoral register. It can only be rectified by an actual Census return. It seems only reasonable to suppose that the increase in house property of this area will be as equally rapid, if not more so, in the future, as it has been in the past. Inspection and Supervision of Food. See Detailed Report of Sanitary Inspector. Milk.—-Approximately less than one-third of the Milk required is produced in the district. No case of Infectious Disease has been traced to the Milk Supply during the Year. All milking cows were again examined by Mr. P. S. Howard, F.R.C.V.S., for the purpose of detecting tuberculous affections of the udder and securing a pure local milk supply. The microscopic examination of samples of milk from suspicious udders was undertaken by the County Bacteriologist. Mr. Howard reported as follows, viz.:— I beg to report that in company with the Sanitary Inspector I have visited during the period from May 18th to June 30th last, the respective cowsheds in the district administered by your Council and have examined 194 cows, especially in reference to the condition of the udders. Samples of milk, totalling 39 in all, were taken and submitted to the County Bacteriologist for microscopic examination. 18 Twenty-three of these samples were taken from individual cows on account of abnormality of the udder or other suspicious symptoms, and the remaining 16 samples were of a collective character, being taken from the mixed milk of the cows in the respective cowsheds, where such course appeared to be indicated as an additional check on the inspection in detail. In relation to the above-mentioned samples, the Bacteriolologist reported an excess of pus cells in the milk from 9 different cows and an excess of pus cells in the collective samples from two distinct premises, also stating that three of the former and one of the latter were unfit for food. The result of the inspection has been that of those reported upon adversely by the Bacteriologist, five cows have been disposed of and in the other cases the use of the milk for human use has been discontinued. In the case of the collective sample that was found to be unfit for food, further collective samples were taken until a satisfactory report was received from the Bacteriologist. The general health and condition of the cows, except those already referred to, were found to be good, and it is satisfactory to note that no tubercle bacilli were reported in a,ny of the samples examined. (Signed) PERCY S. HOWARD, F.R.C.V.S. Milk (Special Designation) Order, 1922. Three licenses for the sale of "Certified Milk," three supplementary licenses for the sale of Grade "A" Milk and one supplementary license for the sale of " Pasteurized'' Milk have been granted during the year. The following samples were procured for Bacteriological examination with results as shown:— 19 Designation. No. of Bacteria per i c.c. Presence of B. Coli in o.I c.c. Action taken. Grade ''A" 4,515 Absent. - ,, ,, 121,000 ,, - ,, ,, 25,300 ,, - "Certified" 11,450 ,, - ,, 11.050 ,, - ,, 121.800 Present. Warned. ,, 712,000 ,, ,, ,, 4.070 Absent. - ,, 2,73° ,, - "Pasteurized" 11,950 ,, - It will be noticed that two samples taken of Certified Milk did not conform to the requirements as specified in the Order as to bacterial content. The source of these was traced and remedied, and as a result further samples proved to be satisfactory upon examination. The other milks sent for analysis showed excellent quality in this respect. The public generally do not appear to have realised the differential character of the graded milk in that by purchasing same they are obtaining a purer, less contaminated milk rather than that of a richer quality. The care and methods of production necessitate a slight extra cost. I am pleased to state that the method of conveying and distributing milk in cans, often old and rusty and open to contamination, is now rapidly giving way to the more hygienic delivery in white flint bottles, which, if efficiently scoured, and preferably sterilised before re-using, should safeguard the public from the dangers which lie solely in distribution. The time is surely opportune when milk bottled at the place ot production on scientific lines and quickly delivered in this condition to the consumer should be made compulsory. Meat. There is no public abattoir. There are four private slaughter houses in the district, two of which arc registered and two licensed. These are inspected frequently to sccure the good condition of same. Limewashing has been carried out in accordance with the provisions of the slaughter-houses bye-laws. 20 Of the meat supply of this district the greater quantity is brought in dead, and all premises where it is stored or exposed for sale are visited frequently and the meat examined. Under the Public Health (Meat) Regulations, 1924, in force April 1st, 1925, increased inspection facilities are possible, and due notice of slaughtering must be given to the Sanitary Authority on every occasion. The general standard of the premises for the sale and storage of meat in this district was satisfactory prior to these regulations coming into force, but the conveyance and delivery of meat into the district leaves much to be desired. It is hoped that stricter supervision in the despatch of meat from market will ensure more wholesome conditions during transit, both as regards the means of conveyance and the cleanliness of those handling this commodity. It is unlikely, however, that any measures such as these regulations will immediately attain the object for which they were brought into force. Before the desired standard is achieved the necessity for the prevention of contamination must be impressed upon those engaged in the meat trade—it is a matter of education in simple hygienic principles. The notification of proposed slaughtering now required is good in that the carcases are twice inspected, locally and at market. If for disposal in the district then two examinations are still possible— at the time of killing and when the meat is exposed for sale. All traders in this district appear desirous of complying with the spirit of the regulations which is of great assistance to the health authority. However, more care might be given to the prevention ot dust contamination, by the closing of shop windows when necessary. Prevalence of, and Control over, Infectious Diseases. The cases of Infectious Disease, on the whole, have been isolated in character. One Return Case of Scarlet Fever occurred. Enquiries made with regard to the source of infection and advice re the close observation of contacts have probably helped to limit the extent of the particular illness. It has not been considered necessary to use the Shick or Dick specific tests, and no artificial methods of immunization have been carried out. 21 No primary vaccinations or re-vaccinations were performed under the Public Health (Smallpox) Prevention Regulations, 1917. Considerable assistance is afforded in the control of non-notifiable infectious illness by the written intimations from the heal teachers of the various schools. Such information of absentees and suspected cases is much appreciated and is made use of by the Medical Officer and School Nurse in the investigation of minor epidemics. Mortality of Influenza.—Pamphlets are available for distribution when an epidemic threatens. Disinfection.—There is no cleansing station, arrangements are made for the disinfection of clothing and bedding with the Walthamstow U.D.C. Rooms and places which have been exposed to infection are disinfected by this Authority. During the year it has not been found necessary to make Chicken Pox notifiable, owing to the absence of Smallpox in this part of the country. There were no cases of Encephalitis Lethargica cr Smallpox. Public Health (Prevention of Tuberculosis) Regulations, 1925.— No action has been taken under these regulations with regard to tuberculous employees engaged in the milk trade. Public Health, 1925, Section 62.—It has not been found necessary for the Council to take, any action under this section. Housing and Town Planning Act, 1925. The Council have adopted the sections of this Act whereby the whole Urban District is included for Town Planning. At the present time the scheme of development is under consideration. Rats and Mice (Destruction) Act, 1919. Power to administer this Act was delegated by the Essex County Council to this Authority in January, 1922. Under the Act 15 ratinfected premises have been dealt with. The National Rat Week was held in November last. By posters and other means special efforts were made to induce residents in ratinfested quarters to co-operate in the work of destruction of these very undesirable pests. Particular attention was drawn to the tremendous loss to the country owing to the ravages of rats (estimated at forty millions annually) and the necessity of combined and simultaneous action by all concerned. 22 There is great difference of opinion as to the best methods of rat destruction, and in some cases it may be wise to seek advice as to the means most likely to prove effective. Drugs such as Barium, Squill, etc., which are not dangerous to man and animals may be used. Viruses of different types are frequently of greater potency, but not immediate in action. With the latter particular care must be taken that any infected rats do not gain access to food supplies as instances of poisoning have been traced to this cause. Tuberculosis. Provision for the supervision and treatment of persons suffering from any form of Tuberculosis is made by the Essex County Council. There is no Tuberculosis Dispensary in Chingford. Patients attend the Dispensary at 334, Hoe Street, Walthamstow, which is under the care of Dr. John Sorley, Tuberculosis Officer for the Urban Districts of Walthamstow and Leyton. Patients unable to attend are visited at home. Despite the arduous duties, both administrative and clerical, of such a largelypopulated area, the work has been most efficiently carried out, and Chingford patients have not suffered any disadvantage by residing some distance away from the Centre. It is likely, however, that with the increased duties imposed on Tuberculosis Officers, some splitting up of this densely-populated district will supervene, and permit of special arrangements for Chingford patients. It will also allow of a more thorough investigation of "contacts" and persons under observation for this complaint than has been possible hitherto. Such should be the aim of Preventive Medicine. Venereal Disease. Persons attend the London Hospital for treatment. Pathological, Bacteriological, and blood examinations are carried out at the Essex County Laboratories free of charge. Maternity and Child Welfare. In September, 1920, Welfare Centres were opened by the Council at the Parish Hall, North Chingford, and the Congregational Church, South Chingford. Dr. E. Billing was appointed Medical Officer, and has been assisted in these duties by Cr. Miss Mathieson and a Committee of Ladies of the District. On February 1st, 1923, this work 23 was transferred to the County Council, who provide a Health Visitor and grant a subsidy towards the Welfare Centre. At present the majority of those attending are seen at the Centre in South Chingford. Advice is given as to feeding, clothing, and general care. Patterns of clothes are provided and the children weighed. The steady growth of this Clinic is in large measure due to the very able and conscientious work of Dr. Billing and his helpers during the past five years. Probably no branch of Public Health work presents so many difficulties or requires so much care and tact in its formation and successful continuance. The decline in Infantile Mortality for this country is a testimony to the excellent work undertaken at these Centres and demands an even greater interest than that already shown. Ophthalmia Neonatorum.—One case of Ophthalmia Neonatorum was notified nine days after birth. The affection was slight and no impairment of vision resulted. GENERAL. It is evident from a consideration of the above statistics that the health of Chingford is exceedingly satisfactory and compares most favourably with any other Urban District of its size throughout the country. Owing to its proximity to a great city, and especially to largelypopulated areas, some relationship might be expected to exist between epidemics occurring therein. Its marked amenability from these influences could certainly appear to be due to some extent to its favourable situation and rural environment. Our present system of Public Health administration places the onus of certain measures on the Local Authority, and in other cases relegates the carrying out of provisions to the County Council. A comprehensive knowledge of local public health matters can best be obtained by a close association with those more widely adopted schemes in which the County functions as a whole. It is doubtless an advantage that all such duties should be coordinated in one medical officer responsible to both Authorities. Whilst thus affording to a medical officer, wholly engaged in public health work, a greater opportunity of keeping in touch with methods of progress, it should ensure a centralization of duties and increased efficiency in administration. 24 I beg to inform you, that the Public Health and Education Committees of the Essex County Council have appointed me as Medical Officer to the various Public Health Services of this district. The Committee of the Child Welfare Centre have under consideration a similar recommendation. Your former Medical Officer of Health, Dr. E. J. F. Hardenberg, was responsible for the satisfactory control of the Public Health duties of this district for a number of years, to September 30th, 1925, and it is much to be regretted that he had to resign the appointment owing to failing health. I crave some indulgence for any errors of omission in this Report. Having only recently been appointed as your Medical Office, it is difficult to become cognisant of the many and varied aspects of the Public Health work of the district. I wish to express my thanks to the Council for their support, to Coun. Miss Mathieson, Dr. Billing, and my Colleagues, for their help in supplying statistics, etc., and to Mr. W. E. Leather, Sanitary Inspector, for his co-operation and invaluable assistance in the preparation of this report. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient servant, MALCOLM BARKER, Medical Officer of Health. Assistant County M.O.H. for Essex. 25 Housing. New Houses erected during the year. (a) Total 347 (b) With State assistance under Housing Acts 1919 or 1923:— (i.) By the Local Authority 0 (ii.) By other bodies of persons 0 Unfit Dwelling Houses. 1.—Inspection.—(1) Total number of dwelling-houses inspected and recorded under Housing (Inspection of District) Regulations 1910152 (2) Number found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 (3) Number found not to be in all respects reasonably fit for human habitation 75 2.—Remedy of Defects without Service of Formal Notice— (1) Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 63 3.—Action under Statutory Powers— A.—Proceedings under Section 28 of the Housand and Town Planning, etc., Act, 1919— (1) No. of dwellings in respect of which notices were served 0 (2) No. of dwellings which were rendered fit— (a) By Owners 0 (b) By Local Authority in default of owners 0 (3) No. of Closing Orders which have become operative 0 B.—Proceedings under Public Health Acts— (1) No. of dwellings in respect of which notices were served 2 (2) No. of dwellings in which defects were remedied— (a) By Owners 2 (b) By Local Authority in default of Owner 0 C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909 0 TABLE I. Year, Population. Births. Rate per 1000. Deaths. Rate per 1000. INFANT MORTALITY Deaths. Rate per 1000 1921 9430 156 16.5 108 11.4 13 83 1922 9494 200 21.06 99 10.4 12 60 1923 9636 170 17.63 76 7.8 8 47 1924 9958 189 18 98 101 10.1 6 31 1925 10310 161 i5.6 86 8.3 7 43 NOTIFIABLE DISEASES. TABLE II Year. Scarlet Fever. Diphtheria. Typhoid. Erysipelas. T uberculosis, Chicken Pox. Measles. Puerperal Fever Ophthalmia Neonatorum. Pneumonia. Cerebral Spinal Fever. Malaria. 1 Acute Poliomyelitis. Other Diseases. Pulmonary Other Forms. 1921 37 16 - 1 15 3 - — — 1 4 — 1 1 1 1922 16 18 — 3 11 1 11 — — — 8 — — — — 1923 15 2 1 4 11 3 28 — — — 7 — — 1 — 1924 20 7 i 2 8 7 6 — — — 12 — 1 — — 1925 19 4 - 6 8 2 — — — 1 6 - 1 - — TABLE III. DEATHS. Under 1 year. 1 and under 2. j and tinder 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 63 and upwards. TOTAL. Year 1921 13 3 1 4 7 8 24 48 108 ,, I922 12 2 1 3 5 15 22 39 99 ,, 1923 8 0 2 4 4 9 21 28 76 ,, 1924 6 4 0 1 3 12 31 44 101 ,, 1925 7 1 2 3 4 5 22 42 86 Table IV.—Birth rate, Death rate, and Analysis of Mortality during the year 1925. [Provisional figures. The rates for England and Wales have been calculated on a population estimated to the middle of 1925. while those for the towns have been calculated on populations estimated to the middle of 1924. Themortality rates refer to the whole population as regards England and Wales, but only to civilians as regards London and the groups of towns.] BIRTHRATE PER 1,000 TOTAL POPULATION. ANNUAL DEATH-RATE PER 1,000 POPULATION. RATE PER 1,000 BIRTHS. All Causes. Enteric Fever. Small-pox. Measles. Scarlet Fever. W hooping Cough. Diphtheria. Diarrhoea and Enteritis (under Two years). 1 Total Deaths i under One year. England and Wales 18.3 12.2 0.01 0.00 0.13 0.03 0.15 0.07 8.4 75 106 County Boroughs and Great Towns, 18.8 12.2 0.01 0. 00 0.17 0.03 0.18 0.09 10.8 79 including London. 157 Smaller Towns (1921 Adjusted 11.3 11.2 0.01 0.00 0.15 0.02 0.14 0.06 7.6 74 Populations 20,000-50,000;. London 18.0 11.7 0.01 0.00 0.08 0.02 0.19 o.ll 10.6 67 chingford U. D. 15.6 8.3 0.00 0.00 0.00 0.00 0.09 0.00 o.o 43 INFANT WELFARE ATTENDANCES During the period 1920-25. Year. Number on Books. New Children. Total Attendances 1921 No Record No Record 526 1922 94 52 459 l928 93 58 632 1924 93 46 615 1925 North. 50 35 367 Total 971 ,, South. 84 54 604 1 1 1 1