CHIN2 LIBRARY Urban District of Chingford. ANNUAL REPORT of the Medical Officer of Health including the Report of the Senior Sanitary Inspector FOR THE YEAR 1937 The Walthamstow Press Ltd. (T.U.), Guardian House, Forest Road, London, E.17. Urban District of Chingford. ANNUAL REPORT of the Medical Officer of Health including the Report of the Senior Sanitary Inspector FOR THE YEAR 1937 1 INDEX Page Acreage8 Ambulance Facilities 10 Bacteriological Examinations 10, 12, 17. 19, 26, 28 Bakehouses 17, 20 Births and Birth Rates 8,9,36 Blindness. Prevention of 30 Cancer 31 Clinics and Treatment Centres 10. 11, 33 Closet Accommodation 12 Committee, Constitution of 5 Complaints of Nuisances 16, 17 Dairies, Cowsheds and Milkshops 17 Deaths and Death Rates 8, 9,33, 35, 36 Drainage and Sewerage 12 Factories and Workshops 17, 21, 22 Food. Inspection and Supervision of 17, 25, 26 Health Education 31 Hospitals 10 Housing and Housing Acts, 1925, 1930 and 1936 . 8, 17, 23. 24, 32 Houses Let in Lodgings 17, 21 Ice Cream 17, 25 Immunisation against Diphtheria 27 Infant Mortality 8, 9, 36 Infectious Diseases 17, 27-31, 34, 35. 36 Inspections 16, 17 Laboratory Facilities 10. 26 Maternity and Child Welfare 10, 33, 36 Meat Inspection 25, 26 Midwives 10 Milk and Dairies 10, 25 4 Page Notices Served 19 Nuisances 16, 17, 18 Nursing and Nursing Homes 10 Nutrition 26 Offensive Trade Premises 20 Overcrowding 17, 24 Population 8, 9 Public Cleansing 13-15, 17 Rateable Value 8 Rats and Mice (Destruction) Act, 1919 23 Refuse Collection and Disposal 13-15, 17 Rivers and Streams 12 Sanitary Administration 12-26 Serum 31 Shops Slaughterhouses 17, 25 Smoke Abatement 16, 17 Social Conditions 8 Special Report 32 Staff 5 Swimming Baths and Pools 17, 19 Tuberculosis 29, 30, 34 Typhoid Fever 28, 34, 35, 36 Verminous Premises 19 Vital Statistics 8, 36 Water Supply 8, 12, 28 5 Chingford Urban District Council Committee, 1937-1938. Public Health and Housing Committee. Chairman:— Councillor Mrs. S. L. Oakes. Councillors Mrs. M. Basford A. C. Bloomfield H. E. Chinner Dr. F. H. Hayward, D.Litt., M.A., B.Sc. E. C. Hurrell Geo. Little, J.P., C.C., F.C.A. (ex officio) Miss Helen Mathieson Miss M. L. Mathieson, C.C. Meeting:—Second Tuesday in each month, at 7.30 p.m. Public Health Officers of the Authority. MEDICAL OFFICER OF HEALTH: L. S. Fry, M.D (Camb.). D.P.H. SENIOR SANITARY INSPECTOR: James F. Rogers, M.R.San.I., M.S.I.A., Certified Inspector of Meat and Other Foods. Superintendent of Refuse Collection and Disposal. Inspector under the Shops Acts and Petroleum Acts. Instructor (C.A.G.S.). ASSISTANT SANITARY INSPECTOR: E. A. Sellar, A.R.San.I., M.S.I.A. (To 1-3-37). J. T. S. Templeman, A.R.San.I., M.S.I.A. (From 1-4-37). CLERK: Miss V. M. Pettit. JUNIOR CLERK: R. H. J. Fanthorpe. (To 27-2-37). A. E. Culpin (From 1-6-37). 7 ANNUAL REPORT FOR THE YEAR 1937. To the Chairman and Members of the Chingford Urban District Council. Madam Chairman, Ladies and Gentlemen, I have the honour to present my Annual Report upon the Health and Sanitary Circumstances of the district, in the form prescribed by the Ministry of Health. I take this opportunity of thanking the Senior Sanitary Inspector, Mr. J. F. Rogers, and the staff of the Public Health Department for their help and co-operation during the year, and of acknowledging also the support received from the Council and from the Chairman and Members of the Public Health Committee. • I am, Ladies and Gentlemen, Your obedient servant, L. S. FRY, Medical Officer of Health. May, 1938. 8 Section A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area 2,860 acres Population—Registrar-General's estimate (resident population) mid-year, 1937 35,970 Number of inhabited houses—end of 1937 (approx) 9,922 Rateable Value on April 1st, 1937 £279,120 Sum represented by a penny rate on April 1st, 1937 (gross) £1,163 Social Conditions Chingford is mainly a residential area and most of the inhabitants earn their living outside the district. Amongst the principal industries must be included the building trades, two large laundries and a firm of hosiery makers, these last three employing mainly female labour. There are, in addition, several factories making cork goods, plywood, electric lamps, cabinets and cardboard boxes. During the last year or so the construction of the Metropolitan Water Board's new reservoir in the Lea Valley has absorbed an appreciable amount of local labour. There is relatively very little employment in the district. Vital Statistics Live Births Total M. F Birth Rate per 1,000 of estimated resident population: 16.3 Legitimate 574 306 268 Illegitimate 16 10 6 Stillbirths j Legitimate 16 7 9 Rate per 1,000 total (live and still) births: 28 Illegitimate 1 1 0 Deaths 269 132 137 Crude Death Rate per 1,000 of estimated resident population: 7.6 Corrected for age distribution of population: S? 8 Deaths from Puerperal Sepsis 0 „ other puerperal causes 0 Death Rate of Infants under one year of age:— All infants per 1,000 live births 44 Legitimate infants per 1,000 legitimate live births 43 Illegitimate infants per 1,000 illegitimate live births 62 Deaths from Cancer (all ages) 40 „ „ Measles (all ages) 0 Whooping Cough (all ages) 2 „ „ Diarrhoea (under 2 years of age) 4 The Birth Rate is the same and the Death and Infantile Mortality Rates are slightly higher than in the previous year. Table of Birth and Death Rates Year. Population. Births. Rate per 1,000 Deaths. Rate per 1,000 infant mortality Deaths. Rate per 1,000 1932 24,600 (estimated) 317 17.5 201 8.1 16 37 1933 26,630 (estimated) 405 15.3 218 8.1 20 49 1934 27,841 (estimated) 495 17.4 204 7.3 17 34 1935 29,690 (estimated) 505 17.0 210 7.0 12 23 1936 32,850 (estimated) 563 16.3 236 7.18 21 37 1937 35,970 (estimated) 590 16.3 269 7.6 26 44 10 Section B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. i(a) Laboratory Facilities. No change. Biological examinations for virulence, test 1 for Tubercle Bacill Number of samples of milk obtained from Producers or Dealers in district and examined biologically. 1st Jan.-31st March, 1937 Negative 5 Positive (b) Ambulance Facilities. No change. The following is a summary of the work performed by the Council's two ambulances during 1937. Police and Accident Private hire calls. calls. Mileage. 54 479 10.203 Thirty-five calls were undertaken by the St. John's Ambulance Brigade. (c) Nursing in the Home. No change. (d) Clinics and Treatment Centres. An additional Child Welfare Centre was opened by the County Council in November at the Mission Hall, Sewardstone Road, North Chingford. (e) Hospitals. Since July, in addition to other infectious diseases, cases of Puerperal Pyrexia and Ophthalmia Neonatorum have, when necessary, been admitted to the Waltham Isolation Hospital. (f) Midwives. One midwife was appointed by the County Council in October for domiciliary service in the district. This brings the total number of practising midwives in the area to nine. (g) Nursing Homes. There are three registered Nursing Homes in the district. The number of specimens examined at the laboratory was as follows:— Diphtheria 281 Sputa 317 Typhoid 92 Ringworm 1 General 73 Milk — Ice Cream — Water 4 Sewage — Total 768 11 Clinics and Treatment Centres. Clinic or Dispensary. Where held. When held. By whom provided. Diphtheria Immunisation Clinic Combined Clinic, Marmion Avenue. Monday mornings, 10 a.m.—12 noon. Chingford U.D.C. in conjunction with Essex C.C. Maternity and Child Welfare Clinic. Combined Clinic Marmion Avenue. Tuesdays at 2 p.m. Essex County Council. Maternity and Child Welfare Clinic. Combined Clinic, Marmion Avenue. Wednesday afternoons at 2.0 p.m. Essex County Council. Maternity and Child Welfare Clinic. Mission Hall, Sewardstone Road, North Chingford. 1 st and 3rd Wednesdays at 2.15 p.m. Essex County Council. Toddlers' Clinic. Combined Clinic Marmion Avenue. Thursday mornings 10 a.m.—12 noon. Essex County Council. Maternity and Child Welfare Clinic Church Hall, The Ridgeway, N. Chingford. Thursday afternoons at 2.30 p.m. Essex County Council. Ante-Natal Clinic. Combined Clinic, Marmion Avenue. Mondays at 2 p.m. and Fridays at 10 a.m. (except 1st Friday in month). Essex County County. Post-Natal Clinic. Combined Clinic, Marmion Avenue. 1st Friday in every month at 10 a.m. Essex County Council. School Clinic. Combined Clinic, Marmion Avenue. Wednesday mornings 9.30 a.m.-12 noon. Essex County Council. Orthopaedic Clinic. Combined Clinic, Marmion Avenue. Masseuse in attendance Mondays, 9.30 a.m. Thursdays, 2 p.m. British Red Cross Society and Essex County Council. Tuberculosis Dispensary. Old Monoux School, High Street, Walthamstow. Mondays, 2-4 p.m. women and children Wed. 10-12 noon, new cases ,, 6-8 p.m. adults Thurs. 2-4 p.m. men Fridays, 10-12 noon children. Essex County Council. Venereal Diseases. London Hospitals. The Essex County Council participating in the London & Home Counties Scheme. 12 Section C—SANITARY CIRCUMSTANCES OF THE AREA. Water Supplies. A hard, pure and constant piped water supply is provided by the Metropolitan Water Board, and the supply has been satisfactory throughout the year, both in quality and quantity. One sample of water was taken during the year from a dwelling house in the district, on account of four of the occupants suffering from gastro-enteritis of unknown origin. The Bacteriologist reported the water to be of a high standard of purity, suitable for drinking and domestic purposes. In December, a sample was taken from an artesian well which supplies water to farm premises, and was used in the cooler and for bottle washing. The well is in gravel subsoil and a previous sample, taken in July, 1930, was found on examination to be bacteriologically of a high standard of purity. The results of the bacteriological examination of the sample taken in 1937, however, showed evidence of a slight contamination, inasmuch as excretal bacilli, such as Bacillus Coli, were present in 50 c.c., though absent in 20 c.c. Immediate action was taken and the use of the water for dairy purposes prohibited. Further samples have been examined, the results of which have been satisfactory, but at the time of writing this report the prohibition had not been removed. The wisdom of periodic sampling is appreciated and the Council has made the necessary arrangements to this end. Work has continued on the second reservoir of the Metropolitan Water Board in the Lea Valley, reference to which was made in the report for 1935. Drainage and Sewerage. No important extension of the sewerage system was carried out by the local authority during the year, but many new sewers were laid down by builders in the development of new estates. The scheme tor additional drainage in the south-west part of the district, to deal with surface water flooding, was completed during the year, and a scheme for the relief of the Chingford Mount Road and Bateman Road sewers in times of storm is now under construction. Part of the main scheme for the piping of ditches and flood prevention on the Chingford Hall Estate has been submitted to the Ministry of Health for their approval, and the remaining portion of the Scheme is now in course of preparation. Rivers and Streams, Action was taken on various occasions during the year to check pollution of ditches and streams in the district. Attention was given from this Department from time to time on the general cleansing of water courses. Closet Accommodation. The whole district is on the water carriage system, with the exception of three cottages in isolated parts of the town and two houses in the area recently added to the district which are served by one cesspool. This cesspool is emptied as required. 13 Public Cleansing. The collection and disposal of house and trade refuse is carried out under the direction of the Senior Sanitary Inspector. A weekly collection was maintained with the three existing 10 cubic yard freighters, but owing to the considerable number of new houses erected during the year, viz., 917, and the corresponding increase in tonnage, the cost of a new vehicle was included in the estimates for the financial year 1938-9. During the year ending March 1938, the total weight of house and trade refuse collected was 7,147 tons, an increase of 1,156 tons over the amount collected during the previous year. The Council had under review the question of charges for the collection of trade refuse, and a questionnaire was sent to adjoining Authorities. The replies clearly indicated that there was little uniformity in the charges made by various Authorities, and it was due to this fact that certain traders coming into the district were loath to conform to the Scheme which the Chingford Council has put into operation. This provides for a charge of 3d. per bin or 10s. 6d. per load of refuse collected, and books of printed, gummed and numbered tickets are sold on request at the Town Hall to the traders. The net cost per ton for the collection of refuse was 6s. 0¾d., as against 6s. 2¾d. for the year ended March, 1937, and 5s. 10¾d. for the year ended March, 1936. The cost of collection per house per week remains similar as in the previous year, namely ¾d. The net cost per ton for the disposal of refuse was 3s. 2d., as against 2s. 5d. in the previous year, and 3s. 1d. for the year ended March, 1936. The increase in the disposal costs per ton (an increase of £688 or 9d. per ton), was due chiefly to additional labour charges, £300, furnace repairs, £200, hedge and trees for screening works, £50, and storage shed, £48. The weighbridge at the Works was maintained under contract and continues to fulfil a public service. Fees received during the year amounted to £35, representing 1,400 weighings, as against £27 in the previous year. The income from the sale of salvaged articles and from other minor items was £1,551, as against £1,282 for the year ended March, 1931.7, Once again it is pleasing to report a record year for income and a detailed analysis of the various items is given on page 15. The main increases are in the sales of metals, rags and bundled newspapers. In the early part of the year the metal market was in a state of agitation, due to re-armament schemes, but prices became normal in the latter half of the year. The income from the sale of fine and coarse screenings is considerably below normal, due to the fact that no tender was received for these materials until the latter part of the year. By burning the whole of the refuse, however, a better grade of clinker was produced, and the increased income on the sale of this material tended to balance the loss on the sale of fine and coarse screenings. 14 Once again it is impossible to publish this report without some comment on the number of milk bottles which were either thrown into dustbins or left lying about in the streets. No less than 44,352 milk bottles were salved at the Works, as against 35,712 in the previous year. The Council is perfectly satisfied that the thorough cleansing and sterilising process to which these bottles are subjected after they leave the Works renders them safe for re-issue to the milk trade, but it must be a matter of regret that such indiscriminate dumping of bottles is possible in these enlightened days. It would appear to indicate that there is something definitely wrong with the milk distribution system which will permit such a state of affairs, or more possibly it indicates sheer carelessness on the part of some householders. Ultimately milk will be packed in non-returnable cartons when once public opinion has realised that local authorities do safeguard both the quality and quantity of milk supplied. Item. Particulars. I.—Collection. II.—Disposal. Including Depreciation or Loan charges Excluding Loan charges etc. Including Depreciation or Loan charges Excluding Loan charges etc. Excluing Loan charges etc. (1) (2) (3) (4) (5) (6) (8) Revenue Account. (See Note a) (See Note a) A. Gross expenditure £2234 £2084 £2682 £2266 £4350 B. Gross income 70 70 1551 1551 1621 C. Net cost £2164 £2014 £1131 £715 £2729 Unit Costs. s. d. a. d. s. d. s. d. 8. d. D. Gross expenditure per ton 6 3 5 9 7 6 6 4 12 E. Gross income, per ton 2 2 4 4 4 4 4 n F. Net cost, per ton 6 Of 5 7 3 2 2 0 7 71 G. Net cost, per 1,000 £ £ £ £ £ lation 60 56 31 20 76 H. Net cost, per 1000 houses or premises from which refuse is collected £ 211 £ 196 £ 110 £ 68 £ 264 1. Total refuse collected (in tons) 7,147 2. Population (Mid Year) 35,970 3. Weight per 1,000 population per day (incwts.) 10.8 4. Number of occupied houses and premises (end of year, 1937) 10,354 Note.—(a) " Loan charges " include interest on loans ; repayment of loans ; revenue contributions to capital outlay and capital receipts. 15 ANALYSIS OF INCOME FOR THE YEAR ENDED 31st MARCH, 1938. Year ended 31-3-37 £ s. d. £ s. d. £ s. d. 1. Sale of Salvaged Articles : — £ s. d. 112 10 4 Fine & Coarse Screenings 27 11 3 6 6 0 Fine Ash 11 19 3 5 1 6 Clinker 42 9 3 81 19 9 Metals:— 65 1 11 Aluminium 75 11 11 12 10 9 Copper 22 9 11 34 18 1 Iron 44 4 7 5 10 0 Pewter 2 11 2 6 12 8 Lead 13 12 5 6 9 8 Battery Lead 18 4 0 33 14 4 Brass 46 5 2 2 11 0 Silver 1 19 6 9 0 Gold 1 18 6 7 1 7 Mixed Metals 18 10 11 105 4 3 Tins 172 5 7 417 13 8 46 10 10 Bones 41 0 4 41 0 4 85 19 0 Broken White Glass 69 6 6 206 12 8 Bottles and Jars 215 6 0 49 12 0 Milk Bottles 61 14 0 346 6 6 201 11 9 Rags 234 17 0 29 12 6 Carpet and Bagging 43 16 6 27£ 13 6 135 17 3 Bundled Newspapers 247 0 4 247 0 4 7 16 0 Bread 7 13 0 1 6 0 Tyres and red tubes 2 8 8 1 4 0 Broken Records 10 1 8 34 15 0 2. Miscellaneous Receipts and Charges 43 8 8 1,466 4 5 27 12 0 3. Weighbridge Fees 35 5 0 4. Rents:— 30 0 0 Foundry 30 0 0 A 20 0 0 Proportion of Allotment Rents 20 0 0 £1,282 10 1 £1,551 9 5 5,991 Tonnage 7,147 16 SANITARY INSPECTION OF THE AREA. Inspections on Complaint. The number of complaints received at the office and recorded in the register of complaints was 490, as compared with 474 in the previous year and 477 for the year 1935. The total inspections made on complaint was 593, and the number of defects or nuisances revealed was 383, which are analysed in the following table. Preliminary notices were at once served on the owners or occupiers of the premises concerned. It will be observed that the number of inspections is greatly in excess of the number of defects found, and this fact indicated that many visits were paid in which no action could be taken under the Housing and Public Health Acts. Such complaints were concerned usually with noise (i.e. vibrations from machinery or irritating noises from animals) or some grievance, due often to neighbourly differences. One fact remained clear, that the Public Health Department, quite apart from its normal functions, has come to be regarded as the repository for all minor petitions of complaint not usually dealt with in the Court of Summary jurisdiction. Table 1. Dirty premises 19 Blocked yard and W.C. drains 104 Accumulations of offensive matter 13 Defective ashbins 85 Lack of suitable latrines 2 Defective drainage 40 Defective woodwork of windows and doors 6 Verminous premises 2 Roofs and eaves gutters defective 14 Defective wall and ceiling plaster 11 Insufficient flushing to W.C. 5 Dampness 18 Defective firegrates and stoves 6 Smoky chimney 1 Accumulation of stagnant water 4 Defective W.C.'s 10 Defective water fittings 5 Watercourse requires cleansing 1 Defective sinks and waste pipes 5 Animals kept so as to be a nuisance 3 Burning of refuse 4 Flooding 5 Defective floors 5 Defective yard paving 2 Pollution of water course 2 Lack of washing accommodation 2 Defective external brickwork 3 Vermin 1 Smoke nuisances 1 Pollution of surface water sewer 1 Insufficient drainage 1 Defective washboiler 1 Nuisance by Caravan 1 383 17 Summary of Inspections The total number of visits paid by the Sanitary Inspectors to various premises for all purposes is summarised below, together with the number of defects found under specific headings. The visits numbered 3,585, as compared with 11,872 in the previous year; the defects dealt with numbered 1,139, as compared with 815 in 1936. It should be noted that the number of visits in 1936 was inflated by those found necessary in connection with the Preliminary Housing Survey. The normal routine work of the inspectorial staff 'was interrupted during the year in no small measure, by changes in personnel and by additional duties caused by the applications received from owners for " permitted numbers " in relation to the houses under their control. Table 2. Visits Paid Nuisances or Defects found Housing Acts 101 64 Re-visits—Housing Acts . 341 Housing—Overcrowding 676 11 On complaint 593 383 Miscellaneous 122 Infectious diseases 220 Slaughter Houses 51 Meat and Food Shops 144 2 Factories 9 1 Workshops 8 Outworkers 1 Bakehouses 11 Cowsheds 21 Dairies and Milkshops 11 Drains Tested 58 Revisits 859 Rats 55 3 Refuse Collection 84 Pigstyes 5 Council Houses 7 Houses-let-in-Lodgings 113 97 Flooding 25 Swimming Pool 2 Ice Cream Vendors 2 Verminous Houses 7 Water sampling 4 Petroleum 25 Shops 21 1 Smoke Observations 2 Food poisoning 2 Hairdressers 3 Meat Regulations 2 3585 1139 18 Nuisances and Defects. In the following table is summarised the nuisances and defects dealt with or in connection with which action was commenced during the year under the Housing Acts, Public Health Acts, Byelaws and other Enactments:— Table 3. Dirty premises 89 Roofs and eaves gutters defective 73 Blocked yard and W.C. drains Accumulation of offensive matter 110 13 Defective wall and ceiling plaster 71 Insufficient flushing to W.C.'s 30 Accumulations of stagnant water 4 Defective W.C's 38 Overcrowding 10 Defective water fittings 4 Watercourses requiring cleansing 3 Dampness 74 Insufficient drainage 5 Defective drainage 59 Defective firegrates and stoves 50 Defective woodwork of windows and doors 71 Smoky chimney 1 Defective ashbins 116 Lack of suitable latrines 2 Defective chimney flue 1 Verminous premises 2 Defective water tanks 18 Animals kept so as to be a nuisance 3 Rat infestation 3 Burning of refuse 4 Flooding 5 Defective floors 39 Defective yard paving 34 Defective sinks and waste pipes 32 Insufficient lighting and ventilation 9 Defective water fittings 3 Insufficient W.C. accommodation 28 Nuisance by caravan 1 House without sink 1 Pollution of Surface water sewer 1 Insufficient water supply 1 Lack of and defective food stores 30 Lack of and defective washboilers 44 Breaches of Byelaws and Acts 8 Defective external brickwork 41 Defective stairs and rails 2 Vermin 5 Smoke nuisances 1 1139 19 Table 4. Letters sent out and notices served in connection with Sanitary Matters. Letters 2379 Public Health Acts: Preliminary Notices 191 Secondary Notices 12 Statutory Notices 1 Housing Acts: Preliminary Notices 61 Secondary Notices 4 Statutory Notices 2 Houses-let-in-Lodgings Byelaws: Preliminary Notices 45 Secondary Notices 1 Statutory Notices 0 Notices re Rats 4 2700 Shops. It was not necessary during the year to take action with regard to the temperature or ventilation of shops but one certificate of exemption was granted under Section 10 (6) of the Shops Acts, 1934, relating to sanitary conveniences and washing facilities. Swimming Baths and Pools Samples of water from the Larkswood Swimming Pool were taken in June, July and August, those in the last-mentioned month being taken by the County Bacteriologist, who personally inspected the pool. All samples were certified on examination to be of a high standard of purity, safe and suitable for swimming purposes. The pool continues to be a successful enterprise, and highest attendances were recorded on the 8th August, when approximately 6,047 persons were admitted. Chlorine and alkalinity readings were forwarded weekly by the Pool Superintendent to the Public Health Department. The pool was closed for repairs (to filter plant) for two days. Eradication of Bed Bugs. (a) The following table gives information on the action taken for the eradication of bed bugs: — Council Houses. Other Houses. Infested 3. Disinfested 3. Infested 10. Disinfested 10. 20 (b) Methods.—Spraying with a contact insecticide is the general rule, following the removal of architraves, skirtings and picture rails. Papered rooms are stripped. In severe cases the rooms are also fumigated with sulphur dioxide gas. (c) Inspectional Methods.—Before any tenant moves into a council house the house and belongings are thoroughly inspected by a Sanitary Inspector, as is also the Council house into which the family is to move. (d) Disinfestation.—Normal fumigation and spraying is carried out by workmen under the direction of the Sanitary Inspectors, but in exceptional cases the local authority instruct a contractor to fumigate with Hydrogen Cyanide. No case of this nature occurred during the year under review. Precautions are observed as outlined in the Ministry of Health Circular 1497. Except in necessitous circumstances, a charge is made for disinfestation carried out by or at the request of the local authority. In one instance, the furniture of one house was fumigated with Hydrogen Cyanide prior to a tenant going into a Council house. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYELAWS OR REGULATIONS. Offensive Trade Premises. The offensive trade premises on the register number 8, being one fat extractor and seven fish fryers. The licences in connection with three of the latter-mentioned trades are subject to annual renewal. Offensive trades are controlled by Byelaws adopted by the Council. Bakehouses. There are 8 of these premises within the district, one new bakehouse having been erected and put into use during the year. The latter premises differ from the normal type of bakehouse in that the oven and workroom are visible to the public through a glass partition. This should have the effect of keeping those engaged therein alive to the responsibilities attaching to premises where food is prepared, and the new departure may be regarded, therefore, as a welcome one. The number of visits paid to bakehouses was 11. 21 Houses-let-in-Lodgings Byelaws. These Byelaws were revised in 1936, coming into operation on the 1st April that year and repealing those made in 1931. The new Byelaws differ from those previously made in that they contain a Clause which brings within their scope those owneroccupied houses which are sublet to one family only of more than two persons. The general provisions of the Byelaws now apply to such houses with the exception of those relating to closet accommodation. The number of sublet six-roomed dwelling houses in this district is so considerable that no attempt has. been made, with the existing staff, to inspect and register them. A large amount of time was expended, however, in the inspection of certain Houses-let-in-Lodgings, which came within the normal scope of the Byelaws and, although the net results were not in any way commensurate with the efforts expended, it is felt they were justified. In actual fact, in only 7 instances were additional requirements obtained, these being the provision of additional closet accommodation, washing coppers, food stores and sink and water supplies, separate and readily accessible for the use of each family. These requirements were provided following the service of informal notices. In 30 cases, the informal notices were amended with the consent of the Council, following objections from owners. From an administrative point of view, it is unfortunate that the Byelaws do not lay down definite requirements as to separate accommodation for every part of a house-let-in-lodgings occupied as a separate dwelling, the operation of the Byelaws resting on the proof of the necessity for such; this is always a matter of opinion, and although easy to perceive difficult to prove. Factories and Workshop Acts. Twenty-eight visits were paid to Factories and Workshops; this number is small, due to pressure of work in other directions. No case of infectious disease occurred at outworkers' premises during the year. Three notices were received from H.M. Inspector of Factories and related to (1) overcrowding of Workroom, (2) lack of sufficient sanitary accommodation and (3) limewashing overdue and no record of statutory cleansing. After the service of informal notices, all nuisances were abated. 22 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. (i) Number of Inspections (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory Laundries) 20 3 — Workshops (Including Workshop Laundries) 8 — — Workplaces (Other than Outworkers' premises) — — — Total 28 3 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects. No. of offences in respect of which Prosecutions were instituted. Found Remedied Referred to H.M. Inspector (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:-* Want of cleanliness 1 1 - - Want of ventilation — — - - Overcrowding 1 1 - - Want of drainage of floors — — - - Other nuisances — — - - Sanitary accommodation insufficient 1 1 - - unsuitable or defective — — - - not separate for sexes — — - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Other offences - - - - (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) Total 3 3 — — "Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 23 RATS AND MICE (DESTRUCTION) ACT, 1919. Fifty-five visits were paid to various premises in connection with rat infestation during the year. Poisons were supplied in certain cases and rat traps loaned. In no case was it found necessary to take statutory action under the above Act. The following is a summary of activities which took place during National Rat Week, 1st to 6th November, 1937: — (a) Posters exhibited calling attention to Rat Week; (b) 250 Ministry of Agriculture bulletins distributed in " Better Health " journals; (c) 500 general leaflets on rat destruction distributed principally at the Public Library; (d) Short article oni Rat Destruction in local newspaper and a further article in "Better Health" journal, of which 1,000 copies were distributed; (e) Baits laid in the main sewers belonging to the Local Authority; (f) Red Squill poisons put down at the Refuse Disposal Works; (g) Visits paid to rat infested premises. The active interest displayed in rat destruction during Rat Week appears to be exceedingly small, in fact it would be difficult to assess the real value, if any, of this form of propaganda. Section D.—HOUSING STATISTICS FOR THE YEAR 1937. 1. Number of New Houses erected during the Year : — (1) By the Local Authority — (2) By other Local Authorities — (3) By other bodies or persons 917 Total 917 2. Inspection of Dwelling-Houses during the Year ; — (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,221 (b) Number of inspections made for the purpose 2,421 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 101 (b) Number of inspections made for the purpose 807 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 318* * Note.—This figure includes all houses where defects were found, including those which were inspected and recorded under the Housing Act, 1936. 24 3. 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 284 4. 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 1 (b) 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 1 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by owners 1 (b) by Local Authority in default of owners — 5. Housing Act—Overcrowding: — A. (1) Number of dwellings overcrowded at the end of the year 56 (2) Number of families dwelling therein 59 (3) Number of persons dwelling therein 364 B. Number of new cases of overcrowding reported during the year 9 C. (1) Number of new cases of overcrowding lieved during the year 8 (2) Number of persons concerned in such cases 51 D. Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — 25 Section E.—INSPECTION AND SUPERVISION OF FOOD. Milk Supply. There are now only six cowkeepers on the register for the district, one farm being given up during the year. This was Manor Farm on the Boothby-Heathcote Estate, which was purchased by the London County Council for Housing purposes. Thus bricks and mortar are gradually replacing the last remaining rural activities in the area. The number of retail purveyors of milk remains as last year, namely, forty-four, and one wholesale purveyor. The visits paid to these premises were 32; the cowsheds have been maintained in a satisfactory state. Milk (Special Designations) Order, 1936. Graded Milks. The following table shows the licences granted during the year for the sale of milk under the new special designations, as provided by the above Order:— 4 dealers' licences to sell milk as Fasteurised. 4 supplementary licences to sell mik as Pasteurised. 3 dealers' licences to sell milk as Tuberculin Tested. 3 supplementary licences to sell milk as Tuberculin Tested. 1 supplementary licence to sell milk as Accredited. 1 dealer's licence to bottle and sell milk as Tuberculin Tested. 1 dealer's licence to pasteurise and bottle milk. Phosphatase Test. During the year the following samples were subjected to Test A, with the results as shown: — No. Designation. Result. 12 Raw Untreated by heat. 13 Pasteurised Properly treated. 14 Pasteurised Properly treated. 15 Raw Untreated by heat. 16 Pasteurised Properly treated. Ice Cream—Registration of Manufacturers and Vendors. Section 158 of the Essex County Council Act, 1933, was adopted by the Council in 1934, and the number of persons registered at the end of the year was as follows: — For the manufacture, storage and sale 17 For the storage and sale only 24 No application for registration was refused during the year, and no samples of ice cream were submitted for examination. Meat and Other Foods. One licensed slaughterhouse is being used within the district and twenty-one butchers' shops; the visits paid to these premises numbered 197. The meat and food shops generally have been maintained in a satisfactory condition. Three slaughtermen's licences were granted during the year under the Slaughter of Animals Act, 1933. The following table gives details of carcases examined during the year:— 26 CARCASES INSPECTED AND CONDEMNED. Cattle excluding cows Cows. Calves. Sheep and Lambs Pigs Number killed (if known) 31 — 2 124 70 Number Inspected (at slaughterhouses and Butchers' shops) 31 — 2 124 149 All diseases except Tuberculosis. Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 9 — — 7 2 Percentage of the number inspected affected with disease other than tuberculosis 29 - - 5.6 1.3 Tuberculosis only. Whole carcases condemned - - - - - Carcases of which some part or organ was condemned 4 — — — 3 Percentage of the number inspected affected with tuberculosis 12.9 — — — 2 Other articles of food which were found to be diseased or unsound and were voluntarily surrendered and destroyed, are shown in the list below:— Article. Condition Weight. One box lettuce Decomposition. One tin corned beef Unsound 6 lbs. Roker Wings Decomposition 14 lbs. Australian Butter . Moulds 15 lbs. One tin of corned beef Blown and unsound 6 lbs. Food and Drugs (Adulteration) Act, 1928. One sample of tinned salmon was taken during the year and on examination was found to be genuine. Chemical and Bacteriological Examination of Food. The Counties Public Health Laboratories, Queen Victoria Street, E.C.4, undertake these examinations for the Council. Nutrition. The Gas Light & Coke Company's "Nutrition" film was shown to a large audience of the Parents' Association at the Chase Lane School in October. As in previous years the B.M.A. book "Family Meals and Catering" has been on sale at Welfare Centres and the Town Hall. 27 Section F.—PREVENTION AND CONTROL OF INFECTIOUS AND OTHER DISEASES. Diphtheria. Twenty-one cases of Diphtheria were notified during the year with one death, that of an adult, who contracted the disease and died outside the district. One mild case of the disease occurred in a child who had been inoculated a few months previously. Immunisation was carried on steadily throughout the year, but there was a slight fall in the total number of children treated, 324, compared with 343 in 1936. Experience has shown that the immunity conferred by a single dose of Alum Toxoid (the method used in 1936) is inferior to and less lasting than that given by two injections at an interval of two weeks. During 1937 the two-dose method was employed and it is not unlikely that this accounts for the decline in the numbers treated, for one injection naturally appeals to parents as saving time and minimising discomfort for the child. It is, however, of great importance that immunisation should not fall into disrepute owing to the use of unreliable methods. A summary of the year's work is given below. Immunisation 1937. Cases carried over from 1936 (i.e. Schick negative in 1937) 23 cases. Schick negative after two doses of A.P.T. 124 (96%) Schick negative after three doses of T.A.F. 5 Total Schick negative 152 Number of cases which failed to attend for or were not due for re-Schicking by end of year 108 Number in which course was not completed by end of year 14 Approximate number immunised by practitioners 50 Total treated during year 324 DIPHTHERIA NOTIFICATION RATE 28 Scarlet Fever. The incidence of Scarlet Fever was much the same as in 1936. The disease was of the mild type now prevalent and there were no deaths. The home nursing of scarlet fever is encouraged whenever circumstances are favourable. Infantile Paralysis. Three cases of anterior poliomyelitis, or infantile paralysis, were notified in July and September. Two boys, both aged 11 years, in the same school but different classes, developed the disease within a few days of one another and were removed to hospital. No further cases occurred. Typhoid Fever. Eleven cases of paratyphoid B and one of typhoid fever were notified during the year, nine of them in the first quarter. At about this time cases were occurring sporadically all over the extra metropolitan part of Essex and the Chingford cases thus formed part of a large outbreak. There was one secondary case, that of a child in whom the onset of the disease occurred 16 days after the removal of her brother to hospital. With this exception, however, careful investigation failed to bring to light a definite source of infection in any of the cases. Water. The Metropolitan Water Board supplies all houses in Chingford from their reservoir in the Lea Valley and this water is chlorinated before delivery. Examination by the Board's Medical Officer of samples from the service pipes in some of the infected houses gave no evidence of pollution. Milk, bread and watercress were investigated, but no article of food was definitely incriminated, although shellfish (winkles) were a possible source of infection in one instance. Agglutination tests and bacteriological examinations were carried out in a large number of contacts and suspects but no evidence of carriers or missed cases was forthcoming. The following table shows the percentage of notified cases of scarlet fever removed to hospital during the last five years: — 1933 1934 1935 1936 1937 Number of cases notified 107 134 59 52 61 Percentage removed to hospital 76 72 63 59 58 29 Pulmonary Tuberculosis. There were 51 cases of pulmonary tuberculosis notified during 1937, an increase of eleven over the previous year. Before drawing conclusions from this, however, it must be remembered that several factors may influence the number of notifications in any district: — (1) Transfers. A case of tuberculosis previously notified in one area must be re-notified on moving to another district. Clearly there will be a tendency for healthy areas outside London to attract sufferers from the disease from districts where the conditions are less favourable. It will be seen from the following table that 21 per cent, of the cases on the register on December 31st, 1937, were transfers from other districts. ANALYSIS OF CASES OF PULMONARY TUBERCULOSIS ON REGISTER ON 31st DECEMBER, 1937. Notified for first time in Chingford. Transfers from other districts. Total. 93 25 (21%) 118 (2) The notification rate depends also to some extent on the efficiency of the medical practitioners in the district and of the local tuberculosis service. There is little doubt that both these factors are tending in Chingford to increase the number of notifications and there seems no reason for supposing that changes in the social conditions of the district, such as overcrowding or poverty, have played any part in the increase. Age periods. NEW CASES. DEATHS. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0 to 1 year — — — — — — 2 — 1 to 4 years — — 1 — — — 1 1 5 to 14 years — 2 1 1 — — — — 15 to 24 years 2 5 — — 1 1 — 1 25 to 34 years 8 13 1 — 4 2 — — 35 to 44 years 2 7 — — 2 — — 1 45 to 54 years 7 3 1 1 — 2 — — 55 to 64 years 2 — — — 1 — — — 65 and upwards - - - - - - - - Totals 21 30 4 2 8 5 3 3 30 Tuberculosis Deaths. Of the 19 deaths from tuberculosis, 6 cases, or 31 per cent., had not been notified. Particulars of these 6 cases are given below. Tuberculous meningitis 2 cases peritonitis 1 case Miliary tuberculosis 2 cases Pulmonary tuberculosis 1 case Particulars are given below of the period elapsing between notification and death in the 13 notified cases. Notified 7 years before death 1 case „ 6 years ,, ,, 1 „ 4 years „ „ 1 „ 2J years „ „ 1 „ „ between 1 & 2 years before death 3 cases „ „ 6&12mths 3 cases „ „ 1&6 mths. „„ 1 case „ 1 week before death 2 cases 13 cases Public Health (Prevention of Tuberculosis) Regulations, 1925 Public Health Act, 1925. Section 62. Public Health Act, 1936. Section 172. No action was taken during the year under the above Regulations and Sections of the Acts. Prevention of Blindness. Public Health Act, 1936. Section 176. During the year arrangements were made for employees of the Council to be provided with goggles when engaged on work likely to cause injury to the eyes. Non-notifiable Infectious Diseases. The figures given below were obtained from the returns received from head teachers of schools and give some indication of the incidence of these diseases during the year. Chickenpox 25 cases Whooping Cough 64 ,, Mumps 49 ,, German Measles 2 „ Influenza. Influenza was prevalent in the early part of the year and was the primary, or a contributory cause, of death in 9 persons. 31 Measles. The year under review was an inter-epidemic period. A supply of convalescent serum, collected locally and prepared by Messrs. Burroughs Wellcome & Co., is kept in a refrigerator at the Town Hall for use by practitioners. Cancer. Deaths from Cancer. Site. 0-25 25-35 35-45 45-55 55- Totals M. F. M. F. M. F. M. F. M. F. M. F. Gastro-Intestinal Tract — — — — 2 - —. 2 10 8 12 10 22 Lungs and Mediastinum — — — — 1 1 1 — 1 — 3 1 4 Genito-urinary organs - - - - - - - 1 4 — 4 1 5 Breast — — — 1 — — — — — 3 — 4 4 Other sites - - - - - - 1 1 3 2 4 3 7 Totals — — — 1 3 1 2 4 18 13 23 19 42 Death rate = 1.1 per 1,000. Health Education. The circulation in the district of the Chingford edition of "Better Health" has been continued. Three pages of the paper are reserved for matters of local interest, including a complete list of clinics, dispensaries and welfare centres. The Central Council for Health Education's film "The Health of the Nation" was shown for a week in July at the Odeon Cinema, South Chingford. A series of the Central Council for Health Education's posters illustrating the value of fresh air and exercise were displayed during the year in an Empire Marketing Board frame outside the Town Hall and from October onwards posters, folders, leaflets and showcards to encourage the greater use of the existing health services were exhibited and widely circulated in the district in connection with the National Fitness Campaign. 32 Special Report to Council. A special Report was made to the Council in June on the extent of subletting in South Chingford. This report was based on an analysis of the Housing Act, 1936, Survey Forms relating to 5,213 houses and showed that of these 12 per cent. were sublet as flats, at rents varying between 15s. and 18s. a week. The results of an analysis of the occupants in 200 of these sublet houses is given in the following table. 200 Sublet Houses (400 flats) in South Chingford. Analysis of Occupants. Actual No. of Children. Married couples without children 166 41.5% 0 „ „ with one child 135 33.75% 135 „ „ with two children 50 12.5% 100 „ „ with three children 20 5.0% 60 „ „ with four children 5 1.25% 20 Single persons 14 3.5% 0 Adults only 4 1.0% 0 Unoccupied flats 6 1.5% 0 400 315 The importance of subletting rests mainly on the fact that these houses were in most cases designed and built to accommodate one family and that when turned into flats they present several undesirable features. Children require space and air, but in many cases the occupants of the top floor have no access to the garden of the house and, for the young mother with a baby, a bathroom and W.C. shared with the family below may be a serious source of inconvenience. Moreover, in some of the small flats the gas-cooker is placed on the landing, an arrangement hardly conducive to harmonious family life. As will be seen from the table, most of the families occupying these flats are small, which seems to provide an argument for the building of the small two-bedroom type of house which could be let to young married couples on the understanding that they would be required to move when the children reached a certain age or increased in number beyond two. 33 Deaths at Various Ages. Age. No. of Deaths. Under 1 year 26 1 and under 2 3 2 and under 5 3 5 and under 15 7 15 and under 25 14 25 and under 35 13 35 and under 45 23 45 and under 55 27 55 and under 65 38 65 and under 75 57 75 and upwards 58 Total .. 269 Attendances at Child Welfare Centres. Year. New Children. Total Attendances. 1933 North 109 1845 Total 6318 „ South 313 4473 1934 North 114 2206 Total 7474 „ South 358 5268 1935 North 150 2572 Total 9302 „ South 384 6730 1936 North 194 3311 South 359 4172 Total 7789 „ Toddlers' 173 306 (Apr. to Dec.) 1937 North 206 3927 „ South 276 5966 Total 10587 Toddlers' 236 694 Total Attendances at Ante-Natal Centre, 1937 — 582 „ „ „ Women's Welfare Clinic, 1937 — 82 34 NOTIFIABLE DISEASES. Year Scarlet Fever Diphtheria Erysipelas Tuberculosis Dysentery Encephalitis Lethargica Puerperal Fever Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerebro-Spinal Fever Enteric Fever Acute Poliomyelitis Smallpox Pulmonary Other Forms 1932 66 24 10 19 8 — — 2 2 1 8 1 — 1 2 1933 107 14 7 38 5 — 1 2 8 — 6 — — — — 1934 134 29 9 24 7 — 2 1 7 — 8 1 — — — 1935 59 18 4 34 7 1 — 2 3 1 4 1 2 — — 1936 53 12 7 40 7 3 — 2 11 1 17 — 4 — — 1937 61 21 10 51 6 4 — — 7 1 34 1 11 3 — 35 NOTIFIABLE DISEASES TABULATED ACCORDING TO AGE. Under I year. i 2 3 4 5-9 10-14 15-19 20-34 35-44 45-64 65 and over. Scarlet Fever - 1 4 2 1 34 7 6 6 - - - Diphtheria — 1 4 2 - 8 2 1 2 - 1 — Erysipelas - - - - - - - - 2 2 4 2 Dysentery 1 — — 1 - 1 1 — —- — — •—• Puerperal Pyrexia - - - - - - - - 5 2 — — Ophthalmia Neonatorum 1 - - - - - - - - - - - Pneumonia 2 — 1 1 3 5 — 2 7 8 2 3 Cerebro - Spinal Meningitis - - - 1 - - - - - - - - Enteric Fever — — — 1 1 3 2 1 1 — 2 — Acute Poliomyelitis — — — - - - 3 - - - - — ANALYSIS OF NOTIFIABLE DISEASES AND DEATHS. Diseases. Total cases notified. Cases admitted to Hospital. Total Deaths. Scarlet Fever 61 35 - Diphtheria 21 18 1 Erysipelas 10 4 — Dysentery 4 2 — Puerperal Pyrexia 7 7 — Ophthalmia Neonatorum 1 1 — Pneumonia 34 7 9 Enteric Fever 11 11 — Cerebro-Spinal Meningitis 1 1 — Acute Poliomyelitis 3 2 - 36 Birth-rates, Death-rates, Analysis of Mortality, Maternal Death-rates, and Case-rates for certain Infectious Diseases in the year, 1937. England and Wales, London 125 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 125 County Boro's and Great Towns including London 148 smaller Towns (Resident Populations 25,000 to 50,000 at 1931 Census) London Administrative County Chingford Rates per 1,000 Population Births :— Live 14.9 14.9 15.3 13.3 16.3 Still 0.60 0.67 0.64 0.54 0.47 All Causes 12.4 12.5 11.9 12.3 8.8 Typhoid and Paratyphoid fevers 0.00 0.01 0.00 0.00 0.00 Smallpox —- — — — — Measles 0.02 0.03 0.02 0.01 0.00 Scarlet fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.04 0.04 0.03 0.06 0.05 Diphtheria . 0.07 0.08 0.05 0.05 0.02 Influenza 0.45 0.39 0.42 0.38 0.33 Violence (including suicide) 0.54 0.45 0.42 0.51 0.44 Notifications:— Smallpox 0.00 — 0.00 — — Scarlet fever 2.33 2.56 2.42 2.09 1.7 Diphtheria 1.49 1.81 1.38 1.93 0.61 Enteric fever 0.05 0.06 0.04 0.05 0.30 Erysipelas 0.37 0.43 0.34 0.44 0.27 Pneumonia 1.36 1.58 1.20 1.18 0.90 Rates per 1,000 Live Births Deaths under 1 year of age 58 62 55 60 44 Deaths from Diarrhoea 1 and Enteritis under > 2 years of age J 5.8 7.9 3.2 12.0 6.7 Maternal Mortality:— Puerperal Sepsis 0.97 Not available. — Others 2.26 Total 3.23 Rates per 1,000 Total Births (i.e., Live and Still) Maternal Mortality:— Puerperal Sepsis 0.94 Not available. — Others 2.17 Total 3.11 Notificatiovs:— Puerperal fever 13.93 17.59 11.52 4.15 11.5 Puerperal pyrexia 14.34