LIBRARY CHIN 3 BOROUGH OF CHINGFORD ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH INCLUDING THE REPORT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1938 E. G. Ellis & Sons (T.U.) Willow Street, Chingford BOROUGH OF CHINGFORD ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH INCLUDING THE REPORT OF THE SENIOR SANITARY INSPECTOR FOR THE YEAR 1938 INDEX Page Acreage 8 Air Raid Precautions 33 Ambulance Facilities 10 Bacteriological Examinations 10, 19, 26 Bakehouses 20 Births and Birth Rates 8, 9, 37 Cancer 33 Clinics and Treatment Centres 10, 11, 34 Closet Accommodation 12 Committee, Constitution of 5 Complaints of Nuisances 16 Dairies, Cowsheds and Milkshops 23 Deaths and Death Rates 8, 9, 31, 33, 37 Drainage and Sewerage 12 Factories and Workshops 17, 20, 21 Food, Inspection and Supervision of 23, 24, 25 Health Services 10 Health Education 30 Hospitals 10 Housing and Housing Acts, 1925, 1930 and 1936. 8, 17, 22, 23 Ice Cream 24 Immunisation against Diphtheria 28, 29, 30 Infant Mortality 8, 9, 37 Infectious Diseases 17, 27'32, 35, 36 Inspections 16, 17 Laboratory Facilities 10 Maternity and Child Welfare 10, 34, 37 Meat Inspection 25, 26 Midwives 10 Milk and Dairies 10, 23 Notices Served 19 Nuisances 16, 17, 18 Nursing and Nursing Homes 10 2 Offensive Trade Premises 20 Overcrowding 17, 23 Population 8, 9 Prosecutions 26 Public Cleansing 12-15 Rateable Value 8 Refuse Collection and Disposal 12-15 Rivers and Streams 12 Sanitary Administration 12-26 Serum 32 Shops 19 Slaughterhouses 17, 25 Smoke Abatement 19 Social Conditions 8 Special Report 33 Staff 6 Swimming Baths and Pools 17, 19 Tuberculosis 11, 30, 31 Typhoid Fever 27, 35, 36, 37 Verminous Premises 20 Vital Statistics 8, 37 Water Supply 12 3 BOROUGH OF CHINGFORD Committee: April—October, 1938. PUBLIC HEALTH AND HOUSING COMMITTEE (Chingford Urban District Council) Chairman:— Councillor Mrs. S. L. OAKES, J.P. Councillors Mrs. M. BASFORD H. E. CHINNER V. E. A. GLASSCOE Dr. F. H. HAYWARD E. C. HURRELL Geo. LITTLE, J.P., C.C. Miss M. L. MATHIESON, C.C. R. Z. SMITH Meeting:—Second Tuesday in each month, at 7.30 p.m. Committee: November, 1938—March, 1939. PUBLIC HEALTH AND HOUSING COMMITTEE (Borough of Chingford) Chairman :— Alderman Mrs. E. E. STUTELY, J.P. Alderman R. Z. SMITH „ E. E. WAY Councillors H. E. CHINNER „ Mrs. N. HART „ E. C. HURRELL „ F. J. KING „ J. C. NORRIS Mrs. S. L. OAKES The Mayor (ex officio) Meeting:—Second Tuesday in each month, at 7.30 p.m. 4 PUBLIC HEALTH OFFICERS OF THE AUTHORITY (1938) MEDICAL OFFICER OF HEALTH: L. S. FRY, M.D. (Camb.), D.P.H. CHIEF SANITARY INSPECTOR : JAMES F. ROGERS, M.R.San.I., M.S.I.A., Certified Inspector of Meat and Others Foods. Superintendent of Refuse Collection and Disposal. Inspector under the Shops Acts and Petroleum Acts. C.A.G.S. Instructor (Special). ASSISTANT SANITARY INSPECTOR: J. T. S. TEMPLEMAN, A.R.San.I., M.S.I.A. CLERK: Miss V. M. PETTIT. JUNIOR CLERK: A. E. CULPIN. 5 ANNUAL REPORT FOR THE YEAR 1938 To the Mayor, Aldermen and Councillors of the Chingford Corporation. Mr. Mayor, Aldermen and Councillors, 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 Chief Sanitary Inspector, Mr. James F. Rogers, and the staff of the Public Health Department for their help and co-operation during the past eight years, 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, 1939. 6 Section A.— STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area 2,860 acres Population—Registrar-General's estimate (resident population) mid-year, 1938 37,510 Number of inhabited houses—end of 1938 (approx) 11,500 Rateable Value on April 1st, 1938 £303,254 Sum represented by a penny rate on April 1st, 1938 (gross) £1,264 Vital Statistics Live Births Legitimate Illegitimate Total M. F. Birth Rate per 1,000 of estimated resident population: 16.31 598 303 295 14 7 7 Stillbirths Legitimate 14 7 7 Rate per 1,000 total (live and still) births: 23.9 Illegitimate 1 — 1 Deaths 269 142 127 Crude Death Rate per 1,000 of estimated resident population: 7.17 Corrected by comparability factor: 8.31 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 45 Legitimate infants per 1,000 legitimate live births 46 Illegitimate infants per 1,000 illegitimate live births — Deaths from Cancer (all ages) 51 „ ,, Measles (all ages) 1 „ „ Whooping Cough (all ages) 0 „ „ Diarrhoea (under 2 years of age) 0 The birth and infantile mortality rates were practically the same as in 1937, but there was a slight fall in the death rate. 7 8 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 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 1938 37,510 (estimated) 612 16.31 269 7.17 28 45 Section B.— GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (a) Laboratory Facilities. No change. The number of specimens from the district examined at the Counties Public Health Laboratories was as follows:— Diphtheria 190 Sputa 270 Typhoid 9 Ringworm — General 200 Milk 21 Ice Cream 1 Water 9 Sewage — Total 700 Biological examinations for virulence test — for Tubercle Bacilli — (b) Ambulance Facilities. The ambulance facilities are adequate for the district and there was no change during the year. The following is a summary of the work performed by th Council's two ambulances during 1938. Police and Accident calls Private hire calls Mileage Council's Ambulance 83 542 10,028 St. John's „ 24 85 2,191 (c) Nursing in the Home. No change. (d) Clinics and Treatment Centres. No change. (e) Hospitals. No change. (f) Midwives. Number of nurse midwives employed by Chingford District Nursing Association:—4 County Council midwife for domiciliary service:—1 (Mrs. P. M. Stenning, 220, Hall Lane, E.4). Independent midwives:—2. (g) Nursing Homes. There are three registered Nursing Homes in the district. 9 CLINICS AND TREATMENT CENTRES Clinic or Dispensary. Where held. When held By whom provided Diphtheria Immunisation Clinic Combined Clinic, Marmion Avenue Mondays 10 a.m.—12 noon Chingford Borough Council 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 Wednesdays at 2 p.m. Essex County Council Maternity and Child Welfare Clinic Mission Hall, Seward stone Road North Chingford Wednesdays at 2.15 p.m. Essex County Council Toddlers Clinic Combined Clinic Marmion Avenue Thursdays 10 a.m.—12 noon Essex County Council Maternity and Child Welfare Clinic Church Hall, The Ridgeway, North Chingford Thursdays 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 Council 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 Wednesdays 9.30 a.m.-12 noon Essex County Council Orthopædic 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. 2-4p.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. 10 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. Work still continues on the second reservoir of the Metropolitan Water Board. Further samples were taken of well water at certain farm premises in the district, five in all and as the results of the samples were satisfactory in each case, periodic sampling was abandoned in June of the year under review. One sample of water was also taken from an artesian well at laundry premises; the examination proved the water to be pure and wholesome and suitable for drinking and domestic purposes. Drainage and Sewerage Part of the main Scheme for the piping of ditches and flood prevention on the Chingford Hall Estate was completed during the year and has proved satisfactory; the remaining portion of the Scheme is still in course of preparation. The drainage of the area added to the Borough in 1934, being 58 acres formerly forming part of the Urban District of Waltham Holy Cross, was completed, necessitating the provision of an automatic pumping station and a new length of sewer up to the new boundary of the district. The cost of the Scheme has been borne by the owners of the estates benefiting, including the Chingford Corporation Other smaller schemes for the improvement of the drainage system in the town were carried out in Ainslie Wood Road, Leadale Avenue and Mornington-Buxton Roads. The continued growth of the district involved the consideration of and preparation for further extensions at the Sewage Disposal Works to cope with the increased quantity of sewage. The district is included in the East Middlesex Drainage Scheme, but the proposed works are regarded as of too urgent a nature to await the inauguration of that Scheme. Rivers and Streams It was necessary only in one instance to take informal action as to the pollution of a water course in the area. Closet Accommodation As mentioned in previous reports, the whole of the district is on the water carnage system, with the exception of two cottages in isolated parts of the town and one house which is served by a cesspool. The cesspool is emptied as required. Public Cleansing The collection and disposal of house and trade refuse is carried out under the direction of the Senior Sanitary Inspector. 11 A weekly collection of refuse was maintained, using three 10 cubic yard freighters, up to December 1938, following which a new freighter (Dennis, 10 cubic yards) was put into use. The total weight of refuse disposed of at the works was 7,421 tons, an increase of 274 tons over the amount collected during the previous year. The net cost per ton for the collection of refuse was 7s. 7¾., as against 6s. 0¾d. for the year ended March 1938 and 6s. 2¾d. for the year ended March 1937. It will be seen, therefore, that the collection costs were higher than in previous years and this increase was due chiefly to increase in wages costs, loan charges on the purchase of a new freighter, and additional licence fee. The cost of collection per house, per week, was 1d., as against ¾d. for the previous year. The net cost per ton for disposal of refuse was 2s. 11½d., as against 3s. 2d. for the previous year, and 2s. 5d. for the year ended March 1937. It is pleasing to be able to record that the efficient disposal of refuse was again maintained at a comparatively low cost per ton, in spite of the reduced income from the sale of salvaged articles. The weighbridge at the works was maintained under contract and the fees received during the year amounted to £36. 9s. 0d., representing 1,458 weighings, as against £35. 5s. 0d., representing 1,410 weighings, in the previous year. The income from the sale of salvaged articles and from the minor items was £1,460, as against £1,551 for the year ended March 1938, thus recording, for the first occasion in ten years, a decrease in income. The loss in the amount of income may be regarded as small, namely £91, and can be directly traced to the difference between the sum received for the sale of paper this year and last, but this superficial loss does not represent the total problematical loss, in that the quantity of refuse disposed of was greater than in the previous year. It has been noted, during the ten years since the disposal plant was erected, that an increase in tonnage has meant increased sales income even though there have been flunctuations in the prices obtained for the various articles. Coincident with the fall in the income for the year was the fact that on the 1st April 1938 a variation was made in the commission paid to employees engaged in the collection and disposal of refuse. Prior to that date, 20% of sales was divided equally amongst the disposal staff and 5% amongst the collectors. The new scheme, whilst amending, and generally improving, the rates of pay, reduced the commission payable to 5% of sales, divided equally by the whole staff. The factors which may cause a variation in income from the sale of salvaged articles are many, and sufficient data is not available to the Council at the moment to enable them to come to any decision on the matter; the coincidence of a fall in income with the payment of a reduced commission is, therefore, not stressed. 12 The number of milk bottles which were salved at the works again increased, being 51,840, as against 44,352 in the previous year. Here, at least, it is clear that the number of such bottles either thrown into dustbins or left lying about in the streets definitely increases with the growth in population. On the 1st April, 1938, the Council instituted a new system for the collection of trade refuse charges, in lieu of the sale of tickets. This merely consisted of the assessment at the commence' ment of each quarter of the number of bins to be collected, when an account was sent to each trader participating in the scheme; the rate remained the same as in previous years, namely 3d. per bin. Accounts were amended for each succeeding quarter in accordance with the actual number of bins collected. HOUSE AND TRADE REFUSE Table showing costs for the year ended 31st March, 1939 Item. Particulars I—Collection II— Disposal Total Including Depreciation or Loan charges Excluding Loan charges etc. Including Depreciation or Loan charges Excluding Loan charges etc. Including Depreciation or Loan charges Excluding Loan charges etc. (1) (2) (3) (4) (5) (6) (7) (8) Revenue Account (See Note a) (See Note a) (See Note a) A Gross expenditure 2914 2667 2564 2162 5478 4829 B Gross income 79 79 1460 1460 1539 1539 C Net cost 2835 2588 1104 702 3939 3290 Unit Costs s. d. s. d. s. d. s. d. s. d. s. d. D Gross expenditure per ton 7 10¼ 7 2¼ 6 10¾ 5 9¾ 14 9¼ 13 0 E Gross income, per ton ... 2½ 3 11¼ 3 11¼ 4 2 4 2 F Net cost, per ton 7 7¾ 6 11¾ 2 11½ 1 10½ 10 7¼ 8 10 G Net cost, per 1,000 population £ 76 £ 69 £ 29 £ 19 £ 105 £ 88 H Net cost, per 1,000 houses or premises from which refuse is collected 247 225 96 61 343 286 1. Total refuse collected (in tons) 7,421 2. Population (Mid Year) 37,510 3. Weight per 1,000 population per day (in cwts.) 10.8 4. Number of occupied houses and premises (end of year, 1938) 11,500 Note.—(a) "Loan charges" include interest on loans; repayment of loans: revenue contributions to capital outlay and capital receipts. 13 ANALYSIS OF INCOME FOR THE YEAR ENDED 31st MARCH, 1939 Year ended 31-3-38 £ s. d. £ s. d. £ s. d. £ s. d. 1. Sale of Salvaged Articles : 27 11 3 Fine & Coarse Screenings 54 0 3 11 19 3 Fine Ash 2 0 0 42 9 3 Clinker 24 14 8 80 14 11 Metals: 75 11 11 Aluminium 57 3 3 22 9 11 Copper 30 9 5 44 4 7 Iron 37 19 7 2 11 2 Pewter 7 14 2 13 12 5 Lead 7 12 1 18 4 0 Battery Lead 9 12 8 46 5 2 Brass 35 4 7 1 19 6 Silver 1 10 0 1 18 6 Gold 1 13 6 18 10 11 Mixed Metals 6 19 5 172 5 7 Tins 208 0 7 403 19 3 41 0 4 Bones 40 18 11 40 18 11 69 6 6 Broken White Glass 85 8 6 215 6 0 Bottles and Jars 216 4 0 61 14 0 Milk Bottles 71 19 4 373 11 10 234 17 0 Rags 218 6 2 43 16 6 Carpet & Bagging 25 1 6 243 7 8 247 0 4 Bundled Newspapers 154 4 9 154 4 9 7 13 0 Bread 7 19 0 2 8 8 Tyres 6? red tubes 3 10 0 — — Broken Records 3 0 0 14 9 0 43 8 8 2. Miscellaneous Receipts and Charges 62 10 11 1,373 17 3 35 5 0 3. Weighbridge Fees 36 9 0 4. Rents: 30 0 0 Foundry 30 0 0 20 0 0 Proportion of Allotment Rents 20 0 0 £1551 9 5 £1,460 6 3 7,1 47 Tonnage 7,421 14 SANITARY INSPECTION OF THE AREA Inspections on Complaint The number of complaints received at the office and recorded in the register was 448, as compared with 490 in the previous year and 474 for the year 1936. The total inspections made on complaint was 458 and the number of defects or nuisances revealed was 398, which are analysed in the following table. Informal notices were at once served on the owners or occupiers of the premises concerned. Once again it will be observed that the number of visits is in excess of the defects found, which indicates that many visits were paid in which no action could be taken under the Housing and Public Health Acts. Table 1 Dirty premises 10 Defective eaves, gutters and roofs 7 Defective sink and waste pipes 6 Yard and W.C. drains blocked 134 Accumulations of offensive matter 18 Defective water fittings 3 Smoke nuisances 1 Dampness 13 Defective drainage 56 Insufficient flushing to W.C.s 9 Defective-dustbins 41 Defective external brickwork 2 Insufficient lighting and ventilation 2 Rat infestation 1 Burning of refuse 3 Defective floors 3 Defective firegrates and stoves 3 Offensive odours 1 Verminous premises 4 Defective yard paving 2 Defective wall and ceiling plaster 7 Defective W.C.s 3 Pollution of watercourse 1 Defective woodwork of windows and doors 3 Flooding 2 Defective washboilers 1 Breach of Byelaws 1 Miscellaneous 9 Insufficient drainage 1 Insufficient W.C. accommodation 1 348 15 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 3,420 as compared with 3,585 in the previous year; the defects dealt with numbered 784, as compared with 1,139 in 1937. The figures stated above reflect in some small measure the disturbance in routine caused by the crisis in September and for some months afterwards. Table 2 Visits Paid Nuisances or Defects found Housing Act 51 407 Re-visits—Housing Act 484 On complaint 458 345 Miscellaneous 82 7 Infectious disease 170 Slaughterhouses 79 Meat and Food Shops 604 9 Dairies and Milk Shops 24 Drains tested 12 1 Re-visits 829 Rats 19 Private slaughtering 2 Houses-let-in-Lodgings 13 4 Housing Act (Overcrowding) 266 7 Bakehouses 19 Refuse Collection and Disposal 51 Council Houses 25 Milk samples 10 Water samples 8 Meat Regulations 10 2 Shops Acts 20 1 Petroleum Acts 18 Factories 44 Cowsheds 13 Offensive trades 4 Pigsties 3 Smoke abatement 12 Food poisoning 2 Verminous premises 1 Swimming Pool 5 Ice Cream Vendors 10 Outworkers 70 Picture Houses 1 1 Food and Drugs Act 12 3431 784 16 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 54 Defective roofs and eaves gutters 37 Blocked yard and W.C. drains 135 Defective yard paving 28 Defective sinks and waste pipes 20 Accumulations of offensive matters 19 Defective wall and ceiling plaster 41 Defective dustbins 50 Defective W.C.s 20 Insufficient lighting and ventilation 17 Defective water fittings 99 Breach of Byelaws 3 Insufficient W.C. accommodation 2 Dampness 40 Defective drainage 70 Defective washboilers 12 Defective external brickwork 29 Defective floors 23 Defective firegrates 28 Defective woodwork of windows and doors 41 Insufficient flushing to W.C.s 13 Overcrowding 41 Verminous premises 11 Lack of food stores 8 Insufficient drainage 2 Miscellaneous 18 Houses without sinks 1 Flooding 2 Pollution of watercourse 1 Offensive odour 1 Burning of refuse 3 Defective stairs and rails 2 Smoke nuisances 1 Lack of washboiler 2 Rats 1 784 17 Table 4 Letters sent out and notices served in connection with Sanitary Matters. Letters 1728 Public Health Acts: Preliminary Notices 175 Secondary Notices 13 Statutory Notices 2 Housing Acts: Preliminary Notices 38 Secondary Notices 4 Statutory Notices 2 Houses-let-in-Lodgings Byelaws: Preliminary Notices 1 Secondary Notices 0 Statutory Notices 0 Notices re Rats 2 Shops Act It was not necessary to take action, during the year, with regard to the public health provisions of the Shops Acts. Smoke Abatement Thirty-one half-hourly observations were taken of chimneys in the town, but it was only necessary in one instance to serve on the occupiers of a factory notice of nuisance. Complaints were received during the year as to the emission of sooty particles from a large industrial concern in the southern part of the district. The nuisance arose out of the disposal of fine cork dust and the difficulties before the Company were great; it is pleasing to report, however, that the proprietors were ever ready to acknowledge their responsibility and to take all steps in their power to effect a remedy. The Council sent delegates to the Conferences of the Greater London Advisory Council for Smoke Abatement held in February and June, 1938. Although the Chingford Corporation considered there was not, generally speaking, an urgent smoke problem in the district, it being mainly residential, they were in support of the aims and objects of the Advisory Council and became members thereof. Swimming Baths and Pools Samples of water from the Larkswood Swimming Pool were taken during the bathing season and one sample was reported on adversely by the bacteriologist. This was of a sample taken in August, following the Bank Holiday period when the pool had been subjected to very heavy bathing loads. During August week, the number of persons who attended was 30,133, the peak load being on August 1st when 6,731 persons paid for admission. Amongst other factors having a bearing on the bacterial purity of the water was the practice of allowing spectators to assemble at the pool side. This has been prohibited during the 1939 season and it is felt that an improvement will result. Chlorine and alkalitrity readings are forwarded weekly to the Public Health Department by the Pool Superintendent. 18 Eradication of Bed Bugs (1) The following table gives information on the action taken for the eradication of bed bugs: Council Houses Other Houses Infested 14. Disinfested 14 Infested 19. Disinfested 8*. (2) Methods. Spraying with a contact insecticide, such as "Pyagra" or "Zaldecide" is the general rule, following the removal of architraves, skirtings and picture rails. Papered rooms are stripped. (3) Inspectional Methods. Before any tenant moves into a Council house, the prospective tenant's house and belongings are thoroughly inspected by a Sanitary Inspector, as is also the Council house into which the family is to move. *During the year under review, fumigation of tenant's belongings' with Hydrogen Cyanide was carried out in eleven instances. (4) Disinfestation. Fumigation with Hydrogen Cyanide is always carried out by a contractor; other disinfestations are carried out by the Local Authority. (5) Preventive Measures. All houses in the ownership of the Local Authority are inspected annually for the presence of bugs, and in all cases advice is given on the life history of the bed bug and remedial measures. Schools The sanitary condition and water supply of Schools has been satisfactory during the year. All cases of infectious disease amongst school children are notified to the head teachers, as are also contacts. It was not necessary during the year to close any school on account of infectious disease. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYELAWS OR REGULATIONS Offensive Trade Premises The offensive trade premises on the register number 9, being one fat extractor and eight fish fryers. The licences in connection with four 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 and they have been maintained in a satisfactory condition during the year. The visits paid to these premises during the year was 19. Factories and Workshop Acts. Forty-four visits were paid to Factories; this number is small, due to pressure of work in other directions. No case of infectious disease occurred at outworkers' premises during the year; 70 visits were paid to these premises. 19 INSPECTION OF FACTORIES AND OTHER PREMISES 1.—INSPECTIONS FOR PURPOSES OF PROVISIONS AS TO HEALTH Including Inspections made by Sanitary Inspectors Premises Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) Factories with mechanical power 35 — — Factories without mechanical power 9 — — †Other Premises under the Act (including works of building and engineering contraction but not including outworkers' premises) - - - †Electrical Stations should be reckoned as factories. Total 44 — — 2.—DEFECTS FOUND Particulars (1) Number of Defects No. of defects in respect of which Prosecutions were instituted (5) Found (2) Remedied (3) Referred to H.M. Inspector (4) Want of cleanliness (S. 1) Overcrowding (S. 2) Unreasonable temperature (S. 3) Inadequate ventilation (S. 4) Ineffective drainage of floors (S. 6) Sanitary Conveniences (S. 7) insufficient unsuitable or defective not separate for sexes Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Total 20 Section D.— HOUSING STATISTICS FOR THE YEAR 1938 1. Number of New Houses erected during the Year: (1) By the L. A. 62 (2) By other L. A. 's 82 (3) Other bodies 444 588 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) 846 (b) Number of inspections made for the purpose 2159 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 51 (b) Number of inspections made for the purpose 535 (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 199* *Note.— This figure includes all houses where defects were found, including those which were inspected and recorded under the Housing Act, 1936. 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 254 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 2 21 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) by owners 2 (b) by Local Authority in default of owners — Proceedings under sections 11 and 13 of Housing Act, 1936: Demolition orders made — Houses demolished — Proceedings under Section 12 of Housing Act, 1936 : Closing Orders — Closing orders determined — 5. Housing Act—Overcrowding: A. (1) *Number of dwellings overcrowded at the end of the year 1 (2) Number of families dwelling therein 1 (3) Number of persons dwelling therein 10 B. Number of new cases of overcrowding reported during the year 1 C. (1) †Number of new cases of overcrowding relieved during the year 56 (2) Number of persons concerned in such cases 362 *Subject to Licence. †"Relieved" means by L.C.C., Chingford Borough Council or the persons concerned. 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 — Any other particulars regarding overcrowding — Section E.—INSPECTION AND SUPERVISION OF FOOD Milk Supply There are now only two cowsheds on the register for the district; the number of retail purveyors of milk is 45 and one wholesale purveyor. The number of visits paid to cowsheds, dairies and milkshops was 37. Four samples of milk were taken from a dairy, following the occurrence of a case of typhoid fever; all samples were satisfactory. 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: 5 dealers' licences to sell milk as Pasteurised. 3 supplementary licences to sell milk as Pasteurised. 3 dealers' licences to sell milk as Tuberculin Tested. 2 supplementary licences to sell milk as Tuberculin Tested. 1 supplementary licence to sell milk as Accredited. 1 dealer's licence to pasteurise and bottle milk. 1 dealer's licence to bottle and sell milk as Tuberculin Tested. 22 The following samples were procured for bacteriological examination during the year: No. Designation Result 115 Accredited Unsatisfactory 116 Pasteurised Satisfactory 117 Tuberculin Tested 55 118 55 Unsatisfactory 119 ,, 55 120 Accredited 55 121 55 55 122 55 55 123 55 55 124 55 Satisfactory 125 55 „ 126 55 127 55 55 128 Tuberculin Tested 55 129 55 55 130 55 55 131 55 55 132 55 55 133 55 55 134 55 55 The above samples of Tuberculin Tested milk were taken on account of adverse reports received from outside local authorities; the dairyman in question is not a producer of Tuberculin Tested milk, so that in addition to the routine investigation of the methods employed in the bottling processes at the dairy, samples were taken of all such milk on arrival at the premises. In two instances it was shewn that the milk on arrival was not of a satisfactorily bacterial standard and the authorities concerned were notified accordingly. 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 26 No application for registration was refused during the year. Eight samples of ice cream were taken during the year and the bacteriologist reported that one sample was unsatisfactory in that the bacterial count exceeded 100.000. Further visits were paid to the vendor in question, when advice was given and subsequently a satisfactory sample was obtained. One sample was taken in connection with a case of typhoid fever; the result of examination shewed the sample to be satisfactory. 23 Meat and Other Foods One licensed slaughterhouse is being used within the district and twenty-one butchers shops; the visits paid to these premises number 683. The meat and food shops generally have been maintained in a satisfactory condition. The undermentioned table sets forth the carcases inspected and the instances in which parts of carcases were condemned: CARCASES INSPECTED AND CONDEMNED Cattle excluding cows Cows Calves Sheep and Lambs Pigs Number killed (if known 33 — 2 166 92 Number Inspected (at slaughterhouses and Butchers' shops) 33 — 2 166 322 All diseases except Tuberculosis. Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 15 — — 9 3 Percentage of the number inspected affected with disease other than tuberculosis 45.4 5.4 1 Tuberculosis only. Whole carcases condemned — - — — — Carcases of which some part or organ was condemned 5 - — — 13 Percentage of the number inspected affected with tuberculosis 15.1 - — — 4 The following list gives details of the diseased or unsound meat, included in the above table, which was voluntarily surrendered and destroyed: Article Condition Weight 1 bullock's liver Tuberculosis 14 lbs. 4 bullocks' mesenteries 55 61 lbs. 4 bullocks' lungs 55 29 lbs. 7 pigs' heads 55 61 lbs. 1 pig's leg, belly-piece, etc. 55 19 lbs. 6 pigs' mesenteries 55 9 lbs. 1 pig's lungs 55 2 lbs. 14 bullocks' livers Distoma Hepaticum 149 lbs. 1 bullock's liver Abscesses 13 lbs. 2 bullocks' lungs Pleurisy 20 lbs. 2 pigs' livers Cirrhosis 82 lbs. 2 sheeps' livers Necrosis 4 lbs. 1 sheep's liver Echinoccus Veterinorum 3½lbs. 7 sheeps' lungs Strongylus Rufescens 21 lbs. 24 Prosecutions Two prosecutions were instituted during the year and particulars are given below: Fine £ s. d. (1) Using unlicensed premises as slaughterhouse 0 10 0 Failure to give notice of slaughter 0 10 0 Failure to give notice of possibility of unsoundness 2 0 0 Removal of carcase and organs before inspection 2 0 0 Costs 1 0 0 £6 0 0 (2) Garage used for the storage of meat intended for human consumption: Suffering filth to accumulate on floor 2 0 0 Walls not cleansed nor limewashed 1 0 0 Failure to protect carcases from contamination 2 0 0 £5 0 0 Food and Drues (Adulteration) Act, 1928. The following articles were submitted for analysis during the year in supplementation of the Essex County Council's Food and Drugs service: No. Sample Result 238 Chocolates Rancid 239 Butter Genuine 240 Butter 55 241 Butter 55 242 Margarine 55 243 Margarine 55 244 Margarine 55 245 Raspberry Jam 55 246 Raspberry Jam 55 247 Condensed Milk (Skimmed) 55 248 Lard 55 249 Lard 55 Chemical and Bacteriological Examination of Food The Counties Public Health Laboratories, Queen Victoria Street, E.C.4, undertake bacteriological examinations for the Council. Dr. Bernard Dyer, 17, Great Tower Street, E.C.3, carries out the chemical analysis of foods and drugs. 25 Section F.— PREVENTION AND CONTROL OF INFECTIOUS AND OTHER DISEASES Scarlet Fever. The incidence of Scarlet Fever in the district was about the same as in 1937. The disease was mild in type, often with only a faint transient rash and there were no deaths. The following table shows the percentage of notified cases removed to hospital during the last five years. 1934 1935 1936 1937 1938 Cases notified 134 59 52 61 66 Percentage removed to hospital 72 63 59 58 72 Typhoid Fever Two cases were notified, one of typhoid, and one of paratyphoid; the source of infection in the former was almost certainly oysters, partaken of in a restaurant outside the district. During the year a female patient who had suffered from typhoid in 1936 was found to be employed as a cook at a restaurant in a neighbouring district and to be a carrier of typhoid organisms. Steps were at once taken to prevent her from undertaking any work involving the handling of food or drink and by agreement with a neighbouring Authority it was ultimately decided to compensate the patient for loss of employment until such time as she could find, or the Local Authorities concerned could offer her, a suitable means of livelihood. Dysentery Eleven cases of bacillary dysentery of the Sonne type were notified in the early part of the year. About half of the cases were in children and there was a history of symptoms of enteritis in other members of the household in several instances. The disease was characterised by a sudden onset, short course, and the absence, so far as is known, of complications or serious after effects. Bacteriological confirmation of the diagnosis was obtained in four only out of the eleven cases notified. A letter was sent to all practitioners informing them of the occurrence of cases in the district. 26 Diphtheria Immunisation Details of the work done during 1938 are given in the following table. It will be seen that efforts have been directed mainly towards getting children of pre-school age protected; moreover, the great majority of school children treated were between five and six years of age. The prophylactic used for those under eight years was alum toxoid, given in doses of 0.2 and 0.5 cc. at one month's interval, and in older children three doses of T.A.F. at a fortnightly interval. Experience shows that two well spaced doses of alum toxoid raise the anti-toxin in the blood to a high level in most cases and this method is probably one of the most reliable at present at our disposal. Reactions were few but when they occurred alum toxoid was discontinued and the course completed with two injections of T.A.F. intramuscularly. DIPHTHERIA IMMUNISATION, 1938. Method No. of Preschool age treated (1-4 years) No. of School-age treated Total Two doses A.P.T. at one month interval 147 75 222 T.A.F. two or three doses:— 6 10 16 153 85 238 Cases carried over from 1937 (i.e. treatment completed in 1938):— 11 249 Approximate number or cases immunised by General Practitioners:— 43 Total 292 27 Results of re Schick Tests. Prophylactic Schick Test Total No. of Tests Negative Positive Two doses A.P.T. (0.2 and 0.5cc) 8-12 weeks after 2nd injection 78 76 (97.5%) 2 (2.5%) One dose A.P.T. 1-2 years after injection 33 29 4 One dose A.P.T. 2-3 years after injection 4 (37) 2 (83.8%) 2 (16.2%) Three doses T.A.M. or T.A.F. (weekly interval) 1-2 years after injection 6 6 0 55 55 55 55 2-3 years after injection 9 7 2 55 55 55 55 3-4 years after injection 22 18 4 55 55 55 55 4 years after injection 4 (41) 4 (85.4%) 0 (14.6%) 28 A Review of Immunisation in Chingford during the years 1935-38. The Chief Medical Officer to the Ministry of Health in his recent report states "that immunisation in this country makes continuous if slow progress, but no city," he says, "has yet succeeded in immunising the 50—60 per cent, of the child population which is necessary before the incidence of diphtheria is affected." In this connection the following figures are of interest. During the four years 1935-38 the total number of new births in Chingford was 1,080 and during the same period 462 children under 4 years of age received a full course of injections at the clinic; in addition a certain number of children in the same age group was immunised by general practitioners. It appears, therefore, that immunisation during the last 4 years has been at the rate of about 45 per cent, of the new births in the district. During the same period the total number of all children up to 14 years of age known to have been immunised was 2,514. In order, however, to estimate the percentage of the child population which this figure represents it would be necessary to know, besides the total births, the number of immigrants into the district during the past four years, for which there are no reliable data, and immigration is a far from neglible factor in Chingford. It seems clear, however, that the time is approaching when the incidence of diphtheria in the district might be expected to fall as a result of active immunisation. It will be seen from table 1 that 7 cases only were notified during 1938, the lowest number recorded for ten years: Nevertheless it would be unwise to claim this as a triumph for immunisation, although this remarkably low incidence should surely encourage a renewed and determined effort to increase the proportion of protected children in the district. In the report of the Medical Research Council for 1937-38 it is remarked that "one of the most striking instances of the delay in the application of new knowledge is the relative lack of public recognition, in Great Britain at the present time, of the existence of a method of proven value for the prevention of diphtheria." The report refers also to the impressive result obtained by immunisation in Canada and the United States of America and cites as an example, the town of Hamilton, Ontario, with a population of 175,000 in which not one case of diphtheria has been diagnosed in the last five years. In 1936 the death rate of children during the ages of 1 to 15 from diphtheria was 2.1 per 100,000 in New York, but 31.8 per 100,000 in England and Wales. Is it then apathy or ignorance which allows 60 per cent, of the parents of Chingford to neglect to have their children protected against a dangerous and not uncommon disease at the price of two small injections? Tuberculosis There were 37 cases of pulmonary tuberculosis notified during 1938, a decrease of 14 on the previous year, and of these, 15 or 40 per cent, were transfers from other districts 29 Deaths There were 16 deaths from tuberculosis during the year, of which 3 had not been previously notified. Particulars of these are given below. Tuberculous meningitis 1 case. „ peritonitis 1 case. Pulmonary tuberculosis 1 case. Ratio of non-notified tuberculosis deaths to total tuberculosis deaths=l to 5.6. The following table gives particulars of the period elapsing between notification and death in the 13 notified cases. Notified 0— 6 months before death 4 „ 6 12 „ ,, 4 „ 1— 2 years „ „ 2 „ 3-4„ „ „ 0 „ 4— 5 „ „ „ 0 „ 5-6 „ „ „ 3 Age periods. NEW CASES DEATHS Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 to 1 year — - - - - - - - 1 to 4 years - - - - - - - - 5 to 14 years 1 1 - - - - - - 15 to 24 years 5 4 1 1 1 3 — — 25 to 34 years 9 3 1 3 4 - — — 35 to 44 years 1 4 — — 3 1 — — 45 to 54 years 4 1 - - - - - - 55 to 64 years 2 2 — - - - - - 65 and upwards — — — — 1 — — — Totals 22 15 2 4 9 4 — — 30 Non-notifiable Infectious Diseases The figures given below were obtained from the returns received from Head Teachers of schools in the district, and give some indication of the incidence of these diseases during the year. Measles 365 cases. Chickenpox 148 cases. Whooping Cough 14 cases Mumps 4 cases. Measles The disease was epidemic in the district during the first threefour months of 1938, but appears to have been mild in type, for one death only was reported. Although not a notifiable disease, some idea of its prevalence can be gained from the returns received from Head Teachers, which showed that 365 children were absent from school on account of Measles during the first four months of the year. A considerable quantity of blood was collected from local adult donors who were either recovering from an attack of measles or had had the disease in childhood, and this was sent to the Wellcome Research Laboratories for the preparation of measles serum, of which the following quantity was issued to practitioners and hospitals. Convalescent serum 225 cc. Adult serum 20 cc. A small amount of Lederle's immune globulin was also used. Particulars of the results obtained with these sera were forthcoming from doctors in but a small proportion of the total number of contacts which must have received treatment and these are given below. Convalescent serum Complete protection 11 cases. Mild or attenuated attack 6 cases. Lederle's immune globulin (in dose of 2 cc.). Mild attack 1 case. Disease uninfluenced 1 case. 31 Air Raid Precautions During the latter part of the year an increasing amount of the time of the Medical Officer of Health and of the clerical staff of the Public Health Department was taken up by A.R.P. work. It should be recorded also that the Chief Sanitary Inspector attended the Anti'Gas Course at Falfield and qualified as a C.A.G.S. Instructor (Special). He has since been responsible for the training of personnel in Anti-Gas precautions and in the organisation of the decontamination scheme. It seems probable that responsibility for the organisation and training in "first aid" of the Casualty Service personnel will continue for some time to come to be an integral part of the duties of the Medical Officer of Health and it is relevant here to refer to the unfailing help received from, and the many hours of voluntary service given by, Mr. E. J. Stemp and Miss Embleton, the Divisional Superintendents, of the S.JA.B. and by Mr. J. Peacham, Divisional Secretary of the S.JA.B. By the end of the year under review approximately 168 volunteers had received a course of instruction in "first aid," but it must be emphasised that this course can be regarded as the basis only for further instruction, and that an efficient Casualty Service can be created only by the gradual development of a team spirit, discipline and continuous training. 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 - - - - - 1 3 1 8 12 11 14 25 Lungs and Mediastinum — — - 1 2 1 3 - 2 I 7 3 10 Genito-urinary organs - - - - - - - - 1 1 1 1 2 Breast — — - — — — — 1 — 4 — 5 5 Other sites — — - — 1 1 — — 3 — 4 1 5 Totals — — — 1 3 3 6 2 14 18 23 24 47 Death rate = 1.25 per 1,000. 32 Deaths at Various Ages Age No. of Deaths Under 1 year 28 1 and under 2 3 2 and under 5 2 5 and under 15 4 15 and under 25 10 25 and under 35 15 35 and under 45 24 45 and under 55 27 55 and under 65 39 65 and under 75 45 75 and upwards 72 Total deaths 269 Attendances at Child Welfare Centres Year New Children Total Attendances 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 1938 North 259 5297 „ South 333 6318 Total 13929 ,, Toddlers' 211 2314 Total Attendances at Ante-Natal Centre, 1938 — 1,150 ,, ,, „ Women's Welfare Clinic, 1938 — 150 33 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 Pulmonary Other Forms 1933 107 14 7 38 5 — ] 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 1938 66 7 7 38 5 11 — — 10 2 23 2 2 — NOTIFIABLE DISEASES TABULATED ACCORDING TO AGE. Under 1 year 1 2 3 4 5-9 10-14 15-19 20-34 35-44 45-64 65 and over Scarlet Fever — 1 2 3 4 34 11 5 5 — 1 — Diphtheria — 1 — — — 2 — 1 3 — — — Erysipelas 1 — — — — — — — 2 — 4 — Dysentery — — 1 1 — 3 — 1 3 — 1 i Puerperal Pyrexia - - - - - - - 1 7 2 — — Ophthalmia Neonatorum 2 - - - - - - - - - - — Pneumonia 2 1 2 1 1 2 — — 4 2 6 2 Cerebro-Spinal Meningitis - — — - - — — — 1 — 1 — Enteric Fever - - - - - - - - - 2 - - ANALYSIS OF NOTIFIABLE DISEASES AND DEATHS. Diseases Total cases notified Cases admitted to hospital Total Deaths Scarlet Fever 66 47 — Diphtheria 7 6 - Erysipelas 7 2 — Dysentery 11 1 — Puerperal Pyrexia 10 9 — Ophthalmia Neonatorum 2 1 — Pneumonia 23 9 9 Enteric Fever 2 1 — Cerebro-Spinal Meningitis 2 2 1 35 Birth-rates, Death-rates, Analysis of England and Wales, London, Mortality, Maternal Death-rates, and 126 Great Towns and 148 Case-rates for certain Infectious Smaller Towns. Diseases in the year 1938. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 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 15.1 15.0 15.4 13.4 16.3 Still 0 60 0.65 0.60 0.48 0.39 Deaths:- All Causes 11.0 11.7 11.0 11.4 8.3 Typhoid and Paratyphoid fevers - - — - — Smallpox — — — — — Measles 0.04 0.05 0.03 0.06 0.02 Scarlet fever 0.01 0.01 0.01 0.01 — Whooping Cough 0.03 0.03 0.02 0.03 — Diphtheria 0.07 0.07 0.06 0.05 — Influenza 0.11 0.10 0.11 0.06 0.05 Notifications:— Smallpox — — — — - Scarlet fever 2.41 2.60 2.58 2.05 1.75 Diphtheria 1.58 1.85 1.53 1.90 0.18 Enteric fever 0.03 0.03 0.04 0.06 0.05 Erysipelas 0.40 0.46 0.39 0.46 0.18 Pneumonia 1.10 1.28 0.98 0.98 0.58 Rates per 1,000 Live Births Deaths under 1 year of age 53 57 51 57 45 Deaths from Diarrhœa and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 Maternal Mortality:— Puerperal Sepsis 0.89 Not available Others 2.19 Total 3.08 Rates per 1,000 Total Births (i.e., Live and Still) Maternal Mortality:— Puerperal Sepsis 0.86 Not available Others 2.11 Total 2.97 Notifications:— Puerperal fever 14.42 18.08 12.51 3.53 Puerperal 11.546 Pyrexia 36