chin 4 BOROUGH OF CHINGFORD ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH INCLUDING THE REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR 1939 BOROUGH OF CHINGFORD Committee : November, 1938—November, 1939. PUBLIC HEALTH AND HOUSING COMMITTEE Chairman :— Alderman Mrs. E. E. STUTELY, J.P. Members :— 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 W. F. Gillham, Esq., J.P. (Mayor) (ex-officio). Meeting:—Second Tuesday in each month, at 7.30 p.m. PUBLIC HEALTH OFFICERS OF THE AUTHORITY (1939) MEDICAL OFFICER OF HEALTH : L. S. FRY, M.D. (Camb.), D.P.H. (To 31.5.39). G. B. MURRAY, MB., Ch. B., D.P.H. (From 1.6.39). 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). ADDITIONAL SANITARY INSPECTORS : J. T. S. TEMPLEMAN, A.R.San.I., M.S.I.A. P. W. EDWARDS, C.R.San.I., M.S.I.A. (From 5.4.39). CLERKS: Miss V. M. PETTIT. A. E. CULPIN. D. G. BLEACH (From 25.7.39). 2 ANNUAL REPORT FOR THE YEAR 1939 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. Owing to the War and the need for economy in the use of paper the contents of the report have been reduced to their main essentials. As will be seen the incidence of scarlet fever increased as compared with the previous year, but not to an excessive degree. (144 cases). There has been no excessive mortality or illness due to infectious diseases or other causes. The health of the community during 1939 has not been affected by the War, as conditions of life were comparatively very little changed from their normal. 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 year, and of acknowledging also the support received from the Chairman and Members of the Public Health Committee. My thanks are also due to my predecessor, Dr. Fry, for his kindly assistance to me at the commencement of my duties in June. I am, Ladies and Gentlemen, Your obedient servant, G. B. MURRAY, Medical Officer of Health. May, 1939. 3 Section A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area 2860 acres Population—Registrar-General's estimate (a) 39,460 (For calculation of birth rates) (b) 38,160 (For calculation of death rates and incidence of infectious disease) Number of inhabited houses end of 1939 12,000 Rateable value on April 1st, 1939 £321,347 Sum represented by a penny rate on April 1st, 1939 (gross) £1,339 Vital Statistics * Infant Mortality † Birth Rate M. F. M. F. Live Births Total 348 311 355 313 Birth Rate per 1,000 of estimated resident population: 16.93 Legitimate 343 305 350 307 Illegitimate 5 6 5 6 * For calculating Infant and Maternal Mortality † For calculating Birth Rates M. F. Stillbirths Total 8 10 Rate per 1,000 total (live and still) births: 26.6 Legitimate 8 9 Illegitimate — 1 Deaths 129 132 Crude Death Rate per 1,000 of estimated resident population: 6.8 Corrected by comparability factor: 7.8 Deaths from Puerperal Sepsis 0 ,, „ other puerperal causes 1 Death Rate of Infants under one year of age:— All infants per 1,000 live births 22 Legitimate infants per 1,000 legitimate live births 22 Illegitimate infants per 1,000 illegitimate live births Deaths from Cancer (all ages) 48 „ „ Measles (all ages) 4 5 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 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 1939 (a) 39,460 668 16.93 261 6.8 15 22 (b) 38,160 Deaths from Whooping Cough (all 6 ages) 1 „ „ Diarrhoea (under 2 years of age) 0 „ „ Scarlet Fever 0 The Birth Rate was slightly higher than last year (16.93 to 16.31). The Infantile mortality rate (22) was exceptionally low, as only 15 deaths occured in infants under one year. 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 261 Sputa 190 Typhoid 12 Ringworm General 98 Milk Ice Cream 49 Water 6 Sewage Total 616 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 the Council's two ambulances during 1939. Private calls Accident calls Council's Ambulance 591 123 St. John's „ 35 15 Total Mileaga 11,404.5 (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:—3. County Council midwife for domiciliary service:—1 (Mrs. P. M. Stenning, 220, Hall Lane, E.4). Independent midwives:—3. There are two registered Nursing Homes in the district. 6 CLINICS AND TREATMENT CENTRES Clinic or Dispensary Where held When held Diphtheria Immunisation Clinics Church Hall First Aid Post, The Ridgeway, North Chingford. Brotherhood Hall, Chingford Mount Road, South Chingford. Wednesdays 10 a.m.—11 a.m. Mondays 10 a.m. Maternity and Child Welfare Clinic Brotherhood Hall, Chingford Mount Road, South Chingford. Tuesdays 1.45 p.m.—3.15 p.m. Maternity and Child Welfare Clinic Brotherhood Hall, Chingford Mount Road, South Chingford. Wednesdays 1.45 p.m.—3.15 p.m. Maternity and Child Welfare Clinic Mission Hall, Sewardstone Road, North Chingford. Wednesdays 1.45 p.m.—3.15 p.m. Toddlers' Clinic Brotherhood Hall, Chingford Mount Road, South Chingford. Thursdays 10 a.m.—12 noon. Maternity and Child Welfare Clinic Spicer Hall, Buxton Road, North Chingford. Thursdays 1.45 p.m.—3.15 p.m. Ante-natal Clinic 50, Friday Hill, E.4. 1st and 3rd Mondays 1.45 p.m. Maternity and Child Welfare Clinic 50, Friday Hill, E.4. 2nd and 4th Mondays 1.45 p.m. Ante-natal Clinic Brotherhood Hall, Chingford Mount Road, South Chingford. Wednesdays 10 a.m. Fridays 10 a.m. (except 1st Friday in each month). Post-natal Clinic (Not being held Brotherhood Hall, Chingford Mount Road, South Chingford. until further notice.) 1st Friday of every month at 10 a.m. Minor Ailment and School Clinic Brotherhood Hall, Chingford Mount Road, South Chingford. Mondays 9.30—12 noon. Orthopædic Clinic Brotherhood Hall, Chingford Mount Road, South Chingford. Masseuse in attendance, Mondays 8.45 a.m. Thursdays 1 p.m. Tuberculosis Dispensary Old Monoux School, High Street, Walthamstow. New cases— Wednesdays 10 a.m.—12 noon. Venereal Diseases London Hospitals. 7 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 in both quality and quantity. Work is still being continued on the second reservoir of the Metropolitan Water Board. One sample of water was taken from a house in the area ; the examination proved the water to be pure and wholesome and suitable for drinking and domestic purposes. Rivers and Streams. It was not necessary to take any action as to the pollution of water courses in the area. Public Cleansing. The collection and disposal of house and trade refuse is carried out under the direction of the Chief Sanitary Inspector. A weekly collection of refuse was maintained, using four 10 cubic yard freighters. The total weight of refuse disposed of at the Works was 6,972 tons, a decrease of 449 tons from the amount collected during the previous year. This decrease was due to the number of families who were evacuated. The net cost per ton for the collection of refuse was 8s. 5½d. as against 7s. 7¾d. for the year ended March, 1939, and 6s. 0¾d. for the year ended March, 1938. The net cost per ton for the disposal of refuse was 4s. l¼d., as against 2s. 11½d. for the previous year and 3s. 2d. for the year ended March, 1938. It will be noticed that these costs are higher than in previous years and this is due mainly to the increased wages account due to the replacement of men engaged on Active Service, and the decrease in income from the sale of salvaged articles. The income from the sale of salvaged articles and from the minor items was £1,379, as against £1,460 in the year ended March, 1939. This decrease of £81 can be traced to the lower prices which were received for the sale of salvage due to the market fluctuations caused by the disturbances in International affairs. The factors which may influence a variation in income from the sale of salvaged articles are many, but owing to pressure of work in other directions, it is not possible to go into detail as to the probable reasons. The weighbridge was maintained under contract and the fees received during the year amounted to £33 16s. 6d., representing 1,353 weighings, as against £36 9s. 0d., representing 1,458 weighings in the previous year. The sums received during the year for the removal of Trade Refuse amounted to £146, an increase of £67 over the amount collected in the previous year. 8 HOUSE AND TRADE REFUSE Table showing costs for the year ended 31st March, 1940 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 3088 2808 2812 2401 5900 5209 B Gross income 146 146 1379 1379 1525 1525 C Net cost 2942 2662 1433 1022 4375 3684 Unit Costs s. d. s. d. s. d. s. d s. d. s. d. D Gross expenditure per ton 8 10¼ 8 0½ 8 0¾ 6 10½ 16 11 14 11 E Gross income, per ton 5 5 3 11½ 3 11½ 4 4½ 4 4½ F Net cost, per ton 8 5¼ 7 7½ 4 1¼ 2 11 12 6½ 10 6½ G Net cost, per 1,000 population £ 75 £ 67 £ 36 £ 26 £ 111 £ 93 H Net cost, per 1,000 houses or premises from which refuse is collected 245 222 119 85 364 307 1. Total refuse collected (in tons) 6,972 2. Population (Mid-Year) 39,460 3. Weight per 1,000 population per day (in cwts) 10.2 4. Number of occupied houses and premises (end of year, 1939) 12,000 Note.—(a) "Loan charges" include interest on loans; repayment of loans; revenue contributions to capital outlay and capital receipts. 9 ANALYSIS OF INCOME FOR THE YEAR ENDED 31st MARCH, 1940 Year ended 31.3.39 £ s. d. £ s. d. £ s. d. s. d. 1. Sale of Salvaged Articles : 80 14 11 Fine Ash, Clinker and Screenings 83 13 11 83 13 11 Metals: 57 3 3 Aluminium 44 12 9 30 9 5 Copper 13 15 8 37 19 7 Iron 25 0 5 7 14 2 Pewter 3 11 6 7 12 1 Lead 5 10 0 9 12 8 Battery Lead 5 8 3 35 4 7 Brass 26 7 9 1 10 0 Silver — — — 1 13 6 Gold — — — 6 19 5 Mixed Metals 4 16 11 Unbaled Scrap 59 11 1 208 0 7 Tins 25 6 6 214 0 10 • 40 18 11 Bones 29 2 7 29 2 7 85 8 6 Broken White Glass 72 7 6 216 4 0 Bottles and Jars 197 18 8 71 19 4 Milk Bottles 62 8 0 332 14 2 218 6 2 Rags 214 7 10 25 1 6 Carpets and Bagging 18 4 6 232 12 4 154 4 9 Newspapers 226 15 8 — — — Mixed Papers 112 7 3 339 2 11 7 19 0 Bread 7 4 0 3 10 0 Tyres and Red Tubes 2 0 3 3 0 0 Broken Records 3 13 6 — — — Felt Hats 0 11 6 — — — Batteries 4 3 0 17 12 3 62 10 11 2. Miscellaneous Receipts and Charges 45 17 3 1,294 16 3 36 9 0 3. Weighbridge Fees 33 16 6 4. Rents : 30 0 0 Foundry 30 0 0 20 0 0 Proportion of Allotment Rents 20 0 0 £1460 6 3 £1,378 12 9 7,421 Tonnage 6.972 10 SANITARY INSPECTION OF THE AREA Inspections on Complaint The number of complaints received at the office and recorded in the register was 439, as compared with 448 in the previous year, and 490 for the year 1937. The total inspections made on complaint was 455, and the number of defects or nuisances revealed was 262, 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 20 Defective sink and waste pipes 1 Yard and W.C. drains blocked 94 Accumulations of offensive matter 12 Smoke nuisances 6 Dampness 15 Defective drainage 12 Insufficient flushing to W.C.s 2 Defective dustbins 45 Defective external brickwork 2 Defective floors 1 Defective firegrates and stoves 4 Verminous premises 1 Defective wall and ceiling plaster 13 Defective W.C.s 2 Defective woodwork of windows and doors 4 Breach of Bye-Laws 2 Miscellaneous 10 Insufficient W.C. accommodation 1 Yard and passage surfaces defective 2 Animals kept so as to be a nuisance 2 Overcrowding 1 262 11 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 4,154, as compared with 3,420 in the previous year ; the defects dealt with numbered 624, as compared with 784 in 1938. Table 2 Visits Paid Nuisances or Defects found Housing Act 59 338 Re-visits—Housing Act 1,158 1 On Complaint 457 263 Miscellaneous 138 Infectious diseases 319 Slaughterhouses 165 Meat and Food Shops 599 4 Dairies and Milk Shops 22 Drains tested 59 1 Re visits 502 4 Rats 78 Housing Act (Overcrowding) 84 Bakehouses 12 Refuse collection and disposal 5 Council houses 40 2 Milk samples 33 Water samples 5 Shop Acts 17 2 Petroleum Acts 4 Factories 8 2 Cowsheds 10 Offensive trades 9 Smoke abatement 27 5 Ice Cream Vendors 12 Outworkers 39 Drainage 69 Measuring re-permitted Nos. 11 Interviews with owners 63 Rehousing 43 Refuse Works 61 Cleansing visits 41 2 Fish shops 4 Billeting of troops 1 4,154 624 12 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 49 Defective roofs and eaves gutters 60 Blocked Yard and W.C. drains 95 Defective Yard paving 17 Defective sinks and waste pipes 14 Accumulations of offensive matters 12 Defective wall and ceiling plaster 44 Defective dustbins 52 Defective W.C.s 16 Insufficient lighting and ventilation 18 Defective water fittings 6 Breach of Byelaws 4 Insufficient W.C. accommodation 3 Dampness 50 Defective drainage 21 Defective washboilers 10 Defective external brickwork 19 Defective floors 24 Defective firegrates 21 Defective woodwork of windows and doors 42 Insufficient flushing to W.C.s 5 Overcrowding 2 Verminous premises 3 Insufficient drainage 1 Miscellaneous 19 Defective stairs and rails 1 Smoke nuisances 12 Animals kept so as to be a nuisance 2 Defective sashcords 2 624 13 Table 4 Letters sent out and notices served in connection with Sanitary Matters. Letters 1657 Public Health Acts: Preliminary Notices 112 Secondary Notices 20 Statutory Notices 1 Housing Acts: Preliminary Notices 72 Secondary Notices 7 Statutory Notices 6 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. Twentyeight observations were taken of chimneys in the Town, and it was necessary in 17 cases to serve notices of nuisance on the occupiers of a factory. The quantity of smoke which was emitted from this particular chimney was viewed with much concern, but, however, the position was much improved by the provision of a smokeless mechanical stoker. Complaints were received in November, 39 of the emission of grits from a chimney of the same factory, and on bringing the matter to the notice of the owners, they wrote saying that these grits were due solely to a very poor quality of coal which they had been compelled to use owing to the shortage of sea-borne industrial coal at the beginning of the war. Swimming Baths and Pools. Samples of water from the Larkswood Swimming Pool were taken during the bathing season and all these were found to be satisfactory and suitable for swimming bath purposes by the bacteriologist. Chlorine and alkalitrity readings are forwarded weekly to the Public Health Department by the Pool Superintendent. 14 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 5. Disinfected 5. Infested 4. Disinfected 4. (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 belong' ings with Hydrogen Cyanide was carried out in seven 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 12. Factories and Workshop Acts. Eight 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 ; 39 visits were paid to these premises. 15 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 8 2 — Factories without mechanical power — — — †other Premises under the Act (including works of building and engineering contruction but not including outworkers' premises) — — — †"Electrical Stations should be reckoned as factories. Total 8 2 — 2.—DEFECTS FOUND Particulars Number of Defects No. of defects in respect of which Prosecutions were instituted Found Remedied Referred to H.M. Inspec tor (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 1 1 — — Overcrowding (S. 2) Unreasonable temperature (S. 3) Inadequate ventilation (S. 4) Ineffective drainage of floors (S. 6) Sanitary Conveniences (S. 7) insufficient 1 1 _— — 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 2 2 — — 16 Section D.—HOUSING STATISTICS FOR THE YEAR 1939 1. Number of New Houses erected during the Year : (1) By the L.A. (2) By other L.A.'s 385 (3) Other bodies 201 586 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) 1,164 (b) Number of inspections made for the purpose 2,824 (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 ... 59 (b) Number of inspections made for the purpose 1,217 (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 220* *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 173 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 17 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : (a) by owners (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 C. (1) †Number of new cases of overcrowding relieved during the year (2) Number of persons concerned in such cases *Subject to Licence. †"elieved" 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 still only two cowsheds on the register for the Chingford district ; the number of retail purveyors of milk is 30 and one wholesale purveyor. The number of visits paid to cowsheds, dairies and milkshops was 32. Milk (Special Designations) Order, 1936. Graded Milks. The following table shows the licences granted during the year for the sale of milk under the 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 dealers' licence to pasteurise and bottle milk. 1 dealers' licence to bottle and sell milk as Tuberculin Tested. 18 Ice Cream—Registration of Manufacturers and Vendors. There was one application for registration for the manufacture of ice cream under section 14 of the Food and Drugs Act, 1938. The number of persons registered at the end of the year was as follows : For the manufacture, storage and sale 18 For the storage and sale only 28 Eight samples of ice cream were taken during the year and the bacteriologist reported that three of them were unsatisfactory in that the bacterial count exceeded 100,000. Registration of Premises under Section 14—Food and Drugs Act. There were twenty applications during the year for registration of premises at which Sausages are manufactured of food potted, pickled, pressed or preserved. No application was refused during the year. Meat and Other Foods There is one licensed slaughter-house and twenty-two butchers shops in the area ; the visits paid to these premises number 764. 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 Inspected (at slaughterhouses and Butchers' shops) 53 2 10 302 348 All diseases except Tuberculosis. Whole carcases condemned — — — 1 — Carcases of which some part or organ was condemned 12 — — 5 6 Percentage of the number inspected affected with disease other than tuberculosis 22.6 — — 2.0 1.1 Tuberculosis only. Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 22 2 — — 9 Percentage of the number inspected affected with tuberculosis 41.5 100.1 — — 2.5 19 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 5 bullock's lungs Tuberculosis 59 lbs. 2 bullock's lungs and mesenteries ,, 30 lbs. 6 bullock's mesenteries ,, 60 lbs. 1 bullock's head, tongue, lungs and mesentery ,, 48 lbs. 1 bullock's head and tongue ,, 30 lbs. 1 bullock's head, liver tongue and mesentery ,, 72 lbs. 1 bullock's Top-piece, head, tongue and pluck ,, 105 lbs. 4 pig's mesenteries ,, 4 lbs. 6 pig's heads ,, 49¾ lbs. 1 cow's liver, lungs and mesentery ,, 32 lbs. 1 cow's liver and lungs Tuberculosis and Abscesses 22 lbs. 18 bullock's livers Flukes 216 lbs. 3 bullock's livers Flukes and Cirrhosis 38 lbs. 1½ bullock's livers Distomum Hepaticum 18 lbs. 4 pig's kidneys Nephritis 1¾ lbs. 1 pig's kidney Cystic and Nephretic ½ lb. 1 pig's lungs Congestion 1 lb. 5½ pig's livers Cirrhosis 17 lbs. 1 sheep's liver Strongylus Rufescens 1½ lbs. 1 sheep's liver Caseons Lymphadenitis l½ lbs. 1 sheep's liver Parasitic 2 lbs. 1 lamb's carcase ... Dropsy and Emaciation 34 lbs. 2 pig's plucks Strongylus 8 lbs. Other articles found unfit for human consumption, and which were voluntarily surrendered and destroyed are as follows : 2 boxes of fillets Unsound 28 lbs. 1 box of dog fish Unsound 70 lbs. Skate Decomposition 28 lbs. 1 doz. imported eggs Unsound 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 food and drugs. 20 The following samples were procured for bacteriological examination during the year: No. Designation Result 135 Tuberculin Tested Satisfactory 136 ,, ,, 137 ,, ,, 138 ,, ,, 139 ,, ,, 140 ,, ,, 141 (Bottle only for sterility test) ,, 142 Tuberculin Tested ,, 143 Pasteurised ,, 144 Tuberculin Tested ,, 145 Pasteurised ,, 146 Accredited ,, 147 Pasteurised ,, 148 Tuberculin Tested ,, 149 ,, „ 150 ,, ,, 151 Pasteurised ,, 152 ,, ,, 153 Tuberculin Tested ,, 154 ,, ,, 155 ,, ,, 156 ,, Unsatisfactory 157 Ordinary ,, 158 Pasteurised Satisfactory 159 ,, ,, 160 ,, ,, 161 Tuberculin Tested ,, 162 ,, ,, 163 ,, ,, 164 ,, Unsatisfactory 165 Pasteurised Satisfactory 166 ,, ,, 167 Ordinary ,, 168 ,, Unsatisfactory The unsatisfactory samples were brought to the notice of the producers concerned and the necessary action taken. Food and Drugs (Adulteration} Act. 1938. The following articles were submitted during the year in supplementation of the Essex County Council's Food and Drugs service : No. Sample Result 250 Butter Genuine 251 Butter ,, 252 Lard ,, 253 Lard ,, 21 PREVENTION AND CONTROL OF INFECTIOUS AND OTHER DISEASES Scarlet Fever The incidence of Scarlet Fever increased in the district during the year. The increased number of cases was due to a small epidemic in May, June and July, 78 cases being notified during these three months. The disease was mild and no deaths occurred. The following table shows the total number of cases notified during the year, and the percentage of cases removed to hospital. The figures for the previous four years are also included. 1935 1936 1937 1938 1939 Cases notified 59 52 61 66 144 Percentage removed to hospital 63 59 58 72 66 Typhoid Fever The carrier of typhoid organisms previously mentioned in last year's report is employed as a lavatory attendant. Dysentery One case was notified, but the diagnosis was not confirmed by bacteriological examination. Diphtheria 26 cases were notified and one death occurred. The type of disease was comparatively mild. The child who died was seen on the third day of illness for the first time by the doctor. Diphtheria Immunisation. Details of the work done during 1939 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 number immunised was less by 29 than last year's figure. This is to be greatly regretted, but probably the war and the consequent initial disturbance and evacuation were the reasons. The prophylactic used for those under eight years was alum toxoid, given in doses of 0.2 and 0.5 c.c. at one month's interval and in older children 3 doses of T.A.F. at weekly intervals. Reactions were few. (Three children were protected by using T.A.M.). 22 Reviewing Diphtheria Immunisation in Chingford, it is extremely disappointing to find how few parents avail themselves of the opportunity offered by the Council of free immunisation, or the supply of free immunising material to private practitioners, and thus having their children protected against this disease. It is strongly urged, especially under war conditions, that parents will in future have their children immunised against Diphtheria. The total number of protected children in Chingford is 2,777, which is equivalent to 33% of the child population. Until this percentage reaches 5 060 of the child population, the incidence of Diphtheria cannot be affected to any appreciable extent. DIPHTHERIA IMMUNISATION, 1938. Method No. of Pre-school age treated No. of School age treated Total Two doses A.P.T. at one month interval :— 106 47 153 T.A.F. two or three doses:— 14 22 36 T.A.M. two or three doses:— 3 2 5 123 71 194 Cases carried over from 1938 (i.e. treatment completed in 1939):— 28 Approximate number of cases immunised by 222 General Practitioners:— 41 Total 263 23 Results of Re Schich Tests. Prophylactic Schick Test Total No. of Tests Negative Positive Two doses A.P.T. (0.2 and 0.5cc) 12 weeks after injection 73 73 — Three doses T.A.M. or T.A.F. (weekly interval) 1-2 years after injection 13 13 — Measles The disease was made notifiable in September. The number of cases notified was 3 and there were no deaths. As far as can be ascertained, the disease has not been prevalent at any time during the year. Convalescent serum to the quantity of 25 c.c. was given to private practitioners for treatment of the disease. 24 Tuberculosis There were 70 cases of all forms of tuberculosis notified during 1939, an increase of 27 on the previous year, and of these, 32 or 45 per cent, were transfers from other districts. Deaths There were 19 deaths from tuberculosis during the year, of which 4 had not been previously notified. Particulars of these are given below : Pulmonary Tuberculosis 3 cases Tuberculosis of shoulder 1 case Ratio of non-notified tuberculosis deaths to total tuberculosis deaths = 1 to 4.7. NEW CASES DEATHS Age periods. Respiratory NonRespiratory Respiratory NonRespiratory M F M F M F M F 0 to 1 year — — — — — — — — 1 to 4 years — 1 2 — — 1 1 — 5 to 14 years 2 1 3 6 — — — — 15 to 24 years 7 12 1 1 — 1 — — 25 to 34 years 5 7 1 2 1 4 -- — 35 to 44 years 6 4 — 1 5 — — 45 to 54 years 2 3 — — 3 — — — 55 to 64 years 1 1 — — 1 1 1 — 65 and upwards 1 — — — 1 — — — Totals 24 29 7 10 11 6 2 — 25 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. Gastrointestinal Tract — — — — 1 1 2 8 10 10 12 22 Lungs and Mediastinum — — — — — 1 — — 2 1 2 2 4 Genito-urinary organs — — — — — — 1 4 2 1 3 5 8 Breast — — — — — — — 2 — 4 — 6 6 Other sites — — — — 1 — — 1 4 2 5 3 8 Totals — — — — 2 1 2 9 16 18 20 28 48 Death rate = 1.20 per 1,000 (as compared with 1.25 per 1,000 in previous year). Deaths at Various Ages Age No. of Deaths Under 1 year 15 1 and under 2 6 2 and under 5 3 5 and under 15 1 15 and under 25 6 25 and under 35 16 35 and under 45 14 45 and under 55 31 55 and under 65 36 65 and under 75 57 75 and upwards 77 Total deaths 262 26 Attendances at Child Welfare Centres Year New Children Total Attendances 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 1939 North 186 5207 „ South 314 5403 Total 11917 „ Toddlers' 247 1307 Total Attendances at Ante-Natal Centre, 1939 1020 Mothers attended 296 27 28 NOTIFIABLE DISEASES Year Scarlet Fever Diphtheria Erysipelas Measles Tuberculosis Dysentery Encephalitis Lethargica Puerperal Fever Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerebro-Spinal Fever Enteric Fever Acute Poliomyelitis Pulmonary Other Forms 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 — 1939 144 26 10 3 53 17 1 — — 8 — 28 1 — — 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 Totals Scarlet Fever 1 2 5 6 7 54 50 4 8 6 1 — 144 Diphtheria — 1 1 — 2 8 8 — 5 1 — — 26 Erysipelas — — — — — — — 1 2 2 4 1 10 Dysentery — — — — — — — — — — — — 1 Puerperal Pyrexia — — — — — — — 1 6 1 — — 8 Pneumonia 1 1 3 1 3 1 — — 6 3 3 6 28 Cerebro-Spinal Meningitis — — — — — — — — — — — — 1 Measles* — 2 — 1 — — — — — — — — 3 * Measles and Whooping Cough were made notifiable in September, 1939. ANALYSIS OF NOTIFIABLE DISEASES AND DEATHS. Diseases Total cases notified Cases admitted to hospital Total Deaths Scarlet Fever 144 96 — Diphtheria 26 24 1 Erysipelas 10 3 — Dysentery 1 1 — Puerperal Pyrexia 8 7 — Pneumonia 28 10 9 Cerebro-Spinal Meningitis 1 1 — Measles 3 2 — 29 30 Birth-rates, Death-rates, Analysis of Mortality, Maternal Mortality and Case-notes for certain Infectious Diseases in the Year 1939 (Provisional figures based on Weekly and Quarterly Returns) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns Resident Pop.: 25,000—50,000 (1931 Census) London Administrative County Chingford England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns Resident Pop.: 25,000—50,000 (1931 Census) London Administrative County Chingford Rates per 1,000 population Rates per 1,000 Live Births Births : Live 15.0 14.8 15.6 12.3 16.9 Deaths under 1 year of age 50.0 53.0 40.0 48.0 22 Still 0.59 0.59 0.57 0.44 0.49 Deaths : All Causes 12.1 12.0 11.2 11.9 7.8 Deaths from Diarrhcea and Enteritis under 2 years of age 4.6 6.3 3.0 8.2 — Typhoid and Paratyphoid — — — — — Smallpox — — — — — Maternal Mortality: Puerperal Sepsis 0.77 Not available — Measles 0.01 0.01 0.01 — — Scarlet Fever 0.01 — — — — Others 2.16 1.51 Whooping Cough. 0.03 0.03 0.02 0.03 0.02 Total 2.93 1.51 Diphthria 0.05 0.05 0.04 0.02 0.02 Influenza 0.21 0.19 0.20 0.14 0.14 Rates per 1,000 Total Births (Live and Still) Notifications : Maternal Mortality: Puerperal Sepsis 0.74] Not available Smallpox Others 2.08 1.47 Scarlet Fever 1.89 1.96 1.78 1.53 3.77 Total 2.82 1.47 Diphtheria 1.14 1.21 1.16 0.98 0.68 Notifications: Puerperal Fever.. 14.35 17.26 12.99 3.31 Enteric 0.04 0.03 0.04 0.03 — Erysipelas 0.34 0.40 0.31 0.37 0.26 Pneumonia 1.02 1.21 0.89 0.99 0.73 ,, Pyrexia 14.22 11.81