LIBRARY CHIN 8 BOROUGH OF CHINGFORD ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH INCLUDING THE REPORT OF THE CHIEF SANITARY INSPECTOR FOR THE YEAR 1943 E. G. Ellis & Sons (T.U.) Willow Street, Chingford BOROUGH OF CHINGFORD Committee : November, 1942—November, 1943 PUBLIC HEALTH AND HIGHWAYS COMMITTEE Chairman:— Councillor Mrs. N. HART. Vice-Chairman:— Councillor A. COLLINS. Members:— Alderman Miss M. L. MATHIESON, C.C. „ R. Z. SMITH Councillor H. E. CHINNER „ R. C. LAOEY. „ Mrs. S. L. OAKES „ E. J. QUANTRILL. „ A. J. STRACHAN. The Mayor, Cr. W. P. SOGGEE, J.P. (ex'officio). Meeting : Second Tuesday in each month at 7.30 p.m. PUBLIC HEALTH OFFICERS OF THE AUTHORITY (1943) MEDICAL OFFICER OF HEALTH: WILLIAM D. HYDE, M.B., Ch.B., D.P.H. CHIEF 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. A.R.P.S. Instructor (Special). ADDITIONAL SANITARY INSPECTORS: J. T. S. TEMPLEMAN, A.R.San.I., M.S.LA. (Military Service from July, 1940). P. W. EDWARDS, C.R.San!, M.S.IA. SENIOR CLERK: Miss V. M. PETTIT. CLERKS: Mrs. E. S. SALTER. Miss P. M. KIMBER (from 8.3.43). A. E. CULPIN (Military Service from 3.9.39). D. G. BLEACH (Military Service from 9.3.42). D. S. TAVERNER (to 27.2.43). A. MORRIS. 1 ANNUAL REPORT FOR THE YEAR 1943 To the Mayor, Aldermen and Councillors of the Chingford Corporation. Mr. Mayor, Aldermen and Councillors, I have pleasure in presenting my third Annual Report upon the health and sanitary circumstances of the Borough. The Birth Rate has continued its upward trend, reaching 18.9, the highest rate recorded since 1930. The Infant Mortality Rate of 23.8 again compares very favourably with that of England and Wales which is 49. The majority of infant deaths in the Borough occurred within one week of birth, and analysis of the causes of death gives reasonable grounds for expecting that medical knowledge combined with health education and increasingly satisfactory environmental conditions, will in measurable time further reduce the figure. The Infant Mortality Rate is generally accepted as a fairly accurate index of the level of health of a community, and, on its consideration in conjunction with the other available vital statistics of the district, it can be said that the general health of the inhabitants has remained satisfactory. During the year the incidence of Measles was markedly reduced and the notifications of Tuberculosis were fortunately slightly less than the previous year. The Influenza epidemic towards the end of the year was evidenced by the increased numbers of cases of Pneumonia. The number of cases of Scarlet Fever was unusually high but the infection was of a mild type and no deaths occurred. No report of Civil Defence activities is included, but the Health Department has continued to devote a considerable proportion of its time to the Casualty and other Civil Defence Services of the Borough. In conclusion, I wish again to record the continued loyal service given by the Chief Sanitary Inspector, Mr. James F. Rogers, and the staff of the Health Department. I am, Ladies and Gentlemen, Your obedient servant, WILLIAM D. HYDE, Medical Officer of Health. June, 1944. 2 Section A.—STATISTICS AND SOCIAL CONDITIONS OF THE AREA Area 2,860 acres Population—Registrar-General's estimate 37,860 Number of inhabited houses, end of 1943 11,475 approx. Rateable value on April 1st, 1943 £329,581 0 0 Sum represented by a penny rate on April 1st, 1943 (gross) £1,373 5 1 Vital Statistics M. F. Total 389 326 Birth Rate per 1,000 of estimated resident population:18.9. Live Births Legitimate 382 321 Illegitimate 7 5 M. F. Total 11 10 Rate per 1,000 total (live and still) births; 28.5. Stillbirths Legitimate 11 10 Illegitimate - - M.F. Deaths 154 159 Crude Death Rate per 1,000 of estimated resident population: 8.3 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 23.8 Legitimate infants per 1,000 legitimate live births 24.2 Illegitimate infants per 1,000 illegitimate live births — Deaths from Cancer (all ages) 60 „ „ Measles (all ages) 1 „ „ Whooping Cough (all ages) 0 „ „ Diarrhoea (under 2 years of age) 0 „ „ Scarlet Fever 0 3 Table of Birth and Death Rates Year Population Births Rate per 1,000 population. Deaths Rate per 1,000 population. infant mortality Deaths Rate per 1,000 live births 1938 37,510 612 16.31 269 7.17 28 45 1939 (a) 39,460 (b) 38,160 668 16.93 261 6.8 15 22 1940 37,220 583 15.66 382 10.26 25 45 1941 35,440 503 14.19 312 8.8 9 16 1942 37,790 667 17.6 282 7.5 19 28 1943 37,860 715 18.9 313 8.3 17 23 4 Section B.—GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (a) Laboratory Facilities. Pathological specimens from this district are still examined at the E.C.C. Pathological Laboratory, St. Margaret's Hospital, Epping. Unfortunately, owing to shortage of laboratory staff, details of the Chingford specimens examined are again not available this year. (b) Ambulance Facilities. Two ambulances and a staff of three paid drivers are maintained. The following is a summary of the work performed by the Council's Ambulance Service during 1943:— Total number of calls dealt with during year— Private Hire 1,081 Accidents 82 Maternity Cases 265 Total 1,428 Total mileage covered by the Borough Ambulances, and one vehicle on hire, during the year—21,623 miles. In addition the following calls were dealt with by the ambulances of adjoining authorities or by other means on occasions when the Chingford ambulances were engaged or under repair— Private Hire 8 Accidents 17 Maternity Cases 5 Total 30 Assistance, by supplying drivers or attendants, was given by the St. John Ambulance Brigade members as under— No. 85 Chingford Nursing Division—attended 19 calls. No. 132 Chingford Ambulance Division— „ 441 calls. (c) Nursing in the Home. The Chingford District Nursing Association has carried on its good work throughout the year. Maternity nursing and midwifery cases, in addition to a large number of general nursing visits, have been undertaken. 5 (d) Clinics and Treatment Centres. See Table of Clinics on page 7. (e) Hospitals. No change. (f) Midwives. Number of County Council practising midwives 1* „ „ midwives employed by Chingford District Nursing Association 3 „ ,, independent domiciliary midwives 0 * Mrs. P. M. Stenning, 237, Hall Lane, E.4. (Telephone : Silverthorn 3263). (g) Registered Nursing Homes. There are two registered Nursing Homes in the district receiving maternity and medical patients. These Homes have been inspected regularly and found to be conducted in a satisfactory manner. (h) War-time Day Nurseries. A Day Nursery for 52 children was opened at 136/138, Chingford Mount Road, on 20th September. A pre-fabricated Hut has been erected in Hatch Lane and a second Day Nursery has been established there during the compilation of this report. Infant Mortality Rate. During the year there were 17 deaths of children under the age of one year, giving an Infant Mortality Rate of 23.8 which again compared very favourably with that of England and Wales which was 49 and that of the 148 Smaller Towns (resident population 25,000—50,000) which was 46. Eleven of the deatrhs occurred within one week of birth and the causes of death were:—prematurity 7, prematurity and congenital deformity 1, congenital malignant tumour 1, congenital intestinal obstruction 1 and birth injury 1. Two of the deaths occurred between the ages of one week and one month and the causes of death were:—prematurity and birth injury 1 and congenital heart disease 1. The remaining four deaths occurred between the ages of one month and ten months, and the causes of death were:— acute broncho-pneumonia and mongolism 1, accident 1, intussusception 1 and broncho-pneumonia and severe congenital abnormality of the chest wall 1. 6 CLINICS AND TREATMENT CENTRES, 1944 Clinic or Dispensary Where held When held Diphtheria Immunisation Clinics Church Hall, The Ridgeway, N. Chingford County Council Clinic, Marmion Avenue, South Chingford. Wednesdays 10 a.m. Thursdays, 11.30 a.m. Child Welfare Clinic County Council Clinic, 16, The Ave., Chingford Tuesdays 1.45 p.m.—3.45 p.m. Child Welfare Clinic County Council Clinic, 16, The Ave., Chingford Wednesdays 1.45 p.m.—3.45 p.m. Child Welfare Clinic Mission Hall, Sewardstone Road, North Chingford. 2nd, 4th and 5th (if any) Wednesday of each month 1.45 p.m.—3.45 p.m. Toddlers' Clinic County Council Clinic, Marmion Avenue, South Chingford Thursdays, 10 a.m.—11.30 a.m. Child Welfare Clinic Spicer Hall, Buxton Road, North Chingford. Thursdays 1.45 p.m.—3.45 p.m. Ante-natal Clinic 50, Friday Hill, Chingford. 1st and 3rd Mondays 1.45 p.m. Child Welfare Clinic 50, Friday Hill, Chingford. 2nd, 4th & 5th Mondays, 1.45 p.m.—3.45 p.m. Ante-natal Clinic County Council Clinic, 16, The Ave., Chingford Wednesdays, 9.30 a.m., Fridays, 9.30 a.m., 3rd Friday in each month, 1.45 p.m. Women's Welfare Clinic County Council Clinic, 16, The Ave., Chingford 4th Friday of every month at 2 p.m. Minor Ailment and School Clinic County Council Clinic, 16, The Ave., Chingford Mondays 9.30 a.m.—12 noon Orthopaedic Clinic County Council Clinic, 16, The Ave., Chingford Masseuse in attendance, Mondays, 2 p.m., Thursdays, 1.30 p.m. Tuberculosis Dispensary Old Monoux School, High Street, Walthamstow, E.17. New cases— Adults: Weds., 10 a.m.—12 noon. Children: Fris., 10 a.m.-12 noon. Venereal Diseases Prince of Wales Hospital, Tottenham. Oldchurch County Hosp. (The Annexe) Romford. And London Hospitals. Mondays to Fridays, 8 a.m.—6 p.m. Saturdays 8 a.m.-12 noon Tuesdays, 4.30 p.m.—7.30 p.m. Thursdays, 12.30 p.m.—3.30 p.m. Acting Relieving Officer: Mr. E. McCRAVE, 53, Diana Road, Walthamstow, E.17 Relief Office: Methodist Church Hall, New Road, South Chingford, (Telephone No.: Silverthorn 2936). Office hours: 9 a.m. to 10 a.m. (Urgent application may be made at the residence of the Acting Relieving Officer: 53, Diana Road, Walthamstow, E.17.) Vaccination Officer: Mr. C.W. BARRETT, 19, Algers Road, Loughton. (Telephone No.: Loughton 576.)Registrar of Births and Deaths: Mr. F. JACKSON, "Cromer," Summerhilll Grove, Bush Hill Park, Enfield. (Telephone No.: Laburnum 4104.) Attends at the Methodist Church Hall, New Road, South Chingford, E.4. on Mondays and Thursdays, 2.30 p.m. to 4.30 p.m.: and Wednesdays and Saturdays, 9 a.m. to 11 a.,. 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 ; the supply has been satisfactory in both quality and quantity. Rivers and Streams. In one instance action was taken in connection with the pollution of a watercourse. Public Cleansing. The collection and disposal of house and trade refuse and salvage is carried out under the direction of the Chief Sanitary Inspector. The weekly collection of refuse was maintained but with difficulty. The total weight of refuse disposed of at the Works was 4,518 tons, a decrease of 825 tons under the previous year. The net cost per ton for the collection of refuse was 21s. 5d. as against 17s. 6½d. for the year ended March, 1943, and 20s. 6¾d. for the year ended March, 1942. The net cost per ton for the disposal of refuse was 5s. 6d. as against nil for the previous year and 5s. 6d. for the year ended March, 1942. The gross costs for refuse disposal were increased considerably by the repayment of an outstanding loan amounting to £1,003. An examination of the analysis of income for the year shows that of the total of £3,849, no less than £1,825 was received for the sale of waste paper. During the year the Council were directed by the Ministry of Supply to take all kitchen waste collected to an approved Concentration Plant and this increased the costs in relation to this part of the Council's salvage scheme. The weighbridge was maintained under contract and the fees during the year amounted to £25 6s. 6d., representing 1,013 weighings as against £40 18s. 6d. or 1,637 weighings in the previous year. The income derived from the collection of trade refuse was £68, which was less than normal due to the remission of charges in cases where the material collected had a salvage value. 8 HOUSE AND TRADE REFUSE Table showing costs for the year ended 31st March, 1944 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 £4908 4776 5088 3838 9996 8614 B Gross income 68 68 3849 3849 3917 3917 C Net cost £4840 4708 1239 - 6079 4697 Unit Costs s. d. s. d. s. d. s. d. s. d. s. d. D Gross expenditure per ton 21 8½ 21 1½ 22 6 16 11¾ 44 2½ 38 1½ E Gross income, per ton 3½ 3½ 17 0 17 0 17 3½ 17 3½ F Net cost, perton 21 5 20 10 5 6 - - 26 11 20 10 G Net cost, per 1,000 £ £ £ £ £ £ lation 128 124 33 - 161 124 H Net cost, per 1,000 houses or premises from which refuse is collected 421 409 107 - 528 409 1. Total refuse collected (in tons) 4,518 2. Population (Mid-Year) 37,860 3. Weight per 1,000 population per day (in cwts.) 6.5 4. Number of occupied houses and premises (end of year, 1943) 11,475 (approx.) Note.—(a) "Loan charges" include interest on loans ; repayment of loans, £1,003 ; revenue contributions to capital outlay and capital receipts. 9 Year ended 31.3.43 ANALYSIS OF INCOME FOR THE YEAR ENDED 31st MARCH, 1944 £ s d. £ s. d. £ s. d. £ s. d. 1. Sale of Salvaged Articles: Fine Ash, Clinker and Screenings Metals: 22 19 7 Aluminium 19 10 10 14 6 4 Copper 7 10 8 56 19 5 Iron 43 4 3 24 13 2 Lead 6 13 9 4 10 4 Battery Lead 4 11 0 32 11 4 Brass 13 2 7 10 0 7 Mixed Metals 37 12 2 21 18 6 Unbaled Scrap 20 2 7 89 14 3 Tins 92 15 11 245 3 9 30 5 8 Bones 35 14 6 35 14 6 80 2 2 Broken White Glass 151 10 10 207 10 10 Bottles and Jars 250 7 9 401 18 7 412 2 6 Rags 434 4 3 41 3 3 Carpets 11 4 3 445 8 6 243 19 0 Newspapers 51 9 0 1928 8 6 Mixed Waste Paper 1,644 15 9 55 6 3 Magazines 129 1 6 1,825 6 3 303 15 9 Pig Food 492 11 9 36 17 8 Rubber 37 11 6 530 3 3 23 4 3 2. Miscellaneous Receipts and Charges 39 5 6 3,523 0 4 40 18 6 3. Weighbridge Fees 25 6 6 201 17 4 4. Subsidy on Sale of Scrap Iron 251 1 3 5. Rents: 30 0 0 Foundry 30 0 0 20 0 0 Proportion of Allotment Rents 20 0 0 £3983 5 4 £3,849 8 1 5,333 Tonnage 4,518 10 SANITARY INSPECTION OF THE AREA Inspections on Complaint The number of complaints received at the office and recorded in the register was 224, as compared with 331 in the previous year and 436 for the year 1940. The total inspections made on complaint was 292 and the number of defects or nuisances revealed was 353, which are analysed in the following table. Informal notices were at once served on the owners or occupiers of the premises concerned. Table 1 Dirty Premises 44 Defective roofs, spoutings and eaves gutters 32 Blocked yard and W.C. drains 12 Defective yard paving 1 Blocked sewers 68 Defective sewers 12 Sinks and waste pipes defective 5 Accumulations of offensive matter 6 Ashbins defective 19 W.C.s without proper flushing arrangements 4 Insufficient water supply 4 Water closets defective 11 Animals kept so as to be a nuisance 1 Pollution of watercourse 1 Defective sashcords 6 Water fittings defective 13 Vermin 8 Defective plaster of walls and ceilings 29 Dampness 13 Defective external brickwork and chimneys 113 Washboilers defective 1 Defective drainage 4 Defective floors 6 Defective firegrates and flues 15 Woodwork, windows and doors defective 25 353 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 3,247, as compared with 2,731 in the previous year; the defects dealt with numbered 812, as compared with 606 in 1942. Table 2 Visits Paid Nuisances or Defects found Housing Act, 1936: Inspections 54 397 Re-visits re Notices served 385 Re Overcrowding 8 On Complaint 292 353 Miscellaneous 52 Infectious Diseases 987 Slaughterhouses 4 Meat and Food Shops 94 Factories 20 Bakehouses 23 Cowsheds 31 1 Dairies and Milk-shops 14 Pigstyes 24 1 Testing of Drainage 13 Re-visits re Notices served (Public Health Act) 511 Infestation by Rats or Mice 167 57 Private Slaughtering 9 Shops Acts 15 1 Re Council Houses and Tenancies 5 Collection and Disposal of Refuse and Salvage 242 Re Crickets 40 Restaurants and Canteens 19 Swimming Pool 3 Stables 6 Re Certificates of Need 17 Licensed Premises 5 1 Private Schools 4 1 Re Kitchen Waste 47 Civil Defence: Depots 20 Food Decontamination Centre 16 Decontamination Laundry 25 Repair Garage 13 Rest Centres 6 Emergency Water Supplies 14 Re Decontamination Personnel 62 3,247 812 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 98 Defective roofs, spoutings and eaves gutters 64 Yard and W.C. drains blocked 12 Blocked sewers 68 Defective sewers 12 Yard and passage surfaces defective 10 Defective sinks and waste pipes 12 Accumulation of offensive matter 6 Defective plaster of walls and ceilings 78 W.C.s without proper flushing arrangements 10 Ashbins defective 26 Defective water closets 17 Animals kept so as to be a nuisance 1 Water fittings defective 28 Defective sashcords 42 Pollution of watercourse 1 Dampness 36 Insufficient water supply 5 Dangerous buildings 3 Vermin 69 Defective drainage 5 Washboilers defective 7 Defective external brickwork and chimneys 50 Defective floors 42 Firegrates and flues defective 42 Defective stairs and rails 3 Defective woodwork, windows, doors, etc. 63 Insufficient W.C. accommodation 2 812 Table 4 Letters sent out and notices served in connection with sanitary matters. Letters 655 Public Health Acts: Preliminary Notices 21 Secondary Notices 1 Statutory Notices 0 Housing Acts: Preliminary Notices 78 Secondary Notices 19 Statutory Notices 23 13 Shops Acts. It was necessary in one instance to take action during the year to secure the provision of sanitary accommodation to shop premises. Smoke Abatement. Owing to the continuance of war conditions no action was taken in respect of smoke abatement. Swimming Baths and Pools. One sample of water from the Larkswood Swimming Pool was taken during the bathing season, and this was found by the Bacteriologist to be satisfactory and suitable for swimming bath purposes. Summaries of the daily chlorine and alkalinity readings are forwarded weekly to the Health Department by the Pool Superintendent. 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, 1. Disinfested, 1. Infested, 6. Disinfested, 6. (2) Methods. Spraying with a contact insecticide 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. (4) Disinfection. Fumigation with Hydrogen Cyanide is always carried out by a contractor; other disinfestations are carried out by the Local Authority. Schools The sanitary condition and water supply of Schools has been satisfactory during the year. All cases of notifiable 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 schools on account of infectious disease. 14 PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYELAWS OR REGULATIONS Offensive Trade Premises The offensive trade premises on the register number 8, all being fish fryers. 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. Factories Act, 1937. Forty-three visits were paid to Factories. No case of infectious disease occurred at outworkers' premises during the year. Numbers and Trades of Outworkers notified during 1943 Baby Linen 3 Flag Day Emblems 4 Wearing Apparel 38 Cardboard Boxes 1 Furrier 1 Brushes 1 Naval Straps and Lacing 1 Sleeve Gas Detectors 5 Embroidery 1 Ladies' Handbags 1 Outworkers were notified from the following Areas: Shoreditch 3 Corporation of London 4 St. Pancras 1 St. Marylebone 7 Islington 1 Bethnal Green 4 Westminster 2 Leyton 11 Stoke Newington 1 Hackney 16 Finsbury 6 15 Section D.—HOUSING STATISTICS FOR THE YEAR 1943 1. Number of New Houses erected during the Year: (1) By the L.A (2) By other L.A.'s (3) Other bodies 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) 1,415 (b) Number of Inspections made for the purpose 2,311 (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 54 (b) Number of Inspections made for the purpose 439 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 143* *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 86 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 23 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 31 (b) By Local Authority in default of owners 6 16 B. Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied (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 the Housing Act, 1936: Undertakings accepted 2 Section E.—INSPECTION AND SUPERVISION OF FOOD Milk Supply. There is only one cowshed on the register for the Chingford district; the number of retail purveyors of milk is 4 and one wholesale purveyor. The number of visits paid to cowsheds, dairies and milkshops was 45. Milk (Special Designations) Order, 1936. Graded 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: 2 dealers licences to sell milk as Pasteurised. 2 supplementary licences to sell milk as Pasteurised. 2 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. Meat and Other Foods There is one licensed slaughterhouse and twenty-two butchers' shops in the area ; the visits paid to these premises numbered 98. The following list gives details of the diseased or unsound meat and other articles found unfit for human consumption, which were voluntarily surrendered and destroyed or used for animal feeding purposes:— 17 TINNED GOODS. No. of Tins. Article. 2 Boiled Mutton. 8 Stewed Steak. 68 Sausage Meat. 4 Prem. 3 Spam. 1 Tang. 12 Marshalls Master Mix. 17 Chopped Ham. 1 Brisket Beef. 6 Prepared Meal. 6 Ox Tongue 2 Corned Beef Hash. 6 Veal and Ham Loaf. 1 Steak and Vegetable. 11 Minced Meat Loaf. 24 Pilchards. 20 Salmon. 19 Sardines. 8 Herrings. 1 Whiting. 1 Fish and Potato Roll. 2 Fish Paste. 1 Crawfish. 52 Beans. 21 Peas. 85 Milk. 72 Soup. 1 Stew. 1 Golden Syrup. 2 Jam. 5 Spinach. 90 Assorted Preserves. 1 Snack. 7 Tomatoes. 4 Beetroot. 4 Carrots. 7 Vegetables. 1 Apple. 2 Pineapple. 1 Rhubarb. 23 Plums. 3 Pears. 4 Grapefruit. 2 Blackcurrants. 1 Peaches. 7 (bottles) Coffee. 18 OTHER FOODS. Article. Weight. Corned Beef 6 lbs. Ox Liver 25 lbs. Pilchards 6 stone. Whiting 5 stone. Cods Livers and Chitterlings 3 stone. Haddock 10 lbs. Cod 10 stone. Bacon 62 lbs. Rabbits 286. 27 Hens 108½ lbs. Cheese Trimmings 36½ lbs. Crushed Oats 1 cwt. Cake 6½ lbs. Chocolate 14 lbs. 6 ozs. Chemical and Bacteriological Examination of Food. The Counties' Public Health Laboratories, Gidea Park College, Gidea Park, Essex, undertake bacteriological examinations for the Council. Dr. Bernard Dyer and Partners, Peek House, 20, Eastcheap, E.C.3, carry out the chemical analysis of food and drugs. The following were forwarded for bacteriological examination during the year: No. Sample. Result. 232 Swimming Pool Water. Satisfactory. 233 Veal (stuffed). Bacteria not excessive. Stuffing not a clean product. 234 Pasteurised Milk Unsatisfactory. 235 Do Sufficiently heat treated. 236 Do Do. 237 Do Do. 238 Do Do. The unsatisfactory sample of milk was brought to the notice of the producers concerned, and the necessary action was taken. 19 Food and Drugs Act, 1938. The following article was submitted for chemical examination during the year in supplementation of the Essex County Council's Food and Drugs service : No. Sample Result 270 Oatmeal Satisfactory. PREVENTION AND CONTROL OF INFECTIOUS AND OTHER DISEASES Scarlet Fever The following table shows the total number of cases notified during the year, the percentage of cases removed to hospital and the corresponding figures for the previous four years : 1939 1940 1941 1942 1943 Cases notified 144 47 32 186 376 Percentage removed to hospital 66 72 91 82 72 The increased incidence of Scarlet Fever which commenced in the autumn of 1942 continued throughout 1943 with occasional monthly fluctuation until falling to a much lower level at the end of November, 1943. The majority of the cases occurred in the Southern part of the district. Reports show that the infection was generally of a mild type and that children of the early school ages were principally, although by no means exclusively, affected. There has been comparatively little Scarlet Fever in Chingford for several years, with the consequent development of a highly susceptible child population. From all available evidence it was clear that the main spread of infection was by the usual means of droplet infection and that milk and other foods played no important part. Analysis of cases in relation to school holidays gave inconclusive findings. It is possible that several factors affecting ventilation at home and elsewhere contributed to the number of cases recorded, but most of those factors are inevitable under present conditions. During recent years Scarlet Fever has become a milder infection than formerly with consequent increased numbers of missed cases for whom medical advice has not been sought and who have mixed freely with other children while in a highly infectious state. Scarlet Fever is recognised nowadays to be only one manifestation 20 of an infection with the streptococcus family of germs which can cause many conditions including sore throat without rash and sore throat with rash which may be called Scarlet Fever. Both conditions are infectious and it will be clear that a patient with a sore throat and little or no rash can infect others if not isolated. It would seem, therefore, that notification and treatment in Hospital wards of only those patients with a rash is irrational and that isolation of all cases of streptococcal sore throat should be undertaken, removal to hospital depending on the severity of the disease, the home nursing facilities, the employment of another member of the household in the preparation or distribution of food for public consumption or the approaching confinement, say within one month, of any female in the patient's home. Finally, in view of the most recent knowledge regarding the streptococcus, it seems advisable to visualise the future Hospitalisation of Scarlet Fever cases in cubicles or small wards. Diphtheria. During the year thirteen cases of Diphtheria occurred, all except one being removed to Hospital for treatment. Seven of these patients were school children, four were female adults and two were pre school children. Two of the cases were fatal—a girl of 3 years and a female adult, neither of whom had been immunised and both of whom were seen by their Doctor only a matter of hours before death. All of the remaining eleven cases were of a fairly mild or moderate degree of severity and only three of them had been immunised. The number of cases during the year is an increase from the very small numbers recorded during the previous three years and serves to stress the fact that Diphtheria will continue to be a danger until a higher proportion of the population has been successfully immunised, especially in view of the possible increase in the carrier rate. Diphtheria Immunisation. Number of children immunised during the year :— Under 5 years 494 Between 5 and 15 years. 466 Total 960 The number of children immunised during the year was lower than during the previous two years which marked the commencment of the intensive campaign for Diphtheria immunisation. When it is realised that it is estimated that in Chingford 71% of the children under 5 years and 76% of the children aged between 5 years and 15 years have been immunised as at 31st December, 1943, it will be understood that the position is fairly satisfactory and that efforts must now be directed primarily to endeavouring 21 to secure that all children are immunised as soon as possible after their first birthday, followed by a boosting dose on reaching school' age. As immunisation of children under 1 year of age is not undertaken, it will be seen that the highest possible percentage of children under 5 years who might be immunised is in the neighbourhood of 80 and therefore the Chingford figure of 71 can be regarded hopefully. The material used in all instances was Diphtheria Alum Precipitated Toxoid, the dosage being 0.2 c.c. and 0.4 c.c. or 0.5 c.c. at an interval of four weeks. Measles. The number of cases of Measles notified during the year showed a marked decrease from the previous year, and only four cases were admitted to Hospital. Unfortunately one child died from Bulbar Paralysis and Encephalomyelitis, a rare complication of Measles. Scabies. Number of cases treated at Church Hall First Aid Post (since 22.7.43) : Pre-school age 3 School age 5 Adults . 9 Only 8 out of the total of 17 returned for second treatment.) Total. 17 No regular clinic for the treatment of Scabies has been inaugurated but by special arrangement, in certain cases, baths and treatment have been provided with the help of Civil Defence First Aid Post personnel. From information and notifications received in the Health Department, it does not appear that the incidence of Scabies was unusually high during the year. Dysentery. During the year there were outbreaks of a mild type of Dysentery in neighbouring districts and two cases in one family were notified in Chingford. These cases were directly attributable to contact with cases in a neighbouring district. Prompt investigation and control ensured that no further cases occurred, either in the household or elsewhere in the district. Tuberculosis. There were 62 cases of all forms of Tuberculosis notified during 1943 (a decrease of 8 on the previous year), and of these, 6 cases (9.7%) were transfers from other districts. There were 17 deaths from Tuberculosis during the year; 7 of these had not been previously notified as suffering from Tuberculosis. The. ratio of non-notified tuberculous deaths to total tuberculous deaths is 1 to 2.4. 22 Vaccination. The Vaccination Officer for the area has following return for 1943 — furnished the Births registered 394 Successfully vaccinated 140 Percentage vaccinated 35.533 Insusceptible — Exemptions 144 Died before vaccination 8 Postponed 22 Removed—new address unknown 1 Removed—address known and V.O. notified 2 Outstanding 77 Medical Examinations. During the year 36 examinations were carried out by the Medical Officer of Health in respect of the Superannuation and Sick Pay Scheme. CAUSES OF DEATH AS GIVEN BY THE REGISTRAR-GENERAL FOR THE YEAR 1943 Causes of Death. Males. Females. Total. Diphtheria 2 2 Tuberculosis of respiratory system 10 2 12 Other forms of tuberculosis 3 2 5 Syphilitic diseases 2 — 2 Influenza 5 6 11 Measles 1 1 Cancer of buccal cavity and oesophagus (M) uterus (F) 2 5 7 Cancer of stomach and duodenum 2 6 8 Cancer of breast - 8 8 Cancer of all other sites 22 15 37 Diabetes 1 2 3 Intra-cranial vascular lesions 9 16 25 Heart disease 31 48 79 Other diseases of circulatory system 5 6 11 Bronchitis 6 6 12 Pneumonia 9 9 18 Other respiratory diseases 3 1 4 Ulcer of stomach or duodenum 4 1 5 Appendicitis 1 — 1 Other digestive diseases 6 4 10 Nephritis 3 2 5 Maternal causes (excluding puerperal sepsis) - 1 1 Premature birth 6 2 8 Congenital malformation, birth injury, infantile disease 5 2 7 Suicide 1 2 3 Road traffic accident 2 — 2 Other violent causes 2 2 4 AH other causes 14 9 23 Totals—all causes 154 160 314 Totals—year 1942 154 128 282 23 Tuberculosis. Age periods. NEW CASES TRANSFERS DEATHS Respiratory NonRespiratory Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. M. F. M. F. 0 to 1 year - - - - - - - - - - - - 1 to 4 years — — 1 — — - - — — — — — 5 to 14 years i 2 1 2 — — — — - — 1 — 15 to 24 years 10 9 1 — — 1 — - - 1 — — 25 to 34 years 6 5 — 1 — 3 — — 1 — — — 35 to 44 years 6 3 1 — — 1 — — 2 1 — — 45 to 54 years 1 1 — — — - — — 1 — — — 55 to 64 years 3 1 - — 1 — — — 3 — — — 65 and upwards — 1 - - - - - - - - - - Totals 27 22 4 3 1 5 — — 7 2 1 — Add—Deaths of un-rrotified cases 2 1 3 1 9 3 4 1 DEATH 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 1 1 3 8 13 10 17 27 Lungs and Mediastinum — — 1 — 2 — 1 1 4 - 8 1 9 Genito-urinary organs - - - — - 1 - 2 5 5 5 8 13 Breast - - - - - 2 — 1 — 5 — 8 8 Other sites — 1 — - — — 1 1 - — 1 2 3 Totals — 1 1 — 3 4 3 8 17 23 24 36 60 Death rate = 1.58 per 1,000 (as compared with 1.53 per 1,000 in previous year). 24 Deaths from all causes at various Ages Age No. of Deaths Under 1 year 17 1 and under 2 5 2 and under 5 2 5 and under 15 7 15 and under 25 6 25 and under 35 13 35 and under 45 23 45 and under 55 30 55 and under 65 43 65 and under 75 71 75 and upwards 96 Total deaths 313 ATTENDANCES AT LOCAL CLINICS DURING 1943 Ante-Natal Clinics: Friday Hill Sessions 23 Attendances 259 16, The Avenue Sessions. 116 Attendances 2,557 Infants' & Toddlers' Welfare Clinics: Friday Hill Sessions 21 Attendances 362 (including Infants & Toddlers) (including 35 new infants). Sewardstone Road Sessions 28 Attendances 734 (including Infants & Toddlers) (including 26 new infants). North Chineford Session's. 51 Attendances 2,865 (including Infants & Toddlers) (including'126 new infants). 16, The Avenue Sessions In'fants 104 Attendances (including 325 pew infants). 5,051 Toddlers 49 Attendances 299 Specialist Obstetric Clinic : 16, The Avenue Sessions 12 Attendances 85 Women's Welfare Clinic: 16, The Avenue Sessions 12 Attendances 63 Minor Ailment & School Clinic: 16, The Avenue Sessions. Whitehall Road School 45 Attendances 827 Sessions 21 Attendances 512 Orthopaedic Clinic: 16, The Avenue Sessions 100 Attendances 653 25 NOTIFIABLE DISEASES Year Scarlet Fever Diphtheria Erysipelas Measles Whooping Cough Tuberculosis Dysentery Encephalitis Lethargica Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerebro Spinal Fever Enteric Fever Pulmonary Other Forms 1938 66 7 7 — — 38 5 11 — 10 2 23 2 2 1939 144 26 10 3 _ 53 17 1 — 8 — 28 1 — 1940 47 6 14 30 1 56 5 1 — 5 1 44 4 2 1941 32 4 4 311 197 41 7 — — ] — 54 7 — 1942 186 4 8 504 75 56 14 1 1 3 — 64 3 — 1943 376 13 16 189 83 55 7 2 — 2 1 88 3 — 26 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 — 4 14 22 24 217 75 8 7 3 2 — 376 Diphtheria — 1 - 1 — 6 1 — 4 — — — 13 Erysipelas — 1 — — — — 1 1 1 1 9 2 16 Measles 3 20 5 19 24 107 5 1 5 — — — 189 WhoopingCough 8 10 6 12 14 29 2 — 2 — — — 83 Puerperal Pyrexia — — — — — — — — 2 — — — 2 Pneumonia 5 4 1 1 4 14 3 3 12 11 20 10 88 Cerebrospinal Fever - - - - - 2 1 - - - - - 3 Dysentery - - - - - 1 - - - 1 - - 2 Ophthalmia Neonatorum 1 - - - - - - - - - - - 1 ANALYSIS OF NOTIFIABLE DISEASES AND DEATHS. Diseases Total cases notified Total admitted to hospital Total Deaths Scarlet Fever 376 271 Diphtheria 13 12 2 Erysipelas 16 9 — Puerperal Pyrexia 2 2 — Pneumonia 88 31 18 Cerebro Spinal Fever 3 3 Measles 189 4 1 Whooping Cough 83 1 — Dysentery 2 — — Ophthalmia Neonatorum 1 — 27 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality and Case rates for certain Infectious Diseases in the Year 1943. (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 Births : Rates per 1,000 Civilian Population:— Deaths under 1 year of age Rates per 1,000 Live Births :— Live 16.5 18.6 19.4 15.8 18.9 49 58 46 58 23.8 Still 0.51 0.63 0.61 0.45 0.55 Deaths : All Causes 12.1 14. 2 12.7 15.0 8.3 Deaths from Diarrhæa and Enteritis under 2 years of age 5.3 7.9 4.4 10.4 — Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 - Scarlet Fever 0.00 0.00 0.00 0.00 - Whooping Cough.. 0.03 0.03 0.03 0.03 — Diphtheria 0.03 0.04 0.04 0.02 0.05 Influenza ... 0.37 0.36 0.37 0.27 0.29 Rates per 1,000 Total Births (Live and Still) Smallpox ... — - — - - Measles 0.02 0.02 0.02 0.02 0.03 Notifications: Notifications : Typhoid Fever ... 0.01 0.01 0.02 0.01 - Puerperal Fever 1 111.68 15.11 9.26 3.05 2.72 Paratyphoid Fever. 0.01 0.01 0.01 0.01 - Cerebro-Spinal Fever 0.08 0.10 0.06 0.09 0.08 ,, Pyrexia 15.23 Scarlet Fever 3.01 3.29 3.54 3.80 9.93 Whooping Cough- 2.54 2.82 2.25 2.68 2.19 Maternal Mortality: Diphtheria 0.88 1.12 0.77 0.74 0.34 1.45 Not available. 1.36 Erysipelas 0.31 0.35 0.27 0.42 0.42 Maternal causes (excluding Abortion and Puerperal Infections) Smallpox — — - —. - Measles 9.88 9.23 9.77 9.17 4.99 Pneumonia 1.34 1.62 1.16 1.27 2.32 28