WANS 034 Wanstead Urban District Council Annual Report of medical officer and sanitary inspector 1919 To the Chairman and Members of The Wanstead Urban District Council. Gentlemen, The Annual Report for 1919, which I now have the honour to submit to you, is presented under conditions widely different from those which have existed during the earlier years of my official experience as Medical Officer of Health for Wanstead. Since my last report Peace has been ratified, and all matters pertaining to the health of the people have been unified under the new Ministry of Health. It is the wish of the Ministry that my Annual Report should be fuller than it has been during the War, and that copies of it should be more freely distributed. In endeavouring to meet this request I shall arrange the material of the Report as closely as possible under the headings which the Ministry suggests, but shall retain the custom of including as an appendix the Report of the Sanitary and Food Inspector. POPULATION The Registrar-General has supplied me with the estimated numbers of 15,447 for birth-rate and 14,829 for death-rate on which to calculate the vital statistics. The Census of 1911 gives the population as 13,831, the number of inhabited houses as 2,856, and the average number of persons per house as 4.52. On this basis, the present population v/ould be about 17,000, having regard to the number of houses built since 1911. But knowing as I do that there are now practically no empty houses and that a large number of houses which formerly contained one family now contain two or more, I have no hesitation in saying that the official population supplied to me is considerably under-estimated. It follows, therefore, that the Death Rate, which must be calculated on the official figures, would be considerably lower if it were possible to have a more accurate estimate of the population. DESCRIPTION OF THE DISTRICT The Urban District of Wanstead is situated within the N.E. section of the London area, and is bounded on the N. by Woodford, on the E. by Ilford, on the S. by East Ham, and on the W. by Leyton. Snaresbrook is but a subdivision of Wanstead Parish, and is situated on the W. side of the Railway Arch, towards the Royal Infant Orphanage. 4 The District can be best described as a parallelogram of 1,679 acres, extending 2½ miles North and South along the West side of the River Roding, and having an average width of little over a mil;. It has a general slope from N.W. to S.E., the highest point (170 feet above sea level) being the extreme N.W. corner of the district, and the lowest point (20 feet) at the extreme S.E. corner, that is on the flood lands attached to the Council's Sewage Farm. The subsoil is mainly gravel, intersected with layers of clay, while the higher levels of the district are of clay formation. Extending from the Western boundary to the centre of the District is an interesting plateau (102ft.) composed of post-glacial gravel of an average depth of 18 ft., forming perhaps the healthiest residential locality immediately to the East of London. Tracts of forest land and of water, including what are commonly known as Wanstead Park and Wanstead Flats, and comprising in all about 509 acres, abound in the southern portion; and these permanent open spaces, being secured against the future inroads of the builder, will doubtless preserve to a large extent the present residential character of the district. The population is fairly distributed north and south, while the central part contains practically the whole of the cottage, shop, and business premises. Here the population is more compact. Many of the inhabitants are employed in the Metropolis in business or professional affairs, and there are a large number of retired middle-class residents. The minor proportion of the population is made up of local tradespeople, outdoor servants, skilled artisans, various officials and others employed in the industrial districts within more or less easy reach. Local industries are almost entirely confined to local needs, and the number of persons employed in factories and workshops is very small. DRAINAGE The Wanstead Council is fortunate in governing a district where the "lie of the land" permits the whole of the surface-water and sewage to be discharged by gravitation without the expense of pumping or lifting. The drainage system is "combined", as far as domestic sanitation is concerned, i.e., the rainwater and sewage are led away by the same pipes. The surface drainage of the streets, however, is in most cases carried off by an entirely separate system of drains, discharging into open water-courses or ponds, which provide also a means of drainage for the numerous open spaces of the district. 5 Thus in the Northern part of Wanstead the greater part of the surface-water is collected by the brick conduit of 3 ft. 6 in. diameter, which extends from the Eagle Pond overflow eastwards through the Cowley Road and Nightingale Lane depression, across Nightingale Farm to the river Roding. Lower down, into the same river, various discharges of surface-water take place, as e.g., into the ditch on the east side of Redbridge Lane, below the Rectory. Turning now to the sewage system, the main outfallsewer (2 ft. 4 in. by 3 ft. 6 in.) of Wanstead runs from the northern boundary in a southerly direction through the fields of Nightingale Farm at the rear of the houses on the east side of Buckingham Road; it strikes Redbridge Lane at the right-angled bend below the Rectory, traverses Wanstead Park, and terminates at the Sewage Farm on the north side of the City of London Cemetery. It collects on its way the whole of the sewage of Wanstead, with the exception of the Aldersbrook and Lake House Estates; these have an independent main sewer of 18 in. diameter following the route—Wood. lands Avenue, Northumberland Avenue, to the Sewage Farm. WANSTEAD SEWAGE DISPOSAL WORKS. I am indebted to your Consulting Surveyor, Lieut.-Colonel C. H. Bressey, F.S.I., for the following description of the new Works at the Sewage Farm which were completed in 1915 :— "On 24th July, 1915, took place the formal inspection of the recently completed additions to the Sewage Disposal Works which can now claim, thanks to the skilful design of Messrs. Willcox & Raikes, to embody the most modern developments of sanitary science. " The new scheme comprises the Construction of new detritustanks (24 ft. by 18 ft.) with mechanical screens, the sub-division and improvement of the old septic-tanks, the formation of a Dortmund humus-tank (24 ft. by 24 ft.), the building of percolating filters (total area 200 ft. by 180 ft.) with four electrically-driven travelling distributors, the building of two motor-houses for same, the laying of a 21-in. outfall-pipe from filter to river, the sinking of a deep sludge-well to receive the sludge from tanks by gravitation, the laying out of five sludge-lagoons each 90 ft. by 40 ft., the provision of a 4-in. "Stereophagus" pump for the lifting of sludge from well to lagoons, the improvement of the old storm tank (470ft. by 20 ft.) so as to increase its filtering efficiency, while facilitating the removal of sludge by the installation of a portable "Stereophagus" pump, the erection of a Manager's office, tool shed, store sheds, and finally the laying out of paths and roads around the new works. The practical results of 6 this most complete and up-to-date installation have fulfilled every expectation, and as a useful means of auxiliary treatment the Council still retain a large area of under-drained land for irrigation, and twelve old contact-beds (each 60 ft. by 44 ft.) "The process now followed may be roughly summarised as follows :— "The crude sewage from the whole of Wanstead flows to the Works through the old main outfall sewer (2 ft. 4 in. by 3 ft. 6 in.) traversing Wanstead Park, and the smaller main sewer of 18 in. which collects the sewage of the Aldersbrook and Lake House Estates. Passing through the detritus-tanks and their screens the sewage is relieved of all the coarse heavier solids, and then flows on to the settling-tanks where a further proportion of suspended matter is deposited. From here the liquid passes to the humus-tank where a final deposition of suspended matter occurs, and the effluent is now fit for treatment on the great percolating filters over which the liquid is sprayed in a thin film by the electrically-driven distributors which form perhaps the most interesting feature of the scheme. By this process of filtration, a clear, bright effluent is yielded which is suitable for discharge into the most jealously guarded water-course. "In times of heavy sewage-flow or when it is desired to 'rest' the distributors, use can be made of the old contact-beds or the underdrained grass-lands. "Storm water is treated in a long scries of open tanks divided by weirs. "To remove the sludge and other deposits from the settlingtanks, humus-tank, etc., recourse is had to electrically-driven "Stereophagus" pumps which raise the thick and heterogeneous mixture with the most unfailing and surprising readiness on to the sludge lagoons where a natural drying process takes place. When the varied components and stiff consistency of the sludge are considered, it seems almost incredible that a pump of so small a bore should be capable of lifting and discharging the dense fibrous gritty paste without clogging or jamming. "The wide interest caused by the unusual features of the Council's Works is proved by the visit recently paid by the Chief Engineer of the London County Council and his predecessor, Sir M. Fitzmaurice." All the work on the farm is carried on practically without noise, and as the Council have thoughtfully forbidden the use of guns the place has become a bird sanctuary. I have seen on the farm in my time the following less common birds : the Kingfisher, the teal and mallard ducks, the snipe, the heron, many varieties of finches, sandmartins pied and yellow wagtails, and partridges. One of the older men on the farm has told me that the former farm manager captured a " golden heron." This may have been a specimen of the bittern. 7 WATER The water of the district is supplied by the Metropolitan Water Board and has been throughout the year of good quality. DEATH RATE Sixty males and eighty-eight females died in the year under review, giving a death rate of 9.9 per 1,000 of the population, as compared with 11.2 in 1918. The death rate for England and Wales in 1919 was 13.8 per 1,000. Thirty-two residents died outside the district and are included in the above figures, while twelve persons belonging to other places died here and are not included. Excluding the infectious diseases, which are discussed in a later paragraph, the principal causes of death were organic heart disease (19 cases) and cancer (19 cases). Bronchitis, pneumonia, and other respiratory diseases were responsible for 18 of the registered deaths. BIRTH RATE The number of children born in the district in 1919 was 227, of whom 39 belonged to other districts and have been transferred. The net number accredited to Wanstead is 188 (119 males, 78 females), giving a birth rate of 12.1 per 1,000 as compared with 9.0 in 1918. I am glad to be able to report an improvement in the birth rate, but it is still considerably below the figure for the whole country (England and Wales), which is 18.5 per 1,000. INFANT MORTALITY In 1919 four children under one year died, two of the deaths being from influenza; the number of deaths under one year in 1918 was six. The death rate per 1,000 births was therefore 21.2 as compared with 38.4 in the previous year. The figure for England and Wales was 89. The infantile mortality rate has always been relatively low in Wanstead, and that for 1919 is the lowest of any previous year. This is of special interest, in view of the work you are doing under the Maternity and Child Welfare Act, 1918. INFECTIOUS EASES A reference to the Table of Notifications of Infectious Diseases shows that Measles heads the list with a total of 92 cases. The greatest number of cases in any one month was 26 (in July, just before the schools broke up for the summer vacation). One of the steps taken to hinder the spread was as follows : Any school class from which a child had been notified was closed during those days in which any child already infected might be expected to show the disease and thus to become a source of further danger. Closing a whole section of a school was not resorted to on any occasion. Thorough cleansing and spraying of the schools were practised, and ventilation between classes was 8 faithfully carried cut. Literature on the care necessary in the treatment of measles was distributed. On the application of the Council measles continues to be notifiable in Wanstead; the mere fact that it remains a notifiable disease causes parents and guardians to exercise more care in its treatment. There were no deaths from Measles. Scarlet Fever and Diphtheria each numbered 23 cases, and these were of a sporadic nature, four being the greatest number that occurred in any one month. All the medical practitioners in the district know the arrangements made for obtaining bacteriological help and antitoxin, and how willing the Council is to provide supplies of swabs and serum for dealing with Diphtheria, and I have little doubt that the freedom with which these methods are utilised had much to do with the prevention of the disease as an epidemic. Chicken-pox is notifiable in Wanstead, and 57 cases were reported. This disease is retained on the notifiable list because of its possible confusion with mild small-pox. Puerperal Fever —Three instances of this disease were notified amongst the 227 maternity cases which occurred in the year. One of these died. Erysipelas. — Of this disease there were two cases : both the patients recovered. Malaria was notified six times. All the persons who suffered had contracted the disease abroad and no indigenous cases occurred. Mr. Howard, the Sanitary Inspector, who served in the Eastern sphere of the War and was employed to a great extent on malarial work there, has made exhaustive search for specimens of the Anopheles, the species of mosquito which carries the disease, but has failed to find a single specimen in the district. All the patients underwent the prescribed quinine treatment. To prevent extension of the disease to others they were offered a supply of mosquito netting, but did not in any case accept it. The residents who have ponds in their gardens were given cards on the prevention of mosquito breeding in such places. Influenza Pneumonia was notified 17 times, 15 being in the month of March. I gave a full report on the subject of Influenza last year and steps similar to those described therein were taken in the third wave of the epidemic which occurred in the Spring of 1919. In 1918 there were 22 deaths certified as due to Influenza, and the number was 20 in 1919, giving a death rate of l.3. The ages of the victims varied from one month to 90 years. The National Schools were closed owing to Influenza from March 6th—17th, 1919. Ophthalmia Neonatorum was notified once—a mild case which recovered with perfect vision. Various contacts from ships where cases of Plague and of Small-pox had occurred came into the district and were kept under supervision. In no instance did either disease arise. Vaccination was performed in fourteen cases by private doctors with lymph supplied by me from the Government Lymph Establishment. 9 Of the other diseases on the notifiable list, viz. : Enteric Fever, Cerebro-Spinal Meningitis, Poliomyelitis and Encephalitis Lethargica not one case was notified. Tuberculosis. -Seven primary notifications of Tuberculosis were received and twenty cases were notified in duplicate. The latter refer to persons who have gone to a sanatorium or hospital or otherwise have changed their district. Many of the patients suffering from this disease, particularly those in the smaller houses, take advantage of the treatment provided at or through the Tuberculosis Dispensary at Leyton ; and Dr. Sorley, the physician-in-charge there, is always glad to help in the diagnosis of early or suspicious cases, while leaving the care of the patients in the hands of their own medical attendants if desired. My own department confines itself to supervision of the housing, the welfare of the other inmates and to disinfection when occasion arises. In addition, I submit specimens of sputum to the County Laboratory for bacteriological examination. Notification of Tuberculosis is sometimes rather a delicate matter and the diagnosis is often uncertain for some time, and although for these reasons there is in some cases delay, I am sure that notification is practically always made. On only one occasion during the year had I to write to the medical attendant in regard to his failure to notify. YENEREAL DISEASES A County scheme for the free diagnosis and treatment of Venereal Diseases has been evolved since the issue of the Report of the Royal Commission on these diseases. Any resident who desires to take advantage of the scheme should apply to me, either directly or indirectly, when he will be instructed what steps to take, and he may be assured that secrecy will be observed. Although he will be required to attend one of a group of hospitals it will be at a convenient hour and in favourable circumstances. If a patient prefers to be treated by his own medical practitioner, facilities are offered to the medical practitioner for obtaining special drugs, etc., but the patient must pay the usual fees. The scheme aims at bringing modern treatment within the reach of all sufferers. It is of the utmost importance that these diseases be treated at the earliest stages, and on no account should a patient place himself in the hands of the vendors of any quack remedy, or of any person other than a qualified medical practitioner. During 1919 there were no cases treated under this scheme, nor were there any pathological examinations made through its agency. In 1918 two such examinations were carried out. All the medical practitioners in the area are no doubt qualified to use salvarsan substitutes, but only one so far as I can gather has taken a certificate for the purpose of obtaining free supplies. RABIES Although there was an outbreak of this disease in some parts of the country in 1919, no definite case arose in this oistrict. One person was very badly bitten by a bad-tempered dog, which was 10 destroyed and buried before either my department or the police were informed. The subsequent disinterment and examination of the dog's carcase gave uncertain results, but for precaution the person bitten was treated at St. Thomas's Hospital by the Pasteur method. The patient did not develop any signs of hydrophobia. ISOLATION HOSPITAL The Wanstead Isolation Hospital is situated in the S.E. corner of the district and adjoins Wanstead Park. It is on the pavilion plan and consists of two pavilions, each sub-divided into wards capable of very complete isolation. It is primarily intended for the accommodation of patients suffering either from Diphtheria or from Scarlet Fever, but I shall be prepared to hear from any medical man who has charge of any severe case of Pneumonia complicating either Measles or Influenza in a young child where the home conditions handicap the chance of recovery, and will endeavour to admit such a case to Hospital, if circumstances at the time permit. During the year, the number of patients treated in the Hospital was 36, namely, Diphtheria 20 and Scarlet Fever 16. Average duration of time spent by patients in Hospital :— Scarlet Fever 40 days. Diphtheria 27 days. No deaths occurred in the Hospital during 1919. HOSPITAL ACCOMMODATION FOR SMALLPOX For the greater part of 1919 the Council were still under their old contract with the West Ham Authorities for the reception of cases of small-pox at Dagenham. Since September, 1919, however, the County Authorities have caused this contract to be discontinued and now any occasional case of small-pox has to be sent to Orsett. We have had no occasion during the year to deal with any case of this terrible disease. MATERNITY AND CHILD WELFARE The supervision of midwives is carried out by the County Authorities, and that these have little to do in the Wanstead area is evident from the fact that the notifications of births sent in by a midwife during 1919 only numbered two. In this connection it may be well to record as a little matter of history why the women of Wanstead, with hardly an exception, engage the services of a medical practitioner for their confinements. For very many years (since about 1882) two maternity charities existed in the parish, and through their agency the poorer women received the services of a good nurse and could have the doctor of their own choice, together with other advantages, all for a nominal sum. Although the activities of these charities came to an end with the passing of the National Insurance Act, the habit of engaging a doctor for confinements remains—much to the benefit of the mothers and infants. Our figures for parturition and infant mortality are eloquent testimony in this direction. 11 The Health Visitor, Mrs. Wild, continued her very useful work among- the mothers and infants. That her work is of the very utmost importance I am convinced, and there are instances where, but for her timely help, disaster would have occurred. She has paid 892 visits to maternity cases (as compared with 894 visits in similar cases in 1918), and 12 to cases of Measles; and she has given useful help in cases of Scabies, Erysipelas and Ophthalmia. She visits also the Wanstead and Woodford Infant Welfare Centre every week and takes a special interest in those mothers and infants of Wanstead who attend there. As instructed she places great stress on the importance of breast feeding, and all mothers are encouraged to adhere to nature's method; and the great majority of them wisely accept th:s counsel. A proprietary preparation is advised or supplied to mothers when the breast milk is scanty, and this is usually found to be helpful. It is a wise and useful policy for every expectant mother to consult her doctor from time to time during her pregnancy. She is thus in a position to be guided in reference both to the care of her own health and the welfare of her expected child. The Health Visitor is able to carry this and other suggestions into a good many homes, and so to promote the welfare of mothers and infants without in any fashion incurring responsibilities which can only be undertaken by medical practitioners. In recent years so many young women have been separated from the usual opportunities of domestic training that they are ill-prepared to start homes and to train families of their own. Thus home visitation by a kindly, tactful and helpful visitor has an increased opportunity. • In view of the danger of Summer Diarrhoea, circulars setting forth the Prevention and Treatment of this malady, and one having reference to the Danger from Flies, were distributed. There were no deaths from epidemic diarrhoea. MILK The supervision of this important article of diet is undertaken by the County Authorities, but in cases of specific complaint I occasionally have samples taken and submitted for analysis. Two such investigations were carried out in 1919, and in both instances the milk was of high quality but of somewhat unusual taste, owing to the food of the cows having been changed. Most of the milk supplied is imported. The ideal of a clean and tuberculosis-free milk supply is always in one's mind, and we are fortunate in having close to our borders and supplying a number of the families in the district one herd of milch cows which are regularly tested for tuberculosis. The competition thus engendered may in time lead to the establishment of other carefully selected and supervised herds. Milk has been supplied by the Council to mothers and young children to the following amount, viz. : 280 pints in twelve cases during the last three months of the year. 12 The demand for free milk occasioned by the present high price is steadily growing. I have placed this matter in the hands of the Health Visitor, but the details of each case are submitted to me and the greatest care is taken that no abuse is made of the supply. SANITARY INSPECTOR During the year under review I have had the advantage of the loyal and able support of Mr. H. C. Howard in his position as Sanitary and Food Inspector. It will be seen from the particulars given in his report that a very large amount of work has been carried out in securing the removal of nuisances and in obtaining improvements of the sanitary conditions of the dwellings, all tending to the benefit of the district and the welfare of the inhabitants. The amount of clerical work in the Public Health Department has grown so enormously of late that the time is not far distant when further assistance will become necessary. WAR SERVICE OF THE COUNCIL'S EMPLOYEES Now that local administration is resuming its normal course after the upheaval of the last five years, it is interesting to place on record the military service of members of the Council's staff. All have fortunately escaped serious injury, with the exception of G. Everett, who, I regret to say, is permanently lamed. C. H. Bressey, Lieut.-Colonel R.E., Assistant Director of Roads, France, and British Member Inter-Allied Road Commission, Rhine Province. G. Everett, Royal West Kents, 3 years 6 months in Army, 2 years in F ranee. H. C. Howard, 1st London (City of London) San. Co., R.A.M.C., 3 years in Army, 2 years in Salonica. W. Godfrey, Dublin Fusiliers, 3 years in Army, 18 months in France. C. Goldstone, R.H. and R.F.A., 4 years 8 months in Army, 4 years 7 months in France. G. E. Hack, Captain R.E., formerly assistant in Surveyor's Office. H. T. Sadler, 1st Field Survey Battalion R.E., 4 years 3 months in Army, 4 years in France. HOUSING The Council have obtained sanction to incur a loan of upwards of £2,500 for the purchase of 4¾ acres of land with frontages to Wigram Road and Redbridge Lane, opposite the Rectory. On this site it is proposed to erect about 50 houses (about 11 to the acre), the scheme for which has in all essentials been approved by the Council. Plans have been submitted for the development on similarly spacious lines, but by private enterprise, of another adjoining estate of equal size, so that a substantial alleviation of the prevalent house shortage may soon be expected. Wanstead will deserve congratulation if these schemes are carried through, thus setting up a high standard for the growth of the district. 13 TOWN PLANNING Through the action recently taken by the Council in passing a Town-planning resolution, wide powers will be placed in their hands for the judicious control of the development of Wanstead, with an eye not merely to the most remunerative utilization of each estate, but to the convenience and welfare of the community as a whole. Bad housing increases the incidence of infectious and other diseases and has further serious consequences, while on the other hand there is nothing in the whole range of Preventive Medicine so important as good housing as an agency in the general welfare of the people. I am, Gentlemen, Your obedient Servant, PATRICK F. MACGREGOR. Public Health Department, Council Offices, Wanstead, April, 1920. The following additional information required by the Ministry of Health has been obtained since the above was printed :— POOR LAW RELIEF in Wanstead in 1919 amounted to £210 16s. lid. for Out-Relief. The cost of Indoor-Relief was not ascertainable. HOSPITAL TREATMENT was received by 28 Wanstead residents during the year at the Walthamstow, Wanstead and Leyton General Hospital. These were in-patients and were chiefly operation cases. A certain number of residents no doubt were treated at other hospitals, but of these no record has been obtained. \ TABLES. 1. VITAL STATISTICS. 2. REGISTERED DEATHS. 3. INFECTIOUS DISEASES. 4. INFANTILE MORTALITY, 5. INSPECTION OF FACTORIES, WORKSHOPS, Etc . ETC. 16 Table I. DISTRICT OF WANSTEAD. VITAL STATISTICS OF WHOLE DISTRICT DURING PREVIOUS YEARS. Year. Population estimated to Middle of Year. Births. Total Deaths Registered in the District Transferable Deaths. Net Deaths belonging to the District. Under 1 Year of Age. At all Ages. Uncorrected Number Net Number Rate of Nonresidents registered in the District of Residents not registered in the District Number. Rate per 1.000 Net Births. Number Rate Number Rate 1 2 3 4 6 6 7 8 9 10 11 12 13 *1914 16,671 216 218 11.1 107 6.4 4 38 10 45.8 141 8.4 *1915 15,635 250 251 16 0 122 7.8 6 22 13 51.8 138 8.8 *1916 †l5,246 ‡16,588 242 242 14.5 119 7.8 10 35 8 33.0 144 9.4 *1917 †l4,424 ‡16.079 186 186 11.3 98 6.7 10 30 9 48.3 118 8.1 *1918 †l3,879 ‡l5,551 160 141 9.0 120 8.6 8 44 6 38.4 156 11.2 1919 †l4,329 ‡15,447 227 188 12.1 11.6 7.8 12 32 4 21.2 148 9.9 Area of District in acres Total population at all ages 13,831 land and inland 1,679 Number of inhabited houses 2,856 At census of 1911 water Average number of persons per house 4.52 *War years. †For Death Rate. ‡For Birth Rate. 17 TABLE II DISTRICT OF WANSTEAD. CAUSES OF DEATH (Civilians only) during the year 1919. All Causes. Males 60 Females 88 Enteric Fever .. .. Smallpox .. .. Measles .. .. Scarlet Fever .. .. Whooping Cough .. 1 Diphtheria and Croup .. .. Influenza 10 10 Erysipelas .. .. Pulmonary Tuberculosis 4 4 Tuberculous Meningitis .. 1 Other Tuberculous Diseases .. .. Cancer, Malignant Disease 8 11 Rheumatic Fever .. .. Meningitis .. .. Organic Heart Disease 8 11 Bronchitis 2 5 Pneumonia (all forms) 3 5 Other Respiratory Diseases 1 2 Diarrhoea, &c. (under 2 years) .. .. Appendicitis and Typhlitis .. .. Cirrhosis of Liver 1 1 Alcoholism .. .. Nephritis and Bright's Disease 2 2 Puerperal Fever .. 1 Parturition, apart from Puerperal Fever .. 1 Congenital Debility, &c. .. .. Violence, apart from Suicide 2 1 Suicide .. 1 Other defined diseases 19 31 Causes ill defined or unknown .. .. 18 TABLE III. DISTRICT OF WANSTEAD. CASES OF INFECTIOUS DISEASES notified during the year 1919. Notifiable Diseases. Cases Notified in Whole District. Total Cases Notified in Institutions in the District. Total Cases Removed to Hospital. At all Ages. At Ages—Years. Under 1 1 to 5 5 to 15 15 to 25 25 to 45 45 to 65 65 and upwards Diphtheria (including Membranous croup) 23 .. 2 14 5 2 .. .. 2 12 Erysipelas 2 .. .. .. .. .. 2 .. .. .. Scarlet Fever 23 .. 2 16 4 1 .. .. 2 15 Enteric Fever .. .. .. .. .. .. .. .. .. .. Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. Poliomyelitis .. .. .. .. .. .. .. .. .. .. Varicella 57 7 46 4 .. .. .. .. 1 .. Puerperal Fever 3 .. .. .. .. 3 .. .. 1 .. Ophthalmia Neonatorum 1 1 .. .. .. .. .. .. .. .. Measles 75 .. 80 42 3 .. .. .. 45 .. German Measles 17 .. 4 9 4 .. .. .. 5 .. Influenza Pneumonia 17 .. 2 .. 2 9 2 2 .. .. Malaria 6 .. .. .. 2 4 .. .. .. .. Totals 224 8 86 85 20 19 4 2 56 27 Isolation Hospital—Empress Avenue, Manor Park. 19 Table IV. DISTRICT OF WANSTEAD. INFANTILE MORTALITY DURING THE YEAR 1919. Net Deaths from stated Causes at various Ages under One Year of Age. causes of death. (All Causes, Certified.) Under 1 Week 1 to 2 Weeks 2 to 3 Weeks 3 to 4 Weeks Total under 4 Weeks 4 Weeks and under 3 Months 3 to 6 Months 6 to 9 9 to 12 Months Months Total Deaths under 1 year Tubercular Meningitis .. .. .. .. .. .. .. 1 1 Influenza .. .. .. 1 1 .. .. 1 2 Convulsions .. .. .. .. .. .. .. 1 1 Total .. .. .. 1 1 .. .. 3 4 Net Births in the year Legitimate 224 Net Deaths in the year of Legitimate Infants 4 Illegitimate 3 Illegitimate Infan 0 20 TABLE V. DISTRICT OF WANSTEAD. I -INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories—Including Factory Laundries 7 1 .. Workshops—Including Workshop Laundries 55 .. .. Workplaces (other than Outworkers' premises, included in Part 3 of this Report) 17 1 .. Totals 79 2 .. 2.—DEFECTS FOUND. Particulars Number of Defects. Number of Prosecutions. Found Remedied Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of Cleanliness 6 6 .. .. Other Nuisances 8 8 .. .. Sanitary accommodation unsuitable or defective 1 1 .. .. Totals 15 15 .. .. 31 TABLE v-continued. DISTRICT OF WANSTEAD. 3.—HOME WORK. Nature of Work. Outwobkers' Lists, Section 107. Lists received from Employers. Notices served on Occupiers as to keeping or sending Lists Prosecutions Unwholesome Premises Sec. 108 Infected Premises Sec. 109-10 Twice in the year Once in the year Failing to keep or permit inspection of Lists Failing to send Lists Lists Outworkers Lists Outworkers Contractors Workmen Contractors Workmen (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) Wearing Apparel— (1) Making, etc. 2 2 2 2 2 2 .. .. .. .. .. 4.—REGISTERED WORKSHOPS. Workshops on the Register (s. 131) at end of year Number (1) (2) Total number of Workshops and Workpeople on Register, including two underground Bakehouses 49 5.—OTHER MATTERS. Class. (1) Number (2) Matters notified to H.M. Inspector of Factories:— .. Failure to affix Abstract of the Factory and Workshop Act (s. 133) .. Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector .. Reports (of action taken) sent to H.M. Inspector .. Other .. Underground Bakehouses (s. 101):— .. In use at the end of the year 2 23 REPORT of the SANITARY and FOOD INSPECTOR To the Chairman and. Members of The Wanstead Urban District Council Gentlemen, I have the honour to submit the following Report for the year 1919, which, whilst covering the work of Inspection of the District, also includes, in their specific order, such details as are required by the Ministry of Health. Whilst building operations during the past five years were practically non-existent, similar conditions prevailed with regard to existing houses, and the older type of building in particular has deteriorated, by reason of the greater upkeep necessary for its preservation and maintainence, hence the need of comparatively costly repair to-day. The attention of owners and others responsible for these matters was therefore in great demand—as evidenced by the unprecedented number of complaints received during the year. An exceedingly busy time is also assured to the Sanitary Inspector in future. COMPLAINTS The total number of complaints subject to attention throughout the year amounted to 329, and the following summary will serve to indicate the more frequent causes :— 1. The non-removal of house refuse 188 2. Damp conditions due to defective roofs, R.W. pipes, guttering, or absence of damp courses 38 3. Choked drains 21 4. Defective house drainage or attachments 18 5. Water in cellars 17 6. General defects, dilapidations, or dirty state of house 16 7. Non-provision or dilapidated condition of dust bins 15 Road drains, including street gullies and surface sewer ventilators, also needed attention, particularly during dry spells of weather. These were dealt with by the Surveyor's Department on request. 21 FOOD INSPECTION The establishments wherein food is stored, or in preparation, or exposed for sale, number forty. These have been inspected as frequently as occasion demanded and have been maintained in a satisfactory condition. Bakehouse Regulations.—There are four retail bakehouses, including one factory and two underground; the usual periodical cleansing was duly carried out, and no complaint arose. Dairies, Cowsheds, and Milkshop Orders—There were seven registered cowkeepers and dairymen carrying on business in the district during the year. One application for registration was received on change of occupation. The cowsheds, three in number, are old wooden buildings, and are kept in fair condition, the number of cows housed averaged 40, and the animals were usually turned out to graze during day time. Slaughterhouses. — These number two, both of which are well constructed, commodious premises, containing also excellent lairage for cattle. The occupiers are licensed, and the licenses are subject to annual renewal. The business is well conducted, and whenever possible the examination of carcases takes place at times of slaughter. The quality of foodstuffs was a matter for outside control, but the following articles of food, largely allocated to local trade, were condemned by me soon after reaching their destination.— 5 carcases of beef (local killed), miliary tuberculosis. 1 hindquarter of bull beef (injured and tubercular), slaughtered on behalf of the Casualty Officer for the area. 12 livers and lungs—tubercle, echinococci, pyaemic abscesses. 114 lbs. of bacon (tainted), probably due to faulty curing. 1 seven pound tin of corned beef. 1 case of Australian rabbits. 5 boxes of Californian apples. 8 boxes of dates. 1. Closet Accommodation.— Comparatively few of the older houses were in existence before the inauguration of a water carriage system of drainage, and of these probably less than a dozen still retain cesspool installations. Privies and middens have long since become almost extinct, and it is probable that the last of these was disposed of during the year. Pail closets, too, are rare and do not exceed half a dozen, thus waterclosets may be said to prevail throughout the District. 25 2. Scavenging —The collection and removal of house refuse is effected by contract, a weekly collection from each house being maintained throughout the year. The debris is carted away from the district immediately following collection, whilst the Sanitary Inspector deals with all complaints in reference to non-collection. The older premises were originally provided with brick-built ash pits and later these were substituted by large galvanised iron, squareshaped receptacles. The familiar portable type of galvanised iron dust bin has almost entirely superseded both during recent years. Early in the year numerous complaints were forthcoming regarding the non-removal of house refuse, the hitherto regulated system of collection not being fully maintained. At a special meeting of the Council the Contractor explained prevailing labour difficulties, illness among the regular collectors, as well as unavoidable delays due to frost and snow. Within the ensuing month the system reached normal proportions again. INFECTIOUS DISEASE Owing to the extension of the list of notifiable diseases, a considerable increase of work was entailed, both regarding enquiries and the quantity of disinfection. In addition to ordinary room disinfection (effected by means of the Alformant Lamp), spraying with formalin solution was frequently resorted to. among the schools and institutions. Hand sprayers and bacterol were also provided for use in churches during the influenza epidemic. The work of disinfection was carried out both promptly and efficiently, and no case of complaint arose during the year. Food and Drug Acts.— Two samples of milk were submitted for analysis during the year; both proved to be genuine. Petroleum Acts.— The petrol stores were periodically inspected and were found to be maintained in a satisfactory state. Two additional licenses were granted. Offensive Trades,— There are no offensive trades conducted within the District. 26 Bye-Laws.— Local bye-laws exist for The Regulation of Slaughterhouses, The Prevention of Nuisances arising from Snow, Filth, and the Keeping of Animals. Pig-keeping.—One pig sty was surreptitiously erected during the year. This was found to be situated within 50 ft. of the house and adjacent to a factory. The occupier yielded to pressure and discontinued its use. Two other war-time piggeries have also fallen into disuse. Factories & Workshops.— Tn the attached tables, the requisite details of the work in connection with the Factories and Workshop Act are given. HOUSING Overcrowding.— Although a great proportion of the dwelling houses in the District appeared to be very fully occupied, yet no statutory case of overcrowding was observed. There were occasions, however, when it was desirable to urge a readjustment of the rooms available for sleeping accommodation, for the separation of the sexes among growing families. Parents usually fell into line with the suggestion of converting the parlour or kitchen for the purpose. Housing (Inspection of District Regulations, 1909.— Under the above Regulations the following statements for the year ending 1919 must be enumerated :— 1 Number of Dwelling Houses in respect of which complaints were made—that they are unfit for human habitation None. 2. Action taken, Section 17, Housing, etc., 43 Houses inspected, repairs Act, 1909 effected or in contemplation without recourse to Closing Orders. 3. Action under Section 28 Housing, etc., Act, 1919 None during the year. 4. Closing Orders None issued. 5. Demolition Orders None. 6. Number of Dwelling Houses demolished voluntarily One. 7. Obstructive Buildings None. 8. Staff engaged on Housing Work Inspector of Nuisances. 27 INSPECTIONS Number of Dwelling-houses inspected 158 Number of Dwelling-houses inspected under Housing Acts 43 Number of Complaints received and attended to 329 Number of Complaints received in reference to non- removal of House Refuse 188 INSPECTION OF SPECIAL PREMISES Bakehouses 29 Butchers 115 Dairies, Cowsheds and Milk Shops 74 Slaughterhouses 190 Factories, Workshops and Workplaces 97 Petroleum Stores 23 Total number of Inspections (initial, or otherwise) 1,628 NOTICES SERYED Informal Notices 98 Statutory Notices 12 INFECTIOUS DISEASES Enquiries made in connection with Infectious Diseases 197 Number of rooms disinfected 80 Loads of bedding, etc. disinfected by steam 55 SANITARY IMPROVEMENTS EFFECTED DURING THE YEAR Drains renewed or repaired 37 Choked drains (obstructions removed) 39 Drains tested 58 Manholes provided 14 Soil or vent pipes provided, renewed, or repaired 22 New 6 in. gullies provided 31 New W.C pans provided 29 Flush cisterns provided, renewed, or repaired 36 New glazed stoneware sinks and wastes provided 17 Sink, bath and lavatory wastes renewed or repair 27 28 STRUCTURAL ALTERATIONS Scullery floors paved or repaired 11 W.C. floors ,, ,, „ 29 House floors renewed ,, „ 18 Walls repaired 25 Walls rendered 19 Light and ventilation improved 7 Yards paved and drained or repaired 31 Roofs repaired 43 Rainwater pipes and guttering renewed or repaired 59 Windows renewed, repaired or made to open 17 Ceilings repaired 32 Air grids fixed 40 Damp courses fixed in house walls 9 WATER SUPPLY Draw off taps provided on rising main 7 Cisterns cleaned, repaired or covered 13 DIRTY PREMISES Special premises cleansed 24 Dirty houses cleansed throughout 7 Dirty rooms cleansed 89 Foul W.C. pans cleansed 10 MISCELLANEOUS Nuisance from pig keeping (or other animals) abated 7 Offensive accumulations removed 18 New portable galvanised iron dustbins provided 24 Cesspools repaired 2 Privy removed 1 Stables drained 2 I am, Gentlemen, Your obedient Servant, HENRY C. HOWARD. Public Health Department, Council Offices, Wanstead. April, 1920.