WANS 2 LIBRARY BOROUGH OF WANSTEAD AND WOODFORD Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1937. WANS 2 BOROUGH OF WANSTEAD AND WOODFORD Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1937. PUBLIC HEALTH STAFF. Medical Officer of Health (part time), R. F. Vere Hodge, M.D., Cantab. Senior Sanitary Inspector, H. C. Howard, M.R.San.I., M.S.I.A. Royal Sanitary Institute Certificates for: (i) Sanitary Inspector; (ii) Inspector of Meat and other Foods. Sanitary Inspectors, G. A. Hiller, M.R.San.I., M.S.I.A. Royal Sanitary Institute and Sanitary Inspectors' Joint Board Certificate. Royal Sanitary Institute Certificates for: (i) Inspector of Meat and other Foods; (ii) Sanitary Science as applied to Buildings and Public Works. A. J. Storer, M.S.I.A. Royal Sanitary Institute and Sanitary Inspectors' Joint Board Certificate. Health Visitors, Miss H. Clarke, S.R.N., S.C.M., (Part time). Royal Sanitary Institute Certificate for Health Visitor. Miss H. Smith, S.R.N., S.C.M., Royal Sanitary Institute Certificate for Health Visitor. Midwives, Miss S. Dilworth, S.R.N., S.C.M. (Retired 31/S/37). Miss E. Dixon, S.R.N., S.C.M. (From 1/6/37). Miss S. Jones, S.C.M. Mrs. L. Straw, S.C.M. Clerks, L. G. Howard. Royal Sanitary Institute and Sanitary Inspectors' Joint Board Certificate. F. E. Farrington. WANSTEAD AND WOODFORD BOROUGH COUNCIL. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year Ending 31st December, 1937. Section A. Statistics and Social Conditions of the Area. Area (in acres) 3,824 Registrar-General's estimate of resident population, 1937 53,840 Number of inhabited houses (end of 1937) according to Rate Books 15,338 Rateable value (end of 1937) £543,916 Sum represented by a penny rate (1937-38) £2,125 Wanstead and Woodford constitutes an area five miles long by two miles broad, the longest diameter running north and south. It contains large tracts of forest and a number of lakes. Extensive building is taking place within the area, and in a few years time all available building land is likely to become covered with houses. The highest point in the district is 215 feet, and the lowest 20 feet above sea level. The subsoil is clay interspersed with pockets of gravel. The district is mainly residential, there being only a few small local industries. The majority of the active inhabitants follow occupations in London. Extracts from Vital Statistics of the Year. Total. M. F. Live Births— Legitimate 696 363 333 Birth Rate per 1,000 of the estimated resident population 13.4 Illegitimate 24 11 13 Total 720 374 346 Rate per 1,000 total (live and still) births 38.8 Stillbirths 29 15 14 Deaths 522 258 264 Crude Death Rate per 1,000 of the estimated resident population 9.7 Adjusted Death Rate 9.4 4 Deaths from puerperal causes:— Puerperal Sepsis nil Other puerperal causes nil Total nil Rate per 1,000 total (live and still) births, nil. Death Rate of Infants under one year of age:— All infants per 1,000 live births 40.3 Legitimate infants per 1,000 legitimate live births 31.6 Illegitimate infants per 1,000 illegitimate live births 291.7 Deaths from Cancer (all ages) 85 Deaths from Measles (all ages) nil Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 5 Deaths at various ages during 1937. Age. No. of Deaths. Under 1 year 29 1—2 4 2— 5 6 5—15 6 15—25 14 25—35 17 35—45 25 45—55 45 55—65 88 65—75 117 75 and upwards 171 Total 522 5 INFANTILE MORTALITY DURING THE YEAR 1937. Net Deaths from stated Causes at various Ages under One Year. 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 Months 9 to 12 Months Total Deaths under 1 year Prematurity 3 2 ... ... 5 ... ... ... ... 5 Pneumonia ... 1 ... 1 2 1 1 1 ... 5 Enteritis ... ... ... ... ... 2 2 1 ... 5 Congenital Malformations 2 ... ... ... 2 2 ... ... ... 4 Injury at birth 2 ... ... ... 2 ... ... ... ... 2 Other Diseases Peculiar to early Infancy 1 1 ... ... 2 ... ... ... ... 2 Marasmus 1 ... ... ... 1 ... ... ... 1 Ophthalmia Neonatorum ... ... 1 ... 1 ... ... ... ... 1 Erysipelas ... ... 1 ... 1 ... ... ... ... 1 Other Specified Causes ... ... ... ... ... 1 2 ... ... 3 Total 9 4 2 1 16 6 5 2 ... 29 6 The following is the Registrar-General's Short List of Deaths and Causes. CAUSES OF DEATH. M. F. All Causes. 258 264 1. Typhoid and paratyphoid fevers ... 1 2. Measles ... ... 3. Scarlet fever ... ... 4. Whooping cough 1 ... 5. Diphtheria ... 2 6. Influenza 5 7 7. Encephalitis lethargica ... ... 8. Cerebro-spinal fever ... ... 9. Tuberculosis of respiratory system 17 9 10. Other tuberculous diseases 4 1 11. Syphilis 1 ... 12. General paralysis of the insane, tabes dorsalis ... ... 13. Cancer, malignant disease 41 44 14. Diabetes 2 9 15. Cerebral haemorrhage, etc. 14 13 16. Heart disease 58 71 17. Aneurysm 2 ... 18. Other circulatory diseases 7 11 19. Bronchitis 9 8 20. Pneumonia (all forms) 14 12 21. Other respiratory diseases 3 4 22. Peptic ulcer 2 ... 23. Diarrhoea, etc. (under 2 years) 5 ... 24. Appendicitis 2 3 25. Cirrhosis of liver 1 1 26. Other diseases of liver, etc. ... 3 27. Other digestive diseases 8 6 28. Acute and chronic nephritis 9 6 29. Puerperal sepsis ... ... 30. Other puerperal causes ... ... 31. Congenital debility, premature birth, malformations, etc. 10 5 32. Senility 3 16 33. Suicide 6 3 34. Other violence 12 9 35. Other defined diseases 22 19 36. Causes ill-defined or unknown ... 1 Special Causes (included in No. 35 above):— Smallpox ... ... Poliomyelitis ... ... Polioencephalitis ... ... 7 Birth-rates. Death-rates, Analysis of Mortality, Maternal Death-rates, and Case-rates for certain Infectious Diseases in the year 1937. England and Wales, London, 125 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 125 County Boroughs and Great Towns including London 148 Smaller Towns (Resident populations 25,000 to 50,000 at 1931 Census) London Administrative County Borough of WANSTEAD and WOODFORD Births: Live Rates per 1,000 Population 14.9 14.9 15.3 13.3 13.4 Still 0.60 0.67 0.64 0.54 0.54 Deaths: All Causes. 12.4 12.5 11.9 12.3 9.4 Typhoid and 0.00 0.01 0.00 0.00 0.02 Paratyphoid Fevers Smallpox — — — — — Measles 0.02 0.03 0.02 0.01 — Scarlet fever 0.01 0.01 0.01 0.01 — Whooping Cough 0.04 0.04 0.03 0.06 0.02 Diphtheria 0.07 0.08 0.05 0.05 0.04 Influenza 0.45 0.39 0.42 0.38 0.22 Violence 0.54 0.45 0.42 0.51 0 52 Notifications: Smallpox 0.00 — 0.00 — — Scarlet Fever 2.33 2.56 2.42 2.09 1.78 Diphtheria 1.49 1.81 1.38 1.93 0.85 Enteric Fever 0.05 0.06 0.04 0.05 0.06 Erysipelas 0.37 0.43 0.34 0.44 0.28 Pneumonia 1.36 1.58 1.20 1.18 1.19 Rates per 1,000 Live Births Deaths under 1 year of age 58 62 55 60 40 Deaths from Diarrhoea and Enteritis under 2 years of age 1 5.8 7.9 3.2 12.0 6.9 Maternal Mortality: Puerperal Sepsis 0.97 — Others 2.26 Not available — Total 3.23 — Rates per 1,000 Total Births (i.e. Live & Still) Maternal Mortality: Puerperal Sepsis 0.94 Others 2.17 Not available — Total 3.11 — Notifications: Puerperal Fever 13.93 17.59 11.52 4.15 8.01 Puerperal Pyrexia 14.34 8 Section B. General Provisions of Health Services for the Area. 1. (1) Public Health Officers of the Authority:— Particulars are given on page 2, at the beginning of this report. (2) (a) Laboratory facilities:— All pathological and bacteriological facilities are provided by the Essex County Council, the work being done at the Essex Public Health Laboratory, 91, Queen Victoria Street, London, E.C.4. The analysis of water, milk and food is carried out by Dr. Dyer, Public Analyst for the County. (b) Ambulance facilities:— (i) For infectious diseases. All cases requiring removal to hospital are conveyed by the ambulances attached to the hospitals. (ii) For non-infectious and accident cases. Cases of this class are taken to hospital by either of the two ambulances belonging to the Borough Council. A satisfactory service is maintained throughout the district. (c) Nursing in the home:— Home nursing is carried out:— (i) By private nurses; (ii) By district nurses working under a Committee and supported by voluntary contributions and receipts from patients. (d) Clinics and Treatment Centres:— Child Welfare Centres. There are four centres in the district:— (i) St. Barnabas Church Hall, Snakes Lane. (ii) Fuller's Road Sunday School. (iii) Baptist Church Hall, Aldersbrook. These are supported and directed by the Borough Council. (iv) Holy Trinity Church Hall, Hermon Hill. This is under the direction of a voluntary committee, but is subsidised by the Council. The following treatment centres in the district are under the control of the County Council:— (i) The Tuberculosis Dispensary. (ii) The School Clinic. (iii) The Orthopaedic Clinic. (Conjointly with the British Red Cross Society). (iv) The Mental Treatment Clinic. These all find accommodation at The Shrubberies, High Road, South Woodford. 9 (e) Hospitals. Public and Voluntary:— Maternity.—There are no maternity hospitals in the district. Arrangements have been made:— (i) With Queen Mary's Hospital, Stratford, for the reception of difficult cases and cases where the home conditions are unsuitable. (ii) With Queen Charlotte's Hospital, for the reception of cases of puerperal sepsis. Children.—There is a children's ward of five beds at the Woodford Jubilee Hospital. Infectious Diseases.—Cases of infectious diseases in Wanstead and Woodford, which required removal, were taken to the Waltham Joint Hospital, under the control of the Waltham Joint Hospital Board. Since November, 1936, the Waltham Joint Hospital Board have been willing to admit, in addition to Scarlet Fever and Diphtheria, cases of the following diseases:— Complicated cases of Measles, Whooping Cough, Influenza and Pneumonia; The acute infectious diseases of the nervous system, Meningitis, Poliomyelitis and Encephalitis; Typhoid and Paratyphoid Fevers; Dysentery, Erysipelas and Ophthalmia Neonatorum. Smallpox.—The London County Council are prepared to receive cases of Smallpox from this area into the London Smallpox Hospital so long as they have sufficient accommodation available. 2. Maternity and Child Welfare:— (1) Midwifery and Maternity Services.—On July 1st, 1937, our midwifery services, in accordance with the Midwives Act, 1936, passed into the control of the Essex County Council, after having been in existence under the control of the local Council for more than twenty years. No changes have been made in the personnel of the service. We have three Municipal Midwives working in the district. Except for ante-natal visiting they devote the whole of their time to midwifery. The number of cases attended by them was as follows:— (a) As Midwives 162 (b) As Maternity Nurses 31 Number of visits paid by these Midwives:— (a) Number of cases 193 (b) Ante-natal visits 1113 (c) Nursing visits 2734 Instead of the fixed fee which was paid in the past, patients now are assessed according to a scale fixed by the County Council. This scale entails the filling up of a somewhat elaborate form and necessitates additional clerical work in the office. 10 Ante-natal Supervision.—This is given to all women attended by the Municipal Midwives and in every case one or more examinations are made and if necessary treatment is given by a doctor of the patients choice. In necessitous cases the fees for the medical services are paid by the Council. In 1937 payments were made to medical practitioners in twenty-two cases. Dental Treatment.—The scheme introduced for providing dental treatment for nursing mothers and children under school age has continued in operation. Thirteen cases were treated during the year 1937. Consultant.—The appointment of Mr. John Ellison, M.B., B.Ch. (Cantab), F.R.C.S. (Ed.), as consulting obstetric surgeon for difficult cases occurring within the district was continued. An arrangement has been made with the Jubilee Hospital, Woodford Green, under which both ante-natal and post-natal cases requiring the opinion of a consultant are seen by Mr. Ellison at the hospital. (2) Institutional Provision for Mothers or Children.—Nearly fifty per cent.—331 out of 664—births in Wanstead and Woodford occurred in private nursing homes. Arrangements have been made with:— (a) Queen Mary's Hospital, Stratford, for the reception of difficult cases and cases where the home conditions are unsuitable. (b) Queen Charlotte's Hospital, for the reception of cases of Puerperal Sepsis. (3) Health Visitors.—The following particulars of this work are taken from Form M.C.W. 96 (Revised), which was sent to the Ministry of Health in advance of this report. Number of visits paid during the year by the Health Visitors: (a) To children under one year of age:— First visits 555 Total visits 2061 (b) To children between the ages' of one and five years:— Total visits 2305 Infant Welfare Centres.—The following attendances were recorded at the four Centres serving the Wanstead and Woodford residents:— (a) Children under one year of age 7427 (b) Children between the ages of one and five years 7509 4. Child Life Protection.—The Health Visitors are appointed Child Life Protection Visitors under Part VII of the Public Health Act, 1936. There were 21 foster mothers and 60 children on the Register at the end of the year. A total of 642 visits were paid by the visitors. 5. Orthopaedic Treatment.—There is an orthopaedic clinic at the Shrubberies, High Road, South Woodford, directed conjointly by the British Red Cross Society and the Essex County Council. 11 Section C. Sanitary Circumstances of the Area. 1. (1) Water Supply.—The water service throughout the district is supplied by the Metropolitan Water Board. (2) Drainage and Sewerage.—The opening up of new building estates and the increase in volume of sewage to be dealt with has necessitated schemes for further extensions to the sewage disposal system. The sewerage outfall and sewage disposal works serving the area are as follows:— (a) The Southern Sewage Works: -For which a scheme of reconstruction and additions is in course of preparation. (b) The Eastern Sewage Works:—The scheme for reconstruction and additions mentioned in the last report is now in progress. (c) The Western Sewage Works:—These serve only a small part of the district and the effluent is discharged into the River Lea. An agreement has been reached with the Chingford Urban District Council whereby these works will be discontinued and the western area sewerage system connected to that of the above Authority. 2. Rivers and Streams.—Test samples of the sewage effluent were taken periodically by the Essex County Council, the Lea Conservancy Board and by the Engineer's Department of this Council; the analyses have proved to be up to standard. 3. (1) Closet Accommodation.—With the exception of four isolated dwellings, house drainage throughout the district is conducted on the water carriage system. (2) Public Cleansing.—The collection and disposal of house refuse continued to be carried out under a contract which required the contractor to maintain a weekly collection throughout the district and to dispose of the refuse by means of controlled tipping on a site suitable for that purpose. During the year Council owned land was used for the tipping of this refuse. Both mechanised transport as well as horse-drawn vehicles were employed in collecting the refuse. (3) Sanitary Inspection of the Area.—The Report of the Senior Sanitary Inspector is included at the end of this Section. (4) Shops.—Under the provisions of the Shops Act, 1934, a total of two hundred and sixty-seven inspections were recorded. Improvements relating to ventilation and temperature and to sanitary accommodation were effected upon six premises. (5) Smoke Abatement.—Observations were made in respect of three premises. The use of an open brick burning kiln was discontinued following request. (6) Swimming Baths and Pools.—Swimming baths are provided at one Public School, one Secondary School and at two large institutions in the district but are not open tb the public. The public are permitted to bathe in two of the lakes in Wanstead Park which is controlled by the Corporation of the City of London. 12 (7) Eradication of bed bugs.—The number of rooms disinfested during the year totalled forty-eight and of this number four were in Council-owned houses. The procedure usually adopted for disinfestation is to obtain the co-operation of the owners of infested premises in removing loose woodwork from the walls of the rooms in question such as skirtings, architraves and picture-rails, and to burn off the exposed surfaces with the blow-lamp; this is followed by spraying with an insecticide and the removal of infested bedding for disinfestation under steam pressure. Spraying and steam disinfestation is carried out by the staff of the Public Health Department. 4. Schools.—The following are situated in the district—one Public School, one Secondary School and eight Elementary Schools including one new Central School opened during the year and referred to in the previous report. In addition, one well-known institution maintains its own educational arrangements. There are several private schools. With regard to the sanitary condition and water supply of the public elementary schools, drainage generally is on the water carriage system and there are no trough closets in use. The water supply is from the main service and with few exceptions draw-off taps are provided direct from the rising mains for dietetic purposes and where water is obtained from storage cisterns arrangements exist for maintaining the cisterns in cleanly condition. All schools including private schools were inspected periodically. Drainage extensions and sanitary improvements were carried out at five schools. There were no school closures during the year. 5. Legislation.—The following changes came into operation during 1937:— The Housing Act, 1936. January 1st. The Shops (Sunday Trading Restriction) Act, 1936. May 1st. The adoption of Byelaws with respect to "Houses intended or used for occupation by persons of the working classes and let in lodgings or occupied by members of more than one family," were confirmed by the Minister of Health on July 15th, and came into operation on September 1st. The Public Health Act, 1936. October 1st. SANITARY INSPECTION OF THE AREA. Report of the Senior Sanitary Inspector. In accordance with Article 27(18) of the Sanitary Officers' (Outside London) Regulations, 1935, I beg to submit the following particulars with regard to the work accomplished by the Sanitary Inspectors during the year 1937. Summary of the various inspections made by the Sanitary Inspectors:— Dwelling Houses— On complaint and other causes 479 Infectious disease enquiries 155 House-to-house inspections 652 Premises measured for purposes of Part IV of the Housing Act, 1936 183 Number of rooms measured in these premises 839 Rent Restriction Act enquiries 6 Total number of re-inspections for all purposes 5891 13 Other Premises— Schools 49 Factories 21 Workshops 29 Workplaces 18 Outworkers premises 17 Slaughterhouses 251 Carcases examined 1777 Butchers' shops and provision stores 488 Bakehouses 56 Fishshops 76 Dairies and Milkshops 74 Ice Cream dealers 45 Other Food premises 37 Rat infestation 102 Verminous premises 21 Petroleum installations 135 Shops Act 267 Premises where animals are kept 74 Smoke observations 6 Miscellaneous 97 Notices served— Informal:— Housing Act, 1936 498 Public Health Acts 338 Statutory:— Housing Act, 1936, Section 9 42 Housing Act, 1936, Section 59 2 Public Health Act, 1875, Section 41 17 Public Health Act, 1875, Section 94 2 Nature of the work executed and the improvements effected to dwelling- houses and premises, under the provisions of the Housing and Public Health Acts:— Dwellings— Roofs repaired or recovered 361 Rain water pipes and guttering provided or renewed 404 Dampness in walls remedied 688 Dilapidated walls under-pinned or repaired 137 Wall or ceiling plaster renewed or repaired 786 Walls and ceilings cleansed 1017 Floors renewed or repaired 283 Air space and ventilation provided under floors 125 Window-frames and sashes renewed or repaired 593 Doors and frames renewed or repaired 120 Door and window furniture renewed or repaired 247 Room light or ventilation improved 26 Sash cords renewed 283 Staircases repaired or handrails provided 95 Stoves and coppers renewed or repaired 455 Chimney pots and stacks renewed or repaired 47 14 Sanitary Conveniences and Drains— Sinks provided or renewed 105 Sink, bath and lavatory waste pipes renewed or repaired 171 Water-closets renewed or structurally repaired 109 Water-closet pans renewed 126 Water-closet flushing cisterns renewed or repaired 121 Soil or ventilating pipes provided or renewed 75 Obstructions removed from drains 113 Defective drains relaid or repaired 122 Houses entirely redrained 72 Miscellaneous— Yard paving provided, renewed or repaired 229 Dust-bins provided 140 Verminous premises disinfested 15 Offensive accumulations removed 17 Nuisance from keeping of animals abated 2 Other repairs and renewals 296 Drainage— The drains provided or reconstructed (on 72 premises) were distributed among the following roads:— Avenue Road; Cambridge Park; Chase Road; Chaucer Road; Chelmsford Road; Cleveland Road; Fullers Road; George Lane; Gordon Road, Wanstead; Grove Road, Wanstead; Grove Road, South Woodford; Horn Lane; Maybank Road; Malmesbury Road; Nightingale Lane; New Wanstead; Onslow Gardens; Pelham Road; Richmond Road; St. Mary's Avenue; Sunset Avenue; Tavistock Road; The Drive; Wellington Road; High Road, Woodford Bridge. Drain Testing.—The Council have a scheme in operation for those who wish to obtain information as to the condition of the drainage before purchase of a house. Upon application being made the house drainage is examined and tested with smoke and a certificate issued specifying the results of the examination at a charge of two per cent, of the gross assessment of the house. Certificates were granted in respect of eight premises. Rent and Mortgage Interest Restrictions Acts, 1920 to 1933.—Several enquiries were made by occupiers of premises with regard to their position under the Act, but notices served in respect of the conditions referred to usually had the desired effect. Two certificates were granted. Rats and Mice (Destruction) Act, 1919.—One hundred and two visits were paid to premises in connection with complaints received and in the majority of cases the source of rat infestation was definitely traced, the premises being freed of rats with the aid of a Cyanogas foot pump wherever this could be applied safely, or by means of Red Squill baits. During the National Rat Week, posters were displayed throughout the district drawing the attention of the public to the danger of rats and inviting their application to the Department for advice and for free baits, but, as constant measures are taken throughout the year the response on that occasion was small. 15 Petroleum (Regulation) Acts, 1928 and 1936.—Fifty-three licences were renewed at the beginning of the year. Five new licences for the storage of petroleum on premises Were granted and the use of three installations discontinued. The total number of premises under licence for storage of petroleum at the end of the year was therefore fifty-five and the total storage capacity under licence, 70,245 gallons. Game Licences.— The eight licences to deal in game were renewed. Section D. Housing. Number of New Houses erected during the Year:— (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies or persons 900 Total 900 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1170 (b) Number of inspections made for the purpose 5891 (2) (a) Number of dwelling-houses (included under subhead (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 652 (b) Number of inspections made for the purpose 3668 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 498 2. 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 795 3. 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 42 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 54 (b) By Local Authority in default of owners Nil 16 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 19 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 1 (b) By Local Authority in default of owners 14 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (d) Proceedings under section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil 4. Housing Act, 1936.—Part IV.—Overcrowding:— (a)(1) Number of dwellings overcrowded at the end of the year 18 (2) Number of families dwelling therein 18 (3) Number of persons dwelling therein 127a (b) Number of new cases of overcrowding reported during the year 3 (c) (1) Number of cases of overcrowding relieved during the year 15 (2) Number of persons concerned in such cases 120 (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 Nil (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of (1) Inspections. (2) Written Notices (3) Occupiers Prosecuted (4) Factories—Including Factory Laundries 21 ... ... Workshops—Including Workshop Laundries 29 ... ... Workplaces (other than Outworkers' premises) 18 4 ... Totals 68 4 ... 2.—DEFECTS FOUND. ' Particulars Number of Defects. Number of (1) Found (2) Remedied (3) Referred to H.M. Inspector (4) (5) Nuisances under the Public Health Acts:- Want of Cleanliness 8 8 ... ... Want of Ventilation 1 1 ... ... Sanitary accommodation unsuitable or defective 4 4 ... ... Other Nuisances 4 4 ... ... Offences under the Factory and Workshops Acts ... ... ... ... Totals 17 17 ... ... 18 Section E. Inspection and Supervision of Food. (a) Milk Supply.— Milk is no longer produced within the district for the purpose of sale. The number of persons and premises registered for the sale of milk within the district are as follows:— Premises registered as Dairies and Milkshops 17 Persons registered as retail purveyors of milk in sealed bottles 11 Persons registered as retail purveyors of milk whose premises are situated outside the district 2l Number of inspections 94 The premises concerned were generally well maintained; minor infringements of the Regulations were abated promptly. "Designated." Milk.— The number of licences granted for the sale of designated milk under the Milk (Special Designations) Order, 1936, and the results of samples taken, are as follows:— Designation. Licences Supplementary Licences. Samples. Results. Satisfactory. Unsatisfactory. Tuberculin Tested 9 4 7 7 ... Tuberculin Tested (Pasteurised) 2 2 ... Accredited 1 1 ... ... ... Pasturised 10 4 10 10 ... 19 The samples of milk taken for bacteriological examination under the Milk (Special Designations) Order, 1936, show the following results:— No. Designations. Result of Examination. Remarks 3 Tuberculin Tested Satisfied methylene blue reduction test. Bacillus Coliform— Absent. Satisfactory 9 ,, ,, ,, 10 ,, ,, ,, 13 ,, ,, ,, 14 ,, ,, ,, 16 ,, ,, ,, 42 ,, ,, ,, 7 Tuberculin Tested (Pasteurised) 120 bacteria per ml. Satisfactory 40 ,, 920 bacteria per ml. ,, 1 Pasteurised 4,600 bacteria per ml. Satisfactory 2 ,, 38,000 ,, ,, 8 ,, 322 ,, ,, 11 ,, 2,200 ,, ,, 15 ,, 81,000 ,, ,, 17 ,, 8,000 ,, ,, 41 ,, 4,660 ,, ,, 43 ,, 720 ,, ,, 49 ,, 490 ,, ,, 50 ,, 6,100 ,, ,, It will be observed that no unsatisfactory report was received upon the bacteriological examination of these samples. 20 Examination of Ordinary Milk.— The following table shows the results of thirty-three samples of ordinary milk subjected to bacteriological examination and animal inoculation test for tubercle bacilli:— No. No. of Bacteria per 1 ml. Presence of Bacillus Coliform. Presence of Tubercle Bacilli. Remarks 4 16,000 0.01 ml. Considered free Unsatisfactory 5 7,000 Absent Considered free Satisfactory 6 9,400 Absent Considered free Satisfactory 12 31,000 0.001 ml. ... Unsatisfactory 18 16,000 0.01 ml. ... Unsatisfactory 19 22,000 0.01 ml. ... Unsatisfactory 20 480,000 0.01 ml. Considered free Unsatisfactory 21 72,000 0.001 ml. Considered free Unsatisfactory 22 180,000 0.001 mi. Test inconclusive Unsatisfactory 23 600,000 0.001 ml. Unsatisfactory 24 24,000 Absent Considered free Satisfactory 25 18,000 Absent Test inconclusive Satisfactory 26 25,000 Absent Considered free Satisfactory 27 48,000 Absent Test inconclusive Satisfactory 28 240,000 0.01 ml. ... Unsatisfactory 29 110,000 0.01 ml. ... Unsatisfactory 30 180,000 0 01 ml. ... Unsatisfactory 31 120,000 0.001 ml. ... Unsatisfactory 32 8,500 Absent Considered free Satisfactory 33 13,000 Absent ... Satisfactory 34 15,800 0.01 ml. Considered free Unsatisfactory 35 9,000 Absent Considered free Satisfactory 36 190,000 0.001 ml. ... Unsatisfactory 37 3,200 Absent ... Satisfactory 38 22,000 0.01 ml. ... Unsatisfactory 39 7,100 Absent ... Satisfactory 44 210,000 0.001 ml. ... Unsatisfactory 45 42,000 0.01 ml. ... Unsatisfactory 46 4,800 Absent ... Satisfactory 47 96,000 0.01 ml. ... Unsatisfactory 48 520,000 0.01 ml. ... Unsatisfactory 51 11,000 Absent ... Satisfactory 52 6,600 Absent ... Satisfactory It will be observed that nineteen of the thirty-three samples examined were reported as unsatisfactory also that tubercle bacilli was considered to be free in all samples tested. The samples recorded as unsatisfactory were taken from producers consignments on delivery at the distributors premises and include consecutive samples taken prior to satisfactory results being reported. Particulars relating to the unsatisfactory samples were forwarded to the authorities concerned with the production of the milk in question and the co-operation of their Inspectors was obtained with regard to conditions affecting the milk supply on the producers premises. 21 Milk-in-Schools Scheme.— Three samples of milk supplied to schools in the district were taken by the Essex County Council for biological examination. These were reported to be satisfactory. Food and Drugs (Adulteration) Act, 1928.—Twenty-six samples of milk were taken from distributors and submitted for analysis. All of these samples were certified by the Public Analyst as being genuine milk. Ice Cream.— Under the provisions of the Essex County Council Act, 1933, with regard to the manufacture and sale of ice cream within the district, the number of premises and vendors registered under the Act was sixty-seven. This does not represent the total number of vendors concerned with the sale of ice cream within the district, as one registration under the Act is sufficient to cover sales throughout the county. Thirty-five samples of ice cream were submitted for bacteriological examination. Although there is no legal standard for bacterial purity in ice cream the Laboratory reported adversely upon seven samples. The premises in question were visited and advice given regarding the cleanliness of utensils and other conditions relating to manufacture and storage. Three consecutive samples taken from a manufacturer's premises were found to be unsatisfactory owing to a faulty plant and arrangements were made by the proprietor to install a new sterilizing apparatus on the premises. Owing to the close of the season the manufacture of ice cream ceased and no further samples were obtained. In the four other cases of unsatisfactory samples, secondary samples gave satisfactory results. (b) Meat and other Foods.— There are nine slaughterhouses in the district, four are registered and five are subject to annual licensing. Under the Slaughter of Animals Act, 1933, nineteen slaughtermen are licensed for the slaughter of animals. No contraventions were observed. Two hundred and fifty-one visits were paid to slaughterhouses and one thousand seven hundred and seventy-seven carcases were examined following slaughter. The Public Health (Meat) Regulations, 1924, were observed satisfactorily. A very large proportion of the meat consumed in the district is obtained from the London Markets. There are no meat traders' stalls, and the butcher's shops are provided with glass fronts. 22 Carcases Inspected and Condemned.— Cattle excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed (if known) 30 Nil 40 1340 367 Number inspected 30 Nil 40 1340 367 All diseases except Tuberculosis Whole carcases condemned Nil Nil Nil Nil Nil Carcases of which some port or organ was condemned 1 Nil 1 2 12 Percentage of the number inspected affected with disease other than tuberculosis 3.3 Nil 2.5 .15 3.27 Tuberculosis only. Whole carcases condemned Nil Nil Nil Nil 5 Carcases of which some part or organ was condemned Nil Nil Nil Nil 25 Percentage of the number inspected infected with tuberculosis Nil Nil Nil Nil 8.18 Unsound carcases and meat surrendered and destroyed following inspection totalled eight hundred and twenty pounds in weight. Other Food Premises.— Six hundred and forty-four visits were made to other premises in which food is prepared, stored or exposed for sale. Cleanliness and repair on these premises was well maintained and necessary requirements received due attention. Bakehouses.— There are fourteen bakehouses in the district; two of these are underground bakehouses. Fifty-six inspections were made and the provisions of the Bakehouse Regulations were observed satisfactorily. 23 Section F. Prevalence of, and Control over, Infectious and other Diseases. 1. (a) Smallpox.— No cases of Smallpox occurred during 1937. (b) Scarlet Fever.— There was a decrease in the number of cases from 149 to 96 during this year. No deaths occurred and most of the cases were mild. (c) Diphtheria.—46 cases of Diphtheria were notified. This is the smallest number recorded in the district for many years. There were 2 deaths. In March, 1936, a scheme was started by the Council for providing immunisation against diphtheria. The inoculations are given by the private practitioners of the district. For all cases of children between 1½ and 9 years of age attending the welfare centres or elementary schools, the material for inoculation is provided free and a fee of 3/6 per case is payable to the medical practitioner. In other cases free material for inoculation is provided on condition that a certificate of inoculation is given by the doctor. The material for inoculation is Alum Precipitated Toxoid of which one injection is given. The Schick test is not used. 160 injections were given during the year under this Scheme. (d) Puerperal Fever and Puerperal Pyrexia.— On October 1st, "Puerperal Fever" ceased to be a notifiable disease under this term, and since then has been included under the designation "Puerperal Pyrexia." Of the six cases notified, four occurred in a hospital within the Metropolitan area, one in a private nursing home and one in the patient's own home. (e) Typhoid and Paratyphoid Fever.— One case of typhoid fever and two cases of paratyphoid fever were notified. One death from typhoid was transferred to the district by the Registrar General. The patient was an inmate of a mental hospital and had not resided in the district for some years. (/) Dysentery.—Four cases of dysentery were notified. In three cases the Sonne bacillus was isolated from the stools. Particulars of the incidence of notifiable diseases during 1937 and an analysis of the cases in age groups are contained in accompanying tables. 24 2. (a) Cancer. Particulars with reference to the prevalence of this disease are as follows:— ANALYSIS OF DEATHS FROM CANCER. Site. Male. Female. Total 15—35 35—45 45—55 55—65 Over 65 15—35 35-45 45—55 55—65 Over 65 Colon ... ... 1 1 4 ... ... 1 2 2 11 Liver ... ... ... ... 2 ... ... ... 1 1 4 Rectum ... 1 2 2 2 ... ... ... 2 1 10 Stomach ... ... 2 2 5 ... ... ... 2 4 15 Other Digestive Organs ... ... ... 1 2 ... ... ... ... 4 7 Lung ... ... 1 ... 3 ... ... ... 1 2 7 Uterus ... ... ... ... ... ... ... ... 4 1 5 Ovaries ... ... ... ... ... ... 1 ... ... 1 4 Breast ... ... ... ... ... ... 2 ... 2 4 8 Bladder ... ... 1 2 1 ... ... ... ... 1 5 Prostate ... 1 1 2 ... ... ... ... 4 Other Sites 1 1 ... ... ... 2 1 5 Total 1 , 2 8 9 22 1 3 2 16 22 85 (b) Disinfection and Disinfestation. The disinfection of bedding and similar articles is done by the saturated steam process in a WashingtonLyons Disinfector; infected premises are sprayed with formalin and fumigated by burning formalin tablets. Number of rooms disinfected 410 Number of verminous rooms disinfested 48 Loads of bedding disinfected 245 Loads of bedding disinfected for Chigwell U.D.C. 61 Number of school classrooms disinfected 8 (c) Laboratory Work. The following specimens from Wanstead and Woodford were dealt with by the Counties Public Health Laboratories:— Diphtheria 397 Sputa 151 Typhoid 11 Ringworm — Miscellaneous 56 Total 615 (d) Tuberculosis. Public Health (Prevention of Tuberculosis) Regulations, 1925, and the Public Health Act, 1936, section 172. No action was necessary with regard to persons suffering from pulmonary tuberculosis employed in the milk trade. 25 3. Tuberculosis.— Particulars of new cases of tuberculosis and mortality from the disease during 1937:— Age Periods. NEW CASES. DEATHS. Pulmonary. Non-Pulmonary Pulmonary. Non-Pulmonary M F M F M F M F 0-1 ... ... ... ... ... ... ... ... 1-5 ... ... 1 ... ... ... 1 1 5-10 ... ... 1 ... ... ... ... ... 10-15 ... ... 2 ... ... ... ... ... 15-20 2 1 ... 2 ... 1 1 ... 20-25 2 4 ... 1 2 2 1 ... 25-35 5 6 1 ... 3 4 ... ... 35-45 3 3 2 ... 5 ... ... ... 45-55 5 2 ... ... 4 ... 1 ... 55-65 1 ... ... ... 2 2 ... ... 65 and upwards ... 3 ... ... 1 ... ... ... Totals 18 19 7 3 17 9 4 1 Eleven deaths occurred from non-notified cases of tuberculosis and the ratio of non-notified to total notified deaths from tuberculosis is therefore as eleven to thirty-one. 47 new cases were notified during the year. 13 cases were transferred into the district. 64 cases were removed from the Register. 197 cases remained on the Register at the close of the year. County Tuberculosis Scheme.— Dr. W. A. Bullough, Chief Tuberculosis Officer of the Essex County Council, has kindly furnished me with the following particulars of Wanstead and Woodford patients sent to institutions for treatment during 1937:- Pulmonary. Non-Pulmonary. Total M. F. M. F. Adults 15 12 1 1 29 Children — — 3 1 4 26 NOTIFICATION OF INFECTIOUS DISEASE. Small Pox Scarlet Fever Diphtheria Typhoid including Paratyphoid Erysipelas Tuberculosis Puerperal Fever Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerebro-apinai Fever Acute Poliomyelitis Other diseases Pulmonary Other Forma 1933 0 112 58 5 13 29 20 0 3 l 40 l 0 0 1934 0 223 70 1 29 33 18 3 4 0 34 0 2 0 1935 0 97 58 1 7 35 13 2 5 l 34 0 2 1 1936 0 149 53 3 13 33 12 2 4 0 41 0 2 1 1937 0 96 46 3 15 37 10 0 6 1 64 0 3 4 27 GASES OF INFECTIOUS DISEASES notified during the year 1937. Notifiable Diseases. Cases Notified in Whole District. Total Cases Notified in Institutions in the District. Total Cases Removed to Hospitals. Total Deaths. At Ages—Years At all Ages. Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 10 10 to 15 15 to 20 20 to 35 35 to 45 45 to 65 65 and upwds Diphtheria ... 2 6 2 4 15 9 4 4 ... ... ... 46 17 41 2 Scarlet Fever ... 4 7 12 7 47 10 1 5 3 ... ... 96 22 67 ... Enteric Fever ... ... ... ... ... 2 1 ... ... ... ... ... 3 ... 2 1 Puerperal Pyrexia ... ... ... ... ... ... ... ... 6 ... ... ... 6 5 5 ... Pneumonia 2 2 4 2 1 4 5 3 6 6 20 9 64 5 7 26 Erysipelas ... ... ... ... ... ... 1 ... 2 2 7 3 15 1 1 2 Dysentery ... ... ... ... ... 1 3 ... ... ... ... ... 4 ... 1 ... Ophthalmia Neonatorum 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Acute Poliomyelitis ... 1 ... 1 ... 1 ... ... ... ... ... ... 3 ... 2 ... Totals 3 9 17 17 12 70 29 8 23 11 27 12 238 50 128 31 28 VITAL STATISTICS OF WHOLE DISTRICT DURING PREVIOUS YEARS. Year. Population. Births Deaths. Infantile Mortality. Number. Rate. Number. Rate. Number. Rate per 1000 Births. 1933 46,550 529 11.1 457 9.8 28 52.9 1934 47,885 612 12.8 500 10.4 29 47.4 1935 50,010 605 12.1 488 9.8 22 36.4 1936 52,010 699 13.4 471 9.1 27 38.6 1937 53,850 720 13.4 522 9.7 29 40.3