LIBRARY BOROUGH OF WANSTEAD AND WOODFORD Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1938. WANS 3 BOROUGH OF WANSTEAD AND WOODFORD Annual Report OF THE MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1938. 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: Retired 31/12/38). Royal Sanitary Institute Certificate for Health Visitor. Miss H. Smith, S.R.N., S.C.M., Royal Sanitary Institute Certificate for Health Visitor. Mid wives, Miss E. Dixon, S.R.N., S.C.M. 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, 1938. Section A. Statistics and Social Conditions of the Area. Area (in acres) 3,824 Registrar-General's estimate of resident population, 1938 54,810 Number of inhabited houses (end of 1938) according to Rate Books 15,700 Rateable value (end of 1938) £566,982 Sum represented by a penny rate (1938-39) £2,225 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 727 368 359 Illegitimate 17 12 5 Total 744 380 364 Stillbirths 20 10 10 Deaths 521 264 257 Birth Rate per 1,000 of the estimated resident population 13.6 Rate per 1,000 total (live and still) births 26.2 Crude Death Rate per 1,000 of the estimated resident population 9.5 Adjusted Death Rate 9.2 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 30.9 Legitimate Infants per 1,000 legitimate live births 28.9 Illegitimate infants per 1,000 illegitimate live births 117.6 Deaths from Cancer (all ages) 84 Deaths from Measles (all ages) NIL Deaths from Whooping Cough (all ages) NIL Deaths from Diarrhoea (under 2 years of age) 2 Deaths at various ages during 1938. Age. No. of Deaths. Under 1 year 23 1—2 1 2— 5 7 5—15 10 15—25 12 25—35 22 35—45 23 45—55 42 55—65 89 65—75 152 75 and upwards 140 Total 521 5 INFANTILE MORTALITY DURING THE YEAR 1938. 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 7 1 ... ... 8 ... ... ... ... 8 Pneumonia 1 ... ... ... 1 1 1 ... ... 3 Enteritis ... ... ... ... ... 1 1 ... ... 2 Acute Bronchitis ... ... 2 ... 2 ... ... ... ... 2 Atelectasis 2 ... ... ... 2 ... ... ... ... 2 Convulsions ... ... 1 ... 1 ... ... ... ... 1 Spina Bifida 1 ... 1 ... 2 ... ... ... ... 2 Asphyxia ... ... ... ... ... ... 1 ... ... 1 Other Diseases Peculiar to early Infancy 1 ... ... ... 1 ... 1 ... ... 2 Total 12 1 4 ... 17 2 4 ... ... 23 6 The following is the Registrar-General's Short List of Deaths and Causes. CAUSES OF DEATH. M. F. All Causes. 264 257 1. Typhoid and paratyphoid fevers ... ... 2. Measles ... ... 3. Scarlet fever ... ... 4. Whooping cough ... ... 5. Diphtheria 1 • • • 6. Influenza ... 1 7. Encephalitis lethargica ... 1 8. Cerebro-spinal fever ... ... 9. Tuberculosis of respiratory system 14 10 10. Other tuberculous diseases 5 ... 11. Syphilis 1 ... 12. General paralysis of the insane, tabes dorsalis 2 ... 13. Cancer, malignant disease 42 42 14. Diabetes 6 6 15. Cerebral haemorrhage, etc. 13 26 16. Heart disease 61 61 17. Aneurysm 1 1 18. Other circulatory diseases 11 17 19. Bronchitis 11 8 20. Pneumonia (all forms) 15 11 21. Other respiratory diseases 2 2 22. Peptic ulcer 9 ... 23. Diarrhoea, etc. (under 2 years) 2 ... 24. Appendicitis 1 3 25. Cirrhosis of liver ... ... 26. Other diseases of liver, etc. ... 2 27. Other digestive diseases 4 6 28. Acute and chronic nephritis 5 3 29. Puerperal sepsis ... ... 30. Other puerperal causes ... ... 31. Congenital debility, premature birth, malformations, etc. 6 9 32. Senility 10 10 33. Suicide 4 2 34. Other violence 14 12 35. Other defined diseases 24 24 36. Causes ill-defined or unknown ... .... ... Special Causes (included in No. 35 above):— Smallpox ... ... Poliomyelitis ... ... Polioencephalitis 1 ... 7 Birth-rates. Death-rates, Analysis of Mortality, Maternal Death-rates, and Case-rates for certain Infectious Diseases in the year 1938. England and Wales, London, 125 Great Towns and 148 8maller 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: Rates per 1,000 Population Live 15.1 15.0 15.4 13.4 13.6 Still 0.60 0.65 0.60 0.48 0.36 Deaths: All Causes 11.6 11.7 11.0 11.4 9.5 Typhoid and Paratyphoid Fevers 0.00 0.00 0.00 0.00 0.00 Smallpox 0.00 — 0.00 — 0.00 Measles 0.04 0.05 0.03 0.06 0.00 Scarlet Fever 0.01 0.01 0.01 0.01 0.00 Whooping Cough 0.03 0.03 0.02 0.03 0.00 Diphtheria 0.07 0.07 0.06 0.05 0.02 Influenza 0.11 0.10 0.11 0.06 0.02 Notifications: Smallpox 0.00 0.00 0.00 — 0.00 Scarlet Fever 2.41 2.60 2.58 2.05 1.51 Diphtheria 1.58 1.85 1.53 1.90 0.64 Enteric Fever 0.03 0.03 0.04 0.05 0.02 Erysipelas 0.40 0.46 0.39 0.46 0.44 Pneumonia 1.10 1.28 0.98 0.98 0.71 Deaths under 1 year of age Rates per 1,000 Live Births 53 57 51 57 31 Deaths from Diarrhoea and Enteritis under 2 years of age 5.5 7.8 3.6 13.1 27 Maternal Mortality: Puerperal Sepsis 0.89 0.00 Others 2.19 Not available 0.00 Total 3.08 0.00 Rates per 1,000 Total Births {i.e. Live & Still) Maternal Mortality: Puerperal Sepsis 0.86 0.00 Others 2.11 Not av ailable 0.00 Total 2:97 0.00 Notifications: Puerperal Fever Puerperal Pyrexia 14.42 18.08 12.51 3.53 15.46 14.78 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 five centres in the district: — (i) St. Barnabas Church Hall, Snakes Lane. (ii) Fuller's Road Sunday School. (iii) Baptist Church Hall, Aldersbrook. (iv) Ashton Playing Fields Pavilion, Chigwell Road. These are supported and directed by the Borough Council. (v) Holy Trinity Church Hall, Hermon Hill. This is under the direction of a voluntary committee, but is subsidised by the Council. Owing to the increase in the child population of the district it was decided to open a new clinic at the Ashton Playing Fields Pavilion, Chigwell Road. The Centre was inaugurated on June 28th by Lady Hawkey, the Mayoress. The need for this Centre has been proved by the satisfactory and steadily increasing attendances. 9 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. (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 for confinement. (ii) WTith Waltham Joint Hospital, for the reception of cases of Puerperal Pyrexia. 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; Puerperal Pyrexia. 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.—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 182 (b) As Maternity Nurses 54 Number of visits paid by these Midwives:— (a) Number of cases 236 (b) Ante-natal visits 1631 (c) Nursing visits 3962 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 patient's choice. In necessitous cases the fees for the medical services are paid by the Council. In 1938 payments were made to medical practitioners in thirty cases. 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.—Over fifty per cent.—400 out of 739—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) Waltham Joint Hospital, for the reception of cases of Puerperal Pyrexia. 3. Health Visitors.—Nurse Clarke, who previously had divided her services between the Essex County and the Wanstead and Woodford Borough, left us at the end of the year to work entirely under the Essex County Council. I should like to take this opportunity of thanking her for the valuable work she performed in Wanstead for so many years. A full time Health Visitor has now been appointed to take her place. The following particulars of the work done by the Health Visitors 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 611 Total visits 1436 (b) To children between the ages of one and five years:— Total visits 2331 Infant Welfare Centres.—The following attendances were recorded at the five Centres serving the Wanstead and Woodford residents: — (a) Children under one year of age 9024 (b) Children between the ages of one and five years 6112 4. Child Life Protection.—The Health Visitors are appointed Child Life Protection Visitors under Part VII of the Public Health Act, 1936, There were twenty-one foster-mothers and forty-one children on the Register at the end of the year. A total of two hundred and eight visits were paid by the Visitors. 11 5. (a) Arrangements for Dental Cases.—Arrangements were made with the local dentists in 1937 to undertake the dental treatment of expectant and nursing mothers and children under school age. Their charges are on an agreed scale and the fees payable by the patients are assessed according to their means, on a scale similar to that of the Essex County Council. During the year 1938, thirteen mothers and two children were treated under this Scheme. (b) Arrangements for Orthopaedic cases.—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. In suitable cases the Wanstead and Woodford Borough Council have paid the fees for the admission of orthopaedic cases to Brookfield Orthopaedic Hospital. 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 Eastern Sewage Disposal Works at Chigwell Road have been enlarged at a cost of £42,658 to deal with a population of 48,000 persons estimated to be attained in 1944, but recent development tends to show that this figure will obtain before that year. Consequent on the development of the Roding Farm Estate, Wanstead, an 18-ins. diameter sewer was relaid and the trunk sewer crossing this land was strengthened and additional manholes provided to facilitate cleansing at a cost of £1,200. Investigations having proved the trunk sewer through Wanstead Park defective, work is now proceeding in the laying of a new 45-ins. by 30-ins. sewer at a cost of £13,500. 2. Rivers and Streams.- The analyses of samples of effluent discharged from the various works have been satisfactory to the authorities concerned. 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 has continued to be carried out under contract requiring the maintenance of a weekly collection throughout the district and the disposal of the refuse under controlled tipping conditions. The present contract dating from March is for a period of three years, the contractor providing mechanised transport only. Council owned land in the Borough is used for the tipping of 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 and Offices.—Under the provisions of the Shops Acts, 1934, a total of two hundred and sixty shop inspections were recorded. Improvements with regard to ventilation and temperature of shops and to sanitary conveniences were effected upon eleven premises. 12 (5) Camping Sites.—There are no camping sites in the district. (6) Smoke Abatement.—One warning was issued with regard to the use of an open brick burning kiln, but further action was unnecessary. (7) Swimming Baths and Pools.—Swimming baths are provided at one Public School, one Private School, one Secondary School and at two large institutions in the district, but are not open to the public. The public are permitted to bathe in two of the lakes in Wanstead Park which are controlled by the Corporation of the City of London. (8) Eradication of Bed Bugs.—The eradication of the bed bug depends primarily upon the co-operation of both landlords and tenants of infested premises and the owner is therefore requested not only to strip wall papers but also loose woodwork including skirtings, architraves and picture rails from the walls of the rooms in question, and to burn off the surfaces exposed with the blow lamp. This procedure is followed by the spraying of all infested surfaces with an insecticide and the removal of infested bedding for steam disinfection. The premises are kept under observation for the following three weeks and during that period the co-operation of the tenant is important in maintaining cleanliness and preventing reinfestation from any eggs of the bugs which may have escaped contact with the blow lamp or insecticide. The number of premises disinfested was nine including three Council owned houses. The insecticides used were Pyagra and Deodex preparations. Spraying and steam disinfestation is carried out by the staff of the Public Health Department. 4. Schools.—One Public School, one Secondary School and eight Elementary Schools are situated in the district. 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 where water is obtained from storage cisterns, draw-off taps are provided direct from the rising mains for drinking purposes. All schools, including private schools, were inspected periodically. The various repairs and improvements carried out included:— Drainage extension or repair on two premises; urinal stalls renewed on three premises; improved sanitary arrangements on two premises and drinking water supply direct from main on three premises. The children of one classroom were excluded from school for two weeks following the occurrence of a series of cases of Scarlet Fever in that one class. 5. Legislation.—The Factories Act, 1937, came into operation on July 1st, 1938. 13 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 1938. Summary of the various inspections made by the Sanitary Inspectors:— Dwelling Houses— On complaint and other causes 497 Infectious disease enquiries 178 House-to-house inspections 511 Premises measured for purposes of Part IV of the Housing Act, 1936 31 Number of rooms measured in these premises 143 Rent Restriction Act enquiries 5 Total number of re-inspections for all purposes 4409 Other Premises— Schools 118 Factories 131 Outworkers premises 13 Slaughterhouses 264 Carcases examined 2221 Butchers' shops and provision stores 394 Bakehouses 44 Fishshops 108 Dairies and Milkshops 64 Ice Cream dealers 38 Other Food premises 59 Rat infestation 152 Verminous premises 12 Petroleum installations 132 Shops Act 268 Premises where animals are kept 71 Smoke observations 3 Miscellaneous 710 Notices served— Informal: — Housing Act, 1936 271 Public Health Acts 358 Statutory:— Housing Act, 1936, Section 9 22 Housing Act, 1936, Section 11 8 Public Health Act, 1936, Section 24 14 Public Health Act, 1936, Section 39 14 Public Health Act, 1936, Section 84 1 Nature of the work executed and the improvements effected to dwellinghouses and premises, under the provisions of the Housing and Public Health Acts: — 14 Dwellings— Roofs repaired or recovered 304 Rain water pipes and guttering provided or renewed 394 Dampness in walls remedied 540 Dilapidated walls under-pinned or repaired 130 Wall or ceiling plaster renewed or repaired 582 Walls and ceilings cleansed 817 Floors renewed or repaired 52 Air space and ventilation provided under floors 67 Window-frames and sashes renewed or repaired 39 Doors and frames renewed or repaired 93 Door and window furniture renewed or repaired 130 Room light or ventilation improved 17 Sash cords renewed 338 Staircases repaired or handrails provided 87 Stoves and coppers renewed or repaired 468 Chimney pots and stacks renewed or repaired 46 Sanitary Conveniences and Drains— Sinks provided or renewed 104 Sink, bath and lavatory waste pipes renewed or repaired 139 Water-closets renewed or structurally repaired 81 Water-closet pans renewed 96 Water-closet flushing cisterns renewed or repaired 120 Soil or ventilating pipes provided or renewed 57 Obstructions removed from drains 62 Defective drains relaid or repaired 124 Houses entirely redrained 51 Miscellaneous— Yard paving provided, renewed or repaired 233 Dust-bins provided 120 Offensive accumulations removed 18 Nuisance from keeping of animals abated 13 Other repairs and renewals 275 Drainage— It may be noted from the preceding details that the number of house drains renewed or repaired during the year was one hundred and twentyfour. The premises redrained were situated in the following roads: — Blake Hall Road; Clarendon Road; Cleveland Road; Church Path; Fullers Road; Forest Road; Grove Road, Wanstead; Grove Road, Woodford; High Road, South Woodford; Horn Lane; Ingatestone Road, Woodford Green; Lakehouse Road; Maybank Road; Monkhams Lane; Prospect Road; Peel Road; Ray Lodge Road; Selsdon Road; Sunset Avenue; Warwick Road. 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 six premises. 15 Factories Act, 1937.—Certificates with regard to means of escape in case of fire were granted in respect of three factories. 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 fifty-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. Petroleum (Regulation) Acts, 1928 and 1936.—Fifty-five licences were renewed at the beginning of the year. Six 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-eight and the total storage capacity under licence 86,505 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 ... ... ... 810 Total ... ... ... ... ... 810 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) 1085 (b) Number of inspections made for the purpose 4409 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 511 (b) Number of inspections made for the purpose 2517 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (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 845 16 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 825 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 22 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 22 (b) By Local Authority in default of owners Nil (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 21 (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 .. 20 (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 4 (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 16 (2) Number of families dwelling therein 16 (3) Number of persons dwelling therein 115½ (b) Number of new cases of overcrowding reported during the year 2 (c)(1) Number of cases of overcrowding relieved during the year 4 (2) Number of persons concerned in such cases 22½ (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 17 FACTORY AND WORKSHOP ACT, 1901, AND THE FACTORIES ACT, 1937. 1. Inspections for the purposes of provisions as to health. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power 31 1 ... Factories without mechanical power 80 5 ... Other premises (other than Outworkers' premises) 20 5 ... Total 131 11 ... 2. Defects found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness 8 8 ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate Ventilation 4 4 ... ... Ineffective drainage of floors 3 3 ... ... Sanitary Conveniences:— ... ... ... ... 1. Insufficient 2 2 ... ... 2. Unsuitable or defective 2 2 ... ... 3. Not separate for sexes 1 1 ... ... Other Offences ... ... ... ... Total 20 20 ... ... 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 13 Persons registered as retail purveyors of milk whose premises are situated outside the district 20 Number of inspections 74 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 8 5 7 7 ... Tuberculin Tested (Pasteurised) 1 1 ... Accredited 1 1 ... ... ... Pasteurised 9 5 4 4 ... 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 2 Tuberculin Tested Satisfied methylene blue reduction test. Satisfactory 14 ,, ,, ,, 18 ,, ,, 20 ,, ,, 21 Tuberculin Tested (Certified) ,, ,, 23 Tuberculin Tested ,, ,, 31 ,, ,, ,, 17 Tuberculin Tested (Pasteurised) 960 bacteria per ml. Satisfactory 16 Pasteurised 1,200 bacteria per ml. Satisfactory 19 ,, 1,800 ,, ,, 22 ,, 42,000 ,, ,, 25 ,, 12,000 ,, ,, It will he 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 twenty 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 in 0.01 ml. Presence of Tubercle Bacilli. Remarks. 1 4,600 Absent ... Satisfactory 3 7,000 Absent Considered free Satisfactory 4 180,000 Present Considered free Unsatisfactory 5 42,000 Present Considered free Unsatisfactory 6 54,000 Absent Considered free Satisfactory 7 24,000 Absent ... Satisfactory 8 48,000 Absent Considered free Satisfactory 9 3,000 Absent Considered free Satisfactory 10 3,800 Absent Considered free Satisfactory 11 42,000 Absent Considered free Satisfactory 12 3,200 Absent Considered free Satisfactory 13 4,800 Absent Considered free Satisfactory 15 72,000 Present Considered free Unsatisfactory 24 290,000 Present Considered free Unsatisfactory 26 72,000 Present ... Unsatisfactory 27 56,000 Present Considered free Unsatisfactory 28 9,600 Absent Considered free Satislactory 29 11,000 Absent Considered free Satisfactory 30 15,000 Absent Considered free Satisfactory 32 54,000 Present ... Unsatisfactory It will be observed that seven of the twenty samples examined were reported as unsatisfactory but that tubercle bacilli was considered to be absent 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. Milk-in-Schools Scheme.—Seven samples of milk supplied to schools in the district were taken by the Essex County Council for bacteriological examination. These were reported to be satisfactory. Food and Drugs (Adulteration) Act, 1928.—Twenty-nine samples of milk were taken from distributors and submitted for analysis. One sample was certified by the Public Analyst as deficient in milk fat to the extent of at least five per cent, of the normal quantity proper to natural milk; the remainder of the samples were certified as being genuine milk. The sample in question was taken from a distributor from an adjoining district and upon enquiry it appeared that samples which had recently been taken from milk consignments on their delivery at the dairy had given 21 similar results. The matter was taken up by the Essex County Council at the farm where the milk was produced. A further sample taken from this source proved to be satisfactory. 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 premised registered under the Act was seventytwo. 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. Twenty-four 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 three samples. The premises in question were visited and advice given regarding the cleanliness of utensils and other conditions relating to manufacture and storage and further 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 sixty-four visits were paid to slaughterhouses and two thousand two hundred and twenty-one 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) 22 Nil 28 1850 321 Number inspected 22 Nil 28 1850 321 All diseases except Tuberculosis Whole carcases condemned Nil Nil 1 Nil 1 Carcases of which some part or organ was condemned ... Nil Nil Nil 5 5 Percentage of the number inspected affected with disease other than tuberculosis Nil Nil 3.57 .27 2.1 Tuberculosis only. Whole carcases condemned Nil Nil Nil Nil 1 Carcases of which some part or organ was condemned Nil Nil Nil Nil 9 Percentage of the number inspected infected with tuberculosis Nil Nil Nil Nil 3.1 Unsound carcases and meat surrendered and destroyed following inspection totalled twenty-seven stone; other unsound food totalled 168 pounds. Other Food Premises.—Four hundred and eighty-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. Sixty-two 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 1938. (b) Scarlet Fever.—Eighty-three cases were notified and no deaths occurred. There has been a further decrease in the number of cases, the number recorded being the lowest since 1926. (c) Diphthria.—Thirty-five cases were notified and one death occurred. This is the lowest number of cases recorded since 1923. One hundred and eighty-four prophylactic inoculations against diphtheria were given under the Council's scheme. I regard this as a disappointingly small number. It is difficult to make the public recognise that this inoculation requires at least two months to produce immunity and is therefore useless as an immediate protective when the disease is prevalent, but of the greatest value if given in time. (d) Pneumonia.—The number of cases notified was much less than last year, thirty-nine compared with sixty-four, but the number of deaths, twenty-six, was the same in both years. (e) Puerperal Pyrexia.—This is the first full year in which notification of puerperal fever and puerperal pyrexia have been joined together for the purposes of notification under the name Puerperal Pyrexia. There was an increase of four compared with the combined notifications of puerperal fever and puerperal pyrexia last year. (f) Typhoid and Paratyphoid Fevers.—One case of Paratyphoid B. was notified. (g) Dysentery.—Three cases were notified. (h) Ophthalmia Neonatorum.—Four cases were notified. In no case was there any impairment of vision. (i) Acute Poliomyelitis.—Two cases occurred in the district; both were adults. One boy, whose home was in Woodford, died of the disease in a London Hospital where he had been taken from a boarding school in another district. (j) Encephalitis Lethargica.—No cases were notified. As can be seen from the statistics given, the year 1938 was a very healthy one in this district. This is perhaps to be accounted for by the almost complete absence of influenza. An epidemic of influenza in the early part of the year not only incapacitates or kills its victims during the epidemic, but produces a lowered state of resistance to disease in the community which tends to allow other diseases to become more prevalent. Particulars of the incidence of notifiable diseases during 1938 and an analysis of the cases in age groups are contained in the 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 2 4 ... ... ... 5 5 18 Liver ... ... ... ... 2 ... ... ... ... 3 5 Rectum ... 1 1 1 1 ... ... ... ... 2 6 Stomach ... ... 1 2 5 ... ... ... 2 1 11 Other Digestive Organs ... ... ... 1 4 ... ... ... ... 3 8 Lung ... ... ... 3 2 ... 1 ... ... 1 8 Uterus ... ... ... ... ... ... ... 1 ... 3 4 Ovaries ... ... ... ... ... 2 ... 1 ... 1 4 Breast ... ... ... ... ... ... ... 2 ... 4 7 Bones 2 ... ... ... 1 ... ... ... ... ... 3 Prostate ... ... ... 1 1 ... ... ... ... ... 2 Other Sites 2 ... ... 1 2 ... 1 ... 1 1 8 Total 4 2 3 11 22 2 2 4 10 24 84 (6) 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 366 Number of verminous rooms disinfested 19 Loads of bedding disinfected 218 Loads of bedding disinfected for Chigwell U.D.C. 144 Number of school classrooms disinfected 19 (c) Laboratory Work. The following specimens from Wanstead and Woodford were dealt with by the Counties Public Health Laboratories: — Diphtheria 686 Sputa 188 Typhoid 8 Ringworm — Miscellaneous 65 Total 947 (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 1938: — 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 ... 5-10 ... ... 4 1 ... ... 2 ... 10-15 1 ... 5 1 ... ... 1 ... 15-20 1 3 1 2 1 1 1 ... 20-25 2 2 2 1 2 1 ... ... 25-35 4 7 ... 1 3 2 ... ... 35-45 1 6 ... 1 9 2 ... ... 45-55 5 2 ... ... 2 1 ... ... 55-65 2 ... ... 1 3 3 ... ... 65 and upwards ... 1 ... ... 1 ... ... ... Totals 16 21 14 8 14 10 5 0 Six deaths occurred from non-notified cases of tuberculosis and the ratio of non-notified to total notified deaths from tuberculosis is therefore as six to twenty-nine. 59 new cases were notified during the year. 14 cases were transferred into the district. 76 cases were removed from the Register. 200 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 1938:— Pulmonary. Non-Pulmonary. Total. M. F. M. F. Adults 11 17 2 1 31 Children 1 — 4 2 7 26 NOTIFICATION OF INFECTIOUS DISEASE. Small Pox Scarlet Fever Diphtheria Typhoid including Paratyphoid Erysipelas Tuberculosis Puerperal Fever Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerebro-splnal Fever Acute Poliomyelitis Other diseases Pulmonary Other Forms 1934 0 223 70 l 29 33 18 3 4 0 34 0 2 0 1935 0 97 58 l 7 35 13 2 5 l 34 0 2 l 1936 0_ 149 53 3 13 33 12 2 4 0 41 0 2 l 1937 0 96 46 3 15 37 10 0 6 1 64 0 3 4 1938 0 83 35 1 24 37 22 11 4 39 0 2 3 27 CASES OF INFECTIOUS DISEASES notified during the year 1938. 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 1 1 3 1 3 14 6 2 4 ... ... ... 35 8 25 1 Scarlet Fever ... 1 2 4 3 43 14 7 7 1 1 ... 83 7 47 ... Enteric Fever ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... Puerperal Pyrexia ... ... ... ... ... ... ... ... 10 1 ... ... 11 3 6 ... Pneumonia 4 1 2 1 2 3 1 ... 5 3 9 8 39 4 6 26 Erysipelas ... ... ... ... ... 1 3 ... 4 3 8 5 24 2 3 ... Dysentery ... 1 ... 1 ... ... ... ... 1 ... ... ... 3 ... ... ... Ophthalmia Neonatorum 4 ... ... ... ... ... ... ... ... ... ... ... 4 2 3 ... Acute Poliomyelitis ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 1 ... Totals 9 4 7 7 8 61 24 9 33 9 18 13 202 26 91 27 28 VITAL STATISTICS OF WHOLE DISTRICT DURING PREVIOUS YEARS. Year. Population. Births. Deaths. Infantile Mortality. Number. Rate. Number. Rate. Number. Rate per 1000 Births. 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 1938 54,810 744 13.6 521 9.5 23 30.9