WANS 4 LIBRARY BOROUGH OF WANSTEAD AND WOODFORD. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR ENDING 31st DECEMBER, 1939. ' 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., (a)(c). DEPUTY SENIOR SANITARY INSPECTOR E. Jackson, M.R.San.I., M.S.I.A., (b)(c)(d) (from 27/3/39). SANITARY INSPECTORS G. A. Hiller, M.R.San.I., M.S.I.A., (b)(c)(d) (to 7/1/39). A. J. Storer, M.S.I.A. (b). SANITARY INSPECTOR AND SENIOR CLERIC L. G. Howard, M.S.I.A., (b)(c) (from 28/8/39). HEALTH VISITORS Miss H. Smith, S.R.N., S.C.M. (e) (to 12/39). Miss H. Hird, S.C.M. (e) (from 17/4/39). MIDWIVES Miss E. Dixon, S.R.N., S.C.M. Miss S. Jones, S.C.N. Mrs. L. Straw, S.C.M., (retired 31/8/39). CLERKS F. E. Farrington. S. C. Hearson (from 31/7/39). (a) Royal Sanitary Institute Certificate for Sanitary Inspector. (b) Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board Certificate. (c) Royal Sanitary Institute Certificate for Inspector of Meat and Other Foods. (d) Royal Sanitary Institute Certificate for Sanitary Science as applied to Buildings and Public Works. (e) Royal Sanitary Institute Certificate for Health Visitor. 1 o. wanstead and woodford borough council. annual report of the medical officer of health. For the Year Ending 31st December, 1939. In accordance with the directions of the Minister of Health, I have curtailed the report for the year 1939 far as possible. The Minister directs that the report should be confined to essential and urgent natters Which have affected the Public Health during the year, especially in matters arising from or connected with the War, outbreaks of Infectious Disease, and measures in Maternity and Child Welfare, together with any exceptional administrative measures taken or recommended by the Medical Officer of Health. In the year under review, the War had no profound effect on the Public Health. A number of people left the district, particularly those who were not of military age and who were unfitted to take active part in War work. At the beginning of the War, this Borough was not officially an evacuation area, but in September, 1939, The Borough was declared an evacuation area. The incidence of Infectious Disease throughout the year was exceptionally low. Our Maternity and Child Welfare service continued its work vigorously throughout the year, there being increased attendances at all Centres. The health and physique of the children of the district is remarkably good. Section A. Statistics and Social Conditions of the Area. Area (in acres) 3,824. Registrar-General's estimate of:- A - Resident population mid 1939 55,880. B - Average population appropriate to the calculation of death rates 53,260. Number of inhabited houses (end of 1939) according to Rate Books 16,000. Rateable value (end of 1939) £590,287. Sum represented by a penny rate (1939-40) £2,271. EXTRACTS FROM VITAL STATISTICS OF THE YEAR. Live Births. (a) for calculating birth rates. Legitimate Males 393. Females 343. TOTAL 736. Illegitimate „ 8 „ 19. „ 27. TOTAL „ 401. „ 362. „ 763. (b) for calculating infantile and maternal mortalities. Legitimate Males 380. Females 334. TOTAL 714. Illegitimate „ 8. „ 19. „ 27. TOTAL „ 388. „ 353 „ 741. Birth rate per 1,000 of the estimated resident population - 13.7 Stillbirths. Legitimate Males 16. Females 19. TOTAL 35. Illegitimate „ 1. „ 0. „ 1. TOTAL „ 17. „ 19. „ 36. Rate per 1,000 total (live and still) births - 45.1 Deaths. Males - 268. Females - 287. TOTAL - 555. Crude Death Rate per 1,000 of the estimated resident population. - 10.4. Adjusted Death Rate - 10.1. 4. Death from puerperal causes:- Puerperal Sepsis 1 Other puerperal causes 1 Total 2 Rate per 1,000 total (live and still) births, 2.7 Death Rate of Infants under one year of age:- All infants per 1,000 live births 37.8 Legitimate infants per 1,000 legitimate live births 39.2 Illegitimate infants per 1,000 illegitimate live Nil. births Deaths from Cancer (all ages) 106 Deaths from Measles (all ages) Nil Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 2 Comparative Birth-rates and Death-rates for the year 1939. (Provisional Figures based on Weekly and Quarterly Returns). Births Deaths Live Still All Causes England and Wales. 15.0 0.59 12.1 125 County Boroughs and Great Towns, including London. 14.8 0.59 12.0 148 Smaller Towns (Resident populations 25,000 to 50,000 at 1931 Census) 15.6 0.57 11.2 London Administrative County. 12.3 0.44 11.9 Borough of Wanstead & Woodford. 13.7 0.64 10.4 (Rates per 1,000 Population). 5. The following is the Registrar-General's Short List of Deaths and Causes. CAUSES OF DEATH. M. F. All Causes 268 287 1. Typhoid and paratyphoid fevers 2 .. 2. Measles .. .. 3. Scarlet fever .. .. 4. Whooping cough .. 1 5. Diphtheria .. .. 6. Influenza 4 10 7. Encephalitis lethargica 1 .. 8. Cerebro-spinal fever .. .. 9. Tuberculosis of respiratory system 15 7 10. Other tuberculous diseases 2 1 11. Syphilis .. .. 12. General paralysis of the insane, tabes dorsalis 1 .. 13. Cancer, malignant disease 51 55 14. Diabetes 5 4 15. Cerebral haemorrhage, etc. 11 27 16. Heart disease 67 53 17. Aneurysm 3 1 18. Other circulatory diseases 8 18 19. Bronchitis 7 9 20. Pneumonia (all forms) 10 12 21. Other respiratory diseases .. 3 22. Peptic ulcer 5 .. 23. Diarrhoea, etc. (under 2 years) 2 .. 24. Appendicitis 1 .. 25. Cirrhosis of liver 1 .. 26. Other diseases of liver, etc. .. 6 27. Other digestive diseases 5 6 28. Acute and chronic nephritis 6 4 29. Puerperal sepsis .. 1 30. Other puerperal causes .. 1 31. Congenital debility, premature birth, malformations, etc. 12 9 32. Senility 7 28 33. Suicide 6 5 34. Other voilence 12 6 35. Other defined diseases 23 20 36. Causes ill-defined or unknown .. .. Diarrhoea (2 years and over) 1 .. Special Causes (included in No. 35 above):- Anthrax .. 1 Poliomyelitis .. .. Polioencephalitis .. .. 6. 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. Dr. Bernard Dyer and Mr. George Taylor were appointed by the Council as Public Analysts for the purpose of the Food & Drugs Act, 1938. (b) Ambulance facilities:- (1) For infectious diseases. All cases requiring removal to hospital are conveyed by the ambulances attached to the hospitals. (2) 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:- (1) By private nurses; (2) 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 arc five centres in the districs:- (1) St. Barnabas Church Hall, Snakes Lane. (2) Fuller's Road Sunday School. (3) Baptist Church Hall, Aldersbrook. (4) Ashton Playing Fields Pavilion, Chigwell Road. These are supported and directed by the Borough Council. (5) Holy Trinity Church Hall, Hermon Hill. This is under the direction of voluntary committee, but is subsidised by the Council. The following treatment centres in the district are under the control of the County Council:- (1) The Tuberculosis Dispensary. (2) The School Clinic. (3) The Orthopaedic Clinic. (Conjointly with the British Red Cross Society). (4) The Mental Treatment Clinic. These all find accommodation at The Shrubberies, High Road, South Woodford. 7. (e) Hospitals. Public and Voluntary:- Maternity. There are no maternity hospitals in the district. Arrangements were in force until the end of the year, with, (1) Queen Mary's Hospital, Stratford, for the reception of cases recommended by a doctor for hospital treatment, and also cases where the home conditions were unsuitable for confinement. (2) With 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 nd 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 171 (b) As Maternity Nurses 47 Number of visits paid by these Midwives:- (a) Number of cases 218 (b) Ante-natal visits 2,284 (c) Nursing visits 3,580 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 1939 payments were made to medical practitioners in twenty-nine cases. Consultant.- Owing to the death of Mr. John Ellison, F.R.C.S. (Ed), this appointment is now vacant. (2) Institutional Provision for Mothers or Children.- Over fifty per cent - 385 out of 709 biths in Wanstead and Woodford occurred in private nursing homes. Arrangements were 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. 8. 3. Health Visitors:- Miss Smith resigned her appointment at the end of the year. She had been with us three years, and was a most valuable worker, whose help I am Very sorry to have lost. 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 6l8 Total visits 1,504 (b) To children between the ages of one and five years:- Total visits 1,839 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 9,963 (b) Children between the ages of one and five years 5,545 4. Child Life Protection.- The Health Visitors are appointed Child Life Protection Visitors under Part VII of the Public Health Act, 1936. There were fourteen fostermothers and eighteen foster children on the Register at the end of the year. A total of three hundred and forty-one visits were paid by the Visitors. 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 1939, twenty-three mothers and eight 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. 9- 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 - No change. 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, 1938, 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 fifty eight shop inspections were recorded. Improvements with regard to ventilation and temperature of shops and to sanitary conveniences were effected upon eight premises. Under the Shops (Hours of Closing) Act, 1928, convictions were obtained against the proprietors of shop premises used for the sale of second hand motor cars, both in respect of prohibited closing hours and failure to observe the required weekly half-day closing. Ten shop keepers were warned against minor contraventions of the Act. (5) Camping Sites - There are no camping sites in the district. (6) Smoke Abatement - No instance of smoke nuisance came under observation. (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, these are supplied from the service water mains. Two schools have open swimming baths. Samples taken from baths and swimming pools were reported upon by the bacteriologist as not being up to the standard of purity required, and further samples taken from school premises following more efficient operation of treatment plants indicated considerable improvement, although one report was again unsatisfactory. The authorities concerned with the latter report agreed to change the water more frequently and at the same time had under consideration the question of providing a modern filtration and chlorination apparatus. 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 means employed for the eradication of the bed bug as outlined in previous reports has been continued with satisfactory results. The number of premises disinfested was nine, including five 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. 10. 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. Considerable building extensions were carried out at one elementary school, whilst extensions and repairs to sanitary arran gements were also carried out at three other schools, including one private school. 5. Legislation - The Food and Drugs Act, 1938, came intc operation on the 1st October, 1939, with the exception of Section 14, relating to the registration of premises used for the manufacture or sale of ice cream or preserved food. The provisions of Section 158 of the Essex County Council Act, 1933 already applied to the registration of premises used for the manufacture or sale of ice cream in the Borough. Application was therefore made to the Minister, to declare the provisions of Section 14 of the Act to be in force within the Borough. The application was approved and Section 14 declared to be in force as from the 1st January, 1940. Dr. Bernard Dyer and Mr. Taylor were duly appointed public analysts and the Borough Council's Sanitary Inspectors were duly appointed "Sampling Officers" for the purposes of the Act. The Rent and Mortgage (Interest Restrictions) Act, 1939 came into force on the 2nd September, 1939. 11. SANITARY lNSPECTION 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 1939. Summary of the various inspections made by the Sanitary Inspectors:- Dwelling Houses- On complaint and other causes 482 Infectious disease enquiries 102 House-to-house inspections 182 Premises measured for purposes of Part IV of the Housing Act, 1936 36 Number of rooms measured in these premises 154 Rent Restriction Act enquiries 7 Total number of re-inspections for all purposes 2,533 Other Premises- Schools 65 Factories 80 Outworkers premises 16 Slaughterhouses 291 Carcases examined 1,711 Butchers' shops and provision stores 223 Bake houses 44 Fishshops 51 Dairies and Milkshops 46 Ice Cream dealers 29 Other Food premises 68 Rat infestation 187 Verminous premises 18 Petroleum installations 129 Shops Act 258 Premises where animals are kept 40 Miscellaneous inspections 392 Total number of inspections and re-inspections 5,415 Notices served- Informal:- Housing Act, 1936 91 Public Health Acts 178 Statutory:- Housing Act, 1936, Section 9 13 Housing Act, 1936, Section 10 1 Housing Act, 1936, Section 11 2 Housing Act, 1936, Section 155 2 Public Health Act, 1936, Section 24 12 Public Health Act, 1936, Section 39 5 Public Health Act, 1936, Section 93 8 Public Health Act, 1936, Section 287 13 Factories Act, 1937, Section 1 2 Nature of the work executed and improvements effected to dwelling-houses and premises, under the provisions of the Housing and Public Health Acts:- Dampness remedied 272 Roofs repaired 110 Rain water pipes and guttering renewed or repaired 132 Walls provided with damp proof courses, underpinned or repaired 298 House drains renewed or repaired 159 Obstruction removed from drains 51 Water closet pans renewed 56 12. Flushing cisterns renewed or repaired 48 Sinks provided or renewed 60 Waste pipes renewed or repaired 87 Yard paving provided, renewed or repaired 65 Floors renewed or repaired 104 Door or window frames, sashes etc., renewed or repaired 195 Stoves, coppers, fireplaces etc., renewed or repaired 121 Plaster renewed 353 Light and ventilation to rooms improved 25 Rooms cleansed 349 Miscellaneous defects remedied 702 Factories Act, 1937 - Certificates with regard to means of escape in case of fire were granted in respect of five factories. The number of factories registered at the close of the year was (1) Power factories - 76, (2) Non-power factories - 37. These included fourteen bakehouses, two being underground bakehouses. Certificates with regard to satisfactory means of escape in case of fire were granted in respect of five factories. Notices were served under Section 1 of the Act to enforce cleanliness of premises and plant in use, as well as repairs to sanitary arrangements on two factory bakehouse premises. Informal notices were also served and satisfactory results obtained in respect of eight other factories with regard to cleanliness of premises, improvement or repair to sanitary arrangements, as well as improved ventilation. Rent and Mortgage Interest Restrictions Acts, 1920 to 1939 - 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 No certificates were granted. Rats and Mice (Destruction) Act, 1919 - One hundred and eighty-seven 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-eight licences were renewed at the beginning of the year. Nine new licences for the storage of petroleum on premises were granted and the use of seven installations discontinued. The total number of premises under licence for storage of petroleum at the end of the year was therefore sixty and the total storage capacity under licence, 91,645 gallons. Game Licences - The eight licences to deal in game were renewed, and one new licence was issued. 13. SECTION D. HOUSING. Number of New Houses erected during the Year by private enterprise only. 507. 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) 664. (b) Number of inspections made for the purpose 2,533. (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 182. (b) Number of inspections made for the purpose 1,137. (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation. 7. (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 295. 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 282. 3. Action under Statutory Powers during the Year:- (a) Proceedings under sections 9, 10, and 16 the Housing Act, 1936: (1) Number of dwelling-houses in respect of which notices were served requiring repairs 14. (2) Number of dwelling-houses which were rendered fit after service of formal not ices:- (a) By owners 13. (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 25. (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 13. (b) By Local Authority in default of owners 12. (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 2. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 4. 14. 4. Housing Act, 1936 - Part IV - Overcrowding:- (a) (1) Number of dwellings overcrowded at the end of the year 14. (2) Number of families dwelling therein 14. (3) Number of persons dwelling therein 98. (b) Number of new cases of overcrowding reported during the year Nil. (c) (1) Number of cases of overcrowding relieved during the year 2. (2) Number of persons concerned in such cases 17½ (d) Particulars of any cases in which dwellinghouses 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. 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 15. Persons registered as retail purveyors of milk whose premises are situated outside the district 21. Number of inspections 46. 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 5 4 1 Tuberculin Tested (Pasteurised) 1 1 ... Accredited • • • 1 ... ... ... Pasteurised 8 4 4 4 ... 15. 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 16 Tuberculin Tested Satisfied methylene blue reduction test. Satisfactory 17 „ „ „ 18 „ „ Did not satisfy test. Unsatisfactory 4 Tuberculin Tested (Certified) Satisfied methylene blue reduction test. Satisfactory 14 „ „ „ 3 Tuberculin Tested (Pasteurised) 160 bacteria per ml. „ 1 Pasteurised 9,000 „ „ „ „ 2 „ 7,200 „ „ „ „ 15 „ 14,000 „ „ „ „ 19 „ 2,700 „ „ „ „ With regard to the unsatisfactory sample, No. 18, this matter was subsequently taken up by the Essex County Council with the producer of the milk. Examination of Ordinary Milk- The following table shows the results of nine 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. 5 45,000 Absent Considered free Satisfactory 6 6,000 Absent Considered free Satisfactory 7 30,000 Absent Considered free Satisfactory 8 12,000 Absent Considered free Satisfactory 9 29,000 Absent Considered free Satisfactory 10 600,000 Present Considered free Unsatisfactory 11 500,000 Present Considered fr^e Unsatisfactory 12 260,000 Present Considered free Unsatisfactory 13 4,000 Absent Considered free Satisfactory It will be observed from the above table that tubercle bacilli was absent from all samples. Particulars relating to the three unsatisfactory samples showing excessive bacteria count, were forwarded to the authorities concerned with the production of the milk, and the co-operation of their Inspectors obtained with regard to adverse conditions affecting the milk supply on the producer's premises. (b) Food and Drugs (Adulteration) Act, 1928. and Food and Drugs Act, 1938. Twenty-one samples of milk were submitted far analysis and the reports received on these samples from the Public Analyst were in every case genuine. Twelve samples of food procured under the Food & Drugs Act, 1938 were also submitted for analysis, and were reported upon by the Public Analyst as being genuine. 16. 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 registered under the Act was seventy-eight. 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-two 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. (c) 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 ninety-one visits were paid to slaughterhouses and one thousand, seven hundred and eleven 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. Carcases Inspected and Condemned- Cattle ex. Cows Cows. Calves Sheep and Lambs Pigs Number killed (if known) 11 Nil 34 1,350 316 Number inspected 11 Nil 34 1,350 316 All diseases except Tuberculosis Whole carcases condemned Nil Nil Nil Nil 1 Carcases of which some part or organ was condemned Nil Nil Nil 10 12 Percentage of the number inspected affected with disease other than Tuberculosis Nil Nil Nil .74 4.11 Tuberculosis only. Whole carcases condemned Nil Nil Nil Nil 1 Carcases of which some part or organ was condemned Nil Nil Nil Nil 8 Percentage of the number inspected infected with tuberculosis Nil Nil Nil Nil 2.85 17. Meat and other Foods (Cont.). Following the decentralisation of London's Meat Market in September, a Government controlled meat distributing centre was established in South Woodford. All meat supplies to this depot have been subjected to inspection, and unsound meat condemned up to the close of the year was as follows:- 26 Carcases of Lamb, 4 Sheep , 193 Sheep's Heads, 184 Sheep's Plucks, 8l Sheep's Livers, 23 Pig's Livers, 3 Calves Plucks, and various other offal, giving a total weight of 1 ton, 2 cwt., 3 qrs., 4 lbs. Other unsound food condemned and destroyed included 19 lbs. Corn Beef, 15 lbs. Cod, 28 lbs. Skate, and 52 lbs. Dog Fish. Other Food Premises- Two hundred and thirty-eight 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. Forty-four inspections were made and the provisions of the Bakehouse Regulations were observed satisfactorily. 18. FACTORY AND WORKSHOP ACT, 1901, AND THE FACTORIES ACT, 1937. 1. Inspections for the purposes of provisions as to health. Including Inspections made by 3 Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories with mechanical power 20 3 ... Factories without mechanical power 50 6 ... Other premises (other than Outworkers' premises) 10 2 • • • Total 80 11 • • • 2. Defects found. Particulars Found. Number of Defects. Remedied Referred to H.M. Inspector. Prosecutions Want of Cleanliness 5 5 ... ... Overcrowding • • • • • • • • • ... Unreasonable temperature • • • • • • ... • • • Inadequate Ventilation 3 3 ... ... Ineffective drainage of floors 2 2 • • • • • • j Sanitary Conveniences:- 1. Insufficient 1 1 • • • • • • 2. Unsuitable or defective 3 3 • • • • • • 3. Not separate for sexes 1 1 • • • Other Offences ... • • • • • • • • • Total 15 15 ... • • • 19. SECTION F. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. 1. (a) Scarlet Fever- Fifty-two cases were notified and no deaths occurred. (b) Diphtheria- Twenty-two cases were notified and no deaths occurred. One hundred and twenty-two preventive inoculations were given during the year. (c) Puerperal Pyrexia- Eight cases were notified. Six of these occurred in the district, five of which were removed to hospital, and the other two were notified from hospitals in the Metropolitan area. No deaths occurred. (d) Typhoid and Paratyphoid Fevers- Two cases of Typhoid and one of Paratyphoid A were notified. (e) Dysentery- Two cases notified, in both cases the Sonne bacillus being found. Particulars of the incidence of notifiable diseases during 1938 and an analysis of the cases in age groups are contained in the accompanying tables. 2. (a) Cancer- Particulars with reference to the prevalence of this disease are as follows:- ANALYSIS OF DEATHS FROM CANCER. Site Male Female 35-45 45-55 55-65 Over 65 35-45 45-55 55-65 Over 65 Total Colon 1 .. 2 3 .. • • 2 5 13 Liver • • .. • • 1 .. .. .. 2 3 Rectum 1 • • 2 1 .. • • 1 .. 5 Stomach • • 2 1 6 .. 2 4 6 21 Other Digestive Organs • • 1 • • 2 .. 1 4 2 10 Lung • • 2 6 .. .. .. .. 2 10 Uterus .. .. .. .. .. 3 2 l 6 Ovaries .. .. .. .. .. .. .. 2 2 Breast .. .. .. .. .. 4 1 5 10 Bones .. .. .. .. 1 .. 1 2 4 Prostate .. .. 2 1 .. .. .. .. 3 Bladder .. .. .. 2 .. .. .. 1 3 Other Sites .. 2 3 10 .. .. .. .. 16 Total 2 7 16 26 1 10 15 29 106 20. (b) Disinfection and Disinfestation- The disinfection of be ding and similar articles is done by the saturated steam process in a Washington-Lyons Disinfector; infected premises are sprayed with formalin and fumigated by burning formalin tablets. Number of rooms disinfected 208 Number of verminous rooms disinfested 24 Loads of beeding disinfected 218 Loads of bedding disinfected for Chigwell U.D.C. 61 Number of school classrooms disinfected 33 (c) Laboratory Work- The following specimens from Wanstead and Woodford were dealt with by the Counties Public Health Laboratories:- Diphtheria 541 Sputa 189 Typhoid 9 Miscellaneous 55 Total 794 (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. 3. Tuberculosis. Particulars of new cases of tuberculosis and mortality from the disease during 1939 28 Pulmonary and 9 non-Pulmonary cases were notified for the first time during the year. 14 cases were transferred into the district. 22 Pulmonary and 3 non-Pulmonary cases died during the year. 5 deaths occurred from non-notified cases of tuberculosis. 50 other cases were removed from the Register. l8l 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 1939:- Pulmonary. Non-Pulmonary. Total. M. F. M. F. Adults 17 23 • • 2 42 Children 2 .. 6 3 11 21. NOTIFICATION OF INFECTIOUS DISEASE. 1935 1936 1937 1938 1939 Small Pox 0 0 0 0 0 Scarlet Fever 97 149 96 83 52 Diphtheria 58 53 46 35 22 Typhoid, including Paratyphoid 1 3 3 1 3 Erysipelas 7 13 15 24 10 Tuberculosis (1) Pulmonary 35 33 37 37 28 (2) Other Forms 13 12 10 22 9 Puerperal Fever 2 2 0 11 • 8 Puerperal Pyrexia 5 4 6 Ophthalmia Neonatorum l 0 1 4 3 Pneumonia 34 41 64 39 28 Cerebro-spinal Fever 0 0 0 0 0 Acute Poliomyelitis 2 2 3 2 0 Other Diseases 1 1 4 3 2 22. 23. VITAL STATISTICS OF WHOLE DISTRICT DURING PREVIOUS YEARS. Year Population Births Deaths Infantile Mortality Number Rate Number Rate Number Rate per 1000 Births 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 1939 55,880 763 13.7 555 10.4 28 . 37.8