BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1941. WANS 6 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1941. 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). Sanitary Inspectors, A. J. Storer, M.S.I.A. (b). (Joined R.A.M.C., 28th May, 1940.) L. G. Howard, M.S.I.A. (b) (c) (to 29th March, 1941). Health Visitors, Miss H. M. Hird, S.C.M. (e) Miss J. E. Rhodes, S.R.N., S.C.M. (e) (to 29th November, 1941). Midivives, Miss S. A. Jones, S.C.M. Mrs. M. Marlow, S.C.M. Miss I. Turner, S.C.M. Clerks, F. E. Farrington. (Joined R.A.D.C., 2nd May, 1940.) S. C. Hearson, Chief Clerk. Miss M. Mylles (from 24th March, 1941, to 14th June, 1941). Miss A. E. Harrison (from 23rd June, 1941). (a) Royal Sanitary Institute Certificate for Sanitary Inspector. (b) Royal Sanitary Institute and Sanitary Inspector's Examination Joint Board Certificate. (c) Royal Sanitary Institute Certificate 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, WANSTEAD AND WOODFORD BOROUGH COUNCIL. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH for the Year Ending 31st December, 1941. In the year under review the public health of the district remained satisfactory and the incidence of infectious disease approximately of the pre-war standard. The estimate of resident population 1941, as given by the RegistrarGeneral shows a decrease of 2,000. The birth rate has continued to fall, but there is also a fall in the death rate. Section A. Statistics and Social Conditions of the Area. Area (in acres) 3,824 Registrar-General's estimate of resident population, 1941 46,640 Number of inhabited houses (end of 1941) according to Rate Books 15,950 Rateable value (end of 1941) £575,649 Sum represented by a penny rate (1941-1942) £2,201 Extracts from Vital Statistics of the Year. Live Births. (a) for calculating birth rates. Legitimate Males 264 Females 282 Total 546 Illegitimate Males 11 Females 9 Total 20 Total Males 275 Females 291 Total 566 (b) for calculating infantile and maternal mortalities. Legitimate Males 236 Females 242 Total 478 Illegitimate Males 10 Females 8 Total 18 Total Males 246 Females 250 Total 496 Birth rate per 1,000 of the estimated resident population— 12.1, 4 Stillbirths. (a) for calculating birth rates. Legitimate Males 12 Females 6 Total 18 Illegitimate Males 2 Females 0 Total 2 Total Males 14 Females 6 Total 20 (b) for calculating infantile and maternal mortalities. Legitimate Males 10 Females 4 Total 14 Illegitimate Males 2 Females 0 Total 2 Total Males 12 Females 4 Total 16 Rate per 1,000 total (live and still) births — 34.13. Deaths. Males — 269. Females — 282. Total—551. Crude Death rate per 1,000 of the estimated resident population — 11.1. Adjusted Death Rate—10.88. Deaths from puerperal causes: — Puerperal and post-abortion sepsis 1 Other maternal causes nil Total 1 Rate per 1,000 total (live and still) births 1.7 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 30.24 Legitimate infants per 1,000 legitimate live births 31.38 Illegitimate infants per 1,000 illegitimate live births 55.5 Deaths from Cancer (all ages) 94 Deaths from Measles (all ages) 4 Deaths from Whooping Cough (all ages) 7 Deaths from Diarrhoea (under 2 years of age) 3 5 Birth-rates. Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1941. England and Wales, London, 126 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 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 Rates per 1,000 Civilian Population Births: Live 14.2 14.7 16.4 8.9 12.1 Still 0.51 0.58 0.60 0.33 0.43 Deaths: All Causes 12.9 14.9 13.0 16.3 11.1 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 services are provided by the Essex County Council. The facilities at the Essex Public Health Laboratory, 91 Queen Victoria Street, London, E.C.4, were available to the beginning of May, but, since then, Dr. Suckling's Emergency Laboratory, Gidea Park College, Gidea Park, Essex, has been used. The analysis of water, milk and food is carried out by Dr. Bernard Dyer and Mr. George Taylor, Public Analysts for the Borough. (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. 6 (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. 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. Our arrangements for the reception of maternity cases which we had before the war with Queen Mary's Hospital, Stratford, are no longer in operation. We are still able to send cases of Puerperal Pyrexia to the Waltham Joint Hospital, but for other cases where the condition of the mother or home conditions require that the mother should be removed, we have been making arrangements to evacuate the patients to hospitals outside the district. 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. 7 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 138 (b) As Maternity Nurses 18 Number of visits paid by these Midwives: — (a) Number of cases 156 (b) Ante-natal visits 1,557 (c) Nursing visits 2,578 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 1941 payments were made to medical practitioners in 33 cases. Consultant.—Mr. Alan Brews, F.R.C.S., has been appointed as Consulting Obstetric Surgeon to the Borough. (2) Institutional Provision for Mothers or Children.—Over 50 per cent.— 228 out of 431 — births in Wanstead and Woodford occurred in private nursing homes. 3. Health Visitors.— Miss Rhodes resigned her appointment at the end of the year. 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 o( 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 418 Total visits 2,061 (b) To children between the ages of one and five years: — Total visits 4,351 Infant Welfare Centres.— During the early part of the year under review, enemy action interfered considerably with our normal routine at our welfare centres. We kept our centres open for medical consultation and for the supply of infant foods, but in view of the frequent raid warnings we did not encourage mothers to linger at the centres. These conditions also interfered with the accurate keeping of records. The 8 lowing attendances were recorded at the five Centres serving the Wanstead and Woodford residents:— (a) Children under one year of age 7,024 (b) Children between the ages of one and five years 3,831 4. Child Life Protection.—The Health Visitors are appointed Child Life Protection Visitors under Part VII of the Public Health Act, 1936 There were nine foster-mothers and twelve foster-children on the Register at the end of the year. A total of seventy-two 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 1941, two 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. 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.- There have been no important extensions of sewerage or improvements made in the arrangements for drainage, sewerage and sewage disposal. 2. Rivers and Streams.— The results of the analyses of samples of effluent from the three sewage works were satisfactory. 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 collation throughout the district and the disposal of the refuse under controlled tipping conditions. The Contract dating from March, 1938, expired in March this year and was renewed for a further period of three years, the contractors to continue the existing arrangements in relation to salvage collection with a provision for review or termination at one month's notice on either side. Council owned land in the Borough is used for the tipping of the refuse. 9 The Ministry of Supply issued a Direction under the Defence General Regulations 1939, dated 23rd September, '1941, requiring the Council to institute a separate collection of kitchen waste to be delivered to the County Borough of East Ham, to be processed for animal food. The Council gave considerable attention to this matter and decided to adopt a scheme for meeting these requirements by means of communal kitchen waste bins and bi-weekly collections by their own lorries. (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 fifty-eight shop inspections were recorded. Improvements with regard to ventilation and temperature of shops and to sanitary conveniences were effected upon three premises. Shops (Hours of Closing) Act, 1928.—Under the provisions of Defence Regulations, 1939, earlier closing hours operated during the winter months and normal closing hours were resumed between March and November. It was unnecessary to warn shopkeepers against any contraventions. (5) Eradication of Bed Bugs.— The means employed for eradication of the bed bug as outlined in previous reports has been continued with satisfactory results. The number of premises disinfested was twenty-two ; no Council owned houses were disinfested. The insecticides used were Pyaga 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. There are several private schools. With the exception of one private school all schools were open during the year. The sanitary condition and water supply remained satisfactory. The children of two classrooms were excluded from school for two weeks following the occurrence of a series of cases of Scarlet Fever in those classes. 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 1941. Owing to war time conditions a considerable amount of time was taken up in connection with the following matters:— Food stocks on damaged premises. 10 Arrangements for the treatment and disposal of foodstuffs contaminated by gas. Civilian war deaths. Salvage operations. Arrangements to collect Kitchen Waste. Underground shelters. Refugee centres. War damaged premises (drains and sanitary arrangements). Summary of the various inspections made by the Sanitary Inspectors:— Dwelling Houses— On complaint and other causes 389 Infectious disease enquiries 129 Food poisoning enquiries 13 Premises measured for purposes of Part IV of the Housing Act, 1936 (abatement of overcrowding) 19 Number of rooms measured in these premises 93 Rent Restriction Act enquiries 6 Total number of re-inspections for all purposes 1,264 Other Premises— Schools 11 Factories 101 Meat distributing centre 322 Butchers' shops and provision stores 280 Bakehouses 38 Fishshops 73 Dairies and Milkshops 48 Massage Establishments 19 Other Food premises 81 Rat infestations 119 Verminous premises 23 Petroleum installations 55 Shops Act 58 Premises where animals are kept 32 Miscellaneous inspections, including visits due to war circumstances 431 Total number of inspections and re-inspections 3,505 Drainage— Renewed or repaired, including war damaged drains... 58 Notices served— Informal:— Housing Act, 1936 8 Public Health Acts 215 Statutory:— Public Health Act, 1936, Section 39 1 11 Factories Act, 1937.—The total number of factories registered at the close of the year was (1) Power Factories—72, (2) Non-power factories—39. These included fourteen bakehouses, two being underground bakehouses. Informal notices were served and satisfactory results obtained in respect of 3 factories with regard to cleanliness of premises, improvement or repair to sanitary arrangements, as well as improved ventilation. 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 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 nineteen visits were paid to premises in connection with compiaints received and ir 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. Factories and Food Premises were also kept under supervision for rat infestation, and methods for their extermination were adopted in necessary cases. Petroleum (Regulation) 'Acts, 1928 and 1936.—A total of fifty-six licences were renewed at the beginning of the year and included one licence for the storage of cellulose, and one for carbide of calcium. In addition, two other licences were granted, one for the storage of petroleum mixture and one for cellulose. The total storage capacity under licences amounted to 80,300 gallons for petroleum, 100 gallons cellulose, 5 cwts. carbide of calcium, and 100 gallons rubber solution. Game Licences.—Eight of the nine licences to deal in game were renewed, and one new licence was issued during the year. Section D. Housing. No houses were actually erected during 1941, but seven houses were completed for occupation during that period. 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) 389 (b) Number of inspections made for the purpose 1264 (2) (a) Number of dwelling-houses (included under head (1) above) which were inspected and recorded ' under the Housing Consolidated Regulations, 1925 and 1932 Nil (b) Number of inspections made for the purpose Nil 12 (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 231 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 223 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 Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners Nil (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 1 (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 Nil (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 4. Housing Act, 1936.—Part IV.—Overcrowding: — (а) (1) Number of dwellings overcrowded at the end of the year 13 (2) Number of families dwelling therein 13 (3) Number of persons dwelling therein 85 (b) Number of new cases of overcrowding reported during the year Nil 13 (c) (1) Number of cases of overcrowding relieved during the year 1 (2) Number of persons concerned in such cases 5 (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 14 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 36 4 ... Factories without mechanical power 47 2 ... Other premises (other than Outworkers' premises) 18 ... ... Total 101 6 ... 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 ... ... ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate Ventilation ... ... ... ... Ineffective drainage of floors ... ... ... ... Sanitary Conveniences :— 1. Insufficient 2 2 ... ... 2. Unsuitable or defective 2 2 ... ... 3. Not separate for sexes 1 1 ... ... Other Offences ... ... ... ... Total 5 5 ... ... 15 Section E. Inspection and Supervision of Food. (a) Milk Supply.—Milk is not 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 48 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, are as follows: — Designation. Licences Supplementary Licences. Tuberculin Tested 7 5 Accredited ... 2 Pasteurised 12 6 16 Examination of Ordinary Milk.— The following table shows the results of eleven samples of ordinary milk subjected to bacteriological examination: — No. No. of Bacteria per 1 ml. Presence of Bacillus Coliform. Remarks. 1 200,000 Present in 0.001 ml. Unsatisfactory 2 60,000 Present in 0.001 ml Unsatisfactory 3 180.000 Present in 0.001 ml. Unsatisfactory 4 120,000 Present in 0.001 ml. Unsatisfactory 5 50,000 Present in 0.01 ml. Unsatisfactory 6 30,000 Absent Satisfactory 7 180,000 Present in 0.001 ml. Unsatisfactory 8 84,000 Present in 0.01 ml Unsatisfactory 9 340,000 Present in 0.001 ml. Unsatisfactory 10 96,000 Present in 0.01 ml. Unsatisfactory 11 54,000 Absent Satisfactory It will be observed from the above table that nine of the eleven samples gave unsatisfactory results. Bacillus Coliform was present in each of these nine samples, and excessive bacteria (exceeding 200,000 per millimetre) was present in one sample. 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. (b) Food and Drugs Act, 1938.- Thirty-six samples of food, including twenty-two samples of milk, were obtained for analysis. Thirty-three of the samples were reported by the Public Analyst as being genuine. The three unsatisfactory samples were of milk found to be deficient in fat to the extent respectively of 5, 8 and IS per cent, of the minimum quantity of fat proper to normal milk as indicated in the Sale of Milk Regulations. In connection with unsatisfactory samples of milk, four " Appeal to Cow " samples were taken by arrangement with the authority concerned, which on analysis were found to be naturally deficient in fat, containing 2.65, 2.75, 2.80 and 2.90 per cent, respectively, thus exonerating the vendor from the suspicion of fat extraction raised on the basis of the Regulations. Ice Cream.—The number of premises registered for the purpose of manufacture and sale of ice cream within the district remained at seventyeight, but little, if any, ice cream was on sale at many of these premises during the year. No samples of ice cream were taken. (c) Meat and Other Foods.—The Government meat distributing depot was under constant supervision during the year, and a total of 322 inspections were made. The total quantity of meat, including offal, condemned as unfit for human consumption amounted to two tons, six hundredweights. 17 Food examined upon other premises and surrendered as unfit for human consumption included the following: — 53¾ lbs. Bacon. 29½ lbs. Meat Roll and Ham. 3 Boxes Fish. 88½ lbs. Pork Sausages. 1 tin Ox Tongue. 7 lbs. Sugar. 154 tins Condensed Milk. 77 jars various kinds of Jam. 5 tins Chicken and Ham Roll. 14 cwts. Potatoes. 2 boxes Pressed Beef. 32 tins Stewed Steak. Sf lbs. Butter. 20 tins U.S.A. Tomatoes. 1 only Sheep's Pluck. 16 lbs. Onions. 1 only Turkey. In addition, large stocks of food were examined in shops and premises following damage by enemy action, the remains of food products were often unidentifiable, and considerable quantities of food were rendered unfit for human consumption by the action of fire and water, or from contamination by dust and dirt from fallen debris or the results of broken and splintered glass. A total of 353 visits were made in connection with the above shops. Registration of Food Premises.—One certificate was granted under Section 34 of the Food and Drugs Act, 1938, for the purpose of carrying on the business of a wholesale dealer in margarine. Bakehouses.-—There are fourteen bakehouses in the district; two of these are underground bakehouses. Thirty-eight inspections were made and the provisions of the Bakehouse Regulations were observed satisfactorily. Section F. Prevalence of, and Control over. Infectious and other Diseases. 1. (a) Scarlet Fever.—Eighty-four cases were notified. No deaths occurred. (b) Diphtheria.—Twenty-one cases were notified. No deaths occurred. 18 Diphtheria Immunisation.—The numbers of completed inoculations made during the year were:—Children under 5 years, 661; children over 5 years but under 15 years, 1,390. (c) Puerperal Pyrexia.—Three cases were notified, one of these occurred in the district and was removed to the Waltham Joint Hospital, and the other two were notified from hospitals in the Metropolitan area. One death occurred. (d) Typhoid and Paratyphoid Fevers.—Eight cases of paratyphoid were notified as occurring in the district. Five were removed to the Waltham Joint Hospital, two to a hospital outside the district, and one occurred in an institution in the district, to which it had been brought from the County Borough of East Ham. No deaths occurred. (e) Dysentery.—No cases were notified. (/) Cerebro-Spinal Fever.—Eight cases were notified as occurring in the district. One was removed to the Waltham Joint Hospital and one to a hospital outside the district. The other six cases occurred in an institution in the district, to which they had been brought from the County Borough of East Ham. One death occurred. (g) Encephalitis Lethargica.—No cases were notified. (h) Acute Anterio Poliomyelitis.—One case occurred in an institution in the district, to which it had been brought from the County Borough of East Ham. Particulars of the incidence of notifiable diseases during 1941 are contained in an accompanying table. 2. (a) Disinfection and Disinfestation.—The disinfection of bedding and similar articles is done by the saturated steam process in a cylindrical horizontal steel " thresh " disinfector; infected premises are sprayed with formalin and fumigated by burning formalin tablets. Number of rooms disinfected 215 Number of verminous rooms disinfested 52 Loads of bedding disinfected 219 Loads of bedding disinfected for Chigwell U.D.C. 5 Number of School classrooms disinfected 8 Under the provisions of Sections 83 and 84 Public Health Act, 1936, the verminous articles of two houses were removed and destroyed, and the premises disinfested. (e) 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 1941: — 46 Pulmonary and 15 non-Pulmonary cases were notified for the first time during the year. 19 28 cases were transferred into the district. 16 Pulmonary cases died during the year. No non-Pulmonary cases died. 3 deaths occurred from non-notified cases of tuberculosis. 2 cases were restored to the register. 35 other cases were removed from the register. 224 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 1941: — Pulmonary. Non-Pulmonary. Total. M. F. M. F. Adults 18 23 1 2 44 Children 3 2 2 1 8 NOTIFICATION OF INFECTIOUS DISEASE. Small Pox Scarlet Fever Diphtheria Typhoid including Paratyphoid Erysipelas Tuberculosis Puerperal Fever Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerehro-apinal Fever Acute Poliomyelitis Measles Whooping Cough Other diseases Pulmonary Other Forms 1937 0 96 46 3 15 37 10 0 6 l 64 0 3 4 1938 0 83 35 1 24 37 22 11 4 39 0 2 3 1939 0 52 22 3 10 28 9 8 3 28 0 0 2 1940 0 24 8 1 Typhoid 13 24 7 7 1 31 12 0 95 4 4 1941 0 85 21 Paratyp'd 8 10 46 15 3 0 41 8 1 • 586 280 0 21 VITAL STATISTICS OF WHOLE DISTRICT DURING PREVIOUS YEARS. Year. Population. Births. Deaths. Infantile Mortality. Number. Rate. Number. Rate. Number. Rate per 1000 Births. 1937 53,850 720 13.4 522 9.7 29 40.3 1938 54,810 744 13.6 521 95 23 30 9 1939 55,880 763 13.7 555 10.4 28 37.8 1940 48,620 611 12.6 653 13.4 18 31.8 1941 46,640 566 12.1 551 11.1 15 30.24