AC 4411(1) WANSTEAD WOODFORD WANS 11 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1946. PUBLIC HEALTH COMMITTEE Alderman A. H. Southam (Chairman) „ C. Turner Councillor A. G. Burness „ Mrs. J. Davey „ H. Hollands „ J. W. C. Lynch „ S. J. McAdden „ V. E. Stevens (Vice-Chairman) „ P. F. N. Warner MATERNITY AND CHILD WELFARE COMMITTEE Councillor Mrs. E. F. M. Hollis (Chairman) „ W. A. Braine „ A. G. Burness „ Mrs. j. Davey (Vice-Chairman) „ R. Drew „ D. L. Forbes „ S. J. McAdden „ V. E. Stevens „ P. F. N. Warner Co-opted Members Mrs. R. Drew „ A. R. Page „ V. Quill „ A. Smith „ T. Smith 1 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health: F. G. Brown, M.B., B.Ch, D.P.H. Senior Sanitary Inspector: H. C. Howard, M.R.San.I., M.S.I.A. (a) (c) (to 19.8.46) M. G. Crook, M.S.I.A. (b) (c) (f) (g) (from 19.8.46) 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) F. Nau, A.R.S.I. (b) (to 14.6.46) H. L. Hughes, A.R.San.I., M.S.I.A. (b) (c) (from 29.7.46) Senior Clerk: Miss A. E. Harrison Health Visitors: Mrs. O. A. Greedus, S.R.N., S.C.M. (e) (to 31.1.46) Miss C. Court, S.R.N., S.C.M. (e) (from 21.1.46) Miss S. Butterly, S.R.N., S.C.M. (e) (from 21.1.46) Miss F. M. Mathie, S.R.N., S.C.M. (e) (from 21.1.46 to 16.8.46) Miss R. M. Harrington, S.R.N., S.C.M. (e) (from 6.8.46) Miss E. Brooks, S.R.N., S.C.M. (e) (from 14.10.46) Municipal Midwives: Miss S. A. Jones, S.C.M. Mrs. M. Marlow, S.C.M. Miss I. Turner, S.C.M. Miss N. M. Tomlinson, S.C.M. Mrs. I. J. Campe, S.C.M. (from 14.9.46) (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. (f) First Class Certificate in Laboratory Technique of Meat Inspection of Smithfield Technical Institute. (g) Diploma of the Royal Institute of Public Health and Hygiene. 2 WANSTEAD AND WOODFORD BOROUGH COUNCIL. To the mayor, the aldermen and councillors, borough of wanstead and woodford Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report as Medical Officer of Health for the year 1946. The incidence of Infectious Disease remained low and compares favourably with that of previous years. Two mild cases of Diphtheria occurred (compared with eight in 1945)—both were inmates of Dr. Barnardo's Homes. Scarlet Fever showed a slight increase over the previous year 72 cases as compared with 62; all cases were mild and the majority were treated at home. Cases of Measles were approximately one-third of the number notified in 1945. There was an increase in the numbers notified as suffering from Whooping Cough, these being four times as many as those notified in the previous year. When comparing the incidence of disease with that of 1945, it must be borne in mind that many children had been evacuated and did not return to the Borough until the latter part of that year. The Diphtheria Immunisation continued, approximately the same number of children being immunised, i.e., 900 as in 1945. Vital Statistics are shown on the Table on page 5 from which it will be seen that the population of the Borough increased by more than 9,000. the Birth-rate per 1,000 of the estimated resident population increased to 19.2 as compared with 16.0 for 1945, while the Death-rate calculated similarly, fell from 13.0 to 11.1. The infantile mortality rate, i.e., the death-rate of infants under 1 year per 1,000 live births, was 31.3; this is .3 lower than in 1945 and compares favourably with the rate for the whole of England and Wales for 1946, which was 43. Particulars of the Maternity and Child Welfare Service will be found in the appropriate section. On account of the large numbers attending, it was found necessary to increase the sessions at the Ante-Natal Clinic from two to three. An additional Infant Welfare Centre was opened in October at the Cromwell Hall, Nightingale Lane, Wanstead. During the year the number of Midwives employed was increased from four to five and the number of Health Visitors from three to four. Owing to the great shortage midwives and hospital domestic staff, much difficulty was experienced in arranging maternity hospital accommodation, and only those persons whose confinements were likely to be abnormal or where home conditions were such as to make domiciliary confinement impossible, could be admitted to hospital. In December, 1946 the maternity wing at the Essex County 3 Hospital was opened; this is proving of much benefit to expectant mothers in the Borough who, previously, have had to travel long distances to obtain maternity hospital accommodation. A further benefit at this hospital is the provision of two emergency beds for the reception of cases which have developed complications during confinement at home or in a private nursing home. I am grateful to Dr. W. A. Bullough, County Medical Officer, Essex County Council, for the help which he has given me in the provision of maternity beds in hospitals controlled by the Essex County Council. Attendances at Infant Welfare Centres totalled 17,060, an increase of 6,102 over the previous year. During the year a questionnaire was sent to all mothers of children under five to determine the necessity for establishing a Day Nursery in the Borough. The response was such as to prove the need. A site for this purpose has now been acquired and approval of the Ministry of Health obtained. At the time of writing it is understood that work on the site is about to commence. Despite food rationing and post-war difficulties the general health of the population has remained at a high standard. Mention must, however, be made of the housing shortage which reflects on the psychological condition of very many persons, more especially those who are recently married and who are compelled to live with their parents, being unable to obtain a home of their own. It is evident that the continued frustration to which these persons are being subjected is having a deleterious effect on their mental well-being. It is also apparent that the old people are having a most difficult time, mainly owing to fuel shortage during the winter months and to the lack of domestic help. I should like to thank the members of the staff of the Public Health Department for the work they have done during the year and for their loyal co-operation. I would also mention the help T have received from the staff of other departments and from the many voluntary workers at the Infant Welfare Centres. I am most grateful to the Chairmen of the Public Health, and Maternity and Child Welfare Committees for their unfailing support. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. G. BROWN, M.B., B.Ch., D.P.H. 27th September, 1947. 4 Section A. Statistics and Social Conditions of the Area Area (in acres) 3,824 PoPulation—Registrar-General's estimate mid-year 1946 57,570 Registrar-General's estimate mid-year 1945 Rateable value 48,230 £583,264 Sum represented by penny rate (1946-47) £2,331 Extracts from Vital Statistics of the Year Live Births: Legitimate Males 537 Females 544 Total 1,081 Illegitimate Males 23 Females 13 Total 36 Total Males 560 Females 557 Total 1,117 Birth-rate per 1,000 of the estimated resident population—19.2. Stillbirths. Legitimate Males 10 Females 10 Total 20 Illegitimate Males 2 Females — Total 2 Total Males 12 Females 10 Total 22 Rate per 1,000 total (live and still) births—19.3. Deaths: Males 317. Females 324. Total 641. Death-rate per 1,000 of the estimated resident population—11.1 Deaths from puerperal causes:— Puerperal and post-abortion sepsis Nil Other maternal causes 3 Total 3 Rate per 1,000 total (live and still) births 2.6 Deaths of Infants under one year of age:— All infants per 1,000 live births 31.3 Legitimate infants per 1,000 legitimate live births 24.0 Illegitimate infants per 1,000 illegitimate live births 250.0 1946 1945 Deaths from Cancer 124 94 „ „ Measles 1 Nil „ „ Whooping Cough Nil Nil „ „ Diarrhoea (under 2 years of age) 4 Nil „ „ Road Traffic Accidents 8 7 „ „ Suicide 7 5 „ „ Other violent causes 8 57* (*This includes enemy action) 5 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1946. 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 Births: (Rates per 1,000 Civilian Population) Live 19.1* 22.2 21.3 21.5 19.2 Still 0.53* 0.67 0.59 0.54 0.38 Deaths: All Causes 11.5* 12.7 11.7 12.7 11.1 Typhoid and Paratyphoid 0.00 0.00 0.00 0.00 0.01 Scarlet Fever 0.00 0.00 0.00 0.00 0.00 Whooping Cough 0.02 0.02 0.02 0.02 0.00 Diphtheria 0.01 0.01 0.01 0.01 0.00 Influenza 0.15 0.13 0.14 0.12 0.22 Smallpox 0.00 0.00 0.00 — 0.00 Measles 0.00 0.01 0.00 0.01 0.01 Deaths under (Rates per 1,000 Live Births) 1 year of age 43.0† 46.0 37.0 41.0 31.3 Deaths from Diarrhoea and Enteritis under 2 years of age 4.4 6.1 2.8 4.2 3.5 * Rates per 1,000 Total Population † Per 1,000 related births Notifications: (Rates per 1,000 Civilian Population) Typhoid 0.01 0.01 0.01 0.01 0.01 Paratyphoid 0.02 0.02 0.01 0.01 0.03 Cerebro Spinal Fever 0.05 0.05 0.04 0.06 0.01 Scarlet Fever 1.38 1.51 1.33 1.42 1.26 Whooping Cough 2.28 2.48 2.05 2.22 3.01 Diphtheria 0.28 0.32 0.31 0.24 0.03 Erysipelas 0.22 0.25 0.22 0.27 0.24 Smallpox 0.00 0.00 0.00 0.00 0.00 Measles 3.92 4.73 3.70 7.35 3.17 Pneumonia 0.89 1.02 0.74 0.75 0.69 (Rates per 1,000 Total Births (Live and Still) Puerperal Pyrexia Puerperal Fever 8.50 10.35 7.63 1.62 9.68 0.13 6 Section B. General Provision of Health Services in the Area. (i) Public Health Officers of the Authority:— See page 2. (ii) (a) Laboratory Facilities:— All pathological and bacteriological services are provided at the Emergency Medical Services Pathological Laboratory, St. Margaret's Hospital, Epping. 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 Service:— Municipal. The Council's ambulance service consists of three vehicles. Two are modern vehicles, fully equipped with up-to-date appliances; they were purchased in 1938. The third ambulance was purchased for Civil Defence in 1945 and is used as a reserve ambulance. Each ambulance can carry two stretchers or six sitting cases. The ambulance station is located at the Squash Courts, Cambridge Park, Wanstead, and the ambulances are easily accessible to all parts of the Borough. The staff consists of 10, all of whom are in possession of the British Red Cross and St. John certificate and three possess the St. John Medallion. All staff have passed a special test in recent first-aid work and have been congratulated on the high standard attained. Thev have also undergone special life-saving examination organised by the Life-saving Society. Ambulance calls: 1946 1945 Accident 274 253 Maternity 267 173 Private 914 711 Other calls 49 31 Total 1,504 1,168 British Red Cross Society. An ambulance of the B.R.C.S. is located at the Eagle Lane Depot and has carried out seven calls during the year. (c) Nursing in the Home:— Arrangements for a Home Nursing Service exist with two voluntary organisations, the Woodford District Nursing Association, and the Wanstead District Nursing Association. The number of whole-time nurses employed in Domiciliary Nursing is four (two Queens Nurses employed by each of the above-mentioned Association). Supervision is carried out by representatives of the Essex County Nursing Association, to which the two voluntary organisations are affiliated. The Chairman of the Woodford Nursing Association and the Secretary of the Wanstead Nursing Association also exercise supervision. 7 (d) Clinics and Treatment Centres:— Maternity and Child Welfare. There are six infant welfare centres in the Borough. Sessions are held as under:— Baptist Church Hall, Aldersbrook, E.12. Monday, 2.30-4 p.m. Ashton Playing Fields Pavilion, Woodford Bridge. Tuesday, 2.30-4 p.m. St. Barnabas Church Hall, Snakes Lane, Woodford Green. Wednesday, 2.30-4 p.m. Fullers Road Sunday School, South Woodford, E.18. Wednesday, 2.30-4 p.m. Cromwell Hall, Nightingale Lane, Wanstead, E.ll. Thursday, 2.30-4 p.m. Holy Trinity Church Hall, Hermon Hill, South Woodford, E.18. Friday, 2.30-4 p.m. Ante-natal Clinic. The ante-natal clinic is situated at 118 Hermon Hill, South Woodford, E.18. Sessions are held on Mondays from 2.30 to 4.30, and on Tuesdays and Thursdays from 2 to 4.30 p.m. School Clinics. The minor ailment clinics are under the control of the Essex County Council and are held as under:— 93 High Road, South Woodford, E.18. Fridays, 9 a.m. Wanstead Church of England School. 2nd, 3rd and 5th Tuesdays at 2 p.m. Orthopædic Centre. The orthopaedic centre is open at 93 High Road, South Woodford, E.18, on Tuesday, Wednesday and Thursday, and is run conjointly by the Essex County Council and the British Red Cross Society. Tuberculosis Dispensary. The Tuberculosis Dispensary administered by the Essex County Council is held at 93 High Road, South Woodford) E.18, on Thursdays at 5 p.m. and Fridays at 9.30 a.m. (e) Hospitals — Municipal Essex County Hospital, Hermon Hill, Wanstead, E.11. 206 beds. Voluntary Jubilee Hospital, Woodford Green. 54 beds. 8 Maternity and Child Welfare 1946 1945 1. Notification of live births (corrected) 1,117 759 Notification of still births (corrected) 22 15 2. Ante-Natal Clinic. 1946 1945 Attendances: New cases registered 571 336 Total attendances—ante-natal 2,502 1,469 Total attendances—post-natal 132 3. Cases Attended by Municipal Midwives. 1946 1945 As midwives 282 170 As maternity nurses 29 28 Total 311 198 Institutional Provision for Maternity Cases. By kind arrangement with the County Medical Officer, Essex County Council, cases were admitted to hospital for confinement as shown below:— St. John's Hospital, Chelmsford 85 St. Margaret's Hospital, Epping 7 Essex County Hospital, Wanstead 7 Oldchurch Hospital, Romford 4 Orsett Lodge Hospital 2 St. Peter's Hospital, Maldon 2 Writtle Park Maternity Hospital 1 Cases were also admitted to Queen Mary's Hospital, Stratford (15), and Forest Gate Maternity Hospital (16). 5. Private Nursing Homes. 1,014 infants were born in Private Nursing Homes situated in the Borough; the majority of these cases belong to areas outside the Borough. 6. Home Help Scheme. Difficulty has been experienced in finding suitable women to act as Home Helps for persons being confined at home. Three Home Helps were ployed, a total of 29 cases being attended. 7. Infant Welfare Centres. The following attendances were recorded:— 1946 1945 Children under 1 year of age 13,142 7,206 Children between 1 and 5 years 3,918 3,652 8. Daily Guardians. The scheme previously operated in conjunction with the Ministry of Labour terminated on 31st March, 1946. Since the termination of hostilities it has become increasingly difficult to obtain suitable Daily Guardians. During the year seven Daily Guardians looked after seven children. 9 9. Premature Infants. During the year 30 premature infants were born to mothers belonging to the Borough. 10 of these births took place at home, and 20 in hospital or nursing home. 29 of these (96.6 per cent.) were alive at the end of one month. 10. Infantile Mortality Rate. The infantile mortality rate for the year was 31.3 per 1,000; deaths in infants under 1 year totalled 35, 21 of these ocurring within four weeks of birth. Causes were as follows:— Lung conditions 16 Gastro enteritis 5 Birth injuries 6 Prematurity 7 Other causes 1 11. Health Visiting. Number of visits paid during the year by Health Visitors:— To children under 1 year of age—First visits 1,344 Total visits 2,568 To children between one and five years of age 1,139 12. Child Life Protection. The Health Visitors are appointed Child Life Protection Visitors under Part VII of the Public Health Act, 1936. Eight Foster Mothers and eleven Foster Children were on the register at the end of the year. A total of 176 visits was paid. Section C. Sanitary Circumstances of the Area. 1. Water Supply. The Water Service throughout the Borough is supplied by the Metropolitan Water Board. Routine tests carried out by the Board reveal that the supply has been satisfactory in quality and quantity. 2. Drainage and Sewerage. I am indebted to the Borough Engineer and Surveyor for the following information:— (a) Eastern Sewage Disposal Works. These works were redesigned in 1938, since when they have been extremely satisfactory. Effluents of the standard required by the Essex County Council have been obtained. (b) Southern Sewage Disposal Works. Had it not been for the outbreak of war these works would have been treated in a similar manner to those at the Eastern Works, and whereas reasonable effluents have been obtained it has now been agreed by the Ministry of Health that extensions are very necessary and work is in hand on the preparation of the scheme (c) Western Sewage Disposal Works. These works are obsolete and require constant supervision to ensure even the minimum standard discharge It is anticipated that the works will be abandoned and the flow diverted into the Chingford system by the end of 1948. 10 3. Refuse and Salvage Collection. (a) Refuse Collection. This is the first year that the Council has undertaken the collection of refuse and salvage by direct labour as in previous years it was done by Contract. I am able to report that the efficiency of the service has improved thereby and all domestic premises have a once-weekly collection. The Council also undertake by arrangement, collection of trade waste. This collection is as frequent as is required by the tradesmen. The service has been somewhat hampered during the year by reason of the necessity for use of aged hired vehicles, but a fleet of modern especially designed vehicles is now in use with a marked improvement in efficiency. This is borne out by the relative absence of the complaints so general in previous years. Disposal of refuse is by controlled tipping with precautions against vermin, crickets and flies. (b) Salvage Collection. Salvage collection is made at the same time as that of house refuse and shows a very welcome income to the Council. Sanitary Inspection of the Area. The Senior Sanitary Inspector reports as follows:— Some delay has been experienced during the year in getting notices complied with. This has been caused by various circumstances, not the least of which has been the difficulty in obtaining materials. Delay is often caused by owners and agents claiming that the defects were caused by enemy action. Opportunity has been given for the necessary contact to be made with the War Damage Commission. It has been noted that in many cases no steps have been taken with the War Damage Commission until a notice has been served. Much work has been carried out in connection with the maintenance of requisitioned property. Much of this property is large and of some considerable age. In consequence, many complaints have been lodged, both at the Housing and Public Health Departments. Some 270 complaints were received necessitating 851 visits. With the good co-operation from local builders, the works of maintenance were speedily carried out. During the year the following notices were served:— Informal Notices. Under Public Health Act 327 Under Housing Act 71 Under Shops Act 1 Total 399 Statutory Notices. Public Health Act Section 24 14 Section 39 17 Section 45 3 Section 75 20 Section 93 7 Housing Act Section 9 36 Total 97 11 Towards the end of the year it was found necessary to make applications to the Local Authority for permission to take legal action or carry out the work in default in cases where the notices were not complied with. As such action was taken during 1947, the result of these applications cannot be given here. Complaints recorded during the year totalled 1,326 Complaints received from the Housing Manager in connection with requisitioned houses and included in the above, amount to 270 Orders given to building contractors to execute repairs to requisitioned houses numbered 459 Orders given to building contractors to execute repairs and reconstruction works to war-damaged drains numbered 66 Rats and Mice Destruction. The Council continue to employ a full-time Rodent Operator, an account of whose work is given below. The Corporation refuse tip received treatment during the year, with good result. Rodent record. Number of inspections made by Sanitary Inspectors 71 Number of visits made by Sanitary Inspectors 29 Complaints received 364 Number of baits laid (baiting points) 2,378 Number of baits taken 1,610 Estimated kill Number of bodies found 679 Number of premises on which gas pump was used 145 Total number of visits made by rat catcher 2,343 Ponds. Various ponds were treated with paraffin as a precaution against mosquito breeding. Petroleum (Regulation) Acts, 1928 and 1936. 45 licences were renewed at the beginning of the year. Game Licences. Four licences to deal in game were renewed. Shops Act, 1934. Under this Act, three visits were made. In one case a notice served for the want of a sanitary convenience for the staff. With reference to closing hours, no offences were noted or reported in fact it can be stated that shops in the Borough are very prompt in closing. Eradication of Bed Bugs. Reports show that the Borough is not badly affected by this pest. use of fluids containing 5 per cent. of D.D.T. has been continued with good results. 12 Use has also been made of Fumite canisters. These generators, by the application of heat, dispel the D.D.T. powder in very fine particles over the room. This form of fumigation has been found to be very effective. The work has been carried out by the staff of the Public Health Department. Owing to the cost of the materials, the Council agreed to make a charge for treatment based on a charge per room. schools. The sanitary condition of the schools in the locality still proved to be satisfactory. War Damage—Drainage. The Department continued to carry out the work of repairing and reconstructing war damaged drains. This duty entailed much work, both inside and outside of the office. In regard to the latter many contractors had to be interviewed and accounts checked before payment could be made. An indication of the amount of work involved is shown under Section D.— drainage inspections and tests, although it must be realised that not all were attributed to war damage. Essex County Council Act, 1933. Upon intimation from the County Council, inspections were made at Massage and Special Treatment establishments in connection with the renewal of licences and new applications. Twelve visits were made to such establishments and all were found to be Maintained in a good hygienic condition. INSPECTIONS CARRIED OUT BY SANITARY INSPECTORS. Infectious disease enquiries including enquiries in respect of scabies 113 Visits in connection with contacts, etc. 77 Enquiries in connection with food poisoning 5 General environmental Public Health Drains and public sewers inspected 836 Tests to drains and public sewers 205 Stables and manure pits inspected 10 Ditches and streams inspected 7 Public Conveniences inspected 3 Tents, vans and sheds (including gipsy encampment) 13 Workplaces inspected 1 Requisitioned houses inspected and visited 851 Smoke observations (casual) 7 Smoke observations (visits to plants) 2 Visits to Council tip 4 Schools inspected 10 Keeping of animals inspections 5 Shops Act inspections 3 Petrol installations 17 Miscellaneous visits 313 13 Section D. Housing No. of houses erected during 1946: 72 Council; 45 Private enterprise; 10 Cost of Works (rebuilds). 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) 905 (b) Number of inspections made for the purpose 1,973 VISITS (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 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 13 (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 176 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 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 36 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 9 (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 61 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 25 (b) By Local Authority in default of owners Nil 14 (c) Proceedings under sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which Demolition Orders were made 13 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 11 4. Housing Act, 1936.—Part IV.—Overcrowding:— No formal action. 56 inspections were made in suspected cases of overcrowding, and six revisits made. Nuisances Abated and Improvements Effected. Dwelling-houses Roof repairs 73 External walls and chimney stacks repaired 20 Walls underpinned 1 Gutters and spouts repaired or renewed 47 Damp-proof courses provided 13 Dampness remedied 34 Yards paved or repaired 4 Internal walls and ceilings repaired 45 Doors and frames repaired or renewed 23 Locks and fasteners repaired or renewed 2 Windows repaired or renewed 28 Floors repaired or renewed 57 Sub-floor vent. provided or improved 13 Skirtings repaired 13 Rooms cleansed or redecorated 33 Rooms with improved lighting 1 Staircases repaired and hand-rails provided 10 Fireplaces and flues repaired or renewed 27 Cooking stoves repaired or renewed 11 Wash coppers repaired or renewed 3 Sinks and washbasins provided or renewed 9 Waste pipes repaired or renewed 25 Food stores provided or improved 7 Dustbins provided or renewed 42 Water supply improved or reinstated 16 Water Closet walls, etc., cleansed 5 Water closet cisterns repaired or renewed 14 Water closet pans repaired or renewed 27 Water closet structures repaired or rebuilt 3 Water closet flush pipe joints repaired 20 Drainage board provided 1 Steps repaired, etc. 2 Mechanical feeder put into commission 1 Storage tanks repaired or renewed 2 Chimney" cowl provided 1 Glass lean-to's repaired 3 15 General Environmental Public Health. Drains cleansed from obstruction 14 Drains repaired or renewed 26 New drains provided 3 New inspection chambers provided 2 Inspection chambers repaired 4 Soil pipes and vent shafts repaired 5 Animal nuisances abated 1 Offensive accumulations removed 2 Ditches and streams cleansed 1 Tents, vans and sheds removed 6 Smoke nuisances abated 1 Improvements in boiler plant or fuel effected 1 702 Disinfection and Disinfestation. No. of rooms disinfected 171 Bedding removed from premises for steam disinfection 192 No. of rooms disinfested 53 FACTORIES ACT, 1937 1. Inspections for the purposes of provisions as to health (including Inspections made by Sanitary Inspectors. Premises (1) Number of Number on Register Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 54 - - - (ii) Factories not included in (i) to which Section 7 applies (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938† 104 - - - (b) Others - - - - (iii) Other Premises under the Act* (excluding out-workers' premises) Total 158 - - - 16 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. Unsuitable or defective 1 ... ... ... 3. Not separate for sexes ... ... ... ... Other Offences 1 ... 1 ... Total 2 ... 1 ... 3. Outwork. Number of out-workers in August list required by Sect. 110 (1) (c):— Wearing apparel—Making, etc. 22 Artificial flowers 1 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 4 Brush making 3 Feather sorting 1 Total 31 Inspection of Foods, etc. Meat shops (including visits to Ministry of Food Depot) 109 Dairies 11 Bakehouses and Bakers Shops 13 Ice Cream premises 74 Fishmongers and poulterers 15 Greengrocers and fruiterers 9 Grocers and wholesale grocers 56 Restaurants, cafes, etc. 26 Other premises 2 17 Surrendered Foods. The large amount of corned beef condemned can be attributed to the tins being returned to the Local Meat Depot by retail shopkeepers. Bread 5 cwt. 85 lb. Butter ½ 1b. Bacon 46¼ lb. Beef (fresh) 874 lb. Beef (corned) 398X6 lb. tins 2,388 lb. 3X2 lb. tins 61b. 153X 12 oz. tins 114¾1b. 2,508 lb. Beans (tinned) 52 tins Beans (haricot) 37 lb. Beans (brown) 58 lb. Cheese 30½ lb. Chocolate 18 lb. Chickens 20 lb. Carrots 4 tins Dates 123 1b. Eggs (dried) 6 tins Eggs (shell) 6 doz. Fish paste 2 jars Fish (fresh) Ray 5 stone Pilchards 6 stone 11 stone Fish (tinned) Brisling 6 tins Mackerel 2 tins Pilchards 71 tins Salmon 60 tin Sardines 17 tins Fruit (tinned) Apricots 1 tin Damsons 1 tin Gooseberries 1 tin Peaches 9 tins Pears 1 tin Plums 31 tin Flour 21 1b. Gravy powder 6 lb. Jelly 2 packets Jam (tinned) Apricot 1 tin Gooseberry 1 tin Pineapple 1 tin Plum 1tin Raspberry 1 tin Lemon Curd 24 jars Lamb, portions of carcase 40 1b. Lambs' liver 40 1b. Meat (tinned) Lamb tongue 1 tin Luncheon meat 11 tins Mutton (corned) 1 tin 18 Meat and vegetable 11 tins Sausage Meat 2 tins Steak 24 tins Steak and kidney 4 tins Tongue 1 tin Meat (sausage) 12 1b. Milk (condensed) 554 tins Mincemeat 7 jars Margarine l½ lb. Margarine (tinned) 3 tins Mustard 10 1b. Mutton (fresh) 8 1b. Peas (tinned) 31 tins Peas (split green) 100 1b. Pigeons 106 1b. Pearl Barley 2 cwt. Rabbits 88 1b. Raisins 25 1b. Suet 18 1b. Soup (tinned) 6 tins Sultanas 30 1b. Tea 35 1b. “Wheta” flavouring 1 cwt. 38 lb. (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 6 Persons registered as retail purveyors of milk in sealed bottles 12 Persons registered as retail purveyors of milk whose premises are situated outside the district 4 Number of inspections 29 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 6 3 Pasteurised 12 4 19 Milk Samples. Six samples of milk were taken for submission to the bacteriologistAll were milk which had been pasteurised and it was pleasing to note that each sample satisfied both the Methylene Blue Test and the Phosphatase Test. Food and Drugs Act, 1938 Samples. Milk 9 Tinned plums 1 Glycerine 1 Butter 4 Margarine 5 Lard and Compo. 4 Sugar (granulated) 2 Macaroni (cut) 2 Split peas 1 Vinegar, non-brewed 1 Pork pie 1 Golden raising flour 1 Edible cake decoration 1 Shredded beef suet 1 Coffee 1 Bloater paste 1 Lemon flavouring 1 Cheese 1 Tea 1 Ammoniated tincture of quinine 1 40 With the exception of one, all samples were classified by the Public Analyst as being genuine. One sample of margarine was reported to contain 16.5 per cent. water or 0.5 per cent. in excess of the approved amount. This sample reported to the Council and in view of the fact that the sample was "informal" one, a repeat sample was obtained. The Analyst reported upon this specimen as being genuine margarine. Ice Cream Samples. Eleven samples of ice-cream were purchased from manufacturers and vendors. In the case of samples from vendors it was found that the product was manufactured outside the Borough. The following table gives the result of the examinations carried out by the Counties Public Health Laboratories. 20 21 Number Hot or cold mix Local or outside manufacture No. of colonies per ml. on Agar at 37deg. C. Coliform test. Positive in 1/100 ml. in 3 tubes Bact. coli. Present in 1/100 ml. in 3 tubes REMARKS 1 Cold Local 700 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity 2 Hot Local 48,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity 3 Hot Local 120,000 3 in 3 tubes 0 in 3 tubes Passable standard of bacterial purity but not of quality expected of a “boiled mix.” 4 Hot Local 36,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity 5 - Outside 4,100 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity 6 — Outside 340,000 3 in 3 tubes 0 in 3 tubes Unsatisfactory and contains excessive numbers of bacteria 7 — Outside 1,000 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity 8 Outside 70,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity 9 Hot Outside ½ million 3 in 3 tubes 0 in 3 tubes Contains excessive numbers of bacteria, including bact. coli. in 1/100 ml. indicative of faecal contamination 10 Hot Outside 70,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity 11 - Outside 3,100 0 in 3 tubes 0 in 3 tubes High degree of bacterial purity It will be noted that sample number six was not of such good quality as most of the other samples, consequently the Senior Sanitary Inspector of the Borough in which the ice-cream was manufactured was communicated with. It was ascertained that the factory was satisfactory and that the firm engaged a bacteriologist to examine weekly supplies in addition to monthly specimens taken during the process of manufacture. The results of the bacterial examinations of ice-cream given by that bacteriologist for the months of June, July and August, 1946, were supplied. They are as follows:— June 95,000 per ml. July 80,000 per ml. August 130,000 per ml. The result of an examination of ice-cream by the same bacteriologist made at a time near to the date of the examination made by the bacteriologist to the Wanstead and Woodford Borough Council showed a count of 28,500 bact. per ml. in a sample mix and 33,000 in a choc-ice. A further sample of ice-cream was taken in the local shop and again a high bacterial count was reported (sample 9—half-a-million bact. per ml.) This result was again referred to the adjoining local authority, but in view of the two results given above, the local vendor was advised to change his manufacturer. This he agreed to do. An examination of the ice-cream from the new source of supply was encouraging as the bacterial count was down to 3,100 per millilitre (sample 11). The registration of premises, manufacturers and vendors is made in connection with the Essex County Council Act of 1933, and the numbers on the register up to the end of the year 1946 were as follows:— Manufacturers 22 Vendors 64 It will be appreciated, however, that because of the difficulties in obtaining supplies in the nature of raw materials, quite a number of manufacturers are not producing but buy the finished product direct from wholesalers. On the other hand, some registered vendors do not at the present sell ice-cream because they are unable to purchase from wholesalers 22 Section F. Prevalence of, and control over, Infectious and other diseases. 1. The following table shows the incidence of infectious disease during the year together with cases admitted to hospital and number of deaths. Disease Total cases notified Cases admitted to hospital Total Deaths Smallpox - - - Scarlet Fever 72 13 - Diphtheria 2 — - Pneumonia 40 11 31 Cerebro-Spinal Fever 1 1 - Acute Poliomyelitis 1 1 — Acute Polioencephalitis — — _ Encephalitis Lethargica — — — Dysentery 19 3 — Ophthalmia Neonatorum 1 — — Puerperal Pyrexia 7 3 — Paratyphoid Fever 2 1 — Enteric or Typhoid Fever 1 1 1 Erysipelas 13 — — Malaria (contracted abroad) 2 — — Measles 173 6 1 Whooping Cough 171 4 — Scabies 69 - — Diphtheria Immunisation. Completed inoculations made during the year were as follows:— Under 1 year 0 1 year 417 2 years 153 3 years 63 4 years 51 5-9 years 173 10-14 years 39 Total 896 23 3. Scabies. 62 cases of Scabies were treated at the Walthamstow Clinic. 4. Tuberculosis. Particulars of new cases of Tuberculosis and mortality from the disease during 1946:— 50 Pulmonary and 7 non-Pulmonary cases were notified for the first time during the year. 11 cases were transferred into the district. 2 cases were restored to the register. 28 Pulmonary and 2 non-Pulmonary cases died during the year. 6 deaths occurred from non-notified cases of Tuberculosis. 32 other cases were removed from the register. 320 cases remained on the register at the close of the year. County Tuberculosis Scheme. Dr. W. A. Bullough, Chief Tuberculosis Officer of the Essex Count Council, has kindly furnished me with the following particulars of Wanstead and Woodford patients sent to institutions for treatment during 1946: — Pulmonary Non-Pulmonary Total M. F. M. F. Adults 16 23 4 2 45 Children 1 — 1 3 5 24