Annual Report of M.O.H. Please circulate as quickly as possible. S.M.O. III. (93 II). S.M.O II. (86 II). S.M.O. IV. (91 II). S.M.O. VI. (39 II). S.M.O. I. (110 II). General Library. WOODF 1 WOODFORD URBAN DISTRICT COUNCIL ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH, FOR THE YEAR ENDING 31st DECEMBER, WOODFORD URBAN DISTRICT COUNCIL ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH, FOR THE YEAR ENDING 3st DECEMBER 1925. 3 WOODFORD URBAN DISTRICT COUNCIL ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH FOR YEAR ENDING DECEMBER 31st. 1925. NATURAL AND SOCIAL CONDITIONS OF WOODFORD. Area (acres) 2145 Population (Census 1921) 21245 „ (Estimated mid-year 1925) 21800 Density of Population per acre 10 No. Inhabited Houses (1921) 4859 No. of families or separate occupiers (1921) 4877 Rateable Value— Buildings £132279 10 0 Land 1277 6 0 Total £133556 16 0 Sum represented by penny rate 525 14 1½ Woodford is situated on the summit and eastern slopes of a ridge between the Rivers Lea and Roding. The highest point is 215 feet, and the lowest 40 feet, above sea level. The district includes a small area to the east of the Roding. This is the hamlet of Woodford Bridge, containing Dr. Barnardo's Boys' Garden City. Owing to the shallow bed of the Roding. and the large quantity of water which is carried down in wet weather, this river frequently overflows, inundating the adjacent fields. The bridge by which the new Arterial Road to Southend crosses the river further contributes to the flooding, by reason of the insufficient span of its arch. The submerging of the High Road 4 to Chigwell. which formerly occurred from time to time, was obviated when the work of raising the road was completed in March, 1924. Both soil and subsoil of Woodford are of clay, with scattered small patches of gravel. The area is largely residential, the majority of the inhabitants following occupations in London. VITAL STATICTICS. Total. Male. Female. Births—Legitimate 330 184 146 Per 1000. Birth rate „ Illegitimate 5 3 2 15.4 Deaths 200 96 104 Death rate 9.2 Birth Rate. The birth rate is the lowest recorded in Woodford since the years of the War. The rates for the past five years are shown in the table on page 17. Comparison of birth rate with rates of country generally: Per 1000 Population. England and Wales 18.3 105 Great Towns 18.8 157 Smaller Towns (populations 20,000—50,000) 18.3 London 18.0 Woodford 15.4 Death Rate. The death rate was again low (9.2). The rate for England and Wales was 12.2; for the 105 Great Towns, 12.2; for the 157 Smaller Towns, 11.2; and for London, 11.7. Infant Mortality. There were 13 deaths of infants under one year in the district during 1925. This corresponds to an infant mortality rate of 39 per 1,000 births. The rate for England and Wales during the same period was 75 per 1000 births. 5 Deaths from Principal Epidemic Diseases. Three deaths occurred from zymotic diseases, viz.; Whooping Cough 1, Diphtheria 1, and Diarrhoea (under 2 years) 1. No deaths occurred from Smallpox, Measles, Enteric Fever, or Scarlet Fever. The zymotic death-rate was thus .14 per 1000 of the population. GENERAL PROVISION OF HEALTH SERVICES IN THE DISTRICT. HOSPITALS— (1) Tuberctilosis.—Patients from the Woodford area attend at the Walthamstow or Leyton Tuberculosis Dispensaries. Sanatorium treatment in suitable cases, and where beds arc available, is provided by the Essex County Council. (2) Maternity.—There are no Maternity Hospitals within the district. Cases are admitted to the Labour Wards of the West Ham Infirmary and to the Maternity Wards of the London Hospitals. (3) Children.—There is a children's ward of 5 beds at the Woodford Jubilee Hospital. (4) Infectious Disease.—Cases of infectious disease occuring in Woodford, and which require removal, are taken to Waltham Joint Hospital. This Hospital also receives cases from Buckhurst Hill, Chingford, and Waltham Holy Cross. The accommodation provided is adequate. (5) Smallpox.—Any cases of this disease occurring in Woodford would be removed to a Joint Hospital, in pursuance of an agreement between the Waltham Joint Hospital Board and the West Ham Local Authority. (6) Other. The Woodford Jubilee Hospital. This Hospital contains 17 beds in the general wards—6 for men, 6 for women, and 5 for children. In addition, there are four private wards and one ward for special cases, making a total of 23 beds. The institution is entirely supported by voluntary contributions. 6 Ambulance Facilities. (a) Infectious cases sent to Waltham Joint Hospital are removed in a motor ambulance attached to the Hospital. (b) Non-infectious and accident cases are removed in an Ambulance loaned to the Council by the British Red Cross Society. It has been proposed that the Woodford Council purchase an Ambulance for its own use. This will in all probability be carried out in the near future. Public Health Officers. Medical Officer of Health (Part Time): R. F. VERE HODGE, M.D., Cantab. Sanitary Inspector (Full Time): W. S. MILLS, Cert. R. San. Inst. Assistant Sanitary Inspector (full Time): F. H. DAY, Cert. R. San. Inst. (Appointed January, 1926). Midwives employed by Council : Mrs. HARVEY, C.M.B. Miss DILWORTH, C.M.B. Miss MOORE. C.M.B. Clinics and Treatment Centres. Child Welfare Centres: (i.) St. Barnabas' Hall. Snakes Lane. (ii.) Fullers Road Sunday School. These are supported and directed by the District Council. A third centre, which is under voluntary direction, meets at Hermon Hill Church Hall. The School Clinic, High Road, South Woodford. This Clinic is under the direction of the Essex County Council. Professional Nursing in the Home. All professional nursing in the district is done by private nurses working independently. There are no organisations for providing home nursing. 7 Midwives. Three Midwives are employed by the Urban District Council, from whom they receive a fixed salary. Fees received by them are payable to the Council. LEGISLATION Adoptive Acts in Force. Public Health Acts Amendment Acts, 1890 and 1907. Private Street Works Act, 1892. Bye-Laws referring to Nuisances, Slaughter Houses, Houses Let in Lodgings. (The Bye-laws made by the Woodford Local Board in 1883 with respect to Slaughter Houses being no longer adequate, they were re-modelled during the course of the year. The new Byelaws were adopted by the Council in October, and confirmed by the Minister of Health in December, 1925). Dairy Regulations under Dairies, Cowsheds and Milk Shops Order, 1885. Public Health Act, 1925.—This Act has been wholly adopted by the Council, and comes into operation on 1st April, 1926. SANITARY CIRCUMSTANCES OF THE AREA. Water Supply is from the mains of the Metropolitan Water Board. Rivers and Streams.— The effluent from the Eastern Sewage Works is received by the River Roding, and that of the Western Works by the River Ching (a tributary of the River Lea). Drainage and Sewarage. Eastern Sewage Works.— The extension of these works was completed towards the close of the year. Four new filters and two pairs of tanks were provided, and several minor improvements made, the total cost amounting to £12,000. There are now 6 filters and 18 contact beds (9 coarse and 9 fine), capable of dealing with a flow of 600,000 gallons daily. The results obtained during the year were satisfactory, as is shown by the reports of the County Analyst. 8 Western Sewage Works.—These works are capable of dealing with 10,000—11,000 gallons daily, and the reports and results of analyses of the samples of effluent taken by the Lea Conservancy Board have been satisfactory. The sewage of a portion of Buckhurst Hill is dealt with at these works. Closet Accommodation.—There are no privies, the watercarriage system being universal throughout the district. Scavenging is done by contract, and is satisfactory. Rubbish is deposited on a portion of vacant land in the district. Hardcore is extracted for the foundations of roads, and ashes for the burning of bricks. Ash-bins.— The great majority of the bins are movable, galvanised, and covered. REPORT OF SANITARY INSPECTOR. Summary of visits and inspections made during the year:— General district inspection (including Housing inspection) 1609 Investigation of complaints of nuisances 110 Testing drains (by request) 6 Special Inspections— Re Rent Act certificates 20 Factories, Workshops, etc. 43 Outworkers' premises 11 Slaughterhouses 45 Bakehouses 20 Cowsheds 13 Dairies and Milkshops 24 Other Food premises 71 Stables, Mews, etc. 9 Picture Hall 2 Schools 27 Taking Samples 8 Visits re cases of infectious disease: on disinfection of premises 87 9 Summary of Defects or Nuisances Found. Dwellings— Defective floors, walls, ceilings, etc. 74 Damp walls 26 Defective roofs 31 Defective or improper guttering, downspouts, etc. 41 Dirty walls or ceilings 71 Drains— Defective 57 Choked 34 Yards— Unpaved 6 Dirty 1 W.c.'s—Defective structure and fittings 50 Baths, Lavatories, etc.— Defective traps, waste-pipes, etc. 19 Insufficient dust-bin 11 Accumulations 17 Insanitary drinking-water cisterns 10 Overcrowding 1 Animals 3 Slaughter Houses. These consist of— Registered 4 Licensed 3 Forty-five inspections were made and the premises found in satisfactory condition. Dairies, Cowsheds, and Milkshops. Thirty-seven visits were paid to these premises. In one instance it was found necessary to serve a notice, i.e., for defective floor to cowshed. The necessary repair was carried out. Schools. Twenty-seven visits of inspection were made during the year. Five minor defects were found and remedied. Generally speaking the sanitary condition; and water supply of the schools within the district is good. 10 Factories, Workshops etc. Forty-nine Inspections were made. Written notices were sent in 7 cases. There were no prosecutions. The details are as follows:— 1. Factories (including Factory Laundries): Inspections. 17; Notices, 3. 2. Workshops (including Workshop Laundries): Inspections, 27; Notices, 3. 3. Workplaces (other than Outworkers' Premises): Inspections, 5; Notices. 2. Defects found. Particulars of Defect. Number of Defects. Found. Remedied. Receiving Attention. Referred to H.M.Inspr Nuisances under Public Health Acts:— Sanitary Accommodation— Insufficient 0 0 0 0 Unsuitable or Defective 4 4 0 0 Not Separate for Sexes 0 0 0 0 Other Nuisances 4 4 0 0 Offences under Factory and Workshop Acts 0 0 0 0 Total 8 8 0 0 Outworkers' Premises.—Notifications were received of 11 premises in Woodford. Notices were given in 2 instances, the premises being unwholesome. The defects were remedied. HOUSING. General Housing Conditions in the Area:— The district is largely residential, and. generally speaking, the houses are well-planned, sanitary, and in good condition. There are, however, scattered areas of old property which are not up to modern standards. 11 Overcrowding:— There is a great shortage of houses suitable for the labouring classes, there being two families in many of the smaller houses. Consequently, the accommodation is inadequate. HOUSING STATISTICS FOR 1925. No. of new houses erected during the year:— (a) Total (including number given separately under (b) ) 64 (b) With State assistance under the Housing Acts: (1) By the Local Authority - (2) By other bodies or persons 3 I.—Unfit Dwelling Houses. Inspection. 1. Total Number of Dwelling Houses Inspected for Housing Defects (under Public Health or Housing Acts) 1609 2. Number of Dwelling Houses inspected and corded under Housing (Inspection of District) Regulations, 1910 341 3. Number of Dwelling Houses found to be in a state so dangerous as to be unfit for human habitation 0 4. Number of Dwelling Houses found not to be in all respects reasonably fit for habitation 251 II.—Remedy of Defects without Service of Formal Notices. Number of Houses rendered fit in consequence of informal action by the Local Authority 244 III.—Action under Statutory Powers. A. Proceedings under Section 3 Housing Act. 1925— 1. Number of Dwelling Houses in respect of which Notices were served requiring repairs 0 2. Number of Dwelling Houses which were rendered fit— (a) By Owners 0 12 (b) By Local Authority in default of owners 0 3. Number of Dwelling Houses in respect of which closing orders became operative 0 B. Proceedings under Public Health Acts— 1. Number of Dwelling Houses in respect of which notices were served 7 2. Number of Dwelling Houses in which defects were remedied (a) By Owners 7 (b) By Local Authority 0 C. Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— 1. Number of Representations made with a view to making Closing Orders 0 2. Number of Dwelling Houses where Closing Orders were made 0 3. Number of Dwelling Houses where Closing Orders were determined 0 4. Number of Dwelling Houses in respect of which Demolition Orders were made 0 5. Number of Dwelling Houses Demolished 0 WALTER S. MILLS. INSPECTION AND SUPERVISION OF FOOD. (a) Milk Supply.—The wholesomeness of the milk supply, of which only a small proportion is produced within the area, is good, as shown by the results of analyses of samples which are taken from time to time. Of the milk produced within the district, no instance of Tuberculosis in cattle or milk was discovered or suspected. The following shows the number of persons registered to sell milk, and the number of licences granted for the sale of graded milk: Wholesale Purveyors of Milk 3 Retail „ „ 17 13 Licensed to sell "Certified" Milk 2 „ „ "Grade A (Tuberculin Tested)" 3 „ „ "Grade A" 2 „ „ "Pasteurised" 2 In addition, two supplementary licences were granted (one for "Grade A'' and one for "Pasteurised"). In no case was it found necessary to revoke or refuse registration or licensing. Any suggestions made by the Sanitary Inspector were well received, and the work carried out. (b) Meat.—There are seven private: slaughterhouses within the district, and notification of intending slaughter is given under the Meat Regulations, 1924. The carcases are inspected at the time of killing, but in no case during the past year was it found necessary to condemn any carcase or portion thereof. Condemned meat is disposed of by burning in the furnace at the Council's Eastern Sewage Works. The following shows the number of slaughterhouses in use in the area at the dates mentioned: In 1920. In Jan., 1925. In Dec., 1925. Registered 4 4 4 Licensed 2 3 3 Total 6 7 7 Steps have been taken to meet as far as possible the requirements of the Meat Regulations, 1924 in regard to the protection of meat in shops from dust and flics. Glass windows to shop fronts have been provided, and great cleanliness is shown in the handling of the meat and utensils. There are no stalls for the sale of meat within the district. (c) Other foods: Seventy-one visits were made during 1925 to other places in which food is prepared, stored, or exposed for sale. No neglect of cleanliness was found. (1) There are 10 bakehouses, none of which are underground. All are in satisfactory condition. (d) Sale of Food and Drugs Acts.—Samples of milk are taken from time to time under these Acts. During the past year 8 samples were taken, all of which were reported by the Analyst to be genuine. 14 INFECTIOUS DISEASES. Prevalence.—During the last five years the incidence of infectious disease has shown little variation. Both scarlet fever and diphtheria appear to be endemic to the district, and the frequent occurrence of single eases in widely separated parts of the district is noticeable. There have been no notifications of smallpox during this period, nor have any vaccinations been performed under the Smallpox Regulations, 1917. No cases of Encephalitis Lethargica have been notified. Laboratory Work.—All Pathological and Bacteriological facilities are provided by the Essex County Council, the work being done at the Essex Public Heath Laboratory, 91, Queen Victoria Street. Diphtheria Antitoxin is provided free by the District Council, and can be obtained by any Doctor requiring it from the Medical Officer of Health. Disinfecting and Disinfestation. A Washington Lyons Disinfector is in use for disinfections, also a Formalin Sprayer and Formalin Vaporisor. Incidence of notifiable diseases in the area during 1925: DISEASE. Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Small Pox 0 0 0 Scarlet Fever 33 21 0 Enteric Fever (including Paratyphoid) 3 1 0 Diphtheria 12 11 1 Erysipelas 6 0 0 Puerperal Fever 2 0 0 Ophthalmia Neonatorum 1 0 0 Pneumonia 29 0 12 Scarlet Fever.—The prevalence of this disease during the year was low, the number of cases notified (33) being the lowest recorded since 1919. Twenty-one (64%) of the cases were removed to Hospital. There were no deaths. Paratyphoid.—Three cases were notified. No connection could be traced between the cases. Diphtheria.—The attack rate per 1,000 living was again low, being .5 as compared with 1.23 for England and Wales. One ease proved fatal. 15 Puerperal Fever.—Two cases were notified. Both recovered. 0phthalmia Neonatorum.—One case was notified. The infant was successfully treated at home, its vision being unimpaired. Disinfections.—One hundred and three disinfections were done, which included Measles, Tuberculosis, Cancer, and Septic Conditions. Seventeen were carried out for a neighbouring Authority. TUBERCULOSIS. Age Periods NEW CASES DEATHS. Palmonary. Non Pulmonary. Pulmonary, Non-Pulmonary M F M F M F M F 0 0 0 0 0 0 0 0 0 1 0 1 2 1 0 0 2 0 5 1 2 3 0 0 0 0 0 10 1 0 3 3 0 0 0 0 15 0 2 1 2 0 1 0 0 20 1 2 0 0 0 0 0 0 25 6 1 1 0 5 0 0 0 35 1 4 0 0 0 0 0 0 45 2 1 1 0 1 0 0 0 55 1 0 0 0 0 1 0 0 65 and upwards 1 0 0 0 1 0 0 0 Total 14 13 11 6 7 2 2 0 Thus the total number of new cases notified during the year was 44, and the number of Woodford residents on the tuberculosis register at the end of the year was 64. There were 11 deaths, which is equivalent to a death-rate from the disease of .5 per 1.000 of the population. Public Health (Prevention of Tuberculosis) Regulations, 1925• It has not been found necessary to- take any action under these Regulations. MATERNITY AND CHILD WELFARE. Midwives.—The inspection of midwives and administration of the Midwives Acts, 1902 and 1918, is carried out by the Essex County Council. 16 Three midwives are employed by the Woodford Council, from whom they receive a fixed salary. Fees received by them arc payable to the Council. Expectant mothers are encouraged to engage with the maternity nurses at the earliest possible moment, as they are then visited regularly in the ante-natal period and examinations of the urine made. All primiparae are urged to have an examination by a doctor. The nurses attend either as a midwife or with a doctor. They also continue to visit the children at whose birth they have attended until they are of school age. Child Welfare Centres.—There are two Child Welfare Centres in the district: (i.) At St. Barnabas' Hall, Snakes Lane; (ii.) at the Fullers Road Sunday School. These are supported and directed by the District Council. A third Centre under voluntary direction meets at Hermon Hill Church Hall, which is just over the Wanstead border. This is attended by mothers and children from both districts. The midwives attend once a week at their Centres. Maternal Mortality. The following table shows the number of women dying in, or in consequence of, childbirth during the past 5 years: From sepsis. From other causes. 1921 1 0 1922 0 2 1923 0 5 1924 0 0 1925 0 0 Total 1 7 For incidence of Puerperal Fever see Infectious Disease Table on Page 18. R. F. VERE HODGE. 17 TABLE I. Vital Statistics. Population. Births. Rate. Deaths. Rate. Infant Mortality. Per 1,000 births. Deaths. Rate. 1921 21170 351 17.2 206 9.7 25 71.0 1922 21310 366 16.7 222 10.4 17 47.7 1923 21460 340 15.84 174 8.1 5 14.7 1924 216l0 340 15.73 204 9.3 15 44.0 1925 21800 335 15.4 200 9.2 13 39.0 18 TABLE II. Notification of Infectious Disease. Scarlet l ever. Diphtheria. Typhoid, including Paratyphoid. Erysipelas. Tuberculosis. Puerperal Fever. Ophthalmia neonatorum. Pneumonia. Cerebral spinal Fever. Malaria. Acute Poliomyelitis. Other diseases. Pulmonary. Other Forms. 1921 48 37 0 7 18 10 1 8 8 0 0 0 0 1922 73 19 0 10 32 10 1 1 77 0 0 0 0 1923 46 10 1 4 24 8 0 0 17 0 0 0 0 1924 69 10 4 9 16 0 0 30 0 0 1 0 I925 33 12 3 6 27 17 2 1 29 0 0 0 0