LIBRARY Rom 19 BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1944 W. & W. Ltd. JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. BOROUGH OF ROMFORD HEALTH DEPARTMENT. INTERIM ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1944 JAMES B. SAMSON, m.d., d.p.h., Medical Officer of Health. 3 BOROUGH OF ROMFORD MEMBERS OF THE COUNCIL (As at 31st December, 1944). His Worship The Mayor: Councillor A. J. Dyer, O.B.E., J.P. Deputy Mayor : Councillor G. F. Chaplin, C.C. Aldermen: Alderman C. H. Barney. Alderman W. M. Goldsmith. ,, F. L. J. Cole, ,, H. W. Hole, J.P. J.P..C.C. ,, w. J. Russell, J.P. ,, R. A. Forge, J.P. ,, C. B. Smart, J.P. Councillors: Councillor Mrs. P. Besant. Councillor Mrs. 0. Haseltine. A. E. Blane. ,, W. D. Hill. ,, R. G. L. Bowyer. ,, Mrs. L. A. Irons. ,, A. J. Brian. ,, L. A. Lucas. ,, G. W. Butcher. ,, A. Needham. ,, H. F. Davenport. ,, E. W. Smith. ,, N. Eyre (Lieut. ,, Mrs. E. S. South. Commdr., R.N.Y.R.) ,, G.A.Stafford. ,, A. E. Fruitnight, C.C. ,, L. S. Webb. ,, J. Gow. ,, Mrs. E. A. White. 4 BOROUGH OF ROMFORD PUBLIC HEALTH COMMITTEE (As at 31st December, 1944). His Woe ship The Mayor : Councillor A. J. Dyer, O.B.E., J.P. (Ex-officio member). Deputy Mayor: Councillor G. F. Chaplin, C.C. (Ex-officio member). Chairman: Councillor Mrs. L. A. Irons. Vice-Chairman: Alderman F. L. J. Cole, J.P., C.C. Alderman C. H. Barney. Councillor A. E. Blane. ,, R. A. Forge, J.P. ,, A.J.Brian. ,, W. M. Goldsmith. ,, Mrs. O. Haseltint ,, W. J. Russell, J.P. ,, Mrs. E. S. South. ,, C. E. Smart, J.P. ,, L. S. Webb. Councillor Mrs. P. Besant. ,, Mrs. E. A. White. Maternity and Child Welfare Committee. As above with the addition of— Mrs. A. Damant. Mrs. A. E. Evans. Mrs. L. Fox. Mrs. E. G. Teal. Maternity, Etc., Cases Sub-Committee. Chairman : Mrs. L. Fox. Councillor Mrs. P. Besant. Councillor Mrs. E. A. White. ,, Mrs. O. Haseltine. Mrs. A. Damant. ,, Mrs. L. A. Irons. Mrs. A. E. Evans. ,, Mrs. E. S. South. Mrs. E. G. Yeal, 6 WAR-TIME NURSERIES COMMITTEE. His Worship The Mayor : Councillor A. J. Dyer, O.B.E., J.P. (Ex-officio member). Chairman: Councillor Mrs. E. A. White. Vice-Chairman: Councillor Mrs. O. Haseltine. Alderman F. L. J. Cole, Councillor Mrs. L. A. Irons. J.P., C.C. ,, Mrs. E. S. South. Councillor Mrs. P. Besant. Mrs. A. Damant. ,, A. E. Blane. Mrs. L. Fox HEALTH DEPARTMENT. Public Health Staff. Medical Officer of Health. J. B. Samson, m.d., ch.b., d.p.h. Assistant Medical Officer of Health. Elizabeth M. James, m.b., b.s., l.h.c.p., d.p.h. Sanitary Inspectors. (a) W. S. Gent, Chief Sanitary Inspector; Certificate of the Royal Sanitary Institute; Certificate of the University of Liverpool School of Hygiene for Meat and Foods. (b) H. C. Boswell, Certificate of the Royal Sanitary Institute ; Certificate of the Royal Sanitary Institute for Meat and Foods. (c) R. Martin, Certificate of the Royal Sanitary Institute; Certificate of the Royal Sanitary Institute for Meat and Foods. (Reported for Military Service 13th May, 1940). Health Visitors. (a) Mrs. E. J. Bingham, State Registered Nurse: State Certified Midwife. (b) Miss O. Clements, State Registered Nurse; State Certified Midwife ; Health Visitor's Certificate. (c) Miss F. K. Wells, State Registered Nurse ; State Certified Midwife; Health Visitor's Certificate. 6 Council Midwives. (a) Mrs. E. Bishop, State Certified Midwife (Commenced duties 18th September, 1944). (b) Miss C. M. Kerr, State Registered Nurse; State Certified Midwife. (c) Mrs. M. Mylward, State Certified Midwife. (d) Mrs. G. E. Sexton, State Registered Nurse; State Certified Midwife ; Queen's Certificate for District Nursing. (e) Mrs. D. Shaddick, State Registered Sick Children's Nurse; State Certified Midwife. (f) Mrs. A. P. Shuttleworth, State Registered Nurse; State Certified Midwife (Resigned 22nd March, 1944). (g) Mrs. J. Thompson, State Registered Nurse; State Certified Midwife. Clerks. (1) Permanent. (a) E. W. Gowers, Senior Clerk. (Reported for Military Service 20th February, 1941). (b) S. Adams. (Reported for Military Service 25th August, 1940). (c) C. G. Humberston. (Reported for Military Service 20th November, 1940). (d) Miss M. E. Pollitt. (Reported for Military Service 16th July, 1943). (2) Temporary. (a) L. Goold, Senior Clerk. (b) Miss P. Brabban. (Resigned 31st January, 1944). (c) Mrs. L. Canham. (d) Miss V. G. Coningham. (e) Miss B. A. Cubitt. (Commenced duties 14th February, 1944). (f) Miss B. Parker. War-time Nurseries—Matrons. "St. Moritz." Mrs. O. Haga, State Registered Nurse. Collier Row. Miss A. H. Charity, State Registered Nurse. Rush Green. (a) Mrs. M. Earl, State Registered Nurse; State Registered Children's Nurse. (Commenced duties 19th June, 1944). (b) Mrs. E. M. Ellerington, State Registered Nurse; State Registered Fever Nurse ; State Certified Midwife; Tuberculosis Certificate. (Resigned 31st May, 1944). 7 BOROUGH OF ROMFORD To His Worship the Mayor, Aldermen, and Councillors of the Borough of Romford. Mr. Mayor, Ladies, and Gentlemen, I have the honour, herewith, to present to yon this, my Annual Report on the Health of the district for the year 1944. This is the Eleventh Report in the series, since I was appointed your Medical Officer of Health, and it is drawn up in accordance with the requirements of Articles 6(3), and 17(5) of the Sanitary Officers (Outside London) Regulations, 1935, as modified by Circular 49/45 of the Ministry of Health, dated 19th March, 1945. This Circular, like those of previous war years, states that the Report for 1944 should again be an Interim one, owing to the necessity of economising in paper. The Minister of Health in his Report for the year ended 31st March, 1944, states that consistently throughout the war the vital statistics of England and Wales have been amongst the most unexpected and cheering items of news on the home front, and that he has found it possible to report that the health of the nation was maintained into the fifth year of war. What applies to the Country as a whole is equally true of this District, and the statistics for the first part of the sixth year of the war appear to be as encouraging. I have much pleasure in recording that for the first time in any one year there was no death in the district of a mother, arising out of confinement, although one maternal death occurred outside the district, and has to be recorded in this area, under the arrangements for the recording of transferable deaths. As before, my best thanks go to all members of my staff, who have assisted in the work of the Department, and in the compilation of this report; to my fellow officials for their kind assistance during the year; and to all the Members of the Council, who have shown sympathetic consideration of our difficulties, and a continued interest in the well-being of the inhabitants of this town. I am, Mr. Mayor, Ladies, and Gentlemen, Your obedient servant, JAMES B. SAMSON, Public Health Department, Medical Officer of Health. Town Hall, Romford, March, 1945. 8 1—GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. (i) Public Health Officers of the Authority. During the year there were several changes amongst the members of the staff, but not to the same extent as in the previous two or three years. The particulars are given at the beginning of this Report. At the time of writing the staff numbers 40, which includes those employed in the War-Time Nurseries, but excludes the Civil Defence personnel, Domestic Staff, etc. (ii) Laboratory Facilities. The scheme for Laboratory services remains the same as during last year, viz., all routine examinations, with the exception of those for Milk and Water, are carried out at the Oldchurch County Hospital Laboratory, and examinations of Milk and Water are carried out at the Counties Public Health Laboratories. It is with deep regret that I have to record the sudden death in November of Dr. E. V. Suckling of these latter laboratories, and I wish to take this opportunity of expressing my appreciation of the many services which he has rendered, and the ever willing advice which he has given. (iii) Nursing in the Home. (a) Midwives. Full advantage was again taken of the domiciliary service of salaried midwives. During the year, owing to domestic reasons, Midwife A. P. Shuttleworth tendered her resignation to the Council, Midwife Shuttleworth commenced duties with this Authority at the beginning of 1933, and, during the period in our service, her work was very much appreciated by all with whom she was associated, staff and mothers alike. Midwife E. Bishop has since been appointed to fill the vacancy which was created. As I mentioned in my last report consideration was being given at the end of last year to the Report of the Midwives Salaries Committee, one of the Committees appointed under the Chairmanship of Lord Rushcliffe, and during 1944 the various recommendations were implemented with the exception of the question of emoluments, which is still under consideration by the Essex Council Council, the Local Supervising Authority, as also the question of week-day, and week-end leaves from duty. To carry out those latter proposals it was felt that two additional midwives should be appointed to act primarily as relief midwives. 9 In addition to the Council Midwives, there are 2 Midwives in independent practice in the District, and also 5 District Nurse Midwives. One Midwife resident outside the Borough, undertook cases in the District during the year. (iv) Midwives Act, 1936. The following gives a summary of the cases attended by the Council Midwives, as Midwives, and as Maternity Nurses during 1944:— As Midwives 277 As Maternity Nurses 99 The attendances this year have been influenced somewhat by the evacuation from Romford of expectant mothers, after this area was included in the scheme of official evacuation, following increased enemy activity in the month of June. To counterbalance this, however, the Midwives attended many mothers who did not leave the district, and who, in normal times, would have been confined in Hospital, but by reason of restricted accommodation in Hospital and staffing difficulties could not be admitted. Only those mothers where abnormality is anticipated, or where the home conditions are unsatisfactory for confinement are now admitted to Hospital. (v) Hospitals: Public and Voluntary. (a) Infectious Diseases. (b) Maternity. (c) Children. (d) Other Cases. There is nothing new to report in either of these sections. 2.—MATERNITY AND CHILD WELFARE. (i) Ante-natal Clinics. Sessions for this purpose continued as before, as also the Consultative Ante-natal Clinic at Oldchurch County Hospital. During the year 1944, 1,081 individual expectant mothers attended the Clinics. In addition 22 mothers attended for postnatal advice. In all 202 sessions were held during the year. The total number of attendances of the 1,103 mothers mentioned above was 4,297 giving an average of 3.9 attendances per patient. The average number attending at each session was 21.3. 10 (ii) Infant Welfare Clinics. These sessions, also, were held as before. Close co-operation was continued with the Local Food Office to enable full advantage to be taken of the schemes of the Ministry of Food for the distribution of National Dried Milk, Fruit Juices, and Cod Liver Oil. These preparations are distributed from each of the Child Welfare Centres, from the Food Office, and from the Food Advice Centre in South Street. The Health Visitors and the Midwives were given instructions to take every opportunity of encouraging Expectant Mothers to apply as early as possible in pregnancy for their allotment of Cod Liver Oil in liquid form or in tablets, and all mothers have been encouraged verbally, and by leaflets, to procure the vitamin preparations, which are on issue for their children. Regarding the provision of Dried Milk, and other preparations, not within the scheme of the Ministry of Food, there were 68 applications received during the year, 18 had to pay a proportion of the cost, and the remaining 50 received free grants. It was found convenient in assessing the amount to be paid to alter the scale of the Council to that adopted by the Ministry of Food for the issue of National Dried Milk and vitamin preparations. During 1944, 362 Child Welfare Sessions were held, and the following table gives a summary of the attendances:— Table 1. Individual Children attending 1,785 Children attending for the first time 1,105 Medical Consultations 6,250 Attendances of Children under 1 year 11,450 Attendances of Children between the ages of 1 and 5 years 3,879 Average attendance per session 42.3 Table 2 relates to the Home Visits paid by the Health Visitors. Table 2. (a) Expectant Mothers. First Visits 173 Total Visits 183 (b) To Children under One Year of age. First Visits 1,074 Total Visits 2,508 (c) To Children between the Ages of 1 and 5 years Total Visits 4,678 11 (iii) Child Life Protection. In Romford, each Health Visitor also holds the appointment of Child Protection Visitor under Sections 206 to 220 of the Public Health Act. 1936. Table 3. (a) Number of persons who were receiving children for reward at the end of the year 21 (b) Number of Children:— (1) At the end of the year 30 (2) Who died during the year 3 (3) On whom inquests were held during the year 1 (c) Number of Child Protection Visitors at the end of the year who were:— (1) Health Visitors 3 (2) Female, other than Health Visitors 0 (3) Male 0 (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or Societies authorised to visit under the proviso to Section 209 (2) of the Public Health Act, 1936 0 (e) Proceedings taken during the year:— (1) Number of Cases 0 (2) Act and Section under which proceedings were taken — Careful revision was made of the number of children who could be received by any one foster mother, and, periodically, investiga. tioris were carried out to ascertain that the appropriate number was not being exceeded. In two or three cases I had to report to the Town Clerk that the number was excessive, and it was necessary for the Town Clerk to send warning letters. Some foster mothers fail to appreciate the great responsibilities involved by receiving children, but, I am pleased to say that in this district the foster mothers do generally take these responsibilities seriously, and the condition of the foster children under their care is all to be desired. Endeavours were still being made during the year to obtain the services of a 4th Health Visitor, but, at the end of the year, we were still unsuccessful. During the year the suggestions as set out in the Second Report of the Nurses Salaries Committee (Cmd. 6487) were adopted in their entirety by the Council, and given effect as from the appropriate date, 13 (viii) The Care of Premature Children. With reference to Ministry of Health Circular 20/44, the "Notification of Birth" cards in current use do not provide a space for the weight at birth, when this is 5½ lbs. or less, but, on receipt of the Circular, all practitioners and midwives were asked to supply this information on the cards. Arrangements have been made for a space to be provided on the new notification cards, and these have now been received. To enable adequate and suitable equipment to be provided in the home, an order has been placed for 2 draught proof cots, with detachable linings, warm and suitable clothing, hot water bottles, special feeding bottles, etc., and when these are delivered, they will be despatched to the homes of premature infants, on the request of a doctor or midwife. When it is necessary for a premature infant to be removed to Hospital an ambulance will be available with a supply of oxygen, and a heated carrier, and a nurse will be in attendance. It has not yet been possible to obtain the services of a paediatrician, but I have been in communication with the County Medical Officer, who informs me that the Essex County Council have approved in principle to the engagement of a part-time Consultant, with a consultative clinic at Oldchurch County Hospital, Romford, and when this Consultant is appointed consideration will be given to our utilising his services. (ix) War-Time Nurseries. During the first half of the year the demand for admissions to the 3 Nurseries exceeded the number of places, and waiting lists were established. When, however, Romford was declared an "Evacuation" Area many children were evacuated, and this resulted in a dropping off of the attendances at the Nurseries', and the necessity to maintain a waiting list did not arise. Later, the demand for admissions again increased, and, at the end of the year, the numbers in attendance had almost reached the figures earlier in the year. The requests from Romford mothers for the admission of their children to the Rush Green Nursery has not been sufficient to fill the Nursery, and, in consequence, it has been possible to admit a number of children whose residence is in neighbouring districts. 12 (iv) Inspection of Nursing Homes, etc. In the month of January 20 Parkland Avenue was registered by the Essex County Council, under Section 187 of the Public Health Act, 1936, as a Nursing Home; permission being given for this Home to receive 1 Maternity Case. A routine inspection was carried out in the first quarter of the year, but later this Home temporarily discontinued accepting cases. The other 2 Registered Nursing Homes were visited quarterly. Routine investigations were also made when notices were given by the Midwives in the district that they had been attending patients who had developed temperatures, indicating puerperal pyrexia, or where babies had shown eye discharge. (v) Adoption of Children (Regulation) Act, 1939. At the request of the various Adoption Societies many enquiries were made by the staff of the Department as to the suitability of persons desiring to adopt children, and, on being informed that such children had been received, further inspections were carried out, and the Adoption Societies notified accordingly. The following statistics are given, as requested by Circular 2790 of the Ministry of Health:— (a) No. of persons who gave notice under Section 7 (3) during the year 0 (b) Total No. of children "adopted" under the Section during the year 0 (c) No. of such children:— (i) Under supervision at the end of the year 0 (ii) Who died during the year 0 (iii) On whom inquests were held during the year 0 (d) Particulars of any proceedings taken during the year (vii) The Care of Illegitimate Children. In last year's report I stated that a preliminary conference had been held between the County Council and separate Welfare Authorities, in order if possible, to formulate a joint scheme for the Care of Illegitimate Children. In November of this year we were informed by the County Council that, owing to the fact that all Autonomous Authorities did not wish to participate in such a joint scheme, the County were drafting a scheme of their own, which, however, could be adapted to include within its scope any of the Autonomous Authorities within the County. At the end of the year, we were awating a copy of this draft scheme. 14 The average attendance for the year at each Nursery is as follows "St. Moritz" Nursery 33 Collier Row Nursery 24 Rush Green Nursery 24 It will be remembered that "St. Moritz" and Collier Row Nurseries are capable of taking 40 children each, and Rush Green Nursery, 50 children. Owing to prevailing conditions the Ministry of Health were asked to give a further opinion as to the necessity of proceeding with plans for a 4th Nursery to serve the area, as, previously, sanction to establish had been obtained. The Ministry indicated that having regard to the urgent demand for building labour for war-damage repairs, etc., the proposed scheme should be abandoned. On the the whole it has been possible to maintain a sufficient staff throughout the year, although there have been several changes of personnel. To supplement the Full-time Stuff, a small number of voluntary workers have attended regularly, and, in addition, assistance has frequently been given by the personnel of the First-Aid Posts. 3.—INSPECTION AND SUPERVISION OF FOOD. The Sanitary Inspectors have again carried out their numerous duties in connection with the inspection of meat and other foods, at the Regional Slaughterhouse, the Meat Depots, Butchers' Shops, Stalls, etc., and, in this connection, we have again been grateful for the assistance rendered by the Sanitary Inspectors of the Dagenham and Hornchurch Districts, who, for the purpose of carrying out inspections, have attended at the Regional Slaughterhouse on one day of each week. Altogether, 989 visits have been paid. At the Slaughterhouse alone, 13,295 carcases were inspected. 4— PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. (i) Notifiable Diseases. (a) Scarlet Fever. During the first six months of the year there was a slight increase in the number of cases of Scarlet Fever, but, as for several years now, the type was mild. 15 (b) Diphtheria. Propaganda in connection with Diphtheria Immunisation was again maintained throughout the whole of the year, and every available opportunity was taken of proving its value to parents. Sessions for Immunisation and Schick Testing were again held at each Child Welfare Clinic, and at all the Schools. It is very difficult to assess the up-to-date percentage of children who have been immunised, owing to the child exodus arising from the evacuation scheme, but it is quite clear that the small number of cases of Diphtheria which now come to our notice is a reflection of the benefits which have occurred from our scheme, which has now been in operation in this district for over 9 years. The agent used for immunisation, viz., Alum Precipitated Toxoid has again been obtained free of charge from one of the Emergency Laboratories, and is likewise issued free from this Department to any practitioner who requires it. The following statistics relate to the state of Immunisation as at 31st December, 1944:— Table 4. Under 5 yrs. 5-15 yrs. Total. No. of children who completed the full course of Immunisation between 1st Jan. and 31st Dec. 710 166 876 (a) Approx. estimated No. of children 4,772 9,700 (b) Percentage Immunised at 31st Dec. 58 64 Table 5 gives the statistics since the inauguration of the scheme in Bomford in 1935, till the end of 1944. Table 5. Number of Immunisation injections given at the Clinics 21,280 Number of children who have completed the Course of Injections, either at the Clinics or Privately 9,477 Number of Schick Test Injections given at the Clinics, including control injections 14,255 Number who have been Schick Tested 7,147 Percentage found to be Immune after Course of Treatment 91.9 17 5.—SUPPLEMENTARY. (i) Water. Mr. Bernard W. Bryan, Engineer to the South Essex Waterworks Company, has informed me that the water supplied throughout the Company's District was sufficient for all purposes. All samples analysed have been reported on as being pure and wholesome. In addition to the above analyses, samples of water have been taken monthly from different premises in the district by the Sanitary Inspectors. These were submitted for Chemical and Bacteriological examinations, and the results have confirmed the findings of the Waterworks Company. Mr. Bryan also states that the supply is constant throughout, that standpipes are not in use, and that the water in the district is not plumbo-solvent. Regarding the question of the number of examinations made prior to and after the treatment of the water, Mr. Bryan reports:— "About 3,000 samples of water are examined annually at our Langham laboratory for chemical, bacteriological and biological purposes. The water supplied by the Company is derived in part from the River Stour (Essex and Suffolk) and in part from eight wells carried into the chalk formation in the Company's district. The proportion of water supplied from the River Stour and from the local wells varies according to the district demands and at the present time it is about 70% of Stour water and 30% well water. Dealing first with the Stour water—The Langham works abstract water from the river which is then passed through a sedimentation reservoir holding about three days' supply and then passes to primary filters and secondary filters and is subsequently treated with ammonia and chlorine. Two samples per week are examined chemically and bacteriologically of the water from the river, from the outlet to the sedimentation reservoir, the outlet to the primary filters and the outlet to the secondary filters before chlorination. A daily sample is examined bacteriologically of the water after chlorination. During the winter and spring months water is also pumped from the same reach of the River Stour in which the Langham intake is situated to our Abberton Reservoir, which has a total capacity of 5,700 million gallons, 16 (c) Measles and Whooping Cough. Whooping Cough was epidemic during the months of January to June. Throughout the year there was no epidemic of Measles, although there was a slight rise in the number of cases during February. (d) Acute Infective Hepatitis. Forty-six cases of this disease were notified during the year, and, in accordance with Ministry of Health Circular '2883, the actual notification forms were forwarded each week to the Regional Medical Officer at Cambridge, where they received consideration by the team of research workers, who are stationed there, and who are endeavouring to ascertain many of the unknown factors of this condition. (e) Smallpox. Early in 1944 a small outbreak of Smallpox occurred in a district near London. Information was received about residents in this area, who were believed to be contacts. These were all visited in the usual way, and kept under surveillance for the requisite period, vaccination or re-vaccination being advised. None of the contacts developed Smallpox. About the same time information was received about certain passengers and crew, proceeding to this area from ships reaching this Country from the Fjast, and on which one or two cases of Smallpox had occurred. These, also, were visited, and kept under supervision, but no cases developed. (ii) Non-Notifiable Diseases. (a) The relative prevalence of these is set out below:— Table 6. Rubella 296 Chickenpox 97 Mumps 6 (b) Influenza. I reported previously on the arrangements which were made in December, 1943 to tackle the epidemic of Influenza, which was then prevalent. This epidemic continued into the early part of 1944, but did not show any higher mortality. The morbidity rate, however, was fairly high, but the period of incapacity on the average was short. Most of the fatal cases occurred in persons over 55 years of age. 18 The water from the Company's Abberton and Layer-de-la-Haye works is examined twice weekly chemically and bacteriologically, from the Abberton storage reservoir and from the primary and secondary filters, just as in the case at the Langham Works. Bacteriological examinations are made daily of the water after chlorination. The mixed water from the above two sources is delivered into a covered reservoir at Herongate near Brentwood and weekly samples are examined bacteriologically and the amount of residual chlorine is also determined; the latter also holds good for the water pumped from the two Stour sources. The local wells of the Company are eight in number which includes the Grays well and pumping station but the latter is only used, for the sake of economy, for emergency supply and, in fact, has not been drawn on so far during the war. Samples, however, have been taken and the water is in all respects satisfactory. Weekly samples for bacteriological examination are taken, from the wells which are in supply, after chlorination and periodical samples of water before chlorination are also taken. Tests for residual chlorine are made daily at each of the pumping stations in supply. The whole of the analytical results are forwarded by our Chief Chemist and Bacteriologist, Mr. G. U. Houghton, to myself weekly, together with a report and a monthly report is submitted by Mr. Houghton to my Directors. In all cases the water supply is reported on as wholesome and suitable for the purposes of a public Supply." (ii) The Rats and Mice (Destruction) Act, 1919. The Infestation Order, 1943. Active steps were again taken to ascertain all likely sources of infestation by Rats and Mice, and all complaints received prompt attention. The procedure of destruction of these vermin by prebaiting and poison baiting was carried out, according to the instructions received, and each month particulars of the work done have been sent to the Infestation Branch of the Ministry of Food. 19 (iii) Infestation. The details with regard to the prevention of Infestation were set out in my Report for last year, and are still in operation. There are very few cases of Lice infestation, and the number of cases of Scabies brought to our notice has been reduced. We still get reports of children, who are dirty in their person, or in their clothing, and when this occurs appropriate action is taken. (iv) Evacuation. Soon after the advent of flying bombs on this part of the Country, Romford was declared an "Evacuation" Area, and complete, although hurried, arrangements were made for the medical examination of all persons to be evacuated. In this connection, I received considerable assistance from the medical and nursing staff of the School Medical Service of the Essex County Council, and it was with pleasure that I noted the infrequency of cases of infestation amongst the children. Furthermore, the great majority were adequately nourished and clad, and well-cared for. Special arrangements were made for expectant mothers, who wished to be evacuated during their last month of pregnancy, and we are indebted to the Women's Voluntary Services, and to the members of the Volunteer Car Pool, who have given us continuous service in the matter of transport. (v) Air Raid Precautions. Owing to increased enemy activity in the area the Casualty Service Personnel again had the opportunity of giving a good account of themselves, and, I am pleased to say, upheld their previous reputation for promptitude and efficiency. This service has been very much appreciated by those members of the public, who have, unfortunately, been subjected to injury. A series of lectures on First-Aid have been given during the year, and interest has been maintained by holding revision classes whenever possible.