WANS 9 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the medical officer OF HEALTH For the Year Ending 31st December, 1944. 77030 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the medical officer of heakth For the Year Ending 31st December, 1944. 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). F. Nau, A.R.S.I. (b) (from 1st March, 1944.) Health Visitors, Miss H. M. Hird, S.C.M. (e) Mrs. O. A.. Greedus, S.R.N., S.C.M. (e). Mrs. H. Underwood, S.R.N., S.C.M. (e) (from 4th January, 1944) 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. (from 15th April, 1944) Clerks, S. C. Hearson, Chief Clerk. (on Military Service) Miss A. E. Harrison. Mrs. D. A. White (to 1st July, 1944) Mrs. M. B. Blanks (from 17th March, 1944) (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, 1944. In the year under review the public health of the district remained satisfactory and the incidence of infectious disease among the civilian population approximated to that of pre-war years. The estimate of the resident population as given by the Registrar General is 46,670, as compared with 50,010 in 1943. This reduction in the Population was due to evacuation, and from information kindly supplied by the Food Office, it would appear that the figure to be given for 1945 will considerably higher. The birthrate again shows a considerable increase, from 17.1 to 18.8. But it is to be noted that this is calculated on the civil population, and takes no account of the male parents on military service. The Infantile Morality rate is 30 per thousand, as compared with 44 for 148 smaller towns with a resident population between 25,000 and 50,000. The Death rate increased from 11.38 to 12.8. This included deaths from enemy action. No deaths occurred from puerperal causes. Section A. Statistics and Social Conditions of the Area. Area (in acres) 3,824 Registrar-Generals estimate of resident population, 1944 46,670 Rateable value (end of 1944) £570,852 §um represented by a penny rate (1944-1945) £2,260 4 Rate per 1,000 total (live and still) births — 26.6. Deaths. Males — 294. Females — 297. Total — 591 Crude Death rate per 1,000 of the estimated resident population—12.8 Deaths from puerperal causes:— Puerperal and post-abortion sepsis nil Other maternal causes Nil Total nil Rate per 1,000 total (live and still) births 0 Death Rate of Infants under one year of age: - All infants per 1,000 live births 30.7 Legitimate infants per 1,000 legitimate live births 29.9 Illegitimate infants per 1,000 illegitimate live births 45.4 Infantile Mortality. The infantile mortality rate for the year was 30.7 per thousand. On analysis it is found that out of 27 deaths occurring in, or transferred into the Borough, 5 were due to prematurity, 4 to pneumonia, 4 to atelectasis, 3 to gastro enteritis, 3 to congenital abnormalities, 4 to injuries at birth, and 4 to other causes. Twenty-one deaths occurred within four weeks of birth. Deaths from Cancer (all ages) 93 Deaths from Measles (all ages) NIL Deaths from Whooping Cough (all ages) 1 Deaths from Diarrhoea (under 2 years of age) 2 Extracts from Vital Statistics of the Year. Live Births. Legitimate Males 439 Females 395 Total 834 Illegitimate Males 23 Females 21 Total 44 Total Males 462 Females 416 Total 878 Birth rate per 1,000 of the estimated resident population — 18.8. Stillbirths. Legitimate Males 13 Females 8 Total 21 Illegitimate Males 2 Females 1 Total 3 Total Males 15 Females 9 Total 24 5 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1944. 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 17.6 20.3 20.9 15.0 18.8 Still 0.50 0.64 0.61 0.42 0.51 deaths: All Causes 11.6 13.7 12.4 15.7 12.8 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 work being done at the 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 facilities:- (i) For infectious diseases. All cases requiring removal to hospital are conveyed by the ambulances attached to the hospital. (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:- Infant 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. (v) Holy Trinity Church Hall, Hermon Hill. The Welfare Centre at Hermon Hill was taken over by the Borough Council in May, 1944. Previous to this it had been directed by a voluntary committee, and subsidised by the Council. Since its foundation in 1916, this centre, which is the largest in the district, and which has done most valuable pioneer work, has been carried on by a band of ladies in the district headed by Mrs. Carpenter. To these ladies the Borough owes a debt of gratitude for their splendid work. 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). These all find accommodation at The Shrubberies, 98 High Road, South Woodford. (e) Hospitals. Public and Voluntary:— Maternity.—There are no maternity hospitals in the district. There has been a continued demand for maternity beds in hospitals. This is due partly to the change of outlook on the part of the mothers in favour of hospital treatment, and partly to the number of expectant mothers who are living under conditions where there are no facilities for a confinement at home. During the year 1944, by the courtesy of the Essex County Council, we were able to make arrangements for 59 cases to be received at St. Margaret's Hospital, Epping. 7 cases were sent to Queen Mary's Hospital, Stratford, and 5 to Danbury Park Hospital, Chelmsford. In all cases the fees payable by the patient were assessed according to scale. 124 cases were evacuated under the Government scheme to maternity hospitals outside London, and in addition, a number of patients made private arrangements for evacuation. Inward transfer births amounted to 238. Cases of Puerperal Pyrexia requiring hospital treatment are sent to the Waltham Joint Hospital. Children.—There is a children's ward of five beds at the Woodford J ubilee Hospital. Infectious Diseases.—Cases of infectious diseases in Wanstead and Woodford, which required removal, were taken to the Waltham Joint 7 Hospital, under the control of the Waltham Joint Hospital Board. Since November, 1936, the Waltham Joint Hospital Board have been filling 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. Smallpox.—The London County Council are prepared to receive cases Smallpox from this area into the London Smallpox Hospital so long as They have sufficient accommodation available. Maternity and Child Welfare:— (1) Midwifery and Maternity Services—We now have four Municipal Midwives working in the district, an additional Midwife having been appointed; she began duty on 15th April. 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 189 (b) As Maternity Nurses 53 Number of visits paid by these Midwives:— (a) Number of cases 242 (b) Ante-natal visits 1,189 (c) Nursing visits 3,654 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 1944 payments were made to medical practitioners in 6 cases'. Ante-natal Clinic. In April, 1944, an ante-natal clinic was opened at 118 Hermon Hill. There are two sessions weekly, on Tuesday, attended by Dr. Sylvia Ashton, and on Thursday, attended by Dr. Mary Fox. The sessions are also attended by the Midwives and Health Visitors. Up to the end of the year 245 cases were registered, and the total attendances numbered 562. Every effort is made to encourage the mothers to attend after confinement for post-natal examination. Cousultant.—Mr. Alan Brews, F.R.C.S., is the Consulting Obstetric Surgeon to the Borough. (2) Institutional Provision for Mothers or Children.—Over 50 per cent — 666 out of 957 — births in the Borough occurred in private nursing homes. A substantial proportion of the mothers coming to these maternity 8 homes belong to other districts, and the births are transferable. (3) Health Visitors.—Mrs. H. Underwood took up her appointment as Health Visitor on 4th January. The following particulars of the work done by the Health Visitors are taken from Form M.C.W.96 (Revised), which was sent to the Ministry of Health in advance of this report. Number of visits paid during the year by the Health Visitors:— (a) To children under one year of age:— First visits 732 Total visits 3,290 (b) To children between the ages of one and five years:— Total visits 3,058 Infant Welfare Centres.—The following attendances were recorded at the five Centres serving the Wanstead and Woodford residents:— (a) Children under one year of age 6,194 (b) Children between the ages of one and five years 2,869 The Centres were closed, except for the sale of infant food, etc., from the last week in June owing to enemy action. 4. Child Life Protection.—The Health Visitors are appointed Child Life Protection Visitors under Part VII of the Public Health Act, 1936. There were ten foster-mothers and ten foster-children on the Register at the end of the year. A total of 70 visits were paid by the Visitors. Illegitimate Children.—Our Health Visitors are giving special attention to the care of illegitimate children. We find that these children are frequently moved from place to place, and every effort is made to trace them and keep in touch with them. If they move out of the district to any known address, a notification is sent to the Health Authority of the district to which they go. Help is also given to the mothers in the special difficulties which confront them. 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 1944, 10 mothers and 2 children were treated under this Scheme. (b) Arrangements for Orthopaedic cases.—There is an orthopaedic clinic at The Shrubberies, 98 High Road, South Woodford, directed conjointly by the British Red Cross Society and the Essex County Council. Section C. Sanitary Circumstances of the Area. 1. (1) Water Supply.—The water service throughout the district is supplied by the Metropolitan Water Board. 9 (2) Drainage and Sewerage.—There have been no important extensins 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 carrriage system. (2) Public Cleansing.—The collection and disposal of house refuse has continued to be carried out under contract requiring the maintenance of a weekly collection throughout the district and the disposal of the refuse under controlled tipping conditions, subject to prevailing salvage operations. Kitchen waste is collected and delivered to the County Borough of east Ham for processing for the purposes of animal food, in accordance with the Ministry of Supply direction. (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, a total of forty shop inspections were recorded. Improvements "Ji regard to ventilation and temperature of shops and to sanitary conniences were effected upon one 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. was unnecessary to warn shopkeepers against any contraventions. (5) Eradication of Bed Bugs.— The means employed for eradication the bed bug as outlined in previous reports has been continued with satisfactory results. The number of premises disinfected was 28. The insecticides used were Fuminol and Zaldecide preparations. Spraying and steam disinfestation is carried out by the staff of the Public Health Department. Schools.— One Public School, one Secondary School and eight Elementary Schools are situated in the district. There are several private schools. The sanitary condition and water supply remained satisfactory. 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 194. The duties carried out by the Sanitary Inspectors were, to a large extent, subject to prevailing war time conditions, and included— 10 1. War damaged premises, (a) Repairs to drains and sanitary arrangements. (b) The examination of food stocks damaged or rendered unfit for human consumption, and their disposal by salvage operations as far as possible. 2. The adaptation of requisitioned premises for rehousing in accordance with Ministry of Health Circulars 2845 and 80S. 3. Civilian war deaths. An additional inspector, Mr. F. Nau, was appointed to augment this work, and commenced duties in March. The bare war-time standard of repair achieved during the war years was further reduced following the ravages caused by flying bombs and rocket incidents, and the pooling of building labour for war damage repairs Prevailing arrangements for the treatment and disposal of foodstuffs in case of contamination by war gases were maintained. Summary of the various inspections made by the Sanitary Inspectors:— Dwelling Houses— On complaint and other causes 565 Infectious disease enquiries 136 Scabies Order enquiries 10 Number of re-inspections for above purposes 1,562 Number of inspections and re-inspections for rehousing and requisitioning purposes 1,049 Other Premises— Schools 21 Factories 37 Meat distributing centre 298 Butchers' shops and provisions stores 205 Bakehouses 41 Fishshops 43 Dairies and Milkshops 35 Massage Establishments 11 Other Food premises 185 Rat infestations (Inspectors) 324 Verminous premises 23 Petroleum installations 57 Shops Act 40 Premises where animals are kept 13 Bombed Sites 75 Miscellaneous inspections, including visits to war damaged 450 food stocks, and in connection with civilian war deaths 5,152 Total number of inspections and re-inspections 5,152 Drainage— Renewed or repaired, including war damaged drains 86 Notices served— Informal:— Housing Act, 1936 46 Public Health Acts 246 11 Statutory: —■ Public Health Act, 1936, Section 24 31 „ 39 22 Housing Act, 1936, Section 9 8 „ 10 1 Factories Act, 1937.—The total number of factories registered at the close of the year was (1) Power Factories—83, (2) Non-power factories—46. These included fourteen bakehouses, two being underground bakehouses. Informal notices were served and satisfactory results obtained in Aspect of 9 factories with regard to cleanliness of premises, improvement or repair to sanitary arrangements, as well as improved ventilation. Rent and Mortgage Interest Restrictions Acts, 1920 to 1939.—A few 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. Infestation Order, 1943.—For the purposes of this Order, a programme of anti-Rat measures was organised to operate in sectional areas, concentrating on food premises and the refuse tip in Chigwell Road, each forming a block control area, within which both Premises and relevant sewers could be cleared together as effectively as Possible. This scheme of baiting and poison baiting commenced in December, 1943, and was completed in March, 1944, for which additional help was obtained from the Borough Engineer's Department. The whole operation was carried out under the direction of one of the staff inspectors. In the first two months of the year prebaiting at 1,600 points during four-day periods resulted in 1,445 takes; poison baits laid at 400 points resulted in 357 takes; these results were regarded as very satisfactory. Secondry operations followed among premises not within the above scheme, but more responsibility was placed on the occupier, the Department supplying particulars, providing baits and finally inspecting after fourteen days' notice, where warranted. A total of 314 visits were paid to these premises by Sanitary Inspectors, whilst the Rat Catcher with one assistant, on block control work, totalled 3,441 visits. Further sewer treatment is to be recommended when the necessary labour is available. Petroleum (Regulation) Acts, 1928 and 1936.—A total of forty-four licences were renewed at the beginning of the year and included two licences for the storage of cellulose. The total storage capacity under licences amounted to 62,600 gallons or petroleum, and 150 gallons cellulose. Game Licences.—Four licences to deal in game were renewed. 12 Section D. Housing. No houses were erected during 1944. 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) 595 (b) Number of inspections made for the purpose 2,213 (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 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 292 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 264 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 9 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 3 (b) By Local Authority in default of owners 9 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 31 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 2 (b) By Local Authority in default of owners 17 13 (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 Housing Act, 1936.—Part IV.—Overcrowding: — (a) (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 (c) (1) Number of cases of overcrowding relieved during the year Nil (2) Number of persons concerned in such cases Nil {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 11 FACTORY AND WORKSHOP ACT, 1901, AND THE FACTORIES ACT 1937 1. Inspections for the purposes of provisions as to healthIncluding Inspections made by Sanitary Inspectors. Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power 11 ... ... Factories without mechanical power 25 ... ... Other premises (other than Outworkers' premises) 4 ... .. Total 40 .. ... 2. Defects found. Particulars. . Number of Defects. Number of defects in respect of which Prose' cutions were instituted. Found. Remedied. Referred to H.M. Inspector. Want of Cleanliness 4 4 ... .. Overcrowding ... ... ... .. Unreasonable temperature .. .. ... ... Inadequate Ventilation 1 1 ... ... Ineffective drainage of floors ... ... ... ... Sanitary Conveniences:— 1. Insufficient 1 1 ... .. 2. Unsuitable or defective 2 2 ... ... 3. Not separate for sexes ... ... ... ... Other Offences 1 1 ... .. Total 9 9 ... ... J5 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 premise.3 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 27 • .^e premises concerned were generally well maintained; minor ririgements 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. Supple- mentary Licences Tuberculin Tested 6 3 Accredited ... 1 Pasteurised 12 4 14 (b) Pood and Drugs Act, 1938.—Twenty-six samples of food, including samples of milk were obtained for analysis. With one exception all the samples were reported by the Public Analyst as being genuine. samples No. 23 (Vinegar). As certified by the Public Analyst, this sample contained only 2.0 per cent of acetic acid, and was therefore deficient to the extent of one-half of the minimum standard quantity of 4 per cent. acetic acid. The vinegar sampled was the last obtainable from a barrel, and the fact that the acetic acid strength of vinegar will neutralise with time, once the barrel is tapped, was confirmed by the Public Analyst. Under these circumstances no action was taken against the vendor. 16 (c) Meat and Other Foods.—The Government meat distributing depot was under constant supervision during the year, and a total of 282 inspections were made. The total quantity of meat, including offal, condemned as unfit for human consumption amounted to two tons, fourteen hundredweights, forty-two pounds. Food examined upon other premises and surrendered as unfit for human consumption included the following:— 122 tins, etc., mixed Meat products. 3 cwt. 41bs. Bacon and Ham. 8 crates Rabbits, Poultry, etc. 190 tins, etc., mixed Fish products. 16 stones 8 lbs. Cod Fillets. 1 1 box (5 stones) Rock Eel. 1 box Kippers. 281 tins mixed Milk products. 611 ¾lbs. Cheese. 138 tins mixed Vegetable products. 41 tins, etc. mixed Fruit products. 50 tins and jars mixed Jams. 13 tins Soup. 5 lbs. Tea. 25 lbs. Dried Fruit. 2 cwt. Sausage Rusk. 129 packets, etc. miscellaneous Groceries. 1 cwt. 2 lbs. Oranges. As a result of War Damage, the following foodstuffs were condemned and disposed of as unfit for human consumption:— Cereals, etc. 119 packets; 6 cwts. 85 lbs. loose. Dried Fruit 76 lbs. Sugar 2 cwts. 49 lbs. Tea 28 lbs. Margarine and Fats 79 lbs. Preserves, Meat, Milk, etc. 203 tins. Vegetables 5 tins. Miscellaneous Groceries 1,178 packets; lcwt. 39 lbs. loose. Registration of Food Premises.—No additional certificates were granted under Section 34 of the Food and Drugs Act, 1938, for the purpose 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-nine inspections were made and the provisions of the Bakehouse Regulations were observed satisfactorily. 17 Section F. Prevalence of, and Control over. Infectious and other Diseases. 1. (a) Scarlct Fever.—Seventy-six cases were notified. One death occurred. (b) Diphtheria.—Twenty-two cases were notified. Of these cases, all occurred at one institution. This institution gathers children from Parts of the country, and many of them have not been immunised. They are immunised promptly on admission, but there is, of course, a time lag before immunity is established. Of the four remaining cases, one was an adult. The other three were recorded as having been immunised. No deaths occurred. Diphtheria Immunisation.—The numbers of completed inocula- tion made during the year were:—Children under 5 years, 502; children over 5 years but under 15 years, 219. Estimated percentage immunised at the end of 1944:—Under 5 years, 73.6%, 5 to 15 years, 96%. (c) Puerperal Pyrexia.—Seven cases were notified, all of which occured in the district; two were removed to the Waltham Joint Hospital. No deaths occurred. (d) Typhoid and Paratyphoid Fevers.—No cases of paratyphoid were notified. (e) Dysentery.—Five Civilian cases were notified. There were no (f) Cerebro-Spinal Fever.—Three cases were notified as occurring district, and two were removed to the Waltham Joint Hospital. 54 cases of Malaria, and 13 cases of Dysentery among non-civilians were notifined, but there does not appear to have been any spread of infection among the civilian population. Particulars of the incidence of notifiable diseases during 1944 are contained in an accompanying table. Venereal Disease.—There are no treatment centres in the Borough. Patients requiring treatment are directed to the V.D. clinic at The London Hospital. 2.(a) Disinfection and Disinfestation.—The disinfection of bedding and similar articles is done by the saturated steam process in a cylindrical horizntal steel "Thresh" disinfector; infected premises are sprayed with formalian and fumigated by burning formalin tablets. Number of rooms disinfected 160 Number of verminous rooms disinfested 82 Loads of bedding disinfected 124 Loads of bedding disinfected for Chigwell U.D.C. 1 Number of School classrooms disinfected 17 18 (c) 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 1944:— 43 Pulmonary and 13 non-Pulmonary cases were notified for the first time during the year. 12 cases were transferred into the district. 4 cases were restored to the register. 16 Pulmonary cases and 4 non-Pulmonary cases died during the year. 7 deaths occurred from non-notified cases of tuberculosis. 46 other cases were removed from the register. 269 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 1944:— Pulmonary. Non-Pulmonary. Total. M. F. M. F. Adults 16 9 3 1 29 Children - - 3 - 3 19 NOTIFICATION OF INFECTIOUS DISEASE. Small Pox Scarlet Fever Diphtheria Typhoid including Paratyphoid Erysipelas Tuberculosis Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerebrospinal Fever Acute Poliomyelitis Measles Whooping Cough Other diseases Pulmonary Other Forma 1940 0 24 8 l Typhoid 13 24 7 7 1 31 12 0 95 4 4 1941 0 85 21 0 Paratyp'd 10 46 15 3 0 41 8 1 586 280 0 8 1942 0 81 3 1 11 42 21 12 2 31 7 0 523 176 9 1943 0 202 9 0 9 38 14 12 1 55 1 0 372 118 2 1944 0 76 22 0 6 43 13 7 1 37 3 0 56 149 2 VITAL STATISTICS OF WHOLE DISTRICT DURING PREVIOUS YEARS. Year. Population. Births. Deaths. Infantile Mortality. Number. Rate. Number. Rate. Number. Rate per 1000 Births. 1940 48,620 611 12.6 653 13.4 18 31.8 1941 4 6,640 566 12.1 551 11.1 15 30.24 1942 49,850 803 16.1 572 11.47 21 26.15 1943 50,010 857 17.1 583 11.65 37 43.17 1944 46,670 878 18.8 591 12.8 27 30.7