ac 4411(1) nansteaa wans 10 BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH (including the report of the senior sanitary inspector) For the Year Ending 31st December, 1945. BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH (including the report of the senior sanitary inspector) For the Year Ending 31st December, 1945. 1 PUBLIC HEALTH STAFF. Medical Officer of Health R. F. Vere Hodge, M.D., Cantab. (to 10th September, 1945) (part-time) F. G. Brown, M.D., B.Ch., D.P.H. (from 10th September, 1945) 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) Health Visitors, Miss H. M. Hird, S.C.M. (e) (to 22nd December, 1945) Mrs. O. A. Greedus, S.R.N., S.C.M. (e). MRs. H. Underwood, S.R.N., S.C.M. (e) (to 16th October, 1945) 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. Clerks, S. C. Hearson (on Military Service) Miss A. E. Harrison. Mrs. M. B. Blanks (to 26th January, 1945) Miss E, Pope (from 16th July to 13th December, 1945) Mrs. E. Humphreys (from 22nd October, 1945) (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. 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 1945. As I did not take up duty as Medical Officer of Health until l0th September, 1945, this report is largely statistical and based on facts obtained from my predecessor. In the year under review the health of the district was satisfactory and the incidence of infectious disease remained at a consistently low level. The resident population as given by the Registrar General is 48,230 as compared with 46,670 for 1944, the increase being due to the return to the Borough of evacuated persons. The birth-rate shows a slight decrease from the previous year, having fallen to 16 per 1,000 as compared with 18.8 in 1944. This is considered to be due to the number of persons who evacuated from the borough during the flying bomb period and who did not return until the latter half of the year. This rate approximates closely to the rate for England and Wales which is 16.1. The death-rate increased from 12.8 in 1944 to 13.02 in 1945, this increase being largely due to deaths from enemy action in the first months of the year. The infant mortality rate is 31.6 per 1,000 as compared with 46 for England and Wales. This is regarded as satisfactory. I am most grateful to the Chairman of the Public Health Committee and to the Chairman of the Maternity and Child Welfare Committee for the support they have given me in my work. I would also like to thank the staff of the Department for their help and co-operation. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. G. BROWN, M.B., B.Ch., D.P.H 3 Section A. Statistics and Social Conditions of the Area. Area (in acres) 3,824 Registrar-General's estimate of resident population, 1945 48,230 Rateable value (end of 1945) £572,299 Sum represented by a penny rate (1945-1946) £2,180 Extracts from Vital Statistics of the Year. Live Births. Legitimate Males 366 Females 342 Total 708 Illegitimate Males 22 Females 29 Total 51 Total Males 388 Females 371 Total 759 Birth rate per 1,000 of the estimated resident population — 16.0 Stillbirths. Legitimate Males 4 Females 8 Total 12 Illegitimate Males — Females 3 Total 3 Total Males 4 Females 11 Total 15 Rate per 1,000 total (live and still) births — 19.3 Deaths. Males 298. Females 329. Total 627. Death rate per 1,000 of the estimated resident population — 13.0 Deaths from puerperal causes:— Puerperal and post-abortion sepsis 1 Other maternal causes nil Total nil Rate per 1,000 total (live and still) births 1.29 Death Rate of Infants under one year of age:— All infants per 1,000 live births 31.6 Legitimate infants per 1,000 legitimate live births 32.4 Illegitimate infants per 1,000 illegitimate live births 19.6 Infantile Mortality. The infantile mortality rate for the year was 31.6 per thousand. On analysis it is found that out of 24 deaths occurring in, or transferred into the Borough, 9 were due to lung conditions, 4 to meningitis, 4 to prematurity. 2birth injuries, 1 gastro enteritis, 4 other causes. Fifteen deaths occurred within four weeks of birth. 4 Deaths from Cancer (all ages) 94 Deaths from Measles (all ages) NIL Deaths from Whooping Cough (all ages) NIL Deaths from Diarrhoea (under 2 years of age) NIL Deaths from Road Traffic Accidents 7 Deaths from Suicide 5 Deaths from other violent causes (including enemy action) 57 Analysis of Deaths according to age incidence. Age No. of Deaths 1945 1944 1943 1942 1941 Under 1 year 24 27 37 21 15 1 and under 2 1 3 5 3 9 2 „ „ 5 4 2 2 2 11 5 „ „ IS 11 7 4 2 5 15 „ „ 25 9 7 6 11 16 25 „ „ 35 16 17 18 18 17 35 „ „ 45 23 25 21 19 25 45 „ „ 55 42 54 39 64 45 55 „ „ 65 112 92 90 110 97 65 „ „ 75 152 138 146 142 125 75 and upwards 232 219 215 180 186 Total 626 591 583 572 551 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1945. 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 16.1 19.1 19.2 15.7 16.0 Still 0.46 0.58 0.53 0.40 0.31 Deaths: All Causes 11.4 13.5 12.3 13.8 13.0 5 Section B. General Provisions of Health Services for the Area. (a) Laboratory facilities:— Em 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:— The Council's ambulance service consists of three vehicles. Two are modern vehicles, fully equipped with up-to-date appliances; they were purchases in 1938 and are in excellent condition. 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 section 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's 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. They have also undergone a special life-saving examination organised by the Life-saving Ambulance calls, 1945:— Occident, 253; Maternity, 173; Private 711, Unused, 31. Total, 1,168. (c) Nursing in the home:— No change. (d)Clinics and Treatment Centres: — Infant Welfare Centres—There are five Centres serving the Wanstead and Woodford residents: — St. Barnabas Church Hall, Snakes Lane. Fuller's Road Sunday School. Baptist Church Hall, Aldersbrook. Ashton Playing Fields Pavilion, Chigwell Road. Holy Trinity Church Hall, Hermon Hill. The following attendances were recorded at the five Centres: — Children under 1 year of age 7,206 Children between the ages of 1 and 5 years 3,652 Centres were closed, except for the sale of infant foods, etc., until the second week in April, owing to enemy action. Ante Natal Clinic, 118 Hermon Hill, South Woodford, E.18. 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. 6 Attendances at the Clinic during the year were:— New cases registered 336 Total attendances 1,469 The following Treatment Centres in the district are under the control of the County Council:— The Tuberculosis Dispensary. The School Clinic. The Orthopædic Clinic (Conjointly with the British Red Cross Society). These all find accommodation at The Shubberies, 93 High Road, South Woodford. (e) Hospitals—Public and Voluntary. Essex County Hospital, Wanstead. Jubilee Hospital, Woodford Green. Infectious Diseases.—Cases of infectious diseases in Wanstead and Woodford, which required removal, were taken to the Waltham Joint Hospital, under the control of the Waltham Joint Hospital Board. Smallpox.—The London County Council are prepared to receive cases of smallpox from this area into the London Smallpox Hospital so long as they have sufficient accommodation available. 2. MATERNITY AND CHILD WELFARE. (i) Midwifery and Maternity Services: — There were four Municipal Midwives working in the district. ExceP??? for ante-natal visiting they devote the whole of their time to midwifery. The number of cases attended by them was as follows: — As Midwives 170 As Maternity Nurses 28 Ante-Natal Supervision: — This is given to all women attended by the Municipal Midwives Every effort is made to encourage the mothers to attend the Ante-Natal Clinic after confinement for post-natal examination. Consultant. Mr. Alan Brews, F.R.C.S., is the Consultant Obstetric Surgeon to the Borough. (ii) Institutional Provision for Mothers or Children. Over 50 per cent., 742 out of 984, births in the Borough occurred in private nursing homes. A substantial proportion of the mothers coming to these maternity homes belong to other districts and the births are transferable. There are no maternity hospitals in the district. There has been a continued demand for maternity beds in hospitals largely due to the number of expectant mothers who are living under conditions where there are no facilities for a confinement at home. 7 During the year 1945, by the courtesy of the Essex County Council, we were able to make arrangements for 36 cases to be received at St. Margaret's Hospital, Epping. Fifteen cases were sent to Queen Mary's Hospital, Stratford. In all cases the fees payable by the patient were assessed according to scale. Thirty-four 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 (iii) Health Visiting. Number of visits paid during the year by the Health Visitors:— To children under 1 year of age:— First visits 720 Total visits 2,474 To children between the ages of 1 and 5 years:— Total visits 2,273 (iv) 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" twelve foster-children on the Register at the end of the year. A total of 50 visits was paid by the visitors. illegitimate Children.—Special attention is given to the care of illegitimate children. (v) Arrangements for Dental Cases. Arrangements are made with the local dentists 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 1945, 20 mothers and three children were treated under this scheme Section C. Sanitary Circumstances of the Area. 1. (1) Water Supply.—The water service throughout the district is supplied by the Metropolitan Water Board. (2) Drainage and Sezverage.—There have been no important extensions of sewerage or improvements made in the arrangements for drainage, sewerage and sewage disposal. 2. Rivers and Streams.— The results of the analyses of samples of effluent from the three sewage works were satisfactory. 3. (1) Closet Accommodation.—With the exception of four isolated dwellings, house drainage throughout the district is conducted on the water carriage system. 8 (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 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. 1934, a total of 37 shop inspections were recorded. Shops (Hours of Closing) Act, 1928.—Under the provisions of Defence Regulations, 1939, earlier closing hours operated during the winter months and normal closing hours were resumed between March and November It was unnecessary to warn shopkeepers against any contraventions. (5) Eradication of Bed Bugs.— The means employed for eradication of the bed bug as outlined in previous reports has been continued With satisfactorv results. The number of premises disinfested was 49. The insecticides used were Fuminol and Zaldecide preparations. Spraying and steam disinfestation is carried out by the staff of Public Health Department. 4. Schools.— One Public School, one Secondary School and eight Elementary Schools are situated in the district. There are several private schools 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 1945. With the cessation of hostilities in 1945, war-time emergency duties carried out by the sanitary inspectors came to an end, in respect of the following:— 1. The examination, salvage and disposal of food stocks damaged by enemy action. 2. The maintenance of a special decontamination and treatment centre and trained squad service, organised to deal with food in case of contamination by poison gases. 3. Civilian war deaths. 4. The wholesale meat distributing centre at Gates Corner, Southend Road, was also closed by the Ministry of Food. 9 On the other hand, the adaptation of requisitioned premises for rehousing purposes, including maintenance repairs, continued to claim the fullest possible attention having regard to the difficulty in finding labour not already absorbed in the war damage building labour pool. Reconstruction or repair to war damaged drains also took up a large share of the inspectors' attention. Summary of various inspection made by the Sanitary Inspectors:— Dwelling Houses:— Requisitioned houses converted for rehousing purposes providing— 60 (a) Single dwellings 8 (b) Flats 95 Total number of visits made for these purposes 935 Maintenance repairs (additional) 89 On complaint and other causes 661 Infectious disease enquiries 90 Scabies Order enquiries 10 Number of re-inspections for above purposes 1,485 Other premises:— Schools 36 Factories 47 Meat distributing centre 272 Butchers' shops and provisions stores 155 Bakehouses 32 Fishshops 48 Dairies and Milkshops 29 Other food premises 162 Massage establishments 11 Rat infestations (Inspectors) 114 Verminous premises 21 Petroleum installations 55 Shops Act 37 Premises were animals are kept 5 Bombed sites 79 Miscellaneous inspections, including visits to war damaged food stocks, and in connection with civilian war deaths 509 Total number of inspections and re-inspections 4,882 10 Drainage:— Renewed or repaired, including war damaged drains Notices served:— 123 Informal (Public Health and Housing Acts) 205 Statutory (Public Health Act, 1936, Section 24) 2 „ (Public Health Act, 1936, Section 93) 23 „ (Public Health Act, 1936, Section 39) 2 „ (Housing Act, 1936, Section 11) 10 (Housing Act, 1936, Section 155) 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 respect of 7 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. One certificate was granted. House Refuse, Dustbins. At the beginning of the year under review the demand for replacememt of worn out dustbins far exceeded the limited quantities available from manufacturers, these being made of sheet iron, painted to retard corrosion. The position improved later and galvanised iron bins re-appeared in gradually increasing supply. Throughout the year the refuse collecting department reported a total of 735 premises with either worn out, or no dust-bins. The owners notified as to their obligations to provide the required receptacles and a large extent demands were met as and when supplies became available Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. Following initial operations of the anti-rat measures taken in regard to infested area, sewers and on the refuse dump, during the earlier part of 1944, the Rat Catcher was able to cope with individual infestations a fair amount of success, but reinfestation gradually increased, particularly in the neighbourhood of the Council's refuse dump in Chigwell Road. in October operations were concentrated on the edge of the dump and salvage depot, with very satisfactory results. According to Ministry of Food, Rat Infestation Department, formula, it was estimated that a total of over 600 rats were destroyed in this drive. The Ministry has stressed the importance of repeating sewer treatment, but owing to labour shortage, Council Surveyors have been unable spare suitable men for this work. 11 Over one hundred visits were paid to premises for the purposes of the Act, by sanitary inspectors and the Rat Catcher totalled 2,260 visits. Petroleum (Regulation) Acts, 1928 and 1936. A total of 45 licenses were renewed at the beginning of the year and included two licenses for the storage of cellulose. The total storage capacity under licenses amounted to 72,250 gallons for Petroleum and 150 gallons cellulose. Game Licenses. Four licenses to deal in game were renewed. Section D. Housing. No houses were erected during 1945. 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) 721 (b) Number of inspections made for the purpose 2,509 (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 10 (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 354 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 321 12 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 Nill (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners NIL (b) By Local Authority in default of owners NIL (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 27 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 12 (b) By Local Authority in default of owners 12 (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 10 (2) Number of dwelling-houses demolished in pursuance or Demolition Orders 1 4. Housing Act, 1936.—Part IV.—Overcrowding:— No formal action. Twelve inspections were made in suspected cases of overcrowding 13 factory and workshop act, 1901, and the factories act, 1937. 1. Inspections for the purposes of provisions as to health (including Inspections made by Sanitary Inspectors. Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories with mechanical power 9 ... ... Factories without mechanical power 21 ... ... Other Premises (other than Outworkers' premises) 2 ... ... Total 32 ... ... 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 2 2 ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate Ventilation 1 1 ... ... Ineffective drainage of floors ... ... ... ... Sanitary Conveniences:— ... ... ... ... 1. Insufficient 2 2 ... ... 2. Unsuitable or defective 1 1 ... ... Not separate for sexes 1 1 ... ... Other Offences ... ... ... ... Total 7 7 14 Section E. Inspection and Supervision of Food. (a) Milk Supply.—Milk is not produced within the district for the purpose of sale. The number of persons and premises registered for the sale of milk within the district are as follows: — Premises registered as Dairies and Milkshops 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 (b) Food and Drugs Act, 1938.—Twenty-one samples of milk obtained for analysis. All the samples were reported by the Public Analyst as being genuine. (c) Meat and other foods.—The Government meat distributing depot was under constant supervision during the year and a total of 272 inspections was made. The total quantity of meat, including offal, condemned as unfit, for human consumption, amounted to 1 ton 13 cwts. 3 qrs. 8 lbs. 481 6 lb. tins and 3,085 12 oz. tins of corned beef and 11 61b. tins of corned mutton were also condemned as unfit for human consumption. 15 Food examined upon other premises and surrendered as unfit for human sumption included the following:— 134 tins, etc., mixed meat products. 8½ lbs. bacon. 1 cwt. 29½ lbs. rabbits, poultry, etc. 229 tins, etc., mixed fish products. 28 st. 13 lbs. wet fish. 288 tins mixed milk products. 12 lbs. cheese. 4 tons 16 cwts. vegetables. 96 tins mixed vegetable products. 7 tins, etc., mixed fruit products. 21 tins and jars mixed jams. 8 tins soup. 1 lb. tea. 1121/4 lbs. dried fruit. 3 cwts. 13 lbs. miscellaneous groceries. As a result of war damage, the following foodstuffs were condemned and disposed of as unfit for human consumption: — 10 packets, 98 lbs., loose cereals, etc. 38½ lbs. dried fruit. 10 lbs. fats. 81/4 lbs. bacon. 1 cwt. 48 lbs. sweets. 69 tins and jars, preserves, meat, milk, etc. 11 packets miscellaneous groceries. Registration of food premises.—No additional certificates were granted under Section 34 of the Food and Drugs Act, 1938, for the purpose of on the business of a wholesale dealer in margarine. Bakehouses.—There are fourteen bakehouses in the district, two of these are underground bakehouses. 32 inspections were made and the provisions of the Bakehouse Regulations were observed satisfactorily. Section F. Prevalence of, and Control over, Infectious and other Diseases. 1.(a) Scarlet Fever.—Sixty-two cases were notified. No deaths occurred (b) Diphtheria.—Eight cases. Of these cases, one was an adult. Of the other seven, five were recorded as having been immunised. No deaths occurred. Diphtheria Immunisation.—The numbers of completed inoculations made during the year were:— Children under S years, 604; children over years but under 15 years, 298. 16 (c) Puerperal Pyrexia.—Three cases were notified as occurring in the district, all were removed to the Waltham Joint Hospital. No deaths occurred. (d) Typhoid and Paratyphoid Fevers.—No cases of paratyphoid were notified. (e) Anterio Polio?nyeliti.s.—Four cases. No deaths occurred. Particulars of the incidence of notifiable diseases during 1945 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. Infected premises are sprayed with formalin and fumigated by burning formalin tablets. Number of rooms disinfected 99 Number of verminous rooms disinfested 88 Loads of bedding disinfected 157 Loads of bedding disinfected for Chigwell U.D.C. 2 Number of school classrooms disinfected. 3 (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 1945: — 47 Pulmonary and 11 non-Pulmonary cases were notified for first time during the year. 19 cases were transferred into the district. 6 cases were restored to the register. 14 Pulmonary cases and 5 non-Pulmonary cases died during the year. 5 deaths occurred from non-notified cases of tuberculosis. 32 other cases were removed from the register. 300 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 1945:— Pulmonary. Non-Pulmonary. Total. M. F. M. F. Adults 21 14 3 1 39 Children — 1 2 1 4 VITAL STATISTICS OF WHOLE DISTRICT DURING PREVIOUS YEARS. Year. Population. Births. Deaths. Infantile Mortality. Number. Rate. Number. Rate. Number. Rate per 1000 Births. 1941 46,640 566 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 1945 48,230 759 16.0 627 13.0 24 31.6 17 NOTIFICATION OF INFECTIOUS DISEASE. Small Pox Scarlet Fever Diphtheria Typhoid including Paratyphoid Erysipelas Tuberculosis Puerperal Pyrexia Ophthalmia Neonatorum Pneumonia Cerebro-spinal Fever Acute Poliomyelitis Measles Whooping; Cough Other diseases Pulmonary Other Forms 1941 0 85 21 Typhoid 0 Paratyp'd 8 10 46 15 3 0 41 8 l 586 280 0 1942 0 81 3 l 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 1945 0 62 8 0 10 47 11 3 2 20 0 ' 5 533 45 14 18