AC 4411(1) WANSTEAD WOODFORD BOROUGH OF WANSTEAD AND WOODFORD WANS 13 Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1948. BOROUGH OF WANSTEAD AND WOODFORD Annual Report of the MEDICAL OFFICER OF HEALTH For the Year Ending 31st December, 1948. PUBLIC HEALTH COMMITTEE Alderman F. G. Booth „ A. H. Southam (Vice-Chairman) „ C. Turner Councillor N. E. Britton „ A. G. Burness „ Mrs. J. Davey „ J. W. Lynch „ C. H. Moss „ V. E. Stevens (Chairman) MATERNITY AND CHILD WELFARE COMMITTEE (Until 5th July, 1948) Alderman A. H. Southam Councillor A. G. Burness „ E. H. Day „ Mrs. J. Davey (Vice-Chairman) „ R. Drew „ E. J. Dutton „ Mrs. E. F. M. Hollis (Chairman) „ V. E. Stevens „ P. F. N. Warner Co-opted Members Mrs. R. Drew „ A. R. Page „ F. G. Geeson „ A. Smith „ T. Smith REPRESENTATIVES ON FOREST HEALTH AREA SUB-COMMITTEE (From 5th July, 1948) Councillor N. E. Britton R. H. S. Fox, M.C., J.P., C.C. „ Mrs. E. F. M. Hollis „ V. E. Stevens 1 STAFF OF PUBLIC HEALTH DEPARTMENT Medical Officer of Health: F. G. Brown, M.B., B.Ch., D.P.H. Senior Sanitary Inspector: M. G. Crook, M.S.I.A. (a) (b) (c) (d) Deputy Senior Sanitary Inspector: J. T. S. Templeman, M.R.San.I., M.S.I.A. (a) (b) Sanitary Inspectors: A. J. Storer, M.S.I.A. (a) H. L. Hughes, A.R.San.I., M.S.I.A. (a) (b) F. M. Flack, M.S.I.A. (a) (b) (from 3.8.48) Health Visitors: Miss C. Court, S.R.N., S.C.M. (e) Miss S. Butterly, S.R.N., S.C.M. (e) Miss R. Harrington, S.R.N., S.C.M. (e) Miss E. Brooks, S.R.N., S.C.M. (e) Miss M. Graham, S.R.N., S.C.M. (e) Municipal Midwives: Miss S. A. Jones, S.C.M. Mrs. M. Marlow, S.C.M. Miss I. Turner, S.C.M. Miss N. M. Tomlinson, S.R.N., S.C.M. Mrs. I. J. Campe, S.C.M. Clerks: Miss A. E. Harrison Miss D. Howlett Miss M. S. Cryer (a) Royal Sanitary Institute and Sanitary Inspector's Examination Joint Board Certificate. (b) Royal Sanitary Institute Certificate of Meat and other Foods. (c) First Class Certificate in Laboratory Technique of Meat Inspection Smithfield Technical Institute. (d) Diploma of the Royal Institute of Public Health and Hygiene. (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 1948. The event of major importance during the year was the coming into force of the National Health Service Act. The inauguration of the National Health Service Act on 5th July meant that the Borough was no longer its own Maternity and Child Welfare authority, a privilege which had been enjoyed for many years. On this date the administration of Maternity and Child Welfare functions was transferred to the Essex County Council. For the purpose of the day-to-day administration of these functions the County Council has been divided into eleven areas, each area having a sub-committee of the County Health Committee. The Borough of Wanstead and Woodfoi'd forms part of the Forest Area which comprises chingford Borough, Wanstead and Woodford Borough, Chigwell, Epping and Waltham Holy Cross Urban Districts and Epping Rural District. The Sub-Committee of the County Health Committee for the Forest Area is formed as follows:— Seven members nominated by the Essex County Council. Four members nominated by the Wanstead and Woodford Borough Council. Three members each nominated by the Chingford Borough, and Chigwell Urban District Councils. Two members each nominated by the Epping and Waltham Holy Cross Urban District Councils and the Epping Rural District Council. One member each nominated by the Hospital Management Committee, the Essex Executive Council (general practitioner services) and the Local Medical Committee. Four members nominated by Voluntary Organizations, making a total of thirty in all. We are fortunate that the present Chairman of this Committee was previously Chairman of our Maternity and Child Welfare Committee. I myself have been delegated by the County Medical Officer of Health to act in the capacity of Area Medical Officer for the Forest Area. By these means,as far as the Borough is concerned, a continuity in the administration of maternity and Child Welfare services has. been effected. Under the section of the report devoted to Maternity and Child Welfare it is gratifying to note that the number of visits paid to homes by Health 3 Visitors increased from 2,827 to 3,781. By this means, rather than by interviewing parents at clinics, is the work of the Health Visitor best carried out. She is able to view the home background and to give the parent undivided attention, not always possible when mothers are seen at a crowded and often noisy clinic. The increase in the number of visits made is partly due to the fact that five of the six Health Visitors were permitted to use cars, this means of transport causing a saving of valuable time. I should like to express my thanks to those voluntary workers who have given help at the Infant Welfare Centres for their unfailing support. Their regular attendance in all weathers has done much to contribute to the smooth running of these centres. The Day Nursery in Spratt Hall Road, Wanstead, was completed in May and opened officially by Mrs. Churchill on 1st June. Approval for the construction of this nursery was given initially by the Borough Council in February, 1946. After some deliberation, approval of the Ministries of Health and Education was obtained. This was followed by numerous setbacks and difficulties over the supply of essential materials, especially steel. However, it is most satisfactory to be able to report that all difficulties were overcome and the nursery opened for admissions prior to the coming into force of the National Health Service Act and the consequent transference of this service to the County Council. The opening of this nursery fulfil a long-standing and very real need in view of the fact that no nursery provision had been made during the war years as had been the case with adjacent authorities. Very many applications were received from parents for the admission of their children to the nursery, which can accommodate fifty children of ages ranging from birth to five years. To deal with these applications a system of priorities was instituted, details of which are as follows:— Category 1. Cases in which the woman is the sole support of the family, e.g., widowed mothers, unmarried mothers. Category 2. Cases in which the husband is partially incapacitated through invalidism. Category 3. Economic or other grounds for admission. Two or three places are held vacant for the temporary admission children in whose homes there has been a sudden emergency, e.g., illness of a parent. Children are also admitted for a few hours while the mother attends hospital as an out-patient. To meet further the needs of the Borough as regards nursery facilities plans are being formulated for the building of a second nursery at Woodford Bridge. The Birth Rate per thousand of the estimated population decreased to 16.0 as compared with 19.8 in 1947. The Death Rate, calculated similarly fell from 10.9 to 10.1. The Infantile Mortality Rate, i.e., the deaths in infants under one year per thousand live births, was 32.7 compared with a rate of 34 for the whole of England and Wales. 4 The incidence of infectious disease remained low and compared favourably with previous years. Two cases of diphtheria occurred, one, a member of the staff at Dr. Barnardo's Homes, aged 20, and the other a girl of 18 in Woodford Green. In neither case was the disease fatal. Scarlet Fever showed a further decrease, 50 cases as compared with 59 in 1947; all were of a mild type. As is usual, by far the most common infectious diseases were measles and whooping cough, the former showed a decrease over 1947, 451 cases as compared with 943; in the latter the figures remained almost identical, 242 cases as compared with 238. One case of acute anterior poliomyelitis (infantile paralysis) occurred, as compared with ten cases in the previous year. Particulars of the Diphtheria Immunisation campaign appear in the Appropriate section, the number of children receiving primary immunisation increasing from 813 to 854. The policy whereby immunisation is carried out by the patient's own doctor, rather than at a municipal clinic, was continued, experience having shown this to be the method best suited to the needs of the Borough. During the latter part of the year a campaign in food hygiene was commenced, a series of lectures being held for the managers and their staffs engaged in premises where food was handled. Although the attendance was not as high as one would have liked, considerable interest was shown by those who were present, particularly in the display panels which were Provided. I am again indebted to the Chairman and Members of the Public health and Maternity and Child Welfare Committees for their support. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. G. BROWN, M.B., B.Ch., D.P.H. 2nd September, 1949. 5 Section A. Statistics and Social Conditions of the Area Area (in acres) 3,824 Population—Registrar-General's estimate mid-year 1948 61,150 Registrar-General's estimate mid-year 1947 60,280 Rateable value £601,460 Sum represented by penny rate £2,429 Extracts from Vital Statistics of the Year Live Births: Legitimate Males 492 Females 449 Total 941 Illegitimate Males 15 Females 21 Total 36 Total Males 507 Females 470 Total 977 Birth-rate per 1,000 of the estimated resident population—16.0 Stillbirths. Legitimate Males 11 Females 8 Total 19 Illegitimate Males — Females 1 Total 1 Total Males 11 Females 9 Total 20 Rate per 1,000 total (live and still) births—20.1 Deaths: Males — 304. Females — 314. Total — 618. Death-rate per 1,000 of the estimated resident population — 10.1 Deaths from puerperal causes: — Puerperal and post-abortion sepsis 1 Other maternal causes - Total 1 Rate per 1,000 total (live and still) births 1.0 Deaths of Infants under one year of age:— All infants per 1,000 live births 32.7 Legitimate infants per 1,000 legitimate live births 31.9 Illegitimate infants per 1,000 illegitimate live births 55.5 1948 1947 Deaths from Cancer 111 125 „ „ Measles 1 Nil „ „ Whooping Cough 2 2 „ „ Diarrhoea (under 2 years of age) 3 2 „ „ Road Traffic Accidents 4 6 „ „ Suicide 4 7 „ „ Other violent causes 11 16 6 Birth-rates, Civilian Death-rates, Analysis of Mortality, Maternal Mortality, and Case-rates for certain Infectious Diseases in the year 1948. England and Wales, London, 126 Great Towns and 148 Smaller Towns. (Provisional Figures based on Weekly and Quarterly Returns) England and Wales 126 County Boroughs and Great Towns including London 148 Smaller Towns (Resident populations 25,000 to 50,000 at 1931 Census) London Administrative County Borough of WANSTEAD and WOODFORD Births: ‡(Rates per 1,000 Civilian Population) Live 17.9* 20.0 19.2 20.1 16.0 Still 0 43* 0.52 0.43 0.39 0.32 Deaths: All Causes 10.8* 11.6 10.7 11.6 10.1 Typhoid and Paratyphoid — — — — — Tuberculosis 0.51 0.59 0.46 0.63 0.34 Whooping Cough 0.02 0.02 0.02 0.01 0.03 Diphtheria 0.00 0.00 0.00 0.01 — Influenza 0.03 0.03 0 04 0.02 — Smallpox 0.00 0.00 0.00 0.00 — Acute Poliomyelitis and Polioencephalitis 0 01 0.01 0.01 0.00 — Pneumonia 0.41 0.38 0.36 0.54 0.28 All causes under (Rates per 1,000 Live Births) 1 year of age 34.0† 39.0 32.0 31.0 32.7 Diarrhoea and Enteritis under 2 years of age 33 4.5 2.1 2.4 3.1 ‡ A dash (—) signifies that there were no deaths * Rates per 1,000 Total Population † Per 1,000 related births Notifications: (Rates per 1,000 Civilian Population) Typhoid 0.01 0.00 0.01 0.00 — Paratyphoid 0.01 0.01 0.01 0.01 0.01 Cerebro Spinal Fever 0.03 0.03 0.02 0 03 — Scarlet Fever 1.73 1.90 1.82 1.37 0 81 Whooping Cough 3.42 3.51 3 31 3.13 3.95 Diphtheria 0.08 0.10 0.09 0.10 0.03 Erysipelas 0.21 0.23 0.21 0 22 0.21 Smallpox — — — — — Measles 9.34 9.75 8.84 9.17 7.39 Pneumonia 0.73 0.84 060 0.57 0.56 (Rates per 1,000 Total Births [Live and Still]) Puerperal Pyrexia and Fever 6.89 8.90 4.71 7.34 9.03 7 Section B. General Provision of Health Services in the Area. 1. (i) Public Health Officers of the Authority:— See page 2. (ii) (a) Laboratory Facilities:— All pathological and bacteriological services are provided at the Emergency Medical Services Pathological Laboratory, St. Margaret's Hospital, Epping. The analysis of water, milk and food is carried out by Dr. Bernard Dyer and Mr. George Taylor, Public Analysts for the Borough. (b) Ambulance Service:— The Council's ambulances were transferred to the service of the County Council on the 5th July, 1948, when the administration of this section of the National Health Service Act became the responsibility of the Essex County Council as Local Health Authority. Unfortunately it is not possible to give statistical details of the number of calls made upon the service from the Borough alone during the whole year, but I have been able to obtain some details covering the first six months of the year and, to give some slight idea of comparison, figures for the whole of 1947. Ambulance calls: 1948 (6 months) 1947 Accident 208 366 Maternity 155 287 Private 613 971 Other calls 18 65 Old Age Pensioners 168 75 Total 1,162 1,764 (c) Nursing in the Home:— The Home Nursing Service in the Borough, which was provided by the Woodford District Nursing Association and the Wanstead District Nursing Association, but which was under the supervision of the Essex County Nursing Association, became the responsibility of the Local Health Authority as from the appointed day. The four whole-time nursing staff were therefore transferred to the staff of the Essex County Council and have been incorporated in the arrangements made for the service covering the Forest Area as a whole. (d) Clinics and Treatment Centres:— Maternity and Child Welfare. There are six infant welfare centres i(l the Borough. Sessions are held as under:- Baptist Church Hall, Aldersbrook, E.12. Monday, 2.30 - 4 p.m. Ashton Playing Fields Pavilion, Woodford Bridge. Tuesday, 2.30-4 p.m. 8 St. Barnabas Church Hall, Snakes Lane, Woodford Green. Wednesday, 2.30 - 4 p.m. Fullers Road Sunday School, South Woodford, E.18. Wednesday, 2.30 - 4 p.m. Cromwell Hall, Nightingale Lane, Wanstead, E.ll. Thursday, 2.30 - 4 p.m. Holy Trinity Church Hall, Hermon Hill, South Woodford, E.18. Friday, 2.30 - 4 p.m. Ante-natal Clinic. The ante-natal clinic is situated at 118 Hermon Hill, South Woodford, E.18. Sessions are held on Mondays from 2.30 to 4.30 (by appointment only) and on Tuesdays and Thursdays from 2 to 4 p.m. School Clinics. The minor ailment clinics are under the control of the Essex County Council and are held as under:— 93 High Road, South Woodford, E.18. Fridays, 9 a.m. Orthopœdic Centre. The orthopædic centre is open at 93 High Road, South Woodford, E.18, on Tuesday, Wednesday and Thursday, and is run conjointly by the Essex County Council and the British Red Cross Society. Tuberculosis Dispensary. The Tuberculosis Dispensary administered by the Essex County Council is held at 93 High Road, South Woodford, E.18, on Thursdays at 5 p.m. and Fridays at 9.30 a.m. (e) Hospitals:— Wanstead Hospital, Hermon Hill, Wanstead, E.ll—206 beds. Jubilee Hospital, Woodford Green — 54 beds. Maternity and Child Welfare 1948 1947 1. Notification of live births (corrected) 977 1,199 Notification of still births (corrected) 20 29 Ante-Natal Clinic Attendances: New cases registered 586 541 Total attendances — ante-natal 2,749 2,764 Total attendances — post-natal 89 92 3. Cases Attended by Municipal Midwives As midwives 265 297 As maternity nurses 82 61 Total 347 358 4. Institutional Provision for Maternity Cases By arrangement with the County Medical Officer, Essex County 9 Council, 317 cases were admitted to hospital for confinement as shown below:— St. John's Hospital, Chelmsford 41 Wanstead Hospital 270 Queen Mary's Hospital, Stratford 2 Forest Gate Maternity Hospital 2 St. Margaret's Hospital, Epping 2 5. Private Nursing Homes 494 infants were born in Private Nursing Homes situated in the Borough; the majority of these cases belong to areas outside the Borough. 6. Domestic Help Scheme During the first part of the year five full-time and one part-time domestic helps were employed by the Borough Council to provide help mainly for persons being confined at home. These members of the Borough staff were transferred on the 5th July, 1948, to the Essex County Council and at the end of the year six full-time and two part-time domestic helps were employed mainly on duties in the Borough of Wanstead and Woodford. 7. Infant Welfare Centres The following attendances were recorded:— 1948 1947 Children under 1 year of age 17,508 19,073 Children between 1 and 5 years 6,089 4,361 23,597 23,434 8. Daily Guardians The scheme operating in the Borough whereby certain suitable persons were registered with the Local Authority as Daily Guardians has been continued throughout the year. It is still difficult to obtain suitable people to act in this capacity. 9. Premature Infants During the year 25 premature infants were born to mothers belonging to the Borough. Six of these births took place at home, and 19 in hospital or nursing home. Twenty of these (80 per cent.) were alive at the end of one month. 10. Infantile Mortality Rate The infantile mortality rate for the year was 32.7 per 1,000; deaths in infants under one year totalled 32, fifteen of these occurring within four weeks of birth. Causes were as follows:— Broncho Pneumonia 7 Gastro enteritis 3 Congenital 5 Prematurity 13 Other causes 4 10 11. Health Visiting Number of visits paid during the year by Health Visitors:— To children under 1 year of age—First visits 1,078 Total visits 3,781 To children between one and five years of age 3,959 12. Child Life Protection Child Life Protection and all work connected with the care of children was from the 5th July, 1948, vested in a special children's department set up by the Local Health Authority and by whom a Children's Officer was also appointed. During the first half of the year the Health Visitors who were appointed Child Life Protection Visitors under Part VII of the Public Health Act, 1936, continued to act in that capacity until the Children's Department was established and during this time paid 32 visits to foster-mothers. SECTION C. SANITARY INSPECTION OF THE AREA The Senior Sanitary Inspector reports as follows:— The year 1948, unlike 1947 with its severe frost and long period of snow, relieved the Sanitary Inspectors' section of the department of much anxiety and worry. There was, however, much to engage the staff, particularly as the duties in connection with the general maintenance of requisitioned houses was still performed by the Sanitary Inspectors. Relief was provided by the appointment in August of an additional Sanitary Inspector who assisted in picking up some of the arrears of work. In order to provide up-to-date information to their staff, the Public Health Committee agreed to the Deputy Senior Sanitary Inspector and District Sanitary Inspectors attending the special course arranged in connection with Food Hygiene and conducted by the Central Council for Health Education. Those officers attended the course held during November and December, 1948. It will be noted that the annual report for 1947 revealed the amount Work involved in trying to eradicate the ravages of dry rot. Once again, one must stress the large amount of damage caused by this fungus, and the heavy cost involved in the work. One house alone cost in the region of £600 and involved the reconstruction of flooring, ceilings, internal and external kitchen walls, etc. In fact, the infection spread from the front bay to the rear external water closet of this large house. In addition to arranging for the cutting out of affected materials, the Inspectors found that they had to stress upon some builders the need for the quick removal of such material from the site for destruction, as there was a tendency to leave affected timber lying about on the flooring. Referring to the maintenance of requisitioned houses, the department was again indebted to the co-operation given by the builders engaged upon that work. In regard to duties performed under the Housing Act, it can again be reported that 43 houses were repaired by the Local Authority because of default on the part of the owner, and accounts rendered to cover the cost thereof. 11 It can be recorded that the Council authorised proceedings to be taken under Section 94 of the Public Health Act, 1936, because of the default on the part of the owners of a large house to carry out works of repair. The case was heard by the Stratford Magistrates on 18th August, 1948, and a Nuisance Order made by them. 1948 saw the approval of the Clearance Order made in connection with Clark's Cottages, Woodford Bridge, the property consisting of four backto-back type houses situated in a court off the main road at Woodford Bridge. These four cottages were very old and it would appear that they were originally built as eight dwellings being adapted at a later date to four, the estimated age being over one hundred years. Demolition is expected early in 1949. Another set of four dwellings were dealt with for demolition, again in the Woodford area. In this case agreement was reached with the owners. The cottages were very old and were built with external walls made of laths and plaster. In one case the roof rafters had broken, causing a large gap to appear in the tiled roof. In another the roof had spread, pushing out the external plaster walls leaving some ceiling joists in the bedroom without means of support. Rodent Control The year saw another step further in connection with the above, and Circular N.S.19 was issued offering among other things a 50 per cent. grant towards the cost of rodent destruction where treatments were made for which the Local Authority make no charge. The Borough Council accepted the terms of the Circular and made charges for work performed on business premises. It is pleasing to note that during December the Workable Area meeting was held in the Council Chamber, a welcome being given by Alderman A. Southam, Vice-Chairman of the Public Health Committee in the absence of the Chairman of the Public Health Committee, to the members and officers of the Local Authorities attending. A successful meeting was held and some further discussion took place upon the new Prevention of Destruction by Pests Bill. Your Senior Sanitary Inspector and one of the District Sanitary Inspectors attended a refresher course held at the Ministry of Agriculture and Fisheries' Headquarters in May. The course was very interesting and instructive and was dealt with from an entirely new angle. The Council continued its maintenance treatment of the sewers, the work being conducted by the Deputy Senior Sanitary Inspector, with one squad of three men. Good results are evident as shown by the tables given below. The first treatment in the year shows 421 "takes" out of 847 manholes baited, or 49.7 per cent., and the second, 905 "takes" out of 1,310 manholes treated, or 67 per cent. This result seems to indicate a build-up of the rat population between the periods of treatment, and confirms the view of many officials that even if the rat population cannot be stamped out it must at least be kept to a minimum. Some interesting remarks concerning this have been made at Workable Area meetings. 12 First Treatment 1 Section 2 No of Manholes 3 No. not baited 4 No. baited 5 c. 6 Average P. 7 Pre-bait Takes Total takes 8 n.t. Area 1 (a) 65 — 65 16 12 28 37 Area 2 (a) 75 — 75 21 13 34 41 Area 3 (a) 74 1 73 10 24 34 39 Area 4 (a) 67 2 65 12 22 34 31 Area 5 (a) 74 — 74 16 22 38 36 Area 6 (a) 75 — 75 18 27 45 30 Area 7 (a) 79 — 79 5 24 29 50 Area 8 (a) 68 — 68 18 19 37 31 Area 9 (a) 69 — 69 21 4 25 44 Area 10 (a) 62 — 62 19 9 28 34 Area 11 (a) 71 — 71 24 12 36 35 Area 12 (a) 71 — 71 20 33 53 18 850 3 847 200 221 421 426 Second treatment 1 Section 2 No of Manholes 3 No. not baited 4 No. baited 5 C. 6 Average P. 7 Pre-bailt Takes Total takes 8 N.T. Test bait 140 — 140 45 19 64 76 Area 1 68 — 68 17 16 33 35 Area 1a 70 5 65 22 24 46 19 Area 2 74 70 4 2 — 2 2 Area 3 77 1 76 27 21 48 28 Area 4 77 1 76 34 25 59 17 Area 5 82 4 78 38 15 53 25 Area 6 84 1 83 25 24 49 34 Area 7 67 2 65 25 14 39 26 Area 8 82 1 81 29 25 54 27 Area 9 77 2 75 31 27 58 17 Area 10 76 4 72 29 16 45 27 Area 11 70 — 70 32 24 56 14 Area 12 70 7 63 41 6 47 16 Area 13 79 — 79 32 24 56 23 Area 14 74 2 72 23 24 47 25 Area 15 72 — 72 45 15 60 12 Area 16 67 1 66 31 20 51 15 Area 17 77 4 73 37 14 51 22 Area 18 72 — 72 35 16 51 21 1415 105 1310 555 350 905 405 13 Rodent record Number of inspections made by Sanitary Inspectors ... 79 Complaints received 210 Number of baits laid (baiting points) 478 Rats found dead ... 414 Estimated kill 718 1,132 Total number of visits made by rat catcher 2,300 Rechargeable premises Premises visited 4 Number of baits laid (baiting points) 32 Rats found dead 16 Estimated kill 39 55 Before passing to other subjects, it must be recorded the good relationship existing between the officers of the Council and those of the Ministry, in particular Mr. Marley, Divisional Rodent Officer, and Mr. Harris, the Ministry's Inspector. Ponds As in previous years, local ponds have been treated as a precaution against mosquito breeding. Petroleum (Regulation) Acts, 1928 and 1936 54 licences were renewed at the beginning of the year. Game Licences Seven licences to deal in game were renewed and five new licences were granted. Shops Act, 1934 No offences have been noted or reported in respect of closing hours, the comments of last year still applying, that shops in the Borough close very promptly. Twenty-seven visits were made under this Act, and three notices were served. Eradication of Bed Bugs Once again the report is good, the small degree of infestation reported last year again applying. In all, some 31 cases were handled as compared with 49 in 1947. The usual solutions containing D.D.T. have been used with good effect. In some cases D.D.T. has been liberated by the use of heat in the form of special generators. Essex County Council Act, 1933. Massage and Special Treatment Establishments. As in previous years, the Sanitary Inspectors made the usual inspection of these premises, all of which are maintained to a good hygienic standard. Twenty-two visits were made during the year, and one new establishment was added to the list recorded, bringing the total to eleven premises in all. 14 War Damage (Drains) The annual report for 1947 put on record the fact that the Borough Council were relieved of their duty as agents for the War Damage Commission but it is interesting to note that during the year 1948 quite an amount of drainage work was executed which was attributed to enemy action and, further, some of the cost was allowed by the War Damage Commission as being that expended in making good defects caused by enemy action. One feels that it may be many years before the effects of war are finally made good, for it is only when drainage gives trouble that one is able to discover defects due to bombing. Delay in making good is inevitable because to be fair with all concerned, the assessors to the War Damage Commission must be given an opportunity to see the pipes before they are removed. In this direction one must record good co-operation from the officers of the War Damage Commission. War Damage (General) When dealing with repairs to property in general, it is quite common to note that many owners of property take no action to get their legitimate war damage rectified until a notice is served upon them either under the public Health Act or the Housing Act. They then request that the notices be held over until their claim is met and what is more, they expect the officers of the Commission to give a quick decision. In fact, it is difficult for those officers, so many years after the cessation of hostilities, to differentiate between damage due to enemy action and dilapidations due to age of the property and lack of proper maintenance. Training Scheme for Sanitary Inspectors Further to details given in the 1947 Report, it can be recorded that during the year further trainees were received into the department and assisted by the Sanitary Inspectors. It is pleasing to think that most of the Pupils were successful at their first examination attempt. Inspections carried out by Sanitary Inspectors Infectious disease enquiries including enquiries in respect of scabies 63 Visits in connection with contacts, etc. 12 Enquiries in connection with food poisoning 3 General environmental Public Health Drains and public sewers inspected 531 Tests to drains and public sewers 123 Stables and manure pits inspected 8 Tents, vans and sheds (including gipsy encampments) 24 Requisitioned houses inspected and visited 1,788 Smoke observations 9 Visits to Council tip 3 Schools inspected 5 Shops Act inspections 27 Petrol installations 21 cinemas 1 Miscellaneous Visits 155 15 Section D. Housing No. of houses erected during 1948: 209 Council; 102 Private enterprise; 170 Cost of Works (rebuilds). 1. Inspection of Dwelling-Houses during the Year:— (1) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,177 (b) Number of inspections made for the purpose 2,386 VISITS (2) (a) Number of dwelling-houses (included under subhead (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 5 (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 185 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 403 3 Action under Statutory Powers during the Year:— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936: (l) Number of dwelling-houses in respect of which notices were served requiring repairs 44 (2) Number of dwelling-houses which were rendered fit after service of formal notices: (a) By owners 37 (b) By Local Authority in default of owners 7 (b) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 123 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: (a) By owners 87 (b) By Local Authority in default of owners 36 16 (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 5 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil 4. Housing Act, 1936.—Part IV .—Overcrowding:— No formal action during the year. 79 inspections were made in suspected cases of overcrowding. Nuisances Abated and Improvements Effected Dwelling-houses Roof repairs 127 External walls and chimney stacks repaired 104 Walls underpinned 2 Gutters and spouts repaired or renewed 97 Damp-proof courses provided 27 Dampness remedied 74 Yards paved or repaired 9 Internal walls and ceilings repaired 236 Doors and frames repaired or renewed 68 Windows repaired or renewed 92 Floors repaired or renewed 73 Sub-floor vent.provided or improved 14 Rooms cleansed or redecorated 170 Rooms with improved lighting 4 Staircases repaired and hand-rails provided 24 Fireplaces and flues repaired or renewed 42 Cooking stoves repaired or renewed 14 Wash coppers repaired or renewed 7 Sinks and washbasins provided or renewed 10 Waste pipes repaired or renewed 60 Food stores provided or improved 10 Dustbins provided or renewed 26 Water supply improved or reinstated 9 Water closet cisterns repaired or renewed 17 Water closet pans repaired or renewed 26 Water closet structures repaired or rebuilt 18 Water closet flush pipe joints repaired 26 GENERAL ENVIRONMENT Public Health Drains cleansed from obstruction 25 Drains repaired or renewed 28 Inspection chambers repaired 10 Soil pipes and vent shafts repaired 4 Offensive accumulations removed 2 1,455 17 Disinfection and Disinfestation No. of rooms disinfected 71 Bedding removed from premises for steam disinfection 161 No. of rooms disinfested 36 1. Inspections for the purposes of provisions as to health (including Inspections made by Sanitary Inspectors). Premises (1) Number of Number on Register Inspections Written notices Occupier prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 62 25 3 - (ii) Factories not included in (i) to which Section 7 applies - - - - (a) Subject to the Local Authorities (Transfer of Enforcement) Order, 1938 120 204 - - (b) Others - - - - (iii) Other Premises under the Act (excluding out-workers' premises) - 4 - — Total 182 233 3 - 2. Defects found. Particulars. Number of Defects Number of defects in respect of which Prose¬were instituted Found Remedied Referred to H.M. Inspector Want of Cleanliness ... ... ... ... Overcrowding ... ... ... ... Unreasonable temperature ... ... ... ... Inadequate Ventilation 3 3 ... ... Ineffective drainage of floors ... ... ... ... Sanitary Conveniences:— 1. Insufficient ... ... ... ... 2. Unsuitable or defective ... ... .. ... 3. Not separate for sexes ... ... ... ... Other Offences ... ... ... ... Total 3 3 ... ... 18 Outwork Number of out-workers in August list required by Sect. 110 (1) (c): — Wearing apparel—Making, etc. 53 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 5 Household linens and furnishings 2 Total 60 Inspection of Foods, etc. Meat shops (including visits to Ministry of Food Depot) 100 Dairies 4 Bakehouses and Bakers Shops 36 Ice Cream premises 122 Fishmongers and poulterers 48 Greengrocers and fruiterers 3 Grocers and wholesale grocers 99 Restaurants, cafes, etc. 52 Fishfryers 5 Other premises - SECTION E. FOOD AND DRUGS ACT During the year 1948 one hundred and nineteen samples of foods were obtained or purchased and submitted to the Public Analyst. It is pleasing to note that only three of the articles of food sampled were below the required standard. Two of these three samples were from two different shops served by the same vendor and one can only presume (owing to the similar degree of deficiency of 7 per cent.) that he was endeavouring to make meat allowed for manufacturing last as long as possible. In no case was adulteration noticed in any of the rationed foods sampled. The following are some notes of samples which were adversely reported upon by the Public Analysts. MILK Sample No. 23 was a specimen of milk handed in at the Public Health Department by the householder who complained that the milk left a very dry feeling in the mouth. When a visit was made at the house, this complaint was substantiated by other occupants, but from casual taste this was not noticed. The specimen was submitted to the Public Analyst, who reported as follows:— This sample was in an acid (sour) condition when received. Analysis yielded the following figures:— Total Milk Solids 10.38 per cent. Including Milk Fat 1.95 per cent. Milk Solids other than Milk Fat 8.43 per cent. Mineral Matter (Ash) 0.74 per cent. 19 This milk was therefore deficient in milk fat to the extent of 35 per cent. of the normal quantity proper to natural milk. This opinion is based on the above figures and on the Sale of Milk Regulations, 1939. The amount of ash, however, indicated that the low figure for milk solids other than milk fat was not due to the addition of water- I understand that there was a complaint in connection with this sample of a dry feeling in the mouth after drinking it. This suggested the possibility of metallic contamination, but analysis yielded no evidence of such. The condition of this milk when received was too bad for tests for taste or rancidity to be made. Sausages and Sausage Meat Sample No. 88 (Pork Sausages) was certified by the Public Analysts to be deficient in meat to the extent of 7 per cent. A report to this effect was made to the Public Health Committee who, after careful consideration the matter, decided that as the sample was informal, a formal sample be obtained and that proceedings be taken if the Analysts' certificate again showed a deficiency. As a result of this recommendation, a further sample (No. 102) was purchased formally and again showed a deficiency of 7 per cent. In view of the low deficiency, and taking into consideration that a margin of error of 2½ per cent. allowed by the regulations would reduce the deficiency t0 4½ per cent., the matter was again referred to the Public Health Committee, who decided that a warning should be issued to the vendor. (A further sample taken in 1949 proved to be above standard). Sample No. 94 was a sample of sausages deficient to the extent 14 per cent. of meat. The Public Health Committee decided that a further sample should be obtained. The purchase of this sample (No. 94) made at a multiple (general) stores and the opportunity did not occur, on account of irregular supplies, to permit the purchase of a further sample. Sample No. 106, a sample of sausage meat, was found to contain sulphur dioxide, present to the extent of 400 parts per million. Although this amount is below the permitted quantity of preservative, it was reported to the Public Health Committee that the presence of preservative was not notified by label or notice, as required by the Public Health (Preservatives in Foods) Regulations. The Committee instructed that a warning be sent to the vendor. As this article of food was supplied at irregular intervals, it was not possible to obtain a further sample during the year. Cereal Foods Sample No. 119 was a carton containing one of the specially prepared cereals and the purchaser complained that there was a taste of disinfectant. The Public Analysts report is given below. It was not possible to obtain a further sample of this food. 20 "The sample possessed a slight but definite taste of disinfectant or paraffin nature. No abnormal smell was observed however with this sample in either a cold or hot condition. Moreover, chemical analysis for tar acid disinfectants yields only insignificant traces. Whilst therefore this sample was objectionable on account of the taste I am unable to say that the taint was sufficient to be of a harmful nature." The following is a list of the food samples during the year, together with the number of samples of each kind obtained:— Bacon 8 Lemonade powder 2 Gutter 11 Luncheon sausage 1 Parley, ground 2 Macaroni 2 Parley flakes 1 Margarine 11 Cereal food 1 Milk 8 Cheese 11 Oats, rolled 1 Cooking fat 11 Oatmeal 1 Crispbread 1 Pudding mixture 3 Coffee 2 Sponge mixture 2 Dates 1 Semolina 2 Dessert mould 1 Sugar 11 Flour 4 Sausages 3 Glace cherries 1 Sausage meat 1 Jellies 3 Tea 7 Jam 1 Vermicelli 1 Surrendered Foods FISH (Fresh) Crab 2 tins Cod 9½ stone Rockfish 1 tin Haddock 11½ stone Codfish 1 tin Kippers 19½ stone Sardines 2 tins Cod liver roes 8 tins Conger 6 stone Silver hake 1 tin Whiting 1 stone Herring roes 3 tins Catfish 6 stone Herring tidbits 3 tins Dogfish 6½ stone Herring fillets 15 jars Skate 19½ stone Fish (marinated) 60 jars FISH (Tinned) Fish cakes Herrings 1 tin FRUIT (Fresh) Herrings (kippered) Salmon 6 tins Apples 3 boxes 6 tins Oranges 1 case Capefish 1 tin Pilchards 12 tins FRUIT (dried) Cravfish 1 tin Dates Crawfish 1 tin Figs 18 lbs. 21 FRUIT (tinned) VEGETABLES (Tinned) Grapefruit 52 tins Peas 106 tins Apricots 5 tins Beans 38 tins Oranges 1 tin Potatoes 6 tins (dried) Orange juice 4 tins Carrots 12 tins Plums 19 tins Beetroot 16 tins Tomatoes 22 tins Mixed Veg 1 tin Tomato juice 4 tins Apples 8 tins MISCELLANEOUS Apple puree 4 tins Cherries 6 tins Milk (Evap.) 250 tins Peaches 25 tins Milk (Condensed) 43 tins Rhubarb 1 tin Jam and Marmalade 72 tins Grapes 1 tin Soup 39 tins Pears 2 tins Spaghetti 4 tins Prunes 1 tin Pork Sausages 1 tin Blackcurrants 1 tin Date Pudding 2 tins Fruit salad 1 tin Treacle Pudding 1 tin Fruit juice 1 tin Sponge Mixture 58 pkts. Vinegar 25 botts. MEAT (Fresh) Golden Syrup 2 tins Lamb (shoulder) 3¼ lb. Mincemeat 1 jar Bacon 17½ lb. Rusk biscuit 1 pkt. Pickle 1 jar MEAT (Tinned) Yorkshire Pudding Mixture 32 pkts. Corned Beef 678 lb. Corned Mutton 241b. Wheat Flakes 5 pkts. Veal 1 tin Sauce 1 bottle Meat Loaf 13 tins Chocolate 100 bars Tongue 1 tin Stewed Steak 2 tins "Nuttalene" 1 bottle Beef and Carrots 1 tin Meat and Veg 1 tin Meat paste 3 tins Milk Samples Fourteen samples of milk were submitted to the Public Analyst for examination by the methylene blue and phosphatase tests. All except one were reported to be satisfactory. This particular sample, which decolourised at the end of five minutes, was supplied from a dairy in a neighbouring authority, but investigation revealed the fact that treatment took place in Metropolitan Borough. Discussions with that Authority brought forward the fact that the machine at the dairy was aged and gave trouble at the time the sample was treated. New machinery was on order; subsequent sample showed that the milk was again up to Ministry standard. Ice Cream The activities of the department during the year were extended in the sampling of ice-cream. Sixty-four samples were obtained compared with 22 Number Local or outside manufacture No. of colonies per ml. on Agar at 37deg. C. in 48 hrs. Coliform test. Positive in 1/100 ml. in 3 tubes Bact. coli. Present in 1/100 ml. in 3 tubes Remarks by Public Health Laboratories METHYLENE BLUE REACTION After preincubation decolourised in (hours) After preincubation not decolourised in (hours) Ministry's Provisiona Grading 1 Outside 180,000 3 in 3 tubes 0 in 3 tubes Barely passable standard of bacterial purity, 0 — IV. 2 Outside 51,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3 — II. 3 Outside 19,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 0 — IV. 4 Outside 85,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. ½ — III. 5 Outside 18,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 4 — II. 6 Local 48,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. — 4½ I. 7 Local 380 0 in 3 tubes 0 in 3 tubes Excellent standard of bacterial purity. — 4½ I. 8 Outside 12,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3½ — II. 9 Local 25,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. — 4½ I. 10 Outside 1,200 0 in 3 tubes 0 in 3 tubes Very satisfactory standard of bacterial purity. — 4½ I. 11 Outside 4,500 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3 — II. 12 Outside 150,000 3 in 3 tubes 0 in 3 tubes Passable standard of bacterial purity. 0 — IV. 13 Outside 40,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. — 4½ I. 14 Outside 3,000 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity. 1½ — III. 15 Local 250,000 3 in 3 tubes 0 in 3 tubes Sample contains excessive numbers of bacteria, most of which are of thermoduric type, suggesting more careful cleansing of the plant is required. ½ III. 16 Outside 20,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 1½ — III. 17 Outside 30,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 4 — II. 18 Outside 60,000 3 in 3 tubes 0 in 3 tubes Fairly satisfactory standard of bacterial purity. 0 — IV. 19 Local 900 ) in 3 tubes 0 in 3 tubes Excellent standard of bacterial purity. — 4½ I. 20 Outside 3,000 3 in 3 tubes 0 in 3 tubes Very satisfactory standard of bacterial purity. 4 — II. 21 Outside 35,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3 — II. 22 Outside 900 3 in 3 tubes 0 in 3 tubes High standard of bacterial purity. — 4½ I. 23 Outside 15,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3½ — II. 24 Outside 4,000 3 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3½ — II. 25 Local 120,000 3 in 3 tubes 0 in 3 tubes Passable standard of bacterial purity. 1 — III. 26 Outside 52,000 3 in 3 tubes 3 in 3 tubes Contains organisms of excremental origin and is therfore unsatisfactory. 0 — IV. 27 Local 2,400 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity. 4 — II 28 Outside 32,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. — 4½ I. 29 Outside 1,200 0 in 3 tubes 0 in 3 tubes Excellent standard of bacterial purity. — 4½ I. 30 Outside 500 0 in 3 tubes 0 in 3 tubes Excellent standard of bacterial purity. 4 — II. 31 Outside 5,200 1 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 2 — III. 32 Local 12,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 2½ — II. 33 Outside 48,000 3 in 3 tubes 0 in 3 tubes Fairly satisfactory standard of bacterial purity. . . 1 1 r 1 . * 1 • , 2½ — II. 34 Outside 18,000 3 in 3 tubes 0 in 3 tubes Fairly satisfactory standard of bacterial purity. 2 — III. 35 Outside 4,000 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity. 3½ — II. 36 Local 250,000 3 in 3 tubes 0 in 3 tubes Contains excessive numbers of bacteria and is therefore unsatisfactory. 0 — IV. 37 Outside 60,000 3 in 3 tubes 0 in 3 tubes Passable standard of bacterial purity. ½ — III. 38 Outside 8,000 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. — 4½ I. 39 Outside 3,000 2 in 3 tubes 0 in 3 tubes Satisfactory standard, of bacterial purity. — 4½ I. 40 Outside 180,000 3 in 3 tubes 1 in 3 tubes Barely passable standard of bacteria! purity. 1½ — III. 41 Outside 10,000 3 in 3 tubes 0 in 3 tubes Fairly satisfactory standard of bacterial purity. 2 — III. 42 Outside 90,000 3 in 3 tubes 0 in 3 tubes Passable standard of bacterial purity. 1½ — III. 43 Outside 1,500 0 in 3 tubes 0 in 3 tubes Very satisfactory standard of bacterial purity. — 4½ I. 44 Outside 800 0 in 3 tubes 0 in 3 tubes Excellent standard of bacterial purity. — 4½ I. 45 Outside 150,000 3 in 3 tubes 1 in 3 tubes Barely passable standard of bacterial purity, organisms of excremental origin being present in small numbers. 0 IV. 46 Local 1,400 0 in 3 tubes 0 in 3 tubes Very satisfactory standard of bacterial purity. — 4½ I 47 Local 2,100 0 in 3 tubes 0 in 3 tubes Very satisfactory standard of bacterial purity. — 4½ I 48 Outside 3,000 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity. — 4½ I. 49 Outside 23,000 3 in 3 tubes 0 in 3 tubes Fair standard—content of coliform organisms should be lower. 3 II. 50 Outside 400 0 in 3 tubes 0 in 3 tubes Excellent standard of bacterial purity. — 4½ I. 51 Outside 16,000 2 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3 II. 52 Outside 32,000 3 in 3 tubes 0 in 3 tubes Fair standard of bacterial purity, but the coliform organisms should be lower in number. 1½ — III. 53 Local 480 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity. — 4½ I 54 Outside 7,800 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3 — I. 55 Outside 5,200 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 4 — II. 56 Outside 370,000 3 in 3 tubes 0 in 3 tubes Unsatisfactory — contains excessive numbers of bacteria. 0 — IV. 57 Outside 9,300 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. 3½ — II. 58 Outside 120,000 3 in 3 tubes 0 in 3 tubes Passable standard of bacterial purity. 0 — IV. 59 Outside 5,200 0 in 3 tubes 0 in 3 tubes Satisfactory standard of bacterial purity. —• 4½ I. 60 Outside 3,800 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity. - 4½ I. 61 Outside 4,800 0 in 3 tubes 0 in 3 tubes High standard of bacterial purity. - 4½ I. 62 Outside 12,000 3 in 3 tubes 0 in 3 tubes Fair standard of bacterial purity, but content of coliform should be lower. 3 — II. 63 Outside 25,000 3 in 3 tubes 0 in 3 tubes Fair standard of bacterial purity, but content of coliform should be lower. 3 II. 64 Outside 90,000 0 in 3 tubes 0 in 3 tubes Fair standard of bacterial purity. 3 — II. twenty-nine in the previous year. A tabulated list of results is shown in this report. The general standard would appear to be good, both bacteriologically and as judged by the Ministry of Health's provisional standard. Referring to the latter, twenty-two samples were in Grade I, twenty-one in Grade II, thirteen in Grade III and eight in Grade IV. Compared with results, the percentages are as follows: — 1948 1947 Grade I 34.25% 8% Grade II 32.81% 24% Grade III 20.3% 32% Grade IV 12.5% 36% The percentage shows an improvement in the quality, and the continual sampling should have a good effect upon the manufacturer and the vendor. In cases of doubtful quality, the local authority concerned is notified, and improvements have been noted after such notification. In the case of the locally-made product, the producer is visited and he is assisted by the Sanitary Inspector in tracing the trouble. Sample 15 is a case in point where advice on thorough sterilisation produced a good result as subsequent simples showed counts of 1,400 and 1,800 and the Provisional Grade I. The Public Health Committee being dissatisfied with the product of two vendors requested them to appear before the Committee and had an informal interview with them. The Chairman pointed out the Committee notice on this interview, since which results have been good. The Commitee are to be congratulated upon taking this step which, in addition to having the desired result, generally assisted the officers in their work. All vendors are notified of the result of the sample procured. This again creates interest and co-operation from the trade. There has been an increase in the number of vendors registered from 64 in1947 to 73 in1948, indicating the popularity in the product, apart from source of income. 23 Section F. Prevalence of, and control over, Infectious and other diseases. 1. The following table shows the incidence of infectious disease during the year together with cases admitted to hospital and number of deaths. Disease Total cases notified Cases admitted to hospital Total Deaths Smallpox - - - Scarlet Fever 50 9 — Diphtheria 2 1 — Pneumonia 34 10 17 Cerebro-Spinal Fever — — — Acute Poliomyelitis 1 1 — Acute Polioencephalitis — — — Encephalitis Lethargica — — — Dysentery 5 2 — Ophthalmia Neonatorum 1 - - Puerperal Pyrexia 9 7 — Paratyphoid Fever 1 1 — Enteric or Typhoid Fever — - — Erysipelas 13 1 — Malaria (contracted abroad) - - — Measles 451 4 1 Whooping Cough 242 2 2 Scabies 19 - - 2. Diphtheria Immunisation and Vaccination The number of children who completed a full course of primal') immunisation during the year is set out below: — Under 5 years 773 5 to 14 years 81 Total 854 The number of children who received a secondary or re-inforcing injection was 101. The number of persons vaccinated or re-vaccinated during the period 5th July, 1948, to 31st December, 1948, were:— Under 1 1-4 yrs. 5-14 yrs. 15 or over Total Primary Vaccination 142 26 33 4 205 Re-vaccination 8 — 4 21 33 24 I am setting out below information on the total number of children under 15 years of age who have at any time received a course of immunisation against diphtheria in the Borough, as at the 31st December, 1948. Immunisation is normally carried out at 9-12 months and again on the attainment of school age. Year of Birth Number 1948 132 1947 536 1946 659 1945 748 1944 502 1943 419 1942 571 1941 697 1940 621 1939 548 1938 409 1937 333 1936 336 1935 297 1934 Total 269 7,077 3. Scabies Five cases of Scabies were treated at the Walthamstow Clinic. This compares favourably with 13 cases treated during the previous year. 4. Tuberculosis Particulars of new cases of Tuberculosis and mortality from the disease during 1948:— 38 Pulmonary and 5 non-Pulmonary cases were notified for the first time during the year. 11 cases were transferred into the district. 1 case was restored to the register. 16 Pulmonary and 3 non-Pulmonary cases died during the year. 42 other cases were removed from the register. 326 cases remained on the register at the close of the year. 25