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7
importance of these diseases, however, must not obscure the fact that the
4 deaths from both combined is to be compared with 53 during the year
from tuberculosis. It is gratifying to note that this latter total is 16 less
than the previous year.
A pleasing record is the fact that no cases of diphtheria were confirmed
during the year. This is to be attributed entirely to the immunisation
campaign, and it would be a great pity if the campaign were to slacken
because of press publicity with respect to poliomyelitis manifesting itself in
those recently immunised. It is extremely doubtful if there is any association
between the agent used in Ilford for immunisation (T.A.F.) and poliomyelitis,
the majority of the cases so far reported being associated with whooping
cough immunisation and other diphtheria antigens. I have investigated the
immunisation history of all Ilford cases of poliomyelitis in the epidemic years
of 1947 and 1949 and in no case could the disease have been brought about
by immunisation in our clinics or by private doctors working under schemes
of which we have records. During the year the number of immunisations
at our clinics declined from 3,917 to 2,811, but when to these figures are
added the number of immunisations carried out by general practitioners of
which we have records, the totals are 4,349 for 1948, and 4,359 for 1949, a
difference of no significance.
No cases of smallpox occurred during the year, but the sanitary inspectors
paid 489 domiciliary visits in connection with the surveillance of 43 contacts
of smallpox aboard ship. Since the introduction of the National Health
Service Act on 5th July, 1948, vaccination has no longer been compulsory,
and is carried out by general practitioners. Throughout the country there
has been a marked fall in the incidence of vaccination; in Ilford we were
notified of 831, 726 of which were among infants under 1 year of age; as a
percentage of the year's births this is 27.5 per cent., which compares with
16 4 per cent. for the aggregate of 79 County Boroughs.

It is apparent that children living in the three districts which contain the
higher income groups are protected to a greater extent than those living
elsewhere in spite of the fact that vaccination is free.
Measles, whilst still remaining the commonest notifiable disease, with
1,663 cases, showed a marked decline over the previous year, and whooping
cough the next highest at 566, was about half the previous year. These
diseases only contributed one death each. Probably the incidence for 1950
will be much higher.
The routine supervision of the purity of food supplies still continues
at a high level, probably the most difficult problem being the ensuring of a
hygienic standard of ice cream. During the year 140 samples were taken
and 27 proved unsatisfactory, requiring re-inspections and further sampling.
Milk is now dealt with under revised Regulations, the general effect of
which is to transfer to the Ministry of Agriculture and Fisheries the
responsibility for the supervision of the production side of the industry and
the Local Authority the retailing side. On the whole the quality of the milk
has been of a high standard.
During the coming year thought will have to be given to measures to
increase the standard of food-handling, a subject of criticism by visitors to
England. Lectures and film shows to all sections of the public would seem
to be amongst the foremost lines of attack.