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WORK OF THE DEPARTMENT
Control of Infectious Diseases
This aspect of the work of the department, in the third year of the existence of Waltham
Forest as a corporate borough, was unremarkable and the incidence of infectious disease followed
closely the pattern of the past two years. Notifications at 3,228 showed a substantial increase
over 1966 (1,657) but, as forecast last year, the biennial measles epidemic accounted for most of
the difference (2,615 cases against 1,157) although whooping cough - 276 (123) was also more
prevalent. Preliminary results of the large scale research project (in which we are participating)
into the causation of whooping cough indicate that almost as many cases of paroxysmal cough in
children are now due to a virus infection as are due to the pertussis organism from which the
prophylactic vaccine against whooping cough is prepared. The incidence of scarlet fever was
almost unchanged at 155 (147) cases as was that of tuberculosis - 77 (79), but, of the latter, three
cases were of acute infectious respiratory tuberculosis among workers at three different factories
and required investigation of several hundred contacts. A teacher and school caretaker also
contracted the disease but, fortunately, after further investigation were found not to be in the
infectious stage. About one third of all notified tuberculosis occurred among immigrants (29.2% of
lung infections; 50% of other sites) and this proportion is likely to increase since some immigrants,
especially those from North East Pakistan, are quite extraordinarily prone to develop the disease
which, for generations, has been unknown in their own country. Lacking the hereditary resistance
developed through several generations of exposure by the urban English, one survey showed them
to be 29 times as susceptible, while their custom of living in very close contact, three or more
families in one house, favours the domiciliary spread of all infections.
There were four cases of enteric fever; a boy of 15, who had almost certainly contracted
typhoid abroad, falling ill just over a fortnight after his arrival here from Pakistan; another
recently arrived Pakistani had paratyphoid A, a local resident who contracted typhoid fever while
on holiday in Spain and a schoolteacher who developed paratyphoid B. The last case was
particularly interesting as the lady concerned lived in a religious community and had had no
separate meals apart from an omelette at a London restaurant. This was at once suspect and the
Medical Officer of Health of the district concerned carried out a full investigation of the staff,
premises and stored food with completely negative results. All the patients made a full recovery
and not one secondary case occurred due to prompt diagnosis, isolation and effective hygienic
precautions.
One case of acute paralytic poliomyelitis occurred in a girl of 6. All her close contacts
were immunised at once and no secondary case occurred. The child unfortunately is left with a
considerable residual paralysis but is slowly improving with regular physiotherapy. There was a
small outbreak of sonne dysentery. As usual, this occurred at an infants' school; nine children
were affected as were four family contacts. The outbreak was quickly brought under control but
these incidents will continue until proper washing facilities are provided (and used!) at all infant
school toilets and until all mothers realise that a child who is "loose" should not be sent to
school. A young West Indian woman was found to be suffering from the much more serious amoebic
dysentery and treatment and investigation of contacts arranged. With good lavatory facilities there
is little danger in this form of the disease spreading in England. 58 families were found to be
suffering from scabies and were taken to the Cleansing Station at Hackney.
Two events of great epidemiological importance occurred during 1967. One was the epidemic
of foot and mouth disease among cattle, affecting several of the dairying counties and leading to
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