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It should be remembered that health visitors, except when acting as cnild life protection visitors,
have no legal powers behind them, and the success of their efforts is dependent on sound knowledge, persuasion,
and perseverence and the greatest of these is probably the last. No matter what clinic facilities
be provided, home visiting will continue to be the most important part of a health visitor's work. With
our present staff of health visitors home visiting is falling short of need.

The age distribution of notifiable disease during 1948 is shown in Table V.
Scarlet Fever.-This disease continued to be of a mild type. No death from this disease has
occurred in the Borough since 1937. Of these 159 cases, 65 were admitted to hospital.

The steady and persistent fall since 1930 can be attributed only to immunisation. Since immunisation
was started in 1930 there have been 818 cases, and 58 deaths from diphtheria, and of these 23 and
1 respectively had been immunised. The progress of the immunisation scheme is shown on Table VI.
This disease can be kept under control only if the parents will co-operate by having their children protected.
In 1947 there were 1,846 births and approximately that number of children reached their first birthday
in 1948, but only 1,032 were immunised. A much higher proportion of young children must be protected
and the future record of diphtheria will be a measure, not of the efficiency of the Health Department,
but of the intelligence and foresight of parents in the Borough.
Erysipelas.-Though 21 cases were notified no death was due to this disease.
Pneumonia.-There was a slight decrease in the notification of pneumonia as compared with 1947.
The death rate per 1,000 population from pneumonia was 0.4 as compared with 0.6 in 1947. Of the total
pneumonia deaths 12 per cent occurred at age 0-4 years and 62 per cent, at age 65 and over.
Cerebro-Spinal Fever.-This disease was less prevalent than in 1947. The sulphonamide drugs
have greatly reduced the mortality from this disease.
Epidemic Encephalitis.-No case or death from epidemic encephalitis occurred during 1948.
Poliomyelitis and Polioencephalitis.-These names describe two types of infection, by the same
virus: In the former the spinal cord is chiefly affected, and in the latter the brain bears the brunt of the
infection.
Though poliomyelitis was apparently known to the ancients, the first account of paralysis associated
with fever in young children was published towards the end of the 18th century. While scattered cases
were reported in Europe and North America it was not till 1870 that the disease was recognised as occurring
in epidemic form. These epidemics made their appearance first in Scandinavia, then in United States,
and then in Australia. In these countries epidemics involving thousands of persons began to be more
frequent, while small outbreaks occurred in England and elsewhere in Europe. Since 1936 there has been
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