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It will be seen that although there was a slight increase in the
population figures for the country as a whole, the number of formal
notifications received each year declined up to the outbreak of the war.
There was then a sharp set-back up to 1944. After that, the situation in
general improved though recovery was not sufficient to restore the position
to what it was at the outbreak of the war, and more recently there has
been a recession.
What exactly the factors were that led to this set-back during the
war years is not known. Certainly the general conditions of strain,
the increased opportunities for conveyance of infection, more especially
the result of crowding might be expected to have brought about a
deterioration in the circumstances ; nevertheless it is difficult to point
with any certainty to any specific causative factor. Among the post-war
conditions there are two which contribute to-day more than before the
war to an increased incidence of disease. The first is housing, more
particularly the results of over-crowding. The other is the shortage of
accommodation in hospitals, largely the result of failure to obtain the
nurses necessary to staff existing accommodation. This acts in two
ways. The first is by increasing the waiting time before a patient can
be admitted ; this results in that patient being a longer time at home in an
infectious condition ; also he becomes that much worse before the time
arrives for him to be admitted. He is, therefore, for that period more
infectious to others and because the disease has progressed, he needs a
longer time before the disease can be arrested. Secondly, the shortage
of accommodation results in many of those who cannot be cured having
to be sent home, there to live with other members of the family while
infectious.
These factors which have brought about changes in the national
rates will be operative in this district to a greater or lesser extent than
they influence the national rates. On the other hand it can be seen that
the increases in the local figures are out of all proportion to the increases
in the national figures ; and further that the effect of this increase is to
change the local rates from the position that they were before the war
when they were lower than the national rates, to their being higher than
those rates to-day. The local figures show marked variations from year