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Smallpox.—No case of smallpox occurred in the Borough during 1954. Persons arriving in the
Borough from parts of the world where smallpox is prevalent, are kept under observation till any chance
of their developing the disease is over.
Freedom from smallpox has resulted in a neglect of infant vaccination. According to the returns,
589 children under the age of one year were vaccinated in 1954. Modern travel is such that the risk
of importing smallpox is ever present.
Scarlet Fever.—The continuing mildness of this disease is tending to make parents, and possibly
doctors, careless about home isolation and other measures to prevent the spread of infection. Of the
71 cases which occurred during the year, 15 were admitted to hospital. No death from this disease
has occurred in the Borough since 1937.
Diphtheria.—No explanation other than immunisation can be offered to account for the great
change (shown in Table VI) that has come about in regard to diphtheria. This change can be maintained
only if a sufficiently high proportion of the child population continue to be protected by immunisation.
Unfortunately, the removal of the fear of diphtheria has resulted in a fall in the proportion of new
babies being immunised. The number of children under the age of one year protected against diphtheria
in 1954 was 610; fewer than in 1953. Parents of young children must not be lulled into a false sense
of security because diphtheria no longer occurs among the children of friends and neighbours.
Erysipelas.—The number of notifications, 17, is an increase of one compared with the previous
year, but no death was due to this disease.
Pneumonia.—Notifications of pneumonia were 34, as compared with 78 in 1953. The death rate
from pneumonia per 1,000 population was 0.3, compared with 0.5 in 1952 and 1953. Of the total
pneumonia deaths, 72 per cent, occurred at age 65 and over.
Meningococcal Infection.—Four cases of this disease, formerlv classified as cerebrospinal
fever, were notified. All were admitted to hospital and recovered.
Epidemic Encephalitis.—No notification was received during the year.
Post-Infective Encephalitis.—Encephalitis is known to occur as a complication of other
infectious diseases and one such case was notified during 1954. The infectious disease in this case
was mumps.
Poliomyelitis and Polioencephalitis.—For the first time since 1943 no case was notified. The
disease was fairly prevalent in the country and no explanation other than chance can be offered for its
absence from the Borough.
Typhoid Fever.—No case of typhoid fever was notified during the year.
Paratyphoid Fever.—During the year one case of paratyphoid fever was notified. The illness
occurred while the child was in a London hospital and the source of the infection was not traced.
Dysentery.—This disease shows great variations in prevalence from year to year and from
place to place. During the year, 9 cases were notified, and of these two were nurses in a local hospital.
I lie ages of the cases ranged from 3 years to 69 years; one was under five years of age and two were
of school age. No connection was traced between any of the local households concerned.
1 he infection in all cases was of the Sonne type and the illness was mild in practically every case.
The mildness of the illness is such that medical advice is not always sought, and unless the disease is
kept constantly in mind, cases are likely to be missed. In all cases of diarrhoea in children and on the
least suspicion in adults, a specimen of faces should be sent for bacteriological investigation. Only
by such vigilance will this disease be kept under some degree of control.
Tuberculosis.—During the year, 81 notifications of pulmonary tuberculosis, and 7 notifications
of non-pulmonarv tuberculosis were received. This is the lowest tuberculosis notification rate recorded
in the Borough. In recent years the notification rate has remained at much the same level, though the
death rate from tuberculosis has fallen and this suggested that there was still some reservoir of infection
which was not being treated. Persons continue to be certified as dying from tuberculosis who have not
been notified during life, but it is hoped that with the improved facilities for diagnosis and treatment
now available, any reluctance to seek investigation and treatment will disappear. Early diagnosis and
treatment are essential to reduce the risks of the spread of infection.

the decline in the death rate from tuberculosis in this country started about the middle of last
century, and it is difficult to assess the many factors which may have played their part.
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