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even this information is inconclusive without knowledge of the
medical history of the mother, and perhaps even of the father,
before the onset of pregnancy, and the antenatal progress of the
mother during pregnancy. As far as I am aware, no work of
this kind has ever been attempted on any large scale. Suggestions
have been made in the past that pregnancy should be made a
notifiable condition in order that the preventive service can be
alerted early and valuable information collected. Notification of
pregnancy would at least ensure a visit from a trained officer who
wouid give early advice and management to the expectant mother,
and the co-operation and confidence of the patient would be sought.
All this could be done by persuasion and I can see no other way
of making even slight progress in reducing the intractable perinatal
mortality rate. The whole organisation of obstetrical care in this
country is long overdue for overhaul and although on balance 1
am still a firm advocate of hospital confinement, a great deal
more information could be exchanged even now between hospitals,
family doctors and local authorities about expectant mothers, which
could be available for assessment after the confinement. Fortunately
it is pleasant to record that there were no maternal deaths.
It is my melancholy duty to report further increases in deaths
from the so-called "stress" diseases like hypertension and coronary
thrombosis. Almost all conditions of malignant illness showed
increase, particularly cancer of the lung and bronchus, which indicates
again the folly of heavy cigarette smoking. One cause of
the increased malignancy, of course, is the fact that the expectation
of life is longer and more people are reaching the age when
malignancy can be expected. The causes of some forms of malignancy
are still wrapped in the mysteries of the phenomenon of life
but lung and bronchial cancers are now, to a substantial extent,
preventable. Stop smoking or, better still, never start and the
chances of lung malignancy if not completely eliminated, are
reduced by a great margin. This is a test of personal will and
responsible behaviour. It is not the business of officialdom to
impose irksome restrictions or to indulge in tedious lectures and
admonitions but to present the facts with honesty and clarity, particularly
to the young who have yet to acquire the smoking habit.
The total number of infectious diseases reported was 184,
a decrease of 1,797 from 1961. Apart from the great reduction
in measles, all the major infectious diseases with the exception of
scarlet fever, showed a decline. There were only 29 cases of
pulmonary tuberculosis, and whooping cough, dysentery and infantile
diarrhoea were all down. No case of poliomyelitis was notified.
The discovery of a case of smallpox in a neighbouring borough
occasioned strenuous efforts not only on the part of the