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associated with prolonged and heavy cigarette smoking, caused 267
deaths as against 285 in 1966. Deaths from bronchitis numbered
231 as against 247 in 1966; this disease is also thought to be linked
with heavy cigarette smoking as well as with atmospheric pollution.
Coronary arterial disease and angina accounted for 742 deaths
compared with 758 in 1966. Heavy smoking may well be a factor
in causing coronary arterial disease although it is now generally
held that the causes are multi-factorial and very complicated and
difficult to assess. These illnesses are important, not only as problems
in community medicine, but because the age groups in which
they occur are predominantly in the most economically productive
period of life when many of the victims must be bearing responsibilities
both to their own families and to the economy of the
country at large. Our measures to deal with atmospheric pollution
in Wandsworth should be making some contribution to the reduction
in the incidence of and deaths from chronic bronchitis and to
some small extent possibly of cancer of the lung. As regards coronary
arterial disease, there seems at the moment to be no clear
indication of how this disease is to be prevented except by exhortations
to avoid excesses in one's mode of life and to be moderate in
one's activities and pleasures. How easy it is to preach such a
gospel but how difficult to put into effect! There could hardly
be a better example of the reaction of people to their sociological
and environmental conditions, using these terms in the broadest
sense, and of the difficulties of influencing these conditions.
During 1967, a total of 3,344 notifications of infectious disease
was received, a considerable increase over the previous year which
was a result of the anticipated biennial increase in the incidence of
measles, since 1967 was a "measles year Details will be found
in the body of the Report of the other infectious diseases which
occurred and how they were dealt with; here I need only make
special reference to the smallpox "outbreak" in Wandsworth in
October 1967, an incident of special interest and importance.
Although for many years this country has been virtually free
from endemic smallpox, I have had occasion in previous years to
refer to the introduction of smallpox into the country and to the
action we had to take in Wandsworth to deal with contacts of cases
and associated problems. In 1967, the only cases of smallpox which
were notified in the British Isles arose in Wandsworth. The first
case was diagnosed in the late evening and early hours of 16/17th
October. No one doubts that the increased volume and speed of
air travel has greatly increased the risk of smallpox being imported
from those countries where it remains an endemic disease and
health authorities near to international airports must be prepared
to deal with smallpox at any time and to act quickly and vigorously.
Indeed, this would apply to areas of large industrial population to
which many travellers likely to be incubating smallpox seem eventually
to go. I am glad to say that by speedy and vigorous action (and