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35
necessary vitamins. It is true that butter was difficult to obtain
during the war, but by that time cod-liver oil had been recognised
as a valuable source of vitamins A and D. Although, not to the extent
which prevailed at the beginning of the century, it is possible
that the depression of recent years may have had some effect in the
slight rise on morbidity which has been noticed in the last ten years.
There was no noticeable change in our administrative methods.
When accommodation permits, certain selected cases are admitted
into the fever hospital. During the spring and summer circumstances
permitted us to admit all urgent cases. Altogether 78 cases
were admitted to hospital.
Diphtheria.
Eighty-six cases of diphtheria were notified during the year,
and there were 7 deaths. These figures compare with 161 notifications
and 23 deaths in 1933, and 151 cases with 21 deaths in 1932.
Although there has been a great reduction in the number of
notifications and deaths compared with the two previous years the
figures show that the type of disease which is present in the district
is of the same virulent character as that experienced in 1932 and
1933. The virulent type of Diphtheria is not a recent mutation.
Ever}7 one with a long experience can recall outbreaks of a virulent
type of the disease. But whereas formerly the virulent type of the
disease occurred not only in a few towns, but was limited to a small
part of the town, recent reports show that this type is now prevalent
in all parts of the country ; in the southern parts as well as in the
northern towns, and the outbreaks are scattered broadly in the
towns affected.
I can recall limited outbreaks at different times in Acton,
but in the last 30 years no outbreak of a virulent type (before the
present one) was found to exist throughout the district. These
graver forms were limited to a school or small circumscribed area.
Since the autumn of 1932, cases of the graver type have been found
in all parts of the district and among pupils of all the schools in the
borough.
Within the last few years Medical Officers of Health in several
parts of the country have been faced with outbreaks of diphtheria
characterised by unusually high incidence and mortality. Whatever
may be the full explanation of the phenomenon, it is wellknown
that the case mortality of diphtheria in many areas has risen
in late years. The graver form of the disease has been present not