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34
fantile mortality rate there has been an even and almost continuous
drop, but the numbers of deaths of toddlers show an alternate
rise and fall in the even and odd years. If the period since the war
be taken, there is a slight but appreciable difference between the
even and odd years. Since 1918, measles has occurred here regularly
even other year, and the appearance of this disease biennially
is sufficient to account for this difference in the mortality
rates. Measles usually makes its appearance in the winter months,
and some of the deaths which belong to even-year epidemics occur
at the end of the odd year : otherwise the difference between the
epidemic and inter-epidemic measles years would make itself more
evident in the mortality in the age period 1 to 5 years. Apart
from measles in the even years, which in Acton have been the
epidemic ones, the diseases which recently have been the most
fruitful cause of death amongst toddlers have been whooping cough
diphtheria and pneumonia.
As far as measles and whooping cough at the present time
are concerned, we have no effective means of preventing them,
but the administrative measures now adopted have probably been
the means of saving many lives and the prevention of many deaths
from measles. It was pointed out in last year's Annual Report
that measles is now much less fatal than it was in the early part
of this century. Many factors have contributed—a better appreciation
of the seriousness of measles, better housing conditions, improved
economic conditions, better infant nurture as a result of
education and of infant welfare work; probably the latter plays
the most important role. Another factor is the institutional
treatment of measles, more especially of its lung complications.
It is frequently stated that measles alone seldom kills, but the fatal
result is brought about by one of its complications., usually bronchopneumonia,
and it is on this account that institutional treatment
has resulted in a lessened number of deaths from the disease. In
the last decade, we have been able to treat a proportion of cases
in the Fever Hospital. It would be impossible to admit into hospital
all the cases of a disease like measles which occurs in an explosive
epidemic, but we have been able to admit most of the cases
in which the home conditions have been unfavourable. So that,
although we are unable to prevent or even control epidemics of
measles, we are able to mitigate to a considerable extent its ravages.
There is one disease to which toddlers are especially susceptible,
and which can be brought under control, and that is diphtheria.
The need for more extensive immunisation of pre-school children
cannot be too strenuously stressed. Although it would be an exaggeration
to state that diphtheria does not occur in immunised
children, if it does occur, it is of so mild a character that even