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15
very few eases were notified in the first six months of
the year: the actual peak of the outbreak occurred in
September and October. The total number of cases
notified was less than half the usual number. Voluntary
evacuation may have had something to do with the reduced
incidence, but I am unable to offer any explanation
which could account for the marked variation in the
periodicity. London, where the 104 week interval has been
a most regular event, had a similar experience.
CEREBRO-SPINAL MINGITIS.
The incidence of this disease is greatly increased
in war-time. It is spread by direct personal contact
only, because the infective parasite cannot survive
except in conditions of temperature approximating to that
of the human body. Secondary cases in the same house as
the original case are rare, and it is seldom possible to
definitely connect one case with any previous case: the
inference of course is that the parasite is spread by
"carriers". In other words, the parasite spreads rapidly
through a community but, either because the resistance of
the average human being is high, or because the intensity
of the infection is too small to provoke a reaction,
comparatively few persons actually contract the disease.
The increased prevalence of this disease in Army camps
and barracks in war-time is understandable, but the
reason why it becomes so provalent among the civilian
population at the same time is not quite so clear.
Congregation of the general Public at night in Public
shelters would certainly offer one explanation of the
matter, but during the first half of 1940, the general
public did not sleep in, or spend any time at all in the
Public shelters: whilst in the outbreak of the disease
in this country in 1914-15, the living conditions of the
civilian population were no different from those existing
in peace-time. Six out of the seven cases which occurred
in 1940 among the civilian population in Beckenham were
in the first six months of the year: and no cases were
notified during September, October and November, when the
Public shelters wore most fully occupied.
TYPHOID FEVER.
No cases of Typhoid Fever or of Paratyphoid Fever
were notified during the year.
A few remarks are desirable on the question of
protective inoculation of the general public against
Typhoid and Paratyphoid Fevers.
Measures for the prevention of any particular
infectious disease can be divided into two classes. First
the control of the parasite: the power of being able to
prevent the parasite from gaining access to the human body.
Second, the production of an Immunity in the individual