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The Health Visitor paid 164 first visits, and 13 revisits,
64 being connected with school children. It was
necessary to limit the visits owing to the large number of
cases occurring at the sane time, more than half being notified
in June and July. Attention was chiefly given to those
families in which children under" school age were suffering from
or in contact with the disease.
It is very doubtful whether compulsory notification and
subsequent visitation is justifiable in a District such as this
particularly when notifications are frequently received too
late for the visits to be of service. (On the average it was
found that the Health Visitor visited on the 14th day of the
illness owing to the lapse of time before diagnosis was made and
notification received.) Protective immunisation is impracticable
at the present time.
From February until April the disease was most
prevalent in Coulsdon, in June and July in Purley and Selsaon,
while Sanderstead, which had missed the main, epidemic, had its
cases in December, extending into 1942.
WHOOPING COUGH.
There were 136 cases of whooping cough notified by
Doctors under the Measles and Whooping Cough Notifications
Order, 1940, these being chiefly received during the last
quarter of the year. From the Schools came 176 notifications,
which number bears about the sane relation to the number
notified by the Doctors as in the case of Measles, the same
conditions applying. On analysis it is found that the degree
of duplication in notification was much less than would have,
been expected, only 24 names coning from both Doctors and School
There was thus a tota1 of at least 286 cases. Of the 13o cases
notified by Doctors more than half were children over 5 years of
age. Of the cases notified by both Doctor and School, in 17
cases the schools notified before the Doctor (the average of
11 days in advance being due to 7 cases in which the Doctor
delayed notification for 21 days). In the 7 cases in which
the Doctors notified first the average difference in dates of
notification was 7 days, only 1 case, of 3 weeks' delay having
occurred. Of the total of some 3OO cases 7 were admitted to
the Isolation Hospital and recovered, but two deaths occurred
from this disease in Patients treated in their own homes,
neither of whom was notified.
The value of notification of whooping cough at the
present time is even more doubtful than that of measles. Very
occasionally the Health Visitors can follow up a case fairly
soon after the onset but the average time which elapses is
3 weeks between the onset and visit. In nearly all the cases
of whooping cough visited by the Health Visitors the Doctor
had been already in attendance for some time. In the first 3
months of the year the infection was most prevalent at Selsdon,
in July at Old Coulsdon, by September it was generalised with
Selsdon and Coulsdon chiefly affected in October.
DYSENTERY.
A total of 224 cases of dysentery-were notified during
the year, all of which except one occurred in one or other of
the two mental institutions in the District. During the first
8 months of the year the cases, chiefly of the Flexner types of
bacillary dysentery occurred solely in one of the Institutions
which had had 68 cases in the latter half of 1940, the
infection originating with the movement of patients from London
Hospitals during the period of air attack. After the wave had
died down in this Hospital and two free months had been
experienced a further 10 and 2 cases occurred in November and
December. A considerable amount of research was undertaken by
Specialists during this period and the results published In the
medical literature. At the other institution 104 cases occurre
also of Flexner types, during the last four months of the year,