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result in wide-spread outbreaks. Fortunately this has not
generally been the case to date, although prolonged war,
especially if accompanied by deprivation, may still have such an
effect.
Apart from mass movements, the position locally has always
been influenced by the fact that this District, whatever its
advantages in other respects, is part of the greater London area,
with no natural boundaries dividing it from the surrounding centres
of population with which it is linked by frequent daily contacts.
This intimate relationship is illustrated by the distribution of
that annoying but fortunately not dangerous disease, scabies, upon
which attention has been focussed during recent years. Its
treatment locally is dealt with in the text of this Report, but its
abolition from the District being dependant, not only on similar
activity in the Services and in all parts of the Country, but on
the co-operation of all affected, cannot be achieved by local or
official effort alone.
In spite of, or it may, in some cases, be because of these
frequent contacts and movements of residents, the incidence of
infectious disease has remained low in this District and in 1942,
if the war-time notifications of measles and whooping cough are
disregarded, together with the cases of dysentery occurring in
the local mental hospitals, the prevalence of infectious disease
was lower than in any previous year, except 1938
This welcome though unexpected reduction in incidence
emphasises the fact that there are many contributory factors
influencing the spread of infectious disease of which deliberate
"control", especially if regarded in its former limited sense as
being synonymous with isolation and disinfection, plays but a
relatively small part. Change in the virulence of the offending
germs themselves undoubtedly occurs, as witness the inoffensive
character of Scarlet Fever at the present time, but these changes
we cannot predict or generate at present.
What can be done, by the intelligent co-operation of all, is:-
(1) To improve bodily health and resistance by following the
comparatively simple"laws of health" (e.g. by cleanliness, by living
as far as possible in really fresh air and sunshine,-by getting
sufficient sleep and relaxation combined with suitable exercise for
the age period and by taking simple nourishing food):
(2) To reduce the risks of heavy infection by avoiding congested
surroundings, by scrupulous cleanliness, especially when dealing
with foods and drinks, by treating seriously our greatest enemies,
the common colds, coughs and influenza, (showing intelligence by
ceasing to mix with others in the early stages, using such handker
chieves as we are allowed when coughing or sneezing and, especially
when dealing with young children, wearing masks temporarily): and
(3) To utilise such knowledge as we possess of artificial
immunisation, e.g. against smallpox and diphtheria.
By such means' further progress can be achieved.
When giving general consideration to these factors I would
particularly draw attention to the references in this report to th
influence of infection on the infant mortality rate and to the
increase of Pulmonary Tuberculosis, especially among older men,
and, to some extent, among young adults.
It is thus, with gratitude for another reasonably satisfactory
year and with a call for continued progress, that I would conclude
this introduction by once-again thanking all who have co-operated
in the her 1th services curing the year 1942, including the most
recent recruits, the staffs of the Wartime Nurseries, the Civil
Defence Casualty Service Staff, the temporary and permanent Council
staffs and particularly the Senior Health Visitor, the Sanitary
Inspector and my Chief Clerk for assistance ih the preparation of
this Report.
I am, Mr. Chairman, Ladies and Gentlemen,
Your obedient Servant,
F. R. EDBROOKE.
Medical Officer of Health.