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Measles.
This disease was again prevalent, 567 cases being notified compared
with 218 in 1947, 141 in 1946, and 705 in 1945, the peak again occurring
after three years, the previous highest number of cases being 479 in 1942.
The increase this year may to some extent reflect the fact that notification
of measles and whooping cough became comparable with that of other
notifiable infectious diseases in April, the normal notification fee replacing
the previously inadequate reward. The fact that both locally and
nationally the number of notifications rose sharply that month suggests
that this is at least a partial explanation.
The number of cases notified was so high that only a relatively small
proportion could be visited.
The disease was most prevalent in the Coulsdon West and East, and
Sanderstead and Selsdon wards, although it first became conspicuous in
the Purley and Kenley wards. Curiously enough the final group of cases
in August and September was also in the Kenley ward. Unfortunately in the
District generally a high proportion of the cases was in pre-school children,
possibly due to the fact that in 1947 the disease occurred mainly among
school children who were thus not susceptible in 1948.
The occurrence of at least four cases in each month of the year illustrates
the way this infection persists among the community. It is also
interesting to note that, although major waves appear to affect the District
as a whole at about three yearly intervals, sections and sub-sections of the
child population experience their own cycles of increasing and decreasing
prevalence, irrespective of the general trend, and that in a District in
which at least the older children and adults mix comparatively easily.
This observation would suggest that the conveyance of infection by the
immune sections is of negligible importance compared with the direct
association of the non-immune children themselves. As our present aim
is to postpone the onset of such diseases as this until the children are at
least five years of age, the influence of Nursery Schools, Child Welfare
Centres or other places at which these young children are brought together
needs to be considered. Only a minority of cases among the younger
children apparently resulted from contact with an older brother or sister
who might have become infected at school.
It is very difficult, however, to segregate toddlers and the solution of
the problem is anticipated to lie in the eventual introduction of a form
of immunisation capable of general use.
Whooping Cough.
The number of notifications during the year, 201, was the highest
yet reported locally, the previous record being 136 in 1941, but it may be
that this latest figure has also been influenced by the change in the notification
policy introduced in April, although the more even spread of cases
throughout the year tends to discredit this suggestion. The secondary
wave of cases in the Autumn is unusual.
The greatest prevalence was in Sanderstead, where cases occurred
chiefly at either end of the year and again the proportion of pre-school
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