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notification is still required, although there is evidence that this is
being observed with decreasing stringency. The fact that only 41
cases were notified in 1956 is therefore of less significance, and it
cannot be assumed that the disease was less prevalent.
As has been noted in the last 13 years, the disease is almost
entirely confined to school children and a smaller number of
younger children. The proportion who were admitted to hospital,
which until 1946 was at least three-quarters, decreased steadily
until in 1953-54 it was only one quarter, but it is now about 40%.
It is doubtful whether this increase is justified from the point of
view of treatment: it certainly is not as a preventive measure.
ERYSIPELAS.
This disease, which is also due to a streptococcus has never
been a major problem and since 1942 only a very few cases have
been notified in any year.
PUERPERAL PYREXIA.
This complication of pregnancy, formerly also chiefly due to
streptococcal infection and frequently very serious, has, fortunately,
become of insignificant importance, thanks to aseptic technique and
the effectiveness of newer types of drug treatment. In the two
mild cases in 1956 the rises in temperature within 14 days of the
confinement were due, in one instance to engorged breasts and in
the other possibly to a mild infection resulting from a forceps
delivery. Both responded rapidly to penicillin-like drugs.
PNEUMONIA.
Only cases of influenzal and primary pneumonia are notifiable,
i.e. those due to a specific infection by the influenzal virus or
pneumococci. It may be because of the uncertainty in differentiating
between these types and the forms of pneumonia complicating
other diseases that the notifications usually emanate from certain
sources only. This year one doctor notified 14 cases, and another
9, while three notified 2 cases each and seven only a single case.
In 1956 there were thus 36 cases notified, which is slightly
above the average for the last 7 years and during the war period.
The cases occurred mainly in the early months of the year and in
the Purley area, but only 2 cases, i.e. a husband and wife, appeared
to have any connection with each other. So far as is known, not a
single death resulted.
ENTERIC FEVER.
During the year 1 case of typhoid and 2 of para-typhoid fever
were notified which is about the average for the last 10 years. All
recovered.
The typhoid was Type E.1. and was probably contracted in
Italy. The cases of paratyphoid originated in a child who presumably
contracted the infection while an inpatient in a children's
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