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death and disability. There seems no doubt that the major reason for this state of
affairs is the introduction of immunisation in 1957, and its acceptance by the general
public.
PUERPERAL PYREXIA
There were 42 notifications, six cases occurring in home confinements and 36 in
hospital confinements. It must be borne in mind that the percentage of hospital
confinements considerably exceeds that of home confinements, and includes the
cases most liable to suffer from puerperal pyrexia.
SCARLET FEVER
There were 124 cases. Not very long ago this disease was responsible for filling
many beds in infectious disease hospitals. It is now a much milder condition,
partially due to antibiotics, but at least in part probably due to some natural decline
in virulence of the organism. With the exception of one case, all were nursed at home.
SMALLPOX
There were no cases notified during the year.
Sixteen people arrived by air and 15 by sea from smallpox areas without being
able to produce valid certificates of vaccination. All were kept under daily surveillance
until the fourteenth day from the last day of possible contact.
TUBERCULOSIS
Although this disease has been partly affected by improved living conditions and
the discovery of new drugs, there is still no cause for complacency since during the
year 129 cases of pulmonary tuberculosis were notified and 42 cases of non-pulmonary
tuberculosis.
TYPHOID FEVER
Although chemotherapy has markedly reduced the fatality rate of this intestinal
disease the occurrence of a case must still be regarded with concern.
The ultimate cause of all cases is a human source of infection and outbreaks take
two possible forms:—
(1) Those in which infection is passed directly from patient to contact.
Such outbreaks usually include only a small number of persons.
(2) Those where water or food supplies have been contaminated producing
an explosive outbreak, involving large numbers of people.
There were in Ealing three cases notified, all of which, fortunately, fell within the
first category.
The first was a woman, aged 24 years, who was immediately admitted to hospital.
Investigation at her home revealed that another 12 people were living there and that
four of them were employed in food premises. These food handlers were excluded
from work and young children were excluded from school. Investigation led to
the belief that the infection was likely to have originated from a carrier, but the
source was not identified. No other case occurred as a result of this case.
The second case was that of a boy, aged 2-J- years, who was admitted to a general
hospital with a provisional diagnosis of broncho-pneumonia, but on a diagnosis of
typhoid being made he was transferred to an isolation hospital. All home contacts
were traced and it was found, in addition, that the patient had recently been cared
for by a foster-mother whilst his mother was in hospital for a confinement. All
contacts of this household were also traced. Several adult contacts of this case were
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