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Whenever I study infectious disease tables, I am
more than ever convinced that our whole system of
notification should be completely overhauled. At the
moment we receive notifications of diseases such as
measles, where we act virtually as a post office only;
erysipelas, which has little or no clinical import these days;
puerperal pyrexia, which may very well be due merely to
constipation or slight cold during the puerperium;
malaria, where the significance of notification entirely
escapes me; and several other diseases which, although
admittedly infectious, have extremely little communal
or epidemiological significance. One must admit
that the collection of information is always valuable.
But when the collection of this information means that
other work must either be neglected or pushed into the
background, when the cost involved might very well be
devoted to other, more important projects, it would seem
that the time has come to act. And there is yet another
aspect of the problem to consider. The diseases
which I have just mentioned are no longer killing
agents, with the possible exception of pertussis,
(whooping cough) in very young children, and paralytic
poliomyelitis.' Even here, the death rate is not at
all excessive. Yet the death rate for such diseases as
coronary thrombosis and lung cancer is steadily rising
among important age groups of the population, while
the aggregation of diseases commonly grouped under the
term ‘rheumatism’ continue to take an extremely heavy
toll, not perhaps of life, but of well-being and the
ability to carry on a useful even a bearable existence.
But in none of these instances is notification required.
This would surely seem a fruitful field in which the
modern epidemiologist might play a truly significant part.
Diphtheria.
No cases of diphtheria were notified in the distric
during 1957. The last death took place approximately
ten years ago.
The remarks set out in my Annual Report for 1956
relating to immunisation apply equally to-day. We
have now implemented the suggestions which I set out
in my report for 1956, replacing immunisation against
diphtheria and pertussis (whooping cough) combined
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