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a comparatively rare disease in this country, has tended to occur
in widespread epidemics over the past few years.
A great deal has been written around this change in the infectious
diseases picture, but the fact still remains that a full explanation
is not yet available. It is, however, very patent that our
previous approach to the control of infectious diseases must be
overhauled. Basically, we are still dependent on the isolation
and adequate treatment of cases, the supervision of contacts,
education of the public, immunisation, vaccination and disinfection.
To these weapons must be added a more widespread search into
the factors which affect the spread of infectious diseases throughout
the community. As 1 mentioned in the foreword to this
Report, we must also remember that epidemiology should never
be confined to a study of infectious diseases. It is just as
important, indeed in many ways more important, to uncover the
reasons for ill-health as a whole, than to attempt to explain the
appearance of specific types of disease. The varying grades of
severity which characterise different types of infection and also
diseases produced by the same infecting agent, alike await
investigation.
Control of the spread of scarlet fever is less significant today
than is a study of the psycho-somatic group of diseases, of which
the gastric and duodenal ulcer is a striking example. To carry
the comparison one stage further, the diagnosis and treatment of
cardiac conditions following scarlet fever, although still requiring
our continued attention, have less significance than the problem as
to why so many individuals die in early middle age from coronary
thrombosis. The vast field of virus infections also remains to be
explored. Today our approach to epidemiology has been virtually
revolutionised. We must recognise the expanding horizon which
opens out before us and appreciate that a fruitful field is available
to the worker in public health who is in daily contact with the
local population.
Diphtheria.—For the second year in succession, no case of
diphtheria was notified in the Borough. It will scarcely be necessary
for me to stress the fact that this happy state of affairs is due very
largely to the level of immunisation maintained among our
children. Our scheme of immunisation, which is now a County
Council Service, remains substantially as set out in my Annual
Report for 1948. I think it would be reasonable to assume that
the success of this scheme is reflected in the absence of diphtheria
from the Borough for a period approaching two-and-a-half years.
Scarlet Fever.—Scarlet fever notifications during the year fell
from 104 to 70. The type of disease continued mild, admission
to hospital being necessary in only 17 cases. Scarlet fever was
most prevalent during January, May and June, when 10, 15 and
13 cases were notified respectively. No particular portion of the
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