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Religious, social and political organisations continue to apply to the department for health lectures,
and all their requests have been answered. Despite shortages of staff, 42 talks were given to 33 organisations
on 21 different subjects. 1,420 people attended the lectures, with attendances ranging from 14 to 150.
Health workers themselves need post-graduate education. Health education films were shown
and lectures given, often by outside lecturers, to separate meetings of doctors, sanitary inspectors, health
visitors, and day nursery matrons and their deputies. These meetings are held regularly, and the interesting
discussions that follow many of them have been most valuable and keep the staff abreast with recent advances
in technique in their special subjects.
One can again look back on the year's work with satisfaction that health education has again
achieved a usef-ul advance in promoting preventive medicine. Grateful thanks are due to the lecturers whose
efforts and enthusiasm have largely contributed to this result.
PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES
The reduction in the incidence and mortality of infectious diseases such as diphtheria, scarlet fever,
measles, whooping cough and typhoid fever in the past 50 years is as much a reflection of the improvement
in living standards as in better methods of treatment. Better housing and better nutrition, improved ventilation
and smaller families have helped to increase resistance and reduce the possibilities of spread of
infection. Health visitors have played an invaluable rôle in health education and in improving hygiene.

Diphtheria
In the past four years there has been only one confirmed case of diphtheria annually. Because of
the almost complete disappearance of this disease in the area, parents are becoming complacent. Outbreaks
of diptheria in other districts have shown that it is dangerous for parents to adopt this attitude, and they are
taking a considerable risk if their children remain unimmunised.
Measles
2,392 cases were notified in 1953 (2,383 confirmed).
At the end of 1952 the largest outbreak of measles for many years commenced in Willesden, and
continued until the end of April, 1953.
There was one death from measles in a child of 5 years.
Whooping Cough
Whooping Cough vaccination was started in Willesden in 1947 as a venture, with no controls for
comparison. It was hoped that if whooping cough vaccination was effective, there would in time be a marked
reduction in its incidence and mortality similar to what was experienced with diphtheria immunisation. It
is far too early to judge the effectiveness of whooping cough vaccination owing to the relatively small
number of children who have been protected up to date. In 1949 it appeared to have had an appreciable
effect on the incidence, but the figures of the following years unfortunately dispelled this pleasant illusion.
There has been no significant reduction in whooping cough in Willesden in the last few years, but the case
rate in Willesden, which was above that of England and Wales in 1947, has been consistently below it
since that date (see table).
There are many difficulties involved in interpreting the results.
Firstly, whooping cough notifications, like Khose of measles, never reflect accurately the actual
number of cases. Indeed, it has been estimated that they reach only 50 per cent, of the total. Since 1948,
every child is provided with a doctor free, and it is likely that a higher proportion of cases of whooping
cough has been notified than hitherto.
Secondly, chloramphenicol undoubtedly has a beneficial effect if given in the early stages, and this
would probably have had some effect in the last few years in reducing the mortality, and by destroying the
organisms in the early stages limit the extent of their spread.
Finally, as whooping cough usually attacks children earlier than other infectious diseases, often
before they are six months old, protection must be given very early if any useful result is to be expected.