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No acceptable explanation of the manner in which changes brought
about by war conditions so soon affected the incidence of and death rate
from tuberculosis has been offered. The most interesting attempt to
account for these changes suggests that such stress of the war as overwork,
food shortage and crowding, coupled with prevalence of the
influenza outbreak and the hard winter exerted a selective influence on
those already affected, resulting in an increased number of deaths. This
increase should therefore be followed by a diminished number of deaths,
partly because of the anticipation of time of death of those who succumbed
and also because the death of these removed a number of spreaders of
infection. On the other hand, those same conditions which hastened
the disease of the declared cases would also be responsible for tipping the
scale of the cases of those persons who in better surroundings and under
better conditions might have successfully overcome their infection. This
influence would manifest itself soonest in those who are most susceptible
such as children and would be patent soonest where infection most
readily gives rise to manifestations such as the meninges and the nervous
system. If this is the position, then any lessening in the incidence of
pulmonary infection may prove to be ephemeral as the infection is there
and is merely taking that much longer to show itself. While the local
figures of new infections of pulmonary disease might fit in with this hypothesis,
the non-pulmonary figures do not do so. On the other hand,
considering the country as a whole, it might be assumed that the country
has, during this war, already experienced an initial wave of anticipated
deaths in the already tuberculous and a wave of fresh meningitis infections.
A secondary wave of pulmonary infections can be anticipated both
because of the continuance of the conditions of stress and secondarily
because any increase in the number of pulmonary infections increases
the number of spreaders of infection.
MATERNITY AND CHILD WELFARE.
REGISTRATION AND NOTIFICATION OF BIRTHS.
The total number of live births registered during the year was
3,268 ; 1,655 male and 1,613 female. Of these 134 were illegitimate, being
a percentage of total births of 4.1.
2,317 births occurred in the district (2,288 live and 29 still births).
Of this number 403 (399 live and four still births) were to residents of
other districts. Of the local confinements, 2,204 were notified by midwives
and 113 by doctors or parents.
1,229 (1,189 live and 40 still birth) notifications were transferred from
other districts, being mostly in respect of births occurring to Harrow
mothers in Middlesex County Council or London hospitals.
STILL BIRTHS.
39 male and 42 female still births were registered, being a rate per
1,000 population of — compared with a figure of 0.54 for the country
as a whole.