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39
more than four cases notified. Contrary to expectations, instead of
the rise in the last quarter there was a further fall, only the 29 cases
being notified in the whole quarter. This extraordinarily low rate
continued into the next year when, in the first quarter there were only
31 cases and 21 in the second. The third quarter's incidence was light,
but there was a marked increase at the end of the year when there were
106 cases in this quarter out of the 217 for the whole year. From that
time the disease became more prevalent, the number of cases being 331
for 1941, 630 in 1942 and 707, the highest incidence ever recorded for
this district, in 1943. Fortunately the distribution of these cases
throughout this year was remarkably uniform so that no difficulty was
experienced in finding hospital accommodation for those seeking it.
The number of notifications fell sharply in 1944 to 387'
The following are the number of notifications of diphtheria from
1938 to 1944:—63, 54, 51, 86, 67, 73 and 57. The corrected figures
are substantially lower, these in some years being only about half the
notification figures. Diphtheria in this locality has for years been of
low incidence. At one time the continued low rate was a cause for
anxiety in that it resulted in a lowering of the herd immunity of the
population, with consequent risk of a substantial explosive outbreak.
Because of the low incidence which this district has enjoyed, it cannot
be claimed that the present low figures are the result of the arrangements
by which large numbers of children have been immunized. On
the other hand, though, the success of the campaign, a success which is
all the more creditable in that its results have been achieved without the
undoubted stimulating effect of the occurrence of cases of diphtheria in
the area, with the production of immunity in so large a proportion of the
population who otherwise would have been susceptible, allays the
anxiety about possible outbreaks.
Cerebro-spinal fever is one of those diseases which are expected to
increase in prevalence during war-time. The very considerable outbreak
which swept through the country though was the peak of a rise
in incidence which had started before the war. In this district there
was a sharp rise to 37 cases in 1940 as compared with the figure 4 in
each of the two previous years. The figures in the following years were
24, 15, 17 and 7.
The distribution of poliomyelitis was irregular, though in no year
was the figure greater than the 6 of 1938 and of 1939. Possibly this
freedom is related to the reduced facilities for children spending their
holidays at the seaside.
Measles and whooping-cough were made notifiable only during the
war years so that there is no pre-war standard for comparison. Measles
behaved entirely contrary to expectations. In ordinary circumstances
this district, as is common to those in and around London, is subjected
to a measles outbreak each even year, the rise which marks the beginning
of the epidemic being apparent in the latter weeks of the odd
year. The 1940 outbreak though failed to put in its appearance to
time. It was not until May that the increase started, to reach epidemic
figures in September, October and November. Fatalities from measles
are mostly due to respiratory complications which are more common in