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40
inclement weather. The delay in onset then was of real advantage to
the sufferers. Except for the rise in the latter weeks of the odd years
which is the prelude to the epidemic of the even year, the disease is
practically absent after an epidemic with very few cases in the odd years.
Again what occurred was not the expected. The epidemic years of 1940
and 1942 with figures of 2,285 and 2,509 were separated by a figure of
1,275 in 1941 and followed by 1,516 in 1943 but in the even year of 1944
only 562 cases were notified. This strange behaviour of a disease which
for the time at least had exhibited stability has been accounted for
in many ways, most of the explanations offered being related to war
conditions and more particularly to distribution of population, especially
by evacuation. Against these explanations though are the facts that
in such a district as this where extensive fluctuations of population did
not occur, the course of incidence was disturbed, while places far removed
from this country which were not subjected to war changes experienced
the same occurrence. It may be that the disease is passing through
a phase in which the cycle of incidence is about to alter.
Only 299 notifications of whooping cough were received in 1940,
the first full notification year. In 1941 though the district was heavily
attacked by 1,259 cases. Relatively low figures of 468 and 393 in the
next two years were followed by a rise to 701 in 1944.
Notifications of the pneumonias relate to diseases of quite different
aetiology, the notifiable conditions being acute primary pneumonia and
acute influenzal pneumonia. Any increases then might be associated
with an epidemic of influenza or of a spell of inclement weather. It is
not felt though that notifications are correct, in that many cases which
should be notified are not, whereas notifications are received of some
conditions not strictly notifiable. The actual number of notifications
received each year from 1938 were 98, 117, 112, 143, 117, 236 and 124.
Of the behaviour of those notifiable diseases spread by droplet
infection then the most striking occurrences have been (a) the almost
complete disappearance of scarlet fever following the outbreak of the
war, the low incidence during the time the health of the district must
have been most subjected to baneful influences, and its later rise to a
peak never before experienced; (b) the erratic behaviour of measles
with its delayed appearance in the first of what should have been its
epidemic war years, the failure to disappear in inter-epidemic years
and its failure to appear as an epidemic in 1944; and (c) the rise which
occurred in the incidence of cerebro-spinal fever taking place at the
same time as the increased prevalence throughout the country but which
had been only a continuation of an increase which started before the
war.
A different group amongst the notifiable infections are the alimentary
complaints which are mostly contracted by the ingestion of
infected foodstuffs. This district, in common with the rest of the
country, suffered from an increase in the incidence of paratyphoid infections
in 1941, but in later years had very few cases. The lowering
of hygienic standards of food production, more especially in some new
preparations replacing those withdrawn during the war, together with
the introduction of labour not educated to the desirable hygienic standards