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deals with conditions closely related to the health or the sickness of the
community the trend is the growth of a social welfare rather than a
health, and certainly rather than a preventive health, service.
The vital statistics for the year were very satisfactory, and as these
are the only standards we have for assessing the health of a community
we can assume that the health of the district was good. The infant
mortality rate, accepted as an index not merely of the welfare services
but of the general hygienic and social conditions of the community,
was low, as was also the maternal mortality rate. There were no widespread
epidemics and even those diseases which did prevail caused
few fatalities. In general the sanitation of the country is now on such
a firm foundation that spectacular outbreaks of those diseases which
are the result of insanitation are largely a thing of the past. Typhoid
fever in Aberystwyth, in Croydon and in Bournemouth though shows
that the freedom from such diseases can be earned only as the result
of unremitting attention, and above all by the education of all sections
of the community about hygiene and its standards. Any district though
can without notice be subjected to a large scale outbreak of infections of
different sorts, so freedom from infection or years of satisfactory vital
statistics can give no assurance that trouble might not be met, nor give
any grounds for complacency or for relaxation of effort on the part of
those who deal with the health services. An outbreak of an infection
such as typhoid fever will strain to the limit the capabilities and the
time of the available staff. The real solid work is done though not when
an outbreak occurs but in the routine, unspectacular day-to-day
inspections and visits to premises to discover and remedy unsatisfactory
conditions, and to educating those dealing with foodstuffs. Shortages
of staff which prevent this work being done are not made obvious at
the time, and become so only when the lowered standard has allowed
practices which are fraught with danger. Many of the diseases which
occur in epidemic form, however, are not related to hygienic conditions,
though these might have a secondary effect on the severity of the illness
in the patients. Even overcrowding seems to affect the incidence only
to a slight degree and it has to be very marked to produce such an effect
on the occupants that their standard of health is so lowered that this is
reflected in the severity of an attack. To-day scarlet fever is a disease
bearing little relation to that which was so feared in the last century.
Last year it was not very prevalent, nor has it been for some years, but
this is not the result of anything which has been done to protect the
community from acquiring it, nor is it the result of any improvement
in the hygienic surroundings of the population. It has been a very
mild type. Again this is not the result of anything that man has done,
unless those are right who hold that hospitalisation of the more severe
cases resulted in a general decline in its severity. For an explanation of
such occurrences we must turn then not to the human or to the host
or the soil, but to the seed or the organism, and presumably what has
happened in the case of scarlet fever is a change in the organism. If so
it can be assumed that it is capable of reverting again to a virulent strain.
Changes of this sort in the organism which cause diphtheria were thought
to have taken place some years ago when certain localities were infected