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6
Much of the report still deals with the communicable diseases,
although these are now responsible for so very much less real illness and
for fewer fatalities than even a few years ago. They cannot be ignored
though, and it is inadvisable to begin to think of them as of no consequence.
Scarlet fever is a disease which to-day is perhaps being treated too lightly;
although to-day a complaint which is innocuous, there is always the
possibility of the streptococcus which causes it reverting to a toxic strain.
The position in regard to tuberculosis has steadily improved, but it is
far from being completely controlled. The setback during the war years
is a reminder of this. Then there is always the possibility of the appearance
of what are in effect new diseases, or of major changes in already
established diseases such as the invasiveness of acute poliomyelitis which
occurred in 1947 and which completely altered the pattern of incidence
of the disease in subsequent years. Even such a childish complaint as
german measles, which had been looked on as a nuisance but little more,
has been shown to be so damaging a complaint when occurring in the
expectant mother. For such reasons as these, an appreciation of the
communicable diseases must always be an important part of any consideration
of the health services of a district. For the improvement in
the position in regard to some of these infections, local authorities can
claim some credit. Although part of the improvement in the position in
regard to tuberculosis might be due to the fact that we are on the decline
of a long-term wave of incidence, what local authorities have done to
improve environmental conditions and especially housing, has undoubtedly
made its contribution. Part of the post-war improvement is due to
chemotherapy, but the position was improving even before the war when
we had not the advantage of these preparations. For the decline of some,
local authorities can claim credit as a result of a more direct attack. The
outstanding instance of course is diphtheria. The exact effect of vaccination
against smallpox in removing this scourge in the last century is
still debated, but between improved hygiene and vaccination smallpox has
been controlled. The parents in this district have responded very well to
the invitation to have their 13-year-old children given B.C.G. vaccination
against tuberculosis. For the high acceptance rate and the smooth
running of the actual arrangements, credit is due to the head teachers of
the schools who were most helpful in this as in all the other activities of
the school health staff. This country was slow to embark on national
arrangements for the immunising of any general body of the public, and
it was only after the results of extensive trials were known that general
approval was given. It has yet to be decided which is the best age to
treat children. Those in favour of a younger age point to the occurrence
of cases amongst those who have not reached 13. Against lowering the
age is the uncertainty as yet of the duration of its protective powers. The
aim is to offer this protection to those who are about to be exposed tor
the first time to special risks on going out to work. Whooping cough is
no longer the serious complaint of childhood it was only a short time
ago. How much the active immunising of children is responsible tor
this happy position is not known, but undoubtedly it has played its par
Another disease in which it is hoped active immunisation will do muc
to control is acute poliomyelitis. Had it not been for the altered pattern