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has failed to identify specific aetiological factors. Both the still birth rate and the perinatal mortality
rate show a significant and welcome improvement. There has been a substantial increase in the
proportion of deaths occurring in the period from the 8th day to the end of the third month of life.
Some 40% of all the deaths in the first year occurred during this period. If it is difficult to identify
casual factors, solutions are easier to suggest. Significant improvements in the infant mortality
rate have occurred during the present century in association with improvements in the child health
services, and in the education of mothers in the health care of their children. It is essential therefore
that the developments in these areas which have been commenced during 1971 should be
maintained and improved.
Infectious Disease
The increase in the number of notified cases of tuberculosis is discussed in more detail in
the appropriate section of the report. These figures are a timely reminder that whilst the trend
towards the ultimate eradication of the disease in this country continues, renewed vigilance is
necessary and control measures of proven value must be rigorously pursued. Difficulties sometimes
arise in persuading patients to accept the need for continued treatment, and it was necessary to
seek an order under the Public Health Act 1936 to ensure the compulsory detention of one patient
in a local hospital because of the potential risk of infection to other members of the community.
The exercise of these statutory powers is never welcome but the authority is sometimes presented
with no other alternative. It is pleasing to record the decision of the Council during the year that
all new employees whose work involves frequent contact with children will now be required to
present evidence of a satisfactory chest X-ray examination every three years.
The Department of Health and Social Security have requested comment to be made on the
progress of schemes for contact tracing in the control of venereal disease. Following a meeting
at the Department in July discussions were held with the consultant venereologist for the area.
It was felt that the situation in Hillingdon showed important differences from the pattern in inner
London and that the introduction of the contact tracing scheme would not be helpful. Arrangements
were completed for more effective communications between the local clinic and the health visiting
service. The number of cases of venereal disease continues to show an accelerating upward trend.
The number of cases of smallpox reported to the World Health Organisation (52,098) showed
a large increase compared with the previous year but over half the cases were reported from
Ethiopia where a major eradication programme was introduced. In the rest of the world there was
a further decline in the total number of cases reported and the number of countries reporting the
disease was again reduced. These trends, to which reference was made in my previous report,
led to a decision to discontinue the present programme of infant vaccination in this country and
to concentrate upon a high level of protection amongst priority groups. Efforts were made to
ensure that airport workers likely to come into contact with passengers from endemic areas were
aware of the importance of protection and the facilities for its provision. Infant vaccination is no
longer offered as a routine procedure but any child who, for particular reasons is thought to require
vaccination may receive it providing no absolute medical contraindications exist.
Co-ordination and Co-operation
Although health centre development was not as rapid as had been hoped, arrangements
were completed by the end of the year for 16 of the 91 family doctors who have surgery premises
in Hillingdon to practise from accommodation provided by the Local Health Authority. The
circulation of a weekly bulletin to family doctors ensures an interchange of information and
discussions take place at an early stage when individual doctors are considering a new project
even if this concerns matters such as the erection of surgery premises over which the department
has no administrative control. Co-operation with the hospital services continues to improve and
has been given fresh impetus by developments in the nursing services. Changes in nurse training
have made it essential that community and hospital nursing services co-operate closely with one
another and these developments have accelerated the trend to close integration of the nursing
and midwifery services. It is usual for the community nurse to visit the hospital before the patient
is discharged where further nursing in the community will be required. The introduction of the
nursing management structure in the local authority service in November has facilitated this
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