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The numbers in different years contributing to the total
have come from different parts of the country. In the epidemic
of 1947 the northern region had the highest notification rate
whereas in 1948, although prevalence was much lower, Greater
London contributed rather more heavily in cases. The number
of cases occurring in the area since 1943 is set out below. It can
be seen that up to 1947 the disease was rare. There had, however,
previously been two years of high prevalence. In 1926
and 1938 the annual number of cases in England and Wales was
double the average level for the other years.
Since it is established that the virus is capable of intestinal
spread, flies, railway tracks, etc., have been suggested as
essential links. It has, of course, long been recognised that the
disease has a seasonal incidence with a peak in late summer. In
view of the probability of intestinal spread it may be of some
significance that this is the period of abundance of uncooked
fruit and vegetables.

Whooping- Cough. There were 390 cases of Whooping
Cough during the year and again the mortality from this
disease is nil. On page 57 is a table which shows the trend of
this disease in our area over the past 45 years. Unfortunately we
have not got records of the numbers of cases in the years up to
1930, but it is felt worth while including the-se years as they
show the number of deaths and the age distribution. Subsequent
to 1930 the figures are available from the school returns and
from 1940 onwards the numbers are of notified Whooping
Cough, as the disease became notifiable in October, 1939. These
figures would appear to show that while there is a very great
increase in incidence since 1938 there has been a correspondingly
great decrease in the mortality. Out of 1,869 cases over
the past seven years there has been only one death. The same
thing has happened with measles as a glance at the table on
page 58 will show. This phenomenon may be due to a reduction
in virulence of the disease, but it is an established fact that
malnutrition was a most potent contributory factor to the
mortality from infectious disease among children and there has
been a noteworthy improvement in this factor over the whole
country; the suburban children have, perhaps, a better
nutritional standard than either the rural areas or the big
cities.
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