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EPIDEMIC ENCEPHALITIS.—Odd cases of this disease continue to be notified, but at no time
during 1939-46 has there been any signs of increasing prevalence.
POLIOMYELITIS.—The occurrence of three cases in 1944, followed by seven in 1945, was viewed;
with some concern, but only one case occurred jn 1946. Most patients are admitted to West Middlesex
County or South Middlesex Fever Hospitals, and there are adequate arrangements at both hospitals
for orthopaedic after-care.
TYPHOID AND PARATYPHOID FEVERS.—Sporadic cases of these fevers continue to be
notified, and efforts to trace the source of infection in individual cases seldom produce satisfactory
results. In 1941 there was a small outbreak of paratyphoid fever (30 cases, no deaths). Much time
and toil were expended on trying to trace the source of infection, and though there were strong reasons
for suspecting artificial cream as the vehicle of infection the source was not found. It is certain that
a carrier of paratyphoid bacilli, engaged in the handling of food, was not exercising due care in the
cleansing of hands after using the water closet. The importance of the provision of adequate washing
facilities for staff and the insistence on the use of such facilities by the staff are not realised in all
premises where food is handled.
DYSENTERY.—If the improved bacteriological technique now available for the detection of
dysentery bacilli was used to a greater extent it is certain that more cases of dysentery would be
notified. Dysentery is usually a mild disease, but as it may be fatal in infants a constant watch has
to be maintained for its appearance in nurseries. In 1944 and 1945 outbreaks occurred in day nurseries,
but were eradicated in due course without serious cases or fatalities.

The position in regard to notfications is not so satisfactory and the peak (200) in 1942 has been succeeded
after a three years fall by a rise to 217 in 1946. While this rise may be associated with the visit to
the Borough of the mass radiography unit, a reduction in notifications and in deaths from non-pulmonary
tuberculosis would be a welcome improvement.
OPHTHALMIA NEONATORUM.—This infection of the eyes of young babies is becoming less
prevalent, and with modern forms of treatment permanent damage to vision is now unusual. Cases
occurring in domiciliary midwifery practice receive special attention with a view to securing early and
adequate treatment.
PUERPERAL PYREXIA.—This condition is defined as " any febrile condition occurring in a
woman within twenty-one days after childbirth or miscarriage in which a temperature of 100.4°F. or
more has been sustained during a period of twenty-four hours or has recurred during that period."
Such a febrile condition, no matter what is the cause, is notifiable, and thus if investigation suggests
that the condition is likely to be puerperal fever, appropriate action can be taken. Apart from an
occasional case in domiciliary or nursing home practice most of our notifications come from West
Middlesex County Hospital. During the last eight years seven women have died from puerperal or
post-abortion sepsis.
MEASLES.—This disease was made notifiable in 1940 and has shown, apart from a break in
1944, the usual bi-annual peaks. Though there is no evidence of a reduced incidence the mortality
has fallen considerably as shown below :—
Death Rate from Measles
per 100,000 population
1901-05 (average) 18.9
1906-10 (average) 31.4
1911-15 (average) 31.0
1916-20 (average) 16.6
1921-25 (average) 10.4
1926-30 (average) 6.8
1931-35 (average) 5.9
1936-40 (average) 1.0
1941-45 (average) 0.8
1946 Nil
Adequate medical care and nursing are still essential if the large amount of ill-health in children
following measles is to be prevented or reduced.
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