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Public Health

Smallpox in SwindonFOUR of the passengers on the infected ship that

berthed at Glasgow on May 28, reached Swindon onJune 1, and were there kept under observation. OnJune 7, a baby was reported ailing and slightly febrile. Hewas well again on the 8th and 9th ; on the 10th a slighterythema appeared on the inner sides of the thighs withone definite pock on the lower abdomen. The child wasconfined to the house but did not look like smallpox untilthe 12th, when papules were felt on the forehead and onthe extremities, and he was removed to hospital. Allknown contacts were vaccinated and kept under observa-tion. One contact, a child, was unwell on the 22nd,and on the 25th had a rash like a sweat rash on itsthighs. By the 26th this child also had distinctive signsof mild smallpox. Vaccination was noted as a good takeon the 22nd. A third child, a sister of the second, wasremoved to hospital on July 1 because of an erythema ofthe thigh, but nothing further developed. On June 26,the day after the second child was removed, a man cameunder observation who had been ailing since the 22nd,when he had headache and stayed away from work, butwas well enough to visit his doctor on the 24th. Onthe 26th he had a definite papular eruption most markedon the face, neck and forearms, where he had beenexposed to the sun on the 21st. He was removed tohospital where he developed a moderately severe semi-confluent type of smallpox.

Dr. Llywelyn Roberts informs us that these are the onlycases of smallpox seen to date (July 20) in the town, butmuch confusion has been caused by skin eruptionsfollowing vaccination, which in some cases simulated acommencing attack of smallpox

War and the Public Health .

Dr. Neil Reid, county medical officer of Stirling, pub-lished his annual reports for 1938, 1939 and 1940 in onevolume, which makes it easy to follow the history ofpublic health from its record year 1938 through theearly phases of the war era. Though the county hasbut 175,000 inhabitants and is not a just sample of thepopulation of Great Britain, the changes in the healthof the people there are similar to those recorded else-where. Generally health declined from 1938, but we arenot justified in attributing this to war conditions, for1938 was the culmination of a series of years of exception-ally healthy conditions and some decline might havebeen expected in any circumstances. The two severewinters of 1939 and 1940 would of themselves havereduced the record of the previous years, so we musttry to estimate whether the deterioration is greater thanwould have occurred in peace. The birth-rate, whichwas 18-5 in 1938 and 18-6 in 1939, fell to 17-3 in 1940.The two first rates are slightly above the average forrecent years ; the rate for 1940 was a low record for thecounty. Infantile mortality showed a brisk rise-53,62, 74-but the rates for 1936-38 were 74, 69, 53. Theaverage rate for the past decennium was 70, but this wasexceeded in seven years out of ten. The general death-rates for the three years were 10-8, 11-7, 13-0, but as theaverage for the five preceding years was 12-0 it is thelow rate of 1938 which was exceptional. The tuber-culosis mortality-rates were 0-44, 0’S 9, 0-45, the threelowest rates ever recorded in the county. The tables ofnotifiable diseases show three very quiet years withrecorded total numbers of 1086, 864 and 747, the onlyunfavourable features being increases in cerebrospinalfever and pneumonia. The numbers of cases of notifiablepneumonia were 107, 107, 142. The brisk rise in 1940is no more than would be expected from the severewinter of that year. On the whole there is no evidencethat war conditions had any influence at all on thehealth of the community, and this is true for most ofBritain. From tradition we expect war to be associatedwith pestilence, but the history of Britain in the pasthundred years shows no such connexion. None of thegreat epidemics of the century occurred in the greatwars, except that the influenza epidemic of 1918 startedbefore the last great war was over and the two mostrecent epidemics of cerebrospinal fever appeared in thelast war and in this. The great London epidemic of

cholera-the famous Aldgate Pump outbreak of 1854-did occur when the Crimean War was in progress, butit was only an exacerbation of an epidemic which hadbeen raging for ten years or so. The influence of war inincreasing tuberculosis mortality seems to be established,but the break in the downward course of tuberculosischaracteristic of the last war period started before warwas declared and the same is true of the slight riseassociated with the present war.

Infectious Disease in England and WalesWEEK ENDED JULY 18

Notifications.-The following cases of infectious diseasewere notified during the week : smallpox, 1 (port ofLiverpool) ; scarlet fever, 1558 ; whooping-cough,1295 ; diphtheria, 692 ; paratyphoid, 6 ; typhoid, 5 ;measles (excluding rubella), 7050 ; pneumonia (primaryor influenzal), 516 ; puerperal pyrexia, 155 ; cerebro-spinal fever, 83 ; poliomyelitis, 16 ; polio-encephalitis,1; encephalitis lethargica, 2 ; dysentery, 198 ; ophthalmianeonatorum, 106. No case of cholera, plague or typhusfever was notified during the week.

The number of civilian and service sick in the Infectious Hospitalsof the London County Council on July 15 was 1549, includingscarlet fever, 225 ; diphtheria, 157 ; measles, 401 ; whooping-cough, 278 ; enteritis, 57 ; chicken-pox, 83 ; erysipelas, 29;mumps, 57 ; poliomyelitis, 2 ; dysentery, 39 ; cerebrospinal fever,13 ; puerperal sepsis, 13 ; german measles, 8 ; other diseases(non-infectious), 115 ; not yet diagnosed, 72.Deaths.-In 126 great towns there were no deaths from

scarlet fever, 1 (0) from an enteric fever, 7 (1) frommeasles, 13 (3) from whooping-cough, 8 (0) from diph-theria, 37 (3) from diarrhoea and enteritis under twoyears, and 10 (1) from influenza. The figures inparentheses are those for London itself.

Hull reported the fatal case of enteric fever. There were 6deaths from diarrhoea at Birmingham and 4 at Liverpool.The number of stillbirths notified during the weekwas 233 (corresponding to a rate of 38 per thousand totalbirths), including 20 in London.

AppointmentsDOWELL, T. L., MB LPOOL: examining factory surgeon for Bentham,

Yorks.FRANKS, HAROLD, MB, BHY DURH, DPH : temp. deputy MOH and

deputy School MO for Barking.HESELTINE, L. B., MB LEEDS : examining factory surgeon for

Brighouse, Yorks.

Births, Marriages and DeathsBIRTHS

BARRINGTON-WARD.—On July 19, the wife of Sir LancelotBarrington-Ward-a son.

DAINTY.-On July 23, the wife of Dr. Ralph Dainty--a daughter.DAVIES.—On July 22, at Derby, the wife of Captain L. E. C.

Davies, RAMC—a son.DICK.—On July 23, at Oxford, the wife of Captain R. C. S. Dick,

RAMC—a son.GUIRDHAM.—On July 22, at Batheaston, Somerset, the wife of

Dr. Arthur Guirdham-a son.HARRIEs.-On July 9, at Gloucester, the wife of Surgeon Lieut.-

Commander C. V. Harries-a daughter.HEISCH.—On July 15, in Nairobi, Kenya, the wife of Dr. Ronald

Heisch, Colonial Medical Service-a daughter.JENKINS.—On July 20, in London, the wife of Dr. J. R. F. E.

Jenkins, of Peterstow, Ross-on-Wye-a son.SHIRE.—On July 18, at Chichester, Sussex, the wife of Surgeon

Lieutenant T. Hugh Shire, RNVR—a son.THORNTON.—On July 23, at Cheam, the wife of Major H. L.

Thornton, RAMC—a daughter.

MARRIAGESBROWN—BRYANT.—On July 25, at Sidcup, Kent, Kenneth

Lansdowne Brown, MB, to Jean’Bryant, LDS.FFRENCH—GODFREY.—On July 18, at Harrow Weald, Geoffrey

Ernest Ffrench, MB, to Marjory Grace Godfrey.PLAYER—HARTE-LOVELACE.—On July 18, at Canterbury, Henry

Percival Player, azxos, to Dora Lilian Harte-Lovelace.RUSSELL—MORRIS.—On July 20, at Leeds, Patrick Morris Gordon

Russell, FROS, lieutenant RAMC, to Stephanie Denman Morrisof Abergele, N. Wales.

DEATHSBIRKETT.—On July 19, in Montreal, Brigadier-General Herbert

Stanley Birkett, CB, MD, LLD, emeritus dean of the medicalfaculty of McGill University aged 78.

HORWOOD.—On June 21, at Eastbourne, Janet Gertrude Horwood,FRCSI, LROPE.ORR.—On July 19, at Rosslynlee, James Henry Cubitt Orr, MD

EDIN. medical superintendent of the Midlothian and PeeblesAsylum.

SPENCER.—On June 3, at Johannesburg, Transvaal, HenryAlexander Spencer, MRCS, aged 79.

TAYLOR.—On July 22, at Formby, Mark Ronald Taylor, MRCS.