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Death rates per mille for 1940 and 1946 were 56.9 and 14.2 respectively.
This very marked fall in the post-war death rate after forty-four months on a very low dietary for most of the com- munity and in the face of high prices of necessities of life and strict rationing, provides food for conjecture.
One theory that has been advanced suggests that the weaker went to the wall under rigorous siege conditions. It is, however, an undoubted fact that a third of the bodies examined at autopsy soon after the liberation showed evidence of death from food deficiency of one sort or another. Another theory suggests that the rationing of rice and its partial replacement by flour has resulted in a better balanced diet and a greatly lessened incidence of beri-beri and other nutritional diseases. This hypothesis is unproven.
C. INFANT MORTALITY.
Although the deaths of infants under one year of age formed a fifth of deaths for all ages, the number of infant deaths per thousand live births was only 109. This figure compares with 327 for 1940 and 617 in 1931. This figure is the lowest to be found in any of the records saved from des- truction going back to the earliest days of the existence of the department.
D. CAUSES OF DEATH.
(i) Acute Infectious Diseases.
(a) Smallpox.
The first case of smallpox occurred at the end of January. The outbreak did not appear to be serious and smouldered on until August when it became apparent that many foci of infection existed. The peak was reached in November and the epidemic showed definite signs of declining by the end of 1946.
1,306 of the total of 1,998 cases were fatal, giving a mortality rate of 65.3 per hundred cases.
Low vaccinal state, concealment of cases, importation of florid cases from Canton, Shanghai and other outports and the dumping of dead, thus preventing disinfection of premises and vaccination of contacts, all tended to the dissemination of the disease.
Counter measures included the vaccination of 1,525,105 persons with the assistance of volunteers from St. John Ambu- lance Brigade; intensive house-to-house searches by the Health Inspectorate for cases; the isolation of 938 cases with 254 deaths; vaccination of contacts; examination and vaccination, where necessary, of all arrivals and departures by sea, air and land; disinfection of premises and effects; cremation of bodies. illegally dumped in streets to avoid disinfection of premises, etc.; and, lastly public health propaganda through mobile