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134
are notified purely on bacteriological evidence or on slender clinical grounds unduly
swell the notification figures. Whatever the explanation, however, the need for
combating diphtheria is one of the paramount problems with which the public health
administration of London is faced. The London County Council is endeavouring
through its school medical service to deal with the question of diphtheria carriers,
undoubtedly a potent factor in the spread of the disease, by arranging with certain
general hospitals to treat such cases intensively in special clinics, for there is no
doubt, on all the evidence available, that the persistence of the carrier state is maintained
by pathological conditions of the throat or nose which require special attention
by operative interference or otherwise. Another more important line ot attack,
and one which holds out more promise than any other method of prevention, is
active immunisation. Already this measure is being carried out in certain London
boroughs on a limited scale, but until the general body of the public is properly
informed as to the advantages of these means for protecting its children from attack
and until, as a result of widely directed propaganda, the public claims the right of
having its children so protected, it cannot be expected that any material effect will
be observed on the incidence of diphtheria. This subject is dealt with more fully
on page 135.
There was a rise in the prevalence of scarlet fever in 1927, but this disease
continues to be mild in type, and it has been decided by the Metropolitan Asylums
Board, after conference with the Ministry of Health, the Society of Medical Officers
of Health (Metropolitan branch) and the Council, that in the matter of hospital
accommodation, preference will be given to measles when the supply of beds in fever
hospitals is uneaual to the demands.

Sohoolinspec
tions in
connection
with
infectious
illness.
1927.
Strict supervision of children attending the Council's schools is exercised and
the visits of assistant medical officers and/or school nurses are paid to schools where
cases of infectious illness have occurred among the pupils with a view to ensuring,
as far as possible, that all sources of infection are eliminated in order that healthy
children may continue to attend school without risk of infection due to school
attendance.