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first, the difficulties arising in connection with the procedures advocated, and as
experience accumulated he was led, fifteen or more years ago, to the conclusion that
in the light of existing knowledge, segregation of healthy carriers could not be
systematically applied in a large community; as he said, if it came to segregation
of healthy persons at all, it must be" segregation of the sound"; for the reason
that the numbers of healthy carriers, of one or another germ under suspicion (rightly
or wrongly) of being a potential source of danger, have proved to be so unexpectedly
large. He was, of course (as was Niven also) a firm believer in the aerial convect ion
of smallpox, and one of his earliest pieces of research work, as medical officer of
health, was to organise the collection, in precise detail, of all the facts relating to
cases admitted to the smallpox hospital (as it then was) in North Islington; this
enquiry had a happy ending, however (particularly for one of the investigators, who
lived within the quarter mile circle drawn from that hospital as centre), when
the building was converted to other uses and smallpox hospitals were thus finally
banished from the County of London altogether. Shirley Murphy, later, greatly
strengthened London's defences against smallpox by securing the services of a consultant
for diagnostic purposes, and this officer's experience was gradually made
available also in a number of areas adjoining the County of London.
Dr. Niven's comprehensive and detailed observations on the influences exerted
by the various measures taken to control the several zymotic diseases in Manchester
are full of interest, especially for those concerned with like problems affecting the
London population. Dr. Niven was inclined (p. 29) to look with some favour
on the view that dissemination of scarlet fever may stand in association with prevalence
of fleas; he held that " it would be unwise to relinquish the assistance
which the hospital affords in keeping scarlet fever down, unless for some important
and temporary object " (such as an epidemic of plague, cholera, or an overwhelming
outbreak of smallpox). He queried whether it is possible " to deal with dangerous
forms of scarlet fever as, for practical purposes, conditioned by the adjuvant microorganisms,
to be prevented through them, or cured through them."
Dr. Niven weighed with great care the evidence as to causation of enteric fever,
and wrote that, in 1905, " new facts emerged, or appeared more strongly than
before, to point to shellfish as a decided source of infection " ; moreover, he told
of action taken by the Manchester Markets Committee to " ensure purity in the
mussels." He said " it is to these measures, I don't doubt, that we owe much of the
reduction in enteric fever from 1914 onwards, possibly also in 1911 and 1912." He
was thus convinced that estuarially polluted food was a prominent factor in typhoid
causation, and after much time and thought devoted to the " carrier hypothesis,"
he "-rote, " I cannot believe that " carrier " cases play an important part in the
spread of enteric fever." He concluded his account of work done in preventing
infectious disease with a full consideration of diphtheria, diarrhoea and influenza
and with a detailed history of the Manchester Venereal Diseases scheme and the
Tuberculosis scheme. As regards tuberculosis especially Dr. Niven, it will be remembered,
must be credited with a lion's share of pioneer work, from the time of his
early championship of notification to that of securing the well-known " Manchester
Milk Clauses."
So much has been achieved as regards control of the once far too familiar
zymotic diseases that there is a disposition displayed by those who never knew
them, in their habit as they lived half a century ago, to declare that disinfection of
premises and isolation of sick persons can now be looked upon as having had their
day; some very advanced thinkers, indeed, propose to substitute, for the " oldfashioned
methods." discouragement of such " dangerous practices " as kissing and
shaking hands, and even insist that almost exclusive attention must nowadays be
concentrated upon " well persons," whom they hold to be the source of most of the
troubles arising in connection with infectious disease at the present day. In the