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It is easy to bring the facilities for mass radiography to the notice of the employees of large
firms, but it is difficult to make them known to the employees of the very numerous small firms.
Moreover, when there are only a few employees, they may fear that a request by an individual
employee for time off to attend for X-ray examination may excite suspicion in the mind of the employer
that such individual has reason to fear that he or she has, at best, a weak chest, and if a second visit
for a full size X-ray is necessary, suspicion, may be deepened.
An effort was made on this occasion with limited success, to bring in the small firms. A total of
812 persons (458 men and 354 women) from 126 such firms were examined.
The staff of the X-ray Unit kindly undertook to examine after office hours a limited number of
persons who were specially anxious that their employers should not know of their visit. Special
arrangements were thus made for 91 persons (44 men and 47 women).
Infectious Diseases.
Poliomyelitis, As you are aware there occurred during the year 1947 the most serious and
widespread epidemic of Poliomyelitis this country has ever experienced. The popular name "Infantile
Paralysis" must be dropped because it gives the public quite an erroneous idea as to the age incidence,
the symptoms and the results of the disease, which is not confined to infants or even children. Paralysis
is not invariably a symptom and permanent paralysis is not an inevitable result, indeed some 50 por
cent. of cases make a complete recovery without any residual paralysis at all.
Though there were cases in every Metropolitan Borough the City residents escaped. I was
notified of 11 persons who worked in the City but resided elsewhere, who developed the disease, and of
15 persons employed in the City who were contacts with cases in their homes.
The recommendations of the Ministry of Health in regard to adult contacts were followed. Such
contacts were instructed that they should remain at work unless they had any departure from their
normal health, in which case they should stay at home until their doctor gave them a certificate that
there was no question of them developing Poliomyelitis.
In a few cases contacts were employed in canteens. These were personally interviewed, and the
need for scrupulous cleanliness in the handling of food was impressed upon them.
In no instance did a second case develop in a business house, either from an original case or a
contact. There may well have been an element of luck in this entirely satisfactory result of the
recommendations. The epidemiology of poliomyelitis presents most interesting problems, but in the
face of an extensive and widespread epidemic occurring at a time when economic survival depends
on maximum production, it is essential to reduce absenteeism to a minimum.
Where schoolchildren were concerned, the exclusion of contacts for three weeks was justified,
but this question did not arise in the City.
The only swimming bath is at St. Bride's Institute. In this the water is chlorinated and chlorination
was stepped up. There was a good deal of public anxiety about swimming baths and the
attendance at St. Bride's fell very considerably, so no question of overcrowding arose, despite the hot
weather, and the bath was not closed. It was suggested that swiming galas should be discouraged,
though the layout of the baths is such that there is not room for many spectators.
There are no cinemas in the City and no question of attendance at school camps or organised
holiday homes arose.
Scarlet Fever. Generally speaking any attempt to control the spread of Scarlet Fever by
swabbing throats and isolating carriers would be useless, but the following instance in which this was
successfully done may be of interest.
In July, 1947, it was reported that three boys from St. Paul's Choir School had been removed
to hospital suffering from scarlet fever.
One previous case had occurred on April 14th and one on May 18th, both of which were discharged
from hospital on May 31st.
In view of the fact that the school is a small residential one, only 34 boys, and that it is a very
self-contained community in term-time, with comparatively few outside contacts, it seemed probable
that the recrudescence of scarlet fever was due either to missed cases or carriers. The school was visited
and all the boys examined, but no missed cases were detected. Arrangements were made for all the
boys to have their temperatures taken morning and evening, and for any who had a rise of temperature
to be isolated in the sick bay. The dormitory arrangements were good, the room light and well
ventilated, the beds well spaced and tall lockers between each two beds at the head end. Professor
Garrod, the bacteriologist of St. Bartholomew's Hospital, was asked whether in such a small, closed
community, he would be prepared to endeavour to find a carrier by bacteriological examination of
swabs from the noses and throats of the boys. This Professor Garrod readily consented to do, and on
July 15th every boy was swabbed. Meanwhile two further cases of scarlet fever had occurred in
the school and had been promptly removed to hospital. As the result of the swabbing three boys
(C. and two brothers A. L. and I). L.), were found to be harbouring hæmolytic streptococci (Group A);
C. and D. L. in the throat only and A. L. in the nose and throat. These boys were promptly isolated
and an endeavour was made to clear the condition with pencillin and sulphathiazole snuff.
On July 15th the Medical Superintendent of the Grove Hospital was asked if he would be good
enough to inform me of the type of streptococcus responsible for the disease in any of the boys from
the Choir school in his hospital. He replied that he did not usually type the hæmolytic streptococci
for their cases of scarlet fever, but under the special circumstances he would comply with my request.
Ultimately the Medical Superintendent reported the strain of streptococcus was Type 3.
The streptococci from the three suspects were also typed at the Central Public Health Laboratory,
Colindale. C. was found to harbour Type 18 and was exonerated from suspicion and released from
isolation. A. L. was found to harbour Type 3 in both nose and throat and so was most probably the