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and public health officials, which was shown in the lecture hall of the Royal Institute of Public Health,
No. 28, Portland Place. They were asked to co-operate with the Department by keeping a special
watch for cases or suspected cases of the disease, while the Council's medical staff were requested to
exercise a similar vigilance at the clinics and day nurseries, and to arrange for the postponement of
operations on the nose and throat whenever possible as there is evidence that a recent tonsillectomy
increases the risk of a child's contracting poliomyelitis. At the public baths arrangements were
made to restrict admissions to the swimming pool in order to avoid possible overcrowding; to ensure
that chlorination of the water was maintained; and to carry out heat treatment of all bathing apparel
issued at the baths. The National Fire Service were approached to pump out all emergency water
tanks in the Borough and as each tank was emptied the Borough Engineer gave instructions for
refuse to be cleared and for holes to be made in the tank to prevent recurrence of nuisance by the
accumulation of water in future. It was also arranged that the use of paddling pools in Regent's Park
or elsewhere should be discontinued for the time being. In addition to accommodation available at
London County Council infectious hospitals, and in accordance with an arrangement for all teaching
hospitals in London to receive cases in the acute stage of the disease, special wards were set aside
for the purpose at the Middlesex Hospital. The total number of cases among inhabitants of the
Borough during the period 1st July, 1947 to 30th September, 1947, was 10, comprising 3 males and 7
females, the ages of the former being 5, 6 and 20 years, and the latter 12, 19, 20, 21, 21, 21 and 22
years. Five other cases occurred in 1947—2 in January (males 12 and 18 years); 2 in October (female
19 years, male 26 years); and 1 in December (male 20 years). St. Marylebone contacts of cases
occurring outside the district were notified to the Department and kept under surveillance.
Rabies.—Rabies (hydrophobia) in man is rare in this country, and the disease has not been reported
in St. Marylebone for the past 30 years at least. A case which occurred in the Borough presented all
the classical symptoms of rabies. The patient, aged 23 years, was bitten by a dog in the right hand
approximately 3-4 months previously whilst serving in India. He returned to England on the 30th
December, 1946, and on the 16th January, 1947, complained of pain at the site of the original injury.
He continued, however, to go about his business in the ordinary way, but on the 21st January, 1947,
when the case first came to the notice of the Department, he was suddenly taken gravely ill at his home
in the Borough, and was immediately removed to University College Hospital where he died the
same evening. All necessary precautionary measures, including thorough cleansing and disinfection
of the home, were at once taken and a full report of the case was sent to the Ministry of Health, who
advised against antirabic vaccination of the four immediate contacts.
Diphtheria Immunisation.—Clinic facilities were available throughout the year at Maternity and
Child Welfare Centres Nos. 1 and 2, and the Middlesex Hospital Clinic re-opened on the 10th October,
1947. Treatments were also carried out at the day nurseries, and at eight elementary schools where,
apart from new cases, 415 additional protective injections were given. Five general practitioners
who wished to carry out immunisation of their patients in the home or at the surgery were supplied
with the necessary prophylactic free of charge. A.P.T. (Alum Precipitated Toxoid) was the agent
generally employed. T.A.F. (Toxoid-Antitoxin Floccules) was used in a small proportion of cases.

Vaccination.—As from the 1st April, 1947, Mr. George Kelly Cargill Rettie, M.B., B.S., M.R.C.S.,
L.R.C.P., of No. 59, Courtland Gardens, S.W.5, was appointed as occasional deputy to the Public
Vaccinator (Dr. C. J. C. Britton) of the Middlesex Hospital district in place of Mr. Peter Thomas
John Christopher Plumbly Warner, M.R.C.S., M.R.C.P.
Vaccinations carried out in the whole Borough numbered 942 (primary, 722; re-vaccinations,
220). Vaccination was successful in 719 instances; unsuccessful in 166: while 57 cases were not
available for inspection. Of the 1,027 children whose births were registered in 1946, 715 (69.62%)
were successfully vaccinated.
Scabies.—The Council's Cleansing Station in Lisson Grove dealt with 916 cases of scabies: adults
143 (men 61, women 82) ; children 773 (boys 408; girls 365). Domiciliary visits paid in connection
with St. Marylebone cases numbered 114,