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The idea when writing that was to offer to immunise all children as soon
as they reached the age of 18 months, and not to bother about the Schick test.
Considering, however, the response made at the present day towards
vaccination against small-pox, which is a more loathsome disease, I am afraid
that few parents would take advantage of the offer; the result would be added
danger from a greater number of immune carriers.
In 1859 the Medical Department of the Privy Council undertook a lengthy
enquiry as regards the incidence of diphtheria, as the result of which it
appeared that the disease prevailed for the most part, although not entirely,
in damp and marshy situations and on cold, wet clay soils, and it seems to
me that, in this respect, that part of Edmonton situated between the main
road and the river Lea agrees.
A boring made some years ago in this part went first through 7ft. of made
ground, then 12 ft. of ballast, into 23 ft. of blue clay; various layers of sand
came next and the boring reached chalk at 122 ft. The ground rises on the
other side of the main road and the London clay is covered by a loam soil and
a subsoil of brick-earth and gravel.
Though only 45% of the houses are on the east side of the main road,
about two-thirds of the cases of diphtheria occur in these houses; other factors,
however, contribute, namely: more overcrowding and a greater proportion of
careless and negligent tenants.
Scarlet fever has been with us all the year. I think the disease is
becoming more difficult to diagnose on account of the incidence of mild cases.
A rash not well marked, slight faucial symptoms, a tongue and general symptoms
not characteristic—these add difficulties in the way of diagnosis.
At the beginning of the outbreak of German measles, several cases were
notified as scarlet fever and removed into the Isolation Hospital. I therefore
made a practice of seeing certain notified cases before removal and prevented
several more such cases going into the Hospital. All the cases of German
measles seen by me were characterisiic of the complaint.
"Return" cases of scarlet fever gave no trouble—there were possibly two
such cases during the year.
The Dick test for scarlet fever has not been used, neither has active
immunisation been adopted.
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