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"The first method is attended by little or no risk, the second
very occasionally gives rise to reactions, while the third very often
upsets the patient. Bearing these facts in mind, I would recommend
the injection of serum intramuscularly in mild or moderately severe
cases, reserving the intraperitoneal method for severe cases where a
speedy reaction of the serum is desired, and the intravenous method
for desperate cases.
''The usual dose of serum would be 10 cubic centimetres for
children and 20 cubic centimetres for adults. The cost of the
material would, of course, be more than offset by the shortening of
the period of detention in hospital.
' 'To carry this method into practice two further lines of action
would be necessary. In the first place, it would be essential to have
a careful "follow up" system of seeing patients approximately 14
days after their discharge from hospital. There should be no
difficulty in carrying this out as we virtually do so at present. In
the second place, it would be very desirable to have some method
of removing the patients after they were allowed up, from the ward
to which they were admitted into a convalescent block. This also
could be done, although it would be very much easier had we more
accommodation.
"It should be noted that the three weeks' discharge period only
applies to mild and uncomplicated cases. As the complication rate
is cut down by the serum-treatment method, however, one would
hope that the majority of cases would be able to go at the end of
that time. Again, it should be remembered that this early discharge
has nothing to do with the "Milne" method of treatment formerly
undertaken at the Hospital. It is the administration of serum and
that alone which makes the early discharge possible.
"Bearing all the facts of the case in mind, I think we would be
coming into step with the most modern technique in the treatment
of scarlet fever were we to adopt this procedure. Its exponents can
show magnificent results after several years' trial, and I feel that
we should at least put it into operation for a period of not less than
twelve months.
4. Report of the Investigation on the Delivery of
Bread within the Borough of Southgate, submitted
to the Public Health Committee, July 1934.
Fourteen bakehouses and 20 bakers' shops were visited in the
course of the investigation and 78 roundsmen were interviewed.
Twenty-three general shops where bread is sold were also visited.
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