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In this connection, it must also be remembered that actual
disease invariably follows a period during which the physiological
functions of the body are disordered. This period of prodromal
disorder, which may be long or short, mild or severe, represents
the time when action should be taken, if indeed such action should
not have been considered before. Factors which influence the
beginnings of ill-health, and over which we do have control, include
housing, supervision of working conditions and, perhaps even more
important, supervision of conditions under which our children are
housed in local schools. All this is epidemiology, as that term is
now understood. If we remember this fact and act upon it, we
may one day be able to apply the brake when and where it is
most required. At the moment, as 1 have already stated, it is not
easy to pick out local conditions which call for immediate, urgent
improvement. We can. however, adopt a policy of education
which will indicate such dangers as exist, and suggest the appropriate
remedies. This we have always endeavoured to do through
our local policy of health education.
Diphtheria.-For the third year in succession no case of
diphtheria was notified in the Borough. The last case of diphtheria
reported in Southgate was notified on 24th February, 1947, while
the last death took place in 1943.
It will be obvious that this very satisfactory situation is due
in great part to immunisation. Remembering this, it has been
somewhat perturbing to find that requests for immunisation have
been affected by the fact that incidents have been reported in which
immunisation has been followed by poliomyelitis, particularly
affecting muscles in the area of injection. In this connection it
must be clearly understood that such cases have been very few
indeed compared with the very large number of injections given
in the course of immunisation throughout the country. It should
also be stated that, so far as we are aware, and I am quite sure
that our information is correct, no case of poliomyelitis following
immunisation has occurred in Southgate.
Types of immunising material are now available which lessen
the risk of such untoward happenings. Our present policy is to
keep a close watch on the virus potential known or suspected to
be present in and around the Borough. If there is any reason
to believe that this is increasing, steps are taken to limit the types
of immunisation offered to parents. Thus, the combined immunisation
against diphtheria and pertussis, which would appear from
available evidence to be most often followed by poliomyelitis, ;s
suspended, although it has never been found necessary to suspend
immunisation against diphtheria alone. The position is made quite
clear to parents, the final decision being left to them.
Although it was very right that the attention of all concerned
should have been drawn to the possibility of poliomyelitis following
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