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immunisation, it is sincerely to be hoped that the publicity given
to this matter in the National Press will not affect the level of
immunisation to any appreciable extent. This would indeed be
a tragedy. As I have already pointed out, the number of cases
of poliomyelitis known to have followed immunisation is minute
compared with the number of children protected against diphtheria.
Should the level of immunisation be allowed to fall below the safety
margin, the results might well be catastrophic. We should at all
costs maintain a comnionsense outlook towards this problem, reviewing
the position in the light of existing circumstances, and not
allowing any panic measures to dictate our policy. It will be
appreciated that immunisation against diphtheria is a matter for
the County Council, acting as local health authority. I felt, however,
that the information set out above would be of interest
to the Borough Council, as the Council is intimately concerned
in the incidence of diphtheria within the Borough and the preventive
measures designed to limit spread.
Scarlet Fever.—Scarlet fever notifications during 1950 were
slightly above the average for the past few years. The increase
was almost entirely due to localised outbreaks of scarlet fever
which occurred during the latter part of 1950 among children
attending Hazelwood Lane School and two private schools, one
in Southgate and one in Winchmore Hill.
The type of disease met with throughout the year was exceptionally
mild. This mildness has almost certainly meant that the
total number of cases reported during 1950 is substantially less
than the number which, in fact, occurred. We have again been
faced with the difficult situation which demands that scarlet fever
cases shall be notified, but excludes from notification cases of
simple tonsillitis, no matter how severe the infection may be. It
is known that cases of tonsillitis without a rash can be just as
infectious, in some instances more infectious, than cases in which
a rash occurs. So long, however, as the present practice in regard
to notification continues, we have no alternative but to operate
the existing system of control.
The time would appear to have arrived, if, indeed, it has not
already passed, when the position of scarlet fever among the notifiable
infectious diseases should be reviewed. It is admittedly a
fact that the more severe type of scarlet fever may return at any
time. Should that happen, more stringent methods of supervision
and control would be required. At the moment, however, and
for some time past, notifications of cases of the present type of
scarlet fever appears to be little more than a waste of time from
the point of view of epidemiology. There seems, for instance,
to be slender evidence that the exclusion of cases of scarlet fever
from school has any appreciable effect on the spread of this disease.
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