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number of visits which mothers would have to pay to clinics for the
immunisation of their infants. We also found that general practitioners
were themselves immunising children in increasing numbers,
either against diphtheria alone, against diphtheria and pertussis, or
by the triple method, i.e. against diphtheria, pertussis and tetanus.
Incidentally, the County Council scheme of immunisation does not
permit of the triple method being used. This was the position at
the end of 1956, although even by that time we were beginning to
become aware of certain difficulties.
What has transpired since belongs rightly to a future report. It
may, however, be stated briefly that an investigation carried out by
the Medical Research Council has shown conclusively that immunisation
by the combined method leaves the children so immunised at
greater risk of contracting poliomyelitis than would otherwise be the
case. The risk is admittedly not great, but the fact remains that
immunisation by any combined method which contains the pertussis
antigen raises this issue. By the time this report is written, we will
have changed to the single type of inoculation, i.e. against diphetheria
alone and against pertussis alone. General practitioners
have been advised of the new policy. This will obviously mean
more numerous visits to our clinics and to doctors' surgeries, where
practitioners decide to adopt a similar procedure. There will thus
be added inconvenience so far as mothers are concerned. We will
await the results of our amended programme with interest, if not
with apprehension. Fortunately, it is hoped that the Ministry of
Health will shortly issue a statement which will clarify the situation
and may eventually allow us to resume our previous policy.
Scarlet Fever.
Nineteen cases of scarlet fever were notified during the year, as
against 30 cases in 1955 and 51 in 1954. From the number of
scarlet fever cases notified during the two previous years, i.e. 1953
and 1952 (133 and 188 respectively) it will be seen that scarlet
fever has declined progressively and substantially over the past five
years. This does not mean that scarlet fever is becoming extinct.
The whole character of this disease has altered materially, so
much so that what was once a very serious illness now has seldom
more than nuisance value. For this reason it may well be that
very mild cases—and there must be many such—pass unnoticed.
So long as scarlet fever maintains its present mild character, there is
no reason for alarm. As I have said several times before, however,
we must still assess the situation from time to time, in order to make
quite sure that the virulence which formerly characterised scarlet
fever is not returning.
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