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being recommended to be given in two small doses. Very favourable
results are recorded, but it will be of interest to learn the degree of
its success in districts with a low herd immunity, and also the
duration of the immunity produced.
In this district there appear to have been comparatively few
instances of failure to complete the first course. Doubtless many
parents who would have their children done if there were an efficient
one-shot preparation are deterred from ever beginning the treatment
in anticipation of the number of attendances. It is questionable,
however, to what extent the response would be more satisfactory
if there were to be only two instead of three injections.
The arrangements for immunization have been in force since
January, 1935. The early results were quite successful, many
parents having their children immunized. Further publicity in the
autumn of 1935, however, did not prove very fruitful of results,
and in 1936 only 315 children completed the course of injections.
It is felt that perhaps better results would be obtained by concentrating
on selected age-groups rather than carrying on a more
diffuse propaganda directed to children of all ages. As the
immunity of the infant passes off at about one year of age and the
toddler is then reaching the stage in which he is more likely to be
exposed to risk, the age-group chosen was nine to twelve months.
A letter is sent to the parents of all children of this age pointing out
the advisability of the child being immunized more particularly at
this age. The medical practitioners were also circularised inviting
their co-operation in the arrangements, and the health visitors were
asked to discuss the subject with the mothers.
Provision of Anti-toxin.
Diphtheria anti-toxin is available free of charge for medical
practitioners for the treatment of necessitous patients. Twenty-five
lots were issued during the year, totalling 336,000 units.
Incidence. SCARLET FEVER.
415 cases of scarlet fever were notified during the year, this
being an incidence of 2.31 per 1,000 population compared with
the figure of 2.56 for the country as a whole.
The incidence of infection was fairly even in the first nine
months of the year, but became rather heavier in the last quarter.
Place of Treatment.
The accommodation at the hospital for the ordinary cases
proved sufficient throughout the year. 110 cases were treated at
home at the election of the parents and 16 were admitted to other
isolation hospitals. Of these, four were cases of double infection
or contacts of some other infection and therefore required to be
nursed other than in a general ward. Most of the remainder were
in-patients at London hospitals. Six patients were first nursed at