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not caused the death of a single child living in this district since 1945,
and since 1946 not more than eight children living here have suffered
from an attack. Memories are short, and this freedom of the district
from infection carries its own risk. Even without active immunisation, or
without their having succumbed to an attack, most adults used to become
relatively immune from attack. This state of immunity was reached
by the individual being exposed to and overcoming doses which were not
sufficiently large to overcome the body defences. The presence of
organisms in the district, then, helped to build up the resistance and
accounted for those in towns being more resistant than those brought up
in rural surroundings. In default of having the stimulus of such sub-infective
doses, an individual unless protected by other means does not acquire
an immunity. Again, whatever protection the population as a whole
might have against wide spread of infection if a substantial proportion have
been immunised, the individual child who is unprotected is still subject to
the risk of infection, a risk which is the greater in such a district as this with
its proximity to the London population. Although it is not maintained
that the freedom of the district from diphtheria is entirely due to the
immunisation of any of the child population, it is felt that any individual
child can be made safe from the risk of attack only by that child himself
being adequately inoculated.
The Local Authority can make available satisfactory arrangements
for children to be immunised. Only the parents of a child can see that
that child is given the benefit of those arrangements.
It is probable that the occasional case of a disease is often missed.
Before poliomyelitis became as common in this country as it has been
since 1947, it is quite possible that the non-paralytic infections were missed
except those which occurred in the few weeks of the year when the disease
was more common. In the same way, there must be a growing risk that
any cases of diphtheria which do occur might not be recognised as such
until a comparatively late stage of development of the disease, so that
freedom from infection of the general population of the district might
add materially to the risks of the few who are attacked. This makes it all
the more urgent that the numbers of these should be reduced to the
minimum.
During the year 2,224 children were treated for the first time, 1,273
by general medical practitioners, 936 at infant welfare centres, and 15
at Day Nurseries. It is estimated that at the end of the year, 47.1 per
cent. of children under 5 years of age were protected, and 77.9 of children
aged 5 to 15 years. The figure relating to the under-fives is rather less,
and that relating to the 5-15 age-group rather more than the corresponding
figures of last year, the fall being because fewer under-five
children were immunised last year than were five years ago.
SCARLET FEVER
Scarlet fever is a disease which varies much in incidence. It is one
of the infections which was considered to have a short cycle of incidence
of four to six years superadded on longer cycles of 15 to 30 years. In
such a district as this which developed so rapidly in the years before the