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61
been immunised, it is quite certain that a high immunisation rate is an
important factor in controlling any spread ; and of course immunisation
is the only active measure which can be practised to prevent infection
whether of the individual or of the community. The very success of the
campaign helping to bring the virtual elimination of the disease sows
the seeds of failure to continue to establish an immunised population
because in the absence of the disease there is less incentive for those who
have not known it to have their children treated. That the disease is
one which cannot be ignored is emphasised by such outbreaks as that
which occurred in 1952 in one part of the country where an infection by
the gravis type of organism gave a population of something less than
that of this district 13% of the corrected notifications in that year of the
whole country. Then, too, in the country as a whole in 1952 the case
fatality rate of the disease of those who had not been immunised was
9.9%. This figure is a marked contrast to the 11 case fatality rate
amongst those who had been immunised. But the effect of immunisation
is much greater than is indicated by the contrast between these two figures
as the figure of 1.1 is the fatality rate amongst those who succumbed to
the infection, whereas the rate of infection is very much smaller amongst
the immunised than amongst those who had not been treated. The
probability is that those who had been immunised but who had suffered
from an attack had been treated in infancy and had not received further
boosting doses. The position is that while in some immunisation in
infancy remains effective, there is no assurance with any individual it
does so. That is why it is so necessary that whatever is done in infancy
should be looked upon only as the first stage of a course of treatment and
that further boosting doses are necessary, more especially at the time the
child is starting to mix with his fellows.
During the year, 2,225 children were treated for the first time, 1,177
by general medical practitioners, 1,046 at infant welfare centres and two
at day nurseries. The number of births notified during the year was
2,721. It is estimated that at the end of the year 62% of children under
five years of age were protected and 85 per cent of children aged 5 to 15
years.
SCARLET FEVER
215 cases were notified in the district in 1953. In three the diagnosis
was changed. The corrected figure of 212 was an incidence rate of 1.0 per
thousand population, a figure to be compared with 1.39 for the country
as a whole.
The distribution was a weekly average of 6.5 for the first quarter,
4.5 for the second, 10 for the third and 4.5 for the last. Only 16 cases
were notified in the third quarter ; there were no cases at all in each of
three weeks and only one in each of five weeks.
55 patients were removed to isolation hospitals, mostly to the Hendon
Isolation Hospital, but seven to others. The numbers removed are
slightly higher than the 51 removed last year although the incidence of
disease was lighter ; even then though only 25 % were removed.