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97
antitoxin is unnecessary. On the other hand, if at the end of
about 12 hours (or sooner in urgent cases), there is no
evidence of improvement, or it is clear that the disease is
advancing, a second dose of similar magnitude should be
given, followed by a further dose if no distinct improvement
occurs."
Larger initial doses, e.g., from 16,000 to 30,000 units,
are specially required when for any reason the administration
of antitoxin has been delayed until the third or fourth
day from the onset. The need for further administration will
be determined by the progress of the disease, on the lines,
just indicated.' "
In 1920, when the Asylums Board were pressed for accommodation
during the last quarter of the year, medical practitioners
were advised to administer the, maximum dose of antitoxin, but
even in that year only 82 bottles of antitoxin of 2,000 units each
were requisitioned.
The number of applications for antitoxin last year increased,
139 bottles of antitoxin of 8,000 units each being supplied to
medical practitioners, as compared with 108 the previous year.
Sanitary Circumstances of the Area.
Water Supply.—The water supply of the Borough is under
the control of the Metropolitan Water Board. Several complaints
from householders regarding the condition of the water were investigated
during the year. There were no adverse reports on
the samples taken for analysis.
Sewerage.—The responsibility for the sewerage of the district
is shared by the London County Council and the Engineer's
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