View report page

57
It has now been established that a much more enduring protection can be
achieved by active immunisation with mixtures of toxoid anti-toxin. The protection
thus conferred lasts at least for seven years, and there is every reason to
believe that it remains for a lifetime. But even if the protection does not last for
ever it must be remembered that the child is rendered immune during a period of
years when it is most susceptible to diphtheria.
The measures that have been employed in past years to control the disease,
viz., hospital isolation and disinfection, cannot be said to have reduced to any great
extent the incidence of diphtheria.
The following table, which shows the number of cases of diphtheria and the
mortality rate from this cause for the past five years, is of interest, as it demonstrates
that the time has arrived when we should invite parents to consider the question
of securing active immunity for their children, which can be obtained without risk
or severe discomfort.

Active immunisation against diphtheria has been practised in America,
Edinburgh, Birmingham, Bristol and one or two Boroughs in London, with results
which go to show that this method, with the active co-operation of the general
public, will considerably reduce the number of cases of diphtheria. It is essential
that such a procedure should be carried out in early childhood, and in recommending
that children over six months should be treated I am influenced by the susceptibility
of those up to 5 years of age and the relatively high mortality rate.
The Schick method of testing whether a person is protected by nature against
diphtheria is by injecting a minute quantity of testing fluid under the skin. The
test is quickly made, with no pain, beyond a needle prick, either at the time or
afterwards.
By looking at the skin at the point of injection one week later the doctor can
tell whether the person is protected or not. The mark on the skin soon fades away
and no scar is left.
If it is found that the person is not protected,and thus could catch the disease,
then immunisation can be secured by the inoculation with toxoid anti-toxin.
As most children between the ages of 6 months and 5 years give a positive
reaction to the Schick test there is no necessity for such test to be carried out before
inoculation, unless the parents specially wish it.
I have no hesitation therefore in suggesting for consideration the opening of a
clinic at the Council's Maternity and Infant Welfare Centre, 140, Camberwell
Road, for the Schick testing and inoculation of children free of charge, and in
support of this suggestion I would stress both the health and economic factors.
From information that has been supplied to me it is computed that the
approximate cost of every diphtheria patient treated in the Metropolitan Asylums
Board Hospitals is £30, excluding administrative charge, whereas the cost of
immunisation would be only a few shillings per person.
The prejudice which exists against any form of protective measures necessitating
the use of the hypodermic syringe is widespread, so that it would be necessary, if
the suggestions contained in this report are adopted, to pave the way by the issue
of a propaganda leaflet to every mother attending the Infant Welfare Centres
explaining the purpose of the clinic and the value of toxoid anti-toxin inoculation
and also, by the display of a poster, containing the following information, on the
notice boards of the public buildings and conveniences in the Borough.