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10
trams, buses, schools, mills, " carriers," etc., etc., which
no doubt at times may contribute to the causation.
One great difference between London and most other
cities is the condition of the uncovered ashbins and dust
carts, to which I refer in another part of the report,
and I will only add here that infection will necessarily
take place if these so-called sanitary dustbins or uncovered
dust carts contain infectious material, which
may be expected if they come from infected houses.
In this connection, I may remark that the public
entertain the idea that infectious disease may be derived
from sitting as out-patients for some time near such
cases, and I am inclined to agree with their views and
have urged the authorities to have a preliminary survey
of cases with sore throats, rashes, etc., and I was glad
to observe at a large hospital here posters inviting such
cases to report at once.
Before me are replies received from various
Metropolitan Boroughs with regard to procedure in
connection with diphtheria, but as they differ materially
on the value of taking swabs, examining contacts and
testing for virulency, it is thought that a memorandum
from the Ministry of Health would be welcome. As a
test to prove whether bacilli found in "contacts" is
virulent or avirulent in the type is so expensive, it is
thought that the County Council or Ministry of Health
would do a great service by establishing an institution
where this investigation could be made more economically.
The possibility of conferring immunity to diphtheria
by toxin-antotixin injections is now an accepted
fact. By the Schick test it is quite possible to ascertain
which among any group of persons are susceptible or
immune to diphtheria. The reaction in 95 per cent,
of the subjects can be read accurately within 24 hours.
The former can then receive at the practitioner's hands
the necessary doses of toxin-antitoxin mixture, rendering
them immune to the disease. In short, we nowadays
have a definite means of controlling diphtheria:
if the public only knew and acted up to this, diphtheria
would be a disease of the past.