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under 14 years and you may be certain that it will come back every
quarter or half-year—as punctual and certain as rates and taxes demand
notes. Why is this so ? For generations we have disinfected premises,
boiled spoons, knives, cups, etc., and of late years we have swabbed
contacts, but it has been of little use. Certainly we must continue
doing all these things, but it is realised more and more that the
conditions which lead to the spread of Diphtheria, and which I shall
discuss, are such that the only way to prevent it is to ascertain what
members of the community, especially those under 14 years of age, have
not acquired 'immunity,' and then proceed forthwith to inoculate them
with three successive intramuscular doses of ' Diphtheria Prophylactic,'
that is Toxoid Anti-Toxin or T.A.T.
What conditions cause Diphtheria ? Put aside 'drains'; everybody
talks 'drains' the moment Diphtheria is mentioned. Examine the
drains of course; the inhalation of drain or sewer air is bad for health,
but it does not of itself cause Diphtheria. Damp is a predisposing
cause of Diphtheria for it sets up catarrh, and if the lining mucous
membranes of the throat and nose become unhealthy, then the
Diphtheria germ will find a suitable bed in which it will flourish.
Overcrowding, dirt and malnutrition have all been blamed, and there
is some truth in these charges. The actual cause is the Diphtheria
germ, discovered by Klebs in 1883. To put it in a nutshell, where
ever you have a child with enlarged unhealthy tonsils or adenoids, or a
child liable to sore throats, or where ever you have a child recovering
from Scarlet Fever, Measles or Mumps, you will have the ideal conditions
for Diphtheria, for under these conditions you will find some inflammation—recurrent
or persistent—of the lining mucous membrane.
Under such circumstances, the Diphtheria germ 'spreads itself,'
multiplies, and gives off those fatal toxins which kill two or three
children every day in the County of London. But where does the
germ come from ? In my opinion, the greatest danger comes from the
child recently convalescent from the disease. Why ? A child may
leave hospital after Diphtheria with a clean bill of health; it may have
been swabbed once, twice or forty times—a pure waste of time and
money—and have been found 'negative.' But alas, the germ lies
buried deep in the spongy tonsils, in the crypts and lacunae, far from the
most vigorously applied swab. The child comes home from hospital;
in Deptford all children coming home from hospital are examined by
me. The mother is instructed in the use of antiseptics; she is told
about enlarged tonsils and adenoids, and sometimes the advice does