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100
DIPHTHERIA.
375 cases were notified compared with 473 the previous year, the attack rate being 2.6
per 1,000 compared with 3.3. This incidence is still high, but the epidemic which commenced
in the fourth quarter of 1934 shows definite signs of waning and the greatest number of cases
this year occurred during the first quarter. All cases were removed to hospital for treatment;
12 deaths occurred, the fatality rate being 3.2% as compared with 6.4% last year. The age
distribution of the cases is shown in Table 35 (p. 94).
DIPHTHERIA ANTITOXIN.
This is available to practitioners upon request at the Health Department. During the
year 72 issues, each of 8,000 units, were made.
DIPHTHERIA IMMUNISATION.
In this country some 60,000 cases of Diphtheria are reported annually, chiefly among
the population of pre-school age, and, unhappily, about 3,000 cases terminate fatally—a heavy
toll. Diphtheria is thus a serious disease, which, despite the most intensive treatment, still
kills about one in twenty of those it attacks. It is most prevalent in the winter and shows
increased epidemicity every five or six years. There also tends to be a still bigger epidemic
about every twenty years. The last five years or so have shown a marked increase in the
virulence of the disease, particularly in northern towns, where a considerable number of cases
of the gravis type have been reported, with a high mortality rate. Fortunately the situation
is not as bad everywhere, but the fact remains that a definite variation in the clinical type
of diphtheria towards the dreaded virulent type has been noted. The case for a simple and
harmless measure designed to check the incidence of the disease is abundantly clear.
Immunisation is still by no means a universal practice. Only about half the total number
of metropolitan and county boroughs and certain smaller sanitary districts in twenty-three
counties in this country offer facilities for this treatment. That it has not been more widely
adopted as a public health measure is largely due to the prejudice which exists against the
practice among people who do not understand its value. Health Visitors and welfare workers
who are in close contact with parents, and who have their confidence, can help to dispel this
prejudice.
A clinic for immunisation was inaugurated in the Borough in April, 1934, and has been
held every Thursday afternoon at 170, Wandsworth Bridge Road. The Medical Officer in
charge is Dr. Guy W. J. Bousfield. Since the inception of this clinic, 1,350 persons have
received treatment, and the following tables show the work which has been done during the
year under review.
All the applicants were Schick tested and, if positive, received three inoculations of
Toxoid-Antitoxin Floccules or Toxoid-Antitoxin Mixture. A final Schick test was made
three months after the last injection, and, if this proved negative, a certificate was issued.
The clinic has been supported by propaganda on the subject in the schools and in the Council's
Infant Welfare Clinics, and by the distribution of leaflets throughout the Borough and also by
the display of poster announcements.
One aspect of Diphtheria Immunisation is of epidemiological importance. Artificial
immunisation does not appear to diminish the incidence of infection in a community until
about forty per cent, of the population is protected. At the commencement of a campaign,
therefore, the benefits are to the individual and not the community.
The economics of Diphtheria Immunisation should be stressed. The average case of
Diphtheria requires six weeks or more in hospital and costs about £20. Allowing for doctors'
and nurses' salaries, for the cost of apparatus and materials, and for administrative expenses,
a Schick test, complete immunisation, and a Re-Schick test costs about four shillings. A
hundred cases can, therefore, be immunised at the same cost as one case can be treated. The
cases which occur annually in this country must cost well over a million pounds.