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under live years of age, each )oung child is brought to the 1 minimisation Centre as
a result of individual effort, but the organisation of a public elementary school
lends itself so easily to the mass immunisation of a large body of children that it
seems very unfortunate that the Borough who has approved the principle should
lose this advantage.
It should be pointed out that the results obtained in Holborn from antidiphtheria
immunisation are not necessarily those which would be obtained from
the widespread practice of the procedure throughout the whole of the country. It
is a commonplace in the public health world that satisfactory statistics cannot be
compiled from a relatively small number of cases. If we are to reduce the incidence
of diphtheria further we are to all intents and pin-poses forced to employ a method
of this nature and for this reason.
Diphtheria is a very difficult disease to control; it is spread mainly by healthy
' carriers," that is to say, by healthy persons who harbour virulent diphtheria
bacteria chiefly in their throats or noses or both, these bacilli are often passed on
during the act of coughing or even loud speaking, or perhaps for a very short
distance by ordinary breathing, especially in the case of overcrowded vehicles or
passenger lifts, or by means of incompletely cleansed drinking vessels or eating
utensils placed in the mouth such as spoons, forks, etc.
Anti-diphtheria immunisation is worthy of an extensive triai. The procedure
has already gained wide acceptance in the United States of America; other
countries nearer home, such as Germany, France and Belgium are immunising
their children in this way. In these islands it has proved its worth as a means
of preventing diphtheria in hospital nurses and in stamping out diphtheria in
institutions where the disease has been present for a considerable time and has
given rise to case after case.
The Edinburgh statistics relating to school children are, to say the least, verv
encouraging.
The control of smallpox obtained by vaccination is so complete that progressive
members of the medical profession have been stimulated to obtain a similar control
of other infectious diseases including not only diphtheria, but also scarlet fever
and measles, and the measure of success already obtained in controlling diphtheria
warrants further effort.
We used to be asked: If it is such a good thing why are not other people
doing it as well as Holborn?" We now fortunately are able to say that Battersea,
Beckenham, Camberwell, Finsburv, Deptford, Lambeth, St. Marylebone, Stoke
Xewington and Westminster are also doing it and others are considering it. In
Manchester the Public Health Committee has reaffirmed it- approval of a report by
the Medical Officer of Health of Manchester respecting immunisation against
diphtheria. The Medical Officer of Health recommended that a scheme for the free
inoculation of children be put in operation by the Public Health Committee acting
with the Education Committee at the School Clinics, the Welfare Centies, and the
civic buildings, only children being treated whose parents permitted.
The following table shows the diphtheria notification rates in England and
Wales, London, and Holborn during the five years 1922-26. As the Schick test