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same boy was discharged for the second time from hospital as not suffering
from diphtheria. It became evident th??? the clinical cases which kept
occurring were being caused by contact with carriers of the type described.
Those of the boys who were susceptible developed diphtheria, while the
immune individuals carried the germs, intermittently, in their throats
and proved positive or negative to swabbing according to the degree of
contact with the carriers which they were experiencing at the time.
It seemed that the most practicable method of dealing with those
recurring cases was to immunise the susceptible scholars by the Schick
method. Dr. Monckton Copeman, of the Ministry, very kindly gave the
benefit of his experience and advice. He and Drs. Letham and Scott, of
the Ministry, performed the preliminary testing of the scholars, at which
the Medical Officer of Health and Medical Officers of the L.C.C. assisted;
material for the purposes of immunization was very graciously supplied
by Burroughs Wellcome & Company free of charge. 72 individuals
including the staff of the school were tested and 13 were found to be
susceptible. The process of administering three successive weekly
injections of toxin-antitoxin (immunising mixture) to each susceptible
scholar was then undertaken.
The Schick test, and the method of immunization associated with it,
are now practised as a preventive measure against diphtheria by certain
sanitary authorities in this country, and the results so far achieved have
been very satisfactory. It has been extensively used in Edinburgh, and
in the fever hospitals of large towns such as Manchester and Birmingham,
in the Metropolitan Borough of Holborn and in many residential schools
throughout the country. A sanitary authority, in considering the
adoption of this method of prevention, is advised that it is particularly
applicable to children under school age, as they are the most susceptible
to diphtheria and are most affected by the mortality of this disease. It
would, therefore, appear appropriate that this work should be carried out
at the Welfare Centres. It would be necessary to interest the parents
and to obtain their co-operation and assent to the Schick work being carried
out, and also to enlist the sympathies and efforts of all officials and others
engaged in child welfare work in the area. A preliminary report dealing
with the Schick test and immunization in its relation to the prevention
of outbreaks of diphtheria was presented to the Public Health Committee
in November, and it was decided that the question of adopting this method
of prevention in the City should be considered.
The second outbreak, which occurred in Victoria Ward, began in
September and involved 74 cases. As in the former case, the outbreak was
due to a carrier, a child attending St. Gabriel's School. The infection
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