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However, at the City fever hospitals of Birmingham and Manchester, the members
of the nursing and hospital staffs have been tested and immunised, and a considerable
number of patients have been Schick tested. It is also understood that Schick
testing and immunisation is contemplated in Birmingham through the agency of
the maternity and child welfare centres. Similar work on a more limited scale has
been carried out in hospitals in Bristol, Newcastle and Brighton. In Edinburgh
in November, 1923, with the sanction of the education authority the application
of the test and the immunisation of school children in that city was commenced
and is now proceeding. In Glasgow the use of the test has been restricted to the
patients and staff of the City Fever Hospital and to the inmates of two residential
institutions. In Fraserburgh, Aberdeen, a clinic has been opened for the preventive
control of diphtheria and a number of children have been tested and immunised.
The number of individuals who have been tested and immunised in Great Britain
is at present too small and the dates too recent to warrant any deductions being
drawn from the subsequent incidence of, and mortality from, diphtheria in the
localities where the experiment has been made.
The authors of " Diphtheria " (Medical Research Council, 1923) draw attention
to the work carried out by Dudley in 1922 as showing that a natural process of
immunisation, in response to exposure to infection, is at work and may alone, in a
suitable social environment, be productive of extensive immunity in a short time.
Therefore results attributed solely to toxin-antitoxin injections, may to a greater
or less extent in reality be due to a coincident natural immunisation. They are
further of the opinion that the duration or permanence of immunity following active
immunisation is not necessarily dependent on the injections alone, but that, more
probably, in the production of immunity in the course of previous years, the
natural immunising process has a larger share, and the primary stimulus of the
injection renders the patient more susceptible to the natural immunising process.
They also add that if a child who is not exposed to infection, e.g., in a rural district,
is immunised, it is probable the immunity will not be found to last so long.
The Council had the subject of the Schick test and active immunisation under
consideration in May, 1924, on an exhaustive report by Dr. J. G. Forbes in which
the whole matter was reviewed. It was resolved to await the publication of the
renort, of the Ministrv of Health on the test before taking anv action.
The number of cases of scarlet fever reported from the schools during 1924
was 5,093, as compared with 4,824 (1923), 8,026 (1922), 17,030 (1921), 11,860 (1920)
and 5,574 (1919). The usual seasonal rise in prevalence occurred during the autumn,
the districts chiefly affected being St. Pancras and Islington north of the river
and Lambeth, Wandsworth and Camberwell in the south. In each of these districts
the disease, as frequently happens, seemed to cling mainly to certain circumscribed
areas. Thus in St. Pancras the schools in the Kentish Town and Camden
Town area were affected during the latter half of the year, whilst in Islington the
districts east and north-east of the Angel were affected throughout the year. An
outbreak began in the North Lambeth district during the summer term and persisted
through the following term. In Wandsworth the Earlsfield district was
chiefly affected. In Camberwell The Friern School, Peckham Rye, was badly
attacked in the autumn and other cases were reported from one or two neighbouring
schools. The outbreak at The Friern School commenced immediately after the
summer holidays and continued until December. The school was visited by the
Council's medical officers. It would appear that the infection was introduced by
an unrecognised case or cases. The number of schools specially affected and
visited by the Council's medical officers during the year was 168, entailing 248
departmental investigations and the inspection of some 30,000 children.
The epidemic of measles referred to in the Annual Report for 1923 (vol. III.,
p. 93) continued until the beginning of June, 1924. The increase in cases from
Scarlet fever.
Measles.