View report page

140
school children to be tested and immunised in certain of the boroughs, and that these
facilities will doubtless be considerably extended in the near future. It would
appear desirable that those parents who desire that their children should be
protected by immunisation should be given every opportunity of satisfying their
wishes.
In this connection we have considered a suggestion that as an experiment, in
connection with selected schools at which the diphtheria incidence is high, facilities
should be provided for the contacts of diphtheria cases to be inoculated as a preventive
measure, with a view to accumulating information as to the results over the next
two or three years. If immunisation were carried out in selected schools on the
lines suggested, it would need to be conducted over a fairly wide area, e.g., a whole
borough, before any reliable results on the local incidence of diphtheria could be
demonstrated. If a few isolated schools were selected for the purpose it is doubtful
whether any sound conclusions could be drawn from the effect upon the incidence of
the disease, owing to fluidity of the school population, and to the fact that in the
present state of public knowledge on the subject, the proportion of parental consents
would not be sufficiently high.
The prevalence of diphtheria fluctuates, both as regards time and place, and the
disease attacks certain districts, remaining prevalent therein for varying periods,
in some cases for two or three years, and then by the very process of natural immunisation
through actual association with the disease—known as the "salting" of a
community—the incidence dies down, only to transfer its activities to another district
where it goes through a similar process.
Active immunisation, as now carried out, produces by scientific means the same
process of "salting" a community as would happen by natural means in a district
where the disease prevails for any length of time, except that the artificial method
of immunisation confers protection in a much shorter time than nature, unaided,
takes to effect the same object, and thus tides over the susceptible period of a child's
life.
(3) To what extent and by what means, if any, the Council should carry out or
assist in propaganda on the subject.—We are informed that the Education Committee
have already given faciliies for the use of the school organisation in three boroughs
(Holborn, Deptford and Camberwell) in the distribution of leaflets, prepared by the
borough medical officer of health on the Schick test, and that these facilities will be
extended to any other metropolitan boroughs in which it is decided to adopt measures
of immunisation. The facilities provided by the school organisation afford a simple
and inexpensive method of providing information for those parents who desire to
be informed on the subject.
(4) Whether any steps for the prevention of diphtheria among school children can
usefully be taken by the Council, apart from measures already adopted in the school
medical service.—The Education Committee have recently had under consideration
the difficulty of dealing with diphtheria "carriers" who are responsible for spreading
the disease. A special clinic has been held at Guy's hospital, at the Council's request,
for more than a year with very satisfactory results, and in order that London may
be properly provided with such facilities, inquiries have been undertaken with a
view to the establishment of clinics of this kind at other hospitals suitably situated
geographically.
(5) Conclusion.—It is important to bear in mind that in London the metropolitan
borough councils are the local authorities statutorily responsible under the
Public Health (London) Act, 1891, for the prevention of infectious disease, although
the Council has certain definite responsibilities in regard to the health of school
children. The cardinal fact remains, however, that measures for the prevention of
the spread of infectious diseases, such as diphtheria, are primarily the duty and
responsibility of the metropolitan borough councils.