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illness and of saving the child's life. The need for securing early medical advice
and for medical practitioners to realise the importance of immediate administration
of anti-toxin is the first principle in the prevention and cure of diphtheria. London,
in spite of its advantages in the matter of hospital and medical services, remains
one of the worst centres as regards the prevalence of diphtheria. The failure to
seek early medical attention, previously referred to, probably plays a part, but this
is doubtless a feature common to other populous towns. It has been pointed out
from time to time also that the actual incidence reflected in the notifications is
swollen by the addition of purely bacteriological cases. But even allowing for these
reservations, the incidence of and mortality from diphtheria continue to give cause
for anxiety. There is, therefore, all the more reason why public health authorities
in London should study seriously and impartially the results of the modern method
of determining susceptibility to the disease by the Schick test, and of securing the
immunisation of young children who are likely to contract diphtheria by the inoculation
of toxoid anti-toxin. This prophylactic measure has already been adopted by
many authorities, in a greater or less degree, in many parts of Great Britain, including
certain London boroughs, with, it is claimed, a beneficial outcome in the reduction
of diphtheria among the immunised. A more detailed reference to this subject will
be found on p. 128.
The task of inculcating modern methods of prevention, based upon scientific
knowledge, is handicapped by popular prejudice or preconceived and erroneous
ideas. An illustration is to be found in the popular attitude to what is now regarded
as an axiom in preventive medicine, namely that the ordinary infectious diseases of
school life are spread almost entirely by infected persons in the act of talking, coughing
sneezing, etc., and not by inanimate objects. The desire for disinfection of supposedly
infected articles, and more especially of school classrooms, is, perhaps, not so clamant
as it was, but even now, faith in the magic powers of chemical disinfection of classrooms
retains many adherents among the public and even in the ranks of school
teachers and managers, etc. It is frequently argued that houses in which cases
of infectious illness occur are disinfected and that what must be good for an infected
house must be beneficial for the school also. The protagonists of this exploded
theory do not appreciate that there is a vast difference between the two sets of
circumstances and that, whereas the bedding and articles used in the room of an
infectious patient are liable to be soiled by the discharges of the patient which may
contain infectious material, the school is a place for healthy pupils and all ailing
children are excluded from school by the operation of strict rules. It may happen
occasionally that a child attends school in the early stage of infection and accidentally
escapes for a brief period the close supervision which is exercised and may thus
infect another child by personal contact, although the machinery is constantly being
tightened up to prevent such occasional occurrences. The chance, however, of the
furniture, school articles or the air of a well-ventilated room retaining infection,
so as to require "disinfection," is so negligible as to be disregarded. Ordinary
cleansing is necessary on general hygienic grounds and quite sufficient as a means
of disinfection. Some local sanitary authorities have abandoned even terminal
disinfection of the bedrooms occupied by infectious patients and rely upon "current"
disinfection and the boiling of bed clothes or other articles personal to the sufferer.
Medical officers of health, in increasing numbers, are coming to the conclusion that
terminal disinfection of rooms occupied by infectious patients is valueless in preventing
the occurrence of secondary cases of such illnesses as scarlet fever, diphtheria,
etc., and their opinions are supported by the results obtained in districts where
disinfection has been abandoned. Others, while reluctant to take the plunge of
discontinuing a traditional practice, regard disinfection merely as a placebo. Investigations
which have been carried out recently by the Board of Education have
demonstrated that school books used by children in school are not capable of transmitting
the common infectious diseases, e.g., scarlet fever and diphtheria.
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