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128
controlling the disease. It is now thoroughly established that diphtheria strikes
where the balance between immunity and susceptibility is weighed down in favour
of the latter condition. This is true both as regards communities and individuals.
The
prevention of
diphtheria.
There are two aspects of the subject of prevention to be considered. Firstly
there is the more modern method of active immunisation by means of inoculation
which, it is claimed, protects the individual against attack, and secondly there is the
general practice arising out of statutory public health enactments relating to isolation
and hospital treatment of the patient, supervision of contacts, disinfection and the
like, which are carried out in the interests of the patient and community after the
individual has been attacked. These measures are described below:—
Schick test
and active
immunisation.
The Schick test is employed to demonstrate an individual s degree of susceptibility
to diphtheria. The interpretation of the test by an expert medical technician
will show in the large majority of instances whether the person will escape diphtheria
altogether or whether he or she will contract the disease mildly or severely if infected,
and will even indicate his or her power of making a good recovery.
Active immunisation with toxoid antitoxin (T.A.T.) is a means of increasing
the individual's powers of resistance or in other words conferring immunity to the
disease by a scientific and less ruthless method than that adopted by Nature, and
in a much shorter space of time. Although this measure is now regarded by the
medical profession as a well established means of protection against diphtheria
and it is being practised successfully in a number of places, the lay public needs
a good deal of education on the subject, and parents themselves will have to decide
whether they will take advantage of this preventive measure.
In London 12 metropolitan boroughs, viz., City of Westminister, Battersea,
Camberwell, Deptford, Hackney, Holborn, Stoke Newington, Wandsworth, Marylebone,
Lambeth, Finsbury and Poplar, have established immunisation clinics and
have distributed propaganda leaflets on the subject. With the Council's consent
the school organisation is assisting borough medical officers in the circulation of
these leaflets in the districts concerned. Although these clinics were primarily
intended for the immunisation of children of pre-school age, many of them are
treating school children in addition. In districts where these facilities are not
available it has been possible to arrange for school children and even teachers to be
immunised at one or other of the Diphtheria Carrier Clinics referred to later on,
when application for this protection has been specially made.
It may be mentioned that it is now a general practice to immunise young
children without first determining their susceptibility to diphtheria by means of the
Schick test. The reason for this practice is that the large majority of children living
in towns are, in their early years if exposed to infection, liable to contract diphtheria
and, by dispensing with the Schick test, unnecessary attendances at the clinic are
avoided.
The following table shows the numbers of persons Schick tested and immunised
at the borough council's Welfare centres and at institutions in London up to the end
of 1928. The figures in brackets denote, for the purpose of comparison, the
numbers which had been dealt with up to the end of 1926.
Where performed.
Schick tested.
Positive reactors.
Number
immunised.
Borough Council's welfare centres
5,658
4,192
4,569
(1,132)
(831)
(662)
Residential institutions (including
London children in out-county
institutions)
12,420
4,839
4,481
(7,187)
(2,519)
(2,002)
Hospitals (including M.A.B. hospitals
to April, 1928
3,044
1,023
759
(1,500)
(420)
(420)
Totals
21,122
10,054
9,809
(9,819)
(3,770)
(3,084)