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There is, however, accumulating evidence in this country and in Scotland,
that where active immunisation has been adopted on a wide scale, particularly in
institutions, it has been followed by a reduction in the incidence of, and the mortality
from, diphtheria among the immunised. With regard to Edinburgh and Aberdeen,
where Schick testing and active immunisation have been carried out in the elementary
schools during the past few years, the figures published by the respective medical
officers of health are interesting. They show that in Edinburgh, with over 11,000
immunised and 95,000 non-immunised children, the diphtheria attack rate was at
least 10 times greater among the latter untreated children than amongst those who
were protected, whilst the death-rate was nil among the immunised and 63 per
100,000 among the non-immunised.
In Aberdeen among approximately 8.000 children age 1-15 years, who had
received the first series of inoculations and over 33,000 who had not been protected,
the reported diphtheria incidence was proportionately nearly 7 times less among
those who had been given preventive treatment. It is clear, however, that in larger
urban communities considerable time must elapse before a sufficient number of
children are immunised to allow of any reliable deductions to be drawn with regard
to the effect upon the general incidence of diphtheria.

Note.—Comparable figures as ascertained at end of 1926 are shown in brackets.
General
precautions
against the
spread of
diphtheria. \
At the present stage of development in London, therefore, active immunisation,
whilst affording a means of protecting the individual, has not made sufficient progress
to produce any material effect upon the incidence of diphtheria in the community,
except in such places as hospitals and institutions where it is regularlv applied.
At the present time, therefore, reliance must be placed very largely upon the
methods hitherto regarded as necessary to prevent the spread of diphtheria.
When the principles of hygiene were first applied in general practice much
emphasis was laid upon environmental influence as one of the most important factors
in the spread of disease and the enactments of the Public Health Act of 1875, bear
out this faith in fomites as the main, if not the only cause of the spread of infection
generally. This theory of the mode of conveyance of infection is still held by the
majority of the public.
Questions are asked from time to time of the Minister of Health in Parliament
on the subject of infectious diseases, based on the erroneous assumption that endemic
and epidemic illnesses can be prevented, and have in fact been controlled by good
housing and sanitation alone. This line of reasoning is just as fallacious as to predicate
that tuberculosis can be prevented by the prohibition of spitting, however
desirable such a precaution may be on general hygienic grounds.