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52
in the case of Diphtheria without actually suffering from a clinical
attack of the disease. Von Behring in 1913 suggested the use ot
toxin anti-toxin as an immunising agent, the toxin being sufficiently
neutralised by anti-toxin to antagonise its dangerous properties.
The use of toxoid-antitoxin as a prophylactic was first adopted on
a large scale in 1921 .in New York City. Three injections of the
prophylactic are needed to develop gradually an immunity against
Diphtheria. It is estimated that about 95% of the Schick-positives
become Schick negatives in less than six months after inoculation.
As far as this country is concerned prophylactic immunisation has
only been used extensively to deal with staffs of nurses and inmato
of large institutions and schools where outbreaks of Diphtheria
have occurred or are likely to occur.
America and Canada are far ahead of this country in instituting
general prophylactic measures against Diphtheria. An idea
of the work done in the United States may be gauged by the records
of Philadelphia where 364,000 children had been immunised by
the end of 1929 ; the attack-rate had fallen to the low level of 0.4
per thousand inhabitants and no hospital for Diphtheria was
required. In this country opposition is fairly strong and it is difficult
to get people to understand the benefits of the process. Stress
is laid upon the accidents which have occurred, these are admitted,
but they have occurred under conditions which are not likely to
occur in this country. No accidents have occurred in England.
The report of the Chief Medical Officer of the Ministry of Health
deals with this aspect. "As a necessary preliminary to such a
process as immunisation it is necesasry to be satisfied that the
reagents employed will in fact effect that which is claimed for them
and that they are otherwise innocuous. Thcie is no doubt that given
the safeguards now supplied by the provisions of the Therapeutic
Substances Regulations, these claims have been fully substantiated
as far as the immunising reagents used in this country are
concerned."
Those who most appreciate the value of immunisation are
by no means eager to press it unduly ; they feel that its future is
assured if it is allowed to make its own way on its merit.
A report was submitted to the Health Committee and the
School Management Committee and it was decided to offer immunisation
to all those who desired it. As two of the schools were
affected the procedure was primarily adapted to the school population.
Requests were also received from parents of children in
other schools for the immunisation of their children. It was therefore
decided to carry out this part of the work at the School Clinc