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might help to stimulate their perhaps waning immunity. It is
conceivable that the last state of that community might be worse
than the first. Immunity conferred for a long enough period to make
Diphtheria a rare disease, and then allowed to lapse, leaves a community
lulled by a false sense of security, a community which would
be virgin soil for a virulent infection from outside.
In Acton therefore in 1936, a new technique has been adopted
which it is hoped will lessen the risks of such an invasion. Babies,
pre-school children and school children are still inoculated as before,
and Schick tested afterwards to ensure that that level of immunity
is at least reached. We do not know that it is a safe level but it
is at least better than no level at all. Fourfold toxin is now used
entirely for Schick testing, no weaker toxin is used in the Borough,
so that the "Schick level" is as high as practicable. The immunity
thus conferred is kept up by regular injections of immunising
material every three years so that until the child leaves school
protection is maintained at that level as far as possible. Time
only will show whether the level attained and kept is sufficient to
prevent Diphtheria altogether in inoculated children, but it is
felt that the community is by this method much more efficiently
protected.
Eight cases of Diphtheria occurred in school children and
there was one death, in a boy whose parents had not had him
protected. The schools at which these cases occurred were 1—
Acton Wells; 3—Berrymede; 3—Derwentwater and 1—Priory.
It is significant that with these four exceptions the schools
were completely free of Diphtheria. This has its dangers, which we
are already facing, because this freedom from infection has bred
a feeling of apathy and indifference in the parents. The immunisation
figures for this year are low as compared with last year,
although the same facilities have been offered and the same course
of action urged as formerly. The herd immunity in most of the
spools was much lower at the end of 1936, as compared with the
end of 1935. It appears as if the seeds of failure were contained
in our successful efforts. The fear of Diphtheria drove the people
to artificial immunisation, and we were in sight of complete freedom
from the disease. In the last 7 mouths of 1936 only 2 cases were
notified, with no deaths. The immediate effects of our efforts to
stamp out Diphtheria have obviously been successful, but we are
apprehensive of the future unless these efforts continue to be successful.