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the number of persons harbouring the specific causative
organisms, shows increase.
In the case of diphtheria this may evidence itself in a
greater number of positive swabs being found as a result of
investigation of sore throats which have little in common with
true clinical diphtheria, or being found without any clinical
evidence whatever in children who are swabbed, in accordance
with routine practice, before going to convalescent homes.
Starting as an organism of the mildest virulence the
bacillus diphtheria? is passed on to persons who have
capacity for enhancing its virulence, and by its passage
through a series of such people who successively add to its
malignity a stage is reached when outbreaks reach an aspect
of gravity and the mortality per cent. of cases attacked is
alarmingly high.
In this connection it may be asked why is comprehensive
immunisation not carried out while as yet warning has not
materialised into an epidemic, or as a routine practice in a
local authority preventive scheme? To this query there are
several answers. Firstly, immunisation is not in this country,
as in Hungary for example, compulsory, and even were it so
there would no doubt be many conscientious objectors. Then
it is argued that were only a portion of the population
immunised, danger would arise from the immunised carrier
who, whilst himself suffering no ill effects from harbouring
the organisms, nevertheless possesses potentiality for infecting
those who are susceptible and have not been immunised.
Other arguments might be adduced against immunisation,
but the fact cannot be ignored that certain communities, e.g..
some cities in the Dominion of Canada and the U.S.A. have by
a comprehensive scheme of protective inoculation well-nigh
stamped out clinical diphtheria as an entity.
With such positive experience of other countries in mind
it would appear that every effort should be made to immunise
as many as possible of the susceptible child population.