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14
through the return home of troops who have served overseas,
or more directly because of pollution of water supplies as a
direct result of enemy action. Because of these possibilities
the Ministry of Health, while not advocating mass immunization
of the population, have recommended that facilities be
available for the treatment of those whose work exposes them
to this hazard or those individuals who wish to be done.
Under these arrangements, local medical practitioners were
informed that vaccine obtained from the Emergency Laboratories
could be supplied for them to administer to their patients.
Up to the end of the year, however, very little advantage had
been taken of these facilities beyond the immunizing of the nursing
and domestic staff of one of the hospitals in the area. The question
of immunizing persons against tetanus has been raised more
particularly in regard to those persons who are more especially
exposed to infection by reason of their occupation. While there
is general acceptance of the degree of protection afforded by the
protective inoculation, the process is the less likely to meet
with general acceptance in view of the fact that any person
injured by enemy action will receive serum prophylactically
whether or not he has been immunized, and early administration of
anti-tetanus serum is effective. In regard to the practice of
subjecting all those who have received injuries which have resulted
in a breach of continuity of the skin surface to the routine of two
or three prophylactic doses of A.T.S., it would seem that many
persons are being unnecessarily put to discomfort and much
material wasted. It is difficult to see a reason for the administration
of serum to persons whose injuries have been received indoors and
whose wounds are therefore most unlikely to be contaminated
with tetanus bacillus. It does not seem to be common practice
in ordinary circumstances for the practitioner to inject A.T.S.
to patients so injured, but as long as the recommendation remains
that all the wounded shall receive the A.T.S., medical officers of
first aid posts will naturally hesitate to refrain from ordering the
injection. The last of the diseases against which prophylactic
inoculation has been shown to be effective that remains to be
considered is diphtheria. As a public health measure diphtheria
immunization is of the first importance and most districts have
made arrangements by which those wishing to avail themselves
of the facilities can have their children protected against this,
one of the most serious of childhood diseases. The local arrangements
provide for the actual work being undertaken by the general
medical practitioners, the Council providing the reagent free and
remunerating the practitioner for the treatment of those persons
in receipt of incomes of less than £250 a year. When the scheme
started three inoculations with T.A.M. was favoured, but for some
time now two doses of A.P.T. were preferred in the case of younger
children. Phials containing small quantities of antigen were