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Let me add a word about the method of administration of the
vaccine. Wherever I went in the three countries the intracutaneous
method devised by Wallgren was regarded as the
quickest, most reliable and practical; and it afforded a more
accurate measure of the dosage. All observers were emphatic
that complications such as significant abscesses never arose when
the injection was truly an intradermal one, but did arise when
the technique was bad and some of the solution had been injected
subcutaneously. I was given, especially in Denmark, an opportunity
of assisting at the B.C.G. vaccinc clinic and I can corroborate
this view from what I saw. Such authorities as Herzberg in Oslo,
Wallgren in Stockholm, Anderson in Gothenburg, and Winge in
Copenhagen strongly favoured this method. The so-called trancutaneous
method, cither by scarification or multiple puncture
with the Birkhaug-Rosenthal instrument, seemed to meet with
little favour for a variety of reasons which space will not permit
me to deal with here, and I had an excellent demonstration of it
by a great authority.
From these impressions I think one is justified in urging that
enthusiasm should be tempered with caution. Wisely handled,
there is little doubt that immunisation should prove a useful
weapon. We have a unique opportunity for starting afresh with
adequate control experiments and filling in the gaps which
Continental and other workers, often through lack of opportunities
and no fault of their own, have omitted. We must furnish sound
statistical proof, beginning for preference with a selected group of
the population who are exposed to unusual risks of tuberculous
infection. It is to be hoped that the Ministry of Health will set
up, as soon as practicable, an authoritative committee under the
auspices of a body such as the Medical Research Council to
institute a clinical trial of what they regard as the most effective
method of tuberculosis vaccination.
Occupational Therapy.
Occupational Therapy continues satisfactorily. The patients
attend with great enthusiasm, and the sphere of activity covers a
wide range, and attention is paid particularly to the following
items:—
(a) Individual tuition in craftwork, e.g., basketry, leatherwork,
stool seating, embroidery, toymaking, etc.