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Introduction.
In writing one's "Swan Song" one may ask "What has one accomplished, what has one
achieved which has been, not only of value to the community one serves, but has been materially
useful to the wider field of the world in general?" On looking back one can only view with
satisfaction the researches and work one has been able to carry out with regard to Diphtheria.
The first five years' research was an endeavour to ascertain accurate figures as to what immunisation
really effected, that is, what the proportions were who benefited by the injection. With
the T.A.M. preparation which we used we were able to establish facts which have made for
progress. Subsequent investigation of other products has given an accurate comparison with the
results we achieved with T.A.M. and none of these can show results in any way better, and in
some ways not as good by reason of the facts which go to produce the results ultimately obtained.
The balance, in my mind, is in favour of the preparation which gives the least possible re-action,
despite the fact that it means an extra injection. The key to the success of this work I believe
very largely hinges on the way in which the syringes are kept, the needles being sent away with
that frequency which ensures that they are in absolutely perfect condition. In that case the pain
is negligible. In the film which I have made, which has gone far afield, the faces of the children
exhibit no trace of pain whatever, except in one case where the slightest tremor showed the
child had felt something when the needle went into its arm for the injection. I felt it was imperative
that something like this should be done so that the parents who were hesitating could
actually see the results of the inoculation. There is not unnaturally fear on the part of the average
mother at a needle being thrust into her child's arm, but despite all propaganda to the contrary, the
spartan attitude which our mothers take up with regard to ensuring that as far as it is humanly
possible, their children shall not have Diphtheria, is a stimulating sight.
Looking back over the 40 years one has been practising the art of medicine and carrying
one's memory back to the pre-anti-toxin days, practising through the days when anti-toxin made
things more bearable in Isolation Hospital work in the Diphtheria Wards to the present time when
one is able to say that with a population of 100,000 one had only 1 death from Diphtheria and
only 18 cases notified, of which only 7 turned out to be real Diphtheria, one feels one has done
something substantial for the children of the district for which one is responsible.
As recorded later in this report, in 1929 we had 23 deaths from Diphtheria with a population
some 40,000 less than it is at present.
The most important accomplishment was the 5 years' investigation into the safety and
efficiency of active immunisation against Diphtheria. In this research one was able to prove
that with the normal number of injections with T.A.M., 11.8% of the children were not efficiently
immunised and to show that in some cases it required as many as 6 injections before safety was
reached. The results of this research together with others which have been continuously carried
out have made some material contribution to the science of immunisation. In 1929, one was
ploughing a lone furrow on the question of immunisation in this area, but it is now being carried
out by all the surrounding Authorities. More recently our researches into the value of A.P.T.
of various makes have accurately established the value of this preparation as compared with the
earlier ones, such as T.A.M., one of which was put on the market with an efficiency which was
tragic in its insecurity. My film has travelled through the length and breadth of this country,
has been purchased by three of the Australian States and New Zealand and has, I have found,
been a very material contribution to parental conversion. Whilst recognition in a wide field
has been given to my pioneer efforts in other fields, the contributions that I have made to
Diphtheria Immunisation give me more satisfaction than any other Public Health subject I have
dealt with.
One of the most satisfactory things one has been able to accomplish has been the provision
of a service for the prevention of measles by co-operation with the Scout Movement. Since
1932 I have during each outbreak been able to obtain adult blood from Rover Scouts who have
had Measles. One has found that the percentages of efficiency that have been published elsewhere
are definitely lower than in one's own experience. It must be borne in mind that the average
parent will not allow its small child to be bled to provide sufficient convalescent serum for the
protection of someone else's child, and it really boils down to the fact that the only source of
Convalescent Serum is to be found in the Isolation Hospitals, and in very few of them. The
results one has obtained with adult serum are almost too good to be true, and fortune, certainly
in the last outbreak, must have favoured us abnormally in that I obtained what has never been
obtained before, namely a complete 100% efficiency, where I desired a complete immunity.
The following is an extract from the report of Dr. Rankin, the Medical Superintendent
of the South Middlesex, and Richmond Joint Hospital.
"During the past year the method of sero-prophylaxis has been applied with
marked success on two occasions when wards of the hospital were exposed to Measles.
We are deeply indebted to Dr. Nash, Medical Officer of Health of Heston and Isleworth,
for supplying batches of measles serum. On each occasion all susceptible contacts were
completely protected and no quarantine was imposed upon the wards."
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