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43
Thus, on the continent of Europe, malignant diphtheria has been
able recently to reappear, and has in fact spread unchecked from
Germany to Scandinavia and the Netherlands, where it now provides
the worst epidemic for 50 years.
In England and Wales there have been several smaller but
similarly virulent outbreaks, and in each the fatalities have included
a number of 'immunised' children, some of whom were also Schick'
negative. Although the toll so exacted may still appear small when
compared with that of former years, it is disquieting to note that each
week there continue to occur in England and Wales some 500 cases of
diphtheria with about 30 deaths.
With a view to consolidating the machinery for Diphtheria
Immunisation throughout the country, in November 1945 the Minister
of Health transferred the responsibility for this work from the local
Health Authorities to the Welfare Authorities.
Newer Technique.
In keeping with the new general outlook, the technique of
immunisation in this country is likewise becoming modified.
The modern view is that immunisation, to be really effective,
should no longer be confined to infants but should follow up each
child throughout its school life; and that, at each review, the action
taken should be directed less to the measurement of susceptibility than
to the securing of all possible protection to the child.
Accordingly the routine usually recommended today is that every
child shall be immunised at or before the age of one year, afterwards
receiving a reinforcing or 'boosting' dose at the age of four and again
at the age of eight. The Schick Test thus becomes reserved for older
children, subject always to their having received in full the three earlier
treatments.
It is a matter for record that these modifications of technique were
first introduced into the routine in Richmond during the autumn of
1944.