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to the essential recording of the work undertaken during the
year has deprived me to some extent of the opportunity to do
this. One piece of important preventive work is Immunisation
against Diphtheria and a national propaganda drive was undertaken
to endeavour to secure a great increase in the number
of individuals and children protected. There are many who
believe that this should be made compulsory, but up to the
present, reliance has been placed on propaganda to achieve the
desired result. It would appear that it is more difficult to
secure attendances of children up to five years of age than the
school age groups. This is a great pity because the mortality
from Diphtheria. is greatest in infants and younger children.
The prolonged exposure of the younger age groups and
contact with numbers of individuals other than their own families
owing to war conditions in such places as shelters, has given
rise to a great deal of anxiety among those engaged in preventive
medicine. Happily there does not seem to have been any disastrous
consequences, but none the less, this is no justification
for complacency, the potential factors are still there and protection
of the children by injection is the only real answer to
the problem. One other fact I think is worth mentioning as a
great advance in this work and that is the substitution of a
two injection method for the previous three injections. Only
quite recently it was the practice to give five injections in all,
a preliminary skin test, three injections of protective substance
and later a final skin test. There was some excuse then for
failure to have a child protected. Now, there are only two
injections at an interval of one month between each injection.
In the latter part of 1939, we were forced to embark upon
perhaps the biggest social experiment ever carried out in this
country, namely the evacuation and transplantation of families
from the urban districts to the rural areas. Among many facts
which came to light as a result, was the high rate of parasitic
infection among sections of the urban population.
The prevention of this infestation is more difficult under
war conditions, particularly in areas subject to prolonged hostile
attack, owing to aggregation of mixed sections of the population
and the added difficulties of maintaining cleanliness of the
person and of personal linen. Scabies or the " itch " has ceased
to be confined to the vagabond, but is to be found mainly as an
accidental infection in persons of a high standard of personal
cleanliness who are often unaware that the irritating rash is
the outward manifestation of the " itch " mite under the skin
and attribute it to water, change of diet or to one or other of
the satisfying explanations of evanescent rashes. Fortunately,
the treatment is simple and the cure can be rapidly secured,
when the condition is recognised.
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