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146
In the annual report of the Ministry of Health for the year 1933
it is stated that immunisation against diphtheria is practised in
approximately only one-half of the Metropolitan and County Boroughs.
1 have looked through the reports of the Medical Officers of Health for
several of the London boroughs where immunisation centres have been
established, but I find that the number of children immunised is almost
negligible, amounting to a few hundreds a year.
I would, however, like to refer to the preventive measures
carried out on a more liberal scale by the Medical Officer for Acton,
and his assistant. An account of these was published in the (1)
Lancet this year in which they state that between October 1932 and
December 1933 they successfully immunised 2,723 children. In
the provinces Birmingham takes the lead, and the number of
children immunised there during the last eight years is greater than
in any other city of this country. For this, Dr. Burn, who is with
us here to-day and who will speak, is mainly responsible, and I
should like to congratulate him on his successful campaign. There
was a sharp rise in the incidence of diphtheria in this country in
the autumn of 1933 and the early months of 1934, and a slight
increase in the mortality rate. Attention has been called to the
fact that in most instances this has been associated with the
prevalence of a specially virulent type of the diphtheria organism,
the so-called 'gravis' strain, first described by (2) Anderson and
others in connection with an epidemic at Leeds in 1931. Several
articles on this subject in relation to preventive inoculation against
diphtheria have recently been published, notably the following, to
which I would call the attention of those especially interested in
this subject:—
'The problem of diphtheria'—Lancet, January 19th and
March 23rd, 1935.
'Schick immunity and diphtheria infection' (Underwood)
—Lancet, February 16th, 1935.
'The Schick test and active immunisation in relation to
diphtheria' (Parish and Wright)—Lancet, March 16th, 1935.
'Alteration in the incidence of "gravis" mitis intermediate
types of C. bacteriae in Manchester' (Robinson and Marshall)—
Lancet, August 24th, 1935.
I have referred to the above-mentioned important papers
because they deal with the problem of occasional occurrence of
diphtheria in Schick negative reactors. In these communications
the relationship of the degree of immunity indicated by this reaction
and the degree necessary to prevent infection is discussed, also, the