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148
diphtheria cases and isolate them when found in order to control
the disease. But when put into practice the result of carrier
hunting on the total incidence of diphtheria in the community was
inappreciable. It is true that small outbreaks of diphtheria were
sometimes traced to a dangerous chronic carrier whose removal
prevented the origin of further infections; but, in general, carrier
hunting has been as dismal a failure as the isolation hospital in
preventing diphtheria. The original hope of its success was based
on the false assumption that carriers were rare pathological
curiosities and, therefore, if one or two were discovered in any one
institution or locality, it was highly improbable that there would
be any more carriers to be discovered in the same place."
Now for many years at Greenwich Hospital School, diphtheria
had reigned triumphant. The sanitation was overhauled, everything
was disinfected and even the boys' feeding gear, crockery,
knives, and forks, etc., were sterilised after each meal. All cases
were immediately isolated and more than a thousand carriers were
found and segregated. Yet during the pre-inoculation years of
which I have first-hand knowledge, fifteen per cent. of all the boys
who joined that school were doomed to get diphtheria before they
left it, and at times there might be as many as 30 or 40 healthy
boys kicking their heels about in the school infirmary, losing their
training and education, because they were carriers of diphtheria
bacilli. At last, in 1928, it was decided to inoculate the boys
against diphtheria. All the boys' parents and guardians were at
first asked to give their consent, and only seven out of more than a
thousand refused to have their boys protected: a good demonstration
that this class of people, chiefly retired naval ratings, had the
sense to leave such matters to the discretion of the school medical
officer. After the preliminary inoculation of the whole school,
submission to anti-diphtheria inoculation became a condition of
entry.
The result of actively immunising this school was highly
satisfactory. During the four and a half years following the event
an occasional sporadic case of abortive diphtheria was recorded,
but in the winter of 1932-1933 there was a definite outbreak of
23 cases. In all, during the five years immediately following the
institution of artificial immunisation, 43 cases of sore throats were
recorded as diphtheria. Here some critic might quite justly ask,
how, if you get forty odd cases of diphtheria in such a thoroughly
inoculated community, can you speak of the procedure as a great
success in the prevention of diphtheria ? This question brings out
the main point I wish to make this morning.
The figures which public health administrators and statisticians
have to deal with in their offices are concerned with "diphtheria"