[Report 1932] / Medical Officer of Health, Belfast County Borough.

  • Belfast (Northern Ireland). County Borough Council.
Date:
1932
Catalogue details

Licence: Attribution 4.0 International (CC BY 4.0)

Credit: [Report 1932] / Medical Officer of Health, Belfast County Borough. Source: Wellcome Collection.

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    one reason is that Belfast is not a tenement city—children do not meet on the stairhead and swap germs by coughing and talk—spraying the germ fauna and flora of their throats into each others faces. Diphtheria is a gangster, a ruthless enemy, without bowels of compassion. It is a twin brother of the garotte, it is an Apache in that it can strike down through the heart. Scarlet fever, on the other hand, belongs rather to the “ receiver ” class of criminal; it is liable to be associated with disreputable company such as ear, kidney and heart complications. There is an insidious note about scarlet fever ; rheumatism may arise as a sequela and where that ends no man can predict. Can nothing be done to stop scarlet fever and diphtheria ? Most certainly it can. I plead with members of the Maternity and Child Welfare Committee to read and ponder over the following. I have not yet asked the Maternity and Child Welfare Committee to make provision in the annual estimates for the money which would enable all children under six years old to be inoculated against both diphtheria and scarlet fever. The reason I have not done this is that first things had to come first, and we had to make a beginning with municipal ante-natal work. This last is the all important need of the times. That service has been inaugurated and is a great success. Coming to Belfast over four years ago, I saw that while Tuberculosis and School Medical Inspection wcrk was thoroughly in hand, Maternity and Child Welfare work was in need of developing. We are doing well, but there is much to be done ; essential services such as Nursery Schools —some four or five, the provision of modern clinics for Child welfare—preferably combined with School Medical Inspection Clinics—the need of two open-air schools for children suffering from early tuberculosis—the need for at least one super- visory centre at a general hospital and a residential hospital school for children suffering from affections connected with rheumatism—all these are urgently needed. Inoculation, then, against scarlet fever and diphtheria requires serious consideration. To explain this, certain medical terms must be made clear. By immunity to a disease we mean that a person is not liable to take it. This immunity is acquired or conferred in different ways, thus, one attack often confers immunity to a disease—a person will not take it again. When I say that eighty to ninety per cent, of children under six years are susceptible to both diphtheria and scarlet fever, I mean that eighty or ninety per cent, are non-immune. Can these children be made immune ? Yes, it is being done every day, and this pro- cess is called active immunisation, and it is obtained by an injection under the skin. Aberdeen and Edinburgh were two pioneer cities in this work. Active immunisation has been employed with success for the protection of nurses in the scarlet fever wards of the city hospitals of Aberdeen and Edinburgh. Here are some remarkable results. Before this inoculation to induce immunisation was undertaken in Edinburgh in children under 15 years of age diphtheria occurred in about 6 per 1,000 (for the five years prior to inoculation). Following upon inoculation the attack rate of diphtheria fell tc 1.8 per 1,000. It stands to reason that if we inoculate children against diphtheria and scarlet fever, we materially reduce deaths and suffering arising from these diseases, and further we would reduce the cost of maintenance of cases in Purdysburn Fever Hospital. This work of inoculation has been going on now actively elsewhere for seven or ten yaars, and we cannot, and we must not lag behind. It can only be done on a voluntary basis and faint hearts may shrink at the opposition and ignorance and prejudice which will have to be overcome amongst parents. I began this work in London several years ago, and whereas parents at first were suspicious, in time they claimed this inoculation—and therefore protection—as a right. Even measles bids fair to take its place as a preventable disease ; at present pro- tection by inoculation against measles has proved to be of the greatest benefit in institutions—it is not yet possible to immunise actively a child population in a city, but it is to be hoped that it will not be long until experience makes its use possible in the community. Meanwhile, we cannot fail to wait any longer as regards diphtheria and scarlet fever. It is through the Child Welfare Centres and the Schools that the propaganda work should be carried out. By apt inculcation we can win over many who will gladly give their sanction that their children should receive this protection. Many there are who will at first refuse, and these will pay the price as has happened before ; meanwhile, it is our bounden duty to go on—to lead, to instruct, to save.