Læknablaðið - 01.06.1973, Page 39

LÆRKiABLAÖIÐ
11ð
milk caused no paratyphoid fever. Had
pasteurization failed, the outbreak would
probably have been much more v/ide-
spread and many times as large. That
story shows not only that there is stiil
need for vigilance but also that our guarri
is normally effective.
Every year in Britain there are out-
breaks of food poisoning, sometimes only
family outbreaks, sometimes affecting
larger numbers through communal feed-
ing. An unnoticed staphyloccccal infection
on the hand of a worker in some whole-
sale food establishment can be the origin
of a substantial outbreak, of food produced
wholesaie is affected. Clostridial infection
of a batch of poultry, perhaps inadequate-
ly cooked and eaten cold after too siow
cooling, can eaually produce an outbreak
of this kind. We have much still to do
in applying the lessons we already know
to the better protection of food, but haa
we not already done a very great deal,
the growth of communal feeding and the
present wholesale and retail systems of
food distribution in Britain would certain-
ly have produced much more wide-spread
harm.
There has recently been much public
debate about the dangers of cholera in
Western Europe. In countries with a sound
sanitary organisation those dangers are
not serious. There could be local out-
breaks, but, given reasonable protection of
water supplies, not the kind of major in-
cident that has occurred so often in tropic-
al countries. What can happen without
sanitation has been all too sadly demon-
strated in Africa in the last vear. But the
solution there is essentially one of sanitarv
engineering. The relatively secure en-
vironment that our ancestors have pro-
vided for us has not not been provided by
the peoples of Africa and Asia or bv those
who should help them. There must one
day be a huge investment in securing
those populations too against the diair-
hceal diseases which used to be the scourge
of Europe in former centuries. They are
still sufficiently prevalent for British holi-
day makers to bving back from Southern
Europe, nearly half of all the new in-
fections reported in Britain each year
from typhoid, paratyphoid and poliomye-
litis. Except for the last, these are not
diseases we are yet able to prevent with
certainty bv immunisation or vaccination.
I look with envy at your record of total
freedom from tvphoid for over a quarter
of a century — but your people too go to
Southern Europe.
The first programme of active immunisa-
tion against disease was the practice, used
in a limited way, of variolation or infec-
tion with smallpox itself at a time when
least harm was expected. 175 years ago
last May, Edward Jenner, a doctor prac-
ticing in Gloucestershire, first artificially
inoculated a boy with vaccinia. From that
grew the world wide use of vaccination
as a primary method of preventing small-
pox. Last month the Expert Committee on
Vaccination in Britain advised that routine
vaccination of infants was no longer justi-
fiable because the WHO programme for
eradication of smallpox has made such pro-
gress that the risk of introducing smallpox
to Britain is now only a small fraction of
what it once was and may be almost
eliminated within perhaps 3 years, while
vaccination causes us from 3 to 5 deaths
every year.
This has been a twofold triumph over
certain human infections in the last 20
years. Primary immunisation against
diphtheria, tetanus, poliomyelitis, measles,
rubella, whooping cough and tuberculosis
is now general in Britain and many other
countries. The protection which can be
conferred against diphtheria, tetanus,
measles and poliomyelitis is virtually com-
plete. Considerable protection can be given
against tuberculosis by BCG. The reli-
ability of the protection against whooping
cough is less certain but is probably con-
siderable and rubella vaccine has been in
use too short a time for reliable conclus-
ions. It must be a continuing objective of
preventive medicine to maintain that prim-
ary protection, as it would still be in
Britain to vaccinate against smallpox if
there were not a real prospect that small-
pox would be eradicated. There could be
other vaccines to come, for instance
against mumps and more important in-
fective hepatitis. We can hope to control