Although modes of communication have changed over time, the need for educating the public about has persisted since the introduction of immunization. Through pamphlets and verbal endorsements to public campaigns and the efforts of governmental agencies, immunization and widespread disease treatments have been largely encouraged. Public health efforts were enacted to heighten immunization rates, and other preventative measures, and recommend treatment approaches for a sometimes hesitant public. One physician, Franklin Royer of Philadelphia’s Municipal Hospital, was so adamant about making antitoxin treatments for those infected with diphtheria more widely and quickly administered that he issued this public announcement: "[t]he time to give it is when you have clinical evidence of diphtheria. Do not await a culture report; do not wait to see if you will have severe diphtheria. Give it at once.”