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41
In four cases the advice given was taken and the treatment continued until
the children were found to be free from diphtheria bacilli.
In five cases of persistent carriers tests for virulence were made; all these
cases were found to be avirulent.
The parents or others in charge of children harbouring diphtheria bacilli were
given written directions as to the precautions necessary; these are detailed
below:—
1. Until the Holborn Health Department or the London County Council
notifies the parent or guardian to the contrary, attendance of the "carrier" at
day school, Sunday school, cinemas, theatres, music halls, teas or treats or any
gatherings is forbidden. The child must be kept away from all other children
and no other child be allowed to visit the house.
2. The child must sleep by himself or herself.
3. Special cups saucers, plates, spoons, knives and forks should be reserved
for the use of the carrier and washed up separately after the others have been
washed up.
4. The child should use pieces of rag instead of handkerchiefs. These
rags should be burnt as soon as possible.
5. No books belonging to a public library should be read by the " carrier,"
or any book which the parents or guardian are not prepared to destroy or have
disinfected by the Public Health Department.
The results of the examinations of child contacts were communicated to the
School Medical Department of the London County Council so that children
harbouring diphtheria bacilli could be kept from school providing there were no
evidence that the organisms were avirulent.
Diphtheria anti toxin was supplied free of charge on application by medical
practitioners. During the year it was supplied in 15 cases.
The Schick Test and Immunisation against Diphtheria.
The Schick test is made by injecting a minute amount of diluted diphtheria toxin
into the skin, the skin of the forearm being usuallvselected. If the person is immune
to diphtheria, that is to say, if his blood contains substances that neutralise the
toxin that is injected no change occurs, but if his blood does not contain this
anti-toxin a small rose coloured spot appears at the point of injection and persists
for a few days; little or no discomfort is caused.
We know that all persons are not susceptible to diphtheria. The value of
the Schick test lies in its selecting those who are susceptible to the disease so that
they may be immunised by a mixture of toxin and anti-toxin.
At, and for a short time after birth very few children (probably less than 10
per cent.) are susceptible to diphtheria infection on account of the anti-toxin
which they have absorbed from their mothers. This natural immunity rapidly
diminishes until, at the end of a year, positive Schick reactions show that threequarters
of all children are susceptible. As the result of repeated small doses of