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admission to hospital. When examined in hospital the membrane
was seen to cover the tonsils, palate and posterior pharyngeal
wall; the glands of the neck were greatly enlarged and patient
had the " poisoned look " which signifies a severe attack. Diphtheria
antitoxin was given in massive doses (432,000 units) by
intravenous drip apparatus and by intramuscular injection ; also
glucose and daily injections of cortin (suprarenal Cortex extract).
Precocious (early) paralyses of 6th nerve (eye muscles) and palate
occurred in the first week of disease —a rare happening and a
further indication of an unusually virulent form of diphtheria.
These paralyses only lasted for a few days and none of the later
and more usual forms of paralysis appeared. Convalescence was
slow but uneventful and recovery was complete.
"It is exceptional for Schick negative subjects to develop
any form of diphtheria, but an unusually virulent type of germ,
may in rare instances, attack a person who is immune to the
ordinary varieties of the disease. Even when this does happen
our experience shows that those whose negative Schick test
indicates the power to resist infection only suffer from a mild
attack. The case described above is therefore most exceptional,
but it illustrates the fact that even if an immunised subject
should develop a grave infection there is still the possibility
that the patient may have sufficient resistance to turn the scale
in his or her favour.
" My view of this case is not that it was one of the rare failures
of diphtheria prevention, but rather that it was an example of a
patient whose natural susceptibility to diphtheria could not be
completely overcome even after two immunising courses. That
the injections stood her in good stead is suggested by the outcome
of the case. This view is supported by our experience of another
Bermondsey patient whos is now in hospital.
" This paticular patient was never Schick tested, but a parent
was a tuberculosis subject and her family doctor thought it would
be a good thing for her to avoid any infectious diseases which
might weaken her resistance and predispose to the parents'
infection. He therefore gave her a series of immunising injections