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children are being brought for treatment while still young and in
a highly susceptible state. While it would be preferable to see
the earlier age groups attending in larger numbers, the result is
by no means unsatisfactory.
It must be borne in mind that in work of the description
done at the Clinic many attendances (approximately five from
first to last) on the part of parents and children are necessary,
it is therefore almost inevitable that some of the subjects will
fail to come up three months after the protective injections for
re-testing to make certain that satisfactory immunity has been
produced. At the same time, a very satisfactory number of the
patients have been brought up to be re-tested and certified
immune, and the results of this have been most encouraging. It
is quite justifiable to state that the majority of those who fail to
come up for re-examination are satisfactorily immunised, though
of course they have not received an immunity certificate.
After-history of cases immunised.—The results of those cases
observed from first to last have been most encouraging, leaving
no doubt that the work is extremely satisfactory and we'll merits
the trouble involved. No child immunised at the Clinic has died
of diphtheria. Considering that most of the children are drawn
from homes where contact with the disease is a frequent occurrence,
this absence of fatal diphtheria must be regarded as of
some real significance.
In only one instance has a child considered to be immune
contracted diphtheria, and the disease was of so mild a form that
it was overcome by the small patient in a few days without treatment
of any sort and with no ill effects to the child.
The attack was not severe, and the child was proved still
to give a negative Schick reaction by a further test made at
the onset of the disease. The case was fully investigated by
me at the time, and though I was completely satisfied that
the attack was one of mild diphtheria, it was on my advice that
no diphtheria anti-toxin was given in the treatment. It appeared
to me that the patient had adequate resistance provided by the
anti-toxin which we had proved was alreardy circulating in his
blood.
An analogy to the above case may be found in the consideration
of a very powerful attack on a secure fort. However strong
the defence is, if the attack be sufficiently powerful, some damage
to the fort must occur, at any rate as regards the outer walls.
When, however, the internal defences are adequate the breach is
soon repaired without external aid, and the fort does not fall,
but is soon as sound as ever.
This instance is strictly comparable with the case of the
above-mentioned child, who, as a result of three injections of
toxoid anti-toxin, had been rendered immune to the effects of
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