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103
APPENDIX.
Diphtheria—The Schick Test.
Report of the Medical Officer of Health.
Diphtheria was known to the ancient Greek physicians Aretaeus
and Galen. It was first accurately described by Home in 1765,
but it was the French physician Brettoneau who showed in 1821
that Angina Suppurative "Cynanche Maligne" and other forms
of malignant sore throat were one and the same disease, to which
he gave the name " la diphtherite." It was not however, until
1884 that the specific organism was discovered by Klebs and
Loeffler. Following on the discovery of the causative germ,
diphtheria anti-toxin was in the year 1890 introduced by Behring
and Kitisato, but it did not come into general use until 1895.
Unfortunately its action is often materially affected by delay in its
administration due to neglect either in calling in medical assistance
in time, or to difficulties of diagnosis in doubtful cases. In this
connection the " carrier " is a fertile source of danger and difficulty,
particularly during epidemic prevalence, and much time and trouble
is experienced in following up and tracing these cases and contacts.
It is evident, therefore, that while the discovery of the
diphtheria germ and the introduction of anti-toxin have greatly
improved our knowledge and methods of treatment, and, to a certain
extent of prevention in Diphtheria, there is still a high incidence
and mortality from the disease in this country. It is fortunate,
therefore, that recent scientific developments such, for example,
as the Schick Test, have considerably advanced our knowledge in
regard to preventive measures against diphtheria and other dangerous
infectious diseases.
Diphtheria is one of the most dangerous infectious diseases
of child life, and its most deadly effect is on the age group under
five years of age. It levies a heavy toll yearly amongst the child
population, and apart from the danger to life during an attack,
it further frequently leaves in the case of surviors serious damage
to the constitution and more or less permanent physical disability.
Although owing to the discovery of the specific organism or germ
responsible for the disease and the consequential universal application
of anti-toxin as a remedy, the death-rate from diphtheria has
greatly decreased in recent years, there is still a heavy mortality,
and, furthermore, the incidence of the disease relatively speaking
shows little diminution. The causes mainly responsible for this
unsatisfactory position are:—
(1) The presence of "carriers," i.e., persons while not
themselves suffering from clinical evidence of the disease,
harbour the germs in the air passages or elsewhere in the
system, but who are capable of transmitting to more susceptible
individuals the disease.