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Reactions.
Our experience is that the reaction after the injection of the toxin antitoxin and
toxoid antitoxin is in practically every case negligible. All we have to record is that
in one child considerable swelling of the whole of the arm occurred, but the next day,
when at the centre, she was running about and helping the other children eat their
cakes; the swelling went down without any further result. Another, a boy of 10 years
of age, his mother informed me, suffered with vomiting after each of his three
inoculations and spent the next day in bed, but he and his mother stuck to it, and he
was subsequently proved to have been satisfactorily immunised. In another child, a
small, hard, slightly tender nodule developed above the external condyle, but the
tenderness only remained for a few days.
The use of toxoid antitoxin does away ivith the risk of fatality incurred by
using improperly made toxin antitoxin.
What of the Future?
Most of the attendances are the result of repeated efforts of persuasion and
encouragement. Prejudice against inoculation is widespread; some of the most
stubborn opponents of inoculation admit that if T.A.T. could be given in tabloid form
or in spoonfuls they would agree to it. They object, in fact, to the introduction of
animal products by means of a hypodermic syringe into the human body, but continued
propaganda is sure to produce its results.
The aim of everyone who takes up the work must be to get all the children living
in the area immunised as soon after they reach the age of 6 months as possible. In
Holborn we have not reached this stage yet; the history of vaccination against smallpox
suggests we never shall. But a local health authority is justified in considering
that it has done all in its power to prevent loss of life and illness from diphtheria if it
offers immunisation.
It might be expected that if the immunisation were carried out among the
school population in a large town the parents would come to regard the procedure
as more ordinary, and be prepared to allow the younger children to be immunised
at infant welfare centres. Apparently it cannot be too often repeated that it is
immunisation at a very early age that we want carried out; if it is delayed till
school age half the deaths will have occurred. In London during five years
1921-25, of the total deaths from diphtheria, 57 per cent. occurred under five years
of age. Certainly if the immunisation could be completed at one visit the energy
spent in looking up those failing to attend could be used in getting new recruits,
and the parents would be spared much trouble. At the present time efforts are
being made to produce a substance which can be used to ascertain the susceptibility
of the individual and at the same time to give some degree of immunity.
Obviously experiments on these lines would seem to be concerned with the use of
toxoid as opposed to a toxoid antitoxin mixture, but the methods used up to the
present do not produce a toxoid of sufficiently uniform strength to enable it to
be used for routine immunisation. There is, however, much probability that this
problem will shortly be solved.