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It is a matter for concern that so many children did not re-attend
for the Schick test in spite of repeated requests. The feeling of
security engendered by the three inoculations is sometimes unfounded,
and it is essential that in every case a Schick Test should be performed
to see whether or not complete immunity against Diphtheria
has been established.
There were three instances of alleged diphtheria in children who
had been immunised. Details of these cases are set out below.
(1) A child aged 3¾ years, who was immunised with 1 c.c.
of Toxoid Antitoxin (Goat) on 4th February, 1936, 18th February,
1936, and 3rd March, 1936. No Schick test was performed. She
was notified as suffering from nasal Diphtheria in September,
1936, and admitted to Hospital. The Medical Superintendent
reports that the child was not suffering from clinical diphtheria
but was merely a carrier.
(2) A child aged 4½ years (sister of the above) injected on
the same dates, was notified as nasal Diphtheria in October, 1936.
There was no clinical evidence of diphtheria on admission to
Hospital, where all throat swabs were negative. The Medical
Superintendent reports that this was not a case of diphtheria and
that it was not certain that the child was even a carrier.
(3) A child aged 6 years. Toxoid Antitoxin was injected on
1st May, 1936, 15th May, 1936, and 29th May, 1936, but the parent
did not bring the child to the clinic for a Schick test when
requested. She was notified as a case of diphtheria on 26th
January, 1937. On admission to hospital she had a minimal
amount of exudate on both tonsils and from this C. diphtheriæ
of the gravis type were isolated. A diagnosis of mild faucial
diphtheria was made. There were no complications. This case
illustrates the necessity for Schick testing all children after
injection. The three injections of toxoid antitoxin did, not
apparently establish complete immunity to diphtheria in this
instance, but there is no doubt that they resulted in the attack
being of a very mild nature, without any of the dangerous
complications or sequelæ which so frequently accompany this
disease.