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still far too small to affect to an appreciable extent the incidence
among the population. In the closed communities like the residential
schools, however, diphtheria has now been conspicuous by its
entire absence for several years with the one exception, D.H.
mentioned later on. In view of the greater efficiency of alum
precipitated toxoid compared with toxoid antitoxin mixture
shown in the annual report of 1936, both clinics now use the former
almost exclusively.
The following cases are recorded who, after immunisation, were
admitted to hospital suffering from diphtheria.
R.P., male, aged 7 years. Admitted in June three days after
the onset with the diagnosis of modified diphtheria in a partially
immune subject. The condition was resolving naturally but after
serum the throat was clear in 24 hours. The child was immunised
in 1931 and the retest was negative in August, 1931, when he was
under 2.
C.B., female, aged 3 1/12 years, admitted with notification of
diphtheria. The diagnosis was altered to tonsillitis as cultures
were negative with no clinical signs of diphtheria. Immunisation
had been completed and the retest was negative two months before.
D.H., female, aged 16 years, a typical case who cleared up
within 24 hours after 40,000 units of anti-diphtheria serum had
been given intravenously. She had been schick tested nine years
previously and found then to be immune. Ten days after the
administration of the serum a virulence test of the organisms
proved positive and a week later she suffered from an attack of
tonsillitis and 20,000 more units of serum were given.
J.M., male, aged 8 years, admitted with the diagnosis "a mild
case of genuine diphtheria." The attack cleared up rapidly with
serum treatment. The child had been immunised and on retest
was negative two months only before admission to hospital.
These four cases are examples of the possibilities now generally
realised which may occur in those who have been treated and
are believed to be immune.