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In all these except three, the disease occurred within a month
of the inoculation. In two the interval was five weeks, in the third
it was 8 weeks. In the child who died she received the first dose
on February 23rd, 1933, the case notified on March 17th and she
died March 22nd.
Of the children who received 2 doses, six developed diphtheria
in 1933 and 1 in 1934.
In 1933 one of the children died, 1 had a severe attack, one
a moderately severe and 3 were mild. The 1934 case was a moderately
severe attack.
In 1933, 12 cases were notified amongst children who had
had three doses.
Four of these were carriers only, two were very mild, 4 were
mild, and two were moderately severe. There were no deaths.
In only one of these had a sehick-negative reaction been
given. All the others occurred before thay were post-schicked,
although in one instance over seven months had elapsed since the
third dose had been given.
There were also five cases in those who had given a schicknegative
reaction. These were all mild cases. In 1934, five cases
occurred amongst those who had had 3 doses, 4 of these has given a
schick-negative reaction ; the fifth contracted the disease eleven
weeks after the third dose. They were all very mild cases.
What results can we hope for from this work? As far as we
are concerned, at the end of six months after the last dose, three
doses are for all practical purposes a protection against the disease,
though it is not an absolute protection. We have given all the
figures and we do not desire to exaggerate the results which can be
obtained. Certain questions remain obscure. The Schick test is
the most usual method of distinguishing between immunity and
susceptibility, and we cannot escape using the Schick test for want
of a better. It is impossible in the case of mass immunization to
estimate the anti-toxin present in the blood, and even if we could,
we should not know what exact amount would be necessary to avoid
an attack. This would only give us a measure of one of the factors.
But if the Schick test is negative, the person concerned probably has
at least 1/30 anti-toxin units per cubic centimetre of blood, and this
should usually be a sufficient protection. But schick-negative children
who showed an anti-toxin content of one of more anti-toxin
units per c.c. have been said to develop diphtheria. It is also possible
that a schick-negative who is immune from the milder form of diphth-