London's Pulse: Medical Officer of Health reports 1848-1972

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Acton 1936

[Report of the Medical Officer of Health for Acton]

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high up into the left forearm and fourfold toxin lower down i s the left forearm. Results were read on the third day.

Years of Age.Total
No. tested6123142935386262496859668511
Neg. both toxins6123132728274951386042506402
Pos. both toxins-----13131474-24
Pos. only with 4-fold, negative ordinary toxir---125611781286167

It will be seen that of the 511 eases tested, 24 were Schick positive
by the ordinary testing, but 91 were positive when fourfold toxin
was used. In other words, by ordinary methods only rather under
5% of cases gave positive reactions, while with fourfold toxin
17.8% gave positive reactions. The total number of Schick positives
is smaller in both cases than would be expected in an open
community, as included in this total were many children who were
being tested 3 years after primary inoculation.
It was not felt that the position was satisfactory. There
are no figures available—indeed the time during which the stronger
toxins have been used has not been long enough to show of the
strength of toxin necessary to ensure that a negative reaction is
synonymous with complete protection. With a fourfold testing
toxin, three times as many children appeared to be susceptible to
Diphtheria, with a tenfold toxin the number might again be trebled,
but even then we have no proof that those children rendered
negative to such a toxin would possess a 100% immunity.
With a test at our disposal, which is not of reliable index
of immunity against Diphtheria, what, it was thought, of the false
sense of security which might dull a highly "immunised" community
to the possibility of their children meeting and falling victims to
a virulent outbreak from outside? From an administrative point
of view the position looked alarming. It is possible, and has to a
large extent been done in Acton, to crush Diphtheria almost out
of the young population so that no longer in their ordinary lives
do the children meet the small sub-clinical doses of infection which