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-5-
number of persons were suffering from tonsillitis at the
tine and the child in question, who had previously been
immunised-, was one of three members of a family, all of whom
had tonsillitis. On swabs being taken this child was
shewn to. have diphtheria-like germs in her throat and
although she was so much less ill than the other two that
she was acting as their nurse, she was removed to hospital
as a suspected case of Diphtheria, though not notified as a
case. It is almost certain that the cause of her
tonsillitis was the same germ as produced tonsillitis in the
remainder of the residents of that locality.
Similarly in another part of the District, one child
in a family of three children, all of whom had been
im unis^d against Diphtheria, developed Scarlet Fever. The
following day a second child had a sore throat diagnosed as
tonsillitis. As, however, this did not improve as expected
the Doctor was called in again some days later and took a
swab which showed diphtheria-like germs to be present.
The child was notified as a case of diphtheria and removed
to hospital only 1 day before the third child was removed
with definite Scarlet Fever. Subsequently all three children
had the typical peeling of the skin which follows Scarlet
Fever> hence it was considered that the second child was
incorrectly diagnosed as having Diphtheria, having only by
coincidence carried the diphtheria-like germs at the time
he was swabbed. It would have been additional evidence
had it been possible to show that the diphtheria-like germ
found in these two cases was not capable of causing
diphtheria in a laboratory animal, but unfortunately in
neither case could the germ be found after admission to
hospital.
These cases are quoted at length in order (1) to
illustrate a condition which may occur more frequently as the
number of immunised persons increases and (2) to refute the
charge sometimes unjustly made that results are being
unfairly stated when such cases are not included as
suffering from Diphtheria.
To turn to the five confirmed cases among children,
three of these were children who had not previously been fully
immunised. (One had received only 1 injection some time
previously and failed to re-attend for the two further necessary
doses.) Two children had been both immunised and Schick
tested.
In passing it may be noted that the three unimmunised
cases occurred among an estimated population of 3,752 unimmunised
children under 15 years of age in the district (i.e. 1 in 1250),
whereas the two immunised cases were the only cases which are
known to have occurred among an' estimated total of 5,046
immunised children in the district under 15 years of age
(i.e. 1 in 2523). With such small numbers, however, nothing
should be deduced from these figures.
Useful lessons can and should be learned from the
two cases occurring among the immunised children, the first of
which is that, even when supported by the evidence of a
negative Schick test, clinical diphtheria can occur amongst
such children, although the risk of such an occurrence has been
reduced by immunisation. Further, unless suspected diphtheria
in a child who has been immunised is treated as promptly as it
would be in an unimmunised child a fatal result may occasionally
be experienced, as unfortunately happened in the first of these
two local cases. Parents, nurses and doctors alike should
have this possibility in mind. While Diphtheria Immunisation
should therefore be encouraged in view of the reduced risks of
contracting the disease and of a severe attack if the disease
does occur, nobody should imagine that because a child has been
immunised it cannot possibly develop diphtheria. If ill with
a suspicious tonsillitis it should be as promptly and adequately
treated as if it had never been immunised.
(The position with regard to immunisation in the
District is dealt with later in this Report.)