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it could achieve. While recent vaccination is a certain protection, this
high degree of immunity falls with the passage of time. A person vaccinated
years ago, then, can succumb to smallpox. The lesson has been learned
by most, and from the first, care had been taken to emphasize that protection
against diphtheria wanes, and that immunity to-day does not
necessarily indicate a permanent inability to contract the infection.
More than this ; it is realised that while a certain dosage is effective in a
very high proportion of children in conferring immunity, it is not effective
in all, either because of something peculiar to the child, or because of the
surroundings in which he has been brought up. Conferring immunity,
then, connotes injections of adequate amounts of a suitable preparation
in properly spaced doses, and this is followed by a test to determine that
the Schick state is negative. Even this is not the whole story. An infant
inoculated and even found Schick negative at one year of age might be
brought so seldom into association with the diphtheria organism that
by the time he is due to enter school his immunity might have seriously
waned. For this reason it is recommended that infants immunised at
about one year of age (the desirable age because of the risk they might
shortly be exposed to at a time when they have lost their natural immunity)
should receive a further dose before entering school so that they are
fully armed before they are exposed to the further risks. When advocating
protective measures then, it is not held out to the parents that their
children if treated cannot in any circumstances contract infection—rather
that the risk of their contracting infection is substantially reduced, and
the risk of their contracting fatal infection almost eliminated.
The following statement summarises the instances in which diphtheria
has occurred amongst those who have had, or are alleged to have had,
protective inoculations against diphtheria :
1941. Number of cases clinically diagnosed 39
Amongst these the number of inoculated children 1
A mild case who had received 01 and 0.3 c.c. A.P.T. but had
not been Schick tested.
1942. Number of cases clinically diagnosed 51
Amongst these the number of inoculated children 6
Of these one child received one dose of A.P.T. two weeks before
and another child one dose four months before the onset of illness.
A boy of 8 had been inoculated at one year of age. A girl of 12
had been treated in 1939 ; one of 13 in 1936 ; neither had been
Schick tested. The last was a boy of 5 inoculated and found
Schick negative in 1939. All these were very mild cases.
1943. Number of cases clinically diagnosed 40
Amongst these the number of inoculated children 4
The first was a boy of 7 inoculated in 1941, and found Schick
negative in 1942. A baby of 15 months inoculated in January
not Schick tested fell ill in January. Both were very mild cases.
A boy of 3 who succumbed in February had received one dose in
October, 1942. The remaining case was the only one to have
a sharp attack of illness, a boy of 8 who was alleged to have been
immunised at the age of two.