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56
1944. Number of cases clinically diagnosed 16
Amongst these the number of inoculated children 2
The first child had been inoculated 12 months before, but had not
been tested. The other was alleged to have been treated years
before in another district. Both were mild cases.
1945. Number of cases clinically diagnosed 29
Amongst these the number of inoculated children 11
Of these eleven seven had been subsequently tested and found to
be Schick negative ; two others received the usual course of treatment,
but were not Schick tested, while the remaining two were
reported to have been immunised. All cases were mild in
character.

In nine instances diphtheria occurred in those who after inoculation
were found to be Schick negative. Another eight succumbed who had
received the recognised course of treatment. In all, including those
who had received one dose, only twenty-four cases occurred as against
146 in the total population and this although by 1943 substantially more
of the children under 15 had been immunised than were unprotected.
Not one of the thirteen deaths from diphtheria which occurred during
these five years took place amongst children who had been immunised.
When diphtheria did occur in an inoculated child, in all but one instance
the attack was of mild character. The one case recorded as being a
sharp attack was that in a child of 8 who was stated to have been
immunised at two years of age.
Schick Testing : The immunity of an individual to diphtheria is
largely dependent on there being sufficient anti-toxin circulating in his
tissues. A measure of the adequacy of this circulating anti-toxin is
determined by the Schick test by which a small amount of toxin is injected
subcutaneously. If there is sufficient circulating anti-toxin to neutralise
the toxin there is no reaction ; the person is said to be Schick negative
and is considered to be immune, by which it is understood that he can
at that time withstand attack by a dose of diphtheria organism to which
persons might ordinarily be exposed. If the amount of circulating antitoxin
is too small, though, un-neutralised injected toxin sets up a reaction
which is manifested by a small red mark which persists for some days.
This is the Schick positive reading, indicating susceptibility and the
necessity for further inoculation. Apart from reacting to the toxin, the