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German Measles
This complaint, which is something quite distinct from the ordinary
type of measles, most often appears when ordinary measles is prevalent,
but sometimes it appears by itself. Of the 135 cases learned of, one-half
were from one school. In none of the schools at which there were these
cases was the ordinary type of measles prevalent at that time.
Tetanus
The organism which causes tetanus is one whose natural habitat is
the alimentary tract of horses, cows etc. Infection occurs by the introduction
of the organism through a wound in the skin. The special risk
is when the wound contains soil from land which has been contaminated
by the organism, but the risk is there from many injuries, especially deep
ones, because the organism is an anaerobe. As a protective against the
infection there is a toxoid which can be given to a normal person to
produce active immunisation, or the serum which can be given to ward
off the attack in one with injuries. Those in the Army are given
this toxoid which protects them for many years; in addition those wounded
receive anti-serum. This was given as a routine to those injured in the
raids in the last war even though the wounds were clean. There are not
many cases in this country; the exact number is not known, as the complaint
is not notifiable; perhaps it is about 200 annually, of which forty
per cent, are fatal. For the years 1945 to 1953 there were between 60 and
80 deaths each year, but for each of the next three years the numbers
were between 30 and 40. These are deaths ascribed to the complaint.
The exact number of deaths, though, is not known because the assignation
of a fatality which is the result of an injury in which tetanus has occurred
depends on the severity of the injury. If it is trivial, then the death is
ascribed to tetanus, whereas if it is severe the death is ascribed to the
injury. Whatever the number, though, most of these deaths could have
been avoided had the person previously been actively immunised. This
is a more practicable procedure than relying on the giving of serum to
those who have been injured, because inevitably there will be the large
numbers of minor injuries which are not treated by doctors and where
no anti-serum will be given. Up to this, the question has not been one
of public health interest; but now it has become one, because of the incorporation
of tetanus toxoid with the toxoids of diphtheria and whooping
cough in a single vaccine. As this entails giving no more injections than
the procedure to give protection against the other two infections, it would
seem that there is little point in not using the combined preparation. But
about one point further assurance is needed. In the case of diphtheria
and whooping cough, it was found that each toxoid enhanced the effect of
the other when they were given together; but when tetanus toxoid is
added, it may be that some of the potency of the others is lost. If this
should be the case, then, the gain of acquiring protection against the
remote chance of infection by tetanus would be at the expense of the
efficacy of the preparation against the other two complaints. Another
point is that for the time being many are reluctant to use the combine
vaccine against whooping cough and diphtheria because of the risk of
provocation poliomyelitis. Until this difficulty has been got over, it is