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The above figures emphasize the necessity for conscientious re-testing of subjects after the
immunising injections.
13 children were Re Primary Schicked after 2 years and still found negative.
10 children were Re-Re-Schicked after 2 years and were found negative.
1 child was Re-Re-Schicked after 2 years and found positive and had 3 extra doses of T.A.M.
We are fortunate in that we have had no single case of clinical diphtheria among cases immunised
by us and certified to be naturally immune during the three years that this work has been in progress.
This is a magnificent record and one which we may not hope to maintain indefinitely. A few mild
cases of diphtheria must inevitably occur among large numbers of immunised persons over a long
period of time. Nevertheless, by thorough and careful work it is hoped to keep the number of such
apparent failures at a very low level. The failures which occur are due to variable levels of immunity
too technical to be discussed in this report. The simplest parallel is that sometimes a person can
resist a cold owing to an immunity to colds—while at another time that same person catches a bad
cold due to a temporary lowering of that immunity. So it is with diphtheria and we are acquainted
with the factors concerned.
When there has been any question of an immunised or certified child having an attack of
diphtheria the most complete investigations have been made and in no case has a diagnosis of clinical
diphtheria been justified.
Singularly few reactions have been reported by parents as a result of the immunising injections
of Burroughs Wellcome's T.A.M. In the case of one brother and sister we considered it advisable
to discontinue the injections on account of excessive reaction. This reaction was a peculiarity of
the blood and bodies of the two children.
This is proved by the fact that many other children inoculated with the same material experienced
no ill effect whatsoever. Reactions in children are most rare and the case of the above brother
and sister is unique in my experience.
In the case of one adult also it was thought better to discontinue the course of treatment on
account of reaction.
Viewing the results as a whole, both as regards last year and the whole time the work has been
in progress we have every cause to be completely satisfied with the results obtained.
In order to attract a still larger proportion of the population more rapidly, one or two things
would appear to be necessary, an epidemic of diphtheria, or the re-instigation of further active propaganda.
In view of the absence of epidemic diphtheria in the district there is every reason to be satisfied
with the steady flow of children to the Diphtheria Prevention Clinics. The standard of attendances
and the number of fresh cases coming for treatment continues to be superior to that obtaining
in other areas with which I am acquainted.
In this class of work the progress is inevitably dependent on two factors.
When the facilities are first provided there is a great demand for treatment by all those parents
who wish to do the best possible for their children. When this initial rush has been dealt with the
continuance of the work depends on the final appearance of procrastinating parents and the conversion
of those who are opposed to any form of inoculation.
Possibly the best stimulus of all is an epidemic of diphtheria. There is no more effective
urge than that of fear. ,
As is always found in this work the number of clinics gradually has to be lessened, while diphtheria
incidence is low, and the Saturday morning clinic at Isleworth had to be closed on 16th July,
1932 as a result of poor support. The Isleworth area has always been tardy of response to the facilities
as compared with Heston and Hounslow.
It was also found inadvisable to continue the Wednesday afternoon clinic and this was discontinued
on 29th June, 1932.
The Monday afternoon session has been found adequate to deal with the fresh cases, inoculations
and re-testing at present required.
It is however, desirable that children whose inoculation was completed 2 years ago should
be re-tested to ascertain that the immunity is still present, and it will probably be necessary to institute
a Saturday morning clinic once more in the near future to deal with this work which is of considerable
magnitude, but nevertheless essential.
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