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ONLY TWO MILD CASES IN IMMUNISED CASES BELIEVED TO BE IMMUNE,
AND ONE MILD CASE IN A NATURALLY SCHICK-NEGATIVE CHILD WHO HAD
REMOVED FROM THE DISTRICT AT THE TIME OF THE ATTACK.'
The Diphtheria incidence among children passed through our hands amounts only to:—
0.06% of all cases tested who received certificates stating that they were believed to be
immune to Diphtheria.
The investigation about to be described was conducted as follows:—
Every new case attending the clinic was Schick-tested irrespective of age. A careful record
was kept of the size and intensity of all the positive or pseudo reactions.
The Schick-positive cases received three injections of T.A.M. by one of two methods.
Method 1.
1 c.cm. was given, followed by 1 c.cm. in 7 days time. A third injection of lc.cm. was
given a fortnight after the second.
Method 2.
This modification, which was employed on a separate series of cases, was identical except
that the third injection consisted of 1.5 c.cm. of T.A.M. instead of lc.cm.
Three to four months later all subjects were sent for in order that they might be re Schicktested.
Any found to be still positive received further injections and, after an interval, further
Schick tests, the procedure being continued in each case until a Schick-negative state was attained.
Cases have been called up again after an average interval of 3.6 years from the date of
their original immunisation, in order that they might receive a further test, and if necessary,
further immunising injections.
Naturally Schick-negative cases have also been re-investigated from 3 to 6 months after
their original Schick test, and also a number were examined at the end of three years. By such
means the exclusion of Diphtheria from this community of thoroughly treated persons was
attempted.
It may be noted at this point that reactions of an undesirable nature in children treated
with T.A.M. (given by deep intra-muscular injection into the upper arm) are rare and trivial.
In only two cases during the whole of this work has it been necessary to abandon the attempt to
produce active immunity on account of excessive reaction, and curiously enough these two cases
were brother and sister. Both appeared to have an extraordinary idiosyncracy to the immunising
material, which has not been met with by us in other children.
Turning to the actual results of the investigation, the figures are given below of the reactions
obtained in 5203 primary Schick tests, divided into their various age groups.
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