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A study of these graphs reveals at least one point of interest. However one looks at them,
the fact emerges that the ideal time at which to undertake active immunisation is under the age of
5 years.
Taking the Schick-Test table dealing with primary tests it will be noted that nearly all
children are susceptible to up to this age.
The tables dealing with the results of immunisation courses show that the response to
active immunisation is, on the whole, definitely more reliable before the age of 5 years than at a
later time in childhood.
The result of Schick tests made 3.6 years after immunisation shows that this early-bestowed
immunity is relatively well maintained.
The greatest consideration of all however lies in the fact that Diphtheria is particularly
liable to be fatal to young children. On this ground alone immunity should be conferred as earl)''
as possible in life.
It is therefore particularly gratifying to find that the experimental work indicates that it
is also expedient from a technical point of view to commence active immunisation at a very early
age.
It will now be of interest to consider the extent to which these measures have been successful
in preventing Diphtheria among those children whose parents have sought the protection of
the clinics, and to compare the incidence of the disease with that which has occurred among the
children of the incredulous or lazy section of the population.
During the five year period, 17 cases which have attended the Immunisation Clinic previously
have been notified as suffering from Diphtheria. These notifications have been made either as
the result of a positive swab being obtained from the patient or because of the opinion of a doctor
on the clinical appearances alone.
A careful examination of such cases has been made as far as was possible, and the history
of each is given under an appropriate heading.
It is unfortunate that in the Hospital to which the majority of these patients has been sent,
the notes previous to 1931 are not of great value, but the records of these cases are included.
Class 1. Cases proved not to have any evidence of Diphtheria at all.
Case 8.F. Aet. 10. Notified 10.11.31. Withdrawn as a case of Vincent's Angina. The
Medical Superintendent's report on this case is :—' Admitted 9.11.31. Said to be the first day of
illness. Had a thick whitish patch of membrane on either tonsil, with moderate enlargement of
cervical glands. Received 20,000 units of antitoxin. No K.L.B. were found in the swabs of
throat and nose taken 9.11.31 and on 10.11.31. A direct smear proved the case to be one of
Vincent's Angina. Discharged 20.11.31.' Duration of stay in hospital 11 days.
Case 12. F. Aet. 6. This child was Schick tested first on 30.9.31. Result, strongly positive.
Received two doses of 1 c.c. T.A.M. 7.10.31, 14.10.31, and one dose of 1.5 c.c. T.A.M. 28.10.31.
A re-Schick test done 16.3.32 was negative. Was notified as suffering from Diphtheria 8.3.33.
Was admitted to hospital 8.3.33 with a history of headache and sore throat since 3.3.33. The
throat was very inflamed and the tonsils enlarged. There was no membrane. Cultures from
the nose and throat were negative 8.3.33 and 10.3.33. A Schick test was done on admission, and
this proved to be negative. No serum was given. Discharged 13.3.33. Duration of stay in
hospital 5 days.
Case 13. F. Aet. 7. Notified 16.3.33 as a case of Diphtheria. Had been Schick tested
24.2.30 and found positive. Was given three injections of T.A.M. (1 c.c.) 26.3.30, 2.4.30, and
16.4.30. A re-Schick test on 27.9.30 was negative. The Medical Superintendent's notes are:—
' Admitted 16.3.33, with a history of sore throat for three days. The tonsils were almost covered
with a patchy membranous-looking exudate. There was very little glandular enlargement. The
smell was strongly suggestive of Diphtheria. 4000 units of antitoxin were given, and a Schick
test was done. The throat was clear in two days, and cultures taken 16.3.33 and 18.3.33 were
negative. The Schick test was also negative, and she was discharged on 20.3.33. Duration of
stay in hospital only 4 days.
Class 2. Cases suspected to have been Diphtheria in which the provisional or subsequent
diagnosis is very doubtful.
Case 2. M. Aet. 8. The child was Schick tested on 23.4.30, the result being doubtful. Was
notified 29.4.30 as suffering from Diphtheria, from the Princess Louise Hospital, Kensington,
where the child was under treatment for Rheumatism, a swab having been taken from its nose.
The case was supposed to be a nasal carrier, but as the swab proved to be negative, there appears
to be no ground even for this diagnosis. The child was discharged from hospital 12.5.30, and a
Schick test performed 28.8.30 was found to be faintly positive. This child was subsequently
immunised and found to be Schick-negative after two injections of T.A.M.
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