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It is extremely difficult to understand how the above case ever came to be certified as
Diphtheria at all.
Case 3. M. Act. 10. Schick tested 3.5.30 and found to be positive. Received first immunising
dose of 1 c.c. of T.A.M. 10.5.30. Was notified as a case of Diphtheria 26.5.30. Treated at
home and discharged as well 4.6.30. A cure effected in nine days hardly appears to confirm a
diagnosis of clinical Diphtheria.
Case 9. M. Aet. 5. Schick test 21.6.30 was markedly positive. Received three injections
of 1 c.c. of T.A.M., 28.6.30, 5.7.30, and 19.7.30. A re-Schick test 11.2.31 proved still to be positive
and two extra doses of 1 c.c. of T.A.M. were given 18.2.31 and 4.3.31. The child did not attend
for a subsequent Schick test. The Medical Superintendent's report was:—'Admitted 11.11.31
with a history of nasal discharge since 9.11.31. This was swabbed at home, and reported by the
Health Office to be doubtful. (The organism was subsequently found to be virulent.) The child
was said to have been immune to Diphtheria, but had been resistant to immunisation. The throat
was slightly injected on admission, and there was a watery nasal discharge, with sores on both
nostrils and upper lip. Throat and nose cultures taken 11.11.31, 15.11.31 and 20.11.31 were all
negative. The Schick test was negative. The child was allowed up on 16.11.31 and discharged
21.11.31.' It will be observed that his stay in hospital amounted only to 10 days, and that no
K.L.B. could be demonstrated after three successive attempts by the hospital authorities. The
grounds for calling this a case of clinical Diphtheria appear to be scanty indeed.
Case 15.M. Aet. 7. Schick tested 29.6.32. Result positive. Received 1 c.c. of T.A.M.
11.7.32. Was admitted to hospital with Scarlet Fever 18.7.32. Found on examination to have
K.L.B. in nasal swab. Throat was injected, but there was no membrane, nor was there nasal
discharge. 2000 units of antitoxin were given. All other swabs were negative to K.L.B., and
he was discharged 25.8.32. Further immunising doses of 1 c.c. of T.A.M. were given 7.11.32
and 14.11.32, and 1.5 c.c. on 28.11.32. Re-Schick 1.5.33 was negative. There appears to be no
ground whatever to regard this as in any way more than a transitory nasal carrier, possibly of
non-virulent K.L.B., for this patient was known to have been Schick-positive within a fortnight
of the discovery of the organisms. If he had been carrying virulent bacilli, he would presumably
have contracted clinical Diphtheria, which he did not.
Class 3. Cases apparently suffering from real clinical Diphtheria at such a time as
immunity could not have been expected to have developed.
Case 1. M. Aet. 8. The patient had had only two of the necessary three immunising injections
of lc.c. of T.A.M. on 17.3.30 and 24.3.30. Was notified as suffering from Diphtheria
22.4.30. Was discharged from hospital 19.5.30. Received a further inoculation 23.6.30 and
when Schick tested 17.1.31 was found to be very positive. Two further injections were given
24.1.31 and 7.2.31 and the patient was re-tested 9.5.31, and was found to have become Schick
negative.
Case 4. F. Aet 6. Was Schick tested 19.5.30 and found to be positive. Received first
immunising dose of T.A.M., 26.5.20. Was removed to hospital suffering from Diphtheria 29.5.30
and died 2.6.30.
Case 5. M. Aet. 10. Patient was Schick-tested 31.5.30 and found positive. Received two
immunising injections of 1 c.c. of T.A.M. 4.6.30 and 11.6.30. This patient was admitted to the
West Middlesex County Hospital 1.7.30, having been taken ill 24.6.30, and was notified by the
hospital authorities on 2.7.30.
Case 6. F. Aet. 6. Tested 7.5.30 and found Schick-positive. Three injections of T.A.M.
(1 c.c.) were given 14.5.30, 21.5.30 and 4.6.30. Was notified from bacteriological examination on
8.7.30 as suffering from Diphtheria. Patient was swabbed as a result of a discharge from the
nose of some weeks' duration. The culture of K.L.B. was found to be virulent.
Case 7. M. Aet. 2. Tested 26.4.30 and found to be positive to the Schick Test. Two
injections of T.A.M. (1 c.c.) were given 3.5.30 and 10.5.30. Was notified as suffering from
Diphtheria 11.7.30. Discharged from hospital 13.8.30 The third injection of T.A.M. was given
27.8.30, and a re-Schick test 17.10.31 proved to be negative.
Case 10. M. Aet. 2. This patient gave a positive primary Schick test 21.3.32, and received
two injections of T.A.M. (1 c.c) 21.3.32 and 28.3.32. Notified as suffering from Diphtheria
5.4.32, and remained in hospital until 2.5.32 Subsequently re-Schicked 1.5.33 and found to< be
still positive. Given 1 c.c. of T.A.M. 8.5.33 and 1.5 c.c. on 22.5.33. Did not subsequently reappear
for Schick testing. Medical Superintendent of Hospital reported :— Admitted 4.4.32
with a history of one day's sore throat. He had a fair-sized membranous patch on the left tonsil,
and several small patches on the right, with some glandular enlargement. He received 8000 units
of antitoxin, and a Schick test was done. The throat culture was negative, but the culture from
the nose showed K.L.B. On 6.4.32, as the throat was not clearing well, 8000 units were again
given. A culture taken from the throat at this date proved positive. On 9.4.32 the throat was
quite clear, and the Schick test proved negative. He was kept in bed until 23.4.32. Further
cultures 22.4.32, 26.4.32 and 30.4.32 were all negative. He was discharged 2.5.32.'
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