View report page

Case 14. F. Act. 9. Schick test 23.11.31 gave a strong positive reading. Two injections of
1 c.c. of T.A.M. were given 30.11.31 and 7.12.31, but the child did not put in any further appearance
Notified as suffering from Diphtheria 21.7.33. She was removed to one of the L.C.C. hospitals.
The report of the Medical Superintendent was :—' Admitted 21.7.33 (2nd day of disease.) Small
deposit on right tonsil. No discharges. 8000 units of antitoxin given. 22.7.33, throat clean.
Throat and nose swabs taken. 5.8.33 throat swab,Virulent K.L.B. Nose swab, no K.L.B. No
complications. Discharged 28.8.33.'
Case 17. Shortly after the closure of the five years, a medical man appeared at the Public
Health Department, just as it was closing on Saturday, reporting that a child who had three injections
of T.A.M., had a suspicious throat. The last injection had only been given a week
previously. On hearing a description of the case, I advised immediate removal. The Medical
Superintendent reported that the condition of the throat was such that in the case of an ordinary
child he would have given her at least 80,000 units intravenously. The child herself, however,
was not ill, and received only 8000 units, with a completely satisfactoiy result.
Class 4. Cases of Diphtheria among persons who might have been expected to be immune.
Case 11. M. Aet. 9. Schick test performed 22.2.30 gave a strong positive result. Three
doses of 1 c.c. of T.A.M. given 1.3.30, 14.4.30 and 28.4.30. Patient was subsequently shown to
have become Schick-negative. Patient removed to hospital 28.11.32. Medical Superintendent's
report:—' A throat swab outside was returned positive. The throat was inflamed and a few
points of exudate were seen on the tonsils. He was Schick-tested and found to be negative
2.12.32, upon which he was allowed to get up. Several successive throat cultures were positive.
He developed Scarlet Fever while in hospital, and was discharged 15.1.33 '
Tn this case it is worthy of note that the patient was only kept in bed on account of the socalled
Diphtheria for a period of 5 days, a truly remarkable instance of the protection of autogenous
antitoxin against Diphtheria toxaemia. Also an admirable example of the slightness of
the disease when it occurs in a conscientiously immunised person.
Case 16. F. Aet. 5. Schick tested 7.3.31. Slightly positive. Received three injections
of T.A.M., 14.3.31, 21.3.31 and 11.4.31 Re-Schick test 19.9.31 was negative. Child was notified
as suffering from Diphtheria 17.10.34. There were small paper-thin patches of yellow membrane
on enlarged tonsils, with a curly edge starting to peel off. The case was bacteriologically positive.
8000 units of antitoxin were given, and the child was not at all ill. This is again another striking
example of the slightness of an attack in a carefully immunised subject.
It is worthy of note that, in this experiment, we have advised parents to have the child's
Schick reaction checked at the clinic in a year or two after immunisation, with a view to finding
any possible backsliders, and re-immunising them. The last case was in a child whose parents
had not availed themselves of this advice, and in the previous case over two years had elapsed.
All the notifications have been investigated and described, as it is desired to make it clear
that there is nothing to hide.
In addition to the above two cases who have been immunised, a case was notified from
another Borough just before Christmas, 1934. This child had been Schick tested and found to
be naturally immune 21/2 years before. She had not come up for a re-test, having left the district,
and was admitted to hospital with what was described by the Medical Officer of Health of the
district, as a " very mild attack of clinical Diphtheria"
The only cases that really concern the actual experiment are the last three, vis., Class 4,
and the nature of these has been so harmless that they are encouraging rather than depressing.
Anything approaching a death in an immunised and Schick-negative child is quite unknown in
our experience.
It must, of course be admitted that the immunity afforded by the present Schick level,
though adequate as a protection against the 'mitis ' strains of K.L.B., may sometimes be expected
to break down when submitted to mass attack by the more virulent ' intermediate and gravis '
strains. Nevertheless, even when these grave infections are encountered, it appears to be the
case that actual life is not in danger, and that grave sequelae are extremely rare in persons who
have ever been immunised by any scientifically efficient process.
CONCLUSIONS.
(1) It appears that by thorough and careful work, Diphtheria can be practically stamped
out by active immunisation, and that fatal Diphtheria can be rendered non-existant, even in an
open community.
(2) A very definite advantage has been shown to result from the administration of a
larger third dose of T.A.M. (Method 2), as only 5% of subjects have been found to be incompletely
immunised as a result of this procedure.
48