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(3) That immunity bestowed by three injections of 1 c.cm. of T.A.M. is maintained at
the end of an average of 3.6 years in 93.1% of children, and that at the end of three years 19 out
of 20 children found to be naturally Schick-negative originally can be expected to have retained
that natural immunity, i.e., the Schick-negative state.
(4) The ideal time to immunise children from every point of view appears to be under
the age of 5 years.
(5) That T.A.M. is an antigen which can be relied upon to produce very few objectionable
reactions indeed.
(6) That children over the age of 7 years ought to be Schick-tested prior to immunisation
treatment, but that if circumstances demand it, the test might be omitted in those of 7 years
of age or under, Pseudo reactions in this age group being rare.
(7) That if all Schick-testing is to be abolished, a general practitioner will be wise in the
light of present knowledge, to adopt our method 2 in preference to modern and incompletely tried
'one shot' (alum toxoid) preparations, or even in preference to our method 1.
(8) That practitioners adopting this method (2) without any Schick-testing, have a duty
to their patients. It behoves them to explain clearly that one child in 20 may not have complete
protection.
(9) That no methods ought to be generally employed which produce excessive or unnecessary
reactions, and which have not been submitted to a really adequate clinical test as to their
merits over a sufficiently long period of time.
(10) It appears that immunising mixtures containing a small amount of serum are liable
to produce a certain amount of sensitisation, but that experience shows that this is not of any
serious extent.
ELWIN H. T. NASH.
GUY BOUSFIELD.
Diphtheria Antitoxin.—Boxes containing a Sterile Antitoxin syringe, and the necessary
dressings, etc., are kept at the Hounslow Police Station so as to be available in case of emergency.
During 1934, 49 vials of Antitoxin of 8000 units each were supplied to medical practitioners.
Smallpox.—No cases were notified during the year 1934.
Enteric Fever.—There were 2 cases notified during the year. One was notified from the
West Middlesex Hospital, and was a resident in this district.
Erysipelas.—Eighty-two cases of this disease were notified, of whom 61 were of cases in
the West Middlesex Hospital. Forty-seven were non-residents in this district.
Ophthalmia Neonatorum.—See page 60.
Puerperal Fever.—Twenty-three cases were notified. Twenty of these cases were notified
from the West Middlesex Hospital, of whom 16 were not usually resident in this district. One
case was confined in Queen Charlotte's Hospital, and two others in Nursing Homes, one of these
being removed to Queen Charlotte's Hospital for treatment.
Only one death occurred from Puerperal Sepsis.
Puerperal Pyrexia.—Forty-one cases were notified; 37 of these were notified from the
West Middlesex Hospital, including 29 who were not usually resident in this district
Encephalitis Lethargica.—One case was notified during the year.
Cerebro-Spinal Fever.—Three cases of this disease were notified. One was notified
from the West Middlesex Hospital, but this case was not usually resident in this district. Two
Military cases were also notified.
Acute Poliomyelitis.—Two cases of this disease were notified.
Pneumonia.—There were 205 cases notified—149 notifications were from the West
Middlesex Hospital. One hundred and seven were non-resident in this district.
Non-Notifiable Diseases.—Information respecting non-notifiable infectious diseases is
usually gained through notifications by the Head Teachers and School Attendance Officers. The
undermentioned table sets forth the numbers of such cases for the last six years:—
49