View report page

Both Convalescent and Adult Serum can be given in two ways, one by giving a full dose
to produce an immediate immunity which only lasts a few weeks to tide over the present outbreak,
or by giving a smaller dose to produce a modified attack which will be in most cases little
more than a passing inconvenience for 36 hours or so, but which will give a permanent immunity
to the individual injected.
During the current outbreak I have used Adult Serum with 100% efficiency but it must
be realised that in every outbreak there is going to be a certain number of children who are not
going to get Measles. The individual children who are going to escape cannot be ascertained
beforehand.
In the Public Schools the figure is round about 3 to 4%. In other outbreaks where there
is no possibility of control the figure is not accurately known, so that although the figure of 100%
which 1 am giving sounds almost incredible, it is the only way in which the figures can be
presented. In our own area in the two hospitals we have had complete prevention, that method
being definitely one of election. Outside in private practice both systems have been adopted,
where there have been young children in the family where a case has arisen. In some cases
there has been a deliberate policy of attenuation with a view to permanent protection.
Apart from our own district I have had the same complete success. During the last outbreak
over two years ago, in one of the oldest and largest preparatory schools in the country, of
which my son was Headmaster for some time, the)' had had 10 mastoids amongst 86 boys. I
promised that during the next outbreak, that is the present one, I would help if they would let
me know in time. I received a telephone message one morning to say that the previous night
a case of Measles had arisen.
I had been trying for some time to arrange with Dr. O'Brien, the Head of the Wellcome
Research Laboratories, to get into operation some scheme whereby adult serum was available at
once on the outbreak of the case. We had arranged that it should be obtainable from his pool,
provided that the individuals requiring it furnished from suitable cases sufficient adult blood to
provide the same amount of serum as was asked for.
In this case, Dr. O'Brien provided the necessary serum and the staff provided the necessary
blood. The 37 non-immune contacts were injected and no> further case has arisen.
In the case of this school I definitely advised giving a full dose for complete temporary
prevention rather than a smaller dose with a view to permanent immunity, by reason of the fact
that the outbreak occureed in the middle of the summer term when the boys were preparing for
scholarship examinations. Even a modified attack produced deliberately, whilst giving permanent
immunity, might irretrievably damage the boy s prospects in life by reason of not being able to
sit for his scholarship. I speak very feelingly as exactly the same thing happened to me when
my chance of a scholarship was as near certain as anything in this world can be, a sharp attack
of measles shortly before an examination being an absolute bar to entrance.
In a school of 50 boys a little further along the south coast, during the last outbreak they
had a record of 10 mastoids out of a total of 50 boys.
There is no need to stress what these abscesses, which occur in the cells behind the ear
just below the brain, mean to the Headmaster. His anxiety is ever present, the parents either
living in or near the school or are everlastingly on the telephone, and it can be but dimly appreciated
by those who are not responsible for a school what it means to the Headmaster in question
to be absolutely freed from any further cases of Measles.
Shortly afterwards I took a deputation from the Council to Lord Mayor Treloar's Home.
Sir Henry Gauvain informed me he thought he had a case of Measles. There is no need to stress
what Measles means in an institution of that kind with a number of T.B. cases and cripples of
all kinds. There is nothing which lights up old tubercular troubles in the same way that Measles
does in children.
The following morning I received a telephone message to say that the case was undoubtedly
one of Measles and he had 17 non-immune contacts. There were 16 doses of serum left over
from the school mentioned above and I was able to obtain one dose of convalescent serum through
Dr. O'Brien from the London Fever Hospital. The contacts were duly inoculated and no further
case arose.
Later on 1 was approached by the Medical Officer of one of our Public Schools as Measles
had broken out and there were 100 non-immune contacts. Owing to the season of the year, it
was advisable to try for permanent immunity with modified attacks rather than immunising the
whole number with a view to temporary immunity. At the time of writing the inoculation is
proceeding and beyond slight temporary upsets in some of the older boys, everything is proceeding
satisfactorily.
Whilst the immunity which I have been able to obtain is 100%, this must not be regarded
as normal, nor can I hope that it is likely to occur again, but for its occurrence I am grateful.
The third method is one which is being practised in America particularly and is by the use
of globulins from the blood extracted from fresh afterbirths. Personally I do not think that
this method, although the report is that the percentage immunity offered is high, is going to
21