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DIPHTHERIA IMMUNISATION.
With this report ends my official investigations into the prevention of Diphtheria, which
have been carried out all along with the help of Dr. Bousfield.
Nowadays the tendency is for the general practitioner to do this work and criticism is
being levelled at those who advocate the work being carried out by anyone other than general
practitioners. In the early days I advocated the appointment of Dr. Bousfield as one of the best
authorities, if not the best, on this matter in order to make the factor of safety as high as possible
so as to ensure that there was no set-back to the work which we were undertaking.
That this policy has been of value is shown by the fact that in all the years this work has
been going on we have not had a single disaster of any kind whatever. As I have reported
before, we had a brother and sister who had a personal idiosyncrasy and reacted violently like
an attack of influenza, and the inoculations were stopped after the second one, otherwise the
record of the years is one of triumphant progress. Of all those immunised two only have subsequently
Contracted Diphtheria and in neither case was there any untoward result.
It is satisfying to know that we have 5,337 children immunised and 959 who are naturally
immune as a result of re-testing. It is also a great satisfaction to know that 42,657 attendances
have been made by mothers who feel that what we have done, and what we are doing is worth
while.
Since 1930, when we had 370 cases of Diphtheria with 23 deaths, we have reduced our
incidence until last year we had 18 cases notified as Diphtheria, of which 11 ultimately turned out
not to be Diphtheria and only 1 death. I had hoped that my last official report would be able
to record an absolutely clean sheet and it was not until the middle of November that the first
death occurred. The toll of deaths has been reduced from 23 until the figures for the last four
years are 4, 3, 2, 1.
It is well to notice how our original satisfaction with T.A.M. has borne the searching
light of later investigation, our figures showing that whereas we got a slight re-action, which
we call undesirable, for want of a better word, to the extent of only 2.2%, using more recent
and more potent preparations that figure rose to 6.4%.
Report on Diphtheria Immunisation Clinic Work during the year ended December 31st, 1937.
As in recent years, two clinics have been held weekly but it was found to be more convenient
to change over one of the Hounslow sessions to the Isleworth Health Centre, so that
from 10th September, 1937, there has been one weekly session at Isleworth and one at Hounslow.
Dr. Bousfield's report follows :—
Annual report on the work of the Diphtheria Immunisation Clinics.
"The Diphtheria Prevention Clinics have, as in past years, been well attended. The
number of attendances in 1937 was 4,937. Applications for treatment numbered 808, against
693 in the previous year.
Certificates of successful immunisation or of natural immunity were issued to 598 children,
of these 575 were actively immunised and 23 were naturally immune. (To these figures
must be added the Nazareth House cases referred to later in the Report. 86 cases certified
immune and 28 were immunised). Most of the immunised children received injections of
Messrs. Burroughs Wellcome's T.A.M. given in a dosage of 1 c.c., 1.5 c.c and 1.5 c.c. at fortnightly
intervals. The remainder were treated with Alum Precipitated Toxoid (Eli Lilly & Co.)
either by means of two injections at fortnightly intervals or as a single injection. The results
of the various treatments described above will be given in detail later.
It was felt that, as T.A.M. had been so thoroughly investigated in the Hounslow Clinics,
in various dosages and at varying intervals, the properties of A.P.T. ought to be similarly tested
in comparable circumstances. So much had been written of the excellent results obtained by
the use of A.P.T. given as two injections that it was confidently anticipated that we should be
taking a step forward by adopting this antigen and method. It was further resolved to determine
to what extent the single injection of A.P.T. advocated by the manufacturers could be
shown to be successful. Accordingly two groups of Schick positive children were treated by
different methods. The first received a single injection of 0.5 c.c. of A.P.T. (Lilly) and were
re-Schick tested from 4 to 6 months later. The second group were treated by two injections of
the same antigen in dosage of 0.2 and 0.5 c.cms. at 14 days interval and were re-tested at the
same period after the final injection as was the former group.
It is unfortunate that, at the present juncture, a large proportion of the children so
treated is still awaiting a final Schick test, but the results so far obtained are both instructive and
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