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The above series is far too short for any inference to be drawn from these unsatisfactory
figures, which may be purely coincidence. There can be no doubt at all as to the merits of the
previous method, i.e., 1 c.c., 1 c.c. and 1.5 c.c. at 0-7-21 days' intervals.
On the subject of these reverted cases, one must bear in mind that many of these children
who have reverted to some degree of Schick-positive reaction have still a marked latent immunity
which is ready to awaken at the first onslaught of diphtheria infection.
All the cases which were found to be again susceptible in the above series received further
injections of diphtheria antigen. Some time ago the additional injections given were of T.A.M.
Latterly supplementary injections have been of A.P.T. which is the antigen now in use, except
for the occasional hypersensitive case requiring the use of the milder antigen, Toxoid-Antitoxin
floccules.
As regards reactions, little complaint has been made by parents on account of any reactions
either local or general, in the use of the two brands of alum-precipitated toxoid with which we
have worked at our clinics. It is quite exceptional for us to have to change over to T.A.F. on
account of severe reaction to A.P.T.
General Remarks.
A satisfactory feature of the clinics is the extreme youth of the greater number of the
children now brought for testing and immunisation. A marked inclination to bring children
between the ages of 9 months and five years is obvious, and this requires no further comment.
Only one case of diphtheria in a child believed to be immune has to be recorded during
the year. This child had received prophylactic injections in the U.S.A. some years previously.
On presentation of the child at our clinic for a post-Schick test, the result was found to be
negative. Ten weeks later the child was notified as suffering from diphtheria. The case was
regarded as one of clinical diphtheria by the Medical Officer of the South Middlesex Fever
Hospital, who kindly provided a very full report. The situation may be best described in his own
words. "As will be seen from the chart, the patient suffered from no complications whatsoever;
the pulse rate remained quiet and steady throughout the illness and the girl made an excellent
recovery."
The occurrence of these occasional cases of diphtheria among immunised children is denied
by no clinician of experience. The point is that such attacks are nearly always extremely mild
and devoid of complications. The reason for their occurrence is probably a temporary waning
of immunity of the subject, coupled with a mass infection by diphtheria bacilli, or produced as
a result of infection by a very virulent strain. It is known that the bare Schick-negative level may
not afford complete protection against occasional heavy infections of the gravis or intermediate
strains of the Diphtheria bacillus.
If the large number of children immunised in this Borough during recent years has only
produced one case of uncomplicated diphtheria during the year, and of course no fatal cases as
far back as our records go, it would appear that the value of the procedure is becoming increasingly
obvious."
GUY BOUSFIELD, M.D., B.S.Lond.
Boxes containing diphtheria antitoxin, a sterile syringe and the necessary dressings are
kept at Hounslow Police Station and are available to doctors in case of emergency. During
1938, 16 vials, each containing 8,000 units of antitoxin, were supplied to medical practitioners.
Smallpox.
No cases were notified during 1938.
Typhoid and Paratyphoid Fevers.
Two cases of typhoid and two cases of paratyphoid fever were notified during 1938.
Three of these cases were notified from West Middlesex County Hospital and two were not
usually resident in the district. No source of infection was traced in the two cases who were
residents in the Borough.
Erysipelas.
Forty-three notifications of this disease, including 17 from the West Middlesex County
Hospital, were received during the year. Fourteen of the cases were non-residents.
Epidemic Encephalitis.
One case was notified from the West Middlesex County Hospital but the patient was not
a resident of the Borough.
Cerebro-Spinal Fever.
Eight cases were notified. Two of the cases notified from the West Middlesex County
Hospital were non-residents.
Poliomyelitis.
Three cases were notified and were removed to the West Middlesex County Hospital for
treatment.
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