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reaction of not more than ½ in. in diameter with no induration, immunisation
should be undertaken by the subcutaneous injection of formol toxoid of 25/35 L. F.,
or of even greater strength, in doses of 1 c.c. on three occasions with fortnightly
intervals.
(6) If the local reaction to the test dose of formol toxoid is strong, however
(as occurs in approximately 5 per cent. of children of all ages), i e , if there is a vivid
flush of more than ½ in. in diameter with central induration, toxoid antitoxin
floccules should be used as the immunising agent, instead of formol toxoid.
(7) Not less than two months after the last immunising dose has been given
the Schick test should be repeated. In the great majority of cases it will be
found to be negative, indicating that immunity has been established. If the
Schick test is positive, however, or doubtfully positive, then one additional
dose of the prophylactic, equal to the last one given, should be administered
and the test again applied not less than two weeks later. If the test proves
again positive then the whole immunising course should be repeated, as should
the subsequent retesting.
(8) Immunisation should not be attempted in children under the age of one
year; with this proviso the procedure is applicable to all healthy children found
to be susceptible.
The testing and immunising agents referred to are not supplied by the
Ministry of Health, but can be obtained through ordinary channels. The
manufacture and importation of these substances are controlled under the
Therapeutic Substances Act, 1925, by a system of licensing based on inspection
and testing of samples, and applicants for a licence must prove compliance
with the requirements of the Therapeutic Substances Regulations, 1931, as
regards the strength, quality and purity of the product and the general conditions
of manufacture. At the present date manufacturing licences in respect of the
substances in question are held by the Wellcome Foundation, Ltd., Messrs.
Evans, Sons, Lescher & Webb, Ltd., the Director of the Inoculation Department
of St. Mary's Hospital (Agents: Messrs. Parke, Davis & Co., Ltd.), and the
Director of the Lister Institute of Preventive Medicine (Agents: Messrs. Allen
& Hanbury); and import licences by Messrs. Parke, Davis & Co., Sharpe &
Dohme, Ltd., Bayer Products, Ltd., and, for diphtheria prophylactic only,
British Drug Houses, Ltd.
Ministry of Health,
Whitehall, London, S.W.I.
November, 1932.
Enteric Fever.—During the year under consideration 2 cases
of enteric fever and 7 cases of paratyphoid B fever were notified.
This shows an increase of 2 on the number of cases that occurred
during 1931. The attack-rate was 0.04 per 1,000 inhabitants,
compared with 0.06 for England and Wales.
In one case the patient presented clinical signs of enteric fever,
but bacteriological examination of specimens of blood did not
provide evidence to support the diagnosis. In the remaining eight
cases the diagnoses were confined by bacteriological examination.
Enquiries were made in every case to ascertain the source of
infection, and the Medical Officers of Health of three seaside and
country districts in which five of the cases might have originated
were asked to assist in this direction. Definite evidence as to the
source of infection was not secured, however, in any of the cases.