Active and passive immunisation against common infectious diseases / by R.A. O'Brien.

  • O'Brien, Richard Alfred, 1878-1970.
Date:
[1925?]
Catalogue details

Licence: In copyright

Credit: Active and passive immunisation against common infectious diseases / by R.A. O'Brien. Source: Wellcome Collection.

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    (2) Has the procedure stopped diphtheria in these institutions ? In three of them diphtheria has practically completely disappeared. In the fourth institution, some 600 of the settled population are kept fully immunised, but the “ floating population ” in and out of the hospital is not immunised. Amongst this latter population 45 cases of diphtheria have been notified during the period of observa¬ tion. Amongst the immunised population no cases of typical clinical diphtheria have occurred. In our four years’ experience four children known to be Schick negative reactors, developed mild attacks of fever with sore throat, in’ the swabs from which virulent diphtheria organisms were found. The signs and symptoms resembled those present in some mild attacks of diphtheria, but no toxaemia was present and the clinical picture was not that of indubitable diphtheria. One may, if one wishes, regard these four cases as being mild attacks of diph¬ theria, or as tonsillitis in carriers of virulent diphtheria organisms. Even allowing for these four exceptions we feel justified in believing that the chance of a patient, negative to the Schick reaction, suffering from diph¬ theria is small and that in the rare cases where possibly an infection occurs the attack will be mild. Our experience in general agrees entirely with that of Park and Zingher and other American workers. We may be allowed to take this opportunity of expressing our deep appreciation of the generous response to any appeals for information, supplies of test material, etc., from American co-workers, particularly Drs. Park and Zingher, the Drs. Dick and Dr. Dochez. We would again emphasize the point my colleagues and I brought forward last year. We have known of a number of patients who have been considered to have developed “ diphtheria,” though they had previously given a negative response to the Schick test, but in none of them have we found indubitable elincial diphtheria when the evidence for the negative Schick reaction was impregnable With the experience of the past five to ten years, we think that, though in such cases it may be necessary for the clinician to act on a diagnosis of diph¬ theria in the interest of safety, it will be found when the full bacteriological and immunological data are available, that this diagnosis cannot be confirmed. In such instances, in addition to the full history of the Schick test and of the illness, it is necessary to have a small sample of blood taken immediately before the giving of the first dose of antitoxin, and a swab to be examined for the pres¬ ence of virulent organisms. I may, perhaps be allowed here to refer to the handling of an outbreak of diphtheria amongst the population of an institution. We would again call attention to the method we suggested several years ago. We would Schick