The control of diphtheria and scarlet fever / by R.A. O'Brien.

  • O'Brien, Richard Alfred, 1878-1970.
Date:
[1928?]
Catalogue details

Licence: In copyright

Credit: The control of diphtheria and scarlet fever / by R.A. O'Brien. Source: Wellcome Collection.

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    rabbits and guinea-pigs, and recently by Parish and Okell in their observations on children, will respond very rapidly to an assault by toxin. Whether this assault be in the form of a Schick test, or a dose of prophylactic, or the growth of true diphtheria bacilli during an attack of sore throat caused by some other organism, the individual will at once make large quantities of antitoxin, enabling him to throw off the attack with very little disturbance, and with no danger of subsequent paralysis or other sequels. Possible Improvements in Testing and Immunization. The test is on a reasonably firm basis. We may some day succeed in making a toxin so pure that a control injection of heated toxin will not be necessary, but so far no one has succeeded in doing this. We may also, if we wish, combine the first test and an immunization dose; W. H. Park does this in young children by giving the first dose of his toxin-antitoxin mixture subcutaneously. A week later the reaction in a Schick-positive reactor can be easily read. The mixture commonly used in England— toxoid-antitoxin—will not give a Schick reaction because toxoid is used and not toxin in making the mixture. A. T. Glenny has made a mixture, called D.PT.M., which on intradermal injection into guinea-pigs gives excellent results. It indicates the condition of immunity by giving a positive or negative Schick reaction, and it simultaneously immunizes. The mixture has not been widely used in human beings; in adults a considerable amount of “ pseudo¬ reaction ” is produced, and the Schick response cannot be read until some days later; there is no reason to doubt that the immunizing effect in children would be as satis¬ factory as in animals, but observations have not been done on a sufficiently large scale to warrant any statement. We are not quite convinced that this is the most promising line to pursue, and have for the moment given up this work. With regard to prophylactic injections, the three mate¬ rials which at present hold the field are toxin-antitoxin (U.S.A., 0.1 L + ), toxoid-antitoxin (Britain), and toxoid (“ anatoxine,” France, etc.). The possibility of undesirable sensitization by the minute amount of antitoxin present in the first-named two mixtures has attracted some atten¬ tion during the past two years. Gordon2 writes : “ As the result of a recent active campaign in Detroit for toxin-antitoxin prophylaxis against diphtheria, it became evident that a considerable proportion of the patients admitted were hypersensitive to horse serum.” Dr. Stewmrt of Minneapolis3 describes serum reactions in seven children who had been previously immunized. Dr. Stewart courteously informed me that these seven were the only children previously immunized against diphtheria into whom he had subsequently injected serum, and all seven had reacted. (See also Lathrop4 and Gatewood and Baldridge5 in favour of sensitization, and Park6 and Backer,7 experience refuting serious sensitization.)