The Health bulletin [serial] - University of North Carolina at Chapel Hill

:
May, 1927 The Health Bulletin 17
SOME IMPORTANT FACTS ABOUT DIPHTHERIA
By CHARLES R. BUGG, M.D., Raleigh, N. C.
Diphtheria is a preventable disease
and should be as rare as smallpox.
There is practically no reason for the
disease existing today, and its disappearance
will quickly follow if the public
will forsake the attitude of slight
suspicion that it sometimes attaches
to new procedure and preventive measures.
Toxin antitoxin has long ago passed
the experimental stage. It has been
proved to be a most efficient preventive
measure and should be as routine a
procedure as smallpox vaccination.
Proof of its efficacy is abundant. Dr.
Sears of Auburn, N. Y., reported the
result of a campaign there and found
90-94 per cent of the children immune
to the disease after 3 doses of toxinantitoxin.
Park and Zingher in New-
York City report 60 per cent reduction
in incidence and mortality. They injected
500,000 children. Dr. Zingher is
convinced that 90 per cent of people
are made immune, probably for life or
certainly tided over the susceptible
period. A practical plan of procedure
is to give 3 weekly doses of 1 c.c. each
to all children between 8 months and
5 years, and to do Schick tests on all
children over 5 years, with toxin-antitoxin
given to all susceptibles. Where
it is impossible to do Schick tests or
where it is not practical, 5 weekly
doses is the wise procedure and the
percentage of those immunized will be
distinctly higher, probably 100 per
cent.
There is some confusion in the mind
of the public between toxin antitoxin
mixture and diphtheria antitoxin, and
the action and principle of each. It is
really very simple and easily understood.
The first false impression is
that toxin antitoxin produces a mild
form of diphtheria which may in some
cases be dangerous. This is absolutely
not true. There is a very minute
amount of unneutralized toxin, or
poison of the disease, in toxin antitoxin.
This is too minute to produce
any disease or symptoms, but does
call forth the production in the body
of self-made antitoxin which remains
in the body permanently, or continues
to be produced over a long period of
time. Antitoxin is the blood serum of
a horse who has been made to produce
this resisting substance in his body. It
quickly immunizes susceptible people
to the disease, and quickly cures the
disease. Its effect is short in duration
—probably 3 to 5 weeks, for the human
body does not retain the horse antitoxin
longer than this. The immunizing
effect of toxin antitoxin is permanent,
for it stimulates the body to produce
its own antitoxin, and this production
continues for a long period of time.
The immunity from toxin antitoxin is
slow in developing. It is probable that
there is little development of immunity
until 2 to 3 months after the last injection.'
The Schick test is a very reliable
one, and it is quite rare for a person
with a negative Schick test to contract
the disease. Both the Schick test and
toxin antitoxin are absolutely devoid
of all danger, and any symptom following
their use is rare and always
negligible.
The susceptibility to the disease at
different ages is interesting and important.
Dr. W. H. Park of New York
gives the following figures
Per Cent Per Cent
Susceptibles Country City
Under 3 months 30 15
3 to 6 months 50 30
6 mouths to 1 year SO 60
1 to 2 years 85 70
2 to 3 years 75 55
3 to 5 years 70 40
5 to 10 years 65 30
10 to 20 years 60 20
Over 20 years 50 15
In short many more people living in
rural districts are susceptible ; there
is a relative immunity up to 5 or 6
months ; and there is a tendency to
immunity as age advances. The most