Incidence Of Diphtheria Research Articles

DOES A CHANGE IN THE SCHICK REACTION USUALLY FOLLOW REMOVAL OF THE TONSILS AND ADENOIDS?

Tomlin,¹in 1916, and many other physicians since then have advanced the opinion that diphtheria develops much less frequently in children whose tonsils and adenoids have been removed. Collins²and Syndenstricker made a statistical study on school children and found that the incidence of diphtheria in children whose tonsils had been removed was 1.4 per thousand as compared with 4.6 per thousand in children with the tonsils present. The lessened susceptibility to clinical diphtheria of children on whom tonsillectomy has been performed has been attributed either to the removal of tissues which are especially subject to infection or to the fact that these children come in contact with diphtheria bacilli and that a clinically unrecognizable infection develops during the ten to twelve days that the mucous membrane of their throats is in the process of healing. It is believed that sufficient toxin is developed and absorbed to stimulate

Advantages of Toxoid in Diphtheria Prophylaxis

ACTIVE immunization against diphtheria has developed during the past 15 years, particularly in North America, into one of the most important specific measures for the prevention of disease. Prior to the use of toxin-antitoxin mixture, smallpox vaccination was considered the most successful individual specific procedure in preventive medicine; but improvements in methods of diphtheria prophylaxis have been so great in the past few years that one can safely say that immunization against diphtheria is at least as satisfactory as vaccination against smallpox. Since no one now-a-days questions the effectiveness of immunization campaigns on incidence of diphtheria as reflected in both cases' and deaths, it is only necessary to cite in passing, the experiences of Auburn, N. Y.,2 Grand Rapids, Mich,' and New York City,4 without going into detail as to the tremendous reduction in both cases and deaths in these places, for which accurate records are available. We are familiar with the extreme difficulty experienced by workers in reaching the most highly susceptible children for immunization, and since these children are reached with such difficulty it is important that we use the immunizing agent which will produce immunity in the greatest number of subjects injected. Toxin-antitoxin mixture and toxoid are both being used and we all wish to know which, if either, is the superior product, and the advantages and disadvantages of both. Toxin-antitoxin mixture is made from mature toxin by adding sufficient diphtheria antitoxin so to decrease its toxicity that it may be safely injected. This delicate balance is readily attained by experienced manufacturers working with toxins and antitoxins, the values of which are accurately known. In the beginning mixtures were made by adding antitoxin to the undiluted toxin-hence the original mixtures containing from 3 to 5 L + doses of toxin per human dose. Some of us will probably re-

Diphtheria as a cause of late heart-block

A group of twenty patients having proved heart-block without the customary causes such as coronary artery disease, digitalis, fever and rheumatic infection were studied to determine the incidence of diphtheria in childhood. The incidence was 50 per cent as compared to six per cent in 600 consecutive control surgical cases. The average age of patients with a positive diphtheria history was 11 years younger and their systolic blood pressure 40 mm. lower than was the case with those with a negative history. Diphtheria in childhood appears to be an etiological factor in the development of heart-block in later years.

THE COMPARATIVE VALUE OF TOXOID AND OTHER AGENTS IN THE IMMUNIZATION OF THE PRESCHOOL CHILD AGAINST DIPHTHERIA

The incidence and mortality of diphtheria have been effectively reduced by the extended introduction of immunization against the disease. In the popularization of such a procedure, the fine work of Park and his associates deserves a place as a distinctly outstanding achievement for public health. The procedure has been adopted in the public schools of hundreds of communities. Through these agencies tangible statistical evidence of its benefits has been recorded. The complete effectiveness of the immunization program has been lessened by the difficulty of reaching the preschool child, among which group the highest incidence of diphtheria prevails, and by the imperfections of methods and materials used. To eradicate diphtheria completely, immunization must become as routine a medical practice for the preschool child as is the administration of orange juice a dietetic measure for the infant. Such custom, however, must be made secure by perfecting methods and materials now available. Errors

EFFECT OF TONSILLECTOMY AND OF ADENOIDECTOMY ON DIPHTHERIA IMMUNITY

Tonsillectomy has been advocated not only to relieve symptoms referable to diseased tonsils themselves, but also as a means of protection against subsequent infections. The evidence concerning the protection that tonsillectomy may afford against diphtheria consists chiefly in statements by experienced clinicians that they have rarely observed this disease in children whose tonsils have been completely removed. In 1916, Tomlin¹of Indianapolis suggested that tonsillectomy might reduce the incidence of diphtheria by eliminating the portal of entry and also by reducing the number of bacilli carriers. In 1917, Boot²of Chicago observed that "there is no doubt that children who have had tonsillectomy done are less susceptible to diphtheria." In the same year, Perry³of St. Louis wrote as follows: "Our city doctors in charge of the isolation department tell me that they have never found a case of diphtheria in a patient who has had the

COMPARATIVE EFFECTS OF DIPHTHERIA TOXOID AND TOXIN-ANTITOXIN AS IMMUNIZING AGENTS

The value of diphtheria toxoid (anatoxin-Ramon), the modified toxin of diphtheria, in active immunization of man has been firmly established since Glenny's experiments with animals and Ramon's clinical demonstration of its efficiency. Its use on a broad scale has grown, particularly in France and in Canada. The lack of any extensive trial of toxoid in this country is, to a large extent, attributable to the strong foothold that prophylaxis with toxin-antitoxin has gained, following the impetus given to its popularization by Park and his collaborators. Through their laudable efforts, a marked reduction in the incidence of diphtheria has been effected in this country. The preference that toxoid has received in other countries within the last few years is the result of certain important advantages that have been recognized in the use of this material. These advantages have been emphasized by Ramon and Helie¹in a recent report to the

BERLIN

<h3>The Value of Protective Inoculation Against Diphtheria</h3> During recent decades, Germany has not suffered to an inordinate extent from diphtheria. The extent to which spontaneous retrogression of morbidity and timely administration of diphtheria antitoxin each may be responsible is an open question. An inquiry was instituted by Prof. J. Schwalbe on the incidence of diphtheria and was published in the<i>Deutsche medizinische Wochenschrift</i>, of which he is the editor. This brought forth the information that diphtheria in many sections has retrogressed to such an extent that it is sometimes difficult to secure sufficient instruction material for students. Only in a few places does the opposite condition prevail; more particularly, in Berlin. Still, the local increase of diphtheria in a few places has directed attention to active immunization against the disease, and the Prussian Landesgesundheitsrat (council on health), at a meeting held in November, recommended widespread prophylactic inoculation. It confers, in

LA ROUGEOLE. ÉPIDÉMIOLOGIE, IMMUNOLOGIE PROPHYLAXIE.

This timely book, published under the egis of the Institute of Hygiene of the Faculty of Medicine of Paris, carries the solemn warning that measles constitutes one of the most important and most pressing problems of preventive medicine among diseases of children at this time. A comparison of the mortality curves of some of the common infectious diseases in European countries shows some striking facts. For example, smallpox was found to have been declining since the early sixties of the last century, and the decrease in the incidence of diphtheria was found to have set in twenty years or more before the contributions of Roux and Behring; since then, of course, it has been striking. Whooping cough has shown a tendency to decline in the last half century, and scarlet fever, as is commonly known, has steadily declined until recent years. Measles, on the other hand, has shown a remarkable

A STUDY OF THE INCIDENCE, MORTALITY AND FATALITY OF DIPHTHERIA

Diptheria is a disease of childhood. Seventy per cent of all cases and ninety per cent of all deaths occur under fifteen years of age. More boys than girls and more women than men have diphtheria. The fatality rate is higher for males than for females.

The Diphtherial Infection in Scarlet Fever

From consideration of the above evidence the following conclusions may be drawn:(1) The prevalence of diphtheria-like bacilli in the fauces of scarlet fever patients on admission to hospital does not definitely follow that of diphtheria outside either in seasonal or yearly prevalence.(2) The majority of such patients show no clinical evidence of the added infection. It is believed that they are instances of scarlet fever developing in diphtheria carriers, and the presence of the organism does not affect the prognosis. However, cases which present such clinical evidence as a mem branous angina are to be considered as instances’ of true double infection and in them the prognosis is bad.(3) Bacteriological examination of a series of cases belonging to the former group reveals the presence of true virulent diphtheria bacilli in about 36 per cent., and these organisms may persist in a virulent state for a considerable period.(4) Routine bacteriological examination to find these cases and their sub sequent isolation materially reduces the incidence of post-scarlatinal diphtheria.

ACTIVE IMMUNIZATION OF NURSES AGAINST DIPHTHERIA IN A CHILDREN'S HOSPITAL

The immunization of children against diphtheria by toxin-antitoxin mixtures has been carried out on a considerable scale with excellent results. Two of the more recent series in which the immunity was confirmed by later Schick tests are those reported by Zingher 1 and by Blum. 2 Such immunization has been advised for susceptible physicians and nurses, especially those caring for children, since they are more intimately exposed to diphtheritic infection. No studies on groups of adults, however, have been reported. Herewith are presented the results of a systematic immunization of all the susceptible individuals in a nurses' training school over a period of years. All the individuals were on duty in the Contagious Pavilion of the St. Louis Children's Hospital during a part of their training, usually from one to two months, and the incidence of diphtheria in the group before and after the immunization was instituted has been noted.

Remarks on the incidence of diphtheria in Birmingham

Remarks on the incidence of diphtheria in Birmingham

The means of minimising the incidence of diphtheria

The means of minimising the incidence of diphtheria

The influence of school attendance on the weekly incidence of scarlet fever and diphtheria in London during 1892 and 1893

The influence of school attendance on the weekly incidence of scarlet fever and diphtheria in London during 1892 and 1893