Preparing The Child For School-Diphtheria Prevention

The conquest of diphtheria is one of the most inspiring triumphs of modern science.

Let us set up a contrast and compare what diphtheria was and is. For what it was we do not have to go back very far—only to 1890. It attacked children usually—and under five years of age. Its effects were swift and powerful. It killed nearly half of those attacked. In a few days a happy youngster, the joy of its father and mother, would wilt, turn white and succumb. The usual method of death was that of an overwhelming poison. But such a mode of exitus was mild compared to the suffocation and choking death which followed the closure of the windpipe from the membrane.

From 1890 to 1894 in the city of Philadelphia there were 119 deaths per hundred thousand population. In 1932 in Philadelphia there were eight-tenths deaths per hundred thousand population.

What has made this change? First, the introduction of diphtheria antitoxin in 1893. This has been the most valuable asset. But it is used only when the disease has already occurred. The hope is to make everyone immune, so the disease will never begin at all. To do this we have the means.

The Schick Reaction.—In 1913 Dr. Schick found that if he introduced a tiny amount of the toxin elaborated by the diphtheria bacillus into the skin, a red reaction would appear in about two days in those persons who were susceptible to diphtheria. In those who had had the disease, or who had acquired immunity in other ways, any redness disappeared after the first few hours. By using this test, then, physicians can tell whether a child is likely to acquire the disease if exposed.

Then it was found that by mixing some of the toxin and some antitoxin this could be injected under the skin without harm, and would turn a positive Schick into a negative Schick. This toxin-antitoxin mixture has been given to hundreds of thousands of school children during the past ten years. Lately another and better preparation known as .’toxoid” has supplanted the toxin-antitoxin mixture.

It is estimated by Bundesen, Fishbein and Niblack of Chicago, that if 35 per cent of pre-school children and 50 per cent of school children in any community be so immunized, diphtheria can be wiped out.

Think of it! That plague which killed 120 out of every hundred thousand every year is to be a thing of the past. In Chicago, by an intensive educational campaign, Bundesen and his fellow workers have almost accomplished this, and have reduced the death rate from 14 per hundred thousand population to 1.8. And to prove that it was this activity that did the work, it is pointed out that the mortality rate in the state outside Chicago has been rising.

Immunizing children 4 to 14 years of age has only a fraction of the value in stemming epidemics that immunization of children below 5 years has, reports Godfrey in the American Journal of Public Health.

The consensus at present is that the best age for immunizing a child against diphtheria is from 6 to 9 months. In country districts six months is considered preferable, because fewer of the mothers in the country districts are immune.