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REVACCINATION IN ADULTS
536 REVACCINATION IN ADULTS SIR,-Dr. J. C. Broom’s paper (March 22) prompts us to report some observations made in the Middle East in 1945. Lieut.-Colonel (now Professor) R. S. Illingworth had pointed out to us that a typical " reaction of immunity " was evoked by a heat-killed vaccine. To verify his statement a series of 20 previously vaccinated patients were revaccinated with both heated and unheated vaccine by a standardised technique with a single scratch 1 cm. in length. The response to both heated and unheated vaccines was similar in each case and had the characteristics of the " reaction of immunity." In a second series of 20 cases where the areas of erythema were plotted no constant differences between reactions to heated and unheated vaccine could be demonstrated. The figure shows the findings in 5 representative cases. To prove that the virus had been killed, material from the same batch of heated vaccine was used to vaccinate 10 previously unvaccinated infants. In no case did a reaction occur ; later these infants were successfully-
Areas of
erythema
after vaccination
with lymph.
unheated and heated vaccine
vaccinated with unheated vaccine. Intradermal tests on rabbits also showed that living virus was no longer present after heating. As calf-lymph vaccine had been employed in these experiments the agents possibly responsible for the reactions were bovine protein, contaminant bacteria, the preservative added to the vaccine, or the proteins of the virus bodies themselves. A series of 10 previously vaccinated patients were accordingly revaccinated with heated vaccine, unheated vaccine, bovine serum, and the preservative. Reactions were noted only with the first 2. Dr. Dennis, of the American University of Beirut, kindly supplied us with vaccine prepared by culture on chickembryo membrane, the bacterial content of which was negligible. In 10 previously vaccinated patients similar A reactions of immunity " were obtained to this vaccine both when heated and unheated. From these observations we concluded that the " reaction of immunity" was an allergic response to the proteins of the virus bodies in an individual sensitised by previous vaccination. Circumstances had prevented us from reading the relevant published work ; but at this stage we discovered that similar observations had been made in 1901 by von Pirquet, who had reached the same conclusion. We therefore pursued our somewhat naive investigations no further, believing that we had been in ignorance of facts well known to better-qualified workers in this field. If our conclusions were correct it followed that the " reaction of immunity " in fact only indicated that the patient was immune to variola when the vaccine employed was known to be potent and viable. This explained our of seeing patients in whom we had previous experiences " ourselves noted a reaction of immunity " develop fatal smallpox within two months of vaccination. Dr. Broom is clearly aware of the problem, but he has noted a considerable number of cases in which unheated " while heated lymph gave a " reaction of immunity lymph gave no reaction. Our experience was different from this : in a few a "reaction of immunity" was given by unheated, but not by heated, lymph; in about an equal number the reverse was noted. We attributed
these
discrepancies
to faults in
our
technique, and repeti-
tion, by producing similar reactions with both heated and unheated lymph, confirmed our view. Dr. Broom admits that the reaction to heated lymph may " closly simulate " that to unheated ; we concluded that the two were indistinguishable. We share his uneasiness about certification ; on several occasions we have seen the sense" of security engendered by a " reaction of immunity prove disastrously false. London, W.1.
RONALD BODLEY SCOTT
Leeds.
R. P. WARIN.
CHEST DISEASE IN RAND MINERS 8 Dr. Frazer and Dr. have a miniature radiography plant at the Witwatersrand Native Labour Association Hospital, which has now been. in operation for several (Like them, we consider that our miniatures are years. of a verv high standard, as also are the large X-ray films taken to check the abnormalities seen in the miniature
SIR,-In their letter of Feb.
Walker
rightly say that we
..
They were wrongly informed, however, that native workers suffering from phthisis may continue to work if they choose to do so. No native mine labourer found to be suffering from pulmonary tuberculosis and/or silicosis is allowed to continue working at the mines ; he is compensated and repatriated at the expense of the mines. The compensation paid is, for silicosis, a sum equal to 36 times the amount of his monthly earnings, or .S180, whichever of the two amounts is the greater. Similar compensation is paid for pulmonary tuberculosis where the labourer has been engaged in a dusty mining occupation for 8 or more years. Where the labourer is found to be suffering from, pulmonary tuberculosis after having worked in a dusty occupation for 30 daysor longer, he is given an amount equal to 20 times the sum of his monthly earnings, or 2100, whichever of the two amounts is the greater. Dr. Frazer and Dr. Walker add that " during a brief visit to the W.N.L.A. Hospital, no case of chest disease was seen." This seems strange, as we detain a large number of patients in hospital for sputum tests and other investigations. Apart from these, all patients on the mines who are suspected to be suffering from pulmonary tuberculosis and/or silicosis, after X-ray, clinical, or sputum investigation, or loss of weight, are sent to our hospital and detained here for examination by the
radiographs.)
medical officers of the Silicosis Medical Bureau, with view to possible compensation. FRANK RETIEF Witwatersrand Native Labour Chief Medical Officer. Association, Ltd., Johannesburg. -
a
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BETTER CARE FOR THE HOMELESS CHILD
SiR,—Your annotation of April 5 suggests that there is fairly general agreement with the recommendations of the Curtis Committee. But it is in fact surprising that more written protests have not appeared from workers in public-health, medical, and educational circles considering the extent of the disagreement which exists. The largest single group of children mentioned in the report is that in public-assistance institutions. It is remarked with surprise that 60 % of these children are short-stay admissions-e.g., children admitted because the mother is having a baby. To this extent the total figures are inflated, for this group can hardly be described as " deprived children." The committee consider that more accommodation for these short-stay children is badly needed, although they remark that there was ample accommodation in children’s homes generally before the war. The overcrowding of the public-assistance institutions, therefore, seems to have developed with the war, when women were encouraged to send their children (even those of 2 years) into institutions while they either went to work or had a baby, and there was little warning to the mother that it might have a bad effect on the child’s emotional development. The legacy of 5000 homeless evacuees tells its own tale. Some propaganda in reverse to emphasise the importance of keeping the child in its own or a, relative’s home where this is at all possible might now be instituted, with a quotation from the Curtis report on " the extreme seriousness of taking a child away from even an indifferent home." To a young child even two weeks is a long time.
Areas of
erythema
after vaccination
with lymph.
unheated and heated vaccine
vaccinated with unheated vaccine. Intradermal tests on rabbits also showed that living virus was no longer present after heating. As calf-lymph vaccine had been employed in these experiments the agents possibly responsible for the reactions were bovine protein, contaminant bacteria, the preservative added to the vaccine, or the proteins of the virus bodies themselves. A series of 10 previously vaccinated patients were accordingly revaccinated with heated vaccine, unheated vaccine, bovine serum, and the preservative. Reactions were noted only with the first 2. Dr. Dennis, of the American University of Beirut, kindly supplied us with vaccine prepared by culture on chickembryo membrane, the bacterial content of which was negligible. In 10 previously vaccinated patients similar A reactions of immunity " were obtained to this vaccine both when heated and unheated. From these observations we concluded that the " reaction of immunity" was an allergic response to the proteins of the virus bodies in an individual sensitised by previous vaccination. Circumstances had prevented us from reading the relevant published work ; but at this stage we discovered that similar observations had been made in 1901 by von Pirquet, who had reached the same conclusion. We therefore pursued our somewhat naive investigations no further, believing that we had been in ignorance of facts well known to better-qualified workers in this field. If our conclusions were correct it followed that the " reaction of immunity " in fact only indicated that the patient was immune to variola when the vaccine employed was known to be potent and viable. This explained our of seeing patients in whom we had previous experiences " ourselves noted a reaction of immunity " develop fatal smallpox within two months of vaccination. Dr. Broom is clearly aware of the problem, but he has noted a considerable number of cases in which unheated " while heated lymph gave a " reaction of immunity lymph gave no reaction. Our experience was different from this : in a few a "reaction of immunity" was given by unheated, but not by heated, lymph; in about an equal number the reverse was noted. We attributed
these
discrepancies
to faults in
our
technique, and repeti-
tion, by producing similar reactions with both heated and unheated lymph, confirmed our view. Dr. Broom admits that the reaction to heated lymph may " closly simulate " that to unheated ; we concluded that the two were indistinguishable. We share his uneasiness about certification ; on several occasions we have seen the sense" of security engendered by a " reaction of immunity prove disastrously false. London, W.1.
RONALD BODLEY SCOTT
Leeds.
R. P. WARIN.
CHEST DISEASE IN RAND MINERS 8 Dr. Frazer and Dr. have a miniature radiography plant at the Witwatersrand Native Labour Association Hospital, which has now been. in operation for several (Like them, we consider that our miniatures are years. of a verv high standard, as also are the large X-ray films taken to check the abnormalities seen in the miniature
SIR,-In their letter of Feb.
Walker
rightly say that we
..
They were wrongly informed, however, that native workers suffering from phthisis may continue to work if they choose to do so. No native mine labourer found to be suffering from pulmonary tuberculosis and/or silicosis is allowed to continue working at the mines ; he is compensated and repatriated at the expense of the mines. The compensation paid is, for silicosis, a sum equal to 36 times the amount of his monthly earnings, or .S180, whichever of the two amounts is the greater. Similar compensation is paid for pulmonary tuberculosis where the labourer has been engaged in a dusty mining occupation for 8 or more years. Where the labourer is found to be suffering from, pulmonary tuberculosis after having worked in a dusty occupation for 30 daysor longer, he is given an amount equal to 20 times the sum of his monthly earnings, or 2100, whichever of the two amounts is the greater. Dr. Frazer and Dr. Walker add that " during a brief visit to the W.N.L.A. Hospital, no case of chest disease was seen." This seems strange, as we detain a large number of patients in hospital for sputum tests and other investigations. Apart from these, all patients on the mines who are suspected to be suffering from pulmonary tuberculosis and/or silicosis, after X-ray, clinical, or sputum investigation, or loss of weight, are sent to our hospital and detained here for examination by the
radiographs.)
medical officers of the Silicosis Medical Bureau, with view to possible compensation. FRANK RETIEF Witwatersrand Native Labour Chief Medical Officer. Association, Ltd., Johannesburg. -
a
-
BETTER CARE FOR THE HOMELESS CHILD
SiR,—Your annotation of April 5 suggests that there is fairly general agreement with the recommendations of the Curtis Committee. But it is in fact surprising that more written protests have not appeared from workers in public-health, medical, and educational circles considering the extent of the disagreement which exists. The largest single group of children mentioned in the report is that in public-assistance institutions. It is remarked with surprise that 60 % of these children are short-stay admissions-e.g., children admitted because the mother is having a baby. To this extent the total figures are inflated, for this group can hardly be described as " deprived children." The committee consider that more accommodation for these short-stay children is badly needed, although they remark that there was ample accommodation in children’s homes generally before the war. The overcrowding of the public-assistance institutions, therefore, seems to have developed with the war, when women were encouraged to send their children (even those of 2 years) into institutions while they either went to work or had a baby, and there was little warning to the mother that it might have a bad effect on the child’s emotional development. The legacy of 5000 homeless evacuees tells its own tale. Some propaganda in reverse to emphasise the importance of keeping the child in its own or a, relative’s home where this is at all possible might now be instituted, with a quotation from the Curtis report on " the extreme seriousness of taking a child away from even an indifferent home." To a young child even two weeks is a long time.