Joan Taylor

Enteritis in a Nursery Home associated with Giardia lamblia.

collected in that area in much greater numbers than in the duodenal wall elsewhere. The muscular thickening and the concentration of ganglion cells must indicate increased muscular action where the common bile duct penetrates the circular coat of the bowel from without. No sign of any intrinsic circular muscle ring round an ampulla has been discernible. It is hoped that in the future further comparative histological investigation

Immunization against Diphtheria with Alum-precipitated Toxoid—I

During recent years evidence has gradually been accumulating to suggest that the best and most economical method of immunizing children against diphtheria is by two suitably spaced doses of alum-precipitated toxoid (A.P.T.). Experience, however, of this method has so far been very limited. The great immunizing campaigns in the United States, Canada, and France have been carried through mainly with toxin-antitoxin mixture and with formol toxoid. Most of the early trials of A.P.T. were made by the onedose method, which is now generally recognized to be un5atisfactory. The number of careful observations made

Combined Active and Passive Immunization against Diphtheria. II. Control of Epidemics in the Field.

In the previous paper (p. 717) evidence was brought to show that by means of combined active and passive immunization a degree of active immunity can be pro duced which, though slower in its development, is ulti mately not greatly inferior to that resulting from active immunization alone. Attention was drawn to the difficulty in practice of pro tecting children against diphtheria during the intermediate phase of relative susceptibility which, according to Gundel and Konigs (1938) experiments on guinea-pigs, probably occurs between the waning of passive immunity due to the injection of antitoxic serum and the development of active immunity due to inoculation with diphtheria pro phylactic. Information on the length and degree of this intermediate phase of relative susceptibility cannot be obtained in human beings by the direct experimental method, but the observations of Gierthmuhlen and Voges (1939) on children during an actual epidemic of diphtheria suggest that with doses of 0.3 to 0.5 c.cm. of A.P.T. and 1,000 units of antitoxin it is at its maximum between about three and six weeks after the first injection of A.P.T. and serum, and that it is considerably less in degree than the susceptibility of uninoculated children. Though this information was not available to us when we were conducting the observations about to be described, we were fully aware of the possible occurrence and danger of such an intermediate phase of relative susceptibility. It seemed to us, therefore, that, if an outbreak of diphtheria was to be brought under immediate and complete control, the only satisfactory way to prevent fresh cases from developing during the relatively susceptible phase was by protecting the children so far as possible from further risk of exposure to infection. This we proposed to do by detecting all carriers in the community and segregating them until the remaining children had acquired an adequate degree of active immunity.

Human Infection with Bact. cholerae-suis

caecum somewhat reddened; Peyers patches not enlarged; no ulceration. Colon appeared normal. Liver (3 lb.) pale and friable; cut surface-pattern blurred. Gall-bladder contained thick dark bile. Spleen (11 oz.) fairly firm; cut surface-dark red with conspicuous Malpighian bodies. Lymph glands: Two or three swollen glands in the transvemse fissure of the liver. Urinary system and brain showed no abnormality. (Bone marrow not examined.) Microscopical Findings.-Heart: Myocardium showed a moderate degree of fatty change and occasional focal necrosis. Liver and spleen revealed collections of mononuclear cells. Gram-negative bacilli were seen in small numbers in the spleen but not in the liver. Some were found in the lymph glands. Bacteriological Findings.-An organism of the Salmonella group was isolated from the heart blood, spleen, and liver, but not in cultures from the mucous surface of the small intestine.