"A girl of five years had received the usual three injections of
toxin-antitoxin in 1926 when one year old. In 1927 she was pronounced Schick-negative. She
developed diphtheria in 1930, and an injection of serum was given in the
left gluteal region, followed three days later by a second dose on the opposite side. In
three hours the buttock began to swell and became extremely tender, until eventually the
whole region became black and gangrenous. By the ninth day a deep area of ulceration
appeared at the margin separating the necrotic tissue from the normal. (See Fig. 1.)
On the twelfth day the child began to complain of extreme pain over
the right lower quadrant of this area, and an incision yielded thick yellow pus. From now
onwards the condition spread over the abdominal wall and thigh until the sixteenth day,
when a large necrotic mass 6" by 8" was cut away under anaesthesia. The author
writes; "This large piece of gangrenous skin with subcutaneous fat and fascia was
lifted off much as a lid from a stove... . . the underlying muscles lay exposed almost
entirely independent of fascia which aloughed, and a large amount of which had come away
in the discharge. After apposition, the muscles lay exposed much as in an anatomic
dissection." (Figs. 2, 3.) In spite of assiduous irrigation of the wound she became
rapidly worse, suffering considerable pain. Following a blood transfusion on the
twenty-seventh day of illness, she became cyanotic, vomited, lost consciousness and died a
few hours afterwards."--Beddown Bayly THE ARTHUS
PHENOMENON [Book 1939] The Schick
Inoculation Against Diphtheria--- Beddow Bayley