Effect of Tonsillectomy and Adenoidectomy on Immunity to Diphtheria

Abstract

Impressed by numerous observations that diphtheria is relatively infrequent in tonsillectomized persons, Schick and Topper 1 of New York studied the effect of tonsillectomy on the production of immunity to diphtheria. They reported that among 100 children who were susceptible to diphtheria, as determined by a positive Schick test just before the operation, 82 per cent gave a negative reaction when retested six months after tonsillectomy. This percentage held true for children under 6 years of age as well as for the older group of children from 6 to 12 years. These authors believe that only a small percentage of a control group could be expected to give negative reactions to the Schick test in a like period of time. The normal expectancy of negative reactions in children, according to the combined figures of Park and Zingher, von Groer and Kassowitz (as presented by Schick and Topper), increases from 16.8 per cent in the first to third years to 76.4 per cent in the twelfth to thirteenth years.Schick and Topper also made Schick tests consecutively on 200 children who had undergone tonsillectomy before entering Mount Sinai Hospital. Of these, 81 per cent were negative; and even in the group under 6 years, 75 per cent were negative. Accordingly, Schick and Topper concluded that tonsillectomy in some way favors "the develop¬ ment of a humoral immunity against diphtheria." They pointed out that the immunity might develop from a mild unrecognized diphtheria after tonsillectomy, or, according to Hirszfeld's 2 hypothesis, by the general production of antibodies following infection, as in the tonsillar fossae after operation, or, according to Opitz'3 theory, by the stimulation to antitoxin production following the minute quantity of toxin contained in the Schick test.From the