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made to continue the inoculation of the remainder One-child (F., aged 1 years) was positive
to the second re-Schick after 6 c.cm., but was negative after 8 c.cm.; this child was the
eldest of four girls; the three younger ones were negative after the routine 3 c.cm.; two of
these receiving their routine injections on the same day and from the same batch of antitoxin
as the eldest.
Of the 767 persons retested, 338 were males and 429 were females. Of those found positive
35 were males and 48 were females. Neither age nor interval seems to have any influence on
the phenomenon. It would seem conceivable that some batches of toxin antitoxin might prove
to be less efficacious than others. An analysis of the results obtained in Holborn would seem
to indicate clearly that this is so; also that the toxoid antitoxin used was as efficacious as
the toxin antitoxin. The toxin-antitoxin mixtures used were all 3 L + per c.cm. mixtures,
the toxoid antitoxin contained toxoid diluted 1-10 with added antitoxin.
Use has also been made of T.A.F. (flocculated toxin-antitoxin) in the case of
23 persons found Schick positive. Of these 23 persons, 22 have been retested;
in five of these the reaction to the first test was so slight that they were recorded
as suitable for immunisation with only one dose, if T.A.M. had been used. 11 of
these (nine children and two adults) were negative to the retest.
Eleven (ten children and one adult) were positive to the re-Schick test; of
these, six were further inoculated with T.A.F. (three of these were negative to the
second re-Schick), five were further inoculated with toxin-antitoxin (three of these
were negative to the retest). The use of T.A.F. has been discontinued for the
time being.
An interesting use of the Schick test was made in connection with a family in
which a baby, A.G., six weeks old, developed diphtheria. There were three other
children in the same family, a boy, L.G., aged 10 years, and girls, M.G. and O.G.,
aged 9 and 8, as well as the mother and father.
Swabs from children contacts were taken; the boy and the girl aged 9 years
were shown to be harbouring diphtheria bacilli in their noses. On reswabbing a
fortnight later the bacilli in the nose of the girl morphologically resembled
diphtheria bacilli, but the virulence test proved negative.
On the 26th February last O.G. and A.G. both gave a negative Schick
reaction and on the nth March L.G. and M.G. also gave negative reactions. As a
matter of interest the mother was tested and gave a positive Schick reaction.
Retesting.
Retesting is unpopular with parents, and the need for it does not help to
increase their confidence in immunisation. Of 767 that have been retested 72
were found to be still Schick positive after three inoculations and 11 after T.A.F.
The facts relating to these are given in Table III.
Diphtheria in Children Treated with Immunising Injections.
Up to the end of the year 1930 nine cases of diphtheria occurred in children
who had been found positive on Schick test and treated with three immunising
injections; the details of these are given in Table IV.
Diphtheria was also notified as having occurred in six other children who had completed
their course of inoculation, but the diagnosis in these cases was eventually not confirmed.
Two of these (brother and sister) were removed to M.A.B. hospitals as suffering from
diphtheria, but they were diagnosed as suffering from rubella and "carrying" diphtheria
bacilli but not as suffering from diphtheria. A third child was removed with diphtheria and
found to have measles. A fourth removed with diphtheria was returned as a case of coryza,
not diphtheria, and a fifth was removed with faucial diphtheria, but the diagnosis was not
confirmed. All these children had been found negative to the retest some time previously.
Three others were removed to M.A.B. hospitals as suffering from diphtheria, but were shortly
afterwards discharged as not cases; neither had been re-Schicked since being inoculated; one
case after his return from hospital gave a negative reaction to the re-Schick test. Tho
ninth was notified as suffering from scarlet fever and diphtheria, but was later diagnosed
as suffering from scarlet fever only.