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diphtheria. The attack was so virulent, however, that the
bacilli were able to produce a small local lesion in the throat,
but this external breach was rapidly repaired by the patient's
own circulating anti-toxin without the administration of outside
help in the form of diphtheria anti-toxin of equine origin. There
was no subsequent toxæmia or paralysis, and the patient was
well in a few days.
Description of the Method of Schick-Testing in Camberwell. —
The toxin used in the above Clinic is diluted immediately before
use. By using a slightly stronger test toxin, an endeavour has
been made to establish a higher degree of immunity in those
attending than that which is accepted by most workers. The
ordinary toxin used for the Schick test contains 1/50 M.L.D. of
toxin in 0.2 ccs. of diluted toxin. My practice has been to use
toxin of approximately one-third greater strength than the orthodox
amount, demanding a larger amount of circulating anti-toxin
in the patient's blood to give a negative Schick test. This increase
in strength is obtained by rejecting a portion of the diluting fluid
when making up the toxin before use.
In this way it is hoped that no slightly susceptible persons
may ever be passed out of the Clinic in the belief that they are
fully protected. It is highly important that the operator should
know that each batch of toxin used for re-testing patients after
immunising injections retains its full activity. The only way of
ensuring this appears to be to test at any rate several new cases
of susceptible ages, so that when positive readings from these
are obtained the negative re-Schick reactions may be fully relied
upon.
Chart 2 shows the numbers of persons in the respective age
groups who have been brought to the Clinic for treatment. The
dotted line indicates the relative susceptibility to diphtheria of
the various age groups. It must be remarked that three protective
injections are not always sufficient to immunise a child,
an occasional case requiring five or even six injections before the
desired result is obtained. Total failure to produce immunity by
perseverance with the injections is very rare, but when it does
occur there is a tendency for the difficulty to be met with in
families. This suggests some hereditary peculiarity. There was
also a case of four brothers, two of whom were dark and two fair.
The two fair boys were immunised with the greatest ease, while
the two dark brothers required several further injections and a
much longer time period before they gave a negative Schick
reaction. This again suggests a maternal and paternal hereditary
element.
G. BOUSFIELD,
MB., B.S. (Lond.).