View report page

Procedure carried out at Clinics conducted by Dr. Guy Bousfield.
A Schick Test is carried out for the purpose of demonstrating susceptibility
to diphtheria or otherwise. 0.2 c.c. of Burroughs Wellcome
diluted toxin is given intradermally into the skin of the left forearm and
o.2 c.c. of heated toxin as a control into the skin of the right forearm.
The readings of these tests are carried out a week later.
Immunisation Treatment for Children.
The original procedure consisted of swabbing the skin over the deltoid
region with iodine solution and injecting 1 c.c. of toxoid anti-toxin intramuscularly
into the deltoid, the site of injection afterwards being touched
with iodine. Three doses of 1 c.c. toxoid anti-toxin were given at weekly
intervals. At the end of three months the child was re-Schicked to assess
the efficiency of the treatment and additional injections given if necessary
until an immunity certificate could be issued.
In 1933 a larger final dose of toxoid anti-toxin, i.e. 1.5 c.c. instead
of 1 c.c. was adopted and a fortnight's interval allowed between the 2nd
and 3rd doses. This procedure produced the satisfactory result that
far less children than previously were found to be positive on re-Schicking.
I n 1936 various types of diphtheria prophylactic were employed at
the Clinic including Alum-precipitated Toxoid for children. The product
was not given in a single or two injections but by the routine use of three
doses at intervals of a fortnight, the dosage being 0.1 c.c., 0.3 c.c. and 0.5 c.c.,
for the purpose of conferring immunity against the more serious types of
diphtheria infection.
Toxoid Anti-toxin Floccules were employed for adult patients in
three doses of 1.0 c.c. at intervals of two weeks.
Later (1940) in treating children the recommended dosage of 0.1 c.c.
and 0.3 c.c. of A.P.T. at one-month intervals was adopted but found to
be unsatisfactory. Subsequently it was demonstrated that 0.2 c.c. and
0.5 c.c. of A.P.T. at one-month intervals was reliable.
In the early days of the war, some of the prophylactics on the
market were either of poor or of very variable quality. Much patient
investigation was performed in the clinics to decide which preparations
were most universally reliable. An endeavour was made to solve some of
the unknown problems of diphtheria immunisation, e.g., optimal dosage
of A.P.T. and the most satisfactory intervals at which to give injections.
The latest and most powerful immunising agent. Purified Toxoid,
Aluminium Phosphate Precipitated, produced by Mr. L. B. Holt in the
Wright-Fleming Institute of Microbiology under the direction of Sir
Alexander Fleming, is also at present under investigation with a view of
finding out whether one really powerful injection will prove adequate instead
of the two now generally used; this would save the mother's time by
diminishing the number of attendances and make it possible to deal with
a correspondingly larger number of children at the clinics in a given period
of time.
It should be emphasised that no child is discharged from the Council's
Clinics as adequately treated, or is given a certificate until it has proved
negative to the Schick Test following treatment.
In the 22 years that the Council's Clinics have been in operation
there is only one instance of a child previously immunised dying of
diphtheria. Even in this case there were factors which make it somewhat
doubtful that the child did, in fact, actually die of diphtheria. However, even
if this case be assumed to be a failure of our attempt to protect infants and
children from dying of the disease—only one failure in 22 years is a truly
remarkable record. It fully justifies the fact that in the Council's Clinics
the most scientific technique known has always been adopted.
Protection given by the treatment tends to wane as time goes on and to
ensure the greatest amount of resistance a child immunised before the age of
one year should receive a reinforcing dose at school age and again at puberty.