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poison. The fluid medium is then filtered to get rid of the germs,
thus leaving a solution of Diphtheria poison or toxin. This solution
is diluted and standardised, and its exact strength ascertained. To
make the Schick test, a small quantity, about 3 minims, is injected
by means of a sterile syringe, not under the skin of the wrist but into
the skin. A control solution of heated toxin is injected into the skin of
the other wrist. In a few days the doctor examines the two wrists and
he can tell from the appearance whether the child is or is not naturally
immune, that is susceptible. If the wrists prove that the child is
susceptible or liable to contract the disease, then we proceed to immunise
the child. The fluid used for this purpose is diluted standardised
Diphtheria toxin, whose toxicity has been destroyed by the addition of
a little formalin antiseptic. To this is added some Diphtheria anti-toxin.
The dose for a child is divided into three parts, one third being given
weekly for three successive weeks. The area is carefully cleansed, of
course, before the dose is given. It is of importance to recognise that
this immunising dose stimulates the child's cells to produce anti-toxin,
as I have explained, but parents should understand that it takes months
—from 2 to 6 months after the inoculation—before the child developes
its own anti-toxin. At the end of 6 months the child which has been
inoculated in this way is again Schick tested. The reason for this is
that in a small percentage of cases the inoculation fails to act on the
child's cells. We can tell from the second Schick test whether the
inoculation has made the child immune. Now, what are the effects, if
any, on the child? Millions of inoculations have now been carried out
and records have been kept carefully. Sometimes we are informed
that a child has been restless in its sleep the night after inoculation,
but the evidence is overwhelming that no disturbance or complaint has
been created or made.
Professor Chapin of Providence in the United States says that the
use of this Schick test and inoculation has led to a 90 per cent. reduction
in the number of cases. In this country the total cost of the material
used for each case is 3/2½d. In London the cost of treating Diphtheria
in the Fever Hospitals of the Metropolitan Asylums Board is £500,000
per annum. It has been estimated roughly that the cost of Schick
testing and inoculating the school children would be £70,000 per year.
It is obvious that as Schick testing and immunising become better
known there will be an immense saving to the ratepayer in addition to
the saving in life.
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