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81
Dr. Davies of the Seamen's Hospital has used Toxoid
Antitoxin Floccules (T.A.F.) which is the specially recognised safe
antigen that may be used without the possibility of dangerous
jeactions. In this case, three injections at 2-weekly intervals is
the rule, and the number of visits by the patient is a disadvantage
which sometimes leads to the giving up of treatment before
completion. (Dr. Davies reports, however, that in only 4 casas
out of 70 has treatment been discontinued).
Comparing the materials used in our scheme, the advantages
and disadvantages might be tabulated thus :—
A.P.T. a. Three visits needed as a rule, i.e., one visit for
inoculation, one for confirmatory Schick test, and
a final visit to interpret same.
Five visits would be the maximum, except in extreme
cases. This routine would cover an initial and final
Schick test and the inoculation.
b. It is not devoid of danger as regards possible reactions,
especially among older children, and therefore
should only be used by an expert.
c. Because only one inoculation is needed as a rule,
the cost of material is reduced 50/60% as compared
with other materials.
T.A.F. a. Five visits are needed as a rule, i.e., three for inoculations
and two for the Schick test. Seven visits
may be regarded as the maximum.
b. May be regarded for all practical purposes as being
devoid of danger and does not necessitate the reservation
of specialist services.
c. Because of the number of injections needed, a scheme
including the use of T.A.F. would be much more
expensive than when the other material is used.
(3) The Scheme generally—
It has proved very easy to administer, and the numbers
would probably grow, especially if propaganda were allowed.
On the other hand, about 1,200 children reach the age of five
and enter school each year, and even if the numbers dealt with
under the present scheme were markedly increased, we should
only be immunising three or four per cent, of school entrants.
I mention this factor since the incidence of Diphtheria and its
fatality are heaviest in children between 3 and 7 years. It is
recognised that the best age to immunise is 2 to 3 years, and
certainly before 5 years if possible. It is my opinion that to
affect materially the incidence and death-rate, and more