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previously to the second one (M. 1), and both were further inoculated, and were negative
to the second test.
In another family of six (Fs.), all Schick positive to the first test, the eldest only was
Schick positive to the retest; this child was still Schick positive after a second course of
3 c.cin.; she became Schick negative after a total of 8 c.cm. had been given.
Routine Procedure.
The routine of the procedure carried out is as follows. The child is Schick
tested at the Council's Maternity and Child Welfare Centre, and if susceptible, to
diphtheria is brought up by the parent at weekly intervals for the next three weeks
for immunisation, and then at the end of another three months (formerly we tried
for the period six to eight weeks) for re-Schick testing, when, if it is
still positive, it receives further inoculation. A modification of the routine occurs
if from the Schick test it is seen that the child is particularly susceptible to
protein reactions; in this case the 3 c.cm. of toxoid antitoxin mixture are given in
four or five dopes at weekly intervals; again if in older children the Schick reaction
is very faint, it is sometimes considered that 1 c.cm. will be sufficient; the retest
as a rule confirms this.
Some difficulty has been experienced in securing the necessary number of immunising
injections owing to families removing from the district; some of these, however, attend to
finish the course. A few adolescents at times fail to complete the course by reason of being
employed and it no longer being convenient for them to attend.
Although Park and Zingher recommended some time ago that Schick testing should be
applied only to children over five years, it seemed inadvisable for some time to dispense with
the test as a routine in Holborn. It was a great satisfaction to nervous parents to think
that there would be no inoculation unless susceptibility was proved. Now that immunisation
is being given at other welfare centres in London, it is easier to dispense with Schick testing
of very young children and at the end of 1927, thirteen children under five were immunised
without a preliminary test, and now nearly all the children under five attending are being
immunised without a preliminary test.
The following table gives particulars of 555 cases retested, of whom 78 were
found to be still Schick positive after three inoculations:—