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made to continue the inoculation of the remainder One child (F., aged 4 years) was positive
to the second re-Schick after 6 c.cm., but was negative after 8 c.cm.; this child was the
eldest of four girls; the three younger ones were negative after the routine 3 c.cm.; two of
these receiving their routine injections on the same day and from the same batch of antitoxin
as the eldest.
Of the 707 persons re-tested, 319 were males and 388 were females. Among the positive
were 34 males and 47 females. Neither age nor interval seems to have any influence on the
phenomenon. It would seem conceivable that some batches of toxin antitoxin might prove
to be less efficacious than others. An analysis of the results obtained in Holborn would seem
to indicate clearly that this is so; also that the toxoid antitoxin used was as efficacious as
the toxin antitoxin. The toxin-antitoxin mixtures used were all 3 Li + per c.cm. mixtures,
tho toxoid antitoxin contained toxoid diluted 1-10 with added antitoxin.
Use has also been made of T.A.F. (flocculated toxin-antitoxin) in the case of
23 persons found Schick positive. Of these 23 persons, 22 have been re-tested;
in five of these the reaction to the first test was so slight that they were recorded
as suitable for immunisation with only one dose, if T.A.M. had been used. 11 of
these (nine children and two adults) were negative to the re-test.
Eleven (ten children and one adult) were positive to the re-Schick test; of
these, six were further inoculated with T.A.F. (three of these were negative to the
second re-Schick), five were further inoculated with toxin-antitoxin (three of these
were negative to the retest). The use of T.A.F. has been discontinued for the
time being.
An interesting use of the Schick test was made in connection with a family in
which a baby, A.G., six weeks old, developed diphtheria. There were three other
children in the same family, a boy, L.G., aged 10 years, and girls, M.G. and O.G.,
aged 9 and 8, as well as the mother and father.
Swabs from children contacts were taken; the boy and the girl aged 9 years
were shown to be harbouring diphtheria bacilli in their noses. On re-swabbing a
fortnight later the bacilli in the nose of the girl morphologically resembled
diphtheria bacilli, but the virulence test proved negative.
On the 26th February O.G. and A.G. both gave a negative Schick reaction
and on the 5th March L.G. and M.G. also gave negative reactions. As a matter
of interest the mother was tested and gave a positive Schick reaction.
Retesting.
Re-testing is unpopular with parents, and the need for it does not help to
increase their confidence in immunisation. Of 707 that have been retested 70
were found to be still Schick positive after three inoculations and 11 after T.A.F.
The facts relating to these are given in Table TIT.
Diphtheria in Children Treated with Immunising Injections.
Up to the end of the year 1929 nine cases of diphtheria occurred in children
who had been found positive on Schick test and treated with three immunising
injections; the details of these are given in Table IV.
Diphtheria was also notified as having occurred in six other children who had completed
their course of inoculation, but the diagnosis in these cases was eventually not confirmed.
Two of these (brother and sister) were removed to M.A.B. hospitals as suffering from
diphtheria, but they were diagnosed as suffering from rubella and "carrying" diphtheria
bacilli but not as suffering from diphtheria. Both these children had been found negative
to the re-Schick test some time previously. Three others were removed to M.A.B. hospitals
as suffering from diphtheria, but were shortly afterwards discharged as not cases; neither
had been re-Schicked since being inoculated; one case after his return from hospital gave a
negative reaction to the re-Schick test. The sixth was notified as suffering from scarlet fever
and diphtheria, but was later diagnosed as suffering from scarlet fever only.