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been displayed by the Public Health Staff in Lambeth in getting
notified cases (practically all notified real cases) removed to Hospital,
where antitoxin is used as a diphtheria routine (and chief) form of
treatment. What applies to the use of antitoxin in Lambeth applies
to its use in other Metropolitan Districts, and, of course, in other
Provincial Districts also.
The Schick Test and Toxin-Antitoxin Preventive Inoculation.
The inestimable value of antitoxin in the treatment of early
diphtheria in reducing the death-rate from that disease is now an
acknowledged fact by all experts and others. The bacteriologists
have proved to be correct, and their prophecy has come true as
regards diphtheria treatment by antitoxin. Why should not their
prophecy in regard to diphtheria-prevention by toxin-antitoxin
inoculation prove to be equally true ? The bacteriological principle
involved is the same. By means of what is known as the Schick
test, susceptibility to diphtheria can be definitely discovered, and,
where and when discovered, can be equally definitely combatted by
the production of artificial active immunisation. Diphtheria is
chiefly a disease of young children (pre-school and school children),
and it follows, therefore, that the inmates of all schools and of all
other institutions (dealing with such a highly sysceptible material)
should be systematically Schick-tested, and all inmates, who are
shown by that test to be susceptible, should be subsequently
rendered artificially immune by treatment with what is known as
toxin-antitoxin inoculation with an anti-diphtheria vaccine or
artificial immuniser.
It must not be assumed that all pre-school or school children
will prove to be susceptible on the application of the Schick test.
Some children (and other individuals) prove to be naturally immune
—very young pre-school children from their mothers.
The principle of the Schick test is easily understood. It consists
of injecting intracutaneously a minute quantity (almost
infinitesimal) of a standardised diluted diphtheria toxin (prepared
from the diphtheria bacillus) into the fore-arm of a child (or other
individual). The pain of the operation is negligible, as is also any
problematical danger to the person operated upon, assuming that
ordinary care and attention are exercised. Redness at the points
of puncture in a few hours or a few days shows susceptibility to
diphtheria, and diphtheria prophylaxis or artificial acute immunisation
should follow, producible by the injection of a small
amount of toxin-antitoxin (three successive doses at several days
intervals), intra-muscularly or sub-cutaneously, into the upper arm
or arms of the persons susceptible. Toxin-antitoxin*, as its name implies,
consists of a mixture, duly standardised—a very small amount