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63
As it is felt that such treatment without subsequent Schick
Testing is of no proved value, and perhaps even a source of danger,
an effort has been made to carry this out in the case of everyone
treated at the Clinic. Such tests were performed at an interval
of 3 months or more after the last injection of T.A.M. or T.A.F.,
1,224 and 40 respectively. The latter all proved to be negative,
while of the former, 1,214 were negative and 10 positive. All tests
so carried out were actually read, or a reliable report received as to
the result; this was made possible by visiting 39 children in thenhomes
during the year, when, by reason of reported illness, they
were unable to attend for final reading.
Of the 10 children Schick positive after treatment, 4 were
retested after a further interval of from 3-5 months, and all proved
to have become Schick negative. One gave a weak positive reaction
on two subsequent occasions, at 2 and then at a further 6 months
interval, when the child received one extra injection of T.A.M.
The Schick Test has not been repeated again so far in the case
of this child. The remaining 5 received extra injections of T.A.M.,
four receiving 1, and one 2, injections on account of their apparent
degree of susceptibility as shown by the Schick Test subsequent to
their course of T.A.M. All gave a negative reaction to a further
test.
Three children, retested after extra injections of T.A.M. given
in 1935, all prove to be Schick negative.
In view of the number of children on the waiting list, it was
found to be impossible to arrange any systematic repeat Schick
Tests among children previously immunised, or naturally immune.
Out of 54 carried out, 50 were confirmatory in children originally
found to be Schick negative, while 4 were repeats in original Schick
positives whose treatment had rendered them Schick negative at
3 months. These latter repeats were carried out at 3 months, 15
months and 2 years (2 cases) after the development of the Schick
negative state, and in all the result was satisfactory.
The Immunisation course employed was one of 3 infra-muscular
or subcutaneous injections of 1.0 T.A.M. (or T.A.F.) into the
left arm near the shoulder, and with due aseptic technique. In
older children injections were given at fortnightly or weekly intervals,
while in younger children, with presumably a lower degree\
of basal immunity, there was frequently an interval of 3 or more
between injections. Gentle rotatory massage was employed
in all cases after injection, to prevent, if possible, the development
of any tender swelling after an injection, by early dissipation of the
injected material throughout the tissues.