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It has been recommended that, as children under 5 years show
by the Schick test a large percentage of susceptibles, there is no
need to apply the Schick test and artificial immunisation should
be carried out at once. Zingher, who has done more work in
Schick testing and immunisation than any other person, recommends
as follows:—
1. Infants under 6 months should not be immunised.
2. Children 6 months to 5 years should be immunised
without the Schick testing.
3. Children of 5 years entering school should be immunised
without the Schick test.
4. Older children up to 15 years should be immunised only
if Schick test is positive.
5. Over 15 years, same procedure.
Under 5 years of age half the deaths occur from diphtheria
and attention should therefore be concentrated on that group. If
the Schick test can be dispensed with in regard to them the procedure
of immunisation is greatly simplified.
The procedure would on the whole be greatly simplified and
would perhaps meet with more ready acceptance on the part of the
parents if the protective injections could be reduced from three
to one, and if the severe reactions occasionally experienced after
them could be mitigated. Improvement in this latter respect has
been provided by the introduction of a modified toxin known as
"toxoid." It is said that by the use of toxoid reactions are almost
completely abolished.
General Application of Schick Testing and Artificial Immunization.—The
general public may be against the general adoption
of immunization in the same way as with vaccination against
smallpox but the protection should be available for those who
desire it.
Immunization is particularly applicable to small towns or
isolated communities where diphtheria is epidemic and where other
measures have failed to effect improvement. It can also be applied
to large residential schools or institutions which are liable to