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tissues might react to the protein constituent of the serum, giving pseudoreactions.
To avoid errors from this cause, it was customary at the time
of the Schick test to inject into the other arm as a control the same
inoculum but with the toxins neutralised. Any reaction then to the
control would be due to the protein. As a matter of practice this injection
of the control has been abandoned here because it has been found in
recent years that the proportion of pseudo-reactors was so very small
that they could be discounted.
In the early days of diphtheria immunisation, stress was laid on the
necessity of carrying out the Schick test after inoculation. It has always
been customary to carry this out not less than three months after the
completion of the course because that length of time has to elapse before
the full benefit of the inoculation was attained. It is only by Schick
testing that the reliability of preparations used can be confirmed. Since
the national publicity campaign in favour of diphtheria immunisation
it seems less stress has been laid on this point. Admittedly, the bigger
numbers treated make it more difficult to carry out the tests. Then again
experience has shown the reliability of the materials used in accepted
doses. Some authorities too, feel that the time of the reduced staffs
available for this work could be better employed in inoculating others,
rather than in testing those treated. In some areas a percentage of those
treated were tested, this step being taken to ensure that every batch of
inoculum used was active. In this district attempts have been made to
continue to offer facilities for having the test carried out on all treated.
It was felt that as long as there was no assurance of a hundred per cent.
success, and there is not, from the use of preparations that the parent who
had accepted advice as to the necessity for having his child treated was
also entitled to know whether the injection was a success in the case of
his child, or whether that child was in the group of perhaps 2 per cent.
who needed further injections to ensure immunity. It was only in the
year 1940 that staff difficulties prevented these facilities being offered
at the usual time. In general it is found that about half of those invited
attend. Of these about 2.5 per cent. are found to be still Schick positive.
The actual figures of those invited for testing in 1945 were 3,914. Of
these 1,801 attended, of whom 66 were found to be positive, a percentage
of 3.7.
Provision of Anti-Toxin.
By the Diphtheria Anti-toxin Order of 1910, local authorities were
empowered to provide a temporary supply of diphtheria anti-toxin for
the poorer inhabitants of the district. These powers were extended
under what is now Section 448 of the Middlesex County Council Act 1944,
so that a local authority may provide and supply, with or without charge,
to any registered medical practitioner antidotes and remedies against
any notifiable disease.
By the kindness of the members of the fire service, arrangements
have been made for serum to be obtainable at the various fire stations as
well as at the two isolation hospitals. On a number of occasions medical
practitioners have been circularised reminding them of these facilities.
The practice of medical practitioners administering serum is not now the