View report page

Undoubtedly it would be desirable to employ a totally serum-free prophylactic if a satisfactory
preparation were available. In the present state of these preparations, however, such
does not seem possible. All the strong toxoid preparations are liable to produce reactions after
the immunising dose unless controlled by Moloney tests, and these tests are not feasible in clinics
held only once weekly. It therefore appears to be desirable to use a prophylactic which causes
little or no disturbance at the time of immunisation, and to run the almost negligible risk of slight
sensitation in event of a child requiring horse serum subsequently for any reason. If the serum
sensitivity were of a dangerous degree this view could not conscientiously be expressed.
One appreciates the fact that a general practitioner may desire to dispense with the Schick
test, as in the absence of mass psychology, which is a feature of the clinic, there is more likely to
be resistance and tears when children are treated separately in the consulting room.
Tears with us are not common, by reason of the mass psychology, and a film which was
taken by one of us is going over the country, and even to Australia, showing that the procedure
of immunisation is not a painful one.
The difficulty of the general practitioner is that if he neglects the Schick test, he remains
unwarned of pseudo-reactors, who definitely are more likely to show reaction to immunising
materials of all descriptions. Obviously also, he has no idea whether he is immunising without
need. On the other hand, if he dispenses with the posterior Schick test, he must warn parents
that the routine with T.A.M. may leave a proportion of the children incompletely immunised. Some
children may require extra injections.
It must be remembered that 'A NON-IMMUNE CHILD, BELIEVED TO BE
IMMUNE, IS IN GREATER DANGER THAN IF IT HAD NEVER BEEN TAKEN BY
ITS PARENTS TO BE PROTECTED, BECAUSE THERE IS LIABLE TO BE DELAY
IN CALLING FOR MEDICAL ASSISTANCE.' Hence the vital importance of making
certain that immunity has been established, or of warning the parents of the true position.
{Note. No quotation from the last paragraph is to be published or copied unless it contains the
whole of that paragraph and the preceeding one.)
In this work, it was hoped to determine exactly what could be accomplished by the use of
one single preparation as regards the initial production of immunity in as large a number of children
as could be thoroughly investigated. Further it was desired to find a partial answer to the oftdebated
question, " How long does artificially-produced active immunity last?"
As far as the co-operation of parents could be obtained, it was determined that every child
who had become Schick-negative as a result of T.A.M. injections should receive a further Schick
test about three years later. If the immunity of any subjects had waned, the purpose-was to
restore it by further injections.
Despite the pronouncement of the League of Nations and the Army Authorities that a
preliminary Schick test is unnecessary, it was decided to apply the test in eveiy case when possible,
for the following reasons :—
(1) To ascertain with accuracy the number of naturally immune cases compared
with those requiring to be immunised.
(2) To ensure that no child should be given immunising injections unless they were
necessary.
(3) To obtain statistical evidence of value. It is clear that no figures purporting
to relate to the efficiency of immunisation are of any value unless it can be shown that all the cases
under discussion were originally susceptible to Diphtheria, i.e., Schick-positive.
Our opinion is that the giving of injections to children who do not need them is both unscientific
and unsound. In our experience the initial sorting of the children into immune and
susceptible classes has been more instrumental in creating public confidence than has any other
part of the procedure. The parent who finds that one of her children is naturally immune and
needs no further injections, compared with the other child who does, is glad indeed, and there
appears to be no doubt that the Schick test is widely appreciated.
It may be easier to overcome prejudiced or nervous parents by stating that when the test is
omitted, the number of injections or attendances is reduced by one. Such procedure has not been
necessary in this work. Such success as we have attained has been by means of scientific work
combined with utter frankness, and by periodic publicity of various kinds.
It must be realised that while Dudley's work was done in a relatively closed community of
a circumscribed character, the investigation described here was carried out in a Borough with a
constantly growing population, the growth being the fourth largest in the country in the last intercensal
period. Much of that growth has been due to a population influx, planted in our midst by
neighbours, who are particularly resistant to all public health overtures.
Before giving figures and stating conclusions, the bare facts may be given. Out of 3526
children either naturally Schick-negative or rendered so as a result of adequate injections.
THERE HAS BEEN NO DEATH FROM DIPHTHERIA. THERE HAVE BEEN
38