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It will be seen therefore that a susceptibie child would have:-
(1) Preliminary Schick tests ;
(2) Three or more injections for immunisation at intervals
of a week;
(3) Posterior Schick test;
(4) Further injections, again followed by Schicking if not
immunised.
I have mentioned that children show considerable immunity
in the first six months of life and then remain very susceptible for
some years, slowly developing immunity as age advances.
There is much to be said, then, for tiding them over the
susceptible age, even if the protection conferred by the injections is
not permanent. Zingher suggests that not only is an active
immunity—such as follows other forms of vaccination — produced,
but that there is also an earlier development of the natural
immunity which would otherwise have manifested itself more
gradually.
The presence of this latter factor would justify the hope that
the immunity is likely to be more or less permanent.
The cost of immunising on a large scale is difficult to estimate
as of course it cannot be made compulsory and therefore it is
impossible to say how many parents will take advantage of the
facilities offered.
One thing, however, is definite. For the amount paid to treat
one case of Diphtheria in Hospital, material to immunise 200 children
can be obtained. In districts where immunisation is carried
out the cost of the scheme varies considerably. This depends on
(1) whether Schick tests are omitted and only immuniastion
injections given, and (2) whether an existing staff is able to deal
with the whole of the work, including the interpretation of the
Schick tests. It seems to me that in a matter of this kind, only
those who are, by experience, skilled both in technique and in the