The Schick Test, given an accurate and
constant technique with some degree of practice in
interpretation of results, gives a reliable
indication of the state of immunity or susceptibility
of persons in relation to diphtheria.
It is possible, moreover, to create in the
susceptible that state of immunity which is found
to exist naturally in others.
The reliability of the Test is proved by the
results obtained in lowering the incidence of
diphtheria in institutions, fever hospitals, and
various closed and semi-closed communities in this
country and in America.
An immunization clinic may be held in special
clinic premises or in a school classroom or welfare
centre. Where schools are c oncerned, little upset
of the daily routine need occur. Shrewd staffing of
such a clinic is advisable and records must be
accurately made and filed, and general clerical
work reduced to a minimum. The more clerical work
the doctor and nurse have to do, the less time will
be available for treatment and the greater will be the cost of this treatment in consequence.
Efficient co- operation between the staff of the
clinic and the district health visitors goes a long
way towards completion of the injection course.
The Schick Test should be dispensed with in
children under the age of five years.
Toxoid anti-toxin mixture is a reliable
product and rarely gives rise to untoward reactions.
These may be either general, local, or general and
local, but seldom lead to discomfort, and are
transient. They are less frequent than with Toxin
anti-toxin, and less severe. While, moreover, it
may be a weaker antigen than Formol toxoid, and
necessitates the giving of three injections as
compared with one or two of Alum-precipitated toxoid,
time taken in acquiring immunity is of no particular
importance, the chief consideration being certainty
of protection with a minimum of upset. In my series
0.6 per cent of injections gave rise to reactions,
the majority occurring after the first injection and
in older children.
The first step to be taken towards the success
of any immunization scheme is the gaining of the
support of Head Teachers. Once this is obtained,
lectures, film demonstrations, posters and even
broadcasting may be employed. General practitioners
and nurses, thereafter, can do more perhaps than
they realise in encouraging those who may rely upon
their advice from day to day in regard to medical
Statistics show that immunization leads to a
marked reduction in incidence among inoculated as
compared with unprotected children, and while it is
possible through immunization to decrease the
incidence-rate very considerably, and even to reduce
the death-rate, it is the inclusion of the pre-school
child in any scheme which is the really important
factor in this reduction.
The cost of immunization is about one- ninetieth
of the cost of treatment in hospital.
While there is a theoretical risk of increase
in the virulent carrier-rate following upon
immunization within a community, this, in practice,
is not of necessity true.