The Health bulletin [serial] - University of North Carolina at Chapel Hill

8 The Health Bulletin August, 1927
sistently through all these years is
the administration of a preparation
known as "toxin-antitoxin." Toxinantitoxin
derives its immunizing potency
from diluted, altered diphtheria
toxin. It is no use to go into a detailed
discussion of this phase of the
question. Suffice it to say that it is
a laboratory product that has been
perfected from the standpoint of
potency and safety through many
years' work and experiment. The
toxin-antitoxin has a very small
quantity of what is called "horse
serum globulin," which causes what
is called a "moderate serum sensitization"
in an occasional person. Very
few people are susceptible to this, but
now and then one reacts and is made
sick. When any doctor or health
officer knows of such a person he does
not give the ordinary toxin-antitoxin.
But the commei'cial laboratories have
a special product in which goat antitoxin
is used in place of the horse
serum in the preparation of the preventive
toxin-antitoxin.
Following are some of the questions
that we wrote and asked Dr. Park:
First: Suppose a child has had
diphtheria one year ago and the attending
physician had given the child
curative antitoxin. Knowing that a
dose of curative antitoxin does not
confer immunity except for a few
days, and knowing also that an attack
of diphtheria fails to confer immunity
in every person against subsequent
attacks, the question naturally
occurs in connection with the
question of serum sensitization, would
it be safe and desirable to give such
a child toxin-antitoxin in order to
provide immunity against further
attack
Dr. Park answered that such a child
should be given the toxin-antitoxin.
To use his own language, "So far as
giving toxin-antitoxin after a dose
of antitoxin, there is no diffei'ence
of opinion that this is absolutely
harmless."
Second: In a child that had toxinantitoxin
administered in three doses
at separate intervals, say one year or
more ago, and who happens to be one
of the small percentage of children
failing to receive immunity from
three doses of toxin-antitoxin and develops
diphtheria, the question arises,
would it be safe to give it antitoxin
Dr. Park answered this question by
saying that "There is no objection to
giving antitoxin to a child who has
had toxin-antitoxin or any other
serum."
The foregoing reply is a definite
and clear-cut statement which should
set at rest the fears of any doctor
or health officer in the State concerning
the free use of antitoxin when an
attack occurs regardless of what the
child has previously had, or concerning
the use of toxin-antitoxin as an
immunizing agent regardless of previous
administration of serum of any
kind. This is a statement that will
pay every doctor and health officer to
remember.
Schick Test
There is a test known as the Schick
reaction which is very simple in the
hands of experienced physicians who
become expert in its use for determining
whether or not any person is
immune to a future attack of diphtheria.
For those who would like to
decide when to use the Schick test,
when it is not necessary to use, and
vvhat may be expected from it, the
following illuminating statement of
Dr. Park will be welcomed by everybody
concerned:
"The Schick test is used when the
giving of the test gives more information
than trouble. In cities the
Schick test is usually done in school
children before giving the
toxin-antitoxin.
In country districts it is
usually not given. The reasons for
this difference is due to the fact that
in the city, childi'en by the time they
reach school age are generally immune,
while in the country the great
majority are still not immune. In