578 PATHOGENIC MICROORGANISMS 



bacilli as a carrier. It has been found unnecessary to give prophylactic 

 injections of antitoxin to individuals with a negative Schick reaction. 

 Park and Zingher 38 have found that negative reactions were obtained 

 in 93 per cent of the new-born, and became less frequent up to the second 

 or fifth year, when 37 per cent were negative. In older children nega- 

 tive reactions were more frequently met with, and about 90 per cent of 

 adults were negative. A pseudoreaction which appears earlier than 

 the true reaction and which disappears in twenty-four to forty-eight 

 hours is occasionally seen in individuals who have natural antitoxin. 

 This is due to sensitiveness to some of the proteins used in the injection, 

 and may be reproduced in the same individual by the injection of autol- 

 ysate of diphtheria bacilli or sometimes by the injection of broth media. 

 The most satisfactory method for detection of the pseudoreaction is to 

 make a control injection of Vso M.L.D. of a toxin which has been 

 heated at 80 C. for five minutes. This heating destroys the toxin, but 

 leaves uninjured the substances which produce the pseudoreaction. 



The Schick reaction has been extensively used in the last six years, 

 especially on large bodies of troops and on school children, and has been 

 found eminently satisfactory, though, of course, as with all other biolog- 

 ical reactions, exceptions are noted and difficulties encountered. The 

 New York Department of Health and other health departments are 

 now putting out materials for the Schick reaction in packets so arranged 

 that the necessary toxin is inclosed in capillary tubes and can be blown 

 out into a mixed amount of salt solution with a rubber bulb. A part 

 of this mixture can then be heated to 80 and an injection with a control 

 done on the upper arm of subjects as indicated. 



Notes on Specific Therapy. Specific therapy in diphtheria is, of 

 course, the main thing in clinical control. It must be remembered here 

 as in all other forms of specific therapy that success depends as much 

 upon the time at which the diagnosis is made as it does upon the manner 

 of treatment. Therefore, in speaking of specific therapy, it is impor- 

 tant to emphasize the necessity for early diagnosis. It is in this par- 

 ticular that the responsibility of the physician is greatest, and every 

 severe sore throat in a child should be immediately cultured and, though 

 not as imperative in adults, it is not a bad rule to culture all throats by 

 the Loeffler method. We have discovered a number of cases in that way, 

 especially in military sanitation, which would not have been suspected 

 clinically. The procedure is easy, consumes no time and requires so 



38 Park and Zingher, Jour. A .M. A., 65, 1915, 2216. 



