Diphtheria Studies: I—The Significance of the Schick Test in the Adult

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Abstract
The relationship between the Schick reaction, antitoxin concn., antigenic stimulation, and age in cf adults was studied in 2 Michigan hospitals for the insane. Blood specimens for antitoxin determination were drawn not more than 24 hrs. before the Schick test. Schick tests were read on the 5th and 7th day or on the 4th and 6th day. 1, 2, or 3 subcut. injections of toxoid were given to Schick positive patients at 3-week intervals. The post Schick test was done 3i mos. after the 1st dose of toxoid in one hospital and 7\ mos. after the 1st dose in the 2nd hospital. The preantigenic sera were titrated to 0.1 unit of antitoxin per cc, the post antigenic sera to 7.5 units. Results indicated that there is no antitoxin level in adults below which all Schick reactions are positive, and above which all are negative; 0.03 units seems to be a satisfactory dividing point; "false negatives" and "false positives" based on 0.03 units as the end point, occur in different proportions before and after antigenic stimulation ; the % of Schick negatives increases more rapidly with age than the % of antitoxin concns. at or above 0.03 units; the intensity of Schick reaction is correlated to a certain degree with the antitoxin concn.; and some factor other than circulating antitoxin is responsible for the decrease in the case rate among Schick positive persons with age.

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