THE “SCHICK” INOCULATION FOR IMMUNISATION AGAINST DIPTHERIA BY M. BEDDOW
BAYLY, M.R.C.S., L.R.C.P.
THE "SCHICK" INOCULATION FOR IMMUNISATION AGAINST DIPTHERIA BY M. BEDDOW BAYLY, M.R.C.S., L.R.C.P. THE "SCHICK" INOCULATION FOR IMMUNISATION AGAINST DIPTHERIA An Exposure of its Dangers and Fallacies M. BEDDOW BAYLY, M.R.C.S., L.R.C.P. 1939 2nd EDITION Issued by The National Anti-Vaccination League (WHALE June 2002, Book supplied by John Wantling) SECTION 1. THE GERM THEORY OF DIPHTHERIA SECTION 2. THE SERUM TREATMENT OF DIPHTHERIA EVIDENCE AGAINST THE USE OF SERUM RECOGNITION OF THE FAILURE OF SERUM WORLD-WIDE CLAIMS VERSUS FACTS SECTION 3. THE HARMFUL EFFECTS OF SERUM TREATMENT 1.ANAPHYLACTIC SHOCK 2. SERUM DISEASE 3. REMOTE EFFECTS OF SERUM ANTI-DIPHTHERITIC SERUM AS A PROPHYLACTIC SECTION 4. THE SCHICK TEST 1.THE TEST IS OF NO VALUE IN CHILDREN UNDER FIVE (when it is most needed) 2. THE TEST IS BEING ABANDONED IN NEW YORK AND OTHER PARTS OF AMERICA ON ACCOUNT OF ITS UNRELIABILITY 2A.THE TEST HAS ALSO BEEN DROPPED IN CERTAIN PARTS OF ENGLAND 3. THE RESULTS OF THE TEST VARY ACCORDING TO THE FIRM SUPPLYING THE MATERIAL 4. SCHICK-NEGATIVES MAY CONTRACT OR EVEN DIE FROM DIPHTHERIA 5. SCHICK-POSITIVE PEOPLE DO NOT CONTRACT DIPHTHERIA 6. RESULTS OF TEST IN LARGE NUMBERS OF SCHOOL CHILDREN IN CONFLICT WITH EXPERIENCE 7. SCHICK-NEGATIVE PERSONS MAY BECOME POSITIVE 8. TEST OF NO VALUE BUT STILL ADVOCATED 9. That the Schick test alone may give rise to undesirable sequelae ALLERGIC REACTIONS FOLLOWING THE SCHICK TEST SECTION 5. "SCHICK" IMMUNISATION THE FAILURE OF IMMUNISATION EVIDENCE FROM AMERICA FRANCE GERMANY GREAT BRITAIN IMMUNISED PERSONS CONTRACT DIPHTHERIA EVIDENCE FROM AMERICA AMSTERDAM ENGLAND & WALES FRANCE IRELAND ITALY SCOTLAND IMMUNISATION HAS NO EFFECT ON SEVERITY OF ATTACK FALLACY UNDERLYING DESCRIPTION "MILD." FALLACY UNDERLYING FAVOURABLE REPORTS GROWING SUSPICION OF "SOMETHING WRONG" WITH THE METHODS IMMUNISATION A PUBLIC DANGER SPECIAL DANGER TO INOCULATED CHILD WHO DOES NOT BECOME IMMUNE COMPULSORY IMMUNISATION SECTION 6. THE DANGERS OF "SCHICK" IMMUNISATION A SERIES OF DISASTERS 1919-1938 SECTION 7. THE INHERENT DANGERS OF "SCHICK" INOCULATION TOXIN-ANTITOXIN TOXOID-ANTITOXIN (T.A.M.) TOXOID-ANTITOXIN FLOCCULES (T.A.F.) TOXOID; FORMOL-TOXOID (F.T.); RAMON’S TOXOID; ANATOXINE ALUM TOXOID (A.T.) DIPHTHERIA TOXOID, ALUM-PRECIPITATED (A.P.T.) A TIMELY WARNING BY THE "MEDICAL WORLD." SECTION 8. DANGERS INHERENT IN ALL MIXTURES CONTAINING ANTITOXIN DANGERS COMMON TO BOTH TOXIN-ANTITOXIN AND TOXOID-ANTITOXIN THE ARTHUS PHENOMENON FREQUENCY OF REACTIONS ACUTE ANAPHYLACTIC SHOCK FOLLOWING INTRACUTANEOUS TEST FOR SENSITIVITY TO HORSE-SERUM A MEDICAL OFFICER OF HEALTH’S CHALLENGE SECTION 9. STATISTICAL FALLACIES 1. ALTERATIONS IN DIAGNOSIS A NEW NAME FOR DIPTHERIA IN THE IMMUNISED A COMPLETE VOLTE FACE MILD CASES IN "IMMUNISED" cannot BE DIPHTHERIA TYPICAL CLINICAL CASES NOT DIPHTHERIA IN "IMMUNISED" UNLESS KLEBS-LOEFFLER BACILLUS PRESENT 2. ERRORS OF CLASSIFICATION 3. ERRORS DUE TO NATURAL VARIATIONS IN INCIDENCE 4. Some eminent bacteriologists do not accept the statistical method when dealing with epidemics SECTION 10. THE FALLACY OF THE THEORY OF IMMUNITY THE CAUSE OF DIPHTHERIA THE PREVENTION OF DIPHTHERIA HOW HEALTH DEPARTMENTS INSTIL FEAR OF DISEASE. SECTION 11. SUFFERING TO ANIMALS INVOLVED IN THE MANUFACTURE AND TESTING OF SERA SECTION 12. WHAT EMINENT DOCTORS THINK ABOUT INOCULATION ADVICE GIVEN BY THE MINISTRY OF HEALTH NOTE REGARDING THE USE OF THE TERM "SCHICK" The qualifying adjective "Schick" is, strictly speaking, only applicable to the skin test which was devised by PROFESSOR BELA SCHICK, of Vienna, in 1913, and has consequently borne his name. But the term has become, by popular usage, so closely associated with the complete process of testing and immunising that for the purposes of this pamphlet it seemed to be of advantage to use it throughout for the immunising inoculation as well for the preliminary test. The reader will understand that wherever the term "Schick" occurs in inverted commas it is being used for convenience and not a strictly scientific sense. NOTE TO SECOND AND REVISED EDITION. In presenting this second and enlarged edition, the author wishes to make it quite clear that in no case does quotation from any authority imply that the writer is to be regarded as in any way opposed to orthodox principles of medical pathology and practice. Indeed, it is largely because the authorities quoted are of orthodox standing that the expressions of opinion extracted from their writings are the more noteworthy. In regard to the criticism sometimes made that these quotations taken from their context create a false impression of the writer’s meaning, great care has been taken by the author to give sufficient context to render the quotations fair in this respect. Moreover, by giving the full page references the reader is encouraged, and is, indeed, urged, to study the original writings. For in most cases it has been impossible, for reasons of space, to do more than extract a more striking passage from among others of equal interest and importance. The author desires to express his indebtedness to DR. I. HARRISON TUMPEER and DR. H. E. IRISH, of CHICAGO, for the copies of their photographs from which the illustrations have been prepared, and for their kind permission to publish the same. Illustrations I, II and III appeared originally in the Journal of the American Medical Association, April 25th, 1931; illustrations IV, V and VI in the same Journal of February 18th, 1933. SECTION 1 THE GERM THEORY OF DIPHTHERIA The attempt in recent years to prevent diphtheria by the injection of toxin-antitoxin and similar products, as well as the routine treatment of diphtheria, when it occurs, by antitoxic serum, is based upon the primary fallacy that diphtheria is caused by a "germ"—the Klebs-Loeffler bacillus. The following facts prove that this belief is a fallacy : — 1. The germ is absent in many cases of the disease it is alleged to cause: In 14 per cent, of cases, according to the Lancet, Sept., 1898, (p. 779) In 20 per cent. of cases, according to the Report of Royal Commission on Vivisection, 1912 (p. 38) In 28-40 per cent, of cases, according to SIR WILLIAM OSLER (Principles and Practice of Medicine, 8th Edition, 1912, pp. 58-60). As the British Medical Journal, May 1st, 1926, quoting a Continental doctor, H. HECKSHER, stated: " Bacterial examination is not infrequently negative in just those cases of diphtheria which are most serious." (Epit. of curr. med. lit., p. 78.) 2. It is commonly present in many diseases it is not supposed to cause. A list of 17 of these, ranging from Eczema to Endocarditis and from Pleurisy to Puerperal fever, will be found in the Medical World (June 15th, 1928, p. 330). SURGEON COMMANDER S. F. DUDLEY was reported in the Lancet, May 12th, 1928, as mentioning in the course of a lecture to the Society of Medical Officers of Health that " 15 per cent, of the swabs from over 1,000 non-membranous sore throats grew the Klebs-Loeffler organism." He went on to say that "the diphtheria throat swab had been in many ways a curse." For : — "a positive report without a virulence or a Schick test must have forced a wrong diagnosis on many non-specific throats, thus falsifying the notification returns." (p. 965.) 3. It is frequently found in the throats of normal healthy people. According to the Ministry of Health Report (No. 10, p. 26), it has been demonstrated in 15 to 20 per cent. of school children. The same Report (p. 14) states that in the Willard Parker Hospital in New York, of 1,200 patients, 20 per cent. had diphtheria bacilli in their throats and were in contact with diphtheria cases, and yet in no single instance developed diphtheria, although in many cases the bacilli were of a virulent type. SURGEON COMMANDER S. F. DUDLEY found that "7 per cent. of some 4,000 healthy boys had been proved to be carriers at the (Greenwich) Royal Naval School." (Lancet, May 12th, 1928, p. 965.) Even " persons giving a positive reaction (Schick)," and therefore supposedly susceptible to attack, " may occasionally harbour diphtheria bacilli in their throats without developing diphtheria." No explanation of this has been offered. (Report on Diphtheria, by the Ministry of Health, No. 10, p. 13.) DR. MASSINGHAM, Resident Medical Officer at the London Fever Hospital, admitted in the Lancet, February 25th, 1928 :— "A positive reaction with virulent diphtheria bacilli in the throat is compatible with perfect health." (p. 416.) The Medical Echo, Vol. 14, No. 55, October, 1936, made an even more striking pronouncement in an article on "The Swab in Diphtheria," saying : — "Persons may harbour virulent diphtheria organisms in their throat, and yield a Schick positive reaction and nevertheless show no signs of the disease clinically. Moreover, an investigation of their blood may show that there is no appreciable amount of antitoxin present." (p. 56.) In fact, as DR. CLAUDE BUCHANAN KER, Medical Superintendent of the City Hospital, Edinburgh, wrote in his textbook, A Manual of Fevers (1912):— "it is certain that a healthy mucous membrane is capable of resisting diphtheria and many persons in perfect health harbour the bacillus in the throat." (p. 224.) 4. The germs are innocuous when experimentally introduced into the healthy body. (a) DR. RODERMUND "sprayed the poisons of diphtheria, smallpox, scarlet fever or consumption into the throat, nose [of his patients], or had them breathe into the lungs, repeating the experiments in most cases every one or two weeks for months with the result that no disease could be developed." (Medical Brief, St. Louis, U.S.A., 1906). (b) DR. J. B. FRASER, of Toronto, and five volunteers swallowed millions of active Klebs-Loeffler bacilli in milk, bread, fish and alone, without any subsequent ill-effects (Canada Lancet, Vol. XLIX, No. 10, June, 1916, p. 447.) (c) PROFESSOR UIRICH FRIEDEMANN, M.D., Berlin, has stated:— "It is known that diphtheria bacilli do not live long in a healthy organism." (The Lancet, Aug. 4th, 1928, p. 214.) 5. It is clear that the claim of the Klebs-Loeffler bacillus to be considered the causal agent in the production of diphtheria is unsupported by scientific evidence. As PROFESSOR FRIEDEMANN affirmed when dealing with its almost ubiquitous nature: "We came to the conclusion that in one year about one-third of the population is infected with diphtheria bacilli without contracting the disease." (Loc. cit.) 6. The part played by the bacillus in the transmission of the disease from one person to another is equally in doubt. For instance, the British Medical Journal, March 26th, 1927, reviewing an article on diphtheria which appeared in a Scandinavian medical journal, stated : — "As in the observations of 1925-26 no case of clinical diphtheria developed in contact with any carrier, the author sees in this observation confirmation of the now general opinion that diphtheria carriers need not be isolated nor be the object of any special measures in the majority of cases." (Epit. of curs. med. lit., p. 57.) PROFESSOR FRIEDEMANN reported that after investigation Doull and Lara: "Came to the conclusion that the danger of infection by carriers is negligible compared with the danger of infection by patients." (The Lancet, Aug. 4th, 1928, p. 215.) Furthermore, in regard to the latter he admitted that as the result of a League of Nations inquiry among seven different nations : "We see that the number of case-to-case infections does not amount to more than 2.9 per cent, of the total diphtheria cases." (Loc. cit.) The following annotation appears in the British Medical Journal, January 19th, 1935:— T. Hünermann (Munch. med. Woch., October 20th, 1934, p. 1660) considers that the danger to the community of the diphtheria ‘carrier’ is apt to be grossly exaggerated. ….. He goes on to quote a statement made by Lenz that no case is known to public health authorities in which children, known to have been carriers for more than eight weeks, have infected a fellow pupil." (Epit. of curr. med. lit., p. 14.) W. L. Scott, M.C., M.D., Second Medical Officer to the Post Office, reported in the Lancet, August 14th, 1937, the results of a careful investigation into the problem of "The Contact in Industry." With regard to diphtheria he found that, over a period of ten years, out of 7,697 contacts with the disease "only 1 contact in 274 (0.36 per cent.) subsequently developed the disease." (p. 398.) 7. No animal develops the signs and symptoms of diphtheria when experimentally injected with the germs. (Report of Royal Commission on Vivisection, 1912, p. 120.) 8. " Other microbes, such as the streptococcus, the tetragenus and the pneumococcus, take upon themselves occasionally to construct membranous formations on the tonsils . . . not to be differentiated clinically from diphtheria …. . they may be accompanied by glandular masses and suppuration." (The FrancoBritish Medical Review, Dec., 1924, Vol. I, No. 3, p. 47.) The Kiebs-Loeffler bacillus, therefore, clearly fails to fulfil a single one of the conditions which would establish it as a causal agent in diphtheria, and were laid down as the essential requirements of the Germ Theory of disease by KOCH and PASTEUR, the originators of that theory. In fact, the editorial… truncated (263,240 more characters in archive)