{"id":3394,"date":"2014-02-25T11:00:02","date_gmt":"2014-02-25T16:00:02","guid":{"rendered":"http:\/\/circulatingnow.nlm.nih.gov\/?p=3394"},"modified":"2021-07-23T10:44:39","modified_gmt":"2021-07-23T14:44:39","slug":"bela-schick-and-serum-sickness","status":"publish","type":"post","link":"https:\/\/circulatingnow.nlm.nih.gov\/2014\/02\/25\/bela-schick-and-serum-sickness\/","title":{"rendered":"B\u00e9la Schick and Serum Sickness"},"content":{"rendered":"

Circulating Now welcomes guest bloggers <\/em>Diane Wendt<\/a> and Mallory Warner<\/a> from the Division of Medicine and Science at the Smithsonian National Museum of American History<\/a>. As curators of our most recent exhibition, <\/i>From DNA to Beer: Harnessing Nature in Medicine and Industry<\/a>, Diane and Mallory spent months researching four different microbes and the influence they\u2019ve had on human life. <\/i><\/p>\n

Corynebacterium diphtheria<\/i>, the bacteria which causes diphtheria, is easily the nastiest microbe we researched for From DNA to Beer<\/i>.\u00a0 Its terrifying symptoms\u2014from slowly poisoning the victim to forming a pseudomembrane in the throat causing slow suffocation\u2014are the stuff of nightmares.\u00a0 It should come as no surprise then, when Emil von Behring developed diphtheria antitoxin<\/a> serum as a cure in the 1890s it was hailed as nothing short of a miracle.<\/p>\n

\"A<\/a>
\u201cInjecting Diphtheria Antitoxin,\u201d illustration from a Parke Davis publication, 1895.
Courtesy The Historical Medical Library of The College of Physicians of Philadelphia.<\/em><\/a><\/figcaption><\/figure>\n

Soon the antitoxin, which works to neutralize the effects of C. diphtheria<\/i>\u2019s toxin in the body, became used for more than just treating the infected.\u00a0 Doctors quickly recognized its potential as a prophylactic and began controlling outbreaks by dosing residents and employees of closed-quartered institutions like hospitals and orphanages with serum after coming into contact with an infected person.\u00a0 An injection conferred immunity on a patient for approximately three weeks.<\/p>\n

As with many miracles, however, antitoxin came with a hitch:\u00a0 serum sickness.\u00a0 In some patients, injections of antitoxin resulted in an immune reaction characterized by fever, rash, swelling of the glands, and joint pain.\u00a0 In 1905, Austrian pediatricians Clemens\u00a0E.\u00a0von\u00a0Pirquet and B\u00e9la Schick published the results of their investigation into this phenomenon, in their treatise Serum Sickness<\/i> (in the original German, Die Serumkrankheit<\/i><\/a>.)<\/p>\n

\"Photograph <\/a>
Clemens E. von Pirquet, ca. 1900. National Library of Medicine #B021350 <\/div> <\/div> <\/div>
\"A <\/a>
B\u00e9la Schick, 1929. National Library of Medicine #b023217 <\/div> <\/div> <\/div> <\/div> <\/div>\n

Their research demonstrated that patients who were repeatedly injected with serum suffered not only more intense bouts of sickness with each successive injection, but in some cases, antitoxin injections resulted in dangerous anaphylaxis.\u00a0 What patients were experiencing was in fact an allergic reaction to horse proteins present in the antitoxin serum.\u00a0 (Von Pirquet and Schick coined the word \u201callergy\u201d in 1906.)<\/p>\n

So now doctors were faced with a conundrum: how to balance the risks of serum sickness with the benefits of controlling diphtheria outbreaks through preventative antitoxin injections?\u00a0 Enter the Schick test.\u00a0 In the early 1910s, Schick developed a simple skin test that allowed doctors to distinguish between those with a natural immunity to diphtheria from previous exposure and those who stood to gain protective temporary immunity from an injection.<\/p>\n

Doctors injected a very small dose of diphtheria toxin in a salt solution (1\/50 of the minimal lethal dose for a guinea pig) into the arm of a patient to be tested.\u00a0 As a control, the other arm was injected with the same amount of toxin in a salt solution, mixed with enough antitoxin to neutralize its effect.\u00a0 Within 24-48 hours, those patients who had never been exposed to diphtheria showed a redness at the injection site of the toxin as the body mounted an immune response to the novel substance.\u00a0 This \u201cpositive\u201d Schick test identified which patients would benefit from a dose of preventative antitoxin serum.<\/p>\n

\"A <\/a>
Example of the Schick Test: Parke, Davis and Company Diphtheria Toxin Diluted for Schick Test, about 1938. Courtesy National Museum of American History. <\/div> <\/div>
\"A <\/a>
Example of the Schick Test Control Material: Eli Lilly and Company Schick Test Control, V-923 (10 tests), about 1952. Courtesy National Museum of American History. <\/div> <\/div> <\/div>
\"A <\/a>
Example of the Schick Test: American Cynamid Company Diphtheria Toxin for Schick Test, Purogenated, 1951. Courtesy National Museum of American History. <\/div> <\/div> <\/div> <\/div> <\/div>\n

The test proved useful not only in preventing unnecessary exposure to serum, but in developing a greater understanding of the epidemiology of diphtheria.\u00a0 Schick tests on large groups of people provided data indicating that the time of greatest susceptibility to diphtheria was between the ages of one and four. This window encompassed a period when infants had lost the immunity provided to them from their mothers but before children had enough exposure to non-virulent strains to develop their own immunity.<\/p>\n

\"Twenty-eight <\/a>
Lining up for the Schick test at P.S. 50, Brooklyn, New York, early 1920s. Courtesy the National Museum of American History. <\/div> <\/div> <\/div>
\"A <\/a>
Diphtheria Prevention: Giving the Schick test in a Baby Health Station, Brooklyn, New York, about 1920. Courtesy the National Museum of American History <\/div> <\/div> <\/div> <\/div> <\/div>\n

In 1923, Schick moved to the US, after accepting a post at New York\u2019s Mount Sinai Hospital.\u00a0 Just two years prior to his arrival, his test provided the New York Public Health System with an important tool in their mass diphtheria immunization campaign for the city\u2019s school children.\u00a0 The Schick test determined which students were not yet immune and should receive a dose of a new vaccine which conferred immunity for years rather than the mere three weeks of the earlier antitoxin serum.\u00a0 Students participating in the drive were given buttons reading \u201cI am Schicked! Are you?\u201d<\/p>\n

In 1957, with diphtheria under control in the United States, an 80 year old, still-practicing Schick was featured in Life <\/i>magazine<\/a>.\u00a0 Despite his lengthy pediatric career, Schick remained best known for his test, prompting him to tell the reporter documenting his day-to-day work \u201cYou see, I\u2019m not just a scratch on the arm!\u201d<\/p>\n

Explore<\/em> From DNA to Beer: Harnessing Nature in Medicine & Industry online for yourself at http:\/\/www.nlm.nih.gov\/exhibition\/fromdnatobeer\/index.html<\/a>. To book the traveling exhibition or see when it comes to your town, visit the traveling exhibition page at http:\/\/www.nlm.nih.gov\/hmd\/about\/exhibition\/fromdnatobeer-bookinfo.html<\/a>. Read more posts in this series here<\/a>.
\n<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Circulating Now welcomes guest bloggers Diane Wendt and Mallory Warner from the Division of Medicine and Science at the Smithsonian<\/p>\n","protected":false},"author":19605840,"featured_media":3412,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_coblocks_attr":"","_coblocks_dimensions":"","_coblocks_responsive_height":"","_coblocks_accordion_ie_support":"","advanced_seo_description":"","jetpack_seo_html_title":"","jetpack_seo_noindex":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[12763,2029,207572835,51014,2347],"tags":[273905,273907,15888,2143828,604852,668,52877],"class_list":["post-3394","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-collections","category-exhibitions","category-from-dna-to-beer","category-guests","category-series","tag-1800s","tag-1900s","tag-collaboration","tag-diphtheria","tag-immunization","tag-research","tag-vaccine"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"https:\/\/i0.wp.com\/circulatingnow.nlm.nih.gov\/wp-content\/uploads\/2014\/02\/ahb2014q039497_.jpg?fit=1112%2C736&ssl=1","jetpack_likes_enabled":true,"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p3xcDk-SK","jetpack-related-posts":[],"amp_enabled":true,"_links":{"self":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/3394","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/users\/19605840"}],"replies":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/comments?post=3394"}],"version-history":[{"count":16,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/3394\/revisions"}],"predecessor-version":[{"id":21739,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/posts\/3394\/revisions\/21739"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media\/3412"}],"wp:attachment":[{"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/media?parent=3394"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/categories?post=3394"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/circulatingnow.nlm.nih.gov\/wp-json\/wp\/v2\/tags?post=3394"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}