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much as at present, for the patients are mostly school children and they must remain in hospital
for a period of approximately six weeks.
The Ministry of Health, in 1932, issued an official circular which states, "It is, therefore, desirable
that attention should be paid to the advantages of diphtheria immunisation, and where practicable,
to offer to the parents or guardians of children over one year of age necessary facilities for protection."
Early in the year the council gave careful consideration to the need for introducing a method
of active immunisation against diphtheria in Kensington, and after prolonged negotiation with
the Kensington division of the British Medical Association they evolved a scheme under which the
work of immunising Kensington children would be undertaken by local doctors on behalf of the
council. The scheme provided that the council should, subject to the conditions mentioned below,
pay a fee of 10s. to a doctor who immunises a Kensington child against the disease :—
(a) The medical practitioner's name must be on a panel prepared by the medical officer of health.
(b) The council will not pay a fee in respect of any child under the age of one year or over the age
of twelve years.
(c) The council will not pay a fee unless the medical officer of health is satisfied that the parent
or guardian cannot reasonably be expected to afford a private fee for this treatment.
(If the wage-earner of the family is entitled to national health insurance medical benefit, or has
an income which would entitle him to benefit if he were insurable, or is unemployed, the medical officer
of health will generally regard the case as one for which the council should pay ; but where the familyis
in better circumstances, the medical officer of health will, unless there are exceptional conditions, regard
the family as one able to pay a private fee to the doctor.)
(d) Before immunising a child, the medical practitioner must obtain the written consent of the
parent or guardian.
(e) The child must be given three immunising injections at weekly intervals.
(/) In order to facilitate the working of the scheme in the early stages, it has been decided to use
only one brand of immunising material—that issued by Messrs. Burroughs, Wellcome and Co. When
further experience has been obtained, it may be possible to extend approval to the products of other
firms.
(g) Each dose of the immunising agent must be contained in a separate sealed glass ampoule. In
no circumstances will the council pay a fee in respect of the immunisation of a child by a preparation
from a container holding more than one dose.
(h) The medical practitioner will enter the particulars of each immunising dose on a record card
provided by the council. When this record card is completed and returned to the public health department,
the medical officer of health will, in appropriate cases, forward particulars to the borough
treasurer in order that the fees due may be paid each quarter.
(i) In every case the medical practitioner must place before the parent or guardian the significance
of the Schick test and advise that this should be applied to children over five years of age. If the
parent or guardian decides to forego the Schick test before immunisation, it may be omitted. The
medical practitioner must urge in every case that the Schick test should be applied three months after
the immunising injections have been given.
(j) If the parent or guardian desires the Schick test to be performed before immunisation, the
medical practitioner must refer the child to the council's immunisation expert. The medical practitioner
will also endeavour to arrange for every child to visit the immunisation expert at the first
opportunity after the expiry of three months from the last injection.
(k) The technique to be employed in connection with diphtheria immunisation work must be that
prescribed by the council's immunisation expert.
(/) The fee of ten shillings to be paid by the council in respect of each child immunised in accordance
with these rules will be the limit of the council's liability in connection with diphtheria immunisation,
and the cost of purchasing the immunising agent must be borne by the medical practitioner, who will
also be responsible for any subsequent medical attention necessary and for any other liability which
may result.
(m) The medical officer of health may examine any child before, during or after the administration
of the immunising doses, and all records kept by the medical practitioners in respect of diphtheria
immunisation must be open to his inspection.
The council appointed an expert in diphtheria immunisation work (Dr. Guy W. J. Bousfield)
who prescribes the technique to be followed in those cases for which the council are prepared to
pay a fee. He also undertakes all Schick testing which may be necessary. He attends at
the tuberculosis dispensary in Ladbroke Grove from 2 to 4 p.m. each Friday. When a doctor or a
parent wishes to have a child Schick tested, the patient is sent to the expert on one Friday and the
test is carried out ; the interpretation of the test is undertaken on the following Friday.
Doctors may consult the expert at his clinic when he is in attendance, or privately at any other
time bv appointment.
Most children under one year of age are immune to diphtheria, and it is therefore not considered
necessary to immunise them. After the age of 12 years the risk of contracting the disease
diminishes rapidly, and the council do not pay fees in respect of persons over this age. In these
circumstances, if a doctor wishes to immunise infants under one year or persons over 12 years of
age, it is necessary for him to arrange for a private fee to be paid for his services and for the services
of the immunisation expert, if desired.
As the majority of children between the ages of one and five years are susceptible to diphtheria,
there is no need to apply the Schick test, and immunisation can be recommended immediately
(except in the case of those who have had diphtheria).
If the Schick test applied after the immunising injections have been given proves positive,
the expert advises the doctor to give further injections, and on the production of evidence that