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82
cularly to prevent the possibility of an epidemic, a more comprehensive
scheme should be adopted.
In 1933, 1934 and 1935 there were 335, 349 and 327 cases
of Diphtheria notified in Greenwich as occurring in the child
population. There were 14, 5 and 3 deaths of children in these
years.
Since 1926 there have been 3,186 cases and 98 deaths among
children in Greenwich.
The value of Immunisation to the individual child is
undoubted, and the value to the community depends on the
proportion of the child population which can bo immunised.
It is, therefore, desirable that propaganda should be undertaken
and the advantages of Immunisation before school age
is reached should be taught from' the Welfare Centres and by
means of leaflets, talks, etc.
There are two ways in which a comprehensive scheme for
Greenwich may be instituted. One is the inauguration of an
Immunisation Clinic by the Council. The other is to utilise the
services of the local practitioners.
If the Council decided to establish a Clinic, this would
need to be housed, equipped and also serviced by a nurse and
doctor. Probably 4 sessions a week would be essential to commence
with. This suggestion is put forward as the principle of
attaching immunisation sessions to the Welfare Centres would
be a bad one in my opinion, and in any case would be extremely
difficult to arrange under present circumstances.
The advantages of such a scheme are that the inoculations
would be carried out by a part-time Medical Officer in the employ
of the local authority, and would probably work out slightly
less expensive than a General Practitioner scheme.
The disadvantages are that long distances would have to
be covered by many of the applicants, which is a consideration
when many visits are necessary. Also full liability would have
to be accepted in cases when extra treatment becomes necessary.
In General Practitioner schemes, such as those established
in Woolwich and Kensington, the local authority provides the
material and general practitioners carry out the inoculations, a
Schick expert being retained to carry out and interpret Schick
tests when necessary. An agreed payment is made to the practitioner
concerned for each completed record accepted as satisfactory
by the Medical Officer of Health.
Although a General Practitioner scheme may be somewhat
unwieldy, there are many advantages. Firstly, there is the free