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83
choice of doctor, which is an important consideration. Secondly,
the practitioner would be responsible for any after treatment, if
such were necessary. Thirdly, it is likely that many parents in
a position to afford it, might prefer to pay the fee, and thus save
a charge on the local authority. Lastly, but by no means least,
the goodwill of the practitioners in the borough would be retained.
I feel bound to put on record the fact that, in my position as
M.O.H., I have found the majority of the practitioners in this
borough willing to co-operate with the Public Health Department.
Recently I reported to the Committee the receipt of many offers
from doctors to help in the coming campaign to make the Health
Services better known.
From a consideration of the whole question, the following
conclusions commend themselves to me :—
(1) That some form of Anti-Diphtheria Scheme is essential.
(2) That the Council's present scheme is not sufficiently
comprehensive.
(3) That a scheme on a wider basis should be adopted, and
should embrace the general practitioners of the borough.
I, therefore, beg to submit the following recommendations
for the consideration of the Committee :—
(1) That the general practitioners of the borough be invited
to take part in the Council's scheme.
(2) That Dr. Davies and Dr. Smith of the Seamen's Hospital
and the Miller General Hospital respectively be retained
to carry out all Schick tests necessary, and the immunisation
of those cases who may apply and do not wish to
attend a general practitioner ; the remuneration in this
case to remain as at present, i.e., 10/6d. for each completed
case, and 2/6d. for a Schick test. There would however
be this difference, that whereas at present no payment
is made when the test precedes or follows immunisation,
under the extended scheme Schick tests in cases referred
by general practitioners would qualify for payment.
(NOTE.—It is the rule to Schick test all children over 7 or 8 years of age
before immunisation, because many children will be negative or non-susceptible
and therefore will not need inoculation. Children below the age of 7 and
certainly below 5 years are practically always positive reactors. It is also
usual to Schick test a few months after the inoculation to test the efficacy
of the immunisation. In a fairly small percentage of cases the Schick test
remains positive, showing that the inoculated individual is still not immune.
Some authorities consider that this test need not be made, because of the low
percentage of resistant cases disclosed. I am of opinion that tho confirmatory
Schick test should be retained until information regarding local
conditions is available).