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Seasonal Prevalence.—The following table shows the number of cases notified in each four-weekly
period during 1934:—

Diphtheria Carriers.—There is a clinic for diphtheria carriers held at St. Mary's Hospital, to
which 4 cases were referred by the Public Health Department during the past year.
Anti-Diphtheritic Serum.—This is stocked at the Town Hall and supplied to medical practitioners
on request for the use of patients who are too poor to obtain such serum privately. During the year
28 phials of 4,000 units and 15 phials of 500 units were distributed.
Diphtheria Immunisation.—In June, 1933, a clinic for the immunisation of children against
diphtheria was inaugurated at the Welfare Centre, 232, Harrow Road, Dr. R. Cove-Smith being
appointed Medical Officer. At first one session weekly was held, but the increasing numbers of children
presenting themselves for treatment, following the distribution of leaflets at the various schools in the
Borough, necessitated the provision of additional facilities, and a second session weekly was accordingly
started in December of that year. Early in 1934 a third session was opened, this being continued until
nearly the end of the year.
The following report has been received from Dr. R. Cove-Smith on the work carried out at the
Clinic during the year:—
The Diphtheria Immunisation Clinic has dealt with over 400 cases during the past year, and of
these 225 have already been fully immunised, while a further 46 will have been completed before this
report appears in print; 153 of those tested have proved to possess a natural immunity of varying
degrees. One of these latter children, A. K., developed a mild attack of naso-pharyngeal diphtheria
due to a virulent microbe, but the natural immunity present prevented the disease from becoming
serious or from developing complications; while one child, H.G., who had already been immunised
also developed an attack, but in his case also owing to the immunisation it was very mild and without
complications. These figures therefore show a high percentage of successes.
Although what one aims to produce is 100 per cent. immunity, no doubt from time to time cases
may occur in which a virulent microbe breaks down the patient's resistence and produces a mild attack,
but as a result of the immunisation we can safely say that these cases will be milder than they would
otherwise have been, that the rate of recovery increases and the risk of complications is reduced.
In contrast to these may be mentioned the case of Mrs. W. who developed diphtheria in October
but luckily had had her two children immunised in the previous May with the result that they escaped
completely.
As a result of the increasing demand for immunisation the Borough are making arrangements
for private practitioners to carry out inoculation in conjunction with the Borough Immunisation
expert, who will undertake the necessary Schick testing.
From the figures presented it will be seen that the majority of cases already immunised fall into
the 5 to 10 year age group. In view of the fact that immunisation lasts from about 5 to 7 years this
is, of course, advantageous, but as the majority of cases of diphtheria occur between the ages of 2 and
5 years this is the time when immunisation is most essential. In order to avoid any undue reactions
the immunising injections are given in 3 small doses at weekly intervals, thus no upset occurs and
children are able to attend school or play with others just as usual.