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Nine medical officers of the Council's hospital staff, with previous experience
of the process, were selected to commence the work and to train the medical officers
of the schools in the necessary technique. The medical officer of one of the schools
undertook the work from its inception.
The arrangements have worked very smoothly, and the medical officers of the
schools are taking full charge as they become conversant with the process.
The Mitcham children's home, at which Dr. R. A. O'Brien, director of the
Wellcome physiological research laboratories, assisted by Dr. H. J. Parish, had
carried out the immunisation work for several years, closed on 31st March, 1932.
The children were transferred to other schools and homes, and arrangements were
made for the history as to Schick-testing and immunisation to be communicated to
the schools and homes concerned.
As stated in my report of last year, the Schick test toxin and prophylactic used
in connection with the immunisation have been supplied from the Council's laboratories
at Belmont, with the exception of that used at Norwood which has been
obtained from the Wellcome research laboratories. The history as to testing and
immunisation has been recorded on a special card by the medical officer in charge of
the work, and arrangements have been made for the cards in respect of those
children whose treatment had been completed to be sent to Dr. White, the director
of the Belmont laboratories, to enable him to collate the results obtained.

N.B.—-In 185 cases immunisation was still in progress on 31st December, 1932.
In the twelve schools and homes in which active immunisation was introduced
during 1932, 25 cases of diphtheria occurred among the children since immunisation
commenced ; in the case of two of these the parents had refused consent to immunisation
against the disease ; in 20 of the cases parental consent to immunisation
had not yet been obtained, while in two cases active immunisation had not been
completed when the children contracted the disease. In the case of one child who
developed diphtheria in December, 1932, there is no definite record of the child's
having been actively immunised, but a reference has been traced from which it
would appear that the child may possibly have been immunised in 1929. The
cases of diphtheria referred to are those in which definite symptoms of the disease
have been diagnosed at the Council's special hospitals.
During the same period 27 children in the schools concerned were found to be
harbouring germs associated with diphtheria. These children were removed to
one or other of the Council's special hospitals, but they did not develop diphtheria.
Active immunisation does not of course affect the " carrier " condition.
In November, 1932, the Ministry of Health issued a memorandum on the
" Production of Artificial Immunity against Diphtheria," in which it was pointed
out that diphtheria causes considerable interference with school life and entails a
heavy charge, and it was urged that attention should be drawn to the advantages
to be obtained from immunisation and that where practicable, the necessary facilities
for obtaining such protection should be offered to parents or guardians of children
over one year of age. The special advantages of immunisation in residential schools
or other establishments for children and adolescents were emphasised. It was
pointed out, however, that immunisation is not a way of dealing with an individual
attack of diphtheria, or with the "carrier" condition, and that, unlike the passive
immunity produced by diphtheria antitoxin which is immediate but transient,
active immunity requires some time for its full development, but endures for years
and perhaps throughout life. The memorandum contained recommendations on
the practice of active immunisation against diphtheria.