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60
immunity among the school population and among the residents of children's
homes.
The arrangements for immunisation work at welfare centres, at day schools
and at the Council's residential establishments for children in London are merged.
General
practitioners
General practitioners take part in the Council s scheme, as many parents prefer
the family doctor to immunise their children. Under this scheme, the family doctor
is paid a fee of 5s. for completing the record of immunisation and returning it to
the Council. The Ministry of Health, through their Public Health Laboratory
Service, make available free of charge A.P.T. and T.A.F. and the Council supplies
these materials to general practitioners taking part in its scheme.
Residential
establishments
outside
London
Since 1st May, the local health authority of the area in which the residential
establishment is situated has been responsible for making arrangements for
immunisation against diphtheria of the children accommodated in the Council's
residential establishments outside the Administrative County, and for paying the
visiting medical officer the fee of 5s. for completing the record of immunisation.
Immunisation
At the end of the year, 86 per cent. of the children then in residence had been
immunised or were in the process of being immunised. Of the remainder, in most
cases parental consent had not been received.
Statistics
The total number of children immunised against diphtheria at infant welfare
centres, at schools, at the Council's residential establishments for children in
London or by general practitioners during the year was 56,030, and, in addition,
38,312 " boosting " doses were given.
Table 17, page 131, shows the number of infants in London who at the end
of 1949 had received a course of diphtheria immunisation injections. This table
also shows the number of cases of diphtheria and deaths occurring in immunised
and unimmunised children. It will be noted that out of the 9 deaths from diphtheria
occurring among children, none occurred among the immunised.

There are reasons for believing these figures to be an understatement of the
figure of immunisation. In the early years of the campaign the metropolitan
borough councils found it difficult to maintain complete records. It is in particular
unlikely that they received complete records of children immunised whilst
evacuated from London. Until recently, returns from general practitioners were not
complete. On the other hand, records obtained at routine medical inspections at
schools indicate that 83 per cent. of school-children claimed to be immunised. This
latter figure is equally likely to be an overstatement, because these records are
based upon verbal assurances from parents without the production of a certificate
of completed immunisation, and there are probably many affirmative answers given
when, in fact, immunisation has not been completed. Probably the truth is intermediate
between the two limits and it is felt that an estimate that, say, 75 per cent.
of school-children have been immunised is not likely to be greatly in error.*
The division of cases between immunised and unimmunised children when the
relative sizes of the two populations are taken into account indicates that the
attack rate in the protected population was only about 10 per cent. of that in the
*The Registrar-General estimated that in England and Wales the proportion immunised at 5-14 had risen to 75 per cent.
by the end of 1947. (See Annual Report of Chief Medical Officer Year Ended 31st March, 1948).