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with interest. Close contact is maintained with general medical practitioners undertaking
vaccination and immunisation and circular letters are sent to them from time to time,
with the approval of the local medical committee, encouraging them to intensify their
efforts and offering them further supplies of propaganda material. Intensified efforts are
made in all divisions during national campaigns, local 'health weeks' or following an
outbreak of infection. A mobile clinic and loudspeaker van are used with success on
these occasions. A keen interest in the work is taken by members of the divisional and
central health committees, who receive regular progress reports.
Parents who are being asked to consent to the vaccination, primary immunisation
or further protection of their children are advised of the alternative means available.
Prominent notices are displayed at appropriate centres announcing the days and times
of special sessions, and pamphlets are also issued in which are listed all the local health
authority services available in each health division, with sessional details.
Particular attention is paid to the vaccination and immunisation of children in the
Council's residential establishments inside and outside the county, and all visiting medical
officers appointed to such establishments are required to give the necessary injections,
subject to parental consent, as one of the routine duties of medical care. Immunisation
against whooping cough is undertaken in all residential nurseries and residential nursery
schools.
Diphtheria immunisation
The steady decline since 1949 in the number of children receiving primary immunisation,
referred to in my last report, has now been checked. General apathy because of the low
incidence of diphtheria, and concern over the possible association of paralysis in poliomyelitis
with the site of recent injections (see below), are still present, but the determined
efforts made to combat these by increased publicity and personal approach have resulted
in 42,232 children receiving primary immunisation in 1952 compared with 40,656 in
1951, and 27,820 children receiving reinforcing doses in 1952 compared with 22,908 in
1951. This increase must be accelerated if an increase in diphtheria incidence is to be
prevented.
Public alarm about the danger of paralysis following inoculations causes great difficulty
both in the maintenance of a continuous propaganda campaign and in explaining to
parents the necessity for postponing immunisation during the season when poliomyelitis
is most likely to occur. From this point of view it is perhaps unfortunate that national
immunisation campaigns tend to be launched just before the poliomyelitis season and it
seems that much might be gained by intensifying propaganda as soon as possible after
poliomyelitis has ceased to be widely prevalent.
Difficulty has been experienced in devising an adequate scheme of dealing with
'booster' doses owing to the incomplete records available of work done before the
operation of the National Health Service Act, 1946. Since 1942, a note has been made
against each name in the school registers indicating whether the child has been immunised,
but this information has frequently been obtainable only from the parents without any
supporting evidence. Generally the head teachers send out letters to parents of children
requiring primary or boosting doses and special sessions are arranged in schools or welfare
centres. The opportunity is to be taken of reviewing this scheme with the entry into
school of the first generation to be fully documented under the National Health Service
Act, 1946, and it is hoped to link the ' booster ' dose more closely with the statutory
routine medical inspections of children under the Education Act, 1944. In one division
duplicates of the school registers are kept in the divisional office, and after the information
therein has been checked with all other available records the following-up for primaries
and 'boosters' at appropriate ages is done by means of letters, followed by a personal
approach by the school nurse where necessary. In many cases health visitors arrange for
children to have ' booster ' doses before starting school.
In the Council's residential establishments for children inside London, 52.8 per cent.
of the children were fully immunised at 31st December, 1952; parental consent had been
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