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for immunisation against measles, whooping cough, or scarlet fever
may be referred to the Centre at Great Ormond Street Hospital by the
Medical Officer of Health, but no applications were received during the
year for cases wishing to avail themselves of these arrangements.
The local Diphtheria Immunisation Clinics commenced activity in
April, 1937, sessions being held at 69, Brighton Road, Purley, and at
the Baptist Hall, Selsdon, as and when required. No attempts whatever
have been made to persuade parents to have their children immunised,
propaganda being limited to the circulation during health visitation
or attendance at the Centres, of a pamphlet briefly stating the case for
diphtheria immunisation and the local arrangements. To date it has
been possible to give definite appointments to all cases and the arrangements
have been much appreciated by those who have attended.
Treatment is provided free of charge to all children who on application
are under 5 years of age, but in the case of older children a charge of
6d. is made for the initial test, and if further treatment is required, a
total charge of 5s. 0d. is made, which covers the cost of the materials
if a sufficient number of children can be treated at a time.
The only prophylactic used has been Toxoid-Antitoxin Floccules
(T.A.F.), which has the great advantage not only of producing a high
defree of immunity with a low relapse rate, but the minimum of reaction
in the recipient. None of the cases treated in 1937 complained of any
thing which could be associated with the injection worse than a slight
local soreness on the day of treatment, while the vast majority noticed
nothing more than the slight prick of the needle. Injections are given
at intervals of from two to four weeks, and the result is tested by the
Schick Test at least three months after the final injection.

It will be noted that all cases subjected to the primary Schick Test
were found positive. These included 2 children who had previously
received the "one shot" form of inoculation, the after effects of which
should always be tested. It is considered that the numbers so far
tested are too small to justify the abandonment of the primary test
in children over 5 years of age.
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