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chiefly in October and November. Both waves of infection had
subsided at the end of the year.
There were three cases in which 10 dysentery was the
terminal infection causing death.
THE CONTROL OF INFECTIOUS DISEASE.
The well recognised methods which Attempt to restrict the
outbreak and spread of infectious disease were continued during
1941, but in the case of diphtheria a special national effort
was made to reduce the loss of life caused by this very serious
disease, the Ministry of Health supporting a campaign to
popularise immunisation.
DIPHTHERIA. IMUNISATION.
Locally the Council had established two immunisation
clinics in Selsdon and Purley in April 1937, and during the
remainder of that year 97 children attend for treatment. In
1958 only about 50 further children were created, in 1939 about
40 and in 3940 about 120. The policy of the Council during
this period was to provide free treatment for children under 5
years of age and charge only for the cost of materials (5/-) for
children over that age, the chief reason being to encourage the
immunisation of pre-school children, in whom the disease is most
deadly. Experience elsewhere shewed that, if generally
encouraged the school children would receive primary and almost
exclusive attention to the detriment of the younger children for
whom the risk might be increased.
Moreover during this period when the proportion of
children under years who were immunised was about 3 times the
number of chose of school age, the scheme was made known but not
over-advertised. The reason underlying this policy was that
unless a good proportion of children could be expected to
respond, no appreciable influence on the incidence of the
disease could be expected locally and infact an increased
number of cases might happen to occur, thus possibly depreciating
the value of the treatment. As from 1937, to 1940 inclusive
only 53 cases occurred locally, nearly half of these being at
the end of the period, a poor response was anticipated,
especially among the susceptible children below school age.
In 1941, however, the powerful support of the Ministry
of Health completely altered the position. With the arrival
for the first tine of strong national propaganda it was possible
to foresee a previously unobtainable degree of success. Free
treatment was therefore offered by the Council to all children
under 16 years of age, and, in co-operation with the Surrey County
Council, arrangements were made to encourage and provide for
the immunisation of all public elementary and secondary school
children while at School. The result was a period of intense
activity during which the local staff was augmented by parttime
Doctors and the School Medical staff
From the first it was decided to continue the use of
Toxin Antitoxin Floccules (T.A.F.), although this meant three
injections being given to each child, rather than change to the
two injections of Alum Precipitated Toxoid (A.P.T.) supplied
free of charge by the Government. It was felt that T.A.F. was
of well-proved efficacy and was the preparation least likely
??? cause complications.
From March until May the School work was chiefly
undertaken by outside staff, but after that month the numerous
school sessions and extra clinics were entirely staffed by
Officers of the Council. After September it was decided not
only to continue the extension of the campaign but to test all
the children over 3 years who had received their injections
some 6 months before. This work, which occupied the remainder
of the year, was entirely undertaken by the Medical Officer of
Health assisted by the Health Visitors and Civil Defence staff.
The following tabular statements give the results to the end
of 1941.