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This district is without doubt very fortunate in that no cases occurred
here in this last year. In spite of the general fall throughout the country,
there were still very many cases, the incidence for England and Wales
being 0.08 per 1,000. At that rate Harrow's population of about 220,000
would have had 18 cases. The difference is not that immunisation in
Harrow has been any more successful than in the country as a whole.
It has not been carried out on a great scale here, nor has it been less,
but has been very much the same as the national rate. Harrow's
percentage of children under 5 who were immunised was, at the end of
1948, 53; of those over 5 but under 15, was 67. In point of fact, even
before immunisation was practised in this district to any large extent,
in some years the local incidence was very slight. The actual numbers of
cases in which the diagnosis was confirmed in each of the years from 1934
to 1947 were 80, 85, 30, 98, 63, 54, 78, 39, 51, 40, 16, 29,17 and 6, giving
rates ot incidence per 1,000 population of 0.60, 0.58, 0.22, 0.54, 0.34, 0.30,
0.41, 0.20, 0.26, 0.21, 0 08, 0.15, 0.08 and 0.03.
Place of Treatment.
All those notified as suffering from diphtheria were admitted for
treatment, almost all to the Hendon Isolation (the Edgware Isolation)
Hospital.
Immunisation.
When the Harrow Council first agreed in 1934 to arrangements
being made for children to be immunised against diphtheria, this was to be
done by the general practitioners rather than by the usual arrangements
by which children attended special immunisation sessions. When the
national campaign started, facilities were offered to those mothers who
brought their children to the infant welfare centres to have them treated
there, while for a short time school children were treated at some of the
schools. All children attending the day nurseries are required to be
immunised against diphtheria. During the last few years the numbers
of those who have been treated at the clinics have exceeded those treated
by the general medical practitioners.
Under the provisions of the National Health Service Act, the responsibility
for offering facilities to the public of the district to be immunised
against diphtheria has passed from the District Council to the
County Council. Under these arrangements the general medical practitioners
will play a big part in the diphtheria immunisation campaign.
It is a service which is quite independent of the general medical service
and can be undertaken by doctors who do not participate in the general
services providing they have entered into the arrangement with the
County Council. On the other hand, it is only those who have entered
into this arrangement that can treat the children under the County
Council's scheme. The treatment is free of cost to the parents, the
medical practitioner being paid a capitation fee by the County Council.
He is also supplied free of cost with the necessary antigens; these can be
obtained from the Public Health Office or from the Central Laboratory,
Colindale. For the immunising of children A.P.T. is the accepted antigen,
0.5 c.c. being given, followed by another dose in a month's time. It is
now recommended that reinforcing doses should be given when a child