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117
followed by a dramatic fall in the incidence of the disease. While other
factors such as a decline in the invasiveness of the organism might have
played some part in this fall of incidence, it is generally accepted that the
main factor is the extent to which the child population has been immunised.
Apart from the factor of immunisation though, the incidence of
diphtheria in this district had been very light for many years. With the
same incidence as the country as a whole this district might in each of the
years of the nineteen-thirties have expected anything between 200 and
400 cases. Actually the highest number of cases notified was the 98 in
1937.
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 play a big part in the diphtheria immunisation campaign.
It was first understood that this would be a service provided by the
doctor for his patient independent of his contract of service under the
Act. Only those therefore who contracted with the County Council
fo undertake the work were to take part in the scheme. Later, though,
it was ruled that this service was part of the ordinary service to be provided
by the doctor for his patient. The County Council, however, pays
5s. for each record of immunisation carried out sent to the local health
°jnce. It is quite likely, though, that many children have been immunised
about whom the health office has received no records, and that a higher
proportion of children have been protected than the records indicate,
'his is certainly the view of the health visitors. General practitioners
can obtain from the public health office, or from the Central Laboratory,
^oundale, the necessary antigen. For the immunising of children
■P-T. is the accepted antigen, 0-5 c.c. being given, followed by another
ose in a month's time. It is now recommended that reinforcing doses
s owd be given when a child attains the age of two, and again at three,
and then again just before he is admitted to school. For those who are
anc^ include most adults who need to be treated,
A r. is recommended as an antigen less likely to cause reactions. This
supplied free of cost to the doctor wishing to use it.
so th Sat^°n t^ie *n^ant*s now advocated at six to nine months,
hat the full effect of the inoculation, which takes some three months