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Report on Diphtheria Immunisation Clinic Work during the year ended December 31st,
1936.
As in recent years, two clinics have been held weekly on Monday morning and afternoon
respectively. The attendances have been satisfactorily good, though the number of cases applying
for treatment is not as high as in the past, and seems to indicate the employment of fresh means
of bringing the advantages of Diphtheria Immunisation before the parents of children resident
in the Borough.
Advantage has been taken of the smaller number of new cases in that it is possible to form
an opinion now on the success of work done in past years. Numbers of the children who were
immunised between two and six years ago have been sent for, and have been re-tested, and the
result of these re-tests after a comparatively long period from the time of protection are distinctly
satisfactory.
Investigations of other methods of using T.A.M. have been made, with the idea of securing
the highest possible percentage of protected children and the highest degree of active immunity.
The method has been to give an initial dose of Burroughs Wellcome T.A.M., of 1 c.c., followed
14 days later by an injection of 1.5 c.cms. A third dose of 1.5 c.cms. has been given a fortnight
after the second. The figures for the results of this method are not yet available, as the work
is not yet ready for analysis, but it is expected from preliminary observation that there will be
some slight improvement on the method previously employed. This was two injections of 1 c.c.
of T.A.M., at weekly intervals, followed by a third of 1.5 c.cms. 14 days after the second injection.
The latter method yielded results of such a high order, viz., 95% success, that not much improvement
can be hoped for. Preliminary observations on the new method show that about 97.1%
of children are immunised by the routine course, an improvement of just over 2% on the old
method.
Plans are made for the investigation of Alum-precipitated Toxoid as a single injection
and as a two injection procedure, one method to be adopted at the morning clinic, the other in
the afternoon. The claims made for the effectivity of the A.P.T., to be employed are high, so
thai the results should be awaited with confidence. As all cases are tested before and at an interval
after immunisation, there is no fear of immunisation work not being satisfactorily completed
owing to the adoption of a new type of prophylactic. Any cases still found susceptible at the
re-test will receive further injections.
Total attendances during the year amounted to 4,831
Number of primary tests. 641
Number of children immunised 564
Number of certificates issued 491
Naturally immune ... 26
Immunised cases ... 465

The above result must be considered as extremely satisfactory and constitutes a high
testimony to the efficiency of Messrs. Burroughs Wellcome's T.A.M., in producing a durable
immunity. The fact remains, however, that three injections of this substance are necessary, and
if it can be shown that two (or even possibly one) injections will produce as good a result when
A.P.T. is employed, there will be a marked advantage in the diminution of the number of injections
required to produce immunity.
The total number of applications for immunisation treatment during the year amounted
to 693
GUY BOUSFIELD,
M.D., B.S., Lond.
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