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to one weekly. The attendances at each session were high, on one occasion they reached 153,
and the average for a considerable portion of the year was 91, but they have now reached
manageable proportions.
The whole of this work was undertaken without the engagement of specialist or additional
staff. Dr. Emslie, whose experience of this work had been considerable before coming to
Twickenham, undertook the major portion of the duties at the Clinic, and I desire to acknowledge
specially the assistance rendered by her in this respect.
All children over 7 years of age were first tested by the Schick test to find out if they
were liable to contract diphtheria, and if found susceptible received as a rule three injections of
Toxoid Anti-toxin Mixture (T.A.M.) at intervals of a fortnight.
As children under 7 years are almost invariably found to be liable to contract diphtheria,
the preliminary Schick test was dispensed with.
It was anticipated that the injection of T.A.M. might produce somewhat severe reaction
in the case of older children, and for a time Toxoid Anti-toxin Floccules (T.A.F.) were used for
these. It was found however, that reaction of any severity with T.A.M. was rare and the use
of T.A.F. was discontinued almost completely.
In all cases an appointment for a subsequent Schick test was given, at intervals of from
two to four months after the last prophylactic injection. If on this subsequent test the child
appeared to be protected, a certificate to that effect was given. In no case was a certificate
given without a negative result of a final Schick test.
The figures given below give some indication of the extent of the work, which will be
realised more readily when it is remembered that for each child immunized, and certified, at
least four, and in most cases five attendances were made.
Although the number of children dealt with has been so considerable, it has not been
large enough to be altogether satisfactory. Approximately 32 per cent. of the children under
7 years of age in Twickenham are protected from Diphtheria as the result of the injections given
or are naturally immune, while of those between 7 and 15 years of age, 28 per cent. are protected.
It is estimated that before it can be said the children of any district are safe from diphtheria, 60
per cent. should be immunised. It will be realised therefore that continued activity on the part
of the Authority and continued interest on the part of the parents are still essential.
It is regrettable that the number of children under 5 years who are brought for
immunization is not greater, as it is among these that the danger from Diphtheria is greatest.
It will be necessary therefore to consider the means if any, by which parents can be induced
to bring their young children for protection.
The number of persons who attended the Clinic for testing or inoculation or both, with
their ages at date of first attendance, were as follows:—

All those found to be incompletely protected after the second Schick test were re-inoculated
arid all those re-tested were found to be immune. Two did not appear for re-test.