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note that there has been a decrease of 23,326 in the number of cases
and of 1,484 in the deaths during the period 1926-30 as compared
with the preceding quinquennium. The death-rate has been
reduced from an average of 10.1 per 100,000 of the population in
1921-25 to 3.8 for the years 1926-30. Approximately 750,000
children, including 185,000 under the age of 5 years, have been
immunised against diphtheria with toxoid-antitoxin.
This method of protective immunisation is now being used in
other countries, including Belgium, France and Germany.
The London County Council, though not yet in a position to
carry out the active immunisation of school children, has afforded
this Council facilities for the distribution of leaflets and cards of
application for treatment to children attending the schools in the
Borough. The history of vaccination against smallpox suggests
that we shall not attain the active immunisation of all children
at an early age, but a local authority is justified in considering
it has done all in its power to prevent loss of life and illness from
diphtheria if it offers and urges immunisation.
The Diphtheria Immunisation Clinic was opened at the Central
Maternity and Child Welfare Centre, No. 28, Lower Clapton Road,
on the 6th January, 1928, Dr. F. Porter-Smith being the Medical
Officer in charge.

Enquiries as to the effect on the individual of the testing and
injections were made as a routine and it can be stated that in no
case has any physical disturbance resulted.
During the three years that the work has been in operation not
one of the 1,049 persons who have been given certificates of immunity
has contracted diphtheria. In one case, however, a child
who had received her third injection and was waiting for a re-test
in three months' time contracted diphtheria and was removed to