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64
Thanks are due to the staff of Princess Louise hospital for their assistance, and to the voluntary
workers for so ably carrying out the social work.
Clinical Report by Dr. R. H. Dobbs.
Since the opening, bi-weekly sessions have been held continuously except for the month of
August when whooping cough was almost non-existent in the borough.
The clinic was established to provide facilities for the diagnosis of whooping cough. The
children referred thereto are treated as suspicious until a definite clinical diagnosis is made. A
cough plate is taken from each suspect, or failing that, a pharyngeal swab. In addition, blood
counts are made in a number of cases. The results are sent to the referring practitioners at the
next session—three or four days later. In addition, the immunisation by the injection of vaccine
is undertaken in the case of children who have recently been in contact with cases of whooping
cough. No case, however remote the contact, is refused immunisation, and indeed, a few cases
have been immunised in whom no contact had occurred. These contact cases are given three
injections during the course of one week. Two vaccines are used, Parke Davis whooping cough
vaccine "A," and Glaxo dissolved vaccine. During 1938, about equal numbers were given each
type of vaccine, but no attempt has been made to take comparable series. The dosage varied
somewhat, but approximately 1 c.c., 2 c.cs. and 4 c.cs. at successive sessions, or 7 c.cs. in all, was
usually given. This is equivalent to 28,000 million organisms for Parke Davis and 70,000 million
for Glaxo preparation.
Results.
Diagnostic Section.
Seventy-four children were referred to the clinic for diagnosis during the year. A history was
taken from the parent, and the child was examined if necessary. As a result of the history and
examination, the cases were classed as "A," "B" or "C."
"A" cases are those in whom the examining doctor considers that, either from the history or
from having heard the child cough, the case is in all probability whooping cough.
"C" cases are those in whom the examining doctor considers from hearing the history that
the probability is much against the diagnosis of whooping cough.
"B" cases comprise all cases not classed as "A" or "C."
It will be seen that group "B" consisted of cases in whom the probability of diagnosis
varied tremendously from case to case. Cases were classed as "A" or "C" only when the observer
felt certain that they were or were not cases of whooping cough. Cough plates or throat swabs,
and as an additional aid to diagnosis, blood counts, were taken in all cases in these three categories
except some in group " A," who were actually heard to whoop whilst attending the clinic.

It will be seen that in group "A" in two cases only was the diagnosis not supported by the
culture of the organisms from either a plate or swab or both. In group "C," culture was attempted
in all cases. The cough plate was positive in one case, and the plate and the swab in a second case.
In group "B," the largest group, the organism was not cultured in 15 cases; of these three only
went on later to develop symptoms of whooping cough. In these three cases a blood count was at
the time suspicious.
It seems, therefore, that a carefully taken cough plate, or failing that a throat swab, is a
moderately satisfactory method of diagnosing the disease.
Blood Counts.
It was not found practicable to take cough plates or swabs from cases at times other than at
sessions. These cases were, therefore, referred to the pathological laboratory, and blood counts
were taken for a white cell estimation and a differential count, and the patients told to attend at
the next clinic session.
Twenty-two blood counts were taken. Very little can be deduced from so few figures, but the
results indicate that the blood count may give valuable confirmatory evidence of the absence of
whooping cough, and since a result can be obtained in less than an hour, this aid to diagnosis should
be retained.
In three cases where both swabs and plates were negative, the blood counts were suggestive,
i.e., with totals over 12,000 and a differential count with more than 70 per cent. lymphocytes.