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65
Immunisation Section.
Immunisation was commenced in 109 cases. Of these, 16 cases did not receive the full three
doses, either because they developed whooping cough, or because they did not return for the second
and third dose. These cases are omitted from the results.
Cases were visited at home by the borough council's health visitors during inoculation, and for
four weeks after the last injection. If whooping cough had not occurred before the fourth week, the
cases were considered to have been protected from the infection. All cases immunised were revisited
after an interval of six months, in order to gain information if possible regarding the period of
protection. At the time of preparing this report a few of the earlier cases have been visited, and
only two cases (twins) have been known to have contracted the disease. Both were mild cases
from a fresh infection seven months after immunisation.
Of the 93 cases fully immunised, 66 had not developed whooping cough four weeks after immunisation,
10 developed the disease, and 17 children were either not visited or could not be traced.
All cases who developed whooping cough, except one, were classed as "mild" or "very mild."
One case was moderate.
In May, 1938, twenty-one children at the Golborne day nursery were inoculated following
contact with a child who had been coughing for two weeks, and who eventually developed whooping
cough. Of these 21 children, two developed whooping cough several weeks later. The attack
was mild.
In December, 1938, nine children at the Lancaster Road day nursery were immunised. A
child had developed whooping cough the previous day. Two of these children developed a mild
attack.
These figures are in themselves satisfactory, although a definite conclusion cannot be drawn
from a small number in one epidemic only. It seems that only nine of 93 contacts (varying from
close contact with a whooping brother or sister, to only indefinite contact with children in the same
building) developed an attack attributable to the contact for which they were referred.
Two groups of children, all contacts of the same whooping cough case, were inoculated, and
form a good indication of the value of the method of protection.
General.
There are one or two points regarding the administration of the clinic that need to be stressed.
The clinic could with ease deal with a larger number of cases, especially contact cases needing
immunisation. It is probable that since the introduction of compulsory notification of the first
case in each house, contact cases can with much greater ease be visited and encouraged to attend
the clinic. In addition, the clinic facilities are always available to the medical officers of welfare
centres and day nurseries, and indeed, children in such centres would probably be most benefited
by wholesale immunisation upon the occurrence of a case of whooping cough.
With regard to visiting immunised contact cases, it is probably desirable for these cases to be
visited up to six weeks after the last injection, instead of four weeks as heretofore. A weekly visit
is probably unnecessary, and it is suggested that visits be made only once during immunisation to
ensure continued attendance, and two, four and six weeks after the last injection.
For record purposes an extension of the health visitors' duties is suggested.
It would be of great value if cases which have been referred for diagnosis, i.e., "suspects," and
in which clinical or laboratory evidence of whooping cough is negative, were visited once after
attending the clinic in order to establish whether the conclusions reached were correct. It is
preferable that such cases should be visited instead of being asked to attend again, because mothers
whose children have not developed whooping cough cannot be relied upon to attend a second time.
Two weeks is the suggested interval for this single visit to be made in such cases, and health visitors
could be informed in the same way as they are for immunised cases.
Other notifiable diseases.—With the exception of tuberculosis, which is dealt with in a separate
section, no other notifiable infectious disease was notified.

This table does not include the work carried out at Wood Lane on behalf of the
Paddington borough council.