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A similar trend is shcwn in the Kensington figures for
these diseases over the past hundred years. Prom the
notification figures (so far as these are available), it will
be seen that although the incidence of measles and whooping
cough has not significantly diminished, the mortality rates
have been substantially reduced.
Whooping cough first became notifiable in England and
Wales in 1939, and earlier statistics are based on mortality.
With the relative increase in importance of this disease, much
research work has been carried out in recent years. It has
been discovered that the disease is much more infectious than
was at one time believed, and that the risk of infection is
directly proportional to the intimacy and frequency of exposure.
Again, one attack of the disease does not necessarily give
life-long immunity, although second attacks are due to a strain
of organism different from the one provoking the first attack.
However, second attacks are relatively rare. Statistics
suggest that a higher proportion of children from better class
districts contract the disease before 12 years of age than from
poorer districts and it is thought that this may be due to the
fact that some auto-immunisation may occur in more crowded
conditions.
A study of the statistics does not reveal any clear
epidemic pattern for the country as a whole although further
investigations are proceeding with a view to establishing whether
or not there is any regular periodicity. It has been found,
for instance, that the fatality rate tends to be higher in towns
and cities than in less populous districts.
No age is immune from whooping cough. It is reported
that infants have been born with the disease, and others have
developed it within ten days of birth. During the ten years
from 1941 to 1950, whooping cough was certified as the cause of
death in ten persons over the age of 75 years.
A remarkable feature of whooping cough is the preponderance
of female deaths, a fact which was noted in the earliest history
of the disease. No satisfactory explanation has been given
for this, except that it is probably due to a combination of two
factors, (a) the greater incidence of the disease in females, and
(b) for some reason the disease is more fatal amongst females.
The disease does not have any marked seasonal trend,
although the lowest weekly figures are recorded in May and
October. By contrast, well above the average weekly figures have
occurred in midsummer as well as midwinter.
Research into immunisation was intensified in 1942 and
has continued. In recent years this work has been complicated
by the possible association between injections of whooping
cough vaccines and paralysis in poliomyelitis. Field
investigations into this aspect have been undertaken by the
Medical Research Council and Kensington is one of the areas
co-operating in this project.
The treatment of the disease has been improved by the use
of the antibiotics, chloramphenicol and aureomycin, but much
still remains to be done. However, as a result of assuming
great importance amongst contemporary infectious diseases, whooping
cough is demanding and receiving more attention.
International Certificates
In order to prevent the spread of infectious diseases,