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53
The risk of contracting the disease at ages 5 to 6 was increased
six or eight-fold by the occurrence of a case in the same house, and
at pre-school ages it would be increased to a greater extent. The
risk of attack at all ages under 10 years within a month was, in
Greenwich, seven times as great if a case occurred in the same
house as if one occurred next door. The risk within a month was
more than twice as great if there was a case next door than if
there was a case in some other house in the street; but was not
appreciably greater if there was a case two or three doors away.
About 45 per cent. of children under 10, who have not had whoopingcough,
may be expected to contract it concurrently with, or within
six months, of the onset of a case in the same house.
Infection between children living in the same street commonly
occurs, and the risk is greatly enhanced for children living next door.
School epidemics tend to come to an end more quickly than in the
surrounding district, but it seems probable that practically all the
susceptible children at school are either attacked or rendered
temporarily immune. The value of excluding home contacts from
infected schools is questionable. It would probably be better to
keep these children at school until the first sign of catarrh or cough,
and then send them home to be kept indoors It is worth while, if
practicable, to attempt isolation from other children within the
home during the most infective period, particularly contacts
under 4 years of age, since this may increase the chance of the
remaining children acquiring temporary latent immunity, or postponing
the attack until an age when the disease is less dangerous.
The proportion of children known to their parents to have
had whooping-cough before entry to school at ages 3 to 6, is
greater in those London boroughs where the population is less
dense and better housed. Though this may be partly accounted
for by more accurate observation and diagnosis in such areas
it is evident that increased crowding of the population does not,
in different districts of London, result in increased incidence but
rather the reverse, a phenomenon difficult to account for unless
latent immunisation occurs.
Dr. Stocks' investigation illustrates some of the difficulties
associated with the administrative control of whooping cough
which, as in the case of measles, is responsible for a considerable
toll of early child life.
The research work which Dr. Stocks has carried out should
prove of considerable value in extending our knowledge of the
disease and of measures for the control of epidemics and the lowering
of the mortality rate which, notwithstanding the admininstrative
methods at present adopted, has remained at a high figure in comparison
with other infectious diseases.
Vaccination.
The Public Vaccinators for the Borough are as follows :—
Districts 1, 3 and 6.
Dr. C. E. McDade, 114 Clapham Common North Side.
(Deputies—District 1: Dr. M. Sayers, 65 Battersea Park
Road. District 3: Dr. F. S. McDade, 114 Clapham
Common North Side. District 6: Dr. L. Golomb, 347
Queens Road.)
Districts 2 and 7.
Dr. M. Lurie, 347 Queens Road.
(Deputy—Dr. L. Golomb, 347 Queens Road.)