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the other two types, was isolated from all but one of the vaccine-associated cases
with residual paralysis recorded between 1962 and 1968. The safety of liveattenuated-virus
vaccine has been one case in four million doses administered".
I acknowledge the assistance given by the Lewisham Group Hospital, in particular
the staff of Hither Green Hospital and the Public Health Laboratory Service.
INFECTIVE HEPATITIS
A mild outbreak of infective hepatitis occurred in May of this year at Christ
Church, Forest Hill, Church of England Primary School, Perry Vale, S.E.23. Two
confirmed cases involving children at the school were notified by general practitioners
and a further two cases, one child and one teacher, were brought to the
notice of the Health Department by the Head Teacher. All cases were in a single
class and none had been immunised. In consultation with the Medical Adviser
to the Inner London Education Authority and a Senior Medical Officer of the
Department of Health and Social Security, it was decided to offer protection against
infective hepatitis to all school contacts, both pupils and staff, using gammaglobulin.
All general practitioners in the Borough were notified and an immunisation
session was arranged at the school on Friday 21 May. Parents of the schoolchildren
were sent a letter explaining the circumstances and pointing out that protection
could alternatively be arranged through the family doctor. Prior parental consent
was necessary in each case.

Arrangements were made for the remaining children to be immunised by their
family doctors.
One of the first two children notified was admitted to hospital because of complications
of an associated diabetes.
Two further cases subsequently occurred, both children, who had obviously been
incubating the infection prior to immunisation.
No further cases of the condition occurred in the school; all patients recovered
satisfactorily.
CERVICAL CYTOLOGY
The examination of healthy women, by a simple smear test to detect early changes
in the neck of the womb which could lead to cancer, is carried out in cytology
clinics, for well women in seven centres in the borough, in all family planning
clinics, and as part of the examination of women attending the adult screening clinic.
In addition to the smear test both a full pelvic examination and breast palpation
are carried out which not infrequently reveal other abnormalities requiring treatment.
Patients attending cytology and adult screening clinics are also instructed
by health visitors on self-examination of the breast.
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