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received from many parts of the world. The conclusion reached was
that the combined method adopted by Barking gave better protection
against diphtheria than the separate injections of A.P.T. then in
common use, but was slightly less effective than separate injections of
P.T.A.P., the diphtheria prophylactic used in our work, and for years
previously used in our clinics.
As our results were encouraging we continued to use P.T.A.P.,
and extended the scope of the research by the addition of Tetanus
Toxoid to the diphtheria and whooping cough vaccine, this we called
Triple Vaccine.
As in the previous scheme the parents of babies aged between
two and five months were offered the alternative of combined or
triple vaccine, and the project was explained to them. About 400
babies were included in the scheme, and at fifteen months a small
amount of blood was withdrawn from each, but by an improved
niethod to that mentioned in the 1954 report. Parents were most
co-operative, and results proved that the children in both groups were
equally well imunised against diphtheria. An account of this aspect
of the work compared with similar research on guinea pigs has been
sent to the World Health Organisation, and will be published shortly.
The childrer included in the first and subsequent schemes have
been carefully followed up over the years, and blood tests are being
repeated as they rach the age of 4½ years to ascertain the level of
protection that remains from the injections received in infancy.
The second aspect of the follow-up has consisted of a very careful
check of those children who in spite of immunization have developed
whooping cough. It seemed an almost endless task even finding many
of them for almost a half of the original 714 in the scheme had
moved, and left no forwarding address. However, in the end only one
has remained entirely undetected, and after careful questioning of
the others the final result was that 33 of these may have developed
whooping cough. mostly of such a mild nature that the diagnosis
was not at all certain (11 of these cases in fact are very doubtful).
There were only 4 serious cases 2 of them in children who were long
overdue for their whooping cough booster injections at 2½ years;
the other 2 children had not been brought up at the correct dates for
their injections and may have been inadequately immunised. In fact
it, was clear that the rate of irregular attendance for injections was
much higher among the group who contracted whooping cough than
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