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57
some stage of their lives. An attack can be avoided or modified by the
use of gamma globulin which is obtainable from the Public Health
Laboratories. Because of the limited supplies, the use of this preparation
should be restricted to infants under six months of age who are exposed
to the disease and whose mothers have never had measles, and to children
under two years exposed to the disease who are weakly, suffering from
some other illness, or are living under adverse conditions.
WHOOPING COUGH
Apart from three months August to October, cases of whooping cough
occurred throughout the year; they were never however on any large
scale. In all 246 cases were notified. The weekly notification rate for
the first quarter was 10, for the second 5 and for the last quarter 1.5.
This is a disease which now causes much less harm and is responsible for
fewer deaths than it was up to quite recently. No patients were admitted
to hospital and there were no deaths.
Although there are no official arrangements for offering facilities
to the public for children to be immunised against whooping cough
by their own doctors in the way they are for diphtheria, many local
medical practitioners have for years treated children by inoculating them
with the one preparation which is aimed at protecting them against
whooping cough and against diphtheria. It is known 970 children were
in this way inoculated against whooping cough. This figure is probably
much smaller than the actual number treated. At the infant welfare
centres 1,147 children are treated with the combined preparation, so
that during the year not less than 2,117 children received protective
inoculations against whooping cough. The preparation used to ward off
whooping cough has not the high standard of efficiency of that used against
diphtheria. It is this lower efficiency which accounts for hesitancy in
introducing official arrangements for protecting the children against the
risk of contracting whooping cough on the same lines as those for
diphtheria prevention because any relative failure might result in a loss of
confidence of the public in all officially sponsored schemes and so damage
the smooth-working arrangements for protecting the population against
diphtheria. Some children who have been inoculated against whooping
cough would seem to be given partial but not complete protection. The
result is that on exposure such a child develops an atypical attack, never
having the characteristic whoop, but apparently suffering from an infective
attack. For that child, this attenuation of the attack is all to the good as
the child is not much inconvenienced and there is no serious illness or
severe complications; but from the point of view of the rest of the population
the position is not so satisfactory because this child is infective and,
not being incapacitated, goes about mixing with other children while
suffering from what is not recognised as being an attack of whooping
cough. Unless then those in the child's surroundings are protected, the
complaint might well spread to a much greater extent than if that child
had not received any protective inoculations. In the early stages of the
diphtheria immunisation campaign it was feared that unless a substantial
Proportion of the susceptibles were protected, the increased carrier rate
might result in the greater spread of infection among those liable to it.