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to be improved. The training programme and conditions of sponsorship for student health visitors
were therefore reviewed. The contract of service after qualification was amended to one year,
book and other allowances were made more realistic, and most important of all, the number of
sponsored students was raised to ten. The benefit of these changes will only be seen in the longer
term, but the recruitment of well qualified students for training already gives grounds for optimism.
In the meantime, however, the existing staff carry the burden of helping with the training in
addition to maintaining the standards of service in the field which the public rightly expects.
Health visiting statistics are recorded on page 164.
HOME HELP SERVICE
The number of Home Helps employed at the end of the year was 6 full-time and 120 parttime
making an equivalent of 71 full-time workers. The following table shows the cases in which
help has been provided. The total number has increased but those aged 65 years and over have
risen from 780 in 1968—887 in 1969 to 959 for the year under review. The annual total gives no
indication that in each of the last two quarters of the year 870 people received help, most of these weekly and many daily.
The standard charge for the service is 8/- per hour, but all persons unable
to pay this are assessed in accordance with the Council's scale. Recipients of Department of Health
and Social Security pensions are not required to pay for the service nor are patients suffering from
toxaemia of pregnancy needing complete bed rest.

IMMUNISATION
The elimination of diphtheria and poliomyelitis which has been associated with the mass
vaccination campaign against these diseases has produced a generation to whom these diseases
are unfamiliar. This welcome change in the health of the community can only be maintained by
a continuous immunisation programme as the occasional outbreaks of these diseases still show.
It is difficult to engender enthusiasm to protect against apparently hypothetical risks and the
increasing variety of vaccines used, together with the complexity of the schedules now advocated
often causes bewilderment even to the most persevering mother.
The changes in the immunisation schedules postpones the date by which the child can be
regarded as fully protected against all of the diseases for which immunisation is now available.
The statistics for Hillingdon whilst generally satisfactory in relation to national averages, nevertheless
imply an adverse trend. This applies particularly to smallpox vaccination where the present
levels of protection must be regarded as totally inadequate to achieve satisfactory community
protection. Persons previously unvaccinated against smallpox still die from occasional importations
of the disease into this country, whilst the experience of the most recent outbreak suggested that
even vaccination in infancy could secure protection from a fatal attack of the disease for very
many years, even when "booster" procedures have been omitted. The decline in smallpox vaccination
rates appears to be related to the advice to Local Health Authorities that all routine
smallpox vaccinations should be carried out by or with the consent of the family doctor in view
of the possibility of accidental infection of an eczematous member of the family. This wise precaution
applies only to a small minority of the total population, and it will be unfortunate if a
scheme primarily designed for their needs should seriously prejudice the essential protection which
can be offered to the majority.
Concern has been expressed about attacks of whooping cough in children apparently fully
immunised against the disease. It is important that the antigenic potency of the vaccine used
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