AUG. 15, 1959
It should perhaps be explained that many of the"gaps "
were due to interruption of immunizationduring a polio
Injection-Disease Time Lapse.-The lapse of time
between the date of last whooping-cough injection and
the development of whooping-cough was 1.7years in the
doubtful group and 1.6 years in the confirmed group.
Actually the shortest time lapse in these cases was four
months and the longest 35 months.
Age at First Injection.-The average age of the
affected children at their first injection was 3.7 months
in both the confirmed and the doubtful group, whereas
the average age for the whole group was 3.9 months.
Blood Results.-Only 10 of the 33 children who
developed whooping-cough had been bled at the age of
15 months and had had their pertussis agglutination titres
These varied from 1/20 to 1/ 1,280, from
which it may be concluded that agglutination titre is no
reliable index of protection against whooping-cough.
This agrees with the findings of Horton and Standfast
Home Contacts.-In our follow-up questioning the
parents of 35 infants reported that their child had been
a home-contact with another suffering from whooping-
Unfortunately we have no information on the home-
contact rate in respect of the 22 almost certain cases and
11 doubtful ones, although, of course, as they developed
the disease they must have been in contact somewhere
with an infected child.
Notification Rate.-Of the 22 definite cases, only 5
were notified in our area.
notified out of the area, but this still leaves 10 definite
cases not notified in their own area.
wary, therefore, of accepting notification incidence as a
reliable measure of whooping-cough prevalence.
diphtheria and pertussis in early infancy.
received three doses of whooping-cough vaccine
monthly intervals, followed by two doses of P.T.A.P.
The other group received three doses of combined
formol-toxoid and whooping-cough vaccine.
subsequent three years no significant difference was
found in the frequency of undoubted whooping-cough
in the two groups.
Since, however, 22 children did
develop the disease some 19 months after the end of
primary immunization, a booster dose at the age of
15-18 months seems to be recommended. As whooping-
cough is a more serious disease in very young babies,
it might be thought advisable to give the first injection
at 2 months or even younger in view of the fact that
those immunized at 2 months appeared to be as well
protected as those whose first injections were given at
3, 4, or 5 months.
Thanks must be accorded to Dr. G. Stewart, County
Medical Officer, Essex, and to Dr. F. Groarke, Area Medical
Officer, Barking, for permission to carry out the work. We
especially the invaluable help of Mr. Brian in the collection
of blood samples, and of Mrs. Pratt, the nurse who assisted
at these sessions.
Thanks are also due to Mrs. Tidbury and
Miss Valerie Harper for many hours of cheerful and willing
Horton, J. M., and Standfast, A. F. B. (1953). VI International
Congress Microbiology, Rome.
Spiller, V., Barnes, J. M., Holt, L. B., and Cullington, D. E.
Another 7 may have been
One should be
Brit. med. J., 2, 639.
Ehiers-Danlos Syndrome with Congenital
Herniae and Pigeon Breast
The Ehlers-Danlos syndrome, described by Ehlers in
1900 and by Danlos in 1908, is rare.
features are: (1) hyperelasticity of skin; (2) friability of
the skin and the blood vessels, with a tendency for
wounds to gape and a susceptibility to intracutaneous
or subcutaneous haemorrhages, even from trivial trauma,
or occasionally to visceral haem.orrhages; (3) profuse
extensibility of joints; (5) frequent presence of tiny
mobile subcutaneous nodules, probably of a lipomatous
nature; and (6) familial incidence of one or more of
the above features.
A 3-year-old French Canadian boy was admitted to
Ottawa General Hospital on July 6, 1957, because of a
lacerated injury over the right knee.
were apt to cause skin cuts, lacerations, bruises, and bumps,
and he had numerous scars over his body.
prematurely and had congenital umbilical and inguinal
The umbilical hernia was repaired.
accident; the wounds gaped after the removal of only two
stitches on the fifth day.
His father's skin was soft, doughy,
and slightly hyperelastic; his palms and soles were soft,
his fingers could be slightly overextended, and his feet were
abnormalities were found in other members of the family.
On physical examination the boy, though mentally alert,
was seen to be somewhat underdeveloped, being 2 ft. 10 in.
(86 cm.) in height, and weighing 27 lb. (12.2 kg.).
circumference was 20 in. (51 cm.) and the fontanelles were
He could stand and walk normally.
pigeon breast (Fig. 1), and there were numerous scars all
over his body, mostly on the face, head, left arm, knees,
legs, and feet.
Some of the scars appeared to be due to
stitched or unstitched wounds.
particularly over the lower abdomen and the forearms.
There were a few bruises. A fresh lacerated gaping wound
was seen across the front of the right knee.
T The skin was doughy, soft, velvety, and elastic, and could
be easily stretched for about 1 to 2+ in (2.5 to 6.4 cm.) over
the arms, forearms (Fig. 2), thighs, and legs.
the skin immediately returned to its position, like a piece
subcutaneous nodules were palpable. The mucus membrane
was not elastic.
The child had large bilateral, reducible, indirect inguinal
herniae, and the scar of the repaired umbilical hernia was
Even minor injuries
Since birth his
. He was
At the age
1 year he received multiple lacerated injuries in a car
He had a
A few scars were papery,
When let go
1 .-Hyperextensible k