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Whooping cough is much less dangerous in the older child and so immunisation with a high risk of reaction is not warranted.

Diphtheria is due to a bacterium, not a virus, and has a short incubation period of about three days.

The disease may be mild and produce little more than a mild sore throat and a “cold” type illness, but it may cause a severe infection with a high temperature, muscle weakness, aches and pains, confusion and delirium.

When the throat is affected, a typical pearl-grey exudate or membrane may appear on the tonsils or back of the throat.

The affected larynx or voice box may swell and lead to obstruction of breathing. It may be necessary to make an opening in the windpipe or trachea (a tracheotomy) to enable the child to breath.

The heart may be affected by toxins or poisons produced by the germ and lead to heart failure and death. Sometimes the nervous system is affected and this can lead to paralysis of muscles.

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Just as we cannot exactly predict for any individual what organ will be affected by secondary growths, so we cannot exactly predict what will eventually cause death. Most causes of death from cancer fall into one of the two following groups. Firstly, cancer may destroy so much of a vital organ (such as the liver, brain or lungs) that it can no longer carry out its normal function. Secondly, cancer can weaken the body and immune system so much that infections such as pneumonia are fatal. These causes all act gradually. Less commonly, cancer causes death through haemorrhage, blood clots or other more sudden processes.

The ‘natural history’ of an illness means what happens if there is no treatment. It is important’ to have some idea of how your cancer might behave without any treatment before you decide what, if any, treatment to have. Of course, cancer behaves in exactly the same way if it is not sensitive to the treatment chosen. Unless you are cured, your cancer will behave like this sooner or later.

As we have learnt, a cancer starts with one or a few cells. These have to double (each one split into two) about thirty times for the cancer to reach the size of a 1cm cube. It is unusual to detect a cancer smaller than this. This means that by the time a cancer is diagnosed, even when it is very tiny, it has actually been there for quite a while. It would be at least a few weeks even in the case of very rapidly-growing cancers and many months or even years for some of the slower-growing types.

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